2000 AKT question

A 42 man Ahmed has presented to see you with his son. He has recently traveled to Australia 3 weeks ago to visit his son. On examination, he appears delirious. He has a temp of 39C and is delirious. He has developed generalized blisters but mainly on his trunk, which appeared a few hours ago. He is well and not on any medications. He last traveled 5 months ago to Italy. Which of the following is the most likely diagnosis?

A 45-year-old male presents with recurrent episodes of epigastric pain that is typically relieved by food intake or antacids. He also experiences occasional nausea and bloating. On physical examination, there is tenderness on palpation of the epigastric region.

Which of the following is the most appropriate diagnostic test to confirm the diagnosis?

Which of the following is a common initial symptom in Alzheimer’s disease?

A 26-year-old woman had unprotected sexual intercourse 12 hours ago. She is mid-cycle and this is the first occasion in this cycle. She wishes to start the combined oral contraceptive pill today in addition to Levonelle emergency contraception. Which is the SINGLE MOST appropriate length of time, if any, that she needs extra precautions to prevent pregnancy? Select ONE option only.

You are working as VMO in a rural hospital. A 71-year-old woman presents with a swollen right lower limb some 6 days after beginning low molecular weight heparin. On examination her BP is 132/72 mmHg, pulse is 80/min and regular. Respiratory and abdominal examination is unremarkable, and there is an obvious right DVT. Investigations;Hb 13.1 g/dl WCC 9.6 x109/l PLT 35 x109/l (195 x109/l on admission) Na+ 138 mmol/l K+ 4.3 mmol/l Creatinine 110 mol/l μ

Which of the following is the investigation of choice to rule out heparin induced thrombocytopaenia (HIT)?

A 17 year old woman has a painless lump on her right breast for 4 weeks. There is no history of trauma. She takes the oral contraceptive pill. Her maternal grandmother had breast cancer.

She has a 1 cm painless lump in the upper outer quadrant of her right breast.

Which is the most appropriate initial investigation?

A 28-year-old male presents with recurrent episodes of sudden-onset muscle weakness, typically triggered by exercise or prolonged periods of rest. On examination, there is weakness and fatigability of the proximal limb muscles. Electromyography (EMG) shows a decremental response with repetitive nerve stimulation.

Which of the following is the most likely diagnosis?

Which of the following types of dementia is most commonly associated with cerebrovascular disease?

50-year-old man presents to the clinic for review. He suffered a rear shunt road traffic accident some 6 months earlier. Initially his neck pain recovered, but he began suffering occipital headaches, pain over the base of his neck, and the posterior border of the right trapezius some 3 months ago. This has not been helped by visits to a chiropractor. On examination his BP is normal at 110/60 mmHg, pulse is 70/min and regular. Movement of the neck and shoulders is limited by pain, and there is sensory loss over the C3/C4 dermatome. Plain x-rays of the neck are unremarkable. Which of the following is the most likely diagnosis?

A 19 year old woman has worsening vaginal discharge and bilateral iliac fossa pain for 3 days. Her vaginal discharge is foul smelling and she has dyspareunia. She is feverish and feels unwell.

Her temperature is 39.0°C.

Which combination of organisms are most likely to cause these symptoms?

A 32-year-old male presents with ascending weakness, tingling sensations in the feet, and difficulty walking. On examination, there is decreased deep tendon reflexes and bilateral symmetrical weakness in the lower extremities.

Which of the following diagnostic tests is most appropriate to confirm the diagnosis?

Which of the following is a risk factor for the development of dementia?

39-year-old woman with a history of manic-depressive disorder visits her GP for review. She is currently treated with lithium therapy. The GP has been monitoring her blood pressure for the last few months; it is 155/105 mmHg in the clinic and he is keen to commence pharmacotherapy. Which of the following agents is likely to carry least risk for her with respect to lithium toxicity?

A 13 year old boy’s mother is concerned that he has no friends and she brings him to the GP surgery. He does not play with other children. He likes model cars and has 1,000 cars in his collection. He is indifferent to either praise or criticism from his mother or teachers.

Which is the most likely diagnosis?

A 50-year-old female presents with bilateral lower limb weakness that started two weeks after a gastrointestinal illness. On examination, she has areflexia and symmetrical weakness in her lower extremities.

Which of the following is the most common variant of GBS in this patient?

Which of the following medications is commonly used for symptomatic treatment of Alzheimer’s disease?

John aged 74 smoker, presents to you with 3 months history of cough and SOB. He does not suffer from any medical conditions and is not currently on any medications. Examination reveals pigmentation of the oral mucosa and also over the palms and soles. You organise some blood test which shows HBA1C 7.5. Electrolytes are normal apart from low potassium.

What is the most probable diagnosis?

A 16-year-old girl was brought to Accident and Emergency with the complaint of a sudden loss of consciousness. This occurred while shopping with her mother a few hours ago. The episode lasted for less than a minute followed by a full recovery. There was no head injury. The mother informed the staff that her daughter had not eaten anything for the last four days because she is extremely fanatic about losing weight. She began a strict diet and exercise regimen to lose weight a few months ago. Her mother appears distressed as she has tried everything to get her daughter to eat but to no avail. The patient herself is adamant that she is fat and that her goal is to lose weight until she is 35 kg. The patient has no past medical history of note and is not taking any regular medications.

