Medicine Flashcard

A 24 year old student, presents at the Emergency Department with sudden onset of a cough and high fever. Chest X-ray shows a left lower lobar consolidation and further history reveals frequent sinus infections requiring antibiotics, and two episodes of lobar pneumonia in the past 5 years. Which of the following organisms is most likely to be responsible for his repeated infections?

Streptococcus pneumonia

A 24 year old man admitted to the Emergency Department following a motor vehicle accident. He has a contused chest wall and is in respiratory distress. His left chest is resonant on percussion and no breath sounds can be heard on auscultation. His trachea is deviated to the right. What is the most likely diagnosis?

Tension pneumothorax

Regarding the anatomy of the lungs, which of the following statements is correct?

The apices of the lungs may pass above the thoracic inlet (1st rib)

Regarding the anatomy of the heart, which one of the following statements is most correct?

The coronary sinus drains directly into the right atrium

A 54 year old asthmatic woman, presents for a routine check up and isfound to have a blood pressure of 150/90mmHg. Examination reveals she is moderately overweight (BMI 28 kg/m²), in sinus rhythm with a heart rate of 80 beats per minute and has an audible fourth heart sound. Which one of the following clinical features is NOT relevant to the possible causation of hypertension in this patient?

The detection of a carotid bruit

Which of the following is true regarding surgical therapy for colorectal cancer?

The goal of adjuvant therapy is to improve the chances of cure

A 75 year old man, presents with painless loss of vision in the left eye one hour ago. VAR:6/9, VAL:light perception only. There is a left afferent pupil defect. He has been on an ACE inhibitor for hypertension. What do you see when you look into his left eye with a direct ophthalmoscope?

The macula has an orange/red spot and the surrounding retina looks pale, with marked attenuation of the retinal arterioles and segmentation of blood in the retinal veins

What is the most useful guide to the likely post-operative opioid requirements of a patient undergoing a laparotomy?

The magnitude of the surgery

Which one of the following statements about the skeleton is true?

The metatarsals are numbered from 1 to 5 from the medial side

Regarding genital chlamydial infections, which of the following statements is FALSE?

The period of infectivity is 7-14 days after infection

Which of the following has the least effect on the diffusing capacity for carbon monoxide of the lung at rest?

The physical properties of carbon monoxide

A 28 year old man is travelling in Thailand when he is involved in a motor vehicle accident. He is taken to a local hospital with visible bone protruding from a wound in his mid-thigh. He undergoes transfusion with multiple units of whole blood as part of his immediate treatment. Six weeks later he develops jaundice. He undergoes a series of tests to investigate his jaundice. Which of the results suggests that his jaundice is likely to be related to his blood transfusion?

The presence of Anti-Hepatitis C Virus antibody

Regarding the blood supply to the heart, which of the following statements is correct?

The right coronary artery descends on the heart between the right atrium andventricle

In the management of pneumothorax, what is the best indication that the intercostal catheter can be removed?

The size of the pneumothorax is less than 25% of the lung volume on chest x-ray

Which of the following statements regarding the use of diagnostic ultrasound for medical imaging is correct?

The use of ultrasound for guidance of percutaneous procedures is decreasing as CT scans and MRI units become more widely available

Regarding the uterine tubes, which of the following statements is NOT correct?

They are most dilated at the isthmus

A 25 year old man who sustains a clean, fairly superficial, 3cm long laceration to his left forearm on a piece of broken glass. Which one of the following statements about management is true?

Thorough cleansing with saline is the decontamination method of choice

What is the laryngeal prominence (Adam's apple) in the neck formed by?

Thyroid cartilage

Which of the following agents/devices used in the treatment of pulmonary embolism is associated with the highest risk of serious bleeding?

Tissue plasminogen activator (TPA)

During pregnancy, which one of the following infectious diseases has the lowest risk of causing congenital infection?

Tuberculosis

A 58 year old man is treated with diuretics for his mild essential hypertension. His blood gas results are shown below: PaO2 = 92 mmHg (normal range: 80-100 mmHg), PaCO2 = 44 mmHg (normal range: 35-45 mmHg), pH = 7.50 (normal range: 7.35-7.45), BE = +10 mmol/L (normal range: -2-+2 mmol/L). Which of the following best describes this picture?

Uncompensated metabolic alkalosis

Jacob Butler is an 18 year old motorcyclist who is brought to hospital by ambulance following a single-vehicle crash. He has a compound fracture of the right femur and is agitated and disorientated. Which of the following is NOT an immediate priority?

Urgent blood sugar level

A 30 year old woman, presents with a 2-day history of fever, vomiting and mild right-sided flank pain. She has evidence of right renal angle tenderness on examination. Urinalysis shows the presence of polymorphonuclear leucocytes and nitrates. What would be the next most appropriate investigation?

