1 minute per question WRITE DOWN YOUR ANSWERS Try not to confer or look up answers Question 1 A 30 year old banker came in with pain in the epigastric region which radiated to his back He says he cant keep anything down amp sitting forward helps On examination there is decreased breath ID: 931230
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Slide1
MOCK EXAM
30 minutes TOTAL
1 minute per question
WRITE DOWN YOUR ANSWERS
Try not to confer or look up answers
Slide2Question 1
A 30 year old banker came in with pain in the
epigastric
region which radiated to his back. He says he can't keep anything down & sitting forward helps. On examination there is decreased breath sounds on the left side which is stony dull to percussion at the base. Which of these investigations is most appropriate?
Abdominal X ray
Serum amylase
Serum lipase
OGD endoscopy
Slide3Question 2
A 30 year old woman presents with aspiration
pnuemonia
. She has a long history of intermittent mild dysphagia for both liquids & solids and often suffers from severe retrosternal chest pain. Occasionally she gets food stuck but overcomes this by drinking vast amounts of water. What is the gold-standard investigation?
Barium swallow
Oesophageal
manometry
OGD endoscopy
Trial of PPIs
Slide4Question 3
A 72-year-old man presents to the emergency department with a 3-hour history of a painful, cold right leg. He has a past medical history of atrial fibrillation. On examination, the right leg is cold and tender. The pedal pulses on the right are not palpable. What would be the most appropriate initial management?
Embolectomy
Aorto-bifemoral
bypass
Conservative
Amputation
Slide5Question 4
You see this AXR. What is most likely underlying cause?
Volvulus
Hiatus hernia
Colorectal cancer
Adhesions
Slide6Question 5
A 70 year old lady has end-stage renal failure receiving regular dialysis. She has lost 2 stone in weight over the last 3 months. How is she most likely to present?
Urinary frequency and
haematuria
Haematuria
, loin pain, abdominal mass
Asymptomatic
Constipation
Slide7Question 6
A 45-year-old woman attends the orthopaedic follow-up clinic to receive the results of a knee X-ray. She has been getting increasing pain in the left knee, aggravated by walking. Practice Paper 5: Questions 186 Which of the following changes on X-ray would most suggest a diagnosis of osteoarthritis?
Joint subluxation
Juxta
-articular erosions
Narrowed joint space
Subchondral
sclerosis
Slide8Question 7
A 50 year old housewife & mother of 5 has sudden severe
epigastric
pain that radiates to the back on the right & has vomited. She puts it down to her recent meal of fish & chips, as she usually never eats fatty food. Examination is somewhat difficult as she is obese but you think she has some guarding over the
epigastium
and right
hypochondrium
. What is the most appropriate initial investigation?
MRCP
AXR
USS abdomen
ERCP
Slide9Question 8
A 70 year old gentleman presents with increased urine frequency and
nocturia
up to 5 times/night. On direct questioning, it is also noted that he also has urinary hesitancy and terminal dribbling. What is the most likely cause?
Prostate cancer
B
ladder cancer
Benign prostatic hypertrophy
UTI
Slide10Question 9
A 20 year old man has a 24 hour history of abdominal pain, which started in the
para
-umbilical region, but seems to have moved to his right iliac fossa. He is tender in this area with guarding and rebound tenderness. What is the most likely cause?
Inflammatory bowel disease
Diverticulitis
Appendicitis
Mesenteric adenitis
Slide11Question 10
A 38 year old man presents with a 2 month history of intermittent pain in the upper abdomen which he describes as dull in nature. It sometimes wakes him up at night and is relieved by food and particularly when he has a glass of milk. He has had a similar episode before where he remembers the doctor prescribed him some pills, which helped. Examination reveals mild
epigastric
tenderness. What is the surgery used to treat this condition?
Heller’s
cardiomyotomy
Vagotomy
Nissen’s
fundoplication
Ivor-Lewis
Slide12Question 11
A 72-year-old man who has no past medical history of note has been referred to you by his GP. His GP found an incidental non-tender
expansile
mass in his abdomen. An ultrasound scan demonstrates an abdominal aortic aneurysm that is 5 cm in diameter. What is the best course of management?
Commence on
antihypertensives
and advise to see GP if he develops abdominal pain
Organize an elective repair
Repeat an ultrasound scan in 3 months
Repeat an ultrasound scan in 1 year
Slide13Question 12
An 81-year-old woman from a nursing home is brought into the emergency department following a fall. She is complaining of pain in her left hip. On examination, her left leg is shortened and externally rotated. The home tells you this woman has dementia but is able to mobilize independently with a frame. An X-ray shows a displaced
intracapsular
femoral neck fracture. Which of the following would be the most suitable management option?
Allow the patient to try to mobilize
Hemiarthroplasty
Open reduction and internal fixation
Total hip replacement
Question 13
A 43 year old housewife complains of a colicky pain in the right upper quadrant which radiates to the back. Associated symptoms are nausea and vomiting. She says it is brought on by fatty foods and not relieved by pain killers bought over the counter. She is also jaundiced. What is the most likely cause?
