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Single best answer (SBA) questions
5. A 76-year-old retired accountant presents with a
change in bowel habit, tenesmus and weight loss. A
colonoscopy is done and shows a carcinoma of the
colon. Which one of the following statements is true
about colorectal cancer?
A. Most occur in patients with a strong family
history.
B. The cancer is likely to be in the ascending
colon.
C. Right-sided tumours usually present earlier.
D. It may present with an iron-deficiency anaemia
alone.
E. Only a minority of tumours can be resected
surgically.
6. An 87-year-old woman was admitted for severe
pneumonia and treated with a broad-spectrum
β-lactamase. On the 10th day after her admission
she develops perfuse diarrhoea with cramping
abdominal pain. A diagnosis of pseudomembranous
colitis is made after further investigation. Which one
of the following statements is true?
A. Is caused by Clostridium difficile itself.
B. It can be prevented by use of alcohol hand gel
after each patient contact.
C. It is diagnosed by demonstration of an
erythematous, ulcerated mucosa covered by a
membrane on sigmoidoscopy.
D. It may be complicated by toxic dilatation of the
colon.
E. It is treated with intravenously administered
metronidazole in first instance.
7. A 22-year-old female medical student registers
with a new GP. On her health questionnaire she
states that she has received a diagnosis of irritable
bowel syndrome (IBS). Which one of the following
statements about IBS is true?
A. The condition is rare.
B. The condition is more common in males.
C. It may present with rectal bleeding.
D. It is a diagnosis of exclusion.
E. It is usually treated with 100% success.
8. A 49-year-old mother of two presents to the
emergency department with right upper quadrant
(RUQ) pain and fever. On examination she is tender
in the RUQ but not jaundiced. The emergency
department doctor suspects she has cholecystitis
secondary to gallstones. Which one of the following
statements about gallstone disease is true?
A. Most are radio-opaque.
B. They are often asymptomatic.
C. Their incidence decreases with age.
D. They cannot cause bowel obstruction.
E. Charcot triad is diagnostic of cholecystitis.
9. Which one of the following may be said of viral
hepatitis?
A. Hepatitis A may cause chronic hepatitis.
B. Hepatitis B is transmitted via the faecal–oral route.
C. Chronic hepatitis B infection may be complicated
by hepatocellular carcinoma.
D. Hepatitis C causes acute hepatic failure.
E. Hepatitis E is not transmitted via the faecal–oral
route.
10. Which of the following is the classic appearance of
the stool in intussusception?
A. Fatty stool.
B. Melaena.
C. Putty-coloured stool.
D. Redcurrant jelly stool.
E. Watery stool.
11. A 53-year-old woman with a previous diagnosis of
autoimmune hepatitis and cirrhosis is seen in the
acute medical assessment unit after being referred
by her GP for increasing abdominal distension. On
examination her body weight is 110 kg and she has
bilateral pitting oedema up to her knees. She is not
jaundiced. Shifting dullness is elicited on examination
of the abdomen. Which one of the following is
the greatest contributing mechanism to the fluid
retention in this patient?
A. Increased sodium absorption in the renal tubules.
B. Inferior vena cava obstruction.
C. Lymphatic obstruction.
D. Portal hypertension.
E. Hypoalbuminaemia.
12. A 45-year-old man presents to the emergency
department with central abdominal pain radiating
to the back, associated with nausea and vomiting.
He has been unable to eat or drink for the past 48
hours. He looks unwell. He has a history of alcohol
abuse, depression and hypertension. You suspect
acute pancreatitis. What is the initial management?
A. Book an MRCP to confirm your suspicion that
the cause of pancreatitis is gallstones.
B. Admit the patient, commence administration
of intravenous fluids, replace electrolytes,
offer analgesia and refer the patient to the
gastroenterology team.
C. Admit the patient, commence administration
of intravenous fluids, replace electrolytes, offer
analgesia and refer the patient to the surgical
team.
D. Rehydrate the patient, replace electrolytes if
necessary and send the patient home with a
course of oral antibiotics with an outpatient clinic
follow up.
E. None of the above.
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Single best answer (SBA) questions
13. A 38-year-old intravenous drug user presents with
jaundice. Blood tests reveal deranged liver function
test values. As part of the investigations, viral serology
is requested. The results are as follows: anti-HBc
positive, HBsAg negative, HCV antibody positive.
What is the interpretation of the results?
A. The patient has acute hepatitis B infection.
B. The patient has acute hepatitis C infection.
C. The patient is a carrier for hepatitis B.
D. The patient is a carrier for hepatitis C.
E. The patient has been vaccinated against
hepatitis B and hepatitis C.
