2014 Flashcards
1
Q
Patient had hyperthyroidism. Treated with carbimazole. 2 weeks later gets a sore throat. What investigation?
A
FBC
2
Q
28 year old lady with wide based gait and optic neuritis. What is the most appropriate investigation?
A
MRI: Gd-enhancing or T2 hyper-intense plaques
3
Q
Patient has had 20mls of lidocaine 0.5%. Max is 3mg/kg and he weighs 80kg. How much more can you give?
A
28ml
0.5% = 0.5g in 100 ml
Therefore the 20mls of that solution that he’s already been given, must contain 0.1g of lidocaine (or 100mg)
Max is 3mg/kg which means for him max is 240mg. So 240mg-100mg = 140mg left.
Then 20/100x140= 28mL
4
Q
Rugby tackle, anterior dislocation of shoulder. What test do you do before and after relocation?
A
Axillary Nerve
5
Q
Patient ex-IVDU, want to see if he has chronic Hep C. What test?
A
anti-HCV implies previous exposure, HCV RNA implies ongoing infection/chronicity
6
Q
Pt has MI, 2 days later new murmur and unwell. Harsh systolic murmur. Diagnosis?
A
Papillary muscle rupture = mitral regurgitation
7
Q
What makes someone cool, pale and clammy when unwell?
A
Sympathetic
8
Q
Lady with previous mastectomy for Breast Ca 4 years ago. Has become thirsty, polyuria and constipated. Now confused. What has caused it? No focal neurology.
A
Hypercalcaemia
9
Q
Child with previous ear infection, now has acute hearing loss and “squishy BOGGY ” mass behind ear. LMN signs on affected side of face. What is the cause?
A
Mastoiditis
10
Q
40 year old woman is anaemic, raised LDH, raised bilirubin. What test?
A
Direct COOMBS (AIHA)
11
Q
Pt in burning building at home. 3 days later he has flashbacks, nightmares and is upset. Returns to work a week later. Diagnosis?
A
Acute stress reaction (too short for PTSD - has to be 1 month)
12
Q
Patient took a handful of pills with alcohol 2 days ago after an argument, now can’t remember what he’s taken. Was on antidepressant medication. LFTs showed liver impairment and raised PT. What has he taken?
A
Paracetamol
13
Q
What is the biggest intervention in a young person to reduce overall cancer risk?
A
Stop Smoking
14
Q
Patient has headache, photophobia, neck stiffness, BP is lowish. What is the most appropriate. Rx?
A
Ceftriaxone
(BNF = cefotaxime for 3 months-50 years
Add amoxicillin in < 3 months or > 50 years old)
15
Q
Child has sore throat. 2 weeks later develops Proteinuria, dehydrated, polyuria, oedema. What is the cause?
A
Post-Strep
Passmed says IgA takes 1-2 days but post-strep takes 1-2 weeks - i wouldve gone for Post strep (I think it’s also commoner in children)
16
Q
Patient has headache, photophobia, neck stiffness, BP is lowish. What is the most appropriate. Rx?
A
Ceftriaxone
17
Q
Man diagnosed with T2DM (not massively raised though). No eye or feet problems. Renal profile is fine. What treatment does he need?
A
Metformin
18
Q
Pt has raised BP on ambulatory monitoring. T1DM and proteinuria. What drug do you give?
A
ACEi
19
Q
Old man is anaemic, newly constipated and has had weight loss for 6 months. What has he got?
A
Sigmoid Cancer
20
Q
HIV +ve, has pneumonia, CXR showed ground glass appearance, perihilar haziness. What do you use to treat?
A
Co-Trimaxole
21
Q
Lady is pre-op and will need a GA. She has RA in hands, knees, hips and neck. She has HTN (150ish) and T2DM. What is the most important pre-op check?
A
Cervical XR (need to be able to intubate if GA - risk of atlanto axial subluxation)
22
Q
Patient has irregular 3cm pigmented lesion on shin with different colours. What is the most important next step?
A
Biopsy (melanoma)
23
Q
Terminal palliative care patient with Lung Ca. Is SOB on minimal exertion but comfortable at rest in his bed. CXR shows epic pleural effusion. What is the best management?
