Alfred Trial EMQs EMQl a) adenosine b) atenolol c) adrenaline d) verapamil e) thiazides f) frusemide g) warfarin Which one of the above drugs is absolutely contraindicated in asthma? EMQ2 a) Mumps b) Sarcoidosis c) Systemic lupus erythematosis . d) Guillain-Barre syndrome e) Diabetes Mellitus Multiple Sclerosis g) Stroke A 25 year old previously perfectly we man presents with weakness and numbness in his lower legs. He has jlSt recovered from a recent chest infection.' On examination deep tendon reflexes are absent and sensation is also lost. CSF from a lumbar puncture shows a normal cell count and glucose but raised protein level. The most likely diagnosis is. EMQ3 a) median nerve palsy b) radial nerve palsy c) ulnar nerve palsy d) scaphoid fracture e) Colles fracture f) Tendon lesion A 22 year old IV drug abuser has injected into the anatomical snuffbox and is now unable to extend his wrist. What is his diagnosis? EMQ4 a) rheumatoid arthritis b) osteoarthritis c) gout d) infective arthritis CI 0olymyal i2 rhcumatia
Transcript
Alfred Trial EMQs
EMQl a) adenosine b) atenolol c) adrenaline d) verapamil e) thiazides f) frusemide g) warfarin
Which one of the above drugs is absolutely contraindicated in asthma?
EMQ2 a) Mumps b) Sarcoidosis c) Systemic lupus erythematosis
A 25 year old previously perfectly well man presents with weakness and numbness in his lower legs. He has jli"St recovered from a recent chest infection.' On examination deep tendon reflexes are absent and sensation is also lost. CSF from a lumbar puncture shows a normal cell count and glucose but raised protein level. The most likely diagnosis is.
EMQ3 a) median nerve palsy b) radial nerve palsy c) ulnar nerve palsy d) scaphoid fracture e) Colles fracture f) Tendon lesion
A 22 year old IV drug abuser has injected into the anatomical snuffbox and is now unable to extend his wrist. What is his diagnosis?
EMQ4 a) rheumatoid arthritis b) osteoarthritis c) gout d) infective arthritis CI 0olymyalc'; i2 rhcumatir:a
..
I
A 6S year old woman presents with weeks of morning stiffness in both knees and pain worse at the end of the day. On examination the knees are swollen. She has a flexion deformity and limitation of movement. Xray shows narrowing of the joint spaces, osteophytes at the margins of the jOints and sclerosis of the underlying bone. The most likely diagnosis is.
EMQ5 a) endoscopy b) double contrast barium meal c) helicobacter pylori breath test d) abdominal xray e) abdominal CT scan
A 50 year old thin man presents complaining of recurrent abdominal pain radiating to the back and made worse by eating. Antacids relieve the pain. He smokes 20 cigarettes a day and is on indomethacin for arthritis. What is the most useful investigation.
EMQ6 a) gastric ulcer b) gastro oesophageal reflux disease c) acute pancreatitis d) achalasia e) Barrett's ulcer of the oesophagus
What is the most likely diagnosis for the patient's presentation in EMQS?
EMQ7 a) right sided pulmonary embolism b) right sided pneumothorax c) left sided pneumothorax d) left bronchopneumonia e) left sided pleural effusion
A 20 year old asthmatic presents with increased shortness of breath. On chest examination he is found to have a deviated trachea to the right, reduced vocal resonance and hyper-resonant percussion note on the left. What is the most likely diagnosis?
EMQ8 a) take blood for urea, creatinine and electrolytes b) take blood for PSA c) Liver function tests d) insert a Foley catheter e) CSU for urinalysis and m/c/s
A 70 year old man, previously well gentleman presents to the outpatient clinic complaining of a one week history of difficulty urinating and urinary incontinence. On abdominal examination he has a distended bladder that reaches the umbilicus. He also complains of back pain. All the above are indicated except.
EMQ9 a)thalassaemia trait b Jiron deficiency anaemia c) sickle cell disease d) anaemia of chronic disease e )sideroblastic anaemia f) Folate deficiency g)B12 deficiency
A 35 year old Italian woman is found to have a Hb of 6 (NR 12-15) . She is a vegetarian and has a history of uterine fibroids. Blood film reveals microcytic, hypochromic red blood cells and a few target cells. What is the MOST likely diagnosis.
