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PT Mock 3 Flashcards

1
Q
  1. Clinical signs of infectious mononucleosis
A
  • Splenomegaly
  • Petechial haemorrhages covering of the soft palate
  • White exudate covering tonsils
  • Lymphadenopathy
  • Hepatomegaly
  • Fever
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2
Q
  1. What test would you do to diagnosis infectious mononucleosis ?
A
  • Monospot test
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3
Q
  1. What are complications of infectious mononucleosis ?
A
  • Splenic rupture
  • Guillian Barre syndrome
  • Encephalitis
  • Meningitis
  • Pericarditis
  • Hepatitis
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4
Q
  1. How could a GP assess for end organ damage ?
A
  • Fundoscopy
  • Urine albumin:creatinine ratio
  • HbA1c
  • U&Es – creatinine and eGFR
  • 12 lead ECG
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5
Q
  1. What is target BP for HTN in a 60yo ?
A
  • <140/90
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6
Q
  1. What is the mechanism for anaphylactic reaction ?
A
  • Type 1 hypersensitivity reaction
  • Where IgE stimulates mast cells to rapidly release histamine/mast cell degranulation
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7
Q

What is the dose for adrenaline in anaphylaxis ?

A
  • 500mcg of 1:1000
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8
Q
  1. What blood test can be performed post anaphylaxis to confirm diagnosis ?
A
  • Serum mast cell tryptase
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9
Q
  1. What dose of adrenaline is given in cardiac arrest situations ?
A
  • 1mg of 1:10000
  • Give as soon as non-shockable rhythm is diagnosed
  • Or once chest compression have restarted after the 3rd shock
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10
Q
  1. What is the pathophysiology of pyloric stenosis ?
A
  • Hypertrophy of the pylorus prevents food traveling from the stomach into the duodenum as normal
  • After feeding, there is powerful peristalsis against the narrow pylorus causing food to be ejected into the oesophagus leading to projectile vomiting
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11
Q
  1. What is the most common finding upon palpation of the abdomen in a child with pyloric stenosis ?
A
  • Olive-shaped mass in the right upper quadrant
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12
Q
  1. What would you find on the blood gas a child that has been vomiting ?
A
  • Hypochloremia, hypokalemia metabolic alkalosis
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13
Q
  1. What are the components of the 6 in 1 vaccine given at 2,3 and 4 months ?
A
  • Diphtheria
  • Hep B
  • Whooping Cough
  • Tetanus
  • Polio
  • H influenzae B
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14
Q
  1. Which hormones are secreted from which areas of the kidney ?
A
  • Zone glomerulosa – Aldosterone
  • Zona fasciculata – Cortisol
  • Zone reticularis – Androgens
  • Medulla – Adrenaline
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15
Q
  1. What is the pathological basis of Cushing’s Disease ?
A
  • Pituitary adenoma
  • Uncontrolled secretion of ACTH
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16
Q
  1. What blood test and at what type of day is done to investigate Cushing’s ?
A
  • Serum cortisol
  • Between 8 and 10 am
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17
Q
  1. What type of pupillary defect is found in optic neuritis ?
A
  • Relative afferent pupillary defect
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18
Q
  1. What is Lhermitte’s sign ?
A
  • Electric shock like pains which travel down the spine and legs when moving the neck
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19
Q
  1. What is found in LP of a pt with MS ?
A
  • Oligoclonal bands
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20
Q
  1. What criteria is used to confirm the diagnosis of MS ?
A
  • McDonald
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21
Q
  1. What organisms could be found using a high vaginal charcoal media swab ?
A
  • Bacterial vaginosis
  • Trichomonas vaginalis
  • Candida
  • Group B strep
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22
Q
  1. What organism causes chlamydia ?
A
  • Chlamydia trachomatis
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23
Q
  1. What organism causes syphilis ?
A
  • Treponema pallidum
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24
Q
  1. Signs and symptoms of PID ?
A
  • Lower abdominal/pelvic pain
  • Deep dyspareunia
  • Postcoital bleeding/ intermenstrual bleeding/ menorrhagia
  • Lower abdominal tenderness/ adnexal tenderness
  • Cervical motion tenderness
  • Fever
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25
Q
  1. Causes of acutely painful red eye ?
A
  • Anterior uveitis
  • Scleritis
  • Corneal abrasion/corneal ulcer
  • Keratitis
  • Foreign body
  • Chemical or traumatic injury
  • Endophthalmitis
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26
Q
  1. What does glaucoma refer to ?
A
  • Optic nerve damage caused by raised intraocular pressure caused by blockage of aqueous humor drainage
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27
Q
  1. What is the pathophysiology of acute angle closure glaucoma
A
  • The iris bulges forward and seals off the trabecular meshwork from the anterior chamber preventing aqueous humor from draining and causing raised intraocular pressure which causes cupping of the optic disc
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28
Q
  1. What is the pathophysiology of primary open angle closure glaucoma
A
  • A gradual increase in resistance to flow through the trabecular meshwork. The pressure slowly builds within the eye.
