Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MBBS VI Medicine > OSCE dead stations > Flashcards

OSCE dead stations Flashcards

1
Q
  1. What is dx?
  2. Name 2 features to support dx
  3. Name 1 immediate non pharmacological mx. based on ALS suggest 1 pharmacological tx
    Another ECG done after tx
  4. Name the most striking abnormality
  5. What is the vessel involved?
  6. Name 2 perfusion strategies
A
  1. Monomorphic Vtach
  2. Wide QRS complex tachycardia, extreme axis deviation, concordance
  3. DCCV, IV amiodarone, procainamide
  4. ST elevation over V1-4
  5. LAD
  6. TPA, PCI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

50y male smoker left sided pleuritic chest pain, spO2 96%
1. most striking feature
2. 2 RF
3. Tx for this admission
PET CT showed hypermetabolic lesion
4. 1 striking feature
5. 3 complications
6. 1 Ix for dx

A
  1. left pneumothrax
  2. chronic smoking/emphysema, Marfan syndrome
  3. O2, analgesics, chest drain if large (symptomatic)
  4. Right apical hypermetabolic lesion
  5. SVCO, cardiac tamponade, SIADH, PTHrP, lung collapse
  6. CT guided percutaneous biopsy as peripheral lesio. If central would do for EBUS Transbronchial biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

M/70, presents with malaise, diarrhoea and nausea. HIstory of pancreatic cancer. PMH AF, HT, chronic renal impairment. DHx: diltiazem, losartan, apixaban
Pancytopenia
Given CBC with WBC differential count.
1. Blood test for pancytopenia
2. definitive Ix of pancytoepnia
3. 1 pharmacological tx of neutropenia
CBC 6 months ago was normal
Px had colchicine, forgot instruction from doctor, taking 4-5 times a day
1. Diagnosis of clinical presentation
2. Px morbidity
3. How does diltiazem contribute to this presentation

A
  1. Vit b12 and folate, PBS, reticulocyte count, liver function test
  2. Bone marrow aspiration and trephine biopsy (requires architectural examination)
  3. G-CSF
  4. Colchicine induced diarrhea and colchicine induced myelosuppression leading to pancytopenia
  5. Chronic renal impairment
  6. Diltiazem is CYP3A4 inhibitor, reduce metabolism of colchicine, increase colchicine level in blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

HyperCa (around 3), hypophosphataemia.
Low Cr (around 60), normal albumin.
1. Name ONE class of anti-hypertensive agent can cause the above abnormalities? (2)
2. Which other biochemical abnormality would this drug cause as well? (1)
3. Name TWO treatments for the biochemical abnormalities in the stem (NOT Q2) (2)
The patient did not take the anti-hypertensive name. The PTH returned to be 10 (increased).
4. What is the diagnosis (2)
Lumbar spine XR
5. What is the site of the lesion and what is the lesion
6. DEXA showing -1 to -2.5 what is dx

A
  1. Thiazide diuretics
  2. HypoK
  3. Fluid replacement, IV bisphosphonates, denosumab
  4. Primary hyperPTH
  5. T12/L1 vertebral body collapse
  6. Osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
  1. What is ECG dx
  2. 1 tx to stop arrhythmia
  3. Acute pharmacotherapy to prevent acute recurrence of arrhythmia
    Mum brings her med: levofloxacin, loperamide, metoclopramide. Biological father collapsed at 26yo, autopsy no obvious findings. K 2.4. Echo normal
    Another ECG
    Blood test result:
    HypoNa
    HypoK
    HypoCa
    TSH normal
    Bedside echo: normal
  4. 2 ECG features
  5. Precipitating factors
  6. 1 long term pharmacotherapy to prevent this arrhythmia
A
  1. polymorphic VT/ torsades de pointes
  2. AED (as pulseless VT)
  3. IV isoproterenol for refractory cases of recurrent TdP –> increases underlying heart rate (or use transvenous pacing. IgMgSO4 is 1st line pharmacologic therapy if VT has pulse.
  4. FHx of young onset sudden cardiac death, electrolytes (HypoCa, hypoK, HypoMg), antibiotics (clarithromycin), antipyschotics (haloperidol, SSRIs)
  5. BB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  1. Comment on XR
    19yo female non smoker SOB, distended face neck and UL veins
  2. 2 causes
  3. 1 immediate Mx
A
  1. Right hilar mass
  2. Lung tumor, lymphoma, thymoma, teratoma
  3. SVC stent and biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

LBP x 2 years, morning stiffness
1. Dx from XR
2. 2 blood test abnormalities that will confirm the dx
3. Initial tx
Failed conservative and developed 2nd pic
4. dx from clinical picture
5. Additional imaging to perform to ix for the low back pain
6. Heard about biologics, what are the viable options?

