MOCK SAQs Flashcards by Erin Dunn

15 year old girl presents to A+E with vomiting, drowsiness, and Kussmaul’s
respirations. Doctors suspect she has diabetic ketoacidosis.

Name two tests required for the diagnosis of DKA and the results required?

Blood glucose = >11.1mmol/l
Plasma ketones = > 3mmol/l 
Ketonuria = >2+ on dipstick 
Venous pH <7.35
HCO3- = <15.0mmol/l

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15 year old girl presents to A+E with vomiting, drowsiness, and Kussmaul’s
respirations. Doctors suspect she has diabetic ketoacidosis.

What is the first line of treatment for this patient?

IV fluids

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15 year old girl presents to A+E with vomiting, drowsiness, and Kussmaul’s
respirations. Doctors suspect she has diabetic ketoacidosis.

What disease is DKA a hallmark sign of?

Type 1 diabetes meillitus

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15 year old girl presents to A+E with vomiting, drowsiness, and Kussmaul’s
respirations. Doctors suspect she has diabetic ketoacidosis.

Name 3 risk factors for DKA?

Stopped insulin
Infection
Pancreatitis
Undiagnosed T1DM
MI
Surgery

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15 year old girl presents to A+E with vomiting, drowsiness, and Kussmaul’s
respirations. Doctors suspect she has diabetic ketoacidosis.

Name 3 complications of DKA?

Hypotension
Coma
Cerebral oedema
Hypothermia
Death
DVT
Pneumonia

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76 year old female patient arrives in A+E, presenting with chest pain and a history of
previous MI, diabetes mellitus type 2 and hypertension. Their BMI is 32 kg/m^2 and
they have 3 children.

What aspect of their chest pain differentiates pericarditis and an MI?

Does NOT radiate to the teeth and jaws in pericarditis

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76 year old female patient arrives in A+E, presenting with chest pain and a history of
previous MI, diabetes mellitus type 2 and hypertension. Their BMI is 32 kg/m^2 and
they have 3 children.

Name 4 features elicited on clinical examination that would may you suspect pericarditis?

Pericardial rub
Sinus tachycardia
Fever
Effusion signs

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76 year old female patient arrives in A+E, presenting with chest pain and a history of
previous MI, diabetes mellitus type 2 and hypertension. Their BMI is 32 kg/m^2 and
they have 3 children.

What would you expect on an ECG of a pericarditis patient?

Saddle shaped ST elevation

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76 year old female patient arrives in A+E, presenting with chest pain and a history of
previous MI, diabetes mellitus type 2 and hypertension. Their BMI is 32 kg/m^2 and
they have 3 children.

How long should colchichine be given for patients who what had acute pericarditis?

6-8 weeks

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76 year old female patient arrives in A+E, presenting with chest pain and a history of
previous MI, diabetes mellitus type 2 and hypertension. Their BMI is 32 kg/m^2 and
they have 3 children.

Whist in hospital she develops AF, from into in chadvasc what should be done?

76 = 1 
T2DM = 1
HTN = 1 
Female = 1 
Previous MI = 1 
chadvasc = 5 
anticoagulate

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A patient has just had a biopsy of their lymph node due to suspected lymphoma.

What cells would you expect to find on microscopy of a Hodgkins lymphoma?

Reed-sternberg cells

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A patient has just had a biopsy of their lymph node due to suspected lymphoma.

Patient is diagnosed with Non Hodgkins lymphoma - what lymphocyte is affected?

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A patient has just had a biopsy of their lymph node due to suspected lymphoma.

Upon taking history the patient has human herpes virus, which is associated with NHL?

Epstein Barr virus

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A patient has just had a biopsy of their lymph node due to suspected lymphoma.

The patient has all three B symptoms - what are they?

Fever
Weight loss
Night sweats §

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A patient has just had a biopsy of their lymph node due to suspected lymphoma.

The patient has pancytopenia - define this?

Deficiency of all blood cells
RBC
WBC
platelets

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A patient presents to their doctor with a history of foreign travel, nausea, fever,
malaise, and is mildly jaundiced. You suspect that they have viral hepatitis.

Which form of viral hepatitis is a notifiable disease and to whom should it be reported?

Hepatitis A, public health england

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A patient presents to their doctor with a history of foreign travel, nausea, fever,
malaise, and is mildly jaundiced. You suspect that they have viral hepatitis.

Upon a blood test it is found that the patient has Hep B, what was present in the blood to diagnose this?

HBsAg OR antiHB antibody

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A patient presents to their doctor with a history of foreign travel, nausea, fever,
malaise, and is mildly jaundiced. You suspect that they have viral hepatitis.

How is hep B transmitted?

Blood

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A patient presents to their doctor with a history of foreign travel, nausea, fever,
malaise, and is mildly jaundiced. You suspect that they have viral hepatitis.

Why is hepatitis D only able to cause disease in those with hep B?

Incomplete RNA - needs hep B to assemble

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A patient presents to their doctor with a history of foreign travel, nausea, fever,
malaise, and is mildly jaundiced. You suspect that they have viral hepatitis.

Name three management for acute hep B?

Avoid alcohol
Vaccinate contacts
Monitor liver function

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A 30 year old woman presents to her doctor with fatigue, joint pain, and mouth
ulcers, and photosensitivity. It is found upon testing and further examination that
she has systemic lupus erythematosus (SLE).

Name a gene associated with an increased risk of SLE?

HLA 88
HLA DR2
HLA DR3

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Name four features of SLE that are required for clinical diagnosis?

A RASH POINTS AN MD

Arthritis 
Renal disorder 
ANA+ 
Serositis 
Haematological disorder
Photosentitivity 
Oral ulcers
Immunological disorder
Neurological disorder
Malar rash 
Discoid rash

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What are two lifestyle changes that can be performed by the patient to reduce symptoms?

Decrease sunlight expose
Wear high factor sunblock
Decrease CVS risk factors

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What medications should be given for an acute SLE attack and what route should they be given?

IV Cyclophosphamide and prednisolone

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A 35 year old male presents to the sexual health clinic having just changed sexual partners for a STD check. The results show that he is HIV positive. Other than sex, how can HIV be transmitted?

Mother to child IV needles Contaminated blood/oragns

A 35 year old male presents to the sexual health clinic having just changed sexual partners for a STD check. The results show that he is HIV positive. What type of virus is HIV?

Retrovirus subgroup lentivirus

A 35 year old male presents to the sexual health clinic having just changed sexual partners for a STD check. The results show that he is HIV positive. Untreated this patient will progress to AIDS, what CD4 count is the defining level for an AIDs diagnosis?

<200ul

A 35 year old male presents to the sexual health clinic having just changed sexual partners for a STD check. The results show that he is HIV positive. What is the overall name for treatment given to HIV patients and what subgroups of medications are given - write in gull

HAART - highly active antiretroviral therapy NRTI - nucleoside reverse transcriptase inhibitors

Patient presents to GP with severe polyuria and polydipsia. What aspect on a urine dipstick would indicate that the patient has DI not DM?

Glucose negative

Patient presents to GP with severe polyuria and polydipsia. The patient is diagnosed with DI, what test would you run to differentiate cranial and nephrogenic DI? What result would inidicate cranial?

