MCQS 189-191:a patient with a pleural mass and a pleural effusion is noted to have a history of calcified pleural plaques

a patient with a pleural mass and a pleural effusion is noted to have a history of calcified pleural plaques. The pleural mass is most likely to be secondary to
a) Congestive heart failure
b) Hypoalbuminemia
c) Mesothelioma
d) Meigs' syndrome
e) Pulmonary embolization
f) Rheumatoid arthritis
g) Pancreatitis
h) Systemic lupus erythematosus
i) Pneumocystis pneumonia
j) Subphrenic abscess

A 10 day old baby girl with persistent neonatal jaundice has developed fever and is not feeding as well as normal. A bag of urine specimen shows red and white cells and a culture of mixed organisms. Antibiotic treatment is proving ineffective. Appropriate investigation should include.
a) Abdominal x-ray
b) Intravenous urogram
c) Renal cortical scintigraphy
d) Laparotomy
e) Urinary glucose test
f) voiding cystourethrogram
g) midstream urine sample
h) Serum creatinine
i) suprapubic aspiration
j) urodynamic testing

A middle aged man has weakness in his right arm for a few hours following a generalised seizure.
a) Migraine
b) Todd's paresis
c) transient ischaemic attack
d) metastases to the brain
e) Subdural haematomas
f) Middle cerebral artery infarction
g) paradoxical embolism
h) multiple sclerosis
i) posterior cerebral artery (PCA) ischaemia
j) vascular malformation

Correct Answer: C
The plain chest film may show pleural plaques associated with asbestosis before the onset of mesothelioma. Later, as the tumor develops, pleural effusion may appear and pleural thickening can become evident.
Correct Answer: I
Appropriate investigation should include. i) suprapubic aspiration In neonates (0-6 weeks), the preferred culture source is urine obtained by suprapubic aspiration (bladder tap). The Criteria for diagnosis of UTI from suprapubic aspiration culture is >10 cfu/mL. An alterative method of urine sampling for culture is bladder catheterization with criteria for diagnosis of UTI traditionally set at >1000-10000 cfu/mL of a single organism.
Correct Answer: B
Todd's paresis: focal weakness may follow generalised or focal motor seizures. Unless the seizure has taken place without being recognised (such as a nocturnal seizure) Todd's paresis should not present diagnostic confusion with stroke. It is uncommon for Todd’s paresis to persist for more than a few hours.


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