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Practice EMQs for Medical Students

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Diabetes

 

A Peripheral neuropathy

B Nephropathy

C Retinopathy

D Cataract

E Autonomic neuropathy

F Onset type I diabetes

G Hyperosmolar coma

H Ischaemic heart disease

I Peripheral arterial disease

J Ketoacidosis

K Hypoglycaemia

L Gastroparesis

M Onset type 2 diabetes

 

Select the most likely situation that is described by the following case scenarios. Each option may be used once, more than once or not at all.

 

1. 45 year old man with 20 year history of diabetes. For the last few months he has had a burning sensation in his feet.

 

1. 72 year old man with diabetes. He has been on insulin for 6 years. His daughter had noticed that he was increasingly vague. He was found unconscious. BP 160/90. Plasma urea, creatinine & electrolytes were normal.

 

1. 26 year old Asian man is found to have glycosuria. He has been waking up at night to pass urine for 2 months. His father & uncle are both diabetic.

 

1. 32 year old woman who has been diabetic for 25 years. She can no longer cross a road on her own as she is worried that she may collapse.

 

1. 56 year old man with newly diagnosed diabetes is given laser treatment.

 

 

 

 

AKMEC

 

Diabetes – Management

 

A Blood pressure control

B Insulin

C Diet alone

D Oral hypoglycaemic drug

E Oral glucose or sugar

F Laser treatment

G Statin

H Bed rest

I Improve glycaemic control

J Intravenous dextrose

 

For each scenario below, select the most appropriate treatment from the list of options. Each option may be used once, more than once or not at all.

 

1. A 55 year old Asian man complaining of nocturia. Random blood glucose 10.2mmol/l. He was overweight.

 

1. A 47 year old man with diabetes for 10 years. At review BP 130/80, glycosylated haemoglobin 8.2% (normal <6.5%), plasma cholesterol 5.7mmol/l (normal 5.2-6.5mmol/l).

 

1. A 52 year old man with diabetes for 15 years. Recently found to have microalbuminuria. Glycosylated haemoglobin 7.2%. BP 150/85. Cholesterol 5.2mmol/l.

 

1. A 55 year old woman in diabetic clinic. She has been waiting for 2 hours & starts feeling sweaty & weak.

 

1. A 22 year old medical student notices that he is thirsty & drinking 3-4 litres of fluid a day while studying for finals. He tests his urine & finds glucose 3+ & ketones 2+.

 

 

 

 

DIAEB

Diabetic Neuropathy

 

A Abducent (VI) nerve palsy

B Amaurosis fugax

C Autonomic neuropathy

D Carpal tunnel syndrome

E Common peroneal nerve palsy

F Diabetic amyotrophy

G Occulomotor (III) nerve palsy

H Peripheral neuropathy

I Retinopathy

J Sciatica

K Ulnar nerve palsy

 

1. A 45 year old type 1 diabetic patient presents with a history of feeling light headed. On examination, he is noted to have a blood pressure of 150/90 lying & 125/70 on standing.

 

1. A 73 year old, previously fit male presents with difficulty ascending stairs. Abnormalities noted on examination are weakness of knee flexion, which is more pronounced on the left with some wasting of the quadriceps & diminished knee reflexes. He is noted to have glycosuria.

 

1. A 62 year old male diabetic presents with a sudden onset of double vision. He is noted to have a ptosis & a deviation of the right eye to the right. Pupillary size & reactions are normal.

 

1. A 66 year old male with type 2 diabetes complains of episodes of loss of vision in the right eye that may last up to 2 hours. On examination he is noted to have an irregularly irregular pulse of 70 beats per minute & a blood pressure of 155/95. Fundoscopy is normal.

 

1. A 56 year old type 2 diabetic female is admitted with pain in the feet that keeps her awake at night. The only abnormality noted on examination is loss of vibration sensation up to the mid-tibia bilaterally.

