Mock Paper questions

Question 1

What is CHADS VASc made up of and what is it used for

Answer 1

CHADS-VASc is used to calculate stroke risk and anticoagulation need in patients with AF
CHADS VASC= Congestive HF, Hypertension, Age (+75), Diabetes, Stroke/TIA/THromboembolism
Vascular disease, Age (65-74), Sex Category (female= 1)

Question 2

state the pulse for 
a- aortic regurgitation 
b- atrial fibrillation 
c- pulsus paradox 
d-  radio-radial delay

Answer 2

a- collapsing pulse
b- irregularly irregular
c- rapid drop in BP during inspiration seen in Asthma, COPD, blood loss etc
d- pulse significantly stronger in one arm than the other, seen in coarctation of aorta

Question 3

heart sounds for 
a- aortic regurgitation 
b- aortic stenosis 
c- mitral regurgitation 
d- mitral stenosis 
e- pulmonary stenosis

Answer 3

a- early diastolic decrescendo murmur (and collapsing pulse)
b- ejection systolic crescendo decrescendo murmur
c- apical pansystolic murmur
d- apical mid diastolic rumble
e- ejection systolic murmur heard loudest on inspiration

Question 4

first line of hypertension treatment for
a- patient under 55
b- patient over 55
c- patient who is afro-carribbean

Answer 4

a- ace inhibitor (rampiril) or ARB (candesartan)

b and c- calcium channel blocker (amlodipine)

Question 5

4 features of tetralogy of fallot

Answer 5

ventricular septal defect
pulmonary stenosis
hypertrophy of right ventricle
overriding aorta

Question 6

what are the clinic readings for the stages of hypertension?

Answer 6

stage 1= >140/90
stage 2= >160/100
stage 3 (severe)= 1>80/110

Question 7

what are the distinctive signs of endocarditis

Answer 7

splinter haemorrhages
osler's node
janeaway lesions
roth spots 
fever

Question 8

what is xanthelasma and when would you see it

Answer 8

lipid deposits around the eyes, seen in dyslipidemia (too much lipid in bloodstream)

Question 9

differential/typical presentations of: 
a- Coeliac disease 
b- IBS 
c- Crohn's 
d- Ulcerative colitis 
e- Infective gastroenteritis

Answer 9

a- pale smelly stools which are hard to flush away, generalised abdominal pain and bloating, diarrhoea and weight loss

b- general abdominal pain which gets better after passing wind/defecation, bloating and changes in bowel habits

c- pain on right side of badomen along with bloody stools and other features such as mouth ulcers

d- pain in lower left quadrant (UC only affects the colon) and blood and mucus in the stool

e- Diarrhoea and abdominal pain + signs of infection e.g. foreign travel, fever and vomiting

Question 10

first and second line medication for GORD

Answer 10

first line= PPI e.g. omeprazole

second line= H2 antagonists e.g. Ranitidine

Question 11

sulfasalazine use

Answer 11

treatment of ulcerative colitis

Question 12

symptoms of peptic ulcer rupture

Answer 12

epigastric pain, pain eating/when hungry, pain relieved by eating, medication use e.g. NSAIDs

Question 13

4 ways H pylori affects acid secretion in the stomach

Answer 13

1- causes G cells to release more gastrin
2- triggers release of histamine which causes more acid secretion
3- increases parietal cell mass- more gastric acid production (HCl)
4- decreases somatostatin release from D cells- more acid secretion

Question 14

how does h pylori cause peptic ulcers

Answer 14

h pylori secrets urease which splits urea in stomach into CO2+ and ammonia.
Ammonia and H+ = ammonium
Ammonium, proteases, phospholipases and vacuolating cytotoxin A damage gastric epithelium. Causes inflammatory response, reducing mucosal defence and causing mucosal damage

Question 15

how does recurrent NSAID use cause peptic ulcers

Answer 15

mucus secretion is stimulated by prostaglandins, and COX-1 is needed for prostaglandin synthesis. NSAIDs inhibit COX-1 -> less mucus secretion -> reduced mucosal defence

Question 16

presentation for small bowel obstruction

Answer 16

intermittent colicky pain
early onset vomiting
some abdominal distension

Question 17

presentation for large bowel obstruction

Answer 17

continuous abdominal pain
pain lower down the abdomen e.g. in Left iliac fossa
vomiting
marked abdominal distension

Question 18

first line investigation for bowel obstruction

Answer 18

x ray abdomen

Question 19

duodenal ulcer symptoms and how is it different from peptic ulcers?

Answer 19

duodenal ulcers cause abdominal pain several hours after eating due to the presence of acid from the stomach in the duodenum. pain caused by gastric ulcers is relieved by eating

Question 20

inflammation- differences between ulcerative colitis and crohn’s

Answer 20

Ulcerative colitis; continuous inflammation from the rectum to the ileocecal valve, does not extent proximal to the ileocecal valve. Smoking is protective

Crohn’s: anywhere in the gastrointestinal tract, skip lesions, trasmural inflammation cobblestone appearance. Smoking is a risk factor

Question 21

gold standard investigation for bowel cancer

Answer 21

colonoscopy

Question 22

which of proximal/distal colon cancer is

• more common
• more dangerous

Answer 22

• distal more common

- proximal more dangerous

Question 23

is pANCA raised in UC or Crohn’s?

