Below are some very good question(clinical) try to solve them
Question 1 | |||||
| A 93 year old gentleman suffered a fall at his nursing home and was bought into A&E by ambulance. He complained of a headache that he described as 'the worst headache of my life'. On examination he showed signs of neck stiffness and photophobia. The physician ordered an urgent CT scan of the head. What is the likely cause of this gentleman's symptoms? | |||||
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| Answer: (a) Subarachnoid haemorrhage Subarachnoid haemorrhage occurs either due to a traumatic event or secondary to a leaking aneurysm. It results in a sudden onset headache often described as being 'the worst headache of my life'. Signs include neck stiffness and photophobia. Investigations of choice include CT scan and cerebral angiography. Treatment is either conservative or surgical with clipping or embolization of an aneurysm. |
Question 2 | |||||
| A 18 year old male presents to the emergency GP with sudden onset of pain in his right testis. He began feeling nauseous and vomited whilst in the GP's. The GP examined the testis, which appeared red and swollen. The GP arranged for immediate transfer to hospital. What is the most likely diagnosis? | |||||
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| Answer: (d) Testicular torsion Testicular torsion can be intravaginal: rotation within the tunica vaginalis, or extravaginal: rotation on the spermatic cord. Symptoms include acute onset of pain in the testicular area, which may extend to the iliac fossa. There may be associated nausea and vomiting, and on examination the testis will appear swollen, tender and have erythematous overlying skin. Doppler ultrasound scan may reveal reduced arterial flow to the testis but this test should not be performed if it will delay definitive treatment. Treatment is by surgical exploration, and untwisting of the testis. |
Question 3 | |||||
| A 63 year old male presents to his GP with an acutely painful right toe, following a drinking binge. On examination the toe is swollen, erythematous with red and shiny overlying skin, and is extremely tender to touch. The patient is currently taking furosemide, atenolol, ramipril and aspirin. Which of the following would be the most useful investigation to obtain a diagnosis? | |||||
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| Answer: (c) Synovial fluid aspirate This gentleman is suffering from an acute attack of gout. Gout is an example of a crystal arthropathy, in which the crystal monosodium urate is deposited in the joint resulting in symptoms of: extreme pain which develops in a few hours, erythematous and shiny skin and possible fever. Environmental factors such as alcohol consumption, dietary purine intake and the use of drugs such as diuretics are risk factors for the development of the condition. Any factor causing over production or under excretion of uric acid will raise the plasma concentration which increases the risk of gout developing. The differential diagnosis of monoarticular gout includes septic arthritis, trauma and cellulitis. Investigations should include the following:
Management includes the use of NSAIDS during the acute attack. If NSAID's are poorly tolerated, colchicine is an alternative. Intra-articular steroids may also be used and are highly effective. Therapy to increase excretion of uric acid, probenecid or sulphinpyrazone, or drugs to limit the production of uric acid such as allopurinol can be used in patients with recurrent attacks. This form of treatment should only be commenced 4-6 weeks after an acute attack. Diet and alcohol intake should also be adjusted. |
Question 4 | |||||
| A 60 year old gentleman, who recently emigrated from Australia, attends the dermatology clinic with a growth on his left ear. The dermatologist examines his ear and notes a 3cm and 2cm lesion with a pearly rolled edge. The lesion is not pigmented; it is painless and is not associated with any discharge. What is the most likely diagnosis of this gentleman's lesion? | |||||
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| Answer: (b) Basal Cell carcinoma (BCC) The most common type of basal cell carcinoma is nodular basal cell carcinoma, a flesh-coloured, round or oval translucent nodule with overlying small blood vessels and a pearly-appearing rolled edge. It is an extremely common neoplasm which often occurs on the face, head or neck of older people. They never metastisize, but growth can lead to deep invasion resulting in high rates of recurrence. Risk factors include sun damage and previous x-ray treatment to the spine for ankylosing spondilitis and scalp for tinea capitis. Treatment options include excision, curettage and cautery or radiotherapy. |
Question 5 | |||||
| A 60 year old ship worker is admitted to the respiratory ward with progressive breathlessness and a cough. On examination there is gross finger clubbing and bibasal end-inspiratory crackles. A chest x-ray reveals symmetrical basal parenchymal changes and pleural plaques. Which type of lung cancer is this patient at increased risk of developing? | |||||
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| Answer: (e) Mesothelioma Asbestos exposure increases the risk of development of asbestosis and mesothelioma. The greater the exposure the higher the risk. There is usually a delay between exposure and development of symptoms related to the disease. Typical symptoms of asbestosis are progressive breathlessness and cough. Clinical signs include end inspiratory crackles on auscultation, and finger clubbing which is present in approximately 50% of patients. Investigations should include chest x-ray, high resolution computed tomography (HRCT) and pulmonary function tests. Chest x-ray may reveal symmetrical basal parenchymal changes and in 75% of cases pleural plaques. HRCT may reveal subpleural changes progressing to honeycombing. Rounded atelectesis may also be distinguished from carcinoma by HRCT. Pulmonary function tests will demonstrate a restrictive defect. There is no effective treatment currently. Mesothelioma is a malignant growth in the pleura or occasionally in the pericardium or peritoneum. Presentation is usually with breathlessness due to bilateral pleural effusions. Pain may also result from invasion of the chest wall by the tumour and encasement of the lung can result in worsening breathlessness. Chest x-ray may demonstrate pleural plaques, pleural effusions or nodularity. CT may reveal pleural thickening and pleural aspiration should be carried out, which in 30% of cases detects blood stained fluid. No treatment has been shown to improve outcome and treatment is symptomatic, including pleural aspiration of effusions. |
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