IM desmopression test Urine becomes concentrated in cranial

Patient presents to GP with severe polyuria and polydipsia. The patient is found to have cranial DI, what class of medication is given and give an example of this?

ADH analogue | Desmopressin

Patient presents to GP with severe polyuria and polydipsia. In a patient with nephrogenic DI you give them NSAIDs, what is the physiology behind this?

Inhibits prostaglandins which stops their inhibition of ADH action

Patient presents to GP with severe polyuria and polydipsia. Name a risk factor for DI?

Family history

A 53-year-old man presents to his GP with headaches, excessive sweating and complaining that his wedding ring no longer fits on his finger. Upon examination, he has enlarged hands and feet, as well as an enlarged jaw. The GP suspects Acromegaly. Name two causes of acromegaly?

Benign Pituitary Tumour (GH secreting) Ectopic Carcinoid Tumour (GH secreting)

1. Large tongue 2. Wide nose 3. Large supraorbital ridge 4. Deep voice

Glucose Tolerance Test MRI of pituitary gland

1. GH is pulsatile | 2. GH can be elevated due to stress/pregnancy/puberty

GH receptor antagonist - sc pegvisomant Somatostatin analoge - sandostatin

A 47-year-old man presents to A&E with progressive dyspnoea which is worse on exertion, haemoptysis and malar flush. Following investigations, the doctor suspects Mitral Valve Stenosis. Name 2 risk factors for developing mitral valve stenosis?

Rheumatic fever Untreated streptococcus infection

A 47-year-old man presents to A&E with progressive dyspnoea which is worse on exertion, haemoptysis and malar flush. Following investigations, the doctor suspects Mitral Valve Stenosis. Give two characteristic heart sounds of mitral valve stenosis?

Diastolic murmur Loud opening S1 snap

A 47-year-old man presents to A&E with progressive dyspnoea which is worse on exertion, haemoptysis and malar flush. Following investigations, the doctor suspects Mitral Valve Stenosis. What is the gold standard investigation for diagnosing mitral valve stenosis?

Echocardiogram

Beta blocker - bisoprolol Diuretics -furosemide

A 47-year-old man presents to A&E with progressive dyspnoea which is worse on exertion, haemoptysis and malar flush. Following investigations, the doctor suspects Mitral Valve Stenosis. Name two surgical interventions for mitral valve stenosis?

1. Percutaneous mitral balloon valvotomy | 2. Mitral valve replacement

A 47-year-old man presents to A&E with progressive dyspnoea which is worse on exertion, haemoptysis and malar flush. Following investigations, the doctor suspects Mitral Valve Stenosis. What cardiac arrhythmia is often associated with mitral valve stenosis?

Atrial fibrillation

A 14-year-old female presents to her GP with fatigue, reoccurring headaches and faintness. Upon examination, she is found to have spoon-shaped nails and angular stomatitis. Following further investigation, she is diagnosed with Microcytic Anaemia, due to iron deficiency. What plasma protein transports iron in the blood to the bone marrow?

Transferrin

A 14-year-old female presents to her GP with fatigue, reoccurring headaches and faintness. Upon examination, she is found to have spoon-shaped nails and angular stomatitis. Following further investigation, she is diagnosed with Microcytic Anaemia, due to iron deficiency. Aside form iron deficiency, give some other cause of microcytic anaemia?

Thalassaemia Malabsorption

A 14-year-old female presents to her GP with fatigue, reoccurring headaches and faintness. Upon examination, she is found to have spoon-shaped nails and angular stomatitis. Following further investigation, she is diagnosed with Microcytic Anaemia, due to iron deficiency. Two features of microcytic anaemia that would be seen on a blood film?

Small RBCs Pale RBCs - hypochromic Variation in shape Variation in size

A 14-year-old female presents to her GP with fatigue, reoccurring headaches and faintness. Upon examination, she is found to have spoon-shaped nails and angular stomatitis. Following further investigation, she is diagnosed with Microcytic Anaemia, due to iron deficiency. Name 2 blood tests that would be carried out to diagnose microcytic anaemia?

Serum ferritin Serum iron Reticulocyte count

A 14-year-old female presents to her GP with fatigue, reoccurring headaches and faintness. Upon examination, she is found to have spoon-shaped nails and angular stomatitis. Following further investigation, she is diagnosed with Microcytic Anaemia, due to iron deficiency. Name 1 pharmacological treatment for iron deficiency anaemia and give an example?

Oral iron Ferrous sulphate

Nausea Diarrhoea / constipation Black stools

A 23-year-old female presents to her GP with heartburn and increased belching. Following a focused history, the GP diagnoses her with Gastro-Oesophageal Reflux Disease (GORD). Give 4 causes of gastro-oesophageal reflux disease?

Lower oesophageal sphincter hypotension Hiatus hernia Slow gastric emptying Drugs e.g. CCBs

Increased salivation | Food/acid regurgitation

Biliary colic Peptic ulcer disease Coronary artery disease

Encourage smoking cessation Weight losss Small regular meals Avoid hot drinks/citrus

A 23-year-old female presents to her GP with heartburn and increased belching. Following a focused history, the GP diagnoses her with Gastro-Oesophageal Reflux Disease (GORD). Name three classes of drugs used for treating GORD and give an example for each?

Proton pump inhibitor e.g. Lansoprazole, omeprazole H2 receptor antagonist e.g. cimetidine Antacids e.g. gaviscon

Peptic stricture Barretts oesophagus

A 65-year-old man presents to his GP with joint pain and joint stiffness after rest. Upon examination, he has limited joint movement and Herberden’s nodes. Following further investigation, he is diagnosed with Osteoarthritis. What is the difference between Herberden's nodes and Bouchard's nodes?

Herberdens = between middle and distal phalanges e.g. distal interphalangeal joint Bouchards nodes = between proximal and middle phalanges e.g proximal interphalangeal joint

``` Interphalangeal Carpometacarpal Metatarsophalageal joints Vertebra Hip Knee ```

Rheumatoid Psoriatic Chronic, tophaceous gout

Loss of joint spact Osteophytes Subarticular sclerosis Subchondral cysts

Paracetamol NSAIDS Dihydrocodeine Intra-articular corticosteroid injections

arthroscopy arthroplasy osteotomy fusion

A baby is born with a smooth, cystic swelling on his testes, resulting in scrotal enlargement. The swelling lies anterior and below the testes. Upon investigation, the new-born is diagnosed with Hydrocele. Where is the excess fluid located within the testis?

Tunica vaginalis

``` Patent processus vaginalis Testis tumour Trauma Infection Testicular torsion Generalised oedema ```

Testicular torsion Strangulated hernia

A baby is born with a smooth, cystic swelling on his testes, resulting in scrotal enlargement. The swelling lies anterior and below the testes. Upon investigation, the new-born is diagnosed with Hydrocele. Name an investigation that would be carried out to diagnose hydrocele?

Scrotal ultrasound

A baby is born with a smooth, cystic swelling on his testes, resulting in scrotal enlargement. The swelling lies anterior and below the testes. Upon investigation, the new-born is diagnosed with Hydrocele. Name a test that would be done to exclude a malignancy teratoma and confirm hydrocele?

