SBAs and explanations 8 Flashcards
Which of the following organisms is a recognised cause of hospital-acquired pneumonia?
A Streptococcus pneumoniae B Pseudomonas aeruginosa C Haemophilus influenzae D Legionella pneumophila E Chlamydophila psittaci
Pseudomonas aeruginosa.
A 19-year-old girl visits her GP after experiencing painful urination over the past week. She has also been urinating more frequently than usual and complains that her urine looks cloudy and smells particularly bad. A urinary tract infection is suspected. Which investigation can definitively confirm the diagnosis?
A Urine dipstick B CRP C Blood cultures D MSU E U+Es
MSU.
A 31-year-old man presents with a 2-day history of diffuse watery diarrhoea and nausea. He admits to recently eating a BBQ at a friend’s house. How should this patient be managed?
A Bed rest and oral rehydration
B Bed rest, oral rehydration and antibiotics
C Anti-diarrhoeal agents
D Call an ambulance and admit to hospital
E Refer to a gastroenterologist for further investigation
Bed rest and oral rehydration.
A 16-year-old boy presents to his GP after noticing the growth of several small, fleshy tags on his torso. He has also noticed that he has many more ‘birthmarks’ now compared to when he was younger. On examination, there are 8 coffee-coloured, flat skin lesions (‘birthmarks’) which are about 2-3 cm in diameter. Freckling around both axillae is also noted. What is the most likely diagnosis?
A Tuberous sclerosis B Neurofibromatosis type 1 C Neurofibromatosis type 2 D Xeroderma pigmentosum E Dercum disease
Neurofibromatosis type 1.
Which of the following is an extra-articular feature of ankylosing spondylitis?
A Erythema ab igne B Subcutaneous nodules C Apical lung fibrosis D Mitral regurgitation E Tophi
Apical lung fibrosis.
A 43-year-old man has been involved in a bar fight. He is rushed, unconscious, into A&E with a stab wound to the chest. On examination, his JVP is raised and he is hypotensive (BP : 86/70 mm Hg). Auscultation of his chest reveals very quiet heart sounds. What is the most likely diagnosis?
A Acute heart failure B Haemopericardium C Pneumothorax D Septic shock E Hypovolaemic shock
Haemopericardium.
A 52-year-old man attends the respiratory clinic complaining of a dry cough that has been bothering him for 2 months. He has never smoked and has not experienced any shortness of breath or chest pain. Respiratory examination detects no abnormalities. He has a past medical history of hypertension, for which he started treatment 4 months ago. What is the most likely diagnosis?
A Asthma B Interstitial lung disease C Bronchiectasis D Drug side-effect E Atypical pneumonia
Drug side-effect.
A 41-year-old female is referred to the dermatology clinic because she has developed multiple purple nodules on her shins. They are tender and have a diameter of 1-2 inches. Erythema nodosum is suspected. Which of the following is not a cause of erythema nodosum?
A Tuberculosis B Reaction to sulphonamides C Inflammatory bowel disease D Ankylosing spondylitis E Behçet’s disease
Ankylosing spondylitis.
A 49-year-old woman is admitted to A+E complaining of severe right upper quadrant pain that began last evening and has not subsided. She admits to eating a lot of fast food and mentions that, in the past, she has experienced a stabbing pain for a couple of hours after eating. The pain during these episodes is less intense than the pain she is currently experiencing, and it tends to be localised around her epigastrium. She drinks no more than 12 units of alcohol per week and has not lost any weight recently. On examination, she is jaundiced and Murphy’s sign is positive. LFTs are requested:
Bilirubin : 45 micromol/L (3-17) AST : 50 iU/L (5-35)
ALT : 45 iU/L (5-35)
ALP : 400 iU/L (30-150)
What is the most likely diagnosis?
A Gallstones B Alcoholic hepatitis C Viral hepatitis D Hepatocellular carcinoma E Gilbert’s syndrome
Gallstones.
A 34-year-old Nigerian man brings his 3-year-old son to A&E. He has been crying and complaining of severe pain in his hands. On examination, his fingers are swollen and warm. The junior doctor suspects a painful crises of sickle cell disease. What is the mode of inheritance of sickle cell disease?
A Autosomal recessive B Autosomal dominant C X-linked recessive D X-linked dominant E Y-linked
Autosomal recessive.
A 16-year-old girl is rushed to A+E by her parents. She is unconscious and shaking uncontrollably. Her mother says that she has been fitting for over half an hour. What is the most appropriate first step in the management of this patient?
A IV phenytoin B IV thiopentone C IV lorazepam/PR diazepam D Reassure her parents and let the seizure terminate by itself E Oral sodium valproate
IV lorazepam/PR diazepam.
A 61-year-old, with a 40 pack-year smoking history, presents with confusion. He has also had a 3-month history of weight loss and haemoptysis. A blood test shows the following results: Na+ : 121 mmol/L (135 - 145) K+ : 4.1 mmol/L (3.5 - 5) Ca2+ : 2.3 mmol/L (2.2-2.6) What is the most likely diagnosis?
A Addison’s disease B Hypothyroidism C Heart failure D SIADH E Cirrhosis
SIADH.
A 27-year-old man presents complaining of sharp chest pain. He mentions that he has taken a few days off work recently because of the flu. What would you expect to see on his ECG?
A ST elevation in leads II, III and aVF B Widespread saddle-shaped ST elevation C ST depression D Tented T waves E Absent P waves
Widespread saddle-shaped ST elevation.
Why are urinary tract infections more common in women?