14. A patient with known ascites secondary to alcoholic
liver disease presents with abdominal pain, tightness
and distension. On examination the patient appears
well and is warm and well perfused with a blood
pressure of 108/80 mmHg and a pulse rate of 78.
Peripheral stigmata of chronic liver disease are visible.
Her abdomen is distended with mild generalized
tenderness on palpation. Shifting dullness is present.
Blood tests show no acute abnormalities. You
decide that pharmacological management should be
commenced. What is the best drug for this patient?
A. Co-amoxiclav.
B. Propranolol.
C. Furosemide.
D. Spironolactone.
E. Piperacillin and tazobactam (Tazocin).
15. A 40-year-old man presents with central abdominal
pain radiating to the back. The pain is associated
with nausea but no vomiting. Blood tests reveal
raised levels of inflammatory markers, but are
otherwise within normal range. Urine dip is negative.
On further questioning he admits to having had
several episodes of bloody stools in the past week.
Which is the least likely diagnosis?
A. Abdominal aortic aneurysm.
B. Pancreatitis.
C. Diverticulitis.
D. Diabetic ketoacidosis.
E. Colorectal cancer.
16. A 20-year-old woman presents to the emergency
department with a 4-day history of diarrhoea. She
has been unable to eat and drink normally. There is
no history of vomiting. Her observations are within
normal limits. What is the most likely metabolic
abnormality found on an arterial blood gas test?
A. Metabolic alkalosis.
B. Normal anion gap metabolic acidosis.
C. Mixed alkalosis.
D. Metabolic acidosis with respiratory
compensation.
E. Raised anion gap metabolic acidosis.
Chapter30 Renal, genitourinary and sexual
health medicine
1. A 62-year -old man has an AKI in relation to
diarrhoea and vomiting. He has a background
of hypertension, and takes ramipril regularly. On
admission he is hypovolaemic and anuric. Which
one of the following conditions is an indication for
emergency haemodialysis/haemofiltration in AKI?
A. Anuria.
B. Serum creatinine level greater than 500 μmol/L
(reference range 80–120 μmol/L).
C. Bicarbonate level less than 20 mmol/L (reference
range 22–28 mmol/L).
D. Potassium level greater than 6.5 mmol/L
(reference range 3.5–5.0 mmol/L) despite
medical therapy.
E. Urea level greater than 30 mmol/L (reference
range 2.5–5.0 mmol/L)
2. A 62-year-old diabetic man is admitted with urinary
sepsis. On routine blood tests he is found to have
a serum potassium level of 6.4 mmol/L (reference
range 3.5–5.0 mmol/L). An EKG is performed. Which
one of the following changes would you most expect
to see?
A. Tented T waves.
B. Absent P waves.
C. Broad QRS complexes.
D. U waves.
E. Sinusoidal waveform.
3. A 5-year-old boy presents with a pale puffy face and
swollen legs. There is generalized oedema on clinical
examination. Which of the following best defines the
triad of the nephrotic syndrome.?
A. Low serum albumin level, PCR greater than
300 mg/mmol and peripheral oedema.
B. Haematuria, proteinuria (>3 g in 24 hours) and
low serum albumin level.
C. Low serum albumin level, proteinuria (>3g in 24
hours) and high serum cholesterol level.
D. Low serum albumin level, more than 3 g protein
in a 24-hour urine collection and increased risk
of infection
E. Low serum albumin level, PCR greater
than 300 mg/mmol and increased risk of
thromboembolism
4. A 59-year-old woman is being investigated for an
AKI with an active urinary sediment, blood and
protein on urine analysis. She mentions to you
that she had an episode of haemoptysis. Which of
the following is the most important blood test to
perform?
A. Anti-streptolysin O titre.
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Single best answer (SBA) questions
B. Complements.
C. CRP.
D. Antinuclear antibodies.
E. ANCA.
5. A 70-year-old old man presents with a creatinine
level of 300 μmol/L (reference range 80–110 μmol/L).
Which one of the following would make you think
that he has CKD?
A. His eGFR is 18 ml/min/1.73 m2 (i.e., stage IV CKD).
B. He is anaemic.
C. He has small scarred kidneys on ultrasound scan.
D. His prostate is enlarged, with a large bladder
and hydronephrosis.
E. He has a monoclonal band on electrophoresis.
6. Which one of the following statements is correct with
respect to CKD?
A. Hypertension is a rare cause.
B. Patients with proteinuria do better.
C. Lowering the blood pressure is dangerous.
D. Microcytic anaemia is a feature.
E. Dietary phosphate must be decreased.
7. An 18-year-old girl presents with rigors, lower
abdominal pain and urinary frequency. Which of the
following is the best first test?
