Speculum - University of Melbourne

SPECULUM 63
been a small bowel action soon after the
onset. As far as we could ascertain she had
always enjoyed good health apart from
vague discomfort in the upper abdomen
and flatulence. There was a little distension,
no tenderness and occasional noisy bowel
sounds. A straight X-ray showed the presence
of a large stone in the gall bladder
area. What had we here?
13. A bright young man came into
Casualty with a clean cut on the dorsum of
his left hand about 2 cm. long. His jacket
was bloodstained. He spoke with an accent
which was unmistakably Scottish and he
was loud in the praises of the Demons. His
wound was sutured and he was given an
injection of tetanus toxoid. As he left, the
pretty nurse on duty said: "Goodnight
Officer". How did she know he was a
policeman?
MEDICINE
Dr. Doyle
1. A man aged 40 had a pleural effusion
10 years ago. He now complains of moderate
dyspnoea on exertion but has no
dyspnoea at rest. His jugular venous pressure
is 10 cms. above the sternal angle, his
heart is normal in size and he has an enlarged
liver and ascites. Diagnosis?
2. A woman aged 33 complains of being
awakened at night by palpitation; she has
noticed that on these occasions her pulse
rate is slow. At the same time she trembles
and sweats profusely and feels that her neck
is swelling. Her B.P. is 155/100 and she
has glycosuria. Diagnosis?
3. A man of 43 has chronic osteomyelitis
of his right leg. He now complains of
oedema of both legs, but no dyspnoea.
Clinically he has gross oedema of both legs,
a palpable spleen and his urine contains 8
G. of protein per litre. Diagnosis?
4. A woman aged 28 has been treated for
5 months for pulmonary tuberculosis. She
now complains of numbness and tingling of
both hands and feet. On examination she
has absent knee and ankle jerks and tender
calves. What is the diagnosis and what is
it due to?
5. A girl aged 13 complains of dyspnoea
on exertion. On examination she has an
enlarged right ventricle, a systolic murmur
in the 2 left space and cyanosis and clubbing
of the toes of both feet, but has none in the
fingers. Diagnosis?
6. A woman aged 36 states that for 17
years she has had recurrent episodes of
frequency of micturition and that she frequently
has haematuria. On examination
she is pale and hyperpnoeic, and both kidneys
are enlarged and readily palpable. Her
B.P. is 250/150. Diagnosis?
7. What changes would you expect to
find in the patient's plasma in (6) in
i. Urea.
ii. Na+
iii. K+
iv. HCO 3-
v. C1.-
8. A single girl aged 31 consulted doctor
complaining of difficulty in swallowing,
trembles and feelings of anxiety since she
was jilted seven years ago. Her doctor prescribed
some white tablets, which she took.
Three days later her skin began to itch, and
on the following day she became jaundiced.
What were the tablets?
9. A male medical student who claimed
to be a teetotaller became nauseated and
lost his appetite a week ago. Three days
later he became jaundiced and noticed that
his stools were pale and his urine dark. On
examination his liver is easily palpable and
his spleen can just be felt. What is the
likely diagnosis?
10. A man aged 53 complains of diplopia
for 3 days. He admits to a cough for 3
months and has lost a little weight. On
examination he has clubbing of the fingers,
a dull percussion note at the apex of the
left lung, a left Homer's syndrome and a
right external rectus palsy. Diagnosis?
11. A widower aged 66, who lives alone,
presents with red spots on the arms and
legs, and says that he has been bleeding
from the mouth for one month. On examination
his gums are swollen and bleed
readily. Diagnosis?
12. A market gardener aged 37 is admitted
with peripheral neuritis. He says that
for three weeks he has had intermittent
diarrhoea and vomiting. On examination
he appears to have lost weight, has hyperkeratosis
of the palms and soles and has
peripheral neuritis. Diagnosis?