Mock exam flashcards
What are the usual findings of haemolytic uraemia syndrome (HUS)? Triad (3)
triad;
AKI
thrombocytopenia
normocytic anaemia
15 yr old girl, 5 day hx sore throat and headache. NKDA. No vomiting/diarrhoea. Treated with amoxicillin, 2 days later she comes in c/o widespread itchy rash. What’s most likely cause?
Infectious mononucleosis (glandular fever)
a maculopapular, pruritic rash develops in 99% of pts who take amoxicillin while they have infectious mononucleosis.
She said NKDA, so most likely answer is above.
What type of reaction is contact dermatitis due of?
Type 4 hypersensitivity reaction - rash that is linked to an allergen
What is shingles caused by and how is it characterised and treated?
Varicella zoster virus
blistery rash and pain in a dermatomal distribution.
Treated with aciclovir 800mg 5x day for 7 days.
When are children vaccinated against rubella?
1year and 3 years
Typical presentation of acute lymphoblastic leukaemia (ALL)?
child seems ‘different’, tired all the time, looks washed out, bruising, high temp, few recent coughs and colds
Investigations when suspecting ALL
blood film and bone marrow biopsy
What test can be done in chronic myeloid luekaemia and what chromosome would we be looking for?
Cytogenic testing - Philadelphia chromosome
10 day old baby, unwell, unconscious and shocked. Urgent blood gas shows hyponatraemia, hyperkalaemia and a metabolic acidosis. What is most likely underlying pathology?
congenital adrenal hyperplasia.
Baby likely to be having a salt-losing adrenal crisis
What’s the triad of DKA presentation?
acidaemia
hyperglycaemia
ketoanaemia
Droopy eyelid, mild ptosis and eye that looks down and out. What is likely cause of this presentation?
Oculomotor nerve palsy (3rd nerve palsy)
What causes infectious mononucleosis (glandular fever)?
EBV (epstein barre virus) (90% of the time)
Also CMV.
What are the sanctuary sites in ALL?
testes and CNS
Treatments for sickle cell anaemia?
- prophylactic penicillin (vast majority will have had a splenectomy)
- stem cell transplant curative (big risks involved)
- hydroxycarbamide used to prevent vaso-occlusive complications
- blood transfusions can be given if pt suffering from severe anaemia to reduce proportion of hbs
baby presents with extensive bruising, painful, swollen right knee join, reluctant to move it. NAI ruled out. Temp been normal all week. What is going on here and what would be 1st line investigation?
Some kind of clotting disorder so 1st line investigation would be a clotting screen.
What does a clotting screen generally include?
- prothrombin time (PT)
- activated partial thromboplastin time (APTT)
- fibrogen
hameophilia A is a deficiency in which component of the coagulation pathway?
Factor VIII (8)
hameophilia B is a deficiency in which component of the coagulation pathway?
Factor IX (9)
Where is fibrin on the coagulation pathway?
final product of coagulation cascade, where it becomes cross-linked to form a clot
What is tissue factor in the coagulation pathway?
1st component of extrinsic pathway and is released when there is a cellular injury.
What are the different severities of haemophilia A and what are the bleeding tendencies?
Severity %factor VIII Bleeding tendancy
Mild - >5-40% bleed after surgery
Moderate 1-5% bleed after minor trauma
severe <1% spontaneous joint/muscle bleeds
What is a typical presentation of Kawasaki disease?
paeds, continuous fever, quiet, miserable, does not engage.
Eyes look sore, skin on fingers appear red and peeling off
What investigation is most important to rule out a dangerous complication in kawasaki disease? And what are the dangerous complications?
transthoracic echocardiogram
dangerous complications - cardiac complications; pericardial effusion, myocardial disease, valve damage or coronary artery aneurysm
What disease is the ‘CRASH and BURN’ mnemonic for? and what is this mnemonic?