A. Dimercaptosuccinic acid scan.
B. Blood cultures and urine microscopy and culture
(midstream urine).
C. Urine β-human chorionic gonadotropin
(pregnancy test).
D. Abdominal X-ray.
E. Full blood count.
8. Which statement regarding UTIs is true?
A. They are more common in females.
B. They affect 5% of the female population at least
once.
C. They are always symptomatic.
D. They are less common in catheterized patients.
E. They rarely ascend to involve the kidneys.
9. A 32-year-old man has a rotator cuff repair under a
general anaesthetic as a day case. Routine blood
tests and urine dip gave unremarkable results during
preoperative assessment. He is discharged after
an uncomplicated operation with paracetamol and
indomethacin for pain. He presents 2weeks later to
his GP with significant bilateral ankle oedema. On
examination his blood pressure is 125/72 mmHg.
Urine dipstick reveals 3+ protein, but no haematuria.
His plasma creatinine level is 65 mmol/L (normal).
What is the most likely diagnosis?
A. Membranous nephropathy.
B. Acute tubular necrosis.
C. Interstitial nephritis.
D. Lupus nephritis.
E. FSGS
Chapter31 Fluid balance and electrolyte
disturbances
1. A 58-year-old man presents with polyuria,
dehydration and abdominal pain. Blood tests reveal
corrected calcium level of 3.2 mmol/L (reference range
2.2–2.6 mmol/L). Which of the following is correct?
A. Sarcoidosis is a cause of hypercalcaemia.
B. Treatment with bisphosphonates is urgently
required.
C. If the calcium level returns to normal with
treatment, no further investigation is needed on
this occasion.
D. Protein-bound calcium is the relevant value.
E. Malignancy is a rare cause.
2. A 30-year-old man is hospital for an elective
cholecystectomy and is nil by mouth, he is
desperately trying to find water to drink and is
aggressive. He has a background of schizophrenia
and has been taking lithium. In the patient’s notes
you read that he complains of being very thirsty
and has been passing high volumes of urine. His
blood rest results come back, and you see that his
sodium level is 150 mmol/L. What is the most likely
diagnosis?
A. Conn syndrome.
B. Addison disease.
C. Diabetes insipidus.
D. Cushing disease.
E. Ingestion of sodium chloride tablets.
3. A 70-year old woman is admitted to hospital
with a urinary infection. She has a background of
hypertension and mild cognitive impairment, and
normally lives in a residential home. Her blood
test results come back showing a sodium level of
123 mmol/L (reference range 135–145 mmol/L). From
her routine blood test results at her GP practice, her
sodium levels are between 130 and 132 mmol/L.
Your senior house officer says this is a syndrome
of inappropriate secretion of antidiuretic hormone
(SIADH). How would you diagnose this condition?
A. Paired serum and urine osmolality and urinary
sodium tests.
B. Fluid deprivation test.
C. Trial of fluid restriction to see if this increases the
sodium level.
D. Do a cortisol level test, followed by a
dexamethasone suppression test.
E. Do a random cortisol level test, followed by a
short Synacthen test.
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Single best answer (SBA) questions
4. A 65-year-old woman goes to her general
practitioner feeling fatigued and reports feeling
forgetful. She has a background of hypertension,
hypothyroidism, mild depression and peptic ulcer
disease. Her medications include bisoprolol,
bendroflumethiazide, levothyroxine omeprazole
and citalopram. Her blood test results show that
her sodium level is 128 mmol/L. Which medication
would be the most likely causative agent?
A. Bisoprolol.
B. Bendroflumethiazide.
C. Levothyroxine.
D. Omeprazole.
E. Citalopram.
5. A 30-year-old woman with depression and anxiety
presents to her general practitioner (GP) with
fatigue and muscle weakness. The GP finds that
her body mass index is extremely low at 18 kg/m2.
On further questioning, she reports than she has
been making herself vomit. Her blood test results
show a potassium level of 2.6 mmol/L. Which of
the following symptoms could be attributed to her
hypokalaemia?
A. Abdominal pain.
B. Polyuria.
C. Urinary tract infections.
D. Seizures.
E. Perioral numbness.
6. A 60-year-old woman had a parathyroidectomy for
hyperparathyroidism. She is back on the ward after
surgery and you have been asked to monitor her
calcium level every 4 hours and replace calcium
as necessary. The calcium result comes back with
a corrected calcium reading of 1.6 mmol/L. You
perform an electrocardiogram. What features of
hypocalcaemia would you be looking for?
