Mock 4 Incorrect

Question 1

falling, can’t feel feet, macrocytic anaemia

Answer 1

B12def

Question 2

A 55 year old man has had lower back pain and fatigue for 3 months.
Investigations:
Haemoglobin 110 g/L (130–175)
White cell count 5.8 × 109
/L (3.8–10.0)
Platelets 120 × 109
/L (150–400)
Corrected calcium 2.90 mmol/L (2.2–2.6)
Albumin 29 g/L (35–50)
Serum electrophoresis: monoclonal Ig kappa peak
Bone marrow biopsy: foci of plasma cells, which account for 18% of all
haematopoietic cells

Answer 2

classic multiple myeloma

Question 3

pneumonia with AKI

Answer 3

likely pre renal hypoeperfusion

raised creat and urea

Question 4

interstitial nephritis

Answer 4

Interstitial nephritis would normally not

appear until 4-7 days of antibiotic exposure and is relatively rare

Question 5

A 70 year old woman has an ulcer above the left medial malleolus. She has a
history of type 2 diabetes mellitus. She smokes 10 cigarettes per day.
The ulcer is 10 × 5 cm and superficial. She has brown discolouration of both
lower legs. The skin has a thickened, waxy feel. Her BMI is 34

Answer 5

classic venous ulcer

Question 6

. A 67 year old man has 3 weeks of progressive ankle oedema. He has a
history of hypertension, treated with amlodipine. He is a lifelong heavy smoker
and drinks 12 units of alcohol per week.
His BP is 125/85 mmHg and oxygen saturation 98% breathing air. His JVP is
4 cm above the sternal angle. He has marked bilateral pitting ankle oedema.
He has dull percussion note at both bases with reduced breath sounds.
Investigations:
Creatinine 85 µmol/L (60–120)
Fasting glucose 5.7 mmol/L (3.0–6.0)
Total cholesterol 9 mmol/L (<5.0)
Albumin 15 g/L (35–50)
Urinary protein:creatinine ratio 568 mg/mmol (<30)
Urine microscopy no cells, no casts

Answer 6

The combination of hypoalbuminaemia, proteinuria, oedema, hypercholesterolaemia
etc. is characteristic of nephrotic syndrome. The most likely causes in the age group
(without diabetes) would be membranous nephropathy, minimal change or FSGS.
Myeloma would also need to be considered. A renal biopsy would be required to
confirm the diagnosis

Question 7

back pain red flags (some of them lol)

Answer 7

wakes from sleep

going on for many weeks

older age

need plain x rays

Question 8

postinfectious GN

Answer 8

Postinfectious

GN would follow a clear-cut infection, particularly streptococcal sore throat

Question 9

classic IgA vasculitis /HSP

Answer 9

Classic presentation of HSP with a purpuric (vasculitic) rash and an active urinary
sediment. Abdominal and joint pain may also occur. Renal function is usually normal

buttock rash

Question 10

SLE history and picture

Answer 10

SLE
would normally have a longer history, does not typically give a vasculitis rash and
would be associated with other features of SLE e.g. alopecia, arthralgia, skin rash,
cytopenias, mouth ulcers.

Question 11

oxybutinin side effect

Answer 11

Oxybutynin is an anticholinergic and a frequent cause of constipation

Question 12

A 65 year old man reports sudden onset of visual disturbance with flashing
lights, floaters and loss of vision in the upper outer quadrant of his right eye.
He has a history of hypertension.

Answer 12

retinal detachement

increasing number of floaters classic then flashing lights as tears off

Question 13

most likely post op complication if fever and reduced sats

Answer 13

The development of a fever in the early postoperative period, in combination with
reduced oxygen saturation, is most likely to be due to the development of bibasal
atelectasis, especially in a patient who has undergone an abdominal procedure and
is experiencing pain.

Question 14

A 69 year old man has 6 months of back pain extending into his buttocks and
back of his thighs. The pain is worse on standing and on walking, and is
relieved when he sits down and leans forward. He has diet-controlled type 2
diabetes mellitus. He is an ex-smoker with a 40 pack-year history.
His BP is 178/95 mmHg. He has weakness of hip flexion bilaterally. His
peripheral pulses are palpable

Answer 14

neurogenic claudication

Question 15

gold standard lung ca imaging

Answer 15

CT

Question 16

small bowel obstruction manage

Answer 16

This is treated conservatively with fluid resuscitation and nasogastric
decompression of the gut. The stomach contents should be aspirated using a
syringe, following which the bag should be placed on free drainage. Further
aspiration may be needed if required. Conservative management is successful in 65-
80% of cases and surgical intervention is only considered for those patients who do
not improve with conservative management

Question 17

typical DIC bloods

Answer 17

. typically patients have thrombocytopaenia, prolonged PT and aPTT, low
plasma fibrinogen and an elevated plasma D-dimer. There may also be
microangiopathic abnormalities on the blood smear.

often sepsis trigger

Question 18

why do anaesthetists apply cricoid pressure on intubation?

Answer 18

The cricoid cartilage is a complete ring; pressure on the front is transmitted to the
back, and this seals the oesophagus, preventing gastric contents in a patient who is
not fasted or has abdominal problems from passing higher up and possibly entering
the airway

Question 19

morphine dosing for palliation of ca pts

Answer 19

The breakthrough dose should be one-sixth of the total daily dose. The current daily
morphine dose is 180 mg, hence MST continues at 90 mg 12 hourly and the
breakthrough at morphine 30 mg.

breakthrough dose = PRN dose

Question 20

pericarditis and pericardial effusion ECGs

Answer 20

The history and ECG changes (widespread PR depression and ST elevation) are
strongly suggestive of pericarditis. A pericardial effusion would produce low-voltage
complexes on the ECG.

