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Past Papers | Sarah Yasmine > 2018 > Flashcards

2018 Flashcards

1
Q

Drug causing urinary retention?

A

Amitriptyline

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2
Q

Ring and little finger tingling - which nerve has been damaged?

A

Ulnar

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3
Q

Deltoid wasting, weakness of flexion and supination. Damage?

A

C5,6) - Upper brachial plexus damage

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4
Q

Crushing pain for an hour and collapsed, young guy.

A

VF

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5
Q

He just started chemo for Burkitt’s. Has high K. Diagnosis?

A

tumour lysis syndrome

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6
Q

Diabetic due for inguinal hernia surgery taking both gliclazide (24 hours before) and metformin (on the day) - HbA1c <69mmmol/L = good control.

A

Omit gliclazide and keep metformin

(longer surgery/missing more than one meal = sliding scale insulin)

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7
Q

Which drug causing hyperkalaemia?

A

ARB

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8
Q

Loss of vision every now and then in right eye which resolves, and weakness in arm. Diagnosis?

A

Carotid artery stenosis

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9
Q

Lateral medullary syndrome picture. Which artery?

A

Posterior inferior cerebellar artery (and vertebral artery)

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10
Q

Lateral Medullary Syndrome (Wallenberg’s). Symptoms?

A

DANVAH

 Dysphagia

 Ataxia

 Nystagmus

 Vertigo

 Anaesthesia: dissociated pain loss

 Horner’s syndrome

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11
Q

Patient with hyponatremia, has bronchogenic carcinoma. Management?

A

vasopressin receptor antagonist (SIADH) (demeclocycline** or **vaptan** or **lithium)

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12
Q

Infective endocarditis. Which investigation would give a definitive diagnosis?

A

blood cultures

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13
Q

Ank Spond. NSAIDs not working. What to give next?

A

Infliximab

(2nd line = steroid injections)

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14
Q

Man about to have hip replacement. Already been given TEDs, which other DVT prophylaxis should you give?

A

Dabigatran

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15
Q

Suspected DVT, calf was not tender or swelling. He had pitting oedema up to his knee in one foot. Started amlodipine (causes swelling?) a month ago. D-dimer normal. What do you do?

A

Add an ACEi

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16
Q

Patient has increasing breathlessness on exertion, which resolves with GTN spray. It’s getting worse. What is an appropriate drug to start to relieve his symptoms?

A
  • all patients should receive aspirin and a statin in the absence of any contraindication
  • sublingual glyceryl trinitrate to abort angina attacks
  • NICE recommend using either a beta-blocker or a calicum channel blocker first-line based on ‘comorbidities, contraindications and the person’s preference’
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17
Q

Patient on beclametasone inhaler and salbutamol inhaler and now has pain on swallowing (i.e. he got oesophageal candidiasis). What advice do you give him?

A

beclometasone with spacer

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18
Q

Alcoholic with long standing ascites, has been abstinent for 6 months. Increasing confusion. Is on regular thiamine and spironolactone. Has recently been started on oral furosemide. Has been feeling unwell and has some worsening of ascites. Na: low, BP low (can’t remember other figures). What is the most important IV therapy to start?

A

500mL of Hartmann’s (really low BP)

N.B. if fever = antibiotics

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19
Q

18 month old boy drinks paracetamol 2 hours ago, and mum has now brought him into A&E. What time is it best to measure his paracetamol levels?

A

Measure paracetamol level in 2 hours

  • Liver damage likely at > 250mg/kg
  • < 1 hour + > 150mg = 50G activated charcoal
  • 8-16 hours = start NAC if > 75mg/kg
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20
Q

What is the likely diagnosis when there is bronchial breathing?

A

Pneumonia

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21
Q

Patient 10 weeks pregnant has urinary frequency and urgency. What is the most appropriate antibiotic?

A

Nitrofurantoin

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22
Q

70 year old patient has 2 cm irregular, mobile lump in upper outer quadrant of breast. What is the most likely diagnosis?

A

invasive ductal carcinoma

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23
Q

What are the differentiating features of malignant breast cancers?

A
  • DCIS = can’t feel (asymptomatic)
  • LCIS = asymptomatic
  • invasive ductal = more common
  • invasive lobular = less common
  • medullary = young people
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24
Q

COPD patient is on salmeterol (= all LABA) and tiotropium (LAMA), but his symptoms are not well controlled. FEV1 is 65%. What to do next?

