VSAs December 2019

Question 1

Answer 1

Adrenaline IM - anaphylaxis

PMH of atopic diseases

Question 2

Answer 2

Long lie/rhabdomyyolysis from trauma/rhabdomyolysis crush injury myoglobin

After a fall and being on floor for a long time causes a crush injury which damages muscles so contents get released (inlc K and myoglobin ) –> kidney injury (rhabdomyolysis)

Creatine kinase raised

Myoglobinuria and haematuria cannot be distinguished between on urinalysis

Question 3

Answer 3

Polymorphic ventricular tachycardia - shape of QRS complex varies in amplitude. If the QTC interval is prolonged then this is called “Torsades de points”

The treatment for this is IV magnesium

Question 4

Answer 4

Dx bladder cancer

Flexible cystoscopy

CT KUB would not be first line unless you think the tumour would have invaded other structures.

Question 5

Answer 5

Myaesthenia gravis - antibodies against the ACh receptor. RA is also autoimmune.

Eyelids will naturally droop in a patient after you ask them to look up for a while

Question 6

Answer 6

Dx: Crohn’s/UC/IBD

Ulcers: pyoderma gangrenosum (ulcers commonly on legs)

Question 7

Answer 7

Addison’s disease

Lack of mineralocorticoids (aldosterone, sodium[–>BP not maintained], blood sugar on low side)

Hyperpigmentation - drive to increase ATHD for which the precursor is POMC –> MSH is a part of this

Addisonian crisis - everything would be a bit more extreme but this is still an acceptable answer.

Question 8

Answer 8

Catheterisation

Question 9

Answer 9

ADH

Question 10

Answer 10

erythema multiforme - mycoplasma(pneumoniae) and herpes simplex cause these target shaped rashes

Commonly caused by respiratory tract infections

Question 11

Answer 11

Pyelonephritis/ascending UTI

You wouldn’t accept loin pain and vomiting/nausea with a normal UTI

Question 12

Answer 12

Roth’s spots - but these are not specific to infective endocarditis.

Question 13

Answer 13

TSH/TFTs/Free T4/thyroid profie/TSH3/4

Question 14

Answer 14

Fine crepitations are caused by pulmonary oedema and pulmonary fibrosis/ILD/IPF

Right sided HF/cor pulmonale as a result of ILD

Question 15

Answer 15

Urinary antigen test/legionella antigen/serum antigens

NOT sputum/blood - only cultured if you get enough sputum

Question 16

Answer 16

CT pulmonary angiogram

Hyperexpanded lung fields are

D dimer is not specific enough

Question 17

Answer 17

Respiratory acidosis

Question 18

Answer 18

Rheumatic fever streptococcus viridans

(NOT calcification of the valve)

Question 19

Answer 19

Motor neurone disease -

Both UMN(fasciculations) and LMN(normal sensory exam/downgoing plantars) - this suggests ALS (the type where UMN and LMN are mixed)

Question 20

Answer 20

• Scleroderma
• Systemic scleorosis
• CREST
• Limited systemic sclerosis

NOT raynaud’s because this patient has more than just this.

Question 21

Answer 21

Acute appendicitis

Question 22

A 71 year old woman has severe central chest pain. Her troponin is raised and she is diagnosed with acute MI. Her ECG is as shown. Which artery has been affected?

Answer 22

I, aVL, II, III, IV, V, VI - anterolateral picture

so LAD/left coronary artery

Question 23

Answer 23

MS / demyelinating disease

Question 24

Answer 24

Gilberts syndrome

This is benign hyperalbuminaemia. Not Hep C because patient is feeling well and other LFTs are normal.

Question 25

Answer 25

Direct inguinal hernia

Question 26

Answer 26

Cushing’s/high cortisol

Question 27

Answer 27

C diff

(now changed from clostridium to clostridioides)

Question 28

Answer 28

Charcot’s triad so ASCENDING CHOLANGITIS (bacterial infection near biliary tree)

Obstructive LFTs

Question 29

Answer 29

Marfan’s causing aortic dissection

Question 30

A 65 year old woman has not opened her bowels in 3 days. She now has nausea and vomiting. An abdominal X-Ray is as shown. What is the most common cause of this presentation?

Answer 30

Small bowel obstrction (central and dilated loops)

Most common cause of small bowel obstruction are adhesions