Y3 Flashcards
(130 cards)
1
Q
organism that causes a sexually transmitted infection. It does not stain with Gram stain. It is an intracellular organism that produces both elementary bodies and reticulate bodies during its reproductive cycle. It is diagnosed by PCR.
A
Chlamydia trachomatis
forms both elementary and reticulate bodies
2
Q
A 42 year old man presents with abnormal movements in his limbs that he can’t control. His memory is not as good. His father died young with a further problem.
A
huntingtons disease
presents in the 40s age group and is an inherited autosomal dominant disorder (the clue with this is his father dying young). Patients classically present with chorea (involuntary movements of the limbs) which leads to cognitive decline
3
Q
An 80 year old man has a tremor, visual hallucinations, a decline in cognition and falls. These symptoms fluctuate.
A
Lewy body disease
exhibits classical symptoms of dementia, hallucinations, falls and Parkinsonism symptoms (tremor). These symptoms classically fluctuate
4
Q
A 35 year old pregnant woman at 34 weeks gestation. As she was feeling tired, her haemoglobin was checked at her recent antenatal visit and has come back as 88 g/l (120-160 g/L). Iron deficiency anaemia is diagnosed on further investigations.
Select the best management plan
A
Oral iron is the recommended first line treatment. Blood transfusion is not recommended when a haemoglobin is over 8g/l
5
Q
A 17 year old woman presents to the emergency department with a 2 day history of diarrhoea. On examination, she looks unwell and has purpura. Her full blood count shows haemaglobin 98g/L (low), white cell count 14.4x109/L (high), platelets 46x109/L (low) and her creatinine is 587µmol/L (high). A blood film shows marked red blood cell fragmentation and polychromasia
diagnosis?
A
HUS due to E.coli 0157
Red cell fragmentation and thrombocytopenia occurs when there is intravascular destruction of red blood cells due to overactivation of the complement system or of platelets. This is known as microangiopathic haemolytic anaemia. The most likely cause in this case is haemolytic uraemic syndrome due to E.Coli due to the history of diarrhoea.
6
Q
A 35 year old presenting with a severe unilateral headache lasting for 6 hours, associated with nausea
A
Migraines are severe headaches lasting between 4 and 72 hours associated with at least two of the following: unilateral, pulsating, moderate to severe, aggravated by routine activities, accompanying symptoms may include photophobia, phonophobia, nausea and vomiting
7
Q
An obese 28 year old woman recently started on the combined oral contraceptive pill, complains of a constant headache, worse in the morning and exacerbated by sneezing
A
Benign intracranial hypotension usually presents with a generalised throbbing headache, associated with nausea and vomiting. The headache can be made worse by any activity that further increases the intracranial pressure such as coughing and sneezing. It can be caused by taking the combined oral contraceptive pill
8
Q
A 55 year old man complains of a moderately severe continuous frontal headache, worse in the evenings.
A
acute tension HA
Typically an acute tension headache is mild to moderate only, non-pulsating and bilateral
9
Q
Which of the following is LEAST LIKELY to happen in the first week of life for a preterm infant born at 29 weeks of gestation:
Sepsis
Respiratory distress syndrome
Intraventricular haemorrhage
Patent ductus arteriosus
Chronic lung disease (Broncho pulmonary dysplasia)
A
All the above are known complications of prematurity, except for chronic lung disease which describes a condition in which the preterm infant will require oxygen supplementation beyond 28 days or beyond 36 weeks corrected gestation
10
Q
treatment for:
A 29 year old female presents with acute mania. There are concerns she might be pregnant after a brief period of sexually disinhibited behaviour.
A
olanzapine
11
Q
treatment for:
A 30 year old male has been diagnosed with schizophrenia. He has been prescribed quetiapine for 8 weeks and this was changed to haloperidol for 8 weeks due to poor symptom control. He remains very psychotic, with troublesome extra pyramidal symptoms
A
Patients with treatment resistant schizophrenia should be offered a trial of clozapine
12
Q
Which neurotransmitter is most involved in appetitive and approach systems
A
Dopamine. The function of the appetitive and approach systems is to mediate seeking and approach behaviours including pleasure; they involve the ascending dopamine systems which project to the mesolimbic areas and the cortex, as well as the striatum, amygdale, anterior cingulate and orbitofrontal cortex.
13
Q
Most people over 60 years old in the UK are immune to this type of hepatitis. It is acquired via faecal-oral route
A
hep A
14
Q
Where does fertilisation normally occur?
