2021 Surg Crit Care MCQ

Question 1

A patient has arrested and CPR & defib performed – what is the best sign for success of resuscitation?
a) Femoral pulse
b) Reactive pupils
c) ECG

Answer 1

= a) a palpable femoral pulse is the most critical and immediate sign of successful resuscitation.

Question 2

Patient has laboured breathing, paradoxical breathing and is cyanotic. How will you manage?
a) Met Call
b) Chin lift, jaw thrust

Answer 2

The correct initial management for a patient with labored breathing, paradoxical breathing, and cyanosis is b) Chin lift, jaw thrust, with subsequent escalation as needed.

Question 3

In ALS – patient has PEA – what should be done next?
a) Adrenaline
b) Shock
c) Amiodarone
d) Continue compression

Answer 3

In Advanced Life Support (ALS), if a patient is in pulseless electrical activity (PEA), the correct course of action is:

a) Adrenaline and d) Continue compression.

Question 4

Best mediation for post-operative prevention of chronic pain?

Answer 4

= NMDA receptor - Ketamine

Question 5

Patient with retropharyngeal abscess. What’s the most likely feature for them to become hypoxic and cyanosed on intubation?
a) Stridor
b) Mallampati 3
c) Beard
d) Thyromental distance 6cm

Answer 5

= a) Stridor

Question 6

Patient on some SSRI, which analgesic can cause Serotonin syndrome?
a) Tramadol
b) Amitryptiline

Answer 6

= a) Tramadol

Question 7

What is a major respiratory complication that is preventable post-operatively?
a) Atelectasis
b) Bronchospasm
c) Exacerbation of COPD

Answer 7

= a) Atelectasis - A major preventable respiratory complication post-operatively is atelectasis. Atelectasis refers to the collapse or closure of a lung, which can occur due to shallow breathing or other factors post-surgery. It can often be prevented with strategies such as encouraging deep breathing exercises, using incentive spirometry, and early mobilization. Bronchospasm and exacerbation of COPD can also be significant, but they are not as universally preventable with post-operative interventions as atelectasis.

Question 8

Which Patient is ASA 3?
a) Person will well controlled essential hypertension
b) Patient with uncontrolled hypertension and diabetes
c) Comatose patient
d) Patient with ARDS secondary to pancreatic Ca
e) Person who is brain dead

Answer 8

The ASA (American Society of Anesthesiologists) classification system is used to assess a patient’s physical status before undergoing anesthesia and surgery. ASA 3 is defined as:
- ASA 3: A patient with severe systemic disease.

So, the patient who is ASA 3 would be:
- b) Patient with uncontrolled hypertension and diabetes

This classification indicates that the patient has significant systemic disease that may increase the risk associated with anesthesia and surgery, but the condition is not necessarily a constant threat to life.

Question 9

Which patient is most likely to have an MI?
a) Emergency Laparotomy
b) Patient with a history of IHD, emergency AAA repair
c) Elective Knee
d) Two other elective ops

Answer 9

The patient most likely to have a myocardial infarction (MI) is:
b) Patient with a history of IHD, emergency AAA repair
Patients with a history of ischemic heart disease (IHD) are at higher risk for MI, and emergency procedures such as abdominal aortic aneurysm (AAA) repair are associated with higher cardiovascular risk due to the stress and potential complications of the surgery. The combination of pre-existing heart disease and an emergency major surgery significantly increases the likelihood of experiencing an MI.

Question 10

Shown ECG with Torsades. What would you give?
a) Magnesium
b) Atropine
c) Adrenaline
d) Calcium

Answer 10

For Torsades de Pointes (TdP) on an ECG, the most appropriate treatment is:

a) Magnesium

TdP is a type of polymorphic ventricular tachycardia that is often associated with prolonged QT interval and can be precipitated by electrolyte imbalances. Magnesium is used to stabilize the heart’s electrical activity and is especially effective in TdP, even when the magnesium levels are normal.

Question 11

Pt with anticholinergic signs and prolonged QRS
a) TCA toxicity
b) Hyperkalaemia

Answer 11

a) TCA toxicity
Tricyclic antidepressant (TCA) toxicity is known to present with anticholinergic signs (such as dry mouth, blurred vision, and urinary retention) and can lead to a prolonged QRS interval on the ECG due to its effect on cardiac conduction. Hyperkalemia can also cause ECG changes, but it is more typically associated with peaked T waves, widening of the QRS complex, and sometimes a sine-wave pattern, rather than anticholinergic symptoms.

