PPQs Flashcards
1
Q
- 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?
A
5th metacarpal
2
Q
- 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?
A
laryngitis
3
Q
- 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.
A
delirium
4
Q
- 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?
A
fibrocystic disease
5
Q
- 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?
A
non-rebreather mask 100% oxygen
6
Q
- 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?
A
epididymal cyst
7
Q
- 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?
A
USS of abdomen
8
Q
- 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?
A
IV TPN
8
Q
- 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?
A
vesicovaginal fistula
9
Q
- 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?
A
toxic epidermal necrolysis
10
Q
- 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?
A
endotracheal tube intubation
11
Q
- 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?
A
CT
12
Q
- 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?
A
ascending cholangitis
13
Q
- 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?
A
AML
14
Q
- 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?
A
metatarsal stress fracture
15
Q
- 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?
A
patient previous opinion
16
Q
- 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?
A
lateral view
17
Q
- 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?
A
obstructive uropathy
18
Q
- 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?
A
digital nerve
19
Q
- 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?
A
death due to industrial disease
20
Q
- 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.
A
superior mesenteric
21
Q
- 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?
A
dcis
22
Q
- 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?
A
adrenaline
23
Q
- 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?
A
c. Systolic BP >130 mmHg
24
Q
- 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?
A
e. Wide local excision and sentinel node biopsy
25
Q
- 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?
A
d. Pooled human immunoglobulin
26
Q
- 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?
A
adenoma
27
Q
- 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?
A
intermittent self catheter
28
Q
- 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?
A
branchial cyst
29
Q
- 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?
A
IV paracetamol
30
Q
- 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?
A
respiratory droplet
31
Q
- 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?
A
psychogenic non epileptic seizure
32
Q
- 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
A
phosphate
33
Q
- 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?
A
simvastatin
34
Q
- 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?
A
spinal canal stenosis
35
Q
- 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
A
topical bacterial decolonisation
36
Q
- 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?
A
epidural
37
Q
- 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?
A
vitreous haemorrhage
38
Q
- 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
A
proctosigmoidoscopy
39
Q
- 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?
A
mobilisation
40
Q
- 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?
A
right superficial femoral artery
41
Q
- Which factor signifies greatest risk of progression in RA?
a. Joint involvement >8
b. CRP
c. Anti-CCP
d. RF
A
anti ccp
42
Q
- Woman 55yo? with pain in groin, mets in femur, where was primary lesion located?
a. Renal
b. Cervical
c. Lung
A
lung
43
Q
- Milky fluid drained from chest after surgery
A
chylothorax
44
Q
- Women with headaches, pushing on the frontal lobe. Which brain tumour?
a. Meningioma
b. Astrocytoma
A
meningioma
45
Q
- Most common side effect of radiotherapy for SCC lung cancer?
a. Oesophagitis
b. Pneumonitis
c. Neutropenia
A
pneumonitis
46
Q
- What cell is primarily affected in MS?
a. Oligodendrocytes
b. Astrocytes
c. Schwann cells
A
oligodendrocytes
47
Q
- COPD wasn’t eating much. Which tool would be most useful?
A
malnutrition universal screening tool
48
Q
- Gram negative bacteria causing pneumonia in CF patient?
A
psuedomonas aeruginosa
49
Q
- Blood supply to 2nd part of duodenum.
A
gastroduodenal artery
50
Q
- Lymphadenopathy, fever, bilateral conjunctival swelling
A
leptosperosis
51
Q
- Gram positive cocci causing pneumonia with cavitations.
A
staph aureus
52
Q
- Lacunar infarct, what drug to give in addition to aspirin?
A
statin
53
Q
- Breastfeeding women with hyperthyroidism. Tx?
a. Carbimazole
b. PTU
c. Radioiodine
A
PTU
54
Q
- 43 year old with pain in bilateral knees, wrists.
A
RA
54
Q
- Intrinsic muscle wasting of hands, biceps reflex reduced.
A
C5
55
Q
- 28yo with some episodes of semi-loose stools. He is healthy between episodes. Tx?
A
FODMAP diet
56
Q
- 18 year old girl comes in with low potassium, macrocytic anaemia and raised urea, physical examination otherwise normal. What is the cause?
