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Extended-matching
questions (EMQs)
Each answer can be used once, more than once or not at all.
Chapter28 Respiratory system
Signs on chest examination
A. Bronchial breathing.
B. Expiratory wheeze.
C. Trachea deviated to left.
D. Trachea deviated to right.
E. Stridor.
F. Increased percussion note.
G. Whispering pectoriloquy.
H. Inspiratory crackles.
I. Intercostal muscle recession.
J. Stony dullness.
For each of the following patients, select the physical signs
that best fit the clinical scenario from the list of options.
1. A patient with a large retrosternal goitre.
2. A right tension pneumothorax.
3. A patient with upper lobe fibrosis of the right lung due
to sarcoidosis.
4. A patient with poorly controlled asthma.
5. A patient with a large pleural effusion.
Haemoptysis
A. Acute bronchitis.
B. Bronchiectasis.
C. Carcinoma of the lung.
D. Exacerbation of chronic obstructive pulmonary disease.
E. Goodpasture syndrome.
F. Hereditary haemorrhagic telangiectasia.
G. Mitral stenosis.
H. Pneumonia.
I. Pulmonary embolism.
J. Tuberculosis.
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 25-year-old man with fever and rusty-coloured sputum.
2. A 35-year-old woman with a history or recurrent nose
bleeds and a family history of haemoptysis.
3. A 45-year-old woman with copious purulent sputum
and brisk haemoptysis.
4. A 45-year-old woman with shortness of breath and
pink, frothy sputum.
5. A 50-year-old man with haematuria and haemoptysis.
Shortness of breath
A. Pneumonia
B. Pulmonary embolism
C. Pneumothorax
D. Interstitial lung disease
E. Exacerbation of chronic obstructive pulmonary
disease/asthma
F. Acute respiratory distress syndrome
G. Aspergillosis
H. Cystic fibrosis
I. Lung cancer
J. Atelectasis
Choose the best diagnosis for the presentations.
1. An 84-year-old ex-smoker comes to see his GP. He
looks thin and pale. He has visible nicotine staining
on his fingers. He reports that he has been having
persistent cough for the past 4weeks. He has a
medical history of hypertension, type 2 diabetes
mellitus and osteoarthritis. There are no added
sounds audible on chest auscultation.
2. A 22-year-old presents to his GP with his partner
with a problem of inability to conceive. They have
been trying for more than 1year and have not been
successful. Neither of them has ever been diagnosed
with any medical conditions.
3. A 73-year-old who used to work on a bird farm
comes in with progressively worsening shortness
of breath. He is normally well, takes tablets only for
his bones and high blood pressure, but has recently
noted that he no longer can go for long walks
with his wife as he gets short of breath and needs
to stop. He has not had a cough, chest pain or
fever. He also reports feeling worse when it is cold
outside.
4. A 34-year-old visits her GP having just come back
from a trip to Asia. She is complaining of productive of
yellow sputum cough, fever and shortness of breath
when walking. She appears flushed and sweaty. She
has no medical history.
5. A 68-year-old required 5days in the intensive care
unit, where she required supportive treatment after
409
Extended-matching questions (EMQs)
undergoing extensive abdominal surgery. She was
mechanically ventilated for 3days. She is now
reporting difficulty in breathing.
Chapter29 Gastrointestinal and
hepatobiliary systems
Abdominal swelling
A. Aortic aneurysm.
B. Ascites.
C. Fibroid uterus.
D. Polycystic kidneys.
E. Ventral hernia.
F. Transplanted kidney.
G. Ovarian cyst.
H. Hepatomegaly.
I. Splenomegaly.
J. Enlarged bladder.
For each of the following patients with a palpable abdominal
mass, suggest the most likely cause from the list of options.
1. A 34-year-old man with Cushingoid features has a
smooth mass palpable in the right iliac fossa.
2. An 81-year-old with urinary incontinence following a
hernia repair and a suprapubic smooth tender mass.