Question 12

58kg person has a scalp lesion to be removed. How much lignocaine (with adrenaline) is needed
a) 40ml
b) 60ml
c) 80ml
d) 20ml
e) 100ml

Answer 12

Question 13

Which medication is safest to discharge a patient on with regards to addiction and effectiveness etc.
a) Codeine
b) Fentanyl
c) Morphine
d) Oxycodone
e) Tramadol

Answer 13

When considering safety with regards to addiction potential and effectiveness for discharge, tramadol is generally considered the safest option among the choices listed.

Tramadol has a lower risk of addiction compared to stronger opioids like codeine, fentanyl, morphine, and oxycodone. It is a weaker opioid and also has additional mechanisms of action, which can make it effective for moderate pain while generally having a lower potential for abuse.

Question 14

Given an ABG and UEC. Cause of hypochloraemic alkalosis?
a) 3% Saline
b) Normal Saline

Answer 14

Question 15

Max dose of lidocaine with adrenaline (mg/kg)
a) 3
b) 4
c) 5
d) 6
e) 7

Answer 15

The maximum recommended dose of lidocaine with adrenaline is generally:

c) 5 mg/kg

This dose can vary slightly depending on specific guidelines and the presence of other factors, but 5 mg/kg is a commonly accepted maximum for lidocaine with adrenaline to minimize the risk of toxicity. Always consult specific guidelines and consider patient factors when determining dosages.

Question 16

Who’s more likely to get malignant Hyperthermia
a) Patient whose brother went to ICU post op for special cooling
b) Patient whose daughter was managed for PONV
c) Patient whose mother starting sweating after taking antidepressants

Answer 16

= a) Patient whose brother went to ICU post op for special cooling - suggests + family history

Question 17

Patient is on rivaroxaban when do you stop
a) 2 days
b) 5 days
c) not at all

Answer 17

The timing for stopping rivaroxaban (an oral anticoagulant) before a procedure or surgery depends on the type of procedure and the patient’s renal function. For most procedures, rivaroxaban is typically stopped:

a) 2 days before the procedure.

This timing helps to reduce the risk of bleeding while ensuring that the anticoagulant effect has diminished. However, for specific situations or higher-risk procedures, your healthcare provider might provide different recommendations based on individual patient factors and the procedure being performed. Always follow the specific guidance provided by the prescribing healthcare professional.

Question 18

Patient has MI and PCI when do you defer elective surgery until?

Answer 18

6-12 months

Question 19

Most common sign on ECG for a PE
a) T wave inversion
b) ST elevation
c) Sinus Tachycardia
d) S1Q3T3

Answer 19

= c) Sinus Tachycardia

Question 20

Patient has a BSL of 2mmol. What should you give?
a) Normal Saline
b) Hartman’s
c) 50ml of 50% Dextrose
d) 500ml of 5% dextrose

Answer 20

For a blood sugar level (BSL) of 2 mmol/L, which indicates severe hypoglycemia, you should administer:

c) 50ml of 50% Dextrose

• This provides a rapid and effective way to increase blood glucose levels and quickly correct the hypoglycemia. The other options are not as effective in rapidly addressing severe hypoglycemia:
• Normal Saline and Hartman’s solutions are primarily for fluid resuscitation and do not address hypoglycemia.
• 500ml of 5% dextrose is a less concentrated solution and may not be sufficient for immediate correction of severe hypoglycemia compared to 50% dextrose.

Question 21

34-week pregnant lady has a seizure, what is the first investigation you would do?
a) BSL
b) Β-HCG

Answer 21

In the case of a 34-week pregnant woman who has had a seizure, the first investigation you would typically perform is:

a) BSL (Blood Sugar Level)

Hypoglycemia can be a cause of seizures, so it’s important to check the blood sugar level to rule out or confirm this as a contributing factor. While β-HCG (beta-human chorionic gonadotropin) is relevant in pregnancy, it is not used for acute investigation of seizures.

