Haroon's SBAs

Question 1

Which of the following investigation results would confirm a diagnosis of
hyperosmolar hyperglycaemic state (HHS)?
A. Blood glucose 14 mmol/l
B. Urinalysis ketones +++
C. Serum bicarbonate 10 mmol/l
D. Serum osmolality 330 mOsm/kg
E. Arterial blood gas pH 7.21

Answer 1

D

REMEMBER!
Severe hyperglycaemia (>30mmol/L)
Hypotension
Hyperosmolality (usually >320 mosmol/kg)
No/very mild ketosis
No acidosis

Question 2

A 39-year-old woman presents to his GP with a 5-week history of haemoptysis,
night sweats and weight loss. She has recently travelled back from West Africa.
Which of the following investigations can be used to confirm the diagnosis of
tuberculosis?

A. Blood cultures
B. Chest x-ray
C. Tuberculin skin testing
D. Ziehl-Nielsen stain
E. Computed tomography pulmonary angiogram (CTPA)

Answer 2

D ziehl nielsen

Question 3

What is the significance of these results?
HBsAg; POSITIVE
Anti-HBc; POSITIVE
Anti-HBc IgM; NEGATIVE
HBeAg; NEGATIVE

A. Acute HBV infection
B. Chronic infection
C. Natural HBV immunity (resolved infection)
D. Occult HBV infection
E. Post vaccination

Answer 3

B
chronic infection

Question 4

Peter, a 73 year old man has developed chest pain in the last month. It
started when he was walking to the shops, but sometimes he now gets pain when watching TV. Peter also tells you that he gets short of breath even when going to the kitchen to get some tea. He has a history of smoking, hypercholesterolemia, and hypertension. He is on medication to control them, however Peter isn’t great at remembering to take the tablets everyday.
What is your diagnosis?
a) Stable angina
b) Unstable angina
c) Stoke
d) Myocardial Infarction
e) GORD

Answer 4

Pain at rest as well as on movement, but not emergency presentation.
Therefore not MI (crushing central chest pain with nausea and sweating
and pallor) or stable angina (pain only on exertion relieved by rest). Not
GORD as no burning pain or indigestion.

Question 5

A 50 year old patient presents due to experiencing episodes of chest pain while
walking. Once the pain starts it quickly resolves and they have no other symptoms.
They have no allergies and have a past medical history of hypertension and severe
asthma. They are diagnosed with stable angina.
What would be the first line
treatment to help relieve their symptoms?
A. Propranolol
B. Ramipril
C. Paracetamol
D. Verapamil
E. Ibuprofen

Answer 5

D
BB contraindicated in asthma!

Question 6

Which of the following is not an associated risk factor for aortic dissection?
A. Marfans syndrome
B. Cocaine use
C. Obesity
D. Smoking
E. Ehlers Danlos syndrome

Answer 6

Obesity

Question 7

A patient is being given advice on how best to manage her ischaemic heart disease better.
Which of the following is an example of secondary prevention of
cardiovascular disease?
A. A cardiovascular risk assessment at a health check up
B. Antiplatelet therapy post MI
C. Eating a balanced diet
D. Percutaneous coronary intervention
E. Stopping smoking

Answer 7

A

Question 8

An ECG is done incidentally during this episode and it shows an erratic, irregular rhythm with absent p waves. What is the most likely culprit for the stroke?
A. Paroxysmal Atrial Flutter
b. Paroxysmal Wolff-Parkinson-White syndrome
c. Paroxysmal Atrial Fibrillation
d. Torsades de Pointes
e. Infective endocarditis leading to septic embolism of the internal carotid

Answer 8

C

Question 9

A patient has just been brought into A and E via an ambulance for severe central crushing chest pain. On examination, he is pale, diffusely sweating and gasping for breath with a respiratory rate of 23. ECG, O2 oximetry, and BP are obtained; his
ECG reveals ST elevation leads V1-V4, and O2 sats are 96%.
Which of the following is not part of the immediate management?
a. Morphine administration
b. Aspirin prophylaxis
c. O2 ventilation
d. Fast acting nitrates
e. Clopidogrel or Fondaparinux

