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2024 Version
patient comes in with new onset astham, bilateral wheeze. facial pain and nasal polyps are found A chest x-ray demonstrated pulmonary infiltrates. what is the most likely diagnosis and investigations - ✔✔chrug straus syndrome and investigations check pANCA levels treatment with high dose of corticoid steroids and if not controlled then add immunosuppressants treatment once an individual with mrsa is found - ✔✔nasal mupirocin and chlorhixadine what is neurofibromatosis - ✔✔its a benign tumour that grows along the nerves autososmal dominant two types type 1 most common skin symptoms: freckles in unusal places axilla groin cafe au spots (indicates neurocutaneous syndromes neurofibromas which are lumps under the skin scoliosis leanring difficulties: mild cognitive impairment- stuggle with radin or wiritng can aalso have attention deficit disorder or be part of the autism spectrum
the eyes: can get optic pathway glioma (OPG)- CASUE BLURRING THE CHILDS VISION- may bump into things can also get brown spot on the iris- Lisch nodules high blood pressure- phaemocytochropma physical development- may have scoliosis may have larger heads may be generally small can also develop psuedoarthiritis- pathological fractures what is tuberous sclerosis - ✔✔case- A 19-year-old man is admitted following a generalised seizure. No past history is available as the man is currently in a postictal state. On examination it is noted that he has three patches of hypopigmented skin and fibromata under two of his finger nails. What is the most likely diagnosis? Given the areas of hypopigmentation and subungual fibromas the most likely diagnosis is tuberous sclerosis and epilepsy (can also get infantile spasms A 45-year-old alcoholic patient starts to fit in the waiting room. You place him in the recovery position and apply oxygen. After 5 minutes he is still fitting. What is the most appropriate medication to administer? - ✔✔diazepam 10mg A 23 year old woman attends a fertility clinic with her partner. She complains of oligomenorrhoea and galactorrhea and has failed to get pregnant after 18 months of regular unprotected intercourse. Blood tests reveal a serum prolactin level of 6000 mIU/l (normal <500 mIU/l). A pituitary MRI is arranged which shows a microprolactinoma. Which of the following is the best initial treatment? - ✔✔bromocriptine
consistent with the underlying condition? - ✔✔resitant hypertension and hypokalemia - muscle weakness think conns abg would show alkalosis A 60-year-old man who is known to have lung cancer comes for review. For the past three weeks he has lost his appetite, has been feeling sick and generally feels tired. On examination he appears to be mildly dehydrated. You order some blood tests: high calcium which one would cause it Amlodipine Simvastatin Bendroflumethiazide Aspirin Lisinopril - ✔✔bendrofluemthiazide- high calcium A 27-year-old female presents with weakness of both hands. On examination you note wasting and weakness of the small muscles of the hands and loss of pain and temperature sensation over the trunk and arms. Vibration sense is intact. What is the most likely diagnosis? - ✔✔syringomyelia Syringomyelia is a condition whereby fluid filled cavities develop within the spinal cord. Pressure can increase resulting in compression of the spinal cord tracts. The syrinx can extend to and damage the anterior horn cells, thereby resulting in lower motor neurone features. The spinothalamic tract axons decussate to the other side of the spinal cord via the anterior white commissure, and they are particularly susceptible to damage from the syrinx. Pain and temperature sensation are lost due to spinothalamic tract damage, and one side may be affected more than the other. Classically, the sensation loss is experienced in a shawl-like distribution over the arms, shoulders and upper body. Light touch, vibration and proprioception may also be affected as the syrinx enlarges into the dorsal columns. risk factors for developmental dysplasia of the hip - ✔✔oligohydramnios breech presentation
birth weight over 5kg positive family history more common in the left hip but 20 percent are bilateral foot deformities treatment: most unstable hips strengthen by 3-6 weeks otherwise a pavlik harness is worn which flexes and abducts the knees n older children may require surgery A 2-year-old child comes in too see you with his mother at the GP surgery. The mother tells you that for the past few months the child has been suffering from diarrhoea. On further questioning she denies that it is foul smelling but does confirm it sometimes contains undigested food. There are no other symptoms such as abdominal pain or bloating. You plot their height and weight and it is appropriate for their age. What's the most likely diagnosis? - ✔✔todler's diarrhoea just fast trasnit of the go system can contain undigested food giardiasis symptoms - ✔✔Giardiasis is an parasitic infection and the child normally has watery stools, nausea and