Question 22

Patient present with central facial trauma. He is coughing up blood and talking. How will you secure his airway?
a) Oral intubation
b) Nasal intubation
c) Cricothyroidotomy
d) Tracheostomy

Answer 22

In the case of a patient with central facial trauma who is coughing up blood and talking, the most appropriate method to secure the airway is:

c) Cricothyroidotomy

Facial trauma can compromise the airway due to swelling, bleeding, and potential disruption of the airway anatomy, making intubation difficult or impossible. Nasal intubation is contraindicated due to the risk of further trauma and bleeding. Oral intubation might be challenging due to the facial injuries and blood. Cricothyroidotomy provides a direct access to the airway through the neck, bypassing potential obstructions or damage in the facial region.

Question 23

At what % blood loss do you start to see decrease in blood pressure?
a) 15%
b) 20%
c) 30%
d) 40%

Answer 23

A decrease in blood pressure typically becomes noticeable with:

c) 30% blood loss

This is approximately when the compensatory mechanisms of the body start to fail, leading to a significant drop in blood pressure. Blood loss up to 15% might not cause a noticeable decrease in blood pressure due to compensatory mechanisms, while a loss of 20% might start to affect it slightly. At 40% blood loss, blood pressure is usually critically low and immediate intervention is required.

Question 24

What sign indicates 1L of blood lost?
a) Cap refill > 2s
b) Blood pressure drops
c) Anuria
d) Tachycardia > 140

Answer 24

The sign that typically indicates approximately 1 liter of blood loss is:

d) Tachycardia > 140

In the context of significant blood loss, tachycardia (heart rate > 140 beats per minute) is a common physiological response as the body attempts to compensate for the reduced blood volume and maintain adequate perfusion. While other signs like prolonged capillary refill, decreased blood pressure, and anuria can also indicate blood loss and shock, tachycardia is a more immediate and direct indicator of substantial blood loss.

Question 25

Patient is Rovsing positive. How is this elicited? a) Palpating in the left lower quadrant b) Flexion of the hi c) Hip IR

Answer 25

**What is Rovsing’s sign?** Rovsing’s sign is a clinical finding that is indicative of acute appendicitis (the inflammation and possible infection of the appendix). A positive Rovsing’s sign is characterized by right lower abdominal pain upon palpation of the left side of the lower abdomen.

Question 26

Why is hypertonic saline better than mannitol in a traumatic brain injury? a) Hypertonic saline can be delivered IV b) Hypertonic saline is a less potent diuretic c) Hypertonic saline prevents both primary and secondary brain injury

Answer 26

In the context of traumatic brain injury (TBI), hypertonic saline is often preferred over mannitol for several reasons: 1. **Hypertonic saline can be delivered IV**: While both hypertonic saline and mannitol can be administered intravenously, hypertonic saline is preferred in many situations because it effectively reduces ICP and increases intravascular volume more rapidly. This can be particularly beneficial in managing acute elevations in ICP. 2. **Hypertonic saline is a less potent diuretic**: Unlike mannitol, which has strong diuretic effects and can lead to dehydration and electrolyte imbalances, hypertonic saline has less pronounced diuretic effects. This reduces the risk of dehydration and helps maintain better fluid balance. 3. **Hypertonic saline prevents both primary and secondary brain injury**: This is less accurate. Hypertonic saline primarily helps manage secondary brain injury by reducing ICP and improving cerebral perfusion, but it does not directly prevent primary brain injury. Mannitol, while also used to manage ICP, may have additional neuroprotective effects. ANSWER = b = less potent diuretic

Question 27

Young girl presents with ongoing headaches. She is overweight and on the OCP. She has bilateral papilloedema & abducens nerve palsy. All other S/S are normal. What is the management? a) Take inflammatory markers, analgesia then discharge b) Analgesia and discharge c) Urgent CT, LP and bloods d) CT and LP e) CT, LP and neuro referral

Answer 27

In a young girl presenting with ongoing headaches, bilateral papilledema, and abducens nerve palsy, these findings suggest increased intracranial pressure, which could be indicative of a serious underlying condition such as idiopathic intracranial hypertension (IIH) or another intracranial pathology. Given the symptoms and the need to assess for potentially serious conditions, the appropriate management is: **e) CT, LP and neuro referral**

