MRCEM SBA Quiz 14

A 67-year-old man was involved in a road accident. A junior doctor wonders if parkinsonism could explain his reportedly slow reactions.

Which of the following examination findings most suggests parkinsonism?

A 54 year old female with a sudden onset headache has subarachnoid haemorrhage confirmed on non-contrast CT. She is conscious and alert, with normal vital signs except blood pressure 156/88. Transfer to a neurosurgery department is being organised.

In the meantime, which of the following treatments is most appropriate?

A 62-year-old woman complains that she felt that she ‘lost control’ of her face. Her symptoms were hard to define precisely. A CT head was normal. The possibility of a ‘stroke mimic’ is being considered.

Which of the following is NOT generally considered a stroke mimic?

A 12-year-old boy has presented with left knee pain. He is a refugee from West Africa and is unable to give much history. He is notably short in stature for his age. He has a temperature of 37.8 °C. His left knee is swollen and warm to the touch and he clearly has pain when walking. This is a plain x-ray of the knee.

Which of the following is the most likely explanation of his problem?

A 54 year old man has been brought into hospital with neck pain two hours after his vehicle was hit from behind at a road junction. He is sitting at the time that you assess him. On examination he has a normal upper limb neurological exam but midline tenderness of the cervical spine.

Which is the most appropriate next diagnostic step?

A 45-year-old man presents to the emergency department with severe right hip pain and inability to move his right leg following a high-speed road traffic collision. On examination there is swelling and bruising over the right hip with marked tenderness and restricted movement due to pain.
An x-ray of the pelvis is shown.

What is the most likely radiological diagnosis?

A foundation year 2 doctor (FY2) asks for your advice about an AP ankle x-ray from a 23-year-old woman who sustained a twisting injury to her ankle after slipping on ice. She is unable to weight bear.

Based on this x-ray, what is the most important point to make to the FY2?

A 78 year old man slipped and hit his head while taking a walk. He was not found until the following morning, when a passer-by spotted him. He is conscious but confused.

Given the appearance of his injuries, which of the following is particularly likely on head CT?

A 47-year-old driver is taken to the emergency department after a head-on collision. He was driving under the influence of alcohol when he hit a parked car. He has been conscious throughout and insists that he is okay.
His chest x-ray is shown below.

Based on this x-ray, which diagnosis would you be most concerned about?

A 22-year-old man presents with a two-day history of chest pain. The pain is sharp, worse on inspiration, and localised just below the right nipple. It is reproducible with palpation and movement of the chest wall. He has no exertional symptoms or breathlessness.

His father had a myocardial infarction aged 58.

His ECG is normal. A high-sensitivity troponin T is 18 ng/L (upper reference limit 14 ng/L), with no rise on repeat testing. The pain has partially improved with ibuprofen.

Which of the following is the most appropriate action?

An 83 year old female arrives by ambulance. She has been feeling generally unwell for the last few days.

This is her ECG on arrival:

Which is the most likely electrolyte abnormality?

A 65 year old woman has presented with chest pain. She is a smoker but has no significant medical history. She is sweaty and pale.

Her observations are as follows: T 36.7 °C, HR 60 /min, BP 102/64, RR 22 /min,
Saturn 96% RA

This is her ECG on arrival:

What of the following drugs would be least appropriate?

A 60-year-old man has been taken to the emergency department after he fell from a ladder whilst painting his house. He landed on the right side of his chest.
This is a chest x-ray soon after arrival:

Which complication over the next 24 hours would you be most concerned about?

A 26-year-old man is brought to the emergency department after a high-speed road traffic collision. He has left-sided chest pain following the impact.
On examination, there is reduced air entry and dullness to percussion at the left lung base. The abdomen is soft with no focal tenderness.
This is a chest x-ray taken early in his assessment:

He will be undergoing CT imaging shortly. However, which of the following specific complications are you most concerned about at this point?

A 34-year-old motorcyclist is brought to the emergency department after his motorcycle skidded on oil and collided with a parked car. He has severe left shoulder pain.
A shoulder x-ray is obtained to assess for dislocation and is shown below.

Which diagnosis is most accurate?