Answer 9

C, sats above 94%

Question 10

Which of the following conditions is inherited in an autosomal recessive
pattern?

a. Glucose-6-phosphate dehydrogenase deficiency
b. Sickle cell anaemia
c. Polycythaemia vera
d. Haemophilia A
e. Von Willebrand’s disease

Answer 10

B sickle cell anaemia

• a – Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive
  condition
• c – Polycythaemia vera is not an inherited condition
• d – Haemophilia A and B are both X-linked recessive conditions so are more
  common in males than females
• e – Von Willebrand’s disease is an autosomal dominant condition

Question 11

You see a 60-year-old man who comes to the GP due to back pain which is
worse with activity. He also complains of not being able to pass urine for the past 3
days, fatigue, shortness of breath and general malaise. Based on this man’s
presentation, what are you primarily concerned about?

a. Urinary tract infection
b. Osteosarcoma
c. Acute lymphoblastic leukaemia
d. Ankylosing spondylitis
e. Multiple myeloma

Answer 11

Multiple myeloma – OLD CRAB
O – old age
C – calcium raised (hypercalcaemia) – nausea, vomiting, muscle
spasms, bone pain, dehydration
R – renal failure – decreased urine output, fluid retention causing ankle
and leg swelling, confusion
A – anaemia – fatigue, shortness of breath
B – bone lytic lesions – back pain

Question 12

A lady complains to her GP about constant constipation for the last 6 months.
There is no blood in stools, just hard in consistency. She explains her job has been really stressful recently, has suffered a long term relationship breakdown over the last year, and complains she suffers with depressive disorder. She has been taking prescribed laxatives for the last few months, but to no avail. Which of the following is
the best management plan?

a) Arrange patient for a 2 week wait as an outpatient
b) Urgent abdominal X ray to check for obstruction
c) Consider prescribing amitriptyline for her symptoms
d) Perform a DRE to check for rectal masses
e) Admit to A & E for surgical decompression of the abdomen

Answer 12

C
TCA next in line for IBS

Question 13

A prostitute comes to her GP presenting with a painful, itchy bottom. She complains there is pain on defecation, and there is bright red blood in the toilet bowl.

Which of these statements is most likely to be correct?

a) Her most likely diagnosis is anal haemorrhoids secondary to anal sex
b) Her most likely diagnosis is an anal fissure secondary to anal sex
c) Her most likely diagnosis is anal haemorrhoids secondary to childbirth
d) Her most likely diagnosis is an anal fissure secondary to childbirth
e) Her most likely diagnosis is a pilonidal sinus which is infected

Answer 13

B
not pain on sitting, defecating

Question 14

Sylvia has Ulcerative colitis and has been on medication for the last 2 months.
She has presented to the emergency department having had 10 bouts of violent bloody diarrhoea. An abdominal XR shows she has a colonic diameter of 8.5cm.
There have been no improvements for 36 hours.
What is the most effective plan of
action?
a) Administer high dose sulfasalazine
b) Infuse 0.9% sodium chloride
c) Give her prophylactic antibiotics
d) Surgical colectomy
e) Reassure her this is normal for a flare up

Answer 14

D
The most severe complication of UC is toxic megacolon – acute colonic distension with severe diarrhoea 6+ times daily
- AXR will show very distended colon and if supportive therapy (fluids, Abx, sulfasalazine) don’t show improvement within 24-
48h, you should pursue surgical colectomy otherwise there is risk of colon necrosis.

Question 15

What is seen on bloods for ALD?

Answer 15

AST:ALT is 2:1

A viral hep should give a AST:ALT of <1

Question 16

Mary Jane is a 48 y.o lady presenting to the GP feeling especially tired for the
past month. She also has generalised itching and finds it very distressing as it is
affecting all aspects of her function
She has a past medical history of Type 1 Diabetes and high cholesterol levels. Family history is significant for Type 1 diabetes and coeliac disease.

