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Past Questions > More phase 3B/4 > Flashcards

More phase 3B/4 Flashcards

1
Q

Health inequalities.

  1. Name 4 reasons why there are health inequalities between different cultures in the UK?
  2. Name 4 ways for successful use of interpreters?
A
  1. Language barrier, religious beliefs, medical beliefs, education and knowledge of services.
  2. Ensure you are aware of the correct language, professional interpreter in person or language line, talk to and look at patient, introduce all parties.
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2
Q

4 triggers for asthma exacerbation?

A

Exercise, pets, infection, cold, smoking.

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3
Q

Mx of asthma exacerbation

A
  1. A to E
  2. Nebulised salbutamol + oxygen
  3. Oral corticosteroid (prednisolone)
  4. Nebulised anticholinergic e.g. Ipratropium bromide.
  5. Magnesium sulfate
  6. Aminophylline..?
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4
Q
  1. 5 features of acromegaly?

2. What happens in glucose tolerance?

A
  1. Coarse facial features, arthralgia, snoring/OSA, low libido, hypertension, headaches, large hands, wide nose, carpel tunnel syndrome,
  2. Lack of suppression of growth hormone during OGTT
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5
Q

RFx for type 2 diabetes

A 
family history
PCOS
Ethnicity (Asian, African)
Physical inactivity
Poor diet
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6
Q

5 side effects of atypical antipsychotic (not to do with muscles)

A

Dry mouth, gynaecomastia, erectile dysfunction, weight gain, constipation

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7
Q

Where do you take a bone marrow biopsy from?

A

Posterior iliac crest of pelvis

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8
Q

Breast Cancer.

  1. 4 features likely to be malignant
  2. If nodes are positive after wide local excision what is Mx?
  3. HER2+ve and oestrogen +ve, name 4 Mx options?
A
  1. Adherent to underlying muscle, hard, skin colour changes (peau d’orange), painless, irregular margins, nipple inversion, nipple discharge.
  2. Total mastectomy + full node clearance
  3. Tamoxifen, herceptin, aromatise inhibitor (anastrozole), chemotherapy, radiotherapy, palliative.
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9
Q

Extradural haemorrhage:

  1. What 4 symptoms would he have with frontal lobe damage?
  2. CFx of 3rd nerve palsy?
  3. 2 features on CT
A
  1. Loss of higher function (unable to make decisions), motor weakness, expressive dysphasia, poor memory.
  2. Eye points down and eye and is dilated (unless PICA stroke).
  3. Midline shift, biconvex haemorrhage.
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10
Q

Alcoholic with Klebisella:

  1. Where is it usually colonised in healthy people?
  2. Where does it colonise in alcoholics?
  3. Antibiotics Rx?
  4. Why is he more At risk? Aspiration risk?
  5. Developed DT - treatment?
A
  1. gut
  2. Lung from aspiration.
  3. Broad spec (Ceftriaxone, Tazosin??)
  4. Increased risk of aspiration from alcohol, poor nutrition likely so immune response is decreased.
  5. Chlordiazepoxide.
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11
Q

Synthetic liver function tests

A

Albumin, PT.

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12
Q

What is pre-test probability?

A

Those at risk of having the disease before they are tested.

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13
Q

The PSA test can pick up prostate tumours that would never cause symptoms and would mean early treatment-what two points in this mean screening is bad?

A
  • Length time bias = slow progressing disease so even though it is detected early, won’t increase survival.
  • Lead time bias = Appear to have a longer survival time because they are picked up in early stages of disease.
  • Unnecessary treatment.
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14
Q

Old woman in prolonged hospital stay for repeated UTIs. At the end of her treatment she is ready to be discharged when she develops abdo pain with foul smelling diarrhoea. Temperature is 38.5
1. What’s the mostly likely organism?
2. What is the key factor from the history contributing to this organism?
3. How you investigate?
Three other patients on the ward (in the nursing home?) also develop diarrhoea
4. What is the route of spread?
5. Four things you can do to prevent further spread?

A
  1. Clostridium difficle.
  2. ABx therapy is prolonged.
  3. Stool sample, FBC
  4. Faeco-oral spread.
  5. Deep cleaning of ward facilities e.g. bathrooms, barrier nurse (gowns and gloves to enter room), strict hand hygiene on ward, correct disposal of waste, use side-rooms for affected patients.
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15
Q

Woman has high calcium

  1. Immediate action and why?
  2. 2 common causes?
  3. How to differentiate between them?
  4. Immediate management?
  5. And if that doesn’t work….?
A
  1. ECG - hypercalcaemia can cause arrhythmias, short QT.
  2. Hyperparathyroidism, malignancy
  3. Serum parathyroid level.
  4. 0.9% saline, bisphosphonates.
  5. Calcitonin.
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16
Q

80 year old woman from a care home. Had a stroke in the past. Her carer is with her but isn’t familiar with her history. 5 days bowels not opened. Still taking food and drink orally. Abdominal discomfort. Na 144, Urea of 8, Cr of 56. All other bloods normal.

