Maia Hard Questions Only Flashcards by Maia Cunningham

Child with hearing loss. Air fluid level on otoscope. Type B tympanogram. Diagnosis?

Otitis media with effusion

‘Glue ear’

Type B tympanogram usually means effusion,

Type B result with normal ECV
= less conductive but normal ear canal volume

IF ECV was up - could be a perforation or grommet

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6 year old NZ Euro child with a low grade fever, runny nose and sore throat with moderate erythema but no exudate. No nodes. Normal obs. What is the most likely cause?
a) Rhinovirus
b) RSV
c) GAS
d) EBV
e) Strep pyogenes
f) Staph aureus

Rhinovirus

NOT strep throat - that would be exudative

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5 year old Maori/Niuean boy with painful leg and fever. There is tenderness of the medial upper aspect of tibia. Normal x-ray, tender and warm area of skin around his tibia. Raised neuts. Tx?
a) Metronidazole
b) Flucloxacillin
c) Flucloxacillin + gentamicin
d) Penicillin G
e) Penicillin G + gentamicin
f) Vancomycin
g) Amoxicillin

Flucloxacillin

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Baby that was fine at birth, presents 3 days later with increasing jaundice, bilirubin 380 (normal <200), direct/conjugated bilirubin 12 (normal<6). What is your initial management?

Phototherapy

Note value of 450 is the threshold for exchange transfusion for anyone >48 hours after birth

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Kid with partial seizures lasting 30-60s. Having multiple attacks per day gazing off into the distance associated with hand movements. Tiredness after the event, jerking and lip smacking with chewing motions. What is the best medication
a) Lamotrigine
b) Levetriracetam
c) Ethosuximide d) Valproate

Valproate (boys)
Levetiracetam (girls)

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12 year old had GTCS on waking. Has twitches in arms and legs occasionally. Had febrile seizure when younger. EEG showed generalised spike and wave when sleep deprived and with photostimulation. Diagnosis?
a) Juvenile myoclonic epilepsy
b) SeLECTS
c) Childhood absence epilepsy

Myoclonic +/- GTCS/abscence, provoked by photo stimulation = juvenile myoclonic epilepsy

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Girl has seizure in the morning, child aware and able to think. Dx?
a) Myoclonic seizure
b) Absence seizure
c) Focal impaired awareness seizure

Myoclonic

Abscence = not aware
Focal impaired = not aware

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8 year old has occasional brief hemifacial seizures, swallowing and chewing movements lasting less than 5 minutes, mostly at night. Once evolved to GTCS. EEG showed high amplitude centrotemporal spikes in drowsiness and sleep. Dx?
a) Juvenile myoclonic epilepsy
b) Childhood epilepsy with centro-temporal spikes (SeLECTS)
c) Childhood absence epilepsy

Self-limiting, brief, hemifacial –> SeLECTS

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5 year old has frequent brief (10s) staring spells, unresponsive to parents and teachers. EEG showed generalised spoke and wave when sleep deprived and with hyperventilation. Dx?
a) Juvenile myoclonic epilepsy
b) SeLECTS
c) Childhood absence epilepsy

Childhood absence epilepsy

Absence = loss of awareness, staring spells

Provoked by hyperventilation

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Investigation of choice in childhood seizures?
a) EEG
b) CT head
c) Nothing

EEG for most…

Nothing may be needed if it is a simple febrile.
Simple febrile seizures are the most common type and are characterized by a single generalized seizure lasting less than 10 to 15 minutes.

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Kid with meningitis and high ICP, raised WBC predominantly lymphocytes, normal glucose, low protein

Viral meningitis

Bacterial - mostly neutrophils, low glucose, high protein

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Distressed child with barking cough and loud inspiratory stridor. What treatment?
a) Oral dexamethasone
b) Intubate
c) Antibiotics

Treat croup with DEXAMETHASONE

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Infant with respiratory distress and fever likely due to bronchiolitis. What investigation do you do?
a) Blood culture
b) Blood gas
c) FBC
d) Nasopharyngeal aspirate (NPA)
e) ECHO
f) Nothing

In most children with bronchiolitis no investigations are required

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4 year old NZ European girl with painful right leg (upper tibia area), febrile, not worse on walking/weight bearing. Knee joint ROM normal and no pain in joint on active or passive movement. Normal X-ray. Neutrophilia (WBC 18 95% neuts). Dx?
a) Osteomyelitis
b) Osgood-Schlatter
c) Acute leukaemia
d) Septic arthritis
e) Osteosarcoma

