mrcp classical presentations.pdf

This is a collecion for some of the

common presentations for the MRCP exam (useful for part 1 & 2) Useful for revision after studying

the only note &/or passmedicine.1a

BADRAWY MRCP revision

HOPE THIS WILL BEBENIFICIAL FOR EVERYONENB I may add some morepresentations to this set, yourcomments are highlyappreciated.

1b


A 17-y girl cardiac arrest asystoleresuscitate unsuccessfulcollapsed in a 1.500m race atcollegeno relevant family history causeof death?

2a


HOCMMCC of SCD in the young

2b


2 day baby cyanotic withfeeding & crying ?

3a


TGAcyanotic: TGA most

common at birth. Fallot'smoss common overall

3b


A 17-y girl recurrent attacks atcollapse occur without warning,occurred whilst she wasrunning for a bus,family history father diedsuddenly when he was 38-s, Dx ?

4a


HOCMMCC of SCD in the young

4b


A 30-y F, central chestpain,severe, non-radiating

and eases onexpiration,ECG,widespread

ST elevation,Dx ?5a


Acute pericarditis

5b


50 -ys M, SOB since themorning,inferior MI 1 y ago,echo following the MI normal LVfunction,still a smoker bibasal crackles,perihilarshadowing,ECG and cardiac enzymesare normal,Dx ?

6a


Penal artery stenosis Renal artery stenosis may causesudden onset or 'flash'pulmonary oedema. A MI isunlikely given the normal ECGand cardiac enzymes

6b


18-y Turner's syndromehas a murmur

soft ejection systolicmurmur,Dx ?

7a


Bicuspid aortic valve MC heart disease with

Turner7b


70 y F, palpitation + chesttightness,ECG atrial

activity 300, ventricularactivity 150 ,Dx ?

8a


Atrial FlutterTachycardia with HR 150

think flutter8b


A 60-y M, SOB onexertion,third heart sound

, respiratory system isunremarkable,Dx ?

9a


Dilated cardiomyopathyA 3rd heart sound is only

considered a normalvariant in patients < 40 s

9b


A 36-y F routine antenatal review,15weeks pregnantBP 154/94 confirmed withambulatory BP monitoringher BP 4 weeks ago was 140/88,urinedipstick protein + and nothingelse,no significant past Hx, Dx ?

10a


Pre-existing hypertension Pregnancy related BPproblems (pre-eclampsia orpregnancy induced HTN)don't occur before 20 weeks.

10b


A 35-y F,DVT in the thirdtrimester of pregnancy,sudden left hemiparesis,

Dx ?11a


Patent foramen ovalepresent in about 20% of

population11b


A 1-y-old girl, a continuousmurmur,loudest at the leftsternal edge,not cyanosed,

Dx ?12a


PDA

12b


A 40-y old F,refractoryhypertension,non-specific chestpains,coronary angiogram,Rightfemoral artery 122/68Left ventricle 202/104,Aorta194/84,left arm BP 188/74, Dx ?

13a


Coarctation of the aorta

13b


An 82-y M, increasingdyspnoea or exertion,

systolicmurmur,BP 100/80,slow

rising pulse,Dx ?14a


AS dt Calcification of theaortic valve

14b


A 56-y M, ED with headaches,chest pain and confusion, BP250/140,equal in botharms,Blurring of the opticdiscs,no significant medicalhistory,Dx ?

15a


Malignant hypertension Rx with Intravenous

nitroprusside15b


A 62-y M,two episodes of 'passingout' for around 15 seconds lastmonths associated with effort,feeling'groggy' for only a few seconds afterthe episode,systolic murmur radiates to the carotid area,Dx ?

16a


ASNext best step isEchocardiogram

16b


A 44-y M, Hx of palpitations +pre-syncopal symptomsECGT wave inversion in leadsV1-3 +notch at the end of theQRS complex,FH of SCD, Dx ?

