2017

Question 1

40-year-old farmer has wheeze for a few weeks. Normal CXR. Diagnosis?

Answer 1

Aspergillosis (normal and eventually bronchiectasis)

Question 2

Transfusion reaction - fever, other obs normal, transfusion stopped. What next?

Answer 2

Check bag against patient details

Question 3

Mid-diastolic murmur

Answer 3

Mitral stenosis 


Question 4

Patient on warfarin for AF has INR of 3.3, falls and found on CT to have intracerebral haematoma - warfarin stopped and been given Vit K, what next?

Answer 4

Prothrombin Complex

Question 5

Lady with palmar erythema, raised ALT, raised bilirubin, strongly positive ANA?

Answer 5

AI Hepatitis

Question 6

Haematemesis and abdo pain, BP 120/80, HR >100 (what was the actual HR?) What do you give IV whilst waiting for endoscopy?

Answer 6

IV crystalloid

• IV terlipressin (in variceal bleeding – can do that first)
• IV PPI (in upper GI bleed) – NO do endoscopy FIRST

Question 7

Small cell lung ca, hilar LN, no distant mets - what treatment?

Answer 7

Chemo

SCLC

 Usually disseminated @ presentation

 Some benefit c¯ chemo

Palliative Care

 Analgesia: opiates for pain and cough

 Radiotherapy: haemoptysis, bone or CNS mets

 SVCO: dex + radio or intravascular stent

 Persistent effusions: chemical pleurodesis

Question 8

Public health question: 200 pts in 2 month period out of 10,000 people get influenza. They ask how many people out of 100,000 in one month period get infection?

Answer 8

1000

Question 9

Patient has bad claudication and can only walk 10m. Distal aorta and both iliac vessels occluded. What do you do?

Answer 9

Aorto-Bifemoral

Indications for bypass:

• V. short claudication distance (e.g. <100 m)
• Affecting QoL
• Rest Pain develops

Question 10

Lady has surgery 4 days ago, after she was given multiple bags of 5% dextrose. Now she is drowsy. What’s the mechanism?

Answer 10

Cerebral Oedema

Question 11

Guy gets claudication in calf. Where is the block?

Answer 11

Calf = superior femoral

Buttock = iliac

Question 12

Lady with RA and purple nodule on shin ulcerating with raised edges. Dx?

Answer 12

Pyoderma Gangrenosum

Question 13

Guy with prostate ca has back pain and bone scan shows increased uptake in spine, how to help with pain?

Answer 13

Radiotherapy

Question 14

Some woman with folate and iron deficiency. Some unstated bowel symptoms following bouts of gastroenteritis as a child. What ix do you do?

Answer 14

Anti TTG abs

Question 15

Post partum breast feeding lady with red tender breast, no mass. What do you do?

Answer 15

Flucloxicillin

Question 16

What does a triple assessment consist of?

Answer 16

Clinical exam + imaging + core biopsy. (Imaging in <35 is USS, >35 is mammogram)

Question 17

Old guy with bacteruria grown from catheter. What do you do?

Answer 17

Treat if symptomatic

Question 18

Smoker has lung cancer near right bronchus removed with raised calcium, what will histology show?

Answer 18

SCC

• Non-Small Cell Lung Cancer*
• ·* SCC: 35%
• § Highly related to smoking
• § Centrally located
• § PTHrP → ↑ Ca2+

Question 19

What is a feature of reactive arthritis other than arthritis, urethritis etc?

Answer 19

Keratoderma blenhorrhagicum (yellow lesions on soles of feet)

Question 20

Idiopathic Intracranial Hypertension

Answer 20

• headache, blurred vision, papilloedema, blind spot, 6^th nerve palsy
• RFs = obese, female, pregnant, OCP, tetracycline, vitamin A, lithium
• Mx = WEIGHT LOSS, acetazolamide (diuretic - inactivates carbonic anhydrase), topiramate (weight loss too), repeated LP, surgery

Question 21

40 year old banker has headaches which have led to taking ibuprofen and paracetamol daily. No neuro or eye signs. No weight loss.

