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.
40 y/o female
pc: hot all the time with palpitations
- lost weight
- irregular periods
- 120 bpm
- 140/90 bp
- urine dip normal
OE: large smooth goitre
blood tests show a suppressed serum thyroid stimulating hormone.
most appropriate initial treatment?
- carbimazole
- seen in hyperthyroidism
Anna, a well 6-week old girl with Downs syndrome, is brought to the surgery for a routine check-up. On examination the GP hears a heart murmur which was not present at her initial post-natal check.
What is the likely cause of her murmur?
ventricular septal defect
A 23 year primigravida has been in labour for 12 hours. She was 4 cm dilated on arrival and is now 8 cm dilated. Her membranes were ruptured eight hours earlier and she has been on a syntocinon infusion for four hours. Her cardiotocograph is normal. The presentation is cephalic and the head is at the ischial spines.
What is the most likely diagnosis?
failure to progress in the first stage of labour
A 25 year old Indian research student is admitted to the Surgical Assessment Unit, with a recurrent attack of right upper quadrant pain. This comes in waves and is identical to pain he has had before. His only medical history is that of sickle cell anaemia.
A trans-abdominal ultrasound scan shows stones in the gall bladder.
What is the likely composition of the gall stone?
predominantly pigment
Three main type of call stones
1. cholesterol stones: poor diet, obesity
- pigment stones: composed purely of bile pigment, seen in those with haemolytic anaemia
- mixed stones: combo of cholesterol and bile
42 y/o female has 750ml PV blood loss 4 hours post birth.
gave birth 40 weeks gestation, bimanual : large, soft , boggy uterus.
what is most appropriate first line treatment to give
oxytocin
20 y/o female
pc: several tender, red lesions on legs for two weeks. usually fit and well. taking COCP.
discrete, firm, erythematous lesions without scaling.
most likely diagnosis?
erythema nodosum
- caused by: inflammation of subcut fat across both shins
- hypersensitivity reaction
Erythema nodosum often indicates inflammatory bowel disease or sarcoidosis in exams.
40 y/o female
- suffers from recurrent chest injections
- past hx of whooping cough
- psuedomonas aeruginosa was grown from sputum sample
likely diagnosis?
Bronchiectasis
A 50 year old woman undergoes a laparoscopic cholecystectomy. She is discharged after 24 hours with no problems. Ten days later, she suffers left sided chest pain and shortness of breath. She has coughed up blood with sputum.
Which is the most likely diagnosis?
classic Pulmonary embolism
what score is used to assess pulmonary embolism risk?
Wells score
what type of picture will be seen on ABG in a patient with a pulmonary embolism and why?
- respiratory alkalosis
- high resp rate
- blows of extra co2
- aar low co2
- blood becomes alkalotic
initial management of PE
LMWH
- apixaban or rivaroxoban
long term anti-caog
- warfarin, noac, lmwh
in a massive PE with haemodynamic compromise, what might be done?
- thrombolysis
- involves injecting a fibrinolytic medication
- this rapidly dissolves clots
state some examples of thrombolytic agents
- streptokinase
- alteplase
- tenecteplase
A 75 year old man presents to his GP with symptoms of hesitancy, poor stream, frequency, and terminal and post-micturition dribbling.
Which of the following is categorised as a storage symptom?
storage symptoms:
- frequency
- urgency
- nocturia
- incontinence: stress , urge
which blood test in most helpful in classifying the severity of a patients pneumonia?
- urea
A 43 year old woman attends the GP with a high temperature, right upper quadrant abdominal pain radiating to the right shoulder tip and vomiting for 3 days. This is her second episode in a month.
What is her most likely diagnosis?
a) cholecystitis
b) duodenitis
c) gastric ulcer
d) oesophageal web
e) pancreatitis
cholecystitis
6 y/o
pc: unwell for 2 wx, sore throat, pyrexial, oral amoxicillin did not help. vomited multiple times yday. drowsy, 140bpm, non blanching rash.
immediate management from GP?
Intramuscular benzylpenicillin
which antibiotic are most suitable first line treatment for chlamydia?
doxycycline
A 60 year old woman has heartburn for the last month. She has taken Gaviscon which helps a little. She has lost 3kg over the last few months. She takes no other medication and drinks 6 units of alcohol per week.
what is the most appropriate management?
refer for urgent direct access OGD.