A
ampulla of the uterine tube
15
Q
what is the infundibulum of the uterine tube
A
the broad end of the uterine tube that receives the oocyte at ovulation
16
Q
what is the isthmus of the uterine tube
A
where the uterine tube narrows to enter the uterus
17
Q
A woman has induction of labour at 42 weeks gestational age. Following an artificial rupture of membrane, there is a prolonged fetal bradycardia to 50 beat per minute. Some fresh vaginal bleeding is noted and on examination the uterus is soft and non-tender.
diagnosis
A
Vasa praevia is a rare condition where cord vessels cross the fetal membranes. It presents with severe fetal distress with a relatively small intrapartum bleed following rupture of membranes
18
Q
A woman is admitted at 38 weeks gestation age with severe abdominal pain and a heavy vaginal bleed. On examination her uterus is tense and the fetal heart is 50 beats per minute.
diagnosis
A
Placental abruption is when there is a retroplacental haemorrhage. If there is severe bleeding the uterus becomes tender, tense and there can be severe fetal distress and sadly sometimes intra-uterine death
19
Q
What is the main mechanism of action of lamotrigine?
A
Blockade of voltage sensitive sodium channels. Lamotrigine antagonises voltage sensitive sodium channels and this reduces the release of glutamate, the main excitatory neurotransmitter
20
Q
what goes in an orange waste bag
A
non sharp clinical waste
21
Q
A 25 year old primigravida has a 2 hour second stage of labour and is exhausted after 1 hour of pushing. Her CTG (cardiotocography) is reassuring. On examination there is a cephalic presentation in a direct occipitoanterior position with a station of 2cm below the ischial spine.
what is the most appropriate action
A
A mid-forceps delivery (e.g. haig ferguson) is appropriate as the position is direct occipitoanterior and the foetal head is below the ischial spine
22
Q
Myasthenia gravis is an autoimmune condition in which antibodies are directed against what?
A
postsynaptic acetylcholine receptors. The autoantibodies compete with acetylcholine released from the presynaptic nerve endings
23
Q
what do autoantibodies act on in lambert eaton syndrome
A
calcium fluxes in presynaptic calcium channels
24
Q
what causes rouleaux formation (when red cells are stacked like coins)
A
when the charge on the surface of cells is altered as a consequence of cell being labelled with proteins. The proteins could be acute phase proteins (as one would find in a reactive process (e.g. infections) or a paraprotein (intact immunoglobulin)) found in plasma cell dyscrasias
25
which neurotransmitter will be low:
| A 21 year old man with known illicit drug use who attends the Emergency Department following a suspected epileptic fit.
In withdrawal from sedative-hypnotic drugs there is a reduced GABA
26
which neurotransmitter will be low:
A 24 year old man brought to the Emergency Department after an episode of bizarre behaviour indicating third party auditory hallucinations. He has no previous medical history.
dopamine
In schizophrenia there appears to be an excessive activation of dopamine receptors and treatment with antipsychotic medications which suppress dopamine are the main treatment
27
which neurotransmitter will be low:
A 50 year old woman attends her GP with a 3 month history of low mood and poor concentration following a relationship breakdown.
In depressed patients 5-hydroxytryptamine is low.
| Selective serotonin re-uptake inhibitors are frequently used in the treatment of depression
28
what do most patients on haemodialysis require to maintain adequate Hb levels
erythropoietin
| anaemia v common in CKD due to decreased renal erythropoietin
29
Which of the following suggests congenital cardiovascular disease in a new-born infant?
A: Delay in femoral pulses
B: Early neonatal jaundice
C: Polycythaemia
D: Peripheral cyanosis
E: Splitting of the second heart sound
Delay of femoral pulses is highly suggestive of coarctation of the aorta. Other symptoms and signs mentioned are normal findings in newborn infants
30
A 76 year old man presents with back pain. His 2nd and 3rd lumber vertebrae are very tender. Urinalysis shows proteinuria and microscopic haematuria. Blood tests are carried out: Haemoglobin 96g/L (low); WBC and platelet count are normal, Urea 12mmol/L (high); Creatinine 160μmol/L (high); Corrected Calcium 2.9mmol/L. (high)
Multiple myeloma is a cancer of the plasma cells, which accumulate in the bone marrow. It commonly causes bone pain in the ribs and spine, anaemia and renal failure
31
A 56 year old non-smoking female with rheumatoid disease, is breathless on exertion walking 200yds on flat ground, has finger clubbing, and a CXR shows shrunken lungs with bilateral infiltrates. What would be MOST LIKELY finding on spirometry?
FEV1 reduced, FVC reduced, FEV1/FVC normal, PEF normal
In a restrictive pattern due to DPLD (ie fibrosing alveolitis secondary to rheumatoid disease), the dynamic forced expiratory lung volumes [FEV1 and FVC] are both reduced in proportion so that the ratio is preserved, but the PEF is normal as there is no obstruction to airflow.
32
Rapidly contracting human muscle cells start producing lactic acid.
Which of the following statements BEST explains this finding?
OPTIONS:
A: The cells have to convert NADH into NAD+.
B: Lactic acid acts as a substrate for gluconeogenesis.
C: Lactic acid is oxidised in the Krebs cycle.
D: Most cells utilise lactic acid as an energy source.
E: Lactic acid is a normal waste product of aerobic metabolism.
