Yr 3 Formative Qs Flashcards
Why wouldn’t you measure serum growth hormone levels for acromegaly?
GH released in pulsatile manner as it has short half life and varies beteween time of day & gender
Insulin stress test- gives hypo and causes a release of stress hormones: should see an increase if working.
Gold standard for testing pituitary
Most common reason for this is post-transphenoidal surgery
Reassurance - transient hyperthyroidism occurs in early pregnancy that will go back to normal
PTU
Describe the dosing differences between initiating hyperthyroidism in pregnant and non-pregnant people [2]
In pregnancy
- start with low dose PTU and titrate up to control T4 levels
In non-pregnant
- start with high dose carbimazole and titrate down
Which thyroid manifestation of hyperthyroidism is a contraindication for radioactive iodine treatment? [1]
Contraindicated if have thyroid eye disease
(so go on anti-thyroid treatment for a year before)
Give IV bisphosphinates
What Ca2+ requires urgent treatment? [1]
> 3.5 mmol
1. Parathyroid adenoma
4. Sarcoidosis
Describe how you work out if high Ca2+ is from primary, secondary or tertiary hyperparathyroidsim [3]
Needle decompression in 2nd IC space
4. Needle aspiration in the triangle of safety
3. Hilar Mass
- Because can cause actelectasis which is what the white mass is
5 Cardiomegaly
- RIPE
L. Upper Zone TB
2. B6
Visual acuity (not fund.)
Pyrazinamide
Vancomycin causes what important AE? [1]
Red man syndrome
2. Kyphoscoliosis
2.
What does this chest x ray show?
Pulmonary fibrosis
Bilateral hilar lymphadenopathy
Widened mediastinum
Cardiomegaly
Pneumothorax
What does this chest x ray show?
Pulmonary fibrosis
Bilateral hilar lymphadenopathy
Widened mediastinum
Cardiomegaly
Pneumothorax
What does this chest x ray show?
Pulmonary fibrosis
Bilateral hilar lymphadenopathy
Widened mediastinum
Cardiomegaly
Pneumothorax
What does this chest x ray show?
Pulmonary fibrosis
Bilateral hilar lymphadenopathy
Widened mediastinum
Cardiomegaly
Pneumothorax
What radiographic abnormality is occuring here? [1]
Thoracic AA
Which are the correctly linked side effects:
A.
Sitagliptin and pancreatitis
B.
Pioglitazone and prostate cancer
C.
Metformin and renal failure
D.
Pioglitazone and Weight loss
E.
Gliclazide and hyperglycaemia
Which are the correctly linked side effects:
A.
Sitagliptin and pancreatitis
B.
Pioglitazone and prostate cancer
C.
Metformin and renal failure
D.
Pioglitazone and Weight loss
E.
Gliclazide and hyperglycaemia
Which of the following endocrine conditions is associated with an increased risk of Type 2 diabetes?
A.
Ectopic ACTH production
B.
Osteoporosis
C.
Hypoparathyroidism
D.
Addison’s disease
E.
Osteomalacia
Which of the following endocrine conditions is associated with an increased risk of Type 2 diabetes?
A.
Ectopic ACTH production
B.
Osteoporosis
C.
Hypoparathyroidism
D.
Addison’s disease
E.
Osteomalacia
A 52 year old man complains of tiredness and nocturia. His blood test shows a glycated haemoglobin of 64 mmol/mol (8.0%) (normal range 30-47 mmol/mol or 4.8 – 6.4%). The next most appropriate step is his management is to:
A.
Repeat glycated haemoglobin
B.
Commence metformin 1000mg twice daily
C.
Refer to a hospital diabetes clinic
D.
Refer to a diabetes education programme
E.
Refer to a podiatrist
A 52 year old man complains of tiredness and nocturia. His blood test shows a glycated haemoglobin of 64 mmol/mol (8.0%) (normal range 30-47 mmol/mol or 4.8 – 6.4%). The next most appropriate step is his management is to:
A.
Repeat glycated haemoglobin
B.
Commence metformin 1000mg twice daily
C.
Refer to a hospital diabetes clinic
D.
Refer to a diabetes education programme
E.