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29
Q
  1. What are risk factors for open-angle glaucoma ?
A
  • Increasing age
  • Family history
  • Black ethnic origin
  • Myopia (nearsightedness)
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30
Q
  1. Risk factors for acute angle-closure glaucoma ?
A
  • Increasing age
  • Family history
  • Female
  • Chinese and east Asian origin
  • Shallow anterior chamber
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31
Q
  1. What medications can predict acute angle closure glaucoma ?
A
  • Adrenergic medications e.g. noradrenaline
  • Anticholinergic medications e.g. oxybutynin
  • Tricyclic antidepressants e.g. amitriptyline
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32
Q
  1. What simple measures can you implement for a patient with acute angle-closure glaucoma pre-hospital ?
A
  • Antiemetic
  • Analgesia
  • Lie flat
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33
Q
  1. Name features of carpal tunnel ?
A
  • Worse at night
  • Gradually worsening
  • Intermittent
  • Relieved by shaking hand
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34
Q
  1. Which nerve is affected in CTS and what are the nerve roots ?
A
  • Median
  • C6-T1
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35
Q
  1. Risk factors for CTS
A
  • Pregnancy
  • Osteoarthritis/Rheumatoid arthritis
  • DM
  • Hypothyroidism
  • Smoking
  • Acromegaly
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36
Q
  1. What is the classical triad seen in cholangitis ?
A
  • Charcot’s triad
  • RUQ pain, fever and jaundice
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37
Q
  1. What should occur for a patient suspected of cholangitis ?
A
  • Blood cultures
  • Measure urine output
  • IV fluid challenge
  • IV antibiotics
  • Measure lactate
  • Give oxygen
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38
Q
  1. What is Mirizzi syndrome ?
A
  • Common hepatic duct obstruction
  • Caused by extrinsic compression from an impacted stone
  • In the cystic duct or infundibulum of the gallbladder
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39
Q
  1. What is ascending cholangitis ?
A
  • A bacterial infection of the biliary tree
  • The most common predisposing factor is gallstones
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40
Q
  1. What are features of ascending cholangitis ?
A
  • Charcot’s triad = Fever, RUQ pain and jaundice
  • Hypotension and confusion are also common
  • Raised inflammatory markers
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41
Q
  1. What is management of ascending cholangitis ?
A
  • IV abxs
  • Endoscopic retrograde cholangiopancreatography
42
Q
  1. What is primary biliary cholangitis ?
A
  • A chronic liver disorder typically seen in middle aged females thought to be autoimmune in origin
  • Interlobular bile ducts become damaged by a chronic inflammatory process causing progressive cholestasis which may eventually progress to cirrhosis
43
Q
  1. What conditions is primary biliary cholangitis associated with ?
A
  • Sjogren’s syndrome (80% of patients)
  • RA
  • Systemic sclerosis
  • Thyroid disease
44
Q
  1. What are clinical features of primary biliary cholangitis ?
A
  • Fatigue, pruritus
  • Cholestatic jaundice
  • Hyperpigmentation over pressure points
  • Around 10% of patients have RUQ pain
  • Xanthelasma or xanthomata
  • Clubbing hepatosplenomegaly
45
Q
  1. How is primary biliary cholangitis diagnosed ?
A
  • Anti-mitochondrial antibodies (98% of patients)
  • Smooth muscle antibodies (30%)
  • Raised serum IgM
  • Magnetic resonance cholangiopancreatography to exclude extrahepatic biliary obstruction
46
Q
  1. How is primary biliary cholangitis managed ?
A
  • Ursodeoxycholic acid
  • Cholestyramine (for peritus)
  • Fat-soluble vitamin supplementation
  • Liver transplantation in late disease
47
Q
  1. What are complications of primary biliary cholangitis ?
A
  • Cirrhosis  portal hypertension  ascites or variceal haemorrhage
  • Osteomalacia and osteoporosis
  • Significant increased risk of hepatocellular carcinoma
48
Q
  1. What are the 4Fs associated with primary biliary cholangitis ?
A
  • Fat
  • Female
  • Forty
  • Fertile
49
Q
  1. What is Acute Cholecystitis ?
A
  • Acute inflammation of the gallbladder
50
Q
  1. What is the pathophysiology of acute cholecystitis ?
A
  • Acute inflammation of the gallbladder that develops secondary to gallstones in 90% of patients
  • 10% of patients will not have stones but multifactorial influence of gallbladder stasis, hypoperfusion and infection
51
Q
  1. What are features of acute cholecystitis ?
A
  • RUQ pain that may radiate to the right shoulder
  • Fever and signs of systemic upset
  • Murphy’s sign
  • Liver functions are typically normal
52
Q
  1. Treatment for acute cholecystitis ?
A
  • IV antibiotics
  • Cholecystectomy
53
Q
  1. What are the different levels of motor function in a GCS assessment ?
A
    1. Obeys commands
    1. Localises to pain
    1. Withdraws from pain
    1. Abnormal flexion from pain
    1. Extending to pain
    1. No response
54
Q
  1. What are the different levels of voice in a GCS assessment ?
A
    1. Orientated
    1. Confused
    1. Words
    1. Sounds
    1. None
55
Q
  1. What are the different levels of eyes in a GCS assessment ?
A
    1. Spontaneous
    1. To speech
    1. To pain
    1. No response
56
Q
  1. What is coning in the context of an EDH ?
A
  • Raised ICP causes herniation of the cerebellar tonsils through the foramen magnum leading to compression of the brainstem and respiratory arrest
57
Q
  1. When does screening for gestational diabetes take place ?
A
  • 24-28 weeks
58
Q
  1. What are fetal complications of gestational diabetes ?
A
  • Macrosomia  shoulder dystocia
  • Organomegaly (particularly cardiomegaly)
  • Polycythemia
  • Polyhydramnios
  • Pre-term delivery
  • Neonatal hypoglycemia
  • Transient tachypnoea of newborn
59
Q
  1. How should a pregnant pt on metformin and gliclazide be managed ?
A
  • Stop gliclazide
  • Start insulin
60
Q
  1. How much folic acid should a high risk patient take before and during pregnancy ?
A
  • 5mg
  • (400mcg in low risk)
61
Q
  1. What is the most common composition of a renal track stone ?
A
  • Calcium oxalate
62
Q
  1. Where in the urinary tract are stones most likely to become impacted ?
A
  • Pelviureteric junction
  • Crossing the pelvic brim
  • Vesicoureteric junction
63
Q
  1. What is the gold standard imaging for diagnosis of renal stones ?
A
  • CT of kidneys, ureter and bladder
64
Q
  1. What is the classic triad of symptoms that would indicate pyelonephritis ?
A
  • Loin or flank pain, fever and nausea or vomiting
65
Q
  1. Name 3 clinical signs you would expect to find on respiratory examination of a pneumothorax ?
A
  • Increased resonance
  • Decreased breath sounds
  • Unequal chest expansion
66
Q
  1. Clinical signs of tension pneumothorax ?
A
  • Tracheal deviation
  • Worsening hypoxia
  • Tachycardia
  • Hypotensive
  • Hypotensive
  • Distended neck veins
67
Q
  1. What are the 3 borders of the triangle of safety ?
A
  • Pectoralis major
  • Latissimus dorsi
  • 5th intercostal space
68
Q
  1. What is physiological jaundice ?
A
  • Breakdown of fetal RBCs releasing bilirubin usually excreted by the placenta
  • Leading to a normal rise in bilirubin shortly after birth causing a mild yellowing of the skin and sclera from 2-7 days of age and usually resolving by 10 days
69
Q
  1. What can causes of neonatal jaundice be split into ?
A
  • Increased production of bilirubin
  • Decreased clearance of bilirubin
70
Q
  1. What can cause increased production of bilirubin in neonatal jaundice ?
A
  • Haemolytic disease of newborn
  • ABO incompatibility
  • Haemorrhage
  • Intraventricular haemorrhage
  • Sepsis and disseminated intravascular coagulation
  • G6PD deficiency
71
Q
  1. What can cause a decrease of bilirubin in neonatal jaundice ?
A
  • Prematurity
  • Breast milk jaundice
  • Neonatal cholestasis
  • Extrahepatic biliary atresia
72
Q
  1. How should jaundice in the 1st 24 hours be managed ?
A
  • Always pathological
  • Needs urgent investigation and management
  • Neonatal sepsis is a common cause
  • Start treatment if any clinical features or risk factors
73
Q
  1. When is prolonged jaundice in a newborn ?
A
  • More than 14 days in full term babies
  • More than 21 days in premature babies
74
Q
  1. What is the pathology of jaundice in premature neonates ?
A
  • Physiological jaundice is exaggerated due to the immature liver
  • This increases the risk of complications particularly kernicterus (brain damage due to high bilirubin levels)