3. A 35-year-old woman is admitted with a thunderclap
headache and has masses in both hypochondria.
4. A 79-year-old woman complains of a swelling in the
centre of her abdomen that appears when she sits up
and disappears when she lies down.
5. A 38-year-old woman is admitted smelling of alcohol.
She is confused, with multiple spider
Diarrhoea
A. HIV infection.
B. Traveller's diarrhoea.
C. Colorectal carcinoma.
D. Crohn disease.
E. Thyrotoxicosis.
F. Irritable bowel syndrome.
G. Villous adenoma of the rectum.
H. Diverticulitis.
I. Systemic sclerosis.
J. Chronic pancreatitis.
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 75-year-old man with a history of chronic
constipation presents with acute left iliac fossa pain
and loose stool mixed with blood.
2. An 82-year-old woman presents to her GP with
episodic diarrhoea and constipation, vague lower
abdominal pain and increasing tiredness.
3. A 35-year-old office manager presents with a 3-month
history of episodic diarrhoea, bloating and abdominal
cramps. He reports no weight loss but says his
symptoms seem to occur only during his working day.
4. A 38-year-old man with a long-term history of excess
alcohol consumption and multiple hospitalizations
presents to his GP with weight loss and loose,
offensive stools.
5. A returning 19-year-old gap year student presents
with a 1-month history of diarrhoea, sweating and
palpitations.
Dysphagia
A. Systemic sclerosis.
B. Candidiasis.
C. Plummer–Vinson syndrome.
D. Oesophageal cancer.
E. Pharyngeal pouch.
F. Achalasia.
G. Hiatus hernia.
H. Coeliac disease.
I. Ischaemic heart disease.
J. Gastro-oesophageal reflux disease (GORD).
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 40-year-old man with a long-term history of
intermittent dysphagia from both solids and liquids
presents with severe retrosternal chest pain.
2. A 32-year-old woman recently diagnosed with renal
impairment gives a history of heartburn and dysphagia
associated with exertional dyspnoea.
3. A 60-year-old lifelong smoker presents with a history
with painful difficulty in swallowing that started with
solids but has now progressed to liquids.
4. A 55-year-old obese woman presents with painful
difficulty in swallowing and disturbed sleep due to
bouts of coughing.
5. A 41-year-old woman presents with painless difficulty
in swallowing associated with a dry rash at the
corners of her mouth.
Hepatobiliary disease
A. Sclerosing cholangitis.
B. Wilson disease.
C. Acute cholecystitis.
D. Biliary colic.
E. Haemochromatosis.
F. Primary biliary cirrhosis.
410
Extended-matching questions (EMQs)
G. Hepatitis C.
H. Pancreatic cancer.
I. Alcoholic hepatitis.
J. Chronic pancreatitis.
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 55-year-old man is found to have an elevated
fasting glucose level. On examination he has greyappearing skin and an enlarged liver.
2. A 40-year-old woman with a history of Addison disease
presents with lethargy and pruritus. Blood tests show
an elevated serum bilirubin level and ultrasound
examination shows no evidence of obstruction.
3. An overweight 52-year-old woman presents with
vomiting and right upper quadrant pain that radiates
to the back. On examination she has rebound
tenderness over the right upper quadrant and a full
blood count shows a raised white cell count (WCC).
4. A 45-year-old man under investigation for abnormal
liver function test results develops a tremor and has
several fits.
5. A 60-year-old man with alcoholism and a history of
alcohol-induced pancreatitis presents with jaundice
and back pain. An ultrasound examination of his liver
shows a dilated common bile duct of 11 mm.
Jaundice
A. Acute alcoholic hepatitis.
B. Acute viral hepatitis.
C. Gilbert syndrome.
D. Carcinoma of the head of the pancreas.
E. Cholangitis.
F. Chronic biliary cirrhosis.
G. Gallstones.
H. Haemolysis.
I. Leptospirosis.
J. Paracetamol toxicity.
For each of the following patients with jaundice, select the
most likely diagnosis from the list of options.