NICE guidelines for suspected cancer
- for patients aged over 55, with weight loss, upper abdo pain, reflux, dyspepsia
- —> offer urgent direct access OGD
A 5 year old boy has been unwell with a sore throat and fever. The following day he breaks out in a widespread erythematous rash, which feels rough to the touch. His face is flushed, sparing around his mouth. His throat is inflamed and his tongue is coated, with prominent papillae.
scarlet fever
- wide spread errythematous rash
- strawberry tongue
- cervical lymphadenopathy
- flushed face with circumoral pallor and pharyngitis
68 y/o 1 month hx weight loss, general malaise, has chronic hep C.
OE: mildly jaundiced, hard nodular feeling liver
admitted for further investigation and US shows multiple hyperechoic nodules in liver.
what is the underlying diagnosis and investigation?
hepatocellular carcinoma
AFP is a tumour marker for hepatocellular carcinoma.
Lactate dehydrogenase (LDH) test done to assess
tissue damage
Breast screening is offered as part of the NHS screening programme to which group of people?
Women age 50 to their 71st birthday every 3 years
A 67 year old lady attends the GP surgery with a history of a facial rash.
The GP suspects acne rosacea.
Which of the following descriptions is most suggestive of this diagnosis?
A. Butterfly rash across cheeks and bridge of the nose
B. Comedones, papules, pustules, nodules, and/or cysts
C. Erythematous papules, flushing and telangiectasia
D. Inflamed, greasy areas with fine scaling over the nasolabial folds and eyebrows
E. Vesicular lesions in a dermatomal pattern
Erythematous papules, flushing and telangiectasia
which diagnosis has the following description?
Butterfly rash across cheeks and bridge of the nose
systemic lupus erythematous
which diagnosis has the following description?
Comedones, papules, pustules, nodules, and/or cysts
acne vulgaris
rest card
rest card
which diagnosis has the following description?
Inflamed, greasy areas with fine scaling over the nasolabial folds and eyebrows
seborrhoeic dermatitis
which diagnosis has the following description?
Vesicular lesions in a dermatomal pattern
shingles / herpes zoster virus
Which analyte is used as the first line test for congenital hypothyroidism in newborn screening?
TSH
A 75 year old man with a history of heavy smoking presents with pneumonia and a CT scan reveals a mass occluding the right main bronchus, but confined to it.
A bronchial biopsy reveals malignant cells linked by desmosomes and which show occasional individual cell keratinisation.
this is indicative of:
squamous cell carcinoma
at what size would an abdominal aortic aneurysm be considered for surgery?
AAA
> 55mm
A 28 year old man is admitted to hospital with a pyrexia of unknown origin.
What proportion of pyrexia of unknown origin, in HIV negative adults, turn out to have an infection causing their symptoms?
a) 1%
b) 5%
c) 10%
d) 30%
e) 50%
f) 70%
30%
Some general anaesthetics, such as ketamine, work by inhibiting the NMDA receptor.
Which neurotransmitter acts on this receptor?
glutamate
A 58 year old man has a painful swollen left knee which has failed to settle after a week’s rest. There is no history of trauma.
He has a moderate sized effusion in his left knee.
A plain radiograph is reported as follows:
Some loss of joint space with linear calcification of the articular cartilage.
What is the most likely diagnosis?
A. Gout B. Osteoarthritis C. Pseudogout D. Rheumatoid arthritis E. Sarcoidosis
Psuedogout
chondrocalcinosis helps distinguish psuedogout from gout
Pseudogout is a crystal arthropathy caused by calcium pyrophosphate crystals. Calcium pyrophosphate crystals are deposited in the joint causing joint problems. It is also known as chondrocalcinosis.
Aspirated fluid will show:
- No bacterial growth
- Calcium pyrophosphate crystals
- Rhomboid shaped crystals
- Positive birefringent of polarised light
management of psuedogout
NSAIDs
Colchicine
Joint aspiration
Steroid injections
Oral steroids
This test is used to measure the flexibility of the hip flexors, which include the iliopsoas muscle group, the rectus femoris, pectineus gracillis as well as tensor fascia latae and the sartorious
The Thomas test
This test is used to indicate weakness in the hip abductor muscles: gluteus medius and gluteus minimus
trendelenburg test
positive test indicates weakness
this test used to evaulate patients for meniscus tears of the knee
McMurray test
this test is used in lower limb examination for rupture of Achilles tendon?
simmonds test
this test is used to diagnose injury to anterior cruciate ligament
lachmanns test
