Question:
A 15-year-old girl presents with a seven day history of fever and malaise, with tender neck glands and discomfort in swallowing. She has previously been well. She had a full term normal delivery with no neonatal problems. Her immunisations are up to date. There is no family or social history of note.
On examination the temperature is 38.5°C, respiratory rate 15/min and pulse 80/min. She appears well and is well perfused. She has a scanty blanching erythematous rash over the trunk, tender cervical and inguinal glands, and a spleen, palpable 4 cm below the costal margin.
Which is the most likely diagnosis?
(Please select 1 option)
HIV
Infectious mononucleosis
Kawasaki disease
Mycobacterial adenitis
Streptococcal pharyngitis
A 3-year-old boy is playing with his brother when he falls. He cries immediately and refuses to walk. His mother carries him to hospital. He is a full term normal delivery with no neonatal complications. Immunisations are up to date. There is no FH/SH of note.
On examination he looks well and well nourished. There are no dysmorphic features. He has slight swelling, warmth and discomfort on the lower third of the left tibia, and refuses to weight bear. AP and lateral x rays of the tibia are normal.
Which is the most likely diagnosis?
(Please select 1 option)
Ankle fracture
Ankle sprain
Fibular fracture
Knee dislocation
Tibial fracture
A 35-year-old gentleman attends the renal clinic with weight gain and shortness of breath.
Laboratory results show a low albumin, raised cholesterol and urine dipstick shows 3+ protein.
What is the minimum value of protein:creatinine ratio that would be classed as ‘nephrotic range’ from the answers below?
(Please select 1 option)
50 mg/mmol
100 mg/mmol
200 mg/mmol
250 mg/mmol
300 mg/mmol
A 36-year-old woman presents with discharge of milk from both breasts spontaneously for the last one week. This has caused her considerable social embarrassment.
She is a divorced mother of two with no current sexual partner. She is not taking any medication. There is no history of headache or visual field defect. Her examination reveals pulse of 62/minute and blood pressure of 120/98 mm of Hg. Blood tests reveal haemoglobin of 90 gm/L with total leukocyte count of 6400/µL and platelet count of 330×109 /L. Red cell indices reveal MCV of 104 fL, MCH 28 pg and MCHC 32 g/dl.
Which of the following is the next most appropriate test?
(Please select 1 option)
Breast USG study
Pituitary MRI scan
Renal and hepatic metabolic profile
Serum prolactin level
TSH level
A 32-year-old woman with IgA nephropathy attended the clinic shortly after having a positive pregnancy test.
On physical examination, pulse rate was 60 / minute and blood pressure was 145/83 mmHg. Fundi and cardiac examinations were normal. There was no pedal oedema.
Urine protein measured 0.7 g daily. Her serum creatinine level was 60 μmol/L. Medications at that time were lisinopril and folic acid.
Which of the following recommendations is most appropriate?
(Please select 1 option)
Continue the folic acid and lisinopril.
Continue the folic acid and lisinopril, but advise to stop lisinopril in the second half of pregnancy.
Change lisinopril to losartan.
Stop lisinopril.
Target blood pressure of < 120/80 mmHg during pregnancy.
A 42-year-old woman had recently undergone an ultrasound screening for polycystic kidney disease (PKD).
Her father had polycystic kidney disease and had received a renal transplant 16 years earlier. At that time, the woman attended a genetic counselling session and decided not to get screened for PKD, but recently, she had changed her mind and underwent the USG screening.
She has now returned to the clinic and is concerned as the screening showed a 5×3 cm cyst in right kidney upper pole.
Which of the following is the most appropriate advice for her?
(Please select 1 option)
PKD can be reasonably ruled out
She has got PKD
She needs immediate surgery
She needs to undergo regular screening to rule out PKD
She should undergo genetic testing now