REAL PAST PAPERS Flashcards by T B

Patient with collapse, P wave rate of 75, Broad qrs rate of 40 Options:
A. complete AV block, 
B. first degree HB, 
C. second degree HB, 
D. Complete heart block

D. Complete heart block

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Type 1 diabetic goes to an all night party, doesn’t eat and sleeps all day. 8pm
presents to A&E with vomiting. pH 7.24

DKA

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Student comes back to England from Nigeria with jaundice, anaemia and
fever. Options: 
A. falciparum, 
B. Hep A, 
C. Influenza A, 
D. typhoid 
E. paratyphoid fever

A. Falciparum

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40 year old farmer has wheeze for a few weeks. Normal CXR. Diagnosis.
Options: 
A. Asthma, 
B. farmers lung,
C. aspergillosis.

A. Farmers long (interstitial lung disease)

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Anal abscess (described as perianal erythema and swelling) with fever and a
lump. What do you do?Options: 
A. Give abx and review early, 
B. incision and drainage,
C. Oral flucloxacillin

B. I&D

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Pain on passive dorsiflexion Compartment syndrome young guy fractured
tibia playing football. Options: 
A. 4 compartment fasciotomy within 6h,
B. review in 12hrs,
C. send home

A. 4 compartment fasciotomy within 6h

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30 something man with joint pain - sacroiliitis and distal interphalangeal joint
pain? 
A. Ank spond,
B. Psoriatic arthritis, 
C. Rheumatoid arthritis.

A. Ank Spond (can also give

you hand arthritis)

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Transfusion reaction - fever, other obs normal, transfusion stopped. What
next? 
A. Check bag against patient details, 
B. start transfusion again, 
C. give
chlorpheniramine

A. Check bag against patient details

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Patient on warfarin having nasal polypectomy - what do you do to the
warfarin.
A. Admit patient two days pre-op and start heparin,
B. change to aspirin after op
to reduce risk of bleed,
C. measure aptt,
D. stop warfarin on the day of surgery

A. Admit

patient two days pre-op and start heparin

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Breast Ca - which is the biggest risk factor in this patient?
Obesity, smoking,
multiple pregnancies, breastfeeding, late menarche

Obesity

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Legionella - which Abx?

Clarithromycin (atypical)

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Which drug is commonly co-prescribed with morphine? Aspirin, hyoscine,
co-danthramer, loperamide

Co danthrusate (stimulant laxative)

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Mid-diastolic murmur

Mitral stenosis

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Pericarditis murmur qs - Patient has widespread ST elevation, which sound
heard on ausc?

scratch (pericardial friction rub)

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Which antibodies are most specific/raised in SLE - dsDNA, anti-cardiolipin

anti dsDNA

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EDM Aortic regurg murmur with sudden onset chest pain going to back.

Aortic Dissection

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Patient with symptoms of aortic dissection - AR etc, what test for confirming
diagnosis?Contrast CT chest, CXR, USS

CT chest with contrast

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Lady with yellow eyes and high reticulocytes.

haemolysis

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70yo lady falls in road onto outstretched hand and gets fracture. What
test should GP follow up with? Vit d levels, DEXA, bone profile

DEXA

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atient on warfarin for AF has INR of 3.3, falls and found on CT to have
intracerebral haematoma - warfarin stopped and been given Vit K, what next?
Prothrombin complex, vit K again in 12 hours, mannitol

give prothrombin complex

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Patient has central chest pain, which ECG criteria would be indication for
thrombolysis? New RBBB (could be PE with RV dysfunction), Q waves in (I dont
remember the rest someone add), ST elevation in leads II, III and aVF, T wave
inversion in aVR, st depression in lead v1-4

ST elevation in leads II, III and aVF

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Male married 30 years, sex with only his wife, pain in testicle and epididymis.
Organism? Chlamydia trachomatis (most common), E.Coli, Neisseria gonorrhoea - ?

Chlamydia trachomatis (most common)

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45 year old with intracapsular #NOF otherwise well (not given Garden
classification) - management? Hemiarthroplasty, dynamic hip screw, cannulated
screws

Hemiarthroplasty

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Patient has cough, apical cavitating lesions, haemoptysis, firm LN in neck.
What test? Auramine stain of sputum, Sputum culture and sensitivity for AAFB, LN
biopsy

Sputum culture and sensitivity for AAFB (TB)