Acute pancreatitis
Acute
cholecystitis
Gallstones
Peptic ulcer disease
Slide15Question 14
A 75 year old man with a 6 month history of straining at stool. He also thinks he is not emptying his rectum completely. He is passing blood & mucus per rectum. He has some weight loss & anorexia. What is the most likely diagnosis?
Right-sided colon cancer
Left-sided colon cancer
Rectal cancer
Anal cancer
Slide16Question 15
A 49 year old man presents with severe right abdominal pain which radiates to the groin. His
english
is very poor and he is unable to give a good history. He appears very anxious and in a great deal of pain. You notice that he can not lie still, seemingly because of the pain. An abdominal X-ray is entirely normal.
Which investigation is most likely to confirm the diagnosis?
USS KUB
USS abdomen
CT KUB
CT abdomen
Slide17Question 16
A 70 year old male who presents with significant weight loss & progressive jaundice. On examination there is a palpable gallbladder, which is painless. Ultrasound demonstrates a dilated biliary system down to the head of the pancreas. What is the serum marker associated with this condition?
Ca-125
PSA
CA19-9
CEA
Slide18Question 17
An 80 year old man presents with a 6 month history of increasing weakness and 8kg weight loss. He also has some difficulty swallowing and a few episodes of black stools. He is a long term smoker. What sign would you see on barium swallow?
Bird’s beak
Apple core
No abnormality
Corkscrew
Slide19Question 18
A 55 year old lady has chronic venous insufficiency. On examination of her legs, she has an an area of whitish looking skin and an inverted champagne bottle appearance bilaterally. Her legs feel hard and woody. What is the CEAP grade?
C3
C4a
C4b
C5
Slide20Question 19
A 75 year old man presents with bilateral testicular pain, swelling & tenderness of both testes & epididymis. His temperature is 37.8 degrees
celsius
. What is the most likely causative organism?
Chlamydia
Gonorrhoea
E.Coli
Staphyloccocus
aureus
TB
Slide21Question 20
A 56 year old builder has an intermittent lump in the left groin for 6 weeks. It is painless. On examination it is above the inguinal ligament, can be induced by coughing, is reducible & is non-tender. What is the most likely cause?
Indirect inguinal hernia
Femoral hernia
Direct inguinal hernia
Strangulated inguinal hernia
Slide22Question 21
An 80 year old lady has a 2 month history of heartburn, regurgitation, and a taste of acid in her mouth. What is the most appropriate investigation you would do?
A trial of PPI
A trial of conservative lifestyle changes
OGD endoscopy
24
hr
PH test
Slide23Question 22
You are in the vascular clinical and your consultant asks you to name the underlying condition. What do you say?
Peripheral arterial disease
Chronic venous insufficiency
Diabetes
Recent burn
Slide24Question 23
A 70 year old gentleman presents with increased urine frequency and
nocturia
up to 5 times/night. On direct questioning, it is also noted that he also has urinary hesitancy and terminal dribbling, and that he thinks he has recently lost weight. What is best diagnostic investigation?
PR examination
PSA levels
Transrectal
USS + biopsy
Cystoscopy + biopsy
Slide25Question 24
Name the fracture.
Slide26Question 25
A 63-year-old woman with known varicose veins presents to the surgical outpatients with a fever and a
sloughy
shallow ulcer above the medial aspect of the ankle with surrounding cellulitis. Which of the following would be the best immediate treatment option?
Debridement and intravenous antibiotics
Debridement and topical antibiotics
Debridement and
sclerotherapy
Dress the ulcer
Slide27Question 26
A 13-year-old girl presents to the emergency department following a fall on the outstretched hand. An X-ray of the affected upper limb shows a fracture of the upper ulna with dislocation of the radial head. Which of the following would be the most appropriate term to describe this fracture?
Colles
fracture
Galeazzi
fracture
Monteggia
fracture
Smith fracture
Question 27
A 24 year old man presents with a 3 month history of episodes of painless, bright red rectal bleeding on straining at stool. He has noticed some blood in the bowl, separate from the stool & some on the paper after wiping. What is the likely cause of this bleeding?
IBD
Colorectal cancer
Haemorrhoids
Anal fissure
Slide29Question 28
A 56 year old lady presents with rigors and abdominal pain. Her husband tells you that she has become extremely confused. On examination, she is jaundiced, her temperature is 38 degrees
celsius
, her blood pressure is 87/50, and her HR is 110. What is the most likely underlying cause?
Hepatitis
Pancreatitis
Acute
cholecystitis
Ascending cholangitis
Slide30Question 29
A 60 year old gentleman presents to his GP complaining of back pain and loose, foul smelling, whitish stools. The GP notices that his breath smells of alcohol. What is the most likely cause?
Coeliac disease
Mechanical back pain
Chronic pancreatitis
Pancreatic cancer of head
Slide31Question 30
A 76 year old lady with a 10 year history of regurgitation and heartburn finally presents to her GP because she is now having some difficulty in swallowing. On endoscopy, a biopsy is taken of the lower
oesophagus
, which shows the presence of columnar cells but nothing else. What is the most likely cause of her swallowing difficulty?
Adenocarcinoma of
oesophagus
Oesophageal
stricture
Squamous cell carcinoma of
oesophagus
Barrett’s
oesophagus
Slide32END