SBAs and explanations 6 Flashcards
Which of the following is not a sign of cirrhosis?
A Gynaecomastia B Asterixis C Koilonychia D Hepatic fetor E Clubbing
Koilonychia.
A 67-year-old pensioner, with a 40 pack-year smoking history, visits his GP complaining of shortness of breath that has gradually been getting worse over the past 6 months. He used to be able to walk 500 metres to the shops but now he struggles to make it up the stairs at home. He has also been suffering from a persistent cough productive of clear sputum. Which investigation is required to confirm the diagnosis?
A Spirometry B Peak Expiratory Flow C Sputum Culture D Chest X-Ray E Bronchoscopy and Biopsy
Spirometry.
An 18-year-old man visits the GP having recently returned from a holiday to Thailand. He complains of a 2-day history of watery, bloody diarrhoea and has vomited 6 times. On examination, he is pyrexial with diffuse abdominal tenderness. Which organism is most likely to be causing his symptoms?
A Giardia lamblia B Vibrio cholera C Norovirus D E. coli 0157 E Salmonella
E. coli 0157.
A 42-year-old man is brought into A+E by his wife. He is clutching his head and appears to be drowsy and distressed. Though a clear history is difficult to ascertain, he mentions that he has an ‘absolutely devastating headache’ that suddenly came on this morning. He has never experienced pain like this before. Towards the end of the consultation he begins to vomit. He is apyrexial and denies any trauma to the head. On examination, the patient’s neck is slightly stiff, he is hypertensive and has large bilateral palpable masses in his abdomen. On direct questioning, he reveals that his father died suddenly at the age of 49. Which underlying disease has predisposed the patient to this clinical scenario?
A Renal cell carcinoma B Polycystic kidney disease C Medullary sponge kidney D Phaeochromocytoma E Subdural haemorrhage
Polycystic kidney disease.
A 33-year-old man has recently been diagnosed with hypertension following the incidental finding of abnormally high blood pressure during a routine check-up at his GP practice. Without further investigation, he was started on Ramipril. 1 week later, he begins to feel very nauseous and vomits several times. He is taken to A+E where his renal function is monitored:
Urea : 8.1 mmol/L (2.5-6.7)
Creatinine : 240 micromol/L (baseline : 102) eGFR : 53 (> 90)
Urine Output : 20 mL/hour (> 0.5 mL/kg/hr) What is the most likely cause of his condition?
A Acute tubular necrosis B Acute interstitial nephritis C Glomerulonephritis D Renal artery stenosis E Vasculitis
Renal artery stenosis.
A 47-year-old man comes to A&E having experienced palpitations. He has a past medical history of hypertension which is being treated with ramipril and spironolactone. An ECG shows tented T waves and flattened P waves. A blood test reveals:
Na+ : 137 mmol/L (135-145) K+ : 6.8 mmol/L (3.5-5) Ca2+ : 2.3 mmol/L (2.2-2.6) pH : 7.35 (7.35-7.45)
What is the first step in the management of this patient?
A IV salbutamol B 50 ml 50% dextrose with 10U insulin C 50 ml 5% dextrose with 10U insulin D 10 ml 10% calcium gluconate E IV sodium bicarbonate
10 ml 10% calcium gluconate.
Whilst eating dinner with his family, an 11-year-old boy suddenly drops his cutlery
and begins to stare blankly into space. His eyelids begin to flutter, his eyes roll upwards and this continues for 10 seconds. His dad notices the event and asks him about it, but he can’t remember what happened. What type of seizure is this describing?
A Absence B Simple partial C Complex partial D Myoclonic E Atonic.
Absence.
A 71-year-old man has had a 2-week history of shortness of breath that improves when lying flat. On examination, the patient has an oxygen saturation of 88%, his fingers are clubbed and there are multiple spider naevi on his chest. Shifting dullness is demonstrated, his spleen is enlarged and there are dilated veins around his umbilicus. The patient has a history of alcohol abuse. What is the most likely diagnosis?
A Congestive cardiac failure B Portal hypertension C Hepatopulmonary syndrome D GI bleed E Alcoholic hepatitis
Hepatopulmonary syndrome.
A 72-year-old man is admitted to the orthopaedic surgery ward after fracturing his distal humerus whilst gardening. He mentioned that he suddenly felt a severe pain in his right arm and denies any significant preceding trauma. He adds that he has
recently been urinating a lot more frequently (often up to 12 times per day) and has suffered from constipation, which he attributes to being ‘part of growing old’. An X- ray of the affected arm reveals a pathological fracture with lytic deposits throughout the bone.
