MaM mocks Flashcards
Answers are uptodate and defo correct
Bumetanide 1mg PO -> Furosemide has poor bioavailability. Therefore IV to Oral there is a need to have a high dose. This means that another loop diuretic such as bumetanide is needed.
NaCl Fluids -> the fluids are needed as this is likely to be Fast AF due to hypovolaemia and therefore reversible AF. Reversing the cause can treat this. The hypovolaemia is suggested by the tachycardia and also by the fact there is history of vomiting.
Isosorbide mononitrite -> This is a vasodilator, this can lead to reduced CO and so can lead to a drop in BP…
Beta blockers are actually used in HF and are not contraindicated in patients with AS
Metformin is stopped 48 hours before surgery to reduce the risk of lactic acidosis however does not need to be stopped upon discharge
Apixaban should again be stopped before surgery.
Tricuspid Regurg PSM on the RSE 4th intercostal space is characteristic of this.
Repeat OGD in 6 months -> For low grade dysplasia, there is a need to do a repeat OGD at 6 months if there is evidence of low grade dysplasia at 2 separate points before the use of endoscopic intervention of Barrets oesophagus with dysplasia
Albuminocytologic dissociation -> Seen in GBS…
Increase in protiens and a normal white cell count.
Oligoclonal IgG antibodies are associated with MS…
Xanthochromia -> SAH
Indian ink stain suggests -> Cryptoformus neoformis
Campylobacter Jejuni -> Common cause of bloody diarrhoea caused by undercooked paultry.
Histolytica does not cause bloody diarrhoea
E.coli can present like this but takes a week
Tertiary HyperPTH -> long term CKD leads to PTH being hypertrophic -> this makes it more likley.
Kidney transplant or no kidney transplant changes the phosphate level
Papillary
Follicular
Medullary
Thyroid cancers
Buzzworddsss
Papillary -> thyroglobulin + most common Psamomma bodies
Follicular -> Thyroglobulin
MEdullary -> Calcitonin + MEN 2
L-DOPA and DOPA-Decarboxylase inhibitor -> The decoarboxulase inhibitor will stop the Dopamine beibnng activated in the peripheries and make this so that is only works centrally.
Amitriptyline
There are 3 main preventative treatment for mrecurrant migraines they are -> Propanolol + topiramate and Amitriptyline
Bisoprolol is a cardioselective inhibitor used for rate control in AF
Aspirin can be used in the acute manageme t of migraines but is contraindicated in children less than 16
High HCO3- the reversible equation tilts to one direction and so it causes there to be raised levels of HCO3-
The hernia is direct if it appears upon coughing while your finger is pressed down on the deep inguinal hernia
Additionally inguinal hernias present medial and above the pubic tubercle.
The most common between indirect or direct inguinal hernia is indirect inguinal hernia.
Left hemicolectomy with end colostony and mucus fistula ->
Hartman is often used in emergency scenarois of a perforation or infection. IT is useually used in the context of diverticulitis or colon cancer.
Subacromial impingement syndrome
The above presents with progressive pains worsend by abduction notably between 60-120 degrees
Ahill-sach lesion-> Compression fracture in the head of the humerus following impaction of the humeral head against the glenoid labrum arising from anterior shoulder disloaction or instability
Adhesive capsulitis -> Limited range of movement of the shoulder joint particularly affecting ecternal rotation and flexion of the shoulder. This patient has full range of motion making this less likely
Fracture of the head of the humerus is unlikkely as there is no trauma history.
Subscapularis tear -> This presents with weakness in abduction, which this patient is not experiencing.
Intrarticular steroid injections -> Adhesive capsulitis is initially treated wtih physiotherapy, the next line in management isintraarticular steroid therapy
Wduaion and assurace should have been offered at the time of diagnosis
Repeat physiotherapy could have been used if there was an improvement in symtptoms
Surgical release is only indicated after ther extensie therapy has been unsuccessful often after 3 monts
Bread cancer -> the features descibed sounds likel inflammtory breast cancer. This cancer mimics mastitis. The skin tetheringm pitting og the areola should be raising alrm bells of cancer.
Fat necrosis -> After breast trauma
Fibrocystic disease -> Bilateral breast changes that occur cyclically in pre menopausal women
Fibroadeonma -> Smooth well demarcated benign stromal tumour
Throat culture -> throat swab is the gold standard.
Antistreptolysin is less useful as it cannot determine previous vs current infection.
Rapid strptococcal antigent test is faster than throat swab but is less sensitive
Analgesia -> The patient has symptroms and it is causeing them diffficulties. The management of viral tonsillitis is supportive and this can be done with analgesia.
A 64-year-old woman is receiving CPR following a cardiac arrest. She has received three shocks from the defibrillator as her initial rhythm was ventricular fibrillation, but at her next rhythm check, organised, regular QRS patterns, each with an associated P wave are seen. Unfortunately, there is still no palpable pulse and chest compressions are restarted.
What is the next most appropriate step in her management?
A) Defibrillation
B) IV Adrenaline 1mg (1:1000)
C) IV Adrenaline 1 mg (1:1000) and IV Amiodarone 300 mg
D) IV Amiodarone 300mg
E) IV Alteplase
IV adrenaline 1mg (1:1000)
This is a description of pulseless electrical activity. This is not shockable and a dose of adrenaline needs to be administered as soon as this is recognised.
Amiodarone is only needed if she was still in a shockable rhythm and finished having her 3 shocks. As she has changed to a non-shockable rhythm this is no longer indicated.
The alteplase would be indicated if the arrest was due to a PE.
A 61-year-old man presents to his GP with ongoing itching, aching, and occasional bleeding of the varicose veins in his legs. His symptoms have been bothering him for the last 6 months despite getting regular exercise and keeping his legs elevated at night. He is referred to a vascular surgeon for specialist input.
What intervention are they most likely to offer?
A) Surgical Avulsion
B) Start Atorvastatin
C) Continue Conservative Management
D) Endothermal Radiofrequency Ablation
E) Surgical Vein Stripping
Endothermal Radiofrequency ablation
Conservativ emanaged cant be used again as this has been ineffective. additionally the symptoms are impacting patients life
Endotheram ablation is preferred as it is less invasive than traditiona; surgical approaches
Surgical avulsion is not used really
Statin is used to modify risk factos
Surgical stripping should be considered if other management options are not successful.
A 70-year-old man is attending the vascular outpatient clinic. He has a known abdominal aortic aneurysm (AAA) and the ultrasound performed today measures its diameter at 5.1 cm. Last year, the diameter was 3.9 cm. He has no symptoms at present.
What is the most appropriate management option?
A) Surgical Consideration
B) 3-Monthly Ultrasound
C) Discharge from Clinic
D) Annual Ultrasound
E) Ambulance Transfer to A&E
surgical consideration
this is because the patient had a AAA that increased in size > 1cm over a year and so needs to be cosidered for removal
A 49-year-old woman is receiving bystander CPR in the community after collapsing on the street. The paramedics arrive and confirm cardiac arrest. Upon attaching the defibrillation pads, the monitor reveals no evidence of cardiac electrical activity. Chest compressions are immediately restarted.
Which of the following is most appropriate at this point?
A) Administer Shock
B) IV Adrenaline 1 mg (1:1000) and IV Amiodarone 300mg
C) IV Adrenaline 1 mg (1:1000)
D) IV Amiodarone 300 mg
E) No Drugs Until 3 Shocks Administered
IV adrenaline 1mg (1:1000)
asystole, which is a non-shockable rhythm. The non-shockable arm of the ALS algorithm recommends administering IV Adrenaline 1 mg (1:1000) as soon as IV access is obtained and it should then be given every 2-3 minutes thereafter.