Question 28

Patient presents with chest pain & tearing back pain. He has tingling down his left leg. ECG shows STEMI. How should you manage a) Heparin b) Thrombolysis c) CT Angio

Answer 28

= c) CT Angio - suspect aortic dissection

Question 29

Ten-year-old boy fell from a tree. What medication is best for management of pain in paediatrics? a) Fentanyl Patch b) Morphine IM c) Fentanyl IV d) Pethidine

Answer 29

= c) Fentanyl IV

Question 30

Man has an ECG with polymorphic VT, what can cause this? a) Thiazides b) Potassium sparing diuretic

Answer 30

= a) Thiazides

Question 31

Which of these causes normal anion gap metabolic acidosis? a) Chronic Antacid use b) Conns syndrome c) Diabetes mellitus d) Uraemia e) Lactate

Answer 31

**Chronic Antacid Use** is the cause of normal anion gap metabolic acidosis among the options listed. **Chronic Antacid Use (a):** Prolonged use of antacids, especially those containing aluminum or magnesium, can lead to a normal anion gap metabolic acidosis due to the accumulation of chloride (hyperchloremic metabolic acidosis). Antacids can neutralize stomach acid, but if they are used excessively, they can cause an imbalance in acid-base homeostasis.

Question 32

Patient comes in following asthma attack. Took 8 puffs of salbutamol, normal SpO2, speaking in full sentences. How should you manage? a) Oral steroid b) Start SAMA c) Admit

Answer 32

= Oral steroid

Question 33

Patient using meth admitted to ED. Becoming increasingly aggressive – how should he be managed? a) Sedate under duty of care b) Call mental health team then sedate c) Mental Health Act d) Two options that were like make him leave

Answer 33

b) Call mental health team then sedate

Question 34

Patient sustains head injury during a football game. Continues to play, 40 minutes later collapses & is unconscious. Most likely diagnosis? a) Extradural haematoma b) Subdural haematoma c) Concussion d) SAH

Answer 34

In the scenario described, where a patient sustains a head injury, continues to play, and then collapses and becomes unconscious 40 minutes later, the most likely diagnosis is: a) Extradural Haematoma - **Onset**: Often occurs after a brief loss of consciousness following a head injury, with a lucid interval before deterioration. - **Symptoms**: The classic presentation involves a period of apparent recovery (lucid interval) followed by rapid deterioration, which aligns with the timeline described (initial injury, period of playing, then collapse). - **Mechanism**: Usually caused by a tear in the middle meningeal artery or vein, leading to bleeding between the skull and dura mater.

Question 35

Patient presents with tachycardia, hypotension, anti-cholinergic delirium. Which drug caused the OD? a) Amitriptyline b) Some Benzo c) Quetiapine

Answer 35

a) Amitriptyline

Question 36

Patient overdose on medication. ECG shows wide QRS – most likely diagnosis?

Answer 36

TCA overdose

Question 37

Patient presents with a sudden collapse – ECG shows massive T wave inversion. Diagnosis?

Answer 37

Sub arachnoid haemorrhage

Question 38

Which of these is true for the ABG of HHS? a) Corrected hypernatremia b) Low pH c) High ketones

Answer 38

For Hyperglycemic Hyperosmolar State (HHS), the following is true regarding the arterial blood gas (ABG) findings: **a) Corrected Hypernatremia** In HHS, hypernatremia is often present due to severe dehydration and high serum osmolality. However, it's important to note that the sodium level in the ABG results can be "corrected" to account for the high glucose levels, reflecting the true level of sodium.

Question 39

CXR post procedure inserting a central line. What’s wrong?

Answer 39

R bronchus intubated (this photo is in an RNM lecture so it’s probably somewhere if you bother to look) Endobronchial intubation is the not infrequent finding of the endotracheal tube located in a bronchus and is a trivial diagnosis to make in most instances provided an adequately penetrated chest radiograph is obtained. The incidence of endobronchial intubation is greatest following emergency intubation.