  1. What would you be excluding with an upright chest xray?
  2. What would you exclude with an abdominal xray?
  3. Explain her unusual blood findings. (raised urea, raised Na)?
  4. Where is she best managed?
  5. First line treatment
  6. Four drugs or classes of drugs which cause constipation?
A
  1. Exclude perforation.
  2. Exclude bowel obstruction.
  3. Faecal impaction, increased ammonia as poor waste excretion, raises urea and affects kidney function.
  4. In hospital, what a lucky lady 🤗
  5. Laxatives e.g. stool softeners (Docusate), Osmotic (Lactulose).
  6. Opioids, anti-psychotics (haloperidol), ferrous sulfate, alendronic acid.
17
Q

2 drugs for ? misscarriage

A

Misoprostol.

Anti-D immunoglobulin.

18
Q

3 local treatments for a bleed?

A

Tranexamnic acid soaked gauze
Adrenaline soaked gauze
sutures
Pressure/packing

19
Q

50 year old woman undergoing a vaginal hysterectomy. On pred, ertanocept and methotrexate. Has easy bruising and tingling in her hands.

  1. Important physical signs in her pre-anaesthetic assessment?
  2. Two helpful pre-op radiological investigations?
  3. What anaesthetic techniques could be done on this patient? What are the alternatives?
  4. Which anaesthetic option would you not choose and why?
  5. Four complications you might see in this RA patient after a routine surgical procedure?
A
  1. C-spine mobility, jaw opening and Mallampati score for oral cavity.
  2. CXR, X-ray C-spine, MRI c-spine…???? FBC for anaemia of chronic disease.
  3. Spinal, epidural, total intravenous anaesthesia.
  4. Intubation with ET tube as needs neck manipulation.
  5. VTE prophylaxis (slower mobilising), increased post-op pain, anaemia, activate other auto-immune diseases.
20
Q

3 risk factors for intermittent claudication?

A

Smoking, hypertension, diabetes, hypercholesterolaemia, older age, CAD, CKD.

21
Q

Explain ABPI

A
  • Lie patient flat.
  • Place cuff on arm at brachial artery, place doppler probe on artery and listen for pulse. Inflate cuff until no pulse detected. Deflate and listen for when pulse returns (SBP). repeat on right and record highest reading,
  • Repeat on ankle and place doppler on posterior tibial artery.
  • ABPI = ankle pressure / arm pressure.
  • Threshold value for ABPI <0.5 for critical limb ischaemia and <0.9 for peripheral arterial disease. If greater than 1 = calcification.
22
Q

Mx of intermittent claudication

A

Exercise programme
Angioplasty
Reduce risk factors.
Drug = Naftidrofuryl oxalate.

23
Q

Differentials for a quinsy

A 
Infectious mononucleosis
Retropharyngeal abscess
Pharyngitis
Lymphoma...?
head and neck cancer
24
Q

What lymph node is affected in quinsy

A

Jugulodigastric lymph node

25
Q

2 signs O/E for testicular torsion

A

No pain relief on elevation

Absent cremasteric reflex

26
Q

How do you monitor pneumonia severity

A

CRP

27
Q

40 year old long distance runner. Develops right sided hip pain with clicking. Worse by running and sitting down on long car journeys. Hurts to sleep on the affected side. Doesn’t affect his walking distance.

  1. List of differentials?
  2. What signs would you elicit on examination?
  3. What tests would you run to confirm the diagnosis?
  4. What treatments would you recommend?
A
  1. Osteoarthritis, iliotibial band syndrome, greater trochanter pain syndrome (trochanteric bursitis), rheumatoid arthritis.
  2. Crepitus, positive Trendelenburg test, pain on movement.
  3. X-ray of hip,CRP/ESR, anti-CCP antibodies.
  4. paracetamol, physio/exercise plan, stretches, ice-packs??
28
Q

Treatment of neutropenic sepsis

A

Beta lactam monotherapy with piperacillin + tazobactam

29
Q

5 Ix for haematuria

A 
Urine microscopy + culture.
Urine dipstick analysis
Urine cytology
FBC, U+E, clotting profile, PSA
X-ray KUB
USS KUB
30
Q

Kidney cancer:

  1. how would you determine what it is? What staging investigation is next?
  2. What is the most likely histological type?
  3. What is a potential curative treatment?
  4. What inherited disease is renal cell carcinoma associated with?
A
  1. Lactate dehydrogenase raised, CT abdo-pelvis for TMN staging.
  2. Clear cell renal carcinoma.
  3. Nephrectomy
  4. von Hippel-Lindau syndrome.
31
Q

4 modifiable RFx for DM

A 
Gestational DM
HTN
CVD
Obesity
Hyperlipidaemia
Inactivity

Past Questions (3 decks)

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