mock Flashcards
1
Q
A 3 week old baby boy in presented with Jaundice to his general practitioner?
List 5 questions you would ask to explore potential causes further?
A
Weight gain? Colour of stools? Colour of urine? Type of feed? Feeding well / feed volumes? Fever? Pallor? Sibling with jaundice? Initial Phototherapy needed? Birth trauma / cephalohaematoma? Activity?
2
Q
A 3 week old baby boy in presented with Jaundice to his general practitioner
List 3 Investigations you wish to undertake? (3)
A
Bilirubin (Conjugated and unconjugated), LFT, FBC, Coombs, Blood film, TF
3
Q
A 3 week old baby boy in presented with Jaundice to his general practitioner
Describe 3 things you would say in response? (3)
A
Acknowledge bloods test in babies are upsetting to think about. Explain need to rule out potentially significant pathology given duration of symptoms. Explain standard approach taken in all babies with this presentation, discuss pain relief, allow mother not to watch if preferr
4
Q
A 3 week old baby boy in presented with Jaundice to his general practitioner
State the most significant potential cause? (2
A
(Congenital) Biliary (1) Atresia (1)
5
Q
A 3 week old baby boy in presented with Jaundice to his general practitioner
What 2 things will you say to the parents regarding next steps? (2
A
Needs for specialist assessment/ further investigation/ referral to paediatrics (discussing potential surgery at this stage would NOT be appropriate until a diagnosis was established)
6
Q
A 3 month old baby girl is presented to A+E with fever (40o c), lethargy, poor feeding and strong smelly urine in her nappy.
List 5 components of the PEWS score that will help guide the acute level of clinical concern? (5)
A
Temperature, Heart rate, Respiratory rate, Saturations, AVP
7
Q
A 3 month old baby girl is presented to A+E with fever (40o c), lethargy, poor feeding and strong smelly urine in her nappy.
List 3 initial investigations that you would undertake? (3)
A
Urine dipstix and culture, FBC, CRP, U+E, Blood culture, Throat swab, LP
8
Q
A 3 month old baby girl is presented to A+E with fever (40o c), lethargy, poor feeding and strong smelly urine in her nappy.
Describe 2 things you would say in response? (2
A
Needs to stay in hospital, needs further investigation, potentially serious infection, oral treatment insufficient at this age, potential to get worse quickly if at home
9
Q
A 3 month old baby girl is presented to A+E with fever (40o c), lethargy, poor feeding and strong smelly urine in her nappy.
What is the most likely diagnosis? (1)
A
UTI (Sepsis, meningitis also possible)
10
Q
A 3 month old baby girl is presented to A+E with fever (40o c), lethargy, poor feeding and strong smelly urine in her nappy.
What initial treatment does she require? (2)
A
IV (1) Broad spectrum Antibiotics / cephalosporin (1)
11
Q
A 3 month old baby girl is presented to A+E with fever (40o c), lethargy, poor feeding and strong smelly urine in her nappy.
Following recovery she is brought back for follow-up investigations f) Give one likely investigation that would be done and the rationale for doing it? (2)
A
Any of; Renal USS (System structure/dilatation/malformation), DMSA (renal scarring), MCUG (Vesico-Ureteric-Reflux)
12
Q
A 3y old developmentally normal boy is presented to A+E with 48h of limp and difficulty walking. a) List 5 potential causes and a specific question you would ask to explore each one? (10)
A
- Transient synovitis/ Reactive arthritis (any recent coughs, colds, sore throats?) - Septic arthritis / Osteomyelitis (Any fever/sweating?) - HSP (Rash on legs?) - Rheumatic fever (any rash, other joints?) - Lyme disease (Any tick bites?) - Leukaemia (Bruising, pallor?) - Fracture / Trauma (Recent falls/injury?) - ?Primary bone tumour (Night pain? - duration makes this unlikely) - Not Juvenile Idiopathic Arthritis - duration too short
13
Q
A 3y old developmentally normal boy is presented to A+E with 48h of limp and difficulty walking.
The next day he is mobilising well and is seen running around the ward. A throat swab sent the previous day was positive for rhino virus. All observations are normal. b) What is the likely diagnosis? (1)
A
Transient synovitis/ reactive arthriti
14
Q
A 3y old developmentally normal boy is presented to A+E with 48h of limp and difficulty walking.
The next day he is mobilising well and is seen running around the ward. A throat swab sent the previous day was positive for rhino virus. All observations are normal.
c) What is the significance of the throat swab result? (2)
A
Typically causes URTIs (1) which are common triggers (1) of this presentation. Or Not necessarily the cause as no specific way to confirm timing of infection unless clear from history.
15
Q
A 3y old developmentally normal boy is presented to A+E with 48h of limp and difficulty walking.
The next day he is mobilising well and is seen running around the ward. A throat swab sent the previous day was positive for rhino virus. All observations are normal.
d) What 2 bits of advice would you give to the parents on discharge? (2
A
Analgesia, mobilise as able, return if fever/joint pain/limp recur. No further investigation needed
16
Q
A 13y old girl is presented to her GP following an episode of collapse at school. Some “jerky movements” were described during the episode. She has no fever and is now back to normal having been a bit pale after the event.
a) List 5 questions you would ask to help identify a potential diagnosis? (5)
A
Who witnessed the episode? - Precipitating event? Circumstances? (Missed meals, dehydration, stress etc.) - First change from normal / alerting circumstance? - Eyes: Rolling? Fixed? Vacant? - Limbs: Jerks? Duration? Tonic? Focal? Shivers? - Colour: Pale? (Before and/or after) Blue? - Responsiveness during episode - Time take to become responsive / total duration - Time taken to be back to normal - Development concerns in previous years Family history of epilepsy / seizures - Previous faints /syncope - Fever / recent illness
17
Q
Q4. A 13y old girl is presented to her GP following an episode of collapse at school. Some “jerky movements” were described during the episode. She has no fever and is now back to normal having been a bit pale after the event.
b) What is the most common cause for this presentation? (2) And list 2 potential triggers? (2
A
Vaso-vagal (1) syncope (1), Dehydration, stress, postural change, temperature change, missed meals
18
Q
Q4. A 13y old girl is presented to her GP following an episode of collapse at school. Some “jerky movements” were described during the episode. She has no fever and is now back to normal having been a bit pale after the event.
c) What is the single most appropriate investigation to request and why? (2)
A
ECG (Not EEG) to rule out long QT
19
Q
Q4. A 13y old girl is presented to her GP following an episode of collapse at school. Some “jerky movements” were described during the episode. She has no fever and is now back to normal having been a bit pale after the event.
d) If you had been present at the time of the event what additional investigation would have been appropriate to preform and why? (2)
A
Finger prick Blood Sugar to rule out hypoglycaemia
20
Q
Q4. A 13y old girl is presented to her GP following an episode of collapse at school. Some “jerky movements” were described during the episode. She has no fever and is now back to normal having been a bit pale after the event.
e) What 2 bits of advice would you give the parents on discharge? (2)
A
optimise Fluid intake, care when changing posture, return if recurs, common at this age, think about potential triggers, review breakfast and lunch choices, physical activity/leg strengthening exercises (aiding venous return
21
Q
A 12 hour old girl is reviewed on the postnatal ward due to concerns about tachypnea (Rate = 80bpm). She was born at term via elective caesarian section and weighed 3.5 kg. She required initial positive pressure ventilation after delivery for 10 seconds but cried spontaneously afterwards. She has no fever and has been breastfeeding intermittently.
a) Describe the normal changes in foetal circulation that occur after delivery? (4)
A
Systemic vascular pressure rises, pulmonary pressure falls (and flow rises), ductus arteriosus and foramen ovale close, umbilical vein and artery close, ductus venosus closes, oxygen saturations rise.
22
Q
A 12 hour old girl is reviewed on the postnatal ward due to concerns about tachypnea (Rate = 80bpm). She was born at term via elective caesarian section and weighed 3.5 kg. She required initial positive pressure ventilation after delivery for 10 seconds but cried spontaneously afterwards. She has no fever and has been breastfeeding intermittently.
b) Give 4 examination features that should be assessed for in this baby? (4
A
Respiratory effort (chest wall retractions), grunting, colour, heart rate, oxygen saturations, presence of peripheral pulses and heart sounds/murmurs, upper airway patency.
23
Q
A 12 hour old girl is reviewed on the postnatal ward due to concerns about tachypnea (Rate = 80bpm). She was born at term via elective caesarian section and weighed 3.5 kg. She required initial positive pressure ventilation after delivery for 10 seconds but cried spontaneously afterwards. She has no fever and has been breastfeeding intermittently.
c) Identify 3 potential causes for this presentation? (3
A
Transient tachypnea of the newborn (TTN), sepsis (inc. GBS), pneumothorax (likely small). Not meconium aspiration (as not described at delivery, very unusual in an elective c-section). Congenital heart disease and upper airway obstruction possible. Not respiratory distress syndrome as very uncommon in term babies.
24
Q
A 12 hour old girl is reviewed on the postnatal ward due to concerns about tachypnea (Rate = 80bpm). She was born at term via elective caesarian section and weighed 3.5 kg. She required initial positive pressure ventilation after delivery for 10 seconds but cried spontaneously afterwards. She has no fever and has been breastfeeding intermittently.
d) What would be the most appropriate next steps in managing this baby? (2
A
Admit to neonatal unit/ special care. Arrange CXR, blood gas, septic screen. Likely stop feeds, give IV fluids and IV antibiotic
25
A 12 hour old girl is reviewed on the postnatal ward due to concerns about tachypnea (Rate = 80bpm). She was born at term via elective caesarian section and weighed 3.5 kg. She required initial positive pressure ventilation after delivery for 10 seconds but cried spontaneously afterwards. She has no fever and has been breastfeeding intermittently.
The parents are keen for her to remain on the postnatal wards e) Describe 2 things you would say in response? (2)
Acknowledge concern. Indicate common cause for admission. Need to cover for potentially more serious causes. Potential risks of getting worse if causes not addressed. Can be self-limiting but further evaluation needed in first instance. Closer observation available in specialist unit. Offer to get senior to speak with them.
26
(T/F) Reiter’s syndrome: Is most common in elderly women
F
27
(T/F) Reiter’s syndrome: Responds promptly to antimicrobials
F
28
(T/F) Reiter’s syndrome: Is associated with a retinitis.
F
29
(T/F) Reiter’s syndrome: May follow infection with Shigella
T
30
(T/F) Reiter’s syndrome: Is a self-limiting illness of less < 6 weeks duration (T/F)
F
31
(T/F)Aminoglycoside antibiotics such as gentamicin: May be administered once daily
T
32
(T/F)Aminoglycoside antibiotics such as gentamicin:: Have synergistic activity with penicillins against enterococci
T
33
(T/F)Aminoglycoside antibiotics such as gentamicin:: Are effective in the treatment of severe pneumococcal pneumonia
F
34
(T/F)Aminoglycoside antibiotics such as gentamicin:: May cause loss of hearing in the elderly.
T
35
(T/F)Aminoglycoside antibiotics such as gentamicin: Should not be given to patients with severe renal impairment
F
36
Useful drugs in fungal infections are:
a) Zidovudine T/F
F
37
Useful drugs in fungal infections are: b)Netilmicin T/F C
F
38
Useful drugs in fungal infections are: c)Itraconazole
T
39
Useful drugs in fungal infections are: d) Nystatin T/F E e)
t
40
Useful drugs in fungal infections are: Amphotericin B
T
41
Varicella zoster virus (VZV): A May cause haemorrhagic shingles in the immuno-compromised T/F
T
42
B Is characterised by Varicella zoster virus (VZV): T/F: a discrete macular rash
F
43
B Is characterised by Varicella zoster virus (VZV): T/F: Can be followed by neuralgia
T
44
B Is characterised by Varicella zoster virus (VZV): T/F:D Is a cause of severe pneumonia
T
45
B Is characterised by Varicella zoster virus (VZV): T/F:E Is not sensitive to existing antivirals.
F
46
5) Pyrexia of unknown origin: T/F A Is a definition applied to any undiagnosed fever > 24 hours
F
47
5) Pyrexia of unknown origin: T/F B May be a feature of cranial arteritis.
T
48
5) Pyrexia of unknown origin: T/F : C Is most frequently caused by viral infections
F
49
5) Pyrexia of unknown origin: T/F
| D May be a feature of miliary tuberculosis
T
50
5) Pyrexia of unknown origin: T/F
| E May be the presenting feature of lymphoma
T
51
6) In malaria due to Plasmodium vivax: T/F Symptoms always develop within one month of returning from an endemic area
F
52
6) In malaria due to Plasmodium vivax: T/F Cerebral malaria is a recognised complication
F
53
6) In malaria due to Plasmodium vivax: T/F Infection is often acquired in the Indian subcontinent.
T
54
6) In malaria due to Plasmodium vivax: T/F Thrombocytopenia is a recognised feature.
T
55
6) In malaria due to Plasmodium vivax: T/F Resistance to antimalarials is common.
F
56
7. In HIV infection: T/F A Acute seroconversion may be associated with rash and diarrhoea
T
57
7. In HIV infection: Disease progress is associated with a decline in CD4 lymphocytes.T/F
T
58
7. In HIV infection: Antiviral treatment is best started with a single agent. T/F
F
59
7. In HIV infection: Symptoms always develop within five years of infection. T/F
F
60
7. In HIV infection: Disease progresses most rapidly in patients infected through homosexual contact T/F
F
61
8. In campylobacter enteritis T/F: A Symptoms start within 24 hours.
F
62
8. In campylobacter enteritis T/F: B Antibiotic treatment is usually indicated.
F
63
8. In campylobacter enteritis T/F: C Positive blood cultures are found in 10% of patients.
F
64
8. In campylobacter enteritis T/F: D Diagnosis is confirmed by culture of the stool.
T
65
8. In campylobacter enteritis T/F: E Guillan-Barre syndrome is a recognized complication following infection
T
66
9. In pseudomembranous colitis: T/F: A Characteristic lesions are seen on colonoscopic biopsy
T
67
9. In pseudomembranous colitis: T/F: Positive blood cultures for Clostridium difficile are found in 50% of patients
F
68
9. In pseudomembranous colitis: T/F: C The diagnosis may be made by detection of Clostridium difficile toxin in the stool
T
69
9. In pseudomembranous colitis: T/F: D A history of antibiotic consumption in the previous six weeks is usually elicited
T
70
9. In pseudomembranous colitis: T/F: E Oral metronidazole often proves effective treatment.
T
71
10: Lyme disease: T/F: A Is caused by Borrelia burgdorferi
T
72
10: Lyme disease: B Is spread by rat fleas T/F:
F
73
10: Lyme disease: C May be associated with cranial nerve palsies T/F:
T
74
10: Lyme disease: T/F: D Does not respond to beta-lactam antibiotics
F
75
10: Lyme disease: T/F: E Is diagnosed on serological tests
T
76
A 25 year old man presents with a three week history of breathlessness and dry cough. He had lost two stones in weight during the previous six months and was found to have generalised lymphadenopathy and oral candidiasis. A chest X-ray shows bilateral peri-hilar pulmonary infiltrates
What is the most likely cause of this patient’s breathlessness and what disease underlies it?
Pneumocystis jirovecci pneumonia or PCP (formerly called Pneumocystis carinii pneumonia, hence the acronym PCP still commonly used). AIDS or HIV disease
77
A 25 year old man presents with a three week history of breathlessness and dry cough. He had lost two stones in weight during the previous six months and was found to have generalised lymphadenopathy and oral candidiasis. A chest X-ray shows bilateral peri-hilar pulmonary infiltrates
How might you confirm the cause of his breathlessness?
PCP confirmed by PCR of induced sputum or broncho- alveolar lavage.
78
A 25 year old man presents with a three week history of breathlessness and dry cough. He had lost two stones in weight during the previous six months and was found to have generalised lymphadenopathy and oral candidiasis. A chest X-ray shows bilateral peri-hilar pulmonary infiltrates
After the patient recovers from his acute illness, what can be done to prevent a recurrence?
Prophylaxis with daily co-trimoxazole or monthly inhaled pentamidine.
79
A 25 year old man presents with a three week history of breathlessness and dry cough. He had lost two stones in weight during the previous six months and was found to have generalised lymphadenopathy and oral candidiasis. A chest X-ray shows bilateral peri-hilar pulmonary infiltrates
What treatment can be given for the underlying disease process and how can the effect of the treatment be monitored?
Combination antiretroviral therapy (eg, reverse transcriptase inhibitors plus protease inhibitors). CD4 lymphocyte counts. Quantitative HIV viral load. Clinical response (weight, patient well-being).
80
A 25 year old man presents with a three week history of breathlessness and dry cough. He had lost two stones in weight during the previous six months and was found to have generalised lymphadenopathy and oral candidiasis. A chest X-ray shows bilateral peri-hilar pulmonary infiltrates
One year later the patient presents with a visual field defect. Which opportunistic infection is the most likely cause?
CMV (cytomegalovirus) retinitis
81
A 17 year old girl who suddenly became drowsy, fevered and is developing a petechial rash. - likely organism out of:
a) Clostridium difficile
b) Superantigen induced toxic shock syndrome
c) Septic shock
d) MRSA
e) E.coli 0157
f) Listeria monocytogenes
g) Pneumococcal meningitis
h) Strep. pyogenes
i) Meningococcal sepsis
j) Group B streptococcus
Meningococcal sepsis
82
A 54 year old man with Gramve bacilli seen on microscopy in 2 bottles of a blood culture, is transferred to ITU because he has gone into renal failure and is hypotensive despite adequate fluid resuscitation. - what is the cause out of?
a) Clostridium difficile
b) Superantigen induced toxic shock syndrome
c) Septic shock
d) MRSA
e) E.coli 0157
f) Listeria monocytogenes
g) Pneumococcal meningitis
h) Strep. pyogenes
i) Meningococcal sepsis
j) Group B streptococcus
c) Septic shock
83
A 75 year old female treated for 5 days with co-amoxiclav for a chest infection who had developed diarrhoea. likely causitive organism?
a) Clostridium difficile
b) Superantigen induced toxic shock syndrome
c) Septic shock
d) MRSA
e) E.coli 0157
f) Listeria monocytogenes
g) Pneumococcal meningitis
h) Strep. pyogenes
i) Meningococcal sepsis
j) Group B streptococcus
a) Clostridium difficile
84
A 19 year old student presents to his GP with a three month history of hearing a voice commenting on what he is doing and making derogatory comments about him. It has recently started telling him to do things. He has started to believe that his flatmates are against him and wish to harm him. He uses no illicit drugs. What is the most likely diagnosis?
Depression with psychotic features
Depression without psychotic features
Drug induced psychosis
Mania
Schizophrenia
schizophrenia
85
A 24 year old man is admitted to the acute psychiatric ward with a history of psychotic symptoms and is given a diagnosis of schizophrenia. Which of the following symptoms is a first rank symptom of schizophrenia?
```
Apathy
Confabulation
Nihilistic delusion
Pressure of speech
Thought insertion
```
thought insertion
86
A research student wishes to conduct a project on anxiety disorders and wishes to use a standardised classification system. Which of the following is the classification system used for mental illness?
```
CAGE
ICD-9
ICD-10
SCAN
SCID
```
ICD-10
87
An 8 year old boy is referred with behavioural problems to the Child Psychiatry Department. He is always active at home and moves from task to task. He finds it difficult to concentrate to read or watch TV. He often puts himself into dangerous situations like climbing onto high roofs. His performance at school is poor where he is distractible and causes distractions to others. What is the most likely diagnosis?
