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Final mock Test -03 for FCPS part-1 with Dr Sohrab
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Final mock Test -03 for FCPS part-1 with Dr Sohrab
Final mock Test -02 for FCPS part-1 with Dr Sohrab
1
Personal infomations
2
True and false
3
multiple choice
Name
*
Phone number
*
Email
In the ECG: a) hyperkalaemia produces flat T wave b) ST elevation is the early sign of acute myocardial infarction c) right ventricular hypertrophy causes right axis deviation d) P mitrale is a feature of left atrial enlargement e) Mobitz type II second degree AV block shows progressive prolongation of PR interval
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
.The following drugs have proven survival benefit in heart failure patients a) amlodipine b) beta-blockers c) ACE-inhibitors d) digoxin e) spironolactone
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Wide splitting of the second heart sound occurs in: A. Severe aortic stenosis B. Fallot's tetralogy C. Right bundle branch block D. Ventricular septal defect B. Ostium primum type of artrial septal defect
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Causes of atrial fibrillation are:( a) infective endocarditis b) acute pulmonary embolism c) dissecting aneurysm d) thyrotoxicosis e) hypertension
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Acute rheumatic fever is characterized by a) a raised anti-streptolysin-o-titre b) pericarditis c) osler's node d) hypocamplementaemia e) endogenous pyrogen production
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Chronic constrictive pericarditis cause: a) Fall of JVP on inspiration b) Pulses alternans c) Ascites d) Low pulse pressure e) High systolic pressure on inspiration
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Causes of loud first heart sound include: a) mitral stenosis b) pulmonary stenosis c) aortic regurgitation d) pericardial effusion. e) tricuspid stenosis
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Patient came with you hypertension, he takes antihypertensive drug for long. Now develops 50 gynaecomastia, which drug responsible for this - a) Digoxin b) Thiazide c) Amlodipine d) Verapamil e) Spironolactone
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Hashimoto's thyroiditis - a) Hyperthyroidism is the cause b) Associated with other autoimmune c) free T3, T4 in serum d) Occur in male aged 30-50 years e) Painful enlargement of thyroid gland occur
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding congenital adrenal hyperplasia - a) 21 ß-hydroxylase deficiencies is a important cause b) ↑ ACTH secretion c) Change in Renin Activity d) May present with activity e) Autosomal dominant disorder
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
n case of turner's syndrome -- a) Elevated FSH b) Decreased LH c) Increased testosterone d) Short stature due to growth hormone deficiency e) Lack of oestrogen
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Site of action of insulin include a) Adipose tissue b) Muscle c) Liver d) Kidney e) Heart
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Involution of thymus in adult done by - a) Adrenocortical hormone 5 b) Thyroxine c) Oestrogen d) Growth hormone e) Testosterone
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding inspiration- a) Abdominal pressure in more positive b) Diaphragm is flattened c) Anterior posterior diameter is increased d) Lateral diameter of lung is decreased e) Vertical diameter of lung in decreased
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding primary TB- a) MT test is positive b) Primary reaction is as like as vaccination c) Resolve spontaneity d) Give lifelong immunity e) Miliary TB occurs
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Emphysema-- a) † FEV₁ b) FEV₁/VC ratio c) Residual volume d) ↑ TLC e) KCO decreased
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Clinical features of sarcoidosis --- a) Bilateral hilar enlargement b) Lymohadenopathy c) No lung parenchymal disease d) Nephrocalcinosis e) Hypercalcemia
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Type II respiratory failure -- a) Hypoxia with hypocapnia b) Hypoxia with hypercapnia c) Respiratory acidosis d) Mismatch ventilation-perfusion e) Reduced total ventilation
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Mantoux test -- a) Diagnostic for TB b) Used for contact tracing c) Positive in sarcoidosis d) Basis is CMI e) Positive in military TB
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Lung cancer --- a) Typically present with massive hemoptysis b) 20% of all male cancer death c) Dermatomyositis, a non-metastatic feature d) Of large bronchus present later
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Uric acid crystals characteristics a) Positive birefringence b) Strong light intensity c) Rhomboid d) Found in WBC e) Free in synovial fluid
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
A 60 years old male presented with fatiguability, back pain & difficulty in standing up from sitting position. To diagnose a case of osteomalacia, what are the laboratory findings? a) Serum PTH ↑ b) Serum Ca+↓ c) Vit D↓ d) Serum phosphadase ↑ e) Serum AL↓
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding Gout --- a) MSU deposit in & around synovial joint b) Hyperuricaemia c) Between Attack, aspiration joint of 1" MTP reveals Crystals d) Lifestyle modification is not effective as drug therapy e) Febuxostat is the drug of 1s' choice
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
The following crystals are associated with inflammatory joint disease a) Monosodium urate b) Calcium pyrophosphate c) Lactate d) Pyruvate e) Basic calcium phosphate
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
The investigations performed in a patient suffering from Raynaud's phenomenon should include a) Assay of hemagglutinating antibodies b) Rheumatoid factor c) Antimitochondrial antibodies d) Serum potassium e) X-ray the root of the neck
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
X-ray findings of OA -- a) I Joint space b) Marginal osteophytes c) Syndesmophytes d) Sub chondral sclerosis e) Sub chondral erosion
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
COX-2 -- a) Constitutive or housekeeping enzyme b) Regulate gut mucosal integrity c) Inflammatory enzyme d) Upregulated at inflammatory site in CNS e) Cause platelet aggregation
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Gene therapy used in following disease a) Leukaemia b) Antitrypsin deficiency c) Thalassemia d) Leukoplakia e) Erythroplakia
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Turner's syndrome is associates with a) Short stature b) Primary amenorrhea c) Deafness d) IGT e) DM
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Cytogenic study in gene effect occurring in a) Skeletal muscle b) Bone marrow c) Blood d) Cartilage e) Nervous tissue
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
During pregnancy a) HB increase b) Thrombocytopenia c) VWF increase d) DVT e) Hemolysis
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Ethical aspects of medical practice includes a) Maintenance of confidentiality b) Personal safety c) Disclosure of mistake, if any d) Personal interest e) Patient's interest
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Inflammation-- a) Release of insulin b) Hypertension c) Hypothalamic change in temperature set point d) Associated with anorexia & confusion e) Impair release of catecholamine from adrenal cortex
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
GIP --- a) Enhance satiety b) Stimulate acid c) Produced by K cell d) Produced throughout GIT e) Stimulate insulin releases
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Drugs causing Acute colonic pseudo obstruction a) Alginates b) Opioids с) ТСА d) Antacid e) Phenothiazine
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Function of gastrin includes -- a) Stimulates pepsin secretion b) Decreases acid secretion c) Stimulates growth of gastrointestinal mucosa d) Contraction of lower esophageal sphincter e) Inhibits pancreatic secretion
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Diagnosis of H. pylori is done by a) Antigen detection b) Antibody detection c) Urea breath test d) Histology e) Rapid urease test
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Glucagon Like Peptide 1 (GLP-1) -- a) Anorectal hormone b) Stimulate glucagon release c) Decreases gastric motility d) Secreted from terminal ileum e) Decreases blood glucose
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Adverse prognostic factors in acute pancreatitis include a) Albumin >32g/L b) Poz<8 KPa c) Glucose > 10 mmoL d) Urea > 16 mmoL/L e) Alanine >200 U/L
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Bile acids --- a) Are water soluble b) Secreted in gall bladder c) Concentrated in gall bladder d) Break down in fatty acids c) Synthesized from the end products of fat s.