Answer 21

Advise to stop taking meds and reassess in a month

Question 22

Someone has hearing changes, haemoptysis, nasal discharge, renal problems. CXR shows 3 cavitated lesions?

Answer 22

Wegener’s Granulomatosis

Question 23

49 yo lady with 2 month history of diffuse thyroid swelling and intense sweating at night

Answer 23

Graves

Question 24

Test for gestational diabetes

Answer 24

Oral glucose tolerance test at 28 weeks

Question 25

Thyroid function low TSH, High T4- post URTI, reduced iodine uptake, hyperthyroid. Cause?

Answer 25

**Viral thyroiditis (de quervains)**

Question 26

Patient has bowel operation 4 days ago, has not opened bowels for 24 hours. Distended with scant bowel sounds. Cause?

Answer 26

**Small bowel obstruction** (tinkling bowel sounds = high pitched)

Question 27

Patient with symptoms of guarding, peritonism, what test?

Answer 27

Erect CXR 


Question 28

Patient with symptoms of bowel obstruction - what test?

Answer 28

**Supine AXR**

Question 29

Patient has been generally unwell for a week. Now has dysuria and is going frequently. Later on, she gets more unwell and has really bad loin pain. What’s wrong?

Answer 29

Pyelonephritis

Question 30

80 year old with essential hypertension and peripheral vascular disease. What meds?

Answer 30

_Nifedipine, Amlodipine,_ **_Felodipine_** (dihydropyridine CCBs) = affects peripheral vascular smooth muscle \> myocardium

Question 31

Testicular pain in a sexually active 18 year old. Management?

Answer 31

Take to theatre

Question 33

Someone has AF and has a cold pale leg. It’s been 6 hours. Mx?

Answer 33

**Amputate** *(\> 6 hours – but otherwise **embolectomy w fogarty catheter**)*

Question 34

Lady with flushing, pustular rash, telangectasia on her face?

Answer 34

**lupus pernio** (sarcoidosis)

Question 35

Gentlemen with bald head, lumpy hyperkeratotic lesions on scalp. What is he at risk of?

Answer 35

SCC

Question 36

Guy with pale stools, abdo pain. Xray shows area of calcification.

Answer 36

Dx - decrease in exocrine pancreatic function. **Chronic Pancreatitis**.

Question 37

Guy who was lifting heavy things. Now just lumbar pain. Mx?

Answer 37

Symptom control with NSAID

Question 38

Patient with 3 weeks of fevers, cough, feeling unwell. On exam: dull percussion, absent Vocal Resonance, reduced expansion?

Answer 38

**Empyema** (vocal resonance increases in consolidation and decreases in effusion)

Question 39

What vitamin you have to give somebody when starting TB treatment?

Answer 39

**Pyridoxine (B6)**

Question 40

Somebody comes in to A&E with drug resistant TB, where do you keep them?

Answer 40

**Negative pressure room + respiratory measures for staff** (allows air into room but not out)

Question 41

Somebody with features of UC - how do you investigate?

Answer 41

**flexible sigmoidoscopy**

Question 42

Pt with known renal cell cancer now gets swollen legs and distended veins below umbilicus what’s the diagnosis?

Answer 42

**Obstruction of IVC**

Question 43

Some guy with obstructive features, long term smoker. Dx?

Answer 43

**Chronic Bronchitis**

Question 44

20 year old female, walks in, has 2yr history of intermittent diarrhoea, IDA, aphthous ulcers, raised ESR. Dx?

Answer 44

Coeliac

Question 45

A man with stab injury to the back - hemisection of the cord. Where would he lose pain sensation from?

Answer 45

. **Contralateral spinothalamic**

Question 46

An ECG shows STEMI in leads V4-V6 and I, AvL - where is the infarct?

Answer 46

**Antero-lateral (circumflex)**