300 Single Best Answers in Clinical Medicine

George Collins, James Davis, Oscar Swift, Huw Beynon

• Publisher: ICP
• Year: 2014
• ISBN:
  9781783264391
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This book is a question book that offers single best answers (SBA) to 300 questions related to topics in general medicine. In order to further enhance knowledge and understanding, detailed answers have been included. This book is designed as both a revision and learning aid, with questions being set in a mock-examination format which can be completed under timed conditions.

The primary target audience of this book is clinical medical students who are revising for examinations. However, questions have been planned in a way that a fairly large secondary target audience will be reached as well. This includes students who are transitioning from pre-clinical to clinical.

As recently qualified medical graduates who have had the option of both online and book-based questions, the authors feel that students often prefer a Single Best Answers book that aids them in advancing their medical knowledge rather than online question banks, which can often have very repetitive and one-dimensional questions. Having questions in paper format replicates examination conditions better than online question banks and, therefore, offers a more realistic revision experience. In addition, though SBAs are becoming increasingly more common as an examination style with medical schools, there are very few SBA question books available. As such, medical students will find this book highly useful in the preparation for their examinations.

Contents:

• Abbreviations List
• Reference Values
• Paper 1 Questions
• Paper 1 Answers
• Paper 2 Questions
• Paper 2 Answers
• Paper 3 Questions
• Paper 3 Answers
• Paper 4 Questions
• Paper 4 Answers
• Paper 5 Questions
• Paper 5 Answers
• Index

Readership: The primary target audience is clinical medical students, especially final year undergraduates. A fairly large secondary target audience will be reached as well and this includes students who are transitioning from pre-clinical to clinical, as well as junior doctors. Key Features:

• The questions written are realistic, case-based questions which are of very high quality and are similar in style to questions set in medical school examinations
• Multi-dimensional questions that encourage problem solving skills. The reader will need to understand and be able to connect multiple pieces of information together, as doctors do in real life situations
• Dr Beynon is an experienced author of several medical revision/question books, mainly for MRCP level exams. He is also a renowned teacher for both students and doctors studying for the MRCP

Paper 1

Paper 1: Questions

1.1 A 46-year-old male who is started on treatment for hypercholesterolaemia complains of the foul taste of his medication.

Which one of the following medications is he most likely to be taking?

ABenecol

BCholestyramine

CNicotinic acid

DSimvastatin

EVerapamil

1.2 An 83-year-old female with atrial fibrillation is reviewed in clinic. The patient and her relatives are discussing whether or not she should be started on warfarin.

In which one of the following situations can warfarin still be used?

AFrequent falls

BMitral regurgitation

CPlatelets less than 50 × 10⁹/L

DPotential compliance issues

EPrevious intracranial bleeds

1.3 A 36-year-old pregnant female presents with sudden-onset shortness of breath and pleuritic chest pain. Her observations are as follows:

Heart rate	110 beats per minute
Respiratory rate	30 breaths per minute
Blood pressure	100/60 mmHg
Oxygen saturations on room air	93%
Temperature	37.3 °C

Which one of the following is the most likely diagnosis?

ADeep vein thrombosis

BMyocardial infarction

CPericarditis

DPneumothorax

EPulmonary embolus

1.4 A 46-year-old male presents with cough and general malaise. ‘Target’ lesions are present on his arms and legs. Chest X-ray shows bilateral alveolar shadowing and Mycoplasma serology is positive for IgM antibodies.

Which one of the following is the most appropriate treatment?

AAmoxicillin

BCeftriaxone

CErythromycin

DMeropenem

EVancomycin

1.5 A 28-year-old male with a history of asthma presents with chest-tightness, shortness of breath, wheeze and cough.

Which one of the following is the best indicator that this asthma attack is life threatening?

AHeart rate of 115 beats per minute

BOxygen saturations of 94%

CPEFR 35% of predicted

DRespiratory rate of 35 breaths per minute

ESilent chest

1.6 A 78-year-old female presents to the Emergency Department for the third time in one month with nausea, headache, weakness and unsteadiness on her feet. On examination coarse crackles are heard bibasally. Her observations are as follows:

Heart rate	110 beats per minute
Respiratory rate	28 breaths per minute
Oxygen saturations (pulse oximetry) on room air	99%

Arterial blood gas sampling reveals a PaO₂ of 12 kPa and oxygen saturations of 80% on room air.

Which one of the following is the most likely explanation in this patient?

AAcute pulmonary haemorrhage

BAcute pulmonary oedema

CCarbon monoxide poisoning

DCommunity-acquired pneumonia

EPulmonary fibrosis

1.7 A 66-year-old male is diagnosed with COPD. The post-bronchodilator FEV₁:FVC is 0.58 and the FEV₁ is 37% that of predicted. He is a smoker with a 50-pack year history. He wants to give up smoking and has been referred for smoking cessation therapy.

Which one of the following subsequent management options is most likely to prolong survival in this patient?

ACorticosteroids

BInfluenza vaccination

CIpratropium bromide

DLong-term oxygen therapy

ESalmeterol inhalers

1.8 A 53-year-old male is being treated for aspiration pneumonia. Twenty-four hours after admission to hospital he develops worsening shortness of breath and cough. The patient is subsequently placed on high-flow oxygen using a non-rebreather mask with a reservoir bag. There are coarse crackles bilaterally and a chest X-ray shows the presence of extensive bilateral lung infiltrates. The arterial blood gas result is as follows:

PaO2	10.8 kPa
PaCO2	4.3 kPa
FiO2	65%

Which one of the following pathological changes is most likely to explain this patient’s clinical presentation?