A
  1. FEV1 > 50% and no asthmatic features = 1) LABA + LAMA 2) Theophylline
  2. FEV1 < 50% and asthmatic features = 1) LABA + ICS; 2) LABA + LAMA + ICS
    • previous asthma dx
    • eosinophils
    • >400ml FEV1 variation over time
    • > 20% diurnal peak flow variation

LABA + ICS combo =

  • budesonide/formoterol (Symbicort)
  • fluticasone/salmeterol (Advair)
  • fluticasone/vilanterol (Breo Ellipta)
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25
Patient has inguinal lymphadenopathy. Lymph node biopsy finds sheets of **RAPIDLY GROWING moderately sized B cells**. What is the diagnosis?
Burkitt’s Lymphoma
26
A rheumatoid patient who is taking prednisolone and methotrexate has a sudden onset lower back pain. What is the cause?
Osteoporotic STRESS fracture
27
Patient with BRCA1 mutation. She is worried that her kids (son + daughter) and sister might have it?
50% (autosomal dominant)
28
Histopathological findings: summary was villous atrophy, crypt hyperplasia, abnormally high number of T lymphocytes. Diagnosis?
Coeliac
29
So there was one about a tongue deviating to the left. Which nerve is damaged?
Left Hypoglossa (tongue licks the wound)
30
Old patient wishes to be cared for at home. He has no living family. He understands that he is refusing hospital treatment. What is the most appropriate way to fulfil his wishes?
_Advanced Directive_ = legal document for patient to specify what they want from their care – e.g. refuse treatments
31
In a randomised controlled trial, what is the most likely form of bias?
Attrition
32
Old COPD patient already on salbutamol, tiotropium etc. Having increasing breathlessness at rest, and has carers come to her place twice a day. Lung auscultation is clear but there is peripheral oedema. What is the most appropriate treatment?
Offer **_LTOT_** to patients with a pO2 of \< 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following: - secondary polycythaemia - peripheral oedema - pulmonary hypertension
33
Angina Ix?
Coronary Angiography
34
Abdominal pain 20 mins after meal. Weight loss. Dx?
mesenteric angina
35
Alcoholic with symmetrical clawed (basically can’t move fingers- dupytryen’s picture). What is the pathophysiology?
**thickened palmar fascia**
36
Which cells responsible for uptake of fat in fatty plaque formation?
macrophages
37
Woman with **SOB**, ECG - **sinus tachycardia**, 35 year olds **overall well**, auscultation- pleural rub on **right sid****e**. Dx?
PE
38
night time coughing
GORD
39
Eye that has industrial liquid splashed on his eye after workplace accident. Eye is now red and painful. Fluorescein dye showed patch. What to do next?
**0.9 NaCl saline wash out**
40
Red flag signs for someone with back pain?
Pain at night
41
Guy has sore throat, looked red, hard to swallow, tonsils were symmetrical and of a normal size?
**_pharyngitis_** (can visualise – larynx = lower down)
42
A patient has 6 month smoking history (lung cancer picture) and hyponatremia- what hormone caused this?
ADH
43
18 yr old guy with hundreds of polyps, dad and grandfather had colorectal cancer. What do you do?
FAP = **panproctocolectomy** + **ileostomy**
44
Guy comes back from travelling a month ago- had headaches and one week ago started getting diarrhea/ fever. Long time since travel. Dx?
**Giardia** * \> 7 days: Giardiasis, Amoebiasis * *But* Amoebiasis = bloody
45
Something about woman on prednisolone and keeping track of risk of fractures?
DEXA
46
Guy with heart failure gets pulmonary oedema, you give him oxygen, sit him up, furosemide. What is appropriate to do next?
* ***Oxygen administration*** * ***IV access and bloods*** * ***_Nitrates_ - Sublingual then iv*** * ***Requests ECG*** * ***_Furosemide_*** * ***CXR*** * ***Recognises need for _CPAP_ and requests it***
47
Guy gets posterior hip dislocation. What is of most concern?
**_Sciatic Nerve Injury_** | (also AVN necrosis)
48
**pain relieved by eating**, **worse at night**
duodenal
49
What in an ABG of a COPD person indicates a state of chronic respiratory acidosis?
High Bicarbonate
50
Has an eosinophilia, iron deficiency anaemia, and bloody diarrhoea. Which infection?
Hookworm
51
Ruptured achilles tendon - best imaging modality?
* **Diagnosis** = **clinical** * **First**/appropriate = **USS** * **Best** = **MRI**
52
Cause of ketoacidosis in DKA?
**altered fatty acid oxidation**
53
What causes genital warts?
HPV
54
Negative D-Dimer, what do you do?
**_Send Patient Home_** * *sensitivity = 95-98%, but poor specificity* * *works for DVT as well as PE*
55
Girl with rheumatoid of hands, what do you do?
Refer to Rheum
56
When do you intubate
GCS \< 8 | (if 8 = oropharyngeal)
57
Impaired Fasting Glucose Management?
* offered an **oral glucose tolerance test** * result **\< 11.1** mmol/l but **\> 7.8** mmol/l = IGT * IFG = 6.1-6.9
58
UC diagnosis
colonoscopy
59
Anterior neck lump biopsied as a squamous cell carcinoma of a tonsillar primary. Which infection causes this cancer?
