Alfred Trial EMQs

LQ1
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?
LQ2
a) Mumps
b) Sarcoidosis
c) Systemic lupus erythematosis
. d) Guillain-Barre syndrome
e) Diabetes Mellitus
f Multiple Sclerosis
g) Stroke
A 25 year old previously perfectly VC! man presents with weakness and
numbness in his lower legs. has jliSt recovered from a recent chest infection.'
On examination deep tendon refexes 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.
LQ3
a) median nerve palsy
b) radial nerve palsy
:}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 cU is
now unable to extend his wrist. What is his diagnosis?
LQ4
a) rheumatoid arthritis
b) osteoarthritis
c) gout
d) infective arthritis
` nn ''d
.
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 fexion 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 refux 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.
L`Q'
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.
L`QJ0
a) acute sinusitis
b )migraine headache
c) cluster headache
d)orbital cellulitis
eJhay fever
fTemporal 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
L`QJJ
a) adenosine
b ) amiodarone
c ) lignocaine
d)procainamide
e )verapamil
A 25 year old woman presents with palpitations. ECG shows AV Nodal Re
entrant Tachycardia (AVNRT) What is first line treatment for AVNRT?
L`QJ2
a) hyperuricaemia
b) increased LDL cholesterol
c) hypokalaemia
e) hypercalcaemia
Recognised side effects of thiazide diuretics include all of the above EXCEPT.
l
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 fexor tenosynovitis
finger
rnatoid may be
EMQ 15
acid cy
subarachnoid h{emorrhage
d) subdural haematoma
e) Wernicke-Korsakoff syndrome
with the above EXCEPT.
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 traf 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?
!
'j l!
I
The most useful investigation (for EMQ l') which also ofers as a management
option.
EMQ21
a) alcoholism
b) biliary tract disease
c) elevated triglycerides
d) loop diuretics
)
The above are causes of acute pancreatitis EXCEPT.
LQ22
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.
LQ23
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:
LQ24
a) Extravascular haemolysis
b) bladder tumour
.
c)gonorrhoea
d) sickle cell anaemia
e) renal calculi
Painless haematuria is most likely associated with which of the above:
LQ25
a) Spider naevi
b)palmar erythema
c)gynaecomastia
d) calcinosis
e) Clubbing
Stigmata of chronic liver disease include all of the above EXCEPT :
LQ26
a) subcutaneous emphysema
b) tension pneumothorax
c) pulmonary embolus
d) Left basal pneumonia
S' S!``
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
fadminister 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 fuids 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
rar 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, Iould 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 \ith 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
ranaged rticosteroids the past years, now mplains of
onset of and the right which and
tender, there are no uric acid crystals on joint fuid 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 erbolism
ElQ 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
L
EXCEP'r
of serum iron,
. He is symptom
APPROPRIATE ini
l`Qo6
a) Inability to extend the wrist
b) Inability to flex the wrist
c) Inability to spread the fingers
lransferrin
a D of JJ., an
d) Inability to fex the distal phalanges of the fourth and fifth digits
to oppose the thur nger
cerates the ulnar
findings is MOST LI
l`Qo/
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 !b
HELPFUL diagnostic investigation at this stage is?
l`Qoo
a) diarrhoea
b)granulomatous inflammation
to steroids
ttstinal disease
course
above features occur
veins
s
c) iliofemoral veins
d) superficial calf veins
e) superficial thigh veins

disease and
is
O! 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 efusion
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 lef 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
vorsening. He gave up srr,oking five years ago dad IHtrns a cmonlC COLgll,
LQ42
P Bec1omethasone Inhaler F Penicillin
Gentamicin G Prednisolone tablets
C High fow oxygen Salbutamol Smgm
D Ipratropium bromide via nebuliser
nebuliser + hourly I Sodium cromoglycate
L IV Saline

Theophylline
The patients below have all presented with complications of their respirator
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 c 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.
LQ43
P

Sleep apnoea
Dissecting thoracic aortic
aneurysm
L Metastatic rib pain
D Myocardial infarction
L Oesophagitis
F Pericarditis
G
H
I

Pulmonary
embolism/infarction
Stable angina
Tietze's
syndrome / costochondritis
Unstable angina
The patients below have presented with chest pain. Choose the most
]]:!!O| )i /Uc CO /`.
!c.I
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 fat 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 lifing, 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.
LQ44
A

C
U
L
Anaemia
Angina
Aortic stenosis
Atrial fibrillation
Cardiac tamponade
F
G
H
I

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 olc man presents to his GP with shortness of breath on exertion which
has been getting VO1't for tlt lSS!X months. 'J 0Xd!!3!O! lht carotid |U!S
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. E 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.
L`Q^S
A Anaemia of chronic disease G Macrocytic anaemia
Anaemia of chronic renal Megaloblastic anaemia
failure I Microangiopathic
C Aplastic anaemia haemolytic anaemia
D Autoimmune haemolytic

