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Question 1
Correct
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A 25-year-old female was admitted following the ingestion of 36 paracetamol tablets. On examination she was confused and disoriented. Investigations after 24 hrs showed a normal FBC, pH - 7.2, serum creatinine - 3.7mg/dl and INR 6.5. Which of the following is the most appropriate management for her?
Your Answer: Liver transplantation
Explanation: -
This question is part of the following fields:
- Emergency & Critical Care
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Question 2
Correct
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A 35-year-old female complains of headache at the back of her head that has been occurring for several days and pain on neck flexion. She works as a housemaid. Which of the following is the most likely cause of her presentation?
Your Answer: Cervical spondylosis
Explanation:Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs). Cervical spondylosis is very common and worsens with age.
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This question is part of the following fields:
- Musculoskeletal System
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Question 3
Correct
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An 82-year-old patient presents to the clinic complaining of palpitations. ECG reveals waves with saw-tooth pattern, QRS complex of 80ms duration, a ventricular rate of 150/min and a regular R-R interval. Which of the following is most likely responsible for these findings?
Your Answer: Atrial flutter
Explanation:Atrial flutter is a common supraventricular tachyarrhythmia that is usually caused by a single macroreentrant rhythm within the atria, associated with a sawtooth appearance on the ECG. In stable patients the treatment includes rate control and rhythm control, however in unstable patients, a synchronized cardioversion is required.
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This question is part of the following fields:
- Cardiovascular System
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Question 4
Correct
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A 7-month-old baby girl is admitted with poor feeding and irritability for 2 days. She is lethargic and persistently crying. Urine dipstick showed leukocytes. What is the single most important investigation to arrive at a diagnosis?
Your Answer: Urine for C&S
Explanation:The clinical presentation and leucocytes on the urine dipstick is suggestive of a urinary tract infection. To confirm the diagnosis, urine should be sent for culture and sensitivity.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 5
Incorrect
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A 30-year-old female presents to the A&E department with epistaxis, which has now stopped. According to her boyfriend, she has a recent history of mucosal bleeding and has at times been very disorientated. On examination, she has a low-grade fever and appears confused and jaundiced. There is bruising over her legs and arms. A urine pregnancy test is negative. You receive the following blood results from the laboratory:
Hb: 8.5 g/dL
Plts: 8 x 10^9/L
WCC: 4.5 x 10^9/L
MCV: 92 fL
Na+: 138 mmol/L
K+: 4.9 mmol/L
Urea: 10.2 mmol/L
Creatinine: 182 mmol/L
Her coagulation profile is normal.
Given the likely diagnosis, what is the most appropriate management of this patient?Your Answer: Platelet transfusion
Correct Answer: Plasma exchange
Explanation:The diagnosis for the aforementioned case is thrombotic thrombocytopenic purpura (TTP). TTP is classically characterised as a pentad of thrombocytopaenia, microvascular haemolysis, fluctuating neurological signs, renal impairment, and fever.
The differential diagnosis for severe thrombocytopaenia is immune thrombocytopenic purpura (ITP). ITP is more common than TTP. However, a patient of ITP would not present with the range of symptoms seen in this scenario.
In TTP, there is deficiency of a protease which breaks down large multimers of von Willebrand factor. This leads to abnormally large and sticky multimers of von Willebrand factor which cause platelets to clump within the vessels.
Untreated TTP has a mortality rate of up to 90%. Therefore, rapid plasma exchange (PEX) may be a life-saving intervention. Platelet transfusion in TTP is only indicated if there is an ongoing life-threatening bleed. Intravenous methylprednisolone is indicated after treatment with PEX has been completed. There is no current role of intravenous immunoglobulin in the routine management of TTP. However, there have been reports of its successful use in PEX- and steroid-refractory cases. Intravenous argatroban is indicated in heparin-induced thrombocytopaenia (HIT), but there is no history of recent heparin administration or hospitalisation in this patient nor are the clinical signs consistent with HIT.
Management options for TTP include PEX as the treatment of choice. Steroids and immunosuppressants are also given. Antibiotics are not recommended as they may worsen the outcome of the disease. For cases resistant to PEX and pharmacologic therapy, vincristine is given.
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This question is part of the following fields:
- Haematology & Oncology
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Question 6
Correct
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A 71-year-old woman presents with dyspnoea and unsteadiness. She's known to suffer from epilepsy and is managed on carbamazepine. Blood exams are as follows: MCV=70, Hb=8.5, WBC=2, Neutrophils=1, Platelets=50. What is the most likely diagnosis?
Your Answer: Aplastic anaemia
Explanation:The results of the blood exam are suggestive of aplastic anaemia which might be secondary to carbamazepine use. The use of antiepileptic’s, in particular carbamazepine and valproate, is associated with a nine fold increased risk of aplastic anaemia.
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This question is part of the following fields:
- Haematology & Oncology
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Question 7
Incorrect
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A 50-year-old man is found incidentally to have hypercalcaemia during a routine health screen.
Which one of the following biochemical findings would be most suggestive of primary hyperparathyroidism rather than any other cause of hypercalcaemia?Your Answer: Elevated 24-h urinary calcium excretion
Correct Answer: Serum PTH concentration within the normal range
Explanation:Primary hyperparathyroidism (PHPT) is diagnosed based upon levels of blood calcium and parathyroid hormone (PTH). In most people with PHPT, both levels are higher than normal. Occasionally, a person may have an elevated calcium level and a normal or minimally elevated PTH level. Since PTH should normally be low when calcium is elevated, a minimally elevated PTH is considered abnormal and indicates PHPT.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 8
Incorrect
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A 55-year-old alcoholic is admitted with portal hypertension. The wedged hepatic venous pressure is recorded. This pressure is reflective of which part of the hepatic vascular system?
Your Answer: Hepatic vein
Correct Answer: Sinusoids
Explanation:The wedged hepatic venous pressure is a reflection of the portal venous pressure in the hepatic sinusoids. This is a fact to remember. Here is a great but concise explanation as to why: https://www.ncbi.nlm.nih.gov/pubmed/18695309
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This question is part of the following fields:
- Hepatobiliary System
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Question 9
Correct
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A 33-year-old lady presented with complaints of an erythematous rash over her shins, along with arthritis and painful swollen knees. What will be the single most likely finding on her chest X-ray?
Your Answer: Bilateral hilar lymphadenopathy
Explanation:Lofgren’s syndrome is characterised by a triad of erythema nodosum, arthritis and bilateral lymphadenopathy. It is a variant of sarcoidosis.
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This question is part of the following fields:
- Respiratory System
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Question 10
Correct
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Regarding haemochromatosis, which of the following is true?
Your Answer: Haemochromatosis may be treated with therapeutic phlebotomy
Explanation:Haemochromatosis is an abnormally high rate of the production of haemoglobin. It is an autosomal recessive disease copied on chromosome 6. It is associated with hepatic disorders, cardiac diseases and skin pigmentation. It is treated by regular venesection.
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This question is part of the following fields:
- Haematology & Oncology
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Question 11
Incorrect
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A 15-year-old girl is admitted to hospital following a ruptured ectopic pregnancy. She comes from a family of Jehovah's Witnesses. Her haemoglobin on admission is 6.7 g/dl. She consents to a blood transfusion but her mother refuses. What is the most appropriate course of action?
Your Answer: Respect parental wishes and withhold the blood transfusion
Correct Answer: Give the blood transfusion
Explanation:People aged 16 or over are entitled to consent to their own treatment. This can only be overruled in exceptional circumstances. Children under the age of 16 can consent to their own treatment if they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment. This is known as being Gillick competent.
Otherwise, someone with parental responsibility can consent for them.
This could be:
the child’s mother or father
the child’s legally appointed guardian
a person with a residence order concerning the child
a local authority designated to care for the child
a local authority or person with an emergency protection order for the child.
Giving the blood transfusion is therefore both clinically and ethically the right course of action.
Jehovah’s Witnesses frequently carry a signed and witnessed Advance Decision Document listing the blood products and autologous procedures that are, or are not, acceptable to them It is appropriate to have a frank, confidential discussion with the patient about the potential risks of their decision and the possible alternatives to transfusion, but the freely expressed wish of a competent adult must always be respected. -
This question is part of the following fields:
- Ethical & Legal
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Question 12
Correct
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A 50-year-old female was admitted to the emergency department with a moderate fever and productive cough. She commonly experiences central chest pain and regurgitation of undigested food particles. She did not suffer from acid reflux. Solid and liquid diet have both been affected for the last 4 months. A CXR showed an air-fluid level behind a normal sized heart. What is the most likely diagnosis?
Your Answer: Achalasia
Explanation:The diagnosis is aspiration pneumonia due to the retained food in the oesophagus. This is the case with achalasia. There is no acid reflux in this disease. An air fluid level behind the heart also favours achalasia. In hiatus hernia, GORD is usually present with nausea and vomiting. In the case of a pharyngeal pouch being present, halitosis would be evident.
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This question is part of the following fields:
- Gastrointestinal System
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Question 13
Correct
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A 23-year-old woman complains of numbness in her right hand that improves by shaking it. The surgeon has suggested a surgical option. Ligation of which of the following structures will improve the condition?
Your Answer: Flexor retinaculum
Explanation:The most likely cause is median nerve inflammation due to carpal tunnel syndrome. It is treated surgically with ablation of the flexor retinaculum.
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This question is part of the following fields:
- Nervous System
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Question 14
Correct
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A 47-year-old woman diagnosed with oestrogen receptor positive breast cancer three months back was started on treatment with tamoxifen. Which of the following is most likely a complaint of this patient during her review today?
Your Answer: Hot flushes
Explanation:The most likely complaint of this patient would be hot flushes.
Alopecia and cataracts are listed in the BNF as possible side-effects. They are however not as prevalent as hot flushes, which are very common in pre-menopausal women.
Tamoxifen is a Selective Oestrogen Receptor Modulator (SERM) which acts as an oestrogen receptor antagonist and partial agonist. It is used in the management of oestrogen receptor-positive breast cancer
Adverse effects:
Menstrual disturbance: vaginal bleeding, amenorrhoea
Hot flushes – 3% of patients stop taking tamoxifen due to climacteric side-effects.
Venous thromboembolism.
Endometrial cancer
Tamoxifen is typically used for 5 years following the removal of the tumour.Raloxifene is a pure oestrogen receptor antagonist and carries a lower risk of endometrial cancer.
Although antagonistic with respects to breast tissue tamoxifen may serve as an agonist at other sites. Therefore the risk of endometrial cancer is increased cancer.
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This question is part of the following fields:
- Women's Health
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Question 15
Correct
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What are the most common types of transformation seen in patients with polycythaemia vera?
Your Answer: Myelofibrosis + acute myeloid leukaemia
Explanation:5-15% of the cases of polycythaemia vera progress to myelofibrosis or acute myeloid leukaemia (AML).
Polycythaemia vera (PV), also known as polycythaemia rubra vera, is a myeloproliferative disorder caused by clonal proliferation of marrow stem cells leading to an increase in red cell volume, often accompanied by overproduction of neutrophils and platelets. It has peak incidence in the sixth decade of life, with typical features including hyperviscosity, pruritus, splenomegaly, haemorrhage (secondary to abnormal platelet function), and plethoric appearance.
Some management options of PV include lose-dose aspirin, venesection (first-line treatment), hydroxyurea (slightly increased risk of secondary leukaemia), and radioactive phosphorus (P-32) therapy.
In PV, thrombotic events are a significant cause of morbidity and mortality. 5-15% of the cases progress to myelofibrosis or AML. The risk of having AML is increased with chemotherapy treatment.
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This question is part of the following fields:
- Haematology & Oncology
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Question 16
Correct
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A 52-year-old gentleman known with rheumatoid arthritis presented with a 5 day history of red, painful swollen knee joint. He was afebrile and the joint was warm on touch. Hamstring muscles were spastic. Which of the following tests should be done next?
Your Answer: Joint aspiration for cytology and culture and sensitivity
Explanation:Rheumatoid arthritis can affect any joint of the body. Aspirate will reveal increased TLC, and it will be sterile.
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This question is part of the following fields:
- Immune System
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Question 17
Correct
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A 27-year-old lady presents with severe morning headaches associated with nausea. Head MRI reveals a large compressive tumour arising from the falx cerebri. The tumour is well delineated. What is the most probable diagnosis?
Your Answer: Meningioma
Explanation:Meningiomas are the most common benign tumours of the brain. Their name is derived from the fact that they arise from the dura mater which together with the pia matter and arachnoid mater form the meninges. The chances that a meningioma is benign are almost 98%. They are non-invasive and well delineated, causing sign and symptoms of brain compression.
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This question is part of the following fields:
- Nervous System
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Question 18
Correct
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A 28-year-old man presents to the clinic with fatigue, exertional dyspnoea, abdominal discomfort, xerophthalmia and xerostomia. Examination reveals enlargement of the parotid glands bilaterally, hepatomegaly and peripheral motor neuropathy. Lab results are negative for RF, ANA, SS-A and SS-B antibodies. What is the most likely diagnosis?
Your Answer: Diffuse infiltrative lymphocytic syndrome (DILS)
Explanation:The Diffuse Infiltrative Lymphocytosis Syndrome (DILS) is a rare multisystemic syndrome described in HIV-infected patients. It is characterised by CD8(+) T-cell lymphocytosis associated with a CD8(+) T-cell infiltration of multiple organs. DILS is usually seen in uncontrolled or untreated HIV infection but can also manifest itself independently of CD4(+) T-cell counts. The syndrome may present as a Sjögren-like disease that generally associates sicca signs with bilateral parotiditis, lymphadenopathy, and extra glandular organ involvement. The latter may affect the lungs, nervous system, liver, kidneys, and digestive tract. Anomalies of the respiratory system are often identified as lymphocytic interstitial pneumonia. Facial nerve palsy, aseptic meningitis or polyneuropathy are among the more frequent neurological features. Hepatic lymphocytic infiltration, lymphocytic interstitial nephropathy and digestive tract lymphocytic infiltration account for more rarely noted complications. Sicca syndrome, organomegaly and/or organ dysfunction associated with polyclonal CD8(+) T-cell organ-infiltration are greatly suggestive of DILS in people living with HIV.
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This question is part of the following fields:
- Musculoskeletal System
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Question 19
Incorrect
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Which is NOT a poor prognostic factor for patients with malignant melanoma?
Your Answer: Breslow thickness > 3 mm
Correct Answer: Diameter of melanoma > 6 mm
Explanation:Features that affect prognosis are tumour thickness in millimetres (Breslow’s depth – the deeper the Breslow thickness the poorer the prognosis.), depth related to skin structures (Clark level – the level of invasion through the dermis), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumour-infiltrating lymphocytes (if present, prognosis is better), location of lesion, presence of satellite lesions, and presence of regional or distant metastasis. Malignant melanoma tends to grow radially before entering a vertical growth phase. The diameter it reaches has not been found to be a prognostic factor.
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This question is part of the following fields:
- The Skin
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Question 20
Incorrect
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A 65-year-old woman was referred due to a pulse rate of 40 bpm. Which of the following answers is associated with the least risk of asystole?
Your Answer: Mobitz type II AV block
Correct Answer: Complete heart block with a narrow complex QRS
Explanation:From the given answers, complete heart block with a narrow complex QRS complex is associated with the least risk of asystole. Transvenous pacing is indicated by the other given responses.
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This question is part of the following fields:
- Cardiovascular System
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Question 21
Correct
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A 34-year-old patient arrives at the clinic with cervical lymphadenopathy and splenomegaly. Which of the following is the most likely cause?
Your Answer: Non-Hodgkin's lymphoma
Explanation:Lymphomas are a type of cancer that arises from lymphocytes. There are two main types of lymphoma:
1. Hodgkin lymphomas, which are characterized by the presence of Reed-Sternberg cells, and
2. Non-Hodgkin lymphomas (NHLs), which comprise all other types of lymphoma. NHLs are further classified according to the cell type, i.e., B cells, T cells, and natural killer (NK) cells, and tumour grade.
Low-grade tumours originate from mature cells that have a slow growth rate and an indolent clinical course. The most common low-grade B-cell lymphoma is follicular lymphoma, while the most common low-grade T-cell lymphomas are the cutaneous T-cell lymphomas such as mycosis fungoides. High-grade tumours, on the other hand, have a rapid growth rate and an aggressive clinical course. Certain subtypes of NHL are more common in children and young adults, such as Burkitt lymphoma.
There is a variety of treatment options, depending on the type of lymphoma. Generally, treatment involves a combination of chemotherapy and radiation therapy. Limited disease low-grade tumours and high-grade NHL are treated with a curative approach. Advanced, low-grade tumours are treated with a palliative approach in symptomatic patients. -
This question is part of the following fields:
- Haematology & Oncology
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Question 22
Incorrect
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A 35-year-old male has presented with a wrist drop of his right hand. After a medical examination, an area of sensory loss on the dorsum is revealed. Choose the nerve most likely to be affected from the list of options.
Your Answer: T1 nerve root
Correct Answer: Radial nerve
Explanation:The radial nerve supplies the following: brachioradialis, extensor carpi radialis longus, and the extensor muscles of the forearm (which is via the posterior interosseous nerve). The sensory branches supply the following: dorsum of the thumb, dorsum of the fingers up to the PIPJ (proximal interphalangeal joint), and the middle of the ring finger. The loss of muscle power depends on the extent of the nerve damage – the usual posture is a wrist drop, coupled with thumb adduction and hand pronation. Sensation in this male patient is impaired in this area. The thoracic nerve supplies the serratus anterior muscle, and thus, damage causes winging of the scapula. A median nerve palsy causes the following: the inability to abduct and oppose the thumb; weakness in the forearm, pronation and finger flexion; and sensory loss of the thumb. A T1 nerve root lesion causes Klimke’s palsy – this is a loss of finger flexion, abduction and adduction, and reduced sensation in the medial upper limb. The ulnar nerve is usually compromised at the elbow which causes numbness in the 5th finger, the medial aspect of the ring finger, and the dorsum of the hand (over the 5th finger). A clawed hand can develop (the little and ring fingers curl in towards the palm) if the weakness of the small muscles of the hand is allowed to progress.
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This question is part of the following fields:
- Nervous System
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Question 23
Incorrect
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A 45-year-old female develops profuse watery diarrhoea with lower abdominal pain seven days after undergoing laparoscopic cholecystectomy. What is the most likely diagnosis?