A
  1. Ankylosing spondylitis
  2. HLAB27, ESR/CRP
  3. NSAID
  4. Enthesitis of left achilles tendon
  5. MRI
  6. TNF inhibitor (adalimumab, entanercept, infliximab), JAK inhibitor (baricitinib, tofacitinib), IL17 inhibitor (secukinumab)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

M/60 presented with 2 weeks hx of intact bulla
1. dx from picture
2. what dx test
3. What blood diagnostic test
4. What is 1st line systemic tx for this condition
5. 2 special precautions for this tx
6. 2 common complications of this tx

A
  1. Bullous pemphigoid
  2. Skin biopsy for histology and direct immunofluorescence test
  3. Anti skin Ab: anti BP180 and anti BP230
  4. Steroid for bullous
  5. Infection related: check TB and HBV status. Hyperglycemia and its complications esp with DM
  6. Hyperglycemia hypokalemia, infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Old man, history of hypertension and non-valvular AF on warfarin presented with swollen L knee, INR 5.1

  1. 3 questions in history taking you will ask to swelling is due to over-warfarination (or ascertain the cause of overwarfanization?) (3M)
  2. MOA of warfarin (1M)
  3. Name one clinical score to assess need of anticoagulation in atrial fibrillation? (1M)
    Have TB and started a med, urine orange
  4. What is that med? (2M)
  5. How the med affects INR? (1M)
  6. What’s the drug drug interaction between the med and warfarin? (2M)
A
  1. Drug compliance, diet restriction, polypharmacy
  2. Vit K epoxidase reductase inhibtor –> reduce synthesis of coagulation F2,7,9,10
  3. CHADVASC score
  4. Rifampicin
  5. Decrease
  6. CYP inducer which increases the metabolism of warfarin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

55/M, good past health, come to your clinic for muscle weakness and myalgia
a. Describe at least 1 lesion from each of the photos (2)
b. dx
c. 2 blood test to confirm dx
d. A long list of Ab) anti-TIF1g +ve, others all -ve One most important finding (1)
e. Significance
f. 3 more ix

A

a. V sign (shawl sign includes the back), gottron papules
b. dermatomyositis
c. Serum CK, LDH. Anti-Jo1, Mi2, MDA5
d. Anti-TIF1g +ve
e. Cancer associated myositis
f. EMG, skin/muscle bx, CXR, nasoendoscopy (NPC), colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

a. What are some suspicious features? (1)
b. 3 DDx (3)
c. dermoscopy features?
d. sun related?
e. groin LNcm, FNAC malignant cells, one Ix
f. Drug tx

A

a. irregular, hyperpigmentation
b. malignant melanoma, BCC, SCC
c. heterogenous hyperpigmentation, irregular
d. No
e. PET CT (lymphatic mapping with lymphosctinigraphy (for sentinal lymph node biopsy if there wasnt any palpable LN)
f. anti PD1 (nivolumab)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  1. ECG
  2. dx
  3. One more Ix
A
  1. RAD, RBBB, S1Q3T3
  2. PE
  3. CTPA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  1. CT findings
  2. 1 more ix
  3. Immediate tx
A
  1. Right ICH, sulcal effacement
  2. CTA, INR
  3. Anti hypertensives, tranexamic acid, reverse coagulopathy (IV vit K, PCC, FFP (takes time), control ICP (mannitol, do not hyperventilate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
A

a. hydropneumothorax, pleural effusion
b. IV Abx, O2, chest drain
c. neutropenia
d. Piperacillin (B lactam), tazobactam: B lactamase inhibitor
e. Date, drug: piperacillin-tazobactam, dosage: 4.0g/0.5g, route: IVI, frequency: q6h, prescribed by: name
f. penicillin allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
A

a. cushing syndrome
b. late night salivary cortisol, low dose dexamethasone suppression test
c. hypoK
d. R adrenal mass
e. R adrenalectomy
f. DM, osteoporosis, AVN, proximal myopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  1. Name 2 abnormalities
  2. Name 1 biochemical test
  3. Name an Ix to rule out septic arthritis
  4. X ray feature
  5. Dx
  6. 2 acute tx
A
  1. swollen erythematous DIp, MCPJ, tophi
  2. Serum uric acid, inflammatory markers: ESR, CRP
  3. Joint fluid analysis for cell count, smear x C/ST
  4. Juxtaarticular erosion
  5. Acute gouty attack
  6. NSAID, colchicine, intraarticular steroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

86yo elderly lady with mostly intact blisters, some ulcerated
1. dx
2. Name 3 Ix that can help with your dx
3. Pathophysio of hte disease
4. Finding in skin biopsy below
5. dosing frequency of methotrexate
6. MoA of methotrexate