Kawasaki disease
conjunctivitis, rash, adeneopathy, strawberry tongue, hands (palmar erythema, swelling), burn (fever >5days)
18 month old boy, presents looking extremely unwell, high fever, been crying constantly for 24hrs. Previously walked normally, no concerns for development but now has stopped mobilising, and is holding right knee close to chest with hip flexed. Recently had chicken pox. What is most likely diagnosis and management?
septic arthritis
admit for prolonged abx and close monitoring
requires investigation with joint aspiration.
a girl with Hodgkin lymphoma has started on combination chemotherapy. What investigation should be used to monitor treatment response?
Positron emission tomography (PET)
uses radioactive tracer to show areas of high uptake and therefore areas of active malignancy
Non-hodgkin lymphoma is more common in childhood, and Hodgkin lymphoma is more common in adolescence. T/F?
True
In lymphomas B cell malignancies cause classical B symptoms. What are the typical B symptoms?
unexplained fever, unexplained weight loss, drenching sweats (particularly at night)
When is Perthes disease most common?
Boys aged 5-10 years.
What are the risk factors for developmental dysplasia of the hip?
female sex, breech birth, high birth weight, oligohydramnios, prematurity
Which genetic condition is associated with a ‘double bubble’ sign on an abdo xray in neonates?
Down syndrome
Duodenal atresia - rare disorder with increased risk in children with Down Syndrome
Down syndrome also associated with Hirchprung’s disease
What is Hirchprung’s disease and which genetic condition is it associated with?
Down syndrome.
typically presents either with delay or failure to pass meconium after birth, or recurrent constipation and abdo distension in older children.
Cystic fibrosis is typically associated with meconium ileus in neonates, what is this and what does it cause?
Bilious vomiting - 24-48hrs after birth with bilious vomiting, and abdo distension. On xray there may be fluid levels seen in bowel, and is treated with surgical decompression with /without serosal resection.
What are the common features of Down syndrome?
hypertonia, brushfield spots (increased pigmentation) in iris, delayed motor milestones, small ears and upslanted palpebral fissures.
others: round face, flat occiput, epicanthic folds, protruding tongue, short stature, and learning difficulties
How does the ICD-11 describe EUPD?
problems in functioning of aspects of self i.e self worth, direction, as well as inability to maintain close relationships, all over a period of time.
What is schizoid personality disorder associated with symptom wise?
anti-social, indifferent and isolated. Delusion may be there but there will be awareness into this.
What type of medications should you not eat cheese with?
Monoamine oxidase inhibitor antidepressants such as phenelzine
66yr old with hx of bipolar affective disorder for which she takes regular medication, was on lithium long term control but found no effect. What is the appropiate medication to start in this case?
Valproate
Long term maitainance - lithium 1st line, if doesn’t work Valproate (mood stabaliser) can be added - not to be used in women of child bearing age unless no other option)
What is lithium toxicity and what are the signs?
lithium levels above 1.5mmol/L = toxicity
ataxia, coarse tremor, seizure, slurred speech, vomiting
Alcohol detoxification, what is most appropiate drug to use?
chlordiazepoxide (long acting benzodiazepine 1st line)
Thiamine
A 75 year old man presents to the emergency department (ED) after a sudden collapse at home. This was preceded by a 24 hour history of feeling clammy and nauseous. He has a past medical history of type 2 diabetes and hypertension. He also has a body mass index (BMI) of 38.
What is the most likely cause of the patient’s symptoms?
MI
A 29 year old man presents to the emergency department (ED) with palpitations and vomiting. His ECG shows supraventricular tachycardia (SVT) at a rate of 170 beats per minute. The patient is stable with no adverse features.
What is the first line treatment for this patient?
Vagal manoruvres - 1st line treatment in pts with SVT to cardiovert back to sinus rythm.
The ED doctor suspects pulmonary embolism (PE). What is the definitive diagnostic investigation for PE in this patient?
Computed tomography pulmonary angiography (CTPA)
haemodynamically stable pts with high clinical probability of PE should be investigate with a CTPA unless CI
An arterial blood gas (ABG) is performed as part of her assessment:
pH 7.27 (7.35 - 7.45)
PaO2 7.1 kPa (11 - 13 kPa)
PaCO2 9.47 kPa (4.7 – 6.0 kPa)
HCO3 43 mEq/L (22 – 26 mEq/L)
Lactate 1.1 mmol/L (0.5 - 2.0 mmol/L)
Inspired oxygen 28%
What is the most likely explanation for this blood gas result?
