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REFINALS REVISION SESSION who are we? what we do? disclaimer: Theknowledge and expertise.hored by medical students and junior doctors to the best of their Cardiology Respiratory Gastroenterology Stroke Haematology Renal Endocrine Paediatrics ENT + General Surgery Musculoskeletal Ophthalmology online medical school finals Infections revision series & many more!easy medium hard Become an ambassador of Crash Course Finals! Do you want to build your CV and portfolio? Represent our network and grow yours! Email us with 200 words. about why you’d be a great ambassador and what you’d bring to the role CrashCourseFinalsUK@gmail.comkeep up to date with all our teaching sessionsHouse rules go on mute questions in chat be respectfulROUND: 1 1. A previously healthy 24 year old woman arrives in A&E with shortness of breath, chest tightness and a respiratory wheeze. Salbutamol nebulisers were Given her clinical presentation administered upon arrival. what would be an appropriate differential? Her observations are A Asthma O2= 98% on room air HR = 100 B COPD BP = 120/80 C emphysema D pneumothorax Given her clinical presentation what would be an appropriate differential? A asthma B COPD C emphysema pneumothorax D2. A 45 y/o smoker presents with a persistent Given the likely diagnosis, what is the most appropriate next investigation? cough and dyspnea for the past 4 months. On examination, decreased breath sounds are noted on the right side of the chest. A chest X-ray has been A Pulmonary functions tests (PFTs) performed, showing a well-defined shadow in his right upper lobe. He mentions that over the past few B Sputum culture and sensitivity months his clothes have been very loose fitting on him. C Bronchoscopy D CT scan of the chest Given the likely diagnosis, what is the most appropriate next investigation? Pulmonary functions tests (PFTs) A Sputum culture and sensitivity B C Bronchoscopy D CT scan of the chest3. A 34-year-old woman presents to her Which of the following medications is a known tuberculosis treatment? general practitioner with a persistent cough, fatigue, and unintentional weight loss over the past three months. On further questioning, she A Izoniazid mentions a history of recent travel to a high TB burden country. A chest X-ray reveals B Rifaximin bilateral upper lobe infiltrates. Suspecting C Pyrimethamine pulmonary tuberculosis (TB), the physician decides to initiate treatment. Ethanol D Which of the following medications is a known tuberculosis treatment? A Izoniazid Rifaximin Izoniazid inhibits the pyridoxine-5'- B phosphate enzyme which is necessary to produce vitamin B6 (pyridoxine) C Pyrimethamine Important side effect is peripheral Ethanol neuropathy D Taking pyridoxine alongisde isoniazid can prevent this4. A 55-year-old female patient with a history Which of the following pathogens is most commonly associated with exacerbations of bronchiectasis in of bronchiectasis presents to the clinic with this patient? increased sputum production and dyspnea over the past week. She reports a chronic cough with A Streptococcus pneumoniae purulent sputum production. On examination, coarse crackles are auscultated over the lower lung fields. Chest X-ray reveals dilated and B Haemophilus influenzae thickened bronchi with a "tram-track" Parvovirus B19 appearance. C D Mycobacterium tuberculosisWhich of the following pathogens is most commonly associated with exacerbations of bronchiectasis in this patient? A Streptococcus pneumoniae B Haemophilus influenzae C Parvovirus B19 D Mycobacterium tuberculosis5. During a routine prenatal ultrasound Which of the following interventions examination, a 28 year old primigravida at 28 would be most appropriate to consider weeks gestation is informed that her unborn at this stage? baby is suspected to have neonatal A Emergency c-section surfactant deficiency. B Antenatal corticosteroids Regular fetal monitoring C Advising the mother to increase her D intake of omega-3 fatty acids Neonatal Respiratory Distress Syndrome (NRDS) NRDS usually occurs when the baby’s lungs have not produced enough surfactant, which helps to keep the lungs inflated and prevents them collapsing. This is normally produced between weeks 24 and 28 of pregnancy Which of the following interventions Treatment: antenatal corticosteroids eg dexamethasone would be most appropriate to consider Steroids stimulate surfactant production - Given 1wk to 24hr at this stage? before birth. 2nd dose 24 hours the first. This would also be given with suspected or confirmed preterm labour to aid fetal lung maturity A Emergency c-section B Antenatal corticosteroids C Regular fetal monitoring Advising the mother to increase her D intake of omega-3 fatty acids6. A 65-year-old male presents to the emergency department with increased dyspnoea, cough, and Which of the following is the most appropriate initial increased sputum production over the past 24 management for this patient's COPD exacerbation? hours. He has a PMH of COPD and is a CO2 retainer. On examination, he has increased work of breathing, bilateral wheezing, and prolonged A Antibiotics expiratory phase. He can still speak in full sentences. B IV corticosteroids His oxygen saturation is 88% on room air. C Nebulised salbutamol D Oxygen therapyWhich of the following is the most appropriate initial management for this patient's COPD exacerbation? A Antibiotics B IV corticosteroids C Nebulised salbutamol Oxygen therapy DROUND: 21.A 45-year-old male soldier stationed in an What is the most appropriate antibiotic old, damp army barrack presents with fever, treatment for this patient’s condition? headache, muscle aches, and a non-productive cough. He also reports chest pain and difficulty breathing. On examination, he A Co - amoxiclav appears ill and has a temperature of 39°C. Auscultation reveals crackles in the lower lung fields. A chest X-ray shows patchy B Doxycycline infiltrates in the lower lobes. C Erythromycin Ceftriaxone DWhat is the most appropriate antibiotic treatment for this patient’s condition? A Co - amoxiclav B Doxycycline C Erythromycin Ceftriaxone D2. A 32-year-old tall man experiencing a car accident, arrives at the Emergency Department What is the most appropriate initial after experiencing chest pain and shortness of action? breath following a collision during a match. His oxygen saturations are 87% on air, respiratory Insert a needle at the 5th A rate is 24 breaths/minute, and heart rate is 115 intercostal space mid axillary line beats/minute. B Administer oxygen Insert a needle at the 2nd intercostal C space at the mid clavicular line D Do a chest x-rayWhat is the most appropriate initial action? Insert a needle at the 5th A intercostal space mid axillary line Administer oxygen B Insert a needle at the 2nd C intercostal space at the mid clavicular line D Do a chest x-ray3. A 62-year-old male smoker presents to his primary care physician with a persistent cough and According to NICE guidelines, what would shortness of breath. Imaging reveals a small be the initial approach offered to this solitary pulmonary nodule in the left upper lobe, and patient? subsequent biopsy confirms a minimally invasive A Surgical resection adenocarcinoma of the lung (MIA). A lung MDT have determined this patient is B Chemotherapy otherwise fit for invasive treatment. C Radiation therapy Targeted therapy with D EGFR inhibitorsAccording to NICE guidelines, what would be the initial approach offered to this patient? Surgical resection A Chemotherapy B C Radiation therapy Targeted therapy with EGFR D inhibitors4. You are asked to review a 65 year old female who was admitted with shortness of breath. On examination, the patient appears What does the ABG show? drowsy and is receiving 10L of oxygen via a mask. A Metabolic acidosis An ABG is performed which provides the following results: B Chronic respiratory acidosis PaO2: 7.0 kPa (11-13 kPa) || 52.5 mmHg (82.5 – 97.5 mmHg) Type 1 respiratory failure C pH: 7.29 (7.35 – 7.45) PaCO2: 9.1 kPa (4.7 – 6.0 kPa) || 68.2 Acute respiratory acidosis D mmHg (35.2 – 45 mmHg) HCO3–: 26 (22 – 26 mEq/L) Base excess: +1 (-2 to +2)Resuscitation Guidelines (UK): What does the ABG show? Metabolic acidosis A In this scenario: Ph is 7.29 => Acidotic PaO2 is low despite 10L oxygen => Hypoxic B Chronic respiratory acidosis PaCO2 is raised => Hypercapnic Therefore T2RF C Type 1 respiratory failure BE is normal HCO3 is normal but on the higher end of normal => not D Acute respiratory acidosis compensating yet Therefore this is acute repsiaroty acidosis5. A 25 year old man is admitted to the acute What airway device should be used surgical ward with appendicitis. The decision is made for the patient to undergo an for this patient to protect the lungs from aspiration? appendectomy and he is prepared for theatre. He has not eaten for 24 hours, however he has i-gel (supraglottic airway) A been vomiting on and off all day. B Laryngeal mask airway C Guedel (oral) airway D Endotracheal tubeAirway Management: What airway device should be used for this patient to protect the lungs from aspiration? i-gel (supraglottic airway) A Laryngeal mask airway B C Guedel (oral) airway D Endotracheal tube What would the initial investigation be? 6. A 6-month-old infant presents with recurrent respiratory infections, failure to Genetic testing for CF mutations A thrive, and steatorrhea. Cystic fibrosis is suspected as the most likely diagnosis. B Sweat chloride test C Chest X-ray Complete blood count D (CBC) with differentialsWhat would the initial investigation be? Genetic testing for CF mutations A B Sweat chloride test C Chest X-ray Complete blood count (CBC) D with differentialsround three1.A 