TT2007

FBMV 4751 Enter candidate number
Second Examination for the Degree of Bachelor of Medicine
Year 3
MEDICINE and SURGERY
TRINITY TERM 2007
Monday, 25 June, 9.30 a.m. – 12.30 p.m.
This examination paper comprises ten Medicine questions and ten Surgery questions.
You are required to answer ALL the questions.
Enter your candidate number in the space provided above and at the top of EVERY odd-numbered
page.
This paper is short answer format. Spaces have been left for you to write your answers. Where the
number of responses is specified (e.g. ‘name five…’), the correct number of spaces has been left for
your answers. Do not exceed the requested number of answers.
This booklet has 46 numbered pages; several pages have been left intentionally blank and these blank
pages are clearly indicated. Do not write on the blank pages.
Separate from this booklet is one figure; this is referred to in question 1.
A table of normal values is provided on page 2 of this booklet.
Remember it is your own personal responsibility to ensure that you:
 write legibly, in permanent dark ink – pencil is not acceptable;

 indicate (by crossing out) anything which is not to be read as part of your answer;
 hand in all material.
Do not turn over until told that you may do so.
1
Second Examination for the Degree of Bachelor of Medicine, 25 June 2007
Normal Values
Haematology
Haemoglobin (Hb) (male) ............................. 13.5-17.6 g/dl
(female) .......................... 11.5-16.0 g/dl
White cell count (WBC) ................................. 4.0-11.0 x109/L
Platelets ........................................................... 150-400 x109/L
Mean Cell Volume (MCV) ............................. 78-100 fl
Erythrocyte Sedimentation Rate (ESR)
(male) 17-50 yr .......... 1-10 mm
> 50 yr ............ 1-14 mm
(female) 17-50 yr .......... 1-12 mm
> 50 yr ............ 1-20 mm
C-reactive protein (CRP) ................................ <10 mg/L
Biochemistry Blood
Albumin .......................................................... 35-50 g/L
Alanine – amino transferase (ALT) ................ 5-35 IU/L
Aspartate – amino transferase (AST) .............. 5-42 IU/L
Alkaline phosphatase ...................................... 80-250 IU/L
Amylase .......................................................... 25-180 Somogyi Units/dl
Bicarbonate ..................................................... 24-30 mmol/L
Bilirubin .......................................................... 3-17 µmol/L
Calcium ........................................................... 2.12-2.62 mmol/L
Gamma-glutamyl transpeptidase (GGT) ........ 15-40 IU/L
Creatinine ........................................................ 70-150 mol/L
Glucose (fasting) ............................................. 3.0-5.5 mmol/L
Lactate dehydrogenase (LDH) ........................ 110-250 IU/L
Parathyroid hormone .......................................1.3-7.6 pmol/L
Phosphate ........................................................ 0.8-1.45 mmol/L
Potassium ........................................................ 3.5-5.0 mmol/L
Prostate specific antigen (PSA) ...................... < 4 μg/L
Sodium ............................................................ 135-145 mmol/L
Total Protein ................................................... 60-80 g/L
Urate (male) .................................................... 210-480 mol/L
Urate (female) ................................................. 150-390 mol/L
Urea ................................................................. 2.5-6.7 mmol/L
Arterial Blood Gases
Pa CO2 ............................................................ 4.7-6.0 kPa
Pa O2 ............................................................... 12.0-14.5 kPa
pH ................................................................... 7.38-7.44
Base excess ..................................................... 2 mmol/L
FBMV 4751 2
Second Examination for the Degree of Bachelor of Medicine, 25 June 2007 Enter candidate number
Question 1 (Medicine)
An 84 year old lady, a smoker, presents with a syncopal episode while walking. There is a three
month history of exertional breathlessness and orthopnea despite bendrofluazide. On examination
pulse, 70, regular, blood pressure 150/100, soft heart sounds and a grade 2 ejection murmur radiating
to the neck.
(A) Give the five most likely possible diagnoses to explain her symptoms. (5 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(B) The ECG from this patient is shown in Figure 1 and is calibrated conventionally. List
four abnormalities on the ECG. (4 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(C) List three key questions to be answered by transthoracic cardiac ultrasound examination.
(3 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
For examiner’s use only:

