SBAs and explanations 4 Flashcards
A 34-year-old woman is complaining of a drooping eyelid that has been affecting her vision. She has also been suffering from fatigue over the past 3 months, which has impacted on her job as a yoga instructor. She feels relatively fine in the morning, however, she feels very weak towards the end of the day and struggles to complete her evening sessions. What is the most likely diagnosis?
A Polymyalgia rheumatic B Anaemia C Myasthenia Gravis D Lambert-Eaton syndrome E Horner’s syndrome
Myasthenia gravis.
A 19-year-old asthmatic visits his GP because he is having to use his salbutamol inhaler more than 3 times per week. What is the next step in the management of this patient’s asthma?
A Add oral prednisolone B Reassure and send home C Increase the dose of inhaled salbutamol D Add inhaled salmeterol E Add inhaled low-dose beclomethasone
Add inhaled low-dose beclomethasone.
A 71-year-old owner of a dye factory presents to his GP having experienced 3 episodes of blood in his urine over the past week. When asked to elaborate, he says that his urine is bright red, however, he experiences no pain when passing urine and has not experienced any trauma to his genitals recently. Otherwise, he has generally been quite healthy although he has noticed that his clothes have become quite loose-fitting despite not having changed his diet or exercised. What is the most likely diagnosis?
A Pyelonephritis B Glomerulonephritis C Bladder Cancer D Prostate Cancer E Ureteric Stone
Bladder cancer.
A 44-year-old woman presents with a 7-month history of heartburn, an acidic taste in the back of her mouth and painful swallowing. The GP suspects gastro- oesophageal reflux that is aggravated by a medication that she is taking for a heart condition. Which of the following options could cause or worsen gastro-oesophageal reflux?
A Beta-blockers B ACE inhibitors C Nitrates D Diuretics E Angiotensin receptor blockers
Nitrates.
A 27-year-old man presents with palpitations and light-headedness. An ECG shows features consistent with a supraventricular tachycardia. Adenosine is administered and the SVT is terminated. A repeat ECG shows a short PR interval and a QRS complex with a slurred upstroke. What is the diagnosis?
A Brugada syndrome B LBBB C Romano-Ward syndrome D Wolff-Parkinson-White syndrome E Complete heart block
Wolff-Parkinson-White syndrome.
An 18-year-old man visits his GP complaining of an itchy scalp and nose. He admits that he has been feeling quite self-conscious since a friend pointed out that he has dandruff. On examination, there are patchy erythematous plaques along his scalp covered with yellow scales and white flakes of dead skin in his hair. Similar lesions are also found in the nasolabial folds. Which type of eczema is this likely to be?
A Nummular B Seborrhoeic C Contact D Atopic E Pompholyx
Seborrhoeic.
Which of the following options fits the criteria for giving long-term oxygen therapy in COPD?
A PaO2 7.3-10 kPa despite maximal treatment
B PaO2 7.3-10 kPa and pulmonary hypertension
C PaO2 < 7.3 kPa despite maximal treatment
D PaCO2 > 6 kPa despite maximal treatment
E PaCO2 > 8 kPa despite maximal treatment
PaO2 <7.3kPa despite maximal treatment.
A 71-year-old female, with a history of atrial fibrillation, presents to A&E with severe, diffuse abdominal pain. Her blood pressure is 84/60 mm Hg and her pulse is irregularly irregular with a rate of 130 bpm. Abdominal examination is normal. An abdominal X-ray is performed. Which of these radiological features is most likely to be seen?
A Rigler’s sign B Pneumoperitoneum C Toxic megacolon D Gasless abdomen E Coffee bean sign
Gasless abdomen.
Which of the following results would you expect to see in a patient with toxic multinodular goitre?
A High TSH, High TRH & High T3/T4 B Low TSH, Low TRH & High T3/T4 C Low TSH, High TRH & High T3/T4 D High TSH, Low TRH & High T3/T4 E High TSH, High TRH & Low T3/T4
Low TSH, Low TRH & High T3/T4.
A 68-year-old man has suddenly developed an extremely painful left leg. On examination, his left leg is pale, cold and his dorsalis pedis and posterior tibial pulses are impalpable. His radial pulse is 120 bpm and has an irregularly irregular rhythm. What is the first step in the management of this patient?
A Duplex ultrasound scan of the lower limb vessels
B Oral aspirin
C IV heparin
D Measure Ankle-Brachial Pressure Index (ABPI)
E DC Cardioversion
IV heparin.
A 22-year-old man presents with a headache, neck stiffness and photophobia. A diagnosis of viral meningitis is suspected. Once raised ICP is excluded, a lumbar puncture is performed. Which set of results would be consistent with viral meningitis?