Refer to a podiatrist
A 56 year old man has Type 2 diabetes, hypertension and hypercholesterolaemia. Examination shows evidence of mild background diabetic retinopathy, blood pressure 152/80 mmHg and no neuropathy. Blood tests show a total cholesterol of 4.0 mmol/L (normal range 3.0-5.5 mmol/L), glycated haemoglobin 64 mmol/mol (8.0%) (normal range 30-48 mmol/mol or 4.8 – 6.4%) and albumin creatinine ratio on two occasions 3.7 mg/mmol and 4.9 mg/mmol (normal range < 3.0 mg/mmol). He takes gliclazide 80mg twice daily, metformin 1000mg twice daily, amlodipine 10mg daily, simvastatin 40mg daily. His blood pressure target is:
A.
130/80 mmHg
B.
140/90 mmHg
C.
110/70 mmHg
D.
90/60 mmHg
E.
150/90 mmHg
130/80 mmHg - has diabetic eye complications
A 24 year old white woman with Type 1 diabetes for 12 years complains of a pink discoloration over her left anterior tibia of two months duration. This is likely to be:
A.
Livedo Reticularis
B.
Diabetic dermopathy
C.
Granuloma Annulare
D.
Acanthosis Nigricans
E.
Necrobiosis Lipidoica Diabeticorum
A 24 year old white woman with Type 1 diabetes for 12 years complains of a pink discoloration over her left anterior tibia of two months duration. This is likely to be:
A.
Livedo Reticularis
B.
Diabetic dermopathy
C.
Granuloma Annulare
D.
Acanthosis Nigricans
E.
Necrobiosis Lipidoica Diabeticorum
A 24 year old white woman with Type 1 diabetes for 12 years complains of a one or more skin coloured or red bumps form rings in the skin over joints, particularly the knuckles.. This is likely to be:
A.
Livedo Reticularis
B.
Diabetic dermopathy
C.
Granuloma Annulare
D.
Acanthosis Nigricans
E.
Necrobiosis Lipidoica Diabeticorum
A 24 year old white woman with Type 1 diabetes for 12 years complains of a one or more skin coloured or red bumps form rings in the skin over joints, particularly the knuckles.. This is likely to be:
A.
Livedo Reticularis
B.
Diabetic dermopathy
C.
Granuloma Annulare
D.
Acanthosis Nigricans
E.
Necrobiosis Lipidoica Diabeticorum
A 24 year old white woman with Type 1 diabetes for 12 years complains ofmottled discolouration of the skin. This is likely to be:
A.
Livedo Reticularis
B.
Diabetic dermopathy
C.
Granuloma Annulare
D.
Acanthosis Nigricans
E.
Necrobiosis Lipidoica Diabeticorum
A 24 year old white woman with Type 1 diabetes for 12 years complains ofmottled discolouration of the skin. This is likely to be:
A.
Livedo Reticularis
B.
Diabetic dermopathy
C.
Granuloma Annulare
D.
Acanthosis Nigricans
E.
Necrobiosis Lipidoica Diabeticorum
This image shows
A.
Livedo Reticularis
B.
Diabetic dermopathy
C.
Granuloma Annulare
D.
Acanthosis Nigricans
E.
Necrobiosis Lipidoica Diabeticorum
This image shows
A.
Livedo Reticularis
B.
Diabetic dermopathy
C.
Granuloma Annulare
D.
Acanthosis Nigricans
E.
Necrobiosis Lipidoica Diabeticorum
This image shows
A.
Livedo Reticularis
B.
Diabetic dermopathy
C.
Granuloma Annulare
D.
Acanthosis Nigricans
E.
Necrobiosis Lipidoica Diabeticorum
This image shows
A.
Livedo Reticularis
B.
Diabetic dermopathy
C.
Granuloma Annulare
D.
Acanthosis Nigricans
E.
Necrobiosis Lipidoica Diabeticorum
This image shows
A.
Livedo Reticularis
B.
Diabetic dermopathy
C.
Granuloma Annulare
D.
Acanthosis Nigricans
E.
Necrobiosis Lipidoica Diabeticorum
Diabetic dermopathy
This image shows
A.
Livedo Reticularis
B.
Diabetic dermopathy
C.
Granuloma Annulare
D.
Acanthosis Nigricans
E.
Necrobiosis Lipidoica Diabeticorum
Granuloma Annulare
A 60 year old homeless man has illness X. Because of his circumstances, his
compliance with treatment has been intermittent and, illness x has become
resistant to ciprofloxacin
.
What is the typical mechanism for this resistance?
A. Enzymic destruction of the antibiotic molecule
B. Enzymic modification of the antibiotic molecule, by adding a small chemical group
C. Modification of the bacterial efflux pump
D. Inhibition of DNA replication (DNA gyrase)
E. Modification of the bacterial RNA polymerase, the target of the drug
A 60 year old homeless man has illness X. Because of his circumstances, his
compliance with treatment has been intermittent and, illness x has become
resistant to ciprofloxacin
.
