Mock MLAs

Question 1

Anal fissure - what to do if conservative (including topical GTN) management doesn’t work?

Answer 1

Sphincterotomy

Question 2

Tachyarrhythmia + adverse feature (shock, syncope, myocardial ischaemia or heart failure)

Answer 2

DC cardioversion

Question 3

Cushing’s reflex/triad in raised ICP =

Answer 3

Bradycardia
Wide pulse pressure (hypertension)
Irregular respirations (Cheyne-Stokes respirations)

• indicates raised ICP and potential brain herniation

Question 4

Pansystolic murmur + soft S1 =

Answer 4

Mitral stenosis

Question 5

Is vancomycin only given orally?

Answer 5

Only given orally in C. difficile infection, otherwise can be given IV

Question 6

What is secondary hyperparathyroidism?

Answer 6

Physiological elevation of PTH levels in response to hypocalcaemia.

• commonly due to renal failure or vitamin D deficiency.

Question 7

What is tertiary hyperparathyroidism?

Answer 7

PERSISTENT

End-stage renal failure

• thought to be due to prolonged secondary hyperparathyroidism which results in the inappropriate continued release of PTH despite normalisation of calcium levels

Question 8

Key diagnostic test in Guillain-Barre syndrome?

Answer 8

Lumbar puncture

• elevated protein with normal white cell count

Question 9

Broca’s area is found in which lobe?

Answer 9

Frontal lobe

B comes before W so it’s at the front

Question 10

Wernicke’s area is found in which lobe?

Answer 10

Temporal lobe

Question 11

Medical therapy to prevent angina attacks?

Answer 11

CCB +/- beta blocker

Question 12

Exudative vs transudative PE ?

Answer 12

Things that aren’t meant to be there = exudative
Failures e.g. heart, liver, kidney = transudative

EXudative = EXtra protein
Pleural fluid with a protein level >30g/L = exudative

Question 13

All men with erectile dysfunction should have what checked?

Answer 13

Morning testosterone

Question 14

What medication to avoid in myasthenia gravis?

Answer 14

Beta-blockers

Question 15

Triangle of safety for chest drain insertion =

Answer 15

Base of axilla, lateral pectoralis major, 5th intercostal space, anterior latissimus dorsi

Question 16

How long before results are seen when using finasteride for BPH ?

Answer 16

6 months

Question 17

Potassium fluid requirement per day = ?

Answer 17

1 mmol/kg/day

Question 18

Medical management of pregnant women who smoke ?

Answer 18

Nicotine replacement therapy only

• Varenicline and bupropion are contraindicated

Question 19

What is Hartmann’s procedure ?

Answer 19

Sigmoid colectomy and formation of end stoma

• usually used in emergencies, e.g. bowel obstruction or perforation

Question 20

What surgical procedure is used to defunction the colon to protect an anastomosis?

Answer 20

Loop ileostomy

(it is reversible)

Question 21

In COPD, when is LTOT indicated?

Answer 21

pO2 of 7.3 - 8 kPa

AND one of the following:
- secondary polycythaemia
- peripheral oedema
- pulmonary hypertension

Question 22

Severe alcoholic hepatitis management = ?

Answer 22

Prednisolone

Question 23

Acute management of insulin in DKA = ?

Answer 23

Fixed-rate insulin infusion (0.1units/kg/hour)

Continue long-acting insulin
STOP short-acting insulin

Question 24

Scoring systems for upper GI bleeds

Answer 24

Glasgow-Blatchford = what management? (Glasgow = schemey)

Rockall = Recurrence

Question 25

Rolled, pearly edges + telangiectasia = ?

Answer 25

Basal cell carcinoma

Question 26

Isolated motor loss (hemiplegia) on left side = ?

Answer 26

Right-sided lacunar stroke

Question 27

Stroke management + times =

Answer 27

Within 4.5 hours: Thrombolysis with Alteplase, followed 24 hours later by aspirin 300mg After 4.5 hours: No thrombolysis; just give Aspirin 300mg

Question 28

Left temporal lesion = which visual field defect ?

Answer 28

PITS Right SUPERIOR homonymous quadratanopia

Question 29

MUST score =

Answer 29

Assessment of nutritional status

Question 30

Lung white-out on CXR: how to differentiate between pleural effusion vs lung collapse

Answer 30

Look for tracheal deviation

Question 31

Memantine vs donepezil drug class

Answer 31

Memantine = NDMA antagonist (memandy) Donepezil = Acetylcholinesterase inhibitor

Question 32

CRVO vs CRAO ?

Answer 32

CRVO = sudden painless loss of vision, severe retinal haemorrhages on fundoscopy CRAO = sudden painless loss of vision, cherry-red spot at the fovea

Question 33

COPD standby medication (to keep at home)

Answer 33

Prednisolone and an antibiotic

Question 34

Overactive bladder medication

Answer 34

Oxybutynin

Question 35

Hepatitis serology :

Answer 35

HbsAg - acute/chronic ongoing disease IgM anti-HBc - acute disease IgG anti-HBc - previous or current infection anti-HBs - immunity

Question 36

HBsAg positive, IgM anti-HBc positive, IgG anti-HBc positive anti-HBs negative

Answer 36

Acute infection

Question 37

HBsAg positive/negative, IgM anti-HBc negative IgG anti-HBc positive anti-HBs negative

Answer 37

Chronic infection

Question 38

Anti-HBs positive ?

Answer 38

Immune

Question 39

Which blood abnormality is caused by prednisolone?

Answer 39

Neutrophilia

Question 40

Which drug to treat delirium in Parkinson's patient?

Answer 40

IM lorazepam

Question 41

TIA + patient is on an anticoagulant or has a bleeding disorder ?

Answer 41

Perform CT head to exclude haemorrhagic stroke