Contingeincy Feedback

Question 1

What causes Borderline hyponatremia with productive cough in ex smoker and pacification of left base?

Answer 1

Necessity for legionella investigation with urinary pneumococcal and legionella antigen

Question 2

What causes New shortness of breath following asthma exacerbation with severely low oxygen saturation?

Answer 2

Pneumothorax

Question 3

What is the Most common cause of productive cough in HIV patient with coarse crackles in right mid zone?

Answer 3

Streptococcus pneumonia.

Right mid zone indicates aspiration cause.

Question 4

What does Positive anticentroemere antibody indicates?

Answer 4

Sclerosis

Question 5

How does Clarithromycin interact with warfarin?

Answer 5

It induces warfarin

Question 6

Which Antibiotics are considered to be high risk for interaction with warfarin?

Answer 6

Trimethoprim/sulfamethoxazole (TMP/SMX), ciprofloxacin, levofloxacin, metronidazole, fluconazole, azithromycin, and clarithromycin

Question 7

What is Moderate COPD?

Answer 7

Between 50-79%

Question 8

What is Severe COPD?

Answer 8

Between 30-49%

Question 9

Which combination of antihypertensive drugs causes hyperkalemia?

Answer 9

ACEi and ARBs which can also cause hypotension when combined

Question 10

What are the top two causes of occupational asthma?

Answer 10

Isocyanates

Followed by cereal flour.

Question 11

Which measure of cardiovascular risk is estimated rather than directly measured?

Answer 11

LDL cholesterol

Question 12

Which angina medication should be avoided in ulcerative colitis?

Answer 12

Nicorandil which increases the risk of ulcers in the GIT.

Nicorandil downregulates cGMP.

Question 13

What is the cigarette level threshold for pharmacological aid?

Answer 13

10 or more a day

Question 14

Which rate limiting drug has the fastest effect?

Answer 14

Metoprolol

Question 15

What is the typical dose of amlodipine?

Answer 15

Starting dose is 5mg and can go up to 10mg

Question 16

Which drug can cause polymorphic ventricular tachycardia?

Answer 16

• PPI like lansoprazole
• Antibiotics: Erythromycin, azithromycin, clarithromycin.
• Antiarrhythmics: Amiodarone, flecainide, sotalol.
• Antidepressants: Citalopram.
• Other: Levofloxacin.

Question 17

What is the next scan from a CT chest for confirming metastasis?

Answer 17

PET scan

Question 18

Which imaging technique for colorectal cancer is best for elderly and frail patients?

Answer 18

CT colonography

Question 19

What causes severe epigastric pain with loss of consciousness and left ventricular hypertrophy on ECG?

Answer 19

Abdominal aortic aneurysm rupture

Question 20

What is the difference between rupture and aneurysm of aorta?

Answer 20

AAAs, which are bulges in the aorta, often present with a pulsating mass in the abdomen or, when they rupture, with sudden severe pain, shock, and rapid loss of consciousness.

Aortic dissection, on the other hand, involves a tear in the aortic wall, usually causing a sudden, severe, tearing pain that can be localized to the chest or back.

Question 21

What is the next most appropriate investigation for haematuria and loin pain?

Answer 21

Ultrasound scan of renal tract

Question 22

What is the antibiotic for epididymis-orchitis?

Answer 22

Doxycycline

Question 23

What causes a duct-like structure on history with regular columnar cells and well-defined margins?

Answer 23

Fibroadenoma of breast

Question 24

What is the most common mode of transmission of hepatitis C globally?

Answer 24

Iatrogenic from medical treatment

Question 25

What is the most common mode of transmission of hepatitis C in the UK?

Answer 25

IV drug use

Question 26

What are the features of the faecal occult blood test?

Answer 26

Uses chemical reaction to detect hidden haemoglobin in stool. ## Footnote It has a high sensitivity of blood loss. False positives can occur from the diet.

Question 27

How does the FIT test work?

Answer 27

Antibodies to haemoglobin.

Question 28

What causes dilation of colon and thumb printing with recent antibiotic clindamycin use?

Answer 28

Pseudomembranous colitis from C. diff infection

Question 29

What does thumb printing mean?

Answer 29

Intestinal ischaemia

Question 30

What can contribute to encephalopathy?

Answer 30

Hypoglycaemia, Hyponatremia, Sepsis, Alcohol withdrawal or Wernicke’s.

Question 31

Which medication is given for explosive diarrhoea with weight loss and abdominal bloating?