Blood tests reveal:
ESR = 48 mm/hr (0-22) Ca2+ = 3.1 mmol/L (2.2-2.6)
What is the most likely diagnosis?
A Multiple myeloma B Paget’s disease C Osteoporosis D Vitamin D deficiency E Thyrotoxicosis
Multiple myeloma.
A 49-year-old man is referred to the respiratory department by his GP. He has been suffering from gradual-onset, worsening shortness of breath over the past 3 months. His 50 pack-year smoking history makes COPD the top differential. Spirometry confirms these suspicions. What is the most appropriate first step in the pharmacological management of this patient?
A Inhaled corticosteroid B Inhaled ipratropium bromide C Inhaled tiotropium D Symbicort E Long-term oxygen therapy
Inhaled ipratropium bromide.
Which of the following is a sign of a lower motor neuron lesion?
A Hyperreflexia B Spasticity C Fasciculations D Clonus E Babinski’s sign
Fasciculations.
A 47-year-old man has been suffering from rhinitis and recurrent nosebleeds for the past 3 months. At first, he attributed this to the cold weather, however, over the last 3 weeks he has started coughing up a small amount of blood. A series of bedside tests are performed, including a urine dipstick, which reveals proteinuria and haematuria. Blood tests and antibody screens reveal a raised ESR and cANCA.
What is the most likely diagnosis?
A Microscopic polyangiitis B Goodpasture’s syndrome C Granulomatosis with polyangiitis D Churg-Strauss syndrome E Behçet’s disease
Granulomatosis with polyangitis.
Which of the following organisms most commonly causes gas gangrene?
A Streptococcus pyogenes B Staphylococcus aureus C Staphylococcus epidermidis D Clostridium perfringens E Haemophilus influenzae
Clostridium perfringens.
A 16-year-old schoolgirl books an appointment with her GP after noticing a lump in her left breast during self-examination. She, sensibly, decided to seek medical attention. She complains of no other symptoms. On examination, a 1 cm x 1 cm firm, smooth and very mobile lump is palpated in the upper-outer quadrant of her left breast. There is no pain on palpation nor is there any axillary or cervical lymphadenopathy.
What is the most likely diagnosis?
A Fibrocystic disease B Fibroadenoma C Breast cancer D Breast abscess E Fat necrosis
Fibroadenoma.
Which of the following drug classes is most likely to cause iatrogenic hypoglycaemia in diabetes patients?
A Sulfonylureas B Metformin C Glucagon D Hydrocortisone E Orlistat
Sulfonylureas.
A 24-year-old swimwear model presents to A&E with severe right iliac fossa pain. The pain was initially poorly localised to the umbilical region, before moving to
the right iliac fossa. This has been accompanied by nausea, anorexia and fever. A diagnosis of appendicitis is made and she is referred for an appendicectomy. What is the most suitable surgical incision for this patient?
A Lanz B Kocher C Pfannenstiel D Rutherford-Morrison E Gridiron
Lanz.
A 55-year-old man presents to his GP having coughed up blood on several
occasions over the past 6 months. He said that he has had a ‘smokers’ cough’ for years but the appearance of blood has been a recent change. On direct questioning, he admits to unintentionally losing about 5 kg of weight over the past 6 months. A chest X-ray shows a 2 cm cavitating lesion in the right upper lobe. There appears to be a few other smaller nodules surrounding the large cavitating lesion. The left lung appears slightly fibrosed, but is otherwise normal. What is the most likely diagnosis?
A Small cell lung cancer B Squamous cell lung cancer C Atypical pneumonia D Lung abscess E Goodpasture’s syndrome
Squamous cell lung cancer.
A 46-year-old airline pilot presents to A+E with severe pain in his right flank. He adds that the pain moves down towards his right groin. Though examination is difficult, as he is writhing around in pain, no abnormalities are detected. However, a urine dipstick reveals haematuria. Which investigation would you do next?
A Renal ultrasound B Cystoscopy C CT-KUB D MRI E Urine MC+S
CT-KUB.
A 32-year-old man, with a history of IV drug abuse, presents to A+E with a high fever and rigors. He has also been very breathless and has experienced epigastric pain that is worse on exertion. On examination, giant V waves are seen in the JVP and tender, pulsatile hepatomegaly is palpated. What is the most likely diagnosis?
A Mitral stenosis B Tricuspid regurgitation C Pulmonary hypertension D Portal hypertension E Viral hepatitis
Tricuspid regurgitation.
