PAST QA Flashcards
A 27 year old woman has a long history of irregular menstruation. She does not take any medication. Her BMI is 29.4 kg/m2. Investigations: LH (pre-menopausal female) 15 U/L (follicular) (1–11) FSH 6 U/L (follicular) (2–8) Testosterone 3.5 nmol/L (0.2–2.9) Cortisol post 1 mg dexamethasone 40 nmol/L (<50) Prolactin 425 U/L (100–500) Which is the most likely diagnosis? A. Androgen secreting tumour B. Cushing's syndrome C. Polycystic ovary syndrome D. Premature ovarian failure E. Prolactinoma
Correct Answer: C
Justification for correct answer
The increased ratio of LH:FSH along with oligomenorrhoea and BMI in the overweight
range indicates PCOS is most likely. A mild elevation in prolactin is sometimes seen in
PCOS.
. A 30 year old lawyer is functioning well at work but avoids all social events.
She has developed a fear of eating in front of others and is very anxious
about blushing when talking to others. She finally gets the courage to seek
help from her GP.
Which is the most appropriate treatment?
A. Counselling
B. Cognitive Behavioural Therapy
C. Motivational Interviewing
D. Psychoanalysis
E. Psychodynamic Psychotherapy
B. Cognitive Behavioural Therapy
A 32 year old woman is 39 weeks pregnant and twisted her ankle.
Which of the following analgesic medications would you prescribe for her?
A. Diclofenac
B. Ibuprofen
C. Morphine
D. Paracetamol
E. Tramadol
D. Paracetamol
A 32 year old pregnant patient comes to her GP for an influenza vaccine.
She has had a recent exacerbation of her asthma, and she has a past
medical history of valvular heart disease.
Which one of the following is a contraindication to her having the vaccine?
A. Pregnancy
B. Previous allergic reaction after a flu vaccination
C. Severe cow’s milk protein allergy
D. Taking prednisolone for a current exacerbation of asthma
E. Warfarin therapy with an INR above target range
B. Previous allergic reaction after a flu vaccination
A 32 year old pregnant patient comes to her GP for an influenza vaccine.
She has had a recent exacerbation of her asthma, and she has a past
medical history of valvular heart disease.
Which one of the following is a contraindication to her having the vaccine?
A. Pregnancy
B. Previous allergic reaction after a flu vaccination
C. Severe cow’s milk protein allergy
D. Taking prednisolone for a current exacerbation of asthma
E. Warfarin therapy with an INR above target range
B. Previous allergic reaction after a flu vaccination
A 25 year old man presents to the Emergency Department after vomiting a
large quantity of blood.
At endoscopy, a deep ulcer is identified in the posterior wall at the junction of
the first and second parts of the duodenum. There is a bleeding vessel in the
base.
From which artery is the bleeding most likely to be arising?
A. Gastroduodenal artery
B. Left gastric artery
C. Short gastric artery
D. Splenic artery
E. Superior mesenteric artery
Correct Answer: A
Justification for correct answer
The gastroduodenal artery runs posterior to the first and second parts of the duodenum
and may be a source of major haemorrhage in peptic ulcer disease.
A 25 year old man presents to the Emergency Department after vomiting a
large quantity of blood.
At endoscopy, a deep ulcer is identified in the posterior wall at the junction of
the first and second parts of the duodenum. There is a bleeding vessel in the
base.
From which artery is the bleeding most likely to be arising?
A. Gastroduodenal artery
B. Left gastric artery
C. Short gastric artery
D. Splenic artery
E. Superior mesenteric artery
Correct Answer: A
Justification for correct answer
The gastroduodenal artery runs posterior to the first and second parts of the duodenum
and may be a source of major haemorrhage in peptic ulcer disease.
A 34 year old woman has headaches for 3 months. Her mother developed hypertension at the age of 38 years. Her BP is 180/92 mmHg. Otherwise, examination, including fundoscopy, is normal. Investigations: Sodium 136 mmol/L (135–146) Potassium 3.3 mmol/L (3.5–5.3) Chloride 97 mmol/L (95–106) Urea 4.0 mmol/L (2.5–7.8) Creatinine 94 µmol/L (60–120) Plasma aldosterone:renin ratio 50 (<25) Cortisol (9am) 307 nmol/L (200–700) Urinalysis is normal. Which is the most likely diagnosis? A. Essential hypertension B. Glucocorticoid excess C. Phaeochromocytoma D. Primary hyperaldosteronism E. Primary hypoadrenalism
Correct Answer: D
Justification for correct answer
FHx of hypertension and biochemistry suggest mineralcorticod excess. High PRA ratio.
A 26 year old woman has 12 months of back pain, located in the low
lumbosacral region. She has intermittent bilateral thigh pain. The back pain
disturbs her sleep. The pain is improved by activity but not relieved by resting.
She finds it difficult to bend down during the day to pick things up from the
floor.
Which clinical feature is most specific for inflammatory back pain?
A. Improvement with activity
B. Nocturnal pain
C. Radiation to leg
D. Stiffness during the day
E. Young age
Correct Answer: A
Justification for correct answer
Inflammatory back pain (IBP) is typically improved with activity and not relieved by rest,
as opposed to mechanical pain which is worse with activity and is relieved by rest. IBP
can wake the patient in the early hours of the morning and sacroilieitis can radiate to the
thigh, but these features are much less specific. Morning stiffness is specific for
inflammatory back pain but not persistent daytime stiffness. IBP can occur at any age
although mechanical pain is less common in young people.
A researcher is seeking to examine whether long-term mobile phone use is
linked to acoustic neuroma risk. The information on mobile phone usage is
collected from participants with acoustic neuroma and a comparable group of
participants without acoustic neuroma, selected from the general practice
register.
Which type of study design is being used?
A. Case–control study
B. Case series
C. Cohort study
D. Cross-sectional study
E. Ecological study
A. Case–control study
A 61 year old woman is admitted with 2 days of confusion. She has a history
of hypertension and takes nifedipine. She smokes 20 cigarettes per day. She
is confused but has no focal neurological deficit. Her pulse rate is 75 bpm, BP
139/87 mmHg and JVP 2 cm above the sternal angle.
Investigations:
Sodium 117 mmol/L (135–146)
Potassium 4.2 mmol/L (3.5–5.3)
Urea 1.9 mmol/L (2.5–7.8)
Creatinine 57 μmol/L (60–120)
Serum osmolality 252 mOsmol/kg (285–295)
Urine osmolality 585 mOsmol/kg (100–1000)
Which mechanism best explains the development of hyponatraemia?
A. Increased sodium secretion in the distal tubule
B. Increased water absorption in the collecting duct
C. Increased water ingestion
D. Reduced cortisol secretion
E. Reduced sodium reabsorption in the proximal tubule
Correct Answer: B
Justification for correct answer
The picture is of syndrome of inappropriate ADH secretion with hyponatraemia and
inappropriately concentrated urine. ADH stimulates synthesis of aquaporin-2 in the apical
membrane of the collecting duct which promotes water absorption. This leads to a
dilutional hyponatraemia
