Practice Questions Flashcards
John’s mother who is aged 58 weeks wakes in the middle of the night with sudden
onset epigastric pain which she can point to with a finger. She rings 111 for advice.
She explains that this happened once a few years ago. Similarly, this was following a
large meal late at night. The 111 service ascertain that she is otherwise well, and the
pain is just below the bottom of the xiphisternum.
What simple medication remedy could be advised for this person to take to best
alleviate the discomfort and make the diagnosis, assuming that they have it in the
household?
Antacid ( Gaviscon )
The next door neighbour, Mr Archer, who is aged 72 and smokes heavily consults the
GP. He has noticed that when walking to the local shop which is 250 yards from his
house and is up an incline, results in a heavy feeling at the front of his chest. This
resolves if he stops for a minute and he can then restart the walk. He is on no
medication. His ECG is normal and his fasting cholesterol is 4.2 mmol/ litre. What
should the GPs management plan now involve?
Referal to cardiac specialist to see cause of angina
John, the 27-year-old proceeds to tell the GP that his chest pain is
posteriorly over the left loin area. This pain comes on when he moves in particular his
left shoulder or he presses on the outside of the area over the lower ribs where it is
tender. It transpires that two days ago he was doing some heavy work in the garden
moving paving slabs. Examination of the cardiovascular and respiratory system is
normal. What is the most likely cause of his pain?
Intercostal muscle tear
John’s father presents to his GP with lower acute left sided in inspiratory chest pain.
Two days previously he was on a flight from New York to Birmingham. His pulse rate
is regular and 130 bpm. He has no fever.
His lung fields are clear on examination. Unlike his son, John, there is no tenderness
of the chest wall.
What other aspects of examination might reveal the diagnosis and what further
measurement can easily be taken in a GP surgery that additionally might suggest a
possible cause?
Check legs for signs of DVT ( Swelling, Redness)
Pulse oximetry ( will be below 95% in PE)
If someone is newly diagnosed with diabetes associated with involuntary weight
loss is it more likely to be type 1 or 2 diabetes?
Type 1 Diabetes Mellitus
What are the 3 crucial elements in the management of diabetic ketoacidosis that
a GP should be thinking of when requesting hospital admission?
Fluid balance
Correcting electrolytes
Insulin
Admission to hospital
What factors affect the accuracy of HbA1C?
Children
Pregnancy
Haemoglobinopathies
Type 1 Diabetes Mellitus
Anaemia
Splenectomy
CKD
Dialysis
Post Transfusion
Name 3 macrovascular complications of diabetes
Stroke
Coronary Heart Disease
Peripheral Vascular Disease
Name 3 side effects of Metformin?
Nausea
Diarrhoea
Lactic acidosis
What side effect of Sulphonyureas can can falls?
Hypoglycaemia
Name 3 microvascular complications of Diabetes?
Retinopathy
Nephropathy
Neuropathy
Other than HbA1C measurement how can the diagnosis of Diabetes be made?
Fasting plasma glucose >7mmol
AND/ OR Random plasma glucose > 11.1mmol
2 measurements needed
If a patient had a high MCV and the blood film is reported as having a macrocytosis and hypersegmented neutrophils, what further two blood tests would you request?
Suspected pernicious Anaemia
Vitamin B12
Folate
What is another potential cause of Macrocytosis?
High alcohol intake
A MCV of higher than 100fl in patients with liver disease indicate alcohol related disease
Name two conditions that can cause a high ESR in the older age groups?
Polymyalgia Rheumatica/ GCA
Multiple Myeloma
