Practice SAQ

Question 1

Mx options for OA before surgery (other than analgesia)?

Answer 1

activity modification
mobility aids
physio
steroid joint injection

Question 2

Reasons for doing a spinal over GA?

Answer 2

lower cost
better post op pain scores
allergy / contraindication to GA (e.g. COPD)

Question 3

Which 2 anatomical layers is spinal anaesthetic given between ?

Answer 3

arachnoid and pia mater

Question 4

What can be used for post-op thromboprophylaxis other than aspirin ? MOA?

Answer 4

LMWH e.g. dalteparin
inhibits factor Xa

Question 5

What nerve can be injured in a knee op to create foot drop? area of sensation loss?

Answer 5

common peroneal / fibular nerve
dorsum of foot and lateral leg

Question 6

malignant and non-malignant conditions that obesity is a risk factor for?

Answer 6

malignant : ovarian, breast, endometrial, bowel cancer
non-malignant: T2DM, htn, IHD, stroke, OA

Question 7

Which joints are most commonly involved in RA?
What are the antibodies seen?

Answer 7

proximal interphalangeal
metacarpophalangeal

RF, anti- CCP

Question 8

Extra-articular manifestations of RA?

Answer 8

dry eyes / mouth
scleritis
pericarditis
lung nodules / ILD
lymphadenopathy
splenomegaly
renal involvement
tendonitis
peripheral neuropathy (carpal tunnel)

Question 9

What specific classes of monoclonal antibodies can be used to treat RA?

Answer 9

anti- TNF
anti- interleukin 6
anti-CD20

Question 10

Anatomical landmark of the deep inguinal ring?

Answer 10

halfway between ASIS and pubic tubercle

Question 11

2 types of anaesthesia that could be used for inguinal hernia repair other than GA?

Answer 11

spinal, local

Question 12

What behavioural strategies can be implemented to help toddlers with constipation?

Answer 12

scheduled toileting - e.g. after each meal or 5 mins before bedtime
bowel habit diary for frequency and consistency ( ERIC toilet tool wall chart)
reward systems
address any social / psychological problems

Question 13

What is the first line medication for simple constipation in kids?

Answer 13

macrogol / Movicol

Question 14

Describe the role of a health visitor

Answer 14

offer support and encouragement to families through early years from pregnancy and birth to primary school

Question 15

Give some features that suggest that asthma is poorly controlled

Answer 15

difficulty sleeping due to sxs
frequently symptomatic during the day
interfering with usual activities
need to use SABA > 1/week
decreasing PEFR

Question 16

What should you ask a patient with a newly reduced peak flow?

Answer 16

adherence to tx?
increase in smoking / starting smoking?
new triggers - new pets, occupational exposure?

Question 17

Key questions to ask in hx of heavy, painful periods?

Answer 17

pattern of pain - onset, timing, character
blood loss - number of pads and tampons, length of period
associated sxs - bloating, mood change
abnormal bleeding (e.g. post-coital), discharge
Sexual hx - STI

Question 18

What advice should you give someone starting COCP?

Answer 18

how to start
how to take (same time each day)
missed pill advice / what to do with D+v
interaction with abx
side effects
does not protect against STI

Question 19

Describe how to perform the Dix-Hallpike manoeuvre

Answer 19

sit patient up on a couch and get them to focus on a point straight ahead
then lower patient down so lying on the bed, keeping eyes open
move head below level of bed and turn left or right
observe for nystagmus

Question 20

What is the pathophysiology of BPPV?

Answer 20

small fragments of crystals deposited in inner ear that can be swept along the fluid filled canal when head moves, send confusing messages to brain causing vertigo

Question 21

Initial advice for BPPV management?

Answer 21

avoid sudden position changes
rest and hydrate
don’t drive if symptomatic
consider adjustments at work

Question 22

Which arteries are likely to be stenosed in intermittent claudication?

Answer 22

superficial femoral or popliteal

Question 23

mechanism of action of aspirin?

Answer 23

irreversible cyclo-oxygenase inhibitor
prevents platelet aggregation

Question 24

Below which ABPI do patients experience rest pain?

Answer 24

0.5

Question 25

Why do patients feet often appear red (hyperaemic) at the end of Buerger’s test?

Answer 25

severe ischaemia = release of local vasodilators that increases perfusion of foot

Question 26

most appropriate urgent intervention for hydronephrosis ?

Answer 26

percutaneous nephrostomy

Question 27

important steps in a patient in Urgent Care who is acutely unwell with exacerbation of COPD?

Answer 27

admit to hospital
prescribe steroids and abx

Question 28

most likely causative organism of exacerbation of COPD?

Answer 28

strep pneumoniae

Question 29

Key points of COPD management post exacerbation?

Answer 29

regular review
review inhaler technique
vaccines
self management plan
rescue pack (abx and steroids)
pulmonary rehab

Question 30

1st line for severe CAP?

Answer 30

IV co-amoxiclav and PO doxycyline

Question 31

2 investigations that must be done before initiating TB tx?

Answer 31

LFTs and visual acuity testing

Question 32

Risk factors for palpitations?

Answer 32

hypertension
OSA
obesity
metabolic syndrome

Question 33

Investigations for underlying cause of palpitations?

Answer 33

U&Es - CKD or hypokalaemia ( AF )
TFTs - hyperthyroidism (AF)
Echo - structural heart disease
Ambulatory BP monitoring / Holter monitoring
Overnight pulse ox (if OSA)

Question 34

Most important tx to commence in AF?

Answer 34

anticoagulant e.g. DOAC to reduce stroke risk

Question 35

Tx for severe dehydration in a patient with diabetes insipidus?

Answer 35

Iv fluids and desmopressin

Question 36

Risks of severe dehydration?

Answer 36

stroke / thrombus
LOC
seizures
worsening hypernatraemia