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Year 4 Key Stuff > Year 4 CAP TEST QUESTIONS FOR PRACTICE (got 69%) > Flashcards

Year 4 CAP TEST QUESTIONS FOR PRACTICE (got 69%) Flashcards

1
Q

Which of the following statements is true for the surgeon’s knot? * The surgeons knot is more secure than the reef knot &may be used in cases with increased tissue tension. * Surgeons knot is faster to do than the square knot * The first part of the surgeons knot and the reef knot are the same * The surgeons knot is made by two half-hitches in opposite directions * The surgeons knot is performed using an instrument tie

A

True - The surgeons knot is more secure than the reef knot &may be used in cases with increased tissue tension. * The surgeons knot provides more friction and reduces the chances of the loosening * As it takes an extra step (a double half hitch), it takes longer than the square knot * The second part of the surgeons and reef knots are the same * The surgeons knot can be performed by either an instrument or hand tie

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2
Q

A 54 year old man presents with cough, fever and right sided chest pain. CXR shows right sided consolidation. Blood cultures are positive. Which is the most likely causative organism? * Profuse gram negative bacilli * Gram positive diplococci * Gram possitive cocci in a ‘grape like’ formation * Gram negative diplococci * Gram positive rods

A

Diagnosis is pneumonia and most likely causative organism is streptococcus pneumonia * Therefore GRAM POSITIVE (DIPLO)COCCI is the correct answer

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3
Q

A 30 year old presents with itchy blisters on extensor surfaces. Immunoflourescence reveals granular IgA at the dermal papilla. What is the most likely diagnosis? * Pemphigus vulgaris * Linear IgA disease * Bullous pemphigoid * Pemphigus foliaceus * Dermatitis herpetiformis

A

Most likely diagnosis is dermatitis herpetiformis (granular depositis of IgA at dermal papillae against tissue transglutaminase) * Pemphigus vulgaris - intracellular IgG (aka chicken wire pattern) * Bullous pemphigoid - linear IgG + complement deposited at basement membrane * Linear IgA disease - linear IgA at basement membrane

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4
Q

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A
  1. C - oral metronidazole * Antibiotic associated colitis usually is due to a C.Difficile infection - treatment with oral metronidazole (severe C.Diff infections require oral vancomycin) 2. G - supportive care 3. J - IV ceftriaxone (or azithromycin) - first line treatment * History of travel to a high risk area, loose stools, fever, rash (probably rose spots rash) - Typhoid aka enteric fever
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5
Q

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A

Correct answer is D - trochanteric bursitis

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6
Q

A term infant aged 4 days (delivered by caesarean section of rmaternal pre-eclampsia) is noted to be jaundiced. He is breast feeding well. Which is the most likely diagnosis? * Breastfeeding jaundice * Physiological jaundice * Jaundice due to haemolysis * Sepsis * Obstructive jaundice

A

B - Physiological jaundice Jaundice at less than 24 hours birth or >14 days is worried to be pathological

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7
Q

6 month old infant is seen by a GP, being unwell with mild fever, cough, reduced oral intake and noisy breathing 2/7. O/E there are signs of mild respiratory distress with O2 sats 98% on air. Auscultation of the chest reveals good air entry bilaterally with widely scattered high pitch bronchi and fine crepitations. Select the MOST APPROPRIATE management option * A - admit, supportive therapy * B - oral steroids * C - oral penicillin * D - nebulised adrenaline * E - nebulised salbutamol

A

Correct answer - A - admit and supportive therapy This is classical presentation of bronchioloitis that is commonly due to respiratory syncitial virus. No specific treatment is needed but admitting the child is indicated for borderline O2 sats with monitoring oral intake

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8
Q

What age does maturity onset diabetes of the young usually present at? Which two mutations are involved?

A

Maturity onset diabetes of the young usually presents before the age of 25 Two mutations that can be involved are * HNF1 alpha gene * the glucokinase enzyme

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9
Q

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A

The patient has maturity onset diabetes of the young (MODY) - strong family history and early age of onset (25) Mutations in glucokinase enzyme can usually be diet controlled * Mutations in HNF1a has a rule of thirds: * 1/3rd diet, 1/3rd sulphonylureas, 1/3rd insulin Correct answer is E - Gliclazide (a sulphonylurea)

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10
Q

An 80-year old woman has incontinence which you suspect is due to detrusor instability. Select the correct statement * Parasympathetic innervation inhibits the detrusor * Parasympathetic innervation stimulates the urethral smooth muscle * Sympathetic innervation inhibits the urethral smooth muscle * Sympathetic innervation acts via beta adrenergic receptors to inhibit the detrusor * Frontal lobes receive afferent stimuli from the detrusor

A

Sympathetic innervation acts via beta adrenergic receptors to inhibit the detrusor - TRUE * Parasympathetic innervation contracts the bladder whilst relaxing the urethral muscle (aiding voiding) * Sympathetic stimulation relaxes the bladder whilst contracting the urethral muscle (inhibits voiding) Afferent stimuli from detrusor are transmitted to brainstem Inhibitory efferent impulses from frontal cortex provide voluntary control of micturition

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11
Q

A 19 year old female presents to genitourinary medicine with a vaginal discharge. She is sexually active with multiple partners. She has a foul smelling discharge and microscopy shows a flagellated protozoa. What is the most likely diagnosis? * Chlamydia trachomatis * Trichomonas vaginalis * Neisseria gonorrhoea * Gardnerella vaginalis * Candida albicans

A

Correct answer - B - Trichomonas vaginalis (parasite causes trichomoniasis) - treat with metronidazole * Chalmydia trachomatis - bacteria (doesnt stain) - treat with azithromcyin or doxycycline * Neisseria gonorrhoea - gram negative diplococci - treat with IM ceftriaxone and oral azithromycin * Gardnerella caginalis - shows clue cells - treat with metronidazole * Candida albicans - thrush (fungi) - antifungal

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12
Q

A 6 month old infant is seen by a GP, being unwell, with mild fever, cough, reduced oral intake and noisy breathing for two days. O/E there are signs of mild respiratory distress with O2 saturation 92% on air. Auscultation of the chest reveals good air entry bilaterally with widely scattered high bronchi and fine creptiations. Select the most appropriate diagnosis * Bronchiolitis * Croup * Pneumonia * Epiglottitis * Laynrgomalacia

A

Bronchiolitis - commonly due to respiratory syncitial virus

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13
Q

Which of the following is correct for early stages of compartment syndrome? * There are no palpable pulses * Intracompartmental pressure is higher than 50mmHG * The limb feels cold * Analgesia and monitoring is the treatment of choice * Pain out of proportion is the most common symptom

A

Pain, paraesthesia, pallor, paralysis and pulsesnesses are symptoms of compartment syndrome with PAIN OUT OF PROPORTION being the most reliable * Loss of pulses, when present, is a very late finding. * Intracompartmental pressure greater than 30mmHg is diagnostic of compartmental syndrome * Treatment of choice is fasciotomies of the involved compartments

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14
Q

Which of the following suggests congenital cardiovascular diseases in a new born infant? * Delay in femoral pulses * Early neonatal jaundice * Polycythaemia * Peripheral cyanosis * Splitting of the second heart sound

A

Delay of femoral pulses - highly suggestive of coarctation of the aorta Other symptoms and signs mentioned are normal findings in new born infants

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15
Q

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A
  1. Patients bradycardia is due to Oculocardiac reflex, also known as Aschner phenomenon; a decrease in pulse rate associated with traction applied to extraocular muscles and/or compression of the eyeball - stop traction and treat with anti-muscarinic acetylcholine antagonist - ATROPINE (Option A)
  2. Patient is haemodynamically stable and therefore does not require urgent DC cardioversion. BBlockers are contrainidcated so give AIODORANE (Option D)
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16
Q

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A

* 1. J - ischaemic bowel - usually more common in elderly arteriopaths (often also in A.fib) - usually presents with left sided abdo pain, fresh PR blood and often diarrhoea - high lactate also

  1. Coeliac disease (DOES NOT CAUSE PR BLOOD) - more common younger age groups - bloating, abdo pain, weight loss and anaemia are common. Itchy rash on elbows is dermatitis herpetiformis

* 3. Inflammatory bowel disease

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17
Q

What goes in each of the following bags - give at least one example * Black bag * Orange bag * Red bag * Yellow bag * Blue bag * Yellow sharps with orange lid * Yellow sharps with blue lid

