Yr 3 Formative Qs Flashcards

Question

Answer 1

What does this chest x ray show? Pulmonary fibrosis **Bilateral hilar lymphadenopathy** Widened mediastinum Cardiomegaly Pneumothorax

Answer 2

What does this chest x ray show? Pulmonary fibrosis Bilateral hilar lymphadenopathy **Widened mediastinum** Cardiomegaly Pneumothorax

Answer 3

Thoracic AA

Answer 4

Which are the correctly linked side effects: A. **Sitagliptin and pancreatitis** B. Pioglitazone and prostate cancer C. Metformin and renal failure D. Pioglitazone and Weight loss E. Gliclazide and hyperglycaemia

Answer 5

Which of the following endocrine conditions is associated with an increased risk of Type 2 diabetes? A. **Ectopic ACTH production** B. Osteoporosis C. Hypoparathyroidism D. Addison’s disease E. Osteomalacia

Answer 6

A 52 year old man complains of tiredness and nocturia. His blood test shows a glycated haemoglobin of 64 mmol/mol (8.0%) (normal range 30-47 mmol/mol or 4.8 – 6.4%). The next most appropriate step is his management is to: A. Repeat glycated haemoglobin B. Commence metformin 1000mg twice daily C. Refer to a hospital diabetes clinic D. **Refer to a diabetes education programme** E. Refer to a podiatrist

Answer 7

**130/80 mmHg** - has diabetic eye complications

Answer 8

A 24 year old white woman with Type 1 diabetes for 12 years complains of a pink discoloration over her left anterior tibia of two months duration. This is likely to be: A. Livedo Reticularis B. Diabetic dermopathy C. Granuloma Annulare D. Acanthosis Nigricans E. **Necrobiosis Lipidoica Diabeticorum**

Answer 9

A 24 year old white woman with Type 1 diabetes for 12 years complains of a one or more skin coloured or red bumps form rings in the skin over joints, particularly the knuckles.. This is likely to be: A. Livedo Reticularis B. Diabetic dermopathy C. **Granuloma Annulare** D. Acanthosis Nigricans E. Necrobiosis Lipidoica Diabeticorum

Answer 10

A 24 year old white woman with Type 1 diabetes for 12 years complains ofmottled discolouration of the skin. This is likely to be: A. **Livedo Reticularis** B. Diabetic dermopathy C. Granuloma Annulare D. Acanthosis Nigricans E. Necrobiosis Lipidoica Diabeticorum

Answer 11

This image shows A. Livedo Reticularis B. Diabetic dermopathy C. Granuloma Annulare D. Acanthosis Nigricans E. **Necrobiosis Lipidoica Diabeticorum**

Answer 12

This image shows A. **Livedo Reticularis** B. Diabetic dermopathy C. Granuloma Annulare D. Acanthosis Nigricans E. Necrobiosis Lipidoica Diabeticorum

Answer 13

**Diabetic dermopathy**

Answer 14

**Granuloma Annulare**

Answer 15

A 43 year old woman with type 1 diabetes complains of diplopia on looking to the left. On examination she is unable to abduct her left eye. The likely cranial nerve involved is: **VI** IV III II VII

Answer 16

**Non functioning pituitary tumour**

Answer 17

**1st pregnancy after age 30**

Answer 18

In Afro-Caribbeans, the estimated Glomerular fitration rate estimated using the MDRD formula should be corrected by multiplying by : Question 33Select one or more: A. 2.01 B. **1.21** C. 1.51 D. 1.01 E. 2.51 Feedback

Answer 19

**Warfarin therapy** - due to bleeding risk

Answer 20

A 60 year old homeless man has Mycobacterium tuberculosis. Because of his circumstances, his compliance with treatment has been intermittent and, Mycobacterium tuberculosis has become resistant to rifampicin. What is the typical mechanism for this resistance? A. Enzymic destruction of the antibiotic molecule B. Enzymic modification of the antibiotic molecule, by adding a small chemical group C. Modification of the bacterial efflux pump D. Modification of the bacterial pores **E. Modification of the bacterial RNA polymerase, the target of the drug**

