SBAs and explanations 9 Flashcards
An 8-year-old girl visits her GP, with her mother, 4 weeks after being prescribed antibiotics for a sore throat. Her urine has become tea-coloured and she has been feeling nauseous with a headache. Urinalysis reveals proteinuria and haematuria and her blood pressure is 137/72mmHg. A diagnosis of post-infectious glomerulonephritis is suspected. Which organism is most likely responsible?
A Streptococcus agalactiae B Streptococcus pyogenes C Escherichia coli D Diphtheria E Bordetella pertussis
Streptococcus pyogenes.
Which of the following drugs is not used in the long-term management of chronic
heart failure?
A Indomethacin
B Carvedilol
C Spironolactone D Candesartan
E Digoxin
Indomethacin.
A 32-year-old man has been suffering from worsening shortness of breath over the past 5 months. He used to be very physically active, but, recently, he has become breathless whilst doing relatively low intensity tasks such as walking to the bus stop. He has also developed a chronic cough, productive of clear sputum. He regularly visits the hospital to monitor his liver function because of a ‘liver disease’ that he has had since he was a child. He has never smoked and does not drink alcohol. What is the most likely diagnosis?
A COPD B Autoimmune hepatitis C alpha 1 antitrypsin deficiency D Haemochromatosis E Wilson’s disease
Alpha 1 antitrypsin deficiency.
A 55-year-old woman presents with a 2-month history of jaundice and right upper quadrant pain. She has a history of ulcerative colitis. LFTs and serology are requested:
ALP : 390 iU/L (30-150) AST : 40 iU/L (5-35) ALT : 40 iU/L (5-35) GGT : 150 iU/L (7-32) pANCA : Positive
What is the most likely diagnosis?
A Haemochromatosis B Primary biliary cirrhosis C Primary sclerosing cholangitis D Autoimmune hepatitis E Wilson’s disease
Primary sclerosing cholangitis.
An 89-year-old woman is brought into A+E after she suddenly became very disorientated and was unable to recognise her own son. On examination, she is blind
in the left half of her visual field. An ischaemic stroke is suspected. Which artery is most likely to be involved?
A Right anterior cerebral artery B Right posterior cerebral artery C Left posterior cerebral artery D Right middle cerebral artery E Left middle cerebral artery
Right posterior cerebral artery.
Which of the following conditions is strongly associated with Giant Cell Arteritis?
A Takayasu’s aortitis B Myalgic encephalomyelitis C Fibromyalgia D Polymyalgia rheumatic E Polymyositis
Polymyalgia rheumatica.
A 58-year-old woman presents with a scaly rash around her right nipple. She says that the rash has been there for the last 3 weeks. On examination, there is a crusty rash around her right nipple and palpation reveals a firm lump just below the areola that appears to be tethered to surrounding tissues. What is the most likely diagnosis?
A Intraductal papilloma B Phyllodes tumour C Paget’s disease of the breast D Breast abscess E Fibroadenoma
Paget’s disease of the breast.
A 43-year-old businesswoman has had a TIA. Soon after landing in the UK from a business trip to Australia, she suddenly became unable to move her right arm. She began slurring her speech, the right side of her face started drooping and she temporarily lost vision in her right eye. She adds that she experienced some pain in her right leg as she was disembarking the plane, however, she assumed it was a muscle strain from wearing high-heels for several days. What underlying defect is most likely to have caused her TIA?
A Atrial fibrillation B Atrial septal defect C Carotid atherosclerosis D Infective endocarditis E Prosthetic heart valve
Atrial septal defect.
Which of the following is not a recognised cause of acute pancreatitis?
A Hyperlipidaemia
B Hypothermia
C Hypocalcaemia D Mumps
E Azathioprine
Hypocalcaemia.
A 34-year-old man is brought to A+E having collapsed in a shopping mall. He did not lose consciousness but mentioned that he felt dizzy and could feel his ‘heart racing’. He has a past medical history of asthma. His ECG shows a regular narrow complex tachycardia with no visible P waves. Vagal manoeuvres failed to terminate the tachycardia. What is the next most appropriate step in the management of this patient?
A Verapamil B Amiodarone C Adenosine D Bisoprolol E Flecainide
Verapamil.
Which of the following is a cause of primary amenorrhoea?
A Prolactinoma B Pregnancy C Haemochromatosis D Polycystic ovarian syndrome E Turner syndrome
Turner’s syndrome.
In which part of the nephron does bendroflumethiazide have its effect?
A Proximal convoluted tubule B Descending limb of the loop of Henle C Ascending limb of the loop of Henle D Distal convoluted tubule E Collecting duct
Distal convoluted tubule.
A 62-year-old heavy smoker is being investigated for lung cancer having presented with a 4-month history of unintentional weight loss, haemoptysis and fatigue. He claims that his voice has become hoarse and a junior doctor adds that he has a textbook ‘bovine cough’. In which part of the lung is the tumour most likely to be found?
A Left apex B Right middle lobe C Right base D Left base E Pleura
Left apex.
Which of the following most accurately describes the sodium and potassium requirements of a 70 kg man over a 24 hour period?
A 100mmol Na+ and 40-50mmol K+ B 120mmol Na+ and 5-10mmol K+ C 120mmol Na+ and 10-20mmol K+ D 120mmol Na+ and 60-70mmol K+ E 140mmol Na+ and 60-70mmol K+
140mmol Na+ and 60-70mmol K+.
