YSKT compile AS

Question 1

Patient has a fall and fractures hip. Cardiac problems, the fall was due to an MI, how do you manage?

Answer 1

Hemiarthroplasty, Dynamic hip screw, intramedullary device

Question 2

57 year old male trips on pavement falls onto outstretched arm. X ray shows midshaft humeral fracture and osteolytic lesion on head of humerus. Fracture was opened and fixed. How would you describe this?

Answer 2

Pathological fracture due to mets

Question 3

Pelvic X ray of osteoarthritis acetabulum, what do you do?

Answer 3

Total hip replacements

Question 4

Patient has a fall and fractures hip - Extracapsular fracture (non special type). Cardiac problems, the fall was due to an MI, how do you manage?

Answer 4

Dynamic hip screw

Question 5

Patient has a fall and fractures hip - Extracapsular fracture (reverse oblique, transverse or sub trochanteric). Cardiac problems, the fall was due to an MI, how do you manage?

Answer 5

Intramedullary device

Question 6

Age <70 Patient has a fall and fractures hip - Displaced intracapsular fracture. Cardiac problems, the fall was due to an MI, how do you manage?

Answer 6

Internal fixation (if possible), hip arthroplasty if not

Question 7

Osteopenia vs Osteoporosis

Answer 7

Male vs female Age (Younger = penia)

Question 8

Patient has anatomical snuffbox tenderness and bait scaphoid fracture but no obvious signs on x ray. How do you manage?

Answer 8

Cast and return for x ray in 2-3 weeks

Question 9

Parathyroid blood results: Raised calcium Raised PTH Low phosphate High ALP Serum Ca:Cr clearance >0.01

Answer 9

Primary hyperparathyroidism

Question 10

Parathyroid blood results: Low/normal calcium High PTH High phosphate Low Vit D High ALP

Answer 10

Secondary hyperparathyroidism (gland hyperplasia)

Question 11

Parathyroid blood results: Raised calcium Very raised PTH decreased or normal phosphate Normal/low Vit D High ALP

Answer 11

Tertiary hyperparathyroidism

Question 12

Parathyroid blood results: High/normal calcium Normal/low PTH High phosphate Normal Vit D High ALP

Answer 12

Familial hypocalciuric hypercalcemia

Question 13

Jaundice in first 24 hours - cause? Mother is O+ve?

Answer 13

ABO incompatibility

Question 14

Jaundice in first 24 hours - cause? Mediterranean/African Americans/ Middle Eastern Male infant

Answer 14

G6PD deficiency

Question 15

Jaundice in first 24 hours - cause, FH and spherocytic blood film

Answer 15

Spherocytosis

Question 16

Jaundice in first 24 hours - Mother was infected during pregnancy Treat?

Answer 16

Growth restriction Hepatosplenomegaly TTP (Congenital infections) Exchange transfusion

Question 17

Parathyroid blood results: High Calcium Normal/low PTH Low phosphate High ALP

Answer 17

Parathyroid malignancy

Question 18

Child presents with bruising, high lymphocytes

Answer 18

ALL

Question 19

Child presents with bruising, high lymphocytes Reddish purple dots on the ankles and feet (petechia)

Answer 19

Immune Thrombocytic Purpura

Question 20

Child with purpuric rash Bloody diarrhoea and abdo pain Rash on buttocks, legs and feet

Answer 20

Henloch Schonlein purpura

Question 21

Child with purpuric rash + splenomegaly

Answer 21

ALL

Question 22

Back pain with irregular prostate, and urinary symptoms

Answer 22

Prostate cancer

Question 23

Solid mass on liver imaging, diabetes, women taking estrogen-containing oral contraceptive medication - 4cm, vascular?

Answer 23

Hepatic adenoma

Question 24

Alcoholic patient with solid mass on liver imaging - 4cm, vascular?

Answer 24

Hepatocellular carcinoma

Question 25

Cancer patient presents acutely with cord compression?

Answer 25

1) Steroids - Dexamethasone 2) MRI spine and review

Question 26

Round opacification of paediatric XR

Answer 26

Pneumonia

Question 27

Paediatric non accidental injury

Answer 27

Bruising on back Mid-shaft transverse femoral fracture

Question 28

APGAR score 0-3 management?

Answer 28

ABCDE on baby High flow O2 Adrenaline Compressions Monitor glucose

Question 29

Renal artery stenosis imaging?

Answer 29

Angiography

Question 30

How to prevent diabetic nephropathy progression in long term diabetic?

Answer 30

ACE-i to stop progression according to BMJ BP Keep BP below 130/80

Question 31

Patient presents 38 weeks pregnant - bp 140/90 and protein ++ Diagnosis? Management?

Answer 31

Pre-eclampsia Deliver the baby

Question 32

Patient presents 35 weeks pregnant - bp 140/90 Diagnosis? Management?

Answer 32

Gestational hypertension B-blockers - labetalol

Question 33

When to give oxytocin in 3rd stage of labor?

Answer 33

10iu of oxytocin as anterior shoulder of baby is out and then double clamp cord -in delay of clamping cord= higher haematocrit levels in neonates

Question 34

What is the gold standard investigation for endometriosis ?

Answer 34

Laproscopy

Question 35

How do you prevent diabetic proliferative retinopathy?

Answer 35

Laser treatment

Question 36

What is the scoring system ABCD2 used for?

Answer 36

TIA Age: >/= 60 =1 BP: >/= 140/90=1 Clinical features: -unilateral weakenss= 2 -speech impairment without weakenss= 1 Duration: >/= 60min= 2 10-59min: 1 Diabetes= 1

Question 37

What is the management of ABCD2 score >4?

Answer 37

carotid imaging within 24hrs of initial assessment -CT/ MRI

Question 38

What is the management of ABCD2 score 0-3?

Answer 38

Need other indication for hospital observation

Question 39

6wks pregnant woman with light bleeding, HCG 650, and TVU showing no fetus?

Answer 39

miscarriage

Question 40

6wks pregnant woman with light bleeding, HCG 100,000, and TVU showing no fetus, intrauterine mass with small cystic spaces (honeycomb)?

Answer 40

Hyaditiform mole (complete)

Question 41

6wks pregnant woman with vaginal bleeding, shoulder tip pain, abdominal pain, bHCG >1500

Answer 41

Ectopic pregnancy

Question 42

6wks pregnant woman with light bleeding, HCG 100,000, and TVU showing fetal tissue?

Answer 42

Hydatidiform mole (incomplete)

Question 43

What are varicose ulcer signs?

Answer 43

Lipodermatosclerosis, swollen, achy legs, shallow red sore with irregular edges

Question 44

What is the management of aspiration pneumonia in post stroke + swallowing problem patient?

Answer 44

SALT referral Metronidazole

Question 45

BPH + LUTS management?

Answer 45

tamsulosin + finasteride

Question 46

Patient jaundice, fever, RUQ pain?

Answer 46

Ascending cholangitis (Charcot’s triad)

Question 47

What is the ix for 51yr-old woman, 14 months amenorrhoea, hot flushes?

Answer 47

menopause- none

Question 48

What is the ix for 42yr-old woman, 14 months amenorrhoea, hot flushes?

Answer 48

FSH

Question 49

33 year old comes for random test - has +ve RF but no sx?

Answer 49

Doesn’t have RA

Question 50

33 year old comes for random test - has +ve RF, +ve anti-CCP, but no sx

Answer 50

RA

Question 51

33 year old comes for random test - has +ve ANCA, CRP, ESR

Answer 51

Most likely connective tissue disorder

Question 52

SLE with Antiphospholipid syndrome, what do you need to warn them about ?

Answer 52

Miscarriage

Question 53

Patient comes in with fever with new heart murmur? Treatment?

Answer 53

Infective endocarditis Flucloxacillin + Gentamicin

Question 54

What’s Duke criteria used for and what does it consist of?

Answer 54

Infective endocarditis Major: +ve blood culture evidence in ECHO Minor: predisposition (IVDU, previous heart) fever microbiology vascular phenomenon (janeaway lesions, etc)

Question 55

Patient been on sertraline for 18 months, not getting on with it, what is the next management?

Answer 55

Switch to other SSRI (fluoxetine)

Question 56

Patient with migraines, experiencing them 2x a week, stressed with new job - what would you start?

Answer 56

Acute: triptan + NSAID/paracetamol Prophylaxis: propanolol

Question 57

Pt with severe unilateral headache, especially around one eye, lacrimation ?

Answer 57

Cluster headache

Question 58

What is the immediate and prophylaxis management of cluster headache?

Answer 58

Acute: 100% O2 + subcut triptan Prophylaxis: verapamil

Question 59

Patient with Phalen’s sign, thenar wasting, weakness of thumb?

Answer 59

Carpal tunnel

Question 60

Cyclist comes in with hypothenar wasting, tingling of fourth and fifth finger?

Answer 60

Guyon’s canal syndrome; ulnar nerve entrapment

Question 61

Presentation in anorexic patient that requires hospitalisation?

Answer 61

BMI <13 or >1kg/ week amenorrhoea abnormally low potassium abnormally low temperature infection of any kind HR <40bpm

Question 62

Bulimia vs AN?

Answer 62

Bulimia= normal BMI -more impulsive than AN -weight fluctuation -parotid hypertrophy (sialadenosis)

Question 63

What is the presentation of patient with Bipolar that stopped taking medication?

Answer 63

anxiety, mania, headaches, pressured speech, irritability, depression

Question 64

Section 2 Used for? Recommendation? Apply? Duration?

Answer 64

Used for assessment Two Section 12 doctors or One section 12 patient’s GP Apply by nearest relative or AMHP (health professional) 28 days –> Discharged or convert to S3 (Patients can appeal in first 14 days)

Question 65

Section 3 Used for? Recommendation? Apply? Condition? Duration?

Answer 65

Used for treatment Two Section 12 doctors or One section 12 patient’s GP Apply by nearest relative or AMHP (health professional) Appropriate treatment available of condition or protect public Duration is 6 months –> Elongate or discharge (Patients can appeal once every 6 months)

Question 66

Section 4 Recommendation? Apply? Condition? Duration?

Answer 66

Emergency admission by any doctor Apply by nearest relative or AMHP (health professional) Mental disorder Duration 72 hours –> Discharge, convert to S2/3, Elongate (can’t appeal)

Question 67

Section 5(2) Recommendation? Apply? Condition? Duration?

Answer 67

Emergency of detention of information patient Doctor in charge of patient No application Mental disorder Duration 72 hours –> Discharge, convert to S2/3, Elongate (can’t appeal)

Question 68

Section 5(4) Recommendation? Apply? Condition? Duration?

Answer 68

Emergency of detention of information patient Nurse in charge of patient No application Mental disorder Duration 4 hours –> Discharge, convert to S5(2), Elongate (can’t appeal)

Question 69

Section 136 Recommendation? Apply? Condition? Duration?

Answer 69

From public place police powers to remove to place of safety (A&E, police station) someone who appears to be suffering from a mental disorder 72 hrs requested by AMHP and granted by magistrate

Question 70

Section 35

Answer 70

remand for hospital for assessment

Question 71

Section 36

Answer 71

remand to hospital for treatment

Question 72

section 48/49

Answer 72

transfer of a remanded prisoner from prison to hospital

Question 73

section 37

Answer 73

hospital order

Question 74

section 37/41

Answer 74

hospital order with restriction order

Question 75

section 47/49

Answer 75

transfer of a sentenced prisoner to hospital for treatment

Question 76

Section 17a

Answer 76

supervised community treatment -compulsory treatment for community patients -apply to patients under section 3 -last for 6 mths

Question 77

Patient with post op, PE and calf swelling. What is the best IX?

Answer 77

CTPA

Question 78

8 year-old that need emergency appendectomy, comes with patient. Can child consent? If not, who can?

Answer 78

Child cannot consent because Gillick non-competent; grandparents do not have parental decision making Can act on patient’s best interest (Beneficence)

Question 79

2-3 week history of feeling tired/ill, in last few days suddenly urine output drops, haematuria, proteinuria, bp is normal: what is cause?

Answer 79

post-strep glomerulonephritis

Question 80

3 day history of feeling tired/ill, in last few days suddenly urine output drops, proteinuria, bp is normal: what is cause?

Answer 80

membranous

Question 81

What are the symptoms of avoidant PD?

Answer 81

AFRAID Avoids social contact Fears Criticism Restricted lifestlye Apprehensive Inferiority Doesn’t involve unless sure of acceptance

Question 82

What are the symptoms of dependent PD?

Answer 82

SUFFER Subordinate Undemanding Feels hopeless when alone Fears abandonment Encourages others to make decisions Reassurance needed

Question 83

What are Cluster A PD?

Answer 83

paranoid, schizoid, schizotypal

Question 84

What are Cluster B PD?

Answer 84

antisocial, borderline, histrionic, narcissistic

Question 85

What are Cluster C PD?

Answer 85

avoidant, OCD, dependent

Question 86

What are the symptoms of paranoid PD?

Answer 86

SUSPECT Sensitive Unforgiving Suspicious Possessive and jealous Excessive self-importance Conspiracy theories Tenacious sense of rights

Question 87

Squamous cell carcinoma arises from?

Answer 87

Arises from actinic keratosis (pre-cancer)

Question 88

Rx for VZV in pregnant woman?

Answer 88

IVIG immediately

Question 89

Ulnar neuropathy first line Ix/

Answer 89

EMG/NCS

Question 90

What are the developmental milestones for 2.5 yrs old?

Answer 90

use 250 words walk, run, turn doorknob, selfish and self-centered

Question 91

Chinese guy with conductive hearing loss?

Answer 91

nasopharyngeal carcinoma

Question 92

What are the croup ddx?

Answer 92

epiglottis foreign body peritonsilar abscess

Question 93

What is the acute management of mild/moderate asthma?

Answer 93

nebulise salbutamol

Question 94

What is the presentation of opiate/ heroin withdrawal?

Answer 94

sweating, muscle aches, sleep problems, runny nose, irritability -later: dilated pupils, vomiting, diarrhoea, abdo pain, tachy/brady, cramping goose bumps

Question 95

Which feature of CTG implies fetal hypoxia?

Answer 95

late deceleration

Question 96

What are the presentations for acoustic neuroma?

Answer 96

vertigo, unilateral hearing loss, tinnitus, absent corneal reflex, facial palsy MRI of CPA

Question 97

What are the common symptoms peripheral vascular disease in diabetics?

Answer 97

Venous ulcer

Question 98

Patient comes in with ear pain, itch and discharge. Otoscopy shows red, swollen canal. What is the management?

Answer 98

Otitis externa Hydrocortisone Rx: topical antifungal (clotrimazole)

Question 99

DVLA laws for stroke patient?

Answer 99

6months

Question 100

DVLA laws for epilepsy?

Answer 100

12 months since last seizure

Question 101

11yr-old girl with 3mths hx of abdo distention, weightloss, no blood or mucus in stool, mouth ulcers and dermatitis herpetiformis?

Answer 101

Coeliac

Question 102

11yr-old girl with 3mths hx of abdo distention, loose, watery stools after drinking milk?

Answer 102

Lactose intolerance

Question 103

11yr-old girl with 3mths hx of bloody diarrhoea, urgency to defacate, tenesmus?

Answer 103

UC

Question 104

11yr-old girl with 3mths hx of recurrent diarrhoea, abdo pain, delayed puberty, and malnutrition?

Answer 104

Crohn’s

Question 105

Patient comes in with generalised weakness, leg cramps and nausea?

Answer 105

HHS (hyperosmolar hyperglycaemic state)

Question 106

What does endomysial and anti-gliadin indicate?

Answer 106

Coeliacs

Question 107

What are the signs for Parkinson’s disease?

Answer 107

TRAPD Tremor Rigidity Postural instability bradykinesia

Question 108

What are the signs of community acquired pneumonia?

Answer 108

increased vocal fremitus

Question 109

Sudden chest pain Increased JVP SOB Low BP Tachypnea Discomfort relieved by sitting or leaning forward

Answer 109

Cardiac tamponade

Question 110

What are the signs of community acquired pneumonia?

Answer 110

Increased vocal fremitus

Question 111

What are the signs of Hospital acquired pneumonia

Answer 111

Decreased vocal resonance

Question 112

How does gout present in a 60 old year old hypertensive who has had it for 2 years?

