General Medicine MCQs for NEET PG
980 worked General Medicine questions across 47 areas. Each one has its own page with the reasoning for every option.
What this set is
General Medicine is one of the largest subjects and is mostly clinical reasoning: recognise the picture, choose the investigation, and pick the next step. It overlaps with pathology, pharmacology and microbiology.
This page lists the 980 General Medicine questions that have a full worked page: 709 application questions that put a fact to use on a patient or a finding, and 271 multi-step questions that combine two or more ideas. Plain one-fact recall items are left out here on purpose. The General Medicine practice bank in the app is larger, with 3,401 questions in all, and is where timed tests and daily practice draw from.
How to use it
- Pick an area you are weak in, below.
- Answer first, then read why each wrong option fails.
- Write a three-line note for every miss, and revisit it in a week.
- Move to a timed General Medicine test once an area feels steady.
These are original practice items, not recalled exam questions, and they are not yet reviewed by independent faculty. Confirm important facts in a standard textbook.
What General Medicine covers in the exam
- Cardiology
- Respiratory medicine
- Gastroenterology and hepatology
- Nephrology and electrolytes
- Endocrinology and diabetes
- Haematology and oncology
- Neurology
- Rheumatology
- Infectious diseases
- Emergency and critical care
A study map from the standard curriculum; the NBEMS bulletin is the authority. See the General Medicine study guide.
Worked questions by area
47 areas, largest first. Open an area to see its questions.
Cardiology127
- Cardiology · ApplicationAn elderly man has exertional angina, syncope and breathlessness, with an ejection systolic murmur radiating to the carotids. What is the most likely diagnosis?
- Cardiology · ApplicationA patient with chest pain has ST elevation in leads II, III and aVF. Which artery is most likely occluded?
- Cardiology · ApplicationA 65-year-old man has palpitations, chest pain and a blood pressure of 80/50 mmHg. His ECG shows irregularly irregular narrow-complex tachycardia at 170 per minute. Wha…
- Cardiology · Multi-stepA 32-year-old man has palpitations and presents with an irregular, very rapid wide-complex tachycardia of 220 per minute with varying QRS morphology. His resting ECG ea…
- Cardiology · ApplicationA 30-year-old man has sharp pleuritic central chest pain that eases on sitting forward, two weeks after a viral illness. ECG shows widespread concave ST elevation with…
- Cardiology · ApplicationA 22-year-old athlete collapses during sport. Examination reveals a harsh ejection systolic murmur at the left sternal edge that becomes louder on standing or on the Va…
- Cardiology: aortic dissection · Multi-stepA 58-year-old hypertensive man has sudden tearing chest pain radiating to the back. Blood pressure is 190/110 mmHg in the right arm and 150/90 mmHg in the left, and the…
- Cardiology: atrial fibrillation · Multi-stepA 72-year-old woman with hypertension and type 2 diabetes has newly diagnosed non-valvular atrial fibrillation. What is her CHA2DS2-VASc score, and what does it imply?
- Cardiology: mitral stenosis · ApplicationA 34-year-old woman with a history of rheumatic fever has exertional breathlessness. She has a loud first heart sound, an opening snap and a mid-diastolic rumble at the…
- Cardiology: rheumatic fever · ApplicationA 10-year-old girl has purposeless, jerky movements of her hands and facial grimacing that have worsened over 3 weeks, with emotional lability. She had a sore throat 3…
- Cardiology: heart failure therapy · ApplicationA 60-year-old man with ischaemic cardiomyopathy and an ejection fraction of 30% remains in NYHA class III despite an ACE inhibitor, a beta-blocker and a mineralocortico…
- Cardiology: atrial septal defect · ApplicationA 20-year-old woman has mild exertional dyspnoea. Examination shows a wide, fixed split of the second heart sound and a soft ejection systolic murmur in the pulmonary a…
- Cardiology: renovascular hypertension · Multi-stepA 62-year-old chronic smoker with hypertension has an abdominal bruit and a history of recurrent episodes of sudden pulmonary oedema. One week after ramipril is started…
- Cardiology: atrioventricular block · ApplicationA 72-year-old man has had two syncopal episodes. His ECG shows a constant PR interval of 180 ms in conducted beats, with intermittent single non-conducted P waves and a…
- Cardiology: torsades de pointes · ApplicationA 55-year-old woman on erythromycin and a diuretic has palpitations and a brief syncope. Her ECG shows a QTc of 570 ms and runs of polymorphic ventricular tachycardia w…
- Cardiology: variant angina · Multi-stepA 38-year-old woman who smokes has episodes of central chest pain at rest, usually between 3 and 5 am. During one episode the ECG shows transient ST elevation in the in…
- Cardiology: complications of myocardial infarction · Multi-stepFour days after an inferior myocardial infarction, a 66-year-old man suddenly develops severe breathlessness and pulmonary oedema. A new loud apical pansystolic murmur…
- Cardiology: reperfusion in STEMI · Multi-stepA 52-year-old man arrives at a district hospital without a catheterisation laboratory, 2 hours after the onset of chest pain, with ST elevation in the anterior leads. H…
- Cardiology: cardiac amyloidosis · ApplicationA 72-year-old man has exertional dyspnoea, bilateral carpal tunnel syndrome and peripheral oedema. Echocardiography shows thickened left ventricular walls with a small…
- Cardiology: prosthetic valve anticoagulation · ApplicationA 44-year-old woman has had a mechanical mitral valve replacement for rheumatic mitral disease and now has atrial fibrillation. Which anticoagulant strategy is appropri…
- Cardiology: Eisenmenger syndrome · ApplicationA 24-year-old woman with a large ventricular septal defect that was never repaired now has exertional breathlessness, central cyanosis and clubbing. The pansystolic mur…
- Cardiology: digoxin toxicity · ApplicationA 70-year-old woman with heart failure and atrial fibrillation takes digoxin and furosemide. She has nausea, yellow-tinged vision and palpitations. Her ECG shows freque…
- Cardiology: constrictive pericarditis versus restrictive cardiomyopathy · Multi-stepA 45-year-old farmer who had tuberculous pericarditis years ago has progressive ankle swelling and ascites. Jugular venous pressure rises on inspiration, an early diast…
- Cardiology: Brugada syndrome · ApplicationA 34-year-old man from Thailand collapsed at night and recovered spontaneously. His brother died suddenly in sleep at 30. ECG shows coved ST elevation with a right bund…
- Cardiology: infective endocarditis with Streptococcus gallolyticus · Multi-stepA 66-year-old man has had fever and weight loss for three weeks. A new aortic regurgitation murmur is heard, and two blood culture sets grow Streptococcus gallolyticus…
- Cardiology: right ventricular infarction · Multi-stepA 60-year-old man has an inferior ST-elevation myocardial infarction. He is hypotensive at 80/50 mmHg with a raised jugular venous pressure, clear lung fields and ST el…
- Cardiology: Takotsubo cardiomyopathy · ApplicationA 64-year-old woman develops central chest pain two days after her husband dies. ECG shows anterior ST elevation and troponin is mildly raised. Coronary angiography sho…
- Cardiology: chronic thromboembolic pulmonary hypertension · Multi-stepA 52-year-old woman had an acute pulmonary embolism eight months ago and has taken warfarin since. She has progressive exertional breathlessness and her echocardiogram…
- Cardiology: ventricular septal defect · ApplicationA 6-year-old child has a loud harsh pansystolic murmur at the left lower sternal border with a palpable thrill. The pulmonary second sound is normal. What is the most l…
- Cardiology: endocarditis prophylaxis · ApplicationWhich of the following patients should receive antibiotic prophylaxis before a dental extraction to prevent infective endocarditis?
- Cardiology: familial hypercholesterolaemia · Multi-stepA 24-year-old man has tendon xanthomas over the Achilles tendons and an LDL cholesterol of 340 mg/dL. His father had a myocardial infarction at 40 years. Which defect i…
- Cardiology: severe aortic stenosis · ApplicationA 68-year-old man has exertional syncope and angina, an ejection systolic murmur radiating to the carotids, a slow-rising pulse and a soft second heart sound. Which int…
- Cardiology: hypertension in pregnancy · ApplicationA 28-year-old woman at 30 weeks of gestation has a blood pressure of 170/110 mmHg. Which antihypertensive must be avoided?
- Cardiology: Marfan syndrome · ApplicationA tall 20-year-old man has an arm span exceeding his height, upward lens subluxation and a dilated aortic root. What is the most important cause of death in this condit…
- Cardiology: heart failure with preserved ejection fraction · Multi-stepA 70-year-old man with type 2 diabetes has heart failure with an ejection fraction of 55 percent and persistent symptoms despite diuretics. Which drug class has been sh…
- Cardiology: acute viral myocarditis · ApplicationA 22-year-old man has chest pain and dyspnoea a week after a flu-like illness. The ECG shows diffuse ST elevation, troponin is raised and coronary angiography is normal…
- Cardiology: vasovagal syncope · ApplicationA 20-year-old faints after standing for a long time in a hot crowded room, with prior nausea and sweating, and recovers quickly. ECG and examination are normal. What is…
- Cardiology: peripartum cardiomyopathy · Multi-stepA 30-year-old woman has orthopnoea and an ejection fraction of 30 percent six weeks after delivery, with no previous heart disease. What is the key counselling point ab…
- Cardiology: posterior MI ECG · Multi-stepA patient with chest pain has ST depression and tall R waves in V1 to V3 with an upright T wave. Which step best confirms the diagnosis?
- Cardiology: ventricular septal rupture · ApplicationA patient on day 3 after anterior MI develops hypotension and a new harsh pansystolic murmur at the left sternal edge with a thrill. Which finding is expected on right…
- Cardiology: Dressler syndrome · ApplicationThree weeks after an anterior MI a patient has fever, pleuritic chest pain and a friction rub. ECG shows diffuse ST elevation. What is the treatment of choice?
- Cardiology: free wall rupture · ApplicationA patient 5 days after MI suddenly loses consciousness with an ECG showing organised rhythm but no pulse. Neck veins are distended just before collapse. What is the mos…
- Cardiology: contraindications to thrombolysis · ApplicationWhich of the following is an absolute contraindication to thrombolysis in STEMI?
- Cardiology: NSTEMI management · ApplicationA patient has chest pain, ST depression and raised troponin without ST elevation. Which combination forms the core of initial treatment?
- Cardiology: Prinzmetal angina · ApplicationA 40-year-old smoker has rest chest pain at night with transient ST elevation that resolves with nitroglycerin. Angiography shows normal coronaries. Which drug is first…
- Cardiology: stable angina therapy · ApplicationIn chronic stable angina, which statement about anti-anginal drugs is correct?
- Cardiology: survival drugs in HFrEF · ApplicationWhich set of drugs improves survival in heart failure with reduced ejection fraction?
- Cardiology: BNP and neprilysin inhibition · Multi-stepA patient with heart failure is switched from enalapril to sacubitril-valsartan. Which biomarker interpretation is correct afterwards?
- Cardiology: percutaneous balloon mitral valvotomy · Multi-stepA 30-year-old woman with rheumatic severe mitral stenosis, NYHA III symptoms, pliable valve, Wilkins score 7 and no left atrial thrombus or significant MR is being plan…
- Cardiology: anticoagulation in valvular AF · ApplicationA patient with moderate-to-severe rheumatic mitral stenosis develops atrial fibrillation. Which anticoagulant is recommended?
- Cardiology: Heyde syndrome · ApplicationAn elderly patient with calcific aortic stenosis has recurrent gastrointestinal bleeding from colonic angiodysplasia and acquired von Willebrand syndrome. What is this…
- Cardiology: hypertrophic cardiomyopathy · ApplicationWhich statement about hypertrophic cardiomyopathy is correct?
- Cardiology: restrictive cardiomyopathy · ApplicationA patient with heart failure has normal ventricular wall thickness on echo, biatrial enlargement and a dip-and-plateau pressure tracing on catheterisation. Which cause…
- Cardiology: Duke criteria and organisms · ApplicationWhat is the commonest causative organism of native valve infective endocarditis worldwide and the diagnostic framework used?
- Cardiology: right-sided endocarditis · ApplicationAn intravenous drug user has fever, multiple cavitating nodules on chest X-ray and a pansystolic murmur at the left lower sternal border that increases with inspiration…
- Cardiology: constrictive pericarditis · Multi-stepA young man from a tuberculosis-endemic area has ascites, raised JVP that rises on inspiration, an early diastolic knock and pericardial calcification on chest X-ray. W…
- Cardiology: complete heart block · ApplicationAn ECG shows P waves and QRS complexes marching independently at rates of 90 and 35 per minute respectively. What is the treatment of choice if the cause is irreversible?
- Cardiology: pulmonary arterial hypertension drugs · ApplicationWhich group of drugs is used specifically for pulmonary arterial hypertension?
- Cardiology: microvascular angina · ApplicationA 48-year-old woman has exertional chest pain relieved by rest. Treadmill testing shows ST depression, but coronary angiography shows smooth, normal epicardial arteries…
- Cardiology: electrical alternans in pericardial effusion · ApplicationA patient with a large malignant pericardial effusion has low-voltage QRS complexes whose amplitude and axis change on alternate beats. What explains this beat-to-beat…
- Cardiology: Graham Steell murmur · Multi-stepA woman with long-standing rheumatic mitral stenosis develops severe pulmonary hypertension. A new high-pitched early diastolic decrescendo murmur is heard at the left…
- Cardiology: cannon a waves in complete heart block · ApplicationA man with syncope has a regular pulse of 36 per minute. Intermittent, very large pulsations are seen in his neck and the intensity of the first heart sound varies from…
- Cardiology: left ventricular aneurysm after infarction · ApplicationSix weeks after an extensive anterior myocardial infarction, a man has no chest pain but his ECG still shows ST elevation with Q waves in V1 to V4. He has had two episo…
- Cardiology: Ebstein anomaly features · Multi-stepA 22-year-old woman has mild cyanosis, widely split heart sounds and a systolic murmur at the lower left sternal border. The chest radiograph shows a very large, box-sh…
- Cardiology: Chagas cardiomyopathy · ApplicationA man who grew up in a mud-walled house in rural Brazil has heart failure. ECG shows right bundle branch block with left anterior fascicular block, echocardiography sho…
- Cardiology: pre-excited atrial fibrillation · Multi-stepA 32-year-old man has had palpitations for 2 hours and is haemodynamically stable. The ECG shows an irregular wide-complex tachycardia at 210 per minute with varying QR…
- Cardiology: Mobitz type I block · ApplicationA 19-year-old athlete is asymptomatic at a routine check. His resting ECG shows progressive lengthening of the PR interval until one P wave is not conducted, after whic…
- Cardiology: mechanism of Austin Flint murmur · ApplicationA 50-year-old man with severe chronic aortic regurgitation has a soft, low-pitched mid-to-late diastolic rumble at the apex. There is no opening snap and the first hear…
- Cardiology: PCSK9 inhibitors · ApplicationA 30-year-old with heterozygous familial hypercholesterolaemia has an LDL of 190 mg/dL despite a maximal statin dose plus ezetimibe. Evolocumab injections are added. Ho…
- Cardiology: Libman-Sacks endocarditis · ApplicationA 26-year-old woman with a malar rash, arthritis and proteinuria develops a new regurgitant murmur. Echocardiography shows small sterile vegetations on both surfaces of…
- Cardiology: Noonan syndrome cardiac lesion · ApplicationA 6-year-old boy has short stature, a webbed neck, low-set ears, ptosis and pectus excavatum. An ejection systolic murmur is heard at the upper left sternal border, pre…
- Cardiology: squatting in tetralogy of Fallot · ApplicationA child with tetralogy of Fallot squats during play and the cyanosis eases. What is the physiological basis of this relief?
- Cardiology: transposition of the great arteries · ApplicationA full-term neonate is cyanosed on day 1 with a single loud second sound and no murmur. The chest radiograph shows a narrow mediastinum, an egg-on-a-string heart and in…
- Cardiology: left atrial myxoma · ApplicationA 45-year-old woman has fever, weight loss and a raised ESR. She also has episodes of breathlessness and presyncope on sitting up, and a low-pitched early diastolic sou…
- Cardiology: ticagrelor dyspnoea · ApplicationA 58-year-old man takes aspirin and ticagrelor after a non-ST elevation myocardial infarction. Two weeks later he notes a feeling of breathlessness at rest, though his…
- Cardiology: clopidogrel activation · ApplicationA patient with a drug-eluting stent develops recurrent stent thrombosis although taking clopidogrel regularly. Genotyping shows two loss-of-function alleles in the gene…
- Cardiology: primary prevention ICD · Multi-stepA 62-year-old man had an anterior myocardial infarction 6 months ago. On optimal ACE inhibitor, beta-blocker and spironolactone he is in NYHA class II. Echocardiography…
- Cardiology: tachycardia-bradycardia syndrome · Multi-stepA 76-year-old woman has episodes of fast palpitations alternating with dizziness, and one syncopal attack. Holter monitoring shows paroxysms of atrial fibrillation that…
- Cardiology: non-compressible vessels and ankle-brachial index · Multi-stepA 63-year-old man with long-standing diabetes and chronic kidney disease has calf pain after 200 metres of walking that settles on rest. Foot pulses are not palpable, b…
- Cardiology: pharmacological stress testing · ApplicationA 70-year-old man who cannot exercise because of severe arthritis has a myocardial perfusion scan with dipyridamole. During the test he develops wheeze and chest discom…
- Cardiology: ivabradine mechanism · ApplicationA 55-year-old man with heart failure and an ejection fraction of 30% is in sinus rhythm with a resting heart rate of 84 per minute despite the maximum tolerated beta-bl…
- Cardiology: ACE inhibitor cough · ApplicationA 55-year-old man takes ramipril for hypertension. He has had a persistent dry, tickling cough for 6 weeks. Examination and chest radiograph are normal. What is the bes…
- Cardiology: spironolactone gynaecomastia · ApplicationA 58-year-old man with heart failure and a low ejection fraction takes spironolactone and develops painful breast enlargement. Serum potassium is 4.6 mmol/L. What is th…
- Cardiology: niacin flushing · ApplicationA man with low HDL cholesterol is started on nicotinic acid and develops facial flushing within an hour of each dose. Which measure reduces this effect?
- Cardiology: intra-aortic balloon pump contraindication · Multi-stepAn intra-aortic balloon pump is being considered in a patient with cardiogenic shock. In which coexisting condition is it contraindicated?
- Cardiology: typical atrial flutter · ApplicationA 66-year-old man has a regular narrow-complex tachycardia at 150 per minute. Adenosine transiently slows the ventricular rate and reveals a saw-tooth baseline at about…
- Cardiology: culture-negative endocarditis · ApplicationA 30-year-old man with a bicuspid aortic valve and a recent dental extraction has 3 weeks of fever and a new murmur. Routine blood cultures are negative at 48 hours, bu…
- Cardiology: atrial fibrillation · ApplicationWhat rhythm is typically irregularly irregular without distinct P waves?
- Cardiology: heart failure · ApplicationWhich biomarker can support diagnosis of heart failure in dyspnea?
- Cardiology: pericardial tamponade · ApplicationHypotension, raised JVP, and muffled heart sounds suggest what?
- Cardiology · ApplicationChest pain with ST elevation requires what pathway?
- Cardiology · ApplicationOrthopnea and edema suggest what syndrome?
- Cardiology · ApplicationSyncope with exertional murmur suggests what valve lesion?
- Cardiology · ApplicationIrregularly irregular pulse suggests what rhythm?
- Cardiology · ApplicationPleuritic pain relieved leaning forward suggests what?
- Cardiology · ApplicationTearing chest pain to back suggests what?
- Cardiology · ApplicationWhat is a common symptom of left-sided heart failure?
- Cardiology · ApplicationWhat investigation records the electrical activity of the heart?
- Cardiology · ApplicationWhat biomarker is commonly used to support diagnosis of myocardial injury?
- Cardiology · ApplicationWhat is a typical symptom of angina?
- Cardiology · ApplicationWhat is a modifiable risk factor for coronary artery disease?
- Cardiology · ApplicationWhat is the usual symptom of atrial fibrillation?
- Cardiology · ApplicationWhat examination finding may suggest fluid overload in heart failure?
- Cardiology · ApplicationWhat is a key immediate assessment in a patient with chest pain?
- Cardiology · ApplicationWhat modifiable lifestyle factor helps reduce hypertension risk?
- Cardiology · ApplicationWhat test is obtained promptly for suspected acute coronary syndrome?
- Cardiology · ApplicationWhat biomarker supports diagnosis of myocardial injury?
- Cardiology · ApplicationWhat symptom commonly occurs in left-sided heart failure?
- Cardiology · ApplicationWhat rhythm is characterized by an irregularly irregular pulse?
- Cardiology · ApplicationWhich feature is most concerning for infective endocarditis in a patient with persistent fever?
- Cardiology · ApplicationWhich symptom pattern is most typical of exertional stable angina?
- Cardiology · ApplicationWhich symptom is most typical of stable exertional angina?
- Cardiology · ApplicationWhat is the usual first investigation for a patient with suspected acute coronary syndrome?
- Cardiology · ApplicationWhich finding is most consistent with left-sided heart failure?
- Cardiology · ApplicationWhich drug class is commonly used to relieve fluid overload in heart failure?
- Cardiology: acute coronary syndrome · Multi-stepA patient develops crushing central chest pain with ST-segment elevation in the inferior leads and is hypotensive with clear lungs. Which complication should be activel…
- Cardiology: aortic stenosis · ApplicationAn older adult has exertional syncope, angina, and a harsh ejection systolic murmur radiating to the carotids. Which valve lesion is most likely?
- Cardiology: infective endocarditis · Multi-stepA patient with fever and a new regurgitant murmur has repeatedly positive blood cultures for Staphylococcus aureus. What is the most appropriate next diagnostic investi…
- Cardiology: acute coronary syndrome · ApplicationA patient with STEMI arrives within 90 minutes of symptom onset at a PCI-capable centre. What is the preferred reperfusion strategy?
- Cardiology: heart failure · ApplicationWhich finding is most typical of left-sided heart failure?
- Cardiology: atrial fibrillation · ApplicationAn unstable patient in atrial fibrillation has hypotension and chest pain. What is the immediate management?
- Cardiology: hypertrophic cardiomyopathy · Multi-stepA young athlete has exertional syncope and a harsh systolic murmur that becomes louder during Valsalva. Which diagnosis is most likely?
- Cardiology: aortic dissection · Multi-stepA patient has abrupt tearing chest pain radiating to the back, unequal arm blood pressures, and a new early diastolic murmur. What diagnosis must be presumed?
- Cardiology: infective endocarditis · ApplicationWhich physical finding is a peripheral manifestation of infective endocarditis?
- Cardiology: mitral stenosis · ApplicationA patient with rheumatic heart disease has exertional dyspnea, hemoptysis, atrial fibrillation, and an opening snap followed by a mid-diastolic murmur at the apex. What…
- Cardiology: constrictive pericarditis · ApplicationA patient has elevated JVP, ascites, peripheral edema, and a sharp early diastolic pericardial knock after prior tuberculosis. What diagnosis is most likely?
- Cardiology: myocarditis · ApplicationA young adult develops chest pain, troponin elevation, and reduced ventricular function several days after a viral illness, with unobstructed coronary arteries. What di…
Neurology108
- Neurology · Multi-stepA chronic alcohol user is brought in confused, with nystagmus and an unsteady gait. What should be given first?
- Neurology · ApplicationA patient arrives 2 hours after the onset of right-sided weakness and aphasia. CT shows no haemorrhage. What is the most appropriate treatment?
- Neurology · ApplicationA 28-year-old woman has drooping eyelids and double vision that worsen by evening and improve after rest. Fatigable weakness is seen on sustained upgaze. Which antibody…
- Neurology · ApplicationA 30-year-old man develops ascending leg weakness with absent knee jerks two weeks after a diarrhoeal illness. Sensation is nearly normal. What is the most important ne…
- Neurology · ApplicationA 72-year-old man has progressive gait disturbance with short magnetic steps, urinary urgency and memory decline over several months. CT shows enlarged ventricles witho…
- Neurology · ApplicationA 28-year-old woman has an episode of painful loss of vision in one eye that recovers, and 8 months later has tingling in the legs with an electric shock sensation on n…
- Neurology · ApplicationA 62-year-old heavy smoker has proximal leg weakness, dry mouth and erectile dysfunction. Strength improves briefly after sustained contraction, and reflexes are reduce…
- Neurology: subarachnoid haemorrhage · ApplicationA 40-year-old woman has a sudden severe headache, 'the worst of her life', with neck stiffness. A non-contrast CT head done 18 hours after onset is normal. What is the…
- Neurology: lateral medullary syndrome · ApplicationA 60-year-old hypertensive man has sudden vertigo, vomiting, hoarseness and dysphagia. Examination shows loss of pain and temperature sensation on the left side of the…
- Neurology: carotid stenosis and stroke prevention · ApplicationA 66-year-old man had a 5-minute episode of painless blindness in the right eye three days ago. Carotid Doppler shows 80% stenosis of the right internal carotid artery,…
- Neurology: extended-window stroke thrombectomy · Multi-stepA 64-year-old man developed witnessed left hemiparesis and gaze deviation 12 hours ago (NIHSS 16). CT shows a small infarct core, CT angiography shows right M1 occlusio…
- Neurology: childhood absence epilepsy · ApplicationAn 8-year-old girl has many daily episodes of staring for about 10 seconds with eyelid fluttering, abrupt recovery and no postictal confusion. Hyperventilation reproduc…
- Neurology: antiseizure drugs and pregnancy · ApplicationA 24-year-old woman with juvenile myoclonic epilepsy is planning a pregnancy. Her neurologist wants to reduce the risk of major malformations and impaired neurodevelopm…
- Neurology: dementia with Lewy bodies · ApplicationA 72-year-old man has fluctuating confusion, well-formed visual hallucinations of children, dream enactment behaviour during sleep and mild parkinsonism that appeared 6…
- Neurology: migraine with aura and contraception · ApplicationA 29-year-old woman has migraine with visual aura (zigzag lines for 20 minutes before the headache) and is taking a combined oral contraceptive pill. What is the most a…
- Neurology: cluster headache · ApplicationA 35-year-old smoker has had severe unilateral orbital pain lasting 45 minutes, occurring several times daily at about the same time for three weeks, with lacrimation,…
- Neurology: idiopathic intracranial hypertension · ApplicationA 27-year-old obese woman has daily headaches worse on lying down, transient visual obscurations and bilateral papilloedema. MRI and MR venography are normal and lumbar…
- Neurology: tuberculous meningitis · Multi-stepA 22-year-old man from a crowded urban slum has 3 weeks of headache and low-grade fever, then drowsiness and a right sixth nerve palsy. CSF is clear with a cobweb clot,…
- Neurology: cryptococcal meningitis in HIV · Multi-stepA 35-year-old man with HIV (CD4 count 40 per mm3) has a 2-week headache and fever. CT head is normal, lumbar puncture opening pressure is 42 cm of CSF, and India ink an…
- Neurology: cysticercal encephalitis · Multi-stepA 19-year-old man has headache, repeated vomiting, seizures and papilloedema. CT shows hundreds of small enhancing lesions scattered throughout the brain, giving a star…
- Neurology: neuromyelitis optica spectrum disorder · ApplicationA 30-year-old woman has severe bilateral visual loss over a week, followed by a transverse myelitis whose MRI lesion spans five vertebral segments, and intractable vomi…
- Neurology: amyotrophic lateral sclerosis · ApplicationA 58-year-old man has progressive wasting and fasciculations of the hands with brisk reflexes and spasticity in the legs. Sensation, eye movements and bladder control a…
- Neurology: chronic inflammatory demyelinating polyneuropathy · Multi-stepA 45-year-old man has symmetrical proximal and distal limb weakness with areflexia that has progressed over 4 months. CSF protein is 180 mg/dL with 2 cells per mm3, and…
- Neurology: Huntington disease genetics · ApplicationA 42-year-old man has progressive chorea, irritability, depression and cognitive decline. His father died in an institution after a similar illness, and MRI shows atrop…
- Neurology: herpes simplex encephalitis · ApplicationA 35-year-old man has had fever, headache and behavioural change for three days, followed by a focal seizure. MRI shows left temporal lobe hyperintensity, and CSF shows…
- Neurology: cerebral venous thrombosis · Multi-stepA 26-year-old woman on an oral contraceptive has had a severe headache for a week, followed by a seizure. She has papilloedema, and CT shows a small parasagittal haemor…
- Neurology: syringomyelia · ApplicationA 30-year-old man has painless burns on both hands, wasting of the small hand muscles, and loss of pain and temperature over both shoulders and arms in a cape distribut…
- Neurology: Brown-Sequard syndrome · Multi-stepAfter a stab injury to the back, a man has weakness with loss of vibration and joint position sense in the right leg, and loss of pain and temperature in the left leg u…
- Neurology: Bell palsy · ApplicationA 30-year-old man wakes with a drooping right face, cannot close his right eye or wrinkle his right forehead, and notes loss of taste on the anterior tongue and sounds…
- Neurology: progressive supranuclear palsy · Multi-stepA 68-year-old man has had repeated backward falls in the first year of illness, stiff neck and trunk, a staring expression and difficulty looking downwards. He has no t…
- Neurology: cauda equina syndrome · Multi-stepA 40-year-old man with low back pain and sciatica develops urinary retention with overflow incontinence, numbness around the perineum, weakness of both legs and reduced…
- Neurology: neurosyphilis (tabes dorsalis) · Multi-stepA 55-year-old man has lightning pains in his legs, a wide-based gait that is worse in the dark, absent ankle jerks, a positive Romberg sign and small irregular pupils t…
- Neurology: Parkinson disease pathology · ApplicationA 65-year-old man has a 4 to 6 Hz pill-rolling resting tremor, bradykinesia and cogwheel rigidity. What is the underlying pathology?
- Neurology: thrombolysis in ischaemic stroke · Multi-stepA patient arrives 2 hours after onset of an ischaemic stroke. Which finding is a contraindication to intravenous alteplase?
- Neurology: painful diabetic neuropathy · ApplicationA 58-year-old with diabetes has burning pain in both feet at night. Which drug has first-line evidence for neuropathic pain?
- Neurology: Alzheimer disease genetics · ApplicationWhich genetic factor is the strongest risk factor for sporadic late-onset Alzheimer disease?
- Neurology: brain abscess · ApplicationA young man with cyanotic congenital heart disease has fever, headache and a focal deficit. CT shows a 3 cm ring-enhancing lesion. Which is the appropriate management?
- Neurology: viral meningitis · ApplicationA 20-year-old has fever, headache and neck stiffness. CSF shows 120 lymphocytes per microlitre, protein 70 mg/dL and glucose 60 mg/dL with a blood glucose of 90 mg/dL.…
- Neurology: high-risk transient ischaemic attack · Multi-stepA 65-year-old has 20 minutes of transient right hand weakness that has fully resolved, and his ABCD2 score is 5. What is the best antithrombotic management?
- Neurology: brainstem death · Multi-stepWhile testing for brainstem death in a ventilated patient with irreversible brain injury, which finding is incompatible with the diagnosis?
- Neurology: middle cerebral artery stroke · ApplicationA patient has right face and arm weakness more than leg, with non-fluent speech and good comprehension. Which vascular territory is affected?
- Neurology: Weber syndrome · ApplicationA patient has right oculomotor nerve palsy with a dilated pupil and left hemiparesis. Where is the lesion?
- Neurology: anterior cerebral artery stroke · ApplicationA patient after a stroke has weakness and sensory loss in the contralateral leg, with apathy and urinary incontinence. Which artery is involved?
- Neurology: lacunar infarct · ApplicationA long-standing hypertensive patient develops sudden pure motor hemiparesis involving the face, arm and leg without sensory or cortical signs. What is the likely lesion?
- Neurology: phenytoin toxicity · ApplicationA patient on phenytoin has nystagmus, ataxia and slurred speech. Which long-term adverse effect is characteristic of this drug?
- Neurology: Parkinson-plus syndromes · Multi-stepA man with parkinsonism poorly responsive to levodopa has severe orthostatic hypotension, urinary retention and cerebellar signs. Which is the likely diagnosis?
- Neurology: Alzheimer disease treatment · ApplicationWhich statement about Alzheimer disease is correct?
- Neurology: Wilson disease · Multi-stepA 17-year-old has tremor, dysarthria, Kayser-Fleischer rings and low serum ceruloplasmin with raised 24-hour urinary copper. What is the treatment?
- Neurology: myasthenia gravis · ApplicationA 30-year-old woman has ptosis and diplopia that worsen in the evening and improve with rest. Which investigation should be done after confirming antibodies?
- Neurology: myasthenic crisis · Multi-stepA myasthenic patient develops dyspnoea, weak cough and a falling forced vital capacity of 15 mL/kg after an infection. What is the right management?
- Neurology: Duchenne muscular dystrophy · ApplicationA 5-year-old boy needs to climb up his own legs to stand and has calf enlargement and raised creatine kinase. What is the defect?
- Neurology: subacute combined degeneration · ApplicationA patient with B12 deficiency has spastic weakness, brisk knee reflexes, extensor plantars and loss of vibration and position sense. Which tracts are affected?
- Neurology: brain abscess imaging · Multi-stepMRI of a febrile patient shows a ring-enhancing lesion with central high signal on diffusion-weighted imaging and low ADC. What does this favour?
- Neurology: third nerve palsy with pupil involvement · Multi-stepA patient has sudden severe headache, ptosis and a dilated non-reactive pupil with the eye down and out. What is the most likely cause?
- Neurology: cardiac involvement in myotonic dystrophy · ApplicationA 30-year-old man has difficulty releasing his grip, frontal balding, bilateral ptosis, cataracts and testicular atrophy. His father had similar symptoms with onset at…
- Neurology: anterior spinal artery syndrome · ApplicationAfter thoracoabdominal aortic aneurysm repair, a man develops sudden bilateral flaccid paralysis of the legs with loss of pain and temperature sensation below T8 and ur…
- Neurology: locked-in syndrome · ApplicationA 55-year-old man with sudden quadriplegia and inability to speak is fully alert. He answers questions by blinking and moving his eyes up and down. Which lesion explain…
- Neurology: essential tremor treatment · ApplicationA 45-year-old teacher has bilateral action tremor of the hands that interferes with writing and drinking. It is absent at rest, improves slightly after a small amount o…
- Neurology: internuclear ophthalmoplegia · Multi-stepA 28-year-old woman with relapsing neurological episodes cannot adduct her right eye on looking to the left, while the left eye abducts with nystagmus. Convergence is p…
- Neurology: Ramsay Hunt syndrome treatment · ApplicationA 60-year-old man has severe left ear pain followed by vesicles in the external auditory canal, left facial weakness involving the forehead, vertigo and hearing loss. W…
- Neurology: lamotrigine rash risk · Multi-stepA 28-year-old woman started lamotrigine 100 mg daily on top of sodium valproate. Ten days later she has fever, mucosal ulceration and a widespread rash with skin detach…
- Neurology: frontotemporal dementia pathology · ApplicationA 58-year-old man has progressive disinhibition, hyperorality and apathy over two years, with memory relatively preserved early on. MRI shows frontal and anterior tempo…
- Neurology: Charcot-Marie-Tooth disease genetics · ApplicationA 20-year-old has high-arched feet, hammer toes, distal leg wasting and a steppage gait with absent ankle jerks. His father has similar features. Nerve conduction studi…
- Neurology: narcolepsy mechanism · ApplicationA 19-year-old has excessive daytime sleepiness with irresistible sleep attacks, sudden loss of muscle tone on laughing, and vivid hallucinations on falling asleep. Whic…
- Neurology: restless legs syndrome associations · ApplicationA 32-year-old woman in her third trimester has an irresistible urge to move her legs in the evening, relieved by walking. Which laboratory abnormality should be looked…
- Neurology: neurofibromatosis type 1 · ApplicationA 12-year-old has six café-au-lait macules larger than 15 mm, axillary freckling and pigmented iris hamartomas. Which gene is mutated and how is it usually inherited?
- Neurology: hemiballismus lesion · ApplicationA 70-year-old hypertensive man has sudden violent flinging movements of the right arm and leg. Where is the lesion most likely located?
- Neurology: uncal herniation signs · ApplicationA patient with a large right hemispheric haematoma becomes drowsy. The right pupil is now dilated and unreactive with the eye deviated down and out, and left hemiparesi…
- Neurology: acute disseminated encephalomyelitis · ApplicationA 7-year-old develops fever, headache, drowsiness and multifocal neurological deficits two weeks after a viral illness. MRI shows multiple large, poorly marginated whit…
- Neurology: anti-NMDA receptor encephalitis · Multi-stepA 24-year-old woman has two weeks of agitation, hallucinations and insomnia, followed by seizures, orofacial dyskinesias and autonomic instability. CSF shows lymphocyti…
- Neurology: entacapone mechanism · ApplicationA man with Parkinson disease on levodopa-carbidopa has end-of-dose wearing-off. Adding entacapone helps by which mechanism?
- Neurology: drug-induced acute dystonia · ApplicationA 22-year-old man given intravenous metoclopramide for vomiting develops painful sustained neck twisting, tongue protrusion and upward eye deviation within hours. What…
- Neurology: neuroleptic malignant syndrome versus serotonin syndrome · Multi-stepTwo patients have fever, rigidity and altered sensorium: one after starting haloperidol, the other after adding tramadol to sertraline. Which feature best identifies th…
- Neurology: cavernous sinus thrombosis · Multi-stepA 30-year-old with a facial furuncle develops fever, unilateral periorbital oedema, proptosis, chemosis and ptosis, followed by diplopia, and soon the other eye is affe…
- Neurology: Miller Fisher syndrome · ApplicationA 35-year-old man has ophthalmoplegia, ataxia and areflexia one week after an episode of diarrhoea. Which antibody is typically present?
- Neurology: conduction aphasia · Multi-stepA patient speaks fluently and understands speech well but cannot repeat sentences and makes frequent phonemic paraphasias. Which structure is disrupted?
- Neurology: glioblastoma histology · ApplicationA 60-year-old man has six weeks of headache and personality change. MRI shows a ring-enhancing frontal mass with central necrosis crossing the corpus callosum, and biop…
- Neurology: posterior reversible encephalopathy syndrome · Multi-stepA 28-year-old woman four days after delivery has blood pressure 190/110 mmHg, headache, visual blurring and a seizure. MRI shows bilateral posterior white matter FLAIR…
- Neurology: TIA · ApplicationTransient focal neurologic deficit resolving fully suggests what?
- Neurology: Bell palsy · ApplicationAcute unilateral lower-motor-neuron facial weakness suggests what?
- Neurology: Parkinson disease · ApplicationRest tremor with bradykinesia suggests what?
- Neurology · ApplicationSudden unilateral weakness needs what pathway?
- Neurology · ApplicationAscending weakness and areflexia suggest what?
- Neurology · ApplicationSevere headache with meningism suggests what?
- Neurology · ApplicationOptic neuritis with disseminated lesions suggests what?
- Neurology · ApplicationRest tremor and rigidity suggest what?
- Neurology · ApplicationAscending paralysis and areflexia suggest what?
- Neurology · ApplicationWhat is a common warning sign of acute stroke?
- Neurology · ApplicationWhat is a priority in suspected acute stroke?
- Neurology · ApplicationWhat is a common feature of migraine with aura?
- Neurology · ApplicationWhat should be considered in sudden severe 'worst-ever' headache?
- Neurology · ApplicationWhat is a warning sign of acute stroke?
- Neurology · ApplicationWhy is time of onset important in suspected stroke?
- Neurology · ApplicationWhich bedside observation should trigger concern for an acute stroke and rapid specialist assessment?
- Neurology · ApplicationAfter a first suspected seizure, which feature suggests that an event was epileptic rather than simple syncope?
- Neurology · ApplicationWhat is the first priority in an adult with suspected acute stroke?
- Neurology · ApplicationWhich symptom is typical of a transient ischaemic attack?
- Neurology: subarachnoid hemorrhage · Multi-stepA patient develops a sudden maximal-intensity headache within seconds while exercising, followed by vomiting and neck stiffness. What is the most appropriate initial in…
- Neurology: myasthenia gravis · ApplicationA patient has fluctuating ptosis and diplopia that worsen late in the day, with normal sensation and pupils. Which diagnosis is most likely?
- Neurology: stroke · ApplicationA patient develops aphasia and right face-arm weakness greater than leg weakness. Which artery is most likely occluded?
- Neurology: myasthenia gravis · ApplicationPtosis that worsens through the day and improves with rest is most consistent with what disorder?
- Neurology: status epilepticus · ApplicationWhat is the first-line medication for convulsive status epilepticus?
- Neurology: Guillain-Barre syndrome · ApplicationA patient develops progressive symmetric ascending weakness and areflexia after a diarrheal illness. What is the most likely diagnosis?
- Neurology: status epilepticus · Multi-stepA patient has a generalized convulsion lasting longer than five minutes. What is the immediate pharmacologic priority?
- Neurology: Parkinsonism · ApplicationWhich finding best distinguishes Parkinson disease tremor from essential tremor?
- Neurology: temporal arteritis · Multi-stepAn older patient has new temporal headache, jaw claudication, raised ESR, and transient visual loss. What should be done immediately?
- Neurology: Lambert-Eaton syndrome · ApplicationA smoker has proximal weakness that improves with repeated use, reduced reflexes that facilitate after exercise, and dry mouth. What is most likely?
- Neurology: subacute combined degeneration · ApplicationA patient with pernicious anemia has impaired vibration sense, gait ataxia, spasticity, and macrocytosis. Which spinal pathways are affected?
Respiratory medicine91
- Respiratory medicine · ApplicationA 30-year-old woman who is otherwise well has painful red nodules on her shins, ankle arthritis and bilateral symmetrical hilar lymphadenopathy on chest radiograph. Wha…
- Respiratory medicine: COPD · ApplicationA 65-year-old man with severe COPD presents with an acute exacerbation, breathlessness and drowsiness. His arterial blood gas on room air shows PaO2 52 mmHg and PaCO2 6…
- Respiratory medicine: acute severe asthma · ApplicationA 24-year-old asthmatic woman is brought in with severe breathlessness. She can speak only single words, her heart rate is 130 per minute and her peak flow is 30% of he…
- Respiratory medicine: tuberculosis diagnosis · ApplicationA 35-year-old man attending a district clinic in India has had cough for 3 weeks with evening fever and weight loss. Under the National TB Elimination Programme, which…
- Respiratory medicine: parapneumonic effusion and empyema · Multi-stepA 40-year-old man treated for right lower lobe pneumonia a week ago still has fever and pleuritic pain. Chest radiograph shows a moderate right effusion. Pleural aspira…
- Respiratory medicine: high-risk pulmonary embolism · ApplicationA 55-year-old man develops sudden breathlessness and syncope on day 5 after hip surgery. Blood pressure is 80/50 mmHg, heart rate 125 per minute, SpO2 86%, the JVP is r…
- Respiratory medicine: idiopathic pulmonary fibrosis · ApplicationA 66-year-old man has had progressive exertional dyspnoea and dry cough for 8 months, with bibasal fine end-inspiratory crackles and finger clubbing. He has no relevant…
- Respiratory medicine: lung cancer targeted therapy · ApplicationA 58-year-old woman who has never smoked is diagnosed with stage IV lung adenocarcinoma. Molecular testing of the tumour shows an EGFR exon 19 deletion. Which is the pr…
- Respiratory medicine: obstructive sleep apnoea · ApplicationA 50-year-old man with a BMI of 36 kg/m2 has loud snoring, witnessed apnoeas and marked daytime sleepiness, with an Epworth score of 16. Polysomnography shows an apnoea…
- Respiratory medicine: non-invasive ventilation · Multi-stepA 68-year-old man with COPD has had an hour of nebulised bronchodilators, oral prednisolone and controlled oxygen via a 28% Venturi mask. He remains drowsy but obeys co…
- Respiratory medicine: allergic bronchopulmonary aspergillosis · Multi-stepA 32-year-old man with long-standing asthma has recurrent wheeze and expectorates brownish mucus plugs. Radiographs show fleeting upper lobe infiltrates, and HRCT shows…
- Respiratory medicine: long-term oxygen therapy · ApplicationA 67-year-old ex-smoker with severe COPD, stable on optimal treatment, has a resting PaO2 of 52 mmHg on two occasions three weeks apart and mild ankle oedema. Which int…
- Respiratory medicine: silicosis · ApplicationA 45-year-old man has worked in a sandstone quarry for 20 years and has progressive breathlessness. The radiograph shows multiple small nodules in the upper zones and e…
- Respiratory medicine: pneumonia severity · Multi-stepA 72-year-old man with pneumonia is confused. His blood urea is 9 mmol/L, respiratory rate 32 per minute and blood pressure 85/50 mmHg. What is his CURB-65 score, and w…
- Respiratory medicine: pulmonary alveolar proteinosis · ApplicationA 38-year-old man has had progressive exertional breathlessness and a dry cough for 8 months, with mild hypoxaemia. HRCT of the chest shows ground-glass opacities with…
- Respiratory medicine: hypersensitivity pneumonitis · ApplicationA 45-year-old dairy farmer has fever, cough and breathlessness starting 5 to 6 hours after handling mouldy hay, settling over the weekend and recurring on returning to…
- Respiratory medicine: pleural fluid classification · Multi-stepA 66-year-old man on furosemide for chronic heart failure has bilateral pleural effusions. Pleural fluid protein is 3.0 g/dL (serum 6.8 g/dL) and pleural LDH is 260 IU/…
- Respiratory medicine: alpha-1 antitrypsin deficiency · ApplicationA 35-year-old lifelong non-smoker has progressive exertional dyspnoea. Chest radiograph shows hyperinflation with lucency predominantly at the lung bases, and spirometr…
- Respiratory medicine: interpretation of pulmonary function tests · Multi-stepA 30-year-old woman has progressive breathlessness on lying flat. Lung examination is clear. Pulmonary function tests show FVC 55% of predicted, FEV1/FVC ratio 88%, tot…
- Respiratory medicine: Pancoast tumour · ApplicationA 62-year-old heavy smoker has right shoulder pain radiating down the medial forearm to the ring and little fingers, wasting of the hand muscles, and right-sided ptosis…
- Respiratory medicine: alveolar-arterial gradient · Multi-stepA 45-year-old man is found drowsy after taking a large dose of an opioid. On room air at sea level (FiO2 0.21, water vapour pressure 47 mmHg, respiratory quotient 0.8),…
- Respiratory medicine: pulmonary embolism work-up · Multi-stepA 29-year-old woman has had 2 days of pleuritic left-sided chest pain after a 9-hour flight. Heart rate is 84 per minute, SpO2 is 98% on air, and there is no leg swelli…
- Respiratory medicine: bronchiectasis imaging · ApplicationA 40-year-old woman has had daily purulent sputum and occasional haemoptysis since childhood tuberculosis. Which HRCT finding is most characteristic of her likely condi…
- Respiratory medicine: Legionella pneumonia · Multi-stepA 60-year-old smoker returns from a hotel stay with a faulty air-conditioning system. He has high fever, confusion, diarrhoea, relative bradycardia and sodium of 126 mm…
- Respiratory medicine: paraneoplastic SIADH · ApplicationA 62-year-old smoker has a central hilar mass. His serum sodium is 120 mmol/L, urine osmolality is 450 mOsm/kg and he is clinically euvolaemic. Which tumour type is mos…
- Respiratory medicine: tuberculous pleural effusion · ApplicationA 25-year-old has a unilateral pleural effusion. Pleural fluid is an exudate with lymphocyte predominance. Which additional finding best supports tuberculosis?