The correct answer is A because rapidly contracting muscle cells require a large amount of energy in the form of ATP, and if they can’t produce enough by oxidative phosphorylation, e.g. because not enough oxygen can be supplied quickly enough, these cells require another way of regenerating NAD+. Without regenerating NAD+, these cells would not be able to produce ATP by glycolysis either
B is a correct statement, but does not explain why muscle cells produce it. C is not possible. D is not a correct statement and would not explain the observation. E is also wrong; lactic acid is only synthesised under anaerobic conditions, when a cell has to rely entirely on glycolysis for ATP generation.
33
Which area of the brain is affected first in Alzheimer's disease?
The nucleus basalis of Meynert is the first area of the brain to be affected by the neuropathology of Alzheimer's disease. It is the main source of the cholinergic projections to the rest of the brain and this is thought to be one of the mechanisms by which Alzheimer's causes cognitive impairment. The fact that cholinesterase inhibitors only delay progression of the symptoms rather than causing complete resolution of symptoms shows that lack of acetylcholine is not the only problem in Alzheimer's
34
what is the most common circulating WBC
neutrophil
35
what is the bodies first line defence against pyogenic organisms
neutrophils
36
what does a neutrophil look like
segmented nucleus (3-5 segments) and blue granules which contain proteins including anti-microbial enzymes. In an activated neutrophil (e.g. in response to infection), prominence of granules is noted, described by the term toxic granulation or toxic neutrophilia (where the neutrophil count is raised)
37
which cranial nerve:
| Can be injured by pituitary adenoma.
optic nerve
38
which cranial nerve:
| Pain across the posterior triangle of the neck
facial nerve (CN VII)
39
what visual defect if this damaged:
| Lateral optic nerve lesion immediately anterior to the chiasma.
Junctional scotomas are caused by lesions just anterior to the optic chiasm and cause different visual field disturbances in each eye
40
what visual defect if this damaged:
| Optic chiasma
Damage to the optic chiasm causes bitemporal field defects
41
what visual defect if this damaged:
| Right optic tract
left homonymous hemianopia
42
diagnosis:
A 40 year old woman who smokes 20 cigarettes a day complains of a green nipple discharge and a non-tender lump below the nipple
duct ectasia
Patients with duct ectasia have a green/cream nipple discharge and this is more common in smokers. A lump (thickened duct) can be felt under the nipple.
43
diagnosis:
A 38 year old woman has noticed a 2cm lump in the upper outer quadrant of her right breast. She was involved in a car accident 2 months ago but was not hurt. Her aunt had breast cancer at the age of 80 years.
Fat necrosis of the breast usually presents after trauma which can be minor enough to be forgotten by the patient. The history of her grandmother with breast cancer is a red herring but these patients must still undergo triple assessment (examination/mammogram for over 35y of age/FNAC) before this diagnosis is reached.
44
diagnosis:
A 70 year old woman develops a hot tender breast with overlying cellulitis. She recently had two courses of antibiotics to treat this.
inflammatory breast cancer
In elderly patients with inflammatory changes in the breast with no resolution despite an adequate course of antibiotics, inflammatory breast cancer must be suspected
45
Which of the following statements about transport in the proximal tubule is true?
OPTIONS:
A: 100% of filtered glucose and amino acids are reabsorbed.
B: About 10% of salt and water are reabsorbed.
C: Reabsorption is by paracellular mechanisms only
D: Urea is secreted.
E: Hydrogen ions are reabsorbed
A. 100% of filtered glucose and amino acids are reabsorbed
The proximal tubule is involved in regulation of pH and also is where 100% of filtered glucose and amino acids are absorbed
46
which nerve root:
| biceps reflex
C5/6
47
which nerve root:
| ankle reflex
S1
48
which nerve root:
| knee reflex
L3/4
49
Someone with an IQ of 45 would be described as having which severity of learning disability?
moderate (35-49)
50
A 22 year old nulliparous woman is in spontaneous labour at 40 weeks gestation. She has had an uncomplicated pregnancy and has been progressing well in labour. On vaginal examination the midwife documented the following on vaginal examination: cervix 9 cm dilated, station 0, direct occipito-anterior with meconium liquor draining. Her contractions are described as moderate, every 2-3 minutes. The CTG is reassuring.
What management is appropriate?
reassure and re-examine in 2 hours
The CTG is reassuring despite there being meconium stained liquor. She is likely to achieve a normal spontaneous vaginal delivery and should be re-examined in 2 hours. There is no sign of fetal distress so fetal blood sample/delivery is not required. She requires continuous CTG monitoring throughout labour because of the meconium stained liquor
51
most likely cause of anaemia:
An 18 year old woman presents with tiredness and dizziness. She also has heavy periods. Her full blood count shows haemoglobin 99g/L (low), MCV 72.4fL (low), white cell count 6.4x109/L (normal), platelet 351x109/L (normal) and her ferritin is 3µg/L (low)
iron deficiency anaemia. Although ferritin can be raised in acute inflammation, a low ferritin always means iron deficiency.
