PPQs

Question 1

1. juA 19 year old man has pain in the ulnar aspect of his right hand since he threw a punch with his right fist. Which structure is most likely to have been injured?

Answer 1

5th metacarpal

Question 2

2. A 44 year old man is admitted for a day-case knee arthroscopy. He is first on the list and is scheduled for 09.00. He drank a cup of black coffee at 06.00. He has a history of oesophagitis and has suffered severe nausea and vomiting after general anaesthesia for a hernia repair. He is recovering from a cold but still has a hoarse voice.
   His temperature is 37.2°C and BP 160/95 mmHg. His throat is inflamed. Which clinical feature is most likely to indicate postponing the operation?

Answer 2

laryngitis

Question 3

4. The neighbours of an 80 year old man report 5 days of hearing him shouting in the middle of the night. The man lives alone and has told his neighbours that he has seen people trying to burgle him, but there is no evidence for this. He has no psychiatric history and is usually fit and well.

Answer 3

delirium

Question 4

6. A 35 year old woman has an ill-defined lumpy area in the upper outer quadrant of her right breast which becomes larger and tender during the second half of her menstrual cycle.
   Which is the most likely diagnosis?

Answer 4

fibrocystic disease

Question 5

7. A 43 year old man is rescued from a house fire. There are no signs of burns to the face or neck, but he has soot deposits in his nose and mouth.
   His temperature is 37.5°C, pulse rate 120 bpm, BP 135/86 mmHg, respiratory rate 20 breaths per minute and oxygen saturation 97% breathing air. He has widespread wheeze.
   Which is the most appropriate management?

Answer 5

non-rebreather mask 100% oxygen

Question 6

12. A 42 year old man reports that his left testicle has been swollen for the past 3 weeks. He is otherwise well. There is a firm, round swelling at the upper pole of the left testis.
    Which is the most likely diagnosis?

Answer 6

epididymal cyst

Question 7

13. A 64 year old man with a two year history of intermittent claudication presents with worsening lumbar back pain, not related to movement. He has type 2 diabetes mellitus.
    Examination of his abdomen and spine is normal, but he has an absent right popliteal pulse and absent pulses in his left foot.
    Which is the most appropriate initial investigation?

Answer 7

USS of abdomen

Question 8

15. A 59 year old man has a prolonged postoperative ileus after a sigmoid colectomy for diverticulitis.
    Which is the most appropriate method of nutrition for this patient?

Answer 8

IV TPN

Question 8

16. A 69 year old woman has constant dribbling of urine and has had to wear pads continuously for the last 12 month. She had radiotherapy for carcinoma of the cervix when she was 48 years old.
    Her temperature is normal. Her bladder is not palpable or tender and neurological examination is normal.
    Which is the most likely cause of her symptoms?

Answer 8

vesicovaginal fistula

Question 9

24. A 40 year old man has an extensive rash that started 2 days ago and is worsening. He is shivering and feeling generally unwell. He has no past medical history, but has recently been treated for a chest infection.
    His skin is now red over most of the body, with some large blisters and some areas of erosion. There is extensive ulceration in the mouth, and the conjunctivae are injected.
    Which is the most likely diagnosis?

Answer 9

toxic epidermal necrolysis

Question 10

28. A 50 year old woman has suddenly become short of breath. She has found it painful to swallow for two months, and she has coughed up a small amount of blood. She is distressed and cannot lie flat.
    Her temperature is 37.5°C. Her respiratory rate is 40 breaths per minute and her oxygen saturation is 78% using 15L pe minute via a re-breather mask. She has inspiratory stridor.
    What is the most appropriate action to take?

Answer 10

endotracheal tube intubation

Question 11

34. A 45 year old window cleaner falls off a ladder and sustains a comminuted closed facture of his right calcaneum.
    There is gross swelling and tenderness over all aspects of his heel.
    Which is the most appropriate imaging to help to plan for surgery?

Answer 11

CT

Question 12

36. A 56 year old man has pain and tenderness in the right upper quadrant of his abdomen, 18 hours after endoscopic retrograde cholangiopancreatography and sphincterotomy for gallstones.
    His temperature is 38.9°C, pulse ate 98 bpm and BP 114/78 mmHg.
    Investigations:
    Bilirubin 45µmol/L (<17)
    Amylase 300 U/L (<220)
    Which is the most likely diagnosis?

Answer 12

ascending cholangitis

Question 13

37. A 70 year old woman is admitted with a one week history of worsening breathlessness.
    She looks pale. She has a temperature of 36.2°C, pulse rate 100 bpm, BP of 132/68 mmHg, JVP +8 cm above the sternal angle and oxygen saturation 94% on 40% oxygen via a face mask. She has bilateral inspiratory crepitations to the midzones. She has a pansystolic murmur at the apex.
    Investigations:
    Haemoglobin 52 g/L (115-150)
    MCV 120 fL (80-96)
    White cell count 3.0 x 109/L (3.8-10.0)
    Platelets 87 x 109/L (150-400)
    Which is the most likely diagnosis?

Answer 13

AML

Question 14

38. A 35 year old man has pain in his left foot for three months; it is worse after playing football but improves when he keeps his foot still. Recently, the pain has become more persistent. He is unable to recall any specific injury that may have brough on the pain. He plays sport several times a week. He is otherwise fit and well. There is tenderness over the mid-foot.
    What is the most likely diagnosis?

Answer 14

metatarsal stress fracture

Question 15

39. A 72 year old man with lung cancer is admitted to the respiratory ward with recurrent haemoptysis. He is known to the palliative carer team and it is felt that he is near the end of his life. He says that he wants to have his terminal care on the respiratory ward because he knows and trusts the nurses. A ‘do not attempt resuscitation’ form is completed. He subsequently has further haemoptysis and becomes more breathless, so he is treated with an opioid infusion to relieve his dyspnoea. A doctor suggests that the local hospice is better equipped to care for the patient. His son agrees with the doctor, believing that the hospice is “the right place to die”.
    Which should b the most important factor influencing the decision on whether to move him to a hospice?

Answer 15

patient previous opinion

Question 16

49. A 24 year old man has had a high speed motorcycle crash. A cervical spine fracture is suspected and a series of cervical spine X-rays is requested.
    Which X-ray view is most likely to reveal a vertebral body crush facture?

Answer 16

lateral view

Question 17

52. A 75 year old man has increased urinary frequency, nocturia (four times per night), poor urine flow and reduced urinary volumes over the past six months. Urinalysis shows glucose trace, blood and protein negative.
    Investigations: electrolytes: normal
    serum creatinine 387 µmol/L (60-120)
    random blood glucose 5.6 mmol/L
    Which is the most likely cause of his renal impairment?

Answer 17

obstructive uropathy

Question 18

53. An 18 year old man attends the Emergency Department after cutting the volar radial border of his left index finger with a knife while cutting up an apple. There was immediate arterial bleeding.
    Other than the digital artery, which is the most likely structure to have been damaged?

Answer 18

digital nerve

Question 19

57. A 71 year old man dies in hospital 36 hours after admission with a chest infection. He was an inpatient briefly 2 weeks ago, when he had an inconclusive bronchoscopy and pleural biopsy. He had been receiving an occupational pension for pneumoconiosis and was living alone, refusing help from social services.
    Which is the most important reason for referring to the coroner/procurator fiscal?

Answer 19

death due to industrial disease

Question 20

61. A 72 year old woman has severe lower gastrointestinal haemorrhage. Colonoscopy shows active bleeding from a caecal carcinoma that cannot be controlled endoscopically. A decision is made to proceed to embolisation.

Answer 20

superior mesenteric

Question 21

63. A 65 year old woman attend for routine breast screening. She has no symptoms of breast disease, no relevant family history and is not on any medication. She has a normal breast examination. The mammogram shows and area of focal microcalcification.
    Which is the most common pathological cause?

Answer 21

dcis

Question 22

65. A 64 year old woman collapses on the ward. The nurses repot that she had breathlessness just before her collapse. She was admitted that morning with cellulitis and had received her first dose of antibiotics in the Emergency Department.
    Her pulse rate is 100 bpm, BP 80/40 mmHg, respiratory rate 32 beaths per minute and oxygen saturation 94% on 10 L/min oxygen.
    Which is the most appropriate immediate treatment?

