Make a Medic Mock 2021

Question 1

How is an NSTEMI and unstable angina differentiated?

Answer 1

NSTEMI will cause raised troponins, however both can cause ECG abnormalities

Question 2

Which drugs have a positive prognostic indication on patients with heart failure with reduced ejection fraction?

Answer 2

Beta blockers and ACE inhibitors

Question 3

What is the management of SVT?

Answer 3

Haemodynamically unstable:

1. DC cardioversion

Haemodynamically stable:

1. Vagal manoeuvres
2. 6mg Adenosine
3. 12mg Adenosine
4. Verapamil (or beta blockers/ diltiazem)
5. DC cardioversion

Question 4

Which murmurs are loudest on inspiration?

Answer 4

Right sided murmurs

Question 5

Which murmurs are loudest on expiration?

Answer 5

Left sided murmurs

Question 6

What is the triad of characterising critical limb ischaemia?

Answer 6

• Tissue loss
• Gangrene
• Pain at rest

Question 7

What is the management of AF?

Question 8

What is the management of ascending cholangitis?

Answer 8

• IV fluids
• Broad spectrum antibiotics
• ERCP to remove obstruction

Question 9

What are the manifestations of portal hypertension?

Answer 9

• Caput medusae
• Oesophageal varices
• Haemorrhoids
• Splenomegaly

Question 10

What does SAAG <11 g/L indicate?

Answer 10

Exudate

• Infection
• Peritoneal mets
  *

Question 11

What does SAAG >11 g/L indicate?

Answer 11

Transudate

Question 12

What is the SAAG of nephrotic syndrome?

Answer 12

Nephrotic syndrome gives a SAAG of <11 g/L due to the decreased serum albumin

Question 13

How is spontaneous bacterial peritonitis diagnosed?

Answer 13

Paracentesis of ascitic fluid with neutrophils >250 per mm3

Question 14

Which organism most commonly causes SBP?

Answer 14

E.coli

Question 15

What will histological analysis of a Crohn’s patient show?

Answer 15

• Transmural inflammation
• Non-caseating granulomas
• Skip lesions

Question 16

Which artery is occluded in chronic mesenteric ischaemia?

Answer 16

Superior mesenteric artery

Question 17

What is the presentation of chronic mesenteric ischaemia?

Answer 17

Post-prandial colicky abdominal pain (pain on exertion of the gut)

Question 18

Occlusion of which artery leads to ischaemic colitis?

Answer 18

Inferior mesenteric artery

Question 19

What is the most common cause of small bowel obstruction?

Answer 19

Adhesions

Question 20

What is the class of carbocisteine?

Answer 20

A mucolytic

Question 21

What is the most useful biomarker of chronic CO2 retainers?

Answer 21

HCO3-, as chronic CO2 retainers will get increased bicarb as a compensatory mechanism

Rasied CO2 doesn’t equal CO2 retainer

Question 22

What are the three subgroups of beta-lactam antibiotics?

Answer 22

• Amoxicillin
• Cephalosporins
• Carbapenems

Question 23

What is the management of provoked PE? (following surgery etc)

Answer 23

3 months of DOACs (some trusts use LMWH and Warfarin)

Question 24

What is the management of unprovoked PE? (not following surgery)

Answer 24

6 months of DOACs (LMWH and warfarin depending on trust) and screening for pro-thrombotic conditions

Question 25

What is the clinical difference between meningitis and encephalitis?

Answer 25

Meningitis rarely causes neurological symptoms, therefore focal neurology or seizures should raise suspicion for encephalitis

Question 26

What is the most common cause of encephalitis?

Answer 26

HSV1 (managed with acyclovir)

Question 27

Which arteries supply the primary motor cortex?

Answer 27

Anterior and middle cerebral arteries

Question 28

What is the pathophysiology of dementia with Lewy bodies?

Answer 28

Deposition of alpha synuclean proteins

Question 29

How can Parkinson's and dementia with Lewy bodies be distinguished?

Answer 29

Parkinson's will present with \>= one year of motor symptoms before cognative, whereas cognative symptoms will preceed motor in DwLB

Question 30

What is the most common cranial bleed following head trauma?

Answer 30

Extradural haemorrhage, usually following damage to the middle meningeal artery after trauma to the pterion

Question 31

What is the presentation of an extra dural haemorrhage?

Answer 31

1. Loss of consciousness 2. Lucid period of feeling generally fine 3. Rapid deterioration with focal neurology

Question 32

What feature of urea makes it a useful marker for dehydration?

Answer 32

Urea is reabsorbed in states of low circulating volume, to utilise its osmotic properites therefore high concentration of urea indicates dehydration

Question 33

What are the indications for haemodialysis in a patient with renal impairment?

Answer 33

* Pulmonary oedema * Acidosis * Hyperkalaemia * Uraemic complications * Pericarditis * Encephalitis

Question 34

Which enzyme do the kidneys produce?

Answer 34

1-alpha hydroxylase

Question 35

What is the mechanism of post-streptococcal glomerulonephritis?

Answer 35

Molecular mimicry

Question 36

What is the function of the direct antiglobulin test?

Answer 36

Autoimmune haemolytic anaemia

Question 37

What is the best investigation for multiple myeloma?

Answer 37

* Serum electrophoresis * Bone marrow biopsy

Question 38

What are the gold standard investigations for Conn's syndrome?

Answer 38

Renan:aldosterone ratio

Question 39

What is the mechanism of action of calcium resonium?

Answer 39

K+, H+ exchange in the bowel leading to increased K+ excretion via the bowel

Question 40

What is the management of DKA?

Answer 40

* A-E assessment * IV fluids and fixed rate insulin * 10% dextrose to avoid hypoglycaemia

Question 41

Which patients are nitrites contraindicated in?

Answer 41

Patients with risk of hypotension and patients with aortic stenosis