Transition TBL Questions Flashcards
MICROBIOLOGY
Which is the best specimen to send to the microbiology lab to screen for STIs in a 20 year asymptomatic female who attends her GP?
Vulvovaginal swab for chlamydia/gonococcal PCR
MICROBIOLOGY
Metronidazole is the treatment of choice for which of the following infections?
- Candida and bacterial vaginosis
- Trichomonas vaginalis and Candida
- Treponema pallidum and Trichomonas vaginalis
- Bacterial vaginosis and Trichomonas vaginalis
- Bacterial vaginosis and Treponema pallidum
Bacterial vaginosis and Trichomons vaginalis
MICROBIOLOGY
Which of the following statements is about Chlamydia is true?
- It has a cycle of reproduction that takes around 20 minutes to complete under ideal culture conditions
- Serotypes L1,L2 &L3 are associated with Lymphogranuloma Venereum infection in MSM
- Serotypes A, B &C are associated with most genital Chlamydia infection is the UK
- It is a virus that can only reproduce inside a host cell
- It usually presents as an acute urethritis in men
Serotypes L1,L2, L3 are associated with Lymphogranuloma Venereum infection in MSM
MICROBIOLOGY
Which genital tract infections is indicated by the presence of “Clue Cells” on microscopy?
Bacterial vaginosis
MICROBIOLOGY
Which of the following statements about Gonorrohoea is true?
- The increase in antimicrobial resistance has resulted in a test of cure being advised for all patients with gonorrhoea.
- It usually causes a clear watery urethral discharge in men
- It is a Gram positive diplococcus (2 kidney beans facing each other)
- Pharyngeal gonorrhoea usually presents as a nasty throat infection
- Neutrophil polymorphs have difficulty phagocytosing N. gonorrhoeae
The increase in antimicrobial resistance has resulted in a test of cure being advised for all patients with gonorrhoea.
MICROBIOLOGY
Which of the following statements about Gonorrohoea infection is true?
-Oral ciprofloxacin is the current recommended treatment
-Oral azithromycin is the current recommended treatment
-Oral cefixime is the current recommended treament
-Oral cefixime and azithromycin is the current recommended treatment
-IM ceftriaxone is the current recommended treatment
-IM ceftriaxone is the current recommended treatment
MICROBIOLOGY
Which of the following statements about coliforms is true?
- Pseudomonas aeruginosa is a type of coliform
- Most coliforms are sensitive to amoxicillin
- Enterococcus faecalis is a type of coliform
- Most coliforms are sensitive to metronidazole
- Most coliforms are sensitive to gentamicin
Most coliforms are sensitive to gentamicin
MICROBIOLOGY
What is the recommended empirical antibiotic treatment for a patient with suspected intra-abdominal sepsis who has normal renal function and is NOT hypersensitive to penicillin?
Amoxicillin, gentamicin and metronidazole
MICROBIOLOGY
Which of the following statements about the diagnosis of sepsis/septic shock is TRUE?
- In order to make a diagnosis of sepsis, a patient must have SIRS plus confirmed positive microbiology
- Low blood pressure is diagnostic of septic shock
- Low blood pressure that does not come back up when IV fluids are given is diagnostic of septic shock
- Patients who have pancreatitis and positive SIRS criteria probably have an infection/abscess developing
- Patients with a low white cell count are very unlikely to have sepsis
Low blood pressure that does not come back up when IV fluids are given is diagnostic of septic shock
MICROBIOLOGY
Which of the following statements about gentamicin is TRUE?
- Dizziness is a recognised side effect of gentamicin
- Gentamicin acts by preventing the cross-linking of peptidoglycan in the bacterial cell wall
- Gentamicin is excreted mainly via the liver
- Single daily dosing is the only way gentamicin is given in NHS Tayside
- Gentamicin blood levels should be checked every day
Dizziness is a recognised side effect of gentamicin
MICROBIOLOGY
Which cause of bacterial meningitis in a previously healthy young adult in the UK should always be considered?
- Neisseria meningitidis
- Streptococcus pneumoniae
- Listeria monocytogenes
- Group B Streptococcus
- Haemophilus influenzae type b
Neisseria meningitidis
MICROBIOLOGY
Which of the following statements is TRUE?
- Steroids are best given with or just before the first dose of antibiotics if they are indicated in a patient with bacterial meningitis
- Almost all patients who have meningitis have a haemorrhagic rash
- There is no effective vaccine against some of the common strains of meningococcal infection seen in the UK
- If you suspect a patient has meningococcal infection antibiotics should NOT be given until CSF has been taken off
- A high lymphocyte count in CSF indicates bacterial meningitis
Steroids are best given with or just before the first dose of antibiotics if they are indicated in a patient with bacterial meningitis
MICROBIOLOGY
Which of the following statements is TRUE?