A: Defibrillation is recommended for shockable rhythms (ventricular fibrillation and pulseless ventricular tachycardia).
B: Amiodarone is not administered for non-shockable rhythms.
D: IV Amiodarone 300 mg is used in shockable rhythms once three shocks have been administered.
E: Adrenaline should be administered as soon as possible once a non-shockable rhythm has been identified
A 22-year-old woman has been admitted to the gastroenterology ward after presenting with new-onset confusion and abdominal distension. An ultrasound of her abdomen reveals a craggy liver edge and small volume ascites. She has been feeling unwell for the past year but did not seek medical attention. She has no other medical history, however, she is currently receiving dialectical behavioural therapy for emotionally unstable personality disorder. Her LFTs are reported below.
Bili 62 3-17
ALT 254 < 40
AST 198 3-30
Alb 24 35-50
Given the most likely diagnosis, which other initial investigation should be requested?
A)Serum Caeruloplasmin
B)Serum Ferritin
C)Serum Alpha-1 Antitrypsin
D)MRI Brain
E)Genetic Testing
Seum Ceruloplasmin
Wilson’s disease is an autosomal recessive condition in which copper accumulates in various tissues across the body, in particular, the brain and liver. It results in** liver failure** at a young age along with various** neuropsychiatric manifestations** such as atremor and emotional lability (which may be masked by a psychiatric diagnosis). The most common causes of liver failure are alcoholic liver disease, non-alcoholic steatohepatitis and viral hepatitis, however, in young patients, other causes to consider include Wilson’s disease, hereditary haemochromatosis and alpha-1 antitrypsin deficiency. Wilson’s disease results from a deficiency in caeruloplasmin, the main copper transporting molecule in the body. This results in an increase in free copper which, subsequently, deposits in the tissues. Serum caeruloplasmin is a useful initial investigation as low levels would be suggestive of Wilson’s disease.
B:* Serum ferritin* would be useful in* hereditary haemochromatosis, which can presents with liver failure but is also likely to cause diabetes mellitus* (due to pancreatic deposits) and bronzed skin (due to skin deposits). It is less likely to cause neuropsychiatric symptoms.
C: Alpha-1 antitrypsin deficiency typically causes liver failure and* early-onset emphysema*.
D: MRI brain may be useful to visualise the copper deposits, however, it would not be the most appropriate initial investigation
Hesselbach’s triangle is an anatomical landmark that demarcates the areas of weakness in the abdominal wall through which abdominal contents could herniate.
Which one of the following statements is true with regards to hernias?
A) Indirect inguinal hernias occur medial to the inferior epigastric vessels
B) Inguinal hernias are typically found superior and lateral to the pubic tubercle
C) Direct inguinal hernias typically herniate along the medial border of the rectus abdominis muscle
D) The deep inguinal ring is located within Hesselbach’s triangle
E) Direct inguinal hernias occur medial to the inferior epigastric vessels
Direct inguinal hernias ccur medial to the inferior epigastric vessels
Hesselbach’striangle is an anatomical landmark that demarcates the potential areas of weakness in the anterior abdominal wall through which herniation can occur.
It has three borders:
● Medial: lateral border of the rectus abdominis
● Lateral: inferior epigastric vessels
● Inferior: inguinal ligament
In a direct inguinal hernia, the viscera herniates through Hesselbach’s triangle (medial to the inferior epigastric vessels). In an indirect inguinal hernia, the viscera passes through the deep inguinal ring and along the inguinal canal. It, therefore, arises lateral to the inferior epigastric vessels.
A 74-year-old female presented to hospital with increasing confusion. It is difficult to take a history or get a collateral. Bloods show the sodium is 98. There are no previous blood results available and there is no other potential source of the confusion identified. The patient has not had any seizures. On examination the patient is clinically dry. The patient had been started on a slow bag of 0.9% saline overnight.
How frequently should the sodiumvalue have been measured with VBGs?
A) 12 hourly VBGs
B) 2 hourly VBGs
C) 6 hourly VBGS
D) 24hrly VBGs
E) 30mins VBGs
2 hourly VBGs
There is a worry about raising the sodium too quickle and causing demylination, to prevent this there is a need to take 2 hourly VBFS intially. with a formal U+Es every 4-6 hours. This is so that if the rate is increasing to greatly then a dextrose infusion can be given.
A 72-year-old woman presents to a follow-up clinic after being notified that her faecal immunohistochemical test produced a positive result. Upon questioning, she has not noted any change in bowel habit but has been experiencing increasing fatigue over thelast 3 months. After undergoing further investigations, including a colonoscopy and a staging CT scan, she is diagnosed with a T3N1M0 colorectal adenocarcinoma of the ascending colon.
What is likely to be the most appropriate surgical approach to manage this case?
A) Extended Right Hemicolectomy
B) Hartmann’s Procedure
C) Anterior Resection
D) Abdomino-Perineal Resection
E) Right Hemicolectomy
Right Hemicolectomy
In Caecal or ascending cancers there is a need to do a right hemicolectomy
In transverse cancers there is a need to an exttended right hemicolectomy
An anterior resection is done i there is a cancer greater than 5 cm from the anal verge. The operation leaves the acus intact. This however requrires a temporary loop ileostomy as a way for the anastamosis to heal.
Hartman’s is doe in emergencied and is used to manage acute mamanegement of the sigmoid colon aka diverticular obstruction or bowel obstruction. Often results in a endcolostomy and a rectal stump.
A 74-year-old man is recovering on the elderly medicine ward after developing a severe community-acquired pneumonia. He had responded well to antibiotics, however, he is noted to have become very hyperglycaemic.
His investigation results are shown below.
Glucose 32 4-7
Ketone 0.1 < 0.6
pH 7.4 7.35-7.45
Na 155 135-145
Ur 7.2 2-7
Which of the following correctly describes the diagnosis and management plan?
A)HHS, Fixed-Rate Insulin Infusion
B) DKA, Variable-Rate Insulin Infusion
C) DKA, Fixed-Rate Insulin Infusion
D) HHS, IV Fluids
E) Isolated Hyperglycaemia, STAT Actrapid
HHS, IV fluids
Serum osmolality = 2(Na) + Ur + Glu
Diagnosis of HHS:
- BM levels > 30
- Serum osmolality >320 mOsmol/kg
- Hypovolaemia
A 32-year-old woman is referred to the neurology clinic due to complaints of recurrent headaches. The headaches are particularly bad when going to bed and are associated with nausea. She has noticed some blurring of her vision but has not noted any manifestations typical of an aura.
Cranial nerve examination is normal, however, fundoscopy reveals swelling of the optic discs bilaterally with blurring of the margins.
An urgent CT head scan is requested which is reported as being normal. She undergoes a lumbar puncture which reveals no abnormalities other than an opening pressure of 31 cm H2O (5-25). She has a background of well-controlled systemic lupus erythematosus.
What is the most appropriate management option?
A) Topiramate
B) Acetazolamide
C) Propranolol
D) Verapamil
E) Lumbar-Peritoneal Shunt
Acetazolamide -> They are suffering from a raised ICP. This is the first line pharmacological management
The topiramate is the managment of an acute migraine
The propanalol is the long term management of this
The Lumbar peritoneal shunt would be used if the raised ICP is persisitant after medical managmeent
A 48-year-old woman presents to her GP surgery complaining of pain in her right eye that has been bothering her for 3 days. It has been associated with neck pain.
