Classic Presentations

Question 1

White plaques on the oral mucosa which can be rubbed off with a painless, red base underneath​

Answer 1

Oral candidiasis

Question 2

Raised, sharply defined white patches found on the oral mucosa which cannot be rubbed off​

Answer 2

Leukoplakia

Question 3

Raised, sharply defined red patches found on the oral mucosa which cannot be rubbed off​

Answer 3

Erythroplakia

Question 4

40 year old presents with numerous “finger like” projections in and around the mouth

Answer 4

Squamous cell papilloma

Question 5

55 year old smoker develops a non-healing ulcer on his lip

Answer 5

Squamous cell carcinoma

Question 6

Slow growing, painless, firm single nodular mass over the parotid gland

Answer 6

Pleomorphic adenoma

Question 7

Colicky, postprandial pain and swelling​ in the mouth

Answer 7

Salivary gland stone

Question 8

Red, smooth and sore tongue

Answer 8

Glossitis

Question 9

Obese patient presents with burning in the chest that is exacerbated by bending/lying down, acid reflux and nocturnal cough

Answer 9

GORD

Question 10

Adult patient presents with intermittent dyspagia and regurgitation of undigested food, especially at night

Answer 10

Achalasia

Question 11

20 year old presents with haematemesis following a night out

Answer 11

Mallory-Weiss tear

Question 12

A 65 year old, male heavy drinker and smoker who has previously been diagnosed with Barrets oesophagus presents with progressive dysphagia, weight loss and lymphadenopathy

Answer 12

Oesophageal cancer

• Squamous cell carcinoma = related to diet and smoking
• Adenocarcinoma = associated with Barrett’s oesophagus​

Question 13

Patient with known liver disease presents with violent haematemesis

Answer 13

Oesophageal varices

Question 14

50 year old presents with heartburn, acid reflux, bad breath, nausea and dysphagia

Answer 14

Hiatus hernia

Question 15

Patient presents with early satiety, nausea and vomiting, weight loss, bloating, abdo pain and loss of appetite

Answer 15

Gastroparesis

Question 16

Postprandial epigastric pain, relieved by food + nausea, bloating, belching

Answer 16

Duodenal ulcer

Question 17

Postprandial epigastric pain worsened by food + nausea, bloating, belching

Answer 17

Gastric ulcer

Question 18

60 year old male presents with epigastric pain, nausea and vomiting, anorexia and weight loss

Answer 18

Gastric cancer - mainly adenocarcinoma

Question 19

60 year old presents with dyspepsia, epigastric discomfort, gastric bleeding, fatigue, low-grade fevers, nausea, constipation, weight loss, anaemia & recurrent RTIs

Answer 19

Gastric lymphoma

Question 20

Periumbilical pain (usually vaguely in centre of abdomen) which eventually moves and becomes localized in the RIF in the first few hours + nausea, vomiting & anorexia

Answer 20

Appendicitis

Question 21

30 year old woman with non-specific symptoms such as diarrhoea/steatorrhoea, abdo pain, angular stomatitis/mouth ulcers and weight loss +/- an itchy, symmetrical rash on the scalp, shoulders, buttocks, elbows and knees

Answer 21

Coeliac disease

Question 22

60 year old with a past medical history of AF presents with moderate-to-severe colicky or constant and poorly localised pain out of proportion to physical signs

Answer 22

Acute mesenteric ischemia

Question 23

60 year old with a history of hypertension and hyperlipidaemia presents with postprandial pain which is moderate-to-severe colicky or constant poorly localised pain + weight loss and a fear of eating​

Answer 23

Chronic mesenteric ischemia

Question 24

70 year old with a history of atherosclerosis and arrhythmia presents with severe left iliac fossa pain, bloody stool and nausea and vomiting

Answer 24

Ischemic colitis

Question 25

Lump which is worst on coughing, disappears when lying down, and can be pushed back in​

Answer 25

Hernia

Question 26

Patient presents with severe diffuse colicky abdominal pain, EARLY vomiting, LATE constipation and decreased tinkling bowel sounds​

Answer 26

Small bowel obstruction

Question 27

A patient with a history of peptic ulcers presents with acute abdominal pain and guarding, rigidity, fever and tachycardia

Answer 27

Peritonitis

Question 28

A patient post-op for abdominal surgery presents with lack of bowel movements and absent bowel sounds

Answer 28

Ilius

Question 29

May present with rectal bleeding/diarrhoea/abdominal pain/mucous discharge​ but are most often incidental findings on colonoscopy

Answer 29

Colonic polyps (adenoms)

Question 30

A 60 year old man presents with tiredness (shown on bloods to be caused be caused by anaemia) and weight loss

Answer 30

Colorectal cancer -majority are adenocarcinomas

Question 31

A 70 year old obese patient presents with non-specific left sided lower abdominal pain and no other symptoms or concerning factors

Answer 31

Diverticular disease (symptomatic diverticulosis)

Question 32

An obese older patient presents with LIF pain (exacerbated by eating and diminished by defecation or flatus), constipation and pyrexia

Answer 32

Diverticulitis

Question 33

Patient presents with severe diffuse colicky abdominal pain, LATE vomiting, EARLY constipation and tinkling bowel sounds​

Answer 33

Large bowel obstruction

Question 34

An elderly patient presents with sudden onset colicky lower abdominal pain with gross abdominal distension and a failure to pas either flatus or stool + tympanic abdomen on examination​

