Handbook Flashcards
“2.099 a 25 year old woman presents with a progressive deafness over the past few months. she’s currently pregnant with her first child at 6 months of gestation And her antenatal progress has thus far been normal. She has had some associated tinnitus of mild degree. she has noted that she can hear better in noisy surroundings. her mother also has a history of deafness Period which one of the following is the most likely cause of her deafness?
A acoustic neuroma B vestibular neuronitis C meniere's disease D otosclerosis E Cholesteatoma "
D
“3.003 a 60 year old woman presents with a pigmented skin lesion on her leg as shown which has grown in size over three months and has occasionally blood when she scratched it arranged excision which confirmed the diagnosis of a 0.3 mm thickness Malignant melanoma on histology In discussing progosis with a patient which one of the following features is the most important prognostic indicator?
A Site of the lesion on the body B width of the lesion C color of the Lesion D thickness of the lesion E history of bleeding "
D
“3.0 06 a 45 year old woman presents with a history of multiple subcutaneous lumps. she has noted them for many years; they do not bother her but are occasionally painful. On examination she has multiple discrete focal lumps beneath the skin surface of various sizes up to 3 cm in diameter which are soft and lobulated some are mildly tender. she has about 20 which are situated bilaterally In the upper and lower limbs and on the trunk. there are no associated skin lesions and she has been otherwise in good general health. she can remember her mother having had some similar lumps removed. which of the following is the most likely diagnosis?
A neurofibromatosis type 1 Von recklinghausen disease of the nerve
B Adiposis dolorosa dercum disease
C multiple symmetrical subcutaneous lipomas
D multiple desmoid tumors
E multiple Epidermoid cysts
“
C
“3.011 the accompanying illustration is a technetium isotopes scan of the thyroid patient in her twenties. the patient most likely presented which of the following symptoms?
A Pathological fracture b lump in the neck c weight loss and Tremor D pain in the neck E dry coarse skin
”
B
"3.016 A 45 year old man presents with a slowly enlarging neck lump. The lump in the posterior triangle lymph nodes of the neck in the mid neck area has had a percutaneous biopsy and histological report Is metastatic squamous cell carcinoma in a lymph node which one of the following would be the most likely primary site if there were no obvious skin lesions present? A buccal cavity B Tonsillar Fossa C larynx d thyroid "
d
“3.031 in establishing the diagnosis of brain death and a patient admitted to hospital , comatose after a massive stroke which one of the following is the most important diagnostic clinical feature?
A Irreversible apnea
B fixed dilated pupils unresponsive to light
c glasgow coma scale score of 3
d complete absence of response To painful stimuli
E Absence of activity on electroencephalography
”
a
“3.041 a 40 year old electrician complains of tremor while working. he has noticed over the past three months since he suffered an electric shock which was not associated with loss of consciousness or any evidence of injury. on examination He has no tremor at rest but has a fine tremor of his outstretched hands. Neurological examination is otherwise normal. His resting pulse rate is at 80/minute. Which of the following is most likely cause of his problem?
A Chronic anxiety B hyperthyroidism C parkinson disease D benign essential tremor E neurodegenerative reaction to electric shock "
d
“3.041 a 40 year old electrician complains of tremor while working. he has noticed over the past three months since he suffered an electric shock which was not associated with loss of consciousness or any evidence of injury. on examination He has no tremor at rest but has a fine tremor of his outstretched hands. Neurological examination is otherwise normal. His resting pulse rate is at 80/minute. Which of the following is most likely cause of his problem?
A Chronic anxiety B hyperthyroidism C parkinson disease D benign essential tremor E neurodegenerative reaction to electric shock "
D
“3.0 45 an 83 year old woman was admitted to hospital 36 hours ago following a fall causing a fractured neck of femur. She has been living alone at home since the death of her husband 12 months ago and was independent in self care. on examination she is now disoriented in time place and person. she is agitated. an adequate history is unobtainable. physical examination shows the clinical features of an Intracapsular femoral neck fracture, confirmed on x-ray, and is otherwise non-contributory. investigations for acute brain syndrome are as follows
chest x-ray and ct scan of the brain are normal urea and electrolytes are normal Urine microscopy is normal full blood examination shows hemoglobin 129 g/L ( 115 - 165) mcv 105 fl ( 80- 100) platelets 80 x 10 ^9 (150-400) Liver function tests are normal except elevated alt and ggt
which of the following is the most likely cause of her acute delirium A fat embolism B alcohol withdrawal C b12 deficiency D Hypothyroidism E cirrhosis of liver "
B
"3.0 87 one week after an oesophagectomy for carcinoma of the cardia Comma a 73 year old man complains of constant left-sided chest pain. on examination the patient looks unwel, with the temperature of 38.5 degrees celsius. bp of 110/70 mmHg, and a pulse 130/min which is irregular. there is Dullness to the left chest base. the abdomen is soft and nontender. which of the following is the most likely cause of the problem? A pulmonary embolus B pneumonia C anastomotic leak D subphrenic abscess E myocardial infarction "
c
”
3.09 8 a 66 year old man presents with intermittent right upper quadrant pain. an ultrasound undertaken looking for gallstones reveals a lesion in the liver. triple phase ct is performed to more clearly define the lesion. This shows a 35 mm subcortical lesion with early prominent dense enhancement which spreads through Solution in the late portal venous phase. which of the following conditions would best fit this description?
