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
PHYSIOLOGY 28yo, Hx anxiety, tingling round mouth and fingers Most likely ABG • pH7.6, PCO2 2.6, HCO3 26, PO2 12.8 • pH7.56, PCO2 3.0, HCO3 26, PO2 6.6
pH7.6, PCO2 2.6, HCO3 26, PO2 12.8
Tall thin 28yo woman, sudden onset right sided chest pain worse on breathing. Suffering from insomnia been taking diazepam, on OCP. OE RR20, HR90, no added sounds in chest
• Loss of transmural pressure gradient across lung wall
• Ventilation perfusion mismatch
• Respiratory muscle paralysis
Ventilation perfusion mismatch
PHYSIOLOGY 26yo man, AE unconscious, needle puncture marks on both arms, RR8, pinpoint pupils Most likely ABGs • pH7.34, PCO2 6.5, HCO3- 38, PO2 6.1 • pH 7.34, PCO2 6.5, HCO3 38, PO2 11.2 • pH 7.1, PCO2 7.1, HCO3 26, PO2 6.2
pH 7.1, PCO2 7.1, HCO3 26, PO2 6.2
Respiratory acidosis due to CO2 retention in respiratory depression
PHYSIOLOGY 64yo man, smoker 50y, coughs up sputum every day, breathless on minor exertion. Admitted to hosp with chest infection, breathless at rest. Most likely ABG • pH7.2, PCO2 6.8, PO2 8.2, HCO3 26 • pH 7.36, pCO2 6.8, PO2 12.2, HCO3 38 • pH 7.36, pCO2 6.8, PO2 12.2, HCO3 38 • pH 7.5, pCO2 3.4, pO2 6.9, HCO3 26 • pH 7.5, pCO2 3.4, pO2 12.2, HCO3 26
pH 7.36, pCO2 6.8, PO2 12.2, HCO3 38
PHYSIOLOGY
56yo life long non-smoker male farmer, increased SOBOE. Hx hypertension – losartan 100mg, bendroflumethiazie 2.5mg. BP 120/82mmHG, ECG normal 76bpm. Chest examination crackles at both lung bases
• Decreased TLC, increased LDC, normal/increased ratio
• Increased TLC, decreased LDC, normal/increased ratio
• Decreased TLC, decreased LDC, decreased ratio
• Decreased TLC, decreased LDC, normal/increased ratio
• Decreased TLC, increased LDC, decreased ratio
Decreased TLC, decreased LDC, normal/increased ratio
PHYSIOLOGY
pH 7.06, PCO2 2.9, PO2 12.8, HCO3 9.2. Which patient?
- 56yo man, COPD, admitted with worsening cough and breathlessness
- 23yo woman, asthma, increasingly wheeze for 2-3d
- 26yo man, morphine overdose
- 28yo man, T1DM, admitted semi-conscious with BD 32
- 68yo women, breathless following MI
28yo man, T1DM, admitted semi-conscious with BD 32
Partially compensated metabolic acidosis
PHYSIOLOGY 75yo man, RLL bronchial carcinoma, practice palliative care register, increasing breathlessness. Wide reports happens more often when on his own and overnight. Pain well controlled – low dose oral morphine daily. OE few coarse creps in RLL. Likely more effective in treating the dyspnoea? • Dexamethasome • Furosemide • Hyoscine • Lorazepam • Midazolam
Lorazepam
PHYSIOLOGY
65yo woman, SOB. Well until 2 months before admission, sore kee, twice daily painkillers. Stools black and tarry. Fees tired, breathless on minimal exertion but not at rest. CV normal and chest clear. Most likely physiological mechanism for SOB
• Reduced pulmonary compliance
• Reduced PO2 in arterial blood
• Stimulation central chemoreceptors
• Reduced O2 carrying capacity of blood
• Reduced diffusion of O2 into the blood through the respiratory membrane
Reduced O2 carrying capacity of blood
BIOCHEMISTRY
Which of the following statements is true?
A. Measurement of urinary sodium has no place in the evaluation of hyponatraemia.
B. Hyponatraemia due to water retention e.g. syndrome of inappropriate ADH (SIADH) secretion is usually associated with clinical evidence of water overload, e.g. oedema.
