CHF
What is the typical ejection fraction threshold used to define HFrEF?
A. LVEF <= 20%
B. LVEF <= 40%
C. LVEF <= 60%
B. LVEF <= 40%
What type of hypersensitivity reaction is asthma?
Type 1 hypersensitivity
Patient with suspected bacterial meningitis but is haemodynamically stable and has no features of raised intracranial pressure.
What should be performed urgently?
A. CT head first
B. Blood cultures and lumbar puncture, with IV antibiotics asap
C. Lumbar puncture only; antibiotics can wait for the results
B. Blood cultures and lumbar puncture, with IV antibiotics after blood cultures
Do not delay treatment even if LP cannot be performed properly.
68/M with an acute abdomen is fully alert, understands the situation, and refuses surgery after you explain the risks and benefits. Their daughter says, “You must operate — they’re not thinking clearly.”
What is the best next step?
A. Proceed with surgery because the daughter has consented
B. Reassess the patient’s capacity and, if intact, respect the refusal
C. Ask a senior nurse to convince the patient
D. Treat without consent because the condition is serious
B.
What are some potential features of a PE?
Chest pain (typically pleuritic), SOB, RR>20, tachycardia, hypotension, hypoxia, haemoptysis
Classically, on respiratory examination, the chest will be clear, however, in real-world practice findings often include crackles (58%).
Which one of these drugs is NOT used as first-line treatment in HFrEF?
A. ACE-i (ARNI/ARB)
B. Beta blocker
C. Mineralocorticoid receptor antagonist
D. Diuretic
E. SGLT2i
D. Diuretic
Not recommended first-line in CHF.
First-line investigations in suspected asthma?
A. Eosinophil count above reference range
B. CXR
C. Fractional nitric oxide (FeNO) >= 50 ppb
A. Eosinophil count above reference range
C. Fractional nitric oxide (FeNO) >= 50 ppb
[Also Bronchodilator reversibility testing and a 2-week Peak flow diary.]
Most likely diagnosis for a patient with following CSF results:
Cloudy appearance
Glucose: low
Protein: high
WCC: high (neutrophils)
A. Viral meningitis
B. Bacterial meningitis
C. Tuberculous meningitis
D. Fungal meningitis
B. Bacterial meningitis
38/F with epilepsy who is homeless has had several breakthrough seizures. She says she “takes the tablets when she can” but often loses them and cannot store them securely. She is frustrated because previous clinicians have repeatedly told her she is “non-compliant”.
What is the most appropriate approach?
A. Increase the dose and discharge her from follow-up
B. Document poor adherence and warn her about the consequences
C. Explore practical barriers and adapt the treatment plan to her circumstances
C. Explore practical barriers and adapt the treatment plan to her circumstances
What is next step for a patient with symptoms of a PE and a Well's score of >4 (ie. PE likely)?
A. Computed tomography pulmonary angio (CTPA)
B. Echocardiogram
C. D-dimer
A. CTPA
Name four examination findings that may be present in HF.
Raised JVP, peripheral oedema, pulmonary crackles, displaced apex beat, tachycardia, hepatomegaly, third heart sound.
The PaCO2 can be useful for grading the severity of an acute asthma attack.
Which is more worrying:
- an acute asthma attack with LOW PaCO2
- an acute asthma attack with NORMAL PaCO2?
A NORMAL PaCO2 in an acute asthma attack indicates respiratory exhaustion and is, therefore, classified as life-threatening.
Most likely diagnosis for a patient with following CSF results:
Slight cloudy, fibrin web appearance
Glucose: low
Protein: elevated
WCC: high (lymphocytes)
A. Viral meningitis
B. Bacterial meningitis
C. Tuberculous meningitis
D. Fungal meningitis
C. Tuberculous meningitis
FY2 prescribes a drug at the request of a senior doctor, but the patient has a documented severe allergy to it. FY2 noticed the allergy but prescribed anyway because “the consultant wanted it”.
Which statement is most accurate?
A. The consultant is solely responsible because they gave the instruction
B. The foundation doctor has no responsibility because they were junior
C. Doctors remain responsible for their own prescribing decisions and should challenge unsafe instructions
C. Doctors remain responsible for their own prescribing decisions and should challenge unsafe instructions
What is next step for a patient with symptoms of a PE and a Well's score of <=4 (ie. PE unlikely)?
A. CTPA
B. Echocardiogram
C. D-dimer
C. D-dimer
Then, if high >> CTPA.
Diagnosis of CHF.
Patient has raised BNP levels, what is the next step to interpret the test?
Echocardiogram (trans-thoracic /-oesophageal)
Which of the following is a feature of life-threatening asthma?
A. PEFR 50–75% predicted
B. Pulse 105 bpm
C. Oxygen saturation 89%
D. Respiratory rate 22/min
C. Oxygen saturation
O2 sat <92% is life-threatening.
Other signs are "moderate".
What medication should be given if meningiococcal disease is suspected in the pre-hospital setting?
IM benzylpenicillin (ceftriaxone often used in hospital)
A patient with severe asthma has received high-dose nebulised salbutamol and oral prednisolone but remains significantly breathless. What additional bronchodilator should be considered?
A. Ipratropium bromide
B. Salmeterol
C. Montelukast
D. Theophylline orally
A. Nebulised ipratropium bromide