2020 paper

Question 1

Keen runner who has irregular periods, where is the pathology?

Hypothalamus
Pituitary
Ovaries

Answer 1

Hypothalamic -> Think this is hypothalamic hypogonadism seen in anorexics/

Question 2

Which factor signifies greatest risk of progression in RA?

Joint involvement >8
CRP
Anti-CCP
RF

Answer 2

Anti CCP

We arent 100% sure but the following are poor prognostic features:

• rheumatoid factor positive
• anti-CCP antibodies
• poor functional status at presentation
• X-ray: early erosions (e.g. after < 2 years)
• extra articular features e.g. nodules
• HLA DR4
• insidious onset

Question 3

Pt with bradycardia and bilateral crackles, was on O2. Next step of mx?

IV furosemide
Atropine

Answer 3

IV furosemide

Question 4

Abx for infective exacerbation of COPD

)

Answer 4

Amoxicillin

BNF states that it is either amoxicillin, tetracycline or clarithromycin

Question 5

Woman 55yo? with pain in groin, mets in femur, where was primary lesion located?

Renal
Cervical
Lung

Answer 5

Renal cancer is normally loin pain, mass and haemtauria… this could be the loin pain COMMONLY mets to bone, like lung.

Cervical or lung as lung more commonly metastasised to long bones

We think that this is cervical as it is more common and it would explain the mets and groin pain??? Not sure

Question 6

Q described the findings from a CXR which showed bilateral multiple air filled sacs 10-20mm

Sarcoidosis
TB
Lung cancer
Lymphoma
Septic emboli

Answer 6

Septic emboli

We just searched up a bunch of pictures and picked the one which looked like it had air filled sacs… That being said the other ones we think present with caseating or non caseating granulomas or hard masses neither of which are air filled.

Question 7

Analgesia for osteoarthritis.

Answer 7

Topical Diclofenac -> This was the option in this exam qs -> There was only one answer…

Paracetamol or Topical NSAIDS

Question 8

Milky fluid drained from chest after surgery

Chylothorax
Empyema

Answer 8

Chylothorax -> this is a collection of fluid where the source is the lymphatics,

Question 9

Women with headaches, pushing on the frontal lobe. Which brain tumour?

Meningioma
Glioblastoma
Astrocytoma

Answer 9

Meningioma -> The most common in adults is Meningioma

-> Listened to the guy with a neuro BSc no other fact checking…

Jiwonn seo fact checked Imperial Neuro BSc is not worth it-> he gonna be a radioologist

NVM turns out jess cant read below is a pie chart that shows a neuro bsc in imperial is worth it. (Glioblastoma is the most common malignant tumour meningiaoma is the most common in tumour)

Screenshot from Giulia

Question 10

45 year old man with BP 190/90, tx?

Answer 10

So in the past paper it said Perindopril

Could be Oral labetolol
IV labetolol
Nitroprurosside

The following was an explanation in MaM mock answers to the question in the picture

This patient has presented with heart failure secondary to severe hypertension. In this circumstance, IV nitrates (e.g. sodium nitroprusside) are the first-line option to reduce blood pressure. GTN is an alternative agent that may be used in the same circumstance. Beta-blockers should be avoided as it can further compromise a heart that is already failing. Methyldopa is an old drug that may be used in the treatment of hypertension in pregnancy. Phentolamine is an alpha-blocker that may be used in the management of blood pressure in patients with phaeochromocytoma.

Question 11

What cell is primarily affected in MS?

Oligodendrocytes
Astrocytes
Schwann cells

Answer 11

Oligodendrocytes ->These are what creates the myelin in the central nervouse systemn

Schwann cells are the ones that create Myelin on the peripheral nervous system

MS attacks the central nervous system

Question 12

What additional vaccine is given to COPD patients?

Answer 12

PCV

The other possible answer ios Influenzaaaa

Question 13

CXR was normal. Upper lobe diversion, what test to do?

Answer 13

CTPA -> CXR is apparently not good at telling upper lobe diversion so you need to do CTPA to confirm,

Question 14

Cholesterol >9.0, triglycerides normal, HDL normal. Dx?

Answer 14

Heterozygous familial hypercholesterolaemia -> Isolated increase in LDL with all other levels are normal is suggestive of this condition.

