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  • Question 1 - A 54-year-old female patient presents with a one week history of bloody diarrhoea,...

    Incorrect

    • A 54-year-old female patient presents with a one week history of bloody diarrhoea, fever and abdominal pain. She has a history of rheumatoid arthritis which she controls with methotrexate. Her stool sample shows Campylobacter jejuni. What is the single most appropriate management?

      Your Answer: Fluids + metronidazole

      Correct Answer: Fluids + clarithromycin

      Explanation:

      This woman is receiving methotrexate, an immunosuppressant, to control her rheumatoid arthritis. In such immunocompromised patients, BNF suggests clarithromycin as first-line management.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      30.1
      Seconds

  • Question 2 - A 24-year-old presents with diarrhoea. She has had a previous ileal resection for...

    Incorrect

    • A 24-year-old presents with diarrhoea. She has had a previous ileal resection for Crohn's Disease. She has also had two recent episodes of loin to groin pain. Her bloods are normal including her inflammatory markers

      What is the most likely diagnosis?

      Your Answer: Flare of Crohns Disease

      Correct Answer: Short bowel syndrome

      Explanation:

      Given her history of bowel resections, the most likely answer in this case is short bowel syndrome. IBS is a diagnosis of exclusion and less likely. Bacterial overgrowth does not relate to resection history, so unlikely. Celiac disease or a flare of IBD are also less likely than short bowel syndrome in this case, simply given the history. Also her labs are normal making these unlikely. History, history, history!

    • This question is part of the following fields:

      • Gastrointestinal System
      29.2
      Seconds

  • Question 3 - A 62-year-old female with a history of COPD and hypertension presents with pain...

    Incorrect

    • A 62-year-old female with a history of COPD and hypertension presents with pain on swallowing. Current medication includes a salbutamol and becotide inhaler, bendrofluazide and amlodipine. What is the most likely cause of the presentation?

      Your Answer:

      Correct Answer: Oesophageal candidiasis

      Explanation:

      The history gives you a woman who is on inhaled steroid therapy. It is always a good idea for patients to rinse their mouths well after using inhaled steroids. Odynophagia (pain on swallowing) is a symptom of oesophageal candidiasis, which is the most likely answer given the steroids. Typically, you might see this in someone who is immunocompromised (classically, in HIV+ patients).

    • This question is part of the following fields:

      • Gastrointestinal System
      0
      Seconds

  • Question 4 - A 65-year-old woman with type 2 diabetes mellitus is feeling more fatigued than...

    Incorrect

    • A 65-year-old woman with type 2 diabetes mellitus is feeling more fatigued than usual. She has not attended the previous three annual check-ups and her blood glucose control has been poor. She has not been compliant with his medications. Blood pressure is 170/90 mmHg. Urinalysis shows microalbuminuria. A blood test reveals her glomerular filtration rate (GFR) is 26 mL/min.

      If a renal biopsy was to be performed in this patient, what would be the expected findings?

      Your Answer:

      Correct Answer: Nodular glomerulosclerosis and hyaline arteriosclerosis

      Explanation:

      This patient has a poorly controlled T2DM with an underlying diabetic nephropathy. The histological findings are Kimmelstiel-Wilson lesions (nodular glomerulosclerosis) and hyaline arteriosclerosis. This is due to nonenzymatic glycosylation.

      Diabetic nephropathy is the chronic loss of kidney function occurring in those with diabetes mellitus. Protein loss in the urine due to damage to the glomeruli may become massive, and cause a low serum albumin with resulting generalized body swelling (edema) and result in the nephrotic syndrome. Likewise, the estimated glomerular filtration rate (eGFR) may progressively fall from a normal of over 90 ml/min/1.73m2 to less than 15, at which point the patient is said to have end-stage kidney disease (ESKD). It usually is slowly progressive over years.

    • This question is part of the following fields:

      • Renal System
      0
      Seconds

  • Question 5 - A 25-year-old female presented with a history of sudden collapse. She had been...