Attention Deficit and Hyperactivity Disorder
Conduct disorder
```
Mania
Schizophrenia
Somnambulism
```
attention deficit and hyperactivity disorder
88
An elderly man has been admitted to hospital with acute onset disorientation, visual hallucinations and agitation. He has no psychiatric history and lives alone and requires no support. What is the most likely diagnosis?
```
Alzheimer's Disease
Delirium
Depression
Lewy Body Dementia
Schizophrenia
```
delirium
89
You are a GP and have diagnosed a 27 year old lady with depression. You are confident that she does not require to be treated in hospital and wish to start her on treatment. Which of the following would be appropriate first line treatment?
```
Benzodiazepines
MAOI
SNRI
SSRI
Tricyclic
```
SSRI
90
You are a foundation doctor in an orthopaedic ward in Inverness and a patient with a moderate learning disability is admitted to the ward. The team believe that he does not have capacity to consent to an operation. Which piece of legislation would be most appropriate to use in this circumstance?
Adult Support and Protection (Scotland) Act 2007
Adults with Incapacity (Scotland) Act 2000
Mental Capacity Act 2005
Mental Health Act 2007
Mental Health (Care and Treatment)(Scotland) Act 2003
adults with incapacity (Scotland) Act 2000
91
A 29 year old junior doctor is being treated for depression with CBT. Which of the following is a term used in CBT?
Interpersonal Map
Negative Automatic Thoughts
Pre-contemplation
Separation Anxiety
Thought Blocking
negative automatic thoughts
92
A middle aged man is admitted to hospital with gall stones. Part of the admission history is to screen for alcohol problems. Which of the following is an appropriate questionnaire to screen for alcohol problems?
```
BDI
FAST
GCS
MADRS
MOCA
```
FAST
93
A 43 year old man is seen in Accident & Emergency after having taken an overdose of Citalopram and Lithium. Which of the following statements is true?
Lithium has a wide therapeutic index
Lithium is not a suitable treatment for unipolar depression
'Rebound mania' is a risk of lithium toxicity
Serum Lithium levels should be measured every 3 months
There is no point continuing lithium if the patient does not show a response within one month
serum lithium levels should be measured every 3 months
94
A 45 year old man is assessed in the outpatient department. He has an intense interest in rare woods and has a very rigid timetable which he sticks to each day. He is upset that the doctor assessing him was 10 minutes late. What is the most likely diagnosis?
Autistic Spectrum Disorder
Delusional Disorder
Generalised Anxiety Disorder
Obsessive Compulsive Disorder
Paranoid Personality
autistic spectrum disorder
95
A 39 year old woman presents with a complaint that she is fearful that something bad may happen to her. This fear occurs where-ever she goes and she cannot describe what might happen. She also complains of pains in her chest, a tremor and sweating at times. What is the most likely diagnosis?
Bipolar Affective Disorder
Depression with psychotic features
Generalised Anxiety Disorder
Paranoid Personality Disorder
Schizophrenia
generalised anxiety disorder
96
A 33 year old male frequently presents to his GP practice appearing to be under the influence of a substance. He seems quite sedated, has small pupils and complains of constipation. He is also noted to Hepatitis C Virus positive. What is the most likely diagnosis?
Acute Alcohol Intoxication
Acute Cannabis Intoxication
Cocaine Dependence Syndrome
Harmful Amphetamine Use
Opiate Dependence Syndrome
opiate dependence syndrome
97
A 67 year old woman arranges for her daughter to be able to manage her money as her own mother developed dementia at the age of 70. Which is the most appropriate legal power to use in this situation?
Assessment Order
Guardianship Order
Place of Safety Order
Power of Attorney
Restriction Order
power of attorney
98
A 28 year old woman with severe depression is admitted to the acute medical assessment ward having taken an overdose. She requires treatment but tries to leave the hospital. The FY2 is the only doctor available. Which is the most appropriate legal power to use in this situation?
Compulsory Treatment Order
Emergency Detention Certificate
Place of Safety Order
Restriction Order
Short Term Detention Certificate
emergency detention certificate
99
A 24 year old man has recently been started on new medication by his psychiatrist. One of the side effects is an unpleasant sensation of restlessness. What is the correct term for this?
Akathisia
Anhedonia
Catatonia
Dysarthria
Dystonia
akathisia
100
A 28 year old man has recently started on antipsychotics. He has been told about a side effect of muscle stiffness and contraction sometimes caused by antipsychotics. What is the correct term for this?
Agraphia
Akathisia
Catatonia
Dyscalculia
Dystonia
dystonia
101
A 34 year old man develops depression and suffers the inability to experience pleasure but can experience other emotions. What is the correct term for this?
Alexithymia
Anergia
Anhedonia
Cyclothymia
Poverty of Thought
anhedonia
102
A 68 year old woman has been diagnosed with severe depression. One of the symptoms is that she believes her bowels are rotting. What is the correct term for this?
Confabulation
Grandiose Delusion
Hallucination
Ideas of Reference
Nihilistic Delusion
nihilistic delusion
103
A 22 year old man with no previous psychiatric illness sees a street lamp flicker and suddenly knows that he is the next Scottish ambassador to Wales. What is the correct term for this?
Confabulation
Delusional Perception
Nihilistic Delusion
Thought Broadcasting
Visual Hallucination
delusional perception
104
A 23 year old man experiences irritability, grandiose delusions and a reduced need for sleep. He has previously been in a psychiatric hospital treated for depression. Which is the most likely diagnosis?
Anxious/Avoidant Personality Disorder
Attention Deficit and Hyperactivity Disorder
Bipolar Affective Disorder
Delusional Disorder
Schizophrenia
bipolar affective disorder
105
A 24 year old woman who has a one month history of low mood, early morning wakening, irritability, reduced appetite and some suicidal thoughts. She also feels guilty that she feels too tired to take her two year old daughter to nursery. Which is the most likely diagnosis?
Agoraphobia
Anorexia Nervosa
Depression
Postnatal Depression
Postpartum Psychosis
depression
106
A 79 year old man who has had two hospital admissions for depression in the past is brought to the GP by his daughter. She is concerned that he is spending lots of money, has a reduced need to sleep, is full of energy and wants to run a marathon. Which is the most likely diagnosis?
Alzheimer’s Disease
Bipolar Affective Disorder
Delusional Disorder
Lewy Body Dementia
Vascular Dementia
bipolar affective disorder
107
You are a psychiatrist treating a 34 year old woman with depression. You are confident of the diagnosis. You have already tried two antidepressants and the second has had only partial effect. Her mood has lifted slightly but she complains of poor sleep, lack of energy and motivation and poor appetite.
Which of the following is the most appropriate next step?
Add amphetamine based stimulant drugs
Add lithium
Add thyroxine
Psychosurgery
Stop the medication
add lithium
108
A 28 year old woman is an inpatient in the general adult ward. She is being treated for schizophrenia and her symptoms are improving on medication. She is allowed to go to the cinema with a friend and on return to the ward is convinced the nurses have been replaced by aliens, the radio is playing songs especially for her and she can hear voices telling her to sit up all night. What is the most appropriate investigation to order?
Blood glucose
CT Scan
Full Blood Count
Temperature
Urinary drug screen
urinary drug screen
109
1. With regards to General Sales List drugs
A. Their sale is restricted to pharmacies
B. They can be bought in some supermarkets
C. They require a prescription written by an appropriate practitioner before they can be supplied by a pharmacist
D. Include controlled drugs
E. Can only be bought by someone over the age of 16
B. They can be bought in some supermarkets
110
```
With regards to good prescribing practice the following abbreviations are acceptable apart from
A. mg for milligrams
B. ml for millilitre
C. ug for micrograms
D. SC for the subcutaneous route
E. TOP for the topical route
```
C. ug for micrograms
111
3. A 57-year-old man with no other medical history is having major abdominal surgery – an open (i.e laparotomy) sigmoid colectomy for bowel cancer.
Which of the following would be a routine part of his anaesthetic care for this type of operation?
A. Continuous ECG monitoring
B. Laryngeal Mask Airway
C. No oral fluids for 12 hours pre-operatively
D. Planned admission to Intensive Care post-operatively
E. Spinal Anaesthesia
A. continuous ECG monitoring
112
. A 65-year-old woman is admitted for planned gynaecological surgery (a vaginal hysterectomy). She has a steroid inhaler for chronic obstructive pulmonary disease secondary to smoking.
Which of the following would be likely to give the most information about the severity of this patient’s lung disease with regards to her fitness for anaesthesia?
A. A recent chest X-Ray
B. Auscultation of her chest
C. Detailed information about her tobacco intake
D. Her dose of inhaled steroid
E. Her exercise tolerance
her exercise tolerance
113
A 75-year-old man with a background of COPD presents electively for a total right knee replacement. It is decided to perform a baseline arterial blood gas as part of his pre-operative assessment.
What pattern would be consistent with chronic respiratory failure?
A. High PaCO2, High PaO2, High HCO3
B. High PaCO2, Low PaO2, High HCO3
C. High PaCO2, Low PaO2, Low HCO3
D. Low PaCO2, Low PaO2, High HCO3
E. Low PaCO2, Low PaO2, Low HCO3
B. High PaCO2, Low PaO2, High HCO3
114
6. A 35-year-old man presents for elective inguinal hernia repair. It is decided to commence a Non Steroidal Anti-Inflammatory Drug (NSAID).
Which if the following is true regarding the prescription of NSAIDS?
A. Asthma is an absolute contraindication
B. Concurrent paracetamol consumption is not advised
C. Diclofenac is preferable to Ibuprofen if the patient is being treated for a peptic ulcer
D. Oral is the only method of administration
E. Renal impairment is a contraindication
E. renal impairment is a contraindication
115
A 12-month-old boy is admitted with presumed bacterial sepsis and is electively intubated to facilitate intensive care transfer. The anaesthetist uses Suxamethonium to facilitate intubation.
Which of the following is true regarding this drug?
A. It is a non-depolarising neuromuscular blocker
B. It provides effective post-operative analgesia
C. It has a long duration of action (>20 minutes)
D. It prevents opening of sodium channels
E. It has a very rapid on-set
E. it has a very rapid on-set
116
```
8. A 77-year-old man presents with confusion. Which of these clinical features is one of the diagnostic criteria for delirium?
A. Aggression
B. Altered conscious level
C. Gait disturbance
D. Gradual onset of confusion
E. Hallucinations
```
B.altered conscious level
117
```
A man presents with a year’s history of worsening memory. His wife states that there has been a gradual decline, and he is now also developing problems with daily tasks such as getting washed and dressed. Blood tests have been normal, and physical examination is unremarkable. What is the most likely diagnosis?
A. Alzheimer’s disease
B. Delirium
C. Dementia with Lewy bodies
D. Normal pressure hydrocephalus
E. Vascular dementia
```
A. Alzheimer's disease
118
An 85-year-old man presents to the acute admissions unit with a community acquired pneumonia.
What is likely to be true of this patient’s pre-morbid physiology, relative to a 55-year-old man?
A. Higher diastolic blood pressure
B. Higher vital capacity
C. Lower creatinine clearance
D. Lower residual volume
E. Lower systolic blood pressure
C. lower creatinine clearance
119
```
An 88-year-old woman presents to the Emergency Department following a witnessed fall in a nursing home. She had risen from her chair to go to the toilet when she went pale and collapsed to the ground. A pulse rate of 50 was noted by the attending nurse. She was conversing appropriately around 10 minutes later. She recalled nausea and blurred vision before the event. Further questioning identified a 5 day history of non-bloody diarrhoea.
What is the most likely diagnosis?
A. Epileptic seizure
B. Guillain Barre Syndrome
C. Orthostatic syncope
D. Paroxysmal ventricular tachycardia
E. Transient ischemic attack
```
C. orthostatic syncope
120
A 65-year-old nulliparous woman presents to primary care with urinary incontinence. She typically has a sudden urge to pass urine straight away and is incontinent if unable to immediately access a toilet. This is most problematic in unfamiliar public places.
Following appropriate non-pharmacological measures, what would be an appropriate initial pharmacological treatment option?
A. Duloxetine (Selective Norepinephrine Re-uptake Inhibitor)
B. Finasteride (Anti-androgen)
C. Oxybutinin (Anti-muscarinic)
D. Propranolol (Beta-blocker)
E. Tamsulosin (Alpha blocker)
C. Oxybutinin (Anti-muscarinic)
121
An 81-year-old man with a past medical history of hypertension, Parkinson’s disease and chronic obstructive pulmonary disease presents to the acute admissions unit with chest pain.
What pharmacokinetic factor is true when prescribing in elderly patients?
A. Increased albumin binding
B. Increased first pass hepatic metabolism
C. Increased renal clearance
D. Reduced distribution volume for fat soluble medication
E. Reduced distribution volume for water soluble medication
E. reduced distribution volume for water soluble medication
122
```
A diagnosis of cystic fibrosis (gene frequency 1 in 25) is made in a baby on newborn screening. The same parents plan for a second child. What is chance of that child being unaffected with the condition?
A. 4%
B. 25%
C. 50%
D. 75%
E. 96%
```
75%
123
A 50-year-old female presents with ataxia, involuntary limb movements and memory loss. Subsequent questioning reveals that her mother presented with similar symptoms in her 6th decade.
Which of the following is true regarding the genetics of the likely underlying diagnosis?
A. Affected gene located on chromosome 7
B. Autosomal recessive inheritance
C. Expansion of a triplet repeat seen
D. Typical presentation in childhood
E. X-Linked inheritance
C. expansion of a triplet repeat seen
124
Of the following, which is not a clinical feature of neurofibromatosis type 1?
```
A. cutaneous neurofibromata
B. café-au-lait patches
C. learning difficulty
D. Colorectal Cancer
E. sarcoma
```
D. colorectal cancer
125
. An adverse event is any unintended or unexpected incident which could have harmed or did lead to harm for one or more patients receiving healthcare. What is the reported frequency of serious adverse events (that did result in harm, disability or death) among hospitalised patients in the UK?
a) <1%
b) 1 - 5%
c) 6 - 10%
d) 10 - 15%
e) >20
b) 1-5%
126
Effective communication is an important aspect of patient safety. Which of the following is an external barrier to effective communication?
a) Culture
b) Distraction
c) Emotions
d) Language
e) Past experience
b) distraction
127
Situational awareness includes the perception and comprehension of the current situation and the anticipation of future events. Which of the following is a barrier to situational awareness?
a) Complacency
b) Effective communication
c) Maintaining fitness for work
d) Minimising interruption during critical tasks
e) Speaking up
a) complacency
128
When performing a procedure, which of the following situations is associated with an decreased risk of error?
a) Familiarity with the task
b) Inadequate checking
c) Inexperience
d) Poor human equipment interface
e) Shortage of time
a) familiarity with the task
129
1) A 21 year old man presents to the Emergency Department with a history of abdominal pain. It is umbilical and radiates to his RIF. It is associated with nausea and vomiting. His observations are HR 97 bpm, BP 122/58, RR 16 bpm, SpO2 99% on room air, T 38.2 oC. He is admitted to undergo general surgery with a differential diagnosis of acute appendicitis. He is due an operation the following day.
On the ward the nurse informs you that he is complaining of worsening pain.
2) What two pain fibres carry pain signals from the peripheries to the spinal cord? (2)
Aδ (1) and C (1)
130
1) A 21 year old man presents to the Emergency Department with a history of abdominal pain. It is umbilical and radiates to his RIF. It is associated with nausea and vomiting. His observations are HR 97 bpm, BP 122/58, RR 16 bpm, SpO2 99% on room air, T 38.2 oC. He is admitted to undergo general surgery with a differential diagnosis of acute appendicitis. He is due an operation the following day.
On the ward the nurse informs you that he is complaining of worsening pain.
3) In which area of the brain does pain perception occur? (1)
cortex
131
A 21 year old man presents to the Emergency Department with a history of abdominal pain. It is umbilical and radiates to his RIF. It is associated with nausea and vomiting. His observations are HR 97 bpm, BP 122/58, RR 16 bpm, SpO2 99% on room air, T 38.2 oC. He is admitted to undergo general surgery with a differential diagnosis of acute appendicitis. He is due an operation the following day.
On the ward the nurse informs you that he is complaining of worsening pain.
what does RAT refer too
recognise assess and treat
132
A 21 year old man presents to the Emergency Department with a history of abdominal pain. It is umbilical and radiates to his RIF. It is associated with nausea and vomiting. His observations are HR 97 bpm, BP 122/58, RR 16 bpm, SpO2 99% on room air, T 38.2 oC. He is admitted to undergo general surgery with a differential diagnosis of acute appendicitis. He is due an operation the following day.
On the ward the nurse informs you that he is complaining of worsening pain.
5) Name three methods to assess pain severity? (3)
Verbal scale (mild, mod, severe) (1)
Numerical rating scale (1)
Visual analogue scale (1)
Faces scale (1)
133
Emergency Department with a history of abdominal pain. It is umbilical and radiates to his RIF. It is associated with nausea and vomiting. His observations are HR 97 bpm, BP 122/58, RR 16 bpm, SpO2 99% on room air, T 38.2 oC. He is admitted to undergo general surgery with a differential diagnosis of acute appendicitis. He is due an operation the following day.
On the ward the nurse informs you that he is complaining of worsening pain.
6) You establish they have mild pain. Using the WHO pain ladder can you name two suitable medications to treat this pain? (2)
Paracetamol (1), Ibuprofen (1)
134
Emergency Department with a history of abdominal pain. It is umbilical and radiates to his RIF. It is associated with nausea and vomiting. His observations are HR 97 bpm, BP 122/58, RR 16 bpm, SpO2 99% on room air, T 38.2 oC. He is admitted to undergo general surgery with a differential diagnosis of acute appendicitis. He is due an operation the following day.
On the ward the nurse informs you that he is complaining of worsening pain.
7) They undergo an open appendicectomy. On the ward afterwards the nurse informs you that he is now complaining of severe pain. Name two medications that would be more suitable to manage this pain? (2)
Morphine (1), Oxycodone (1), Fentanyl (1), Diamorphine (1)
135
Emergency Department with a history of abdominal pain. It is umbilical and radiates to his RIF. It is associated with nausea and vomiting. His observations are HR 97 bpm, BP 122/58, RR 16 bpm, SpO2 99% on room air, T 38.2 oC. He is admitted to undergo general surgery with a differential diagnosis of acute appendicitis. He is due an operation the following day.
On the ward the nurse informs you that he is complaining of worsening pain.
8) The same patient is reviewed in outpatient follow-up clinic 6 months following the procedure. He is now complaining of pain around the wound which is burning, numb and feels like “pins and needles”. Can you name two classes of drugs which would be better suited to treat this pain? (2)
Tricyclics e.g. Amitriptyline(1)
| Anticonvulstants e.g. Gabapentin (1)
136
a 6 week old girls is brought to the ortho clinic by her mother, she is worried she might have a developmental dislocation of her hip liker her sister. what is the screening method most likely to detect a dislocated hip if present?
US screening of the hip
137
45yr old man attends A+E with a 24hr acute onset pain and swelling of his R knee which he finds difficult to move. he is febrile and there is no history of injury. only significant medical history of hypertension treated with thiazide diuretics what is the likeliest diagnosis
gout
138
25 year old epileptic attends the GP after prolonged gran mal seizure complaining of pain around his shoulder and difficulty moving it. what would be the single most important part of the examination you carry out?
examining the external rotation of the shoulder
139
you are the FY1 on the medical ward treating a patient with metastatic lung cancer with known brain and lumber spine secondaries. this morning he complains of difficulty walking and passing urine. on examination he has reduced power and tone on his legs. he has an enlarged bladder and reduced anal sphincter tone. what is the most important next investigation?
MRI of spine
140
16 year old boy attends his GP with three months of knee pain treated with PT. X-ray shows a possible bone forming tumour in the distal femur. he is afrebile and his FBC is normal, what is the likeliest diagnosis between osteosarcoma, ALL, chondroblastoma?
chondroblastoma
141
What is the most likely cause of an outbreak of nausea and vomiting on a cruise ship?
norovirus
142
What is the commonest cause of traveller’s diarrhoea?
1. Campylobacter
2. Cryptosporidium
3. E coli O157
4. enterotoxigenic E. coli
5. Giardia
enterotoxigenic E. Coli
143
Which of the following is not diagnosed by culture?
1. Campylobacter jejuni
2. Clostridium difficile
3. E. coli O157
4. Salmonella enterica
5. Vibrio cholerae
Clostridium difficile
144
A 22 year old man presents to A+E with this rash which extends in patches over his chest, abdomen and legs, and developed over 6 hours. He is hypotensive (80/50) and pyrexial (39.1oC)
What should your immediate actions include?
1. Call for senior help
2. Give fast IV fluids
3. Intravenous high dose Cephalosporin (e.g. Ceftriaxone 2g)
4. Blood cultures
5. All of the above
All of the above
145
A 22 year old man presents to A+E with this rash which extends in patches over his chest, abdomen and legs, and developed over 6 hours. He is hypotensive (80/50) and pyrexial (39.1oC):
```
What should his family be given?
Amoxicillin or Chloramphenicol
2. Rifampicin or Ciprofloxacin
3. Chloramphenicol or Cefalexin
4. Cefalexin or Trimethoprim
5. None of the above
```
Rifampicin or Ciprofloxacin
146
A 22 year old man presents to A+E with this rash which extends in patches over his chest, abdomen and legs, and developed over 6 hours. He is hypotensive (80/50) and pyrexial (39.1oC):
4 days later he becomes hypotensive and is noted to have a low sodium and high potassium. The most likely reason is:
. Too little Saline in his intravenous fluid regime
2. Syndrome of inappropriate ADH secretion
3. Adrenal Insufficiency
4. Renal failure
5. Antibiotic-associated diarrhoea
Adrenal Insufficiency
147
```
What component of Neisseria meningitidis causes septic shock?
. capsule
2. fimbriae
3. lipo-polysaccharide
4. peptidoglycan
5. superantigens
```
3. lipopolysaccharide
148
30 yr old IV drug user admitted with jaundice
HBV surface antigen negative
HBV core antibody negative
HBV surface antibody positive
HAV IgM antibody positive
1. He has acute hepatitis B infection
2. He has acute hepatitis A infection
3. He previously had hepatitis B infection
4. He has not been immunised against hepatitis B
He has acute hepatitis A infection
149
For which of the following infections is there no vaccine?:
1. hepatitis A
2. hepatitis C
3. polio
4. typhoid
5. yellow fever
Hepatitis C
150
Which of the following is true of active immunisation?:
1. always contains live organism
2. contains immunoglobulin
3. gives immediate protection against infection
4. stimulates the host immune response
stimulates the host immune response
151
He is found to be HIV positive. The Candida is treated with Fluconazole. His further treatment should be:
1. Beetroot
2. Immunise with BCG as he is at great risk of developing TB
3. Commence at least 3 antiretrovirals
4. Wait until he has an “AIDS defining illness” and then commence anti-retrovirals
5. Immunotherapy with an HIV vaccine.
The Candida is treated with Fluconazole. His further
| treatment should be: Commence at least 3 antiretrovirals
152
You are taking blood from an acutely ill HIV positive patient in the Infection unit at midnight and you accidentally stab yourself with the needle
1. Phone the on-call Occupational Health doctor
2. Call the registrar
3. Wash the wound and encourage bleeding
4. Phone MBChB Office
3. Wash the wound and encourage bleeding
153
Risk of blood borne virus transmission
HIV risk is highest
2. hepatitis C risk is highest
3. hepatitis B risk is highest
hepatitis B risk is highest
154
What is the commonest bacterial cause of infective diarrhoea in the UK?
1. Salmonella
2. E. coli O157
3. Campylobacter
4. Entamoeba histolytica
Campylobacter
155
In meningococcal meningitis, what would you expect to find in the CSF?:
1. high protein, high glucose, gram positive bacilli
2. low protein, low glucose, gram positive cocci
3. high protein, low glucose, gram negative cocci
high protein, low glucose, gram negative cocci
156
You have isolated E.coli from two sets of blood cultures taken on a jaundiced patient who was admitted in septic shock.Which of the following is a likely source?
1. biliary sepsis
2. gastroenteritis
3. infective endocarditis
4. osteomyelitis
5. pneumonia
Biliary sepsis
157
A 27 year old woman present with a history of 6 weeks of dry cough, weight loss and fevers, 3 months after returning from working in a Bolivian orphanage:
The most likely diagnosis is:
1. Miliary TB
2. HIV
3. Mycoplasma pneumonia
4. Pneumococcal Pneumonia
5. Pulmonary Tuberculosis
Pulmonary Tuberculosis
158
which test would confirm Tb rapidly
1. Gram stain
2. India ink
3. Overnight culture
4. Ziehl Neelsen (ZN) stain/Auramine stain
4. Ziehl Neelsen (ZN) stain/Auramine stain
159
tb should initially treated with
1. Rifampicin
2. Isoniazid
3. Pyrazinamide
4. Ethambutol
5. All of the above
all of the above
160
how do you confirm the diagnosis for legionella?
1. Blood culture
2. Serology
3. Sputum culture
4. Urinary antigen
urinary antigen
161
E.coli O157 tx:
```
. Flucloxacillin
2. Gentamicin
3. Metronidazole
4 None
5. Ceftriaxone & Metronidazole
```
4.none
162
A 28 year-old oil worker returns from a month working offshore in Nigeria. He is febrile, vomiting and unwell. The most important investigation is:
A malaria film +/- antigen test
163
treatment for malaria:
1. Artemether/Lumefantrine (ACT)
2. Intravenous Artesunate
3. Intravenous Ciprofloxacin
4. Oral Quinine unless the parasitaemia increases
5. Chloroquine intravenously or orally if tolerated.
Intravenous Artesunate
164
47 year old lady with a background history of mild asthma presents to hospital with 5 day history of coryzal symptoms followed by fever, productive cough and shortness of breath.
She was alert and orientated on examination. O2 saturations were 90% on air, She was pyrexial at 38.5C. BP was 110/60, Pulse rate was 110 bpm, Respiratory rate was 32.
She did not have any known allergies.
No history of travel.
Bloods showed- WCC 31.9, Urea 8, CRP 344
what is her CURB65 score:
1. 1
2. 3
3. 4
4. 2
5. 5
3
165
background history of mild asthma presents to hospital with 5 day history of coryzal symptoms followed by fever, productive cough and shortness of breath.
She was alert and orientated on examination. O2 saturations were 90% on air, She was pyrexial at 38.5C. BP was 110/60, Pulse rate was 110 bpm, Respiratory rate was 32.
She did not have any known allergies.
No history of travel.
Bloods showed- WCC 31.9, Urea 8, CRP 344
Treatment?
1. iv Amoxycillin
2. iv ceftriaxone
3. iv meropenum
4. iv Co amoxicalv and clarythromycin
5. iv levofloxacin
iv Co amoxicalv and clarythromycin
166
Congenital Clubfoot (True or False)
1) Is a rare birth defect
2) Is caused by a single gene defect
3) Is associated with limited space in the womb
4) the sole of the foot turns laterally and the foot is everted
1) false
2) false
3) true
4) false
167
Name 3 blood tests indicated in the diagnosis and treatment of suspected osteomyelitis (2marks each)
```
FBC + diff WBC expect a neutrophil leucocytosis
ESR - elevated
CRP - elevated
blood cultures - x3-60% +ve
U&Es – ill, dehydrated
```
168
Name 3 types of imaging that can be used in the diagnosis of osteomyelitis(2marks each)
```
X-ray (normal in the first 10-14 days)
ultrasound
aspiration
Isotope Bone Scan (Tc-99, Gallium-67)
labelled white cell scan (Indium-111)
MRI
```
169
name 3 differentials for osteomyelitis
acute septic arthritis
trauma (fracture, dislocation, etc.)
acute inflammatory arthritis
transient synovitis (“irritable hip”)
rare
sickle cell crisis
Gaucher’s disease
rheumatic fever
haemophilia
soft tissue infection
cellulitis - (deep) infection of subcutaneous tissues (Gp A Strep)
erysipelas - superficial infection with red, raised plaque (Gp A Strep)
necrotising fasciitis - aggressive fascial infection (Gp A Strep, Clostridia)
gas gangrene - grossly contaminated trauma (Clostridium perfringens)
toxic shock syndrome - secondary wound colonisation (Staph aureus)
170
name two likeliest cause for acute osteomyelitis in an 8yr old child
Staph aureus
Strep pyogenes
Haemophilus influenza
Salmonella (sickle cell)
171
two treatments you'd institute for young boy with acute osteomyelitis
Supportive treatment for pain and dehydration
general care - rehydration
analgesia
```
Rest
Splintage
Antibiotics (intravenous)
```
172
3 complications for acute osteomyelitis in a child
```
Septicemia
Death
Metastatic infection
Pathological fracture
Septic arthritis
Altered bone growth
Chronic osteomyelitis
```
173
Name the 4 muscles in the Thenar eminence of the hand.
```
Flexor pollicis brevis
Abductor pollicis brevis
Adductor pollicis
(innervated by Ulnar N)
Opponens pollicis
```
174
Name the three direction in which the shoulder joint can dislocate (2 marks each)
anterior, posterior and inferior
175
commonest direction for a shoulder dislocation
anterior (90%)
176
A 50 year old woman presents with a sensation of painful clicking in the volar aspect of her ring finger when bending her finger. What is the most likely diagnosis? (4 marks):
```
Osteoarthritis of the metacarpophalangeal joint
Dupuytrens disease
A flexor ganglion
A trigger finger
A ruptured flexor tendon
```
trigger finger
177
thumb arthritis two non operative treatments
Life style modifications
NSAIDS
Splint
Steroid Injection
178
thumb arthritis two treatments
Operative (2 marks each)
Trapeziectomy
Fusion
Replacement
179
Name 4 potential causes of a fracture healing slowly ie Delayed union (2 marks for each)
```
high energy injury
distraction (ie large gap between ends)
instability
infection
steroids
immune suppressants
smoking
warfarin
NSAID
Ciprofloxacin
```
180
Name 3 non-operative managements for painful foot conditions (2 marks each)
```
Non-operative management
Analgesia
Shoe wear modification
Activity modification
Weight loss
Physiotherapy
Orthotics including insoles and bracing
```
181
A 40 year old woman attends your surgery complaining of shooting pains in the 3rd web space of her foot made worse by wearing high heels. You suspect Mortons neuroma.
Name 2 clinical signs you might elicit (2marks each)
Reduced sensation 3rd web space/toes
Intermetatarsal pain on compression
Palpable swelling on nerve
Positive Mulders click
182
A 40 year old woman attends your surgery complaining of shooting pains in the 3rd web space of her foot made worse by wearing high heels. You suspect Mortons neuroma.
Name 2 treatments for this condition (2 marks each)
Adaption shoewear/insole
Steroid injection
Nitrogen freezing
Surgical removal
183
A 50 year old diabetic attends your clinic complaining of heel pain first thing in morning and on walking. You suspect he has plantar fasciitis
Name one potential differential diagnosis
Nerve entrapment syndrome
Arthritis
Calcaneal pathology
184
Name 4 of the traditional treatments used for this condition (2 marks for each) for plantar fasciitis
```
Treatments
Rest, change training
Stretching – Achilles +/- direct stretching
Ice
NSAIDs
Orthoses – Heel pads
Physiotherapy
Weight loss
Injections – corticosteroid Night Splinting
```
185
Name 2 Newer /Third Line treatments for plantar fasciitis ( 2marks for each)
```
Extracorporeal Shockwave therapy
Topaz Plasma Coblation
Nitric Oxide
Platelet Rich Plasma
Endoscopic / Open Surgery
```
186
name 3 muscles that attach to the clavicle
```
Trapezius
Deltoid
Pectoralis Major
Subclavius
Sternocleidomastoid
Sternohyoid
```
187
A 60 year old man falls whilst working in his garden fracturing his left hip. Once he has recovered from the fracture which of the following would be the next step in his management?
1) Reassure him that this is was simply bad luck as men of his age at not at risk of osteoporosis
2) Commence him on bisphosphonate therapy
3) Refer for a bone density scan
4) Advise him to avoid working in the garden
5) Commence calcium and Vitamin D supplements
Refer for a bone density scan
188
A 75 year old man presents with acute sudden onset unilateral headache, scalp tenderness and pain in his jaw on eating on a background of 2-month history of pain and stiffness of the shoulder girdle.
Which of the following investigations would be the most likely to help towards a diagnosis?
```
ESR
Rheumatoid factor (RF)
CT head
Temporal artery biopsy
Anti-neutrophil cytoplasmic antibodies (ANCA)
```
Temporal artery biopsy
189
acute swollen toe in someone with a high BMI and high blood pressure what option is likely to help establish a diagnosis?
```
Serum urate
HLA-B27 status
CRP
Aspirate joint
X-ray foot
```
Aspirate joint
190
A 22 year old female patient presents with 3 month history of stiffness and swelling of the hand joints and new onset right sided sharp chest pain on inspiration. Urinalysis shows microscopic haematuria and proteinuria.
Which of the following immunological tests would support your clinical suspicion?
```
Anti-centromere antibodies
Anti-CCP antibodies
Rheumatoid factor
Anti double stranded DNA antibodies
Anti smooth muscle antibodies
```
Anti double stranded DNA antibodies
191
A 35 year old Asian computer programmer presented to his GP with widespread muscle pain and weakness, and difficulty rising from his chair. His alkaline phosphatase is elevated at 2000 and serum calcium is just below the reference range.
Which of the following tests would be diagnostic for the underlying cause of his problems?
```
Creatinine kinase
Rheumatoid Factor
Ultrasound of his muscles
Vitamin D status
Isotope bone scan
```
Vitamin D status
192
```
In Rheumatoid Arthritis which cells are directly responsible for the loss of articular cartilage?
Macrophages
Synovial fibroblasts
T cells
B cells
Osteoclasts
```
Synovial fibroblasts
193
A 78 year old healthy woman on no medications, presents acutely with a hot, swollen left knee. She was previously well with only mild knee pain on coming down stairs. No other joints are involved. She is struggling to weight bear on her knee.
What is the most likely diagnosis?
```
Rheumatoid arthritis
Psoriatic arthritis
Pseudogout
Trauma
Osteoarthritis
```
Pseudogout
194
```
Which autoantibodies are specific for Rheumatoid Arthritis?
ANA
ENA
Anti-CCP
ANCA
Rheumatoid factor
```
Anti-CCP
195
A 50 year old lady attends her GP. She is concerned that she has osteoporosis as her mother has been diagnosed with this. How should her GP proceed?
Perform a fracture risk assessment
Refer for a bone density scan
Explain that she is too young for osteoporosis and ask her to return in 5 years time
Commence therapy with HRT
Commence calcium and Vitamin D supplements
Perform a fracture risk assessment
196
A 23 year student sees his GP with a several year history back pain and stiffness. The pain is worse at night, first thing in the morning and if he has been sitting for long periods studying. He is otherwise well apart from a previous episode of a red, painful eye for which he received some steroid eye drops. On examination he has a reduced Schobers test and is tender over his right sacroiliac joint.
Which investigation would be most helpful in reaching a diagnosis?
CRP
HLA B27
MRI whole spine
Anti-CCP antibody
Trial of non-steroidal anti-inflammatory medication
MRI whole spine
197
A 67 year old female patient presents with 3 month history of proximal weakness of the upper and lower limbs. She struggles to lift her arms above the shoulder level and to stand from sitting unaided. Her blood tests show elevated ESR at 80 and raised creatine kinase at 5 times the upper limit of normal range.
What is the most likely diagnosis?
```
Polymyalgia rheumatica
Rheumatoid arthritis
Osteoarthritis
Polymyositis
Giant cell arteritis
```
Polymyositis
198
A 30 year old woman is newly diagnosed with rheumatoid arthritis. She has a two year old daughter and is currently trying for another baby. She has synovitis across the MCPs in both hands and has evidence of erosions and joint damage on X-ray.
```
Which of the following treatment options would be best in this case?
Non steroidal anti-inflammatory
Methotrexate
Sulfasalazine
Leflunomide
Paracetamol
```
Sulfasalazine
199
What are women offered as routine screening for Down’s syndrome?
