SBAs and feedback Flashcards
A 31 year old man has epigastric pain for 2 months, worsened by eating.
His stool antigen test is positive.
Investigations
: Haemoglobin 147 g/L (130–175)
White Cell Count 7.2 x109 /L (4.0–10.0)
Platelets 349 x109 /L (150–400)
Mean Cell Volume (MCV) 86.0 fL (80–96)
What is the most likely cause of his symptoms?
• A. Biliary colic • B. Inflammatory bowel disease • C. Mesenteric ischaemia • D. Pancreatitis • E. Peptic ulcer disease
Peptic ulcer disease [related to H Pylori]
An 18 year old man has severe left sided pain in the scrotum, radiating to the abdomen.
The right testis appears normal but the left side is swollen and tender and is lying high in the scrotum.
What is the most likely diagnosis?
• A. Acute orchitis • B. Epididymitis • C. Seminoma • D. Testicular torsion • E. Varicocele
Testicular torsion
A 25 year old female has painful left lower limb swelling.
She is 26 weeks pregnant.
Distal pulses are intact and she has no other symptoms.
Investigations:
White Cell Count 10.2 x10⁹/L (4.0–10.0)
C Reactive Protein (CRP) 8 mg/L (<5)
Which is the most appropriate initial investigation?
• A. CT venogram lower limb •
B. D-dimer
- C. Doppler ultrasound lower limb
- D. Thrombophilia screen
- E. Ventilation/perfusion isotope lung scan
Doppler USS lower limb NOT D-dimer- b/c pregnant
A 18 year old woman has a headache and drowsiness for two days.
Her temperature is 38.9°C, pulse rate 98 bpm, BP 106/70 mmHg, respiratory rate 17 breaths per minute and oxygen saturation 100% breathing air. There is marked neck stiffness.
Microscopy of cerebrospinal fluid shows numerous segmented neutrophils and gram-negative diplococci.
Which is the most likely causative organism? • A. Listeria monocytogenes • B. Mycobacterium tuberculosis • C. Neisseria meningitidis • D. Staphylcoccus aureus • E. Streptococcus pneumonia
C. Neisseria meningitidis
A 75 year old woman has memory problems.
Her husband describes a gradual deterioration over one year with marked decline in the past four weeks.
She has stopped cooking as she is frustrated at using the wrong ingredients. She occasionally starts crying for no reason.
Two months ago, she had an episode when she could not speak properly. She is aware of the change and has been low in mood.
She has hypertension and takes nifedipine.
There is slightly increased tone in the right arm and an extensor plantar response in the right leg. Her mini mental state examination (MMSE) score is 20/30.
Investigations:
CT scan of head: A number of white matter hypodensities
Which is the most likely diagnosis? •’
A. Alzheimer’s disease • B. Chronic subdural haematoma • C. Depressive pseudo-dementia • D. Lewy body dementia • E. Vascular dementia
E. Vascular dementia
An 18 year old woman has episodes of zig-zagging and flashing lights in both eyes associated with headaches for three years.
Typically, they occur two or three times per month, last approximately half an hour, and are associated with nausea and vomiting.
Her vision is affected at the time of each episode but returns to normal afterwards. Which is the most likely diagnosis?
A. Acute glaucoma • B. Migraine • C. Occipital lobe epilepsy • D. Retinal detachment • E. Tension-type headache
B. Migraine
An 80 year old woman has a collapse.
She has left hemianopia, left facial palsy, expressive dysphasia and left-sided sensory loss and motor weakness.
Which is the most likely affected territory?
• A. Left anterior cerebral artery • B. Left middle cerebral artery • C. Left posterior cerebral artery • D. Right anterior cerebral artery • E. Right middle cerebral artery
E. Right middle cerebral artery
A 51 year old man has epigastric pain radiating through to his back, and vomiting. He has a history of alcohol excess. His erect chest X-ray is normal. Investigations: Amylase 814 U/L (<220) ALT 98 IU/L (10–50) AST 156 IU/L (10–40) Bilirubin 28 µmol/L (<17) What is the most likely diagnosis? A. Alcoholic hepatitis • B. Cholecystitis • C. Gastritis • D. Pancreatitis • E. Peptic ulcer disease
D. Pancreatitis
A 60 year old woman has dyspepsia and a three month history of weight loss and fatigue.