On examination, the patient was found to be sweaty and wearing a baggy dress.

Weight 49 kilgrams

Height 165 centimeters

BMI 18 kg/m2

Capillary blood glucose 2.1 mmol/L I

t was proposed that the patient be admitted but when the subject was broached to the patient, she began to scream and demanded to be released. What is the SINGLE best treatment option in this patient?

An 19 year old woman is worried that she is overweight and is seen in the GP surgery. She has reduced her food intake and has been exercising for 2 hours each day for 18 months. She has amenorrhoea. She is in her first year of university and is struggling with her studies.

Her body mass index is 15.5 kg/m² and her blood pressure is 90/60 mmHg.

Which specialist service should she initially be referred to?

A 65-year-old male presents with ascending paralysis and respiratory distress. On examination, he has generalized areflexia and cranial nerve involvement, including bilateral facial weakness and difficulty swallowing.

Which of the following is the most likely variant of GBS in this patient?

Which of the following clinical features is most commonly associated with neurofibromatosis type 1 (NF1)?

A 22-year-old woman thinks she is overweight. She has a body mass index of 21.8 kg/m2 . She often has constipation and abdominal pain. She eats uncontrollably and feels guilty resulting in self-induced vomiting. Sometimes to compensate for her big meal, she would exercise intensively.

What is the SINGLE most likely diagnosis?

A 28 year old woman requests contraception from the GP surgery. She has a 28 day menstrual cycle with a 6 day very heavy menstrual bleed. She had a pulmonary embolism in her previous pregnancy.

Which is the most appropriate contraception?

A 65-year-old male presents with sudden-onset right-sided weakness and difficulty speaking. Which of the following investigations is most appropriate for the initial evaluation of this patient?

In the diagnosis of neurofibromatosis type 2 (NF2), which of the following findings is typically present?

A 24-year-old depressed man has neglected his personal hygiene and physical health. He denies the existence of his bowels and believes that his bowels are blocked. He also believes that his limbs are missing and that no one cares about it.

What SINGLE kind of delusion is he suffering from?

A 38 year old man is constantly worried about his house being infected by germs for 3 months and he is seen in the GP surgery. He is worried about his personal safety and has been checking that the doors and windows are locked 20-30 times a day for 8 weeks. He has been washing his hands every time he touches the locks.

Which is the most appropriate initial management?

Which of the following best describes the typical clinical presentation of dermatofibroma?

Which of the following is a major diagnostic criterion for neurofibromatosis type 1 (NF1) according to the National Institutes of Health (NIH) diagnostic criteria?

A 50-year-old man has become increasingly tired and lethargic over the past six months and has developed erectile dysfunction. His wife comments that he looks tanned even in the winter months. His serum ferritin and transferrin levels are significantly raised, but his haemoglobin is normal. Which is the SINGLE MOST likely diagnosis? Select ONE option only.

A 6-year-old child is brought to the clinic by his mother. She says that his teacher complains that he is easily distracted and interrupts others when it is their turn to answer questions. His mother says that he is not able to do a particular task for a long time and cannot play quietly. He is careless and often breaks things.

What is the SINGLE most likely diagnosis?

An 84 year old woman has worsening confusion. She has visual hallucinations, disturbed sleep and urinary incontinence for 1 week. She has Alzheimer’s dementia and arthritis and has recently started taking paracetamol.

Her abbreviated mental test score is 2/10.

Which is the most likely underlying reason for her deterioration?

60-year-old James presents to you with this lesion for the last 6  months. The picture of the lesion is given below

What is your likely diagnosis?

Which of the following is an important management consideration in individuals with neurofibromatosis type 1 (NF1)?

A 33-year-old woman was diagnosed with a duodenal ulcer at gastroscopy. She has recently completed a course of Helicobacter pylori triple therapy. She comes to see you four weeks later and is symptom-free.

Which is the SINGLE MOST appropriate management option? Select ONE option only.

A 26-year-old man strongly believes that every elderly man he meets is likely to be his father. Although they look different, he is sure that it is his father wearing a different disguise.

What is the SINGLE most likely kind of delusion this man is suffering from?

A 38 year old man has worsening vertigo and tremor. His symptoms are more pronounced in the morning. He has longstanding alcohol dependence and drinks 60 units of alcohol per week.

His abbreviated mental test score is 9/10. He has an intention tremor, horizontal nystagmus and walks with a broad-based gait.

Which is the most likely diagnosis?

60-year-old James presents to you with this lesion for the last 6  months. The picture of the lesion is given below

What is your likely diagnosis?

A couple attends a marriage counseling session because of marital problems. The wife states that her husband is having affairs although she has no proof of this. The husband states that she is “insane” because she is having him followed by a private detective and she is overly preoccupied with him being unfaithful. She goes through his personal belongings almost every day to look for signs of infidelity. Her actions are putting considerable strain on their marriage.

What is the SINGLE most likely syndrome she is suffering from?

A 32 year old woman has a febrile illness and swelling of the small joints of her hands for 2 days. She is seen in the GP surgery. She has not travelled outside Australia. She has two young children.

She has a maculopapular rash and palpable, small cervical lymph nodes. The small joints of her feet, wrists and knees are swollen.

Which is the most likely diagnosis?

Which of the following is the gold standard diagnostic test for temporal arteritis?

A 27-year-old man presents with a one-week history of a dry cough that has now started to produce a little sputum. He is also complaining of myalgia, tiredness, headaches and has had diarrhoea for the past 2 days. His observations are as follows: temperature 38.9^oC, HR 91, BP 128/75, RR 22, SaO₂ 98% on air. On examination, he has audible crackles on the right side of his chest. His chest X-ray shows right upper lobe consolidation.

A seven-year-old girl has a fever associated with a sore throat and loss of appetite. She has small red ulcers in her mouth and itchy spots on the palms of her hands and soles of her feet. She does not suffer from any medical conditions and is not on any regular medications

Which is the SINGLE MOST likely virus causing her symptoms? Select ONE option only.

A 29-year-old male presents to Accident & Emergency with the complaint of neck stiffness. The patient’s past medical history is significant for schizophrenia, diagnosed a few months ago. His notes mention that his psychiatrist had just started him on a new drug called clozapine due to his previous medication not working. He is on no other medication and denies the use of over-the-counter medications or illicit drugs. He smokes around five cigarettes a day but does not drink alcohol. Upon physical examination, the patient appears to be working hard to breathe. Active and passive flexion and extension of his neck are extremely difficult to achieve. The patient’s face also appears red and flushed. He also appears to be confused. His vital signs are as follows:

Blood pressure 168/98 mmHg

Heart rate 114 beats per minute

Temperature 39.2 C

Oxygen saturation on room air 95%

What is the SINGLE most likely diagnosis?

A 78 year old woman has pain in her left thigh and calf on walking for 8 weeks. The pain is relieved with rest. She has a 40 pack-year smoking history.

Her left popliteal and pedal pulses are not palpable.

Investigation:
Hand held Doppler: monophasic waveform in her left Dorsalis Pedis artery.

Which is the most likely site of arterial pathology?

Which of the following symptoms should raise suspicion for temporal arteritis in an elderly patient?

A 50-year-old woman, who has recently been diagnosed with hypertension, complains of pain in her knees. She feels tired and her memory is poor. She has lost her appetite recently and feels nauseated most of the time. Urinalysis is normal.

Which is the SINGLE MOST likely diagnosis? Select ONE option only

An 18 year old male washes his hands 6 times every time he uses the toilet. On his way out of the toilet, he has to switch off the light, turn it back on and turn it
off once more.

What is the SINGLE most appropriate management?

A 68-year-old female presents with a new-onset throbbing headache localized to her left temple. She describes the pain as severe and constant, which has been present for the past week. On further inquiry, she mentions experiencing jaw pain and tenderness while chewing food. She denies any visual changes, fever, or recent infections.

What is the most likely diagnosis?

A 46-year-old gentleman was involved in a road traffic accident where his car hit a wall. He was extricated at the scene and has been brought in by ambulance. He has cervical immobilisation in situ. He is complaining of chest pain on the left side of his chest and is breathless. You are the trauma call team leader. His observations are as follows: HR 110, BP 102/63, SaO₂ 90% on air. GCS 15/15. On examination, he has extensive bruising on the left side of his chest and he has reduced chest expansion, dullness to percussion and reduced breath sounds throughout the entire left hemithorax.

For the past week, a 30-year-old woman has noticed fresh red blood on the toilet paper and experiences sharp pain around the anus when she defecates. Today she can feel a very tender lump at the anal margin.

Which is the SINGLE MOST likely diagnosis? Select ONE option only.

A 45 years old woman has lost weight for over 12 months. She has also noticed episodes where her heart beats rapidly and strongly. On examination she has a regular pulse rate of 90bpm. Her ECG is given below

What is the most appropriate investigation to be done?

A 16 year old girl has an enlarging lump on the right side of her neck for 6 weeks. She is seen in the GP surgery. She has no other symptoms.

She has a 2 x 2 cm lymph node in the right anterior triangle of the neck and several smaller cervical lymph nodes. Her tonsils are enlarged and covered by a grey membrane.

Which is the most likely diagnosis?

A 72-year-old male presents with a new-onset headache and visual changes. He reports a persistent, throbbing headache localized to his temples, which worsens with chewing. He also describes episodes of blurred vision and transient visual obscurations in both eyes. His medical history is significant for polymyalgia rheumatica.

What is the most likely diagnosis?

A 40-year-old man presents with a dry cough and a fever for the past few days. His cough is non-productive. Today he has also had several episodes of diarrhoea and has developed bilateral pleuritic chest pain. He states that he is short of breath, most notably on exertion. He works as a Jacuzzi and whirlpool installer and smokes 15 cigarettes per day.

A 35-year-old man who is a non-smoker suddenly develops a severe headache and double vision. His right pupil is fixed and dilated. He does not suffer from any medical conditions and he is not on any regular medication. He is generally fit and healthy

Select the SINGLE MOST likely diagnosis from the list of options. Select ONE option only

A 50 year old woman has lost weight for over 12 months. She has also noticed episodes where her heart beats rapidly and strongly. You request an ECG. The ECG is given below.

What is your diagnosis?

A 66 year old man has increasing abdominal pain. He had an anterior resection 5 days ago.

His temperature is 38.5 ˚C, pulse rate 120 bpm and BP 90/60 mmHg. His abdomen is tender and there is generalised rigidity.

Which is the most likely diagnosis?