fever. A 3-year-old girl presents with a 3 day history of fever and bloody diarrhoea. Over the past 24 hours she has had 5 episodes of loose bloody stools. On examination she has a temperature of 39.6ºC, a heart rate of 175 bpm and her abdomen is soft with generalised tenderness. It is also noted that she has a reduced urinary output. Blood tests show a haemolytic anaemia and raised urea. gram negative bacteria What is the most likely diagnosis? - ✔✔e.coli gastroenteritis rasied urea (renal failure) and haemolytic anaemia- indicate haemolytic uraemic syndrome the only thing missing is thrombocytopenia treatment is supportive, antibiotics are contraindicated what blood results would coincide with dka - ✔✔The blood results are concurrent with a diagnosis of DKA. Bloods will often show a hyponatraemia, low bicarbonate and a hypokalaemia in severe cases. The low bicarbonate in this question gives the indication that there is an acidosis in this patient
ventricular septal defect coarctation of the aorta patent ductus aortiosus pulmonary stenosis - ✔✔vsd- pansystolic murmur in the lower left sternal border coa- crescendo-decrescendo of the murmur in the upper left sternal border machinery murmur upper left sternal border pulmonary stenosis- ejection systolic murmur in the upper left sternal border asd name 3 cyanotic congenital heart defects - ✔✔tetraology of fallot - 1 - 2 months tricuspid atresia transposition of great arteries- more common at birth what cerebral palsy is most associated with intraventricular haemorrhage - ✔✔spastic diplegic You are working on the neonatal unit and examine a new-born baby. On examination you note a small left sided haematoma over the parietal bone. It does not extend beyond the margins of the parietal bone and is soft to touch. The baby is otherwise well. The baby was born by spontaneous vaginal delivery at term. There were no problems prenatally or during labour. most likely diagnosis - ✔✔cephalohaematoma- don't cross the suture lines cranial abrasions occur in c section or instrumental delivery Chignon's are birth traumas that occur after use of a ventouse device during deliver A 12-year-old boy presents to clinic complaining of having to urinate more frequently. Upon assessment you decide to investigate for type 1 diabetes mellitus. Which of the following would most likely support this diagnosis? Weight gain Family history of type 2 diabetes mellitus
Excessive tiredness Black or Asian family origin Evidence of acanthosis nigricans - ✔✔Weight loss is associated with type 1 diabetes mellitus. Genetic factors such as family history and racial origin are more associated with type 2 diabetes mellitus. Acanthosis nigricans is a sign of insulin resistance, also associated with type 2 diabetes mellitus answer is excessive tiredness what diet can be used to help with epilepsy - ✔✔The ketogenic diet is a high fat, low carbohydrate, controlled protein diet. It is an established treatment for children with epilepsy that is hard to control and is generally unresponsive to antiepileptic medications. Following the diet requires specialist input from an epilepsy specialist and a dietician. An 8-year-old boy presents to his GP complaining of fatigue and excess sleep. An initial set of results indicated that reticulocytes and the bilirubin level were raised. A set of further blood tests reveal, microcytic anaemia - ✔✔B thalassemia extrahemopoeisis- splenomegaly causing abdominal discomfort and ruq pain due to gallstones causing a raised bilirubin A 6-year-old boy is brought to surgery by his mother. For the past 2 months he has been complaining of pain in his shins and ankles at night-time. His symptoms are bilateral he is otherwise well. There is no family history of note. Clinical examination is unremarkable. What is the most likely diagnosis? - ✔✔A common presentation in General Practice is a child complaining of pain in the legs with no obvious cause. Such presentations, in the absence of any worrying features, are often attributed to 'growing pains' what is the stepwise management of epilepsy or seizure - ✔✔buccal midazolam iv lorazapam iv phenytoin Rapid sequence induction of anaesthesia using thiopental sodium
Henry is a 29 week premature baby who was born 2 weeks ago. Over the past week it has been noted that he has had bloody stool, abdominal distension and has not been feeding well. Physical examination reveals an increased abdominal girth with reduced bowel sounds. Abdominal X-ray shows dilated asymmetrical bowel loops and bowel wall oedema. What is the likely diagnosis? - ✔✔Necrotising enterocolitis is one of the leading causes of death among premature infants. Initial symptoms can include feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis what is plagiocephaly - ✔✔plagiocephaly is more common since there have been campaigns to encourage babies to sleep on their back to reduce the risk of sudden infant death syndrome (SIDS). Plagiocephaly is a skull deformity producing unilateral occipital flattening, which pushes the ipsilateral forehead