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Flashcards in 2007 paper Deck (60)
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1

A 60 year old lady takes steroids for chronic obstructive pulmonary disease. She tells her GP that she has back pain between her shoulders which came on after she moved a paving stone in the garden. She is referred for an investigation which confirms that she has osteoporosis. Choose the correct investigation from the list below:
a - bone biopsy
b - bone mineral density scan
c - CT scan
d - isotope bone scan
e - MIR scan
f - parathyroid hormone measurement
g - serum alkaline phosphatase
h - serum calcium measurement
i - serum protein electrophoresis

Answer: B

2

An elderly man has been followed in clinic for several years because he has Paget’s disease of bone. This affects his left femur and right tibia. On review, he reports an increase in pain in his right shin. He has an investigation which confirms an increase in activity of his Paget’s disease.
Choose the correct investigation from the list below:
a - bone biopsy
b - bone mineral density scan
c - CT scan
d - isotope bone scan
e - MIR scan
f - parathyroid hormone measurement
g - serum alkaline phosphatase
h - serum calcium measurement
i - serum protein electrophoresis

Answer G

3

A 70 year old lady presents with severe back pain and height loss of 4 inches which has developed over a few weeks. She has been generally unwell and her GP has found her to be anaemic. She has an investigation which suggests that the cause of her back pain is myeloma.

Choose the correct investigation from the list below:
a - bone biopsy
b - bone mineral density scan
c - CT scan
d - isotope bone scan
e - MIR scan
f - parathyroid hormone measurement
g - serum alkaline phosphatase
h - serum calcium measurement
i - serum protein electrophoresis

Answer I

4

A 66 year old male has a history of chronic cough with grey-black sputum production over ten years duration. He has noticed a progressive deterioration in exercise tolerance and radiology shows emphysematous changes together with large nodules within the lungs.
Choose the most likely occupational cause from the list below:
a. Asbestos exposure
b. Aviary working in zoo
c. Cadmium fume exposure
d. Coal mining
e. Deep sea diving
f. Knife grinding
g. Paint spraying
h. Radon exposure
i. Steel foundry work
j. Tobacco smoking

D

5

A 39 year old female presents with increasing shortness of breath and a dry cough. Radiology shows a diffuse reticular-nodular chest X-ray. A lung biopsy shows small granulomas without caseation within the interstitium.
Choose the most likely occupational cause from the list below:
a. Asbestos exposure
b. Aviary working in zoo
c. Cadmium fume exposure
d. Coal mining
e. Deep sea diving
f. Knife grinding
g. Paint spraying
h. Radon exposure
i. Steel foundry work
j. Tobacco smoking

B

6

A 73 year old male ex-shipyard worker presents with chest pain and rapidly increasing shortness of breath. He has never smoked. Radiology shows pleural plaques and a diffuse tumour extending around the right lung. Biopsy confirms a malignant neoplasm.
Choose the most likely occupational cause from the list below:
a. Asbestos exposure
b. Aviary working in zoo
c. Cadmium fume exposure
d. Coal mining
e. Deep sea diving
f. Knife grinding
g. Paint spraying
h. Radon exposure
i. Steel foundry work
j. Tobacco smoking

A

7

A 56 year old man treated 2 days ago for an acute myocardial infarction becomes acutely breathless and collapses. On examination he has evidence of a cerebrovascular accident with a left hemiparesis, and auscultation of the heart reveals a pansystolic murmur.
Acute myocardial infarction is a significant cause of mortality and morbidity in the UK. For each of the following scenarios select the most likely sequelae described.
a. Cardiac tamponade
b. Contractile dysfunction
c. Dressler’s syndrome
d. Ischaemic cardiomyopathy
e. Mural thrombosis
f. Myocardial rupture
g. Papillary muscle rupture
h. Supraventricular tachycardia
i. Ventricular aneurysm
j. Ventricular tachycardia

E

nb mural thrombus: the formation of a thrombus in contact with the endocardial lining of a cardiac chamber, or a large blood vessel, if not occlusive.

8

A 78 year old woman had been complaining of chest pain a week ago. A neighbour is worried because she hasn’t seen the woman for a couple of days and calls the police who break into the missing woman’s house. The woman is found sat in her armchair in front of the television with no signs of life. Postmortem examination shows the pericardial sac contains 400ml of clotted blood.
Acute myocardial infarction is a significant cause of mortality and morbidity in the UK. For each of the following scenarios select the most likely sequelae described.
a. Cardiac tamponade
b. Contractile dysfunction
c. Dressler’s syndrome
d. Ischaemic cardiomyopathy
e. Mural thrombosis
f. Myocardial rupture
g. Papillary muscle rupture
h. Supraventricular tachycardia
i. Ventricular aneurysm
j. Ventricular tachycardia

F

nb tamponade: compression of the heart by an accumulation of fluid in the pericardial sac. (so isnt blood)

9

A 62 year old man retired from work after suffering from an acute myocardial infarction 6 months ago. He has recently been feeling unwell with a fever and sharp chest pain. Auscultation reveals a pericardial rub.
Acute myocardial infarction is a significant cause of mortality and morbidity in the UK. For each of the following scenarios select the most likely sequelae described.
a. Cardiac tamponade
b. Contractile dysfunction
c. Dressler’s syndrome
d. Ischaemic cardiomyopathy
e. Mural thrombosis
f. Myocardial rupture
g. Papillary muscle rupture
h. Supraventricular tachycardia
i. Ventricular aneurysm
j. Ventricular tachycardia

C

nb Dressler syndrome is a secondary form of pericarditis that occurs in the setting of injury to the heart or the pericardium (the outer lining of the heart). It consists of fever, pleuritic pain, pericarditis and/or a pericardial effusion.

10

A 64-year old man presents with a 2-hour history of sudden severe abdominal pain radiating to his back. He has a history of treated hypertension and angina. On examination he is drowsy and pale, has cold extremities with a weak radial pulse of 136/min and a BP of 66/38.
Choose the most likely underlying cause:
a. Adrenaline
b. Anaphylaxis
c. Atenolol
d. Autonomic neuropathy
e. Cardiogenic shock
f. Glyceryl trintitrate
g. Gram negative sepsis
h. Hypovolaemic shock
i. Morphine
j. Noradrenaline

H

11

A 72-year old woman with a history of ischaemic heart disease and chronic atrial fibrillation undergoes an emergency laparotomy for a perforated sigmoid colon. 24-hours after surgery, her conscious level begins to deteriorate and urine output falls to 15ml/hour. On examination she has warm and clammy extremities, with a bounding radial pulse of 124/min and BP of 76/48.
Choose the most likely underlying cause:
a. Adrenaline
b. Anaphylaxis
c. Atenolol
d. Autonomic neuropathy
e. Cardiogenic shock
f. Glyceryl trintitrate
g. Gram negative sepsis
h. Hypovolaemic shock
i. Morphine
j. Noradrenaline

G

12

A 35-year old man is admitted with a right lower lobe pneumonia. He is treated with intravenous Amoxicillin and oral Erythromycin. Soon after admission, he complains of chest tightness. His condition deteriorates rapidly and on examination his pulse is 88/min, BP 62/42 and there is a florid rash throughout his torso and limbs.
Choose the most likely underlying cause:
a. Adrenaline
b. Anaphylaxis
c. Atenolol
d. Autonomic neuropathy
e. Cardiogenic shock
f. Glyceryl trintitrate
g. Gram negative sepsis
h. Hypovolaemic shock
i. Morphine
j. Noradrenaline

B

13

A 55-year old man presents with a scaly eruption present over the forehead and upper back. What diagnosis is most likely?
For each of these patients with rash, select the most likely diagnosis from the list below.
a. Atopic eczema
b. Drug eruption
c. Guttate psoriasis
d. Lichen planus
e. Pityriasis rosea
f. Pityriasis versicolor
g. Seborrhoeic dermatitis
h. Tinea corporis
i. Urticaria
j. Viral exanthem

G

14

A 19-year- old girl with no previous history of skin problems developed a slightly itchy eruption on the chest and back two weeks after a sore throat. What is the most likely diagnosis?
For each of these patients with rash, select the most likely diagnosis from the list below.
a. Atopic eczema
b. Drug eruption
c. Guttate psoriasis
d. Lichen planus
e. Pityriasis rosea
f. Pityriasis versicolor
g. Seborrhoeic dermatitis
h. Tinea corporis
i. Urticaria
j. Viral exanthem

C

15

A boy aged 3 presents with an itchy eruption affecting the antecubital and popliteal fossae present for 6 months. What diagnosis is most likely?
For each of these patients with rash, select the most likely diagnosis from the list below.
a. Atopic eczema
b. Drug eruption
c. Guttate psoriasis
d. Lichen planus
e. Pityriasis rosea
f. Pityriasis versicolor
g. Seborrhoeic dermatitis
h. Tinea corporis
i. Urticaria
j. Viral exanthem

A

16

A 65 year old man, a long term smoker, frequently has a cough productive of sputum in winter. Now he has a cough with discoloured sputum and is wheezy but has a normal chest X ray. Small Gram negative bacilli are seen on examination of a sputum specimen.