Osteomyelitis

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Young boy with bilateral infrapatellar swelling. Management?
a) Advise rest
b) Steroid injections
c) IV antibiotics
d) Surgery

Osgood Schlatter –> rest, NSAIDs, knee-pads/straps

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Kid with diabetic ketoacidosis (DKA). First line treatment?
a) 0.9% NaCl + KCl IVF
b) 0.9% NaCl IVF
c) Insulin
d) NaHCO3

Usually need potassium too - total body deficit which will rapidly appear when begin to treat with insulin

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11 year old with short stature and delayed puberty onset. Bone age is 9 years. Diagnosis?
a) GH deficiency
b) Constitutional delay
c) Genetic short stature
d) TH deficiency

Constitutional delay

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Child falls with hematoma over occiput. No neuro signs. Investigation?
a) CT scan
b) None needed
c) MRI

If absolutely no neuro signs, no palpable skull fracture or signs of AMS

AMS: Agitation, somnolence, repetitive questioning, or slow response to verbal communication

PECARN recommends observation over imaging, depending on provider comfort; 0.9% risk of clinically important Traumatic Brain Injury.

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Newborn baby distressed and appeared to be cyanosed when lie on back. Better when lie on belly Has small jaw. Dx?

Pierre Robin

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Baby w/ swelling on one side of scrotum, reducible, transilluminates

Likely a hernia

More common to have a non-communicating hernia (rather than a communicating one) which is not reducible

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Baby with sunset eyes and frontal head swelling. Investigation?

US first then CT i think

Children suspected of having hydrocephalus require cranial imaging by CT, MRI, or ultrasonography (if the anterior fontanelle is open).

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9-month-old baby girl presents with episodes of screaming, yellow non-bilious vomit, pallor and a mildly distended abdomen. Well between episodes. A single loose motion was passed when the episodes started. Dx?
a) Intussusception
b) Pyloric stenosis
c) Gastroenteritis
d) GERD

Intussussception

Tx = air/fluid enema

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9 days old baby with bilious vomiting and weight loss, no fever. Abdomen distended. Passed meconium at 4 days and was jaundiced day 2. Born at 36 weeks. Best investigation?
a) Abdo USS
b) Abdo X-ray
c) Blood cultures
d) Urine
e) Serum bilirubin
f) Barium meal

Abdo xray

?intestinal atresia

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5 year old girl, who for the past 3 weeks has been vomiting each morning before breakfast/school, rarely at other times. Occasional headaches, otherwise well. Diagnosis?
a) Migraine
b) Gastritis
c) Medulloblastoma
d) Sinusitis

Medulloblastoma

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Baby vomiting, now bilious. Management? a) Admit and observe 24 hours b) Reassure c) Antibiotics

Admit

6 month old baby boy with R inguinal mass causing no discomfort. Not evident on exam anymore. Both testes present in the scrotum. R spermatic cord thicker than the left. What should you do? a) Surgery for inguinal hernia repair b) Review once a week c) Reassure that it doesn’t need treatment d) Orchidoplexy

This is a hernia - non-urgent surgical repair On starship: If reduces keep overnight and operate next day as acute.

5 year old with a bulge above umbilicus for last few weeks. Soft non-tender. Treatment? a) Reassurance b) Surgical repair c) Aspirate d) Antibiotics

ABOVE belly button = epigastric, only refer if discomfort/interference etc. Umbilicius - usually reduce by 3 years, refer if after that

Dude had MI 6 months ago and was put on ACEi, furosemide and amiodarone. Presents with fatigue, mental slowing and weight gain of 10kg. Been bed-bound for 6 weeks. What initial investigation should be done? a) BNP b) TFTs

Amiodarone --> can cause hypothyroidism

72 year old female lots of meds (including ACEi and levothyroxine) presents with confusion, lack of appetite and fatigue. Blood tests show Na 120 (low) low TSH. What’s the cause? a) Perindopril b) Indapamide/bendroflumethiazide c) Oxybutynin d) Allopurinol e) Thyroxine f) Atorvastatin

b) Indapamide/bendroflumethiazide

Theophylline overdose 4 hours ago. Management? a) No active management b) Activated charcoal c) Naloxone d) Flumazenil

Use of Activated Charcoal and Cathartic (either sorbitol of polyethylene glycol) This has been shown in several studies to reduce the half-life of theophylline substantially, even when absorption has been completed. The recommended dose is 1 g/kg every 4-6 hours (or 10 g/hour) until the theophylline level has plateaued or commenced falling or is below 55 µmol/L.