A. Amniocentesis
B. CUB (combined ultrasound/biochemical) screening
C. AFP test
D. Fetal blood sampling
E. Nuchal translucency scan
CUB (combined ultrasound/biochemical) screening
200
2. A 40-year-old, Para 4 with a BMI of 40 presents with leakage of urine on laughing and coughing. All the following are appropriate management steps except: A. Anti-cholinergic medication B. Decrease caffeine intake C. Physiotherapy D. Transvaginal tape E. Weight loss
A. Anti-cholinergic medication
201
3. A woman attends for induction of labour. Certain conditions need to be met before proceeding with induction. Which of the following is a contraindication to induction of labour? A. Cephalic presentation B. Obesity C. Oblique lie D. Previous caesarean section E. Rupture of membranes
C. Oblique lie
202
4. Which of the following drugs is contraindicated in pregnancy? A. Ramipril – an ACE inhibitor B. Labetalol C. Methyldopa D. Magnesium sulphate E. Nifedipine
A. Ramipril – an ACE inhibitor
203
5. In order to prevent rhesus disease in the baby, which women are recommended to receive Anti-D in their pregnancy? A. All rhesus negative women B. All rhesus positive women C. All women D. Rhesus negative women with rhesus positive partner E. Rhesus positive women with rhesus negative partner
A. All rhesus negative women
204
6. A 22-year-old woman is referred to the gynaecology clinic with cyclical pain and dyspareunia. The consultant is concerned that she has endometriosis. What is the best investigation to confirm the diagnosis? A. Barium enema B. CT scan C. Diagnostic laparoscopy D. MRI scan E. Transvaginal ultrasound
C. Diagnostic laparoscopy
205
7. During the menstrual cycle the levels of hormones changes throughout the menstrual cycle. Which hormone has sudden rise in level just before ovulation? A. 17 (OH) Progesterone B. Oestrogen C. LH (Luteinizing hormone) D. Progesterone E. Testosterone
C. LH (Luteinizing hormone)
206
8. A 31-year-old woman presents with severe right sided upper abdominal pain at 34 weeks gestation. She reported normal fetal movements up until now. She has no vaginal bleeding but pain is getting worse. Abdomen is tense and tender. High blood pressure was recorded at her midwife visit. Urine dipstick is normal. What is the most likely diagnosis? A. Cholecystitis B. Placental abruption C. Pre-eclampsia D. Pre term labour E. Urinary infection
B. Placental abruption
207
9. A 73-year-old nulliparous lady presented to the General Practitioner with 3 episodes of unprovoked vaginal bleeding. She is menopausal, obese and diabetic. Her smears were up to date till 60 years of age, the limit for the National Screening programme at that time. She was referred to the hospital by the GP. What is the most probable diagnosis? A. Cervical cancer B. Endometrial cancer C. Ovarian cancer D. Pelvic inflammatory disease E. Rectal cancer
B. Endometrial cance
208
10. A 27-year-old primigravid patient has been admitted at 37 weeks with a 6 hour history of contractions. She is having 2 contractions in 10 minutes and each is lasting 50 seconds. She has had no show and her membranes are intact but she thinks she is in labour. Which one of the following is the best clinical sign to assess if she is in established labour? A. Abdominal examination to assess the descent of the fetal head B. Abdominal examination to assess the strength of the contractions C. Speculum examination to assess cervical dilatation D. Vaginal examination to assess cervical dilatation E. Vaginal examination to assess if the membranes are intact
D. Vaginal examination to assess cervical dilatation
209
11. A parous patient is in established labour and the head is just visible at the introitus. She has had no analgesia. She is pushing well but is screaming for pain relief. What method of pain relief is best for her? A. Epidural anaesthetic B. Entonox C. Morphine D. Spinal anaesthetic E. Supportive care
B. Entonox
210
12. A 26-year-old woman is pregnant with her first baby. She has remained very well during her pregnancy but her haemoglobin has dropped from 13g/dl at 12 weeks to 11g/dl at 28 weeks pregnant. What is the most likely explanation for this? A. Concealed haemorrhage B. Iron deficiency anaemia C. Normal physiological change in pregnancy D. Pernicious anaemia E. Sickle cell disease
C. Normal physiological change in pregnancy
211
13. Considering secondary prevention of cervical cancer in the UK, CIN is diagnosed by: A. Colposcopy B. Cytology C. HPV testing D. Histology E. MRI scan
D. histology
212
14. What is true about pregnant women who are Diabetics? A. They do not suffer from a higher rate of stillbirth B. They have babies who are at risk from neonatal hyperglycaemia C. They need good diabetic control before conception to help prevent anomalies in the baby D. They only suffer complications in the mother as glucose does not cross the placenta and therefore does not harm the baby E. They typically have babies which are smaller than non-diabetic mothers
C. They need good diabetic control before conception to help prevent anomalies in the baby
213
15. A 50-year-old woman has irregular periods and suffering from mood swings and night sweats. She is perimenopausal and wishing to commence on HRT to help her symptoms. Which hormone’s reducing level results in such menopausal symptoms? A. FSH B. LH C. Oestrogen D. Progestogen E. Thyroxine
C. Oestrogen
214
16. The primary prevention of cervical cancer in the UK is performed by:
A. HPV 6 and 11 immunisation B. High risk HPV testing C. HPV 16 and 18 immunisation D. HIV immunisation E. Cervical screening
C. HPV 16 and 18 immunisation
215
17. In the UK National Breast Screening Programme A. The screening target population are women aged between 40 and 70 years of age B. The screening target population are offered primary screening by clinical examination of the breasts C. The screening target population are offered a mammogram every five years D. The screening target population are registered with a GP practice and aged 50-70 years E. The screening target population is anyone with a family history of a first degree relative with breast cance
D. The screening target population are registered with a GP practice and aged 50-70 year
216
18. The pregnant patient should always be nursed in a left lateral position because: A. In the supine position the umbilical cord is compressed by the overlying fetus B. In the supine position the pressure of the gravid uterus on the inferior vena cava causes a reduction in venous return to the heart with a possible 25% reduction in cardiac output C. In the left lateral position there is an increase in functional residual capacity of the lungs D. In the supine position the pressure of the gravid uterus on the aorta reduces blood flow to vital organs by 10% E. Nursing in the left lateral position ensures that blood flow to a posterior placenta is not compromised
B. In the supine position the pressure of the gravid uterus on the inferior vena cava causes a reduction in venous return to the heart with a possible 25% reduction in cardiac output
217
19. Iron deficiency anaemia is by far the commonest cause of anaemia and iron deficiency anaemia is the commonest haematological problem in pregnancy. In pregnancy the following is true A. A pregnancy causes a 10 fold increase in the requirement for iron not only for haemoglobin synthesis but also for certain enzymes and the fetus. B. Because the expansion in plasma volume is greater than the increase in red cell mass there is a fall in haemoglobin concentration, haematocrit and red cell count C. Changes in the coagulation system during pregnancy produce a physiological hypercoaguable state – clotting factors VIII, IX, X decrease and fibrinogen increases D. A woman will not be iron deficient if she has a normal haemoglobin and MCV (mean cell volume) E. All women planning a pregnancy should be advised to take 400mcg folate periconceptually and up until 12 weeks gestation to prevent megaloblastic anaemia
B. Because the expansion in plasma volume is greater than the increase in red cell mass there is a fall in haemoglobin concentration, haematocrit and red cell count C
218
20. A 33 year old para 1+2 presents to the antenatal clinic at 9+ weeks gestation. From this, what do we know about this woman’s obstetric history? A. This is her 2nd pregnancy B. This is her 4th pregnancy and she has one child who is alive and well C. This is her 4th pregnancy and she has had 2 miscarriages D. This is her first pregnancy E. This is her 4th pregnancy and she had 2 previous early pregnancy losses
E. This is her 4th pregnancy and she had 2 previous early pregnancy losses
219
21. Women are seen by a midwife for a booking appointment when they are offered screening for certain infections. Which of the following infections are women NOT routinely offered at booking? A. Hepatitis B B. Human immunodeficiency virus (HIV) C. Sickle cell D. Thalassaemia E. Varicella (chicken pox
E. Varicella (chicken pox)
220
22. A 22 year old woman attends her GP requesting emergency contraception. She has a regular 28 day menstrual cycle and this is day 15. She reports unprotected intercourse 78 hrs ago. Which is the most effective option for this woman? A. Emergency copper intrauterine device B. Levonelle C. Mifepristone D. Mirena levonorgestrel intrauterine system E. Ulipristil acetate
A. Emergency copper intrauterine device
221
A 35 year primigravid patient at 36 weeks gestation is noted to have a blood pressure of 160/98 at routine community antenatal check. Which of the following additional findings would be diagnostic of pre eclampsia? A. Excessive weight gain B. Oedema C. Parasthesia D. Proteinuria E. Visual disturbance
D. Proteinuria
222
.A women presents with vaginal bleeding and lower crampy abdominal pain at approximately 9 weeks gestation. Her observations are stable. Speculum examination reveals blood and small clots coming through the open cervical os. Which of the following is the most likely diagnosis? A. Complete miscarriage B. Ectopic pregnancy C. Inevitable miscarriage D. Pelvic infection E. Threatened miscarriage
C. Inevitable miscarriage
223
A 28 year old woman is seen at the infertility clinic. She has irregular periods and a diagnosis of polycystic ovarian syndrome (PCOS). Her partner’s semen analysis is normal. The decision is made to commence on ovulation stimulation. Which one of the following drugs would be the best option? A. Clomiphene B. Danazol C. Decapeptyl SR D. Dianette E. Follicle stimulating hormones (FSH)
A. Clomiphene
224
1) a healthy 14 month old boy, born at term, presents for routine assessment with his health visitor.
Assuming normal development, up to what milestones/ skills is he likely to have attained?
a) Rolling, reaching, smiling
b) Running, scribbling with a crayon, using simple sentences
c) Sitting, transferring bricks, 2 syllable babble
d) Taking steps, pincer grasp, saying 1-2 words with meaning
e) Walking up stairs, circular scribbles, saying 30-50 words
Taking steps, pincer grasp, saying 1-2 words with meaning
225
a healthy 14 month old boy, born at term, presents for routine assessment with his health visitor.
Assuming a normal UK immunisation schedule, which of the following conditions will he not have been immunised against?
```
Chicken Pox
Haemophilus Influenzae Type B
Meningococcal Disease Type B
Polio
Tetanus
```
chicken pox
226
A healthy baby girl is born at term via forceps delivery. She is noted to have several small irregular, flat, pink, blanching marks on her left upper eyelid and just below the hair line on the posterior aspect of her neck.
```
diagnosis?
Capillary naevi
Delivery related bruising
Epsteins Pearls
Melanotic naevi
Mongolian spot
```
Capillary naevi
227
A healthy girl is seen for routine review by their health visitor. She can pull herself to stand but does not walk independently. She has a pincer grasp but doesn’t stack bricks or hold a crayon. She has polysyllabic babble and 2 specific words. She will push food to her mouth and is able to waive bye-bye and seems comfortable with strangers.
age?
```
3 Months
7 Months
11 Months
15 Months
19 Months
```
228
A baby girl is born at 41 weeks gestation weighing 3.2kg. She develops apnoeas on the postnatal ward and has temperature instability. She is admitted to neonatal intensive care. Gram negative bacilli are identified in blood and CSF cultures
```
What pathogen is most likely to be responsible for this girl’s symptoms?
Escherichia-coli
Group B Streptococcucs
Klebsiella pneumoniae
Neisseria meningitidis
Pseudomonas aeruginosa
```
Escherichia-coli
229
A baby boy is born at 26 weeks gestation. He is intubated and ventilated for respiratory distress syndrome and transferred to an incubator. His fist recorded temperature is 35.5OC.
Which of the following is an adverse effect of cold stress on a neonate?
```
Decreased energy expenditure
Decreased oxygen consumption
Decreased surfactant production
Metabolic alkalosis
Pulmonary hypotension
```
Decreased surfactant production
230
A baby boy is born at 26 weeks gestation. He is intubated and ventilated for respiratory distress syndrome and transferred to an incubator. His fist recorded temperature is 35.5OC.