A
  1. Bullous pemphigoid
  2. Skin biopsy wth direct IF staining, anti skin antibodies (antihemidesmosome), CBC for eosinophilia
  3. Autoantibody against dermal-epidermal junction
  4. Skin biopsy with direct immunofluorescence staining –> linear deposits along the dermoepidermal junction
  5. weekly
  6. Dihydrofolate reductase inhibitor that inhibits purine synthesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q
  1. 2 features of bradycardia in the ECG
  2. dx
  3. 2 blood tests
A
  1. AV dissociation, rSR’ pattern in V1, poor R wave progression
  2. Complete heart block
  3. Cardiac biomarkers, electrolytes, NTproBNP (heart failure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
  1. cause of headache
  2. 2 anatomical pathologies that cause such
  3. Immediate mx before definitve tx
A
  1. Subarachnoid hemorrhage
  2. Berry aneurysm, AVM
  3. Antihypertensive, mannitol (reduce ICP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

25/M, Low back pain x 6 months, Improves with Exercise, Worsens with Rest
(AP Pelvic XR)
1. 2 Ix (2 marks)
2. 2 tx options
3. 1 biochemical test for disease activity?
4. Name 2 findings osn the XR
5. Likely dx
6. Eye Cx of the dx

A
  1. HLAB27, inflammatory markers (ESR, CRP)
  2. NSAID, DMARD (sulfasalazine), biologics (TNFa inhibitors: infliximab), IL17 inhibitors (secukinumab)
  3. ESR/CRP
  4. Marginal syndesmophytes, fusion of SIJ, squaring of vertebral bodies
  5. AS
  6. Anterior uveitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
  1. Rash found in body, chest, back, limbs. Name 3 other sites would you look for in the skin? (3 marks)’
  2. What drug was started? (1 mark)
  3. What gene
  4. Skin sliding away, what is this?
  5. 2 more causes of this sign
  6. Name another drug and the gene that can cause this condition
A
  1. Palms, soles, face
  2. Allopurinol
  3. HLA B5801
  4. Nikolsky sign
  5. Staph scalded skin syndrome, pemphigus vulgaris
  6. Carbamezapine and HLA-B 1502
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Palpitation, SOB, no chest pain with high random BG
1. 2 features of tachycardia
2. 2 ddx of ECG
3. Most appropriate Mx

A
  1. Wide QRS, right axis deviation
  2. VT, SVT with aberrancy
  3. Vagal maneuvre, amiodarone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
  1. most striking feature on ECG
  2. 2 most likely ddx of the sx
  3. 2 Ix to confirm the dx
A
  1. T wave inversion of leads V2-6, lead I and aVL
  2. Wellen type B, GERD
  3. CXR, echocardiogram, cardiac enzymes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Patient with T2DM, HT on losartan, no chest pain. Complains of nausea and ankle edema
1. what abnormalities
2. What ix
3. Drug tx

A
  1. Peaked T wave, loss of P wave (QRS wide)
  2. Serum K, RFT
  3. 10% IV calcium gluconate, DI drop, sodium bicarbonate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

PRP scars for PDR (In real photo -> not much neovascularization) Same patient taking Metformin, Pioglitazone, Sitagliptin for his DM. eGFR is 30ml/min; ECHO done with LVEF 40%…
1. most important abnormality
2. What is the dx
3. Which 2 drugs would you withdraw and why?
4. Additional measure to help slow down progression of the renal failure

A
  1. PRP scars
  2. Proliferative diabetic retinopathy
  3. Metformin: GFR low –> risk of lactic acidosis
    Pioglitazone –> LVEF low –> risk of congestive heart failure
  4. ACEI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q
  1. Describe CXR
  2. Cause
  3. 2 radiological Ix
  4. Ix to look for underlying cause
A
  1. Pleural effusion
  2. CA lung
  3. CT thorax, PET CT
  4. Bronchoscopy or CT guided percutaneous biopsy of lesion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q
  1. What is ecg dx
  2. name 2 biochemical blood tests
  3. Name 3 effective mx modalities
A
  1. Aflutter
  2. TFT, electrolytes, cardiac enzyme
  3. Antiarrhythmic e.g. amiodarone, anticoagulant
    Synchronized DC cardioversion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q
  1. Name 3 abnormalities on CTB
  2. What is the cause of this condition
  3. Name 1 immediate mx
A
  1. ICH, midline shift, blood in lateral ventricles
  2. Hemorrhagic stroke
  3. Antihypertensive (keep MAP < 130) e.g. CCB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q
  1. what is dx
  2. Name 1 immediate test for disease
  3. name 2 other RF for this disease
  4. Name 1 important blood test for Mx
A
  1. TB
  2. Sputum culture (ziehl neelson stain), PCR, AFP sbear
  3. Immunocompromised, old age
  4. HbA1c, BG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q
  1. ECG abnormalities
  2. Most likely dx
  3. Site of lesion
  4. 3 mx
A
  1. ST elevation in V2-4
  2. Acute aneroseptal STEMI
  3. LAD
  4. Anti thrombotic: aspirin and clopidogrel, LMWH, anti ischemic BB, ACEI, statin, PCI if < 12 hours

