practice questions

Question 1

retroperitoneal structures

Answer 1

Question 2

what is the most likely site of perforation in complete large bowel obstruction

Answer 2

caecum

Question 3

what is the approximate volume of bile to enter the duodenum per 24 hours

Answer 3

500ml

Question 4

extraintestinal manifestations of colitis

Answer 4

erythma nodosum
apthous ulcers
nail clubbing
episcleritis
anterior uveitis
acute arthropathy/enteropathic arthritis
iritis

primary sclerosing cholangitis
ankylosing spondylitis

Question 5

causes of hyperkalaemia

Answer 5

MACHINE
M - medications (ACE inhibitors, NSAIDS)
A - acidosis (metabolic and respiratory)
C - cellular destruction (burns, traumatic injury)
H - hypoaldosteronism, haemolysis
I - intake (excessive)
N - nephrons (renal failure)
E - excretion (impaired)

Question 6

gene associated with ankylosing spondylitis

Answer 6

HLA-B27

Question 7

gene associated with giant cell arteritis

Answer 7

HLA-DR4

Question 8

causes of pancreatits

Answer 8

GET SMASHED

Gallstones
Ethanol (Alcohol)
Trauma
Steroids
Mumps
Autoimmune disease, such as Systemic Lupus Erythematosus (SLE) or Sjogren’s syndrome
Scorpion venom (a rare and unlikely cause in most countries)
Hypercalcaemia
Endoscopic retrograde cholangio-pancreatography (ERCP)
Drugs, such as Azathioprine, NSAIDs, or Diuretics

Question 9

protocol for dilated AAA

Answer 9

small AAA: 3.0cm to 4.4cm
repeat ultrasound scan in 12 months

medium AAA: 4.5cm to 5.4cm
repeat ultrasound scan in 3 months

large AAA: 5.5cm or bigger
referral to specialist vascular team in 2 weeks

Question 10

what are the risk factors for developing gallstones from acute cholecystitis

Answer 10

the 5 F’s
fat (bmi greater than 30 kg/m2)
female
fertile (one or more children)
fair (caucasian)
forty (age greater than or equal to 40 years)

Question 11

common gall stone compositions

Answer 11

cholesterol stones – purely of cholesterol from excess cholesterol production (linked with poor diet, obesity)

pigment stones – from excess bile pigments production (commonly seen in those with known haemolytic anaemia)

mixed stones - comprised of a mixture of both cholesterol and pigment

Question 12

common renal stone compositions

Answer 12

calcium oxalate
calcium phosphate
urate stone

Question 13

causes of c.diff

Answer 13

spread from infected person via faeco-oral route
broad abx use (eg. ceftriaxone, ciprofloxacin)

Question 14

list some different anatomical positions of the appendix

Answer 14

Pre-ileal – anterior to the terminal ileum – 1 or 2 o’clock.
Post-ileal – posterior to the terminal ileum – 1 or 2 o’clock.
Sub-ileal – parallel with the terminal ileum – 3 o’clock.
Pelvic – descending over the pelvic brim – 5 o’clock.
Subcecal – below the cecum – 6 o’clock.
Paracecal – alongside the lateral border of the cecum – 10 o’clock.
Retrocecal – behind the cecum – 11 o’clock

Question 15

landmarks at T12, L1, L2, L3 and L4

Answer 15

T12 - coeliac trunk
L1 - superior mesenteric artery
L2 - testicular artery and renal artery
L3 - inferior mesenteric artery
L4 - bifurcation of aorta

Question 16

gene associated with a family history of breast and ovarian cancer

Answer 16

BRCA genes (1 and 2)

Question 17

drugs that cause renal impairment/should be considered to stop

Answer 17

DIAMOND

Diuretics
IV contrast
ACE inhibitor /ARBs
Metformin
Opiates (not completely contraindicated but consider smaller dose)
NSAIDS
Digoxin

+ aminoglycosides (gentamicin)

Question 18

hep b antigens (acute infection, past infection, chronic infection and never infected but vaccinated)

Answer 18

Question 19

ecg changes in hyperkalaemia

Answer 19

tented t waves
prolonged QRS complex
absent p waves
asystole

Question 20

ecg changes in hypokalaemia

Answer 20

ST depression
t wave flattening/inversion
prominent u waves (best seen in the precordial leads V2-V3)

Question 21

how does pseudogout differ from gout in investigations

Answer 21

on joint aspiration in gout, you will see needle shaped, negatively birefringent, monosodium urate crystals under polarised light

in pseudogout, you will see weakly-positively birefringent, rhomboid-shaped, calcium pyrophosphate dihydrate crystals