Question 40

Old lady who has IHD, bipolar disease, is recently started on diuretics. She presents with visual disturbances and has green/yellow halos around objects a) Lithium toxicity b) Digoxin toxicity

Answer 40

The visual disturbances with green/yellow halos around objects in a patient who is on diuretics are most likely due to: b) Digoxin Toxicity

Question 41

Young guy with past history of bronchiectasis presenting with pleuritic chest pain 2 weeks after a knee surgery. History of unilateral leg swelling was present after surgery. what do you do next? a) D-dimer b) Perc c) CTPA d) VQ Scan

Answer 41

Given the clinical scenario—a young man with a history of bronchiectasis presenting with pleuritic chest pain 2 weeks after knee surgery, and a history of unilateral leg swelling—the next step would be to evaluate for a potential pulmonary embolism (PE). The appropriate next step in this situation is: c) CTPA (Computed Tomography Pulmonary Angiography) Reasoning: CTPA: This is the gold standard for diagnosing pulmonary embolism. It provides detailed images of the pulmonary arteries and can confirm or rule out a PE with high accuracy.

Question 42

Sexually active 28-year-old presents to ED with dysuria, frequency, and pyuria. what bacteria would you target for treatment? a) E. coli b) Chlamydia

Answer 42

In a sexually active 28-year-old presenting with dysuria, frequency, and pyuria, you should consider both common uropathogens and sexually transmitted infections. Given the symptoms and demographic, the appropriate initial treatment would target: **b) Chlamydia** Chlamydia trachomatis: This is a common cause of dysuria and can be associated with pyuria. It’s also a frequent cause of urethritis in sexually active individuals. Given the presentation and demographic, chlamydia should be considered and treated appropriately.

Question 43

What would suggest you need to give antivenom in a snake bite? a) Hyperkalaemia b) Bite looks like that of a brown snake c) Creatinine d) Piloerection of affected limb e) Ptosis

Answer 43

e) Ptosis - objective neurological signs

Question 44

Patient with complete heart block found by ambulance. What should they give if pacing is unavailable? a) Atropine b) Β-blockers c) Amiodarone

Answer 44

If pacing is unavailable for a patient with complete heart block (third-degree AV block), the recommended treatment is: **a) Atropine** Atropine: This is a first-line treatment for acute symptomatic bradycardia, including complete heart block, especially when pacing is not immediately available. Atropine works by increasing the heart rate by inhibiting the vagal (parasympathetic) influence on the heart.

Question 45

Anaphylaxis – immediate response a) IM 0.5mg b) IV 0.5mg c) IV 1mg

Answer 45

Intramuscular (IM) Adrenaline: The standard dose for treating anaphylaxis is 0.5 mg of adrenaline (epinephrine) administered intramuscularly. This is typically given in the mid-anterolateral thigh (vastus lateralis) and is the first-line treatment for rapidly reversing the symptoms of anaphylaxis.

Question 46

Question about someone with pericarditis, what is Mx? a) Oral NSAIDs and oral colchicine b) Oral NSAIDs and IV colchicine

Answer 46

**a) Oral NSAIDs and oral colchicine** Oral NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce inflammation and relieve pain associated with pericarditis. Ibuprofen or indomethacin are often used. Oral Colchicine: Colchicine is recommended as an adjunctive treatment to reduce symptoms and prevent recurrence. It is usually administered orally.

Question 47

40ish woman has intermittent left sided headaches, feels like electric shock, extends to cheek and jaw, no exam findings. a) 1mg/kg pred and urgent surgical review b) Occipital nerve block c) Sumitriptan d) Carbamazepine or oxcarbazepine or something like that

Answer 47

Diagnosis = Trigeminal neuralgia Carbamazepine and oxcarbazepine are the first-line treatment options for TN and offer meaningful initial pain control in almost 90% of patients.

Question 48

Burns question – chest, front of one arm, front of one leg a) 22.5% b) 31.5%

Answer 48

To estimate the total body surface area (TBSA) affected by burns, you can use the "Rule of Nines" for adults, which allocates percentages to various body parts: Chest (front): 18% Front of one arm: 4.5% Front of one leg: 9% Adding these together: Chest (front): 18% Front of one arm: 4.5% Front of one leg: 9% Total: 18% + 4.5% + 9% = **31.5%**

Question 49

Patient is confused and had a gaze palsy. What is the diagnosis? a) Wernicke’s b) Alcohol

Answer 49

a) Wernicke’s encephalopathy This condition is characterized by confusion, ophthalmoplegia (which includes gaze palsy), and ataxia. It is commonly caused by thiamine (vitamin B1) deficiency, often related to chronic alcohol consumption but not exclusive to it.

