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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

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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

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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

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4
Q

Which type of thyroid carcinoma produces calcitonin?

A

medullary

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5
Q

what is the target INR for someone on warfarin?

A

2.5 - usually, but depends what it’s for

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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

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7
Q

Which WBC would be raised in strep pneumonia?

A

Monocytes

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8
Q

What is the neurotransmitter associated with OCD??

A

5-hydroxytryptamine (serotonin)

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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

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10
Q

Which hormonal change would support a diagnosis of premature menopause?

A

inc FSH

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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

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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

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13
Q

how would you investigate subacute infective endocarditis?

A

urine dip for microscopic haematuria

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14
Q

Which analgesic should be avoided in children?

A

aspirin

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15
Q

what are high levels of anti-neutrophil cytoplasmic Abs assocaited with? (ANCAs)

A

vasculitis

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16
Q

What is the immediate treatment of a patient with CT head showing acute left cerebral infacrtion?

A

aspirin

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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

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18
Q

what is non-maleficence?

A

do no harm

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19
Q

You see a cyanosed 12 hr old baby who is otherwise normal - what is the diagnosis?

A

transposition of the great arteries

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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)

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21
Q

What can cause painful penile ulcers?

A

HSV

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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

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23
Q

which clotting test will be prolonged in haemophilia A?

A

APTT

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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

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25
Q

A traveller has been to Thailand and now has diarrhoea, low Hb, high eosinophils - what is the organism?

A

hookworm

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26
Q

If someone reports inappropriate behaviour in a colleague, who do you report to first?

A

Consultant in charge

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27
Q

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

A

basal ganglia

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28
Q

which neurotransmitter is targeted in medical therapy for bulimia?

A

serotonin - give SSRIs

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29
Q

what change in lung fucntion supports idiopathic pulmonary fibrosis?

A

reduced transfer factor

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30
Q

If a woman is pregnant and has ?chicken pox - which intervetion would you start immediately?

A

IV aciclovir

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31
Q

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?

A

overflow incontinence

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32
Q

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?

A

idiopathic urtacaria and angioedema

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33
Q

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?

A

IV corticosteriod - In the setting of spinal cord compression, steroids decrease the associated vasogenic edema and thereby substantially improve neurologic function and decrease pain.

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34
Q

what is the initial investigation for a patient with persistent swallowing problem?

A

upper GI endoscopy

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35
Q

What nail signs might you see in hands of someone with psoriasis?

A

nail dystropy

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36
Q

which drug for HTN might you see renal impairment in?

A

ACEIs eg ramipril

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37
Q

20M 1/52 worsening sore throat, drooling, difficulty speaking, R palatoglossal fold is swollen and R tonsil reaches misline - WCC = 15 - Dx?

A

peritonsillar abscess

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38
Q

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?

A

admit + IV ABx - the patient might have neurtopenic sepsis

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39
Q

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?

A

churg-strauss

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40
Q

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?

A

IVC occlusion

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41
Q

45yo taking clozapine has sore throat and fever, which is the best initial blood test and what are you looking for?

A

FBC - looking for raised WCC and CPK. Clozapine can cause neuroleptic malignat syndrom, of which fever is a synptom

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42
Q

Where is the most likely site for failure of lactation in the brain?

A

anterior pituitary

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43
Q

what is the likely diagnosis - glomerularnephritis, end stage renal disease, hearing loss?

A

Alport’s syndrome

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44
Q

what is the most likely organism in cellulitis in a DM?

A

strep pyogens

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45
Q

what is the indication for medical cardioversion and what would you use?

A

narrow complex tachycardia (SVT)

adenosine (could attempt valsalva manoeuvre or carotid massage first)

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46
Q

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?

A

delerium

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47
Q

which ABx affets anticoags?

A

clartihromycin

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48
Q

what kind of a pulse would you expect in CO2 narcosis, sepsis or liver failure?

A

bounding

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49
Q

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?

A

renal biopsy

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50
Q

An infant bruises easily due to haemophilia A - what factor is deficient and what is the deficient factor required for?

A

factor VIII, formation of the tenase complex with activated factor IX

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51
Q

what kind of pulse would you expect in aortic stenosis?

