Mock 2 Incorrect

Question 1

49-year-old man has 1 day of severe epigastric pain. He has vomited five times.
He smokes 13 cigarettes per day and drinks 37 units of alcohol per week. His
temperature is 37.8°C, pulse rate 89 bpm and BP 145/86 mmHg. He is tender in the
epigastrium and right upper quadrant, and there is voluntary guarding.

Answer 1

acute cholecystitis

bilirubin would be much higher with cholangitis apparently

Question 2

oral MST to subcut

Answer 2

Dose of morphine sulfate SC in 24 hours = 0.5 x

Total Morphine sulfate oral dose in 24 hours

Question 3

lower back pain advice

Answer 3

Justification for correct answer(s): Short duration acute low back pain in fit person.
Therefore, most appropriate response would be to continue usual activity and to
provide appropriate safety netting advice. NICE Clinical Knowledge Summaries - back
pain.

Question 4

severe abdo pain, ): History of vascular disease and lactic acidosis

Answer 4

mesenteric ischaemia

Question 5

PE but recent bleeding history or high bleeding risk

Answer 5

instead of LMWH, IV heparin as more easily reversed

Question 6

calculating lifetime risk

Answer 6

%per year multiplied by av remaining life expectancy

Question 7

alteration of BP controlling drugs following creatinine rise

Answer 7

Justification for correct answer(s): The patient has had a <30% increase in serum 
creatinine. At this level there is no indication to change treatment, repeat of renal 
function in 2-4 weeks is reasonable.

ANY drug not just ACEx

Question 8

Joint aspiration: no organisms on Gram stain, white cell count 1747/µL (<200),
mostly neutrophils, no crystals. She is advised to take oral paracetamol.

with fever and joint pain and hx of RA

Answer 8

DO NOT assume not septic as half get no culture

The patient should be considered to have septic
arthritis. The patient is septic and is immunocompromised. The gram stain is positive
in about 50% of cases, so a negative gram stain does not mean there is no infection.
Intravenous antibiotics should be started pending culture results.

Question 9

glucagon side effecs

Answer 9

(nausea and flushing)

Question 10

pioglitazone

Answer 10

Pioglitazone is contraindicated in heart failure, bladder cancer and can cause fractures.

Question 11

CKD and T2DM drugs

Answer 11

after metformin and gliclazide

Sitagliptin approved for use in CKD. Dulaglutide is
sc injection. Empagliflozin currently not licensed for CKD.

Question 12

acarbose

Answer 12

bad GI side effects

Question 13

42-52 Hba1c

Answer 13

Diabetes Prevention Programme

Question 14

diagnosiing DIC

Answer 14

Justification for correct answer(s): Diagnosis of DIC is based on presence of ≥1
known underlying condition causing DIC plus abnormal global coagulation tests:
decreased platelet count, increased prothrombin time, elevated fibrin-related marker
(D-dimer/fibrin degradation products) and decreased fibrinogen level. In this patient
the underlying condition triggering DIC is sepsis and it is likely that further blood
tests would show abnormalities in the above markers

Question 15

unilateral sensineural loss

Answer 15

Justification for correct answer(s): Where there is a unilateral sensorineural hearing
loss, it is vital to exclude the presence of a vestibular schwannoma or other neoplasm
of VIII nerve or brainstem. This is done via an MRI scan.

Question 16

primary care next investigation IBD after FBC, LFT, inflam markers

Answer 16

ustification for correct answer(s): NICE CKS suggest stool cultures as part of work
up in primary care before referral. Most likely diagnosis is IBD.

Question 17

s recurrent episodes of collapse over 6 months. When
excited, her muscles feel limp and she falls to the floor, but she remains conscious.
She has a history of anxiety and depression

Answer 17

cataplexy

Question 18

A 64 year old woman has 18 months of worsening right-sided hip pain caused by
osteoarthritis. Her pain is partially controlled by regular paracetamol and ibuprofen
gel. She remains active. She has ischaemic heart disease and chronic kidney
disease. Her medication includes bisprolol fumarate, aspirin and simvastatin. She
has crepitus on active and passive movements of both hips. Her BMI is 30 kg/m2.

