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001Newborn after shoulder dystocia has adducted internally rotated arm and extended elbow. Which diagnosis best explains this presentation?Anatomy
A. Cavernous sinus thrombosis anatomy
B. Carpal tunnel syndrome
C. Long thoracic nerve palsy
D. Erb palsy
Correct answer: D. Erb palsy
Explanation: Erb palsy. Upper trunk brachial plexus injury predominantly involves C5-C6. Key clue: Waiter's-tip posture
Explanation: Erb palsy. Upper trunk brachial plexus injury predominantly involves C5-C6. Key clue: Waiter's-tip posture
006Exercising muscle with high CO2 unloads more oxygen. Which diagnosis best explains this presentation?Physiology
A. Renal glucose handling
B. Central diabetes insipidus
C. Bohr effect
D. Respiratory acclimatisation to altitude
Correct answer: C. Bohr effect
Explanation: Bohr effect. Raised CO2 and H+ reduce haemoglobin oxygen affinity and enhance tissue unloading. Key clue: Right shift of oxygen dissociation curve
Explanation: Bohr effect. Raised CO2 and H+ reduce haemoglobin oxygen affinity and enhance tissue unloading. Key clue: Right shift of oxygen dissociation curve
011Infant has doll-like face, hepatomegaly and severe fasting hypoglycaemia. Which diagnosis best explains this presentation?Biochemistry
A. Von Gierke disease
B. Maple syrup urine disease
C. Phenylketonuria
D. Vitamin B12 deficiency
Correct answer: A. Von Gierke disease
Explanation: Von Gierke disease. Glucose-6-phosphatase deficiency causes severe fasting hypoglycaemia, lactic acidosis and hepatomegaly. Key clue: Hypoglycaemia with lactic acidosis and hyperuricaemia
Explanation: Von Gierke disease. Glucose-6-phosphatase deficiency causes severe fasting hypoglycaemia, lactic acidosis and hepatomegaly. Key clue: Hypoglycaemia with lactic acidosis and hyperuricaemia
016Young adult has painless cervical nodes and biopsy shows owl-eye binucleate cells. Which diagnosis best explains this presentation?Pathology
A. Hodgkin lymphoma
B. Papillary thyroid carcinoma
C. Amyloidosis
D. CML
Correct answer: A. Hodgkin lymphoma
Explanation: Hodgkin lymphoma. Classic Hodgkin lymphoma contains Reed-Sternberg cells in a characteristic inflammatory background. Key clue: Reed-Sternberg cells, typically CD15/CD30 positive
Explanation: Hodgkin lymphoma. Classic Hodgkin lymphoma contains Reed-Sternberg cells in a characteristic inflammatory background. Key clue: Reed-Sternberg cells, typically CD15/CD30 positive
021Farmer exposed to pesticide develops salivation, wheeze, miosis and fasciculations. Which diagnosis best explains this presentation?Pharmacology
A. Paracetamol poisoning
B. Methanol poisoning
C. Organophosphate poisoning
D. Malignant hyperthermia
Correct answer: C. Organophosphate poisoning
Explanation: Organophosphate poisoning. Acetylcholinesterase inhibition causes muscarinic, nicotinic and CNS cholinergic excess. Key clue: Bronchorrhoea, miosis and fasciculations
Explanation: Organophosphate poisoning. Acetylcholinesterase inhibition causes muscarinic, nicotinic and CNS cholinergic excess. Key clue: Bronchorrhoea, miosis and fasciculations
026Abscess culture grows golden colonies of Gram-positive cocci in clusters. Which diagnosis best explains this presentation?Microbiology
A. Streptococcus pneumoniae
B. Staphylococcus aureus
C. Clostridium tetani
D. Neisseria meningitidis
Correct answer: B. Staphylococcus aureus
Explanation: Staphylococcus aureus. S. aureus is a catalase-positive, coagulase-positive Gram-positive coccus. Key clue: Catalase positive and coagulase positive
Explanation: Staphylococcus aureus. S. aureus is a catalase-positive, coagulase-positive Gram-positive coccus. Key clue: Catalase positive and coagulase positive
031Screening programme wants to miss as few true cases as possible. Which diagnosis best explains this presentation?PSM
A. Odds ratio
B. Relative risk
C. Specificity
D. Sensitivity
Correct answer: D. Sensitivity
Explanation: Sensitivity. Sensitivity is the probability of a positive test among truly diseased individuals. Key clue: Low false-negative rate
Explanation: Sensitivity. Sensitivity is the probability of a positive test among truly diseased individuals. Key clue: Low false-negative rate
036Man with inferior STEMI is hypotensive with clear chest and elevated JVP. Which diagnosis best explains this presentation?Medicine
A. Crohn disease
B. Acute inferior MI with RV infarction
C. Absence epilepsy
D. Anti-GBM disease
Correct answer: B. Acute inferior MI with RV infarction
Explanation: Acute inferior MI with RV infarction. Right-ventricular infarction is preload dependent and may present with hypotension, raised JVP and clear lungs. Key clue: Hypotension + raised JVP + clear lungs in inferior MI
Explanation: Acute inferior MI with RV infarction. Right-ventricular infarction is preload dependent and may present with hypotension, raised JVP and clear lungs. Key clue: Hypotension + raised JVP + clear lungs in inferior MI
071Young adult has periumbilical pain migrating to RLQ with anorexia. Which diagnosis best explains this presentation?Surgery
A. Breast carcinoma
B. Necrotising fasciitis
C. Acute cholecystitis
D. Acute appendicitis
Correct answer: D. Acute appendicitis
Explanation: Acute appendicitis. Appendiceal inflammation classically causes migratory pain to the right lower quadrant. Key clue: Migration of pain with McBurney tenderness
Explanation: Acute appendicitis. Appendiceal inflammation classically causes migratory pain to the right lower quadrant. Key clue: Migration of pain with McBurney tenderness
079Primigravida at 34 weeks has BP 170/110, headache and proteinuria. Identify the most likely underlying disorder.OBG
A. Ectopic pregnancy
B. Placental abruption
C. Placenta previa
D. Preeclampsia
Correct answer: D. Preeclampsia
Explanation: Preeclampsia. New hypertension after 20 weeks with proteinuria or specified maternal organ dysfunction. Key clue: Hypertension after 20 weeks with end-organ features
Explanation: Preeclampsia. New hypertension after 20 weeks with proteinuria or specified maternal organ dysfunction. Key clue: Hypertension after 20 weeks with end-organ features
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