ear forwards producing a 'parrallelogram' appearance. The vast majority improve by age 3- 5 due to the adoption of a more upright posture. Helmets are not usually recommended as there was no significant difference between groups in a randomised controlled trial. Turning the cot around may help the child look the other way and take the pressure off the one side. A 4-year-old boy was discharged from the hospital six weeks ago after an episode of viral gastroenteritis. He now has 4-5 loose stools each day which has been present for the past four weeks. What is the most likely diagnosis? - ✔✔Transient lactose intolerance is a common complication of viral gastroenteritis. Removal of lactose from the diet for a few months followed by a gradual reintroduction usually resolves the problem. childhood infections The prodrome is characterised by fever, irritability and conjunctivitis? May cause vesicles in the mouth and on the palms May cause a crop of white spots on the inside of the mouth - ✔✔measles coxsackie a16-hand foot mouth disease measles-koplik spots
A 1-year-old girl is investigated for recurrent urinary tract infections. A micturating cystourethrogram is ordered: shows bilateral dilatation of the ureters, renal pelvis and calyces - ✔✔vesicoureteric reflux A 6-year-old boy is noted to have pectus excavatum and pulmonary stenosis during a cardiorespiratory exam. What is the most likely diagnosis? - ✔✔noonans sydnrome also get webbed neck and short stature what is osgood schlatter disease? - ✔✔Osgood-Schlatter disease may be diagnosed on the basis of clinical features alone. This age group (adolescent) is the most likely age to suffer from this condition and is localized to the tibial tuberosity. Typically, pain is: Unilateral (but may be bilateral in up to 30% of people). Gradual in onset and initially mild and intermittent, but may progress to become severe and continuous. Relieved by rest and made worse by kneeling and activity, such as running or jumping. A 4-year-old boy is admitted with abdominal pain and painless haematuria. On examination, there is a mass on palpation of the left flank. What is the most likely diagnosis? - ✔✔most common renal tumour in children is WILMS tumour, one of the most common childhood malignancies Management nephrectomy chemotherapy radiotherapy if advanced disease prognosis: good, 80% cure rate how much adrenaline would you give in a child under 6 months - ✔✔150 micrograms 6 - 12yrs 300 micrograms adult 500 (10.5ml 1 in 1,000)
uterine artery embolization treatment for fibroids that are causing sub fertility and for a woman that is trying to have kids - ✔✔myomectomy You are reviewing test results. The midstream specimen of urine (MSU) from a 24-year-old woman who is 11 weeks pregnant shows a urinary tract infection. On discussing the result with the patient she does describe some dysuria and 'smelly urine'. What is the most appropriate management? - ✔✔nitrofurantoin for 7 days trimethoprim is teratogenic Ms. Andrews a 24-year-old sales promoter was diagnosed with left tubal ectopic pregnancy 3 weeks ago. She was started on medical treatment with methotrexate and her progress was then closely monitored. However, her hCG titres failed to respond adequately. Surgical treatment was indicated and considered. She has no significant medical history and is medically fit. Which of the following surgery is mostly likely to be carried out by the surgeon? - ✔✔Based on the NICE guidelines, salpingectomy is offered to women who has a tubal ectopic unless they have other risk factors for infertility eg. Contra lateral tube damage. Otherwise, salpingotomy is offered as an alternative. answer: salpingectomy give an example of gnrh agonist used for fibroids - ✔✔Leuprolide A primigravid 43 year-old woman, who is at 27 weeks gestation, presents to the maternity unit with regular weak contractions. Examination reveals her cervix is 3 cm dilated and membranes are intact. What would be the most appropriate management? - ✔✔tocolytics to try and stop the pregnancy and steroids should be given in case premature labour then decrease the risk of respiratory distress sysndrokme A 56-year-old man with metastatic prostate cancer comes for review. He is known to have spinal metastases but until now has not had any significant problems with pain control. Unfortunately, he is now getting regular back pain despite taking paracetamol 1g qds. The pain is stopping him sleep at times. Neurological examination is unremarkable. What is the most appropriate next step? - ✔✔Whilst