A 31-year-old female presents to her GP with a 2-month history of fatigue and worsening muscle weakness. She also complains that her left eyelid droops considerably more than her right. She feels fine in the morning but her strength decreases throughout the day, especially if she exerts herself more so than usual. Myasthenia gravis is suspected. Which of the following investigations may provide evidence supporting this diagnosis?
A Dix-Hallpike test B Schirmer’s test C Romberg’s test D Tensilon test E Trendelenberg test
Tensilon test.
A 15-year-old school boy is rushed into A+E having accidentally ingested some peanuts, to which he is extremely allergic. His face and lips are swollen, he is wheezing and struggling to breathe. Vital signs: HR = 132 bpm, BP = 88/53 mm Hg. His airway has been secured and he is being given 100% oxygen. What is the next most appropriate step in the management of this patient?
A IV chlorpheniramine B IV hydrocortisone C IV saline D IV adrenaline E IM adrenaline
IM adrenaline.
Which of the following is a cause of microcytic anaemia?
A Myelodysplasia B Multiple myeloma C Thalassaemia D Myelofibrosis E Aplastic anaemia
Thalassaemia.
A 63-year-old type 2 diabetic presents with a rash on her shins that has gradually got worse over the past 3 months. On closer inspection, there are three areas of raised, reddened and hardened skin with a yellowish centre. What is the most likely diagnosis?
A Acanthosis nigricans B Diabetic dermopathy C Necrobiosis lipoidica diabeticorum D Granuloma annulare E Pruritus
Necrobiosis lipoidica diabeticorum.
A 76-year-old woman is brought into A+E with central crushing chest pain that radiates to her jaw and left arm. An ECG is performed, which shows ST elevation in leads ll, lll and aVF. Her SaO2 is 90%. Before she is sent to the cathlab for percutaneous coronary intervention, she is started on a combination of drugs. Which of the following should not be given?
A Morphine B Oxygen C Aspirin D Clopidogrel E Warfarin
Warfarin.
A 42-year-old amateur rugby player presents to his GP complaining that his team mates have been making fun of his ‘man boobs’. He admits that he appears to have developed breasts over the past few months and it is causing him considerable embarrassment and distress. Which of the following drugs is most likely to have caused this unfortunate circumstance?
A Cimetidine B Aspirin C Salbutamol D Ramipril E Omeprazole
Cimetidine.
Which part of the prostate gland undergoes progressive hyperplasia in BPH?
A Central zone B Transitional zone C Peripheral zone D Ejaculatory duct E Anterior fibromuscular stroma
Transitional zone.
A 62-year-old obese man visits his GP complaining of a cramping pain in his buttocks that comes on when he walks his Pomeranian, Skippy. This pain was first noticed 4 months ago and it is relieved by sitting down. He has a 40 pack-year smoking history. On direct questioning, he sheepishly admits to suffering from erectile dysfunction over the last 2 months. Examination is normal except for noticeably weak pedal pulses. What is the most likely diagnosis?
A Chronic compartment syndrome B Leriche syndrome C Critical limb ischaemia D Spinal stenosis E Chronic deep vein thrombosis
Leriche syndrome.
A 43-year-old man, who has recently moved to the UK from Greece, has been referred for an outpatient appointment to discuss his recurrent mouth ulcers. He says that, for the past 8 months, he has regularly suffered from oral ulcers and he, quite timidly, mentions that he has also noticed ulcers on his penis. During the consultation, you notice that his eyes look quite red. When asked about it, he mentions that his eyes have been very itchy and painful recently, but attributes this to hay fever. What is the most likely diagnosis?
A Inflammatory bowel disease B Behçet’s disease C Herpes simplex virus D Syphilis E Reactive arthritis
Behçet’s disease.
Which of the following ECG findings is associated with pulmonary embolism?
A Bradycardia B Tall tented T waves C Reverse tick sign D S1Q3T3 E T wave inversion
S1Q3T3.
Which of the following is not a feature of Parkinson’s disease?
A Hypomimia B Hypophonia C Micrographia D Up-gaze impairment E Wide-based gait
Wide-based gait.
What are the signs associated with liver failure?
A-J of liver failure. Asterixis. Bruising. Clubbing. Dupuytren's contracture. Erythema (palmar). Fetor hepaticus. Gynaecomastia. Hepatomegaly (in early cirrhosis). Itching. Jaundice. Also spider naevi, leukonychia, testicular atrophy, and signs of portal hypertension: splenomegaly, GI bleeds, caput medusae, haemorrhoids, ascites.
What is koilonychia and what condition is it associated with?
Koilonychia is spooning of the nails which occurs due to chronic iron deficiency. It is associated with Plummer-Vinson syndrome.