Your Answer: Bile acid diarrhoea
Correct Answer: Pseudomembranous colitis
Explanation:Pseudomembranous colitis is caused by a C. difficile infection that causes membranes to form on the colon wall. It is caused most commonly by broad-spectrum antibiotics. This would include cephalosporins, broad-spectrum penicillin, and clindamycin. Macrolides and quinolones have also been reported as potential aetiologies, but much less commonly. This woman would have received antibiotics prophylactically before her surgery, predisposing her to a possible c difficile infection. This is a much better answer choice than pseudo obstruction, abdominal sepsis, bile acid diarrhoea, and campylobacter gastroenteritis simply based on history of present illness.
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This question is part of the following fields:
- Gastrointestinal System
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Question 24
Correct
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A 30-year-old male underwent an urgent appendectomy. 3 hours after the procedure he developed tachycardia and fever. He was also having pain in his abdomen and shoulder area. What is the first step in the management?
Your Answer: Maintain IV access and give IV fluids
Explanation:The features mentioned in this case indicate an internal haemorrhage. This should be managed initially by passing an IV line and IV fluids.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 25
Correct
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A 71 year-old dentist is seen in clinic with a history of worsening memory problems and confusion. His wife had noted that his sleep was becoming more disturbed and he complains of vivid nightmares and visual hallucinations. Over the past few weeks, he has had increasing difficulty in dressing himself, and his mobility has deteriorated. On examination, he is bradykinesia with a resting tremor and rigidity affecting his arms and legs. His Mini-Mental-State Examination (MMSE) is 18/30. Which of the following is the most likely diagnosis?
Your Answer: Lewy body disease
Explanation:Lewy body dementia is the second most common cause of dementia in the elderly after Alzheimer’s disease. The core feature is a progressive dementia, but other characteristic features include Parkinsonism, visual hallucinations, fluctuating cognitive abilities and executive function, and an increased risk of falls or autonomic failure.
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This question is part of the following fields:
- Nervous System
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Question 26
Correct
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A 28-year-old woman is referred to the endocrinology clinic. She has been trying to conceive for the last 3 years without any success. Her prolactin level is 2600 mU/l (normal <360). The Endocrinologist arranges pituitary magnetic resonance imaging (MRI) that demonstrates a microprolactinoma.
Which two of the following pharmacological agents may be appropriate treatment choices?Your Answer: Carbergoline
Explanation:Cabergoline, an ergot derivative, is a long-acting dopamine agonist. It is usually better tolerated than Bromocriptine (BEC), and its efficacy profiles are somewhat superior to those of BEC. It offers the convenience of twice-a-week administration, with a usual starting dose of 0.25 mg biweekly to a maximum dose of 1 mg biweekly. Some studies have shown efficacy even with once-a-week dosing. Cabergoline appears to be more effective in lowering prolactin levels and restoring ovulation. Up to 70% of patients who do not respond to BEC respond to cabergoline.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 27
Correct
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A 22-year-old man who has recently returned from a trip to Far East presents with sore eyes and symmetrical joint pain in his knees, ankles and feet. Labs reveal an elevated ESR. The synovial fluid aspirate is sterile and has a high neutrophil count. What is the most likely diagnosis?
Your Answer: Reactive arthropathy
Explanation: -
This question is part of the following fields:
- Musculoskeletal System
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Question 28
Correct
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What is the mechanism of action of sildenafil citrate?
Your Answer: Inhibition of phosphodiesterase V
Explanation:Sildenafil citrate (Viagra) is the first oral drug to be widely approved for the treatment of erectile dysfunction.
It is a potent and selective inhibitor of type-V phosphodiesterase, the primary form of the enzyme found in human penile erectile tissue, thereby preventing the breakdown of cyclic guanosine monophosphate (cGMP), the intracellular second messenger of nitric oxide.Uses:
It is used for the treatment of erectile dysfunction, idiopathic pulmonary hypertension, premature ejaculation, high altitude illness, penile rehabilitation after radical prostatectomy, angina pectoris, and lower urinary tract symptoms.Adverse effects:
Mild headache, flushing, dyspepsia, cyanopsia, back pain, and myalgias – due to a high concentration of PDE11 enzyme in skeletal muscle, which shows significant cross-reactivity with the use of tadalafil.
It can also cause hypotension, dizziness, and rhinitis. -
This question is part of the following fields:
- Pharmacology
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Question 29
Correct
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A 35-year-old male presented to the ER after being rescued from a house fire. He complained of feeling dizzy and having a worsening headache. On examination, he was dyspnoeic, drowsy and confused. There was no evidence of facial burns and no stridor. He was normotensive, tachycardic (pulse rate: 102 bpm), tachypnoeic (respiratory rate: 35/min) and had O2 saturation of 100% in room air. His venous blood gas results are given below:
pH - 7.28
pCO2 - 3.5 kPa
pO2 - 15.9 kPa
Na+ - 139 mmol/L
K+ - 4.5 mmol/L
Bicarbonate - 11 mmol/L
Chloride - 113 mmol/L
Lactate - 13.6 mmol/L
Keeping in mind the likely diagnosis, which among the following is the most appropriate intervention for this patient?Your Answer: Intravenous hydroxocobalamin
Explanation:The most appropriate intervention in this patient is intravenous hydroxocobalamin.
The clinical scenario provided is suggestive of acute cyanide toxicity secondary to burning plastics in the house fire.
Cyanide ions inhibit mitochondrial cytochrome oxidase, preventing aerobic respiration. This manifests in normal oxygen saturations, a high pO2 and flushing (or ‘brick red’ skin) brought on by the excess oxygenation of venous blood. In the question above it is important to note that the blood gas sample given is venous rather than arterial. His blood gas also demonstrates an increased anion gap, consistent with his high lactate (generated by anaerobic respiration due to the inability to use available oxygen).The recommended treatment for moderate cyanide toxicity in the UK is one of three options: sodium thiosulfate, hydroxocobalamin or dicobalt edetate.
Among the options given is hydroxocobalamin and this is, therefore, the correct answer. Hydroxocobalamin additionally has the best side-effect profile and speed of onset compared with other treatments for cyanide poisoning.
Other options:
– Intubation would be appropriate treatment in the context of airway burns but this patient has no evidence of these, although close monitoring would be advised.
– High-flow oxygen is the treatment for carbon monoxide poisoning – a sensible differential, but this man’s very high lactate and high venous pO2 fit better with cyanide toxicity. Intravenous dexamethasone would be another treatment for airway oedema once an endotracheal tube had been placed.
– Intravenous sodium nitroprusside is a treatment for high blood pressure that can cause cyanide poisoning, and would, therefore, be inappropriate.Note:
Cyanide may be used in insecticides, photograph development and the production of certain metals. Toxicity results from reversible inhibition of cellular oxidizing enzymes
Clinical presentation:
Classical features: brick-red skin, the smell of bitter almonds
Acute: hypoxia, hypotension, headache, confusion
Chronic: ataxia, peripheral neuropathy, dermatitisManagement:
Supportive measures: 100% oxygen
Definitive: hydroxocobalamin (intravenously), also a combination of amyl nitrite (inhaled), sodium nitrite (intravenously), and sodium thiosulfate (intravenously). -
This question is part of the following fields:
- Pharmacology
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Question 30
Incorrect
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Which of the following peripheral neuropathy inducing clinical diagnoses is predominantly associated with sensory loss?
Your Answer: Hereditary sensorimotor neuropathies
Correct Answer: Uraemia
Explanation:Diseases that cause predominantly sensory loss include diabetes, uraemia, leprosy, alcoholism, vitamin B12 deficiency, and amyloidosis.
Those that cause predominantly motor loss include Guillain-Barre syndrome, porphyria, lead poisoning, hereditary sensorimotor neuropathies, chronic inflammatory demyelinating polyneuropathy, and diphtheria. -
This question is part of the following fields:
- Nervous System
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Question 31
Correct
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A 63-year-old woman visits the diabetes clinic for review. She has had type-2 diabetes for 9 years and is now on insulin therapy. She has diabetic nephropathy, as exemplified by hypertension and proteinuria (urinary PCR 155); a recent creatinine level was 205 μmol/l and eGFR 24 ml/min.
Â
Which of the following options best fits her prognosis or management?Your Answer: Treatment with ARB or ACE-I may slow further deterioration in renal function
Explanation:Treatment with ARB or ACE-I may slow further deterioration in renal function in this patient, as studies have shown that blocking of the RAS in type 2 diabetic patients improve renal function.
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This question is part of the following fields:
- Renal System
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Question 32
Incorrect
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A 60-year-old female presented after an acute overdose of amiodarone. Her blood pressure was 110/70 mmHg and pulse rate was 35 bpm. She was given 500 mcg of atropine but there was no response. Which of the following is the most appropriate next step?
Your Answer: Glucagon
Correct Answer: Isoprenaline
Explanation:Permanent pacing is not indicated as the bradycardia is reversible. Temporary pacing is the definite treatment. Isoprenaline can be used until temporary pacing is available.
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This question is part of the following fields:
- Cardiovascular System
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Question 33
Correct
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A 38-year-old male presented with multiple bruises and fractured pelvis after a road traffic accident. He is also complaining of anuria for the past 4 hours. The next management step would be?
Your Answer: Suprapubic catheter
Explanation:Stress and urge urinary incontinence has been observed in patients who have sustained pelvic fractures due to trauma. The best treatment option would be to pass suprapubic catheter. If there is still no urine output, then ureteral damage might be the cause, which needs to be managed.
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This question is part of the following fields:
- Renal System
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Question 34
Incorrect
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An 87-year-old woman had to double up her dosage of morphine 60mg into 120mg twice a day, in addition to another 10mg oral Morphine 6 times a day. What is the best method of management?