A 65-year-old male presents with memory impairment, disorientation, and personality changes. His family reports that he has become increasingly apathetic and withdrawn. Neurological examination reveals  rigidity and bradykinesia.

What is the most likely type of dementia?

You are asked to review a 5-week-old baby boy by the community midwife. He has been feeding poorly and mum states that he has been vomiting after most feeds. His nappy is stained with dark urine and his mum states that his stools have been pale and ‘chalky’. He has some bruises present on his arms and legs. The midwife has organised a heel prick test, which has revealed total serum bilirubin of 208 mmol/l of which 80% was conjugated.

A 35-year-old man presents to you with a problem with his toes which have been going on for the last 6 months. The picture of the foot is given below. What treatment option is most appropriate?

65 year old Graham presents with on/off painless episodes of haematuria, On examination the prostate is mildly enlarged with  mild frequency. IVU is normal.

What is the most appropriate next investigations? 

1. US Abdomen 
2. Flexible cystoscopy 
3. MRI 
4. Nuclear imaging 
5. PSA 

An 83 year old woman has visual hallucinations and is confused for 4 hours. She is on the medical inpatient ward and is being treated for pneumonia. She is restless and verbally abusive towards the staff who she believes are trying to poison her. She has no previous psychiatric history.

Which is the most likely diagnosis?

A 75-year-old female presents with progressive memory loss, language impairment, and visuospatial difficulties. She has difficulty finding her way home and frequently misplaces objects. Neurological examination is unremarkable. Imaging shows atrophy of the temporal and parietal lobes.

What is the most likely type of dementia?

A 58-year-old woman had an ST-segment-elevation myocardial infarction two months ago. She has made a good recovery but has a low mood and a poor sleep pattern with early morning wakening. She wishes to try medication as her symptoms are affecting her ability to work. Which is the most appropriate antidepressant drug? Select ONE option only.

A 44yo woman has lost weight over 12 months. She has also noticed episodes where her heart beats rapidly and strongly. She has a regular pulse rate of 90bpm. Her ECG shows sinus rhythm. What is the most appropriate investigation to be done?

A healthy boy is born by vaginal delivery at 40 weeks gestation. His mother had confirmed acute hepatitis B during this pregnancy.

Which preventative intervention should be given immediately to the baby?

1. Confirm hepatitis B status of baby as first step
2. Full course of hepatitis B vaccine
3. Full course of hepatitis B vaccine and hepatitis B immunoglobulin
4. Hepatitis B immunoglobulin
5. Hepatitis B vaccine as a single dose

A 58-year-old male presents to his GP with a history of epigastric pain that has been present for the past 2 weeks. The pain is described as burning in nature and is relieved with antacids. He has also experienced nausea and occasional vomiting. He denies any recent use of non-steroidal anti-inflammatory drugs (NSAIDs) or alcohol consumption.

Which of the following is the most likely diagnosis?

Which of the following screening tools is commonly used in Australia for the initial assessment of cognitive impairment and dementia?

A 35-year-old woman has noticed increasing weakness and numbness in her legs and arms over the past few days, and today she is feeling short of breath on exertion. Six weeks ago she had diarrhoea while on holiday abroad and stool culture-confirmed infection with Campylobacter jejuni. She was treated with ciprofloxacin and recovered fully. What is your likely diagnosis

A 44yo woman has lost weight over 12 months. She has also noticed episodes where her heart beats rapidly and strongly. She has a regular pulse rate of 90bpm. She does not suffer from any medical conditions and is not on any regular medications. You do an ECG which is given below. What is the most appropriate next investigation you will request?

A 63-year-old man presents with sudden severe chest pain that radiates through to his back. He is sweaty and nauseated. On examination, his BP is 95/60 mmHg. On auscultation, you can hear an early diastolic murmur.

75-year-old James works as a farmer. He presents to you with 6 months history of pain in his ankle which is worse on walking. On examination, there is painful movements at the ankle joint. You arrange an X-ray which is given below.

What is your diagnosis?

A 70-year-old woman attends for her repeat prescription of 100 mcg levothyroxine daily, which she has been taking for the past 30 years. The last record of any blood test was six years ago. She mentions a recent episode of quite severe localized back pain which has now settled to a dull ache around the L3 region. She has no neurological signs

Which is the SINGLE MOST likely diagnosis? Select ONE option only.

A 65yo man presents with painless hematuria, IVU is normal, the prostate is mildly enlarged with mild frequency. He does not suffer from any medical conditions and is currently not on any regular medications.

What is the most appropriate next step?

A 55-year-old woman with a history of sarcoidosis presents with polyuria and polydipsia. She is passing almost 10 litres of urine per day. You organise for her to have blood tests, the results of which are shown below:

• Na: 150 mmol/L (135-147 mmol/L)
• K: 3.7 mmol/L (3.5-5.5 mmol/L)
• Urea: 9.5 mmol/L (2.0-6.6 mmol/L)
• Creatinine: 127 mmol/L (75-125 mmol/L)
• Fasting blood glucose: 5.0 mmol/L (3.4-5.5 mmol/L)

A 74yo smoker presented to his GP with cough and SOB. Exam revealed pigmentation of the oral mucosa and also over the palms and soles. Tests show that he is diabetic and hypokalemic. He does not suffer from any medical conditions and is currently not on any medications. You organise some tests which show HBA1C 8.2, fasting glucose  12 and potassium 3.1. What is the most probable dagnosis?