Select one pathogen which is most likely to be the cause:
a. Bordetella pertussis
b. haemophilus influenza
c. haemophilus parainfluenzae
d. legionella pneumophilia
e. moraxella catarrhalis
f. mycobacterium avium
g. mycobacterium tuberculosis
h. mycoplasma pneumoniae
i. staphylococcus aureus
j. streptococcus pneumoniae

B

17

A 70 year old woman has been unwell for 3 months with a cough and 5 kg of weight loss.
She has intermittent fever and upper zone changes on chest X ray.
Select one pathogen which is most likely to be the cause:
a. Bordetella pertussis
b. haemophilus influenza
c. haemophilus parainfluenzae
d. legionella pneumophilia
e. moraxella catarrhalis
f. mycobacterium avium
g. mycobacterium tuberculosis
h. mycoplasma pneumoniae
i. staphylococcus aureus
j. streptococcus pneumoniae

G

18

A 30 year old intravenous heroin user presents after 2 weeks of ill health with a cough, shortness of breath, a temperature of 40 degrees and a white cell count of 30,000. The chest X ray shows several rounded opacities. Gram positive cocci are seen in a blood culture after 12 hours of incubation.
Select one pathogen which is most likely to be the cause:
a. Bordetella pertussis
b. haemophilus influenza
c. haemophilus parainfluenzae
d. legionella pneumophilia
e. moraxella catarrhalis
f. mycobacterium avium
g. mycobacterium tuberculosis
h. mycoplasma pneumoniae
i. staphylococcus aureus
j. streptococcus pneumoniae

I

19

A 40 year old woman has noticed a swelling around 3cm in diameter in the left side of her neck that has increased in size over 3 months. It is painless and moves with swallowing. Thyroid function tests reveal a TSH of 2.5 mU/L (normal range 0.4 – 4.0) and TPO antibodies are negative. There is lymphadenopathy of the cervical nodes on both sides. There is no family history of note.
Identify the most likely type of swelling from the list below:
a. Colloid nodule
b. De Quervain’s (subacute) thyroiditis
c. Graves’ disease
d. Hashimoto’s thyroiditis
e. Papillary carcinoma
f. Parathyroid carcinoma
g. Reidel’s thyroiditis
h. Thyroglossal cyst
i. Toxic adenoma
j. Toxic multinodular goitre

E

Papillary carcinoma (PTC) is the most common form of well-differentiated thyroid cancer, and the most common form of thyroid cancer to result from exposure to radiation. Papillary carcinoma appears as an irregular solid or cystic mass or nodule in a normal thyroid parenchyma.

20

A 78 year old woman presents with breathlessness and weight loss; she is found to be in atrial fibrillation. Thyroid function tests show a TSH of 0.1 (normal range 0.4 – 4.0) and elevated free T4. She tells you she has had a goitre for many years but tests for this have been satisfactory.
Identify the most likely type of swelling from the list below:
a. Colloid nodule
b. De Quervain’s (subacute) thyroiditis
c. Graves’ disease
d. Hashimoto’s thyroiditis
e. Papillary carcinoma
f. Parathyroid carcinoma
g. Reidel’s thyroiditis
h. Thyroglossal cyst
i. Toxic adenoma
j. Toxic multinodular goitre

J

21

A 51 year old woman with pernicious anaemia has noticed a painless swelling on both sides of her neck which has gradually increased in size over 2 years. She is well. Thyroid function tests show a normal free T4 but the TSH is 10mU/l (normal range 0.4 – 4.0).
identify the most likely type of swelling from the list below:
a. Colloid nodule
b. De Quervain’s (subacute) thyroiditis
c. Graves’ disease
d. Hashimoto’s thyroiditis
e. Papillary carcinoma
f. Parathyroid carcinoma
g. Reidel’s thyroiditis
h. Thyroglossal cyst
i. Toxic adenoma
j. Toxic multinodular goitre

D

22

A 47 year old woman, who has previously had a total hysterectomy and chemotherapy for ovarian serous adenocarcinoma, presents with an umbilical mass. The umbilicus has been obliterated by a hard reddish nodule which is oozing serous fluid. On palpation of the abdomen, there is an ill-defined, hard central abdominal mass.
a. Chronic pancreatitis
b. Distended loops of bowel
c. Enlarged bladder
d. Enlarged kidney
e. Enlarged liver
f. Enlarged spleen
g. Enlarged stomach
h. Gastro-intestinal stromal tumour
i. Metastatic carcinoma
j. Pregnant uterus