EMQ 10 a) acute sinusitis b )migraine headache c)cluster headache d)orbital cellulitis eJhay fever f)Temporal arteritis
A 40 year old man complains of constant, right sided headache with severe throbbing orbital pain. The pain lasts for an hour. He also complains of watery eyes and runny nose. He has had several episodes in the last few months and is worried he may have a brain tumour. What is the most likely diagnosis
EMQ 11 a) adenosine b )amiodarone c ) lignocaine d)procainamide e )verapamil
A 25 year old woman presents with palpitations. ECG shows AV Nodal Reentrant Tachycardia (AVNRT) What is first line treatment for AVNRT?
EMQ 12 a) hyperuricaemia b) increased LDL cholesterol c) hypokalaemia
e) hypercalcaemia
Recognised side effects of thiazide diuretics include all of the above EXCEPT.
13
mycobacterium avium b) toxoplasma gondii c) pneumocystis carinii
cytomegaloviru helicobacter
All the following are opportunistic infections in HIV disease EXCEPT.
14 ar drift d
carpal tunnel syndrome c) Dupytron's contracture d) painful flexor tenosynovitis
year old m presents acute onset nfusion with a b based gaiL n examination ere is
rectus palsies bilaterally. There is alcoholic foetor. The most likely diagnosis would be.
16 extradural hacmatoma
b) subdural haematoma c) basal skull fracture d) depressed occipital skull fracture e) intracerebral haemorrhage
year old involved road traffi dent is into ED She noted to have bruising over mastoid and
periorbital haematoma. On otoscopic examination she has bleeding behind the tympanic membrane. What is the most likely diagnosis?
17
'j l!
I
The most useful investigation (for EMQ 19) which also offers as a management
option.
EMQ21 a) alcoholism
b) biliary tract disease
c) elevated triglycerides
d) loop diuretics
�) mumps
The above are causes of acute pancreatitis EXCEPT.
EMQ22 a) indirect inguinal hernia b) direct inguinal hernia c) saphena varix d) psoas abscess e) femoral hernia
A lump is situated above and medial to the pubis tubercle and is felt on the tip of the finger when the patient coughs on scrotal invagination. What is the most likely diagnosis is.
EMQ23 a) avascular necrosis of the hip b )adrenal hyperplasia c)diabetes d) proximal myopathy e) osteoporosis
Complications of steroid therapy include all of the above EXCEPT:
EMQ24 a) Extravascular haemolysis b) bladder tumour
Stigmata of chronic liver disease include all of the above EXCEPT :
EMQ26 a) subcutaneous emphysema b) tension pneumothorax c) pulmonary embolus d) Left basal pneumonia f'l stai-us asthm�lticus
I
A 60yo man presents with dyspnoea and rigors, he has bronchial BS in the left base with increased vocal resonance.
EMQ27 a) administer IV antibiotics b) Oral antibiotics c) IV heparinisation d) obtain CXR e) Pleural drainage for therapeutic and diagnostic reasons f)administer nebuliser therapy
In treating this man (EMQ 26) the next most appropriate step in management would be:
EMQ28 a) contrast swallow b ) upper GI series c)endoscopy d)blood for LFTs e) chest xray
A40 year old man presents with haematemesis. He smells of alcohol. Following resuscitation with oxygen, IV fluids and blood products, what is the next most important step in management?
EMQ29 a) Crohn's disease b) hernias c) carcinoma d) adhesions e ) gallstone ileus
What is the most common cause of mechanical small bowel obstruction?
EMQ30 a) cervical spondylosis b) carpal tunnel syndrome c) mUltiple sclerosis d) rheumatoid arthritis e )myasthenia gravis
A 50 year old secretary complains of tingling and numbness over the right thumb, index, middle and lateral half of the ring finger, worse at night. She also complains of weakness in holding a book. On examination there is weakness of thumb abduction and wasting of the thenar muscles. What is the most likely diagnosis?
