Phase 3B 2004/2005

Question 1

What test would you do to confirm Legionnaires disease

Answer 1

Urinary antigen test

Question 2

Treatment of Legionnaires

Answer 2

Azithromycin
Eryhtromycin
Doxycycline
Clairthromycin

Question 3

Signs of sepsis

Answer 3

increased HR
Increased cap refill
Increased RR 
Rash 
Temperature 
Drowsy

Question 4

Mechanism of action of SSRIs

Answer 4

Selectively inhibit the reuptake of 5HT at the prefrontal cortex

Question 5

Features of TGA overdose

Answer 5

Tachycardia 
Dilated pupils 
Hypotension 
Arrthymias 
Seizures 
Absent bowel sounds 
Urinary retention

Question 6

Examples of infectious diseases that causes splenomegaly

Answer 6

Salmonella typhi 
Malaria 
Leishmanias 
Viral hepatitis 
Typhoid fever 
Trypanosomiasis

Question 7

Define empirical

Answer 7

Basis of a clinically educated guess in the absences of a complete information

Question 8

What cells are affected in EBV

Answer 8

B lymphocytes

Epithelial cells

Question 9

Signs of anaphylaxis

Answer 9

Flushed 
Swelling of the tongue 
Swelling of the lips 
SOB
Stomach pain 
Fainting 
Sweating

Question 10

Outline the mechanism in which hypotension occurs in anaphylaxis

Answer 10

An allergen reacts with specific IgE antibodies on mast cells and basophils (type 1 hypersensitivity reaction), triggering the rapid release of stored histamine and the rapid synthesis of newly formed mediators. These cause capillary leakage, mucosal oedema and ultimately shock and asphyxia.

Question 11

What drugs are given in anaphylaxis

Answer 11

Corticosteriods
IM adrenaline
Chloramphenamine

Beware of a biphasic reaction a couple of hours later

Question 12

ECG changes defining an MI

Answer 12

ST elevation of 1mm in at least 2 contiguous limb leads
Hyperacute T waves
New onset BBB
ECG changes of ST elevation in 2mm in at least 2 contiguous chest leads

Question 13

Contra indications to thrombolysis

Answer 13

Previous intracranial bleed 
Aortic dissection 
GI bleed 
Neuro 
Severe HTN

Question 14

Mechanism of action of statins

Answer 14

Competitively inhibits HMG-CoA reductase

Decrease the production of cholesterol

Question 15

Drug to treat postural hypotension

Answer 15

Fludrocortisone

Question 16

ECG signs of hyperkalaemia

Answer 16

Tall tented T waves
Absent P waves
Widened QRS complex
Increased PR interval

Question 17

Modality of imaging in Intussusception and what will be seen

Answer 17

Ultrasound

Doughnut or target sign

Question 18

Complications of CF seen in neonates

Answer 18

Meconium illeus

Pancreatic obstruction

Question 19

Common disease causing organism in CF

Answer 19

Staph aureus
Haemophilus influenza
Pseudomonas aerginuosa

Question 20

What organism requires isolation treatment in CF patients

Answer 20

Burkhoderi cepacia

Question 21

Chromosomal abnormality in Down

Answer 21

Non disjunction of chromosomes
Transloaction
Mosacism

Question 22

Examples of trisomys and which chromosomes are affected

Answer 22

Pateaus (13)
Edwards (18)
Down’s (21)

Question 23

Non infective causes of splenomegaly

Answer 23

Leukaemia
Hepatitis
Sickle cell

Question 24

Examples of gram - ve bacillus

Answer 24

Klebsiella 
E.coli 
Enterobacter
Salmonella 
Shigella

Question 25

Give an example of a DNA gyros inhibitor

Answer 25

Ciprofloxacin

Question 26

Define incidence

Answer 26

Measure of probability of occurrence of a disease

Question 27

Define absolute risk

Answer 27

Actual numbers involved

Question 28

Define relative risk

Answer 28

Risk of those in the exposed group compared to risk of those in the unexposed

Question 29

Name the three types of cells found in the ovary and what tumours can arise from them

Answer 29

Granulosa cells - Granulosa cell tumours Germ cells - Teratomas Theca cells - Thecoma