Answer 21

A 60 year old homeless man has illness X. Because of his circumstances, his compliance with treatment has been intermittent and, illness x has become resistant to **ciprofloxacin** . What is the typical mechanism for this resistance? A. Enzymic destruction of the antibiotic molecule B. Enzymic modification of the antibiotic molecule, by adding a small chemical group C. Modification of the bacterial efflux pump **D. Inhibition of DNA replication (DNA gyrase)** E. Modification of the bacterial RNA polymerase, the target of the drug

Answer 22

A 35 year-old woman visits her general practitioner (GP) complaining of a productive cough of 6 weeks duration. On further questioning she has a history of fever and night sweats and lost about 10 kg in weight during this time. She lived in Nigeria until she was 16 years old. Which one of the following investigations should the GP request first? A. bronchoscopy B. full blood count C. Mantoux test D. serum interferon-gamma release assay **E. sputum for acid fast bacilli**

Answer 23

A 38 year-old woman has tiredness, joint aches and joint swelling. She is noted to have this appearance on her skin (see image). Her pulse rate is 80 bpm and regular and her BP 158/102 mmHg. Her investigations are shown below: Urinalysis: Blood ++ Protein ++ Urine microscopy: Red cell casts Creatinine 143 µmol/L (60–120) Which other test is most likely to confirm the diagnosis? **A. anti-nuclear antibodies** - she has **lupus** B. anti-nuclear cytoplasmic antibodies C. erythrocyte sedimentation rate D. gastric parietal antibodies E. rheumatoid factor

Answer 24

A 58-year-old man with Type 2 diabetes mellitus is seen in diabetes clinic for review. He is noted to have good glucose control (HbA1c 52 mmol/mol [30-42]), but has an elevated albumin:creatinine ratio of 30.5 ummol/mg (< 3). His eGFR is 54 ml/min/1.73m2 . He is on metformin 100mg twice daily, ramipril 10mg daily and a statin. Blood pressure is 124/76 mmHg.What is the most appropriate next step in his management? A. add a calcium channel blocker B. add a gliptin **C. add a sodium glucose transporter-2 inhibitor** D. add a sulphonylurea E. no change needed

Answer 25

A 75 year-old man has ongoing severe pain at the site where he had shingles 4 months ago. He is still finding the light touch of clothing painful. What is the most appropriate treatment? A. codeine **B. gabapentin** C. ibuprofen D. morphine E. paracetamol

Answer 26

A seven year-old boy has a fever, sore throat, severe pain on swallowing and lack of appetite. He does not have a cough. His temperature is 39.5°C. He has a bilateral tonsillar exudate and bilateral cervical lymphadenopathy. Which is the most likely causative organism? A. Epstein-Barr virus **B. group A streptococcus** - effects young children more C. Haemophilus influenzae D. paraninfluenza virus E. respiratory syncytial virus

Answer 27

A medical student has a fever, sore throat, severe pain on swallowing and lack of appetite. He does not have a cough. His temperature is 39.5°C. He has a bilateral tonsillar exudate and bilateral cervical lymphadenopathy. Which is the most likely causative organism? **A. Epstein-Barr virus** - glandular fever more common in older teenagers B. group A streptococcus C. Haemophilus influenzae D. paraninfluenza virus E. respiratory syncytial virus

Answer 28

4. A 28 year old man is investigated for polyuria and polydipsia. He has bipolar disorder for which he has taken lithium for 2 years. Initial investigations: Sodium 145 mmol/L (135–146) Potassium 3.9 mmol/L (3.5–5.3) Serum osmolality 296 mOsmol/kg (285–295) Urinary osmolality 356 mOsmol/kg (350–1000) Fasting glucose 5.8 mmol/L (3.0–6.0) Serum lithium 0.75 mmol/L (0.5–1.2) Which is the most useful diagnostic investigation? A. 24-h urinary cortisol test B. Glucose tolerance test **C. Serum corrected calcium** D. Short Synacthen test E. Water deprivation test It is essential to exclude hypercalcaemia due to hyperparathyroidism before progressing to a water deprivation test.

