EMQs in Clinical Medicine.pdf - Peshawar Medical College

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Adverse effects of chemotherapy 59 27 Adverse effects of chemotherapy A B C D E F G paclitaxel folic acid prednisolone mesna bleomycin dihydrotestosterone flutamide H I J K L M N trimethoprim erythromycin doxorubicin chlorambucil 5-fluorouracil cyclophosphamide tamoxifen For each scenario, choose the drug most likely to be responsible for the adverse effects encountered. Each option may be used only once. 1 A 66-year-old woman treated with an alkylating agent for myeloma presents with severe haematuria. 2 A 34-year-old woman treated with a microtubular inhibitor for carcinoma of the breast develops a peripheral neuropathy. 3 A young man treated with an antibiotic for acute leukaemia develops arrhythmias and heart block shortly after the administration of chemotherapy. 4 A patient treated with an antibiotic for lung cancer develops pulmonary fibrosis. 5 A 55-year-old man on treatment for prostate cancer complains of gynaecomastia. Answers: see page 67.
60 Haematology and oncology ANSWERS 20 Causes of anaemia Answers: D F L J A D F L A 23-year-old man presents with recurrent nose-bleeds and infection after a course of chemotherapy. Aplastic anaemia is a presentation of pancytopenia with hypoplastic marrow. Aplastic anaemia can be either primary or secondary. The most common cause of primary aplastic anaemia is idiopathic acquired aplastic anaemia. Congenital causes of primary aplastic anaemia are very rare, e.g. Fanconi’s anaemia. Secondary causes of aplastic anaemia include infection (especially viral, e.g. hepatitis, measles, parvovirus B19) and drugs. Cytotoxic drugs such as busulphan and doxorubicin are wellrecognized causes of secondary aplastic anaemia via a type A (doserelated) response. Non-cytotoxic drugs such as chloramphenicol and gold have also been reported to cause aplasia via a type B (not dose-related) response. Rarely, pregnancy is associated with a secondary aplastic anaemia. A 24-year-old Cypriot man presents with a worsening anaemia and jaundice. A blood film taken several weeks after the incident shows the presence of Heinz bodies. Glucose-6-phosphate dehydrogenase (G6PDH) deficiency is the most common red blood cell enzyme defect and is more common in patients of Mediterranean origin. Individuals with this condition are susceptible to oxidative crises precipitated by fava beans and drugs such as ciprofloxacin and sulphonamides. G6PDH plays an important role in the hexose monophosphate shunt which provides NADPH (reduced nicotinamide adenine dinucleotide phosphate – the reducing agent). NADPH is used to regenerate glutathione. In the absence of glutathione, red blood cells are exposed to oxidative stress. Heinz bodies represent oxidized haemoglobin. A 50-year-old man presents with tiredness, dyspnoea and paraesthesia. On examination he showed extensor plantars, brisk knee jerks and absent ankle jerks. His blood film shows macrocytic anaemia. Pernicious anaemia is the most common cause of vitamin B 12 deficiency. This is an autoimmune condition characterized by atrophy of the gastric mucosa with subsequent failure of intrinsic factor production. Intrinsic factor is required for vitamin B 12 absorption. Other causes of vitamin B 12 deficiency are terminal ileum disease, gastrectomy and low dietary intake (e.g. vegans).
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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
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
Page 66 and 67: Anaemia 53 21 Anaemia A B C D E F s
Page 68 and 69: Haematological diseases 55 23 Haema
Page 70 and 71: Tumour markers 57 25 Tumour markers
Page 74 and 75: Anaemia - answers 61 It is importan
Page 76 and 77: The peripheral blood film - answers
Page 78 and 79: Cancer care - answers 65 In Ham’s
Page 80 and 81: Adverse effects of chemotherapy - a
Page 82 and 83: Haematology and oncology - revision
Page 84 and 85: 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
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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
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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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