MLA QuesMed mock

Question 1

The three oral antibiotics recommended for IECOPD

Answer 1

amoxicillin

If pen allergic: doxycycline, or clarithromycin

Question 2

Blood results in adrenal crisis show:

Answer 2

• Hyponatraemia
• Hyperkalaemia
• hypoglycaema

Question 3

What might be given to prevent a variceal rebleed?

Answer 3

Propranolol
- non selective beta blocker
- reduce portal pressures

Question 4

Recap the hypersensitivity reactions

Answer 4

Type 1 - anaphylaxis (IgE antibodies), mast cell degranulation

Type 2 - IgM OR IgG –> haemolytic disease of the newborn

Type 3 - immune complexes, SLE!

Type 4 - delayed reaction by T cells: contact dermatitis

Type 5 - stimulating antibodies produced against specific receptor (GRAVES)

Question 5

21 Male presents with red, painful eye: Diagnosis + Mx

Answer 5

HSV Keratitis

1. Same day opthalmology referral!
2. STOP wearing contact lenses
3. Topical ABx
   - quinolones = 1st line (ciprofloxacin)
4. Cycloplegic for pain relief
   - cyclopentolate

Dendritic lesions are a typical finding in HSC keratitis

Complications
- corneal scarring
- perforation
- endophthalamitis
- visual loss

Question 6

Diagnosis and management

When might you reffer:

Answer 6

1. usually self limiting
2. Topical ABx if not settling
   - chloramphenicol
   - fusidic acid

** Referral**
- severe persistent infection
- periorbital cellulitis
- atypical features (excess pain, visual distortion)
- pain on eye movements

Question 7

Diagnosis and management

Patient presents with photophobia and an irregular pupil, cilliary flush seen

Answer 7

Dx: ANTERIOR UVEITIS

Mx:
1. URGENT opthal review
2. cycloplegics: atropine / cyclopentolate
3. Steroid eye drops

Cycloplegics dilate pupil to help relieve eye pain and photophobia

Question 8

47 Female: SOB 2/7 days post ABDOMINAL surgery. Reduced air entry bilaterally lung bases. Elevated RR. Normal sats, calves SNT

What is likely diagnosis and management:

Answer 8

ATELECTASIS

Mx: chest physio and optimise pain control

Small areas of collapse. Due to pain on deep breathing and coughing leading to incomplete clearing of secretions. Managed conservatively at first.

Question 9

57 Male: DRY COUGH

PMH: IHD, renal transplant

OE: chest clear, saturations drop after walking around the room. No medication allergies.

What is likely diagnosis and what would you give:

Answer 9

PNEUMOCYSTIS JIROVECCI

• suspect in immunocompromised patients with dry cough and exercise induced desaturations

Initially treated
- CO-TRIMOXAZOLE

Question 10

Criteria used to grade flares of ulcerative colitis

Answer 10

TRULOVE and Witts

Question 11

Ulcerative colitis: inducing remission

Answer 11

Inducing Remission

1. Mild to moderate disease
   
   1. FIRST LINE: aminosalicylate (e.g. mesalazine oral or rectal)
   2. SECOND LINE: corticosteroids (e.g. prednisolone)
2. Severe
   
   1. FIRST LINE: IV corticosteroids (e.g. hydrocortisone)
   2. SECOND LINE: IV ciclosporin

Maintaining Remission

• Aminosalicylate(e.g.mesalazineoral or rectal)
• Azathioprine
• Mercaptopurine

Surgery: panproctocolectomy (pt left w/ permanent ileostomy or ileo-anal anastomosis (J-pouch))

Question 12

43 Female: sudden onset painless visual loss.

PMH: RA, poorly controlled T2DM

Diagnosis and treatment:

Answer 12

Diagnosis: VIRTRIAL HAEMORRHAGE

TX: vitrectomy

Patients with poorly controlled diabetes often develop proliferative diabetic retinopathy
–> fragile blood vessels which are prone to bleeding

Question 13

40 year old female has presented with pain and tenderness over the temporal arteries along with systemic upset: diagnosis and management

Answer 13

GIANT CELL ARTERITIS

MX:
1. 60mg OD prednislone
2. If visual symptoms/blindness: IV METHYLPREDNISOLONE
3. PPI and bisphophonates
–> prevent osteoporosis and gastric ulcers

Definitive IX
- temporal artery biopsy
- 3-5cm of artery due to skip lesions

Question 14

Erectile dysfunction Mx:

Answer 14

Cause of ED: organic?

