KaungHtetCho/plab1_sample · Datasets at Hugging Face

question stringlengths 106 544	opa stringlengths 6 55	opb stringlengths 6 62	opc stringlengths 3 63	opd stringlengths 3 58	ope stringlengths 3 60	cop stringlengths 3 63
A 55 year old man has diarrhoea and weight loss for 9 months. He has an intensely itchy red rash on his buttocks and thighs. Investigations: Haemoglobin 108 g/L (130–175) Blood film: anisocytosis. Which is the most likely histological appearance on small bowel biopsy?	Hyperplasia of Brunner’s glands	Increased intraepithelial macrophages	Increased lymphocytes in submucosa	Ulceration	Villous atrophy	Villous atrophy
A 26 year old woman is asking for strong pain relief for her abdominal pain and is seen in the Emergency Department. She has no significant past medical history. She looks malnourished. She is restless and irritable. Her temperature is 37.1°C. Which non-prescribed substance is the most important to enquire about in this presentation?	Alcohol	Amphetamines	Cannabis	Cocaine	Heroin	Heroin
A 74 year old man has painless jaundice and pale faeces for 1 week. He has lost 4 kg in weight in 3 months. His temperature is 37.4°C, pulse rate 90 bpm, BP 138/76 mmHg, respiratory rate 18 breaths per minute. His sclera and skin are yellow. Chest and abdominal examinations are normal. Which is the most appropriate investigation?	CT scan of abdomen	Endoscopic retrograde cholangio-pancreatography	MR cholangio-pancreatography	PET scan of abdomen	Ultrasound scan of the abdomen	CT scan of abdomen
A 26 year old woman has taken an overdose of paracetamol and is seen in the Emergency Department. She says the overdose was impulsive and now regrets taking the tablets. Investigations: Paracetamol level below treatment line for N-acetylcysteine. Which is the most appropriate course of action?	Admit to psychiatric ward from the Emergency Department	Assessment by liaison psychiatry in Emergency Department	Discharge home with GP follow-up	Prescribe antidepressant medication	Refer for cognitive behavioural therapy (CBT)	Assessment by liaison psychiatry in Emergency Department
A 75 year old woman has sudden onset left-sided chest pain and breathlessness for 1 hour. She also had one episode of haemoptysis. She had a total hip replacement for a fractured neck of femur 3 days ago and is on the orthopaedic ward. Her temperature is 37.2°C, pulse rate 100 bpm, BP 132/78 mmHg, respiratory rate 22 breaths per minute and oxygen saturation 92% breathing air. Chest examination is normal. Which is the most appropriate diagnostic investigation?	Arterial blood gases	Chest X-ray	CT pulmonary angiogram	D-dimer	ECG	CT pulmonary angiogram
A 48 year old man has moderate epigastric pain for 2 days and is seen at his GP surgery. He had a duodenal ulcer 6 months ago and was treated with Helicobacter pylori eradication therapy. Which is the most appropriate test to confirm Helicobacter pylori eradication?	C13 urea breath test	Faecal Helicobacter antigen	Gastric aspirate urease test	Helicobacter pylori serology	Repeat endoscopy and biopsy	C13 urea breath test
An 18 year old man has visual disturbance after he was punched in the face. He has double vision when he looks upwards. He has a left periorbital haematoma and enophthalmos. Which is the most likely site of fracture?	Ethmoid	Frontal bone	Maxilla	Nasal bones	Sphenoid	Maxilla
An 18 year old woman has blurred vision for 24 hours and is seen in the Emergency Department. She has increased thirst and drinks 4 litres of water a day. She has lost 10 kg's in weight in 6 weeks. Her temperature is 37.2°C, pulse rate 100 bpm, BP 90/50 mmHg, respiratory rate 30 breaths per minute and oxygen saturation 98% breathing air. Which is the most important initial investigation?	Arterial blood gases	Blood cultures	Capillary glucose	Full blood count	Serum electrolytes	Capillary glucose
A 78 year old man has low back pain for 6 weeks and is seen in his GP surgery. There is no history of trauma. He has not taken any analgesia for his pain. He takes no regular prescription medication. He has previously been treated for polymyalgia rheumatica. His BMI is 22 kg/m² and his temperature is 37.4 °C. There is bony tenderness over his lumbar spine. There is no radiation of pain. Neurological examination is normal. Investigations: Haemoglobin 78 g/L (130–175) ESR 98 mm/hr (<20) Which is the most likely diagnosis?	Discitis	Mechanical back pain	Multiple myeloma	Osteoporotic wedge fracture	Recurrence of polymyalgia rheumatica	Multiple myeloma
An 8 week old boy has worsening vomiting for 3 weeks. He is feeding well and is constantly hungry but is losing weight. He has wet nappies and no diarrhoea. His pulse rate is 110 bpm, respiratory rate 24 breaths per minute and oxygen saturation 98% breathing air. Which is the most likely acid base state?	Metabolic acidosis	Metabolic alkalosis	Normal acid/base state	Respiratory acidosis	Respiratory alkalosis	Metabolic alkalosis
A 27 year old woman has a small area of redness on her right breast for 4 weeks. A course of antibiotics, given 3 weeks ago, slightly improved the redness. She has had similar episodes before. She has a red superficial tender lump at the edge of her right areola and 0.5 mL of greenish fluid is aspirated. Which is the most likely diagnosis?	Breast abscess	Breast cancer	Duct papilloma	Paget's disease	Periductal mastitis	Periductal mastitis