 

 

 

 

CFGBH

 

Diagnosis of Ascites

 

A Primary biliary cirrhosis

B Right heart failure

C Primary liver tumour

D Secondary liver tumours

E Bacterial peritonitis

F Nephrotic syndrome

G Carcinoma of the ovary

H Tuberculous peritonitis

I Carcinoma of caecum with peritoneal secondaries

J Budd Chiari syndrome

K Portal hypertension

 

For each patient below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

 

1. 52 year old man presents with abdominal distension & ankle swelling. He has been drinking 6 pints of beer & half a bottle of whisky a day for some years. On examination he has palmar erythema & spider naevi on his chest.

 

1. A71 year old man who has had a MI 6 months ago presents with shortness of breath & fatigue. On examination, the JVP is raised. He has pitting oedema to the knees. There is tenderness in the right upper quadrant with a smooth liver edge at 5cm.

 

1. A 50 year old man with a 1 month history of progressive abdominal distension preceded by increased tiredness, shortness of breath on exertion & weight loss of 10kg. There is a non-tender irregular mass in the right iliac fossa.

 

1. A 20 year old man presents with generalised swelling of the limbs, face & abdomen. Tests show that he has a normal blood count & liver function tests, excepting an albumin level of 18g/l & a cholesterol of 9.5mmol/l.

 

 

 

 

LBIF

 

Diagnosis of Cardiovascular Diseases in Children

 

A Kawasaki disease

B Hereditary angioedema

C Congenital nephritic syndrome

D Myocarditis

E Pericarditis

F Primary pulmonary hypertension

G Juvenile rheumatoid arthritis

H Acute rheumatic fever

I Congestive heart failure

J Toxic synovitis

K Aortic stenosis

 

From each patient below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

 

1. A 10 year old boy presents with stridor. He has h/o recurrent swelling of the hands & feet with abdominal pain & diarrhoea. His sister also suffers from similar attacks.

 

1. A 6 year old girl presents with spiking fevers. On examination, she has spindle-shaped swellings of the finger-joints.

 

1. A 12 year old boy presents with polyarthritis & abdominal pain. He had a sore throat a week ago. On examination, he is noted to have an early blowing diastolic murmur at the left sternal edge.

 

1. A 10 year old boy presents to casualty following a seizure during gym. On examination, he has a loud systolic ejection murmur with a thrill.

 

1. A 12 year old girl presents with pallor, dyspnoea, & pulse rate of 190. She is noted to have cardiomegaly & hepatomegaly.

 

 

 

 

BGHKI

 

 

Diagnosis of Causes of Postoperative Hypotension

 

A MI

B Sepsis

C Hypovolaemia

D Cardiac dysrhythmia

E Pulmonary oedema

 

Choose the single most likely diagnosis from the above options of the scenario described.

 

1. A 70 year old man who has had a gastrectomy for a GI bleed complains of shortness of breath. He has a heart rate of 120/min & is hypotensive. He has received 10 units of packed red cells, 3L of gelofusine & 1L of crystalloid. His postoperative Haemoglobin is 15.2g/dl.

 

1. A 62 year old man in recovery following abdominal surgery complains of chest pain, is pale & clammy with a heart rate of 100/min & a BP 90/65mmHg.

 

1. A 52 year old patient 24 hours post laparotomy for perforated duodenal ulcer is found to have a pulse rate of 120/min & BP 95/40mmHg. He is apyrexial & his WCC is 1.5 (units).

 

1. A 60 year old female had a fractured femur fixed 12 hours earlier. The operative blood loss was measured at 4L & was replaced intra-operatively with 3 units of packed red cells & 1L gelofusine. She has been written up for 1L dextrose saline 8 hourly. She has a heart rate of 110 & BP of 100/70mmHg.

