Passmedicine questions


Biliary Colic

A 45 year old F 

Intermitted RUQ pain after eating a large meal 

Inflammatory markers, pulse and temp are all norma 

1 of 19


A patient with HD is noted to have slurred speech which is difficult to comprehend 

He retains the ability to understand what is being said to him 

(Refers to motor speech disorder not an aphasia) 

2 of 19

Mitral regurgitation

Most common to cause a third heart sound 

3 of 19

Primary Biliary cirrhosis

A 45 year old woman presents with fatigue and pruritus (severe itching) 

Blood tests:
Raise bilirubin
Raised ALP
Raised IgM 

4 of 19

Rheumatoid arthritis


More common in women 

Seen in adults of all ages 

MCP and PIP joints involved 

Morning stiffness, improves with use 

Bilateral symptoms 

Systemic upset 

X-ray = loss of joint space, juxta-articular osteoporosis, periarticular erosion, subluxation 

5 of 19


Similar incidedence in men and women 

Seen most commonly in elderly 

Large weight bearing joints as well as carpometacarpal, DIP and PIP 

Pain following use, improves with rest 

Unilateral symptoms 

No systemic upset 

X-ray = loss of joint space, subchonrdral sclerosis, subchondral cysts, osteophytes forming at joint margin

6 of 19


Ischaemic changes in leads V4-6, I and aVL 

7 of 19


Ischaemic changes in leads V1-V4 

8 of 19

Ascending cholangitis

A 55 year old Male 

PC: RUQ pain, fever and jaundice 

Blood pressure = 98/60 

Appears confused 

9 of 19

Ant. Inf. cerebral artery

Sudden onset vertigo and vomitting 

Ipsilateral facial paralysis and deafness 

10 of 19


Hx of heartburn 

Presents with odynophagia (pain when swallowing) 

No weight loss, vomitting or anorexia 

11 of 19

Pancreatic cancer

Painless Jaundice 


12 of 19

Acute pancreatitis

Severe central abdominal pain 

Hx of alcohol and gall stones 

13 of 19

Mitral stenosis

A 50 year old Female

Hx of rheumatic fever 

PC: dyspnoea 

Exam = AF, Loud S1, split S2 and a diastolic murmur 

14 of 19

Mitral stenosis

Low volume Pulse 

15 of 19


A patient develops acute heart failure 5 days post MI 

A new pan-systolic murmur is noted 

16 of 19


A 65 year old Female 

PC: Jaundice, weight loss, clay-coloured stools, recurrent bouts of colicky RUQ pain 

Palpable mass in the RUQ 

17 of 19

Renal colic

35 year old man 

Severe, episodic loin pain that radiates to the front 

Blood +++
Leukocytes ++ 
(on urine dipstick) 

18 of 19

Mitral regurgitation

Soft S1 sound 

19 of 19


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