Circle one Clear Fail Borderline Fail Clear Pass High Pass Total Marks= /12
FBMV 4751 3 [turn over]
[This page has been left intentionally blank and should not be used to
write any answers since this page will not be seen by an examiner.]
FBMV 4751 4
A 78 year old frail mail has been referred to hospital by his general practitioner. He presents with a 4
week history of increasing breathlessness, sweats and 1 stone (6.5 kg) weight loss. Investigations
reveal a normal FBC, U&E, creatinine and liver function tests. A chest X-ray, performed on the
previous day, is reported to show a large right-sided pleural effusion. A diagnostic tap is performed.
(A) If the fluid is blood stained, give the two most likely causes (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(B) If the fluid is straw-coloured, give a biochemical investigation that you would request
to confirm that this was an exudate and state the concentrations you are expecting.
(2 marks)
Investigation Concentration in exudate
............................................................... ...............................................................
(C) What are the four most common diagnoses to consider for a large exudative pleural
effusion? (4 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(D) If the fluid were found to be a transudate, give two of the most common causes of a
transudative pleural effusion. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
The pleural effusion is confirmed to be an exudate. Microscopy, Ziehl-Nielsen staining, and culture
of the fluid, and bronchoscopy and CT scan of the thorax, fail to establish the diagnosis.
(E) What further investigation would you request? (1 mark)
..............................................................................................................................................
He is found to have developed a very large pleural effusion and for symptomatic relief, you are asked
to drain the effusion.
(F) What adverse effect, apart from a pneumothorax, might follow rapid draininage of 2.5l
of this effusion? (1 mark)
..............................................................................................................................................
FBMV 4751 6
A 38 year old woman presents to the emergency department with a ten hour history of severe colicky
pain in the right hypochondrium with radiation around to the back. There is associated vomiting.
She has had several episodes of mild pain in this region over the past six months, typically one to two
hours after eating. Examination reveals a temperature of 38.0oC, yellow sclerae, a dry mouth and
tender right upper quadrant of theabdomen. She has an oxygen saturation of 99% on room air.
(A) Give the two most likely diagnoses. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(B) Apart from Hb, FBC, CRP, ESR, U&E, serume calcium, glucose, INR and LFT, name
two essential blood tests that you would request. (2 marks)
..............................................................................................................................................
(C) Name two features of an upper abdominal ultrasound that would assist you with planning
her future management. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(D) Name four initial management actions that you would instigate in the emergency
department. (4 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(E) Over the next twenty-four hours the patient’s symptoms do not resolve and she becomes
clinically more jaundiced. Name two therapeutic interventional procedures that could be
performed to improve her condition. (2 marks)
..............................................................................................................................................
..............................................................................................................................................

FBMV 4751 8
An 80 year old widower, who was previously well, is brought to the emergency department. He was
found by his home help disorientated, immobile in his chair and not having eaten his lunch. The
mini mental state examination score was 12/30 (or 5/10). He does not know where he is, his mind
keeps wandering and he is restless although he cannot get out of bed. His temperature is 37 oC.
(A) What is the precise term for his condition? (1 mark)
..............................................................................................................................................
(B) There was nothing remarkable to find on examination. Routine blood tests (comprising
Hb, WBC, Na, K, creatinine, Ca2+ and liver function tests) and chest X-ray are normal.
Give six other investigations that would be essential to do at this stage. (6 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(C) All appropriate initial investigations have been unhelpful. Name two further causes that
should be considered for his acute deterioration. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(D) His condition and mental state improve over the next ten days, and he is deemed
medically fit for discharge. What three other assessments would be appropriate prior to
discharge? (3 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................

FBMV 4751 10
A 55 year old woman is referred with a macrocytic anaemia. The Hb is 8.9 g/dl and the MCV 100fl.
A diagnosis of pernicious anaemia is suspected.
(A) Give two abnormalities which may be present on the blood film to support this
diagnosis. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(B) What three diagnostic investigations, other than a blood film, would you arrange to
confirm the diagnosis and for each give the expected abnormality. (6 marks)
Investigation Expected abnormality
............................................................... ...............................................................
............................................................... ...............................................................
............................................................... ...............................................................
(C) Give two complications that are associated with this disease. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(D) Give two non-haematological conditions associated with macrocytosis. (2 marks)
..............................................................................................................................................
..............................................................................................................................................