 

 

 

 

EACC

 

Diagnosis of Clubbing

 

A Carcinoma of bronchus

B Bronchiectasis

C Pleural empyema

D Fibrosing alveolitis

E Cirrhosis

F Inflammatory bowel disease

G Congenital heart disease

H Mesothelioma

I Hypertrophic pulmonary osteoarthropathy

J Congenital

K COAD

L RA

M Carcinoma of caecum

 

For each patient below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

 

1. A 40 year old woman with weight loss & bloody diarrhoea for 14 months is noted to have clubbing of her fingernails. She has a tender swelling in the right iliac fossa.

 

1. A 73 year old central heating engineer presents with a non-productive cough & weight loss for the past 10 months. He has never smoked. On examination he has finger clubbing with normal breath sounds with no adventitial sounds.

 

1. A 30 year old medical secretary has noticed increasing breathlessness & fatigue. She recalls having had chest x-rays as a child & avoiding games at school. She is noted to be cyanotic on exercise testing & has finger clubbing.

 

1. A 59 year old man presents to the rheumatology outpatient department with haemoptysis, weight loss & painful swelling of the wrists. He has smoked since the age of 14.

 

1. A 45 year old man of no fixed abode, is seen in the A&E department, because of vomiting blood. Examination reveals a distended abdomen with prominent periumbilical veins.

 

 

 

 

MHGIE

 

Diagnosis of Diarrhoea

 

A Viral gastroenteritis

B Bacterial gastroenteritis

C Ulcerative colitis

D Crohn’s disease

E Irritable bowel syndrome

F Constipation

G Malabsorption

H Amoebic dysentery

I Drug induced

J Thyrotoxicosis

K Blind loop syndrome

L Autonomic neuropathy

M Diverticular disease

N Cancer of the rectum

O Cancer of colon

P Clostridium difficile

 

For each scenario below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

 

1. 65 year old woman admitted with diarrhoea & weight loss. On examination, she has a fine tremor & was in rapid atrial fibrillation, FBC, ESR & C-reactive protein were normal.

 

1. A 30 year old city banker comes to the GP with symptoms of abdominal bloating, intermittent constipation & diarrhoea & occasional nausea. This has been going on for the last 6 months & there has been no weight loss of malaise. She has no blood in her stool.

 

1. An 18 year old student attends accident & emergency with acute onset of vomiting at 2am followed by abdominal cramps & profuse diarrhoea. He has eaten a take-away that evening. There is some blood in the stool & he has a high fever. There has been no recent foreign travel & the FBC shows a normal haemoglobin & raised neutrophils.

 

1. 76 year old woman admitted with chest infection which was treated with cefuroxime & erythromycin. On the day prior to discharge she develops diarrhoea not associated with blood. She appears unwell. T 38⁰C & CRP 150.

 

 

 

 

JEBP

 

Diagnosis of Falls

 

A Vasovagal syncope

B Cerebrovascular accident

C Hypoglycaemia

D MI

E Fracture neck of femur

F Postural hypotension

G Epilepsy

H Visual impairment

I Substance abuse

J UTI

K Pulmonary embolism

L Panic attack

M Stokes-Adams attack

N GI haemorrhage

O Atrial fibrillation

 

For each situation below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

 

1. An 18 year old secretary is out with friends & suddenly collapses on the floor & loses consciousness. She is unresponsive for a minute or 2 & was incontinent of urine. She was previously completely well. Full clinical examination is subsequently normal.

 

1. A 90 year old woman is found lying on the floor unable to get up & unable to move her right side. She is fully conscious & able to answer questions.

 

1. A 75 year old man is found on his bedroom floor by his wife & is conscious. He got out of bed in the middle of the night to go to the toilet & felt dizzy & fell to the ground. He is on treatment for hypertension & has no other significant medical problems.

 

1. Miss AF, a 65 year old retired solicitor, falls in your surgery. She has long-standing RA. She is coming to see you because of recent onset of indigestion & change in bowel habit. Clinically she is very pale, with a rapid pulse & BP 100/60.