there is a role for oral bisphosphonates in treating such pain the effects may take several weeks to materialise and the number needed to treat is higher than that of strong opioids. Referral to a clinical oncologist should be considered for all patients with such pain as radiotherapy is an effective treatment. so answer is strong opiod explain the pathophysiology of renal osteodystrophy - ✔✔kidneys not being able to convert enough vitamin D to its active form and they are also not able to adequately excrete phosphate. Due to this insoluble calcium phosphate forms, removing calcium from the circulation, which results in hypocalcaemia. The parathyroid glands detect this and secrete parathyroid hormone to try and raise serum calcium levels. This is achieved through several mechanisms, including increasing the osteoclastic activity of bone, resulting in renal osteodystrophy. treatment of secondary hyperparathryoidism - ✔✔In individuals with chronic kidney disease, this being the most common cause of secondary hyperparathyroidism, treatment consists of dietary restriction of phosphorous, supplemented with active vitamin D and phosphate binders. Most patients will improve following renal transplantation. phosphorous food meats, poultry, fish, nuts, beans and dairy products if patient with large pleural effusion but stable, what would be the management - ✔✔The first step in the management of this patient is pleural aspiration, preferably under ultrasound guidance. This will help guide further management and determine the aetiology of the effusion. There is no need for immediate chest drain insertion as she is stable. A 72-year-old man is brought to clinic by his family. They are very concerned about his declining cognition. He was normally very well and independent until 3 months ago. He has lost no weight, has no headache but has been falling a lot. He also complains of urinary incontinence. - ✔✔the clinical features are very suggestive of normal pressure hydrocephalus. The features of this condition can be remembered by 'wet, wobbly and whacky' which represent urinary incontinence, gait ataxia, and dementia respectively. Imaging hydrocephalus with an enlarged fourth ventricle
path physiology of alpha 1 antriypsin - ✔✔Alpha-1 antitrypsin (A1AT) is produced in the liver, and one of its functions is to protect the lungs from neutrophil elastase, an enzyme that can disrupt connective tissue. many of these patients will develop emphysema due to lack of elastase and also develop liver cirrhosis as the alpha 1 antitrypsin builds up and becomes toxic A 66 year old woman presents to her General Practitioner after a fall. She describes that the episode was preceded by the onset of dizziness while hanging out washing. She fell and had difficulty getting back up. She vomited twice but was not incontinent and did not bite her tongue. Her symptoms have improved gradually, but have recurred abruptly over the few days since the first episode. On examination she is well, but certain head movements provoke her symptoms and induce nystagmus. - ✔✔benign position vertigo An 85 year old woman presents to the Accident and Emergency Department following a collapse whilst standing in a queue - ✔✔vasovagal syncope A 25 year old woman is referred from the optician following an episode of blurred vision 18 months previously and a recent episode of double vision in the last week. In the last 3 months she has also found that she can suddenly experience the feeling of needing to go to pass urine and has to rush to get to the toilet in order to avoid wetting herself. - ✔✔multiple sclerosis symptoms of oestrogen deficiency - ✔✔dryness and urinary frequency A 60 year old man has a long history of gastro-oesophageal reflux symptoms, with pain on swallowing. He underwent an upper gastro-intestinal endoscopy 2 months ago, with no malignancy seen. He contiues to have difficulty swallowing. His body mass index is 24. - ✔✔gord and endoscopy are both risk factors for oesophageal stricture An 88 year old man presents with a sensation of burning in his mouth. He has a history of chronic obstructive pulmonary disease, and has had several courses of antibiotics recently. He has lost weight and eats poorly. His body mass index is 18. - ✔✔oral candiasis associated with broad spectrum antibiotic usage
A 60 year old woman presents with a retrosternal chest pain, associated with regurgitation of gastric acid into the mouth. A chest x-ray reveals an air fluid level overlying the cardiac shadow. Her body mass index is 34 - ✔✔hiatus hernia- air fluid level is characteristic An 18 year old black West Indian man presents with painful joints. He has a high temperature and complains of repeated chest infections. On examination his sclerae are slightly yellow. Urine Dipstix shows blood and protein in small amounts. - ✔✔sickle cell disease A 40 year old man presents at an infertility clinic. He and his wife have been unable to have children, although his wife has a child from her first marriage. On examination, he is 1.9m (6' 4") tall, with gynaecomastia and small testes. - ✔✔klinefelters sydnrome A six hour old baby girl born at term is recognised by the midwife to be grunting. She is of Indian origin. She was born by normal vaginal delivery following the rupture of her mother's membranes 36 hours previously. On examination she has a respiratory rate of 70/min, flaring of the alae nasae and marked intercostal recession. Oxygen saturation measured 80% in air name the pathogen - ✔✔group b streptococcus- most common cause of