Flip SBA practice questions November 2023

1. Tiredness - 139
A 33-year-old obese woman complains of tiredness. She has recently given birth to
a healthy baby boy and is enjoying being a mother. However, she is becoming more
reliant on her partner for support as she always feels exhausted and often becomes
depressed. The patient has a poor appetite and often does not finish her meals,
despite this she has gained 5 kg in the last 2 weeks. The most likely diagnosis is:
A. Postpartum depression
B. Eating disorder
C. Hyperthyroidism
D. Hypothyroidism
E. Occult malignancy
2. Heart failure - 18
A 78-year-old woman is admitted with heart failure. The underlying cause is
determined to be aortic stenosis. Which sign is most likely to be present?
A. Pleural effusion on chest x-ray
B. Raised jugular venous pressure (JVP)
C. Bilateral pedal oedema
D. Bibasal crepitations
E. Atrial fibrillation
3. Breathlessness - 46
You see a 68-year-old man in clinic, with a 40 (cigarette) pack year history, who
has been experiencing breathlessness on exertion and a productive cough of white
sputum over the last four months. You assess his spirometry results which reveal an
FEV1/FVC of 51 per cent with minimal reversibility after a 2-week trial of oral
steroids. Cardiological investigations are normal. Which of the following is the
most likely diagnosis?
A. Asthma
B. Chronic obstructive pulmonary disease (COPD)
C. Left ventricular failure
D. Chronic bronchitis
E. Lung fibrosis
4. Valve lesion signs- 18
A patient is admitted with pneumonia. A murmur is heard on examination. What
finding points to mitral regurgitation?
A. Murmur louder on inspiration
B. Murmur louder with patient in left lateral position
C. Murmur louder over the right 2nd intercostal space midclavicular line
D. Corrigan’s sign
E. Narrow pulse pressure
5. GI-166
A previously healthy 23yo presented a week hx of bloody diarrhea and abdominal
pain with cramps and fever. Exam: tenderness in lower abdomen. What is the most
appropriate dx?
a. Celiac disease
 b. Colorectal polyps
c. UC
d. Laxative abuse
e. Gastroenteritis

6. Visual disturbance -141

A 42-year-old woman presents with visual disturbances. She reports having double
vision which was intermittent initially but has now become much more frequent.
In addition, she becomes breathless very easily and experiences palpitations. On
examination, raised, painless lesions are observed on the front of her shins and
finger clubbing. The most likely diagnosis is:
A. De Quervain’s thyroiditis
B. Thyroid storm
C. Phaeochromocytoma
D. Graves’ disease
E. Plummer’s disease

7. Goitre - 141
A 16-year-old girl presents to her GP complaining of a swelling in her neck which
she has noticed in the last 2 weeks. She has felt more irritable although this is often
transient. On examination, a diffuse swelling is palpated with no bruit on
auscultation. The most likely diagnosis is:
A. Hyperthyroidism
B. Simple goitre
C. Riedel’s thyroiditis
D. Thyroid carcinoma
E. Thyroid cyst
8. Chest pain - 19
A 55-year-old man has just arrived in accident and emergency complaining of 20
minutes of central crushing chest pain. Which feature is most indicative of
myocardial infarction at this moment in time?
A. Inverted T waves
B. ST depression
C. ST elevation
D. Q waves
E. Raised troponin
9. GI - 160

A 30yo lady complains of intermittent diarrhea, chronic abdominal and pelvic pain
and tenesmus. Sometimes she notices blood in her stool. Select the most likely
cause leading to her symptoms?
a) Inflammatory bowel disease
b) Diverticulosis
c) Irritable bowel disease
d) Adenomyosis
 e) UTI

10. Interpretation of arterial blood gases (1) – 47

You are asked to interpret an arterial blood gas of a 76-year-old patient who was
admitted to accident and emergency with an acute onset of breathlessness and low
oxygen saturations. The test was taken on room air and read as follows: pH 7.37,
PO2 7.8, PCO2 4.1, HCO3 24, SO2 89 per cent. Choose the most likely clinical
interpretation from these arterial blood gas results:-
A. Compensated respiratory acidosis
B. Type 1 respiratory failure
C. Compensated respiratory alkalosis
D. Type 2 respiratory failure
E. None of the above
11. Dizziness - 142
A 22-year-old woman complains of dizziness and feeling light-headed. She works
in an office and most frequently experiences this when standing up to visit the
toilet. She has never fainted. The patient has lost 5 kg, but attributes this to eating
more healthily. She has noticed a recent scar on the back of her hand which has
started to turn very dark. The most appropriate investigation is:
A. Synacthen test
B. Low-dose dexamethasone test
C. Cortisol measurement
D. Urinary free cortisol measurement
E. Abdominal ultrasound (US) scan
12. GI- 159
A 55yo woman complains of retrosternal chest pain and dysphagia which is
intermittent and unpredictable. The food suddenly sticks in the middle of the chest,
but she can clear it with a drink of water and then finish the meal without any further
problem. A barium meal shows a ‘corkscrew esophagus’. What is the single most
likely dysphagia?
a) Esophageal candidiasis
b) Esophageal carcinoma
c) Esophageal spasm
d) Pharyngeal pouch
e) Plummer-vinson syndrome
13. Shortness of breath – 20

A 66-year-old woman presents to accident and emergency with a 2-day history of

shortness of breath. The patient notes becoming progressively short of breath as
well as a sharp pain in the right side of the chest which is most painful when taking
a deep breath. The patient also complains of mild pain in the right leg, though there
is nothing significant on full cardiovascular and respiratory examination. Heart
rate is 96 and respiratory rate is 12. The patient denies any weight loss or long haul
flights but mentions undergoing a nasal polypectomy 3 weeks ago. The most likely
diagnosis is:
A. Muscular strain
B. Heart failure
C. Pneumothorax
D. Angina
E. Pulmonary embolism
14. Shortness of breath - 47
A 54-year-old woman is seen in clinic with a history of weight loss, loss of appetite
and shortness of breath. Her respiratory rate is 19 and oxygen saturations (on
room air) range between 93 and 95 per cent. On examination, there is reduced air
entry and dullness to percussion on the lower to midzones of the right lung. There
is also reduced chest expansion on the right. From the list below, select the most
likely diagnosis:
A. Right middle lobe pneumonia
B. Pulmonary embolism
C. Right-sided pleural effusion
D. Right-sided bronchial carcinoma
E. Right lower lobe pneumonia

15. Chest pain – 21

A 60-year-old man presents to accident and emergency with a 3-day history of

increasingly severe chest pain. The patient describes the pain as a sharp, tearing
pain starting in the centre of his chest and radiating straight through to his back
between his shoulder blades. The patient looks in pain but there is no pallor, heart
rate is 95, respiratory rate is 20, temperature 37°C and blood pressure is
155/95 mmHg. The most likely diagnosis is:
A. Myocardial infarction
B. Myocardial ischaemia
C. Aortic dissection
D. Pulmonary embolism
E. Pneumonia
16. Polyuria 142
A 29-year-old man presents with a 4-week history of polyuria and extreme thirst.
The patient denies difficulty voiding, hesitancy or haematuria, although the urine
is very dilute. The patient does not believe he has lost any weight and maintains a
good diet. No findings are found on urine dipstick. The most appropriate
investigation is:
A. Serum osmolality
B. Fasting plasma glucose
C. Urinary electrolytes
D. Magnetic resonance imaging (MRI) scan of the head
E. Water deprivation test
17. GI - 157
A young woman complains of diarrhoea, abdominal cramps and mouth ulcers. AXR
shows a distended transverse colon with globet cell depletion on rectal biopsy. What
is the most probable dx?
a. CD
 b. UC
c. Bowel Ca
d. Bowel obstruction
e. IBS

18. Finger clubbing- 49

A 30-year-old man presents to your clinic with a cough and finger clubbing. From
the list below, which of these answers is not a respiratory cause of finger clubbing?
A. Empyema
B. Mesothelioma
C. Bronchogenic carcinoma
D. Cystic fibrosis
E. COPD

19. Myocardial infarction - 17

A 65-year-old man presents with central crushing chest pain for the first time. He
is transferred immediately to the closest cardiac unit to undergo a primary
percutaneous coronary intervention. There is thrombosis of the left circumflex
artery only. Angioplasty is carried out and a drug-eluding stent is inserted. What
are the most likely changes to have occurred on ECG during admission?
A. ST depression in leads V1–4
B. ST elevation in leads V1–6
C. ST depression in leads II, III and AVF
D. ST elevation in leads V5–6
E. ST elevation in leads II, III and AVF

20. Swallowing - 154

A 60yo man presents with dysphagia and pain on swallowing both solids and liquids.
A barium meal shows gross dilatation of the esophagus with a smooth narrowing at
the lower end of the esophagus. What is the SINGLE most likely cause of
dysphagia?
a) Achalasia
b) Myasthenia gravis
c) Esophageal carcinoma
d) Esophageal web
e) Systemic sclerosis