quiz 2

A 67-year-old man with chest pain that started 30 minutes ago presents to the emergency department. There is radiation to the jaw and the patient says that 'it feels like an elephant is sitting' on their chest.His heart rate is 108 bpm, his blood pressure is 137/75 mmHg, and he is afebrile. He is diaphoretic and visibly in pain. An ECG is obtained:

• left anterior descending a. only

• r coronary and left anterior descending a.

• right coronary a. and left circumflex a.

• right coronary a. only

• right coronary, left anterior descending, left circumflex

A 78-year-old man visits his GP with his wife.She tells you he has been very forgetful over the past 2 months and is concerned about some inappropriate comments he has made, which is out of character. He has also had multiple falls and two admissions to hospital recently with falls.He has a background of hypertension and usually takes ramipril 10mg. The GP measures lying blood pressure at 160/78 mmHg and standing blood pressure at 117/60 mmHg.On examination, you note he has bradykinesia of movement, a pill-rolling left-sided tremor and cogwheel rigidity of his left arm. His pupils are equal and reactive to light but he can't look upwards. What is the most likely diagnosis?

• drug-induced parkinsonism

• lewy-body dementia

• motor neurone disease

• multiple system atrophy

• progressive supra nuclear palsy

A 35-year-old man is admitted with an episode of collapse and passage of malaena. He has been suffering from post prandial abdominal pain for 5 weeks and this is most marked several hours after eating. What is the most likely cause?

• duodenal ulcer

• oesophageal varices

• diverticulitis

• dieulafoy lesion

A 61-year-old man presents with a chronic cough. His past medical history includes hypertension and gout. He is due to retire shortly from his job as a sewage worker. He drinks around 50 units of alcohol a week and smokes 20 cigarettes per day. A chest x-ray is ordered:

• lung abscess

• tuberculosis

• aspiration pneumonia

• lung cancer

A 75 year old Chinese woman had an anterior resection (large bowel operation) 4 days ago. She develops fever, abdominal pain and has not opened her bowels since surgery. She has an intravenous cannula in her forearm and one in her foot. She also has an indwelling urinary catheter. Her heart rate is 130 beats per minute, her blood pressure has fallen to 90/50 mmHg, and her temperature is 38.3°C. She is breathing rapidly. You are the on call junior doctor and are asked to review her.

It is 9pm at night and clinically she has peritonism, is distressed and speaking incomprehensible statements in Cantonese. What is the first thing that you should do?

• Give her strong pain relief and reassess in 15 min

• Call for help – send out an emergency MET (Medical Emergency Team) call

• Take two sets of blood cultures to identify the cause of her symptoms.

• Try to calm her down and ask for a repeat of vital signs in 20 mins to see if they improve.

An 8-year-old boy presents with his mother to the GP practice with a red macular rash covering his trunk and back. He has been feeling lethargic for the last two weeks. His mother recalls seeing a larger patch appear on his back initially a week ago, which was then followed by smaller red macules elsewhere on his trunk. His observations are all normal. What is the most likely diagnosis?

• meningococcal septicaemia

• scarlet fever

• chicken pox

• pityriasis rosea

• measles

A 70-year-old man had been referred to clinic with progressive dysphagia and weight loss. His past medical history includes gastro-oesophageal reflux disease (GORD) for the past 5 years. He is a smoker with 10 pack-year history and drinks 20 units of alcohol weekly. An upper GI endoscopy reveals columnar epithelium in the gastro-esophageal junction and biopsy demonstrates high grade dysplasia. What is the most appropriate management?

• Endoscopic mucosal resection

• routine endoscopic surveillance

• presribe a proton pump inhibitor to manage symptoms of GORD

• initiate palliative care

• repeat biopsy after 6 months

A 65-year-old man presents to his general practitioner with pain in his hands, which is worse with activity and at the end of the day. He has a past medical history of psoriasis. He does not take any regular medications.

On examination, there were bony tender swellings of 3 distal interphalangeal (DIP) joints on both hands. 

What is the likely diagnosis?

• osteoarthritis

• psoriatic arthritis

• reactive arthritis

• rheumatoid arthritis

• systemic lupus erythematosus

A 55-year-old man with a history of gallstone disease presents with a two day history of pain in the right upper quadrant. He feels 'like I have flu' and his wife reports he has had a fever for the past day. On examination his temperature is 38.1ºC, blood pressure 100/60 mmHg, pulse 102/min and he is tender in the right upper quadrant. His sclera have a yellow-tinge. What is the most likely diagnosis?

• pancreatic cancer

• biliary colic

• ascending cholangitis

• acute cholecystitis

• acute viral hepatitis

A 65-year-old woman attends her GP clinic, complaining of several weeks of rash and itching. She feels well otherwise and has no other symptoms. She has a past medical history of hypertension, myocardial infarction and type 2 diabetes mellitus. Her drug history includes amlodipine, losartan, aspirin, bisoprolol and metformin.

On examination, there is a widespread urticarial rash.

Which of her medications is the most likely cause?

• amlodipine

• aspirin

• bisoprolol

• losartan

• metformin