INTRODUCTION TO THE MCQ

EXAM

Dr Cintia Fornaso

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MULTIPLE CHOICE QUESTION :
• Best Tip:
ALWAYS read FIRST the Question.
First step – Next – Best – Gold standard
Most likely Dx -

• Then the Stem.

Looking for clues or prompts.

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Stem:
• Take into account ALWAYS:
• Gender
• Age
• Background – Family Hx
• Setting – Role you are in.
• Distance from Tertiary hospital – Specialist treatment
• Previous Medical History
• SAD (Smoking – Alcohol – Drugs)
• Main Symptom or complaint.
• Associated or secondary symptoms

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MCQ checklist:
Gender Age Background- Setting/ Main Added Positive Q?
Group Px Hx distance complaint symptoms: findings-

M/ F Infant HT- DM- gout- .Gp practice - Abd Pain -Hypotension Xray Mx?
Child Asthma- .Rural - Chest Pain -Melena Lab
Teen allergies hospital - Etc. -Jaundice Ct-scan Dx?
-Oedema
Adult BMI- .Tertiary Ultrasound
-Vomiting
Elderly Aboriginal- hospital
-Diarrhoea
European -HT
descent- Intern -SOB
Medication- GP -bleeding
Previous EM doctor -etc.
surgery-
SAD

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DIFFERENTIAL DIAGNOSIS:

Gender Age Background- Setting/ Main Added Positive Q?

Group Px Hx distance complaint symptoms: findings-

M/F Infant Abdominal Dx?

Child (1) Pain (2)
Teen (3)
Adult
Elderly

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 • Nausea
ABDOMINAL PAIN: • Vomiting

Patient background or history: Associated • Fever

symptom: • Bloody stools
• Age / sex. • Hypotension / HT
• FX HX
• DM
• Previous surgery or
hospitalization • Skin conditions/
• Medication: Antibiotics manifestations
• Travel Hx • Jaundice
• Descendent - Heritage
• Anaemia
• Social economical level
• Location - occupation • Oedema
• Pregnancy / fertile ? • Bloating
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 • Mesenteric adenitis.
ABDOMINAL PAIN :
• Gastroenteritis.
MEDICAL • Constipation.
SURGICAL CAUSE :
CAUSE: • UTI
• Appendicitis. • Hepatitis.
• Meckel’s diverticulitis. • HS purpura.
• Peritonitis.
• Diabetic ketoacidosis.
• Intestinal obstruction.
• Pneumonia.
• Inguinal hernia.
• Tonsillitis.
• Testicular torsion.
• Trauma: Including child abuse. • Meningitis.
• Ectopic pregnancy/ PID • Endometriosis

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 • MCQ 1

Sex Age Background- Main Added Findings Q?

Group Px Hx complaint symptoms
M Infant Diarrheal Abdominal Screaming Ph Ex: sausage Dx?
(5mths) episode a Pain Vomiting shaped mass
week ago Pale in RUQ.
Blood stained Lethargic
nappy Anxious Xray as shown.
unwell

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 A- Duodenal Atresia
• MCQ 1
B- Pyloric stenosis

OPTIONS GIVEN ARE: C- GORD

D- GI infection
E- Intussusception

INTUSSUSCEPTION:
Distal ileum telescopes into distal bowel.
3 months-1 yo
Intestinal obstruction

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 • MCQ 2

Sex Age Px Hx Main complaint Added symptoms Positive Question?

Group findings-
M 3 weeks nil Projectile vomiting Gastric peristalsis Pyloric Most likely
old Milk stained clearly visible in tumour cause?
Baby appears abdominal wall. Feed test
HUNGRY (+)

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• MCQ 2
A- Duodenal Atresia
B- Pyloric Stenosis

OPTIONS GIVEN ARE: C- GORD

D- GI Infection
E- Intussusception

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When VOMITING is the main symptom in an infant:

GREEN/BILE stained: MILK stained:

• Duodenal atresia. • Pyloric Stenosis

• Small bowel obstruction. • GORD
• Sepsis. • Infection: UTI, Otitis Media.
• Infection: UTI, Otitis media.