Question 15

Polymyositis description, what blood test would help diagnosis? (Anti-Jo was not an option)

CK
ANA
ASMA

Answer 15

CK -> Is what the majority think it is

Antijo-1 would be more correct apparently for screening ANA is used.

Question 16

COPD wasn’t eating much. Which tool would be most useful?

Answer 16

Mini nutritional assessment

Honestly not sure what the answer is… Seems pretty low yield..

Malnutrition universal screening tool

Mini nutritional assessment
Malnutrition universal screening tool

Question 17

Tx for spinal cord compression caused by mets.

Radiotherapy
Surgical decompression
Chemotherapy

Answer 17

surgical decompression

Surgical decompression is not done for metatstatic disease. If there is multiple mets or they are unstable.

Question 18

Guy who kept falling asleep in the daytime.

Answer 18

Polysomnography

Question 19

Guy who had an incident where he nearly fell asleep while driving a lorry. What is the most important thing to do?

Tell him to inform the DVLA
Polysomnography

Answer 19

Tell him to inform the DVLA

Question 20

Blood supply to 2nd part of duodenum.

Answer 20

**Gastroduodenal artery
**
Essentially everything upto the 2nd part of the duodenum is supplied by the gastroduodenal artery.
After this the next component the midgut is supplied by the SMA and the final component is the IMA.

Abdominal osesophagus to the major duodenal papilla; oancreas; liver; gall bladder; spleen are all part of the coeliac trunk and its branches

SMA -> latter 2 parts of the duodenum the jejunum ileum caecum ascending colon and 2/3rds of the transverse colon

IMA -> distal 1/3rd of the transverse colon, descending, sigmoid,rectum and canal colon.

Question 21

Lymphadenopathy, fever, bilateral conjunctival swelling.

Answer 21

Leptospirosis
This was the option that was on the paper. This is often seens with rat places.

Question 22

What pneumoia causes cavitations on CXR? these are Gram +ve Cocci

Answer 22

Staphylococcus aureus -> This is also associated wtih recent viral infection.

Question 23

Lacunar infarct, what drug to give in addition to aspirin?

Statin
Beta blocker
ACEi
ARB

Answer 23

Statin
This is the secondary prevention for strokes.

ACEi is provided if the causes if a haemorhragic hypertensive stroke.

Question 24

Loud 2nd HS, pansystolic murmur. Right bundle branch block. - queried

Pulmonary HTN
Mixed aortic disease

Answer 24

Pulmonary HTN -> Giulia’s dad said its this… He a surgeon so we shall believe him…Mitral Regurgitation, causing Pul HTN I think that leads to a snapping close of the pulmonary valve. The Mitral regurg probably also causes the PSM.

NOT SURE

Mixed aortic disease would explain the PSM -> MR -> also leads to Pulmonary HTN + Aortic Stenosis (Loud S2) -> the RBBB -> Is a sign of Pulmonary HTN …… Leaning towards mixed diasease

Question 25

Woman gave birth 4 months ago. High TSH, low T3/4. Primary hypothyroidism Viral thyroiditis Postpartum thyroiditis

Answer 25

**Post-partum thyroiditis** -> this is a common post pregnancy and often presents a couple of months after pregnancy. Initially it presents like thyrotoxicosis. this is often self limiting I believe the history of the recent pregnancy makes Postpartum more likely. Primary hypothyroidism however is still another cause of low thyroxine and HIGH TSH.

Question 26

Prevention of steroid-induced osteoporosis.

Answer 26

**Bisphosphonates**

Question 27

Post hysterectomy and ovaries removal what is the prophylactic treatment of osteoperosis?

Answer 27

**Oestrogen** While looking this up online, we found that for risk reducing surgery with bilateral oopherectomy, HRT is given as prophylactic treat. I thought oestrogen but i think bisphosphonates were reccomended whereas oestrodial was like suggested as a possible option.

Question 28

Tx of neuropathic heel ulcer which had black crust. Low contact cast Sharp debridement Larval therapy

Answer 28

**Low contact cast** -> i believe this is done to relieve the pressure that is causing the ulcer in the first place Sharp debridement – used in the presence of infection This is only treated if there is a wet gangrene.

Question 29

Type of aphasia in women who can talk fluently but doesnt follow instructions Receptive Expressive Global Progressive Conductive

Answer 29

**Receptive**

Question 30

Colon biopsy showed caseous necrosis and Langerhan histiocytes. Feverish and GI sx.