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Drugs contraindicated in pregnancy are a) Quinolones b) Aciclovir c) Trimethoprim d) Fluconazole e) Meropenem
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Sepsis -- a) Is scored by SOFA score b) SBP <100, which is fluctuating c) Vasoconstriction cause increase systolic HTN d) Altered mental status which causes coma e) Consequence to septic shock
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Dengue - a) Incubation period 2-7 days b) IgM positive in blood in 3 days c) Glucocorticoid have role in the treatment d) Aedes albopictus is the causative agent e) Narrow pulse pressure occurs in Dengue shock syndrome
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
In eryptosporidiosis -- a) Parasite of human & domestic animals b) Infection acquired by feco-oral route c) Causes watery diarrhea d) Illness is usually self limiting in immunocompromissed e) In HIV infected pt causes severe diarrhea
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Opportunistic mycoses are -- a) Mucor b) Mycetam c) Aspergilus d) Candida e) Rhizopore
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding infection with cytomegalovirus -- a) LFT normal b) Alkaline phosphatase level raises out of proportion to liver disease c) Atypical lymphocytosis is not as prominent as infectious mononucleosis d) Heterophile antibody negative e) Common in HIV positive transplant recipient patient
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Visceral leishmaniasis can be diagnosed by- a) Urinary rk39 b) Splenic aspirate showing LD bodies c) Positive leismanin test d) Blood culture showing amastigots e) Bone marrow showing promastigotes
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Warfarin action potentiated by which drugs? a) Indomethacin b) Miconazole c) Phenytoin d) Phenylbutazone e) Metronidazole
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
O₂ hemoglobin dissociation curve shift to the right a) ↑ H⁺ b) High pH c) ↑ PCO₂ d) ↑ Temperature e) ↑ 12,3 PPG
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Erythropoietin levels are increased in - a) High altitude b) Anemia c) Renal cell carcinoma d) Asthma e) Hypertension
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
During treatment of CKD with injection erythropoietin, which of the following side effect may occur-- a) Hypertension b) Hypotension c) Thromboembolism d) Diarrhea e) Hirsutism
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Plasma ferritin decrease in a) Liver disease 'b) IDA c) Vitamin C Deficiency d) Hypothyroidism e) Alkalosis
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Hypo-plastic bone marrow is found in a) Rifampicin b) Methotrexate c) Insecticide d) Vit B12 deficiency e) Pregnancy
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
The laboratory method of ELISA a) Can only analyses samples qualitatively b) Can detect both antigen & antibody c) Uses the enzyme horse radish peroxide d) Can use a spectrophotometer to measure the color reaction e) Is a sensitive test
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding hereditary angioedema a) Mediator is Bradykinin b) Ureticaria rarely occur c) Deficiency of complement may cause d) Treatment is anti-histamine e) C4 level should be investigated
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Barriers to good communication in health care are a) Hurried approach by the clinician b) Use of jargon by the clinician c) Dismissive attitude of the clinician d) Cognitive impairment of the patient e) Patient's reluctance to discuss sensitive issues
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Clinical reasoning comprises a) Clinical skills b) Using and interprete diagnostic tests c) Doctor centered EBM d) Thinking of thinking e) Shared decision making
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
The followings are the trisomy's a) Down's syndrome b) Edward's syndrome c) Turner's syndrome d) Patau's syndrome e) Fragile X syndrome
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Feature of X linked recessive inheritance a) X-linked diseases are mostly recessive and restricted to males who carry the mutant anere b) Occasionally female carries may exhibit signs of an x-linked disease c) The gene can be transmitted from female carries to their sons d) Affected males cannot transmitted the condition to their sons e) Risk of female carrier having an affected child is 25%
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Nerve conduction study is done for the diagnosis of a) Multiple sclerosis b) GBS c) Myasthenia gravis d) Entrapment neuropathy e) Brachial plexus damage
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Gullain barre syndrome causing organisms are а) ЕBV b) HIV c) Campylobacter jejune d) Rota virus e) HBV
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Medications used in the management of Parkinson's disease are a) Levodopa b) Bromocriptine c) Benztropine d) Benzhexol e) Apomorphine
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Red flag symptoms of headache a) New onset aged > 50 years b) Worse on lying down c) Focal neurological symptoms d) Constitutional symptoms e) Gradual onse
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
A 35 year patient came to you with quasdriplegia, shortens of breath. If it is suspected as GBS which are the following features -- a) Ankle jerk are absent b) Descending pattern of paralysis c) Cause of death is respiratory failure d) Upper limb weakness is more than lower limb e) CSF findings cell count rises
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Features of autonomic neuropathy -- a) Fixed heart rate b) Accelerated systolic hypertension c) Retrograde ejaculation d) Autonomic gastropathy e) Peripheral neuropathy
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Cavernous sinus contains a) 1st nerve b) 3rd nerve c) 4th nerve d) 9th nerve e) Sympathetic plexus
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding post infectious glomerulonephritis a) More common with pharyngeal infection than skin infection b) Children are usually victims c) It is curable d) Associated with hypertension e) Not associated with hematuria
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Membranous nephropathy a) Common cause of nephrotic syndrome in adults b) Increase C3 level c) Deposition of IgG (subepithelially) d) Associated with HBV, malignancy e) Frank hematuria common
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Typical features of CRF a) Polycythemia b) Hypophosphatasemia c) Hypercalcemia d) Metabolic acidosis e) Impaired concentrating ability of kidney
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Causes of polyuria a) Hypercalcemia b) Hypocalcemia c) Hyperkalemia Hyperglycemia e) Diabetes insipidus
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
The macula dense a) Monitors serum electrolyte levels b) Assess the amount of sodium delivery c) Analyses the amount of potassium deli- d)Responds to sympathetic stimulation e) Influences the rate of renin release
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
In case of IgA nephropathy [FCPS-Medicine-July-2019] a) Thematuria is d earliest sign b) Proteinuria is early feature c) Progress to end stage renal disease d) Asymptomatic presentations dominate in older adults e) Responds to immune suppressive therapy is poor
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Minimal change disease a) Most commonly disease occur in children b) In investigation mesangial matrix are found c) Segmental scar is present d) History of respiratory tract infection may present e) Thickening of basement membrane occurs
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
A 62-year-old man presents to the Emergency Department with persistent indigestion-like pain, retrosternal in nature and radiating to his jaw. He is a heavy smoker of some 40 cigarettes per day and has been previously treated for Barrett’s oesophagus. On examination he is bradycardic at 55 bpm, has a blood pressure of 100/50 mmHg and looks unwell. ECG reveals ST elevation in leads II, III and aVF. What diagnosis fits best with this clinical picture?