Answer 22

adrenaline

Question 23

67. A 72 year old woman is admitted with three days of cough and fever. She has been unwell for the past two to three months with lethargy, arthralgia and anorexia. She has hypertension. Her creatinine concentration two months previously was 71 µmol/L (60-120).
    She has a temperature of 38°C, pulse rate 87 bpm and BP of 132/70 mmHg, and her oxygen saturation is 98% on 40% oxygen via a face mask. She has coarse inspiratory crackles at the right base. Urinalysis shows protein 4+, blood 1+.
    Investigations:
    sodium 132 mmol/L (135-146)
    potassium 5.3 mmol/L (3.5-5.3)
    urea 14.7 mmol/L (2.5-7.8)
    creatinine 275 µmol/L (60-120)
    eGFR 25/mL/min/1.73 m2 (>60)
    albumin 28 g/L (35-50)
    urinary protein:creatinine ratio 340 mg/mmol (<20)
    urinary sodium 18 mmol/L
    Ultrasound scan shows that both kidneys are 11 cm in diameter and not obstructed.
    Which feature favours an intrarenal, as opposed to a prerenal, cause for her acute kidney injury?

Answer 23

c. Systolic BP >130 mmHg

Question 24

70. A 75 year old woman has a 1.5cm left breast lump. She has a history of hypertension and COPD.
    Investigations:
    Core biopsy: grade 3 invasive ductal carcinoma that is oestrogen receptor negative
    Ultrasound scan of axillary: negative
    Which is the most appropriate initial treatment?

Answer 24

e. Wide local excision and sentinel node biopsy

Question 25

72. An 84 year old woman has cut her leg following a fall in the garden. She cannot provide any immunisation history.
    There is a deep laceration. The laceration is cleaned and sutured, and she is given analgesia and antibiotics.
    Which is the most appropriate additional treatment?

Answer 25

d. Pooled human immunoglobulin

Question 26

82. A 70 year old man has bright red rectal bleeding. Rigid sigmoidoscopy reveals a smooth and pedunculated polyp, 1 cm in diameter and 3 cm from the anal margin.
    Which type of tumour is this polyp most likely to be?

Answer 26

adenoma

Question 27

85. A 25 year old man has urinary hesitancy and a sensation of incomplete voiding, just after recovering from a severe urinary infection. He has primary progressive multiple sclerosis but lives independently.
    An ultrasound scan of his bladder indicates 400 mL of urine after voiding. Urinalysis reveals heavy growth of Proteus species.
    Which is the most appropriate long term management?

Answer 27

intermittent self catheter

Question 28

89. A 22 year old woman has a painless swelling in the left side of her neck. She first discovered the lump several months ago and noticed that it became slightly more prominent after a recent cold.
    She looks well. Her temperature is 37.2°C. There is a 3 cm x 4 cm oval, non-tender, fluctuant mass along the lower third of the anteromedial border of the sternocleidomastoid muscle.
    Which is the most likely diagnosis?

Answer 28

branchial cyst

Question 29

92. A 27 year old man is brought to the Emergency Department having fallen from a ladder. He has a compound fracture of his right femur.
    He is maintaining his airway and has cold peripheries with a capillary refill time of 4 seconds. His pulse rate is 135 bpm, BP 89/55 mmHg, respiratory rate 32 breaths per minute and oxygen saturation 98% breathing 15 L/min oxygen via a non-rebreathing mask.
    Fluid resuscitation is started with Hartmann’s solution.
    Which is the most appropriate initial treatment for his pain?

Answer 29

IV paracetamol

Question 30

97. A 19 year old man presents to the Emergency Department with 48 hours of fever, sore throat and a generalised rash that began on his face and has spread downwards.
    His temperature is 39.1°C, pulse rate 112 bpm and BP 106/65 mmHg. He has a widespread blanching rash and conjunctivitis. There are white spots in his mouth.
    Which is the major mode of transmission of the pathogen?

Answer 30

respiratory droplet

Question 31

101. A 42 year old man is found unconscious at home. He has Huntington’s disease, which has deteriorated recently. En route to the hospital he has a generalised seizure.
     In the Emergency Department, he has a temperature of 35.8°C and GCS is . Examination shows no focal neurology.
     CT scan of the head shows no acute structural change. A lumbar puncture is performed.
     Cerebrospinal fluid results:
     Appearance clear
     Total protein 0.3 g/L (0.15-0.45 g/L)
     Glucose 4.5 mmol/L (paired serum glucose 5.0 mmol/L) (reference range 2.2-4.4)
     Cell count 2/µL (<5/µL)
     Which is the most likely diagnosis?

