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Clinical MCQs: Mixed Systems Review MCQs
MBBS Professional Review: Medicine · MBBS / Medicine · 24 practice questions
- Causes of hypertension - differential diagnosis
- Lumbosacral nerve root compression
- Young adult hypertension - differential diagnosis
- Renal imaging and nephropathy
- Secondary hypertension - renal artery stenosis vs Conn syndrome
- Abdominal imaging - pancreatic and cystic lesions
- Endocarditis complications
- Paediatric growth monitoring
1. A 63-year-old man presents with persisting upper abdominal pain two months after an episode of acute epigastric pain. CT abdomen shows a 5cm homogeneous cystic swelling anterior to and partially obliterating the anterior border of the pancreas, with omentum anterior to the cyst. Which one of the following would best explain these radiological findings?
- AGastrointestinal stromal tumour
- BHydatid cyst
- CPeripancreatic pseudocyst
- DSplenic cyst
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C. Peripancreatic pseudocyst The homogeneous cystic lesion adjacent to the pancreas, in the context of a prior episode of acute pancreatitis-type pain two months earlier, is most consistent with a peripancreatic pseudocyst. Hydatid cysts are usually intrahepatic and septate/multilocular, and GIST or obstructed viscus contents tend to be heterogeneous.
2. In the setting of prosthetic valve staphylococcal endocarditis with a new first degree AV block, why is digitalis toxicity considered a less likely explanation than septal abscess in this particular patient?
- ADigitalis toxicity only causes third degree block, not first degree
- BDigitalis toxicity would cause tachycardia rather than heart block
- CThere is no indication in the history that the patient is on digoxin
- DDigitalis toxicity does not affect AV conduction
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C. There is no indication in the history that the patient is on digoxin The text states digitalis toxicity is associated with all degrees of heart block but notes there is no indication the patient is on digoxin, making it a less likely cause than an abscess in this endocarditis scenario.
3. A young adult presents with asymptomatic hypertension found incidentally on a routine check. Which one of the following features would most strongly support a diagnosis of essential hypertension over an underlying chronic glomerulonephritis?
- AHistory of childhood febrile illness with nephritis
- BImpaired renal function on blood tests
- CPresence of proteinuria and haematuria
- DA strong family history of hypertension with no history of childhood renal disorder
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D. A strong family history of hypertension with no history of childhood renal disorder The text notes that essential hypertension in an asymptomatic young adult is usually accompanied by a strong family history of hypertension and no history of childhood disorder, distinguishing it from chronic glomerulonephritis which often has a preceding history of childhood nephritis with haematuria/proteinuria.
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