EMQs in Clinical Medicine.pdf - Peshawar Medical College

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Treatment of Parkinson’s disease 87 41 Treatment of Parkinson’s disease A B C D E F G clozapine thalamotomy bromocriptine ondansetron carbidopa metoclopramide benzhexol H I J K L M apomorphine nortriptyline domperidone amantadine entacapone haloperidol For each clinical scenario below, suggest the most appropriate management. Each option may be used only once. 1 Improvement of tremor in a 70-year-old patient with Parkinson’s disease on treatment with levodopa. 2 Control of vomiting in a patient being treated for Parkinson’s disease. 3 A 65-year-old man with Parkinson’s disease cannot tolerate levodopa-based therapy despite careful titration. 4 A patient on therapy for Parkinson’s disease requires urgent treatment for acute psychosis. 5 A 75-year-old man with severe Parkinson’s disease with symptoms that remain uncontrolled on maximum oral therapy. Answers: see page 104.
88 Neurology ANSWERS 28 Dizziness and vertigo Answers: J F D B I J F D A 45-year-old woman presents with a left-sided facial palsy and vertigo. She has impaired hearing on her left side and a vesicular rash is noted around her external auditory meatus. Ramsay Hunt syndrome is the name attributed to herpes zoster infection of the geniculate ganglion. The external auditory meatus receives some sensory innervation from the facial (VII) nerve, hence the vesicular rash over this area. Aciclovir is the treatment of choice. A 55-year-old man presents with a history of recurrent spontaneous attacks of vertigo, hearing loss and tinnitus. These attacks last up to 2 h and are sometimes associated with vomiting. Menière’s disease is associated with the triad of vertigo, tinnitus and deafness. The aetiology is unclear and some authorities suggest that it may arise from a dilatation of the endolymphatic system. The vertigo may be disabling and associated with vomiting. The deafness is of a sensorineural nature. Rest is advised for acute attacks. Long-term prophylaxis involves the use of vestibular sedatives, e.g. cinnarizine or betahistine, but results are disappointing. A 65-year-old woman presents with vertigo, vomiting and dysphagia. On examination there is a left-sided Horner’s syndrome, and loss of pain and temperature on the right side of the face. The posterior inferior cerebellar artery (PICA) supplies the dorsal lateral medullary plate and parts of the posterior medial cerebellum. PICA thrombosis results in lesions affecting cranial nerves, descending tracts and the cerebellum that are known collectively as ‘lateral medullary syndrome’. Ipsilateral signs include: – decreased pain and temperature sensation of the face (descending tract and nucleus of nerve V) – palatal, vocal fold paralysis (nerve IX, X involvement) – Horner’s syndrome (sympathetic tract) – cerebellar signs, e.g. ataxia, nystagmus. Contralateral signs include: – decreased pain and temperature sensation of the body (spinothalamic tract) – lateral medullary syndrome, eponymously known as Wallenberg’s syndrome.
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EMQs in CLINICAL MEDICINE
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EMQs in CLINICAL MEDICINE Irfan Sye
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Dedication To Mum, Dad, Reshma and
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Contents vii SECTION 4: NEUROLOGY 7
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Preface Extended matching questions
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INTRODUCTION: EMQ REVISION The most
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SECTION 1: CARDIOVASCULAR MEDICINE
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Pulses 3 2 Pulses A B C D E F mitra
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Jugular venous pressure 5 4 Jugular
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ECG abnormalities 7 6 ECG abnormali
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Treatment of heart failure 9 8 Trea
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Cardiovascular emergencies 11 10 Ca
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Pulses - answers 13 D A 23-year-old
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Jugular venous pressure - answers 1
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Hypertension - answers 17 activity.