Serum alpha-fetoprotein | Serum hCG

Therapeutic aspiration to remove fluid Surgical removal of hydrocele

A 67-year-old women presents to A&E with a small, painful ulcer on her leg, which is worsened when elevated. There is no oedema present. Following further investigation, she is diagnosed with an Arterial Ulcer. Name two risk factors for arterial ulcers?

Atherosclerosis Smoking Hypercholesterolaemia Diabetes Meillitus

Doppler ultrasound of leg Ankle brachial pressure index

Keep ulcer clean and covered Analgesic Vascular reconstruction

ARTERIAL vs venous ``` SMALL vs large PUNCHED OUT vs shallow PAINFUL vs minimal pain NO OEDEMA vs oedema ABSENT PULSES vs peripheral pulses present COLD SKIN vs warm skin ```

A 21-year-old female presents to her GP complaining of abdominal pain, bloating and a change in bowel habit. She notices that her abdominal pain is relieved by defecation. Following a series of investigations, she is diagnosed with Irritable Bowel Syndrome – D (i.e. IBS with diarrhoea). Give three main causes of IBS?

``` Depression Anxiety Psychological stress Trauma Sexual, physical or verbal abuse Eating disorders ```

Painful periods Change in urinary frequency/urgency Back pain Fatigue

``` Coeliac Lactose intolerance Bile acid malabsorption Inflammatory bowel disease Colorectal cancer ```

ESR / CRP FBC tTG - tissue transglutaminase antibody

Rome III diagnostic criteria

Antispasmodics

A 23-year-old male presents to A&E with newly developed ventricular tachycardia, fever and confusion. He is a known intravenous drug user. Following further investigation, he is diagnosed with Infective Endocarditis. Aside from IVDU, give two other risk factors for for infective endocarditis?

``` Old age Prosthetic valve Recent cardiac surgery Congenital heart disease IV cannula ```

A 23-year-old male presents to A&E with newly developed ventricular tachycardia, fever and confusion. He is a known intravenous drug user. Following further investigation, he is diagnosed with Infective Endocarditis. Name three organisms that can cause infective endocarditis?

Staphylococcus aureus Pseduomonas aeruginosa Streptococcus Viridans

``` Splinter haemorrhage on beds of fingers Embolic skin lesions Osler nodes Janeway lesions Roth spots Petechiae New valve lesion Clubbing ```

A 23-year-old male presents to A&E with newly developed ventricular tachycardia, fever and confusion. He is a known intravenous drug user. Following further investigation, he is diagnosed with Infective Endocarditis. What is the name of the criteria used to diagnose infective endocarditis?

Modified dukes criteria

A 23-year-old male presents to A+E with newly developed ventricular tachycardia, fever and confusion. He is a known intravenous drug user. Following further investigation, he is diagnosed with Infective Endocarditis. What class of drug is given to treat infective endocarditis and how long are they given for?

Antibiotics for 4-6 weeks

An 84-year-old women presents to A&E with severe, constant pain in the epigastric and right upper quadrant region. She is nauseous and has vomited twice. Following investigation, she is diagnosed with a Biliary Colic. Give two main functions of the liver?

Glucose metabolism Fat metabolism Detoxification and excretion of billirubin/alcohol/toxins Protein synthesis: albumin / clotting factors

Irritable bowel sydrome Carcinoma on right side of the colon Renal colic Defence against infection

Obese Female Fertile Smoker

Abdominal ultrasound

Stone dissolution Shock wave lithotripsy Laprascopic cholecystomy

During a routine GP appointment, a 42 year old man is found to have a blood pressure of 156/92mmHg. The GP suspects he has stage 1 essential hypertension. What is essential hypertension?

Hypertension with primary cause unknown

During a routine GP appointment, a 42 year old man is found to have a blood pressure of 156/92mmHg. The GP suspects he has stage 1 essential hypertension. How might the size of the kidney change with hypertension?

Kidney size is reduced

During a routine GP appointment, a 42 year old man is found to have a blood pressure of 156/92mmHg. The GP suspects he has stage 1 essential hypertension. Give 2 investigations that the GP might request? what are the relevant features?

Urinanalysis - protein/albumin:creatinine ratio Opthamoscopy - retinal haemorrhage ECG - LV hypertrophy

During a routine GP appointment, a 42 year old man is found to have a blood pressure of 156/92mmHg. The GP suspects he has stage 1 essential hypertension. Give 5 risk factors of hypertension?

``` Age Black ethnic . origin Family histroy Overweight Sedentary lifestyle Smoker ```

During a routine GP appointment, a 42 year old man is found to have a blood pressure of 156/92mmHg. The GP suspects he has stage 1 essential hypertension. Give four lifestyle modifications for hypertensive patients?

``` Change diet Regular physical excercise Reduce alcohol intake Lose weight Stop smoking ```

A 38 year old woman presents to A&E with hyperpyrexia, tachycardia, and extreme restlessness. The doctor suspects she is having a thyroid crisis. What hormonal changes result in a thyroid storm / crisis?

Rapid T4 increase

A 38 year old woman presents to A&E with hyperpyrexia, tachycardia, and extreme restlessness. The doctor suspects she is having a thyroid crisis. Name 2 things that thyroid storm can progress to if not treated promptly?

Delirium Coma Death

A 38 year old woman presents to A&E with hyperpyrexia, tachycardia, and extreme restlessness. The doctor suspects she is having a thyroid crisis. Name 3 events which can precipitate a thyroid storm?

Stress Infection Surgery

A 38 year old woman presents to A&E with hyperpyrexia, tachycardia, and extreme restlessness. The doctor suspects she is having a thyroid crisis. Name three drugs you would give orally to a patient during a thyroid crisis?

Oral carbimazole Oral propanolol Oral potassium iodide

A 38 year old woman presents to A&E with hyperpyrexia, tachycardia, and extreme restlessness. The doctor suspects she is having a thyroid crisis. How does hydrocortisone work to reverse the thyroid storm?

Inhibits peripheral conversion of T4 to T3

A 73 year old woman presents to her GP with a 4 month history back pain, polydipsia, tiredness, and bruising. Her GP suspects she might have myeloma. Which cells are affected in myeloma?

Plasma cells

A 73 year old woman presents to her GP with a 4 month history back pain, polydipsia, tiredness, and bruising. Her GP suspects she might have myeloma. Define monoclonal paraprotein?

One immunoglobulin which is excessively produced

A 73 year old woman presents to her GP with a 4 month history back pain, polydipsia, tiredness, and bruising. Her GP suspects she might have myeloma. Which type of anaemia is commonly observed in patients with myeloma?

Normocytic, normochromic

A 73 year old woman presents to her GP with a 4 month history back pain, polydipsia, tiredness, and bruising. Her GP suspects she might have myeloma. Why do you give bisphosphonates to patients with myeloma?

Reduce fracture rates and bone pains

A 73 year old woman presents to her GP with a 4 month history back pain, polydipsia, tiredness, and bruising. Her GP suspects she might have myeloma. How much fluid should myeloma patients drink daily

A 33 year old man attends a routine GP appointment and his blood shows abnormal transferase values. He has a history of IV drug use. His GP suspects he has hepatitis, and tests confirm that he has chronic hepatitis C. Which country has a failed public health initiative resulting in widespread hep C?

Egypt

A 33 year old man attends a routine GP appointment and his blood shows abnormal transferase values. He has a history of IV drug use. His GP suspects he has hepatitis, and tests confirm that he has chronic hepatitis C. Which type of cancer is strongly associated with chronic hepatits?

Hepatocellular carcinoma

A 33 year old man attends a routine GP appointment and his blood shows abnormal transferase values. He has a history of IV drug use. His GP suspects he has hepatitis, and tests confirm that he has chronic hepatitis C. Name 2 types of patient that ay have a hepatitis C infection but have a false negative blood result for the HCV antibody?

Immunosurpressed Patients still in the acute infection stage

A 33 year old man attends a routine GP appointment and his blood shows abnormal transferase values. He has a history of IV drug use. His GP suspects he has hepatitis, and tests confirm that he has chronic hepatitis C. Name two first line drugs this patient might be prescribed to treat chronic hepatitis?

SC peglyated interferon a Oral ribavirin

Rapid mutations so envelope proteins chage rapidly

A 33 year old man attends a routine GP appointment and his blood shows abnormal transferase values. He has a history of IV drug use. His GP suspects he has hepatitis, and tests confirm that he has chronic hepatitis C. Name 2 ways the spread of hepatitis C can be prevented ?

Screen blood products Protection / precaution when handling bodily fluids

A 69 year old woman presents to her GP with morning stiffness in her DIP and PIP joints, hips and knees. The GP observes Heberden’s and Bouchard’s nodes primarily on her right hand. The GP suspects she has osteoarthritis. Give three characteristics of osteoarthritis that can be used to differentiate between rheumatoid arthritis?

Pattern of joint involvement - asymmetrical Absence of systemic features Morning stiffness less than 30 mins

``` Diabetes Joint hypermobility Age Gender - F Occupation Genetic predisp ```

A 69 year old woman presents to her GP with morning stiffness in her DIP and PIP joints, hips and knees. The GP observes Heberden’s and Bouchard’s nodes primarily on her right hand. The GP suspects she has osteoarthritis. Name 4 features you would see on an x ray of a joint affected with osteoarthritis?

Loss of joint space Osteophytes Subchondral cysts Subarticular sclerosis

A 39 year old man presents to A&E in the at 3am with excruciating loin pain. He is vomiting and writhing in pain. He notes that he has recently been struggling to pass urine and feels a burning 2 ways for confirming diagnosis of kidney stones and positive result of them?

Ultrasound - visualisation urine dipstick - haematuria/protein/glucose

A 39 year old man presents to A&E in the at 3am with excruciating loin pain. He is vomiting and writhing in pain. He notes that he has recently been struggling to pass urine and feels a burning What type of drug would the doctor prescribe for renal colic and give an example of this drug?

Analgesics IV diclofenac

A 39 year old man presents to A&E in the at 3am with excruciating loin pain. He is vomiting and writhing in pain. He notes that he has recently been struggling to pass urine and feels a burning Name three lifestyle modifications that this patient could make to prevent reoccurance of kidney stones?

``` Overhydrations Normal / low Ca 2+ intake Low sodium diet Normal dairy intake Reduce BMI Reduce animal protein ```

A 39 year old man presents to A&E in the at 3am with excruciating loin pain. He is vomiting and writhing in pain. He notes that he has recently been struggling to pass urine and feels a burning The patients urine is noted to be acidic - what type of stone will only form in acidic urine?

Uric acid stones

A 58 year old man presents to his GP with increased frequency, urgency, and haematuria.He also reports he hasnt been sleeping very well and has to urinate multiple times in the night, GP suspects benign prostatic hyperplasia. Which ethnicity is more severly affected by BPH and why?

Afro-caribbean men Higher levels of testosterone

``` Bladder tumour Bladder stones Trauma Prostate cancer UTI ```

A 58 year old man presents to his GP with increased frequency, urgency, and haematuria.He also reports he hasnt been sleeping very well and has to urinate multiple times in the night, GP suspects benign prostatic hyperplasia. What is that name of the clinical examination which allows a doctor to palpate the prostate?

Digital prostate examination

A 58 year old man presents to his GP with increased frequency, urgency, and haematuria.He also reports he hasnt been sleeping very well and has to urinate multiple times in the night, GP suspects benign prostatic hyperplasia. What would a mid stream urine sample help you exclude from your differential diagnoses?

Infection

Prostate specific antigen

The bacteria appear purple after a gram stain. What does this tell the microbiologist about the bacteria?

Gram positive

Catalase test is performed on a +ve bacteria and there is a negative result, what family of bacteria is this?

Streptococcus is negative on catalase test

Upon haemolysis test it is concluded that the bacteria is S.pyogenes or S.agalactiae, what would the agar plate look like? What type of haemolysis?

Clear / colourless zone around colonised Beta haemolysis

This bacteria caused a skin infection and thus is lancefield group A, is it S. pyogenes or S. agalactiae?

S.pyogenes

What is the recommended treated for a confirmed group A streptococci infection?

IV benzylpenicillin IV clindamycin Urgent surgical exploration with extensive debridement

Give three differences between the structure of the cell envelope of gram negative and gram positive bacteria?

Gram positive have single cytoplasmic membrane Gram positive have a large layer of peptidoglycan Gram positive do not have endotoxin/LPS

A 66 year old male presents to his GP with recurrent burning epigastric pain. He notes a significant weight loss and loss of appetite. The GP suspects he has a peptic ulcer. Give two causes of stomach ulcers?

NSAIDS H Pylori Ischaemia of gastric cells Too much acid production

A 66 year old male presents to his GP with recurrent burning epigastric pain. He notes a significant weight loss and loss of appetite. The GP suspects he has a peptic ulcer. Define ulcer?

Breach of the mucosal surface

A 66 year old male presents to his GP with recurrent burning epigastric pain. He notes a significant weight loss and loss of appetite. The GP suspects he has a peptic ulcer. What is the gold standard of investigation . for this patient?

Endoscopy

A 66 year old male presents to his GP with recurrent burning epigastric pain. He notes a significant weight loss and loss of appetite. The GP suspects he has a peptic ulcer. Give three lifestyle adjustments to recommend to the patient?

stop smoking reduce stress avoid irritating foods

A 66 year old male presents to his GP with recurrent burning epigastric pain. He notes a significant weight loss and loss of appetite. The GP suspects he has a peptic ulcer. What drugs are involve in h pyolri treatment

Amoxicillin Clarythromycin PPi

A 66 year old male presents to his GP with recurrent burning epigastric pain. He notes a significant weight loss and loss of appetite. The GP suspects he has a peptic ulcer. If the ulcer causes a haemorrhage, what action must be taken?

Surgery

A 38-year-old female presents to A&E with hyperthyroidism Name four symptoms of hyperthyroidism?

``` Diarrhoea Weight loss Increased appetite Sweating Palpitations Heat intolerance Tremour Anxiety ```

A 38-year-old female presents to A&E with hyperthyroidism Name four signs of hyperthyroidism

``` Tachycardia AF Thin hair Lid lag Lig retraction Exophthalmos Onycholysis Nodules Bruit ```

A 38-year-old female presents to A&E with hyperthyroidism After further investigation, she is diagnosed with Grave's disease, what class of immunoglobulin is involved in Grave's disease?

IgG

A 38-year-old female presents to A&E with hyperthyroidism What is another possible cause of hyperthyroidism?

Toxic multinodular goitre | Toxic thyroid adenoma

A 56 year old male presents to his GP with sudden onset agonising pain in his metatarsophalngeal joint of the big toe. Doctor suspects gout. What would the result of polarised light microscopy of the crystals from a joint fluid aspiration be?

Negatively | Bifringement

A 56 year old male presents to his GP with sudden onset agonising pain in his metatarsophalngeal joint of the big toe. Doctor suspects gout. Name two risk factors for gout?

Reduced urate excretion - elderly, men, HTN Excess urate production - diet (shellfish), genetics Associations - CVD, HTN, DM

A 56 year old male presents to his GP with sudden onset agonising pain in his metatarsophalngeal joint of the big toe. Doctor suspects gout. Name one precipitating factor of gout?

``` Trauma Surgery Starvation Infection Diuretics ```

A 56 year old male presents to his GP with sudden onset agonising pain in his metatarsophalngeal joint of the big toe. Doctor suspects gout. What is the most common drug given as prophylaxis for gout and what enzyme does it inhibit?

Allopurinol Xanthine oxidase

A 56 year old male presents to his GP with sudden onset agonising pain in his metatarsophalngeal joint of the big toe. Doctor suspects gout. Differential of pseudogout - caused by deposition of a different crystal - what joint is most commonly affected and what crystal?

Calcium pyrophosphate Knee

A 19 year old girl presents to her GP practice after experiencing fatigue, lethargy, and dyspnoea. GP notices that she has angular stomatis and koilonychia. Blood tests confirm anaemia What is that cause of anaemia and what classification is it?

Iron deficiency - angular stomatis and koilonychia are specific signs of IDA Microcytic anaemia

A 19 year old girl presents to her GP practice after experiencing fatigue, lethargy, and dyspnoea. GP notices that she has angular stomatis and koilonychia. Blood tests confirm anaemia A different cause of anaemia is B12 deficiency anaemia, Where is B12 absorbed and what is it bound to?

Terminal ileum Intrinsic factor

A 19 year old girl presents to her GP practice after experiencing fatigue, lethargy, and dyspnoea. GP notices that she has angular stomatis and koilonychia. Blood tests confirm anaemia A cause of B12 deficiency anaemia is pernicious anaemia, what causes the B12 . deficiency in pernicious anaemia?

Atrophic Gastritis

A 19 year old girl presents to her GP practice after experiencing fatigue, lethargy, and dyspnoea. GP notices that she has angular stomatis and koilonychia. Blood tests confirm anaemia B12 deficiency anaemia has specific neurological signs - give 3 examples?

Any 3 from - Irritability - Depression - Psychosis - Dementia - Paraesthesia - Peripheral neuropathy

A 45 year old man presents to A+E with a fever and a new murmur, the doctor suspects infective endocarditis, What is the most common cause of infective endocarditis?

Streptococcus viridans

A 45 year old man presents to A+E with a fever and a new murmur, the doctor suspects infective endocarditis, Blood cultures are taken to aid diagnosis of infective endocarditis. The blood is normally a sterile site, name three other sterile sites?

CSF Pleural fluid Peritoneal cavities Joints

A 45 year old man presents to A+E with a fever and a new murmur, the doctor suspects infective endocarditis, Blood cultures undergo gram testing and stain purple, after further testing the blood cultures are catalase negative and coagulase negative?

Purple = gram postive Catalase negative = staphylococcus Coagulase negative = S.aureus

A 45 year old man presents to A+E with a fever and a new murmur, the doctor suspects infective endocarditis, To aid diagnosis, modified Duke's criteria is used, name one major and two minor criteria?

Major - Blood cultures +ve >12 hours apart - Evidence of endocardial involvement Minor - Fever >38C - Vascular phenomena (janeaway lesions) - Evidence from immunology (roth spots, olser nodes) - Risk groups (prosthetic valve)

A 33 year old presents to her GP with a lump in her right breast. All breast lumps should undergo triple assessment, what are the three aspects of triple assessment?

Clinical examination Radiology Histology/cytology

A 33 year old presents to her GP with a lump in her right breast. Name three differential diagnoses of breast lump which are benign?

Fibroadenoma Breast cysts Infective mastitis Duct ectasia

A 33 year old presents to her GP with a lump in her right breast. After referral, the patient is diagnoses with breast cancer which is localised and the lump will be removed by wide local excision. In order for surgery to be performed, the patient must consent, what are the three principles of informed consent?

Given voluntarily By someone who has capacity By an individual who has been fully informed about the issue

a 33 year old presents to her GP with a lump in her right breast. Screening for breast cancer is given to women age 43-73 every 3 years, the screening involves a 2-view mammography. What type of prevention is this?

Secondary prevention

A 21 year old woman presents to A+E as she is unable to control her movements, and her friends have noticed she is starting to slur her words. Additionally she has noticed a marked reduction in her memory. On examination she has a greenish brown tinge around her cornea. What is the diagnosis and what is this a disorder of?

Wilsons disease Copper excretion

Kayser Fleischer Rings

A 21 year old woman presents to A+E as she is unable to control her movements, and her friends have noticed she is starting to slur her words. Additionally she has noticed a marked reduction in her memory. On examination she has a greenish brown tinge around her cornea. A different disorder haemochromatosis leads to iron deposition in the organs. What gene mutation causes haemochromatosis and what inheritance pattern is it?

HFE gene Autosomal recessive

A 21 year old woman presents to A+E as she is unable to control her movements, and her friends have noticed she is starting to slur her words. Additionally she has noticed a marked reduction in her memory. On examination she has a greenish brown tinge around her cornea. There is a different condition, haemochromatosis, give 2 signs and 2 symptoms of this?

Signs - Bronze pigmentation - Hepatomegaly - Signs of chronic liver disease Symptoms - Tiredness - Arthralgia - Erectile disfunction

A 37 year old female presents to A+E with pylonephritis, she is not pregnant What is the classical triad of symptoms for pylonephritis?

Midstream specimen of urine culture

A 37 year old female presents to A+E with pylonephritis, she is not pregnant A urine dipstick is performed, what who main results will be increased in pyelonephritis?

Nitrates Leukocytes

A 37 year old female presents to A+E with pylonephritis, she is not pregnant What antibiotics should be given to this patient?

