Self-assessment questionnaire: SAQs and answers are ONLINE for RCP fellows and collegiate members
The SAQs printed in the CME section can only be answered online to achieve external CPD credits.
Any comments should be sent in via email only: clinicalmedicine{at}rcplondon.ac.uk
Format
SAQs follow a best of five format in line with the MRCP(UK) Part 1 exam. Candidates are asked to choose the best answer from five possible answers.
The answering process
Go to www.rcplondon.ac.uk/SAQ
Log on using your usual RCP username and password
Select the relevant CME question paper
Answer all 10 questions by selecting the best answer from the options provided
Once you have answered all the questions, click on Submit
Registering your external CPD credits
Carrying out this activity allows you to claim two external CPD credits. These will be automatically transferred to your CPD diary, where you can review the activity and claim your points.
A 28-year-old woman with anorexia nervosa was admitted for enteral feeding. She had no other medical history. She was taking fluoxetine 20 mg once daily. On assessment, she was found to be severely malnourished with a body mass index of 13 kg/m2 (18–25). Continuous nasogastric feeding was initiated with her consent. Her baseline electrolytes were normal.
Three days after admission she was found on the floor of her room and was observed by the nursing staff to have a tonic–clonic seizure.
What is the most likely cause for this event?
hypercalcaemia
hyperkalaemia
hypernatraemia
hypoglycaemia
hypophosphataemia
A 64-year-old man was admitted to hospital complaining of diarrhoea and a rash. He had been receiving home total parenteral nutrition for six months following a small bowel resection for bowel ischaemia.
On examination, he was afebrile, with a pulse of 72 beats per minute and blood pressure of 178/87 mmHg. His abdomen was soft. He had a widespread crusting erythematous rash on his trunk and limbs.
Investigations:
View this table:What is the most likely diagnosis?
amyloidosis
coeliac disease
pellagra
tuberculo sis
zinc deficiency
A 56-year-old man was referred to the outpatient department with a six-month history of worsening dysphagia. An endoscopy had revealed a pharyngeal tumour and radiotherapy followed by surgery was planned.
What is the most appropriate way to provide nutrition during treatment?
nasogastric feed
surgical jejunostomy
oral supplement drinks
percutaneous endoscopic gastrostomy
total parenteral nutrition
A 72-year-old man was referred to the outpatient department having been found to be anaemic. He had a history of hypertension and his medications included furosemide and ramipril.
Investigations:
View this table:What is the most appropriate next test?
MR enteroclysis
colonoscopy
CT scan of abdomen
faecal calprotectin
tissue transglutaminase antibody
An 82-year-old man presented to hospital after a fall. He had a history of diabetes mellitus, diagnosed six months previously, which was treated with metformin. He was found to have sustained a fractured neck of femur which was corrected surgically. During his post operative recovery, he developed a urine infection, treated with gentamicin. His pain was controlled with co-codamol 30/500, taken regularly. He developed episodes of explosive diarrhoea, which lasted more than one week.
What is the most likely cause for his diarrhoea?
clostridium difficile
codeine
colonic cancer
metformin
norovirus
A 78-year-old woman was admitted to hospital with pneumonia. She had a history of ischaemic heart disease and hypertension. Six days into her admission, she developed diarrhoea. Stool cultures confirmed the presence of Clostridium difficile infection and she was commenced on vancomycin 125mg, four times daily. After three days she became unwell with abdominal pain. On examination she had a distended abdomen with reduced bowel sounds.
Investigations:
View this table:Which is the most appropriate action?
colectomy
endoscopic colonic decompression
increase vancomycin to 250 mg TDS
intravenous immunoglobulin
nasogastric tube
A 55-year-old man was referred with episodic watery diarrhoea. He also complained of flushing, particularly after food and alcohol consumption. Examination revealed hepatomegaly and a soft pansystolic murmur in the tricuspid area.
What is the most likely diagnosis?
carcinoid syndrome
glucagonoma
hyperthyroidism
phaeochromocytoma
VIPoma
A 52-year-old man presented with a two-month history of diarrhea. He also complained of abdominal pain and bloating, which was worse after eating but relieved by defecation. His weight was stable. He had no significant past medical history and was taking no regular medication. Examination was normal.
Investigations:
View this table:What is the most appropriate next step?
colonoscopy
faecal occult blood
thyroid function tests
CT scan of abdomen
upper GI endoscopy
A 55-year-old man presented with haematemesis. His alcohol consumption was estimated to be 80 units per week. On examination he was agitated, confused and clammy. Blood pressure was 100/60 with a pulse rate of 105 per minute. There were stigmata of chronic liver disease. He was started on oxygen, antibiotics and resuscitated with fluid and blood. An upper GI endoscopy was arranged.
Investigations:
View this table:What is the next step?
omeprazole
propranolol
terlipressin
tranexamic acid
vitamin k
A 77-year-old man presented to the emergency department with a six-hour history of severe abdominal pain and bloody diarrhoea. He had a history of a myocardial infarction five years previously, and hypertension for which he was taking amlodipine and lisinopril. He smoked 10 cigarettes a day and drank 20 units of alcohol a week. On examination, his temperature was 36.9 8C. His pulse was 110 beats per minute and irregularly irregular, and his blood pressure was 160/88 mmHg. His abdomen was generally tender but with no features of peritonism. Bowel sounds were present, and per rectal examination was normal.
Investigations:
View this table:What is the most likely diagnosis?
carcinoma of the rectum
diverticulitis
ischaemic colitis
pseudomembranous colitis
ulcerative colitis
CME Renal medicine SAQs
Answers to the CME SAQs published in Clinical Medicine October 2012
- © 2012 Royal College of Physicians
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