Mechanism of naltrexone in alcohol dependence treatment a) Opioid receptor antagonist b) Treat withdrawal symptoms

Opioid receptor antagonist

Man presents to ED after bike accident. Blood tests reveal mild anion gap metabolic acidosis. Cause? a) Alcohol ketoacidosis b) DKA c) Salicylate poisoning

Alcohol ketoacidosis

Young adult who is known to be on treatment for epilepsy present with ataxia. Suspected phenytoin toxicity. Treatment? a) IV benzodiazepine b) Supportive management

<4 hrs = charcoal >4 hours: supportive

Which drug worsens reflux? a) ACEi b) Thiazide c) CCB

CCB

Which of the following Parkinson’s drugs doesn't act on dopamine? a) Benserazide b) Benztropine c) Etacapone d) L-dopa

Benztropine (anticholinergic)

Guy who was 68. Fhx two brothers who had prostate cancer in their 60s. He had a PSA that had gone from 3.5-5.5 in 1 year. He has had some urinary symptoms like decreased stream. His prostate was smooth and no obvious masses felt. a) Transperineal biopsy b) Repeat PSA in 3 months c) MRI prostate d) Ultrasound prostate

Repeat PSA

Lady with reasonable stress incontinence worse with exercise. 3 children. Had tried pelvic floor exercises not helped. On exam: Grade 1 uterus prolapse, Grade 1 cystocoele, Grade 1 rectocele. Next step in treatment? a) Anterior vaginal repair b) Tension free vaginal tape c) Bladder retraining d) Estrogen cream e) Duloxetine f) Doxazosin g) Pelvic floor exercises

Tension free vaginal tape

PID in pregnancy (third trimester) caused by chlamydia. Treatment? a) Azithromycin b) Ceftriaxone c) Metronidazole d) Amoxicillin

Azithromycin

Letrozole vs clomphene

Lroztole = better fertility odds, lower chance of multiples

50 year-old lady presents with an abdominopelvic mass which can be palpated just below the xiphisternum. Unilocular cyst is seen on the USS. Ca125 is within normal limits. What is the most likely diagnosis? a) Ovarian cystadenoma b) Colorectal metastasis c) Ovarian carcinoma

Cystadenoma, benign, can grow very large

Alcoholic man comes in with fractured tibia, gets repaired with internal fixation. Admits to drinking a bottle of vodka a day. A day later he becomes confused. Which other symptoms would most likely point towards acute thiamine deficiency? a) Peripheral neuropathy b) Seizure c) Abnormal eye movement d) Hallucination e) Vomiting f) Hypotension

Abnormal eye movement Wernicke's encephalopathy

Lady experiencing episodes of vertigo and nausea, this is worst when turning over in bed and moving her head. Best diagnostic test? a) CT head b) Romberg test c) Dix-Hallpike manoeuvre d) Tilt table test

Dix-Hallpike manoeuvre

Man with 6-12 hours episodes of unilateral hearing loss and swooping noises with nausea, vomiting, vertigo (not related to head movement) and tinnitus. Started a few months ago, getting worse, now impacting ability to function. No neuro sx, normal neuro exam. Audiometry graph with sensorineural hearing in affected ear. What is the diagnosis? a) Meniere’s disease b) Acoustic neuroma c) Presbycusis d) Labyrinthitis e) Vestibular lithiasis

Meniere’s disease Attacks with normal periods in between

Young dude in MVA. Loss of movement, reflexes, vibration in right leg, loss of pain and temperature in the left leg. Where is the lesion? a) Right hemicord b) Left hemicord c) Central cord

Right hemicord

Old lady had a stroke but she can’t say how it has affected her. She can move her limbs but doesn’t know how to put on pyjamas. Looks like her left arm and leg are often in positions that appear uncomfortable. It had also affected her speech and there was a left inferior homonymous quandrantanopia and left inattention on exam. Dx? a) Denial b) Dementia c) Delirium d) Non-dominant parietal hemisphere syndrome e) Vascular dementia f) Temporal lobe stroke

Non-dominant parietal hemisphere syndrome

Alcoholic man comes into ED with confusion, nystagmus, seizures. History of drinking 2 bottles of wine a day for 10 years. He had diplopia in lateral and upwards gaze. Left eye couldn’t look down or outwards. No Hx of head trauma. Immediate management? a) IV thiamine b) Other vitamin infusions c) IV Dextrose d) CT head e) Antibiotics

