Example MCQ & EMQ

EXAMPLE OF AN MCQ QUESTION - SINGLE BEST ANSWER (BEST OF FIVE)

Mr Peterson is a 72-year-old retired carpenter. His brother recently died of a heart attack at the age of 75 and Mr Peterson comes to see you to request a check up. He claims to be fit and well, and walks his puppy dog for an hour every day on the Moors. He denies any chest pain or shortness of breath and is on no medication. On examination, he has a good volume pulse at 78 beats per minute and blood pressure is 122/68 mmHg. You hear an ejection systolic murmur at the left sternal edge. There are no murmurs at the carotids. What is the most likely diagnosis?

1. Aortic stenosis
2. Aortic sclerosis
3. Pulmonary valve stenosis
4. 'Flow' murmur
5. Hypertrophic obstructive cardiomyopathy

Answer: 2
While all the options are associated with an ejection systolic murmur, it is the additional clinical features that aid diagnosis. This is a fit 72-year-old man with no angina or dyspnoea; therefore functional valve disease or left ventricular outflow obstruction is unlikely. This rules out options 1, 3 and 5. Aortic sclerosis is a thickening of the aortic valve - very common with advancing age - and can be differentiated from stenosis by the absence of radiation to the carotid arteries. While flow murmurs are also benign and commonly detected on examination, they are a result of turbulent flow associated with a hyperdynamic state e.g. anxiety, sepsis or pregnancy. Since the pulse rate and blood pressure are not elevated, a flow murmur is unlikely.

EXAMPLE OF AN EMQ QUESTION

Options

1. Mesenteric adenitis
2. Inflammatory bowel disease
3. Acute appendicitis
4. Henoch-Schonlein purpura
5. Urinary tract infection
6. Constipation
7. Intussusception
8. Peptic ulcer
9. Renal stones
10. Bowel obstruction

    Questions
    Pick the most likely diagnosis for each of the following scenarios.

    1. An 8 year old boy has lost his appetite and had central abdominal pain which has now radiated to the right iliac fossa.
    2. A child complains of abdominal pain and has a purpuric rash on the buttocks with some joint pains.
    3. A 4-month-old girl has a recent episode of gastroenteritis. Now she has episodic screaming and pallor. There is some passage of blood and mucous in the stool. Ultrasound shows a ‘doughnut sign’.
    4. A 15 year old boy has had pains most nights for at least a month. He is afebrile. The pains are eased by drinking milk.
    5. The patient has recurrent abdominal pain and malabsorption.

       Answer

       1. a. = 3
       2. b. = 4
       3. c. = 7
       4. d. = 8
       5. e. = 2