Ciprofloxacin or Co-amoxiclav

A 37 year old female presents to A+E with pylonephritis, she is not pregnant Name four risk factors for UTIs?

``` Female Sexually active Urinary incontinance Faecal incontinance Constipation Dehydration Urinary obstruction ```

A 61 year old male presents to his GP practice with constricting central chest pain that is relieve with rest. What is the most likely diagnosis?

Stable angina

A 53yr old Caucasian man has his blood pressure taken by his GP. The reading is 156/98 mmHg. The GP tells him he has hypertension What is the WHO definition of hypertension?

140/90 mmHg

A 53yr old Caucasian man has his blood pressure taken by his GP. The reading is 156/98 mmHg. The GP tells him he has hypertension GP is worried about end organ damage - give an example of a finding that indicates end organ damage?

Retinopathy, proteinuria

A 53yr old Caucasian man has his blood pressure taken by his GP. The reading is 156/98 mmHg. The GP tells him he has hypertension List three lifestyle modifications for the management of hypertension?

1. Smoking cessation 2. Weight loss 3. Exercise 4. Reduce fat in diet 5. Reduce salt in diet 6. Reduce alcohol intake

A 53yr old Caucasian man has his blood pressure taken by his GP. The reading is 156/98 mmHg. The GP tells him he has hypertension What would be the first line drug for this patient and give an example?

Class: ACEi becase <55 and caucasian Example: Ramipril

A 53yr old Caucasian man has his blood pressure taken by his GP. The reading is 156/98 mmHg. The GP tells him he has hypertension Hypertension can lead to malignant hypertension - give an example for for this?

Markedly raised diastolic BP

A 36 year old woman presents to her GP worried about weight loss, sweating and increased anxiousness. Her GP refers her to an endocrinologist as he suspects she has Hyperthyroidism. Name two other symptoms of hyperthyroidism?

``` Diarrhoea Tremor Palpitations Loss of concentration Heat intolerance ```

``` Tachycardia Lid lag Lid retention Thin hair Onycholysis Exophalmos ```

TSH - Decreased T3/T4 - Increased

Class - thioaminde Example - carbimazole

Agranulocytosis

Graves' disease

A 75yr old woman presents to her GP with ‘stomach pain’, nausea and a loss of appetite. The GP refers her for an endoscopy due to her age - he suspects a peptic ulcer. Give two causes of peptic ulcer disease?

``` NSAIDS Helicobacter Pylori Ischaemia Increased stomach acid Alcohol ```

A 75yr old woman presents to her GP with ‘stomach pain’, nausea and a loss of appetite. The GP refers her for an endoscopy due to her age - he suspects a peptic ulcer. What type of vomit is seen in peptic ulcer disease?

Coffee ground haematemesis

A 75yr old woman presents to her GP with ‘stomach pain’, nausea and a loss of appetite. The GP refers her for an endoscopy due to her age - he suspects a peptic ulcer. Apart from endoscopy, name two other investigations for peptic ulcer disease?

Urea breath trest Stool antigen test IgG antibodies

A 75yr old woman presents to her GP with ‘stomach pain’, nausea and a loss of appetite. The GP refers her for an endoscopy due to her age - he suspects a peptic ulcer. Name 4 red flag symptoms of GI cancer?

``` Unexplained weight los Blood in stool Family history of bowel cancer Change in bowel habit Anaemia Raised inflammatory markers ```

A 75yr old woman presents to her GP with ‘stomach pain’, nausea and a loss of appetite. The GP refers her for an endoscopy due to her age - he suspects a peptic ulcer. This drug is due to stomach acid, give two drugs and examples that could be used to treat this?

H2 antagonist - Ranitidine PPi - Lansoprazole

A 76yr old woman presents to her GP with pain and stiffness in her hands. Her GP suspects that she has osteoarthritis. Is osteoarthritis degenerative or inflammatory?

Degenerative

A 76yr old woman presents to her GP with pain and stiffness in her hands. Her GP suspects that she has osteoarthritis. Name a joint deformity that you would expect to see on the hands of someone with osteoarthritis?

Herbdens nodes | Bouchards nodes

A 76yr old woman presents to her GP with pain and stiffness in her hands. Her GP suspects that she has osteoarthritis. Name four things you would expect to see on an x ray of osteoarthritis?

Loss of joint space Ostephytes Subchondral sclerosis Suchondral cysts

A 76yr old woman presents to her GP with pain and stiffness in her hands. Her GP suspects that she has osteoarthritis. Give 1 lifestyle, 1 medical and 1 surgical treatment of osteoarthritis?

Lifestyle: weight loss, physio, excercise, walking aids Medical: NSAIDs, DMARDs, Steroid injections Surgical: arthroplasty, fusion, arthroscopy, osteotomy

A 17yr old boy presents at A&E with sudden pain in his left testis. He is suspected to have testicular torsion. What would you expect the affected testis to be like?

Hot Swollen Tender High

A 17yr old boy presents at A&E with sudden pain in his left testis. He is suspected to have testicular torsion. A doppler ultrasound is done and reveals that the bloods supply is normal, it is now believed he has epidydmo-orchitis. What other symptom would you expect?

Dysuria Fever

E. Coli, N. gonorrhoea, Chlamydia trachomatis

A 17yr old boy presents at A&E with sudden pain in his left testis. He is suspected to have testicular torsion. What investigations would you carry out if it was suspected he had epidydmo-orchitis

1st catch urine sample STI testing

A 17yr old boy presents at A&E with sudden pain in his left testis. He is suspected to have epidydmo-orchitis. What treatment would you give - give examples?

Antibiotics Doxycycline - because under 35

A 17yr old boy presents at A&E with sudden pain in his left testis. He is suspected to have epidydmo-orchitis. What treatment would you give if gonorrhoea was suspected?

Ceftriaxone

A 53yr old woman is referred to a specialist breast clinic after she had a lump picked up on her latest screen. What is the age range for breast cancer screening in the UK?

50-70

A 53yr old woman is referred to a specialist breast clinic after she had a lump picked up on her latest screen. What is the name of the screening procedure for breast cancer?

Mammography

A 53yr old woman is referred to a specialist breast clinic after she had a lump picked up on her latest screen. How often do women within the age range have a breast cancer screening?

Every three yearts

A 53yr old woman is referred to a specialist breast clinic after she had a lump picked up on her latest screen. Name 2 pros and 2 cons of screening programs?

Pros: prevent suffering, improved prognosis with early identification, early treatment cheaper Cons: False positives= unessesary anxiety, false negatives = reduced awareness / overly relaxed

A 73 year old man presents to his GP with weight loss and night sweating. His GP notices that he also has lymphadenopathy and is concerned that he may have Lymphoma. Lymphoma can be divided into 2 classifications, what are they?

Hodgkins and Non Hodgkins

A 73 year old man presents to his GP with weight loss and night sweating. His GP notices that he also has lymphadenopathy and is concerned that he may have Lymphoma. The patient is referred for lymph node biopsy which shows characteristic cells of Hodgkins lymphoma, what are these cells called?

Reed Sternberg

A 73 year old man presents to his GP with weight loss and night sweating. His GP notices that he also has lymphadenopathy and is concerned that he may have Lymphoma. What type of imagine would you do to stage this cancer?

Full body CT or PET scan

A 73 year old man presents to his GP with weight loss and night sweating. His GP notices that he also has lymphadenopathy and is concerned that he may have Lymphoma. What classification is used for staging Hodgkins lymphoma?

Ann-Arbour Classification

A 73 year old man presents to his GP with weight loss and night sweating. His GP notices that he also has lymphadenopathy and is concerned that he may have Lymphoma. What treatment is used for stage 1-2 Hodgkins lymphoma?

Short course chemotherapy followed by radiotherapy

A 42 year old man goes to his GP as he’s been feeling very ‘down’ after losing his job. He says that he doesn’t like to socialise with his friends anymore as he’s embarrassed. The GP is worried that he may be suffering from depression. Name a questionnaire that the GP may use with the patient to assess the presence /severity of the depression?

PHQ-9

A 42 year old man goes to his GP as he’s been feeling very ‘down’ after losing his job. He says that he doesn’t like to socialise with his friends anymore as he’s embarrassed. The GP is worried that he may be suffering from depression. Name three lifestyle modifications that can help with depression?

Exercise Reduce drinking / drug use Reduce stress More sleep Healthy eating Weight loss Meditation

CBT Interpersonal therapy Mindfulness Electroconvulsive therapy

A 42 year old man goes to his GP as he’s been feeling very ‘down’ after losing his job. He says that he doesn’t like to socialise with his friends anymore as he’s embarrassed. The GP is worried that he may be suffering from depression. The GP prescribes an SSRI, give an example of an SSRI, the mechanism and a side effect?

Example: sertraline, fluoxetine, vortioxetine Mechanism: Blocks the uptake of serotonin, prolongs action in brain Side effects: nausea, headache, dry mouth, sexual dysfunction

What metabolic product is in excess in gout?

Monosodium Urate

Gout can be due to over production or under-excretion, give an example of both?

Over production: Alcohol, excess meat, fructose sweetened drinks, hyperlipidaemia Under excretion : Alcohol, renal impariement, hypertenion, insulin resistance

What is the pathonomic sign of chronic gout?

Tophaceous gout

A joint fluid aspirate was taken and looked at under a polariser, what would be seen?

Negatively Birefringent Needles

A drug given for gout targets a key enzyme in the production of uric acid. Name the drug class and give an example?

Xathine oxidase inhibitors Allopurinol

A 45 year old man presents with increasing abdominal distension. Clinical examination of the abdomen demonstrates tense ascites as a result of chronic liver disease List two clinical signs other than abdominal distension that would help confirm the presence of ascites?

Shifting dullness Flank dullness Fluid thrill Bulging flanks

List three clinical signs of chronic liver disease that may be found on examination of the hands?

