Question.

You see a 54year old at his GP practice. He was discharged 8 weeks ago from hospital. A diagnosis of acute anterior MI was made, and he had coronary stents. He has been feeling more breathless on climbing stairs in last week. On examination there is a pan systolic murmur at the left sternal edge. What structural damage could cause this?

• • • 1. Ventricular rupture
      2. Papillary muscle rupture
      3. Mitral regurgitation
      4. Subacute Bacterial Endocarditis
      5. Pulmonary edema

  Answer

  Answer.

  2. Papillary Muscle Rupture

   

  Explanation.

  

Question.

During a pre anesthetic check up for laparoscopic cholecystectomy; 56 year old man is found to have a systolic murmur. He is asymptomatic and never known about this. ECG is normal sinus rhythm. BP 118/66 mmHg. There are no known medical or surgical conditions or on any regular medication. What is the most appropriate next step?

• • • 1. Urgent consultation with on call cardiology registrar
      2. Cancel the procedure all together
      3. Ask patient to attend A+E
      4. Refer to GP for further investigation
      5. Book urgent outpatient echocardiogram

  Answer

  Answer.

  5. Book urgent outpatient echocardiogram

   

  Explanation.

  1. Asymptomatic murmur is most likely to be benign
  2. Any signs or symptoms of cardiac decompensation i.e.; exertional dyspnea, chest pain, radiation of murmur, fever or peripheral edema
  3. If suspected endocarditis or MI urgent referral to ED and speak to cardiologist
  4. Choice of investigation for structural heart disease Transthoracic echocardiogram
  5. No indication to cancel procedure at present

Question.

10 month old has been brought by his mother, as he is not gaining weight and height at 30 th percentile. He was born at 29th week of pregnancy. This mother says that he is easily tired. There is a “to and fro ” murmur at sternum, with left ventricular thrill. What is the most likely pathology?

• • • 1. Venous Hum
      2. Ventricular Septal Defect(VSD)
      3. Tetralogy of Fallot(ToF)
      4. Patent Ductus Arteriosus(PDA)
      5. Aortic Stenosis

  Answer

  Answer.

  4. Patent Ductus Arteriosus(PDA)

   

  Explanation.

  

Question.

How would you manage a conscious patient, with this cardiac rhythm?

• • • 1. IV Morphine
      2. DC Shock
      3. IV Adenosine
      4. Oral Digoxin
      5. IV Amiodarone

  Answer

  Answer.

  3. IV Adenosine

   

  Explanation.

  

Question.

60 year old man is brought in by ambulance with breathlessness. He is drowsy and unable to give any history. His ambulance card shows BP 100/60, RR 26, SpO2 92%, HR106. His past medical history includes type 2 diabetes, hypertension and asthma. An ECG is performed. What is your diagnosis?

• • • 1. Hypercalcemia
      2. Acute Myocardial Infraction
      3. Sinus Tachycardia
      4. Hyperkalemia
      5. Normal Sinus Rhythm

  Answer

  Answer.

  4. Hyperkalemia

   

  Explanation.

  

Question.

You are working in Emergency department ; asked to see a 20 year old university student. She woke up with numbness over left leg and unable to lift her left foot. She went out with friends and had a few drinks, last night. She cant recall any falls; but fell asleep on an armchair. On examination , there is reduced sensation on lateral part of leg and reduced power in left foot dorsiflexion. What structures might be damaged?

• • • 1. Sural Nerve
      2. Femoral Nerve
      3. Peroneal Nerve
      4. Sciatic Nerve
      5. Planter Nerve

  Answer

  Answer.

  3. Peroneal Nerve

   

  Explanation.

  

  

  
   

Question.

A 35 year old banker noticed a lump in right side of scrotum. He was seen at his GP practice. On examination his right testicle is firm and enlarged to size of golf ball. There were no palpable lymph nodes. Urine dip showed +leukocytes. Ultrasound scan revealed testicular mass. He goes on to have CT scan after attending a Urology clinic at local hospital. The CT reports lymphadenopathy , but no metastasis. Which lymph nodes might be affected?

• • • 1. Mesenteric Lymph Nodes
      2. Para aortic Lymph Nodes
      3. Inguinal Lymph Nodes
      4. Femoral Lymph Nodes
      5. Abdominal Lymph Nodes

  Answer

  Answer.

  2. Para-aortic Lymph Nodes

   

  Explanation.

  
   

Question.

An 84-year-old man being treated for pneumonia on a general medical ward develops profuse diarrhoea. He has been treated with broad spectrum intravenous antibiotics for 6 days. The F1 examines him and finds his clinical exam to be unremarkable apart from a slightly raised temperature compared to the last few days. His blood results show that the WCC has markedly increased, it had been decreasing earlier in the admission. What is the SINGLE most important diagnosis to consider in this scenario?

• • • 1. Worsening pneumonia due to broad spectrum antibiotic use
      2. Clostridium difficle infection
      3. Viral gastroenteritis
      4. Ischaemic colitis
      5. Diverticulitis

  Answer

  Answer.

  2. Clostridium difficle infection 

   

  Explanation.

  Difficle is an antibiotic-associated diarrhoea and can occur with anyone on antibiotics but the classic affected person is usually an elderly hospitalized patient. The WCC is usually markedly raised. Apart from diarrhoea, other symptoms and signs are more vague and include abdominal pain and fever. The diarrhoea usually has a distinctive foul smell!

   

Question.

A 48 years old gentleman with celiac sprue presents to the GP for annual check-up. He is in relatively good health and has a family history of coronary artery disease: his brother had a myocardial infarction at the age of 55 years. He has a blood pressure of 125/80 mmHg and heart rate of 70 beats per minute. He mentions that his friend has just been diagnosed with prostate cancer and wants to know what screening test would be appropriate for him?

• • • 1. Cystoscopy
      2. Prostate specific antigen
      3. Digital rectal examination
      4. None of the above

  Answer

  Answer.

  4. None of the above 

   

  Explanation.

  Routine screening won’t be offered, to asymptomatic men <50 years of age. More explanation on the course

   

Question.

A 34 years old lady is admitted with a diagnosis of severe asthma. She has a long history of asthma with multiple hospitalizations for severe asthmatic attacks. Three days prior to admission she has moved to a newly refurbished house. Ever since then she has had a progressively worsening shortness of breath. She is nauseas and has vomited three times today. Salbutamol and Ipratropium bromide nebulizer treatments did not relieve her symptoms. Her peak flow rate has decreased by nearly 50% from baseline.

What should be the next step in the patient’s treatment be to relieve her symptoms?

• • • 1. Terbutaline sulfate
      2. Beclomethasone
      3. Prednisolone
      4. Hydrocortisone
      5. Disodium cromoglycate

  Answer

  Answer.

  4. Hydrocortisone 

   

  Explanation.

  Adding an IV steroid will augment the action of the bronchodilators by reducing inflammation surrounding the airways.

  Terbutaline sulfate: is a beta-adrenergic receptor agonist which can be given as an alternative to Salbutamol to reverse bronchospasm.

  Beclomethasone: A surface acting steroid dispensed in aerosolized form. It is used in the long-term treatment of chronic asthma to prevent recurrent attacks. It can not be used for acute attacks.

  Prednisolone: In this scenario since the patient has history of recent vomiting, she will not be able to take oral prednisolone. A parentral hydrocortisone or intramuscular methylprednisolone are better alternatives.

  Disodium cromoglycate: is a mast cell stabilizer used to decrease the occurrence and severity of asthma attacks. Once bronchospasm is established it has little use.