Based on the most likely diagnosis, which of the following is false?
A.Liver transplant is an option for severe disease progression
B.Patient is likely to be positive for AMA
C.Patient can be started on Ursodeoxycholic acid for symptomatic relief
D.Patient may develop osteoporosis
E. The disease affects males and females equally

Answer 16

PBS affects females more so E

Question 17

Bart is a 74 year old gentleman presenting to the emergency department with jerky hands, widespread bruising and jaundice. When questioned he reveals he is an ex IVDU and drinks at least 80 units a week for the last 25 years. On examination you note palmar erythema and spider angioma. Which of the following statements is
incorrect?

A) Palmar erythema is due to increased oestrogen
B) He is unlikely to have hepatic encephalopathy
C) He is at risk of developing Hep C
D) He is at risk of developing hepatocellular carcinoma
C) He is likely to have compensated hepatic failure

Answer 17

B
His jerky hands are indicative of ‘liver flap’ or asterixis which is, under the West Haven Criteria, a stage 2-3 sign of hepatic encephalopathy. The other statements
are all likely to be correct (remember SBA = single best answer, it isn’t black and white clarity on what is the right answer

Question 18

What is diagnostic for bladder cancer?

Answer 18

Flexible cystoscopy + biopsy

Question 19

Which one of the following laboratory findings is most likely to be found in
patients with membranous nephropathy?

A Rapid onset haematuria
B Red blood cell casts
C Oliguria
D Albuminuria
E Hypertension

Answer 19

Albuminuria

Question 20

A 6 year old boy has become more irritable over the past two months and does
not want to eat much at meals. On physical examination the paediatrician notes a
palpable mass on the left flank. An abdominal CT scan reveals a 10 cm solid mass
involving the left kidney. The child receives resection surgery, chemotherapy and
radiotherapy which is successful.
Which of the following neoplasms is this child most likely to have had?

A Angiomyolipoma
B Renal cell carcinoma
C Urothelial carcinoma
D Wilms tumour
E Medullary fibroma

Answer 20

Wilms tumour most common in children
RCC in adults

Question 21

A 67-year-old diabetic female is brought into accident and emergency following a
collapse at her home, who was found by her daughter. The patient did not lose
consciousness and appears well. Her lying blood pressure is 100/70 and standing
115/79. Urine dipstick is positive for nitrates, leukocytes and haematuria. The most
likely diagnosis is which of the following?…
A. Diabetic ketoacidosis
B. UTI
C. Orthostatic hypotension
D. Diabetic nephropathy
E. Hypoglycaemia

Answer 21

B

Question 22

A 65 year old male reports significant weight loss as well severe pain in his right
loin over the last 4 months which is abnormal for him. He is afrebrile but reports
visible clots in his urine. CXR reveal cannon ball cancer metastases in his lungs.
What genetic condition predisposes him the most to developing his primary cancer?
a) Cystic fibrosis
b) Polycystic Kidney disease
c) Kawasaki disease
d) Von-Hippel Lindau syndrome
e) Multiple Endocrine Neoplasia

Answer 22

Von hippel lindau
Von Hippel Lindau is most closely linked to development of Renal Cell Carcinoma
(RCC). RCCs form cannon ball metastases to the lungs, as well as being one of the
main cancers that metastasise to bone.

Question 23

What is ESR?

Answer 23

Erythrocyte sedimentation rate
A measure of how quickly erythrocytes will fall to the bottom of a tube.

Question 24

Wendy is a 55-year-old supermarket worker presenting to her GP with a 3-week
history of pain and stiffness in her knees. She describes her knees as feeling
unstable and says that she has been struggling with walking up the stairs,
particularly when going upstairs to go to bed at night.
What would be your first line treatment?
A. Bisphosphonates
B. Methotrexate
C. NSAIDs
D. Codeine
E. Steroid injections

Answer 24

NSAIDS
Wendy has osteoarthritis, as we can see from her typical
symptoms of knee pain that is worse with use, in the evening. The first line
treatment for osteoarthritis is NSAIDs, but can progress to codeine later on.
Bisphosphonates are largely used for osteoporosis, methotrexate and steroid
injections used in rheumatoid arthritis.

