Question bank

A 35-year-old homeless man presents to the emergency department unconscious and fitting. You estimate that he has been fitting now for 35 minutes. He smells of alcohol and looks dishevelled. He has an adequate airway and is breathing 10 L/min 02. His pulse and blood pressure are within normal range, and his capillary glucose is normal. What should your immediate management be?

A 28-year-old woman with a past medical history of asthma has been using her inhaled salbutamol more frequently of late. She is currently on an inhaled short-acting beta-2 agonist and an inhaled steroid 800 µg/day. She has been compliant. What should you do?

An 87-year-old man with a background of Alzheimer's disease, a previous stroke, and atrial fibrillation (for which he is on warfarin), is admitted with increasing amounts of painless haematuria. He is catheterised and the warfarin stopped. The haematuria reduces and then seems to stop. Problems with his residential home are delaying discharge. You note 2 days later that his creatinine level has risen to 250 µmol/L. When you go to see him, he seems stable, as do his observations. He does seem slightly dry with reduced skin turgor and delayed capillary refill. The urine output has not been carefully documented in the last few days, and by your calculations, 100 ml have been passed in the last 24 hours. On examination he appears to have a mass in his central lower abdomen. What should be your next step?

A 70-year-old lady with a history of asthma presents with shortness of breath for some days. She is also treated with ramipril 10mg daily. On examination her blood pressure is 135/85 mmHg, pulse is 100/min (atrial fibrillation). She is not in cardiac failure. Examination of the respiratory system reveals wheeze consistent with asthma. Results; Hb 13.2 g/dl, WCC 6.1 x109/I, PLT 240 x109/I, Na+ 138 mmol/1, K+ 4.7 mmol/1, Creatinine 125 µmol/1. CXR Cardiomegaly consistent with longstanding hypertensive heart disease. Which of the following is the most appropriate treatment for her atrial fibrillation?

A 41-year-old man with a family history of sudden death presents to casualty with a second episode of collapse. On this occasion he is referred to the Cardiology Department for review. Echocardiography reveals asymmetrical septa) hypertrophy, abnormal systolic motion of the anterior mitral valve leaflet and narrowing of the left ventricular outflow tract. The 24-h electrocardiogram (ECG) monitoring as an outpatient reveals several periods of non-sustained ventricular tachycardia. Which of the following would be most appropriate for the management of his arrhythmia?

A 70-year-old man presents to the emergency department with a cough productive of blood-stained green sputum and shortness of breath. A chest X-ray demonstrates a suspicious lesion in the right lower zone associated with consolidation. On further questioning, he admits to recent weight loss and back pain. Blood tests show: Na+ 137 mmol/L, Corrected Ca2+ 3.0 mmol/L, K+ 3.8 mmol/L, PO4 0.33 mmol/L, Urea 14.5 mmol/L, Creatinine 160 µmol/L, AJk Phos 450 mmol/L. Which of the following is NOT appropriate in the management of this patient?

A 19-year-old patient with Wolff-Parkinson-White syndrome presents to the emergency department with a two-hour history of rapid palpitations. The heart rate is 180 beats/min (bpm). Blood pressure is 130/80 mrnHg. The electrocardiogram (ECG) shows a regular broad complex tachycardia. What is the best treatment for the tachycardia?

A 64-year-old man with Wolff-Parkinson-White syndrome presents with uneasiness and palpitations. The ECG shows fine oscillations of the baseline and no clear P waves. The QRS rhythm is rapid and irregular. The ventricular rate is 120 beats per minute. His blood pressure is 90/60 mmHg. Which of the following interventions would be most appropriate in this case?

A 25-year-old primigravida who is 26 weeks' pregnant, presents to the casualty department with symptoms of headache, flashing lights and vomiting. Her blood pressure was recorded at 140/100 mmHg and her antenatal diary showed consistent systolic readings of 110-120 mmHg and consistent diastolic readings of less than 80 mmHg. She has a history of mild asthma but was otherwise in good health prior to pregnancy, and there is no family history of note. Which of the following would be the drug of first choice?