17a


Arrhythmogenic rightventricular

cardiomyopathy17b


A 76-y, palpitationsirregular cannon 'a'

waves,Dx18a


Complete heart block

18b


an elderly Hx of chronicglaucoma & HTN a suddenpainless loss of vision in one eye.Fundoscopy reveals multipleflame-shaped haemorrhages andoptic disc oedema

19a


Central retinal veinocclusion

19b


an elderly short-sightedman presents with a floater

on the temporal field ofvision. Visual acuity is

normal20a


Posterior vitreousdetachment

20b


An elderly mancomplains of dysphagia,halitosis, regurgitation

and cough21a


pharyngeal pouch

21b


an elderly patient presentswith bone pain,

depression, renal stonesand recurrent peptic ulcer

22a


Primaryhyperparathyroidism

22b


a teenage girl primaryamenorrhoea, well developedsecondary sexual characteristics& breasts. scanty pubic hair andblind-ending vagina

23a


Androgen insensitivitysyndrome

23b


An elderly women developsitchy, tense blisters around

the flexures. There is nomucosal involvement -

24a


bullous pemphigoid

24b


A 30-year-old manhaemoptysis and renal

failure. A renal biopsy linearIgG deposits along thebasement membrane

25a


Goodpasture's syndrome

25b


A 45-year-old womanpresents with fatigue and

pruritus. Blood tests show araised bilirubin, ALP and

IgM level26a


primary biliary cirrhosis

26b


A 55-year-old presents withfever, headache, confusionand aphasia. A CT showspetechial haemorrhages inthe temporal lobe

27a


herpes simplexencephalitis

27b


A 30-year-old man presentswith recurrent palpitationsand syncope. A resting ECGshows T wave inversion inV1-3 and epsilon waves

28a


arrhythmogenic rightventricular

cardiomyopathy28b


A teenager with tear droppapules on the trunk andlimbs 3 weeks after a sore

throat29a


Guttate psoriasis

29b


a young child with a history ofatopic eczema develops a suddeneruption of painful, oedematousvesicles and pustules. They haveare systemically unwell and havea fever

30a


Eczema herpeticum

30b


A 60-Hx of TB dyspnoeaand fatigue. JVP is

elevated, loud S3 andKussmaul's sign is positive.

Hepatomegaly31a


constrictive pericarditis

31b


bitemporal hemianopia(upper quadrant defect >

lower quadrant defect)32a


Pituitary tumour

32b


A tall, slim man presentswith infertility. He is notedto have small, firm testes.Gonadotrophin levels are

elevated33a


Klinefelter's syndrome

33b


a tall, slim 18-year-old manpresents with hypogonadism.

He also complains ofanosmia. Gonadotrophin

levels are reduced34a


Kallman's syndrome

34b


An elderly gradualworsening dementia and

bradyphrenia , a slow,shuffling gait. urinary

incontinence35a


normal pressurehydrocephalus

35b


An elderly Jewish womandevelops painful, flaccid, easilyruptured vesicles and bullae onthe skin.not itchy and werepreceded by mouth lesions

36a


pemphigus vulgaris

36b


A woman rheumatoid arthritisred right eye.no pain,discharge or photophobiaalthough the eye is tearing.Visual acuity is normal

37a


episcleritis

37b


A patient develops footdrop following a fibular

neck fracture38a


common peroneal nerve

38b


middle aged womanthyrotoxicosis and a goitre.exophthalmos and pretibialmyxoedema. Anti-TSH receptorstimulating antibodies arepositive -

39a


Graves' disease

39b


persistent foul-smellingwatery diarrhoea and

weight loss after travellingto India.symptoms for two

weeks40a


giardiasis

40b


a patient speak fluently butmakes little sense with mulitpleword substitutions andneologisms. + difficultyunderstanding what people aresaying to him

41a


Wernicke's aphasia

41b


a patient have laboured,non-fluent, halting speech.He does however retain hisability to understand whatpeople are saying to him

42a


Broca's aphasia

42b


A 40-year-old womanpresents with fever,

fluctuating neurologicalsigns, thrombocytopenia

and renal failure43a


TTP

43b


An elderly acute onsetataxia, nystagmus and

sensory loss.sensory lossaffecting the left side of the

face and right arm44a


posterior inferiorcerebellar arteryocclusion (lateral

medullary syndrome)44b


A man presents withsevere vomiting. Earlier inthe day he reheated some

rice from a takeaway45a


Bacillus cereus

45b


unilateral spastic paresis andloss of proprioception /vibrationsensation with loss of pain andtemperature sensation on theopposite side.

