Question bank

You see a 56-year-old man who was admitted for an elective upper GI endoscopy due to longstanding GORD which has failed to improve on antacids and PPis. Your registrar suspects that this patient may have Barrett's oesophagus and asks you to define what this is. The most appropriate description of Barrett's oesophagus is:

A 69-year-old man present with a 2-week history of abdominal pain which has worsened over the last few days. On examination, the patient is jaundiced and the abdomen is distended with tenderness in the epigastric region. In addition, there is a smooth hepatomegaly and shifting dullness. Which of the foilowing is a cause of hepatomegaly?

You see a 47-year-old woman who presents with a 3-day history of jaundice. You assess her liver function tests (LFTs) and see that the ALP iu/L is raised at 350 iu/L, AST 45 iu/L, ALT 50 iu/L and bilirubin 50 iu/L. The patient feels well in herself, although she has noticed that her urine has become quite dark and her stools quite pale. You assess her medication history. Which of the following drugs from the patient's medication history may be responsible for the cholestasis?

A 68-year-old man presents to his GP with signs of drastic weight loss. He is known to have PSC. The GP suspects an underlying malignancy. Which of the foilowing tumours would a patient with primary sclerosing cholangitis be more at risk of developing?

You are told by your registrar that one of the clinic patients has been admitted with a 'flare up' of ulcerative colitis (UC) which he reports as being severe. From the list of answers below, select the parameters which are likely to reflect a severe flare up of ulcerative colitis:

A 29-year-old anxious man is diagnosed with mild Crohn's disease. Due to time constraints, the patient was asked to come back for a follow-up appointment to discuss Crohn's disease in more detail. The patient returns with a list of complications he researched on the internet. Which of the following are not associated with Crohn's disease?

You see a 40-year-old woman who was diagnosed with Crohn's disease ten years ago. Due to a severe attack of Crohn's which failed to respond to medical therapy, she had a small bowel resection. Your registrar tells you that she is at risk of developing vitamin B12 deficiency as a result of her surgery. Which part of the small bowel is responsible for the absorption of vitamin B12?

A 74-year-old type 2 diabetic woman undergoes a bowel resection for cancer of the colon. She is well prior to the operation with well-controlled diabetes and no other underlying disease. The operation is successful and the patient is given postoperative insulin and IV dextrose. Two days after the operation she becomes very agitated. Sodium 124 (135-145),Potassium3.3 (3.5-5.0), Urea 3.1 (3.0--7.0), Glucose 7.2 (2.5---6.0), Serum osmolality 265 (275-295), Urine osmolality 150. The most likely cause of the hyponatraemia is:

28 A 46-year-old woman presents to your clinic with a week's history of jaundice. Her past medical history includes longstanding atrial fibrillation and hypertension. Physical examination reveals hepatomegaly. You assess her liver function which shows a bilirubin of 41 iu/L, AST 111 iu/L, ALT 55 iu/L and ALP 98 iu/L. There is no history of travel. You have a look at the patient's medication history. Which of the following drugs below is likely to have caused the derangement in the patient's liver function?

A SO-year-old woman, who has received a recent diagnosis of rheumatoid arthritis, presents to her GP with ongoing pain and stiffness in her hands and feet. Which joints are usually spared at onset of rheumatoid arthritis?

A 74-year-old woman presents to accident and emergency with sudden onset pain and swelling in the left knee. On examination, she is apyrexial and the left knee is swollen. There is reduced range of movement in the knee due to swelling and pain. X-ray of the right knee shows chondrocalcinosis. Microscopy of the fluid aspirated from the joint is most likely to show:

A 20-year-old man presents to accident and emergency with sudden onset pain in the right eye, with associated blurred vision and discomfort when gazing at the lights. He has a history of back pain and has recently been diagnosed with ankylosing spondylosis. What is the most likely cause of his eye pain?

A 55-year-old woman presents to her GP with shortness of breath and dry cough. The symptoms began a few months ago and have progressed. She has a past medical history of rheumatoid arthritis, diagnosed ten years earlier. On respiratory examination, there are bibasal fine inspiratory crackles on auscultation. What is the most likely cause of her symptoms?

A 42-year-old woman presents to accident and emergency with retrosternal discomfort. She was diagnosed with systemic sclerosis a year ago. Which of the following statements is true about systemic sclerosis?

A 60-year-old man presents with abdominal pain and a cupful of haematemesis. On examination he is noted to have ascites, hepatomegaly and a very enlarged spleen extending to the right iliac fossa. His initial blood tests reveal a leukoerythroblastic picture with a haemoglobin of 8, white cell count (WCC) of 3 and platelets of 120. A diagnosis of myelofibrosis is made. What is most likely to be seen on the peripheral blood smear?

A 27-year-old man presents with increasing tiredness and shortness of breath. A macrocytic anaemia with reticulocytes is discovered on blood tests and smear. Genetic analysis reveals the patient has glucose-6-phosphate dehydrogenase deficiency. What cell type is most likely to have been seen on the blood smear?

A young patient presents with features of anaemia, neutropenia and thrombocytopenia. A large number of blasts are present on bone marrow biopsy. Which investigation would help differentiate between acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL)?

A 29-year-old woman presents complaining of shortness of breath, especially when walking up stairs. She is starting to struggle with yoga classes, which were never a problem before. She does not suffer from any medical conditions and takes no regular medication. On examination there USMLE IM2e/Basic is pallor, heart rate is 90 and blood pressure 119/79 mm.Hg. The patient mentions that she has recently become a vegetarian and in the morning only has time for tea before heading to work. Which of the following would you expect to be increased in this patient?

A 27-year-old woman who suffers from rheumatic mitral stenosis develops atrial fibrillation. She is placed on warfarin therapy. What is the most appropriate target international normalized raio (INR) range?

A 70-year-old woman complains of a dull pain in her lower back, especially when bending forwards to lift things. She presents after a severe episode in the last 2 days. An x-ray reveals a lumbar compression fracture. Blood tests show a normocytic anaemia and urine electrophoresis reveals a monoclonal gammopathy. A diagnosis of multiple myeloma is made. Which of the following is not a recognized cause of multiple myeloma?