past paper questions 4

Question 1

this is a smooth muscle tumour of the myometrium that is a common cause of menorrhagia:

Answer 1

leiomyoma (fibroid)

Question 2

this is a tumour of the ovary that contains hair, teeth and thyroid tissue:

Answer 2

benign mature teratoma (dermoid cyst)

Question 3

this is a tumour that makes up 90-95% or all cases of cervical cancer?

Answer 3

squamous cell carcinoma

Question 4

this is a oestrogen dependent tumour that commonly presents as post menopausal bleeding in overweight, nulliparous diabeter women?

Answer 4

endometrial adenocarcinoma

Question 5

this is a common manlignant ovarian tumour that typically presents late with stage 3 disease.

patients often complain of vague symptoms.

a) basal cell carcinoma
b) benign Mature teratoma (dermoid cyst)
c) endometrial adenocarcinoma
d) leiomyoma (fibroid)
e) leiomyosarcoma
f) seminoma
g) serous epithelial adenocarcinoma
h) serous epithelial adenoma
i) squamous cell carcinoma

Answer 5

serous epithelial adenocarcinoma

Question 6

a 58 year old woman with type 2 diabetes. She has had no periods for 9 years, but presents with a sudden heavy painless bleed.

most likely diagnosis:

a) appendicitis
b) constipation
c) dysmenorrhoea
d) ectopic pregnancy
e) endometrial carcinoma
f) endometriosis
g) incomplete miscarriage
h) Meckel’s diverticulum
i) silent miscarriage (missed abortion)
j) uterine fibroids
k) follicular cyst

Answer 6

endometrial carcinoma

Question 7

An injected drug that produces a sustained uterine contraction, is used in the treatment of post-partum haemorrhage and commonly causes nausea and hypertension.

a) Atosiban
b) Ergometrine
c) Indomethacin
d) Misoprostol
e) Oxytocin
f) Prostaglandin F2a (Hemabate)
g) Recombitant factor VII
h) Syntometrine

Answer 7

ergometrine

Question 8

A non-steroidal anti-inflammatory drug that can be used in the treatment of pre-term labour

Answer 8

indomethacin

Question 9

is produced by the posterior lobe of the pituitary gland. A synthetic form of it may be given to women to treat slow progress in labour.

Answer 9

oxytocin

Question 10

what blood test would reveal acute renal failure?

Answer 10

• serum urea

Question 11

what blood test would reveal hepatitis?

Answer 11

serum alanin transferase

Question 12

what blood tests would reveal nephrotic syndrome?

Answer 12

serum albumin

remember: nephrotic syndrome is the kidneys leaking protein into urine

Question 13

A 4 year old boy is seen in A&E with a high fever (39.50C). He has a cough and examination reveals a stony dull percussion note over the whole of the right lung. CXR demonstrates a collection of fluid outside the right lung.

Answer 13

pleural empyema

• infected pleural effusion
• treated with chest drain and antibiotics

Question 14

A ten year old boy presents with shortness of breath and fever. Examination reveals tachypnoea, dullness to percussion over the left base and bronchial breathing on auscultation.

Answer 14

streptococcal pneumonia

Question 15

A 59 year old lady with poorly controlled diabetes presents with a 1 week history of altered sensation and weakness of her right hand and a 2 day history of worsening left foot drop.

indicative of:

Answer 15

motor neuritis mulitplex

- painful, asymmetrical, sensory and motor peripheral neuropathy

Question 16

from what age does the human papilloma virus (HPV) vaccination programme start in the UK?

Answer 16

aged 12

Question 17

how many doses comprises the HPV vaccination schedule?

Answer 17

2 doses

should be completed within 12 months

Question 18

A 32 year old lady referred to the medical outpatient clinic with weight loss. Clinical examination reveals lid lag, fine tremor, tachycardia and a goitre.

what might you give?

Answer 18

indicative of hyperthyroidism

give carbimazole

Question 19

An 18 year old girl whose sister has been admitted to hospital for meningococcal meningitis. She is asymptomatic.

likely antibiotic;

a) Ceftriaxone
b) Flucloxacillin
c) Gentamicin
d) Metronidazole
e) Clarithromycin
f) Rifampicin
g) Isoniazid

Answer 19

rifampicin

Penicillin is the drug of choice for the treatment of meningococcal meningitis and septicemia. Chemoprophylactic antimicrobials most commonly used to eradicate meningococci include rifampin, quinolones (eg, ciprofloxacin), ceftriaxone.