A
Pleural Aspiration
24
Q
Patient is post op, on 40% O2. Becomes unwell RR26 and sats drop to 86%. Type 1 respiratory failure. What is the most important first step?
A
Increase O2
25
Patient is on ventilator. ABG shows PaO2 is 12, PaCO2 is 9.8, pH is acidotic, bicarb is 19. What do you do?
Increase Ventilation
26
Old man has bronchial carcinoma. Gets pain in his femur. XR shows lytic bone lesion (and some in spine). On good pain control. What do you do to manage this patient?
Radiotherapy (when secondary to bone tumours)
27
Patient has central lung mass. Turns out to be Small cell lung cancer. How do you treat?
* usually metastatic disease by time of diagnosis
* patients with very early stage disease (T1-2a, N0, M0) are now considered for **surgery**. NICE support this approach in their 2011 guidelines
* however, most patients with limited disease receive a combination of **chemotherapy** and **radiotherapy**
* patients with more extensive disease are offered **palliative** **chemotherapy**
28
Old man who’s a smoker has lost voice of last 2 weeks, become horse. Examination shows normal larynx and no obvious masses in neck. Palate/mouth is fine. What is the next important investigation?
CXR
29
Young athlete (25) keeps fainting. ECG shows sinus rhythm with narrow QRS and long QT. What arrhythmia is happening?
Irregular Ventricular Arrhythmia (Torsades de Pointes)
Torsades de pointes ('twisting of the points') is a rare arrhythmia associated with a long QT interval. It may deteriorate into ventricular fibrillation and hence lead to sudden death
Management
**IV magnesium sulphate**
30
Patient comes in with BP 80/40, pulse 160, loads of other shit and wide QRS. How do you manage them?
**Shock**
*Unstable VT*
If the patient has adverse signs (systolic BP \< 90 mmHg, chest pain, heart failure, syncope) then immediate cardioversion is indicated. In the absence of such signs antiarrhythmics may be used. If these fail, then electrical cardioversion may be needed with synchronised DC shocks
_Drug therapy_
amiodarone: ideally administered through a central line
lidocaine: use with caution in severe left ventricular impairment
procainamide
31
Patient comes in with fluid overload, drowning in fluid (crackles everywhere) and acute AF. How do you treat the AF (NB; not the fluid)?
**DC Cardioversion** (1st line for unstable AF)
32
Most important thing to correct in DKA?
Fluids
33
Total gastrectomy, why did they get B12 deficiency?
No intrinsic factor
34
40 year old, no symptoms other than PR fresh bleed occasionally for 2 weeks. No change in bowel habits, pain or illness. What is the investigation?
Proctosigmoidoscopy (haemorrhoids)
35
Patient has UC flair, on mesalazine. Abdo pain, \>8 diarrhoea with blood and fever for 2 days. What treatment?
IV hydrocortisone (required for acute flare)
36
Child with downs syndrome develops cervical lymphadenopathy, is pale and bleeding. What is it?
ALL
37
3 year old child bangs head on desk this morning, has a bruise. NO LOC, no vomiting. Mother brings him to GP. Has 12 bruises of different ages on shins. What is the cause?
Abuse
38
Patient has signs of High potassium, low calcium and acidosis post chemo for lymphoma. What is the best investigation?
_Tumour Lysis Syndrome_ = Increase in **urate**, **phosphate** and **K** (KUP) and decrease in Ca
39
Patient with sudden pale, cold, clammy, pulseless leg, has AF. Best management?
Embolectomy
40
Teenage boy with tender lumps in breasts on both sides. What Ix?
Leave and observe
41
Lady has severe dyskaryosis. What is the most appropriate next step?
Colposcopy
42
What’s the best investigation for a patient with multiple myeloma? Bloods showed low HB, low PLT, low WCC
Protein electrophoresis
43
Patient in bladder retention. What caused it?
Amitriptyline
44
What is the antidote to TCA overdose?
IV bicarb
45
Old lady with melaena. Her INR 9.8. What do you give?
Major bleeding =
Stop warfarin
Give intravenous **vitamin K** 5mg
**Prothrombin complex concentrate** - if not available then FFP\*,
46
Pt has athlete's foot. Wakes up at night with swollen, tender, red leg. What is it?
Cellulitis
47
Pt has stroke affecting R arm, R leg and inattention. Where is the stroke?
