2025 WH practice exam: clinical applications

In June, a 24-year-old female presents with angioedema of the face, including eyelids and lips. She has had two previous similar episodes. This episode, like the previous ones, occurred during the summer and was accompanied by diarrhea, low grade fever once and classical urticarial lesions. What is the most likely diagnosis?

• Hereditary angioedema

• Food allergy

• Enterovirus infection

• Idiopathic angioedema

A 45-year-old woman with a strong family history of both allergies and glaucoma presents with frequent red eyes that sometimes itch, sometimes feel dry and sometimes water. On exam, bulbar conjunctivae are injected, palpebral conjunctiva are normal in colour. Nasal mucosa is moderately swollen and pale. Which of the following is the most likely diagnosis?

• Vernal conjunctivitis

• Allergic conjunctivitis

• Glaucoma

• Behcet’s disease

A 63 year old lady presents with a solitary 2.0 cm thyroid nodule discovered during carotid ultrasound performed for investigations of dizzy spells. Her only medical history is that of early breast cancer, treated with mastectomy and radiotherapy 4 years prior to presentation. She has been on anastrozole treatment since. She is clinically euthyroid. TSH is 0.02 mIU/L [reference range 0.27-4.20], free T4 18.5 pmol/L [reference range 12.0-22.0], free T3 6.2 pmol/L [reference range 3.1-6.8]. On repeat 2 weeks later TSH is 0.04 mIU/L. What is the most appropriate next step?

• Perform thyroid uptake scan.

• Perform fine needle aspiration and cytology of the nodule.

• Perform a whole-body PET scan

• Repeat neck ultrasound in 3 months, and perform fine needle aspiration and cytology if nodule size increases by >20%.

A 66 year old woman complains of malaise, anorexia, night sweats, arthralgia and stiffness in the shoulders for 6 months. She has pallor with no other relevant physical findings. FBE reveals – Hb 80g/L (normal 115 – 165) WCC 8,900/m3 (normal 4, 000 – 11, 000), Platelets 724x109/L (150 – 450), MCV72 f/L ( normal 80 – 99), ESR 68mm/hr (normal 5 – 15), Retics 23x109/L ( 10 – 100), Serum Ferritin is 485mg/L ( normal 30 – 300), the most likely cause of the haematological abnormalities is:

• Refractory sideroblastic anaemia

• Myelodysplasia

• Polymyalgia rheumatica

• Essential thrombocythaemia

A 70 year old gentleman presents to your clinic with a large wound on his right leg that has gradually increased in size in the last 6 months after hitting it against a table. He is clinically well, and has not reported any fevers or night sweats. His recent review with a podiatrist showed an Ankle-Brachial Index of 0.75. Examination of his right leg revealed a wound on his lower leg. Which of the following is the mainstay of therapy that would improve wound healing?

• Angiogram and angioplasty

• Antibacterial dressings

• Oral ciprofloxacin

• Compression stockings

You are reviewing Mr S, a 55-year-old accountant who initially presented to your clinic with excessive daytime sleepiness and morning headaches. He has a BMI of 41. Subsequent polysomnogram showed an AHI of 55 events/hour with regular desaturations overnight. His awake arterial blood gas results are as follows: pH 7.41 (7.35-7.45), pO2 80 mmHg (80-100), pCO2 55 mmHg (35-45), HCO3- 29 mmol/L (22-26). What is the most appropriate initial management approach?

• Nocturnal non-invasive ventilation (NIV)

• Nocturnal continuous positive airway pressure (CPAP)

• Aggressive weight loss

• Refer for mandibular advancement splint

A 43-year-old gentleman with a history of alcoholism presents to the Emergency Department with chest pain, fevers and dizziness. He is initially tachycardic and hypotensive but responds to fluid resuscitation. A chest X ray shows a large right-sided pleural effusion, and CT demonstrates the presence of multiple locules within the effusion. An intercostal catheter is inserted via ultrasound guidance and the results of the pleural fluid analysis are listed below: pH 7.17, Glucose 1.9 mmol/L, Protein 60 g/L, LDH 460 U/L. In order to maximise the likelihood of complete drainage, which agent/s should be instilled into the chest drain?

• tPA

• DNase

• tPA and DNase

• Normal saline

A 27-year-old G1P0 with known epilepsy has increasing seizures at 34 weeks’ gestation. Her lamotrigine dose is subsequently uptitrated. Her epilepsy remained well controlled and she had an uncomplicated delivery. What should be done with her anti-epileptic medication immediately post-delivery?

• The lamotrigine dose should be reduced

• The lamotrigine dose should stay the same

• The lamotrigine dose should be increased

• If breastfeeding, the lamotrigine should be ceased and switched over to Sodium Valproate

A 23 year old man with a family history of autosomal dominant polycystic kidney disease(ADPKD) has recently been diagnosed with the condition following an abdominal US performed as screening. He has normal renal function, with eGFR=90 ml/min/1.73m2. Blood pressure is 162/92 mmHg. What is the most appropriate treatment?

• Commence antihypertensive therapy

• Commence Tolvaptan and observe blood pressure

• Commence Tolvaptan and antihypertensive therapy

• No treatment is currently indicated due to young age

A 26 year old woman is admitted to a general ward via the emergency department with a temperature of 39°C and a blood pressure of 88/48 mmHg. She has a past history of hereditary spherocytosis which was diagnosed in childhood. She has not seen a doctor for over ten years and has been lost to follow-up. A blood film is performed (shown below) and is reported as follows: Numerous spherocytes seen with some Howell-Jolly bodies present.

• Transfusion of packed cells

• Urgent plasmapheresis

• Immediate administration of intravenous ceftriaxone

• Commencement of intravenous methylprednisolone