What is the typical mechanism for this resistance?
A. Enzymic destruction of the antibiotic molecule
B. Enzymic modification of the antibiotic molecule, by adding a small chemical group
C. Modification of the bacterial efflux pump
D. Inhibition of DNA replication (DNA gyrase)
E. Modification of the bacterial RNA polymerase, the target of the drug
A 38 year-old woman has tiredness, joint aches
and joint swelling. She is noted to have this
appearance on her skin (see image). Her pulse rate
is 80 bpm and regular and her BP 158/102 mmHg.
Her investigations are shown below:
Urinalysis: Blood ++ Protein ++
Urine microscopy: Red cell casts
Creatinine 143 µmol/L (60–120)
Which other test is most likely to confirm the
diagnosis?
A. anti-nuclear antibodies
B. anti-nuclear cytoplasmic antibodies
C. erythrocyte sedimentation rate
D. gastric parietal antibodies
E. rheumatoid factor
A 38 year-old woman has tiredness, joint aches
and joint swelling. She is noted to have this
appearance on her skin (see image). Her pulse rate
is 80 bpm and regular and her BP 158/102 mmHg.
Her investigations are shown below:
Urinalysis: Blood ++ Protein ++
Urine microscopy: Red cell casts
Creatinine 143 µmol/L (60–120)
Which other test is most likely to confirm the
diagnosis?
A. anti-nuclear antibodies - she has lupus
B. anti-nuclear cytoplasmic antibodies
C. erythrocyte sedimentation rate
D. gastric parietal antibodies
E. rheumatoid factor
Correct Answer: B
This patient is hypovolaemic due to long lie without hydration and the probably sepsis.
The level of CK is compatible with minor soft tissue injury. Rhabdomyolysis would give a CK of >10,000. There is no indicators of glomerulonephritis and the urinalysis
abnormalities are compatible with a catheter sample +/- urosepsis. Renal emboli are
rare and would give loin pain. Ureteric obstruction is unlikely as the patient is still
passing some urine.
Correct Answer: D
Justification for correct answer
The description of the arrhythmias best fits with ectopics (either supraventricular or
ventricular). Supraventricular are probably more common in this age group. There are no
worrying features and the cause is most likely benign.
Correct Answer: B
Justification for correct answer
This is because nuclear enlargement, hyperchromasia and pleomorphism are features
that suggest carcinoma in all sites of the body.
Correct Answer: E
Justification for correct answer
Respiratory acidosis needs to be corrected with ventilation in an alert patient.
Correct Answer: C
Justification for correct answer
Immediate release anticholinergics are the first line treatment for overactive bladder with
urge incontinence in the NICE 2013 guidelines.
Correct Answer: C
Justification for correct answer
The patient has evidence of a paralytic ileus. The initial treatment would involve making patient nil by mouth and inserting a nasogastric tube. Morphine would make the condition worse. There is no indication for antibiotics. An enema would not be appropriate and unlikely to be of benefit. There is no indication for immediate surgery as further
investigations will be required to identify treatable causes.
Correct Answer: E
Justification for correct answer
Description of adequate (if not over) hydration. Needs vasoconstriction.
Correct Answer: B
Justification for correct answer
The picture is of syndrome of inappropriate ADH secretion with hyponatraemia and
inappropriately concentrated urine. ADH stimulates synthesis of aquaporin-2 in the apical membrane of the collecting duct which promotes water absorption. This leads to a dilutional hyponatraemia.
Correct Answer(s): D
Justification for correct answer(s):
- The student should be able to identify the
potential for neutropenic sepsis in a patient who is 8 days post-chemotherapy,
(even though agent is unknown) and must know the importance of prompt
antibiotic administration prior to any other action.
Correct Answer(s): D
Justification for correct answer(s): The student should be able to identify the
potential for neutropenic sepsis in a patient who is 8 days post-chemotherapy,
(even though agent is unknown) and must know the importance of prompt
antibiotic administration prior to any other action.
Correct Answer(s): D
Justification for correct answer(s): The student should be able to identify the
potential for neutropenic sepsis in a patient who is 8 days post-chemotherapy,
(even though agent is unknown) and must know the importance of prompt
antibiotic administration prior to any other action.
