A 52-year-old man suddenly develops weakness of the right side of his face and upper limb and difficulty in speech. This episode lasts for 20 minutes. His past history contains hypertension, which is well controlled on a calcium channel blocking. His brother had a severe, disabling stroke at the age of 50.
His cholesterol level is 5.9 mmol/litre. A CT scan performed the same day showed the presence of two old lacunar strokes in the left middle cerebral artery territory. CT angiogram of the carotid system shows a 60% stenosis of the right internal carotid artery.
Which one of the following factors is the strongest predictor of his being at a high risk of early recurrent stroke?
Positive family history
History of hypertension
Hyperlipidaemia
Presence of moderate carotid stenosis
Presence of previous strokes on CT scan
A 45 year old man with no previous past medical history presents with a BP of 180/100 mm Hg, frothy urine and peripheral oedema. There is +++ blood and +++ protein on urinalysis. 24-hour protein loss is 5 grams.
Plasma albumin is 25 g/L. Plasma C3 is 0.10 (low). Plasma creatinine is 160 umol/l. A renal biopsy is performed. Which of the following is most likely to be found on the biopsy?
A. Minimal change glomerulonephritis
B. Mesangiocapillary glomerulonephritis
C. IgA nephropathy
D. Post streptococcal glomerulonephritis
E. Focal segmental glomerulosclerosis
In Down syndrome, which is the commonest congenital heart defect?
- Atrial septal defect
- Atrioventricular septal defect
- Patent ductus arteriosus
- Tetralogy of Fallot
- Ventricular septal defect
Time period to stop certain Drugs before Surgery 
️
Aspirin…stop 1 week before surgery.
(Remember ‘A’ is the 1st alpahabet)
Lithium…stop 2 weeks before surgery.
(Remember ‘L’ is formed by 2 straight lines)
MAO-inhabitors…stop 3 weeks before surgery.
(Remember ‘MAO’ has 3 letters)
Estrogen pills…stop 4 weeks before surgery.
(Remember ‘E’ is formed by 4 straight lines)
A 45-year-old solicitor had an onset of severe, crushing, substernal chest pain
while attending a football match. He collapsed on his way to the car. Bystander
Cardiorespiratory Resuscitation was begun immediately and continued until arrival in
Casualty where an endotracheal tube was inserted and ventilation was maintained on
100% oxygen.
Investigations revealed:
pH 7.13
PaO2 560 mmHg
PaCO2 18 mmHg
Bicarbonate 5.8
SaO2 98%
Based on these laboratory values, which of the following statements best describes his
current pathophysiology?
- He is demonstrating a primary respiratory alkalosis
- He probably developed a large right to left intracardiac shunt
- His anion gap is probably normal
- His oxyhemoglobin curve is shifted to the left
- His pulmonary artery pressure is probably elevated
A 50-year-old man is recovering from an episode of pancreatitis, his third in the past 3 years, thought to be related
to alcohol consumption. He admits to having lost approximately 4kg in weight over the past 6 months and is
thirsty all the time. On examination his BP is 110/70 mmHg, pulse is 75/min and regular, his BMI is 21.
Investigations;
Hb 10.5 g/dl
WCC 9.8 x109/l
PLT 203 x109/l
Na+ 137 mmol/l
K+ 4.0 mmol/l
Creatinine 105 μmol/l
Glucose (fasting) 10.5 mmol/l
Which of the following is the best way to treat his diabetes mellitus?
Exenatide
Glibenclamide
Insulin
Metformin
Vildagliptin
Cannabinoids. Which is the incorrect statement?
- Bioavailability after oral administration is about 16%
- Inhibit eicosanoid synthesis
- Lower intraocular pressure
- Naloxone blocks the antinociceptive actions of cannabinoids
- 9-tetrahydrocannabinol is an active constituent of the resin
On discovering an unconscious patient in a pre-hospital environment:
- Rapid assessment of the airway and breathing is our primary objective
- Cross infection with Neisseria meningitidis may occur during CPR
- Two effective rescue breaths should be given once apnoea is confirmed
- On confirming an arrest, one minute of CPR should be performed before leaving the patient and getting help
- On confirming an arrest, a ratio of 15 compressions to 2 ventilations should be adopted at all times
A stable hand is referred to the medical admission unit with increasing breathlessness over the last six months since starting work at a new yard.
He reports initially symptoms of dyspnoea in the evenings with a dry cough. He has also noted occasional fevers at night. His breathing has become steadily worse.
A chest x ray is performed which shows some fluffy nodular shadowing.
What is the most likely causative agent for his condition
Avian proteins
Epicoccum nigrum
em>Klebsiella
Penicillium species
Thermophilic Actinomyces bacteria