 

1. Mr FB, an 80 year old man is brought in to the A&E after a fall at home. His wife reports that he suddenly went pale & then blacked out. He rapidly recovered consciousness & his face became red. He had a MI 10 years ago & is on atenolol & aspirin. His daughter, a nurse, noticed his pulse was slow (and irregular).

 

 

 

 

GBFNM

 

Diagnosis of Fever

 

A Malaria

B Influenza

C Glandular fever

D Appendicitis

E Pneumonia

F Lymphoma

G Tuberculosis

H Systemic lupus erythematosis

I Sarcoidosis

J Post immunisation

K Drug reaction

L Pyelonephritis

M HIV infection

 

For each patient below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

 

1. A 45 year old woman from Jamaica presents with a 6 month history of weight loss & a 2 week history of fever & night sweats. On examination she had cervical lymphadenopathy. Her calcium was 3.0 & CXR showed bilateral lymphadenopathy with peri-hilar shadowing.

 

1. A 25 year old man with a 3 day history of high temperatures, aching limbs & neck discomfort. Apart from temperature of 39⁰C & some mild conjunctivitis, examination was normal. Antibiotics were prescribed but had had no effect.

 

1. A 50 year woman normally resident in the UK returned from visiting relatives in Pakistan. She described intermittent fevers with rigors, diarrhoea & severe headaches. She had experienced previous symptoms in the past.

 

1. A 22 year old man presented with a 2 week history of fever & drenching night sweat. He had experienced severe itching during this time. Examination was normal. CXR showed a mediastinal mass.

 

1. A 35 year old pregnant woman developed a temperature & increased urinary frequency. She was tender in the right loin. Full blood count showed neutrophil leucocytosis & urine was positive for nitrates on urinary dipstix.

 

1. A 50 year old woman presented with a temperature & aching joints, 2 days prior to her departure on holiday to Egypt. On examination she had a tender swelling on her left upper arm.

 

 

IBAFLJ

Diagnosis of Fractures & Dislocations

 

A Calcaneal fracture

B Colles’ fracture

C Anterior shoulder dislocation

D Posterior shoulder dislocation

E Navicular fracture

F Humeral shaft fracture

G Supracondylar fracture of the humerus

H Monteggia’s fracture

I March fracture

J Galeazzi fracture

K Greenstick fracture

L Spiral fracture of the tibia

M Fracture of the proximal fibula

 

From each patient below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once, or not at all.

 

1. A 33 year old man, with a history of epilepsy, presents to Casualty following a fit now unable to move his right arm & shoulder. He supports the arm in internal rotation with the other hand.

 

1. A 26 year old woman sustains a twisting injury to her left leg while skiing. She has mid-calf swelling & tenderness & is unable to weight-bear.

 

1. A 10 year old girl falls & sustains an injury to her right arm. The forearm is stiff, & the hand is deformed. She is only able to extend her fingers when her wrist is passively flexed.

 

1. A 28 year old marathon runner complains of pain in the second toe. He ran his last marathon a week ago.

 

1. A 16 year old girl falls onto her outstretched hands. She complains of pain & decreased mobility of her right wrist. On examination, she is tender in the anatomical snuffbox.

 

 

 

 

DLGIE

 

Diagnosis of Gastrointestinal Conditions

 

A Hepatoma

B Oesophageal varices

C Mallory-Weiss tear

D Perforated peptic ulcer

E Fractured rib

F Haematoma of the rectus sheath

G Umbilical hernia

H Sigmoid volvulus

I Splenic rupture

J Pancreatic pseudocyst

K Divarication of the recti

L Acute pancreatitis

 

From each patient below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be sued once, more than once, or not at all.

 

1. A 50 year old alcoholic man presents with nausea, vomiting, & epigastric pain. On examination, he has a palpable epigastric mass & a raised amylase. CT scan of the abdomen shows a round well-circumscribed mass in the epigastrium.

 

1. A 40 year old multiparous woman presents with a midline abdominal mass. The mass is non tender & appears when she is straining. On examination, the midline mass is visible when she raises her head off the examining bed.

