266418857-mrcp-classical-presentations-pdf.pdf

‫اﻟرﺣﯾم‬ ‫اﻟرﺣﻣن‬ ‫ﷲ‬ ‫ﺑﺳم‬
❂ This is a collecion for some of the
common presentations for the
MRCP exam (useful for part 1 & 2)
❂ Useful for revision after studying
the only note &/or passmedicine.
1a
BADRAWY MRCP revision

HOPE THIS WILL BE
BENIFICIAL FOR EVERYONE
NB➜ I may add some more
presentations to this set, your
comments are highly
appreciated.
1b

A 17-y girl cardiac arrest asystole
resuscitate unsuccessful
collapsed in a 1.500m race at
college
no relevant family history cause
of death?
2a

HOCM
MCC of SCD in the young
2b

2 day baby cyanotic with
feeding & crying ?
3a

TGA
cyanotic: TGA most
common at birth. Fallot's
moss common overall
3b

A 17-y girl recurrent attacks at
collapse occur without
warning,occurred whilst she was
running for a bus,
family history father died
suddenly when he was 38-s, Dx ?
4a

HOCM
MCC of SCD in the young
4b

A 30-y F, central chest
pain,severe, non-radiating
and eases on
expiration,ECG,widespread
ST elevation,Dx ?
5a

Acute pericarditis
5b

50 -ys M, SOB since the
morning,inferior MI 1 y ago,
echo following the MI ➜normal LV
function,still a smoker
bibasal crackles,perihilar
shadowing,ECG and cardiac enzymes
are normal,Dx ?
6a

Penal artery stenosis
Renal artery stenosis may cause
sudden onset or 'flash'
pulmonary oedema. A MI is
unlikely given the normal ECG
and cardiac enzymes
6b

18-y Turner's syndrome
has a murmur
soft ejection systolic
murmur,Dx ?
7a

Bicuspid aortic valve ➜
MC heart disease with
Turner
7b

70 y F, palpitation + chest
tightness,ECG ➜ atrial
activity 300, ventricular
activity 150 ,Dx ?
8a

Atrial Flutter
Tachycardia with HR 150
➜ think flutter
8b

A 60-y M, SOB on
exertion,third heart sound
, respiratory system is
unremarkable,Dx ?
9a

Dilated cardiomyopathy
A 3rd heart sound is only
considered a normal
variant in patients < 40 s
9b

A 36-y F routine antenatal review,15
weeks pregnant
BP 154/94 confirmed with
ambulatory BP monitoring
her BP 4 weeks ago was 140/88,urine
dipstick protein + and nothing
else,no significant past Hx, Dx ?
10a

Pre-existing hypertension
Pregnancy related BP
problems (pre-eclampsia or
pregnancy induced HTN)
don't occur before 20 weeks.
10b

A 35-y F,DVT in the third
trimester of pregnancy,
sudden left hemiparesis,
Dx ?
11a

Patent foramen ovale
present in about 20% of
population
11b

A 1-y-old girl, a continuous
murmur,loudest at the left
sternal edge,not cyanosed,
Dx ?
12a

A 40-y old F,refractory
hypertension,non-specific chest
pains,coronary angiogram,Right
femoral artery 122/68
Left ventricle 202/104,Aorta
194/84,left arm BP 188/74, Dx ?
13a

Coarctation of the aorta
13b

An 82-y M, increasing
dyspnoea or exertion,
systolic
murmur,BP 100/80,slow
rising pulse,Dx ?
14a

AS dt Calcification of the
aortic valve
14b

A 56-y M, ED with headaches,
chest pain and confusion, BP
250/140,equal in both
arms,Blurring of the optic
discs,no significant medical
history,Dx ?
15a

Malignant hypertension
Rx with Intravenous
nitroprusside
15b

A 62-y M,two episodes of 'passing
out' for around 15 seconds last
months associated with effort,feeling
'groggy' for only a few seconds after
the episode,systolic murmur
radiates to the carotid area,Dx ?
16a

AS
Next best step is
Echocardiogram
16b

A 44-y M, Hx of palpitations +
pre-syncopal symptoms
ECGT wave inversion in leads
V1-3 +notch at the end of the
QRS complex,FH of SCD, Dx ?
17a