Answer 18

always remember your pain ladder - more paracetamol up to co codomal next

Question 19

poisoning presenting within 1 hour

Answer 19

Activated charcoal should be considered for
people who have self-harmed by poisoning, who present early (within one hour of
ingestion), are fully conscious with a protected airway, and are at risk of significant
harm as a result of poisoning.

Question 20

adhesive capsulitis history

Answer 20

Adhesive capsulitis (frozen shoulder) presents
with dull shoulder pain, that often disturbs sleep, followed by stiffness and loss of
shoulder mobility. Adhesive capsulitis is unlikely in patients younger than 40 years of
age.
Adhesive capsulitis is more common is diabetics.

Question 21

older than 70, shoulder pain probs

Answer 21

patients older than 70 are more likely to have rotator cuff tears or
glenohumeral osteoarthritis.

Question 22

subacromial shoulder pain

Answer 22

Patients with subacromial pathology often give an
occupational or athletic history of heavy lifting or repetitive movements, especially
above shoulder level.

Question 23

rotator cuff probs or bursisits hx

Answer 23

Patients with rotator cuff tendinopathy and subacromial bursitis
often complain of activity-related pain and problems in ADLs

Question 24

room is spinning, head movement triggers short episodes

Answer 24

BPPV

Question 25

adding BP control drugs with low kidney function

Answer 25

Furosemide will reduce
peripheral oedema, lower BP and help with hyperkalaemia. Bendroflumethiazide is
less effective when compared to furosemide when the creatinine clearance is below
30. Although the potassium is elevated this is not an indication to stop lisinopril.

Question 26

adrenal crisis

Answer 26

Justification for correct answer(s): Classic presentation of adrenal crisis. Nearly all
patients have a history of lethargy and weight loss. Plasma cortisol and ACTH should
be sent immediately so that definitive treatment can be initiated. You would not wait
for results before starting IV steroids

Question 27

A 26 year old man has a brief episode of feeling faint. He has had 5 days of cough, 
sore throat and fever. He has been feeling tired for 6 months and has lost 3 kg in 
weight.
His temperature is 37.6°C, pulse rate 90 bpm, BP 100/55 mmHg lying and 90/50 
mmHg sitting, respiratory rate 18 breaths per minute and oxygen saturation 95% 
breathing air. His JVP is not visible.
Investigations:
Haemoglobin 106 g/L (115–160)
White cell count 14 × 109/L (3.8–10.0)
Platelets 201 × 109/L (150–400)
Sodium 130 mmol/L (135–146)
Potassium 5.6 mmol/L (3.5–5.3)
Urea 9.5 mmol/L (2.5–7.8)
Creatinine 98 µmol/L (60–120)
Random plasma glucose 3.2 mmol/L
12-lead ECG sinus rhythm

Answer 27

adrenal crisis

Question 28

considering cause of post op reduced urine output

Answer 28

Justification for correct answer(s): The patient continues to show signs of
hypovolaemia so a pre-renal cause for the oliguria is most likely. ATN usually takes
longer to develop and would need to ensure adequate fluid resuscitation. Ureteric
injury is unlikely and would need to be bilateral to cause AKI. Catheter blockage
would cause anuria. Renal artery occlusion is rare and would cause loin pain and
more severe clinical picture.

Question 29

false negative false positive

Answer 29

ensure understood

Question 30

A 48 year old man has 15 hours of a severe headache of sudden onset. When the
headache started, he collapsed and vomited; he also reports photophobia. He has a
history of cluster headaches.
Neurological examination is normal. A non-contrast CT scan of brain is normal.

Answer 30

MUST do LP next as could be a subarac!!!

looking for xanthochrom

Question 31

y well demarcated red, scaly patches classically affecting the extensor
surfaces, sacrum and scalp.

Answer 31

plaque psoriasis

Question 32

y muscle weakness that worsens with exercise (fatiguability) and
improves with rest. Double vision, ptosis, difficulty chewing and swallowing, and
slurring of speech that worsen throughout the day

Answer 32

myasthenia gravis

Question 33

norovirus

Answer 33

stool PCR

Question 34

wahoo let’s do dis

Answer 34

bye bye