A. Peaked T waves.
B. Delta waves.
C. Sinusoidal QRS complex
D. Prolonged QT interval.
E. J waves.
Chapter32 Nervous system
1. A 63-year-old woman presents 2 hours after sudden
onset right-sided weakness. She takes warfarin
for atrial fibrillation. Which one of the following
statements is correct?
A. Imaging of the brain should be done within the
next 24 hours but is not urgent.
B. If the CT scan shows haemorrhage, the effects of
warfarin should be reversed with cryoprecipitate.
C. Because she takes warfarin, the stroke is
definitely haemorrhagic.
D. Haemorrhage is the most common cause of
stroke.
E. Facial weakness in stroke usually spares the
forehead.
2. A 26-year-old man presents with a severe,
throbbing, unilateral headache preceded by
odd visual symptoms. It is worsened by loud
noises, bright light or moving around. He is
afebrile. Which one of the following statements is
correct?
A. The most likely diagnosis is meningitis.
B. Subarachnoid haemorrhage (SAH) commonly
has visual warning symptoms.
C. A triptan is a suitable treatment in this case.
D. Acute migraine headache can be treated with
β-blockers
E. Patients with cluster headache typically avoid
movement.
3. You see a 55-year-old man in the clinic who has
noticed a gradually worsening, low-frequency tremor
in his right hand over the last 6months. Which one
of the following statements is true?
A. Parkinson disease (PD) is usually symmetrical in
onset.
B. The tremor of PD is more noticeable at rest.
C. l-DOPA is definitely the best treatment for this
patient.
D. A radioiodine scan is necessary to make the
diagnosis in this case.
E. Rigidity is an uncommon feature.
4. You see a 23-year-old woman in the clinic. She
experienced an episode of visual blurring in her
right eye, associated with pain on movement, which
came on over hours but her vision has improved
over the last month. Which one of the following
statements is correct?
A. This is definitely multiple sclerosis (MS).
B. It is unusual to get MS at this age.
C. Night vision is likely to be most affected.
D. If there are lesions on MRI, her risk of developing
MS is higher.
E. Vision only improves in a minority of patients.
5. A 19-year-old male student is admitted with
confusion, fever, photophobia and a purpuric rash.
His friends say he was complaining of a severe
headache and has vomited. Which one of the
following is correct?
A. Streptococcus is the most likely causative
organism.
B. The diagnosis should be confirmed with blood
cultures before treatment.
C. Listeria is a common cause in young adults.
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Single best answer (SBA) questions
D. Lumbar puncture should be performed
immediately.
E. He should be treated urgently with intravenous
antibiotics.
6. Which one of the following statements is correct
regarding raised intracranial pressure (ICP)?
A. The headache is worse at the end of the day.
B. Tachycardia is part of the Cushing reflex.
C. Papilloedema is not caused by raised ICP.
D. Sixth nerve palsy is a feature.
E. Abdominal pain is a feature.
7. A 64-year-old woman presents with progressive
weakness that started in her legs. She has noticed
'flickering' of her muscles. Which one of the following
is correct regarding motor neurone disease (MND)?
A. It is more common in women.
B. It commonly causes sensory problems as well as
motor problems.
C. It may present with diplopia.
D. The 5-year survival rate is almost 75%.
E. It may cause a mixture of upper and lower motor
neurone symptoms.
8. A 45-year-old man presents following a severe
sudden onset headache that occurred during
exercise. CT scan shows blood in the subarachnoid
space. Which one of the following statements is
correct regarding this condition?
A. Mortality is low.
B. Most are preceded by a 'sentinel headache'.
C. Reduced consciousness following initial
improvement may be due to hydrocephalus.
D. He should be given β-blockers.
E. Fluid intake should be restricted.
B. Jerking or twitching is never seen in vasovagal
syncope.
C. An EKG is unlikely to be helpful in determining
the cause.
D. Biting the tip of the tongue suggests a seizure.
E. Syncope on exertion suggests a cardiac cause.
11. A 32-year-old man presents to his GP with a few
months’ history of involuntary movements of both
upper and lower limbs and the face. He recalls that his
mother told him that his father had similar problems but
unfortunately he died in his early 40s, when the patient
was young. What should the GP advise the patient?
A. This is most likely a space-occupying lesion, and
an urgent CT scan of the head is required.
B. He most likely has Sydenham chorea. Treatment
with penicillin should be started. The condition
rarely leads to long-standing complications.
C. The patient has an autosomal dominant disorder,
likely Huntington disease. An urgent referral to
the neurology clinic is necessary.
D. Blood samples should be sent to the laboratory
to investigate the presence of low levels of
ceruloplasmin, indicating Wilson disease.
E. Use of haloperidol, which the patient takes for
schizophrenia, should be stopped.