C. Pseudohyponatraemia is a common cause of abnormally low sodium concentrations.
D. Oedema is always associated with an expanded circulating blood volume.
E. Renal excretion of sodium is a key mechanism by which the kidneys regulate blood volume.
E - Renal excretion of sodium is a key mechanism by which the kidneys regulate blood volume.
- Pseudohyponatraemia is an artefact
- Oedema is often associated with reduced circulating blood volume e.g. fluid in the wrong place
BIOCHEMISTRY
Which of the following statements is true?
A. DDAVP, the synthetic analogue of AVP (ADH), is used to distinguish between central and nephrogenic diabetes insipidus.
B. SIADH in association with lung cancer is always due to ectopic secretion of ADH by the tumour.
C. The sodium loss seen in Addison’s disease is always associated with hyponatraemia.
D. ADH acts only on the kidneys.
E. Non-osmotic stimuli and osmotic stimuli (hypernatraemia) cause similar increases in ADH.
A - DDAVP the synthetic analogue of ADH is used to distinguish between central and nephrogenic diabetes insipidus.
Water deprivation test
- SIADH associated with small cell lung cancer there is typically ectopic ADH secretion, but very rare
- In Addison’s low Na and high K develop over time, not in early disease
- Non-osmotic stimuli don’t increase ADH
BIOCHEMISTRY
Which of the following statements is true?
A. In patients with suppression of the HPA axis by long-term prescription of prednisolone, 1 mg daily reliably provides adequate steroid replacement, i.e. the patient is getting enough exogenous steroid to cover any insufficiency of endogenous steroid production.
B. Patients with adrenal insufficiency are less able to retain infused saline (sodium) than normal subjects.
C. Random cortisol measurements have no place in the investigation of the HPA axis.
D. Palmar pigmentation is a feature of secondary adrenal insufficiency.
E. ‘Mineralocorticoid activity’ refers to exchange of Na+ for any cation, e.g. K+, H+, Ca++, Mg++.
B - Patients with adrenal insufficiency are less able to retain infused saline (sodium) than normal subjects.
- 1mg of prednisolone is not enough to maintain steroids in someone with a suppressed HPA axis.
- Cortisol is measured when investigating the HPA axis to aid determining adrenal reserve, e.g. someone in ICU should have very high cortisol but if cortisol is low this tells you their adrenal function is compromised.
- Palmar pigmentation is a feature of primary adrenal insufficiency, since raised ACTH interferes with melanin hormone, and ACTH only raised in primary insufficiency.
- Mineralocorticoid activity refers specifically to K+ and H+.
BIOCHEMISTRY
Which of the following statements is true?
A. ‘Adrenal insufficiency’ refers specifically to the adrenal cortex; the adrenal medulla is preserved.
B. Failure of the adrenals to respond to synacthen in a short synacthen test unequivocally indicates primary adrenal insufficiency.
C. In intensive therapy unit (ITU) patients, synacthen tests are most often done to diagnose primary adrenal insufficiency.
D. Measurement of ACTH may be used to distinguish primary and secondary adrenal insufficiency.
E. Replacement steroids e.g hydrocortisone do not interfere with the cortisol assay, and therefore do not need to be withheld if cortisol is being measured.
D - Measurement of ACTH may be used to distinguish primary and secondary adrenal insufficiency.
- In autoimmune Addison’s, only the cortex is affected, but in Addison’s due to TB both the cortex and medulla are affected.
- In positive Synacthen don’t get the rise that you should, in secondary insufficiency a short Synacthen may be abnormal (like in primary insufficiency) so a long Synacthen with higher ACTH dose required to stimulate adrenals - this can help differentiate primary and secondary adrenal insufficiency.
BIOCHEMISTRY
Which of the following statements is true?
A. Long-term immobilisation (bed-bound) is a common cause of hypercalcaemia.
B. Patients with malignancy-associated hypercalcaemia have high circulating concentrations of PTH.
C. PTH is stable for up to three days and can be added retrospectively within this timeframe.
D. Secondary hyperparathyroidism results from pituitary stimulation of the parathyroid glands, whereas primary hyperparathyroidism originates within the parathyroid glands themselves.