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Lady with palmar erythema, raised ALT, raised bilirubin, strongly positive ANA. AI hepatitis, SLE, Drug induced cholestasis, PBC

``` AI hepatitis (anti smooth muscle antibody most specific) ```

Haematemesis and abdo pain, BP 120/80, HR >100 (what was the actual HR?) What do you give IV whilst waiting for endoscopy?IV crystalloid, O-ve blood, IV terlipressin (in varoceale), IV PPI

IV PPI (in upper GI bleed)

Alcoholic with diplopia on looking laterally both sides, nystagmus, what vitamin to give him?

Thiamine - B1 (wernicke's)

Diabetic with weakness in all four limbs started 3 days ago, weakness worse proximally cf distally in LL, no change to sensation in LL, UL has some pins and needles, bilateral eyelid weakness. Loss of reflex and plantar response. GBS, Myasthenia, Diabetic neuropathy, MS

Myasthenia

Alcoholic with multiple bruises on legs, has bloods and clotting which show Low bili (i think?), low platelets, low fibrinogen, raised APTT, raised PT - cause of his clotting abnormalities?

DIC (give FFP if low fibrinogen)

Patient with nephrotic syndrome picture (oedema, proteinuria, low albumin) what test for specific diagnosis? 24 hour urine, renal biopsy, 24 urine collection to measure protein (if >3.5g/dl then diagnostic)

``` 24 urine collection to measure protein (if >3.5g/dl then diagnostic) ```

Small cell lung ca, hilar LN, no distant mets - what treatment Palliative, chemo, radio, surgery

chemo

Legionella pneumonia → abx. Options Ciprofloxacin, clarithromycin, cefotaxime and some others

clarithromycin

Klebsiella pneumonia → Abx to give. Options Ciprofloxacin, clarithromycin, cefotaxime, co-amoxiclav and some others.

Ciprofloxacin

Pneumocystis jiroveci → Abx

Co-trimoxazole

Public health question: 200 pts in 2 month period out of 10,000 people get influenza. They ask how many people out of 100,000 in one month period get .infection 100, 200, 1000, 2000

1000

Some guy flew in from Tel Aviv he has chest pain and then a few hours later his leg goes white and there are no pulses. Aortic dissection, thromboses of the popliteal artery, PE, MI, DVT → no idea ?

mural thrombus

Patient has bad claudication and can only walk 10m. Distal aorta and both iliac vessels occluded. What do you do? Endarterectomy, femoral crossover bypass, aorto bifemoral

femoral crossover bypass

Distal aorta and common iliac disease which bypass do you do?Aorta bi-fem, fem crossover, iliac endarterectomy

Aorta bi-fem

Lady has has surgery 4 days ago, after she was given multiple bags of 5% dextrose. Now she is drowsy. Whats the mechanism? Options: Cerebral oedema, infection, osmotic demyelination, osmotic shrinkage

osmotic shrinkage

60 year old man unilateral left hand tremor at rest. Worse when people looking at tremor. Able to do buttons and hold teacup without shaking. Mild cogwheeling at wrist and fingers on left. What is cause? Anxiety state, early parkinsonism, benign essential, right sided cerebellar lesion. (what was it?)

early | parkinsonism

Stroke with hemiparesis, 2 days later SALT assessment → unsafe swallow. Best feeding? NG, PEG, TPN, thickened fluids, pureed food

PEG

Diagnosing legionella.

urinary antigen

Open comminuted fracture with some kind of skin loss and really dirty basically. What do you do? External fixation, internal fixation, Thomas’ splint, skin traction, plaster cast

internal fixation

T2DM controlled on diet presenting with red painful eye and blurry vision. What do you do? Refer urgently to ophthal, get urgent retinal imaging, start topical timolol, start topical chloramphenicol, start topical steroids

Refer urgently to ophthal (retinal detachment)

Guy gets claudication in calf. Where is the block? SFA, posterior tibial, common iliac . thigh (CFA) , buttock (common iliac), aorta (everywhere)

SFA

Guy following RTA has shortened, internally rotated, slightly flexed and adducted right leg. What’s wrong? Posterior hip dislocation, anterior hip dislocation, NOF, femur shaft fracture

NOF

Calculate GCS - eyes open to pain, localising to pain, making noises

Man does not open his eyes, localises to pain, groaning. What airway is right for him? Nasopharyngeal, oropharyngeal, cuffed, LMA - laryngeal mask airway, tracheostomy

oropharyngeal

Guy falls 10m, what’s the first thing you do?

Secure his airway (ABCDE)

56 year old with weight loss, heartburn responding to antacids, smoker, drinker. What do you do? Gastroscopy, gastroscopy and treat H pylori if positive, trial of PPI, more antacids + lifestyle advice

gastroscopy and treat H pylori if positive

Lady with RA and purple nodule on shin ulcerating with raised edges. Pyoderma gangrenosum, SCC, venous ulcer

Pyoderma gangrenosum

Guy with prostate ca has back pain and bone scan shows increased uptake in spine, how to help with pain? Radiotherapy, chemotherapy, bisphosphonates

Radiotherapy

32 year old woman with mobile non-tender lump in breast.

Fibroadenoma

Some woman with folate and iron deficiency. Some unstated bowel symptoms following bouts of gastroenteritis as a child. What ix do you do? Anti TTG abs, colonoscopy, Schilling’s

nti TTG | abs

Post partum breast feeding lady with red tender breast, no mass. What do you do?

Fluclox

What does a triple assessment consist of?

Clinical exam, imaging + core | biopsy. (Imaging in <35 is USS, >35 is mammogram)

Lady sudden onset severe headache starting 12 hours ago. CT scan normal. What do you do?

LP (xanthochromia - SAH)

Old guy with bacteruria grown from catheter. What do you do? Treat, ignore, treat if symptomatic, change catheter

change catheter (? remove cathetor)

Guy post thyroidectomy with hoarse voice and weak cough. What damage? Recurrent laryngeal, phrenic nerve, laryngeal oedema

Recurrent laryngeal

Smoker has lung cancer near right bronchus removed with raised calcium, what will histology show?

Squamous cell carcinoma (PTHrP)

Few months breathlessness, fine end-inspiratory bibasal creps, clubbing, JVP at 5cm?

Pulmonary fibrosis

Man has taken 32 paracetamol 500mg tablets 18 hours ago. He weighs 80kg. You take bloods, but what do you do whilst waiting for the levels to come back? Wait for the levels, give saline, give naloxone, give acetylcysteine (give acetylcysteine as he has taken 200mg/kg, and anything over 150 is probably toxic so should be treated)

give acetylcysteine (give acetylcysteine as he has taken 200mg/kg, and anything over 150 is probably toxic so should be treated)

What is a feature of reactive arthritis other than arthritis, urethritis etc? Keratoderma blenhorrhagicum (yellow lesions on soles of feet). Triad of arthrtis, urethritis and conjuctivitis.

``` Keratoderma blenhorrhagicum (yellow lesions on soles of feet). Triad of arthrtis, urethritis and conjuctivitis. ```

Primary tension pneumo. Management (didn’t say directly, gave description of deviated trachea etc) Aspirate (large bore cannula in 2nd IC space mid clavicular line). Give NIPPV. Give 24% oxygen through venturi

Aspirate (large bore cannula in 2nd IC space mid clavicular | line)

Lady with AI history has sore, gritty eye, dry mouth and bilateral parotid swelling? Sjogrens, cancer, mumps, sarcoidosis

Sjogrens

Man has no pain, jaundice, dark urine, pale stools?

pancreatic ca

Lady has headaches. Transiently loses vision when she strains to defecate. SIgns seen in eyes. She is obese, smokes a lot, drinks a lot, drinks 12 coffees a day. What can she do that will help the most? Stop drinking, stop smoking, give up coffee, lose weight

lose weight (idiopathic intracranial HTN)

Man with known AF presents with 1hr hx of epigastric pain 15 minutes after a meal. Mesenteric ischaemia, duodenal ulcer, biliary colic, cholestasis

Mesenteric ischaemia

40 year old banker has headaches which have led to taking ibuprofen and paracetamol daily. No neuro or eye signs. No weight loss.

Advise to stop taking meds | and reassess in a month (analgesia headache). Add codeine

Guy with pneumonia with green sputum, hyponatraemia, euvolaemic. Initial treatment? Fluid restrict, oral vasopressin antagonist, give normal saline

Fluid restrict

Someone has hearing changes, haemoptysis, nasal discharge, renal problems. CXR shows 3 cavitated lesions?

Wegener’s Granulomatosis

Patient on immunosuppression develops difficulty swallowing, is on lansoprazole, ibuprofen, dexamethasone. Neutropenia. - Cause for dysphagia?

oesophageal candidiasis

Man has low eGFR, high calcium, high creatinine. Calcium was also high a year ago, but not as much? Vit D problem, pri hyperPTH, tertiary hyper PTH, Multiple myeloma

tertiary hyper PTH

Guy with lateral epicondyle pain. Which movement hurts? Wrist extension, wrist flexion, elbow flexion, elbow extension

elbow extension

Guy with dull ache in groin, lump appears on standing, no cough impulse, does not transilluminate…. Cause? Varicocele, inguinal hernia, epididymal cyst

inguinal hernia

49 yo lady with 2 month history of diffuse thyroid swelling and intense sweating at night - Graves, toxic nodular goitre, subacute thyroiditis

Graves

Bipolar, taking lithium. Glucose normal. Symptoms - thirst, polyuria. (also had some cheeky hypothyroidism) What is the cause of his symptoms?Options: diabetic insipidus, diabetes mellitus, psychogenic polydipsia, hypothyroidism

nephrogenic | diabetes insipidus

Test for gestational diabetes. Oral glucose tolerance test at 28 weeks, random blood glucose or sth, fasting glucose

OGTT at 28 weeks

Thyroid function low TSH, High T4- post URTI, reduced iodine uptake, hyperthyroid. Cause? Viral thyroiditis, Graves, Hashimoto, nodule

Viral thyroiditis (de quarvans)

Man of 60ish gets diagnosed with diabetes. His BMI is 30. DIet and exercise have failed. What do you do next?

Metformin

Patient has bowel operation 4 days ago, has not opened bowels for 24 hours. Distended with scant bowel sounds. Cause?

Post op ileus

Patient has operation for perforated duodenal ulcer - gets hiccoughs and nausea - what is the cause?Subphrenic abscess, pelvic abscess, small bowel obstruction

Subphrenic abscess

Patient with symptoms of guarding, peritonism, what test?

Erect CXR

Patient with symptoms of bowel obstruction - what test?

Supine AXR

Renal colic - what is the first imaging you’d do? - AXR, CT KUB, abdo USS

CT KUB

Patient has been generally unwell for a week. Now has dysuria and is going frequently. Later on she gets more unwell and has really bad loin pain. What’s wrong?

Pyelonephritis

80 year old with essential hypertension and peripheral vascular disease. What meds - Diltiazem, felodipine, irbesartan, moxonidine

felodipine

Patient with stiffness in shoulders, thighs, buttocks. fatigue. ESR 80, normal CK, Polymyalgia rheumatica, Polymyositis, dermatomyositis

Polymyalgia rheumatica

Testicular pain in a sexually active 18 year old. Management

Antibiotics (neisseria - ceftriaxone and azithromycin)

Uvula deviated, cervical lymph nodes, sore throat, inflamed soft palate. Peritonsillar abscess , tonsillitis, infectious mononucleosis

Peritonsillar abscess (Quinsy)

Man had 1cm painless penile ulcer on the shaft. What caused it? Options:- Neisseria Gonorrhoea, Chlamydia Trachomatis, Treponema Pallidum, Herpes simplex

Treponema Pallidum,

Lady with flushing, pustular rash, telangectasia on her face. Rosacea, Lupus pernio, acne, discoid lupus

Rosacea

Someone has AF and has a cold pale leg. It’s been 6 hours.

Get rid of clot

Gentlemen with bald head, lumpy hyperkeratotic lesions on scalp. What is he at risk of?

Scc

Lesion on shin, irregular borders, multiple colours. You suspect melanoma.What’s the commonest type?

Superficial spreading

Guy with pale stools, abdo pain. Xray shows area of calcification. Dx - decrease in exocrine pancreatic function

Chronic pancreatitis

Lady with #NOF - IV paracetamol not helping. What analgesia next? Patient controlled pethidine, femoral block, IM diclofenac, iv repeated bolus of morphine, Gas and Air

femoral block- note: Paracetamol 1g po/iv qds Femoral/fascia iliaca nerve block in A+E Oramorph for breakthrough pain Intravenous fluids through a pump - Hartmann’s started in A+E

Guy who was lifting heavy things. Now just lumbar pain.

control with NSAID

Hayfever symptoms, how is it mediated? IgA, IgE, IgG, IgM, IgD

IgE

Features of AS

slow rising pulse, ejection systolic murmur, loud s1, narrow | pulse pressure, soft s2 (or absent in severe AS)

Patient with 3 weeks of fevers, cough, feeling unwell. On exam: dull percussion, absent Vocal Resonance, reduced expansion- empyema, consolidation, collapse

collapse

What vitamin you have to give somebody when starting TB treatment?

Pyridoxine (B6)

Somebody comes in to A&E with drug resistant TB, where do you keep them?

negative pressure room + respiratory | measures for staff

Somebody with features of UC - how do you investigate - flexible sigmoidoscopy, CT, US

flexible | sigmoidoscopy

Pt comes in fitting for ages, given two loads of lorazepam, whats next?

Phenytoin loading

ytoin loading 107. Lady with splenectomy, needs to be on penicillin - why? Pneumococcus, staph aureus, haemophilus. Nb. protection against encapsulated organisms

Pneumococcus

Pt with known renal cell cancer now gets swollen legs and distended veins below umbilicus what’s the diagnosis? Obstruction of IVC, lymphatics (right renal vein and right testicular vein directly to IVC, left testicular vein goes into the left RENAL vein at a 90 degree angle, then the left renal vein goes into the IVC)

Obstruction of IVC

Patient with severe pain on defecation and blood on paper: fissure, rectal ca, haemorhoids

fissure

Patient ventilated on ITU, develops respitatory alkalosis, what do you do?

Decrease frequency of ventilations

Gives FEV1/FEVC ratio - shows restrictive pattern. Dx? Pulmonary fibrosis, COPD, Bronchiectasis

Pulmonary fibrosis

Some guy with obstructive features, long term smoker. Dx?

Chronic | bronchitis

Guy who is IVDU develops harsh murmur. What’s the cause?

Staph Aureus

20 year old female, walks in, has 2yr history of intermittent diarrhoea, IDA, aphthous ulcers, raised ESR

crohns

A ECG shows STEMI in leads V4-V6 and I, AvL - where is the infarct? Antero-lateral (circumflex), antero-septal (V1 -V4, left anterior descending), inferior (RCA 2, 3, avF)

Antero-lateral (circumflex)

Lady with falciparum. Other than doxy, what other abx would you give her? Chloroquine, quinine, proguanil, pyrimethamine

quinine

Which of the DMARDs cause retinopathy?

Hydroxychloroquine

A man with stab injury to the back - hemisection of the cord. Where would he lose pain sensation from? Contralateral spinothalamic, ipsilateral motor and dorsla columns below the lesion

ipsilateral

Which of the DMARDs cause azoospermia and bone marrow suppression? Sulfasalazine, azathioprine, methotrexate

Sulfasalazine

Lady with tremor, weight loss, proptosis and exophthalmos. Has ophthalmoplegia. What is likely cause? Rectus muscle thickening (Graves), retrobulbar tumour, cavernous sinus syndrome

Rectus muscle thickening (Graves)

69 year old guy with two previous TIAs and AF. What do you start him on?

aspirin

Lady with hx of AF presents to A&E with fast AF, pulmonary oedema and peripheral oedema. What do you give initially?

furosemide | and Ramipril

6. Lady presents with acute MI, no details. What do you give?

aspirin and beta blocker

Guy on prednisolone presents with darkened red reflex and problems with night vision. What does he have?

Cataracts

Lady from some Pakistan or somewhere with HTN controlled on amlodipine and BP of 150/90 has retinal findings: blot haemorrhages and yellow deposits (hard exudates I think) on macula. What is this?

diabetic | retinopathy

Footballer inverts his ankle and presents with foot pain, surprised he has no ankle pain. What does he have?

damaged | ligaments

Guy jumps and lands on his knee – medial meniscus | tear, patella fracture, damage to ACL

patella fracture

Pulmonary adenocarcinoma Ca met to liver via what route? Transcoelomic, direct invasion, haem, lymph

haem

Lady playing squash suddenly runs, hears a crack from behind ankle then pain whenever she tries to plantar flex. What happened? Ruptured Achilles, fractured talus, fractured calcaneus

Ruptured Achilles

Some weird question at the end about pre test probability- Evidence based medicine works by deciding pre-test probability of something and then doing tests and changing the probability of that thing accordingly. Middle aged lady presenting with atypical chest pain – what would be used to decide pre test probability she has ischaemic heart disease? Options: epidemiological evidence of something, case Page no. 7 control study on atypical chest pain RFs, clinical experience, exercise ECG and something

exercise ECG and | something

Person with 4cm head of pancreas ca that has invaded mesenteric vessels. How do you manage? ERCP and biliary stent, PTC drainage, Whipple’s, Vit k, abx

Whipple’s

Son of 75 year old lady requests home visit for mother who has recent behavioural changes. Sometimes gets confused and sees people in the room who aren’t there. Recent loss of appetite. Cause? Lewy body dementia, Alzheimer’s, depression with psychosis

Lewy body dementia

Guy post-op with delirium and morphine epidural in situ, what is best initial management? Put in well lit side room, haloperidol, discontinue morphine epidural

discontinue morphine epidural

Guy with short history of back pain and painless black lesions on his feet appear. What ix do you do? Arteriogram, CT abdo, MRI Spine (as malingnant melanoma)

``` MRI Spine (as malingnant melanoma) ```

ma) 138. Guy presenting to GP with nocturia. PSA 18, urinalysis trace blood and protein, urea and cr mildly elevated. What do you do? Refer routinely to uro, refer urgently to uro, refer routinely to renal, refer urgently to renal

urgently to uro

75 year old lady with 2.5cm firm breast lump not tethered to skin and no skin changes. Daughter 40 year old just had benign breast cyst diagnosed. What does the old lady have? Ductal carcinoma, breast cyst, lobular carcinoma in situ

Ductal carcinoma

45 year old lady with spontaneous dark brown nipple discharge. Examination reveals only one duct producing discharge. What does she have?

duct ectasia

Tall 28 year old man with radiofemoral delay and hypertension. BP 210/110. Has rib notching. What is underlying diagnosis? Coarctation, Marfan’s, ED

Coarctation

Young guy vomiting after a night out presents with chest and epigastric pain, left sided pleural effusion, subcutaneous emphysema. What happened?

Oesophageal rupture

Sickle cell girl with severe back pain (?) What do you do first? Exchange transfusion, epidural anaesthesia, paracetamol/ibuprofen, fluid bolus

paracetamol/ibuprofen

Old man with smear cells. Cause? CLL, Hodgkin’s, NHL

CLL

Guy on ibuprofen started recently for some pain. Comes in with two episodes of vomiting bright red blood. No further episodes. Stable obs, low Hb. What do you do? Observe for 24 hours and discharge with omeprazole, OGD within 2 hours, OGD on next endoscopy list

OGD within 2 hours

Lady collapses on hospital ward. Had co-amox in A&E earlier and reports feeling breathless before collapse, 2 hours later is slightly tachy, slightly hypotensive, resp rate 34, sats 94% on 10L o2. What do you give first? Adrenaline, chlorephenamine, steroids, iv fluid bolus

Adrenaline

2 PBC questions - 1) antibody test for PBC 2) histology showing classic PBC

1. anti mitochondrial antibody 2. dense lymphoid infiltrate in a portal tract with minimal periportal lymphoid extension in a pre-cirrhotic stage of PBC.

Guy with metastatic renal cancer has severe pain. Is/has vomited 4 times or something. Currently on oral morphine solution prn and helps for about 2 hours. What pain therapy should he be on? Fentanyl transdermal, morphine sub cut infusion, morphine subcut prn, oral morph slow release tablets, oral morph solution prn

morphine sub cut infusion,

Someone with previous TKR, now tender, febrile, hot, swollen. No evidence of crystals on microscopy. Aspirate showed turbid fluid. Cause - septic arthritis, reactive arthritis, gout

septic arthritis

Nutrient deficiency in coeliacs - Vit. D, folate, b12

b12

Guy who smokes and keeps pigeons, progressive shortness of breath on climbing hills. CXR shows reticulonodular shadowing. EAA, IPF, Pneumonia

EAA

Acute presentation of gout. PMH Heart failure, on ramipril. 3rd recurrence. What do you give? Naproxen, colchicine, allopurinol (AT LEAST 2 episodes in 1 year, have to wait 2 weeks since the resolution of symptoms)

Naproxen

Caucasian lady with Raynaud’s colour order

White → blue → red

Post transplant patient has dry cough and SOB. Desaturates from 90+ to 83% on exercising. What does he have?

PCP (treat with cotrimoxazole)

Bilateral conductive hearing loss in old lady (Had to interpret Rinne Webers to work it out). Cause? Otosclerosis, Meniere’s, Presbyacusis (symmeticral age related sensineural loss)

Otosclerosis

Someone with URTI symptoms has purple nodules on shins. What does she have?

Erythema nodosum

Commonest cause of corneal ulceration (branching)? HSV (dendritic ulcer), VZV, HIV

HSV (dendritic ulcer)

Painful vesicular derm lesion on one side of face around forehead, eye and cheek. Cause?

VZV (shingles)

65 yo guy comes to GP with new onset dyspepsia. No weight loss or dysphagia. What do you do first? H.pylori stool antigen test, refer routinely, refer 2 weeks, OGD

OGD

30+ year old lady with fever and fits. Scan shows temporal lobe necrosis. Cause?

HSV

Ring enhancing lesions on ct brain with HIV?

Toxoplasmosis

Lady coming to GP with blood test results showing raised prolactin levels and raised IGF-1. Normal TSH, LH, FSH, ACTH. Most likely diagnosis? Acromegaly, macroprolactinoma, TSHoma

Acromegaly

Old lady, takes nitrofurantoin - gets watery diarrhea, 2 others in care home have diarrhoea too? C. difficile, Norovirus, Rotavirus

Norovirus

Blood transfusion, starts second unit, immediately has chest pain, SOB, dark urine. What happened?

``` ABO incompatibility (immediate haemolytic transfusion reaction) ```

T1DM girl on subcut insulin pump comes in with frequent episodes of SOB, palpitation and tingling of fingers. Cause? Hyperventilation syndrome, anaemia, anorexia

Hyperventilation syndrome

Most appropriate pre-operative investigation for well-controlled asthmatic about to undergo a diagnostic laparoscopy?

PEFR

Guy falls down can’t remember how long he’s been on the floor for, comes in with renal failure and dark red urine, raised potassium. What is cause of renal failure?

Rhabdomyolysis

Some thin 18 year old girl comes in with low potassium, macrocytic anaemia and raised urea, physical examination otherwise normal. What is cause? AN, coeliac disease - melonosis coli and lentigo hair (fine hair)

Smoker comes in with progressive breathlessness. GP does spirometry and sends him home with PEFR diary. Which will help GP diagnose COPD? Long history of smoking, reversible airflow limitation with beta 2 agonist, normal FVC and low FEV1, low FVC and low FEV1 (<70%) Ratio has to be <80%

low FVC and low FEV1 (<70%) Ratio has to be <80%

Patient with pernicious anaemia then has ?iron def as well and gastroscopy shows ulcer in stomach. What malignancy? Lymphoma ( MALT - mucosal assocaited lymphoid tissue). NB. EATL - enteropathy associated T cell lymphoma associated with coeliac disease, Adeno (GORD), SCC (worldwide cause of esophageal cancer), adenosquamous carcinoma (occurs in lung)

Lymphoma ( MALT - mucosal | assocaited lymphoid tissue)

Old guy comes in to GP with one episode of visible painless haematuria. What do you do? Refer to urology - cystoscopy, CT urogram, USS renal tract

efer to urology - cystoscopy

Guy comes in with loin to groin pain and blood ++ on urine dip. What ix do you do to confirm? CT KUB urogram without contrast, IVU, USS renal tract (pregnant ladies)

CT KUB urogram without contrast

Guy comes in with lots of swelling and protein in urine and hypoalbumina. What test will confirm a specific diagnosis?

Renal biopsy

Guy comes in with swollen legs and bilateral scrotal swelling with recent 10kg weight gain? Lymphoedema, peripheral oedema, hydrocele

peripheral oedema

Lady with metastatic breast ca and hypercalcaemia (like over 3). What do you do first? IV fluids, furosemide, bisphos, haemodialysis

IV fluids

Guy with hypercalcaemia, renal failure, anaemia, bone pain. What does he have? MM, secondary hyper pth

Lady who recently came from Afghanistan with low calcium, raised PTH. What test to confirm Dx?

Serum vitamin D (secondary hyperparathyroidism)

Guy with epilepsy and now housebound. Pain in spine and on compressing rib cage? What does he have - osteomalacia, osteoarthritis, polychondritis

osteomalacia

Guy has episodes of syncope and and goes blue during. No other problems. How to investigate? - 24 hour ECG, echo, angiography

24 hour ECG

``` Someone with right sided hemiparesis, aphasia, some kind of visual deficit - doesn’t blink to hand waving on right side but does on left. Which artery? MCA, ACA, basilar, posterior circulation Brocas area supplied by MCA, contralateral homonomous hemianopia (left sided lesion causes a right sided defect) ```

MCA

Bitemporal hemianopia person where is lesion. She’s almost knocking pedestrians down.

Optic chiasm

Fit guy whose dad died early comes to you worried. He passes out during sports I think. What investigation? Echo (HOCM), ECG (increased S waves in V1 and R wave in V5- V6), refer to cardiology

ECG (increased S waves in V1 | and R wave in V5- V6)

Guy falls down from somewhere and has no more biceps reflex (C5 lesion), hand held in (basically Erb’s palsy position but this is described out in excruciating detail without using the words Erb’s palsy - waitors tip). What got damaged? Upper brachial plexus, lower brachial plexus, median, ulnar, radial. Klmpke’s lesion - C8, T1 so triceos reflex lost, wastage of small muscles of the hand

Upper | brachial plexus

Zig zag lines (scintillating scatoma) and painful eyes + N&V for 30 min episodes ? No cluster headache option. Migraine, Glaucoma

Migraine

Guy with haemorrhoids that do not prolapse. First line? Fibre, sclerotherapy, surgery, topical GTN - haemorrhoidectomy (if prolapsed and irreducible)

Fibre

High esr, pain on abducting shoulder?

PMR (Polymyalgia rheumatica)

Patent ductus arteriosus murmur. What is it? Machinery murmur, diastolic murmur, venous hum

Machinery murmur

Old person with painful swollen knee and now has swollen dip.?

Osteoarthritis | valgus

Patient has dislocated shoulder. What nerve should we watch out for? Axillary, radial, ulnar

Axillary

Lady with fever with catheter in situ 14 days after some bowel surgery. Eating and drinking normally, no resp or GI symptoms. Cause of fever? UTI, Anastomotic leak, basal atelectasis, pneumonia, wound infection

UTI

Patient has long term indwelling suprapubic catheter. Keeps getting blocked and flushed out by nurses a few times. What do you do? Flush, bladder washout, change suprapubic catheter, change to other catheter, do a turp

change suprapubic catheter

ENT question on purulent otorrhoea, hearing loss, some reference to keratin. Cause? Cholesteatoma (unilateral conductive hearing loss) - surgical removal, recurrent otitis externa, recurrent otitis media

holesteatoma (unilateral conductive hearing loss) - surgical removal

Lady comes back from india 3 days ago with abdo pain, diarrhoea and vomiting. What do you do? Stool culture and microscopy, colonoscopy, start abx

Stool culture and microscopy

Hypertensive young guy with mildly raised creatinine and proteinuria on multiple occasions. Physical exam otherwise unremarkable. What does he have? Orthostatic proteinuria, amyloid, hypertensive nephropathy

hypertensive nephropathy

Lady about to undergo ovarian tumour resection and needs thromboprophylaxis but had a PE in the past. What do you give? LMWH, Unfractionated heparin, high dose warfarin, low dose warfarin

LMWH

Something about a guy with a droopy face including forehead?

