Year 2 CAP TEST QUESTIONS FOR PRACTICE (got 63%)

Question 1

The three stages of Dupuytren’s contracture are the early, involutional (active) and the residual (advanced) phase What are the the main cells that predominate the active contractile phase (involutional)?

Answer 1

The myofibroblasts predominate the active phase and are capable of contraction

Question 2

What are risk factors associated with Dupuytren’s contracture?

Answer 2

Alcohol Smoking Diabetes mellitus

Question 3

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Answer 3

E - The growth plate is actually a relatively weak part of bone as injuries can result hear

Question 4

Prepubertal overweight adolescent boy, presents with pain in the groin and the knee with a limp What is the diagnosis?

Answer 4

SUFE -the growth plate is not strong enough to support the adolescents weight and the epiphysis slips

Question 5

Anthropometric measurements What is used to assess upper extremity muscle strength? What measurement provides an estimate of height?

Answer 5

Hand grip dynamometry - upper extremity muscle strength Ulna length - provides an estimate of the height

Question 6

What does triceps skinfold thickness estimate?

Answer 6

Triceps skinfold thickness estimates the total body fat

Question 7

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Answer 7

Waist circumference is the best predictor of cardiovascular risk Mid upper arm circumference reflex muscle mass and subcutaneous fat

Question 8

Which investigation is not appropriate?

Answer 8

All investigations are appropriate however the initial investigation to be carried out would be D - Urine beta human chorionic gonadotrophin (HCG) to determine whether pregnancy is the cause

Question 9

What is the likely diagnosis in this scenario also?

Answer 9

History is suggestive of Grave’s disease First step would be to carry out a thyroid function test so D.

Question 10

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Answer 10

The area missed most frequently is C - Area 3

Question 11

Behaviour in which a child appears stressed, exhibiting tension movements, activated by departure and return of the caretaker What type of behaviour temperament/attachment is this?

Answer 11

This is disorganised attachment

Question 12

A child who is tense on return or departure of the mother? What is this type of attachment?

Answer 12

The is disorganized attachement

Question 13

Readily explores, using carer as a secure base. Cries infrequently. Easily put down after being held. Confident. What is this?

Answer 13

Secure attachment

Question 14

What are the two types of anxious attachment?

Answer 14

Ambivalent and avoidant attachment

Question 15

A child who is unsure how to respond to the parent when he or she returns Can be distressed or uncertain Typically explores little and is often wary of strangers Which type of attachemnt is this?

Answer 15

This is anxious ambivalent attachment

Question 16

Descrbe avoidant attachment?

Answer 16

the child is not distressed when parent enters the room Pays little attention to the parent (treats almost like the stranger)

Question 17

Child with a positive overall mood. Eats at regular intervals and is readily approachable What is this?

Answer 17

This is an easy temperament child

Question 18

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Answer 18

Child is tense/distressed on arrival of mother - B disorganized attachment Usually sits alone and is distressed/uncertain on arrival - AMbivalent attachment - F Easy child - Easy temperament - C

Question 19

When red reflexes are diminished on examination of the eye, what does this make you think in an elderly patient?

Answer 19

Cataracts

Question 20

If an elderly patient has gradual central vision loss and has haemorrhage on macula with drusen depositis (yellow deposits) What do you think? If there is a central haemorrhage in the macula instead of the drusen depositis, with sudden central visual loss then what do you think?

Answer 20

Think dry age related macular degenration Think wet age related macular degenratiojn

Question 21

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Answer 21

1. F - Cataracts 2. E - Wet age related macular degenration

Question 22

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Answer 22

A - ulnar neuropathy Ulnar nerve gives sensory innervation to the 4th and 5th digits

Question 23

When a patients lens becomes sclerotic with age and they can no longer read close work, what is this known as?

Answer 23

This is called presbyopia

Question 24

Also, what disease is this man likely to have?

