Mock Exam Questions

Question 1

Name 6 steps to be undertaken within one hour when concerned about sepsis (3)

Answer 1

Administer oxygen therapy
IV access and commence IV fluids
Blood cultures
Check blood tests - FBC and lactate
Arrange to monitor urine ouput
Administer antibiotics

Question 2

What is the definitions of sepsis? (1)

Answer 2

Sepsis is defined as the presence of likely or confirmed infection in addition to the presence of organ dysfunction suggesting an abnormal physiological response to the infection

Question 3

Describe the qSOFA score and explain how it is used to suggest that sepsis is likely (2)

Answer 3

The qSOFA score is used to suggest that a patient has sepsis. A point is given for each of: presence of confusion, increased respiratory rate and hypotension. A qSOFA score of 2 or more suggests that sepsis is likely.

Question 4

List organisms associated with intra-abdominal sepsis. (2)

Answer 4

Gram-negative organisms, Anaerobes

Accept: E.coli, Enterobacteriaceae, Enterococci

Question 5

Patient with sepsis has now become hypotensive elevated lactate levels.
What complication of sepsis has now developed? (1)

Answer 5

Septic shock

Question 6

Describe how Digoxin works (2)

Answer 6

Inhibits Na+/K+/ATPase increasing intracellular Na+ in turn raising intracellular Ca2+ which inc. force of cardiac contraction. (1)
Inc. diastolic resting membrane potential at the SA and AV nodes and inc. vagal tone which dec. AV node conduction and ventricular rate. (1)

Question 7

Describe how apixaban works (2)

Answer 7

A highly selective direct inhibitor of factor Xa. (1)
Factor Xa catalyzes the conversion of prothrombin to thrombin, the final enzyme in the coagulation cascade that is responsible for fibrin clot formation. (1)

Question 8

List 2 common causes of atrial fibrillation. (2)

Answer 8

Ischaemic heart disease
Valvular heart disease
Hypertension
Hyperthyroidism
Chronic Alcohol Excess
Resp disease such as pneumonia, pulmonary embolism

Question 9

List 2 important investigations in newly diagnosed atrial fibrillation. (2)

Answer 9

Echocardiography
Electrocardiography
Haemoglobin
Thyroid function tests

Question 10

Outline the general principles of management of atrial fibrillation. (2)

Answer 10

Thromboprophylaxis with anticoagulation or antiplatelet therapy. (1)
Rate control with drugs or rhythm control, either with medical or electric cardioversion. (1)

Question 11

Other than iron deficiency anaemia, give 2 other causes of a microcytic hypochromic blood film. (2)

Answer 11

Thalassaemia
Sideroblastic anaemia
Anaemia of chronic disease

Question 12

List 2 possible clinical signs of iron deficiency anaemia that you would look for on examination. (2)

Answer 12

Pallor palmar creases
Pallor conjuctival membranes
Angular Stromatitis
Atrophic Glossitis
koilonychia

Question 13

List 3 serum parameters that you should measure in order to confirm the diagnosis of IDA and state whether the parameter would be elevated, lowered or normal. (3)

Answer 13

Serum iron - lowered
Serum ferritin - lowered
Serum TIBC - elevated

Question 14

List 3 possible mechanisms that could have led to IDA. (3)

Answer 14

Dietary intake, blood loss or malabsorption.

Question 15

Define chronic bronchitis and emphysema. (2)

Answer 15

Bronchitis - the production of sputum on most days for at least 3 months in at least 2 years (chronic bronchitis)

Emphysema = abnormal, permanaent enlargement of the airspaces distal to the terminal bronchioles

Question 16

Name and describe one type of emphysema that causes significant airflow obstruction. (2)

Answer 16

Centri-acinar - dilatation/destruction around respiratory bronchioles, the central portion of the acinus

Pan-acinar - enlargement/destruction of all parts of the acinus, from the level of respiratory bronchiole to the terminal blind alveoli

Question 17

What is the mechanism of action of salbutamol in the airway? (2)

Answer 17

Adrenergic agonist that is moderately selective for beta-2-adrenergic receptors
Acts on airway smooth muscle causing relaxation; and as bronchoprotective preventing constriction

Question 18

List 2 non-pharmacological approaches to the management of COPD? (2)

Answer 18

Smoking cessation

Pulmonary rehabilitation

Question 19

Why does high protein levels cause leg oedema? (3)

Answer 19

Proteinuria causes the serum albumin to fall, reducing oncotic pressure, causing fluid to leak out of the circulation into the subcutaneous tissues

Question 20

What is the most likely cause of proteinuria? (1)

Answer 20

Membranous nephropathy

Question 21

Which hormone system can be blocked to reduce protein loss through the glomerular basement membrane? (1)

Answer 21

Renin-angiotensin system

Question 22

Give 2 ways in which blocking the renin-angiotensin system reduces proteinuria. (2)

Answer 22

Reduces system blood pressure and glomerular efferent arterial tone

Question 23

Describe 3 microbiological characteristics of Clostridium difficile. (3)

Answer 23

Anaerobic
Gram-positive bacilli
Spore forming
Toxin producing (A+B)
Can exist in spore and vegetative forms
Antibiotics resistance
Part of a normal bowel flora

Question 24

List 4 parameters you would use to assess and classify the severity of the patient’s Clostridium difficile associated diarrhoea (CDAD). (2)

Answer 24

Colonic dilatation > 6cm
WCC > 15
Creatinine > 1.5 times the baseline
Temp > 38.5
immunnosppression

Question 25

List 2 gastrointestinal complications of CDAD. (2)

Answer 25

Pseudomembranous colitis
Toxic megacolon
Perforation

Question 26

List one antibiotic class that is commonly implicated in exacerbating or causing CDAD. An example antibiotic from the class is an acceptable answer. (1)

Answer 26

Cephalosporins
Fluoroquinolones (ciprofloxacin)
Beta lactam-betalactamse inhibitors (co-amoxiclav, piperacillin-tazobactam)
Clindamycin
Carbapenems (meropenem, ertapenem)