NOV 2018 Recall (Tried to compile the convo)

Medicoman · November 2, 2018, 7:15am

Man travelled to Italy, bullae on trunk…acute bullous pemphigoid/ chicken pox
38weeks, and pain, blood, next inv…abd us/ ctg
77 year old with muscle weakness, difficulty vertical gaze, memory problems, right sided headache, facial numbness—progressive supranuclear palsy/ shy dragger/ myasthenia
Pleuritic chest pain, dyspnea, cough, 39c temp…strep pneumo/ mycoplasma
ECG- Inferior MI/ pericarditis
ECG- Hyperkalemia/ Hypercalcaemia
ECG given which was flat line—route of adrenaline? IV/IM/ Intracardiac
Pleural effusion, cancer…aspirate
Pleural effusion, breathless, left lobe, protein 42g/dl—benign ovarian tumor/ heart failure/ bronchial carcinoma
hyperkalemia—calcium resonin/ salbutamol/ repeat test
Mirena, 6 week, intermittent bleed—reassure?
TIA/Stroke, takes 75mg aspirin…continue same treatment/ add clopidogrel/ add dipyramidole bd
Taking heparin since before operation…breathlessness…inc dose and do CTPA
Hoarseness for 6months hilar enlargement—-lymph node biopsy/ Bronchoscopy
What will inc chance of ectopic? IUCD/ COCP
RA, takes aspirin…paracetamol/ naproxen
Dysmenorrhea, heavy bleeding, cocp not helping, want to preserve fertility…Mirena
Flucloxacillin, ALP inc…cholestatic jaundice
Old man, acute eye pain, haloes a day before—glaucoma
History of ant. Uveitis, rashes on shin…erythema nodosum
63 Woman recovering from fracture…Bisphosphonate/ HRT was also in options
What will show further risk of fracture? DEXA scan
Cancer spread to liver etc, inc corrected calcium, dec albumin—0.9% N/S/ albumin
Another question of inc. potassium—calcium gluconate
Dehydrated child, lost weight, dec. sodium, 0.9% saline option was not given…5% dextrose, 0.45 saline OR 10% glucose?
Itchy eyes, crusting——antibiotics/ anaesthetic/ antiviral/ steroids
Leptospirosis inv.—blood and urine culture
sexually active man, intermittent pain in scrotum, now pain for 4hrs, swelling—emergency U/S/ Surgical referral
Female, short stature, no breasts, genitalia normal—turners
CAH—1/4
NF-2- ½
Duchenne- 1/4
Lost IUCD thread, not found on U/S—X-ray abdomen?
Nose bleed for 1 hr, apttt raised by one point—functional platelet disorder/ haemophilia
12hr, Post- Cholecystectomy patient collapsed, miosis, what will you do initially…Intubate/ naloxone
Fixed dialated pupil, ptosis—3rd CN palsy
6th CN palsy- lateral gaze palsy ipsilateral
28ml lidocaine repeat question
Confront your colleague/ inform senior for suspected alcohol abuse
Audiometery after meningitis treatment
Laryngeotracheobronchitis resolve normally if untreated
0.5ml of 1:1000 adrenaline for 25 year old man
Jehovah witness, patient unconscious, family refusing, no written agreement—start transfusion
Episodes of aural fullness, hearing loss etc.—Meniere’s disease
1*1cm mass lateral neck mass, young girl, painless cervical nodes—diagnostic will be lymph node biopsy
Atrial fibrillation, old lady, no heart failure, hr was 80—bisprolol/ warfarin
Mechanism of action of heparin—-inhibits conversion of prothrombin to thrombin
Young man, breathless, playing—do X-ray to differentiate
Child playing with toy, stridor—laryngoscopy is diagnostic
Man on epidural, low bp, cold hands, warm legs, 30ml urine—fluid challenge
Boy with edema, what will you expect in urine? Protein
Protein uria, hypertension, no history of previous illness- Membranous nephropathy
Reduced sensation in thigh, medial leg, foot— Obturator n.
