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1
Q

A 31-year-old man presents to his GP with a 2-day history of central chest pain, which gets worse when he breathes in and when exercising. Cardiovascular and respiratory examinations detect no abnormalities, however, the patient winces in pain when the GP palpates for heaves and thrills. What is the most likely diagnosis?

A Pulmonary embolism
B Myocarditis
C Tension pneumothorax
D Costochondritis
E Pleurisy
A

Costochondritis.

2
Q

Which of the following is unlikely to cause pleuritic chest pain?

A Tension pneumothorax
B Rib fracture
C Pulmonary fibrosis
D Pneumonia
E Pericarditis
A

Pulmonary fibrosis.

3
Q

A 28-year-old PhD student books an appointment to see her GP about some small lumps on her groin. On closer inspection, there are multiple small, firm, dome- shaped lumps with an umbilicated centre. On direct questioning, she reveals that she has recently had a new sexual partner. What is the most likely diagnosis?

A Molluscum contagiosum
B Varicella zoster
C Syphilis
D Gonorrhoea
E Sebaceous cysts
A

Molloscum contagiosum.

4
Q

A 71-year-old woman presents to A&E with a headache that has gradually been getting worse over the past week. The pain is localised over the left half of her forehead and does not radiate. She has also been eating less frequently as her jaw becomes painful when she chews her food. On direct questioning, she admits to experiencing some stiffness and pain in her shoulders over the past 6 months. On examination, she has a thickened, non-pulsatile temporal artery. What is the first step in her management?

A Check ESR
B Temporal artery biopsy
C IV hydrocortisone
D Oral prednisolone
E IV antibiotics.
A

Oral prednisolone.

5
Q

A 24-year-old female, who has recently returned from a 3-week trip to Vietnam, complains that she has been feeling ‘under the weather’ with fevers and joint pain. On direct questioning, she reveals that she had unprotected sexual intercourse with a stranger whilst in Vietnam. She is jaundiced and has right upper quadrant tenderness. Hepatitis B serology is requested. The results are shown below:
HBsAg +
HBeAg -
HBcAb IgM +
HBcAb IgG +
HBsAb -
What is the hepatitis status of this patient?

A Acute infection
B Chronic infection
C Cleared
D Vaccinated
E Susceptible
A

Acute infection.

6
Q

An 18-year-old female is brought to A&E, by ambulance, having been involved in a road traffic accident. She has bled significantly and needs an urgent blood transfusion. Her blood group is AB+. Which of the following blood groups will she be
able to accept?

A A+ 
B AB- 
C B-
D O-
E All of the above
A

All of the above.

7
Q

Which clinical test can be used to diagnose ankylosing spondylitis?

A Schober's test
B Schirmir's test
C Buerger's test
D W eber's test
E Tensilon test
A

Schober’s test.

8
Q

A 53-year-old Afro-Caribbean man visits the GP to have his blood pressure measured. He has a history of hypertension and has been taking Amlodipine for 6 months. His blood pressure is 162/110 mm Hg. The GP is not satisfied with his blood pressure control and wants to step up his management. Which medication should be added?

A Verapamil
B Spironolactone
C Bendroflumethiazide D Doxazosin
E Enalapril

A

Enalapril.

9
Q

An 81-year-old man has been urinating about 12 times every day, including at night, and has difficulty starting a stream, which he describes as being ‘very weak’. He has also suffered from lower back pain over the past month. A DRE is performed, revealing an asymmetrically enlarged, nodular prostate gland. Which investigation is most likely to provide a definitive diagnosis?

A PSA
B Acid phosphatase
C Transrectal ultrasound-guided biopsy
D CT Scan
E Isotope bone scan
A

Transrectal ultrasound guided biopsy.

10
Q

A 61-year-old man is brought to A&E by his daughter as he has become increasingly breathless over the past 24 hours and he has been coughing up a large amount of green sputum. He has a past medical history of COPD. Arterial blood gases are requested which show the following results (on room air):
pH : 7.33 (7.35-7.45)
PaO2 : 6.7 kPa (> 10.6 kPa on air)
PaCO2 : 9.6 kPa (4.7 - 6 kPa on air) HCO3- : 33 mmol/L (22 – 28 mmol/L) Respiratory Rate : 22 /min
What is the diagnosis?

A Partially compensated respiratory acidosis
B Fully compensated respiratory acidosis
C Partially compensated metabolic acidosis
D Fully compensated metabolic acidosis
E Acute type 1 respiratory failure

A

Partially compensated respiratory acidosis.