A 93 year old woman is in hospital having completed treatment for a urinary tract infection. She has mild dementia. She lives alone. She is medically fit for discharge and is keen to go home but her daughter is unhappy about this course of action. Which is the most appropriate next step?	Arrange for an assessment by an independent advocate	Assess patient's mental capacity to decide about her discharge	Contact local psychiatry team for assessment	Discharge to a nursing home	Keep in hospital until daughter agrees	Assess patient's mental capacity to decide about her discharge
A 30 year old man took an overdose of 45 paracetamol 500 mg tablets 10 hours ago and is seen in the Emergency Department. His GCS is 15/15. His temperature is 37.0°C, pulse rate 80 bpm, BP 120/70 mmHg, respiratory rate 15 breaths per minute and oxygen saturation 99% breathing air. Blood for paracetamol level has been taken. Which is the most appropriate initial management?	Await paracetamol levels before further action	Gastric lavage	Give 50 g charcoal orally	No treatment required	Start N-acetylcysteine	Start N-acetylcysteine
A 6 year old girl has an itchy, red rash with yellow crusting on her face and neck. Her mother has tried non-prescription creams but the rash has continued to spread. She is otherwise well. Her temperature is 36.9°C. She has a yellow crusting on the sores around her mouth. Which is the most likely diagnosis?	Chickenpox	Fungal infection	Impetigo	Measles	Psoriasis	Impetigo
A 59 year old man has a painless enlarging neck lump for 6 months. He has a firm, mobile swelling measuring 2 cm at the angle of his jaw. Cranial nerves are unaffected. Which is the most likely diagnosis?	Ameloblastoma	Benign parotid tumour	Cystic hygroma	Lipoma	Tuberculous lymphadenitis	Benign parotid tumour
A 70 year old woman has lower abdominal pain for 5 days and is seen in the GP surgery. She feels unwell and has had episodes of shivering. Her temperature is 38.3°C, pulse rate 105 bpm, BP 115/65 mmHg, respiratory rate 24 breaths per minute and oxygen saturation 97% breathing air. There is a tender mass in the left iliac fossa. Which is the most likely diagnosis?	Diverticular abscess	Incarcerated inguinal hernia	Sigmoid carcinoma	Tubo-ovarian abscess	Uterine fibroid	Diverticular abscess
A 50 year old man wants to stop drinking alcohol and has been admitted to the inpatient ward for detoxification. He is alcohol dependant and his average alcohol intake is 84 units a week for 3 months. He has no other relevant medical history. Which is the most appropriate initial drug to prescribe?	Chlordiazepoxide	Clomethiazole	Disulfiram	Fluoxetine	Propranolol	Chlordiazepoxide
A 40 year old woman is found at home in a drowsy state and taken to the Emergency Department. She has had multiple Emergency Department admissions for severe and recurrent depression. Her pulse rate is 108 bpm. She is confused with dilated pupils, dry mucous membranes and a palpable bladder to the umbilicus. Which medication is most likely responsible for her clinical findings?	Amitriptyline	Fluoxetine	Lithium	Phenelzine	Venlafaxine	Amitriptyline
A 14 year old girl has cyclical central abdominal pain for 2 years and is seen in the GP surgery. She has never menstruated. She is of normal stature and has secondary sexual characteristics appropriate to her age. She has a pelvic mass on bimanual examination. Which is the most likely cause of this mass?	Fibroid	Haematocolpos	Hydronephrosis	Meckel diverticulum	Ovarian arrhenoblastoma	Haematocolpos
A 54 year old man has swelling of both ankles and is seen in the GP surgery. He has hypertension and takes amlodipine. His pulse rate is 92 bpm and BP 162/90 mmHg. His BMI is 41kg/m². His jugular venous pressure is not raised. Urinalysis shows no abnormality. He has pitting oedema of both ankles. Which is the most likely cause of his ankle swelling?	Drug side effect	Heart failure	Lymphoedema	Nephrotic syndrome	Obesity	Drug side effect
A 43 year old man has fallen twice when standing up from being seated. He has severe vomiting and diarrhoea for 3 days. He has a glioblastoma. He takes dexamethasone 6 mg daily and cyclizine 50 mg when needed. Investigations: Sodium 119 mmol/L (135–146), Potassium 5.5 mmol/L (3.5–5.3), Urea 14.2 mmol/L (2.5–7.8), Creatinine 118 micromol/L (60–120), Urine osmolality 400 mOsmol/kg, Urinary sodium 30 mmol/L, Serum osmolality 260 mOsmol/kg (285–295). Which is the most likely cause for these results?	Adrenal insufficiency	Dehydration	Medication side-effects	Stroke	Syndrome of inappropriate ADH secretion	Syndrome of inappropriate ADH secretion
A 5 year old boy has an episode of unconsciousness and is seen in the Emergency Department. He ran into his school desk, cried out in pain and then fell to the floor unconscious. He was limp and pale for 1 minute then his body became stiff and he started to shake. His eyes rolled back and he had froth foaming from his mouth. The episode lasted 2 minutes and he gradually started to regain consciousness. He had one previous similar episode following a cut to his finger. Neurological examination is normal. Which is the most likely diagnosis?	Absence seizure	Febrile convulsion	Hyperventilation	Reflex anoxic seizure	Tonic-clonic seizure	Reflex anoxic seizure
