Mock 3 Incorrect

Question 1

define case control study

Answer 1

. A
case-control study finds individuals with a given outcome along with a suitable control
group and looks back retrospectively at how many individuals from both groups had the
exposure(s) of interest

Question 2

define cross sectional study

Answer 2

. A cross-sectional study measures prevalence in a population at a
given point in time.

Question 3

define randomised clinical trial

Answer 3

A randomised clinical trial tests the effects of a specific intervention
or interventions against a control group.

Question 4

define restrospective cohort

Answer 4

A retrospective cohort begins after the outcome

has occurred and looks back at the exposure of interest.

Question 5

Koebnerisation - psoriasis

Answer 5

well-defined areas of scale formation at the sites of

minor skin injuries, such as scratches or insect bites

Question 6

A 64 year old man has vomiting and severe chest pain after eating a large
meal.
His temperature is 37.6°C, pulse rate 130 bpm, BP 95/50 mmHg and
respiratory rate 30 breaths per minute. There is palpable subcutaneous
emphysema on the left side of his neck.

Answer 6

oesophageal rupture

Boerhaave’s

Question 7

which airway protects against aspiration?

Answer 7

i-gels are often used in cardiac arrest situations as they are easier to place than tracheal
tubes. However, only the tracheal tube can seal the trachea off and protect against
aspiration.

Question 8

screening test for haemochromatosis and follow up test

Answer 8

Transferrin saturation is the screening test for haemochromatosis

liver biospy gold standard

Question 9

standard fasting times for surgery

Answer 9

2 h for clear liquids, 6 h for solids

Question 10

non functional thyroid nodule

Answer 10

do ultrasound then consdier FNA

Question 11

differentiate these 
. Bias
B. Discrimination
C. Inequity
D. Prejudice
E. Stereotyping

Answer 11

just as they may ask as a one off Q

Question 12

very high potassium (6+)

Answer 12

always repeat U+Es as likely lysed sample

unless ECG changes obvs

Question 13

cocaine triggers

Answer 13

coronary artery spasm

Question 14

A 31 year old man visits his GP with a painless lump in his scrotum.
There is a well-defined, non-tender spherical 1 cm mass on the right side of
the scrotum. It is superior to the testis and transilluminates.

Answer 14

epididymal cyst

hydrocoele will transilluminate but can’t get above it and it surrounds the testis

Question 15

thinking through surgical complications

bowel ca, early stage, distended and constipated

Answer 15

Adhesional bowel obstruction is most likely as he has had a hemicolectomy. Recurrence
is less likely because this is Dukes A (early stage). Too late after surgery for anastamotic
leak. Pancreatitis and cholecystitis are less likely because they don’t cause constipation.

Question 16

maintenance fluids if someone has HF/LVF

Answer 16

Maintenance fluid requirements for someone with underlying cardiac disease is
recommended as 20-25 mL/kg

normally 30ml/kg I think

Question 17

A 72 year old woman has 6 months of increasing pain at the base of her right
thumb. She is having difficulty opening jars and sewing. She is otherwise well.
No other joints are painful. She is taking regular analgesia.
The first carpometacarpal joint is swollen and tender, with reduced opposition
of the thumb

Answer 17

classic osteoarthr`itis history

Question 18

de Quervain’s tenosynovitis

Answer 18

repetitive movement hx
The
pain of de Quervains tenosynovitis would be felt over the radial aspect of the wrist.

Question 19

myasthenic crisis info

Answer 19

Myasthenic crisis is an acute respiratory failure characterised by forced vital capacity
(FVC) below 1 L, negative inspiratory force (NIF) of 20 cm H2O or less, and the need for
ventilatory support. The use of accessory muscles indicates significant inspiratory
weakness. Weak cough indicates weakness of expiratory muscles. Arterial blood gas
analysis commonly shows hypercapnia before hypoxia. There should be a low threshold
for endotracheal intubation due to rapid deterioration of bulbar and respiratory muscles

Question 20

immediate gout managemetn

Answer 20

start NSAID e.g. naproxen

start colchicine

Question 21

A previously healthy 10 year old boy has deafness of new onset. He has a
history of a recent respiratory tract infection.
Tuning fork tests show:
a) when the tuning fork is placed in the middle of his forehead he hears the
tone loudest in his right ear;
b) when the tuning fork is held in front of his right external auditory meatus it is
quieter than when it is placed on the bone behind the same ear;
c) when the tuning fork is held in front of the left external auditory meatus the
sound is louder than when it is placed on the bone behind the same ear.

classify

Answer 21

The combination of lateralisation of Weber’s test to the right and a negative Rinne’s test on
the right (i.e. bone conduction louder than air conduction) occurs with right conductive
deafness. This also fits with the clinical history of a recent respiratory tract infection

Question 22

most common bug cellulitis

Answer 22

Streptococcus is the most common pathogen in leg cellulitis (including in patients with
diabetes)