E. Primary hyperparathyroidism is diagnosed much earlier than in the past because of hypercalcaemia; as a result, radiological changes like osteitis fibrosa cystica are rarely seen any more.
E - Primary hyperparathyroidism is diagnosed much earlier than in the past because of hypercalcaemia; as a result, radiological changes like osteitis fibrosa cystica are rarely seen any more.
- Long term immobilisation rarely can cause a mild hypercalcaemia.
- Patients with malignancy associated hypercalcaemia have low PTH.
- Primary hyperparathyroidism originates within the glands.
- Secondary hyperparathyroidism occurs due to hypocalcaemia in CKD.
BIOCHEMISTRY
Which of the following statements is true?
A. Most patients in ITU have a low adjusted total calcium concentration.
B. Rehydration is always instituted early in the management of severe hypercalcaemia. This is because hypercalcaemia interferes with proximal tubular reabsorption of sodium and so causes loss of sodium and water – patients are usually dehydrated
C. Widespread bony metastases are almost invariably associated with severe hypercalcaemia.
D. Following removal of a parathyroid adenoma, the remaining parathyroid glands adjust immediately to the new calcium concentration.
E. The finding of low vitamin D levels should routinely prompt prescription of vitamin D supplements.
B - Rehydration is always instituted early in the management of severe hypercalcaemia. This is because hypercalcaemia interferes with proximal tubular reabsorption of sodium and so causes loss of sodium and water – patients are usually dehydrated
- Widespread bony metastases may be associated with a mild-moderate hypercalcaemia
- Most ITU PTx have normal adjusted total calcium conc.
- After parathyroid adenoma removal, the remaining parathyroid glands DO NOT adjust immediately to the new calcium conc.
BIOCHEMISTRY
Which of the following statements is true?
A. Benchtop centrifuges are rarely used in rural general practice surgeries to minimize the problem of pseudohyperkalaemia
B. Some GP surgeries store blood samples in the fridge overnight. This is associated with artefactually low potassium results.
C. Once haemolysis and renal failure have been excluded, antihypertensive drugs e.g. spironolactone, are the most likely cause of hyperkalaemia.
D. Separated plasma and serum give similar potassium results in patients with clotting disorders.
E. In the laboratory, haemolysis is detected by visual inspection of separated samples.
C. Once haemolysis and renal failure have been excluded, antihypertensive drugs e.g. spironolactone, are the most likely cause of hyperkalaemia.
-Haemolysis is detected by spectrometry machines.
K sparing diuretics can cause hyperkalaemia
ACEIs can also cause hyperkalaemia
BIOCHEMISTRY
Which of the following statements is true?
A. Tented/peaked T waves are the only ECG abnormality seen in severe hyperkalaemia.
B. Renal failure is likely in rhabdomyolysis when the CK exceeds 500 U/L.
C. Potassium salts of intravenous drugs are the commonest cause of hyperkalaemia in hospital patients.
D. In treatment of DKA, potassium should not be given if the [K+] is normal.
E. The finding of gross hyperkalaemia and hypocalcaemia suggests contamination with potassium EDTA, the anticoagulant used in the FBC (‘purple-top’) bottle.
E. The finding of gross hyperkalaemia and hypocalcaemia suggests contamination with potassium EDTA, the anticoagulant used in the FBC (‘purple-top’) bottle.
Renal failure is likely in rhabdomyolysis when the CK exceeds 10,000 U/L.
Hyperkalaemia ECG: tall tender T waves plus prolonged PR interval.
ANATOMY
PTx has DVT in posterior tibial artery that has now gone past the level of the inguinal ligament. Which vein is it in?
