Finals questions

A 54 year old female presents to her GP with a lump in her groin that has been present for several years but has recently become much larger and painful. She has also experienced diarrhoea, night sweats, fever and abdominal pain. She has known follicular non-Hodgkin’s lymphoma that is usually asymptomatic and is not being actively treated but is under surveillance.

She has hepatomegaly, abdominal distension and an abdominal mass can be felt on deep abdominal palpation.

The lump in her groin is in keeping with an enlarged lymph node.

Which of the following investigations would confirm the most likely diagnosis?

• Bone marrow biopsy

• Contrast CT

• Excision lymph node biopsy

• FDG-PET CT

• FISH

You are called urgently to see a 46 year old female on a surgical ward 2 days post thyroidectomy. She has had some difficulty breathing and intermittent stridor. She has experienced tingling in her lips and face, has painful muscle cramps and abdominal pain. The nurses tell you that she has been more irritable and confused than usual.

On urgent blood tests you find she has a calcium of 1.6mmol/L.

Which of the following ECG changes would be most likely?

• Atrial fibrillation

• ST-elevation

• SVT

• Tall tented T waves

• QT prolongation

A 27 year old male presents to the GP with a painful lump in his neck, he has noticed this pain is worse after drinking alcohol. He has previously seen the GP with lymphadenopathy associated with EBV infection. He has noticed a fever, night sweats and worsening of his asthma. He is an ex-smoker and drinks alcohol at the weekends. He has hepatomegaly and splenomegaly.

Which diagnosis is this presentation indicative of?

• Glandular fever

• Hodgkin’s Lymphoma

• Leukemia

• Sarcoidosis

• TB

You are working in A&E. A 16-year-old boy is brought in by his mother following an acute episode of vomiting followed by an episode of confusion. His mother reports he has had similar vomiting episode previously and has had a gradual decline in his visual acuity over the past 2 months. He has a past medical history of depression and social anxiety and is followed by CAMHS.

On examination you notice he is unsteady when walking. You also notice his has a large pupil in his left eye. He is currently orientated to time and place however is complaining of a headache.

What is the most appropriate next step in his management to confirm your diagnosis?

• Serum Alcohol level

• CAMHS assessment

• Urine toxicology

• Urgent Brain MRI

• Reassure about Noro Virus and discharge

A 27-year-old male presents to her GP with loss of libido and erectile dysfunction. He also reports enlargement of his breast tissue over the past 4 months. He has no significant past medical history and isn’t on any medication. Upon examination, the GP notices he has bilateral hemianopia.

What is the most appropriate next step in his management?

• Urgent brain CT

• Request Serum Prolactin levels

• Refer to Mental Health services

• Request routine liver USS

• 2 weeks wait referral to breast clinic

A 60-year-old Asian woman presents to dermatology clinic. She is complaining of multiple painful blisters on her skin and painful sores in her mouth. She is very concerned about these lesions as she has recently lost her job and feels that they are affected her appearance in job interviews.

On examination you note multiple flaccid turbid blister on normal skin. On her oral mucosa you notice irregular and poorly defined lesions.

Which of the following regarding pemphigus is false?

• It is a disease confined to the sub-epidermal layer

• It is an autoimmune driven disease

• It is usually triggered by environmental factors

• Pemphigus vulgaris is often confined to the oral mucosa

• Pemphigus herpetiformis is tone of the rarest form of pemphigus

A 45-year-old woman has been referred to rheumatology for assessment by her GP. She has noticed that over the last few years she has had difficulty swallowing.

She has a PMHx of Raynaud’s Phenomenon and recently diagnosed with pulmonary fibrosis

O/E: Swelling of the fingers and toes with evidence of calcinosis. There Is also some tightening of the skin around the lips. Areas of telangiectasia were noted on the face.

Which autoantibody is most specific for the underlying diagnosis?

• Anti-Scl 70

• Anti-Nuclear antibody

• Rheumatic Factor

• Double-stranded DNA antibody

• Anti-Ro antibody

A 45-year-old woman has been referred to rheumatology for assessment by her GP.

She has history of Raynaud’s Phenomenon and has recently developed joint pains and swelling of the fingers and toes.

The rheumatologist would like to exclude systemic sclerosis as a cause of her symptoms.

Which of the following investigations would be most useful in the diagnosis of systemic sclerosis?

• Renal Biopsy

• Plain X-ray of the hands

• Nailfold capillaroscopy

• Urinalysis

• Blood film

A 61 year old male presents to the GP surgery with weakness in this arms. The weakness is worst in his right hand and wrist causing difficulty in writing and he is struggling to open jars. He is very distressed as he feels the deterioration has been quick. He also starting to notice a stiffness in his foot and a foot drop. He has had no recent trauma and no bowel or bladder problems.

On examination, there is weakness particularly in the arm extensors with hyperreflexia, hypertonia, muscle atrophy and fasciculations.

What is the most likely diagnosis?

• Amyotrophic Lateral Sclerosis

• Bulbar Motor Neurone Disease

• Myasthenia Gravis

• Polymyositis

• Spinal Cord Tumour

A 71 year old male retired truck driver presents with weight loss, rectal bleeding and change in bowel habit. He denies any pain. He smokes 20 a day and drinks 3 pints every evening. He has past medical history of diabetes mellitus and ulcerative colitis.

On examination, he appears pale with no other abnormalities.

What is the most likely diagnosis?

• Crohn’s disease

• Diverticular disease

• Haemorrhoids

• Colorectal carcinoma

• Ulcerative colitis