Regarding Aortic Dissection

Regarding Aortic Dissection answer the following questions:

1. What is acute aortic dissection?
2. What is the most common cause of aortic dissection in the general population, in men younger than 40 years, and in women younger than 40 years?
3. What is the most sensitive initial diagnostic test for aortic dissection?
4. Where are the most common points of origin for aortic dissections?

Answers:
1. What is acute aortic dissection?
Acute aortic dissection results from a tear in the aortic intima. Driven by systemic pressure, arterial blood enters the diseased media of the vessel. Within this layer, blood creates a separation plane as it dissects the aorta longitudinally. The area of dissection filled with blood is called the false lumen. The shear forces of the dissecting blood can cause additional intimal tears. As the false lumen fills  with blood, it may compress the true lumen, resulting in obstruction of major arteries.
Infrequently, dissection can be initiated by hemorrhage into the media without an intimal tear.

2. What is the most common cause of aortic dissection in the general population, in men younger than 40 years, and in women younger than 40 years?
In the ascending aorta, the most common cause of aortic dissection in the general population is medial degeneration usually associated w ith aging and hypertension.
In the abdominal aorta, atherosclerosis plays a more important role.

• In men younger than 40 years, the most common cause of dissection is Marfan's syndrome associated with the more typical cystic medial degeneration lesions. 
• In women younger than 40 years, 50% of all dissections occur during pregnancy.

Regarding Primary Biliary Cirrhosis

Primary biliary cirrhosis is most characteristically associated with:
A. Anti-nuclear antibodies
B. Anti-ribonuclear protein antibodies
C. Anti-mitochondrial antibodies
D. Rheumatoid factor
E. Anti-neutrophil cytoplasmic antibodies

Answer:

Red Flags Symptoms In Patient Presenting With Headache

A 23-year-old presents for review. For the past 3 months or so he has been having problems with frequent headaches. These are now occurring on an almost daily basis and can be severe at times. Which one of the following features should prompt investigation for a secondary cause of headaches?

A. Photophobia during the headache
B. Feeling of nausea during the headache
C. Severe unilateral eye pain
D. Headache worsens on coughing
E. Numbness lasting 30 minutes before the headache

Answer:

Regarding Anorexia Nervosa

Regarding the investigations and blood abnormalities seen in patient with Anorexia nervosa answer the question given below: 

Answer And Discussion:

Regarding Grading Of Internal Hemorrhoids.

A 37-year-old man with a history of internal hemorrhoids presents as his symptoms have recently flared. He now describes piles which he has to manually reduce following defecation. What grade of hemorrhoids does he have?

A. Grading system does not apply to internal hemorrhoids
B. Grade I
C. Grade II
D. Grade III
E. Grade IV

Answer:

Regarding Clinical Presentations Of Dysphagia

Regarding Dysphagia Select a diagnosis from the list below for the given clinical scenarios:

A. Pharyngeal pouch
B. Achalasia
C. Kaposi's sarcoma
D. Systemic sclerosis
E. Oesophageal cancer
F. Myasthenia gravis
G. Oesophagitis
H. Motor neuron disease
I. Oesophageal candidiasis
J. Plummer-Vinson syndrome

1. An 40-year-old man presents with dysphagia. He reports being reasonably well in himself other than an occasional cough. The dysphagia occurs with both liquids and solids. Clinical examination is normal.

Answer: Achalasia ( Patients like this should be referred to exclude a carcinoma. Achalasia typically presents between the ages of 25-40 years.)

2. A 55-year-old woman presents with swallowing difficulties for the past 5 weeks. She has also noticed some double vision.

Answer: Myasthenia gravis

3. A 42-year-old haemophiliac who is known to be HIV positive presents with pain on swallowing for the past week. He has been generally unwell for the past 3 months with diarrhoea and weight loss.

Answer: Oesophageal candidiasis
( Unfortunately many haemophiliacs contracted HIV and hepatitis C in the 1980's from blood transfusions. Immunocompromised patients are prone to oesophageal candidiasis. This patient requires an urgent endoscopy to confirm the diagnosis.)