A

Black bag - paper towels Orange bag - non-sharp clinical waste Red bag - soiled waste Yellow bag - theatre waste Blue bag - confidenital waste Yellow sharps with orange lid - empty sharps (unused needle, empty vaccine vial) Yellow sharps with blue lid - drug vial with residual drug

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18
Q

50 y/o man presented with 2 months of worsening bilateral lower limb weakness. On further questioning he admits to losing weight and difficulty on passing urine. Physical examination revealed bilateral lower motor neuron weakness and decreased reflexes. Blood investigations revealed a raised calcium level. What is the most likely diagnosis? * Motor neuron disease * Spinal cord compression * Cebrovascular event * Multiple sclerosis * Guillain-Barre syndrome

A

Spinal cord compression - could be secondary to a malignany (would explain the weight loss and raised calcium)

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19
Q

A 52 year old man is admitted to the coronary care unit with chest pain. He is immediately managed with aspirin and sublingual GTN. IV access is obtained and bloods are taken. On the 12-lead ECG you notice ST elevation in V2-5. What is the most likely site of infarct. * Anterior * Anteroseptal * Anterolateral * Inferior * Posterior

A

Anterior - V2-5 - CORRECT Anteroseptal - V1-3 Anterolateral - V4-6, I, aVL Inferior - II, III, aVF Posterior - V1,V2 (reciprocal - st depression)

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20
Q

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A
  1. Anti-CCP antibodies (patients with rheumatoid arthritis - polyarthritic red hot swollen small joints) 2. Anti-centromere antibodies - occurs in limited systemic sclerosis (calcinosis, Raynaud’s, esophageal dysmotility, sclerodactyly, and telangiectasia) - may also be pulmonary hypertension
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21
Q

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A
  1. F - Cataracts - elderly, gradual, painless and loss of red reflexes
  2. E - ARMD is loss of central vision due to degenerative damage to the macula. Wet ARMD - sudden and painless with haemorrhage in the macula
  3. B - Acute closed-angle glaucoma - pressure in eye rapidly elevated due to blockage of the drainage of the aqueous fluid - fixed dilated pupil, which is painful and red and sudden Often accompanied by nausea/vomiting and halo lights
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22
Q

State the correct answer for each of the following The percentage of children that will have a height within 2 standard deviations of the mean? The age (in months) at which it is recommended that child height rather than length should be measured?

A

In a normally distributed population

* 68% should be within one SD

* 95% should be within two SD

* 99.7% should be within three SD

Recommended supine length used up to 24 months. At 24 months, use height as child will be able to stand

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23
Q

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A
  1. H - Paraproteins such as M protein and Bence Jones protein can be used in the monitoring of patients with multiple myeloma 2. B - CA-125 is a marker for ovarian cancer - it can be useful in both diagnosis and monitoring of the disease
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24
Q

The recommended intervention for a conscious choking baby is * A - chest thrusts * B - abdominal thrusts * C - Five rescue breaths * D - Airway opening manoevures * E - Chest compressions

A

A - Chest compressions

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25
Q

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A

* 1. D - Group B strep (strep agalactiae) - part of maternal vaginal flora - important cause of neonatal meningitis especially in preterm infants (streptococcus are gram positive cocci in chains)

* 2. F - HSV - Fever, confusion and inflammation of brain - encephalitis most commonly caused by HSV

* 3. G - Listeria monocytogenase (gram positive bacillia) affects the elderly and immunocompromised and neonates (avoid eating potentially contaminated foods in pregnancy-soft cheeses, unpasterusied milk)

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26
Q

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A
  1. G -Wilson’s disease - Unusual feature in eyes is probably Kayser-Flaischer rings - due to an autosomal recessive disorder causing copper accumulation - classically cerebrellar signs (ataxia, tremor), personality changes &peripheral neuropathy 2. H - Huntigton’s Disease - presents in 40s - autosoomal dominant (clue with father dying) - classically chorea and cognitive decline (dementia) 3. J - Lewy Body Dementia - classic signs of dementia, hallucinations, falls and parkonsonism - often fluctuate
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27
Q

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A

* 1. F- Neuroleptic malignant syndrome (NMS) is a life-threatening reaction that can occur in response to neuroleptic or antipsychotic medication - features include muscular rigitidy, pyrexia, autonomic instability (sweaty, tachycardic), delirious & agitated - treat with dopamine agonist eg bromocriptine * 2. A - Parksononism is a common extrapyramidal side effect of anti-psychotics (amisulpride) - rigitiy, pill-rolling termor, bradykinesia, shuffling gait