``` Finger clubbing Palamar erythema Jaundice Spider naevi Easy bruising ```

List two investigations to further investigate the cause of ascites?

``` Ascitic tap Ultra sound of abdomen Pertioneal tap CT abdomen LFTs ```

List three complications that can arise as a result of chronic liver disease?

``` Variceal bleed GI bleeding Portal hypertenison Malnutrition HCC Spenomegaly ```

A 35-year-old female presents to her GP with fatigue, weight loss, anxiety and eye changes. After some tests she is diagnosed with Graves disease and treated for it. What is the pathophysiology of Grave's disease?

Autoantibodies attack TSH receptor stimulating them to increase T3/T4

A 35-year-old female presents to her GP with fatigue, weight loss, anxiety and eye changes. After some tests she is diagnosed with Graves disease and treated for it. What is the eye pathology of Grave's disease and give two components of it?

Thyroid eye disease ``` Optic nerve straightened Upper eyelid retraction Lid lag Periorbital swelling Conjunctival oedema ```

A 35-year-old female presents to her GP with fatigue, weight loss, anxiety and eye changes. After some tests she is diagnosed with Graves disease and treated for it. Name the treatment regime for Grave's and a drug used for each step?

Block and replace Carbimazole, levothyroxine

A 35-year-old female presents to her GP with fatigue, weight loss, anxiety and eye changes. After some tests she is diagnosed with Graves disease and treated for it. What are the remission rates for Grave's disease?

30-50%

A 60-year-old male attends A&E with crushing chest pain that is radiating down his left arm. After an ECG he is diagnosed with a STEMI of the right coronary artery (RCA). What does STEMI stand for?

ST elevation myocardial infarction

A 60-year-old male attends A&E with crushing chest pain that is radiating down his left arm. After an ECG he is diagnosed with a STEMI of the right coronary artery (RCA). What % of the population have their posterior descending artery supplied by RCA?

85%

A 60-year-old male attends A&E with crushing chest pain that is radiating down his left arm. After an ECG he is diagnosed with a STEMI of the right coronary artery (RCA). Which nerve root is responsible for the radiation of pain down his left arm?

A 60-year-old male attends A&E with crushing chest pain that is radiating down his left arm. After an ECG he is diagnosed with a STEMI of the right coronary artery (RCA). What will be seen on the ECG, in which leads to diagnose an infarct in the RCA?

ST elevation!! In leads aVF, II, III

A 60-year-old male attends A&E with crushing chest pain that is radiating down his left arm. After an ECG he is diagnosed with a STEMI of the right coronary artery (RCA). Give two pathological findings that may be seen later on the ECG?

Bundle branch blocks Pathological Q waves Arrhythmias

A 22 yr old male has been admitted to hospital with myalgia, diarrhoea and vomiting, after recently returning from volunteer work in Africa. His doctors suspect malaria. What type of organism causes malaria?

Protozoa

A 22 yr old male has been admitted to hospital with myalgia, diarrhoea and vomiting, after recently returning from volunteer work in Africa. His doctors suspect malaria. What other symptom will he definitely have if its malaria?

Fefver

A 22 yr old male has been admitted to hospital with myalgia, diarrhoea and vomiting, after recently returning from volunteer work in Africa. His doctors suspect malaria. What is the diagnostic tool for malaria?

Thick and thin blood films

A 22 yr old male has been admitted to hospital with myalgia, diarrhoea and vomiting, after recently returning from volunteer work in Africa. His doctors suspect malaria. Give three complications of malaria?

``` Pulmonary oedema Anaemia Renal failure Thromocytopenia Sepsis Coma ```

IV artesunate OR IV Quinine + doxycycline

A 22 yr old male has been admitted to hospital with myalgia, diarrhoea and vomiting, after recently returning from volunteer work in Africa. His doctors suspect malaria. Name a species that can cause a relapse of treated malaria?

Plasmodium ovale or vivax

A 50 yr old man with jaundice and abdomen distension is referred for chronic liver failure. Give 4 functions of the liver?

``` Glucose metabolism Fat metabolism Protein synthesis Defence against infection Detoxification Excretion ```

A 50 yr old man with jaundice and abdomen distension is referred for chronic liver failure. What type of jaundice is this?

Hepatic

A 50 yr old man with jaundice and abdomen distension is referred for chronic liver failure. Give two possible causes of inherited liver failure?

Haemochromatosis Wilsons Alpha-1-antitrypsin deficiency

A 50 yr old man with jaundice and abdomen distension is referred for chronic liver failure. What is the name of his abdominal distension and how can it be treated?

Ascites Fluid retstriction, salt restriction, TIPS, albumin

A 50 yr old man with jaundice and abdomen distension is referred for chronic liver failure. Give a complications of liver failure that causes haematemesis?

