IM Eleetro

A 74-year-old type 2 diabetic woman undergoes a bowel resection for cancer of the colon. She is well prior to the operation with well-controlled diabetes and no other underlying disease. The operation is successful and the patient is given postoperative insulin and IV dextrose. Two days after the operation she becomes very agitated. Sodium 124 (135-145), Potassium3.3 (3.5- 5.0), Urea 3.1 (3.0-7.0), Glucose 7.2 (2.5--6.0), Serum osmolality 265 (275-295), Urine osmolality 150. The most likely cause of the hyponatraemia is:

A 55-year-old woman with metastatic pancreatic cancer attends the oncology clinic prior to her second cycle of chemotherapy. She tolerated her first cycle well but her husband mentions that there have been occasions where she has been confused. Her urea and electrolyte blood tests reveal a serum sodium of 116 mmol/L. All other results were within the normal range. The chemotherapy is delayed and a urine specimen is sent off. This reveals a urine osmolality of 620 mmol/kg. The most likely cause of the hyponatraemia is:

A 16-year-old boy presents with a low-grade fever which started 1 week ago. The patient also reports feeling fatigued and indicates pain in his joints. His parents mention that he has been visiting the toilet more often than usual. A urine dipstick shows trace proteins, while a blood test shows raised eosinophils. The most likely diagnosis is:

A 60-year-old diabetic man recovering from sepsis after collapsing at home was treated with appropriate antibiotics after blood culture and aggressive fluid management with 0.9 per cent saline for 2 days for hypotension. Although blood pressure returned to normal, the patient had the following abnormal biochemical blood results: pH 7.32, PC02 5.2, P02 11.1, Sodium 147 mmol/L, Potassium 3.5 mmol/L, Chloride 119 mmol/L, Bicarbonate 19.5. The most likely diagnosis is:

A 75-year-old man has been recently diagnosed with Parkinson's disease and started on levodopa (L-DOPA), which has helped his tremor and bradykinesia significantly. However, in the past week he had a fall shortly after getting out of his chair, during which he briefly blacked out, and afterwards was sweating and felt cold. Which of the following side effects most likely explains the fall?

A 63-year-old male smoker, on diuretics for essential hypertension, presents to the emergency department with chest pain. His ECG is presented to you. Amongst other signs, you notice T-wave inversion. Which of the following does not cause T-wave inversion?

A 59-year-old man is admitted to the emergency department following a fall. He complains of increased tiredness and jerking movement of his legs, which led to his fall from the staircase. He is a smoker. On arrival, he has an oxygen saturation level of 76% in air, and an arterial blood gas reading-demonstrates: pH 7.40, Pa02 6 kPa, PaC02 9.3 k.Pa, HC03 35 mmol/L on room air. His respiratory rate was 20/min. What does this blood gas result show?

A 32-year-old woman presents to her GP complaining of tingling and numbness around her mouth for 1 week. Occasionally, she also develops painful carpal spasm. She has a past medical history of Graves disease for which she just recently had subtotal thyroidectomy. What is the most likely diagnosis?

A 73-year-old man has been admitted with severe sepsis and acute renal failure secondary to a urinary tract infection. He has been treated with intravenous antibiotics and fluid resuscitation but the following day you are called to see him as he is worse. He looks extremely unwell. His airway is patent and he has laboured breathing at a rate of 22 breaths/min. His saturations are 98o/o on air and his chest sounds clear. His pulse is 120 bpm and blood pressure 85/55 mmHg. His capillary refill rate is 4 seconds. His urine output has been 40 ml in the last 5 hours. You see from his blood tests that his creatinine level has increased slightly. You take an arterial blood gas reading. Which of the following is the most likely result?

A 56-year-old woman who has recently been discharged from your ward, with oral antibiotics for right basal community-acquired pneumonia, is re-admitted with transient pyrexia and shortness of breath. She is found to have a right-sided pleural effusion which is drained and some pleural aspirate sent for analysis. The results reveal an empyema. Which of the following, from the pleural aspirate analysis, would typically be found in a patient with an empyema?

You are told that a patient in clinic has been diagnosed with cystic fibrosis using the sodium chloride sweat test. Which of the following results from the latter test would indicate a positive diagnosis of cystic fibrosis?

A 21-year-old woman complains of urinary frequency, nocturia, constipation and polydipsia. Her symptoms started 2 weeks ago and prior to this she would urinate twice a day and never at night. She has also noticed general malaise and some pain in her left flank. A urine dipstick is normal. The most appropriate investigation is:

Which of the following arterial blood gas results, taken on room air, would you expect to see in a 67-year-old patient who has been suffering with COPD for two years and is not on home oxygen?

A 39-year-old man presents with a three-month history of depression. The patient recently lost a family member and around the same period began to feel unwell with constipation and a depressed mood. He has started taking analgesia for a sharp pain in his right lower back that often radiates towards his front. The most appropriate investigation is:

A 42-year-old man presents with a 2-day history of severe chest pain. The patient reports a sudden ripping sensation at the front of the chest that occasionally radiates to the back. The patient has tried paracetamol and ibuprofen to alleviate the pain, but has had no success. The patient suffers from poorly controlled hypertension and at the last GP appointment his blood pressure was 167/95 mmHg. The most definitive investigation is:

You are informed that one of your ward patients has been breathless over the last hour and has been quite anxious since her relatives left after visiting. The patient is a 67-year-old woman who was admitted 6 days ago for a left basal pneumonia which has responded well with intravenous antibiotics. Her past medical history includes dementia and hypertension. You are asked by your registrar to interpret the patient's arterial blood gas (ABG) measurements taken during her tachypnoea: pH 7.49 kPa, P02 14.1, PC02 3.1 kPa, HC03 24. From the list of answers below, choose the most appropriate ABG interpretation:

A seven-year-old girl is brought to accident and emergency by her mother because of a nose bleed that keeps on bleeding despite pressure and ice-packs. Petechiae and ecchymoses can be seen on examination and the mother reports the child has recently recovered from a throat infection. You suspect the patient is suffering from immune thrombocytopenic purpura and organize tests to measure platelets (Pit), bleeding time (BT), prothrombin time (PT) and partial thromboplastin time (PTT). Which of the foil owing is the most appropriate result?

A 66-year-old man with a 10-year history of chronic obstructive pulmonary disease is assessed in the respiratory clinic for eligibility for long-term domiciliary oxygen therapy. Which of the following is NOT a criterion for prescription of long-term oxygen therapy?