    Incorrect

    • A 25-year-old female presented with a history of sudden collapse. She had been playing netball and had suddenly collapsed. This collapse had been accompanied by a brief period of loss of consciousness. She experienced palpitations for a brief period prior to losing consciousness. On examination her BP was 120/70 mmHg and pulse rate was 72 bpm, which was regular. The rest of the examination was also normal.
      She had similar experience of collapse, about two years ago. She was well except for these two incidents and she has not been on any medication. All the investigations done at the first presentation (2 years ago), including FBC, ECG and echocardiography were normal. Her ECG done at this presentation revealed QT prolongation of 0.50 s. FBC, CXR and other investigations were normal. Which of the following is the best way of managing this patient?

      Your Answer:

      Correct Answer: Start on a beta-blocker

      Explanation:

      Beta-blockers are drugs of choice for patients with LQTS. The protective effect of beta-blockers is related to their adrenergic blockade, which diminishes the risk of cardiac arrhythmias. They may also reduce the QT interval in some patients.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 6 - What is the site of action of antidiuretic hormone? ...

    Incorrect

    • What is the site of action of antidiuretic hormone?

      Your Answer:

      Correct Answer: Collecting ducts

      Explanation:

      Vasopressin, also called antidiuretic hormone (ADH), regulates the tonicity of body fluids. It is released from the posterior pituitary in response to hypertonicity and promotes water reabsorption in the collecting ducts of the kidneys by the insertion of aquaporin-2 channels.. An incidental consequence of this renal reabsorption of water is concentrated urine and reduced urine volume. In high concentrations may also raise blood pressure by inducing moderate vasoconstriction.

    • This question is part of the following fields:

      • Renal System
      0
      Seconds

  • Question 7 - Arrange the following opioid analgesics in order of increasing potency. ...

    Incorrect

    • Arrange the following opioid analgesics in order of increasing potency.

      Your Answer:

      Correct Answer: Codeine, morphine, oxycodone, diamorphine

      Explanation:

      Opioid analgesics produce pain relief by attaching to the opioid receptors in the brain. Out of these, codeine is the least potent and diamorphine the most potent. Codeine is used to relieve mild to moderate pain. Morphine is a stronger analgesic used to treat pain like that experienced after surgery or injury. Oxycodone acts like the endorphins in the brain and reduces pain sensation. It is more potent than codeine and morphine and is used for relieving moderate to severe forms of pain. Among the listed, diamorphine is the most potent opioid analgesic. It is administered intravenously, subcutaneously, or intramuscularly to treat severe pain after surgery or in terminally-ill patients.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds

  • Question 8 - A 43-year-old man with hemochromatosis presents with a painful and swollen right knee....

    Incorrect

    • A 43-year-old man with hemochromatosis presents with a painful and swollen right knee. X-ray shows extensive chondrocalcinosis but no fracture. Given the most likely diagnosis, which of the following would be present in the joint fluid aspirate?

      Your Answer:

      Correct Answer: Positively birefringent rhomboid-shaped crystals

      Explanation:

      Pseudogout is a paroxysmal joint inflammation due to calcium pyrophosphate crystal deposition (calcium pyrophosphate dihydrate). Arthrocentesis should be performed, especially in acute cases.
      Polarized light microscopy: detection of rhomboid-shaped, positively birefringent CPPD crystals.
      Synovial fluid findings: 10,000-50,000 WBCs/μL with > 90% neutrophils.
      X-ray findings: cartilage calcification of the affected joint (chondrocalcinosis).
      Fibrocartilage (meniscus, annulus fibrosus of intervertebral disc) and hyaline cartilage (joint cartilage) may be affected.

    • This question is part of the following fields:

      • Musculoskeletal System
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  • Question 9 - A 35-year-old man is referred to the clinic by his GP. He complains...

    Incorrect

    • A 35-year-old man is referred to the clinic by his GP. He complains of lethargy and tiredness. He has recently been discharged from the hospital after being admitted to the intensive care unit following a motorbike accident.
      His thyroid function testing is :
      TSH 0.3 IU/l (0.5-4.5)
      Free T4 8 pmol/l (9-25)
      Free T3 3.1 pmol/l (3.4-7.2)

      Which of the following is most likely to be the diagnosis?

