Get ahead! Medicine

150 EMQs for Finals, Second Edition

Anthony B. Starr, Hiruni Jayasena, Saran Shantikumar, David Capewell

• Publisher: CRC Press
• Year: 2016
• eBook ISBN: 9781315352343
• Topic: Medicine
• Subtopic: Internal Medicine & Diagnosis

The new edition of Get ahead! Medicine: 150 EMQs for Finals has been completely updated by two junior doctors who have achieved recent success in their finals, overseen by the book's experienced author team. The 150 EMQ themes, each with five stems, are arranged as 10 practice papers, each containing 15 themes. All the main conditions are included as well as more detailed knowledge suitable for candidates aiming at the higher deciles.

The questions are written to follow the house style of the Medical Schools Council Assessment Alliance EMQs and are therefore of a similar format to those you can expect in your exams. All the questions are accompanied by explanatory answers, including a succinct summary of the key features of each condition. Whether you work through the practice papers systematically or dip in and out by topic, this bestselling revision guide will offer a life rope for anyone preparing for undergraduate finals.

Practice Paper 1: Questions

THEME 1: CAUSES OF COLLAPSE

Options

A. Acute myocardial infarction

B. Cerebrovascular accident

C. Dissecting aortic aneurysm

D. Drug allergy

E. First-dose hypotension

F. Left ventricular failure

G. Ruptured abdominal aortic aneurysm

H. Stable angina

I. Stokes–Adams attack

J. Supraventricular tachycardia

K. Vasovagal syncope

L. Ventricular rupture

M. Wolff–Parkinson–White syndrome

For each of the following scenarios, select the most appropriate diagnosis. Each option may be used once, more than once or not at all.

1. A 45-year-old woman collapses during a church service in summer. Her husband states that she turned pale and collapsed shortly after standing up. She did not jerk or lose urinary continence. She denies chest pain, shortness of breath and palpitations. She recovered after 30 seconds and now feels back to her usual self. All observations – including blood tests, ECG, and lying and standing blood pressures – are normal.

2. A 25-year-old man collapses suddenly while visiting his grandmother in the hospital. There appears to be no pulse. The crash team is called and manage to resuscitate him after identifying ventricular fibrillation on the cardiac monitor. The attending anaesthetist records a repeat ECG and notes that the QRS complexes are broad with a slurred upstroke of the R-wave.

3. A 75-year-old woman is brought to the emergency department after collapsing. On examination, her heart rate is 80 beats/min and irregular, with a blood pressure of 150/90 mmHg. She has difficulty in moving her left arm and leg.

4. A 67-year-old man presents to the emergency department following a collapse. He has a history of ischaemic heart disease (IHD) and had been diagnosed with hypertension only last week. He remembers feeling dizzy when he got out of his chair to go to the toilet before fainting. He regained consciousness almost immediately and had fully recovered within 5 minutes.

5. A 57-year-old man is found collapsed at work. On arrival at the emergency department, he is complaining of mild epigastric discomfort that started at rest. He appears pale and sweaty and has vomited once. He is on insulin for type 1 diabetes mellitus.

THEME 2: NERVE LESIONS OF THE UPPER LIMB

Options

A. Accessory nerve

B. Anterior interosseous nerve

C. Axillary nerve

D. Distal median nerve

E. Distal ulnar nerve

F. Long thoracic nerve

G. Lower brachial plexus

H. Posterior interosseous nerve

I. Proximal median nerve

J. Proximal ulnar nerve

K. Radial nerve

L. Upper brachial plexus

For each of the following scenarios, select the most likely nerve lesion. Each option may be used once, more than once or not at all.

1. A 28-year-old man is involved in a motorcycle accident. He has fractured both of his femurs and complains of pain in his neck. On examination, his right arm is hanging by his side, is fully extended at the elbow and is rotated inward. There is loss of sensation on the outer edge of the right arm and forearm.

2. A 67-year-old woman attends a follow-up clinic following a right mastectomy for invasive breast cancer. Her husband has pointed out that her right shoulder blade occasionally sticks out more than the left. On examination, there is no evidence of sensory loss.

3. A 72-year-old man attends the emergency department following a fall. On examination, there is bruising on the right upper arm and the man is unable to extend his metacarpals on the same side. There is loss of sensation over the lateral dorsal aspect of the hand.

4. An 18-year-old woman who recently had neck surgery attends a follow-up clinic. She complains of pain in the left side of her neck. On examination, she is unable to shrug her left shoulder. There is no evidence of sensory loss.

