Passmedicine questions

A 45 year old F 

Intermitted RUQ pain after eating a large meal 

Inflammatory markers, pulse and temp are all norma 

A patient with HD is noted to have slurred speech which is difficult to comprehend 

He retains the ability to understand what is being said to him 

(Refers to motor speech disorder not an aphasia) 

Most common to cause a third heart sound 

A 45 year old woman presents with fatigue and pruritus (severe itching) 

Blood tests:
Raise bilirubin
Raised ALP
Raised IgM 

Autoimmune 

More common in women 

Seen in adults of all ages 

MCP and PIP joints involved 

Morning stiffness, improves with use 

Bilateral symptoms 

Systemic upset 

X-ray = loss of joint space, juxta-articular osteoporosis, periarticular erosion, subluxation 

Similar incidedence in men and women 

Seen most commonly in elderly 

Large weight bearing joints as well as carpometacarpal, DIP and PIP 

Pain following use, improves with rest 

Unilateral symptoms 

No systemic upset 

X-ray = loss of joint space, subchonrdral sclerosis, subchondral cysts, osteophytes forming at joint margin

Ischaemic changes in leads V4-6, I and aVL 

Ischaemic changes in leads V1-V4 

A 55 year old Male 

PC: RUQ pain, fever and jaundice 

Blood pressure = 98/60 

Appears confused 

Sudden onset vertigo and vomitting 

Ipsilateral facial paralysis and deafness 

Hx of heartburn 

Presents with odynophagia (pain when swallowing) 

No weight loss, vomitting or anorexia 

Painless Jaundice 

Steatorrhoea 

Severe central abdominal pain 

Hx of alcohol and gall stones 

A 50 year old Female

Hx of rheumatic fever 

PC: dyspnoea 

Exam = AF, Loud S1, split S2 and a diastolic murmur 

Low volume Pulse 

A patient develops acute heart failure 5 days post MI 

A new pan-systolic murmur is noted 

A 65 year old Female 

PC: Jaundice, weight loss, clay-coloured stools, recurrent bouts of colicky RUQ pain 

Palpable mass in the RUQ 

35 year old man 

Severe, episodic loin pain that radiates to the front 

Blood +++
Leukocytes ++ 
(on urine dipstick) 

Soft S1 sound