Past year qs Flashcards
What is the medication choice in a 24wk pregnant woman with newly diagnosed hyperthyroidism?
Carbimazole
PTU is used in 1st trimester and carbimazole in 2nd trimester.
Carbimazole - risk of fetal abnormalities in 1st trimester
PTU - risk of liver failure
A 60yo lady presents with hypercalcaemia. She complains of epigastric pain and has been using over-the-counter antacids for several years. What is the most likely diagnosis?
Milk-alkali syndrome
Excess consumption of calcium in her Gaviscon calcium carbonate drinks!
Hypercalcaemia, renal failure and metabolic alkalosis
A 70yo diabetic man presents with discoloration of his toenails and clippings show Trichophyton rubrum. What is the most appropriate management?
Oral terbinafine is first-line if tx is needed (e.g. diabetic, immunocompromised). Alternative: oral itraconazole
A 67yo woman presents with shoulder stiffness in the mornings and feeling more lethargic. She also complains of loss of appetite. Blood tests reveal a raised ESR. Which is the single most appropriate management step?
Prednisolone - for polymyalgia rheumatica
A 9mo child presents with vomiting and inconsolable crying for the last 6h. He is in pain and has had redcurrant jelly diarrhoea. O/e he has a mass in the RUQ. What is the likely diagnosis?
Intussusception
What is the most common organism for septic arthritis in a 7yo boy?
Staph aureus is the most common organism regardless of age group
A 69yo gentleman is started on an antihypertensive. He develops ankle swelling. Which drug was likely responsible?
A calcium channel blocker e.g. amlodipine
A 73yo gentleman is started on antihypertensives. 3wks later he has tiredness, weakness and leg cramps. An ECG shows prolongation of the PR interval and flattened T waves. Which of the following drugs is most likely responsible?
- Indapamide
- Ramipril
- Spironolactone
- Atenolol
- Candesartan
Indapamide (thiazide diuretic)
A 5yo boy is brought to your GP surgery with a back rash that has been present for the last week. You notice multiple small dome-shaped pearly lesions with a punched-out centre. Which is the most appropriate management?
- Refer for curretage
- 5% potassium hydroxide
- Topical steroid
- Cryotherapy
- Advice and reassurance
Advice and reassurance
Treatment for molluscum contagiosum may only be required if there is auto-infection or infection of others - they usually clear within 18 months`
A 62yo M presents with a ruptured Achilles tendon after receiving a short course of abx. Which is the single most likely causative antibiotic?
- Trimethoprim
- Nitrofurantoin
- Doxycycline
- Flucloxacillin
- Ciprofloxacin
Ciprofloxacin
A 60yo man presents with confusion, ataxia and horizontal nystagmus. Blood tests show a significantly raised AST. What is the most likely diagnosis?
- Wernicke’s encephalopathy
- Pick’s disease
- Hepatic encephalopathy
- Wilson’s disease
- Normal pressure hydrocephalus
Wernicke’s encephalopathy (triad of confusion, ataxia and ophthalmoplegia)
Notes on the rest:
- Pick’s disease –> inappropriate / disinhibited behaviour
- Hepatic encephalopathy –> confusion, reduced GCS, personality change
- Wilson’s –> depression, psychosis, asymmetrical tremor
- NPH –> wacky, wobbly, wet (mental disturbance, ataxia, incontinence)
A 75yo lady presents to her GP with urinary incontinence. On examination, she has an ataxic gait and scores 24 on her MMSE. What is the most likely diagnosis?
- Wernicke’s encephalopathy
- Pick’s disease
- Normal pressure hydrocephalus
- Multisystem atrophy
- Alzheimer’s disease
Normal pressure hydrocephalus.
Notes:
Alzheimer’s: memory lapses initially > psychiatric and behavioural problems
MSA: urinary dysfnction, postural hypotension, cerebellar ataxia, late Parkinsonian sx
A 37yo sex worker presents with a paiful genital ulcer. O/e she has a painful ulcer on her labia majora and swollen inguinal lymph nodes which are also tender to palpation. No vaginal discharge is present. Which organism is most likely responsible?
- Haemophilus ducreyi
- Chlamydia trachomatis
- Neisseria gonorrhoea
- Trichomonas vaginalis
- Treponema pallidum
Haemophilus ducreyi.
Painful genital ulcers –> chancroid (this) or herpes simplex
A 3yo boy presents with a rash and low grade fever. O/e oval vesicles are present on his palms and soles and ulcers are present in his mouth. What is the most likely causative organism?
Coxsackievirus A (Hand-foot-mouth disease)
A 35yo lady is requesting contraception. She has a hx of HTN and heavy periods, which is the most appropriate contraception?
