progress test past questions Flashcards
1
Q
A patient with AML having CTx becomes febrile and the area around his hickman line is red - what is the most likely organism?
A
staph aur
2
Q
6yo boy has been unwell for a few days with mild fever and rash - rash covers face trunk and features blisters, spots and some scabs - what is the causative organism?
A
varicella zoster
3
Q
54yo M has 2x episodes of R sided pneumonia within 6/12. CXR = partial RLL collapse but no mass on CT - what Ix next?
A
bronchoscopy
4
Q
Which type of thyroid carcinoma produces calcitonin?
A
medullary
5
Q
what is the target INR for someone on warfarin?
A
2.5 - usually, but depends what it’s for
6
Q
A 22yo F finds a lump in her L breast. There has been no size change in 8/52 when she found the lump. Her maternal aunt had breast Ca. The mass = 2cm, mobile, firm, rubbery, no-tedeness. There are no other lumps inc axilla - what is the most likely diagnosis?
A
fibroadenoma
7
Q
Which WBC would be raised in strep pneumonia?
A
Monocytes
8
Q
What is the neurotransmitter associated with OCD??
A
5-hydroxytryptamine (serotonin)
9
Q
if a woman has had unprotected sex 3/7 ago what contraceptive could you give her?
A
high dose progesterone - morning after pill
10
Q
Which hormonal change would support a diagnosis of premature menopause?
A
inc FSH
11
Q
A 64 yo M has chest pain and is SOB. His HR 34, BP 85/64. ECG = ST elevation in inferior leads and complete atriovetricular dissociation (complete heart block) - what is the most appropriate 1st line Tx?
A
atropine
12
Q
A 35M is having palpitations. He is unwell - HR 170 with a narrow complex, BP 70/50 RR 24, CRT = 3s - what is the most app Tx?
A
DC cardioversion - unstable SVT. If stable attempt medically using amioderone
13
Q
how would you investigate subacute infective endocarditis?
A
urine dip for microscopic haematuria
14
Q
Which analgesic should be avoided in children?
A
aspirin
15
Q
what are high levels of anti-neutrophil cytoplasmic Abs assocaited with? (ANCAs)
A
vasculitis
16
Q
What is the immediate treatment of a patient with CT head showing acute left cerebral infacrtion?
A
aspirin
17
Q
A 33M is admitted with SOB, cough, haemoptysis. He is caucasian and smokes 20/day. No recent foreign travel. Looks unwell, centrally cyanosed and bilateral wheeze. Urinalysis = blood 4+, protein 3+. Urea/Cr high, eGRF 22 (n >60), anti-glomerular basement membrane ABs +ve - which mechanism best explains the development of AKI?
A
binding of IgG in glomerular capillaries - glomerular nephritis
18
Q
what is non-maleficence?
A
do no harm
19
Q
You see a cyanosed 12 hr old baby who is otherwise normal - what is the diagnosis?
A
transposition of the great arteries
20
Q
A 65F has a 6/12 Hx of swallowing difficulties and pain and stiffness in her joints. OE - cold white fingers and reduced RoM in her hips and kness - which AB is likely to be positive?
A
Anti-cholinesterase Abs (myasthenia gravis)
21
Q
What can cause painful penile ulcers?
A
HSV
22
Q
what is the indication for DC cardioversion?
A
VF, pulseless VT, fast AF (new onset of haemodynamically unstable), SVT if medical fails or if haemodynamically unstable
23
Q
which clotting test will be prolonged in haemophilia A?
A
APTT
24
Q
A 45F presents with abdo pain + jaundice - her LFTS = albumin n, ALT n, ALP (H) 351, BR (H) 207, CRP 8 - what,s the Dx?
A
gall stones - picture of obstructive jaundice
25
A traveller has been to Thailand and now has diarrhoea, low Hb, high eosinophils - what is the organism?
hookworm
26
If someone reports inappropriate behaviour in a colleague, who do you report to first?