A 54 year old man is unable to grip effectively with his right hand following recovery from a general anaesthetic for bowel surgery. At the end of the procedure his right arm was found to be hanging over the edge of the operating table. There is weakness of extension of his right wrist and altered sensation over the dorsum of his first web space. Which is the most likely affected nerve?	Axillary	Median	Musculocutaneous	Radial	Ulnar	Radial
A 75 year old woman has three dizzy spells where she has collapsed to the floor in the past week. She does not lose consciousness and has no preceding warning symptoms. She has hypertension and ischaemic heart disease. She takes amlodipine, aspirin, atorvastatin and indapamide. Which is the most appropriate diagnostic investigation?	24 hour blood pressure monitoring	24 hour ECG monitoring	ECG	Echocardiogram	Postural blood pressure measurement	Postural blood pressure measurement
A 24 year old man has mild discomfort in his left scrotum for 4 months. He has noticed his scrotum is lower on the left than on the right, especially in the evenings. He has palpable structures in his left scrotum that feel worm-like. There is no tenderness on palpation. Which is the most appropriate next investigation?	Gram stained urethral smear	Midstream urine for culture and sensitivity	Scrotal exploration	Semen analysis	Ultrasound scan of scrotum	Ultrasound scan of scrotum
A 9 year old boy is treated for an exacerbation of his asthma in the Emergency Department. He has been given continuous salbutamol and ipratropium nebulisers. He was given oral prednisolone 1 hour ago. He is conscious and talking in full sentences. His pulse rate is 125 bpm, respiratory rate 30 breaths per minute and oxygen saturation 95% on 10 litres of oxygen. He has intercostal recession and has bilateral wheeze throughout both lung fields. Which is the most appropriate next management step?	Intravenous aminophylline infusion	Intravenous hydrocortisone bolus	Intravenous magnesium sulfate infusion	Intubate and ventilate	Nebulised adrenaline	Intravenous magnesium sulfate infusion
A 65 year old woman has low mood, hopelessness, anhedonia, poor concentration, low energy, insomnia, lack of appetite and suicidal ideation for 8 weeks. She takes long-term anticoagulant therapy with warfarin for atrial fibrillation. Which is the most appropriate management?	Amitriptyline	Cognitive behavioural therapy	Psychodynamic therapy	Sertraline	Zopiclone	Sertraline
An 18 month old girl has poor weight gain and is seen in the GP surgery. She eats the same food as her 3 year old brother. She has had loose stools for several months. She has had no vomiting. Her weight is 10.5 kg. Her abdomen is distended and she has loose skin over her buttocks.	Coeliac disease	Cow’s milk protein allergy	Crohn’s disease	Lactose intolerance	Non-organic failure to thrive	Coeliac disease
A 20 year old man is admitted with status epilepticus and aspiration pneumonia. He has worsening respiratory failure requiring mechanical ventilation. He has a chronic life limiting neurological condition with drug resistant epilepsy. He has severe global developmental delay. He has had three previous admissions to the intensive care unit this year. The family want to continue with active treatment but the intensive care team have advised that the patient should not be ventilated.	Apply for a court order to withdraw treatment	Complete a Do Not Resuscitate (DNR) form	Discuss the concerns of the intensive care team with the family	Follow the advice of the intensive care team	Follow the family wishes for active treatment	Discuss the concerns of the intensive care team with the family
A 64 year old man has retrosternal chest pain for 1 hour. He had similar pain 12 hours earlier that lasted for 3 hours. His pulse rate is 40 bpm and BP 120/60 mmHg. He is currently pain free after taking oral aspirin and sublingual glyceryl trinitrate.	Angiogram	Chest X-ray	Creatine kinase level	ECG	Troponin level	ECG
A 6 week old baby girl has a murmur found at her routine baby check. She is breastfeeding well. She is not cyanosed. Both femoral pulses are palpable. There are no heaves or thrills. She has a harsh pansystolic murmur, grade 3/6, loudest at the lower left sternal edge with no radiation. Her liver is not enlarged.	Coarctation of the aorta	Innocent murmur	Pulmonary stenosis	Tetralogy of Fallot	Ventricular septal defect	Ventricular septal defect
A 27 year old woman with Crohn’s disease is passing feculent material through her vagina. Which part of the bowel is most likely to be causing the symptoms?	Caecum	Descending colon	Ileum	Jejunum	Sigmoid colon	Sigmoid colon
A 23 year old woman has worsening diarrhoea with blood and mucus for 2 months and is seen in the GP surgery. She has abdominal pain and bloating. She has no weight loss. Her abdomen is soft and there is mild left-sided tenderness on deep palpation. She has active bowel sounds.	Colonoscopy	Faecal calprotectin	Faecal occult blood	Helicobacter pylori stool antigen	Stool culture and sensitivity	Colonoscopy
A 31 year old woman has increasing shortness of breath and left-sided pleuritic chest pain for 1 week. She smokes 10 cigarettes per day. She takes the combined oral contraceptive pill. Her temperature is 36.8°C, pulse rate 105 bpm, BP 105/80 mmHg, respiratory rate 22 breaths per minute and oxygen saturation 98% breathing air. Her chest is clear.	Bronchiectasis	Lung cancer	Pneumonia	Pulmonary embolism	Pulmonary tuberculosis	Pulmonary embolism
