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Question 1
Correct
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A 3-year-old girl was accompanied by her mother to the hospital due to a change in speech, which is now an indistinct nasal speech. She is always tired by day, has restless sleep and even snores at night. What is the best management strategy?
Your Answer: Refer to ENT surgeon
Explanation:Adenoid tissue sometimes swell as a result of fighting off the infection as germs are trapped in the adenoids. Adenoid enlargement is suspected.
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This question is part of the following fields:
- Child Health
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Question 2
Incorrect
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A 35-year-old woman with no psychiatric history has attempted suicide 10 times. Her neurological examination is apparently normal. What would be the most appropriate management?
Your Answer: Cognitive behaviour therapy (CBT)
Correct Answer: Problem focussed treatment
Explanation:Problem focussed treatment focuses on solutions to the problem, rather than on the problem itself that brought patients to seek therapy, in this case the suicide attempts. The patient seems to be parasuicidal which is a feature of some personality disorders such as histrionic and borderline personality disorders which do not require medical treatment but psychotherapy.
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This question is part of the following fields:
- Mental Health
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Question 3
Correct
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A 12-year-old boy was admitted with profound diarrhoea and low urine output. His mucous membranes seem dry and his skin turgor is low. What is the most appropriate next step?
Your Answer: Fluid replacement
Explanation:Fluid replacement therapy should be initiated immediately because the patient is suffering from severe dehydration as shown by the low urine output, the dry mucous membranes and the low skin turgor.
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This question is part of the following fields:
- Gastrointestinal
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Question 4
Correct
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A 20 year old female is suffering from amenorrhea. She has a BMI of 14 but still thinks that she needs to lose weight. Choose the most likely diagnosis.
Your Answer: Anorexia nervosa
Explanation:Anorexia is consistent with the symptoms described.
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This question is part of the following fields:
- Mental Health
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Question 5
Incorrect
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A 32 year old primigravida in her 12th week of gestation, presents to her GP with concerns regarding the evolution of her pregnancy. She's afraid she might experience an obstetric cholestasis just like her older sister did in the past. What is the fundamental symptom of obstetric cholestasis?
Your Answer: Skin rash
Correct Answer: Pruritus
Explanation:Cholestasis of pregnancy is associated with increased fetal morbidity and mortality and should be treated actively. The significance attached to pruritus in pregnancy is often minimal, but it is a cardinal symptom of cholestasis of pregnancy, which may have no other clinical features.
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This question is part of the following fields:
- Obstetrics
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Question 6
Correct
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A 25-year-old pregnant mother who is known to have hepatitis B gave birth to a male infant. She is now concerned about her child contracting hep B. Which of the following is the most suitable option for the baby in this case?
Your Answer: HepB full vaccine and Ig
Explanation:Hepatitis B full vaccine and Ig should be given to babies born to hepatitis B positive mothers. Hepatitis B vaccine alone or Ig alone is not sufficient to prevent the infection in the new-born baby.
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This question is part of the following fields:
- Infectious Diseases
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Question 7
Incorrect
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A 22 year old woman had a C-section two hours ago. However, she has not urinated since then and claims she had no urinary complaints before the operation. Upon inspection she appears unwell and her abdomen is distended and tender suprapubically and in the left flank. Auscultation reveals no bowel sounds. Further examination reveals the following: Temp=37.5C, BP=94/73mmHg, Pulse=116bpm, Sat=97%. What's the most likely complication?
Your Answer: Acute pyelonephritis
Correct Answer: Urinary tract injury
Explanation:Urologic injury is the most common injury at the time of either obstetric or gynaecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during caesarean section include previous caesarean delivery, adhesions, emergency caesarean delivery, and caesarean section performed during the second stage of labour.
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This question is part of the following fields:
- Obstetrics
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Question 8
Incorrect
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A 33 year old lady in her first trimester of pregnancy presented with loss of weight, abdominal pain and frequent episodes of vomiting. Her vital signs are normal. She has been given a cyclizine injection but without any significant improvement. The next step would be?
Your Answer: IV fluids
Correct Answer: IV steroids
Explanation:In hyperemesis gravidarum, IV corticosteroids can be given to reduce vomiting, if the patient is not responding to standard anti emetics.
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This question is part of the following fields:
- Gynaecology
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Question 9
Correct
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A 30 year old primigravida with diabetes suffered a post partum haemorrhage following a vaginal delivery. Her uterus was well contracted during labour. Her baby's weight is 4.4 kg. Which of the following is the most likely cause for her post partum haemorrhage?
