mock answer

A 34-year-old woman with depression, abdominal pain, and twitching in her hand now presents with muscle weakness and dark urine after working long hours. She also mentions a family history of similar symptoms. What test can confirm the diagnosis?

A 42-year-old man with chronic hepatitis B infection presents with jaundice, weight loss, and abdominal pain. A liver ultrasound shows a mass in the right lobe of the liver. What is the most likely diagnosis?

A 72-year-old man presents with bilateral leg swelling, shortness of breath, and an elevated jugular venous pressure. His echocardiogram shows left ventricular hypertrophy and an ejection fraction of 25%. What is the most likely diagnosis?

A 32-year-old woman who has systemic lupus erythematosus (SLE) comes to the clinic for review. Her disease is well controlled, and she came off medication three months ago to try and get pregnant. She is worried about the risk of venous thromboembolism in pregnancy. Which of the following antibodies is most associated with risk of venous thromboembolism?

A 54-year-old man in pulseless ventricular tachycardia (VT) is undergoing cardiopulmonary resuscitation (CPR). Apart from giving a further dose of adrenaline, what is the most appropriate next step?

A 78-year-old man with prostate cancer on high doses of morphine suffers from constipation. What is the most appropriate medication?

A 61-year-old woman with breast cancer is being treated with trastuzumab. What is the mode of action of trastuzumab?

A 30-year-old woman presents with painless neck swelling and sweating. On examination, her thyroid is diffusely enlarged and tender. Her thyroid function tests show suppressed TSH and elevated free T4. What is the most likely diagnosis?

A 55-year-old woman with a history of hypertension and type 2 diabetes presents with dizziness and palpitations. An ECG shows atrial fibrillation with a rapid ventricular rate. What is the most appropriate treatment for rate control?

A 60-year-old man presents with weight loss, jaundice, and dark urine. A CT scan reveals a mass in the head of the pancreas. What is the most likely diagnosis?

A 32-year-old woman diagnosed with primary pulmonary hypertension (PPH) asks about the prognosis. Which of the following is most associated with poor prognosis in PPH?

A 38-year-old man with ulcerative colitis presents with increasing alkaline phosphatase levels. You suspect primary sclerosing cholangitis (PSC). What is the most appropriate investigation to diagnose PSC?

A 58-year-old woman with hot flushes and irregular periods seeks treatment for menopausal symptoms. What is the most appropriate therapy?

A 50-year-old man with a history of chronic alcohol use presents with severe epigastric pain and vomiting. His serum amylase is elevated. Which of the following is the most likely diagnosis?

A 28-year-old woman with a history of migraine presents with an acute, severe headache, nausea, and photophobia. She denies neck stiffness and fever. What is the most appropriate initial management?

A 27-year-old woman with primary pulmonary hypertension asks about her prognosis. What is an indicator of poor prognosis?

A 45-year-old woman reports feeling like her skin is crawling and accuses the nursing staff of implanting insect eggs in her body. What is the most likely delusion?

A 27-year-old woman presents with red, painful nodules on her shins and a sore throat. What is the most useful first-line investigation?

A 68-year-old man with a droopy left eyelid and pupillary constriction but no visual acuity issues also reports hoarseness of voice. What is the most likely cause?

A 33-year-old woman presents with fatigue, pallor, and shortness of breath. Laboratory findings reveal a hemoglobin of 7 g/dL and a mean corpuscular volume (MCV) of 65 fL. What is the most likely diagnosis?

A 35-year-old man with ankylosing spondylitis presents with shortness of breath. He has reduced chest expansion and evidence of apical fibrosis on CT. What is most likely to be found on pulmonary function testing?

A 54-year-old taxi driver is referred to the Respiratory Clinic after momentarily losing concentration, causing a road accident. His wife reports that he is a heavy snorer and stops breathing on occasions during the night. He smokes ten cigarettes per day. Examination reveals a quiet wheeze on auscultation, and his BMI is 35 kg/m². Which of the following investigations would lead to a diagnosis?

A 58-year-old man presents with worsening dyspnea, cough, and fatigue. He has a history of smoking and occupational asbestos exposure. His chest x-ray reveals pleural thickening and a pleural effusion. What is the most likely diagnosis?

A 45-year-old woman presents with polyuria and polydipsia. Her fasting glucose is 180 mg/dL, and her HbA1c is 8.2%. What is the most appropriate initial treatment?

A 65-year-old man with chronic kidney disease presents with muscle weakness and bone pain. His laboratory results show hypocalcemia and elevated phosphate levels. What is the most likely underlying condition?

A 19-year-old woman with short stature, webbed neck, and rib notching on chest x-ray presents with a radio-femoral delay. What additional pathology is most associated with her condition?

A 59-year-old woman presents with a second episode of cholecystitis and is curious about the constituents of gallbladder bile. What is the largest constituent of bile?

A 25-year-old man presents with left knee pain and swelling, redness in his eyes, and dysuria. He recently had an episode of diarrhea. What is the most likely diagnosis?

A 75-year-old man presents with right-sided Horner syndrome, facial weakness, and sensory loss, along with left-sided loss of pain and temperature sensation. What is the cause of this presentation?

A 55-year-old woman with stress incontinence has failed pelvic floor exercises and declines surgery. What is the most appropriate next intervention?

A 19-year-old woman wants to commence the combined oral contraceptive pill (COCP) but is concerned about its cancer risks. The risk of which of the following cancers is most increased in patients who take the COCP?

A 32-year-old Chinese man develops a severe skin rash after starting carbamazepine. Examination reveals annular lesions and blistering. What is the most likely diagnosis?

A 25-year-old man presents with acute onset of right-sided weakness and slurred speech. A CT scan shows an ischemic stroke in the middle cerebral artery territory. What is the most appropriate immediate management?

A 68-year-old woman presents with progressive lymphadenopathy, weight loss, night sweats, and palpable painless cervical lymphadenopathy. Blood results show a marked lymphocytosis with smear cells. What is the likely underlying cause of her anaemia?

A 19-year-old man presents with severe epigastric pain, vomiting, and hyperventilation. Blood tests confirm elevated amylase and lipase levels, consistent with pancreatitis. The sample is reported as lipaemic. What is the most likely cause of his pancreatitis?

An 18-year-old man is reviewed with deteriorating night vision and maculopathy, and a family history suggests an inherited peroxisomal disorder. Which of the following correctly describes peroxisome function?

A 67-year-old man with a history of aortic stenosis presents with angina, syncope, and dyspnea. His blood pressure is 110/60 mmHg, and his pulse is slow and weak. What is the most appropriate management?

A 35-year-old woman, an intravenous drug user, presents with a new murmur of tricuspid regurgitation. What is the most likely JVP waveform to be seen in this patient?

A 42-year-old HIV-positive man presents with a rash. He has clusters of firm, flesh-colored, umbilicated papules on his thighs, buttocks, and groin. What virus is most likely responsible for these lesions?

A 28-year-old woman comes to the Rheumatology Clinic for review. She has suffered from multiple joint pains affecting her hands, wrists, elbows, knees, and feet over the past 12 weeks. Symptoms have failed to respond to regular naproxen. Examination reveals evidence of small-joint polyarthritis, with metacarpophalangeal joint (MCP) joint inflammation. Which of the following is the best initial investigation for detecting early rheumatoid joint changes in the hands?

A 47-year-old woman with a history of Crohn’s disease presents with chronic diarrhea and weight loss. What is the most appropriate diagnostic test?

A 45-year-old woman with systemic lupus erythematosus (SLE) comes to the clinic for review. She is currently well controlled on hydroxychloroquine. Which of the following markers would be best for assessing disease activity in this patient?

An 18-year-old woman is concerned about forgetting to take the combined oral contraceptive pill (COCP) and asks about an alternative contraceptive method. What is the most appropriate alternative contraception for this patient?

A 43-year-old woman is reviewed 14 days post-renal transplant from a cytomegalovirus (CMV)-positive donor. She has been treated with CMV prophylaxis and a tacrolimus- and prednisolone-based immunosuppressive regimen. Her BP is 142/88 mmHg and pulse 70 bpm, regular. There is erythema over her scar and minor tenderness over the transplanted kidney. The estimated glomerular filtration rate (eGFR) has fallen by 30 ml/min, and CRP is 29 mg/l. What is the most likely diagnosis?

A 41-year-old woman who works in a nursing home presents with an intensely itchy papular rash. The web spaces between her fingers are particularly itchy, and the itching worsens at night. What is the most appropriate intervention?

A 35-year-old man with recurrent UTIs is diagnosed with medullary sponge kidney (MSK) after imaging. What is the most common complication associated with this condition?

A 60-year-old man with weight loss and intermittent regurgitation of solid food is diagnosed with achalasia. What is the most likely underlying mechanism for his oesophageal dysfunction?

A 72-year-old woman with primary hyperparathyroidism has a phosphate level below normal. Where is the most pronounced effect of parathyroid hormone (PTH) on phosphate reabsorption?

A 45-year-old woman presents with proximal muscle weakness, dysphagia, and a rash on her eyelids. Her laboratory tests show elevated creatine kinase (CK). What is the most likely diagnosis?

A 42-year-old woman presents to the Outpatient Clinic for review of her BP management. She is taking a combination of amlodipine and indapamide, but is still hypertensive with a clinic BP of 155/95 mmHg. Her pulse is 70 bpm and regular. Her BMI is 22 kg/m². The creatinine level is elevated at 120 µmol/l and the potassium level is 3.4 mmol/l. Abdominal ultrasound scanning reveals asymmetrical kidneys, with a shrunken left kidney. Urine dipstick is positive for protein. Which of the following is the most likely cause of hypertension in this patient?