Answer 31

psychogenic non epileptic seizure

Question 32

107. A 23 year old woman commenced her chemotherapy for Burkitt’s lymphoma yesterday. Since then she has been feeling increasingly nauseated. Urine output has been 40 mL in the last 12 hours.
     Her temperature is 36.8°C, pulse rate 96 bpm and BP 112/80 mmHg.
     Investigations on admission were normal. Investigations today:
     Potassium 6.2 mmol/L (3.5-5.3)
     Urea 9 mmol/L (2.5-7.8)
     Creatinine 410 µmol/L (60-120)
     Which investigation is most likely to identify the cause of her acute deterioration?
     a. Blood cultures
     b. C reactive protein
     c. Creatine kinase
     d. Phosphate – both are elevated in tumour lysis syndrome but couldn’t come to an agreement
     e. Urate

Answer 32

phosphate

Question 33

111. A 75 year old man has been diagnosed with pneumonia, and treatment started with clarithromycin and amoxicillin. He has ischaemic heart disease and a previous stent. His medications include aspirin, bisoprolol, clopidogrel, ramipril and simvastatin.
     Which medication should be stopped during treatment for his pneumonia?

Answer 33

simvastatin

Question 34

124. A 78 year old man has slowly increasing right leg pain, radiating from the buttocks to just below his knee. He has intermittent low back. He is otherwise and is a non-smoker.
     The leg pain is precipitated by walking. Foot pulses are present.
     Which is the most likely cause of his symptoms?

Answer 34

spinal canal stenosis

Question 35

121. A 78 year old woman is due to be admitted to hospital for an elective laparoscopic cholecystectomy. She has a chronic lower leg ulcer with no signs of cellulitis. This is swabbed by her community nurse, and culture from the ulcer grows MRSA.
     Which is the most appropriate next step?
     a. Admit for intravenous antibiotic therapy
     b. Continue with planned surgery
     c. Oral antibiotic therapy
     d. Surgical debridement
     e. Topical bacterial decolonisation

Answer 35

topical bacterial decolonisation

Question 36

119. A 76 year old man undergoes an abdominoperineal resection for a low rectal carcinoma. He is an ex-smoker and has exertional dyspnoea.
     All blood tests are normal. Preoperative spirometry shows FVC 1.8 L (predicted 3.5) and FEV1 0.9 L (predicted 2.8).
     Which is the most appropriate treatment for controlling his pain during the early postoperative period?

Answer 36

epidural

Question 37

118. A 38 year old man wakes with severely reduced vision in his right eye. He noticed a few floaters the previous evening. He has no pain and no flashing lights. He has had type 1 diabetes for 25 years and is hypertensive. At retinal screening 18 months previously, he had pre-proliferative retinopathy, but failed to attend follow up.
     Visual acuity in his right eye is reduced to light perception only.
     Which is the most likely diagnosis?

Answer 37

vitreous haemorrhage

Question 38

115. A 40 year old man is referred to the General Surgery Clinic after two episodes of painlessly passing blood per rectum. On each occasion there was a small volume of bright red blood, with no obvious mucus. His general health is good and he has not lost any weight. He has not had any other change in bowel habit.
     Which is the most appropriate initial investigation?
     a. Barium enema
     b. Coagulation screen
     c. Colonoscopy
     d. Faecal occult blood testing - silly
     e. Proctosigmoidoscopy

Answer 38

proctosigmoidoscopy

Question 39

113. A 32 year old woman has 2 weeks of low back pain, with no radiation and no other associated symptoms. There is no history of trauma and no significant past medical history.
     There is lower back tenderness but no neurological abnormalities. She is advised to take analgesia.
     Which is the most appropriate next step in management?

Answer 39

mobilisation

Question 40

112. A 60 year old man has pain in his right calf on walking 400 yards that forces him to stop walking. The pain disappears within 2 or 3 minutes when he stops walking but returns again when he walks another 400 yards. He smokes 15 cigarettes daily. His BP is 156/88 mmHg. His ankle:brachial pressure index is 0.6 on the right, and 0.9 on the left.
     Which is the most likely site of pathology?