11
Q

A 73-year-old man has come to the outpatient clinic with his wife. She says that her husband seems very confused on some days and then seems completely normal on others. During the consultation, the patient appears confused with an AMTS of 4/10. He is distressed and claims that he can see little men running across the desk towards him. The doctor also notices a resting tremor. What is the most likely diagnosis?

A Lewy body dementia
B Alzheimer’s disease
C Depressive pseudodementia
D Frontotemporal dementia
E Vascular dementia
A

Lewy body dementia.

12
Q

Which of the following is part of the diagnostic criteria for diabetes mellitus?

A Two fasting blood glucose > 7.8 mmol/L in an asymptomatic patient
B One fasting blood glucose > 11.1 mmol/L in an asymptomatic patient
C One random blood glucose > 11.1 mmol/L in a symptomatic patient
D Two random blood glucose > 7 mmol/L in an asymptomatic patient
E Glycosuria and ketonuria on urine dipstick

A

One random blood glucose > 11.1 mmol/L in a symptomatic patient.

13
Q

The red reflex is an important part of the ophthalmological examination. Which
of the following conditions can result in loss of the red reflex?

A Herpes simplex keratitis
B Cataract
C Astigmatism
D Conjunctivitis
E Aniridia
A

Cataract.

14
Q

A 32-year-old man presents to his GP with an 8-month history of diffuse abdominal pain and frequent loose motions. He has also been passing blood with his stools. On examination, a red ring around the cornea is seen in both eyes. The patient is referred for a colonoscopy and biopsy. What would you expect the biopsy to show?

A Non-caseating granulomas
B Eosinophilic infiltration
C Villous atrophy and crypt hyperplasia
D High grade dysplasia and metaplastic columnar epithelium
E Mucosal ulcers, goblet cell depletion and crypt abscesses

A

Mucosal ulcers, goblet cell depletion and crypt abscesses.

15
Q

A 28-year-old professional cyclist visits his GP complaining of headaches and blurred vision. He is worried that his symptoms will affect his performance in an important race in 3 weeks’ time. On direct questioning, he admits to taking ‘performance enhancers’ in preparation for his race. On examination, scratch marks are seen on his trunk. What is the most likely diagnosis?

A Thalassaemia
B Polycythaemia rubra vera
C Secondary polycythaemia
D Hodgkin’s lymphoma
E Non-Hodgkin’s lymphoma
A

Secondary polycythaemia.

16
Q

A 22-year-old teacher visits her GP after fainting several times over the past 2 months. She does not experience any palpitations, light-headedness or auras before she faints, and she recovers very quickly. She has not bitten her tongue or become incontinent at any point. When questioned about the timing of these episodes, she reveals that she has only ever collapsed at work after she has been writing on the whiteboard for quite some time. On examination, a firm, immobile lump is palpated in her left supraclavicular fossa. What is the most likely diagnosis?

A Paroxysmal atrial fibrillation
B Transient ischaemic attack
C Atonic seizures
D Subclavian steal syndrome
E Vasovagal syncope
A

Subclavian steal syndrome.

17
Q

Which of the following triads best describes the main features of nephrotic syndrome?

A Proteinuria, Hypoalbuminaemia, Oedema
B Haematuria, Hypoalbuminaemia, Oedema
C Proteinuria, Haematuria, Hyperlipidaemia
D Proteinuria, Haematuria, Hypoalbuminaemia
E Frequency, Urgency, Dysuria

A

Proteinuria, hypoalbuminaemia, oedema.

18
Q

A 63-year-old man with ascending bilateral limb weakness and ascending paraesthesia is diagnosed with Guillain-Barré syndrome. 3 weeks prior to the onset of these symptoms he suffered from gastroenteritis. Which organism is most likely to have caused this infection?

A Salmonella
B Campylobacter jejuni
C E. coli 0157
D Rotavirus
E Entamoeba histolytica
A

Campylobacter jejuni.

19
Q

A 79-year-old care home resident is admitted to hospital with a 4-day history of a cough productive of green sputum. She has also experienced some chest pain and shortness of breath. A chest X-ray shows an area of consolidation in the right middle lobe with a right-sided pleural effusion. What is the most appropriate treatment option?

A Co-amoxiclav and clarithromycin
B Co-trimoxazole
C Metronidazole
D Flucloxacillin
E Rifampicin and isoniazid
A

Co-amoxiclav and clarithromycin.

20
Q

A 76-year-old care home resident has fractured his neck of femur having fallen out of bed. He is referred to the orthopaedic surgery department and undergoes an operation. Post-operatively, he is in considerable pain and is given 5 mg morphine sulphate. Which of these side-effects is he most likely to experience?

A Constipation 
B Blurred vision 
C Cough
D Tremor 
E Rash
A

Constipation.