      Your Answer:

      Correct Answer: Sick euthyroid syndrome

      Explanation:

      Euthyroid sick syndrome (also known as nonthyroidal illness syndrome) can be described as abnormal findings on thyroid function tests that occurs in the setting of a nonthyroidal illness (NTI), without pre-existing hypothalamic-pituitary and thyroid gland dysfunction. After recovery from an NTI, these thyroid function test result abnormalities should be completely reversible.
      Multiple alterations in serum thyroid function test findings have been recognized in patients with a wide variety of NTIs without evidence of pre-existing thyroid or hypothalamic-pituitary disease. The most prominent alterations are low serum triiodothyronine (T3) and elevated reverse T3 (rT3), leading to the general term low T3 syndrome. Thyroid-stimulating hormone (TSH), thyroxine (T4), free T4 (FT4), and free T4 index (FTI) also are affected in variable degrees based on the severity and duration of the NTI. As the severity of the NTI increases, both serum T3 and T4 levels drop, but they gradually normalize as the patient recovers.
      Reverse T3 is used to differentiate between this condition and secondary thyroid failure.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
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      Seconds

  • Question 10 - A 23-year-old female visited the OPD with a complaint of postcoital bleeding as...

    Incorrect

    • A 23-year-old female visited the OPD with a complaint of postcoital bleeding as well as excessive vaginal discharge. Her past medical history is positive for oral contraceptive pills. Which of the following investigations would you recommend in this case?

      Your Answer:

      Correct Answer: Speculum with or without cervical smear

      Explanation:

      A speculum test is necessary in order to visualize the cervix to rule out cervical ectropion that may be responsible for the post-coital bleeding. A smear is not necessary if the cervix is adequately visualized, however, it can rule out infection as well.

    • This question is part of the following fields:

      • Women's Health
      0
      Seconds

  • Question 11 - A 32-year-old man notices a pruritic scaly annular rash on his thigh. He...

    Incorrect

    • A 32-year-old man notices a pruritic scaly annular rash on his thigh. He claims that the rash appeared after a walk in the park. Which drug would you suggest he starts?

      Your Answer:

      Correct Answer: Doxycycline

      Explanation:

      The clinical picture of an itchy, scaly annular rash after a walk in the park suggests erythema migrans. The pathogen responsible is a spirochete, Borrelia Burgdorferi transmitted by ticks leading to Lyme disease. Doxycycline is the antibiotic of choice if no contraindications.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

  • Question 12 - A 56-year-old woman presents with persistent cough, pyrexia, crackles and left sided chest...

    Incorrect

    • A 56-year-old woman presents with persistent cough, pyrexia, crackles and left sided chest pain which worsens upon deep inspiration. She has a history of smoking. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Pneumonia

      Explanation:

      The clinical picture is very suggestive of pneumonia. Pneumonia presents with chest pain exacerbated by deep breathing, fever and localized crackles or consolidation.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds

  • Question 13 - A 19-year-old female presented with irregular menstrual cycles for 4 months. On examination...

    Incorrect

    • A 19-year-old female presented with irregular menstrual cycles for 4 months. On examination her weight was 85 kg and height was 145 cm. She was not on any medications. Which of the following is the most appropriate investigation to arrive at a diagnosis?

      Your Answer:

      Correct Answer: Pelvic ultrasound

      Explanation:

      Oligomenorrhoea and BMI of 40.4 is suggestive of Polycystic ovary syndrome (PCOS). To diagnose PCOS 2 out of following 3 criteria should be present : oligo/anovulation, hyperandrogenism, clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone) and polycystic ovaries on ultrasound.

    • This question is part of the following fields:

      • Women's Health
      0
      Seconds

  • Question 14 - A 28-year-old female presents to her GP with joint pain , fever, a...

    Incorrect

    • A 28-year-old female presents to her GP with joint pain , fever, a butterfly rash and fatigue. She has marked peripheral oedema. She is found to be hypertensive, in acute renal failure, low albumin levels and proteinuria.
       
      A renal biopsy is performed and reveals focal glomerulonephritis with subendothelial and mesangial immune deposits.
       
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Lupus nephritis Class III

      Explanation:

      This case presents with characteristic symptoms of SLE and with her renal biopsy results of focal glomerulonephritis, this is clearly Class III SLE.

    • This question is part of the following fields:

      • Renal System
      0
      Seconds

  • Question 15 - A 60-year-old male complained of pain and redness at the metatarsophalangeal joints of...

    Incorrect

    • A 60-year-old male complained of pain and redness at the metatarsophalangeal joints of left big toe. He was on treatment for hypertension. Which of the following antihypertensive drugs is responsible for the above symptom?

      Your Answer:

      Correct Answer: Bendroflumethiazide

      Explanation:

      The clinical diagnosis is acute gout. According to the latest research diuretics, β blockers, angiotensin converting enzyme inhibitors, and non-losartan angiotensin II receptor blockers are associated with an increased risk of gout, as those drugs increase serum uric acid levels. Calcium channel blockers and losartan are associated with a lower risk. Thiazide diuretics have the highest association with gout.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds

  • Question 16 - A young man complains of dyspnoea and tiredness. His blood film shows spherocytes...

    Incorrect

    • A young man complains of dyspnoea and tiredness. His blood film shows spherocytes and 6% reticulocytes. What test would you perform next?

      Your Answer:

      Correct Answer: Coomb's Test

      Explanation:

      A Coomb’s test should be performed to test for autoimmune haemolytic anaemia. Spherocytes and reticulocytes in the blood film are indications for haemolytic anaemia.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds

  • Question 17 - A 54-year-old female has complained of a sudden and severe pain on the...

    Incorrect

    • A 54-year-old female has complained of a sudden and severe pain on the left side of her skull. She is also experiencing pain in and around her jaw. What is the most appropriate next step in her treatment?

      Your Answer:

      Correct Answer: ESR

      Explanation:

      A diagnosis of giant cell arteritis or temporal arteritis is likely here as many points favour it. She is over 50 years old, is female, has severe pain in the left half of her skull, and is complaining of pain around the jaw (jaw claudication).

    • This question is part of the following fields:

      • Emergency & Critical Care
      0
      Seconds

  • Question 18 - A 75-year-old man was brought to the clinic by his wife because lately...

    Incorrect

    • A 75-year-old man was brought to the clinic by his wife because lately he has lost interest in activities he previously enjoyed. His wife is worried and claims he's generally withdrawn. What would exclude depression in favour of dementia?

      Your Answer:

      Correct Answer: Urinary incontinence

      Explanation:

      Urinary incontinence is not a usual symptom of depression. A depressed patient is usually capable of maintaining control of his body sphincters. In dementia, however, urinary incontinence is an important and late symptom of the disease, non-related to any urinary tract pathology. It is rather related to the cognitive impairment caused by dementia.

    • This question is part of the following fields:

      • Geriatric Medicine
      0
      Seconds

  • Question 19 - A 30-year-old male with a history of premature cardiovascular disease in the family...

    Incorrect

    • A 30-year-old male with a history of premature cardiovascular disease in the family has come for review of his lab investigations.
      His fasting cholesterol is 8.4 mmol/l with high-density lipoprotein (HDL) of 1.6 mmol/l.
      You elect to commence him on atorvastatin 20 mg PO daily.
      Which of the following best describes the mechanism of action of the statins?

      Your Answer:

      Correct Answer: They inhibit HMG CoA reductase

      Explanation:

      Statins are a selective, competitive inhibitor of hydroxymethylglutaryl-CoA (HMG-CoA) reductase, which is the enzyme responsible for the conversion of HMG-CoA to mevalonate in the cholesterol synthesis pathway.
      Statins are usually well tolerated with myopathy, rhabdomyolysis, hepatotoxicity, and diabetes mellitus being the most common adverse reactions.
      This is the rate-limiting step in cholesterol synthesis, that leads to increased hepatic low-density lipoprotein (LDL) receptors and reduced hepatic VLDL synthesis coupled with increased very-low-density lipoprotein (VLDL) clearance.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds

  • Question 20 - A 35-year-old woman is referred to the oncology clinic by a general surgeon....

    Incorrect

    • A 35-year-old woman is referred to the oncology clinic by a general surgeon. She has undergone mastectomy for carcinoma of the right breast.

      Out of the following, which factor is associated with a poor prognosis in patients with breast cancer?