I

23

A 69 year old man presents with lower abdominal pain which has been getting worse for 24 hours. Onset of symptoms occurred after a coach trip to Blackpool and pub crawl. He gives a history of treated hypertension, intermittent constipation and urinary hesitancy. On examination, there is acute tenderness in the lower abdomen, associated with a mass arising out of the pelvis. The mass is soft and dull to percussion. Nothing is heard over it on auscultation.
a. Chronic pancreatitis
b. Distended loops of bowel
c. Enlarged bladder
d. Enlarged kidney
e. Enlarged liver
f. Enlarged spleen
g. Enlarged stomach
h. Gastro-intestinal stromal tumour
i. Metastatic carcinoma
j. Pregnant uterus

C

24

A 45 year old woman, with a known history of alcoholism, presents with acute fever. Although this has just come on, she has been feeling very tired and run down for the last few months, and has had a dragging sensation in her abdomen. Palpation reveals a firm slightly tender mass arising under the ribs in the left upper quadrant which moves down on inspiration. A full blood count reveals haemoglobin 10g/dl, white cell count 400 x 10 9 /l (mainly neutrophils) and platelets 450 x 10 9 /l.
a. Chronic pancreatitis
b. Distended loops of bowel
c. Enlarged bladder
d. Enlarged kidney
e. Enlarged liver
f. Enlarged spleen
g. Enlarged stomach
h. Gastro-intestinal stromal tumour
i. Metastatic carcinoma
j. Pregnant uterus

F

25

A 15 year old boy presents at his GP’s surgery with a temperature of 38 o C, erythematous pharynx with white papillae, and swollen neck glands only. A throat swab reveals an organism which grows on blood agar, with colonies with a clear zone of lysis around them.

Select the most likely microbial cause from the list below:
a. Adenovirus
b. Coronavirus
c. Haemophilus influenzae
d. Influenza A
e. Influenza C
f. Respiratory syncytial virus
g. Rhinovirus
h. Streptococcus pneumoniae
i. Streptococcus pyogenes
j. Streptococcus viridans

I

26

A 10 year old boy is seen at his home with a history of sudden onset of fever, cough, sore throat and headache: he now has back and thigh pains, and is confined to bed. Serology eventually reveals that he was infected with an organism that expresses a haemagglutinin and neuraminidase.
Select the most likely microbial cause from the list below:
a. Adenovirus
b. Coronavirus
c. Haemophilus influenzae
d. Influenza A
e. Influenza C
f. Respiratory syncytial virus
g. Rhinovirus
h. Streptococcus pneumoniae
i. Streptococcus pyogenes
j. Streptococcus viridans

D

27

A 60 year old man with chronic obstructive pulmonary disease has cough with production of green phlegm. Sputum culture reveals an organism that grows on agar but which requires factors X and V.
Select the most likely microbial cause from the list below:
a. Adenovirus
b. Coronavirus
c. Haemophilus influenzae
d. Influenza A
e. Influenza C
f. Respiratory syncytial virus
g. Rhinovirus
h. Streptococcus pneumoniae
i. Streptococcus pyogenes
j. Streptococcus viridans

C

28

A 21 year old female intravenous drug abuser collapses following a 2 day history of rapidly increasing malaise, fever and a patchy rash. Although previously well, she now has a systolic cardiac murmur. Her urine shows both protein and blood on dipstick test.
Identify, from the patients’ symptoms and investigation results, the most likely cause of the collapse.
a. Acute rheumatic fever
b. Amyloid valve tissue
c. Congenital valve anatomy abnormality
d. Infective endocarditis
e. Metallic valve prosthesis
f. Mitral valve prolapse
g. Non-bacterial thrombotic endocarditis
h. Normal valve
i. Senile calcific valve stenosis
j. Xenograft valve

D

29

A 71 year old male presents with anginal symptoms, shortness of breath and syncopal attacks when exercising. He has a harsh systolic flow murmur in the aortic region.
Identify, from the patients’ symptoms and investigation results, the most likely cause of the collapse.
a. Acute rheumatic fever
b. Amyloid valve tissue
c. Congenital valve anatomy abnormality
d. Infective endocarditis
e. Metallic valve prosthesis
f. Mitral valve prolapse
g. Non-bacterial thrombotic endocarditis
h. Normal valve
i. Senile calcific valve stenosis
j. Xenograft valve

I

30

An 81 year old male patient with carcinoma of the bronchus collapses and dies. The autopsy shows irregular vegetations on the mitral valve. No septic event was identified prior to the patient’s death, and the clinicians did not detect an ante-mortem murmur.
Identify, from the patients’ symptoms and investigation results, the most likely cause of the collapse.
a. Acute rheumatic fever
b. Amyloid valve tissue
c. Congenital valve anatomy abnormality
d. Infective endocarditis
e. Metallic valve prosthesis
f. Mitral valve prolapse
g. Non-bacterial thrombotic endocarditis
h. Normal valve
i. Senile calcific valve stenosis
j. Xenograft valve

G