Your Answer: Increase to 200 mg bd orally
Correct Answer: Subcutaneous morphine infusion
Explanation:Stable dose of Morphine is essential for chronic cases of pain that are non-malignant in origin. Using the SC route avoids having to intravenously cannulate a patient and allows for a continuous infusion of drugs over a calculated period of time providing constant dosing A significant advantage is that plasma levels of a drug are much more stable, and appropriate symptom control can be achieved without the toxic effects of the peaks and troughs resulting from episodic drug administration.
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This question is part of the following fields:
- Geriatric Medicine
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Question 35
Incorrect
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A 30-year-old previously well female presented with yellowish discolouration of her sclera. Investigations revealed low haemoglobin, a retic count of 8% and the occasional spherocyte on blood film. Which of the following is the most appropriate single investigation?
Your Answer: Indirect coombs test
Correct Answer: Direct coombs test
Explanation:A low haemoglobin and a high retic count is suggestive of a haemolytic anaemia. Occasional spherocytes can be seen on blood film during haemolysis and it is not a specific finding. Direct Coombs test will help to identify autoimmune haemolytic anaemia, where there are antibodies attached to RBCs.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 36
Incorrect
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A 78-year-old retired journalist known to have prostatic carcinoma presents to the ED complaining of pain in the spine and the onset of severe lower-leg weakness accompanied by a loss of sensation. On examination, he is found to have percussion tenderness of his spine, loss of sensation up to the umbilicus and a distended bladder. He has markedly reduced power of the lower legs with hyperreflexia. Which of the following should not be part of your management of this patient?
Your Answer:
Correct Answer: Spinal X-rays
Explanation:Acute cord compression is a medical emergency. Typically, signs of segmental damage at the level of compression are usually combined with corticospinal tract dysfunction (e.g., hyperreflexia, Babinski’s sign and weakness) and sensory deficits below the level of compression. Symptoms include spinal pain that precedes the development of weak legs and sensory loss. There may be loss of bladder (and anal) sphincter control, manifesting as hesitancy, frequency and, finally, painless retention.
Spinal X-rays are rarely diagnostic. MRI is usually the investigation of choice and should not be delayed, but if not available consider doing a CT scan and myelography to confirm cord compression and fully define the level and extent of the lesion. If malignancy is the cause, it is important to give dexamethasone (oral or intravenous) while considering therapy more specific to the cause. -
This question is part of the following fields:
- Nervous System
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Question 37
Incorrect
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A 38-year-old woman returns from a summer holiday with a dry cough. Her CXR shows bilateral consolidated areas. Which antibiotic would you suggest?
Your Answer:
Correct Answer: Ciprofloxacin
Explanation:Ciprofloxacin is a well-established broad-spectrum fluoroquinolone antibiotic that penetrates well into the lung tissues.
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This question is part of the following fields:
- Infectious Diseases
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Question 38
Incorrect
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A 55-year-old man attends follow-up for liver cirrhosis, which reveals a large dominant nodule in the right lobe of liver on CT Scan. Which tumour marker would most likely be elevated?
Your Answer:
Correct Answer: Alpha feto-protein (AFP)
Explanation:A considerably increased serum AFP is characteristic of hepatocellular cancer. A distinct nodule for cirrhotic patients should be investigated to rule out hepatocellular cancer.
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This question is part of the following fields:
- Gastrointestinal System
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Question 39
Incorrect
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During the examination of an elderly confused and non-coherent gentleman who was brought to casualty by a concerned neighbour, you notice that he has bilaterally small pupils, which do not appear to react to light. Under the circumstances, it is difficult to judge their response to accommodation.
Which of the following conditions may not account for the pupillary appearance in this patient?Your Answer:
Correct Answer: Acute alcohol intoxication
Explanation:Acute alcohol intoxication presents with pupillary dilation, thus, this is ruled out in this patient. All the other listed causes present with small pupils bilaterally.
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This question is part of the following fields:
- Nervous System
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Question 40
Incorrect
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A 13-year-old boy presented with difficulty in breathing on exertion. According to his mother who was also present, his exercise tolerance has been gradually worsening for the past weeks. It has reached the point where he is unable to participate in his weekly soccer match. Cardiac catheterization was performed and the results are given below.
Anatomical site
Oxygen saturation (%)
Pressure (mmHg)
Superior vena cava
73
-
Right atrium
71
6
Right ventricle
72
-
Pulmonary artery
86
53/13
PCWP
-
15
Left ventricle
97
111/10
Aorta
96
128/61
Which of the following is the diagnosis?Your Answer:
Correct Answer: Patent ductus arteriosus
Explanation:The oxygen saturation in the pulmonary artery is higher than that of the right ventricle. The pressure of the pulmonary artery and of the PCWP are also high. So patent ductus arteriosus is highly suggestive.
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This question is part of the following fields:
- Cardiovascular System
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Question 41
Incorrect
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Which of the following statements regarding the proton pump inhibitors is true?
Your Answer:
Correct Answer: They cause hair loss, diarrhoea, and headache
Explanation:Common side effects of omeprazole include: headache, abdominal pain, diarrhoea, nausea, vomiting, gas (flatulence), dizziness, upper respiratory infection, acid reflux, constipation, rash, cough.
Less common side effects of Omeprazole include: bone fracture (osteoporosis related), deficiency of granulocytes in the blood, loss of appetite, gastric polyps, hip fracture, hair loss, chronic inflammation of the stomach, destruction of skeletal muscle, taste changes, abnormal dreams.
Rare side effects of Omeprazole include: liver damage, inflammation within the kidneys, pancreatitis, dermatologic disorder, potentially life threatening (toxic epidermal necrolysis). -
This question is part of the following fields:
- Pharmacology
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Question 42
Incorrect
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A 40-year-old female presented with pain and whitening of the hands on exposure to cold. She has difficulty in swallowing solid foods so she has started swallowing only liquids. She developed shortness of breath on exertion and, subsequently, at rest. Which of the following is the most likely cause for dysphagia in this patient?
Your Answer:
Correct Answer: Systemic sclerosis
Explanation:Difficulty in swallowing which improves with liquids is mainly due to an obstructive lesion in oesophagus. But pulmonary involvement (breathlessness on exertion and later on rest) and Raynaud’s phenomena can only be described by systemic sclerosis.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 43
Incorrect
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A 40-year-old man has had multiple blood transfusions for sideroblastic anaemia. However, this time, 15 minutes into the blood transfusion, he complains of severe breathlessness. CXR shows diffuse bilateral pulmonary infiltrates.
What is the most likely diagnosis?Your Answer:
Correct Answer: Transfusion-related acute lung injury (TRALI)
Explanation:Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion characterised by the acute onset of non-cardiogenic pulmonary oedema following transfusion of blood products.
TRALI is a more severe manifestation of the febrile non-haemolytic group of transfusion reactions and usually occur in patients who have had multiple previous transfusions. TRALI is related to leucocyte antibodies which are present in the plasma of the blood donor. Multiparous women are the highest-risk donors for TRALI.
For management, leucocyte-depleted blood is now used for transfusion and this is associated with a reduced risk of this type of transfusion reaction.
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This question is part of the following fields:
- Haematology & Oncology
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Question 44
Incorrect
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A 48-year-old male presents to the clinic complaining of a swelling in his left groin that disappears on lying down. He also reports occasional haematuria and a mass in his left loin. On examination, the swelling is bluish in colour and has an appearance and consistency like that of a 'bag of worms'. What is the most likely diagnosis?
Your Answer:
Correct Answer: Left sided renal cell carcinoma
Explanation:Renal cell carcinoma (RCC) may remain clinically occult for most of its course. The classic triad of flank pain, haematuria, and flank mass is uncommon (10%) and is indicative of advanced disease. A varicocele, usually left sided, is due to obstruction of the testicular vein.
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This question is part of the following fields:
- Men's Health
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Question 45
Incorrect
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A west Indian man complains of limb and abdominal pain. He is also anaemic and has frequent infections, which precipitate these symptoms. On examination, his spleen is not palpable and he has a mild jaundice. What is your most probable diagnosis?
Your Answer:
Correct Answer: Sickle cell disease
Explanation:Sickle cell disease (SCD) and its variants are genetic disorders resulting from the presence of a mutated form of haemoglobin, haemoglobin S (HbS). This leads to a rigid, sickle-like shape of red blood cells under certain circumstances which can result in attacks of pain (sickle cell crisis), anaemia, swelling in the hands and feet, bacterial infections and stroke. Anaemia and jaundice happen due to insufficient healthy red blood cell capacity and increased breakdown of haem groups by the liver.
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This question is part of the following fields:
- Gastrointestinal System
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Question 46
Incorrect
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A 61-year-old man presented with a TIA and loss of consciousness for 30 min. His CT brain scan is normal and his ECG shows atrial fibrillation. Which risk assessment score is best used in this case?
Your Answer:
Correct Answer: CHADS2
Explanation:CHADS2 score provides a comprehensive prediction of thromboembolic events in avalvular AF patients:
C Congestive heart failure – 1
H Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication) – 1
A Age >75 years – 1
D Diabetes mellitus – 1
S2 Prior Stroke or TIA or Thromboembolism – 2 -
This question is part of the following fields:
- Nervous System
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Question 47
Incorrect
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A 66-year male with long standing diabetes was bed bound for a right femur fracture. Family members called for help as he developed a sudden onset dyspnoea. By the time help arrived, the patient had passed away. What is the most probable cause for his death?