A 22 year old woman requires long-term contraception and is reluctant to take regular tablets. She has two children. She is a shift worker. Her BP is 138/81 mmHg and BMI 26 kg/m².	Combined oral contraceptive pill	Diaphragm	Etonogestrel implant (Implanon)	Levonorgestrel-releasing intrauterine system (Mirena coil)	Tubal ligation	Etonogestrel implant (Implanon)
A 75 year old man has attended the Emergency Department on two occasions over a 6 week period with bruising to his forearms and face. He has dementia. He is physically fit and takes no regular prescription medication.	Bleeding disorder	Non-accidental injury	Occult malignancy	Scurvy	Vasculitis	Non-accidental injury
A 26 year old woman has severe abdominal pain and heavy vaginal bleeding and is seen on the labour ward. She is 40 weeks pregnant in her first pregnancy. Her uterus is tender and hard. The fetal heart rate is 180 bpm.	Cervical ectropion	Disseminated intravascular coagulation	Placenta praevia	Placental abruption	Vasa praevia	Placental abruption
A 55 year old man has difficulty breathing after being stabbed with a knife in the right side of his neck. The wound is in the right posterior triangle of his neck. His chest movements are asymmetrical.	Greater splanchnic nerve	Phrenic nerve	Recurrent laryngeal nerve	Spinal accessory nerve	Vagus nerve	Phrenic nerve
A 36 year old woman gave birth to her first child 4 weeks ago. She feels tired and is worried about her lack of feelings for the baby. She has loss of appetite, sleep disturbance and occasional intrusive thoughts of harming the baby.	Drug induced psychosis	Generalised anxiety disorder	Normal postnatal symptoms	Obsessive compulsive disorder	Postnatal depression	Postnatal depression
A 34 year old woman has had secondary amenorrhoea for 8 months. She has lost 6 kg in weight despite having a good appetite.	Hyperthyroidism	Hypogonadism	Polycystic ovary syndrome	Premature ovarian failure	Prolactinoma	Hyperthyroidism
A 30 year old woman has bright red rectal bleeding. The blood is on the surface of the stool and she has intermittent mucus on wiping. She has a longstanding constipation with the passage of hard faeces.	Anal fissure	Haemorrhoids	Meckel diverticulum	Systemic bleeding disorder	Trauma	Haemorrhoids
A 55 year old man has acute retrosternal discomfort and is unable to swallow an hour after eating a sandwich. For the last month he has found swallowing painful and has lost weight.	Barium swallow	Chest X-ray	CT scan of the thorax	Outpatient clinic referral	Upper gastrointestinal endoscopy	Upper gastrointestinal endoscopy
An 18 month old boy has delay in his developmental progress. He scribbles meaninglessly using a pencil and has no hand dominance. He has a social smile. He does not hold eye contact. He has started walking. He is unable to run or kick a ball. He speaks two-syllable words with no meaning.	Absence of hand dominance	Inability to hold eye contact	Inability to run or kick a ball	Meaningless scribbling	Speaking two-syllable words with no meaning	Inability to hold eye contact
A 38 year old woman has red itchy eyes with crusting in the morning for 9 days. She works in a laboratory and is having difficulty using her microscope. There is no history of trauma. Her conjunctivae are red. Pupils and visual acuity are normal.	Anaesthetic	Antibacterial	Antiviral	Mydriatic	Steroid	An�bacterial
A 28 year old woman has a generalised seizure and is admitted to the antenatal ward. She is 38 weeks pregnant. Her BP is 190/120 mmHg	Diazepam	Hydralazine	Levetiracetam	Magnesium sulfate	Phenytoin	Magnesium sulfate
A 42 year old woman tests positive for high-risk human papillomavirus (HPV) on a routine cervical smear and is seen in the GP surgery.	No action required	Refer for colposcopy	Repeat smear in 3 months	Repeat smear in 1 year	Repeat smear in 3 years	Refer for colposcopy
A 55 year old woman is due to have a diagnostic gastroscopy. She has type 2 diabetes and takes gliclazide.	Change gliclazide to metformin	Change gliclazide to subcutaneous insulin	Omit gliclazide for 24 hours prior to procedure	Omit gliclazide on morning of procedure	Start glucose-potassium-insulin infusion on day of procedure	Omit gliclazide on morning of procedure
A 32 year old woman has intermittent palpitations, paraesthesia, breathlessness and dizziness for 6 months. She is unable to tolerate crowded places and avoids trains and supermarkets.	Amitriptyline	Diazepam	Moclobemide	Propranolol	Sertraline	Sertraline
A 55 year old woman has shortness of breath on exertion. She has Hashimoto’s thyroiditis and takes levothyroxine. Investigations: Haemoglobin 64 g/L (115–150) Mean cell volume 103 fL (80–96) Thyroid stimulating hormone 1.4 mU/L (0.3–4.2)	Folate deficiency	Haemolysis	Iron deficiency	Myelodysplasia	Pernicious anaemia	Pernicious anaemia
A 60 year old man is anuric. He recently had a left nephrectomy for renal cell carcinoma. His temperature is 39.0°C, pulse rate 98 bpm and BP 80/60 mmHg.	Bladder catheterisation	Lithotripsy	Percutaneous right nephrostomy	Retrograde drainage of the right renal tract	Suprapubic catheterisation	Percutaneous right nephrostomy