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28
Q

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A
  1. G - Specialist nurse - best position to help a patient understand their medication and condition once the drug has been prescribed 2. J - Podiatrist 3. A - Health visitor - specialize in education and health promotion by working with children and families
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29
Q

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A
  1. F - Adults with Incapacity Guardianship Order - The power of attonery is not acting in the person’s best interests and therefore the local authority can apply for a guardianship order so they can take over decision making on the person’s behalf 2. A - Mental Health Act section 36 - Emergency Detention Certificate ( allows up to 72 hours detention, does not allow for treatment) 3. For a patient to be given ECT (apart from two life-saving treatments when there is no time to wait for a DMP) , need to apply for a MHA - Certificate of the Designated Medical Practitioner - OPTION D
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30
Q

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A
  1. Polymositis 2. Polymalgia rheumatica
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31
Q

Which area of the brain is affected first in Alzhiemers disease?

A

The nucleus basalis of Meynert is the first area of the brain to be affected by the neuropathology of Alzheimer’s disease

32
Q

A 30 year old man presents to his GP with a painful red eye for a few days. He also complains of right knee pain and stinging sensation on passing urine. Which of the following tests would identify the underlying cause of the symptoms described? * VDRL serology * HIV serology * Swab for culture and sensitivity * Urine for PCR * Urine for culture and sensitivity

A

Urine for PCR - chlamydia is most likely in this case

33
Q

For each description, state the antibody that BEST fits * The most abundant antibody type in the blood * The antibody type that exists as a dimer in breast milk, saliva and tears * The antibody type found in blood as a pentameric molecule

A

The most abundant antibody type in the human blood is IgG The antibody type that exists as a dimer in breast milk, saliva and tears is IgA The antibody type found in blood as a pentameric molecule is IgM

34
Q

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A
  1. Correct answer = A - 1mg * 1ml of 1:1000 adrenaline * = 1g in 1000ml * = 0.001g in 1ml 2. Correct answer = C - 100mg - unsure as to how 3. Correct answer = J - 10g - unsure as to how
35
Q

Which of the following describes a change from one mature cell type to another? * Metaplasia * Dysplasia * Neolasia * Hyperplasia * Hypoplasia

A

Metaplasia - change from one mature cell type to another Dysplasia - non-neoplastic abnormal proliferation Neoplasia - abnormal cell proliferation Hyperplasia - phsyiological increase in cell numbers Hypoplasia - physiological decrease in cell numbers

36
Q

Which of the following symptoms would be most likely to lead you to consider a diagnosis of schizophrenia? * The patient believes that their heart rate has stopped beating and they cannot be saved * The patient believes strongly that they can fly * The patient believes strongly that their thoughts are made available to everyone around them * The patient described hearing voices within their head of their partner saying “You are a waste of time, I will leave you” whilst stressed

A

C - The patient believes strongly that their thoughts are available to everyone around them - first rank symptom of schizophrenia - THOUGHT BROADCASTING

37
Q

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A
  1. I - Droplet precautions are recommended here - Single room, surgical masks for staff 2. J - Bay bed no special precautions required as Legnionella is not transmittable from person to person
38
Q

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A

C - Brief episode of vertigo not associated with hearing loss or tinnitus, usually occurring on turning in bed

39
Q

What is the main mechanism of action of lamotrigine?

A

Blockage of voltage sensitive sodium channels - this reduces the release of glutamate, the main excitatory neurotransmitter (Same mechanism for lamortigine, carbamezapine and phenytoin)

40
Q

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A
  1. C - Iron deficiency anaemia (low ferritin always means iron deficiency)
  2. H - Autoimmune haemolytic anaemia - anaemia and jaundice should make you consider the possibility of haemolysis
  3. J - Myeloma - classic presenting features of myeloma, namely anaemia, bone pain, hyerclacaemia and renal failure (NSAIDs are relatively contraindicated in myeloma as can often precipitate renal failure)
41
Q

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A

D - Urine protein 3.5g/day (normal range up to 30mg/day) Low serum albumin reduces oncotic pressure and can lead to bilateral leg oedema which can occur with significant proteinuria - this can occur in nephoritc syndrome where urinary protein loss is significant

42
Q

Which neurotransmitter is MOST INVOLVED in appetitive and approach systems?