On examination, she has reduced visual acuity in her right eye but both pupils are equal and reactive to light. The patient complains of right eye pain when eye movements are tested. The rest of the neurological examination is unremarkable.
Upon examination of her neck, she complains of a tingling sensation in her fingers and a shooting sensation down her spine.
What is the name of this clinical sign?
A) Uhthoff’s Phenomenon
B) Kernig’s Sign
C) Brudzinski Sign
D) Lhermitte’s Sign
E) Babinski Sign
Lhermitte sign
So the pain in the eye with reduced visual acuity was suggestive of Multiple sclerosis.
This sign is seen that when the patient flexes the neck they get parathersiia in the upper limbs and trunk. Often associated with MS, cervical spondylosis, cervical spinal cord tumour.
A 45-year-old man has been under investigation by the respiratory medicine department for chronic shortness of breath. It began 6 months ago and has progressed steadily in that time. He does not complain of a cough,and he has never smoked. He has, however, become increasingly lethargic over this period and has developed vague joint pains. His CXR is shown below.
Given the most likely diagnosis, which of the following investigations may also be useful?
A) Serum Vitamin D
B) Serum Ca 19-9
C) Serum aFP
D) Serum LDH
E) Serum ACE
Serum ACE
This patient has sarcoidosis….
The non-pulmonary features of sarcoidodid include -> lethargy, joint pain, neuropathy and erythema nodosum and uveitis. ACE is a surrogate marker for granuloma burden in the body and is elvated in sarcoidosis patients. It is released bu macrophages in the granulomas
Vitamin D taht is measured are the precursor levels and as sarcoidosis is activates Vitamin D the precursor levels will not highlight a surplus of activated Vitamin D.
A 42-year-old woman is brought into A&E with severe shortness of breath and a fever. The fever began 2 days ago, however, the shortness of breath has become particularly bad only today. She has taken several puffs of her salbutamol inhaler, however, it hasnot given her any relief. She has a background of poorly controlled type II diabetes mellitus and asthma, and she has recently been in contact with someone who tested positive for COVID-19. Her admission observations and bloods are shown below:
A CXR and PCR confirm COVID-19 pneumonitis.
What is the most appropriate treatment option?
A) Supplementary oxygen therapy only
B) Dexamethasone only
C) Remdesivir only
D) Remdesivir and Dexamethasone
E) Non-invasive ventilation
Dexamethasone only
Remdesvir, Oxygen therapy and dexamethasone are all treatments of COVID 19 pneumonitis
HOWEVER Remdesevirs is contraindicated in Renal impairement <30 mL/min or if ALT > x5 upper limit normal
An 81-year-old woman has desaturated and become acutely short of breath on the elderly medicine ward. She is currently being treated with IV ciprofloxacin for urosepsis and was improving clinically until today. A CXR reveals no abnormalities so a CTPA is requested due to high clinical suspicion of a PE.
CTPA Report: pulmonary embolus in the left lower lobar branch of the pulmonary artery.
The patient has a background of CKD with a baseline eGFR of 18 mL/min. He is started on an IV heparin infusion.
Which of the following is required as part of the monitoring requirements for a heparin infusion?
A) INR
B) PT
C) APTT
D) APTT Ratio
E) Fibrinogen
APTT ratio
Unfractioned heparin has a very short half life compared to low molecular weight heparn so will be given as an infusion.
Heparins are anti thrombin III enhancers -> It leads to the ability for anti thrombin III binding and inhibitin factor 2 4 10 and 11. As these factors are involved in the intrinsic pathway the APTT is needed,
Anti Xa can be used but to help results to be followed earier often the APTT will be expressed as a ration as a way to better monitor the infusion of unfractioned heparin
A 42-year-old woman presents to the GP with a 6-month history of tiredness and 3 kg of unintentional weight loss.
On further questioning, she reveals an extensive family history for colorectal cancer with her father being diagnosed aged 50 years and her paternal grandmother being diagnosed aged 60 years.
She is sent for further investigation including colonoscopy and genetic testing. A mutation in a DNA mismatch repair gene (MLH1) was identified.
After colorectal cancer, which cancer is next most closely associated with the underlying diagnosis?
A) Endometrial Cancer
B) Thyroid Cancer
C) Gastric Cancer
D) Pancreatic Cancer
E) Breast Cancer
Endometrial cancer
the inheritable cancers include HNPCC and FAP.
If you have the gene for HNPCC there is a near garuntee that you will have a cancer… This is also the more common reason for inheritable cancers…
HNPCC is also heavily linked with enndometrial cancers.
A 16-year-old man presented to A&E with severe abdominal pain. He has vomited 3 times this morning butdenies dysuria or a change in bowel habit. On examination, he is hot and clammy, with diffuse abdominal tenderness, worse in the right lower abdomen. His observations and blood test results are shown below.
Which of the following is the most appropriate initial management option?
A) Ultrasound Scan
B) CT Scan
C) MRI Scan
D) IV Morphine
E) Bleep the registrar about taking the patient to theatre
Bleep the regitrar about taking patient to the theatre
the diagnosis is Acute appendicitis… this patient is acutely unwell considering his low BP and the relevant team needs to be notified first before starting the invetigations or management,,,,
In regards to this case a clinical diagnosis can be made
Ultrasound and CT scans can be used to aids diagnosis
Ultrasound can’t rule out diagnosis
CT scan is generally avoided in younger patients due to radiation worries.
A 58-year-old man presents to his GP with complaints of persistent lower abdominal discomfort. He has a background of hypertension, type 2 diabetes mellitus and constipation, and has a BMI of 28 kg/m2. On abdominal examination, he has mild tenderness on deep palpation of the left lower quadrant. His current observations are shown below.
He is referred for an outpatient CT abdomen and pelvis with contrast which reveals multiple outpouchings of the colonic wall in the distal sigmoid colon.
Which of the following is the most appropriate management option?
A) Diagnostic Laparoscopy
B) Reassure and Discharge
C) Analgesia and Antibiotic Therapy
D) Analgesia and Dietary Advice
E) Inpatient Colonoscopy
Analgesia and diettary advice
The CT rules out Cancer and there is no need for colonoscopy for this reason as there are also no features of a cancer
Therfore as the diverticular disease is not infected or bleeding this can be managed conservatively with analgesia and a high fibre diet
A 40-year-old former semi-professional footballer presents to the knee clinic. He had previously presented to his GP with bilateral knee pain. On examination, he was found to have bilateral crepitus and varus deformity. X-rays confirmed bilateral medial compartment osteoarthritis, worse on the left. He has undergone a course of intensive physiotherapy with good compliance but is still finding his symptoms unbearable.
After discussion, he elects to undergo a left medial compartment knee replacement.When should rehabilitation be offered?
A) No more than 12 hours after surgery
B) No more than 24 hours after surgery
C) Patient must wait 36 hours after surgery before mobilising
D) Patient must wait 72 hours after surgery before mobilising
E) Patient must wait one week after surgery before mobilising
no more than 24 hours post surg
Guidelines state Physio should be done on the day of the surgery and this rehabilitation includes mobilisation of people who have had knee or hip replacement as errl as advice on managing activities of daily living ot home exercises.
A 65-year-old man who has recently received his third cycle of chemotherapy for multiple myeloma has been brought in by ambulance after becoming very unwell at home. Upon arrival in resus, his blood pressure is 88/62 mm Hg with a heart rate of 112 bpm and a temperature of 39.8C. He is commenced on empirical antibiotics for presumed neutropenic sepsis and given 3 x 500 mL fluid boluses without a satisfactory improvement in his blood pressure. Aside from the multiple myeloma, he has no other past medical history.