Lateral leads: lead I, aVL, V5,6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q
  1. what is dx
  2. 2 non pharm maneuvres you can do
  3. What is drug tx
  4. What is the definitive tx
A
  1. SVT
  2. Vagal manouvres (carotid sinus pressure, ice water immersion)
  3. ATP 10mg iv push
  4. Catheter ablation of accessory pathway
32
Q
  1. 2 ecg abnormalities
  2. dx
  3. 2 drug contraindicated
  4. definitive tx
A
  1. delta wave, short PR interval
  2. WPW
  3. AVN blocking agent: adenosine, BB, CCB, digoxin
  4. Catheter ablation of accessory pathway
33
Q

Hypertension on atenolol
1. dx
2. 2 factors contributing to this condition
3. 2 mx

A
  1. AV dissociation, wide QRS complex –> complete heart block
  2. AMI, degenerative
  3. Atropine, temporary cardiac pacing
34
Q
  1. dx
  2. Immediate mx
  3. 2 conditions
  4. 2 drugs used
A
  1. monomorphic VT
  2. DC cardioversion
  3. AMI, valvular heart disease
  4. Amiodarone, procainamide
35
Q
  1. dx
  2. underlying pathology
  3. Ix
  4. 2 immediate mx
A
  1. SAH
  2. aneurysm, or AVM
  3. DSA, MRA
  4. ABC, CCB (nimodipine to prevent vasospasm), tranexamic acid (withint 48h), neurosurgical consultation for microsurgical clipping/ endovascualr coiling
36
Q
  1. dx
  2. 2 drugs for patient
  3. 1 electrophysiological problem associated with this problem
  4. Which arrhythmia associated with this condition
  5. What is definitve tx for this condition
  6. 1 mechanical complication
A
  1. Inferior STEMI
  2. Immediate tx: triple therapy (aspirin + ticagrelor + LMWH), rosuvastatin, pain relief (nitrate, morphine)
    Post PCI: statins, ACEI (prevent LV remodelling), BB (decrease cardiac workload), sublingual nitrate, tx of cardiovascular RF
  3. Arrhythmia
  4. AV block (AMI involve AVN): inferior STEMI means RCA blocked and RCA supplies the AVN through AV nodal branch before going down to inferior walls. Other arrhythmias of inferior/anterior STEMI: VT/ VF.
    If AMI affect SAN, it will cause sinus arrest
  5. Emergency PCI, thrombolytic therapy with tenecteplase
  6. VSD from rupture of interventricular septum due to weakening
37
Q
  1. describe abnormality
  2. dx
  3. 2 pharma tx
A
  1. bradycardia HR 40bpm, ST elevation in lead II, III, aVF. TWI in anterior leads
  2. Inferior STEMI with 3rd degree heart block
  3. Acute tx of STEMI + pacemaker implant for complete heart block
38
Q
  1. Name 2 ECG features
  2. dx
  3. 2 Mx
A
  1. STE elevation in V4R, ST elevation in leads III > lead II (that means coming from RCA), RV infarct usually occurs in the setting of inferior infarct (due to proximal RCA occlusion)
  2. STEMI likely right ventricular
  3. Aspirin + clopidogrel (avoid nitrate as decreases preload –> decreases cardiac output), LMWH
39
Q
  1. dx
  2. 2 causes of condition
  3. immediate Mx
  4. Give 1 drug to control condition
A
  1. VT. (regular, tachcyardiac, wide QRS)
  2. With structural heart diseases: IHD, dilated cardiomyopathy, HOCM, RCM, ARVD
    Without structural heart disease:
    Congenital: brugada, long QT, short QT
    Acquire: hypoK, hypoCa, hypoxia, aacidosis, drugs that prolong QT interval
  3. Defibrillation if pulseless VT, direct current cardioversion
  4. Acute: class 1 fast Na channel blockers (IV lignocaine, IV procainamide), class 3 K channel blockers (IV amiodarone)
    Long term: PO class 1 and 3 OAA (true AA)
40
Q

Lady with thyrotoxic symptoms
1. dx
2. 2 predisposing causes
3. 1 blood Ix
4. 1 immediate ix
5. 1 medical mx that has long term survival benefit
6. 1 complication of drug
7. 1 complication

