past paper questions 4 Flashcards
this is a smooth muscle tumour of the myometrium that is a common cause of menorrhagia:
leiomyoma (fibroid)
this is a tumour of the ovary that contains hair, teeth and thyroid tissue:
benign mature teratoma (dermoid cyst)
this is a tumour that makes up 90-95% or all cases of cervical cancer?
squamous cell carcinoma
this is a oestrogen dependent tumour that commonly presents as post menopausal bleeding in overweight, nulliparous diabeter women?
endometrial adenocarcinoma
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
serous epithelial adenocarcinoma
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
endometrial carcinoma
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
ergometrine
A non-steroidal anti-inflammatory drug that can be used in the treatment of pre-term labour
indomethacin
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.
oxytocin
what blood test would reveal acute renal failure?
- serum urea
what blood test would reveal hepatitis?
serum alanin transferase
what blood tests would reveal nephrotic syndrome?
serum albumin
remember: nephrotic syndrome is the kidneys leaking protein into urine
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.
pleural empyema
- infected pleural effusion
- treated with chest drain and antibiotics
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.
streptococcal pneumonia
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:
motor neuritis mulitplex
- painful, asymmetrical, sensory and motor peripheral neuropathy
from what age does the human papilloma virus (HPV) vaccination programme start in the UK?
aged 12
how many doses comprises the HPV vaccination schedule?
2 doses
should be completed within 12 months
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?
indicative of hyperthyroidism
give carbimazole
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
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.
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
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
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
gentamicin
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?
metronidazole
most appropriate antibiotic for a patient with :
community acquired pneumonia CURB65 = 1
patient is allergic to penicillin
clarithromycin
CURB 65 = low severity
1st line: amoxicillin
alternative treatment: doxycycline or clarithromycin
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
ceftriaxone
third generation cephalosporin
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
diltiazem
An anti-cholinergic drug used in the treatment of symptomatic bradycardia and heart block
atropine
A drug which is associated with transient feelings of impending doom, dyspnoea and chest tightness, used in the treatment of supraventricular tachycardia (SVT)
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
A drug which is the first line treatment for ventricular tachycardia in a patient with no adverse symptoms or signs
amiodarone
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
ciprofloxacin increased the risk of developing tendinitis
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?
ceftriaxone
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
sodium valporate not to be used in women with child bearing potential
A 32 year old man in admitted with a supraventricular tachycardia. Name one contra-indication to administering adenosine.
for patients with asthma
resp picture:
results from an excessive loss of H+ ions due to prolonged vomiting
metabolic alkalosis
resp picture:
will occur due to acute respiratory failure
respiratory acidosis
resp picture:
results from the excessive excretion of CO2, commonly seen in hyperventilation due to anxiety states
resp alkalosis
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:
lobar pneumonia
characteristic signs:
1. bronchial breath sounds: harsh sounds equally loud on insp and exp
- focal coarse crackles: air passing through sputum
- dullness to percussion: due to lung tissue collapse and/ or consolidation
signs of pnuemonia on x-ray
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
common causes of pneumonia
- streptococcus pneumonia (50%)
- 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
68 y/o
pc: difficulty breathing, dry cough, wheezes on a regular basis.
pmh: breathlessness
OE: bibasal fine inspiratory crackles. he is afebrile.
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.
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
prostatic hyperplasia
LUTS
- DRE, abdo exam, urinary freq vol chart, urine dipstick, PSA
medical management of patients with benign prostatic hyperplasia?
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).
action of finasteride (5 alpha reductase)
converts testosterone to dihydrotestosterone
more potent androgen hormone
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
Exercise induced wheeze
which valve pathology would cause:
left atrial hypertrophy
mitral stenosis
which valve pathology would cause:
left ventricular dilatation
aortic regurgitation
which valve pathology would cause:
malar flush
mitral stenosis
which valve pathology would cause:
slow rising pulse
aortic stenosis
which valve pathology would cause:
mid-diastolic low pitched rumbling murmur
mitral stenosis
which valve pathology would cause:
pan-systolic, high pitched whistling murmur
mitral regurgitation
which valve pathology would cause:
early diastolic soft murmur
aortic regurgitation
which valve pathology would cause:
atrial fibrillation
mitral stenosis