12. From the list below choose the most appropriate
first-line drug for a 65-year-old man with Parkinson
disease (PD). He is complaining of resting tremor
and rigidity.
A. Ropinirole.
B. Selegiline.
C. Carbidopa.
D. l-DOPA.
E. Propranolol.
9. A 44-year-old woman presents with symptoms of
raised intracranial pressure. MRI scan reveals a
solitary lesion. Which one of the following statements
is correct regarding intracerebral tumours?
A. Primary tumours are more common than
secondary tumours.
B. If primary tumour is suspected, MRI is sufficient
to determine the type of tumour.
C. Meningiomas may be cured with surgical
resection.
D. Glioblastomas are indolent tumours with a good
prognosis.
E. Breast cancer rarely metastasizes to the brain.
10. A 64-year-old man presents following a 'blackout'.
Which one of the following statements is correct
regarding the cause?
A. Seizure is probable if urinary incontinence
occurred.
402
13. A 56-year-old man is brought to the emergency
department after being involved in a road traffic
accident. He opens his eyes and attempts to
withdraw when you perform a trapezius squeeze.
His speech is unclear, and he makes only
incomprehensible sounds. What is his Glasgow
Coma Scale score?
A. 6.
B. 7.
C. 8.
D. 9.
E. 10.
14. Which is not a feature of pseudobulbar palsy?
A. Brisk jaw jerk.
B. Tongue spasticity.
C. Dysphagia.
D. Dysarthria.
E. Tongue wasting and fasciculations.
Single best answer (SBA) questions
15. A 60-year-old woman presents to her GP with a
3-month history of muscle weakness and a rash
affecting her hands and eyelids. Examination reveals
erythematous papules over the metacarpal and
interphalangeal joints, heliotrope rash over the face
and proximal muscle weakness. What is the most
likely diagnosis?
A. Dermatomyositis.
B. Myasthenia gravis.
C. SLE.
D. Vitamin B12 deficiency.
E. Guillain–Barré syndrome.
Chapter33 Metabolic and endocrine
systems
1. A 55-year-old man goes to his general practitioner
and is tested for diabetes. Which one of the
following allows a diagnosis of diabetes to be made?
A. Fasting plasma glucose level of 6.0 mmol/L.
B. Random glucose level of 10.9 mmol/L.
C. Random glucose level of 11.2 mmol/L and polyuria.
D. Fasting glucose level of 6.9 mmol/L and 2-hour
glucose level of 10.4 mmol/L.
E. Fasting glucose level of 6.6 mmol/L and 2-hour
glucose level of 7.5 mmol/L.
C. Hypocalcaemia is seen on testing.
D. A T score of −2.0 is diagnostic.
E. The prevalence is around 25% in White women
aged 80years or older.
5. A 58-year-old man presents with polyuria,
dehydration and abdominal pain. Blood tests reveal
a calcium level of 3.2 mmol/L. Which one of the
following is correct?
A. Sarcoidosis is a cause of hypercalcaemia.
B. Treatment with bisphosphonates is urgently
required.
C. If the calcium level returns to normal with treatment,
no further investigation is needed on this occasion.
D. Protein-bound calcium level is the relevant value.
E. Malignancy is a rare cause.
6. A 42-year-old man comes to see you because his
family are concerned his appearance has changed.
He has experienced headaches over the last year.
Which one of the following is a feature of acromegaly?
A. Increased interdental spacing.
B. Homonymous hemianopia.
C. Retrognathism.
D. Hypergonadism.
E. Hypoglycaemia.
2. A 17-year-old woman with diabetes is found
unconscious by her mother following a chest
infection. Which one of the following is correct
regarding diabetic ketoacidosis (DKA)?
A. Insulin replacement should be the first treatment.
B. In young patients there is no need to worry
about fluid overload.
C. Hypoventilation is typical.
D. Antibiotics are often required.
E. Raised blood glucose level and clinical signs are
sufficient for the diagnosis.
3. Which one of the following is correct regarding the
long-term treatment of diabetes?
A. Type 1 diabetes can often be managed with oral
medication.
B. The aim should be an HbA1c fraction below 10%.
C. Sulphonylureas are the first choice in overweight
patients.
D. Metformin is contraindicated in renal failure.
E. Once-daily subcutaneous insulin administration
is the treatment of choice for type 1 diabetes.
4. A 66-year-old woman who takes low-dose steroids
long-term for rheumatoid arthritis sustains a Colles
fracture. Which one of the following statements is
correct regarding osteoporosis?
A. It is frequently painful.
B. It is less common in women.
7. A 60-year-old British woman with a background
of vitiligo and diabetes complains of constipation,
weight gain and constantly feeling cold. Which is the
most likely cause of her hypothyroidism?