A
  1. AF due to hyperthyroidism
  2. degenerative, ischemic heart disease, valvular heart disease, hyperthyroidism, rheumatic heart disease
  3. TFT
  4. IV digoxin, IV class 2 and 4 OAA (BB: esmolol and diltiazem), PTU
  5. NOAC (rivaroxaban), warfarin (valvular AF)
  6. Increase bleeding tendency (risk of intracranial hemorrhage)
  7. Acute heart failure
41
Q
  1. What is the ecg abnormality
  2. 2 Ix
  3. Why SOB
  4. Name 1 immedaite Mx tx for the above abnormality
  5. Non pharmacological
  6. Complication
A
  1. Atrial flutter, 4:1 block
  2. CXR, echocardiogram, troponin I, electrolytes, CBC, TFT
  3. Heart failure causing acute pulmonary edema (arrhythmia can cause heart failuure)
  4. IV digoxin, IV class 2 and 4 OAA (BB: esmolol and slow Ca channel blocker: diltiazem)
  5. Acute: DCCV. Long term: catheter ablation, pacing, surgery
  6. Acute pulmonary edema, AFlu has thromboembolic risk but lower than AF
42
Q
  1. Most likely dx
  2. 2 non pharmacological maneuvers
  3. immediate Tx
  4. Name 1 Ix
  5. 1 definitive tx
A
  1. Narrow complex tachycardia (SVT)
  2. Carotid sinus massage, vagal maneuvres (increase vagal tone to slow AVN conduction and termination of SVT), valsalva maneouvre (gagging, drinking ice water, cold water immersion of face)
  3. IV ATP, IV class II (esmolol) and class 4 slow CCB (diltiazem)
  4. Holter ECG, electrophysiolgoy study
  5. RF catheter ablation, PO immediate tx
43
Q
  1. Name 2 ecg abnormalities
  2. 2 causes
  3. ECG dx
  4. drug to give
  5. what tx if drug fails
  6. long term tx
A
  1. bradycardia, AV dissocation (QRS 120ms), slow ventricular rhythm (ventricular escape rhythm is the intrinsic beating of the ventricle because signal blocked from AVN)
  2. AMI, hypothyroidism, drugs (AVN blockers), hyperK
    Drugs ABCD: antiarrhythmics, BB, CCB, digoxin
  3. Complete heart block
  4. IV atropine, IV isoproterenol
  5. Temporary transvenous/ transcutaneous pacing
  6. Permanent pacemaker implant
44
Q
  1. dx
  2. Ix
  3. Tx
A
  1. J wave amplitude or an ST segment elevation of >2mm
    Negative T wave
    RBBB
  2. Ix: procainamide to unmask a brugada syndrome (however can trigger a polymorphic VT), electrophysiological study
  3. ICD
45
Q
  1. dx
  2. Risk
  3. Tx
A
  1. Long QT syndrome (calculated from beginning of q wave to end of T wave. QTc >450ms (adult male)
  2. Torsades de pointes
  3. Avoid strenuous excercise, avoid LQT drugs (macrolides, antiepileptics, 1st gen antihistamines), give BB, ICD

If hypocalcemia –> calcium gluconate

46
Q
A

Hypercalcemia (shortened ST segment and QT interval)

47
Q
  1. ECG features
  2. risk
  3. tx
A
  1. epsilon wave (tick after QRS), T wave inversion in V1-3, localized QRS widening and prolonged S wave upstroke in V1-3
  2. Ventricular arrhythmia, heart failure
  3. BB (sotalol), amiodarone
    ICD, avoid strenuous excercise

Epsilon wave is an indicator for right arrhythmogenic ventricular cardiomyopathy

48
Q
  1. ECG features
  2. Ix
  3. Tx
  4. Long term tx
A
  1. LVH, q waves in lateral and inferior leads (due to septal hypertrophy)
  2. Echo, cardiac MRI
  3. Tx: BB, CCB, dispyramide
  4. Long term tx: surgical myectomy, septal alcohol ablation. ICD
49
Q
  1. ecg features
  2. causes
  3. tx
A
  1. 35bpm (bradycardia), prominent U wave in precordial leads (becomes more prominent below 65bpm)
  2. Anorexia nervosa, hypoK, HyperCa, MI, hypothyroidism. BB, CCB, digoxin.
  3. IV atropoine, IV isoproterenol (B agonist), temporary/transvenous/transcutaneous pacing
50
Q
  1. 2 ecg features
  2. dx
  3. 2 Ix
  4. Therapeutic Ix
  5. Tx
A
  1. Diffuse concave ST elevation with PR depression, ST depression and PR elevation in aVR and V1
  2. Acute pericarditis
  3. Echcoardiogram, CXR, nasopharyngeal swab for viral PCR, viral serology, cTnT/cTnI, cardiac MR/CT
    Pericardiocentesis
    NSAID, colchicine, prednisolone
51
Q
  1. name abnormality seen in the ECG
  2. Dx?
  3. Immediate Tx?
  4. 1 long term tx
  5. Ix?
A
  1. Diffuse low voltage (electrical alternans), tachcyardia
  2. Pericardial effusion
  3. Pericardiocetensis, insertion of pericardial fluid drain under LA/GA, fluid resuscitation, open drainage under LA/GA
  4. Pericardiectomy
  5. CXR, echocardiogram, HSTI, send pericardial fluid for analysis (blood count, gram stain, cytology, AFB smear, PCR)
52
Q
  1. 2 ECG abnormalities
  2. most likely dx
  3. Give 1 useful ix
  4. Give 1 pharmacological tx
  5. Prevention
A
  1. sinus tachycardia, RV strain pattern (right axis deviation), RBBB, S1Q3T3
  2. Acute PE
  3. CTPA, VQ scan, CXR, duplex doppler USG for DVT, D-dimer (if not highly suspicious)
  4. Haemodynamically stable: anticoagulation with LMWH bridging to warfarin/NOAC
    Haemodynamically unstable: thrombolytic thereapy with streptokinease followed by heparin, surgical embolectomy (large emboli)
  5. IVC filter (if contraindicated to anticoagulant, PE despite anticoagulant), anticoagulation for at least 3-6 months
53
Q

