Question bank

A 56-year-old man, diagnosed with emphysema, presents with a one-month history of jaundice and ascites. Your registrar suspects that this patient may have liver disease secondary to al-antitrypsin deficiency. Select the most likely mode of inheritance from the list below:

You are asked by your registrar to request an imaging investigation for a 49-year- old woman with jaundice and abdominal pain. She has a past medical history of gallstones and you suspect this is a recurrence of the same problem. The most appropriate imaging investigation is:

A 67-year-old woman suffered a fracture to her hip during a fall and undergoes a successful hip replacement. After 2 weeks, the patient complains of pain in her right leg, particularly on movement. On examination, the leg is swollen below the knee, erythematous and tender on palpation. The most appropriate management is:

A 49-year-old woman attends your clinic suffering from chronic renal failure due to progressive glomerular disease. She appears well and her blood pressure is 141/92mmHg. Blood tests reveal elevated phosphate, serum creatinine and urea, while calcium levels are low. Her estimated glomerular filtration rate is 35mL/min/1.73m2. You also notice the patient's cholesterol levels are moderately raised. The most appropriate management is:

Which of the following medications is not likely to prolong survival in this patient?

You are told that a patient in clinic has been diagnosed with cystic fibrosis using the sodium chloride sweat test. Which of the following results from the latter test would indicate a positive diagnosis of cystic fibrosis?

You see an 80-year-old man who presents to accident and emergency with epigastric pain. The pain started 3 days ago and today he noticed that the colour of his stools has changed to a 'tarry-black' colour. Associated symptoms include nausea and lethargy. The patient is a smoker of 20 cigarettes a day and has recently finished eradication treatment for a duodenal ulcer. The patient is alert and orientated with a pulse rate of 99 and blood pressure of 98/69, respiratory rate of 18, oxygen saturations of 98 per cent on room air and temperature of 37.2°C. On examination, the abdomen is soft with marked tenderness in the epigastric region and bowel sounds are present. The rectum is empty, on PR examination, with some traces of malaena. The patient has been started on high flow oxygen and has been given some oral analgesia. The most appropriate next step in managing this patient is:

A 56-year-old woman who has recently been discharged from your ward, with oral antibiotics for right basal community-acquired pneumonia, is re-admitted with transient pyrexia and shortness of breath. She is found to have a right-sided pleural effusion which is drained and some pleural aspirate sent for analysis. The results reveal an empyema. Which of the foilowing, from the pleural aspirate analysis, would typically be found in a patient with an empyema?

You are asked to request imaging for a patient with a suspected pneumothorax who you have just examined in accident and emergency. Which of the following would be the most appropriate first step imaging modality?

You see a 46-year-old man who has presented to accident and emergency with an acute onset of shortness of breath. Your registrar has high clinical suspicion that the patient is suffering from a pulmonary embolism and tells you that the patient's ECG bas changes pointing to the suspected diagnosis. From the list below, which of the foilowing ECG changes are classically seen?

You are discussing a patient with your registrar who has become acutely short of breath on the ward. After performing an arterial blood gas, you have high clinical suspicion that the patient has a pulmonary embolism. Which of the following is the investigation of choice for detecting pulmonary embolism?

A 29-year-old woman goes to see her GP complaining of fatigue and palpitations. She says she has also lost weight, though without dieting. On examination, her pulse rate is approximately 120/min and irregularly irregular. Her blood pressure is 142/89 mmHg and her body mass index is 19. There are no added cardiac sounds. The ECG confirms the diagnosis of atrial fibrillation. What would you suggest as the most useful next investigation.

A 35-year-old woman complains of a sharp central chest that is acutely exacerbated each time she moves, breathes in or lies flat. The pain tends to stay in the centre of the chest but occasionally moves towards her neck and shoulders. The pain is relieved by sitting forward. The USMLE IM2e/Paraclinic patient does not drink alcohol, is not diabetic and does not smoke. A pericardia) rub is heard on auscultation. The most appropriate diagnostic investigation is:

A 25-year-old woman with known mitral valve prolapse develops a low grade fever, malaise and night sweats within a couple of weeks of a major dental procedure. Examination reveals a pulse USMLE IM2e/Paraclinic rate of 110/minute, which is regular, tender vasculitic lesions on the finger pulps and microscopic haematuria. Which investigation is most likely to provide a defmitive diagnosis?

A 28-year-old man has been newly diagnosed with asthma. He has never been admitted to hospital with an asthma exacerbation and experiences symptoms once or twice a week. You discuss the treatment options with him. His peak expiratory flow reading is currently 85 per cent of the normal predicted value expected for his age and height. Which of the following is the most appropriate first step in treatment?

A 69-year-old man has been admitted to the emergency department with syncope. He felt hot, complained of nausea and then fainted. His electrocardiogram (ECG) was normal. His brother suffers from adult onset epilepsy. What is the most appropriate investigation?

A 44-year-old woman presents with episodes of headaches, associated with anxiety, sweating and a slow pulse rate. At the time of her initial consultation, her blood pressure was 150/95 mmHg seated, but 24 hour ambulatory monitoring shows a peak of 215/130 mmHg, associated with the symptoms described above. Which of the following would be your initial diagnostic procedure?

A 42-year-old man presents with a 2-day history of severe chest pain. The patient reports a sudden ripping sensation at the front of the chest that occasionally radiates to the back. The patient has tried paracetamol and ibuprofen to alleviate the pain, but has had no success. The patient suffers from poorly controlled hypertension and at the last GP appointment his blood pressure was 167/95 mmHg. The most definitive investigation is:

A 57-year-old male is admitted complaining of headaches and blurring of vision. His blood pressure is found to be 240/150 mmHg and he has bilateral papilloedema, but is fully orientated and coherent. He had been known to be hypertensive for about five years and his blood pressure control had been good on three drugs. However, he had decided to stop all medication two months before this event. Which of the following would be your preferred parenteral medication at this point?

A 43-year-old woman presents to accident and emergency with epigastric pain that started 4 hours ago. The woman describes the pain as being sharp and radiating to her back. She feels nauseous but has not vomited and is fully alert and orientated. The patient responds well to IV fluids and analgesia. Biochemical blood results show: Bilirubin 8 µmol/L, ALT 38 IU/L, AST 34 IU/L, ALP 421 IU/L, Amylase 1850 U/L. The most appropriate investigation would be: