QuesMed

Question 1

What is an irregular broad complex tachycardia on an ECG assumed to be

Answer 1

Ventricular Fibrillation

Question 2

What typically causes a subacute presentation of infective endocarditis in patients with existing cardiac disease

Answer 2

Strep. Viridans

Question 3

What would cause exertional dyspnoea, ejection systolic murmur, apical thrill and jerky pulse

Answer 3

Hypertrophic cardiomyopathy

Question 4

Mx of VT with a pulse

Answer 4

DC Cardioversion

Question 5

What is first line for diagnosing stable angina

Answer 5

CT Coronary Angiogram

Question 6

What is indicated if lead I is positive but lead II and III are negative

Answer 6

Left axis deviation

Question 7

Compare Mobitz Type 1 and Type 2

Answer 7

Type 1 has gradually increasing PR intervals

Question 8

Ix of Aortic Dissection

Answer 8

Trans-oesophageal echocardiography (TOE)

TTE if unstable

Question 9

What causes weakness and reduction in sensation over the medial digits of the hand

Answer 9

Cubital Tunnel Syndrome

(ulnar nerve)

Question 10

What causes parkinisonism and vertical gaze palsy

Answer 10

Progressive supranuclear palsy

Question 11

What is the only medication licensed for treating MND

Answer 11

Riluzole

Question 12

What causes bilateral left inferior quadrantanopia

Answer 12

Infarct in parietal lobe

“PITS” - which stands for “Parietal Inferior ; Temporal Superior”

Question 13

What is Meig’s syndrome

Answer 13

Triad of

Ovarian tumour
Ascites
Pleural effusion

Question 13

What may be used as a treatment option in idiopathic pulmonary fibrosis

Answer 13

Pirfenidone

Question 14

Definitive Ix of PCP

Answer 14

Bronchoscopy with bronchoalveolar lavage

Question 15

Name an Abx for UTI which can cause pulmonary fibrosis

Answer 15

Nitrofurantoin

Question 16

When treating PE when would unfractionated heparin be preferred to a DOAC

Answer 16

Renal insufficiency
Haemodynamically unstable

Question 17

Mx of primary pneumothorax, SoB, 2.5cm

Answer 17

Aspiration

Question 18

Most common cause of mechanical ventilator associated pneumonia?

Answer 18

Pseudomonas Aeruginosa

Question 19

Tx of pneumonia caused by Pseudomonas Aeruginosa

Answer 19

IV Tazocin

Question 20

What could be indicated by big P waves on ECG

Answer 20

P pulmonale - COPD

Question 21

First line Ix of Cushing’s syndrome

Answer 21

Overnight Dexamethasone suppression test

Question 21

Tx of Gastroparesis

Answer 21

Metoclopramide or domperidone

Question 22

What is the most common type of thyroid cancer

Answer 22

Papillary

Question 22

Severe side effect of pioglitazone?

Answer 22

Fluid retention

Question 23

Slightly raised TSH and normal T4

Answer 23

Sub clinical hypothyroidism

Question 24

Tx of Carcinoid tumours

Answer 24

Octreotide

Question 25

What does Faecal calprotectin screen for

Answer 25

IBD

Question 26

Causes of high SAAG ascites (4)

Answer 26

Cirrhosis Heart failure Budd Chiari syndrome Hepatic failure

Question 27

Causes of low SAAG ascites

Answer 27

Infection Malignancy Nephrotic syndrome

Question 28

What is given in acute severe ulcerative colitis which does not respond to steroirds

Answer 28

IV ciclosporin

Question 29

First line to induce remission of Crohn's disease

Answer 29

Glucocorticoids (prednisolone)

Question 30

A duodenal biopsy performed at this time demonstrated infiltration of the lamina propria by periodic acid-Schiff- (PAS-) positive macrophages.

Answer 30

Whipple's disease

Question 31

What is Felty's syndrome

Answer 31

Triad of rheumatoid arthritis, splenomegaly and neutropenia

Question 32

Name a condition pseudogout is strongly associated with

Answer 32

Haemochromatosis

Question 33

Mx of Polymyositis

Answer 33

Prednisolone

Question 33

First choice of treatment for eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

Answer 33

Corticosteroids

Question 34

Mx of renal stones

Answer 34

<5mm watch and wait >5mm Extracorporeal shock wave lithotripsy Signs of sepsis - Nephrostomy

Question 35

1st step of Mx of Hyperosmolar Hyperglycaemic State

Answer 35

1L 0.9% saline over 1-2 hours Note that initial resuscitation is slightly slower than in DKA (Diabetic Ketoacidosis). This because the dehydration in HHS develops over a long time period and is more pronounced so should be corrected slightly more cautiously to avoid rapid fluid shifts

Question 36

Side effect of doxorubicin

Answer 36

Cardiomyopathy

Question 37

Side effect of vincristine

Answer 37

Peripheral Neuropathy

Question 38

Side effect of bleomycin

Answer 38

Lung fibrosis

Question 39

What causes hyperkalaemia, hyperphosphatemia, hypocalcaemia, hyperuricaemia and increased blood urea nitrogen

Answer 39

Tumour Lysis Syndrome

Question 40

Mx of malignant hyperthermia

Answer 40

IV dantrolene

Question 41

What prophylactic Abx should people take post-splenectomy

Answer 41

Phenoxymethylpenicilln

Question 42

What is the most common microbiological cause of otitis externa

Answer 42

Pseudomonas aeruginosa

Question 43

Mx of Quinsy

Answer 43

Antibiotics and aspiration are now preferred to the traditional incision and drainage

Question 44

Mx of Vestibular schwannoma

Answer 44

Over 40mm require surgery. Under 40mm require 6-monthly annual surveillance scans via MRI.

Question 45

Adjuvant Tx for ER positive and Her-2 positive breast cancer

Answer 45

Tamoxifen - ER positive Trastuzumab - Her2 positive

Question 46

Outline the N in TNM staging

Answer 46

N0 = No spread to nearby nodes N1 = Spread to 1-3 local nodes N2 = Spread to 4-9 local nodes N3 = Spread to 10 or more local nodes or spread to supraclavicular or infraclavicular lymph nodes.

Question 47

Mx of Bacterial conjunctivitis

Answer 47

Topical Chloramphenicol eyedrops

Question 48

Sudden painless loss of vision Stormy sunset appearance

Answer 48

Central retinal vein occlusion

Question 49

Compare central retinal vein and artery occlusion

Answer 49

Vein occlusion far more common Artery occlusion - rapid vision loss, cherry-red spot on macula

Question 50

Patients present with floaters and flashes followed by a 'curtain falling over' their vision

Answer 50

Retinal detachment

Question 51

Floaters in vision, painless loss of vision, history of Diabetes

Answer 51

Vitreous Haemorrhage

Question 52

A 23-year-old male presents to the sexual health clinic with dysuria and urethral discharge. On examination, he has tender inguinal lymphadenopathy and a green urethral discharge. Most likely organism

Answer 52

Neisseria gonorrhoeae

Question 53

Main cause of erysipelas (butterfly rash in cheek)

Answer 53

Strep. Pyogenes

Question 53

What causes peripheral neuropathy in TB Tx? What is given to prevent this?

Answer 53

Isoniazid Give Vitamin B6 (Pyridoxine)

Question 54

Mx of Erysipelas

Answer 54

Flucloxacillin

Question 55

What Abx can reduce seizure threshold in patients with epilepsy, and should be used with extreme caution

Answer 55

Ciprofloxacin (and other quinolones)