Acute anterior myocardial infarction
Inferior myocardial infarction
Non-ST elevation myocardial infarction
Recurrence of Barrett’s oesophagus
Unstable angina
A 67-year-old man is admitted to the Emergency Department with complete heart block. He has a past medical history of ischaemic heart disease, diabetes mellitus type 2 and smoking-related airways disease. He takes medication for his heart disease and diabetes mellitus. On physical examination, his blood pressure is 100/80 mmHg, with heart rate 30 bpm and irregular. Which of the following would you most expect on auscultation?
Louder first heart sound
Louder second heart sound
Quieter first heart sound
Quieter second heart sound
Variable intensity of the first heart sound
A 17-year-old boy is reviewed in the clinic with increasing shortness of breath. He and his family have not consulted medical services for many years. On examination, he looks mildly cyanosed at rest and has a respiratory rate of 21/min. His blood pressure is 122/51 mmHg, and he has a pulse of 105 bpm. He has a continuous machinery murmur, loudest in the left upper chest, which is accentuated partially in systole. Colour-flow Doppler echocardiography identifies flow directly between the aortic arch and pulmonary artery. There are signs of pulmonary hypertension. Given the probable diagnosis, what is the likely nature of his pulse on clinical examination?
Collapsing
Jerky
Slow rising
Dicrotic
Thready
A 31-year-old man has been referred following a ‘blackout’. This had occurred the previous morning. He recalls waking from sleep, standing up, feeling light-headed and nauseated, falling back on to the bed and losing consciousness. He then woke up on the floor. He had not bitten his tongue but his head was badly bruised. His wife woke up when she heard him falling to the ground and describes him as being pale and sweaty before giving a loud moan followed by ‘spasms’ of his arms and legs lasting about 20 seconds, he was propped up against the side of the bed when the spasms occurred. He was rousable after a minute. What is the most likely diagnosis?
Cardiac arrhythmia
Epileptic seizure
Hypoglycaemia
Pseudoseizure
Vasovagal syncope
A 28-year-old man presents with a 2-year history of increasing dyspnoea with strenuous exertion. Hypertrophic cardiomyopathy (HOCM) is diagnosed. Which is the most appropriate screening method for his brother?
Computed tomography (CT) scan
Echocardiography
Exercise tolerance test
Genetic screening
Ventilation–perfusion scan
An 18-year-old student who has never been vaccinated against measles presents to his GP with symptoms suggestive of the disease. He is sent home and advised to rest, but later presents to the Emergency Department with anterior chest pain that is worse on inspiration and relieved by sitting forward. On examination there appears to be a rub on auscultation. What diagnosis fits best with this clinical picture?
Myocardial ischaemia
Pericarditis
Pneumothorax
Secondary bacterial pneumonia
Viral pleurisy
A 54-year-old man is 48 h post-myocardial infarction. You are asked to review him as he has new pulmonary oedema and falling urine output. On examination he has a pansystolic murmur, loudest at the apex. Which one of the following complications of his myocardial infarction is most likely to have occurred?
Acute mitral regurgitation
Acute pulmonary regurgitation
Atrial septal defect
Ventricular rupture
Ventricular septal defect
A 28-year-old woman is listed for routine cardiac catheterisation. She is being investigated for probable pulmonary hypertension as she has symptoms of increased shortness of breath and probable mild right-sided heart failure, which have developed over the past 4 months. Which of the following would you expect to see on cardiac catheterisation?
Mean pulmonary artery pressure 42 mmHg
Pulmonary capillary wedge pressure 20 mmHg
Mean right atrial pressure 3 mmHg
Right ventricular systolic pressure 18 mmHg
Right ventricular diastolic pressure 4 mmHg
A 38-year-old man of Chinese descent who smokes 60 cigarettes per day presents to his GP. He is developing pain at rest in his legs, and is unable to walk more than a few yards owing to ischaemic pain. On examination there is prolonged capillary refill and necrotic ulcers at the tips of his toes. There is also evidence of thrombophlebitis. What diagnosis fits best with this clinical picture?
Buerger’s disease
Familial hypercholesterolaemia
Polyarteritis nodosa
Simple peripheral vascular disease
Temporal arteritis
A 36-year-old woman presents with a transient left hemiparesis following treatment for a left calf deep venous thrombosis. Cardiovascular examination is normal. Which one of the following is the most likely predisposing cardiac abnormality?
Eisenmenger ASD
Ostium primum ASD
Ostium secundum ASD
Partial anomalous pulmonary venous drainage
Patent foramen ovale
A 70-year-old man is admitted to hospital in a comatose condition. His wife gives a history of past episodes of sweating and palpitations, confusion, fits and occasional abnormal behaviour. He has gained approximately 4 kg in weight over the past 5 months due to persistent hunger. On examination his pulse is 92 bpm and his blood pressure is 140/90 mmHg. His BMI is 32. His plasma catecholamine level is normal and blood glucose is 1.9 mmol/l (normal range 3.0–6.0 mmol/l). What is the most likely diagnosis?
Multiple endocrine neoplasia type 2 (MEN 2)
Phaeochromocytoma
Insulinoma
Pseudodementia
Epilepsy
A 48-year-old alcoholic presents to the Endocrine Clinic with loss of libido, erectile dysfunction and breast tenderness. On examination his BP is 110/70, pulse is 70 and regular. You confirm gynaecomastia and signs of chronic liver disease and his BMI is elevated at 30. Elevated oestrodiol and liver function tests consistent with cirrhosis are noted on laboratory testing. Which of the following is a direct precursor to oestradiol?