Hx of COPD, presented with SOB and bilateral LL swelling, SaO2 88%
1. 3 ecg features
2. dx
3. 1 tx that is shown to provide survival benefit

A
  1. tachycardia, regular rhythm, right axis deviation. Peaked P waves: p pulmonale (r atrial enlargement due to R heart failure), delayed R-S transition point
  2. Cor pulmonale complicating COPD
  3. Long term oxygen therapy, treat heart failure
54
Q
  1. ECG abnormality
  2. Dx
  3. Likely cause
  4. Tx
A
  1. Peaked narrow T wave, prolonged PR, broad and bizarre QRS
  2. HyperK
  3. History of CRF and DM, ACEI
  4. IV calcium gluconate, IV dextrose insulin, IV sodium bicarbonate
  5. Stop ACEI, urgent HD (indicated because ECG abnormal)
55
Q

ECG features

A

PR prolongation, T wave flattening, ST depression, prominent U wave (T-U fusion)

Most likely HypoK

56
Q
  1. Most clinically relevant CXR finding
  2. 2 ddx of finding
  3. 3 Ix
  4. How to obtain definitive dx?
  5. Developed bil LL weakness + urinary retention, what Cx
A
  1. R coin lesion at RMZ
  2. Diffuse bilateral reticulonodular shadow
  3. TB, CA lung
  4. Contrast CT thorax, sputum/BAL cytology, CT/bronchoscopy guided biopsy of lesion
  5. CT guided percutaneous biopsy of lesion (as peripheral)
  6. Spinal cord compression from metastatic CA lung lesion
57
Q

Non hormone complication of CA lung

A
  • Hypertrophic pulmonary osteoarthropathy
  • Cerebellar ataxia
  • Dermatomyositis
  • Horner syndrome
  • SVC obstruction
  • Pericardial effusion
  • Spinal cord compression
  • Hormonal: hypercalcemia (PTHrP), ectopic ACTH, SIADH
58
Q
  1. 3 abnormalities
  2. dx
  3. further Ix
  4. Name 1 public measure in preventing the disease
  5. RF
A
  1. tracheal deviation to the right, right apical fibrosis, tenting of the right diaphragm
  2. Apical fibrosis likely due to TB
  3. Sputum AFB ZN smear, TB PCR, blood/sputum culture, CT thorax
  4. Directly observed treatment short course
  5. Old age, past TB, immunocompromised (DM, HIV, TNFa inhibitor)
59
Q

80/F with long term DM, now presented with fever and weight loss
1. What finding?
2. dx?
3. 2 Ix to guide treatment
4. 1 most common etiology
5. tx

A
  1. RLL consolidation or haziness, air bronchogram
  2. Pneumonia
  3. Sputum culture and smear, C/ST, blood culture, NPA (viral), urinary antigen test (legionella)
  4. Strept pneumoniae, haemophilus influenzae, moraxella catarhallis. Atypical: chlamydophila pneimoniae, legionalla pneumophila, mycoplasma pneumoniae
  5. Empirical regimen: augmentin + doxycycline (cover atypical pneumonia)
60
Q

67/F complains of increased productive cough over the last 2 years. Admitted due to fever and increased productive cough.
1. CXR abnormalities
2. Underlying condition
3. Confirmatory imaging for cndition
4. Cause of episode
5. Agents
6. 1 drug for tx
7. 2 RF for underlying condition

A
  1. Tramline, cystic shadows
  2. Bronchiectasis
  3. HRCT of thorax
  4. Pneumonia
  5. Typical pneumonia agents: haemophilus influenzae, strept pneumoniae
    Long standing: pseudomonas aeruginosa
  6. Antipseudomonals: extended spectrum penicillins (tazocin), carbopenems (meropenem), aminoglycosides (gentamicin, amikacin), fluoroquinolones
  7. Infection, congenital (cystic fibrosis, primary ciliary dyskinesia, alpha 1 antitrypsin deficiency), autoimmune (RA, sjogrens, IBD), traction bronchiectasis (from pulmonary fibosis)
61
Q
  1. 3 abnormality
  2. clinical dx
  3. 3 factors to consider before giving tx
  4. Tx
  5. List 2 RF for condition
A
  1. Pleural line with hyperlucent right periphery, larger right intercostla spaces, flattening of right diaphragm
  2. Right sided pneumothoarx
  3. Symptoms (dyspnea), size (< 2cm), recurrent pneumothorax/ persistent airleak (pleurodesis or VATS)
  4. Tension pneumothorax: immediate needle decompression. < 2cm and asymptomatic can do observe. >2cm chest drain and O2.
  5. Smoking, Marfan syndrome, underlying lung disease (COPD, TB, asthma, cystic fibrosis, lung disease with lung bullae)
62
Q

