Questions Part 2 Flashcards by Daniel Part

Which one of the following treatments have not been shown to improve mortality in patients with chronic heart failure?

Beta-blockers
Spironolactone
Frusemide
Nitrates and hydralazine
Enalapril

Frusemide

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You are reviewing the management of a number of patients with chronic obstructive pulmonary disease (COPD). Which one of the following factors should prompt an assessment for long-term oxygen therapy?

FEV1 54% of predicted
Haemoglobin of 18.4 g/dl
Body mass index 18.8 kg / m^2
Oxygen saturations of 93% on room air
FEV1/FVC of 0.47

Haemoglobin of 18.4 g/dl (polycythaemia)

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When should long-term oxygen therapy be considered in COPD?

Very severe airflow obstruction (FEV1

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A 19-year-old man is referred to the general medical clinic. For the past six months his family have noted increasing behavioural and speech problems. He himself has noticed that he is more clumsy than normal and reports excessive salivation. His older brother died of liver disease. Given the likely underlying condition what is the most appropriate therapy?

Vitamin B6 supplements
Venesection
Ribavirin + interferon alpha
Pulsed methylprednisolone
Penicillamine

Penicillamine:

- This patient has Wilson’s Disease

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Which one of the following conditions is least likely to develop following hepatitis B infection?

Glomerulonephritis
Hepatocellular carcinoma
Acute pancreatitis
Chronic infection
Polyarteritis nodosa

Acute pancreatitis

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What are the ECG indications for thrombolysis or PCI?

ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6)
OR
ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR
New Left bundle branch block

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What does the loss of haustral markings on a barium enema indicate?

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A 65-year-old man with no significant past medical history is admitted to the Emergency Department. His ECG is consistent with an anterior myocardial infarction. Unfortunately he develops cardiac arrest shortly after arriving in the department. What is the most common cause of death in patients following a myocardial infarction?

Pulmonary embolism
Cardiogenic shock
Papillary muscle rupture
Ventricular fibrillation
Complete heart block

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A woman who is know to have gallstones presents with pain in her right upper quadrant. On examination she is not jaundiced and has a temperature of 37.8ºC. Palpating under the right costal margin causes her to catch her breath.

Acute cholecystitis

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A 72-year-old man who is known to have heart failure and type 2 diabetes mellitus presents with a persistent dull ache in his right upper quadrant. Blood tests show a mild elevation of the alanine aminotransferase level.

Congestive hepatomegaly

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A 23-year-old student who has recently returned from a trip to North Africa presents with anorexia, nausea, mild right upper quadrant pain and lethargy. Blood tests show a marked elevation of his alanine aminotransferase level.

Viral hepatitis

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One day following a thrombolysed inferior myocardial infarction a 72-year-old man develops signs of left ventricular failure. His blood pressure drops to 100/70mmHg. On examination he has a new early-to-mid systolic murmur.

Papillary muscle rupture

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Four weeks after an anterior myocardial infarction a 69-year-old presents with pulmonary oedema. The ECG shows persistent ST elevation in the anterior leads.

Left ventricular aneurysm

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A 50-year-old man who has had a cough for the past week develops a rash. It initially appeared on his arms but has now spread to the torso -> It is erythema multiforme

Mycoplasma pneumoniae

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A 42-year-old overweight man presents with a two day history of anterior chest pain that is worse on deep inspiration and lying down

Pericarditis

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A 30 year old woman has a six month history of palpitations. Her resting ECG shows Wolff-Parkinson White syndrome. She has a paroxysmal SVT. She has a history of abnormal heart structure as a child. First step management?

Adenosine

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A 24 year old woman presents to A&E complaining of dizziness. Her ECG shows re-entry tachycardia. She has had one similar episode in the past which stopped spontaneously. She is on no medication. She is 31 weeks pregnant. First step management?

Carotid sinus massage

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A 60 year old man has chronic renal failure. He has a low grade fever and abdominal pain for two days. His dialysate is cloudy. His potassium is 7.0. He becomes unwell with a broad complex tachycardia. His BP is 100/70. First step management?

Calcium gluconate (to protect heart)

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A 35 year old woman has the following ABG results:
- pH 7.40
- pCO2 4.4
- pO2 9.4
- KCO 160% expected
All results were normal 24 hours ago

Pulmonary haemorrhage

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What is classed as a significant bronchodilator response and is significantly positive for diagnosing asthma?

Increase in FEV1 of at least 200ml and by at least 12%

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There is a harsh pan-systolic murmur, loudest at the lower left sternal edge and inaudible at the apex. The apex is not displace. It does not intensify on inspiration

VSD

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Soft late systolic murmur at the apex, radiating to the axilla

Mitral valve prolapse/Mild mitral stenosis

Pulse is jerky and regular. Cardiac impulse is hyperdynamic and not displace. There is a mid-systolic murmur with no ejection click, loudest at the left sternal edge

HOCM

What lung cancer most commonly causes cavitating lesions?

Squamous cell carcinoma (primary or secondary)

How do we manage a pneumothorax that is >2cm and/or the patient is breathless?

Aspiration using a 16-18G cannula sited in the 2nd intercostal space, mid-clavicular line

If aspiration of a >2cm pneumothorax fails, what do we do next?