A 65yo man presents w/ painless hematuria, IVU is normal, the prostate is mildly enlarged with mild
frequency. What is the most appropriate next step?

A 46-year-old man developed a sudden loss of hearing in his right ear six weeks ago. His hearing has not improved at all. He has had no other symptoms and is otherwise well. Examination of the ear canals and tympanic membranes is normal. A private hearing assessment clinic has confirmed 90% sensorineural hearing loss on the right side. Which is the SINGLE MOST likely diagnosis? Select ONE option only.

A 25-year-old patient with Wilson’s disease presents with sudden-onset altered mental status, flapping tremors, and severe coagulopathy. Laboratory investigations reveal significantly elevated ammonia levels. Which of the following is the most likely complication in this patient?

A 30-year-old patient with Wilson’s disease develops hepatocellular carcinoma. Which of the following factors is most strongly associated with the development of hepatocellular carcinoma in patients with Wilson’s disease?

A 25-year-old patient with Wilson’s disease presents with sudden-onset altered mental status, flapping tremors, and severe coagulopathy. Laboratory investigations reveal significantly elevated ammonia levels. Which of the following is the most likely complication in this patient?

A 17-year-old patient presents with a tremor, dysarthria, and dystonia. On examination, Kayser-Fleischer rings are observed in the patient’s cornea. He does not suffer from any medical condition and is not on any regular medications Which of the following is the most likely diagnosis?

A 23-year-old patient presents with hepatomegaly, jaundice, and neurological symptoms such as tremors and personality changes. Laboratory investigations reveal elevated liver enzymes, decreased serum ceruloplasmin levels, and increased urinary copper excretion. Which of the following investigations is the gold standard for diagnosing Wilson’s disease?

A 65-year-old patient presents with painless jaundice, weight loss, and a palpable gallbladder. Laboratory investigations reveal elevated levels of bilirubin and alkaline phosphatase. Imaging studies show a dilated common bile duct  What is the most likely diagnosis?

A 70-year-old patient presents with persistent epigastric pain radiating to the back, unexplained weight loss, and new-onset diabetes. He does not suffer from any medical conditions and is not on any regular medications. The symptoms have been going on for 3 months. What is the most likely diagnosis?

A 55-year-old patient presents with vague abdominal discomfort, unintentional weight loss, and steatorrhea. On examination, the patient has a palpable epigastric mass. Which of the following tumour markers should be measured to aid in the diagnosis and monitoring of this patient?

A 65-year-old patient with a history of chronic pancreatitis presents with new-onset jaundice, pruritus, and pale stools. Laboratory investigations reveal elevated levels of total bilirubin, alkaline phosphatase, and gamma-glutamyl transferase (GGT). Which of the following investigations should be performed to establish the cause of the patient’s symptoms?

A 60-year-old patient presents with persistent upper abdominal pain radiating to the back, weight loss, and new-onset diabetes. Physical examination reveals jaundice and a palpable gallbladder. Which of the following investigations should be performed as the initial diagnostic test to evaluate the patient’s symptoms?

A 50-year-old female patient with liver cirrhosis presents with massive hematemesis. On physical examination, she is hypotensive and tachycardic. Initial resuscitation and stabilization are performed, and an urgent upper gastrointestinal endoscopy is scheduled. Which of the following complications is the most likely cause of this patient’s presentation?

A 65-year-old male patient with liver cirrhosis presents with altered mental status, confusion, and asterixis. Laboratory investigations reveal elevated ammonia levels. Which of the following complications is the most likely cause of these findings?

A 55-year-old patient with a history of liver cirrhosis presents with increasing abdominal distension, lower limb edema, and difficulty breathing. On examination, shifting dullness and a fluid wave are noted. Which of the following complications is the most likely cause of these findings?

Which of the following classes of medications is commonly associated with drug-induced liver injury and can progress to acute liver failure?

Which of the following antituberculosis medications has the potential to cause drug-induced liver failure?

Which of the following medications is known to be associated with the development of drug-induced liver cirrhosis?

Which of the following inherited metabolic disorders can result in liver cirrhosis due to impaired copper metabolism?

Among the following viral infections, which one is a primary cause of chronic hepatitis and can progress to liver cirrhosis?

Which of the following chronic liver diseases can lead to the development of liver cirrhosis characterized by fibrosis and regenerative nodules?

A 60-year-old male presents with progressive dysphagia for the last 6 months. A repeat upper gastrointestinal endoscopy reveals a luminal narrowing with a “bird’s beak” appearance in the distal esophagus. Which of the following is the most likely cause of this finding?

A 55-year-old male presents with sudden-onset right-sided facial weakness. He also reports difficulty closing his right eye completely and increased sensitivity to sound in his right ear. He denies any pain or vesicular rash. The rest of the neurological examination is normal. Which of the following is the most likely cause of his symptoms?

A 45-year-old female presents with recurrent episodes of sudden spinning sensation that lasts for a few seconds. The episodes are triggered by specific head movements, such as rolling over in bed or looking upwards. There is no associated hearing loss or tinnitus. Which of the following is the most likely diagnosis?