1. A 50-year-old woman with central abdominal pain and
a history of weight loss over 4months.
2. A 50-year-old woman with a history of ulcerative colitis
and a recent onset of fever, rigors and jaundice.
3. A 60-year-old woman with recurrent episodes of right
hypochondrial pain.
4. A 25-year-old woman with a 2-week history of muscle
pains and fever.
5. A 35-year-old farm worker with fever, red eyes and
abdominal pain.
Investigations in gastrointestinal disease
A. Anti-tissue transglutaminase antibodies.
B. Low blood caeruloplasmin level.
C. Antimitochondrial antibody positivity.
D. Raised 24-hour urine 5-hydroxyindoleacetic acid level
(5-HIAA).
E. Raised alpha-fetoprotein level.
F. Raised CA125 level.
G. Raised serum amylase level.
H. Raised serum ferritin level.
I. Raised serum glucagon level.
J. Raised unconjugated bilirubin level.
For each of the following patients, select the most likely
condition represented by the investigation used to
diagnose it from the list of options.
1. A 30-year-old woman with weight loss, steatorrhoea
and a blood film suggesting hyposplenism.
2. A 50-year-old man with a mass in the right
hypochondrium and episodes of flushing and
diarrhoea.
3. A 50-year-old woman with pruritus and obstructive
jaundice.
4. A 55-year-old man with acute abdominal pain
radiating to the back.
5. A 55-year-old man with darkening skin, arthralgia,
impotence and abnormal liver function.
Gastrointestinal bleeding
A. Variceal bleed
B. Mallory–Weiss tear
C. Angiodysplasia
D. Infective colitis
E. Colorectal cancer
F. Inflammatory bowel disease (IBD)
G. Haemorrhoids
H. Diverticulitis
I. Peptic ulcer
J. Coagulopathy
Choose the most appropriate diagnosis for the following
patients presenting with gastrointestinal (GI) bleeding.
Each option can be used once, more than once, or not
at all.
1. A 68-year-old man with known haemorrhoids presents
to his GP with a history of occasional rectal bleeding,
unintentional weight loss and bloating.
2. A 38-year-old man with a history of excessive alcohol
consumption presents to the urgent care centre
concerned about fresh blood in his vomitus. He
411
Extended-matching questions (EMQs)
reports he has been having nausea and vomiting for
the past few days. He is normally fit and well.
3. A 40-year-old presents with a 5-day history of bloody
diarrhoea of more than 10 episodes per day. This
is associated with generalized abdominal pain and
nausea. The patient had two episodes of vomiting.
The patient also reports night-time fever.
4. A 60-year-old with previous splenectomy and portal
vein thrombosis.
5. A 65-year-old with anaemia and a positive faecal occult
blood test result who was previously investigated
with oesophagogastroduodenoscopy (OGD) and
colonoscopy, but no obvious causes were found.
Chapter30 Renal, genitourinary and sexual
health medicine
Haematuria
A. Benign prostatic hypertrophy.
B. Goodpasture syndrome.
C. Acute pyelonephritis.
D. Acute cystitis.
E. Prostatic carcinoma.
F. Ureteric calculi.
G. Bladder carcinoma.
H. Renal cell carcinoma.
I. Polyangiitis with granulomas.
J. IgA nephropathy.
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 23-year-old woman presents with fever, tachycardia
and tenderness in the left loin. The white cell count is
raised and the urine is cloudy.
2. A 70-year-old man describes intermittent colicky left
loin pain, weight loss and night sweats. He has noted
testicular changes, which, on examination, are a
varicocele. The haematuria is macroscopic.
3. A 36-year-old woman presents with malaise, recurrent
epistaxis, haemoptysis and microscopic haematuria.
Examination reveals septal perforation and nodules on
the CXR. The serum creatinine level is elevated at 307
μmol/L (reference range 80–110 μmol/L)
4. A 39-year-old man presents to the emergency
department in high summer with severe colicky right
loin pain radiating down into the scrotum. Examination
findings are unremarkable and the dipstick shows
haematuria.