Young men presented with left-sided chest pain. Arachnodactyly. Arm span: height ratio 1.1
1. Name abnormality?
2. Inheritance
3. Name 2 vascular complicatinos
4. 1 ocular complication
5. 1 joint complication
6. CXR finding

A
  1. Left sided pneumothorax
  2. AD
  3. Aortic root dilatation, AR, aortic dissection, mtiral valve prolapse, MR
  4. Superotemporal lens dislocation, high myopia
  5. Joint hypermobility, arachnodactyly, thumb sign, wrist sign, pectus excavatum/carinatum, scoliosis
  6. Enlarged aortic knuckle
63
Q
  1. 3 abnormalities
  2. 2 dx
  3. Ix
  4. Tx
A
  1. Bilateral reticulonodular shadowing, loss of lower lung volumes, shaggy heart borders and diaphragms
  2. MTX induced interstitial lung disease, usual interstitial pneumonitiis/ILD from RA
  3. HRCT, lung function test (spirometry)
  4. MTX induced ILD (stop MTX), corticosteroid, immunosuppressant, oxygen therapy, pulmonary rehab, chest physio, vaccination
64
Q

Heart Failure patient with dyspnea & ankle swelling, irregularly irregular pulse
1. expected cxr findings
2. dx
3. 2 Ix to identify underlying cause
4. Name medical tx

A
  1. upper lobe venous diversion, kerle B line, batwing opacty, cardiomegaly, bilateral perihilar haze, peribronchiolar cuffing
  2. Pulmonary edema
  3. ECG, echocardiogram, cTnI/cTnT, BNP/NT-proBNO
  4. Furosemide
65
Q
  1. abnormalities
  2. dx
  3. Name 2 ix
  4. bedside procedure to avoid
  5. pathogens
  6. 2 tx
A
  1. left frontal hypodense lesion with rim contrast enhancement
  2. Brain abscess
  3. Bloods: blood culture
    Imaging: CXR, echocardiogram, MRI brain
  4. lumbar puncture
  5. Polymicrobial: s aureus, s. pneumococcus, haemophilus influenzae
  6. Close monitoring of clinical status, empirical antibiotics for 6-8 weeks: IV benzypenicillin + cefotaxime + metronidazole
    Prophylactic antiepileptics: valproate
    Refer to neurosurg for stereotactic guided/USG guided aspiration or excision of abscess cavity
66
Q

known CA lung suddenly pw/headache and right limb weakness
1. 2 CT abnormalities
2. cause of abnormality
3. 1 more imaging
4. 1 more invasive Ix for dx
5. Name 2 appropriate tx

A
  1. midline shift, compression of ventricles, hydrocephalus, sulcal effacement, vasogenic edema (surrounding the lesion)
  2. Metastasis from lung primary
  3. MRI brain
  4. Biopsy of lesion
  5. Acute: IV dexamethasone, prophylactic antiepileptic, surgery (EVD, VP shunt)
    Long term: palliative chemo, RT
67
Q
  1. findings
  2. explain cause of vertigo and vomiting
  3. pathogenic mechanism
  4. Ix
  5. likely ECG pattern
  6. If increased headache, increased vomiting, what is most likely cause
  7. complication
  8. future tx
A
  1. L cerebellar hypodensity
  2. Left sided cerebellar infarct
  3. Atherosclerosis /thromboembolism/ cardioembolism/ small vessel disease
  4. CT/MRI head, cerebral angiography, LP, CBC, ESR, FBG, lipid profile
    ECG, 24 hour holter (paroxymal AF), CXR, echocardiogram
  5. AF
  6. Increase ICP
  7. Cerebellar edema: compression of brainstem, tonsillar herniation
    Hemorrhagic transformation, seizure
  8. Aspirin, statin, anticoagulants (NOAC)
68
Q

L hemiplegia
1. CT abnormality
2. dx
3. Signs expected on PE
4. 2 RF
5. Initial tx
6. long term tx
7. 2 neurological complications