A 55-year-old female presents with episodes of vertigo triggered by sudden head movements. She experiences brief, intense spinning sensations that last for less than a minute. She does not have any associated hearing loss or tinnitus. Which of the following is the most appropriate diagnostic test for this patient?

A 55-year-old man has had severe central chest pain radiating into his left arm for the past two hours. He has no previous significant medical history. His BP is 150/85, his chest is clear and his pulse is regular 90/min. In addition to aspirin, which is the SINGLE MOST appropriate NEXT drug for this patient? Select ONE option only.

This nine-year-old boy has been unwell for the past few days and developed a rash affecting his trunk and limbs yesterday. He has no underlying medical problems and is feeling better today. His mother has used a cream recommended by the pharmacist. The picture of the rash is given below. Which is the most appropriate management option? Select ONE option only.

A 4 year old boy is referred by the GP to the paediatrician with a cervical lymphadenopathy that is 2 cm in size. His mother says that she thinks the lymph node is growing. It was first noticed 6 weeks ago. The child is generally well with no complaints of tenderness. He has no history of fever. On examination, the spleen is not palpable and there are no other palpable lymph nodes around the body. The cervical lymph node is firm, non-tender and immobile. His throat is clear with no signs of infection. What is the SINGLE most appropriate initial investigation to perform?

A 4 week old boy has episodes of vomiting since birth. The vomiting occurs soon after feeding. He is exclusively breastfed. He does not vomit after every feed and it is not related to the amount he takes. He is otherwise well and is gaining weight appropriately.

Which is the most likely diagnosis?

A 64yo man has recently suffered from a Myocardial infarction and is on aspirin, atorvastatin and ramipril. He has been having trouble sleeping and has been losing weight for the past 4 months. He doesn’t feel like doing anything he used to enjoy and has stopped socializing. He says he gets tired easily and can’t concentrate on anything.

What is the most appropriate treatment?

A 14-year-old presents with left knee pain for the past 4 weeks. There is no history of trauma. The pain is felt in the anterior aspect of the joint and is worse when walking up and downstairs. There is no tenderness at tibial tuberosity The examination is unremarkable. What is the most likely diagnosis?

A 33-year-old schizophrenic says the following. “Life is unfair, I eat air, law chair, I like fairs, fairs have foot, it must be good, in adulthood, I misunderstood”.

What term describes this patient’s speech?

A 40-year-old male presents with a severe, unilateral headache accompanied by eye redness, tearing, nasal congestion, and restlessness. The headache lasts for 30 minutes to 3 hours and occurs several times a day over several weeks. Between the episodes, the patient is completely symptom-free. Which of the following is the most likely diagnosis?

A 21 year old woman has increasing severe pain in her left leg. She had an undisplaced fracture of the midshaft of her left tibia 2 days ago which was treated conservatively with a plaster cast.

Her toes are warm and pulses are present.

Which is the most important immediate action?

A 45-year-old male presents with exertional dyspnea and chest pain. On physical examination, a harsh systolic murmur is heard at the left sternal border, which increases with the Valsalva maneuver. ECG shows left ventricular hypertrophy. An echocardiogram confirms asymmetric septal hypertrophy and systolic anterior motion of the mitral valve.

A 32-year-old female with a family history of sudden cardiac death presents with exertional syncope. On examination, a systolic murmur is heard at the left sternal border, which decreases with squatting. Echocardiogram shows asymmetric septal hypertrophy. What is the most appropriate initial management for this patient?

A 60-year-old female with a history of hypertrophic obstructive cardiomyopathy (HOCM) presents with worsening exertional dyspnea and fatigue. The echocardiogram shows a progression of left ventricular hypertrophy and increased left ventricular outflow tract obstruction. She is currently on bisoprolol 2.5 mg bd. What is the most appropriate next step in the management of this patient?

A 65-year-old male with hypertrophic obstructive cardiomyopathy (HOCM) presents with new-onset atrial fibrillation. His heart rate is well-controlled with beta-blockers, but he remains in atrial fibrillation. What is the most appropriate next step in the management of this patient’s rhythm?

An eight-year-old child has had a localised rash around the nose for two days. What is your likely diagnosis?

22-year-old woman is admitted from a night club with drowsiness, hallucinations and muscle rigidity. According to her friends she has taken some tablets that she purchased from a local dealer. A past admission 6 month earlier for bladder stones is noted. On examination her BP is 155/82 mmHg, pulse is 85/min and regular, temperature is 37.6oC. Her eyes are open but she does’nt respond to your questions. There is excessive salivation. On neurological examination you elicit bilateral increased tone with what appear to be involuntary tonic clonic movements.

Which of the following is the most likely cause of her symptoms?

A 34-year-old patient was admitted for severe depression and suicidal thoughts. He attempted to commit suicide. He has been on sertraline for the past year which he had stopped a month ago. He had been admitted to the psychiatric ward two years ago for mania. On discharge, the patient wishes to know if he can be started on long-term medication to alleviate his symptoms.

What SINGLE medication will be most useful for his disorder?

A 50-year-old male with a history of chronic alcohol abuse presents with fatigue, weight loss, and abdominal distension. On examination, there are signs of jaundice, hepatomegaly, and ascites. Laboratory investigations reveal low serum albumin levels, prolonged prothrombin time, and elevated liver enzymes. Which of the following is the most likely diagnosis?

