saq mock 2 med school

Question 1

List features you would expect to see on a patient with a blood film that showed iron deficiency anaemia:

Answer 1

● hypochromic red cells (1 mark)
● hypochromic microcytosis (1 mark)
● microcytic red cells (1 mark)
● pencil cells (1 mark)
● Anisocytosis (1 mark)
● Poikilocytosis (1 mark)
● Thrombocytosis (raised platelet count) (1 mark)

• Hypochromia means that the red blood cells have less color than normal when examined under a microscope.
• Microcytic anemia is defined as the presence of small, often hypochromic, red blood cells in a peripheral blood smear
• Elliptocytes, also known as ovalocytes or cigar cells, are abnormally shaped red blood cells that appear oval or elongated, from slightly egg-shaped to rod or pencil forms.

Question 2

List further symptoms you would enquire about to elicit the cause of the iron deficiency anaemia:

Answer 2

● Menorrhagia/heavy periods/problems with periods (1 mark)
● Haematuria/blood in urine (1 mark)
● Haematemesis/vomiting blood (1 mark)
● Malaena (1 mark)
● PR bleeding (1 mark)
● Nose bleeds (1 mark)
● Gum bleeding (1 mark)
● Change in bowel habit (1 mark)
● Pregnancy (1 mark)

Question 3

List two features on physical examination you would expect to find in this patient:

Answer 3

● Pallor (1 mark)
● Pale conjunctiva (1 mark)
● Angular stomatitis (1 mark)
● Koilonychia/spoon shaped nails/brittle nails (1 mark)
● Glossitis (1 mark)
● Tachycardia (1 mark)
● Postural hypotension (1 mark)
● Cold hands and feet (1 mark)

• Pale conjunctivae were those with very little or no evidence of red color on the anterior rim
• Angular cheilitis is a common inflammatory skin condition
• inflammation of the tongue.

Question 4

What serum protein carries iron around the body?

Answer 4

transferrin

Question 5

osteoporosis risk factors

Answer 5

• Family history of osteoporosis
• Previous history of fractures
• BMI<18.5
• Inactivity
• Smoking
• Alcohol
• Low calcium/Vitamin D (due to poor diet or lack of exposure e.g. housebound, cultural reasons)
• Premature menopause
• Amenorrhoea> 6 months
• Glucocorticoids (accept steroids or prednisolone)
• Coeliac disease, Type 1 diabetes, Hyperthyroidism, Cushing’s, Crohn’s disease, CKD, Chronic liver disease or Rheumatoid arthritis.

Question 6

osteoporosis pathophysiolocial processes

Answer 6

• Increased bone turnover (1 mark)
• Bone resorption (1 mark)
• Increased osteoclast activity (1 mark)
• Reduced osteoblast activity (1 mark)
• Micro architectural deterioration (1 mark)

Question 7

FRAX score

Answer 7

A FRAX score estimates the probability of a fracture within the next 10 years

Question 8

List two questions the patient should be asked about the nature of the episode

Answer 8

• Did you get any warning
• how long did you lose consciousness for
• did you bite your tongue
• did you wet yourself

Question 9

What three questions should the witness (friend) be asked about the episode?

Answer 9

Were the eyes open or closed, how quickly did she come round again, were there any limb movements?, if described pattern – symmetrical or asymmetrical, tonic-clonic or not

Question 10

Suggest two other relevant questions regarding her previous medical history

Answer 10

previous head injury, underlying brain disease, fever, history of fits, born at full term, have they taken any drugs/alcohol (1 mark)

Question 11

List one finding that may be present on physical examination?

Answer 11

normal, bitten tongue, confusion, incontinence, loss of memory

Question 12

Which two investigations should be requested for anybody who has definitely had an epileptic seizure?

Answer 12

EEG, MRI – brain or head, CT Scan Head, CT brain

Question 13

important features that suggest IBD

Answer 13

• blood or mucus in the stool
• presence of abdominal pain
• family history of bowel problems
• presence of bloating
• weight loss
• clarify what patient means by diarrhoea – consistency
• type of diarrhoea etc. Extra-intestinal symptoms e.g. red eye, joint pain, mouth ulcers.

Question 14

ibd blood test

Answer 14

fbc
esr/crp

Question 15

layers of bowel wall does ulcerative colitis affect

Answer 15

mucosa

Question 16

histological feature seen in U.C.

Answer 16

increase in plasma cells

Question 17

Excluding spirometry with reversibility, what other investigation should be arranged and state one reason why?

Answer 17

Question 18

Obstructive airways disease is confirmed by spirometry. What feature of spirometry confirms this?

Answer 18

FEV1/FVC less than 0.7/70%

Question 19

After 10 puffs of salbutamol the spirometry is repeated, what reading confirms a diagnosis of asthma rather than COPD?