Question 25

A 56-year-old woman presents after she has been struggling to climb the stairs
and get up off her sofa recently. Blood tests show positive anti-nuclear antibodies
and elevated creatinine kinase. What is the most likely diagnosis?
a. Systemic lupus erythematosus
b. Systemic sclerosis
c. Rheumatoid arthritis
d. Antiphospholipid syndrome
e. Polymyositis

Answer 25

Polymyositis
dermatomyositis when skin involvement

Question 26

A 25-year-old male presents with a painful left knee that started 5 days ago. He
noticed that his knee would be very stiff when he first got up in the morning but
would wear off as he moved around. He also mentioned that for the past few days, he has had a burning sensation when going to the toilet. He has recently got a new girlfriend who he is sexually active with on a regular basis. On examination of his
eyes, you also note some conjunctival injection.

What is the most likely diagnosis?
a. Septic arthritis
b. Psoriatic arthritis
c. Rheumatoid arthritis
d. Reactive arthritis
e. Osteoarthritis

Answer 26

Reactive arthritis
Cant see cant pee cant climb a tree
reiters triad

Question 27

A patient presents to their GP with worsening joint pain, particularly in their big
toe. It is red, hot and swollen but he shows no systemic symptoms. When asked
about his diet, he mentions that they eat a lot of red meat and frequently enjoys a
few beers at the pub with his friends. What would be the first line immediate
treatment for this patient?

A. Colchicine
B. NSAIDs
C. Allopurinol
D. Steroids
E. Lifestyle changes

Answer 27

NSAIDs first line for gout

Question 28

What is the effect on tremors in a benign tumour when you drink alcohol?

Answer 28

Gets better

Question 29

A 28-year-old pregnant woman comes to see you complaining of pins and
needles in the fingers of her right hand. She tells you that she is also having difficulty
picking up some objects around the house and over the last week, she has been
woken up by pain in her wrist. What treatment plan would you offer for this woman?
A) Splint the wrist and prescribe naproxen
B) Offer a steroid injection
C) Nothing is needed here
D) Refer for surgical intervention
E) Advise she rest the wrist and avoid gripping objects

Answer 29

Advise she rest the wrist and avoid gribbing objects
since she’s pregnant it may resolve post partum

Question 30

You are working in A&E and a 67 year old man arrives after noticing a sudden
weakness in his left legs and arms two hours ago. A head CT rules out a
hemorrhagic transformation. What would be the best management plan?

a. Aspirin 300mg
b. Thrombectomy
c. Thrombolysis with alteplase
d. Blood glucose
e. Carotid stenting

Answer 30

C
Within 4.5 hours thrombolysis with alteplase
Also aspirin

Question 31

A 67-year-old woman comes to the GP complaining about a tremor in her left
hand that has progressively gotten worse over the last year. Upon further
questioning, she states that the tremor goes away whilst doing household chores
and when she drinks alcohol the tremor remains. She also notes that she has been
suffering with constipation and excessive sweating in the last few months. What is
the most likely diagnosis?

A. Dementia with Lewy bodies
B. Parkinson’s disease
C. Multiple system atrophy
D. Benign tremor
E. Huntington’s chorea

Answer 31

Multiple system atrophy due to autonomic signs

Question 32

A 45-year old man is admitted with headache and neck stiffness. A lumbar
puncture is performed and reveals the following results: cloudy fluid, lymphocytes
1329/mm3, neutrophils 12/mm3, low glucose, high protein, Gram-negative diplococcus seen. Select the most appropriate diagnosis?

A. Cryptococcus neoformans
B. Multiple sclerosis
C. Mycoplasma tuberculosis
D. Neisseria Meningitidis
E. Mumps

Answer 32

D

Question 33

A 55-year-old woman is referred to the stroke clinic after a suspected stroke.
She states that whilst out at lunch with some friends she was suddenly unable to
talk, and she had a sensation of tingling and numbness going up her left arm slowly
for about 25 minutes but no weakness. She also stated that her vision changed in
her left eye where she saw small flickers of light. During this time, she did not lose
consciousness, and everything resolved within a few hours. The patient mentions
that a similar event happened a few years ago. What is the most likely diagnosis?

Answer 33

Migraine
What she experienced was aura, light flickers