infection septicaemia meningitis in children A 14 year old girl presents for follow up. She has a cough productive of green sputum. She has cystic fibrosis and is of white British origin. She is otherwise well. Despite a course of amoxicillin and flucloxacillin the cough and sputum have not resolved. She has lost 1kg in weight since her last clinic visit. On examination, there are no signs of respiratory distress. There are coarse crackles at her right base. Correct Answer I) - ✔✔Pseudomonas aeruginosa the four common organises that colonise in cystic fibrosis Staphylococcus aureus Pseudomonas aeruginosa Burkholderia cepacia* Aspergillus A 16 year old girl presents to her General Practitioner accompanied by her mother. She describes that she has not yet commenced her periods. She has always been fit, and was a regional cross-country
A 35 year old patient presents with a four day history of vaginal bleeding. Ten days ago she had a forceps delivery for delayed labour at 39 weeks in her second pregnancy. On examination her pulse and blood pressure are normal. The uterus is enlarged and tender - ✔✔endometriasis Puerperal pyrexia may be defined as a temperature of > 38ºC in the first 14 days following delivery. Causes: endometritis: most common cause A 51 year old man presents with fever, abdominal pain and diarrhoea. He also gives a six month history of joint pains. An abdominal CT scan is normal. A small bowel biopsy shows periodic acid-Schiff positive rods within the macrophages - ✔✔acid shift positive rods- whipples disease A 28 year old woman presents with abdominal pain. She was treated for a peri-anal disorder two years previously. Investigations show a macrocytosis and raised c-reactive protein. - ✔✔crohns perianal disease- Perineal inspection may show fissures or fistulae for uc eri anal disease is usually absent. A 50 year old man presents to his General Practitioner with a three month history of an intensely itchy eruption which began on his legs but which has now spread to the arms. He has had no previous skin disease and no one in the family has had skin problems. His General Practitioner prescribes a moderate potency topical steroid and refers him to the dermatology department. At his appointment with the dermatologist two months later, there has been no improvement. On examination he has numerous discrete circular scaly excoriated patches with evidence of crusting. These are predominantly on his limbs - ✔✔excoriations - discoid ezcema A 55 year old woman presents to her General Practitioner with a four week history of an itchy eruption. The use of a moisturiser has not had any effect. She had a similar rash 15 years ago and it lasted for 12 months. On examination there are numerous flat topped purplish papules located over her forearms and flexor aspects of the wrists. She has several relatively painless ulcers on buccal mucosa. - ✔✔lichen planus
itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms rash often polygonal in shape, 'white-lace' pattern on the surface (Wickham's striae) Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma) oral involvement in around 50% of patients nails: thinning of nail plate, longitudinal ridging An 80 year old woman with dementia is visited in her nursing home by her General Practitioner after staff are concerned that she is uncontrollably scratching herself. On examination she has numerous excoriated papules on her upper limbs and trunk. Her General Practitioner has previously prescribed oral antibiotics and a topical steroid, but this only produced a temporary improvement. Three other residents have developed a similar eruption - ✔✔scabies A 75 year old woman presents with an exquisitely painful swollen knee which is warm to the touch. She is finding it difficult to walk to the toilet. This is particularly problematic for her as she suffers from urinary frequency which she attributes to her furosemide tablets - ✔✔furosemide- big risk factor for gout A young man presents two weeks after returning from holiday in Spain, with a painful swollen knee which he cannot fully bend. On examination the knee is swollen with a positive patellar tap, and is warm to the touch. He describes an episode of diarrhoea whilst on holiday for which he was treated with antibiotics. - ✔✔reactive arthritis post sti post dysentry A 23 year old man presents complaining of an 18 month history of intermittent low back discomfort. This has been associated with numbness and tingling in the left leg. Pain is relieved by resting and he reports no nocturnal symptoms. He has noticed mild urinary incontinence. Examination reveals no abnormal neurology in the lower limbs and no other significant clinical findings. investigation of choice - ✔✔query cauda equina syndrome mri scan A 25 year old man presents to his General Practitioner with headache, fever and malaise. He is a keen canoeist. On examination the patient has hepatosplenomegaly and lymphadenopathy. There appears to be suffusion of the conjunctiva. Full blood count is normal. - ✔✔leptospirosis