Question 30

Management of ovarian cancer

Answer 30

Bilateral salingo-oophrectomy with hysterectomy and lymph node clearance

Question 31

What investigations would you do in a case of suspected SIADH

Answer 31

``` U&Es: sodium and potassium Osmolality - Serum osmolality (expect it to be low) - Urine osmolality (expect it to be high) - Urine sodium (expect it to be high TFTs Adrenal function (ensure not in a salt losing crisis) Imaging (may be an ectopic) ```

Question 32

Three ECG features of WPW

Answer 32

Delta wave Widened QRS Shorten PR interval

Question 33

Causes of a palpitations

Answer 33

``` AF Atrial flutter Palpatations AVNRT Frequent ectopics Hyperthyroid Alcohol Anxiety ```

Question 34

Types of AF

Answer 34

``` Paroxysmal Af ( ~7 days) Persistent AF Chronic AF (>12mnths) ```

Question 35

Causes of AF

Answer 35

``` Hyperthyroid Mitral stenosis Alcohol Infraction Iscahemia Inflammation Metabolic ```

Question 36

List the components of CHADsVASc

Answer 36

``` Congestive heart failure Hypertension Age > 75 Diabetes Vascular disease Age >60 Sex ```

Question 37

What options do you have for rate controlling AF

Answer 37

``` Calcium channel blocker Beta blockers (must be cardioselective) Digoxin Pill in pocket (flecanide) ```

Question 38

What is the danger with WPW

Answer 38

If you go into AF you have a risk of slipping into VF

Question 39

Sides of a previous MI on an ECG

Answer 39

T wave inversion | Pathological Q waves

Question 40

Name the cardiac enzymes that may be measured in MI

Answer 40

``` Troponin T or I Creatine Kinase Myocyctes Creatine kinase skeletal muscle AST Lactate dehydrogenase ```

Question 41

Name some causes other than MI for a raised trop

Answer 41

``` Myocardiits Endocarditis Pericarditis Trauma to the heart CKD Sepsis ```

Question 42

Reversible cause of MI

Answer 42

4 Ts - Toxins - Tamponade - Tension pneumothorax - Thrombosis 4H's - Hyperkalaemia - Hypothermia - Haemoorhage - Hypoglycaemia

Question 43

Investigations in case of microcytic hypochromic anaemia

Answer 43

``` Blood film HB electrophoresis Iron studies - Fe - Ferritin (is an acute phase reactant can be skewed) - TIBC ```

Question 44

Foetal complications in a mother with DM

Answer 44

``` Macrosomia Sudden uterine death Structural congenital defects Hypoglyaemia Shoulder dystocia ```

Question 45

Sings of Down syndrome

Answer 45

``` Epicanthic folds Brush field spots Wide saddle gap Single palmer crease Falt occiput Low set ears ```

Question 46

What is the biochemical picture typically seen in bulmia nervosa

Answer 46

Hypocholoraemia hypokalaemia hypophosphataemia hypomagnesium metabolic alkalosis if laxatives are being used it is a metabolic acidosis

Question 47

Signs of hypokalaemia

Answer 47

``` Hypotonia Cramps Tetany Palpatations Muscle weakness Reduce reflexes Arrythymias ```

Question 48

List the side effects associated with the TB drugs

Answer 48

Rifampacin: orange sercretion Isoniazid: peripheral neuropathy Pryzidamide: hepatitis Ethamabutol: Colour blindness, loss of peripheral vision

Question 49

Treatment for MS - flares - maintenance

Answer 49

Flares - IV methlypred Maintenance - IFN-beta - Natilizumab - Alemtuzumab

Question 50

6 causes of rectal bleeding

Answer 50

``` Haemorroids Constipation Inflammatory bowel disease Malignancy ischaemic colitis infective colitis ```

Question 51

Management of HONK

Answer 51

IV fluids (0.9% NaCl) - Rehydrate slowly Replace any lost K+ If glucose doesn't fall by 5mmol/L by the hour with rehydration think about starting an insulin sliding scale

Question 52

What is the bradford hill criteria

Answer 52

``` Strength of association Consistency Temporality Biological gradient Specificity Biological plausible Coherence Anaology ```