- Respiratory medicine: obesity hypoventilation syndrome · ApplicationA 45-year-old man with BMI of 48 kg/m2 has daytime sleepiness, ankle oedema, a daytime PaCO2 of 52 mmHg and bicarbonate of 33 mmol/L. What is the diagnosis?
- Respiratory medicine: Caplan syndrome · ApplicationA coal miner with rheumatoid arthritis has multiple well-defined peripheral lung nodules of 0.5 to 5 cm on a chest X-ray. What is the diagnosis?
- Respiratory medicine: tropical pulmonary eosinophilia · ApplicationA 30-year-old from a filariasis-endemic region has nocturnal cough and wheeze, eosinophil count above 3000 per microlitre, very high IgE and reticulonodular shadows on…
- Respiratory medicine: primary spontaneous pneumothorax · ApplicationA tall thin 18-year-old has mild pleuritic pain and a small (under 2 cm) apical pneumothorax. He is not breathless and has normal oxygen saturation. What is the best ma…
- Respiratory medicine: acute severe asthma · ApplicationA young woman with acute severe asthma has a peak flow of 40 percent predicted and cannot complete sentences. Which combination is the appropriate initial treatment?
- Respiratory medicine: ventilator-associated pneumonia · ApplicationA patient on a ventilator for 6 days develops fever, purulent tracheal secretions and a new infiltrate. Which empirical approach is appropriate?
- Respiratory medicine: rifampicin-resistant TB · ApplicationA patient with newly diagnosed rifampicin-resistant pulmonary TB, no fluoroquinolone resistance and no contraindications is eligible for a six-month all-oral regimen. W…
- Respiratory medicine: TB preventive treatment · ApplicationWho should be offered TB preventive treatment after excluding active disease?
- Respiratory medicine: Light criteria · ApplicationPleural fluid protein is 4.2 g/dL with serum protein 6.0 g/dL, and fluid LDH is 280 U/L with serum LDH 400 U/L (upper limit of normal 300). Interpretation?
- Respiratory medicine: chylothorax · ApplicationAfter thoracic surgery a patient develops a milky pleural effusion. Which finding confirms chylothorax?
- Respiratory medicine: obstructive sleep apnoea · ApplicationAn obese man with loud snoring, witnessed apnoeas and daytime sleepiness undergoes polysomnography. Which finding confirms OSA?
- Respiratory medicine: ARDS Berlin definition · Multi-stepA patient with sepsis develops bilateral opacities within 3 days. PaO2 is 80 mmHg on FiO2 0.8 with PEEP 8 cm H2O, and echo shows normal left ventricular function. How i…
- Respiratory medicine: ABG interpretation · Multi-stepABG shows pH 7.30, PaCO2 25 mmHg, HCO3 12 mmol/L; Na 140, Cl 108. What is the acid-base disorder?
- Respiratory medicine: DLCO · Multi-stepWhich condition increases the diffusing capacity for carbon monoxide?
- Respiratory medicine: pulmonary infarct on radiograph · ApplicationA woman has sudden pleuritic chest pain and haemoptysis five days after a hip replacement. The chest radiograph shows a peripheral, pleura-based, wedge-shaped opacity w…
- Respiratory medicine: chronic beryllium disease versus sarcoidosis · Multi-stepA 45-year-old man who has worked in a metal alloy factory for 15 years has dry cough and breathlessness. Chest imaging shows bilateral hilar lymphadenopathy and biopsy…
- Respiratory medicine: bronchiolitis obliterans after transplant · Multi-stepA 38-year-old man 14 months after allogeneic stem cell transplantation for leukaemia has progressive dry cough and breathlessness. The chest radiograph is clear, spirom…
- Respiratory medicine: cryptogenic organising pneumonia · Multi-stepA 55-year-old woman has had six weeks of dry cough and low-grade fever. CT shows patchy peripheral consolidations that have shifted site between scans, and two courses…
- Respiratory medicine: aspirin-exacerbated respiratory disease · ApplicationA 35-year-old woman with asthma and recurrent nasal polyps develops severe bronchospasm with rhinorrhoea within an hour of taking ibuprofen. Which drug is a suitable ad…
- Respiratory medicine: omalizumab mechanism · ApplicationA 28-year-old with severe persistent allergic asthma has a serum IgE of 450 IU/mL and positive skin tests to perennial allergens. She has frequent exacerbations despite…
- Respiratory medicine: anti-IL-5 therapy in eosinophilic asthma · ApplicationA 45-year-old with late-onset severe asthma and nasal polyps has blood eosinophils of 700 per microlitre and normal total IgE. He has exacerbations despite high-dose in…
- Respiratory medicine: roflumilast · ApplicationA 66-year-old ex-smoker with chronic bronchitis, FEV1 of 40% predicted and frequent exacerbations continues to exacerbate despite triple inhaled therapy. Roflumilast is…
- Respiratory medicine: Hoover sign · ApplicationA 68-year-old smoker with severe emphysema is breathless. On inspection the lower costal margins move inwards during inspiration. What explains this sign?
- Respiratory medicine: Mycoplasma pneumonia · ApplicationA 20-year-old student has had 10 days of dry cough, headache and low-grade fever. The chest radiograph shows patchy reticular shadowing that looks worse than he feels.…
- Respiratory medicine: Klebsiella pneumonia · ApplicationA 55-year-old chronic alcoholic has high fever and a cough productive of thick, blood-mixed, gelatinous sputum. The chest radiograph shows dense consolidation of the ri…
- Respiratory medicine: post-influenza staphylococcal pneumonia · Multi-stepA 24-year-old man develops high fever, haemoptysis and hypotension 5 days after influenza. The chest radiograph shows multiple cavitating nodules and thin-walled air-fi…
- Respiratory medicine: Pneumocystis pneumonia adjunct steroid · Multi-stepA 38-year-old man with HIV, a CD4 count of 60 per microlitre and 3 weeks of dry cough and exertional dyspnoea has a room air PaO2 of 58 mmHg. LDH is raised and the radi…
- Respiratory medicine: pulmonary hamartoma · ApplicationA routine chest radiograph in a 50-year-old non-smoker shows a 2 cm round, well-circumscribed nodule with scattered popcorn-like calcification. It is unchanged from a f…
- Respiratory medicine: malignant pleural mesothelioma immunohistochemistry · Multi-stepA 62-year-old retired shipyard worker has progressive chest pain and breathlessness. CT shows nodular pleural thickening with a right effusion, and a pleural biopsy sho…
- Respiratory medicine: lymphangioleiomyomatosis · Multi-stepA 32-year-old woman presents with her second spontaneous pneumothorax, progressive exertional breathlessness and a milky pleural effusion. CT shows numerous thin-walled…
- Respiratory medicine: pulmonary Langerhans cell histiocytosis · ApplicationA 28-year-old heavy smoker has a dry cough, dyspnoea and a spontaneous pneumothorax. HRCT shows bizarre-shaped cysts and nodules in the upper and mid zones with sparing…
- Respiratory medicine: aspergilloma · ApplicationA 45-year-old man with old cavitary tuberculosis has recurrent haemoptysis. The radiograph shows a mobile round mass within an upper-lobe cavity, separated from the wal…
- Respiratory medicine: high-altitude pulmonary oedema · ApplicationA 30-year-old trekker ascends quickly to 4,500 m and on day 2 develops dry cough and breathlessness at rest with crackles. SpO2 is 70% and he is afebrile. Apart from de…
- Respiratory medicine: acetazolamide at altitude · ApplicationA mountaineer who had severe headache and nausea on a previous ascent is advised acetazolamide before a trek to 4,000 m. How does it help prevent acute mountain sickness?
- Respiratory medicine: varenicline · ApplicationA 45-year-old smoker wants to quit. He failed with nicotine patches previously and is prescribed varenicline. How does this drug act?
- Respiratory medicine: flow-volume loop in tracheal stenosis · Multi-stepA 45-year-old woman who was intubated for 3 weeks four months ago has inspiratory stridor and exertional breathlessness. Spirometry shows a flow-volume loop with a plat…
- Respiratory medicine: Lofgren syndrome · ApplicationA 30-year-old woman has fever, tender red nodules on the shins, ankle arthritis and bilateral hilar lymphadenopathy with clear lung fields. What is the expected course…
- Respiratory medicine: Meigs syndrome · ApplicationA 48-year-old woman has weight loss, abdominal distension and a right-sided pleural effusion. Imaging shows a solid ovarian tumour that is benign on histology. Both the…
- Respiratory medicine: methacholine challenge · ApplicationA 25-year-old has episodic nocturnal cough, but spirometry and bronchodilator response are normal between episodes. A methacholine challenge is performed. Which result…
- Respiratory medicine: antituberculosis drug hepatotoxicity · ApplicationA 40-year-old woman, 3 weeks into isoniazid, rifampicin, pyrazinamide and ethambutol, develops nausea and jaundice. ALT is 520 U/L (about ten times the upper limit) and…
- Respiratory medicine: limited-stage small cell lung cancer · Multi-stepA 62-year-old smoker has a central hilar mass with mediastinal nodes and a serum sodium of 124 mmol/L with concentrated urine. Biopsy shows small round cells with scant…
- Respiratory medicine · ApplicationWhat is a common symptom of asthma?
- Respiratory medicine · ApplicationWhat test helps demonstrate reversible airflow limitation in asthma?
- Respiratory medicine · ApplicationWhat is a common manifestation of chronic obstructive pulmonary disease?
- Respiratory medicine · ApplicationWhat is a key intervention for smoking-related COPD?
- Respiratory medicine · ApplicationWhat physical finding can occur in a pleural effusion?
- Respiratory medicine · ApplicationWhat is a common symptom of pulmonary embolism?
- Respiratory medicine · ApplicationWhat test can assess oxygenation in an acutely breathless patient?
- Respiratory medicine · ApplicationWhat test demonstrates reversible airflow obstruction in asthma?
- Respiratory medicine · ApplicationWhat finding suggests a pleural effusion on examination?
- Respiratory medicine · ApplicationWhat symptom can occur in pulmonary embolism?
- Respiratory medicine · ApplicationWhich arterial blood gas pattern is most consistent with acute hypercapnic respiratory failure?
- Respiratory medicine · ApplicationWhich examination finding is most compatible with a pneumothorax on the affected side?
- Respiratory medicine · ApplicationWhich spirometry pattern supports a diagnosis of obstructive airway disease?
- Respiratory medicine · ApplicationWhat is the immediate priority in a severe acute asthma exacerbation?
- Respiratory medicine: asthma exacerbation · Multi-stepA patient with acute severe asthma has a respiratory rate of 34/min, cannot complete sentences, and becomes drowsy. Which blood-gas change is especially ominous after i…
- Respiratory medicine: pulmonary embolism · ApplicationA patient develops sudden pleuritic chest pain, dyspnea, tachycardia, and hemoptysis six days after a hip replacement. Which diagnosis is most likely?
- Respiratory medicine: pleural effusion · ApplicationA patient with heart failure has reduced breath sounds, stony dullness to percussion, and decreased vocal fremitus at the right lung base. What is the most likely findi…
- Respiratory medicine: COPD · ApplicationA COPD exacerbation presents with pH 7.28 and PaCO2 70 mmHg despite initial bronchodilators. Which support is appropriate if no contraindication exists?
- Respiratory medicine: asthma · ApplicationWhich feature in an acute asthma attack indicates life-threatening severity?
- Respiratory medicine: interstitial lung disease · ApplicationA patient has progressive exertional dyspnea, dry cough, bibasal fine end-inspiratory crackles, and clubbing. Which process is most likely?
- Respiratory medicine: tension pneumothorax · Multi-stepA ventilated trauma patient suddenly becomes hypoxic and hypotensive with absent breath sounds on one side and rising airway pressures. What is the immediate action?
- Respiratory medicine: ARDS · Multi-stepA patient with severe sepsis develops acute hypoxemia, bilateral pulmonary infiltrates, and poor lung compliance without evidence of cardiogenic pulmonary edema. What s…
- Respiratory medicine: alpha-1 antitrypsin deficiency · ApplicationA nonsmoker in their 30s has panacinar emphysema predominantly affecting the lower lobes and abnormal liver enzymes. What inherited disorder is most likely?
- Respiratory medicine: bronchiectasis · ApplicationA patient has chronic daily productive cough with large volumes of purulent sputum, recurrent infections, and coarse crackles. What structural lung disease is likely?
Rheumatology73
- Rheumatology · ApplicationA 24-year-old woman has a malar rash, symmetrical arthralgia and new proteinuria. Which autoantibody best correlates with lupus nephritis and disease activity?
- Rheumatology: gout · ApplicationA 50-year-old man has sudden severe pain, redness and swelling of the first metatarsophalangeal joint. Joint fluid shows needle-shaped, negatively birefringent crystals…
- Rheumatology: antiphospholipid syndrome · Multi-stepA 34-year-old woman has a first unprovoked proximal deep vein thrombosis. The aPTT is prolonged and does not correct on mixing with normal plasma. Lupus anticoagulant,…
- Rheumatology: lupus nephritis histology · Multi-stepA 26-year-old woman with SLE has a creatinine of 2.0 mg/dL, hypertension and nephrotic-range proteinuria with red cell casts. Renal biopsy shows endocapillary prolifera…
- Rheumatology: neonatal lupus · ApplicationA newborn has a heart rate of 55 per minute and an ECG showing complete heart block. The mother is asymptomatic, and later tests suggest Sjogren syndrome. Which materna…
- Rheumatology: Sjogren syndrome complications · ApplicationA 54-year-old woman with long-standing primary Sjogren syndrome develops persistent unilateral parotid enlargement, palpable purpura and a low C4. Which complication sh…
- Rheumatology: scleroderma renal crisis · Multi-stepA 45-year-old woman with diffuse systemic sclerosis has been on prednisolone 30 mg daily. She develops headache, blood pressure 210/120 mmHg, rising creatinine and micr…
- Rheumatology: limited systemic sclerosis · ApplicationA 50-year-old woman has had Raynaud phenomenon for 15 years, skin thickening limited to the fingers and face, telangiectasia, calcinosis and oesophageal dysmotility. Wh…
- Rheumatology: dermatomyositis · Multi-stepA 58-year-old woman has a heliotrope rash, Gottron papules, difficulty climbing stairs and a creatine kinase of 4,500 U/L. Muscle biopsy shows perifascicular atrophy. B…
- Rheumatology: inclusion body myositis · ApplicationA 68-year-old man has had slowly progressive weakness of quadriceps and wrist and finger flexors for three years, causing falls and difficulty gripping. Creatine kinase…
- Rheumatology: giant cell arteritis · Multi-stepA 72-year-old woman has a two-week history of new temporal headache, jaw pain on chewing, scalp tenderness and one episode of transient blurring of vision. ESR is 98 mm…
- Rheumatology: polymyalgia rheumatica · ApplicationA 70-year-old woman has had three weeks of bilateral shoulder and hip girdle pain with morning stiffness lasting over an hour. Examination shows no true weakness. ESR i…
- Rheumatology: Takayasu arteritis · ApplicationA 24-year-old woman has fatigue, left arm claudication, an absent left radial pulse, a supraclavicular bruit and hypertension in the right arm. ESR is raised. Which is…
- Rheumatology: polyarteritis nodosa · ApplicationA 45-year-old man with chronic hepatitis B has fever, weight loss, livedo reticularis, hypertension, testicular pain and foot drop. ANCA is negative, and the chest radi…
- Rheumatology: granulomatosis with polyangiitis · ApplicationA 40-year-old man has chronic sinusitis with bloody nasal discharge, a saddle-nose deformity, cavitating lung nodules and rapidly progressive glomerulonephritis. Which…
- Rheumatology: eosinophilic granulomatosis with polyangiitis · ApplicationA 38-year-old man with adult-onset asthma and allergic rhinitis develops foot drop, transient pulmonary infiltrates and palpable purpura. Eosinophils are 18% of white c…
- Rheumatology: rheumatoid arthritis and the cervical spine · Multi-stepA 58-year-old woman with 20 years of seropositive rheumatoid arthritis is scheduled for knee replacement under general anaesthesia. Which pre-operative step best reduce…
- Rheumatology: biologic therapy safety · ApplicationA 45-year-old man in India has active rheumatoid arthritis despite methotrexate, and adalimumab is planned. Which pre-treatment investigation is most important?
- Rheumatology: reactive arthritis · ApplicationA 24-year-old man has asymmetric swelling of the knee and ankle, heel pain and conjunctivitis three weeks after urethral discharge. Synovial fluid shows inflammatory ce…
- Rheumatology: psoriatic arthritis · ApplicationA 40-year-old man with scalp psoriasis has swelling of the distal interphalangeal joints, nail pitting and a sausage-shaped toe. Which radiographic finding would be cha…
- Rheumatology: disseminated gonococcal infection · ApplicationA 22-year-old sexually active woman has fever, migratory polyarthralgia, painful swelling over the extensor tendons of the right wrist and a few pustules on the hands a…
- Rheumatology: Felty syndrome · ApplicationA 58-year-old woman with long-standing seropositive rheumatoid arthritis with deformed hands, who takes only NSAIDs, has recurrent skin and chest infections. Examinatio…
- Rheumatology: adult-onset Still disease · Multi-stepA 28-year-old woman has had 3 weeks of daily fever spikes to 39.5 degrees Celsius that return to normal between episodes, with an evanescent salmon-pink rash on the tru…
- Rheumatology: cryoglobulinaemic vasculitis · Multi-stepA 55-year-old man with untreated chronic hepatitis C has palpable purpura on the legs, arthralgia and new haematuria with proteinuria. Which laboratory pattern is most…
- Rheumatology: antisynthetase syndrome · ApplicationA 45-year-old woman has fever, dry cough and breathlessness, with proximal muscle weakness, a raised CK, Raynaud phenomenon and symmetrical arthritis. Her fingers show…
- Rheumatology: leflunomide in pregnancy · Multi-stepA 34-year-old woman with rheumatoid arthritis has been on leflunomide for a year and finds she is 6 weeks pregnant. What is the most appropriate management?
- Rheumatology: allopurinol hypersensitivity · ApplicationA 60-year-old man with gout and chronic kidney disease starts allopurinol 300 mg daily. After 4 weeks he develops fever, a widespread rash, eosinophilia, abnormal liver…
- Rheumatology: septic arthritis · ApplicationA 55-year-old has an acutely hot, swollen, painful knee with fever. What is the best next step?
- Rheumatology: IgA vasculitis · ApplicationA 20-year-old develops palpable purpura on the legs, colicky abdominal pain, arthralgia and haematuria after an upper respiratory infection. What does skin or renal bio…
- Rheumatology: fibromyalgia · ApplicationA 38-year-old woman has widespread musculoskeletal pain, fatigue and unrefreshing sleep for a year, with multiple tender points and normal ESR, CRP and CK. What is the…
- Rheumatology: anti-CCP antibody · ApplicationWhich autoantibody is most specific for rheumatoid arthritis and predicts erosive disease?
- Rheumatology: Kawasaki disease · ApplicationA 3-year-old has six days of fever, non-exudative conjunctival injection, red cracked lips, a cervical lymph node, a rash and peeling of the fingertips. Which treatment…
- Rheumatology: methotrexate toxicity · Multi-stepA patient on weekly methotrexate develops mouth ulcers, pancytopenia and dry cough with diffuse infiltrates. What should be given?
- Rheumatology: Behcet disease · ApplicationA young man from the Silk Route region has recurrent oral and genital ulcers, uveitis and a papule at needle-prick sites. Which HLA is associated?
- Rheumatology: Buerger disease management · ApplicationA 32-year-old man who smokes bidis heavily has painful ulcers on his fingertips, rest pain in the feet and a history of migratory superficial thrombophlebitis. Choleste…
- Rheumatology: relapsing polychondritis · Multi-stepA 40-year-old woman has repeated episodes of painful red swelling of both ear pinnae that spares the lobules, along with a saddle-nose deformity and hoarseness. Blood t…
- Rheumatology: alkaptonuria · ApplicationA 45-year-old man has low back stiffness, bluish-black discolouration of the ear cartilage and sclerae, and urine that darkens on standing. Which enzyme is deficient?