Answer 40

right superficial femoral artery

Question 41

3. Which factor signifies greatest risk of progression in RA?
   a. Joint involvement >8
   b. CRP
   c. Anti-CCP
   d. RF

Answer 41

anti ccp

Question 42

6. Woman 55yo? with pain in groin, mets in femur, where was primary lesion located?
   a. Renal
   b. Cervical
   c. Lung

Answer 42

lung

Question 43

10. Milky fluid drained from chest after surgery

Answer 43

chylothorax

Question 44

12. Women with headaches, pushing on the frontal lobe. Which brain tumour?
    a. Meningioma
    b. Astrocytoma

Answer 44

meningioma

Question 45

14. Most common side effect of radiotherapy for SCC lung cancer?
    a. Oesophagitis
    b. Pneumonitis
    c. Neutropenia

Answer 45

pneumonitis

Question 46

16. What cell is primarily affected in MS?
    a. Oligodendrocytes
    b. Astrocytes
    c. Schwann cells

Answer 46

oligodendrocytes

Question 47

22. COPD wasn’t eating much. Which tool would be most useful?

Answer 47

malnutrition universal screening tool

Question 48

26. Gram negative bacteria causing pneumonia in CF patient?

Answer 48

psuedomonas aeruginosa

Question 49

27. Blood supply to 2nd part of duodenum.

Answer 49

gastroduodenal artery

Question 50

28. Lymphadenopathy, fever, bilateral conjunctival swelling

Answer 50

leptosperosis

Question 51

29. Gram positive cocci causing pneumonia with cavitations.

Answer 51

staph aureus

Question 52

31. Lacunar infarct, what drug to give in addition to aspirin?

Answer 52

statin

Question 53

42. Breastfeeding women with hyperthyroidism. Tx?
    a. Carbimazole
    b. PTU
    c. Radioiodine

Answer 53

PTU

Question 54

54. 43 year old with pain in bilateral knees, wrists.

Answer 54

RA

Question 54

58. Intrinsic muscle wasting of hands, biceps reflex reduced.

Answer 54

C5

Question 55

59. 28yo with some episodes of semi-loose stools. He is healthy between episodes. Tx?

Answer 55

FODMAP diet

Question 56

128. 18 year old girl comes in with low potassium, macrocytic anaemia and raised urea, physical examination otherwise normal. What is the cause?

Answer 56

anorexia nervosa

Question 57

4. Elderly man with catheter-associated UTI. Had pain, confusion and fever, dark and smelly urine. Recently changed his catheter. What would make you prescribe an abx?
   a. Pain
   b. Confusion and fever
   c. Smelly urine
   d. Recently changed his catheter

Answer 57

confusion and fever

Question 58

8. 19yo girl inverted her ankle during football practice. WHat ligament is most likely to be damaged?
   a. Anterior tabofibular ligament
   b. Posterior talofibular ligament
   c. Transverse tibiofibular ligament
   d. Calcaneal fibular ligament
   e. Interosseus ligament

Answer 58

anterior

Question 59

9. Pt is diagnosed with Hodgkin’s lymphoma, how would you describe the treatment?
   a. Neoadjuvant chemotherapy
   b. Adjuvant chemotherapy
   c. Curative chemotherapy

Answer 59

adjuvant

Question 60

17. Gleason score 3 + 3, what is the appropriate mx?
    a. Watchful waiting
    b. Surgery
    c. Medication

Answer 60

watchful waiting

Question 61

22. Pt post-surgery had been given 3L of 0.9% saline, 4 glucose and 10mmol/L of potassium. Had paralytic ileus? What biochemical abnormality is most likely to be seen?