5. A 78-year-old man with long-standing nocturia,
poor urinary stream and terminal dribbling notices
macroscopic haematuria towards the end of the
urine stream. He has become more lethargic and is
troubled by lower back pain.
412
Renal impairment
A. Myeloma.
B. Contrast nephropathy.
C. Polyangiitis with eosinophilia
D. Polyangiitis with granulomas
E. Diabetes mellitus.
F. Leukaemia.
G. Amyloidosis.
H. Angiotensin-converting enzyme inhibitors.
I. Polycystic kidney disease.
J. Systemic lupus erythematosus.
For each of the following patients with renal impairment,
select the most likely diagnosis from the list of options.
1. A 24-year-old woman with a history of recurrent
UTIs presents with loin pain and haematuria. On
examination she is noted to have hypertension. Her
mother is receiving dialysis.
2. A 32-year-old man presents with a history of
haemoptysis, epistaxis, mouth ulcers, lethargy and
arthralgia. He is found to have renal impairment.
3. A 65-year-old woman with a long history of
bronchiectasis presents with loose stools. She is
found to have renal impairment and proteinuria.
4. A 52-year-old with poorly controlled diabetes
is admitted with suspected appendicitis and is
investigated with an abdominal CT scan. His renal
function subsequently worsens 3days after admission.
5. A 72-year-old man with recurrent infections and bony
pain. A full blood count shows a haemoglobin level of
96 g/L (reference range 120–160 g/L)
Disturbance of micturition
A. Chronic kidney disease.
B. Diabetes insipidus.
C. Diabetes mellitus.
D. Glomerulonephritis.
E. Hypercalcaemia.
F. Hypokalaemia.
G. Inappropriate secretion of antidiuretic hormone.
H. Nephrotic syndrome.
I. Overhydration.
J. Pyelonephritis.
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 20-year-old man with shortness of breath, a pH of
7.25 (normal range 7.35–7.45) and Paco2 of 2.5 kPa
(normal range 4.0–6.0 kPa).
2. A 35-year-old man with polyuria whose CXR shows
bilateral hilar lymphadenopathy.
Extended-matching questions (EMQs)
3. A 50-year-old woman treated with lithium for depression.
4. A 65-year-old man with polyuria, bone pain and
Bence Jones protein in the urine.
5. A 75-year-old woman with loin pain, frequency and
dysuria.
Renal disease
A. Amyloidosis.
B. Anti-GBM disease (Goodpasture syndrome).
C. HIV-associated nephropathy.
D. IgA nephropathy.
E. Lupus nephritis.
F. Minimal change nephropathy.
G. Multiple myeloma.
H. Pyelonephritis.
I. Sarcoidosis.
J. Polyangiitis with granulomas
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 12-year-old boy with hypoalbuminaemia, oedema
and frothy urine.
2. A 25-year-old man who feels well but has
macroscopic haematuria 2days after an upper
respiratory tract infection.
3. A 30-year-old man with weight loss and renal
impairment showing FSGS on renal biopsy.
4. A 45-year-old man with AKI associated with fever,
sinusitis, nose bleeds and haemoptysis.
5. A 65-year-old woman with anaemia associated with
lytic bone lesions.
Chapter31 Fluid balance and electrolyte
disturbances
Calcium problems
A. Bony metastases
B. Familial hypocalciuria
C. Hyperthyroidism
D. Hypoparathyroidism
E. Multiple myeloma
F. Primary hyperparathyroidism
G. Sarcoidosis
H. Secondary hyperparathyroidism
I. Prostate carcinoma
J. Tertiary hyperparathyroidism
For each of the following patients select the most likely
diagnosis from the list of options.
1. A 30-year-old man with bilateral hilar
lymphadenopathy.
2. A 35-year-old woman with muscle cramps and
perioral tingling following a recent neck operation.