21
Q

A 65-year-old man, who is currently undergoing treatment for chronic lymphocytic leukaemia, presents with an extremely painful left great toe. On closer inspection, he has a fiercely inflamed left metatarsophalangeal joint. He has no other symptoms. What would you expect to see on analysis of the joint fluid aspirate?

A High WCC, turbid fluid
B Positively birefringent, rhomboid-shaped crystals
C Positively birefringent, needle-shaped crystals
D Negatively birefringent, rhomboid-shaped crystals
E Negatively birefringent, needle-shaped crystals.

A

Negatively birefringent, needle-shaped crystals.

22
Q

A 47-year-old woman has had several ‘dizzy spells’ over the past 6 weeks. She has been feeling very faint when getting out of bed in the morning and has also experienced some vague abdominal pain along with weight loss and lethargy. Examination reveals dark palmar creases and vitiligo on her back. What is the most appropriate investigation to request?

A Full blood count
B Fasting blood glucose
C ECG
D Short synacthen test
E Thyroid function test
A

Short synacthen test.

23
Q

A 78-year-old woman visits her GP with a 4-month history of constipation and blood coating her stools. She has also lost 9 kg of weight and complains that she doesn’t ‘feel empty’ after defecating. Abdominal examination is normal, apart from an enlarged left supraclavicular lymph node. What is the most likely diagnosis?

A Cancer of the rectum
B Cancer of the sigmoid colon
C Gastric carcinoma
D Cancer of the caecum
E Pancreatic cancer
A

Cancer of the rectum.

24
Q

A 75-year-old man is rushed into A&E by ambulance. He finds it difficult to answer simple questions and is struggling to speak. On examination, power is 2/5 in his right arm, 4/5 in his right leg and 5/5 in his left arm and leg. He has marked facial muscle weakness on the right half of his face and he is blind in the right half of his visual field. A CT head scan is performed and an ischaemic stroke is diagnosed. Which artery is most likely to be involved?

A Right anterior cerebral artery
B Left anterior cerebral artery
C Right posterior cerebral artery
D Right middle cerebral artery
E Left middle cerebral artery
A

Left middle cerebral artery.

25
Q

A 62-year-old diabetic on metformin sees his GP for a routine blood test. He claims that he has been compliant with his treatment and has not experienced any symptoms recently. His blood test reveals:
Na+ : 116 mmol/L (135-145)
K+ : 3.7 mmol/L (3.5-5)
Ca2+ : 2.4 mmol/L (2.2-2.6)
Total Cholesterol : 9.2 mmol/L (< 5) Serum Albumin : 48 g/L (35 -50) TFT - Normal
SST - Normal
What is the most likely cause of his hyponatraemia?

A Addison's disease
B Hypothyroidism
C Erroneous result
D Drug side-effect
E Nephrotic syndrome
A

Erroneous result.

26
Q

Which of the following lung pathologies produces the ‘sail sign’ appearance on CXR?

A Right upper lobe collapse
B Right middle lobe collapse
C Right lower lobe collapse
D Left upper lobe collapse
E Left lower lobe collapse
A

Left lower lobe collapse.

27
Q

A 47-year-old man has vomited 3 times and has not passed any faeces or flatus for the last 4 days. He had an open cholecystectomy 6 years ago but has otherwise been relatively fit and healthy. What is the best immediate management option for this patient?

A NG tube and IV fluids
B Surgery to resolve the obstruction
C Gastrograffin
D IV antibiotics
E Reassure and discharge
A

NG tube and IV fluids.

28
Q

Which of the following is not a major criterion in the Framingham criteria for congestive cardiac failure?

A Bilateral ankle oedema
B Paroxysmal nocturnal dyspnea
C Cardiomegaly
D S3 gallop
E Acute pulmonary oedema
A

Bilateral ankle oedema.

29
Q

A 46-year-old female has experienced a painful sensation on the outer side of her left thigh for the past 3 months. She mentions that the sensation is very ‘bizarre’ and sometimes feels like it is burning or tingling. She has no other symptoms and has no past medical history of note. What is the most likely diagnosis?

A Meralgia paraesthetica
B Multiple sclerosis
C Sciatica
D Peripheral neuropathy
E Disc herniation
A

Meralgia paraesthetica.

30
Q

A 47-year-old female suffering from RUQ pain, lethargy and pruritus, is found to have an ALP of 300 IU/L (30-150 IU/L) and serology is positive for anti-mitochondrial antibodies. She also complains of dry, itchy eyes. Examination findings include icterus and xanthelasma. What is the most likely diagnosis?