- Aciclovir is useful for treating most causes of viral meningitis
- Listeria is a small Gram negative bacillus
- Gentamicin has good penetration into CSF and is useful for treating some types of meningitis
- Listeria infection is associated with the consumption of soft cheese
- Listeria meningitis is commonest in older children and young adults
Listeria infection is associated with the consumption of soft cheese
MICROBIOLOGY
Why is ceftriaxone chosen for empirical treatment for suspected bacterial meningitis instead of penicillin?
- Ceftriaxone has a longer half-life than penicillin
- Ceftriaxone penetrates better than penicillin into CSF
- Most bacteria that cause meningitis are now penicillin resistant.
- Resistance is less likely to emerge during therapy if ceftriaxone if used
- Ceftriaxone also has activity against Listeria infection
Ceftriaxone has a longer half-life than penicillin
PHYSIOLOGY A 67‐year‐old man who smokes since his teens has been diagnosed with chronic obstructive pulmonary disease (COPD). His disease is stable. His FEV1/FVC% is likely to be: A. 90% B. 4% C. 80% D. 60% E. 20%
D. 60%
PHYSIOLOGY Which of the followings is correct in a patient with emphysema? A. Gas exchange is unaffected B. The work of breathing is decreased C. The pulmonary compliance is increased D. The total lung volume is decreased E. The FEV1/FVC ratio is increased
C. The pulmonary compliance is increased
PHYSIOLOGY
Which of the followings is correct in a patient with COPD? Select ONE BEST OPTION
A. Inspiration will be more difficult than expiration
B. Dynamic airway compression is likely to occur during active expiration
C. The presence of emphysema will help alleviate dynamic airway compression
D. Oxygen saturation should be maintained near 100% if the patient is retaining CO2
E. Dynamic airway compression is likely to occur during inspiration
B. Dynamic airway compression is likely to occur during active expiration
PHYSIOLOGY
From the list below select the ONE MOST RELEVANT option which describes the mechanisms involved in the causation of shortness of breath in this patient
A 21‐year‐old woman sees her GP about intermittent breathlessness. She often feels breathless when she’s in a crowded room. When she feels breathless, she also notices numbness and tingling around her mouth. A full blood count requested by the GP showed haemoglobin of 10.5 grams/dl.
A. Increased work of breathing due to reversible airways obstruction
B. Increased central and autonomic arousal
C. Reduced oxygen carrying capacity of the blood
D. Stimulation of peripheral chemoreceptors
E. Reduced surface area for gas exchange
B. Increased central and autonomic arousal
PHYSIOLOGY
From the list below select the ONE MOST RELEVANT option which describes the mechanisms involved in the causation of shortness of breath in this patient.
A 52‐year‐old man complains of gradually increasing shortness of breath on exertion and a dry cough. He has smoked 10 cigarettes a day since he was 14. On examination of his chest there are dry crackles at both bases.
A. Reduced pulmonary compliance and impaired gas diffusion
B. Increased work of breathing caused by reversible airway obstruction
C. Increased alveolar surface tension
D. Fixed airway obstruction and decreased surface area for gas exchange
E. Metabolic acidosis
A. Reduced pulmonary compliance and impaired gas diffusion
PHYSIOLOGY In a patient with pulmonary fibrosis, the FEV1/FVC% is likely to be Select ONE OPTION A. 35% B. 40% C. 80% D. 60% E. 20%
C. 80%
PHYSIOLOGY
From the list below select the ONE MOST RELEVANT option which describes the mechanisms involved in the causation of shortness of breath in this patient
A 72‐year‐old woman has had two myocardial infarctions in the past, and a recent echocardiogram has shown moderately impaired left ventricular function. She complains to her GP of shortness of breath, which is worse at night.
A. Increased alveolar surface tension
B. Increased work of breathing due to reversible airways obstruction
C. Reduced oxygen carrying capacity of the blood
D. Reduced pulmonary compliance and impaired gas diffusion
E. Stimulation of central chemoreceptors
D. Reduced pulmonary compliance and impaired gas diffusion
PHYSIOLOGY A previously fit 22 old man has been unwell for 2 days. He presents with cough productive of greenish septum, fever, and shortness of breath. His PO2 is 8.2 kPa. What is his saturation likely to be? 98% 90% 82% 75% 60%
90%
PHYSIOLOGY
52y.o. man w SOB on exertion diagnosed w diffuse pulmonary fibrosis. His ABG results under resting conditions showed a PO2 10.2 kPa, saturation 97%, and PCO2 of 4.9 kPa. His Hb is 10.5 grams/dl. Which of the followings sets of results would be expected for him during climbing stairs?