**L internal capsule** (Key - this is where all motor fibres pass AND fibres from the parietal lobe which would give the inattention)
48
Pt has pain behind nose. Worse leaning forward and reproducible to touch. What do you use to treat it?
**Sinusitis**
1) Analgesia
2) Nasal decongestant/saline
3) Intranasal **Corticosteroids** if Sx \>10d
*oral antibiotics are not normally required but may be given for severe presentations. The BNF recommends **phenoxymethylpenicillin** first-line, co-amoxiclav if 'systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications'*
49
Women with pneumonia, urine BM 8. 2 weeks later, OGTT 7.1, fasting glucose 6.2. Why was BM raised?
Acute stress reaction
50
Child with hx of atopic eczema. Presents with blistering rash on face and trunk. What is the cause?
Eczema herpeticum
51
Lady presents with haematemesis. Has palpable spleen tip and spider naevi. What is the diagnosis?
Oesophageal varices
52
Gentleman admitted for nasal polyp removal. He is T1DM. What is the best way to control his sugars?
Insulin sliding scale until eating and drinking normally
53
Woman with abdo cancer. Has pitting oedema to groin and distended veins below the level of the umbilicus. Cause?
Inferior Vena Cava Obstruction
54
Man has loss of sensation below the level of the umbilicus. Where is the lesion?
T10
55
23-year old female comes in with RIF pain, had previous appendicectomy. Tenderness and guarding
Ruptured ectopic
56
Need to draw up insulin, It comes in a 10ml ampoule bottle. 1ml is 100 units. Want to make 1 unit per ml and have a 50ml syringe (i.e. you need to draw up 50 units) How many mls do you draw from ampoule.
0.5ml
57
L
sided homonymous Hemianopia. Where is the lesion?
Right Optic Tract
(right occipital lobe = macular sparing)
due to dual blood supply from both posterior cerebral artery and middle cerebral artery.
58
Which of these is a sign of **proliferative** retinopathy?
Neo-vascularisation
59
CVP line insertion, suddenly SOB and sats 88%
Pneumothorax
60
50 year old CEO, has acute epigastric pain. Soft to palpation but tender. What is the most important investigation to get?
Erect CXR
61
Chance of a man with haemophilia and his wife who’s a carrier having a son with
haemophilia?
50%
X-Linked Recessive
62
Choledocolithiasis
also called bile duct stones or gallstones in the bile duct
63
Patient with blurring of their vision, red eye and pain
Scleritis
64
Patient with oral ulcers, rash on face and pleuritic chest pain. What Ix?
dsDNA (SLE)
65
Child stabs himself in the eye with a pencil. He has an irregular pupil, excessive lacrimation, red
eye and pain. What suggests a penetration of the globe?
Irregular pupil
66
21 year old girl has acne. Tried a number of treatments but still has comedones. GP prescribes Isoretanoin. What else should you prescribe?
OCP
67
Patient has severe abdo pain. Examination reveals tinkling bowel sounds, AXR shows gas under
the diaphragm. What is the cause?
Bowel obstruction
68
Woman aged 40(ish) with T2DM. Her BMI is 28 and HBA1C is raised (?64). What management
plan?
Is this q saying she's newly dx or has had DM for ages- cos that changes it since you'd probs start with ddiet as always:
a patient is newly diagnosed with HbA1c and wants to try **lifestyle** treatment first. You agree a target of 48 mmol/mol (6.5%)
But if she's had the chance to change HBA1C with diet and not worked then surely whack her on Metformin?
metformin is still first-line and should be offered if the HbA1c rises to 48 mmol/mol (6.5%)\* on lifestyle interventions
69
Patient has metaclopramide IV with morphine. 10 minutes later develops upward looking eyes,
neck is flexed and agitated. What do you use to treat?
oculogyric crisis = **procyclidine** or **benztropine**
70
54 year old lady presents with PV bleed. Hasn’t has period in 3 years. What is the next step in
. Mx?
Refer to gynae
71
Young adult male with back pain for 6 weeks worse in the morning. Has a number of tests, all
antibodies return negative. What is the cause?
Ank Spond
72
Patient with diabetes has renal and eye disease. Wakes up at night with leg pain. What is the first
line treatment?
Amitriptyline
73
Young adult male schizophrenic treated with risperidone. Develops bitemporal hemianopia and bilateral nipple discharge. What test would help confirm the diagnosis?
MRI of brain
74
24-year-old male notices a testicular lump 2 weeks ago after a football injury. It is 3cm, in the
testicle hard and irregular. It does not trans-illuminate. What is it?
**Teratoma** (right age group - 25)
Seminoma = 35 years
AFP is elevated in around 60% of germ cell tumours
LDH is elevated in around 40% of germ cell tumours
seminomas: hCG may be elevated in around 20%
**USS** = 1st line
75
Man has months of dribbling, incomplete voiding. PR shows prostate has one side harder than the other but smooth. His PSA is “significantly” elevated. What is it?
Prostate cancer
76
Patient has T1DM that has been well controlled. He has had vitiligo for 10 years on his arms. He
presents gaining weight and drowsy. What test do you need to do?
**TFTs**
* Vitiligo
* T1DM
* Addison’s
* Thyroid
77
Patient has “irregular” heart beat and a mid diastolic murmur. They already have heart failure.
What other complication is the biggest long term risk?
Systemic emboli (AF leading to **_STROKE_**)
78
Patient is post op. They have been given 5% dex for a 24 hours. Blood tests show low Na and
they are now drowsy. Why?
Cerebral oedema
79
28-year-old painter has pain. It hurts when he grips brushes and when he paints. On examination
there is pain in the lateral epicondyle. What action causes pain?
Wrist extension
('tennis elbow')
80
Young man in new relationship with hockey girl. Notices yellow discharge from penis and is sent
to GUM. What is the initial investigation they will do?
**MSU**
traditional cell culture is no longer widely used
nuclear acid amplification tests (NAATs) are now rapidly emerging as the investigation of choice
urine (**first void urine sample**), vulvovaginal swab or cervical swab may be tested using the NAAT technique
81
Young adult has come from Africa 2 weeks ago. He has fever night sweats, weight loss and a neck lump. What is the cause?
TB (lymph)
82
Man in car crash, has severe facial lacerations. What is the most important first step?
Secure C-spine and airway
83
Patient has partial gastrectomy for Crohns. What vitamin will they become deficient of?
B12 (intrinsic factor)
84
Old lady has lesion on her labia majora which is ulcerated. What is the cell type on biopsy?
SCC (vulval carcinoma)
85
35 year old lady is 20 weeks pregnant and attends for the first time. Her BP is 155/80. You’re
antenatal clinic very kindly check renal function which looks normal. What is the cause of the high
BP?
Essential HTN (no proteinuria)
86
Guy with COPD. Has FEV1 of 25%, What other finding would you expect on spirometry?
Inc residual volume
87
Man 2 days post MI on CCU, goes unresponsive and pulseless VF. First thing to do?
Shock the shit out of him
88
Young Boy (?5) at school is failing to climb the climbing frame. Comes in, leg weakness but big
calves. Where is the problem?
Muscle fibre (Duchenne)
89
Patient has temperature, renal damage and “painful finger pulp”. What is it?
Infective Endocarditis (oslers nodes and renal immune complex damage)
90
Patient has bone pain and roleaux +ve on testing
Multiple Myeloma
## Footnote
*Conditions which cause rouleaux formation include infections, multiple myeloma, Waldenstrom's macroglobulinemia, inflammatory and connective tissue disorders, and cancers*
91
Patient has leg weakness that has spread to the arms over last day. Sensation is only minimally
affected. What is the problem?
Demyelinating peripheral neuropathy
92
Old man with pneumonia, has low plasma sodium. Osmolality about 250. Urinary sodium is
“\>50” and urine osmolality 380. What is the cause?
SIADH
93
Patient has nosebleed. How do you manage?
**Tilt head forward pinch bridge
(soft cartilage)**
If the patient is haemodynamically stable, bleeding can be controlled with first aid measures. This involves:
Asking the patient to sit with their torso forward and their mouth open- avoid lying down unless they feel faint. This decreases blood flow to the nasopharynx and allows the patient to spit out any blood in their mouth. It also reduces the risk of aspirating blood.
Pinch the cartilaginous (soft) area of the nose firmly and consistently for at least 15 minutes and ask the patient to breathe through their mouth
94
Old man has prostate cancer. He comes in with GCS of 12 and drowsy. BP is 120/80. Has been
taking pain relief for 4 weeks. Why is he drowsy?