1. Intracavernosal prostaglandins
2. Sildenafil

Beware concurrent use of nitrates and sildenafil –> prodound HYPOtension

Question 15

According to NICE guidelines, the first line treatment for acute attacks of migraine include

Answer 15

Ibuprofen 400mg, Aspirin 900mg or Paracetamol 1g.

Question 16

43 Male

PC: loin to groin pain
HPC: severe, intermittent pain in left going radiating to testicle, 9/10 severity w/ associated nausea. no significant PMH.

Likely diagnosis and management:

Answer 16

Renal colic.

Mx: IM/PR diclofenac

Question 17

75 Male: 7 kg weight loss over 3/12, tender palpable swelling in left arm. noticed few similar swellings in left arm. appears jaundiced.

Likely diagnosis and investigation:

Answer 17

CT ABDOMEN

pancreatic cancer??

Trousseau sign of maligancy
- migratory thrombophlebitis which presents as a tender nodule under the skin

Question 18

40 MALE: Diarrhoea + Flushing 1/12. Dizzy when stands up, BP 100/60, pansystolic murmur heard loudest over 4th ICS.

Likely diagnosis and management:

Answer 18

Carinoid syndrome
- serotonin production from tumour
- diarrhoea, flushing, hypotension, predominantly right sided heart murmurs

TX –> OCTREOTIDE

Ix: 24 hour urine 5HIAA (breakdown product of serotonin)

Question 19

56 Male
PC: breathlessness, increased thirst and urination
OE: peripheral oedema + tanned complexion

Important blood test to request and why:

Answer 19

Haemochromatosis: transferrin saturation

Mx:
- venesection (weekly)
- monitor serum ferritin
- monitoring and treating complications

Haemochromatosis has a long list of complications:

1. Pancreas –> secondary diabetes
2. Liver cirrhosis
3. Endocrine –> hypogonadism, erectile dysfunction, amenorrhoea, reduced fertility
4. Cardiomyopathy
5. Hepatocellular carcinoma
6. Hypothyroidism (iron deposits in thyroid)
7. chondrocalcinosis (calcium pyrophosphate deposits in joints)

Question 20

Patient presents with yellowing of skin without any other symptoms: likely diagnosis

Answer 20

Gilberts syndrome
- hyperbilirubinaemia occurs in absence of liver disease

Ix = check LFTs! isolated rise in unconjugated bilirubin

Question 21

A 35 year old man comes to the GP with widespread raised papules with a central umbilication on his trunk, face, hands, legs and feet. He reports they have been present for the last 2 years without improvement and he is worried about them. What is the most appropriate course of action?

Answer 21

MOLLUSCUM CONTAGIOSUM - caused by pox virus
In adults if they persist may indicate underlying immunocompromise –> HIV testing indicated

Question 22

Elderly patient admitted to ICU following diagnosis of severe UTI –> urosepsis. Pt has AKI and is catheterised.
Nurses concerned about fluctuations in mood.

Has had periods of being withdrawn, disorientated, apathetic and periods of agitation, hallucinations and delusions:

What is the likely cause of patients symptoms:

Answer 22

Delerium
- may be triggered by infection, change in environment or due to pain

Acute psychosis:
Although the patient describes hallucinations and delusions, the mixed picture and acuity following a physical health illness, especially in elderly patients is more suggestive of a delirium.

Question 23

Pt presents w/ severe abdominal pain and swelling. Bloody diarrhoea, fever and vomiting. He has undergone triple therapy for the last two weeks for H pylori infciton.

AXR performed:

What is the most likely cause of this presentation:

Answer 23

Clostridium Difficile

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