IV thiamine

Man on cardiology ward. On second day develops difficulty talking. Replies with single words or short sentences only. Has trouble finding the right word, but usually gets his meaning across. What’s the problem? a) Motor aphasia b) Sensory aphasia c) Dysarthria d) Delirium

Motor aphasia

Asked to copy and draw a picture of two intersecting pentagons in a cognitive assessment. Which part of a) b) c) d) e) brain is she using? Dominant parieto-temporal Non-dominant parieto-temporal Non-dominant parietal Hippocampus Frontal lobe

Non-dominant partietal

Sudden brain event. Symptoms on face one side, on body other side. Horner’s syndrome. Tongue deviation too? Diplopia. Has HTN. Diagnosis? a) Vertebral artery occluded b) Basilar artery occluded c) Brain stem glioma d) Infection or something else e) Wernicke’s Encephalopathy f) Cerebral artery occluded

PCA off vertebral artery

Ptosis, pupil down and out, fixed dilated pupil. What is problem? a) Oculomotor nerve palsy b) Trochlear nerve palsy c) Adbucens nerve palsy

Oculomotor

Papilloedema. Headaches at night. Nystagmus on lateral gaze. Diagnosis? a) Benign intracranial hypertension b) Traumatic brain injury c) Brain tumour

Brain tumour for me lol

Female with ear infection develops Bell’s palsy. Treatment? a) Prednisone b) Prednisone + acyclovir c) Acyclovir

Prednisone + acyclovir

Patient with hemiparesis and hypertension. Diagnosis? a) Lacunar infarct b) Thrombotic infarct c) Embolic infarct d) Haemorrhagic stroke

Thrombotic

Patient with head injury clear nasal discharge, swelling over the mastoid, bruising around eyes look like racoon. Diagnosis? a) Basal skull fracture b) Broken nose

Basal skull --> CSF out nose

Loss of sensation (discriminative and non-discriminative) and burning pain in upper lateral thigh. Dx? a) Meralgia paresthetica b) Cauda equina syndrome

Meralgia paresthetica

Fall down in bath. Head injury due to seizure, reducing LOC. X-ray shows parietal bone fracture. Diagnosis? a) Extradural hematoma b) Subdural haematoma

Pterion --> MMA --> extradural

Action tremor. Cause? a) Parkinson’s b) Cerebellar c) Essential

Cerebellar

75 year old man on cilazapril, metoprolol, furosemide and aspirin. Ejection fraction of 29%. Breathless. Cr 10, K+ 4. What is next treatment? a) Spironolactone b) Diltiazem c) Digoxin

Spirinolactone

Man just returned from a pacemaker insertion. HR 100, RR high, muffled heart sounds, high JVP +++. ECG showed AF. What imaging do you do? a) Echocardiogram b) CXR c) CT

ECHO - cardiac tamponade

Guy gets pericardial effusion drained then has asymmetrical chest, decreasing sats and respiratory distress, and then trachea deviated to right. Treatment? a) Left 5th intercostal midaxillary space tap b) Right 5th intercostal midaxillary space tap c) Left 2nd intercostal space midclavicular needle thoracostomy d) Right 2nd intercostal space midclavicular needle thoracostomy e) Left 2nd intercostal midaxillary chest drain

Left 2nd intercostal space midclavicular needle thoracostomy

20 year old man with anechoic testicular mass with raised B-hCG. What type? a) Choriocarcinoma b) Seminoma c) Ledig cell tumor d) Sertoli tumour lol

Very raised = charciocarcinoma <50 = seminoma

Dude with small cell lung cancer had a calcium of 3.2. What is this due to? a) Bone mets b) PTHrP

SMALL CELL = BONE METS Squamous = PTHrP

Asymptomatic guy, bilirubin 40 on screen for his VISA. All other things normal. Likely diagnosis? a) Gilbert Syndrome b) Wilson’s disease c) Alcoholism d) Fatty liver disease e) Hepatitis

Gilbert

25yo lady with bouts of mucousy diarrhoea. Pulse 100. 5kg of weight loss in last 6 months. Dx? a) IBS b) Salpingitis c) Giardiasis d) IBD

IBD - THIS IS MUCUS SO... CD. UC = BLOODY

Crohn’s disease with pustule on leg

Pyoderma gangrenosum

79 year old lady presents with jaundice and weight loss. Has a painless mass in the RUQ, dark urine, pale stools. Has had abdo USS show dilated bile duct and gallbladder. Bloods show obstructive jaundice. What investigation would you do next? a) Abdo CT b) Abdo XR c) ERCP d) MRCP

