UCL 2017 Paper 2 Flashcards by Chris E

Fundus photograph of someone with deterioration of vision, pic show yellow exudates ringed around macula.

Diabetic maculopathy

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Young chap 72 hour hx of sore throat but for last 24hr can’t eat/drink. o/e, has an erythematous soft palate and uvula deviated other way. He cant open his mouth fully.

quinsy

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Woman 30yo who has been in UK 8 years , originally from brazil. Has pain, tingling, sensory loss all limbs v weird no obvious pattern. Has thickened ulnar and peroneal nerves. Answer likely Leprosy therefore rx is

Dapsone

Primary options
rifampicin: 600 mg orally once monthly

and

clofazimine: 50 mg orally once daily plus an additional 300 mg once monthly

and

dapsone: 100 mg orally once daily

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A patient with CKD is given a drug and K rises to 7.2.

Trimethoprim 
Trimethoprim (an organic cation) acts like amiloride and blocks apical membrane sodium channels in the mammalian distal nephron. As a consequence, the transepithelial voltage is reduced and potassium secretion is inhibited. Decreased renal potassium excretion secondary to these direct effects on kidney tubules leads to hyperkalemia in a substantial number of patients being treated with trimethoprim-containing drugs.

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Description of diabetic gastroparesis young T1DM ha dyspepsia and nausea after meals what is best rx -

domperidone or metoclopramide

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Middle lobe collapse

Remember CXR looks like wedge wipe out

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25yo from Bangladesh 2 week ago gram negative rods were grown in aerobic and anaerobic bottles, had rash buttocks thighs. which organism?

salmonella typhi/paratyphi

^These are rose spots or ‘enteric fever’ – also look for a relative bradycardia

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Brain with fucked temp lobe. This patient had prolonged seizure then died -

hsv enceph

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. Guy has transjugular shunt, and next day noted to be solmnent. Why?

TIPS predisposes to hepatic encephalopathy because ammonia can reach brain and cause osmotic change, damaging astrocytes

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Wasted small muscles hand, abduction adduction and thumb adduction all weak. Loss of sensation of medial aspect of forearm (? Classic c8 dermatome). Triceps biceps reflexes and finger flex normal. L arm normal. T1 or c8 lesion, or median nerve palsy?

C8 or T1

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Guy who plays golf with pain at lateral epicondyle what muscles weak?

extensors wrist (ie muscles on ventral aspect of forearm)

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Ecg shows pr depression and curved st elevation but only get some leads, dX?

PR depression MOST sensitive sign of pericarditis

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Gram positive diplococi

strep pneumo for example

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Person has 2 episodes of hemoptysis and upper lobe consolidation on XR. What is best Ix -

AFBs

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Description of asthma lady who has exacerbations despite SABA LABA and ICS at maximum dose, what next?

LTRA

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Lady with UC, has been well controlled for 3 years with mesalazine, now admitted with severe 8 bloody stools/d ,

IV hydrocort

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Girl 30 pr fresh red blood on tissue and described an episode where blood was dripping into bowl. Pr normal no masses next Ix?

protoscopy

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Long description of breast cancer an how many kids shes had. What is her greatest risk factor for breast ca?

, ?obesity

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Msm with painless ulcer, causative organism?

treponema palidum

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Guy dysuria for 4 days and 4 raised painful lesions on corona of penis

herpes simplex

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Guy decreased maximal urine flow post gonorehoa which was like 2 years ago, which complication has occurred?

stricture

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Woman has dry eyes and mouth enlarged parotids what it? May also have said her schirmer test was 7mm (should be >5, gives you reference range).

sjogren

young person normally moistens 15 mm of each paper strip. Because hypolacrimation occurs with aging, 33% of normal elderly persons may wet only 10 mm in 5 minutes. Persons with Sjögren’s syndrome moisten less than 5 mm in 5 minutes.

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Woman with obvious ra but RhF factor negative. Discussed she been tired, metacarpophalangeal swelling and pain

answer still RA

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Guy with metatarsophalangeal pain exquisitely tender. This is podagra. What is best rx?

Naproxen. NB its NSAID 1st line acutely and colchicine in NSAID CI like asthma/renal failure. If already on allopurinol, continue dose. If not, start AFTER event if predisposed.