Your Answer:
Correct Answer: Pulmonary embolism
Explanation:Prolonged immobilization could have caused deep vein thrombosis which ultimately resulted pulmonary embolism. Other causes are also possible but the most probable cause is acute pulmonary embolism.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 48
Incorrect
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A 36-year-old man is scheduled to start on interferon-alpha and ribavirin for the treatment of hepatitis C. His past history includes intravenous drug usage. Which are the most common side effects of interferon-alpha?
Your Answer:
Correct Answer: Depression and flu-like symptoms
Explanation:Adverse effects due to IFN-alpha have been described in almost every organ system. Many side-effects are clearly dose-dependent. Taken together, occurrence of flu-like symptoms, haematological toxicity, elevated transaminases, nausea, fatigue, and psychiatric sequelae are the most frequently encountered side effects.
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This question is part of the following fields:
- Infectious Diseases
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Question 49
Incorrect
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Which treatment of chronic obstructive pulmonary disease (COPD) increases the long-term prognosis in patients?
Your Answer:
Correct Answer: Long-term domiciliary oxygen therapy
Explanation:COPD is commonly associated with progressive hypoxemia. Oxygen administration reduces mortality rates in patients with advanced COPD because of the favourable effects on pulmonary hemodynamics.
Long-term oxygen therapy improves survival 2-fold or more in hypoxemic patients with COPD, according to 2 landmark trials, the British Medical Research Council (MRC) study and the US National Heart, Lung and Blood Institute’s Nocturnal Oxygen Therapy Trial (NOTT). Hypoxemia is defined as PaO2 (partial pressure of oxygen in arterial blood) of less than 55 mm Hg or oxygen saturation of less than 90%. Oxygen was used for 15-19 hours per day.
Therefore, specialists recommend long-term oxygen therapy for patients with a PaO2 of less than 55 mm Hg, a PaO2 of less than 59 mm Hg with evidence of polycythaemia, or cor pulmonale. Patients should be evaluated after 1-3 months after initiating therapy, because some patients may not require long-term oxygen.
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This question is part of the following fields:
- Respiratory System
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Question 50
Incorrect
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A newly married female presented with fever, dysuria, frequency and lower abdominal pain for 2 days duration. On examination, she was febrile with lower abdominal tenderness. Urine microscopy reveals 20-30 pus cells/hpf and 10-20 red cells/hpf. Which of the following would be the most probable cause for this presentation?
Your Answer:
Correct Answer: Cystitis
Explanation:The patient has what is known as ‘honeymoon cystitis’.
Most common presentation of schistosomiasis is haematuria.
Patients with kidney trauma also present with haematuria following a positive history for such injury.
Pain due to calculi are colicky in nature and severe. -
This question is part of the following fields:
- Women's Health
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Question 51
Incorrect
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There are number of diseases that have to be notified to the consultant responsible for communicable disease control. Which of the following conditions does not belong to above category?
Your Answer:
Correct Answer: Pneumococcal pneumonia
Explanation:There are number of diseases that have to be notified to relevant authorities to prevent or reduce their spread. Those conditions include Cholera, Diphtheria, Food poisoning, Infectious bloody diarrhoea, Malaria, Measles, Meningococcal septicaemia, Mumps, Plague, Rabies and Rubella.
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This question is part of the following fields:
- Infectious Diseases
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Question 52
Incorrect
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A 35-year-old female, known case of antiphospholipid syndrome, arrives at the clinic due to a swollen and painful left leg. Doppler ultrasonography confirms the diagnosis of a deep vein thrombosis. She was previously diagnosed with DVT 4 months back and was on warfarin therapy (target INR 2-3) when it occurred. How should her anticoagulation be managed?
Your Answer:
Correct Answer: Life-long warfarin, increase target INR to 3 - 4
Explanation:If the INR in the range of 2-3 has still resulted in thrombosis, the target INR is increased to 3-4. However, because the risk of bleeding increases as the INR rises, the INR is closely monitored and adjustments are made as needed to maintain the INR within the target range.
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This question is part of the following fields:
- Musculoskeletal System
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Question 53
Incorrect
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A 58-year-old male attends a doctor's surgery to get help with quitting drinking alcohol. He expressed that he wishes to avoid the unpleasant alcohol craving experiences. From the following options, what should be prescribed to the patient?
Your Answer:
Correct Answer: Acamprosate
Explanation:Acamprosate (calcium acetyl-homotaurine) helps to restore the normal activity of glutaminergic neurons, which usually become hyperexcited following chronic alcohol exposure.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 54
Incorrect
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Which of the following statements regarding dipeptidyl peptidase-4 inhibitors in the management of type 2 diabetes mellitus is correct?
Your Answer:
Correct Answer: Do not cause weight gain
Explanation:Several dipeptidyl peptidase-4 (DPP-4) inhibitors are in clinical development; these are orally active and increase levels of active glucagon-like peptide-1 (GLP-1), which in turn increases insulin secretion and reduces glucagon secretion, thereby lowering glucose levels.
Sitagliptin and vildagliptin both have a long duration of action, allowing once-daily administration. Both sitagliptin and vildagliptin are safe and tolerable with a low risk of hypoglycaemia. In drug-naïve subjects with type 2 diabetes, both sitagliptin and vildagliptin reduce A1C levels by ,1% as monotherapy. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 55
Incorrect
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A 15-year-old girl is referred to the paediatric unit with reduced urine output and lethargy. She has been passing bloody diarrhoea for the past four days. On admission she appears dehydrated. Bloods show the following:
Na+ 142 mmol/l
K+ 4.8 mmol/l
Bicarbonate 22 mmol/l
Urea 10.1 mmol/l
Creatinine 176 µmol/l
Hb 10.4 g/dl
MCV 90 fl
Plt 91 * 109/l
WBC 14.4 * 109/l
Given the likely diagnosis, which one of the following organisms is the most likely cause?Your Answer:
Correct Answer: E. coli
Explanation:The likely diagnosis in this case is Haemolytic Uremic Syndrome (HUS), which is generally seen in young children presenting with a triad of symptoms, namely: acute renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia. The typical cause of HUS is ingestion of a strain of Escherichia coli.
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This question is part of the following fields:
- Infectious Diseases
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Question 56
Incorrect
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A 70-year old man presents with difficulty speaking and has a history of weakness in his facial muscles, as well as in his right arm and leg. What is the most appropriate prophylactic regimen in this case?
Your Answer:
Correct Answer: Aspirin 300mg for 2 weeks followed by aspirin 75mg and dipyridamole 200mg
Explanation:Left-sided hemiparesis along with slurred speech are strong indications of stroke in the right cerebral hemisphere. This occurs due to poor blood flow to the brain from the heart. Aspirin 300mg has analgesic, antipyretic, and anti-inflammatory properties that can address the acute symptoms of stroke like migraine and neuralgic pain. With a reduced dose of 75mg of Aspirin, its anti-platelet effect can inhibit further thrombus formation and prevent another stroke. Dipyridamole 200mg is an anti-coagulant preventing clot formation in the blood.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 57
Incorrect
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A 34-year-old lady presented with complaints of generalised body ache, arthritis, dryness of eyes and mouth. The most likely diagnosis would be?
Your Answer:
Correct Answer: Primary Sjögren's syndrome
Explanation:Sjogren syndrome is characterised by keratoconjunctivitis sicca, dry mouth and generalised body aches. It is one of the connective tissue diseases and has positive auto Ro and La antibodies.
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This question is part of the following fields:
- Musculoskeletal System
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Question 58
Incorrect
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A 70-year-old male presented in the OPD with a complaint of abdominal pain and blood in his stools for the last two days. He reports that the stools are black in colour and sometimes accompanied by fresh blood. There is also a history of significant weight loss. Blood tests revealed elevated CA 19-9. What is the patient most likely suffering from?
Your Answer:
Correct Answer: Colorectal carcinoma
Explanation:The patient’s symptoms along with his age indicates a diagnosis of colorectal cancer. Blood test marker CA-19-9 is a prognostic index for colorectal cancer which confirms the suspicion.
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This question is part of the following fields:
- Gastrointestinal System
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Question 59
Incorrect
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A 24-year-old woman presents as an emergency to her GP with acute vomiting which began some 3-4 hours after attending an afternoon meeting. Cream cakes were served during the coffee break.
Which of the following organisms is the most likely cause of this acute attack of vomiting?Your Answer:
Correct Answer: Staphylococcus aureus
Explanation:Staph. aureus is the most likely cause. It is found in foods like dairy products, cold meats, or mayonnaise. It produces a heat-stable ENDOTOXIN (remember this) that causes nausea, vomiting, and diarrhoea 1-6 hours after ingestion of contaminated food. B. cereus is classically associated with fried rice being reheated. Salmonella is typical with raw eggs and undercooked poultry. Campylobacter which is most commonly associated with food poisoning, is seen with poultry 50% of the time. Yersinia enterocolitica is seen with raw or undercooked pork, and may be a case presenting with mesenteric adenitis.
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This question is part of the following fields:
- Gastrointestinal System
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Question 60
Incorrect
-
A 46-year-old gentleman diagnosed with type 2 diabetes, hypertension, and proteinuria is started on Ramipril to prevent development of renal disease. He reports to his GP that he has developed a troublesome cough since starting the medication. He has no symptoms of lip swelling, wheeze and has no history of underlying respiratory disease.
