SAQ/MCQ Practice

SAQ 1
• A 50 year old male patient presents to the Accident and Emergency
department with a history of haematemesis and melena for the past
3 days. He in hypotensive and tachycardia, there is stigmata of chronic
liver disease.

• a. List 4 possible causes of the patient's UGIB.

• b. List the pertinent investigations.
• b. Outline the patient's management.
SAQ 2
• A 32 year old female presents with uncontrolled hypertension with
severe headaches, nausea and confusion. On examination
papilledema and flame hemorrhages were noted. The blood pressure
was 200/100 mmHg.
• A. State 4 questions to be asked in the history that would help
determine the etiology of this condition
• B. State 4 investigations that you would request
• C. State 2 drugs that would be used to treat and the contraindications
SAQ 3
• A 58 year old man presents with acute confusion. On examination he
was noted to be jaundiced with a distended abdomen.
• A. State 4 likely etiologies
• B. Blood results later reveal a complete blood count, AST 3500, ALT
3700 AND INR of 2.7. What is the most likely etiology
• C. Devise a management plan based on the above answer
SAQ 4
You are called by a relatively inexperienced physician practising in a rural emergency department 3 hours from
your centre. He has just admitted a 22-year-old woman with type 1 diabetes who has confirmed diabetic
ketoacidosis.  On physical examination, she is oriented and in moderate distress. Vital signs are as follows:
blood pressure 95/55 mm Hg, heart rate 110 bpm, respiratory rate 22/min, temperature 37.2°C; oxygen
saturation is 99% on 2 L O2/min via nasal prongs. The physical examination is otherwise non-contributory. 
• Initial laboratory investigations reveal the following results: 
• pH 7.1
• pCO2 24 mm Hg
• pO2 99 mm Hg (99%)
• HCO3 8 mmol/L 
• Na 145 mmol/L
• K 4.4 mmol/L
• Cl 107 mmol/L
• Urea 25 mmol/L
• Creatinine 130 μmol/L
• Glucose 30 mmol/L 
• 1a. List FOUR general goals of initial treatment. (total marks, 4) 
• 1b. List THREE items of general information that you will provide to
the physician about managing the patient as her glucose level
normalizes. (total marks, 3) 
SAQ 5
• A 64 year old Afro – Trinidadian Male presents with increasing
forgetfulness. He reports on the history that is unable to feel the
vibration of his phone.
• What is the likely diagnosis
• List one other symptom that this patient may report
• List 4 signs this patient may have
• State three drugs that you start the patient
MCQ 1
• You are seeing your patient with polymyositis in follow up. He has been taking
prednisone at high doses for 2 months, and you initiated mycophenolate mofetil at
the last clinic visit for steroid sparing effect. He began a steroid taper 2 weeks ago.
His symptoms were predominantly in the lower extremities and face, and he has
improved considerably. He no longer needs a cane and his voice has returned to
normal. Laboratory data show a creatinine kinase (CK) of 1300 U/L, which is
unchanged from 2 months ago. What is the most appropriate next step in this
patient’s management?
• A. Continue current management
• B. Continue high-dose steroids with no taper
• C. Switch mycophenolate to methotrexate
• D. Repeat muscle biopsy
MCQ 2
• A patient complains of numbness in his neck. Over months, the numbness has become
more pronounced and involves a dense area bilaterally from the sternal notch to the
area behind the ear. On examination, scalp sensation, cranial nerve function, and upper
extremity motor examination are normal. The patient has decreased pain and
temperature sensation in the distribution of C4. Vibration sensations normal. Cranial
and caudal to the affected area, sensation is intact. Bladder and anal sphincter function
are also normal. What is the most likely cause of this patient’s neurological disorder?
• A. Amyotrophic lateral sclerosis
• B. Disc herniation
• C. Intramedullary tumor
• D. Knife or bullet injury
• E. Neurosyphilis
MCQ 3
• A 44-year-old man with a history of hypertension and Paget's disease has had lower
back pain for the past 3 months. The pain is worse with standing and improves with
sitting. Walking does not necessarily exacerbate his symptoms. He has no leg or
buttock pain. On examination, he has mild weakness on the right at the hip flexors,
knee extenders, and knee flexors and more distally to the same degree. Reflexives are
diminished in the right lower extremity. He has no sensory findings in the lower
extremities or in the perineum. What is the most likely diagnosis?
• A. Intervertebral disc herniation
• B. Lumbar spinal stenosis
• C. Metastatic malignancy
• D. Occlusive aortoiliac atherosclerosis
• E. Tethered cord syndrome
MCQ 4
• On the neurologic consultation service, you are asked to evaluate a patient with mesial
