12738017
Descripción
Test por Plymouth Med, actualizado hace más de 1 año
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Creado por Plymouth Med
hace más de 6 años
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Pregunta 1
Pregunta
38-year-old male fell whilst horse riding earlier in the day. He was unconscious briefly after his fall but was able to continue horse riding. He now complains of disorientation and a severe headache. His GCS is 13. He feels nauseous. Examination reveals a bruise on his temple. His blood pressure is 160/105, HR 55bpm, RR 20, temperature 37.1. What vessel may have been ruptured?
Respuesta
-
Anterior cerebral artery
-
Middle meningeal artery
-
Sagital sinus
-
Subdural vein
-
Vertebral artery
Pregunta 2
Pregunta
A 42 year old male, of no fixed abode, presents with increased forgetfulness over the past month. He complains of a mild headache which does not improve with paracetamol. Initial blood tests show ALT 392 (0-55), AST 228 (0-60), ALP 160 (40-150), bilirubin 45 (3-21). He has a 20 pack year smoking history and his alcohol intake is 80u/week.
What is the most likely diagnosis?
Respuesta
-
Vascular dementia
-
Extradural haemorrhage
-
Subarachnoid haemorrhage
-
Subdural haemorrhage
-
Venous sinus thrombosis
Pregunta 3
Pregunta
An elderly female presents to ED with subacute worsening of back pain which is 5/10 in severity. She has had longstanding lower back pain. She does not report any recent changes in urinary or bowel symptoms. Examination reveals local, central tenderness on lower palpation. There is normal lower limb sensation and power. Renal function and FBC are normal. Spinal XR is ordered.
What is the next step in management?
Respuesta
-
Adequate analgesia, discharge
-
Alendronic acid
-
Spinal CT scan
-
Surgical referral
-
Urinary electrophoresis
Pregunta 4
Pregunta
An elderly male attends his GP complaining of left-sided hip pain. The pain has been worsening slowly over the past few weeks and has not responded to naproxen. On further questioning, he admits he has been feeling tired and has stopped gardening. Examination reveals full range of hip motion, non-tender to palpation and left hip feels slightly warm.
Hb 120 (130-180)
Plt 110 (150-400)
WCC total 12.5 (4-11)
CRP 27 (<10)
Ca 2.3 (2.1-2.6)
eGFR 59 (>90)
Cr 190 (70-150)
Urea 9.1 (2.5-6.7)
What is the diagnosis?
Respuesta
-
Myeloma
-
Osteopenia
-
Osteoporosis
-
Paget’s disease of bone
-
Rheumatoid Arthritis
Pregunta 5
Pregunta
Diagnosis of multiple myeloma has been made. What do you expect to see on urinary electrophoresis?
Respuesta
-
Monoclonal kappa light chain IgG
-
Monoclonal kappa light chain IgM
-
Monoclonal lambda light chain IgG
-
Multiclonal kappa light chain IgM
-
Multiclonal lambda light chain IgM
Pregunta 6
Pregunta
Ig[blank_start]A[blank_end] is present in breast milk.
Ig[blank_start]G[blank_end] is transplacental and is a specific antibody
Ig[blank_start]M[blank_end] is a general antibody
Ig[blank_start]E[blank_end] is allergy related
Ig[blank_start]D[blank_end] is a BCR
Respuesta
-
A
-
G
-
M
-
D
-
E
Pregunta 7
Pregunta
75 year old male was found unconscious at home and initial assessment has revealed a neck of femur fracture. He was previously able to walk 4 miles without stopping and performed all activities of daily living.
What is the most appropriate definitive management plan?
Respuesta
-
Dynamic hip screw
-
Hemiarthroplasty
-
Leg cast and strong analgesia
-
Open reduction, internal fixation
-
Total hip arthroplasty
Pregunta 8
Pregunta
75 year old male was found unconscious at home and initial assessment has revealed a neck of femur fracture. He was previously able to walk 4 miles without stopping and performed all activities of daily living. In ED, he suddenly becomes tachypnoeic, and complains of pleuritic chest pain. His O2 sats drop to 88% (10L O2), HR is 120 and BP is 90/50.
What is the most likely diagnosis?
Respuesta
-
Acute haemorrhage
-
Myocardial infarction
-
Pulmonary Embolism due to fat embolus
-
Pulmonary Embolism due to Venous Thrombosis
-
Septic Shock
Pregunta 9
Pregunta
55 year old male presents to his GP with a lump on DIP on his left hand. The lump is hard, non-mobile and adherent to overlying and underlying tissue. The lump does not give him any issues. He does not want surgical intervention.
