1.やさしい
Which colour change is typical of Raynaud's phenomenon?
- AFingers stay red and hot for several days
- BFingers turn white, then blue, then red
- CFingers turn yellow, then green, then brown
- DThe whole arm turns pale and then black
2.やさしい
What is a "barrel chest"?
- AA curved spine that bends to one side and twists the ribs
- BA sunken breastbone that has been present since birth
- CA chest that moves inward on breathing in
- DA wider front-to-back chest diameter from air trapping
3.やさしい
Together with fever, which finding should raise suspicion of infective endocarditis?
- AA slow heart rate
- BA new heart murmur
- CA dry, tickly cough
- DPain in one calf
4.ふつう
Why are patients with mitral stenosis at high risk of atrial fibrillation?
- AThe coronary arteries become blocked by the valve
- BThe left atrium enlarges as it pushes blood through the narrow valve
- CThe right ventricle shrinks and stops contracting properly over time
- DThe narrow valve presses on the sinus node and slows it down directly
5.ふつう
How does digoxin help a patient with atrial fibrillation and heart failure?
- AIt speeds conduction through the AV node to the ventricles
- BIt dissolves clots that have formed in the left atrium
- CIt slows AV node conduction and increases contractility
- DIt lowers potassium to stabilise the heart
6.ふつう
Which investigation is usually used to confirm a deep vein thrombosis in the leg?
- AAn exercise ECG
- BA lung function test
- CCompression duplex ultrasound
- DA plain chest X-ray and an ECG
7.むずかしい
A patient has new chest pain at rest. The ECG shows ST depression, but serial troponins remain normal. Which diagnosis fits best?
- AStable angina
- BST-elevation myocardial infarction
- CNon-ST-elevation myocardial infarction
- DUnstable angina
8.むずかしい
A patient declines enoxaparin for VTE prevention because it is made from pork, which conflicts with their beliefs. What is the best response?
- ATell the patient that refusal means they cannot have surgery
- BRespect the decision, inform the prescriber and discuss non-animal options
- CDocument the refusal in the notes and take no further action at all
- DGive the injection anyway without explaining what the medicine is made from
解答
- 1. B · Fingers turn white, then blue, then red
- 2. D · A wider front-to-back chest diameter from air trapping
- 3. B · A new heart murmur
- 4. B · The left atrium enlarges as it pushes blood through the narrow valve
- 5. C · It slows AV node conduction and increases contractility
- 6. C · Compression duplex ultrasound
- 7. D · Unstable angina
- 8. B · Respect the decision, inform the prescriber and discuss non-animal options
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