 

1. A 19 year old man presents with sudden severe upper abdominal pain after being tackled during rugby practice. He was recently diagnosed with glandular fever.

 

1. A 7 year old girl presents with spontaneous massive haematemesis.

 

1. A 55 year old male alcoholic presents with vomiting 800ml of blood. His blood pressure is 80/50 with a pulse rate of 120. He also has ascites.

 

 

 

 

JKIBB

 

Diagnosis of Headaches

 

A Cervival spondylosis

B Stroke

C Bacterial meningitis

D Cerebral tumour

E Extradural haemorrhage

F Tension headache

G Encephalitis

H Subarachnoid haemorrhage

I Congenital heart disease

J Trigeminal neuralgia

K TIA

L Migraine

 

1. A 25 year old, highly stressed Junior House Officer complains of a headache that has been persistent for weeks. She describes the pain as being “like a tight band around her head”. Over the counter medication has been used to no avail.

 

1. A 40 year old housewife complains of a repeated history of a unilateral throbbing headache lasting several hours for 6 months. The headache is associated with a disturbance of vision. She claims that eating cheese may trigger it.

 

1. A 19 year old male 1^st year university student complains of a rapidly developing headache & a stiff neck. He has been vomiting & his friends say that he cannot stand to be in bright rooms. Examination reveals a pyrexia of 37.5⁰C.

 

1. A 70 year old man presents to his GP surgery with repeated episodes left sided hemiparesis. A recent ECG reveals that he is in atrial fibrillation. His symptoms fully resolve within 24 hours.

 

1. A 55 year old known hypertensive male complains of a sudden devastating occipital headache. He says that he feels as though he had “been kicked in the head” even though he has not experienced any trauma in the last few weeks. He is feeling drowsy & during the examination he loses consciousness.

 

 

 

 

FLCKH

 

Diagnosis of Headaches

 

A Temporal arteritis

B Meningitis

C Encephalitis

D Subarachnoid haemorrhage

E Sinusitis

F Migraine

G Tension headache

H Raised intracranial pressure

I Severe hypertension

J Analgesic rebound headache

K Trigeminal neuralgia

 

For each patient below, choose the SINGLE most likely cause of the symptom from the above list of options. Each option may be used once, more than once or not at all.

 

1. A 60 year old lady with recent onset unilateral headache made worse by combing her hair. Her thyroid function was in the hypothyroid range & her ESR was 60mm/hr.

 

1. A 70 year old man with pain in the jaw after chewing food. He has also noticed pains in his shoulder & pelvic areas over the past 3-4 weeks, plus an episode of transient visual loss in the right eye.

 

1. A 15 year old girl presented to her GP with headache & a rash. On examination she was pyrexial (38 degrees C), there was restricted neck movement & photophobia. She has a purpuric rash on her legs, which did not fade on pressure.

 

1. A 15 month old toddler developed a maculo-papular rash 10 days after receiving the MMR vaccine, followed by a swelling at the angle of the left jaw. His mother telephoned the surgery in a state of panic one morning because he is having convulsions & a high temperature.

 

1. A 30 year old man presented at the local A&E department with severe headaches, which he described, like an “explosion” inside his head. Whilst lying on the hospital trolley he suddenly became unconscious. There was no organism isolated in his CSF but the SHO who performed the LP commented about blood in the sample.

 

1. A 40 year old teacher presented with a 24 hour history of occipital headache, which became worse in the evenings after work. Her school is due for an Ofsted inspection shortly. On examination she is apyrexial but looked ill & anxious with a pulse rate of 120/min.

 

1. A 30 year old nurse presented with frontal headache after an acute viral illness. The pain was constant, affecting the right side of her head only. On examination there was marked tenderness on the right side of her face, over the maxillary area.

