MCQs
Questions and Answers
- 1.
Meckel's diverticulum most commonly presents as:
- A.
Gastrointestinal bleeding.
- B.
Obstruction.
- C.
Diverticulitis.
- D.
Intermittent abdominal pain
Correct Answer
A. Gastrointestinal bleeding.Explanation
Meckel's diverticulum is a small pouch that forms in the wall of the small intestine. It is a congenital abnormality that occurs in about 2% of the population. The most common symptom of Meckel's diverticulum is gastrointestinal bleeding, which can occur due to the presence of gastric tissue in the diverticulum. This gastric tissue produces acid, which can irritate the surrounding tissue and cause bleeding. Other symptoms may include abdominal pain, obstruction, and diverticulitis, but gastrointestinal bleeding is the most frequently observed presentation of Meckel's diverticulum.Rate this question:
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- 2.
Patients with established, complete, simple, distal small bowel obstruction usually have the following findings on plain and upright abdominal radiographs:
- A.
Distended small bowel identifiable by the valvulae conniventes and . multiple air-fluid levels.
- B.
Modest amount of gas in the pelvis.
- C.
Peripheral, rather than central, distribution of gas.
- D.
Prominent haustral markings.
- E.
Free air.
Correct Answer
A. Distended small bowel identifiable by the valvulae conniventes and . multiple air-fluid levels.Explanation
Patients with established, complete, simple, distal small bowel obstruction typically have a distended small bowel that can be identified by the presence of valvulae conniventes (folds of the small intestine) and multiple air-fluid levels. This is because the obstruction prevents the passage of stool and gas, leading to accumulation and distention of the bowel. The presence of a modest amount of gas in the pelvis, peripheral distribution of gas, prominent haustral markings, and absence of free air are also consistent with this condition.Rate this question:
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- 3.
A 42-year-old man with acute renal failure is confused. His serum potassium is 8.1 mEq/L . The most likely abnormal ECG finding is
- A.
T wave inversion
- B.
PR interval of 300ms
- C.
QT interval of 0.4s
- D.
U wave
- E.
Tall tented T waves test
Correct Answer
E. Tall tented T waves testExplanation
In acute renal failure, there is a decrease in kidney function, leading to impaired potassium excretion. This can result in hyperkalemia, which is indicated by a high serum potassium level. One of the ECG findings associated with hyperkalemia is tall tented T waves. These T waves appear peaked and narrow, resembling a tent. Therefore, the most likely abnormal ECG finding in this case would be tall tented T waves.Rate this question:
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- 4.
75 year old woman presents with severe headaches.What is the most likely diagnosis?
- A.
Takayasu arteritis
- B.
Giant cell arteritis
- C.
Aortic dissection
- D.
Polyarteritis nodosa
- E.
Wegener's granulomatosis
Correct Answer
B. Giant cell arteritisExplanation
The most likely diagnosis for a 75-year-old woman presenting with severe headaches is Giant cell arteritis. This condition is characterized by inflammation of the blood vessels, particularly the temporal arteries, leading to headaches, scalp tenderness, and vision problems. It is more common in older individuals, especially women. Other options such as Takayasu arteritis, Aortic dissection, Polyarteritis nodosa, and Wegener's granulomatosis are less likely in this case based on the given information.Rate this question:
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- 5.
25 year old woman has several episodes of gastrointestinal bleeding of unclear source with muscle pains. What is the most likely diagnosis?
- A.
Takayasu arteritis
- B.
Giant cell arteritis
- C.
Aortic dissection
- D.
Polyarteritis nodosa
- E.
Wegener's granulomatosis
Correct Answer
D. Polyarteritis nodosaExplanation
Polyarteritis nodosa is the most likely diagnosis in this case. Polyarteritis nodosa is a systemic vasculitis that primarily affects medium-sized arteries. It commonly presents with symptoms such as gastrointestinal bleeding and muscle pains. Other symptoms may include fever, weight loss, and skin rashes. Takayasu arteritis, giant cell arteritis, aortic dissection, and Wegener's granulomatosis are other types of vasculitis, but they typically do not present with gastrointestinal bleeding as a prominent symptom.Rate this question:
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- 6.