Arrhythmogenic right
ventricular
cardiomyopathy
17b

A 76-y, palpitations
irregular cannon 'a'
waves,Dx
18a

Complete heart block
18b

an elderly Hx of chronic
glaucoma & HTN ➜ a sudden
painless loss of vision in one eye.
Fundoscopy reveals multiple
flame-shaped haemorrhages and
optic disc oedema
19a

Central retinal vein
occlusion
19b

an elderly short-sighted
man presents with a floater
on the temporal field of
vision. Visual acuity is
normal
20a

Posterior vitreous
detachment
20b

An elderly man
complains of dysphagia,
halitosis, regurgitation
and cough
21a

pharyngeal pouch
21b

an elderly patient presents
with bone pain,
depression, renal stones
and recurrent peptic ulcer
22a

Primary
hyperparathyroidism
22b

a teenage girl primary
amenorrhoea, well developed
secondary sexual characteristics
& breasts. scanty pubic hair and
blind-ending vagina
23a

Androgen insensitivity
syndrome
23b

An elderly women develops
itchy, tense blisters around
the flexures. There is no
mucosal involvement -
24a

bullous pemphigoid
24b

A 30-year-old man
haemoptysis and renal
failure. A renal biopsy linear
IgG deposits along the
basement membrane
25a

Goodpasture's syndrome
25b

A 45-year-old woman
presents with fatigue and
pruritus. Blood tests show a
raised bilirubin, ALP and
IgM level
26a

primary biliary cirrhosis
26b

A 55-year-old presents with
fever, headache, confusion
and aphasia. A CT shows
petechial haemorrhages in
the temporal lobe
27a

herpes simplex
encephalitis
27b

A 30-year-old man presents
with recurrent palpitations
and syncope. A resting ECG
shows T wave inversion in
V1-3 and epsilon waves
28a

arrhythmogenic right
ventricular
cardiomyopathy
28b

A teenager with tear drop
papules on the trunk and
limbs 3 weeks after a sore
throat
29a

Guttate psoriasis
29b

a young child with a history of
atopic eczema develops a sudden
eruption of painful, oedematous
vesicles and pustules. They have
are systemically unwell and have
a fever
30a

Eczema herpeticum
30b

A 60-Hx of TB dyspnoea
and fatigue. JVP is
elevated, loud S3 and
Kussmaul's sign is positive.
Hepatomegaly
31a

constrictive pericarditis
31b

bitemporal hemianopia
(upper quadrant defect >
lower quadrant defect)
32a

Pituitary tumour
32b

A tall, slim man presents
with infertility. He is noted
to have small, firm testes.
Gonadotrophin levels are
elevated
33a

Klinefelter's syndrome
33b

a tall, slim 18-year-old man
presents with hypogonadism.
He also complains of
anosmia. Gonadotrophin
levels are reduced
34a

Kallman's syndrome
34b

An elderly gradual
worsening dementia and
bradyphrenia , a slow,
shuffling gait. urinary
incontinence
35a

normal pressure
hydrocephalus
35b

An elderly Jewish woman
develops painful, flaccid, easily
ruptured vesicles and bullae on
the skin.not itchy and were
preceded by mouth lesions
36a

pemphigus vulgaris
36b

A woman rheumatoid arthritis
red right eye.no pain,
discharge or photophobia
although the eye is tearing.
Visual acuity is normal
37a

episcleritis
37b

A patient develops foot
drop following a fibular
neck fracture
38a

common peroneal nerve
38b

middle aged woman
thyrotoxicosis and a goitre.
exophthalmos and pretibial
myxoedema. Anti-TSH receptor
stimulating antibodies are
positive -
39a

Graves' disease
39b

persistent foul-smelling
watery diarrhoea and
weight loss after travelling
to India.symptoms for two
weeks
40a

giardiasis
40b

a patient speak fluently but
makes little sense with mulitple
word substitutions and
neologisms. + difficulty
understanding what people are
saying to him
41a

Wernicke's aphasia
41b

a patient have laboured,
non-fluent, halting speech.
He does however retain his
ability to understand what
people are saying to him
42a

Broca's aphasia
42b

A 40-year-old woman
presents with fever,
fluctuating neurological
signs, thrombocytopenia
and renal failure
43a

