SBAs and explanations 2 Flashcards
A 31-year-old man presents to his GP with a 2-day history of central chest pain, which gets worse when he breathes in and when exercising. Cardiovascular and respiratory examinations detect no abnormalities, however, the patient winces in pain when the GP palpates for heaves and thrills. What is the most likely diagnosis?
A Pulmonary embolism B Myocarditis C Tension pneumothorax D Costochondritis E Pleurisy
Costochondritis.
Which of the following is unlikely to cause pleuritic chest pain?
A Tension pneumothorax B Rib fracture C Pulmonary fibrosis D Pneumonia E Pericarditis
Pulmonary fibrosis.
A 28-year-old PhD student books an appointment to see her GP about some small lumps on her groin. On closer inspection, there are multiple small, firm, dome- shaped lumps with an umbilicated centre. On direct questioning, she reveals that she has recently had a new sexual partner. What is the most likely diagnosis?
A Molluscum contagiosum B Varicella zoster C Syphilis D Gonorrhoea E Sebaceous cysts
Molloscum contagiosum.
A 71-year-old woman presents to A&E with a headache that has gradually been getting worse over the past week. The pain is localised over the left half of her forehead and does not radiate. She has also been eating less frequently as her jaw becomes painful when she chews her food. On direct questioning, she admits to experiencing some stiffness and pain in her shoulders over the past 6 months. On examination, she has a thickened, non-pulsatile temporal artery. What is the first step in her management?
A Check ESR B Temporal artery biopsy C IV hydrocortisone D Oral prednisolone E IV antibiotics.
Oral prednisolone.
A 24-year-old female, who has recently returned from a 3-week trip to Vietnam, complains that she has been feeling ‘under the weather’ with fevers and joint pain. On direct questioning, she reveals that she had unprotected sexual intercourse with a stranger whilst in Vietnam. She is jaundiced and has right upper quadrant tenderness. Hepatitis B serology is requested. The results are shown below:
HBsAg +
HBeAg -
HBcAb IgM +
HBcAb IgG +
HBsAb -
What is the hepatitis status of this patient?
A Acute infection B Chronic infection C Cleared D Vaccinated E Susceptible
Acute infection.
An 18-year-old female is brought to A&E, by ambulance, having been involved in a road traffic accident. She has bled significantly and needs an urgent blood transfusion. Her blood group is AB+. Which of the following blood groups will she be
able to accept?
A A+ B AB- C B- D O- E All of the above
All of the above.
Which clinical test can be used to diagnose ankylosing spondylitis?
A Schober's test B Schirmir's test C Buerger's test D W eber's test E Tensilon test
Schober’s test.
A 53-year-old Afro-Caribbean man visits the GP to have his blood pressure measured. He has a history of hypertension and has been taking Amlodipine for 6 months. His blood pressure is 162/110 mm Hg. The GP is not satisfied with his blood pressure control and wants to step up his management. Which medication should be added?
A Verapamil
B Spironolactone
C Bendroflumethiazide D Doxazosin
E Enalapril
Enalapril.
An 81-year-old man has been urinating about 12 times every day, including at night, and has difficulty starting a stream, which he describes as being ‘very weak’. He has also suffered from lower back pain over the past month. A DRE is performed, revealing an asymmetrically enlarged, nodular prostate gland. Which investigation is most likely to provide a definitive diagnosis?
A PSA B Acid phosphatase C Transrectal ultrasound-guided biopsy D CT Scan E Isotope bone scan
Transrectal ultrasound guided biopsy.
A 61-year-old man is brought to A&E by his daughter as he has become increasingly breathless over the past 24 hours and he has been coughing up a large amount of green sputum. He has a past medical history of COPD. Arterial blood gases are requested which show the following results (on room air):
pH : 7.33 (7.35-7.45)
PaO2 : 6.7 kPa (> 10.6 kPa on air)
PaCO2 : 9.6 kPa (4.7 - 6 kPa on air) HCO3- : 33 mmol/L (22 – 28 mmol/L) Respiratory Rate : 22 /min
What is the diagnosis?
A Partially compensated respiratory acidosis
B Fully compensated respiratory acidosis
C Partially compensated metabolic acidosis
D Fully compensated metabolic acidosis
E Acute type 1 respiratory failure
Partially compensated respiratory acidosis.
A 73-year-old man has come to the outpatient clinic with his wife. She says that her husband seems very confused on some days and then seems completely normal on others. During the consultation, the patient appears confused with an AMTS of 4/10. He is distressed and claims that he can see little men running across the desk towards him. The doctor also notices a resting tremor. What is the most likely diagnosis?
