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Common AMK pathologies :)

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Content credits to Ali Bakhsh
Plymouth Med
Quiz by Plymouth Med, updated more than 1 year ago
Plymouth Med
Created by Plymouth Med about 6 years ago
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Resource summary

Question 1

Question
38-year-old male fell whilst horse riding earlier in the day. He was unconscious briefly after his fall but was able to continue horse riding. He now complains of disorientation and a severe headache. His GCS is 13. He feels nauseous. Examination reveals a bruise on his temple. His blood pressure is 160/105, HR 55bpm, RR 20, temperature 37.1. What vessel may have been ruptured?
Answer
  • Anterior cerebral artery
  • Middle meningeal artery
  • Sagital sinus
  • Subdural vein
  • Vertebral artery

Question 2

Question
A 42 year old male, of no fixed abode, presents with increased forgetfulness over the past month. He complains of a mild headache which does not improve with paracetamol. Initial blood tests show ALT 392 (0-55), AST 228 (0-60), ALP 160 (40-150), bilirubin 45 (3-21). He has a 20 pack year smoking history and his alcohol intake is 80u/week. What is the most likely diagnosis?
Answer
  • Vascular dementia
  • Extradural haemorrhage
  • Subarachnoid haemorrhage
  • Subdural haemorrhage
  • Venous sinus thrombosis

Question 3

Question
An elderly female presents to ED with subacute worsening of back pain which is 5/10 in severity. She has had longstanding lower back pain. She does not report any recent changes in urinary or bowel symptoms. Examination reveals local, central tenderness on lower palpation. There is normal lower limb sensation and power. Renal function and FBC are normal. Spinal XR is ordered. What is the next step in management?
Answer
  • Adequate analgesia, discharge
  • Alendronic acid
  • Spinal CT scan
  • Surgical referral
  • Urinary electrophoresis

Question 4

Question
An elderly male attends his GP complaining of left-sided hip pain. The pain has been worsening slowly over the past few weeks and has not responded to naproxen. On further questioning, he admits he has been feeling tired and has stopped gardening. Examination reveals full range of hip motion, non-tender to palpation and left hip feels slightly warm. Hb 120 (130-180) Plt 110 (150-400) WCC total 12.5 (4-11) CRP 27 (<10) Ca 2.3 (2.1-2.6) eGFR 59 (>90) Cr 190 (70-150) Urea 9.1 (2.5-6.7) What is the diagnosis?
Answer
  • Myeloma
  • Osteopenia
  • Osteoporosis
  • Paget’s disease of bone
  • Rheumatoid Arthritis

Question 5

Question
Diagnosis of multiple myeloma has been made. What do you expect to see on urinary electrophoresis?
Answer
  • Monoclonal kappa light chain IgG
  • Monoclonal kappa light chain IgM
  • Monoclonal lambda light chain IgG
  • Multiclonal kappa light chain IgM
  • Multiclonal lambda light chain IgM

Question 6

Question
Ig[blank_start]A[blank_end] is present in breast milk. Ig[blank_start]G[blank_end] is transplacental and is a specific antibody Ig[blank_start]M[blank_end] is a general antibody Ig[blank_start]E[blank_end] is allergy related Ig[blank_start]D[blank_end] is a BCR
Answer
  • A
  • G
  • M
  • D
  • E

Question 7

Question
75 year old male was found unconscious at home and initial assessment has revealed a neck of femur fracture. He was previously able to walk 4 miles without stopping and performed all activities of daily living. What is the most appropriate definitive management plan?
Answer
  • Dynamic hip screw
  • Hemiarthroplasty
  • Leg cast and strong analgesia
  • Open reduction, internal fixation
  • Total hip arthroplasty

Question 8

Question
75 year old male was found unconscious at home and initial assessment has revealed a neck of femur fracture. He was previously able to walk 4 miles without stopping and performed all activities of daily living. In ED, he suddenly becomes tachypnoeic, and complains of pleuritic chest pain. His O2 sats drop to 88% (10L O2), HR is 120 and BP is 90/50. What is the most likely diagnosis?
Answer
  • Acute haemorrhage
  • Myocardial infarction
  • Pulmonary Embolism due to fat embolus
  • Pulmonary Embolism due to Venous Thrombosis
  • Septic Shock

