Question bank

You see a 67-year-old man who has been referred to the chest clinic following a three-month history of weight loss and signs which may suggest a Pancoast's tumour. Which of the following symptoms from the list below is not associated with a Pancoast's tumour?

A SO-year-old Afro-Caribbean man, with no past medical history, presents with a four-month history of dry cough and shortness of breath on exertion. The patient's GP referred him to the chest clinic after performing blood tests which revealed a raised erythrocyte sedimentation rate (ESR) and serum angiotensin-converting enzyme (ACE) level. You review the patient's chest x-ray which reveals bilateral hilar lyphadenopathy. From the list below, select the most likely diagnosis:

You are told by your registrar that a 69-year-old man has been admitted to the chest ward with dyspnoea, cyanosis and finger clubbing. His chest x-ray shows bilateral lower zone reticulo-nodular shadowing. From the list below, which is the most likely diagnosis?

You see a 70-year-old man diagnosed with hypersensitivity pneumonitis following a four-month history of shortness of breath at rest and cyanosis. Which of the following does not fall under the category of hypersensitivity pneumonitis?

During the consultant ward round, you see a 78-year-old woman who is being investigated for hyponatraemia, weight loss and haemoptysis. A mass lesion was detected on a CT-chest scan which has been biopsied and sent for histological analysis. Your consultant has a high suspicion that the patient may have bronchogenic carcinoma. From the list below, select the most likely type ofbronchogenic carcinoma that would explain the above patient's symptoms:

A 56-year-old man attends your clinic with a three-month history of a productive cough with blood-tinged sputum, following his return from India. Associated symptoms include lethargy, night sweats and decreased appetite. He is normally fit and healthy with no past medical history. On examination, the patient's chest bas good air entry bilaterally with no added sounds and bis temperature is 37.3°C. A sputum sample sen.t from the patient's GP reveals a growth of acid fast bacilli. From the list below, which is the most likely diagnosis?

A 37-year-old woman is admitted to accident and emergency with severe facial burns. Despite prompt management, she develops acute respiratory distress syndrome (ARDS). Which of the following is not associated with the diagnostic criteria for ARDS?

You see a 47-year-old man in clinic with a three-month history of epigastric dull abdominal pain. He states that the pain is worse in the mornings and is relieved after meals. On direct questioning, there is no history of weight loss and the patient's bowel habits are normal. On examination, his abdomen is soft and experiences moderate discomfort on palpation of the epigastric region. The most likely diagnosis is:

You see a 48-year-old lorry driver, who presents to you with a three-month history of heartburn after meals which has not been settling with antacids and PPis. You suspect that the patient has a l1iatus hernia. The most appropriate investigation for diagnosing a hiatus hernia is:

You see a 25-year-old woman who presents with a 24-hour history of watery diarrhoea. She states that she has opened her bowels 11 times since her onset of symptoms. Associated symptoms include nausea and vomiting with abdominal cramps and pain which started in the evening following a barbeque meal in the afternoon that day. The patient is alert and orientated and her observations include a pulse rate of 69, blood pressure of 124/75 and temperature of 37.1°C. On examination, her abdomen is soft, there is marked tenderness in the epigastric region and bowel sounds are hyperactive. The patient is nor1nally fit and well with no past medical history. The most likely diagnosis is:

You see a 54-year-old woman, referred to accident and emergency through her GP, with a week's history of jaundice and right upper quadrant abdominal pain. Associated symptoms include dark urine and pale stools. There is no history of weight loss and the patient does not consume alcohol. Her liver function tests reveal a bilirubin of 40 µmol/L, ALT of 40 iu/L, AST 50 iu/L and ALP of 350 iu/L. The most likely diagnosis is:

A 67-year-old man presents feeling unwell and complaining of general malaise. He mentions a long history of alcohol abuse and his past medical history sl1ows deranged liver function tests. Which of the following clinical signs does not form part of chronic liver disease?

You see a 52-year-old woman with rheumatoid arthritis in your clinic. She was referred by her GP after her ALP levels were found to be abnormally high at 300 iu/L. In addition, she was also found to be serum anti-mitochondrial antibody (AMA) positive. The most likely diagnosis is:

You are told by your registrar that one of your inpatients has been diagnosed with primary sclerosing cholangitis (PSC). Your registrar suspects that the patient may have an associated condition. Primary sclerosing cholangitis is associated with which of the following diseases?

A 28-year-old man undergoes a sigmoidoscopy for longstanding diarrhoea and weight loss. On visualization of the rectum, the mucosa appears inflamed and friable. A rectal biopsy is taken and the histology shows mucosal ulcers with inflammatory infiltrate, crypt abscesses with goblet cell depletion. From the list of answers below, which is the most likely diagnosis, describing the histology report?

You read a report which was handwritten in a patient's medical notes who you suspect has inflammatory bowel disease. The report reads, ' ... there is cobblestoning of the terminal ileum with the appearance of rose thorn ulcers. These findings are suggestive of Crohn's disease'. Select the most likely investigation that this report was derived from:

A 47-year-old woman has been experiencing a four-month history of diarrhoea and bloating. Associated symptoms include lethargy and weight loss. Full blood count reveals haemoglobin of 9.3 d/gL and MCV 70 fL. Which of the following investigations would be helpful in the patient's diagnosis?

A 21-year-old man presents with painless haematuria which he has noticed in the last 3 days. He suffers from type 1 diabetes which is well controlled, but is otherwise fit and healthy. The patient USMLE IM2e/Diagnostic has recently recovered from a mild throat infection. Urine dipstick analysis reveals blood and protein in the urine. The most likely diagnosis is:

A 16-year-old boy presents with a low-grade fever which started 1 week ago. The patient also reports feeling fatigued and indicates pain in his joints. His parents mention that he has been visiting the toilet more often than usual. A urine dipstick shows trace proteins, while a blood test shows raised eosinophils. The most likely diagnosis is:

A 42-year-old diabetic Asian male complains of dysuria, increased urinary frequency and general malaise for the past six months. In the last few days, he has noticed blood in the urine. Examination of the urine shows the presence of neutrophils with no organisms detected on urine culture. The most likely diagnosis is: