Medical MCQs,GUIDELINES and Books

A 2 year old girl presented with a 12-hour history of fever and poor feeding. The family owned two cats. Her temperature was 39.5°C, and she was irritable, with no localising signs or skin lesions. A full septic screen was performed. Cerebrospinal fluid (CSF) showed a neutrophilic pleocytosis and gram-negative coccobacilli. She was treated with intravenous cefotaxime and gentamicin. Within 24 hours both CSF and blood cultures showed growth of gram-negative bacilli.
What is the likely infective organism?

A. Legionella pneumophilia
B. Haemophilus influenzae
C. Pasteurella multicoda
D. E coli
E. Pseudomonas aeruginosa

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A 65 year old gentleman with type 2 diabetes mellitus is found incidentally to have left bundle branch block on his ECG. It had not been present on previous ECGs. An ECHO reveals no structural abnormality. You want to exclude a myocardial infarct. What investigation should be performed in the first instance?
1- Thallium perfusion scan
2- Exercise tolerance test
3- Coronary angiography
4- CT angiography
5- Repeat ECG

A 62 year old has had two syncopal episodes. She complains of intermittent palpitations. There is nil of note on examination and her bloods are normal. What is a useful first investigation ?

1- Echocardiogram
2- EEG
3- 24 hour ECG
4- Exercise tolerance test
5- Nil required

Good Evening Life Savers

A 64 year old male presents unwell. He has been suffering from vomiting and diarrhoea for the last few days and has been unable to eat and drink. He is normally well although does suffer from type 2 diabetes mellitus which is normally well controlled. He is currently only on metformin. On examination he is tachycardic and tachypnoeic. There is nil else of note. Bloods reveal an elevated urea (11.0 mmol/L) and creatinine (190 mmol/l) and a bicarbonate of 16mmol/l. An arterial blood gas reveals hydrogen ions of 55. The anion gap is elevated. Urinalysis reveals protein+ but nil else. What is the most likely cause ?

Hyperosmolar Hyperglycaemic Non-Ketotic Coma
Diabetic ketoacidosis
Sepsis
Lactic Acidosis
Acute Renal Failure