EMQs in Clinical Medicine.pdf - Peshawar Medical College

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Treatment of gastrointestinal conditions – answers 191 A D Strictures and fistulae are typical of Crohn’s disease. Ulceration and fissuring give rise to ‘rose thorn’ ulcers. There is discontinuous involvement of the gastrointestinal tract with skip lesions. A 45-year-old man presents with severe epigastric pain and vomiting. Abdominal film shows absent psoas shadow and ‘sentinel loop’ of proximal jejunum. The absence of the psoas shadow is the result of a build up of retroperitoneal fluid. The sentinel loop refers to a segment of gas-filled proximal jejunum. However, it is important to remember that an abdominal plain film can be completely normal in a patient presenting with acute pancreatitis. 77 Treatment of gastrointestinal conditions Answers: E A J G H E A J G H A 50-year-old man presenting with a perforated gastric ulcer. This is a surgical emergency and requires laparotomy for surgical repair. A 55-year-old woman with severe oesophagitis confirmed on endoscopy. High-dose proton pump inhibitor is indicated as first-line treatment to ensure healing. Once healed, low-dose therapy can be continued. A 60-year-old man with cirrhosis presenting with haematemesis. Acute upper gastrointestinal bleeding is most commonly caused by peptic ulcer disease, except in patients with known cirrhosis when variceal bleeding is the cause in 85 per cent of cases. Suspected oesophageal varices are an indication for upper gastrointestinal endoscopy. A 30-year-old man with ulcerative colitis presents to A&E with fever, tachycardia and abdominal distension. This is presentation of severe ulcerative colitis and intravenous hydrocortisone is indicated. Other markers of a severe attack are anaemia, marked rectal bleeding and an ESR significantly raised from baseline. When the patient improves after a few days, oral prednisolone and a maintenance agent such as sulfasalazine (sulphasazine) can be prescribed. A 24-year-old woman with suspected irritable bowel syndrome complains of colicky pain and bloating. Mebeverine is an anti-spasmodic agent and relieves symptoms in some patients. This agent has the advantage of relaxing intestinal smooth muscle without anti-cholinergic side effects.
192 The abdomen and surgery REVISION BOXES The abdomen and surgery EMQs describing abdominal pain are very common. Box 1 describes some classic presentations that you may find in questions. Box 1 Abdominal pain [54, 55] Classic presentation Colicky loin pain radiating to groin Jaundice and constant right upper quadrant pain Severe epigastric pain radiating to back associated with vomiting Periumbilical pain radiating to right iliac fossa Central abdominal pain, expansile pulsatile mass Iliac fossa pain, positive pregnancy test Problem Ureteric colic Biliary colic Acute pancreatitis Acute appendicitis Abdominal aortic aneurysm Ectopic pregnancy Box 2 summarizes various signs that may be mentioned in an EMQ which should prompt you to look for particular options in the question. Box 2 On examination of the abdomen Signs Asterixis (liver flap) Leukonychia Koilonychia Angular stomatitis Buccal pigmentation Glossitis Aphthous ulceration Expansile pulsatile mass Craggy hepatomegaly Option Hepatic encephalopathy Hypoalbuminaemia Iron-deficiency anaemia Iron-deficiency anaemia Peutz–Jeghers syndrome Addison’s disease Vitamin B 12 deficiency Inflammatory bowel disease Coeliac disease Aneurysm Liver malignancy Box 3 gives some examples of signs of liver disease particularly relevant to EMQs.
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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
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SECTION 4: NEUROLOGY 28 Dizziness a
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Headache 75 29 Headache A B C D E F
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Weakness in the legs 77 31 Weakness
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Cranial nerve lesions 79 33 Cranial
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Neurological problems 81 35 Neurolo
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Falls and loss of consciousness 83
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Antiepileptic drug therapy 85 39 An
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Treatment of Parkinson’s disease
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Headache - answers 89 B I A 50-year
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Headache - answers 91 The clusters
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Weakness in the legs - answers 93 D
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Abnormal movements - answers 95 33
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Neurological problems - answers 97
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Falls and loss of consciousness - a
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Antiepileptic drug therapy - answer
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Treatment of headache - answers 103
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Neurology - revision boxes 105 REVI
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Neurology - revision boxes 107 Box
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Neurology - revision boxes 109 Box
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SECTION 5: ORTHOPAEDICS AND RHEUMAT
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Joint pain 113 43 Joint pain A B C
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Back pain 115 45 Back pain A B C D
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Complications of fractures 117 47 C
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Fall on the outstretched hand 119 4
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Knee problems 121 51 Knee problems
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Disease-modifying anti-rheumatic dr
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Joint pain - answers 125 triggered
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Back pain - answers 127 males. The
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Rheumatological conditions - answer
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Fall on the outstretched hand - ans
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Shoulder problems - answers 133 50
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Disease-modifying anti-rheumatic dr
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Orthopaedics and rheumatology - rev
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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
Page 188 and 189: Presentation with a lump - answers
Page 190 and 191: Lumps in the groin - answers 177 G
Page 192 and 193: Anorectal conditions - answers 179
Page 194 and 195: Treatment of peripheral vascular di
Page 196 and 197: Haematuria - answers 183 G A 46-yea
Page 198 and 199: Dysphagia - answers 185 G K A 10-ye
Page 200 and 201: Haematemesis - answers 187 Common b
Page 202 and 203: Constipation - answers 189 L J A 17
Page 206 and 207: The abdomen and surgery - revision
Page 208 and 209: SECTION 7: METABOLIC AND ENDOCRINE
Page 210 and 211: Nutritional deficiencies 197 79 Nut
Page 212 and 213: Disorders of sodium balance 199 81
Page 214 and 215: Diabetic complications 201 83 Diabe
Page 216 and 217: Endocrine problems - answers 203 AN
Page 218 and 219: Electrolyte and metabolic disturban
Page 220 and 221: Hypercalcaemia - answers 207 The wa
Page 222 and 223: Treatment of diabetes - answers 209
Page 224 and 225: Metabolic and endocrine disturbance
Page 226 and 227: SECTION 8: MISCELLANEOUS 85 Antibio
Page 228 and 229: Antibiotics 215 86 Antibiotics A B
Page 230 and 231: Antiviral therapies 217 88 Antivira
Page 232 and 233: Treatment of poisioning and overdos
Page 234 and 235: Adverse drug reactions 221 92 Adver
Page 236 and 237: Adverse drug reactions 223 94 Adver
Page 238 and 239: Infections 225 96 Infections A B C
Page 240 and 241: Medical emergencies 227 98 Medical
Page 242 and 243: Drugs and immunity 229 100 Drugs an
Page 244 and 245: Treatment of infection - answers 23
Page 246 and 247: Poisoning and overdose - answers 23
Page 248 and 249: Treatment of poisoning and overdose
Page 250 and 251: Adverse drug reactions - answers 23
Page 252 and 253: 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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