Investigations:
Haemoglobin 88 g/L (115–165)
Mean Cell Volume (MCV) 72.2 fL (80–96)
White Cell Count 7.9 x109 /L (4
.0–10.0)
Platelets 189 x109/L (150–400)
Ferritin 6 µmol (12–200)
What is the next most appropriate investigation?
• A. CT abdomen with contrast • B. OGD (gastroscopy) • C. Thalassaemia screen • D. Transvaginal USS • E. Ultrasound abdomen
B. OGD (gastroscopy)
A 70 year old man is unable to walk for three days and has not passed urine for eight hours. He has carcinoma of the prostate with bone metastases.
Which is the most important diagnosis to exclude?
• A. Brain metastases • B. Cardiovascular accident • C. Cauda equina compression • D. Para-neoplastic syndrome • E. Pathological fracture
C. Cauda equina compression
A 52 year old woman has malaise and fatigue. She has koilonychia and her cardiorespiratory examination is normal. What is the most likely finding on blood tests?
A. Hypoalbuminaemia • B. Hypothyroidism • C. Iron deficiency anaemia • D. Thyrotoxicosis • E. Vitamin B12 deficiency
C. Iron deficiency anaemia
An 18 year old man has had abdominal pain and vomiting for two days. He is usually fit and well. An ABG is performed.
Investigations:
Arterial blood gas on air:
pH 7.23 (7.35–7.45)
pO2 12.5 kPa (10–14)
pCO2 3.5 kPa (4.5–6.0)
Bicarbonate 11 mmol/L (22–26)
Lactate 1.0 mmol/L (1–2)
Potassium 5.5 mmol/L (3.5–5.0)
Glucose 22 mmol/L (<6)
What test should be performed next to reach a diagnosis?
• A. CT pulmonary angiogram • B. Capillary ketones • C. Full blood count • D. HbA1c • E. Urine toxicology screen
B. Capillary ketones- suspected DKA [metabolic acidosis + high glucose]
A 60 year old man has constipation, backache and abdominal pain. He has a four week history of urinary frequency, malaise and 6 kg weight loss.
Investigations:
Calcium 3.2 mmol/L (2.1–2.60)
Phosphate 0.8 mmol/L (0.8–1.5)
ALP 43IU/L (25 –115)
Creatinine 397 µmol/L (50–95)
Urea 17.7 mmol/L (2.5–7.8)
PTH 0.5 pmol/L (0.9–5.4)
What condition is most likely causing this patients hypercalcaemia?
A. Chronic renal failure
- B. Multiple myeloma
- C. Primary hyperparathyroidism
- D. Prostate cancer with bony metastases
- E. Sarcoidosis
• B. Multiple myeloma
*A 58 year old woman with a 24 year history of rheumatoid arthritis develops peripheral oedema.
Investigations:
HbA1c 40 mmol/mol (20–42)
Echocardiogram: Normal systolic function
Urinalysis: Nitrite negative
Leukocytes negative
Blood negative
Protein 3+
What is the most likely cause of her peripheral oedema?
• A. Amyloidosis • B. Cardiac failure • C. Diabetic nephropathy • D. Glomerulonephritis • E. Lymphoedema
• A. Amyloidosis [Glomerulonephritis- may have blood in urine, more of an infective/inflammatory picture]
A previously fit 67 year old woman has a two hour history of sudden onset left sided arm weakness and slurring of speech.
Her capillary blood glucose, full blood count and clotting are normal.
What is the next most important investigation to perform prior to administering thrombolysis?
A. CT head • B. Carotid artery Doppler Ultrasound • C. Chest X-ray • D. ECG • E. Urea and Electrolytes
A. CT head
A 65 year old female has a one week history of palpitations. She is usually fit and well. What is the cause of her symptoms?
Her ECG is below:
• A. Atrial fibrillation • B. Atrial flutter • C. Sinus tachycardia • D. Ventricular tachycardia • E. Wolff-Parkinson White syndrome
A. Atrial fibrillation