Which of the following additional agents would be most appropriate in this patient?
A) Dobutamine
B) Metaraminol
C) Adrenaline
D) Milrinone
E) Epoprostenol
Metaraminol
Metaraminol is a alpjha 1 agonist and a vasoconstrictor like this is needed. Apparently the metaraminol is better and is great if the patient doesnt not have a central line.
Adrenaline would increase both the HR and the BP
Dobutamine -> improves the contractility of the heart.
This 45-year-old male presents for review 1-week after receiving his first round of chemotherapy for acute lymphoblastic leukaemia. His blood test results are shown below.
Which of the following additional investigations is most helpful in confirming the underlying diagnosis?
A) CT CAP
B) Serum Urate
C) ECG
D) Biopsy of Lymph Node
E) Venous Blood Gas
Serum Urate
This patient has Tumour lysis syndrome. This is associated with chemotherapy of leukaemia and lymphoma.
Electrolyte changes seen inc:
* Urate > 476 or 25% increase from baseline
* K+ > 6 or 25% increase from baseline
* PO4 >1.45 or 25% increase from baseline
* Ca < 1.75 or 25% increase from baseline
It can lead to AKI or suddent death as well as arrythmias
A 23-year-old man has presented to A&E with a 1-day history of intense right loin pain associated with vomiting. On examination, his abdomen is soft and nontender and the patient’s pain has improved with a PR diclofenac. He denies dysuria and is able to provide a urine sample. A subsequent non-contrast CT KUB reveals a 21 mm stone in the right renal pelvis. There is no hydronephrosis and his renal function is normal.
What is the most appropriate management option?
A) Extracorporeal Shock Wave Lithotripsy
B) Percutaneous Nephrostomy
C) Percutaneous Nephrolithotomy
D) JJ Stent Insertion
E) Ureteroscopic Lithotripsy
Percutaneous Nephrolithotripsy
This is a large renal calculus that will require direct removal,
Extracorporeal shockwave lithotripsy may be considered for stones smaller than 20mm
Percutaneous nephrostomy is an emergency decompress
JJ stents are inserted for obstructed ureters, stones tumours or retroperitoneal fobrosis
Ureteroscopic lithotripsy is primarily used for lower ureteric stones
A primigravida 31-year-old woman on the labour ward, who is at term, is complaining of severe pain during contractions. Her pregnancy has been uneventful so far. She requests an epidural as she cannot tolerate the pain any longer. The anaesthetist draws up a syringe of low-dose mix containing bupivacaine and fentanyl. She begins performing the procedure, inserting the needle into the L3/L4 space, but notices cerebrospinal fluid leaking through the catheter.
What is the main concern if the anaesthetist proceeds in injecting the full syringe?
A) Cardiac arrest
B) Direct trauma to spinal cord
C) Inadequate analgesia for the patient
D) Intravascular injection of medication
E) Severe headache on injection
Cardiac arrest
The leakage of fluid suggests that the needle is within the dura and therefore in the subarachnoid space.
If the dose was given in the subasrachnoid space then there is achance that the anaesthetic block will extend above the desired level above T4 and result in a a dangerous bradycardia and life thretening hypotension….
A 72-year-old man has presented to A&E after his wife noticed that he was drooling and had become weak on his right side. He has a CT head scan which reveals no intracranial haemorrhage,so he is given 300 mg Aspirin STAT. He has been reviewed by the speech and language therapist and his swallow has been deemed unsafe. He is noted to be very tachycardic and has an ECG which reveals atrial fibrillation with a rapid ventricular response (180 bpm).
Which of the following beta-blockers would be most appropriate to rate control this patient?
A) Propranolol
B) Metoprolol
C) Bisoprolol
D) Labetalol
E) Sotalol
Metoprolol
Bisoprolol is the first line in treating AF with rate control medications such as B eta blockers. BUTTT this persion is nbm and so there is a need to have a medications that can be delivered by a different route and that Beta blockers is metoprolol
Another possible option is IV atenolol
Other than that labetolol can come in an IV preparation but this is non-cardioselective and is more indicatedd for high blood pressure,
A 75-year-old man has been admitted to hospital after having a fall at home. He has sustained a Colles’ fracture of his right wrist and is being reviewed by the orthopaedic team. He has an ECG upon admission (shown below).
What is the most likely diagnosis?
A) Complete Heart Block
B) Paced Rhythm
C) Premature Ventricular Complex
D) Ventricular Escape Rhythm
E) Junctional Bradycardia
Premature Ventricular complex
Ventricular because it is wide. Premature becuase it is before the anticipated next heart beat.
A 47-year-old man visits his GP complaining of epigastric pain that is particularly bad after spicy meals and is exacerbated by lying down. He is diagnosed with gastro-oesophageal reflux disease and is prescribed omeprazole 20 mg OD.
Which of the following is associated with omeprazole use?
A) Pancreatic Cancer
B) Hypernatraemia
C) Fractures
D) Norovirus Infection
E) Somnolence
Fractures
Omeprazole is a PPI. There is an increased risk of osteoperosis with omeprazol and increased riisk of fractyres.
There is also an increased risk of C.Diff infection and hyponatraeima.
It can increase the risk of gastric cancer with long term use.
Nizatidine is an alternative to treat gord.
A 34-year-old woman is referred to the outpatient gastroenterology clinic after her epigastric pain, thought to be gastro-oesophageal reflux, failed to improve with a trial of proton-pump inhibitors. A full blood count reveals microcytic anaemia, so an
OGD is arranged (report below).
OGD: normal appearance of proximal oesophagus, extensive ulceration seen across loweroesophagus, stomach and proximal duodenum.
Given the most likely diagnosis, which of the following investigations would be most appropriate?
A) Urease Breath Test
B) Serum Gastrin
C) Oesophageal Manometry
D) Haematinics
E) CT Abdomen and Pelvis
Serum Gastrin -> The extensive ulceration with multiple locations is suggestive of zollinger ellison syndrome. This conditions results in an excess production of gastrin and produces gastric acid.
A 44-year-old man underwent an endoscopy for persistent epigastric pain and dyspepsia that was refractory to treatment with omeprazole. A biopsy from the lower oesophagus was reported by the histopathologist as being consistent with Barrett’s oesophagus.
Which of the following types of epitheliawould you expect to see in the affected area?
A) Keratinising Squamous
B) Non-Keratinising Squamous
C) Ciliated Columnar
D) Non-Ciliated Columnar
E) Transitional
Non-ciliated Columnar
Barrets oesophagus is the metaplasia of the oesophageal cells to the stomach cells. These cells are columnar and non-cilated.
Ciliated columnar cells are found in airways
Keratinisisng Squamous is found in the skin
Non-keratinising squamous is found in the oesophagus
Transitional is found in the urinary tract.
A 46-year-old female presents to her GP with intermittent palpitations and sweating. She has noticed she has lost weight recently and that she has developed a tremor in her hands. Otherwise, she is usually fit and well. She smokes 3 packs of cigarettes a week and drinks minimal alcohol.
Her main concern is that her neck feels larger, and given hermother and sister have hyperthyroidism, she is keen to have some thyroid function tests. She explains her sister has been visiting an endocrinologist as she has been having issues with her eyes.
Which of the following is the strongest prognostic factor for the development of Graves’ eye disease?
A) Family History
B) Smoking
C) TSH Receptor Antibody Titre
D) Radioactive Iodine Treatment
E) Single Nucleotide Polymorphisms
Smoking -> This is the risk factor most liked with the progression and the severity of Graves disase.
