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WorksheetsPost acute tutorial test
Total questions: 27
Worksheet time: 14mins
Mr. Imran, a 40-year-old businessman, presents with redness, mild pain, and purulent discharge in his right eye for one day.
He denies photophobia or blurring of vision. No trauma or contact lens use.
What is the most likely diagnosis?
Acute bacterial conjunctivitis
Viral conjunctivitis
Allergic conjunctivitis
Acute anterior uveitis
Mr. Imran, a 40-year-old businessman, presents with redness, mild pain, and purulent discharge in his right eye for one day.
He denies photophobia or blurring of vision. No trauma or contact lens use.
Which of the following features warrants immediate referral to an ophthalmologist?
Eye pain with purulent discharge
Photophobia and decreased visual acuity
Redness and watery discharge
Bilateral itchy eyes without discharge
Mr. Imran, a 40-year-old businessman, presents with redness, mild pain, and purulent discharge in his right eye for one day.
He denies photophobia or blurring of vision. No trauma or contact lens use.
In the absence of red flags, what is the most appropriate first-line treatment for Mr. Imran’s condition?
Topical corticosteroids 4-hourly
Chloramphenicol 0.5% eye drops every 2–4 hours for 5–7 days
Oral antibiotics for 7 days
Lubricating drops only
A 45-year-old man presents with sudden severe left knee pain and swelling since last night.
He is hypertensive on hydrochlorothiazide and consumed a large amount of wine yesterday.
There is no fever, no trauma, and WBC is normal.
Which of the following is the most likely precipitating factor for this attack?
Recent upper respiratory tract infection
Alcohol consumption and thiazide diuretic use
Physical trauma to the knee
Viral illness with rash
A 45-year-old man presents with sudden severe left knee pain and swelling since last night.
He is hypertensive on hydrochlorothiazide and consumed a large amount of wine yesterday.
There is no fever, no trauma, and WBC is normal.
Which clinical or investigation finding best differentiates gout from septic arthritis in this case?
Monoarticular large joint involvement
Normal total white blood cell (WBC) count
Warm, swollen joint with tenderness
Presence of hypertension as comorbidity
A 45-year-old man presents with sudden severe left knee pain and swelling since last night.
He is hypertensive on hydrochlorothiazide and consumed a large amount of wine yesterday.
There is no fever, no trauma, and WBC is normal.
What is the most appropriate treatment during the acute phase?
Start allopurinol immediately and colchicine prophylaxis
Start naproxen 500 mg twice daily for 5 days and rest the joint
Start hydrochlorothiazide to control blood pressure and pain
Intra-articular steroid before excluding infection
40-year-old man presents with sudden, severe left loin pain since last night.
The pain radiates to the groin and is not relieved by paracetamol.He has had similar mild episodes before.No fever or urinary symptoms.
Urine test: RBC 5–10/HPF, WBC absent.
Which of the following features is most characteristic of ureteric colic?
Dull, constant pain at the loin
Sudden colicky pain radiating to the groin
Pain associated with fever and chills
Bilateral flank pain with urinary retention
A 40-year-old man presents with sudden, severe left loin pain since last night.
The pain radiates to the groin and is not relieved by paracetamol. He has had similar mild episodes before. No fever or urinary symptoms.
Urine test: RBC 5–10/HPF, WBC absent.
What is the best investigation to confirm the diagnosis?
Ultrasound KUB
Non-contrast CT KUB
X-ray KUB
Urine culture and sensitivity
A 40-year-old man presents with sudden, severe left loin pain since last night.
The pain radiates to the groin and is not relieved by paracetamol. He has had similar mild episodes before. No fever or urinary symptoms.
Urine test: RBC 5–10/HPF, WBC absent.
What is the most appropriate immediate management for this patient?
Give antibiotics and IV fluids
Start NSAIDs and encourage hydration
Begin tamsulosin immediately
Refer for lithotripsy
A 34-year-old foreign worker presents with cough and low-grade fever for three weeks, unrelieved by two courses of antibiotics.He reports 3 kg weight loss and mild pallor.
On examination: crepitations over the right upper zone.
Chest X-ray shows upper lobe infiltrates.
What is the most appropriate next step in managing this patient at the clinic level?
Start another course of oral antibiotics
Refer for bronchoscopy
Collect sputum samples for AFB smear and GeneXpert test
Order full blood count and ESR
A 34-year-old foreign worker presents with cough and low-grade fever for three weeks, unrelieved by two courses of antibiotics.He reports 3 kg weight loss and mild pallor.
On examination: crepitations over the right upper zone.
Chest X-ray shows upper lobe infiltrates.
Once pulmonary TB is confirmed, what is the most important next step at the primary care level?
Educate the patient on infection control and start contact tracing
Notify the District Health Office and initiate DOTS
Refer immediately to hospital for admission
Screen only household members if they are symptomatic
A 34-year-old foreign worker presents with cough and low-grade fever for three weeks, unrelieved by two courses of antibiotics. He reports 3 kg weight loss and mild pallor.
On examination: crepitations over the right upper zone.
Chest X-ray shows upper lobe infiltrates.
Which of the following anti-TB drugs is most commonly associated with visual disturbance?
Isoniazid
Rifampicin
Ethambutol
Pyrazinamide
A 25-year-old man presents with right ankle pain and swelling after he jumped and landed on another player’s foot while playing football last night.
He can stand but walks with a limp. There is tenderness and swelling over the lateral malleolus.
What clinical feature best differentiates an ankle sprain from an ankle fracture?
Ability to bear weight immediately after injury
Presence of swelling around the lateral malleolus
Presence of bruising and tenderness
Pain during ankle inversion movement
A 25-year-old man presents with right ankle pain and swelling after he jumped and landed on another player’s foot while playing football last night.