A

anacrotic/slow-rising

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52
Q

Where is the pathology in this patient - loss of vision in left visual field of both eyes, central vision good, Hx angina and TIA

A

Right occipital lobe

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53
Q

if a hypertensive diabetic finds their blood glucose poorly controlled, what drug might be to blame?

A

thiazide

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54
Q

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?

A

ductal carcinoma in situ

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55
Q

what process is increased in DKA?

A

increased lipolysis

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56
Q

A schizophrenic patient is given olanzapine and becomes hot, confused, sweaty, fever with varying BP, what is the Dx?

A

neuroleptic malignat syndrome

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57
Q

A man with HTN is admitted with hypoTN, as well as fluid resus what do you do?

A

stop anti-HTNs

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58
Q

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?

A

VSD

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59
Q

2 sets of nonparametric quantative data from same popn, what test looks at the diff between 2 datasets?

A

mann-whitney U

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60
Q

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?

A

oral dexamethasone

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61
Q

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?

A

iron

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62
Q

what should you treat bacterial tonsillitis with?

A

penicillin V (phenoxymethylpenicillin), particularly in paeds and strep throat

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63
Q

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?

A

prothrombin complex concetrate

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64
Q

What class of drugs are used for the prostate?

A

alpha blockers

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65
Q

What is the course of action if you are pregnant and contract chicken pox?

A

aciclovir within 24hrs of rash developing

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66
Q

what may someone with uncontrolled coeliac disease be more at risk of?

A

small bowel lymphoma

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67
Q

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?

A

angle closure glaucoma

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68
Q

A 12F presents who is ?meningococcal septsis - when should communicable disease control consultant be informed?

A

upon clinical Dx

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69
Q

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?

A

baker’s cyst

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70
Q

which mechanism that normally preserves GFR in the face of hypovolaemia is blocked by ramipril?

A

constriction of the efferent arteriole

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71
Q

Which vitamin in higher than normal amounts = dry skin, generalised itch, HA worse in am that wake from sleep, skin yellow?

A

Vit A

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72
Q

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?

A

90%

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73
Q

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?

A

direct antiglobulin test AKA Coombes test for autoimmune haemolytic anaemia

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74
Q

A 3 yo F has an ear infections, which ABX would you use?

A

amoxicillin

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75
Q

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?

A

IgA endomysial AB - another test for coeliac disease

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76
Q

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?

A

Advise to discuss with parents

77
Q

how many days before surgery should you withhold warfarin?

A

5

78
Q

what would the diagnosis be - how would you describe a schizoid personality?

A

aloof, lack of interest in forming relationships, solitary, apathetic

79
Q

A 3yo F is resisting mum’s attempts to toilet train. Phones GP. What is the most appropriate professional to help?

A

health visitor

80
Q

which drug for HTN might you see oedema in?

A

CCBs eg amlodipine

81
Q

long Hx repetative unpleasent thoughts, recognises own thoughts but is unbale to stop throughts - diagnosis?

A

OCD

82
Q

how would you investigate angina?

A

exercise ECG

83
Q

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?

A

oral flucloxacillin

84
Q

What is the initial teatment for broad complex tachycardia when the patient is unstable?

A

cardioversion

85
Q

What is used to measure dunfractionate heparin?

A

APTT

86
Q

What is the antibody for lupus?

A

anti DS-DNA

87
Q

39yo female presents with acute onset of the ‘worst headache ever’. The initial CT = n, what is the next step in her management?

A

LP

88
Q

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.

A

anterior uveitis

89
Q

A 20F had unprotected sex 5/7 ago - which is the most appropriate emergency contrception?

A

ulipristil acetate 30mg single dose

90
Q

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?

A

radial nerve

91
Q

in what conditions if ALP raised?

A

pregnancy, bowel disease, bone disease, liver disease

92
Q

Who can confirm brain stem death?

A

2 docs, 1 must be consultant, both >5yrs registration

93
Q

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?

A

methotrexate

94
Q

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?

A

sodium cromoglicate

95
Q

8yo boy with a productive cough, abdo pain, refusing fluids, febrile, RR 50, lung creps - which organism is most likely?

A

strep pneumonia

96
Q

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

A

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
Q

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?

A

pericarditis

98
Q

What do you use these for-
Atropine
Adenosine
Amioderone

A

Atropine - speeds up heart, used in symptomatic brady eg heart block

Amioderone - ALS pathway

Adenosine - SVT

99
Q

A 72M is treated for CHF. He has occasional nausea, vomiting, anorexia and yellowish tint - which drug is causing these symptoms?