 

1. A 40 year old man presented with generalised pain in his head, which became progressively worse especially in the mornings. Sitting & standing made his pain worse but lying down relieved it significantly. He mentioned that he vomited twice on his way to the surgery.

 

1. Julie is a 20 year old student who is complaining of a right sided headache extending over the right eye. She noticed that the pain is worse in the evenings. She experienced a similar episode 3 months previously, which lasted for approximately 4 weeks. Her mother also suffers from headaches. Physical examination was unremarkable. Her BP was 120/80.

 

1. A 60 year old lady is complaining of an intense pain over the left frontal area, which is worse whenever she combs or brushes her hair. Eating also makes the pain worse.

 

1. Mr. Jones is a 50 year old man who is awaiting a hospital appointment to see an Orthopaedic surgeon. He has suffered from Lumbago for many years & consequently has not worked for the past 5 years. He has been depressed recently & has experienced difficulty in sleeping for which he was prescribed sleeping tablets. As well as his back pain he now complains of a persistent headache for which he has taken painkillers but without much symptomatic relief.

 

 

 

 

AABCDGEHFKJ

Diagnosis of Neck Lumps

 

A Hodgkin’s lymphoma

B Lymphadenopathy 2⁰ to infection

C Lymphadenopathy 2⁰ to malignancy

D Carotid body tumour

E Thyroid cancer

F Thyroiditis

G TB lymphadenitis

H Thyroid goitre

I Salivary gland tumour

J Parotitis

K Mumps

L Thyroglossal cyst

M Pharyngeal pouch

N Glandular fever

 

For each patient below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

 

1. 80 year old presents with symptoms of dysphagia. He has been a lifelong smoker. On examination there is a reducible mass over lateral aspect of the neck.

 

1. An anxious 19 year old female presents with a lump in the neck. She has lost 3kg in 3 months. On examination there is lymphadenopathy on both sides of the neck & larger nodes on the right. Her pulse is 96 regular; thyroid function tests are normal.

 

1. A 17 year old male presents with a 1 week history of fever, malaise, pain on swallowing & has found lumps in the neck. On examination a tender scrotal swelling is also noted.

 

1. A 58 year old male presents to his GP with a lump in the neck. He reports that he suffered from a mild upper respiratory infection in the previous week. On examination there is a hard mobile lump in the supraclavicular fossa.

 

1. An 18 year old girl presents with a midline swelling in the neck which has recently become tender. It moves on swallowing & on protusion of the tongue.

 

 

 

 

MAKCL

 

Diagnosis of Patient with Vomiting

 

A Pyloric stenosis

B Viral gastroenteritis

C Salmonella

D Uraemia

E Oesophageal carcinoma

F Gastric carcinoma

G Combined oral contraceptive pill

H Bowel obstruction

I Peptic ulcer disease

J Appendicitis

K Pancreatitis

L Bulimia

M Intussusception

 

For each patient below, choose the SINGLE most likely diagnosis from the above list. Each option may be used once, more than once or not at all.

 

1. 34 year old male with Crohn’s disease had had no bowel motions for 4 days & has been vomiting for 24 hours. Examination reveals a distended abdomen & tinkling bowel sounds.

 

1. 83 years old man with longstanding heart failure for which he takes digoxin & diuretics. For the last 24 hours he has been vomiting & passed very little urine. On examination he is pale & mildly dehydrated; examination of the abdomen is normal.

 

1. 54 year old publican has 48 hour history of severe epigastric pain & vomiting. On examination he is unwell. Pulse rate is 110/min, BP 130/90. Temp 38⁰C. Upper abdomen very tender. Amylase 1000U/l.

 

1. 34 year old man has had vomiting 2-3 times a day for 3 days. Complains of severe crampy abdominal pain & blood stained watery diarrhoea. On examination temp 37.7⁰C, abdomen soft; complains of generalised tenderness. No masses/rebound/guarding.

 

1. A 25 year old travelling salesman is awoken in his hotel with crampy abdominal pain, feeling very ill & vomits 3 times over the next half an hour. He asks the receptionist to call a doctor.