Hypercalcaemia
95
Old man faints at home. ECG shows HR of 45. JVP is “significantly elevated”. What is the cause?
Complete Heart block (can cause raised JVP if atrial and ventricular systole out of sync)
96
Study shows oral drug X has a smaller area under the curve than IV drug X. What could be the
reason for this?
First pass metabolism
97
Patient notices a bug flies in their eye. After 15 minutes, their eye swells up. Shortly after, the swelling subsides. What cell type was responsible?
Mast cells
98
Patient jumps during sports. Falls over and lands on right leg with it bent and twisted. Comes to
A+E with leg in flexion at 30 degrees, O/E you can’t move it passively beyond 30 degrees. Whats the
problem?
**Medial Meniscus**
_Features_
* pain worse on straightening the knee
* displaced meniscal tears may cause knee locking
* tenderness along the joint line
* Thessaly's test - weight bearing at 20 degrees of knee flexion, patient supported by doctor, postive if pain on twisting knee
99
Woman with green discharge, petichaie on cervix and looking under microscopic showed motile
organisms. What is it?
Trich Vag
100
Patient on ward has IV saline drip, is drowsy and unresponsive. BM 1.8. What is the best initial
management?
80ml 20% dex IV
101
Lady visits opticians. Told she has bilateral optic disc swelling so comes to doctor. Denies any
symptoms but does remember some transient visual loss when she got out of bed. What is the cause?
benign intracranial
102
Patient has bitemporal hemianopia and big hands/face. Where is the lesion?
**Anterior** Pituitary
103
Patient has cerebral mets from breast Ca aged 39. On 7.5mg dex. Develops weakness in legs and
is worried about mets. Has weak proximal thighs and shoulder. No pain. What do you do?
Reduce dex dosing (steroid side effect - proximal myopathy)
104
SCC of tonsillar primary
HPV 16
105
Which metastases are sclerotic to spine?
Prostate Cancer
*Sclerotic bone metastases: These are also known as blastic bone metasteses. Prostate carcinoma
is the most common. Breast carcinoma may cause a mixed picture.*
106
Patient with sx of Guillain Barre. What Ix to monitor respiratory function?
In the investigation of Guillain Barre **_spirometry_** is important. Forced vital capacity is a major
determinant of the need for admission to ICU and then the need for intubation. This should be
measured 4 hourly.
107
Man with sx of BPH. What treatment?
Medical management is suitable for mild BPH. Alpha-blockers (**_Tamsulosin_**) is 1 st line and
decreases smooth muscle tone of the bladder and prostate. 5 Alpha reductase inhibitors
(Finastride) is second line which decreases the conversion of testosterone to
dihyodroxytestoreone. Surgical management with TURP is only indicated for severe BPH.
108
Woman with vaginal discharge – which Ix?
Patients who present with symptoms suggestive of bacterial vaginosis or vulvovaginal candidiasis
can be treated without sampling. Otherwise, swabs should be taken. **_Endocervical Swab_** in
transport medium (charcoal or non-charcoal) to diagnose gonorrhoea. Endocervical swab for a
chlamydial DNA amplification test to diagnose chlamydia. NB: a high vaginal swab (HVS) is only
worthwhile where there are recurrent symptoms, treatment failure, or in pregnancy,
postpartum, post-abortion or post-instrumentation.
109
Woman with vaginal discharge. Diagnosis?
Most common cause of **_PID_** is chlamydia infection hence discharge may be indicative of this.
110
Man with diabetes hypertension atherosclerosis etc. Cause of erectile dysfunction?
Erectile Dysfunction: This occurs as a result of **autonomic neuropathy** for which the most
common systemic cause is **_diabetes_**. This presents as impotence, ejaculatory failure and female
sexual dysfunction.
111
Large lymphoid cells. Diagnosis?
**Chronic Lymphocytic Leukaemia**: This is associated with a lymphocytosis due accumulation of
mature B cells. Smear cells may also be seen on blood films.
112
Chief medical officer wants to make MMR compulsory before children start school. Ethical principle?
Utilitarianism
113
Man comes with 48hr chest pain. ECG normal – what do you do?