Medial side of hand, little finger—ulnar nerve
Pregnant, 38weeks, hb 11.1—no intervention needed
Gastrectomy, mcv raised—loss of intrinsic factor
4 penile ulcers, painful——HSV/ gonorrhea/ chlamydia
Trichomonas Vaginalis- Metronidazole
Not itchy, ph>4.5, foul smelling discharge—gardenerella vaginallis
Herpes zoster old man—give ig to pregnant women who do not have antibodies
Pain in back, calcium inc.—Multiple myeloma
Intermitternt hematuria, Psa >15—prostate cancer
Axillary lymph node biopsy—ascending lymphangitis/ lymphedema
Axillary lymph node surgery, pitting edema—lymphedema
6 month old child, fissuring of eyes, skin peeling—Staphylococcal scalded skin syndrome/ Impetigo
Multiple sclerosis, diagnostic? MRI
Young man came in with GCS 15 which suddenly became 8—Extradural hemorrhage
Young girl, acidosis, sweating—check blood glucose
Anorexic woman, fainted—check for compulsory admission
Alzhiemers, wants to change will——check for mental capacity
Depression not improving, SSRI stopped—Mirtazipine/ ECT
Man with MI, depression—sertraline
Old man, severe depression, doesn’t find meaning in life, thinks he is a burden—ECT
Young man brought by sister, doesn’t want to live—compulsory admission
History of SVT, neuropathic pain—gabapentin
Wants to go the bathroom, but urinates before—detrusor instability
Coughs, sneezes, urine leaks—pelvic floor exercises
Surgery for endometriosis, urine flows—ureterovaginal fistula
Old lady, recurrent UTIs, initial treatment—Vaginal oestrogen/ long term antibiotics
Purple Urine bag, nitrites negative, protein positive—do nothing/ porphobilinogen?
Placebo people drawing out of experiment—not sufficient info to draw out conclusions/ by chance
Neutropenia—Broad spectrum IV antibiotics
Travel to Africa, blood in urine—Malaria
Spherocytes in blood, inc. retics. Low hb—direct anti globulin test
Mid-diastolic murmur, atrial fibrillation, long term sequelae—cerebral embolism/ LV hypertrophy
Cardiac tamponade features—Muffled heart sounds, raised JVP
PFT improved after inhaler—asthma
COPD, on maximum inhaled therapy, ph normal—oral steroids/ ltot
Low sodium, raised potassium, pigmentation—Cortisol decreased
FBS raised, no symptoms—do another FBS
Post op- 12mmmol/L, Fasting 4mmol/l, post 2hr- 7.1mmol/L- Stress Hyperglycemia
Normal, UCE- start metformin
Mass incidentally found on appendectomy, tranmural lymphocytes, Crohn’s dx/ lymphoma
GERD, dysphagia, diagnostic test—Oesophageogastroduodenoscopy
Anterior resection of colon, mets to liver—portal vein
Jaundice, Hemoptysis—transfuse FFPs
Stiffness, inc. temp—metacloprmide
Young woman, itching after, hot bath, in between finger webs and genitalia or something—sarcoptes scabie
Old woman shouting in house—delirium
Hospitalized man, seeing spiders—delirium tremens
Woman collapsed infant of husband after headache—subarachnoid haemorrhage
BP 180/?, nystagmus, unsteady gait—cerebellum
Lung cancer, horners—sympathetic trunk
Meta-tarsophalyngeal affected before, now knee- aspirate fluid for microscopy
Gym session, Back pain, reduced sensation—MRI
Prophylactic antibiotic—with induction of anaesthesia
Woman, Urinary frequency and urgency, Haematuria on dipstick and protein too- Urine culture/ U/S KUB
Pregnant woman, post op swollen calf or something—do U/S doppler
Grandmother brings child, yellow brown spots over buttocks and back—NAI
To prevent contrast induced renal damage—0.9%N.S
Pre-eclampsia- 0.6g protein in urine/ 24hr+ Hypertension
Paracetamol poisoning—Patient guilty—compulsory admission to psych ward/ discharge
Milestones described, most worrying feature—speaking 2 meaningless words at 18months/ no eye contact
Pregnanct woman, accident, skin dimpling at breast—Fat necrosis
Man, headache since 2 days, neck stiffness, photophobia but no papilledema—meningitis/ encephalitis
Rhesus negative mom- give anti-D within 72hrs
Alternate mania and depression symptoms given—give lithium for long term rx.