Bell’s (LMN lesion)

What is most appropriate osteoporosis prophylaxis for 65 year old lady on long term pred? Bisphos, vit D, HRT, calcium

Bisphos

9. Post mastect + LN clearance lady gets winging of scapula. What nerve damaged?

Long thoracic

Patient with lung ca findings + cushingoid features. Heavy smoker. What’s wrong? Small cell (ectopic ACTH - SIADH, LEMS), adeno, squamous cell carcinoma (ectopic PTHRP)

Small cell (ectopic ACTH - SIADH, LEMS)

Someone with Hodgkins lymphoma, mediastinal mass and night sweats. What is most appropriate treatment? Curative chemo (ABVD), adjuvant chemo, neoadjuvant chemo, radio, surgery

Curative chemo (ABVD

Old lady gets dysphagia to solids every now and again, 20 year hx of GORD.? Stricture, Cancer (Adenocarcinoma- GORD), achalasia (solids and liquids)

Cancer (Adenocarcinoma- GORD)

Some standard change in bowel habit + weight loss + fresh blood mixed in with stool. Dilation of colon proximal to sigmoid. Diagnosis?

CRC

Someone has bloody stool. Proctosigmoidoscopy is normal. What do you do next?

Colonoscopy

Patient with hx of biliary colic, now presenting with jaundice and obstructive -picture. What is diagnosis?

Gallstone in CBD (gallstone ileus)

Lady with collapse High K, Low Na, plus some other bloods suggesting addisons. What would get you the Dx?

ACTH and cortisol levels (Addison's)

What to put in an alcoholics drip when he comes in confused and ataxic and shit (wernickes) Repeated from yesterday.?

Thiamine

Patient gets pain to right of epigastrium a few hours after food. Relieved by milk and wakes up at night with pain? Duodenal ulcer, gastric ulcer, gastritis

Duodenal ulcer

Guy with history of delirium tremens. Wants to quit again. What do you do for him? Reducing regime of chlordiazepoxide, refer to AA, refer to local specialist alcohol services

Reducing regime of chlordiazepoxide

Someone with Sjogren’s, which test do you do? Anti-Ro, sialography, biopsy

Anti-Ro

Someone with SLE described, which test do you do?

anti- dsDNA

Post op lady with sx consistent with DVT. What test confirms diagnosis? Venous duplex, ultrasound, coagulation screen.

Venous duplex

Which cardiac drug contraindicated in asthma?

atenolol

One about someone with CXR pleural plaques, presenting with picture of pleural effusion, breathlessness. What ix helps with diagnosis?

USS guided tap

Guy with pulseless electrical activity, given one dose of adrenaline (1ml 1 in 10,000). Still no carotid pulse. What now? Another dose of adrenaline, shock, pericardiocentesis. Continue CPR. Asystole and PEA are both non shockable rhythms

Continue CPR

One with a patient with RTA then complete white out of one side of lung. Options I think included haemothorax, flail chest, tamponade

haemothorax

There was another vasc one about someone who had something that sounded like leaking AAA. What is ix you would do immediately? FBC, CT abdo, arteriogram, USS

CT abdo

Guy with hx of BPH, IHD, indigestion, diabetes on metformin, simvastatin, bisoprolol, bunch of other drugs, has erectile dysfunction. All pulses present. Normal peripheral sensation. LSBP no orthostatic hypotension. Cause? Adverse drug effect, BPH, autonomic neuropathy, vascular insufficienc

Adverse drug effect

Young guy with poor stream, takes ages to pee, previous episode of non-specific urethritis. Cause? Detrussor something dys something, urethral stricture

urethral stricture

Opioid overdose one.

Give naloxone

Chest pain with nausea vomiting and sweating for 1 hour. What was it?

Acute | MI

Another DKA one where you had to choose between giving.

IV fluids with IV | insulin

Marathon runner has a large heart found on post mortem? Hypertrophy, hyperplasia, metaplasia, dysplasia

Hypertrophy

RA patient with previous TKR has red hot swollen knee, recently had cystoscopy for longstanding urinary tract problems.

Infection

38 year old lady with cyclical breast pain. Abnormal normal development and involution of breast (ANDI), Mastitis, fibrocystic disease (PAIN)

fibrocystic disease (PAIN!!!)

Patient with asthma has a short hx of yellow sputum and wheeze, was given oral amox which improved sputum but wheeze still there but afebrile, what now? Give prolonged course of amox, give clari, give oral prednisolone

give oral prednisolone (10mg OD 5 days???)

Patient has carotid endarterectomy and develops stridor post-op?

Haemorrhage

Man newly diagnosed with DM found to have glucose+++ in urine, BMI 32, random blood glucose 14. First line? Diet and exercise, metformin, gliclazide

Diet and exercise

Why is MR spine the best imaging choice in someone with disc prolapse (?)

Better soft tissue detail