A Cloudy CSF, high neutrophils, high protein and low glucose
B High lymphocytes, high protein and normal glucose
C High lymphocytes, low protein and normal glucose
D High neutrophils, high protein and high glucose.
E Fibrinous CSF, high lymphocytes, high protein and low glucose
High lymphocytes, high protein and normal glucose.
Which of the following is not a clinical feature of anaemia?
A Conjunctival pallor B Glossitis C Angular stomatitis D Ruddy/Red complexion E Shortness of breath
Ruddy/red complexion.
A 39-year-old female presents at her GP practice having coughed up blood last night. This has happened on two previous occasions. She has no significant past medical history although she does experience regular nosebleeds. Blood tests reveal a high ESR and urinalysis reveals proteinuria and haematuria. The presence of which antibody would support the most likely diagnosis?
A Anti-GBM antibody B pANCA C cANCA D Anti-liver/kidney microsomal antibody E Anti-smooth muscle antibody
cANCA.
Which of the following is not part of the criteria for diagnosing sepsis?
A Heart Rate >90bpm B Respiratory Rate >20 breaths per minute C Temperature >38°C D White Cell Count <4 x 10^9/L E Blood Pressure <90/60mmHg
Blood Pressure <90/60mmHg.
A 72-year-old patient with severe COPD has recently experienced worsening dyspnoea despite maximal treatment. On examination, he is cyanotic with a raised JVP and ankle oedema. Palpation reveals hepatomegaly. What is the most likely diagnosis?
A Left ventricular failure B Congestive cardiac failure C Cor pulmonale D Pulmonary hypertension E Restrictive cardiomyopathy
Cor pulmonale.
A 32-year-old man with psoriasis presents to his GP with deformed hands that have been affecting his ability to do his daily tasks. It has gradually got worse over several years. On closer inspection, his fingers are badly deformed and appear to be telescoped. What is the most likely diagnosis?
A Rheumatoid arthritis B Arthritis mutilans C Psoriatic spondylopathy D Osteoarthritis E Distal interphalangeal joint disease
Arthritis mutilans.
A 21-year-old woman has fainted 4 times in the past 3 months. She becomes sweaty and nauseous before she faints and is usually unconscious for a few seconds. Her friends have told her that she looks abnormally pale before she collapses. She doesn’t know if she jerks whilst unconscious, but has not lost control of her bladder or bitten her tongue. When she regains consciousness, she feels slightly dizzy but does not feel confused. What is the most likely cause of her fainting?
A Hypoglycaemia B Epileptic seizure C Vasovagal syncope D Arrhythmia E Hypertrophic obstructive cardiomyopathy
Vasovagal syncope.
A 50-year-old taxi driver attends a GP appointment because he has recently been ‘bumping into things’ quite regularly and has had to take a break from work over fears about his vision. He struggles to see anything in the left half of his visual field. Examination reveals a left homonymous hemianopia. In which part of the visual pathway is the lesion likely to be located?
A Optic chiasm B Left optic tract C Left optic radiation D Right optic nerve E Right optic tract
Right optic tract.
A 75-year-old woman has had a 3-week history of lower abdominal discomfort and bloating. She is embarrassed to admit that she has recently started wearing adult diapers because she has been soiling her underwear. Her stools are usually very watery and drip into the pan. She has not lost any weight or noticed any blood in the stool. She claims to have a balanced, healthy diet. She has taken codeine every day for the past 4 months since she suffered a hip fracture. On examination, her abdomen is mildly distended and a solid mass is palpated in the left iliac fossa. On digital rectal examination, her underwear is soiled and liquid stool is seen on withdrawal of the finger. What is the most likely diagnosis?
A Rectal carcinoma B Faecal impaction C Inguinal hernia D Ischaemic colitis E Rectocoele
Faecal impaction.
A 24-year-old female presents to her GP complaining that her periods have become extremely irregular. She normally has 26-29 day cycles, but in the past 6 months her periods have been much less frequent. On closer inspection, she appears to have an abnormally large amount of facial hair for a young female and she is also suffering from acne, which, she claims, she never had as a teenager. She has gained weight over the past few months, which, alongside the acne and facial
hair growth, has made her feel depressed. What is the most likely diagnosis?
A Hypothyroidism B Turner’s syndrome C Polycystic ovarian syndrome D Pregnancy E Panhypopituitarism
Polycystic ovarian syndrome.
Which of the following is a respiratory cause of asterixis?
A Hypoxia B Carbon dioxide retention C Salbutamol side-effect D Secondary polycythaemia E Bronchiectasis
Carbon dioxide retention.