61-year-old man, six days post right pneumonectomy, presents with complaints of coughing, dyspnea, and hemoptysis. His vital signs What is the most likely complication include a temperature of 37.2°C, pulse rate of 89 based on the clinical presentation and beats/minute, blood pressure of 130/88 mmHg, imaging findings? saturations of 96% on room air and respiratory rate of 18 breaths/minute. A post-operative chest A Atelectasis x-ray reveals the following findings: B Pneumothorax Broncho-pleural fistula C D Empyema What is the most likely complication based on the clinical presentation and imaging findings? A Atelectasis B Pneumothorax C Broncho-pleural fistula D Empyema Image take from Radiopaedia2. A 72-year-old male presents to the What is the most appropriate next step emergency department with a productive cough, in management according to the CURB- confusion, and a temperature of 38.5°C. His 65 scoring system? oxygen saturation is 88% on room air and a RR Immediate admission to the of 33. Upon further examination, coarse A intensive care unit (ICU) crackles are heard bilaterally. Outpatient management with oral B antibiotics and close follow-up Administration of intravenous C antibiotics and observation in the emergency department Assessment of serum electrolytes and D renal function before deciding on the level of care What is the most appropriate next step in management according to the CURB- 65 scoring system? Immediate admission to the intensive A care unit (ICU) Outpatient management with oral B antibiotics and close follow-up Administration of intravenous antibiotics and observation in the C - 1 C emergency department U - ? R - 1 Assessment of serum electrolytes and B - ? D renal function before deciding on the level of care 65 - 1 Scores 3 on the CURB -653. A 55 year old woman develops acute onset of shortness of breath. PMH: She recently underwent a laparoscopic cholecystectomy 9 What medication should be given to this days previously. Her temperature is 37.4C, patient? HR 126 bpm, BP 85/60, RR 25 breaths per minute and oxygen saturation 94% breathing A apixaban air. Her chest is clear on auscultation. A CTPA confirms a large pulmonary embolism B rivaroxaban and the chief consultant believes active treatment should be initiated. C alteplase dalteparin D Normally a DOAC is used for management of a PE However... PE + hypotension => thrombolysis (alteplase) Which medication should be given to this patient? A apixaban B rivaroxaban C alteplase D dalteparin4. A 30 y/o female complains of fatigue in the past few months. She also reports experiencing intermittent joint pain and What is the most likely diagnosis for this patient? swelling in her ankles. On examination, circular skin lesions are noted on both knees. Additionally, bilateral hilar lymphadenopathy is Sjogren’s Syndrome A observed on chest X- ray. Rheumatoid arthritis B C Systemic Lupus erythematosus (SLE) D SarcoiodosisWhat is the most likely diagnosis for this patient? Sjogren’s Syndrome A B Rheumatoid arthritis Systemic Lupus erythematosus (SLE) C D Sarcoidosis Which of the following interventions 5. A 42-year-old male presents to the should be prioritized in the initial management of this patient? emergency department with severe asthma exacerbation. On examination, he is in Administering a high dose of inhaled A corticosteroids tachypneic, with audible wheezing and difficulty speaking in full sentences. His peak expiratory B Administering a short-acting beta agonist flow rate (PEFR) is measured at 35% of (SABA) via nebulizer predicted. Initiating continuous nebulized C ipratropium bromide therapy Administering intravenous D aminophyllineAsthma Exacerbation Management Which of the following interventions should be prioritized in the initial management of this patient? Administering a high dose of inhaled A corticosteroids Administering a short-acting beta B agonist (SABA) via nebulizer Initiating continuous nebulized C ipratropium bromide therapy Administering intravenous D aminophylline 6. A 22 year old woman presents to the GP with a productive cough ongoing for the past four What is the most likely diagnosis? days. Her temperature is recorded as 38.1C, HR 90 bpm and BP 118/78. She has a PMH of recurrent chest infections and also is currently A Asthma seeing a fertility doctor as she is struggling with conceiving a child. B Cystic fibrosis C Kartagener syndrome D Bronchiectasis Kartagener's Syndrome: also known as primary ciliary dyskinesia (PCD) => a rare, autosomal recessive genetic ciliary disorder What is the most likely diagnosis? Triad: situs inversus, chronic sinusitis, and bronchiectasis A Asthma B Cystic fibrosis C Kartagener syndrome D Bronchiectasis Thank you very much for listening! Note: Certificates will be received once feedback is completed General surgery & next session peri-operative care Tuesday 5th March 7-8pm