Urine microscopy and culture

A 45 year old morbidly obese male presents with a two day history of pain in the left calf and swelling of the ankle. Which of the following is the correct management?

Venous duplex ultrasound scan of the left leg

Gail Tran is a 39 year old woman who is 20 weeks pregnant. You have just received her amniocentesis result which shows: 47 XY Trisomy 21. What is the most common cause of a left to right cardiac shunt in an infant with Trisomy 21?

Ventricular septal defect

An obese 65 year old female with renal failure has had a laparotomy. On day five post operative she develops copious serous ooze from her midline abdominal wound. She is afebrile. This is likely to be due to which of the following?

Wound dehiscence

Hyperalgesia is defined as which of the following?

Increased sensitivity to pain

A 45 year old woman presents with a 3 month history of arthritis. Physical examination reveals tender swollen metacarpo-phalangeal joints in a symmetrical pattern. What is the most likely diagnosis?

Rheumatoid arthritis

A patient with Parkinson's disease has been treated successfully for several years with a levodopa based medication. He has recently developed prominent involuntary writhing movements of the limbs. Which of the following terms describes this phenomenon?

Dyskinesia

Sara, a 25 year old woman, presents to the Emergency Department with 5 days of cough, 2 days of fever and increased lethargy. Her oxygen saturation on air is 90%, blood pressure is 90/50 mmHg, heart rate is 120 bpm and temperature is 38.5ºC. On examination, she has bronchial breathing at her right lung base. You have assessed Ms Jones and have decided to give her IVfluids. How much fluid will you give before reassessing her?

1 litre normal saline over 2 hours

A 26 year old nurse has had wheezy bronchitis as a child. She went to a night club and suffered an attack of asthma. She is given nebulised salbutamol in the Emergency Department. Which of the following is the best explanation of why Salbutamol produces bronchodilation?

Increases cyclic AMP in airway smooth muscle cells

Type I diabetes mellitus is caused by an auto-immune process. Which of the following mechanisms is responsible for this?

Infiltrate of islets by CD4+ and CD8+ T cells

Which device would deliver oxygen at a concentration close to 100 percent?

Self-inflating bag- valve- mask device with reservoir and oxygen flow at 15L/min

A 22 year old woman who is an active intravenous drug user presents to her general practitioner, six weeks pregnant. On investigation she is found to be positive for anti-hepatitis C virus (HCV). Her hepatitis A and B and HIV serology are negative. What advice is most appropriate for this patient at this point?

She should be vaccinated against hepatitis A and B unless she is already immune

Regions that are innervated by the ulnar nerve include which of the following?

Skin over the palmar surface of the little (5th) finger

Which of the following is NOT a recognised side effect of non-steroidal antiinflammatory drugs (NSAIDs)?

Squamous cell carcinoma of the skin

Susan is a 35 year old woman who is brought into the Emergency Department by ambulance after being found lying in the gutter. She is able to speak but is unable to give coherent answers to questions. Her initial vital signs are as follows: heart rate 120 bpm, blood pressure 80/40 mmHg, temperature 38ºC and respiratory rate 28bpm. What would be your first step on reaching her bedside?

Insert an intravenous cannula

What is the main vein draining the brain?

Internal jugular vein

A 26 year old woman has a history of wheezing as a child. She has suffered from seasonal rhinitis in recent years. She is brought in by ambulance from a night club having developed severe shortness of breath. Which of the following findings is in keeping with a severe asthma attack?

88 percent oxygen saturation on pulse oximetry

Which of the following is a feature of the inferior vena cava?

It empties blood into the right atrium

Regarding the scapula, which one of the following statements is correct?

It helps form the acromioclavicular joint

Mrs Betty Smith is a 75 year old woman with osteoarthritis for whom you prescribe diclofenac. Which one of the following statements about diclofenac sodium is correct?

It inhibits both Cox I and Cox II isoenzymes

Alex is a 25 year old woman who presents to the Emergency Department with sharp central chest pain. You make a provisional diagnosis of pericarditis. Which of the following is TRUE of this condition?

It is sometimes associated with pulsus paradoxus

Which of the following micro-organisms is the commonest cause of communityacquired pneumonia?

Klebsiella pneumonia

Where should the normal apex beat be palpated whilst undertaking a cardiovascular examination?

Left 5th intercostal space, mid-clavicular line

What is an advantage of tramadol over morphine?

Less respiratory depression

Maternal cardiovascular changes during pregnancy include which one of the following?

A decrease in red blood cell production

A 19 year old man, presents to the Emergency Department with a supra-condylar fracture of the distal humerus. Later that evening, after surgical fixation he is noted to have a wrist drop with a patch of numbness on the dorso-radial aspect of the wrist. What is this most likely to be due to?