Correct Answer(s): B
Justification for correct answer(s): This patient has suffered an iatrogenic
pneumothorax secondary to insertion of a chest drain.
C. Plaque psoriasis
Justification for correct answer(s): The image shows typical well demarcated
red, scaly patches on the back of the patient. This is typical of plaque psoriasis
which is characterised by well demarcated red, scaly patches classically
affecting the extensor surfaces, sacrum and scalp.
Correct Answer(s): D
Justification for correct answer(s): The patient continues to show signs of
hypovolaemia so a pre-renal cause for the oliguria is most likely. ATN usually
takes longer to develop and would need to ensure adequate fluid resuscitation.
Ureteric injury is unlikely and would need to be bilateral to cause AKI. Catheter
blockage would cause anuria. Renal artery occlusion is rare and would cause
loin pain and more severe clinical picture.
Justification for correct answer(s): Chest X-ray shows multiple nodules,
making metastatic cancer most likely.
Correct Answer(s): D
Justification for correct answer(s): Classic presentation of adrenal crisis.
Nearly all patients have a history of lethargy and weight loss. Plasma cortisol
and ACTH should be sent immediately so that definitive treatment can be
initiated. You would not wait for results before starting IV steroids. -
Justification for Unselected: Presentation does not fit with either a PE or
cerebral disease. Hypotension more likely to be due to adrenal insufficiency
than cardiac disease. Urine and plasma osmolality is not required as there is
more likely cause for hyponatraemia.
Correct Answer(s): A
Justification for correct answer
The patient has an unprovoked DVT. Patients should be offered CT scan abdomen and
pelvis to help identify possible malignancy.
Correct Answer(s): E
Justification for correct answer
All patients with mechanical valves require treatment with aspirin and warfarin. Low
molecular weight heparin is used as bridging anti-coagulation but not long-term. There is
no place for novel oral anticoagulants (yet).
Correct Answer(s): A
Justification for correct answer
Cabergoline (a dopamine agonist) is the first-line treatment for a micro- and
macroprolatinomas.
Correct Answer(s): E
Justification for correct answer
i-gels are often used in cardiac arrest situations as they are easier to place than tracheal
tubes. However, only the tracheal tube can seal the trachea off and protect against
aspiration.
Correct Answer(s): B
Correct Answer(s): B
Correct Answer(s): E
Justification for correct answer
This is a non-functional thyroid nodule so needs ultrasound to classify - FNA may then
be indicated.
Correct Answer(s): E
Justification for correct answer
This is likely spurious - and needs repeat.
Correct Answer(s): B
Justification for correct answer
Separate and can get above mass which is cystic is an epididymal cyst (spermatocele)
which is benign and usually asymptomatic and managed conservatively. Although a
hydrocele trans illuminates it would surround the testis.
Correct Answer(s): C
Justification for correct answer
Myasthenic crisis is an acute respiratory failure characterised by forced vital capacity
(FVC) below 1 L, negative inspiratory force (NIF) of 20 cm H2O or less, and the need for
ventilatory support. The use of accessory muscles indicates significant inspiratory
weakness. Weak cough indicates weakness of expiratory muscles. Arterial blood gas
analysis commonly shows hypercapnia before hypoxia. There should be a low threshold
for endotracheal intubation due to rapid deterioration of bulbar and respiratory muscles.
Correct Answer(s): E
Justification for correct answer
Streptococcus is the most common pathogen in leg cellulitis (including in patients with
diabetes).
Correct Answer(s): C
Justification for correct answer
NSAIDs are the first-line treatment for superficial thrombophlebitis (NICE CKS
thrombophlebitis – superficial, May 2017)
Correct Answer(s): E
Justification for correct answer
Fibrocystic disease characteristically causes pain associated with the menstrual cycle. The
fine needle aspiration supports this with no malignant cells seen. A fibroadenoma is a solid
lump. Pain if present would be localised with fat necrosis. Breast abscess would be a more
acute history and again would not be expected to cause bilateral breast pain.
Correct Answer(s): A
Justification for correct answer
Despite gradual improvement this venous ulcer would be best managed with stockings,
which would also help prevent further lesions.
Correct Answer(s): D
Justification for correct answer
Prothrombin complex concentrate is used to reverse warfarin in medical emergencies. It is
quicker to administer than FFP and can reverse anti-coagulation within minutes. FFP also
carries the risk of allergic reactions, transfusion-related lung injury and volume overload.
PCC is therefore considered first-line to reverse warfarin. The other drugs do not reverse
warfarin.