A

digoxin

100
Q

which hormone is released from adrenal cortex as a consequece of rumanitve thoughts?

A

cortisol - stress!

101
Q

if a patient has an MI with complete heart block, which vessel is affected?

A

right coronary

102
Q

A 16 year old F suffers from spots that are worse with stress and pre-period.What type of bacteria do drugs target?

A

propionbacterium

103
Q

what is the diagnostic technique used for a patient that presents with painless jaundice?

A

high res CT scan for pancreatic Ca

104
Q

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?

A

cerebral toxoplasmosis

105
Q

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?

A

dermatitis herpetiformis, underlying coeliac disease

106
Q

what is the appropriate lifetime relapse rate of thyrotoxicosis after stoppping antithyroid drug treatment?

A

50%

107
Q

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?

A

striated muscle - he has DMD

108
Q

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?

A

lorazepam

109
Q

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?

A

primary cerebral lymphoma

110
Q

A 19yo F is being followed up for suspected inflammatory arthropathy. Her CRP = 52. Which cytokine was responsible for this observation?

A

IL6

111
Q

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?

A

CCBs eg amlodipine

112
Q

What is the first line fluid to give in fluid resus?

A

0.9% NaCl

113
Q

A 50F presents with double vision post serious head injury, she sees one image above the other - which CN is affected?

A

Trochlear

114
Q

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?

A

Have AB testing for varicella zoster, if not immune then treat with Ig

115
Q

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?

A

eating contaminated food - hep A spread by eating or drinking food or water contaminated with infected faeces

116
Q

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?

A

none

117
Q

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?

A

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
Q

how can sodium valporate affect an unborn child?

A

spina bifida

119
Q

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

A

right coronary - the bradycardia and complate heart block is caused by ischaemia of the SANode

120
Q

what is the most sensitive imaging for renal calculi?

A

non contrast CT urography

121
Q

What is the fastest way to reverse warfarin?

A

prothrombin complex factor

122
Q

What is the initial treatment for Bell’s palsy?

A

prednisoloe

123
Q

What are the indications of urine and plasma osmolality?

A

diagnosing diabetes insipidus
assessing hydration status
assess concentrating ability of the kidney
assessing disorders involving ADH

124
Q

What action should be taken if you are pregnant and non-immune to chicken pox and come into contact with an infected person?

A

varicella zoster Ig

125
Q

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?

A

antibody deposition- bullous pemphigoid, chronic AI disease, type II hypersensitivity reaction

126
Q

how would you manage narrow complex tachycardia and what would you do if that didn’t work?

A

valsalva manouevre followed by amioderone

127
Q

ABX for c diff?

A

metranidazole

128
Q

which vessel is affected if you see ST elevation in leads II, III, F?

A

inferior MI, right coronary artery

129
Q

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?

A

cetirizine tablets

130
Q

A primiparous woman who has pre-eclampsia has an emergecy c-sec - what is the best VTE prophylaxis?

A

stockings and 7/7 LMWH

131
Q

You have a patient with a low RR who has been given morphine - what is the best immediate intervetion?

A

IV naloxone

132
Q

What is the first suggestion for an alternative contraceptio for someone who keeps forgetting the pill?

A

Depot injection

133
Q

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?

A

non-haemolytic febrile reaction

134
Q

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?

A

vitreous haemorrhange

135
Q

An unwell T1DM child who is refusing food and has a low BM is brought in in the morning - what is the best Mx?

A

inc freq BM monitoring, usual morning insulin dose + carb rich oral fluids

136
Q

30yo male, infection 2 weeks ago, chest pain through to back, ST elevation on ECG - what’s the diagnosis?

A

acute pericarditis

137
Q

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?

A

reduce dose and lengthen dosing iterval

138
Q

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?

A

strep pneumonae

139
Q

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?

A

post semicircular canal

140
Q

what is charcot’s triad and which diagnosis does it make you think of?

A

RUQ pain, fever, jaundice = ?ascending cholangitis (bacterial infection in biliary tree)
- gall stones predispose, give IV ABx and ERCP to release any blockage

141
Q

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?