A 55 year old man has diarrhoea and weight loss for 9 months. He has an intensely itchy red rash on his buttocks and thighs. Investigations: Haemoglobin 108 g/L (130–175) Blood film: anisocytosis. Which is the most likely histological appearance on small bowel biopsy?

Hyperplasia of Brunner’s glands

Increased intraepithelial macrophages

Increased lymphocytes in submucosa

Ulceration

Villous atrophy

A 26 year old woman is asking for strong pain relief for her abdominal pain and is seen in the Emergency Department. She has no significant past medical history. She looks malnourished. She is restless and irritable. Her temperature is 37.1°C. Which non-prescribed substance is the most important to enquire about in this presentation?

Alcohol

Amphetamines

Cannabis

Cocaine

Heroin

A 74 year old man has painless jaundice and pale faeces for 1 week. He has lost 4 kg in weight in 3 months. His temperature is 37.4°C, pulse rate 90 bpm, BP 138/76 mmHg, respiratory rate 18 breaths per minute. His sclera and skin are yellow. Chest and abdominal examinations are normal. Which is the most appropriate investigation?

CT scan of abdomen

Endoscopic retrograde cholangio-pancreatography

MR cholangio-pancreatography

PET scan of abdomen

Ultrasound scan of the abdomen

CT scan of abdomen

A 26 year old woman has taken an overdose of paracetamol and is seen in the Emergency Department. She says the overdose was impulsive and now regrets taking the tablets. Investigations: Paracetamol level below treatment line for N-acetylcysteine. Which is the most appropriate course of action?

Admit to psychiatric ward from the Emergency Department

Assessment by liaison psychiatry in Emergency Department

Discharge home with GP follow-up

Prescribe antidepressant medication

Refer for cognitive behavioural therapy (CBT)

Assessment by liaison psychiatry in Emergency Department

A 75 year old woman has sudden onset left-sided chest pain and breathlessness for 1 hour. She also had one episode of haemoptysis. She had a total hip replacement for a fractured neck of femur 3 days ago and is on the orthopaedic ward. Her temperature is 37.2°C, pulse rate 100 bpm, BP 132/78 mmHg, respiratory rate 22 breaths per minute and oxygen saturation 92% breathing air. Chest examination is normal. Which is the most appropriate diagnostic investigation?

Arterial blood gases

Chest X-ray

CT pulmonary angiogram

D-dimer

ECG

CT pulmonary angiogram

A 48 year old man has moderate epigastric pain for 2 days and is seen at his GP surgery. He had a duodenal ulcer 6 months ago and was treated with Helicobacter pylori eradication therapy. Which is the most appropriate test to confirm Helicobacter pylori eradication?

C13 urea breath test

Faecal Helicobacter antigen

Gastric aspirate urease test

Helicobacter pylori serology

Repeat endoscopy and biopsy

C13 urea breath test

An 18 year old man has visual disturbance after he was punched in the face. He has double vision when he looks upwards. He has a left periorbital haematoma and enophthalmos. Which is the most likely site of fracture?

Ethmoid

Frontal bone

Maxilla

Nasal bones

Sphenoid

Maxilla

An 18 year old woman has blurred vision for 24 hours and is seen in the Emergency Department. She has increased thirst and drinks 4 litres of water a day. She has lost 10 kg's in weight in 6 weeks. Her temperature is 37.2°C, pulse rate 100 bpm, BP 90/50 mmHg, respiratory rate 30 breaths per minute and oxygen saturation 98% breathing air. Which is the most important initial investigation?

Arterial blood gases

Blood cultures

Capillary glucose

Full blood count

Serum electrolytes

Capillary glucose

A 78 year old man has low back pain for 6 weeks and is seen in his GP surgery. There is no history of trauma. He has not taken any analgesia for his pain. He takes no regular prescription medication. He has previously been treated for polymyalgia rheumatica. His BMI is 22 kg/m² and his temperature is 37.4 °C. There is bony tenderness over his lumbar spine. There is no radiation of pain. Neurological examination is normal. Investigations: Haemoglobin 78 g/L (130–175) ESR 98 mm/hr (<20) Which is the most likely diagnosis?

Discitis

Mechanical back pain

Multiple myeloma

Osteoporotic wedge fracture

Recurrence of polymyalgia rheumatica

Multiple myeloma

An 8 week old boy has worsening vomiting for 3 weeks. He is feeding well and is constantly hungry but is losing weight. He has wet nappies and no diarrhoea. His pulse rate is 110 bpm, respiratory rate 24 breaths per minute and oxygen saturation 98% breathing air. Which is the most likely acid base state?

Metabolic acidosis

Metabolic alkalosis

Normal acid/base state

Respiratory acidosis

Respiratory alkalosis

Metabolic alkalosis

A 27 year old woman has a small area of redness on her right breast for 4 weeks. A course of antibiotics, given 3 weeks ago, slightly improved the redness. She has had similar episodes before. She has a red superficial tender lump at the edge of her right areola and 0.5 mL of greenish fluid is aspirated. Which is the most likely diagnosis?

