July 2025 (New addition)

✅ Delirium in Parkinson’s Disease:

84-year-old man with Parkinson’s admitted after fall, increasingly agitated, pulling lines + History of cognitive impairment + On exam: Alert but disoriented + Investigation shows: Sodium 130, CXR consolidation + What is the most appropriate next step in managing his agitation >> Insert 1:1 nursing (enhanced observation and orientation measures)

 

 

✅ Severe Lithium Toxicity:

44-year-old man presents with confusion, coarse tremor and polyuria + Bipolar disorder, recent diarrhoea + On exam: GCS 14/15, no focal deficits + Investigation shows: Lithium 2.8 mmol/L, Creatinine 132 + What is the most appropriate next step in management >> Commence haemodialysis

 

 

✅ Anti-GBM Disease:

27-year-old man with 4-week fatigue, dark urine, exertional dyspnoea and haemoptysis + No significant history + On exam: Pale, BP 152/92 + Investigation shows: Creatinine 278, Anti-GBM positive + What is the most likely diagnosis >> Anti-glomerular basement membrane disease

 

 

✅ Idiopathic Intracranial Hypertension:

41-year-old woman presents with 3-week episodic headaches and transient visual blurring + BMI 32 kg/m2 + On exam: Bilateral optic-disc swelling + Investigation shows: Visual acuity 6/6, normal CT + Which of the following is the most likely diagnosis >> Idiopathic intracranial hypertension

 

 

✅ Central Retinal Artery Occlusion:

64-year-old man presents with sudden painless vision loss in right eye + History of AF, not anticoagulated + On exam: Pale retina with cherry-red spot + Investigation shows: Acuity counting fingers + Which of the following best explains the underlying pathophysiology of this presentation >> Arterial embolus from the carotid circulation

 

 

✅ Dissociative Seizure:

28-year-old woman collapsed, shaking, eyes closed, asynchronous movements, pelvic thrusting + Epilepsy history, recent stress + On exam: No tongue biting + Investigation shows: Normal CT and EEG + What is the most likely classification of this episode >> Dissociative (non-epileptic) seizure

 

 

✅ Scleroderma-Associated PAH:

44-year-old woman with systemic sclerosis has worsening dyspnoea and ankle oedema + No cough or wheeze + On exam: Loud P2, basal crackles + Investigation shows: DLCO 35% predicted, RV dilatation + Which investigation is most appropriate to confirm the diagnosis and guide therapy >> Right-heart catheterisation

 

 

✅ Coeliac Disease:

32-year-old woman has fatigue, oral ulcers, itchy rash, bloating and loose stools + History of itchy arm rash + On exam: Aphthous ulcers + Investigation shows: Microcytic anaemia + What is the most likely underlying cause of her symptoms >> Coeliac disease

 

 

✅ Prolactinoma:

35-year-old woman presents with secondary amenorrhoea and galactorrhoea + No visual disturbance + On exam: Visual fields normal + Investigation shows: Prolactin 4000 mIU/L, MRI reveals pituitary mass + What is the most likely diagnosis >> Macroprolactinoma

 

 

✅ Hepatic Encephalopathy:

65-year-old man with alcoholic cirrhosis brought in with worsening confusion + Recent SBP, taking lactulose + On exam: Asterixis, GCS 13 + Investigation shows: Ammonia 94, Sodium 129 + What is the most appropriate initial treatment for his condition >> Add rifaximin

 

 

✅ Drug-Induced Orthostatic Hypotension:

76-year-old woman admitted after fall, lightheaded when rising + Taking amitriptyline and antihypertensives + On exam: Significant postural BP drop + Investigation shows: Normal cardiovascular exam + What is the most appropriate next step in her management >> Discontinue amitriptyline

 

 

✅ Paroxysmal Nocturnal Haemoglobinuria:

35-year-old woman has fatigue, morning dark urine and abdominal pain + No transfusion history + On exam: Mild pallor + Investigation shows: LDH 1250, CD55/CD59 deficiency + What is the most appropriate first-line disease-modifying treatment for this patient >> Eculizumab

 

 

✅ Löffler Syndrome:

35-year-old woman with cough, wheeze and fatigue after Thailand trip + Transient urticaria reported + On exam: Chest clear + Investigation shows: Eosinophilia 2.4, IgE 600, migratory infiltrates + What is the most likely diagnosis >> Löffler syndrome