52
most likely cause of anaemia:
A 38 year old man presents to the acute medical unit with painless jaundice and exertional dyspnoea. His full blood count shows haemoglobin 59g/L (low), MCV 115fL (high), white cell count 8.8x109/L (normal), platelet 204x109/L (normal) and reticulocyte count 358x109/L. A blood film shows polychromasia and spherocytes and the Direct Antiglobulin Test (DAT) is strongly positive.
autoimmune haemolytic anaemia
Anaemia and jaundice should also make you consider the possibility of haemolysis. The bone marrow is working hard to make new red cells and the reticulocyte is usually very high as in this case. Spherocytes on the blood film could mean autoimmune haemolysis or hereditary spherocytosis but the history and the strong direct antiglobulin test indicate that this is autoimmune. Note that crossmatching blood in this condition is difficult.
53
A 62 year old woman has been diagnosed with chronic congestive heart failure secondary to ischaemic heart disease.
Which of the following medications improve survival in chronic congestive heart failure?
A:Calcium channel blockers
B:Loop diuretics
C:Statins
D:ACE inhibitors
E:Nitrates
ACE inhibitors
ACE inhibitors block the conversion of angiotensin I to angiotensin II by angiotensin converting enzyme (ACE). Chronic up-regulation of the renin-angiotensin-aldosterone system (RAAS) in congestive heart failure places an extra strain on the heart by increasing cardiac preload and afterload. Medications which interfere with the RAAS may help improve survival in heart failure. Other medications, which improve survival in heart failure, include beta-blockers.
54
An 85 year old man is admitted with confusion. You suspect delirium. Which three features are essential for a diagnosis of delirium?
acute onset plus, inattention with fluctuating course, plus one of: disorganised thinking or altered level of consciousness.
55
MOST APPROPRIATE treatment for a 30 year old woman, who has sudden episodes of inability to speak, associated with altered hearing and loss of spatial awareness, lasting 1-2 minutes.
The symptoms described are most likely to be due to a simple partial seizure in which consciousness is not lost and a variety of short lasting symptoms can occur. The first line treatment is oral lamotrigine or carbamazepine
56
best treatment:
A 25 year old female attends her GP for a sexual health screen and is diagnosed as having Chlamydia trachomatis infection. She is asymptomatic
Oral azithromycin is the treatment of choice for uncomplicated chlamydia infection
57
best treatment:
A 35 year old female patient with an offensive vaginal discharge who is diagnosed as having Trichomonas vaginalis infection by her GP.
Oral metronidazole is the treatment of choice for Trichomonas vaginalis infection
58
best treatment:
A 21 year old female who attends the sexual health clinic with vaginal discharge who is diagnosed as having Neisseria gonorrhoeae. She has no symptoms or clinical signs of pelvic inflammatory disease.
ceftriaxone IM + oral azithromycin
| ensure you do test of cure
59
Select the most appropriate daily supplement you would recommend in a woman attending an antenatal clinic at 8 weeks into her first pregnancy. She is low risk apart from having diabetes mellitus.
Folic acid 5mg and Vitamin D 10mcg
60
area of brain responsible for:
| receptive aphasia
wernickes
Receptive aphasia is due to a temporo-parietal lesion, an area of the brain known as Wernicke’s area (hence this type of aphasia is sometimes called Wernicke’s aphasia). In this type of aphasia, a patient’s speech is fluent, but the words that are spoken are incorrect. This can vary from a few incorrect words to complete nonsense. Those who recover say that they are unable to understand what other people are saying.
61
what is aphasia
acquired language disorder caused by damage to frontal, temporal and/or parietal lobes of the dominant hemisphere
62
area of brain responsible for:
| Expressive aphasia.
brocas area
lesions in the frontal lobe of the dominant hemisphere, in an area known as Brocca’s area (and so, not surprisingly, this is also known as Brocca’s aphasia). While patients are able to understand language they lose fluency, and those who recover describe being unable to get the words out, despite knowing what they want to say.
63
area of brain responsible for:
| nominal aphasia
Angular gyrus
Nominal aphasia occurs when patients are unable to name familiar objects, but language is otherwise preserved. It can occur as part of other aphasic syndromes, but when it occurs on its own, it suggests an inferior parietal lesion, and area known as the angular gyrus
64
Unfractionated heparin is best dosed by performing which test?
The APTT is used to monitor heparin
65
which hormone to measure:
| To determine whether a woman has ovulated.
Progesterone
secreted by the corpus luteum, peaking approximately 7 days after ovulation
66
which hormone to measure:
| To assess ovarian reserve prior to in vitro fertilisation treatment.
