past paper questions 3 Flashcards
name an ENT complication that may occur in tonsilitis?
- tonsillar abscess (or Quinsy)
- increased difficulty swallowing
three common sites of spread for cervical cancer?
- bladder
- bowerl
- ureter
- vagina
describe some causes of macrocytic anaemia
- pernicious anaemia
- folate deficiency
- malabsorption (lack of intrinsic factor )
- hypothyroidism
- excess alcohol
what is pernicious anaemia?
- autoimmune
- antibodies against the parietal cells or intrinsic factor
- lack of IF prevents absorption of vitamin B12
- patient becomes vitamin B12 deficient
describe some symptoms (4) caused by vitamin B12 deficiency?
- peripheral neuropathy with numbness or paraesthesia
- loss of vibration sense or proprioception
- visual changes
- mood or cognitive changes
testing for pernicious anaemia?
- intrinsic factor antibody 1st line
- gastric parietal cell antibody
what drug might be given to a patient with pernicious anaemia?
- hydroxocobalamine (vit b12) IM
Theme > Labour
Scenario
A 24 year old woman is admitted to the Labour Ward for induction of labour at 42 weeks in an otherwise uncomplicated pregnancy. The cervix is long, closed, posterior and firm. This is her first child.
What is the most suitable method of induction for this patient?
give prostaglandins
- promote cervical ripening
A 25 year old woman has a 6 month history of heavy periods. Her cycle is regular but menstruation is associated with pain. She uses condoms for contraception.
What is the most appropriate treatment for her heavy periods?
combined oral contraceptive pill
Theme > Gynaecology
Scenario
A 60 year old woman has vaginal bleeding. A cervical smear is reported by the cytopathologist as ‘abnormal cells present of uncertain significance’. You refer her to a gynaecology clinic where a hysteroscopy and tissue sampling is planned.
Which is the most important pathology that will be excluded by this procedure?
important to exclude endometrial cancer
Theme > Stridor in a child
Scenario
A previously healthy, fully immunised eight month old boy has developed gradually worsening stridor over the past 24 hours. He has had coryzal symptoms for the past two days. He is feeding adequately.
He has a temperature of 37.2°C, pulse rate 120 bpm, respiratory rate 30 breaths per minute and oxygen saturation 98%.
Which is the most likely diagnosis?
layngotracheobronchitis also known as CROUP
- URTI, oedema in larynx
key presentation
- increased work of breathing
- barking cough
- hoarse voice
- stridor
- low grade fever
common causes for croup (4)
- parainfluenza
- influenza
- adenovirus
- respiratory syncytial virus
Croup used to be caused by diphtheria. Croup caused by diphtheria leads to epiglottitis and has a high mortality. Vaccination mean that this is very rare in developed countries.
what might be given to manage croup?
- oral dexamethasone
- oxygen
- neb budesonide
- neb adrenaline
- intubation and ventilation
Theme > Hand trauma
Scenario
A 32 year old man cut his hand, with a deep cut to the flexor surface of the wrist. It was treated, but when the patient returns for follow up a few weeks later, there is flattening of the thenar eminence.
What nerve is most likely to have been damaged?
median nerve
A 70 year old man has a collapse. His wife says that he had severe abdominal pain prior to collapsing, but that he was previously well apart from hypertension. The pain radiates to his back. He is pale, and he has a pulse rate 114 bpm and BP of 108/58 mmHg. His abdomen is tender on deep palpation, and his legs are cool with reduced capillary refill
likely diagnosis
ruptured abdominal aortic aneurysm
A 70 year old woman has left sided abdominal pain. She is known to have suffered from bouts of diarrhoea and constipation over the last five years. Her temperature is 38.5°C. There is tenderness and guarding in the left iliac fossa. An ultrasound scan shows an abscess in the left paracolic gutter.
likey diagnosis
diverticular disease
Scenario
A 35 year old man has 12 hours of severe epigastric pain associated with vomiting. The pain radiates to his back. He has been drinking one to two bottles of vodka daily for the past five years.
He has a temperature of 37.6°C, pulse rate 110 bpm and BP of 130/95 mmHg. He is sweaty and has upper abdominal tenderness with guarding.
Which investigation is most likely to give a definitive diagnosis?
?? pancreatitis
in which case serum amylase will need to be looked at
A 65 year old man has a right-sided scrotal swelling. This has been present for 18 months. There is a cough impulse. It is not possible to get above the swelling and it does not transilluminate.
What is the most likely diagnosis?
inguinoscrotal hernia
Theme > Cardiology
Scenario
A 79 year old woman has six months of increasing breathlessness on exertion.
She has a pulse rate 72 beats per minute, irregularly irregular, and BP of 118/72 mmHg. She has a diastolic murmur.
Which is the most likely cause of her murmur?
mitral regurgitation
A 28 year old woman has tiredness, pleuritic chest pain and joint pain in the fingers and wrist of one arm. She has recently suffered two miscarriages. Her renal function is impaired, with a creatinine of 145 µmol/L (60–120). Her blood count shows a mild neutropaenia and thrombocytopaenia. Her urine contains 3+ protein and 3+ blood.
Could be indicative of:
Systemic lupus erythematosus
SLE is characterised by:
- anti-nuclear antibodies
SLE presents with non specific symptoms
- hair loss
- weight loss
- photosensitive malar rash
- SoB
- pleuritic chest pain
- mouth ulcers
- raynauds
investigations for SLE
- autoantibodies
- fbc
- C3 & C4
- CRP and ESR
- immunoglobulins
- urinalysis and urine protein: creatine ration for proteinuria in lupus nephritis
56 y/o white male with T2DM.
Blood pressure have all been above 180/100 over the past few months. no existing symptoms or diagnosed conditions.
what is the most appropriate first line treatment for his raised blood pressure?
ccb
Theme > Endocrinology, Diabetes & Metabolism
Scenario
A 50 year old woman attends the Emergency Department concerned that she is urinating more frequently. On questioning, she has been feeling generally weak for the last six weeks, and has gained 12kg in weight. Her BP is 165/90mmHg and she has purple abdominal striae.
Investigations:
serum sodium 150mmol/L (135–146)
potassium 2.9mmol/L (3.5–5.3)
fasting blood glucose 7 mmol/L (4.5–5.6).
What test is most likely to confirm the diagnosis?
indicative of Cushing
therefore dexamethasone suppression test
Theme > Diarrhoea
Scenario
An 18 year old woman has recurrent episodes of abdominal pain and diarrhoea. She has recently returned from a back packing trip in South East Asia. Her mother was recently diagnosed with early colon cancer. She looks slightly flushed, and her temperature is 37.3°C. She has a pulse rate of 88bpm and a blood pressure of 104/72mmHg. Palpation of the abdomen reveals some mild tenderness in the left iliac fossa. On sigmoidoscopy discrete areas of inflammation in the bowel with a nodular cobblestone appearance are observed.
What is the most likely cause?
Crohns
- any part of GI tract
- transmural
- deep ulcers
- cobblestone appearance
- not continuous inflammation
- therefore skip lesions
35 y/o
pc:
- increased weight
- constipation
- tiredness
- irregularity of her menstrual periods
- coarser hair
- moderately obese
what investigation would confirm most likely diagnosis?
Thyroid function tests
- indicative of hypothyroidism
Theme > Endocrinology, Diabetes & Metabolism
Scenario
A 47-year-old woman has a lump in her neck. After some investigations, she has a thyroidectomy because an infiltrative mass is found in the thyroid gland. Initially, the pathologist finds the diagnosis difficult, but the cells in the mass are eventually shown to produce calcitonin.
Which is the most likely diagnosis?
medullary carcinoma
parafollicular cells produce calcitonin
Calcitonin lowers blood calcium levels by suppressing osteoclast activity in the bones and increasing the amount of calcium excreted in the urine. The hormone also prevents the absorption of calcium from the intestine, as well as increasing the calcium absorbed by the kidney.