TSH receptor antibody levels -> is somewhat useful in checking to response to treatment and predictiong disease course but not eye disease
Family history, radioiodine and some single nucleotide polymorphisms are all associated with higher risk of thyroid eye disease by far the biggest risk factor is smoking.
A 66-year-old female is admitted to hospital with fever, a productive cough and chest discomfort. On examination, she has well perfused peripheries with a normal, regular pulse. The JVP is not visible. On chest auscultation, there are crepitations over theright lung base. There is also a dull percussion note over this area andincreased vocal resonance. There is no pitting oedema of the sacrum or lower limbs. Her past medical history includes type 2 diabetes mellitus, hypertension, ischaemic heart disease, heart failure, and hypothyroidism. Her regular medications are levothyroxine, metformin, gliclazide, ramipril, indapamide, bisoprolol and isosorbide mononitrate. Her initial blood tests show raised inflammatory markers, as well as a serum sodium concentration of 120 mmol/L. Therefore, a hyponatraemia screen is completed (results below).
What is the most likely diagnosis?
A) Diabetes Insipidus
B) Adrenal Insufficiency
C) SIADH
D) Decompensated Heart Failure
E) Hypothyroidism
SIADH
Urine osmlality > 100
Urinary sodium > 20
there is excess SIADH produced….
with the low sodium in the serum there shoud be an even lower concentration of urine as it would be very diluted.
Diabetes insipidus is urine osmolality would be innapproapriately low cpmpared to the raised plasma osmolality
A 49-year-old man is brought in by ambulance to the Emergency Department after collapsing at work. He has a past medical history of hypertension and smokes 5-10 cigarettes per day. About 3 hours ago, he developed sudden-onset right-sided neck pain after which he lost vision in his right eye and lost consciousness. His vision has since returned to normal,but the neck pain has persisted. His eyelid is drooping on the right side.
Which other signs would you expect to find on examination?
A) Right facial anhidrosis and right sided miosis
B) Left facial anhidrosis and left sided miosis
C) Right facial anhidrosis and left sided miosis
D) Left facial anhidrosis and right sided miosis
E) Bilateral anhidrosis with right sided miosis
Right sided facial anhidrosis and righ sided miosis
The description is of sudden onset neck pain is suggestive of carotid dissection.
With cases of dissection the symptoms of horner syndrtome present on the ipsilateral side.
A 68-year-old woman presents to her GP with ongoing left-sided shoulder and arm pain. It has been getting progressively worse over the last 6 months, and has recently noticed that parts of her left arm feel numb to touch. She has a past medical history of hypothyroidism, right total knee replacement, and is an ex-smoker.On examination, power is normal in both arms, but she has lost fine touch sensation in the medial aspect of her left arm. The range of motion in her left shoulder is limited by pain in all directions. She is also noted to have left-sided ptosis.
What is the most appropriate initial investigation?
A) MRI Spine
B) Chest X-Ray
C) Ultrasound left shoulder
D) MRI Brain
E) Nerve conduction studies
Chest X-ray
Lateralising shoulder girl pain associated with upper limb neurological symptoms should raise suspicion of potential brachial plexus injury.
the patient also complains of horners syndrome togethere this is could be explained with a pancoast tumour. this would meand that CXR would be the best investigation
The ultrasound of the shoulder could be used to investigate a rotator cuff injury.
A: An MRI spine would be useful for investigating potential radiculopathy secondary to cervical vertebra or disc disease
D: MRI brain would be useful in delineating parenchymal brain abnormalities like multiple sclerosis. It would not be the most appropriate initial investigation.
E: Nerve conduction studies may be carried out to diagnose diseases that affect peripheral nerves (e.g. motor neurone disease).
A 24-year-old man presents to the Emergency Department with severe chest pain and breathlessness that started 3 hours ago whilst he was watching TV. He is otherwise fit and well with no past medical history. On examination the patient is visibly in pain. On auscultation there are clear lung fields and his trachea is central.His observations are as follows:
Which of the following investigations is most likely to reveal the most likely diagnosis?
A)Chest X-Ray
B)Electrocardiogram
C)CT Pulmonary Angiogram
D)CT Aortic Angiogram
E)Ultrasound Chest
Chest X-ray
For a patient of this age with no other PE risk factors a spontaneous Pneumothorax is the most likely cause of this patients symptoms and the best way to investigate that is with the use of Chest X-ray.
PE is unlikely in this age group.
A 59-year-old man presents to A&E with a 6-week history of breathlessness. He has completed a course of antibiotics prescribed by his GP, yet he is still coughing up some green phlegm. He has come to hospital today as he has coughed up some blood.His past medical history includes COPD and hypertension, and he stopped smoking 10 years ago. On examination, the patient has visibly increased work of breathing and with right basal crackles and a monophonic wheeze. Routine bloods are sent,and a chest X-ray has been ordered.
What is the most likely diagnosis?
A) Infective Exacerbation of COPD
B) Adenocarcinoma
C) Pulmonary Tuberculosis
D) Lung Abscess
E) Squamous Cell Carcinoma
Squamous cell carcinoma
Patient has haemoptysis, dyspnoea and poorly resolcving pneumonia secondary to bronchial obstruction which is suggested by monophasic wheeze.
85% lunc cancers are non-small cell lung cancers of which 40% are squamouce cell carcinoma. which is more common in smokers. Another 40 % of the 85% are adenocarcinoma and these are more associated woth non-smokers. The remaining 20 % are Large cell carcinoma, carcinoid tumours and bronchoalveolar carcinomas
NSCLC
* 40 % Smokers -> SCC
* 40 % Non-smokers -> Adenocarcinoma
* 20 % -> large cell carcinoma/ carcinoid / Bronchoalveolar cell carcinoma
A 56-year-old man presents to A&E with acute lower abdominal pain. He was found to have large bowel obstruction secondary to a tumour in his sigmoid colon and was treated with an emergency Hartmann’s procedure. This left him with an end colostomy. He has been recovering well since the operation and discharge planning is underway. During a routine review, it is noted that his stoma output over the last four daysis as follows: 800 mL, 1100 mL, 1600 mL, 1300 mL (today). His bloods are all within normal range and the patient feels well.
Which of the following is the most appropriate management option?
A) Routine Stoma Nurse Follow-Up
B) Restrict Fluid Intake to < 500 mL/day
C) Abdominal X-Ray
D) Loperamide and Omeprazole
E) Oral Rehydration Solution
Loperamide and omeprazole
Complications of stoma:
* Ileus
* Necrosis
* High stoma output defined as >1L in 24 hours for 3 or more days
This can lead to the development of Electrolyte imbalances. Therefore the first step to manage this is to give loperamide and a PPI which decreases stomach ascid.
Fluid restriction is used along side the above
A 66-year-old man presents to his GP with concerns about blood in his stools. Over the last 2 months, he has intermittently noted fresh red blood in the toilet pan, associated with some perianal itching. He has not noticed any change in stool consistency or his body weight. On examination, he has a 1 cm blue-ish swelling that protrudes from the anal canal. It is easily reducible. The patient adds that he has noticed the swelling before but that it seems to go away once he is off the toilet.
Which of the following is the most appropriate management option?
A) Topical Diltiazem
B) Surgical Haemorrhoidectomy
C) Rubber Band Ligation
D) Haemorrhoidal Artery Ligation
E) Sclerotherapy
Describe the management of Haemorrhoids
Rubber band ligation therapy
This is describing a grade 2 haemorrhoid.
Diltiazam is used in anal fissure
Steroids could be used to ease itching.
Surgical removal would be considered in stage 4 disease and if other methods fail.