Answer 30

**Tuberculosis** -> This is a cause of Caseating granulomas They also have langerhan histocytes...

Question 31

Pt with COPD on 28% mask, but O2 sats are 85% after 30mins. What should you do? Increase to 35% 100% O2 Stay on 28% Reduce to 24%

Answer 31

**Increase to 35%** If NIV or BiPAP is an option it is that. I dont think that you go down on Oxygen if they are desaturating.

Question 32

Intrinsic muscle wasting of hands, biceps reflex reduced. C5 nerve damage Axillary nerve damage Posterior brachial plexus damage

Answer 32

**Posterior brachial plexus damage** Basically the C5-6 nerve is what controls the reflexes and we think thats the reason that is not functional. However, the intrinsic muscles are innervated with the ulnar nerve which is innervated by the nerve roots C8 - T. The nerves where the above 2 interact are in the posterior cord as that cord recieves input from all of C5 all the way to T1. Therefore we thought that The posterior brachial plexus made the most sense.

Question 33

28yo with some episodes of semi-loose stools. He is healthy between episodes. Tx for IBS diet??

Answer 33

**FODMAP** -> This is the treatment for IBS. this is the reccomended diet. you can also do symptomatic management. Options were: FODMAP diet Lactulose diet

Question 34

CXR showed multiple lung mets in a guy with an undescended testicle. Which tumour marker?

Answer 34

**HCG** It could also be AFP, both are related with testicular cancer

Question 35

Aortic stenosis pt, gradient 50%, LEVF 45%, mx? Refer for aortic valve replacement Reassure

Answer 35

**Refer for Aortic Valve replacement** - In Severe Aortic Stenosis ⇒ GTN spray may be contraindicated because it can cause a reduction of preload of the heart leading to a risk of rapid decrease in Blood pressure and myocardial perfusion. - Surgical treatment is indicated when ⇒ Symptomatic or there is SEVERE AS + LVEF <50% and undergoing other cardiac surgery - What is Severe AS? - Jet velocity > 4 - pressure gradient ≥ 40 - aortic valve area > 1cm - TAVI or SAVR - SAVR if younger - TAVI if older

Question 36

What test to assess liver damage after paracetamol overdose?

Answer 36

**PT** The only answer in the options provided...

Question 37

Friction rub. Dx?

Answer 37

**PE** So this was again the only option, the possible causes inc pericardits and PE apparently also pneumonia.

Question 38

SVC obstruction Most likely cause? Treatment 1st and 2nd line

Answer 38

**Lung tumour** 1st line is dexamethasone 2nd line is Intubat and stent.

Question 39

Dejavu and picking at clothes, where is the lesion?

Answer 39

**Temproral lobe** -> Memory is in the temporal lobe. the deja vu is suggestve of this,

Question 40

Lung cancer with low Na and K. What hormone is being produced?

Answer 40

**ADH**

Question 41

Person had an endoscopy and colonoscopy, what investigation next? Capsule endoscopy CT abdomen

Answer 41

**Capsule endoscopy** Small bowel monitoring is the same thing as this. The next step after endo and colonscopy is the small bowel monitoring. Bare in mind that this is the answer if the previous 2 investigations found no results on malignancy... If there was then this would be a CT abdo.

Question 42

Oesophageal cancer with mets, how would they feed?

Answer 42

**Gastrostomy** -> this is for long term and also obstructive cancer NGT -> Acute obstruction and also short term use where they may improve with physio Paraenteral -> GI tract is not really work, so things like UC and Crohn's. Maybe CF??

Question 43

Endoscopy showed granulation tissue with necrotic layer on top

Answer 43

**Ulceration**

Question 44

Colonoscopy found inflammation in rectum and colon. UC Diverticulitis

Answer 44

**UC**

Question 45

Cholestatic picture in pt with thyroid problem.

Answer 45

**PBC** -> Autoimmune disease with thyroid so suggests another autoimmune disease, such as PBC which will present with a cholestatic picture. This is only Extrhepatic bile duct involvment

Question 46

Supraclavicular lymphadenopathy and weight loss

Answer 46

**Gastric carcinoma** -> this is likely to be a gastric cancer. Colorectal cancer rarely presents with virchow node thickening.

Question 47

Swabbed ulcer had MRSA, tx?

