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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3017_Библиотеки_им_академика_М_И_Перельмана
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212 Diagnostic EMQs
ARTERIAL BLOOD GAS
INTERPRETATION 2
A. Metabolic acidosis – fully compensated
B. Metabolic acidosis – partial compensated
C. Metabolic acidosis – uncompensated
D. Metabolic alkalosis – fully compensated
E. Metabolic alkalosis – partial compensated
F. Metabolic alkalosis – uncompensated
G. Respiratory acidosis – fully compensated
H. Respiratory acidosis – partial compensated
I. Respiratory acidosis – uncompensated
J. Respiratory alkalosis – fully compensated
K. Respiratory alkalosis – partial compensated
L. Respiratory alkalosis – uncompensated
For each of the following, what is the MOST likely diagnosis?
1. pH 7.30, PaCO
2
31mmHg and HCO
3
20 meq/L
2. pH 7.38, PaCO
2
33 mmHg and HCO
3
21 meq/L
3. pH 7.36, PaCO
2
54 mmHg and HCO
3
30 meq/L
4. pH 7.30, PaCO
2
55 mmHg and HCO
3
23 meq/L
See page 234 for answers.
ENT 1
A. Acute mastoiditis
B. Acute otitis media
C. Acute rhinosinusitis
D. Allergic rhinitis
E. Bullous myringitis
F. Choanal atresia
G. Chronic otitis media
H. Chronic rhinosinusitis with polyps
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Respiratory 213
I. Chronic rhinosinusitis without polyps
J. Deviated nasal septum
K. Granulomatosis with polyangiitis
L. Nasal foreign body
M. Otitis externa
N. Otitis media with effusion
O. Rhinitis medicamentosa
For each of the following, what is the MOST likely diagnosis?
1. A 14-year-old girl presents with a seven-week history of painless right ear dis-
charge. The discharge is serous and without odour. She has a history of recur-
rent ear infections. On examination she has a temperature of 36.3°C and Weber
test lateralises to the right side.
2. A 13-year-old boy presents with right sided ear pain and headache. His symp-
toms started two days ago and have progressively worsened. He now reports
that he has swelling behind his right ear. On examination he has a temperature
of 38.6°C, he has a bulging right tympanic membrane, there is swelling and
pain on palpating posterior to his right ear.
3. A 21-year-old man presents to your clinic with epistaxis and nasal obstruction.
He explains that his symptoms are associated with a cough, haemoptysis and
pleuritic chest pain. Urine dipstick reveals haematuria and proteinuria. He has
a strongly positive c-ANCA level detected in the serum.
4. You are working in a remote ED and are asked to review an 8-month-old child
who has presented with a fever which started 24hours ago. Her mother reports
that she has been irritable and has been tugging on her left ear. On examination
she has a temperature of 38.9°C, she also has an erythematous and bulging left
tympanic membrane.
5. A 4-year-old girl presents to your clinic with a two-day history of foul-smelling
brown discharge from her left nostril. Her mother explains that she has been
complaining of a blocked nose for the past three days and today she has had an
episode of epistaxis.
6. A 6-year-old boy presents to your clinic complaining of left ear pain and itch.
He recently returned from Bali where his family took him for a vacation. He
has been feeling unwell for the past two days, complaining of a sore throat
and runny nose. He has no known sick contacts and his mother explains that
he spent most of his time abroad playing with his siblings in the pool and on
the beach. On examination there is narrowing of the ear canal and a large
amount of exudate. He experiences signicant pain when placing pressure on
the tragus.
See pages 234–235 for answers.
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214 Diagnostic EMQs
ENT 2
A. Acute mastoiditis
B. Acute otitis media
C. Acute rhinosinusitis
D. Allergic rhinitis
E. Bullous myringitis
F. Choanal atresia
G. Chronic otitis media
H. Chronic rhinosinusitis with polyps
I. Chronic rhinosinusitis without polyps
J. Deviated nasal septum
K. Granulomatosis with polyangiitis
L. Nasal foreign body
M. Otitis externa
N. Otitis media with effusion
O. Rhinitis medicamentosa
For each of the following, what is the MOST likely diagnosis?
1. A 43-year-old male presents to your clinic with a three-month history of nasal
congestion. He has been struggling to breathe through his nose and has had rhi-
norrhoea. He has a history of allergic rhinitis and has been using nasal decon-
gestant sprays daily for the past four months. On examination his nasal mucous
membranes appear beefy red in colour.
2. A 6-year-old boy attends your GP clinic with his mother who explains that she
is concerned about his hearing. He has been turning the volume up to a high
level on the television at home and has been getting into trouble at school with
his teacher, who complains that he is not paying attention. He has been behav-
ing this way for the past few weeks. On questioning he explains that his right
ear feels blocked. He has a history of asthma and you note that he has presented
several times with ear infections. On examination he is afebrile, the tympanic
membrane on the right side is translucent with diminished mobility and an air
uid level is present behind it.
3. A 30-year-old man attends your GP clinic complaining of runny nose, with
clear nasal discharge and watery eyes. He explains that his symptoms have been
present for the past week and that they happen every year at roughly the same
time. His symptoms are causing him difculties with sleep and are affecting his
function throughout the day.
4. A 37-year-old woman presents with right sided purulent nasal discharge for
several weeks. You arrange for a CT scan which reveals vomer thickening,
right sided narrowing of the posterior nasal passage and an airway width of
2mm.
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Respiratory 215
5. A 26-year-old man presents to your clinic with severe right sided ear pain and
loss of hearing. On examination his right tympanic membrane is oedematous
and covered in blood lled blisters.
6. A 21-year-old male presents to your clinic with a six-day history of thick green
nasal discharge, left sided facial pain and a fever. He explains that his symptoms
initially started with a sore throat and dry cough which resolved after two days,
he improved slightly but his situation then began to deteriorate. On examination
he has a temperature of 38.6
o
C, facial pain on percussion over the left cheek and
pressure in the same location on leaning forward.
See pages 235–236 for answers.
PAEDIATRIC RESPIRATORY 1
A. Acute epiglottitis
B. Asthma
C. Bronchiolitis
D. Croup
E. Infectious mononucleosis
F. Inuenza
G. Inhaled foreign body
H. Laryngitis
I. Laryngomalacia
J. Peritonsillar abscess
K. Pulmonary sequestration
L. Retropharyngeal abscess
M. Tonsillitis
N. Tracheo-Esophageal stula
O. Upper airway cough syndrome
For each of the following, what is the MOST likely diagnosis?
1. A 6-week-old presents to your emergency department with her mother who is
concerned about a fever. She has been coughing for the past four weeks particu-
larly with feeding.
2. A 6-year-old boy presents to your GP clinic with a six-day history of cough. His
mother explains that he has been coughing throughout the day due to irritation
in the back of his throat. He describes this as if there is something “dripping
down” the back of his throat. His mother further explains that he has also had a
runny nose but denies any fever.
3. A 14-year-old girl attends your clinic complaining of a sore throat and dyspha-
gia. She reports that this started one week ago and has progressively worsened
and is associated with difculty fully opening her mouth and some drooling. On
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216 Diagnostic EMQs
examination she is talking with a “hot potato” voice and she has deviation of her
uvula to the right.
4. A 9-year-old boy presents to your clinic with a one-day history of myalgia and
shortness of breath. His brother has similar symptoms which started two days
ago. He has no medical history. On examination he has a temperature of 38.1°C,
you note signicant nasal discharge which is clear in colour, his chest is clear
and he is talking in full sentences.
5. A 6-month-old girl attends your ED with her concerned mother. Her mother
reports that her daughter had a two-day history of runny nose, cough and
reduced feeds. She is also concerned that her daughter has been breathing rap-
idly throughout the day. On examination she has normal behaviour, a tempera-
ture of 37.3°C, respiratory rate of 56, saturations of 94% in room air, mild chest
wall retraction and minimal wheeze bilaterally.
See page 236 for answers.
PAEDIATRIC RESPIRATORY 2
A. Acute epiglottitis
B. Asthma
C. Bronchiolitis
D. Croup
E. Infectious mononucleosis
F. Inuenza
G. Inhaled foreign body
H. Laryngitis
I. Laryngomalacia
J. Peritonsillar abscess
K. Pulmonary sequestration
L. Retropharyngeal abscess
M. Tonsillitis
N. Tracheo-Esophageal stula
O. Upper airway cough syndrome
For each of the following, what is the MOST likely diagnosis?
1. A 4-year-old boy presents to your emergency department with a ve-day his-
tory of fever and reduced oral intake. On examination he appears unwell, has
a temperature of 39.2°C, is drooling and seated leaning forward with his neck
extended.
2. A 4-year-old girl attends your clinic with her mother. For the past three days
she has been coughing intermittently and has a low-grade fever. In clinic you
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Respiratory 217
observe a barking cough, she has intermittent inspiratory stridor at rest and
moderate chest wall retractions. Her chest is otherwise clear.
