Quesmed MLA mocks

Question 1

scaly, red rash that initially improved with steroids but then worsened =

Answer 1

fungal infection like tinea corporis

Steroids can temporarily suppress inflammation, but they also suppress the immune response, causing the fungal infection to worsen after the steroids wear off.

Question 2

Causes of Cushing’s syndrome = ?

Answer 2

CAPE

Cushing’s disease - ACTH producing pit adenoma
Adrenal adenoma/carcinoma
Paraneoplastic syndrome (ACTH producing tumour e.g. Small cell lung ca)
Exogenous (e.g. steroid use)

Question 3

most common cause of Cushing’s syndrome?

Answer 3

exogenous steroids

(pit. adenoma is most common endogenous cause)

Question 4

How does the presence of hyperpigmentation in a Cushing’s patient help you to determine the cause?

Answer 4

hyperpigmentation is present in ACTH dependent Cushing’s (e.g. ACTH-secreting pituitary adenoma) but not in ACTH independent Cushing’s (adrenal adenoma)

it results from excess ACTH stimulating melanocortin-1 receptors (MC1R)

Question 5

A 68 year old man is admitted to the AMU with severe nausea, vomiting, and confusion. He appears clinically dehydrated. He has a history of chronic kidney disease and is currently receiving diuretic therapy for congestive heart failure.

His blood tests reveal a sodium of 158. How should you manage him?

Answer 5

5% dextrose with water- this is hypotonic, which helps lower the serum sodium gradually, thus preventing overcorrection and potential cerebral oedema.

Question 6

meningitis sxs + severe neurological symptoms such as seizures, altered consciousness, or focal neurological deficits =

Answer 6

encephalitis

if someone with fever + neck stiffness + photophobia has confusion but no other focal neurology this is NOT likely to be encephalitis - encephalitis has severe neurological sxs

Question 7

A 35 year old man presents to clinic with occasional chest pain and easy fatigability for the past month. He was an active swimmer but recently stopped due to severe itching and fatigue after swimming. His father passed away aged 60 due to ischaemic heart disease. His BMI is 22 kg/m2 and his observations are within normal limits. On examination, there is a palpable mass in the left hypochondrium extending toward the umbilicus.

What is the most likely dx? Mx?

Answer 7

Polycythaemia vera

PV is a myeloproliferative neoplasm that causes erythrocytosis, hyperviscosity, and an increased risk of thrombosis. Patients typically complain of aquagenic pruritis (itching after hot showers), splenomegaly as seen in this patient, and hyperviscosity syndrome (fatigue, dizziness, chest pain).

Manage with venesection

Question 8

cluster headache tx?

Answer 8

high flow O2/ SC triptan

Question 9

lung cancer, central lesion on CXR and low sodium =

Answer 9

small cell lung cancer

low sodium due to SIADH - causes water retention and dilutional hyponatraemia

Question 10

2 week hx of nephrotic syndrome with preserved renal function in an adult with no preceding illness =

Answer 10

think membranous nephropathy!

Diabetic nephropathy develops over years and is usually associated with other diabetic complications.

Focal segmental glomerulosclerosis
is more common in those with HIV, sickle-cell or individuals of African or Afro-Caribbean ethnicity. It usually has nephrotic picture + declining renal function.

Question 11

A 45 year old woman presents to her GP with a 3 month history of painless, firm swelling in the left axilla. She has no lumps in the breast, and both mammogram and ultrasound are normal. She recalls having a few episodes of night sweats. She denies having a fever or recent infections. Bloods are unremarkable.

What is the most likely diagnosis?

Answer 11

lymphoma

Question 12

A 45 year old woman presents to her GP with double vision, particularly when looking to the left.

On examination, there is impaired adduction of the right eye. When asked to look to the left, the right eye does not move past the midline, while the left eye abducts with associated nystagmus.

What is the most likely location of the lesion?

Answer 12

Internuclear ophthalmoplegia (INO), caused by a lesion in the medial longitudinal fasciculus (MLF)

Question 13

unvaccinated individuals with post-auricular and suboccipital lymphadenopathy followed by a pink maculopapular rash that spares the palms and soles =

Answer 13

rubella

Question 14

unvaccinated individuals with a prodrome of cough, coryza, conjunctivitis, and Koplik spots, followed by the exanthem stage (a high fever > 38.5°C and maculopapular rash) =

Answer 14

measles

Question 15

sudden high fever that resolves abruptly, followed by the onset of a maculopapular rash starting from the trunk and spreading outwards =

Answer 15

roseola (commonest in children under 2 )

Question 16

Your colleague is conducting a study to evaluate the effectiveness of a new screening test for diabetes mellitus. The test is designed to identify individuals with diabetes from a large population. He is particularly interested in determining the test’s ability to correctly identify all individuals who have the disease.

Which of the following measures is your colleague likely assessing?

Answer 16

Sensitivity measures a test’s ability to correctly identify individuals who have a particular disease (true positives) among all those who test positive for the disease.

Question 17

Haemoptysis post-COVID =

Answer 17

raises concern for PE due to COVID-associated hypercoagulability.

Question 18

A 45 year old woman presents to the emergency department with 2 days of confusion, lethargy, and generalised weakness. She has a past medical history of hypertension and anxiety. She reports that she has been feeling increasingly fatigued and has had difficulty concentrating for the past week. She mentions she takes several regular medications, but cannot recall the name of them.

Her observations are normal. Neurological examination reveals mild confusion, but she is oriented to time, place, and person.

Blood results show hyponatraemia.

What common medication may be responsible?

Answer 18

SSRIs = can cause SIADH

Question 19

What is SAAG?

Answer 19

Serum Ascites Albumin Gradient

Calculated by doing Serum albumin - ascites albumin

If you have a low SAAG < 1.1 g/dL, there is more albumin in the ascites than in the rest of the body. This is because either
1. the ascites is full of albumin and is EXUDATIVE = due to peritoneal cancer or TB peritonitis
OR
2. the serum has a comparatively low level of albumin because protein is being lost (e.g. from nephrotic syndrome)

If you have a high SAAG >1.1 g/dL, this means the ascites has low albumin and is TRANSUDATIVE = water is being pushed out due to portal hypertension = cirrhosis, heart failure, budd chiari

Question 20

Maintaining dopaminergic stimulation in Parkinson’s disease is crucial to avoid motor deterioration and NMS. What can you do for a PD patient who is NBM?

Answer 20

Switch to rotigotine patch

Question 21

A 75 year old man is brought to the clinic by his wife, who is concerned about his behaviour at night. He experiences vivid dreams and nightmares, sometimes accompanied by shouting or kicking movements during sleep. His wife reports that he appears distressed during these episodes. He does not have daytime sleepiness and is otherwise cognitively intact.

What is the most likely diagnosis?

Answer 21

Parkinson’s disease

REM sleep behaviour disorder can precede the motor symptoms of Parkinson’s disease

Question 22

Stevens Johnson syndrome versus TEN?

Answer 22

Stevens-Johnson Syndrome (SJS) typically involves less than 10% of the body surface area, with mucosal involvement and characteristic targetoid lesions.

TEN is defined by widespread epidermal detachment involving more than 30% of the body surface area.

Question 23

Ix for suspected aortic dissection? Mx?

Answer 23

stable = CT angio
unstable = TOE

ascending (A) = surgery + BP control
descending (B) = BP control (IV labetalol)

Question 24

murmur in aortic dissection?

Answer 24

early diastolic murmur over left sternal edge - aortic regurge due to disruption of the aortic valve

Question 25

definitive mx for tension pneumo?

Answer 25

chest drain insertion NOTE THE WORD DEFINITIVE emergency/ first line mx is needle decompression, definitive is chest drain

Question 26

What are the types of renal tubular acidosis and how do you distinguish?

Answer 26

patient has hypokalaemia? = Type 1 (stones) or Type 2 (bones) Type 3 - v rare Type 4 - hyperkalaemia

Question 27

What causes Type 4 renal acidosis?

Answer 27

aldosterone deficiency or resistance - consider if they are on aldosterone antagonist drugs

Question 28

HIV and prolonged diarrhoea =

Answer 28

do a stool culture

Question 29

when do you do VQ scan instead of CTPA for PE?

Answer 29

eGFR <30 (severe CKD) if they have stage 1/2 CKD they can have CTPA still, it is a better test

Question 30

A 64 year old man presents to A&E with sudden visual loss in the right eye. Fundoscopy reveals an elevated, dome-shaped retinal area with smooth, bullous elevation. The lesion is reddish-brown and does not extend to the optic disc. What is the most likely diagnosis?

Answer 30

Choroidal detachment - appears as a smooth, dome-shaped elevation on fundoscopy and is distinct from retinal detachment

Question 31

What should be considered in patients with unexplained breathlessness, especially when signs of right heart strain and volume overload are present?

Answer 31

pulmonary hypertension

Question 32

what is the max dose of metformin?

Answer 32

2g OD always uptitrate before adding new drugs

Question 33

which Alzheimer's medication is available as a patch for patients with impaired swallow?

Answer 33

Rivastigmine - also has a slower onset of SEs such as N+V compared to other oral Alzheimer's meds

Question 34

Which type of laxative does NICE recommend as the first-line treatment for constipation, especially in the elderly, due to its gentle action and safety profile?

Answer 34

Fybogel (isphagula husk) - a bulk-forming laxative that increases stool mass and promotes peristalsis

Question 35

A 60 year old man presents to the GP with a 5 month history of progressive fatigue and intermittent facial flushing. He has intentionally lost 5 kg in the past two months through diet. He also mentions frequent headaches and blurry vision. He denies night sweats or pruritus. He has an elevated haemoglobin and haematocrit. What is the most likely diagnosis?

Answer 35

polycythaemia vera, a JAK2-positive myeloproliferative neoplasm This patient’s symptoms (facial flushing, headaches, blurry vision) and blood results (raised Hb and Hct) are classic The absence of secondary causes (e.g. smoking, hypoxia) and the lack of elevated EPO support a primary process.

Question 36

2.5 cm ulcerated SCC=

Answer 36

excise with 6mm margin >2cm + ulcerated = high risk = 6mm margin <2cm, non-ulcerated, well differentiated, and on an extremity = low risk = 4mm margin

Question 37

A 45 year old woman develops a fever and headache three hours after a blood transfusion. She has thalassaemia major and receives routine transfusions. Her post-transfusion haemoglobin levels are optimal. Her temperature is 39°C, pulse is 75/min, and blood pressure is 135/87 mmHg. Blood tests show normal serum bilirubin and lactate dehydrogenase (LDH) levels, with a negative direct antiglobulin test (DAT). Which is the most likely mechanism for this patient's underlying condition?

Answer 37

this is a febrile non-haemolytic transfusion reaction (no signs of haemolysis, normal bilirubin) due to preformed cytokines from donor leukocytes

Question 38

most common cause of nephrotic syndrome in non-diabetic adults?

Answer 38

membranous nephropathy can be idiopathic, or due to cancer, hepatitis or NSAIDs

Question 39

what causes GI dysfunction in PD?

Answer 39

Aganglionic innervation progression In Parkinson’s disease, α-synuclein pathology affects the enteric nervous system, leading to degeneration of autonomic and parasympathetic ganglia in the gut wall. This results in reduced peristalsis, delayed gastric emptying, and constipation.

Question 40

testicular tumour + normal AFP with mildly elevated β-hCG (< 500 IU/L) =

Answer 40

seminoma

Question 41

first line tx for Lyme disease = if child or pregnant =

Answer 41

doxycycline amoxicillin

Question 42

painless haematuria, frequent urination, and mild systemic inflammation (raised WCC and slight fever)=

Answer 42

TCC

Question 43

A 3 year old boy is brought to the GP clinic due to a one month history of loose, foul-smelling stools. His parents report that similar episodes have occurred previously but they have become more noticeable. He has a history of recurrent respiratory tract infections since infancy. On examination, his height is at the 10th percentile and weight at the 2nd percentile. Physical examination reveals abdominal distension and bilateral nasal polyps. Which complication is most likely seen in this patient?

Answer 43

Likely CF vitamin deficiency - cystic fibrosis is associated with exocrine pancreatic insufficiency, leading to fat malabsorption and deficiencies in fat-soluble vitamins (A, D, E, and K).

Question 44

Does CF cause obstructive or restrictive lung disease?

Answer 44

obstructive - due to mucous plugging

Question 45

how can you investigate HOCM if an echo is not available?

Answer 45

cardiac MRI

Question 46

most appropriate initial test for infective endocarditis?

Answer 46

blood cultures

Question 47

A 28 year old man presents to the GP complaining of heart palpitations that occur during physical activity. He notes that the palpitations start shortly after beginning his workouts and last for a few minutes, after which they resolve spontaneously. He has no significant medical history and does not take any medications. The patient reports that he has been increasing the intensity and duration of his exercise routine over the past few weeks. What is the most likely cause of his heart palpitations?

Answer 47

exercise-induced tachycardia

Question 48

first-line treatment for oesophageal candidiasis in HIV-positive patients = what if they weren't immunocompromised?

Answer 48

oral fluconazole a healthy person would get miconazole gel

Question 49

lung abscess initial mx =

Answer 49

IV abx (co-amox), rather than aspiration

Question 50

differentiate between capput succedaneum and cephalohaematoma

Answer 50