Variceal haemorrhage | or portal hypertension

A 67 year old male presents with a hot, red, painful, swollen, first metatarsophalangeal joint that appeared suddenly over night. Define inflammation?

Local physiological response to tissue injury

A 67 year old male presents with a hot, red, painful, swollen, first metatarsophalangeal joint that appeared suddenly over night. Give three outcomes of acute inflammation?

Resolution Suppuration Repair Chronic inflammation

A 67 year old male presents with a hot, red, painful, swollen, first metatarsophalangeal joint that appeared suddenly over night. Give three differentials for this man?

Gout Pseudogout Septic arthritis

A 67 year old male presents with a hot, red, painful, swollen, first metatarsophalangeal joint that appeared suddenly over night. What is your first line of investigation?

Aspirate the joint

A 10 year old female is referred to you for AKI, you do some urgent tests including an ECG. To be an AKI, how should her creatinine of changed compared to the last 48hours?

Risen by 50%

A 10 year old female is referred to you for AKI, you do some urgent tests including an ECG. What complications are you looking for with the ECG and how do you treat AKI?

Hyperkalemia ``` Insulin Dextrose IV fluids Calcium gluconate Salbutamol ```

A 10 year old female is referred to you for AKI, you do some urgent tests including an ECG. Give three renal causes of AKI?

``` Glomeruolonephritis Malignant hypertension Vascular occlusion Vasculitis Haemolytic uraemic syndrome ```

A 55-year-old female presents to her GP with headache, scalp tenderness and pain when eating. The GP suspects Giant Cell Arteritis (GCA). What group of conditions is giant cell arteritis within?

Large vessel vasculitis

A 55-year-old female presents to her GP with headache, scalp tenderness and pain when eating. The GP suspects Giant Cell Arteritis (GCA). Which specialty should the GP refer her to?

Rheumatology

A 55-year-old female presents to her GP with headache, scalp tenderness and pain when eating. The GP suspects Giant Cell Arteritis (GCA). What is the gold standard investigation?

Temporal Artery Biospy

A 55-year-old female presents to her GP with headache, scalp tenderness and pain when eating. The GP suspects Giant Cell Arteritis (GCA). What is the emergency complication associated with GCA and who should she be referred to for this?

Arteritic anterior ischaemic optic neuropathy Opthalmology

A 55-year-old female presents to her GP with headache, scalp tenderness and pain when eating. The GP suspects Giant Cell Arteritis (GCA) What treatment should she be started on promptly and give an example of this?

Corticosteroids - prednisolone

A 55-year-old female presents to her GP with headache, scalp tenderness and pain when eating. The GP suspects Giant Cell Arteritis (GCA). What type of headache is this and give an example of another type?

Secondary Meningitis Subarachnoid haemorrhage Brain tumour

A 33-year-old female visits her GP worried about breast cancer. She has no children, has been taking the combined oral contraceptive pill since the age of 15 and has a BMI of 26. She has no family history of breast or ovarian cancer. You refer her to oncology where she is diagnosed after a triple assessment with an ER positive tumour. Give two types of benign breast lump?

Fibroadenoma Cyst

BRCA1 / BRCA2

Clinical assesment Mammogram Biospy

TNM

Tamoxifen Competitive inhibitor of oestrogen

A 52-year-old man visits his GP worried about recent problems with his ‘water works’. His father had prostate cancer and he requests a screen for prostate cancer as he has heard of PSA testing on the news. Give 5 of the wilson and junger screening criteria?

1. Natural progression of disease should be well understood 2. There should be a detectable early stage 3. Treatment at an early stage should be of more benefit than at a later stage 4. A suitable test should be devised for early stage 5. The test should be acceptable 6. Benefits should outweigh costs

BPE Old age Recent ejaculation Prostate cancer

A 52-year-old man visits his GP worried about recent problems with his ‘water works’. His father had prostate cancer and he requests a screen for prostate cancer as he has heard of PSA testing on the news. What is the diagnostic test for prostate cancer and what is the grading system used for this?

Prostate biopsy Gleason grading system

A 21 year old female presents to her GP with non-specific symptoms of dysuria and discharge. After taking a detailed sexual history you instruct her to take vaginal swabs for N. Gonorrhoea and Chlamydia tachomatis. Her sexual contacts are traced. How will gonorrhoea be seen under a microscope when gram stained?

Gram negative diplococci

No growth because only grows inside cells

Secondary

Break chain of transmission Prevent reinfection of index patient Prevent complications of untreated infection

First void urine

A 60-year-old male with known co-morbidities visits his GP wanting to find out how he can improve his health as he is worried about his heart. He has a triad of impaired glucose metabolism, central obesity and hyperlipidaemia. He also smokes but is thinking about stopping. Define comorbidity?

Coexistance of 2 or more diseases

Metabolic sydrome | central obesity, impaired glucose metabolism and hyperlipidaemia

Contemplation

Ask Advise Assist

A 22-year-old man presents to his General Practitioner with a two-week history of pain and swelling of the proximal interphalangeal joint (PIPJ) of his left index finger. There is no history of trauma. On examination, there is a mildly-tender fusiform swelling of the PIPJ of left index finger and a fusiform swelling of the PIPJ of the right second toe. The overlying skin is slightly erythematous and feels warm. The GP notes that the patient also has some pitting of his nails. She also asks the patient if they have any skin rashes. The GP is concerned that the patient may have developed psoriatic arthropathy Describe two characteristic features of the skin rash seen in psoriatic arthropathy?

Itchy Skin may be thickened under plaque Deep red colour with a silvery surface scale Hidden sites include behind ears, nails, navel Distributed on scalp, trunk, extensor surfaces of limbs (elbow/knees)

A 22-year-old man presents to his General Practitioner with a two-week history of pain and swelling of the proximal interphalangeal joint (PIPJ) of his left index finger. There is no history of trauma. On examination, there is a mildly-tender fusiform swelling of the PIPJ of left index finger and a fusiform swelling of the PIPJ of the right second toe. The overlying skin is slightly erythematous and feels warm. The GP notes that the patient also has some pitting of his nails. She also asks the patient if they have any skin rashes. The GP is concerned that the patient may have developed psoriatic arthropathy State two features in the pattern of joint involvement of psoriatic arthritis that would help distinguish it from rheumatoid?

Dactlylitis Distal interphalangeal joint involvemnt Spinal / axial involvment Enthesitis

Anti IgG

A 22-year-old man presents to his General Practitioner with a two-week history of pain and swelling of the proximal interphalangeal joint (PIPJ) of his left index finger. There is no history of trauma. On examination, there is a mildly-tender fusiform swelling of the PIPJ of left index finger and a fusiform swelling of the PIPJ of the right second toe. The overlying skin is slightly erythematous and feels warm. The GP notes that the patient also has some pitting of his nails. She also asks the patient if they have any skin rashes. The GP is concerned that the patient may have developed psoriatic arthropathy. The patient starts taking diclofenac, what class of drug is this?

Non Steroidal Ani Inflammatory Drug

Cyclooxygenase-1