SBAs and explanations 5 Flashcards
Which of the following is a feature of limited cutaneous systemic sclerosis?
A Calcinosis B Cyanosis C Striae D Onycholysis E Clubbing
Calcinosis.
A 32-year-old basketball player is brought to A+E extremely breathless. He was at basketball training when he suddenly felt himself getting more and more breathless and developed a ‘stabbing’ pain on the right side of his chest. He has never experienced anything like this before. On examination, he is very tall and thin, and breath sounds are reduced over the right side of his chest. What is the most likely diagnosis?
A PE B Primary pneumothorax C Secondary pneumothorax D Myocardial infarction E Asthma attack
Primary pneumothorax.
A 22-year-old student presents with a severe headache and fever that has lasted 1 day. On examination, he has a stiff neck and a rash across his arms and legs. The junior doctor gently flexes the patient’s neck. As he does this, the patient’s hips flex. What is the name of this sign?
A Uhthoff’s sign
B Lhermitte’s sign C Kernig’s sign
D Brudzinski’s sign
E Tinel’s sign
Brudzinski’s sign.
A 61-year-old woman visits the GP complaining of 13 kg of weight loss over the past 6 months. On direct questioning, she admits that her faeces are lighter in colour than normal and her urine has become darker. She is jaundiced and a large non- tender mass is palpated in her right upper quadrant. What is the most likely diagnosis?
A Gallstones B Hepatocellular carcinoma C Pancreatic cancer D Bile duct stricture E Cirrhosis
Pancreatic cancer.
A 46-year-old man has been admitted to A&E after experiencing palpitations, which began about 4 hours ago. An ECG is performed, which reveals atrial fibrillation. He has no previous history of ischaemic heart disease. He refuses DC cardioversion. What is the next most appropriate treatment option?
A Defibrillation B Low molecular weight heparin C Warfarin D Flecainide E Digoxin
Flecainide.
A 4-year-old boy is referred to the paediatric department by his GP after a 3-week history of fatigue, shortness of breath and recurrent chest infections. A thorough examination is performed, which revealed extensive bruising across the child’s body, hepatosplenomegaly and cervical lymphadenopathy. Based on the information provided, what is the most likely diagnosis?
A Acute lymphoblastic leukaemia B Acute myeloid leukaemia C Chronic lymphocytic leukaemia D Chronic lymphoblastic leukaemia E Hodgkin’s lymphoma
Acute lymphoblastic leukaemia.
A 79-year-old woman is accompanied by her granddaughter to A+E. She has had a productive cough and a fever for the past 4 days. On examination, she has an AMTS of 5/10, respiratory rate of 31/min and blood pressure of 92/66 mm Hg. Her urea is 3 mmol/L (2.5-6.7). A CXR reveals an area of consolidation in the right middle lobe. Community-acquired pneumonia is suspected. What is her CURB-65 score?
A There is not enough information to tell. B 2
C 3
D 4
E 5
3.
A 28-year-old man has experienced several episodes of sweating, palpitations and anxiety over the past 6 months. He has a past medical history of thyroid cancer (aged 19) which was treated with total thyroidectomy. What is the most appropriate investigation?
A Serum 17-hydroxyprogesterone levels
B 24 hr urine 5-hydroxyindoleacetic acid levels
C 24 hr urine vanillylmendelic acid
D Plasma adrenaline concentration
E Thyroid uptake scan
24hr urine vanillylmendelic acid.
Which of the following triads best describes Horner’s syndrome?
A Ptosis, miosis, anhydrosis B Proptosis, miosis, hyperhidrosis C Ptosis, mydriasis, anhydrosis D Ptosis, enophthalmos, hyperhidrosis E Proptosis, miosis, anhydrosis
Ptosis, miosis, anhydrosis.
Which virus is implicated in around 50% of cases of Hodgkin’s lymphoma?
A Human cytomegalovirus B Herpes simplex virus 2 C Varicella zoster D Epstein-Barr virus E Human herpes virus 7.
Epstein Barr virus.
A 54-year-old man is complaining of abdominal heaviness and shortness of breath. On examination, his abdomen is distended, non-tender and exhibits shifting dullness with a fluid thrill. The junior doctor suspects ascites and requests a diagnostic paracentesis. It reveals a Serum-Ascites Albumin Gradient (SAAG) of 9 g/L. Which of the following is a potential cause of his ascites?
A Cirrhosis B Congestive cardiac failure C Portal hypertension D Budd-Chiari syndrome E Nephrotic syndrome
Nephrotic syndrome.
A 56-year-old man has been waking up several times at night to empty his bladder. He says he doesn’t feel completely empty after finishing and his stream seems to be quite ‘stop and start’. He often has to strain to maintain the flow. Which of his symptoms is considered irritative?
A Incomplete emptying B Having to start and stop C Increased urination at night D Straining E Weak flow
Increased urination at night.
An 8-year-old boy is brought to the GP by his mother. He has a very swollen and painful knee which arose yesterday without any preceding trauma. On closer inspection, he is afebrile and the joint, despite being swollen, does not appear inflamed. He also has several bruises across his torso. His mother mentions that her father suffered from haemophilia and that she is worried that her son may have the same disease. Blood tests are requested. Which of the following results would be suggestive of a diagnosis of haemophilia?
