Progress Test Questions

A man in his 40s presents with a mole on his ear. He says he has had this mole for a long time. On examination you note a small, <4mm diameter with pearly appearance and rolled edges. What is the most likely diagnosis?

(Nodular) Basal cell carcinoma

What is the normal urine output for an average adult?

0.5ml/kg/hr

Cavity-formation with upper love predominance on radioimaging in the lungs is suggestive of which bacterial infection?

TB (Acid-fast bacilli test positive)

What would a person score on the GCS if they opened their eyes spontaneously, were alert, orientated in time and place, and moving spontaneously and purposefully?

15 (4 for eyes, 5 for verbal and 6 for motor - full marks)

When can Amniocentesis be carried out?

15 weeks

To diagnose diabetes mellitus type 2 in an asymptomatic patient, what criteria are required?

2 separate demonstrations of fasting glucose >7mmol/L and random glucose >11.1mmol/L

When does pregnancy-induced hypertension typically start?

20 weeks + (late gestation, and usually resolves after delivery)

What is the typical 'lag' period between exposure and diagnosis in mesothelioma?

20-30 years (but can be up to 45 years)

What would a person score on the GCS if they did not open their eyes, did not respond verbally or by movements?

3 (1 each for eyes, verbal and motor)

How long should steroid treatment be continued following an acute episode of asthma?

5 days minimum

What score on a DEXA scan is indicative of osteoporosis?

< -2.5

In measurement of peak flow, what result indicates severe obstructive asthma?

<200 L/min

What HbA1c measurement is diagnostic of diabetes mellitus, according to 2011 WHO criteria?

>6.5% (equivalent of 48mmol/mol)

The AEIOU mnemonic helps us to remember indications for dialysis. What are they?

Acidosis, electrolyte abnormalities, ingestions (drugs), overload and uraemic symptoms.

What is the most common form of skin cancer in black people?

Acral lentiginous melanoma (which is characterised by moles on the palms, soles of feet or under the nails)

32 year old lady presents with epigastric pain which radiates to the RUQ, associated with nausea and vomiting. She drinks 1 glass of wine per day, but LFTs are normal. She has had two similar episodes before. Amylase is normal, she is not jaundiced, but she is tachycardic with raised CRP. What is going on?

Acute cholecystitis

In which ethnic groups is lactose intolerance most common?

African (and south american)

This cardiac drug has numerous potential side effects, including hepatic and pulmonary fibrosis, thyroid derangement and a blue-grey photosensitive rash.

Amiodarone (antiarrythmic)

What class of drugs can induce angle closure between the iris and the cornea, causing acute closed angle glaucoma?

Anti-muscarinics (because they prevent pupil closure by parasympathetic nerves)

What are the most common antibodies found in patients with primary biliar cirrhosis?

Anti-nuclear and anti-mitochondrial

An 18-year old man is found in a snowdrift, collapsed. His ECG is likely to show J waves. What are these a sign of?

Hypothermia (active warming is necessary during resuscitation. J waves appear just after the QRS but hypothermia can also cause AF and VF)

By which means does follicular cell carcinoma of thyroid spread?

Blood

What culprit bacteria is most commonly associated with refried rice and causes diarrhoea and vomiting?

Bacillus cereus

Injury to which artery is a serious complication of a supracondylar fracture of the humerus?

Brachial artery (presents with cold fingers and pain on extension of digits)

What is the most sensitive prognostic factor in staging malignant melanoma?

Breslow Thickness (which measures the depth of tissue invasion)

A 60 year old man with a history of renal cell carcinoma presents with diffuse abdominal distention with evidence of caput medusa, smooth hepatomegaly and fluid. What is the most likely reason for this presentation?

Budd-Chiari syndrome (hepatic vein obstruction due to back-pressure - causing relative hepatomegaly - the fact it is smooth means it is unlikely to be secondary metastases from previous cancer)

Ischaemic orchitis can be a possible complication of inguinal hernia repair in males due to damage to which artery, which lies lateral to the deep inguinal ring?

Testicular artery (the inferior epigastric artery is also at risk, which lies medial to the deep inguinal ring)

A 40 year old, fit and well, lady who has been travelling to numerous tropical places presents with an uncomfortable, raised rash on the anterior aspects of both lower legs. What is the best initial investigation?

Chest XRay (this sounds like ERYTHEMA NODOSUM, which, although only eventually confirmed in diagnosis by skin biopsy, the most dangerous causes must be excluded initially and these are TB and sarcoidosis)

What is the earliest test that can be performed on pregnant women who want to know whether their baby is likely to have Down's Syndrome?