A
anorexia nervosa
57
Q
- 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
A
confusion and fever
58
Q
- 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
A
anterior
59
Q
- Pt is diagnosed with Hodgkin’s lymphoma, how would you describe the treatment?
a. Neoadjuvant chemotherapy
b. Adjuvant chemotherapy
c. Curative chemotherapy
A
adjuvant
60
Q
- Gleason score 3 + 3, what is the appropriate mx?
a. Watchful waiting
b. Surgery
c. Medication
A
watchful waiting
61
Q
- 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?
A
hypokalaemia
62
Q
- Bone most likely fractured in pt with diplopia, facial anaesthesia
A
zygomatic
63
Q
- What explains fast progression of atherosclerosis?
A
more LDL production
64
Q
- Woman on recreational drugs has hypokalaemia and hyponatraemia?
a. Ketamine
b. MDMA (ecstasy)
c. Nitrous oxide
A
MDMA
65
Q
- Sx of C3-6 dysfunction. Where is lesion?
A
cavernous sinus
66
Q
- 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
A
alendronic acid
67
Q
- DEEP abdominal pain and right loin pain, vomiting 1 hour, now hypotensive, cap refill 5s. pmhx hypertension and hypercholesteremia
A
ruptured aaa
68
Q
- Overdose, dilated pupils with widened QRS. Patient refuses to disclose what medication was overdosed. What was the agent?
A
amitryptilline
69
Q
- Correct statin target 3 months after starting treatment:
A
> 40% reduction in non-HDL cholesterol
70
Q
- 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
A
orientation techniques
71
Q
- 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
A
change asprin to apixaban
72
Q
- 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
A
ct
73
Q
- 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
A
abnormal alveolar cap osmosis
74
Q
- 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
A
wrist extensors
75
Q
- 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
A
reassure
76
Q
- 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
A
renin
77
Q
- 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
A
total hip
78
Q
- 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
A
pleomorphic adenoma
79
Q
- 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
A
stop epidural
80
Q
- 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
A
femoral nerve block
81
Q
- 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
A
cxr
82
Q
- 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?
A
lateral soft tissue next x ray
83
Q
- 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?
A
radial nerve
84
Q
- 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
A
ivermectin cream
85
Q
- 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?
A
methadone
86
Q
- Patient had winging of the scapula. Long thoracic nerve innervates which muscle?
A
serratus anterior
87
Q
- 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
A
plaster cast
88
Q
- 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
A
ciprofloxacin
89
Q
- 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?
A
give slidenafil
90
Q
- 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
A
radiotherapy
91
Q
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
A
performance
92
Q
Palliative Px with terminal agitation, what is the tx?
A
midazolam
93
Q
Elderly man, dysphagia with solids but not liquids, what is the initial investigation?
A
upper Gi endo
94
Q
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
A
stop driving and inform dvla
95
Q
Patient with metastatic breast cancer. Has nausea and vomitting - vomitting doesn’t relieve the nausea. Tx?
A
ondansetron
96
Q
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
A
start critical incident
97
Q
What does anastomosis for haemodialysis mean?
A
artery and vein
98
Q
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
A
systemic hypertension
99
Q
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?
A
beclomethasone
100
Q
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
A
-
101
Q
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
A
tamoxifen and radio
102
Q
11) Man with mild pain when raising arm above shoulder, on extremes of motion. Putting flexed arm across chest reproduces symptoms
A
supraspinatus tendonitis
103
Q
12) Woman post-flu. Large erythematous patch with scaly edges, 4 days later lots of red patches on the whole body
A
pityriasis rosea
104
Q
17) Young man drank cheap vodka. Slurring speech, ataxia, nystagmus. ?metabolic acidosis, low chloride
a) Ethylene glycol poisoning
b) Methanol poisoning
c) Ethanol poisoning
A
ethylene glycol
105
Q
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
A
capnocyto
106
Q
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
A
carcinoma
107
Q
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
A
same time
108
Q
44) Something about a female px’s hallux.
a) Gout
b) Pseudogout
c) Charcot joint
A
gout
109
Q
41) 72yo lady prepping for surgery I think. 40kg in weight, how much IV fluids should be given over 24 hours?
A
1L
110
Q
32) Man in his 60s with psoriasis and psoriatic arthritis. Never had any systemic treatment before. Best treatment?
A
methotrexate
111
Q
29) Elderly female patient. Feeling well in herself, eats healthy and very active. brusiing
A
senile purpura
112
Q
24) Someone with delirium and ?mild hyponatraemia. Which drug is contributing?
a) Amitriptyline
b) Furosemide
c) ramipril
A
furosemide
113
Q
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
A
e