Autopsy findings of a 57 year old woman are as follows: Multiple 2-4 mm vegetations were found on an otherwise normal mitral valve. the vegetations were made of fibrin on histological section, and the underlying valve was essentially normal. What would be the most likely history when you get her clinic chart:
- A.
Long history of intravenous drug abuse with recent history of fevers to 104 degree F
- B.
Pancreatic carcinoma being treated on an experimental protocol for chemotherapy
- C.
History of rheuthmatic fever at age nine with long term mitral stenosis and recent onset of fevers to 103 degree F
- D.
Long history of systemic lupus erythematosis (SLE)
Correct Answer
D. Long history of systemic lupus erythematosis (SLE)Explanation
The autopsy findings of multiple vegetations on an otherwise normal mitral valve, made of fibrin, suggest the presence of Libman-Sacks endocarditis, which is commonly seen in patients with systemic lupus erythematosus (SLE). This autoimmune disease can cause inflammation and damage to various organs, including the heart. The other options, such as intravenous drug abuse, pancreatic carcinoma, and rheumatic fever, are not typically associated with this specific pathology. Therefore, the most likely history for this patient would be a long history of systemic lupus erythematosus (SLE).Rate this question:
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- 7.
Which of the following is not likely to see in mitral valve prolapse
- A.
Stroke
- B.
Arrhythmias
- C.
Infective endocarditis
- D.
Mitral stenosis
- E.
Embolism of leaflet thrombi
Correct Answer
D. Mitral stenosisExplanation
Mitral valve prolapse is a condition where the valve between the left atrium and ventricle of the heart does not close properly. It is characterized by the bulging of the valve leaflets into the left atrium. While mitral stenosis is a narrowing of the mitral valve, it is not commonly associated with mitral valve prolapse. The other options, such as stroke, arrhythmias, infective endocarditis, and embolism of leaflet thrombi, are more likely to be seen in patients with mitral valve prolapse.Rate this question:
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- 8.
Disorders predisposing to cor pulmonale include all of the following except:
- A.
Cystic fibrosis
- B.
Chronic obstructive pulmonary disease
- C.
Left-sided heart failure
- D.
Kyphoscoliosis
- E.
Pulmonary embolism
Correct Answer
C. Left-sided heart failureExplanation
Left-sided heart failure does not predispose to cor pulmonale because cor pulmonale is a condition characterized by right-sided heart failure caused by long-term high blood pressure in the pulmonary arteries and right ventricle of the heart. Left-sided heart failure, on the other hand, is caused by a weakened left ventricle and is not directly related to pulmonary hypertension. Therefore, left-sided heart failure is not a disorder that predisposes to cor pulmonale.Rate this question:
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- 9.
Which of the following is less likely to be a manifestations of ischemic heart disease
- A.
Myocardial infarction
- B.
Chronic ischemic heart disease
- C.
Sudden cardiac death
- D.
Myocarditis
- E.
Angina pectoris
Correct Answer
D. MyocarditisExplanation
Myocarditis is less likely to be a manifestation of ischemic heart disease because it is an inflammation of the heart muscle usually caused by viral infections, autoimmune diseases, or certain medications, rather than a lack of blood flow to the heart. Ischemic heart disease, on the other hand, is characterized by reduced blood supply to the heart muscle, leading to conditions such as myocardial infarction, chronic ischemic heart disease, angina pectoris, and sudden cardiac death.Rate this question:
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- 10.
A 44 year old builder presents with weakness over the past 48 hours. A neurological exam reveals the following (N=normal) Upper Limbs Lower Limbs Right Left Right Left Tone N reduced N N Power (MRC) 4/5 4/5 3/5 4/5 Coordination N N N N Sensation Fine touch Proprioception N N N N N N N N Reflexes Biceps triceps supinator - (absent) - (absent) + - (absent) - (absent) + with reinforcement Knee Ankle Plantar - (absent) - (absent) down - (absent) - (absent) down Which of the following is the most likely diagnosis?