temporal lobe epilepsy syndrome. The patient has a history of intractable complex
partial seizures that rarely generalize. Her seizures often begin with an aura and
commonly manifest as behavioral arrests, complex automatisms, and unilateral
posturing. MRI findings include small temporal lobes and a small hippocampus with
increased signal on T2- weighted sequences. Which of these additional historic factors
are also likely to be present in this patient?
• A. History of febrile seizures
• B. Hypothyroidism
• C. Neurofibromas
• D. Recurring genital ulcers
• E. Type 2 diabetes mellitus
MCQ 5
• The patient in the preceding scenario was admitted with refractory
seizures. You are asked to see the patient and offer treatment
options. What treatment option will be the most efficacious in a
patient with mesial temporal lobe epilepsy (MTLE) syndrome?
• A. Acyclovir
• B. Amygdalohippocampectomy
• C. Levetiracetam
• D. Primidone
• E. Vagus nerve stimulation
MCQ 6
• A 56 year old woman is referred for progressive dysphagia for 3 years.
She has been experiencing minimal weight loss. She describes chest
tightness and regurgitation of undigested food. What is the most
likely diagnosis
• A- Peptic Stricture
• B- Candidiasis
• C- Achalasia
• D-Scelroderma esophagus
• E- Diffuse esophageal spasm
MCQ 7
• A 30 year old man complains of unilateral headaches. He was
diagnosed with migraine headaches at age 24. The headaches did not
respond to triptan therapy at the time, but after 6 week the
headaches resolved. He has had 3-4 spells of severe headaches since
then. Currently his headaches have been present for the past 2
weeks. The headaches start with a stabbing pain just below the right
eye. Usually the affected eye feels irritated and is accompanied by
lacrimation. It lasts about 60 -90 mins but he may have several
discrete episodes each day. Normal neurological exam. What is the
best approach to treat at this time?
• A. Prescribe oral sumatriptan for use at the onset of headache
• B. Prednisone 60 mg daily for 2 to 4 weeks
• C. Obtain MRI scan of the head with gadolinium contrast
• D. Begin Propranolol 20 mg bid
• E. Refer for neuropsychiatric testing
MCQ 8 AND 9
• Match each scenario to the appropriate antiepileptic drug treatment.
Each lettered option may be used once, more than once, or not at all
• A. IV lorazepam, 0.1 mg/kg
• B. IV fosphenytoin, 20 phenytoin equivalents/kg
• C. Carbamazepine, 200 mg po bid
• D. Phenytoin, 100 mg po tid
• E. Levetiracetam 500 mg po bid
• F. No treatment
MCQ 8
• A 67 year old woman is admitted because of witnessed generalized
seizure associated with urinary and fecal incontinence and followed bt
postictal confusion. She has recently been started on
hydrochlorothiazide for essential hypertension and is found to have
serum sodium level of 114 mEq/L. The neurological exam is nonfocal,
and neurological imaging studies are normal. A second seizure occurs
just as the infusion of 3% hypertonic saline is begun, but the patient
has no further neurological events after the serum sodium
concentration is corrected. She is now ready for discharge and has a
sodium level of 136 mEq/L. Her hypertension has responded to an
ACEi. What anti-epileptic drug regimen should be started ?
MCQ 9
• A 20 year old woman presents to the emergency department after a
witnessed seizure. She is a college student and had been awake most
of the previous night studying for her final examinations. One the
morning of admission she suffered a generalized seizure. There was
no warning aura and no evidence of focal weakness. The patient
denies a history of seizures as well as recreational drug use or alcohol
use. Her father has been on an unknown antiepileptic drug for many
years. The patient often has muscle twitches in the morning so severe
that she has dropped objects. CBC and electrolytes are normal. What
antiepileptic drug regimen should be recommended ?
MCQ 10
• A 50 year old diabetic, alcoholic man is brought to the emergency
department by the police after they found him lying in a pool of his
own urine on the side of the road downtown, not far from a bar. On
examination his is obtunded, BP 110/70, pulse 120, resp rate 20, o2
sat 95% on room air, mouth is dry, lungs have crackles in the right
axilla and right upper chest, heart is regular, abdomen somewhat
tense but bowel sounds present, extremities without edema, and
neurological exam non focal.
• Lab results as follows :
• Na : 122 mEq/L
• K : 3.5 mEq/L
• Cl : 100 mEq/L
• HCO3 : 5 mEq/L
• BUN : 40 m/dL
• Cr: 1.8 mg/dL
• Glucose : 800 mg/dL
• Serum osmolality : Elevated
• Serum ketones : Negative
• What is most likely the cause of this patients hyponatremia ?
• A. SIADH caused by the patient’s delirium tremens
• B. Primary polydipsia
• C. Adrenal crisis in the setting of sepsis
• D. Hyperglycemia – related hyponatremia
• E. Pseudohyponatremia