Question 22

what are the 4 TB medications and their side effects

Answer 22

rifampicin - causes urine/tears to turn orange or drug induced hepatitis
isoniazid - peripheral neuropathy
pyrazinamide - drug-induced hepatitis, gout
ethambutol - optic neuropathy

Question 23

what are the indications of renal replacement therapy in aki patients

Answer 23

hyperkalaemia refractory (resistant) to medical therapy
metabolic acidosis refractory to med therapy
resistant fluid overload
uraemic pericarditis
uraemic encephalopathy - vomiting, confusion, drowsiness, reduced consciousness

Question 24

landmarks at S2 and S3

Answer 24

S2 - posterior superior iliac spines
S3 - posterior inferior iliac spines

Question 25

intra-peritoneal structures

Answer 25

**SALTDSPR** S: stomach A: appendix L: liver T: transverse colon D: duodenum (first part) S: small intestines (jejunum and ileum) P: pancreas (only tail) R: rectum (upper third)

Question 26

different stoma types

Answer 26

- colostomy - flush to the skin and are not spouted, as the stool produce is less alkali due to the enzymes present in the large bowel, typically in LIF - ileostomy - commonly in RIF, using the small bowel, spouted as then enzymes in the small bowel can irritate the skin and the stool has a more liquid consistency - urostomy - created after a cystectomy, typically located in RIF, bag will contain urine - loop colostomy or loop ileostomy - contains two loops of bowels which are visible, often done to protect distal anastomoses and to allow the bowel to recover before reconnecting the bowel

Question 27

management of influenza

Answer 27

antipyretic anti-viral – oseltamivir (Tamiflu)

Question 28

staining technique for TB

Answer 28

Ziehl–Neelsen stain

Question 29

borders of the inguinal triangle

Answer 29

medial – lateral border of the rectus abdominis muscle lateral – inferior epigastric vessels inferior – inguinal ligament

Question 30

borders of the femoral triangle

Answer 30

roof - fascia lata superior - inguinal ligament lateral - medial border of sartorius medial - medial border of adductor longus

Question 31

drugs that cause drug-induced SLE

Answer 31

carbamazepine chlorpromazine isoniazid pyrazinamide infliximab

Question 32

common locations for renal stone impaction/colic

Answer 32

pelvic-ureteric junction vesico-ureteric junction pelvic brim

Question 33

what are the indications of surgery in patients with renal stones

Answer 33

pain not managed medically stone is over 7mm they only have one kidney bilateral stones sepsis

Question 34

prophylaxis for PONV

Answer 34

ondansetron (5HT3 receptor antagonist) – avoided in patients at risk of prolonged QT interval dexamethasone (corticosteroid) – used with caution in diabetic or immunocompromised patients cyclizine (histamine (H1) receptor antagonist) – caution with heart failure and elderly patients

Question 35

CSF in viral meningitis

Answer 35

clear CSF with a high-normal protein, high-normal glucose and a very high WCC mainly lymphocytes

Question 36

CSF in bacterial meningitis

Answer 36

cloudy, turbid CSF with high protein, low glucose and a high white cell count which are mostly neutrophils

Question 37

cause and symptoms of post cholecystectomy syndrome

Answer 37

attributed to changes in the bile flow after removal of the gallbladder but symptoms go away over time - diarrhoea - indigestion - epigastric or right upper quadrant pain and discomfort - nausea - intolerance of fatty foods - flatulence

Question 38

extrapulmonary manifestation of squamous cell lung cancer

Answer 38

hypercalcaemia

Question 39

extrapulmonary manifestations of small cell lung cancer

Answer 39

SIADH (ectopic ADH secretion) Cushing’s syndrome (ectopic ACTH secretion) limbic encephalitis (small cell lung cancer causes the immune system to make antibodies in the brain, esp against the limbic system)

Question 40

differentials of upper GI bleed

Answer 40

cancer oesophageal varices Mallory Weiss tears PUD

Question 41

which zone does BPH primarily affect

Answer 41

transitional zone

Question 42

which zone does prostate cancer primarily affect

Answer 42

peripheral zone

Question 43

risk of transmission of hep B in needlestick injury

Answer 43

1/3 (much lower if recipient is vaccinated)

Question 44

risk of transmission of hep C in needlestick injury

Answer 44

1/30

Question 45

risk of transmission of HIV in needlestick injury

Answer 45

1/300 (much lower if patient’s on ARV)

Question 46

staining technique for malaria

Answer 46

Geimsa staining