EMQ31 a) extend the thumb
rnar abduct thumb er little
the completely e) adduct the thumb
resistance
spread apart
A 20 year old woman presents with a wrist laceration. To test the function of the nerve, INould you her to do?
EMQ32 a)decreased vocal fremitus
decreased resonance c hyper-resonant percussion
breath sounds e )tracheal shift to the same side
Clinical findings \vith pneumothorax include all of the above EXCEPT which
EMQ33 a)an exacerbation of rheumatoid arthritis b) concurrent
secondary osteoarthritis c arthritis
e )unrecognised trauma
A 60 year old woman who has had rheumatoid arthritis for 3S years and has rnanaged rticosteroids the past years, now mplains of
onset of and the right which and tender, there are no uric acid crystals on joint fluid examination. There is no other evidence of synovitis. What is the MOST LIKELY diagnosis?
34 increased second pulmonary
b)syncope c)pleural rub d) dyspnoea e)stridor
pulmonary ernbolism
ElV1Q 35
sound
associated all of
a) recommendation for follow up blood count in 3 months b )test for occult blood in a series of three stools
Ll oscoPY
EXCEP'r
of serum iron,
. He is symptom APPROPRIATE ini
EMQ36 a) Inability to extend the wrist b) Inability to flex the wrist
c) Inability to spread the fingers
lransferrin
a Hb of 11.5, an
d) Inability to flex the distal phalanges of the fourth and fifth digits to oppose the thurn nger
cerates the ulnar findings is MOST LI
EMQ37 a) cholecystogram b) abdominal ultrasound
c) liver function tests d) X-ray examination of the abdomen
amylase
old woman presents to pper abdominal
On examination sh
the wrist. Which
is marked tenderness nght costal margin. What IS
HELPFUL diagnostic investigation at this stage is?
EMQ38 a) diarrhoea b)granulomatous inflammation
to steroids tt�stinal disease
course
above features occur
veins s
c) iliofemoral veins d) superficial calf veins
e) superficial thigh veins
p
disease and
is
011 ng
EMQ40 a) aspirin
b) indomethacin c) prednisolone d)paracetamol e)warfarin
Which of the above drugs in therapeutic doses would NOT be implicated in a patient with easy bruising
EMQ41 A B
C
D
Asbestosis
Asthma
Cryptogenic fibrosing
alveolitis
Emphysema/ chronic
bronchitis
E
F
G
H
I
J
Farmer's lung
Mycoplasma pneumonia
Pleural effusion
Pneumothorax
Pulmonary embolism
Sarcoidosis
The patients below have all presented with shortness of breath Choose the most appropriate diagnosis from the above list 41.1 A 19-year-old man presents to his GP with a two day history of shortness of breath on exertion and a non-productive cough. He has felt non-specifically
unwell with a headache for several days. Clinical examination is normal but a
chest X-r.ay shows patchy shadowing of both lower lobes.
41.2 A 64-year--old man with a six month history of weight loss, constipation and
rectal bleeding presents to his GP with shortness of breath and pleuritic chest pain which came on suddenly during rest. He had a recent viral illness and was bed-rested in the preceding week. Chest examination & CXR are normal.
41.3 A 22-year-old woman known to have asthma presents to the A&E Department acutely short of breath. On examination there are polyphonic wheezes throughout the chest; these gradually disappear as her condition worsens.
41.4 A 24 year old man is brought to the ED by ambulance following a motor vehicle accident. He is complaining of chest pain and is noticeably short of breath. Reduced air entry is noted on the left side of the chest. The percussion note on that side is hyperresonant.
41.5 A 77 year old retired factory worker presents to the ED with shortness of breath and discoloured sputum production. He has a past history of frequent presentations with the same problem and r:s condition appears to h: gradually
vV"orsening. He gave up srr,oking five years ago dad IHtrns a cmonlC COLLgll,
EMQ42 A Bec1omethasone Inhaler F Penicillin B Gentamicin G Prednisolone tablets C High flow oxygen H Salbutamol Smgm D Ipratropium bromide via nebuliser
nebuliser 4 hourly I Sodium cromoglycate E IV Saline J Theophylline
The patients below have all presented with complications of their respiratory
treatments. From the above list, choose the most likely medicine responsible
for the complications 42.1 A few weeks after starting this inhaled medicine, the patient notices that her mouth is sore and red with soft, white patches on the tongue and pharynx which are easily dislodged.
42.2 24 hours after being admitted as an emergency and receiving nebulised medication this patient finds that she is unable to write owing to hand tremor.
42.3 This patient, who is on the waiting list for a transurethral resection of the prostate, is brought to the A&E Department in acute urinary retention one week after starting this medicine.
42.4 This patient has been taking her medicine for several years before she falls and sustains a Calles' fracture. No sooner has she been discharged from hospital than she is readmitted with excruciating back pain. X-ray shows crush fractures of T10 and Tll.
42.5 This patient suffered from nausea and recurrent palpitations from the time the medication was started and as a result it had to be ceased.
EMQ43 A B
Sleep apnoea Dissecting thoracic aortic
aneurysm
C Metastatic rib pain D Myocardial infarction
E Oesophagitis
F Pericarditis
G
H
I
J
Pulmonary
embolism/infarction
Stable angina
Tietze's syndrome / costochondritis
Unstable angina
The patients below have presented with chest pain. Choose the most app:opriatc. ia.,]l1 osisji-om the above Jj'J.
43.1
A 32 year old man presents to his GP with a two day history of dyspnoea and retrosternal chest pain which came on gradually. The patient cannot recall any trauma or abnormal exertion and has never been ill before. The pain is stabbing in quality, radiates to the neck and left shoulder, is relieved by sitting upright, and is made worse by lying flat and coughing.
43.2 A 45 year old man is brought to the ED by ambulance having collapsed at work. His chest pain began forty minutes ago and has worsened gradually. It is now in a tight band across his chest and radiates to his neck but not his arms. On examination, he is grey, sweaty and short of breath with a pulse of 40 bpm.
43.3 A 67 year old hypertensive, obese man is brought to the ED by ambulance having collapsed while moving a chest of drawers. His chest pain, which began suddenly as he started lifting, is central, severe, burning and tearing in quality, and radiates through to his back and up to the neck. Measured with a thigh cuff, BP is 190/120 in the right arm and 120/90 in the left arm.
43.4 A 68 year old woman presents to the ED with heavy central chest pain radiating to her left arm which began an hour ago and woke her from sleep. The pain is similar to, but more severe than, her usual angina, and her glyceryl trinitrate spray has not relieved it. Troponin levels taken in the ED and again the following morning are normal.
43.5 A 38 year old woman with systemic lupus erythematosus presents to the ED with a 24 hour history of sharp right sided chest pain which is made worse by deep inspiration. She is not short of breath. She suffered a miscarriage five days ago, necessitating overnight admission to hospital for evacuation of retained products of conception. Since leaving hospital her left leg has become erythematous, swollen, warm and tender to palpation.
EMQ44 A
B
C
D E
Anaemia
Angina
Aortic stenosis
Atrial fibrillation Cardiac tamponade
F
G
H
I
J
Ischaemic Cardiomyopathy
/ cardiac failure
Constrictive pericarditis
Graves' disease
Silent angina
Ventricular septal defect
The patients below have all presented with shortness of breath. Choose the
most likely diagnosis from the above list.
44.1 A 62 year olci man presents to his GP with shortness of breath on exertion which has been getting worse for the last six months. On examination the carotid pulse
I
systolic murmur which is heard over the left sternal edge, the right second intercostal space and radiating to the carotids.
44.2 A 69 year old man who has suffered four myocardial infarctions presents to his GP with shortness of breath which has become gradually worse over the last six months. He has to sleep in an armchair and becomes breathless on minimal exertion. On examination, the apex beat is in the sixth intercostal space, mid axillary line. A gallop rhythm is evident on auscultation of the heart and, in the chest, there are bilateral basal crepitations. Echocardiography shows an ejection fraction of 20%.
44.3 A 53 year old woman with rheumatoid arthritis presents to her GP with a three month history of gradually increasing shortness of breath. Examination findings include sinus rhythm at a rate of 80 bpm; raised JVP; pulmonary basal crepitations and pitting ankle oedema. She improves initially on digoxin and diuretics but, gradually, the symptoms worsen again so the GP arranges referral to a cardiologist, who notices prominent x and y descents in the jugular venous pulsation, the JVP rises in inspiration and on auscultation hears a third heart sound.