Troponin
114
AAA found by GP on examination. What Ix?
**_Ultrasound_** is simple and cheap; it can assess the aorta to an accuracy of 3 mm. It is used for
initial assessment and follow-up. CT provides more anatomical details, eg it can show the visceral
arteries, mural thrombus, the 'crescent sign' (blood within the thrombus, which may predict
imminent rupture), and para-aortic inflammation. CT with contrast can show rupture of the
aneurysm.
115
Woman receives blood transfusion then gets pain in lower back. Problem?
Acute haemolytic transfusion reaction: Occurs due to **ABO incompatibility**, in which compliment
becomes activates and results in DIC. Symptoms include back pain, bloody urine, chills, fainting,
dizziness, fever, flank pain and flushing of skin.
116
Patient with hearing loss. Then gets a lump in posterior triangle of neck. What’s the cause?
Cancer of the nasopharynx is most likely to cause a lump in the neck, but may also cause nasal
obstruction, deafness and postnasal discharge.
Answer: **Nasopharyngeal Cancer**
117
Low Ca and High Phosphate in Chronic Renal Failure. Reason?
**Lack of hydroxylation of Vitamin D**
## Footnote
Renal Osteodystrophy: This occurs due to decreased excretion of phosphate by the damaged
kidneys. Low activate vitamin D levels are a result of the damaged kidneys’ ability to convert
vitamin D into its active form, calcitrol, and result in further hypocalcaemia. The body is therefore
unable to absorb calcium from the intestines and subsequently removes it from the bones.
118
Spherocytes in blood film. Diagnosis?
Spherocytosis is an auto-hemolytic anemia characterised by the production of red blood cells that
are sphere-shaped, rather than bi-concave disk shaped. Spherocytes are found in hereditary
and **_autoimmune hemolytic aneamia_**.
119
OD dilated pupils. Cause?
**Amitriptyline** Overdose: Commonly include sinus tachycardia, hot dry skin, dry mouth and
tongue, dilated pupils and urinary retention. The most important ECG feature of toxicity is
prolongation of the QRS interval, which indicates a high risk of ventricular tachycardia.
Antidote = intravenous sodium bicarbonate
120
A 24-year-old female presents with worsening headache, fever, and double vision. Her headache is located in the periorbital region. Medical history is significant for a left-sided mid-facial furuncle which she attempted to squeeze over one week prior. On physical exam, there is bilateral supraorbital edema, lateral gaze palsy, ptosis, mydriasis, and chemosis?
**_Cavernous Sinus Thrombosis_**
*Symptoms*
* fever
* periorbital edema
* headache
*Physical Symptoms*
* cranial nerve palsies
* first involve CN 6 as it runs through the middle of the sinus
121
Dorsum of Great Toe sensory loss?
L5
122
Patient with ascites and R swollen leg which ca?
Pelvic masses are most likely to cause localised compression of the large veins and subsequent
oedema of a unilateral limb. Of the malignancies given only **_ovarian cancer_** occupies the pelvis. It is
commonly associated with ascites (i.e. Meig’s Syndrome)
123
Young man with urethritis and obstructive urinary sx?
**_Urethral Stricture_** - Urethritis due to gonorrhoea or Chlamydia can result in urethral stricture which is
the commonest cause in young men.
124
Patient has sx of COPD, partial response to salbutamol inhaler? What Ix?
Diagnosis:According to NICE guidelines diagnosis in a symptomatic person should be confirmed using
* *_post-bronchodilator spirometry_**. Additional investigations include CXR (to exclude other
pathologies) , FBC (to identify anaemia or polycythaemia) and BMI.
125
Tender hepatomegaly, raised JVP, ascites, AF. Ca-125 is 40. Cause?
**Heart Failure**
## Footnote
A normal range for Ca 125 is less than 35 U/ml therefore only slightly elevated. Ca 125 is generally a
non-specific marker and only useful in monitoring people who have a known diagnosis of ovarian
cancer, screening for recurrence.
126
Lymph node biopsy had 5% larger cells?
Not enough information here. Lymph node biopsies are commonly done for Hodgkin and _**Non-
Hodgkin lymphomas**_, the latter having a particular subtype associated with large cells (Diffuse Large
Cell Lymphoma). The only other blood cancer associated with large cells is CLL in which blasts are
commonly found, however this is seen on blood film and not lymph node biopsy.