A 60-year-old female with a history of chronic hepatitis C infection presents with worsening jaundice, easy bruising, and peripheral edema. On examination, there are signs of spider angiomas, palmar erythema, and gynecomastia. Laboratory investigations reveal low platelet count, prolonged prothrombin time, and elevated serum bilirubin levels. Which of the following is the most likely diagnosis?

A 45-year-old male with a history of non-alcoholic fatty liver disease presents with recurrent episodes of gastrointestinal bleeding and abdominal pain. On examination, there are signs of hepatosplenomegaly and collateral circulation. Upper gastrointestinal endoscopy reveals esophageal varices. Laboratory investigations reveal low platelet count, prolonged prothrombin time, and decreased serum albumin levels. Which of the following is the most likely diagnosis?

A 60-year-old male with a history of type 2 diabetes presents with signs and symptoms of liver cirrhosis, including jaundice and ascites. Further investigation reveals the presence of non-alcoholic fatty liver disease. Which of the following risk factors contributes most significantly to the development of liver cirrhosis in this patient?

A 45-year-old male presents with signs of decompensated liver cirrhosis, including ascites, hepatic encephalopathy, and jaundice. Further investigations confirm the diagnosis of Liver cirhosis. Which of the following is the most significant risk factor for the development of liver cirrhosis in this patient?

A 65 year old man has pain in his abdomen and is seen on the surgical inpatient ward. He had a closure of his colostomy 5 days ago.

His temperature is 36.5°C, pulse rate is 76 bpm, BP 124/82 mmHg and respiratory rate is 15 breaths per minute. There is a tender, localised fluctuant swelling 4 cm in diameter in the wound.

Which is the most appropriate management?

What is the mechanism of action of methotrexate?

A 60-year-old male presents with episodic vertigo associated with tinnitus and fluctuating sensorineural hearing loss in his left ear. The vertigo attacks last for several hours to a day and are often preceded by aural fullness. Which of the following is the most likely diagnosis?

Where do u live

A 67yo man after a stroke presents with left-sided ptosis and constricted pupil. He also has a loss of pain and temp on the right side of his body and the left side of his face.

Which part of the brain is most likely affected?

A 20-year-old woman notices bright lines of light in both visual fields followed shortly afterwards by a partial loss of her vision. Her visual symptoms resolve after one hour but she has slight nausea. She does not suffer from any medical conditions and is currently not on any regular medications. Which is the SINGLE MOST likely diagnosis? Select ONE option only.

A 50-year-old male presents with dysphagia and weight loss. An upper gastrointestinal endoscopy reveals a nodular mass in the middle third of the esophagus. Biopsy confirms the presence of adenocarcinoma. Which of the following conditions is strongly associated with the development of this type of esophageal cancer?

A 62-year-old male presents with dysphagia, weight loss, and occasional chest pain. On examination, he has a long history of smoking and alcohol consumption. Upper gastrointestinal endoscopy reveals a circumferential mass in the lower esophagus. Biopsy confirms the presence of squamous cell carcinoma.

What is the most common risk factor associated with this type of esophageal cancer?

A 55-year-old male presents with dysphagia for both solids and liquids, unintentional weight loss, and frequent episodes of choking while eating. He denies any history of acid reflux. On examination, there is evidence of cachexia. A barium swallow study reveals a smooth narrowing in the mid-esophagus. What is the most likely diagnosis?

A 60-year-old male presents with progressive dysphagia for solids, weight loss, and occasional episodes of food regurgitation. He also reports a history of chronic acid reflux. On examination, he appears malnourished, and there is evidence of digital clubbing.  What is the most likely diagnosis?

A 68-year-old female presents with parkinsonism symptoms, including resting tremors, bradykinesia, and postural instability. She also experiences cognitive impairment, visual hallucinations, and fluctuations in her mental state. Which of the following is the most likely diagnosis?

A 62-year-old male presents with resting tremors, bradykinesia, and rigidity. His symptoms predominantly affect the left side of his body. On examination, he also demonstrates asymmetric limb rigidity and a stooped posture. Which of the following is the most appropriate next step in management?

A 70-year-old female presents with a six-week history of bilateral shoulder pain and stiffness. She has a normal range of motion in other joints. Her ESR is within normal limits. What is the most appropriate next step in the management of this patient?

A 72-year-old female presents with a six-week history of bilateral shoulder pain and stiffness. She reports difficulty combing her hair and getting out of bed in the morning due to stiffness. She denies any joint swelling or redness. She has a normal range of motion in her neck and hips. Her ESR is elevated. What is the most likely diagnosis?

A 65-year-old male presents with a four-week history of bilateral shoulder and hip pain and stiffness. He reports morning stiffness lasting longer than an hour and significant fatigue. He denies any other joint symptoms or red flags. Physical examination reveals limited range of motion in the affected joints. What is the most appropriate initial investigation for this patient?

An 80yo man presented with pain in his lower back and hip for the last 3 months. The pain is especially worse at night and thinks he has recently been losing weight. He also complains of waking up in the night to go to the washroom and has urgency as well as dribbling.

What is the most likely diagnosis?

An 80yo man presented with pain in his lower back and hip for the last 3 months. The pain is especially worse at night and thinks he has recently been losing weight. He also complains of waking up in the night to go to the washroom and has urgency as well as dribbling.