Answer 29

**Correct Answer: B** This patient is hypovolaemic due to long lie without hydration and the probably sepsis. The level of CK is compatible with minor soft tissue injury. Rhabdomyolysis would give a CK of >10,000. There is no indicators of glomerulonephritis and the urinalysis abnormalities are compatible with a catheter sample +/- urosepsis. Renal emboli are rare and would give loin pain. Ureteric obstruction is unlikely as the patient is still passing some urine.

Answer 30

**Correct Answer: D** Justification for correct answer The description of the arrhythmias best fits with ectopics (either supraventricular or ventricular). Supraventricular are probably more common in this age group. There are no worrying features and the cause is most likely benign.

Answer 31

**Correct Answer: B** Justification for correct answer This is because nuclear enlargement, hyperchromasia and pleomorphism are features that suggest carcinoma in all sites of the body.

Answer 32

**Correct Answer: E** Justification for correct answer Respiratory acidosis needs to be corrected with ventilation in an alert patient.

Answer 33

**Correct Answer: C** Justification for correct answer Immediate release anticholinergics are the first line treatment for overactive bladder with urge incontinence in the NICE 2013 guidelines.

Answer 34

**Correct Answer: C** Justification for correct answer The patient has evidence of a paralytic ileus. The initial treatment would involve making patient nil by mouth and inserting a nasogastric tube. Morphine would make the condition worse. There is no indication for antibiotics. An enema would not be appropriate and unlikely to be of benefit. There is no indication for immediate surgery as further investigations will be required to identify treatable causes.

Answer 35

**Correct Answer: E** Justification for correct answer Description of adequate (if not over) hydration. Needs vasoconstriction.

Answer 36

**Correct Answer: B** Justification for correct answer The picture is of syndrome of inappropriate ADH secretion with hyponatraemia and inappropriately concentrated urine. ADH stimulates synthesis of aquaporin-2 in the apical membrane of the collecting duct which promotes water absorption. This leads to a dilutional hyponatraemia.

Answer 37

**Correct Answer(s): D** Justification for correct answer(s): - The student should be able to identify the potential for neutropenic sepsis in a patient who is 8 days post-chemotherapy, (even though agent is unknown) and must know the importance of prompt antibiotic administration prior to any other action.

Answer 38

Correct Answer(s): D Justification for correct answer(s): The student should be able to identify the potential for neutropenic sepsis in a patient who is 8 days post-chemotherapy, (even though agent is unknown) and must know the importance of prompt antibiotic administration prior to any other action.

Answer 39

**Correct Answer(s): D** Justification for correct answer(s): The student should be able to identify the potential for neutropenic sepsis in a patient who is 8 days post-chemotherapy, (even though agent is unknown) and must know the importance of prompt antibiotic administration prior to any other action.

Answer 40

**Correct Answer(s): B** Justification for correct answer(s): This patient has suffered an iatrogenic pneumothorax secondary to insertion of a chest drain.

Answer 41

**C. Plaque psoriasis** Justification for correct answer(s): The image shows typical well demarcated red, scaly patches on the back of the patient. This is typical of plaque psoriasis which is characterised by well demarcated red, scaly patches classically affecting the extensor surfaces, sacrum and scalp.

Answer 42

**Correct Answer(s): D** Justification for correct answer(s): The patient continues to show signs of hypovolaemia so a pre-renal cause for the oliguria is most likely. ATN usually takes longer to develop and would need to ensure adequate fluid resuscitation. Ureteric injury is unlikely and would need to be bilateral to cause AKI. Catheter blockage would cause anuria. Renal artery occlusion is rare and would cause loin pain and more severe clinical picture.

