MOSCE

Question 1

what is the gold standard investigation for stable angina?

Answer 1

CT coronary angiography

Question 2

in an inferior MI, which 3 leads would show ST elevation?

Answer 2

2, 3 and aVf

Question 3

which blood tests can differentiate an NSTEMI and unstable angina?

Answer 3

troponin

Question 4

what would indicate a positive Murphy’s sign?

Answer 4

arrested inspiration due to pain which is not elicited with the manoeuvre on the left side

Question 5

give 2 thyroid examination signs which are specific to Graves’ disease?

Answer 5

proptosis, pretibial myxoedema, onycholysis

Question 6

what results would you expect on TFT in Graves’ disease?

Answer 6

low TSH, high T3/T4

Question 7

patient has a pericardial friction rub + increased JVP. what is the differential diagnosis?

Answer 7

pericarditis

Question 8

what classic finding would you see on ECG in a patient with pericarditis?

Answer 8

saddle-shaped ST-elevation

Question 9

how would you manage a patient with pericarditis?

Answer 9

NSAIDs (1st line)
Alternative medications:
- Colchicine (adjunct for 3 months)
- Corticosteroids (2nd line)

Question 10

name the specific component consumed in leafy green salad that can alter blood clotting?

Answer 10

vitamin K

Question 11

would you give vitamin K if the patients INR was too high or too low?

Answer 11

too high

Question 12

?pernicious anaemia

Answer 12

b12 / folate deficiency
macrocytic

Question 13

what autoantibody is most useful to diagnose pernicious anaemia?

Answer 13

intrinsic factor antibodies

Question 14

what vitamin needs to be replaced in patients with pernicious anaemia?

Answer 14

B12

Question 15

in examination of CN VIII, you might perform Rinne and Weber’s test. what are the two types of hearing loss that these exams test for?

Answer 15

BOTH conductive and sensorineural

Question 16

name the three sensory branches of the trigeminal nerve.

Answer 16

ALL OF: V1 = ophthalmic, V2= maxillary, V3 = mandibular

Question 17

what name is given to the type of sight loss commonly associated with a pituitary tumour?

Answer 17

bitemporal hemianopia. – pressing on optic chiasm

Question 18

name one finding you would see on an x ray of a patient with a pleural effusion.

Answer 18

blunting of the costophrenic angle, fluid in the lung fissures, meniscus (a curving upwards where it meets the chest wall and mediastinum in larger ones),
tracheal and mediastinal deviation away from the effusion in very large effusions

Question 19

ame a cause of an exudative pleural effusion?

Answer 19

cancer (e.g. lung cancer or mesothelioma), infection (e.g. pneumonia or TB), Rheumatoid Arthritis

Question 20

how do you differentiate a transudative pleural effusion from an exudative pleural effusion?

Answer 20

transudative has <30g/l protein, exudative has >30g/l protein

Question 21

name an anti-epileptic medication that is contraindicated in this patient?

Answer 21

Sodium Valproate – should not be used in women who are able to become pregnant. (high risk of birth defects and developmental disorders)

Question 22

this patient is later diagnosed with epilepsy and asks you if they can drive. what will you tell them?

Answer 22

patient must contact DVLA and avoid driving for until seizure free for >1 year. must mention seizure free for 1 year

Question 23

this is primary tuberculosis. which skin test might be used to identify active tuberculosis in this patient?

Answer 23

Mantoux test

Question 24

can you name 1 drug included in the regimen used to treat active tuberculosis?

Answer 24

Rifampicin, Isoniazid, Pyrazinamide or Ethambutol

Question 25

what is the triad associate with acute cholangitis?

Answer 25

Charcot’s Triad (or “RUQ pain” + “fever” + “jaundice”)

Question 26

CAUSE OF TRANSUDATIVE PLEURAL EFFUSION?

Answer 26

heart failure, cirrhosis with ascites, and hypoalbuminemia (usually due to the nephrotic syndrome)