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Original questions in the exam's style. Choose an answer, then check it.
A 28-year-old woman presents with sudden right leg weakness after a stressful bereavement. Reflexes, tone and sensation are normal. When she is asked to flex the left hip against resistance, the weak right hip extends with normal force. MRI brain and spine are normal. What is the most appropriate management?
Answer: A. A positive Hoover sign (weak hip extension that returns with contralateral hip flexion) shows a functional leg weakness. Management is a clear, positive explanation that the symptoms are genuine and reversible, physiotherapy with specialist neurorehabilitation and, where relevant, psychological therapy. Repeated tests or implying that she is faking harm engagement. Based on: Stone J, Carson A, Sharpe M. Functional symptoms and signs in neurology: assessment and diagnosis. J Neurol Neurosurg Psychiatry 2005;76(Suppl 1)
An 8-year-old boy weighing 26 kg develops wheeze, vomiting, facial swelling and pallor 10 minutes after eating a biscuit containing peanut. His blood pressure is 70/40 mmHg. Using Resuscitation Council UK guidance, what is the correct initial dose of intramuscular adrenaline (1 mg/mL)?
Answer: B. Age-based IM adrenaline doses are 500 micrograms (over 12 years), 300 micrograms (6 to 12 years), 150 micrograms (6 months to 6 years) and 100 to 150 micrograms in infants under 6 months. It can be repeated after 5 minutes. A child with anaphylaxis should be observed in hospital afterwards. Based on: Resuscitation Council UK, Anaphylaxis Guidelines (2021)
A 29-year-old man had a closed tibial shaft fracture treated with a below-knee plaster cast 6 hours ago. He now has severe pain despite regular opioids, the calf feels tense, and passive extension of the toes causes marked pain. Capillary refill is normal and the foot pulses are palpable. What is the most appropriate immediate action?
Answer: D. Pain out of proportion, a tense compartment and pain on passive stretch indicate evolving compartment syndrome. Pulses are usually preserved until late. The first step is to release all constricting dressings and the cast, keep the limb at heart level, and obtain urgent senior review for fasciotomy if there is no improvement. Based on: BOAST: Diagnosis and management of compartment syndrome of the limbs
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