Try 5 free practice MCQs
Practice MCQ 1 · Surgery (Systemic)
A 27-year-old man presents to the emergency department with painful swelling of the right side of his scrotum after being struck during a football match 2 days ago. The swelling has progressively increased in size. On examination, the scrotum is tense and tender. The upper limit of the swelling is palpable and confined to the scrotum. Transillumination test is negative. There is no cough impulse. Which of the following is the most likely diagnosis?
- AHydrocele
- BInguinoscrotal hernia
- CVaricocele
- DTesticular torsion
- EHaematocele
Show the answer and explanation
Answer: E — Haematocele
The diagnosis is a haematocele, blood within the tunica vaginalis after blunt scrotal trauma. Two findings settle it: the swelling does not transilluminate, since blood is opaque, and the upper limit is palpable with no cough impulse, localising it to the scrotum and excluding an inguinal origin. Progressive enlargement over two days fits continued bleeding; management is scrotal ultrasound to exclude testicular rupture, with exploration if rupture or a large expanding collection is found. A hydrocele also gives a palpable upper limit but transilluminates brightly and is usually painless. An inguinoscrotal hernia has an impalpable upper limit and a cough impulse. A varicocele has a bag-of-worms texture, softer lying flat, unrelated to trauma. Testicular torsion causes sudden pain with a high-riding testis and absent cremasteric reflex, usually without trauma.
Practice MCQ 2 · Psychiatry
A 26-year-old woman presents to the psychiatry outpatient clinic with complaints of recurrent thoughts of contamination. She repeatedly thinks that her hands are dirty even after washing them multiple times. She reports that these thoughts are distressing and involuntary, and she spends hours daily washing her hands until the skin becomes sore. She is aware that her behaviour is excessive and irrational, but she is unable to control it. She denies hallucinations or delusions. Her mood is anxious, and daily activities are significantly impaired. Which of the following is the most likely diagnosis? (PGMI Recall)
- AGeneralised Anxiety Disorder
- BObsessive-Compulsive Disorder
- CSchizophrenia
- DHypochondriasis (Illness Anxiety Disorder)
- ESpecific Phobia
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Answer: B — Obsessive-Compulsive Disorder
This is obsessive-compulsive disorder. The obsessions are recurrent intrusive thoughts of contamination, experienced as involuntary, distressing and her own, and the compulsions are repetitive handwashing performed to neutralise the anxiety they generate. Features sealing the diagnosis are insight, in that she recognises the behaviour as excessive and irrational, the hours consumed daily, and the resulting impairment with excoriated skin. Treatment is an SSRI at higher doses than for depression, with exposure and response prevention. Generalised anxiety disorder produces free-floating worry without ritualised neutralising behaviour. Schizophrenia requires hallucinations or delusions held without insight, and she has neither. Illness anxiety disorder centres on fear of serious disease and drives reassurance-seeking rather than washing rituals. A specific phobia produces anxiety only on confronting the feared object, managed by avoidance, not compulsions.
Practice MCQ 3 · Respiratory
A 32-year-old man is brought to the emergency department after a high-speed collision. He appears pale, diaphoretic, and confused. His vital signs show blood pressure 80/50 mm Hg, pulse 135/min, and respiratory rate 28/min. On examination, his abdomen is distended and diffusely tender, and bedside ultrasound shows free fluid in the abdominal cavity. He is started on intravenous fluids and blood transfusion. After initial stabilisation, the physician wants to assess whether circulatory volume and tissue perfusion have been adequately restored. Which of the following is the most reliable indicator of adequate resuscitation in this patient? (PGMI Recall)
- ASystolic blood pressure
- BHeart rate
- CUrine output
- DCentral venous pressure
- ERespiratory rate
Show the answer and explanation
Answer: C — Urine output
Resuscitation is judged by organ perfusion, not monitor numbers. Urine output is the bedside measure of renal blood flow; a sustained output of about 0.5 mL/kg/hour means the kidney is again perfused, and since it integrates flow over time it cannot be produced by a transient reading. This man needs an indwelling catheter and hourly measurement alongside bleeding control. Systolic pressure is maintained by vasoconstriction until roughly a third of blood volume is lost, so a normal reading can conceal ongoing haemorrhage. Heart rate is confounded by pain, fear, alcohol and beta-blockade. Central venous pressure reflects filling pressure rather than flow and predicts fluid responsiveness poorly. Respiratory rate rises with anxiety and acidosis, and is not specific.
Practice MCQ 4 · Surgery (Systemic)
A 64-year-old man presents with fatigue, weight loss, and intermittent painless haematuria for 3 months. He has a 40-pack-year smoking history. On examination, his blood pressure is 165/95 mmHg, and a right-sided flank mass is palpable. Laboratory studies show: haemoglobin 18.5 g/dL, serum calcium 11.8 mg/dL. CT scan reveals a heterogeneous enhancing mass in the right kidney with extension into the renal vein. Which of the following is the most likely diagnosis? (PGMI Recall)
- ATransitional cell carcinoma of bladder
- BRenal cell carcinoma
- CWilms tumour
- DPolycystic kidney disease
- EOncocytoma
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Answer: B — Renal cell carcinoma
Painless haematuria, a flank mass and loin pain form the classic triad of renal cell carcinoma, and the paraneoplastic findings clinch it. Tumour erythropoietin explains a haemoglobin of 18.5 g/dL, parathyroid hormone-related peptide explains the hypercalcaemia, and renin secretion contributes to hypertension. Its propensity to invade the renal vein and grow as a tumour thrombus towards the inferior vena cava, as shown here, is critical to surgical planning for radical nephrectomy. Transitional cell carcinoma also causes painless haematuria and links to smoking, but arises in the urothelium, presenting as a filling defect rather than a solid mass, without erythrocytosis or venous thrombus. Wilms tumour affects young children. Polycystic kidney disease gives bilateral cystic kidneys with a family history. Oncocytoma is benign and does not invade the renal vein.
Practice MCQ 5 · Surgery (General)
A 22-year-old man presents to the emergency department with worsening pain and discharge from a wound on his forearm. He sustained a laceration 4 days ago during a fall and received initial care from paramedics, who cleaned the wound and applied a tight bandage. Over the past 2 days, he has developed increasing pain, swelling, and a foul-smelling discharge soaking through the bandage. He also reports mild fever. On examination, the wound appears moist with purulent discharge and a characteristic greenish discolouration. There is surrounding erythema and tenderness. Which of the following is the most likely causative organism? (PGMI Recall)
- AStaphylococcus aureus
- BStreptococcus pyogenes
- CClostridium perfringens
- DPseudomonas aeruginosa
- EEscherichia coli
Show the answer and explanation
Answer: D — Pseudomonas aeruginosa
This is a wound infection with Pseudomonas aeruginosa, favoured by a tight occlusive bandage over a moist four-day-old laceration. Pseudomonas is an aerobic Gram-negative rod that thrives in damp, macerated tissue under occlusive dressings; it produces pyocyanin and pyoverdine, giving the blue-green discolouration, and its exudate has a characteristic odour. Management is removing the dressing, debridement and an antipseudomonal agent such as ciprofloxacin or piperacillin-tazobactam. Staphylococcus aureus gives thick creamy pus and localises into an abscess rather than green exudate. Streptococcus pyogenes causes spreading serous cellulitis with lymphangitis, not green discharge. Clostridium perfringens causes gas gangrene with crepitus and thin dishwater fluid; he is too well for that. Escherichia coli is expected in perineal wounds, not a forearm laceration.