MRCP Classical Presentations PDF

BADRAWY MRCP revision
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
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
PDA
12b
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
TTP
43b
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 northeast 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 nonreacting 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 semidilated 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 lowgrade 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. globallyuptake
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 highpitched 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 'tightband'
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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