A Type 1 autoimmune hepatitis
B Type 2 autoimmune hepatitis
C Primary sclerosing cholangitis 
D Primary biliary cirrhosis
E Cirrhosis
A

Primary biliary cirrhosis.

31
Q

What is costochondritis and how does it usually present?

A

Costochondritis is acute inflammation of the costal cartilage. It is usually idiopathic.
Costochondritis usually presents with chest pain and tenderness on palpation either side of the sternum. The pain often gets worse when coughing, on deep inspiration or during exercise.

32
Q

What is Tietze’s syndrome?

A

Tietze’s syndrome is a form of costochondritis characterised by painful swelling of the costal cartilage.

33
Q

What are the causes of pleuritic chest pain, and what is it?

A

Pleuritic chest pain is described as ‘a sharp, stabbing pain that gets worse when breathing in or coughing’.
5Ps: PE, pneumothorax, pericarditis, pleurisy and pneumonia.
Other causes of pleuritic chest pain include subphrenic pathology (e.g. abscess), rib fractures and costochondritis

34
Q

What is molloscum contagiosum and how does it present?

A

Molluscum contagiosum is a skin condition caused by a pox virus. It mainly occurs in children and is spread via skin-to-skin contact. In adults, it tends to be transmitted via sexual contact and occurs on the lower abdomen and genital area. The skin lesions are typically described as dome-shaped, firm and smooth with an umbilicated centre. The lesions will last for around 8 months.

35
Q

What is a sebaceous cyst and how does it present?

A

A sebaceous cyst is a keratinous, epithelium- lined cyst arising from a blocked hair follicle. They are very common and appear as smooth lumps with an overlying punctum that may discharge a creamy substance.

36
Q

What is gonorrhoea and how does it present?

A

Gonorrhoea is another sexually-transmitted infection, caused by Neisseria gonorrhoeae, which presents with vaginal or urethral discharge, dysuria and dyspareunia (in women).

37
Q

How does chicken pox present?

A

Chicken pox is characterised by the sudden appearance of an extremely itchy rash. The vesicles appear, weep and crust over. It is also often accompanied by prodromal flu-like symptoms.

38
Q

What causes shingles and how does it present?

A

Shingles is caused by reactivation of VZV (during times of stress), which lies dormant in dorsal root ganglia after primary infection. It causes tingling and painful skin lesions in a dermatomal distribution.

39
Q

What is syphilis and how does it present?

A

Syphilis is a sexually- transmitted disease caused by Treponema pallidum. It begins as a single painless genital ulcer, which is followed by generalised lymphadenopathy and widespread skin lesions. Tertiary syphilis is when the infection spreads to the brain and causes neurological complications.

40
Q

What is temporal arteritis and how does it present?

A

Temporal arteritis (also known as giant cell arteritis) is a large-vessel vasculitis that typically presents with a unilateral headache, scalp tenderness and jaw claudication. There may also be systemic features such as malaise, fever and weight loss. Temporal arteritis, if left untreated, can cause irreversible loss of vision (due to ophthalmic artery involvement) so it must be treated urgently with oral prednisolone.

41
Q

How is temporal arteritis diagnosed and treated?

A

ESR will be measured and is likely to be elevated. Temporal artery biopsy showing inflammatory changes is diagnostic of temporal arteritis. Risk of false-negatives- biopsy may not sample affected tissue.
These investigations should not delay treatment with oral prednisolone.

42
Q

Where is hepatitis B virus (HBV) prevalent?

A

Sub-Saharan Africa and Southeast Asia.

43
Q

How is hepatitis B virus transmitted?

A

Sexual contact.
Blood, e.g. contaminated needles.
Vertical transmission from mother to child.

44
Q

What is the molecular biology of hepatitis B virus?

A

HBV is a small DNA virus composed of an outer envelope which contains surface antigen (HBsAg).
This surrounds a nucleocapsid which encloses the viral DNA.
The nucleocapsid carries the core antigen (HBcAg), which is involved in viral replication.
The e antigen (HBeAg) is also closely associated with the nucleocapsid.

45
Q

Which components of hepatitis B serology will susceptible individuals be positive/negative in?

A

Susceptible individuals will be negative in all components of hepatitis B serology.

46
Q

Which components of hepatitis B serology will acutely infected individuals be positive in?

A

HBsAg +ve.
HBeAg +/-ve.
HBcAb IgM +ve.
HBcAb IgG +ve.

47
Q

Which components of hepatitis B serology will chronically infected individuals be positive in?

A

HBsAg +ve.
HBeAg +/-ve.
HBcAb IgG +ve.
If HBsAg is detected in the serum 6 months after an acute infection, it suggests that the patient has developed chronic hepatitis B.

