MOCK SAQs Flashcards
15 year old girl presents to A+E with vomiting, drowsiness, and Kussmaul’s
respirations. Doctors suspect she has diabetic ketoacidosis.
Name two tests required for the diagnosis of DKA and the results required?
Blood glucose = >11.1mmol/l Plasma ketones = > 3mmol/l Ketonuria = >2+ on dipstick Venous pH <7.35 HCO3- = <15.0mmol/l
15 year old girl presents to A+E with vomiting, drowsiness, and Kussmaul’s
respirations. Doctors suspect she has diabetic ketoacidosis.
What is the first line of treatment for this patient?
IV fluids
15 year old girl presents to A+E with vomiting, drowsiness, and Kussmaul’s
respirations. Doctors suspect she has diabetic ketoacidosis.
What disease is DKA a hallmark sign of?
Type 1 diabetes meillitus
15 year old girl presents to A+E with vomiting, drowsiness, and Kussmaul’s
respirations. Doctors suspect she has diabetic ketoacidosis.
Name 3 risk factors for DKA?
- Stopped insulin
- Infection
- Pancreatitis
- Undiagnosed T1DM
- MI
- Surgery
15 year old girl presents to A+E with vomiting, drowsiness, and Kussmaul’s
respirations. Doctors suspect she has diabetic ketoacidosis.
Name 3 complications of DKA?
- Hypotension
- Coma
- Cerebral oedema
- Hypothermia
- Death
- DVT
- Pneumonia
76 year old female patient arrives in A+E, presenting with chest pain and a history of
previous MI, diabetes mellitus type 2 and hypertension. Their BMI is 32 kg/m^2 and
they have 3 children.
What aspect of their chest pain differentiates pericarditis and an MI?
Does NOT radiate to the teeth and jaws in pericarditis
76 year old female patient arrives in A+E, presenting with chest pain and a history of
previous MI, diabetes mellitus type 2 and hypertension. Their BMI is 32 kg/m^2 and
they have 3 children.
Name 4 features elicited on clinical examination that would may you suspect pericarditis?
- Pericardial rub
- Sinus tachycardia
- Fever
- Effusion signs
76 year old female patient arrives in A+E, presenting with chest pain and a history of
previous MI, diabetes mellitus type 2 and hypertension. Their BMI is 32 kg/m^2 and
they have 3 children.
What would you expect on an ECG of a pericarditis patient?
Saddle shaped ST elevation
76 year old female patient arrives in A+E, presenting with chest pain and a history of
previous MI, diabetes mellitus type 2 and hypertension. Their BMI is 32 kg/m^2 and
they have 3 children.
How long should colchichine be given for patients who what had acute pericarditis?
6-8 weeks
76 year old female patient arrives in A+E, presenting with chest pain and a history of
previous MI, diabetes mellitus type 2 and hypertension. Their BMI is 32 kg/m^2 and
they have 3 children.
Whist in hospital she develops AF, from into in chadvasc what should be done?
76 = 1 T2DM = 1 HTN = 1 Female = 1 Previous MI = 1 chadvasc = 5 anticoagulate
A patient has just had a biopsy of their lymph node due to suspected lymphoma.
What cells would you expect to find on microscopy of a Hodgkins lymphoma?
Reed-sternberg cells
A patient has just had a biopsy of their lymph node due to suspected lymphoma.
Patient is diagnosed with Non Hodgkins lymphoma - what lymphocyte is affected?
B
A patient has just had a biopsy of their lymph node due to suspected lymphoma.
Upon taking history the patient has human herpes virus, which is associated with NHL?
Epstein Barr virus
A patient has just had a biopsy of their lymph node due to suspected lymphoma.
The patient has all three B symptoms - what are they?
- Fever
- Weight loss
- Night sweats §
A patient has just had a biopsy of their lymph node due to suspected lymphoma.
The patient has pancytopenia - define this?
Deficiency of all blood cells
RBC
WBC
platelets
A patient presents to their doctor with a history of foreign travel, nausea, fever,
malaise, and is mildly jaundiced. You suspect that they have viral hepatitis.
Which form of viral hepatitis is a notifiable disease and to whom should it be reported?
Hepatitis A, public health england
A patient presents to their doctor with a history of foreign travel, nausea, fever,
malaise, and is mildly jaundiced. You suspect that they have viral hepatitis.
Upon a blood test it is found that the patient has Hep B, what was present in the blood to diagnose this?
HBsAg OR antiHB antibody
A patient presents to their doctor with a history of foreign travel, nausea, fever,
malaise, and is mildly jaundiced. You suspect that they have viral hepatitis.
How is hep B transmitted?
Blood
A patient presents to their doctor with a history of foreign travel, nausea, fever,
malaise, and is mildly jaundiced. You suspect that they have viral hepatitis.
Why is hepatitis D only able to cause disease in those with hep B?
Incomplete RNA - needs hep B to assemble
A patient presents to their doctor with a history of foreign travel, nausea, fever,
malaise, and is mildly jaundiced. You suspect that they have viral hepatitis.
Name three management for acute hep B?
Avoid alcohol
Vaccinate contacts
Monitor liver function
A 30 year old woman presents to her doctor with fatigue, joint pain, and mouth
ulcers, and photosensitivity. It is found upon testing and further examination that
she has systemic lupus erythematosus (SLE).
Name a gene associated with an increased risk of SLE?
HLA 88
HLA DR2
HLA DR3
A 30 year old woman presents to her doctor with fatigue, joint pain, and mouth
ulcers, and photosensitivity. It is found upon testing and further examination that
she has systemic lupus erythematosus (SLE).
Name four features of SLE that are required for clinical diagnosis?
A RASH POINTS AN MD
Arthritis Renal disorder ANA+ Serositis Haematological disorder Photosentitivity Oral ulcers Immunological disorder Neurological disorder Malar rash Discoid rash
A 30 year old woman presents to her doctor with fatigue, joint pain, and mouth
ulcers, and photosensitivity. It is found upon testing and further examination that
she has systemic lupus erythematosus (SLE).
What are two lifestyle changes that can be performed by the patient to reduce symptoms?
Decrease sunlight expose
Wear high factor sunblock
Decrease CVS risk factors
A 30 year old woman presents to her doctor with fatigue, joint pain, and mouth
ulcers, and photosensitivity. It is found upon testing and further examination that
she has systemic lupus erythematosus (SLE).
What medications should be given for an acute SLE attack and what route should they be given?
IV Cyclophosphamide and prednisolone
A 35 year old male presents to the sexual health clinic having just changed sexual
partners for a STD check. The results show that he is HIV positive.
Other than sex, how can HIV be transmitted?
Mother to child
IV needles
Contaminated blood/oragns
A 35 year old male presents to the sexual health clinic having just changed sexual
partners for a STD check. The results show that he is HIV positive.
What type of virus is HIV?
Retrovirus subgroup lentivirus
A 35 year old male presents to the sexual health clinic having just changed sexual
partners for a STD check. The results show that he is HIV positive.
Untreated this patient will progress to AIDS, what CD4 count is the defining level for an AIDs diagnosis?
<200ul
A 35 year old male presents to the sexual health clinic having just changed sexual
partners for a STD check. The results show that he is HIV positive.
What is the overall name for treatment given to HIV patients and what subgroups of medications are given - write in gull
HAART - highly active antiretroviral therapy
NRTI - nucleoside reverse transcriptase inhibitors
Patient presents to GP with severe polyuria and polydipsia.
What aspect on a urine dipstick would indicate that the patient has DI not DM?
Glucose negative
Patient presents to GP with severe polyuria and polydipsia.
The patient is diagnosed with DI, what test would you run to differentiate cranial and nephrogenic DI? What result would inidicate cranial?
IM desmopression test
Urine becomes concentrated in cranial
Patient presents to GP with severe polyuria and polydipsia.
The patient is found to have cranial DI, what class of medication is given and give an example of this?
ADH analogue
Desmopressin
Patient presents to GP with severe polyuria and polydipsia.
In a patient with nephrogenic DI you give them NSAIDs, what is the physiology behind this?
Inhibits prostaglandins which stops their inhibition of ADH action
Patient presents to GP with severe polyuria and polydipsia.
Name a risk factor for DI?
Family history
A 53-year-old man presents to his GP with headaches, excessive sweating and
complaining that his wedding ring no longer fits on his finger. Upon examination, he has
enlarged hands and feet, as well as an enlarged jaw. The GP suspects Acromegaly.
Name two causes of acromegaly?
Benign Pituitary Tumour (GH secreting)
Ectopic Carcinoid Tumour (GH secreting)
A 53-year-old man presents to his GP with headaches, excessive sweating and
complaining that his wedding ring no longer fits on his finger. Upon examination, he has
enlarged hands and feet, as well as an enlarged jaw. The GP suspects Acromegaly.
Name 4 other signs of acromegaly?
- Large tongue
- Wide nose
- Large supraorbital ridge
- Deep voice
A 53-year-old man presents to his GP with headaches, excessive sweating and
complaining that his wedding ring no longer fits on his finger. Upon examination, he has
enlarged hands and feet, as well as an enlarged jaw. The GP suspects Acromegaly.
Name 2 investigations for acromegaly?