Breast abscess

Breast cancer

Duct papilloma

Paget's disease

Periductal mastitis

A 93 year old woman is in hospital having completed treatment for a urinary tract infection. She has mild dementia. She lives alone. She is medically fit for discharge and is keen to go home but her daughter is unhappy about this course of action. Which is the most appropriate next step?

Arrange for an assessment by an independent advocate

Assess patient's mental capacity to decide about her discharge

Contact local psychiatry team for assessment

Discharge to a nursing home

Keep in hospital until daughter agrees

Assess patient's mental capacity to decide about her discharge

A 30 year old man took an overdose of 45 paracetamol 500 mg tablets 10 hours ago and is seen in the Emergency Department. His GCS is 15/15. His temperature is 37.0°C, pulse rate 80 bpm, BP 120/70 mmHg, respiratory rate 15 breaths per minute and oxygen saturation 99% breathing air. Blood for paracetamol level has been taken. Which is the most appropriate initial management?

Await paracetamol levels before further action

Gastric lavage

Give 50 g charcoal orally

No treatment required

Start N-acetylcysteine

A 6 year old girl has an itchy, red rash with yellow crusting on her face and neck. Her mother has tried non-prescription creams but the rash has continued to spread. She is otherwise well. Her temperature is 36.9°C. She has a yellow crusting on the sores around her mouth. Which is the most likely diagnosis?

Chickenpox

Fungal infection

Impetigo

Measles

Psoriasis

Impetigo

A 59 year old man has a painless enlarging neck lump for 6 months. He has a firm, mobile swelling measuring 2 cm at the angle of his jaw. Cranial nerves are unaffected. Which is the most likely diagnosis?

Ameloblastoma

Benign parotid tumour

Cystic hygroma

Lipoma

Tuberculous lymphadenitis

Benign parotid tumour

A 70 year old woman has lower abdominal pain for 5 days and is seen in the GP surgery. She feels unwell and has had episodes of shivering. Her temperature is 38.3°C, pulse rate 105 bpm, BP 115/65 mmHg, respiratory rate 24 breaths per minute and oxygen saturation 97% breathing air. There is a tender mass in the left iliac fossa. Which is the most likely diagnosis?

Diverticular abscess

Incarcerated inguinal hernia

Sigmoid carcinoma

Tubo-ovarian abscess

Uterine fibroid

Diverticular abscess

A 50 year old man wants to stop drinking alcohol and has been admitted to the inpatient ward for detoxification. He is alcohol dependant and his average alcohol intake is 84 units a week for 3 months. He has no other relevant medical history. Which is the most appropriate initial drug to prescribe?

Chlordiazepoxide

Clomethiazole

Disulfiram

Fluoxetine

Propranolol

Chlordiazepoxide

A 40 year old woman is found at home in a drowsy state and taken to the Emergency Department. She has had multiple Emergency Department admissions for severe and recurrent depression. Her pulse rate is 108 bpm. She is confused with dilated pupils, dry mucous membranes and a palpable bladder to the umbilicus. Which medication is most likely responsible for her clinical findings?

Amitriptyline

Fluoxetine

Lithium

Phenelzine

Venlafaxine

Amitriptyline

A 14 year old girl has cyclical central abdominal pain for 2 years and is seen in the GP surgery. She has never menstruated. She is of normal stature and has secondary sexual characteristics appropriate to her age. She has a pelvic mass on bimanual examination. Which is the most likely cause of this mass?

Fibroid

Haematocolpos

Hydronephrosis

Meckel diverticulum

Ovarian arrhenoblastoma

Haematocolpos

A 54 year old man has swelling of both ankles and is seen in the GP surgery. He has hypertension and takes amlodipine. His pulse rate is 92 bpm and BP 162/90 mmHg. His BMI is 41kg/m². His jugular venous pressure is not raised. Urinalysis shows no abnormality. He has pitting oedema of both ankles. Which is the most likely cause of his ankle swelling?

Drug side effect

Heart failure

Lymphoedema

Nephrotic syndrome

Obesity

Drug side effect

A 43 year old man has fallen twice when standing up from being seated. He has severe vomiting and diarrhoea for 3 days. He has a glioblastoma. He takes dexamethasone 6 mg daily and cyclizine 50 mg when needed. Investigations: Sodium 119 mmol/L (135–146), Potassium 5.5 mmol/L (3.5–5.3), Urea 14.2 mmol/L (2.5–7.8), Creatinine 118 micromol/L (60–120), Urine osmolality 400 mOsmol/kg, Urinary sodium 30 mmol/L, Serum osmolality 260 mOsmol/kg (285–295). Which is the most likely cause for these results?

Adrenal insufficiency

Dehydration

Medication side-effects

Stroke

Syndrome of inappropriate ADH secretion

A 5 year old boy has an episode of unconsciousness and is seen in the Emergency Department. He ran into his school desk, cried out in pain and then fell to the floor unconscious. He was limp and pale for 1 minute then his body became stiff and he started to shake. His eyes rolled back and he had froth foaming from his mouth. The episode lasted 2 minutes and he gradually started to regain consciousness. He had one previous similar episode following a cut to his finger. Neurological examination is normal. Which is the most likely diagnosis?