48
Q

Which components of hepatitis B serology will previously infected patients who have cleared the virus be positive in?

A

HBcAb IgG +ve.

HBsAb +ve.

49
Q

Which component of hepatitis B serology is administered in the vaccination?

A

HBsAg.

50
Q

What will the hepatitis B serology of a vaccinated individual show?

A

HBsAb +ve.

51
Q

What is the earliest serological mark of acute hepatitis B infection?

A

Rise in HBsAg.

52
Q

What serological result follows a rise in HBsAg in acute hepatitis B infection?

A

This will be followed by a rise in HbcAb IgM and HBcAb IgG.

53
Q

When is HBcAb IgM present in hepatitis B serology?

A

Acute phase of infection.

54
Q

When can HBeAg be present in hepatitis B serology, and what is it used as?

A

HBeAg can be present in both acute and chronic infection – it tends to be used as a marker of infectivity and to monitor response to treatment.

55
Q

Which component of hepatitis B serology will persist once the virus is cleared or if the infection becomes chronic?

A

HBcAb IgG.

56
Q

What is ankylosing spondylitis and how does it present?

A

Ankylosing spondylitis is a seronegative spondyloarthropathy that presents with lower back pain and stiffness that is worst in the morning and improves with activity.
It leads to a reduced range of spinal motion, which can be detected using Schober’s test.

57
Q

What is Schirmer’s test used for?

A

Schirmer’s test assesses tear production in patients with Sjögren’s syndrome.

58
Q

What is Buerger’s test used for?

A

Buerger’s test is used to demonstrate peripheral vascular disease.

59
Q

What is Weber’s test used for?

A

Weber’s test, when used in combination with Rinne’s test, can differentiate between conductive and sensorineural hearing loss.

60
Q

What is the Tensilon test and what is it used for?

A

The Tensilon test involves administering a very
short-acting acetylcholinesterase inhibitor to diagnose myasthenia gravis by demonstrating by a rapid improvement in muscle weakness.

61
Q

What is the Schober’s test for and how is it performed?

A

A mark is made on the skin overlying the 5th lumbar spinous process (usually at the level of the posterior superior iliac spine) and a second mark is made 10 cm above the first.
The patient is then asked to bend over, which flexes the spine.
In normal subjects, the distance between the two marks will increase to > 15 cm.
If the distance is less than 15 cm, this indicates a reduction in spinal flexion, which supports a diagnosis of ankylosing spondylitis.

62
Q

What are the NICE guidelines for treating hypertension?

A

STEP 1: Patients <55y/o = ACE inhibitor (e.g. enalapril) or angiotensin receptor blocker (ARB e.g. losartan).
Patients >55y/o or of Afro-Caribbean origin = calcium channel blocker (CCB e.g. amlodipine) or, if evidence/high risk of heart failure, a thiazide-like diuretic (e.g. bendroflumethiazide).

STEP 2: CCB with ACEi or ARB.
If CCBs are not suitable, thiazide-like diuretic instead.

STEP 3: Combination of ACEi or ARB with CCB and thiazide- like diuretic.

STEP 4: ‘Resistant hypertension’ = seek expert help, add 4th antihypertensive e.g. spironolactone.

NICE guidelines aim for an average blood pressure below 135/85mmHg for people <80 and below 145/85mmHg for people >80.

63
Q

What lower urinary tract symptoms do diseases of the prostate gland typically present with?

A
Storage and voiding symptoms.
Frequency.
Urgency.
Nocturia.
(FUN storage).
Weak stream.
Intermittency.
Straining.
incomplete Emptying.
(WISE voiding).
Other features include terminal dribbling, urinary retention, and overflow incontinence.
64
Q

What symptoms can prostate cancer cause in addition to LUTS?

A

Symptoms due to metastasis (e.g. back pain due to bone metastases), paraneoplastic syndromes (e.g. hypercalcaemia) and constitutional upset (e.g. weight loss, malaise).

65
Q

What test most reliably confirms a diagnosis of prostate cancer?

A

Transrectal ultrasound (TRUS) guided biopsy allows a histological analysis of the prostate tissue, which can most reliably confirm a diagnosis of prostate cancer.

66
Q

What is the screening test for prostate cancer?

A

PSA (prostate-specific antigen), but not very specific.

67
Q

When might be a CT scan be useful in prostate cancer?

A

Once the diagnosis is confirmed, to assess the extent of local invasion and lymph node involvement.

68
Q

Why might an isotope bone scan be done in patients with prostate cancer?

A

To check for bone metastases?

69
Q

What results do you expect on ABG for respiratory acidosis?

A

High PaCO2 + low pH + high HCO3-.

