January 5th, 2012
A 37 year old intravenous drug user is referred by his GP for a suspected Bells Palsy. On examining his inner ear there are a number of vesicles visible on his ear drum. His cranial nerve examination reveals a weakness of the whole of the left side of his face.
The most likely diagnosis is:
a. Steven Johnson Syndrome
b. HIV
c. Stroke
d. Ramsay Hunt Syndrome
e. Bells Palsy
Leave your answer as a comment below – answer in a few days!
December 30th, 2011
Medical student in hot water?
We always enjoy stories about medical students getting up to fun and frolics over the festive period but it seems that an unfortunate incidence at the 9/11 memorial in New York has left one medical student in the US facing jail.
Meredith Graves, 39, from Tennessee apparently had a permit for the gun, a .32 calibre pistol for her home state. On asking a guard where she could check her hand-gun, she was promptly arrested leading to a flurry of comments from the on-line community about the rights and wrongs of being jailed over such actions.
Her mother in law is quoted as saying the following.
Everyone down there carries, and she just forgot. She was being honest, and this is the treatment they give innocent people.
Be careful when approaching an armed medical student?
We’re a little worried about the slightly more serious prospect of being confrunted by an armed medical student at a job interview or on a post-take ward round. It brings a whole new tact to the question “is that fast-slow AV-NRT or slow-fast AV-NRT”. One of Medical Educator’s contributors had the following to say.
It makes a change hearing about students getting into problems with social media. Two thoughts. One: what’s the stupidest thing you have taken to a job interview (a gun would be up there, although could prove useful for some competitive specialities). Two: is jail the right thing. I can’t imagine what my own institutions fitness to practice committee would say about it. But jail?
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Footnote
*We think that most people that claim to know the difference between these forms of atrio-ventricular nodal re-entrant tachycardia are either (1)lying (2)trainee cardiologists (3)deluded.
October 20th, 2011
Well done to those who answered correctly, and comisserations tho those who got caught out… the correct answer to this question was:
g. Guillain Barre Syndrome
See why it was Guillain Barre Syndrome below. Check your hypothesis against the clinical signs:
| Tone |
any sign of UMN lesion or hypotonia (cerebellar?) NO
but there is some reduced tone in the left arm: |
| Power |
He is weak and its come on over the past few days: this is classical of GBS: an ascending peripheral motor and sensory poylneuropathy. |
| Coordination |
Normal: as expected |
| Sensation |
Normal: So can it still be GBS???
YES! The sensory signs are often vary vague: there may be only back pain as the presenting feature. |
| Reflexes |
Clinical tip: no reflexes suggests a lower motor neurone problem. Could it me MND? Very unlikely: there’s only LMN signs and the onset of the illness is too acute. |
| Other things |
GBS: measure the Forced Vital Capacity:
If this is low: the patient may need ventilation.
Also remember: cardiac conduction deficits (monitor the patient on a cardiac monitor) |
Remember FVC monitoring in GBS.
Get more free questions here!
October 19th, 2011
MedicalEducator.co.uk has teamed up with the Medical Protection Society to offer some free OSCE revision resources for their new Facebook pages. Best of all the resources are completely free, and require no login.
One of our testing medical students said the following about the resources:
“They are simple to use, well-structured and take you through a mock clinical case. They throw in a few curveballs just like you get in the OSCE stations”.
Medical students need exposure to cases. These resources provide an easy way for you to test out some of your clinical knowledge in 14 or so different areas. The cases have input from specialties and from a general practice perspective so you get a little internal medicine, a little dermatology, cardiology, paediatrics, pharmacology, endocrinology, surgery…. a little bit of everything!
One of our Medical Specialist contributors commented:
“I examine medical students in OSCE examinations, the last ones I did were October 2011. It’s clear that stress plays a big part in how students can approach OSCE exams, hopefully this provides a little bit of a taster for the sorts of questions you can get in medical final examinations. We hope its good practice, and a free resource like this can only be good news for students.
Find all the resources on the MPS Facebook pages here.
September 21st, 2011
A 44 year old builder presents with weakness over the past 48 hours.
A neurological exam reveals the following (N=normal):
|
Upper Limbs
|
|
|
Lower Limbs
|
|
|
Right
|
Left
|
|
Right
|
Left
|
|
Tone
|
N
|
reduced
|
|
N
|
N
|
|
Power (MRC)
|
4/5
|
4/5
|
|
3/5
|
4/5
|
|
Coordination
|
N
|
N
|
|
N
|
N
|
|
Sensation
Fine touch
Proprioception
|
N
N
|
N
N
|
|
N
N
|
N
N
|
|
Reflexes Biceps
Reflexes triceps
Reflexes supinator
|
- (absent)
- (absent)
+
|
- (absent)
- (absent)
+ with reinforcement
|
Knee
Ankle
Plantar
|
- (absent)
- (absent)
down
|
- (absent)
- (absent)
down
|
Which of the following is the most likely diagnosis?
a. Polio
b. Motor Neurone disease
c. Myasthenia gravis
d. Stroke
e. Multiple sclerosis
f. Creutzfeldt Jacob disease
g. Guillain Barre Syndrome
Leave your answers as comments, and we will give you the full professional medical answer in a few days!
Remember, for more MCQs check out our free question bank here.