A 27-year-old female presents to her GP complaining of an episode of painful loss of vision that lasted 1 day and resolved spontaneously. 6 months ago, she lost sensation across the lateral half of her left leg which also resolved spontaneously. Which of the following would you expect to see in her diagnostic work up?
A Bence Jones proteins B Oligoclonal bands on CSF electrophoresis C High CSF protein D Xanthochromia E Raised ICP
Oligoclonal bands on CSF electrophoresis.
Which of the following is an acquired cause of long QT syndrome?
A Romano-Ward syndrome B Hyponatraemia C Hyperkalaemia D Hypomagnesaemia E Hypercalcaemia
Hypomagnesaemia.
A 70-year-old man presents with a 3-month history of polyuria. He has been urinating up to 12 times per day and has also experienced some constipation, abdominal pain and back pain. More recently, he has noticed that his face appears ‘puffier’ than usual and his ankles are swollen. He is on citalopram to treat his depression and takes no other regular medications. Blood tests reveal: ESR = 64 mm/hr (< 22). Urinalysis reveals:
Protein: Positive
Blood: Negative
24 hr urine protein (g): 9.8 (< 3.5) What is the most likely diagnosis?
A Cushing’s syndrome B Amyloidosis C Glomerulonephritis D Malignancy E Congestive cardiac failure
Amyloidosis.
What is the most common cause of urinary tract infections?
A Staphylococcus aureus B Staphylococcus saprophyticus C Enterococcus faecalis D Escherichia coli E Klebsiella pneumonia
Escherichia coli.
A 36-year-old man presents to his GP with a 1-month history of shortness of breath on exertion. He has also experienced a low-grade fever and a dry cough. He has a past medical history of HIV. A pulse oximeter is attached showing an oxygen saturation of 97% at rest. The patient is then asked to walk up and down the room a few times and his oxygen saturation drops to 88%. What is the most likely diagnosis?
A Interstitial lung disease B Pulmonary embolism C Pneumocystis jirovecii pneumonia D Mycobacterium avium complex E Bronchiectasis
Pneumocystis jirovecii.
An 88-year-old care home resident is receiving oral clarithromycin to treat a chest infection. She develops profuse watery diarrhoea and her temperature rises to 38.2C. She has vomited three times and is experiencing diffuse abdominal discomfort. A stool sample is positive for Clostridium difficile toxin. Which antibiotic should be given to this patient?
A Co-amoxiclav B Penicillin C Metronidazole D Ciprofloxacin E Tetracycline
Metronidazole.
What is another name for target cells?
A Codocyte B Dacrocyte C Spherocyte D Reticulocyte E Schistocyte
Codocyte.
A 34-year-old man with Marfan’s syndrome, comes to A+E having experienced a sudden tearing chest pain. He adds that the pain seems to move to his back. On examination, an early diastolic murmur is heard over the aortic valve and unequal arm pulses are palpated. What is the most likely diagnosis?
A Ruptured aortic aneurysm B Coarctation of the aorta C Aortic dissection D Myocardial infarction E Tension pneumothorax
Aortic dissection.
Which set of spirometry results is most likely to be seen in a patient with COPD?
A FEV1 > 0.8 and FEV1:FVC > 0.7 B FEV1 < 0.8 and FEV1:FVC < 0.7 C FEV1 > 0.8 and FEV1:FVC < 0.7 D FEV1 < 0.8 and FEV1:FVC > 0.7 E Impossible to tell without FVC measurement
FEV1 < 0.8 and FEV1:FVC < 0.7.
A 15-year-old boy arrives at A+E with sudden-onset pain and swelling in his scrotum, which began 2 hours ago whilst playing a rugby match. He also starts vomiting and complains of pain in his right iliac fossa. On examination, his right hemiscrotum is red and swollen. What is the most appropriate first step in his management?
A Doppler ultrasound of the testes B CT Scan C Exploratory surgery D Empirical antibiotics E Abdominal X-ray
Exploratory surgery.
Which scoring system is used to determine a patient’s risk of developing
pressure sores?
A GRACE score B ABCD2 score C Ranson score D Waterlow score E Rockall score
Waterlow score.
A 36-year-old man presents with a 3-week history of fatigue, frequent urination and excessive thirst. He also mentions that he has been unable to take part in his weekly 5-a-side football sessions for the past month because his ‘muscles feel weak’. The patient’s notes reveal that, during a previous appointment 6 months ago, his blood pressure was measured at 164/98 mm Hg. He was offered a follow-up appointment to discuss management options, however, he did not attend. The GP measures the patient’s blood pressure again, and it is 172/102 mm Hg. What would you expect to see on the ECG of this patient?
A Tented T waves B Absent P waves C ST elevation D J waves E U waves
U waves.
A 40-year-old man is brought into A+E after he was found lying unconscious on the side of the road with an empty bottle of whisky next to him. Once he regains consciousness, he starts yelling at the ward staff expressing that he thinks he has been kidnapped and is being held hostage. He jumps out of bed, but finds it difficult to walk. He has a wide-based gait and he is taking small steps. Given the most likely diagnosis, what should form part of the immediate management?
A Acamprosate
B Chlorediazepoxide C Thiamine
D Naloxone
E Disulfiram
Thiamine.