An elderly acute onset
ataxia, nystagmus and
sensory loss.sensory loss
affecting the left side of the
face and right arm
44a

posterior inferior
cerebellar artery
occlusion (lateral
medullary syndrome)
44b

A man presents with
severe vomiting. Earlier in
the day he reheated some
rice from a takeaway
45a

Bacillus cereus
45b

unilateral spastic paresis and
loss of proprioception /vibration
sensation with loss of pain and
temperature sensation on the
opposite side.
46a

Brown-Sequard
syndrome
46b

A 20-y presents in summer
with gradually worsening
flu-like symptoms and a dry
cough. + erythema
multiforme
47a

mycoplasma pneumonia
47b

bilateral spastic paresis
and loss of pain and
temperature sensation
48a

Anterior spinal artery
occlusion
48b

A 6-yboy passing dark
urine 10 days after having
had a sore
throat.periorbital oedema
49a

Post-streptococcal
glomerulonephritis
49b

a 5-year-old child develops acute
renal failure shortly after being
admitted with bloody diarrhoea
and fever. Bloods show renal
failure, thrombocytopaenia and
anaemia
50a

Haemolytic uraemic
syndrome
50b

A 30-y Turkish man
recurrent oral and genital
ulceration. anterior uveitis
and thombophlebitis -
51a

Behcet's syndrome
51b

A 30-y woman with a
history of recurrent peptic
ulcer disease,
hypercalcaemia on routine
bloods. -
52a

multiple endocrine
neoplasia (type 1)
52b

40-y man with a history of
ulcerative colitis fatigue,
jaundice and pruritus and
right upper quadrant pain
53a

primary sclerosing
cholangitis
53b

Young adult with an
abdominal herald patch,
erythematous, oval, scaly
patches in a 'fir-tree'
distribution
54a

pityriasis rosea
54b

A patient with a long history
of 'migraines' presents with
regular headaches despite
using sumatriptan on a daily
basis -
55a

medication overuse
headache
55b

A young man an acute
headache + unilateral
periorbital edema. On
examination there is a
lateral gaze palsy
56a

cavernous sinus
thrombosis
56b

A 45-y man diarrhoea,
weight loss and arthralgia.
Jejunal biopsy deposition of
macrophages PAS-positive
granules
57a

Whipple's disease
57b

An elderly alcoholic man
persistent headache after
falling over the previous
day.fluctuating level of
consciousness
58a

subdural haemorrhage
58b

A 65-y man chronic
hepatitis b infection
symptoms and signs of liver
cirrhosis. Alpha-fetoprotein
is elevated. -
59a

hepatocellular carcinoma
59b

A young athlete paralysis of
his right leg before an
athletics meet. Neurological
examination is inconsistent
-
60a

conversion disorder
60b

Flacid paresis of the
intrinsic hand muscles
with loss of pain and
temperature sensation -
61a

syringomyelia
61b

A 50-y man history of
sinusitis presents with
haemoptysis and renal
impairment.renal biopsy
crescentic GN
62a

Wegener's
granulomatosis
62b

Elderly 2 week history of
unilateral headache +
pain on chewing and
brushing her hair
63a

temporal arteritis
63b

A man itchy, purple,
papular rash on the palms
and flexor surfaces of arms.
polygonal and covered in a
'white-lace' -
64a

lichen planus
64b

A 15-year-old presents with
nephrotic syndrome. Their
blood pressure and renal
blood tests are normal -
65a

minimal change disease
65b

A 30-y woman foul smelling oily
diarrhoea, abdominal bloating,
fatigue and weight loss.
papulovesicular lesions on the
extensor aspects of her arms
66a

coeliac disease
66b

A 60-y muscle fasciculation
+ wasting of the small ms of
the hand. MN signs in the
arms and UMN signs in the
legs
67a

motor neuron disease
67b

A teenage boyclumsy
walking. gait ataxia, an
intention tremor and loss
of lower limb reflexes -
68a

Friedreich's ataxia
68b

A 15-y midline neck lump
painless and cystic in
nature. It moves upwards
on protrusion of the tongue
69a

thyroglossal cyst
69b

60-y man lung cancer ➜
dyspnoea. tachycardic,
hypotensive,↑JVP absent Y
descent pulsus paradoxus
70a

cardiac tamponade
70b

Intense pain around one eye.
Attacks occurs once/day, each
episode 1 hour for the past 8
weeks. + red and watery eye
and a constricted pupil -
71a

cluster headache
71b

A 60-y man flu-like
symptoms & dry cough.
relative bradycardia +
confused. + low sodium -
72a