3. A 45-year-old woman with an incidental finding of a
raised calcium level and low phosphate level.
4. A 50-year-old man with renal impairment, normal
calcium level and high phosphate level.
5. A 65-year-old man with weight loss and sclerotic
lesions in ribs on chest X-ray.
Hyponatraemia
A. Syndrome of inappropriate secretion of antidiuretic
hormone (SIADH)
B. Diuretics medications
C. Addison disease
D. Ace inhibitor
E. Nephrotic syndrome
F. Bartter syndrome
G. Gitelman syndrome
H. False hyponatraemia
I. Hypothyroidism
J. Liver failure
For each of the scenario below give the single most likely
cause of the hyponatraemia.
1. A 30-year-old woman with vitiligo and rheumatoid
arthritis complains of abdominal pain and dizziness.
Her laboratory glucose levels have been on the
low side.
2. A 30-year-old man is nil by mouth preceding
abdominal surgery. He has blood taken from his hand
arm proximal to where he is receiving has received 1 L
of 5% dextrose.
3. Second-line antihypertensive medication is started in
a 65-year-old women in addition to her amlodipine
therapy.
4. A 65-year-old woman reports feeling cold, tired and
depressed.
5. A 45-year-old man is admitted to hospital with severe
pneumonia. He is receives second-line antibiotic
therapy, Piperacillin/Tazobactam with clarithromycin.
Potassium disorders
A. Diarrhoea
B. Diabetic ketoacidosis
C. Tea and toast diet
D. Renal artery stenosis
E. Renal tubular acidosis
F. Cushing syndrome
G. Systemic lupus erythematosus
H. Addison disease
I. Iatrogenic
J. Renal failure
413
Extended-matching questions (EMQs)
For each of the scenarios give the single most likely cause
of the potassium disorder.
1. A 65-year-old man with a history of poorly controlled
chronic hypertension visits his general practitioner
with symptoms of fatigue, metallic taste and itch. He
has a potassium level of 6.2 mmol/L (reference range
3.5–5.0 mmol/L), his phosphate level is raised and he
is anaemic.
2. A 35-year-old woman has a blood pressure of
90/60 mmHg. She has been having long-standing
abdominal pain. Her routine blood tests show she has
a mildly raised potassium level and mildly low sodium
and low glucose levels.
3. A 70 -year-old man is admitted to hospital for
treatment of pyelonephritis. He is receiving Hartmann
solution as intravenous fluid resuscitation and has
been given gentamicin for his pyelonephritis. His
potassium level is 6.2 mmol/L (reference range
3.5–5.0 mmol/L) on a venous blood gas test.
4. A 55-year-old woman has a history of dry eyes, dry
mouth and arthralgia. She is in hospital for treatment
of multiple renal calculi. Her laboratory potassium level
is 2.9 mmol/L (reference range 3.5–5.0 mmol/L).
5. A 65-year-old woman with diabetes and peripheral
vascular disease has her blood values rechecked after
commencing treatment with a further antihypertensive
drug for poor blood pressure control. This shows
her creatinine level has increased by 50% and her
potassium level is 5.9 mmol/L (reference range
3.5–5.0 mmol/L).
Chapter32 Nervous system
Headache
A. Meningitis.
B. Encephalitis.
C. Subarachnoid haemorrhage.
D. Tension headache.
E. Migraine.
F. Cluster headache.
G. Glaucoma.
H. Giant cell arteritis.
I. Trigeminal neuralgia.
J. Raised intracranial pressure.
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 21-year-old university student presents with a
severe headache of gradual onset. He cannot tolerate
the ophthalmoscope and is febrile.
2. A 56-year-old woman has recently been experiencing
severe shooting pain over one side of her face, lasting
a few seconds and occurring many times per day.
She has noticed that eating seems to bring it on.
3. A 39-year-old businessman presents with a rapid
onset of severe pain around his right eye that is
associated with lacrimation, lasts 1–2 hours and has
been occurring nightly for 2weeks.