Answer 19

Increase in FEV1 of > 400ml or 20%

Question 20

What are the major elements in the pathophysiology of asthma?

Answer 20

Airways inflammation
Airways hypersensitivity
Bronchospasm
Bronchoconstriction

Question 21

The GP prescribes a salbutamol inhaler for as required use. What receptor does the inhaled drug salbutamol work on?

Answer 21

Beta-2 adrenergic receptor

Question 22

Answer 22

Inhaled corticosteroid

Question 23

define carcinoma

Answer 23

malignant epithelial neoplasm

Question 24

histological features of primary carcinoma

Answer 24

• Hyperchromatic nuclei
• Pleomorphic nuclei
• Ulceration
• Endophytic growth
• Invasion/poorly circumscribed margin
• Variable resemblance to normal tissue (differentiation)

Question 25

State three routes by which a carcinoma may metastasise

Answer 25

• Haematogenous (via the blood)
• Lymphatic
• Trans-coelomic (across body cavities)
• Iatrogenic spread

Question 26

State two cancers, apart from carcinoma of the bronchus, that commonly metastasis to bone in women.

Answer 26

breast thyroid kidney

Question 27

How does the Chlamydia Screening Programme aim to control the increase in STIs?

Answer 27

To control chlamydia through early detection of and treatment of asymptomatic infection

Question 28

The Chlamydia Screening programme is an example of secondary prevention to control STIs.

Describe the aim of primary prevention strategies employed to control STIs, including an example of this approach.

Answer 28

• Primary prevention concerns reducing the risk of acquiring chlamydia, health promotion/education strategies aim to reduce personal risk behaviour
• e.g. STI awareness campaigns, posters communicating the risk/ safe behaviour, risk reduction discussion

Question 29

Two measures commonly used to evaluate the performance of screening tests are:

(a) the sensitivity and (b) the specificity of the test. Describe briefly what each of these measures refers to.

Answer 29

• Sensitivity is the proportion of people with the disease correctly identified by the screening test
• Specificity is the proportion of people without the disease who are correctly excluded by the screening test

Question 30

diagnostic criteria for nephrotic syndrome

Answer 30

Question 31

List three complications of nephrotic syndrome and state why they occur.

Answer 31

• hyperlipidaemia (1 mark) or atherosclerosis (1 mark) due to either over production in the liver ( 1 mark) abnormal catabolism (1 mark)
• thrombosis /renal vein thrombosis/ hypercoagulability (1 mark) due to renal loss of antithrombin III (1 mark)
• Infections (1 mark) due to renal loss of immunoglobulin (1 mark) fluid stasis i.e. ascites/ pleural effusion/oedema (1 mark)/ steroid or immunosuppressive therapy (1 mark)
• Renal impairment (1 mark) due to hypovolaemia (1 mark) drugs (1 mark) renal vein thrombosis (1 mark) sepsis (1 mark) renal oedema (1mark)
• Anaemia (1 mark) due to renal loss of ferritin (accept iron) (1 mark)
• Hypothyroid (1 mark) due to renal loss of thyroid binging globule (1 mark)
• Vitamin D deficiency (1 mark) due to renal loss of Vitamin D binding globule (1 mark)

Question 32

Answer 32

Focal segment glomerulosclerosis (1 mark)
Accept glomerulosclerosis

Question 33

List two findings on the dipstick test that suggest he has a Urinary Tract Infection (UTI)?

Answer 33

Presence of blood, leucocytes, nitrites, protein.

Question 34

How could you reduce his risk of UTIs?

Answer 34

Review need for catheter and remove if possible, change if inserted for more than 7 days or when starting antibiotics, consider antibiotics when changing catheter if history of UTIs, maintain aseptic technique when inserting catheter, ensure catheter is draining properly.

Question 35

His urine sample is inoculated on CLED agar, and there are at least 3 colonies growing, one is lactose fermenting.

Q3: What should the urine culture be reported as?

Answer 35

Mixed growth (accept answers indicating non diagnostic of UTI)

Question 36

Give three situations in which it is usually appropriate to send a urine sample for culture.

Answer 36

• any of Pregnancy- if symptomatic, or during 1st antenatal visit for asymptomatic bacteriuria
• Men with symptoms of UTI
• severe symptoms (suggestive of ascending or systemic infection e.g. pyelonephritis)
• failed antibiotic treatment or persistent symptoms.

Question 37

aortic stenosis clinical features

Answer 37

Question 38

possible symptoms of a severe anaphylactic reaction

Answer 38

Question 39

Name one life-saving drug which must be given if there is evidence of a severe systemic allergic reaction and give the mechanism of action

Answer 39

Question 40

Name two drugs which are also given to minimise the severity of anaphylactic shock

Answer 40

• Intravenous chlorpheniramine
• Intravenous hydrocortisone.