 

 

 

 

HDKCB

 

Diagnosis of Patients with Abnormal Electrolytes

 

A SIADH

B Diabetes insipidus

C Diabetes mellitus

D Psychogenic polydipsia

E Primary hyperparathyroidism

F Sarcoidosis

G Amyloidosis

H Addison’s disease

I Vitamin D deficiency

 

For each patient below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

 

1. A 25 year old man complains of thirst & polyuria. Investigations: Na 151mmol/l, K 4.0mmol/l, Urea 7.1mmol/l, Creatinine 115umol/l, urine specific gravity 1.005 (normal 1.001–1.035), Glucose 4.3mmol/l (3.0-6.1), Calcium 2.4mmol/l (2.2-2.6), Phosphate 0.9mmol/l (0.8-1.6).

 

1. A 25 year old man complains of thirst & polyuria. Investigations: Na 129mmol/l, K 3.7mmol/l, Urea 4.2mmol/l, Creatinine 90umol/l, urine specific gravity 1.002, Glucose 4.6mmol/l, Calcium 2.38mmol/l, Phosphate 1.0mmol/l.

 

1. A 40 year old woman complains of thirst & polyuria. Investigations: Na 145mmol/l, K 4.0mmol/l, Urea 6.2mmol/l, Creatinine 100umol/l, Urine specific gravity 1.030, Glucose 4.5mmol/l, Calcium 2.91mmol/l, Phosphate 0.4mmol/l.

 

1. A 60 year old man is admitted with confusion following an epileptic fit. Na 121mmol/l, K 3.2mmol/l, Urea 4.2mmol/l, Creatinine 78umol/l, Urine specific gravity 1.030mmol/l, Glucose 4.5mmol/l, Calcium 2.4mmol/l, Phosphate 1.1mmol/l.

 

1. A 60 year old man is admitted with confusion following an epileptic fit. Na 135mmol/l, K 3.5mmol/l, Urea 6.5mmol/l, Creatinine 98umol/l, Urine specific gravity 1.010, Glucose 4.5mmol/l, Calcium 1.9mmol/l, Phosphate 0.4mmol/l, Parathyroid hormone 85pg/nl (normal 10-50).

 

 

 

 

BDEAI

 

Diagnosis of Patients with Hepatomegaly

 

A RA

B Polycythaemia rubra vera

C Haemachromatosis

D CLL

E CML

F Systemic amyloidosis

G Kalaazar

H Malaria

I Congestive cardiac failure

J Severe emphysema

K Malignant melanoma

L Portal vein thrombosis

M Toxoplasmosis

N Cirrhosis with hepatoma

 

For each of the patients below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

 

1. A 30 year old woman who has recently returned from holiday in the Gambia. She is in the 3^rd trimester of pregnancy & complains of headaches & fever. On examination her BP is 110/70, there is a soft ESM, shotty lymphadenopathy & hepatosplenomegaly. Examination of the skin is unremarkable. Investigations revealed a Hb of 10.5g/dl, WBC of 5x10⁹/l, platelet count of 80x10⁹/l.

 

1. A 78 year old woman attends complaining of widespread itching. Examination reveals hepatosplenomegaly. The patient appears plethoric with no lymphadenopathy.

 

1. A 78 year old woman attends complaining of recent onset of tiredness. She is pale & has hepatosplenomegaly & generalised lymphadenopathy in the neck, axillae & groins.

 

1. A 60 year old woman is found to have hepatomegaly. She has a history of moderate alcohol use. She had an anterior MI 2 years previously. Examination reveals significant ankle oedema, elevated JVP & 1-2 spider naevi on her chest.

 

1. A 50 year old male with haemophilia & hepatitis C presents with weight loss & abdominal discomfort. He is mildly icteric with features of chronic liver disease & a large left lobe of the liver.