High HCO3- is attempting to compensate.

70
Q

What results do you expect on ABG for metabolic acidosis?

A

Low PaCO2 + low pH + low HCO3-.

Low CO2 is attempting to compensate.

71
Q

What results do you expect on ABG for metabolic alkalosis?

A

High PaCO2 + high pH + high HCO3-.

High CO2 is attempting to compensate.

72
Q

What results do you expect on ABG for respiratory alkalosis?

A

Low PaCO2 + high pH + low HCO3-.

Low HCO3- is attempting to compensate.

73
Q

How does Alzheimer’s disease typically present?

A

Anterograde amnesia, confusion, changes in personality and mood and difficulty planning.

74
Q

How does frontotemporal dementia present?

A

Frontotemporal dementia tends to first present with a change in personality or behaviour.

75
Q

What is vascular dementia and how does it present?

A

Vascular dementia is caused by multiple small cerebral infarcts, leading to a loss of brain function. Patients may have a history of experiencing stroke-like symptoms. The patient’s state tends to undergo a step-wise decline in vascular dementia.

76
Q

How does depressive pseudodementia present?

A

Depressive pseudodementia is when dementia-like symptoms result from underlying depression.
Likely recent bereavement or traumatic life event.

77
Q

What are the diagnostic criteria for diabetes mellitus?

A

One fasting blood glucose measurement > 7 mmol/L in a symptomatic patient.

Two fasting blood glucose measurements > 7 mmol/L in an asymptomatic
patient.

One random blood glucose measurement > 11.1 mmol/L in a symptomatic
patient.

Two random blood glucose measurements > 11.1 mmol/L in an asymptomatic
patient.

Oral glucose tolerance test – 2 hr blood glucose > 11.1 mmol/L.

HbA1c > 48 mmol/mol or > 6.5%.

78
Q

What is the red reflex?

A

The red reflex is the red reflection of light from the retina at the back of the eye. It can be seen using a fundoscope.

79
Q

What causes loss of the red reflex?

A

Loss of the red reflex suggests that something is obscuring the retina.
Cataracts (opacification of the lens) and retinoblastoma (a rare form of cancer involving cells of the retina in children).

80
Q

What is herpes simplex keratitis and how does it present?

A

Infection of the cornea which causes a branched lesion on the cornea known as a ‘dendritic ulcer’. It usually presents in adults due to reactivation of HSV, which has been lying dormant in the trigeminal nerve.

81
Q

What is astigmatism?

A

Refractive error of the focusing apparatus of the eye, caused by abnormalities of the cornea and lens.

82
Q

What is conjunctivitis?

A

Inflammation of the conjunctiva, which causes itching and watering.

83
Q

What is aniridia?

A

Absence of the iris, which can be congenital or due to an injury.

84
Q

In which disease are mucosal ulcers, goblet cell depletion and crypt abscesses seen?

A

Ulcerative colitis.

85
Q

In which disease are non-caseating granulomas seen?

A

Crohn’s disease.

86
Q

In which condition does eosinophilic infiltration occur?

A

Eosinophilic gastroenteritis, an extremely rare condition characterised by eosinophilia of unknown cause.

87
Q

In what disease are villous atrophy and crypt hyperplasia diagnostic?

A

Coeliac disease.

88
Q

In which condition are high

grade dysplasia and metaplastic columnar epithelium seen?

A

Barrett’s oesophagus - a condition characterised by metaplastic change of the lower oesophagus due to acid reflux.

89
Q

What are the features of hyperviscosity?

A
Blurred vision. 
Headaches. Vertigo.
Seizures. 
Hearing loss.
Ataxia. 
Increased bleeding tendency.
90
Q

Give a cause of hyperviscosity.

A

Polycythaemia (elevated haemoglobin concentration).

91
Q

What are the different types of polycythaemia and how do they present?

A

Polycythaemia can be relative (normal red cell mass but reduced plasma volume) or absolute (increased red cell mass).
Polycythaemia commonly presents with symptoms of hyperviscosity and pruritus (especially after a hot bath).
Polycythaemia can be further divided into primary or secondary polycythaemia.
Polycythaemia rubra vera is a primary polycythaemia caused by clonal proliferation of myeloid stem cells.
Secondary polycythaemia is caused by natural or artificial increases in erythropoietin (EPO) production.
This increase in EPO production may be appropriate (e.g. in response to chronic hypoxia in COPD) or inappropriate (e.g. EPO abuse amongst athletes).

92
Q

What is subclavian steal syndrome?