Answer 24

B. Pigmentation is due to ACTH Man is likely to have Addison’s disease

Question 25

What is the most accurate investigation to assess prolapsed discs?

Answer 25

Most accurate - MRI

Question 26

2The type of compression fracture related to high-energy axial loading spinal trauma that results in disruption of the posterior veertbral body cortex What is this?

Answer 26

This is knwon as a Burst fracture

Question 27

the eponymous name given to a burst fracture of C1?

Answer 27

Jefferson fracture (axial loading on back or neck eg caused by diving)

Question 28

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Answer 28

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Question 29

A 65 year old patient complains of left ankle swelling for many months. He has very little pain. There is slight erythema over the ankle and the foot seems insensate. What is the most probable diagnosis?

Answer 29

Charcot arthropathy

Question 30

What is the other name for charcot arthropathy?

Answer 30

Neuropathic arthropathy

Question 31

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Answer 31

D - Trochanteric bursitis from the prominent metalwork

Question 32

What is the most common cause of neonatal jaundice? Name 2other causes?

Answer 32

Physiological jaundice 2 other causes - hypothyoridism and neonatal infection

Question 33

What is the most common type of psoriasis?

Answer 33

Chronic plaque psoariasis - psoriasis vulgaris

Question 34

What is the initial treatment for psoriasis if mild?

Answer 34

Topical emollients

Question 35

What type of psoriasis usually appears about 2to3 weeks after a streptococcal infection and small salmon pink spots all over the skin?

Answer 35

Guttate psoriasis

Question 36

If psoriasis is well controlled and mild, what is the initial treatment?

Answer 36

The initial treatment would be for emollients

Question 37

What are the two types of topical agents given for psoriasis? Which is given first?

Answer 37

If under good control then Vitamin D analogue However can give Topical corticosteroids

Question 38

What is the name of the main vitamin D analogue given for psoriasis? What is the next step for psoriasis if topical treatments fail to work?

Answer 38

Cacipitriol Next step is phototherapy

Question 39

Very poorly controlled significant plaque psoriaiss managemtn after topicals, phototherapy moves on to what final treatments?

Answer 39

Methotrexate if no contra indications Followed by a biological agent eg adaluminab

Question 40

Which type of phototherapy has a greater chance of causing cancer?

Answer 40

PUVA

Question 41

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Answer 41

1. H - topical Vitamin D anaologue 2. B - UVB phototherapy 3. A - methotrexate

Question 42

Open reduction is where the fracture fragments are exposed surgically by dissecting the tissues. Closed reduction is the manipulation of the bone fragments without surgical exposure of the fragments. Which is the preffered managemnt?

Answer 42

Closed reduction is the preferred managemnt Open reduction usually only takes place where there is soft tissue entrapment

Question 43

What foramen of the skull does the internal carotid artery pass through? What foramen does the middle meningeal artery?

Answer 43

ICA - Carotid canal Middle meningeal - foramen spinosum Foramen spinosum is lateral to the foramen rotundum

Question 44

What is the most biologically active form of thyroid hormone?

Answer 44

Tri-iodothyronine(T3)

Question 45

What are the three main thyroid hormone carriers in the blood? Which is the main thyorid hormone carrier?

Answer 45

Thyroxine binding globulin - 70% Thyroxine binding pre-albumin Albumin

Question 46

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Answer 46

J - Mono-iodo tyrosine (MIT)

Question 47

What is the patient describing?

Answer 47

Patient is describing gastroparaesis D. Autonomic neuropathy is the underlying neurological process

Question 48

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Answer 48

E - Dupuytrens contracture

Question 49

3 year old girl develops lip and tongue swelling after eating a peanut butter sandwich What is this mediated by?

Answer 49

Type 1 hypersensitivity reaction mediated by IgE cells

Question 50

When are hands washed with soap instead of with alcohol gel?