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Guy has huge trauma and bleeds out, how does body combat this?

Increased sympathetic tone

What is the single scenario a GP may prescribe sildanefil on nhs?

He depressed and its causing him

How does sildanefil cause postural hypotensive

PDEV inhibitor resulting in vasodilation

Ground glass hepatocytes. aa1 low levels

pathognomnic of hepatitis B

. Guy severe ckd anemia 79, v microcytic. Ferritin 5

Clinical history, presentation, and findings include fatigue, pallor, dyspnoea on exertion, and pica. Microcytic, hypochromic anaemia; low reticulocyte count. Characteristics include low serum iron, increased total iron-binding capacity (TIBC), less than 16% transferrin saturation, and low serum ferritin. The diagnosis of iron deficiency anaemia necessitates investigation of the underlying cause. There is no single reliable cut-off for red cell transfusion, but patients should be transfused according to clinical need based on co-existing disease (such as anaemia and unstable angina) and haemodynamic stability. Studies suggest that red cell transfusion may be overused. [99] The use of a blood transfusion does not obviate the need for other forms of iron replacement, because one unit of packed red blood cells will provide only approximately 250 mg of elemental iron and would provide only enough iron to raise the haemoglobin by 1 g.

Budd Chriari prv description. A man has polycythaemia which is well treated. He then moves practice area and represents 2 years later with distended abdomen and dilated abdominal veins. Portal vein, splenic vein thrombosis. Answer is PRV which causes Budd Chiari which is

HEPATIC vein thrombosis Includes hepatic venous outflow obstruction at any level from the small hepatic veins to the junction of the inferior vena cava and the right atrium, regardless of the cause of the obstruction. Classic triad of symptoms is abdominal pain, ascites, and hepatomegaly. Seventy-five per cent of patients have at least one underlying hypercoagulable state. Colour and pulsed Doppler ultrasonography is the first-line investigation for diagnosis. Patients should also undergo testing for hypercoagulable states to identify any predisposition to venous thrombosis. The aim of therapy and interventional management is to relieve hepatic congestion and prevent necrosis, fibrosis, and ultimately liver failure, cirrhosis, and/or portal hypertension. The main treatment options are radiological interventional procedures including angioplasty of hepatic vein and/or inferior vena cava, or transjugular intrahepatic portosystemic shunts (TIPS). Further to this, surgical procedures may be used, such as surgical shunts and liver transplantation.

Bre comes with painful knee t 38.5. Start empirical abx or aspirate and ix fluid?

aspirate because will need to confirm dx and need culture and sensitivities to narrow the spectrum.

Guy tired all time normal t4 7, tsh <0.01, testosterone also low 0.02.

Hypopituatrism

Man has painful face and headache with no cause found. He represents a few days later with a few red bumps which extend past the orbit to midline, what is like nerve affected?

Trigeminal opthalmic branch. Good hx of pain before herpes zoster ophthalmicus and as usual, funny way of asking an easy question

Guy with HIV has culture with silver stain which is positive, organism?

Aspergillus

. Ix for pulseless cold R leg?

As already stated, embolectomy is the treatment for an embolic occlusion; whereas more complicated techniques such as arterial angioplasty, thrombolysis and possibly arterial bypass are the treatments for arterial thrombosis.[47] The gold standard to differentiate between these two scenarios is an angiogram,

Another similar question described a R leg which is cold and pulseless and no pulses except femoral pulse, where is pathology?

Superficial femoral

Woman with no mass but bloody discharge. Classic qn from previous years

ductal papiloma

Guy punched someone 3 days ago. Oe cut on 3rd knuckle and exquisitely tender on palmar aspect and can't move passively.

surgical debridement and iv abx | pain on passive felxion is key word

3 weeks a guy has been off work feeling unwell. O/E has no air movement at R base and dull to percussion and decreased vocal resonance.

I'd say collapse

A lady taxi driver has urticaria but wants non sedating rx due to her job

Remember: cetirizine

Kid has pt aptt etc all normal plt 10. Refers you to a pic petechiae on ankle, dx?

ITP

Bad smoker 50 a day. RUQ pain so has liver bx which demonstrates a random made up marker which suggests lung primary. How'd it get there?