FBMV 4751 12
A 48 year old nurse is referred to the general medical clinic with a two month history of weight loss
and episodes of palpitation. She is thin and has atrial fibrillation. She does not admit to taking any
regular medicaltion. Serum TSH requested by the GP is <0.04mU/l (reference range (0.4 – 4.0
mU/l). You suspect a diagnosis of hyperthyroidism.
(A) Give four possible causes for her thyroid disease. (4 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(B) Give two routine investigations that would help you to determine the underlying causes
of her condition. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(C) Name a drug you would use to treat the acute symptoms. (1 mark)
..............................................................................................................................................
(D) Give three specific treatments that could be used to treat her underlying condition.
(3 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(E) She is given oral drug therapy and returns to the emergency department 3 weeks later
with a high fever and sore throat. What is the single most important test to request and
what is the likely diagnosis? (2 marks)
Test: ........................................................................................................................
Diagnosis: ........................................................................................................................

FBMV 4751 14
A 75 year old man is referred to the medical outpatient clinic for an opinion on his worsening skin
disease. He tells you that he has a 20 year history of psoriasis. He has used a variety of topical
treatments and has had numerous courses of ultraviolet light in the past 20 years. Now he takes a
small dose of methotrexate (10mg) each week.
(A) Give three characteristic features of the rash psoriasis. (3 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(B) Careful examination of the hands might help to confirm the diagnosis of psoriasis. Give
two signs that may be present in the hands of a patient with psoriasis. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(C) Give two factors that may exacerbate psoriasis. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(D) Give three features you would enquire from the patient to help to determine the most
appropriate management of his psoriasis. (3 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(E) The patient has been taking low dose methotrexate (10mg/week) for five years. Name
two serious complications of long-term treatment with low dose weekly methotrexate.
(2 marks)
..............................................................................................................................................
..............................................................................................................................................

FBMV 4751 16
Whilst examining a 35 year old man for an insurance medical you discover his BP to be 150/100,
together with bilateral abdominal masses. You arrange an ultrasound which shows polycustic
kidneys.
(A) Give four other renal presentations of this disease. (4 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(B) State three extra-renal manifestations of this condition. (3 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(C) A blood test reveals a creatinine of 500µmol/l, calcium of 1.98mmol/l, phosphate of

2.2mmol/l and albumin of 43g/l. What two medications should be started to improve his
calcium and phosphate metabolism? (2 mark)
..............................................................................................................................................
..............................................................................................................................................
(D) You start him on an angiotesin-converting enzyme (ACE) inhibitor. State three
important side-effects, other than rashes and gastrointestinal disturbances, that you
would warn him about. (3 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................

FBMV 4751 18
Sub-question A
A 58 year old man who is a fellow at an Oxford College, presents with double vision. On
examination he has a right ptosis, the right eye is deviated downwards and to the right. On trying to
look downwards the right eye rotates inwards. There are no other cranial nerve abnormalities.
(A) Which cranial nerve is affected? (1 mark)
..............................................................................................................................................
..............................................................................................................................................
(B) Name the two ocular muscles that are spared in this condition. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(C) Which nerve fibres lying on the outside of the nerve sheath are affected by external
complession of this cranial nerve and what clinical sign results? (2 marks)
Fibres: .....................................................................................................................
Clinical sign: ......................................................................................................................
(D) What two ordinary tasks, other than driving, might this patient find difficult? (2 marks)
..............................................................................................................................................
..............................................................................................................................................
Sub-question B
A 40 year old woman presents with unilateral facial weakness.
(E) How would you clinically distinguish between an upper and lower motor neurone lesion
of the seventh cranial nerve? (1 mark)
..............................................................................................................................................
(F) Name two additional features, apart from facial muscle weakness, that may be present in
a patient who has a lower motor neurone lesion of the seventh cranial nerve. (2 marks)
..............................................................................................................................................
..............................................................................................................................................

FBMV 4751 20
Question 9 (Medicine) continued
(G) Give an initial treatment that is appropriate for a patient with Bell’s palsy and name a
long-term complication that can arise from Bell’s palsy. (2 marks)
Treatment: ......................................................................................................................
Complication: ....................................................................................................................