A

panc enzyme supps

142
Q

IVDU with fever, inc JVP, soft pancystolic murmur in L sternal edge - what is the most likely causative organism?

A

staph aur

143
Q

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?

A

gamma globulin levels - hypogammglobulinaemia in bronchiectasis (permanent enlargement of parts of the airways of the lung). Causes of brnchiectasis inc CF

144
Q

what is the pathological cellular origin of a dermoid ovarinl cyst?

A

germ cell

145
Q

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?

A

Noradrenaline

146
Q

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?

A

ESR, giant cell arteritis

147
Q

what kind of pulse would you expect in aortic regurg?

A

collapsing

148
Q

what is the appropriate Mx for a neuropathic baldder?

A

intermittant self catheterisation

149
Q

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?

A

triple assessment - clinical exam, mammogram, biopsy

150
Q

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?

A

treat for 1ry TB

151
Q

How would you treat a UTI in pregnancy?

A

amoxicillin, even if nitro is on the list

152
Q

A 25 yo F with anorexia is admitted and s eating again. She becomes tachypnoeic - which is the most important serum analyate to measure?

A

phosphate

153
Q

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?

A

L5

154
Q

how could you make aortic stenosis louder?

A

squatting

155
Q

what is beneficence?

A

action that is done for the benefit of others

156
Q

A 30M with psoriasis has tried topical therapy which hasn’t been effective - what is 1st line systemic Tx for him?

A

phototherapy

157
Q

which organism causes ‘slapped cheek’ in paeds?

A

parvovirus B19

158
Q

which vessel is affected if you see ST elevation in leads V1-V6, I, L?

A

anterior MI, left ant. Decending

159
Q

What effect can fluoxitine in pregnancy have on the baby?

A

persistant pulmonary hypertesion of the newborn

160
Q

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?

A

withold simvastatin - can cause rhabdomyolysis

161
Q

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?

A

furosemide

162
Q

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?

A

bronchoscopy

163
Q

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?

A

5mg daily from 3/12 preconception

164
Q

53F - most likely cause of meningitis when CSF grows +ve cocci?

A

strep pneumoniae

165
Q

Where is the most likely site of bleeding in recurrent epistaxis in child?

A

little’s area

166
Q

What is the anatomical and physiological basis for sensorineural presbyacusis?

A

loss of cochlear hair cells and auditory nerve fibres

167
Q

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?

A

low blood clearence

168
Q

49 yo male has a pituitary tumour involving the optic chiasm - which visual field defect is most likely?

A

bitemporal hemianopia

169
Q

If a patient taking haloperidol experiences twisting and rigidity of neck how would you treat them?

A

procyclidine - used for S/E in haloperidol

170
Q

What is the initial treatment in hypercalcaemia?

A

IV 0.9% NaCl

171
Q

how would you manage a broad complex tachycardia in a stable patient?

A

amioderone

172
Q

what is the most sensitive blood test for acute pancreatitis?

A

lipase!

173
Q

A patient is on carbimazole for grave’s disease and is experiencing malaise and sore throat - what is your initial investigation and why?

A

FBC to investigate neutropenia. Neutropenia = infections/sore throat/fever etc

174
Q

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?

A

Magnesium sulphate

175
Q

what would you see in an ECG for wolf-parkinson-white?

A

short PR and delta waves

176
Q

In an emergency surgical situation, what kind of consent is needed?

A

none

177
Q

If a liver biopsy is found to have multiple granulomata with cetral acellular appearece, what’s the diagnosis?

A

TB

178
Q

disease of which valve is most common in AF?

A

mitral (stenosis)

179
Q

What is the target for infliximab?

A

TNF alpha

180
Q

What is the most likely organism to cause D+V after BBQ meat?

A

campylobacter

181
Q

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?

A

bisphosphonate

182
Q

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?

A

chronic lymphoid leukaemia

183
Q

ABx for MRSA and the best route?

A

IV vancomycin

184
Q

which anticonvulsant can cause SIADH?

A

carbamazapine

185
Q

How would you diagnose and treat BPPV?

A

diagnose - dix hallpike

treat - epley

186
Q

how is general fertility rate in a popn expressed?

A

no live births/1000 women 15-44

187
Q

Which organism causes swollen epiglottis in paeds?

A

Haemophilus influ

188
Q

Which prophylactic ABx would you for knee replacement?

A

cefuroxime

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