Typical Presentations

Question 1

53 yr old man with 30 pack year smoking history presents to GP with 2 month history of epigastric pain that wakes him up at night. It is relieved by drinking glass of milk. Pain is worse after being at the pub.

Answer 1

Peptic ulcer

Question 2

23 yr old student who has recently returned from a trip from Asia presents with anorexia, nausea, RUQ pain, lethargy. His bloods show very high ALT.

Answer 2

Viral hepatitis

Question 3

65 yr old man with history of peptic ulcer disease presents to GP due to vomiting blood. Feels tired all the time.

Answer 3

Upper GI bleed

Question 4

Female, Fat, Fair, Forty

Presents with RUQ pain and vomiting

Answer 4

Gallstones

Question 5

Overweight 53 yr old man with 20 pack year smoking history, who drinks 30 units of alcohol a week. Presents with burning epigastric pain and intermittent acidic taste in throat. He can’t say if the pain is in his abdomen or chest. He has history of depression, takes medication for it.

Answer 5

GORD

Question 6

RUQ pain, fever, palpation under costal margin causes her to catch her breath

Answer 6

Cholecystitis

Question 7

40 yr old man has intermittent waves of excruciating abdominal pain that radiates to his groin. He is rolling around the floor in pain.

Answer 7

Renal stones

Question 8

75 yr old man with 20 pack year smoking history presents to GP with weight loss, haematuria, frequency, no pain

Answer 8

Bladder (transitional cell) carcinoma

Question 9

70 yr old woman with osteoarthritis in her spine attends A&E with 3 hour history of lower back pain and numbness in buttocks/groin. She has developed faecal and urinary incontinence.

Answer 9

Cauda equina syndrome

Question 10

40 yr old woman with diabetes presents to GP with abdominal pain radiation to back that began 6 hours ago. On examination, she has loin tenderness and a fever.

Answer 10

Pyelonephritis

Question 11

Dysphagia and • retrosternal chest pain relieved by regurgitating food

Answer 11

Achalasia

Question 12

60 yr old woman with previous abdominal surgery presents with abdominal pain and vomiting. She has not opened her bowels for 2 days.

Answer 12

Small bowel obstruction

Question 13

80 yr old woman develops fever and crampy left iliac fossa pain. There is a large amount of fresh red blood mixed in with stool. On examination she has a tender abdomen and investigations reveal leukocytosis.

Answer 13

Diverticulitis

Question 14

72 yr old man presents with sudden RIF pain and rectal bleeding and AF. He is an ex-smoker, history of HTN and 2 previous Mis

Answer 14

Ischaemic bowel

Question 15

42 yr old woman presents to GP with chronic diarrhoea, weight loss, diffuse intermittent abdo pain. Has been feeling tired and bloated. Her sister suffers from similar symptoms.

Answer 15

Coeliac disease

Question 16

65 yr old man
20 pack year smoking history
Type 2 diabetes
Presents to A&E with severe sudden onset epigastric pain that radiates to his back and testicular pain

Answer 16

AAA

Question 17

26 yr old taken to A&E after becoming increasingly drowsy and confused
Diffuse abdominal pain
Vomiting
Thirsty with polyuria
Has been under the weather for a few days with a cold

Answer 17

Diabetic ketoacidosis

Question 18

12 yr old brought into A&E after sudden onset of central abdo pain and vomiting, without diarrhoea. Pain is exacerbated by movement. Tender RIF.

Answer 18

Appendicitis

Question 19

26 yr old man presents to GP with painful lower abdomen and inability to pass urine for 24 hours following heavy night of drinking in pub. He is sheepish about drug use.

Answer 19

Urinary retention

Question 20

20 yr old woman presents to GP with intermittent abdo pain and diarrhoea. She has lost weight. Smoking history.

Answer 20

Crohn’s disease

Question 21

50 yr old woman with type 2 diabetes and chronic liver disease visits GP with swollen, painful leg. It is erythematous and warm.

Answer 21

Cellulitis

Question 22

Elderly man who has recently had a hip replacement with family history of thrombophilia develops tender, red, swollen calf. He has fever and pitting oedema.

Answer 22

DVT

Question 23

69 yr old man with FH of heart disease and hypertension develops swollen legs and increasing intolerance to exercise. He is woken in the night due to difficulty breathing. O/E he has peripheral oedema, lung base crackles, S3 heart sound.

Answer 23

Heart failure

Question 24

45 yr old man with history of sarcoidosis and diabetes develops swelling in his face and legs. His urine is foamy. O/E he has mild ascites and basal crackles in lungs.

Answer 24

Nephrotic syndrome

Question 25

Pleuritic chest pain worsened by inspiration

Associated with SOB, productive cough, anorexia, haemoptysis, fever, confusion

Answer 25

Pneumonia

Question 26

Tall skinny male with sharp, sudden onset chest pain that is worse on inspiration
Associated with Sob, cyanosis, cough, fatigue

Answer 26

Pneumothorax

Question 27

Sharp, pleuritic chest pain

Exacerbated by lying flat + movement + swallowing, relieved by leaning forwards

Answer 27

Pericarditis