Discussion:

Regarding Acute Pulmonary Edema

Regarding Acute Pulmonary Edema, answer the following questions:

1. What are the two most common underlying mechanisms of pulmonary edema?
2. What are the most common causes of acute cardiogenic pulmonary edema?
3. What is the immediate treatment of acute cardiogenic pulmonary edema?

Answers:

1. What are the two most common underlying mechanisms of pulmonary edema?
Acute pulmonary edema can have a cardiogenic or noncardiogenic etiology.
In cardiogenic pulmonary edema, a high pulmonary capillary pressure is responsible for the transudation of protein-poor fluid into the lungs caused by an imbalance of Starling's forces. With acute rises in pulmonary capillary pressure, the pulmonary lymphatics cannot rapidly increase the rate of fluid removal; as a result, pulmonary edema occurs.

Treatment Of Otitis Media In Children

A 6-year-old girl presents with her first episode of otitis media. She has been treated with antibiotics on one prior occasion for a urinary tract infection. She has no known drug allergies. Which of the following is the most appropriate antibiotic to treat this patient?

A. Cefuroxime
B. Azithromycin
C. Amoxicillin
D. Cephalexin
E. Amoxicillin/clavulanic acid

 Answer :

A 55 Year Old Man With Known Heart Failure Comes For A Review In OPD

A 55-year-old man with known heart failure and LVEF of 37% is reviewed in the outpatient clinic with breathlessness. He is NYHA class III with no signs of fluid overload on examination. His BP is 110/60 mmHg, and his heart rate is 55 bpm. He is on bisoprolol 5 mg od and ramipril 10 mg od.
His U&E tests reveal Na 137 mmol/L, K 4.5 mmol/L, urea 7 mmol/L, and creatinine 85 μmol/L.
Which one of the following medications will you chose next?
A. Furosemide 40 mg od
B. Spironolactone 25 mg od
C. Digoxin 62.5 micrograms od
D. Hydralazine 37.5 mg and isosorbide dinitrate 20 mg od
E. Candesartan 4 mg od

Answer:

Management Of Post-Herpetic Neuralgia

A 56-year-old woman comes for review. Around 4 weeks ago she had a blistering rash under her right breast which extended around to the back. A diagnosis of shingles was made. Unfortunately since that time she has been experiencing severe 'shooting' pains. The skin is also very tender to touch. Neither paracetamol nor ibuprofen have helped her symptoms. What is the most appropriate next step in management?
A. Lidocaine patch
B. Tramadol
C. Amitriptyline
D. Carbamazepine
E. Diclofenac

Answer:

Regarding Acute Ecstasy Intoxication

Regarding Acute Ecstasy Intoxication answer the following question

Answer And Discussion:

Regarding Utricaria

Regarding utricaria answer the following questions:
1. What is the definition of chronic urticaria?
2. What is the pathogenesis of chronic urticaria?
3. What therapeutic approach is desirable for utricaria?

Discussion
1. What is the definition of chronic urticaria?
Chronic urticaria is defined as urticaria that persists for 6 weeks or more.

2. What is the pathogenesis of chronic urticaria?
The pathogenesis of chronic urticaria includes a spectrum of events. Commonly, there is simple local edema and itching caused by the release of histamine from mast cells. Other more severe cases have an inflammatory component, such as vasculitis that is revealed by biopsy specimens. In these cases, the responsible mechanism may be either tumor necrosis factor α- leased from activated mast cells,

Interpreting Hepatitis Serology

A 42-year-old man presents to his GP complaining of persistent lethargy. Routine bloods show abnormal liver function tests so a hepatitis screen is sent. The results are shown below:
Anti-HAV IgG negative
HBsAg negative
Anti-HBsAb positive
Anti-HBcAg negative
Anti-HCV positive
What do these results most likely demonstrate?
A. Hepatitis B infection
B. Hepatitis C infection
C. Previous vaccination to hepatitis B and C
D. Hepatitis C infection with previous hepatitis B vaccination
E. Hepatitis B and C infection

Answer:

Approach To A Patient With Fever, Weight Loss And A Heart Murmur

Case Scenario:  A 28-year-old man with a history of intravenous drug abuse presents with a 6- week history of recurrent sweats and weight loss. He comes to the Emergency Department because he is feeling increasingly unwell.
On examination he is tachycardic and has a swollen, hot and tender left knee joint and a faint pansystolic murmur at the left sternal edge.
You are called to assess him.
1. How will you approach to this case.?
2. Give the important points to ask in history?
3. What examination would be important?
4. Give the Differential diagnosis?
5. The investigations that would help in the diagnosis?