75
Q
  1. Why are breast fed babies more likely to have (breast milk) jaundice ?
A
  • Components of breast milk inhibit the ability of the liver to process the bilirubin
  • Breast fed babies are more likely to become dehydrated if not feeding adequately
  • Inadequate breastfeeding may lead to slow passage of stools increasing absorption of bilirubin in the intestines
76
Q
  1. What are common causes of prolonged jaundice ?
A
  • Biliary atresia
  • Hypothyroidism
  • G6PD deficiency
77
Q
  1. What are complications of kernicterus ?
A
  • Bilirubin can cross the blood brain barrier causing damage to the CNS
  • Causing cerebral palsy, learning disability and deafness
  • Baby will present as less responsive, floppy, drowsy and with poor feeding
78
Q
  1. A neonate is found to have clunking of the hips on his NIPE. What condition could this be ?
A
  • Developmental dysplasia of the hip
79
Q
  1. What special tests in the NIPE can detect signs of hip pathology ?
A
  • Ortolani and Barlow tests
80
Q
  1. Differentials for neck lumps
A
  • Lymphoma
  • Thyroid tumour
  • Lymphadenopathy
  • Sarcoidosis
  • Thyroid disease e.g. goitre
  • Dermoid cyst
81
Q
  1. What are features of Hodgkin’s lymphoma ?
A
  • Painless cervical lymphadenopathy
  • Weight loss
  • Night sweats
  • Generalised pruritus
  • Neck lumps painful after drinking
82
Q
  1. Clinical signs for Hodgkin’s lymphoma ?
A
  • Splenomegaly
  • Hepatomegaly
  • Pallor (+ other signs of anaemia)
  • Fever
  • Purpura and easy bruising
83
Q
  1. What is the name of characteristic findings from biopsy in Hodgkin’s lymphoma ?
A
  • Reed-Sternberg Cells
84
Q
  1. What is the classification system used to stratify patients with Hodgkin’s lymphoma ?
85
Q
  1. Primary causes of amenorrhea ?
A
  • Hypothyroidism/hyperthyroidism
  • Prolactinoma
  • Premature ovarian insufficiency
  • Anorexia nervosa
  • Excessive exercise
  • Stress
86
Q
  1. Secondary causes of amenorrhea ?
A
  • Pregnancy/menopause
  • Chronic systemic illness/stress /weight loss
  • Prolactinoma
  • Chemo/radio
  • Cushing’s
  • Thyroid disease
87
Q
  1. Criteria for PCOS ?
88
Q
  1. Which medication is used 1st line for management of acne ?
89
Q
  1. What cancer is associated with PCOS ?
A
  • Endometrial cancer
  • Less progesterone  irregular menstruation  endometrial hyperplasia  increased risk of endometrial cancer
90
Q
  1. Features of nephritic syndrome
A
  • Haematuria
  • Mild proteinuria
  • Fluid retention or oedema
91
Q
  1. What renal pathology is associated with Haemoptysis and what antibodies are linked?
A
  • Goodpasture syndrome
  • Anti-GBM antibodies
92
Q
  1. Name nephritic conditions
A
  • IgA nephropathy (Berger’s disease)
  • Post-streptococcal glomerulonephritis
  • Granulomatosis with polyangiitis
  • Lupus nephritis
93
Q
  1. How can a cause of glomerulonephritis be differentiated ?
A
  • Renal biopsy
94
Q
  1. What is management for severe hyperkalemia ?
A
  • Calcium gluconate 10% to temporarily protect against myocardial excitability
  • Insulin-glucose infusion to move K+ into cells
  • Nebulized salbutamol
95
Q
  1. What scale can be used to screen for depression in postnatal women who are at risk of developing a mental health condition ?
A
  • Edinburgh postnatal depression scale
96
Q
  1. How is the positive predictive value of a screening test calculated ?
A
  • True positive/ (true positive + false positive) = PPV
97
Q
  1. How is the negative predictive value of a screening test calculated ?
A
  • True negative/ (True negative + false negative)
98
Q
  1. How is the sensitivity of a screening test calculated ?
A
  • True positive /(total positive + False negative)
99
Q
  1. How is the specificity of a screening test calculated ?
A
  • True negative/(true negative + false positive)
100
Q
  1. What are the strengths of a cross sectional study ?
A
  • Relatively quick/cheap
  • No long periods of follow up
  • Multiple outcomes and exposures can be studies
  • Can be used for large data sets
101
Q
  1. What are the weaknesses of a cross sectional study ?
A
  • Not suitable for rare disease
  • Not suitable for diseases with a short duration
  • Difficulty to assess if exposure or outcome came first
  • Unable to measure incidence

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