Artery ligation is the third line measure after 1) rubber band ligation and 2) sclerotherapy
A 40-year-old woman has undergone a total hysterectomy for dysfunctional uterine bleeding secondary to uterine fibroids. The operation was uneventful,and she is recovering well. On postoperative day 2, she develops a temperature of 38.1 C. A full septic screen is performed and a chest X-ray reveals loss of lung volume in the right lower zone.
How could this post operative complication have been prevented?
A) Prophylactic Co-Amoxiclav
B) High Flow Oxygen Therapy
C) Incentive Spirometry
D) Prophylactic Tinzaparin
E) Delayed Extubation
Incentive spirometry
This is atelectasis. This can be avoided with breathing excercises which would be possible with spirometry
A 20-year-old woman has presented to A&E after developing an exquisitely tender spot on her lower back. She works as a data analyst and has found it difficult to work because the pain is unbearable when she sits down at work. She has a background of type 1diabetes mellitus that is managed with a basal bolus insulin regimen.
On examination, there is a single 2 x 3 cm tender, fluctuant mass to the right of the natal cleft. The mass has an opening that expresses a purulent substance upon compression. What is the most likely diagnosis?
A) Perianal Abscess
B) Anorectal Fistula
C) Pilonidal Sinus
D) Sacral Osteomyelitis
E) Hidradenitis Suppurativa
Piloniddal sinus
A pilonidal sinus is a chronic inflammatory condition caused by an ‘ingrown hair’ usually in the natal cleft of the buttocks. The insertion of hair into the skin initiates an inflammatory response which leads to the formation of a sinus tract deep into the tissue. This will usually present as a painful swelling with purulent, foul-smelling discharge. It affects younger men and women and risk factors include hirsutism, metabolic conditions (e.g. diabetes mellitus) and a sedentary lifestyle. It isusually treated surgically with excision of the tract.
A: A perianal abscess will present as a red, painful, fluctuant mass in the perianal region. Its overlying skin will be intact, unlike the pilonidal sinus described that is discharging a purulent substance.
B: An anorectal fistula will similarly present with a mass draining purulent discharge, however, it is usually found around the anus.Furthermore, there is likely to be a background of an underlying inflammatory condition (e.g. Crohn’s disease).
D: Sacral osteomyelitis would not cause a mass on the surface.
E: Hidradenitis suppurativa is a chronic inflammatory condition characterised by the development of recurrent abscesses in the skin. The abscesses tend to arise in areas with lots of hair (e.g. groin, axillae)
A 20-year-old netball player presents to A&E after sustaining an injury during a netball match. She reports pivoting on her right leg and feeling a “pop” in her knee followed by a deep, intense pain that has been making it difficult for her to bear weight.The knee is difficult to examine due to the extent of the swelling. Her admission X-ray shows a Segond fracture.
Which of the following is the most appropriate definitive management option?
A) Meniscal Repair
B) Anterior Cruciate Ligament Reconstruction
C) Posterior Cruciate Ligament Reconstruction
D) Intra-articular Steroid Injection
E) Open Reduction and Internal Fixation of the Tibial Plateau
Anteroir Cruciate ligament injury
Segmond fracture is a avulsion fracture of the proximal lateral tibia and is associated with ACL injuries.
An 86-year-old Afro-Caribbean woman with severe peripheral vascular disease is admitted to the vascular surgery ward with extensive gangrene of the right lower limb. She is a bedbound nursing home resident and has a past surgical history of a below knee amputation of the left leg 9 years ago. On examination, the entire right foot is black, dry and shrunken, with a clear demarcation line between black and pink tissue just above the level of the ankle.
What is the most appropriate management option in this scenario?
A) Surgical Debridement
B) Revascularisation Surgery
C) Below Knee (trans-tibial) Amputation
D) Through-the-Knee Amputation (Knee Disarticulation)
E) Above Knee (trans-femoral) Amputation
Above knee amputation
Honestly the most BS qs… Essentially they are not mobalising so there is no point for below the knee amputation as this person does not need the below knee to help with prosthesis.
Revascuralisation would be useful if the tissue was viable with gangrene the tissue is dead and so it cannot be reversed.
Describe the different definitions and stages of AKI using the RIFLE stage… Urine output and GFR (Creatinine and GFR)
A 74-year-old man presents to his GP with a 2-day history of dysuria. He also tells the GP that for the last 2 years he has been getting up to pass urine up to 4 times every night. He also goesmuch more frequently during the day. When he passes urine, the stream is very slow and there is dribbling at the end. He says that these symptoms do not bother him except for dysuria. The results of his urine dipstick test are shown below.
This patient has had 3 similar episodes in the last 6 months.
Alongside antibiotics, what is the most appropriate management option?
A) Prescribe Tamsulosin
B) Prescribe Phenoxybenzamine
C) Prescribe Finasteride
D) Refer to Urology
E) Watchful Waiting
Refer to urology
Benign prostatic hyperplasia (BPH) is extremely common. This patient has presented with typical symptoms of BPH
-frequency, nocturia, terminal dribbling and poor stream.
The dysuria and urine dipstick testing positive for nitrites and leucocytes suggest that this patient currently also has a urinary tract infection for which he requires antibiotics. He has had three other urinary tract infections in the last 6 months. These are most likely a complication of his BPH.
- BPH that has led to complications is an indication for referral to urology for surgery*.
Surgery can be both minimally invasive or open which will depend on the size of the prostate alongside clinical factors.
A: Tamsulosin is an alpha-blocker that is used first-line in the management of uncomplicated BPH. It induces smooth muscle relaxation in the prostate and bladder neck.
B: Phenoxybenzamine is an alpha-blocker that is used in the treatment of phaeochromocytomas, not BPH.
C: Finasteride is a 5-alpha-reductase inhibitor that is also used first-line in the management of uncomplicated BPH. It inhibits the synthesis of dihydrotestosterone which, in turn, reduces prostate volume
E: Watchful waiting is only appropriate for patients who present with mild symptoms and whose symptoms are not bothersome.
A mother brings her 10-day-old son to the GP. She is worried about something she saw around the baby’s testicles when giving him a bath. The GP examines the baby and reassures the mother by saying it should resolve on its own within the next few months, but that she will refer the baby to a specialist at one year of age if it has not resolved by then.
What is the most likely diagnosis?
A) Epididymal Cyst
B) Haematocele
C) Varicocele
D) Hydrocele
E) Inguinal Hernia
Hydrocele
They are common in newborn boys, especially if preterm. The majority resolve on their own within the first year of life.
If the hydrocele has not resolved on its ownby the time the baby is one year old, referral to a paediatric surgeon should be considered.
Persistent hydroceles may require surgery (usually laparoscopic) at 12-24 months of age.
A 64-year-old woman has been brought into the anaesthetic room before her elective knee replacement. The anaesthetist induces the patient with propofol and also administers rocuronium. The patient is then maintained on sevoflurane. Shortly after the administration of these medications, the anaesthetic monitor shows the following values.
They also notice significant contracture of the patient’s masseter muscle.
What should the anaesthetist do next?
A) Give Dantrolene
B) Give Sugammadex
C) Active Cooling of Patient
D) Permissive Hypoventilation
E) Give IV Fluids
Dantrolene
This is malignant hyperthermia….
This is a a congential problem where when given anesthetic agents they react with a really high temperature. This is treated with dantrolene
This would also be managed with hyperventialation
An 82-year-old man has been recovering on the elderly medicine ward after being admitted with sepsis secondary to a chest infection. His stool chart reveals that he has not opened his bowels in 4 days. The medications on his inpatient drug chart are listed below.