Discussion: 
In the presence of a murmur, whether new or not, the diagnosis of Infective endocarditis (IE) must be the favored differential diagnosis. Also the use of intravenous drugs in the patient presented in the scenario favors towards a diagnosis of Infective endocariditis.

A careful history and examination are essential to help rule out other non infective and non-cardiac causes for his symptoms, although these would clearly be very unlikely in this case.

History of the Presenting problem: The history (and examination) will be dominated by consideration of the most likely diagnosis (IE), but clues may emerge that take you in another direction. Keep in mind the other differential diagnosis( given below) as you take the history and examine the patient.

• Determine the severity of the patient’s condition. In acute IE, the fever is high with rigors and prostration. 

Clinical Presentations In Multiple Sclerosis

A 35-year-old woman presents with a variety of symptoms including generalized skin tingling and headache. She is concerned she may have multiple sclerosis. What is the most common presentation of multiple sclerosis?
A. Tremor
B. Urinary incontinence
C. Optic neuritis
D. Motor neuropathy
E. Internuclear ophthalmoplegia

Answer:

Regarding Benign Prostatic Hyperplasia

A 62-year-old man presents with nocturia, hesitancy and terminal dribbling. Prostate examination reveals a moderately enlarged prostate with no irregular features and a well defined median sulcus. Blood tests show: PSA 1.3 ng/ml What is the most appropriate management?
A. Alpha-1 antagonist
B. 5 alpha-reductase inhibitor
C. Non-urgent referral for transurethral resection of prostate
D. Empirical treatment with ciprofloxacin for 2 weeks
E. Urgent referral to urology

Answer:

Medication Effective In preventing Atrial Fibrillation

A 60-year-old man attends clinic because of hypertension. His BP in clinic is 170/90 mmHg and his echocardiogram shows mild LVH and mild LA dilatation. He is not diabetic and has no other medical history of note.
Which one of the following medications is most effective in preventing AF?
A. ACE inhibitors
B. Beta-blockers
C. Calcium-channel antagonists
D. Diuretics
E. Alpha-blockers

Answer:

Approach To A Patient Who Presents To ER After A Fall. (Case Study)

A 52-year-old male presents to your ED via ambulance complaining of a headache after a fall. He was working and fell approximately 10 feet. He notes no injury except for head and neck pain. A quick survey reveals that he has a BP of 128/86, pulse 100, and respiration 12. There was no loss of consciousness at the scene. He “saw stars” and was clumsy, dazed, and
slow at the scene without any focal neurologic deficit. He is now back to his baseline.

A concussion is defined as:
A) Any neurologic symptoms (e.g., clumsy, dazed, or slow) after head injury.
B) Loss of consciousness followed by return to baseline.
C) Loss of consciousness with continued neurologic symptoms.
D) Requires confusion after head trauma regardless of whether the patient lost consciousness or not.
E) Any traumatic injury to the head.

Answer And Discussion
The correct answer is “A.” Any neurologic symptoms (e.g., clumsy, dazed, or slow) after head injury.

A concussion is defined as any neurologic symptom after head trauma. Note that a concussion does not require a loss of consciousness. For this reason, “B” and “C” are incorrect.
“D” is incorrect because manifestations of concussion are not limited to confusion but also include protracted vomiting, transient amnesia, slowed mentation, “dizziness,” and other neurologic symptoms.
“E” is incorrect because by definition, a concussion requires neurologic symptoms.

* *
Your patient opens his eyes on his own, follows commands, answers all orientation questions correctly, but appears unsteady when ambulating.
His Glasgow Coma Scale (GCS) is:
A) 5.
B) 10.
C) 14.
D) 15.
E) 20.

Answer And Discussion

Regarding Treatment Of Obsessive Compulsive Disorder

Answer And Discussion:

Regarding Screening For Celiac Disease

Coeliac disease should be excluded in all patients who are diagnosed with:
A. Splenomegaly
B. Pancreatitis
C. Colon cancer
D. Type 2 diabetes mellitus
E. Graves' disease

Answer:

Acute Pericarditis and Cardiac Tamponade

Regarding Acute Pericarditis and Cardiac Tamponade answer the following questions.