AAlveolar hyaline membrane formation

BAlveolar wall destruction

CDiffuse pulmonary haemorrhage

DGranulomatous inflammation

EMucous gland hypertrophy

1.9 A 32-year-old female with known ulcerative colitis presents with bloody diarrhoea and abdominal pain. Her observations are as follows:

Blood pressure	90/55 mmHg
Heart rate	120 beats per minute

Abdominal X-ray shows ‘thumb-printing’.

Which one of the following medications is contraindicated?

AAminosalicylate

BCiclosporin

CCiprofloxacin

DMorphine sulphate

EPrednisolone

1.10 A 46-year-old male presents with upper epigastric pain, anorexia and a three-month history of weight loss. On endoscopy a malignant ulcer is visualised. Subsequent biopsy reveals a low-grade gastric mucosal-associated lymphoid tissue lymphoma. Helicobacter pylori infection is also shown to be present.

Which one of the following is the most appropriate initial treatment of this patient?

ABand ligation

BChemotherapy

CInjection sclerotherapy

DProton pump inhibitor and antibiotics

ERadiotherapy

1.11 A 47-year-old male presents with fatigue, renal colic and depression. His corrected serum calcium is found to be 3.12 mmol/L.

Which one of the following is the most likely cause of his hypercalcaemia?

ALoop diuretic administration

BOsteomalacia

COsteoporosis

DSarcoidosis

ESecondary hyperparathyroidism

1.12 A 63-year-old female presents with lethargy, blurred vision and weight loss. Clinical examination reveals splenomegaly and blood tests reveal pancytopaenia with a raised ESR.

Which one of the following is the most likely diagnosis?

AAcute lymphoblastic leukaemia

BChronic myeloid leukaemia

CMonoclonal gammopathy of uncertain significance

DMultiple myeloma

EWaldenström’s macroglobulinaemia

1.13 A 36-year-old female with sickle cell disease presents with shortness of breath, joint pains and a maculopapular rash on the face, arms and legs. Blood tests are as follows:

Haemoglobin	6.9 g/dL
Reticulocyte count	0.2%

Which one of the following is the most likely aetiological agent in this patient?

AEscherichia coli O157

BMeasles virus

CMycoplasma pneumoniae

DParvovirus B19

ESalmonella species

1.14 A 79-year-old female is admitted to the Intensive Care Unit with severe community-acquired pneumonia. Blood cultures grow Streptococcus pneumoniae. Bloods for urea and electrolytes and urine biochemistry tests are also taken and show evidence of pre-renal acute kidney injury.

Which one of the following profiles is most likely to be found in this patient?

AIncreased urea:creatinine ratio, high urinary sodium

BIncreased urea:creatinine ratio, low urinary sodium

CNormal urea:creatinine ratio, high urinary sodium

DNormal urea:creatinine ratio, low urinary sodium

EReduced urea:creatinine ratio, high urinary sodium

1.15 A 66-year-old male is seen in the Emergency Department with generalised malaise, arthralgia and haematuria. On examination there is significant peripheral oedema. He also complains that his fingers become white, cold and numb when exposed to cold temperatures. On taking his past medical history, it is revealed that he is under the care of the hepatology department at the hospital for chronic liver disease. Urine dipstick reveals +++ blood and ++++ protein. Selected blood tests are as follows:

Albumin	21 g/L
Low-density lipoprotein cholesterol	5.2 mmol/L
C3	0.72 g/L
C4	0.11 g/L

A renal biopsy is performed and examined under the light microscope. Which one of the following is the most likely histological abnormality to be identified?

ACrescentic glomerulonephritis

BFocal segmental glomerulosclerosis

CMembranous nephropathy

DMesangiocapillary glomerulonephritis

EMinimal change nephropathy

1.16 A 37-year-old previously healthy male presents to the Emergency Department after an episode of ‘pricking’ sensation on the tip of his left index finger that progressed to involve his left hand and arm over the course of two minutes. He reports that he has had four similar episodes over the past six weeks and they all resolved spontaneously after about three minutes. There is no associated motor weakness or loss of consciousness.

Which one of the following is the most likely diagnosis in this patient?

AC7 radiculopathy

BComplex partial seizure

CDiabetic neuropathy

DJacksonian seizure

ETransient ischaemic attack

1.17 A 72-year-old female undergoes a dual-energy X-ray absorptiometry bone scan that reveals a T-score of −2.8. She has a 50-pack year smoking history and underwent the menopause aged 39. She subsequently commences treatment on risedronate but soon after stops taking it due to intolerable odynophagia.

Which one of the following treatment options is now the most appropriate for this patient?

AAlendronate

BHormone replacement therapy

COmeprazole

DRanitidine

EZoledronate

1.18 A 38-year-old male with Raynaud’s syndrome presents to the Emergency Department. Clinical examination reveals the presence of tight skin over his hands, face and chest and ‘red spots’ that blanch when pressure is applied to them on his chest, face and arms. His blood pressure is 201/138 mmHg. Blood tests are as follows:

Serum creatinine	389 µmol/L
Serum urea	24.3 mmol/L

Which one of the following antibodies is most associated with this clinical scenario?

AAnti-centromere

BAnti-Jo1

CAnti-liver kidney microsomal

DAnti-RNA polymerase III

EAnti-SSA

1.19 A 38-year-old intravenous drug user presents with an acutely painful swollen left knee and a temperature of 38.3 °C. Joint aspiration reveals...