 

1. A 65 year old heavy smoker. He has been progressively short of breath over a few years. He has a smooth liver edge 2cms below the costal margin.

 

HBDINJ

Diagnosis of Pleural Effusion

 

A Pneumonia

B Pulmonary oedema

C Pulmonary tuberculosis

D Aspiration pneumonia

E Chest injury with rib fractures

F Lung metastases

G Carcinoma of bronchus

H Pleural mesothelioma

I RA

J Pneumothorax

K Acute asthma

L Pulmonary embolus

M COAD

N Sarcoidosis

O Subphrenic abscess

 

For each of the patients below, choose the SINGLE most likely diagnosis from the list of options. Each option may be used once, more than once or not at all.

 

1. 45 year old doctor from Ethiopia with a 6 week history of fever & a left sided pleural effusion. He is a heavy smoker. On examination he is thin & looks unwell. Has nicotine stained fingers. Chest examination – trachea shifted to the left. Dull to percussion at right base with reduced breath sounds.

 

1. 25 year old female with acute onset of chills, fever, cough with brown phlegm for 3 days. On examination she appears toxic, temperature 40⁰C, reduced breath sounds, bronchial breathing & stony dullness left lung base.

 

1. 70 year old male ex-builder with progressive pain in his right chest, & with cough & shortness of breath for a few months. Chest x-ray shows pleural thickening & right pleural effusion.

 

1. 70 year old female, heavy smoker for several years who presents with weight loss, reduced appetite & haemoptysis for 1 month. On examination she is thin, afebrile & is clubbed. She has bronchial breathing right upper zone. Reduced breath sounds & dullness on the right base. Chest x-ray shows right lung collapse with effusion.

 

1. 10 days following abdominal surgery, a 46 year old accountant presents with a 3 day history of cough & hiccups. He is now febrile (temp 40⁰C) & is tachypnoeic; his liver is enlarged & tender. He has right basal effusion on chest x-ray.

 

1. A 50 year old Asian diabetic woman is admitted with increasing shortness of breath & ankle swelling. ECG shows inverted T waves in Levels I, AVL & V4-6. Upper lobe blood diversion & bilateral pleural effusions are found on chest x-ray.

 

 

FAHGOB

Diagnosis of Problems with a Change in Bowel Habit

 

A Colorectal cancer

B Inflammatory bowel disease

C Irritable bowel syndrome

D Infectious diarrhoea

E Diverticular disease

F Ischaemic colitis

G Radiation proctitis

H Benign colonic stricture

I Hyperthyroidism

 

For each patient below, choose the SINGLE most likely cause of the symptoms from the above list of options. Each option may be used once, more than once or not at all.

 

1. A 25 year old female trainee solicitor presents complaining of bloating & excessive flatus. She is passing pellet-like stools associated with abdominal pains. Her symptoms have been intermittent for several years.

 

1. A 75 year old man with a 6 month history of straining at stool. He also thinks he is not emptying his rectum completely. He is passing blood & mucus per rectum. He has some weight loss & anorexia.

 

1. A 32 year old female presents with a 4 week history of bloody liquid stool with mucus, 9 times a day. She has anorexia, weight loss & anaemia.

 

1. A 19 year old male returns from a recent back packing holiday in India. He is passing bloody liquid stools about 15 times a day. He has lassitude, anorexia & a temperature of 37.5⁰C.

 

1. A 65 year old man had an elective aortic aneurysm repair 5 days ago. He now has abdominal distension & left sided abdominal pain. He is passing a small amount of blood & mucus per rectum.

 

 

 

 

CABDF

 

Diagnosis of Scrotal Lumps

 

A Strangulated indirect inguinal hernia

B Varicoele

C Hydrocoele

D Epididimo-orchitis

E Trauma

F Torsion of testis

G Seminoma

H Metastasis

I Cryptoorchidism

J Retractile testis

K Mumps orchitis

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Word Count: 9918
Date: Fri, 22 Jan 2010 Time: 4:36 PM
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