5. A 24-year-old man presents with severe right shoulder pain following a tackle during a rugby match. On examination, the contour of the affected shoulder is flattened and the humeral head is palpable. There is also sensory loss at the upper outer aspect of the arm.

THEME 3: COMPLICATIONS OF DIABETES MELLITUS

Options

A. Atherosclerosis

B. Autonomic neuropathy

C. Charcot’s joint

D. Connective tissue disease

E. Diabetes dermopathy

F. Lipoatrophy

G. Lipohypertrophy

H. Peripheral vascular disease

I. Neuropathic ulcer

J. Nephropathy

K. Necrobiosis lipoidica

L. Osteoarthritis

M. Venous ulcer

For each of the following scenarios, select the most appropriate complication. Each option may be used once, more than once or not at all.

1. A 66-year-old man with a long history of poorly controlled type 2 diabetes is found to have a foot lesion during his podiatry appointment. The lesion is located on the ball of his left foot. It is small and well circumscribed and appears punched out. The patient denies any pain.

2. A 55-year-old woman with poorly controlled diabetes has collapsed several times over the previous 2 months. All collapses have occurred when she stands from a lying position, and she recovers within minutes. Her husband says that she has never fitted or lost urinary continence during an episode.

3. A 50-year-old type 1 diabetic man presents to his GP with ‘unstable’ ankle joints. On examination, both ankles are significantly deformed, hypermobile and cold, but are not painful.

4. A 46-year-old type 1 diabetic man attends a routine follow-up clinic. A urine dipstick analysis demonstrates 3+ protein, 1+ blood, no nitrates and no leucocytes. His annual blood tests show a sodium of 135 mmol/L, a potassium of 4.9 mmol/L, a creatinine of 130 μmol/L and a urea of 8.9 mmol/L.

5. A 70-year-old woman with diet-controlled type 2 diabetes is found to have a lower leg lesion during her podiatry appointment. On examination, the lesion is located at the medial aspect of the right leg above the ankle, is painless and is granulating with an irregular base. She also has varicose veins and complains of ‘achy legs’ following exercise.

THEME 4: DIAGNOSIS OF RESPIRATORY CONDITIONS 1

Options

A. Asbestos-related lung disease

B. Asthma

C. Bronchiectasis

D. Chronic obstructive pulmonary disease

E. Cryptogenic fibrosing alveolitis

F. Cystic fibrosis

G. Extrinsic allergic alveolitis

H. Mesothelioma

I. Non-small cell lung tumour

J. Open pneumothorax

K. Sarcoidosis

L. Secondary lung metastases

M. Sleep apnoea

N. Small cell lung tumour

O. Tuberculosis

For each of the following scenarios, select the most appropriate diagnosis. Each option may be used once, more than once or not at all.

1. A 68-year-old retired accountant has a 3-week history of small haemoptysis. He has also noticed that he is not passing as much urine as normal, although he is otherwise well. On examination, a monophonic wheeze is heard over the left lobe.

2. A 12-year-old boy is brought to the GP by his mother. Over the past couple of years, he has suffered from repeated chest infections, and his mother is worried that he is not putting on any weight. On examination, there are coarse crepitations throughout both lung lobes.

3. A 58-year-old builder complains of left-sided chest discomfort that has been progressing over the last fortnight. He is otherwise well. On examination, the left lower lobe is dull to percussion. A pleural tap is performed and reveals blood-stained fluid.

4. A 53-year-old shopfitter is admitted to hospital for an elective inguinal hernia operation. A routine chest X-ray shows white lesions over both lungs that cross the lobar boundaries. The patient feels well and auscultation reveals no abnormality.

5. A 16-year-old boy presents to his GP with a 6-month histo...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• Introduction to Get ahead!
• Practice Paper 1: Questions
• Practice Paper 1: Answers
• Practice Paper 2: Questions
• Practice Paper 2: Answers
• Practice Paper 3: Questions
• Practice Paper 3: Answers
• Practice Paper 4: Questions
• Practice Paper 4: Answers
• Practice Paper 5: Questions
• Practice Paper 5: Answers
• Practice Paper 6: Questions
• Practice Paper 6: Answers
• Practice Paper 7: Questions
• Practice Paper 7: Answers
• Practice Paper 8: Questions
• Practice Paper 8: Answers
• Practice Paper 9: Questions
• Practice Paper 9: Answers
• Practice Paper 10: Questions
• Practice Paper 10: Answers
• Index