Mock 2 Incorrect Flashcards
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.
acute cholecystitis
bilirubin would be much higher with cholangitis apparently
oral MST to subcut
Dose of morphine sulfate SC in 24 hours = 0.5 x
Total Morphine sulfate oral dose in 24 hours
lower back pain advice
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.
severe abdo pain, ): History of vascular disease and lactic acidosis
mesenteric ischaemia
PE but recent bleeding history or high bleeding risk
instead of LMWH, IV heparin as more easily reversed
calculating lifetime risk
%per year multiplied by av remaining life expectancy
alteration of BP controlling drugs following creatinine rise
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
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
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.
glucagon side effecs
(nausea and flushing)
pioglitazone
Pioglitazone is contraindicated in heart failure, bladder cancer and can cause fractures.
CKD and T2DM drugs
after metformin and gliclazide
Sitagliptin approved for use in CKD. Dulaglutide is
sc injection. Empagliflozin currently not licensed for CKD.
acarbose
bad GI side effects
42-52 Hba1c
Diabetes Prevention Programme
diagnosiing DIC
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
unilateral sensineural loss
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.
primary care next investigation IBD after FBC, LFT, inflam markers
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.
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
cataplexy
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.
always remember your pain ladder - more paracetamol up to co codomal next
poisoning presenting within 1 hour
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.
adhesive capsulitis history
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.
older than 70, shoulder pain probs
patients older than 70 are more likely to have rotator cuff tears or
glenohumeral osteoarthritis.
subacromial shoulder pain
Patients with subacromial pathology often give an
occupational or athletic history of heavy lifting or repetitive movements, especially
above shoulder level.
rotator cuff probs or bursisits hx
Patients with rotator cuff tendinopathy and subacromial bursitis
often complain of activity-related pain and problems in ADLs
room is spinning, head movement triggers short episodes
BPPV
adding BP control drugs with low kidney function
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.
adrenal crisis
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
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
adrenal crisis
considering cause of post op reduced urine output
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.
false negative false positive
ensure understood
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.
MUST do LP next as could be a subarac!!!
looking for xanthochrom
y well demarcated red, scaly patches classically affecting the extensor
surfaces, sacrum and scalp.
plaque psoriasis
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
myasthenia gravis
norovirus
stool PCR
wahoo let’s do dis
bye bye
