MCQS 199-201:A 19-year-old tennis player has a swollen right knee which gives way for 2 months

A middle aged bus driver takes a few days off work a week following the death of his mother. He feels some guilt about not having visited his mother in hospital the week before she died unexpectedly. He returns to work the following week and although more quiet than usual he goes about his daily work as normal. The feelings of guilt he felt the week after his mother passed away are best described as
a) panic disorder
b) Seasonal affective disorder
c) adjustment disorder
d) schizophrenia
e) familial depression
f) psychosomatic disorder
g) bereavement
h) dysthymia
i) clinical depression
j) Bipolar depression

A 19-year-old tennis player has a swollen right knee which gives way for 2 months. Examination reveals quadriceps wasting and tenderness in the medial aspect of the joint . An X-ray of the knee shows a bony defect in the tibial plateau. A likely aetiology is
a) Systemic lupus erythematosus
b) Osteoarthritis
c) Reiter's disease
d) Gouty arthritis
e) Pseudogout
f) Ankylosing spondylitis
g) Psoriatic arthropathy
h) Polymyalgia rheumatica
i) Septic arthritis
j) Osteochondritis dissecans
A 65 year old farmer presents with a week's history of frank hematuria. On examination he is found to be febrile and his blood pressure is elevated. An IVP is unremarkable. Cystoscopy reveals a polypoid mass at the right ureteric orifice. A biopsy is performed. The expected diagnosis is:
a) urethral stricture
b) pyelonephritis
c) papillary necrosis
d) recto-vesical fistula
e) ureterocoele
f) ureteric colic
g) transitional cell carcinoma
h) squamous cell carcinoma
i) posterior urethral valves
j) vesico-uereteral reflux
Correct Answer: G
Grief is a natural reaction to losses in life. It often involves sadness, lethargy, and in serious cases such as the death of a loved one, despair, anger, insomnia, unusual weight loss or gain, obsessions with the lost person, and terrible guilt about any problems in the depressed person's relationship with the deceased individual. What makes these reactions fall within a normal range is that people eventually recover. Beavement may also take the form of lethargy, and in serious cases such as the death of a loved one, despair, anger, insomnia, unusual weight loss or gain, obsessions with the lost person. Grief or bereavement is the most common of the normal reactions to a loss or separation, such as the death of a loved one, divorce, or romantic disappointment. Bereavement and loss don't generally cause persistent, incapacitating depression except in people predisposed to mood disorders.
Correct Answer: J
Osteochondritis dissecans refers to an osteochondral fracture in an otherwise previously healthy or ischaemic bone that has resulted in non-union. The knee is the most commonly affected joint followed by the ankle. Trauma is the main causative factor in osteochondritic lesions. It also affects the hips and elbows. It is occasionally multiple and familial. The patient, usually a young adult, presents with pain and swelling in the joint. A loose body may cause the knee to lock or 'give way'. An X-ray of the knee normally shows the defect. Treatment is not always necessary. A simple supporting bandage may be adequate. An established loose body requires removal. Prognosis is reasonably good, however if the lesion is extensive, the defect in the joint surface may result in osteoarthritis later in life
Correct Answer: G
Hematuria and irritative bladder symptoms, such as dysuria or urinary frequency, are the most common presenting symptoms of bladder cancer. Most patients have hematuria, which is frequently gross but occasionally microscopic. The hematuria can be episodic. Irritative urinary symptoms, such as urgency, dysuria, and frequency without hematuria, particularly in the absence of infection, should lead to an evaluation for bladder cancer. Larger tumors may cause bladder outlet obstruction or ureteral obstruction resulting in hydronephrosis. Bilateral ureteral obstruction leading to azotemia is rare. Bladder tumors may cause pelvic pain by infiltrating regional nerves or bone, may cause lymphedema as a result of lymphatic obstruction from lymph node metastasis, or may present as manifestations of metastatic disease to bone, lungs, or liver. If bladder cancer is suspected, an intravenous pyelogram (IVP) should be undertaken to locate filling defects in the bladder and in the upper tracts. In addition, cystoscopy should be performed to locate the tumor and to facilitate biopsy for pathologic confirmation and to determine depth of invasion. Urinary cytologic analysis is a useful adjunct in the initial assessment and follow-up evaluation. Newer tests including an evaluation of the urine for bladder cancer antigens, such as bladder tumor antigen and nuclear matrix protein 22, and the genetic fingerprinting of exfoliated cells is under study. Evaluation of metastatic sites is essential, including abdominal pelvic CT, chest radiograph, and bone scan.


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