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Sex Age Group Px Hx Main complaint Positive findings- Q?

M 3 weeks old nil Projectile vomit Gastric peristalsis clearly First step in
stained with milk visible in abdominal wall. MX?
Baby appears Pyloric tumour
hungry Feed test (+) Moderate Best Step in
But lethargic. dehydration MX?

VBG =
Alkalosis
low chloride
low potassium.

Vomiting: Loss of water and HCl (hydrochloric acid)

Kidneys initially conserve H⁺ (hydrogen).
With dehydration : water and Na⁺(sodium) are conserved in exchange for H⁺ and K⁺(potassium).
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OPTIONS GIVEN ARE:
A- Admit to hospital for treatment
B- Refer to Paediatric Surgeon
C- Send home with rehydration formula
D- Metoclopramide IV to stop vomiting
E- Rehydrate through a NG cannula

First step: Best step in mx:

ADMIT for immediate treatment of Surgery: Refer to paediatric
dehydration and electrolyte surgeon for Pylorotomy.
imbalance.
IV fluid replacement: 0.45% (1/2
excellent prognosis.
normal saline) with 5% dextrose.
+ Potassium
when Px. is urine output is restored

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 • MCQ 3
Sex Age Background-Px Hx Main Added Positive Question?
complaint symptoms findings-
Fem 35yo -Irish background Diarrhoea for Bloating after Explosive liquid Most likely
-Travelled to UK to visit weeks some foods. morning stools suspected DX?
family 3 weeks ago No fever. with mucous.
-no medication Seems pale Feels better after
-natural laxative Complains of defecation.
frequently tiredness
-no previous Hx of surgery
or hospitalization
-Lives in QLD on a cattle
farm with her 2 young
children and husband
-case worker/nurse for
aboriginal children at the
community centre.

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• MCQ 3

A- Travellers diarrhoea
B- Coeliac disease
C- Infectious gastroenteritis
OPTIONS GIVEN ARE:
D- IBS
E- Colonic Carcinoma

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 • MCQ 3
Sex Age Background-Px Hx Main complaint Added symptoms Positive findings- Question?

F 35 -Irish background Diarrhoea Bloating after Explosive liquid DX?

-Travelled to UK to visit for weeks some foods. morning Stools
family No fever. with mucous.
-no medication (natural Pale Feels better after
laxative frequently) Tired defecation.
-no previous Hx of
surgery or
hospitalization
-Lives in QLD on a cattle
farm with her 2 young
children and husband,
-case worker/nurse for
aboriginal children at
the community centre.

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• MCQ 4

Sex Age Background-Px Hx Main Added Positive Question?

complaint symptoms findings-

F 15 Aboriginal Lower Fever Pending Most likely

SAD(+) Abdominal Smelly vaginal urinalysis DX?
Sexually active pain discharge and
pain during Abdominal Immediate
sex. USD MX?

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OPTIONS GIVEN ARE:
A- PID
B- UTI
• WHAT IS THE MOST LIKELY DX? C- Acute appendicitis
D- Ectopic pregnancy
E- GI infection

A- ANTIBIOTICS : Azithromycin 1g in 1 dose

B- CONTACT TRACING- Notification
• IMMEDIATE MX IN THIS CASE? C- SCREENING FOR STIs
D- Patient safe sex education
E- all of the above

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IN THE CASE OF ABORIGINAL AND PACIFIC ISLANDERS:

• All females under 25 years old are screened opportunistically for chlamydia
and gonorrea.
• Follow up after mx if possible
• Contact Tracing
• Regular Screening for STI
• Empiric treatment with antibiotics
• Notification the Health Department

http://mshc.org.au/HealthProfessional/MSHCTreatmentGuidelines/STI

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Australasian Contact Tracing guidelines
http://contacttracing.ashm.org.au/contact-tracing-guidance/how-far-back-to-trace

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