Med Ed SBAs Flashcards
A nervous 16-year-old college student attends the local A&E department with her boyfriend, complaining of an episode of sudden onset right-sided pain in her abdomen. Physical examination of the patient is unremarkable except from a small scar located near the inguinal ligament. What is the most appropriate first line investigation in this case? A. USS of the abdomen B. 𝞫-hCG test C. Full blood count D. CT scan of the abdomen E. No investigations, immediate surgery
B. B-hCG Test
A 85 year old woman is seen in Heart Failure clinic for a review of her long term condition. She is currently taking enalapril and bisoprolol. Which other drug can be added to help control her symptoms?
A. Spironolactone B. Amlodipine C. Salbutamol D. Morphine E. Omeprazole
A. Spironolactone
A 29 year old man presents to the GP with lower back pain and stiffness for the last 3 months. His symptoms are worse in the morning and improve with exercise. He also complains of a painful Achilles tendon when walking. You note that he last attended the practice 1 month ago with a red eye.
What is the most likely diagnosis? A. Spinal stenosis B. Multiple myeloma C. Ankylosing spondylitis D. Reactive arthritis E. Polymyalgia rheumatica
C. Ankylosing Spondylitis
22-year-old woman presents to clinic with a single lump in her right breast. Examination reveals a mobile, firm, smooth and non-tender lump of 2cm in the lower outer quadrant that is not attached to the overlying skin. No axillary lymph nodes are palpable.
The most likely diagnosis is: A. Acute mastitis B. Breast abscess C. Breast cyst D. Fibroadenoma E. Periductal mastitis
D. Fibroadenoma
A 38 year old lady presents with swelling in her leg, and associated calf tenderness. She has been taking the OCP for several years.
What is the best management for this patient? • Warfarin + LMWH • Warfarin • Aspirin • LMWH + Aspirin • LMWH
A. Warfarin + LMWH
Risk factors for developing breast cancer include:
A. Having only one child B. Early menarche C. Early menopause D. Anaemia E. HIV/AIDS
B. Early Menarche
A 56 year old woman presents with pain and stiffness of her hands. This pain is particularly bad at the end of the day. She has occasionally dropped things, and thinks her grip has become worse. She is taking regular over the counter analgesia.
What is the most likely diagnosis? A. Rheumatoid arthritis B. Osteoarthritis C. Reactive arthritis D. Psoriatic arthritis E. Systemic sclerosis
B. Osteoarthritis
A 65 year old gentleman is coming in for screening for a AAA following a letter received in the post. What modality would be used as a screening tool?
A. Abdominal Ultrasound
B. Abdominal CT
C. Abdominal X-ray
D. Doppler Ultrasound
A. Abdo USS
A 22 y/o female presents to her GP with a two year history of intermittent diarrhoea and constipation. She complains of bloating and abdominal pain, which eases with defecation.
Which condition is she likely to have? A. Coeliac disease B. Ulcerative colitis C. Crohn’s disease D. Irritable bowel syndrome E. Infectious diarrhoea
D. IBS
A 52-year-old man was watching TV yesterday when he suddenly become very aware of his heart beating rapidly. This lasted for around 45 mins and then subsided spontaneously. It has happened several times over the past 2 months. An ECG reveals no abnormalities. However, due to the strong suspicion of atrial fibrillation, the patient is placed on a 24-hr tape, which confirms the diagnosis.
Which scoring system should be used to determine the benefit of long-term anticoagulation in this patient?
A QRISK2 score B ABCD2 Score C GRACE score D CHA2DS2-VASc score E CURB-65 score
D. Cha2DS2-Vasc score
A 12-year-old girl presents with dry, itchy skin that involves the flexures in front of her elbows and behind her knees. She has symptoms of hay fever and was diagnosed with egg and milk allergy at 6 months old. Her mother has asthma.
