PassMedicine Flashcards
A 56-year-old male presents to the acute surgical take with severe abdominal pain. He is normally fit and well. He has no malignancy. The biochemistry laboratory contacts the ward urgently, his corrected calcium result is 3.6 mmol/l. What is the medication of choice to treat this abnormality?
IV Pamidronate
A surgical trainee is incising a groin ‘abscess’ in an intravenous drug abuser. Unfortunately the ‘abscess’ is a false aneurysm and torrential bleeding ensues. In the panic of the situation the doctor then stabs himself in the finger. It transpires that the patient is a Hepatitis B carrier and the doctor is not immunised! What type of virus is Hepatitis B?
double stranded DNA
A 79-year-old woman with a history of type 2 diabetes presents with a hyperosmolar hyperglycaemic state and violent, jerking movements of the proximal limbs on the right hand side. This has only been occurring for the last 2 hours and the patient cannot control it.
The neurological examination is unremarkable, apart from the occasional witnessed, repetitive, large amplitude movements of her right arm and lower leg. An MRI brain is requested.
Where is the most likely location of the brain lesion?
Subthalamic nucleus
Subthalamic nucleus is the correct option. Lesions to this part of the basal ganglia cause a contralateral hemiballismus. In this case the lesion is most likely cause by the hyperglycaemia, which is the second most common reported cause for hemiballismus; most common being stroke.
A 68-year-old man attends his general practitioner with his wife. His wife reports that over the past three weeks he has been speaking normally however his sentences do not make any sense. He is unaware that there is any issue.
It is noted during the consultation that his fluency is preserved however he is unable to understand many of the questions you ask him verbally and is unable to interpret written language. His speech is inappropriate and consists of sentences that make no sense.
A CT head is performed to determine the aetiology of his symptoms.
Where would you expect to find a lesion given this man’s symptoms?
Wernickes aphasia
Left superior temporal lobe
67%
You are a medical student based in a general practice. A 61-year-old female presents with bilateral leg swelling. Which of her medicines is most likely to be contributing to this?
Amlodipine
A 65-year-old female presents with a 4-week history of worsening vision in her left eye. On examination of the cranial nerves, the left pupil is found to be constricted more than the right. There is minimal ptosis of the left lid. The patient reports dryness of the left side of the face with reduced sweating. There is no reduced sweating reported elsewhere. Peripheral neurology is intact and the gait is normal.
The patient has no known past medical history. The patient lives independently with her family, drinks 5 units per week and has a 30 pack-year smoking history.
Given the neurological features and history, where is the lesion likely to be?
sympathetic chain
Horner’s syndrome - anhydrosis determines site of lesion:
head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast’s, cervical rib
absent = post-ganglionic lesion: carotid artery
A 48-year-old women presents with recurrent loin pain and fevers. Investigation reveals a staghorn calculus of the left kidney. Infection with which of the following organisms is most likely?
Proteus mirabilis
Infection with Proteus mirabilis accounts for 90% of all proteus infections. It has a urease producing enzyme. This will tend to favor urinary alkalinisation which is a relative prerequisite for the formation of staghorn calculi.
Which muscle is not innervated by the trigeminal nerve?
Medial pterygoid Mylohyoid Stylohyoid Masseter Temporalis
Stylohyoid is innervated by the facial nerve.
A 40-year-old female with known type 1 diabetes and Graves’ disease presents to the GP with worsening fatigue. She describes a history of headaches, shortness of breath and palpitations. Blood tests are taken and the results are displayed below.
Haemoglobin 79 g/dl
MCV 103 fl
White cell count 4.2 mmol/l
Platelets 220 mmol/l
Which vitamin or mineral is she most likely to be deficient in?
Iron
B12
Vitamin A
B6
Calcium
B12
Headaches, shortness of breath and palpitations are classical symptoms of anaemia. The most common nutritional causes of anaemia are B12, Folate and Iron.
Vitamin A, B6 and Calcium will rarely result in anaemia and thus can be excluded. Iron deficiency anaemia will typically result in a microcytic anaemia and thus a low MCV. This is not the case and thus Iron can be excluded. However, our patient is found to have a raised MCV and thus a macrocytic anaemia. The common culprits of this are B12 and folate deficiency.
A 19-year-old woman has recently been started on a new antibiotic for her acne. The doctor informs her that the medication can harm a developing fetus and recommends contraception. He also advises the patient to always use sun cream as this new medication can increase the risk of sun burn. When checking the drug information form, the 19-year-old learns that the new medication can also cause teeth discolouration in children.
What is the mechanism of action of this class of antibiotic?
Binds to the 30S subunit of bacterial ribosomes to impair protein synthesis
47%
A 78-year-old man has been admitted to hospital with an exacerbation of his heart failure. The current medication that he is taking hasn’t controlled his symptoms well enough, so the consultant starts him on digoxin.
How will this improve his symptoms?
Slows AVN conduction and increases contractility
52%
A 24-year-old man presents for imaging three weeks after falling onto his outstretched right hand during a game of basketball. He reports significant pain and tenderness on the radial side of his wrist. An X-ray is performed and confirms a scaphoid fracture.
What is the main vascular structure that is compromised in this fracture?
The dorsal carpal branch of the radial artery is the main neurovascular structure that is compromised in a scaphoid fracture
What is measured to obtain renal plasma flow?
Para-amino hippuric acid (PAH)
Renal plasma flow = (amount of PAH in urine per unit time) / (difference in PAH concentration in the renal artery or vein)
Normal value = 660ml/min
A 27-year-old female from Japan presents to the emergency department with sudden onset weakness in her right arm and leg. She described that her symptoms lasted 4 hours and gradually improved. She reports that these symptoms are recurrent and has never sought medical advice until now. An urgent CT angiogram of the head is performed which had a ‘puff of smoke’ appearance.
What is the most likely diagnosis?
Moyamoya disease patients present with recurrent transient ischaemic attacks with classic ‘puff of smoke’ appearance on angiogram
You are a junior doctor working in orthopaedics. Whilst on a ward round, you see a patient who underwent a hemiarthroplasty 5 days ago for a broken hip. Unfortunately, they have now developed a bacterial infection of the surgical site. You consider the patient’s immune response to the bacteria which are causing this infection.
Which of the following immune-mediated processes would be occurring to help the patient fight this infection?
Plasma cells - produces large amounts of antibody specific to a particular antigen