127
HIV patient being treated with sulfadiazine and primethamine. Diagnosis?
Toxoplasmosis
128
Lump inferolateral to pubic tubercle?
Femoral Hernia
129
Pleural Plaques
Asbestosis
130
Pt with erythema all over sparing mucosal surfaces and BP is ok. What do you do first?
IV **ceftriaxone** is good antibiotic cover for most pathogens which cause septicaemia.
131
New positive HIV test has 96% chance of having HIV?
**Positive Predictive Value**
* Positive predictive value = The probability of actually having the disease if you had a positive result
* Negative predictive value = The probability of actually not having the disease if you had a negative result
132
Cause of Myasthenia Gravis?
Nicotinic acetylcholine **receptor** autoantibodies
(lambert eaton = presynaptic calcium channels)
133
Bloods show really high K, and really low Ca. Cause?
**Haemolysed Sample**
## Footnote
Pseudohyperkalaemia occurs in haemolysed blood samples. In terms of both pseudohyperkalaemia
and pseudohypocalcaemia, I could only find one resource which states identifies both of these
electrolyte abnormalities together and occurs when the sample is contaminated with incorrect EDTA
bottles. I doubt this is what King’s is looking for
134
Cr high, Urea high, PTH high, Ca high, Phosphate high. Myeloma? Hyperparathyroidism?
Answer: **Hyperparathyroidism**
_Multiple Myeloma_: This is a cancer of plasma cells in the blood. This is commonly associated with
hypercalcaemia due to the formation of lytic lesions within the bone causing systemic release of
calcium. Renal failure is also a common feature of MM. I could not find any data on parathyroid
hormone levels but having researched the mechanism of action you’d expect to see low levels of
PTH.
_Hyperparathyroidism_: This will obviously cause hypercalcaemiaand high levels of phosphate in urine
(although low levels will be seen in the serum). Renal calcium stones can possibly develop into renal
135
Gram positive cocci in capsule?
Streptococcus Pneumoniae
136
Menorrhagia in woman, and arising from pelvis?
Fibroids
137
Woman has low Hb and low MCV, and doesn’t want blood transfusion during op? What can you
offer?
**_Cell salvage_**: This is autologous transfusion of blood collected within the procedure itself, it can be
given back during the procedure or after the procedure. One possible concern is that in operations
to remove cancers, tumour cells may be found in the blood salvaged which is highly unfavourable.
138
Woman undergoes hysteroscopy, when would you do hysterectomy?
To save her life
139
Lady being treated with Chemo and she gets sepsis signs. Diagnosis?
Neutropenic Sepsis
140
Bowel obstruction post op and vomiting. What do you do first?
This sounds like paralytic postoperative ileus. In such cases an **NG tube** is used for vomiting and
intensive fluid resuscitation is required. The patient may also benefit from electrolyte correction
which is a cause of pseudo-obstruction.
141
Carpal tunnel syndrome Q. Which does median n supply?
Answer: **lateral lumbricals** (opponens pollicis, abd poll brevis, flexor poll brevis)
142
Ca pancreas? What is the most common site?
Up to 75% of pancreatic carcinomas occur at the **_head_** or neck of the pancreas
143
Renal transplant treated with immunosupressants. Lesion with keratinising centre on arm?
SCC
144
Different lung cancer types?
**_Adenocarcinoma:_** (Non-small cell carcinoma) Arise from mucous cells in bronchial epithelium. Most
common bronchial carcinoma associated with other asbestos and is more common in non-smoker
compared to other cell types. Invasion of the pleura and mediastinal lymph nodes is common.
**_Squamous cell carcinoma:_** (Non-small cell carcinoma) Associated with PTH secretion. Most present
as an obstructive lesion of the bronchus, leading to infection. Local spread is common.
**_Small cell carcinoma:_** Rapidly growing and highly malignant cells growing around bronchus. They are
found with metasteses on diagnosis. Particularly associated with SIADH, hypercalcaemia, ACTH and
gynaecomastia. Also associated with Eaton Lambert syndrome.
145
Pt is in AF, what’s the most easily avoidable complication?