MCRP - diagnostic gold standard, this could be cancer so want to diagnose

Guy with diarrhoea and PR bleeding that didn’t go away with over the counter diarrhoea treatments or antibiotics. Sigmoidoscopy showed red raw mucosa and pseudopolyps. Diagnosis? a) Salmonella b) E. coli c) Crohn’s d) Pseudomembranous colitis e) Clostridium perfringens f) Ulcerative colitis

Ulcerative colitis – ulceration 􏰀 surviving mucosa = pseudopolyps

Endoscopy showed gastric cancer. What other pathology is associated? a) Atrophic gastritis b) Barrett’s oesophagus c) Gastric ulcer

Atrophic gastritis

Patient with cirrhosis develops ascites. Treatment? a) Spironolactone b) Furosemide c) Fluid restriction

Spirinolactone

Patient with IBD develops abdo pain and distension and severe bloody diarrhea. Abdo CT shows colon diameter increased (>6cm). Management? a) Urgent laparotomy for colectomy b) IV glucocorticoid

Toxic megacolon --> IV glucocorticoid

Man 8hr post anterior resection, difficult surgery requiring drain insertion, has a catheter in. Only had 100mL of urine output since. Has had 1.5L of saline since surgery. BP 110/70 HR 100. What is the best investigation to determine cause of his oliguria? a) U/E’s and creatinine b) Bladder ultrasound c) Urine output after saline fluid bolus d) Central Venous Pressure e) Serum and urine osmolality

U/E’s and creatinine

What is this ureteric calculus most likely comprised of? a) Calcium oxalate b) Calcium phosphate c) Urate d) Struvite

Calcium oxalate

Rolled edged ulcerated lesion, under eye lid

BCC

Woman with painful hand at night, dangles over bed for relief. Which nerve is affected? a) Median b) Radial c) Ulnar

median, carpal tunnel

Comminuted fracture tibia, ORIF. What metabolic disturbance are they most likely to have? a) Hyperkalaemia b) Hypercalcaemia

Hyperkalemia

Young girl in teens. Bone pain in knee with large soft tissue mass. Dx? a) Chondrosarcoma b) Osteosarcoma

Osteosarcoma

40 year old man. Painful swelling in femur. Dx? a) Chondrosarcoma b) Osteosarcoma

Chondrosarcoma

A 26-year-old man has increasing discomfort in his left knee and a lump at one side. An xray shows a mushroom shaped mass extending from the lower femoral metaphysis. a) Osteochondroma b) Osteosarcoma c) Chondrosarcoma

Osteochondroma

50 year old woman presents with pruritis and jaundice. She complains of dry eyes and dry mouth. Xanthelasma and hepatosplenomegaly present. Investigation. a) Mitochondrial antibody (AMA) b) Anti ro and anti La (SSA, SSB) c) Antibodies against nuclei and actin d) LFTs

AMA for primary biliary cholangitis

Skin thickening and Reynauds. Which diagnostic marker? a) Anti-centromere b) Anti-histone c) Anti-SSA/B d) Anti-Smith

Anti-centromere

Man with severe epigastric pain. X-ray shows psoas sign (loss of psoas shadow) and sentinel loop. Diagnosis? f) Acute Pancreatitis g) Chronic pancreatitis h) Peptic ulcer i) Diverticulitis j) Acute appendicitis

Acute Pancreatitis

Ulcerating mass low in anal canal. Which lymph nodes does it metastasise to first? a) Inguinal nodes b) Anorectal nodes

Inguinal

Mass extend below groin, fever, back/flank pain, limp, weight loss. Dx? a) Psoas abscess b) Renal carcinoma

Psoas abscess

Man with swollen lower eyelid. No pain or ophthalmoplegia. Tx? a) IV amoxicilin + clavulanic acid (amoxiclav) b) Chloramphenicol eye drops c) Incision and drainage

IV abx

50 year old Chinese lady with bilateral nipple retraction and painless discharge. Excision biopsy of nipple shows central duct dilatation and inflammation and periductal inflammation. Has been treated with surgery and requires no more treatment. What is the most likely diagnosis? a) Mammary duct ectasia b) Paget’s disease of the breast c) Intraductal papilloma d) Eczema

Mammary duct ectasia

Unilateral breast duct secretion with blood present. Diagnosis? a) Mammary duct ectasia b) Paget’s disease of the breast c) Intraductal papilloma d) Eczema

Intraductal papilloma