Glucose Tolerance Test
MRI of pituitary gland
A 53-year-old man presents to his GP with headaches, excessive sweating and
complaining that his wedding ring no longer fits on his finger. Upon examination, he has
enlarged hands and feet, as well as an enlarged jaw. The GP suspects Acromegaly.
Why would measuring plasma growth hormone not be diagnostic?
- GH is pulsatile
2. GH can be elevated due to stress/pregnancy/puberty
A 53-year-old man presents to his GP with headaches, excessive sweating and
complaining that his wedding ring no longer fits on his finger. Upon examination, he has
enlarged hands and feet, as well as an enlarged jaw. The GP suspects Acromegaly.
Name 2 types of drugs used for acromegaly and give examples
GH receptor antagonist - sc pegvisomant
Somatostatin analoge - sandostatin
A 47-year-old man presents to A&E with progressive dyspnoea which is worse on
exertion, haemoptysis and malar flush. Following investigations, the doctor suspects
Mitral Valve Stenosis.
Name 2 risk factors for developing mitral valve stenosis?
Rheumatic fever
Untreated streptococcus infection
A 47-year-old man presents to A&E with progressive dyspnoea which is worse on
exertion, haemoptysis and malar flush. Following investigations, the doctor suspects
Mitral Valve Stenosis.
Give two characteristic heart sounds of mitral valve stenosis?
Diastolic murmur
Loud opening S1 snap
A 47-year-old man presents to A&E with progressive dyspnoea which is worse on
exertion, haemoptysis and malar flush. Following investigations, the doctor suspects
Mitral Valve Stenosis.
What is the gold standard investigation for diagnosing mitral valve stenosis?
Echocardiogram
A 47-year-old man presents to A&E with progressive dyspnoea which is worse on
exertion, haemoptysis and malar flush. Following investigations, the doctor suspects
Mitral Valve Stenosis.
Name 2 classes of drugs and examples that are used for treating mitral valve stenosis?
Beta blocker - bisoprolol
Diuretics -furosemide
A 47-year-old man presents to A&E with progressive dyspnoea which is worse on
exertion, haemoptysis and malar flush. Following investigations, the doctor suspects
Mitral Valve Stenosis.
Name two surgical interventions for mitral valve stenosis?
- Percutaneous mitral balloon valvotomy
2. Mitral valve replacement
A 47-year-old man presents to A&E with progressive dyspnoea which is worse on
exertion, haemoptysis and malar flush. Following investigations, the doctor suspects
Mitral Valve Stenosis.
What cardiac arrhythmia is often associated with mitral valve stenosis?
Atrial fibrillation
A 14-year-old female presents to her GP with fatigue, reoccurring headaches and
faintness. Upon examination, she is found to have spoon-shaped nails and angular
stomatitis. Following further investigation, she is diagnosed with Microcytic Anaemia, due to
iron deficiency.
What plasma protein transports iron in the blood to the bone marrow?
Transferrin
A 14-year-old female presents to her GP with fatigue, reoccurring headaches and
faintness. Upon examination, she is found to have spoon-shaped nails and angular
stomatitis. Following further investigation, she is diagnosed with Microcytic Anaemia, due to
iron deficiency.
Aside form iron deficiency, give some other cause of microcytic anaemia?
Thalassaemia
Malabsorption
A 14-year-old female presents to her GP with fatigue, reoccurring headaches and
faintness. Upon examination, she is found to have spoon-shaped nails and angular
stomatitis. Following further investigation, she is diagnosed with Microcytic Anaemia, due to
iron deficiency.
Two features of microcytic anaemia that would be seen on a blood film?
Small RBCs
Pale RBCs - hypochromic
Variation in shape
Variation in size
A 14-year-old female presents to her GP with fatigue, reoccurring headaches and
faintness. Upon examination, she is found to have spoon-shaped nails and angular
stomatitis. Following further investigation, she is diagnosed with Microcytic Anaemia, due to
iron deficiency.
Name 2 blood tests that would be carried out to diagnose microcytic anaemia?
Serum ferritin
Serum iron
Reticulocyte count
A 14-year-old female presents to her GP with fatigue, reoccurring headaches and
faintness. Upon examination, she is found to have spoon-shaped nails and angular
stomatitis. Following further investigation, she is diagnosed with Microcytic Anaemia, due to
iron deficiency.
Name 1 pharmacological treatment for iron deficiency anaemia and give an example?
Oral iron
Ferrous sulphate
A 14-year-old female presents to her GP with fatigue, reoccurring headaches and
faintness. Upon examination, she is found to have spoon-shaped nails and angular
stomatitis. Following further investigation, she is diagnosed with Microcytic Anaemia, due to
iron deficiency.
2 side effects of ferrous sulphate?
Nausea
Diarrhoea / constipation
Black stools
A 23-year-old female presents to her GP with heartburn and increased belching.
Following a focused history, the GP diagnoses her with Gastro-Oesophageal Reflux Disease (GORD).
Give 4 causes of gastro-oesophageal reflux disease?
Lower oesophageal sphincter hypotension
Hiatus hernia
Slow gastric emptying
Drugs e.g. CCBs
A 23-year-old female presents to her GP with heartburn and increased belching.
Following a focused history, the GP diagnoses her with Gastro-Oesophageal Reflux Disease (GORD).
Give 2 other symptoms of GORD?
Increased salivation
Food/acid regurgitation
A 23-year-old female presents to her GP with heartburn and increased belching.
Following a focused history, the GP diagnoses her with Gastro-Oesophageal Reflux Disease (GORD).
Name 2 differential diagnoses of GORD?
Biliary colic
Peptic ulcer disease
Coronary artery disease
A 23-year-old female presents to her GP with heartburn and increased belching.
Following a focused history, the GP diagnoses her with Gastro-Oesophageal Reflux Disease (GORD).
Name 3 lifestyle changes for someone which GORD?
Encourage smoking cessation
Weight losss
Small regular meals
Avoid hot drinks/citrus
A 23-year-old female presents to her GP with heartburn and increased belching.
Following a focused history, the GP diagnoses her with Gastro-Oesophageal Reflux Disease (GORD).
Name three classes of drugs used for treating GORD and give an example for each?
Proton pump inhibitor e.g. Lansoprazole, omeprazole
H2 receptor antagonist e.g. cimetidine
Antacids e.g. gaviscon
A 23-year-old female presents to her GP with heartburn and increased belching.
Following a focused history, the GP diagnoses her with Gastro-Oesophageal Reflux Disease (GORD).
Give 2 possible complications of GORD?
Peptic stricture
Barretts oesophagus
A 65-year-old man presents to his GP with joint pain and joint stiffness after rest. Upon
examination, he has limited joint movement and Herberden’s nodes. Following further
investigation, he is diagnosed with Osteoarthritis.
What is the difference between Herberden’s nodes and Bouchard’s nodes?
Herberdens = between middle and distal phalanges e.g. distal interphalangeal joint
Bouchards nodes = between proximal and middle phalanges e.g proximal interphalangeal joint
A 65-year-old man presents to his GP with joint pain and joint stiffness after rest. Upon
examination, he has limited joint movement and Herberden’s nodes. Following further
investigation, he is diagnosed with Osteoarthritis.
6 joints commonly affected in osteoarthritis?
Interphalangeal Carpometacarpal Metatarsophalageal joints Vertebra Hip Knee
A 65-year-old man presents to his GP with joint pain and joint stiffness after rest. Upon
examination, he has limited joint movement and Herberden’s nodes. Following further
investigation, he is diagnosed with Osteoarthritis.
Name three differentials of osteoarthritis?
Rheumatoid
Psoriatic
Chronic, tophaceous gout
A 65-year-old man presents to his GP with joint pain and joint stiffness after rest. Upon
examination, he has limited joint movement and Herberden’s nodes. Following further
investigation, he is diagnosed with Osteoarthritis.
Name 4 features seen on an xray of osteoarthritis?
Loss of joint spact
Osteophytes
Subarticular sclerosis
Subchondral cysts
A 65-year-old man presents to his GP with joint pain and joint stiffness after rest. Upon
examination, he has limited joint movement and Herberden’s nodes. Following further
investigation, he is diagnosed with Osteoarthritis.
2 Pharmacological treatments of osteoarthritis?
Paracetamol
NSAIDS
Dihydrocodeine
Intra-articular corticosteroid injections
A 65-year-old man presents to his GP with joint pain and joint stiffness after rest. Upon
examination, he has limited joint movement and Herberden’s nodes. Following further
investigation, he is diagnosed with Osteoarthritis.
2 surgical treatments for osteoarthritis?
arthroscopy
arthroplasy
osteotomy
fusion
A baby is born with a smooth, cystic swelling on his testes, resulting in scrotal
enlargement. The swelling lies anterior and below the testes. Upon investigation, the new-born is diagnosed with Hydrocele.
Where is the excess fluid located within the testis?
Tunica vaginalis
A baby is born with a smooth, cystic swelling on his testes, resulting in scrotal
enlargement. The swelling lies anterior and below the testes. Upon investigation, the new-born is diagnosed with Hydrocele.
Name three causes of hydrocele?
Patent processus vaginalis Testis tumour Trauma Infection Testicular torsion Generalised oedema
A baby is born with a smooth, cystic swelling on his testes, resulting in scrotal
enlargement. The swelling lies anterior and below the testes. Upon investigation, the new-born is diagnosed with Hydrocele.
