EMQs in Clinical Medicine.pdf - Peshawar Medical College

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Disease-modifying anti-rheumatic drugs (DMARDs) 123 53 Disease-modifying anti-rheumatic drugs (DMARDs) A B C D E F penicillamine sulfasalazine (sulphasalazine) ciclosporin mebeverine hydroxychloroquine anti-TNF (tumour necrosis factor) therapy G H I J K ibuprofen methotrexate prednisolone diclofenac gold Select the medication, from the above options, that is most likely to be responsible for the adverse effects in the patients on DMARDs presenting in the questions below. 1 Computed tomography (CT) of patient on long-term DMARD treatment shows pulmonary and hepatic fibrosis. 2 Fertility testing reveals oligospermia in a 48-year-old man on DMARD treatment. 3 A patient complains of grossly swollen gums. 4 A patient taking an intramuscular DMARD presents with an itchy erythematous rash covering the whole body. 5 A 65-year-old woman patient presents with gross irreversible retinopathy. Answers: see page 135.
124 Orthopaedics and rheumatology ANSWERS 42 Arthritis Answers: C N E H A C N E H A 54-year-old woman presents to her GP with swollen painful hands and feet, which are stiffer in the mornings. On examination there are signs of ulnar deviation and subluxation at the MCP joints. Ulnar deviation and subluxation of MCP joints are signs of advanced disease. Swelling of the fingers (sausage-like) and MCP joint swelling are earlier signs. A 65-year-old woman complains of pain in her fingers on movement, which is worst at the end of the day. On examination there is joint tenderness and bony lumps at the DIP joints. A radiograph shows loss of joint space. The radiological changes of osteoarthritis include loss of joint space, subchondral sclerosis, osteophytes and subchondral cyst formation. Osteophytes at the proximal interphalangeal and DIP joints are called Bouchard’s and Heberden’s nodes respectively. Previous joint damage is a risk factor for the development of osteoarthritic disease. Simple analgesics such as paracetamol should be prescribed for pain relief rather than long courses of non-steroidal anti-inflammatory drugs (NSAIDs) (risk of gastrointestinal bleeding with prolonged use). A 30-year-old woman complains of joint pain in her hands and feet. Her chest radiograph shows reduced lung volumes. Systemic lupus erythematosus (SLE) is an inflammatory multisystemic disorder that is nine times more common in women than in men. The joints are most often affected in a symmetrical fashion with no bony erosion (unlike rheumatoid arthritis). Rarely, there may be markedly deformed joints caused by joint laxity that resemble rheumatoid arthritis (Jaccoud’s arthropathy). Lung involvement occurs in up to half of patients with SLE. Manifestations include pleuritic chest pain, pleural effusions (these are common and often bilateral), acute/chronic pneumonitis and the rare ‘shrinking lung syndrome’. A 22-year-old man presents with an acute arthritis of the left knee, dysuria and bilateral conjunctivitis. He has recently suffered from gastroenteritis. Reiter’s disease involves a triad of urethritis, conjunctivitis and seronegative arthritis. Joint symptoms may be the presenting complaint. It is often
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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
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Shortness of breath - answers 37 AN
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Haemoptysis - answers 39 and Mycopl
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Chest radiograph pathology - answer
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Treatment of asthma and COPD - answ
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Emergency management: respiratory d
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Treatment of respiratory infections
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Respiratory medicine - revision box
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SECTION 3: HAEMATOLOGY AND ONCOLOGY
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Anaemia 53 21 Anaemia A B C D E F s
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Haematological diseases 55 23 Haema
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Tumour markers 57 25 Tumour markers
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Adverse effects of chemotherapy 59
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Anaemia - answers 61 It is importan
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The peripheral blood film - answers
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Cancer care - answers 65 In Ham’s
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Adverse effects of chemotherapy - a
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Haematology and oncology - revision
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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 100 and 101: Treatment of Parkinson’s disease
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 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
Page 150 and 151: Orthopaedics and rheumatology - rev
Page 152 and 153: Orthopaedics and rheumatology - rev
Page 154 and 155: SECTION 6: THE ABDOMEN AND SURGERY
Page 156 and 157: Abdominal pain 143 55 Abdominal pai
Page 158 and 159: Liver diseases 145 57 Liver disease
Page 160 and 161: Jaundice 147 59 Jaundice A B C D E
Page 162 and 163: Presentation with a lump 149 61 Pre
Page 164 and 165: Lumps in the groin 151 63 Lumps in
Page 166 and 167: Anorectal conditions 153 65 Anorect
Page 168 and 169: Treatment of peripheral vascular di
Page 170 and 171: Haematuria 157 69 Haematuria A B C
Page 172 and 173: Dysphagia 159 71 Dysphagia A B C D
Page 174 and 175: Haematemesis 161 73 Haematemesis A
Page 176 and 177: Constipation 163 75 Constipation A
Page 178 and 179: Treatment of gastrointestinal condi
Page 180 and 181: Abdominal pain - answers 167 Helico
Page 182 and 183: Liver diseases - answers 169 E F A
Page 184 and 185: Causes of splenomegaly - answers 17
Page 186 and 187:
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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