Omeprazole 40 mg OD
Metformin 1 g BD
Ondansetron 4 mg PRN
Magnesium Aspartate 1 Sachet OD
Co-Amoxiclav 500/125 mg TDS
Which of these options is most likely to contribute to constipation?
A) Omeprazole
B) Metformin
C) Ondansetron
D) Magnesium Aspartate
E) Co-Amoxiclav
Ondansetron
Constiapation is a common cause of delerium in patients.
It is important to be able to identify the drug causes of constiaption.
Common drugs to cause constipation
* codiene
* CCB
* Iron supplelemts
* Ondansetron
A 52-year-old female is being treated for left leg cellulitis with IV antibiotics in hospital. On her blood test results, a low sodium is identified. She undergoes a hyponatraemia screen, upon which she is diagnosed with SIADH. Her past medical history includes HTN, T2DM, hypercholesterolaemia, GORD, and epilepsy. Her regular medications are metformin, ramipril, atorvastatin, carbamazepine and omeprazole.
What is the best initial management plan?
A)Prescribe Furosemide
B)Prescribe Urea
C)Prescribe Demeclocycline
D)Prescribe Desmopressin
E)Consider Alternatives to Carbamazepine and Omeprazole
Consider alternatives to carbamazepine and omeprazole
SIADH can be precipitated by drugs such as
* SSRI
* TCAs
* Anti epileptics (carbamazepine)
* PPIs
Therefore the first step in management should be to stop these medications as a way to stop the precipatiatng factors.
Then fluid restrict
Then Demeclocycline
A 31-year-old woman presents to ED with a left-sided headache accompanied by loss of vision in her right eye and strange sensations spreading up her right arm. She has no past medical history. She was brought in by ambulance as her family thought that she was having a stroke.Her visual and sensory symptoms have spontaneously resolved, but her headache persists.
She undergoes a CT head scan which is reported as normal. What is the most appropriate treatment of her ongoing headache?
A) Codeine 30 mg PO
B) Diclofenac 150 mg PR
C) Propranolol 80 mg PO
D) Aspirin 900mg PO
E) Morphine Oral Solution 5 mg
Aspirin 900mg PO
The patient has presented with a unilateral severe headache accompanied by a preceding visual and sensory aura, in keeping with migraine. Patients with migraines should be advised to keep a headache diary to identify possible triggers. Acutely, migraines can be treated with high-dose aspirin (900 mg), paracetamol or ibuprofen in the first instance. Triptans (e.g. sumatriptan) may also be used. Other classes of medications, such as antiemetics, may be used to provide symptomatic relief. Patients who experience two or more headaches per month should be considered for migraine prophylaxis (amitriptyline, topiramate or propranolol).
A: Codeine does not tend to be effective in migraines.
B: PR Diclofenac is highly effective at relieving pain caused by ureteric calculi.
C: Propranolol is used for migraine prophylaxis.
E: Morphine is a strong opioid that is effective in managing various types of pain, however, opioids are generally not thought to be particularly effective in migraines.
An 89-year-old woman has presented to A&E with abdominal pain. She is a nursing home resident with a background of type 2 diabetes mellitus, chronic kidney disease, previous NSTEMI and severe Alzheimer’s disease. She has a community DNACPR in place. Her carers have said that she has vomited twice over the last 24 hours and has been off her foot for 1 week. She also developed a high fever this morning. On examination, the patient is visibly tender in the right upper quadrant and is Murphy’s sign positive. A CT scan reveals a thick-walled gallbladder with some pericholecystic fluid. An obstructing stone is identified within the common bile duct. Her observations are shown below.
She is started on IV fluids, IV ceftriaxone and metronidazole, and paracetamol.
Which of the following is the most appropriate management option?
A)Percutaneous Cholecystostomy
B)Emergency Laparoscopic Cholecystectomy
C)ERCP
D)Elective Laparoscopic Cholecystectomy Once Stable
E)Refer to Intensive Care Unit
Percutaneous cholecystomy
This patient has ascending cholangitis. the main aim is to decompress the biliary system.
This can be done with all of the above management except the referral, but the least invasive method would be with percutaneous cholecystomy therefore making it the right answer.
A 50-year-old woman presents to the emergency department with severe epigastric pain radiating to the back. She is known to the community alcohol and drug services and has previously presented to ED intoxicated.
Which of the following investigations is most useful in predicting the severity of this patient’s pancreatitis?
A) Serum Lipase
B) Serum Albumin
C) Serum Amylase
D) Abdominal Ultrasound
E) Alanine Aminotransferase
Serum Albumin
Low albumin is associated with multiorgan failure…
A 56-year-old man presents to his GP with rectal bleeding that has persisted over the last 3 months. He is examined using a proctoscope and right posterior internal haemorrhoids are visualised. They are painless and can be manually reduced.
How would these haemorrhoids be classified?
A) Grade I
B) Grade II
C) Grade III
D) Grade IV
E) Grade V
Grade III
Grade I: does not prolapse
Grade II: spontaneously reduces
Grade III: can be reduced manually
Grade IV: irreducible
A 55-year-old man is seen in clinic with difficulty walking. His past surgical history includes a left total hip replacement.On examination, there is a well healed surgical scar on the anterolateral left hip. Whilst standing upright, the patient is asked to stand on his left leg alone and his hip tilts toward his right side.
Which of the following abnormalities would explain the examination findings?
A) Wasting of left gluteus medius
B) Inferior gluteal nerve injury
C) Superior gluteal nerve injury
D) Wasting of left gluteus maximus
E) Wasting of left gluteus minimus
Superior gluteal nerve injury
The above nerve innervates the hup abductors, gluteus medius and minimus, this means that injury to this nerve will cause weak hip abduction that presents in the trendelenburg test.
This is a common complication of the Total hip replacement surgery.
The inferior gluteal nerve which is also at risk in a total hip replacement if the scar was seen posteriorly would present with weakness on hip extension.
Which of the following is most likely to be injured with the use of a plaster cast that has been applied for a tibial fracture?
A) Tibial Nerve
B) Common Peroneal Nerve
C) Femoral Nerve
D) Lateral Cutaneous Nerve
E) Sciatic Nerve
Common peroneal nerve
Common peroneal nerve damage is usually caused by compression of the fibular head as the nerve passes along its fibular neck. Injury leads to foot drop. The common peroneal nerve is a terminal division of the sciatic nerve which divides above the knee joint at the popliteal fossa into the tibial and common peroneal nerves.
A: The tibial nerve travels down the posterior compartment of the leg into the foot. It is deep and well protected and thus not commonly injured.
C: The femoral nerve supplies the anterior compartment of the thigh and is commonly injured in hip and pelvic fractures. It is responsible for knee extension and provides sensory function to the anterior and medial aspect of the thigh.
D: Lateral cutaneous nerve injuries occur due to compression near the ASIS, leading to paraesthesia and pain at the lateral aspect of the thigh (meralgia paraesthetica).
E: The sciatic nerve divides into the tibial nerve and the common peroneal nerve. ALSO PRESENTS WITH FOOT DROP
A 48-year-old man presents to hospital with a red, hot swollen knee. He explains that this happened quite suddenly overnight and denies receiving any trauma to the area. The knee is extremely painful upon active and passive movement but he otherwise feels well. He has no significant past medical history.
He has an X-ray of the affected knee which reveals subchondral cysts, joint degeneration and calcification of the medial meniscus.
What is the most likely diagnosis?
A) Osteoarthritis
B) Pseudogout
C) Psoriatic Arthritis
D) Reactive Arthritis
E) Gout
Pseudogout
the calcification of the cartilage with the acute history is suggestive of pseudogout.