A isolated metastatic deposit B hemangioma C hepatocellular carcinoma D liver cyst E hydatid cyst
”
B
“3.104 you are about to perform a femoral venipuncture. You should be aware that the structures in the groin under the england al ligament from medial to lateral are
A lacunar ligament, femoral artery, Femoral vein, femoral nerve
B lacunar ligament, Femoral vein, femoral artery, femoral nerve
C lacunar ligament, femoral vein, femoral nerve, femoral artery
D femoral vein, femoral artery, femoral nerve, lacunar ligament
E Lacunar ligament femoral vein femoral nerve femoral artery
“
B
“3.1 12 an otherwise fit 57 year old woman spikes a temperature of 39 degrees celsius 5 days after an appendectomy for acute appendicitis. there is a tender, Reddened and fluctuant swelling at the medial end Of the wound. which of the following would be the most appropriate next step in management?
A administer High dose broad spectrum intravenous antibiotics
B return the patient to theatre for resuturing of the wound
C place the patient on oral antibiotics
D make an incision over the swelling to allow free drainage
E remove the underlying suture material to prevent sinus formation
“
D
“3.125 A 50 year old woman presents with a history of nipple inversion in the left breast developing over a three month period. she is postmenopausal and has no previous family of breast problems.
on examination left nipple is retracted and inverted. A 1.5 cm firm lump Is palpable beneath and attached to the nipple and areola at 2 o’clock. the right breast is normal and the lymph node areas of axillae and neck are clear. mammogram and ultrasound confirm the presence of a stellate lesion consistent with the clinical findings In the left breast.
percutaneous biopsy Is done and reported as showing an invasive ductal carcinoma of medium histologic grade without evidence of lymphatic or vascular invasion. chest xray is clear. estrogen and progesterone receptor status of the tumor is positive. which of the following is the most appropriate initial management of the breast lesion?
A total mastectomy B partial mastectomy C Radiation therapy D tamoxifen E aromatase inhibitor "
B
“3.131 A 68 year old woman has had type 2 diabetes mellitus for 15 years and presents for a routine quarterly review. she has hypertension ischemic heart disease congestive failure Renal impairment proliferative retinopathy and peripheral neuropathy. Her diabetic control was good until the past 12 months. she walks 1 km 3 times per week
her current drug therapy is gliclazide pravastatin, lisinopril, metoprolol, aspirin and a GTN patch. Her BMI is 32. Bp is 142/ 78 mmhg. there is + + proteinuria on dipstick analysis. hba1c is 11%. creatinine is 0.20 mmol/L. Which one of the following is the most appropriate next step in therapy
A commence insulin B commence metformin C Commence rosiglitazone D Advice increase in exercise "
A
“3.134 a 40 year old woman presents with a painless swelling in the neck present for 3 months. on examination there’s a 4cm swelling in the lower pole of the left lobe of the thyroid. on ultrasound and no tool is mainly cystic but with some solid areas. the t4 level is 20pmol/L (10-25). which one of the following is the most appropriate next step in management?
A repeat ultrasound examination in 6 months
B. fine needle aspiration cytology Of the nodule under ultrasound
C. Mri of the neck
D. core biopsy of the thyroid nodule under stereotactic xray control
E thyroid lobectomy and frozen section diagnosis
“
B
“3.139 a 50 year old woman complains of a lack of energy tiredness and constipation over several months. on examination She has a pallid complexion and a pulse rate of 56/ min.
on investigation the blood film shows a macrocytic anemia (Hb 100g/L) with mild lymphocytosis which one of the following is the most likely diagnosis?
A Pernicious anemia B carcinoma of the Bowel C alcoholism and malnutrition D primary hypothyroidism E Chronic lymphocytic leukemia"
d
“3.143 85 year old woman, who recently returned from a holiday overseas, presents with Transient blurring of vision 30 minutes ago, which has now completely resolved. she looks well and is a febrile. ophthalmological and neurological examination are within normal limits. her bp is 150/80, pr 78 and regular. her spleen is palpable 5 cm below the costal margin. she has been a smoker 20 cigarettes per day for the past 30 years. she is on a thiazide diuretic for hypertension. Full blood examination shows
Hgb 180/L (115-165)
WBC 14
RBC 8
Platelets 800
The smear shows A normal leukocyte differential pattern Which of the following is the most likely diagnosis? A Plasmodium falciparum malaria B chronic myeloid leukemia C secondary polycythemia D polycythemia rubra vera E Myelofibrosis "
d
“3.147 a 24 year old male presents to the emergency department complaining of persisting and severe abdominal pain Radiating from the loin to the groin. on clinical examination there is no tenderness over the site of the pain and no other positive findings. a specimen of urine which he has brought in is obviously blood-stained. he requests an injection of pethidine for relief of pain. which one of the following is the most appropriate next step in management?
A arrange a plane film and computed tomograph as soon as possible
B Examine a freshly voided specimen of urine
C Prescribe pethidine hnbb tablets and review the next day
D administer 100 mg pethidine IM and review in 4 hours
E Arrange admission to hospital for investigation
“
B
“3.148 A 64 year old man with a 3 months history of increasing frequency nocturia and dysuria undergoes a cystoscopy. instrumentation is difficult. 6 hours after the procedure he has a rigor and develops a temperature of 40 degrees celsius. which one of the following is the most likely explanation for this complication?
A. acute pyelonephritis B. Rupture of the bladder C. Gram negative bacteremia D. rupture of the prostatic urethra E. rupture of the membranous urethra "
C