Answer 43

Justification for correct answer(s): Chest X-ray shows multiple nodules, **making metastatic cancer most likely.**

Answer 44

**Correct Answer(s): D** Justification for correct answer(s): Classic presentation of adrenal crisis. Nearly all patients have a history of lethargy and weight loss. Plasma cortisol and ACTH should be sent immediately so that definitive treatment can be initiated. You would not wait for results before starting IV steroids. - Justification for Unselected: Presentation does not fit with either a PE or cerebral disease. Hypotension more likely to be due to adrenal insufficiency than cardiac disease. Urine and plasma osmolality is not required as there is more likely cause for hyponatraemia.

Answer 45

**Correct Answer(s): A** Justification for correct answer The patient has an unprovoked DVT. Patients should be offered CT scan abdomen and pelvis to help identify possible malignancy.

Answer 46

**Correct Answer(s): E** Justification for correct answer All patients with mechanical valves require treatment with aspirin and warfarin. Low molecular weight heparin is used as bridging anti-coagulation but not long-term. There is no place for novel oral anticoagulants (yet).

Answer 47

**Correct Answer(s): A** Justification for correct answer Cabergoline (a dopamine agonist) is the first-line treatment for a micro- and macroprolatinomas.

Answer 48

Correct Answer(s): E Justification for correct answer i-gels are often used in cardiac arrest situations as they are easier to place than tracheal tubes. However, only the tracheal tube can seal the trachea off and protect against aspiration.

Answer 49

Correct Answer(s): B

Answer 50

Correct Answer(s): B

Answer 51

**Correct Answer(s): E** Justification for correct answer This is a non-functional thyroid nodule so needs ultrasound to classify - FNA may then be indicated.

Answer 52

Correct Answer(s): E Justification for correct answer This is likely spurious - and needs repeat.

Answer 53

**Correct Answer(s): B** Justification for correct answer Separate and can get above mass which is cystic is an epididymal cyst (spermatocele) which is benign and usually asymptomatic and managed conservatively. Although a hydrocele trans illuminates it would surround the testis.

Answer 54

**Correct Answer(s): C** Justification for correct answer Myasthenic crisis is an acute respiratory failure characterised by forced vital capacity (FVC) below 1 L, negative inspiratory force (NIF) of 20 cm H2O or less, and the need for ventilatory support. The use of accessory muscles indicates significant inspiratory weakness. Weak cough indicates weakness of expiratory muscles. Arterial blood gas analysis commonly shows hypercapnia before hypoxia. There should be a low threshold for endotracheal intubation due to rapid deterioration of bulbar and respiratory muscles.

Answer 55

**Correct Answer(s): E** Justification for correct answer Streptococcus is the most common pathogen in leg cellulitis (including in patients with diabetes).

Answer 56

**Correct Answer(s): C** Justification for correct answer NSAIDs are the first-line treatment for superficial thrombophlebitis (NICE CKS thrombophlebitis – superficial, May 2017)

Answer 57

**Correct Answer(s): E** Justification for correct answer Fibrocystic disease characteristically causes pain associated with the menstrual cycle. The fine needle aspiration supports this with no malignant cells seen. A fibroadenoma is a solid lump. Pain if present would be localised with fat necrosis. Breast abscess would be a more acute history and again would not be expected to cause bilateral breast pain.

Answer 58

Correct Answer(s): A Justification for correct answer Despite gradual improvement this venous ulcer would be best managed with stockings, which would also help prevent further lesions.

Answer 59

**Correct Answer(s): D** Justification for correct answer Prothrombin complex concentrate is used to reverse warfarin in medical emergencies. It is quicker to administer than FFP and can reverse anti-coagulation within minutes. FFP also carries the risk of allergic reactions, transfusion-related lung injury and volume overload. PCC is therefore considered first-line to reverse warfarin. The other drugs do not reverse warfarin.

Yr 3 Formative Qs Flashcards

(89 cards)