Answer 50

Soap and water if hands are visibily soiled, contact with bodily fluids, dealing with patients with either Cdifficle or MRSA

Question 51

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Answer 51

D - Prior to inserting intravenous canula

Question 52

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Answer 52

A

Question 53

What type of hearing loss does presbycusis cause?

Answer 53

Causes sensorineural hearing loss and is due to age

Question 54

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Answer 54

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Question 55

When Xrays are focussed in front of a persons retina they require corrective lenses. Which type of lens is required? What is their site called?

Answer 55

Require a concave lens They are miopic

Question 56

What type of lens does somebody who is astigmatic or hypermetropic (long sighted) require?

Answer 56

Astigmatic - a cylindrical lens Hypermetropic - convex lens

Question 57

What does this child have and what age group does it usually affect?

Answer 57

This child has Bronchiolitis Usually affects children under the age of 2

Question 58

For compartment syndrome, you can get limb ischaemia What are the 5Ps of limb ischaemia?

Answer 58

Pale, Pallor, Pain, Paraesthesia, Pulses

Question 59

What is the most reliable early stage finding for compartment syndrome? When does loss of pulses present?

Answer 59

Pain out of proportion is the most common syptom Loss of pulses is usually a late stage finidng

Question 60

What intracompartmental pressure is diagnostic of compartment syndrome? What is the treatment?

Answer 60

Intracompartmental pressure greater than 30mmHg is diagnostic Treat with a fasciotomy

Question 61

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Answer 61

A -Prosthesis loosening

Question 62

Which type of hepatitis requires a co-exisiting infection with another hepatitis? How is the hepatitis transmitted?

Answer 62

Hepatitis D requires a coinfection with hepatitis B Transmitted via blood

Question 63

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Answer 63

the circulating blood volume decreases in the septic patient - A Heart rate increases in a septic patient

Question 64

This long bone has a tuberosity and a malleolus What bone and what attaches at the tuberosity?

Answer 64

This is the tibia Patellar tendon attaches at the tuberosity

Question 65

Which bone forms part of the acetabulum? Where does the biceps tendon insert?

Answer 65

Ilium forms part of the acetabulum Biceps tendon inserts at the radial tuberosity

Question 66

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Answer 66

E - Dermatitis herpetiformis - blisters at flexor surfaces

Question 67

Which antibiotic should not be used in children under the age of 12?

Answer 67

Tetracycline

Question 68

Apart from the LOAF muscles of the hand (supplied by the median nerve), what supplies all the other intrinsic muscle of the hand?

Answer 68

The ulnar nerve

Question 69

What nerve supplies sensation to the little finger? Which supplies sensation of the anatomical snuffbox and dorsum of 2lateral fingers of hand?

Answer 69

Little finger recieves sensation from the ulnar nerve Radial nerve supplies anatomical snuffbox

Question 70

What is hyperextension of the MCP joints and flexion of the DIP and PIP known as?

Answer 70

Claw hand

Question 71

What are the LOAF muscles? What nerve injury prevents opposition of the thumb?

Answer 71

LOAF muscles - lateral lumbricals, opponens pollicis (opposition of the thumb), abductor pollicis brevis and flexor pollicis brevis Median nerve injury prevents opposition of the thumb

Question 72

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Answer 72

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Question 73

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Answer 73

1. - Lateral right knee pain - Common peroneal nerve - B 2. A - Anterior cruciate ligament, unable to weight bear and instability

Question 74

What is used for long term diabetic control? What is used to identify peripheral neuropathy by assessing 10different aspects of the foot?

Answer 74

HbA1c 10g Monofilament test

Question 75

Best tool for checking for retinopathy

Answer 75

Fundoscopy

Question 76

How does Menieres present?

Answer 76

Vertigo - vomiting can happen during the vertigo Associated with hearing loss and tinnitus Aural fullness Lasts a few hours

Question 77

What is the best imaging technique to identify if there is a vestibular schwannoma or not? This is used to examine in a unilateral hearing loss

Answer 77

Use MRI

Question 78

What is the anatomy of the paranasal sinuses best seen on?