What is the most likely diagnosis?

A 79yo anorexic male complains of thirst and fatigue. He has symptoms of frequency, urgency, and terminal dribbling. His urea and creatinine levels are high. His serum calcium is 2.5 and he is anemic. His BP is 165/100 mmHg.

What is the most probable diagnosis?

A 79yo anorexic male complains of thirst and fatigue. He has symptoms of frequency, urgency, and terminal dribbling. His urea and creatinine levels are high. His serum calcium is high and he is anemic. On examination, his BP is 165/95 mmHg. What is the most probable diagnosis?

A 79yo anorexic male complains of thirst and fatigue. He has symptoms of frequency, urgency, and terminal dribbling. His urea and creatinine levels are high. His serum calcium is 2.5 and he is anemic. His BP is 165/100 mmHg.

What is the most probable diagnosis?

John aged 45 presents to you because of numbness in his right hand. Soon after he woke up, he felt numbness and weakness in that hand, and on examination, he has limited wrist movement/wrist drop and sensory loss over the dorsum of that hand, weakness of extension of the fingers, and loss of sensation at the web of the thumb. What structure is likely to be affected?

A 50-year-old male presents with sudden-onset right-sided facial weakness. He reports pain around his right ear, a vesicular rash in the right ear canal, and decreased taste sensation on the anterior two-thirds of his tongue. He also experiences hyperacusis in his right ear. Which of the following is the most likely diagnosis?

A 48-year-old businessman returns from a trip to Los Angeles with shortness of breath and pleuritic chest pain. The results of his arterial blood gas (ABG) on-air are shown below:

• pH: 7.48
• pO₂: 7.4 kPa
• PCO₂: 3.1 kPa
• HCO₃-: 24.5 mmol/l

A 65-year-old male with a history of chronic alcohol abuse is brought to the emergency department with altered mental status. On examination, he has signs of cirrhosis, asterixis, and multiple spider angiomata. CT scan reveals a chronic subdural haematoma with midline shift. Which of the following is the most appropriate management?

A 72-year-old male presents to the emergency department after a fall. He has a history of anticoagulant use for atrial fibrillation. On examination, he has a Glasgow Coma Scale (GCS) score of 14, with a headache and confusion. A non-contrast head CT scan reveals a crescent-shaped collection of blood overlying the cerebral hemisphere. What is the most likely diagnosis?

A 45yo woman complains of pain in her hands precipitated by exposure to the cold weather. She is breathless on walking. When she is eating, she can feel food suddenly sticking to the gullet. It seems to be in the middle of the oesophagus but she can’t localize exactly where it sticks. It is usually relieved with a drink of water. Choose the single most likely cause of dysphagia from the options?

A 45yo female looking pale has bluish discolouration of hands whenever she goes out in the cold. She has also noticed some reddish spots on her body. She has symmetrical peripheral arthropathy for the last yr. What is the most probable dx?

A 45-year-old male presents with recurrent episodes of throbbing headache that lasts for several hours. The headache is always localized to the right temple area and is accompanied by tenderness over the affected area. The patient also experiences scalp tenderness, jaw claudication, and vision changes, particularly temporary loss of vision in the right eye. There is no associated nausea or vomiting. Which of the following is the most likely diagnosis?

A 28-year-old female presents with recurrent episodes of headaches that are usually triggered by stress or lack of sleep. The headache is typically bilateral, pressing in nature, and lasts for a few hours to a couple of days. The patient does not experience nausea, vomiting, or sensitivity to light or sound during these episodes. Over-the-counter pain medications, such as acetaminophen or ibuprofen, provide relief. Which of the following is the most likely diagnosis?

A 65-year-old female presents with recurrent episodes of severe, stabbing facial pain on the right side of her face. The pain is triggered by simple activities such as eating, talking, or brushing her teeth. Between the episodes, she is completely symptom-free. Which of the following is the most likely diagnosis?

A 60-year-old female presents with severe, unilateral facial pain that is triggered by touching her cheek. She describes the pain as sharp and shooting in nature, lasting for a few seconds. The rest of the neurological examination is normal. Which of the following is the most likely diagnosis?

A 50-year-old male presents with severe, electric shock-like pain in the right side of his face that lasts for a few seconds to a minute. The pain is primarily located in the distribution of the second and third divisions of the trigeminal nerve. Which of the following is the most appropriate initial treatment for this patient?

A 55-year-old male presents with severe, lancinating facial pain on the left side of his face, primarily in the distribution of the maxillary division of the trigeminal nerve. The pain is constant and worsens with touch or cold exposure. There are no associated symptoms. Which of the following is the most likely diagnosis?

A 22 year old man has a painful right eye for 1 day. He had similar symptoms 1 year ago. He has had episodic back pain and stiffness for 4 years which is relieved by exercise and ibuprofen.

His right eye is red and his vision is blurred.

Which is the most likely cause of his red eye?

A 50-year-old female presents with recurrent episodes of vertigo that last for hours and are associated with severe headache, photophobia, and phonophobia. She does not have any significant hearing loss or tinnitus. Which of the following is the most likely diagnosis?

A 70-year-old male presents with parkinsonism symptoms, including resting tremors, bradykinesia, and rigidity. He has a history of chronic liver disease and exhibits a flapping tremor on examination. Which of the following is the most likely cause of his symptoms?