MSCA general mocks and Imperial past papers Flashcards
A 67 year old man is found to have an ejection systolic murmur. He is otherwise well. His pulse rate is 72 bpm and BP 128/84 mmHg. His chest is clear.
Investigations:
ECG shows sinus rhythm.
Echocardiography shows aortic stenosis, valve gradient 50 mmHg. Left ventricular (LV) diastolic dysfunction, LV ejection fraction 45% (>55).
Which is the most appropriate management?
A. Clinical review and echocardiography in 6 months
B. Reassure and discharge
C. Refer for aortic valve replacement
D. Start bisoprolol fumarate and advise review if symptomatic
E. Start lisinopril and advise review if symptomatic
Aortic valve replacement
LVEF <55% and aortic valve gradient ≥40 mmHg
Which nerve root covers the sensation of the big toe?
L5
Osmolality equation
2(Na + K) + urea + glucose
Anion gap equation
(Na + K) - (Cl + HCO3)
Normal urine output rate?
0.5-1.5ml/kg/hour
Diagnostic investigation for acute heart failure?
Echocardiography
Ulcer with raised white margin on left ear. Which skin cancr?
Basal cell carcinoma
First imaging for polycystic kidneys?
USS renal tract
Patient with ulcerative colitis has fatigue and hepatomegaly. Abnormal LFTs. Diagnosis?
Primary sclerosing cholangitis
Management for abdominal aortic aneurysm depending on width.
< 3cm - nothing
3-4.4cm - rescan every 12 months
4.5-5.4 - rescan every 3 months
>=5.5 - refer to vascular within 2 weeks
Indications for bariatric surgery
BMI >40
BMI >35 + related co-morbidity
Management for neuropathic bladder
Intermittent self catheterisation
A 43 year old man is involved in a low speed road traffic collision. Following this he develops pain in his lower back that it is still troublesome several months later. The pain is worse after activity and is relieved by rest. He has an exaggerated lumbar lordosis with a palpable depression above L5. The range of movement of his spine is grossly normal. Neurological examination of his lower limbs is also normal. Condition?
Spondylothesis
First line analgesic for mechanical back pain?
Ibuprofen
Which drug can reverse the effects of muscle relaxants (such as atracurium, vecuronium, pancuronium) following surgery?
Neostigmine (ACh-esterase inhibitor)
Which is the best marker of tumor lysis syndrome
High urate
(high phosphate, high potassium, low calcium)
A 35 year old woman has a painful lump in her breast. Her mother had breast cancer at the age of 65 years. She is 32 weeks pregnant with no past medical history. She is not taking any medication. She smokes 5 cigarettes per day. There is a 2 cm lump in her right breast that is tender on palpation. There is redness of the overlying skin. Management?
Triple assessment
Secondary anticoag/platelet prevention for PE, MI, AF, stroke, TIA.
PE
1) DOAC
2) heparin
MI
- aspirin
- clopidogrel
AF
1) DOAC
2) warfarin
Stroke
- aspirin
- clopidogrel
- dipyridamole
TIA
- clopidogrel
Why would a patient need to be ventilated after inhaling smoke after a fire?
Due to bronchospasm
What is normal potassium daily requirement?
1mmol/kg/24hours
Most common type of parotid gland tumour
Pleomorphic adenoma
Management for euvolaemic hyponatraemia
Fluid restriction
Patient with #NOF with pain uncontrolled pain. Was on IV paracetamol but it did not relieve pain. What is the next analgesia to offer?
Femoral block
Addisonian crisis immediate management?
IV hydrocortisone (fluids after)
When do you start levothyroxine in subclinical hypothyroidism?
TSH > 10
Investigation after blood film in CLL
Flow cytometry
Covid x-ray findings
Bilateral lower lobe consolidation
Patient breathless after cisplatin chemo. Cause?
Chemotherapy-induced pneumonitis
Lewy body dementia presentation
Progressive cognitive impairment
Parkinsonism
Visual hallucinations