Answer 112

Cyclical flares of joint pain, swelling and erythema 12 hours - several days (Predisposed by diuretics)

Question 113

Treatment for glaucoma?

Answer 113

Medical - pilocarpine Surgical - Iridoplasty

Question 114

Treat oligomenorrhoea in patient with BMI 30 with PCOS who desires fertility after advising weight loss?

Answer 114

Metformin

Question 115

Meningitis CSF - Clear Normal pressure Lymphocytes mostly Normal glucose High protein PCR-assay

Answer 115

Viral

Question 116

Meningitis CSF - Cloudy Pressure increase Neutrophils Decreased glucose High protein Gram stain culture

Answer 116

Bacterial

Question 117

Meningitis CSF - Opaque High pressure Mostly neutrophils Decreased glucose High protein Acid fast bacillus stain PCR

Answer 117

TB

Question 118

Meningitis CSF - Clear High pressure High lymphocytes Decreased glucose Moderately high protein India ink stain

Answer 118

Cryptococcal

Question 119

MS patient on low dose baclofen, not experiencing side effects. How would you treat her pain?

Answer 119

Increase baclofen

Question 120

Bilateral conjunctivitis + itchy eyes

Answer 120

Topical antihistamines

Question 121

Patient is delirious with diagnosis 80. Squamous cell lung cancer with liver mets diagnosed?

Answer 121

Hepatic encephalopathy

Question 122

Patient in Ventricular Tachycardia arrests?

Answer 122

DC cardiovert Stable – pharmacological cardioversion with Amiodarone, Lidocaine, Procainamide

Question 123

Patient has fit, seen to have jerking movements, loses continence and bites tongue - what is it?

Answer 123

Generalised tonic clonic seizure

Question 124

Endometrial cancer, what type of cancer is it?

Answer 124

Adenocarcinoma

Question 125

Patient with weight loss, dysphagia and occult blood - next investigation?

Answer 125

Upper OGD

Question 126

Dyskaryosis

Answer 126

Multi nucleation Increased cytoplasm:nucleic ratio

Question 127

Patient presents, after vomiting for past few days, with a little bleed - cause?

Answer 127

Mallory Weis tear

Question 128

Dyskaryosis

Answer 128

Multi nucleation Increased cytoplasm:nucleic ratio Irregular chromatin distribution Hyperchromasia

Question 129

Hep B Immune marker to indicate Hepatitis division/multiplying

Answer 129

HbsAg

Question 130

COPD on Salbutamol and comes into clinic, breathless, FEV <40% (acute) - management?

Answer 130

Salbutomal and Ipratropium Nebulised and Prednisolone

Question 131

COPD on Salbutamol and comes into clinic, breathless, FEV <40% (chronic) - management?

Answer 131

Oral pred ICS

Question 132

Psoriasis question, gentleman doesn’t want to take anything oral, which of options has good evidence?

Answer 132

Topical corticosteroid

Question 133

Baby with asymmetrical gluteal creases, what investigation do you do?

Answer 133

Ultrasound Developmental dysplasia of the hip

Question 134

Baby with asymmetrical gluteal creases, what investigation do you do?

Answer 134

Ultrasound and then hip XR Developmental dysplasia of the hip

Question 135

Psoriasis question, gentleman doesn’t want to take anything oral, which of options has good evidence?

Answer 135

Topical corticosteroid (mild) Phototherapy (moderate to severe)

Question 136

Patient had depression, had core symptoms + extras - 6 in total - Management?

Answer 136

Antidepressant (Sertraline) + CBT

Question 137

Girl with primary nocturnal enuresis - First line management?

Answer 137

Behavioural

Question 138

Progressive hip pain (over weeks), Limp, stiffness and reduced range of movement in 7 year old, trendelenburg +ve - Diagnosis?

Answer 138

Perthes disease

Question 139

What symptom most likely to be found in meningococcal septicaemia?

Answer 139

Non-blanching rash

Question 140

Patient post stroke, has IT job and 5th floor flat with lift. Has quite a few problems. - what would you do?

Answer 140

Full OT assessment and home visit before discharge

Question 141

Patient wanted contraception. When is it advised to start?

Answer 141

First day of period

Question 142

Melanoma - key factor for prognosis?

Answer 142

Thickness (depth)

Question 143

Patient with hx of macular degeneration was agitated and delirious but was not a threat to anyone - how would you manage?

Answer 143

Reassurance patients Reduce noise and distraction (Side room)

Question 144

XR of colles fracture

Answer 144

Horizontal across radius

Question 145

Imaging ACL tear

Answer 145

MRI

Question 146

Patient with osteoarthritis - mild sx and managed with analgesia. How would you manage?

Answer 146

Physiotherapy

Question 147

Open fracture of tibia - how do you manage?

Answer 147

Abx & dress

Question 148

MS relapse management ?

Answer 148

IV methylprednisolone

Question 149

Woman BMI>40 and previous macrosomic baby - when do you test for GDM in pregnancy?

Answer 149

28 weeks

Question 150

Epistaxis management after pressure attempted, what next?

Answer 150

Packing (children/not well tolerated) Cauterise sphenopalatine

Question 151

Acne treatment causing blue patch?

Answer 151

Minocycline

Question 152

CT show calcification in alcoholic patient?

Answer 152

Chronic pancreatitis

Question 153

Teenager RTA with bruising on the chest and hypovolaemia. Resp exam is ok - first step?

Answer 153

Cannula Bloods - FBC, U&Es, crossmatch, clotting Fluid resus

Question 154

Child with red rash on Flexor aspects of elbows and on wrist

Answer 154

Atopic eczema

Question 155

NSTEMI with normal troponin

Answer 155

Unstable angina

Question 156

2 week of haematuria post URTI

Answer 156

Post Strep Glomerulonephritis

Question 157

Peripheral artery disease management

Answer 157

Quit smoking Atorvastatin Clopidogrel Endovascular revascularisation

Question 158

ADHD - what would aid in the diagnosis?

Answer 158

Report from the teacher

Question 159

Most common cause pyelonephritis

Answer 159

E.Coli

Question 160

Painful eye movements, Swollen fingers + eosophageal

Answer 160

Myasthenia gravis

Question 161

Contraception for adolescents

Answer 161

Gillick competencies Under 16s having sex call police Recommend the use of condoms both as a contraceptive, and to prevent sexually transmitted infections (STIs).

Question 162

Cause of Intermenstrual bleeding in woman with COCP

Answer 162

Missed COCP pill Alternative remedies taken Clotting drugs Tamoxifen Cervical pathology, vaginal or uterine causes Smear tests

Question 163

Everything normal pretty much and endometrial tissue is 5mm in woman with bleeding

Answer 163

Dysfunctional uterine bleeding

Question 164

Rheumatoid arthritis lung changes

Answer 164

Both restrictive and obstructive (fibrosis)

Question 165

Endometriosis symptom most indicative

Answer 165

Deep dyspareunia

Question 166

Most common cause of Pelvic Inflammatory Disease

Answer 166

Chlamydia Gonorrhoea

Question 167

What to do before inducing labor

Answer 167

Cervical sweep

Question 168

Haematuria 1 year ago, then painless haematuria

Answer 168

Renal cell carcinoma

Question 169

Painless jaundice ddx

Answer 169

Pancreatic cancer

Question 170

Necrotizing enterocolitis biggest risk factor

Answer 170

Preterm

Question 171

Commonest cause of preterm babies

Answer 171

Pregnancy with multiple babies Hx of preterm labour/birth Infection Diabetes/HTN

Question 172

Subfertility, cycles 35-48 days, causes of why she can’t get pregnant?

Answer 172

Smoking

Question 173

Kid wanted to sleep but couldn’t due to rash

Answer 173

Eczema (itching at night)

Question 174

Wife has manic symptoms on a background of depression, currently on SSRI, what do you do?

Answer 174

Bipolar Stop SSRI, swap to Lithium

Question 175

Management of PTSD

Answer 175

Watchful waiting for mild symptoms Trauma focussed CBT Severe - Eye movement desensitisation and reprocessing (Paroxetine if drugs being used)

Question 176

Management of OCD

Answer 176

CBT SSRI

Question 177

Diagnosis of asthma

Answer 177

Reversibility

Question 178

18m old child, can’t walk, crawls. Alert to strangers - where is delay?

Answer 178

Gross motor delay

Question 179

Fraser guidlines

Answer 179

1. He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment 2. He/she cannot be persuaded to tell her parents or to allow the doctor to tell them 3. He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment 4. His/her physical or mental health is likely to suffer unless he/she received the advice or treatment 5. The advice or treatment is in the young person’s best interests.

Question 180

What is the most common injury with anterior dislocation of shoulder?

Answer 180

Axillary nerve and artery 95% Presentation in examination: humeral head visible, flattened deltoid

Question 181

What are the causes of anterior shoulder dislocation?

Answer 181

falling in outstretched arm

Question 182

RTA patient with open book fracture pelvis, scaphoid fracture. stable but absent bowel sounds?

Answer 182

ABCDE and then CT TAP Internal fixation

Question 183

Management for Open comminuted fracture of tibia?

Answer 183

wash out in theatre and give abx immobilise, IV ABx, tetanus vaccine (everyone gets, if not fully immunised–> 3 vaccines and 2 boosters 10 years apart), debride and lavage, fixation if indicated

Question 184

Management of Cervical spine fracture, developed neurological symptoms?

Answer 184

immobilise + analgesia and immediate neurosurgical referral + IV methlyprednisolone

Question 185

Management of Cervical spine fracture with pain?

Answer 185

NSAID and Follow Up can add temporary opioid

Question 186

Sensory lost on medial 1 and a half finger, where is the lesion?

Answer 186

cubital tunnel syndrome

Question 187

Pronounced claw hand and motor symptoms, normal back of hand sensation?

Answer 187

guyon’s canal syndrome

Question 188

Man, smoker, alcohol drinker, lost weight. Picture of a lesion at the back of the throat?

Answer 188

Squamous cell

Question 189

Numbness half face, post nasal drip and other signs, when is the investigation is most appropriate: Nasal endoscopy? CT? MRI?

Answer 189

Considering CSF leakage OR cancer CT Scan is good for identifying breaks in bones/skull or if cancer has spread to bone. MRI is better to see the type and size of the cancer

Question 190

Sensorineural hearing loss (unilateral), tinnitus, headache, CN palsies (trigeminal/facial/vestibulocochlear nerve), vertigo (late sign), signs of raised ICP Diagnosis? Investigation?

Answer 190

Acoustic neuroma (vestibuloschwannoma) MRI brain - gadollinium enhanced

Question 191

Complications of cataract surgery?

Answer 191

Posterior capsule opacity (PCO) Intraocular lens dislocation. Eye inflammation. Light sensitivity. Photopsia (perceived flashes of light) Macular edema (swelling of the central retina) Ptosis (droopy eyelid) Ocular hypertension (elevated eye pressure)

Question 192

Diabetic proliferative retinopathy and macular oedema in one eye. How best to manage?

Answer 192

Anti-vegf injection +/- panretinal photocoagulation (if significant then photocoag first then, intravitreol anti vegf, macular laser)

Question 193

Patient has anterior uveitis. What medication is contraindicated?

Answer 193

Pilocarpine - irritates ocular surface

Question 194

Patient with renal transplant, lesion on lip - diagnosis?

Answer 194

Immunosuppression due to the transplant -> increased risk of SCC.

Question 195

Prodromal fever and malaise. Lesions start on the head, then spread to trunk and peripheries. Lesions as papules → Vesicles → Pustules → Crusting Diagnosis? Treatment?

Answer 195

Analgesia and go home

Question 196

Occasional barking cough and no audible stridor at rest. No or mild suprasternal and/or intercostal recession. The child is happy and is prepared to eat, drink, and play.

Answer 196

Mild croup

Question 197

Frequent barking cough and easily audible stridor at rest. Suprasternal and sternal wall retraction at rest. No or little distress or agitation. The child can be placated and is interested in its surroundings

Answer 197

Moderate croup

Question 198

Management of croup

Answer 198

Single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity - prednisolone is an alternative if dexamethasone is not available - Advise paracetemol or ibuprofen for fever/pain Emergency treatment ● high-flow oxygen ● nebulised adrenaline

Question 199

Frequent barking cough with prominent inspiratory (and occasionally, expiratory) stridor at rest. Marked sternal wall retractions. Significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia). Tachycardia occurs with more severe obstructive symptoms and hypoxaemia.

Answer 199

Severe croup

Question 200

Acute asthma, already on salbumatol nebs and steroid, no improvement, what do you give next?

Answer 200

1. Oxygen (if <94%) 2. Salbutamol - also consider IV 3. Ipratropium bromide 4. Oral steroids = prednisolone 3-5 days 5. Aminophylline/theophylline (OSHIMT) Magnesium sulphate IV is an adjuvent that can be given if no response after step 4.

Question 201

Asthma not well controlled, told about a wheeze and other signs. What would you like to know next?

Answer 201

Peak flow

Question 202

Downs, healthy at birth no cardiac signs. Parents have been told of complications. What do you do next?

Answer 202

Echo

Question 203

Down syndrome with failure to thrive

Answer 203

Coeliac disease

Question 204

Down syndrome conditions risk

Answer 204

• An abdominal x-ray is indicated in infants with DS, as they may be born with a GI defect such as duodenal or anal stenosis, or duodenal or anal atresia (30%). - Hearing screen and thyroid tests are required in all newborns in general. - Vision should be examined in the newborn period because some infants with DS are born with ophthalmic problems. - Haemoglobin for anemia - Dental due to caries - Obstructive sleep apnea

Question 205

Malaysian girl, persistent jaundice (>2 weeks), yellow/brown urine, pale stools, hepatosplenomegaly after 3rd/4th week. High conjugate bilirubin Diagnosis?

Answer 205

Biliary atresia (rare) → absence of bile ducts. (Immediate Kasai procedure hepatoportoenterostomy → Drain bile) Ddx - neonatal hepatitis

Question 206

Causes of prolonged jaundice in newborns

Answer 206

Biliary atresia Hyperthyroid Galactossemia UTI Breast milk jaundice (unconjugated bilirubin) CMV/Toxoplasmosis

Question 207

Has had 2 vasoocclusive crises in a Sickle Cell Disease patient. Also takes penicillin, spleen enlargement with abdo pain + circulatory collapse. What treatment is best?

Answer 207

Splenectomy

Question 208

Patient has vasoocclusive crisis in a SCD patient. Also takes penicillin, 1cm palpable spleen. What treatment is best?

Answer 208

Hydroxyurea (prevent future crisis) Acutely - NSAIDs, antihistamine

Question 209

Child misbehaving at home, but fine at school. What meds will help?

Answer 209

Nothing ADHD is worse in school

Question 210

Newborn sob, grunting, 6 hours after birth. Normal delivery, was fine before. What is likely cause?

Answer 210

Acute respiratory distress syndrome

Question 211

Menorrhagia treatment - 1st line? 2nd line?

Answer 211

1st line: Mirena Coil (IUS) 2nd line: Tranexamic Acid (or if want kid)

Question 212

41 week gestation, unremarkable pregnancy, 2cm dilated, station 0, cervix position anterior, soft consistency, almost fully effaced. What do you do?

Answer 212

Membrane sweep Intravaginal prostaglandins Breaking of waters (amniotomy with amnihook) Oxytocin

Question 213

41 week gestation, unremarkable pregnancy, 2cm dilated, station 0, cervix position anterior, soft consistency, almost fully effaced. What do you do?

Answer 213

Membrane sweep Intravaginal prostaglandins If doesn’t work: Do CTG monitoring Breaking of waters (amniotomy with amnihook) Oxytocin

Question 214

What is Bishop score used for and what does each mean?

Answer 214

Assess the necessity of induction in prolonged pregnancy (>12days after EDD or 41 (+3)) <5= induction 5-9= ARM >9= spontaneous labour Call PEDS C: consistent P: position E: effacement D: dilatation S: station

Question 215

Indications for induction of labour?

Answer 215

-prolonged pregnancy (>12 days EDD) -prelabour premature rupture of the membranes without labour starting -DM mother >38weeks -Rh incompatibility

Question 216

What are CI for induction of labour?