What is the most likely diagnosis? A. Seborrheic dermatitis B. Atopic dermatitis C. Psoriasis (chronic plaque) D. Psoriasis (guttate) E. Urticaria
B. Atopic Dermatitis
A 4-year old girl presents to the GP with multiple lesions on her face. The lesions are raised and shiny, non-tender, non-erythematous, and 3 mm in diameter. They have an umbilicated centre. The patient is known to be HIV positive.
What is the most likely diagnosis? A. Chicken pox B. Molluscum contagiosum C. Atopic eczema D. Eczema herpeticum E. Herpes simplex virus
B. Molluscum Contagiosum
A 74 year old male with a 30 pack year smoking history is admitted to AMU. He has had 2 myocardial infarctions in the last 5 years. On examination he is producing frothy pink sputum, he has bilateral pitting oedema, bibasal crackles and oxygen saturations of 89%.
Which of the following is most likely to be identified by auscultating the chest?
A. Third heart sound B. Carotid bruit C. Ejection systolic murmur D. Pericardial rub E. Fourth heart sound
A. Third Heart Sound
A 60 year old male with known atrial fibrillation presents to A&E with a sudden onset of a painful, cold leg. The doctor is unable to feel peripheral pulses, and upon examination notes a loss of sensation and paralysis. A venous doppler is inaudible.
What is the definitive management? A. Embolectomy B. Watch and wait C. Angioplasty D. Amputation
D. Amputation
A 54-year-old man is complaining of sharp, central chest pain that has arisen over the last 24 hours. On inspection, the patient is sitting forward on the examination couch. On auscultation, a scratching sound is heard – loudest over the lower left sternal edge, when the patient is leaning forward. He has a past medical history of a ST-elevation MI which was diagnosed, and treated with PCI, 6 weeks ago.
What is the most likely diagnosis? A Viral pericarditis B Constrictive pericarditis C Cardiac tamponade D Dressler syndrome E Tietze syndrome
D. Dressler Syndrome
A 35 y/o man presents with a two week history of jaundice and RUQ pain. He is taking mesalazine for a “bowel condition”. What is the most likely cause of his jaundice? A. Autoimmune hepatitis B. Haemochromatosis C. Primary sclerosing cholangitis D. Primary biliary cirrhosis E. Drug side effect
C. Primary Sclerosing Cholangitis
Which of the following statements regarding breast disease is FALSE?
A. Orange peel skin may be a sign of inflammatory breast cancer
B. Ulcerated breast lumps are generally not concerning
C. Alcohol intake is a modifiable risk factor for breast cancer
D. Women ages 50-70 are offered routine screening every 3 years
E. USS are more suitable for women aged <35 years
B. Ulcerated Breast lumps are generally not concerning
A 31 y/o male presents with a history of diarrhoea, weight loss and RIF pain. On examination you note a number of red marks on his shins. After a number of investigations his diagnosis is confirmed.
Which treatment would you start him on?
A. IV corticosteroid B. Oral prednisolone C. Oral mesalazine D. Oral azathioprine E. IV cyclosporin
B. PO Pred
25 yo F presents to A&E with 2d hx of productive cough, SOB and fever. The cough is worse at night. She’s reported having brought up green mucus for the last 2 days. O/E you hear crackles throughout. On further questioning you find out that she’s been diagnosed with cystic fibrosis at birth and has had these symptoms in the past.
What is the first line investigation for this patient? A. Bloods (FBC, CRP) B. CXR C. CT D. Pulmonary function
B. CXR
72 y/o man with cirrhosis presents to A&E with diffuse abdominal pain and fever. He is nauseous and has vomited. His abdomen is distended and there is shifting dullness on examination.
Which investigation would be most urgent? A. Paracentesis B. Stool sample MC&S C. Abdominal USS D. LFTs E. Blood cultures
A. Paracentesis
A 60-year-old man presents to his GP with gradually increasing fatigue and some exertional dyspnoea. Blood pressure is 118/74mmHg and pulse rate is 81/minute. There are no abnormal physical findings and on echocardiography the ejection fraction is 0.47. However, the clinical impression remains one of early heart failure.