Acute flares of pseudogout are usually managed similarly to gout -with NSAIDs and colchicine.
A: Osteoarthritis presents with chronic joint pain and radiographic features including loss of joint space, osteophytes, subchondral cysts and subchondral sclerosis.
C: Psoriatic arthritis refers to the development of arthritis in patients with psoriasis. It can take five main forms: symmetrical polyarthritis, asymmetrical oligoarthritis, distal interphalangeal joint disease, arthritis mutilans and psoriatic spondylopathy.
D: Reactive arthritis is a sterile arthritis that arises several weeks after an infection (e.g. usually gastrointestinal or genitourinary). It classically manifests with a triad of arthritis, urethritis and uveitis.
E: Gout presents similarly to pseudogout, with acute-onset joint pain. It has a predilection for affecting the first metatarsophalangeal joint and is caused by the deposition of monosodium urate crystals. It does not cause chondrocalcinosis
A 46-year-old woman has a background of end-stage renal failure secondary to poorly controlledtype 1 diabetes mellitus. She undergoes a simultaneous pancreas and kidney transplant which was uneventful. She returns to hospital 2 weeks later complaining of reduced urine output and feeling generally unwell. Graft rejection is suspected.
What type of rejection is this most likely to be?
A) Hyperacute
B) Accelerated Acute
C) Acute
D) Chronic
E) Acute-on-Chronic
Acute
Hyperacute
● Within seconds of clamp release
● Mediated by preformed antibodies
● Results in immediate loss of graft
Accelerate Acute
● First few days
● Cellular and antibody mediators
Acute
● Days to weeks
● Cell mediated –usually lymphocytes
Chronic
● Most common
● Graft atrophy and atherosclerosis
● Fibrosis is a very late event
A 77-year-old man has been brought to A&E after becoming drowsy at his residential home. On examination, he has a GCS of 10 and engages poorly. He has a background of hypertension and hypercholesterolaemia. His vital signs and ECG findings are shown below.
ECG: widespread T wave inversion with ST elevation in leads I, II, V3, V4, V5 and V6.
What is the most appropriate initial management option?
A) CT Head Scan
B) Administer Aspirin 300 mg and Clopidogrel 300 mg immediately
C) Administer Aspirin 300 mg and Clopidogrel 300 mg once troponin result has returned
D) Commence IV unfractionated heparin infusion and arrange PCI
E) Administer IV Alteplase
CT scan of head
Raised ICP can present with ECG changes that mimic STEMI.
Patients who are driwsy and have ECG changes should have a CT head
A 55-year-old man is undergoing inpatient investigations after presenting with a severe bout of haematemesis. He had an OGD which revealed bleeding varices, which have since been banded, and extensive gastric ulceration. He also has evidence of chronic liver disease with a background of alcohol excess. During his inpatient admission, he is noted to have developed a swollen, tender right calf. A doppler ultrasound scan confirms a large thrombuswithin the right femoral vein. His blood test results are shown below.
What is the most appropriate management option?
A) 4500 U Tinzaparin
B) 10500 U Tinzaparin
C) IV Unfractionated Heparin Infusion
D) 15 mg Rivaroxaban BD
E) IVC Filte
** IVC filter**
This patient has a DVT and just had a major oesophageal variceal bleed meaning the risk of putting then in anticoags is too great therefore in an attempt to reduce the risk of the clot spreading into the lungs and IVC filter can be used.
A 52-year-old woman presented to A&E with a 1-month history of diarrhoea and rectal bleeding. The blood is bright red and mixed in with the stools. She also experiences intermittent abdominal pain. A PR examination reveals tenderness upon insertion and traces of blood on withdrawal. Her admission blood test results are shown below.
She has been prescribed tinzaparin 4500 units SC OD by the admitting doctor and her first dose has been given.
Which of the following is the most appropriate action to take?
A) Remove tinzaparin from drug chart only
B) Remove tinzaparin from the drug chart andprescribe vitamin K
C) Remove tinzaparin from the drug chart and prescribe protamine
D) Remove tinzaparin from the drug chart and prescribe prothrombinase complex concentrate
E) No action needed
No Action Needed
This patient probably has a diagnosis of IBD. there is a second peak incidence at around 60 years old.
However as IBD is a pro inflammatory condition and is associated with a dehydrated state because of blood loss and diarrhoea there is a larger thrombotic risk, when confounded with the being ADMITTED into hospital, meaning they do need prophylaxis.
Therefore patients who have symptomatic IBD in hospital and are being admitted do need VTE prophylaxis.
A 55-year-old man has presented to the GP with ongoing symptoms of heartburn despite trialling omeprazole 40 mg OD for the past 3 months. He has undergone H. pyloritesting which was negative.
What is the most appropriate next step in his management?
A) Lansoprazole 30 mg OD
B) Nizatidine 150 mg BD
C) Ranitidine 150 mg BD
D) POEM
E) Nissen Fundoplication
Nizatidine
GORD that is not treated with PPI should be trialled on a histamine antagonist -> Nizatidine
Peroal endocscopic myotomy -> Treatment for Achalasia
Nissen Fundoplications -> Surgical treatment of GORD where medical treatment is not effective
RANITDIINE is generally avoided because of carcinogen worries.
A 77-year-old man has been admitted to the stroke unit after developing sudden-onset right sided arm and facial weakness. His CT scan revealed no abnormalities and as he presented promptly after symptom onset, he was thrombolysed successfully. He has also been started on aspirin 300 mg OD. What is the mechanism of action of aspirin?
A) Leukotriene Receptor Antagonist
B) P2Y12 Receptor Antagonist
C) Phosphodiesterase Inhibitor
D) Endothelin Receptor Antagonist
E) Irreversible COX Inhibitor
Irreversible COX inhibitor
B -> Clopigogrel
A 56-year-old man is admitted to the general surgical ward after presenting with sudden onset abdominal pain. Acute pancreatitis is suspected and an ABG is performed to calculate his Glasgow (results below). He has a past medical history of recurrent venous ulcers on his lower limbs, type II diabetes mellitus and morbid obesity.
Which of the following is likely to have given rise to his ABG abnormality?
A) Poorly Controlled Diabetes Mellitus
B) Metformin Use
C) Obesity
D) Angiodysplasia
E) Parkes Weber Syndrome
Obesity
Obesity Hypoventilation syndrome -> They develop high CO2 concentration because they are less able to breathe fast or deeply enough to clear the CO2… This is associated with Obstructive sleep apnoea
An 81-year-old man is being reviewed in the respiratory clinic after undergoing a high-resolution CT scan to investigate his chronic shortness of breath. The CT scan reveals widespread ground glass opacities in keeping with a diagnosis of interstitial lung disease.
He explains that he spent the majority of his younger years as a shipbuilder and many of his colleagues had developed similar health problems.
What is the most likely diagnosis?
A) Pneumoconiosis
B) Mesothelioma
C) Extrinsic Allergic Alveolitis
D) Hypersensitivity Pneumonitis
E) Bronchiectasis
Pneumoconiosis
This is a term used to describe a group of interstitial lung diseases that occurs secondary to the inhalation of iatrogenic allegens such as : Aesbestosis, coal dust or silica.
This particular presentation is suggestive of asbestosis.
Extrinsic allergic alveolitis -> would have exposure to organic allergens such as moulds
Hypersensitivity pneumonitis is another term used for extrinsic allergic alveolitis
Bronchiectasis is irreversible dilatation of the airways usually secondary to infections or inflammations.