Question 50

Patient is currently taking a ACE inhibitor for BP, presents with angio-oedema following new anti-hypertensive. Which one? a) CCB b) ACEI

Answer 50

a) CCB - pt is already on an ACEI and this is a new problem.

Question 51

Patient on the ward has an oculogyric crisis. What drug? a) Haloperidol b) Droperidol

Answer 51

An oculogyric crisis is typically associated with the use of antipsychotic medications, particularly those that are known to cause extrapyramidal symptoms. In the context of the two options provided: **a) Haloperidol** - This typical antipsychotic is well-known for causing extrapyramidal side effects, including oculogyric crisis. It is a common culprit in such cases. Droperidol (b): While droperidol can also cause extrapyramidal symptoms, haloperidol is more commonly associated with oculogyric crisis and other dystonic reactions.

Question 52

Patient collapses and ambos have done CPR, ECG performed and shows VT what do you do? a) Defibrillation b) Adrenaline c) Amiodarone

Answer 52

The two shockable rhythms are ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). In the case of a patient who collapses and is found to be in VT on the ECG, the immediate management depends on the patient's hemodynamic status. If the VT is sustained and the patient is unstable (e.g., unresponsive, with poor perfusion), immediate defibrillation is indicated. For stable VT, the treatment approach would include medications like amiodarone.

Question 53

Patient presents with HHS which could cause? a) Someone whos surgeon told them to take metformin 5 days later b) Lady who went on holiday forgot insulin so increased metformin dose

Answer 53

Question 54

Best drug for narrow complex tachycardia?

Answer 54

For a stable patient with narrow complex tachycardia, adenosine is commonly used as it can help terminate the arrhythmia by temporarily blocking the AV node. Best Drug for Narrow Complex Tachycardia = **Adenosine** - This drug is effective for treating certain types of narrow complex tachycardias, particularly those involving reentrant circuits that pass through the AV node (such as supraventricular tachycardias). It works by temporarily interrupting AV node conduction, which can restore normal sinus rhythm.

Question 55

Shown ABG, acidosis, low bicarb, low CO2 - what type of derangement?

Answer 55

= Metabolic acidosis

Question 56

Which finding is most indicative of acute liver failure post paracetamol toxicity? a) INR 6 b) ALT 3000’s

Answer 56

In acute liver failure following paracetamol toxicity, INR 6 is more indicative of severe liver impairment and is used to assess the degree of liver dysfunction, making it the most critical finding in this scenario.

Question 57

Patient had BP 77/40 after fluid IV resus – what do you do? a) Add vasopressor b) Add inotrope

Answer 57

a) Add vasopressor

Question 58

What medication is best for treating a patient with bradycardia & hypotension? a) Amiodarone b) Lignocaine c) Adenosine d) Atropine

Answer 58

**d) Atropine** This medication is used to treat bradycardia (slow heart rate) by increasing the heart rate through its action as an anticholinergic agent. It is typically the first-line treatment for bradycardia associated with symptoms such as hypotension.

Question 59

How can BIPAP help in Multiple rib fractures?

Answer 59

Question 60

When would increasing minute ventilation work to reverse call? a) Opioid depression b) Multiple rib fractures c) ARDS d) Pneumonitis

Answer 60

c) ARDS

Question 61

Management of sepsis due to Candida - what tx? a) Cotrimoxazole b) Amphotericin B

Answer 61

Question 62

Showed a table with a bunch of vitals values. Which results indicate cardiogenic shock?

Answer 62

For cardiogenic shock, high PCP and low CO are the most characteristic findings. Normal lactate does not rule out cardiogenic shock, but elevated lactate would suggest significant tissue hypoperfusion. Low CRT might not be as specific to cardiogenic shock as it can vary depending on overall perfusion status.

Question 63

Someone given packed red cells and has reaction. What’s the most common reaction? a) HLA reaction b) TRALI c) TACO

Answer 63

Transfusion-Associated Circulatory Overload (TACO)

Question 64

Atropine acts on what receptors?