A

Stenosis of the subclavian artery proximal to the origin of the vertebral artery results in blood being ‘stolen’ from the brain by retrograde blood flow down the vertebral artery and into the arm.
This tends to occur when there is an increased demand for blood in the arm (i.e. due to increased arm activity such as writing on a whiteboard).
The retrograde blood flow down the vertebral artery means that less blood is flowing to the brain, resulting in blackout.
Causes of subclavian artery stenosis include cervical ribs (firm lump in supraclavicular fossa), atherosclerosis and Takayasu’s arteritis.

93
Q

What is nephrotic syndrome, and what may cause it?

A

Nephrotic syndrome is a constellation of clinical features best described as a triad of proteinuria (> 3.5 g/24 hrs), hypoalbuminaemia (< 25 g/L) and oedema (often periorbital, peripheral or genital). Excretion of large amounts of protein in the urine means that there is less protein within the serum, therefore, there is less oncotic pressure drawing fluid back into the vasculature from the interstitium. This gives rise to oedema. Severe hyperlipidaemia is also associated with nephrotic syndrome. It is not a diagnosis in itself, so appropriate investigations are required to identify the underlying cause. Nephrotic syndrome may be caused by primary renal disease (e.g. minimal-change nephropathy, membranous nephropathy) or it may occur secondary to a systemic disorder (e.g. SLE, amyloidosis).

94
Q

What is Guillain-Barre syndrome and what might trigger it?

A

Guillain-Barre syndrome is an acute demyelinating polyneuropathy characterised by ascending symmetrical limb weakness and paraesthesia. In 2/3 cases, symptoms occur a few days or weeks following an infection, with 30% of these infections being gastroenteritis caused by Campylobacter jejuni.
Other organisms often implicated include cytomegalovirus, EBV, HIV, influenza and travel infections such as Zika virus, dengue fever.
Non-microbiological triggers include malignancy, surgery and post- vaccination (specifically the 1976 flu vaccine used against swine flu in the USA).

95
Q

What organism most often causes community-acquired pneumonia?

A

Community-acquired pneumonia (CAP) is most often caused by Streptococcus pneumoniae (70%).

96
Q

How are community-acquired pneumonias treated?

A

CAPs are treated with empirical antibiotics: co-amoxiclav (effective against S. pneumoniae) and clarithromycin (provides cover against atypical organisms).

97
Q

What antibiotics are used to treat Pneumocystis jiroveci pneumonia in HIV patients?

A

Co-trimoxazole, a combination of trimethoprim and sulfamethoxazole, is used to treat
Pneumocystis jiroveci pneumonia in HIV patients.

98
Q

What is co-trimoxazole used to treat?

A

Pneumocystis jiroveci pneumonia in HIV patients.

It can also be used to treat some UTIs and respiratory tract infections.

99
Q

What is metronidazole used to treat?

A

Metronidazole is effective against anaerobes, and, so, is used to treat several GI infections (e.g. C. difficile colitis), pelvic inflammatory disease and aspiration pneumonia.

100
Q

What is flucloxacillin used to treat?

A

Flucloxacillin is a penicillin that is effective against Gram-positive bacteria (mainly S. aureus). It is often used to treat skin and soft tissue infections.

101
Q

What drugs are used to treat TB?

A
Rifampicin.
Isoniazid.
Pyrazinamide.
Ethambutol.
(RIPE).
102
Q

What is the typical side effect of morphine?

A

Constipation.

103
Q

What is the typical side effect of anti-muscarinic agents, e.g. atropine?

A

Blurred vision.

104
Q

What is the typical side effect of ACE inhibitors?

A

Dry cough.

105
Q

What is the typical side effect of beta-adrenergic receptor agonists, e.g. salbutamol?

A

Tremor.

106
Q

What is the typical side effect of ampicillin and amoxicillin in glandular fever treatment?

A

Rash.

107
Q

What is gout, how does it present and how is it diagnosed?

A

Gout is an inflammatory arthritis caused by deposition of uric acid crystals within joints.
The inflammation is most commonly localised to the metatarsophalangeal joint of the great toe (also known as podagra) and usually presents with excruciating monoarticular pain.
Diagnosis is made by microscopy of a synovial fluid aspirate.
Microscopy of synovial fluid in gout will show negatively birefringent, needle-shaped crystals.

108
Q

What is pseudo gout, how does it present and what does microscopy of synovial fluid show?

A

Pseudogout is a crystal arthropathy caused by the deposition of calcium pyrophosphate crystals.
It typically affects the knees and wrists.
Positively birefringent, rhomboid-shaped crystals.

109
Q

In what condition is turbid synovial fluid with a high WCC seen?

A

Septic arthritis.

110
Q

What region of the brain does the anterior cerebral artery supply?