46a


Brown-Sequardsyndrome

46b


A 20-y presents in summerwith gradually worsening

flu-like symptoms and a drycough. + erythema

multiforme47a


mycoplasma pneumonia

47b


bilateral spastic paresisand loss of pain and

temperature sensation48a


Anterior spinal arteryocclusion

48b


A 6-yboy passing darkurine 10 days after having

had a sorethroat.periorbital oedema

49a


Post-streptococcalglomerulonephritis

49b


a 5-year-old child develops acuterenal failure shortly after beingadmitted with bloody diarrhoeaand fever. Bloods show renalfailure, thrombocytopaenia andanaemia

50a


Haemolytic uraemicsyndrome

50b


A 30-y Turkish manrecurrent oral and genitalulceration. anterior uveitis

and thombophlebitis -51a


Behcet's syndrome

51b


A 30-y woman with ahistory of recurrent peptic

ulcer disease,hypercalcaemia on routine

bloods. -52a


multiple endocrineneoplasia (type 1)

52b


40-y man with a history ofulcerative colitis fatigue,

jaundice and pruritus andright upper quadrant pain

53a


primary sclerosingcholangitis

53b


Young adult with anabdominal herald patch,erythematous, oval, scaly

patches in a 'fir-tree'distribution

54a


pityriasis rosea

54b


A patient with a long historyof 'migraines' presents withregular headaches despiteusing sumatriptan on a dailybasis -

55a


medication overuseheadache

55b


A young man an acuteheadache + unilateralperiorbital edema. Onexamination there is a

lateral gaze palsy56a


cavernous sinusthrombosis

56b


A 45-y man diarrhoea,weight loss and arthralgia.

Jejunal biopsy deposition ofmacrophages PAS-positive

granules57a


Whipple's disease

57b


An elderly alcoholic manpersistent headache afterfalling over the previousday.fluctuating level of

consciousness58a


subdural haemorrhage

58b


A 65-y man chronichepatitis b infection

symptoms and signs of livercirrhosis. Alpha-fetoprotein

is elevated. -59a


hepatocellular carcinoma

59b


A young athlete paralysis ofhis right leg before an

athletics meet. Neurologicalexamination is inconsistent

-60a


conversion disorder

60b


Flacid paresis of theintrinsic hand muscleswith loss of pain and

temperature sensation -61a


syringomyelia

61b


A 50-y man history ofsinusitis presents withhaemoptysis and renal

impairment.renal biopsycrescentic GN

62a


Wegener'sgranulomatosis

62b


Elderly 2 week history ofunilateral headache +pain on chewing and

brushing her hair63a


temporal arteritis

63b


A man itchy, purple,papular rash on the palms

and flexor surfaces of arms.polygonal and covered in a

'white-lace' -64a


lichen planus

64b


A 15-year-old presents withnephrotic syndrome. Theirblood pressure and renalblood tests are normal -

65a


minimal change disease

65b


A 30-y woman foul smelling oilydiarrhoea, abdominal bloating,fatigue and weight loss.papulovesicular lesions on theextensor aspects of her arms

66a


coeliac disease

66b


A 60-y muscle fasciculation+ wasting of the small ms ofthe hand. MN signs in the

arms and UMN signs in thelegs

67a


motor neuron disease

67b


A teenage boyclumsywalking. gait ataxia, an

intention tremor and lossof lower limb reflexes -

68a


Friedreich's ataxia

68b


A 15-y midline neck lumppainless and cystic in

nature. It moves upwardson protrusion of the tongue

69a


thyroglossal cyst

69b


60-y man lung cancer dyspnoea. tachycardic,

hypotensive,JVP absent Ydescent pulsus paradoxus

70a


cardiac tamponade

70b


Intense pain around one eye.Attacks occurs once/day, eachepisode 1 hour for the past 8weeks. + red and watery eyeand a constricted pupil -

71a


cluster headache

71b


A 60-y man flu-likesymptoms & dry cough.relative bradycardia +

confused. + low sodium -72a


Legionnaires' disease

72b


Bilateral spastic paresis,loss of proprioception

and vibration sensationand limb ataxia -

73a


subacute combineddegeneration of the

spinal cord73b


bitemporal hemianopia(lower quadrant defect >upper quadrant defect)

74a


Craniopharyngioma -

74b


Young child withmultiple small, pearly,

umbilicated lesions75a


molluscum contagiosum

75b


A young man acute, painfulred eye + photophobia &

blurred vision.pupil issmall and irregular -

76a


anterior uveitis

76b


A patient persistent STelevation 4 weeks aftermyocardial infarction.

bibasal crackles +third andfourth heart sound

77a


left ventricular aneurysm

77b


an elderly short-sighted manflashing lights worse on eyemovement located in thetemporal visual field.uppervisual field loss 'like a curtaincoming down'

78a


Retinal detachment

78b


an elderly man with a longhistory of diabetes sudden visualloss in one eye. For the past fewdays floaters and 'cobwebs'.Visual acuity is reduced tosensing light

79a


Vitreous haemorrhage

79b


A woman complains oflethargy, diplopia anddysphagia. a ptosis on

examination -80a


myasthenia gravis

80b


a 30-y M visual problems. Hisvision is much worse in the dark +started to lose peripheral vision.He has a family history of similarproblems

81a


Retinitis pigmentosa

81b


an elderly female smokerreduced visual acuity, +'blurred' vision. central

scotoma and fundoscopymultiple drusen

82a


Macular degeneration

82b


a patient develops acuteheart failure 5 days after a

MI. A new pan-systolicmurmur is noted on

examination83a


Ventricular septal defect

83b


a patient is noted to have anew early-to-mid systolic

murmur 10 days afterbeing admitted for a MI

84a


Ischaemia of thepapillary muscle

84b


A 30-y man productivecough, fever and chestpain.herpes labialis +

consolidation in the rightlower zone -

85a


pneumococcalpneumonia

85b


A 25-y woman irregularperiods hirsutism.elevatedLH:FSH ratio and raised

testosterone level -86a


polycystic ovariansyndrome

86b


A 20-y painless swellingon the lateral aspect of theneck. smooth, non-tender

and fluctuant -87a


branchial cyst

87b


A 30-y man progressiveweakness of his hands. wasting ofthe small muscles of the hand.pain and temperature sensationis reduced but light touch ispreserved. -

88a


syringomyelia

88b


combination of bothupper and lower motor

neuron signs89a


Amyotrophic lateralsclerosis

89b


A man developshaematuria and

frequency after visitingMalawi -

90a


Schistosomahaematobium

90b


Sudden onset vertigo andvomiting, dysphagia, ipsilateralfacial pain and temperatureloss, contralateral limb pain andtemperature loss and ataxia -

91a


posterior inferiorcerebellar artery

91b


a 45-year-old woman withnephrotic syndrome is noted

to have marked loss ofsubcutaneous tissue from

the face92a


Membranoproliferativeglomerulonephritis (type

II)92b


A 2-year-old childdevelops perianal itching,which is particularly bad

at night -93a


Enterobius vermicularis

93b


a patient Hx of heartburnpresents with odynophagia.

There no weight loss,vomiting or anorexia

94a


Oesophagitis

94b


A middle-aged womensymptoms of

hypothyroidism. a diffuse,non-tender goitre .TSH

,T4 , anti-TPO +ve95a


Hashimoto's thyroiditis

95b


An elderly man restingtremor in right hand.

shuffling gait and a generalslowness of movement -

96a


Parkinson's disease

96b


A 50-year-old alcoholicpresents with fever. He is

found to have an rightupper lobe pneumonia -

97a


Klebsiella pneumonia

97b


a patient develops waterydiarrhoea one week after

arriving in Mexico98a


Escherichia coli(enterotoxigenic)

98b


A young man from north-east of the USA

fever,arthralgia. + rash 5 cmerythematous oval area with

central clearing99a


Borrelia burgdorferi

99b


A young man weakness oflegs shortly after severegastroenteritis. normal

Sensation in legs+ loss ofDTR

100a


Guillain-Barre syndrome

100b


A 75-yewoman colickypain typically in the LLQ+ diarrhoea and fever -

101a


diverticulitis

101b


A 40-y woman tremor ofboth hands.worse when sheis stressed and relieved by

alcohol. FH of similarproblems

102a


essential tremor

102b


A patient has difficultabducting their arm

following a humeral neckfracture

103a


Axillary nerve

103b


wrist drop following ahumeral midshaft

fracture104a


Radial nerve

104b


An elderly man acute,painful red eye + decreasedvisual acuity. worse in the

dark. semi-dilated non-reacting pupil

105a


acute angle closureglaucoma

105b


gradual onset bloodydiarrhoea after travelling to

Egypt. lasted four weeks.occasional abdominal pain

and tenesmus106a


Amoebiasis

106b


profuse 'rice water' diarrhoeaafter visiting a disaster reliefzone.vomiting but has noabdominal pain. Onexamination he is severelydehydrated

107a


Cholera

107b


sudden onset severeoccipital headache, like

being 'kicked in the backof the head'

108a


Subarachnoidhaemorrhage

108b


constant headacheassociated with nausea. Theheadache is present at nightand worse when coughing

109a


Raised intracranialpressure

109b


frontal headachefollowing URTI,worse on

leaning forward110a


Sinusitis

110b


A 30-y woman weight gainand irregular menstruation.BP is elevated at 170/100mmHg + evidence ofproximal muscle weakness

111a


Cushing's syndrome

111b


A 35-y woman BP180/110 mmHg. tired

and weak. Routine bloodsshow hypokalaemia

112a


primaryhyperaldosteronism

112b


a 15-year-old boy developsfever and tachypnoea one

week after recoveringfrom influenza

113a


Staphylococcus aureuspneumonia

113b


a 60-y Pt Hx of COPD infective exacerbation+productive cough and

consolidation on the chestx-ray

114a


Haemophilus influenzaepneumonia

114b


Recurrent, severe headacheunilateral and throbbing in

nature. Associated withnausea and

photosensitivity115a


migraine

115b


a patient with Huntington'sdisease speech which is

difficult to comprehend. canunderstand what is being

said to him116a


Dysarthria

116b


young adult noticeshypopigmented patches on hertrunk after coming gettingsuntan. Patches are mildlypruritic with some scale

117a


Pityriasis versicolor

117b


a 35-y man severe, episodicloin pain radiates round to

the front. blood+++,leucocytes ++ on the urine

dipstick118a


Renal colic

118b


an elderly man severecentral abdominal pain

radiating to the backassociated with

hypotension119a


Ruptured abdominalaortic aneurysm

119b


a 60-y with a history oftuberculosis dyspnoea &fatigue. JVP , loud S3 and

Kussmaul's sign +ve,Hepatomegaly

120a


Constrictive pericarditis

120b


a 25-y man is investigatedfor recurrent syncope anddyspnoea. ejection systolic

murmur121a


Hypertrophic obstructivecardiomyopathy

121b


a 60-y alcoholic man severechest pain after repeated

episodes of vomiting. + SCemphysema

122a


Boerhaave syndrome

122b


a patient who is known tohave HIV presents with

odynophagia123a


Oesophageal candidiasis

123b


a 55-yman fever andmalaise past few weeks

common peroneal nervepalsy. hepatitis B surface

antigen +ve124a


Polyarteritis nodosa

124b


a 30-y woman from Singaporeheadache, malaise & myalgia.BP 160/100 mmHg, the rightradial pulse is difficult topalpate and a carotid bruit isnoted

125a


Takayasu's arteritis

125b


a 65-y Male IgGparaprotein band +

asymptomatic + calciumand renal function are

normal126a


Monoclonal gammopathyof undetermined

significance126b


a 70-y DVT. monoclonalIgM paraprotein band . lost

weight and feels unwell.calcium and renal function

normal127a


Waldenstrom'smacroglobulinaemia

127b


an obese 55-y pain in theRUQ associated with fever.

Palpation of the RUQcauses arrest of respiration

128a


Acute cholecystitis

128b


a patient Hx of Barrett'soesophagus presents with

dysphagia and weightloss

129a


Oesophageal cancer

129b


a middle-aged patientdysphagia of both liquidsand solids from the start.

regurgitation and apersistent cough

130a


Achalasia

130b


an elderly man severe painaround his right eye,

nausea, redness of the eye,'misty vision' and a semi-

dilated pupil131a


Acute narrow-angleglaucoma

131b


a patient feigns chroniclower back pain to allow

him to claim governmentbenefits

132a


Malingering

132b


a car crash survivor feelslike he is 'watching a movie'when trying to recall details

of the episode133a


Dissociative disorder

133b


a 75-y man large amountsof a mucous-like diarrhoea.

Bloods demonstratehypokalaemia

134a


Villous adenoma

134b


a man who presents withintussusception is noticed to havemultiple polyps on colonoscopy.These are later shown to behamartomatous. He also haspigmented lesions on his lips andpalms

135a


Peutz-Jeghers syndrome

135b


A woman develops awinged scapula after

mastectomy136a


long thoracic nerve

136b


An elderly womanitchylesion on her vulva. It

started as a red patch buthas now turned into a white

plaque137a


lichen sclerosus

137b


a 65-y man back pain andlethargy.raised calcium,renal dysfunction and a

raised ESR138a


Multiple myeloma

138b


a 20-y woman recurrent episodesof abdominal pain +bloating.pain is relieved ondefecation. She normal passes 3loose stools with mucous in themornings

139a


Irritable bowel syndrome

139b


A man diarrhoea andabdominal pain,

papulovesicular lesions onthe soles & urticarial rash

140a


Strongyloides stercoralis

140b


a child sore throat and low-grade fever.vesicles in themouth and on the palms

and soles of the feet141a


Hand, foot and mouthdisease

141b


a child pink maculopapularrash, initially on the face beforespreading to the whole body.Suboccipital & postauricularlymphadenopathy is present

142a


Rubella

142b


a middle-aged womandevelops painful,

erythematous, nodularlesions over both shins

143a


Erythema nodosum

143b


a young child history of atopiceczema a sudden eruption ofpainful, oedematous vesiclesand pustules. systemicallyunwell and have a fever

144a


Eczema herpeticum

144b


a middle aged woman tendergoitre + hyperthyroidism.

TSH & T4. globallyuptakeon iodine-131 scan

145a


Subacute thyroiditis

145b


A patient presents with a'droopy eyelid'. unilateralmiosis, ptosis and narrowpalpebral aperture giving theappearance of enophthalmos

146a


Horner's syndrome

146b


A 50-y man Marfan syndromepalpitations &dyspnoea.collapsing pulse, the BP160/60 mmHg and a high-pitched diastolic murmur

147a


aortic regurgitation

147b


An elderly woman developsa reticulated,

hyperpigmented rash afterusing a hot water bottle

excessively -148a


erythema ab igne

148b


a 35-y woman loin pain +fever. She has blood+++,

leucocytes +++ on theurine dipstick

149a


Pyelonephritis

149b


a 50-year-old manpresents with epigastricpain relieved by eating

150a


Duodenal ulcer

150b


an ECG shows progressiveprolongation of the PRinterval until a dropped

beat occurs151a


Second degree heartblock (Mobitz I)

151b


a man develops a cardiacarrest shortly after MI. TheECG monitor shows rapid,

irregular waveforms152a


Ventricular fibrillation

152b


a 2-y abdominal mass andpallor. raised urinary

(VMA) and homovanillicacid (HVA) levels

153a


Neuroblastoma

153b


A man history of syphilisbilateral small, irregularpupils which respond toaccomodation but not to

light154a


Argyll-Robertson pupil

154b


an elderly Hx of HTN andglaucoma visual acuity &peripheral visual field loss.

Fundoscopy optic disccupping

155a


Primary open-angleglaucoma

155b


a baby is born withmicrocephaly, small eyes,low-set ears, cleft lip and

polydactyly156a


Patau syndrome

156b


a young boy is noted tohave learning difficulties,macrocephaly, large ears

and macro-orchidism157a


Fragile X

157b


a 55-y woman recurrent episodesof vertigo often triggered by achange in head position. Eachepisode lasts around 10-20seconds and is associated withnausea

158a


Benign paroxysmalpositional vertigo

158b


a 45-y man unilateralhearing loss. tinnitus andsome problems with hisbalance. absent corneal

reflex159a


Acoustic neuroma

159b


a 6-week-old baby with 1*1.5cmswelling in the left axilla. Theywere given the BCG vaccine at

birth160a


Reactivelymphadenopathy

160b


a 20-y man tender, swollen 2cmmass in the right submandibularregion. His temperature is38.2degC and he is noted to havepoor dental hygiene

161a


Reactivelymphadenopathy

161b


a 40-y alcoholichaematemesis after

repeated vomiting. Anendoscopy two months ago

no evidence of varices162a


Mallory-Weiss syndrome

162b


a middle-aged woman Hxof Raynaud's phenomenonc/o dysphagia + multiple

telangectasia163a


Systemic sclerosis

163b


a 40-year-old womandysphagia. Oesophageal

manometry oesophagealperistalsis & lower

oesophageal sphincter tone164a


Systemic sclerosis

164b


an elderly patient waterydiarrhoea after being treatedfor pneumonia. Blood tests

show a new, markedneutrophilia

165a


Clostridium difficile

165b


a 20-y man bloodydiarrhoea. abdominal pain

and tenesmus. Yesterday hehad flu-like symptoms

166a


Campylobacter

166b


a 60-y woman dysphagiaand lethargy. smooth,

swollen tongue and paleconjunctivae

167a


Plummer-Vinsonsyndrome

167b


a patien Hx of anxietyc/o having a 'lump' in her

throat168a


Globus hystericus

168b


a 30-y woman with a historyof recurrent peptic ulcerdisease is found to have

hypercalcaemia on routinebloods

169a


Multiple endocrineneoplasia (type 1)

.169b


A teenage girl anterior kneepain worse when going

down stairs and rising fromprolonged sitting

170a


chondromalacia patellae

170b


A 70-y womanpan-systolicmurmur after presentingwith dyspnoea. A soft S1

and split S2171a


mitral regurgitation

171b


a 1-y is swelling on theleft side of the neck. Themass is soft, non-tender

and transilluminates172a


Cystic hygroma

172b


ipsilateral oculomotorpalsy and contralateral

weakness173a


Branches of the posteriorcerebral artery that

supply the midbrain173b


contralateral hemiparesis andsensory loss with the upperextremity being more affectedthan the lower, contralateralhomonymous hemianopia andaphasia

174a


Middle cerebral artery

174b


a young woman takes aparacetamol overdose aftersplitting with her boyfriend. Twodays later she is in a newrelationship which is troubled byher repeated outbursts of anger

175a


Borderline personalitydisorder

175b


a woman presents to her male familydoctor wearing a low-cut top and ashort skirt. She tries to flirt with thedoctor. The consultation is filled withdrama and she becomes annoyedwith the centre of attention shiftsfrom her

176a


Histrionic personalitydisorder

176b


a boy is noted to havereduced tone,

hypogonadism andobesity

177a


Prader-Willi syndrome

177b


a baby micrognathia and a cleftpalate. He is placed prone dueto upper airway obstruction.There is no family history ofsimilar problems

178a


Pierre-Robin syndrome

178b


an overweight 50-y manlethargy and excessive

thirst. Fundoscopy blothaemorrhages

179a


Type 2 diabetes mellitus

179b


a 40-y patient Hxhypertension presents with

episodic palpitations,excessive sweating,

headaches and tremor180a


Phaeochromocytoma

180b


a boy arm problems after fallingfrom a tree, caught a branch tosave himself. On examination hehas a claw hand with ahyperextended wrist

181a


Lower trunk of thebrachial plexus (C8, T1)

181b


Loss of proprioceptionand vibration . No motor

deficit182a


neurosyphilis

182b


A 35-y jerky, random anduncontrollable movements of hisarms. getting progressively worsefor the past few months. His wifealso says he is increasinglyirritable and moody

183a


Huntington's disease

183b


a patient with acute HF 10days after MI. JVP, pulsusparadoxus and diminished

heart sounds184a


Left ventricular free wallrupture

184b


A woman Hx of rheumatoidarthritis severe, constant pain inher right eye. right eye is red andthere is a degree of photophobia.Visual acuity is normal

185a


scleritis

185b


a patient speak fluently but havedifficulty repeating phrases. Heis aware of the errors he ismaking and comprehensionremains normal

186a


Conduction aphasia

186b


A patient presents withsevere vomiting 4 hours

after eating at arestuarant -

187a


Staphylococcus aureus

187b


A 2-year-old child isadmitted with watery

diarrhoea, vomiting anddehydration -

188a


rotavirus

188b


a sporty teenage boypresents with pain,

tenderness and swellingover the tibial tubercle

189a


Osgood-Schlatter disease

189b


a sporty teenager presentswith knee pain after

exercise associated withintermittent swelling and

locking190a


Osteochondritisdissecans

190b


An elderly patient with a historyof atrial fibrillation presents witha sudden painless loss of vision inone eye. Fundoscopy reveals a'cherry red' spot on a pale retina-

191a


central retinal arteryocclusion

191b


transient unilateral lossof vision described as a

'curtain descending'192a


Ophthalmic artery

192b


locked-in syndrome

193a


Basilar artery

193b


A man episodic angioedemawhilst in west Africa. Onone occasion he noticed a'worm moving across the

left eye'194a


Loa loa

194b


a patient is suspected ofinjecting her mothers

insulin to cause repeatedepisodes of hypoglycaemia

195a


Factitious disorder

195b


Flaccid paralysis of upper+ lower face -

196a


CN VII

196b


A patient complains ofpins/needles and pain on

the lateral aspect of thehand -

197a


median nerve

197b


A 25-y man presents withvisible haematuria. He alsocomplains of having a badsore throat at the current

time198a


IgA nephropathy

198b


A man presents withcentral, pleuritic chest painand fever 4 weeks following

MI. The ESR is elevated -199a


Dressler's syndrome

199b


recurrent, non-disabling,bilateral headache,

described as a 'tight-band'

200a


Tension headache

200b


a man with raised, red,spherical lesion on his neck.It initially was a red spot but

rapidly grew over 4 weeks201a


Pyogenic granuloma

201b


a man with HIV presents with apainful, vesicular rash on theright side of his face around theeye. Fluorescein staining revealsmultiple small defects on theright cornea

202a


Herpes zosterophthalmicus

202b


a patient with an acute,painful red eye +

photophobia and epiphora.Fluorescein staining ragged

area on the cornea203a


Herpes simplex keratitis

203b


an elderly man withparkinsonism atonic

bladder, posturalhypotension and cerebellar

signs204a


Multiple system atrophy

204b


a 40-y man with headachesand coarsening of his facialfeatures.his wedding ring

and shoes no longer fit him205a


Acromegaly

205b


a newborn's arm is noted to behanging loosely following adifficult forceps delivery. Thearm is adducted and internallyrotated, elbow extended

206a


Upper trunk of thebrachial plexus (C5,C6)

206b


A child presents with fever,malaise and tonsillitisassociated with a 'strawberry'tongue and a fine punctateerythematous rash sparing theface -

207a


scarlet fever

207b


a 35-y man Hx of HTNand SAH presents with

recurrent UTIs andepisodic haematuria

208a


Autosomal dominantpolycystic kidney disease

208b


an elderly male smokervisible haematuria + loinpain. a loin mass can befound on the same side

209a


Renal cell carcinoma

209b


a 25-y man develops a painlesspustule that later erodes to forman ulcer. By the time he presentshe has painful inguinallymphadenopathy andproctocolitis

210a


Lymphogranulomavenereum

210b


middle-aged man head injury fallingdown some stairs. After losingconsciousness he quickly recoversc/o of a headache. Over the next fewhours he becomes more confusedand has one seizure -

211a


extradural (epidural)haematoma

211b


A patient develops abradycardia of 36/min followinga myocardial infarction. TheECG shows no associationbetween the P waves and QRScomplexes -

212a


complete heart block

212b


Plz don't hesitate to sharecomments & suggestions

for this set ..144a


Thank You

144b


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