Which of the following is not a typical associated complication of extreme preterm delivery?
```
Brocho-Pulmonary Dysplasia
Intra-Ventricular Haemorrhage
Necrotising Enterocolitis
Neonatal Abstinence syndrome
Patent Ductus Arteriosus
```
Neonatal Abstinence syndrome
231
. A 3 week old breast fed Italian baby girl, born at term, presents for assessment of jaundice. Her jaundice was most visible on day 4 and is still present on her nose and conjunctivae. She has pale yellow urine and yellow-brown stools. Her investigations show a serum bilirubin of 150 micromols/l (Normal 5-40)- 5% of which is conjugated. Her haemoglobin and blood film are normal.
what is the diagnosis?
ABO Incompatibility
Congenital biliary atresia
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
Prolonged physiological jaundice/ Breast Milk Jaundice
Rhesus Incompatibility
Prolonged physiological jaundice/ Breast Milk Jaundice
232
A 9 month old baby presents with 2 days of increasing episodic distress. She is described as looking very pale during these with colour returning to normal afterwards. She has had 3 vomits today that were described as “green.” She has had no stools for 36h. A small mass can be felt in her right iliac fossa.
```
diagnosis?
Intussusception
Malrotation
Pyloric stenosis
Tetralogy of Fallot
Urinary Tract infection
```
Intussusception
233
A 2 year old boy presents to primary care with a 2 day history of cough and runny nose. On further questioning he has a 6 month history of foul smelling stools, food refusal and lethargy. His weight has dropped from the 50th to the 2nd centile over the last 12 months.
diagnosis
```
Coeliac disease
Constipation
Failure to thrive
Food refusal of toddlerhood
Psychosocial deprivation
```
coeliac disease
234
A 4 y old boy presents after his parents noticed “red stuff” in his urine and were concerned this was blood. He has had a recent upper respiratory tract infection. Mothers grandfather had a “kidney problem” but is not sure what type.
```
Which of the following is not typically associated with macroscopic haematuria?
IgA Nephropathy
Minimal Change Nephrotic Syndrome
Post Infectious Glomerulonephritis
Renal angle trauma
Wilm’s Tumour
```
Minimal Change Nephrotic Syndrome
235
13. A 10 year old girl is referred for assessment of short stature
Which of the following is not associated with short stature in girls?
```
Coeliac disease
Hypothyroidism
Klinefelter’s Syndrome
Prader Willi Syndrome
Turner’s Syndrome
```
Klinefelter’s Syndrome
236
A 13 year old boy presents with a 2 month history of right sided limp and knee pain whilst exercising. There is no fever and he is otherwise well. Examination shows limited internal rotation of his right hip. His full blood count and ESR are normal
diagnosis
```
Congenital hip dysplasia
Perthe’s disease
Reactive arthritis
Septic arthritis
Slipped upper femoral epiphysis
```
Slipped upper femoral epiphysis
237
15. A 12y girl attends hospital for the first time for assessment of short stature. Subsequent investigation reveals a 45XO karyotype.
What abnormality may be identified following further assessment and investigation?
```
Bilateral renal agenesis
Coarctation of the aorta
Duodenal atresia
Imperforate anus
Transposition of the great arteries
```
Coarctation of the aorta
238
A 5y old boy has recently presented to the ward with an abdominal mass. Further investigation reveals a probable neuroblastoma. He is started on chemo therapy. Subsequent blood tests identify elevated blood levels of urea, creatinine, potassium, phosphate and urate.
correct for IV fluid managment?
Fluid Excess (Hyper-hydration, 2.5l/m2) is necessary
Fluid restriction (Hypo-hydration, 0.1l/m2) is necessary
He should receive oral rehydration solution only
Potassium should be infused slowly with his IV fluids
Potassium should be infused quickly with his IV fluids
Fluid Excess (Hyper-hydration, 2.5l/m2) is necessary
239
17. A 4 month old baby boy presents with worsening respiratory distress secondary to bronchiolitis.
Relative to an adult what anatomical or physiological factor must be considered in this boy when planning his clinical care?
```
Decreased chest wall compliance
Fewer type 1 respiratory muscle fibres
Higher systemic vascular resistance
Larger area for air tissue interface
Smaller surface area to weight ratio
```
Fewer type 1 respiratory muscle fibres
240
A 12-month-old girl presents to primary care with a 3 day history of sneezing, runny nose and cough. She has a temperature of 37.8OC, mild sub-costal recession and bilateral wheeze with scattered crepitations. She has bilateral pink tympanic membranes and mildly erythematous fauces.
Tx?
```
Intravenous Cefotaxime
Intravenous Benzlypenicillin
No Medical therapy
Oral Amoxicillin
Oral Trimethoprim
```
none
241
A 12 month old girl presents to A+E with fever, vomiting lethargy and a non-blanching rash. She is pale, clammy and peripherally shut down. It is decided to initiate immediate antibiotic therapy.
What weight should be estimated to guide initial treatment?
```
5kg
10kg
15kg
20kg
25kg
```
B. 10kg
242
A 4-year-old boy is brought in to the Accident and Emergency department following a witnessed episode of choking. He is unconscious with no evidence of any respiratory effort or cough.
appropriate action?
Administer 5 back blows
Administer 5 abdominal thrusts
Administer 15 chest compressions
Encourage cough and continue to check for deterioration
Open the airway and administer 5 rescue breaths
Open the airway and administer 5 rescue breaths
243
A male child is found to have an injury.
Which of the following does NOT suggest non-accidental injury?
A 3 hour old baby with a clavicle fracture
A 3 week old baby with a bruise on the right ear
A 6 week old baby with a torn frenulum
A 3 month old infant with a humeral fracture
A 3 month old infant with a rib fracture
A 3 hour old baby with a clavicle fracture
244
. A 9 month old girl is admitted following a febrile UTI. She is treated with IV antibiotics. The consultant wants to know if she will develop renal scarring.
Which the following investigations would be most useful for this?
```
Abdominal Computerised Tomography (CT)
DMSA (Isotope scan)
MAG3 Renogram
Micturating Cystourethrogram (MCUG)
Renal Ultrasound
```
DMSA (Isotope scan)
245
A 3 day old baby presents with bilious vomiting for 2 days. Examination shows she is lethargic. Her heart rate is 180. She has cold peripheries and a respiratory rate of 70.
Which is the most appropriate type of fluid to use immediately?
0.45% Sodium Chloride + 5% Dextrose with potassium
0.45% Sodium Chloride + 5% Dextrose without potassium
0.9% Sodium Chloride without potassium
5% Dextrose with potassium
10% Dextrose with potassium
0.9% Sodium Chloride without potassium
246
A 6y old boy is being reviewed on the ward round after presenting the previous day following a first afebrile generalised tonic-clonic seizure. He has fully recovered and is currently playing. His blood sugar was not checked on arrival
Which of the following is correct regarding further investigation?
A blood sugar should be performed immediately
A normal EEG excludes epilepsy
An ECG should be performed before discharge
Blood for genetic and metabolic studies should be sent
Performing an EEG will be diagnostic for epilepsy
An ECG should be performed before discharge
247
A 4y old girl who is a type 1 diabetic is noticed to be pale, quiet and complaining of being dizzy. Her parents check her blood glucose and note it to be 2.9 mmol/l
Which of the following would not be appropriate initial treatment?
```
3-6 Lucozade glucose tablets
50g of Dairy Milk Chocolate
120ml of (New) Lucozade
60ml of Berry Burst Glucojuice
100ml of Apple Juice
```
50g of Dairy Milk Chocolate
248
```
The main muscle group that provides plantar flexion of the foot is:
Plantaris
Tibialis anterior
Flexor digitorum longus
Gastronemius/Soleus
Flexor hallucis longu
```
Gastronemius/Soleus
249
Name three groups of individuals involved in the clinical management of osteoarthritis (2 marks each)
```
Physiotherapist
Orthopaedics
Nurses
Dieticians
Physicians
Occupational therapist
```
250
Name two pharmacological treatments for patients with osteoarthritis (2 marks each)
```
Oral analgesia (Paracetamol, NSAIDs)
Topical treatments (NSAIDs, Capsaicin but for knee and hand)
```
251
Name two non-pharmacological treatments for patients with osteoarthritis (2 marks each)
```
Thermotherapy
Electrotherapy
Aids and devices
Manual therapy
Non-NICE : Acupuncture
```
252
Name 2 Static constraints of the knee (2 marks each)
```
Collateral ligaments
ACL/PCL
Capsule
ITB (iliotibial band)
Meniscii
```
253
Name 2 Dynamic constraints of the knee (2 marks each)
Quadriceps
Hamstrings
Medial and lateral gastrocemius
popliteus
254
A young netball player lands awkwardly after receiving the ball. A sharp pain and a “pop” is felt in the knee. The joint is seen to swell rapidly over the next 30 minutes. The cause of the swelling is most likely to be: (2 marks)
Haemarthrosis (fracture/rupture ACL/peripheral meniscal tear)
255
Asking a patient to perform a straight leg raise as part of the examination of an injured knee is important. A successful manoeuvre by the patient will indicate: (2 marks)
an intact extensor mechanism of the knee
256
Salter-Harris is the classification system for
epiphyseal injuries
257
What are the symptoms, signs or tests used in the diagnosis of SUFE . Name 3 ( 1 mark each)
Pain in hip or knee, externally rotated posture hip & gait
Reduced internal rotation of hip, especially in flexion
Plain X-Rays showing SUFE
258
What is the treatment of SUFE? ( 2 marks)
Surgical fixation +/- reduction
259
Hallux ValgusName Four treatments that can be used for Hallux Valgus
```
Non operative
Shoe wear modofocation
Orthotics
Activity modification
Analgesia
```
2. Operative
- Release lateral soft tissues