Question 23

superficial thrombophlebitis no DVT treatment

Answer 23

NSAIDs are the first-line treatment for superficial thrombophlebitis

Question 24

T2DM meds with surgery

Answer 24

Take as
normal day before

for a.m. surgery - Omit morning
dose if NBM

for p.m. surgery -
Give morning
dose if eating

Stop once VRIII
commenced, do
not recommence
until eating and
drinking normally

aim is to minimise disruption to regime

Question 25

differnetiate painful breast lumps by hx

Answer 25

Fibrocystic disease characteristically causes pain associated with the menstrual cycle. The
fine needle aspiration supports this with no malignant cells seen. A fibroadenoma is a solid
lump. Pain if present would be localised with fat necrosis. Breast abscess would be a more
acute history and again would not be expected to cause bilateral breast pain.

Question 26

A 70 year old man has a brief episode of twitching that starts in his left hand
and spreads up the arm over 2 minutes, then stops. His arm feels weak for an
hour afterwards. He had an ischaemic stroke affecting his left side 6 months
ago with good functional recovery. He has a history of type 2 diabetes mellitus
and is taking clopidogrel, metformin, ramipril and simvastatin. He is anxious
about a further stroke.
There is no weakness on neurological examination

Answer 26

partial seizure

affecting R hemisphere

Question 27

most likely ovarian lymphatic spread

Answer 27

The main lymphatic drainage of the ovary is to the para-aortic nodes. The iliac nodes are
less frequently involved.

Question 28

A 52 year old woman has had three episodes of severe epigastric pain
associated with vomiting over the past 3 months. The episodes occurred
following eating and lasted for about 1 hour. She has type 2 diabetes mellitus
and takes metformin.
Abdominal examination is normal. Her BMI is 35 kg/m2(18–25).

Answer 28

classic symptomatic gallstone disease

remove GB

Question 29

A 56 year old woman develops vertigo, nausea, vomiting and intense occipital
headache of sudden onset. She is unable to walk without falling. She has a
history of hypertension treated with ramipril. has nystagmus

Answer 29

cerebellar stroke

Question 30

managing venous ulcer

Answer 30

if not healed, keep on with compression stockings

Question 31

recall GCS score

Answer 31

.

Question 32

4. A 65 year old man has sudden pain and redness in his right eye. He also has
   a headache and nausea.
   Visual acuity is 6/60 in the right eye. The eye is congested, with a hazy
   cornea and mid-dilated pupil.

Answer 32

acute glaucoma

Question 33

red eye ddx

Answer 33

acute glaucoma
Uveitis whilst causing
red eye, headache and visual disturbance is associated with a small pupil. Scleritis, corneal
ulcer and conjunctivitis are not generally associated with headache and nausea or a
significant drop in visual acuity

Question 34

A 25 year old man sustains 40% full-thickness burns in a house fire. Despite
intensive treatment, he becomes breathless and hypotensive. He develops a
petechial rash.
His temperature is 38°C, pulse rate 110 bpm, BP 80/50 mmHg and oxygen
saturation 96% breathing 40% oxygen.
Investigations:
Haemoglobin 110 g/L (130–175)
White cell count 4.2 × 109/L (3.8–10.0)
Platelets 15 × 109/L (150–400)
APTT 75 seconds (22–41)
PT 25 seconds (10–12)
Fibrinogen 0.7 g/dL (1.5–4.0)

Answer 34

disseminated intravascular coagulation

DIC

classic hx of it

Question 35

A 65 year old woman with newly diagnosed advanced lung cancer has 1
day of breathlessness and 1 week of progressive headache.Her pulse rate is
88 bpm, respiratory rate 20 breaths per minute and oxygen saturation 95%
breathing 4 L/min oxygen via nasal prongs. She has a swollen face and neck
and distended veins on her chest. Her chest is clear. CT scan of chest shows
mediastinal lymphadenopathy compressing the superior vena cava.

Answer 35

superior vena cava obstruction

give dexamethasone

if stridor - intubation, more steroids, then endovenous stent

only thrombolyse if evidence of a clot

Question 36

reverse warfarin acutely

Answer 36

prothrombin complex concentrate

Question 37

heavy smoker and drinks 12 units of alcohol per week.
His BP is 125/85 mmHg and oxygen saturation 98% breathing air. He has
marked bilateral pitting ankle oedema.
Investigations:
Creatinine 85 µmol/L (60–120)
Urinary protein: creatinine ratio 400 mg/mmol (<30)
Fasting glucose 5.7 mmol/L (3.0–6.0)
Total cholesterol 9 mmol/L (<5.0)
Albumin 20 g/L (35–50)
He is treated with furosemide.

Answer 37

nephrotic syndrome in an adult

Question 38

diagnostic test nephrotic syndrome

Answer 38

renal biopsy