Progress Test Questions:

Question 1

What is Murphy’s sign?

Answer 1

Indicates cholecysitis: right subcostal area is palpated- pain isn’t felt on inspiration as the inflamed gallbladder comes into contact with the hand

Question 2

What is Horner’s syndrome?

Answer 2

A combination of syndromes that arise when the sympathetic trunk is damaged- ptosis (drooping of upper eyelid- anhidrosis (decreases sweating) -miosis (constriction of pupil) are all observed

Relevant to respiratory examination as a pancoast tumour may be pressing on the sympathetic chain of nerves in the chest

Question 3

What is a pancoast tumour?

Answer 3

A tumour of the pulmonary apex- it typically spreads to nearby tissues such as the ribs and vertebrae

The tumour May cause horner’s syndrome by pressing the nerves of the sympathetic ganglion

Question 4

How is giant cell arteritis diagnosed?

Answer 4

Blood test for ESR and CRP- a raised ESR and CRP will be seen in GCA as it is an inflammatory condition

• 10% of people will not have these raised
• temporal artery biopsy is the gold standard for diagnosis- the others would be used as they are less invasive and this can also take a long time to give results

Question 5

What are ESR and CRP?

Answer 5

Inflammatory markers detected on blood tests

Question 6

How would you treat GCA?

Answer 6

corticosteroids- begin prednisolone immediately if suspected- 60-100mg daily (high dose)

Question 7

What is the Rockall scoring system used for?

Answer 7

Assessing the severity of upper GI bleeding- includes BP and HR, comorbidities and any stigmata of recent haemorrhage

Question 8

What can lactic acidosis be a sign of?

Answer 8

It is a form of metabolic acidosis that occurs during ischaemia- may be seen in ischaemic bowel

Question 9

What is a strangulated hernia?

Answer 9

A hernia in which the blood supply has been compromised- the hernia contents are ischaemic and the patient should undergo emergency surgery

Question 10

When are ESR and CRP raised?

Answer 10

In any chronic inflammatory conditions (e.g. rheumatoid arthritis, GCA), infections and accesses.

Question 11

Which is the most common type of hernia?

Answer 11

Inguinal hernia

Question 12

What is the difference between a direct and indirect inguinal hernia?

Answer 12

An indirect hernia passes through the inguinal canal- enters laterally to the deep inguinal ring and exiting via the superficial ring; a direct hernia the contents merge into the inguinal canal medially to the deep inguinal ring

Question 13

Where does Chron’s disease commonly present?

Answer 13

the terminal ileum- this is often associated with right iliac pain

Question 14

What is a central line and where are they typically placed?

Answer 14

A central line or central venous catheter (CVC) is a catheter placed into a large vein- if there is risk of significant blood loss in surgery they may be placed

Internal Jugular Vein
Subclavian/axillary vein
Femoral vein

Question 15

post pituitary gland hormones?

Answer 15

ADH and oxytocin

Question 16

ant pituitary gland hormones?

Answer 16

growth hormone, ACTH (adrencorticotropic hormone), TSH, FSH and LH, prolactin

Question 17

What is Sheehan’s syndrome?

Answer 17

if during childbirth a woman loses a lot of blood or has severely low blood pressure there is damage to the pituitary gland due to lack of oxygen- this affects the hormones produced by the pituitary gland and may result in being unable to breastfeed and amenorrhea

Question 18

What are the two most common heart valve deformities in the UK?

Answer 18

Atrial stenosis, mitral regurgitation

Question 19

What are some drugs that require careful monitoring?

Answer 19

gentamycin, vancomycin, digoxin, warfarin (INR)

Question 20

What is pernicious anaemia?

Answer 20

An autoimmune disorder affecting the gastric mucosa- it results in vitamin B12 deficiency

Question 21

What are causes of vitamin b12 deficiency?

Answer 21

pernicious anaemia, atrophic gastritis (H. pylori infection), gastrectomy, malnutrition

Question 22

What is vitamin b12 used for and as a result what are the symptoms of deficiency?

Answer 22

myelenation of nerves- symptoms may include paraesthesia and muscle weakness as well as symptoms of anaemia

Question 23

What autoimmune conditions does pernicious anaemia tend to occur alongside?

Answer 23

type 1 diabetes

Grave’s disease

Question 24

What is Courvoisier’s sign?

Answer 24

a palpable gallbladder with painless jaundice- this is likely to be cholangiocarcinoma

Question 25

What is primary sclerosing cholangitis?

Answer 25

a long-term progressive disease of the gallbladder and pancreas characterised by inflammation and scarring of the bile ducts

Question 26

What does palpable Virchow’s node indicate?

Answer 26

As Virchow’s node receives lymph from the abdomen- if it is palpable it indicates metastatic malignancy from somewhere in the abdomen e.g. cholangiocarcinoma, gastric cancer, kidney cancer

Question 27

What is Gilbert’s syndrome?

Answer 27

An autosomal recessive condition characterised by defective bilirubin conjugation (caused by a deficiency of UDP glucuronosyltransferase)

Question 28

What are ACE inhibitors used for, example and a common side effect?

Answer 28

hypertension, given after a heart attack, example: ramirpril, common side effect: dry cough

Question 29

What is the QRISK3 score?

Answer 29

an algorithm which calculates someones risk of developing a heart attack or stroke in the next 10 years

Question 30

Example of a thiazide diuretic and a common side effect?

Answer 30

hydrochlorothiazide, indapamide, chlorothiazide- common side effect is hyponatraemia as sodium is moved into the DCT to increase diuresis

Question 31

What are the differentials for headaches?

Answer 31

migraine, cluster headache, tension headache, temporal arteritis, sub-arachnoid headache

Question 32

Which type of headache presents with a ‘thunderclap’ onset?

Answer 32

sub-arachnoid

Question 33

What are some clinical signs of meningitis?

Answer 33

Pyrexia, unblanching rash (meningococcal), Kernig’s sign (hamstring stiffness) and nuchal rigidity

Question 34

Which investigation should be carried out if meningitis is suspected and what are you looking for?

Answer 34

lumbar puncture- opening pressure measured, consistency, glucose and protein contents and WCC of the CSF is considered

Question 35

Protein + glucose content in bacterial meningitis

Answer 35

very low glucose and very high protein

Question 36

Protein + glucose content in viral meningitis

Answer 36

normal glucose and raised protein

Question 37

How does temporal arteritis present?

Answer 37

localised pain in the temporal region- may be painful to brush hair, jaw claudication due to cramping and loss of blood supply

Question 38

What is vasculitis?

Answer 38

an inflammatory disorder of the blood vessels- it can affect the vessels in any organ- presentation will depend on which organs are involved

Question 39

Whats should you consider protecting if you are prescribing a high dose of corticosteroids?

Answer 39

gastric and bone protection- e.g. a PPI and alendronate

Question 40

Why is hyperkalaemia dangerous?

Answer 40

it may cause arrythmias or cardiac arrest

Question 41

What is achondroplasia?

Answer 41

a disorder of bone growth that prevents the changing of cartilage- characterised by dwarfism

Question 42

Which group of drugs are contra-indicated in Parkinson’s and why?

Answer 42

anti-psychotics; this is because they usually function using dopamine

Question 43

What bacteria are aminoglycosides used against?

Answer 43

aerobic gram negative bacteria