Wentwest SGPe 2: Mock Written Exam

The sudden onset of tearing central chest pain through to the back, along with hypotension and weak asymmetrical radial pulses, is highly suggestive of aortic dissection. Aortic dissection occurs when there is a tear in the inner layer of the aorta, causing blood to flow between the layers and potentially leading to life-threatening complications. This presentation requires immediate medical attention and intervention.

Jack's presentation of multiple simple lesions elsewhere in the body, as well as macular patches on his arms and legs, is consistent with the diagnosis of neurofibromatosis. Neurofibromatosis is a genetic disorder that causes tumors to form on nerve tissue, leading to the development of multiple skin lesions and macular patches. Lipoma, Dercum's disease, gouty tophi, and rheumatoid nodule do not typically present with these specific characteristics.

The most likely diagnosis for Jo's symptoms is Morton's neuroma. Morton's neuroma is a condition characterized by sharp pain radiating into the toes, typically between the 3rd and 4th metatarsals. This condition is caused by a thickening of the tissue around the nerves leading to the toes, often due to repetitive stress or compression. The tenderness between the 3rd and 4th metatarsals seen on examination further supports this diagnosis. Hammer toe, gout, bunion, and plantar fasciitis do not typically present with the same symptoms or tenderness in this specific location.

The most likely diagnosis in this case is nephrotic syndrome. The presence of puffiness around the eyes, ankle edema, and significant proteinuria (4+) on the urine dipstick are all suggestive of nephrotic syndrome. Nephrotic syndrome is a kidney disorder characterized by increased permeability of the glomerular filtration barrier, leading to excessive loss of protein in the urine. This can result in edema, particularly around the eyes and ankles. The presence of blood (1+) on the urine dipstick may be indicative of glomerular damage. This condition is more common in children and is often associated with infections, such as tonsillitis.

The correct answer is c. Pityriasis versicolor. Pityriasis versicolor is a common fungal infection of the skin caused by the yeast Malassezia. It typically presents as small, scaly patches that can be lighter or darker than the surrounding skin. The eruption tends to occur during the summer months and is more common in young adults. This matches the patient's presentation of an acute eruption on the torso, neck, and upper arms, with a history of getting it at the same time last year during summer.

Murray's presentation of sharp pleuritic chest pain that is relieved by leaning forwards suggests acute pericarditis. This condition is characterized by inflammation of the pericardium, the membrane surrounding the heart. The sharp chest pain is typically worsened by deep breathing or lying flat and is relieved by sitting up or leaning forwards. The absence of cardiac risk factors and the presence of ST elevation across all leads on the ECG further support the diagnosis of acute pericarditis.

Epiglottitis is a condition characterized by inflammation of the epiglottis, a flap of tissue that prevents food from entering the airway during swallowing. It is commonly seen in children aged 2-6 years, as mentioned in option a. The patient with epiglottitis appears unwell and septic, as stated in option b. The voice becomes muffled due to the swelling of the epiglottis, as mentioned in option c. Drooling is also a common symptom of epiglottitis, as stated in option d. However, epiglottitis can also occur in adults, so it is not exclusively seen in children, as mentioned in option e.

The patient's presentation of an acutely swollen, red, and painful knee, along with the presence of calcium pyrophosphate crystals on microscopy, is consistent with pseudogout. Pseudogout is a form of arthritis caused by the deposition of calcium pyrophosphate crystals in the joints. The absence of fever and the slightly turbid fluid on aspiration suggest that the condition is not septic arthritis. There is no mention of warfarin therapy or gout in the patient's history or presentation. Therefore, the most likely diagnosis in this case is pseudogout.

Molluscum contagiosum is a viral infection that commonly affects children. It is usually spread through direct skin-to-skin contact or contact with contaminated objects. While treatment may be recommended to prevent the spread of the infection or to alleviate symptoms, it is not always necessary. In many cases, molluscum contagiosum resolves on its own within 3 to 18 months. Therefore, the statement that it should always be treated is not true.

Rhinorrhoea, or a runny nose, is not a typical symptom of cholesteatoma. Cholesteatoma is a noncancerous growth of skin cells in the middle ear behind the eardrum. Typical symptoms include dizziness, otorrhoea (ear discharge), deafness, and facial nerve palsy (weakness or paralysis of the facial muscles). Rhinorrhoea is more commonly associated with conditions affecting the nose and sinuses, rather than the middle ear.

The patient's presentation of a rash that started with a singular lesion and spread to involve the upper limbs, along with mild itchiness and overall well-being, is consistent with the diagnosis of pityriasis rosea. Pityriasis rosea is a common skin condition characterized by a herald patch, which is a single larger lesion that appears first, followed by smaller lesions that spread in a Christmas tree pattern. The rash is typically mildly itchy and resolves on its own within a few weeks to months.

The correct answer is e. It is usually a sign of underlying malignancy. This means that tender lumps on the shins, as seen in the picture, are not typically associated with underlying malignancy.

Central retinal artery occlusion is a condition where there is a blockage in the main artery that supplies blood to the retina. This sudden loss of blood flow can lead to ischemia and damage to the retina. Fundoscopy, which involves examining the back of the eye, reveals a bright red spot at the macula in central retinal artery occlusion. This is known as a cherry red spot and is caused by the contrast between the pale retina and the red choroid. The other options are not consistent with a diagnosis of central retinal artery occlusion.

Carey's acute eruption on his hands and palms over the last 72 hours suggests a possible diagnosis of erythema multiforme. Erythema multiforme is a skin condition characterized by the sudden onset of red, target-like lesions on the skin, typically affecting the hands and extremities. It can be triggered by various factors such as infections, medications, or allergic reactions. The timing and presentation of Carey's symptoms align with erythema multiforme, making it the most likely diagnosis.

Campylobacter infection is usually acquired through eating contaminated poultry, particularly chicken. This is because poultry, such as chicken, can carry the bacteria without showing any signs of illness. Therefore, consuming undercooked or contaminated chicken can lead to Campylobacter infection. The other options are not true based on the given information.