Qs

Question 1

Symptoms: Chest pain when eating, sweaty, pain is severe. Smoker. Clean history. No ECG available.
Best next step?

Answer 1

Refer to emergency department

Question 2

Symptoms: anal pain + itch. 9/10 severity. Blood on stools.

Next step?

Answer 2

Physical examination

Question 3

Symptoms: dark urine, abdominal pain, non-specific joint pain sore throat, headache.
Urine dip stick= microscopic haematuria + proteinuria
What investigation do we want?

Answer 3

Renal biopsy

Question 4

Contradiction to having a contraceptive coil fitted?

Answer 4

Smoking

Question 5

Knee locked, unable to fully straighten, difficulty with stairs
Diagnosis?

Answer 5

McMurray’s

Question 6

Symptoms: Itch, maculopapular rash on trunk, no discharge, bloating, loose stools, constipation
Diagnostic test?

Answer 6

LFTs

Question 7

Symptoms: fever, malaise, sore throat, scant yellow exudates, pharyngeal erythema, enlarged posterior cervical lymph nodes, no airway obstruction, no diffuse skin rashes.
Mono spot test positive
What physical finding can we expect in patients with this condition?

Answer 7

Splenomegaly

Question 8

72 y/o shortness of breath, palpitations, fainted pushing lawnmower. Slow raising pulse apex with mid-systolic murmur. BP= 101/50 mmHg.
Likely diagnosis?

Answer 8

Aortic stenosis

Question 9

45 y/o, cough, sore throat, headache, nasal congestion, sneezing. Cough= productive and purulent. Lung exam= rhonchi- no signs of consolidation. Afebrile, eats at desk, smokes, drinks alcohol.
Causative risk factor?

Answer 9

Smoking

Question 10

38 y/o, elective cholecystectomy due to gallstones, right sided thyroid module, 2 year history of hypertension, recurrent urinary tract stones.
Biomarker measured?

Answer 10

calcitonin

Question 11

30 y/o, painful right eye, watery red, redness around sclera and cornea, pupil=irregular, fluorescein staining= no abnormalities
Diagnosis? 
Corneal abrasion
dendritic ulcer
anterior uveitis
acute conjunctivitis

Answer 11

anterior uveitis

Question 12

55 y/o, dyspnoea, chest pain, productive cough, smoking= high, 20 units of alcohol per day. No haemoptysis, sore throat, weight loss, night sweats.
Temp= 38c
pulse= 98bpm
BP= 110/85mmHg
resp rate= 16 breaths per min
oxygen sat= 95% in air
What is the organism responsible?
Haemophilus
Influenzae
Pneumocystis jirovecii
Klebsiella pneumonia

Answer 12

Klebsiella pneumonia

Question 13

56 y/o, 4 week history of higher urinary frequency and urgency throughout the day. Wait longer and strain before peeing. Frequency at night = problem. He is apyrexial, pulse= normal, bp=normal, no meds.

Appropriate management?
metronidazadole TURP
Tamsulosin
Catheterization
Desmopressin

Answer 13

Tamsulosin

Question 14

23 y/o, emergency department, abdomen pain felt on walking, collapsed while eating, no med history.
Pulse= 120bpm, weak, thready
BP= 80/50mmHg
sweating heavily, tender to palpitation of lower abdominal
Appropriate management?
Emergency laparotomy
Prescribe inotropes
serum bHGG
Transvaginal ultrasound
abdo ultrasound

Answer 14

Emergency laparotomy

Question 15

52 y/o pituitary tumour involving cavernous sinus. Suspect abducens nerve of patient= damaged by tumour. Which direction would you have patient turn right eye to confirm defect?
Downward
Upward
Outward
Inward

Answer 15

Outward

Question 16

26 y/o, detained in police, abdominal cramps, aching muscles, nausea, vomitting, agitated shivering, shaking hands. 
Cause of symptoms?
Alcohol withdrawal
Opiate withdrawal
Benzodiazepine withdrawal
delirium tremens
LSD withdrawal

Answer 16

Opiate withdrawal

Question 17

6 months old, excoriations + lichenified plaques on extensor aspect of arms and legs, family history of asthma, itchy dry skin.
Likely diagnosis?
Contact dermatitis
Psoriasis
Scabies
Atopic eczema
seborrheic dermatitis

Answer 17

Atopic eczema

Question 18

40 y/o, non-productive cough, 6 months no dyspnoea/ chest pain, stable weight, good appetite, non-smoker, has hypertension and diabetes mellitus
Chest exam= SO2= 98% on air
respiratory rate= 19
chest auscultation and cardiac exam= normal
X-ray= normal
medication responsible for cough?
Amlodipine 
Doxazocin
gliclazide
ramipril
valsartan

Answer 18

ramipril

Question 19

CHA2DS2-VASc score high or low risk? Score- calculate and should there be recommended to commence on oral anticoagulation for store prevention?

Answer 19

-

Question 20

30 month old boy, echoes words, no speech, no interaction, likes spinnings objects, flaps hands when excited/ agitated
Diagnosis?
Isolated speech delay
language disorder
Autism spectrum disorder

Answer 20

Autism spectrum disorder

Question 21

50 y/o, chronic alcohol excess admitted with alcohol withdrawal and seizures. Clubbed fingernails, palmer erythema, gynaeomastria. Clinically jaundices, abdominal exam = no ascites / hepatomegaly with mild splenomegaly
What clinical signs most likely to predict poor outcome?
finger clubbing
gynaecomastia
non-palpable liver splenomegaly
Palmer erythma

Answer 21

splenomegaly