Testosterone
Dihydrotestosterone
Cortisol
Progesterone
Oestriol
A 30-year-old man and his wife are referred to the Reproductive Endocrinology Clinic after failing to conceive for two years. The man admits to use of recreational drugs and anabolic steroids in the past. Examination of the man is as follows: height 189 cm, weight 95 kg (with central distribution of adipose tissue) and bilateral gynaecomastia. Ultrasound examination of the patient’s testes calculated a right testicular volume of 10.5 ml (right) and 10.1 ml (left). Which of the following investigations is most helpful in providing a diagnosis?
Chromosomal analysis
Computed tomography of the pituitary gland
Measurement of serum gonadotropins
Measurement of serum testosterone
Semen analysis
An obese 38-year-old man presents with rapid weight gain and the development of extensive abdominal striae, and his midnight cortisol is found to be elevated. He has hypertension with a BP of 155/82 mmHg, type 2 diabetes currently treated with metformin, and has recently suffered a left Colles’ fracture. Which of the following would best differentiate between a pituitary adenoma and ectopic ACTH production as a cause of hypercortisolism?
Low-dose dexamethasone suppression test
Synacthen® test
24-hour urinary cortisol collection
High-dose dexamethasone suppression test
Basal adrenocorticotropic hormone levels
A 55-year-old-woman presents with the clinical features of Cushing syndrome. She is on no medication. The results of routine biochemical investigations are normal. Her 0900-hours cortisol concentration is 800 nmol/l (normal 150-650) and ACTH 80 ng/ml (normal <50). Following a high dose dexamethasone the previous evening, a repeat 0900-hours cortisol concentration is 380 nmol/l. Which of the following is the most likely diagnosis?
Adrenal adenoma
Adrenal carcinoma
Cushing’s disease
Depression
Ectopic ACTH secretion
A 17-year-old girl has been referred by her gynaecologist: she has been complaining of amenorrhoea for 5 months she states that she feels well and is very active, but her weight has decreased from 61 kg to 43 kg in the last 6 months (BMI 17kg/m2). On examination her blood pressure is 90/60 mmHg and her heart rate is 64 bpm; blood glucose is 5mmol/l. What is the most likely diagnosis?
Conn syndrome
Crohn’s disease
Anorexia nervosa
Hyperthyroidism
Diabetes mellitus
A 42-year-old man with recurrent episodes of pancreatitis is found to have severe hypertriglyceridaemia. He is seen by a lipid specialist and is diagnosed with hyperlipoproteinaemia type IB. This condition is associated with mutations in the gene coding for which protein?
Apolipoprotein E (APO E)
Apolipoprotein CII (APO CII)
Apolipoprotein AII (APO AII)
Lipoprotein B
Low-density lipoprotein (LDL) receptor
A 45-year-old man presents with prognathism and interdental separation. His GP has found it increasingly difficult to manage his blood pressure control over the past 2 years and he is now taking 3 oral agents. In addition despite a BMI of only 25, he has recently been diagnosed with impaired glucose tolerance. Which of the following is the most appropriate investigation?
Basal growth hormone measurement
Fasting glucose test including growth-hormone measurement
Glucose tolerance test including growth-hormone measurement
Serum prolactin measurement
Thyroid function test
A 45-year-old woman with a long history of steroid-treated sarcoidosis presents with extreme thirst and nocturia five times per night. Her serum calcium concentration is 2.3 mmol/l, glucose is 4.6 mmol/l and potassium is 3.5 mmol/l. After an overnight fast including water restriction, her serum Na+ is 149 mmol/l. Which one of the following is the cause of her symptoms?
Chronic cystitis
Cranial diabetes insipidus
Hypokalaemia-induced polyuria
Iatrogenic adrenal insufficiency
Psychogenic polydipsia
A 32-year-old man presents with unilateral gynaecomastia. He had breast reduction surgery on the other side ten years ago. On examination, he has sparse body hair in the axilla and pubic regions. Two testicles are identified, both small-volume. On further questioning you elucidate that he has a normal sense of smell. His blood tests reveal: testosterone 4 nmol/l (normal range 9–35 nmol/l), luteinising hormone (LH) and follicle-stimulating hormone (FSH) both elevated, prolactin 300 mU/l (normal level is < 360 mU/l). Which of the following is the most likely diagnosis?
Klinefelter syndrome
Kallmann syndrome
Hypothalamic hypogonadism
Androgen insensitivity syndrome
11ß-hydroxylase deficiency
A patient has a two-month history of intermittent flushing associated with tachycardia and wheezing. There have also been episodes of profuse watery diarrhoea. On examination the patient has facial plethora and is flushed. On examination BP is 160/80, cardiovascular examination reveals a pansystolic murmur which is louder on inspiration in keeping with tricuspid regurgitation, and abdominal examination reveals a palpable liver edge. Given the suspected diagnosis, what would be the most appropriate investigation?
Dexamethasone suppression test
Urinary catecholamine collection
Urinary 5-hydroxyindoleacetic acid (5-HIAA) collection
Abdominal ultrasound
Fasting gastrin
A 25-year-old woman presents to the endocrine clinic with a rapidly enlarging left thyroid nodule. Histology of this lesion suggests that it is a medullary thyroid carcinoma. Her blood pressure is also elevated at 155/90. Which of the following would you consider as the most likely cause of her hypertension?
Coarctation of the aorta
Hyporeninaemic hyperaldosteronism
Liddle’s syndrome
Phaeochromocytoma
Renal artery stenosis
A 42-year-old woman is referred to the endocrine clinic with a prolactin of 200 mU/l. Medication of note includes ramipril for hypertension and orlistat for weight loss. She tells you that her periods have been rather heavy over the past few months but she puts this down to the menopause. On examination in the clinic her BP is 155/72 mmHg, pulse is 70/min and regular. Her BMI is 31, she admits to not having managed to lose any weight over the past few months. Her visual field examination is normal. Which of the following is the most likely diagnosis?
Drug induced hyperprolactinaemia
Microprolactinoma
Macroprolactinoma
Hypothyroidism
Non-functioning pituitary adenoma
A 23-year-old woman presents to her GP after the birth of her second child. She complains of extreme tiredness and a persistent hoarse voice that she is having problems shaking off. Although she is breastfeeding her child, she is failing to lose her pregnancy weight. Thyroid autoantibodies are negative; her thyroidstimulating hormone (TSH) level is 12 mU/l, with a free T4 (FT4) of 5 pmol/l. There is no thyroid tenderness on examination. Her GP notes that her pulse is only 52 bpm. What diagnosis fits best with this clinical picture?