Chorionic Villus Sampling (CVS - this is diagnostic by karyotyping in the first trimester and can be carried out at 11 weeks.)

What are the 3Cs of idiopathic pulmonary fibrosis?

Clubbing, cyanosis and cough

Turner syndrome is associated with which congenital cardiac defect?

Coarctation of aorta

A 35 year old woman presents with chest pain. She denies drinking alcohol, takes no medication and is otherwise fit and well. ECG shows anterior displacement and spasm of the coronary arteries. What drug is most likely to have caused this?

Cocaine

A 30 year old man who has been working in the Australian rainforest presents to the GP with high fever, night sweats, nausea and vomiting. He is also bleeding from the gums and has a very inflamed pharynx, as well as a petechial rash. Bloods show a lymphopenia. What is the most likely diagnosis?

Dengue fever (this is found in Australia, as well as S America and the Far East. It is carried by Aedes mosquito and is viral. The disease is usually self-limiting and can be managed with pain relief and fluid replacement)

Familial hypercholesterolaemia has at its core which genetic abnormality?

Deficiency in apo B-100 (LDL receptors - which causes accumulation of cholesterol)

Which bone is broken in a Colle's fracture?

Distal radius

Malignant transformation of moles into malignant melanoma is rare, with the exception of what predisposing conditions?

Dysplastic naevus syndrome and atypical mole syndrome

Traveller's diarrhoea is most commonly due to what pathogen?

E. Coli

How are incidental abdominal aortic aneurysms over 5.5cm diameter (which is the cut-off within the NHS) best managed?

Elective repair

What term describes a condition experienced in psoriasis, eczema and lymphoma in which the majority of the skin over the body becomes inflamed, red and scaly?

Erythroderma

A 3 year old child has a sore throat and cough with a three day history. This evening he had a generalised convulsion lasting two minutes and is now drowsy but rousable, without localising signs. There is no history of convulsions. The only other findings are enlarged, red tonsils. What is the most likely cause of the convulsion?

Febrile convulsion (the convulsion itself won't need specific examination, although blood glucose, biochemistry and cultures should be performed for the throat symptoms)

31 year old woman, 1 week post-partum, has stopped lactating because of a breast abscess that has become painful. What is the most appropriate management?

Fine needle aspiration in the first instance. In the event that this in unsuccessful, incision and drainage may be used. Antibiotics should be given at the same time - usually flucoxacillin if penicillin non-allergic and the patient should be advised that she can continue to breast feed.

Shoulder pain and stiffness, with inability to internally and externally rotate and abduct the shoulder are suggestive of which condition?

Frozen shoulder (adhesive capsulitis - seems to be more common amongst the diabetic population)

What is the most common loop diuretic?

Furosemide

Fractures of the distal radius with cocominant dislocation of the distal ulna (commonest in children) are known as:

Galeazzi fractures (open reduction and internal fixation is usually required)

Virchow's node, a painless, enlarged lymph node in the left supraclavicular fossa, suggests what pathology?

Gastric carcinoma

A 50 year old woman is investigated for anaemia and is found to have b12 deficiency. which antibodies might be present in her blood?

Gastric parietal cell antibodies (Pernicious anaemia is usually associated with gastric parietal cell antibodies)

A 32 year old lady returns from a holiday in east Africa with acute diarrhoea. She admits to eating barbecued food from beachside sellers. The diarrhoea is associated with bloating, painful cramping and severe flatulence. Stool examination showed 'tear-drop' shaped organisms with moving flagelle.

Giardiasis (Giardia lamblia is a flagellate protozoan water borne organism. It is transmitted on food prepared in poor hygiene. Standard therapy is with a short course of METRONIDAZOLE)

This type of fracture is associated with an anterior shoulder dislocation and features cortical depression of the head f the humerus due to the impact.

Hills-Sachs

A 5 year old baby with Down's Syndrome is brought back to the paediatric ward by a concerned parent. He has failed to pass meconium and now his abdomen is distended with bilious vomiting today. Xray shows a dilated large and small bowel, while rectal biopsy shows absence of ganglion cells in the submucosa (which means the rectum cannot squeeze out faeces).

Hirshprung's Disease (this is a classic presentation of this condition - it is also most common in patients with Down's. It usually presents in the first few days of life with failure to pass meconium.)