Legionnaires' disease
72b

Bilateral spastic paresis,
loss of proprioception
and vibration sensation
and limb ataxia -
73a

subacute combined
degeneration of the
spinal cord
73b

bitemporal hemianopia
(lower quadrant defect >
upper quadrant defect)
74a

Craniopharyngioma -
74b

Young child with
multiple small, pearly,
umbilicated lesions
75a

molluscum contagiosum
75b

A young man acute, painful
red eye + photophobia &
blurred vision.pupil is
small and irregular -
76a

anterior uveitis
76b

A patient persistent ST
elevation 4 weeks after
myocardial infarction.
bibasal crackles +third and
fourth heart sound
77a

left ventricular aneurysm
77b

an elderly short-sighted man
flashing lights worse on eye
movement located in the
temporal visual field.upper
visual field loss 'like a curtain
coming down'
78a

Retinal detachment
78b

an elderly man with a long
history of diabetes sudden visual
loss in one eye. For the past few
days floaters and 'cobwebs'.
Visual acuity is reduced to
sensing light
79a

Vitreous haemorrhage
79b

A woman complains of
lethargy, diplopia and
dysphagia. a ptosis on
examination -
80a

myasthenia gravis
80b

a 30-y M visual problems. His
vision is much worse in the dark +
started to lose peripheral vision.
He has a family history of similar
problems
81a

Retinitis pigmentosa
81b

an elderly female smoker
reduced visual acuity, +
'blurred' vision. central
scotoma and fundoscopy
multiple drusen
82a

Macular degeneration
82b

a patient develops acute
heart failure 5 days after a
MI. A new pan-systolic
murmur is noted on
examination
83a

Ventricular septal defect
83b

a patient is noted to have a
new early-to-mid systolic
murmur 10 days after
being admitted for a MI
84a

Ischaemia of the
papillary muscle
84b

A 30-y man productive
cough, fever and chest
pain.herpes labialis +
consolidation in the right
lower zone -
85a

pneumococcal
pneumonia
85b

A 25-y woman irregular
periods hirsutism.elevated
LH:FSH ratio and raised
testosterone level -
86a

polycystic ovarian
syndrome
86b

A 20-y painless swelling
on the lateral aspect of the
neck. smooth, non-tender
and fluctuant -
87a

branchial cyst
87b

A 30-y man progressive
weakness of his hands. wasting of
the small muscles of the hand.
pain and temperature sensation
is reduced but light touch is
preserved. -
88a

syringomyelia
88b

combination of both
upper and lower motor
neuron signs
89a

Amyotrophic lateral
sclerosis
89b

A man develops
haematuria and
frequency after visiting
Malawi -
90a

Schistosoma
haematobium
90b

Sudden onset vertigo and
vomiting, dysphagia, ipsilateral
facial pain and temperature
loss, contralateral limb pain and
temperature loss and ataxia -
91a

posterior inferior
cerebellar artery
91b

a 45-year-old woman with
nephrotic syndrome is noted
to have marked loss of
subcutaneous tissue from
the face
92a

Membranoproliferative
glomerulonephritis (type
II)
92b

A 2-year-old child
develops perianal itching,
which is particularly bad
at night -
93a

Enterobius vermicularis
93b

a patient Hx of heartburn
presents with odynophagia.
There no weight loss,
vomiting or anorexia
94a

Oesophagitis
94b

A middle-aged women
symptoms of
hypothyroidism. a diffuse,
non-tender goitre .↑TSH
,↓T4 , anti-TPO +ve
95a

Hashimoto's thyroiditis
95b

An elderly man resting
tremor in right hand.
shuffling gait and a general
slowness of movement -
96a

Parkinson's disease
96b

A 50-year-old alcoholic
presents with fever. He is
found to have an right
upper lobe pneumonia -
97a

Klebsiella pneumonia
97b

a patient develops watery
diarrhoea one week after
arriving in Mexico
98a

Escherichia coli
(enterotoxigenic)
98b

A young man from north-
east of the USA
fever,arthralgia. + rash 5 cm
erythematous oval area with
central clearing
99a

Borrelia burgdorferi
99b

A young man weakness of
legs shortly after severe
gastroenteritis. normal
Sensation in legs+ loss of
DTR
100a

Guillain-Barre syndrome
100b

A 75-yewoman colicky
pain typically in the LLQ
+ diarrhoea and fever -
101a

diverticulitis
101b

A 40-y woman tremor of
both hands.worse when she
is stressed and relieved by
alcohol. FH of similar
problems
102a

essential tremor
102b

A patient has difficult
abducting their arm
following a humeral neck
fracture
103a

Axillary nerve
103b

wrist drop following a
humeral midshaft
fracture
104a

Radial nerve
104b

An elderly man acute,
painful red eye + decreased
visual acuity. worse in the
dark. semi-dilated non-
reacting pupil
105a

acute angle closure
glaucoma
105b

gradual onset bloody
diarrhoea after travelling to
Egypt. lasted four weeks.
occasional abdominal pain
and tenesmus
106a

Amoebiasis
106b

profuse 'rice water' diarrhoea
after visiting a disaster relief
zone.vomiting but has no
abdominal pain. On
examination he is severely
dehydrated 107a

Cholera
107b

sudden onset severe
occipital headache, like
being 'kicked in the back
of the head'
108a

Subarachnoid
haemorrhage
108b

constant headache
associated with nausea. The
headache is present at night
and worse when coughing
109a

Raised intracranial
pressure
109b

frontal headache
following URTI,worse on
leaning forward
110a

Sinusitis
110b

A 30-y woman weight gain
and irregular menstruation.
BP is elevated at 170/100
mmHg + evidence of
proximal muscle weakness
111a

Cushing's syndrome
111b

A 35-y woman BP
180/110 mmHg. tired
and weak. Routine bloods
show hypokalaemia
112a

primary
hyperaldosteronism
112b

a 15-year-old boy develops
fever and tachypnoea one
week after recovering
from influenza
113a

Staphylococcus aureus
pneumonia
113b

a 60-y Pt Hx of COPD ➜
infective exacerbation+
productive cough and
consolidation on the chest
x-ray
114a

Haemophilus influenzae
pneumonia
114b

Recurrent, severe headache
unilateral and throbbing in
nature. Associated with
nausea and
photosensitivity
115a

migraine
115b

a patient with Huntington's
disease➜ speech which is
difficult to comprehend. can
understand what is being
said to him
116a

Dysarthria
116b

young adult notices
hypopigmented patches on her
trunk after coming getting
suntan. Patches are mildly
pruritic with some scale
117a

Pityriasis versicolor
117b

a 35-y man severe, episodic
loin pain radiates round to
the front. blood+++,
leucocytes ++ on the urine
dipstick
118a

Renal colic
118b

an elderly man severe
central abdominal pain
radiating to the back
associated with
hypotension
119a

Ruptured abdominal
aortic aneurysm
119b

a 60-y with a history of
tuberculosis ➜ dyspnoea &
fatigue. ↑JVP , loud S3 and
Kussmaul's sign +ve,
Hepatomegaly
120a

Constrictive pericarditis
120b

a 25-y man is investigated
for recurrent syncope and
dyspnoea. ejection systolic
murmur
121a

Hypertrophic obstructive
cardiomyopathy
121b

a 60-y alcoholic man severe
chest pain after repeated
episodes of vomiting. + SC
emphysema
122a

Boerhaave syndrome
122b

a patient who is known to
have HIV presents with
odynophagia
123a

Oesophageal candidiasis
123b

a 55-yman fever and
malaise past few weeks
common peroneal nerve
palsy. hepatitis B surface
antigen +ve
124a

Polyarteritis nodosa
124b

a 30-y woman from Singapore
headache, malaise & myalgia.
BP 160/100 mmHg, the right
radial pulse is difficult to
palpate and a carotid bruit is
noted 125a

Takayasu's arteritis
125b

a 65-y Male IgG
paraprotein band +
asymptomatic + calcium
and renal function are
normal
126a

Monoclonal gammopathy
of undetermined
significance
126b

a 70-y DVT. monoclonal
IgM paraprotein band . lost
weight and feels unwell.
calcium and renal function
normal
127a

Waldenstrom's
macroglobulinaemia
127b

an obese 55-y pain in the
RUQ associated with fever.
Palpation of the RUQ
causes arrest of respiration
128a

Acute cholecystitis
128b

a patient Hx of Barrett's
oesophagus presents with
dysphagia and weight
loss
129a

Oesophageal cancer
129b

a middle-aged patient
dysphagia of both liquids
and solids from the start.
regurgitation and a
persistent cough
130a

Achalasia
130b

an elderly man severe pain
around his right eye,
nausea, redness of the eye,
'misty vision' and a semi-
dilated pupil
131a

Acute narrow-angle
glaucoma
131b

a patient feigns chronic
lower back pain to allow
him to claim government
benefits
132a

Malingering
132b

a car crash survivor feels
like he is 'watching a movie'
when trying to recall details
of the episode
133a

Dissociative disorder
133b

a 75-y man large amounts
of a mucous-like diarrhoea.
Bloods demonstrate
hypokalaemia
134a

Villous adenoma
134b

a man who presents with
intussusception is noticed to have
multiple polyps on colonoscopy.
These are later shown to be
hamartomatous. He also has
pigmented lesions on his lips and
palms
135a

Peutz-Jeghers syndrome
135b

A woman develops a
winged scapula after
mastectomy
136a

long thoracic nerve
136b

An elderly womanitchy
lesion on her vulva. It
started as a red patch but
has now turned into a white
plaque
137a

lichen sclerosus
137b

a 65-y man back pain and
lethargy.raised calcium,
renal dysfunction and a
raised ESR
138a

Multiple myeloma
138b

a 20-y woman recurrent episodes
of abdominal pain +
bloating.pain is relieved on
defecation. She normal passes 3
loose stools with mucous in the
mornings
139a

Irritable bowel syndrome
139b

A man diarrhoea and
abdominal pain,
papulovesicular lesions on
the soles & urticarial rash
140a

Strongyloides stercoralis
140b

a child sore throat and low-
grade fever.vesicles in the
mouth and on the palms
and soles of the feet
141a

Hand, foot and mouth
disease
141b

a child pink maculopapular
rash, initially on the face before
spreading to the whole body.
Suboccipital & postauricular
lymphadenopathy is present
142a

Rubella
142b

a middle-aged woman
develops painful,
erythematous, nodular
lesions over both shins
143a

Erythema nodosum
143b

a young child history of atopic
eczema a sudden eruption of
painful, oedematous vesicles
and pustules. systemically
unwell and have a fever
144a

Eczema herpeticum
144b

a middle aged woman tender
goitre + hyperthyroidism.
↓TSH & ↑T4. globally↓uptake
on iodine-131 scan
145a

Subacute thyroiditis
145b

A patient presents with a
'droopy eyelid'. unilateral
miosis, ptosis and narrow
palpebral aperture giving the
appearance of enophthalmos
146a

Horner's syndrome
146b

A 50-y man Marfan syndrome
palpitations &dyspnoea.
collapsing pulse, the BP
160/60 mmHg and a high-
pitched diastolic murmur
147a

aortic regurgitation
147b

An elderly woman develops
a reticulated,
hyperpigmented rash after
using a hot water bottle
excessively -
148a

erythema ab igne
148b

a 35-y woman loin pain +
fever. She has blood+++,
leucocytes +++ on the
urine dipstick
149a

Pyelonephritis
149b

a 50-year-old man
presents with epigastric
pain relieved by eating
150a

Duodenal ulcer
150b

an ECG shows progressive
prolongation of the PR
interval until a dropped
beat occurs
151a

Second degree heart
block (Mobitz I)
151b

a man develops a cardiac
arrest shortly after MI. The
ECG monitor shows rapid,
irregular waveforms
152a

Ventricular fibrillation
152b

a 2-y abdominal mass and
pallor. raised urinary
(VMA) and homovanillic
acid (HVA) levels
153a

Neuroblastoma
153b

A man history of syphilis
bilateral small, irregular
pupils which respond to
accomodation but not to
light
154a

Argyll-Robertson pupil
154b

an elderly Hx of HTN and
glaucoma ↓visual acuity &
peripheral visual field loss.
Fundoscopy optic disc
cupping
155a

Primary open-angle
glaucoma
155b

a baby is born with
microcephaly, small eyes,
low-set ears, cleft lip and
polydactyly
156a

Patau syndrome
156b

a young boy is noted to
have learning difficulties,
macrocephaly, large ears
and macro-orchidism
157a

Fragile X
157b

a 55-y woman recurrent episodes
of vertigo often triggered by a
change in head position. Each
episode lasts around 10-20
seconds and is associated with
nausea
158a

Benign paroxysmal
positional vertigo
158b

a 45-y man unilateral
hearing loss. tinnitus and
some problems with his
balance. absent corneal
reflex
159a

Acoustic neuroma
159b

a 6-week-old baby with 1*1.5cm
swelling in the left axilla. They
were given the BCG vaccine at
birth
160a

Reactive
lymphadenopathy
160b

a 20-y man tender, swollen 2cm
mass in the right submandibular
region. His temperature is
38.2degC and he is noted to have
poor dental hygiene
161a

Reactive
lymphadenopathy
161b

a 40-y alcoholic
haematemesis after
repeated vomiting. An
endoscopy two months ago
no evidence of varices
162a

Mallory-Weiss syndrome
162b

a middle-aged woman Hx
of Raynaud's phenomenon
c/o dysphagia + multiple
telangectasia
163a

Systemic sclerosis
163b

a 40-year-old woman
dysphagia. Oesophageal
manometry ↓oesophageal
peristalsis & ↓lower
oesophageal sphincter tone
164a

Systemic sclerosis
164b

an elderly patient watery
diarrhoea after being treated
for pneumonia. Blood tests
show a new, marked
neutrophilia
165a

Clostridium difficile
165b

a 20-y man bloody
diarrhoea. abdominal pain
and tenesmus. Yesterday he
had flu-like symptoms
166a

Campylobacter
166b

a 60-y woman dysphagia
and lethargy. smooth,
swollen tongue and pale
conjunctivae
167a

Plummer-Vinson
syndrome
167b

a patien Hx of anxiety
c/o having a 'lump' in her
throat
168a

Globus hystericus
168b

a 30-y woman with a history
of recurrent peptic ulcer
disease is found to have
hypercalcaemia on routine
bloods
169a

Multiple endocrine
neoplasia (type 1)
.
169b

A teenage girl anterior knee
pain worse when going
down stairs and rising from
prolonged sitting
170a

chondromalacia patellae
170b

A 70-y womanpan-systolic
murmur after presenting
with dyspnoea. A soft S1
and split S2
171a

mitral regurgitation
171b

a 1-y is swelling on the
left side of the neck. The
mass is soft, non-tender
and transilluminates
172a

Cystic hygroma
172b

ipsilateral oculomotor
palsy and contralateral
weakness
173a

Branches of the posterior
cerebral artery that
supply the midbrain
173b

contralateral hemiparesis and
sensory loss with the upper
extremity being more affected
than the lower, contralateral
homonymous hemianopia and
aphasia
174a

Middle cerebral artery
174b

a young woman takes a
paracetamol overdose after
splitting with her boyfriend. Two
days later she is in a new
relationship which is troubled by
her repeated outbursts of anger
175a

Borderline personality
disorder
175b

a woman presents to her male family
doctor wearing a low-cut top and a
short skirt. She tries to flirt with the
doctor. The consultation is filled with
drama and she becomes annoyed
with the centre of attention shifts
from her
176a

Histrionic personality
disorder
176b

a boy is noted to have
reduced tone,
hypogonadism and
obesity
177a

Prader-Willi syndrome
177b

a baby micrognathia and a cleft
palate. He is placed prone due
to upper airway obstruction.
There is no family history of
similar problems
178a

Pierre-Robin syndrome
178b

an overweight 50-y man
lethargy and excessive
thirst. Fundoscopy blot
haemorrhages
179a

Type 2 diabetes mellitus
179b

a 40-y patient Hx
hypertension presents with
episodic palpitations,
excessive sweating,
headaches and tremor
180a

Phaeochromocytoma
180b

a boy arm problems after falling
from a tree, caught a branch to
save himself. On examination he
has a claw hand with a
hyperextended wrist
181a

Lower trunk of the
brachial plexus (C8, T1)
181b

Loss of proprioception
and vibration . No motor
deficit
182a

neurosyphilis
182b

A 35-y jerky, random and
uncontrollable movements of his
arms. getting progressively worse
for the past few months. His wife
also says he is increasingly
irritable and moody
183a

Huntington's disease
183b

a patient with acute HF 10
days after MI. ↑JVP, pulsus
paradoxus and diminished
heart sounds
184a

Left ventricular free wall
rupture
184b

A woman Hx of rheumatoid
arthritis severe, constant pain in
her right eye. right eye is red and
there is a degree of photophobia.
Visual acuity is normal
185a

scleritis
185b

a patient speak fluently but have
difficulty repeating phrases. He
is aware of the errors he is
making and comprehension
remains normal
186a

Conduction aphasia
186b

A patient presents with
severe vomiting 4 hours
after eating at a
restuarant -
187a

Staphylococcus aureus
187b

A 2-year-old child is
admitted with watery
diarrhoea, vomiting and
dehydration -
188a

rotavirus
188b

a sporty teenage boy
presents with pain,
tenderness and swelling
over the tibial tubercle
189a

Osgood-Schlatter disease
189b

a sporty teenager presents
with knee pain after
exercise associated with
intermittent swelling and
locking
190a

Osteochondritis
dissecans
190b

An elderly patient with a history
of atrial fibrillation presents with
a sudden painless loss of vision in
one eye. Fundoscopy reveals a
'cherry red' spot on a pale retina
-
191a

central retinal artery
occlusion
191b

transient unilateral loss
of vision described as a
'curtain descending'
192a

Ophthalmic artery
192b

locked-in syndrome
193a

Basilar artery
193b

A man episodic angioedema
whilst in west Africa. On
one occasion he noticed a
'worm moving across the
left eye'
194a

Loa loa
194b

a patient is suspected of
injecting her mothers
insulin to cause repeated
episodes of hypoglycaemia
195a

Factitious disorder
195b

Flaccid paralysis of upper
+ lower face -
196a

CN VII
196b

A patient complains of
pins/needles and pain on
the lateral aspect of the
hand -
197a

median nerve
197b

A 25-y man presents with
visible haematuria. He also
complains of having a bad
sore throat at the current
time
198a

IgA nephropathy
198b

A man presents with
central, pleuritic chest pain
and fever 4 weeks following
MI. The ESR is elevated -
199a

Dressler's syndrome
199b

recurrent, non-disabling,
bilateral headache,
described as a 'tight-
band'
200a

Tension headache
200b

a man with raised, red,
spherical lesion on his neck.
It initially was a red spot but
rapidly grew over 4 weeks
201a

Pyogenic granuloma
201b

a man with HIV presents with a
painful, vesicular rash on the
right side of his face around the
eye. Fluorescein staining reveals
multiple small defects on the
right cornea
202a

Herpes zoster
ophthalmicus
202b

a patient with an acute,
painful red eye +
photophobia and epiphora.
Fluorescein staining ragged
area on the cornea
203a

Herpes simplex keratitis
203b

an elderly man with
parkinsonism atonic
bladder, postural
hypotension and cerebellar
signs
204a

Multiple system atrophy
204b

a 40-y man with headaches
and coarsening of his facial
features.his wedding ring
and shoes no longer fit him
205a

Acromegaly
205b

a newborn's arm is noted to be
hanging loosely following a
difficult forceps delivery. The
arm is adducted and internally
rotated, elbow extended
206a

Upper trunk of the
brachial plexus (C5,C6)
206b

A child presents with fever,
malaise and tonsillitis
associated with a 'strawberry'
tongue and a fine punctate
erythematous rash sparing the
face - 207a

scarlet fever
207b

a 35-y man Hx of HTN
and SAH presents with
recurrent UTIs and
episodic haematuria
208a

Autosomal dominant
polycystic kidney disease
208b

an elderly male smoker
visible haematuria + loin
pain. a loin mass can be
found on the same side
209a

Renal cell carcinoma
209b

a 25-y man develops a painless
pustule that later erodes to form
an ulcer. By the time he presents
he has painful inguinal
lymphadenopathy and
proctocolitis
210a

Lymphogranuloma
venereum
210b

middle-aged man head injury falling
down some stairs. After losing
consciousness he quickly recovers
c/o of a headache. Over the next few
hours he becomes more confused
and has one seizure -
211a

extradural (epidural)
haematoma
211b

A patient develops a
bradycardia of 36/min following
a myocardial infarction. The
ECG shows no association
between the P waves and QRS
complexes - 212a

complete heart block
212b

Plz don't hesitate to share
comments & suggestions
for this set ..
144a

Thank You
144b

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