1. What are the most common causes of acute pericarditis?
2. What is cardiac tamponade?
3. Does acute pericarditis often result in cardiac tamponade?
4. What are the signs and symptoms of pericarditis and tamponade?
5. How is the echocardiogram helpful in the diagnosis of pericarditis or tamponade?
6. What is the treatment for cardiac tamponade?

Answers:

Regarding Treatment For Epilepsy

Regarding treatment for epilepsy select the drugs from the list given below for the given clinical scenarios:

A. Clonazepam
B. Ethosuximide
C. Levetiracetam
D. Sodium valproate
E. Phenytoin
F. Lamotrigine
G. Gabapentin
H. Carbamazepine

1. A 24-year-old man with complex partial seizures:
Answer: Carbamazepine

2. First-line anti-epileptic in a 17-year-old girl with tonic-clonic seizures. She has the Depo-Provera injection for contraception
Answer: Sodium valproate (If there was a high-risk of pregnancy (for example just using condoms for contraception) lamotrigine may be a more suitable choice.)

3. Useful in patients with absence seizures who are intolerant of sodium valproate
Answer: Ethosuximide

Discussion:
Epilepsy: Treatment
Most neurologists now start antiepileptics following a second epileptic seizure.

NICE guidelines suggest starting antiepileptics after the first seizure if any of the following are present:

A 45 Year Old Woman presents To ER With Epigastric pain, Nausea, Vomiting & Jaundice

A 45-year-old woman presents to the emergency room when you are on call. She complains of epigastric pain, radiating to the back. She also has nausea and vomiting. She states that she has had similar symptoms for many years but has never felt this bad. She does not use tobacco or alcohol. You suspect obstruction of the common bile duct because the patient is jaundiced. The optimal diagnostic study is:

A. Ultrasound evaluation
B. Computerized tomography (CT) scan of the abdomen
C. Plain abdominal films, flat and upright
D. HIDA scan
E. Endoscopic retrograde cholangiopancreatography

 Answer :

Regarding Use Of Folic Acid Before Planning A Pregnancy

A 25-year-old woman presents for preconception counseling. She wants to know more about nutrition, particularly about folic acid. She has read a lot about it in magazines. You can tell her that:

A. Folic acid supplementation is associated with an increased level of alpha-fetoprotein in maternal serum.
B. She needs to take either a prenatal vitamin or a supplement that provides at least 4 mg (4,000 µg) of folic acid.
C. She needs to start folic acid supplementation as soon as her pregnancy test is positive.
D. Most women get enough folic acid through their diet.
E. Folic acid requirements are higher in women with type 1 diabetes mellitus.

Answer And Discussion:

Regarding Peri operative Evaluation....

You are asked to perform a preoperative evaluation on a 55-year-old white woman with type 2 diabetes mellitus prior to elective femoral– anterior tibial artery bypass surgery. She is unable to climb a flight of stairs or do heavy work around the house. She denies exertional chest pain and is
otherwise healthy. Based on current guidelines, which one of the following diagnostic studies would be appropriate prior to surgery because the results could alter the management of this patient?
A) Pulmonary function studies
B) Coronary angiography
C) Carotid angiography
D) A dipyridamole-thallium scan
E) A hemoglobin A1c level

Answer and Discussion
The answer is

Regarding The Adverse Effect Of Cabergoline Used In Treatment Of Parkinson's Disease

A 64-year-old man with a history of Parkinson's disease is reviewed in clinic and a decision has been made to start him on cabergoline. Which one of the following adverse effects is most strongly associated with this drug?
A. Optic neuritis
B. Transient rise in liver function tests
C. Pulmonary fibrosis
D. Renal failure
E. Thrombocytopenia

Answer:

Regarding Anaphylaxis...

Regarding Anaphylaxis answer the following questions:
1. What is the clinical presentation in a typical case of anaphylaxis?
2. What is the underlying pathophysiologic process?
3. What conditions should be considered in the differential diagnosis?

