Kuwait Medical Licensing Examination (KMLE / KIMS) · Clinical Medicine And Surgery

Clinical cases

99 practice questions, each with the answer and an explanation.

Practise Clinical cases now

Random questions from this topic, one at a time. You see the answer and the explanation straight after each one.

All 99 questions

  1. A 60-year-old smoker has crushing central chest pain for 40 minutes, sweating, and ST elevation in leads II, III and aVF. What is the most likely diagnosis?
  2. Which is the most appropriate initial treatment for Inferior ST-elevation myocardial infarction?
  3. Which investigation best confirms Pulmonary embolism?
  4. Which complication or association is classically linked with Pulmonary embolism?
  5. After a road accident a man is gasping, has absent breath sounds on the right, a deviated trachea and low blood pressure. What is the most likely diagnosis?
  6. Which is the most appropriate initial treatment for Tension pneumothorax?
  7. Which investigation best confirms Diabetic ketoacidosis?
  8. Which complication or association is classically linked with Diabetic ketoacidosis?
  9. A 20-year-old has central abdominal pain that moves to the right iliac fossa, with anorexia, low-grade fever and rebound tenderness. What is the most likely diagnosis?
  10. Which complication or association is classically linked with Acute appendicitis?
  11. Which investigation best confirms Acute cholecystitis?
  12. Which complication or association is classically linked with Acute cholecystitis?
  13. A man with heavy alcohol use has severe epigastric pain radiating to the back, vomiting and a serum lipase five times the upper limit. What is the most likely diagnosis?
  14. Which is the most appropriate initial treatment for Acute pancreatitis?
  15. Which is the most appropriate initial treatment for Small bowel obstruction?
  16. A man taking regular NSAIDs vomits coffee-ground material and passes black tarry stools. What is the most likely diagnosis?
  17. Which is the most appropriate initial treatment for Bleeding duodenal ulcer?
  18. Which investigation best confirms Acute ischaemic stroke?
  19. Which complication or association is classically linked with Acute ischaemic stroke?
  20. A 40-year-old describes a sudden thunderclap headache, the worst of her life, with neck stiffness. What is the most likely diagnosis?
  21. Which complication or association is classically linked with Subarachnoid haemorrhage?
  22. Which investigation best confirms Bacterial meningitis?
  23. Which complication or association is classically linked with Bacterial meningitis?
  24. A 45-year-old woman has weight gain, cold intolerance, constipation and dry skin, with a high TSH and a low free T4. What is the most likely diagnosis?
  25. Which is the most appropriate initial treatment for Hypothyroidism?
  26. Which investigation best confirms Graves disease?
  27. Which complication or association is classically linked with Graves disease?
  28. A woman has fatigue, weight loss, skin pigmentation, postural hypotension, low sodium and high potassium. What is the most likely diagnosis?
  29. Which is the most appropriate initial treatment for Addison disease?
  30. Which investigation best confirms Cushing syndrome?
  31. Which complication or association is classically linked with Cushing syndrome?
  32. A 55-year-old has kidney stones, bone pain and constipation, with a high calcium and a raised parathyroid hormone. What is the most likely diagnosis?
  33. Which is the most appropriate initial treatment for Primary hyperparathyroidism?
  34. Which investigation best confirms Iron deficiency anaemia?
  35. Which complication or association is classically linked with Iron deficiency anaemia?
  36. A 60-year-old woman has fatigue, tingling in the feet and a sore tongue, with macrocytic anaemia and anti-intrinsic factor antibodies. What is the most likely diagnosis?
  37. Which is the most appropriate initial treatment for Pernicious anaemia?
  38. Which investigation best confirms Sickle cell painful crisis?
  39. Which complication or association is classically linked with Sickle cell painful crisis?
  40. A 50-year-old has fatigue, splenomegaly and a very high white cell count with the Philadelphia chromosome. What is the most likely diagnosis?
  41. Which is the most appropriate initial treatment for Chronic myeloid leukaemia?
  42. Which investigation best confirms Rheumatoid arthritis?
  43. Which complication or association is classically linked with Rheumatoid arthritis?
  44. A man has a sudden red, swollen and very painful first metatarsophalangeal joint after a heavy meal and alcohol. What is the most likely diagnosis?
  45. Which is the most appropriate initial treatment for Acute gout?
  46. Which investigation best confirms Systemic lupus erythematosus?
  47. Which complication or association is classically linked with Systemic lupus erythematosus?
  48. A 55-year-old has fever, productive cough, pleuritic pain and right lower zone consolidation. What is the most likely diagnosis?
  49. Which is the most appropriate initial treatment for Community-acquired pneumonia?
  50. Which investigation best confirms Pulmonary tuberculosis?
  51. Which complication or association is classically linked with Pulmonary tuberculosis?
  52. A young man has wheeze, cannot complete sentences and has a peak flow at 40 percent of his best. What is the most likely diagnosis?
  53. Which is the most appropriate initial treatment for Acute severe asthma?
  54. Which investigation best confirms Chronic obstructive pulmonary disease?
  55. Which complication or association is classically linked with Chronic obstructive pulmonary disease?
  56. A man with a previous infarct has ankle swelling, orthopnoea, paroxysmal nocturnal dyspnoea and a displaced apex beat. What is the most likely diagnosis?
  57. Which is the most appropriate initial treatment for Heart failure with reduced ejection fraction?
  58. Which investigation best confirms Atrial fibrillation?
  59. Which complication or association is classically linked with Atrial fibrillation?
  60. An intravenous drug user has fever, a new murmur, splinter haemorrhages and Roth spots. What is the most likely diagnosis?
  61. Which is the most appropriate initial treatment for Infective endocarditis?
  62. Which investigation best confirms Helicobacter pylori duodenal ulcer?
  63. Which complication or association is classically linked with Helicobacter pylori duodenal ulcer?
  64. A 25-year-old has bloody diarrhoea with urgency, and the inflammation is continuous from the rectum. What is the most likely diagnosis?
  65. Which complication or association is classically linked with Ulcerative colitis?
  66. Which investigation best confirms Crohn disease?
  67. Which complication or association is classically linked with Crohn disease?
  68. A 28-year-old woman has fever, loin pain and dysuria with pyuria. What is the most likely diagnosis?
  69. Which is the most appropriate initial treatment for Acute pyelonephritis?
  70. Which investigation best confirms Hyperkalaemia with ECG changes?
  71. Minutes after a wasp sting a man has wheeze, facial swelling and low blood pressure. What is the most likely diagnosis?
  72. Which is the most appropriate initial treatment for Anaphylaxis?
  73. Which investigation best confirms Paracetamol overdose?
  74. Which complication or association is classically linked with Paracetamol overdose?
  75. A man is found with pinpoint pupils, slow shallow breathing and reduced consciousness. What is the most likely diagnosis?
  76. Which complication or association is classically linked with Opioid overdose?
  77. Which investigation best confirms Organophosphate poisoning?
  78. Which complication or association is classically linked with Organophosphate poisoning?
  79. A man with atrial fibrillation has a sudden painful, pale, cold and pulseless leg. What is the most likely diagnosis?
  80. Which is the most appropriate initial treatment for Acute limb ischaemia?
  81. Which investigation best confirms Ruptured abdominal aortic aneurysm?
  82. A 14-year-old has sudden severe scrotal pain with a high-riding testis and an absent cremasteric reflex. What is the most likely diagnosis?
  83. Which is the most appropriate initial treatment for Testicular torsion?
  84. Which investigation best confirms Ureteric colic?
  85. A 55-year-old woman has a hard painless breast lump with skin dimpling. What is the most likely diagnosis?
  86. Which is the most appropriate initial treatment for Breast carcinoma?
  87. Which investigation best confirms Colorectal carcinoma?
  88. Which complication or association is classically linked with Colorectal carcinoma?
  89. A man with type 1 diabetes is sweaty, tremulous and confused with a capillary glucose of 2.0 mmol/L. What is the most likely diagnosis?
  90. Which is the most appropriate initial treatment for Hypoglycaemia in type 1 diabetes?
  91. Which investigation best confirms Acute cholangitis?
  92. Which complication or association is classically linked with Acute cholangitis?
  93. A 70-year-old has a new headache, jaw claudication, scalp tenderness and an ESR of 90 mm/hour. What is the most likely diagnosis?
  94. Which is the most appropriate initial treatment for Giant cell arteritis?
  95. Which investigation best confirms Myasthenia gravis?
  96. Which complication or association is classically linked with Myasthenia gravis?
  97. A man has ascending symmetrical leg weakness with absent reflexes two weeks after a diarrhoeal illness. What is the most likely diagnosis?
  98. Which is the most appropriate initial treatment for Guillain-Barre syndrome?
  99. Which is the most appropriate initial treatment for Parkinson disease?

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