Consultant in charge
27
In paedes, which part of the brain is damaged when they have prolonged jaundice? Sx = variable muscle tone, abnormal posturing of hands when reaching for objects
basal ganglia
28
which neurotransmitter is targeted in medical therapy for bulimia?
serotonin - give SSRIs
29
what change in lung fucntion supports idiopathic pulmonary fibrosis?
reduced transfer factor
30
If a woman is pregnant and has ?chicken pox - which intervetion would you start immediately?
IV aciclovir
31
An 8yo boy has been soiling himself at school. He has a Hx of hard stools every 3 days, abdo pain and poor appetite for the last 3/12. Recetly he has had loose and offensive stools - diagnosis?
overflow incontinence
32
6yo boy has had a red rash on his limbs and trunk for past 2 months, Sx are intermittant and has had some lip swelling - what's the diagnosis?
idiopathic urtacaria and angioedema
33
A 64M in seen in A&E with sudden onset of bilateral parasthesia in both lower limbs, loss of bladder control, altered perineal sensation and weakness in LL. His lumber spine XR show sclerotic areas. PMHx = DM and prostate Ca. What is most approprite immediate medical Mx?
IV corticosteriod - In the setting of spinal cord compression, steroids decrease the associated vasogenic edema and thereby substantially improve neurologic function and decrease pain.
34
what is the initial investigation for a patient with persistent swallowing problem?
upper GI endoscopy
35
What nail signs might you see in hands of someone with psoriasis?
nail dystropy
36
which drug for HTN might you see renal impairment in?
ACEIs eg ramipril
37
20M 1/52 worsening sore throat, drooling, difficulty speaking, R palatoglossal fold is swollen and R tonsil reaches misline - WCC = 15 - Dx?
peritonsillar abscess
38
If a patient who has recently had or is currently having chemo and they present with a fever >38 what is the initial management and why?
admit + IV ABx - the patient might have neurtopenic sepsis
39
A 54yo M has a 6/12 Hx of worsenig breathlessness, wheeze, and itermittant abdo pain. PMHx = allergic rhinitis and asthma. He has a purpuric rash on his abdo and legs. He has bilateral polyphoic wheeze. His bloods = WBC+, low lymphocytes, eosinophils+, p-ANCA positive -what is the most likely diagnosis?
churg-strauss
40
A 52 yo F presents wth progessive swelling of her legs over 2/52. She has a Hx of dissemiated renal Ca. She has pitting oedema to her groin and dilated veins over her lower abdomen - what is the most likey cause of her leg swelling?
IVC occlusion
41
45yo taking clozapine has sore throat and fever, which is the best initial blood test and what are you looking for?
FBC - looking for raised WCC and CPK. Clozapine can cause neuroleptic malignat syndrom, of which fever is a synptom
42
Where is the most likely site for failure of lactation in the brain?
anterior pituitary
43
what is the likely diagnosis - glomerularnephritis, end stage renal disease, hearing loss?
Alport's syndrome
44
what is the most likely organism in cellulitis in a DM?
strep pyogens
45
what is the indication for medical cardioversion and what would you use?
narrow complex tachycardia (SVT)
| adenosine (could attempt valsalva manoeuvre or carotid massage first)
46
A 73 year old male is admitted with chest infection.The following day he has confusion, anxiety, aggression during which he attempts to leave. He is convinced he's being spied on and insists there are cameras have been installed. The episodes alternate with peiods of lethergy which become more pronounced toward the evening. temp 37.8, bp 110/73, rr12 - what is the diagnosis?
delerium
47
which ABx affets anticoags?
clartihromycin
48
what kind of a pulse would you expect in CO2 narcosis, sepsis or liver failure?
bounding
49
A 62yo M is having difficulty walking due to leg swelling. He smokes 20/day. BP 144/94 and he has odema up to his scrotum. Urinalysis shows blood 1+, protein 4+. He has a high urea/creatinie, U:C, low albumin - which Ix most likey to lead to diagnosis?
renal biopsy
50
An infant bruises easily due to haemophilia A - what factor is deficient and what is the deficient factor required for?
factor VIII, formation of the tenase complex with activated factor IX
51
what kind of pulse would you expect in aortic stenosis?