Hematogenous,

. Kid sniffly nose in June every year, which Ab most likely high?

IgE

Guy Rx for PRV goes well but plt noted later are 568. Mx?

Nothing – observe

Woman on warfarin falls whilst shopping inr 3.3, maybe said has had recent erythromycin for infection? CT head shows bleed behind eye she already given IV vit k what's best to add?

PCC

Bre going on erythromycin for CAP, gives list of his cardiac drugs, whats best to do?

Hold simvastatin, classic scenario of statin-induced rhabdomyolysis after taking an inhibitor

Bre has a stroke, whats best drug to add in addition to the 300mg of aspirin? (that was exact question).

Atorvastatin 80mg

Bre with LMN 7 palsy presents at 48hr, what rx is indicated?

Answer is pred | ^YOU TREAT A LMN 7th UP UNTIL 72 HOURS OF Sx

Kid unwell with bump behind ear which pushes pinna forward, dx?

Acute mastoiditis

Woman with lots of sensory sx and clumsiness. A few years ago she had a weakness of her right hand. What is the next diagnostic ix? This obviously MS sx.

MRI is first line before anything else.

Bre diabetes diet not worked and sugars 13. What next?

Metformin

45yo black guy and has HTN. What rx you give?

amlodopine

Guy during flexible cystoscopy becomes unresponsive and HR 38 bradycardic. 1st rx

atropine

Guy alcoholic found at home. Which dx is most matched to values. Ph 7.15 cr 150 k 4.4 ck 100 or sutn. Glucose was 5 (so couldn’t be DKA which was also option). Anion gap was 34 so I went for ethylene glycol.

Ethylene glycol Methanol, ethylene glycol (antifreeze) Altered mental status, seizures, dyspnea, anion gap metabolic acidosis (see ethylene glycol poisoning and methanol poisoning) antidote: Fomepizole, ethanol

Guy has COPD, which spirometer value high will be high?

residual volume.

Heart failure pt with past hx of IHD, whats best ix?

ECHO

On ventilation in itu, tidal volume is 0.5L, ABG shows high co2 and ok 02 of like just 10kPa on loads of 02 like inspired fraction was high maybe 50L. What to do?

Increase ventilation rate so blow off co2

V myopic (NB myopia major rf for development of RD) person sudden loss vision curtain in eye

retinal detachment

Someone addisonian. Descrption was electrolytes show low Na, high K, has postural drop in BP of like 20/10, and looks unwell. What is best rx?

100mg hydrocortisone

Another qn 9am cortisol low what's best dx for addisons?

synacthen

Woman is Addisonian, commonest cause in this country?

Autoimmune destruction

Student come back 3 month travel in South Africa travel. 2 weeks painless hematuria. Dipstck showed 3+ myoglobin. Paper 1 qn was likely organism? Paper 2 best ix after Mc+s?

schistosomiasis | Terminal urine microscopy

Guy ready for dc but OT think he needs help cook clean. He wants to go home and says he doesn’t want carers, next step?

Assess capacity,

Guy had UTI and was treated with Abx. At review appointment, cr 430 and k high most likely dx?

trimethoprim

Mrsa rx. You have treated with fluclox and clari, and get sesnitivies which state it is resistant to fluclox, what rx do you switch to post empirical?

teico

Pt is pen allergic, what drug can u give?

Teicoplanin only one. Others were a cephalosporin, meropenem, tasocin and co-amoxiclav

Person has cap and has sugar 8. Checked 6 weeks later 5 fasting and 7 ogtt why was it higher during the CAP?

Stress hyperglycaemia

Old woman with osteoporosis has severe pain trying to lift shopping bag first ix?

Xray

Pt having a GI bleed is peripherally ‘shut down’ and it is decided to cannulate his subclavian vein, what is the most likely complication?

Pneumothorax (or it is brachial plexus injury?)

Woman abpi 0.3 most likely cause?

Peripheral arterial disease

Pt admitted who is alcoholic, given 2 pictures of bad teeth and another of hair follicles with parafollicular haemorrhage, what is the likely deficiency?

scurvy

What to give with tb drugs?

pyrodoxine (vitamin B6, otherwise will be depleted by isoniazid causing peripheral neuropathy)

Description of guy who has carpal tunnel syndrome and changed facial appearance and has had to change wedding rings. Given results of an OGTT and it shows his GH fails to suppress, what is likely cause?

autonomous GH production

Bre 1 year hx ed. has dm and past thyroidectomy what's cause

. Classic qn a patient has low p low ca high alp, dx?