A 23-year-old student has arranged an appointment with his GP to discuss his ‘incredibly itchy’ eyes. Yesterday morning he noticed that his left eye became quite red and itchy, and started watering. A few hours later, his right eye also started to display the same symptoms. On closer inspection, both eyes show conjunctival injection and watering. A yellow crust is seen across the margins of the eyelids.
What is the most likely diagnosis?
A Hypopyon B Hyphaema C Bacterial Conjunctivitis D Viral Conjunctivitis E Uveitis
Bacterial conjunctivitis.
A 53-year-old man visits his GP to discuss a swollen scrotum that has caused him some discomfort and much embarrassment since he first noticed it 3 weeks ago. The swelling has grown gradually and, although it is uncomfortable, it is not painful. He reports no difficulties with passing urine. On examination, his left hemiscrotum is considerably enlarged, fluctuant and non-tender. It is possible to get above the swelling, however, the left testicle cannot be distinguished. When a pen torch is shone on the swelling, it illuminates brightly. What is the most likely diagnosis?
A Varicocoele B Hydrocoele C Testicular tumour D Epididymal cyst E Indirect inguinal hernia
Hydrocoele.
A 52-year-old man has been experiencing some chest pain and shortness of
breath, which is worse when lying down. He has also collapsed 3 times in the past couple of months. His father died of a heart condition when he was 58 years old, although he cannot recall the details of the condition. On examination, a jerky carotid pulse is palpated and a crescendo-decrescendo murmur is heard over the carotid artery. What is the most likely diagnosis?
A Aortic stenosis B Hypertrophic obstructive cardiomyopathy C Left heart failure D Mitral regurgitation E Constrictive pericarditis
Hypertrophic obstructive cardiomyopathy.
A 48-year-old man has been in hospital for 2 days receiving treatment for pneumonia. He has a past medical history of acute pancreatitis, which occurred 3 years ago. He has a long history of alcohol abuse. In the last hour, he has started sweating excessively, complains of palpitations and appears very anxious. He is clearly agitated and begins shouting at the nurses to ‘get these creatures off me!’ What is the most appropriate treatment?
A Diazepam
B Phenobarbital
C Loperamide
D Chlordiazepoxide E Risperidone
Chlordiazepoxide.
A 56-year-old man has recently registered at a new GP practice. As part of the registration process he has been asked to undergo some routine blood tests. FBC reveals the following results:
Hb : 106 g/L (130-180)
WBC : 95 x 109 /L (4-11) Platelets : 86 x 109 /L (150-400) Lymphocytes : 85 x 109 (1.5-4.5)
A diagnosis of chronic lymphocytic leukaemia is suspected. Which of the following features are you most likely to see on his blood film?
A Smear cells B Atypical lymphocytes C Auer rods D Reed-Sternberg cells E Schistocytes
Smear cells.
A 21-year-old university student presents with a 1-week history of sore throat, fever and malaise. On examination, there is cervical lymphadenopathy, splenomegaly and inflamed tonsils. The GP diagnoses the patient with bacterial tonsillitis and prescribes ampicillin. The patient comes back 2-days later with a widespread maculopapular rash. What is the underlying diagnosis?
A Penicillin allergy B Erythema multiforme C Stevens-Johnson syndrome D Infectious mononucleosis E Idiopathic thrombocytopaenic purpura
Infectious mononucleosis.
A 47-year-old man presents to his GP having experienced a few episodes of haemoptysis over the past month. He returned from a holiday to Bangladesh 6 weeks ago. On direct questioning, he admits to losing approximately 5 kg in weight over the past month and he has had to replace his bed sheets more frequently because they are often drenched with sweat when he wakes up in the morning. A chest X-ray reveals an area of consolidation in the right upper zone. Sputum microscopy using Ziehl-Neelsen stain reveals acid-fast bacilli. What is the most appropriate treatment option?
A Rifampicin and isoniazid for 6 months; ethambutol and pyrazinamide for the first 2 months
B Ethambutol and pyrazinamide for 6 months; rifampicin and isoniazid for the first 2 months
C Rifampicin and isoniazid for 6 months; ethambutol and pyrazinamide for the first 4 months
D Rifampicin and pyrazinamide for 6 months; ethambutol and isoniazid for the first 2 months
E Rifampicin, pyrazinamide, ethambutol and isoniazid for 6 months
Rifampicin and isoniazid for 6 months; ethambutol and pyrazinamide for the first 2 months.
A 23-year-old university student is brought to A&E at 2 am by his friends. He is
clearly inebriated and struggles to maintain conversation. His friends explain that he had been celebrating the recent election results at a bar when he began to vomit. He vomited several times and splashes of ‘bright red’ blood was seen the last two times that he vomited. What is the most likely diagnosis?