Your Answer: Cervical/vaginal trauma
Explanation:A well contracted uterus excludes an atonic uterus. Delivery of large baby by a primigravida can cause cervical +/- vaginal tears which can lead to PPH.
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This question is part of the following fields:
- Obstetrics
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Question 10
Incorrect
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A 20-year-old boy returning from vacation in India presented with a history of fever, myalgia, headache and abdominal pain for 4 days duration. He revealed that he had bathed in a river during his vacation. On examination, he had severe muscle tenderness, hypotension (BP - 80/60mmHg) and tachycardia (140 bpm). What would be the first step in management?
Your Answer: Urgent surgical consult
Correct Answer: IV normal saline
Explanation:The history is suggestive of leptospirosis. This is a zoonotic infection caused by a spirochete. As the patient is in shock, resuscitation with IV fluids is the first step in the management. IV antibiotics should be started (Doxycycline or Penicillin) as soon as possible. Other investigations mentioned are important during the management to rule out other possible diagnoses.
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This question is part of the following fields:
- Infectious Diseases
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Question 11
Correct
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A 54 year old lady was found unconscious at home and passed away later in the ambulance, due to cardiac arrest. The paramedic's report reveals the woman was a diabetic patient on anti-diabetic medication, lately immobilized due to hip pain. Ulcers were also found on the medial side of her ankle. What is the most likely cause of her death?
Your Answer: Acute myocardial infarction
Explanation:The patient was old and had a major cardiovascular risk because she was a diabetic. The ulcers indicate poor glycaemic control and advanced disease which further increased her risk for an ischemic heart attack. Immobilization most probably was the favouring background on which the MI occurred.
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This question is part of the following fields:
- Seriously Ill
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Question 12
Correct
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A 30 year old previously well male presented with dysuria and lower abdominal pain. He also complained of passage of air bubbles when he urinated. His urine sample had faecal matters. The abdomen was soft with mild suprapubic tenderness. Which of the following is the most likely pathology?
Your Answer: Crohn's disease
Explanation:Passage of faecal matters in the urine is suggestive of a fistula. Crohn’s disease is the most common cause of an ileovesical fistula. The diagnostic features of a fistula to the urinary system are pneumaturia, fecaluria, and recurrent or persistent urinary tract infections. Cystoscopy will confirm the diagnosis.
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This question is part of the following fields:
- Colorectal
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Question 13
Incorrect
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A 30 year old female with a history of two first trimester miscarriages presented at 9 weeks of gestation with per vaginal bleeding. Which of the following is the most appropriate management?
Your Answer: Trans-vaginal sonography (TVS)
Correct Answer: Aspirin
Explanation:Antiphospholipid syndrome is the most important treatable cause of recurrent miscarriage. The mechanisms by which antiphospholipid antibodies cause pregnancy morbidity include inhibition of trophoblastic function and differentiation, activation of complement pathways at the maternal–fetal interface, resulting in a local inflammatory response and, in later pregnancy, thrombosis of the uteroplacental vasculature. This patient should be offered referral to a specialist clinic as she has had recurrent miscarriages. Low dose aspirin is one of the treatment options to prevent further miscarriage for patients with antiphospholipid syndrome.
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This question is part of the following fields:
- Obstetrics
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Question 14
Correct
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The main source of nutrients in the liver is via the
Your Answer: Portal vein
Explanation:The portal vein or hepatic portal vein is a blood vessel that carries blood from the gastrointestinal tract and spleen to the liver. This blood is rich in nutrients that have been extracted from food, and the liver processes these nutrients; it also filters toxins that may have been ingested with the food. 75% of total liver blood flow is through the portal vein, with the remainder coming from the hepatic artery proper.
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This question is part of the following fields:
- Hepatobiliary
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Question 15
Correct
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Where is the normal upper border of the liver situated?
Your Answer: 6th rib midclavicular line on right
Explanation:Assessment of liver margins is important clinically to determine the size of the liver and is done via percussion during the physical examination. The liver typically extends from the fifth intercostal space or 6th rib to the right costal margin in the midclavicular line and the 10th rib on anterior axillary line.
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This question is part of the following fields:
- Hepatobiliary
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Question 16
Correct
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A 35-year-old African female presents with a history of heavy menstrual bleeding and dysmenorrhoea for 4 months. Which of the following could be the most likely cause for this presentation?