Answer 23

pANCA (anti-neutrophilic cytoplasmic antibody) is always negative in Crohn’s but may be positive in Ulcerative colitis

Question 24

What might investigation results show in crohn’s disease?

Answer 24

• Raised ESR and CRP (IBD)

- Iron and folate deficiency anaemia- commonly due to malabsorption

Question 25

4 causes of AKI

Answer 25

1 acute tubular necrosis- most common cause, tubular epithelial cells die impairing kidney ability to filter waste products 2- nephrotoxins- cause intrinsci/renal AKI, kidneys are directly damaged impairing their ability to function 3- prostate hyperplasia- causes post-renal AKI; urinary tract is obstructed, increasing intra-tubular pressure and decreasing GFR and thus increasing urea and creatinine remaining in the blood 4- sepsis- prerenal cause of AKI; bp falls leading to renal hypoperfusion and decreased GFR which causes a rise in serum urea and creatinine

Question 26

what are the GFRs for the different stages of CKD?

Answer 26

stage 1- >90ml/min with evidence of renal damage stage 2- 60-89 ml/min with evidence of renal damage stage 3a- 45-59 ml/min with/without renal damage stage 3b- 30-44 ml/min with/without renal damage stage 4- 15-29 ml/min with/without renal damage stage 5- <15ml/min, established renal failure

Question 27

5 organisms which cause pyelonephritis and the most common one

Answer 27

coagulase negative staph, enterococcus, e.coli (most common), Klebsiella, proteus

Question 28

best investigation in the management of pyelonephritis

Answer 28

midstream urine microscopy, culture and sensitivity

Question 29

characteristic symptoms of chronic prostatitis

Answer 29

pelvic or perineal pain lasting longer than 3 months is the key symptom. Also trauma causing nerve damage in the lower urinary tract is a risk factor for chronic prostatitis.

Question 30

which UTI drug is teratogenic and which is first line in pregnancy?

Answer 30

trimethoprim can be teratogenic, nitrofurantoin is first line in pregnant women

Question 31

what is retiers syndrome? what is the reiters triad?

Answer 31

reactive arthritis. triad is conjunctivitis, urethritis and arthritis

Question 32

4 possible complications of polycystic kidney disease

Answer 32

1- PKD causes hypertension, which can result in cardiovascular disease. 2- Kidney stones may form in those with PKD as urine travels more slowly in the kidneys of these patients allowing more time for stones to develop. 3- Polycystic liver disease can occur as people with PKD develop cysts in other organs. 4- PKD is associated with Berry’s aneurysms and if they rupture results in a subarachnoid haemorrhage.

Question 33

What are the stages of the Ann Arbor staging system?

Answer 33

I Confined to single lymph node region. II Involvement of two or more nodal areas on the same side of the diaphragm. III Involvement of nodes on both sides of the diaphragm. IV Spread beyond the lymph nodes, e.g. liver or bone marrow. Each stage is either ‘a’—no systemic symptoms other than pruritus; or ‘b’—presence of b symptoms: loss of appetite, weight loss and drenching night sweats.

Question 34

treatment for DVT

Answer 34

acute management with a LMWH (e.g. deltaparin) or Fondaparinux followed by maintenance treatment for 6 months with an oral anticoagulant (e.g. warfarin)

Question 35

describe the mechanism of action and uses for - rituximab - trastuzumab - adalimumab

Answer 35

- rituximab is a monoclonal antibody used to treat non-hodgkin lymphoma, chronic lymphocytic leukemia etc. Rituximab stcks to CD20 proteins on the surface of B Cells and immune cells then pick them out and kill them - Adalimumab is a biological disease modifier used to treat rheumatoid arthritis and other chronic conditions mediated by tnf-alpha, inhibiting its actions. also used in the treatment of psoriatic arthritis, ankylosing spondylitis - Trastuzumab is a targeted cancer drug which treatds cancers with a large amount of the protein human epidermal growth factor receptor 2 (HER2) e.g. early breast cancer, advanced breast cancer and stomach cancer.

Question 36

Malaria treatment - uncomplicated - severe/complicated - second line severe/complicated

Answer 36

- uncomplicated = chloroquine - severe/complicated= IV artesunate - 2nd line severe/complicated= IV quinine and doxycycline

Question 37

- transferrin- job | - ferritin- jon

Answer 37

- ferritin= mainly in body cells, with little circulating in blood. Protein that stores iron and releases it when your body needs it - transferrin is a protein which combines with ferritin to transport it to where new blood cells are made

Question 38

4 signs of liver failure

Answer 38

- asterixis (liver flap) - dupuytren's contractures (progressive shortening and thickening of the palmar fascia causing finger contractures) - leukonychia (white nails) - spider naevi (small swollen blood vessels beneath the skin)

Question 39

GET SMASHED- pancreatitis causes?

Answer 39

gall stones, ethanol excess, trauma, steroids, mumps, autoimmunity, scorpion venom, hyperlipidemia (or hypercalcaemia/hypothermia), ERCP and drugs

Question 40

4 common signs of an upper GI bleed

Answer 40

coffee ground vomit (haematemesis) hypotension Malaena (black stools) tachycardia

Question 41

first line treatment for alcohol withdrawal

Answer 41

Chlordiazepoxide

Question 42

Wernickes encephalopathy is caused by a deficiency in vitamin

Answer 42

B1 (thiamine)

Question 43

Folate and vitamin D deficiencies are common causes of

Answer 43

macrocytic anaemia