Anti-mullerian hormone (AMH) is used to measure ovarian reserve and is useful to predict response to supra-ovulation in IVF treatment
67
which hormone to measure:
| To perform serial assessment to help with the possible diagnosis of an ectopic pregnancy
Human chorionic gonadotrophin (HCG)
secreted by the trophoblast and in an ectopic pregnancy will fail to rise at an appropriate level (should double every 48 hours)
68
At what stage does the embryo implant into the uterus?
blastocyst (forms around day 5, has inner cell mass and trophoblast)
implantation occurs days 6-10
69
most likely cause of lymphadenopathy:
A 65 year old man presents to his GP with lumps under his arms. On examination, he has cervical, axillary, and inguinal lymphadenopathy up to 2cm in size. His Full Blood Count shows Haemoglobin 124g/L (normal), White Cell Count 231x109/L (high), lymphocytes 223x109/L (high) , Platelets 332x109/l.(normal)
Chronic lymphocytic leukaemia
With the lymphocyte count so high this can only really be CLL. Lymphocytosis can be seen in non-Hodgkin's lymphoma and acute viral infection but never this high (rarely more than 20x109/L)
70
most likely cause of lymphadenopathy:
A 16 year old girl presents with a 1 week history of general malaise and is found to have small tender cervical and axillary lymphadenopathy. Her FBC shows Haemoglobin 143 g/L (normal), White Cell Count 10.2x109/L (high), lymphocytes 7.6x109/L (high), Platelets 177x109/l (normal) and her ALT is 569U/L (high) with otherwise normal liver function tests. Blood film shows atypical mononuclear cells and a monospot test is positive.
Acute Epstein-Barr virus infection
Atypical mononuclear cells are often seen in acute viral infections and are activated (predominantly T) lymphocytes responding to the viral infection. They are classiclly seen in acute EBV infection, hence its other name of infectious mononucleosis. Lymphadenopathy and acute hepatitis are also common. This is usually a self-limiting infection but some people experience chronic fatigue after EBV infection. Immune medicated cytopenias such as neutropenia, thrombocytopenia, and even autoimmune haemolytic anaemia can occur with EBV infection and may require specific therapy
71
most likely cause of lymphadenopathy:
A 23 year old woman from Nigeria who is studying at University goes to see her GP because she is feeling run down. On examination, she has widespread small volume lymphadenopathy, oral candidiasis and oral hairy leukoplakia.
HIV
is a cause of generalised lymphadenopathy that should not be forgotten - unexplained cytopenias (especially lymphopenia and thrombocytopenia) or lymphadenopathy should trigger HIV testing even in low risk individuals. HIV is also associated with many types of lymphoma and many authorities recommend testing all patients diagnosed with lymphoma as it will affect management
72
What is the most common mode of inheritance of Hereditary Spherocytosis?
autosomal dominant
This is due to mutations in one of several red cell membrane proteins and is one of the commonest genetic disorders in the UK. It is usually autosomal dominant although rare autosomal recessive cases are described (where the mutation is not in one of the typically described proteins). Patients have chronic haemolysis and may require splenectomy or cholestectomy for pigment gallstones.
73
A patient presents with a 3 week history of low mood, early morning wakening, poor energy and anhedonia. They have lost significant weight. There are no other known problems with their physical health.
Which antidepressant would you start with?
SSRIs e.g. citalopram
74
A patient presents with a 3 week history of low mood, early morning wakening, poor energy and anhedonia. They have lost significant weight. There are no other known problems with their physical health.
Which antidepressant would you start with?
SSRIs e.g. citalopram
75
Which of the following is a recognised maternal adaption to pregnancy?
A: Blood pressure decreases in second trimester, and returns to pre-pregnancy level by the third trimester
B: Cardiac output decreases by 30-50% from 6 weeks gestational age and then increases back to normal in the last 8 weeks of pregnancy
C: Erythropoiesis decreases by 25% resulting in anaemia
D: Glomerular filtration rate stays the same through-out pregnancy
E: Vital capacity increase by 50%
A
The blood pressure decreases in the second trimester due to the expansions of uteroplacental circulation and decreased peripheral resistance. Cardiac output and glomerular filtration rate increases by 30-50%. Erythropoiesis increases by 25% and haemoglobin is reduced by dilution. Tidal and minute volumes increase, but vital capacity is unchanged.
76
The thoracic duct drains into the left “venous angle”. This is the angle between which vein and the subclavian vein?
internal jugular vein
77
Drains into the chamber of the heart in which the sinoatrial node (SA) is located.
IVC (or coronary veins) (SA node in RA)
78
Intercostal veins from the anterior aspect of the intercostal spaces drain into this vein
internal thoracic vein
Deoxygenated blood from the structures in the intercostal spaces drains into the internal thoracic vein anteriorly and the azygous vein posteriorly (oxygenated blood to the structures in the intercostal spaces arises from the internal thoracic artery anteriorly and the thoracic aorta posteriorly
79
A 53 year old woman attends her GP surgery with troublesome hot flushes and night sweats. Her GP decides to start her on combined sequential hormone replacement therapy.
Which of the following is a contraindication to hormone replacement therapy?