Answer 47

**Vancomycin** options were: Flucloxacillin Vancomycin

Question 48

Pt had a resection and epidural was not controlling his pain. What do you do? Oral morphine IV morphine Check level of block

Answer 48

**Check level of block** If epidural doesnt work then opioids will not work either so need to see if epidural has taken effect. Epidural is better that spinal as it can be titrated and topped up.

Question 49

19yo girl inverted her ankle during football practice. WHat ligament is most likely to be damaged? Anterior tabofibular ligament Posterior talofibular ligament Transverse tibiofibular ligament Calcaneal fibular ligament Interosseus ligament

Answer 49

**Anterior tabofibular ligament** The lateral complex is made up of the Anterior tabofibular complex, Calcaneal fibular ligament and the Posterior tabofibular ligament. The injuries to this lateral comples is in the order described above, with the most likely injury being the anterior tabofibular complex.. Deltiod ligament for eversion.... I am not gonna learn the anatomy.

Question 50

Pt is diagnosed with Hodgkin’s lymphoma, how would you describe the treatment? Neoadjuvant chemotherapy Adjuvant chemotherapy Curative chemotherapy –

Answer 50

**Curative Chemotherapy** -> this is for Hodgkin’s, ALL, testicular cancers these are the curative option.

Question 51

Pt with MS with neurogenic bladder. Urine was sterile and no signs of infection, what catheter to use? Suprapubic catheter Intermittent catheterisation

Answer 51

**Intermittent Cathertisation** -> Catheter is a good option for treatment of MS

Question 52

Gleason score 3 + 3, what is the appropriate mx? Watchful waiting Surgery Medication

Answer 52

**Surgery** This is a guess... What we found online was actually something called brachytherapy.

Question 53

Signs of upper abdominal bruising in pt after RTA who is on warfarin. INR is 5.3 after IV vitamin K, what to do next? Stop warfarin Reduce warfarin PCC

Answer 53

**Stop Warfarin** this describes a person with a person with INR >5. this requires warfarin to be stopped We think PCC should be added as I think it is a major internal bleed post RTA. However defininetly needs to warfarin,,, so this is pretty dumb as a question.

Question 54

A 43 year old man is involved in a low speed road traffic collision. Following this he develops pain in his lower back that it is still troublesome several months later. The pain is worse after activity and is relieved by rest. He has an exaggerated lumbar lordosis with a palpable depression above L5. The range of movement of his spine is grossly normal. Neurological examination of his lower limbs is also normal. An MR scan is obtained (see image). What is the diagnosis? A. Cauda equina syndrome B. Compression fracture C. Herniated intervertebral disc D. Spondylolisthesis E. Spondylosis

Answer 54

**Spondylolisthesis** -> This means that the disc has slipped forward. as seen in the bottom vertebra of this MRI scan.

Question 55

Pt post-surgery had been given 3L of 0.9% saline, 4 glucose and 10mmol/L of potassium. Had paralytic ileus? What biochemical abnormality is most likely to be seen? Hypokalaemia Hypernatraemia Hypercalcaemia Hyponatraemia

Answer 55

**Hypokalaemia** -> Paralytic ileus is associated with Hypokalaemia and Hypercalcaeimia and Hypomagnesium. We think there was insufficient fluids and with detrose fluids, we think this lead to hypokalaemia and so we THINK this is the answer Ogilvie -> Hypokal, hypomag, hypothyr + hypercal REcent surgery + medication can cause this Neuro causes -> Parkinsons+MS+hirschspruung The 30 mmol of K+ is to low for the day as they need roughly 1mmol.kg... This means it is likely they are hypokalaemic... Or the hypokalaemia cuased the ileus...

Question 56

Bone most likely fractured in pt with diplopia, facial anaesthesia Zygomatic Maxilla not an option Frontal

Answer 56

**Zygomatic** -> This needs to be afracture at the base of the orbital floor, so this includes the Zygomatic bone and the Maxilla.

Question 57

Cause of thrombocytosis in pt who had a flare of UC trated with steroids and azathioprine? Primary proliferative thrombocytosis Reactive thrombocytosis Side effect of steroids Side effect of azathioprine

Answer 57

**Side effect of steroids.**

Question 58

Woman found passed out on the street with an empty bottle of vodka. WHat is the most urgent test that needs to be done? Alcohol level in blood Urea and electrolytes Urine dip

Answer 58

**U + Es** If glucose is an option it is probably that otherwise, we think U and Es would be helpful in knowing the level of dehydration.