Name two differential diagnoses of hydrocele?
Testicular torsion
Strangulated hernia
A baby is born with a smooth, cystic swelling on his testes, resulting in scrotal
enlargement. The swelling lies anterior and below the testes. Upon investigation, the new-born is diagnosed with Hydrocele.
Name an investigation that would be carried out to diagnose hydrocele?
Scrotal ultrasound
A baby is born with a smooth, cystic swelling on his testes, resulting in scrotal
enlargement. The swelling lies anterior and below the testes. Upon investigation, the new-born is diagnosed with Hydrocele.
Name a test that would be done to exclude a malignancy teratoma and confirm hydrocele?
Serum alpha-fetoprotein
Serum hCG
A baby is born with a smooth, cystic swelling on his testes, resulting in scrotal
enlargement. The swelling lies anterior and below the testes. Upon investigation, the new-born is diagnosed with Hydrocele.
Give two treatment options for hydrocele?
Therapeutic aspiration to remove fluid
Surgical removal of hydrocele
A 67-year-old women presents to A&E with a small, painful ulcer on her leg, which is
worsened when elevated. There is no oedema present. Following further investigation, she is diagnosed with an Arterial Ulcer.
Name two risk factors for arterial ulcers?
Atherosclerosis
Smoking
Hypercholesterolaemia
Diabetes Meillitus
A 67-year-old women presents to A&E with a small, painful ulcer on her leg, which is
worsened when elevated. There is no oedema present. Following further investigation, she is diagnosed with an Arterial Ulcer.
What two investigations would be carried out to diagnose arterial ulcer?
Doppler ultrasound of leg
Ankle brachial pressure index
A 67-year-old women presents to A&E with a small, painful ulcer on her leg, which is
worsened when elevated. There is no oedema present. Following further investigation, she is diagnosed with an Arterial Ulcer.
Give 1 treatment option for arterial ulcer?
Keep ulcer clean and covered
Analgesic
Vascular reconstruction
A 67-year-old women presents to A&E with a small, painful ulcer on her leg, which is
worsened when elevated. There is no oedema present. Following further investigation, she is diagnosed with an Arterial Ulcer.
Give 4 differences between arterial and venous ulcer?
ARTERIAL vs venous
SMALL vs large PUNCHED OUT vs shallow PAINFUL vs minimal pain NO OEDEMA vs oedema ABSENT PULSES vs peripheral pulses present COLD SKIN vs warm skin
A 21-year-old female presents to her GP complaining of abdominal pain, bloating and a
change in bowel habit. She notices that her abdominal pain is relieved by defecation.
Following a series of investigations, she is diagnosed with Irritable Bowel Syndrome – D (i.e. IBS with diarrhoea).
Give three main causes of IBS?
Depression Anxiety Psychological stress Trauma Sexual, physical or verbal abuse Eating disorders
A 21-year-old female presents to her GP complaining of abdominal pain, bloating and a
change in bowel habit. She notices that her abdominal pain is relieved by defecation.
Following a series of investigations, she is diagnosed with Irritable Bowel Syndrome – D (i.e. IBS with diarrhoea).
Give two non intestinal symptoms of IBS?
Painful periods
Change in urinary frequency/urgency
Back pain
Fatigue
A 21-year-old female presents to her GP complaining of abdominal pain, bloating and a
change in bowel habit. She notices that her abdominal pain is relieved by defecation.
Following a series of investigations, she is diagnosed with Irritable Bowel Syndrome – D (i.e. IBS with diarrhoea).
Name two differential diagnoses for IBS?
Coeliac Lactose intolerance Bile acid malabsorption Inflammatory bowel disease Colorectal cancer
A 21-year-old female presents to her GP complaining of abdominal pain, bloating and a
change in bowel habit. She notices that her abdominal pain is relieved by defecation.
Following a series of investigations, she is diagnosed with Irritable Bowel Syndrome – D (i.e. IBS with diarrhoea).
Name two blood tests that would exclude possible differential diagnoses?
ESR / CRP
FBC
tTG - tissue transglutaminase antibody
A 21-year-old female presents to her GP complaining of abdominal pain, bloating and a
change in bowel habit. She notices that her abdominal pain is relieved by defecation.
Following a series of investigations, she is diagnosed with Irritable Bowel Syndrome – D (i.e. IBS with diarrhoea).
What is the name of the criteria used to diagnose IBS?
Rome III diagnostic criteria
A 21-year-old female presents to her GP complaining of abdominal pain, bloating and a
change in bowel habit. She notices that her abdominal pain is relieved by defecation.
Following a series of investigations, she is diagnosed with Irritable Bowel Syndrome – D (i.e. IBS with diarrhoea).
What class of drug can be given to relieve bloating and the associated pain?
Antispasmodics
A 23-year-old male presents to A&E with newly developed ventricular tachycardia,
fever and confusion. He is a known intravenous drug user. Following further investigation, he is diagnosed with Infective Endocarditis.
Aside from IVDU, give two other risk factors for for infective endocarditis?
Old age Prosthetic valve Recent cardiac surgery Congenital heart disease IV cannula
A 23-year-old male presents to A&E with newly developed ventricular tachycardia,
fever and confusion. He is a known intravenous drug user. Following further investigation, he is diagnosed with Infective Endocarditis.
Name three organisms that can cause infective endocarditis?
Staphylococcus aureus
Pseduomonas aeruginosa
Streptococcus Viridans
A 23-year-old male presents to A&E with newly developed ventricular tachycardia,
fever and confusion. He is a known intravenous drug user. Following further investigation, he is diagnosed with Infective Endocarditis.
Give three other signs of infective endocarditis?
Splinter haemorrhage on beds of fingers Embolic skin lesions Osler nodes Janeway lesions Roth spots Petechiae New valve lesion Clubbing
A 23-year-old male presents to A&E with newly developed ventricular tachycardia,
fever and confusion. He is a known intravenous drug user. Following further investigation, he is diagnosed with Infective Endocarditis.
What is the name of the criteria used to diagnose infective endocarditis?
Modified dukes criteria
A 23-year-old male presents to A+E with newly developed ventricular tachycardia,
fever and confusion. He is a known intravenous drug user. Following further investigation, he is diagnosed with Infective Endocarditis.
What class of drug is given to treat infective endocarditis and how long are they given for?
Antibiotics for 4-6 weeks
An 84-year-old women presents to A&E with severe, constant pain in the epigastric and right upper quadrant region. She is nauseous and has vomited twice. Following
investigation, she is diagnosed with a Biliary Colic.
Give two main functions of the liver?
Glucose metabolism
Fat metabolism
Detoxification and excretion of billirubin/alcohol/toxins
Protein synthesis: albumin / clotting factors
An 84-year-old women presents to A&E with severe, constant pain in the epigastric and right upper quadrant region. She is nauseous and has vomited twice. Following
investigation, she is diagnosed with a Biliary Colic.
Give two differential diagnoses of biliary colic?
Irritable bowel sydrome
Carcinoma on right side of the colon
Renal colic
Defence against infection
An 84-year-old women presents to A&E with severe, constant pain in the epigastric and right upper quadrant region. She is nauseous and has vomited twice. Following
investigation, she is diagnosed with a Biliary Colic.
Give four risk factors for biliary colic?
Obese
Female
Fertile
Smoker
An 84-year-old women presents to A&E with severe, constant pain in the epigastric and right upper quadrant region. She is nauseous and has vomited twice. Following
investigation, she is diagnosed with a Biliary Colic.
What investigations would be carried out for biliary colic?
Abdominal ultrasound
An 84-year-old women presents to A&E with severe, constant pain in the epigastric and right upper quadrant region. She is nauseous and has vomited twice. Following
investigation, she is diagnosed with a Biliary Colic.
Give two treatment options for biliary colic?
Stone dissolution
Shock wave lithotripsy
Laprascopic cholecystomy
During a routine GP appointment, a 42 year old man is found to have a blood
pressure of 156/92mmHg. The GP suspects he has stage 1 essential hypertension.
What is essential hypertension?
Hypertension with primary cause unknown
During a routine GP appointment, a 42 year old man is found to have a blood
pressure of 156/92mmHg. The GP suspects he has stage 1 essential hypertension.
How might the size of the kidney change with hypertension?
Kidney size is reduced
During a routine GP appointment, a 42 year old man is found to have a blood
pressure of 156/92mmHg. The GP suspects he has stage 1 essential hypertension.
Give 2 investigations that the GP might request? what are the relevant features?
Urinanalysis - protein/albumin:creatinine ratio
Opthamoscopy - retinal haemorrhage
ECG - LV hypertrophy
During a routine GP appointment, a 42 year old man is found to have a blood
pressure of 156/92mmHg. The GP suspects he has stage 1 essential hypertension.
Give 5 risk factors of hypertension?
Age Black ethnic . origin Family histroy Overweight Sedentary lifestyle Smoker
During a routine GP appointment, a 42 year old man is found to have a blood
pressure of 156/92mmHg. The GP suspects he has stage 1 essential hypertension.
Give four lifestyle modifications for hypertensive patients?
Change diet Regular physical excercise Reduce alcohol intake Lose weight Stop smoking
A 38 year old woman presents to A&E with hyperpyrexia, tachycardia, and extreme
restlessness. The doctor suspects she is having a thyroid crisis.