Question 9

Question
55 year old male presents to his GP with a lump on DIP on his left hand. The lump is hard, non-mobile and adherent to overlying and underlying tissue. The lump does not give him any issues. He does not want surgical intervention. He has a history of multiple episodes of acute finger joint pain. His regular medication is naproxen, ramipril and bendroflumathiazide. What is the most appropriate management plan?
Answer
  • Advise lumpectomy
  • Allopurinol
  • Biopsy lump
  • Colchicine
  • Increased NSAID dose

Question 10

Question
You are a GP and are called out to see a known IVDU who complains of a painful right knee. She is walking with a limp. On examination, her right knee is erythematous, tender and warm on palpation and there is reduced knee flexion. She is tachypnoeic and sweating. What is the next most appropriate step?
Answer
  • Emergency admission to ED
  • Flucloxacillin 500mg TDS PO
  • High dose NSAIDs
  • Oral steroids

Question 11

Question
You are a FY1 and you aspirate the swollen knee of a 55 year old female patient. She presented with a red, hot, swollen knee. She is otherwise well. The fluid is turbid and straw coloured. What is the most likely diagnosis:
Answer
  • Osteoarthritis
  • Rheumatoid arthritis
  • Septic arthritis
  • Reactive arthritis

Question 12

Question
On a normal healthy patient, bridging veins should be visible.
Answer
  • True
  • False

Question 13

Question
Calcification of the choroid plexus is common in elderly patients and can be seen in CTs as surrounding the ventricles
Answer
  • True
  • False

Question 14

Question
What's this pattern indicative of? Trauma--> Lucid phase--> Headache
Answer
  • Epidural hemorrhage
  • Subdural hemorrhage
  • Subarachnoid hemorrhage
  • Intercerebral hemorrhage

Question 15

Question
Because the complications of epidural hemorrhages include [blank_start]herniation[blank_end], the management is a urgent [blank_start]non[blank_end]-[blank_start]contrast[blank_end] [blank_start]CT[blank_end] of the head and urgent [blank_start]neurosurgeon[blank_end] [blank_start]referral[blank_end].
Answer
  • herniation
  • contrast
  • non
  • CT
  • neurosurgeon
  • referral

Question 16

Question
Because subdural hemorrhages are [blank_start]venous[blank_end] and slower, even [blank_start]acute[blank_end] subdural hemorrhages take place over many [blank_start]days[blank_end]/weeks. They're usually due to [blank_start]minor[blank_end] trauma and are more common in children, elderly, and [blank_start]alcoholics[blank_end]. Symptoms include [blank_start]pseudo[blank_end]-[blank_start]dementia[blank_end] and [blank_start]confusion[blank_end].
Answer
  • venous
  • acute
  • minor
  • days
  • alcoholics
  • pseudo
  • dementia
  • confusion

Question 17

Question
Acute subdural hematoma requires urgent referral to the neurosurgeon.
Answer
  • True
  • False

Question 18

Question
What are the different types of subdural hemorrhages?
Image:
Screen Shot 2018 03 10 At 9.44.58 Pm (binary/octet-stream)
Answer
  • acute
  • subacute
  • chronic

Question 19

Question
What is true regarding subarachnoid hemorrhages?
Answer
  • Worst 10/10, sudden headache
  • investigate: check for protein and urea
  • most common in middle aged women
  • blood between sulci and in sub-arachnoid space
  • due to berry aneurysm bursting
  • investigate: positive Kerniq's sign
  • manage: urgent non-contrast CT scan and neurosurgeon referral
  • investigate: spinal tap after 12 hours
  • symptom: neck stiffness and backpain
  • investigate: reduced GCS

Question 20

Question
Which of these is not a Liver Function Test?
Answer
  • ALT
  • AST
  • ALP
  • GGT
  • Bilirubin
  • ERCP

Question 21

Question
Raised ALP alone can be helpful in differential diagnosis.
Answer
  • True
  • False

Question 22

Question
If ALP and AST are more raised than ALP and Bilirubin, this is indicative of
Answer
  • Alcoholic liver disease
  • Gilbert's syndrome
  • Jaundice
  • Cirrohosis