Answer 216

-acute fetal compromise -abnormal lie -placenta praevia -pelvic mass/deformity -cephalopelvic disproportion

Question 217

What medication for induction of dead fetus?

Answer 217

Misoprostal

Question 218

Lady positive pregnancy test (7weeks) , LIF pain and bleeding, what is most appropriate investigation?

Answer 218

TVUS

Question 219

Lady positive pregnancy test (<5 weeks) , LIF pain and bleeding, what is most appropriate investigation?

Answer 219

quantitative serial b-HCG

Question 220

Patient has pcos. What investigative ratio is most suggestive of diagnosis?

Answer 220

testosterone/ SHBG –> baseline test for evaluation of hyperandrogenism

Question 221

What is the best ix to rule out causes of oligomenorrhoea/ amenorrhoea in PCOS?

Answer 221

LH/FSH ratio

Question 222

Risk factors for gestational diabetes screening?

Answer 222

BMI >30 previous macrosomic baby previous GDM 1st degree relative with DM ethnicity of high DM prevalence (South Asia, black carribean, middle eastern)

Question 223

Treatment for pregnancy induced HTN?

Answer 223

labetalol Methyldopa for asthmatic

Question 224

What week gestation for GDM screening?

Answer 224

booking appointment (8-10wk) and 24-8 weeks

Question 225

Secondary PPh, what initial investigation will show retained placenta?

Answer 225

TVUS–> will show endometrial thickness >10mm

Question 226

Lady has progressive weakness, subdued deep tendon reflexes and normal tone, had URTI a week ago?

Answer 226

Guillain-Barre syndrome

Question 227

What is the management of Guillain-Barre syndrome?

Answer 227

IVIg or plasma exchange

Question 228

35 yr-old female with eye pain and vision problems, numbness and pain on limbs, headache and coordination problems?

Answer 228

Multiple Sclerosis

Question 229

What is the management for MS relapse?

Answer 229

IV methylprednisolone 3 days

Question 230

What is the management for relapsing-remitting MS?

Answer 230

beta interferon (glatiramer, teriflunomide)

Question 231

Lady has self harm, fight with boyfriend, history of child abuse. How do you treat?

Answer 231

DBT

Question 232

Pregnant women with Mania and presenting to A&E?

Answer 232

Olanzapine IM Stop depression

Question 233

Guy arrested carrying knives, said paert of religious beliefs. Is ‘aloof’, what is likely diagnosis?

Answer 233

Schizotypal

Question 234

Schizotypal characteristics

Answer 234

●Indifference to praise and criticism ●Preference for solitary activities ●Lack of interest in sexual interactions ●Lack of desire for companionship ●Emotional coldness ●Few interests ●Few friends or confidants other than family

Question 235

Schizoid characteristics

Answer 235

●Ideas of reference (differ from delusions in that some insight is retained) ●Odd beliefs and magical thinking ●Unusual perceptual disturbances ●Paranoid ideation and suspiciousness ●Odd, eccentric behaviour ●Lack of close friends other than family members ●Inappropriate affect ●Odd speech without being incoherent

Question 236

Lady is mad depressed, feels dead inside, her organs are rotting. What do you give?

Answer 236

Cotard syndrome fluoxetine + olanzapine

Question 237

62, increasingly withdrawn, few words used, finding it difficult to name things. Mmse 28/30. What was likely cause?

Answer 237

Primary progressive aphasia the language capabilities slowly and progressively become impaired. (Caused by alzheimers)

Question 238

Which following features would suggest Lewy body dementia?

Answer 238

In LWB, get visual hallucinations, parkinsonism and fluctuating cognition. Do a DaTSCAN

Question 239

Schizophrenic guy, police bring in under 136

Answer 239

MHA assessment and admit

Question 240

COPD, on salbutamol and ipratropium. FEV1 was 40%. What do start?

Answer 240

LABA + ICS combination inhaler (Seretide - salmeterol + fluticasone

Question 241

Man has Pancoast tumour, miosis, ptosis, clubbing, chest pain. What sign indicates extra-thoracic growth?

Answer 241

Thoracic outlet syndrome causes pain, in horner’s shouldn’t normally have pain. Pain characteristically is around the shoulder/scapula, but can also move to arm/hand if brachial plexus is affected.

Question 242

Crohn’s - Drugs used to induce remission?

Answer 242

1st line: Steroids (use mesalazine if can’t use steroids) Adjunct: Azathioprine/mercaptopurine

Question 243

Crohn’s - Drugs used to maintain remission?

Answer 243

• Azathioprine (1st line) - Methotrexate (2nd line)

Question 244

UC - Drugs used to induce remission?

Answer 244

1st line: Aminosalycate (Mesalazine) 2nd line: Steroids (pred)

Question 245

UC - Drugs used to maintain remission?

Answer 245

1st line: oral Aminosalicyates – Mesalazine 2nd line: Azothioprine / Mercaptopurine

Question 246

Young lady with polydipsia and urea. Had DKA – which fluids do you give?

Answer 246

0.9% NaCl 1L – over 1st hour, 0.9% NaCl 1L – over next 2 hours, etc

Question 247

DKA – once patient has been put on saline, what else do you give?

Answer 247

(Potassium if <3.5 then add potassium chloride to NaCl) Insulin

Question 248

Man with nocturnal back pain, high ESR. Obvious myeloma – what do you do next?

Answer 248

1st Ix: Serum/Urine electrophoresis - to identify paraprotein / light chain urinary excretion Confirm with BM aspirate Imaging (in order of preference) - MRI, CT, skeletal survey (X-Rays)

Question 249

Patient with Graves – Whats the treatment? Side effects?

Answer 249

Carbimazole SE: Rashes, pruiritus. Serious SE: Agranulocytosis

Question 250

DM Type 1 nephropathy – patient has high hba1c and high protein in urine. What do you do?

Answer 250

Increase insulin

Question 251

Mitral valve replacement and low arterial BP, distended neck veins, muffled heart sounds. Next step?

Answer 251

(Beck’s triad) Refer to CT surgeon immediately for pericardiocentesis.

Question 252

Infective endocarditis antibiotics: Non prosthetic? Prosthetic? MRSA? Staph Aureus?

Answer 252

Non prosthetic: Amoxicillin + Gentamicin (>1wk) [<1wk is flucox and gentamicin] Prosthetic: Vancomycin, Rifampicin + Gentamicin MRSA: Vancomycin + Gentamicin

Question 253

Hospital acquired pneumonia: Most common causes - Gram stain?

Answer 253

Pseudomonas aeruginosa primarily … gram -ve bacilli Staph aureus … gram +ve cocci also common cause of HAP

Question 254

Hospital acquired pneumonia: Treatment before MC&S in mind and severe?

Answer 254

If mild – Doxycycline PO + Metronidazole PO If severe or can’t take oral – Benzylpenicillin IV + gentamycin IV

Question 255

Patient with RUQ pain, hepatomegaly, jaundice, distension/ascites, early satiety, weight loss/cachexia, hepatic encephalopathy –which biochemical marker do you use?

Answer 255

HCC Alpha fetoprotein

Question 256

Treatment of IgA nephropathy - Whats the other name for it?

Answer 256

Berger’s disease Most common GN Management: 1.Conservative if mild 2.Supportive therapy – ACE-I to control BP (<140/90) 3.If risk of high progression (persisting proteinuria + preserved renal function) – Prednisolone 4.If RPGN/AKI involved – Immunosuppression -> Prednisolone + Azathioprine

Question 257

Lady with recurrent UTI and scarring. Reflux nephropathy - chronic pyelonephritis + vesico-ureteric reflux: Presentation? Investigations?

Answer 257

Dysuria Frequency Pyrexia Urinary incontinence at night 1.MCUG: contrast is used to see the reflux of urine during voiding 2.IVU: show scarring with thin cortex overlying a distorted calyx. Clubbing of calyx: normal cupping of calyx is reversed. 3.DMSA scan: show renal scarring due to reflux.

Question 258

XRay of rheumatoid

Answer 258

Early x-ray findings ● loss of joint space ● juxta-articular osteoporosis ● soft-tissue swelling Late x-ray findings ● Periarticular erosions ● Subluxation

Question 259

Pt with frank haematuria. He had this before and took Abx and it went away. But now it has returned. Smokes 30 ciggs a day since he was born. Bladder cancer, UTI

Answer 259

UTI (Be aware Penicillin can cause haematuria)

Question 260

Patient with raynauds and anticentromere - Diagnosis?

Answer 260

Limited cutaneous systemic sclerosis Scleroderma affects face and distal limbs predominately – hardening of the connective tissue.

Question 261

CREST syndrome What does it stand for?

Answer 261

Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia

Question 262

Scleroderma affects trunk and proximal limbs predominately Associated with scl-70 antibodies Hypertension, lung fibrosis and renal involvement seen

Answer 262

Diffuse cutaneous systemic sclerosis

Question 263

Patient with rheumatoid + steroid use and methotrexate with swollen elbow for past 1 week. She felt hot (but didn’t tell us there was fever) - Ddx? Microscopy?

Answer 263

Gout, Septic arthritis (but its not cause 1 wk hx) Long needle-shaped crystals which are negatively birefringent under polarised light.

Question 264

Short term management of Gout

Answer 264

1. NSAIDs- diclofenac or indomethacin 50mg/8h for up to 8 days (strong NSAIDs) 2. Colchicine 0.5mg/6h until pain resolves. Also use if NSAIDs are contraindicated

Question 265

Long term management of Gout

Answer 265

Long term therapy – Allopurinol. Do not start within 1 month of an attack, and NSAIDs/ Colchicine given for 4 weeks before and after starting allopurinol. 2nd line is Probenecid.

Question 266

Neuro rehab: purpose of rehab

Answer 266

Re-learn lost functionality Reduce symptoms and improve the wellbeing of people with diseases

Question 267

Patient has really high BP, low platelets and a bruise after an injection. Which of these is a relative contraindication to heparin?

Answer 267

Elderly Low platelets / thrombocytopenia are absolute CI to heparin, recent cerebral haemorrhage, severe hypertension; peptic ulcer; after major trauma or recent surgery to eye or nervous system; acute bacterial endocarditis

Question 268

Paediatric epilepsy - protocol for status epilepticus

Answer 268

Time 0 mins (1st step) - Seizure starts Check ABC, high flow O2 if available Check blood glucose 5 mins (2nd step) - Midazolam 0.5 mg/kg buccally Or Lorazepam 0.1 mg/kg if intravenous access established 15 mins (3rd step) Lorazepam 0.1 mg/kg intravenously 25 mins (4th step) Phenytoin 20 mg/kg by intravenous infusion over 20 mins or (if on regular phenytoin) Phenobarbital 20 mg/kg (if known heart block or already on phenytoin)intravenously over 5 mins 45 mins (5th step) Rapid sequence induction of anaesthesia using thiopental sodium 4 mg/kg intravenously

Question 269

Venous leg ulcer management

Answer 269

Compression bandaging (4 layer), moisturiser, oral pentoxifylline (reduces platelet aggregation and inflammation)

Question 270

When do you give anti-D to non-sensitised Rh-ve mothers? When would you give ASAP?

Answer 270

28 and 34 weeks ● delivery of a Rh +ve infant, whether live or stillborn ● any termination of pregnancy ● miscarriage if gestation is > 12 weeks ● ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required) ● external cephalic version ● antepartum haemorrhage ● amniocentesis, chorionic villus sampling, fetal blood sampling

Question 271

6 week child with congenital dysplasia -

Answer 271

Most unstable hips spontaneously stabilise by 3-6 weeks Pavlik harness – if child <5 months If older than – surgery

Question 272

How does the COCP protect against PID?

Answer 272

Thickens cervical mucus – making it difficult for both sperm and bacteria to enter.

Question 273

Pt with rh arthritis, on methotrexate with 6 month hx of SOB. Both fev1 and FVC reduced with ratio @ 86%. Diagnosis? Cause?

Answer 273

Pulmonary fibrosis Methotrexate

Question 274

Patient with painful ankle and negatively birifringent crystals – what is dx?

Answer 274

Gout

Question 275

80 year old patient with hip fracture and normal bloods (pretty much). What management (if needed) should you initiate for osteoporosis? Treatment?

Answer 275

Assess risk by FRAX Oral alendronate (biphosphonate) All patients starting steroids for >3 months should have an osteoporosis assessment *All patients age >65 starting steroids should be commenced on Adcal D3 + alendronate*

Question 276

Patient with muscle weakness, difficulty combing hair (i.e. raising arm) with raised ESR and raised CK and Anti-Jo1 antibody, positive rheumatoid factor. Diagnosis?

Answer 276

Polymyositis Symmetrical, proximal muscle weakness Elevated skeletal muscle enzyme levels Symmetrical, proximal muscle weakness with insidious onset Muscles usually painles

Question 277

70 year old patient with muscle aching, difficulty combing hair (i.e. raising arm) with raised ESR and normal CK and EMG normal. Diagnosis? Treatment?

Answer 277

Polymyalgia rheumatica Prednisolone

Question 278

Patient with psoriasis – tried emollients and wants to avoid oral meds. What next?

Answer 278

1st line mod-severe = narrow band UVB. (Phototherapy)

Question 279

Pt diagnosed with open angle glaucoma. Which piece of advice should patient be given?

Answer 279

Pt’s eyesight is irreversible Damage to the optic nerve is likely to be prevented or delayed. Sadly treatment cannot restore any sight that has already been lost.

Question 280

Patient with sensorineural hearing loss, tinnitus, vertigo and aural fullness. Diagnosis?

Answer 280

Menieres

Question 281

The patient gets dizzy every time he turns his head. Presents with left lateral gaze and nystagmus Diagnosis? Investigation? Treatment?

Answer 281

Benign paroxysmal positional vertigo Dix-halpike Epley

Question 282

Patient with sensorineural unilateral hearing loss, vertigo and on MRI found to have an abnormal lesion leaving the internal auditory meatus. Diagnosis?

Answer 282

Acoustic neuroma aka vestibular schwannoma, arising from vestibular nerve

Question 283

Pt with nose bleed which has now become bilateral with blood leakage into the mouth. Bleeding hasn’t stopped after holding onto nose. Next step?

Answer 283

Topical anaesthetic and cotton wool soaked in vasoconstrictor (oxymetazoline) Then cauterise with silver nitrate sticks

Question 284

Pt with STEMI – Immediate management?

Answer 284

Morphine + metoclopramide Oxygen GTN – sublinhual/IV Aspirin 300mg Ticagrelor Anticoag – enoxaparin/abciximab

Question 285

CHA2DS2-VASc score

Answer 285

C Congestive heart failure (or Left ventricular systolic dysfunction) - 1 H Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication) - 1 A2 Age ≥75 years - 2 D Diabetes Mellitus - 1 S2 Prior Stroke or TIA or thromboembolism - 2 V Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque) - 1 A Age 65–74 years - 1 Sc Sex category (i.e. female sex) - 1

Question 286

Patient with past mitral valve replacement presenting with new pan systolic murmur and fever. What is most important investigation?

Answer 286

Blood cultures

Question 287

Patient diagnosed with angina but also has asthma. Already on aspirin – what is the first drug pt should be put on?

Answer 287

Verapamil

Question 288

Wells criteria - What is it for?

Answer 288

Pulmonary embolism clinical signs and symptoms of DVT = 3 an alternative diagnosis is less likely than PE = 3 heart rate more than 100 = 1.5 immobilisation for 3 or more consecutive days or surgery in the previous 4 weeks = 1.5 previous objectively diagnosed PE or DVT = 1.5 haemoptysis = 1 malignancy (on treatment, treatment in last 6 months or palliative) = 1

Question 289

Pt with TB signs – what type of stain should be done on sputum?

Answer 289

Ziehl Nielsen

Question 290

Pt with weakness and dizziness alongside changing colour in palmar creases. What is best test? Top differential?

Answer 290

SynACTH. Addison’s – palmar crease pigmentation, weakness, abdo pain. Short synacthen test is best diagnostic + 1st line in diagnosing

Question 291

Pt with T2 diabetes and keeps having hypos. What is the cause?

Answer 291

Glimeperide (Insulin/sulfonylureas (gliclazide and glimepiride)

Question 292

Patient with t2 diabetes mellitus (on metformin) with high cholesterol, high BMI (31) and poor glucose control. How should the pt control their cholesterol?

