MCQS 265-267 :A man was admitted to the Emergency department with a known history of a gastric ulcer


A man was admitted to the Emergency department with a known history of a gastric ulcer.He complained of severe epigastric pain and discomfort. Perforation of the ulcer was suspected. In which other site did he most likely experience pain and discomfort?

a) fourth left intercostal space
b) junction between the body and xiphoid process of the sternum
c) fifth left intercostal space
d) just above the level of the sixth rib
e) second right intercostal space
f) right shoulder
g) The second costal cartilage
h) jugular notch
i) midclavicular line
j) mid-axillary line



A 55 year old woman complains to her general practitioner of a progressive difficulty of holding objects with her left hand. She also admitted to swallowing difficulties over the past 6 months. Examination demonstrates widespread lower motor neuron involvement. The most appropriate diagnostic test is

a) muscle biopsy
b) thyroid microsomal antibody titer
c) serum complement levels
d) radiograph of the wrist
e) erythrocyte sedimentation test
f) lumbar puncture
g) Cardiolipin antibody titer
h) Antinuclear antibody titer
i) electromyography
j) Congo red staining of carpal tissue biopsy


A 72 year old non-insulin dependent diabetic oral hypo glycemics for 12yrs develops progressive drowsiness. Laboratory evaluation reveals a very high plasma glucose, a pH of 7.4, a bicarbonate level of over 20mEq/L (elevated). Serum ketones are negative and ketonuria is absent. Serum osmolarity is very high and insulin levels are normal. A likely diagnosis is

a) keto acidosis
b) Nonketotic Hyperosmolarity
c) autonomic neuropathy
d) Hypoglycaemia unawareness
e) peripheral neuropathy
f) infection
g) Amytrophy
h) Focal nerve palsy
i) retinopathy
j) nephropathy


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