Question 23

Question
Isolated raised bilirubin levels are indicative of [blank_start]Gilbert's[blank_end] [blank_start]Syndrome[blank_end].
Answer
  • Gilbert's
  • Syndrome

Question 24

Question
Types of Hip Fractures:
Image:
Screen Shot 2018 03 10 At 10.57.44 Pm (binary/octet-stream)
Answer
  • intracapsular
  • extracapsular
  • trochanteric
  • sub

Question 25

Question
The joint capsule is made up of a femur [blank_start]head[blank_end] and [blank_start]neck[blank_end].
Answer
  • head
  • neck

Question 26

Question
Only intracapsular fractures can be either displaced or nondisplaced.
Answer
  • True
  • False

Question 27

Question
Which of these can you manage via internal fixation with a dynamic hip screw (DHS)?
Answer
  • undisplaced intracapsular
  • displaced intracapsular
  • undisplaced extracapsular
  • displaced extracapsular

Question 28

Question
The management for an intracapsular displaced fracture is hip arthroplasty within 24 hrs (total hip replacement or hemiarthroplasty)
Answer
  • True
  • False

Question 29

Question
Paget's disease is very much visible in an x-ray of a spinal vertebrae.
Answer
  • True
  • False

Question 30

Question
In Paget's disease, serum calcium and phosphate levels would be increased drastically.
Answer
  • True
  • False

Question 31

Question
Osteopenia may present with a history of excessive steroid usage or fraility fractures.
Answer
  • True
  • False

Question 32

Question
Osteoporosis will have normal calcium serum levels but a raised ALP
Answer
  • True
  • False

Question 33

Question
Alendronic acid is a treatment for osteoporosis.
Answer
  • True
  • False

Question 34

Question
some bone conditions and pathologies involve DEXA scans for diagnostic purposes.
Answer
  • True
  • False

Question 35

Question
What is true regarding multiple myeloma?
Answer
  • it is due to cloning of a plasma cell
  • there is overproduction of an antibody IgG (light chain)
  • investigation: urinalysis (with ++ protein)
  • hypocalcemia
  • renal failure
  • anemia
  • bone pain
  • present: back pain
  • investigation: skeletal survey and head and vertebrae x-ray
  • pepper pot appearance

Question 36

Question
For Multiple Myeloma: Monoclonal band urine electrophoresis known as Bence [blank_start]Jones[blank_end] proteins aka monoclonal [blank_start]kappa[blank_end] [blank_start]light[blank_end] chains Also: [blank_start]low[blank_end] RBC, Calcium [blank_start]high[blank_end] ALP [blank_start]normal[blank_end], PTH [blank_start]normal[blank_end]
Answer
  • low
  • high
  • normal
  • normal
  • Jones
  • kappa
  • light

Question 37

Question
If IgM is found in urine electrophoresis, the condition is Waldenstrom’s macroglobinaemia.
Answer
  • True
  • False

Question 38

Question
What would you prescribe for a 40 year old with a painful red toe?
Answer
  • aciclovir
  • allopurinol
  • NSAIDs
  • paracetamol
  • urgent referral

Question 39

Question
Hemarthrosis is due to factor 11 deficiency.
Answer
  • True
  • False

Question 40

Question
Septic arthritis is usually seen in one really red, hot, and tender joint (large.)
Answer
  • True
  • False

Question 41

Question
In any really red and hot joint, always aspirate to investigate.
Answer
  • True
  • False

Question 42

Question
What is true regarding septic arthritis?
Answer
  • cause: staphylococcal
  • cause: viral
  • treatment: IV penicillin
  • treatment: analgesia
  • common with trauma
  • common with joint prosthetics
  • common in the homeless
  • common in IV drug users

Question 43

Question
[blank_start]Gout[blank_end] in common in middle aged males. There is a history of poor diet, such as too much [blank_start]meat[blank_end], alcohol, and too high of a [blank_start]BMI[blank_end]. There is high serum levels of [blank_start]urate[blank_end], which may be due to renal failure. Usually, there is [blank_start]monoarthropathy[blank_end] because the problem is in only one joint. It presents acutely, and the patient may suddenly wake in the middle of night from the pain.
Answer
  • Gout
  • meat
  • BMI
  • urate
  • monoarthropathy