Answers:

Regarding Management Of Clostridium difficile diarrhea (Pseudomembranous colitis)

A 78-year-old woman develops profuse, offensive watery diarrhea following a course of co-amoxiclav. A diagnosis of Clostridium difficile diarrhea is made. On examination she is haemodynamically stable, afebrile and has no abdominal signs. What is the most appropriate first-line therapy?
A. Oral vancomycin for 7 days
B. Oral metronidazole for 10-14 days
C. Oral metronidazole + vancomycin for 10-14 days
D. Oral metronidazole for 7 days
E. Probiotic yoghurt for 14 days

Answer:

Drugs Causing A Prolonged QT Interval On ECG

Which one of these drugs does not prolong the QT interval?
A. Amiodarone
B. Erythromycin
C. Carbemazpine
D. Clozapine
E. Methadone

Answer:

Breast Disorders

Regarding Breast lumps and disorders select an option from the list below for the given scenarios:

A. Lipoma
B. Paget's disease of the breast
C. Breast cancer
D. Sebaceous cysts
E. Fibroadenoma
F. Fibroadenosis
G. Duct papilloma
H. Breast abscess
I. Fat necrosis
J. Mammary duct ectasia

1. A 72-year-old woman complains of 'eczema' on her left nipple. On examination the areola is erythematous and thickened.

Answer:  Paget's disease of the breast

2. A 26-year-old woman has noticed a discrete, non-tender lump which is highly mobile on examination.

Answer: Fibroadenoma

3. A 35-year-old woman complains of 'lumpy' breasts. Her symptoms are worse in the premenstrual period.

Answer:  Fibroadenosis

Discussion:

Breast Disorders: A few common disorders and features of lumps is described below:

1. Fibroadenoma: Common in women under the age of 30 years Often described as 'breast mice' due as they are discrete, non-tender, highly mobile lumps.

2. Fibroadenosis (fibrocystic disease, benign mammary dysplasia): Most common in middle-aged women 'Lumpy' breasts which may be painful. Symptoms may worsen prior to menstruation.

3. Breast cancer: Characteristically a hard, irregular lump. There may be associated nipple inversion or skin tethering.

4. Paget's disease of the breast: intraductal carcinoma associated with a reddening and thickening (may resemble eczematous changes) of the skin/areola.

5. Mammary duct ectasia: Dilatation of the large breast ducts Most common around the menopause May present with a tender lump around the areola +/- a green nipple discharge If ruptures may cause local inflammation, sometimes referred to as 'plasma cell mastitis'

6. Duct papilloma: Local areas of epithelial proliferation in large mammary ducts Hyperplastic lesions rather than malignant or premalignant. May present with blood stained discharge.

7. Fat necrosis: More common in obese women with large breasts May follow trivial or unnoticed trauma Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump Rare and may mimic breast cancer so further investigation is always warranted.

8. Breast abscess: More common in lactating women Red, hot tender swelling.

9. Lipomas and sebaceous cysts may also develop around the breast tissue.

Regarding Signs And Symptoms Of Drug Overdose.

A patient presents to the hospital with a diphenhydramine overdose. Which of the following signs and symptoms are you likely to find in this patient?
A) Bradycardia, dilated pupils, flushing.
B) Bradycardia, pinpoint pupils, flushing.
C) Tachycardia, dilated pupils, diaphoresis.
D) Tachycardia, dilated pupils, flushing.
E) Tachycardia, pinpoint pupils, flushing.

Answer And Discussion: The correct answer is

Treatment Of Bipolar Disorder

Which of the following medications is used in the classic treatment of bipolar disorder?
A) Lithium
B) Sertraline
C) Amitriptyline
D) Phenytoin
E) Alprazolam

Answer:

A 27-year-old presents with the worst headache of his life.

A 27-year-old presents with the worst headache of his life. Which of the following is least likely to be helpful?

