MCQS 280-282 :A 75-year-old farmer presents with pain in his right thigh and left upper arm


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


2 month old female is brought to the Casualty department with acute onset of loss of consciousness. On examination the child is unresponsive. A noncontrast CT of the head demonstrates an extensive area of edema involving the right cerebral hemisphere as well as the ACA territory of the left cerebral hemisphere. The bone windows also demonstrate a subdural hematoma. These features are suspicious of

a) Moya Moya disease
b) child abuse
c) migraine
d) aneurysmally dilated great vein of Galen
e) disseminated gonorrhea
f) encephalitis
g) thrombosis of a major dural sinus
h) medulloblastoma
i) pseudotumour cerebri
j) meningitis


A 75-year-old farmer presents with pain in his right thigh and left upper arm. The pain has been present for several months but has become worse. Examination reveals an enlarged and warm left humerus. His right leg is bowed Calcium: 2.34 mmol/l; PO43-: 0.9 mmol/l; ALP: 756 iu/L. Normal values for Calcium: 2.12-2.65mmol/l; Phosphate: 0.8-1.45mmol/l; ALP [Alkaline phosphatase] 30-300iu/L; Serum 25(OH) D: 20-105nmol/l; Urea: 2.5-6.7mmol/l; Creatinine: 70-120µmol/l

a) Osteoporosis
b) Thiazide diuretics
c) Skeletal metastases
d) Primary hyperparathyroidism
e) Hypoparathyroidism
f) Osteomalacia
g) Multiple myeloma
h) Paget's disease of bone
i) Sarcoidosis
j) Hyperthyroidism


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