Hashimoto’s thyroiditis
Post-partum thyroiditis
Toxic multinodular goitre
Iodine deficiency
Graves’ disease
A 58-year-old man with a history of multiple sclerosis presents with horizontal diplopia. Clinically, the diplopia is most apparent while looking to the left. The outer image disappears when the right eye is occluded. On examination he has weakness of adduction of the right eye and nystagmus on attempted lateral gaze to either side, worse on looking to the left. What is the most likely explanation of these clinical signs?
Fourth nerve (NIV) palsy
Internuclear ophthalmoplegia
Parinaud’s syndrome
Sixth nerve (NVI) palsy
Third nerve (NIII) palsy
A 54-year-old man presents with slowly progressive facial weakness and loss of taste. He has also noticed that he is more sensitive to loud sounds than usual and has begun to develop tinnitus. He has no other medical illnesses. . On examination there is weakness of the facial muscles on the right (including the forehead), a small patch of altered sensation on the right cheek and decreased taste sensation. Where is the most likely location of this lesion?
Cerebellopontine angle
Internal auditory canal
Parotid gland
Petrous temporal bone
Stylomastoid foramen
A 70-year-old man presents with a subacute history of intermittent difficulty in walking, dry mouth and variable slurring of speech. When the latter is severe he also has difficulty in swallowing. He mentions that he notices an increase in strength when he first starts walking or exercising, which then gets progressively more difficult as he continues. He has lost 3 kg in weight in the last 2 months. On examination he has bilateral mild ptosis, dysarthria and proximal weakness of the upper and lower limbs and is areflexic. The degree of weakness is variable. Nerve conduction studies confirm the clinical suspicion of a neuromuscular junction disorder. Which one of the following autoantibodies is most likely to be identified in his blood?
Acetylcholine receptor antibody
Antiganglioside antibody GM1
Antiganglioside antibody GQ1B
Anti-Hu paraneoplastic antibody
Anti voltage gated calcium channel antibody
A 45-year-old man presents to the Emergency Department complaining of blurred vision, bilateral shoulder pain and shoulder girdle weakness over a week or so. In particular, he finds it difficult to lift his arms above his head or to pull objects towards him. On examination, his BP is 110/72 mmHg, pulse is 75/min and regular. There is bilateral diplopia and nystagmus, he finds it difficult to maintain lateral gaze. You can also demonstrate bilateral weakness of the shoulder girdle. Deep tendon reflexes are reduced throughout. He has an ataxic gait. Which of the following is the most likely diagnosis?
Myotonic dystrophy
Motor neurone disease
Multiple sclerosis
Miller Fisher syndrome
Hereditary motor and sensory neuropathy (HMSN)
A 65-year-old man is admitted via the Emergency Department. He has deteriorated rapidly over the past few months after retiring from his job as an accountant due to difficulty in concentrating. He was originally diagnosed with depression but has not responded to SSRIs. He is now very confused and over the past 48 h has not been able to get out of bed. On examination his BP is 135/85 mmHg, with pulse 85/min and regular. Mini-mental state examination reveals a score of 12/30. He has increased tone bilaterally, an ataxic gait and has myoclonic jerks when startled by a nurse slamming a door on the ward. Which of the following is the most likely diagnosis?
Alzheimer’s disease
Endogenous depression
Multi-infarct dementia
Pick’s disease
Sporadic Creutzfeldt-Jakob disease
A 36-year-old man presents with a 1-day history of left-sided neck pain and right-sided sensorimotor disturbance. Shortly after the neck pain had begun, he had noted that his left eyelid was ‘drooping’, and that he had developed weakness and altered sensation in his right arm and leg. He had recently visited a chiropractor for neck pain after a road traffic collision. Examination reveals a left Horner syndrome and weakness and sensory disturbance on the right-hand side with an extensor right plantar. What is the most likely clinical diagnosis?
Carotid artery dissection
Lateral medullary infarction
Subarachnoid haemorrhage
Venous sinus thrombosis
Vertebral artery dissection
An 80-year-old lady with a history of hypertension, type II diabetes mellitus and a 50-pack-per-year smoking history presents to her GP complaining of ‘bumping into things’ all the time. On examination her gait is normal, there are no cerebellar signs and her eye movements are normal. However, assessment of her visual fields reveals a complete left-sided homonymous hemianopia. Which of the following is the most likely diagnosis?
Temporal lobe tumour
Migraine
Occipital cortex lesion
Optic chiasm lesion
Optic nerve lesion
A 31-year-old man presents with weakness of his right leg. Examination reveals decreased proprioceptive sensation in the right leg and absent pinprick sensation in the left leg. What is the most likely diagnosis?
Anterior spinal artery occlusion
Brown-Séquard syndrome
Guillain–Barré syndrome
Lumbosacral disc herniation
Syringomyelia
A 40-year-old woman with a history of Graves’ disease presents with a 6-month history of progressive tingling and weakness of her legs. On examination of the lower limbs, there is bilateral pyramidal weakness, depressed deep tendon reflexes and flexor plantar responses. There is reduced joint position sense and vibration sensation in her lower limbs but no other sensory abnormalities. What is the most likely cause?
Anterior spinal artery thrombosis
HTLV-1 infection
Hypothyroid associated peripheral neuropathy
Taboparesis
Vitamin B12 deficiency
A 45-year-old man presents with sudden onset double vision and right arm weakness. Examination reveals a left-sided ptosis with the left eye deviated downwards and outwards during attempts to look straight ahead. Which of the following would best describe this presentation?
Binswanger’s disease
Millard-Gubler syndrome
Moya moya disease
Wallenberg syndrome
Weber syndrome
A 63-year-old man is admitted with a severe cough productive of rust-coloured sputum that he has had for the past 4 days. On admission he is pyrexial (38.5°C), has a blood pressure of 105/65 mmHg and a pulse of 105 bpm. His respiratory rate is 29/min. There is extensive bronchial breathing over the lower right lung field. Routine blood testing reveals an increased white blood count of 13.2 x10(9), and an elevated urea of 8.2 mmol/l. Which of the following factors in his history, examination or investigations would be the worst prognostic factor for pneumonia?
Age 63
Blood pressure of 105/65 mmHg
Pyrexia of 38.5 °C
Respiratory rate 29/min
Urea 8.2 mmol/l
A 33-year-old man presents with increasing symptoms of severe breathlessness on exercise. Up until the last few months he had been holding down a job as a successful salesman. There is a history of smoking 8–10 cigarettes per day. His father died at a young age (under 50) of severe chest disease. Routine blood tests reveal that this patient is mildly jaundiced with a bilirubin of 90 µmol/l; his aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are also outside the normal range. Chest X-ray reveals basal emphysema. Which diagnosis best fits this clinical picture?
