Peer teaching formatives Flashcards by Lauren Hartley

64yo male, chest pain on exertion, eases if sits down, stress ECG findings?

a) Saddle shaped ST with PR depression
b) Tall tented T waves and pathological Q waves
c) ST Elevation
d) ST Depression
e) Absent P waves

ST Depression

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Acute pericarditis pain:

a) Fine in chair, comes on if stand up
b) If lean forward it hurts, when lie down it is fine
c) Hurts lead down, sit up and lean forwards better
d) Hurts during inhalation
e) Zumba = pain, rest is fine.

c) Hurts lead down, sit up and lean forwards better

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Mitral regurgitation murmur:

a) Early-diastolic murmur
b) Early-systolic click murmmur
c) Ejection systolic ‘crescendo-decrescendo’ murmur
d) End-diastolic murmur
e) Pansystolic murmur

e) Pansystolic murmur

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54yo caucasian, high BP, metformin and simvastatin. Appropriate anti-hypertensive?

a) Amlodipine
b) Bendroflumethiazide
c) Candesartan
d) Diltiazem
e) Isomorbide mononitrate

c) Candesartan

ACEi/ARB

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Which of the following is the correct mechanism of drug action for Heparin?

a) Increases cGMP and reduces intracellular Ca2+ concentration
b) Inhibits cyclooxygenase (COX) reducing production of thromboxane A2
c) Inhibits production of vitamin-K dependent clotting factors
d) Inhibits thrombin and factor Xa
e) Induces Vagal Nerve stimulation

d) Inhibits thrombin and factor Xa

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Fever and new heart murmur & hand symptoms. Infective endocarditis. Which is NOT Seen in infective endocarditis?

a) Roth Spots
b) Janeaway lesions
c) Oslar nodes
d) Splinter haemorrages
e) Clubbing

Roth Spots

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Left calf swollen and red, Well’s score less than 4. Medium risk. Further test?

a) FBC
b) C-reactive protein
c) D-dimer
d) Tropomyosin I
e) Anti-phospholipid antibody

c) D-dimer

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BP definition?

a) Cardiac output x Total vascular resistance
b) HR x Stroke volume
c) Diastolic pressure + pulse pressure
d) End diastolic volume - end systolic volume
e) Blood velocity x diameter of tube.

a) Cardiac output x Total vascular resistance

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Which of the following blood tests is diagnostic of heart failure?

a) Troponin I
b) Atrial natriuretic peptide (ANP)
c) Brain natriuretic peptide (BNP)
d) CK-MB
e) FBC

c) Brain natriuretic peptide (BNP)

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43yo male, on ACEi for angina. Cough. Changes ACEi to ARB. What is responsible for the cough?
a) Acetylcholine.
B. Bradykinin
C. Histamine.
D. IgE
E. Prostaglandin

B. Bradykinin

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34yo man, bloating, stinking floating stools. Coeliac. Which antibodies associated with coeliac disease?

a) Anti-DsDNA
b) Anti-phospholipid
c) ANCA
d) Alpha-gliadin
e) Rheumatoid factor

d) Alpha-gliadin

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Diarrhoea. IBS, tried low FODMAP. Intervention?

a) Ferrous sulphate
b) Loperamide
c) Methotrexate
d) Metronidazole
e) Omeprazole

b) Loperamide

Immodium

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34yo South African, left iliac abdominal pain, sudden onset. Unable to pass stool. No previous surgery, non-smoker and tTg results negative. Most likely diagnosis?

a) Coeliac disease
b) Colorectal cancer
c) Large bowel obstruction- volvulus
d) Small bowel obstruction- adhesion
e) Strangulation hernia

c) Large bowel obstruction- volvulus

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Not a feature of chron’s?

a) Mouth Ulcers
b) Mucosal inflammation
c) Graulomatous skip lesions
d) Raised CRP levels
e) Smoking decreases the risk of disease

e) Smoking decreases the risk of disease

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What indicates IBD instead of IBS?

a) Smelly stools
b) DXA scan revealing decreased bone mineral density
c) Nocturnal diarrhoea
d) Abdominal cramps
e) Feeling fatigued

c) Nocturnal diarrhoea

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Which ascending cholangitis is false?

a) Caused by bacterial infection of biliary tree
b) Patients experience epigastric pain
c) Patients present with a temperature
d) Patients present with yellowing of the skin and sclera
e) Murphy’s sign is negative

b) Patients experience epigastric pain

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Gallbladder is supplied blood by the systic artery. What is the cystic artery a branch of?

a) Coeliac trunk
b) Gastoduodenal artery
c) Left gastro-epiploic artery
d) Right hepatic artery
e) Splenic artery

d) Right hepatic artery

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Which form of hepatitis is a DNA virus?