FBMV 4751 22
A 45 year old man with a history of hypertension attends your clinic complaining of a painful foot.
On examination the metatarso-phalangeal joint of the left great toe is swollen and hot. The most
likely diagnosis is gout.
(A) If you could obtain some joint fluid, what laboratory findings would confirm your
diagnosis? (1 mark)
..............................................................................................................................................
(B) Which class of antihypertensive drugs has been identified as a relatively common cause
of gout? Give three adverse effects associated with this class of drugs, other than gout,
gastrointestinal disturbances and skin rashes. (4 marks)
Drug class: ....................................................................................................................
Adverse effect 1:...................................................................................................................
2: ...................................................................................................................
3: ...................................................................................................................
(C) State two treatment options that you could use to alleviate the immediate symptoms of
gout. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(D) Name two drugs that can be used for the long-term control of gout. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(E) Give two dietary modifications that you would suggest to this man. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(F) Give one non-articular manifestation, other than tophi, associated with gout. (1 mark)
..............................................................................................................................................

FBMV 4751 24
Question 11 (Surgery)
A 30 year old woman presents with a 20mm mass in her breast. Her GP has told her that this is
likely to be a breast “mouse” (a fibroadenoma).
(A) Name four clinical features that the lump is likely to show. (4 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(B) Having examined her, what two investigations would you request to confirm this
diagnosis. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(C) If these tests do not confirm that the lump is a fibroadenoma, what are the other two
most likely diagnoses? (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(D) Name four indications when surgical removal of a clinical fibroadenoma might be
indicated. (4 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................

FBMV 4751 26
A 72 year old man presents with profuse bright red rectal bleeding that had commenced 5 hours
previously. He normally struggles to open his bowels more than three times a week. Pulse 130
regular, BP 90/50. Rectal examination reveals bright red blood.
(A) What are your four immediate priorities? (4 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(B) An initial full blood count reveals: Hb 13.1; platelets 330; WCC 12. How do you
interpret the HB value in this situation? (1 mark)
..............................................................................................................................................
(C) What therapy would you investigate if his blood pressure continued to fall further?
(1 mark)
..............................................................................................................................................
(D) Bleeding actually subsided quickly and his condition improved with the measures that
you instigated. Proctoscopy reveals no evidence of bleeding piles. List four alternative
investigations that are appropriate for this patient with GI bleeding. (4 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(E) If the patient continues to actively bleed what investigation would you undertake?(1 mark)
..............................................................................................................................................
(F) If that fails what other intervention is possible? (1 mark)
..............................................................................................................................................

FBMV 4751 28
A 36 year old woman presents with a 2 year history of intermittent bouts of pain in the right upper
abdomen that radiates around to the back. The symptoms are brought on by meals and usually last
for a few hours. An ultrasound scan demonstrates the presence of gallstones in a slightly thick
walled gallbladder. All other findings are normal.
(A) What is the likely diagnosis? (1 mark)
..............................................................................................................................................
(B) The patient is put on the waiting list for laparoscopic cholecystectomy. What other
measure should the patient take in the meantime? (1 mark)
..............................................................................................................................................
(C) What other investigation is essential before proceeding with treatment? (1 mark)
..............................................................................................................................................
(D) The patient asks about non-surgical therapies for gallstones. List any two. (2 mark)
..............................................................................................................................................
..............................................................................................................................................
The patient returns to the emergency department 2 days after an uneventful laparoscopic
cholecystectomy complaining of abdominal pain and vomiting. On examination she has tachycardia
and tachypnoea and is febrile.
(E) What is the most likely problem? (1 mark)

