Let's Play Doctor... Trivia Quiz

Answer: Meningococcal meningitis

This is a classical history of bacterial meningitis caused by Neisseria meningiditis. Inflammation of the meninges, which are the membranes covering the brain and spinal cord, cause fever, pain on stretching and photophobia. The organism can also cause septicaemia (blood poisoning) with a purpuric (bleeding) rash.

Answer: Myocardial infarction (Heart attack)

This history is once again fairly classical, this time of an acute myocardial infarction, or a heart attack. Severe asthma can also cause crushing chest pain and breathlessness; however radiation of the pain to the arms and jaw is more common in myocardial infarcts.

Answer: Bell's palsy (Cranial nerve VII lesion)

The two most likely diagnoses here are Bell's palsy and stroke. The fact that the lady is unable to raise her eyebrow on the affected side implies that the nerve controlling the muscles is damaged, rather than the brain. This is because the muscle frontalis, which performs the action, is controlled by both sides of the brain, whereas most muscles are controlled by just one side (the opposite side).

The lesion is therefore in the VII cranial nerve which supplies frontalis, known as Bell's palsy.

Answer: Cystitis

This history is classical of cystitis, an infection of the bladder. This is common in young women for anatomical reasons. Pyelonephritis is a kidney infection, usually the patient would have severe back pain and be very unwell.

Answer: Ruptured abdominal aortic aneurysm

All of the options could cause back pain and abdominal discomfort, and all are common in elderly gentlemen. The low blood pressure, however, would make one very suspicious of a bleeding AAA, and in the absence of other symptoms this is the most likely diagnosis.

Answer: Schizophrenia

Diagnosis of mental illness is very difficult and the picture tends to evolve over time. This young man has at least two symptoms suggestive of schizophrenia: thought insertion and auditory hallucinations. Low mood and withdrawal are not exclusive to depression, however that diagnosis is unlikely. Overall, however, schizophrenia is the more likely diagnosis.

Answer: Extradural haemorrhage

The middle meningeal artery is vulnerable where it crosses the temple. Bleeds from this vessel are into the extradural space. The history of immediate loss of consciousness, a lucid period and gradual deterioration is classical.

Answer: Crohn's disease

The history suggests an inflammatory disease of the bowel, Crohn's being the most likely in this age group. The presence of blood and the worsening nature make irritable bowel unlikely; and bowel cancer is extremely rare in someone of this age.

Answer: Pancreatic cancer

Jaundice and dark urine suggest a blockage in the biliary system after it has left the liver. In this case there is no pain, making gall stones unlikely. The history of weight loss and the age of the gentleman are strong implicating factors for cancer.

Answer: Amyotrophic lateral sclerosis (Motor neurone disease)

The mixture of upper motor neurone symptoms (stiff limbs and increased reflexes) and lower motor neurone symptoms (wasting and fasciculations) suggest motor neurone disease. This disease affects the junction of upper and lower motor neurones in the spinal cord.