Answer 61

hypokalaemia

Question 62

25. Bone most likely fractured in pt with diplopia, facial anaesthesia

Answer 62

zygomatic

Question 63

32. What explains fast progression of atherosclerosis?

Answer 63

more LDL production

Question 64

51. Woman on recreational drugs has hypokalaemia and hyponatraemia?
    a. Ketamine
    b. MDMA (ecstasy)
    c. Nitrous oxide

Answer 64

MDMA

Question 65

82. Sx of C3-6 dysfunction. Where is lesion?

Answer 65

cavernous sinus

Question 66

1. 74 y/o patient on an assortment of medications for the past 10 years, presents with a #NOF low impact (think she kicks a football to her grandson and has a fracture) subtrochanteric femur #. Which drug is the most likely cause
   a. Omeprazole
   b. Alendronic acid
   c. Bendroflumethiazide
   d. Atorvastatin

Answer 66

alendronic acid

Question 67

8. DEEP abdominal pain and right loin pain, vomiting 1 hour, now hypotensive, cap refill 5s. pmhx hypertension and hypercholesteremia

Answer 67

ruptured aaa

Question 68

13. Overdose, dilated pupils with widened QRS. Patient refuses to disclose what medication was overdosed. What was the agent?

Answer 68

amitryptilline

Question 69

16. Correct statin target 3 months after starting treatment:

Answer 69

> 40% reduction in non-HDL cholesterol

Question 70

18. Delirium and usually well, patient wandering the wards at night and refuses to go to bed
    a. Lorazepam
    b. Haloperidol
    c. Orientation techniques
    d. Zopiclone

Answer 70

orientation techniques

Question 71

23. 82 year old female had stroke, found to have AF, currently taking aspirin 75mg for previous MI.
    a. Change aspirin to apixaban
    b. Add clopidogrel
    c. Add warfarin
    d. Do nothing

Answer 71

change asprin to apixaban

Question 72

28. Old man had a 3/7 hx of a fall, since then unable to weight bear. Physiotherapist unable to assess him due to patient being in pain when touched, but x-ray only showed minor degenerative changes only. What do you do?
    a. CT hip and pelvis
    b. Encourage him to weight bear
    c. Refer to old age psychiatry
    d. IV morphine

Answer 72

ct

Question 73

29. House fire inhaled. Patient needs increased ventilatory pressures, what is the reason?
    a. Abnormal alveolar capillary osmosis
    b. Surfactant insufficiency
    c. Accelerated pulmonary fibrosis
    d. Bronchospasm

Answer 73

abnormal alveolar cap osmosis

Question 74

30. A man who works as a painter and has lateral epicondylitis, what muscle group is responsible for his pain?
    a. Wrist flexors
    b. Wrist extensors
    c. Elbow flexors
    d. Elbow extensors
    e. Elbow pronator

Answer 74

wrist extensors

Question 75

34. A 40 year old patient worried about getting cancer. Mum received a diagnosis of unilateral breast cancer at 67, brother has metastatic melanoma 5 years ago, uncle with lung cancer at XX age, grandparent with colorectal cancer at 82
    a. Send for BRCA1
    b. Reassure patient they do not have increased risk of breast cancer
    c. Sent to breast clinic
    d. Sent to mammography

Answer 75

reassure

Question 76

38. A middle-aged man with headache, intermittent left-sided claudication, history of a TIA. He has 220/80 BP and has AKI. Biochemistry (presumably U&E) is normal. Ultrasound showing one kidney is 10cm and the other is 7cm. A scan also showed no obstruction in the ureters.
    a. MR urography
    b. Renin:aldosterone ratio
    c. MR angiography
    d. Urine catecholamines
    e. Renal biopsy

Answer 76

renin

Question 77

46. Displaced intracapsular NOF fracture, in a 68 year old man who fell off motorbike, controlled HTN, no other health issues. Most appropriate surgery?
    a. Total hip arthroplasty
    b. Hemiarthroplasty
    c. Dynamic screw
    d. ORIF

Answer 77

total hip

Question 78

48. Parotid gland swelling 6 months, not tethered to skin, face weakness and numbness, dribbling fluids.
    a. Adenoid cystic carcinoma
    b. Pleomorphic adenoma
    c. Warthin’s tumour
    d. Suppurative parotitis

Answer 78

pleomorphic adenoma

Question 79

83. Pt 5 days post-op on epidural pain relief, was feeling well in bed, had clammy hands, warm feet, BP 90/60, normal HR. 30ml urine produced in past 2 hours
    a. Bladder scan
    b. Saline 500ml challenge
    c. Stop epidural
    d. Go back to theatre?
    e. Flush catheter

Answer 79

stop epidural

Question 80

93. Patient with #NOF with pain uncontrolled pain. Was on IV paracetamol but it did not relieve pain. What is the next analgesia to offer?
    a. Repeated IV bolus morphine
    b. Diclofenac IM
    c. Femoral Nerve block
    d. Pethidine PCA

Answer 80

femoral nerve block

Question 81

94. Pt had colorectal surgery w primary anastamosis, after has normal obs but rebound tenderness, fever and dull lung bases, what next?
    a. Call for senior help
    b. Erect CXR
    c. Lying abdo X-ray
    d. CT abdo with contrast

Answer 81

cxr

Question 82

1. 76 F ate fish and chips. Now has throat pain and pain on swallowing. All of her observations and examination were stable. What are your next steps?