α1-Antitrypsin deficiency
Chronic obstructive pulmonary disease secondary to excessive smoking
Cirrhosis
Gilbert syndrome
Stress
A 72-year-old woman presents to the Respiratory Clinic for review with increasing shortness of breath over the past 4–6 months. She used to be able to walk her dog, but she now finds her exercise tolerance limited to only a few hundred metres. There is a dry cough but no significant wheezing, and her GP has tried a salbutamol inhaler with no effect. She has a 10-pack-year smoking history, takes medication for hypertension and has complained of symptoms consistent with gastro-oesophageal reflux disease (GORD) in the past. On examination her BP is 135/85 mmHg; pulse is 75/min and regular. There is early bilateral clubbing. Auscultation reveals bilateral inspiratory crackles, more marked in the mid-zones and at the lung bases. Abdomen is soft and non-tender and her BMI is 22. SpO2 on air is 91%. Chest X-ray reveals patchy shadowing, which is more marked at the lung bases. Which of the following is the most likely diagnosis?
Aspiration pneumonia
Bronchiectasis
COPD
Idiopathic pulmonary fibrosis
Left ventricular failure
A 69-year-old woman with rheumatoid arthritis is referred with a history of recurrent chest infections, intermittent wheeze and production of half an eggcup of phlegm daily, on occasions with a streak of blood. She is a retired secretary and has never smoked. On examination she had coarse crepitations at both the bases. What is the most likely diagnosis?
Bronchiectasis
Carcinoma of the lung
Chronic bronchitis
Diffuse interstitial lung fibrosis
Tuberculosis
A 55-year-old patient has presented with a 4-week history of shortness of breath and cough with occasional bloody phlegm. He has been smoking 10 cigarettes per day for 25 years. The clinical examination, chest X-ray is reported as unremarkable. Laboratory work up reveals mild CO2 retention consistent with chronic obstructive pulmonary disease (COPD) and an elevated erythrocyte sedimentation rate (ESR) of 91 mm/h. Which of the following investigations is most likely to give the correct diagnosis?
Computed tomography thorax
Follow-up chest X-ray in 6 weeks
Spirometry
Sputum cytology
Ventilation/perfusion scan of the lung
A 46-year-old man with a history of asthma, well controlled with regular low-dose Seretide, presents with a cough productive of purulent, blood-stained sputum. On examination his temperature is 38.6 °C, pulse is 90/min and regular; there is a cluster of cold sores on his upper lip. Auscultation reveals left-sided consolidation. Which of the following causes of lower respiratory tract infection is most likely to be associated with herpes labialis?
Haemophilus influenzae
Mycoplasma pneumoniae
Staphylococcus aureus
Streptococcus pneumoniae
Streptococcus pyogenes
Untitled Quiz Field
A 68-year-old man presents with sudden-onset, left-sided weakness. He has a past history of smoking but nothing else significant. There is a suggestion of papilloedema on fundoscopy. His chest X-ray on admission to the Emergency Department reveals right middle- and lower-lobe consolidation, with evidence of a mass at the right hilum. Blood testing reveals a normochromic normocytic anaemia, a calcium concentration of 2.9 mmol/l and mildly raised urea and creatinine concentrations (urea 9.1 mmol/l, creatinine 148 micromol/l). What is the best way to confirm the underlying cause for the weakness?
Admit for bronchoscopy
Arrange urgent treatment of his hypercalcaemia
CT brain scan after an interval of 3–5 days
Urgent CT brain followed by contrast scan
Urgent non-contrast computed tomography
You are reviewing a 79-year-old man who has had multiple myeloma for the past three years. He presents with lethargy, muscle aches and pain in his lower back. Arterial blood sampling reveals a metabolic acidosis. Serum potassium is 3.1 mmol/l (3.5-4.9), and urine pH is 5.2. Which one of the following is the most likely diagnosis?
Renal tubular acidosis-type IV
Renal tubular acidosis-type III
Renal tubular acidosis-type I
Renal tubular acidosis-type II
Urinary obstruction
A 25-year-old man presents with haematuria, haemoptysis, oedema and proteinuria. He is currently being investigated for respiratory symptoms, and has been recently diagnosed with hypertension. Dipstick of his urine shows +3 blood and +3 protein; his blood results show a normal albumin. Which one of the following investigations would be the most appropriate for arriving at a diagnosis?
Anti-nuclear antibody estimation
Antistreptolysin O titre (ASO)
Chest X-ray
Renal biopsy
Renal ultrasound
During the course of a routine medical examination, a 26-year-old man is found to have +3 haematuria. This is confirmed on microscopy and on a second urinalysis 9 months later. He remembers two episodes during the past year when his urine was red, and both occurred in association with an upper respiratory tract infection. The family history is negative for renal disease. His blood pressure is 150/100 mmHg and he has no oedema. Plasma creatinine is 65 μmol/l. Which one of the following would a renal biopsy most probably show?
Cast nephropathy
IgA nephropathy
Kimmelstiel-Wilson lesions
Minimal change disease
Thin basement membranes
A 49-year-old woman presents to her GP with symptoms of urinary tract infection. There is a history of multiple attendances for various aches and pains, and a previous neurology referral for headache. She admits to using large amounts of over the counter analgesics including paracetamol, ibuprofen and naproxen. BP is 165/95 mmHg. Urinalysis reveals haematuria and her GP commences her on a 2-week course of ciprofloxacin. She returns, still complaining of symptoms, at which point the presence of a normochromic normocytic anaemia is noted, along with a serum creatinine of 220 μmol/l. Which one of the following diagnoses fits best with this clinical picture?
Acute kidney injury (AKI) secondary to urosepsis
Reflux nephropathy
Medullary sponge kidney
Interstitial nephritis
Retroperitoneal fibrosis (RPF)
A 28-year-old woman presents to the Emergency Department with flank pain and a 48-hour history of dysuria. Her past medical history includes polycystic ovarian syndrome. She is not in a steady relationship at present. There is haematuria, leukocytes, nitrites and proteinuria on urine dipstick testing. Examination reveals a pyrexia of 38.1°C and flank pain. Which of the following is the most likely diagnosis?
Acute glomerulonephritis
Nephrolithiasis
Ovarian cyst pain
Pelvic inflammatory disease
Pyelonephritis
A week after an episode of infective diarrhoea, a 17-year-old teenager presents with fever, hypertension and haematuria. You understand that he had been doing work experience at a farm a short period before he became unwell. Blood tests reveal anaemia with an Hb of 84 g/l, and an elevated creatinine of 185 μmol/l. A possible diagnosis could be:
Acute interstitial nephritis
Haemolytic–uraemic syndrome
Henoch–Schönlein purpura
Membranoproliferative glomerulonephritis
Post-infectious glomerulonephritis
A 75-year-old woman, who is a chronic alcoholic, presents with recurrent episodes of a swollen, redhot right ankle. Renal function is normal. Aspiration of the joint reveals negatively birefringent crystals. What is the probable diagnosis?
