random revision

Question 1

What are the indications for long-term oxygen therapy (LTOT) in COPD?

Answer 1

• LTOT is indicated in patients who have a PaO2 of <7.3 kPa (measured when the patient is clinically stable, on two occasions, at least 3 weeks apart).

LTOT is also indicated in patients who have a PaO2 of 7.3-8 kPa (measured when the patient is clinically stable, on two occasions, at least 3 weeks apart) WITH one of the following:

Nocturnal hpoxaemia (SaO2 below 90% for over 30% of the time), or;
Secondary polycythaemia, or;
Pulmonary hypertension (pulmonary artery pressure >25 mmHg), or;
Peripheral oedema.

Question 2

What are some of the causes of Mobitz type I?

Answer 2

-Seen in athletes due to increased vagal tone

-Drugs e.g. Beta-blockers, calcium channel blockers, digoxin and amiodarone

-Inferior myocardial infarction

Question 3

How is atrial fibrillation with onset >48 hours typically treated if there signs of heart failure?

Answer 3

Atrial fibrillation with onset >48 hours is typically managed with rate control (i.e. metoprolol or bisoprolol or verapamil, or digoxin if there are signs of heart failure).

Question 4

What are the features of high radial nerve lesions (at the humeral shaft)?

Answer 4

For high lesions, the cause is normally a humeral shaft facture. This will give wrist dorp, reduced sensation in the anatomical snuffbox but no triceps weakness

Question 5

What is the mechanism of action of metoclopramide?

Answer 5

anti-emetic
D2 agonist

Question 6

What are the features of Stage 5 CKD?

Answer 6

eGFR is less than 15

Stage 5 CKD if eGFR is <15 ml/min/1.73m^2.

remeber the clock

Question 7

How are progressive muscular atrophy and polio similar?

Answer 7

• breakdown of muscle which can’t allow breathing to occur
• Progressive muscular atrophy and Polio are both degeneration of the anterior horn cells so both give a lower motor neurone picture only.

Question 8

What are the risk factors for gastric cancer?

Answer 8

Smoking
Pernicious anaemia
H. pylori infection
High alcohol intake (> 6 units per day)
Dietary nitrosamines (found in smoked foods and gastric cancer has higher incidence in Japan)
Atrophic gastritis
Blood group A
Adenomatous polyps
Achlorhydria (as seen in Menetrier’s disease)

Question 9

What are the clinical features of Motor neurone disease?

Answer 9

Progressive upper and lower motor neurone signs, with bulbar and respiratory failure

Question 10

What are the clinical features in a history of mesenteric ischaemia?

Answer 10

• Acute severe abdominal pain out of proportion to examination findings
  -PR bleeding
  -Metabolic acidosis

Question 11

How to differentiate L5 radiculopathy and common peroneal nerve palsy?

Answer 11

L5 root lesion (radiculopathy) is distinguished by loss of inversion (inversion is a tibial nerve function and is not lost in patients with a common peroneal nerve lesion)

Question 12

Name the two Major modified duke’s criteria

Answer 12

Two seperate positive blood culutres growing typical organisms or echo evidence of endocardial involvement

Question 13

What is the otoscopic findings for otitis media with effusion?

Answer 13

Otoscopy would reveal a non-inflamed, retracted and dull tympanic membrane.

Question 14

Mean age of motor neuron disease onset

Answer 14

50-60 years old

Question 15

What is the most appropriate treatment for a patient with asymptomatic mitral stenosis?

Answer 15

regular follow ups

Question 16

What is the main difference between bilevel positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP)?

Answer 16

CPAP- single form
BiPAP- varies between two pressures

Question 17

What is the mechanism of action of Venlafaxine?

Answer 17

Serotonin-noradrenaline reuptake inhibitor

Question 18

What are the causes of CSF rhinorrhoea?

Answer 18

Fracture of the anterior skull base
Iatrogenic following surgery (FESS)
Spontaneous leak

Question 19

When should patients treated for H. Pylori be retested?

Answer 19

At least 4-8 weeks after initial treatment.

The patient should not have taken a PPI for two weeks before and antibiotics/bismuth for four weeks before testing.

Question 20

name of the large baby in utero

Answer 20

macrosomia

Question 21

organisms which cause partial haemolysis on blood films

Answer 21

Strep viridans
Strep pneumoniae
These belong to the group of alpha haemolytic Streptococci.

Question 22

What investigation is most useful to visualise stones in the urinary system?

Answer 22

CT KUB

Question 23

Which congenital condition is ventricular septal defect commonly associated with?

Answer 23

Down’s syndrome

Question 24

What is Linitis plastica?

Answer 24

It is a diffusively infiltrative gastric adenocarcinoma, which leads to a thick and rigid stomach wall. Also known as leather bottle stomach.

Question 25

What is the treatment of an unprovoked PE

Answer 25

DOAC for 6 months
apixiban

Question 26

Causes of raise in troponin

Answer 26

Cardiac
-Arrhythmias
-Coronary artery
-spasms
-Aortic dissection
-Severe hypertension

non-cardiac causes
- Chronic kidney disease
-Pulmonary embolism
-Sepsis

Question 27

A 59 year old woman presents to her GP with a few weeks of epigastric pain, which is particularly bad about one to two hours after food. The pain can sometimes radiate through to the back. She hasn’t had any fever or weight loss.

She has a past medical history of asthma and rheumatoid arthritis. She uses a salbutamol inhaler infrequently and takes over the counter ibuprofen for her arthritis. She smokes 20/day and has a glass of wine each evening.

What is the most likely diagnosis?

Answer 27

peptic ulcer

Question 28

Peptic ulcer vs chloecystitis

Answer 28

• both have epigastric pain which radiates to the back

Peptic ulcer
- pain is relieved after eating food
Peptic ulcers are commonly caused by infection with Helicobacter pylori bacteria, long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol consumption, smoking, and stress.

chloecystitis
- RUQ/ epigastric pain
- radiates to the scapular
- assoicated with fever

Question 29

A 38 year old woman presents to the GP with high blood pressure of 162/110. As her blood pressure has been consistently high despite diet and lifestyle measures, the GP is keen to start her on an antihypertensive. Her past medical history includes anaphylaxis and she keeps an epipen with her.

Which antihypertensive drug should be avoided with an Epipen?

Answer 29

labetalol

Question 30

Low molecular weight heparin has the greatest inhibitory effect on which one of the following proteins involved in the coagulation cascade?

Answer 30

FACTOR XA

Question 31

What is the minimum HbA1c that would be diagnostic of type 2 diabetes mellitus?

Answer 31

6.5%
48 mmol/mol