Answer 64

Ach, muscarinic

Question 65

Hyperkalemic picture and ECG. What’s the best management? a) Dialysis b) Ca and insulin/dextrose c) Neb salbutamol

Answer 65

**ECG features of hyperkalaemia** 1. Peaked T waves 2. P wave widening/flattening, 3. PR prolongation 4. Bradyarrhythmias: sinus bradycardia, high-grade AV block with slow junctional and ventricular escape rhythms, slow AF 5. Conduction blocks (bundle branch block, fascicular blocks) QRS widening with bizarre QRS morphology **Management**:

Question 66

What electrolyte abnormality is most likely in the following scenarios: 1) Lost a heap of urine – hyponatraemia 2) What electrolyte disturbance is most often associated with cardiothoracic surgery – hypomagnesemia 3) There was one like “this electrolyte abnormality is causing the patient’s bleeding” but this might have been absorbed in another one of these 4) Women who has eclampsia that has been managed- hypermagnesemia a) Could possibly have not mentioned the management part which would make it hypo I guess 5) Patient with bulky lymphoma who’s had chaemo- hyperkalaemia (TLS?)

Answer 66

1) Lost a heap of urine – Hypokalemia (low potassium) 2) What electrolyte disturbance is most often associated with cardiothoracic surgery – hypomagnesemia 4) Women who has eclampsia that has been managed - hypermagnesemia - Magnesium Sulfate Use: Treatment for Seizure Prevention: Magnesium sulfate is commonly used to prevent seizures in preeclampsia and eclampsia. Although it is effective in managing seizures, it can lead to hypomagnesemia if not properly managed, especially if the patient is over-treated or has issues with renal excretion of magnesium. Monitor Levels: Magnesium levels should be monitored regularly during and after treatment with magnesium sulfate to avoid both hypomagnesemia and hypermagnesemia. 5) Patient with bulky lymphoma who’s had chemo- hyperkalaemia (TLS) - Released from intracellular compartments.

Question 67

Hypotensive patient post MVA with seatbelt sign injury. Complains of plain but CT showed nil intraperitoneal blood. Organ injured: a) Bowel b) Liver c) Spleen d) Kidney e) Aorta

Answer 67

Given the hypotension and seatbelt sign, bowel injury is a likely culprit even if no intraperitoneal blood is visible on the CT scan. Further diagnostic exploration such as laparoscopy or exploratory surgery may be needed to identify and manage bowel injuries.

Question 68

Young male dockworker with longstanding constipation now had pain on defecation. No bleeding. What is the diagnosis? a) Thrombosed haemorrhoids b) Fissure in ano c) Fistula in ano

Answer 68

= b) Fissure in ano

Question 69

Patient with neck lump. Found to be medullary. Most important history feature to ask? a) Family history b) Smoking c) Alcohol

Answer 69

a) Family history (of MENs)

Question 70

Most appropriate place for split skin graft? a) Muscle b) Bone c) Joint

Answer 70

= a) muscle

Question 71

Patient with swelling post breast cancer surgery a) Seroma b) Lymph node left behind c) Haematoma d) Infection

Answer 71

a) Seroma

Question 72

Patient with migratory thrombophlebitis – next investigation a) Urgent triphasic CT for pancreas b) UGI endoscopy for gastric cancer

Answer 72

Urgent triphasic CT for pancreas is the most appropriate next step to investigate the underlying malignancy associated with migratory thrombophlebitis.

Question 73

Which nodes does the anus drain to? a) Inguinal b) Para-aortic c) Other

Answer 73

a) Inguinal

Question 74

Patient with history of significant weight loss, itchy skin, jaundice and epigastric pain. Liver feels nodular a) Body & tail pancreatic cancer b) PUD c) Biliary tree cancer d) Sigmoid Ca

Answer 74

**b) CA19.9** - **CA19.9**: This is the most commonly used tumor marker for pancreatic and biliary tree cancers, both of which can cause jaundice and pruritus (itchy skin). It is particularly useful in diagnosing and monitoring cholangiocarcinoma and pancreatic adenocarcinoma. - **AFP (Alpha-fetoprotein)**: This is a tumor marker primarily associated with hepatocellular carcinoma and certain germ cell tumors, but it's less commonly used for biliary or pancreatic cancers. - **CEA (Carcinoembryonic Antigen)**: This marker is more often associated with colorectal cancer and other adenocarcinomas but is not the most specific marker for biliary or pancreatic conditions

Question 75

Patient with dysphagia – scope shows dilated lower oesophagus. No strictures or mass. Biopsy most likely to show a) Absent of ganglion myenteric plexus b) Barret’s oesophagus c) Adenocarcinoma

Answer 75

The most likely biopsy finding in this case would be absence of ganglion cells in the myenteric plexus, indicative of achalasia.

