Medical quiz

Medical Quiz 1. A 5-year-old boy is brought to the office because he has had pain in his left knee for the past three days. The patient walks with a mild limp because of the pain. He has no history of trauma to the knee. He had symptoms of cold one week ago but is otherwise healthy. Vital signs are within normal limits. Physical examination shows full range of motion of the left knee with limited internal rotation of the left hip. On laboratory studies, erythrocyte sedimentation rate is slightly elevated and white blood cell count is within normal limits. Anteroposterior and frog-leg x-ray studies of the left hip and knee show no abnormalities. Which of the following is the most likely cause of the pain in this patient's knee?

1. Developmental dysplasia of the hip
2. Legg-Calvé-Perthes disease
3. Septic joint
4. Slipped capital femoral epiphysis
5. Transient synovitis

2. A 3 and half-year-old boy is brought to the paediatrician by his parents for general examination. Height is in the third percentile, and weight is in the first percentile. During the interview, the parents say that the patient has been treated multiple times since infancy because of sinus infections and pneumonia. They also note that his stools are generally loose, greasy, and full of mucous. During physical examination, the patient coughs frequently. No other abnormalities are noted. Which of the following studies is most effective to determine the diagnosis in this patient?

1. Bronchoscopy
2. CT scan of the sinuses
3. Culture of aspirate from the trachea
4. Measurement of serum immunoglobulin levels
5. Sweat chloride test

3. Complications of blood transfusion :

1. Haemolytic transfusion reaction due to incompatibility
2. Fluid overload
3. Disseminated intravascular coagulation (DIC)
4. Hypocalcaemia
5. Infection

Choose and match the correct diagnosis from the list above with each of the scenarios given below:

1. A 86-year-old woman is admitted with a haemoglobin (Hb) of 5.6 g/dL. The HO prescribes 4 units of blood. These 4 units are transfused over a period of 6 h. Four hours later the patient is found to be having difficulty in breathing. Chest examination reveals fine creps bilaterally. Chest X-ray confirms pulmonary oedema.

2. A 28-year-old male is taken to a nearby hospital after sustaining injuries while on a safari in Africa. He has lost a lot of blood and is hence given 2 units of blood transfusion. He develops fever and chills with rigors the next day. Peripheral blood smear demonstrates malarial parasite.

3. A 38-year-old man requires several units of blood transfusion due to multiple injuries sustained as a result of a fall. He develops tetany and complains of circumoral tingling.

4. A 34-year-old motorcyclist sustains multiple injuries after an RTA. He is brought to the hospital in severe shock and requires multiple blood transfusions. It is observed that the bleeding is still uncontrolled and the blood fails to clot.

5. The ward is very busy and quite a few staff have phoned in sick. There are two patients (with the same surnames) needing blood transfusions. The staff nurse points to the blood units on the table and asks the HCA to start them as she is just going off for her break. The blood transfusion is started. Within a few minutes the patient is unwell and his urine is haemorrhagic. He collapses and becomes anuric. He is also found to be jaundiced.

Q4. Ulcers

1. A. Diabetes
2. B. Deep vein thrombosis insufficiency
3. C. Marjolin’s ulcer
4. D. Systemic lupus erythematosus (SLE)
5. E. Diabetes
6. F. Neuropathy
7. G. Arterial disease

Choose and match the correct diagnosis from the list above with each of the scenarios below:

1. 1. A 55-year-old woman presents with brown discoloration and induration around the ankle and a 3-cm-diameter ulcer lying just above the medial malleolus.
2. 2. A 60-year-old man presents with a history of pins and needles in his left foot following multiple back operations and an ulcer over the plantar aspect of his second metatarsal head.
3. 3. A 70-year-old male, who is chronic smoker presents with a painful ulcer over the head of his first metatarsal where he is noted to have a mild hallux valgus.
4. 4. A 65-year-old man presents with a chronic ulcer of seven years lying over the medial aspect of his calf and which has recently become painful and enlarged.
5. 5. A patient presents with small punched-out, painful ulcers over the dorsum of her foot.