Phase 3 Examinations

Practice EMQ questions 2001-02

DIAGNOSIS OF HAEMOPTYSIS

A. CARCINOMA OF BRONCHUS H. PULMONARY ASPERGILLOSIS

B. TUBERCULOSIS I. INHALED FOREIGN BODY
C. ACUTE BRONCHITIS J. ACUTE LEFT VENTRICULAR FAILURE
D. BRONCHIECTASIS K. THROMBOCYTOPENIA
E. PULMONARY EMBOLUS L. SICKLE CELL CRISIS
F. ASTHMA
G. ARTERIO-VENOUS MALFORMATION

For each patient below, choose the SINGLE most likely diagnosis from the above list of
options. Each option may be used once, more than once or not at all.

1. A 37 year old Somali doctor with a history of coughing up about half a cup of fresh blood
on 4-5 occasions over the period of 2 months. He had lost 5kg in weight and had
drenching night sweats almost daily. Chest x-ray shows a large cavitating nodule in the
left upper zone.

2. A 55 year old lorry driver, a ‘fit’ smoker of 20-30 cigarettes a day, presents to his GP
with a history of coughing up 2 streaks of blood on separate mornings in the previous
week. He has had a morning cough with small amounts of sputum over the previous 10
years and admits on questioning that he may have lost weight and has had to tighten his
trouser belt. The ESR was 75 and chest x-ray showed collapse of the right middle lobe.

3. A 50 year old cleaner, with a history of pertussis as a child, had a fever and increasing
shortness of breath with sweating on exertion. She has had a cough productive of yellow
sputum for 25 years but this is recently blood stained. She is a non-smoker. She has come
to her GP for a further course of antibiotics and he refers her for a chest X-ray because he
thinks she is clubbed.

4. A 25 year old public relations executive has gained weight on the combined oral
contraceptive and is reluctant to give up smoking 10-15 cigarettes a day. She presents at
an A&E department with acute left sided pleuritic chest pain, slight shortness of breath
and a cough with a little sputum containing smears of blood. Chest X-ray is
unremarkable.

5. A 45 year old woman who is HIV positive reports easy bruising, frequent nose bleeds and
coughing up small streaks of blood. She is otherwise well at present. Chest X-ray shows
no abnormality. A full blood count shows Hb of 10.5g/dl, WBC 5.0 x 10 9/l platelet count
28 x 109/l.
PRESENTATION OF JAUNDICE

A. VIRAL HEPATITIS A F. LIVER SECONDARIES

B. PRIMARY BILIARY CIRRHOSIS G. ALCOHOLIC CIRRHOSIS
C. AUTOIMMUNE HAEMOLYTIC ANAEMIA H. GILBERT’S DISEASE
D. CHOLELITHIASIS I. PARACETAMOL POISONING
E. CARCINOMA OF HEAD OF PANCREAS

For each patient below, choose the SINGLE most likely diagnosis from the above list of
options. Each option may be used once, more than once or not at all.

1. A 30 year old man appears jaundiced:

Hb 15.1g/dl, WBC 8.0 x 109/L, Platelets 90 x 10 9/L, Na 140 mmol/l, K 4.0 mmol/l, Urea
3.5 mmol/l, Creatinine90 µmol/l, Alkaline Phosphatase 70IU/l, Bilirubin 70 µmol/l,
Alanine transaminase 20 IU/l, Albumin 41 g/l.

2. A 20 year old woman complains of breathlessness and appears pale.

Hb 7.3 g/dl, WBC 7.0 x 10 9/L, Platelets 100 x 109/l, Alkaline phosphatase 79 IU/l,
Bilirubin 140 µmol/l, ALT 160 IU/l, Albumin 39 g/l.

3. A 55 year old man complains of abdominal distension.

Hb 10.0 g/dl, WBC 7.0 x 109/l, Platelets 100 x 109/l, Na 129 mmol/l, K 2.9 mmol/l, Urea
1.4 mmol/l, Creatinine 90 µmol/l, Alkaline phosphatase 130 IU/l, Bilirubin 40µmol/l,
ALT 160, Albumin 26 g/l.

4. A 30 year old man complains of right upper quadrant pain and nausea.
Hb 14 g/dl, WBC 7.0 x 109/L, Platelets 120 x 109/L, Na 141 mmol/l, K 3.9 mmol/l, Urea
4.5 mmol/l, Creatinine 90 µmol/l, Alkaline phosphatase 200 IU/l, Bilirubin 20 µmol/l,
ALT 600 IU/l, Albumin 39 g/l.

5. A 45 year old obese woman complains of intermittent abdominal pain with jaundice.
Hb 13.1 g/dl, WBC 8.3 x 109/l, Platelets 200 x 109/l, Na 140 mmol/l, K 4.1 mmol/l, Urea
5.2 mmol/l, Creatinine 88 µmol/l, Alkaline phosphatase 580 IU/l, Bilirubin 264 µmol/l,
ALT 70 IU/l.
DRUG SIDE EFFECTS

A. COLD TOES AND FINGERS F. INDIGESTION AND GI BLEED

B. CONSTIPATION AND DRY MOUTH G. NAUSEA AND VOMITING
C. DEAFNESS H. SWELLING OF FEET AND ANKLES
D. DRY COUGH I. PERIPHERAL NEUROPATHY
E. GOITRE J. TREMOR

What is the frequent side effect for each of the following drugs or class of drug taken
from the list above?

1. Beta-blockers (e.g. atenolol)

2. Beta adrenergic bronchodilators (e.g. salbutamol, terbutaline)

3. Erythromycin

4. Tricyclic antidepressants (e.g. amitriptyline, imipramine)

5. ACE inhibitors (e.g. captopril, ramipril)

DIAGNOSIS OF FEVER

A. MALARIA H. SYSTEMIC LUPUS ERYTHEMATOSIS

B. INFLUENZA I. SARCOIDOSIS
C. GLANDULAR FEVER J. POST IMMUNISATION
D. APPENDICITIS K. DRUG REACTION
E. PNEUMONIA L. PYELONEPHRITIS
F. LYMPHOMA M. HIV INFECTION
G. TUBERCULOSIS

For each patient below, choose the SINGLE most likely diagnosis from the above list of
options. Each option may be used once, more than once or not at all.

1. A 45 year old woman from Jamaica presents with a 6 month history of weight loss and a
two week history of fever and night sweats. On examination she had cervical
lymphadenopathy. Her calcium was 3.0 and CXR showed bilateral lymphadenopathy
with perihilar shadowing.

2. A 25 year old man with a 3 day history of high temperatures, aching limbs and neck
discomfort. Apart from temperature of 39OC and some mild conjunctivitis, examination
was normal. Antibiotics were prescribed but had had no effect.

3. A 50 year woman normally resident in the UK returned from visiting relatives in

Pakistan. She described intermittent fevers with rigors, diarrhoea and severe headaches.
She had experienced previous symptoms in the past.

4. A 22 year old man presented with a two week history of fever and drenching night sweat.
He had experienced severe itching during this time. Examination was normal. CXR
showed a mediastinal mass.

5. A 35 year old pregnant woman developed a temperature and increased urinary frequency.
She was tender in the right loin. Full blood count showed neutrophil leucocytosis and
urine was positive for nitrates on urinary dipstix.

6. A 50 year old woman presented with a temperature and aching joints, 2 days prior to her
departure on holiday to Egypt. On examination she had a tender swelling on her left
upper arm.
THYROID DISEASE

A. MYXOEDEMA G. GRAVE’S DISEASE

B. PITUITARY FAILURE H. TOXIC NODULAR GOITRE
C. ANXIETY STATE I. MEDULLARY THYROID CARCINOMA
D. EXOPHTHALMOS J. PAPILLARY THYROID CARCINOMA
E. LID LAG K. VIRAL THYROIDITIS
F. LABYRINTHITIS L. THYROGLOSSAL CYST

For each patient below, choose the SINGLE most likely diagnosis from the above list of
options. Each option may be used once, more than once or not at all.

1. A 35 year old woman complains of weight loss, tremors, palpitation large appetite and
diarrhoea. Examination revealed tachycardia over 120 beats/min and exophthalmos. She
appeared anxious.

2. A 50 year old woman complains of weight loss, tremor of hands, palpitations, large
appetite, diarrhoea and a lump in the neck. Examination revealed tachycardia over 120
beats/minute and a lump on left side of neck. Eye examination showed no exophthalmos
but lid lag was present.

3. A 24 year old woman complains of weight loss, tremor of hands, palpitations and loss of
appetite. Examination revealed tachycardia and she appeared nervous. Investigation
revealed TSH 1.0 (range 0.3-4.5) and ESR within normal limits.

4. A 24 year old woman complains of weight loss, tremor of hands, palpitations and pain in
neck radiating to the left ear and tiredness. Examination revealed tender swelling in neck,
tachycardia of 120 beats/min and fever of 38oC. TSH <0.05 (range 0.3-4.5) and ESR
60mm/hr.

5. An 18 year old woman complains of a swelling in the neck. Examination revealed the
swelling is painless, non-tender. There is no weight loss, no tremors of hands or
palpitations. Swelling moves up and down with protrusion and intrusion of tongue
respectively. Investigation revealed normal TSH and ESR.

6. A 50 year old man woman complains of a lump in neck on left side. Examination
revealed painless, non-tender lump on left side of neck which moves on swallowing.
Investigation revealed normal TSH and ESR. Fine needle aspiration revealed sheet of
follicular epithelial cells.

7. A 60 year old woman complains of weight gain, tiredness, loss of appetite. Examination
revealed bradycardia. Investigations revealed TSH 30 (range 0.3-4.5). ECG showed
ischaemic changes.
INVESTIGATION OF OEDEMA

A. LIVER FUNCTION TESTS H. ELECTROCARDIOGRAM

B. 24HR URINARY PROTEIN I. CHEST X-RAY
C. UREA & ELECTROLYTES J. DRUG HISTORY
D. FULL BLOOD COUNT K. ECHOCARDIOGRAM
E. PELVIC ULTRASOUND L. LYMPH NODE BIOPSY
F. VENOUS DUPLEX SCAN M. BLOOD FILM EXAMINATION
G. CREATININE CLEARANCE

For each patient below, choose the SINGLE most appropriate investigation from the
above list of options. Each option may be used once, more than once or not at all.

1. A 20 year old male with generalised oedema. He has noticed ‘frothy’ urine recently.
Liver function tests show plasma albumin of 15g/l.

2. A 60 year old woman complained of a painful swollen left leg on arrival at Heathrow
airport. On examination her leg is tender with shiny skin. She was taking hormone
replacement therapy.

3. A 45 year old publican developed bilateral limb oedema and noticed that his trousers
were becoming tight. On examination he had gynaecomastia and Duputyren’s
contractures

4. A 60 year old female with uncontrolled hypertension, whose medication has been
recently changed by he GP presents with bilateral ankle swelling. Clinical examination of
her chest and cardiovascular system were normal.

5. A 70 year old woman with swelling of her right leg. She gives a history of recent weight
loss and lower abdominal discomfort. Examination shows pitting oedema of the entire
leg and a possible right sided pelvic mass.

6. A 60 year old man who is a heavy smoker presents with a longstanding history of cough
and breathlessness. He has recently noticed increasing difficulty in walking due to leg
swelling. On examination he is centrally cyanosed and has bilateral wheezes on chest
auscultation.