What hormonal changes result in a thyroid storm / crisis?
Rapid T4 increase
A 38 year old woman presents to A&E with hyperpyrexia, tachycardia, and extreme
restlessness. The doctor suspects she is having a thyroid crisis.
Name 2 things that thyroid storm can progress to if not treated promptly?
Delirium
Coma
Death
A 38 year old woman presents to A&E with hyperpyrexia, tachycardia, and extreme
restlessness. The doctor suspects she is having a thyroid crisis.
Name 3 events which can precipitate a thyroid storm?
Stress
Infection
Surgery
A 38 year old woman presents to A&E with hyperpyrexia, tachycardia, and extreme
restlessness. The doctor suspects she is having a thyroid crisis.
Name three drugs you would give orally to a patient during a thyroid crisis?
Oral carbimazole
Oral propanolol
Oral potassium iodide
A 38 year old woman presents to A&E with hyperpyrexia, tachycardia, and extreme
restlessness. The doctor suspects she is having a thyroid crisis.
How does hydrocortisone work to reverse the thyroid storm?
Inhibits peripheral conversion of T4 to T3
A 73 year old woman presents to her GP with a 4 month history back pain,
polydipsia, tiredness, and bruising. Her GP suspects she might have myeloma.
Which cells are affected in myeloma?
Plasma cells
A 73 year old woman presents to her GP with a 4 month history back pain,
polydipsia, tiredness, and bruising. Her GP suspects she might have myeloma.
Define monoclonal paraprotein?
One immunoglobulin which is excessively produced
A 73 year old woman presents to her GP with a 4 month history back pain,
polydipsia, tiredness, and bruising. Her GP suspects she might have myeloma.
Which type of anaemia is commonly observed in patients with myeloma?
Normocytic, normochromic
A 73 year old woman presents to her GP with a 4 month history back pain,
polydipsia, tiredness, and bruising. Her GP suspects she might have myeloma.
Why do you give bisphosphonates to patients with myeloma?
Reduce fracture rates and bone pains
A 73 year old woman presents to her GP with a 4 month history back pain,
polydipsia, tiredness, and bruising. Her GP suspects she might have myeloma.
How much fluid should myeloma patients drink daily
3L
A 33 year old man attends a routine GP appointment and his blood shows abnormal
transferase values. He has a history of IV drug use. His GP suspects he has hepatitis,
and tests confirm that he has chronic hepatitis C.
Which country has a failed public health initiative resulting in widespread hep C?
Egypt
A 33 year old man attends a routine GP appointment and his blood shows abnormal
transferase values. He has a history of IV drug use. His GP suspects he has hepatitis,
and tests confirm that he has chronic hepatitis C.
Which type of cancer is strongly associated with chronic hepatits?
Hepatocellular carcinoma
A 33 year old man attends a routine GP
appointment and his blood shows abnormal
transferase values. He has a history of IV drug use. His GP suspects he has hepatitis,
and tests confirm that he has chronic hepatitis C.
Name 2 types of patient that ay have a hepatitis C infection but have a false negative blood result for the HCV antibody?
Immunosurpressed
Patients still in the acute infection stage
A 33 year old man attends a routine GP appointment and his blood shows abnormal
transferase values. He has a history of IV drug use. His GP suspects he has hepatitis,
and tests confirm that he has chronic hepatitis C.
Name two first line drugs this patient might be prescribed to treat chronic hepatitis?
SC peglyated interferon a
Oral ribavirin
A 33 year old man attends a routine GP appointment and his blood shows abnormal
transferase values. He has a history of IV drug use. His GP suspects he has hepatitis,
and tests confirm that he has chronic hepatitis C.
Why can a vaccine for hep C not be developed?
Rapid mutations so envelope proteins chage rapidly
A 33 year old man attends a routine GP appointment and his blood shows abnormal
transferase values. He has a history of IV drug use. His GP suspects he has hepatitis,
and tests confirm that he has chronic hepatitis C.
Name 2 ways the spread of hepatitis C can be prevented ?
Screen blood products
Protection / precaution when handling bodily fluids
A 69 year old woman presents to her GP with morning stiffness in her DIP and PIP
joints, hips and knees. The GP observes Heberden’s and Bouchard’s nodes primarily
on her right hand. The GP suspects she has osteoarthritis.
Give three characteristics of osteoarthritis that can be used to differentiate between rheumatoid arthritis?
Pattern of joint involvement - asymmetrical
Absence of systemic features
Morning stiffness less than 30 mins
A 69 year old woman presents to her GP with morning stiffness in her DIP and PIP
joints, hips and knees. The GP observes Heberden’s and Bouchard’s nodes primarily
on her right hand. The GP suspects she has osteoarthritis.
Three risk factors for osteoarthritis?
Diabetes Joint hypermobility Age Gender - F Occupation Genetic predisp
A 69 year old woman presents to her GP with morning stiffness in her DIP and PIP
joints, hips and knees. The GP observes Heberden’s and Bouchard’s nodes primarily
on her right hand. The GP suspects she has osteoarthritis.
Name 4 features you would see on an x ray of a joint affected with osteoarthritis?
Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis
A 39 year old man presents to A&E in the at 3am with excruciating loin pain. He is
vomiting and writhing in pain. He notes that he has recently been struggling to pass
urine and feels a burning
2 ways for confirming diagnosis of kidney stones and positive result of them?
Ultrasound - visualisation
urine dipstick - haematuria/protein/glucose
A 39 year old man presents to A&E in the at 3am with excruciating loin pain. He is
vomiting and writhing in pain. He notes that he has recently been struggling to pass
urine and feels a burning
What type of drug would the doctor prescribe for renal colic and give an example of this drug?
Analgesics
IV diclofenac
A 39 year old man presents to A&E in the at 3am with excruciating loin pain. He is
vomiting and writhing in pain. He notes that he has recently been struggling to pass
urine and feels a burning
Name three lifestyle modifications that this patient could make to prevent reoccurance of kidney stones?
Overhydrations Normal / low Ca 2+ intake Low sodium diet Normal dairy intake Reduce BMI Reduce animal protein
A 39 year old man presents to A&E in the at 3am with excruciating loin pain. He is
vomiting and writhing in pain. He notes that he has recently been struggling to pass
urine and feels a burning
The patients urine is noted to be acidic - what type of stone will only form in acidic urine?
Uric acid stones
A 58 year old man presents to his GP with increased frequency, urgency, and haematuria.He also reports he hasnt been sleeping very well and has to urinate multiple times in the night, GP suspects benign prostatic hyperplasia.
Which ethnicity is more severly affected by BPH and why?
Afro-caribbean men
Higher levels of testosterone
A 58 year old man presents to his GP with increased frequency, urgency, and haematuria.He also reports he hasnt been sleeping very well and has to urinate multiple times in the night, GP suspects benign prostatic hyperplasia.
Give three differential diagnoses of BPH?
Bladder tumour Bladder stones Trauma Prostate cancer UTI
A 58 year old man presents to his GP with increased frequency, urgency, and haematuria.He also reports he hasnt been sleeping very well and has to urinate multiple times in the night, GP suspects benign prostatic hyperplasia.
What is that name of the clinical examination which allows a doctor to palpate the prostate?
Digital prostate examination
A 58 year old man presents to his GP with increased frequency, urgency, and haematuria.He also reports he hasnt been sleeping very well and has to urinate multiple times in the night, GP suspects benign prostatic hyperplasia.
What would a mid stream urine sample help you exclude from your differential diagnoses?
Infection
A 58 year old man presents to his GP with increased frequency, urgency, and haematuria.He also reports he hasnt been sleeping very well and has to urinate multiple times in the night, GP suspects benign prostatic hyperplasia.
What protein can someones be raised in BPH?
Prostate specific antigen
The bacteria appear purple after a gram stain. What does this tell the microbiologist about the bacteria?
Gram positive
Catalase test is performed on a +ve bacteria and there is a negative result, what family of bacteria is this?
Streptococcus is negative on catalase test
Upon haemolysis test it is concluded that the bacteria is S.pyogenes or S.agalactiae, what would the agar plate look like? What type of haemolysis?
Clear / colourless zone around colonised
Beta haemolysis
This bacteria caused a skin infection and thus is lancefield group A, is it S. pyogenes or S. agalactiae?
S.pyogenes
What is the recommended treated for a confirmed group A streptococci infection?
IV benzylpenicillin
IV clindamycin
Urgent surgical exploration with extensive debridement
Give three differences between the structure of the cell envelope of gram negative and gram positive bacteria?
Gram positive have single cytoplasmic membrane
Gram positive have a large layer of peptidoglycan
Gram positive do not have endotoxin/LPS
A 66 year old male presents to his GP with recurrent burning epigastric pain. He
notes a significant weight loss and loss of appetite. The GP suspects he has a peptic
ulcer.
Give two causes of stomach ulcers?
NSAIDS
H Pylori
Ischaemia of gastric cells
Too much acid production
A 66 year old male presents to his GP with recurrent burning epigastric pain. He
notes a significant weight loss and loss of appetite. The GP suspects he has a peptic
ulcer.
Define ulcer?