Absence seizure

Febrile convulsion

Hyperventilation

Reflex anoxic seizure

Tonic-clonic seizure

Reflex anoxic seizure

A 54 year old man is unable to grip effectively with his right hand following recovery from a general anaesthetic for bowel surgery. At the end of the procedure his right arm was found to be hanging over the edge of the operating table. There is weakness of extension of his right wrist and altered sensation over the dorsum of his first web space. Which is the most likely affected nerve?

Axillary

Median

Musculocutaneous

Radial

Ulnar

Radial

A 75 year old woman has three dizzy spells where she has collapsed to the floor in the past week. She does not lose consciousness and has no preceding warning symptoms. She has hypertension and ischaemic heart disease. She takes amlodipine, aspirin, atorvastatin and indapamide. Which is the most appropriate diagnostic investigation?

24 hour blood pressure monitoring

24 hour ECG monitoring

ECG

Echocardiogram

Postural blood pressure measurement

A 24 year old man has mild discomfort in his left scrotum for 4 months. He has noticed his scrotum is lower on the left than on the right, especially in the evenings. He has palpable structures in his left scrotum that feel worm-like. There is no tenderness on palpation. Which is the most appropriate next investigation?

Gram stained urethral smear

Midstream urine for culture and sensitivity

Scrotal exploration

Semen analysis

Ultrasound scan of scrotum

A 9 year old boy is treated for an exacerbation of his asthma in the Emergency Department. He has been given continuous salbutamol and ipratropium nebulisers. He was given oral prednisolone 1 hour ago. He is conscious and talking in full sentences. His pulse rate is 125 bpm, respiratory rate 30 breaths per minute and oxygen saturation 95% on 10 litres of oxygen. He has intercostal recession and has bilateral wheeze throughout both lung fields. Which is the most appropriate next management step?

Intravenous aminophylline infusion

Intravenous hydrocortisone bolus

Intravenous magnesium sulfate infusion

Intubate and ventilate

Nebulised adrenaline

Intravenous magnesium sulfate infusion

A 65 year old woman has low mood, hopelessness, anhedonia, poor concentration, low energy, insomnia, lack of appetite and suicidal ideation for 8 weeks. She takes long-term anticoagulant therapy with warfarin for atrial fibrillation. Which is the most appropriate management?

Amitriptyline

Cognitive behavioural therapy

Psychodynamic therapy

Sertraline

Zopiclone

Sertraline

An 18 month old girl has poor weight gain and is seen in the GP surgery. She eats the same food as her 3 year old brother. She has had loose stools for several months. She has had no vomiting. Her weight is 10.5 kg. Her abdomen is distended and she has loose skin over her buttocks.

Coeliac disease

Cow’s milk protein allergy

Crohn’s disease

Lactose intolerance

Non-organic failure to thrive

Coeliac disease

A 20 year old man is admitted with status epilepticus and aspiration pneumonia. He has worsening respiratory failure requiring mechanical ventilation. He has a chronic life limiting neurological condition with drug resistant epilepsy. He has severe global developmental delay. He has had three previous admissions to the intensive care unit this year. The family want to continue with active treatment but the intensive care team have advised that the patient should not be ventilated.

Apply for a court order to withdraw treatment

Complete a Do Not Resuscitate (DNR) form

Discuss the concerns of the intensive care team with the family

Follow the advice of the intensive care team

Follow the family wishes for active treatment

Discuss the concerns of the intensive care team with the family

A 64 year old man has retrosternal chest pain for 1 hour. He had similar pain 12 hours earlier that lasted for 3 hours. His pulse rate is 40 bpm and BP 120/60 mmHg. He is currently pain free after taking oral aspirin and sublingual glyceryl trinitrate.

Angiogram

Chest X-ray

Creatine kinase level

ECG

Troponin level

ECG

A 6 week old baby girl has a murmur found at her routine baby check. She is breastfeeding well. She is not cyanosed. Both femoral pulses are palpable. There are no heaves or thrills. She has a harsh pansystolic murmur, grade 3/6, loudest at the lower left sternal edge with no radiation. Her liver is not enlarged.

Coarctation of the aorta

Innocent murmur

Pulmonary stenosis

Tetralogy of Fallot

Ventricular septal defect

A 27 year old woman with Crohn’s disease is passing feculent material through her vagina. Which part of the bowel is most likely to be causing the symptoms?

Caecum

Descending colon

Ileum

Jejunum

Sigmoid colon

A 23 year old woman has worsening diarrhoea with blood and mucus for 2 months and is seen in the GP surgery. She has abdominal pain and bloating. She has no weight loss. Her abdomen is soft and there is mild left-sided tenderness on deep palpation. She has active bowel sounds.

Colonoscopy

Faecal calprotectin

Faecal occult blood

Helicobacter pylori stool antigen

Stool culture and sensitivity

Colonoscopy

A 31 year old woman has increasing shortness of breath and left-sided pleuritic chest pain for 1 week. She smokes 10 cigarettes per day. She takes the combined oral contraceptive pill. Her temperature is 36.8°C, pulse rate 105 bpm, BP 105/80 mmHg, respiratory rate 22 breaths per minute and oxygen saturation 98% breathing air. Her chest is clear.