A Lewy body dementia B Alzheimer’s disease C Depressive pseudodementia D Frontotemporal dementia E Vascular dementia
Lewy body dementia.
Which of the following is part of the diagnostic criteria for diabetes mellitus?
A Two fasting blood glucose > 7.8 mmol/L in an asymptomatic patient
B One fasting blood glucose > 11.1 mmol/L in an asymptomatic patient
C One random blood glucose > 11.1 mmol/L in a symptomatic patient
D Two random blood glucose > 7 mmol/L in an asymptomatic patient
E Glycosuria and ketonuria on urine dipstick
One random blood glucose > 11.1 mmol/L in a symptomatic patient.
The red reflex is an important part of the ophthalmological examination. Which
of the following conditions can result in loss of the red reflex?
A Herpes simplex keratitis B Cataract C Astigmatism D Conjunctivitis E Aniridia
Cataract.
A 32-year-old man presents to his GP with an 8-month history of diffuse abdominal pain and frequent loose motions. He has also been passing blood with his stools. On examination, a red ring around the cornea is seen in both eyes. The patient is referred for a colonoscopy and biopsy. What would you expect the biopsy to show?
A Non-caseating granulomas
B Eosinophilic infiltration
C Villous atrophy and crypt hyperplasia
D High grade dysplasia and metaplastic columnar epithelium
E Mucosal ulcers, goblet cell depletion and crypt abscesses
Mucosal ulcers, goblet cell depletion and crypt abscesses.
A 28-year-old professional cyclist visits his GP complaining of headaches and blurred vision. He is worried that his symptoms will affect his performance in an important race in 3 weeks’ time. On direct questioning, he admits to taking ‘performance enhancers’ in preparation for his race. On examination, scratch marks are seen on his trunk. What is the most likely diagnosis?
A Thalassaemia B Polycythaemia rubra vera C Secondary polycythaemia D Hodgkin’s lymphoma E Non-Hodgkin’s lymphoma
Secondary polycythaemia.
A 22-year-old teacher visits her GP after fainting several times over the past 2 months. She does not experience any palpitations, light-headedness or auras before she faints, and she recovers very quickly. She has not bitten her tongue or become incontinent at any point. When questioned about the timing of these episodes, she reveals that she has only ever collapsed at work after she has been writing on the whiteboard for quite some time. On examination, a firm, immobile lump is palpated in her left supraclavicular fossa. What is the most likely diagnosis?
A Paroxysmal atrial fibrillation B Transient ischaemic attack C Atonic seizures D Subclavian steal syndrome E Vasovagal syncope
Subclavian steal syndrome.
Which of the following triads best describes the main features of nephrotic syndrome?
A Proteinuria, Hypoalbuminaemia, Oedema
B Haematuria, Hypoalbuminaemia, Oedema
C Proteinuria, Haematuria, Hyperlipidaemia
D Proteinuria, Haematuria, Hypoalbuminaemia
E Frequency, Urgency, Dysuria
Proteinuria, hypoalbuminaemia, oedema.
A 63-year-old man with ascending bilateral limb weakness and ascending paraesthesia is diagnosed with Guillain-Barré syndrome. 3 weeks prior to the onset of these symptoms he suffered from gastroenteritis. Which organism is most likely to have caused this infection?
A Salmonella B Campylobacter jejuni C E. coli 0157 D Rotavirus E Entamoeba histolytica
Campylobacter jejuni.
A 79-year-old care home resident is admitted to hospital with a 4-day history of a cough productive of green sputum. She has also experienced some chest pain and shortness of breath. A chest X-ray shows an area of consolidation in the right middle lobe with a right-sided pleural effusion. What is the most appropriate treatment option?
A Co-amoxiclav and clarithromycin B Co-trimoxazole C Metronidazole D Flucloxacillin E Rifampicin and isoniazid
Co-amoxiclav and clarithromycin.
A 76-year-old care home resident has fractured his neck of femur having fallen out of bed. He is referred to the orthopaedic surgery department and undergoes an operation. Post-operatively, he is in considerable pain and is given 5 mg morphine sulphate. Which of these side-effects is he most likely to experience?
A Constipation B Blurred vision C Cough D Tremor E Rash
Constipation.