Question 59

Urea 16, calcium slightly raised. Drowsiness and other sx in pt with CKD. Hypercalcaemia Uraemia

Answer 59

**Uraemia** -> More raised so more likely to be the cause of the symptoms...

Question 60

Pt with hyperkalaemia, how would you manage? Calcium gluconate was not an option IV 500ml 0.9% saline IV sodium bicarbonate Insulin and glucose

Answer 60

**Insulin and glucose**

Question 61

What explains fast progression of atherosclerosis? Less HDL breakdown More LDL production

Answer 61

**More LDL** LDL badddd HDL gooood I got no pneumonics

Question 62

Pt just underwent allogenic haematopoiteic stem cell transplant. Few days later develops a fever and breathing diffuclties, consolidation found.. What is most likely causative orgsnism? Staph aureus Klebsiella Strep pneumoniae Pneumocytstic jiroveci

Answer 62

**PCP** The patient is immunosuppressed, The presentation of the CXR is also supportive of the

Question 63

Bristol stool scale of 7 after surgery. What to do next? Stool sample over 3 days Start vancomycin Start metronidazole Isolate pt in side room

Answer 63

**Isolate pt in side room**

Question 64

An 86 year old woman has had three falls in the past 3 months. On each occasion, she describes feeling lightheaded and dizzy prior to falling. She is taking alendronic acid, amlodipine, atorvastatin, metformin and zolpidem tartrate. Her BP is 132/80 mmHg sitting and 138/84 mmHg standing. Which medication is most likely to be contributing to her falls? A. Alendronic acid B. Amlodipine C. Atorvastatin D. Metformin E. Zolpidem tartrate

Answer 64

**Zolpidem**

Question 65

Pt on NSAIDs for 2 weeks has blood, leukocytes, protein on urine dip. Interstitial nephritis ATN Membranous nephropathy

Answer 65

**Interstitial Nephritis** -> 4-7 days after the precipitating factor -> 95 % are drug induced esp NSAIDS

Question 66

Different pt with blood, leukocytes, protein on urine dip and oedema. Interstitial nephritis ATN Membranous nephropathy Minimal change disease

Answer 66

**Membranous nephropathy** None of these were nephritic syndrome but we think this is the most common anyway but not sure?

Question 67

Man comes in after RTA, unconscious, pulseless, not breathing, CPR started. IV adrenaline Synchronised 200J shock Unsynchronised 360J shock IV 500ml 0.9% saline

Answer 67

**unsynchronised 360 J shock** -> This a defibrillation and that is an unsynchronised shock. The management of pulseless VT is CPR as well as Shock.

Question 68

Management of hernia causing small bowel obstruction. CT abdomen Surgery

Answer 68

**Surgery** -> this is the management of this... The CT abdomen NGT decompression is possible as well CT would be the investigation of choice but this is not done!!! Hernia is investigated with US but most of the time it is a clincial diagnosis... If this patient had an incarcerated hernia then the management would be the Surgical decompression

Question 69

Most urgent investigation for intraocular foreign body in metal welder. CT orbit Fluorescein angiography

Answer 69

**CT orbit** -> one of the most important things is to confirm if there is an intraocular object still. This confirmation of diagnosis is done with CT orbit.

Question 70

Woman’s dad has haemophilia A. What is the chance that the woman is a carrier? 0 1 in 1 1 in 2 1 in 4

Answer 70

**1 in 1** This is an X-linked condition and so if a male has the condition and they have a daughter they will 100 % be at least a carrier.

Question 71

Woman on recreational drugs has hypokalaemia and hyponatraemia? Ketamine MDMA (ecstasy) Nitrous oxide

Answer 71

**MDMA (ecstacy)** We searched it up apparently, the MDMA causes SIADH or increased release of the pituitary hormones leading to the low Na and K The nitrous oxide I think does the opposite and causes the collecting ducts to be less permable.

Question 72

Pt presents with left superotemporal vision loss after having floaters for a few days. Retinal detachment Infranasal artery occlusion

Answer 72

**Retinal detachement** -> the floaters and the loss of vision is characteristic of this... Apparently Infranasal artery occlusion will be a much more acute history.