anacrotic/slow-rising
52
Where is the pathology in this patient - loss of vision in left visual field of both eyes, central vision good, Hx angina and TIA
Right occipital lobe
53
if a hypertensive diabetic finds their blood glucose poorly controlled, what drug might be to blame?
thiazide
54
A 65yo F has routine breast screening. She has no symptoms of breast disease, no relevet FHx and a normal breast exam. Her mammogram showed a focal area of microcalcification - what is the most common pathological cause?
ductal carcinoma in situ
55
what process is increased in DKA?
increased lipolysis
56
A schizophrenic patient is given olanzapine and becomes hot, confused, sweaty, fever with varying BP, what is the Dx?
neuroleptic malignat syndrome
57
A man with HTN is admitted with hypoTN, as well as fluid resus what do you do?
stop anti-HTNs
58
You see a 6/52 infant who has decreasing weight, RR 50 and mild subcostal and intercostal recession. The liver is palpable 3-4cm. He has a parasternal heave and promenant pansystolic murmur loudest at lower L sternal margin - what is the cardiac abnomality?
VSD
59
2 sets of nonparametric quantative data from same popn, what test looks at the diff between 2 datasets?
mann-whitney U
60
A 3yo M is seen in A&E. He is SOB with a barking cough. He has been unwell for 2/7 with a cough, temp and runny nose. He is in respiratory distress and has noisy breathing - what is the best initial Tx to improve his breathing?
oral dexamethasone
61
An elderly woman has sores at the corner of her mouth. She also has a sollen dark red tongue and is pale - what is the deficit?
iron
62
what should you treat bacterial tonsillitis with?
penicillin V (phenoxymethylpenicillin), particularly in paeds and strep throat
63
If a patient has had a stroke with a large intracerebral haemorrage and is on warfarin (INR = 4.6) you can give vit K but what else can you give?
prothrombin complex concetrate
64
What class of drugs are used for the prostate?
alpha blockers
65
What is the course of action if you are pregnant and contract chicken pox?
aciclovir within 24hrs of rash developing
66
what may someone with uncontrolled coeliac disease be more at risk of?
small bowel lymphoma
67
62M has increasing pain in R eye for 6/24. He has a cataract op on same eye 2/52 ago. Conjuntiva = bright red and corena hazy. Vis ac = 6/60 in R and 6/9 in L - what's the Dx?
angle closure glaucoma
68
A 12F presents who is ?meningococcal septsis - when should communicable disease control consultant be informed?
upon clinical Dx
69
A 61yo F presents with a painful swelling in back of her knee. She has a 10yr Hx of RA. The soft swelling is only visible when the knee is exteded - what is the diagnosis of swelling?
baker's cyst
70
which mechanism that normally preserves GFR in the face of hypovolaemia is blocked by ramipril?
constriction of the efferent arteriole
71
Which vitamin in higher than normal amounts = dry skin, generalised itch, HA worse in am that wake from sleep, skin yellow?
Vit A
72
66yo male has episode of amaurosis fugax, you order carotid duplex, which level of carotid artery stenosis would promt you to refer him for carotid endartectomy?
90%
73
35 year old female presents with 6/52 fatigue. She is pale, has low Hb, MCV+, AAT+, biliruben+ - which test to confirm diagnosis and why?
direct antiglobulin test AKA Coombes test for autoimmune haemolytic anaemia
74
A 3 yo F has an ear infections, which ABX would you use?
amoxicillin
75
A 7F has diarrhoea and failure to thrive. She is pale and on the 25th centile for height, below 3rd centile for weight. At preschool check up she was 25th for both height and weight. Stool culture was -ve. Which blood test would be most informative?
IgA endomysial AB - another test for coeliac disease
76
A 14F is requesting the OCP. Her boyfriend is her own age and she doesn't want to tell parents. Gp thinks ok to prescribe but what is the best thing to do?
Advise to discuss with parents
77
how many days before surgery should you withhold warfarin?