A 77-year old woman with end-stage renal failure presents with general malaise. She missed her last dialysis appointment. She appears fluid overloaded and her ECG shows small P waves with a widened QRS. She subsequently has an MI. What is the most likely cause for this?

Hyperkalaemia

A diagnosis of pre-eclampsia requires fulfilment of what two criteria?

Hypertension and proteinuria

What coagulopathy, featuring thrombocytopenia, is commonest in children and young females? It typically occurs after a short-lived infection and presents with nosebleed (epistaxis) and easy bruising.

ITP (immune thrombocytopenic purpura)

A urostomy is also know as:

Ileal conduit (an opening into the urinary tract, where a section of the ileum has been used to form the stoma)

A stoma formation in the small bowel is known generally as:

Ileostomy

Numbness in the groin can be a possible complication of inguinal hernia repair due to damage to which nerve?

Ilioinguinal nerve

What are the risks associated with Chorionic Villus Sampling?

Increases risk of iatrogenic miscarriage.

Osler's nodes, retinal haemorrhages and finger clubbing presenting in a patient are consistent with what pathological diagnosis?

Infective Endocarditis

What are the main risks to patients with an ileostomy?

Irritation of skin (due to the presence of acidic small bowel contents and enzymes) and dehydration (due to high-output and loss of fluids and salts - >1.5L in 24 hours)

What commonly happens to the mother's blood pressure during the first half of gestation?

It falls (surprisingly)

Purple-coloured skin rash that starts at the feet, moves upwards and is commonest in the HIV population.

Kaposi's sarcoma

What condition is common in babies with known cystic fibrosis who present with small bowel obstruction?

Meconium ileus (because the meconium is thick and particularly viscous)

Fracture of the femoral neck may lead to avascular necrosis of the femoral head as a result of the interruption of which artery?

Medial circumflex femoral artery (the 'perforating' deep femoral branches supply the posterior compartment of the thigh - i.e. hamstrings - while the lateral circumflex supplies the lateral thigh and hip)

A 12 year old boy presents with an 8 hour history of headaches and photophobia. In 2 hours, the mother starts noticing a non-blanching rash over the trunk and forearms. The neck is stiff. What is the most likely diagnosis?

Meningococcal meningitis (this should be treated STAT with intramuscular antibiotics, even before diagnosis confirmed)

What lung condition is frequently found amongst workers involved in manufacturing and insulation, with asbestos exposure?

Mesothelioma

What cranial vessel is damaged in an extradural haematoma?

Middle meningeal artery

An MRI of a 36 year old lady shows multiple regions of increased signal in the white matter, cerebellum and brain stem. These are compatible with demyelination or inflammation. What is the underlying diagnosis?

Multiple sclerosis

What is a common side effect of simvastatin use?

Myalgia and myositis (because statins can lower cholesterol by inhibiting the liver enzyme HMG-CoA reductase, they can cause deranged amino acid metabolism and thus affect muscles)

What does epistaxis mean?

Nosebleed

What is the most common type of thyroid cancer?

Papillary cell carcinoma (which likes to spread via lymphatics)

In instances of what medical presentation in the acute setting would you give N-acetylcysteine IV?

Paracetamol overdose

This type of AF reverts to sinus rhythm sponteanously.

Paroxysmal AF (this should be treated with antiarrhythmetic and anticoagulation drugs, such as FLECAINIDE and WARFARIN)

What should you administer to patients experiencing recurrent epileptic fits, which are only temporarily responsive to benzodiazepams?

Phenytoin (bolus dose followed by IV infusion)

What electrolyte is the most important to monitor in patients taking digoxin?

Potassium (hypokalaemia can potentiate digoxin's effects on the heart, causing toxicity)

What is the most common cause of lower respiratory tract infection in children?

RSV (respiratory syncytial virus)

Persistent and Permanent cases of AF should be managed how?

Rate control (e.g. pacemaker) plus anticoagulation (to reduce risk of thrombotic events)

A patient comes to the renal transplant clinic, approximately 4 months after having received her new kidney. She asks you about a mole on her finger. It is red and scaly in appearance. What should you do?

Refer patient urgently (2 week rule) for potential squamous cell carcinoma

A 19 year old girl presents to the GP complaining of having not started her periods. She has no breast tissue, no pubic hair and is quite short in stature. On closer examination, she has low-set ears and a webbed neck. What condition may this patient have?

Turner's syndrome (45 X)

A 70 year old man with hypertension and T2DM presents with acute deterioration of the vision in the right eye. He can see dots. What is the most likely cause of this?