..............................................................................................................................................
(F) What three immediate therapeutic steps would you initiate? (3 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(G) What is the first relevant radiological test that you would arrange? (1 mark)
..............................................................................................................................................
(H) The radiological investigation shows a collection in the right upper quadrant. Name two
options for the further management of the most likely problem. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
FBMV 4751 30
A 72 year old man is admitted with a ten day history of jaundice.
(A) Name three aspects of this man’s history that would make you suspect that the
jaundice is obstructive in nature. (3 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(B) Name two aspects of the history that would make you suspect that the cause of the
obstructive jaundice is neoplastic rather than due to common bile duct stones.
(2 marks)
..............................................................................................................................................
..............................................................................................................................................
(C) What is Courvoisier’s law? (1 mark)
..............................................................................................................................................
..............................................................................................................................................
(D) The patient undergoes a CT scan that shows a carcinoma of the head of the pancreas.
What operation would you recommend as curative therapy? (1 mark)
........................................................................................................................................
An ERCP has been arranged. Blood tests the day before the procedure show that the prothrombin
time is raised to18 seconds and the INR is 1.6.
(E) What is the cause of this derangement? (1 mark)
..............................................................................................................................................
(F) What action would you take? (1 mark)
..............................................................................................................................................
(G) At ERCP the endoscopist reports that the medical wall of the duodenum is distorted
and abnormal, making it impossible to cannulate the bile duct. What other method
can be used to decompress the biliary tree and insert a stent? (1 mark)
..............................................................................................................................................

FBMV 4751 32
Question 14 (Surgery) continued
This man has a stent inserted and is finally diagnosed to have advanced cancer. He is advised
to have palliative care. Name four symptoms that may need to be palliated.
(2 marks, ½ each)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................

FBMV 4751 34
A 35 year old man presents with right sided loin pain. He has never had an episode like this before.
Your working diagnosis is ureteric colic.
(A) Give three key features in the history which suggest a diagnosis of renal colic, as
opposed to acute appendicitis. (3 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(B) What feature on abdominal examination might suggest that a calculus is causing
obstruction of the kidney? (1 mark)
..............................................................................................................................................
(C) List six investigations that should be undertaken in the assessment of this patient.
(6 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(D) Analgesia is an important part of the management of renal colic. What is the most
appropriate class of drug and give one specific example of this drug (2 marks)
..............................................................................................................................................
..............................................................................................................................................

FBMV 4751 36
A 65 year old man presents with a transient loss of vision in his right eye. A diagnosis of amaurosis
fugax is made.
(A) What is the most likely cause of this symptom? (1 mark)
..............................................................................................................................................
(B) Excluding examination, what is the first investigation to identify a treatable cause?
(1 mark)
..............................................................................................................................................
(C) List four of the specific risk factors you would discuss with this patient. (4 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(D) What immediate medical therapy is indicated? (1 mark)
..............................................................................................................................................
(E) Carotid endarterectomy is used as a treatment to prevent further TIA/stroke. What

would be the major criterion for this patient to meet the indication for surgery?
(1 mark)
..............................................................................................................................................
(F) List four specific complications of carotid endarterectomy that you must discuss pre-
operatively to achieve informed consent. (4 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................

FBMV 4751 38
A 55 year old man has a sigmoid colectomy for carcinoma. You are asked to see him on the 4 th post-
operative night and he has a fever of 38o and feels unwell. He has some redness around the wound
suggesting wound infection.
(A) Give four other possible causes of this fever. (4 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(B) Assuming physical examination does not reveal any obvious cause for the fever, what
four investigations are appropriate at this stage? (2 marks, ½ mark each)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(C) The following morning there is purulent discharge from the central portion of the wound
and marked erythema around this area. What is the single most important action that
should be taken at this point? (1 mark)
..............................................................................................................................................
(D) List three non-operative measures that can be used in patients undergoing bowel surgery
to minimise the risk of post-operative wound infection.
(3 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(E) Give two common organisms responsible for post-operative wound infection in this
situation. (2 marks)
..............................................................................................................................................
..............................................................................................................................................

FBMV 4751 40
A 65 year old man presents to the ENT department with a six week history of an enlarged cervical
lymph node in the right anterior triangle. He is a long standing smoker and you think that this is
probably due to metastatic cancer.
(A) Name five likely sources for the primary cancer. (5 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(B) What would be the diagnosis if this were a primary malignant tumour? (1 mark)
..............................................................................................................................................
(C) What two non-radiological outpatient procedures could be performed to establish the
diagnosis? (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(D) The diagnosis has not been established. What procedure is now indicated? (1 mark)
..............................................................................................................................................
(E) Name two cranial nerves that are most at risk of being injured during neck lymph node
dissection. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(F) What is the most likely histology? (1 mark)
..............................................................................................................................................