A 65-year-old man, who is currently undergoing treatment for chronic lymphocytic leukaemia, presents with an extremely painful left great toe. On closer inspection, he has a fiercely inflamed left metatarsophalangeal joint. He has no other symptoms. What would you expect to see on analysis of the joint fluid aspirate?
A High WCC, turbid fluid
B Positively birefringent, rhomboid-shaped crystals
C Positively birefringent, needle-shaped crystals
D Negatively birefringent, rhomboid-shaped crystals
E Negatively birefringent, needle-shaped crystals.
Negatively birefringent, needle-shaped crystals.
A 47-year-old woman has had several ‘dizzy spells’ over the past 6 weeks. She has been feeling very faint when getting out of bed in the morning and has also experienced some vague abdominal pain along with weight loss and lethargy. Examination reveals dark palmar creases and vitiligo on her back. What is the most appropriate investigation to request?
A Full blood count B Fasting blood glucose C ECG D Short synacthen test E Thyroid function test
Short synacthen test.
A 78-year-old woman visits her GP with a 4-month history of constipation and blood coating her stools. She has also lost 9 kg of weight and complains that she doesn’t ‘feel empty’ after defecating. Abdominal examination is normal, apart from an enlarged left supraclavicular lymph node. What is the most likely diagnosis?
A Cancer of the rectum B Cancer of the sigmoid colon C Gastric carcinoma D Cancer of the caecum E Pancreatic cancer
Cancer of the rectum.
A 75-year-old man is rushed into A&E by ambulance. He finds it difficult to answer simple questions and is struggling to speak. On examination, power is 2/5 in his right arm, 4/5 in his right leg and 5/5 in his left arm and leg. He has marked facial muscle weakness on the right half of his face and he is blind in the right half of his visual field. A CT head scan is performed and an ischaemic stroke is diagnosed. Which artery is most likely to be involved?
A Right anterior cerebral artery B Left anterior cerebral artery C Right posterior cerebral artery D Right middle cerebral artery E Left middle cerebral artery
Left middle cerebral artery.
A 62-year-old diabetic on metformin sees his GP for a routine blood test. He claims that he has been compliant with his treatment and has not experienced any symptoms recently. His blood test reveals:
Na+ : 116 mmol/L (135-145)
K+ : 3.7 mmol/L (3.5-5)
Ca2+ : 2.4 mmol/L (2.2-2.6)
Total Cholesterol : 9.2 mmol/L (< 5) Serum Albumin : 48 g/L (35 -50) TFT - Normal
SST - Normal
What is the most likely cause of his hyponatraemia?
A Addison's disease B Hypothyroidism C Erroneous result D Drug side-effect E Nephrotic syndrome
Erroneous result.
Which of the following lung pathologies produces the ‘sail sign’ appearance on CXR?
A Right upper lobe collapse B Right middle lobe collapse C Right lower lobe collapse D Left upper lobe collapse E Left lower lobe collapse
Left lower lobe collapse.
A 47-year-old man has vomited 3 times and has not passed any faeces or flatus for the last 4 days. He had an open cholecystectomy 6 years ago but has otherwise been relatively fit and healthy. What is the best immediate management option for this patient?
A NG tube and IV fluids B Surgery to resolve the obstruction C Gastrograffin D IV antibiotics E Reassure and discharge
NG tube and IV fluids.
Which of the following is not a major criterion in the Framingham criteria for congestive cardiac failure?
A Bilateral ankle oedema B Paroxysmal nocturnal dyspnea C Cardiomegaly D S3 gallop E Acute pulmonary oedema
Bilateral ankle oedema.
A 46-year-old female has experienced a painful sensation on the outer side of her left thigh for the past 3 months. She mentions that the sensation is very ‘bizarre’ and sometimes feels like it is burning or tingling. She has no other symptoms and has no past medical history of note. What is the most likely diagnosis?
A Meralgia paraesthetica B Multiple sclerosis C Sciatica D Peripheral neuropathy E Disc herniation
Meralgia paraesthetica.
A 47-year-old female suffering from RUQ pain, lethargy and pruritus, is found to have an ALP of 300 IU/L (30-150 IU/L) and serology is positive for anti-mitochondrial antibodies. She also complains of dry, itchy eyes. Examination findings include icterus and xanthelasma. What is the most likely diagnosis?
A Type 1 autoimmune hepatitis B Type 2 autoimmune hepatitis C Primary sclerosing cholangitis D Primary biliary cirrhosis E Cirrhosis
Primary biliary cirrhosis.
What is costochondritis and how does it usually present?
