EMQs in Clinical Medicine.pdf - Peshawar Medical College

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Drugs and immunity 229 100 Drugs and immunity A B C D E F G specific Ig penicillamine TNF antagonist interferon- tetanus immunization interferon- pertussis immunization H I J K L M normal Ig ciclosporin botulism antitoxin gold methotrexate rabies immunization Choose the therapy indicated for the clinical scenarios below from the above options. Each option may be used only once. 1 A 28-year-old man requires medication to prevent kidney transplant rejection. 2 A 35-year-old man reports being bitten by a bat while on holiday abroad a few weeks ago. 3 A 21-year-old man returning from a camping holiday presenting with diplopia and photophobia develops cardiorespiratory failure. 4 A 40-year-old woman with multiple sclerosis is prescribed medication to reduce the number of relapses. 5 A 30-year-old woman presents with a laceration on her hand sustained while gardening. She has not had any injections in the last 15 years. Answers: see page 246.
230 Miscellaneous ANSWERS 85 Antibiotics Answers: A H I D G A H I D G A 35-year-old man with a hot swollen knee where septic arthritis is suspected. This is a medical emergency and urgent Gram staining and culture are indicated. Staphylococcus aureus is the most common infecting pathogen in septic arthritis. Intravenous benzylpenicillin plus flucloxacillin is the preferred treatment until sensitivities are known. Remember the possibility of opportunistic infection if the patient is immunocompromised, e.g. HIV positive. A 54-year-old patient on the ward requires drug therapy for systemic MRSA infection. Vancomycin is a glycopeptide antibiotic and is indicated for the treatment of MRSA infection. It should be given only intravenously for systemic infection because it is not significantly absorbed when given orally. Teicoplanin is a similar glycopeptide antibiotic with a longer duration of action (so it can be given once daily). A 23-year-old pregnant woman requires treatment for an uncomplicated urinary tract infection (UTI). Trimethoprim should not be given in pregnancy because it is a folic acid antagonist and teratogenic. Quinolones and tetracycline should also be avoided. The adverse effects of nitrofurantoin include diarrhoea, vomiting, neuropathy and fibrosis. Nitrofurantoin should be avoided in pregnant mothers at term and in breast-feeding mothers. A 45-year-old woman requires antibiotic prophylaxis for a cholecystectomy. Intravenous co-amoxiclav is an alternative prophylactic antibiotic regimen for abdominal surgery. A 25-year-old woman presents with sore throat and hoarseness of voice followed by pneumonia. Chlamydia serology is positive. Tetracycline is first-line treatment for chlamydia infection. Tetracycline is absolutely contraindicated in pregnancy and when breast-feeding. Tetracyclines are deposited in growing bone and can lead to permanent staining of teeth and dental hypoplasia. Patients treated with tetracycline are told to avoid milk products because these decrease absorption of the drug.
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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
Page 52 and 53:
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
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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
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 204 and 205: Treatment of gastrointestinal condi
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 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
Page 254 and 255: Infections - answers 241 D H N A 72
Page 256 and 257: Infections - answers 243 I G A This
Page 258 and 259: The confused patient - answers 245
Page 260 and 261: Drugs and immunity - answers 247 J
Page 262 and 263: Index 249 antibiotics 85, 86 antibo
Page 264 and 265: Index 251 compartment syndrome 47 c
Page 266 and 267: Index 253 gastric carcinoma 26, 56,
Page 268 and 269: Index 255 laparotomy 77 lateral med
Page 270 and 271: Index 257 penicillamine 53, 57, 81,
Page 272 and 273: Index 259 spinal stenosis 45 spiron
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