PROMETRIC EXAM
GENERAL
Page 1 of 209
,Page 2 of 209
, 1. A 24 year old man has poor urine flow and takes a very long time to empty his
bladder. He has no other urinary symptoms. He has been well previously
apart from one episode of non-gonococcal urethritis 1 year ago.
Which is the most likely diagnosis?
A. Overactive bladder
B. Neurogenic bladder
C. Phimosis
D. Prostatic hypertrophy
E. Urethral stricture
Correct Answer(s): E
Justification for correct answer(s): Based on the symptoms described, the most likely
diagnosis for the 24 year old man is urethral stricture. Urethral stricture is a condition
that occurs when the urethra narrows, which can cause difficulty in passing urine and
a slow urinary stream. This can lead to a feeling of incomplete emptying of the
bladder and a need to strain to empty the bladder completely. Urethral stricture
follows previous urethral inflammation due to infection. Other possible causes of
these symptoms include prostatic hypertrophy, but this condition is more common in
older men, usually over the age of 50. Overactive bladder and neurogenic bladder
can also cause urinary symptoms, but they typically present with other symptoms
such as urgency, frequency, and incontinence. Phimosis refers to the condition
where the foreskin cannot be retracted from the tip of the penis and is unlikely to
cause the urinary symptoms described.
Page 3 of 209
, 2. A 67 year old man is found to have an ejection systolic murmur. He is
otherwise well. His pulse rate is 72 bpm and BP 128/84 mmHg. His chest is
clear.
Investigations:
ECG shows sinus rhythm.
Echocardiography shows aortic stenosis, valve gradient 50 mmHg. Left
ventricular (LV) diastolic dysfunction, LV ejection fraction 45% (>55).
Which is the most appropriate management?
A. Clinical review and echocardiography in 6 months
B. Reassure and discharge
C. Refer for aortic valve replacement
D. Start bisoprolol fumarate and advise review if symptomatic
E. Start lisinopril and advise review if symptomatic
Correct Answer(s): C
Justification for correct answer(s): The aortic valve gradient of 50mmHg is
considered the level where aortic valve replacement should be considered. In
addition, the mild reduction in LV function would also support prompt consideration
of an AVR. Medications should not be started as these have no effect on the valve
disease progression and may even cause side effects. The patient needs to start the
process of definitive treatment with valve replacement, so it is not good practice or
safe to either discharge or review in 6 months.
Page 4 of 209
GENERAL
Page 1 of 209
,Page 2 of 209
, 1. A 24 year old man has poor urine flow and takes a very long time to empty his
bladder. He has no other urinary symptoms. He has been well previously
apart from one episode of non-gonococcal urethritis 1 year ago.
Which is the most likely diagnosis?
A. Overactive bladder
B. Neurogenic bladder
C. Phimosis
D. Prostatic hypertrophy
E. Urethral stricture
Correct Answer(s): E
Justification for correct answer(s): Based on the symptoms described, the most likely
diagnosis for the 24 year old man is urethral stricture. Urethral stricture is a condition
that occurs when the urethra narrows, which can cause difficulty in passing urine and
a slow urinary stream. This can lead to a feeling of incomplete emptying of the
bladder and a need to strain to empty the bladder completely. Urethral stricture
follows previous urethral inflammation due to infection. Other possible causes of
these symptoms include prostatic hypertrophy, but this condition is more common in
older men, usually over the age of 50. Overactive bladder and neurogenic bladder
can also cause urinary symptoms, but they typically present with other symptoms
such as urgency, frequency, and incontinence. Phimosis refers to the condition
where the foreskin cannot be retracted from the tip of the penis and is unlikely to
cause the urinary symptoms described.
Page 3 of 209
, 2. A 67 year old man is found to have an ejection systolic murmur. He is
otherwise well. His pulse rate is 72 bpm and BP 128/84 mmHg. His chest is
clear.
Investigations:
ECG shows sinus rhythm.
Echocardiography shows aortic stenosis, valve gradient 50 mmHg. Left
ventricular (LV) diastolic dysfunction, LV ejection fraction 45% (>55).
Which is the most appropriate management?
A. Clinical review and echocardiography in 6 months
B. Reassure and discharge
C. Refer for aortic valve replacement
D. Start bisoprolol fumarate and advise review if symptomatic
E. Start lisinopril and advise review if symptomatic
Correct Answer(s): C
Justification for correct answer(s): The aortic valve gradient of 50mmHg is
considered the level where aortic valve replacement should be considered. In
addition, the mild reduction in LV function would also support prompt consideration
of an AVR. Medications should not be started as these have no effect on the valve
disease progression and may even cause side effects. The patient needs to start the
process of definitive treatment with valve replacement, so it is not good practice or
safe to either discharge or review in 6 months.
Page 4 of 209