Question 21

A 18 year old woman has 6 hours of severe dizziness and nausea. She says
that the room is constantly spinning round and she has vomited several times.
The dizziness is worse when she opens her eyes. She reports that her
hearing has not changed.
She has nystagmus with the fast phase to the left, which does not fatigue

Answer 21

vestibular neuronitis

single attack - don’t consider BPPV or vestibular migraine unless recurrent!

Question 22

visible haematuria in a man

Answer 22

refer urology in case of bladdre ca

Question 23

`mixed growth with no leucocytes

Answer 23

suggests contaminated MSU, repeat

Question 24

A 53 year old man has increasing abdominal swelling over several weeks. He
has developed severe abdominal pain over the past 12 hours. He drinks one
to two bottles of vodka per day.
He has jaundice, and has spider naevi and prominent veins on his abdominal
wall. His temperature is 37.6°C. His abdomen is diffusely tender.

with septic bloods and obs

Answer 24

spontaneous bacterial peritonitis

Question 25

Painful eye with loss of acuity needs

Answer 25

urgent ophthalmology assessment

Question 26

immediate treatment in suspected spinal cord compression

Answer 26

dex

Question 27

breast ca triple assessment

Answer 27

Clinical examination, breast imaging and core biopsy

Question 28

prospective cohort study

Answer 28

A prospective cohort study is a longitudinal cohort study that follows over time a
group of similar individuals (i.e. babies) who differ with respect to certain factors
under study (i.e. maternal smoking history), to determine how these factors affect
rates of a certain outcome (i.e. birth weight).

Question 29

A 60 year old woman is brought in after found drowsy and confused by her
daughter. She has been unwell for the past 2–3 days with diarrhoea and
vomiting. She has a history of bipolar disorder. Her regular medication
includes lithium, risperidone and co-codamol.
Her temperature is 37.3°C, pulse rate 94 bpm, BP 122/70 mmHg, respiratory
rate 14 breaths per minute and oxygen saturation 99% breathing high-flow
oxygen. Her GCS score is 12/15. She has coarse tremor in her arms and
jerking movements of her legs

Answer 29

lithium toxicity

Question 30

PBC

Answer 30

The clinical picture fits a diagnosis of primary biliary cirrhosis (raised ALP, AMA
positive with no evidence of obstruction. There is good evidence that
Ursodeoxycholic acid should be prescribed for all patients with this diagnosis

Question 31

evidence of postural drop with D+V or sepsis hx in older person

Answer 31

hypovolaemic, give stat fluids

Question 32

Conn’s

Answer 32

Conn’s is the commonest endocrine cause of hypertension and much more common
than Cushing’s/Phaeo. The classic presenting signs of primary aldosteronism are
hypertension and hypokalemia, although the later is not present in all cases. The
diagnosis should also be considered in those with severe hypertension (>150/100
mmHg), hypertension with sleep apnoea and hypertension with a family history of
early onset hypertension

Question 33

. Multiple fractures followed by early onset (within
24 hours) of hypoxia, dyspnea, and tachypnea are the most frequent findings.
Neurologic manifestations range from the development of an acute confusional state
and altered level of consciousness to seizures and focal deficits and usually follow
respiratory symptoms. A petechial rash is the last component to appear and only
appears in about a third of cases.

Answer 33

fat embolus

Question 34

A 46 year old man has a cardiac arrest in the Emergency Department after an
episode of chest pain. He remains in ventricular fibrillation after three DC
shocks, and he is treated with a bolus of intravenous adrenaline/epinephrine.

Answer 34

If VF/VT persists after a third shock, resume chest compressions immediately and
then give adrenaline 1 mg IV and amiodarone 300 mg IV while performing a further 2
min CPR. As per ALS guidelines 2015.

Question 35

EBV typical story

Answer 35

EpsteinBarr virus (EBV)-induced infectious mononucleosis (IM) should be suspected when a
young adult complains of sore throat, fever, and malaise and also has
lymphadenopathy and pharyngitis. The presence of palatal petechiae is also
characteristic. Lymphocytosis is usually seen in the FBC. The diagnosis can be
confirmed through EBV specific antibodies.

Question 36

A 17 year old boy has repeated episodes characterised by a funny ‘racing’
sensation in his abdomen, followed by loss of awareness. His girlfriend
describes that he has a vacant stare and waves his left arm around in a
writhing manner during these attacks.

Answer 36

He has focal onset impaired awareness seizures, the aura implicates one of the
temporal lobes

Question 37

if standard CAP picture, what is most likely bug

Answer 37

strep pneumoniae

Question 38

passing orange urine

Answer 38

Rifampicin typically causes an orange or red-orange discolouration of body fluids
(including urine, sweat, saliva, and tears). The patient should be warned of this
possibility

Question 39

A 46 year old woman attends the Emergency Department with fever,
headache and confusion, which have developed over several hours. She finds
it impossible to lift her head from the pillow and resists your attempts to feel
her neck.
Her temperature is 38.1°C, pulse rate 105 bpm and BP 110/60
mmHg. Her GCS score is 14. A CT scan of her head is normal. A lumbar
puncture is performed

Answer 39

typical bacterial meningitis

LPHigh pressure, raised protein, excess neutrophils

Question 40

‘columnar epithelium

containing goblet cells and Paneth cells’.

Answer 40

small intestinal metaplasa

of lower oesophagus

Question 41

acute vs chronic type 2 RF COPD

Answer 41

difference is in acute the pH is abnormal as not compensated yet