Calcium oxalate arthropathy
Calcium pyrophosphate arthropathy
Monosodium urate monohydrate arthropathy
Osteoarthritis
Osteoporosis
A 45-year-old woman presents with a 4-month history of malaise, weight loss, occasional fever and progressive difficulty in climbing stairs. She also has dyspnea and a dry cough. On examination there is wasting of the pelvic girdle muscles with weakness and bibasal crepitations on chest auscultation. Electromyography (EMG) shows spontaneous fibrillation, high-frequency repetitive potentials and polyphasic potentials on voluntary movements. What is the best diagnostic test?
Anti-Jo 1 antibody
EMG (electromyography)
High resolution CT chest
Muscle biopsy
Pulmonary function tests
A 70-year-old man attends the Rheumatology Clinic complaining of a stiff, painful right hand and pain and swelling in both knees. On examination, bony lumps are seen at the distal interphalangeal joints. ESR is 30mm/hr. What is the most probable diagnosis?
Osteoarthritis
Pseudogout
Psoriatic arthritis
Reactive arthritis
Rheumatoid arthritis
A 22-year-old man complains of having low back pain for the past 3 months. He has also noticed a swelling of his right second toe and has pain in his heels when he walks. He was treated for red eyes 6 months earlier. Which investigation would most likely lead to a diagnosis of his symptoms?
HLA testing
Joint aspirate and microscopy for uric acid crystals
MRI of the sacroiliac joint
X-ray of the foot
X-ray of the sacroiliac joints
A 47-year-old woman complains of exertional dyspnoea associated with a dry cough and bloody discharge from her nose. Her ankles, fingers and toes are swollen. Blood tests for antibodies are positive for cytoplasmic antineutrophil cytoplasmic antibodies (cANCA). What is the most likely diagnosis?
Churg–Strauss syndrome (eosinophilic granulomatosis with polyangitiis, EGPA)
Goodpasture’s syndrome
Rheumatoid arthritis with fibrosing alveolitis
Systemic lupus erythematosus
Granulomatosis with polyangiitis (GPA)
A 30-year-old woman presents with a 2-month history of polyarthralgia, dry eyes and a low-grade fever (up to 37.8 °C). She has tender joints with no demonstrable synovitis. Investigations show: antinuclear antibodies (ANA) 1:640, rheumatoid factor 1:320, antibodies to double-stranded DNA (anti-dsDNA) and anti-Ro antibodies are present. Which one of the following is the most likely diagnosis?
Mixed connective tissue disease
Primary Sjögren’s syndrome
Rheumatoid arthritis
Systemic lupus erythematosus
Systemic sclerosis
A 58-year-old man complains of tiredness, fever, weight loss, arthralgia and diarrhoea. Jejunal biopsy reveals flattened mucosa that contains macrophages positive for periodic acid–Schiff (PAS). What is the most likely diagnosis?
Coeliac disease
Tuberculosis
Tropical sprue
Parasitic infection
Whipple’s disease
A 24-year-old patient presents with a 7-week history of colicky abdominal pain, fevers and diarrhoea 2–3 times per day on most days without blood. Over the past year he has lost 6 kg in weight and has felt more fatigued. He has not had any recent foreign travel. He is a non-smoker and occasionally drinks alcohol. On examination, his BMI is 19, pulse is 110 bpm, temperature is 37.6 °C, and he has a tender diffuse mass in the right iliac fossa. PR shows soft stool, and an anal tag. His haemoglobin is 115 g/l, white cell count 12.6 × 109/l, platelets 566 × 109/l and erythrocyte sedimentation rate (ESR) 48 mm in 1 hour. Stool culture is negative for infection. What is the most likely diagnosis?
Crohn's disease
Ileocaecal tuberculosis
Small bowel lymphoma
Ulcerative colitis
Yersiniosis
A 55-year-old man complains of intermittent epigastric pain, diarrhoea and steatorrhoea. He has mild iron deficiency anaemia and raised calcium and parathyroid hormone levels. An upper gastrointestinal endoscopy has shown peptic ulcers in the stomach, duodenum and jejunum. Which of the following tests is most likely to help in diagnosis?
Duodenal biopsy
Plain X-ray of the abdomen
Serum gastrin level
Small-bowel follow-through
Stool fat content
A 45 year old patient who has just moved to the UK from Cambodia, has chronic kidney disease secondary to diabetes mellitus and is on dialysis. She speaks very limited English but she appears asymptomatic. Her last bloods showed an ALT of 120 u/l and AST 200 u/l. Further investigations show: Hepatitis C antibody: negative, Hepatitis B surface antigen: negative, Hepatitis B surface antibody positive, CMV IgG positive, EBV negative, anti-mitochondrial antibody negative, ferritin normal, caeruloplasmin normal. What is the next most appropriate step in investigating the cause of her raised ALT and AST?
Order HBV DNA levels
Perform a liver biopsy to exclude auto-immune hepatitis
Order Hepatitis C PCR
Order a HIV test
Perform a liver biopsy to exclude steatohepatitis
A 47-year-old man attends clinic with a 3-month history of malaise and 1 stone weight loss. He also complains of upper abdominal pain, which radiates to the back and seems worse when lying flat. Over the last 2 weeks his wife, a qualified nurse, has noticed that he has become jaundiced. There is no history of foreign travel, IVDU or excess alcohol use. On examination, he is icteric but has no evidence of chronic liver disease. There is no hepatosplenomegaly. Epigastric discomfort is elicited on deep palpation. What is the most likely clinical diagnosis?
Acute hepatitis B infection
Adenocarcinoma of the pancreas
Gilbert syndrome
Hepatocellular carcinoma
Chronic pancreatitis
A 51-year-old man presented to his general practitioner complaining of tiredness. He had no history of alcohol excess and took no medication. There had been a history of intermittent bloody diarrhoea over the past few years. His general practitioner noticed that his alkaline phosphatase level was raised, and that his antineutrophil cytoplasmic antibody (ANCA) was positive. He was then referred for a gastroenterological opinion. What is the most likely diagnosis?
Alcohol-related cirrhosis
Familial hypercholesterolaemia
Haemochromatosis
Primary biliary cholangitis
Primary sclerosing cholangitis
A nurse was investigated following a needle-stick injury sustained while taking a blood sample from a patient infected with hepatitis B virus. The nurse’s vaccination record for hepatitis B was unknown. Which test would provide the earliest diagnosis of hepatitis B infection in the nurse?