5
78
what would the diagnosis be - how would you describe a schizoid personality?
aloof, lack of interest in forming relationships, solitary, apathetic
79
A 3yo F is resisting mum's attempts to toilet train. Phones GP. What is the most appropriate professional to help?
health visitor
80
which drug for HTN might you see oedema in?
CCBs eg amlodipine
81
long Hx repetative unpleasent thoughts, recognises own thoughts but is unbale to stop throughts - diagnosis?
OCD
82
how would you investigate angina?
exercise ECG
83
A 6yo M has multiple discrete red patches with irregular edges on his face and hads. There is a yellow crusting cap. He has had contact with other children with similar rash - what is the best Tx?
oral flucloxacillin
84
What is the initial teatment for broad complex tachycardia when the patient is unstable?
cardioversion
85
What is used to measure dunfractionate heparin?
APTT
86
What is the antibody for lupus?
anti DS-DNA
87
39yo female presents with acute onset of the 'worst headache ever'. The initial CT = n, what is the next step in her management?
LP
88
What is the diagnosis - 28 year old male presents with a painful red eye for 5/7. There is redness at boarder of sclera and cornea and hiseye is watery. Flourescein staining was normal. His pupil is irregular.
anterior uveitis
89
A 20F had unprotected sex 5/7 ago - which is the most appropriate emergency contrception?
ulipristil acetate 30mg single dose
90
which nerve is affected if a patient presents with weakness in wrist extension and reduced sensation on the backof their hand between their thumb and index finger?
radial nerve
91
in what conditions if ALP raised?
pregnancy, bowel disease, bone disease, liver disease
92
Who can confirm brain stem death?
2 docs, 1 must be consultant, both >5yrs registration
93
A 65M has severe psoriasis for 6/12 requiring systemic Tx. He has had no previous systemic Tx. He has HTN and hyperlipidaemia. Which is the most app Tx?
methotrexate
94
A 13 yo M has bilateral itchy watery eyes. He has been taking oral antihistimine for hayfever. His mother worries that his eyes might affect his exams in 4/52 weeks time. What is the most appropriate Mx?
sodium cromoglicate
95
8yo boy with a productive cough, abdo pain, refusing fluids, febrile, RR 50, lung creps - which organism is most likely?
strep pneumonia
96
what would you do in the following scenarios involving patients on warfarin:
1 - significant or life threatening bleeding
2 - no active bleeding, INR above theraputic range but <4.5
3 - no active bleeding, INR 4.5 - 10.0
4 - no active bleeding, INR >10
1 - stop warfarin, give vit K and prothrombin +/- FFP
2 - stop warfarin, restart as pt approaches therapeutic level
3 - stop warfarin, consider vit K
4 - stop warfarin, PO vit K
ALWAYS CONSIDER WHY INR IS HIGH
97
You see a 71yo M with chest pain and fever for 1/52. He had an inferior MI 1/12 ago. His temp = 37.5, hr 68, bp 116/78, sats 95%. He has a soft systolic murmur at apex. ECG = Q waves and T inversion in leads I II, III, avF - what is the most likely diagnosis?
pericarditis
98
What do you use these for-
Atropine
Adenosine
Amioderone
Atropine - speeds up heart, used in symptomatic brady eg heart block
Amioderone - ALS pathway
Adenosine - SVT
99
A 72M is treated for CHF. He has occasional nausea, vomiting, anorexia and yellowish tint - which drug is causing these symptoms?
digoxin
100
which hormone is released from adrenal cortex as a consequece of rumanitve thoughts?
cortisol - stress!
101
if a patient has an MI with complete heart block, which vessel is affected?
right coronary
102
A 16 year old F suffers from spots that are worse with stress and pre-period.What type of bacteria do drugs target?
propionbacterium
103
what is the diagnostic technique used for a patient that presents with painless jaundice?
high res CT scan for pancreatic Ca
104
A 34F with HIV presents with head ache and right hemiparesis. CD4 count is 56 (n 430-1690). Her CT head = multiple cerebral masses that enhance with contracts - what's the Dx?
cerebral toxoplasmosis
105
An 18yo F has a rash on her elbows that is very itchy. She is tired and has had bouts of abdo pain and loose stools for 1 yr. She has pulovesicular eruptions on both elbows -what is the diagnosis for rash?
dermatitis herpetiformis, underlying coeliac disease
106
what is the appropriate lifetime relapse rate of thyrotoxicosis after stoppping antithyroid drug treatment?