- A.
Polio
- B.
Multiple Sclerosis
- C.
Myasthenia Gravis
- D.
Stroke
- E.
Guillian Barre
Correct Answer
E. Guillian BarreExplanation
The most likely diagnosis for the patient's symptoms and neurological exam findings is Guillain-Barre syndrome. This is supported by the weakness in both the upper and lower limbs, reduced tone in the right upper limb, reduced power in the right lower limb, absent reflexes in multiple muscle groups, and normal coordination and sensation. Guillain-Barre syndrome is a neurological disorder characterized by progressive muscle weakness and paralysis, often starting in the legs and spreading to the upper body.Rate this question:
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- 11.
A 64 year old man presents to hospital with his first epileptic seizure whilst sat reading a newspaper at home. Drug history - Nil A clinical examination reveals the following:
- Temp 37Ëš
- BP 182/102
- O2 Saturation 99% on room air
- GCS 15
- HGT 3.9mmol/l
- No jaudince, pallor, cyanosis, clubbing, lymphadenopathy.
- CVS – NAD
- Chest – NAD
- GI – NAD
- A.
Brain metastasis
- B.
Hypercalcemia
- C.
Syndrome of inappropriate ADH secretion (SIADH)
- D.
Idiopathic epilepsy
Correct Answer
A. Brain metastasisExplanation
The most likely etiology for the patient's seizure is brain metastasis. This is suggested by the ill-defined lesion seen in the left midzone on the chest X-ray. Brain metastasis refers to the spread of cancer cells from another part of the body to the brain. Seizures can be a presenting symptom of brain metastasis, especially in older individuals. The patient's age and lack of significant findings on examination and blood tests make other causes less likely.Rate this question:
- 12.
An obese 63 year old lady presents with jaundice. There is no history of abdominal pain. Examination of her abdomen reveals a palpable gall bladder. There is evidence of extensive pruritis. She tells you she drinks 42 units of alcohol a week. Her blood results are as follows Albumin 32 (35-50) Alk Phos 456 (<110) ALT 88 (<40) Bilirubin 120 (<20) INR 1.6 GGT 400 (0-70) What’s the most likely diagnosis?
- A.
Gallstones
- B.
Paracetamol Overdose
- C.
Pancreatic cancer
- D.
Alcoholic Hepatitis
- E.
Primary billiary cirrhosis
Correct Answer
C. Pancreatic cancer -
- 13.
A 37 year old intravenous drug user is referred by his GP for a suspected Bells Palsy. On examining his inner ear there are a number of vesicles visible on his ear drum. His cranial nerve examination reveals a weakness of the whole of the left side of his face. The most likely diagnosis is:
- A.
Steven Johnson Syndrome
- B.
HIV
- C.
Stroke
- D.
Ramsay Hunt Syndrome
- E.
Bells Palsy
Correct Answer
D. Ramsay Hunt SyndromeExplanation
The most likely diagnosis in this case is Ramsay Hunt Syndrome. Ramsay Hunt Syndrome is a viral infection caused by the varicella-zoster virus, which is the same virus that causes chickenpox and shingles. It is characterized by facial paralysis, often accompanied by a rash and vesicles on the ear drum. Given that the patient is an intravenous drug user, it is possible that the virus was reactivated due to a weakened immune system. This is a more likely diagnosis than Bells Palsy, as the presence of vesicles on the ear drum is a distinguishing feature of Ramsay Hunt Syndrome.Rate this question:
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- 14.
A 45 year old female presents to A&E with mild pleuritic right sided chest pain. A Chest X ray reveals a small (<1cm) ring of air outside the lung at the apex. What is the correct management?
- A.
Chest drain (Seldinger technique)
- B.
Aspiration under ultrasound guidance
- C.
Aspiration without ultrasound
- D.
Observation initially
- E.
Chest drain (trochar technique)
Correct Answer
D. Observation initiallyExplanation
Observation initially is the correct management for a 45-year-old female presenting with mild pleuritic right-sided chest pain and a small ring of air outside the lung at the apex on a chest X-ray. This approach is appropriate because the patient's symptoms are mild and the size of the air leak is small. Observation allows for monitoring of the patient's condition and allows time for spontaneous resolution of the air leak. If the patient's symptoms worsen or the air leak increases in size, further intervention such as chest drain insertion may be necessary.Rate this question:
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- 15.
A 76 year old man presents with atrial fibrillation which is permanent. He is lucid and has specifically made an appointment with you to discuss the best way of stopping him "dying " as a result of the AF. PMHx: Hypertension (treated), Mild COPD. Nil else of note. DHx Verapamil (as treatment for AF) Amlodipine Simvastatin PRN inhalers SHx Lives alone. Independent. Can carry out all ADL's (activities of daily living) What is the anticoagulation schedule you would recommend to prevent stroke?
- A.
Clopidrogel
- B.
Warfarin
- C.
Aspirin
- D.
No anticoagulation
- E.
Warfarin and Aspirin
Correct Answer
B. WarfarinExplanation
The correct answer is Warfarin. Atrial fibrillation (AF) is a risk factor for stroke, and anticoagulation therapy is recommended to prevent stroke in patients with AF. Warfarin is a commonly used anticoagulant that has been shown to be effective in reducing the risk of stroke in patients with AF. Aspirin and clopidogrel are less effective than warfarin in preventing stroke in AF patients. Therefore, warfarin is the recommended anticoagulation schedule for this patient.Rate this question:
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- 16.
A 42 year old man develops a sore throat. He does not consult his local health centre but takes some over the counter painkillers and an anti-inflammatory. 1 week later he has a non itchy rash starting on his feet then spreading to his trunk. The rash has the appearance of tiny teardrops. He is correctly diagnosed with guttate psoriasis. The patient is put on penicillin orally 250mg QDS for 1 week. He then starts passing small volumes of urine. His urine is described as "orangey brown" . He continues taking a non steroidal anti inflammatory drug (ibuprofen 800mg TDS). What is the most likely explanation for this?
- A.
Post infective glomerulonephritis
- B.
Rheumatic fever
- C.
Secondary to penicillin
- D.
Interstitial nephritis secondary to anti inflammatory medication
- E.
None of the listed answers
Correct Answer
A. Post infective glomerulonephritisExplanation
The most likely explanation for the patient's symptoms is post infective glomerulonephritis. This condition can occur after an infection, such as streptococcal infection, which can cause a sore throat. The rash that the patient developed is consistent with guttate psoriasis, which can also be triggered by a streptococcal infection. The patient's urine becoming orangey brown and passing small volumes could be indicative of kidney dysfunction, which is a characteristic of post infective glomerulonephritis. The fact that the patient was put on penicillin and continued taking an anti-inflammatory drug further supports this diagnosis.Rate this question:
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- 17.
A 27 year old female presents with a headache. She has had it for 3 days. She has no other symptoms. She has a normal CT brain. Her lumbar puncture shows the following. CSF Opening Pressure (10-20cm H20) 42 Macroscopic appearance Clear Bottle 1 Bottle 3 RBC 150 mm3, WCC 0mm3 RBC 0mm3,WCC 0mm3 Gram stain Negative MCS No growth Glucose 4.5 Xanthochromia negative What is the most likely diagnosis?
- A.
Benign Intracranial Hypertension
- B.
Tension headache with traumatic Lumbar Puncture
- C.
Sub arachnoid haemarrage missed on CT
- D.
TB Meningitis
- E.
Sub Arachnoid Haemorrage
Correct Answer
A. Benign Intracranial HypertensionExplanation
The most likely diagnosis is Benign Intracranial Hypertension. This is supported by the finding of an elevated CSF opening pressure (42 cm H20), which is above the normal range. The absence of red and white blood cells in Bottle 3 suggests that the elevated opening pressure is not due to bleeding or infection. Additionally, the clear macroscopic appearance of the CSF and negative gram stain and MCS further support a diagnosis of benign intracranial hypertension.Rate this question:
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- 18.
Which of these symptoms of hypoadrenalism will distinguish between primary adrenal failure and secondary (pituitary) adrenal insufficiency?
- A.
Postural Hypotension
- B.
Weight Loss
- C.
Fatigue
- D.
Hypoglycaemia
- E.
Skin Pigmentation
Correct Answer
E. Skin PigmentationExplanation
Skin pigmentation is a symptom that can help distinguish between primary adrenal failure and secondary adrenal insufficiency. In primary adrenal failure (also known as Addison's disease), the adrenal glands themselves are damaged or not functioning properly, leading to a decrease in cortisol production. This can result in hyperpigmentation of the skin, particularly in areas of increased friction or pressure, such as the knuckles, elbows, knees, and lips. In contrast, secondary adrenal insufficiency occurs when there is a problem with the pituitary gland or hypothalamus, leading to a decrease in adrenocorticotropic hormone (ACTH) production. This does not typically cause skin pigmentation.Rate this question:
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- 19.
A 63 year old male who was previously fit and well presents with easy bruising and profusely bleeding gums when he cleans his teeth. He has had the symptoms for 5 weeks. On examination he has numerous ecchymoses and purpura. You can feel no palpable lymph nodes. His wife arrives in the clinic late. She explains that he’s a forgetful chap and forgot to tell you he’s taking warfarin for atrial fibrillation. She also tells you he has recently been prescribed some antibiotics for a sore throat. She shows you his INR book with the readings from the previous 6 weeks Date INR 3 days ago 2.0 3 weeks ago 2.1 5 weeks ago 2.3 7 weeks ago 1.8 13 weeks ago 2.6 What is the most likely explanation for his symptoms?
- A.
Cranberry juice ingestion
- B.
Antibiotics affecting warfarin
- C.
Accidental overdosing of warfarin
- D.
None of the above
Correct Answer
D. None of the aboveExplanation
The most likely explanation for his symptoms is accidental overdosing of warfarin. The patient's symptoms of easy bruising and profusely bleeding gums are consistent with the side effects of warfarin, a blood thinner. The INR readings from the previous 6 weeks show that his INR levels have been consistently within the therapeutic range, indicating that the warfarin dosage has been appropriate. The fact that he has been taking antibiotics for a sore throat does not explain his symptoms, and cranberry juice ingestion is not known to cause these symptoms. Therefore, the most likely explanation is accidental overdosing of warfarin.Rate this question:
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- 20.
A 62 year old man presents with a swollen right calf 3 weeks after undergoing a total left hip replacement. He is known to have rheumatoid arthritis. An Emergency Department doctor tells you that he feels the patient can be discharged. He tells you this because he shows you the D-Dimer result, which is “negative”. The result is shown below. D-Dimer 0.08 (Normal range 0-0.18) Which of the following statements is true about D-Dimer testing in general patients with a suspected DVT?
- A.
Following a clinical assessment, clinicians should not rely on the test as a basis to 'discharge' or 'investigate'
- B.
It is of no use in patients who have had recent surgery (e.g. within the last 12 weeks)
- C.
It is of no clinical use in patients with malignancy and secondary metastases
- D.
It can be used to discharge patients based on their underlying estimated clinical risk score
- E.
None of the listed answers are correct
Correct Answer
D. It can be used to discharge patients based on their underlying estimated clinical risk scoreExplanation
The correct answer is "It can be used to discharge patients based on their underlying estimated clinical risk score". D-Dimer testing can be used as a tool to assess the probability of a patient having a deep vein thrombosis (DVT). In patients with a low clinical probability of DVT, a negative D-Dimer result can help support the decision to discharge the patient without further investigation. However, it should be noted that D-Dimer testing should not be used as the sole basis for discharge or investigation, and should be interpreted in conjunction with a clinical assessment.Rate this question:
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Mar 22, 2023Quiz Edited by
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May 26, 2012Quiz Created by
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