EMQs in Clinical Medicine.pdf - Peshawar Medical College

Infections – answers 241
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A 72-year-old woman taking medication for osteoarthritis complains
of dyspepsia.
Dyspepsia is common with non-steroidal anti-inflammatory drugs
(NSAIDs) because they block the production of gastro-protective
prostaglandins in the stomach.
There is little evidence that NSAIDs provide a significantly superior analgesic
effect to paracetamol in the management of osteoarthritic pain.
A 68-year-old man complains of constipation after starting ‘heart’
medication.
Verapamil is a calcium channel antagonist and constipation can result
from the effect of blocking calcium channels in the gastrointestinal
smooth muscle.
It is used in the treatment of supraventricular arrhythmias (class IV
anti-arrhythmic drugs), e.g. prophylaxis of recurrent supraventricular
tachycardia. It can also be used as rate control in patients with atrial
fibrillation that is poorly controlled with digoxin alone.
Verapamil can be used in the treatment of hypertension and angina but
should be avoided in heart failure because it reduces cardiac output.
A 55-year-old woman presents with a vertebral crush fracture.
Long-term corticosteroid therapy can predispose to osteoporosis and thus
pathological fractures. The pathological state of osteoporosis is not
associated with pain; it is the fracture that results from the loss of bone
density that causes pain. The lumbar vertebrae, distal radius and femoral
neck are the classic sites of osteoporotic fracture.
96 Infections
Answers: K A H D L
K
A
A 10-year-old girl presents with fever, photophobia and neck
stiffness.
These symptoms and signs are suggestive of meningitis, most likely to be
meningococcal/pneumococcal infection. This is a medical emergency and
antibiotic therapy must be commenced immediately and without delay.
Cerebrospinal fluid (CSF) analysis of a typical bacterial meningitis shows
a very high neutrophil count, glucose less than half of the plasma value
and increased protein.
A 40-year-old patient presents with bloody diarrhoea after treatment
with broad-spectrum antibiotics.
This is a presentation of pseudomembranous colitis (PMC) and is caused
by overgrowth of Clostridium difficile. The symptoms result from the
toxins produced by the organism. Sigmoidoscopy usually reveals the
characteristic erythematous and ulcerated mucosa covered by