Â
What increased chemical is thought to be the cause of his cough?Your Answer:
Correct Answer: Bradykinin
Explanation:Ramipril is an ACE inhibitor that blocks the conversion of angiotensin I to angiotensin II as well as preventing the breakdown of bradykinin, leading to blood vessel dilatation and decreased blood pressure. However, bradykinin also causes smooth muscles in the lungs to contract, so the build-up of bradykinin is thought to cause the dry cough that is a common side-effect in patients that are on ACE inhibitors.
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This question is part of the following fields:
- Renal System
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Question 61
Incorrect
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A 25-year-old male presents to the emergency department with fever, sweating, hyperventilation and breathing difficulty. He also complains of a continuous ringing sensation in both his ears for the past couple of days. He admits to consuming a lot of over the counter painkillers for the past few days. Which of the following drugs is the most likely cause of these symptoms?
Your Answer:
Correct Answer: Aspirin
Explanation: -
This question is part of the following fields:
- Emergency & Critical Care
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Question 62
Incorrect
-
A 55-year-old man presented with retrosternal chest pain associated with excessive sweating and vomiting. On examination his BP was 100/60 mmHg and pulse rate was 72 bpm. Bibasal crepitations were auscultated. His ECG showed ST elevation in V1 to V4 and ST depression in leads II, III and aVF. Which of the following would be the finding during angioplasty?
Your Answer:
Correct Answer: Complete occlusion of the left anterior descending artery
Explanation:The ECG findings are suggestive of anterior myocardial infarction and the most likely artery affected is the left anterior descending artery. Occlusion of the right coronary artery will be shown by ST elevation in lead II, III, aVF and occlusion of the circumflex artery will show changes in leads I, aVL, V5 and V6. To have ST elevation, there should be complete occlusion of the artery.
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This question is part of the following fields:
- Cardiovascular System
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Question 63
Incorrect
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A 2-month-old infant was brought to the paediatrics ward by her mother with a complaint of excessive crying during urination. The urine culture of the infant revealed E.coli. Which of the following investigations should be done next?
Your Answer:
Correct Answer: US
Explanation:Urine culture confirms a diagnosis of a UTI. A kidney ultrasound will be the next best investigation because it will help us to visualise the bladder, kidneys, and ureters to rule out any congenital obstruction in the urinary tract that might be the actual cause of infection in this 2-month old girl.
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This question is part of the following fields:
- Renal System
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Question 64
Incorrect
-
A 41-year-old gentleman underwent kidney transplantation for end-stage renal disease. Now, 2 months after the operation, he has developed fever and features suggestive of bilateral diffuse interstitial pneumonia.
Â
What is the most likely etiological cause?Your Answer:
Correct Answer: Cytomegalovirus
Explanation:After renal transplantation, cytomegalovirus has been identified to affect 1/4 of the post-op patients. It is the most common viral infection causing morbidity and mortality in post-op patients in the first 3 months.
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This question is part of the following fields:
- Renal System
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Question 65
Incorrect
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A 67 year-old attorney presents with a 2 month history of tremors affecting his left arm. He suffers from depressive psychosis for the last 10 years, for which he has been receiving intermittent chlorpromazine and amitriptyline but has not been on any therapy for the last 4 months. He describes that his two brothers also had tremors. Upon examination, he has a resting tremor of his left hand with cogwheel rigidity of that arm and mild generalized bradykinesia. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Idiopathic Parkinson's disease
Explanation:The most likely diagnosis is idiopathic Parkinson’s disease because of the unilateral presentation. In addition, cogwheel rigidity is a classic presenting symptom. Neuroleptic-induced parkinsonism is usually bilateral and symmetrical. Essential tremors do not cause rest tremors.
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This question is part of the following fields:
- Nervous System
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Question 66
Incorrect
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Conjugated bilirubin is converted and metabolised into urobilinogen before excretion. This metabolism takes place in which part of the body?
Your Answer:
Correct Answer: Large intestine
Explanation:Unconjugated bilirubin is conjugated to glucuronic acid in the hepatocyte. Conjugated bilirubin passes into the enterohepatic circulation and the bilirubin which evades this system is metabolised by bacteria, primarily in the large intestine, to urobilinogen, then stercobilinogen and eventually oxidised to stercobilin. Stercobilin gives faeces its brown colour.
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This question is part of the following fields:
- Gastrointestinal System
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Question 67
Incorrect
-
A 59-year-old patient presents with altered bowel habits and bleeding per rectum. Exam and sigmoidoscopy showed an ulcer. What is the single most likely diagnosis?
Your Answer:
Correct Answer: Colorectal carcinoma
Explanation:The patient’s symptoms along with his age indicates a diagnosis of colorectal cancer. Blood test marker CA-19-9 is a prognostic index for colorectal cancer which confirms the suspicion. Celiac disease is not usually associated with bleeding per rectum and it is associated with a reaction to products containing gliadin. Crohn’s disease and UC are inflammatory bowel diseases and on endoscopy, show many other features of inflammation and not just a single ulcer. A patient with IBS will also have bloating and intermittent diarrhoea with constipation.
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This question is part of the following fields:
- Gastrointestinal System
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Question 68
Incorrect
-
A 21-year-old singer, who had thyroid surgery a few months before, now complains of not being able to raise the pitch of her voice, and suspects it was because of the surgery. What is the most likely diagnosis?
Your Answer:
Correct Answer: External laryngeal nerve injury
Explanation:The external laryngeal nerve may be injured or traumatized following thyroid surgery due to its close proximity, which may result in hoarseness or loss of voice.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 69
Incorrect
-
Choose the correct statement regarding hyponatremia:
Your Answer:
Correct Answer: Hyperlipidaemia may cause pseudohyponatraemia
Explanation:The Hyperlipidaemia Effect: Pseudohyponatremia in Pancreatic Cancer; Patients who have disorders of cholestasis commonly present with volume depletion due to vomiting and poor oral intake, which, in turn, often leads to hypovolemic hyponatremia. It is less well known that disorders of cholestasis, including tumours of the hepatobiliary system, can be accompanied by hyperlipidaemia.
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This question is part of the following fields:
- Fluids & Electrolytes
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Question 70
Incorrect
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A 44-year-old woman is investigated for hot flushes and night sweats. Her blood tests show a significantly raised FSH level and her symptoms are attributed to menopause. Following discussions with the patient, she elects to have hormone replacement treatment. What is the most significant risk of prescribing an oestrogen-only preparation rather than a combined oestrogen-progestogen preparation?
Your Answer:
Correct Answer: Increased risk of endometrial cancer
Explanation:The use of hormone replacement therapy (HRT) based on unopposed oestrogen increases the risk of endometrial cancer, and uterine hyperplasia or cancer.
Evidence from randomized controlled studies showed a definite association between HRT and uterine hyperplasia and cancer. HRT based on unopposed oestrogen is associated with this observed risk, which is unlike the increased risk of breast cancer linked with combined rather than unopposed HRT. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 71
Incorrect
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A 70-year-old male presents with an ulcer between his toes - it has a punched-out appearance. He is known to both smoke and drinks heavily. Upon examination, the ulcer is yellow in colour. His foot also turns red when it hangs from the bed. From the list given, choose the single most likely diagnosis for this patient.
Your Answer:
Correct Answer: Arterial ischemia ulcer
Explanation:Arterial ischemia ulcers present with many of the symptoms observed in this patient: ulcer on the lower extremities, pain, swelling, yellow sores, a punched-out appearance, the foot turning red when dangling from a bed. Smoking a lot is also known to be a causative factor here. This type of ulcer develops due to damage to the arteries caused by a lack of blood flow to the tissue – they are also deep wounds. Venous ischemic ulcers usually form in the knee or inner ankle area as opposed to the foot.
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This question is part of the following fields:
- The Skin
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Question 72
Incorrect
-
A 32-year-old male presents to the emergency after being involved in a horrific fire incident at home with 55% burns over is trunk, back and arms. He has an episode of 300ml of hematemesis which prompts endoscopy. Endoscopy reveals several ulcers in the stomach. How would you manage this patient?
Your Answer:
Correct Answer: IV PPI
Explanation:Curling’s ulcer is an acute gastric erosion resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa. The medical management of patients with stress ulcers is more or less similar to the management of peptic ulcer disease in general. The medication targeting acid peptic disease includes proton pump inhibitors, antihistamines, and ulcer-healing drugs like sucralfate. Patients with overt GI bleeding from ulceration will require endoscopic evaluation and management of the stress ulcers. Endoscopic therapies may include epinephrine injection, electro-cauterization, or clipping of the bleeding vessels. Bleeding ulcers refractory to localized endoscopic treatment may need embolization of the culprit vessel or rarely surgical intervention as a last resort. Surgical interventions are commonly indicated for patients with refractory bleeding despite endoscopic or angiographic treatment or patients with unstable hemodynamics to undergo endoscopic or angiographic procedures. Surgeries are performed as an ultimate life-saving approach.
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This question is part of the following fields:
- Fluids & Electrolytes
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Question 73
Incorrect
-
A 60-year-old patient with hypertension attended his regular clinic. His compliance was poor. His blood pressure was 180/100 mmHg. His pulse rate was 85 bpm which was irregularly irregular. On examination there was bibasal crepitation. No murmurs were heard. What is the most likely cause for these findings?
Your Answer:
Correct Answer: Left ventricular hypertrophy
Explanation:Left ventricular hypertrophy due to long standing hypertension is the most probable cause. The irregularly irregular pulse was suggestive of atrial fibrillation, which is due to diastolic dysfunction. Poor ventricular filling causes pulmonary congestion which manifests as bibasal crepitations.