Answer 292

Statin

Question 293

Patient with 3 month history with bowel troubles and campylobacter infection prior to this. Abdo pain relieved by defacation. Altered stool passage (straining, urgency, incomplete evacuation) abdominal bloating (more common in women than men), distension, tension or hardness symptoms made worse by eating and passage of mucus Normal bloods, no fever and negative stool. What is most likely dx?

Answer 293

IBS

Question 294

Patient with signs consistent with encephalopathy (liver failure) on the background of alcoholic cirrhosis and being alcohol independent. What is the first step in Mx?

Answer 294

20 degree head tilt, A-E, lactulose, treat sepsis, +/- Abx (rifaxilline), +/- Mannitol

Question 295

Patient with signs consistent with encephalopathy (liver failure) on the background of alcoholic cirrhosis and being alcohol independent. What is the first step in Mx?

Answer 295

Lactulose Phosphate enemas Stop diuretics if low potassium

Question 296

Pt with melaena, altered bowel habit and weight loss, no lesions anywhere on body. What is Dx?

Answer 296

Colon cancer

Question 297

Pt had surgery 3 days prior and has dropped in renal output with increased creatinine. He was on amox, met and gent. What is the most immediate step in management?

Answer 297

Stop gent

Question 298

Pt had surgery 3 days prior and has dropped in renal output with increased creatinine. He was on amox, met and gent. What is the most immediate step in management?

Answer 298

Stop gent

Question 299

Pt with 2 weeks hx of frank haematuria and varicoceale. What is most likely Dx?

Answer 299

Renal cell carcinoma

Question 300

Pt with PET and has HELLP. 39 weeks pregnant, what is the best step in Rx?

Answer 300

Delivery + IV Dexamethasone MgSO4 If hypertensive: IV Labetolol

Question 301

HELLP?

Answer 301

Haemolysis (H), elevated liver enzymes (EL) and low platelet count (LP) . It’s a serious but rare pregnancy complication.

Question 302

Pt with light bleeding and crampy pain @ 7 weeks. Has a closed OS but on USS there is something which looks like a gestational sac?

Answer 302

Threatened miscarriage - presents with a closed cervical OS, normal uterus size, mild / light bleeding.

Question 303

Pt with light bleeding and lower abdominal pain @ 9 weeks gestation. What is definitive investigation to find out whats happening?

Answer 303

TV USS

Question 304

Patient stage 1 and needs augmentation. What is best way?

Answer 304

Oxytocin

Question 305

Patient stage 3 and wanted to naturally deliver placenta. What is the best way to ensure she does not loose any extra blood?

Answer 305

Syntometrine - is a combination of oxytocin + ergometrine. Carboprost Used in combination for delivery of placenta and prevention of PPH.

Question 306

Woman with late decelerations on CTG, what next?

Answer 306

Do another foetal investigation - foetal blood sampling with pH. Late decelerations = deceleration starts at peak of uterine contraction, recovers after. Requires foetal blood sampling with pH. If acidotic -> Emergency c section.

Question 307

Lady trying to conceive with low progesterone, oligomenorrhoea, normal fsh and LH, normal TSH. What is the cause?

Answer 307

Premature menopause

Question 308

Pt with signs of endometriosis and a 4mm endometrioma on USS. What is the best way to manage? Investigation?

Answer 308

COCP TVUS

Question 309

Pt with signs of endometriosis and a 4mm endometrioma on USS. What is the best way to manage? Investigation?

Answer 309

COCP GnRH analogues - reduce the size Laprascopic laser to reduce complications TVUS

Question 310

RLQ pain sudden onset and constant pain, N+V, increased CRP, but normal WBC.

Answer 310

Ovaian torsion

Question 311

Child born at term and starts to seize. Weight is 4.8kg, what is the first investigation that should be done?

Answer 311

Glucose and electrolytes

Question 312

Baby (8 months) with crying episodes where baby brings legs to tummy. Mother opened nappy to find red current stool

Answer 312

Intersussception

Question 313

Indian baby who was bought in with mum looking pale. Hb done and found to be low. Baby is 1 years old and is on cows milk. What is the reason for anaemia?

Answer 313

Low iron in cows milk.

Question 314

New born baby and tests done. Levels of immunoreactive trypsin were found to be high. What does this point to?

Answer 314

Cystic fibrosis

Question 315

Child with seizure going on for 20 minutes. Has been given lorazepam, what should you give him now?

Answer 315

Lorazepam 0.1 mg/kg intravenously Benzo

Question 316

Child with seizure going on for 20 minutes. Has been given lorazepam, what should you give him now?

Answer 316

Lorazepam 0.1 mg/kg intravenously (Benzo)

Question 317

Pt has migraine which are getting more frequent. What is the best prophylactic measure?

Answer 317

Propanolol - Beta Blocker.

Question 318

Women presents with mixture of distal sensory and motor signs after having gastroenteritis 1 week ago. What is the worst thing you want to rule out first? Triggered by?

Answer 318

Guillain Barre syndrome Immune mediated demyelination often triggered by Campylobacter jejuni.

Question 319

Pt with sensory and motor signs peripherally. Vitamin?

Answer 319

Vitamin B12 (Vitamin E)

Question 320

Pt with right sided stroke with legs>arms and vision loss. What blood supply is affected?

Answer 320

ACA

Question 321

Pt comes in with left sided weakness which lasts for 60 minutes. Treatment?

Answer 321

If 0-3 = Specialist assessment within 1 week of symptom onset +/- brain imaging 4 or more = Aspirin 300mg immediately, specialist assessment within 24 hours, address RFs

Question 322

Pt with stroke that occurred 1 hr ago. What is the best Rx?

Answer 322

tpA intravenous

Question 323

GCS

Answer 323

Eyes Spontaneous To sound To pressure None Verbal Orientated Confused Words Sounds None Motor Obey commands Localising Normal flexion Abnormal flexion Extension None

Question 324

Patient with constant worries going out. Diagnosis?

Answer 324

Agorophobia

Question 325

Patient with normal weight but having a problem binge eating. Patient uses laxatives to vomit after feeling bad. Diagnosis?

Answer 325

Bulimia

Question 326

Patient with low TSH, normal t3 and t4, oligomenorrhoea, low FSH and LH, and exercises a lot. What is the most likely Dx?

Answer 326

Levothyroxine misuse

Question 327

Patient with schizophrenia with high BMI and cholesterol. What medication should the pt be started on?

Answer 327

Amisulpiride, *Aripiprazole*, Ziprasidone - least weight gain

Question 328

Pt started on clozapine and is told to come back on a weekly basis for Ix. Why?

Answer 328

Agranulocytosis

Question 329

Patient with varicose veins with a single bleeding episode from vein. What should you do after seeing the patient in the clinic? Ix?

Answer 329

Refer pt to vascular team Duplex

Question 330

Patient with gangrenous toe and ulcer under foot with leg pain at rest. What is the next step?

Answer 330

Revascularisation (critical limb ischaemia)

Question 331

Patient with acute ischaemic limb. No pulses past femoral pulse and cold limp up till below knee. What is Rx?

Answer 331

Thrombolise from femoral down 6Ps: pain, pallor, perishingly cold, pulseless, paralysis, parasethesia

Question 332

How to reduce risk of kidney stones?

Answer 332

● high fluid intake Reduce high purine foods such as red meat, organ meats, shell fish ● low animal protein, low salt diet ● thiazides diuretics (increase distal tubular calcium resorption)

Question 333

Antibodies for SLE - Most sensitive? Most specific?

Answer 333

Anti-nuclear antibodies (ANA) are autoantibodies to the nuclei of your cells. dsDNA and anti-smith antibodies

Question 334

COPD ladder

Answer 334

Vaccinations - influenza and pneumococcal Rehab Step 1: Inhaled therapy (SABA or SAMA) (Salbutamol + Ipratropium) Step 2: Without asthmatic features - LABA (Salmeterol) + LAMA (Tiotropium) Step 2: With asthmatic features - LABA + ICS (Budesonide/Beclomethasone) Step 3: If still breathless then LAMA + LABA + ICS

Question 335

Newborn baby from C-Section having difficulty breathing, cyanosis, CXR shows hyperinflated lungs and fluid in horizontal fissure

Answer 335

Transient tachypneoa of the new born–> usually gets better in 1-2 days

Question 336

Newborn baby from mother with polyhydramnios, having difficulty breathing, difficulty swallowing secretions

Answer 336

Esophageal atresia

Question 337

Acute management of depression with psychosis?

Answer 337

antipsychotics- olanzapine/ haloperidol

Question 338

Management of schizophrenia

Answer 338

Atypical antipsychotics (Respiradone, olanzapine, quetiapine, apriprazole)

Question 339

Cerebral oedema - CT scan

Answer 339

Ventricle disappears

Question 340

chronic pelvic pain dysmenorrhoea - pain often starts days before bleeding deep dyspareunia subfertility tender nodularity in the posterior vaginal fornix and visible vaginal endometriotic lesions may be seen

Answer 340

Endometriosis

Question 341

Treatment of compartment syndrome with trauma

Answer 341

Fasciotomy Amputation (With rhabdo –> hydration and bicarb)

Question 342

Investigating for retained products of miscarriage?

Answer 342

USS

Question 343

Investigating for retained products of pregnancy?

Answer 343

USS (TVS)

Question 344

Male have sexual tendency towards underage girl what would indicate that she not is at immediate risk?

Answer 344

Been less than 6 months of these tendencies

Question 345

What is the management of alcohol withdrawal?

Answer 345

chlordiazapoxide 300mg

Question 346

What are the side effects of oxybutynin?

Answer 346

anti-cholinergic -dry mouth, dizziness, drowsiness, blurred vision, dry eyes, N&V, constipation, diarrhea, weakness, runny nose

Question 347

SZ vs schizotypal disorder?

Answer 347

retained insight in schizotypal -odd beliefs and magical thinking, odd, eccentric behaviour

Question 348

Signs of physical abuse (non-accidental injury) including bruises, burns, fractures?

Answer 348

Bruises: -symm. bruised eyes -mouth, eyes, soft tissues on face -finger marks on legs, arms, chest -linear buttock or back -uncommon sites: chest, stomach, genitalia, neck Burns, scalds -cigarettes -backs of hands, soles of feet -glove and stocking distribution Human bite mark Fractures: -long bones (arms, legs, ribs) -multiple fractures in various bones -fractures of different ages

Question 349

What is rehabilitation?

Answer 349

the action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness.

Question 350

Treatment of woman who comes in contact with check pox unsure if chicken pox in childhood.

Answer 350

Treat with IVIG

Question 351

Parameters in acute asthma

Answer 351

Moderate - PEFR - 50-75% Speech normal Resp <25 Pulse <110 Severe - PEFR - 33-50% Can’t complete sentences RR > 25 Pulse >110 Life-threatening - PEFR - < 33% O2 SATS < 92% Silent chest Cyanosis Feeble resp effort Pulse <80 HTN Exhaustion

Question 352

HbsAg - positive Anti-Hbc - positive IgM anti-Hbc - negative anti HbS - negative

Answer 352

Chronic hepatitis

Question 353

High lipid, which drug to treat dyslipidemia?

Answer 353

Atorvastatin

Question 354

Woman trying to conceive for 18m periods 28-70 day cycle, partner ok, no past hx, all blood result normal except for low 21day progesterone

Answer 354

Early menopause

Question 355

Placenta retained

Answer 355

Placenta oxytocin or ergometrine injection into the umbilical vein with 20 IU of oxytocin in 20 ml of saline is recommended, followed by proximal clamping of the cord

Question 356

Patient with stroke symptoms, regain movement after 45min - management?

Answer 356

Alteplase then start aspirin 300mg 24 hours later.

Question 357

Spasticity on 5mg bd baclofen. Management?

Answer 357

increase baclofen (100mg/d is maximum)

Question 358

Indications for CT head in children?

Answer 358

-LOC -vomiting, headache -post traumatic seizure (no hx epilepsy) - GCS < 14 - suspected fracture - any signs of fracture - focal deficits

Question 359

Glasgow scale - Which parameter indicates worse outcome?

Answer 359

P - PO2 <8 A - age >55 N - WCC >15 C - Calcium <2 R - renal urea >16 E - AST >200 A - Albumin <32 S - Sugar >10 (3 or more is pancreatitis)

Question 360

Definition of Privacy

Answer 360

Privacy refers to freedom from intrusion and relates to all information and practice that is personal or sensitive in nature to an individual Dignity is being worthy of respect

Question 361

Diabetic drug that causes hypoglycemia

Answer 361

Insulin, sulfonylureas (Glucoside)

Question 362

What is Akathisia?

Answer 362

Restlessness

Question 363

2y old know only few words, but understands clearly, no motor delay what is the next step?

Answer 363

• assessment → audiological, neurodevelopmental and SALT • medical treatment → correction of hearing loss, correct cleft lip/palate • social → support at school

Question 364

7y year old still bedwetting, father has history of bedwetting until 8. Nothing in the hx about previous treatment What is the next treatment?

Answer 364

Lifestyle Eneursis alarm

Question 365

2nd degree prolapse management?

Answer 365

Asymp - lifestyle and pelvic floor Symp - pessary

Question 366

Patient presented with stroke within 1hr- which treatment provide best possible outcome?

Answer 366

Thrombolysis

Question 367

Dialysis patient 3day/week complains of tingling sensation, low power reflex, had diarrhea 2 weeks ago, which condition needs to be exclude?

Answer 367

Guillain Barre

Question 368

Melena and microcytic hypochromic anemia in older guy?

Answer 368

Anemia of chronic disease (cancer)

Question 369

Stroke affecting vision weakness in arm>leg – which territory is affected?

Answer 369

MCA

Question 370

Neonate premature at 30 with intermittent apnea, what is the management options include Corticosteroid, diuretics, and caffeine?

Answer 370

Caffeine

Question 371

Psychotic symptoms with suicidal ideation want to leave a&e, which law would you use?

Answer 371

Mental health act

Question 372

what does anti tissue transglutaminase indicate?

Answer 372

Coeliac

Question 373

Raynaud’s, positive Scl-70, DsDNA negative?

Answer 373

Systemic sclerosis (diffuse cutaneous)

Question 374

Patient with NSTEMI, what to do?

Answer 374

O2 Nitrates Metoclopramide Aspirin + Clopidogrel/Ticagrelol LMWH B-blocker - diltiazam/verapamil (Tirofiban in high risk patients)

Question 375

RTA broken nose, abnormal chest movement, weirdly displaced leg, leg bleeding management?

Answer 375

C-spine/ airway/ chest drain

Question 376

Lady with gallstones, presenting with acute pancreatitis because of gallstones, after stabilization, how would you manage?

Answer 376

Cholecystectomy

Question 377

Cystic fibrosis on xray

Answer 377

Consolidation, hyperinflation, dilatation

Question 378

USS shows echogenicity (more dense) and hepatomegaly, ALT>AST

Answer 378

NAFLD

Question 379

Lady with lower abdominal pain, painful VE in fornices, pyrexial

Answer 379

PID

Question 380

Third stage of labour management

Answer 380

Oxytocin/Syntocinon and then Ergometrine Immediate cord clamping

Question 381

Man couldn’t close eye, facial and unilateral hearing loss - Investigation?

Answer 381

MRI Cerebellopontine angle

Question 382

Haematuria, smoker, ct found multiple lesions in lungs and renal kidney lesion - Diagnosis?

Answer 382

RCC

Question 383

Treatment of small cell lung cancer

Answer 383

multidrug platinum-based chemotherapy limited-stage SCLC then offer thoracic irradiation concurrently with the first or second cycle of chemotherapy or after completion of chemotherap

Question 384

UTI kid why do USS?

Answer 384

To show dilated calyces

Question 385

Difficulty having kids, trying 14 months, hubby fine, periods every 2-3 months. Normal testosterone and SHBG, FSH:LH ratio raised, normal progesterone and prolactin - Diagnosis?

Answer 385

PCOS

Question 386

Endometriosis - lady wants to have kids in future -management?

Answer 386

Laparoscopic ovarian cystectomy with excision Can do laparoscopic surgery if severe disease if >3cm

Question 387

Treatment of thyrotoxicosis

Answer 387

Propylthiouracil

Question 388

55 year old new onset gastritis - treatment?