Acute-on-chronic type 2 respiratory failure
- usual compensatory metabolic processes have been overwhelmed by additional acute resp insult.
- increase in PaCO2 with significant resp acidosis, alongside elevated HCO3
A 23-year-old female presents to the emergency department with severe abdominal pain. This started 24 hours ago and was generalised in location but has now become markedly worse overnight, alongside migration of the pain to be more focussed in her right iliac fossa. She also reports some associated nausea, but no vomiting.
Which of the following is the next best step in the management of this patient?
urinary beta-HCG
- in women of child bearing age a urine pregnancy test should be prioritised to rule out possibility of ectopic pregnancy
A 57-year-old male presents to the Emergency Department with confusion and abdominal pain. He is unable to give any information about his medical history, due to his confusion. Blood tests identify significantly deranged liver function tests.
On examination, what clinical sign may suggest that this is an acute rather than chronic form of liver disease?
Tender, smooth hepatomegaly
- suggests acute liver pathology with potential causes; acute viral hepatitis, hepative vein thrombosis, right heart failure with portal congestion.
- in chronic there’s usually liver cirrhosis, which can cause liver to have irregular shape
A 22-year-old female presents to her GP with a three month history of sharp upper abdominal pain occurring shortly after eating. She has lost 5 kilograms in the last month due to limiting her food intake to minimise her pain. She has also tried to cut out various foods from her diet, including gluten, lactose, spicy foods and fatty foods, but has not managed to identify any triggers.
She was previously referred for an abdominal ultrasound, which has come back with no abnormality detected.
What is the most likely diagnosis?
gastric ulcer
- pain from gastric ulcer classically exacerbated by food, and maximal within 30 mins to an hour of eating a meal.
- would require a oesophagealgastroduodenoscopy
An 18-year-old female presents to the GP with a three-year history of intermittent cramping abdominal pain and loose stools. She has decided to seek medical advice on this occasion as last week she noted some streaked fresh red blood, as well as some mucous, in her stool.
She undergoes a colonoscopy with results as follows: there are multiple, small, discrete areas of inflamed mucosa scattered throughout the large bowel, with interspersed regions of normal mucosal appearance. The most significant pathology was identified in the distal ileum, where there were multiple deep and discrete ulcers in a cobblestone appearance.
What is the most likely diagnosis?
Crohn’s disease
- ileum most common site of this disease
- classic findings: skip lesions and cobblestone appearance, strictures and fistulae.
A 63-year-old man presents to his GP with worsening pain in both knees over a period of 6 months. The pain is worse on physical activity and limits his independence as he lives in a second-floor flat and now struggles to get up and down the stairs. He has a past medical history of type 2 diabetes, hypercholesterolaemia and a body mass index (BMI) of 36.
What is the most likely diagnosis?
osteoarthritis
A 19-year-old female with a history of severe depression presents to the Emergency Department at 7 pm after taking an overdose of paracetamol. She describes taking 36 500mg tablets of paracetamol over the course of the afternoon, between 2 pm and 6 pm.
What is the first line treatment for this patient?
N-acetylcysteine
A 23-year-old female presents to the GP with fatigue. She describes herself as very healthy, following a vegan diet and exercising four times a week - although the fatigue is now making this more challenging to maintain. She has no past medical history.
Blood tests reveal:
Hb 94 (135-175g/dL)
MCV 106 (80-96 fl)
What is the most likely cause of the patient’s anaemia?
B12 deficiency anaemia
- macrocytic anaemia
- people with vegan or vegetarian diets more at risk of B12 deficiency
A 40-year-old male presents to the Emergency Department. He appears unkempt, cachectic and on questioning it is identified that he is experiencing homelessness. He describes a very poor diet consisting of donated food when this is available, and otherwise mainly eats scraps from bins. He is noted to be very pale and his full blood count results demonstrate a normocytic anaemia.