Retinal vein occlusion

What is the most common pathogen associated with diarrhoea and irritability in children <1?

Rotavirus (unlikely to be bacterial at this age - you should investigate using electron microscopy of the stool, rather than culturing)

What first-line treatment is indicated for GAD?

Sertraline

What components of an FBC are you most concerned about during an acute asthma attack?

Serum potassium and blood glucose levels. (Salbutamol use can cause hypokalaemia and steroids can increase glycaemic levels)

A 60 year old lady presents with very dry, 'gritty' eyes that have recently become more painful. She says she has had this problem for a long time, on and off. On further questioning she reveals she suffers with a chronic dry cough and sometimes find it hard to swallow dry foods. What is the most likely diagnosis?

Sjorgen's syndrome

What is the most commonly used potassium-sparing diuretic?

Spironolactone

Immunosuppression is an important risk factor for what particular type of skin tumour?

Squamous cell carcinoma (tumours of keratinocytes)

Marjolin's ulcers represent what malignant condition?

Squamous cell carcinomas (these occur in chronic ulcers where there is malignant transformation due to chronic inflammation)

What are the most common pathogens responsible for community-aquired pneumonia?

Strep. pneumoniae, Mycoplasma pneumonia and Haemophilus Influenzae

What are the most common pathogens responsible for pneumonia in ICU settings?

Strep. pneumoniae, Straph. aureus and Legionella.

A 56 year old man presents with a sudden, severe headache which he describes as 'the worst he has ever had'. He is slightly drowsy, but there are no focal signs. What is the most likely diagnosis?

Subarachnoid haemorrhage (classic tag line 'worst headache ever' or 'being hit on the head')

A 30 year old woman, who works as a banker, comes into the GP with 'the worst headache of her life', which has not felt any better after taking numerous types of pain relief. She has had migraines in the past, but experienced no visual/auditory disturbances and denies any previous trauma. What important diagnosis do you want to exclude before proceeding?

Subarachnoid haemorrhage (the 'worst pain ever' without worsening or alleviating factors is characteristic)

How can you distinguish between an extradural and subdural haematoma?

The subdural haematoma follows the shape of the brain (i.e. is crescentic) and does not cross the midline as it is localised to one hemisphere only. Extradural haematoma bulge out of the side of the skull and are normally associated with a skull fracture.

Why are NSAIDs the offered first-line treatment for dysmenorrhoea pains?

They inhibit prostaglandin synthesis, which causes contractions in the uterine muscle and is the cause of period pain

What rapid sequence induction should you give to patients where vomiting (and thus aspiration) are a risk?

Thiopentone (3-7mg/kg) as induction and Suxemethonium (100mg - this is a depolarising muscle relaxant)

Which types of renal calculi can be seen on plain film X-Ray?

Those containing calcium are all radio-opaque. (This is in contrast to uric acid and cystine stones)

Ramstedt's procedure is used in which scenario?

To open the pylorus muscle (as in pyloric stenosis)

A homeless man with a six week history of headaches, malaise and double vision associated with weight loss presents to the emergency department. He is thin and has right-sided VI and VII palsy. CSF shows high protein. What is the most likely type of infection?

Tuberculous meningitis

Patients found to be at high-risk of osteoporosis (DEXA scan score of < 2.5) should be managed in which way?

Weekly bisphosphonates (e.g. Alendronate/Alendronic Acid or, if this is not tolerated, strontium/PTH)

A patient consults you with an ulcer just above the medial malleolus. It is red, swollen and has a sloping edge. The patient is 30 years old and works as a cleaner. What type of ulcer is this most likely to be?

Venous (affecting the long saphenous vein, which is located on the medial side of the leg)

A man presents after falling off his mountain bike and landing on the outstretched hand. There is pain in the anatomical snuffbox, but nothing found on Xray. How should you handle this patient?

Where suspicion for scaphoid fracture is high, it is important to have the wrist immobilised in a cast anyway. (It is especially important to immobilise a scaphoid fracture because the blood supply is one-directional and, if disrupted, can cause avascular necrosis)

This flavivirus (clue in the name!) is transmitted by mosquitoes and causes fever, myalgia (particularly of the lower back) and a transient rise in ALTs. Fatality is very high, at 70%.

Yellow Fever

In which patients is full colonoscopy favoured instead of flexible sigmoidoscopy?

Young patients with persistent symptoms of per rectal bleeding but who are at low risk of colorectal cancer