44.4 You are called to the ward to see a 48 year old man who underwent coronary artery bypass surgery two days ago. He started to feel breathless ten minutes ago but does not have chest pain. On examination' he is grey and sweaty. Pulse is 120 bpm, regular but impalpable during respiration. Blood pressure is 78/40 and the JVP is grossly elevated, lung fields are clear. There is no time to listen to the heart sounds before he arrests. The monitor shows electromechanical dissociation.
44.5 A 51 year old woman presents to her GP with palpitations and shortness of breath. She has lost 10 kg over the last four months. On examination she appears anxious with greasy skin and a fine tremor. Her pulse is 140 bpm and irregular. Although heart sounds are normal with no murmurs, a bruit is audible in the neck.
EMQ 45 A Anaemia of chronic disease G Macrocytic anaemia B Anaemia of chronic renal H Megaloblastic anaemia
failure I Microangiopathic
C Aplastic anaemia haemolytic anaemia D Autoimmune haemolytic J Pernicious anaemia
anaemia K Sickle cell anaemia
E G6PD deficiency L Sideroblastic anaemia
F Iron deficiency anaemia
For each of the patients belmv', ,e/E'l'1. til£" i, }/!*.4 Cl1Wt /lIiu they arc m os, fllle!)' to have from the above list.
old man presents
IIacmatological investigation rnonth history of right
haemoglobin of onoscopy shows an
inal
, low MCVand a the ascending colon.
45.2
in
A 25 year old man presents with a one year history of abdominal discomfort and more recently steatorrhoea. He has also felt tired recently and has been taking iron supplements. Blood tests show a haemoglobin of 92gjL, a high MCVand a
MCHC. A blood film hypersegmented neutrophils. red concentrations arc 1 biopsy shows s
consistent with coel
A 35 year old man presents with a two rnonth history of tiredness, lethargy and
easy bruising. Blood tests show a haemoglobin of 45gjL with low white cell and platelet counts and a virtual absence of reticulocytes. Bone marrow examination shows a hypo cellular marrow with increased fat spaces.
45.4
45.5
on he is found to MCV and a normal
evidence I)f megalo
the ED with a minor tests show a haemogl
Subsequent bone marrow
A 54 year old woman with long standing chronic osteomyelitis has a routine blood test taken by her GP. This shows a haemoglobin of 98gjL with a normal MCVand MCHC.
E Anterior myocardial E Lateral
infarction infarction
Digoxin effect F Left ventricular
take off in the G Pericarditis
leads H Posterior
nferior myocardial infarction
infarction I Prolonged
of the ST segment below, choose the the above
46.1
Atrial bigemini and non -specific ST jT wave changes (esp. in anterolateral leads )
t16.2
\Vid<;:spre.lL ::,aL';L�"�"kl}";Ll ST ation.
I
46.3 Tall R wave in Vi and V2 with deep ST depression in V1-V3.
46.4 Q waves and 4 mm ST elevation in leads II, III and a VF.
46.5 Deep Q waves and 5 mm elevation of ST segments in leads V1 to V4.
EMQ47 A
B
C D
Carcinoma of the
colon/rectum
Chronic idiopathic
constipation
Depression
Diabetes mellitus
E
F
G
H
I
Diverticular disease
Hypercalcaemia
Hypothyroidism
iatrogenic: drug therapy
Pelvic nerve/spinal cord injury
The patients below have all presented with constipation. Please select the
most appropriate diagnosis from the above list. 47.1 A 66-year-old man presents with a three month history of difficulty passing stool. On direct questioning, his bowels had previously been open daily with the passage of normal formed stool. He now complains of straining to pass small worm-like stools with mucus. He also has a sensation of needing to pass stool but being unable to do so.
.
47.2 A 28-year-old chronic schizophrenic is referred by the psychiatric team complaining of abdominal pain, bloating and constipation. She opens her bowels approximately twice per week with passage of hard stool. She also complains of a dry mouth.
47.3 A 92-year-old woman falls and fractures her right neck of femur. She has been admitted to hospital by the orthopaedic team under whom she has a dynamic hip screw. She is receiving pain relief. Six days post-operatively she is complaining of colicky lower abdominal pain and the nurses tell you that she has not opened her bowels since the operation. Faeces is palpable in the left colon and on rectal examination. A plain abdominal radiograph confirms the presence of faecal loading.
47.4 A 24-year girl gives a life-long history of constipation from early childhood, She opens her bowels every two weeks and gets little or no urge to pass faeces between these times. She complains of chronic lower abdominal discomfort, nausea and bloating.
47.5
A 56-year-old man is admitted to hospital with a short history of confusion, lower abdominal pain and difficulty opening his bowels. At the time of admission be has not passed faeces for six days and is now experiencing polyuria. Direct
uestioning that he has month of chronic cough with hemoptysis which Ls down iJeing a . His wife:
that he may also have lost some weight recently.
EMQ48
C
o
E
Acute pancreatitis
Appendicitis
Ascending cholangitis
Cholecystitis
Diverticulitis
H
I
J
Faecal peritonitis
Gastritis
Large bowel obstruction
Peptic ulcer disease
Ureteric colic
patients have all with abdominal Please most appropriate diagnosis from the above list. 48.1 A 60-year-old man presents with fever (T: 39.2°C). rigors and upper abdominal
48.2
examination he is jaundiced has a blood press rnmHg.
A 17 -year-old man with no previous medical history presents with a 24 hour
48.3
right ilia pain with and vorni clear; FB " 12.5 g/dt 16.8 x
A 45-year-old man with a history of heavy alcohol intake presents with a history ncreasing e upper pain to the
retching Departmen is clinic(] lly chydratecL general abdominal pain guarding. Investigations ketones
trace glucose in the urine; FBe: wee 14.2 x 109/1, Mev 104 fl; U&Es: Na 135 mmoljl, K 3.2 mmol/l; urea 10.1 mmoljl, his lipase is significantly elevated.
-year-old presents long history intermittent iliac pain and constipation. In the last few days this has become more severe and she has felt nauseous and unable to eat. Examination reveals tenderness and guarding in the left iliac fossa. FBC: Hb 12.7 gjdl; wee 15.3 x 109/1
48.5 f15-year-old presents short history severe sided
radiating groin. He writhing unable to lie still. history is available. An abdominal X-ray is normal, The investigation
that comes back positive is the finding of some blood in the urine.
49
Cannonball metastases Cardiac I tire
EMQ50 A
B
C
D
E
Acromioclavicular j oint
dislocation
CoUes' fracture
Dislocated shoulder
Fracture of the clavicle
Fracture of the proximal
humerus
F
G
H
I
J
Fracture of the radial head Fracture of the shaft of the
humerus
Scaphoid fracture
Smith's fracture
Supracondylar fracture of
the humerus . ..
below have all/allen, appropriate fracture
their upper limb. from the above list
man falls on hi hand. He opposite hand.
is seen and felt zwicle. There is a anaesthesia over the distal attachment of the deltoid muscle.
50.2
the
A 70-year-old woman falls on her elbow. She has marked bruising and
tenderness of the upper arm. Neurovascular examination reveals a wrist drop.
man presents hand. He compJ
after spraining his tent pain and weakness
A 10-year-old child fell on his outstretched hand 30 minutes ago. The child is complaining of severe pain in the elbow, which is very swollen and tender. Examination reveals an absent radial pulse.
50.5 banker falls
of pain and decrea reported as showl
obvious fracture. Several loss of extension at the elbow.
EMQ51 A
B
C
Anal carcinoma
Anal tag
Colonic carcinoma
fissure
Irritable bowel
Diverticular disease
onto his out stretched epartment the following
of the elbow. An of the elbow jOint the patient continues
G
H
I
Haemorrhoids
Infective colitis
Ischaemic colitis
Inflammatory
disease
sIgn' of
below have all appropriate diagnosis
rectal bleeding, list
the
man presents rectal bleeding m
c has complained bowel habits for the mtermittent diarrhoea and has noticed some
Rectal examination and proctoscopy are normal FBC: Hb 9.9 g/dl; wee 62 x 109 II, MCV 75 fl.
51.2 ,\ 24-y[:l1'-o , .� Its wit:1 a r .
colicky pain, diarrhoea (bowels open 6-10 times per day & night) and passage
of blood mixed with the stool. FE C: Hb 8.8 g/dl, W C C 12.1 x 109/1, M CV 78.6 fl, ESR: 6 2 mm/hr.
51.3 A 34-year-old man with a poor fibre diet complains of several episodes of painful bright red rectal bleeding which is separate from the stool. Rectal examination is very painful & couldn't be performed. FE C: Hb 12.5 g/ dl, W C C 5.4 x 109/1,
51.4 A 24-year-old man presents with a three month history of episodes of painless, bright red rectal bleeding on straining at stool. He has noticed some blood in the bowl, separate from the stool and some on the paper after wiping. FEC: Hb 13.7 g/dl.
51. 5 A 28-year-old female medical student returns from her elective in Africa with a short history of severe lower abdominal cramps and the passage of bloody diarrhoea. FEC: Hb 13.7 g/dl, W C C 13,2 x 109/1, ESR: 50 mm/hr.
EMQ52 A
B
C
D
E
Anticoagulant therapy
Bladder cancer
Catheter trauma
Cystitis
Glomerulonephritis
F
G
H
I
J
Haemophilia
Polycystic kidney disease
Prostate cancer
Renal cell carcinoma
Ureteric calculus
The patients below have all presented with blood in the urine. Please select
the most appropriate diagnosis from the above list.
5 2.1 An 86-year-old man presents with a three day history of noticing frank blood in his urine especially at the start of the stream. He has recently been investigated for urinary frequency and hesitancy, but failed to attend his outpatient investigations. On direct questioning he also notes some lower back pain for some months. FBe: Hb 9.7 g/dI, W C C 10.2 x 109/1, U&Es: urea 11.1 mmol/l, Cr 0.09 mmoljl; PSA 452 mcg/l.
52.2 A 78-year-old man presents with a twelve hour history of passing heavily blood-stained urine. He is a smoker and worked in the rubber industry in the 1950s. He has no other symptoms and examination is unremarkable. FEC: Hb 11.2 g/dl, WCC 8.6x 109/1, U&Es: urea 4. 5 mmoljl, Cr 0.09 mmoljl; PSA 4 mcg/l.
52.3 A 40-year-old man presents with macroscopic haematuria throughout the urine stream. Abdominal examination reveals bilateral ballotable masses in the flanks. FEC: Hb13.2 g/dl, WCC 6.8x 109/1, U&Es: urea 2 2.3 mmol/1, Cr 0.30 mmoljl; PS,<\ 2 Tncg I]
I
52.4 For two months a 60-year-old man has noticed some blood in his urine mixed throughout the stream. He also has some right loin pain. Examination reveals a right loin mass. FBC: Hb 9.9 g/dl, WCC 8.2 x 109/1, U&Es: urea 10.1 mmol/l, Cr 0.12 mmol/l; ESR 80 mm/hr.
52.5 A 34-year-old man presents with a four hour history of sudden-onset, severe left loin pain radiating to the groin. Examination is unremarkable. Urinalysis demonstrates haematuria. FBC: Hb 14.8 g/dl. WCC 9.2 x 109/1, U&Es: urea 6.1 mmoljl, Cr 0.06 mmoljl
The patients below have all presented with abdominal pain. Please select the
most appropriate diagnosis from the above list. 53.1 A 92-year-old man presents with a one day history of upper abdominal pain and nausea. On gen(2ral examination he is sweaty and breathless. He has no gastrointestinal symptoms and a normal abdominal examination. Investigations reveal: FBC: Hb 11.2 g/dl, WCC 10.8 x 109/1, CK 2000 u/l, troponin I >100.
53.2 A 60-year-old woman who has had several abdominal operations presents with a three day history of increasing central colicky abdominal pain. She has been vomiting today and feels distended. She last opened her bowels normally 1 day ago. Investigations reveal: FBC: Hb 13.2 g/dl, WCC 9.8 x 109/1 and U&Es: K+ 3.4 mmoljl, abdominal X-rays revealed several distended small bowel loops & many air/fluid levels.