FBMV 4751 42
A 46 year old car mechanic presents with a history of having sudden onset of a foreign body
sensation in his right eye at work.
(A) List four likely diagnoses. (4 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(B) List four features from the history or examination suggesting intraocular foreign body.
(4 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(C) List two early complications of intraocular foreign body. (2 marks)
..............................................................................................................................................
..............................................................................................................................................
(D) List two late complications of intraocular foreign body. (2 marks)
..............................................................................................................................................
..............................................................................................................................................

FBMV 4751 44
A 72 year old restrained car driver is involved in a front end collision with a truck. On arrival in the
emergency department the driver reports marked pain on the right side of his chest and difficulty
breathing. There are no abnormal upper airway noises. Respiratory rate is 24 breaths per minute and
pulse oximetry reveals oxygen saturation of 91% on 15 litres O2/minute via a non-rebreathing mask.
The ambulance crew report that he has a flail chest.
(A) Define the term “flail chest”. (1 mark)
..............................................................................................................................................
(B) How is flail chest diagnosed? (1 mark)
..............................................................................................................................................
(C) List the three commonest life threatening complications of flail chest. (3 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(D) What are the preferred landmarks for chest drain insertion? (1 mark)
..............................................................................................................................................
(E) List three key steps enabling chest drain insertion after consent, sterile preparation and
administration of local anaesthesia. (3 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(F) List three regional anaesthetic techniques used in management of flail chest. (3 marks)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................

FBMV 4751 46

TT2007

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

TT2007

Uploaded by

Copyright:

Available Formats

FBMV 4751 Enter candidate number

Second Examination for the Degree of Bachelor of Medicine

MEDICINE and SURGERY

TRINITY TERM 2007

Monday, 25 June, 9.30 a.m. – 12.30 p.m.

 write legibly, in permanent dark ink – pencil is not acceptable;

Do not turn over until told that you may do so.

For examiner’s use only:

(A) Give the two most likely diagnoses. (2 marks)

For examiner’s use only:

(A) What is the precise term for his condition? (1 mark)

For examiner’s use only:

Investigation Expected abnormality

(D) Give two non-haematological conditions associated with macrocytosis. (2 marks)

For examiner’s use only:

For examiner’s use only:

(A) Give three characteristic features of the rash psoriasis. (3 marks)

(C) Give two factors that may exacerbate psoriasis. (2 marks)

For examiner’s use only:

(A) Give four other renal presentations of this disease. (4 marks)

(B) State three extra-renal manifestations of this condition. (3 marks)

(C) A blood test reveals a creatinine of 500µmol/l, calcium of 1.98mmol/l, phosphate of

For examiner’s use only:

(A) Which cranial nerve is affected? (1 mark)

Clinical sign: ......................................................................................................................

A 40 year old woman presents with unilateral facial weakness.

For examiner’s use only:

For examiner’s use only:

Drug class: ....................................................................................................................

Adverse effect 1:...................................................................................................................

For examiner’s use only:

For examiner’s use only:

(A) What are your four immediate priorities? (4 marks)

(F) If that fails what other intervention is possible? (1 mark)

For examiner’s use only:

(A) What is the likely diagnosis? (1 mark)

(E) What is the most likely problem? (1 mark)

A 72 year old man is admitted with a ten day history of jaundice.

(C) What is Courvoisier’s law? (1 mark)

(E) What is the cause of this derangement? (1 mark)

(F) What action would you take? (1 mark)

For examiner’s use only:

For examiner’s use only:

For examiner’s use only:

(A) What is the most likely cause of this symptom? (1 mark)

(D) What immediate medical therapy is indicated? (1 mark)

(E) Carotid endarterectomy is used as a treatment to prevent further TIA/stroke. What

For examiner’s use only:

(A) Give four other possible causes of this fever. (4 marks)

For examiner’s use only:

(F) What is the most likely histology? (1 mark)

For examiner’s use only:

(A) List four likely diagnoses. (4 marks)

(C) List two early complications of intraocular foreign body. (2 marks)

(D) List two late complications of intraocular foreign body. (2 marks)

For examiner’s use only:

(A) Define the term “flail chest”. (1 mark)

(B) How is flail chest diagnosed? (1 mark)

For examiner’s use only:

You might also like