a) Hepatitis A
b) Hepatitis B
c) Hepatitis C
d) Hepatitis D
e) Hepatitis E

b) Hepatitis B

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Haemochromatosis is a metabolic liver disease caused by uncontrolled intestinal absorption of which ion?

a) Ca2+
b) Cu2+
c) Fe2+
d) Li+
e) K+

Fe2+

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42yo lawyer, 5/10 epigastric pain after eating. H. pylori breath test = peptic ulcer. Strategy: giving PPI eg. omeprazole, giving two antibiotics. Which two?

a) Amoxicillin and Clarithromycin

PAC man
PPI.
Amoxicillin
Clarithromycin

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Non-inflammatory cause of joint pain?
a) Rheumatoid arthritis
B Septic arthritis
C Spondyloarthritis
D Fibromyalgia
E  Gout

d) fibromyalgia

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Which of these is not a feature of Rheumatoid Arthritis?
a) NSAIDs help
B Pain eases with use
C Effects the distal interphalangeal joints
D Pain lasts for an hour or so in the morning
E Ulnar deviation

c) affects the distal interphalangeal joints

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Which of the following best describes the method of action of bisphosphonates?

a) Cause increased bone deposition
b) Cause reactivation of the metaphysis and epiphysis
c) Inhibit osteoclast activity and cause osteoclast apoptosis
d) Reduce the signally pathway between osteoblasts and clasts by increasing RANK ligand
e) Increase removal of calcium into the haversian canal within bone

c) Inhibit osteoclast activity and cause osteoclast apoptosis

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Lavish lifestyle, wine and cheese. Painful big toe and gout. Joint aspiration, what confirms gout?
a) Tophi
B Needle shaped crystals which are +ve birefringent
C Needle shaped crystals which are -ve birefringent
D Rhomboid shaped/ brick like crystals which are +ve birefringent
ERhomboid shaped/ brick like crystals which are -ve birefringent

C Needle shaped crystals which are -ve birefringent

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``` 21yo male, 3 week history or stiff painful knee. Painful urination and eye. Organism? a) Staphylococcus aureus B E.coli 0194 C Streptococcus Pneumonia D Heamophilius influenza E Chlamydia ```

E Chlamydia Can't pee, can't see, can't climb a tree Could be salmonella/shigella

55yo painter. Aching hand and arm with pins and needles sensation in thumb, index and middle fingers. Shaking hand seeps to help. Most likely: a) Cervical spine fracture b) Compression of median nerve c) Compression of radial nerve d) C8-T1 nerve lesion e) Compression of ulnar nerve

b) Compression of median nerve

21yo male, back pain 3 months, MRI = bamboo spine/ Ankylosing spondylitis. What tissue is associated with this condition? a) HLA DQ2 b) HLA B27 c) HLA DR3 d) HLA DR2 e) HLA AD6