A. An iatrogenic cause; following radioactive
treatment for hyperthyroidism.
B. Iodine deficiency.
C. Hashimoto thyroiditis.
D. Graves disease.
E. Pituitary adenoma.
8. Which one of the following statements is correct
regarding Addison disease?
A. Most cases in the developed world are due to
infection.
B. Blood tests demonstrating hyponatraemia
and hyperkalaemia would be consistent with
Addison’s disease.
C. Diagnosis is usually made with a random cortisol
measurement.
D. Aldosterone replacement with fludrocortisone is
the most important treatment in Addisonian crisis.
E. Hypopigmentation is common.
9. A 37-year-old woman presents with tremor,
palpitations and loose stools. Which one of the
following may be seen in thyrotoxicosis of any cause?
A. Atrial fibrillation.
B. Pretibial myxoedema.
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Single best answer (SBA) questions
C. Finger clubbing.
D. Menorrhagia.
E. Bilateral proptosis.
10. Which one of the following hormones is secreted by
the posterior pituitary?
A. Thyroid-stimulating hormone (TSH).
B. Adrenocorticotrophic hormone (ACTH).
C. Growth hormone GH).
D. Antidiuretic hormone (ADH).
E. Prolactin.
Chapter34 Musculoskeletal system
1. A 25-year-old woman presents with increasing joint
pain. Clinical examination reveals swollen tender
distal interphalangeal (DIP) joints, pitting in her nails
and swollen toes. Her spinal movements are also
restricted. She also describes episodes of bloody
diarrhoea and weight loss over the past year. What
is most likely causing her joint pains?
A. Rheumatoid arthritis.
B. Systemic lupus erythematosus.
C. Reactive arthritis.
D. Psoriatic arthritis.
E. Fibromyalgia.
2. A 30-year-old woman with known seropositive
(20 mg weekly) and is doing well. She is keen to
start a family. What is the best advice regarding her
current treatment?
A. Stop use of methotrexate and start use of
cyclosporine.
B. Reduce the dose of methotrexate.
C. Continue with use of methotrexate and add oral
steroids.
D. Stop use of methotrexate and start use of
leflunomide.
E. Stop use of methotrexate and give oral steroids
if necessary for disease flares.
3. A 60-year-old teacher presents with widespread
joint pain. Her hands are particularly painful,
notably small joints in her fingers and the joint at
the base of her thumb. Her wrist is also painful,
and she has a scar from Colles fracture repair
20years ago. She also describes left groin and
knee pain when walking and low back pain. Which
of the following joints are not affected by primary
osteoarthritis (OA)?
A. Wrist.
B. Metatarsophalangeal (MTP) joints.
C. Distal interphalangeal (DIP) joints.
D. Carpometacarpal joints.
E. Hip.
4. A 65-year-old woman with known rheumatoid
arthritis (RA) presents to the clinic with her daughter.
She is doing well, with no inflammation, and leads
an active life. She has been maintained with the
same therapy for more than 20years. Her daughter
reports that over the past year she has developed
a blue-grey discolouration on her face that has
become more noticeable. Otherwise, she is well,
with no other side effects. She attends her GP
practice for regular blood monitoring, the results
of which have been satisfactory. Which of the
following DMARDs could be responsible for her skin
discolouration?
A. Salazopyrin.
B. Intramuscularly (IM) administered gold.
C. Methotrexate.
D. Leflunomide.
E. Azathioprine.
5. A 25-year-old teacher presents with
haemoptysis. She also has a vasculitic rash on her
legs, where some areas are coalescing and forming
ulcers. She has a background of sinusitis for the
past few years. Her ESR is 100 mm/h. She has
moderate proteinuria on dipstick urinalysis. A chest
X-ray shows multiple focal opacities in the lungs.
An autoimmune screen shows a negative result
for ANA, a negative result for anti-double-stranded
DNA, a negative result for rheumatoid factor but
a positive result for cytoplasmic antineutrophil
cytoplasmic antibodies (ANCAs). What is the most
likely diagnosis?
A. Polymyalgia rheumatica (PMR).
B. Granulomatosis with polyangiitis.
C. Microscopic polyangiitis.
D. Kawasaki disease.
E. Eosinophilic granulomatosis with polyangiitis.
Chapter35 Skin disease
1. A young woman develops a red scaly rash on her
nose and cheeks with arthralgia and fever while on
holiday. On her return, she has chest pain caused
by pericarditis. Pancytopenia and proteinuria are
discovered. What is the likely diagnosis?