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Treatment of arrhythmias - answers
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Cardiovascular emergencies - answer
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Cardiovascular medicine - revision
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Cardiovascular medicine - revision
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SECTION 2: RESPIRATORY MEDICINE 11
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Causes of pneumonia 29 12 Causes of
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Chest radiograph pathology 31 14 Ch
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Treatment of asthma and COPD 33 16
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Management of COPD 35 18 Management
Page 50 and 51: Shortness of breath - answers 37 AN
Page 52 and 53: Haemoptysis - answers 39 and Mycopl
Page 54 and 55: Chest radiograph pathology - answer
Page 56 and 57: Treatment of asthma and COPD - answ
Page 58 and 59: Emergency management: respiratory d
Page 60 and 61: Treatment of respiratory infections
Page 62 and 63: Respiratory medicine - revision box
Page 64 and 65: SECTION 3: HAEMATOLOGY AND ONCOLOGY
Page 66 and 67: Anaemia 53 21 Anaemia A B C D E F s
Page 68 and 69: Haematological diseases 55 23 Haema
Page 70 and 71: Tumour markers 57 25 Tumour markers
Page 72 and 73: Adverse effects of chemotherapy 59
Page 74 and 75: Anaemia - answers 61 It is importan
Page 76 and 77: The peripheral blood film - answers
Page 78 and 79: Cancer care - answers 65 In Ham’s
Page 80 and 81: Adverse effects of chemotherapy - a
Page 82 and 83: Haematology and oncology - revision
Page 84 and 85: Haematology and oncology - revision
Page 86 and 87: SECTION 4: NEUROLOGY 28 Dizziness a
Page 88 and 89: Headache 75 29 Headache A B C D E F
Page 90 and 91: Weakness in the legs 77 31 Weakness
Page 92 and 93: Cranial nerve lesions 79 33 Cranial
Page 94 and 95: Neurological problems 81 35 Neurolo
Page 96 and 97: Falls and loss of consciousness 83
Page 98 and 99: Antiepileptic drug therapy 85 39 An
Page 102 and 103: Headache - answers 89 B I A 50-year
Page 104 and 105: Headache - answers 91 The clusters
Page 106 and 107: Weakness in the legs - answers 93 D
Page 108 and 109: Abnormal movements - answers 95 33
Page 110 and 111: Neurological problems - answers 97
Page 112 and 113: Falls and loss of consciousness - a
Page 114 and 115: Antiepileptic drug therapy - answer
Page 116 and 117: Treatment of headache - answers 103
Page 118 and 119: Neurology - revision boxes 105 REVI
Page 120 and 121: Neurology - revision boxes 107 Box
Page 122 and 123: Neurology - revision boxes 109 Box
Page 124 and 125: SECTION 5: ORTHOPAEDICS AND RHEUMAT
Page 126 and 127: Joint pain 113 43 Joint pain A B C
Page 128 and 129: Back pain 115 45 Back pain A B C D
Page 130 and 131: Complications of fractures 117 47 C
Page 132 and 133: Fall on the outstretched hand 119 4
Page 134 and 135: Knee problems 121 51 Knee problems
Page 136 and 137: Disease-modifying anti-rheumatic dr
Page 138 and 139: Joint pain - answers 125 triggered
Page 140 and 141: Back pain - answers 127 males. The
Page 142 and 143: Rheumatological conditions - answer
Page 144 and 145: Fall on the outstretched hand - ans
Page 146 and 147: Shoulder problems - answers 133 50
Page 148 and 149: Disease-modifying anti-rheumatic dr
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Orthopaedics and rheumatology - rev
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Orthopaedics and rheumatology - rev
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SECTION 6: THE ABDOMEN AND SURGERY
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Abdominal pain 143 55 Abdominal pai
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Liver diseases 145 57 Liver disease
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Jaundice 147 59 Jaundice A B C D E
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Presentation with a lump 149 61 Pre
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Lumps in the groin 151 63 Lumps in
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Anorectal conditions 153 65 Anorect
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Treatment of peripheral vascular di
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Haematuria 157 69 Haematuria A B C
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Dysphagia 159 71 Dysphagia A B C D
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Haematemesis 161 73 Haematemesis A
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Constipation 163 75 Constipation A
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Treatment of gastrointestinal condi
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Abdominal pain - answers 167 Helico
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Liver diseases - answers 169 E F A
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Causes of splenomegaly - answers 17
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Jaundice - answers 173 C A J L M He
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Presentation with a lump - answers
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Lumps in the groin - answers 177 G
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Anorectal conditions - answers 179
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Treatment of peripheral vascular di
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Haematuria - answers 183 G A 46-yea
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Dysphagia - answers 185 G K A 10-ye
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Haematemesis - answers 187 Common b
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Constipation - answers 189 L J A 17
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Treatment of gastrointestinal condi
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The abdomen and surgery - revision
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SECTION 7: METABOLIC AND ENDOCRINE
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Nutritional deficiencies 197 79 Nut
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Disorders of sodium balance 199 81
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Diabetic complications 201 83 Diabe
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Endocrine problems - answers 203 AN
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Electrolyte and metabolic disturban
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Hypercalcaemia - answers 207 The wa
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Treatment of diabetes - answers 209
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Metabolic and endocrine disturbance
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SECTION 8: MISCELLANEOUS 85 Antibio
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Antibiotics 215 86 Antibiotics A B
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Antiviral therapies 217 88 Antivira
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Treatment of poisioning and overdos
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Adverse drug reactions 221 92 Adver
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Adverse drug reactions 223 94 Adver
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Infections 225 96 Infections A B C
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Medical emergencies 227 98 Medical
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Drugs and immunity 229 100 Drugs an
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Treatment of infection - answers 23
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Poisoning and overdose - answers 23
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Treatment of poisoning and overdose
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Adverse drug reactions - answers 23
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Adverse drug reactions - answers 23
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Infections - answers 241 D H N A 72
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Infections - answers 243 I G A This
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The confused patient - answers 245
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Drugs and immunity - answers 247 J
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Index 249 antibiotics 85, 86 antibo
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Index 251 compartment syndrome 47 c
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Index 253 gastric carcinoma 26, 56,
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Index 255 laparotomy 77 lateral med
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Index 257 penicillamine 53, 57, 81,
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Index 259 spinal stenosis 45 spiron
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