A. Careful history eliciting recent trauma or head injury
B. Evaluation of cranial nerves including the retina
C. Strong consideration of CT or MRI of the head
D. Plain film of the skull
E. History of previous headache problems and treatments

 Answer :

A 24-year-old man presents with rectal bleeding and a 'sharp, stinging' pain on defecation

A 24-year-old man presents with rectal bleeding and a 'sharp, stinging' pain on defecation. This has been present for the past two weeks. He has a tendency towards constipation and notices that when he wipes himself fresh blood is often on the paper. Rectal examination is limited due to pain but no external abnormalities are seen. What is the most likely diagnosis?
A. Internal haemorrhoids
B. Anal carcinoma
C. Rectal polyp
D. Anogenital herpes
E. Anal fissure

Answer:

High-Risk Markers For Sudden Cardiac Death In Hypertrophic Cardiomyopathy

Which one of the following would not be considered a high-risk marker for sudden cardiac death in hypertrophic cardiomyopathy?
A. Family history of sudden cardiac death
B. Non-sustained VT on cardiac monitoring
C. Left Ventricular septal thickness of 2.3cm
D. Drop in blood pressure on ETT
E. Syncope

Answer And Discussion:

Drug-Induced Liver Disease

A 54-year-old woman presents with jaundice shortly after being discharged from hospital. Liver function tests are reported as follows:
Albumin = 49 g/l, Bilirubin = 89 mmol/l, Alanine transferase (ALT) = 66 iu/l,
Alkaline phosphatase (ALP) = 245 mmol/l, Gamma glutamyl transferase (yGT) = 529 u/l.
Which of the following antibiotics is she most likely to have received?
A. Co-amoxiclav
B. Gentamicin
C. Ciprofloxacin
D. Trimethoprim
E. Ceftazidime

Answer:

Treatment of Choice for Bordetella pertussis Infection

Which of the following medications is considered the treatment of choice for Bordetella pertussis infection?
A) Penicillin
B) Ciprofloxacin
C) Azithromycin
D) Tetracycline
E) Cefuroxime

Answer and Discussion:

Causes Of Nephrotic Syndrome

A 54-year-old female with rheumatoid arthritis is noted to have proteinuria on annual review. Which one of the following drugs is most associated with the development of proteinuria?
A. Ciclosporin
B. Gold
C. Methotrexate
D. Infliximab
E. Sulfasalazine

Answer:

Management Of A Patient With Tachycardia In CCU

A 61-year-old with a history of a myocardial infarction 2 years ago with a known ejection fraction of 25% presents to A&E with a 2 hour history of mild palpitations. He is otherwise fit and well. His ECG monitoring shows a regular broad complex tachycardia at a rate of 170 bpm which self terminated before a 12-lead ECG was performed. His U&Es are normal. The patient’s blood pressure was 130/90 mmHg during the tachycardia and he was not unduly distressed. He is transferred to CCU where a 12-lead ECG shows LBBB with a QRS duration of 100 ms.
What will be his appropriate management?
A. He needs an ICD (Implantable Cardioverter Defibrillator)
B. He needs an urgent revascularization
C. He needs an EP study (electrophysiology study)
D. He tolerated his tachycardia well; therefore it is likely to be an SVT with aberrancy
E. He should be commenced on flecainide

Answer:

A 31 Year Old Man Presents With A 2 Week H/O Headache With Watery Eyes.

A 31-year-old man presents to his GP with a two week history of headaches around the left side of his face associated with watery eyes. He describes having about two episodes a day each lasting around 30 minutes. What is the likely diagnosis?
A. Migraine
B. Cluster headache
C. Trigeminal neuralgia
D. Acute angle closure glaucoma
E. Meningioma

Answer:

Essential Tremors

A 60-year-old woman presents with a tremor. Which one of the following features would suggest a diagnosis of essential tremor rather than Parkinson's disease?
A. Difficulty in initiating movement
B. Tremor is worse following alcohol
C. Postural instability
D. Unilateral symptoms
E. Tremor is worse when the arms are outstretched

Answer:

Irritable Bowel Syndrome - Diagnosis - NICE Guidelines

A 35-year-old female presents with abdominal pain associated with bloating for the past 6 months, Which one of the following symptoms is least associated with a diagnosis of irritable bowel syndrome?
A. Feeling of incomplete stool evacuation
B. Weight loss
C. Back pain
D. Lethargy
E. Nausea

Answer:

Which of the following is an indication for bone marrow biopsy in a patient with suspected idiopathic thrombocytopenic purpura?

