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Phase 2a medicine > Stuff I got wrong > Flashcards

Stuff I got wrong Flashcards

1
Q

Which scoring system is used to calculate stroke risk in patients with AF?

A

CHADS VASc

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2
Q

What does CHADs VASc stand for?

A 
Congestive heart failure
Hypertension 
Age 75+ 
Diabetes 
Stroke 
TIA
Thromboembolism 
Vascular disease 
Age 65-74
Sex (female =1)
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3
Q

What are the 3 cardinal signs of HF?

A

SOB, Fatigue, ankle oedema

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4
Q

. A 56-year-old Asian man has come into your GP surgery, he has tried to modify his diet,
exercise more and improve other lifestyle factors. He wishes to be put onto a tablet and his
ambulatory blood pressure reading was 155/100. What would you advise?
A. Amlodipine prescription
B. Candesartan prescription
C. Further lifestyle measures are recommended
D. He should return for a health check once he turns 60
E. Ramipril prescription

A

a. amplodipine

over 55 therefore CCB

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5
Q 
Which of these isn’t a feature of tetralogy of Fallot?
A. Atrial septal defect
B. Hypertrophy of the right ventricle
C. Overriding aorta
D. Pulmonary stenosis
E. Ventricular septal defect
A

A

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6
Q

What are the features of the tetralogy of fallot?

A

Ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, Aorta overrides the VSD

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7
Q 
Which of these is a not a cause of peptic ulcers?
A. H. Pylori
B. Increased stomach acid production
C. Recurrent NSAID use
D. Autoimmune gastritis
E. Mucosal ischaemia
A

D

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8
Q

What is autoimmune gastritis?

A

Chronic inflammatory disease with destruction of the parital cells of the stomach, causing vit B12 deficiency.

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9
Q

A patient comes into the GP with a case of suspected gastritis due to an H. Pylori infection.
Which of these managements should you use first?
A. Clarithromycin, lansoprazole and omeprazole
B. Penicillin, co-amoxiclav and ranitidine
C. Lansoprazole, cimetidine and amoxicillin
D. Clarithromycin, amoxicillin and omeprazole
E. Amoxicillin, ceftriaxone and lansoprazole

A

D

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10
Q

How to treat a H.pylori infection?

A

CAP
Clarithromycin
Amoxicillin
PPI

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11
Q

First line investigation for LBO?

A

Abdo X-ray.

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12
Q

What is achalasia?

A

Lower oesophageal sphincter fails to open up during swallowing

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13
Q

Which of these is correct regarding duodenal ulcers?
A. They cause pain when eating and it is relieved several hours after eating
B. They cause pain several hours after eating and the pain gets better when eating
C. They cause pain when the patient is hungry, and it is relieved by eating
D. They cause pain when eating and are relieved by drinking
E. They cause pain when the patient drinks and is relieved by eating

A

B

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14
Q 
. Which of the following is not a risk factor for Oesophageal Cancer?
A. Achalasia
B. Alcohol
C. Obesity
D. Smoking
E. Spicy food
A

E

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15
Q 
Where are majority of colon cancers found?
A. Ascending colon
B. Caecum
C. Descending colon
D. Transverse colon
E. Distal colon
A

E

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16
Q 
Which of these is not a cause of diverticulum?
A. Alcohol
B. Low fibre diet
C. Obesity
D. NSAIDs
E. Smoking
A

A

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17
Q

A 48-year-old female complains of bright red rectal bleeding which can be found upon
wiping, she has been constipated recently and admits to straining. She feels tired but has
not noticed any weight loss. What would the likely diagnosis be?
A. Anal Fistula
B. Anal Fissure
C. Inflammatory Bowel Disease
D. Haemorrhoids
E. Rectal Cancer

A

D

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18
Q

A 38-year-old female presents to you with bouts of diarrhoea with urgency, fatigue,
abdominal pain and mouth ulcers. She smokes and complains of a stressful life. What
investigation result may you expect to see?
A. Anaemia due to Iron and Folate deficiency
B. C.Diff positive stool sample
C. Duodenal biopsy showing villous atrophy and crypt hyperplasia
D. Normal ESR and CRP
E. pANCA positive

A

A - She has crohns so you’d see symptoms of malabsorption

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19
Q 
Which of the following organisms is the most common cause of pyelonephritis?
A. Staphylococcus Saprophyticus
B. Enterococcus
C. Escherichia coli
D. Klebsiella
E. Proteus
A

C

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20
Q

. James is a 25-year-old male who recently tested positive for Chlamydia, he went to get
tested after he noticed pain on urinating and discharge from his penis. He is now quite
concerned as his eyes have turned red and his ankles and feet have become swollen. Which
of the following can be used to describe his symptoms?
A. Behcet’s syndrome
B. Budd-Chiari syndrome
C. Charcot’s triad
D. Reiter’s syndrome
E. Saint’s triad

A

D - otherwise known as reactive arthritis.
After an infection you can get a triad of symptoms:
Conjunctivitis, urethritis and arthritis.