A

Medial aspect of the frontal and parietal lobes.

111
Q

What region of the brain does the middle cerebral artery supply?

A

Lateral aspect of the frontal, temporal and parietal lobes.

Subcortical structures, e.g. basal ganglia, internal capsule.

112
Q

What region of the brain does the posterior cerebral artery supply?

A

Occipital lobes.

Inferior and medial portion of temporal lobes.

113
Q

How does occlusion of the anterior cerebral artery present?

A

Behavioural changes.
Weakness of contralateral leg > arm.
Mild sensory deficit.

114
Q

How does occlusion of the middle cerebral artery present?

A

Contralateral hemiparesis of face > arm > leg.
Aphasia.
Hemisensory deficits.
Loss of contralateral half of visual field.

115
Q

How does occlusion of the posterior cerebral artery present?

A

Loss of contralateral half of visual field.
Sensory deficit.
Visual agnosia.
Prosopagnosia.

116
Q

What are the symptoms of moderate hyponatraemia?

A

Moderate hyponatraemia (125-130 mmol/L) may cause nonspecific symptoms, such as headaches, nausea, lethargy and muscle cramps.

117
Q

What are the symptoms of severe hyponatraemia?

A

Severe hyponatraemia is defined as serum sodium < 120 mmol/L and is associated with neurological symptoms such as seizures, hallucinations, confusion and memory loss.
Hyponatraemia can be fatal if the serum sodium drops acutely over 24-28 hours as this can lead to cerebral oedema, coning and respiratory arrest.

118
Q

How is bowel obstruction managed?

A

Bowel obstruction is a surgical emergency and it is managed using ‘drip and suck’.
This involves gaining IV access to administer fluids (drip) and inserting an NG tube to aspirate gastric contents (suck) and decompress the bowel.
In 75% of cases, adhesions resolve spontaneously with conservative management.
Patients must be assessed regularly to look for signs of peritonism (indicative of a strangulated or perforated bowel).
Surgery is considered in patients who have not improved with conservative management after 48 hours, have signs of peritonism, a palpable mass or a virgin abdomen (no previous surgery).

119
Q

What are the cardinal features of bowel obstruction?

A

Vomiting, colicky abdominal pain, constipation (described as ‘absolute’ if no flatus or faeces has been passed) and abdominal distention.

120
Q

What are adhesions?

A

Fibrous bands that form between the intestines and the peritoneum and can cause bowel obstruction, typically after abdominal surgery.

121
Q

What are the most common causes of bowel obstruction?

A

Adhesions are the most common cause of bowel obstruction in the Western world. Tumours, constipation, hernias.

122
Q

What is the Framingham criteria used for?

A

Congestive cardiac failure: diagnosis requires simultaneous presence of at least 2 major criteria or 1 major + 2 minor criteria.

123
Q

What are the major criteria in the Framingham criteria for congestive cardiac failure?

A
Paroxysmal nocturnal dyspnea.
Crepitations.
S3 gallop.
Cardiomegaly.
Increased central venous pressure.
Weight loss > 4.5kg in 5 days in response to treatment.
Neck vein distention.
Acute pulmonary oedema.
Hepatojugular reflex.
124
Q

What are the minor criteria in the Framingham criteria for congestive cardiac failure?

A
Bilateral ankle oedema.
Dyspnoea on ordinary exertion.
Tachycardia (>120bpm).
Decrease in vital capacity by 1/3 from maximum recorded.
Nocturnal cough.
Hepatomegaly.
Pleural effusion.
125
Q

What is meralgia paraesthetica?

A

Numbness, pain or paraesthesia affecting an area of skin on the outside of the thigh caused by injury to the lateral femoral cutaneous nerve.
It can be caused by weight gain resulting in gradually tightening belts or trouser waistbands. Patients are often advised to lose weight and wear looser clothing. NSAIDs may also be used to help deal with the pain.

126
Q

What is primary biliary cirrhosis and how does it present?

A

T-cell mediated autoimmune inflammation and destruction of the intrahepatic biliary ducts.
Patients are often asymptomatic with a diagnosis being made due to abnormal LFTs (persistently elevated ALP, GGT and mild transaminitis).
Symptoms may include extreme lethargy, right upper quadrant pain, pruritus and jaundice and signs include jaundice, xanthelesma and xanthomata (due to increased cholesterol levels), hepatomegaly and splenomegaly.
>90% of PBC patients test positive for anti-mitochondrial antibodies.

127
Q

What other conditions is primary biliary cirrhosis associated with?

A

Autoimmune conditions such as rheumatoid arthritis, Sjögren’s syndrome, coeliac disease and scleroderma.