PAPER 1 (76%)

Question 1

Presentation of duodenal ulcer?

Answer 1

Epigastric pain typically relieved by eating
Nausea

Question 2

Presentation of gastric ulcer?

Answer 2

Epigastric pain worsened by eating
Nausea

Question 3

Which post-op analgesia is CI in pts with severe COPD?

Answer 3

Opioids - can cause respiratory depression!! PICA often contains opioids so be careful!
Epidural is a better option

Question 4

Which drugs do we use for rate control of AF?

Answer 4

Beta blocker (not sotalol) OR a rate-limiting CCB e.g. diltizaem or verapamil

If 1 drug does not control the rate then combination therapy with any 2 of the following:
- BB (not sotalol)
- diltiazem
- digoxin (only if above drugs are not suitable)

Question 5

Outline the CHA2DS2-VASc score

Answer 5

Congestive HF
Hypertension (even if treated)
Age >65 (1) OR >75 (2)
Diabetes
Stroke, TIA or VTE in past (2)
Vascular disease (IHD or PAD)
Sex (F)

0 = no Tx
1 = males consider
2 or more = anticoagulants!

Remember even if this score suggest no need for anticoagulation then remember its important to do a Transthoracic echo to exclude valvular heart disease! As if present, combined with AF, if an absolute indication for anticoagulation

Question 6

What should you manage gout with if pt has CKD and therefore NSAIDs and colchicine are CI?

Answer 6

Oral steroids

Question 7

First line investigation for a ?C-spine injury?

Answer 7

CT neck

Question 8

What should you consider if a pt has polyuria/polydyopsia and are taking lithium?

Answer 8

Nephrogenic diabetes insipidus
Hypercalcaemia secondary to hyperparathyroidism

Question 9

Which region of the brain does alzheimers most commonly affect?

Answer 9

The hippocampus and medial temporal lobe

Question 10

Outline the common acute complications of duodenal ulceration depending on the anatomical location of the ulcer?

Answer 10

Anterior: the ulcer may erode into the peritoneal cavity, causing peritonitis
Posterior: the ulcer may erode into blood vessels, such as the gastroduodenal artery resulting in massive haemorrhage

Question 11

In which situations would you choose a rhythm control for AF?

Answer 11

If HF that’s thought to be primarily caused by AF
First & new onset AF (<48 hours)
If there is an obvious reversible cause
For whom a rhythm control strategy would be more suitable based on clinical judgment

(Note the pt must either have has a short short duration of symptoms <48 hours, or be anticoagulated for at least 3 weeks prior to attempting cardioversion)

Question 12

What are the options for rhythm control of AF?

Answer 12

Electrical cardioversion OR Pharmacological cardioversion: flecainide or amiodarone (if structural heart disease)
Note if AF <48 hours you can do it immediately but if >=48 hours then anticoagulate for 3 weeks first

Drugs for long term rhythm control: BB, dronedarone, amiodarone (best for pts with HF)
If drugs fail or pt wishes to avoid antiarrhythmics -> Catheter ablation