He can stand but walks with a limp. There is tenderness and swelling over the lateral malleolus.
What is the next best step in managing this patient in the clinic?
Apply R.I.C.E. and provide ankle support with early physiotherapy advice
Immediately refer for surgical evaluation
Apply hot compress and allow weight bearing
Prescribe long-term immobilization with a plaster cast
A 25-year-old man presents with right ankle pain and swelling after he jumped and landed on another player’s foot while playing football last night.
He can stand but walks with a limp. There is tenderness and swelling over the lateral malleolus.
When should the patient be referred to an orthopaedic specialist?
If there is mild pain after 3 days
If unable to bear weight after 3 days or if fracture suspected
If swelling persists for 12 hours
If there is bruising on the lateral side
A 28-year-old man presents with fever, headache, chills, joint pain, and body ache for 5 days.
He now has abdominal pain and vomiting since yesterday.
On examination: T 38.5°C, P 96/min, BP 130/60 mmHg, tender hepatomegaly, no jaundice.
Which finding in this patient suggests dengue with warning signs rather than uncomplicated dengue?
Headache and muscle pain
Abdominal pain and persistent vomiting
Mild fever and body ache
Joint pain and backache
A 28-year-old man presents with fever, headache, chills, joint pain, and body ache for 5 days.
He now has abdominal pain and vomiting since yesterday.
On examination: T 38.5°C, P 96/min, BP 130/60 mmHg, tender hepatomegaly, no jaundice.
What is the key investigation to confirm dengue infection within the first five days of illness?
Dengue IgM antibody test
Dengue NS1 antigen test
Blood culture and sensitivity
Liver function test
A 28-year-old man presents with fever, headache, chills, joint pain, and body ache for 5 days.
He now has abdominal pain and vomiting since yesterday.
On examination: T 38.5°C, P 96/min, BP 130/60 mmHg, tender hepatomegaly, no jaundice.
Which advice should be given to this patient to avoid complications before referral?
Take plenty of water and avoid NSAIDs
Rest at home and take ibuprofen for fever
Restrict fluid intake to prevent overload
Continue antibiotics until fever subsides
A 65-year-old man presents with chronic dyspepsia for the past 3 months, associated with fullness and nausea after meals.
He appears pale, and his Hb is 9.0 g/dL.
Which of the following features in this patient represents an alarm (red-flag) symptom that warrants urgent endoscopy?
Nausea and postprandial fullness
Dyspepsia for more than 1 month
Iron-deficiency anaemia
Bloating after meals
A 65-year-old man presents with chronic dyspepsia for the past 3 months, associated with fullness and nausea after meals.
He appears pale, and his Hb is 9.0 g/dL.
Which of the following risk factors increases the likelihood of serious underlying pathology in this patient?
Occasional indigestion after heavy meals
Long-term NSAID use for joint pain
Consumption of spicy food
Family history of allergic rhinitis
A 65-year-old man presents with chronic dyspepsia for the past 3 months, associated with fullness and nausea after meals.
He appears pale, and his Hb is 9.0 g/dL.
What is the next most appropriate investigation to confirm the diagnosis?
Abdominal ultrasound
H. pylori urea breath test
Upper GI endoscopy (OGDS) with biopsy
CT abdomen
A 30-year-old teacher presents with a 2-week history of headache after transferring to a new school.
She is worried it could be brain cancer, but has no neurological symptoms, vomiting, or vision changes.
Which feature in this case most suggests a benign (primary) cause of headache?
Recent onset of dull bilateral pressure-type pain related to stress
Early morning headache with vomiting
Headache worsening on coughing or straining
Headache associated with visual blurring and papilloedema
A 30-year-old teacher presents with a 2-week history of headache after transferring to a new school.
She is worried it could be brain cancer. There are no neurological symptoms, vomiting, or visual disturb.
What is the most likely diagnosis for this patient?
Migraine with aura
Cluster headache
Tension-type headache
Raised intracranial pressure
A 30-year-old teacher presents with a 2-week history of headache after transferring to a new school.
She is worried it could be brain cancer. There are no neurological symptoms, vomiting, or visual disturbances.
Which management strategy is most appropriate at this stage?
Request urgent CT brain to exclude tumour
Reassure, advise stress management, and give paracetamol
Start long-term migraine prophylaxis (propranolol)
Prescribe strong opioids for pain control
A 55-year-old man presents with chronic cough and shortness of breath on exertion for the past month, gradually worsening.
He is a smoker of 35 years (1 pack/day) and has no acute fever.
Which feature most strongly supports the diagnosis of COPD in this patient?
Intermittent wheezing episodes since childhood
Progressive exertional dyspnoea with long-term smoking history
Sudden onset breathlessness with pleuritic chest pain
Productive cough lasting two days with high-grade feve
A 55-year-old man presents with chronic cough and shortness of breath on exertion for the past month, gradually worsening.
He is a smoker of 35 years (1 pack/day) and has no acute fever.
Which investigation confirms the diagnosis of COPD?
Chest X-ray showing hyperinflated lungs
Arterial blood gas with low PaO₂
Spirometry showing post-bronchodilator FEV₁/FVC < 0.7
ECG showing right-axis deviation
A 55-year-old man presents with chronic cough and shortness of breath on exertion for the past month, gradually worsening.
He is a smoker of 35 years (1 pack/day) and has no acute fever.
What is the most important non-pharmacological intervention to slow disease progression?
Long-term oxygen therapy
Annual influenza vaccination
Smoking cessation with counselling support
Daily use of inhaled corticosteroids
