Passmed

Question 1

Renal stones.

1. Which type are radio-lucent?
2. Which type occur after an infection and name a pathogen which precedes these?
3. Which type are genetically linked?

Answer 1

1. Uric acid
2. Struvite, Proteus mirabilis, urease production enzyme.
3. Cystine

Question 2

A 28-year-old man falls onto an outstretched hand. On examination there is tenderness of the anatomical snuffbox. However, forearm and hand x-rays are normal.. What is the management?

Answer 2

Discharge home with Futura splint and fracture clinic review.
?Scaphoid fracture due to fall on out-stretched hand.
At risk of avascular necrosis

Question 3

A 10-year-old boy undergoes a delayed open reduction and fixation of a significantly displaced supracondylar fracture. On the ward he complains of significant forearm pain and paraesthesia of the hand. Radial pulse is normal. Management?

Answer 3

Fasciotomy for compartment syndrome.

Loss of arterial pulsation occurs in late disease.

Question 4

Man is treated for glaucoma which medication can cause long eyelashes

Answer 4

Latanoprost (prostaglandin analogue)

Question 5

What electrolyte abnormalities can occur after a blood transfusion?

Answer 5

Hyperkalaemia

Hypocalcaemia

Question 6

A 34-year-old female presents with fatigue and frequent headaches. On examination of her eyes, you notice an abnormality during the swinging light test. As the light is moved from the left to the right eye both pupils appear to dilate. The pupillary response to accommodation is normal bilaterally. Fundoscopy is also normal bilaterally. Her past medical history includes type one diabetes and hypertension.

1. What is the most likely explanation for this patients’ signs?
2. What other Ix would you do?

Answer 6

1. Marcus-Gunn pupil on the right.
2. Seen in MS patients so rule that out with: evoked potentials, LP with CSF oligocloncal bands, visual evoked potential studies, MRI scan of head.

Question 7

Pupil which has slow to accommodate

Answer 7

Holmes-Aide’s pupil

Question 8

Pupil responds to light but not accommodation and potential cause?

Answer 8

Argyll Robertson pupil seen in neurosyphilis.

Question 9

What vaccine can a patient on azathioprine not get?

Answer 9

Live-vaccines such as yellow fever or BCG.

Immunocompromised.

Question 10

Type of stroke:

Only neurological sign is homonymous hemianopia

Answer 10

Posterior cerebral artery infection –> left occipital infarct.

Question 11

Type of stroke:

isolated hemisensory less

Answer 11

Lacunar infarction

Question 12

How to classify strokes

Answer 12

Oxford / Bamford stroke classification

Question 13

Max recommended rate of potassium infusion via peripheral line

Answer 13

10mmol/hour

If over 20mmol/hr need to have cardiac monitor!!!

Question 14

What to check before starting a patient on Azathiprine

Answer 14

TPMT levels - if they are low and the patients takes azathioprine can cause pancytopenia.

Question 15

A 65-year-old man calls an ambulance as he has central crushing chest pain that radiates to his left arm and jaw. As he arrives at the emergency department his heart rate is found to be 50/min. An ECG is performed which shows ST elevation and bradycardia with a 1st-degree heart block.

Given the history, which leads will most likely show the ST elevation?

Answer 15

II, III, aVF –> right coronary artery supplies AV node so ischaemia will lead to arrythmia.

Question 16

Patient over 60 years old with new iron-deficiency anaemia what Mx?

Answer 16

Urgent (2WW) colorectal cancer pathway referral.