A:Current smoker
B:Well controlled angina
C:Obesity with BMI of 37kg/m2
D:Sister with breast cancer
E:Osteoporosis
B
Active or recent arterial thromboembolic disease (e.g. angina or MI) are contraindications for HRT
80
Which artery is MOST LIKELY to be the cause of bleeding during the following surgical procedures?
Insertion of a lateral abdominal port, during female laparoscopic sterilisation
The inferior epigastric artery
branch of the external iliac artery and runs on the posterior surface of the lower half of the rectus abdominis muscle. Care must be taken when inserting lateral ports to avoid injuring this artery
81
Which artery is MOST LIKELY to be the cause of bleeding during the following surgical procedures?
Incision of a Bartholin’s abscess.
Internal Pudendal Artery
Branches from the internal pudendal artery supply to the labia and clitoris. A Bartholin’s abscess forms in the labia
82
Which artery is MOST LIKELY to be the cause of bleeding during the following surgical procedures?
Dissection of the lower end of the ureter.
uterine artery
The lower end of the ureter passes under the uterine artery as it passes through the base of the broad ligament beside the cervix, before entering into the trigone of the bladder
83
A 14 month old child presents with acutely painful and swollen fingers. Both parents have recently moved here from Nigeria. A blood film shows abnormal red bloods cells.
Which of the following tests is MOST LIKELY to give a definitive diagnosis?
A:Bone marrow biopsy
B:Haemoglobin high performance liquid chromatography of whole blood lysate(HPLC)
C:Lymph node biopsy
D:Serum protein electrophoresis
E:Peripheral blood immunophenotyping
Haemoglobin high performance liquid chromatography of whole blood lysate(HPLC)
This is a clinical description of dactylitis, which is a common presentation of sickle cell anaemia. Clinical manifestations of sickle cell disease are rare in younger infants because of the protective effect of foetal haemoglobin (hbF). Haemoglobin S (HbS) carrier status is much more common in sub-Saharan Africa and it is likely that both parents are carriers. A sickle solubility test can give a rapid indication of the presence of sickle cells but note this is also positive in carriers of the disease. Haemoglobin high performance liquid chromatography is the best method to confirm the presence of HbS.
84
Which of the following allows detention of a patient in hospital for 6 months in the first instance?
A:Compulsion order
B:Compulsory treatment order
C:Short term detention
D:Emergency detention
E:Assessment order
A compulsory treatment order (CTO) is a civil order allowing detention in hospital for 6 months in the first instance
85
test that is MOST USEFUL for monitoring the therapeutic effect of anticoagulation:
A 24 year old woman is 30 weeks pregnant and is on therapeutic dose Dalteparin (low molecular weight heparin) for a pulmonary embolus she had 3 weeks ago.
Anti-Xa assay
It is only necessary to monitor a patient on dalteparin in special circumstances such as pregnancy or renal impairement. The APTT is useful for monitoring intravenous unfractionated heparin but is often normal in patients on low molecular weight heparin. The anti-Xa assay measures the inhibition of Factor X by LMWH and other drugs. This is the main mechanism of action of LMWH. Note that the timing of the sample in relation to the dose is very important and that this test should be done 3-4 hours post dose
86
test that is MOST USEFUL for monitoring the therapeutic effect of anticoagulation:
A 75 year old woman is found to be in atrial fibrillation. She has hypertension and a history of transient ischaemic attacks. Her renal function is normal and she is started on dabigatran (direct thrombin inhibitors).
No routine monitoring required
Dabigatran is a new oral direct thrombin inhibitor. It is licensed for use in atrial fibrillation to prevent stroke and studies show that it is at least as good as warfarin for this and causes fewer intracranial haemorrhages than warfarin. It is largely renally excreted and is contraindicated if the GFR is less than 30ml/min. One of the major benefits of the new anticoagulents is that routine monitoring is not required although it is recommended to monitor renal function as if this deteriorates then a change of therapy will be required
87
You are asked to see a 19 year female prisoner who was moved to the segregation unit of a young offender's institute 4 weeks ago. She has been describing hearing some of the other prisoners talking about her and has fashioned a weapon from her toothbrush as she believes that the prison officers wish to kill her. Diagnosis?
paranoid schizophrenia
88
You see a 25 year old woman in the Emergency Department who is suffering from problems related to smoke inhalation following a fire which killed her 14 day old baby. She is tearful and is distracted by loud voices stating "they told me to start the fire". Diagnosis?
puerperal psychosis
89
A 32 year old asks her community midwife for contraceptive advice two days after the delivery of her third child. She has a BMI of 41kg/m2 and her husband has a vasectomy booked for three months' time.
Select the MOST APPROPRIATE contraception:
Progesterone only pill (Cerazette)
The combined pill is contraindicated in women with a BMI of over 39kg/m2. Long term contraception is not appropriate in view of her husband's planned vasectomy. The correct answer is E.
