PASSMED 04/04 - 07/04

Question 1

UKMEC 3 conditions:

Answer 1

> 35 years old and smoking <15 cigarettes per day
BMI >35
FHx thromboembolic disease
Controlled hypertension
Wheelchair use
Carrier of BRCA1/2
Current gallbladder disease

Question 2

UKMEC 4 conditions:

Answer 2

> 35 years old and smoking >15 cigarettes a day
Thromboembolic disease
Migraine with aura
Current breast cancer
Post partum and breastfeeding <6 weeks
Uncontrolled hypertension
Positive antiphospholipid antibodies e.g. SLE
History of stroke / VTE

Question 3

Triad of renal cell cancer:

Answer 3

Loin pain
Haematuria
Abdominal mass

Question 4

An unresolving varicocele can be due to renal tract cancer, due to compression. What are the investigation steps?

Answer 4

Cystoscopy if painless haematuria because could be bladder cancer.

Renal tract cancer = renal tract ultrasound.

Question 5

Non-shockable rhythms:

Answer 5

PEA
Asystole

Question 6

Shockable rhythms:

Answer 6

VF
Pulseless VT

Question 7

VF / Pulseless VT witnessed vs non-witnessed management:

Answer 7

Witnessed: 3 successive shocks

Non-witnessed: 1 shock then CPR

Question 8

Drug delivery during cardiac arrest:

Answer 8

IV first line

IO if IV not available

Question 9

Non-shockable rhythms initial management:

Answer 9

Adrenaline asap for non-shockable rhythms

(Adrenaline is given in shockable rhythms after the 3rd shock, alongisde amiodarone 300mg)

Question 10

Red flags of secondary dysmenorrhoea:

Answer 10

Ascites +/or pelvic or abdominal mass
Abnormal cervix
Persistent IMB or PCB (without associated PID symptoms)

Question 11

SSRI of choice for children and adolescents:

Answer 11

Fluoxetine

Question 12

Lithium toxicity can be precipitated by dehydration, renal failure, and certain drugs. List some of the drugs, and give 2 management options.

Answer 12

Diuretics esp thiazides, ACEi/ARB, NSAIDs and metronidazole.

IV fluids with isotonic saline. Monitor sodium closely to watch for nephrogenic diabetes insipidus.

Haemodialysis for severe cases e.g. seizures, profound renal failure.

Question 13

Cut off protein level for exudates and transudates, and light’s criteria:

Answer 13

> 30 = exudate
<30 = transudate

Pleural fluid protein / serum protein >0.5

Pleural fluid LDH / serum LDH >0.6

Pleural fluid LDH >2/3 upper limit of normal serum LDH

Question 14

What does a) low glucose b) raised amylase c) low complement and d) heavy blood staining indicate in pleural fluid?

Answer 14

a) RA, TB
b) Pancreatitis, oesophageal perforation
c) SLE
d) Mesothelioma, PE, TB

Question 15

A pleural infection is suspected - when should a chest tube be placed to drain it?

Answer 15

Fluid is cloudy / turbid

Fluid is clear but pH is <7.2

Question 16

Most common type of glomerulonephritis in adults?

Answer 16

Membranous GN

Question 17

Management of membranous GN;

Answer 17

ACEi or ARB (reduce proteinuria)

Only give steroids + cyclophosphamide if severe

?anticoagulation

Question 18

Triad of shaken baby syndrome:

Answer 18

Subdural haemorrhage
Retinal haemorrhage
Encephalopathy

Question 19

Diagnosis of G6PD deficiency:

Answer 19

At and 3 months after presentaiton

G6PD ENZYME ASSAY

Question 20

Treatment for suspected epididymo-orchitis:

Answer 20

IM Ceftriaxone once only + Oral doxycycline for 10-14 days

Question 21

First line investigation for cholangitis, and management:

Answer 21

US to look for bile duct dilatation and stones

IV abx and ERCP after 24-48 hours to relieve any obstruction

Question 22

Which steroid is used for fetal lung maturation?

Answer 22

Dexamethasone

Question 23

Weakened femoral pulses, upper limb hypertension, left sternal edge / back murmur, tachycardia:

Answer 23

Coarctation of the aorta

Question 24

Cyanosis, tet spells, harsh systolic ejection murmur, RVH, reduced o2 sats:

Answer 24

TOF

Question 25

pda and coarctation are which type of shunt?

Answer 25

Left to right shunt

Question 26

Features of PDA:

Answer 26

continuous machinery murmur Bounding pulses, wide pulse pressure, respiratory distress. O2 sats typically normal unless pulmonary hypertension develops.

Question 27

6th nerve palsy (abducens):

Answer 27

Lateral rectus affected; eye abduction limited. CNVI has a long intracranial course therefore making it more likely to be damaged by raised ICP.

Question 28

Familial hypercholesterolaemia is an AD inherited disorder. Which protein is mutated in this condition?

Answer 28

LDL receptor

Question 29

What does a positive head impulse test indicate?

Answer 29

Pathology with the vestibulocochlear nerve on the IPSILATERAL side of the positive test.

Question 30

Discuss the meaning of uni and bidirectional nystagmus:

Answer 30

Unilateral is reassuring, likely to be peripheral in origin. When the nystagmus changes direction or is vertical, it is more likely to be central in origin. Bidirectional is highly specific for stroke - saccadic movement beats in the direction that the patient is looking.

Question 31

Hoffman's sign positive indicates an upper motor neuron lesion. Give 2 diseases that a positive Hoffman's sign may be associated with:

Answer 31

Degenerative cervical myelopathy Multiple sclerosis

Question 32

Management pathway for endometriosis:

Answer 32

NSAIDs / paracetamol COCP or progestogen GnRH analogue (inducing pseudomenopause) Laparoscopic excision or ablation to improve chances of conception

Question 33

How often should a patient with a spontaneous pneumothorax be followed up?

Answer 33

2-4 days until resolution

Question 34

4 ways to assess frailty in primary care:

Answer 34

PRISMA-7 questionnaire Informal gait speed assessment Self reported health status Formal assessment of gait speed - >5 second to walk 4m = frail

Question 35

2 extra tools to assess frailty that can be used in the outpatient settingL

Answer 35

Timed Up and Go test Physical Activity Scale for the Elderly

Question 36

What tool can be used to optimise elderly patient's medications?

Answer 36

STOPP / START

Question 37

% values for 1SD, 2SD and 3SD of the mean:

Answer 37

68.3% 95.4% 99.7%

Question 38

Most common cause of pleural exudate vs transudate respectively:

Answer 38

Pneumonia exudate Heart failure transudate

Question 39

Causes of transudative pleural effusion:

Answer 39

Heart failure Hypoalbuminaemia e.g. nephrotic syndrome, liver disease, malabsorption Hypothyroididm Meig's syndrome

Question 40

Causes of exudative pleural effusion:

Answer 40

Pneumonia TB CTD e.g. RA, SLE Lung cancer, mesothelioma, mets Pancreatitis PE Dressler's syndrome