1. A 60-year-old man presents with an episode of memory loss.Three days
earlier he had become confused. His wife led him into the house where he
apparently sat down at her request and had a cup of tea. He then wandered
around the house confused, but remained conscious and able to have some
conversation with his wife, though continuing to ask similar questions
repeatedly.After three hours, he abruptly returned to normal and had no
recollection of the events.What is the most likely diagnosis?
A. Transient global amnesia
B. Chronic subdural haematoma
C. Hysterical fugue state
D. Complex partial status epilepticus
E. Alcohol related amnesia
Answer: A
Explanation: Key learning points
Emergency Medicine, Geriatrics, Miscellaneous, Neurology
● Transient global amnesia lasts less than 24 hours and normal cognition and
an awareness of personal identity is retained
Explanation
This is the typical clinical description of transient global amnesia which represents a
transient vascular insufficiency of both hippocampi.
This is a rare condition which usually affects people over the age of 50. It lasts less
than 24 hours and an awareness of personal identity is retained, along with normal
cognition.
Reference:
GM Journal: Trasient Global Amnesia
Mayo Clinic. Transient Global Amnesia.
,2. Which of the following is the minimum dataset for identifying a patient and a
sample for purpose of a non-emergency blood transfusion?
A. The full name, gender and patient identity number
B. The full name, gender, address and patient identity number
C. The full name, date of birth and patient identity number
D. The full name, gender, previous blood grouping details, address and patient
identity number
E. The full name and gender
Answer: C
Explanation:
Key learning points
Haematology
● Minimum data set for transfusion include Full name, Date of Birth, Patient
identity number and, in some areas, Address.
Explanation
Given that the largest number of errors and near misses occur because of
mislabelling or mistaken identity of patient or the sample, a minimum data set is
prescribed for transfusion requests.
This involves recording the:
● Full name
● Date of birth
● Patient identity number, and
● Address (in some areas, such as Wales).
Previous blood grouping details are not required and missing elements of this
minimum dataset are not acceptable in the transfusion service.
Reference:
British Committee for Standards in Haematology. Guideline on the Administration of
Blood Components.
3. A 17-year-old female presents with three headaches over a six month period. She
describes the headaches as severe, right-sided and lasting for twelve hours and
,associated with nausea and photophobia. Each is preceded by spots before her
eyes.
What is the most appropriate initial treatment for this patient?
A. Prophylaxis with propranolol
B. Ergotamine suppository at the onset of the next attack
C. Paracetamol plus metoclopramide at the onset of the next attack
D. Diclofenac at the onset of the next attack
E. Sumatriptan at the onset of the next attack
Answer: E
Explanation: Key learning points
Neurology, Pharmacology
● NICE guidelines state that an oral triptan and an NSAID or paracetamol
should be used for the acute treatment of migraine.
Explanation
This history is consistent with a migraine.
NICE guidelines state that an oral triptan and an NSAID or paracetamol should be
used for the acute treatment of migraine. If these are not tolerated or ineffective,
non-oral preparations of metoclopramide, prochlorperazine, NSAIDs or triptans can
be used.
Prophylactic topiramate or propranolol can be used if the attacks are numerous or
debilitating. Topiramate is associated with foetal malformations, and therefore it
should be offered in conjunction with appropriate contraception.
Reference:
NICE. Headaches (CG150).
4. A 16-year-old boy presented with fever, headache, and neck stiffness for 24
hours. He had an identical illness requiring admission to hospital one year
previously.
Cerebrospinal fluid analysis shows white cells of 400/ml with a 90% neutrophilia and
Gram stain revealed scanty Gram-negative diplococci.
, Which component of the immune system is likely to be defective?
A. Neutrophils
B. Immunoglobulin
C. B lymphocytes
D. Complement pathway
E. T lymphocytes
Answer: D
Explanation: Key learning points
Clinical Sciences, Immunology, Infectious Diseases, Microbiology
● Deficiencies of complement C5-9 predispose to disseminated Neisseria
infections.
Explanation
This young man has a recurrent meningococcal meningitis, and deficiencies of
complement C5-9 predispose to disseminated Neisseria infections (complement
deficiencies). Deficiency of C3 also predisposes to infection by encapsulated
organisms, such as Neisseria or Pneumococcus.
One must recognise that the diplococci seen on microscopy are those of Neisseria
meningitidis.
5. A 35-year-old lady presents for follow up for a right-sided Colles' fracture. This
was sustained following a slip in the kitchen at home. You are suspicious given the
apparent low velocity mechanism of injury.
Which of the following measurements would correspond to a diagnosis of
osteoporosis?
A. T-score −2.5
B. T-score −1.5
C. Z-score −2.0
D. None of the above
E. Z-score −1.5
Answer: A
Key learning points
earlier he had become confused. His wife led him into the house where he
apparently sat down at her request and had a cup of tea. He then wandered
around the house confused, but remained conscious and able to have some
conversation with his wife, though continuing to ask similar questions
repeatedly.After three hours, he abruptly returned to normal and had no
recollection of the events.What is the most likely diagnosis?
A. Transient global amnesia
B. Chronic subdural haematoma
C. Hysterical fugue state
D. Complex partial status epilepticus
E. Alcohol related amnesia
Answer: A
Explanation: Key learning points
Emergency Medicine, Geriatrics, Miscellaneous, Neurology
● Transient global amnesia lasts less than 24 hours and normal cognition and
an awareness of personal identity is retained
Explanation
This is the typical clinical description of transient global amnesia which represents a
transient vascular insufficiency of both hippocampi.
This is a rare condition which usually affects people over the age of 50. It lasts less
than 24 hours and an awareness of personal identity is retained, along with normal
cognition.
Reference:
GM Journal: Trasient Global Amnesia
Mayo Clinic. Transient Global Amnesia.
,2. Which of the following is the minimum dataset for identifying a patient and a
sample for purpose of a non-emergency blood transfusion?
A. The full name, gender and patient identity number
B. The full name, gender, address and patient identity number
C. The full name, date of birth and patient identity number
D. The full name, gender, previous blood grouping details, address and patient
identity number
E. The full name and gender
Answer: C
Explanation:
Key learning points
Haematology
● Minimum data set for transfusion include Full name, Date of Birth, Patient
identity number and, in some areas, Address.
Explanation
Given that the largest number of errors and near misses occur because of
mislabelling or mistaken identity of patient or the sample, a minimum data set is
prescribed for transfusion requests.
This involves recording the:
● Full name
● Date of birth
● Patient identity number, and
● Address (in some areas, such as Wales).
Previous blood grouping details are not required and missing elements of this
minimum dataset are not acceptable in the transfusion service.
Reference:
British Committee for Standards in Haematology. Guideline on the Administration of
Blood Components.
3. A 17-year-old female presents with three headaches over a six month period. She
describes the headaches as severe, right-sided and lasting for twelve hours and
,associated with nausea and photophobia. Each is preceded by spots before her
eyes.
What is the most appropriate initial treatment for this patient?
A. Prophylaxis with propranolol
B. Ergotamine suppository at the onset of the next attack
C. Paracetamol plus metoclopramide at the onset of the next attack
D. Diclofenac at the onset of the next attack
E. Sumatriptan at the onset of the next attack
Answer: E
Explanation: Key learning points
Neurology, Pharmacology
● NICE guidelines state that an oral triptan and an NSAID or paracetamol
should be used for the acute treatment of migraine.
Explanation
This history is consistent with a migraine.
NICE guidelines state that an oral triptan and an NSAID or paracetamol should be
used for the acute treatment of migraine. If these are not tolerated or ineffective,
non-oral preparations of metoclopramide, prochlorperazine, NSAIDs or triptans can
be used.
Prophylactic topiramate or propranolol can be used if the attacks are numerous or
debilitating. Topiramate is associated with foetal malformations, and therefore it
should be offered in conjunction with appropriate contraception.
Reference:
NICE. Headaches (CG150).
4. A 16-year-old boy presented with fever, headache, and neck stiffness for 24
hours. He had an identical illness requiring admission to hospital one year
previously.
Cerebrospinal fluid analysis shows white cells of 400/ml with a 90% neutrophilia and
Gram stain revealed scanty Gram-negative diplococci.
, Which component of the immune system is likely to be defective?
A. Neutrophils
B. Immunoglobulin
C. B lymphocytes
D. Complement pathway
E. T lymphocytes
Answer: D
Explanation: Key learning points
Clinical Sciences, Immunology, Infectious Diseases, Microbiology
● Deficiencies of complement C5-9 predispose to disseminated Neisseria
infections.
Explanation
This young man has a recurrent meningococcal meningitis, and deficiencies of
complement C5-9 predispose to disseminated Neisseria infections (complement
deficiencies). Deficiency of C3 also predisposes to infection by encapsulated
organisms, such as Neisseria or Pneumococcus.
One must recognise that the diplococci seen on microscopy are those of Neisseria
meningitidis.
5. A 35-year-old lady presents for follow up for a right-sided Colles' fracture. This
was sustained following a slip in the kitchen at home. You are suspicious given the
apparent low velocity mechanism of injury.
Which of the following measurements would correspond to a diagnosis of
osteoporosis?
A. T-score −2.5
B. T-score −1.5
C. Z-score −2.0
D. None of the above
E. Z-score −1.5
Answer: A
Key learning points