3. A 13-year-old girl presents to your emergency department with a sore throat,
odynophagia and fever. She explains that her symptoms initially started a week
ago and have progressively worsened. On examination she is talking with a
“hot potato” voice, has a temperature of 40.2°C, has some stiffness in her neck
and pain on palpation of her anterior neck. Alateral X-ray of her neck reveals
widening of the prevertebral soft tissue and swelling posterior to the pharynx.
4. A 16-year-old boy presents to your GP clinic complaining of a two-day his-
tory of sore throat and fever. He has no signicant medical history and takes
no regular medication. On examination he has a temperature of 37.9°C, he has
enlarged tonsils covered in a white lm, cervical lymph nodes are enlarged and
he has splenomegaly. Aheterophile antibody test returns a positive result.
5. A 16-year-old girl presents with a one-day history of sore throat. She has been
maintaining uids but struggles to swallow food. On examination she has
swelling of bilateral tonsils which are erythematous and covered with white
exudate bilaterally, she has a temperature of 38.8°C. Abdominal examination is
unremarkable.
See pages 236–237 for answers.
PAEDIATRIC RESPIRATORY 3
A. Acute epiglottitis
B. Asthma
C. Bronchiolitis
D. Croup
E. Infectious mononucleosis
F. Inuenza
G. Inhaled foreign body
H. Laryngitis
I. Laryngomalacia
J. Peritonsillar abscess
K. Pulmonary sequestration
L. Retropharyngeal abscess
M. Tonsillitis
N. Tracheo-Esophageal stula
O. Upper airway cough syndrome
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218 Diagnostic EMQs
For each of the following, what is the MOST likely diagnosis?
1. A 20-month-old boy is brought to your ED by ambulance with a complaint of
acute respiratory distress. His father is in attendance and explains that he has
been well and was playing with his older sister just before his symptoms started.
On examination he has a temperature of 37.9
o
C, marked stridor, saturations of
91% at room air and a clear chest.
2. A 6-year-old boy presents to your clinic with a history of recurrent chest infec-
tions affecting the left lower lobe of his lungs. CT angiography reveals anoma-
lous blood supply to the affected lobe from the descending thoracic aorta.
3. A 6-week-old child is brought to your clinic by her mother, who is concerned
about noisy breathing she has noticed for the past ve weeks. Her mother
explains that the noise is more noticeable when she lays her at or when she is
sleeping, it disappears when she changes her position.
4. An 8-year-old girl presents to your clinic with her father, she has been coughing
for the past two weeks. Her cough is non-productive, it is associated with chest
tightness and wheeze. She explains that her symptoms are worse at night and
rst thing in the morning when she wakes, she has had broken sleep over this
period. She has not had a fever.
5. A 15-year-old girl presents to your clinic complaining of a sore throat and
dysphagia. Her symptoms have been present for the past seven days and she
has developed a hoarse voice since yesterday. On examination she has ery-
thema at the back of her throat, cervical lymphadenopathy and a temperature
of 37.6°C.
See page 237 for answers.
RESPIRATORY CONDITIONS 1
A. Acute pulmonary oedema
B. Asthma
C. Bronchiectasis
D. Chronic obstructive airways disease
E. Churg–Strauss syndrome
F. Cystic brosis
G. Empyema
H. Goodpasture syndrome
I. Granulomatosis with polyangiitis
J. Haemothorax
K. Idiopathic pulmonary brosis
L. Lobar pneumonia
M. Lung abscess
N. Lung cancer
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Respiratory 219
O. Mesothelioma
P. Mycoplasma pneumonia
Q. Pneumothorax
R. Pulmonary aspergillosis
S. Pulmonary embolism
T. Sarcoidosis
U. Silicosis
V. Tuberculo sis
For each of the following, what is the MOST likely diagnosis?
1. A 40-year-old Caucasian woman presents with a four-month history of dry
cough and associated shortness of breath. She reports that she has been signi-
cantly fatigued during this period of time and has lost 3 kg. On examination she
has a bluish-red rash over her nose, her chest sounds clear. Chest X-ray reveals
bilateral hilar lymphadenopathy.
2. A 32-year-old woman presents to your clinic with a history of cough. She
explains that her symptoms are fever, haemoptysis and shortness of breath. She
was previously started on broad spectrum antibiotics but has had no response
to these. She has breast cancer and is currently undergoing chemotherapy. You
arrange for a CT chest which reveals a halo sign.
3. A 28-year-old receptionist presents to your clinic complaining of a long history
of nocturnal cough which has been waking her nightly for the past month, she
explains that she has had these symptoms in the past but they have become con-
siderably more bothersome. She explains that she also has chest tightness and
wheeze throughout the day on most days during this period.
