MS AKT Paper 1 2023

Question 1

• 60, M
• 6 months dry cough
• Increasing SOB on effort
• Non-smoker
• Temp 36.8
• PR 60 bpm, oxygen sat 89% breathing air
• Finger clubbing
• Chest exam reveals bilateral crepitations

Answer 1

Pulmonary idiopathic fibrosis

Question 2

• 52, M
• 3 days epigastric pain, radiates to back
• No chest pain
• Previously well
• 60 units drink / week, 20 cigarettes / day (1 pack)
• Epigastric tenderness
• Abdomen nto distended
• Bowel sounds present

Which test to confirm most likely diagnosis?

Answer 2

Serum amylase concentration for acute pancreatitis

Question 3

• 24, F
• Diarrhoea
• HIV pos
• Worked in Namibia

Faeces microscopy shows protoza

Causative organism?

Answer 3

Cryptosporidium parvum

Protozean parasite, can cause diarrhoea in immunocompromised patients, found in contaminated water sources in developing countries

Question 4

• 18, F
• 3 years intermittent zig-zagging and flashing lights in both eyes
• Associated with headache
• 2-3 times/month episodes
• Last half an hour
• Associated with nausea and vomiting
• Vision affected at time of episode but returns to normal after

Likely diagnosis?

Answer 4

Migraine (with aura)

Question 5

• 75, M
• 3 days intermittent headaches, blurred vision, vomit
• For past 24 hrs left sided headache, eye pain w/ blurred vision, vomit
• Left eye red, pupil dilated

Which investigation to confirm diagnosis?

Answer 5

Measure intraocular pressure

(Acute angle closure glaucoma, medical emergency, high IC pressure characteristic)

Question 6

• 29, F
• 2 days of marked vision loss
• Acute pain in left eye
• Pain worse when changing gaze direction
• Eyes appear normal on general inspection
• Vision is ‘count fingers only’ in affected eye
• Swinging flashlight test, left pupil dilates when bright light moved from right to left eye
• Optic discs normal on fundoscopy

Likely diagnosis?

Answer 6

Retrobulbar optic neuritis

Relative afferent pupil defect on swinging flashlight test, eye pain, marked vision loss

Question 7

• 35 , M
• Red, painful left eye with no discharge
• Diffuse area of redness in medial aspect of left sclera
• Pupils and visual acuity normal

Answer 7

• Arrange eye clinic assessment
• Scleritis — inflammatory condition of the sclera

Question 8

• F, 22
• Worsening SOB
• Productive cough of 4-5 tablespoons sputum per day
• History of childhood pneumonia
• Recurrent chest infections
• Coughed up blood on two occasions many years ago
• On chest auscultation, bilateral wheezes and coarse inspiratory crackles

Most likely diagnosis?

Answer 8

Bronchiectasis

Permanent dilatation and thickening of bronchi resulting in chronic cough w daily sputum production and recurrent resp infections
Haemoptysis can be a feature