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21
Q 
Which of the following is not a complication of polycystic kidney disease?
A. Cardiovascular disease
B. Kidney stones
C. Nephrotic syndrome
D. Polycystic liver disease
E. Subarachnoid haemorrhage
A

C - PKD is not a cause of nephrotic syndrome

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22
Q

A patient presents to A&E with a fever and confusion. Upon further investigation, you find
that she has AKI and her FBC reveals thrombocytopenia and anaemia. You recognise this as
Thrombotic Thrombocytopenic Purpura and realise it is a medical emergency and you need
to treat her immediately without waiting for diagnostic confirmation. What is the urgent
gold standard treatment for someone with TTP?

A

D - this will remove the antibodies that are working against the platelets.

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23
Q

You are the FY1 on an orthopaedic ward. A 65-year-old man is on the ward recovering from
a recent total hip replacement following a neck of femur fracture. What is an appropriate
thromboprophylaxis regimen?
A. Alteplase
B. Compression stockings and aspirin
C. Dalteparin acutely and then maintenance treatment with apixaban
D. Dalteparin acutely and then maintenance treatment with aspirin
E. Aspirin acutely and then maintenance treatment with apixaban

A

C

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24
Q 
What is the protein target of Rituximab?
A. CD4
B. CD8
C. CD20
D. HER2
E. TNF-alpha
A

C - CD20 is found on the surface of B-cells. It sticks to the cells it finds and kills them.

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25
Q

What type of crackles do you hear in pulmonary fibrosis?

A

End-inspiratory crackles

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26
Q

What is pulmonary fibrosis?

A

Deposition of collagen in the lungs reducing the gas exchange of the lungs.

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27
Q

Key symptoms of PF>

A

Dry cough (unlike COPD where there is a productive cough)

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28
Q

What is the triad for sjorgens syndrome?

A

Dry eyes, dry mouth, inflammatory arthritis?

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29
Q

What type of arthritis is sjogrens?

A

Inflammatory, symmetric, non-erosive, autoimmune, chronic

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30
Q

What does autoimmune damage in sjogrens attack?

A

Minor salivary glands, lacrimal glands and joints

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31
Q

What type of hypersensitivity reaction is sjorgrens?

A

Type 4

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32
Q

What gene is sjogrens accosicate with?

A

HLA-DQ and HLA-DR

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33
Q

WHat is PBC?

A

Primary biliary cholangitis

34
Q

Pathophysiology of PBC?

A

Autoimmune destruction of small bile ducts in the LIVER

35
Q

Common symptoms of PBC?

A

Itching, jaundice, malaise and tiredness

36
Q

Most common type of bladder cancer in smokers?

A

Transitional cell carcinoma of the bladder

37
Q

What is the CURB-65 score used to assess?

A

To assess the severity of a patients pneumonia

38
Q

What is a Tensilon test?

A

A diagnostic test for Myastenia gravis

39
Q

How does the Tensilon test work?

A

Tensilon is injected into the muscle, after 30seconds someone with myastenia gravis will see an improvement in their muscle strength and ability to sustain activity.

40
Q

How do you treat myastenia gravis?

A

Pyridostigmine and steroids, immunosuppressants also (azathioprine)

41
Q

Which nerve supplies the motor to the small muscles of the hand?

A

Ulnar

42
Q

What are the nerve roots of the ulnar nerve/

A

C8-T1

43
Q

Which pathogen is most likely to cause proctitis in AIDS patients?

A

Cytomegalavirus.

44
Q

A 38-year-old woman presents in the emergency department with a one-month history of
painful enlargement of her cervical and axillary lymph nodes. She also is lethargic and has
severe oral ulceration. On examination, she has gross cervical, axillary and inguinal
lymphadenopathy associated with splenomegaly. Her blood film shows ‘occasional blast cells’.
The diagnosis is subsequently confirmed on lymph node biopsy. What is the most likely
underlying pathological condition?
a) Acute lymphoblastic leukaemia
b) Acute myeloblastic leukaemia
c) Chronic lymphocytic leukaemia
d) Chronic myeloid leukaemia
e) Hodgkin’s lymphoma

A

B

45
Q

What type of drug is candesartan?