Breach of the mucosal surface
A 66 year old male presents to his GP with recurrent burning epigastric pain. He
notes a significant weight loss and loss of appetite. The GP suspects he has a peptic
ulcer.
What is the gold standard of investigation . for this patient?
Endoscopy
A 66 year old male presents to his GP with recurrent burning epigastric pain. He
notes a significant weight loss and loss of appetite. The GP suspects he has a peptic
ulcer.
Give three lifestyle adjustments to recommend to the patient?
stop smoking
reduce stress
avoid irritating foods
A 66 year old male presents to his GP with recurrent burning epigastric pain. He
notes a significant weight loss and loss of appetite. The GP suspects he has a peptic
ulcer.
What drugs are involve in h pyolri treatment
Amoxicillin
Clarythromycin
PPi
A 66 year old male presents to his GP with recurrent burning epigastric pain. He
notes a significant weight loss and loss of appetite. The GP suspects he has a peptic
ulcer.
If the ulcer causes a haemorrhage, what action must be taken?
Surgery
A 38-year-old female presents to A&E with hyperthyroidism
Name four symptoms of hyperthyroidism?
Diarrhoea Weight loss Increased appetite Sweating Palpitations Heat intolerance Tremour Anxiety
A 38-year-old female presents to A&E with hyperthyroidism
Name four signs of hyperthyroidism
Tachycardia AF Thin hair Lid lag Lig retraction Exophthalmos Onycholysis Nodules Bruit
A 38-year-old female presents to A&E with hyperthyroidism
After further investigation, she is diagnosed with Grave’s disease, what class of immunoglobulin is involved in Grave’s disease?
IgG
A 38-year-old female presents to A&E with hyperthyroidism
What is another possible cause of hyperthyroidism?
Toxic multinodular goitre
Toxic thyroid adenoma
A 56 year old male presents to his GP with sudden onset agonising pain in his metatarsophalngeal joint of the big toe. Doctor suspects gout.
What would the result of polarised light microscopy of the crystals from a joint fluid aspiration be?
Negatively
Bifringement
A 56 year old male presents to his GP with sudden onset agonising pain in his metatarsophalngeal joint of the big toe. Doctor suspects gout.
Name two risk factors for gout?
Reduced urate excretion - elderly, men, HTN
Excess urate production - diet (shellfish), genetics
Associations - CVD, HTN, DM
A 56 year old male presents to his GP with sudden onset agonising pain in his metatarsophalngeal joint of the big toe. Doctor suspects gout.
Name one precipitating factor of gout?
Trauma Surgery Starvation Infection Diuretics
A 56 year old male presents to his GP with sudden onset agonising pain in his metatarsophalngeal joint of the big toe. Doctor suspects gout.
What is the most common drug given as prophylaxis for gout and what enzyme does it inhibit?
Allopurinol
Xanthine oxidase
A 56 year old male presents to his GP with sudden onset agonising pain in his metatarsophalngeal joint of the big toe. Doctor suspects gout.
Differential of pseudogout - caused by deposition of a different crystal - what joint is most commonly affected and what crystal?
Calcium pyrophosphate
Knee
A 19 year old girl presents to her GP practice after experiencing fatigue, lethargy, and dyspnoea. GP notices that she has angular stomatis and koilonychia. Blood tests confirm anaemia
What is that cause of anaemia and what classification is it?
Iron deficiency - angular stomatis and koilonychia are specific signs of IDA
Microcytic anaemia
A 19 year old girl presents to her GP practice after experiencing fatigue, lethargy, and dyspnoea. GP notices that she has angular stomatis and koilonychia. Blood tests confirm anaemia
A different cause of anaemia is B12 deficiency anaemia, Where is B12 absorbed and what is it bound to?
Terminal ileum
Intrinsic factor
A 19 year old girl presents to her GP practice after experiencing fatigue, lethargy, and dyspnoea. GP notices that she has angular stomatis and koilonychia. Blood tests confirm anaemia
A cause of B12 deficiency anaemia is pernicious anaemia, what causes the B12 . deficiency in pernicious anaemia?
Atrophic Gastritis
A 19 year old girl presents to her GP practice after experiencing fatigue, lethargy, and dyspnoea. GP notices that she has angular stomatis and koilonychia. Blood tests confirm anaemia
B12 deficiency anaemia has specific neurological signs - give 3 examples?
Any 3 from
- Irritability
- Depression
- Psychosis
- Dementia
- Paraesthesia
- Peripheral neuropathy
A 45 year old man presents to A+E with a fever and a new murmur, the doctor suspects infective endocarditis,
What is the most common cause of infective endocarditis?
Streptococcus viridans
A 45 year old man presents to A+E with a fever and a new murmur, the doctor suspects infective endocarditis,
Blood cultures are taken to aid diagnosis of infective endocarditis. The blood is normally a sterile site, name three other sterile sites?
CSF
Pleural fluid
Peritoneal cavities
Joints
A 45 year old man presents to A+E with a fever and a new murmur, the doctor suspects infective endocarditis,
Blood cultures undergo gram testing and stain purple, after further testing the blood cultures are catalase negative and coagulase negative?
Purple = gram postive
Catalase negative = staphylococcus
Coagulase negative = S.aureus
A 45 year old man presents to A+E with a fever and a new murmur, the doctor suspects infective endocarditis,
To aid diagnosis, modified Duke’s criteria is used, name one major and two minor criteria?
Major
- Blood cultures +ve >12 hours apart
- Evidence of endocardial involvement
Minor
- Fever >38C
- Vascular phenomena (janeaway lesions)
- Evidence from immunology (roth spots, olser nodes)
- Risk groups (prosthetic valve)
A 33 year old presents to her GP with a lump in her right breast.
All breast lumps should undergo triple assessment, what are the three aspects of triple assessment?
Clinical examination
Radiology
Histology/cytology
A 33 year old presents to her GP with a lump in her right breast.
Name three differential diagnoses of breast lump which are benign?
Fibroadenoma
Breast cysts
Infective mastitis
Duct ectasia
A 33 year old presents to her GP with a lump in her right breast.
After referral, the patient is diagnoses with breast cancer which is localised and the lump will be removed by wide local excision. In order for surgery to be performed, the patient must consent, what are the three principles of informed consent?
Given voluntarily
By someone who has capacity
By an individual who has been fully informed about the issue
a 33 year old presents to her GP with a lump in her right breast.
Screening for breast cancer is given to women age 43-73 every 3 years, the screening involves a 2-view mammography. What type of prevention is this?
Secondary prevention
A 21 year old woman presents to A+E as she is unable to control her movements, and her friends have noticed she is starting to slur her words. Additionally she has noticed a marked reduction in her memory. On examination she has a greenish brown tinge around her cornea.
What is the diagnosis and what is this a disorder of?
Wilsons disease
Copper excretion
A 21 year old woman presents to A+E as she is unable to control her movements, and her friends have noticed she is starting to slur her words. Additionally she has noticed a marked reduction in her memory. On examination she has a greenish brown tinge around her cornea.
What is the name given to the greenish brown tinge around her cornea?
Kayser Fleischer Rings
A 21 year old woman presents to A+E as she is unable to control her movements, and her friends have noticed she is starting to slur her words. Additionally she has noticed a marked reduction in her memory. On examination she has a greenish brown tinge around her cornea.
A different disorder haemochromatosis leads to iron deposition in the organs. What gene mutation causes haemochromatosis and what inheritance pattern is it?
HFE gene
Autosomal recessive
A 21 year old woman presents to A+E as she is unable to control her movements, and her friends have noticed she is starting to slur her words. Additionally she has noticed a marked reduction in her memory. On examination she has a greenish brown tinge around her cornea.
There is a different condition, haemochromatosis, give 2 signs and 2 symptoms of this?
Signs
- Bronze pigmentation
- Hepatomegaly
- Signs of chronic liver disease
Symptoms
- Tiredness
- Arthralgia
- Erectile disfunction
A 37 year old female presents to A+E with pylonephritis, she is not pregnant
What is the classical triad of symptoms for pylonephritis?
Midstream specimen of urine culture
A 37 year old female presents to A+E with pylonephritis, she is not pregnant
A urine dipstick is performed, what who main results will be increased in pyelonephritis?
Nitrates
Leukocytes
A 37 year old female presents to A+E with pylonephritis, she is not pregnant
What antibiotics should be given to this patient?
Ciprofloxacin or Co-amoxiclav
A 37 year old female presents to A+E with pylonephritis, she is not pregnant
Name four risk factors for UTIs?
Female Sexually active Urinary incontinance Faecal incontinance Constipation Dehydration Urinary obstruction
A 61 year old male presents to his GP practice with constricting central chest pain that is relieve with rest.
What is the most likely diagnosis?
Stable angina
A 53yr old Caucasian man has his blood pressure taken by his GP. The reading is 156/98 mmHg. The GP tells him he has hypertension
What is the WHO definition of hypertension?
140/90 mmHg
A 53yr old Caucasian man has his blood pressure taken by his GP. The reading is 156/98 mmHg. The GP tells him he has hypertension
GP is worried about end organ damage - give an example of a finding that indicates end organ damage?
Retinopathy, proteinuria
A 53yr old Caucasian man has his blood pressure taken by his GP. The reading is 156/98 mmHg. The GP tells him he has hypertension
List three lifestyle modifications for the management of hypertension?
