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1

RTA. Conscious at the event. Brought into the A&E with reducing consciousness. Had to work out GCS from the info. Calculated as 6/7:

  1. Neurosurgical review
  2. Intubated and ventilate
  3. Rapid CT
  4. Burr hole

Intubated and ventilate

2

Anterior neck lump biopsied as a squamous cell carcinoma of a tonsillar primary. Which infection causes this cancer:

  1. EBV
  2. HPV
  3. Cytomegalovirus
  4. HTLV-1
  5. HIV

EBV

3

Man with rheumatoid arthritis has painless ulcer on the medial malleolus what’s the diagnosis, had evidence of lipodermatosclerosis and hemosiderosis (thickened brown pigmentation surrounding it):

  1. venous ulcer
  2. pyoderma gangrenosum
  3. Granuloma annulare
  4. Necrobiosis lipoidica

venous ulcer

4

Small lump, Mammograohy shows calcication, DCIS diagnosed on histology what is the treatment

  1. wide local excision
  2. Mastectomy
  3. Radiotherapy
  4. Review in 6 months
  5. Tamoxifen

wide local excision

5

55 year old Woman smokes 10 per day with a 6 month history of white sputum and a cough what should be done first  

  1. CXR
  2. PEF diary
  3. Spirometry
  4. Culture

CXR

6

5 days post AP resection and now peritonitic, temp 38 abdo distension and lower abdo pain. (rpt Q) 

  1. Pelvic abcess
  2. Anastomotic leak
  3. Subphrenic abscess
  4. Subpelvic abscess

Anastamotic leak

7

Private healthcare screening 21 y/o asymptomatic. Fasting bm was 7.2. What should you do with him?

  1. HbA1c
  2. Diet
  3. Gliclazide
  4. Dietary advice

HbA1c

8

Breast cancer with lung and bone mets. On low-dose haloperidol. Confused, constipated, (hypercalcaemia). What is causing these symptoms:

  1. Hypercalcaemia
  2. Brain mets
  3. Haloperidol
  4. Diabete Mellitus

Hypercalcaemia

9

22 year old soldier Comes out of cramped military aircraft after a long flight and collapses and hits her head some limb twitching for 15 seconds, regains consciousness after 5 mins​. looks pale

  1. Vasovagal
  2. PE
  3. Tachyarrhythmia
  4. Epilepsy

Vasovagal

10

Young woman, no lump, bloody discharge from boob:

  1. Intraductal papilloma
  2. DCIS
  3. Duct ectasia

Intraductal papilloma

11

Woman who had been in bangladesh for 6 months found to have decreased chest expansion, dull percussion on R side

  1. Pneumothorax
  2. Pleural effusion
  3. Emphysema

Pleural effusion

12

Patient with symptoms of UC, which investigation is diagnostic

  1. Colonoscopy
  2. Faecal calprotectin
  3. Flexi sig
  4. CT 
  5. USS

Faecal calprotectin

BMJ: 

Faecal calprotectin  is recommended. It is elevated when there is bowel inflammation and correlates with endoscopic and histological gradings of disease severity. It is useful in supporting clinicians in the differential diagnosis of irritable bowel syndrome (IBS)/inflammatory bowel disease (IBD) and can prevent unnecessary referrals for colonoscopy. In those with an established diagnosis of IBD this test can be useful to assess for ongoing bowel inflammation

Colonoscopy is expensive, requires full bowel preparation and sedation, and should be performed in a special setting (endoscopy suite).

Indicated in patients with UC who are not responding well to treatment, in order to rule out infections (particularly cytomegalovirus and Clostridium difficile ) and assess the need for surgery.

13

Patient with UC, what features indicate for colectomy

  1. Epithelial dysplasia
  2. Paneth cell metaplasia
  3. Crypt abscess
  4. Crypt architecture disruption
  5. Numerous granulomas

Epithelial dysplasia

Epithelial dysplasia a term becoming increasingly referred to as intraepithelial neoplasia, is the sum of various disturbances of epithelial proliferation and differentiation as seen microscopically. Individual cellular features of dysplasia are called epithelialatypia.