b) HLA B27

``` Most common cause of osteomyelitis? a) Strep Pneumonia B Staph Aureus C Strep Pyogenes D Mycobaterium tuberculosis E. H. Influenzae ```

B Staph Aureus

29yo female, fatigued, mouth ulcers, butterfly shaped rash on face. She has lupus. Her blood tests reveal which of the following? a) Anti-DsRNA positive b) Raised ESR and CRP c) Raised ESR but normal CRP d) ANCA+ e) ANA negative

c) Raised ESR but normal CRP

92yp fall and fractured hip. DXA scan = T-score of -1.6. What does this mean? a) Normal b) Osteopenia c) Osteoperosis d) Severe osteoperosis e) Padget's disease

b) Osteopenia

Patient presents with chest pain on exertion. Diagnosis?

Stable angina

ECG shows saddle-shapped ST.. diagnosis?

Pericarditis

Name a condition in which beta blockers are contraindicated?

Asthma

MRI reveals CNS lesions disseminated in space and time.. diagnosis?

Multiple sclerosis

Common side effect of ACEi?

Cough

Commonest cause of hospital acquired pnseumonia?

Staph aureus

Bowel biopsy reveals transmural lesion.. diagnosis?

Chron's

Pain in big toe, diet of excessive red win and cheese.. diagnosis?

Gout

Antibiotics for treating TB?

Rifampicin, isoniazid, pyrazinamide, ethambutol

Painless haematuria - works in a dye factory.. diagnosis?

Bladder cancer

Routine blood glucose measurement comes back a little high. What is NOT a physiological response to increased blood glucose? a) Decreased breakdown of mucle b) Glycogenesis c) Increased lipolysis d) Increased uptake of glucose cells e) Production of insulin from pancreas

c) Increased lipolysis

Who doesn't have DM T2? a) Fasting plasma glucose - 10mmol/L b) Fasting plasma glucose 8 mmol/L c) Oral glucose tolerance test 25 mmol/mol d) HbA1c 47 e) Random plasma glucose of 13 mmol/L with symptoms

d) HbA1c 47

3 risk factors for developing T2DM?

Non mod- ethnicity, FHx, Hx gestational diabetes | Mod - diet, exercise, obesity, medications (thiazide diuretic with beta blockers)

2 symptoms of DMT2?

Blurred vision, polydipsia, polyuria, fatigue

Hot and bothered, mood changes, weight loss. What other symptoms would align with diagnosis? a) Dry skin b) Hair loss c) Consitipation d) Lethargy e) Clubbing

e) Clubbing ``` Everything ramps up. Head - anxiety, heat intolerance Eyes - bulging Mouth - increased appetite Neck - goitre Chest - tachy Hands - tremor, clubbing, sweating Abdomen - weight loss, diarrhoea Menstrual - oligomenorrhoea (infrequent) ```

What are common symptoms of hypothyroidism?

Dry skin, cold intolerance, slow brain, Hair loss, hearing loss, decreased libido, Apathy/blank expression Mouth - decreased appetite Chest - brady Hands - brittle nails Abdomen - weight gain, Consitipation, Lethargy Menstrual - amenorrhoea/menorrhagia

What is the treatment of hyperthyroidism?

Carbimazole, radioiodine, surgery

What is the treatment of hypothyroidism?

Levothyroxine

16yo, abdo pain for 24hrs, weight loss and lots of water. Tachycardic, tachypnoeic, clammy, confused. Diagnosis? a) Cushing's b) Diabetes insipidus c) Diabetic ketoacidosis (DKA) d) Hyperaldosteronism e) Syndrome of inappropriate anti-diuretic hormone secretion (SIADH)

c) Diabetic ketoacidosis (DKA)

Treatment of DKA?

IV fluids and insulin

Action of aldosterone?

Increases sodium retention --> water retention --> hypertension Increases exretion of potassium ---> hypokalaemis

Thyroid function tests (TFTs) come back with TSH high, T4 low. Diagnosis? a) Sub-clinical hypothyroidism b) Primary hypothyroidism c) Sub-clinical hyperthyroidism d) Primary hyperthyroidism e) TSH secreting tumour

Primary hypothyroisism

High TSR, high T4. Diagnosis?

Pituitary problem, eg. TSH secreting tumour

TSH low, high T4. Diagnosis?

Thyroid problem - primary hyperthyroisism

TSH low, T4 low. Diagnosis?

Pituitary problem

What secretes TRH and what is TRH?

The Hypothalamus secretes TRH (Thyrotropin-releasing hormone)

What does TRH do?

This stimulates the anterior pituitary to produce Thyroid Stimulating Hormone (TSH).

What does TSH do?

This stimulates the production of T4 (thyroxine) and T3 (triiodothyronine).

Looks like they have a tan, 68yo woman. Tired and tearful. U&E show low sodium, high potassium. Most likely diagnosis? a) Addison's b) Conn's c) Cushing's d) Depression e) T1DM

Addison's

No sex drive, skin thinning, easy bruising, mood swings. BP 160/105. What investigation do you perform? a) Arterial blood gas b) 24hr urine cortisol collection c) CT head d) Thyroid function test e) Liver function tests

b) 24hr urine cortisol collection Cushing's?

Conditions caused by long term steroids? a) Adrenal insufficiency b) Conn's c) Hypothyroidism d) Hyperparathyroisism e) Phaeochromocytoma

a) Adrenal insufficiency

What causes adrenal insufficiency?

Addison's disease, steroids

What causes Conn's?

Adrenal adenoma (80%)

What causes hypothyroidism?

AI (Hashimoto's thyroiditis), iatrogeneic, iodine deficiency, drugs eg. lithium

What causes hyperparathyroidism?

Parathyroid gland ademona

What causes phaechromocytoma?

Tumur of chromaffin cells of adrenal medulla

High calcium doesn't cause..? a) Bone pain b) Constipation c) Depression d) Hypertension e) Kidney stones

d) Hypertension Hypercalaemia = BONES, STONES, GROANS AND PSYCHIC MOANS

Fasting plasma glucose threshold for diagnosing DMT2?

>7mmol/L

Oral glucose tolerance test threshold for diagnosing DMT2?

>11.1mmol/mol

Random plasma glucose threshold for diagnosing DMT2?

>11mmol/L + Sx

Symptoms of Cushing's?

Weight gain, no drinking oproblems, no acute crisis

Symptoms of diabetes insipidus instead of DKA?

No polydipsia, no weight loss, less likely to cause dehydration & shock

Symptoms of hyperaldosteronism?

Polydipsia, polyuria

Symptoms of hyperthyroidism?

Weight loss but no thirst or polydipsia

Blood test result for Cushing's?

High cortisol

Blood test result for Conn's?

High aldesterone = low potassium and high sodium

Blood test result for Addison's?

High potassium, low sodium