You see a 19-year-old Caucasian man in your clinic who presents with a history of transient jaundice. On direct questioning, you ascertain that the jaundice is noticeable after periods of increased physical activity and subsides after a few days. The patient bas no other symptoms and physical examination is 11nremarkable. Full blood count is normal (with a normal reticulocyte count) and liver function tests reveal a bilirubin of 37 µmol/L. The most appropriate management is:

During your on-call, you are bleeped to see an 80-year-old woman on the ward who l1as not opened her bowels for the last 4 days. She is not known to have a history of constipation. On examination, her observations are within normal range, the abdomen is soft and there is mild discomfort at the left iliac fossa. Bowel sounds are present and on PR examination, the rectum is empty. You consult your registrar who asks you to prescribe an osmotic laxative. What is the most appropriate treatment?

A 60-year-old man with alcoholic liver disease was admitted with an upper GI bleed secondary to oesophageal varices. The patient undergoes endoscopic variceal banding and is discharged after 2 weeks in-hospital stay. Which of the following medications would act as prophylaxis in preventing are bleed from bis oesophageal varices?

You see a 56-year-old woman who presents with a two-month history of jaundice. Associated symptoms include lethargy and polyartbralgia. Her LFTs reveal a bilirubin of 46 iu/L, AST 200, ALT 175, ALP 104. On examination, the patient is jaundiced and has finger clubbing. There are several spider naevi on the front and back of the trunk. Her abdomen is soft and there is a USMLE IM2e/Management smooth hepatomegaly. Prior to her onset of symptoms, the patient has been fit and well. Viral serology is normal and anti-soluble liver antigen (SLA) is detected. You decide to start this patient on treatment. The most appropriate treatment is:

You are asked to see a 29-year-old woman diagnosed with ulcerative colitis 18 months ago. Over the last 4 days she has been experiencing slight abdominal cramps, opening her bowels approximately 4-5 times a day and has been passing small amounts of blood per rectum. The patient is alert and orientated and on examination her pulse is 67, blood pressure 127/70, temperature 37.3°C and her abdomen is soft with mild central tenderness. PR examination is nil of note. Blood tests reveal haemoglobin of 13.5 g/dL and a CRP of 9 mg/L. The most appropriate management plan for this patient is:

A 65-year-old man attends your clinic with a three-month history of weight loss of approximately 9 kg despite a normal appetite. A full blood count reveals that his haemoglobin is 9.0 g/dL (previous haemoglobin was 13.5 g/dL one year ago) and the MCV is 71 fL. Abdominal examination is unremarkable and per recttim exam is nil of note. The patient states that he has normal bowel habits and has been feeling quite tired lately. The most appropriate management 1• s:

A 58-year-old African man presents with pitting oedema of his ankles. He suffers from recently diagnosed hypertension, but is otherwise healthy. Blood results show low albumin and a urine dipstick is positive for protein. The most appropriate initial treatment is:

A 28-year-old woman patient who is 13 weeks pregnant presents for an antenatal clinic appointment. The patient feels embarrassed when asked to provide a urine sample and produces enough for a urine dipstick test only which is positive for leukocytes and nitrites. The patient denies any symptoms. The most appropriate treatment is:

A 55-year-old woman is seen in clinic, she has a ten-year history of type 2 diabetes treated with glibenclamide. Her blood pressure is 148/93 with new onset proteinuria, her serum results show elevated lipid levels, glycated haemoglobin of 5.5 per cent and fasting glucose of 6.0 mmol/L. A renal biopsy shows the presence of Kimmelstiel-Wilson lesions. The most appropriate management is:

A 21-year-old man presents with lethargy over the last week, he has periorbital oedema and proteinuria. The patient mentions he has been to hospital a number of times in the past due to the same symptoms as well as mild eczema. Light microscopy of a renal biopsy showed normal morphology. Electron microscopy of the renal biopsy reveals the diffuse effacement of the epithelial podocytes. The most appropriate treatment is:

A 65-year-old woman complains of panic attacks. She has recently retired as a school teacher, but 2-3 times a week she suffers extreme anxiety, becomes short of breath and sweats excessively. Elevated catecholamines are detected in the urine. The most appropriate medical treatment is: