VSA formative questions 2018/9 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)
PUD Gastric ulcer Duodenal ulcer Peptic ulcer Helicobacter pylori infection H. pylori
(not accepted: Coeliac GORD Gastritis IBD Pancreatitis Gallstones Crohns GI ulceration)
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?
Torsion
Left 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)
What is the most appropriate initial investigation?
Ultrasound leg USS leg (left) Ultrasound leg (left) USS left leg Doppler ultrasound leg (left) Doppler ultrasound left leg Ultrasound left leg Doppler ultrasound leg USS leg Ultrasound lower limb Doppler ultrasound lower limb USS lower limb Duplex ultrasound
A 71 year old man has a five-day history of confusion, personality change and headache. A diagnosis of encephalitis is made.
What is the most common causative organism in encephalitis?
Herpes simplex virus
HSV
Herpes simplex
Herpes simplex type 1
A 68 year old woman has a four week history of right-sided headache which is worse when she combs her hair. She also reports pain on chewing.
What is the next most appropriate investigation?
Erythrocyte sedimentation rate
ESR
(N.B. not CT head, trial pred., inflammatory markers)
A 24 year old woman has had two months of unilateral frontal pulsating headaches lasting 12-18 hours, occurring weekly. They are associated with nausea and relieved by over the counter ibuprofen and sleeping. Fundoscopy is normal.
She is otherwise fit and well.
What is the most likely cause of her headaches?
Migraine
Migraine without aura
(N.B. not cluster headaches, tension headaches etc.)
A 45 year old woman with rheumatoid arthritis has weakness in her arms, worse in the evening. She has trouble keeping her eyes open when reading long reports. She has a bilateral ptosis which develops after staring upwards for some time. What is the most likely diagnosis?
MG
Myasthenia gravis
(N.B. not MS, Horner’s, Graves)
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?
Pancreatitis
Acute pancreatitis
Alcoholic pancreatitis
(N.B. not alcoholic hepatitis, chronic pancreatitis, alcoholic liver disease)
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?
OGD
Endoscopy
Upper GI endoscopy
A 21 year old student has two weeks of visual disturbance. She describes blurring of her vision which is worse after having a hot shower. She has no history of visual problems and is usually fit and well.
Eight months ago she had a three week episode of numbness in her right leg, which resolved spontaneously.
What is the most likely underlying diagnosis?
Multiple sclerosis
MS
Demyelinating disease
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?
Iron deficiency anaemia Microcytic anaemia Low iron Low ferritin IDA
An 18 year old man has had abdominal pain and vomiting for two days. He is usually fit and well.
An ABG is performed showing the following:
pH: 7.23 (7.35–7.45)
pO2: 12.5 kPa (10–14)
pCO2: 3.5 kPa (4.5–6.0)
HCO3: 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?
Urine ketones Ketones Blood ketones Urinary ketones Capillary ketones Capillary blood ketones Urine dipstick ketones
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 43 IU/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?
MM
Myeloma
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?
Membranous glomerulonephritis Amyloidosis Nephrotic syndrome AA amyloid Low albumin Hypoalbuminaemia Nephrotic syndrome protein loss
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?
Head scan Head CT Brain scan CT scan CT head Brain CT CT brain
A 40 year old woman on prednisolone for rheumatoid arthritis has a wrist fracture after minimal trauma. She requires screening for osteoporosis as part of her work-up for this. What is the best method of investigating for osteoporosis?
DXA scan DEXA scan DEXA Bone density scan DXA Dual energy X-ray absorptiometry
A 70 year old man has a 2 day history of severe epigastric pain. He has no history of alcohol intake. He is diagnosed with acute pancreatitis. What is the most likely underlying cause of his pancreatitis?
Gallbladder stone Ductal stone Gallstones Choledocolithiasis biliary stones Cholelithiasis Gallstone causing obstruction
A 26 year old man develops an itchy vesicular rash on the extensor surfaces of his elbows and knees. He has a diagnosis of coeliac disease but is otherwise fit and well. What is the most likely diagnosis of the rash?
Dermatitis herpetiformis
N.B. not eczema, psoriasis, dermatitis herpaticum etc.
A 17 year old man has multiple neurofibromas. He has 8 large brown macules over his torso and axillary freckling. What is the mode of inheritance of this disease?
Autosomal Dominant
A 25 year old man develops a red eye. He has had two weeks of swelling of his fingers, a painful swollen right ankle and left knee. He has also been experiencing pain on passing urine. He had an episode of diarrhoea 2 weeks ago. He has mouth ulcers and a scaly brown maculopustular rash on the soles of his feet. Urethral swabs and urine culture are negative. What is the most likely diagnosis?
Reactive arthritis Reiter’s syndrome Reiter’s triad Seronegative arthritis Reiter’s disease
An 85 year old woman has 2 days of dysuria and frequency.
Urinalysis:
Nitrite 2+
Leukocytes 2+
Blood negative
Protein negative
Her urine is sent for culture and she is started on trimethoprim for suspected urinary tract infection (UTI).
What is the most common causative organism?
E. Coli
A 49 year old man with a 25 year history of ulcerative colitis develops nausea and jaundice. He has no abdominal pain.
Investigations:
ALT 57 IU/L (10–50)
AST 106 IU/L (10–40)
Bilirubin 98 μmol/L (<17)
ALP 43 IU/L (25 –115)
What is the most likely cause of these findings?
PSC
Primary Sclerosing Cholangitis
Sclerosing Cholangitis
(N.B. not hepatitis, PBC, cholangitis, haemolytic anaemia)
A 57 year old man has had fatigue for six weeks. He has no other symptoms. He has chronic kidney disease, hypertension and type 1 diabetes. He is found to have conjunctival pallor but the remainder of his examination is normal. Investigations: Haemoglobin 84 g/L (130–175) White Cell Count 6.9 x109/L (4.0–10.0) Platelets 229 x109/L (150–400) Mean Cell Volume (MCV) 85.2 fL (80–96) Ferritin 100 μmol/L (12–200) What is the most likely cause of his anaemia?
CKD Chronic kidney disease Erythropoietin deficiency EPO deficiency Lack of erythropoietin Chronic renal failure Lack of EPO Renal failure Low erythropoietin
(N.B. not perincious anaemia, anaemia of chronic disease, iron deficiency)
An 18 year old university student has a 3 day history of sore throat. She has bilateral grey exudate covering both tonsils. Examining the abdomen reveals splenomegaly. What is the most likely diagnosis?
Infective mononucleosis
EBV
Infectious mononucleitis
(N.B. not tonsillitis)