Your Answer: Fibroid
Explanation:History of heavy menstrual bleeding and amenorrhoea favour the diagnosis of a fibroid uterus. All the given responses are causes for subfertility. Ectopic pregnancy presents with abdominal pain has an acute presentation. Endometriosis and adenomyosis usually don’t present with amenorrhoea or heavy bleeding respectively. PID presents with chronic pelvic pain and is not related to menstruation.
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This question is part of the following fields:
- Gynaecology
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Question 17
Correct
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A 35 year old female was afraid of being at crowded places such as supermarkets, trains etc. She felt extreme anxiety at such places and started avoiding such places. Physical examination was normal. Which of the following is the diagnosis of this condition?
Your Answer: Agoraphobia
Explanation:Agoraphobia is a psychiatric disorder that results from anxiety regarding and avoidance of situations such as crowds, shopping malls, public transportation, and being away from home.
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This question is part of the following fields:
- Mental Health
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Question 18
Incorrect
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The ECG of a 48-year-old man shows broad complex tachycardia with a HR of 154bpm 2 days after an MI. His BP is 90/60mmHg and he is complaining of palpitations and dyspnoea. What is the most appropriate management?
Your Answer: IV amiodarone
Correct Answer: DC Shock
Explanation:Dysrhythmias are the most frequent MI complication. The patient seems to have a post MI atrial fibrillation which is treated, in an emergency context, with DC shock.
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This question is part of the following fields:
- Cardiovascular
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Question 19
Correct
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A 71 year old female presents with a pan-systolic murmur. History reveals a myocardial infarction which manifested three days ago. What is the most likely cause of the murmur?
Your Answer: Rupture of papillary muscle
Explanation:A pan-systolic murmur is the result of mitral regurgitation. Mitral regurgitation in this case is most probably due to post-MI rupture of the papillary muscle of the mitral valve.
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This question is part of the following fields:
- Cardiovascular
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Question 20
Incorrect
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A 48-year-old woman presented to you with a breast mass. On examination, it is hard, irregular and ill defined. The surface of the breast is slightly bruised however, there is no discharge. The most probable diagnosis is?
Your Answer: Fibro adenoma
Correct Answer: Fat necrosis
Explanation:Fat necrosis is often a result of a trauma or surgery. In fat necrosis the enzyme lipase releases fatty acids from triglycerides. The fatty acids combine with calcium to form soaps. These soaps appear as white chalky deposits which are firm lumps with no associated discharge. The given case has a bruise which indicates prior trauma.
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This question is part of the following fields:
- Breast
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Question 21
Correct
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A 35 year old primigravida was in labour for 24 hours and delivered after an induction. She developed postpartum haemorrhage. Which of the following is the most likely cause for PPH?
Your Answer: Atonic uterus
Explanation:Uterine atony and failure of contraction and retraction of myometrial muscle fibres can lead to rapid and severe haemorrhage and hypovolemic shock. Poor myometrial contraction can result from fatigue due to prolonged labour or rapid forceful labour, especially if stimulated.
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This question is part of the following fields:
- Obstetrics
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Question 22
Incorrect
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Select the correct statement regarding the portal vein.
Your Answer: It supplies 25% of the total blood flow to the liver.
Correct Answer: It drains most of the gastrointestinal tract and the spleen.
Explanation:The portal vein supplies 75% of total blood flow to the liver and enters the liver centrally via the porta hepatis. Portal venous flow increases after meals. The portal vein receives blood from the intestines via the superior and inferior mesenteric veins, from the stomach via gastric veins and from the spleen and pancreas via the splenic vein.
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This question is part of the following fields:
- Hepatobiliary
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Question 23
Incorrect
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Of the following medications, which is available over the counter (OTC) to treat heavy blood loss during menstruation?
Your Answer: Combined oral contraceptives
Correct Answer: Tranexamic acid
Explanation:Since March 2011, tranexamic acid has been available to buy from pharmacies to help treat heavy blood loss during menstruation. NSAIDs (such as ibuprofen and naproxen) are available to purchase over the counter, but these aid in the treatment of dysmenorrhea rather than menorrhagia. MIRENA, norethisterone, and COCP are not available to purchase over the counter to treat heavy blood loss (however COCP is available for contraceptive use).