A. Acute leukaemia.
B. Systemic lupus erythematosus.
C. Sarcoidosis.
D. Acute rheumatic fever.
E. Lyme disease.
2. A 50-year-old man develops weakness of his
legs (examination shows proximal myopathy), an
erythematous rash over his knuckles and purple
discolouration around his eyes. He complains of
difficulty in swallowing, and initial blood tests show
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Single best answer (SBA) questions
his creatine kinase level to be more than 3000 IU/L.
What is the most likely diagnosis?
A. Polymyalgia rheumatica.
B. Osteomalacia.
C. Multiple sclerosis.
D. Dermatomyositis.
E. McArdle syndrome.
3. A 40-year-old man finds it difficult to stand from a
squatting position, and develops acne, headaches,
truncal obesity and a very thin skin with purpura.
Investigations show elevated blood glucose level.
What is the most likely diagnosis?
A. Reiter syndrome.
B. Cushing syndrome.
C. Hyperthyroidism.
D. Diabetes mellitus.
E. Granulomatosis with polyangiitis.
4. A 24-year-old man presents to the emergency
department with arthralgia and syncope. He has a
complete heart block on his electrocardiogram. He
returned from a camping trip a few months ago,
where he developed round, indurated, erythematous
lesions on his legs. What is the most likely cause of
his symptoms?
A. Lyme disease.
B. Tuberculosis.
C. Systemic lupus erythematosus.
D. Adrenal tumour.
E. Granuloma annulare.
5. A 14-year-old male adolescent presents to the
emergency department with a purpuric rash on
his buttocks and legs. Initially, he describes lesions
that began as erythematous macules. He also has
bloody diarrhoea, and a urine dipstick test reveals
proteinuria and haematuria. He had a viral cold
1week ago. Given the most likely diagnosis, what is
the most likely outcome?
A. Full recovery.
B. Chronic kidney disease.
C. Acute kidney failure without full recovery.
D. Recurring episodes.
E. Steroid treatment followed by full recovery.
Chapter36 Haematological disorders
1. A patient with sickle cell anaemia and chronic joint
hands that she describes as 10 out of 10. Which
one of the following would confirm the patient is
experiencing vasoocclusive crisis rather than her
usual arthritic pain and will alter the management?
A. Haemoglobin (Hb) level.
B. Reticulocyte count.
C. Hb electrophoresis.
D. Sickle cell solubility.
E. None of the above.
2. Which one of the following best describes the
pattern of incidence of acute lymphoblastic
leukaemia (ALL)?
A. Peak in the first year of life followed by
secondary rise at the age of 10years and then
gradual decline through adulthood.
B. Peak in first 2–5years of life, less common with
increasing age but gradual rise after the age of
60years.
C. Peak in the first 10years with secondary peak at
the age of 50years.
D. Stable but high incidence in the first 18years
followed by gradual increase in adulthood.
E. Peak incidence after the age of 50years.
3. A 55-year old man has been complaining of fatigue
and right upper quadrant pain to his GP. After
ordering a blood film test, the general practitioner
(GP) explains to the patient that there may be a
problem with his liver. Which of the following did the
GP most likely notice on the blood film results?
A. Pencil cell.
B. Schistocytes.
C. Basophilic stippling.
D. Bite cells.
E. Acanthocytes.
4. A 35-year-old woman with family in Greece is found
to have hypochromic microcytic anaemia with target
cells. On investigation, her ferritin and iron levels are
at the higher end of normal and her HbA2 level is
5%. What is the most likely diagnosis?
A. β-Thalassaemia.
B. α-Thalassaemia.
C. Sideroblastic anaemia.
D. Iron-deficiency anaemia.
E. Anaemia of chronic disease.
5. A 20-year-old woman undergoes minor surgery
involving incision and drainage of an abscess and
bleeds profusely. On her preoperative blood test
results, you notice a prolonged activated partial
thromboplastin time (APTT) and normal bleeding time
and prothrombin time (PT). When you take her history,
she mentions that as a child she used to bruise very
easily. What is the likely cause of her symptoms?
A. Von Willebrand disease (vWD).
B. Disseminated intravascular coagulation.
C. Haemophilia B.
D. Thrombocytopenia.
E. Liver disease.
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Single best answer (SBA) questions
Chapter37 Infectious diseases
1. A 65-year-old man has had a knee joint
replacement. After 2weeks, a purulent discharge
occurs, which grows methicillin-resistant
Staphylococcus aureus (MRSA). Which antibiotic
therapy is advised?
A. Nafcillin
B. Vancomycin
C. Cefuroxime
D. Gentamicin
E. Tetracycline
2. A young woman presents with a 2-day history of
a headache, fever but no neck stiffness or focal
neurological signs. She has widespread purpura
over the trunk and limbs. She is gravely ill. What
investigation is most helpful?