Answer 388

Test for H Pylori

Question 389

Migraine prophlyaxis patient previous depression

Answer 389

Venlafaxine (SNRIs)/Amitryptilline Duloxetine Milnacipran

Question 390

60 year old Migraine lady had really severe headache, neck stiffness, subjective lateral gaze diplopia, CT normal - Management?

Answer 390

Temporal arteritis

Question 391

Migraine prophlyaxis patient previous depression

Answer 391

Venlafaxine (SNRIs) Duloxetine Milnacipran

Question 392

Trichomonas vaginalis treatment?

Answer 392

Metronidazole

Question 393

Pregnancy induced hypertension why given labetalol?

Answer 393

Prevent superimposed pre-eclampsia

Question 394

Baby born 6 hours at term, fed well 45mls, developed grunting and subcostal recession - Diagnosis?

Answer 394

Transient tachypnoea of newborn

Question 395

Baby born developed grunting and subcostal recession - Diagnosis?

Answer 395

RDS

Question 396

Guy had cataract surgery came back 3 days later with eye pain

Answer 396

endopthalmitis

Question 397

Stroke guy, why can’t he drive?

Answer 397

if stroke or TIA: 1 month off driving may not need to inform DVLA if no residual neruological deficit if multiple TIA over short period times: 3 months off driving and inform DVLA

Question 398

Carpal tunnel definitive sign

Answer 398

Phalen’s test/Tinnels

Question 399

Girl fell over, incontinent of urine, biting of tongue etc. - Investigation before leaving hospital?

Answer 399

EEG

Question 400

Old lady saw spiders, incontinent, not looking after herself for last few days - Differentials?

Answer 400

Delirium tremens Lewy body dementia

Question 401

Features of parkinson plus

Answer 401

Vertical gaze palsy +- falls Impotence/Incontinence Visual hallucinations Interfering activity by affected limb (Alien limb syndrome) Diabetic/HTN patient who falls

Question 402

Glaucoma - lady used to wear glasses, had vomitted. Definitive test?

Answer 402

Gonioscopy (slit lamp examination)

Question 403

Indication to below the knee amputation.

Answer 403

If all other methods have failed/Unsuitable for revascularisation

Question 404

14 year boy comes in asking for contraception to have sex with 15year old.

Answer 404

Both are below age of 16 and above age 13 Underage sexual activity should always be seen as a possible indicator of child sexual exploitation.

Question 405

1st rank symptoms of schizo

Answer 405

Auditory hallucinations, somatic hallucinations, thought withdrawal or inserting, broadcasting, delusional perception, delusions of control

Question 406

Insomnia Anxiety Tremor Loss of appetite Tinnitus Perspiration Perceptual disturbances and seizures

Answer 406

Diazepam/Benzo withdrawal

Question 407

Depression Anxiety Fatigue Decreased conc Cravings (increased appetite) Excess sleep Vivid dreams CRASH - suicide ideation, N&V, formication

Answer 407

Cocaine withdrawal

Question 408

Diarrheoa Lacrimation Vomiting Rhinorrhea Dysphoria Nausea Fevers Sweating Insomnia Agitation and aches Dilated pupils

Answer 408

Heroine withdrawal

Question 409

Boy with developmental delay….thick calves - Diagnosis?

Answer 409

Duchenne’s

Question 410

Melanoma - what’s the most prognostic factor?

Answer 410

Breslow

Question 411

Endometrial cancer. Risk factor?

Answer 411

Obesity >50 yrs Endometrial hyperplasia Unopposed oestrogen (early menarchy, late menopause, HRT) Tamoxifen FH

Question 412

Shoulder dystopia. Most likely cause to get shoulder dystocia?

Answer 412

Macrosomic baby

Question 413

Respiratory Distress Syndrome. After giving surfactant. Next treatment?

Answer 413

Another surfactant dose

Question 414

Cholesystitis treatment

Answer 414

IV co-amoxiclav lap chole

Question 415

Hep B treatment

Answer 415

Pegylated INF-a - tenofovir and entecavir

Question 416

Cholangiocarcinoma investigations? Tumour markers?

Answer 416

CT abdo CA 19-9

Question 417

Increased prolactin Increased GH Normal/low LH+FSH Normal/low testosterone+estradiol

Answer 417

Pituitary adenoma

Question 418

IgA nephropathy diagnosis

Answer 418

Renal biopsy - diffuse mesangial IgA deposition Urine analysis MC&S U&Es eGFR Renal USS CT KUB (normal) C3 and c4 complement (normal)

Question 419

Acamprosate use

Answer 419

Acts on NMDA and GABAa Reduces Cravings and risk of relapse

Question 420

Disulfiram use

Answer 420

Inhibits acetaldehyde dehydrogenase - leading to accumulation

Question 421

Epistaxis Telangiectasis Visceral lesions FHx (first degree)

Answer 421

3 or more - hereditary haemorrhagic telangiectasia

Question 422

How to aid women with External cephalic version?

Answer 422

Tocolytic (Terbutaline) in primiparous women

Question 423

Why do you give Anti D?

Answer 423

Stop mother making antibody Prevent maternal sensitisation

Question 424

Spirometry asthma vs COPD; FEV1/FVC

Answer 424

COPD <70% Asthma <80%

Question 425

Osteoarthritis drug management

Answer 425

LA Diclofenac (with omeprazole) Steroid injection (methylpred)

Question 426

Cystocele first line management

Answer 426

Bladder training, Kegel exercises

Question 427

Large Bowel obstruction treatment.

Answer 427

Drip and suck - nasogastric decompression plus fluid resus

Question 428

First line management of angina

Answer 428

Exercise Diet Nitrates Antiplatelet therapy

Question 429

Small Bowel obstruction treatment.

Answer 429

Drip and suck - nasogastric decompression plus fluid resus

Question 430

Diabetic with hyperlipidaemia and high cholesterol and raised Hba1c. How to control cholesterol levels?

Answer 430

Atorvastatin 80 mg

Question 431

Rheumatoid features - most likely RA?

Answer 431

Swan neck deformity Boutonnieres deformity *Ulnar deviation* Nodules on elbow (Morning stiffness)

Question 432

Blood results showing HELLP syndrome.

Answer 432

Total Bili >1,2 LDH >600 GGT >70 Platelets <100,000

Question 433

Mechanism of Baclofen

Answer 433

Muscle relaxant and antispastic inhibiting both monosynaptic and polysynaptic reflexes at the spinal level

Question 434

18 month of a child has respiratory distress that came on suddenly. Biphasic wheeze + afebrile. Investigations? Asthma emergency management?

Answer 434

SABA and PEFR Inhaled SABA, ICS, abx if needed, O2

Question 435

Management of Primary 8mm pneumothorax?

Answer 435

Aspiration

Question 436

Causes of Akathesia

Answer 436

SSRIs, CCBs, anti-emetics (metoclopramide), anti-vertigo

Question 437

Biggest risk factor for completed suicide?

Answer 437

Age >65 Postnatal status Personal/FHx of depression Steroids IFN male

Question 438

Treatment for PTSD

Answer 438

Trauma focussed CBT FOR EXAMPLE eye movement desensitisation and processing

Question 439

Pt with proximal myopathy-ish symptoms - and low Na and high K. Diagnosis?

Answer 439

Addisons

Question 440

Child with UTI. You do a USS. Parent asks why you chose to do USS?

Answer 440

vesicoureteric reflux

Question 441

Lady with pregnancy-induced HTN with bp at 146/something. Why do you control her bp?

Answer 441

To prevent superimposed pet

Question 442

Pt with FHx of hypertension or PET, but has DM and is obese. What is most likely risk factor of her getting pet/what makes you want to investigate further?

Answer 442

First baby Hx of pre-eclampsia FHx of pre-eclampsia BMI>30 Maternal age >35

Question 443

Tests before starting Vit D and alendronate?

Answer 443

Serum 25-hydroxy VitD (D1) Serum ALP Serum calcium Fasting phosphorus PTH

Question 444

Pitting in nails and swelling in 3 DIP joints and dactylitis - Diagnosis?

Answer 444

Psoriatic arthritis (Hx of psoriasis is common)

Question 445

Where do you place grommet?

Answer 445

Anterior inferior

Question 446

Patient presents with one red eye that are: pain or photophobia no itching poorly reactive pupil irregularity of the pupil Diagnosis?

Answer 446

Anterior uveitis

Question 447

Loss of deterioration of central vision (can be sudden or gradual) Flashes of light

Answer 447

Retinal detachment

Question 448

Patient comes in with periorbital pain, loss of visual acuity with scotoma (blind spot), loss of color vision, and rapid afferent pupillary defect. Diagnosis?

Answer 448

Optic neuritis

Question 449

Patient with weight loss and UC. Primary sclerosing cholangitis or cholangiocarcinoma?

Answer 449

Primary sclerosing cholangitis

Question 450

Started someone on ACEi, he had a small creatinine rise what do you do?

Answer 450

Discontinuation of angiotensin-converting enzyme (ACE) inhibitor is recommended if patients experience ≥30% Treat with NaCl fluid

Question 451

Bone pain with fragility fractures, depression and renal stones

Answer 451

Primary hyperparathyroidism

Question 452

Placenta praevia (placenta is low) - when do you do elective C section?

Answer 452

37-38 weeks

Question 453

Long term MI management?

Answer 453

Aspirin, B blockers (bisoprolol, metoprolol), Statin (atorvastatin)

Question 454

Most likely cause of PPH?

Answer 454

Atonic uterus

Question 455

Trichomonas vaginalis microscopy

Answer 455

Motile trophozoites in vaginal discharge smears.

Question 456

Lady had a loss of sensation up to umbilicus and bad cough and significant pack years

Answer 456

Chest xray and thoraco-lumbar MRI

Question 457

Paeds pneumonia - management?

Answer 457

Penicillin V or amoxycillin (In pneumonia associated with influenza, co-amoxiclav is recommended)

Question 458

CURB-65 - Score 3 management?

Answer 458

• Confusion (abbreviated Mental Test Score <=8) (1 point) - Urea (BUN > 19 mg/dL or 7 mmol/L) (1 point) - Respiratory Rate > 30 per minute (1 point) - Blood Pressure: diastolic < 60 or systeolic < 90 mmHg (1 point) - Age >= 65 years (1 point)

Question 459

CURB-65 - Score 3 management?

Answer 459

• Confusion (abbreviated Mental Test Score <=8) (1 point) - Urea (BUN > 19 mg/dL or 7 mmol/L) (1 point) - Respiratory Rate > 30 per minute (1 point) - Blood Pressure: diastolic < 60 or systeolic < 90 mmHg (1 point) - Age >= 65 years (1 point) Admit and Ben Pen IV and doxycycline PO

Question 460

CXR with ground glass appearance

Answer 460

Respiratory distress syndrome

Question 461

Infected bile duct obstruction (ascending cholangitis) - management?

Answer 461

IV abx (tazobactam or piperacillin) + ERCP

Question 462

Presents frequently to healthcare Intense but unstable relationships Persistent feelings of boredom and emptiness with uncertainty Unstable mood - Anger, low tolerance of stress Impulsive (and damaging behaviour) Diagnosis?

Answer 462

Emotionally unstable personality disorder

Question 463

Characteristic cystic fibrosis features?

Answer 463

Failure to pass meconium (meconium ileus), Failure to thrive, voracious apetite

Question 464

Coryzal symptoms Dry cough Increasing breathlessness Wheezing Fine inspiratory crackles Feeding difficult

Answer 464

Bronchiolitis (Respiratory syncytial virus)

Question 465

Goserelin - What is it? Mechanism of action?

Answer 465

GNRH receptor agonist Inhibition of pituitary gonadotropin secretion

Question 466

Anti-d – why don’t you give it before 12 weeks?

Answer 466

Blood transferred during that time is not significant

Question 467

Kid hits her head bad and vomits 2 times what do you do?

Answer 467

Skull XR if suspected fracture 3 or more for CT MRI

Question 468

Man has replaced hip and is hallucinating and has long QT - Drug that’s causing it? lorazepam, risperidone, tamazepam, quetiapine and benzo, haloperidol

Answer 468

Haloperidol

Question 469

Man had AF and raised amylase(very slightly)

Answer 469

Mesenteric ischaemia

Question 470

Reasons for referral to psychiatry

Answer 470

superficial self-harm

Question 471

What to check before starting COCP?

Answer 471

Blood pressure

Question 472

Failure to pass meconium – does a pr exam and lots of faeces come out. Investigations?

Answer 472

Meconium plug syndrome CF blood sample Rectal suction biopsy Contrast enema

Question 473

Bronchiolitis, a premature baby born 24 weeks, what do you give the baby?

Answer 473

Oxygen

Question 474

How to diagnose Hirschsprung’s? First line?

Answer 474

Rectal biopsy Plain abdo XR Contrast enema

Question 475

How to diagnose Hirschsprung’s? First line? Screening tool?

Answer 475

Rectal biopsy Plain abdo XR Contrast enema (most valuable)

Question 476

B-hcG of 650 in 5-week pregnant woman, can pick up heartbeat but can’t see anything on USS, what is this?

Answer 476

Pregnancy of unknown location

Question 477

Type of miscarriage? pain; bleeding > bleeding equivalent to menstruation; cervix = open; uterine size = dates; ultrasound Fetal heart may/may not be visualised

Answer 477

Inevitable miscarriage

Question 478

Type of miscarriage? no pain; bleeding < bleeding equivalent to menstruation; cervix = closing; uterine size = dates; ultrasound = empty uterus

Answer 478

Complete miscarriage

Question 479

Type of miscarriage? minimal pain; bleeding < bleeding equivalent to menstruation; cervix closed; uterine size = dates; ultrasound = Fetal Heart visualised

Answer 479

Threatened miscarriage

Question 480

Type of miscarriage? pain +/-; bleeding >>bleeding equivalent to menstruation; cervix = open; uterine size = or < dates; ultrasound = retained products/no fetal heart

Answer 480

Incomplete miscarriage

Question 481

Type of miscarriage? no pain; bleeding = minimal brown; cervix = closed; uterine size = small; ultrasound = no fetal heart

Answer 481

Missed miscarriage

Question 482

woman with monochromic (one placenta) diamniotic twins (diagnosed at 1st US scan) suddenly gets intense abdo pain and is large for dates. What is cause?

Answer 482

Twin to twin transfusion polhydro

Question 483

Causes of menorrhagia, no intermenstrual bleed, multiparous, abdo exam normal, didn’t want to have bimanual?

Answer 483

Fibroids

Question 484

Causes of menorrhagia

Answer 484

PID Dysfunctional uterine bleeding Fibroids Anovulatory cycles Hypothyroid IUD

Question 485

Depression admission criteria

Answer 485

Severe agitation Psychotic Suicidal Catatonia

Question 486

Management of stone that couldn’t be ERCP?

Answer 486

Emergency CBD exploration + Abx

Question 487

Paeds clavicle fracture, macrosomic 4-week old baby, CXR of chest showed clavicle fracture /w callus, examination (for other signs of abuse) was unremarkable?

Answer 487

If in ED then send to GP Fracture clinic - if it doesn’t heal in 6 weeks

Question 488

Best schizophrenia prognosis

Answer 488

Paranoid

Question 489

Acute heart failure management

Answer 489

O2 therapy Loop diuretics - furosemide GTN spray

Question 490

Side effects of respiridone

Answer 490

Depression Anaemia Anxiety Abnormal appetite Chest discomfort/Cough Conjunctivitis

Question 491

ENT what is associated with polyps & post nasal drip

Answer 491

asthma & aspirin allergy

Question 492

ENT what is associated with polyps & post nasal drip

Answer 492

asthma, hay fever & aspirin allergy

Question 493

Hypothyroid in children treatment

Answer 493

Levothyroxine

Question 494

Afebrile paed with wheeze and expiratory crackles 9 weeks old with recession

Answer 494

exacerbation of asthma

Question 495

Surveillance for 4.8cm aaa

Answer 495

3 monthly

Question 496

Diabetic brought into hospital hypernatremic, what will be given to him next?

Answer 496

NaCl Insulin IV (Glucose if low)

Question 497

Labour, mention of repeated late decelerations over last 40 mins, what do u do next?