IUS
A 42yo lady with diabetes presents with right shoulder pain. Her entire shoulder joint is tender and movements are limited, especially passive external rotation. What is the most likely dx?
Adhesive capsulitis
A 65yo smoker with a 40 pack year hx presents with SoB, haemoptysis and weight loss. On examination, they have features of clubbing. What is the single most appropriate first-line investigation?
- CXR
- Sputum cytology
- Bronchoscopy
- CT CAP
- High res CT chest
CXR
How long can a patient be detained for under sectioni 5(2)?
Doctor’s holding power: 72h
What is the most common cause of death in Friedrich’s ataxia?
Cardiomyopathy
A patient with known Crohn’s disease presents with a 2 week history of severe diarrhoea, frequency and abdominal pain. Which is the single most appropriate investigation to exclude an exacerbation of Crohn’s disease?
- FBC
- Faecal calprotectin
- AXR
- CRP
- Stool MCS
CRP
CRP correlates well with disease activity for Crohn’s, but not so well for UC.
Faecal calprotectin correlates well with disease activity for UC, but less so for Crohn’s and is also much more expensive.
A 37F complains that food gets stuck in her throat, requiring her to drink large amounts of water to help swallow. She also notices her hands go very pale in the cold and then red once indoors. You notice thickening and tightening of the skin of her fingers and calcific nodules. Anti-centromere antibodies are positive. What is the most likely dx?
Limited CREST
A 76yo man with dementia presents with worsening sleep disturbance including restless legs, painful cramps and difficulty turning over in bed. What is the most likely dx?
- Parkinson’s
- Vascular dementia
- Alzheimer’s
- Frontotemporal
- Creutzfeldt-Jakob disease
Parkinson’s disease
- Nocturnal akinesia (difficulties turning), painful cramps, tremo.
AD and vascular –> insomnia, frequent nighttime awakenings, increased daytime sleep
A pregnant lady at 26wks gestation presents with hypothyroidism. What is the most appropriate treatment?
- Carbimazole
- Propylthiouracil
- Beta-blockers
- Radio-iodine
- Surgery
Carbimazole.
PTU for 1st trimester as CBZ is teratogenic.
CBZ from 2nd trimester onwards as PTU has high risk of liver failure.
BB and radio-iodine are contra-indicated in pregnancy. Surgery is best avoided during pregnancy.
A 9yo girl presents with absence seizures. What is the most appropriate first-line treatment?
- Carbamazepine
- Primidone
- Phenytoin
- Ethosuximide
- Topiramate
Ethosuximide
A 70yo man with lung ca is found to have a raised calcium level. Which of the following lung cancers is most associated with hypercalcaemia?
- Small cell carcinoma
- Adenocarcinoma
- Squamous cell carcinoma
- Mesothelioma
- Large cell carcinoma
Squamous cell carcinoma –> PTHrP
All the other paraneoplastic syndromes are from small cell lung ca (ACTH, SIADH, Lambert-Eaton)
A young woman presents with symptoms of blurred vision in her left eye which is painful to move. She has also noticed a change in red colour vision in that eye. What is the single most helpful diagnostic intervention?
- Tonometry
- MRI
- LP
- Slit lamp assessment
- FBC, ESR, CRP
MRI (for MS)
A 3 month old infant presents to her GP with severe eczema and bouts of D&V. What is the most likely diagnosis?
- Lactose intolerance
- Cow’s milk protein allergy
- Norovirus
- Inflammatory bowel disease
- Hischsprung’s disease
Cow’s milk protein allergy
A 13yo boy who recently moved to the UK from Poland is noted to have large ears, an elongated face and large testes. Which of the following choromosomal abnormalities is most likely?
- Down’s
- Edward’s
- William’s
- Fragile X
- Patau’s
Fragile X
A 42yo woman presents with a 5 month history of amenorrhoea. An abdominal mass is palpable on examination. Which of the following is the most likely diagnosis?
- Ovarian ca
- Endometrial ca
- Polycystic ovary syndrome
- Pregnancy
- Menopause
Pregnancy: the most probable cause of amenorrhoea and abdominal mass in a woman of reproductive age
A 62yo man presents to his GP with constipation, left loin-to-groin pain and myalgia. His serum calcium levels are elevated. Which of the following tests would be the most useful in determining the cause of his hypercalcaemia?
- DEXA scan
- LFTs
- TSH levels
- PTH levels
- Vitamin D levels
PTH levels.
PTH levels will differentiate between PTH-mediated and non-PTH-mediated causes.
NB. this q is not asking for what you think the most likely cause is!
