PASSMED ALL

Question 1

Bedwetting under age of 5 treatment

Answer 1

Reassurance

It’s normal

Question 2

First line for over age 5 bedwetting

Answer 2

Enuresis monitor

Question 3

Bedwetting over age 5, if short-term control is needed (e.g. for sleepovers) or an enuresis alarm has been ineffective/is not acceptable to the family

Answer 3

Desmopressin (to be assessed regularly)

Question 4

Important side effect of sulfonylureas ? (e.g. gliclazide)

Answer 4

Hypoglycaemia

Question 5

19 year old male, nipple discharge, gynaecomastia and poor vision

Answer 5

Prolactinoma

Poor vision = prolactinoma compressing the optic chiasm

Question 6

A 14 year-old boy develops visible haematuria following an upper respiratory tract infection

Answer 6

IgA nephropathy

Question 7

60 year old male
1. Haematuria
2. Loin pain
3. Abdominal mass

Answer 7

Renal cell carcinoma

(could have varicocele as a testicular vein could be occluded)

Question 8

21-year-old female
Dysuria for the past week, despite just completing a three day course of trimethoprim.
Urine dipstick = positive for blood + and leucocytes
A MSSU shows no organism.

Answer 8

Chlamydia

Question 9

Sore throat, pyrexia and lymphadenopathy - 3 weeks, young adult

Answer 9

Glandular fever a.k.a. infectious mononucleosis

Question 10

2-4 weeks, flu-like illness followed by the patient feeling nauseous, + arthralgia, then can cause hepatosplenomegaly and jaundice

Answer 10

Viral hepatitis A

Spread by seafood - faecal-oral route

Question 11

Chronic ear infections and offensive discharge + vertigo for the past 48 hours

Answer 11

Cholesteatoma

Large cholesteatoma can invade the inner ear resulting in sensorineural hearing loss and vertigo

Question 12

Elderly, presents with pneumonia. Why do thyroid tests show low T4 + normal TSH ?

Answer 12

Sick euthyroid

Normal, no need to treat thyroid symptoms

Question 13

Before starting azithromycin, what tests must be done ?

Answer 13

ECG + baseline LFTs

Question 14

Acutely painful red eye, photophobia, small pupil, reduced visual acuity, pus in the anterior chamber (a hypopyon)

Answer 14

Anterior uveitis

Associated with HLA-B27 related conditions

Question 15

HLA-B27 related conditions

Answer 15

ankylosing spondylitis
reactive arthritis
ulcerative colitis, Crohn’s disease
Behcet’s disease
sarcoidosis: bilateral disease may be seen

Question 16

Management of anterior uveitis

Answer 16

urgent review by ophthalmology
cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate
steroid eye drops

Question 17

Investigation for bladder cancer

Answer 17

Flexible cystoscopy

Question 18

Rheumatoid + painful red eye

Answer 18

Scleritis

usually atoimmune cause e.g. RA, lupus, sarcoidosis, GPA

Question 19

Hand clumsiness, difficulty word-finding, with new symptoms of acute photophobia
Examination shows double vision and papilloedema (blurring of the optic disc margin)

Answer 19

Potential space-occupying lesion (tumour)

requires urgent CT head

Question 20

Raised intracranial pressure - what investigation is contraindicated and why?

Answer 20

Lumbar puncture

due to risk of cerebral herniation

Question 21

What medication causes lower zone lung fibrosis?

Answer 21

Amiodarone

Question 22

Dysphagia - barium swallow shows ‘bird’s beak’ appearance of the lower oesophagus

Answer 22

Achalasia

LOS constricted, oesophagus above dilated

in more detail:
Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from Auerbach’s plexus

Question 23

Papilloedema - unilateral or bilateral ?

Answer 23

Almost always a bilateral finding

due to raised ICP

Question 24

Newly-started medication
Widespread rash with large, flaccid, blisters over her arms and trunk and an erythematous macular rash
Severe mucosal involvement

Answer 24

Steven-Johnson syndrome

Hospital admission required for supportive management,
opthalmology admission required to rule out ocular involvement

Question 25

Dabigatran causing bleeding. What should be prescribed?

Answer 25

Idarucizumab - reverses effects of dabigatran

monoclonal antibody which binds directly to dabigatran molecules with greater affinity than thrombin