Answer 497

Fetal blood sampling

Question 498

Skier - knee swelling that is delayed by one day

Answer 498

Meniscal tear

Question 499

Guy who leans on the table gets ulnar neuropathy, where is lesion?

Answer 499

Cubital canal

Question 500

Treatment of mastitis

Answer 500

Continue breastfeeding The first-line antibiotic is flucloxacillin for 10-14 days (Staph aureus)

Question 501

Simple humeral fracture presented 5 days after fracture, what next?

Answer 501

immobilisation collar and cuff

Question 502

CURB-65 - Score 0 management?

Answer 502

Community care Doxycycline PO 200mg STAT then 100mg OD

Question 503

Treatment of viral meningitis

Answer 503

Ceftriaxone IV and acyclovir If immunocompromised or >55 add amoxicillin

Question 504

Simple pain management already on nsaids, what next?:

Answer 504

Weak opioids - codiene, dyhydracodeine, tramadol Strong opioids - diamorphine, fentanyl

Question 505

What more likely to cause endometrial cancer?

Answer 505

Obesity Nulliparity Early menarche Late menopause Unopposed estrogen

Question 506

HRT contraindications

Answer 506

Breast cancer Estrogen sensitive cancer Undiagnosed vaginal bleedings Endometrial hyperplasia

Question 507

Schizo acute dystonia treatment?

Answer 507

Procyclidine Hydrochloride

Question 508

Pt has ptosis slightly weak medial eye movement, whats caused this?

Answer 508

Subarachnoid haemorrhage

Question 509

Test before starting azathioprine?

Answer 509

Thiopurine methyltransferase (TPMT)

Question 510

Red painful eye with normal visual acuity - what to do next?

Answer 510

Look at the surface of the eye Snellen chart Inspection of lid and brow Inspection of the ocular surface and subtarsal surface, pupillary reactions

Question 511

Given vancomycin antibiotic for chest infection then gets erythroderma, what is cause?

Answer 511

drug reaction

Question 512

Tia abcd2 calculation & management, if u worked it out he had a score of 6?

Answer 512

Admission + MRI

Question 513

Prostate symmetrically enlarged smooth on exam, raised PSA (1.0 over normal range), what do u do next?

Answer 513

Repeat PSA in 6 months

Question 514

Parkinsons off symptom management

Answer 514

Levodopa + Entacapone

Question 515

Risk factors for suicide

Answer 515

male Hx of self harm Alcohol or drug misuse Hx of mental illness Hx of chronic disease Advancing age Unemployment or social isolation/living alone Being unmarried, divorced or widowed

Question 516

Paeds urticaria management, the boy forgot his blue inhaler?

Answer 516

IM adrenaline

Question 517

Neonate that’s grunting and 92 sats after 20hr premature rupture of membrane labour, what do you do next?

Answer 517

O2/CPAP or Intubate, surfactant

Question 518

After operation become hypertensive, <38C temp ?normal sats, what is the cause of fever

Answer 518

Atelectasis

Question 519

What antibiotics do u give in pyelonephritis

Answer 519

Co amox +- IV gent

Question 520

Repeat key differentiating thing between stress & urge?

Answer 520

Nocturia

Question 521

What is oxybutinin?

Answer 521

Antimuscarinic

Question 522

Guy that wants to stop getting depressed, how do u treat him, hes tried to OD on pills in the past

Answer 522

CBT

Question 523

Boy who had delayed puberty, said father also was delayed.

Answer 523

Constitutional delay

Question 524

GCA management

Answer 524

Steroids

Question 525

Vascular surgery man is awaiting angioplasty for intermittent claudication revascularisation, what do u give him in mean time?

Answer 525

Statin

Question 526

Kid has hypovolemic shock weighed 12kg: how much fluid do you give them?

Answer 526

20ml/kg bolus over 10 mins.

Question 527

Treatment of dysmenorrhagia

Answer 527

Mefanamic acid COCP

Question 528

55 year old new onset gastritis

Answer 528

1) Refer to urgent endoscopy

Question 529

Migraine lady had really severe headache, neck stiffness, subjective lateral gaze diplopia, CT normal

Answer 529

MRI because SAH

Question 530

Migraine lady had really severe headache, neck stiffness, CT normal, photophobia

Answer 530

LP because meningitis

Question 531

Antepartum haemorrhage: 8 weeks pregnant investigation

Answer 531

Pregnancy test FBC Rhesus Serum BHCG TVUS

Question 532

Urinary retention and pain in back of legs where was the lesion?

Answer 532

S234

Question 533

Presentation of posterior humeral fracture

Answer 533

Wrist extension (wrist drop) Radial nerve fracture Loss of sensation in dorsal aspect of 1st+2nd

Question 534

Guy fell from climbing frame, snapping sound heard and had haematoma on sole of foot. He can’t stand on the toes or push off. Diagnosis?

Answer 534

Achilles tendon rupture

Question 535

Giant cell arteritis treatment

Answer 535

High dose prednisolone Emergency opthamology review (if confirmed give aspirin additionally) (Allergic/relapsing then give methotrexate)

Question 536

Mechanism of urticaria due to IgE

Answer 536

Mast cell degranulation

Question 537

Cause of urticaria due to autoimmunity

Answer 537

Complement Phagocytes Immune deficiency (HIV)

Question 538

Guy had something that looked like psoriasis after coming back from Africa, what do you give?

Answer 538

Seborrheic dermatitis ketoconazole (steroid for flareups)

Question 539

Guy had hep c and hep b - management?

Answer 539

Treat hep c interferon alfa and ribavirin.

Question 540

Guy couldn’t find the right words for things, what is this?

Answer 540

Anomic aphasia

Question 541

Cervical screening – why do you not screen people under 25?

Answer 541

high false positive rate

Question 542

Alcoholic man with chronic pancreatitis?

Answer 542

Creon

Question 543

she was feeling hot then cold and yawning and dilated pupils

Answer 543

Opioid withdrawal

Question 544

lifetime prevalence of schizophrenia

Answer 544

1%

Question 545

Guy had AKI after surgery - what do you assess?

Answer 545

saline bolus 250ml

Question 546

Primary ovarian failure presentation

Answer 546

Low progesterone High LH

Question 547

What further test do you need to do to make sure lp is safe?

Answer 547

CT only done if contraindications

Question 548

Lady spontaneously changed from speaking English to fluent polish and was delusional shouting that Lady gaga wanted to kill her, whats the diagnosis?

Answer 548

transient psychosis

Question 549

Lady is bleeding after birth 4500 ml of blood what radiological intervention would you do?

Answer 549

intrauterine balloon

Question 550

Q of a guy who hit his head and had symptoms the next day in a rugby match?

Answer 550

CT scan

Question 551

Mechanism of action of COCP?

Answer 551

Suppress the secretion of gonadotropins (follicle stimulating hormone, FSH and luteinizing hormone, LH) through negative feedback inhibition.

Question 552

What is amount of blood loss is considered post partum haemorrhage?

Answer 552

Over 500 mL

Question 553

Sickle cell disease with chest syndrome - management?

Answer 553

O2 (sats >94%)+ incentive spirometry+ fluids+analgesia (sc morphine 0.1mg/kg)

Question 554

ACL tear bare co-morbidities (T2DM un-controllable, CABG) Risk factors?

Answer 554

Acute trauma Female sex (after puberty) Hx of previous ACL injury Use of cleats

Question 555

What blood test do you do before prescribing retinoids for acne?

Answer 555

B-hcg LFTs and serum lipids before treatment, 1 month after starting and then every 3 months

Question 556

Which medication causes memory problems - bisphosphantes, bisoprolol, oxybutynin , rivoraxaban

Answer 556

Oxybutynin

Question 557

Treatment of hypercalcaemia?

Answer 557

First record the patient’s weight. Stop drugs known to cause hypercalcaemia. Give 0.9% NaCl to render the patient euvolaemic, aiming to increase urine volume to 200 mL/hr.

Question 558

Thoraco-lumbar Kyphosis investigations?

Answer 558

XRay

Question 559

Diplegic spastic child already had baclofen+ physio. Next mx?

Answer 559

Surgery, physio, more baclofen, cast Baclofen 40mg/day max if still no improvement give botulin toxin type A injection

Question 560

Lung ca central tumour on x-ray - Next investigation?

Answer 560

Bronchoscopy+biopsy

Question 561

Sinusitis management?

Answer 561

Abx - Amoxicillin Steroids nasal spray (budesonide) Decongestant spray (oxymetazoline)

Question 562

Vocal nerve damage investigation?

Answer 562

Laryngoscopy

Question 563

Bilateral glue ear, hearing loss, speech deficit?

Answer 563

Grommet

Question 564

Endometrial cancer staging investigations?

Answer 564

FIGO staging (surgical) Pelvic USS Biopsy and histology

Question 565

Presentation of intussusception

Answer 565

Vomiting, colicky abdo px, male, 6-12mths, lethargy, red-currant jelly stool

Question 566

Risk factors for vaginal prolapse

Answer 566

Vaginal delivery (forceps delivery) Older age High BMI Previous surgery for prolapse Genetic factors

Question 567

1 core and 4 minor depressive management?

Answer 567

Cbt, anti-depressant

Question 568

10 year old, limp, knee pain, no fever -groin or knee pain -bilateral hip px -trendelenburg’s gait -weight >90th ; obesity -endocrine disorders that cause obesity -puberty (12-13.5 boys) Diagnosis?

Answer 568

SUFE (Slipped capital femoral epiphysis

Question 569

Osteochandroma (patient with swelling) investigation?

Answer 569

CXR, x-ray pelvis

Question 570

Which drug would you give old man who was not sleeping + depressive symptoms?

Answer 570

Mirtazapine

Question 571

HPV - high risk types and low risk types?

Answer 571

16&18 - high risk 6&11 - low risk

Question 572

Colectomy of crohns pt, 2 days post-op asks nurse about feeding?

Answer 572

eat and drink normally to get gut moving

Question 573

Paeds severe life threatening asthma, silent chest sats 88%?

Answer 573

O2 + admission + nebulised SABA (salbutamol) and anticholinergic (ipaproprium) + prednisolone

Question 574

Hypokalaemia, hypernatremia, headache, muscle weakness

Answer 574

Conns (primary hyperaldosteronism)

Question 575

Diet of patient with diabetic nephropathy already on ace-I, hypertensive

Answer 575

low salt diet

Question 576

Patient on risperidone and has oligo-menorrhea which hormone?

Answer 576

Hyperprolactinemia

Question 577

Leg claudication on exercise, pulses palpable and obs stable – what management?

Answer 577

Aspirin/clopidogrel+ exercise + risk factor modification (statin, b-blocker +/-ACEi)

Question 578

Man presents as worried because dad died of colorectal ca – what screening should he be offered?

Answer 578

If strong fhx -> genetic testing for FAP or HNPCC; if -ve but strong hx then colonoscopy 35-45 (If 60-74 every two yrs offer fecal occult blood testing 55 one off flexi sigmoid -> full colonoscopy if polyp found)

Question 579

Marfans presents with severe tearing chest pain radiating to back – TTE showed aortic dissection. Next investigation?

Answer 579

CT angiography

Question 580

Man returning from india with jaundice had diarrhoea?

Answer 580

Hepatitis A

Question 581

Baby jaundiced 6 weeks high unconjugated bilirubin and pale stool?

Answer 581

Biliary atresia

Question 582

Keratitis appearance fluorescein stain showed branch like appearance so management? Diagnosis?

Answer 582

HSV Gancyclovir

Question 583

Bilateral conjunctivitis itchy eyes - management?

Answer 583

Anti-histamine - epinastine, azelastine, pheniramine, alcaftadine

Question 584

Dehydrated baby, poor feeding, irritable, dry nappies, what to do?

Answer 584

rehydration therapy

Question 585

Acute HF management?

Answer 585

Freusemide

Question 586

Ovarian cancer commonest type?

Answer 586

Serous

Question 587

Patient had lucid interval secondary to trauma, fell off step ladder?

Answer 587

extradural haematoma

Question 588

Death certificate 1a - what to write as reason of death?

Answer 588

WHO defines the underlying cause of death as “a) the disease or injury which initiated the train of morbid events leading directly to death, or b) the circumstances of the accident or violence which 5 produced the fatal injury”. From a public health point of view, preventing this first disease or injury will result in the greatest health gain.

Question 589

Patient had symptoms of raised ICP (early morning headache and change in personality, and headache worse on movement) mx?

Answer 589

Urgent referral to neurologist CT/MRI scanning to determine any underlying lesion.

Question 590

ABO incompatibility jaundice test?

Answer 590

Coombs test

Question 591

90. Impetigo advice to miss school-

Answer 591

This practice is implemented by many schools as they exclude children from attending until until the affected child no longer has crusty or bullous lesions

Question 592

Impetigo advice to miss school-

Answer 592

This practice is implemented by many schools as they exclude children from attending until until the affected child no longer has crusty or bullous lesions

Question 593

Man had a fall, loss of motor on one side and loss of proprioception on same side. Loss of sensory on opposite. What is the diagnosis?

Answer 593

Brown-Sequard syndrome is a spinal cord hemisection. On the ipsilateral side there will be loss of motor function (Corticospinal tract) and loss of proprioception & vibration sense (dorsal column). On the contralateral side there will be loss of pain, temperature and crude touch.

Question 594

Sudden onset severe headache. Ct scan normal. Next investigation?

Answer 594

MRI or LP

Question 595

Young girl one eye facing inwards towards nose. What lesion?

Answer 595

CN IV esotropia

Question 596

School exclusion for chicken pox?

Answer 596

5 days after first skin eruption

Question 597

Best investigation for multiple sclerosis?

Answer 597

s MRI. (Sagittal)

Question 598

HBeAg - what does it mean?

Answer 598

This means the person infected with Hepatitis B can likely transmit the virus on to another person

Question 599

Child with otitis media. Treatment?

Answer 599

Abx (amoxicillin) if: Child with systemic features and no improvement > 4 days Immunocompromised Age <2 with bilateral otitis media Discharge from ear

Question 600

Hernia that doesn’t go into scrotum. Medial and superior to pubic tubercle. What type of hernia?

Answer 600

Inguinal hernia – medial and superior to pubic tubercle Femoral hernia – lateral and inferior to pubic tubercle

Question 601

Police picks up crazy guy from home. What section can they detain on? Time?

Answer 601

Section 135 Upo 24 hours

Question 602

Patient has hypomania. What is the first line treatment?

Answer 602

olanzapine

Question 603

Haloperidol. What drug gets rid of side effects of haloperidol?

Answer 603

procyclidine

Question 604

Definitive management of endometriosis

Answer 604

Hysterectomy with bilateral salpingo.

Question 605

Patient comes in she has urethretis, iritis, and joint pain. What investigation will you do?

Answer 605

ESR, CRP HLA-B27 “can’t pee, can’t see. can’t climb a tree - Reiter’s syndrome”

Question 606

Patient wakes up after anaesthesia. Headache and vertigo on standing up. Relieved completely on lying down. What is the diagnosis?

Answer 606

Post lumbar puncture headache (common in females with low BMI)

Question 607

Vascular patient intermittent claudication. No pain at rest. Pulses are not palpable on right hand side but present on Doppler. How would you best manage this patient?

Answer 607

Risk modification (e.g. diabetes, obesity, smoking, hypertension) + Statin + Clopidogrel

Question 608

Patient comes in 2 months old Turkish parents. Jaundiced and anaemic. Diagnosis? Blood film?

Answer 608

G6PD deficiency Heinz body

Question 609

Patient comes in been treated. Got necrotising fasciitis. Next line of treatment?

Answer 609

Urgent surgical debridement 2) IV antibiotics (normally MRSA therefore give Vanc).

Question 610

A woman is on epidural. What is her/her baby most at risk of?

Answer 610

Severe hypotension, leakage of spinal fluid (mom) severe respiratory depression & bradycardia (fetus)

Question 611

Baby has vomiting then diarrhoea? What is the likely organism?

Answer 611

Rotavirus (non bloody diarrhoea) Oral immunisation at 2 and 3 months

Question 612

Pericarditis ECG changes?

Answer 612

ECG changes: • Widespread ST elevation (saddle shapes) • PR depression (most sensitive marker!)