      Your Answer:

      Correct Answer: Young age

      Explanation:

      Poor prognostic factors for breast cancer include:
      1. Young age (<40 years)
      2. Premenopausal at the time of diagnosis
      3. Increased tumour size
      4. High-grade tumour
      5. Oestrogen and progesterone receptor-negative tumour
      6. Positive lymph node status

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds

  • Question 21 - A 50-year-old woman with lung cancer develops deep vein thrombosis (DVT). She is...

    Incorrect

    • A 50-year-old woman with lung cancer develops deep vein thrombosis (DVT). She is reviewed in the hospital clinic and started on low-molecular-weight heparin (LMWH).

      Which of the following should be the most appropriate treatment plan?

      Your Answer:

      Correct Answer: Continue on LMWH for 6 months

      Explanation:

      Patients with active cancer are at a continuous risk of having venous thromboembolism (VTE), such as DVT. Therefore, a six-month course of an anticoagulant such as LMWH is recommended. LMWH is the drug of choice since its side effects can be reversed and it can be stopped easily in case of a cancer-related bleed, for example, massive haemoptysis in a patient with lung cancer.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds

  • Question 22 - A 35-year-old male complains of a headache that gets worse when he moves...

    Incorrect

    • A 35-year-old male complains of a headache that gets worse when he moves his head forward. From the list of options, which is the most likely diagnosis?

      Your Answer:

      Correct Answer: Chronic Sinusitis

      Explanation:

      Symptoms such as pain worsening when bending forward, are consistent with chronic sinusitis. Sinusitis also does not present with nausea or vomiting, which is worsened by loud noises or bright lights.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds

  • Question 23 - A 54-year-old patient presented with a dry cough after starting treatment for hypertension....

    Incorrect

    • A 54-year-old patient presented with a dry cough after starting treatment for hypertension. He was prescribed ramipril 2.5mg and the dry cough started after that, which disturbed his sleep. His blood pressure was normal. Which of the following is the most appropriate management?

      Your Answer:

      Correct Answer: Stop the ramipril and prescribe candesartan

      Explanation:

      ACE inhibitors are known to cause a dry cough and they should be stopped, to settle the cough. The next drug of choice is an angiotensin receptor blocker such as candesartan.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 24 - A 65-year-old man having small cell lung cancer is admitted onto the ward...

    Incorrect

    • A 65-year-old man having small cell lung cancer is admitted onto the ward for chemotherapy. He has a history of severe nausea and vomiting secondary to chemotherapy, in the past.

      The consultant asks you to prescribe a neurokinin 1 (NK1) receptor blocker. Which agent, out of the following, will you choose?

      Your Answer:

      Correct Answer: Aprepitant

      Explanation:

      Aprepitant is an anti-emetic which blocks the neurokinin 1 (NK1) receptor and acts as a substance P antagonist. It is licensed for chemotherapy-induced nausea and vomiting (CINV) and for prevention of postoperative nausea and vomiting.

      Nausea and vomiting are the common side effects of chemotherapy. Risk factors for the development of these symptoms include age<50 years, anxiety, concurrent use of opioids, and the type of chemotherapy administered.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds

  • Question 25 - Vancomycin is a glycopeptide. It acts by which mechanism? ...

    Incorrect

    • Vancomycin is a glycopeptide. It acts by which mechanism?

      Your Answer:

      Correct Answer: Cell wall inhibition

      Explanation:

      Peptidoglycans are a component of bacterial cell wall and are inhibited by this antibiotic.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds

  • Question 26 - A 48-year-old chronic smoker who smokes 20 cigarettes per day, presented with a...

    Incorrect

    • A 48-year-old chronic smoker who smokes 20 cigarettes per day, presented with a persistent cough, wheezing and difficulty in breathing. He was treated with oxygen but the symptoms did not improve. Which of the following is the next step?

      Your Answer:

      Correct Answer: Check ABG

      Explanation:

      The history is suggestive of a COPD exacerbation. As he is not responding to oxygen, an ABG should be performed to assess the level of hypoxaemia and then a decision about further management can be made. A CXR and salbutamol are also important in the acute management.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds

  • Question 27 - A 22 year-old university graduate presented with progressive unsteadiness during walking over the...