Intercostal small-bore drain in the 5th intercostal space, mid-axillary line

How do we treat a tension pneumothorax?

Oxygen and immediate aspiration with a 16-18G cannula sited in the 2nd intercostal space, mid-clavicular line. Chest drain immediately after the initial chest decompression

What ECG changes are seen with a digoxin overdose?

Reversed-tick-ST segment depression AV block VT

What ECG effects can erythromycin have?

Prolonged QT interval

A 25 year old man with central chest pain, tachycardia and sweating. He has taken cocaine.

Coronary artery spasm

A 37 year old woman with severe left-sided chest pain which is worse on inspiration. She has antiphospholipid syndrome and a swollen left ankle

A 42 year old man with central chest pain. Movement exacerbates the pain and the anterior chest wall is tender

Tietze's disease (chostocondritis)

What antihypertensive drug can cause gingival hyperplasia?

Calcium channel blockers

An otherwise healthy 13 year old boy presents with recurrent episodes of facial and tongue swelling with abdominal pain. His father had similar episodes

C1 esterase deficiency

A 40 year old man with marked weight loss over preceding six months has bilateral white, vertically corrugated lesions on the lateral surfaces of his tongue

HIV (with EBV infection)

What is a persistently raised amylase associated with?

Pancreatic pseudocyst formation

What chemicals are raised in a common bile duct stone?

ALP and bilirubin

Which of the following is not a prognostic marker for acute pancreatitis: - Age over 55 - Severely raised amylase - Raised white count - Blood glucose - LDH - AST - Urea - Fall in haematocrit - Calcium and ABG derangement

Severely raised amylase

A patient presents to A&E with recurrent colicky abdominal pain. There are a number of small brownish-black macules affecting the perioral skin and oral mucosa

Peutz-Jeghers syndrome

In each of the following stages of Sarcoidosis, what would be seen on CXR: - Stage 0 - Stage 1 - Stage 2 - Stage 3 - Stage 4

0 -> Normal CSR 1 -> Bilateral hilar lymphadenopthy 2 -> BHL and bilateral pulmonary infiltrates 3 -> Bilateral pulmonary infiltrates alone 4 -> End-stage lung fibrosis

What antihypertensives are safe in pregnancy?

1st line - Labetalol | 2nd line - Methyldop OR Nifedipine

A 41 year old man presents to the GP with upper abdominal pain, which is worse before meals and occasionally radiates through to his back. The pain comes and goes and is associated with 'burping' and dyspepsia. He is anaemic. A C14 breath test is positive

Duodenal ulcer

A 64 year old woman presents with weight loss and constipation. An abdominal USS shows multiple hypoechogenic lesions in the liver.

Colonic carcinoma with liver mets

``` A 39 year old man presents to the GP with lethargy and jaundice. Blood tests as follows: - Hb 9.2g/dL - MCV 104fl - WCC 4.4x10^9/L - Platelets 61+10^9/L - Total bilirubin 42 - AST 314 IU/L - ALT 211 IU/L - ALP 565 IU/L - Albumin 26g/L - GGT 207 IU/L - INR 1.8 He was admitted with large fresh haematemesis ```

Oesophageal varices

An ileal lesion 50-60cm from the ileocaecal valve

Meckel's diverticulum

What CXR view is useful for detecting a small pleural effusion?

Lateral decubitus film

What is the standard CXR view?

Posteroanterior film

An 18 year old woman presented with lower abdominal pain, urinary frequency and dysuria. She is pyrexial and has right iliac fossa tenderness with rebound tenderness and guarding. Pregnancy test is negative

Acute appendicitis

Where is the commonest site of mesenteric ischaemia?

Splenic flexure (site of watershed between superior and inferior mesenteric arterial supplies)

A 25-year-old man with a history of Crohn's disease is reviewed. Over the past week he has developed painful perianal ulcers. On examination numerous shallow ulcers can be seen with a small number of skin tags. What is the most appropriate first-line treatment? - Topical aciclovir - Oral metronidazole - Barrier creams + laxatives - Oral prednisolone - Oral mesalazine

Oral metronidazole

A 29-year-old man presents with a 12 day history of watery diarrhoea that developed one week after returning from India. He had travelled around northern India for two months. On examination he is apyrexial and his abdomen is soft and non-tender. What is the most likely causative organism? - Amoebiasis - Giardiasis - Campylobacter - Shigella - Salmonella

Giardiasis

A 50-year-old man complains of central, pleuritic chest pain 24 hours after being admitted with an anterior myocardial infarction. The pain is eased when he sits upright.

Pericarditis

Which one of the following causes of pneumonia is most associated with the development of Stevens-Johnson syndrome? - Legionella - Mycoplasma - Coxiella - Staphylococcus - Klebsiella

Mycoplasma

A 30-year-old man comes for review. He returned from a holiday in Egypt yesterday. For the past two days he has been passing frequent bloody diarrhoea associated with crampy abdominal pain. Abdominal examination demonstrates diffuse lower abdominal tenderness but there is no guarding or rigidity. His temperature is 37.5ºC. What is the most likely causative organism? - Giardiasis - Enterotoxigenic Escherichia coli - Staphylococcus aureus - Salmonella - Shigella

Shigella