Question 44

Question
Osteoarthritis/rheumatoid arthritis is better at night .
Answer
  • True
  • False

Question 45

Question
Aspirate: Septic arthritis: [blank_start]opaque[blank_end] (clarity) and [blank_start]red[blank_end] (color) Rheumatoid arthritis: [blank_start]straw[blank_end] colored Osteoarthritis: [blank_start]clear[blank_end] colored
Answer
  • opaque
  • red
  • straw
  • clear

Question 46

Question
Acute Gout: 1st treatment: [blank_start]NSAIDS[blank_end] such as [blank_start]naproxen[blank_end], diclofenac Contraindications to NSAIDS include: [blank_start]peptic[blank_end] [blank_start]ulcer[blank_end] disease, [blank_start]Asthma[blank_end], [blank_start]renal[blank_end] [blank_start]failure[blank_end] 2nd line medication is then: [blank_start]colchicine[blank_end]
Answer
  • naproxen
  • NSAIDS
  • peptic
  • ulcer
  • Asthma
  • renal
  • failure
  • colchicine

Question 47

Question
[blank_start]Allopurinol[blank_end] (xanthene oxidase inhibitor) if there are [blank_start]two[blank_end] or more attacks per year It will increase uric acid initially so give [blank_start]NSAIDs[blank_end] short course.
Answer
  • Allopurinol
  • two
  • NSAIDs

Question 48

Question
What is true regarding pseudogout?
Answer
  • usually affects larger joints in women
  • presents sub-acutely
  • investigation: positive needle crystals (befringement)
  • investigation: negative needle crystals (befringement)
  • manage: NSAIDS (1st line)
  • manage: intra-articular steroid injection (2nd line)
  • manage: NSAIDS (2nd line)
  • manage: intra-articular steroid injection (1st line)

Question 49

Question
Reactive athritis can have diarrhea as well
Answer
  • True
  • False

Question 50

Question
Drugs to stop before surgery: Aspirin [blank_start]7[blank_end] [blank_start]days[blank_end] Clopidrogrel [blank_start]7[blank_end] [blank_start]days[blank_end] Metformin [blank_start]morning[blank_end] [blank_start]of[blank_end]
Answer
  • 7
  • 7
  • days
  • days
  • morning
  • of

Question 51

Question
adrenaline in anaphylaxis is 1 in 1000
Answer
  • True
  • False

Question 52

Question
Adrenaline in advanced life support is less than the amount in an anaphylactic treatment.
Answer
  • True
  • False

Question 53

Question
Metformin can cause hyperglycemia.
Answer
  • True
  • False

Question 54

Question
Veraparil can be given as hypertension medication. (calcium channel blocker)
Answer
  • True
  • False

Question 55

Question
Calcium channel blockers (should be given at [blank_start]night[blank_end]) and can cause [blank_start]pulmonary[blank_end] [blank_start]edema[blank_end]. EX: [blank_start]Valpromide[blank_end]
Answer
  • pulmonary
  • edema
  • night
  • Valpromide

Question 56

Question
Hyperkalemia can cause heart arrhythmias.
Answer
  • True
  • False

Question 57

Question
A potential side effect of ACE inhibitors: renal failure
Answer
  • True
  • False

Question 58

Question
Break through morphine dosage calculation for acute pain: ([blank_start]total[blank_end] [blank_start]morphine[blank_end] dose for the day) divided by ([blank_start]6[blank_end])
Answer
  • morphine
  • total
  • 6

Question 59

Question
INFR deals with thrombopoietin
Answer
  • True
  • False

Question 60

Question
if INFR is [blank_start]8[blank_end]< (major bleeding) then give [blank_start]Vitamin[blank_end] [blank_start]K[blank_end] or [blank_start]fresh[blank_end] [blank_start]plasma[blank_end] if needed. if INFR is [blank_start]8[blank_end]> (minor to no bleeding) then just [blank_start]vitamin[blank_end] [blank_start]K[blank_end] if needed at all
Answer
  • Vitamin
  • K
  • fresh
  • plasma
  • 8
  • 8
  • vitamin
  • K
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