Answer 78

Best seen on CT scan

Question 79

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Answer 79

1. Delayed gross motor development (sit unsupported is achieved at 3months) 2. Concern about language/hearing development ( starting to vocalise is 3 months) 3. Gross developmental delay

Question 80

What is normal at 6 and 18 months of development?

Answer 80

18 months - Gross - child can run, Fine motor - child can build 3 blocks, Language and hearing - 5-20words/points to body parts, Social - Feeds with spoon 6months - Gross - Pushes up on arms in prone, Fine motor and vision - Grasps toys, palmar grasp hand to hand, Language - Babbles, Social skills - Friendly with strangers

Question 81

What are exclamation mark hairs pathognomonic off?

Answer 81

Pathogonomonic off Alopecia areta

Question 82

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Answer 82

D - cortisol H - Oxytocin (synthetic oxytocin can be used to induce labour as causes contraction)

Question 83

People with renal impairment may develop gout arthropathy

Answer 83

EDefinition

Question 84

What organism causes this?

Answer 84

B - croup Caused by paraninfluenza virus

Question 85

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Answer 85

1. E 2. A - crossing over of fibres causes it at opposite side 3. J - Temporal causes superior quadrantanopia due to its fibres coming from the inferior reitina (the optic radiation has parietal and temporal radiations)

Question 86

Cause of infectious diarrhoea with effects mediated by toxins More common in people taking PPIs and more likely in patients who have taken drugs to alter their normal gut flora What is this?

Answer 86

This is Clostridium difficile (C.difficle) Non severe - metronidazole Severe - oral vancomycin recurrent - fidomaxacin

Question 87

What are these patient suspected to have?

Answer 87

1. wegenr's granulomatosis 2. Sjorgern's - positive schrimer test 3. Systemic lupus erythematous

Question 88

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Answer 88

1. H - fibromyalgia 2. G - prolapsed intervetebral disc 3. F - dermatomyositis (proximal muscle weakness)

Question 89

Which hormone triggers ovulation? What causes urticaria? (nettle rash)

Answer 89

Lutienzing hormone Mast cell degranulation

Question 90

What drugs are urticarial rections a known aside effect of?

Answer 90

Ace inhibitos, codeine and aspirin - pink wheals Doxycycline and bendroflumethiazide cause Photosensitivty

Question 91

What drug is given in the acute management of gout? What is prescribed 2 weeks later?

Answer 91

naproxen (NSAIDs) are given for acute attack Allopurinol or colchichine are given 2 weeks after as prophylactics to gout

Question 92

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Answer 92

A - HPV C - HSV

Question 93

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Answer 93

D -Stomach

Question 94

Which part of the intestine is intraperitoneal?

Answer 94

The ascending and descending colon are intraperitoneal

Question 95

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Answer 95

F -Diclfenac - NSAID G - predinsolone - can cause osteoporosis increasing the chance of wedge fractures H -Hydroxychloroquine

Question 96

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Answer 96

1. Malrotation or volvulus - A 2. D - pyloric stenosis - Projectile vomiting 3. B

Question 97

Label A and B

Answer 97

A - complementary determining region B - Fc region (binds to Fc receptor) The complimentary determining region is an extension of the Fab region

Question 98

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Answer 98

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Question 99

What is the main energy source for slow jogging for 40minutes? What is the main energy store for ligting a heavy wait for 4 seconds?

Answer 99

Slow jogging for 40 minutes - Glycgen stores Heavy weight for 4 seconds - ATP

Question 100

How long do these provide energy ATP Phosphocreatinase Free circulating glucose Glycogen stores Fat stores

Answer 100

ATP - 4 seconds Phosphocreatinase - 15seconds Free circulating glucose - 4minutes Glycogen stores - 77 minutes Fat stores - 4+ days