Anti-HBe
HBeAg
HBsAg
IgG anti-HBc
IgM anti-HBc
A 24-year-old woman was referred with abdominal pain, diarrhoea and weight loss. On examination, she had an itchy blistering rash on both elbows. Investigations revealed haemoglobin of 103 g/l and mean corpuscular volume (MCV) 71 fl. What is the most appropriate diagnostic test?
Barium meal and follow-through
Crosbie capsule jejunal biopsy
Endoscopy and duodenal biopsy
Skin biopsy of the rash
Ultrasound of the pancreas
A 68–year-old gentleman presents with a lesion on his temple that looks shiny, has a rolled edge and is gradually increasing in size. Routine blood tests are unremarkable. What is the most likely diagnosis?
Amelanotic melanoma
Basal cell carcinoma
Lentigo maligna
Seborrhoeic wart
Squamous cell carcinoma
You are asked to review a 53-year-old diabetic man who has diarrhoea. He is currently taking metformin at total daily dose of 2 g/day. The diarrhoea appears to worsen with increased metformin dose. What is the most likely cause of his diarrhoea?
Autonomic neuropathy related to diabetes
Osmotic diarrhoea related to ‘diabetic foods
Secretory diarrhoea
Bile acid malabsorption
Steatorrhoea
A 56-year-old woman had an upper gastrointestinal endoscopy for long-standing reflux symptoms. This showed the squamo-columnar junction at 32 cm, the gastro-oesophageal junction at 39 cm and the diaphragmatic hiatus at 40 cm. Biopsies from the distal oesophagus revealed a columnar mucosa with goblet cells. What is the most likely explanation for these findings?
Barrett’s oesophagus
Gastric metaplasia
Oesophageal atresia
Rolling hiatus hernia
Sliding hiatus hernia
A 22-year-old White woman with a history of Type 1 diabetes presents for review. She has just returned from a summer holiday in Spain and has noticed some patches on her body that do not appear to have tanned. Examination shows depigmented macules symmetrically on the hands, feet and chest. Which diagnosis fits best with this clinical picture?
Leprosy
Melasma
Morphoea
Pityriasis versicolor
Vitiligo
A 32-year-old man presents with painful mouth sores, a painful red eye and polyarthralgia. Ulcers on a yellow base with erythematous edges are seen in the buccal mucosa. He gives a history of recurrent painful genital ulcers in the past few months which have now healed. What is the most likely diagnosis?
Behçet syndrome
Crohn’s disease
Reactive arthritis
Syphilis
Systemic lupus erythematosus
A 32-year-old army corporal has returned to the UK after 4 months in Central America. He complains of intense itching affecting the finger webs, chest and the flexural aspect of the wrists. On examination there appears to be excoriation in the finger webs and a couple of linear scabs on the wrists measuring a few millimetres in length; he also has eczematous changes around the nipples. What diagnosis fits best with this clinical picture?
Cutaneous larva migrans
Cutaneous leishmaniasis
Dermatitis herpetiformis
Eczema
Sarcoptes scabiei infestation
A 22-year-old woman presents with an asymptomatic eruption over her chest and interscapular area, which she noticed recently. Examination shows scattered warty brown papules. Which diagnosis fits best with this clinical picture?
Darier’s disease
Lichen planus
Lichen simplex
Pityriasis rosea
Pityriasis rubra pilaris
An 18-year-old man comes to the Dermatology Clinic for review. He is concerned by some skin changes he has noticed. He has pseudoxanthoma elasticum with ‘plucked chicken’ skin around his neck, and lax, saggy folds of skin affecting both axillae. Which of the following complications is he most likely to suffer from?
Aortic stenosis
Lens dislocation
Lower gastrointestinal (GI) haemorrhage
Thoracic aorta dissection
Upper GI haemorrhage
A 31-year-old man presents with a number of small blisters, predominantly affecting his scalp, scapular area and buttocks. The blisters are intensely itchy. Skin biopsy is positive for IgA immunofluorescence. Which diagnosis fits best with this clinical picture?
Dermatitis herpetiformis
Erythema multiforme
Pemphigoid
Pemphigus
Porphyria cutanea tarda
Where is the chromosomal translocation in acute promyelocytic leukaemia located?
t(9:22)
t(10:19)
t(13:18)
t(15:17)
t(16:18)
A 58-year-old patient has been complaining of feeling unwell for the last 6 months. He complains of night sweats and weight loss. Molecular analysis of the peripheral blood film shows a reciprocal t(9;22) chromosome translocation. Which one of the following is the most likely diagnosis?
Acute lymphocytic leukaemia
Acute myeloblastic leukaemia
Chronic lymphocytic leukaemia
Chronic myeloid leukaemia
Myeloma
A 40-year-old patient has been complaining of headache, weakness, dizziness and pruritus for the last 2 months. He has also noticed a 2-stone (12.7 kg) weight loss. Gout was diagnosed some 6 months earlier. On examination he is cyanosed, has hepatosplenomegaly and his blood pressure is 170/100 mmHg. Which one of the following is the most likely diagnosis?
Acute myeloblastic leukaemia
Chronic lymphocytic leukaemia
Chronic myeloid leukaemia
Myeloma
Polycythaemia vera
A 25-year-old woman presents 2 days postpartum with sudden onset left-sided chest pain and shortness of breath. She is tachycardic and has a respiratory rate of 24 breaths per minute. She is started on intravenous unfractionated heparin. She is started on warfarin the day after when a ventilation/perfusion (V/Q) scan confirms a pulmonary embolus, but is slow to reach therapeutic anticoagulation and heparin is therefore continued. Eight days into the treatment she requires increasing doses of heparin to maintain a therapeutic activated partial thromboplastin time (APTT). On day ten she has a pale, pulseless and painful right foot. Which one of the following diagnostic laboratory results supports your clinical diagnosis?
A low factor VII assay
A low platelet count of 50 ×10^9/l
A low protein C level of 43%
An APTT ratio of 1.7
A prolonged international normalised ratio (INR)
A 17-year-old girl undergoes a thrombophilia screen 1 week after discontinuing warfarin for a previous PE sustained while on the combined oral contraceptive pill. The results are as follows: protein C 40% (50–150), protein S 36% (50–150), antithrombin III 199 (50–150), APC resistance 1.4 (3–4). What further action will you take?
DNA analysis for Factor V Leiden
Family study
Reintroduce anticoagulants
Repeat thrombophilia screen 3 weeks later
Screen for the prothrombin polymorphism