Question 76

8 Clinical features of Trisomy 21 – Down syndrome?

Answer 76

**Trisomy 21 – Down syndrome** 1. Upward slanting of eyelids 2. Epicanthal folds 3. Low set ears 4. Transverse palmar crease 5. Joint hyper flexibility (atlantoaxial instability, dysplastic hips) 6. Atrioventricular septal defects 7. Duodenal/oesophageal/anal atresia 8. Hirschsprung’s disease

Question 77

6 Clinical features of Trisomy 21 – Down syndrome?

Answer 77

**Trisomy 18 – Edward’s syndrome** 1. Clenched fists with flexion contracture of fingers 2. Cleft lip and palate 3. Congenital heart defects (e.g. VSD, ASD, tetralogy of Fallot) 4. Diaphragmatic hernias 5. Microcephaly, prominent occiput, low-set ears 6. Rocker-bottom feet

Question 78

7 Clinical features of 15q21.1 mutation - Marfans?

Answer 78

15q21.1 mutation – Marfan’s syndrome 1. Mitral regurgitation 2. Aortic dissection 3. Tall stature and long extremities 4. Joint hypermobility 5. High-arched palate 6. Pectus carinatum/excavatum 7. Lens dislocation

Question 79

5 Clinical features of 22q11.2 deletion – DiGeorge syndrome?

Answer 79

**22q11.2 deletion – DiGeorge syndrome** 1. Cardiac anomalies (tetralogy of Fallot or truncus arteriosus, ASD, VSD) 2. Anomalous face (prominent nasal bridge, hypoplastic nose, dysplastic ears) 3. Thymic aplasia/hypoplasia 4. Cleft palate 5. Hypoparathyroidism

Question 80

How does Hairy cell leukaemia usually manifest? What would the peripheral bllood smear show?

Answer 80

Hairy cell leukaemia usually manifests with pancytopenia and symptomatic splenomegaly. The peripheral blood smear usually shows mononuclear cells with filamentous, hair-like projections and tear drop red blood cells.

Question 81

How might a patient with sarcoidosis present? 5 other features? What would a biopsy show?

Answer 81

In sarcoidosis, patients may present with: 1. Malaise 2. Fever 3. Weight loss Other features include: 1. Uveitis 2. Arthritis 3. Erythema nodosum 4. Hypercalcemia 5. High angiotensin converting enzyme levels. A biopsy would show non-caseating granulomas.

Question 82

How do patient's with Hodgkin lymphoma often present?

Answer 82

Patients with Hodgkin lymphoma frequently present with painless supra-diaphragmatic lymphadenopathy (one to two lymph node areas), B symptoms including unexplained profound weight loss, high fevers, and drenching night sweats (in up to 30% of patients).

Question 83

What is Chancroid?

Answer 83

Chancroid usually presents with non-indurated painful ulcers, characterised by an irregular border surrounding a friable base covered with a necrotic and often purulent exudate. Chancroid is a sexually transmitted infection caused by Haemophilus ducreyi.

Question 84

What is Lymphogranuloma venereum?

Answer 84

Lymphogranuloma venereum (LGV) is a rare sexually transmissible infection that is mainly seen in gay and bisexual men. It often presents as a single papule or a shallow ulcer, which initially heals after a few days. LGV can cause severe symptoms, however it can be successfully treated with antibiotics. Timely treatment prevents long-term complications. Condom use helps prevent infection.

Question 85

Hypertensive Retinopathy - Features of each grade?

Answer 85

Question 86

Features of Proliferative & Non-Proliferative Diabetic Retinopathy (NPDR)?

Answer 86