Question 20

A 72 year old lady with a hot, swollen and red left leg following an insect bite 4 days ago. She is apyrexial and has no known drug allergies

a) Ceftriaxone
b) Flucloxacillin
c) Gentamicin
d) Metronidazole
e) Clarithromycin
f) Rifampicin
g) Isoniazid

Answer 20

likely to be cellulitis:

Usually, cellulitis is presumed to be due to staphylococci or streptococci infection and may be treated with cefazolin, cefuroxime, ceftriaxone, nafcillin, or oxacillin. Antimicrobial options in patients who are allergic to penicillin include clindamycin or vancomycin.

–> flucloxacillin

Question 21

A 40 year old man with sweats and a high temperature. Clinical examination reveals a pansystolic murmur and echocardiogram shows amitral valve vegetation. He is already on intravenous benzylpenicillin and the microbiologists request the addition of an antibiotic that exhibits synergy with the benzylpenicillin.

a) Ceftriaxone
b) Flucloxacillin
c) Gentamicin
d) Metronidazole
e) Clarithromycin
f) Rifampicin
g) Isoniazid

Answer 21

gentamicin

Question 22

An 80 year old woman with profuse diarrhea following a course of ciprofloxacin. Clostridium Difficile Toxin (CDT) is positive in the faeces.

which antibiotic would you give?

Answer 22

metronidazole

Question 23

most appropriate antibiotic for a patient with :

community acquired pneumonia CURB65 = 1

patient is allergic to penicillin

Answer 23

clarithromycin

CURB 65 = low severity

1st line: amoxicillin

alternative treatment: doxycycline or clarithromycin

Question 24

A 20 year old student who has been admitted with a severe headache. The cerebrospinal fluid contains 100 white cells/ mm3, which are 98% neutrophils

what antibiotic would you give?

a) clarithromycin
b) doxycycline
c) flucloxacillin
d) ceftriaxone
e) flucloxacillin

Answer 24

ceftriaxone

third generation cephalosporin

Question 25

A class IV anti-arrhythmic drug used as a second line agent for atrial arrhythmias; it is contraindicated in heart failure due to its negative inotropic effect

Answer 25

diltiazem

Question 26

An anti-cholinergic drug used in the treatment of symptomatic bradycardia and heart block

Answer 26

atropine

Question 27

A drug which is associated with transient feelings of impending doom, dyspnoea and chest tightness, used in the treatment of supraventricular tachycardia (SVT)

Answer 27

adenosine

Mild side effects of adenosine are common. They include a transient sinus pause that usually lasts less than five seconds, chest pressure or tightness, dyspnea, facial flushing and the feeling of impending doom

Question 28

A drug which is the first line treatment for ventricular tachycardia in a patient with no adverse symptoms or signs

Answer 28

amiodarone

Question 29

26 y/o

pc: dysuria and increased urination. given ABx for UTI. she later presents with pain in her Achilles tendon.

which of the following would be most likely to cause this side effect

a) nitrofurantoin
b) cefuroxime
c) ciprofloxacin
d) co-trimoxazole
e) trimethoprim

Answer 29

ciprofloxacin increased the risk of developing tendinitis

Question 30

A 19 year old student is admitted to the Emergency Department with a severe headache, photophobia, neck stiffness and vomiting. Lumbar puncture confirms the presence of Gram negative cocci within the CSF.
What is the most appropriate antibiotic choice for this patient?

Answer 30

ceftriaxone

Question 31

A 16-year old girl presents with her second tonic-clonic seizure. It was preceded by twitches of both arms. On some mornings she is quite twitchy and may drop things.
Which of the following drugs is most likely to prevent her seizures?

a) carbamazepine
b) lamotrigine
c) sodium valproate
d) topiramate

Answer 31

sodium valporate not to be used in women with child bearing potential

Question 32

A 32 year old man in admitted with a supraventricular tachycardia. Name one contra-indication to administering adenosine.

