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.