A

An ARB

46
Q

A 51-year-old woman has pernicious anaemia. She noticed a painless swelling on both sides of
her neck which has gradually increased in size over 2 years. She is well. Thyroid function tests
show a normal free T4 but TSH is 10mU/ml (normal range 0.5-5). What is the likely diagnosis?
a) Grave’s Disease
b) Hashimoto’s thyroiditis
c) De Quervain’s thyroiditis
d) Thyroglossal cyst
e) Toxic multinodular goitre

A

B (hashimotos often presents with hyperthyroid then turns into hypo?) not sure

47
Q

Symptoms of IE?

A

Patchy rash, blood and protein in urine, malaise

48
Q

A 21-year-old female IVDU collapses following a 2-day history of rapidly increasing malaise,
fever and a patchy rash. Although previously well, she now has a systolic cardiac murmur. Her
urine shows both protein and blood on urine dipstick test. What is the likely cause?
a) Hepatitis C
b) Acute rheumatic fever
c) Amyloid valve tissue
d) Renal failure
e) Infective endocarditis

A

E (IVDU stands for IV drug user)

49
Q

What is a harsh systolic murmur over the left second intercostal space indicative of?

A

Calcific aortic stenosis

50
Q

What should you expect if a patient gives this description “He describes waking up in
the night gasping for breath and having to open the bedroom windows.”

A

Pulmonary oedema

51
Q

Classic symptoms of pulmonary oedema?

A

Propping head up in bed with lots of pillows to be able to breath.
Difficulty breathing when lying down
Coughing up blood or bloody froth

52
Q

What is bronchiectasis?

A

Permenant dilation of bronchi and bronchioles leading to the thinning of these airways, due to obstruction and severe inflammation.

53
Q

Symptoms of bronchiectasis?

A

Chronic cough with lots of foul smelling sputum.

54
Q

What are the common infections that cause bronchiectasis>

A

H.influenza, strep pneumonia, staph aureus, pseudomonas aruginosa

55
Q

A 25-year-old woman presents with fever, nausea, abdominal pain, diarrhoea and weight loss.
Abdominal exam reveals a mass in the right iliac fossa. Rectal exam reveals chronic fissures and
sepsis in the perianal area. What is the likely diagnosis?
a) Coeliac disease
b) Crohn’s disease
c) Appendicitis
d) Sigmoid volvulus
e) Ulcerative colitis

A

B

56
Q

For a 55-year-old male, what is the recommended duration of moderate physical activity per
week according to the chief medical officer’s guidelines?
a) 30 mins
b) 60 mins
c) 75 mins
d) 120 mins
e) 150 mins

A

E

57
Q

What type of drug is allopurinol?

A

A xanthine oxidase inhibitor

58
Q

Name a tumour necrosis factor-a antagonist used in crohns?

A

Infliximab

59
Q

A 67-year-old woman presents with dysuria, frequency and her urine is foul-smelling. Which of
the following organisms is least likely to be the causative organism?
a) Proteus Mirabilis
b) Klebsiella pneumoniae
c) Enterococcus faecalis
d) Staph. Aureus
e) Strep. Pyogenes

A

E

60
Q 
46) A 35-year-old gentleman presents to his GP with problems with his coordination, forgetfulness
and mood swings. He reports that his father had Huntington’s which started at 43 years of age and his grandfather had gait and coordination problems from his 50’s. What is this pattern of
genetic inheritance called?
a) Anticipation
b) Deep resequencing
c) Linkage
d) Penetrance
e) Variance
A

A

Anticipation is where a genetic disorder is passed onto the next generation

61
Q

A 22-year-old university student presents to her GP with her housemate, having woken up very
drowsy, throwing up and disliking bright lights. The GP lays her on the examination couch and
asks the patient to extend her knee with her hip flexed at 90 degrees. What is the GP trying to
illicit?
a) McMurray’s sign
b) Kernig’s sign
c) Brissaud’s reflex
d) Hoffman’s sign
e) Russell’s sign

A

B

62
Q

What is Kernig’s sign?

A

A demonstratable sign of meningitis

Severe stiffness of the hamstrings shows an inability to straighten the leg while the hip is flexed at 90 degrees

63
Q

What type of drug is salmetrol?

A

A LABA

64
Q

Which receptors does salmeterol act upon?

A

Beta-2-adrenergic receptors

65
Q

53) A 25-year-old male is admitted to the emergency department feeling very agitated, anxious
and shaking and sweating a lot. He had broken his leg a couple of days previous and was given
morphine to treat the pain. His housemate says that the patient has not been coping with the
pain well and he had seen him take lots of the medication in response. If this account is true,
what would be the appropriate medical response?
a) Methadone
b) Naltrexone
c) Oxycodone
d) Naloxone
e) Fentanyl

A

D

66
Q

A 38-year-old man goes to see his GP as he is concerned about his drinking habits. He admits to
drinking heavily for over 20 years. What is the maximum recommended upper limit for alcohol
intake in units for men?

