MSCA general mocks and Imperial past papers

Question 1

A 67 year old man is found to have an ejection systolic murmur. He is otherwise well. His pulse rate is 72 bpm and BP 128/84 mmHg. His chest is clear.
Investigations:
ECG shows sinus rhythm.
Echocardiography shows aortic stenosis, valve gradient 50 mmHg. Left ventricular (LV) diastolic dysfunction, LV ejection fraction 45% (>55).
Which is the most appropriate management?
A. Clinical review and echocardiography in 6 months
B. Reassure and discharge
C. Refer for aortic valve replacement
D. Start bisoprolol fumarate and advise review if symptomatic
E. Start lisinopril and advise review if symptomatic

Answer 1

Aortic valve replacement

LVEF <55% and aortic valve gradient ≥40 mmHg

Question 2

Which nerve root covers the sensation of the big toe?

Answer 2

L5

Question 3

Osmolality equation

Answer 3

2(Na + K) + urea + glucose

Question 4

Anion gap equation

Answer 4

(Na + K) - (Cl + HCO3)

Question 5

Normal urine output rate?

Answer 5

0.5-1.5ml/kg/hour

Question 6

Diagnostic investigation for acute heart failure?

Answer 6

Echocardiography

Question 7

Ulcer with raised white margin on left ear. Which skin cancr?

Answer 7

Basal cell carcinoma

Question 8

First imaging for polycystic kidneys?

Answer 8

USS renal tract

Question 9

Patient with ulcerative colitis has fatigue and hepatomegaly. Abnormal LFTs. Diagnosis?

Answer 9

Primary sclerosing cholangitis

Question 10

Management for abdominal aortic aneurysm depending on width.

Answer 10

< 3cm - nothing
3-4.4cm - rescan every 12 months
4.5-5.4 - rescan every 3 months
>=5.5 - refer to vascular within 2 weeks

Question 11

Indications for bariatric surgery

Answer 11

BMI >40
BMI >35 + related co-morbidity

Question 12

Management for neuropathic bladder

Answer 12

Intermittent self catheterisation

Question 13

A 43 year old man is involved in a low speed road traffic collision. Following this he develops pain in his lower back that it is still troublesome several months later. The pain is worse after activity and is relieved by rest. He has an exaggerated lumbar lordosis with a palpable depression above L5. The range of movement of his spine is grossly normal. Neurological examination of his lower limbs is also normal. Condition?

Answer 13

Spondylothesis

Question 14

First line analgesic for mechanical back pain?

Answer 14

Ibuprofen

Question 15

Which drug can reverse the effects of muscle relaxants (such as atracurium, vecuronium, pancuronium) following surgery?

Answer 15

Neostigmine (ACh-esterase inhibitor)

Question 16

Which is the best marker of tumor lysis syndrome

Answer 16

High urate

(high phosphate, high potassium, low calcium)

Question 17

A 35 year old woman has a painful lump in her breast. Her mother had breast cancer at the age of 65 years. She is 32 weeks pregnant with no past medical history. She is not taking any medication. She smokes 5 cigarettes per day. There is a 2 cm lump in her right breast that is tender on palpation. There is redness of the overlying skin. Management?

Answer 17

Triple assessment

Question 18

Secondary anticoag/platelet prevention for PE, MI, AF, stroke, TIA.

Answer 18

PE
1) DOAC
2) heparin

MI
- aspirin
- clopidogrel

AF
1) DOAC
2) warfarin

Stroke
- aspirin
- clopidogrel
- dipyridamole

TIA
- clopidogrel

Question 19

Why would a patient need to be ventilated after inhaling smoke after a fire?

Answer 19

Due to bronchospasm

Question 20

What is normal potassium daily requirement?

Answer 20

1mmol/kg/24hours

Question 21

Most common type of parotid gland tumour

Answer 21

Pleomorphic adenoma

Question 22

Management for euvolaemic hyponatraemia

Answer 22

Fluid restriction

Question 23

Patient with #NOF with pain uncontrolled pain. Was on IV paracetamol but it did not relieve pain. What is the next analgesia to offer?

Answer 23

Femoral block

Question 24

Addisonian crisis immediate management?

Answer 24

IV hydrocortisone (fluids after)

Question 25

When do you start levothyroxine in subclinical hypothyroidism?

Answer 25

TSH > 10

Question 26

Investigation after blood film in CLL

Answer 26

Flow cytometry

Question 27

Covid x-ray findings

Answer 27

Bilateral lower lobe consolidation

Question 28

Patient breathless after cisplatin chemo. Cause?

Answer 28

Chemotherapy-induced pneumonitis

Question 29

Lewy body dementia presentation

Answer 29

Progressive cognitive impairment
Parkinsonism
Visual hallucinations