Paneth cell metaplasia occurs in chronic inflammatory conditions of the colon, most notably ulcerative colitis and colonic Crohn's disease

14

Greek guy takes antimalarials and becomes jaundice

  1. G6PD deficiency
  2. SCD
  3. Autoimminue heamolytic anaemia 
  4. Adverse drug side effect 

G6PD deficiency

15

Asthma in a 40yr old lady with unable to finish sentences, hypoxic, high PCO2, pH on ABG 7.30. Already treated with IV nebulisers and pred. 

  1. CPAP
  2. IV aminophylline
  3. Intubate ventilate
  4. Reduce her O2

Intubate

CO2 high->intubate 

 

British Thoracic Society guidelines

  • magnesium sulphate recommended as next step for patients who are not responding (e.g. 1.2 - 2g IV over 20 mins)
  • little evidence to support use of IV aminophylline (although still mentioned in management plans)
  • if no response consider IV salbutamol

16

Old guy with COPD with CO poisoning, normal O2 sats

  1. 15L non rebreather mask
  2. 2L nasal cannula
  3. Different concentrations with venturi mask

15L non rebreather mask

17

PEFR 65%, Sats 95%, Pulse 130 bpm. What clinical feature is most useful in determining whether someone with asthma needs admission

  1. Peak flow
  2. O2 sats
  3. Heart rate
  4. Wheeze
  5. Respiratory rate

Peak flow

18

Hypotensive patient post op, has been given 500ml bolus, no signs of HF, 10 ml urine, no pain

  1. Remove epidural
  2. Give fluids
  3. Give vasoconstrictor
  4. Give diuretics
  5. Put them head down

Give fluids

19

Sickle cell disease with back pain, what analgesia do you give first

  1. paracetamol/ibuprofen
  2. Epidural
  3. Fluids
  4. Exchange transfusion

Fluids

20

Person on morphine epidural after THR and confused, shouting in middle of night about things in his kitchen. How to manage

  1. Stop morphine
  2. IM Haloperidol
  3. Diazepam
  4. Well lit side room
  5. Midazolam

Well lit side room

21

Epilepsy not responsive to two xLorazepam

  1. Phenytoin
  2. Propofol
  3. Diazepam
  4. Thiopentone
  5. Thiamine

Phenytoin

22

Full-thickness ulcer on medial malleolus, person with rheumatoid, hardended dark brown skin around it

  1. Venous ulcer
  2. Pyoderma gangrenosum
  3. Granuloma annulare
  4. Erythema Multiforme

Venous ulcer

23

Peripheral oedema, scrotal oedema, proteinuria. Which diagnostic investigation do you do?

  1. Renal biopsy
  2. Protein creatinine ratio
  3. Ureteroscopy

Renal biopsy

24

Post tonsillitis guy who got proteinuria, haematuria, swollen face, red cell casts, self resolved over the next 3 months

  1. Iga nephropathy
  2. Acute glomerulonephritis
  3. Nephrotic syndrome

Iga nephropathy

25

Tonsillar exudates, jaundice (change in skin colour), upper abdo pain. What was the cause

  1. EBV
  2. Tonsillitis
  3. Staph sepsis
  4. Influenza
  5. Malaria

EBV

26

Guy with seizure and no focal neurology. LP results normal protein, normal glucose, raised cell count (20). CT head clear.

  1. Viral encephalitis
  2. Pneumococcal meningitis
  3. Viral meningitis
  4. TB meningitis.

Viral encephalitis

27

80 year old guy with increased confusion, type 2 diabetes AF with warfarin. Complains of headaches and had 2 falls, increased confusion

  1. UTI
  2. Chronic subdural
  3. Extradural
  4. Thrombotic emboli

Chronic subdural

28

Old lady falls in nursing home, GCS 14 dropped next day to 9, had headache

  1. Extradural
  2. Subdural
  3. SAH
  4. Intracerebral haematoma

????extradural 

29

Someone has watery vomiting and diarrhoea. What precautions will you take

  1. None
  2. Don’t let kids see her
  3. Ask staff and visitors to wash hands
  4. Side room + enteric precautions

Side room + enteric precautions

30

Woman calls GP about husband with terminal prostate cancer and is breathless. What do you do?

  1. Call 999
  2. Ask GP to go next week
  3. Visit them in that morning + palliative care discussion
  4. Ask district nurse to see them urgently

Visit them in that morning + palliative care discussion