    Incorrect

    • A 22 year-old university graduate presented with progressive unsteadiness during walking over the last year. She had been otherwise healthy apart from recent difficulty hearing her lecturer in classes. She took no prescription medication but had occasionally taken cocaine during her first year of college. She also admits to drinking up to 30 units of alcohol per week and smoked 10 cigarettes per day. Her parents were both well, but her father's sister had problems with walking before she died. Examination reveals normal tone and power throughout all four limbs. Reflexes were normal in the upper limbs but decreased at the knees and absent at the ankles. Coordination was normal in all four limbs but her gait was ataxic. Sensation in the upper limbs was normal but decreased vibratory sensation and proprioception was noted to the ankles bilaterally. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Friedreich's ataxia

      Explanation:

      Friedreich’s ataxia is an autosomal recessive disorder that usually begins before the end of the teens. It has an estimated prevalence in Europe of 1 in 50,000 and life expectancy is around 40-50 years. Neurological features include a progressive ataxia, cerebellar dysarthria, lower limb areflexia, decreased vibratory sensation and proprioception, and pyramidal weakness. Pes cavus and scoliosis are also both seen. Cardiomyopathy occurs in over 70% of cases. Less common features include optic atrophic, diabetes mellitus, and deafness.

    • This question is part of the following fields:

      • Nervous System
      0
      Seconds

  • Question 28 - A 60-year-old female who was on dexamethasone underwent abdominal surgery. Her blood sugar...

    Incorrect

    • A 60-year-old female who was on dexamethasone underwent abdominal surgery. Her blood sugar levels remained around 18 mmol/l during and after the surgery. Which of the following is the most suitable method to control her blood sugar level?

      Your Answer:

      Correct Answer: Insulin

      Explanation:

      She has steroid induced hyperglycaemia. She needs satisfactory glycaemic control to avoid post surgical infections. As she is in a stressful event following a major surgery, insulin is the best method to manage her hyperglycaemia.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      0
      Seconds

  • Question 29 - A 57-year-old male arrives at the clinic due to intermittent vertigo, tinnitus and...

    Incorrect

    • A 57-year-old male arrives at the clinic due to intermittent vertigo, tinnitus and hearing loss. Which of the following will be the best treatment option for this patient?

      Your Answer:

      Correct Answer: Buccal prochlorperazine

      Explanation:

      This patient’s history of intermittent attacks suggests Meniere’s disease. Meniere’s disease is a disorder of the inner ear that can lead to dizzy spells (vertigo) and hearing loss. In most cases, Meniere’s disease affects only one ear. Prochlorperazine can be used for complaints of nausea, vomiting and vertigo associated with Meniere’s disease. It is available as a tablet, injection and buccal preparation.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds

  • Question 30 - A 78-year-old retired journalist known to have prostatic carcinoma presents to the ED...

    Incorrect

    • A 78-year-old retired journalist known to have prostatic carcinoma presents to the ED complaining of pain in the spine and the onset of severe lower-leg weakness accompanied by a loss of sensation. On examination, he is found to have percussion tenderness of his spine, loss of sensation up to the umbilicus and a distended bladder. He has markedly reduced power of the lower legs with hyperreflexia. Which of the following should not be part of your management of this patient?

      Your Answer:

      Correct Answer: Spinal X-rays

      Explanation:

      Acute cord compression is a medical emergency. Typically, signs of segmental damage at the level of compression are usually combined with corticospinal tract dysfunction (e.g., hyperreflexia, Babinski’s sign and weakness) and sensory deficits below the level of compression. Symptoms include spinal pain that precedes the development of weak legs and sensory loss. There may be loss of bladder (and anal) sphincter control, manifesting as hesitancy, frequency and, finally, painless retention.
      Spinal X-rays are rarely diagnostic. MRI is usually the investigation of choice and should not be delayed, but if not available consider doing a CT scan and myelography to confirm cord compression and fully define the level and extent of the lesion. If malignancy is the cause, it is important to give dexamethasone (oral or intravenous) while considering therapy more specific to the cause.

    • This question is part of the following fields:

      • Nervous System
      0
      Seconds

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