Costochondritis is acute inflammation of the costal cartilage. It is usually idiopathic.
Costochondritis usually presents with chest pain and tenderness on palpation either side of the sternum. The pain often gets worse when coughing, on deep inspiration or during exercise.
What is Tietze’s syndrome?
Tietze’s syndrome is a form of costochondritis characterised by painful swelling of the costal cartilage.
What are the causes of pleuritic chest pain, and what is it?
Pleuritic chest pain is described as ‘a sharp, stabbing pain that gets worse when breathing in or coughing’.
5Ps: PE, pneumothorax, pericarditis, pleurisy and pneumonia.
Other causes of pleuritic chest pain include subphrenic pathology (e.g. abscess), rib fractures and costochondritis
What is molloscum contagiosum and how does it present?
Molluscum contagiosum is a skin condition caused by a pox virus. It mainly occurs in children and is spread via skin-to-skin contact. In adults, it tends to be transmitted via sexual contact and occurs on the lower abdomen and genital area. The skin lesions are typically described as dome-shaped, firm and smooth with an umbilicated centre. The lesions will last for around 8 months.
What is a sebaceous cyst and how does it present?
A sebaceous cyst is a keratinous, epithelium- lined cyst arising from a blocked hair follicle. They are very common and appear as smooth lumps with an overlying punctum that may discharge a creamy substance.
What is gonorrhoea and how does it present?
Gonorrhoea is another sexually-transmitted infection, caused by Neisseria gonorrhoeae, which presents with vaginal or urethral discharge, dysuria and dyspareunia (in women).
How does chicken pox present?
Chicken pox is characterised by the sudden appearance of an extremely itchy rash. The vesicles appear, weep and crust over. It is also often accompanied by prodromal flu-like symptoms.
What causes shingles and how does it present?
Shingles is caused by reactivation of VZV (during times of stress), which lies dormant in dorsal root ganglia after primary infection. It causes tingling and painful skin lesions in a dermatomal distribution.
What is syphilis and how does it present?
Syphilis is a sexually- transmitted disease caused by Treponema pallidum. It begins as a single painless genital ulcer, which is followed by generalised lymphadenopathy and widespread skin lesions. Tertiary syphilis is when the infection spreads to the brain and causes neurological complications.
What is temporal arteritis and how does it present?
Temporal arteritis (also known as giant cell arteritis) is a large-vessel vasculitis that typically presents with a unilateral headache, scalp tenderness and jaw claudication. There may also be systemic features such as malaise, fever and weight loss. Temporal arteritis, if left untreated, can cause irreversible loss of vision (due to ophthalmic artery involvement) so it must be treated urgently with oral prednisolone.
How is temporal arteritis diagnosed and treated?
ESR will be measured and is likely to be elevated. Temporal artery biopsy showing inflammatory changes is diagnostic of temporal arteritis. Risk of false-negatives- biopsy may not sample affected tissue.
These investigations should not delay treatment with oral prednisolone.
Where is hepatitis B virus (HBV) prevalent?
Sub-Saharan Africa and Southeast Asia.
How is hepatitis B virus transmitted?
Sexual contact.
Blood, e.g. contaminated needles.
Vertical transmission from mother to child.
What is the molecular biology of hepatitis B virus?
HBV is a small DNA virus composed of an outer envelope which contains surface antigen (HBsAg).
This surrounds a nucleocapsid which encloses the viral DNA.
The nucleocapsid carries the core antigen (HBcAg), which is involved in viral replication.
The e antigen (HBeAg) is also closely associated with the nucleocapsid.
Which components of hepatitis B serology will susceptible individuals be positive/negative in?
Susceptible individuals will be negative in all components of hepatitis B serology.
Which components of hepatitis B serology will acutely infected individuals be positive in?
HBsAg +ve.
HBeAg +/-ve.
HBcAb IgM +ve.
HBcAb IgG +ve.
Which components of hepatitis B serology will chronically infected individuals be positive in?
HBsAg +ve.
HBeAg +/-ve.
HBcAb IgG +ve.
If HBsAg is detected in the serum 6 months after an acute infection, it suggests that the patient has developed chronic hepatitis B.
Which components of hepatitis B serology will previously infected patients who have cleared the virus be positive in?
HBcAb IgG +ve.
HBsAb +ve.
Which component of hepatitis B serology is administered in the vaccination?
HBsAg.
What will the hepatitis B serology of a vaccinated individual show?
HBsAb +ve.
