Medical Finals Quiz
August 2006

(Closing date: 1st September 2006)

By: Dr Elisabeth McCausland,
Specialist Registrar,
Rheumatology,
Musgrave Park Hospital,
Belfast

Please take part in our monthly quiz. This quiz is open to all.

This month for the quiz winner, there is a very useful book on "Essential Revision Notes in Medicine for Students" By: Dr Philip Kalra. (This book focuses on what is essential learning for medical undergraduates and gives readers an 'all round' knowledge of medicine at this level.) This book is very kindly provided by PasTest.

The winner will be picked at random from all entries (ie. does not matter if your answers are correct or not).

In order to contact the winner of the book, please enter your name and email address at the bottom of this page.

The closing date is 1st September 2006.

Learn as you test yourself. Detailed answers with teaching points will be given after you complete this page.

Question 1

These are the fingers of a 25 year old man who suffers from a chronic disease. His FEV₁ is 0.5 litres and his BMI is 18 kg/m².

What is the most likely diagnosis?

	(a) Cystic fibrosis
	(b) Congenital heart disease
	(c) Crohn's disease
	(d) Liver cirrhosis due to alpha-1-anti-trypsin deficiency
	(e) Cryptogenic fibrosing alveolitis

Question 2

The same patient as in Question 1 develops acute abdominal pain with a serum amylase of 1784 iu/litre.

What is the most appropriate initial course of action?

	(a) Commence IV tobramycin and ceftazidime
	(b) Nil by mouth & IV fluids
	(c) An urgent surgical opinion
	(d) Passage of a naso-gastric tube and commencement of elemental feeding
	(e) Commence IV proton pump inhibitor twice daily

Question 3

In the same patient, colonisation with which of the following organisms is associated with the poorest prognosis?

	(a) Burkholderia Cepacia
	(b) Streptococcus Pneumoniae
	(c) Methicillin Resistant Staphylococcus Aureus
	(d) Pseudomonas aeruginosa
	(e) Haemophilus Influenzae

Question 4

This is a CT scan of the chest of a 49 year old lady with haemoptysis. She is a life-long smoker. She is apyrexic. Her CRP and ESR are normal, and her PaO2 is 9.5 kPa.

What is the most likely diagnosis?

	(a) Lung abscess
	(b) Wegener's granulomatosis
	(c) Tuberculosis
	(d) Lung cancer
	(e) Chronic obstructive pulmonary disorder

Question 5

This is the same patient undergoing a CT guided biopsy.

Which of the following investigations is it essential to check before performing this procedure?

	(a) Coagulation screen
	(b) Lying and standing blood pressure
	(c) MRSA screen
	(d) ECG
	(e) Full blood count

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