Question 613

Patient comes in had a TIA. Blind in the eye temporarily. Doppler show one artery stenosed 40% and one 80%? What is the treatment?

Answer 613

Carotid endarterectomy

Question 614

Treatment of cervical cancer with lymph node involvement?

Answer 614

Chemotherapy + Radiotherapy

Question 615

Patient diagnosed and has mild cervical Dyskariosis. Next investigation?

Answer 615

HPV status If positive - Colposcopy

Question 616

Boy leaning forward, taking deep breaths epiglottitis? Next line of treatment.

Answer 616

Oxygen and abx (ceftriaxone and ampicillin)

Question 617

New born. Doctor says more likely to get UTI. Patient asks what symptoms to look out for if he gets UTI?

Answer 617

Irritability, fever, foul smelling urine, poor feeding

Question 618

Patient has long term catheter. Patient does not want catheter anymore. What would you do?

Answer 618

Trial without catheter

Question 619

Patient comes in intermenstrual bleeding. Smear is fine done two years ago. Speculum is normal. Next investigation?

Answer 619

Endocervical swab

Question 620

Patient has come in. One vocal cord isn’t moving properly. What is the next investigation?

Answer 620

Layngoscopy

Question 621

Patient has retinal detachment. What feature in history predisposes him the most?

Answer 621

Increasing age, previous retinal detachment, family history of retinal detachment, myopia, diabetes, vitreous haemorrhage, previous eye surgery (e.g. cataract).

Question 622

Has an afferent pupillary defect. What nerve is it? Differential?

Answer 622

Optic

Question 623

Young patient pain in hands. Stiff in the morning. What is the diagnosis? Management?

Answer 623

Juvenile Idiopathic arthritis MDT + lifestyle NSAIDs Long term - methotrexate and folic acid

Question 624

Patient comes in been to GP several times complaining of hand pain, tummy aches, urinary problems etc. Diagnosis?

Answer 624

Somatisation disorder (multiple physical symptoms present for at least 2 years, patients refuses to accept reassurance or negative tests)

Question 625

Dermoid cyst - Cell type?

Answer 625

aka mature cystic teratoma germ cell Epithelioid cell

Question 626

Main advantage of breast milk over formula?

Answer 626

Reduces risk of sudden infant death syndrome, reduces infections, reduced DM1, reduced asthma, eczema

Question 627

Patient doesn’t respond to anything apart from opening eyes a tiny bit and moves them. What is the diagnosis?

Answer 627

Locked in syndrome/ Pseudocoma/ brain stem infarct

Question 628

In GUM clinic which infections can you test for and get results the same day?

Answer 628

HIV Chylamidia Gonorrhea

Question 629

Hyperkalaemia. Tented T waves. First line treatment?

Answer 629

1. 10% Calcium gluconate (and repeat until ECG normal) 2. Dextrose/insulin infusion (and repeat until normokalaemia) 3. Consider sodium bicarb if acidosis 4. Consider nebulised salbutamol

Question 630

30 year old Abdominal distension, diarrhoea, vomiting. Doctor gives a list of differentials including appendicitis, crohns, mesenteric adenitis etc. What is the next line of investigations?

Answer 630

CT abdo pelvis

Question 631

Upper motor neurone lesions symptoms

Answer 631

Weakness, spasticity, clonus, and hyperreflexia

Question 632

Pt has a ‘nettle rash’ episodes lasting for 6h for the last 12 months. Most likely pathogenesis?

Answer 632

Allergy

Question 633

Common diazepam side effect?

Answer 633

Allertness decreased Anxiety Confusion Depression Dizzy Drowsy GI disorder Resp depression

Question 634

Pain at site, malaise and fatigue, local swelling, low grade fever with reduced range of movement and tenderness Diagnosis? Management?

Answer 634

Osteomyelitis Flucloxacillin (6 weeks)

Question 635

Haemorrhagic stroke management

Answer 635

Beta blocker (Labetalol) DVT prophylaxis - heparin

Question 636

Ischemic stroke management

Answer 636

Alteplase - only is before 4.5 hrs Aspirin Endovascualr intervention SALT assessment

Question 637

A woman who smokes 10/d has started getting regular painful contractions at 31weeks and a bloody vaginal discharge.

Answer 637

Placental rupture

Question 638

Placental abruption risk factors

Answer 638

Chronic HTN Pre-eclampsia Smoking Cocaine Trauma Choreamnionitis

Question 639

Management of Pelvic Inflammatory disease (PID)

Answer 639

Ceftriaxone + doxycycline

Question 640

Chronic demyelinating neuropathy

Answer 640

Progressive weakness and impaired sensory function in the legs and arms. Caused by damage to the myelin sheath of the peripheral nerves. CIDP is more common in young adults, and in men Tingling or numbness (beginning in the toes and fingers), weakness of the arms and legs, loss of deep tendon reflexes (areflexia), fatigue, and abnormal sensations. Diabetes HIV SLE

Question 641

Chronic demyelinating neuropathy

Answer 641

Progressive weakness and impaired sensory function in the legs and arms. Caused by damage to the myelin sheath of the peripheral nerves. CIDP is more common in young adults, and in men Tingling or numbness (beginning in the toes and fingers), weakness of the arms and legs, loss of deep tendon reflexes (areflexia), fatigue, and abnormal sensations. Diabetes HIV SLE

Question 642

Causes of early decelerations

Answer 642

Increased foetal intracranial pressure During labour Reduced amniotic volume Umbilical cord compression

Question 643

A child presents with severe anaemia, pale, poor growth - recently stopped having breastmilk. What is the cause for the anaemia?

Answer 643

Beta thalassemia trait

Question 644

2/5 palpable occipital posterior – which forceps to use?

Answer 644

Kielland forceps

Question 645

The most common cause of LV dysfunction

Answer 645

IHD

Question 646

Child abuse - investigations?

Answer 646

FBCs Clotting Dilated fundoscopy Photodocumentation Skeletal survey CT brain LFTs and amylase Serum calcium, phophate, ALP Parathyroid 25-hydroxy D3

Question 647

Breast cancer, liver lung and 70% bone cortex in tibia mets – treatment? Post menopausal - HER2 -ve? Post-menopausal - HER2 +ve? Pre-menopausal - HER2 +ve?

Answer 647

a.If post-menopausal (HER2 –ve) – anatrozole+ palbociclib + bisphos+ calcium and vit d b.If post-menopausal (HER2 +ve) – pertuzumab+ trastuzumab+ docetaxel + bisphosphonates+ calcium and vit d c.If pre-menopausal – tamoxifen (and mab if HER2 +ve) ; then ovarian ablation ++bisphosphonates+ calcium and vit d

Question 648

Pain in the abdomen- the pain is located either in the centre of the abdomen, or in the lower right-hand side of the abdomen (known as the ‘right iliac fossa’ area) - Fever (high temperature) >38.5 - Feeling generally unwell - Nausea and/or diarrhoea - Sore throat/ symptoms of a cold

Answer 648

Mesenteric adenitis

Question 649

Commonest cause of preterm labour?

Answer 649

hx of premature labour hx cervical trauma hx of induced abortion maternal infections multiple pregnancies

Question 650

Causes of infertility?

Answer 650

age >35 hx of STD BMI extremes smoking

Question 651

Patient comes in with periorbital pain, loss of visual acuity with scotoma (blind spot), loss of color vision, and rapid afferent pupillary defect. Normal optic disc on examination. Diagnosis?

Answer 651

Retrobulbar neuritis

Question 652

TIA prevention?

Answer 652

lifestyle modification statins BP control carotid endarterectomy or stenting clopidogrel

Question 653

Hepatitis B treatment for positive surface antigen, + anti-HBc, + IgM, -antiHB, - anti HBe, +HBeAg

Answer 653

acute infection supportive care

Question 654

Patient with +ve HbsAg , +ve anti-HBc, -ve IgM anti HBc, -ve anti HBs. Management?

Answer 654

chronic infection entecavir or peginterferon

Question 655

Good prognosis MI medication (low ejection)

Answer 655

ACEi/ARBs B-blocker Hydralazine Spironolactone Vasodilators and Nitrates

Question 656

Wernicke’s- Guy had confusion, nystagmus and ataxia

Answer 656

pabrinex

Question 657

Minimal change disease - Presentation? Kidney biopsy?

Answer 657

More common in children Nephrotic syndrome - normotension, proteinuria Serum albumin loss Fusion of podocytes

Question 658

Minimal change disease management?

Answer 658

Steroids - Prednisolone Fluid restriction and low salt diet (Steroid resistant - cyclophosphamide)

Question 659

Uteric calculus, currently has infection. WCC raised. Treatment?

Answer 659

Hydration and pain killers Nephrostomy (>0.5 cm) Gent IV

Question 660

Bilirubin in a neonate is high, baby has gone home, mom phones GP and mentions the baby was jaundiced at aged 14 hours. Management?

Answer 660

phototherapy (exchange transfusion only in encephalopathy or hypotonia or bilirubin >95%)

Question 661

ABPI doppler criteria for critical limb ischemia

Answer 661

• >0.9 = normal • 0.4 – 0.9 = intermittent claudication • < 0.4 = critical limb and pain at rest

Question 662

CHADsVASC2 - criteria

Answer 662

• CHF • Hypertension • Age > 75 (2) • Diabetes • Stroke (2) • Vascular – ischaemic heart disease and peripheral arterial disease • Age 65 -74 • Sex - female (If male then consider at 1, and if 2 offer anticoag - stop aspirin)

Question 663

Women couldn’t dorsiflex - nerve damage

Answer 663

Common peroneal nerve

Question 664

Thyroxine, long-term DM, control recently deteriorated thyroxine effects on diabetes.

Answer 664

Increase glucose in thyroxine

Question 665

Infections with Argyll-Robertson?

Answer 665

Occurs in neurosyphilis and diabetes

Question 666

Pt in alcohol outreach team has a convulsion what treatment do you give him?

Answer 666

Treat DT with Diazepam

Question 667

Old ladies husband has passed away what features tell us that she is suffering from depression as opposed to normal grief: diurnal mood variation, agitation, auditory hallucinations of her dead husband

Answer 667

Diurnal mood variation

Question 668

What is a somatic feature of depression?

Answer 668

headaches, backaches, general muscle pain and digestive pain like stomach pain, dizziness, dyspnea [Take, for example, a red and tender joint. The joint is objectively red. It’s a sign everyone can objectively measure or assess. But the pain (the symptom) is only something you can experience and put into context, and is therefore subjective.]

Question 669

Drugs that cause depression

Answer 669

Vigabtrin, topiramte, primidone, phenobarbital, lacosamide, gabapentin

Question 670

The patient comes in with manic episode what treatment should you give him?

Answer 670

Olanzapine Lithium Sodium valproate

Question 671

Lady comes in who use to be heavy alcoholic has ‘echogenic liver’ what test do you do to confirm the diagnosis?

Answer 671

Biopsy liver - to identify why its dense

Question 672

Patient who is 70, hx of MI, with AF -Initial management?

Answer 672

Beta-blockers (Propanolol) or CCB

Question 673

Patient who is 50 with AF and CHF - Initial management?

Answer 673

Sotalol Amiodarone Flecainide

Question 674

What is the definition of critical limb ischemia?

Answer 674

Critical limb ischaemia (CLI) is a manifestation of peripheral arterial disease (PAD) that describes patients with chronic ischaemic rest pain, or patients with ischaemic skin lesions, either ulcers or gangrene

Question 675

What is the common cause for dilated left ventricle in old ladies?

Answer 675

HTN

Question 676

Pt after stoke suffers from double vision, he is very upset by this what do tell him to do?

Answer 676

Optometrists

Question 677

What change occurs in proliferative diabetic retinopathy and not in nonproliferative?

Answer 677

New vessel formation

Question 678

Builder comes in with tingling of hands whats differential, previous hx of neck trauma?

Answer 678

Cervical radiculopathy

Question 679

Pt has food poisoning and develops loss of sensation in legs. Whats diagnosis?

Answer 679

Guilian barre secondary to campylobacter

Question 680

2yr Baby boy with bloody stools?

Answer 680

Shigella (<5 + bloody)

Question 681

Heart condition baby goes blue when feeds? What is likely diagnosis

Answer 681

Transposition of great arteries Tetralogy of Fallot

Question 682

When hip is posteriorly dislocated- described as?

Answer 682

ANS = shortened, flexed, internally rotated, ADDucted

Question 683

Guy has posterior triangle irregular lumps, and some other symptoms of cancer – where is his cancer?

Answer 683

Nasopharynx Other things that can be caused: -temporal bone -ear -skull base

Question 684

Not passing meconium, put finger in and stool is expelled

Answer 684

Hirschprungs

Question 685

Women comes in with incontinence that happens only when she laughs or coughs. What does she have?

Answer 685

stress incontinence

Question 686

Bacterial vaginosis

Answer 686

metronidazole twice a day for 5 to 7 days.

Question 687

Women comes in with incontinecne which occurs when she is laughing and also has urgency.

Answer 687

Mixed incontinence

Question 688

Old man comes in because he has been leaking urine and feeling of incomplete emptiness.

Answer 688

Overflow incontinence

Question 689

How does oxybutinin work?

Answer 689

used to treat incontinence 1st line by decreasing muscle spasms. (anti-cholinergic) But avoid in frail older women

Question 690

8. PV bleed, LMP 6 weeks ago, BHCG high, US shows no sac – Dx?

Answer 690

pregnancy of unknown location

Question 691

5 year old girl wants pill, she threatens she is about to start shagging, what to do?

Answer 691

Give her the damn pill and do not tell her parents or social services cuz Gillick competent and Fraser guidelines

Question 692

When do you refer depressed woman?

Answer 692

Agitation

Question 693

Stroke patient has face and arm UM weakness, sensory loss and Broca’s aphasia where is the stroke?

Answer 693

MCA

Question 694

UPM hemiparesis and apahsia where is the lesion?

Answer 694

MCA

Question 695

Patient comes in with UMN weakness, behavioural abnormalities, where is the lesion?

Answer 695

ACA

Question 696

left Hemineglect and behavioural abnormalities where is the lesion?

Answer 696

ACA

Question 697

Homonymous hemianopia and hemisensory loss in both upper and lower limbs where is the lesion?

Answer 697

PCA

Question 698

Patient who hit his head lost consciousness and then had consciousness right away and was normal. Now presents with headache and confusion. What is it?

Answer 698

Extradural haemorrhage

Question 699

Old lady has confusion and fluctuating consciousness. Her son says that she bumped her head a few weeks ago. What is it?

Answer 699

subdural haemorrhage

Question 700

70 year old man comes in with chronic back pain, leg and thighs. Dull pain that feels cramping. Also has numbness and tingling with claudication.

Answer 700

Lumbar spinal stenosis

Question 701

Rx for lumbar spinal stenosis?

Answer 701

Drugs: NSAIDs, PGE1, gabapentin and vit B1. Physio may have epidrual steroid injections Surgical: traditional laminectomy, bilateral laminotomies

Question 702

What is the next line ix for BPH?

Answer 702

USS CT abdo/pelvis

Question 703

DDx for fresh, red rectal blood

Answer 703

anal fissures, haemorrhoids, cancers and polyps of the rectum and colon diverticulosis

Question 704

CTPA vs d-dimer

Answer 704

Bait PE: CTPA unsure: d-dimer

Question 705

man presents with pain in epigastrium. blood pressure is 200/100, what is it?

Answer 705

Hypertensive crises because bp is >180/110 Rx is labetalol

Question 706

Sudden loss of vision ddx

Answer 706

Stroke TIA acute glaucoma retinal detachment anterior uveitis retinal occulsion

Question 707

Features of innocent murmurs

Answer 707

Seven S: -sensitive (changing position) -short duration (jot holosystolic) -single -small (non-radiating) -soft -sweet -systolic

Question 708

Pregnant first trimester UTI rx?

Answer 708

Nitrofuratoin

Question 709

Pregnant 2nd or 3rd trimester UTI rx?

Answer 709

trimethoprim-sulfamethoxazole

Question 710

Rx for abscence seizures?

Answer 710

clonazepam ethosuximide

Question 711

tonic clonic/ partial seizure rx?

Answer 711

carbamezapine lamotrigine

Question 712

myoclonic seizures rx?