50%
107
A 3M is struggling to run as fast as his peers. He is falling over more often, struggles to climb and stairs are becoming more difficult. OE he has enlarged calves but legss and trunk are weak. Leg reflexes are absent. Which anatomical structure is moslt likely to be affected?
striated muscle - he has DMD
108
A relapseing schizophrenic is admitted to a pshychitric hospital and is very agitated so requires sedation. Which medication is most likely to have caused the deterioration of his behaviour?
lorazepam
109
An HIV +ve patient presents with hemiplegia, low CD4, abd CT head shows a brain mass in midline crossing corpus calosum + oedema - what is the diagnosis of the brain mass?
primary cerebral lymphoma
110
A 19yo F is being followed up for suspected inflammatory arthropathy. Her CRP = 52. Which cytokine was responsible for this observation?
IL6
111
if a patient being treated for HTN who has been on BBs for over 10 years feels dizzy and light headed with the addition of a new drug, what drug might have been added?
CCBs eg amlodipine
112
What is the first line fluid to give in fluid resus?
0.9% NaCl
113
A 50F presents with double vision post serious head injury, she sees one image above the other - which CN is affected?
Trochlear
114
What action should be taken if you are pregnant and are exposed to a person with chicken pox and you do not know if you have had it in the past?
Have AB testing for varicella zoster, if not immune then treat with Ig
115
A 22F has anorexia, nause and abdo discom for 3/7. She has a recent holiday in thailand. Blood tests show raised serum IgA AB for hep A - what is the most likely risk factor?
eating contaminated food - hep A spread by eating or drinking food or water contaminated with infected faeces
116
A 42 yo F has a total hysterectomy for leiomyomata. Her last smear was 2 years ago and was normal - which further screening should be offered?
none
117
A 45yo M has a 3/52 Hx of teder red lumps on both shins. Initially they were red and shiey but some have progressed to blueish bruises - what is the pathology of lesions?
panniculitis - s a group of diseases whose hallmark is inflammation of subcutaneous adipose tissue (the fatty layer under the skin - panniculus adiposus). Symptoms include tender skin nodules, and systemic signs such as weight loss and fatigue.
118
how can sodium valporate affect an unborn child?
spina bifida
119
Which artery is being affected in this patiet and why - ECG showing complete heart block, BP 65/49, HR 26, central chest pain, SOB, pain radiating to l arm+jaw
right coronary - the bradycardia and complate heart block is caused by ischaemia of the SANode
120
what is the most sensitive imaging for renal calculi?
non contrast CT urography
121
What is the fastest way to reverse warfarin?
prothrombin complex factor
122
What is the initial treatment for Bell's palsy?
prednisoloe
123
What are the indications of urine and plasma osmolality?
diagnosing diabetes insipidus
assessing hydration status
assess concentrating ability of the kidney
assessing disorders involving ADH
124
What action should be taken if you are pregnant and non-immune to chicken pox and come into contact with an infected person?
varicella zoster Ig
125
A 85M has a 4/52 Hx of progressive and intensely itchy blisters over his trunk and legs. PMHx of parkinsons, no regular meds. no mucosal involvement, no systemic Sx. photo of large blisters - what is the underlying pathological mechanism?
antibody deposition- bullous pemphigoid, chronic AI disease, type II hypersensitivity reaction
126
how would you manage narrow complex tachycardia and what would you do if that didn't work?
valsalva manouevre followed by amioderone
127
ABX for c diff?
metranidazole
128
which vessel is affected if you see ST elevation in leads II, III, F?
inferior MI, right coronary artery
129
A 34 year old female has a recurrent itchy rash. She is a taxi driver therefore wants non-drowsy treatment. What is the most appropriate Tx?
cetirizine tablets
130
A primiparous woman who has pre-eclampsia has an emergecy c-sec - what is the best VTE prophylaxis?
stockings and 7/7 LMWH
131
You have a patient with a low RR who has been given morphine - what is the best immediate intervetion?