4. A 69-year-old woman describes a worsening
headache and pain in her jaw when she chews. Her
vision is normal. Her erythrocyte sedimentation rate is
88 mm/h.
5. A 28-year-old man with a family history of kidney
disease presents with a sudden onset severe occipital
headache. He has neck stiffness.
Altered level of consciousness
A. Brainstem infarction.
B. Drug overdose.
C. Hepatic encephalopathy.
D. Hypoglycaemia.
E. Hyponatraemia.
F. Hypothermia.
G. Meningitis.
H. Renal failure.
I. Schizophrenia.
J. Subarachnoid haemorrhage.
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 93-year-old woman is brought in following a sudden
loss of consciousness. Two days later, she remains
deeply unconscious with pinpoint pupils.
2. A 42-year-old man is brought in after a sudden
collapse. Subhyaloid haemorrhages are seen on
fundoscopy.
3. A dishevelled 22-year-old woman is brought in having
been found in the street. She responds to painful
stimuli and has pinpoint pupils.
4. A 56-year-old man is brought in by ambulance. He
is extremely drowsy and jaundiced. His wife says he
has been 'battling the drink' for years and has been
coughing up dark sputum recently.
5. An elderly, hypertensive woman is admitted in a
postictal state after a witnessed tonic–clonic seizure.
She has recently started taking a diuretic for her
hypertension.
Cranial nerves
A. Horner syndrome.
B. Argyll Robertson pupil.
C. Bell palsy.
D. Sixth nerve palsy.
E. Ramsay Hunt syndrome.
414
Extended-matching questions (EMQs)
F. Third nerve palsy.
G. Pituitary adenoma.
H. Senile miosis.
I. Fourth nerve palsy.
J. Holmes–Adie pupil.
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 56-year-old man presents to his GP complaining
of loss of peripheral vision bilaterally. On examination
it is noted that he has an enlarged lower jaw and is
hypertensive.
2. On review at the endocrine clinic, a 64-year-old
woman is noted to have a unilateral drooping eyelid
and a fixed and dilated pupil with the eye looking
downwards and outwards.
3. A 49-year-old man with a hard, irregular, palpable,
right-sided thyroid swelling presents with a drooping
eyelid on the same side. On examination you also
notice that his right pupil is constricted.
4. A 28-year-old woman presents with left-sided facial
weakness associated with a vesicular rash in the
external auditory meatus.
5. A 79-year-old diabetic man has a fall walking down
the stairs. On questioning, he reports that he has had
double vision on looking downwards for some months.
Seizures
A. Febrile convulsion.
B. Glioma.
C. Alcohol withdrawal.
D. Meningitis.
E. Absence seizure.
F. Encephalitis.
G. Temporal lobe epilepsy.
H. Alcohol toxicity.
I. Hypocalcaemia.
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 15-year-old girl is brought in by her parents after
several episodes where she says she has a feeling
of déjà vu and then becomes unresponsive, but
appears awake and picks at her clothes. She cannot
remember the episodes, which last around 2 minutes.
2. A 10-year-old boy is admitted to hospital with
a nonblanching rash and decreased level of
consciousness. In the accident and emergency
department he begins to have a generalized seizure.
3. A 36-year-old pub landlord is admitted to hospital with
a fractured tibia. At 36 hours after admission he starts
hallucinating and has a seizure.
4. A 38-year-old previously fit and well man presents
to his GP feeling depressed with a history of two
witnessed generalized seizures and early-morning
headaches.
5. A 5-year-old boy is noticed by his mother to have
episodes of unresponsiveness. On EEG a pattern of
three spike-and-wave discharges per second is seen.
Miscellaneous neurological disorders
A. Skeletal muscle.
B. Sciatic nerve.
C. Peripheral nerves.
D. Cavernous sinus.
E. Substantia nigra.
F. Neuromuscular junction.
G. Frontal lobe.
H. Common peroneal nerve.
I. Dorsal columns.
J. Middle cerebral artery.
For each of the following symptoms and signs, select the
most likely location of the lesion from the list of options.