He has a history of multiple episodes of acute finger joint pain. His regular medication is naproxen, ramipril and bendroflumathiazide.
What is the most appropriate management plan?
Respuesta
-
Advise lumpectomy
-
Allopurinol
-
Biopsy lump
-
Colchicine
-
Increased NSAID dose
Pregunta 10
Pregunta
You are a GP and are called out to see a known IVDU who complains of a painful right knee. She is walking with a limp. On examination, her right knee is erythematous, tender and warm on palpation and there is reduced knee flexion. She is tachypnoeic and sweating.
What is the next most appropriate step?
Respuesta
-
Emergency admission to ED
-
Flucloxacillin 500mg TDS PO
-
High dose NSAIDs
-
Oral steroids
Pregunta 11
Pregunta
You are a FY1 and you aspirate the swollen knee of a 55 year old female patient. She presented with a red, hot, swollen knee. She is otherwise well. The fluid is turbid and straw coloured.
What is the most likely diagnosis:
Respuesta
-
Osteoarthritis
-
Rheumatoid arthritis
-
Septic arthritis
-
Reactive arthritis
Pregunta 12
Pregunta
On a normal healthy patient, bridging veins should be visible.
Respuesta
- True
- False
Pregunta 13
Pregunta
Calcification of the choroid plexus is common in elderly patients and can be seen in CTs as surrounding the ventricles
Respuesta
- True
- False
Pregunta 14
Pregunta
What's this pattern indicative of?
Trauma--> Lucid phase--> Headache
Respuesta
-
Epidural hemorrhage
-
Subdural hemorrhage
-
Subarachnoid hemorrhage
-
Intercerebral hemorrhage
Pregunta 15
Pregunta
Because the complications of epidural hemorrhages include [blank_start]herniation[blank_end], the management is a urgent [blank_start]non[blank_end]-[blank_start]contrast[blank_end] [blank_start]CT[blank_end] of the head and urgent [blank_start]neurosurgeon[blank_end] [blank_start]referral[blank_end].
Respuesta
-
herniation
-
contrast
-
non
-
CT
-
neurosurgeon
-
referral
Pregunta 16
Pregunta
Because subdural hemorrhages are [blank_start]venous[blank_end] and slower, even [blank_start]acute[blank_end] subdural hemorrhages take place over many [blank_start]days[blank_end]/weeks. They're usually due to [blank_start]minor[blank_end] trauma and are more common in children, elderly, and [blank_start]alcoholics[blank_end]. Symptoms include [blank_start]pseudo[blank_end]-[blank_start]dementia[blank_end] and [blank_start]confusion[blank_end].
Respuesta
-
venous
-
acute
-
minor
-
days
-
alcoholics
-
pseudo
-
dementia
-
confusion
Pregunta 17
Pregunta
Acute subdural hematoma requires urgent referral to the neurosurgeon.
Respuesta
- True
- False
Pregunta 18
Pregunta
What are the different types of subdural hemorrhages?
Respuesta
-
acute
-
subacute
-
chronic
Pregunta 19
Pregunta
What is true regarding subarachnoid hemorrhages?
Respuesta
-
Worst 10/10, sudden headache
-
investigate: check for protein and urea
-
most common in middle aged women
-
blood between sulci and in sub-arachnoid space
-
due to berry aneurysm bursting
-
investigate: positive Kerniq's sign
-
manage: urgent non-contrast CT scan and neurosurgeon referral
-
investigate: spinal tap after 12 hours
-
symptom: neck stiffness and backpain
-
investigate: reduced GCS
Pregunta 20
Pregunta
Which of these is not a Liver Function Test?
Respuesta
-
ALT
-
AST
-
ALP
-
GGT
-
Bilirubin
-
ERCP
Pregunta 21
Pregunta
Raised ALP alone can be helpful in differential diagnosis.
Respuesta
- True
- False
Pregunta 22
Pregunta
If ALP and AST are more raised than ALP and Bilirubin, this is indicative of
Respuesta
-
Alcoholic liver disease
-
Gilbert's syndrome
-
Jaundice
-
Cirrohosis
Pregunta 23
Pregunta
Isolated raised bilirubin levels are indicative of [blank_start]Gilbert's[blank_end] [blank_start]Syndrome[blank_end].
Respuesta
-
Gilbert's
-
Syndrome
Pregunta 24
Respuesta
-
intracapsular
-
extracapsular
-
trochanteric
-
sub
Pregunta 25
Pregunta
The joint capsule is made up of a femur [blank_start]head[blank_end] and [blank_start]neck[blank_end].
Respuesta
-
head
-
neck
Pregunta 26
Pregunta
Only intracapsular fractures can be either displaced or nondisplaced.
Respuesta
- True
- False
Pregunta 27
Pregunta
Which of these can you manage via internal fixation with a dynamic hip screw (DHS)?
Respuesta
-
undisplaced intracapsular
-
displaced intracapsular
-
undisplaced extracapsular
-
displaced extracapsular
Pregunta 28
Pregunta
The management for an intracapsular displaced fracture is hip arthroplasty within 24 hrs (total hip replacement or hemiarthroplasty)
Respuesta
- True
- False
Pregunta 29
Pregunta
Paget's disease is very much visible in an x-ray of a spinal vertebrae.
Respuesta
- True
- False
Pregunta 30
Pregunta
In Paget's disease, serum calcium and phosphate levels would be increased drastically.
Respuesta
- True
- False
Pregunta 31
Pregunta
Osteopenia may present with a history of excessive steroid usage or fraility fractures.
Respuesta
- True
- False
Pregunta 32
Pregunta
Osteoporosis will have normal calcium serum levels but a raised ALP
Respuesta
- True
- False
Pregunta 33
Pregunta
Alendronic acid is a treatment for osteoporosis.
Respuesta
- True
- False
Pregunta 34
Pregunta
some bone conditions and pathologies involve DEXA scans for diagnostic purposes.
Respuesta
- True
- False
Pregunta 35
Pregunta
What is true regarding multiple myeloma?
Respuesta
-
it is due to cloning of a plasma cell
-
there is overproduction of an antibody IgG (light chain)
-
investigation: urinalysis (with ++ protein)
-
hypocalcemia
-
renal failure
-
anemia
-
bone pain
-
present: back pain
-
investigation: skeletal survey and head and vertebrae x-ray
-
pepper pot appearance
Pregunta 36
Pregunta
For Multiple Myeloma:
Monoclonal band urine electrophoresis known as Bence [blank_start]Jones[blank_end] proteins aka monoclonal [blank_start]kappa[blank_end] [blank_start]light[blank_end] chains
Also:
[blank_start]low[blank_end] RBC,
Calcium [blank_start]high[blank_end]
ALP [blank_start]normal[blank_end],
PTH [blank_start]normal[blank_end]
Respuesta
-
low
-
high
-
normal
-
normal
-
Jones
-
kappa
-
light
Pregunta 37
Pregunta
If IgM is found in urine electrophoresis, the condition is Waldenstrom’s macroglobinaemia.
Respuesta
- True
- False
Pregunta 38
Pregunta
What would you prescribe for a 40 year old with a painful red toe?
Respuesta
-
aciclovir
-
allopurinol
-
NSAIDs
-
paracetamol
-
urgent referral
Pregunta 39
Pregunta
Hemarthrosis is due to factor 11 deficiency.
Respuesta
- True
- False
Pregunta 40
Pregunta
Septic arthritis is usually seen in one really red, hot, and tender joint (large.)
Respuesta
- True
- False
Pregunta 41
Pregunta
In any really red and hot joint, always aspirate to investigate.
Respuesta
- True
- False
Pregunta 42
Pregunta
What is true regarding septic arthritis?
Respuesta
-
cause: staphylococcal
-
cause: viral
-
treatment: IV penicillin
-
treatment: analgesia
-
common with trauma
-
common with joint prosthetics
-
common in the homeless
-
common in IV drug users
Pregunta 43
Pregunta
[blank_start]Gout[blank_end] in common in middle aged males. There is a history of poor diet, such as too much [blank_start]meat[blank_end], alcohol, and too high of a [blank_start]BMI[blank_end]. There is high serum levels of [blank_start]urate[blank_end], which may be due to renal failure.
Usually, there is [blank_start]monoarthropathy[blank_end] because the problem is in only one joint. It presents acutely, and the patient may suddenly wake in the middle of night from the pain.
Respuesta
-
Gout
-
meat
-
BMI
-
urate
-
monoarthropathy
Pregunta 44
Pregunta
Osteoarthritis/rheumatoid arthritis is better at night .