Normal PCO2 4.7‐6.1, PO2 12.0‐14.7
A. %Saturation: 90%, PO2: 8.3, and PCO2: 4.8
B. %Saturation: 97%, PO2: 11.3, and PCO2: 5.9
C. %Saturation: 98%, PO2: 12.6, and PCO2: 3.4
D. %Saturation: 90%, PO2: 9.4, and PCO2: 6.7
E. %Saturation: 95%, PO2: 8.3, and PCO2: 7.1
A. %Saturation: 90%, PO2: 8.3, and PCO2: 4.8
PHYSIOLOGY
A 32‐year‐old woman with well controlled T1DM. She is admitted with a 2 day history of dysuria, urinary frequency and vomiting. On arrival, she is comatose, with deep, ‘sighing’ respiration, and a temperature of 38.2oC.
Normal pH 7.36‐7.44, PCO2 4.7‐6.1, HCO3‐ 24‐30, PO2 12.0‐14.7
A. pH 7.26 PCO2 3.2 HCO3‐ 8 PO2 12
B. pH 7.08 PCO2 5.2 HCO3‐ 8 PO2 11.8
C. pH 7.1 PCO2 7.1 HCO3‐ 26 PO2 10.2
A. pH 7.26 PCO2 3.2 HCO3‐ 8 PO2 12
PHYSIOLOGY
Which of the followings is correct about Functional Residual Capacity?
A. Is usually increased in obese subjects
B. Is measured by spirometry
C. Is decreased in COPD
D. Is normally about 20% of total lung capacity
E. Is approximately about 2.2 liters in a young adult man
Is approximately about 2.2 liters in a young adult man
PHYSIOLOGY
Which of the followings is correct about normal lungs?
A. A low PO2 causes pulmonary vasoconstriction
B. Larger airways are supplied by pulmonary circulation
C. Beta 1 agonists causes bronchodilation
D. Parasympathetic stimulation causes bronchodilation
E. The surface area for gas exchange remains constant in the absence of disease
A. A low PO2 causes pulmonary vasoconstriction
PHYSIOLOGY
Which of the followings is correct in a patient with tension pneumothorax?
A. The intra‐pleural pressure becomes more negative
B. The trachea may deviate to the same side
C. Patient is likely to be hypotensive
D. Breath sounds are increased
E. Chest pain is not a symptom
C. Patient is likely to be hypotensive
PHYSIOLOGY A 35‐year‐old man has been diagnosed with severe anaemia. What is his saturation and PO2 likely to be, if he is breathing air Normal PO2 12.0‐14.7 A. Saturation 90%, PO2 PO2 9.2 kPa B. Saturation 99%, PO2 13.1 kPa C. Saturation 88%, PO2 13.1 kPa D. Saturation 99%, PO2 8.6 kPa E. Saturation 95%, PO2 16.9 kPa
B. Saturation 99%, PO2 13.1 kPa
PHYSIOLOGY
62yo man, smoked since teens, increasing SOB. Chest examination – barrel shaped and hyper-resonant percussion. What are the likely PFTs?
-Decreased TLC, increased lung diffusion capacity (LDC), normal/increased FEV1/FVC ratio
-Increased TLC, decreased LDC, normal/increased ratio
-Increased TLC, decreased LDC, decreased ratio
-Decreased TLC, decreased LDC, normal/increased ratio
-Decreased TLC, increased LDC, decreased FEV1/FVC
Increased TLC, decreased LDC, decreased ratio
PHYSIOLOGY
48yo man, acute anterior MI, wakes up SOB, sitting up on high-flow O2. OE mild tachycardia and chest crackles posteriorly. Best management:
• IV furosemide and oral digoxin
• IV furosemide and nitrate infusion
• IV furosemide and B-blocker
• IV furosemide and calcium channel blocker
• IV furosemide and ACEi
IV furosemide and nitrate infusion
PHYSIOLOGY Previously fit 74yo, SOBOE for several weeks. Weight loss despite eating well. OE irregularly irregular pulse, 110bpm, tremor of hands, normal cardiac auscultation Most diagnostic investigation: • FBC • Echo • CXR • TFT • Troponin-T
TFT
