phase 2 saq 3

Question 1

first line treatment for unstable angina

Answer 1

GTN spray (1 mark) and either B-blocker or Calcium Channel Blocker

Question 2

extra-articular manifestations of ankylosing spondylitis

Answer 2

5 A’s: anterior uveitis (2), autoimmune bowel disease (2), apical lung fibrosis (2), aortic regurgitation (2), amyloidosis

Question 3

ankylosing spondylitis management

Answer 3

NSAIDS (1), Steroids during flares (1), Anti-TNF

Question 4

describe moderate asthma

Answer 4

PEFR more than 50-75% best or predicted and normal speech, with no features of acute severe or
life-threatening asthma.

Question 5

descrbe acute severe asthma

Answer 5

PEFR 33-50% best or predicted (less than 50% best or
predicted in children) or respiratory rate of at least 25/min in people over the age of 12 years, 30/min in children between the ages of 5-12 years, and 40/min in children between 2-5 years old, or pulse rate of at least 110/min in people over the age of 12 years, 125/min in children between the ages of 5-12 years, and 140/min in children between 2-5 years old, or inability to complete sentences in one breath, or accessory muscle use, or inability to feed (infants), with oxygen saturation of at least 92%

Question 6

describe life threatning asthma

Answer 6

PEFR less than 33% best or predicted, or oxygen saturation of less than 92%, or altered consciousness, IorI poor respiratory effort, or silent chest, or confusion.

Question 7

indications of good asthma control

Answer 7

No night-time symptoms
● Inhaler used no more than three times per week
● No breathing difficulties, cough or wheeze on most days
● Able to exercise without symptoms
● Normal lung function test

Question 8

adrenaline mechanism of action

Answer 8

Stimulation / agonist (1) of beta (1) adrenergic (1) receptors

Question 9

physiological responses to mediators of anaphylaxis

Answer 9

Vasodilation (1), Increased vascular permeability (1), tachycardia (1), hypotension (1), maximise blood glucose levels in brain

Question 10

non malignant causes of lymphadenopathy

Answer 10

infection, sarcoidosis, phenytoin, EBV associated lymphoproliferative disease, SLE

Question 11

symotoms of CLL

Answer 11

anorexia, weight loss, fatigue, bleedings, infections, abdominal pain

Question 12

additional test to confirm CLL diagnosis

Answer 12

Immunophenotyping

Question 13

3 treatments for CLL

Answer 13

• chemotherapy
• radiotherpay
• stem cell transplant

Question 14

non-pharmacological management options for OA

Answer 14

Patient education (1), activity / exercise (1), weight loss (1), improved diet (1) - anti-inflammatory foods physiotherapy (1), occupational therapy

Question 15

topical management for OA

Answer 15

NSAIDs (1), capsaicin

Question 16

oral managemnt of OA

Answer 16

paracetamol (1), NSAIDs (1), opioids (1), bisphosphonates

Question 17

What treatment would you prescribe Trevor to prevent stroke AFTER tia

Answer 17

aspirin

Question 18

treatment for ischaemic total anterior circulation stroke

Answer 18

thrombolysis / Alteplase within 4.5 hours

Question 19

chest x ray for TB

Answer 19

Bilateral hilar lymphadenopathy (1), ghon focus

Question 20

specific signs of IBD

Answer 20

pyoderma gangrenosum, erythema nodosum, clubbing, arthritis

Question 21

gold standard test for UC

Answer 21

Colonoscopy and biopsy

Question 22

What marker, if raised, is definitive for diagnosing iron deficiency anaemia
in an iron profile?

Answer 22

ferritin

Question 23

pathophysiology of bronchitis

Answer 23

an irritant leads to inflammation causing the epithelium to become ulcerated and
squamous epithelium replaces columnar cells when the ulcer heals, leading to
scarring and thickening of the wall

Question 24

treatment for a moderate acute exacerbation of COPD caused
by a bacterial infection?

Answer 24

nebulisers, steroids and antibiotics

Question 25

Why are diabetics a classic culprit of silent MIs?

Answer 25

Diabetic neuropathy so do not feel anginal pain so the diagnosis may be missed. Patients can often die from a sudden collapse

Question 26

two cells involved in acute inflammation

Answer 26

Neutrophils, monocytes

Question 27

What does beta-naphthylamine increase the risk of ?

Answer 27

bladder cancer

Question 28

methods of innate immunity

Answer 28

lysozyme in tears, skin as a physical barrier, cilia and mucus in bronchus, vaginal flora

Question 29

what two factors do TH2 cells release and what are their functions

Answer 29

IL-4 – induces B cell proliferation ; IL-5 – induces B cell differentiation into plasma cells

Question 30

what does F stand for in adverse drug reactions

Answer 30

Failure of therapy eg Failure of Oral contraceptive pill in the presence of an enzyme inducer

Question 31

Which two markers would indicate a chronic infection of liver cirrhosis due to hepatits

Answer 31

hepatitis surface antigen hepatitis core antibody

Question 32

most common cause of spontaneous bacterial peritonitis?

Answer 32

E.coli

Question 33

complications of CML

Answer 33

Myelosuppression, neutropenic sepsis, blast crisis, tumour lysis syndrome

Question 34

what cancer can CLL change to

Answer 34

non hodghkins lymphoma

Question 35

risk factors for tonic clonic seizures

Answer 35

Premature birth, cerebral palsy, brain tumour, meningitis, neurofibromatosis, family history, traumatic brain injury, stroke, cocaine use

Question 36

driving rules for epilepsy

Answer 36

seizure free for 12 months if this is not the patient’s first seizure

Question 37

comlplication. of epilpeys

Answer 37

Injury, tongue biting, status epilepticus, sudden death, Todd’s paralysis, shoulder dislocation

Question 38

Which area of the brain is the primary motor cortex found

Answer 38

Anterior to central sulcus in the frontal lobe

Question 39

investigation to diagose feltys

Answer 39

abdominal ultrasound

Question 40

Define the Z score for DEXA scan

Answer 40

Number of standard deviations patient’s bone density falls below mean for their age

Question 41

why does nephritis syndrome cause hameaturia

Answer 41

Increased permeability of glomeruli leads to red blood cells moving into the filtrate

Question 42

What parasympathetic nerve is involved in micturition?

Answer 42

Pelvic splanchnic nerve

Question 43

tests for cushings

Answer 43

Random plasma cortisol or overnight dexamethasone suppression test or 24 hour urinary free cortisol

Question 44

two of the criteria for a screening process to be performed.

Answer 44

Condition should be important, recognisable latent or early symptomatic stage, natural course of condition should be adequately understood, suitable test, test acceptable to population

Question 45

Define incidence.

Answer 45

= a measure of the risk of developing some new condition within a specified period of time

Question 46

Define deontology

Answer 46

based on the belief that we owe a duty of care to each other, ignores the consequences.

Question 47

fiest line test for stroke

Answer 47

non contract ct head