A High APTT, Normal PT B Normal APTT, High PT C High APTT, High PT D Low bleeding time E Low vWF
High APTT, normal PT.
An 82-year-old man is brought into A&E complaining of severe flank pain that started suddenly about 30 minutes ago. On examination, he looks very unwell and his palms are cold and sweaty. Vital Signs: HR = 132 bpm; BP = 84/52 mm Hg. What is your top differential?
A Myocardial infarction B Ruptured abdominal aortic aneurysm C Ureteric colic D Disc prolapse E Muscle sprain
Ruptured AAA.
A 31-year-old lady, who is 7 months pregnant, is brought to A&E having become extremely short of breath this morning. She has also experienced sharp chest pain on her right side. Examination reveals no abnormalities and an ECG shows sinus tachycardia. A pulmonary embolism is suspected. What is the most appropriate investigation to request?
A D-Dimer B CTPA C VQ scan D Chest X-ray E Doppler ultrasound of the lower limbs
VQ scan.
A 76-year-old woman is brought to A+E by her daughter. She is complaining of severe left iliac fossa pain accompanied by nausea, vomiting and fever. On inspection, she shows signs of peritonism. Vital signs: HR = 123 bpm, RR = 24 bpm, Temp = 38.7°C and BP = 87/54 mm Hg. An erect CXR is requested, which shows air under the diaphragm. A diagnosis of perforated diverticulitis localised to the sigmoid colon is made. What is the most appropriate surgical procedure?
A Left colectomy B Abdominoperineal resection C Hartmann’s procedure D Delorme procedure E Anterior resection
Hartmann’s procedure.
Which of the following tumour markers is associated with ovarian cancer?
A CA 15-3 B CA 19-9 C CA125 D CEA E aFP
CA125.
A 61-year-old man visits his GP complaining of a ‘shooting pain’ in his legs. The pain comes on when he walks his dog, and it gets particularly bad when walking downhill. On questioning, he reveals that he has been urinating about 10 times every day, which is much more than usual. On examination, there is a loss of sensation up to the T10 vertebral level, increased tone in his legs and brisk ankle jerks. The GP also notices that the patient has a stooped posture. What is the most likely diagnosis?
A Benign prostate hypertrophy B Motor neuron disease C Sciatica D Spinal cord stenosis E Cauda equina syndrome
Spinal cord stenosis.
An 11-year-old girl, who has recently moved to the UK from Cambodia, is referred to the cardiology department after her GP identified a heart murmur a few weeks after diagnosing her with a throat infection. She has also experienced intermittent joint pain, mainly affecting her knees and hips. On examination, she has a mid-diastolic murmur heard loudest over the mitral area and a few small, mobile nodules are palpated along the ulnar border of her forearms. What is the most likely diagnosis?
A Infective endocarditis B Rheumatic fever C Septic arthritis D Rheumatoid arthritis E Lyme disease
Rheumatic fever.
A 12-year-old boy is brought into A&E – he is extremely drowsy, appears dehydrated and has vomited whilst in the ambulance. He is also clutching his abdomen and appears to be in considerable pain. He is a known diabetic, and DKA is suspected. The patient begins breathing in a very deep and laboured manner. What is the name given to this pattern of breathing?
A Cheyne-Stokes breathing B Hypoventilation C Kussmaul breathing D Biot’s respiration E Apnoea
Kussmaul breathing.
A 21-year-old man has been experiencing some scrotal discomfort over the past month, which he describes as feeling ‘heavier than usual’. On examination, a firm, non-tender lump can be palpated at the base of the right testicle. The patient had an undescended testicle as a child, which was corrected with orchidopexy. A diagnosis of testicular cancer is suspected. The registrar recommends performing a CT scan to assess for spread. Which group of lymph nodes does testicular cancer spread to?
A Inguinal B Femoral C Para-aortic D Iliac E Mesenteric
Para-aortic.
Which of the following matches the criteria for type 2 respiratory failure?
A PaO2 < 10.5 kPa, PaCO2 > 6 kPa B PaO2 <8kPa,PaCO2 >6kPa C PaO2 < 10.5 kPa, PaCO2 > 8 kPa D SaO2 < 90%, PaCO2 < 8 kPa E SaO2 <90%,PaO2 <8kPa
PaO2 <8kPa, PaCO2 >6kPa.
A 26-year-old model comes to see her GP after having noticed some blood streaked on the paper after emptying her bowels. This started two weeks ago. She adds that defecation is very painful. When asked about her diet, she reveals that she often eats ready meals and drinks relatively little water because her job involves regular travelling making it difficult for her to maintain a healthy diet. What is the most likely diagnosis?
A Haemorrhoids B Anal fissure C Anal fistula D Colorectal cancer E Ulcerative colitis
Anal fissure.
A 71-year-old man presents with an 8-month history of worsening shortness of breath on exertion, orthopnoea and a cough productive of pink, frothy sputum. He has a past medical history of ischaemic heart disease and type 2 diabetes mellitus. Heart failure is suspected. What is the best investigation to confirm a diagnosis of heart failure?
A ECG B Brain natriuretic peptide C Atrial natriuretic peptide D Echocardiogram E Chest X-ray
Echocardiogram.