Pernicious anaemia
anaemia h Sickle cell anaemia
L G6PD deficiency Sideroblastic anaemia
F Iron defciency anaemia
JI cOcD /CUIl0USDtiU, tl | \ |u |D 't\
to have from the above list.
old man presents
IIacmatological investigation
ronth 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 ! 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 l 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.
L
Anterior myocardial L Lateral
infarction infarction
Digoxin efect Lef ventricular
take of in the G Pericarditis
leads H Posterior
nferior myocardial infarction
infarction I Prolonged
o]i|e1seqmeni heIow,c|oosei|e
i|eahove
46.1
Atrial bigemini and non -specific ST jT wave changes (esp. in anterolateral leads )
`

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.
LQ4/
A

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.
+7.O
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 ieing a . His wife
that he may also have lost some weight recently.
EMQ48
C

Acute pancreatitis
Appendicitis
Ascending cholangitis
Cholecystitis
Diverticulitis

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: 39.2C). rigors and upper abdominal
48.2
examination he is jaundiced has a blood press
rmHg.
A 17 -year-old man with no previous medical history presents with a 24 hour
48.3
right ilia pain with and vori
clear; l ' 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; lL. VLL14.2 x 109/1, `LV104 f; U&Es: Na 135
mmoljl, 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 lef iliac fossa. lL. Hb 12.7 gjdl; VLL15.3 x 109/1
48.5
f5-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.

d 55 d I tre
EMQ50

U
L

CYODIOCdVICUdY OIH\
UISOCd\IOD
LOUCS1YdC\UYC
ISOCd\CUSHOUUCY
YdC\HYCO1\HCCdVICC
YdL\ O1\HCQ1OXIDd

YdC\UYCO1\HC1dUIdHCdU
YdC\UYCO1\HCSHdDO1\HC
HUDCYUS
bCdQHOIU1YdL\UYC
bDI\HS1YdC\UYC
bUQYdCOHU]dY IUYCO1
HC 1US
. ..
heIow|aveaII{aIIen,
appropri aie]raciure
i|eirapperIimh.
]romi|eahoveIisi
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
i|e
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.
L`Q'1
A
D
C
Anal carcinoma
Anal tag
Colonic carcinoma
fssure
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
Infammatory
disease
sIgn'
of
heIowhaveaII
appropri aieoiaqnosis
reciaIhIeeoInq.
Iisi
i|e
man presents rectal bleeding I
L has complained bowel habits for the
mtermittent diarrhoea and has noticed some
Rectal examination and proctoscopy are normal \. Hb 9.9 g/dl; VLL62 x
109 II, ^\V 75 H.
J.
, .
colicky pain, diarrhoea (bowels open 6-10 times per day c night) and passage
of blood mixed with the stool. FEC: Hb 8.8 g/dl, WCC 12.1 x 109/1, MCV 78.6 f,
ESR: 62 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. FEC: Hb 12. 5 g/ dl, WCC 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, WCC 13, 2 x 109/1, ESR: 50 mm/hr.
EMQ52
A

Anticoagulant therapy
Bladder cancer
Catheter trauma
Cystitis
Glomerulonephritis

O
H

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
52.1
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, WCC 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 fanks.
FEC: Hb13.2 g/dl, WCC 6.8x 109/1, U&Es: urea 22.3 mmol/1, Cr 0.30 mmoljl;
`.` Tncg '
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
LQ53
A Diabetes mellitus
B Renal colic
C
D
L

Ischaemic colitis
Myocardial infarction
Large Bowel obstruction
Diverticulitis
G
H
Perforated duodenal ulcer
Ruptured abdominal aortic
aneurysm
I Sickle cell disease

Small bowel obstruction

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(ral 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/fuid 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 shocke
d
: pulse 120 bpm; 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.
,- )
-
.. .J ,",,:j
I
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 Mononeuritis multiplex
Autonomic neuropathy H Peripheral sensory
C Cerebrovascular disease neuropathy
D Diabetic nephropathy I Recurrent urinary tract
Hypertriglyceridemia infection
Ischaemic heart disease

. 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 O 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 O 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 refex.
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 faccid paresis of the wrist extensors and fexors, 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

Amoebic Dysentery
Autonomic neuropathy
'H!J en 1`
l.OU lh. cJr 'inorL<

'
Crohn's disease
Irritable bowel syndrome
|VCO |!:

H

Pseudomembranous colitis
Thyrotoxicosis

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 c 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. 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 =
12.6gjdl : VLL = 6.5 : ESR = 10 : L = 5. Flexible sigmoidoscopy is normal.
55.4
An c 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. examination is normal.
55.5
A 42 year old woman presents to her Gwith 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.