HPV 16
60
DCIS diagnosed on right outer quadrant, on first mammography what is the treatment?
wide local excision (if invasive = mastectomy)
61
Woman who had been in bangladesh for 6 months found to have decreased chest expansion, reduced VR, reduced AE, dull percussion on R side, productive cough
Pleural Effusion
62
Guy with seizure and no focal neurology. LP results normal protein, normal glucose, raised cell count (20). CT head clear. Dx?
Viral Encephalitis
63
Woman calls GP about husband with terminal prostate cancer and is breathless. What do you do?
Visit them in that morning + community palliative care discussion
64
Erectile dysfunction in a man with HF and hypothyroidism on metformin, BBlocker, statin etc no vasc symptoms, palpable peripheral pulses, normal sensation peripherally, no postural hypotension (<5mmHg changed). What’s the cause?
Beta Blockers
65
Facial swelling, distended chest veins, weight loss, JVP raised but non pulsating, clubbing?
Bronchial Carcinoma
66
Bell palsy (facial weakness, non forehead sparing, normal ear and no rash). Treatment?
Prednisolone
67
Commonest arrhythmia post-MI causing death?
VF
68
Anti-Jo. Confirm diagnosis?
polymyositis = **muscle biopsy**
69
CREST sx on a patient. Pleuritic CP/sob with crackles? Which ix?
HRCT
70
First ix for lady with exertional breathless, HR 42. 1st ix?
ECG
71
Myelodysplasia which has got worse in the last few weeks. Primitive cells on slide and pancytopenia, what have they developed?
AML
72
Features of SLE, on hydroxychloroquine. Jaundiced, raised reticulocytes. Spherocytes and polychromasia?
AIHA
73
Hyponatraemia and dehydrated. Dry mucous membrane. How do you decide on fluid status?
Serum Urea
74
Clarithromycin and atorvastatin, metformin. What to do?
clarithromycin and atorvastatin = causes **myopathy** (**change** for a different **antibiotic**)
75
Vocal cord endoscopy, struggling to speak, tachypnoeic 28, could not maintain a strong grip when asked by nurses to squeeze. What is the antidote?
**_Neostigmine_** (or **sugammadex**) = rocuronium poisoning
76
curved gram negative rods
curved/bent = camp —\> campylobacter (camping)
77
Young guy, collapses frequently during sport? with ECG - Sinus rhythm. PR or QRS 120ms, cQT 510ms. Dx?
Prolonged QT = VT ## Footnote (normal QT interval = 0.38-0.5 seconds)
78
Hips dislocate posteriorly. Findings?
internal rotated, short and adducted
79
Woman BMI32, drinks loads of coffee, smokes, drinks alcohol etc - Getting recurrent headaches, losing vision when straining to poo. Exam shows papilledema. LP pressure high (40) Best advice to give to her?
Lose weight = benign intracranial hypertension
80
Woman with metastatic cancer, taking Morphine 60 mg BD oral and can’t tolerate oral anymore, what to replace it with?
morphine subcut 60mg/24h (half morphine for subcut)
81
Mc Murray’s positive, twisted knee during sport and heard a pop, what Ix most appropriate?
MRI knee
82
Fatigue, diabetic with photocoagulation, urine had protein etc
CKD
83
Treatment for meningitis (neck stiffness etc)
IV ceftriaxone
84
59 yr old female with pruritus and got IgM anti-mitochondrial antibodies. What makes PBC likely?
Xanthelasma
85
BCC - what does it do?
Local invasion only
86
Patient with floaters and sudden loss of vision in left superotemporal quadrant?
Retinal Detachment
87
Pt recently had dosage of atorvastatin increased, presents with myalgia etc. CK elevated to 5x upper limit of normal (2000). What to do?
**_Stop Statin_** - if the symptoms resolve can restart at a lower dose (if myopathy and high CK)
88
Guy with renal failure. Which drug is contributing to abnormal blood tests?
Diclofenac
89
IVDU with back pain. urine blood 1+ protein +. Systolic murmur. Anaemia on bloods.Tenderness over L1 to L3. Diagnosis?
Infective Endocarditis = spinal abscess
90
Acute diverticulitis. What is the diagnostic investigation?
CT scan
91
Surfer’s ear (pain on pulling pinna, can’t visualise the membrane due to artefact in the canal, she felt she had hearing loss)?
Otitis Externa
92
Blurred vision, painful right eye, right eye congested and bigger. Dx?
Angle closure glaucoma
93
Management of Person with metastatic cancer and has brain lesions and raised ICP?
Dexamethasone
94
Lady with chronic renal failure for 9 years on dialysis. PTH massively increased (148), Ca high (2.9), Phosphate high?
Tertiary Hyperparathyroidism
95
Man has ultrasound to look for gallstones, incidental finding of 4cm solid renal mass. No other sx?
angiomyolipoma
96
Caucasian man presents with dysphagia/weight loss ‘food getting stuck behind chest’?
Adenocarcinoma
97
Lady with asthma. On various inhalers + LTRA + Theophylline tablet. Which one has caused his painful swallow?
eclomethasone = painful swallow w candidiasis
98
Man with sciatic pain after heavy lifting?
Disc prolapse
99

Past Papers | Sarah Yasmine (5 decks)

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