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This question is part of the following fields:
- Cardiovascular System
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Question 74
Incorrect
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A 26-year-old woman is 32 weeks pregnant. She has a history of Sjogren Syndrome. The foetus would be at a risk for which of the following?
Your Answer:
Correct Answer: All correct
Explanation:Women with Sjögren syndrome are likely to experience more complications during pregnancy than women without an autoimmune disease as the anti-Ro and anti-La antibodies cross the placenta and lead to various life threatening complications. Studies show a high incidence of poor fetal outcomes for these patients. Congenital heart block, neonatal lupus, congestive cardiac failure, hydrops fetalis can all be caused as a result of Sjogren syndrome.
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This question is part of the following fields:
- Musculoskeletal System
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Question 75
Incorrect
-
A 25-year-old youth was brought to the A&E following a stab injury to the right back of the chest. On examination he was dyspnoeic, his trachea was deviated to the left side and there were engorged veins and absent breath sounds on the right side. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Tension pneumothorax
Explanation:History is suggestive of right sided tension pneumothorax. It can’t be a simple pneumothorax because of tracheal deviation and engorged veins.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 76
Incorrect
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A 60-year-old male presents with intermittent haemoptysis and chronic, productive cough. He has a strong history of smoking and has recently lost weight. What is the patient most likely suffering from?
Your Answer:
Correct Answer: Bronchogenic carcinoma
Explanation:The combination of haemoptysis, chronic productive cough, and recent weight loss in a smoker is a strong indication of bronchogenic carcinoma.
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This question is part of the following fields:
- Respiratory System
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Question 77
Incorrect
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A 54-year-old female has complained of a sudden and severe pain on the left side of her skull. She is also experiencing pain in and around her jaw. What is the most appropriate next step in her treatment?
Your Answer:
Correct Answer: ESR
Explanation:A diagnosis of giant cell arteritis or temporal arteritis is likely here as many points favour it. She is over 50 years old, is female, has severe pain in the left half of her skull, and is complaining of pain around the jaw (jaw claudication).
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This question is part of the following fields:
- Emergency & Critical Care
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Question 78
Incorrect
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A 40-year-old male, known with osteoarthritis and taking analgesics for it, presented with sudden onset severe epigastric pain and tenderness. The most likely cause will be?
Your Answer:
Correct Answer: Perforated peptic ulcer
Explanation:NSAIDS are the leading cause of dyspepsia, GERD, peptic ulcer disease and perforation. Perforation is characterised by severe abdominal pain, tenderness and muscles guarding & rigidity.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 79
Incorrect
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A 55-year-old female school teacher complains of double vision when she writes on the school blackboard. She has no history of trauma. Her most recent visit to her GP was to seek attention for a rash which developed after she was bitten when walking through the forest on a school trip. Choose the cranial nerve most likely to be affected here.
Your Answer:
Correct Answer: Abducens
Explanation:This nerve is responsible for the side to side movement of the eye, hence why damage can cause double vision.
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This question is part of the following fields:
- Nervous System
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Question 80
Incorrect
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A 51-year-old man speaks fast and does not take enough breaths before speaking again. He ignores interruptions and does not want to pause in between. What best describes this kind of speech?
Your Answer:
Correct Answer: Pressure of speech
Explanation:A pressured speech is too fast for the listener to understand and is very difficult to interrupt.
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This question is part of the following fields:
- Nervous System
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Question 81
Incorrect
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A 50-year-old male patient with Pulmonary Tuberculosis is taking Ethambutol, Isoniazid, Pyrazinamide, Pyridoxine, and Rifampicin. Which of the above drugs is associated with peripheral neuropathy?
Your Answer:
Correct Answer: Isoniazid
Explanation:Isoniazid is associated with peripheral neuropathy, which occurs due to deficiency of biologically active pyridoxine. The deficiency is caused by the combination of isoniazid and pyridoxine to form a hydrazone which is excreted in the urine. Pyridoxine supplementation reduces the risk associated with Isoniazid.
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This question is part of the following fields:
- Pharmacology
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Question 82
Incorrect
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A 28-year-old woman with a history of recurrent pulmonary emboli (PE) has been identified as having factor V Leiden. How does this particular inherited thrombophilia increase her risk of venous thromboembolic events?
Your Answer:
Correct Answer: Activated factor V is inactivated much more slowly by activated protein C
Explanation:In patients with factor V Leiden, inactivation of the active factor V (a clotting factor) by active protein C occurs 10x more slowly than normal. Therefore, this condition is also called activated protein C resistance.
Factor V Leiden is the most commonly inherited thrombophilia, being present in around 5% of the UK’s population. It occurs due to gain-of-function mutation in the Factor V Leiden protein.
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This question is part of the following fields:
- Haematology & Oncology
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Question 83
Incorrect
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A 73-year-old woman presents with severe emphysema. She is on maximal therapy including high dose Seretide and tiotropium. She tells you that she is so unwell that she can barely manage the walk the 160 metres to the bus stop.
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On examination she looks short of breath at rest. Her BP is 158/74 mmHg, pulse is 76 and regular. There are quiet breath sounds, occasional coarse crackles and wheeze on auscultation of the chest.
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Investigations show:
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Haemoglobin 14.2 g/dl (13.5-17.7)
White cell count 8.4 x 109/l (4-11)
Platelets 300 x 109/l (150-400)
Sodium 137 mmol/l (135-146)
Potassium 4.1 mmol/l (3.5-5)
Creatinine 127 micromol/l (79-118)
pH 7.4 (7.35-7.45)
pCO2 7.5 kPa (4.8-6.1)
pO2 9.7 kPa (10-13.3)
Chest x-ray - Prominent upper lobe emphysema.
FEV1 - 30% of predicted.
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Which of the features of her history, examination or investigations would preclude referral for lung reduction surgery?Your Answer:
Correct Answer: pCO2 7.4
Explanation:Nice guidelines for lung reduction surgery:
FEV1 > 20% predicted
PaCO2 < 7.3 kPa
TLco > 20% predicted
Upper lobe predominant emphysemaThis patient has pCO2 of 7.4 so she is unsuitable for referral for lung reduction surgery.
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This question is part of the following fields:
- Respiratory System
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Question 84
Incorrect
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An soccer player suddenly collapsed on the field and started coughing along with shortness of breath. The investigation of choice in this case would be?
Your Answer:
Correct Answer: Chest x-ray
Explanation:Exercise induced asthma is characterised by sudden onset wheezing, cough and shortness of breath while performing hectic physical activity. The best investigation to perform is a chest X-ray.
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This question is part of the following fields:
- Respiratory System
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Question 85
Incorrect
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A 51-year-old man was brought to the Emergency department for loose stools. He was dehydrated, weak and in shock. He had previously been complaining of large stool volumes for a one month period. Stool colour was normal. There was no history of laxative abuse and no significant past medical history.
What is the most likely diagnosis?Your Answer:
Correct Answer: VIPoma
Explanation:Given that the patient has had large amount, high volume watery diarrhoea in an acute period of time, from the answer choices given, this narrows the diagnosis down to VIPoma or carcinoid syndrome. You would expect with carcinoid syndrome for there to be periodic episodes of diarrhoea, though, with a description of flushing, additionally, associated with these episodes. Thus, VIPoma is the most likely answer here. VIPomas are known to cause hypokalaemia from this large amount of watery diarrhoea. Stool volume should be > 700 ml/day.
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This question is part of the following fields:
- Gastrointestinal System
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Question 86
Incorrect
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A 69-year-old male, who is a hypertensive and a smoker presented with sudden onset central chest pain radiating to his back. Examination revealed a pulsatile mass in the abdomen. Which of the following is the most appropriate next step?
Your Answer:
Correct Answer: USG
Explanation:The history is suggestive of ruptured Abdominal Aortic Aneurysm (AAA). Characteristic pain, pulsatile abdominal mass and risk factors such as age>60, hypertension and smoking support the diagnosis. Ultrasonography is the standard imaging tool for AAA. It can also detect free peritoneal blood.
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This question is part of the following fields:
- Cardiovascular System
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Question 87
Incorrect
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A 26-year-old technician with no past medical history presents to the neurology clinic complaining of muscle pain. He describes severe bilateral cramping calf pain on minimal exercise. This has been present since his late teens and as such he has avoided exercise. Recently, he has attended the local gym to try and lose weight, but attempts at exercise have been dampened by the pain. He does note that if he perseveres with exercise, the pain settles. He has noticed passing dark urine in the evenings following a prolonged bout of exercise. Which of the following clinical tests would be most useful in aiding the diagnosis in this patient?
Your Answer:
Correct Answer: Muscle biopsy
Explanation:The differential diagnosis of bilateral exercise-induced pain would include metabolic muscle disease, lumbar canal stenosis and intermittent claudication. The patient’s age, history and lack of other risk factors make the latter two options unlikely.
The syndrome described is in fact McArdle’s disease (myophosphorylase deficiency). This is a disorder of carbohydrate metabolism. Clinical features of pain and fatigue are precipitated in early exercise, as carbohydrates cannot be mobilized to provide an energy substrate to the muscle. With prolonged exercise, fatty acid metabolism provides energy, and symptoms lessen. The dark urine described is likely to represent myoglobinuria following rhabdomyolysis. Definitive diagnosis of most metabolic muscle diseases relies on muscle biopsy and enzyme analysis.
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This question is part of the following fields:
- Nervous System
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Question 88
Incorrect
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Which of the following is the most useful marker of prognosis in multiple myeloma?