A

Dopamine - function of appetitive and approach systems is to mediate seeking and approach behaviours including pleasure, they involved the ascending dopamine systems, which project to different areas of the brain

43
Q

Which of the following may cause conductive hearing loss? * Menieres disease * Otosclerosis * Occupational loud noise exposure * Vestibular scwhannoma * Genatmicin

A

B - Otosclerosis All the others are causes of sensorineural hearing loss

44
Q

A 56 year old lady on a resp ward was diagnosed with a PE one wee ago and was started on warfarin at the time of diagnosis. She has no other medical history. For the past two weeks she has been taking 4mg warfarin daily and her INR four days ago was 2.2. Her INR has been checked today and is 1.3. Select the ONE MOST APPROPRIATE MANAGEMENT * Increase dose of warfarin to 6mg * Increase dose of warfarin to 6mg and start LMWH * Start LMWH and stop warfarin * Continue 4mg warfarin and start LMWH * Stop warfarin

A

You need to increase the patient’s warfarin to get the INR in range of 2-3 but cover with LMWH until her INR is therapeutic. Correct answer is B - increase dose of warfarin to 6mg and start LMWH

45
Q

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A
  1. Vocal cords are contained within the larynx. The muscles which elevate the larynx are the longitudinal muscles of the larynx - extremely important during swallowing so that the laryngeal inlet is greatly reduced in size - OPTION E 2. J - Internal oblique muscle (skin, fascia, external oblique, internal oblique, transversus abdominus, transversalis fascia, parietal peritoneum) 3. H - Scalenus anterior muscle (scalene tubercle of rib 1)
46
Q

A 72 year old woman has been taking oral digoxin 125 micrograms daily to improve her symptoms of end stage heart failure. From the following options select a common adverse effect that may occur if the digoxin dose is too high * Thromboembolism * Tachycardia * Hypotension * Rash * Blurred vision

A

Blurred vision is a sign of digoxin toxicty - can cause bradycardia, and thrombocytopenia

47
Q

Which of the following is a recognised complication of thyoidectomy? * Hoarseness of voice * Difficulty swallowing * Hypercalcaemia * Elevation in vocal pitch * Tongue swelling

A

A - Hoarseness of voice

48
Q

Rapidly contracting human muscle cells start producing lactic acid. Which statement best explains this finding? * The cells have to convert NADH into NAD+ * Lactic acid acts as a substrate for gluconeogenesis * Lactic acid is oxidised in the Kreb’s cycle * Most cells utulise lactic acid as an energy source * Lactic acid is a normal waste product of aerobic metabolism

A

The cells have to convert NADH into NAD+ - TRUE Lactic acid acts as a substrate for gluconeogenesis - technically correct but does not explain why muscle cells produce it Lactic acid is oxidised in the Kreb’s cycle - FALSE Most cells utulise lactic acid as an energy source - FALSE Lactic acid is a normal waste product of aerobic metabolism - FALSE (only under anaerobic conditions when a cell has to rely entirely on glycolysis for ATP)

49
Q

A 27 y/o man presents to the emergency department stating he has taken an overdose of paracetamol (approximately 16 tablets) 6 hours ago. Blood tests show a paracetamol level of 100mg/l. Select the ONE MOST APPROPRIATE NEXT STEP * Monitor patient and repeat level at 12 hours * Start an acetylcysteine infusion * Determine if the patient is at high or low risk of liver toxicity and treat if high risk * Start an acetylcystein infusion immediately. Dose according to renal function * Check LFTs and if deranged, start acetylcysteine

A

Option B is correct - acetylcystein dose is also calculated using body weight, not renal function

50
Q

A 24y/o female asthmatic becomes increasingly breathless and wheezy and requires her reliever 4 times on most days and on at least 3 nights a week with coughing. She is taking salbutamol. Serial peak flow measurement shows 30% diurnal variability. What regular treatment would you consider? * Treatment with ICS alone * Treatment with ICS + LABA as combination inhaler * Treatment with LABA alone * Treatment with oral theophylline alone * Treatment with oral mucolytic alone