Answer 31

Tinidazole

Question 32

What organism causes explosive diarrhoea and is water borne?

Answer 32

Vibrio cholera which is treated with tinidazole

Question 33

What initial assessment should be performed in a patient with metastatic cancer who has new urinary retention?

Answer 33

Full neurological exam to assess for new spinal cord dysfunction due to risk of bone metastases and compression

Question 34

What are the features of newly diagnosed metastatic breast cancer?

Answer 34

Bone metastases will be lytic

Question 35

How does liver metastases present?

Answer 35

Gradual decline in liver function

Question 36

What is a key feature of the WHO analgesic ladder?

Answer 36

Adjuvant analgesics can be used at any stage

Question 37

What is delusional disorder?

Answer 37

Delusional disorder is a mental illness where someone holds firm, false beliefs (delusions) that persist for at least a month.

Question 38

What causes sensory loss associated with a traumatic event?

Answer 38

Dissociative disorder

Question 39

What is an acute stress reaction?

Answer 39

Short-term, intense psychological and emotional response to a traumatic or stressful event, typically occurring within the first month after the event

Question 40

What is the first drug to prescribe for depression?

Answer 40

SSRI

Question 41

Other than exposure therapy, what therapy is done for phobia?

Answer 41

CBT

Question 42

What causes words to be linked but jump around?

Answer 42

Flight of ideas

Question 43

What is knight’s move thinking?

Answer 43

Lack of link between sentences

Question 44

After a patient had a stroke and has random changes to their emotions, what is the cause of this?

Answer 44

Damage to prefrontal cortex

Question 45

How long should depression medication be continued?

Answer 45

For six months once they feel it has resolved

Question 46

When can ECT be given against consent?

Answer 46

Under mental health act with second opinion from specialist

Question 47

Which type of dementia has clock drawing test impaired?

Answer 47

Lewy body dementia

Question 48

How does alcohol induced dementia affect memory?

Answer 48

Preserved executive function and working memory but issues with short and long term recall

Question 49

What test is most appropriate to investigate thrombocytopenia?

Answer 49

Fibrinogen and d-dimer

Question 50

Which team provides ongoing care to severely ill psychiatric patients when they leave hospital?

Answer 50

Assertive outreach team

Question 51

What is the difference between the assertive outreach team and community mental health team?

Answer 51

Assertive outreach team provide intensive, individualized support to individuals with severe mental illness who struggle to engage with traditional services. ## Footnote Community Mental Health Teams (CMHTs) offer a broader range of services within the community, including outpatient care and support for a wider spectrum of mental health needs.

Question 52

What causes Arthralgia, night sweats and weight loss with haematuria and low sodium?

Answer 52

Glomerulonephritis

Question 53

What causes normal calcium and phosphate but high ALP with bone pain?

Answer 53

Paget’s disease of bone

Question 54

What investigation is performed for necrotic ulcer on medial aspect of the foot on first metatarsal, when pulses are palpable, after X-ray?

Answer 54

Necrosis always do MR imaging of the foot after x-ray

Question 55

What causes persistent fatigue and primary hypothyroidism 4 months after birth with upper respiratory tract infection 2 months ago?

Answer 55

Post partum thyroiditis where there is a thyrotoxicosis (hyperthyroidism), hypothyroidism, and then a recovery phase

Question 56

What causes progressive thirst and urination in an elderly person with diabetes and acute urinary retention?

Answer 56

Hyperosmolar hyperglycaemic state

Question 57

Which paraneoplastic syndrome of the lungs causes low sodium and low potassium?

Answer 57

ADH due to dilutional hyponatraemia from fluid retention and low K+ from increased loss of aldosterone from small cell lung cancer

Question 58

What defect in cholesterol metabolism is related to acute MI in middle age?

Answer 58

Heterozygous familial hypercholesterolaemia leads to elevated low-density lipoprotein (LDL) cholesterol

Question 59

What is the difference between heterozygous familial hypercholesterolemia and familial combined hyperlipidaemia?

Answer 59

HeFH primarily affects LDL cholesterol levels, while FCH can affect both LDL cholesterol and triglyceride levels.

Question 60

How does ADH affect electrolyte levels?

Answer 60

Excess ACTH can lead to conditions like hypercortisolism, which can result in electrolyte imbalances like low potassium and high sodium

Question 61

What physical marker is a specific measure of cardiovascular risk?

Answer 61

Waist circumference