Phase 3B 2018

Question 1

Four investigations to confirm HF

Answer 1

CXR
BNP
ECG
Bloods

Question 2

4 cardiac complications from the MI could exacerbate heart failure

Answer 2

Arrhythmias from ischaemic damage (AF)
Papillary cord rupture
Valvular disease
Dresslers syndrome

Question 3

Treatment of acute angle closure glaucoma

Answer 3

Triad of treatment

• Beta-blockers (timolol): suppress aqueous humour production
• IV acetazolamide: reduces aqueous production
• Pilocarpine: miosis opens blocked drainage duct

Question 4

Laser treatment for acute glaucoma

Answer 4

Peripheral iridectomy, piece of iris is removed at 12 o clock position in both eyes to allow aqueous to flow

Question 5

What is a pleural effusion an explain the underlying mechanism

Answer 5

A pleural effusion is fluid in the pleural space
Divided into transudates
- Increased venous pressure or low proteinaemia
Exudates
- Increased leakiness of the pleural capillaries secondary to infection, inflammation and malignancy

Question 6

Four tests to confirm TB

Answer 6

Sputum culture
Qunatiferon test
Biopsy of any lesion or pleural biopsy
PCR of sputum sample

Question 7

Explain confounding

Answer 7

A situation in which the estimate between an exposure and an outcome is distorted because of the association of the exposure with another factor (confounder) that is also independently associated with the outcome.

Question 8

Example of confounding

Answer 8

Study looking at association between occupation and lung cancer could be the result of the occupational cohort more likely to smoke and therefore at increased risk

Question 9

Features that could be felt on DRE and possible causes for each

Answer 9

Smooth and large: BPH
Craggy and irregular: PCa
Boggy and tender: Prostatis

Question 10

Complications of BPH

Answer 10

Urinary retention
Impotence
Nocturia/Daytime sleepiness

Question 11

Risk factors for developing perinatal psychosis

Answer 11

History of postpartum depression 
Unplanned pregnancy 
Lack of support 
Marital problems 
Social circumstances 
Sleep deprivation 
Hormonal changes

Question 12

Features of base of skull fractures

Answer 12

Battle sign: brusied mastoid
Pando sign: bilateral orbital bruising
Haemotypmanum

Question 13

Management of a base of skull fracture

Answer 13

Neurosurgical consult if CT +ve 
Neuro obs until GCS 15/25
Analgesia 
Suture scalp lacs
ABC if open 

Increased ICP

• Elevate the bed
• Good sedation, analgesia + NM block
• Neuroprotetive ventilation
• Mannitol or hypertonic saline

Question 14

Role of GCS

Answer 14

Measure level of consciousness following a traumatic brain injury

Question 15

Differential diagnosis in a case of PCOS

Answer 15

Cushing’s
Androgen secreting tumour
Thyroid dysfunction