Answer 712

clonazepam lamotrigine

Question 713

Drugs that cause restrictive lung disease?

Answer 713

amiodarone methotrexate nitrofuratoin

Question 714

Diabetic what is the BEST investigation for eyes

Answer 714

digital retinal imaging (put tropicamide first to dilate)

Question 715

Same day STI test?

Answer 715

trichomonas

Question 716

Prolonged (>3 wks) hoarse voice guy who is alcoholic, fat, and ugly. What is first line ix?

Answer 716

CT neck and chest

Question 717

DDx sudden onset RAPD?

Answer 717

optic neuritis severe glaucoma retinal detachment severe macular degeneration

Question 718

What is the bitchy snaky name for GBS?

Answer 718

acute inflammatory demyelinating polyradiculoneuropathy

Question 719

patient long time immunosuppression, post-transplant. What dermatological condition is in the highest risk?

Answer 719

SCC

Question 720

What is the most common cancer is HIV patients

Answer 720

Kaposi sarcoma and lymphoma

Question 721

What is the management of endometrial cancer?

Answer 721

Complete treatment: total hysterectomy+ salphingoophorectomy+ node dissection

Question 722

Types of ovarian tumours?

Answer 722

high serous carcinoma clear cell endometrioid low grade serous mucinous teratoma fibroma

Question 723

At what gestation stage does the sucking reflex manifest?

Answer 723

32 weeks Therefore premature babies <31 wks old need ng tube

Question 724

Cancers that cause osteoporosis

Answer 724

multiple myeloma breast cancer prostate cancer lung cancer

Question 725

Boy comes in. Upper respiratory tract infection followed by red scaling plaques (salmon scaly plaques on back)

Answer 725

guttate psoriasis

Question 726

Acute glaucoma managment?

Answer 726

urgent refer+ acetazolamide + pilocarpine

Question 727

Most common viral meningitis in children cause?

Answer 727

herpes

Question 728

Milestones of 6 wks?

Answer 728

– can smile (refer if cannot smile at 10 weeks)

Question 729

Milestones of 3 months

Answer 729

3 months – good head control (e.g. no head lag, able to lie with head up, can be held sitting), laughs, reaches for objects

Question 730

Milestones of 6mths

Answer 730

6 months – palmar grasp, can pass objects from one hand to another, coos

Question 731

Milestones of 7 months

Answer 731

can sit without support (Refer if cannot sit at 12 months)

Question 732

Milestones of 9 mths

Answer 732

– pulls to standing, crawls, shy but plays peek a boo, takes everything to the mouth (pincer), babble (inc mama, dada(

Question 733

Milestones of 12 mths

Answer 733

12 months – cruises, walks with one hand held (refer if cannot walk at 18 months), good pincer, bangs toys, knows 2 to 6 words (refer at 18 months)

Question 734

Milestones of 18 mths

Answer 734

plays alone (3 bricks)

Question 735

Milestones of 2 yrs

Answer 735

plays near others (not with them) (6 bricks), 2 word sentence, 200 words

Question 736

Milestones of 3 yrs

Answer 736

can ride a tricycle (9 bricks), 3 word sentence, count to 10

Question 737

Milestones of 4 yrs

Answer 737

can hop on one leg, plays with other children, asks W questions

Question 738

Rx for acute anxiety/ panic?

Answer 738

reassurance and benzo

Question 739

Nicotine replacement that is most effective and reduces cravings?

Answer 739

varenicline

Question 740

IgA nephropathy and post strep - a difference in urine dip

Answer 740

IgA has 2+ blood while post strep has 3/4+ IgA has 3+/4+ protein while post strep has 2+

Question 741

Well’s score - used for PE?

Answer 741

Previous PE or DVT (1.5) Clin features of DVT (3) HR > 100 (1.5) Immobilisation for 3 days or surgery in last 4 weeks (1.5) Haemoptysis (1) Cancer (1) PE more likely than any other test (3)

Question 742

not passing meconium, put finger in and stool is expelled

Answer 742

Hirschprungs

Question 743

Baby born 36 weeks, good apgars - what is it?

Answer 743

Respiratory distress

Question 744

Bacterial vaginosis

Answer 744

Metronidazole

Question 745

Goserelin - mechanism of action? side effects?

Answer 745

GnRH agonist - Synthetic hormone. In men, it stops the production of the hormone testosterone, which may stimulate the growth of cancer cells. In women, goserelin decreases the production of the hormone estradiol (which may stimulate the growth of cancer cells) to levels similar to a postmenopausal state. Alopecia; arthralgia; bone pain; breast; depression; gynocomastia; headache; hot flushes

Question 746

Management of pelvic inflammatory disease

Answer 746

Oral Ofloxacin AND metronidazole OR IM ceftriaxone + oral doxy + oral metronidazole

Question 747

Paracetamol OD - liver transplant criteria?

Answer 747

pH < 7.3 or INR > 6.5 AND creatinine > 300 AND encephalopathy III or IV

Question 748

Non Paracetamol OD - liver transplant criteria?

Answer 748

INR >6.5 (PT >100 seconds), or any 3 of the following: age <10 or >40 years; aetiology non-A, non-B hepatitis, or idiosyncratic drug reaction; duration of jaundice before hepatic encephalopathy >7 days; INR >3.5 (PT >50 seconds); serum bilirubin >300 micromol/L (>17.6 mg/dL)

Question 749

Patient who has had a stroke -Is thrombocytopenic and has haematoma Management?

Answer 749

Give FFP/prothrombin complex AND cryoprecipitate Platelet transfusion

Question 750

Taking anti epileptics, taking antidepressants has tremor. Reduced facial movements. What drug is causing side effect?

Answer 750

Carbamazepine Gabapentin Pregabalin Levoterazatam

Question 751

Sudden onset headache and third nerve palsy - Differentials?

Answer 751

Mid brain strokes Cavernous sinus thrombosis Posterior communicating artery aneurysm SAH - due to uncal herniation

Question 752

Focal neurological seizure followed by secondary generalisation lasted for 20 seconds - Next step?

Answer 752

Refer to neurologist

Question 753

Other name for guillan barre syndrome?

Answer 753

Acute inflammation demyelinating polyradiculoneuropathy

Question 754

Better prognosis for SZ

Answer 754

female acute onset of symptoms older age of first episode positive> negative symptoms presence of new symptoms good pre-illness function

Question 755

Worse prognosis for SZ

Answer 755

Early onset FHX structural brain abnormalities

Question 756

Side effects of diazepam?

Answer 756

drowsiness tiredness or fatigue muscle weakness inability to control muscle movements (ataxia) headache tremor dizziness dry mouth or excessive saliva nausea constipation

Question 757

Patient wakes up after anaesthesia. Headache and vertigo on standing up. Relieved completely on lying down. What is the diagnosis?

Answer 757

BPPV

Question 758

FSH high, LH high, Prolactin normal, TSH high, Testosterone normal.

Answer 758

Premature ovarian failure

Question 759

Baby has vomiting than diarrhoea? What is the likely organism?

Answer 759

Rotavirus Campylobacter Salmonella Shigella E coli Ebola - Guinea, Liberia, Sierra-leone

Question 760

New born gets UTI - symptoms?

Answer 760

•fever •vomiting •lethargy or irritability •poor feeding or failure to thrive •jaundice •septicaemia or shock •offensive smelling urine •febrile convulsions

Question 761

Child age 1-5 UTI - symptoms?

Answer 761

•dysuria and frequency •abdominal pain and loin tenderness fever +/- rigors •lethargy and anorexia •vomiting, diarrhoea •haematuria •offensive or cloudy urine •febrile convulsions

Question 762

Child age >5 UTI - symptoms?

Answer 762

have symptoms that are classically described in the adult: •LUTI → dysuria, frequency, supra-pubic pain. Fever may be mild •UUTI → fever, loin pain

Question 763

Risk factor of downs syndrome

Answer 763

Advanced maternal age Previous child with DS Parental karyotype

Question 764

Main advantage of breast milk over formula

Answer 764

Reduces risk of sudden infant death syndrome

Question 765

baby was feeding well for the first 6 hrs of life and then deteriorated - diagnosis?

Answer 765

Cyanotic heart disease

Question 766

What further test do you need to do to make sure LP is safe?

Answer 766

•Cardiorespiratory instability •Focal neurological signs •Signs of raised ICP → coma, Cushing’s response (high BP and bradycardia due to compression of the brainstem) •Coaguloapthy •Thrombocytopenia •Local infection at the site of LP •Performing and LP would delay antibiotic therapy

Question 767

Sickle cell kid with temp of 39 - management?

Answer 767

Ceftriaxone (Vancomycin if meningitis)

Question 768

Man had nose bleed and INR of 4.5 and metallic heart valve what do you do?

Answer 768

Give vitamin K

Question 769

Red painful eye with decreased visual acuity - what to do next?

Answer 769

Pupillary light reflex - Glaucoma (acute)

Question 770

Guy had surgery, complaining of decreased visual acuity, double vision and nystagmus in left eye. - next line?

Answer 770

Patch

Question 771

SLE - pathophys

Answer 771

Cell apoptosis

Question 772

St elevation in leads 1 to 4. After troponin what would you do next?

Answer 772

PCI or thrombolysis

Question 773

Chronic heart failure - management?

Answer 773

ACEi B blocker

Question 774

Guy had AKI after surgery do you assess his fluid balance or saline over 1 hr or calcium gluconate?

Answer 774

Assess fluid balance

Question 775

What is it called when the eye looks in?

Answer 775

Esotropia

Question 775

Interpret this CTG

Answer 775

Late decelerations

Question 776

Interpret the CTG

Answer 776

Early decelerations

Question 777

Interpret this ECG

Answer 777

Inferolateral STEMI

Question 778

Interpret this ECG

Answer 778

Pericarditis

Question 779

Identify this ECG

Answer 779

1st degree Heart block

Question 780

Identify this ECG

Answer 780

Type 2 Heart Block

Mobitz I

Question 781

Identify this ECG

Answer 781

Type 2 Heart Block

Mobitz II

Question 782

Identify this ECG

Answer 782

Complete heart block

Question 783

Identify this ECG

Answer 783

Slow AF

Question 784

Identify this ECG

Answer 784

Atrial fibrillation

Question 785

Identify this ECG

Answer 785

Pulmonary Embolism

Question 786

Identify this ECG

Answer 786

Ventricular Tachycardia

Question 787

Identify this ECG

Answer 787

Torsades

Question 788

Identify this ECG

Answer 788

AVNRT

Question 789

Identify this ECG

Answer 789

Ventricular fibrillation

Question 790

Identify this ECG

Answer 790

hyperkalaemia

Question 791

Identify this ECG

Answer 791

Atrial flutter

Question 792

Identify this ECG

Answer 792

Unstable angina

Question 792

Identify this ECG

Answer 792

Atrial fibrillation

Question 794

These white rashes found in newborn on the sole of hands and feet. What is this?

Answer 794

Congenital syphilis (rare in UK now)

Question 795

Newborn with hydropcephalus, intracranial calcification, acute fundal chorioretinitis as shown below. What is this?

Answer 795

Congenital toxoplasmosis

Question 796

A 35-year-old female patient presents to you in the cardiology department with a sharp, stabbing chest pain behind the breastbone. The pain does not radiate to any other region of the body and on questioning she refutes feeling sweaty and has not experienced any nausea and vomiting. She explains the pain is worse at night when she is lying flat in bed and improves somewhat once she sits up. She discloses that she has been diagnosed with systemic lupus and is taking regular medication for this. On auscultation you note scratchy, rubbing sounds loudest during systole.

Answer 796

Pericarditis

• widespread saddle shaped ST elevation
• PR depression: most specific ECG marker

*note that SLE or any rhematic disease is a risk of getting pericarditis

Question 797

what is this?

Answer 797

Inferolateral STEMI

ST elevation in leads II, III and aVF

Progressive development of Q waves in II, III and aVF

Reciprocal ST depression in aVL (± lead I)

Question 798

What is it?

Answer 798

Mongolian Blue spot

Question 799

A 4-year-old boy develops multiple tear-drop papules on his trunk and limbs. He is otherwise well.

Hx of streptococcal infection 3 wks ago.

Answer 799

Guttate psoriasis

-Most cases resolve spontaneoulsy within 2-3mths

Question 800

A middle aged man develops a non-pruritic rash after starting allopurinol therapy for gout. The rash develop within 24 hours and started on the back of his hands.

Answer 800

Erythema multiforme

• target lesions that starts in the back of hands and feet then spread to torso
• upper limbs affected more commonly

Question 801

A 30-year-old man presents with a two-week history of a productive cough. Whilst examining him you notice a large number of atypical naevi over his torso. On his back you count between 20-25 moles. He reports no change in any of his moles, no bleeding and no itch. One particular mole is noted due to the irregular border. It is 6 * 4 mm in size.

Answer 801

Superficial melanoma

• mostly affects arms, legs, back and chest
• more in young people

*Remember changes in size, shape and color

Question 802

What is this?

Answer 802

Squamous cell carcinoma

-characterised: raised, keratotic (scaly, crusty), ill-defined nodule, may be ulcerated

Question 803

What is it?

Answer 803

Basal Cell carcinoma

• nodular is most common
• characterised: skin-colored, surface telangiectasia, pearly rolled edge, ulcerated center

Question 804

What is it?

Answer 804

Actinic keratosis

*premalignant lesion–> SCC

-characterised:

small, crusty or scaly, lesions

may be pink, red, brown or the same colour as the skin

typically on sun-exposed areas e.g. temples of head

multiple lesions may be present

Question 805

What is it?

Answer 805

Bowen’s disease

*intradermal SCC

-characterised:

red, scaly patches

often occur on sun-exposed areas such as the lower limbs

-more common in older females

Question 806

What is it?

Answer 806

Erythema nodosum

• seen in IBD (crohn’s, UC)
• characterised:

inflammation of subcutaneous fat

typically causes tender, erythematous, nodular lesions

usually occurs over shins, may also occur elsewhere (e.g. forearms, thighs)

usually resolves within 6 weeks

lesions heal without scarring

Question 807

Patient comes in with persistent ulceration of the mouth, pain and sore throat.

O/E: neck lymphadenopathy and inside mouth (pic below)

Answer 807

Oropharyngeal cancer

Question 808

What is it?

Answer 808

Systemic sclerosis

-Characterised: sclerodactyly, skin thickening, raynaud’s phenomenon, swelling of hands and feet

Question 809

What is it?

Answer 809

Lentigo melanoma

Question 810

what is it?

Answer 810

Acanthosis nigricans

Question 811

what is it?

cause?

Answer 811

Red man syndrome

Vancomycin

Question 812

What is it?

Answer 812

Subungal melanoma

Question 813

Diagnosis?

Answer 813

Central Retinal Vein Occlusion

Question 814

Diagnosis?

Answer 814

Central retinal artery occlusion

Question 815

Diagnosis?

Answer 815

Papilloedema

Question 816

Diagnosis?

Answer 816

Diabetes retinopathy

Question 817

What is it?

Answer 817

Hypermetropia

Eye turn upwards

Question 818

What is it?

Answer 818

Exotropia

Eye turns outward

Question 819

What is it?

Answer 819

Anterior uveitis

Question 820

What is it?

Answer 820

Diabetic non proliferative retinopathy

Question 821

Diagnosis?

Signs?

Answer 821

Respiratory distress syndrome - ground glass

Question 822

Diagnosis?

Answer 822

GI perforation

Question 823

What is it?

Answer 823

Gottrons papules

Question 824

Diagnosis?

Answer 824

Lupus pernio

Question 825

CD4+ AIDS infections

Answer 825

:)

Question 826

Identify bleed?

Vessel Affected?

Answer 826

MCA

Ischemic stroke

Question 827

Identify bleed?

Vessels affected?

Answer 827

Subdural haematoma

Bridging veins

Question 828

Identify type of bleed?

Vessel?

Answer 828

Extradural/Epidural haematoma

Middle meningeal artery

Question 829

Identify the type of bleed?

Answer 829

Subarachnoid haemorrhage

Question 830

Identify the type of bleed?

Answer 830

Intracerebral haemorrhage

Question 831

Bilirubin graph for newborn

Answer 831

:)

Question 832

Staging for colorectal cancer

Answer 832

Dukes criteria