- Smoking cessation
- Weight loss
- Exercise
- Reduce fat in diet
- Reduce salt in diet
- Reduce alcohol intake
A 53yr old Caucasian man has his blood pressure taken by his GP. The reading is 156/98 mmHg. The GP tells him he has hypertension
What would be the first line drug for this patient and give an example?
Class: ACEi becase <55 and caucasian
Example: Ramipril
A 53yr old Caucasian man has his blood pressure taken by his GP. The reading is 156/98 mmHg. The GP tells him he has hypertension
Hypertension can lead to malignant hypertension - give an example for for this?
Markedly raised diastolic BP
A 36 year old woman presents to her GP worried about weight loss, sweating and increased anxiousness. Her GP refers her to an endocrinologist as he suspects she has
Hyperthyroidism.
Name two other symptoms of hyperthyroidism?
Diarrhoea Tremor Palpitations Loss of concentration Heat intolerance
A 36 year old woman presents to her GP worried about weight loss, sweating and increased anxiousness. Her GP refers her to an endocrinologist as he suspects she has
Hyperthyroidism.
Give two signs of hyperthyroidism?
Tachycardia Lid lag Lid retention Thin hair Onycholysis Exophalmos
A 36 year old woman presents to her GP worried about weight loss, sweating and increased anxiousness. Her GP refers her to an endocrinologist as he suspects she has
Hyperthyroidism.
In primary hyperthyroidism, what would the results of thyroid function tests be?
TSH
T3/T4
TSH - Decreased
T3/T4 - Increased
A 36 year old woman presents to her GP worried about weight loss, sweating and increased anxiousness. Her GP refers her to an endocrinologist as he suspects she has
Hyperthyroidism.
Name the class of drug she would be prescribed and give and example?
Class - thioaminde
Example - carbimazole
A 36 year old woman presents to her GP worried about weight loss, sweating and increased anxiousness. Her GP refers her to an endocrinologist as he suspects she has
Hyperthyroidism.
What is the most serious side effect of this medication?
Agranulocytosis
A 36 year old woman presents to her GP worried about weight loss, sweating and increased anxiousness. Her GP refers her to an endocrinologist as he suspects she has
Hyperthyroidism.
Name the autoimmune disease that can be a cause hyperthyroidism?
Graves’ disease
A 75yr old woman presents to her GP with ‘stomach pain’, nausea and a loss of appetite. The GP refers her for an endoscopy due to her age - he suspects a peptic ulcer.
Give two causes of peptic ulcer disease?
NSAIDS Helicobacter Pylori Ischaemia Increased stomach acid Alcohol
A 75yr old woman presents to her GP with ‘stomach pain’, nausea and a loss of appetite. The GP refers her for an endoscopy due to her age - he suspects a peptic ulcer.
What type of vomit is seen in peptic ulcer disease?
Coffee ground haematemesis
A 75yr old woman presents to her GP with ‘stomach pain’, nausea and a loss of appetite. The GP refers her for an endoscopy due to her age - he suspects a peptic ulcer.
Apart from endoscopy, name two other investigations for peptic ulcer disease?
Urea breath trest
Stool antigen test
IgG antibodies
A 75yr old woman presents to her GP with ‘stomach pain’, nausea and a loss of appetite. The GP refers her for an endoscopy due to her age - he suspects a peptic ulcer.
Name 4 red flag symptoms of GI cancer?
Unexplained weight los Blood in stool Family history of bowel cancer Change in bowel habit Anaemia Raised inflammatory markers
A 75yr old woman presents to her GP with ‘stomach pain’, nausea and a loss of appetite. The GP refers her for an endoscopy due to her age - he suspects a peptic ulcer.
This drug is due to stomach acid, give two drugs and examples that could be used to treat this?
H2 antagonist - Ranitidine
PPi - Lansoprazole
A 76yr old woman presents to her GP with pain and stiffness in her hands. Her GP suspects that she has osteoarthritis.
Is osteoarthritis degenerative or inflammatory?
Degenerative
A 76yr old woman presents to her GP with pain and stiffness in her hands. Her GP suspects that she has osteoarthritis.
Name a joint deformity that you would expect to see on the hands of someone with osteoarthritis?
Herbdens nodes
Bouchards nodes
A 76yr old woman presents to her GP with pain and stiffness in her hands. Her GP suspects that she has osteoarthritis.
Name four things you would expect to see on an x ray of osteoarthritis?
Loss of joint space
Ostephytes
Subchondral sclerosis
Suchondral cysts
A 76yr old woman presents to her GP with pain and stiffness in her hands. Her GP suspects that she has osteoarthritis.
Give 1 lifestyle, 1 medical and 1 surgical treatment of osteoarthritis?
Lifestyle: weight loss, physio, excercise, walking aids
Medical: NSAIDs, DMARDs, Steroid injections
Surgical: arthroplasty, fusion, arthroscopy, osteotomy
A 17yr old boy presents at A&E with sudden pain in his left testis. He is suspected to have testicular torsion.
What would you expect the affected testis to be like?
Hot
Swollen
Tender
High
A 17yr old boy presents at A&E with sudden pain in his left testis. He is suspected to have testicular torsion.
A doppler ultrasound is done and reveals that the bloods supply is normal, it is now believed he has epidydmo-orchitis. What other symptom would you expect?
Dysuria
Fever
A 17yr old boy presents at A&E with sudden pain in his left testis. He is suspected to have testicular torsion.
A doppler ultrasound is done and reveals that the bloods supply is normal, it is now believed he has epidydmo-orchitis. What could of caused this?
E. Coli, N. gonorrhoea, Chlamydia trachomatis
A 17yr old boy presents at A&E with sudden pain in his left testis. He is suspected to have testicular torsion.
What investigations would you carry out if it was suspected he had epidydmo-orchitis
1st catch urine sample
STI testing
A 17yr old boy presents at A&E with sudden pain in his left testis. He is suspected to have epidydmo-orchitis.
What treatment would you give - give examples?
Antibiotics
Doxycycline - because under 35
A 17yr old boy presents at A&E with sudden pain in his left testis. He is suspected to have epidydmo-orchitis.
What treatment would you give if gonorrhoea was suspected?
Ceftriaxone
A 53yr old woman is referred to a specialist breast clinic after she had a lump picked up on her latest screen.
What is the age range for breast cancer screening in the UK?
50-70
A 53yr old woman is referred to a specialist breast clinic after she had a lump picked up on her latest screen.
What is the name of the screening procedure for breast cancer?
Mammography
A 53yr old woman is referred to a specialist breast clinic after she had a lump picked up on her latest screen.
How often do women within the age range have a breast cancer screening?
Every three yearts
A 53yr old woman is referred to a specialist breast clinic after she had a lump picked up on her latest screen.
Name 2 pros and 2 cons of screening programs?
Pros: prevent suffering, improved prognosis with early identification, early treatment cheaper
Cons: False positives= unessesary anxiety, false negatives = reduced awareness / overly relaxed
A 73 year old man presents to his GP with weight loss and night sweating. His GP notices that he also has lymphadenopathy and is concerned that he may have Lymphoma.
Lymphoma can be divided into 2 classifications, what are they?
Hodgkins and Non Hodgkins
A 73 year old man presents to his GP with weight loss and night sweating. His GP notices that he also has lymphadenopathy and is concerned that he may have Lymphoma.
The patient is referred for lymph node biopsy which shows characteristic cells of Hodgkins lymphoma, what are these cells called?
Reed Sternberg
A 73 year old man presents to his GP with weight loss and night sweating. His GP notices that he also has lymphadenopathy and is concerned that he may have Lymphoma.
What type of imagine would you do to stage this cancer?
Full body CT or PET scan
A 73 year old man presents to his GP with weight loss and night sweating. His GP notices that he also has lymphadenopathy and is concerned that he may have Lymphoma.
What classification is used for staging Hodgkins lymphoma?
Ann-Arbour Classification
A 73 year old man presents to his GP with weight loss and night sweating. His GP notices that he also has lymphadenopathy and is concerned that he may have Lymphoma.
What treatment is used for stage 1-2 Hodgkins lymphoma?
Short course chemotherapy followed by radiotherapy
A 42 year old man goes to his GP as he’s been feeling very ‘down’ after losing his job. He says that he doesn’t like to socialise with his friends anymore as he’s embarrassed. The GP is worried that he may be suffering from depression.
Name a questionnaire that the GP may use with the patient to assess the presence /severity of the depression?
PHQ-9
A 42 year old man goes to his GP as he’s been feeling very ‘down’ after losing his job. He says that he doesn’t like to socialise with his friends anymore as he’s embarrassed. The GP is worried that he may be suffering from depression.
Name three lifestyle modifications that can help with depression?
Exercise
Reduce drinking / drug use
Reduce stress
More sleep
Healthy eating
Weight loss
Meditation
A 42 year old man goes to his GP as he’s been feeling very ‘down’ after losing his job. He says that he doesn’t like to socialise with his friends anymore as he’s embarrassed. The GP is worried that he may be suffering from depression.
Name 2 non pharmalogical treatments for depression?
CBT
Interpersonal therapy
Mindfulness
Electroconvulsive therapy
A 42 year old man goes to his GP as he’s been feeling very ‘down’ after losing his job. He says that he doesn’t like to socialise with his friends anymore as he’s embarrassed. The GP is worried that he may be suffering from depression.
