VSA_mock_1_flashcards
Case
Diagnosis
A 25-year-old woman complains of right iliac fossa pain, diarrhoea and weight loss worsening over several weeks. Laparotomy reveals an oedematous, reddened terminal ileum and a biopsy uncovers transmural inflammation with the presence of granulomas. What is the likely diagnosis?
Crohn’s disease
A 35-year-old woman presents with diarrhoea and lower abdominal pain. Examination of her stools reveals blood and mucus. A biopsy reveals a continuous superficial ulceration of the colon. What is the likely diagnosis?
Ulcerative colitis
A 60-year-old patient presents with chronic left-sided abdominal discomfort and the passage of fresh blood from the rectum. He denies weight loss and on examination has no palpable masses. However a colonoscopy reveals pouches of mucosa extruding through the muscle layer. What is the likely diagnosis?
Diverticular disease
A 70-year-old man who has been receiving broad-spectrum antibiotic treatment develops profuse diarrhoea and frequent episodes of incontinence. A biopsy of the colon reveals a membrane like material covering the surface composed of mucin, fibrin, polymorphs and what seems to be debris of leukocytes and mucosal epithelial cells. What is the likely diagnosis?
Clostridium difficile
A 68-year-old man presents with rectal bleeding and new onset constipation. Some years ago, he was diagnosed with polyps in his colon and recently has lost a lot of weight. An abdominal examination reveals a mass in the right lumbar region which is non-tender. What is the likely diagnosis?
Colorectal carcinoma
A 28-year old junior doctor comes in feeling ‘pretty lousy and aching all over’. She is wearing dark glasses and complains of a stiff neck. CSF examination reveals a normal CSF/blood glucose ratio and slightly raised protein of 0.7 g/L with a lymphocyte count of 150 and no neutrophils. There were no red cells in the CSF which proved that the lumbar puncture was well carried out, and that the SHO undertaking it had not punctured any veins. What is the likely diagnosis?
Aseptic/viral meningitis
A 56-year old male presents with fever, vomiting and seizures. Examination reveals a well established ear infection and there is a ‘ring-enhancing’ lesion on the MRI of his brain. What is the likely diagnosis?
Cerebral abscess
A 40-year old man complains of a stiff neck. He is the member of a cheese club and enjoys unpasteurised cheese. He has a high neutrophil count in the CSF, and gram staining reveals gram positive rods. What is the likely organism?
Listeria monocytogenes
Gram staining of a blood culture reveals Gram positive diplococci. What is the likely organism?
Streptococcus pneumoniae
A 27-year old patient has a knee effusion drained. The gram stain reveals Gram negative intracellular diplococci. What is the likely organism?
Neisseria gonorrhoeae
A 28-year old woman presents with malaise, weight loss, an erythematous rash on the face and joint pains. Both antinuclear antibodies (ANA) and double-stranded DNA (dsDNA) antibodies were found in the serum. What is the diagnosis?
Systemic lupus erythematosus
A 40-year old man presents with weight loss, muscle aches and abdominal pain. On examination he has high BP and urine dipstick reveals blood + and protein +. The patient is thought to have a vasculitis and is p-ANCA positive. What is the diagnosis?
Eosinophilic granulomatosis with polyangiitis / microscopic polyangiitis / primary sclerosing cholangitis
A patient is found to have a very high titre of anti mitochondrial antibody. What is the likely diagnosis?
Primary biliary cirrhosis
A patient presents with haemoptysis and haematuria. She is thought to have Goodpastures syndrome. What antibody should you look for?
Anti glomerular basement membrane
A 32-year old woman complains of fatiguability in many muscles and double vision. She is thought to be at risk of other autoimmune diseases as she has a family history of various autoimmune diseases and herself has autoimmune hypothyroidism. Her thyroid function is normal because she is well replaced with thyroxine. What might be causing her muscle weakness?
Myasthenia gravis
A four-year-old boy presents with a purpuric rash across the legs and buttocks. Two weeks previously you had seen the child about a chest infection. Further examination reveals abdominal pain and haematuria. Serum IgA levels are raised. What is the likely diagnosis?
Henoch-Schonlein Purpura
A patient is found to have a positive Coombes (anti-globulin) test. What is the likely diagnosis?
Autoimmune haemolytic anaemia
A child is found to be anaemic, and molecular studies show a defect in the spectrin molecule. What is the diagnosis?
Hereditary spherocytosis
A 70 year old lady presents with pallor and has the following results: Hb 90. (NR 120-150) g/dl MCV 125 fl (NR 76-96). The film shows hyper-segmented neutrophils. The patient also has type 1 diabetes and hypothyroidism that are both well treated. What is the underlying cause of her low haemoglobin.
Pernicious anaemia / B12 deficiency
A 70 year old man presents with pallor and has the following results: Hb 90. (NR 120-150) g/dl MCV 65 fl (NR 76-96). What is the likely underlying cause of the low haemoglobin.
Iron deficiency anaemia
A patient presents with tiredness and is found to have a calcium of 3.0mM and a normal PTH at 3.0pM (NR 1.1 to 6.8). What is the likely diagnosis?
Primary hyperparathyroidism
A patient presents with tiredness and is found to have a calcium of 2.0 mM and a raised PTH at 30pM (NR 1.1 to 6.8). What is the likely diagnosis?
Vitamin D deficiency / osteomalacia
A patient presents with tiredness and notices that he is more pigmented than usual. His results reveal : Na 129 K 6.2 and his blood pressure is 80/50. What is the likely underlying diagnosis?
Addison’s disease
Which vitamin deficiency is associated with Pellagra?
Niacin (vit B3)
A patient presents with tiredness and has these results: TSH=30 (NR 0.3 to 4.7). What is the likely diagnosis?
Primary hypothyroidism
