Medical Finals Quiz - October 2006

(Closing date: 1st November 2006)

With Ann Johnston

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 "Therapeutics & Pharmacology" (A systems-based easy reference for busy students. Provides guidance on all aspects of pharmacology, including usage for each drug, dose, characteristics, side effects and how it works. Helps answer questions from patients and your tutor, and has practice questions in preparation for medical finals.) 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 November 2006.

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

Question 1

A 22 year old man had been out drinking after a victory for his local football team.

The following day whilst at work seated at his computer he lost consciousness and was told by his colleague that he fitted. It occurred without warning and lasted 2 minutes. He bit his tongue, was incontinent of urine and had a headache for the remainder of the day.

A finger prick glucose measurement taken by paramedics measured 4.2 mmol/l. He had no similar previous episodes and has had none since. Clinical examination was normal.

An EEG performed 1 month later was reported as normal.

Based on this information, what is the most likely diagnosis?

	(a) Syncope
	(b) Epilepsy
	(c) Provoked seizure
	(d) Juvenile myoclonic epilepsy
	(e) Hypoglycaemia

Question 2

The patient described in Question 1 above, is now concerned about driving.

What advice do you give him?

	(a) That there is no restriction on driving
	(b) That he should stop driving indefinitely
	(c) That he should inform the DVLA and stop driving for 12 months
	(d) That he should inform the DVLA and stop driving for 6 months
	(e) That he should stop driving for 12 months and his doctor will inform the DVLA

Question 3

A 56 year old Indian man presents to A&E after a seizure.

A CT scan is performed.

His temperature is 37.7°C. His full blood count, CRP and chest x-ray are normal.

Examination is unremarkable apart from a visual field defect.

On exploring his history, the following day, he tells you that he had a renal tumour removed years ago, and that he recently had been home to India to visit relatives.

His CT is shown below:

Which of the following is the most unlikely diagnosis?

	(a) Brain metastasis
	(b) Primary brain tumour
	(c) TB
	(d) Abscess
	(e) Posterior circulation infarct

Question 4

For the patient in Question 3 above, which of the following would be the best diagnostic investigation?

	(a) MRI scan
	(b) Lumbar puncture
	(c) Blood cultures
	(d) Brain biopsy
	(e) Repeat CT scan

Question 5

A 74 year old man was admitted to hospital after he was found collapsed at the roadside.

Over the following hours he was noted to have a fluctuating level of consciousness.

His blood alcohol level measured 389 mg/100ml (legal limit <80/100 ml).

Here is his CT scan:

Based on the above information and the brain imaging what is the most likely diagnosis?

	(a) Large left sided infarct
	(b) Subdural haemorrhage
	(c) Extradural haemorrhage
	(d) Subarachnoid haemorrhage
	(e) Meningococcal meningitis

Question 6
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