Which of the following circulating biomarkers would lend support to that conclusion? A. Atrial natriuretic peptide B. Brain natriuretic peptide C. Endothelin D. Noradrenaline E. Adrenomedullin
B. BNP
A 25 year old female presents to A&E with a 2 day history of pain in right knee. She is an intravenous drug user, with no other significant past medical history.
On examination: Red, hot and swollen right knee with a reduced range of movement. The patient is febrile (38.5 ͦ C).
Blood tests have been sent and the patient is stable.
What is the next most appropriate course of action?
A. Request review by orthopaedic surgeon
B. MRI knee
C. X-ray of the knee
D. Start broad-spectrum IV antibiotics
E. Aspirate the joint effusion
E. Joint Aspiration
A 27 y/o male presents with a history of mucoid, bloody diarrhoea and weight loss. On examination you note a number of red marks on his shins. After a number of investigations his diagnosis is confirmed.
Which treatment would you start him on? A. IV corticosteroid B. Oral prednisolone C. Topical mesalazine D. Oral azathioprine E. IV cyclosporin
After starting treatment, his symptoms improve. Which additional treatment would you start him on to maintain his remission? A. IV corticosteroid B. Oral prednisolone C. Oral mesalazine D. Oral azathioprine E. IV cyclosporin
C. Topical Mesalazine
D. PO Azathioprine
A 35 y/o male presents to his GP following an episode of rectal bleeding. He noticed fresh blood on the toilet paper after wiping. There was no blood mixed in with the stool. He adds that he is very sore ‘down there’ and it is agony to defecate.
Which condition is he likely to have? A. Haemorrhoids B. Anal fissure C. Crohn’s disease D. Ulcerative colitis E. Colorectal carcinoma
B. Anal Fissure
A 76-year-old man is found collapsed in the care home and has a suspected hip fracture. He says that he temporarily lost consciousness as he got up from his arm chair and came about, a matter of seconds later, on the floor. He has never experienced a fall before. He has a past medical history of a total knee replacement and heart failure which is treated with ramipril, furosemide and bisoprolol.
What is the most likely cause of his collapse? A Vasovagal syncope B Medication side-effect C Arrhythmia D Anaemia E Dilated cardiomyopathy
B. Medication Side Effect
A 72-year-old man attends the GP complaining of increased shortness of breath and a cough productive of clear sputum. The GP notes the gentleman has a history of diagnosed COPD and decides to review his medications. The man hands the GP two inhalers, one a SABA and the other a LABA. After conducting spirometry, the GP calculates an FEV1 of 40% expected.
What is the next most appropriate treatment step?
A. Replace the SABA with a LAMA
B. Replace the LABA with an LAMA
C. Add a LAMA
D. Add an ICS
E. I need to conduct more tests to determine what medications to review
A. Replace SABA with LAMA
A 69 year old man with a background of hypertension complained of flank pain all day at work. He then has sudden onset abdominal pain that radiates to his back and groin. He arrives in an ambulance unconscious. The doctor notes Grey Turner’s and Cullen’s signs.
What is the most likely diagnosis? A. Renal colic B. Myocardial Ischaemia C. Ruptured AAA D. Pancreatitis
C. Ruptured AAA
A 54 year old man presents to A&E with severe pain in his left foot. The pain started suddenly 45 minutes ago. He denies any trauma, and has only recently been discharged following treatment for pneumonia.
On examination: Red, hot and swollen metatarsophalangeal joint.
His basic observations are normal.
Bloods: ↑WCC, ↑CRP, uric acid normal
Joint aspiration: Needle-shaped negatively birefringent crystals
What is the most likely diagnosis? A. Gout B. Pseudogout C. Septic arthritis D. Reactive arthritis E. Osteomyelitis
A. Gout