A

Correct answer - A * Start first line anti-inflammatory therapy with ICS and assess response in terms of symptoms, reliever use and peak flow

51
Q

A patient is seen in the neurology clinic, complaining of abnormal head movements and neck pain. He also notes that his head has a tendency to turn left and indeed he finds it uncomfortable to keep his head facing forward. What is the most likely diagnosis? * Blepharospasm * Oromandibular dystonia * Cervical dystonia * Hemifacial spasm * Hemiballismus

A

C - Cervical dystonia aka spasmodic torticollis - typified by turning of the head to one side due to contraction of SCM muscle - a dystonia is a sustained abnormal posture caused by persistent contraction of large trunk or limb muscles * Spasm is uncontrollable contraction of a muscle - blepharospasm is twitch or spasm of the eyelid * Hemiballismus is characterised by uncontrollable flailing of the arms

52
Q

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A
  1. B - Imperforate hymen - typically presents with abdo pain roughly 2 years after starting puberty 2. G - Premature ovarian failure - diagnosed by elevated serum levels of FSH 3. I - Polycystic ovarian syndrome
53
Q

The universal routine neonatal check is designed to pick up * Asplenia * Congenital cataract * Lactose intolerance * Pyloric stenosis * Visual field defects

A

B - congenital cataract

54
Q

Which of these disorders has the highest mortality rate? * Unupolar depression * Bipolar disorder * Anorexia nervosa * Schizoaffective disorder * Bulimia nervosa

A

Anorexia nervosa - disorder has a mortality rate about 18% - half of these are due to suicide and half due to physical complications

55
Q

Which neurotransmitter is most involved in the aversive and defensive systems?

A

Serotonin - function of the aversive and defensive systems is to promote survival in the event of threat

56
Q

Which feature would make you think that it was likely that a 77 year old woman with severe Alzheimer’s disease has a superimposed delirium? * Fluctuating conscious level * Short term memory impairment * Normal sleep pattern * Disorientation in time * Euthymia with reactive affect

A

A - Fluctuating conscious level Short term memory impairment and disorientation in time are consistent with severe dementia Disturbance of the sleep wake cycle and emotional disturbance would be associated with delirium

57
Q

Which sexual transmitted infection reveals gram negative diplococci on gram staining?

A

Neisseria gonorrhoea

58
Q

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A
  1. B - clopidogrel (Morphine/Oyxgen/Nitrogen/Aspirin+P2Y12 inhibitor)
  2. G - Lisinopril
  3. H - Bisoprolol
59
Q

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A

C - Strength and balance training before and after knee replacement will help improve quadriceps muscle bulk and increase stability of the knee Patient should be encouraged to continue their physical activity while awaiting surgery NSAIDs in older people can increase renal risk and GI bleeds

60
Q

The side effects of anti-cholinesterases include * Decreased peristalsis * Bradycardia * Reduced bronchial secretions * Bronchodolation * Urinary retention

A

Anticholinesterases result in increased cholinergic side effects such as bradycardia - B

61
Q

What are the anti-cholinergic side effects?

A

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62
Q

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A
  1. Vasa praevia - cords cross the foetal membranes - presents with severe foetal distress with a relatively small intrapartum bleed following ROM
  2. Placental abruption - retroplacental haemorrhage - in severe bleeding the uterus can become tender, tense and severe foetal distress
63
Q

A 35 year old complains of severe premenstrual pain and dysparenuia caused by known severe endometriosis. Which of the following is the MOST APPROPRIATE treatment? * A - Cyproterone acetate * B - Clomiphene acetate * C - Combined oral contraceptive pill * D - Chorionic gonadotrophin * E - Finasteride

A

Combined oral contraceptive pill is an effective treatment for endometriosis - as is any treatment that reduces menstruation - OPTION C

64
Q

A 34 year old is currently taking the combined oral contraceptive pill for contaceptions. Which of the following drugs is known to reduce the contraceptive efficacy of the drug? * Methyldopa * Phenytoin * Mefanamic acid * Amoxycillin * Codeine

A

Phenytoin reduces contraceptive efficacy as it is a liver enzyme inducer

65
Q

Which of the following is a recognised maternal adaptation to pregnancy? * Blood pressure decreases in second trimester, and returns to pre-pregnancy level by third trimester * Cardiac output decreases by 30-50% from 6 weeks gestational age and then increases back to normal in the last 8 weeks of pregnancy * Erythropoiesis decreases by 25% causing anaemia * GFR rate stays the same through-out pregnancy * Vital capacity increases by 50%

A

Blood pressure decreases in second trimester, and returns to pre-pregnancy level by third trimester - CORRECT * Cardiac output and GFR increase by 30-50%. * Erythropoeisis increases by 25% and haemoglobin is reduced by dilution. * Tidal and minute volume increase, but vital capacity is unchanged.