Auditory hallucinations coming from head—pseudo hallucinations
Tremor, slow movements, what is he being treated for? Schizophrenia
Person developing extrapyramidal symptoms, what to give in depot? Risp
Swelling of ankle, absent distal pulses, immediate action—stablize with splint/ call vascular surgeon/ reduce
Person wants to leave alcohol, what to give in decreasing amounts? Chlordiazepoxide
Pain over maxillary area—sinusitis
Fell from some floor, Hematuria after RTA- CT Scan abdomen
Seizures after fight with brother- Reassure
Most sensitive modality for stone- CT urography
Mechanism of Addison’s—autoimmune
A woman with irregular, heavy bleeding—COCP
Patient with nystagmus etc.—give thiamine
Twitching started from hand to arm—simple partial seizure/ myoclonic
Infecting organism after TURP—E.coli/ strep faecalis?
Post-menopausa bleeding—TVS
Ate grandmom’s meds, dialated pupil, extrasystole- amitryptilline
Old male, tiredness, fatigue, back pain, nocturia, dribbling, raised bp 160, urea cr inc, potassium raised, calcium 1.9, hb low, psa 4.5—CA prostate/ chronic gm/ bph/ myeloma
13year old child having sex with 23 yr old male…inform safeguarding authority
Lidocaine given with adrenaline to prolong the duration of anaesthesia/ no effect
Man passed out on road, pupils 2mm—give naloxone
Hepatitis C, confirmed test—PCR
Features of acoustic neuroma with CN palsy—MRI Internal acoustic meatus
Depression—take ssri for atleast 6 months
Old man, wanting to commit suicide after wife death—Refer for urgent psychiatric assessment
Mother asking for cocp for daughter----come back with daughter
Morning stiffness- OA/RA
Duputryen’s contracture—palmar fascia
TIA, no time given…aspirin
Child with fever and vomiting, initial inv—MSU?
Depression, enlarged prostate, low bp—TCA/ SSRI
Bloody discharge—duct papilloma
Firm, Mobile mass, history of previous lump, grandmom had cancer- fibroadenoma
Hard mass, nodes involved- breast cancer
Orbital cellulits—IV ceftriaxone
Man taking 5% dextrose—cerebral edema
Drug to prevent renal complications—ACEi
Drug injured in chest drain—intercostal artery
Patient in pain after op, shouted on doctors and nurses, then thanked them—adjustment disorder
Immunocompromised—Fluconazole suspension
Builder, mesothelioma—asbestos
Old man, recurrent falls, pale during falls, taking antihypertensives?—bp/ ecg/ echo
Route of morphine in MI—IV
Child with foreign body—laryngoscopy
Supraclavicular lymph node and dysphagia—gastric cancer
Hoarseness—recurrent laryngeal nerve
6month old child had 5-6episodes of diarrhea, vomiting, electrolyte disturbance- IV fluid/ ORS
Guy found unconscious around cans of beer—hypoglycemia
3rd degree hemorrhoid found incidentally—do nothing
Varicose vein surgery—saphenous nerve
Normal ear drum examination, rugby player—oral analgesia
Anterolateral thigh anaesthesia, weak knee extensors—femoral nerve
Patient tried to commit suicide—best predictor of another attempt—Previous attempt
Male child, recurrent UTI—VUR
Patient with bone pain, radio given…give zoledronate
Bone pain, only pain killers were given—radiotherapy
A patient on amiloride and metformin—hyperkalemia
A infant with basal crepitations, abd distension, sob—cystic fibrosis/ bronchiolitis/ Heart failure/ pneumonia
A patient who is hypertensive, cr 180, urea 18, add acei
Safe method for baby sleeping—on back, near head end
Baby, inc. breathlessness, poor appetite but weight gain of 300g…?
Doxycycline… after food
Pt with nystagmus and I think tremor, on antiepileptics. Cause? Drug/cerebellar degeneration
Progressive memory impairment, doesn’t know time/ place—alzhiemers/ vascular/ fronto-temporal