 

 

✅ Chronic Kidney Disease Assessment:

28-year-old woman found to have mild renal impairment (eGFR 72) + Mild fatigue + On exam: BP 132/78 + Investigation shows: Creatinine 128, Urinalysis 1+ protein + What is the most appropriate next step in assessing her renal function >> Urine albumin: creatinine ratio

 

 

✅ Hypertensive Intracerebral Haemorrhage:

65-year-old man presents with sudden confusion and right-sided weakness + Hypertension on aspirin + On exam: BP 186/102, drowsy + Investigation shows: CT reveals deep intracerebral haemorrhage + Which of the following is the most likely underlying cause of the radiological findings >> Hypertensive vasculopathy

 

 

✅ Wet Age-Related Macular Degeneration:

72-year-old woman has progressive blurring and distortion of central vision + Straight lines appear wavy + On exam: Drusen and pigment changes + Investigation shows: OCT subretinal fluid + What is the most likely diagnosis >> Wet age-related macular degeneration

 

 

✅ Lung Cancer Investigation:

85-year-old smoker with severe COPD and weight loss has lung mass + Poor performance status + On exam: Reduced breath sounds + Investigation shows: 38mm peripheral mass, no nodes + Which of the following is the most appropriate next step in the management of this patient >> CT-guided percutaneous biopsy

 

 

✅ Acute Severe Asthma:

23-year-old woman with asthma has worsening wheeze despite back-to-back salbutamol + Speech limited + On exam: RR 32, PEF 40% + Investigation shows: Sats 94% on air + What is the most appropriate next step in the acute management >> IV magnesium sulphate

 

 

✅ Adult-Onset Still’s Disease:

36-year-old woman with daily fevers, sore throat, myalgia and salmon-pink rash + Increasing joint stiffness + On exam: Rash during fever + Investigation shows: Ferritin 3200, Neutrophilia + What is the most likely diagnosis >> Adult-onset Still’s disease

 

 

✅ Toxic Alcohol Ingestion:

47-year-old man found confused and ataxic after handling car antifreeze + Alcohol dependence history + On exam: Slurred speech, normal fundoscopy + Investigation shows: Metabolic acidosis, envelope crystals + What is the most appropriate initial treatment >> Start fomepizole infusion

 

 

✅ Supraventricular Tachycardia:

28-year-old woman has sudden palpitations and light-headedness + History of similar episodes + On exam: HR 182, BP 106/68 + Investigation shows: Narrow complex tachycardia + What is the most appropriate initial management for this patient >> Adenosine

 

 

✅ IgA Vasculitis (HSP):

45-year-old woman has recurrent painful leg lesions after URTI + Occasional arthralgia + On exam: Palpable purpura on shins + Investigation shows: Biopsy reveals vessel wall inflammation + What is the most likely diagnosis >> Henoch-Schönlein purpura (IgA vasculitis)

 

 

✅ Primary Hyperaldosteronism:

45-year-old woman has headaches, fatigue and proximal weakness + Hypertension + On exam: BP 170/100 + Investigation shows: Potassium 2.8, High Aldosterone/Renin ratio + What is the most appropriate initial treatment for this patient >> Spironolactone

 

 

✅ Amoebic Liver Abscess:

52-year-old man has fever and RUQ pain after India trip + No past medical history + On exam: Jaundice, tender RUQ + Investigation shows: Hypoechoic liver lesion + What is the most appropriate next step in management >> Begin oral metronidazole and arrange serology for Entamoeba histolytica

 

 

✅ Hepatitis E in Pregnancy:

28-year-old pregnant woman has nausea, vomiting and jaundice after barbecue + No medical history + On exam: Jaundiced, stable + Investigation shows: ALT 248, Bilirubin 45 + What is the most likely diagnosis >> Hepatitis E

 

 

✅ Iron Deficiency Anaemia Investigation:

78-year-old woman has progressive fatigue, pallor and mild dyspepsia + Anticoagulated for AF + On exam: Pallor + Investigation shows: Hb 9.8, MCV 72, Ferritin 10 + What is the most appropriate next investigation >> Faecal Immunochemical test

 

 

✅ Parvovirus B19 Infection:

32-year-old woman with hereditary spherocytosis presents with worsening anaemia + Viral illness history + On exam: Pallor + Investigation shows: Hb 84, Reticulocytes 0.2% + What is the most likely cause of her current anaemia >> Erythroparvovirus B19 infection

 

 

✅ Pneumocystis Pneumonia:

36-year-old man with untreated HIV has cough, fever and exertional dyspnoea + On piperacillin-tazobactam + On exam: Sats 89%, CD4 150 + Investigation shows: PaO2 66 mmHg, perihilar infiltrates + What is the most appropriate next step in management >> Add cotrimoxazole

 

 

✅ Neuropathic Pain in CKD:

66-year-old man with CKD 4 has chronic burning back/leg pain + Intolerant to gabapentin + On exam: No focal deficits + Investigation shows: eGFR 21 + What is the most appropriate next step in managing his pain >> Buprenorphine patches

 

 

✅ Guillain-Barré Syndrome:

24-year-old man has progressive leg weakness and tingling after diarrhoea + Recent GI illness + On exam: Areflexia, symmetrical weakness + Investigation shows: CSF protein 1.4, Cells 1 + What is the most likely diagnosis >> Guillain-Barré syndrome

 

 

✅ Latent TB Screening:

34-year-old woman has positive Mantoux test for employment screening + BCG vaccinated + On exam: Normal chest exam + Investigation shows: Normal CXR, ALT 98 + What is the most appropriate management for this patient >> Interferon-gamma release assay

 

 

✅ Lung Cancer Management:

55-year-old woman has 38mm right-upper-lobe mass, PET avid + Good performance status + On exam: Normal spirometry + Investigation shows: Resectable NSCLC, ppo-FEV1 66% + What is the most appropriate next step in her management >> Right upper lobectomy with systematic mediastinal lymph-node sampling/dissection

 

 

✅ Bronchiolitis Obliterans:

45-year-old woman post-stem cell transplant has dyspnoea and air trapping + GVHD history + On exam: Chest clear + Investigation shows: Obstructive spirometry, mosaic attenuation + What is the most likely diagnosis >> Bronchiolitis obliterans

 

 

✅ Hepatitis C Cryoglobulinaemia:

52-year-old woman has fatigue, arthralgia, purpura and tingling fingers + Raynaud’s symptoms + On exam: Palpable purpura, wrist tenderness + Investigation shows: Low C4, RF positive, Cryoglobulins + What is the most likely underlying cause of her cryoglobulinaemia >> Chronic hepatitis-C infection

 

 

✅ Paracetamol Overdose:

25-year-old woman ingested 12g paracetamol 10 hours ago + Alcohol involved + On exam: Drowsy, acidosis + Investigation shows: Metabolic acidosis, level pending + What is the most appropriate immediate management step >> Administer IV N-acetylcysteine without delay

 

 

✅ Cardiomyopathy Investigation:

42-year-old man with exertional syncope and family history of sudden death + No chest pain + On exam: Normal exam + Investigation shows: ECG deep Q waves/LVH + What is the most appropriate next investigation >> Transthoracic echocardiography

 

 

✅ Phaeochromocytoma:

48-year-old woman with episodic palpitations, sweating and anxiety + Resistant hypertension + On exam: BP 160/100, HR 110 + Investigation shows: Normal renal function + What is the most appropriate next step in the management of this patient >> Check plasma metanephrine

 

 

✅ Liver Capsule Pain:

58-year-old woman with liver metastases has RUQ pain and nausea + Poor appetite + On exam: Tender RUQ + Investigation shows: Multiple metastases + What is the most appropriate management to alleviate her pain >> Dexamethasone

 

 

✅ Hepatitis B Post-Exposure:

34-year-old nurse sustains needlestick from Hep C positive patient + Non-responder to vaccine + On exam: Site clean + Investigation shows: Anti-HBs <10 + What is the most appropriate next step >> Administer hepatitis-B immunoglobulin and initiate hepatitis-B vaccination series

 

 

✅ Membranous Nephropathy:

41-year-old woman on penicillamine for RA has ankle swelling + Frothy urine + On exam: Oedema + Investigation shows: Albumin 24, Proteinuria 4+ + What is the most likely cause of her renal findings >> Membranous nephropathy

 

 

✅ Cluster Headache:

33-year-old woman has nightly excruciating unilateral headaches with eye watering + Agitated during attacks + On exam: Normal neurology + Investigation shows: Normal between attacks + What is the most appropriate initial treatment to abort her symptoms >> Sumatriptan

 

 

✅ Massive Pleural Effusion:

68-year-old man with mesothelioma history has progressive breathlessness + Previous pleurodesis + On exam: Dullness, reduced breath sounds + Investigation shows: White-out with tracheal deviation away + Which of the following is the most likely explanation for the radiographic findings >> Massive pleural effusion

 

 

✅ Digoxin Toxicity:

72-year-old woman has confusion, nausea, blurred vision and bradycardia + Renal impairment + On exam: HR 44 + Investigation shows: Potassium 6.1, Digoxin 3.8 + What is the most appropriate treatment for her condition >> Give digoxin-specific antibody fragments

 

 

✅ SVT in COPD:

67-year-old man with COPD has palpitations and breathlessness + Stable BP + On exam: HR 158 regular + Investigation shows: Narrow complex tachycardia + What is the most appropriate next step in management >> Adenosine

 

 

✅ Sweet Syndrome:

39-year-old woman has fever, painful violaceous plaques and cough + Lung infiltrates + On exam: Plaques with blistering + Investigation shows: Neutrophilic dermatosis, leukocytosis + What is the most likely diagnosis >> Sweet syndrome

 

 

✅ Insulinoma Investigation:

32-year-old woman has dizzy spells relieved by sugar + Low glucose noted + On exam: Normal + Investigation shows: Glucose 2.2 mmol/L during attack + What is the most appropriate next step in the investigation of this patient >> 72-hour fasting test

 

 

✅ Anal Fissure Treatment:

28-year-old woman has severe anal pain and bleeding on defaecation + Constipation + On exam: Posterior midline fissure + Investigation shows: Chronic fissure absent + What is the most appropriate initial treatment for this condition >> High-fibre diet and stool softeners

 

 

✅ Angiodysplasia:

79-year-old man has melaena and dizziness + Normal endoscopy + On exam: Stable + Investigation shows: Hb 78, MCV 85 + What is the most likely source of his gastrointestinal bleeding >> Angiodysplasia of the jejunum

 

 

✅ Hyperviscosity Syndrome:

68-year-old man has fatigue, nosebleeds, blurred vision and retinal vein dilation + Monoclonal band + On exam: Fundoscopy abnormal + Investigation shows: IgM paraprotein, Viscosity 4.5 + What is the most appropriate next step in management >> Plasmapheresis

 

 

✅ Pulmonary Tuberculosis:

45-year-old man with COPD has fever, weight loss and cavitary lung lesion + Steroid use + On exam: Crackles + Investigation shows: Sputum AFB positive + What is the most likely causative organism >> Mycobacterium tuberculosis

 

 

✅ Ramipril Monitoring:

63-year-old woman started ramipril, creatinine rose from 90 to 112 + Asymptomatic + On exam: BP 106/64 + Investigation shows: Potassium 5.3 + What is the most appropriate management plan for this patient >> Reduce Ramipril dose and recheck U and E

 

 

✅ Spinal Stenosis:

65-year-old man has back/leg pain worse walking, better sitting + Normal pulses + On exam: Reduced reflexes + Investigation shows: No limb ischaemia + What is the most likely diagnosis >> Lumbar spinal stenosis

 

 

✅ Hepatocellular Carcinoma:

51-year-old woman with Hep B has ascites, RUQ pain and weight loss + Hepatomegaly + On exam: Absent hepatic vein flow + Investigation shows: AFP 780, liver mass + What is the most likely underlying cause of her Budd-Chiari syndrome >> Hepatocellular carcinoma

 

 

✅ COPD Escalation:

68-year-old smoker with COPD (FEV1 48%) and exacerbations + No asthma features + On exam: Chest clear + Investigation shows: FEV1/FVC 0.52 + Which of the following is the most appropriate next step in management >> Long-acting beta-agonist + long-acting muscarinic antagonist combination

 

 

✅ Cryoglobulinaemic Vasculitis:

45-year-old woman has fatigue, rash, protein/blood in urine after flu-like illness + Hepatitis C positive + On exam: Purpuric rash + Investigation shows: Low C4, Proteinuria + What is the most appropriate next step in managing her condition >> Initiate antiviral therapy for Hepatitis C

 

 

✅ Azathioprine Interaction:

39-year-old man on azathioprine starts allopurinol, presents with pancytopenia + Gout treatment + On exam: Unwell, no rash + Investigation shows: Severe pancytopenia + What is the most likely cause of his presentation >> Drug interaction between azathioprine and allopurinol

 

 

✅ Tuberous Sclerosis:

28-year-old woman with angiomyolipomas and palpitations + Family history of epilepsy + On exam: Ash-leaf spots + Investigation shows: Normal ECG + What is the most likely underlying condition >> Tuberous sclerosis

 

 

✅ Hyperthyroidism in Pregnancy:

28-year-old pregnant woman (8 weeks) has Graves’ disease + Tremor/Goitre + On exam: HR elevated + Investigation shows: Thyrotoxicosis + Which is the most appropriate anti-thyroid drug at this stage of pregnancy >> Propylthiouracil

 

 

✅ Primary Biliary Cholangitis:

52-year-old woman has fatigue, pruritus and cholestatic LFTs + AMA positive + On exam: Normal + Investigation shows: ALP 268, Bilirubin normal + Given the likely diagnosis, what is the most appropriate initial treatment >> Ursodeoxycholic acid

 

 

✅ Common Variable Immunodeficiency:

28-year-old man has recurrent sinus/lung infections and splenomegaly + No malignancy + On exam: Splenomegaly + Investigation shows: Low IgG, IgA, IgM + What is the most likely diagnosis >> Common variable immunodeficiency

 

 

✅ Pyonephrosis Risk:

68-year-old man with BPH and CKD has persistent fever despite antibiotics + Retention risk + On exam: Suprapubic discomfort + Investigation shows: CRP 145, Creatinine 164 + What is the single most appropriate next step >> Arrange urgent renal-tract ultrasound (including bladder scan)

 

 

✅ Cauda Equina Syndrome:

67-year-old woman has back pain, urinary symptoms and saddle anaesthesia + Diabetes history + On exam: Retention (780ml), lax anal tone + Investigation shows: Urinary retention + What is the most appropriate next step in management >> Arrange for an urgent MRI of the spine

 

 

✅ Bronchiectasis Management:

55-year-old woman with chronic cough and frequent exacerbations + Physio ongoing + On exam: Crackles + Investigation shows: CT bronchiectasis + What is the most appropriate long-term management strategy to reduce further exacerbations >> Azithromycin prophylaxis

 

 

✅ Tricyclic Overdose:

32-year-old woman drowsy after overdose + Tachycardia + On exam: HR 120, BP 100/60 + Investigation shows: ECG wide QRS + What is the most appropriate treatment >> IV sodium bicarbonate

 

 

✅ Resistant Hypertension:

58-year-old man on ramipril, amlodipine, indapamide has BP >180/100 + No heart failure + On exam: BP 180/100 + Investigation shows: Normal K + What is the most appropriate next step in managing this patient’s resistant hypertension >> Add spironolactone

 

 

✅ Nephrogenic Diabetes Insipidus:

41-year-old man on lithium has polyuria + Water deprivation failed + On exam: Dehydrated + Investigation shows: No response to desmopressin + What is the most likely diagnosis >> Nephrogenic diabetes insipidus

 

 

✅ Coeliac Disease Presentation:

34-year-old woman has diarrhoea, fatigue, weight loss and anaemia + No pain + On exam: Pallor + Investigation shows: Hb 98, Ferritin 10 + What is the most likely underlying diagnosis >> Coeliac disease

 

 

✅ Botulism:

46-year-old man has weakness, dysphagia and blurred vision after eating home-canned food + Ptosis + On exam: Diminished reflexes + Investigation shows: Clinical diagnosis + What is the most appropriate treatment for this condition >> Botulinum anti-toxin

 

 

✅ ACE Inhibitor Monitoring:

52-year-old man on ramipril has creatinine rise from 141 to 174 + Asymptomatic + On exam: BP 132/78 + Investigation shows: Potassium 4.9 + What is the most appropriate next step regarding his antihypertensive therapy >> Repeat renal function and potassium in one week

 

 

✅ Cerebral Amyloid Angiopathy:

68-year-old woman has sudden confusion and left weakness + History of AF + On exam: Confusion + Investigation shows: Lobar haemorrhage on CT + What is the most likely underlying cause of her condition >> Cerebral amyloid angiopathy

 

 

✅ COPD and Oxygen:

68-year-old smoker with hypoxic COPD (PaO2 6.3) seeks help + Still smokes + On exam: Sats 88% + Investigation shows: Hypoxia + What is the most appropriate management for this patient >> Recommend smoking cessation

 

 

✅ Methotrexate Toxicity:

62-year-old man on methotrexate/trimethoprim has fever, ulcers, pancytopenia + Sepsis signs + On exam: Oral ulcers, petechiae + Investigation shows: Neutrophils 0.2 + What is the most important next step in the management of this patient >> Administer folinic acid (leucovorin)

 

 

✅ STEMI Management:

58-year-old man has chest pain, STEMI on ECG, PCI center >2 hours away + Stable + On exam: Normal + Investigation shows: ST elevation + What is the most appropriate next step in his management >> Administer IV thrombolysis

 

 

✅ Granuloma Annulare:

43-year-old woman has non-itchy annular plaques on hands + No scale + On exam: Violaceous rings + Investigation shows: Fungal scrape negative + What is the most appropriate next step in management >> Perform a skin biopsy for histopathology

 

 

✅ Acromegaly Diagnosis:

45-year-old woman has increasing shoe size and coarse features + Jaw enlargement + On exam: Acromegalic features + Investigation shows: Clinical suspicion + What is the most appropriate test to confirm the suspected diagnosis >> Oral glucose tolerance test

 

 

✅ Progressive Multifocal Leukoencephalopathy:

42-year-old man on biologics has confusion, ataxia and white matter lesions + Crohn’s disease + On exam: Ataxia + Investigation shows: MRI T2 hyperintensities + What is the most likely diagnosis >> Progressive multifocal leukoencephalopathy

 

 

✅ Thrombotic Thrombocytopenic Purpura:

33-year-old woman has fatigue, confusion, bruising and renal impairment + No fever + On exam: Petechiae + Investigation shows: Hb 90, Plt 22, Schistocytes + What is the most appropriate initial management for this patient >> Plasma exchange

 

 

✅ Epididymo-orchitis:

27-year-old man has scrotal pain and swelling + Multiple partners + On exam: Tender epididymis + Investigation shows: STI risk + What is the most appropriate oral antibiotic to prescribe in addition to intramuscular ceftriaxone >> Doxycycline

 

 

✅ IgA Nephropathy:

27-year-old man has recurrent dark urine after sore throats + Hypertension + On exam: BP 152/94 + Investigation shows: Dysmorphic red cells + What is the most likely diagnosis >> IgA nephropathy

 

 

✅ Essential Tremor:

63-year-old woman has progressive bilateral hand tremor worse with action + Mild asthma + On exam: Kinetic tremor + Investigation shows: Normal + What is the most appropriate initial treatment >> Primidone

 

 

✅ Atrial Fibrillation in Heart Failure:

78-year-old man with COPD and HF (EF 35%) has AF with RVR + Breathless + On exam: HR 130 + Investigation shows: Reduced EF + What is the most appropriate pharmacological agent to control his ventricular rate >> Bisoprolol

 

 

✅ Scleroderma Pulmonary Hypertension:

56-year-old woman with scleroderma has breathlessness and clear lungs + Normal volumes + On exam: Loud P2 + Investigation shows: Low DLCO, normal spirometry + What is the most appropriate next step in her management >> Refer for echocardiography

 

 

✅ Drug-Induced Dystonia:

32-year-old woman has agitation and oculogyric crisis after anti-emetics + Distressed + On exam: Eye deviation, spasms + Investigation shows: Dystonia + What is the most appropriate treatment >> Procyclidine

 

 

✅ Anticoagulation in Atrial Fibrillation:

76-year-old man with fall and fatigue has ECG showing AF + Stable + On exam: Normal neuro + Investigation shows: AF on ECG + What is the most appropriate next step in this patient’s management >> Discharge with 24 hours Holter monitoring

 

 

✅ Antisynthetase Syndrome:

49-year-old woman has proximal weakness, rash, mechanics hands and crackles + Raynaud’s + On exam: Gottron’s papules, crackles + Investigation shows: Anti-Jo-1 positive + What is the most likely diagnosis >> Anti-synthetase syndrome

 

 

✅ Addison’s Disease: 44-year-old woman has fatigue, weight loss, dizziness and pigmentation + Postural drop + On exam: Pigmented creases + Investigation shows: Na 127, K 5.8, Low cortisol + What is the most appropriate next step in confirming the diagnosis >> Adrenocorticotropic hormone stimulation (short Synacthen) test

 

 

✅ Salmonella Gastroenteritis:

32-year-old woman with UC has Salmonella diarrhoea, now improving + Stable + On exam: Benign abdomen + Investigation shows: Salmonella positive + What is the most appropriate next step in management >> Continue current treatment without added antibiotics

 

 

✅ Symptomatic Anaemia:

80-year-old man has severe fatigue, breathlessness and Hb 69 + No bleeding + On exam: Stable + Investigation shows: Normocytic anaemia + What is the most appropriate management for this patient >> Red blood cell transfusion

 

 

✅ Nodular Glomerulosclerosis:

62-year-old man has nephrotic syndrome and kappa light chain excess + No M-spike + On exam: Oedema + Investigation shows: LCDD suspected + What is the most likely finding on light microscopy >> Nodular glomerulosclerosis

 

 

✅ Kidney Transplant Types:

40-year-old man receives kidney from identical twin + Healthy donor + On exam: Iliac fossa implant + Investigation shows: Genetic identity + How is this type of transplantation best described >> Heterotopic isograft

 

 

✅ Transverse Myelitis:

52-year-old woman has back pain, band sensation and rapid paraparesis + Post-viral + On exam: Sensory level T8, retention + Investigation shows: Cord signs + What is the most likely diagnosis >> Anterior spinal artery Infarction

 

 

✅ Cancer Pain Management:

55-year-old woman with lung cancer has worsening chest pain + Opioid naïve + On exam: Stable + Investigation shows: ECOG 3 + What is the most appropriate next step in pain control >> Immediate-release morphine

 

 

✅ Eosinophilic Asthma:

44-year-old woman with severe asthma has exacerbations despite maximal therapy + High eosinophils + On exam: Wheeze + Investigation shows: Eosinophils 0.6, IgE normal + Which of the following is the most appropriate next step in management >> Initiate mepolizumab therapy

 

 

✅ Beta-Blocker Overdose:

30-year-old woman with propranolol overdose is bradycardic and hypoglycaemic + Atropine failed + On exam: HR 38, Glucose 3.1 + Investigation shows: ECG bradycardia + What is the most appropriate next step in management >> Administer IV glucagon

 

 

✅ WPW Syndrome:

25-year-old woman with Ebstein’s has palpitations + Stable + On exam: HR 180 + Investigation shows: Delta waves/Pre-excitation + What is the most appropriate first-line management for this patient >> Adenosine

 

 

✅ Cushing’s Syndrome Investigation:

48-year-old woman has weight gain, bruising and proximal weakness + Striae + On exam: Cushingoid + Investigation shows: Clinical suspicion + What is the most appropriate initial investigation to confirm hypercortisolism >> Dexamethasone-suppression test

 

 

✅ Common Variable Immunodeficiency:

35-year-old woman has recurrent pneumonia and low immunoglobulins + No chemo + On exam: Normal + Investigation shows: IgG 3.5, IgA 0.4 + What is the most likely diagnosis >> Common variable immunodeficiency

 

 

✅ Antidepressant Switching:

34-year-old woman with depression has no response to sertraline + Sexual side effects + On exam: Normal + Investigation shows: PHQ-9 18 + What is the most appropriate next step in management >> Switch to mirtazapine (and cross-taper off sertraline)

 

 

✅ Restrictive Allograft Syndrome:

52-year-old lung transplant patient has worsening dyspnoea and fibrosis + 18 months post-op + On exam: Crackles + Investigation shows: Restrictive spirometry + What is the most likely diagnosis >> Restrictive allograft syndrome

 

 

✅ Dermatomyositis Antibody:

46-year-old woman has rash, proximal weakness and interstitial lung disease + Heliotrope rash + On exam: Gottron’s papules + Investigation shows: ILD on CT + Which autoantibody is most likely to be positive in this patient >> Anti-Jo-1 antibody