Answer 32

for patients with asthma

Question 33

resp picture:

results from an excessive loss of H+ ions due to prolonged vomiting

Answer 33

metabolic alkalosis

Question 34

resp picture:

will occur due to acute respiratory failure

Answer 34

respiratory acidosis

Question 35

resp picture:

results from the excessive excretion of CO2, commonly seen in hyperventilation due to anxiety states

Answer 35

resp alkalosis

Question 36

51 y/o female

pc: 3 day hx of severe cough and pain. cough productive of green sputum. tinged with blood. examination of chest shows left basal crackles and normal heart sound

indicative of:

Answer 36

lobar pneumonia

characteristic signs:
1. bronchial breath sounds: harsh sounds equally loud on insp and exp

2. focal coarse crackles: air passing through sputum
3. dullness to percussion: due to lung tissue collapse and/ or consolidation

Question 37

signs of pnuemonia on x-ray

Answer 37

consolidation

C – Confusion (new disorientation in person, place or time)
U – Urea > 7
R – Respiratory rate ≥ 30
B – Blood pressure < 90 systolic or ≤ 60 diastolic.
65 – Age ≥ 65

Question 38

common causes of pneumonia

Answer 38

1. streptococcus pneumonia (50%)
2. haemophilus influenza (20%)

other causes
Moraxella catarrhalis in immunocompromised patients or those with chronic pulmonary disease

Pseudomonas aeruginosa in patients with cystic fibrosis or bronchiectasis

Staphylococcus aureus in patients with cystic fibrosis

Question 39

68 y/o

pc: difficulty breathing, dry cough, wheezes on a regular basis.
pmh: breathlessness

OE: bibasal fine inspiratory crackles. he is afebrile.

Answer 39

pulmonary fibrosis

Fibrosis involves the replacement of the normal elastic and functional lung tissue with scar tissue that is stiff and does not function effectively.

idiopathic pulmonary fibrosis :
Examination can show bibasal fine inspiratory crackles and finger clubbing.

Question 40

A 65 year old man had a 12 month history of nocturia where he would go to the toilet up to five times each night. He also had hesitancy symptoms and micturition dribbling. Over the past five weeks this patient noticed he was feeling very tired and was not passing water as frequently

Answer 40

prostatic hyperplasia

LUTS
- DRE, abdo exam, urinary freq vol chart, urine dipstick, PSA

Question 41

medical management of patients with benign prostatic hyperplasia?

Answer 41

Alpha blockers (e.g. tamsulosin), relax smooth muscle

5-alpha reductase inhibitors (e.g. finasteride) to gradually reduce size of prostate

surgical
Transurethral resection of the prostate (TURP)
Transurethral electrovaporisation of the prostate (TEVAP/TUVP)
Holmium laser enucleation of the prostate (HoLEP)
Open prostatectomy via an abdominal or perineal incision

The notable side effect of alpha-blockers like tamsulosin is postural hypotension. If an older man presents with lightheadedness on standing or falls, check whether they are on tamsulosin and check their lying and standing blood pressure. The most common side effect of finasteride is sexual dysfunction (due to reduced testosterone).

Question 42

action of finasteride (5 alpha reductase)

Answer 42

converts testosterone to dihydrotestosterone

more potent androgen hormone

Question 43

A 5 year old child symptoms of cough and intermittent wheeze. He had eczema as an infant and Father has hayfever and asthma.
Which else would best help you make the diagnosis of Asthma for this child?

Answers:

Serial peak flow measurements

Cough productive of sputum

Exercise induced wheeze

Stunted growth

Raised IgE

Answer 43

Exercise induced wheeze

Question 44

which valve pathology would cause:

left atrial hypertrophy

Answer 44

mitral stenosis

Question 45

which valve pathology would cause:

left ventricular dilatation

Answer 45

aortic regurgitation

Question 46

which valve pathology would cause:

malar flush

Answer 46

mitral stenosis

Question 47

which valve pathology would cause:

slow rising pulse

Answer 47

aortic stenosis

Question 48

which valve pathology would cause:

mid-diastolic low pitched rumbling murmur

Answer 48

mitral stenosis

Question 49

which valve pathology would cause:

pan-systolic, high pitched whistling murmur

Answer 49

mitral regurgitation

Question 50

which valve pathology would cause:

early diastolic soft murmur

Answer 50

aortic regurgitation

Question 51

which valve pathology would cause:

atrial fibrillation

Answer 51

mitral stenosis