66
Q

A 60 year old male complains of a six week history of sore throat and hoarse voice. What is the most likely diagnosis? * Tonsilitis * Glandular fever * Peritonsillar abscess * Layngopharyngeal reflux * Epiglottitis

A

Layngopharyngeal reflux - variety of chronic symptoms including hoarseness, sore throat, cough and asthma

67
Q

Regarding the physiological changes with ageing, which statement below is correct? * Serum creatinine within normal range indicates normal renal function * The cardiac output of an 80 year old is less than one fourth that of a 20 year old * Body weight may remain normal despite reduction in muscle mass * Around 50% of bone mass may be lost by the age of 90 in women * Loss of bone mass in men with ageing is not routinely expected

A

C - Body weight may remain normal despite reduction in muscle mass * Muscle mass is a source of creatinine and serum levels may be low despite poor renal function in people with low muscle * Cardiac output of an 80 year old is about half a 20 year old

68
Q

Someone with an IQ of 45 would be described as having which severity of learning disability?

A

IQ 45 = moderate learning disability

Borderline = 70-84

Mild = 50-69 Moderate = 35-49

Severe = 20-34

Profound = <20

69
Q

What is the average age of onset of bipolar disorder? * 16 * 18 * 21 * 27 * 35

A

21 years of age

70
Q

Which investigation should be done prior to initiation of lithium carbonate?

A

Urea and electrolytes -> Lithium can cause renal impairment so it is important to get a baseline measure for comparison

71
Q

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A
  1. F - Mean - arithmetic average of a set of values. Mode is the most frequent value. Median is the middle value in a list of numbers
  2. J - Standard deviation - the degree to which individuals within the sample different from the sample mean
  3. H - Ninetieth Percentile
72
Q

A 6 month old baby girl presents with her mother to the paediatric short stay assessment area. Her mother reports ‘funny breathing’ and a cough for the last 2 days. On examination, you notice subcostal recession and hear widespread wheeze on asucultation. Her big brother has had a runny nose recently. What is the most likely organism? * Rhinovirus * Parainfluenza virus * Streptococcus pneumonia * Respiratory syncital virus * Haemophilus influenza

A

This baby has bronchioloitis -inflammation of the bronchioles - 70% due to RESPIRATORY SYNCITIAL VIRUS - usually occurs under the age of 2 Typicaly wheeze and cough with signs of respiratory distress (subcostal recession)

73
Q

Drainage of the aqueous humour is via: * Ciliary body * Iris * Trabecular meshwork * Choroid * Lens

A

Trabecular meshwork Aqueous humour is produced by the ciliary body. It is drained at the angle of the eye through the trabecular meshwork into the canal of Schlemm

74
Q

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A
  1. A - volvulus - bile colour vomit is abnormal and must always be investigated (midgut malrotation and volvulus are most likely diagnosis) 2. D - Pyloric stensosi - classic projectile vomit and a hungry child - USS reveals thickened pylorus 3. B - Gatro-oesophageal reflux - mild symptoms, unlikely allergy as infant is otherwise well, no history of irritability or excessive crying
75
Q

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A
  1. I - Gastroenteritis 2. B - Cholecystitis 3. Appendicitis
76
Q

72 year old man with advanced Parkinson’s disease presents very unwell with increased shortness of breath, cough, pyrexia and reduced oxygen saturations. He normally requires thickened fluids due to a poor swallow. What is the most likely diagnosis? * Influenza * Aspiration pneumonia * Legionella pneumonia * Upper respiratory tract infection * Infective exacerbation of COPD

A

B - Aspiration pneumonia

77
Q

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A
  1. E - Arterial disease 2. C - Vasculitis - Multiple superficial ulcers, purpura and connective tissue diseases should make you think vasculitis 3. A - Venous insufficiency

Year 4 Key Stuff (22 decks)

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