- Deep femoral
- Femoral
- External iliac
- Common iliac
- Great saphenous
• External iliac
ANATOMY Pain on active flexion of hip. Which muscle is most likely source of pain? • Semitendinosus • Piriformis • Gluteus maximus • Iliopsoas • Sartorius
• Iliopsoas
ANATOMY Which innervates 1st dorsal web space • Deep fibular nerve • L5 posterior root • Superficial fibular nerve • Tibial nerve • Internal capsule of brain
• Deep fibular nerve
ANATOMY On review at fracture clinic, inability to extend left wrist joint. Paraesthesia over posterior forearm and hand. Most likely cause? • Mid-shaft fracture of humerus • Surgical neck of humerus fracture • Supracondylar humerus fracture • Olecranon fracture • Fracture of anatomical neck of humerus
• Mid-shaft fracture of humerus
Surgical neck of humerus fracture associated with axillary nerve damage
Supracondylar humerus fracture associated with median nerve and brachial artery damage
ANATOMY Which transected as consequence of standard laminectomy procedure • Ligamentum flavum • Anterior longitudinal • Posterior longitudinal • Annulus fibrosis • Dura mater
• Ligamentum flavum
ANATOMY Ankle jerk reflex tests • Common fibular nerve, L5 • Deep fibular nerve L5 • Saphenous nerve L3, L4 • Tibial nerve S1, S2 • Lateral plantar nerve S1/S2
• Tibial nerve S1, S2
ANATOMY Inversion injury to ankle whilst running. Most likely • Anterior talofibular ligament rupture • Calcaneofibular ligament • Medial malleolus avulsion fracture • Achilles tendon rupture • Rupture of deltoid ligament
• Anterior talofibular ligament rupture
Calcaneofibular ligament is one most frequently injured in inversion injuries but since running less likely
ANATOMY Severe left sided sciatica for 4 weeks. Most likely sign: • Reduced/absent knee jerk • Decreased power of hip flexion • Impaired sensation on medial thigh • Decreased power of plantar-flexion • Impaired sensation of medial leg
• Decreased power of plantar-flexion
Question is basically asking you - which of these is supplied by the sciatic nerve
ANATOMY Pins and needle in right little finger and adjacent palm and weakness of right hand. Wasting of muscles between metacarpal bones of right hand dorsally and flattening of anteromedial border of forearm, where is affected nerve most likely compressed? • Carpal tunnel • Cubital tunnel • Guyon’s canal • Tarsal tunnel • Thoracic outlet
• Cubital tunnel
ANATOMY Cause of left foot drop • Left internal capsule stroke • Left fracture neck of fibula • Fracture left neck of femur • Left femoral nerve compression • Ruptured left Achilles tendon
• Left fracture neck of fibula
PHARMACOLOGY Which of the following drugs is not used as secondary prevention following an MI • Furosemide • Ramipril • Bisoprolol • Simvastatin • Aspirin
• Furosemide
PHARMACOLOGY Which of the following is most likely to cause hyperkalaemia • Allopurinol • Furosemide • Simvastatin • Ramipril • Metformin
• Ramipril
PHARMACOLOGY Which doesn’t interact with the others to cause hypotension? • Furosemide • Simvastatin • Bisoprolol • Ramipril • GTN
• Simvastatin
PHARMACOLOGY The combination of which PPI with clopidogrel should be avoided? • Lansoprazole • Pantoprazole • Rabeprazole • Omeprazole • Dexlansoprazole
• Omeprazole
PHARMACOLOGY Which don’t need to be used in caution in patients with renal impairment? • Allopurinol • Simvastatin • Omeprazole • Ramipril • Metformin
• Omeprazole
PHARMACOLOGY
With regard to a drug that exhibits 1st order elimination kinetics administered IV which is true
• The time to steady-state plasma concentration (Cpss) is halved if the rate of infusion is doubled
• The time to steady-state plasma concentration (Cpss) is not influenced by the half-life (t½) of the drug
• Steady-state plasma concentration (Cpss) is achieved when the rate of administration equals the rate of elimination
• The time to steady-state plasma concentration (Cpss) is independent of clearance (Cl)
• The rate of elimination of the drug is independent of the plasma concentration (Cp)
• Steady-state plasma concentration (Cpss) is achieved when the rate of administration equals the rate of elimination
PHARMACOLOGY
Which of the following statements regarding the apparent volume of distribution (Vd) is correct?