Complications of AF include **_systemic embolism_**, precipitation of acute heart failure, worsening of
existing heart failure and development of cardiomyopathy. The most easily avoidable is systemic
embolic with anticoagulant medication such warfarin, rivaroxiban and dabigatran.
146
Fluctuating consciousness what investigation would you do?
CT head (subdural)
147
Differentiating LP results?
148
Man with BPAD falling over what making him fall?
**Lithium** toxicity is associated with dizziness, ataxia, inco-ordination, muscle twitching and tremor.
Other manifestations of lithium toxicity include anorexia, diarrhoea, vomiting, drowsiness, apathy,
restlessness and dysarthria. Severe toxicity may result in hyperreflexia, convulsions, collapse, coma,
renal failure, dehydration, circulatory collapse, hypokalaemia and death.
149
Male presents with acute severe unilateral pain in eye blurred vision and pupils dilated. Whatwould you expect on Ix?
_Acute angle-closure glaucoma_: Acutely **_raised intraocular pressure_**. This commonly presents with
rapidly progressive pain which may be confined to one eye but usually spreads to the other. There is
rapid blurring of vision and colour halo around lights. Mid-dilated pupils may be a causative factor.
Systemic malaise is a common feature. On examination the patient has red eye, with cloudy cornea
and non –reactive mid-dilated pupil. Investigation reveals IOP greater than **21 mmHg**
150
Persistent vomiting. What metabolic abnormality?
Hypochloraemic metabolic alkalosis (loss of HCL from stomach)
151
Skin tags, discontinuous lesions?
Crohn's
152
Naloxone indications. RR of 7? Pinpoint pupils?
Naloxone is indicated if respiratory depression occurs as a result of opioid overdose.
Answer: Respiratory rate of 7
153
Signs of a perforated something in the abdomen. Which Ix first?
Erect CXR
154
Petechiae on the palate. Splenomeg.
**_Infectious Mononucleosis_**
Presents with low grade fever, fatigue and malaise. Sore throat due to
tonsillar enlargement is common with palatal petechiae and uvular oedema. Fine macular non-pruritic rash which rapidly disappears.
Lymphadenopathy is common. Later signs include hepatomegaly and splenomegaly.
155
Med most likely to cause hypo?
**_Glicazide_**
156
Myeloma getting weakness?
Myeloma: Complications in myeloma include hypercalcaemia, anaemia, infection, hyperviscosity and **_c_****_ord compression_** (a medical emergency for which local radiotherapy is the treatment of choice).
157
Antibody for systemic sclerosis?
* **Limited** systemic sclerosis (CREST) - Anti-**centromere** antibody
* **Diffuse** systemic sclerosis - Anti-**Scl-70**
158
Sticky discharge, itchy eye, for 2-3 days, one eye only?
* _**Bacterial** Conjunctivitis:_ Gritty discomfort, minimal pain, visual usually unaffected, thick yellow mucopurulentdischarge.
* **Chlamydial** Conjunctivitis: Chronic low grade conjunctivitis with green stringy discharge in themorning. History of sexual symptoms.
* **Gonococcal** Conjunctivitis:Rapid onset on unilateral/bilateral hyperpurulent red eye. History of sexual symptoms.
* **Viral** Conjunctivitis: Gritty foreign body sensation, morning crusting. Symptoms present initially on one side and then progress to become bilateral.History of upper respiratory tract infection.Watery mucoid discharge**. Pre-auricular lympadenopathy** is a classical sign.
159
Flaky rash, painful joints, discoloration of nails?
Psoriasis
160
Old woman with fractured NOF and also has asthma. Which analgesic do you give?
**Codeine**
NSAIDs are contraindicated in asthma and morphine may initially be strong for an elderly woman
161
Child had a fever then started fitting (?febrile convulsion). Becoming cyanosed. Lasting about 5 mins. What do you give?
Paracetamol
162
RA patient localised area of eye redness?
Scleritis
163
Redness all over sparing the area around the limbus
subconjunctival haemorrhage
164
paradoxical chest movement in one part of chest–
flail chest
165
alcoholic man got into fight and chest hurts
simple rib fracture
166
intensely itchy discoid areas on extensor surfaces on young man who had suffered from similar as a child
eczema
167
excoriations between fingers
scabies
168
sore throat then shin lesions appeared
erythema nodosum