Answer 82

lateral soft tissue next x ray

Question 83

8. Male patient suddenly unable to raise arm. 3/5 wrist extension and finger extension. Supinator reflex reduced. Arm flexion 5/5. Dorsum of hand is numb. What nerve is damaged?

Answer 83

radial nerve

Question 84

13. 40 yo F, face rash around the nose and cheeks with pustules, with red eyes and had a gritty feeling. Telangiectasia under the eyelid. No blackheads. What long term management? rosacea

Answer 84

ivermectin cream

Question 85

23. Patient presents to ED. Takes a multitude of recreational drugs (doesn’t tell you). Has not taken anything for 48 hours. Has dilated pupils and abdominal pain, sweaty, what treatment?

Answer 85

methadone

Question 86

26. Patient had winging of the scapula. Long thoracic nerve innervates which muscle?

Answer 86

serratus anterior

Question 87

32. Surgeon cut himself and has a ruptured extensor tendon his DIP. How do you manage?
    a. Fix with K wires
    b. Regular physio
    c. Plaster cast
    d. Spica thumb cast
    e. Tendon repair surgery

Answer 87

plaster cast

Question 88

37. Patient with campylobacter jejuni. Bloody diarrhoea 6 times a day and has a fever. Treatment?
    a. Supportive care
    b. Ciprofloxacin
    c. Doxycycline
    d. Cefuroxime
    e. Azithromycin

Answer 88

ciprofloxacin

Question 89

43. Difficulty getting erections for the past year, BPH taking ramipril and other drugs, BP 130, pt is otherwise well (worsening over a long time = organic cause, acute onset = psychological)
    a. Give penile pump
    b. Give sildenafil
    c. Change antihypertensive medication
    d. Send to psychosexual counselling
    e. Intraurethral prostaglandin?

Answer 89

give slidenafil

Question 90

48. Post-chemo and post-radiotherapy for cervical cancer. Patient develop breathlessness but no pain, no fever, HR 105, RR 16. Chemotherapy agent= cisplatin
    a. Chemotherapy-induced pneumonitis
    b. Pneumonia
    c. PE
    d. Radiotherapy fibrosis

Answer 90

radiotherapy

Question 91

Drug trial for painkillers. Patients split into groups, given either drug or placebo. Don’t know what treatment they’re getting. Treating clinicians KNOW what treatment their patients are getting. Investigators who will be scoring and assessing post-operative pain don’t know what treatment patients will have gotten. What form of bias can this type of study lend to?

- confirmation - reporting - detection bias - attrition bias - performance

Answer 91

performance

Question 92

Palliative Px with terminal agitation, what is the tx?

Answer 92

midazolam

Question 93

Elderly man, dysphagia with solids but not liquids, what is the initial investigation?

Answer 93

upper Gi endo

Question 94

Px with sleep apnoea not using cpap as feels incompatible. Finds himself falling asleep multiple times in day. DVLA question.

• stop driving, patient inform DVLA – patient responsibility to inform
• stop driving, doctor inform DVLA
• drive short distances

Answer 94

stop driving and inform dvla

Question 95

Patient with metastatic breast cancer. Has nausea and vomitting - vomitting doesn’t relieve the nausea. Tx?

Answer 95

ondansetron

Question 96

Patient died after an anastomosis (cancer, op, tumours in adhesions). What to do?

• Start critical incident
• Refer to coroner
• Write up death certificate
• post mortem-
• reform to CEPOD

Answer 96

start critical incident

Question 97

What does anastomosis for haemodialysis mean?