A. Lumbar puncture
B. Blood culture
C. Full blood count
D. Fibrin degradation products
E. Plasma cortisol levels.
3. A 45-year-old man is known to be HIV positive.
He was recently found to have mediastinal and
retroperitoneal masses on CT scan. He also
complains of weight loss, sweats and fevers. What is
the most likely cause of his symptoms?
A. T-cell lymphoma
B. Tuberculosis (TB)
C. Myeloma
D. Sarcoidosis
E. Metastatic colon cancer
4. A 23-year-old woman with a known diagnosis of
psychosis visits your general practitioner practice
to seek antimalarial medication for her trip to
Africa. Which medication would you not consider
prescribing in this case?
A. Quinine
B. Mefloquine
C. Doxycycline
D. DEET
E. Chloroquine
5. A 35-year-old with advanced AIDS is admitted
to hospital with high temperature. Blood cultures
are performed, and you receive a call from the
microbiology department that they are growing
mycobacteria. Which one is the most likely?
A. Mycobacterium leprae
B. Mycobacterium avium
C. Mycobacterium kansasii
D. Mycobacterium marinum
E. Mycobacterium bovis
Chapter38 Drug overdose and abuse
1. A 55-year-old man presents sweaty, tachycardic
and tachypnoeic. He is drowsy and complaining
of tinnitus. An arterial blood gas test is done and
shows a metabolic acidosis with hypokalemia.
Overdose of which one of the following drugs is
most likely?
A. Aspirin
B. Tricyclic antidepressant
C. Benzodiazepine
D. Opiates
E. Digoxin
2. A 35-year-old woman has taken an unknown mixed
overdose, staggered over the last 8 hours. Which of
the following is the best management plan?
A. Gastric lavage, administer activated charcoal,
attach the patient to a cardiac monitor and send
blood samples to the biochemistry laboratory for
measurement of paracetamol and salicylate levels.
B. Administer activated charcoal, attach the patient
to a cardiac monitor, send blood samples for
measurement of paracetamol and salicylate
levels and start N-acetylcysteine infusion, before
the paracetamol level is known.
C. Attach the patient to a cardiac monitor,
send blood samples for measurement of
paracetamol and salicylate levels and start Nacetylcysteine infusion, before the paracetamol
level is known.
D. Attach the patient to a cardiac monitor, send
blood samples for measurement of paracetamol
and salicylate levels and start N-acetylcysteine
infusion and urinary alkalinization, before the
paracetamol and salicylate levels are known.
E. Attach the patient to a cardiac monitor, send
blood samples for measurement of paracetamol
and salicylate levels and observe the patient.
3. A 60-year-old woman with heart failure and
depression is brought to the emergency
department. Her husband found her with empty
blister packets around her. She is drowsy,
hypotensive and tachycardic. Her pupils are
dilated. She complains of a dry mouth. Her
electrocardiogram demonstrates a prolonged QT
interval, with a widened QRS duration of 0.6 s
(reference range 0.35–0.44 s) and her venous blood
gas demonstrates a metabolic acidosis, pH 7.1.
A test for paracetamol is negative. Which of the
following should be given to treat her overdose?
A. Oxygen, intravenous (IV) fluids and naloxone
infusion.
B. Oxygen, IV fluids and flumazenil.
C. Oxygen, IV fluids and N-acetylcysteine.
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Single best answer (SBA) questions
D. Oxygen, IV fluids, electrolyte imbalance
correction and IV sodium bicarbonate.
E. Oxygen, IV fluids, electrolyte imbalance
correction and Digibind (A digoxin antidote
containing digoxin specific antibody Fab
fragments).
4. A 50-year-old man was admitted to hospital 3days
ago with cellulitis. He normally drinks 26 units of alcohol
a day. He is found on the ward extremely agitated and
tremulous and is having scary visual hallucinations.
Which of the following is the most likely diagnosis?
A. Alcohol toxicity.
B. Delirium tremens.
C. Wernicke encephalopathy.
D. Korsakoff psychosis.
E. Sepsis.
5. A 45-year-old woman known to have alcoholism
is admitted to hospital with haematemesis and is
waiting for a nonurgent endoscopy. Which of the
following scores can help you access her risk of
alcohol withdrawal and guide you to the amount of
benzodiazepine she will require?
A. CAGE.
B. Alcohol Use Disorders Identification Test—
Consumption (AUDIT-C).
C. Clinical Institute Withdrawal Assessment for
Alcohol (CIWA).
D. National Early Warning Score (NEWS).
E. Mini-Mental State Examination (MMSE).
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