53.3 A 72-year-old man, who is a known vasculopath, presents with a sudden onset (half an hour ago) of very severe epigastric pain radiating to the back. On examination he is shocked: pulse 120 bpm; BP 70/50 mmHg. Femoral pulses are present but weak. There is generalized abdominal tenderness and guarding.
53.4 A 76-year-old woman who is in chronic atrial fibrillation presents with a three day history of non-specific abdominal pain and tenderness. On examination she looks unwell; her abdomen is generally tender there is no rigidity or guarding.
,- ) -
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A 40-year-old man presents with a rapid onset of severe constant epigastric pain. On examination he is lying still and appears very distressed. Examination: pulse 118 bpm; BP 120/70 mmHg; RR: 30. The abdomen is tender and there is intense guarding with rigidity. The abdomen is silent to auscultation.
EMQ54 A Amyotrophy G Mononeuritis multiplex
B Autonomic neuropathy H Peripheral sensory
C Cerebrovascular disease neuropathy D Diabetic nephropathy I Recurrent urinary tract E Hypertriglyceridemia infection
F Ischaemic heart disease J . Retinopathy
The patients below have all presented with complications of their diabetes. Choose the most appropriate diagnosis from the above list. 54.1 A 31 -year-old man with type 1 diabetes mellitus presents to his GP with balance problems which are manifest only in the dark. Fundoscopy and visual acuity are normal but there is loss of proprioception bilaterally in the toes and ankles, and a small painless ulcer is evident beneath the left first metatarsal head. 54.2 A 77-year-old man with type 2 diabetes mellitus presents to his GP with a two month history of pain in the right upper leg. On examination, the right quadriceps is wasted and very tender with an absent reflex.
54.3 A 62-year-old woman with type 2 diabetes mellitus presents to the diabetes clinic with gradual onset of weakness of the left hand and forearm. On examination there is a flaccid paresis of the wrist extensors and flexors, the thenar and hypothenar eminences and the small muscles of the hand. Sensation is intact.
54.4 A 38-year-old man with type 1 diabetes mellitus and hypertension is found to have large proteinuria on dipstick testing. Blood tests show a normal urea and creatinine.
54.5 A 78-year-old woman with type 2 diabetes mellitus presents to the A&E Department after a fall. She has fallen frequently over the past six months, each time upon standing up. Her BP is 146/72 mmHg lying and 98/50 mmHg standing.
EMQ55 A
B
C
D
Amoebic Dysentery
Autonomic neuropathy
Bacterial en e r () c ol'ti s
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F
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Crohn's disease
Irritable bowel syndrome Overflow (fClccaJ
Lmpac tionJ
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Pseudomembranous colitis
Thyrotoxicosis J Ulcerative colitis
The patients below have all presented with diarrhoea as a predominant symptom. Please select the most appropriate diagnosis from the above list. 55.1 An 80 year old man with opiate dependent chronic pain presents with a history of several days of faecal incontinence. He previously opened his bowels once weekly with laxative use. PR examination reveals a full rectum.
55.2 A 55 year old lady diabetic presents with a two month history of diarrhoea up to six times a day. She also has symptoms of nausea, and a peripheral neuropathy. On examination she has a postural drop in her blood pressure of 30mmHg
55.3 A 24 year old woman gives a long (several years) history of intermittent diarrhoea and constipation. She also complains of abdominal bloating and left iliac fossa pain. The pain and bloating are made worse by eating and relieved to some extent by defaecation. Abdominal examination is unremarkable. Hb =
55.4 An 80 year old lady is admitted to hospital with staphylococcus left lower lobe pneumonia, she is allergic to penicillin. She receives intravenous Vancomycin, followed by oral Clindamycin. She makes a good recovery & represents with copious diarrhoea 2 weeks later. PR examination is normal.
55.5 A 42 year old woman presents to her GP with a two month history of diarrhoea. She is eating well, but has noticed that she has lost some weight. She also complains of tiredness and occasional palpitations. On examination she appears to be very nervous and has a very obvious tremor in her hands.
