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REAL PAST PAPERS Flashcards

1
Q 
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
A

D. Complete heart block

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2
Q

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

A

DKA

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3
Q 
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

A. Falciparum

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4
Q 
40 year old farmer has wheeze for a few weeks. Normal CXR. Diagnosis.
Options: 
A. Asthma, 
B. farmers lung,
C. aspergillosis.
A

A. Farmers long (interstitial lung disease)

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5
Q 
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
A

B. I&D

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6
Q 
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

A. 4 compartment fasciotomy within 6h

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7
Q 
30 something man with joint pain - sacroiliitis and distal interphalangeal joint
pain? 
A. Ank spond,
B. Psoriatic arthritis, 
C. Rheumatoid arthritis.
A

A. Ank Spond (can also give

you hand arthritis)

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8
Q 
Transfusion reaction - fever, other obs normal, transfusion stopped. What
next? 
A. Check bag against patient details, 
B. start transfusion again, 
C. give
chlorpheniramine
A

A. Check bag against patient details

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9
Q

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

A. Admit

patient two days pre-op and start heparin

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10
Q

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

A

Obesity

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11
Q

Legionella - which Abx?

A

Clarithromycin (atypical)

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12
Q

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

A

Co danthrusate (stimulant laxative)

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13
Q

Mid-diastolic murmur

A

Mitral stenosis

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14
Q

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

A

scratch (pericardial friction rub)

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15
Q

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

A

anti dsDNA

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16
Q

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

A

Aortic Dissection

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17
Q

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

A

CT chest with contrast

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18
Q

Lady with yellow eyes and high reticulocytes.

A

haemolysis

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19
Q

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

A

DEXA

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20
Q

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

A

give prothrombin complex

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21
Q

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

A

ST elevation in leads II, III and aVF

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22
Q

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

A

Chlamydia trachomatis (most common)

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23
Q

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

A

Hemiarthroplasty

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24
Q

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

A

Sputum culture and sensitivity for AAFB (TB)

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25
Q

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

A 
AI hepatitis (anti smooth
muscle antibody most specific)
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26
Q

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

A

IV PPI (in upper GI bleed)

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27
Q

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

A

Thiamine - B1 (wernicke’s)

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28
Q

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

A

Myasthenia

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29
Q

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?

A

DIC (give FFP if low fibrinogen)

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30
Q

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)

A 
24 urine collection to
measure protein (if >3.5g/dl then diagnostic)
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31
Q

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

A

chemo

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32
Q

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

A

clarithromycin

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33
Q

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

A

Ciprofloxacin

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34
Q

Pneumocystis jiroveci → Abx

A

Co-trimoxazole

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35
Q

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

A

1000

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36
Q

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 ?

A

mural thrombus

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37
Q

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

A

femoral crossover bypass

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38
Q

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

A

Aorta bi-fem

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39
Q

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

A

osmotic shrinkage

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40
Q

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?)

A

early

parkinsonism

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41
Q

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

A

PEG

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42
Q

Diagnosing legionella.

A

urinary antigen

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43
Q

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

A

internal fixation

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44
Q

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

A

Refer urgently to ophthal (retinal detachment)

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45
Q

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

A

SFA

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46
Q

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

A

NOF

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47
Q

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

A

8

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48
Q

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

A

oropharyngeal

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49
Q

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

A

Secure his airway (ABCDE)

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50
Q

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

A

gastroscopy and treat H pylori if positive

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51
Q

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

A

Pyoderma gangrenosum

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52
Q

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

A

Radiotherapy

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53
Q

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

A

Fibroadenoma

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54
Q

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

A

nti TTG

abs

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55
Q

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

A

Fluclox

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56
Q

What does a triple assessment consist of?

A

Clinical exam, imaging + core

biopsy. (Imaging in <35 is USS, >35 is mammogram)

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57
Q

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

A

LP (xanthochromia - SAH)

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58
Q

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

A

change catheter (? remove cathetor)

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59
Q

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

A

Recurrent laryngeal

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60
Q

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

A

Squamous cell carcinoma (PTHrP)

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61
Q

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

A

Pulmonary fibrosis

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62
Q

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)

A

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

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63
Q

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.

A 
Keratoderma blenhorrhagicum (yellow lesions on soles of feet). Triad of arthrtis,
urethritis and conjuctivitis.
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64
Q

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

A

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

line)

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65
Q

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

A

Sjogrens

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66
Q

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

A

pancreatic ca

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67
Q

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

A

lose weight (idiopathic intracranial HTN)

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68
Q

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

A

Mesenteric ischaemia

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69
Q

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

A

Advise to stop taking meds

and reassess in a month (analgesia headache). Add codeine

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70
Q

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

A

Fluid restrict

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71
Q

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

A

Wegener’s Granulomatosis

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72
Q

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

A

oesophageal candidiasis

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73
Q

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

A

tertiary hyper PTH

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74
Q

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

A

elbow extension

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75
Q

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

A

inguinal hernia

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76
Q

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

A

Graves

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77
Q

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

A

nephrogenic

diabetes insipidus

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78
Q

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

A

OGTT at 28 weeks

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79
Q

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

A

Viral thyroiditis (de quarvans)

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80
Q

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

A

Metformin

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81
Q

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

A

Post op ileus

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82
Q

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

A

Subphrenic abscess

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83
Q

Patient with symptoms of guarding, peritonism, what test?

A

Erect CXR

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84
Q

Patient with symptoms of bowel obstruction - what test?

A

Supine AXR

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85
Q

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

A

CT KUB

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86
Q

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?

A

Pyelonephritis

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87
Q

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

A

felodipine

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88
Q

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

A

Polymyalgia rheumatica

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89
Q

Testicular pain in a sexually active 18 year old. Management

A

Antibiotics (neisseria - ceftriaxone and azithromycin)

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3
4
5
Perfectly
90
Q

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

A

Peritonsillar abscess (Quinsy)

91
Q

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

A

Treponema Pallidum,

92
Q

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

A

Rosacea

93
Q

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

A

Get rid of clot

94
Q

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

A

Scc

95
Q

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

A

Superficial spreading

96
Q

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

A

Chronic pancreatitis

97
Q

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

A

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

98
Q

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

A

control with NSAID

99
Q

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

A

IgE

100
Q

Features of AS

A

slow rising pulse, ejection systolic murmur, loud s1, narrow

pulse pressure, soft s2 (or absent in severe AS)

101
Q

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

A

collapse

102
Q

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

A

Pyridoxine (B6)

103
Q

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

A

negative pressure room + respiratory

measures for staff

104
Q

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

A

flexible

sigmoidoscopy

105
Q

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

A

Phenytoin loading

106
Q

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

A

Pneumococcus

107
Q

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)

A

Obstruction of IVC

108
Q

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

A

fissure

109
Q

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

A

Decrease frequency of ventilations

110
Q

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

A

Pulmonary fibrosis

111
Q

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

A

Chronic

bronchitis

112
Q

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

A

Staph Aureus

113
Q

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

A

crohns

114
Q

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)

A

Antero-lateral (circumflex)

115
Q

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

A

quinine

116
Q

Which of the DMARDs cause retinopathy?

A

Hydroxychloroquine

117
Q

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

A

ipsilateral

118
Q

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

A

Sulfasalazine

119
Q

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

A

Rectus muscle thickening (Graves)

120
Q

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

A

aspirin

121
Q

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

A

furosemide

and Ramipril

122
Q
  1. Lady presents with acute MI, no details. What do you give?
A

aspirin and beta blocker

123
Q

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

A

Cataracts

124
Q

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?

A

diabetic

retinopathy

125
Q

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

A

damaged

ligaments

126
Q

Guy jumps and lands on his knee – medial meniscus

tear, patella fracture, damage to ACL

A

patella fracture

127
Q

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

A

haem

128
Q

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

A

Ruptured Achilles

129
Q

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

A

exercise ECG and

something

130
Q

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

A

Whipple’s

131
Q

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

A

Lewy body dementia

132
Q

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

A

discontinue morphine epidural

133
Q

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)

A 
MRI Spine (as malingnant
melanoma)
134
Q

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

A

urgently to uro

135
Q

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

A

Ductal carcinoma

136
Q

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

A

duct ectasia

137
Q

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

A

Coarctation

138
Q

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

A

Oesophageal rupture

139
Q

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

A

paracetamol/ibuprofen

140
Q

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

A

CLL

141
Q

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

A

OGD within 2 hours

142
Q

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

A

Adrenaline

143
Q

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

A
  1. anti mitochondrial antibody
  2. dense lymphoid infiltrate in a portal tract with minimal
    periportal lymphoid extension in a pre-cirrhotic stage of PBC.
144
Q

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

A

morphine sub cut infusion,

145
Q

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

A

septic arthritis

146
Q

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

A

b12

147
Q

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

A

EAA

148
Q

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)

A

Naproxen

149
Q

Caucasian lady with Raynaud’s colour order

A

White → blue → red

150
Q

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

A

PCP (treat with cotrimoxazole)

151
Q

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)

A

Otosclerosis

152
Q

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

A

Erythema nodosum

153
Q

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

A

HSV (dendritic ulcer)

154
Q

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

A

VZV (shingles)

155
Q

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

A

OGD

156
Q

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

A

HSV

157
Q

Ring enhancing lesions on ct brain with HIV?

A

Toxoplasmosis

158
Q

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

A

Acromegaly

159
Q

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

A

Norovirus

160
Q

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

A 
ABO incompatibility (immediate haemolytic transfusion
reaction)
161
Q

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

A

Hyperventilation syndrome

162
Q

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

A

PEFR

163
Q

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?

A

Rhabdomyolysis

164
Q

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)

A

AN

165
Q

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%

A

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

166
Q

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)

A

Lymphoma ( MALT - mucosal

assocaited lymphoid tissue)

167
Q

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

A

efer to urology - cystoscopy

168
Q

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)

A

CT KUB urogram without contrast

169
Q

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

A

Renal biopsy

170
Q

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

A

peripheral oedema

171
Q

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

A

IV fluids

172
Q

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

A

MM

173
Q

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

A

Serum vitamin D (secondary hyperparathyroidism)

174
Q

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

A

osteomalacia

175
Q

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

A

24 hour ECG

176
Q 
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)
A

MCA

177
Q

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

A

Optic chiasm

178
Q

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

A

ECG (increased S waves in V1

and R wave in V5- V6)

179
Q

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

A

Upper

brachial plexus

180
Q

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

A

Migraine

181
Q

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

A

Fibre

182
Q

High esr, pain on abducting shoulder?

A

PMR (Polymyalgia rheumatica)

183
Q

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

A

Machinery murmur

184
Q

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

A

Osteoarthritis

valgus

185
Q

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

A

Axillary

186
Q

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

A

UTI

187
Q

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

A

change suprapubic catheter

188
Q

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

A

holesteatoma (unilateral conductive hearing loss) - surgical removal

189
Q

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

A

Stool culture and microscopy

190
Q

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

A

hypertensive nephropathy

191
Q

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

A

LMWH

192
Q

Something about a guy with a droopy face including forehead?

A

Bell’s (LMN lesion)

193
Q

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

A

Bisphos

194
Q
  1. Post mastect + LN clearance lady gets winging of scapula. What nerve
    damaged?
A

Long thoracic

195
Q

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

A

Small cell (ectopic ACTH - SIADH, LEMS)

196
Q

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

A

Curative chemo (ABVD

197
Q

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

A

Cancer (Adenocarcinoma- GORD)

198
Q

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

A

CRC

199
Q

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

A

Colonoscopy

200
Q

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

A

Gallstone in CBD (gallstone ileus)

201
Q

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

A

ACTH and cortisol levels (Addison’s)

202
Q

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

A

Thiamine

203
Q

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

A

Duodenal ulcer

204
Q

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

A

Reducing regime of chlordiazepoxide

205
Q

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

A

Anti-Ro

206
Q

Someone with SLE described, which test do you do?

A

anti- dsDNA

207
Q

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

A

Venous duplex

208
Q

Which cardiac drug contraindicated in asthma?

A

atenolol

209
Q

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

A

USS guided tap

210
Q

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

A

Continue CPR

211
Q

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

A

haemothorax

212
Q

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

A

CT abdo

213
Q

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

A

Adverse drug effect

214
Q

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

A

urethral stricture

215
Q

Opioid overdose one.

A

Give naloxone

216
Q

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

A

Acute

MI

217
Q

Another DKA one where you had to choose between giving.

A

IV fluids with IV

insulin

218
Q

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

A

Hypertrophy

219
Q

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

A

Infection

220
Q

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

A

fibrocystic disease (PAIN!!!)

221
Q

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

A

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

222
Q

Patient has carotid endarterectomy and develops stridor post-op?

A

Haemorrhage

223
Q

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

A

Diet and exercise

224
Q

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

A

Better soft tissue detail

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