90
A 32 year old asks her community midwife for contraceptive advice two days after the delivery of her third child. She has a BMI of 41kg/m2 and her husband has a vasectomy booked for three months' time.
Select the MOST APPROPRIATE contraception:
Progesterone only pill (Cerazette)
The combined pill is contraindicated in women with a BMI of over 39kg/m2. Long term contraception is not appropriate in view of her husband's planned vasectomy.
91
An 85 year old woman presents with incontinence. She is unable to get to the toilet in time. The very thought of the toilet makes her incontinent. What type of incontinence does she have?
urge
92
what consent is needed?
| A 14 year old girl who is about to undergo a termination of pregnancy and who appears to fully understand the procedure.
A patient under the age of 16 years can be shown to have the capacity to consent. Written consent is required for a surgical procedure
93
what consent is needed?
A 77 year old man is admitted to the Emergency Department unconscious, requiring emergency repair to a fractured hip which will take place later in the day. His wife accompanies him.
written consent from relative
An emergency procedure can be performed without consent if it is not possible to obtain consent and treatment is immediately required to save their life or prevent serious deterioration of a patient's condition. As treatment is not immediately necessary, there is time to discuss treatment with the patient's wife. The patient's wife is able to consent to treatment on his behalf as she is his nearest relative
94
what consent is needed?
A 30 year old severely brain damaged woman with menorrhagia. Her husband is requesting a total hysterectomy to improve her personal hygiene.
Court of law decides overriding need for consent
95
A patient is seen in the neurology clinic, complaining of abnormal head movements and neck pain. He also notes that his head has a tendency to turn to the left, and indeed he finds it uncomfortable to keep his head facing forward.
What is the most likely diagnosis?
cervical dystonia
A dystonia is a sustained abnormal posture caused by persistent contraction of large trunk or limb muscles. Cervical dystonia, AKA spasmodic torticollis, is typified by the head turning to one side due to contraction of the sternocleidomastoid muscle. The aetiology and pathology are unknown. It can be treated with anticholinergics, phenothiazines and injections with Botulinum toxin.
96
what is blepharospasm
twitch/spasm of the eyelid
97
what is hemiballismus
uncontrolled flailing of limbs. It is due to either a structural lesion or metabolic dysfunction of the subthalamic nucleus
98
What LP results would you expect to see in acute bacterial infection?
Cloudy
glucose <50%
protein Increase
Neutrophils
oligoclonal bands -ve
99
what does Xanthochromic CSF indicate
the presence of blood, and is likely to be seen in a patient with subarachnoid haemorrhage
100
when is CSF clear
viral meningitis, Guillaun-Barré syndrome, multiple sclerosis and normal samples
101
when is CSF cloudy
bacterial meningitis and tuberculous meningitis (although in the latter it may also be clear)
102
when are lymphocytes raised in CSF
viral and tuberculous meningitis, and in multiple sclerosis
103
when is protein raised in CSF
in most conditions, but are very raised in bacterial meningitis
104
what do oligoclonal bands suggest
MS
105
An 80 year old woman presents with a 3 month history of falls. Her right knee gives way when she is walking. She has chronic kidney disease, mild dementia, osteoarthritis and is awaiting a knee replacement. She has been struggling to climb stairs due to the pain in her knees. She takes paracetamol and was started on codeine two weeks ago for pain.
From the options below choose the ONE MOST APPROPRIATE action you would take.
A:Add a nonsteroidal anti-inflammatory drug for pain relief
B:Stop Codeine as this can cause confusion and falls.
C:Strength and balance training before knee replacement.
D:Advise her to stop climbing stairs.
E:Increase physical activity after knee replacement.
Strength and balance training before and after surgery will improve quadriceps strength, increase stability of the knee joint, and help improve outcomes. Patients should be encouraged to continue their physical activity while awaiting surgery. NSAIDs in older people can increase their risk of renal impairment and gastrointestinal bleeding and should be avoided. Although opiates can cause confusion and falls, her falls have preceded the addition of codeine with no history of increased confusion
106
Which drug is the best choice for a patient with hyperactive delirium secondary to a urinary tract infection and no other medical problems?
haloperidol
107
do benzodiazepines help delirium
no they worsen and lengthen it
108
A 35 year old complains of severe premenstrual pain and dyspareunia caused by known severe endometriosis.
what Tx
The combined oral contraceptive pill is an effective treatment for endometriosis, as is any treatment that reduces menstruation
109
A 34 year old is currently taking the combined oral contraceptive pill for contraception. Which of the following drugs is known to reduce the contraceptive efficacy of the combined oral contraceptive pill?
A:Methyldopa
B:Phenytoin
C:Mefenamic acid
D:Amoxycillin
E:Codeine
Phenytoin reduces contraceptive efficacy as it induces liver enzymes
110
what inheritance:
| Wilson’s disease.
autosomal recessive
condition in which copper accumulates in tissues. It causes neurological, psychiatric and hepatological conditions. Copper can be deposited around the iris, forming Kayser-Fleischer rings
111
what inheritance:
| Becker’s muscular dystrophy.