4. An 18-year-old basketball player is brought into your emergency department
with sudden onset shortness of breath associated with right sided chest pain. He
appears pale in colour and is struggling to talk. On examination he has a tem-
perature of 36.7
o
C and saturations of 91% at room air, he has decreased breath
sound on the right side of his chest and associated tracheal deviation towards
the left.
5. A 32-year-old male presents with a two-week history of cough and haemoptysis.
He has no associated symptoms. On examination he has a blood pressure of
158/94 mmHg, temperature of 36.6°C, heart rate of 92 beats per minute and a
respiratory rate of 24 breaths per minute. He has bilateral crackles in his lungs
and peripheral oedema. Dipstick reveals haematuria. You send the urine off
which reveals the presence of red cell casts. Abiopsy is arranged which shows
strongly positive linear staining of glomerular capillaries for IgG.
6. A 68-year-old male presents to your emergency department with a two-week
history of productive cough and fever. He also reports left sided pleuritic chest
pain. On examination he has a temperature of 39.1°C, heart rate of 112 beats
per minute and a respiratory rate of 24 breaths per minute. He is also found to
have reduced breath sounds in the lower half of the left chest. ACT of the chest
is requested, split pleura sign on the left side is observed.
See pages 237–238 for answers.
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220 Diagnostic EMQs
RESPIRATORY CONDITIONS 2
A. Acute pulmonary oedema
B. Asthma
C. Bronchiectasis
D. Chronic obstructive airways disease
E. Churg–Strauss syndrome
F. Cystic brosis
G. Empyema
H. Goodpasture syndrome
I. Granulomatosis with polyangiitis
J. Haemothorax
K. Idiopathic pulmonary brosis
L. Lobar pneumonia
M. Lung abscess
N. Lung cancer
O. Mesothelioma
P. Mycoplasma pneumonia
Q. Pneumothorax
R. Pulmonary aspergillosis
S. Pulmonary embolism
T. Sarcoidosis
U. Silicosis
V. Tuberculo sis
For each of the following, what is the MOST likely diagnosis?
1. A 33-year-old sandblaster presents to your GP clinic for the rst time with a
12-month history of productive cough and shortness of breath on exertion. He
has had multiple courses of antibiotics during this period of time which have
had little effect. His chest X-ray reveals bilateral hilar adenopathy with egg
shell calcication.
2. A 61-year-old man presents to your clinic with a ve-day history of fever asso-
ciated with a productive cough. He reports that his symptoms have worsened
and his sputum is now rust coloured. On examination he has a temperature of
38.5°C, heart rate of 106 beats per minute and a respiratory rate of 22 breaths
per minute. There are bronchial breath sounds and dullness to percussion in the
left lower zone.
3. A 12-year-old refugee attends your clinic as he has been suffering from a
chronic upper respiratory tract infection for the past six weeks. He has had a
course of amoxicillin without any response to treatment. He explains that he
has had a cough and runny nose intermittently for the past two years. He also
reports that he snores at night. He further explains that he has had very thick
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Respiratory 221
and greasy white stools during this period. He denies any shortness of breath or
haemoptysis. He has had all of his catch-up immunisations.
4. A 58-year-old labourer presents to your consulting rooms complaining of a two-
month history of dry cough which is now associated with haemoptysis. He is a
non-smoker and reports that he has lost 6 kg over this period of time.
5. A 66-year-old man presents to your emergency department with a two-week
history of cough and fever. He was recently admitted to the hospital for a stroke
but has no other signicant medical history. He previously smoked a pack of
cigarettes a day but quit smoking 15years ago. On examination he has a tem-
perature of 38.8°C, heart rate of 110 beats per minute and a respiratory rate of
26 breaths per minute. Achest X-ray is performed which reveals a round shaped
cavity containing an air-uid level in the right middle lobe.
See page 238 for answers.
RESPIRATORY CONDITIONS 3
A. Acute pulmonary oedema
B. Asthma
C. Bronchiectasis
D. Chronic obstructive airways disease
E. Churg–Strauss syndrome
F. Cystic brosis
G. Empyema
H. Goodpasture syndrome
I. Granulomatosis with polyangiitis
J. Haemothorax
K. Idiopathic pulmonary brosis
L. Lobar pneumonia
M. Lung abscess
N. Lung cancer
O. Mesothelioma
P. Mycoplasma pneumonia
Q. Pneumothorax
R. Pulmonary aspergillosis
S. Pulmonary embolism
T. Sarcoidosis
U. Silicosis
V. Tuberculo sis
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