Practice questions › MBBS / Medicine › MBBS Professional Review: Medicine
Integrated Clinical Scenarios MCQs
MBBS Professional Review: Medicine · MBBS / Medicine · 42 practice questions
- Lumbosacral Nerve Root Compression
- Acute Abdomen and Pneumoperitoneum Imaging
- Shoulder Injury Differential
- Infective Endocarditis Complications
- Trauma - Flail Chest Management
- Endocrine Hypertension — Renal Artery Stenosis vs Conn Syndrome
- Lumbosacral Nerve Root Lesions
- Adolescent Dysmenorrhoea
1. A 60-year-old woman has had several years of pain in her left shoulder when raising the arm above the head. After a recent lifting strain the pain became acutely worse and she is now unable to actively lift the arm at all. On examination, active attempts at abduction are limited, with the deltoid muscle palpably contracting during the attempt, but the arm can be moved passively to full abduction without difficulty. Which one of the following best explains this combination of findings?
- AAdhesive capsulitis ('frozen shoulder')
- BGlenohumeral joint dislocation
- COsteoporotic fracture of the humeral neck
- DAcute rupture of the supraspinatus tendon
Show answer
D. Acute rupture of the supraspinatus tendon A torn rotator cuff (supraspinatus) prevents initiation of active abduction despite a contracting deltoid, because the supraspinatus is needed to maintain glenohumeral apposition; full passive range is preserved because the joint itself is not restricted, distinguishing this from adhesive capsulitis where passive movement would also be limited.
2. A 60-year-old woman with several years of intermittent left shoulder pain on abduction develops sudden inability to actively lift her arm after a lifting strain. On examination, deltoid contraction is palpable but she can only actively abduct to about 40 degrees; full abduction is possible passively. Which of the following best explains why active abduction is limited to this degree despite normal deltoid activity?
- AAdhesive capsulitis has caused capsular contracture limiting both active and passive movement
- BOsteoporotic collapse of the humeral head is preventing joint congruency
- CThe deltoid alone cannot initiate abduction without the stabilising and initiating action of an intact supraspinatus tendon
- DGlenohumeral arthritis is restricting the joint mechanically
Show answer
C. The deltoid alone cannot initiate abduction without the stabilising and initiating action of an intact supraspinatus tendon The supraspinatus tendon maintains glenohumeral apposition and initiates abduction; when it ruptures, active abduction cannot be initiated by deltoid alone, though passive movement remains full and deltoid contraction is preserved, unlike arthritis or frozen shoulder which also limit passive movement.
3. A treatment-resistant teenager with primary dysmenorrhoea, in whom no organic pathology is suspected, has failed a trial of an NSAID. According to standard practice for this age group, what should be tried next before considering invasive investigation such as laparoscopy?
- AImmediate diagnostic laparoscopy
- BHysteroscopy
- CEmpirical antibiotics for presumed pelvic infection
- DCombined oestrogen/progestogen contraceptive pill
Show answer
D. Combined oestrogen/progestogen contraceptive pill The text notes hysteroscopic and laparoscopic assessment are usually reserved for teenagers only when appropriate pain relief with NSAIDs and the combined oral contraceptive pill has failed.
Practise all 42 questions free
Every answer is marked the moment you tap it, with the reason. Your weak topics come back until you get them right.
Start free, no card needed