1. Painless muscle weakness that worsens on repetitive
contraction.
2. Progressive paraparesis or tetraparesis with lower
motor neurone signs and sensory symptoms following
a diarrhoeal illness.
3. Painful proximal muscle weakness manifested by
difficulty getting up from a chair or climbing stairs.
4. Unilateral foot drop and weakness of ankle eversion
foot.
5. Loss of vibration sense and reduced proprioception,
with preservation of pain and temperature sensation.
Nerve lesions
A. Carpal tunnel syndrome.
B. Diabetic neuropathy.
C. Guillain–Barré syndrome.
D. Lead poisoning.
E. Mononeuritis multiplex.
F. Multiple sclerosis.
G. Pancoast tumour.
H. Spinal cord infarction.
I. Subacute combined degeneration of the cord.
J. Syringomyelia.
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 60-year-old man with abdominal pain and weakness
in both feet.
415
Extended-matching questions (EMQs)
2. A 65-year-old woman with loss of vibration and joint
position sense in the feet with extensor plantars.
3. A 70-year-old man with pain in the right shoulder and
weakness of the small muscles of the right hand.
4. A 70-year-old man with weakness of the small
muscles of both hands with loss of pain and
temperature sensation in the hands.
5. A 70-year-old woman with pain in the right forearm at
night and weakness of the right thumb.
Headache
A. Cluster headache.
B. Giant cell arteritis.
C. Meningitis.
D. Migraine.
E. Postherpetic neuralgia.
F. Sinusitis.
G. Subarachnoid haemorrhage.
H. Temporomandibular joint problems.
I. Tension headache.
J. Trigeminal neuralgia.
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 30-year-old man with severe pain around the right
eye lasting about 1 hour and occurring daily for the
last 2weeks.
2. A 30-year-old woman with a constant headache
described as a band around the head for 3weeks.
3. A 50-year-old woman with hypertension and acute
onset of severe pain around the back of the head.
4. A 55-year-old woman with headache that is worse on
bending over and tenderness over the forehead.
5. A 70-year-old woman with headache and tenderness
over her forehead and scalp.
Transient loss of consciousness
A. Simple faint.
B. Transient ischaemic attack (TIA).
C. Stroke.
D. Postural hypotension.
E. Epilepsy.
F. Aortic stenosis.
G. Pulmonary stenosis.
H. Cardiac arrhythmia.
I. Hypoglycaemia.
J. Subdural haematoma
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 22-year-old man is walking along a street with
his friends when he suddenly falls to the floor. He is
unconscious for around 1 minute and then regains
consciousness but appears flushed. He sustains
a head injury during the fall. He had two similar
episodes in the past but was never investigated for a
cause.
2. An 89-year-old patient with a history of vascular
dementia falls and loses consciousness after getting
out of bed in the morning. No EKG changes are noted
on assessment in the emergency department.
3. A 49-year-old man collapses whilst running after his
granddaughter. An ejection systolic murmur is heard
on examination. The murmur is better heard on
expiration.
4. A 76-year-old nursing home resident presents with
left-sided facial droop and new onset confusion. She
has a history of hypertension and ischaemic heart
disease.
5. A 36-year-old type 1 diabetic man taking insulin is
brought to the emergency department unconscious.
Paramedics report that his body was twitching when
they attended to him and that he was incontinent of
urine.
Chapter33 Metabolic and endocrine
systems
Endocrine tests
A. Two-hour oral glucose tolerance test.
B. Dexamethasone suppression test.
C. Domperidone test.
D. Insulin-like growth factor 1 (IGF-1) measurement.
E. Insulin stress test.
F. Prolonged fast.
G. Prolonged glucose tolerance test.
H. Short Synacthen test.
I. Thyrotropin-releasing hormone test.
J. Water deprivation test and response to desmopressin.
For each of the following clinical scenarios, select the
most appropriate initial investigation from the list of
options.