Answer 34

Volvulus (either sigmoid or caecal)

Question 35

A classic appendicitis patient presents with RIF pain and fever but when you operate the appendix is fine - what else can mimic appendicitis

Answer 35

Meckel’s diverticulum

Question 36

2 year old presents with watery diarrhoea, pyrexia and vomiting. Similar symptoms have been occurring in other children in their nursery

Answer 36

Rotavirus

Question 37

Normally fit and healthy adult presents with diarrhoea and explosive vomiting + pyrexia during the winter

Answer 37

Noravirus

Question 38

Patient presents with watery diarrhoea and abdominal cramps or nausea and vomiting 1-6 hours after eating leftover curry from the night before

Answer 38

Gastroenteritis caused by bacillus cereus

Question 39

Patient presents with nausea, explosive vomiting, abdominal cramps/pain, headache, weakness and diarrhoea 1-6 hours after eating funny tasting cheese

Answer 39

Gastroenteritis caused by staph aureus

Question 40

Patient presents with bloody diarrhoea, abdominal pain, fever, headache, nausea, and/or vomiting 2-14 days after eating undercooked meat and raw milk

Answer 40

Gastroenteritis caused by campylobacter

Question 41

Patient presents with diarrhoea, fever, abdominal cramps and vomiting 12-48 hours after eating a dish containing raw eggs and pink chicken

Answer 41

Gastroenteritis caused by salmonella

Question 42

Patient presents with intense abdominal cramps and watery diarrhea but no fever or vomiting 12-48 hours after eating food that was left to sit for a few hours before being eaten

Answer 42

Gastroenteritis caused by clostridium perfringens

Question 43

Patient presents with bloody diarrhoea and stomach cramps 2-14 days after going to a petting zoo

Answer 43

Gastroenteritis caused by E. coli 0157

Question 44

5-10 days after a child presents with with abdominal cramps, bloody diarrhoea and a mild fever, they begin to develop blood in the urine with a decreased urine output and anaemia

Answer 44

Hemolytic–uremic syndrome (often after E. coli 0157 infection)

Question 45

A patient presents with diarrhoea containing blood and mucus + abdominal cramps and high fever after changing the nappy of a baby with similar symptoms

Answer 45

Shigellosis (caused by shigella) - also called dysentery

Question 46

A 27 year old patient presents with long standing abdominal cramps, diarrhoea and weight loss =/- mouth ulcers

Answer 46

Chron's disease

Question 47

A 35 year old patient presents with long-standing bloody diarrhoea + mucus, increased bowel frequency and urgency, tenesmus and weight loss

Answer 47

Ulcerative colitis

Question 48

22 year old woman presents with abdominal pain, bloating, mucus in stool and feeling of incomplete emptying for several months. She has a PMH of anxiety

Answer 48

IBS

Question 49

Patient presents with anal pain on defecation and some fresh blood

Answer 49

Anal fissures

Question 50

Patient presents with perianal pain and bleeding, faecal incontinence and a palpable mass

Answer 50

Anal cancer

Question 51

Patient presents with painless fresh bleeding on defecation

Answer 51

Haemorrhoids

Question 52

An IVDU patient presents with fatigue, nausea, vomiting, poor appetite and RUQ pain +/- jaundice

Answer 52

Hepatitis

Question 53

A 25 year old woman with rheumatoid arthritis and type 1 diabetes (or other autoimmune conditions) who is taking the pill begins feeling tired and generally unwell, has muscle pain, low appetite, bloating, diarrhoea, nausea and puritius

Answer 53

Autoimmune hepatitis

Question 54

A patient with a history of alcohol excess presents with persistent fatigue, malaise, RUQ pain and hepatomegaly​

Answer 54

Alcoholic fatty liver disease

Question 55

An obese, diabetic patient without a history of alcohol excess presents with persistent fatigue, malaise, RUQ pain and hepatomegaly​

Answer 55

Non-alcoholic fatty liver disease

Question 56

Patient with known liver disease presents with oedema, ascites, easy bruising, poor concentration and memory, bleeding oesophageal varices, jaundice, pruritis, spider naevi, bruising, finger clubbing and hepatomegaly​ ​

Answer 56

Cirrhosis

Question 57

A patient with known cirrhosis begins to have increased jaundice, ascites and RUQ pain and starts to lose weight. Radiology shows a mass in the liver

Answer 57

Hepatocellular carcinoma

Question 58

A 45 year old woman with a history of gallstones, thyroid disease, and Crohn’s disease​presents with fatigue, puritis and RUQ pain

Answer 58

Primary biliary cirrhosis

Question 59

A patient with ulcerative colitis presents with tiredness and abdominal discomfort with abnormal LFTs that eventually leads to itching, jaundice and hepatomegaly and splenomegaly

Answer 59

Primary sclerosing cholangitis

Question 60

A patient who works in the aviation industry and used to work in the rubber industry presents with jaundice, weight loss, RUQ pain, pruritis, hepatomegaly, splenomegaly and a palpable gallbladder​

Answer 60

Cholangiocarcinoma

Question 61

A 55 year old woman presents with fatigue, weight loss, weakness, joint pain, hepatomegaly, hypothyroidism and a slate grey or bronze appearance

Answer 61

Haemachromatosis

Question 62

A 19 year old presents with a dramatic personality change, signs of liver disease and Kayser-fleisher rings

Answer 62

Wilson's disease