Your Answer:
Correct Answer: B2-microglobulin
Explanation:B2-microglobulin is a useful marker of prognosis in multiple myeloma (MM). Raised levels imply a poorer prognosis. Low levels of albumin are also associated with a poor prognosis.
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This question is part of the following fields:
- Haematology & Oncology
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Question 89
Incorrect
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In a study, 50 out of 100 smokers develop lung cancers and 50 out of 200 non-smokers develop lung cancers. Which of the following is accurate?
Your Answer:
Correct Answer: Relative risk=2
Explanation:Relative risk = (Incidence in exposed group)/incidence in unexposed group). So in this case RR = (50/100)/(50/200) = 2.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 90
Incorrect
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A 25-year-old previously well female, in her 10th week of pregnancy presented with a left sided painful calf swelling. An ultrasound scan revealed deep venous thrombosis (DVT) of her left leg. Which of the following is the most appropriate management of this patient?
Your Answer:
Correct Answer: Initiate and then continue treatment with heparin until delivery
Explanation:Warfarin is contraindicated during pregnancy due to its teratogenic effects. She should be given heparin throughout her pregnancy. It can be converted to warfarin if necessary after the delivery.
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This question is part of the following fields:
- Cardiovascular System
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Question 91
Incorrect
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A 50-year-old man presented with a rash over his forearms, shins and face when he visited the clinic in the summer. Which of the following medications is the most likely to be associated with this photosensitive rash?
Your Answer:
Correct Answer: Bendroflumethiazide
Explanation:Photosensitivity is a common adverse effect of cardiology drugs including amiodarone and thiazide diuretics. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (A2RBs) commonly also cause rashes only some of which appear to be photosensitive.
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This question is part of the following fields:
- Pharmacology
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Question 92
Incorrect
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A 25-year-old obese woman is diagnosed with polycystic ovarian syndrome (PCOS). Which of the following findings is most consistently seen in PCOS?
Your Answer:
Correct Answer: Ovarian cysts on ultrasound
Explanation: -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 93
Incorrect
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A 65-year-old gentleman with a history of chronic renal failure due to diabetes comes to the clinic for review. He has reported increasing bone and muscle aches over the past few weeks.
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Medications include ramipril, amlodipine and indapamide for blood pressure control, atorvastatin for lipid management, and insulin for control of his blood sugar. On examination his BP is 148/80 mmHg, his pulse is 79 and regular. His BMI is 28.
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Investigations show:
Haemoglobin 10.7 g/dl (13.5-17.7)
White cell count 8.2 x 10(9)/l (4-11)
Platelets 202 x 10(9)/l (150-400)
Serum sodium 140 mmol/l (135-146)
Serum potassium 5.0 mmol/l (3.5-5)
Creatinine 192 μmol/l (79-118)
Calcium 2.18 mmol/l (2.2-2.67)
Phosphate 1.9 mmol/l (0.7-1.5)
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He has tried following a low phosphate diet.
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Which of the following would be the next most appropriate step in controlling his phosphate levels?Your Answer:
Correct Answer: Sevelamer
Explanation:Sevelamer is a phosphate-binding drug that can lower raised serum phosphate levels in chronic kidney disease. Because of its aluminium-related side-effects, aluminium hydroxide is no longer the drug of choice.
The other options are calcium-containing salts that may increase risks of tissue calcification. -
This question is part of the following fields:
- Renal System
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Question 94
Incorrect
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A 62-year-old obese female presented with dilated veins over the lateral aspect of her right ankle. Which of the following is most responsible for her presentation?
Your Answer:
Correct Answer: Short saphenous vein
Explanation:Varicose veins (venous insufficiency syndrome) are dilated, tortuous veins due to reverse venous flow. All the given veins can be affected from this condition. As the patient has varicose veins over lateral aspect of ankle, the short saphenous vein is affected. The great or long saphenous vein travels along the medial aspect of the ankle
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This question is part of the following fields:
- Cardiovascular System
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Question 95
Incorrect
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A 59-year-old man complains of weakness in his right lower and upper limb since 3 for a few hours. He is has been taking Digoxin for 2 years. What is the most definitive investigation for this condition?
Your Answer:
Correct Answer: Angiography
Explanation:Digoxin is a cardiac glycoside, having positive inotropic effects on the heart. It increases the strength of contractility of the heart, increasing the heart rate, but lowering blood pressure. This patient developed weakness in his limbs most likely caused by extremely low blood pressure that could be due to diseased blood vessels reacting to the side-effects of digoxin, therefore an angiography would be the best investigation.
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This question is part of the following fields:
- Cardiovascular System
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Question 96
Incorrect
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A 41-year-old female is referred to medical assessment unit by her physician for querying thrombotic thrombocytopenic purpura (TTP) after she presented with a temperature of 38.9C. Her subsequent urea and electrolytes showed deteriorating renal function with a creatinine 3 times greater than her baseline.
What is the underlying pathophysiology of TTP?Your Answer:
Correct Answer: Failure to cleave von Willebrand factor normally
Explanation:Thrombotic thrombocytopenic purpura (TTP) is characterised by the von Willebrand factor (vWF) microthrombi within the vessels of multiple organs. In this condition, the ADAMTS13 metalloprotease enzyme which is responsible for the breakdown of vWF multimer, is deficient, causing its build-up and leading to platelet clots that then decreases the circulating platelets, leading to bleeding in the patient.
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This question is part of the following fields:
- Renal System
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Question 97
Incorrect
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From the list of options, choose the least useful therapy in preventing oesophageal variceal bleeding in portal hypertension.
Your Answer:
Correct Answer: Variceal sclerotherapy
Explanation:Selective beta blockade and nitrates help to reduce portal pressure and therefore reduce the risk of bleeding (as does banding). Moreover, sclerotherapy, despite its use, has not actually been shown to reduce the risk of bleedings as primary prevention – however, it may reduce the risk of rebleeding after an index bleed. The mortality of variceal bleedings is known to be 50% at each episode.
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This question is part of the following fields:
- Gastrointestinal System
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Question 98
Incorrect
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A 72-year-old male presented to the Emergency Department with a broad complex tachycardia. Which of the following features is more suggestive that this has resulted because of a supraventricular tachycardia (SVT) rather than a ventricular tachycardia (VT)?
Your Answer:
Correct Answer: Absence of QRS concordance in chest leads on ECG
Explanation:To differentiate ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with aberrant conduction the following electrocardiographic features should be looked for:
Evidence of preceding atrial activity for SVT. Oesophageal leads are helpful if P waves are hidden in the QRS complex.
QRS duration more than 140 ms for VT.
QRS morphology: Features of QRS morphology that favour SVT are RBBB or triphasic patterns like rSR in V1 and qRS in V6. Monophasic pattern like R or qR in V1 and rS or QS in V6 or multiple morphology QRS complexes favour VT.
AV dissociation for VT. -
This question is part of the following fields:
- Cardiovascular System
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Question 99
Incorrect
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A 58-year-old psychologist with small cell lung cancer complains of muscle weakness. Each one of the following are features of Lambert-Eaton syndrome, except:
Your Answer:
Correct Answer: Repeated muscle contractions lead to decreased muscle strength
Explanation:In myasthenia gravis, repeated muscle contractions lead to reduced muscle strength. The opposite is however classically seen in the related disorder Lambert-Eaton syndrome. Lambert-Eaton myasthenic syndrome is seen in association with small cell lung cancer, and to a lesser extent breast and ovarian cancer. It may also occur independently as an autoimmune disorder. Lambert-Eaton myasthenic syndrome is caused by an antibody directed against pre-synaptic voltage gated calcium channel in the peripheral nervous system.
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This question is part of the following fields:
- Nervous System
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Question 100
Incorrect
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A 18-year-old female is brought to the emergency department by her boyfriend. He is concerned that she may have taken an overdose of her mom's morphine sulphate pills after being depressed about her mother, who is dying of carcinoma of the breast.
Which of the following may point towards his suspicion?Your Answer:
Correct Answer: Sweating
Explanation:Excessive sweating points towards a morphine overdose.
Morphine is considered the classic opioid analgesic with which other painkillers are compared. Like other medications in this class, morphine has an affinity for delta, kappa, and mu-opioid receptors.
Most commonly used in pain management, morphine provides major relief to patients afflicted with pain.Among the more common adverse effects of morphine use is constipation. Other side effects include nausea, vomiting, drowsiness, and confusion. Psychological and physical dependence may occur.
Other side effects include bronchospasm, angioedema, urinary retention, ureteric or biliary spasm, dry mouth, sweating, rash, facial flushing, vertigo, tachycardia, bradycardia, palpitations, orthostatic hypotension, hypothermia, restlessness, mood change, hallucinations, seizures (adults and children) and miosis, headache and allergic reactions (including anaphylaxis) and decreased libido or potency.
Raised intracranial pressure occurs in some patients. Muscle rigidity may occur with high doses. Elevated liver enzymes may occur due to biliary sphincter constriction. Large doses can lead to respiratory depression, circulatory failure, and coma.
Treatment of opioid overdose:
Initial treatment of overdose begins with supportive care.
Naloxone is a pure competitive antagonist of opiate receptors and has no agonistic activity. The drug is relatively safe and can be administered intravenous, intramuscular, subcutaneous or via the endotracheal tube.
Alternatively, nalmefene and naltrexone maybe considered. -
This question is part of the following fields:
- Emergency & Critical Care
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SESSION STATS - PERFORMANCE PER SPECIALTY