Bronchiectasis

Lung cancer

Pneumonia

Pulmonary embolism

Pulmonary tuberculosis

Pulmonary embolism

A 22 year old woman requires long-term contraception and is reluctant to take regular tablets. She has two children. She is a shift worker. Her BP is 138/81 mmHg and BMI 26 kg/m².

Combined oral contraceptive pill

Diaphragm

Etonogestrel implant (Implanon)

Levonorgestrel-releasing intrauterine system (Mirena coil)

Tubal ligation

Etonogestrel implant (Implanon)

A 75 year old man has attended the Emergency Department on two occasions over a 6 week period with bruising to his forearms and face. He has dementia. He is physically fit and takes no regular prescription medication.

Bleeding disorder

Non-accidental injury

Occult malignancy

Scurvy

Vasculitis

Non-accidental injury

A 26 year old woman has severe abdominal pain and heavy vaginal bleeding and is seen on the labour ward. She is 40 weeks pregnant in her first pregnancy. Her uterus is tender and hard. The fetal heart rate is 180 bpm.

Cervical ectropion

Disseminated intravascular coagulation

Placenta praevia

Placental abruption

Vasa praevia

Placental abruption

A 55 year old man has difficulty breathing after being stabbed with a knife in the right side of his neck. The wound is in the right posterior triangle of his neck. His chest movements are asymmetrical.

Greater splanchnic nerve

Phrenic nerve

Recurrent laryngeal nerve

Spinal accessory nerve

Vagus nerve

Phrenic nerve

A 36 year old woman gave birth to her first child 4 weeks ago. She feels tired and is worried about her lack of feelings for the baby. She has loss of appetite, sleep disturbance and occasional intrusive thoughts of harming the baby.

Drug induced psychosis

Generalised anxiety disorder

Normal postnatal symptoms

Obsessive compulsive disorder

Postnatal depression

A 34 year old woman has had secondary amenorrhoea for 8 months. She has lost 6 kg in weight despite having a good appetite.

Hyperthyroidism

Hypogonadism

Polycystic ovary syndrome

Premature ovarian failure

Prolactinoma

Hyperthyroidism

A 30 year old woman has bright red rectal bleeding. The blood is on the surface of the stool and she has intermittent mucus on wiping. She has a longstanding constipation with the passage of hard faeces.

Anal fissure

Haemorrhoids

Meckel diverticulum

Systemic bleeding disorder

Trauma

Haemorrhoids

A 55 year old man has acute retrosternal discomfort and is unable to swallow an hour after eating a sandwich. For the last month he has found swallowing painful and has lost weight.

Barium swallow

Chest X-ray

CT scan of the thorax

Outpatient clinic referral

Upper gastrointestinal endoscopy

An 18 month old boy has delay in his developmental progress. He scribbles meaninglessly using a pencil and has no hand dominance. He has a social smile. He does not hold eye contact. He has started walking. He is unable to run or kick a ball. He speaks two-syllable words with no meaning.

Absence of hand dominance

Inability to hold eye contact

Inability to run or kick a ball

Meaningless scribbling

Speaking two-syllable words with no meaning

Inability to hold eye contact

A 38 year old woman has red itchy eyes with crusting in the morning for 9 days. She works in a laboratory and is having difficulty using her microscope. There is no history of trauma. Her conjunctivae are red. Pupils and visual acuity are normal.

Anaesthetic

Antibacterial

Antiviral

Mydriatic

Steroid

An�bacterial

A 28 year old woman has a generalised seizure and is admitted to the antenatal ward. She is 38 weeks pregnant. Her BP is 190/120 mmHg

Diazepam

Hydralazine

Levetiracetam

Magnesium sulfate

Phenytoin

Magnesium sulfate

A 42 year old woman tests positive for high-risk human papillomavirus (HPV) on a routine cervical smear and is seen in the GP surgery.

No action required

Refer for colposcopy

Repeat smear in 3 months

Repeat smear in 1 year

Repeat smear in 3 years

Refer for colposcopy

A 55 year old woman is due to have a diagnostic gastroscopy. She has type 2 diabetes and takes gliclazide.

Change gliclazide to metformin

Change gliclazide to subcutaneous insulin

Omit gliclazide for 24 hours prior to procedure

Omit gliclazide on morning of procedure

Start glucose-potassium-insulin infusion on day of procedure

Omit gliclazide on morning of procedure

A 32 year old woman has intermittent palpitations, paraesthesia, breathlessness and dizziness for 6 months. She is unable to tolerate crowded places and avoids trains and supermarkets.

Amitriptyline

Diazepam

Moclobemide

Propranolol

Sertraline

A 55 year old woman has shortness of breath on exertion. She has Hashimoto’s thyroiditis and takes levothyroxine. Investigations: Haemoglobin 64 g/L (115–150) Mean cell volume 103 fL (80–96) Thyroid stimulating hormone 1.4 mU/L (0.3–4.2)

Folate deficiency

Haemolysis

Iron deficiency

Myelodysplasia

Pernicious anaemia

A 60 year old man is anuric. He recently had a left nephrectomy for renal cell carcinoma. His temperature is 39.0°C, pulse rate 98 bpm and BP 80/60 mmHg.

Bladder catheterisation

Lithotripsy

Percutaneous right nephrostomy

Retrograde drainage of the right renal tract

Suprapubic catheterisation

Percutaneous right nephrostomy