The GP prescribes an SSRI, give an example of an SSRI, the mechanism and a side effect?
Example: sertraline, fluoxetine, vortioxetine
Mechanism: Blocks the uptake of serotonin, prolongs action in brain
Side effects: nausea, headache, dry mouth, sexual dysfunction
What metabolic product is in excess in gout?
Monosodium Urate
Gout can be due to over production or under-excretion, give an example of both?
Over production: Alcohol, excess meat, fructose sweetened drinks, hyperlipidaemia
Under excretion : Alcohol, renal impariement, hypertenion, insulin resistance
What is the pathonomic sign of chronic gout?
Tophaceous gout
A joint fluid aspirate was taken and looked at under a polariser, what would be seen?
Negatively Birefringent Needles
A drug given for gout targets a key enzyme in the production of uric acid. Name the drug class and give an example?
Xathine oxidase inhibitors
Allopurinol
A 45 year old man presents with increasing abdominal distension. Clinical
examination of the abdomen demonstrates tense ascites as a result of chronic liver
disease
List two clinical signs other than abdominal distension that would help confirm the presence of ascites?
Shifting dullness
Flank dullness
Fluid thrill
Bulging flanks
List three clinical signs of chronic liver disease that may be found on examination of the hands?
Finger clubbing Palamar erythema Jaundice Spider naevi Easy bruising
List two investigations to further investigate the cause of ascites?
Ascitic tap Ultra sound of abdomen Pertioneal tap CT abdomen LFTs
List three complications that can arise as a result of chronic liver disease?
Variceal bleed GI bleeding Portal hypertenison Malnutrition HCC Spenomegaly
A 35-year-old female presents to her GP with fatigue, weight loss, anxiety and eye
changes. After some tests she is diagnosed with Graves disease and treated for it.
What is the pathophysiology of Grave’s disease?
Autoantibodies attack TSH receptor stimulating them to increase T3/T4
A 35-year-old female presents to her GP with fatigue, weight loss, anxiety and eye
changes. After some tests she is diagnosed with Graves disease and treated for it.
What is the eye pathology of Grave’s disease and give two components of it?
Thyroid eye disease
Optic nerve straightened Upper eyelid retraction Lid lag Periorbital swelling Conjunctival oedema
A 35-year-old female presents to her GP with fatigue, weight loss, anxiety and eye
changes. After some tests she is diagnosed with Graves disease and treated for it.
Name the treatment regime for Grave’s and a drug used for each step?
Block and replace
Carbimazole, levothyroxine
A 35-year-old female presents to her GP with fatigue, weight loss, anxiety and eye
changes. After some tests she is diagnosed with Graves disease and treated for it.
What are the remission rates for Grave’s disease?
30-50%
A 60-year-old male attends A&E with crushing chest pain that is radiating down his
left arm. After an ECG he is diagnosed with a STEMI of the right coronary artery
(RCA).
What does STEMI stand for?
ST elevation myocardial infarction
A 60-year-old male attends A&E with crushing chest pain that is radiating down his
left arm. After an ECG he is diagnosed with a STEMI of the right coronary artery
(RCA).
What % of the population have their posterior descending artery supplied by RCA?
85%
A 60-year-old male attends A&E with crushing chest pain that is radiating down his
left arm. After an ECG he is diagnosed with a STEMI of the right coronary artery
(RCA).
Which nerve root is responsible for the radiation of pain down his left arm?
T1
A 60-year-old male attends A&E with crushing chest pain that is radiating down his
left arm. After an ECG he is diagnosed with a STEMI of the right coronary artery
(RCA).
What will be seen on the ECG, in which leads to diagnose an infarct in the RCA?
ST elevation!!
In leads aVF, II, III
A 60-year-old male attends A&E with crushing chest pain that is radiating down his
left arm. After an ECG he is diagnosed with a STEMI of the right coronary artery
(RCA).
Give two pathological findings that may be seen later on the ECG?
Bundle branch blocks
Pathological Q waves
Arrhythmias
A 22 yr old male has been admitted to hospital with myalgia, diarrhoea and
vomiting, after recently returning from volunteer work in Africa. His doctors suspect
malaria.
What type of organism causes malaria?
Protozoa
A 22 yr old male has been admitted to hospital with myalgia, diarrhoea and
vomiting, after recently returning from volunteer work in Africa. His doctors suspect
malaria.
What other symptom will he definitely have if its malaria?
Fefver
A 22 yr old male has been admitted to hospital with myalgia, diarrhoea and
vomiting, after recently returning from volunteer work in Africa. His doctors suspect
malaria.
What is the diagnostic tool for malaria?
Thick and thin blood films
A 22 yr old male has been admitted to hospital with myalgia, diarrhoea and
vomiting, after recently returning from volunteer work in Africa. His doctors suspect
malaria.
Give three complications of malaria?
Pulmonary oedema Anaemia Renal failure Thromocytopenia Sepsis Coma
A 22 yr old male has been admitted to hospital with myalgia, diarrhoea and
vomiting, after recently returning from volunteer work in Africa. His doctors suspect
malaria.
What is the curative treatment for malaia and what route is it given?
IV artesunate
OR
IV Quinine + doxycycline
A 22 yr old male has been admitted to hospital with myalgia, diarrhoea and
vomiting, after recently returning from volunteer work in Africa. His doctors suspect
malaria.
Name a species that can cause a relapse of treated malaria?
Plasmodium ovale or vivax
A 50 yr old man with jaundice and abdomen distension is referred for chronic liver
failure.
Give 4 functions of the liver?
Glucose metabolism Fat metabolism Protein synthesis Defence against infection Detoxification Excretion
A 50 yr old man with jaundice and abdomen distension is referred for chronic liver
failure.
What type of jaundice is this?
Hepatic
A 50 yr old man with jaundice and abdomen distension is referred for chronic liver
failure.
Give two possible causes of inherited liver failure?
Haemochromatosis
Wilsons
Alpha-1-antitrypsin deficiency
A 50 yr old man with jaundice and abdomen distension is referred for chronic liver
failure.
What is the name of his abdominal distension and how can it be treated?
Ascites
Fluid retstriction, salt restriction, TIPS, albumin
A 50 yr old man with jaundice and abdomen distension is referred for chronic liver
failure.
Give a complications of liver failure that causes haematemesis?
Variceal haemorrhage
or portal hypertension
A 67 year old male presents with a hot, red, painful, swollen, first metatarsophalangeal joint that appeared suddenly over night.
Define inflammation?
Local physiological response to tissue injury
A 67 year old male presents with a hot, red, painful, swollen, first metatarsophalangeal joint that appeared suddenly over night.
Give three outcomes of acute inflammation?
Resolution
Suppuration
Repair
Chronic inflammation
A 67 year old male presents with a hot, red, painful, swollen, first metatarsophalangeal joint that appeared suddenly over night.
Give three differentials for this man?
Gout
Pseudogout
Septic arthritis
A 67 year old male presents with a hot, red, painful, swollen, first metatarsophalangeal joint that appeared suddenly over night.
What is your first line of investigation?
Aspirate the joint
A 10 year old female is referred to you for AKI, you do some urgent tests including an ECG.
To be an AKI, how should her creatinine of changed compared to the last 48hours?
Risen by 50%
A 10 year old female is referred to you for AKI, you do some urgent tests including an ECG.
What complications are you looking for with the ECG and how do you treat AKI?
Hyperkalemia
Insulin Dextrose IV fluids Calcium gluconate Salbutamol
A 10 year old female is referred to you for AKI, you do some urgent tests including an ECG.
Give three renal causes of AKI?
Glomeruolonephritis Malignant hypertension Vascular occlusion Vasculitis Haemolytic uraemic syndrome
A 55-year-old female presents to her GP with headache, scalp tenderness and pain
when eating. The GP suspects Giant Cell Arteritis (GCA).
What group of conditions is giant cell arteritis within?
Large vessel vasculitis
A 55-year-old female presents to her GP with headache, scalp tenderness and pain
when eating. The GP suspects Giant Cell Arteritis (GCA).
Which specialty should the GP refer her to?
Rheumatology
A 55-year-old female presents to her GP with headache, scalp tenderness and pain
when eating. The GP suspects Giant Cell Arteritis (GCA).
What is the gold standard investigation?
Temporal Artery Biospy
A 55-year-old female presents to her GP with headache, scalp tenderness and pain
when eating. The GP suspects Giant Cell Arteritis (GCA).
What is the emergency complication associated with GCA and who should she be referred to for this?
Arteritic anterior ischaemic optic neuropathy
Opthalmology
A 55-year-old female presents to her GP with headache, scalp tenderness and pain
when eating. The GP suspects Giant Cell Arteritis (GCA)
What treatment should she be started on promptly and give an example of this?
Corticosteroids - prednisolone
A 55-year-old female presents to her GP with headache, scalp tenderness and pain
when eating. The GP suspects Giant Cell Arteritis (GCA).
What type of headache is this and give an example of another type?
Secondary
Meningitis
Subarachnoid haemorrhage
Brain tumour
A 33-year-old female visits her GP worried about breast cancer. She has no children,
has been taking the combined oral contraceptive pill since the age of 15 and has a BMI of 26. She has no family history of breast or ovarian cancer. You refer her to
oncology where she is diagnosed after a triple assessment with an ER positive
tumour.
Give two types of benign breast lump?
Fibroadenoma
Cyst
A 33-year-old female visits her GP worried about breast cancer. She has no children,
has been taking the combined oral contraceptive pill since the age of 15 and has a BMI of 26. She has no family history of breast or ovarian cancer. You refer her to
oncology where she is diagnosed after a triple assessment with an ER positive
tumour.
What gene mutation is linked to a family history of breast cancer?
BRCA1 / BRCA2
A 33-year-old female visits her GP worried about breast cancer. She has no children,
has been taking the combined oral contraceptive pill since the age of 15 and has a BMI of 26. She has no family history of breast or ovarian cancer. You refer her to
oncology where she is diagnosed after a triple assessment with an ER positive
tumour.
What are the components of a triple assessment?
Clinical assesment
Mammogram
Biospy
A 33-year-old female visits her GP worried about breast cancer. She has no children,
has been taking the combined oral contraceptive pill since the age of 15 and has a BMI of 26. She has no family history of breast or ovarian cancer. You refer her to
oncology where she is diagnosed after a triple assessment with an ER positive
tumour.
What staging is used for breast cancer?
TNM
A 33-year-old female visits her GP worried about breast cancer. She has no children,
has been taking the combined oral contraceptive pill since the age of 15 and has a BMI of 26. She has no family history of breast or ovarian cancer. You refer her to
oncology where she is diagnosed after a triple assessment with an ER positive
tumour.
What drug will she be offered for her tumour as she is premenopausal and how does it work?
Tamoxifen
Competitive inhibitor of oestrogen
A 33-year-old female visits her GP worried about breast cancer. She has no children,
has been taking the combined oral contraceptive pill since the age of 15 and has a BMI of 26. She has no family history of breast or ovarian cancer. You refer her to
oncology where she is diagnosed after a triple assessment with an ER positive
tumour.
At what age does the national breast screening program begin?
50
A 52-year-old man visits his GP worried about recent problems with his ‘water
works’. His father had prostate cancer and he requests a screen for prostate cancer
as he has heard of PSA testing on the news.
Give 5 of the wilson and junger screening criteria?
- Natural progression of disease should be well understood
- There should be a detectable early stage
- Treatment at an early stage should be of more benefit than at a later stage
- A suitable test should be devised for early stage
- The test should be acceptable
- Benefits should outweigh costs
A 52-year-old man visits his GP worried about recent problems with his ‘water
works’. His father had prostate cancer and he requests a screen for prostate cancer
as he has heard of PSA testing on the news.
Give three reason for a raised PSA other than prostate cancer?
BPE
Old age
Recent ejaculation
Prostate cancer
A 52-year-old man visits his GP worried about recent problems with his ‘water
works’. His father had prostate cancer and he requests a screen for prostate cancer
as he has heard of PSA testing on the news.
What is the diagnostic test for prostate cancer and what is the grading system used for this?
Prostate biopsy
Gleason grading system
A 21 year old female presents to her GP with non-specific symptoms of dysuria and
discharge. After taking a detailed sexual history you instruct her to take vaginal
swabs for N. Gonorrhoea and Chlamydia tachomatis. Her sexual contacts are traced.
How will gonorrhoea be seen under a microscope when gram stained?
Gram negative diplococci
A 21 year old female presents to her GP with non-specific symptoms of dysuria and
discharge. After taking a detailed sexual history you instruct her to take vaginal
swabs for N. Gonorrhoea and Chlamydia tachomatis. Her sexual contacts are traced.
How will chlamydia be seen on agar plate and why?
No growth because only grows inside cells
A 21 year old female presents to her GP with non-specific symptoms of dysuria and
discharge. After taking a detailed sexual history you instruct her to take vaginal
swabs for N. Gonorrhoea and Chlamydia tachomatis. Her sexual contacts are traced.
What type of prevention is partner notification?
Secondary
A 21 year old female presents to her GP with non-specific symptoms of dysuria and
discharge. After taking a detailed sexual history you instruct her to take vaginal
swabs for N. Gonorrhoea and Chlamydia tachomatis. Her sexual contacts are traced.
Give three reasons for partner notification?
Break chain of transmission
Prevent reinfection of index patient
Prevent complications of untreated infection
A 21 year old female presents to her GP with non-specific symptoms of dysuria and
discharge. After taking a detailed sexual history you instruct her to take vaginal
swabs for N. Gonorrhoea and Chlamydia tachomatis. Her sexual contacts are traced.
What sample will be taken from her male contacts?
First void urine
A 60-year-old male with known co-morbidities visits his GP wanting to find out how he can improve his health as he is worried about his heart. He has a triad of impaired glucose metabolism, central obesity and hyperlipidaemia. He also smokes but is
thinking about stopping.
Define comorbidity?
Coexistance of 2 or more diseases
A 60-year-old male with known co-morbidities visits his GP wanting to find out how he can improve his health as he is worried about his heart. He has a triad of impaired glucose metabolism, central obesity and hyperlipidaemia. He also smokes but is
thinking about stopping.
What syndrome does he have with his triad of conditions?
Metabolic sydrome
central obesity, impaired glucose metabolism and hyperlipidaemia
A 60-year-old male with known co-morbidities visits his GP wanting to find out how he can improve his health as he is worried about his heart. He has a triad of impaired glucose metabolism, central obesity and hyperlipidaemia. He also smokes but is
thinking about stopping.
What stage of the transtheoretical behaviour change model is he at?
Contemplation
A 60-year-old male with known co-morbidities visits his GP wanting to find out how he can improve his health as he is worried about his heart. He has a triad of impaired glucose metabolism, central obesity and hyperlipidaemia. He also smokes but is
thinking about stopping.
What are the components of primary care brief advice should he of recieved about smoking in the past?
Ask
Advise
Assist
A 22-year-old man presents to his General Practitioner with a two-week history of pain
and swelling of the proximal interphalangeal joint (PIPJ) of his left index finger. There
is no history of trauma. On examination, there is a mildly-tender fusiform swelling of the PIPJ of left index finger and a fusiform swelling of the PIPJ of the right second toe. The overlying skin is slightly erythematous and feels warm.
The GP notes that the patient also has some pitting of his nails. She also asks the
patient if they have any skin rashes.
The GP is concerned that the patient may have developed psoriatic arthropathy
Describe two characteristic features of the skin rash seen in psoriatic arthropathy?
Itchy
Skin may be thickened under plaque
Deep red colour with a silvery surface scale
Hidden sites include behind ears, nails, navel
Distributed on scalp, trunk, extensor surfaces of limbs (elbow/knees)
A 22-year-old man presents to his General Practitioner with a two-week history of pain
and swelling of the proximal interphalangeal joint (PIPJ) of his left index finger. There
is no history of trauma.
On examination, there is a mildly-tender fusiform swelling of the PIPJ of left index
finger and a fusiform swelling of the PIPJ of the right second toe. The overlying skin is
slightly erythematous and feels warm.
The GP notes that the patient also has some pitting of his nails. She also asks the
patient if they have any skin rashes.
The GP is concerned that the patient may have developed psoriatic arthropathy
State two features in the pattern of joint involvement of psoriatic arthritis that would help distinguish it from rheumatoid?
Dactlylitis
Distal interphalangeal joint involvemnt
Spinal / axial involvment
Enthesitis
A 22-year-old man presents to his General Practitioner with a two-week history of pain
and swelling of the proximal interphalangeal joint (PIPJ) of his left index finger. There
is no history of trauma.
On examination, there is a mildly-tender fusiform swelling of the PIPJ of left index
finger and a fusiform swelling of the PIPJ of the right second toe. The overlying skin is
slightly erythematous and feels warm.
The GP notes that the patient also has some pitting of his nails. She also asks the
patient if they have any skin rashes.
The GP is concerned that the patient may have developed psoriatic arthropathy
What immunological compound is rheumatoid factor?
Anti IgG
A 22-year-old man presents to his General Practitioner with a two-week history of pain
and swelling of the proximal interphalangeal joint (PIPJ) of his left index finger. There
is no history of trauma.
On examination, there is a mildly-tender fusiform swelling of the PIPJ of left index
finger and a fusiform swelling of the PIPJ of the right second toe. The overlying skin is
slightly erythematous and feels warm.
The GP notes that the patient also has some pitting of his nails. She also asks the
patient if they have any skin rashes.
The GP is concerned that the patient may have developed psoriatic arthropathy.
The patient starts taking diclofenac, what class of drug is this?
Non Steroidal Ani Inflammatory Drug
A 22-year-old man presents to his General Practitioner with a two-week history of pain
and swelling of the proximal interphalangeal joint (PIPJ) of his left index finger. There
is no history of trauma.
On examination, there is a mildly-tender fusiform swelling of the PIPJ of left index
finger and a fusiform swelling of the PIPJ of the right second toe. The overlying skin is
slightly erythematous and feels warm.
The GP notes that the patient also has some pitting of his nails. She also asks the
patient if they have any skin rashes.
The GP is concerned that the patient may have developed psoriatic arthropathy
What enzyme does diclofenac inhibit?
Cyclooxygenase-1