• It corresponds to a defined anatomical compartment
• It tends to have a low value for highly lipophilic drugs
• It has no influence upon the rate of elimination of a drug
• Knowledge of it allows the calculation of a loading dose
• It can be calculated as Vd = Cp0/dose for a drug given as a bolus injection, where Cp0 is the plasma concentration at time zero
• Knowledge of it allows the calculation of a loading dose
PHARMACOLOGY A drug with a half-life (t½) of 4 hours is administered as a rapid bolus injection and a blood sample within a few minutes reveals a plasma concentration of 10 mg per litre. Assuming first order elimination kinetics, select the concentration of drug in the plasma after 24 hours. • 5 mg per liter • 0.625 mg per liter • 1.25 mg per liter • 0.156 mg per liter • 2.5 mg per liter
• 0.156 mg per liter
PHARMACOLOGY
For a drug with 1st order elimination kinetics, which will NOT occur if its dose via the oral route at each administration is doubled?
• Doubling of average steady state plasma concentration [Cpss(average)]
• Doubling of the rate of elimination
• Doubling of the half-life (t1/2)
• Prolongation of the duration of drug action by one half-life
• Doubling of the difference between the peaks and the troughs of the plasma concentration profile between doses
• Doubling of the half-life (t1/2)
Drug X has a very long half-life but is required urgently to achieve a target plasma concentration of 4 mg per litre. With knowledge that drug X has a volume of distribution of 0.25 litre per Kg, an oral bioavailability 0.5 and that the weight of the patient is 84 Kg calculate an initial loading dose to be given prior to successive maintenance doses • 16.8 mg • 84 mg • 168 mg • 336 mg • 1.68 g
• 168 mg
PHARMACOLOGY
What drug exacerbates gout?
Furosemide
PHARMACOLOGY
Grapefruit juice combined with that drug cause myalgia?
Simvastatin
Not other statins, due to enzyme induction
PHARMACOLOGY
Viagra aka sildenafil interacts with _____ causing severe hypotension
Nitrates (eg isosorbide mononitrate)
PHARMACOLOGY The effectiveness of which of the following drugs may be decreased by impaired renal function? • Metformin • Simvastatin • Furosemide • Aspirin • Bisoprolol
• Furosemide
PHARMACOLOGY For a gout flare up, what would you not consider in a patient with CKD? • Colchicine • Naproxen • PO prednisolone • Intra-muscular steroid • Intra-articular steroid
• Naproxen
PHARMACOLOGY Mr TP takes warfarin as an anti-coagulant for AF prophylaxis. He also has mild OA. Which of the following is most suitable? • Aspirin • Diclofenac • Paracetamol • Ibuprofen • Naproxen
Why?
• Paracetamol
All others are NSAIDs which interact with warfarin causing GI bleeding
PHARMACOLOGY
How many days before surgery should you stop warfarin?
5 days
PHARMACOLOGY
Man taken 30 paracetamol 6 hours ago under influence of alcohol, current nausea, management?
• Supportive management only
• Gastric aspiration and lavage
• Oral administration of activated charcoal
• IV n-acetylcysteine
• Alkaline diuresis
• IV n-acetylcysteine
Given up to 8 hours after
PHARMACOLOGY
What drug is used to prevent hypotension when administering spinal anaesthesia?
Ephridine
PHARMACOLOGY
Which of statement regards lipid soluble drugs and their Vd vol of distribution of correct?
• Vd is larger in men compared to women of similar body mass
• Vd is unaffected by BMI
• Vd is typically less than 5 liters or approximately 70 ml per kg
• Rate of elimination is independent of Vd
• Vd may exceed the total volume of the body
• Vd may exceed the total volume of the body
PHARMACOLOGY
Spinal anaesthesia most commonly causes hypotension by what mechanism?
• Blockade of alpha adrenoceptors causing vasodilation
• Blockade of sympathetic transmission to blood vessel causing vasodilation
• Direct local anaesthetic action of cardiac myocytes causing impaired cardiac function
• Parasympathetic blockade causing bradycardia and reduced CO
• Parasympathetic stimulation causing vasodilation
• Blockade of sympathetic transmission to blood vessel causing vasodilation