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This question is part of the following fields:
- Pharmacology
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Question 24
Correct
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A 71 year old male got trapped under a cupboard for 4 hours which accidentally fell on his leg while he was moving his house. Which enzyme activity would you measure in this patient?
Your Answer: Creatinine kinase
Explanation:Creatine kinase (CK) is an enzyme found in the heart, brain, skeletal muscle, and other tissues. Increased amounts of CK are released into the blood when there is muscle damage. This test measures the amount of creatine kinase in the blood.
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This question is part of the following fields:
- Mental Health
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Question 25
Correct
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A 70-year-old chronic smoker presented with difficulty in opening his mouth and right sided ear pain for six months, which was increasing in severity. On examination, there was an ulcer at the base of their tongue and two hard, non-tender cervical lymph nodes. What is the most possible cause for this presentation?
Your Answer: Oropharyngeal malignancy
Explanation:The smoking history, ulcer at the base of the tongue, earache, difficulty in opening the mouth, and hard non tender lymph nodes favours the diagnosis of oropharyngeal malignancy. The other given conditions would generally not result in ulceration of the tongue and Herpes would have vesicles and associate pain over the affected nerve distribution.
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This question is part of the following fields:
- ENT
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Question 26
Incorrect
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Which of the following electrolyte abnormalities is most likely to be seen in SIADH?
Your Answer: High serum Na, high serum osmolarity, low urine osmolarity
Correct Answer: Low serum Na, low serum osmolarity, high urine osmolarity
Explanation:In SIADH, there is increased secretion of the ADH hormone resulting in increased water absorption. That’s why there would be decreased serum Na, decreased osmolarity and increased urine osmolarity.
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This question is part of the following fields:
- Endocrine
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Question 27
Incorrect
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A 30 year old male presented with a cut injury to his forearm. There were no tendon cut or muscle cut, so suturing was done under local anaesthesia. Lignocaine with adrenaline was injected prior to suturing. Which of the following is the action of adding adrenaline to lignocaine?
Your Answer: Reduces side effects
Correct Answer: Prolongs the effect
Explanation:The vasoconstrictive action of adrenaline will reduce the dilution of local anaesthetic lignocaine and reduce the bleeding. So the combination of lignocaine and adrenaline greatly prolongs and intensifies its action.
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This question is part of the following fields:
- Pharmacology
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Question 28
Correct
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A 24 year old female with a history of severe depression has presented at the hospital with secondary amenorrhoea. Upon examination, her prolactin is 645 mU/L (the normal level is 50-350). Which of her medications is likely to cause this?
Your Answer: Risperidone
Explanation:Antipsychotic medications are known to increase prolactin levels – this is especially true for typical antipsychotics and risperidone. This is because they block the dopamine D2 receptors, and therefore block dopamine’s action on the pituitary gland. This causes a reduction in the inhibition of prolactin secretion, and thus causes hyperprolactinaemia. The symptoms include amenorrhoea, galactorrhoea, infertility, loss of libido, and erectile dysfunction. Sertraline is not thought to exert the antagonistic effects of dopamine, and therefore does not usually cause hyperprolactinaemia (although there have been some reported cases in literature). The patient’s other medications are not associated with hyperprolactinaemia.
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This question is part of the following fields:
- Pharmacology
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Question 29
Correct
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A 70 year old female presented with throbbing and continuous headache and loss of vision. Her ESR was elevated. Which of the following is the most appropriate management?
Your Answer: Corticosteroids
Explanation:Giant Cell Arteritis (Temporal Arteritis) is the most probable diagnosis. GCA should always be considered in the differential diagnosis of a new-onset headache in patients 50 years of age or older with an elevated erythrocyte sedimentation rate. Temporal artery biopsy remains the criterion standard for diagnosis of this granulomatous vasculitis. High-dose corticosteroid therapy is the universally accepted treatment.
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This question is part of the following fields:
- Ophthalmology
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Question 30
Correct
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An 81-year-old woman had fallen down in her house. She is now unable to walk. An x-ray was done on her left hip joint, which showed a fracture in the neck of the femur. Which nerve is most likely to be injured?
Your Answer: Sciatic nerve
Explanation:Femoral neck fractures are common injuries that most often result from low-energy falls in the elderly; however, they also can occur in young patients as a result of high-energy mechanisms
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This question is part of the following fields:
- Musculoskeletal
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SESSION STATS - PERFORMANCE PER SPECIALTY