A radial nerve injury

In the context of drug use, which one of the following statements best describes the difference between addiction and dependence?

A withdrawal syndrome is always present in addiction

SOK, aged 63, is in left ventricular failure following a myocardial infarct. Which of the following is the most appropriate to maximise life expectancy?

ACE inhibitors - to inhibit the renin-angiotensin system

A 15 year old male presents with central periumbilical pain, a low grade temperature and nausea. Over the next couple of hours, the pain shifts to the right iliac fossa. Which of the following is the most likely diagnosis?

Acute appendicitis

A 55 year old woman, presents to the Emergency Department with a 24 hour history of right upper quadrant pain, passing dark coloured urine and a fever of 38.7ºC. Abdominal ultrasound shows multiple gallstones in the gallbladder and adilated common bile duct of 1.5 cm. What is the most likely diagnosis?

Acute cholangitis

Mary is a 17 year old student who presents complaining of recurrent nasal discharge, irritation and sneezing. What is the most likely cause of her complaint?

Allergic rhinitis

Chandra, a 50 year old Indian migrant, presents with a two week history of high spiking fever and right upper quadrant pain. A CT scan of the abdomen shows features of a liver abscess. Ultrasound guided aspiration of the collection shows fluid that looks like anchovy sauce. What is the most likely diagnosis?

Amoebic liver abscess

How is an "open" fracture defined?

Associated with a breach in the overlying skin

A 39 year old receptionist with a history of chronic asthma, has her blood pressure checked by her GP. It is found to be 165/95 mmHg. The patient's body mass index is 32 kg/m² (NR: 20 -25kg/m 2 ) and the remainder of the physical examination is normal. Urinalysis is negative for blood and protein. Which of the following anti-hypertensive agents is contraindicated in this case?

Atenolol

A 36 year old woman who presents with palpitations and is found to have significant mitral stenosis. Which of the following arrhythmias is the most likely cause of her palpitations?

Atrial fibrillation

Red cell fragments (schistocytes) are commonly seen in which of the following conditions?

Autoimmune haemolytic anaemia

If a patient has an isolated iron deficiency, which of the following sets of results would you expect to find?

Low serum iron, high serum transferrin and low serum ferritin

A 19 year old girl presents to the Emergency Department with a one day history of drowsiness, headache, fever and photophobia. There is no history of trauma, and she doesn't have a rash. Which of the following is the most appropriate next step in managing this patient?

Lumbar puncture with CSF sampling

Multiple myeloma is characterised by plasma cell infiltration of which of the following organs?

Bone marrow

Smoking is a known risk factor for a number of cancers. Smoking cessation can modify a person's risk of these cancers. Despite this, smoking cessation has NOT been shown to reduce the risk of which of the following?

Lung cancer

Radiotherapy with or without chemotherapy can be used to cure (without surgery) all of the cancers listed EXCEPT which of the following below?

Lymphoma

The cranial nerves IX, X, XII are characterised by the fact that they all emerge from which one of the following structures?

Medulla

Which of the following pharmacological agents used in the management of type 2 diabetes is NOT associated with significant weight gain?

Metformin

A 69 year old man presents to the doctor with an acutely swollen right knee. He has had previous episodes of acute pain and swelling in his big toes and ankles over the last 10 years. What is the most appropriate initial investigation to determine the diagnosis?

Microscopy of synovial fluid

Which of the following is NOT an indication for tracheotomy?

Moderate sleep apnoea

Which one of the following is the specific treatment for paracetamol overdose?

N-acetyl cysteine

Which of the following investigations is useful in the monitoring of rheumatoid arthritis?

C- reactive protein

A 75 year old woman who presents with a six-month history of pain in her right knee, which is worse with prolonged walking. She has no relevant past history. Physical examination reveals a small effusion and crepitus on movement. Her body mass index is 32. You make a diagnosis of osteoarthritis Which of the following is the most important initial aspect of treatment?

Non-steroidal anti-inflammatory drugs

Which of the following is the main risk factor for ischaemic heart disease in men and women older than 75?

Cholesterol

A 28 year old man, is involved in a head-on vehicle collision. He had allegedly been drinking at a pub with friends and left after a dispute. He was initially trapped in the car with the major impact on his right thigh. He is brought into the Emergency Department conscious, but pale with a pulse of 135bpm and blood pressure of 90/60mmHg. He has deformity of his mid thigh with visible bone protruding from a wound. Which of the following is the correct terminology to describe his fracture?

Compound fracture

An 85 year old woman comes to see you, her local doctor, with her daughter. Her daughter tells you that her mother has become increasingly confused over the last week. She has also developed increasing generalised weakness, poor mobility and her overall ability to carry out her activities of daily living has deteriorated. Which of the following investigations would you perform first?

Computed tomography (CT) scan of the brain

Mr Wong, a 53 year old office worker, is found by his General Practitioner to have a blood pressure of 150/95mmHg. Which one of the following findings is most likely?

Normal renal function

Which of the following does the median nerve innervate?

Opponens pollicis

Anna is a 50 year old woman who is brought to the Emergency Department after collapsing at home while standing at the sink. She says that she remembers feeling hot and nauseated before developing tunnel vision and then passing out. She is usually well and takes a single anti-hypertensive agent. On physical examination, she is now well. There are no significant cardiovascular findings and no focal neurological deficits. What is the most likely cause for her syncopal episode?

Orthostatic hypotension

How do you calculate the Mean Arterial Pressure (or MAP)?

Diastolic BP + 1/3 (systolic BP - diastolic BP)

Which of the following joints are affected most commonly by osteoarthritis?

Distal interphalangeal joint

Which of the following is most likely to cause damage to cardiac muscle?

Doxorubicin

With regard to the pathology of rheumatoid arthritis, which of the following statements is correct?

Pannus destroys articular cartilage and underlying bone

A 45 year old man is involved in a motor vehicle accident. He presents 2 weeks later with pain involving the right shoulder, scapula and upper limb. What sensory findings would be suggestive of a C6 radiculopathy?

Paraesthesia of the index finger and thumb

A 17 year old girl, presents with a 1-day history of central abdominal pain that then localises to the right lower quadrant of the abdomen. This is associated with nausea, decreased appetite and a temperature of 37.8°C. What is the most appropriate initial management of this patient?

Pelvic ultrasound

A 20 year old university student presents to you with a one week history of fatigue, fevers, night sweats and poor appetite. He was well prior to this episode. Examination reveals multiple tender lymph nodes in the cervical and axillary areas and splenomegaly palapable 3cm below the costal margin. What would most appropriate initial management include?

Perform a monospot and viral serology

A 64 year old female presents with a two-year history of perianal itching and irritation more noticeable in the past month. Inspection of the perineum shows an area of hyperkeratosis, leucoplakia and an associated large irregular ulcer on the anal verge in the mid-line posteriorly. What should be the next step in her management?

Perform an incisional biopsy

Which of the following statements about right-sided heart failure is true?

Pitting oedema of dependent parts is a common sign

Management of atrial fibrillation of onset within 4 hours of presentation includes all of the following EXCEPT:

Echocardiography

Which one of the following is the correct order of tissues lining the gastrointestinal tract from the lumen (inside) outwards?

Epithelium, lamina propria, muscularis mucosa, submucosa, muscularis externa

Sara presents to the Emergency Department with 5 days of cough, 2 days of fever and increased lethargy. Her oxygen saturation is 90 percent, blood pressure is 90/50 mmHg, heart rate 120/min and temperature is 38.5°C. On examination, she has bronchial breathing at her right lung base. What is the most likely diagnosis?

Pneumonia

Which of the following is the least important factor contributing to Total lung capacity (TLC)?

Gender

Which of the following tests is most likely to establish a definitive microbiological diagnosis in a patient with community-acquired pneumonia?

Gram stain of sputum

Soft tissue healing is an ordered process. Which of the following is NOT a stage in this type of wound healing?

Granuloma formation

Which of the following is NOT a stage in normal soft tissue wound healing?

Granuloma formation

How does chronic suppurative otitis media most commonly present?

Hearing loss

A 30 year old woman presents with polyuria and is diagnosed with diabetes mellitus. She has a blood glucose level of 24 mmol/L. Which of the following is the strongest indication to commence insulin treatment immediately?

Her very high blood glucose level

Which of the following is most useful for identifying the cause of syncope?

History from patient

A 28 year old man, is involved in a head-on vehicle collision. He had allegedly been drinking at a pub with friends and left after a dispute. He was initially trapped in the car with the major impact on his right thigh. He is brought into the Emergency Department conscious, but pale with a pulse of 135bpm and blood pressure of 90/60mmHg. He has deformity of his mid thigh with visible bone protruding from an anterior wound. Which of the following is the most likely early complication?

Femoral artery injury

Macrocytosis refers to enlarged red cells while the term megaloblastosis refers to a specific morphological appearance observed in haemopoietic cells forming in the absence of adequate amounts of either vitamin B12 or folate. Which of the following morphological features in a peripheral blood smear indicates megaloblastic haemopoiesis?

Hypersegmented neutrophils

Which of the following terms best describes the usual response of cardiac myocytes to hypertension?

Hypertrophy

Which of the following statements about the autonomic nervous system is most accurate?

In response to stress, sympathetic nerves regulating different effectors tend to be activated simultaneously

What is the most important direct action of the hormone 1,25 Dihydroxyvitamin D?

Increase gut calcium absorption