Respuesta
- True
- False
Pregunta 45
Pregunta
Aspirate:
Septic arthritis: [blank_start]opaque[blank_end] (clarity) and [blank_start]red[blank_end] (color)
Rheumatoid arthritis: [blank_start]straw[blank_end] colored
Osteoarthritis: [blank_start]clear[blank_end] colored
Respuesta
-
opaque
-
red
-
straw
-
clear
Pregunta 46
Pregunta
Acute Gout:
1st treatment: [blank_start]NSAIDS[blank_end] such as [blank_start]naproxen[blank_end], diclofenac
Contraindications to NSAIDS include: [blank_start]peptic[blank_end] [blank_start]ulcer[blank_end] disease, [blank_start]Asthma[blank_end], [blank_start]renal[blank_end] [blank_start]failure[blank_end]
2nd line medication is then: [blank_start]colchicine[blank_end]
Respuesta
-
naproxen
-
NSAIDS
-
peptic
-
ulcer
-
Asthma
-
renal
-
failure
-
colchicine
Pregunta 47
Pregunta
[blank_start]Allopurinol[blank_end] (xanthene oxidase inhibitor) if there are [blank_start]two[blank_end] or more attacks per year
It will increase uric acid initially
so give [blank_start]NSAIDs[blank_end] short course.
Respuesta
-
Allopurinol
-
two
-
NSAIDs
Pregunta 48
Pregunta
What is true regarding pseudogout?
Respuesta
-
usually affects larger joints in women
-
presents sub-acutely
-
investigation: positive needle crystals (befringement)
-
investigation: negative needle crystals (befringement)
-
manage: NSAIDS (1st line)
-
manage: intra-articular steroid injection (2nd line)
-
manage: NSAIDS (2nd line)
-
manage: intra-articular steroid injection (1st line)
Pregunta 49
Pregunta
Reactive athritis can have diarrhea as well
Respuesta
- True
- False
Pregunta 50
Pregunta
Drugs to stop before surgery:
Aspirin
[blank_start]7[blank_end] [blank_start]days[blank_end]
Clopidrogrel
[blank_start]7[blank_end] [blank_start]days[blank_end]
Metformin
[blank_start]morning[blank_end] [blank_start]of[blank_end]
Respuesta
-
7
-
7
-
days
-
days
-
morning
-
of
Pregunta 51
Pregunta
adrenaline in anaphylaxis is 1 in 1000
Respuesta
- True
- False
Pregunta 52
Pregunta
Adrenaline in advanced life support is less than the amount in an anaphylactic treatment.
Respuesta
- True
- False
Pregunta 53
Pregunta
Metformin can cause hyperglycemia.
Respuesta
- True
- False
Pregunta 54
Pregunta
Veraparil can be given as hypertension medication. (calcium channel blocker)
Respuesta
- True
- False
Pregunta 55
Pregunta
Calcium channel blockers (should be given at [blank_start]night[blank_end]) and can cause [blank_start]pulmonary[blank_end] [blank_start]edema[blank_end].
EX: [blank_start]Valpromide[blank_end]
Respuesta
-
pulmonary
-
edema
-
night
-
Valpromide
Pregunta 56
Pregunta
Hyperkalemia can cause heart arrhythmias.
Respuesta
- True
- False
Pregunta 57
Pregunta
A potential side effect of ACE inhibitors: renal failure
Respuesta
- True
- False
Pregunta 58
Pregunta
Break through morphine dosage calculation for acute pain:
([blank_start]total[blank_end] [blank_start]morphine[blank_end] dose for the day) divided by ([blank_start]6[blank_end])
Respuesta
-
morphine
-
total
-
6
Pregunta 59
Pregunta
INFR deals with thrombopoietin
Respuesta
- True
- False
Pregunta 60
Pregunta
if INFR is [blank_start]8[blank_end]< (major bleeding) then give [blank_start]Vitamin[blank_end] [blank_start]K[blank_end] or [blank_start]fresh[blank_end] [blank_start]plasma[blank_end] if needed.
if INFR is [blank_start]8[blank_end]> (minor to no bleeding) then just [blank_start]vitamin[blank_end] [blank_start]K[blank_end] if needed at all
Respuesta
-
Vitamin
-
K
-
fresh
-
plasma
-
8
-
8
-
vitamin
-
K
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