IV naloxone
132
What is the first suggestion for an alternative contraceptio for someone who keeps forgetting the pill?
Depot injection
133
A 60 year olds M receives a blood transfusion. 4hrs post-transfusion his temp increases, pulse increases, sats decrease and BP increases - what is the cause of this condition?
non-haemolytic febrile reaction
134
A 38yo M wakes with severely reduced vision in his R eye. He had a few floaters the previous evening but no pain or flashing lights. PMHx = T1DM, HTN. His current visual acuilty = light only - what is the diagnosis?
vitreous haemorrhange
135
An unwell T1DM child who is refusing food and has a low BM is brought in in the morning - what is the best Mx?
inc freq BM monitoring, usual morning insulin dose + carb rich oral fluids
136
30yo male, infection 2 weeks ago, chest pain through to back, ST elevation on ECG - what's the diagnosis?
acute pericarditis
137
You have a 44 yo M with chronic hepatic impairment. You ant to give him a new drug that is lipid soluble and binds exclusively to albumin and undergoes 1st pass metabolism. What adjustment to dose is appropriate?
reduce dose and lengthen dosing iterval
138
30yo male is febrile with HR 150 and BP 90/60. He had a splenectomy 4 years ago and has had no vaccinations in last 10 years - what is the most likely causative aoganism?
strep pneumonae
139
Where is the site of pathology - 4 week Hx of vertigo lasting few secs when looking up and turning to left with a normal neurological examination?
post semicircular canal
140
what is charcot's triad and which diagnosis does it make you think of?
RUQ pain, fever, jaundice = ?ascending cholangitis (bacterial infection in biliary tree)
- gall stones predispose, give IV ABx and ERCP to release any blockage
141
A patient presents with severe abdo pain and reports pale bulky stool that float. AXR = calcification in epigastric region - how would you treat this patient?
panc enzyme supps
142
IVDU with fever, inc JVP, soft pancystolic murmur in L sternal edge - what is the most likely causative organism?
staph aur
143
A 21yo M attends chest clinic. He has coughed up an eggcupfull of yellow sputum everyday since childhood. The sputum is often blood stained during chest infections. He becomes SOB and wheezy during infections. He has clubbing, crackles,and a wheeze in both lungs - which blood test might explain his condition?
gamma globulin levels - hypogammglobulinaemia in bronchiectasis (permanent enlargement of parts of the airways of the lung). Causes of brnchiectasis inc CF
144
what is the pathological cellular origin of a dermoid ovarinl cyst?
germ cell
145
An 18M has septic shock - HR 125, BP 85/40, urieg output <30ml/h. He is receiving IV fluids and ABx. What else should he have?
Noradrenaline
146
What would be the best blood test for diagnosis is someone with vision loss over short time, headache, shoulder pain and weight loss? What is the diagnosis?
ESR, giant cell arteritis
147
what kind of pulse would you expect in aortic regurg?
collapsing
148
what is the appropriate Mx for a neuropathic baldder?
intermittant self catheterisation
149
A pregnant women presents with a with breast lump that is tender, red and 2cm. She is a smoker - what is the best initial management for her?
triple assessment - clinical exam, mammogram, biopsy
150
A child who hasn't had a BCG is exposed to active TB. He has a strong +ve mentoux but no Symptoms - how would you manage him?
treat for 1ry TB
151
How would you treat a UTI in pregnancy?
amoxicillin, even if nitro is on the list
152
A 25 yo F with anorexia is admitted and s eating again. She becomes tachypnoeic - which is the most important serum analyate to measure?
phosphate
153
A 46M has a painful left leg and tingling in his L big toe. He is unable to walk on the ball ofhisL foot - which nerve root?