Osteomalacia

95yo lady has fallen and NOF# rx?

hemi

Woman admitted with biliary colic. USS shows CBD dilated but normal LFTs and her pain subsides with morphine. She is reviewed a few weeks later and LFTs normal. Next rx?

lap chole

A 27yo lady has sudden searing RLQ pain. Obs show hypotensive tachycardic. Most likely dx?

Ectopic ruptured sudden onset. Other options ovarian torsion, acute appendicitis

90 yo lady sent to ward after 4 hours in recovery where she had 10mg iv morphine. Now she drowsy and nonresponsive. She currently has a head tilt chin lift by nurse: RR 10, HR BP unremarkable. which or following next best action.

Tube and vent, bag valve mask (

Bre had mixed OD of benzodiazepines and paracetemol 2 hours ago. What next?

flumaz to deal with a problem now.

Metallica valve warfarinised but has taken erythromycin and INR now 9.1, presents with nosebleed. 10mg or 1mg vit k IV?

INR 5.0-8.0 Minor bleeding Stop warfarin Give intravenous vitamin K 1-3mg Restart when INR < 5.0

Guy with MSM unprotected sex other men. Has rash on back dx?

acute HIV

Pt on rchop chemo, why hyperglcaemia?

Predinsolone

Young Pt on chemo, why’d he develop heart failure

Doxorubicin

.Pt from trip abroad and given results which show ida –

hookworm

Pt ra and spleen. Whats most likely blood differential?

Has felty syndrome so neutropaenia

.Pt has colonscopy for left sided sx obv continuous 30cm from rectum up. But granulomas there. Likely cause?

Crohns. -> hallmark of crohns!

Obv description of pt has UC. What is most likely histology?

superficial ulceration

Pt to be discharged. Their previous FBCs from past 3 days show a slowly correcting hyponatraemia, what do u recommend?

Hold fruseomide and see what happens

Pt severe resp infection has na 119 and urinary na 70

vasopressin antag or fluid restricted. o/e euvolemic no crackles jvp ok. Think was trying to see if you could recognised high urinary Na and euvolemia suggest siADH and then know the treatment

Homeless R lower lobe crackles, ‘hacking cough’, yellow suptum. Organism?

?Klebsiella pneumonia

Pic of vf loss right superior quadrantopia which lobe is lesion

Temporal

Rheumatic fever crp 300. Admitted. Whats cause, ie?

Streptococcus pyogenes

Pt has increased dyspnoea, high jvp find end insp crackles and clubbing, dx

IPF

Question about patient on medications for stress incontinence, what is likely cause of their confusion and retention?

Oxybutynin

Woman 4 episodes hemoptysis all tests normal but cxr still shows this rounded peripheral lesion? Dx?

Cancer

Guy married 30 years to same partner but painful right testicle and epidymus on palpation. Wife only sexual partner, organism?

E coli

Metabolic acidosis low bicarb low pc02

met acid and resp compensation

Guy has collapsed in football. Had undescended testis fixed at 4. Given CT chest with so many mets, most likely histology?

Choriocarcinoma Choriocarcinoma: This is a very rare and fast-growing type of testicular cancer in adults. Pure choriocarcinoma is likely to spread rapidly to other parts of the body, including the lungs, bones, and brain. More often, choriocarcinoma cells are seen with other types of non-seminoma cells in a mixed germ cell tumor

30ish man with extreme pain left metatarsophalangeal joint (obviously describe podagra) most important ix?

Aspirate (to rule out spetic arthritis)

Knee locking after heavy landing

medial meniscus tear

Patient with recurrent hypoglycaemia, cause?

insulinoma

Which of following is most specific sign of LVF?

S3 gallop

Description of pt with severe asthma exacerbation, given an ABG with classic feature of a pc02 which is not low. In this case was actually high, like 8. Shows tiring

intubation and ventilation/refer to ITU

.Classic case lateral knee X ray

haemarthoris (ACL rupture)