X-linked recessive condition.
Various defects can be implicated, but all affect the dystrophin gene. Some cases occur de-novo, and individuals can be affected to varying degrees due to genetic mosaicism
112
what inheritance:
| Myoclonic epilepsy with ragged red fibers.
mitochondrial disease
Clumps of mitochondria accumulate in muscle fibres giving a ragged, red appearance. Other features include progressive myoclonic epilepsy, short stature, hearing loss, lactic acidosis, exercise intolerance and poor night vision.
113
A 35 year old attends the Emergency Department in the morning concerned that she has forgotten to take her oral contraceptive pill last night. This would have been the 19th pill in the packet. She had sexual intercourse 2 nights ago.
What would be the best advice to give?
She should be advised to take her forgotten pill now and the next one at the usual time. Additional precautions are only required if she missed 2 or more pills
114
A 16 year old girl presents with her mother to the family GP, complaining of abdominal cramps. Her mother is concerned that her daughter has never had a menstrual period although her breasts have developed. You observe that she is a suitable height and weight for her age.
Diagnosis?
The usual presentation of an imperforate hymen is in a girl approximately 2 years after starting puberty who complains of abdominal pain
115
A 32 year old woman presents to her GP with secondary amenorrhoea for 6 months, excited because she and her husband have been trying for a baby for the past year. She had chemotherapy as a child as treatment for a renal tumour. Her GP carries out a urine pregnancy test which is negative.
Diagnosis?
Premature ovarian failure
can be caused by previous chemotherapy or radiotherapy and can be diagnosed by elevated serum levels of FSH. In this case it is important to exclude a pregnancy with a urinary pregnancy tes
116
A 35 year old woman presents to her GP with secondary amenorrhoea for 9 months. She is embarrassed regarding increasing facial and abdominal hair growth. Her GP carries out a urine pregnancy test which is negative.
Diagnosis?
Polycystic ovarian syndrome
diagnosed when at least 2/3 of the following are present: Oligo or amenorrhoea, clinical or biochemical increase androgens, enlarged ovaries with multiple peripheral cysts on scan.
117
MOST ACCURATE psychopathology term:
"All my food has a metallic taste, like someone is poisoning me"
Gustatory hallucination
118
MOST ACCURATE psychopathology term:
"Everywhere I go there is this terrible smell, I keep washing but I can't get rid of it, other people say they can't smell it but I think they're just being polite"
Olfactory hallucination
119
A 19 year old female presents to the Genitourinary Medicine clinic with a vaginal discharge. She is sexually active with multiple partners. She has a foul smelling discharge and microscopy shows a flagellated protozoa.
What is the MOST LIKELY diagnosis?
Trichomonas vaginalis
120
what GU infection has clue cells
gardnerella vaginalis
121
what GU infection is diplococci
neisseria gonorrhoea
122
Which of the following changes results in a right shift of the oxyhaemoglobin dissociation curve?
A:Decreased carbon dioxide
B:Decreased pH
C:Decreased temperature
D:Decreased 2,3 - DPG (diphosphoglycerate)
E:Decreased hydrogen ions
decreased pH
Right shift of the oxyhaemoglobin dissociation curve is caused by acidosis (reduced pH or increased hydrogen ion concentration), increased CO2, increased concentration of 2, 3-DPG and increased temperature. The opposite changes result in a left shift of the oxyhaemoglobin dissociation curve
123
what is the most likely cause:
24 with schizophrenia brought into hospital by the police v agitated. he is given 5mg haloperidol and becomes calmer but an hour later he begins screaming and complains of a severely sore back and neck which he cannot move
acute dystonic reaction
is an EPSE that occurs within hours of antipsychotic administration
124
what is the most likely cause:
| 55 on olanzapine for schizoaffective disorder has MI
metabolic syndrome
125
what should you assess before starting the COCP
BP and BMI
126
what blood test should be done prior to initiation of lithium carbonate
urea and electrolytes- lithium can cause renal impairment
127
```
which of these in CI in breastfeeding:
warfarin
labetalol
tetracycline
amoxicillin
amitriptylin
```
tetracycline (absorbed into breast milk and is CI as can cause dicolouration of the infants teeth)
128
which term describes:
30 y/o women with borderline personality disorder pretends to have seizures so that she can claim disability living allowance
malingering- faking illness for secondary gain
129
which term describes:
30 y/o woman with borderline personality disorder has episodes where she loses consciousness and appears to have a tonic clonic seizure but her EEG is normal
non epileptic seizures
| often involve childhood abuse- like Borderline personality disorder
130
diagnosis:
72 y/o man with advanced parkinsons presents v unwell, SOB, cough, pyrexia, reduced O2 saturation. normally he needs thickened fluids due to a poor swallow
aspiration pneumonia
PD affect swallow in advanced stages