L5
154
how could you make aortic stenosis louder?
squatting
155
what is beneficence?
action that is done for the benefit of others
156
A 30M with psoriasis has tried topical therapy which hasn't been effective - what is 1st line systemic Tx for him?
phototherapy
157
which organism causes 'slapped cheek' in paeds?
parvovirus B19
158
which vessel is affected if you see ST elevation in leads V1-V6, I, L?
anterior MI, left ant. Decending
159
What effect can fluoxitine in pregnancy have on the baby?
persistant pulmonary hypertesion of the newborn
160
A 58yo M has a 4/7 Hx of productive cough, SOB, fever. He has HTN and T2DM. His meds = ferusemide, lisinopril, metformin, simvast. temp 38, hr 90, bp 122/87, and he has coarse inspiratory crackles at theHe is advised to take erythromicin - what is the best advice regarding his current meds?
withold simvastatin - can cause rhabdomyolysis
161
84 female attends A+E with SOB, HR 100, BP 146/94, RR 22, sats 94 on 4L, bibasal insp creps and peripheral oedema in both calves - what is the best immediate Tx?
furosemide
162
A 54M has 2 episodesof R pneumonia within 6/12. CXR shows partial RLL collapse, no mass on CT. What Ix should be performed nect?
bronchoscopy
163
A 26 yo F is planning her next pregancy. Her first pregnancy was termiated due to spina bifida - what is the best folic acid supplementation for her?
5mg daily from 3/12 preconception
164
53F - most likely cause of meningitis when CSF grows +ve cocci?
strep pneumoniae
165
Where is the most likely site of bleeding in recurrent epistaxis in child?
little's area
166
What is the anatomical and physiological basis for sensorineural presbyacusis?
loss of cochlear hair cells and auditory nerve fibres
167
If a aptient had liver cirrhosis and needed to take a lipid soluble drug that bids to albumin, what would the effect be on its metabolism?
low blood clearence
168
49 yo male has a pituitary tumour involving the optic chiasm - which visual field defect is most likely?
bitemporal hemianopia
169
If a patient taking haloperidol experiences twisting and rigidity of neck how would you treat them?
procyclidine - used for S/E in haloperidol
170
What is the initial treatment in hypercalcaemia?
IV 0.9% NaCl
171
how would you manage a broad complex tachycardia in a stable patient?
amioderone
172
what is the most sensitive blood test for acute pancreatitis?
lipase!
173
A patient is on carbimazole for grave's disease and is experiencing malaise and sore throat - what is your initial investigation and why?
FBC to investigate neutropenia. Neutropenia = infections/sore throat/fever etc
174
A pregnant lady who is 36/40 weeks is found unconscious in the bathroom. She is now conscious but has a headache, BP 160/95, urine dip = protein+++ - how would you medically manger her?
Magnesium sulphate
175
what would you see in an ECG for wolf-parkinson-white?
short PR and delta waves
176
In an emergency surgical situation, what kind of consent is needed?
none
177
If a liver biopsy is found to have multiple granulomata with cetral acellular appearece, what's the diagnosis?
TB
178
disease of which valve is most common in AF?
mitral (stenosis)
179
What is the target for infliximab?
TNF alpha
180
What is the most likely organism to cause D+V after BBQ meat?
campylobacter
181
A 78F is finding it increasingly difficult to get out of bed in the AM. OE - no swollen joints, ESR = 88 (n=<20), tender around shoulders and thighs. She was started on prednisolone and adcal - what else should she have?
bisphosphonate
182
A 68 yo has a neck lump for 2/12 but is otherwise well. They have palpable LNs - cervical, supraclavicular, axillae, inguinal. WCC++, lymphocytes++, blood film = inc lymphocytes - what is the most likely diagnosis?
chronic lymphoid leukaemia
183
ABx for MRSA and the best route?
IV vancomycin
184
which anticonvulsant can cause SIADH?
carbamazapine
185
How would you diagnose and treat BPPV?
diagnose - dix hallpike
| treat - epley
186
how is general fertility rate in a popn expressed?
no live births/1000 women 15-44
187
Which organism causes swollen epiglottis in paeds?
Haemophilus influ
188
Which prophylactic ABx would you for knee replacement?
cefuroxime