1. A patient presents with headaches. You notice
interdental spacing, large hands and feet,
hypertension and prominent supraorbital ridge.
2. A 39-year-old woman complains of episodic fainting,
which is most likely to occur if she misses a meal.
She is not taking any regular medications. Initial
investigations demonstrate a normal Synacthen test
result.
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Extended-matching questions (EMQs)
3. A 28-year-old woman with vitiligo complains of
lethargy. She is noted to have pigmented palmar
creases and oral mucosa.
4. A 29-year-old man has recently been discharged
following a significant head injury. He now presents
with polyuria, polydipsia and hypernatraemia.
5. A 50-year-old woman is referred to the clinic with
hirsutism, weight gain, diabetes and hypertension.
Clinical features in endocrine disease
A. Phaeochromocytoma.
B. Acromegaly.
C. Hypothyroidism.
D. Diabetes mellitus.
E. Addison disease.
F. Conn syndrome.
G. Digoxin.
H. Cushing syndrome.
I. Hyperthyroidism.
J. Prolactinoma.
For each of the following patients, select the most likely
diagnosis from the list of options.
1. A 34-year-old man presents with a history of
abdominal pain and weight loss. On examination he
has pigmented buccal mucosa and a systolic blood
pressure of 92 mmHg.
2. A 48-year-old with a long-term history of severe
asthma presents complaining of weight gain and
bruising easily.
3. A 44-year-old man presents with headaches, sweating,
tremor, weight loss and palpitations. He is hypertensive.
4. A 48-year-old man reports muscle cramps, weakness
and headaches. He is hypertensive. Urea and
electrolyte test results show hypokalaemia.
5. A 68-year-old man in whom atrial fibrillation recently
diagnosed presents with new onset gynaecomastia.
On examination he has normal testicles and no signs
of liver disease.
Metabolic bone disease
A. Paget disease.
B. Osteomalacia.
C. Osteoporosis.
D. Adynamic bone disease.
E. Osteoarthritis.
F. Osteogenesis imperfecta.
G. Osteosarcoma.
H. Rickets.
I. Metastatic bone disease.
What is the most likely diagnosis in the following?
1. A 30-year-old female marathon runner with
amenorrhoea.
2. A 30-year-old woman with abdominal pain, diarrhoea
and an itchy blistering rash on elbows and knees
since eating a diet high in bread and pasta.
3. An 80-year-old British man with long-standing bone
pain receiving regular bisphosphonate treatment
presents with a painful, hot swollen leg that does not
improve despite strong analgesia
4. A 75-year-old man with deafness, poor vision
and tender shins, who is experiencing increasing
breathless on exertion.
5. A 70-year-old woman on dialysis, being treated
with high doses of vitamin D, found to have an
undetectable PTH level.
Hypoglycaemic medication and insulin
A. Metformin.
B. Linagliptin.
C. Pioglitazone.
D. Variable-rate intravenous insulin infusion.
E. Fixed-rate intravenous insulin infusion.
F. Scarbose.
G. Gliclazide.
H. Actrapid.
I. Exenatide
Chose the most sensible drug in the following cases.
1. A 25-year-old man admitted to hospital with
hyperglycaemia, ketones and acidosis following
gastroenteritis.
2. A 45-year-old with long-standing type 2 diabetes,
who normally takes insulin, is nil by mouth for an
appendicectomy.
3. A 50-year-old man with renal impairment, currently
raking gliclazide but with poor glucose control. He is
reluctant to start using insulin.
4. A 45-year-old obese man with a new diagnosis of
diabetes.
5. A 45-year-old woman who has been prescribed a onceweekly injectable preparation to help control her type 2
diabetes in addition to her metformin and saxagliptin.
Emergency management
A. Intravenous fluid, following this give pamidronate
intravenously.
B. Intravenous fluid, fixed-rate intravenous insulin infusion
(0.1 units per kilogram per hour), antibiotics and lowmolecular-weight heparin.
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