A Women have a shorter urethra
B Men have a larger bladder
C Men have a shorter distance between their urethral opening and their anus
D Women are more likely to be catheterised
E Men have longer ureters
Women have a shorter urethra.
A 44-year-old bus driver from the West Indies has suffered from shortness of breath and a dry cough for the last 4 months. He also complains of some ‘sore lumps on his shins’. Closer inspection reveals tender violet nodules on both shins. A chest X-ray is requested, which shows bilateral hilar lymphadenopathy. Blood tests are also requested, including U+Es – which parameter would you expect to be raised?
A Sodium B Potassium C Calcium D pH E Urea
Calcium.
A 35-year-old woman presents to clinic with a 6-month history of watery diarrhoea and abdominal pain that improves after defecation. She admits to defecating 4-5 times per day compared to her normal frequency of once per day. On examination, a papulovesicular rash is seen on both elbows. Which investigation would be most useful in aiding the diagnosis? A Stool sample for MC+S B Serology for anti-tTG antibodies C Full blood count D Blood cultures E Barium follow-through
Serology for anti-tTG antibodies.
Which of the following is a risk factor for breast cancer?
A Breastfeeding B Late menarche C Early menopause D Not having children E Age <50yrs.
Not having children.
A 26-year-old man presents with an acutely swollen left knee. The pain and swelling started 2 days ago, but he didn’t pay much attention to it as he thought it was just a muscle strain. He has also developed a fever over the past 24 hours. On examination, his left knee is red, swollen and extremely painful on passive flexion. Septic arthritis is suspected and a joint aspirate is requested. Which of the following organisms most commonly causes this condition?
A Haemophilus influenza B Staphylococcus aureus C Neisseria meningitidis D Escherichia coli E Mycobacterium tuberculosis
Staphylococcus aureus.
A 44-year-old female presents to her GP complaining of worsening hearing. A full cranial nerves examination is performed. When Weber’s test is performed, she hears the sound louder in her left ear. Then, Rinne’s test is performed and she reports that, in both ears, the sound is loudest when the tuning fork is held in front of the auditory canal rather than when the fork is held against her mastoid processes. Which of the following best describes the patient’s condition?
A Conductive hearing loss in the right ear
B Conductive hearing loss in the left ear
C Sensorineural hearing loss in the right ear
D Sensorineural hearing loss in the left ear
E Bilateral sensorineural hearing loss
Sensorineural hearing loss in the right ear.
Which of the following best defines chronic kidney disease?
A GFR < 60 mL/min/1.73m2 for more than 3 months
B GFR < 60 mL/min/1.73m2 for more than 6 months
C GFR < 90 mL/min/1.73m2 for more than 3 months
D GFR < 90 mL/min/1.73m2 for more than 6 months
E Requirement of long-term renal replacement therapy
GFR < 60 mL/min/1.73m2 for more than 3 months.
A 77-year-old man, with a history of ischaemic heart disease, presents to A+E with acute-onset dyspnoea, a wheeze and a cough productive of pink frothy sputum. A diagnosis of acute left ventricular failure, resulting in pulmonary oedema, is made. Which of the following is not part of the immediate management of this patient?
A Administer oxygen B Lie the patient down C IV Diamorphine D GTN infusion E IV furosemide
Lie the patient down.
Which of the following is not a cause of macrocytic anaemia?
A Iron deficiency B Vitamin B12 deficiency C Folate deficiency D Methotrexate E Hypothyroidism
Iron deficiency.
A 62-year-old shop owner is brought to A+E, by his daughter, having experienced worsening shortness of breath. His face and arms have also become quite swollen. On examination, he has a plethoric face and his JVP is raised and non-pulsatile. He seems disinterested when the history is taken because he does not trust doctors. His daughter adds that he has been coughing up blood and losing weight for about 6 months, however, he has refused to seek medical attention until his recent worsening of symptoms. What is the most likely diagnosis?
A Asbestosis B Congestive cardiac failure C Polycythaemia D Superior vena cava syndrome E Mesothelioma
Superior vena cava syndrome.
An 82-year-old man is brought to A&E with a severe headache. He complains of an intense aching pain, focused around his right eye, that has rapidly worsened. He has never experienced anything like this before. A nurse informs you that he vomited whilst waiting to be admitted, and has been complaining of nausea since. Closer inspection reveals a red, congested right eye with a cloudy cornea. He complains that his vision has worsened with the onset of this headache and he has started
seeing haloes around all sources of light. What is the most likely diagnosis?
A Meningitis B Subarachnoid haemorrhage C Acute glaucoma D Cluster headache E Migraine
Acute glaucoma.
Which of the following is associated with left ventricular systolic failure?
A Pulsus alternans B Pulsus paradoxus C Water-hammer pulse D Pulsus parvus et tardus E Pulsus bisferiens
Pulsus alternans.
A 46-year-old truck driver is accompanied by his wife to see his GP after he fell asleep at the wheel two days ago. He appears to be quite shaken by the ordeal as he recalled having to veer away from oncoming traffic. On further questioning, he says that his sleep hasn’t been disrupted, however, he has been feeling very tired during the day. His wife interjects and mentions that her own sleep has been disturbed because her husband has been ‘snoring ferociously’. When asked about diet and exercise, he admits to eating badly and exercising very little since he started
working as a truck driver 3 years ago. In that time, he has gained a considerable amount of weight.
What is the most likely diagnosis?
A Narcolepsy B Cataplexy C Absence Seizure D Obstructive Sleep Apnoea E Central Sleep Apnoea
Obstructive sleep apnoea.
A 28-year-old IV drug-user visits his GP practice for an annual check-up. Hepatitis serology is requested and the following results are reported.
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
Cleared.