A
  1. Large hypodense lesion in right frontoparietal area compatible with MCA territory, compression of lateral ventricle
  2. Right ischemic stroke
  3. L hemiparesis and UMN signs
  4. Unmodifiable: old age, male history of TIA/stroke
    Modifiable: hypertension, AF, DM, smoking, hyperlipidemia, heart disease, carotid artery stenosis
  5. IV tPA
  6. aspirin, statin, NOAC
  7. Hemorrhagic transformation, cerebral edema, seizure
69
Q
  1. 2 abnormalities
  2. Dx
  3. Cause
  4. 2 other Ix to help. find out cause
  5. Tx for vasospasm and aneurysm
  6. 2 complications that arise from q3
A
  1. Star sign, hyperdense area obliterating ventricles, sulcal hyperdensity
  2. SAH
  3. Ruptured aneurysm of posterior communicating artery (CN3 palsy), other RF: PKD, hypertension, smoking, trauma, AVM
  4. CT angiogram/MR angiogram, DSA
  5. Vasospasm: nimodipine, aneurysm (microsurgical clipping or endovascular coiling)
  6. Rebleeding, vasospasm, seizure, hydrocephalus, cerebral edema
70
Q
  1. 2 extrarenal complications of PKD
  2. commonest mode of inheritance of PKD
A
  1. valvular heart disease (MVP, aortic regurgitation), intracranial cerebral anuerysm, hepatic cyst, pancreatic cyst, diverticular disease, hernia
  2. AD
71
Q
  1. abnormalities
  2. dx
  3. Ix
  4. complication
  5. precipitating factor
  6. Immediate Mx
A
  1. crescent shaped hyperdense lesion (can cross sutures), hyperdense thickening of interhemispheic falx
  2. Subdural haematoma
  3. CBC, clotting profile, MRI
  4. Seizure, increase ICP, cerebral edema, hernation, SIADH
  5. Head injury, bleeding tendency
  6. Monitoring of vitals and GCS, intubation if GCS < 8, correction of any underlying coagulopathy
    Decrease ICP: prop up position, controlled hyperventilation, mannitol, last line: barbiturate coma, decompressive craniotomy with clot evacuation
72
Q
  1. Abnormality
  2. dx
  3. Physical signs you expect
  4. Ix
  5. If GCS deteriorate, what to do nexdt for Ix
  6. 3 medical tx
  7. Surgical tx
  8. Most important RF
A
  1. Irregular hyperdensity in right frontal lobe with cerebral edema and midline shift, obliteration of ventricle
  2. Right ICH near internal capsule
  3. Left hemiparesis, left hemisensory loss, left facial weakness of UMN pattern
  4. MRI brain, cerebral angiography, INR
  5. CT/MRI brain for brain herniation
  6. Control ICP: mannitol, induced hypothermia, controlled hyperventilation, enhanced venous drainage by head elevation to 30 degrees. Seizure tx (not prophylaxis), bleeding tendency correction (Vit K, PCC)
  7. CSF drainage (EVD, VP shunt), evacuation of mass lesion, decompressive craniectomy
  8. HT, anuerysm, AVM, bleeding tendency, tumor.
73
Q
  1. Name 2 abnormalities
  2. What is dx, what complication?
  3. Name 2 drugs that can cause this abnromality
  4. Patients condition stabilized after initial medical therapy. There were no reversible causes. What tx would you give?
A
  1. AV dissociation, slow ventricular beat
  2. Dx: complete heart block, complication: congestive heart failure
  3. BB (esmolol), CCB (diltiazem), digoxin
  4. Permanent pacemaker implant
74
Q

A male elderly patient with hypertension (on atenolol 100 mg daily), experienced syncope with BP ~ 70/50 mmHg. This is his ECG.
1. Name 2 ECG abnormalities
2. Give 2 caues of this cardiac condition
3. How to manage

A
  1. 2nd degree AV block, bradycardia
  2. Anterior MI, Levs disease, cardiac surgery, inflammatory conditions (rheumatic fever, myocarditis), autoimmune (SLE, systemic sclerosis), infiltrative myocardial disease (amyloidosis, haemochromatosis, sarcoidosis), drugs (BB, CCB, digoxin, amiodarone)
  3. IV atropine, IV isoproterenol. Temporary transvenous/transcutaneous pacing. Stop BB
75
Q
  1. ECG abnormality
  2. dx
  3. Anatomical structure affected
  4. List 3 pharmacological tx
A
  1. ST elevation in leads V1-5, aVL, I
  2. Anterolateral STEMI
  3. Proximal LD
  4. Morphine, aspirin and ticagrelor, LMWH, IV tPA, BB, ACEI
76
Q
  1. 2 abnormalitis on CXR
  2. Likely cardiac rhythm of this patient
  3. most likely murmur
  4. most likely valvular abnormality
  5. 2 pharmacological tx for her condition
A
  1. Straight left heart border, double density of left atrial enlargement
  2. AF
  3. Mid diastolic rumbling murmur with opening snap (loud S1)
  4. Mitral stenosis
  5. AF (rate control (diltiazem/verapamil, rhythm control (flecainide, amiodarone)), anticoagulation (warfarin for valvular AF)

MBBS VI Medicine (101 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions