Medical Finals Quiz - July 2007

(Closing date: 1st August 2007)

With: Sandy Davey, Belfast & Ian Bickle, Sheffield

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 Skills Practice for OSCEs in Medicine" By: Dr. D McCluskey - is divided into 'skills' sections - History Taking, Clinical signs, Clinical Examination, Communication Skills, Therapeutics and Pharmacology, Radiology, Interpretation of Data. Each section includes 15 to 20 OSCEs in question & answer format. 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 August 2007.

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

Question 1

This 71 year-old lady suffers from a chronic rheumatological condition.

Choose the correct combination of hand joints affected and the likely disease that would be in keeping with the above picture.

	(a) Psoriatic arthritis of the mutilans subtype with onycholysis and pitting of the nails
	(b) Enteropathic arthritis involving the DIP and PIP joints
	(c) Ankylosing spondylitis involving the MCP joints with 'Z'-shaped deformity of the thumb
	(d) Rheumatoid arthritis with Swan neck and Boutonniere deformities of the fingers
	(e) Rheumatoid arthritis involving the MCP joints and a 'Z'-shaped thumb

Question 2

A 65 year-old arteriopath had a carotid endarterectomy in the past 2 weeks following recurrent episodes of amarosis fugax.

At, and above, what degree of carotid stenosis is this procedure indicated?

	(a) 40%
	(b) 50%
	(c) 60%
	(d) 70%
	(e) 90%

Question 3

This 64 year-old man has been suffering from osteoarthritis in both knees for several years.

Which joint in the hand is he most likely to have similar problems with?

	(a) Radio-ulnar
	(b) Scapho-lunate
	(c) 1st carpometacarpal joint
	(d) 1st interphalangeal joint
	(e) 2nd interphalangeal joint

Question 4

An 84 year-old nursing home resident is admitted with vomiting and a grossly distended abdomen. AXR is highly suggestive of a sigmoid volvulus.

Which other patient group is susceptible to sigmoid volvulus?

	(a) Children
	(b) Sufferers of Crohn's disease
	(c) Chronic laxative users
	(d) Short sigmoid mesentery
	(e) Psychiatric patients

Question 5

A 56 year old male patient is admitted to your surgical ward on take with a history of abdominal pain, diarrhoea, malaise and fever.

His past medical history reveals that he was treated conservatively for diverticulits three weeks ago and has been feeling unwell for a few days.

On examination, his abdomen is soft with mild tenderness and guarding in the left iliac fossa. There is a palpable mass on rectal examination. His temperature is 37.7°C but otherwise stable.

What condition would you think of first when ordering a CT Abdomen?

	(a) Sigmoid neoplasm
	(b) Pelvic abscess
	(c) Prostate neoplasm
	(d) Psoas abscess
	(e) Caecal mass

Question 6
Select which charity medicalfinals.co.uk should next give donations from 2007 to:
StreetReach - provides support services for adults and young people involved in prostitution or sexual exploitation. www.StreetReach.org.uk Treeton church tower - restoration of St Helen's church tower in Treeton, Yorkshire. Treeton partnership projects Tearfund's "Work a Miracle" project - aims to reduce HIV transmission to babies in Africa by giving anti-HIV drugs to the mother just before delivery. www.TearFund.org.uk/Miracle "Shine a Light" - Billy McCrory (52), from Belfast, who has suffered from a heart condition for 10 years, founded Shine A Light in 1997 in order to give children with cancer a better life. Newspaper writeup MIND - leading mental health charity in England and Wales. Works to create a better life for everyone with experience of mental distress. www.mind.org.uk
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