EMQs in Clinical Medicine.pdf - Peshawar Medical College

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Drugs and immunity – answers 247 J D E of time elapsing between transfer of infection and onset of symptoms. The classic form of rabies is known as ‘furious rabies’. Symptoms in the prodromal period include fever, malaise, headache and itching at the site of the bite. The patient may become agitated, hallucinate and exhibit bizarre behaviour. The patient should be nursed in a quiet, darkened room because the hallmark of furious rabies is hyperexcitability to auditory and visual stimulation. Hydrophobia is present as a result of severe pharyngeal spasm when the patient attempts to eat or drink. Death is inevitable once the classic signs appear. A 21-year-old man returning from a camping holiday presenting with diplopia and photophobia develops cardiorespiratory failure. This is the presentation of botulism. It should be remembered that the symptoms occur with no gastrointestinal signs. There is marked cholinergic blockade. Respiratory insufficiency can be considerable and therefore there should be no delay in intubating patients if it is deemed necessary. A 40-year-old woman with multiple sclerosis (MS) is prescribed medication to reduce the number of relapses. Interferon- has been shown to reduce the number of plaques/lesions seen on magnetic resonance imaging (MRI) over time in patients with MS. Patients should be referred to a neurologist to establish whether treatment is indicated. Interferon- is indicated in chronic hepatitis C infection. 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. Post-exposure prophylaxis with tetanus immunization is indicated. Tetanus vaccine stimulates the production of protective antitoxin. The infective agent responsible is Clostridium tetani, the spores of which are often found in soil. Pathology results from the release of an exotoxin. The neurotoxin responsible (tetanospasmin) causes disinhibition at motor synapses and promotes neuromuscular blockade, giving rise to the characteristic skeletal muscle spasm. The most obvious sign of generalized tetanus is the appearance of ‘lockjaw’ (trismus caused by masseter muscle spasm). Facial muscle spasm gives rise to the characteristic risus sardonicus (grinning expression). Progressive muscle spasm causes arching of the neck and back muscles (opisthotonus). Laryngeal spasm impairs ventilation and can be life threatening. The patient usually presents with non-specific symptoms of fever, headache and general malaise before the onset of the classic pathognomonic signs. Active immunization with tetanus toxoid is given along with pertussis and diphtheria vaccine during the first year of life. Boosters are given before school/nursery school entry and in early adulthood. In this scenario tetanus immunization should be administered because more than 10 years have elapsed since the previous booster.
Index Note: Numbers refer to Questions not pages. Numbers preceded by ‘Box’ refer to Revision Boxes, thus ‘Box 6.2’ is Revision Box 2 in Section 6 abdomen abnormal radiographs 76 examination Box 6.2 mass 56 pain 54, 55, 58, 68, Box 6.1 abscess 61 breast 60 ischiorectal 65 psoas 56, 63 pulmonary Box 2.2, Box 2.4 tuberculous 62 ACE inhibitors 6, 80, 92, Box 1.8 acetazolamide 40 N-acetylcysteine 90 aciclovir 88 ACLS guidelines 10 acne 39 acoustic neuroma 28 acromegaly 78, Box 7.3 actinomycetes 11 acute respiratory distress syndrome 11 addisonian crisis 99 Addison’s disease 81, Box 6.2, Box 7.3 adenoma ACTH-secreting 81 pituitary 78 adenosine 8, 9, 91 ADH 25 adhesions 68 adhesive capsulitis 50 adrenalectomy 78 adrenaline 10, 17 Advanced Cardiac Life Support guidelines 10 adverse drug reactions 91, 92, 93, 94, 95 AFP 25, 57 akathisia 34 alcohol abuse 30, 34, 36, 56, 57, 73, 79, 99 alkalosis metabolic 7 respiratory 89 allopurinol 52 alopecia 27 -fetoprotein 25, 57 1 -antitrypsin deficiency 57, Box 2.4, Box 6.3 Alzheimer’s disease 36 amantadine 41, 88 amaurosis fugax 29 amenorrhoea 78 aminophylline 16, 18, 93 amiodarone 9, 91, Box 1.8 amitriptyline 24, 40, 89, 92 amoxicillin 18, 19, 77, 86 amphetamines Box 4.7 amphotericin 80, 87 ampicillin 58 amputation 67 amyloidosis 23 amyotrophic lateral sclerosis 31 amyotrophy, diabetic 83 anaemia 11, 21, 58, 75, Box 3.2 aplastic 20, 21 autoimmune haemolytic 20, 21 causes 20 of chronic disease 21, 22, Box 3.2 haemolytic 59 iron-deficiency 20, 21, 22, Box 3.1, Box 3.2, Box 6.2 macrocytic 20, Box 3.2 megaloblastic 22 microcytic 56, Box 3.2 normocytic Box 3.2 pernicious 20, 26, 58, 73 sickle-cell 20, 22, Box 3.2 sideroblastic 20, 21 analgesia, in fracture 48 anaphylaxis 17 anaplastic carcinoma 62 anatomical snuffbox 49 angina 1 aniline dyes 26, 69 ankle brachial pressure index 67 ankylosing spondylitis 42, 45, 46, 52, Box 5.1, Box 5.7 anorectal conditions 65 anorexia nervosa 70 ANP 25 anterior cruciate ligament injury 51, Box 5.6 anti-acetylcholine receptor antibodies 35
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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
Page 10 and 11:
Preface Extended matching questions
Page 12 and 13:
INTRODUCTION: EMQ REVISION The most
Page 14 and 15:
SECTION 1: CARDIOVASCULAR MEDICINE
Page 16 and 17:
Pulses 3 2 Pulses A B C D E F mitra
Page 18 and 19:
Jugular venous pressure 5 4 Jugular
Page 20 and 21:
ECG abnormalities 7 6 ECG abnormali
Page 22 and 23:
Treatment of heart failure 9 8 Trea
Page 24 and 25:
Cardiovascular emergencies 11 10 Ca
Page 26 and 27:
Pulses - answers 13 D A 23-year-old
Page 28 and 29:
Jugular venous pressure - answers 1
Page 30 and 31:
Hypertension - answers 17 activity.
Page 32 and 33:
Treatment of arrhythmias - answers
Page 34 and 35:
Cardiovascular emergencies - answer
Page 36 and 37:
Cardiovascular medicine - revision
Page 38 and 39:
Cardiovascular medicine - revision
Page 40 and 41:
SECTION 2: RESPIRATORY MEDICINE 11
Page 42 and 43:
Causes of pneumonia 29 12 Causes of
Page 44 and 45:
Chest radiograph pathology 31 14 Ch
Page 46 and 47:
Treatment of asthma and COPD 33 16
Page 48 and 49:
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
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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
Page 74 and 75:
Anaemia - answers 61 It is importan
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The peripheral blood film - answers
Page 78 and 79:
Cancer care - answers 65 In Ham’s
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Adverse effects of chemotherapy - a
Page 82 and 83:
Haematology and oncology - revision
Page 84 and 85:
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
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
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Headache - answers 91 The clusters
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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
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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
Page 132 and 133:
Fall on the outstretched hand 119 4
Page 134 and 135:
Knee problems 121 51 Knee problems
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Disease-modifying anti-rheumatic dr
Page 138 and 139:
Joint pain - answers 125 triggered
Page 140 and 141:
Back pain - answers 127 males. The
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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
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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 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 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
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 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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