Think you know your alendronic acid from your bisoprolol? Test your medical knowledge in our twelve-question quiz, put together using questions and answers from Oxford Assess and Progress: Clinical Medicine.
A 71-year-old man has had central chest pain radiating to his left arm for 1 hour. His observations are:
T 37.1˚C, HR 44bpm, BP 110/65 mmHg, RR 22/minute.
What is the single most likely occluded coronary artery?
A 23-year-old woman has suffered an infective exacerbation of her asthma. She has taken a 5-day course of prednisolone 40 mg oral (PO) once daily and is now ready to be discharged from hospital. This is her first hospital admission because of her asthma since childhood. Her discharge summary and prescription are being prepared. Which is the single most appropriate instruction for taking the prednisolone?
A 40-year-old man is acutely confused. He has an uncontrollable thirst, along with regular polyuria of >5L a day.
Serum osmolality 296 mOsmol/kg
Urine osmolality 280 mOsmol/kg; increases to 620 mOsmol/kg after desmopressin 20 micrograms nasally.
Which is the single most appropriate explanation for his symptoms?
A 74-year-old man has had retrosternal pain, nocturnal cough, and belching for 8 weeks. He has had no loss of appetite or weight loss. He has recently been started on some new medication and feels that this may be the cause of his symptoms. Which is the single most likely cause of his symptoms?
A 17-year-old woman has noticed her face becoming very puffy, particularly around the eyes, and her legs swelling up over the past 6 weeks. She has noticed that her urine is frothy. She has no other symptoms or medical problems.
Urea 4 mmol/L, creatine 60 micromol/L, albumin 12 g/L.
Urine protein:creatinine ratio (PCR) 1200 mg/mmol.
Which is the single most likely diagnosis?
A 62-year-old woman has had a high temperature for the past 3 hours. Other than a slightly sore throat and a general feeling of tiredness, she has no real symptoms of note. Eight days previously she completed her first cycle of chemotherapy for carcinoma of the breast.
T 38.4˚C, HR 110 bpm, BP 95/65 mmHg.
Blood and urine samples are sent for culture.
Which is the single most appropriate next stage in her treatment?
A 74-year-old woman attends her general practice with a 4-day history of progressive lower leg pain, with enhancing redness. She grazed her left shin while cleaning her fireplace at home. She has ischaemic heart disease and varicose veins. She feels generally unwell, but not febrile. Her general practitioner identifies a large area of non-purulent, tender erythema and associated swelling on her left lower leg. She is able to mobilize. He prescribes her first-line antibiotics and considers investigations.
What is the single most likely means of diagnosing this condition?
A 22-year-old man has sustained a sports injury. He scuffs the top of his right shoe along the floor as he walks and cannot turn his foot outwards against resistance. Which is the single most likely distribution of sensory compromise?
A 57-year-old man with a large primary brain tumour has deteriorated at home and is admitted to a hospice for end-of-life care. He is now unresponsive. His main symptoms prior to admission were nausea and vomiting and seizures.
His oral medications are dexamethasone 4 mg twice daily (bd), sodium valiproate 600 mg bd, metoclopramide 10 mg three times daily (tds), and ondansetron 8 mg tds.
What is the most appropriate drug to manage his risk of further seizures?
A 30-year-old woman has had a painful and swollen right ankle. It has developed gradually over the last week or so. She has suffered flare-ups of the same joint at regular intervals over the last 18 months. The first attack occurred within a month of a urinary tract infection, but otherwise she has remained well.
Choose the single most likely diagnosis.
A 19-year-old woman has a 2cm x 2cm mobile, non-tender, soft lump with smooth edges in her right breast. She takes the combined oral contraceptive pill. Her mother had breast cancer ages 48. She is referred and undergoes standard quadruple assessment at the local breast unit.
Which is the single most likely management?
A 45-year-old man with previous unspecified mental health problems is brought to hospital by his family, having become progressively jaundiced over the last 2 days. On questioning, he discloses a paracetamol overdose 4 days ago but is unsure of the quantity. You arrange laboratory blood tests.
Which of the following of his results is an indication for referral to a specialist liver unit for consideration for liver transplantation?