A

14

67
Q

A 43-year-old woman with an extensive history of alcohol dependency attends the emergency
department following a heavy night of drinking and a bout of vomiting the following morning.
She has a small haematemesis. What is the least likely cause?
a) Mallory-Weiss tear
b) Bleeding varices
c) Gastritis
d) Peptic ulcer
e) Epistaxis

A

E

68
Q

What would you see in LP for meningitis?

A

Low glucose, high protein

69
Q

61) A 65-year-old male is brought to the emergency department acutely ill. His wife says that after
eating his evening meal, he suddenly became breathless and developed a widespread rash on
his torso. His pulse is 118bpm and his blood pressure is 84/58mmHg. You suspect he is
undergoing anaphylaxis. What immunoglobulin is prominent in this condition?
a) IgA
b) IgD
c) IgE
d) IgG
e) IgM

A

C - IgE

70
Q

A 60-year-old gentleman presents to his GP with lymphadenopathy, splenomegaly, loss of
appetite and weight loss of 6kg over the past 3 months. He is diagnosed with chronic myeloid
leukaemia and genetic testing shows that he has the Philadelphia chromosome. What two
chromosomes are translocated to form this abnormality?
a) 9 and 22
b) 13 and 17
c) 14 and 21
d) 13 and 14
e) 1 and 23

A

A

71
Q

An 80-year-old woman presents to her GP with her carers. They report that she is generally
unwell, has gone off her food and is feverish. She has a poorly demarcated, warm,
erythematous area of skin on her right thigh that is sore to touch. You suspect she has
cellulitis. What is the most appropriate antibiotic?
a) Ciprofloxacin
b) Cefotaxime
c) Tazocin
d) Carbapenem
e) Flucloxacillin

A

E

72
Q

A 39-year-old air conditioning maintenance engineer presents to his GP with a 2-day history of
a minimally productive cough, myalgia and breathlessness. He has not been abroad for over 18
months, has no exposure to birds and is not immunocompromised. The GP examines him and
settles on a diagnosis of right lower lobe pneumonia. What is the likely causative organism?
a) Strep. Pneumoniae
b) Haemophilus influenzae
c) Legionella pneumophilia
d) Moraxella catarrhalis
e) Chlamydophila pneumoniae

A

C- Legionella can multiply in air conditioning systems very well.

73
Q 
A 58-year-old man presents to his GP with clumsiness and difficulty walking. He is referred to a
neurologist who suspects motor neurone disease. Which of the following is a lower motor
neurone sign?
a) Hyperreflexia
b) Clonus
c) Fasciculations
d) Hypertonia
e) Upgoing plantars
A

C

74
Q

Upper motor neuron signs?

A

Weakness, spasticity, clonus, and hyperreflexia

75
Q

Lower motor neuron signs?

A

Muscle atrophy, weakness, fasciculations

76
Q

A student calls NHS 111 asking for advice about self-isolation following a possible exposure to
someone who tested positive for Covid-19. They ask about what symptoms they might expect
to suffer from. Which of the following is not a key symptom of Covid-19 which would call for
immediate isolation?

a) Pyrexia
b) Anosmia
c) Myalgia
d) Ageusia
e) Persistent cough

A

C

77
Q

A patient comes in with abdominal pain, bloating, constipation. You examine the abdomen
and discover a hard mass in the left iliac fossa and carry out a digital rectal examination which
shows an empty rectum. What investigation should you carry out first to best reach a
diagnosis?
a) Abdominal X-ray
b) Abdominal CT
c) Abdominal ultrasound
d) Abdominal MRI
e) Full blood count

A

A

78
Q

Which of these is not a common bacterial cause of urinary tract infections?

a) E. coli
b) Proteus mirabilis
c) Klebsiella pneumoniae
d) Staphylococcus saprophyticus
e) Streptococcus pneumoniae

A

E

79
Q

97) A 12-year-old boy with minimal change disease presents to the nephrology clinic for a review.
Which of the following clinical pictures fits correctly for minimal change disease?
a) Haematuria, hypoalbuminaemia and peripheral oedema
b) Hypoalbuminaemia, peripheral oedema and proteinuria
c) Proteinuria, haematuria and oliguria
d) Hyperlipidaemia, haematuria and hyperalbuminaemia
e) Proteinuria, hyperalbuminaemia and peripheral oedema

A

B

80
Q

A patient presents to A&E with left sided loin pain. An abdominal x-ray shows a stone blocking
the ureter on the left side. Monitoring of the patient’s urine output shows it has been less than
0.5ml/kg/hr for over 6 hours and the medical team are worried about an AKI. Which value are
they most worried about when monitoring the patient’s U&Es?
a) Urea
b) Sodium
c) Potassium
d) Chlorine
e) Creatinine

A

C

Phase 2a medicine (14 decks)

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