Which of the following is an indication for bone marrow biopsy in a patient with suspected idiopathic thrombocytopenic purpura?
A. Use of corticosteroid therapy for treatment
B. Use of intravenous immunoglobulin for treatment
C. Platelet count less than 50,000

D. Thrombocytopenia persisting for more than 1 month
E. Thrombocytopenia with normal hemoglobin and white blood cell counts

Answer :

Markers For Monitoring Colorectal Cancer;

Which one of the following may be used to monitor patients with colorectal cancer?
A. CA-125
B. Carcinoembryonic antigen
C. Alpha-fetoprotein
D. CA 19-9
E. CA 15-3

Answer:

Risk Of Epidural Anesthesia During LAbor

In discussing the risk of placing an epidural during labor, you explain to your patient that
A) The ACOG (The American Congress of Obstetricians and Gynecologists) recommends that epidural anesthesia in nulliparous women is not recommended until cervical dilation has reached 4 to 5 cm regardless of maternal request.
B) Early epidural anesthesia increases the risk of cesarean section.
C) Epidural anesthesia may increase the rate of vacuum extraction.
D) Epidural anesthesia has no effect on the length of the second stage of labor.
E) Epidural anesthesia is of little help with pain management in early labor.

Answer and Discussion
The answer is

Restless Legs Syndrome

A 33-year-old woman is diagnosed as having restless legs syndrome. What is the most relevant blood
test to perform?
A. ESR
B. Ferritin
C. Blood glucose
D. Urea and electrolytes
E. Liver function tests

Answer:

Explanation to a patient who is reluctant to receive treatment

Case Scenario: You are a junior doctor in a medical outpatient clinic. A 30 year old female who has come for a prescription of an oral contraceptive pills is found to have high blood pressure. Her BP has been measured on several occasions and found to be consistently in the region of 180/100 mmHg. It has been explained to her that she has high BP that requires investigation and treatment, but she feels well and only wants a prescription for the oral contraceptive pill, not any tests or medication.
Your task is to inform the patient why investigations and treatment are required.

Key issues to explore
The key to a successful outpatient consultation will be to understand the reason why the patient does not want further investigation or treatment.

• Does she feel that investigation and treatment are unnecessary because she feels well?
• Is she afraid of what may be found?
• Is she concerned about the effects of treatment?

Key points to establish

• It is very important to establish a rapport with this woman so that she will trust you and thus hopefully follow the recommended management plan. 
• Explain to her that hypertension is a common and often asymptomatic condition that is frequently detected on routine screening, or incidentally as part of investigations for other medical problems. 
• It is important that she understands what hypertension is and why it should be taken seriously, even in the absence of  any complaints or limitations: the potential harmful effects of long term high BP must be explained.
• She will need reassurance and an explanation that investigations are necessary to exclude a secondary cause of high BP, which might mean that the hypertension can be cured and that she would not need long term treatment. 
• If no specific cause for hypertension is found, then simple changes to her lifestyle may be adequate to treat her BP. But in some situations this is not enough and she may require medication.
• Your advice should be accompanied by provision of reading material and help with associated programmes for smoking cessation, weight loss and dietary advice.

Appropriate responses to likely questions

Most Common Cause Of Death In Patients With Chronic Renal Disease.

You are reviewing a 65-year-old in the renal clinic. He has been on haemodialysis for chronic kidney disease for the past 6 years. What is he most likely to die from?
A. Hyperkalaemia
B. Malignancy
C. Dilated cardiomyopathy
D. Dialysis related sepsis
E. Ischemic heart disease

Answer:

Management of Drug Overdose

A 36 year old woman presents to the emergency department stating that she took too many pills as a suicide attempt. Now she is scared to die and also don't know what pills they were as she found it in her grand mother's house and just took them. How would you manage this patient.

Management of Drug Overdose:

1. Establish an IV access.
2. Check the patient's vitals.
3. If the vitals are stable and patient is conscious keep the patient in a quiet room with continuous monitoring and let a close relative or friend be with the patient for reassurance.
4. If the vital signs are not stable and patient shows signs of mental status changes, appropriate measures should be taken to stabilize the vital signs.
5. Overdose with stimulant drugs can lead to tachycardia, cardiac arrhythmia, elevated blood pressure and seizures.