Free MLA Sample Questions

Sample Questions

Sample Questions

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1. A 25 year old woman is admitted to the Acute Medical Unit with malaise, sore throat and intermittent fever for 5 days. She has missed her last 3 meals due to severe pain whilst swallowing. She has type 1 diabetes mellitus. She takes insulin glargine (Lantus ^®) 14 units at night and human soluble insulin (Actrapid ^®) 4 units before meals.
Her pulse rate is 98 bpm, BP 110/71 mmHg, respiratory rate 17 breaths per minute and oxygen saturation 96% breathing air. She has bilaterally enlarged, erythematous tonsils with patchy white exudate. Her uvula is central.
Investigations:
Blood capillary glucose 18 mmol/L
Blood capillary ketones 0.5 mmol/L (<0.6)
Venous pH 7.37 (7.35–7.45)
She is treated with intravenous fluids and antibiotics.

What is the most appropriate management with regard to her insulin therapy?

A
Continue current basal-bolus insulin therapy at a lower dose

Exclude

B
Reassure and increase frequency of blood ketone monitoring

Exclude

C
Stop short-acting insulin and switch to fixed rate insulin infusion

Exclude

D
Stop short-acting insulin and switch to variable rate insulin infusion

Exclude

E
Temporarily suspend all insulin therapy until oral intake resumes

Exclude

2. A 4 month old boy, born at term, has 2 days of irritability and increasingly frequent wet nappies with foul-smelling urine. He has previously been well and had no complications during delivery.
Investigations:
Urea 2.9 mmol/L (1.0–5.5)
Creatinine 27 µmol/L (14–34)
Urine culture: Escherichia coli >10⁵ CFU/mL
He is started on antibiotics and makes a complete recovery within 48 hours.

What is the most appropriate additional investigation?

A
Dimercaptosuccinic acid scintigraphy scan in 4 to 6 months

Exclude

B
Micturating cystourethrogram within 2 weeks

Exclude

C
No additional investigation needed

Exclude

D
Repeat urine microscopy and culture in 48 hours

Exclude

E
Urinary tract ultrasound scan within 6 weeks

Exclude

3. A 48 year old woman has 2 days of vomiting and diarrhoea. She was previously fit and well.
Her temperature is 36.6°C, pulse rate 90 bpm and BP 110/67 mmHg. Her blood capillary
glucose is 5.8 mmol/L. She has sunken eyes and reduced skin turgor. Her JVP is not visible.
Investigations:
Sodium 148 mmol/L (135–146)
Potassium 5.8 mmol/L (3.5–5.3)
Urea 14.1 mmol/L (2.5–7.8)
Creatinine 140 µmol/L (60–120) (baseline 90 µmol/L)
ECG shows sinus rhythm.

What is the most appropriate management for her hyperkalaemia?

A
Insulin and 10% dextrose infusion

Exclude

B
Intravenous 0.9% sodium chloride

Exclude

C
Intravenous 10% calcium gluconate

Exclude

D
Nebulised salbutamol

Exclude

E
Oral sodium zirconium cyclosilicate

Exclude

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