A Peptic ulcer disease
B Boerhaave syndrome
C Mallory-Weiss syndrome
D Gastritis
E Osler-Weber-Rendu syndrome
Mallory-Weiss.
A 65-year-old man is brought in to A&E by his wife. She says that he has been very confused over the last few days and has fallen over several times. She adds that her husband has wet the bed twice over the last 2 days – this has never happened before. What is the most likely diagnosis?
A Alzheimer’s disease B Obstructive hydrocephalus C UTI D Subdural haematoma E Normal pressure hydrocephalus
Normal pressure hydrocephalus.
What is myasthenia gravis and how does it present?
Myasthenia gravis is an autoimmune disease of the neuromuscular junctions characterised by the destruction of nicotinic acetylcholine receptors leading to weakness in various muscle groups across the body.
Eye signs, such as ptosis and fatigue of extra-ocular muscles, are early features of myasthenia gravis.
The disease can also affect bulbar muscles (supplied by CN 9-12), leading to difficulty swallowing and chewing.
Generalised weakness affecting multiple muscle groups is also common.
Myasthenia gravis is characterised by fatigue that gets worse with activity – patients often complain about severe fatigue towards the end of the day.
What is Lambert-Eaton syndrome and how does it present in comparison to myasthenia gravis?
Lambert-Eaton syndrome is a paraneoplastic disease caused by the destruction of pre-synaptic calcium channels, which presents very similarly to myasthenia gravis.
However, fatigue, in Lambert-Eaton syndrome, improves with activity.
What is polymyalgia rheumatica and how does it present?
Polymyalgia rheumatica is an inflammatory condition, which causes pain and stiffness (without weakness) of the shoulder and pelvic girdle that is typically worst in the morning.
What is Horner’s syndrome and what may cause it?
Horner’s syndrome is caused by disruption of the sympathetic nervous supply to the head and neck.
Its main features are ptosis, miosis and anhidrosis.
Causes include apical lung tumours, strokes and carotid artery dissection.
How does bladder cancer present?
Painless macroscopic haematuria. Some may experience storage symptoms such as frequency, urgency and nocturia- very variable.
Patients are also likely to experience systemic symptoms of malignancy, such as weight loss.
What are the different types of bladder cancer?
Bladder cancer can either be a transitional cell carcinoma (most common) or a squamous cell carcinoma.
What is the main environmental association with bladder cancer?
Bladder cancer is strongly associated with exposure to dye-stuffs.
How is suspected bladder cancer investigated?
Cystoscopy and biopsy.
What accompanies haematuria in pyelonephritis?
Symptoms of infection (e.g. high fever).
Describe the haematuria in glomerulonephritis.
Glomerulonephritis usually causes microscopic haematuria.
How do ureteric stones present?
A ureteric stone will cause microscopic haematuria and is likely to present as an emergency with the patient suffering from excruciating, colicky ‘loin to groin’
pain.
What medications can exacerbate symptoms of reflux?
Drugs that damage the mucosa, e.g. NSAIDs, aspirin, steroids and bisphosphonates.
Drugs that affect oesophageal motility, e.g. TCAs, nitrates and anticholinergics.
How is GORD managed?
Lifestyle interventions such as stopping smoking, avoiding spicy food, losing weight, having small, regular meals and avoiding eating before bed.
Patients are usually started on a once daily PPI and patients who do not respond should be offered twice daily PPIs.
What is supraventricular tachycardia?
‘Supraventricular tachycardia’ technically means any tachycardia that originates above the ventricles, however, the term tends to, more specifically, refer to atrioventricular re-entry tachycardia (AVRT) and atrioventricular nodal re-entry tachycardia (AVNRT).
When does AVRT occur?
AVRT occurs when a re-entry circuit is established between the atria and the ventricles via an accessory pathway, the bundle of Kent.
What are the ECG findings of a terminated SVT, and why?
Once an SVT is terminated, depolarisation will still travel down the bundle of Kent and cause ‘pre-excitation’ of the ventricles, producing a slurred upstroke and a short PR interval on the ECG.
What is Wolff-Parkinson-White syndrome?
Accessory pathway, pre-excitation of the ventricles and a tendency to develop SVTs.
What is Brugada syndrome?
Brugada syndrome is a rare but well known genetic disease associated with sudden death in adults.
What ECG changes are seen in left bundle branch block?
Left bundle-branch block would produce wide QRS complexes with a ‘W’ shape in V1 and an ‘M’ shape in V6.
‘WiLLiaM’.