Answer 97

artery and vein

Question 98

Middle aged man died, thick left ventricles (hypertrophy). Hadn’t seen GP IN ~10 years. Most likely cause of heart hypertrophy?
 Genetic cardiomyopathy
 Systemic hypertension
 Aortic stenosis
 Mitral regurgitation

Answer 98

systemic hypertension

Question 99

Asthma patient on salbutamol, beclomethasone, salmetrol, LABA, LTRA and amino/theophylline. Px had white spots inside mouth (I think it was alluding to oral candidiasis?) Which med is causing it?

Answer 99

beclomethasone

Question 100

Patient asks what is likelihood of having a condition even if test is negative (think it said ‘abnormal’ I.e. positive). Which value to look at?
 Odds
 Negative predictive value
 Positive predictive value
 Sensitivity
 Specificity

Answer 100

-

Question 101

R positive, PR positive, HER-2 negative breast cancer. No metastases. Spread to 1 out of 12 lymph nodes. What would be tx combination?
a) Tamoxifen and radiotherapy
b) Tamoxifen, radiotherapy and chemotherapy
c) Trastuzumab and something starts with A
d) Trastuzumab, the something that starts with A and another something rip

Answer 101

tamoxifen and radio

Question 102

11) Man with mild pain when raising arm above shoulder, on extremes of motion. Putting flexed arm across chest reproduces symptoms

Answer 102

supraspinatus tendonitis

Question 103

12) Woman post-flu. Large erythematous patch with scaly edges, 4 days later lots of red patches on the whole body

Answer 103

pityriasis rosea

Question 104

17) Young man drank cheap vodka. Slurring speech, ataxia, nystagmus. ?metabolic acidosis, low chloride
a) Ethylene glycol poisoning
b) Methanol poisoning
c) Ethanol poisoning

Answer 104

ethylene glycol

Question 105

20) Man bitten by dog. 3 days later hand is swollen and inflamed and black. Organis
a) S. aureus
b) Streptococcus pyogenes
c) Capnocytophaga canimorsus

Answer 105

capnocyto

Question 106

53) Female px. Firm lump upper breast quadrant. Painless. Indented into skin upon raising arm
a) Fibroadenoma
b) fibrocystic disease
c) fat necrosis
d) Carcinoma
e) breast abcess

Answer 106

carcinoma

Question 107

47) Patient had major haemorrhage and needs massive transfusion, is blood type O RhD negative. Hospital blood bank gave 6 O RhD negative units, but units of O RhD positive blood were brought to ER. One of the nurse staff asked about this. What should you do?
a) Do not transfuse
b) Can be transfused if she doesn’t have Rh factor antibodies
c) Can be transfused if given anti-Rhesus immunoglobulin at the same time
d) Can be transfused but ?give anti-Rhesus immunoglobulin with next transfusion

Answer 107

same time

Question 108

44) Something about a female px’s hallux.
a) Gout
b) Pseudogout
c) Charcot joint

Answer 108

gout

Question 109

41) 72yo lady prepping for surgery I think. 40kg in weight, how much IV fluids should be given over 24 hours?

Answer 109

1L

Question 110

32) Man in his 60s with psoriasis and psoriatic arthritis. Never had any systemic treatment before. Best treatment?

Answer 110

methotrexate

Question 111

29) Elderly female patient. Feeling well in herself, eats healthy and very active. brusiing

Answer 111

senile purpura

Question 112

24) Someone with delirium and ?mild hyponatraemia. Which drug is contributing?
a) Amitriptyline
b) Furosemide
c) ramipril

Answer 112

furosemide

Question 113

CAA-240216-12338
20. A 45 year old man with pain caused by cancer has been using opioids to
control his pain very successfully. He is taking a regular dose of MST
Continus® 60 mg 12-hourly orally. He has been using three breakthrough
doses (oral morphine 20 mg) per day for the past week.
Which is the most appropriate opioid prescription?
A. Diamorphine 60 mg subcutaneously over 24 h by syringe driver
B. Morphine 90 mg subcutaneously over 24 h by syringe driver
C. MST Continus ® 60 mg 12-hourly and morphine 30 mg as required (up to 4-
hourly) orally
D. MST Continus ® 90 mg 12-hourly and morphine 20 mg as required (up to 4-
hourly) orally
E. MST Continus ® 90 mg 12-hourly and morphine 30 mg as required (up to 4-
hourly) orally

Answer 113

e