What is the most likely cause of this anaemia?
generalised malnutrition
A 23-year-old female experiences rapid “closing in” of her vision and then collapses when travelling as a standing passenger on a busy tube train. Passers-by witness convulsing movements of her arms and legs for approximately 15 seconds following the collapse. She regains consciousness immediately after and has a Glasgow Coma Scale (GCS) of 15.
What is the most likely diagnosis?
vasovagal syncope
- simple faint
- commonly positional; following period of long standing
- preceded by tunnel vision
- no post ictal phase
A 27-year-old female with a history of epilepsy is brought into the Emergency Department by ambulance following a seizure at home 20 minutes ago. She usually takes levetiracetam. She is post-ictal and has intravenous access established by the ambulance crew. During your assessment, she starts having a second seizure.
What is the first-line agent to stop this patients seizure?
IV lorazepam
- benzodiazepines 1st line agents for terminating seizures
A 49-year-old male presents to the Emergency Department with palpitations and nausea. He has a past medical history of hypertension, migraine and gout. His regular medications include amlodipine, ramipril, indapamide, propranolol and allopurinol.
Blood tests reveal hyperkalaemia at 6.4 mmol/L.
Which of his regular medications should be suspended during treatment of his hyperkalaemia?
Ramiprill
A 76-year-old female presents to the Emergency Department. She has been brought in by her carers, who feel she is more confused and drowsy than normal. She has a past medical history of type 2 diabetes, hypertension and depression. Her regular medications include metformin, gliclazide, ramipril, amlodipine and sertraline.
Blood tests reveal hyponatraemia at 125 mmol/L.
Which medication is most likely contributing to this patients hyponatraemia?
Sertraline (SSRI)
when does delerium tremens occur
48-72hrs after alcohol withdrawal
typical presentation of fronto temporal dementia
personality changes
social conduct problems
increased appetite
language problems
What is borderline personality disorder
Class B personality disorder
pattern of abrupt mood swings, unstable relationships and instability in self image
self harm common
relationships alternate between idealization and devaluation
inability to control temper and general affect
hard to keep jobs
sleep disturbance
insecure relationships
What is antisocial personality disorder
cluster B personality disorder
characterised by patterns of disregard and violation of rights of others
inidividuals lack empathy and are often manipulative and impulsive
aggressive and unremorsful
consistently irresponsible with failure to obey laws and social norms
What is Histrionic personality disorder
characterised by attention seeking behaviour and excessive displays of emotion
often sexually inappropiate
shallow and self dramatising
relationships are considered to be more intimate that they really are
What’s narcissistic personality disorder
pattern of grandiosity, need for admiration of others and lack of empathy
has a sense of entitlement and will take advantages of others to achieve own wants
arrogant and preoccupied by their own fantasies and desires
1st line treatment for delerium tremens
chlordiazepoxide
what should be suspected with: CNS depression, respiratory depression and pupillary constriction and what is 1st line treatment
opioid toxicity
naloxone
1st line management of borderline personality disorder
DBT
Sertraline can be used if depressive symptoms
Signs of gender dysphoria
desire to hide physical signs of birth assigned gender
distressed by own genitals
prefer dressing in clothes of opposite gender
rejection of toys, games and other things associated with their birth assigned gender
Examples of withdrawl symptoms seen within 24hrs after a period of high cocaine use
anxiety, fatigue, irritability , lack of motivation
A 20 year old woman attends her GP on the 15th of March following a positive pregnancy test. She is keen to know when the baby will be due.
Her last menstrual period started on the 1st of February. She usually has regular cycles.
What is her estimated date of delivery (EDD)?
Naegele’s rule
Naegele’s rule is used to calculate the EDD based on the first day of the woman’s last menstrual period (LMP).
The calculation is to add one year and seven days to the first day of the last menstrual period (LMP) and subtract three months.
This method may not be accurate in women with irregular or long cycles, or those who had recently been using the combined oral contraceptive pill.
Important to stress this is an ESTIMATE.
A: 8th Novemeber