Question 73

Long term diabetes pt with peripheral microaneurysms and RADP, blurry optic disc. AION Diabetic maculopathy

Answer 73

**AION** Anterior ischemic optic neuropathy. This is a quick loss of vision due to there not being enough blood flow to the eye. optic neuropathy is normally the cause of a RAPD... Apparently it is also associated with the other findings that were described. Diabetic retinopathy would not explain the RAPD (rare to present with this). Microaneurysms would be present. Hard exudates may be present.

Question 74

Pt with haemoptysis and renal dysfunction, what antibody test. ANCA Anti-GBM ANA

Answer 74

**Anti-GBM** – for Goodpasture’s ANCA – for microscopic polyangiitis- but would expect palpable purpura

Question 75

Which resection for UC? Hartmann’s Right hemicolectomy Anterior resection

Answer 75

**Anteroir Resection** -> hartman's is often used in emergencies so this is unlikely. Therefore we thought anterior resection cause it seems similar to the proctocolectomy

Question 76

Pt on atorvastatin, cholesterol was still >5.3, LDL and HDL were normal. What to do? Increase statin Keep statin same Reduce statin Stop statin Add something else

Answer 76

**Increase Statin** (if <80mg -> increase; if >80mg -> ezetemide) – check medicines complete for treatment summary

Question 77

40 year old patient whacked by football 2 days ago, noticed swelling in left groin, diffuse swelling at upper pole of left testes, does not transluminate, right one normal. Epididymo-orchitis Seminoma Teratoma Spermatocoele

Answer 77

**Epididymo- Orchitis** This needs more information. If this is an acute onset unilateral pain then this is the above as described. Otherwise the below questions suggests how the other conditions may present.

Question 78

Sickle cell pt with severe pain leg

Answer 78

IV Morphine If no options of opioids give fluidsss

Question 79

AAA screen 3.3cm

Answer 79

**Yearly review** 3-4.4 yearly review 4.5-5.4 3 month review >-5.5 refer for surgery.

Question 80

AAA rupture, already been given 4 units of blood, what else can you give? FFP Platelets Cryoprecipitate TXA

Answer 80

**FFP** We dont think you are able to keep give too much blood all at once The TXA is only really effective at the start of bleeding

Question 81

Primary pneumothorax 4cm tx? Aspirate Chest drain Needle decompression – this is only for tension

Answer 81

**NEW GUIDELINES** If they are symptomatic you treat... If they are not you reassure and discharge If they are symptomatic and at high risk and >2cm then you give Chest drain-> if less than 2cm need a CT to reassess then get a chest drain IF they are symptomatic but not at high risk eg this persion then it would be based on the preference of the patient

Question 82

Pt with acne. Tried retinoin and topical abx.

Answer 82

**Lymecycline** -> its the next step oral abx. this or doxy

Question 83

Pain at 80-120 degree, shoulder movement?

Answer 83

**Subacromial bursitis**

Question 84

Sx of C3-6 dysfunction. Where is lesion?

Answer 84

**Cavernous sinus thrombosis**

Question 85

55yo male with change in bowel habit had rigid sigmoidoscopy that was normal. Next investigation Colonoscopy Capsule endoscopy CT abdomen

Answer 85

**Colonoscopy**

Question 86

Best investigation to diagnose 20yo male with sweats, fever, rubbery lump in neck. Excision biopsy BM aspirate

Answer 86

**Excision biopsy** This is an iffy one cause it is either Lymphoma or leukaemia We think that it is a lymphoma because of – rubbery lump probs suggest lymphoma.

Question 87

Guy with sinusitis i think, was given abx but sx persist. Refer to ENT Continue abx Change abx

Answer 87

**Refer to ENT**

Question 88

Most likely cause of bloody diarrhoea after BBQ 5 days ago

Answer 88

**Campylobacter jejuni**

Question 89

Reactive changes found in axillary LNs, next step? * Reassure * Sentinel LN biopsy * Axillary LN clearance

Answer 89

**Reassure** Not enough info to answer this question... If simple reactive lymph nodes theis is common with infections so would not need biopsy or clearance.?

Question 90

43 year old with pain in bilateral knees, wrists. RA Osteoarthritis

Answer 90

**RA** -> too young for osteoarthritis and RA is often bilateral and affects the small joints with later progression to the knee.

Question 91

CXR shows widened mediastinum with different BP in arms. What investigation to do next? CT angiography TEE TOE

Answer 91

**CT angiography** Stable and AD -> CT angio IF unstable and AD -> TTE The widened mediastinum is more suggestive of Aortic dissection. If there was