- Rheumatology: microscopic polyangiitis · Multi-stepA 60-year-old man has rapidly progressive glomerulonephritis, pulmonary haemorrhage and mononeuritis multiplex. Serum p-ANCA with anti-myeloperoxidase antibodies is pos…
- Rheumatology: eosinophilic fasciitis · Multi-stepA 35-year-old man develops painful swelling and then woody induration of the forearms and legs with a peau d'orange appearance a week after strenuous exercise. His hand…
- Rheumatology: anti-topoisomerase I antibody · ApplicationA 38-year-old woman has rapidly progressive skin thickening of the fingers, forearms, upper arms and trunk over 8 months, with exertional breathlessness and fine bibasa…
- Rheumatology: anti-RNA polymerase III antibody · Multi-stepA 50-year-old man with diffuse cutaneous systemic sclerosis has skin thickening that is spreading quickly. He is counselled to check his blood pressure at home daily. W…
- Rheumatology: subacute cutaneous lupus and anti-Ro · ApplicationA 34-year-old woman develops non-scarring, annular, scaly red plaques over the shoulders, upper chest and arms after sun exposure. She also has mild joint pains. Which…
- Rheumatology: choice of urate-lowering drug in overproducers · ApplicationA 45-year-old man with recurrent tophaceous gout has had two uric acid renal stones. A 24-hour urine collection shows very high uric acid excretion. Which urate-lowerin…
- Rheumatology: familial Mediterranean fever · ApplicationA 14-year-old boy of Armenian descent has had recurrent attacks of high fever with severe abdominal pain and a swollen knee, each lasting 1 to 3 days and settling compl…
- Rheumatology: hypertrophic osteoarthropathy · ApplicationA 62-year-old smoker has finger clubbing, painful swollen wrists and ankles, and radiographs showing linear new bone formation along the shafts of the tibia and radius.…
- Rheumatology: oligoarticular juvenile arthritis and uveitis · ApplicationA 3-year-old girl has had a swollen, non-painful knee for 3 months without fever or rash. ANA is positive and rheumatoid factor is negative. Which complication should b…
- Rheumatology: azathioprine and allopurinol interaction · Multi-stepA 40-year-old woman with lupus nephritis is on stable azathioprine. After a gout-like attack she is started on allopurinol, and two weeks later she has pancytopenia. Wh…
- Rheumatology: mechanism of mycophenolate · ApplicationA patient with class IV lupus nephritis is started on mycophenolate mofetil. Which enzyme does its active metabolite inhibit to limit lymphocyte proliferation?
- Rheumatology: haemochromatosis arthropathy · ApplicationA 52-year-old man with diabetes and bronze skin has pain in the second and third metacarpophalangeal joints. Radiographs show hook-like osteophytes and chondrocalcinosi…
- Rheumatology: enteropathic arthritis · Multi-stepA 28-year-old man with active ulcerative colitis develops a swollen, painful knee and ankle. The arthritis improves quickly after his colitis is controlled with treatme…
- Rheumatology: dermatomyositis and malignancy · Multi-stepA 58-year-old woman has heliotrope rash, Gottron papules and proximal weakness. Her myositis-specific antibody panel is positive for anti-TIF1-gamma. What is the most i…
- Rheumatology: tocilizumab and inflammatory markers · Multi-stepA 70-year-old woman with giant cell arteritis on tocilizumab presents with fever and cough. Her CRP is normal, though chest radiograph shows lobar consolidation. What e…
- Rheumatology: serology of active lupus nephritis · ApplicationA patient with lupus has haematuria, rising creatinine and new oedema. Which laboratory pattern best indicates active lupus nephritis?
- Rheumatology: RA · ApplicationSymmetric MCP and PIP inflammatory arthritis suggests what?
- Rheumatology: SLE · ApplicationPhotosensitivity, oral ulcers, and nephritis suggest what?
- Rheumatology · ApplicationTemporal headache and jaw claudication suggest what?
- Rheumatology · ApplicationSacroiliitis and inflammatory back pain suggest what?
- Rheumatology · ApplicationProximal pain and stiffness in older adult suggest what?
- Rheumatology · ApplicationPhotosensitivity and nephritis suggest what?
- Rheumatology · ApplicationWhat symptom pattern is typical of an inflammatory arthritis?
- Rheumatology · ApplicationWhat feature helps distinguish systemic lupus erythematosus from isolated mechanical pain?
- Rheumatology · ApplicationWhat feature favors inflammatory arthritis?
- Rheumatology · ApplicationWhat polarized-light finding supports pseudogout?
- Rheumatology · ApplicationWhich joint pattern is most typical of rheumatoid arthritis?
- Rheumatology · ApplicationWhich investigation confirms monosodium urate crystals in suspected acute gout?
- Rheumatology · ApplicationWhich feature favors rheumatoid arthritis over osteoarthritis?
- Rheumatology: giant cell arteritis · Multi-stepA 74-year-old has a new temporal headache, scalp tenderness, jaw claudication, and transient visual blurring. What is the most important immediate treatment?
- Rheumatology: gout · ApplicationA patient develops abrupt severe pain, erythema, and swelling of the first metatarsophalangeal joint after a heavy meal and alcohol intake. Which crystal is most likely…
- Rheumatology: giant cell arteritis · ApplicationNew temporal headache, jaw claudication and visual symptoms in an older adult require immediate treatment with what?
- Rheumatology: polymyalgia rheumatica · ApplicationAn older adult has bilateral shoulder and hip girdle aching with morning stiffness, raised inflammatory markers, and no true muscle weakness. What is most likely?
- Rheumatology: systemic sclerosis · ApplicationA patient has Raynaud phenomenon, skin tightening of the fingers, telangiectasia, and dysphagia from reflux. What connective-tissue disease is most likely?
- Rheumatology: ankylosing spondylitis · ApplicationWhich extra-articular manifestation is commonly associated with ankylosing spondylitis?
- Rheumatology: dermatomyositis · ApplicationA patient has symmetrical proximal muscle weakness, heliotrope rash, and Gottron papules. What diagnosis is most likely?
Infectious diseases70
- Infectious diseases · ApplicationWhat is the standard treatment of uncomplicated Plasmodium falciparum malaria in India?
- Infectious diseases · ApplicationA 22-year-old has had stepwise rising fever for 7 days, relative bradycardia, abdominal distension and a few rose spots on the trunk. Which investigation has the highes…
- Infectious diseases · ApplicationA man returning from a malaria-endemic area is drowsy and jaundiced, and his blood film shows Plasmodium falciparum. What is the preferred first-line antimalarial?
- Infectious diseases · ApplicationOn day 5 of fever, a 20-year-old with confirmed dengue has persistent vomiting, abdominal pain and bleeding gums. His platelet count falls to 30,000 and haematocrit ris…
- Infectious diseases: rickettsial infection · ApplicationA farmer from a rural area has 6 days of fever, headache, myalgia and a dark scab with a surrounding red halo on the groin, with tender regional lymph nodes. He has no…
- Infectious diseases: HIV and tuberculosis · Multi-stepA man newly diagnosed with HIV, with a CD4 count of 30 cells/mm3, has smear-positive pulmonary tuberculosis and no neurological symptoms. He starts antituberculosis tre…
- Infectious diseases: cryptococcal meningitis · ApplicationA 35-year-old man with HIV and a CD4 count of 40 cells/mm3 has had headache and low-grade fever for 3 weeks, with neck stiffness. Non-contrast CT is normal. CSF opening…
- Infectious diseases: cerebral toxoplasmosis · ApplicationA 32-year-old man with HIV, a CD4 count of 60 cells/mm3 and positive Toxoplasma IgG has headache, fever and right hemiparesis. MRI shows multiple ring-enhancing lesions…
- Infectious diseases: antituberculosis drug toxicity · ApplicationA 45-year-old man in the second month of a daily four-drug antituberculosis regimen reports blurred vision. Visual acuity is reduced and he cannot distinguish red from…
- Infectious diseases: tuberculous meningitis · ApplicationA 24-year-old man has had 2 weeks of headache, low-grade fever and vomiting, and now has a right sixth nerve palsy. CSF shows 150 cells/mm3 (85% lymphocytes), protein 2…
- Infectious diseases: bacterial meningitis · Multi-stepA 64-year-old diabetic man has fever, neck stiffness and drowsiness for one day. CSF is turbid with neutrophilic pleocytosis, low glucose and high protein. The Gram sta…
- Infectious diseases: acute hepatitis B serology · Multi-stepA 26-year-old man has jaundice and ALT of 1800 U/L. Serology shows HBsAg negative, anti-HBs negative, IgM anti-HBc positive and anti-HBc total positive. How should this…
- Infectious diseases: septic shock · ApplicationA 58-year-old man with urosepsis has a blood pressure of 78/40 mmHg and lactate 5.2 mmol/L. After 30 mL/kg of crystalloid and antibiotics, his mean arterial pressure re…
- Infectious diseases: visceral leishmaniasis · ApplicationA 25-year-old farmer from Bihar has had fever for 3 months, weight loss and abdominal swelling. He has massive splenomegaly and pancytopenia, and the rK39 rapid test is…
- Infectious diseases: neurocysticercosis · Multi-stepA 28-year-old man from a pig-rearing community has a first generalised seizure. CT shows two small cystic lesions in the cerebral cortex, each with an eccentric dot-lik…
- Infectious diseases: amoebic liver abscess · ApplicationA 35-year-old man with alcohol use has fever and right upper quadrant pain. Ultrasound shows a single 6 cm abscess in the right lobe, and aspirated pus is chocolate-bro…
- Infectious diseases: rhino-orbital mucormycosis · ApplicationA 52-year-old man with poorly controlled diabetes, recently treated for ketoacidosis, has facial pain, unilateral periorbital swelling and proptosis. A black necrotic e…
- Infectious diseases: Plasmodium vivax radical cure · ApplicationA 20-year-old man with confirmed Plasmodium vivax malaria has been treated with chloroquine, and his G6PD status is normal. Which additional drug is needed to prevent r…
- Infectious diseases: diphtheria · ApplicationA 6-year-old unimmunised child has fever, sore throat and a swollen neck. The tonsils are covered by a grey, adherent membrane that bleeds on scraping and extends to th…
- Infectious diseases: Strongyloides hyperinfection · Multi-stepA 58-year-old farmer from an endemic area has been on prednisolone 60 mg daily for four weeks for an autoimmune disease. He develops abdominal pain, diarrhoea, cough an…
- Infectious diseases: brucellosis · ApplicationA 35-year-old dairy farmer in Punjab who drinks unpasteurised milk has had undulant fever with night sweats, low back pain with sacroiliitis, and hepatosplenomegaly for…
- Infectious diseases: cytomegalovirus retinitis · ApplicationA man with untreated HIV and a CD4 count of 25 cells per microlitre has painless progressive loss of vision in one eye. Fundoscopy shows yellowish-white retinal necrosi…
- Infectious diseases: syphilis serology · Multi-stepA 30-year-old woman with systemic lupus erythematosus is asymptomatic. A routine VDRL test is reactive at 1:4, but the TPHA test is non-reactive. She has had no genital…
- Infectious diseases: rifampicin-resistant tuberculosis · Multi-stepA 38-year-old man with sputum smear-positive pulmonary tuberculosis has a CBNAAT (Xpert) result showing Mycobacterium tuberculosis detected with rifampicin resistance.…
- Infectious diseases: NTEP drug-sensitive tuberculosis · ApplicationA 40-year-old adult has newly diagnosed drug-sensitive pulmonary tuberculosis. Which regimen is prescribed under the National TB Elimination Programme?
- Infectious diseases: rabies post-exposure prophylaxis · Multi-stepA man is bitten on the face by a stray dog and the wound is bleeding. How is this managed?
- Infectious diseases: opportunistic infection prophylaxis in HIV · ApplicationA patient with HIV infection has a CD4 count of 150 per microlitre. Which drug prevents Pneumocystis pneumonia and cerebral toxoplasmosis?
- Infectious diseases: lepromatous leprosy · Multi-stepA patient has diffuse symmetrical skin infiltration, loss of eyebrows, leonine facies and numerous acid-fast bacilli on slit-skin smear. What is the expected lepromin t…
- Infectious diseases: prevention of mother-to-child transmission of HIV · Multi-stepA woman is newly diagnosed with HIV infection at 20 weeks of pregnancy. What is the approach under NACO guidelines?
- Infectious diseases: TB preventive treatment · Multi-stepA 30-year-old asymptomatic person with HIV infection has no cough, fever, weight loss or night sweats and a normal chest X-ray. What is the recommended management under…
- Infectious diseases: immune reconstitution inflammatory syndrome · Multi-stepFour weeks after starting ART, a patient on treatment for TB develops fever and enlarging lymph nodes despite falling viral load and rising CD4 count. Cultures are nega…
- Infectious diseases: HIV post-exposure prophylaxis · ApplicationA nurse has a needle-stick injury from an HIV-positive patient. When should PEP be started and for how long?
- Infectious diseases: malaria smear morphology · ApplicationA peripheral smear shows crescent or banana-shaped gametocytes. Which species is responsible?
- Infectious diseases: dengue shock · Multi-stepOn day 5 of fever a child with dengue has cold extremities, narrow pulse pressure, a rising haematocrit and falling platelets. What is the first management step?
- Infectious diseases: XDR typhoid · Multi-stepSalmonella Typhi isolated from a patient is resistant to chloramphenicol, ampicillin, cotrimoxazole, fluoroquinolones and ceftriaxone. What is the treatment?
- Infectious diseases: tetanus management · ApplicationA farmer has trismus, risus sardonicus and spasms 8 days after a foot wound. Which measures are included in treatment?
- Infectious diseases: snake bite · ApplicationA farmer has bilateral ptosis, dysphagia and respiratory weakness after a night bite from a snake in the home with minimal local swelling. What is the best treatment?
- Infectious diseases: Sepsis-3 definition · ApplicationAccording to Sepsis-3, which statement defines sepsis?
- Infectious diseases: COVID-19 steroid use · ApplicationA patient with COVID-19 has SpO2 of 88 percent on room air requiring supplemental oxygen. Which drug has shown a mortality benefit in this group?
- Infectious diseases: recognition · ApplicationA patient with HIV and CD4 count of 40 per microlitre has headache, fever and hemiparesis. CT shows multiple ring-enhancing lesions in the basal ganglia and serology sh…
- Infectious diseases: Kaposi sarcoma · ApplicationA man with HIV and a CD4 count of 90 cells per microlitre has multiple violaceous nodules on his legs and palate. Biopsy shows spindle cells forming slit-like vascular…
- Infectious diseases: anthrax capsule · ApplicationA wool sorter has a painless black necrotic ulcer on the forearm with marked surrounding oedema. Smear shows large non-motile gram-positive bacilli in chains with squar…
- Infectious diseases: disseminated histoplasmosis · Multi-stepA man with advanced HIV and a CD4 count of 30 cells per microlitre has fever, weight loss, pancytopenia, hepatosplenomegaly and hypotension. Marrow biopsy shows small o…
- Infectious diseases: cryptosporidiosis in HIV · ApplicationA man with HIV and a CD4 count of 40 cells per microlitre has had profuse watery diarrhoea for three weeks. A modified acid-fast stain of stool shows round oocysts of 4…
- Infectious diseases: progressive multifocal leukoencephalopathy · Multi-stepA man with HIV and a CD4 count of 40 cells per microlitre has a subacute hemiparesis and cognitive decline. MRI shows asymmetric T2 hyperintense white matter lesions wi…
- Infectious diseases: necrotising fasciitis · ApplicationA 55-year-old diabetic man has a rapidly spreading red, swollen leg with severe pain out of proportion to the visible changes. He is hypotensive and a few areas of skin…
- Infectious diseases: toxic shock syndrome · ApplicationA 22-year-old woman using a tampon develops sudden fever, diffuse sunburn-like rash, vomiting, hypotension and later peeling of the palms. What is the mechanism by whic…
- Infectious diseases: melioidosis · Multi-stepA 52-year-old diabetic rice farmer has fever, cough and multiple abscesses in the liver and spleen. Culture grows an oxidase-positive Gram-negative bacillus showing bip…
- Infectious diseases: post-kala-azar dermal leishmaniasis · ApplicationA 25-year-old man from Bihar was treated for kala-azar two years ago. He now has hypopigmented macules and nodules over the face and trunk without sensory loss. What is…
- Infectious diseases: hydatid cyst aspiration · ApplicationA 35-year-old shepherd has a 9 cm cystic liver lesion with daughter cysts and a thick wall on ultrasound. Why is blind percutaneous aspiration of such a lesion avoided?
- Infectious diseases: hookworm anaemia · ApplicationA barefoot agricultural labourer has fatigue, pallor and microcytic hypochromic anaemia with eosinophilia. Stool examination shows oval eggs with a thin shell and four-…
- Infectious diseases: choroid tubercles in miliary tuberculosis · ApplicationA 30-year-old man has 3 weeks of fever and weight loss. Chest radiograph shows innumerable 1 to 2 mm nodules scattered uniformly through both lungs. Which fundoscopic f…
- Infectious diseases: spinal tuberculosis imaging · Multi-stepA 40-year-old man has back pain, low-grade fever and a gibbus. MRI of the thoracic spine shows destruction of adjacent vertebral bodies with a paravertebral abscess. Wh…
- Infectious diseases: diagnosis of enteric fever in the first week · ApplicationA 24-year-old man has had 4 days of stepladder fever, headache and constipation. He has relative bradycardia. Which investigation is most useful at this stage?
- Infectious diseases: quartan malaria and nephrotic syndrome · ApplicationA boy in an endemic area has recurrent fever every 72 hours and develops periorbital oedema with heavy proteinuria and a low serum albumin. Which species is most likely…
- Infectious diseases: acute HIV infection · Multi-stepA man has fever, sore throat, maculopapular rash and cervical lymphadenopathy 3 weeks after unprotected sex. A rapid HIV antibody test is negative. Which test should be…
- Infectious diseases: invasive pulmonary aspergillosis · ApplicationA patient with acute leukaemia has had 12 days of neutropenia with persistent fever on broad-spectrum antibiotics. CT chest shows nodules surrounded by ground-glass hal…
- Infectious diseases: Campylobacter and Guillain-Barre syndrome · ApplicationA 30-year-old man has bloody diarrhoea and fever after eating undercooked poultry. Two weeks later he develops symmetrical ascending weakness with absent reflexes. Whic…
- Infectious diseases: erythema nodosum leprosum · ApplicationA man with lepromatous leprosy has been on multidrug therapy for 6 months. He develops fever, tender red subcutaneous nodules, joint pain and new neuritis. What is the…
- Infectious diseases: Coxiella endocarditis · Multi-stepA 45-year-old abattoir worker with a known bicuspid aortic valve has 2 months of fever and weight loss. Three sets of blood cultures are negative, and echocardiography…
- Infectious diseases · ApplicationWhich presentation should raise urgent concern for bacterial meningitis?
- Infectious diseases · ApplicationWhat is the most useful first investigation when pyelonephritis is suspected before antibiotics are started?
- Infectious diseases · ApplicationWhich finding is most suggestive of sepsis in a patient with suspected infection?
- Infectious diseases · ApplicationWhat is an important stewardship principle when prescribing antibiotics?
- Infectious diseases: meningitis · Multi-stepA febrile patient has headache, neck stiffness, photophobia, and a nonblanching purpuric rash. What is the appropriate approach?
- Infectious diseases: HIV · ApplicationWhich infection is particularly associated with advanced HIV when the CD4 count is below 200 cells/mm3?
- Infectious diseases: malaria · ApplicationA traveler returning from a malaria-endemic area has fever, rigors, anemia, thrombocytopenia, and confusion. What is the key diagnostic test?
- Infectious diseases: tuberculosis · ApplicationWhich feature most strongly suggests reactivation pulmonary tuberculosis?
- Infectious diseases: infective diarrhea · ApplicationA patient develops profuse watery diarrhea after recent broad-spectrum antibiotics, with fever and abdominal pain. What organism should be suspected?
- Infectious diseases: HIV · ApplicationWhich opportunistic infection is strongly associated with a CD4 count below 50 cells/mm3 in untreated HIV?
Endocrinology69
- Endocrinology · Multi-stepA 19-year-old with type 1 diabetes presents with vomiting, deep rapid breathing, fruity breath and a glucose of 450 mg/dL. After airway and monitoring, what is the most…
- Endocrinology · ApplicationWhat is the first step in the management of diabetic ketoacidosis?
- Endocrinology · Multi-stepA 35-year-old woman has hypertension that is difficult to control, persistent low serum potassium with mild metabolic alkalosis, and no oedema. Which is the most approp…
- Endocrinology · Multi-stepA man passes large volumes of dilute urine. During a water deprivation test the urine stays dilute, but after desmopressin the urine osmolality rises markedly. What is…
- Endocrinology · ApplicationA 35-year-old woman with known autoimmune adrenalitis develops vomiting and diarrhoea, then collapses with a blood pressure of 70/40 mmHg, sodium 122 and potassium 6.1…
- Endocrinology · Multi-stepA woman with Graves disease develops fever of 40 degrees Celsius, agitation, heart rate 160 and vomiting after an emergency appendicectomy. Which sequence of drugs is c…
- Endocrinology: Cushing syndrome · Multi-stepA woman has features of Cushing syndrome. Morning ACTH is raised, and serum cortisol is not suppressed by low-dose dexamethasone but falls by more than 50% after high-d…
- Endocrinology: phaeochromocytoma · Multi-stepA 38-year-old man has paroxysms of headache, sweating and palpitations. His blood pressure is 190/110 mmHg, 24-hour urinary metanephrines are markedly raised, and CT sh…
- Endocrinology: post-thyroidectomy hypocalcaemia · ApplicationTwo days after total thyroidectomy, a 45-year-old woman has perioral numbness and carpopedal spasm. Her serum calcium is 6.8 mg/dL. The ECG would be expected to show a…
- Endocrinology: acromegaly · ApplicationA 40-year-old man has enlarging hands and shoe size, coarse facial features, carpal tunnel syndrome and headache. Which is the best initial screening test for acromegaly?
- Endocrinology: prolactinoma · ApplicationA 28-year-old woman has 8 months of secondary amenorrhoea and galactorrhoea. Pregnancy test is negative, TSH is normal, and she takes no medicines. Serum prolactin is 2…
- Endocrinology: factitious hypoglycaemia · Multi-stepA 30-year-old nurse has recurrent episodes of confusion with glucose of 32 mg/dL, relieved by dextrose. During an episode, serum insulin is high, C-peptide is suppresse…
- Endocrinology: Graves disease in pregnancy · ApplicationA woman with Graves disease on carbimazole finds she is 6 weeks pregnant. Her free T4 is raised. What is the most appropriate change in management during the first trim…
- Endocrinology: subacute thyroiditis · ApplicationTwo weeks after an upper respiratory tract infection, a 38-year-old woman has fever, a painful tender thyroid and palpitations. Free T4 is raised, TSH is suppressed and…
- Endocrinology: congenital adrenal hyperplasia · ApplicationA 10-day-old genetic female infant has ambiguous genitalia, vomiting and dehydration. Serum sodium is 124 mmol/L, potassium 7.0 mmol/L and glucose is low. Which investi…
- Endocrinology: multiple endocrine neoplasia · ApplicationA 25-year-old man has medullary thyroid carcinoma, and his father had a phaeochromocytoma and hypercalcaemia. Which gene is most likely mutated?
- Endocrinology: Sheehan syndrome · Multi-stepA 30-year-old woman who had major postpartum haemorrhage 6 months ago has failed to lactate, remains amenorrhoeic and has fatigue and hypotension. Free T4 is low with a…
- Endocrinology: hypothyroidism in pregnancy · ApplicationA 28-year-old woman with primary hypothyroidism on a stable dose of levothyroxine has a positive home pregnancy test. What should be done?
- Endocrinology: solitary thyroid nodule · Multi-stepA 38-year-old woman has a 2-cm solitary thyroid nodule with no compressive symptoms or lymphadenopathy. Her serum TSH is suppressed at 0.01 mIU/L. What is the best next…
- Endocrinology: osteomalacia · ApplicationA 30-year-old woman who is strictly veiled and eats little dairy has diffuse bone pain, proximal muscle weakness and a waddling gait. Radiographs show bilateral pseudof…
- Endocrinology: non-thyroidal illness · Multi-stepA 62-year-old man in the intensive care unit with septic shock has no prior thyroid disease. Thyroid tests show TSH 0.2 mIU/L (reference 0.4 to 4), free T4 at the lower…
- Endocrinology: Klinefelter syndrome · ApplicationA 22-year-old tall man with long limbs has gynaecomastia, sparse facial hair, and small firm testes of 3 mL. Semen analysis shows azoospermia. Testosterone is low and L…
- Endocrinology: pituitary apoplexy · Multi-stepA 45-year-old with a known pituitary macroadenoma develops a sudden severe headache, visual loss, ophthalmoplegia and hypotension. What is the immediate treatment?
- Endocrinology: Graves ophthalmopathy · ApplicationA smoker with Graves disease and active thyroid eye disease asks about treatment options. Which treatment may worsen the eye disease?
- Endocrinology: insulinoma · ApplicationA 40-year-old woman has episodes of confusion on fasting that resolve with glucose. During an episode, glucose is 38 mg/dL with high insulin, high C-peptide and a negat…
- Endocrinology: radioiodine contraindication · ApplicationWhich of the following is an absolute contraindication to radioiodine therapy for hyperthyroidism?
- Endocrinology: myxoedema coma · ApplicationA 75-year-old woman with known hypothyroidism is found in winter with hypothermia, bradycardia, hypoventilation and sodium of 118 mmol/L. What is the best treatment?
- Endocrinology: pioglitazone adverse effects · ApplicationA diabetic patient with NYHA class III heart failure is on pioglitazone. What is the main concern?
- Endocrinology: insulin regimens · ApplicationWhich statement about basal-bolus insulin therapy is correct?
- Endocrinology: diabetic foot · ApplicationA diabetic man has a painless punched-out ulcer on the plantar surface under the first metatarsal head with warm foot and bounding pulses. What is the ulcer type and ke…
- Endocrinology: LADA · Multi-stepA 35-year-old lean adult is labelled type 2 diabetes but is anti-GAD antibody positive and needs insulin within 18 months of diagnosis. What is the diagnosis?
- Endocrinology: gestational diabetes screening in India · ApplicationIn Indian practice (DIPSI), how is gestational diabetes diagnosed?
- Endocrinology: Graves disease · ApplicationA young woman has weight loss, diffuse non-tender goitre, exophthalmos and pretibial myxoedema. Which antibody is responsible?
- Endocrinology: low radioiodine uptake thyrotoxicosis · Multi-stepA woman has thyrotoxic symptoms, suppressed TSH and a 24-hour radioiodine uptake of 1 percent. Thyroglobulin is undetectable. What is the likely cause?
- Endocrinology: Hashimoto thyroiditis · ApplicationA 40-year-old woman has a firm goitre, fatigue and TSH of 18 mU/L. Biopsy would show which finding?
- Endocrinology: subclinical hypothyroidism · ApplicationA non-pregnant adult has TSH of 12 mU/L with normal free T4, repeated twice. What is the recommendation?
- Endocrinology: inferior petrosal sinus sampling · Multi-stepA patient has ACTH-dependent Cushing syndrome with a 4 mm pituitary lesion on MRI and failure of suppression on high-dose dexamethasone is equivocal. What investigation…
- Endocrinology: familial hypocalciuric hypercalcaemia · Multi-stepAn asymptomatic patient has mild hypercalcaemia, high-normal PTH and a calcium to creatinine clearance ratio of 0.005. What is the diagnosis?
- Endocrinology: pseudohypoparathyroidism · Multi-stepA short child with round face and short fourth metacarpals has low calcium, high phosphate and high PTH. What is the diagnosis?
- Endocrinology: Turner syndrome · ApplicationA 16-year-old girl is short, has webbed neck, primary amenorrhoea and elevated FSH. Which cardiac lesion is most associated?
- Endocrinology: statin adverse effects · ApplicationA patient on atorvastatin develops muscle pain and creatine kinase of 10 times the upper limit of normal. What is the correct action?
- Endocrinology · ApplicationWhat is the hallmark biochemical abnormality in diabetes mellitus?
- Endocrinology · ApplicationWhat symptom may suggest hypoglycemia?
- Endocrinology · ApplicationWhat is a common symptom of hypothyroidism?
- Endocrinology · ApplicationWhat is a common feature of hyperthyroidism?
- Endocrinology · ApplicationWhat symptom is common in diabetic ketoacidosis?
- Endocrinology · ApplicationWhat is the immediate safety concern with severe hypoglycemia?
- Endocrinology · ApplicationWhat laboratory test reflects average glycemic control over recent months?
- Endocrinology · ApplicationWhat symptom may indicate adrenal insufficiency?
- Endocrinology · ApplicationWhat laboratory test reflects average glucose control over recent months?
- Endocrinology · ApplicationWhat symptom may indicate hypoglycemia?
- Endocrinology · ApplicationWhat symptom is common in hyperthyroidism?
- Endocrinology · ApplicationWhich clinical combination most strongly suggests primary hypothyroidism?
- Endocrinology · ApplicationWhich treatment is given first when adrenal crisis is suspected in a severely unwell patient?
- Endocrinology · ApplicationWhich biochemical feature is most typical of primary hypothyroidism?
- Endocrinology · ApplicationWhat is a common presenting symptom of diabetes mellitus?
- Endocrinology · ApplicationWhich feature suggests diabetic ketoacidosis rather than uncomplicated hyperglycaemia?
- Endocrinology: diabetic ketoacidosis · Multi-stepA patient with type 1 diabetes has abdominal pain, vomiting, deep rapid breathing, glucose 26 mmol/L, and positive blood ketones. Which initial management principle is…
- Endocrinology: primary adrenal insufficiency · ApplicationA patient has fatigue, weight loss, postural dizziness, hyperpigmentation, hyponatremia, and hyperkalemia. Which diagnosis best fits?
- Endocrinology: SIADH · Multi-stepA euvolemic patient with small-cell lung cancer has serum sodium 118 mmol/L, low serum osmolality, and inappropriately concentrated urine. Which mechanism best explains…
- Endocrinology: diabetic ketoacidosis · Multi-stepIn diabetic ketoacidosis, why is potassium replacement often required even when initial serum potassium is normal or high?
- Endocrinology: adrenal crisis · ApplicationA patient with chronic steroid use presents with hypotension, vomiting, hyponatraemia and hypoglycaemia during sepsis. What treatment should not be delayed?
- Endocrinology: thyroid storm · ApplicationWhich drug is used early in thyroid storm to control adrenergic symptoms?
- Endocrinology: thyroid storm · Multi-stepA patient with untreated thyrotoxicosis develops fever, agitation, tachyarrhythmia, diarrhea, and heart failure after surgery. What syndrome is most likely?
- Endocrinology: myxedema coma · Multi-stepAn older patient with longstanding hypothyroidism presents with hypothermia, bradycardia, hypoventilation, hyponatremia, and reduced consciousness. What is the diagnosis?
- Endocrinology: primary hyperparathyroidism · ApplicationA patient has recurrent kidney stones, constipation, high calcium, low phosphate, and elevated parathyroid hormone. What is the most likely diagnosis?
- Endocrinology: acromegaly · ApplicationA patient has enlarged hands, coarse facial features, headaches, glucose intolerance, and bitemporal visual-field loss. What diagnosis is most likely?
- Endocrinology: prolactinoma · ApplicationA patient has galactorrhea, amenorrhea, reduced libido, and a pituitary microadenoma. What hormonal abnormality is likely?
- Endocrinology: pheochromocytoma · ApplicationA patient has episodic headache, sweating, palpitations, and paroxysmal hypertension. Which biochemical test is most appropriate for initial evaluation?
Gastroenterology67
- Gastroenterology · ApplicationFever, jaundice and right upper quadrant pain together (Charcot's triad) suggest:
- Gastroenterology · ApplicationA man with alcoholic cirrhosis and ascites develops fever and diffuse abdominal tenderness. What is the most appropriate next step in management?
- Gastroenterology: cholestatic liver disease · ApplicationA 48-year-old woman has generalised itching and fatigue for 8 months. She has a raised alkaline phosphatase, normal bilirubin and ultrasound without bile duct dilatatio…
- Gastroenterology: Helicobacter pylori eradication testing · ApplicationA 45-year-old man with an H. pylori-associated duodenal ulcer has just completed 14 days of bismuth-based quadruple therapy and is still taking omeprazole. His physicia…
- Gastroenterology: Zollinger-Ellison syndrome · Multi-stepA 38-year-old man has recurrent ulcers in the duodenum and proximal jejunum with chronic diarrhoea. Fasting serum gastrin is 450 pg/mL (normal below 100) and basal gast…
- Gastroenterology: coeliac disease diagnosis · Multi-stepA 30-year-old woman from Punjab with iron deficiency anaemia, bloating and loose stools began a strict gluten-free diet on her own six months ago and feels better. Seru…
- Gastroenterology: acute severe ulcerative colitis · Multi-stepA 26-year-old man with ulcerative colitis has 10 bloody stools daily for 4 days, pulse 112 per minute, temperature 38.2 C, haemoglobin 9 g/dL and CRP 90 mg/L. Abdominal…
- Gastroenterology: bile acid diarrhoea after ileal resection · ApplicationA 40-year-old man had 60 cm of terminal ileum resected for Crohn disease. Six months later he has watery, non-bloody diarrhoea, and stool fat excretion is normal. What…
- Gastroenterology: Whipple disease · ApplicationA 50-year-old man has had seronegative arthralgia for years and now has weight loss, diarrhoea with steatorrhoea and low-grade fever. Duodenal biopsy shows lamina propr…
- Gastroenterology: carcinoid syndrome · ApplicationA 55-year-old man has episodic facial flushing, watery diarrhoea and wheeze. CT shows an ileal mass with multiple liver metastases. Which test is the most useful to con…
- Gastroenterology: revised Atlanta classification of pancreatitis · ApplicationA 45-year-old man with gallstone pancreatitis has, from the day of admission, persistent respiratory failure (PaO2/FiO2 of 250) and a creatinine of 2.3 mg/dL (baseline…
- Gastroenterology: Clostridioides difficile infection · ApplicationA 70-year-old woman who received ceftriaxone for pneumonia a week ago has 8 watery stools daily and a white cell count of 18,000 per mm3. Stool C. difficile toxin is po…
- Gastroenterology: Crohn disease and nephrolithiasis · ApplicationA 28-year-old man with long-standing terminal ileal Crohn disease and an intact colon has steatorrhoea. He presents with colicky flank pain and haematuria, and imaging…
- Gastroenterology: small intestinal bacterial overgrowth · ApplicationA 62-year-old man with known jejunal diverticulosis has chronic bloating, diarrhoea and weight loss. His haemoglobin is low with a raised mean corpuscular volume, serum…
- Gastroenterology: chronic pancreatitis and steatorrhoea · ApplicationA 45-year-old man with long-standing alcohol-related chronic pancreatitis and pancreatic calcification has weight loss and pale, bulky, foul-smelling stools. He has sto…
- Gastroenterology: eosinophilic oesophagitis · ApplicationA 24-year-old man with atopic asthma has had years of dysphagia for solids and a recent episode of meat impaction. Endoscopy shows concentric rings and longitudinal fur…
- Gastroenterology: gastric MALT lymphoma · ApplicationA 58-year-old man with dyspepsia has gastric biopsies showing a low-grade marginal zone B-cell lymphoma with lymphoepithelial lesions, confined to the stomach wall, and…
- Gastroenterology: Boerhaave syndrome · Multi-stepAfter a night of heavy drinking and violent vomiting, a man develops severe chest pain, subcutaneous emphysema in the neck and a left pleural effusion. What is the most…
- Gastroenterology: lactose intolerance · ApplicationA 22-year-old has bloating, flatulence and watery diarrhoea within an hour of drinking milk. Stool pH is acidic and reducing substances are positive. Which test best co…
- Gastroenterology: pancreatic head carcinoma · ApplicationA 65-year-old man has painless progressive jaundice, weight loss and a palpable non-tender gallbladder. Which is the best initial imaging?
- Gastroenterology: Lynch syndrome · ApplicationA 40-year-old man has colon cancer with microsatellite instability. His mother and aunt had endometrial and colon cancer at young ages. Which genes are involved?
- Gastroenterology: upper gastrointestinal bleeding · ApplicationA 55-year-old man presents with melaena and, after fluid resuscitation, is haemodynamically stable. When should endoscopy be performed?
- Gastroenterology: H pylori therapy · ApplicationWhich regimen is recommended as first-line therapy for H pylori in areas with high clarithromycin resistance such as India?
- Gastroenterology: Zollinger-Ellison syndrome · Multi-stepA patient has multiple recurrent ulcers in the duodenum and jejunum, diarrhoea and fasting serum gastrin of 1500 pg/mL with gastric pH of 1. Where is the tumour most co…
- Gastroenterology: refractory variceal bleeding · Multi-stepVariceal bleeding continues despite vasoactive therapy and two sessions of band ligation. What is the rescue treatment?
- Gastroenterology: primary prophylaxis of varices · ApplicationEndoscopy in a cirrhotic patient shows large oesophageal varices that have never bled. What is the recommended primary prophylaxis?
- Gastroenterology: coeliac disease diagnosis · ApplicationA patient with chronic diarrhoea, weight loss and iron deficiency is evaluated for coeliac disease. What is the best initial test?
- Gastroenterology: dermatitis herpetiformis · ApplicationItchy grouped vesicles on extensor surfaces of elbows and knees with IgA granular deposits at dermal papillae on direct immunofluorescence suggest which underlying cond…
- Gastroenterology: ulcerative colitis features · ApplicationA young man has bloody diarrhoea. Colonoscopy shows continuous mucosal inflammation from the rectum to the splenic flexure. Which extraintestinal association is charact…
- Gastroenterology: toxic megacolon · Multi-stepA patient with severe ulcerative colitis has fever, tachycardia, abdominal distension and a transverse colon diameter of 7 cm on plain radiograph. What is the management?
- Gastroenterology: Truelove and Witts severity · ApplicationWhich finding defines severe ulcerative colitis by Truelove and Witts criteria?
- Gastroenterology: intestinal TB versus Crohn disease · Multi-stepA patient has ileocaecal thickening and strictures. Which feature favours intestinal tuberculosis over Crohn disease?
- Gastroenterology: stool osmotic gap · Multi-stepA patient has chronic watery diarrhoea that stops with fasting. Stool Na 40, K 30 mmol/L and stool osmolality 290 mOsm/kg. What does this indicate?
- Gastroenterology: familial adenomatous polyposis · ApplicationA 17-year-old has hundreds of colonic adenomas on colonoscopy and a family history of colon cancer. What is the definitive management?
- Gastroenterology: acute pancreatitis management · ApplicationWhich statement about the management of mild acute pancreatitis is correct?
- Gastroenterology: autoimmune pancreatitis · Multi-stepA 60-year-old man has obstructive jaundice, a diffusely enlarged sausage-shaped pancreas, serum IgG4 elevated and a mass-free biliary stricture. What is the treatment?
- Gastroenterology: HBeAg interpretation · ApplicationA patient is HBsAg positive, HBeAg positive, with HBV DNA of 10 million IU/mL and normal ALT. Which phase and implication fit best?
- Gastroenterology: hepatitis D · ApplicationA chronic HBsAg carrier presents with sudden severe hepatitis and is positive for anti-HDV IgM. What does this indicate?
- Gastroenterology: acute liver failure · Multi-stepA 22-year-old develops jaundice, confusion and INR of 2.5 within 10 days. There is no earlier liver disease. Which is the most appropriate definition and action?
- Gastroenterology: serum-ascites albumin gradient · ApplicationSerum albumin is 3.0 g/dL and ascitic fluid albumin is 0.8 g/dL with protein 1.0 g/dL. Which conclusion is correct?
- Gastroenterology: Child-Pugh and MELD · ApplicationWhich statement about cirrhosis prognostic scores is correct?
- Gastroenterology: Dubin-Johnson syndrome · ApplicationA young man has mild recurrent jaundice with conjugated hyperbilirubinaemia, normal liver enzymes and a grossly black liver on laparoscopy. What is the defect?
- Gastroenterology: GERD · ApplicationBurning retrosternal pain worse after meals and lying down suggests what?
- Gastroenterology: IBS · ApplicationRecurrent abdominal pain with altered bowel habit but no alarm features suggests what?
- Gastroenterology: ulcerative colitis · ApplicationContinuous colitis beginning at rectum is typical of what?
- Gastroenterology · ApplicationWhat is a common symptom of gastroesophageal reflux disease?
- Gastroenterology · ApplicationWhat investigation visualizes upper gastrointestinal mucosa directly?
- Gastroenterology · ApplicationWhat is a common presentation of peptic ulcer disease?
- Gastroenterology · ApplicationWhat symptom can indicate upper gastrointestinal bleeding?
- Gastroenterology · ApplicationWhat is a common feature of inflammatory bowel disease?
- Gastroenterology · ApplicationWhat is a major cause of chronic liver disease worldwide?
- Gastroenterology · ApplicationWhat symptom is typical of gastroesophageal reflux disease?
- Gastroenterology · ApplicationWhat stool appearance can indicate upper gastrointestinal bleeding?
- Gastroenterology · ApplicationIn a patient with cirrhosis and new tense ascites, which procedure helps evaluate spontaneous bacterial peritonitis?
- Gastroenterology · ApplicationWhat is the most appropriate initial priority for a patient with haematemesis and hypotension?
- Gastroenterology · ApplicationWhich laboratory result is most useful for confirming acute pancreatitis when compatible pain is present?
- Gastroenterology · ApplicationWhich presentation is an alarm feature in dyspepsia requiring prompt assessment?
- Gastroenterology · ApplicationWhich test is commonly used to confirm active Helicobacter pylori infection noninvasively?
- Gastroenterology: upper GI bleeding · Multi-stepA patient presents with hematemesis, tachycardia, and hypotension. What is the first management priority?
- Gastroenterology: celiac disease · ApplicationA patient has chronic diarrhea, iron-deficiency anemia, weight loss, and dermatitis herpetiformis. Which test is the most appropriate initial serologic investigation wh…
- Gastroenterology: upper GI bleeding · ApplicationA cirrhotic patient with haematemesis should receive which vasoactive drug while urgent endoscopy is arranged for suspected variceal bleeding?
- Gastroenterology: acute pancreatitis · ApplicationWhich laboratory test is more specific than amylase for acute pancreatitis?
- Gastroenterology: acute liver failure · Multi-stepA patient with acute hepatitis develops INR elevation and new confusion without known cirrhosis. What syndrome is present?
- Gastroenterology: acute cholangitis · ApplicationFever, jaundice, and right-upper-quadrant pain in a patient with biliary obstruction is known as which triad?
- Gastroenterology: inflammatory bowel disease · ApplicationWhich feature favors Crohn disease over ulcerative colitis?
- Gastroenterology: achalasia · ApplicationA patient has progressive dysphagia to both solids and liquids, nocturnal regurgitation of undigested food, and a bird-beak appearance on contrast study. What is the di…
- Gastroenterology: spontaneous bacterial peritonitis · Multi-stepA patient with cirrhosis and ascites has fever, worsening encephalopathy, and ascitic fluid neutrophil count of 320 cells/mm3. What is the diagnosis?
Haematology43
- Haematology · ApplicationWhich investigation best distinguishes iron deficiency anaemia from anaemia of chronic disease?
- Haematology · Multi-stepA 60-year-old woman has macrocytic anaemia, a sore smooth tongue, tingling in both feet and loss of vibration sense. Serum vitamin B12 is low. Which treatment is most a…
- Haematology · ApplicationA 55-year-old woman has macrocytic anaemia, a smooth red tongue and numbness in both feet with loss of vibration sense. Which antibody is the most specific for the like…
- Haematology · ApplicationA 28-year-old woman presents with fever, confusion, haematuria and petechiae. Haemoglobin is low with schistocytes on the smear, platelets are very low, and PT and aPTT…
- Haematology · Multi-stepA 45-year-old man has fatigue, a massive spleen, a total leukocyte count of 2,40,000 per microlitre with myelocytes and basophils, and a low leukocyte alkaline phosphat…
- Haematology · ApplicationA 6-year-old boy has recurrent painful swelling of the knee and bleeds after tooth extraction. Platelet count and PT are normal, but aPTT is prolonged and corrects on m…
- Haematology: myeloproliferative neoplasms · ApplicationA 55-year-old man has facial plethora, an itchy skin after a hot bath, splenomegaly and a haemoglobin of 19 g/dL with a low serum erythropoietin. Which mutation is most…
- Haematology: beta-thalassaemia trait · Multi-stepA 24-year-old woman has mild fatigue. Haemoglobin is 10.2 g/dL, MCV 62 fL, red cell count 5.6 million per microlitre, RDW normal and serum ferritin 90 ng/mL. The smear…
- Haematology: G6PD deficiency · ApplicationA 26-year-old man develops dark urine, jaundice and pallor three days after starting primaquine for Plasmodium vivax malaria. Haemoglobin falls from 13 to 7.5 g/dL, the…
- Haematology: warm autoimmune haemolytic anaemia · ApplicationA 45-year-old woman with systemic lupus erythematosus has fatigue and jaundice. Haemoglobin is 6.8 g/dL, reticulocytes 12%, LDH is raised, the film shows spherocytes an…
- Haematology: aplastic anaemia · ApplicationA 19-year-old man has three weeks of fever and bleeding gums. Haemoglobin is 6 g/dL, white cells 1,200 per microlitre with an absolute neutrophil count of 300, and plat…
- Haematology: immune thrombocytopenia in adults · ApplicationA 30-year-old woman has easy bruising, gum bleeding and petechiae. Platelets are 12,000 per microlitre with a normal haemoglobin and white cell count, giant platelets o…
- Haematology: disseminated intravascular coagulation · ApplicationA 40-year-old woman with Gram-negative sepsis from pyelonephritis has oozing from venepuncture sites and haematuria. PT is 24 s (control 13), aPTT 62 s, platelets 38,00…
- Haematology: multiple myeloma · Multi-stepA 66-year-old man has back pain and fatigue. Creatinine is 2.4 mg/dL, calcium 12 mg/dL, haemoglobin 8.4 g/dL and ESR 120 mm in the first hour. Urine dipstick is negativ…
- Haematology: transfusion reactions · Multi-stepTen minutes into the first unit of red cells, a 45-year-old woman develops fever, rigors, chest and loin pain and hypotension. Her urine becomes red-brown. What is the…
- Haematology: heparin-induced thrombocytopenia · Multi-stepA 60-year-old man was started on unfractionated heparin after coronary bypass surgery. On day 7, platelets fall from 250,000 to 70,000 per microlitre and a new left leg…
- Haematology: hairy cell leukaemia · ApplicationA 55-year-old man has fatigue, recurrent infections, a palpable spleen 8 cm below the costal margin and no lymphadenopathy. Counts show pancytopenia with monocytopenia,…
- Haematology: CLL versus mantle cell lymphoma · Multi-stepA 66-year-old man has generalised painless lymphadenopathy and a lymphocyte count of 55,000 per microlitre, with smudge cells on the film. Flow cytometry shows CD19-pos…
- Haematology: paroxysmal nocturnal haemoglobinuria · ApplicationA 30-year-old woman has episodes of dark urine in the morning, a haemoglobin of 7.5 g/dL, raised LDH and a negative direct Coombs test. She also had a recent hepatic ve…
- Haematology: warfarin-induced skin necrosis · Multi-stepA 52-year-old woman with a proximal deep vein thrombosis is started on warfarin 10 mg daily without heparin cover. On day 4 she develops painful erythematous patches on…
- Haematology: von Willebrand disease · ApplicationA 20-year-old woman has heavy menstrual bleeding and recurrent nosebleeds since childhood. Platelet count and PT are normal, the aPTT is mildly prolonged, and the bleed…
- Haematology: lead poisoning · ApplicationA 6-year-old child living near an informal battery-recycling unit has colicky abdominal pain, constipation, irritability and anaemia. The blood film shows coarse basoph…
- Haematology: isoniazid-induced sideroblastic anaemia · Multi-stepA 48-year-old man on a standard four-drug antituberculosis regimen for 3 months has increasing fatigue. Haemoglobin is 8.2 g/dL, MCV 72 fL, serum iron is high, transfer…
- Haematology: Waldenstrom macroglobulinaemia · Multi-stepA 70-year-old man has fatigue, recurrent epistaxis, headaches and blurred vision. Fundoscopy shows dilated, segmented retinal veins. Serum protein electrophoresis shows…
- Haematology: vitamin B12 deficiency · Multi-stepA 62-year-old strict vegetarian has macrocytic anaemia, paraesthesia and loss of vibration sense. Which biochemical result is expected?
- Haematology: haemophilia A management · ApplicationA boy with known severe haemophilia A develops an acutely painful swollen knee after minor trauma. What is the most appropriate treatment?
- Haematology: secondary polycythaemia · ApplicationA 60-year-old smoker with severe COPD has a haemoglobin of 19 g/dL. Which pattern supports secondary polycythaemia rather than polycythaemia vera?
- Haematology: reversal of dabigatran · ApplicationA patient on dabigatran develops life-threatening intracranial bleeding. Which agent specifically reverses its effect?
- Haematology: factor V Leiden · Multi-stepA 28-year-old woman has a deep vein thrombosis, a family history of venous thrombosis and normal levels of protein C, protein S and antithrombin. What is the most likel…
- Haematology: anaemia of chronic disease · ApplicationA patient with rheumatoid arthritis has MCV of 80 fL, serum iron low, TIBC low and ferritin of 400 ng/mL. What is the mechanism?
- Haematology: pernicious anaemia · ApplicationA 55-year-old woman with vitiligo has megaloblastic anaemia and positive anti-intrinsic factor antibodies. Which long-term risk should be monitored?
- Haematology: thalassaemia major · ApplicationA 2-year-old child has severe anaemia, hepatosplenomegaly and frontal bossing. Haemoglobin electrophoresis shows predominantly HbF. What is the cornerstone of management?
- Haematology: warfarin reversal · Multi-stepA patient on warfarin has an INR of 9 with intracranial haemorrhage. Which is the most appropriate reversal?
- Haematology: deep vein thrombosis duration · ApplicationA patient develops a calf DVT after a long flight (provoked by a transient risk factor). How long should a DOAC be given?
- Haematology: acute lymphoblastic leukaemia · ApplicationA child has pancytopenia and lymphoblasts that are positive for TdT and CD10. Which statement about management is correct?
- Haematology: essential thrombocythaemia and myelofibrosis · Multi-stepA patient has massive splenomegaly, teardrop red cells, leucoerythroblastic smear and a dry tap on bone marrow aspiration. What is the diagnosis?
- Haematology: superior vena cava syndrome · ApplicationA smoker has facial swelling, distended neck veins and dilated chest wall collaterals with a mediastinal mass. Which is the correct approach?
- Haematology · ApplicationWhich blood-film description is most characteristic of iron deficiency anaemia?
- Haematology · ApplicationWhat is the key immediate action for suspected neutropenic sepsis in a patient receiving chemotherapy?
- Haematology · ApplicationWhich laboratory result best supports iron-deficiency anaemia?
- Haematology · ApplicationWhat is a major clinical concern in severe neutropenia with fever?
- Haematology: immune thrombocytopenia · ApplicationA patient has isolated thrombocytopenia with petechiae and normal PT/aPTT after a viral illness. What is the likely diagnosis?
- Haematology: TTP · Multi-stepThrombocytopenia, microangiopathic haemolytic anaemia, neurologic symptoms and renal dysfunction suggest TTP. What therapy is urgent?
Nephrology41
- Nephrology · ApplicationRed blood cell casts in the urine most strongly suggest:
- Nephrology: acute kidney injury · ApplicationA man develops acute kidney injury after 3 days of vomiting and diarrhoea. Which set of findings best supports a pre-renal cause rather than acute tubular necrosis?
- Nephrology: CKD mineral and bone disorder · ApplicationA 55-year-old man on maintenance haemodialysis has serum phosphate 7.8 mg/dL, corrected calcium 10.9 mg/dL and coronary artery calcification on CT. Dietary phosphate re…
- Nephrology: membranous nephropathy · ApplicationA 52-year-old man has oedema and 6 g/day proteinuria with serum albumin 2.1 g/dL. Complement levels are normal. Serum anti-phospholipase A2 receptor antibodies are posi…
- Nephrology: post-streptococcal glomerulonephritis · Multi-stepAn 8-year-old boy has cola-coloured urine, periorbital puffiness and blood pressure of 140/90 mmHg two weeks after a skin infection. Which serological pattern would you…
- Nephrology: IgA nephropathy · ApplicationA 22-year-old man has an episode of painless macroscopic haematuria one day after a sore throat, his third similar episode. Blood pressure is normal, and serum C3 and C…
- Nephrology: acute interstitial nephritis · ApplicationA 45-year-old woman taking omeprazole for 3 weeks develops fever, a rash and a rise in creatinine from 0.9 to 2.6 mg/dL. Urine microscopy shows white cells and white ce…
- Nephrology: rhabdomyolysis · Multi-stepA 28-year-old labourer was trapped under rubble for six hours. He passes dark brown urine. The dipstick is strongly positive for blood, yet microscopy shows no red cell…
- Nephrology: uraemic pericarditis · Multi-stepA 48-year-old man with end-stage kidney disease who missed several dialysis sessions has pleuritic chest pain and a pericardial friction rub. Urea is 210 mg/dL. Echocar…
- Nephrology: dialysis complications · ApplicationA 60-year-old man with a urea of 280 mg/dL undergoes his first haemodialysis session. Towards the end he develops headache, nausea and then a generalised seizure, with…
- Nephrology: contrast-associated acute kidney injury · ApplicationA 68-year-old diabetic man with chronic kidney disease (eGFR 35 mL/min/1.73 m2) needs an urgent contrast-enhanced CT scan. Which measure best reduces his risk of contra…
- Nephrology: chloride-responsive metabolic alkalosis · Multi-stepA 24-year-old woman with BMI 17 kg/m2 has weakness and palpitations. She is mildly dehydrated with a normal blood pressure. Arterial pH is 7.52, HCO3 36 mmol/L, PaCO2 4…
- Nephrology: granulomatous hypercalcaemia · ApplicationA 34-year-old woman has bilateral hilar lymphadenopathy, thirst and polyuria. Serum calcium is 12.9 mg/dL, intact PTH is suppressed, 25-hydroxyvitamin D is normal and 1…
- Nephrology: renal vein thrombosis · ApplicationA 40-year-old man with biopsy-proven membranous nephropathy (urinary protein 8 g/day, serum albumin 1.8 g/dL) develops sudden left flank pain, gross haematuria and a ri…
- Nephrology: anti-GBM disease · ApplicationA 25-year-old smoker has haemoptysis and breathlessness, haematuria and a serum creatinine rising from 1.2 to 4.8 mg/dL over 10 days. Renal biopsy shows crescentic glom…
- Nephrology: peritoneal dialysis peritonitis · Multi-stepA 52-year-old man on continuous ambulatory peritoneal dialysis has abdominal pain and notices cloudy effluent. The dialysate cell count shows 800 white cells per microl…
- Nephrology: HIV-associated nephropathy · Multi-stepA 30-year-old man with untreated HIV infection presents with nephrotic-range proteinuria and rapidly declining renal function. Which biopsy pattern is expected?
- Nephrology: pauci-immune crescentic glomerulonephritis · Multi-stepA 55-year-old man has rapidly progressive glomerulonephritis with positive myeloperoxidase ANCA. What is the expected immunofluorescence finding on renal biopsy?
- Nephrology: analgesic nephropathy · ApplicationA 60-year-old woman with chronic headaches who has taken combination analgesics for 20 years has sterile pyuria and chronic kidney disease. CT shows papillary calcifica…
- Nephrology: calcineurin inhibitors · Multi-stepA renal transplant recipient on immunosuppression develops new-onset diabetes mellitus and tremor. Which adverse effect is more characteristic of tacrolimus than of cyc…
- Nephrology: anaemia of chronic kidney disease · ApplicationA patient with chronic kidney disease and a haemoglobin of 8 g/dL does not respond to erythropoiesis-stimulating agent therapy. What is the most common cause of poor re…
- Nephrology: emphysematous pyelonephritis · ApplicationA diabetic woman has fever, flank pain and septic shock. Which CT finding confirms emphysematous pyelonephritis?
- Nephrology: acute tubular necrosis · ApplicationA patient with septic shock develops oliguria. Urine microscopy shows muddy brown granular casts and FENa is 3 percent. What is the diagnosis?
- Nephrology: CKD mineral bone disorder · ApplicationA patient with advanced CKD has serum calcium 7.8 mg/dL, phosphate 7.4 mg/dL and markedly elevated PTH. What is the mechanism?
- Nephrology: anaemia of CKD · ApplicationA patient on dialysis has haemoglobin of 8 g/dL with normal transferrin saturation and ferritin. What is the treatment?
- Nephrology: membranoproliferative GN · Multi-stepA renal biopsy shows lobular glomeruli with duplication of the basement membrane giving a tram-track appearance, and serum C3 is persistently low. Which infection is a…
- Nephrology: autosomal dominant polycystic kidney disease · ApplicationA 40-year-old has hypertension, bilateral enlarged kidneys with multiple cysts, and a sudden severe headache with neck stiffness. Which is the likeliest cause of the he…
- Nephrology: high anion gap acidosis · ApplicationWhich of the following causes a high anion gap metabolic acidosis?
- Nephrology: normal anion gap acidosis · ApplicationA patient with severe diarrhoea has pH 7.28, bicarbonate 14 mmol/L, chloride 115 mmol/L, sodium 138 mmol/L. What is the urine anion gap likely to show?
- Nephrology: haemolytic uraemic syndrome · Multi-stepA child develops bloody diarrhoea followed after 5 days by pallor, oliguria, haemoglobin 7 g/dL with schistocytes and platelet count of 40,000. What is the diagnosis an…
- Nephrology: renal transplant rejection · ApplicationWithin minutes of reperfusion of a transplanted kidney, the graft becomes mottled and cyanotic. What is the mechanism?
- Nephrology · ApplicationWhat is a common sign of acute kidney injury?
- Nephrology · ApplicationWhat is a frequent cause of chronic kidney disease?
- Nephrology · ApplicationWhat symptom may occur with nephrotic syndrome?
- Nephrology · ApplicationWhat can precipitate acute kidney injury in a dehydrated patient?
- Nephrology · ApplicationWhat laboratory trend suggests acute kidney injury?
- Nephrology · ApplicationWhat is a common cause of chronic kidney disease?
- Nephrology: nephrotic syndrome · ApplicationA patient has generalized edema, urine protein 4+, serum albumin 20 g/L, and hyperlipidemia. Which renal syndrome is present?
- Nephrology: acute kidney injury · Multi-stepA patient with vomiting and diarrhea has oliguria, concentrated urine, and a fractional excretion of sodium below 1%. Which mechanism of acute kidney injury is most lik…
- Nephrology: nephrotic syndrome · ApplicationWhich complication is increased in nephrotic syndrome because of urinary loss of anticoagulant proteins?
- Nephrology: acute kidney injury · ApplicationWhich urine finding most strongly supports acute tubular necrosis?
Gastroenterology and hepatology28
- Gastroenterology and hepatology: tropical sprue · Multi-stepA man who has lived in Chennai for many years develops chronic diarrhoea with steatorrhoea, weight loss and macrocytic anaemia. Duodenal biopsy shows villous flattening…
- Gastroenterology and hepatology: spontaneous bacterial peritonitis · ApplicationA man with cirrhosis and ascites develops fever and diffuse abdominal tenderness. Ascitic fluid analysis shows 600 neutrophils per microlitre. What is the most appropri…
- Gastroenterology and hepatology: diffuse oesophageal spasm manometry · Multi-stepA 50-year-old woman has intermittent chest pain and dysphagia for both solids and liquids, often triggered by cold drinks. A barium swallow shows a corkscrew appearance…
- Gastroenterology and hepatology: Schatzki ring · ApplicationA 55-year-old man has intermittent dysphagia only for solids, especially bread and meat, with occasional food sticking that clears with water. He has no weight loss. Ba…
- Gastroenterology and hepatology: dumping syndrome management · ApplicationA man three months after a partial gastrectomy has sweating, palpitations, abdominal cramps and diarrhoea 20 to 30 minutes after meals. What is the first-line management?
- Gastroenterology and hepatology: glucagonoma · ApplicationA 58-year-old woman has weight loss, new mild diabetes, anaemia and a painful rash in the groin and perineum with migrating erythematous patches, central blistering and…
- Gastroenterology and hepatology: Plummer-Vinson syndrome · ApplicationA 45-year-old woman has fatigue, glossitis, koilonychia and difficulty swallowing solids. Haemoglobin is 8.5 g/dL with microcytic indices. A barium swallow shows a thin…
- Gastroenterology and hepatology: Zenker diverticulum · ApplicationA 70-year-old man has dysphagia, regurgitation of undigested food hours after eating, halitosis and a gurgling sound in the neck. A barium swallow shows a posterior out…
- Gastroenterology and hepatology: Candida oesophagitis · ApplicationA 34-year-old man with HIV and a CD4 count of 40 per microlitre has odynophagia and white plaques on the tongue. Endoscopy shows creamy linear plaques in the oesophagus…
- Gastroenterology and hepatology: pill oesophagitis · ApplicationA 25-year-old woman with acne is prescribed doxycycline. She takes it with a sip of water just before lying down and the next day has severe retrosternal pain and pain…
- Gastroenterology and hepatology: diabetic gastroparesis · ApplicationA 40-year-old man with type 1 diabetes for 15 years has early satiety, vomiting of food eaten many hours earlier and erratic glycaemic control. Endoscopy shows retained…
- Gastroenterology and hepatology: gastrointestinal stromal tumour · ApplicationA 58-year-old man presents with melaena. CT shows a 6 cm exophytic gastric mass. Histology shows spindle cells positive for CD117 and DOG1. Which drug is appropriate fo…
- Gastroenterology and hepatology: ischaemic colitis · Multi-stepA 75-year-old woman with heart failure has sudden left-sided cramping abdominal pain followed within hours by bloody diarrhoea. CT shows segmental thickening of the spl…
- Gastroenterology and hepatology: acute mesenteric ischaemia · Multi-stepA 68-year-old man with atrial fibrillation, not on anticoagulants, develops sudden severe periumbilical pain with a soft, non-tender abdomen, vomiting and passage of bl…
- Gastroenterology and hepatology: abetalipoproteinaemia · Multi-stepA 3-year-old child has steatorrhoea and failure to thrive. A blood film shows acanthocytes, serum cholesterol is very low, and chylomicrons and LDL are absent. Later he…
- Gastroenterology and hepatology: giardiasis · ApplicationA trekker returns with 2 weeks of foul-smelling, greasy pale stools, bloating and flatulence, without fever or blood. Stool microscopy shows pear-shaped flagellated tro…
- Gastroenterology and hepatology: collagenous colitis · Multi-stepA 58-year-old woman on lansoprazole and ibuprofen has 3 months of watery, non-bloody diarrhoea, including at night. Colonoscopy looks normal and CRP is normal. Colonic…
- Gastroenterology and hepatology: sigmoid volvulus · Multi-stepA 78-year-old nursing home resident with chronic constipation has abdominal distension and absolute constipation. Radiograph shows a hugely dilated loop shaped like a c…
- Gastroenterology and hepatology: hypertriglyceridaemic pancreatitis · Multi-stepA 38-year-old man with poorly controlled diabetes has acute pancreatitis. His serum looks milky, there are no gallstones, he drinks no alcohol, and serum triglycerides…
- Gastroenterology and hepatology: pancreatic pseudocyst · Multi-stepSix weeks after severe acute pancreatitis, a 40-year-old man has persistent epigastric pain, early satiety and vomiting. CT shows a 9 cm thin-walled fluid collection ab…
- Gastroenterology and hepatology: gallstone ileus · ApplicationA 75-year-old woman with previous gallstone attacks has 3 days of vomiting and colicky abdominal pain. A radiograph shows dilated small bowel loops and gas in the bilia…
- Gastroenterology and hepatology: choledochal cyst · ApplicationA 4-year-old girl has intermittent jaundice, abdominal pain and a right upper quadrant mass. Ultrasonography shows fusiform dilatation of the common bile duct. What is…
- Gastroenterology and hepatology: sinistral portal hypertension · Multi-stepA 45-year-old man with chronic pancreatitis has haematemesis. Endoscopy shows isolated fundal gastric varices with no oesophageal varices. The liver looks normal on CT,…
- Gastroenterology and hepatology: focal nodular hyperplasia · ApplicationA 30-year-old woman has an incidental 4 cm liver lesion on CT. It is homogeneous, enhances brightly in the arterial phase and has a central stellate scar without calcif…
- Gastroenterology and hepatology: hepatocellular adenoma · ApplicationA 28-year-old woman on long-term combined oral contraceptive pills presents with sudden severe right upper quadrant pain and hypotension. CT shows a 7 cm liver mass wit…
- Gastroenterology and hepatology: hepatic hydatid cyst · ApplicationA 35-year-old farmer from a sheep-rearing region has a 9 cm septated cystic lesion with daughter cysts in the right hepatic lobe. Surgery is planned. Which drug is give…
- Gastroenterology and hepatology: Dieulafoy lesion · Multi-stepA 60-year-old man has massive painless haematemesis. Endoscopy shows a pinpoint mucosal defect high on the lesser curve with a spurting vessel, and no ulcer crater or s…
- Gastroenterology and hepatology: porphyria cutanea tarda · ApplicationA 50-year-old man with chronic hepatitis C has fragile blisters, erosions and hypertrichosis on the sun-exposed backs of his hands, and his urine is pink-brown. What is…
Endocrinology and diabetes23
- Endocrinology and diabetes: thyroid storm treatment sequence · Multi-stepA patient with thyroid storm has been given propranolol, propylthiouracil and hydrocortisone. Which drug is given at least an hour after the thionamide to block release…
- Endocrinology and diabetes: primary hyperaldosteronism · Multi-stepA 38-year-old woman has resistant hypertension and serum potassium of 3.0 mEq/L. Plasma aldosterone-to-renin ratio is raised. What is the next step to confirm the diagn…
- Endocrinology and diabetes: adrenal insufficiency · Multi-stepA 35-year-old woman has weight loss, fatigue, postural hypotension and skin creases that are darkly pigmented. Sodium is 127 mEq/L and potassium is 5.9 mEq/L. Which tes…
- Endocrinology and diabetes: Paget disease of bone · ApplicationA 65-year-old man has increasing head size and bone pain. Serum calcium and phosphate are normal and ALP is markedly elevated. X-ray of the skull shows thickened bone w…
- Endocrinology and diabetes: work-up after Cushing screen · Multi-stepA 35-year-old woman has weight gain, purple striae, proximal weakness and hypertension. Her morning cortisol after 1 mg of dexamethasone at night is 9 micrograms/dL (no…
- Endocrinology and diabetes: Nelson syndrome · ApplicationA woman who had bilateral adrenalectomy for Cushing disease three years ago now has progressive darkening of the skin and a bitemporal visual field defect. Her ACTH is…
- Endocrinology and diabetes: iodine-induced hyperthyroidism · Multi-stepA woman from an iodine-deficient hilly region has a long-standing multinodular goitre. She develops palpitations and weight loss within weeks of receiving iodinated con…
- Endocrinology and diabetes: postpartum thyroiditis · ApplicationThree months after delivery, a woman has palpitations, weight loss and a small painless goitre. TSH is suppressed, free T4 is raised, radioiodine uptake is low and anti…
- Endocrinology and diabetes: antithyroid drug agranulocytosis · ApplicationA woman started on carbimazole for Graves disease five weeks ago develops fever and a severe sore throat. What is the best next step?
- Endocrinology and diabetes: hypercalcaemia of malignancy treatment · ApplicationA 62-year-old man with squamous cell lung cancer has confusion, polyuria and dehydration. Serum calcium is 14.2 mg/dL, PTH is suppressed and PTHrP is raised. After star…
- Endocrinology and diabetes: amiodarone-induced thyrotoxicosis · Multi-stepA 64-year-old man on long-term amiodarone develops weight loss and palpitations. TSH is suppressed with raised free T4, radioiodine uptake is very low, colour Doppler f…
- Endocrinology and diabetes: diabetic gastroparesis · ApplicationA 38-year-old man with type 1 diabetes for 20 years has early satiety, postprandial vomiting of undigested food and erratic glucose control. Endoscopy shows retained fo…
- Endocrinology and diabetes: craniopharyngioma · ApplicationA 9-year-old boy has headache, growth failure and bitemporal visual field loss. MRI shows a partly cystic, calcified suprasellar mass. What is the most likely diagnosis?
- Endocrinology and diabetes: stalk effect hyperprolactinaemia · Multi-stepA 35-year-old woman has headache, bitemporal hemianopia and amenorrhoea. MRI shows a 3 cm sellar mass. Serum prolactin is 85 ng/mL and does not change when the assay is…
- Endocrinology and diabetes: Kallmann syndrome · ApplicationA 17-year-old boy has absent pubertal development, small testes and anosmia. Serum LH, FSH and testosterone are all low, other pituitary function is normal and MRI of t…
- Endocrinology and diabetes: adrenal incidentaloma work-up · Multi-stepA 55-year-old normotensive woman has a 3.5 cm right adrenal mass found incidentally on CT done for abdominal pain. Unenhanced attenuation is 35 Hounsfield units. Which…
- Endocrinology and diabetes: secondary adrenal insufficiency features · Multi-stepA 45-year-old woman took prednisolone 20 mg daily for eight months for giant cell arteritis and stopped it abruptly. She now has fatigue, nausea and postural hypotensio…
- Endocrinology and diabetes: perioperative steroid cover · ApplicationA 50-year-old man has taken prednisolone 10 mg daily for two years for polymyalgia rheumatica. He needs elective hip replacement under general anaesthesia. What is the…
- Endocrinology and diabetes: acute iodide effect on thyroid hormone release · ApplicationA patient with Graves disease is given a large dose of iodide before thyroid surgery and thyroid hormone release falls promptly. Which mechanism explains this?
- Endocrinology and diabetes: glucocorticoid-induced hyperglycaemia · Multi-stepA 60-year-old man with type 2 diabetes starts prednisolone 40 mg every morning. His fasting glucose is normal, but readings reach 300 mg/dL in the afternoon and evening…
- Endocrinology and diabetes: MEN1 gene · ApplicationA 30-year-old man has recurrent peptic ulcers with diarrhoea, hypercalcaemia with raised PTH, and a pituitary adenoma. Mutation in which gene is most likely?
- Endocrinology and diabetes: cerebral oedema in paediatric DKA · ApplicationA 9-year-old with newly diagnosed type 1 diabetes in ketoacidosis improves on treatment, but 6 hours later develops headache, vomiting, bradycardia and drowsiness. Whic…
- Endocrinology and diabetes: solitary toxic adenoma scintigraphy · ApplicationA 50-year-old woman has weight loss and palpitations. TSH is suppressed and T3 is raised. She has a solitary 3 cm thyroid nodule, and radionuclide scanning shows focal…
Hepatology22
- Hepatology: hepatitis B reactivation with chemotherapy · Multi-stepA 60-year-old woman with newly diagnosed diffuse large B-cell lymphoma is about to start rituximab-containing chemotherapy. Screening shows HBsAg negative, total anti-H…
- Hepatology: autoimmune hepatitis · ApplicationA 32-year-old woman has fatigue, arthralgia and amenorrhoea. ALT is 480 U/L, serum IgG is markedly raised, ANA is positive at 1:320 and anti-smooth muscle antibody is p…
- Hepatology: hereditary haemochromatosis · ApplicationA 45-year-old man has bronze skin, diabetes mellitus, hepatomegaly and arthropathy of the second and third metacarpophalangeal joints. Ferritin is 2,800 ng/mL and trans…
- Hepatology: severe alcoholic hepatitis · ApplicationA 45-year-old man with heavy alcohol use has jaundice and tender hepatomegaly. Bilirubin is 8 mg/dL, prothrombin time is 24 s (control 14 s), AST 160 U/L and ALT 70 U/L…
- Hepatology: hepatic encephalopathy prevention · ApplicationA 58-year-old man with alcohol-related cirrhosis has a second episode of overt hepatic encephalopathy within three months while taking lactulose regularly. Precipitants…
- Hepatology: ascitic fluid interpretation · Multi-stepA 25-year-old woman has fever, weight loss and abdominal distension for 6 weeks. Ascitic fluid analysis shows albumin 2.6 g/dL (serum albumin 3.4 g/dL), protein 4.8 g/d…
- Hepatology: Budd-Chiari syndrome · ApplicationA 32-year-old woman has abdominal pain, rapidly accumulating ascites and tender hepatomegaly. Ascitic protein is 3.8 g/dL. Ultrasound shows an enlarged liver with promi…
- Hepatology: primary sclerosing cholangitis · ApplicationA 34-year-old man with long-standing ulcerative colitis has pruritus and an alkaline phosphatase five times the upper limit of normal. MRCP shows multifocal beaded stri…
- Hepatology: diagnosis of hepatocellular carcinoma · Multi-stepA 55-year-old man with hepatitis C cirrhosis under six-monthly ultrasound surveillance has a new 2.5 cm liver nodule, and the serum alpha-fetoprotein is 600 ng/mL. What…
- Hepatology: hepatopulmonary syndrome · Multi-stepA 55-year-old man with cirrhosis has progressive breathlessness that is worse when sitting upright and better when lying flat. Oxygen saturation is 88% sitting and 95%…
- Hepatology: metabolic dysfunction-associated steatotic liver disease · Multi-stepA 50-year-old obese man with type 2 diabetes has fatty liver on ultrasound. Laboratory results show AST 60 U/L, ALT 64 U/L and platelet count 110 x 10^9/L. Using FIB-4…
- Hepatology: unconjugated hyperbilirubinaemia · Multi-stepA 19-year-old man develops mild jaundice during a viral fever and a day of fasting. Total bilirubin is 3.0 mg/dL, almost entirely unconjugated. Liver enzymes, haemoglob…
- Hepatology: chronic hepatitis B antiviral therapy · ApplicationA patient with chronic hepatitis B, compensated cirrhosis, a high HBV DNA level and raised ALT needs antiviral treatment. Which drug is a preferred option?
- Hepatology: encephalopathy · ApplicationAsterixis and confusion in cirrhosis suggest what?
- Hepatology · ApplicationFever and neutrophil-rich ascites suggest what?
- Hepatology · ApplicationWhat laboratory test often rises with hepatocellular injury?
- Hepatology · ApplicationWhat physical sign may suggest chronic liver disease?
- Hepatology · ApplicationWhat finding may suggest chronic liver disease?
- Hepatology · ApplicationWhich feature most suggests hepatic encephalopathy in a patient with advanced cirrhosis?
- Hepatology · ApplicationWhich blood test pattern commonly suggests hepatocellular injury?
- Hepatology: spontaneous bacterial peritonitis · Multi-stepA patient with cirrhosis and ascites develops fever, abdominal discomfort, and worsening encephalopathy. Which test is required urgently to evaluate for spontaneous bac…
- Hepatology: hepatic encephalopathy · ApplicationLactulose improves hepatic encephalopathy primarily by what action?
Hematology18
- Hematology: DVT · ApplicationUnilateral swollen tender calf after immobility suggests what?
- Hematology: hemophilia · ApplicationHemarthroses with prolonged aPTT suggest what disorder?
- Hematology · ApplicationPancytopenia with hypocellular marrow suggests what?
- Hematology · ApplicationLymphadenopathy with B symptoms warrants evaluation for what?
- Hematology · ApplicationPallor with low ferritin suggests what?
- Hematology · ApplicationLytic lesions, anemia, renal injury suggest what?
- Hematology · ApplicationWhat is a common symptom of anemia?
- Hematology · ApplicationWhat test measures the proportion of blood volume occupied by red cells?
- Hematology · ApplicationWhat laboratory feature supports iron deficiency anemia?
- Hematology · ApplicationWhat is a common complication of severe neutropenia?
- Hematology · ApplicationWhat symptom commonly occurs with anemia?
- Hematology · ApplicationWhat test measures the percentage of blood occupied by red cells?
- Hematology: microcytic anemia · ApplicationWhich iron-study pattern most strongly supports iron-deficiency anemia?
- Hematology: thrombotic thrombocytopenic purpura · Multi-stepA patient has thrombocytopenia, microangiopathic hemolytic anemia with schistocytes, confusion, and renal impairment. Which diagnosis requires urgent plasma exchange?
- Hematology: hemolytic anemia · ApplicationWhich laboratory pattern supports hemolysis?
- Hematology: disseminated intravascular coagulation · Multi-stepA septic patient develops diffuse bleeding from venepuncture sites, thrombocytopenia, prolonged PT and aPTT, high D-dimer, and low fibrinogen. What is the diagnosis?
- Hematology: polycythemia vera · ApplicationA patient has headaches, aquagenic pruritus, splenomegaly, elevated hematocrit, and low erythropoietin level. What is most likely?
- Hematology: G6PD deficiency · ApplicationAfter taking an oxidant drug, a patient develops jaundice and hemoglobinuria; blood film shows bite cells. Which enzyme defect is likely?
Nephrology and electrolytes18
- Nephrology and electrolytes: Bartter syndrome site of defect · Multi-stepA 4-year-old child has failure to thrive, polyuria and muscle weakness. Investigations show potassium 2.6 mmol/L, metabolic alkalosis, raised renin and aldosterone, nor…
- Nephrology and electrolytes: Fanconi syndrome · Multi-stepA 30-year-old man starts a tenofovir-containing antiretroviral regimen. Months later he has bone pain, serum phosphate is low, urine shows glucose despite a normal bloo…
- Nephrology and electrolytes: atheroembolic renal disease · Multi-stepA 68-year-old man has a rise in serum creatinine over three weeks after coronary angiography. He has livedo reticularis and painful blue toes with palpable pedal pulses…
- Nephrology and electrolytes: pseudohyponatraemia · Multi-stepA man with multiple myeloma has a serum sodium of 124 mmol/L, but the measured serum osmolality is normal. He is euvolaemic and asymptomatic, and his total serum protei…
- Nephrology and electrolytes: medullary sponge kidney · ApplicationA 35-year-old man has recurrent calcium stones and episodes of haematuria with normal renal function. An intravenous urogram shows brush-like linear streaks of contrast…
- Nephrology and electrolytes: uric acid stone prevention · ApplicationA 52-year-old man with gout has recurrent renal colic. A plain abdominal radiograph shows no calcification, but ultrasound shows a stone. Urine pH is persistently 5.0 a…
- Nephrology and electrolytes: cystinuria transport defect · ApplicationA 20-year-old man has had recurrent renal stones since adolescence, and his brother is similarly affected. Urine microscopy shows flat hexagonal crystals and the sodium…
- Nephrology and electrolytes: chloride-responsive metabolic alkalosis · ApplicationA 58-year-old man with gastric outlet obstruction has vomited for a week. Blood pH is 7.52, bicarbonate 40 mmol/L, potassium 2.9 mmol/L, and spot urine chloride is 8 mm…
- Nephrology and electrolytes: low solute intake hyponatraemia · Multi-stepA malnourished man who drinks mostly beer and eats little else is confused. Serum sodium is 112 mmol/L with low serum osmolality, urine osmolality is 70 mOsm/kg and uri…
- Nephrology and electrolytes: hepatorenal syndrome treatment · Multi-stepA man with decompensated alcohol-related cirrhosis and ascites has creatinine rising from 1.1 to 2.6 mg/dL. Diuretics were stopped and albumin was given for two days wi…
- Nephrology and electrolytes: uraemic platelet dysfunction · ApplicationA man with end-stage kidney disease has prolonged bleeding from a fistula puncture site and recurrent epistaxis. Platelet count, PT and aPTT are normal, but bleeding ti…
- Nephrology and electrolytes: glomerular haematuria · ApplicationA 30-year-old has painless microscopic haematuria. Phase-contrast microscopy of fresh urine shows many dysmorphic red cells with acanthocytes and occasional red cell ca…
- Nephrology and electrolytes: primary membranous nephropathy antibody · ApplicationA 55-year-old man has nephrotic syndrome with no diabetes, lupus features or drug exposure. Renal biopsy shows diffuse thickening of glomerular capillary walls with sub…
- Nephrology and electrolytes: gadolinium in advanced kidney disease · ApplicationA 58-year-old man on haemodialysis has an MRI with a gadolinium-based agent. Weeks later he develops thickened, woody skin over the limbs with joint contractures, but t…
- Nephrology and electrolytes: osmolal gap in toxic alcohols · Multi-stepA man is brought in confused with a high anion gap metabolic acidosis. His measured serum osmolality exceeds the calculated osmolality by 35 mOsm/kg. How is this differ…
- Nephrology and electrolytes: saline-induced acidosis · ApplicationA 30-year-old receives 6 litres of 0.9% saline for resuscitation. Blood shows sodium 142 mmol/L, chloride 118 mmol/L, bicarbonate 16 mmol/L and pH 7.30. What explains t…
- Nephrology and electrolytes: pharmacological aquaresis in SIADH · ApplicationA 65-year-old woman with SIADH from small cell lung cancer has serum sodium 123 mmol/L, remains euvolaemic and has not responded to fluid restriction. Which drug class…
- Nephrology and electrolytes: haemodynamic AKI with NSAID · Multi-stepA 72-year-old man with hypertension takes an ACE inhibitor and furosemide and starts regular ibuprofen for back pain. After a diarrhoeal illness, his creatinine rises f…
Haematology and oncology17
- Haematology and oncology: recognition · Multi-stepA 30-year-old woman has fever, confusion, renal dysfunction, thrombocytopenia and a microangiopathic haemolytic anaemia with schistocytes. PT and aPTT are normal and AD…
- Haematology and oncology: paroxysmal cold haemoglobinuria · Multi-stepA 6-year-old boy has sudden dark urine and pallor after playing in cold water, two weeks after a viral illness. The direct antiglobulin test shows complement C3 only, c…
- Haematology and oncology: Glanzmann thrombasthenia · Multi-stepA child has recurrent mucosal bleeding and easy bruising. The platelet count is normal, bleeding time is prolonged, and PT and aPTT are normal. Platelet aggregation is…
- Haematology and oncology: bleomycin lung toxicity · ApplicationA 28-year-old man is treated for a testicular germ cell tumour. After three cycles he develops a dry cough and progressive breathlessness, with bibasal fibrosis on imag…
- Haematology and oncology: acute graft-versus-host disease · ApplicationThree weeks after allogeneic stem cell transplantation, a patient develops a maculopapular rash, cholestatic jaundice and profuse watery diarrhoea. What is the most lik…
- Haematology and oncology: myelodysplastic syndrome · ApplicationA 72-year-old man has macrocytic anaemia that has not responded to vitamin B12 or folate, and normal levels of both. The smear shows neutrophils with hypolobated nuclei…
- Haematology and oncology: follicular lymphoma translocation · ApplicationA 60-year-old woman has painless, waxing and waning lymphadenopathy for two years. Node biopsy shows a nodular pattern of small cleaved cells and centroblasts, and the…
- Haematology and oncology: monoclonal gammopathy of undetermined significance · ApplicationA 68-year-old man has an incidental serum M-protein of 1.8 g/dL. Bone marrow shows 5% clonal plasma cells. Haemoglobin, calcium and creatinine are normal and a skeletal…
- Haematology and oncology: leukaemoid reaction versus CML · Multi-stepA 35-year-old man with a large abscess has a leucocyte count of 60,000 per microlitre with neutrophilia, left shift, toxic granulation and Dohle bodies. Which finding f…
- Haematology and oncology: massive transfusion citrate effect · ApplicationA trauma patient receives 12 units of stored red cells and plasma rapidly. He develops perioral tingling, hypotension and a prolonged QT interval. Which abnormality is…
- Haematology and oncology: preparation for splenectomy · ApplicationA 25-year-old is scheduled for elective splenectomy for refractory immune thrombocytopenia. Against which organisms should vaccination be arranged at least two weeks be…
- Haematology and oncology: cisplatin toxicity · ApplicationA man on cisplatin-based chemotherapy for testicular cancer develops a rising creatinine, hypomagnesaemia and high-frequency hearing loss. Which measure reduces the nep…
- Haematology and oncology: gastrointestinal stromal tumour therapy · ApplicationA 55-year-old man has melaena. CT shows a 6 cm submucosal gastric mass. Biopsy shows spindle cells that are positive for CD117 (KIT). Which drug is the targeted therapy…
- Haematology and oncology: anticoagulation in cancer-associated thrombosis · ApplicationA 60-year-old woman with metastatic pancreatic cancer develops a proximal deep vein thrombosis. Which anticoagulant approach is preferred for long-term treatment?
- Haematology and oncology: cutaneous T-cell lymphoma · ApplicationA 58-year-old man has several years of scaly patches and plaques on the trunk, later progressing to generalised erythroderma. Skin biopsy shows epidermal collections of…
- Haematology and oncology: pure red cell aplasia · Multi-stepA 55-year-old woman has severe normocytic anaemia with reticulocytopenia. Bone marrow shows absent erythroid precursors, and white cells and platelets are normal. CT of…
- Haematology and oncology: Trousseau syndrome of malignancy · ApplicationA 62-year-old man with weight loss and epigastric pain develops recurrent migratory superficial thrombophlebitis without immobility. Which cancer is classically associa…
Toxicology17
- Toxicology · ApplicationA farmer is brought in after spraying pesticide. He has salivation, sweating, pinpoint pupils, bradycardia and muscle fasciculations. Which drug should be given first?
- Toxicology · ApplicationA man develops blurred vision, visual field described as 'snowstorm', abdominal pain and severe high anion gap metabolic acidosis after drinking illicit liquor. Besides…
- Toxicology: organophosphate poisoning · ApplicationA farmer with organophosphate poisoning is being treated with incremental intravenous atropine. What is the best clinical endpoint indicating adequate atropinisation?
- Toxicology: paracetamol overdose · Multi-stepA 19-year-old woman is brought 12 hours after taking about 25 g of paracetamol. She is nauseated with mild right upper quadrant tenderness, and a plasma level is not ye…
- Toxicology: snakebite in India · ApplicationA farmer bitten on the foot by a snake in a field in Maharashtra has progressive local swelling and bleeding from the gums. Which bedside test best detects coagulopathy…
- Toxicology: carbon monoxide poisoning · ApplicationA family is found drowsy in a closed room where a coal stove was burning overnight. They have headache and vomiting, and pulse oximetry reads 98% on room air. What is t…
- Toxicology: methaemoglobinaemia · ApplicationA 30-year-old man taking dapsone develops cyanosis with SpO2 of 85% that does not improve on 100% oxygen. Arterial PaO2 is normal and his blood appears chocolate brown.…
- Toxicology: cyanide poisoning · Multi-stepA 30-year-old man is rescued from an enclosed house fire with soot around the nostrils. He is unresponsive (GCS 8), hypotensive, and arterial lactate is 12 mmol/L. Puls…
- Toxicology: chronic lithium toxicity · Multi-stepA 55-year-old woman with bipolar disorder on lithium has recently been started on an NSAID for knee pain and a thiazide for hypertension. She now has coarse tremor, vom…
- Toxicology: aluminium phosphide poisoning · ApplicationA 24-year-old man ingested rice-preserving tablets about an hour ago. He has vomiting with a garlic-like odour on his breath, severe hypotension unresponsive to fluids,…
- Toxicology: salicylate poisoning · Multi-stepA 19-year-old woman is brought in 6 hours after an overdose of aspirin with tinnitus, tachypnoea and sweating. Arterial gas shows pH 7.46, PaCO2 22 mmHg and HCO3 15 mmo…
- Toxicology: tricyclic antidepressant overdose · ApplicationA 30-year-old woman is found drowsy after ingesting a large number of amitriptyline tablets. She has dilated pupils, dry mouth, tachycardia and a seizure. The ECG shows…
- Toxicology: Datura poisoning · Multi-stepChildren who ate thorn apple seeds have hot dry flushed skin, dilated pupils, urinary retention, tachycardia and agitated delirium. After benzodiazepines for agitation,…
- Toxicology: iron poisoning · ApplicationA child who swallowed many iron tablets has haematemesis, lethargy and metabolic acidosis, and an abdominal X-ray shows radio-opaque tablets. Which is the antidote?
- Toxicology: alcohol withdrawal delirium · Multi-stepA 45-year-old heavy drinker admitted with a fractured femur develops tremor, tachycardia, fever, disorientation and visual hallucinations of small animals on day 3. Wha…
- Toxicology: organophosphate poisoning · Multi-stepAfter pesticide exposure, a farm worker has salivation, lacrimation, wheeze, bradycardia, miosis, and diarrhea. Which antidote most directly treats the muscarinic manif…
- Toxicology: salicylate poisoning · Multi-stepA patient with salicylate toxicity has tinnitus, tachypnea, and an arterial blood gas showing respiratory alkalosis with high-anion-gap metabolic acidosis. What is the…
Emergency and critical care15
- Emergency and critical care: severe hypothermia · ApplicationA homeless man found in winter has a core temperature of 28 C, bradycardia and J waves on the ECG. What is the correct management?
- Emergency and critical care: venous air embolism position · ApplicationWhile a central venous catheter is being removed from the neck of a sitting patient, he suddenly develops breathlessness and hypotension, and a churning mill-wheel murm…
- Emergency and critical care: calcium channel blocker overdose · Multi-stepA woman who has swallowed a large number of slow-release verapamil tablets has bradycardia, hypotension and altered consciousness. Which metabolic abnormality is expect…
- Emergency and critical care: isoniazid overdose · ApplicationA young woman who has ingested a large amount of isoniazid has recurrent seizures that have not responded to diazepam, along with a severe anion gap metabolic acidosis.…
- Emergency and critical care: paraquat poisoning oxygen · Multi-stepA farmer who drank a herbicide has ulcers in the mouth and then progressive breathlessness with pulmonary fibrosis over several days. The team avoids giving oxygen unle…
- Emergency and critical care: ethylene glycol poisoning · ApplicationA man is brought after drinking radiator coolant. He is drunk, tachypnoeic, has a pH of 7.1 with a high anion gap and osmolar gap, and urine shows envelope-shaped cryst…
- Emergency and critical care: findings compatible with brain death · ApplicationDuring formal brain-death testing in a deeply comatose ventilated patient, which finding does not exclude the diagnosis?
- Emergency and critical care: Parkland formula · ApplicationA 70 kg adult has 30 percent total body surface area partial and full thickness burns. Using the Parkland formula of 4 mL per kg per percent burn with Ringer lactate, h…
- Emergency and critical care: Amanita phalloides poisoning · Multi-stepEight hours after a family meal of wild mushrooms, a woman has severe vomiting and watery diarrhoea that settles for a day. On day 3 she has jaundice, coagulopathy and…
- Emergency and critical care: kerosene ingestion · ApplicationA 2-year-old accidentally drank a mouthful of kerosene and has coughed since. He is alert, with respiratory rate 40 per minute and crackles on the right side. Which mea…
- Emergency and critical care: combined acid-base disorder · Multi-stepA patient with diarrhoea and drowsiness has arterial pH 7.17, PaCO2 40 mmHg and bicarbonate 14 mmol/L. Using Winter's formula, expected PaCO2 is 1.5 x bicarbonate + 8,…
- Emergency and critical care: alcohol withdrawal delirium · ApplicationA chronic heavy drinker is admitted after a fall. Three days after his last drink he becomes agitated, disoriented, has coarse tremor, sweating, tachycardia and vivid v…
- Emergency and critical care: arsenic poisoning · ApplicationA man has vomiting and watery diarrhoea followed by a painful sensory neuropathy. His breath smells of garlic and nails show transverse white lines. Which chelating age…
- Emergency and critical care: capnography during resuscitation · ApplicationDuring cardiopulmonary resuscitation, the end-tidal carbon dioxide trace suddenly jumps from 10 to 40 mmHg. What does this most likely indicate?
- Emergency and critical care: neurogenic shock · ApplicationA 25-year-old man has a cervical spine fracture after a diving accident. His blood pressure is 80/50 mmHg and heart rate is 48 per minute, with warm dry extremities. Wh…
Electrolytes14
- Electrolytes · ApplicationWhich is the earliest ECG change in hyperkalaemia?
- Electrolytes · Multi-stepA patient with end-stage kidney disease who missed dialysis has potassium of 7.2 mmol/L, peaked T waves and a widened QRS. Which drug is given first?
- Electrolytes · Multi-stepA smoker with a lung mass has serum sodium 124 mmol/L and appears euvolaemic. Urine osmolality is high and urine sodium is raised. He has mild headache only. What is th…
- Electrolytes: osmotic demyelination · ApplicationA chronic alcohol-dependent woman with serum sodium 108 mmol/L is given hypertonic saline, and sodium rises to 128 mmol/L within 24 hours. Three days later she develops…
- Electrolytes: nephrogenic diabetes insipidus · Multi-stepA 40-year-old man with bipolar disorder on long-term lithium passes 6 litres of urine daily. After water deprivation, urine osmolality stays at 160 mosm/kg. After intra…
- Electrolytes: salt-wasting tubulopathy · ApplicationA 22-year-old woman has muscle cramps and tetany. Blood pressure is 100/60 mmHg. Investigations show potassium 2.8 mmol/L, magnesium 0.5 mmol/L, serum bicarbonate 32 mm…
- Electrolytes: Liddle syndrome · ApplicationA 19-year-old has resistant hypertension, potassium 3.0 mmol/L and metabolic alkalosis. Plasma renin and aldosterone are both suppressed. His father had early-onset hyp…
- Electrolytes: drug-induced hyperkalaemia · ApplicationAn HIV-positive man receiving high-dose co-trimoxazole for Pneumocystis pneumonia develops potassium 6.1 mmol/L with normal creatinine. Which mechanism explains the hyp…
- Electrolytes: hypomagnesaemia · Multi-stepA 66-year-old woman on a proton pump inhibitor for 8 years and on furosemide has persistently low potassium (3.0 mmol/L) and low calcium (corrected 1.95 mmol/L) despite…
- Electrolytes: refeeding syndrome · ApplicationA severely malnourished 30-year-old with anorexia nervosa is started on full enteral feeding. On day 3 she develops generalised weakness, respiratory muscle weakness an…
- Electrolytes: albumin-corrected calcium · Multi-stepA 55-year-old man with cirrhosis has no symptoms. Serum total calcium is 7.6 mg/dL with serum albumin 2.0 g/dL. Using the standard correction of 0.8 mg/dL for every 1 g…
- Electrolytes: cerebral salt wasting · Multi-stepOn day 5 after a subarachnoid haemorrhage, a 50-year-old man has serum sodium 122 mmol/L. He has dry mucous membranes, postural hypotension and a low central venous pre…
- Electrolytes: hypernatraemia correction · Multi-stepA 70-kg man (total body water taken as 60% of body weight) has had chronic hypernatraemia for several days, with serum sodium 168 mmol/L. The target sodium is 140 mmol/…
- Electrolytes: thyrotoxic periodic paralysis · Multi-stepA 28-year-old man wakes with sudden flaccid weakness of the legs after a carbohydrate-rich meal. Potassium is 2.1 mmol/L, heart rate is 120 per minute and TSH is suppre…
Emergency medicine13
- Emergency medicine: reversible causes of arrest · Multi-stepA 30-year-old man with rib fractures after a road traffic collision collapses. The monitor shows an organised rhythm with no pulse. The trachea is deviated to the left,…
- Emergency medicine: severe hyponatraemia · Multi-stepA 34-year-old woman drank large volumes of water during a marathon. She develops headache and vomiting followed by a generalised seizure. Serum sodium is 118 mmol/L. Wh…
- Emergency medicine: status epilepticus · ApplicationA 25-year-old man has had a generalised tonic-clonic seizure for 8 minutes and is still convulsing in the emergency department. Intravenous access has just been obtaine…
- Emergency medicine: heat stroke · ApplicationA 22-year-old soldier collapses during a march in 42 degrees Celsius heat. His core temperature is 41.5 degrees Celsius, he is confused, with hot dry skin, heart rate 1…
- Emergency medicine: variceal haemorrhage · Multi-stepA 50-year-old man with alcohol-related cirrhosis vomits about 800 mL of blood. His blood pressure is 90/60 mmHg, heart rate 118 per minute and haemoglobin 8.4 g/dL. Whi…
- Emergency medicine: massive haemoptysis · Multi-stepA 48-year-old man with sequelae of old pulmonary tuberculosis and a cavity in the right upper lobe coughs up about 600 mL of fresh blood in 24 hours and is tachypnoeic.…
- Emergency medicine: serotonin syndrome · Multi-stepA 40-year-old man on sertraline was started on tramadol 6 hours ago. He now has agitation, sweating, diarrhoea, tremor, brisk hyperreflexia, inducible ocular clonus, di…
- Emergency medicine: hypertensive emergency · Multi-stepA 45-year-old man has severe headache, confusion and a seizure. Blood pressure is 230/136 mmHg, fundoscopy shows papilloedema with flame haemorrhages and exudates, and…
- Emergency medicine: acute pulmonary oedema · ApplicationA 70-year-old man with acute pulmonary oedema has a blood pressure of 150/90 mmHg, bilateral crackles and an oxygen saturation of 85 percent. Which initial combination…
- Emergency medicine: scorpion sting · Multi-stepA child stung by a red scorpion in rural Maharashtra develops profuse sweating, hypertension, tachycardia, priapism and early pulmonary oedema. Which drug is the treatm…
- Emergency medicine: malignant hyperthermia and NMS · Multi-stepWithin an hour of induction with sevoflurane and succinylcholine, a patient develops rigidity, rising end-tidal CO2 and temperature of 40 C. What is the specific treatm…
- Emergency medicine: ventilator weaning · Multi-stepA ventilated patient after pneumonia is awake, haemodynamically stable with FiO2 of 0.4 and PEEP of 5. Which tool best predicts successful extubation?
- Emergency medicine: anaphylaxis · ApplicationWhat is the first-line treatment for anaphylaxis with airway swelling and hypotension?
Oncology11
- Oncology: Hodgkin lymphoma · ApplicationA 22-year-old man has painless cervical lymphadenopathy, drenching night sweats, pruritus and an 8 kg weight loss over 3 months. A node biopsy shows binucleate cells wi…
- Oncology: acute promyelocytic leukaemia · Multi-stepA 35-year-old woman has one week of fatigue and bruising. White cells are 3,000 per microlitre, platelets 18,000 and haemoglobin 7 g/dL. PT and aPTT are prolonged with…
- Oncology: tumour lysis syndrome · Multi-stepA 12-year-old boy with Burkitt lymphoma has urine output falling 24 hours after starting chemotherapy. Potassium is 6.4 mmol/L, phosphate 8.2 mg/dL, calcium 6.9 mg/dL,…
- Oncology: febrile neutropenia · ApplicationA 50-year-old woman is admitted 10 days after chemotherapy for breast cancer. Her temperature is 38.6 degrees Celsius, blood pressure 100/60 mmHg and heart rate 110 per…
- Oncology: malignant spinal cord compression · ApplicationA 66-year-old man with known metastatic prostate cancer has three days of progressive back pain, and now has bilateral leg weakness, urinary retention and a sensory lev…
- Oncology: superior vena cava syndrome · ApplicationA 60-year-old smoker presents with facial swelling, dilated neck veins and worsening dyspnoea, with a positive Pemberton sign. What is the most common underlying cause?
- Oncology: diffuse large B-cell lymphoma · ApplicationA 60-year-old man has a rapidly enlarging neck node, raised LDH and a biopsy showing sheets of large CD20-positive B cells. Which regimen is standard treatment?
- Oncology · ApplicationPainless lymph-node enlargement needs exclusion of what?
- Oncology: superior vena cava syndrome · ApplicationA patient with a mediastinal mass develops facial swelling, distended neck veins, and dyspnea that worsen when lying flat. Which syndrome is most likely?
- Oncology: tumour lysis syndrome · ApplicationAfter chemotherapy for high-grade lymphoma, a patient develops hyperkalaemia, hyperphosphataemia, hypocalcaemia and acute kidney injury. What syndrome is present?
- Oncology: tumor lysis syndrome · Multi-stepSoon after chemotherapy for high-burden lymphoma, a patient develops hyperkalemia, hyperphosphatemia, hypocalcemia, and acute kidney injury. What syndrome is present?
Diabetes9
- Diabetes: SGLT2 inhibitor adverse effect · ApplicationA 55-year-old man with type 2 diabetes taking empagliflozin and metformin is admitted after a day of fasting before elective surgery. He has nausea, abdominal pain and…
- Diabetes: glycaemic monitoring · Multi-stepA 30-year-old man with type 2 diabetes and hereditary spherocytosis has an HbA1c of 5.3%, but his home glucose readings average 230 mg/dL. Which is the most appropriate…
- Diabetes: nephropathy · ApplicationA 52-year-old man with type 2 diabetes for 10 years and blood pressure 148/92 mmHg has a urine albumin-to-creatinine ratio of 150 mg/g on two of three samples. eGFR is…
- Diabetes: hyperosmolar hyperglycaemic state · Multi-stepA 68-year-old man with type 2 diabetes has had polyuria and increasing confusion for five days. Blood glucose is 900 mg/dL, serum sodium 150 mmol/L, pH 7.35, bicarbonat…
- Diabetes: sulfonylurea-induced hypoglycaemia · Multi-stepA 72-year-old man with chronic kidney disease on glibenclamide is found unconscious with a glucose of 32 mg/dL. He recovers after intravenous dextrose but has repeated…
- Diabetes: metformin and renal impairment · ApplicationA 70-year-old man with type 2 diabetes takes metformin 1 g twice daily. After an episode of acute kidney injury his eGFR is 24 mL/min/1.73 m2. What is the main reason t…
- Diabetes: monogenic diabetes (MODY) · ApplicationA lean 19-year-old woman has mild hyperglycaemia found at screening, with no ketosis. Her father was diagnosed with diabetes at 25 and her grandmother at 30, both treat…
- Diabetes: diagnostic criteria · ApplicationAn obese 45-year-old has an HbA1c of 6.7% on two separate occasions. What is the diagnosis?
- Diabetes: Somogyi effect · Multi-stepA person with type 1 diabetes on evening NPH insulin has high fasting glucose, but a 3 a.m. glucose of 48 mg/dL. What is the appropriate adjustment?
Endocrine9
- Endocrine: hypothyroidism · ApplicationWhich symptom is typical of hypothyroidism?
- Endocrine: hyperthyroidism · ApplicationWhich symptom is typical of thyrotoxicosis?
- Endocrine: Cushing syndrome · ApplicationWhich feature supports cortisol excess?
- Endocrine · ApplicationPolyuria and hypernatremia with dilute urine suggest what?
- Endocrine · ApplicationWeight loss, tremor, and heat intolerance suggest what?
- Endocrine · ApplicationHypotension, hyperkalemia, and pigmentation suggest what?
- Endocrine · ApplicationHeat intolerance and tremor suggest what?
- Endocrine · ApplicationCold intolerance and bradycardia suggest what?
- Endocrine · ApplicationEpisodic headache, sweat, hypertension suggest what?
Respiratory9
- Respiratory: COPD · ApplicationWhat spirometry pattern supports COPD?
- Respiratory: pneumonia · ApplicationWhat finding supports community-acquired pneumonia?
- Respiratory: pulmonary edema · ApplicationPink frothy sputum with crackles suggests what?
- Respiratory · ApplicationChronic cough and smoking with obstruction suggest what?
- Respiratory · ApplicationAcute pleuritic pain and hypoxia after surgery suggests what?
- Respiratory · ApplicationFever and focal crackles with infiltrate suggest what?
- Respiratory · ApplicationChronic dry cough with restrictive spirometry suggests what?
- Respiratory · ApplicationWheeze and reversible airflow obstruction suggest what?
- Respiratory · ApplicationPink frothy sputum suggests what?
Renal medicine8
- Renal medicine · ApplicationWhich finding most suggests a pre-renal cause of acute kidney injury in a patient with vomiting?
- Renal medicine · ApplicationWhich electrolyte disturbance is especially dangerous in advanced kidney failure because of its cardiac effects?
- Renal medicine · ApplicationWhich finding is most concerning for acute kidney injury?
- Renal medicine · ApplicationWhat is a common pre-renal cause of acute kidney injury?
- Renal medicine: nephritic syndrome · ApplicationA patient has edema, hypertension, cola-colored urine, red-cell casts, and reduced renal function. Which syndrome is present?
- Renal medicine: hyperkalemia · Multi-stepA patient with acute kidney injury has potassium 6.8 mmol/L and ECG changes with peaked T waves. Which treatment stabilizes the cardiac membrane first?
- Renal medicine: renal tubular acidosis · ApplicationA patient has normal-anion-gap metabolic acidosis, hypokalemia, nephrolithiasis, and urine pH persistently above 5.5. Which disorder is most likely?
- Renal medicine: nephrolithiasis · ApplicationWhich urinary finding is most associated with calcium oxalate kidney stones?
Infectious disease7
- Infectious disease · ApplicationWhat is the drug of choice for Pneumocystis jirovecii pneumonia in a patient with advanced HIV?
- Infectious disease · ApplicationWhat is a common systemic sign of infection?
- Infectious disease · ApplicationWhat test is essential before giving antibiotics for suspected bloodstream infection when feasible?
- Infectious disease · ApplicationWhat is an important early action in suspected sepsis?
- Infectious disease · ApplicationWhat early action is important in suspected sepsis?
- Infectious disease: infective endocarditis · ApplicationWhich finding is a major Duke criterion for infective endocarditis?
- Infectious disease: malaria · ApplicationA patient with Plasmodium falciparum malaria has confusion, acidosis and jaundice. How should this be classified?
Infection6
- Infection: sepsis · ApplicationInfection with hypotension and organ dysfunction requires what approach?
- Infection: tuberculosis · ApplicationChronic cough, weight loss, night sweats, and upper-lobe disease suggest what?
- Infection · ApplicationFever and murmur with positive blood cultures suggest what?
- Infection · ApplicationFever, weight loss, and night sweats may indicate what?
- Infection · ApplicationAntibiotic-associated watery diarrhea suggests what?
- Infection · ApplicationFever, murmur, positive cultures suggest what?
Clinical pharmacology5
- Clinical pharmacology · ApplicationWhich adverse effect should be monitored when starting an ACE inhibitor?
- Clinical pharmacology · ApplicationWhat is the key danger of prescribing an NSAID to a dehydrated patient with kidney impairment?
- Clinical pharmacology: digoxin toxicity · Multi-stepA patient taking digoxin develops nausea, confusion, yellow-green visual halos, and atrial tachycardia with block. What is the diagnosis?
- Clinical pharmacology: warfarin · ApplicationWhich laboratory test is used to monitor warfarin therapy?
- Clinical pharmacology: heparin-induced thrombocytopenia · Multi-stepFive days after heparin exposure, a patient has a platelet fall of more than 50% and a new deep-vein thrombosis. What condition is most likely?
Geriatric medicine5
- Geriatric medicine · ApplicationWhat is a core approach to medication review in older adults?
- Geriatric medicine · ApplicationWhat is a key aim of medication review in older adults?
- Geriatric medicine · ApplicationWhich feature distinguishes delirium from dementia most reliably?
- Geriatric medicine · ApplicationWhich is a common atypical presentation of infection in an older adult?
- Geriatric medicine: delirium · ApplicationWhich bedside test most directly assesses the core cognitive deficit in delirium?
GI5
- GI · ApplicationBloody diarrhea with continuous colitis suggests what?
- GI · ApplicationJaundice, ascites, and varices indicate what?
- GI · ApplicationDysphagia to solids and liquids from onset suggests what?
- GI · ApplicationEpigastric pain radiating to back with high lipase suggests what?
- GI · ApplicationHematemesis and shock require what first?
Renal5
- Renal: pyelonephritis · ApplicationFever, flank pain, and CVA tenderness suggest what?
- Renal · ApplicationHematuria, edema, and hypertension suggest what syndrome?
- Renal · ApplicationHeavy proteinuria and hypoalbuminemia suggest what?
- Renal · ApplicationOliguria after diarrhea suggests what AKI mechanism?
- Renal · ApplicationFlank pain, fever, and CVA tenderness suggest what?
Acid-base3
- Acid-base: renal tubular acidosis · ApplicationA 9-year-old girl has poor growth and polyuria. Investigations show potassium 2.9 mmol/L, bicarbonate 14 mmol/L, chloride 112 mmol/L and a normal anion gap. Urine pH is…
- Acid-base: hyperkalaemic acidosis in diabetes · ApplicationA 62-year-old man with long-standing diabetes and an eGFR of 40 has potassium 5.9 mmol/L, bicarbonate 17 mmol/L, sodium 138 mmol/L and chloride 110 mmol/L. Urine pH is…
- Acid-base: compensation and mixed disorders · Multi-stepA septic patient is drowsy. Arterial blood gas shows pH 7.10, PaCO2 40 mmHg and bicarbonate 12 mmol/L. Sodium is 138 mmol/L and chloride 100 mmol/L. Using the expected…
Critical care3
- Critical care · Multi-stepA man develops widespread urticaria, lip swelling, wheeze and hypotension within minutes of a wasp sting. Which is the single most important first drug?
- Critical care · ApplicationA patient with pneumonia becomes severely hypoxic with bilateral infiltrates on chest X-ray and a normal pulmonary capillary wedge pressure. Which ventilatory strategy…
- Critical care: types of shock · Multi-stepA 64-year-old man with a large anterior myocardial infarction has cool clammy skin, blood pressure 80/50 mmHg, heart rate 120 per minute, basal crepitations, a raised J…
Dermatology3
- Dermatology · ApplicationWhat simple feature distinguishes a nonblanching purpuric rash?
- Dermatology: erythema multiforme and SJS · Multi-stepAfter starting a high-risk medication, a patient develops fever, painful widespread erythematous rash, mucosal erosions, and skin detachment. What is the most appropria…
- Dermatology: Stevens-Johnson syndrome · ApplicationPainful mucosal erosions with widespread targetoid rash after a high-risk medication should prompt concern for what?
Emergency3
Complications of cirrhosis2
- Complications of cirrhosis · Multi-stepA patient with decompensated alcohol-related cirrhosis and ascites develops progressive oliguria and serum creatinine of 3.2 mg/dL. Urine sodium is under 10 mEq/L, urin…
- Complications of cirrhosis · ApplicationA cirrhotic patient with ascites has fever and abdominal tenderness. Diagnostic paracentesis is performed. Which ascitic fluid result confirms spontaneous bacterial per…
Diabetes mellitus2
- Diabetes mellitus · ApplicationA conscious patient with diabetes is sweaty, tremulous, and has a capillary glucose of 2.8 mmol/L. What is the immediate treatment?
- Diabetes mellitus · ApplicationWhich biochemical feature most strongly supports diabetic ketoacidosis rather than uncomplicated hyperglycaemia?
Clinical safety1
Endocrinology and metabolism1
Fluid and electrolytes1
Infective endocarditis1
Preventive medicine1
Common questions
How many General Medicine questions are there?
980 original questions across 754 topics, and the bank grows over time.
Which General Medicine topics are covered?
Endocrinology, Electrolytes, Infectious disease, Neurology, Cardiology, Nephrology, Haematology, Gastroenterology, Infectious diseases, Infective endocarditis, Respiratory medicine, Toxicology, and more.
How difficult are these General Medicine questions?
0 are recall, 709 are application and 271 are multi-step. The tags are our own editorial judgement, not an official difficulty rating.
Are these General Medicine questions from past papers?
No. They are original practice items. NBEMS does not publish its paper or an official key, and we do not use recalled or leaked questions.
Can I practise General Medicine for free?
Yes. The free plan includes 20 practice questions a day across all subjects, and the free 20-question assessment covers every subject. A paid term removes the daily limit.
Is there a timed General Medicine test?
Yes. The General Medicine subject test is included with a paid term, with a countdown and a question palette.
How should I use these General Medicine questions?
Answer before you look, read the reason for every option, and write a three-line note for each mistake. A few questions you fully review are worth more than many you skim.
Have these General Medicine questions been reviewed by faculty?
Not yet. They are original and drafted with AI assistance, then edited by our team. Independent faculty review is planned, and each item shows its status. Confirm important facts in a standard textbook.