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ACMMCQ-my Qbank > Medicine > Flashcards

Medicine Flashcards

1
Q
A

Mite (Sarcoptes scabier)
-Tx: gamma benzene hexachloride (Lindane®)

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2
Q
A

Molluscum contagiosum
-DNA poxvirus
-Pearly, dome-shaped papules with central umbilication

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3
Q

Chicken pox

A

Widespread, tear-drop ni appearance and polymorphic ni
evolution, with surrounding
erythema

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4
Q

HSV

A

Small blisters (vesicles) which are colseyl grouped and often will show some ulceration

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5
Q

Viral warts

A

Well demarcated with prickly roughened surfaces

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6
Q
A

Pityriasis
-HHV6/7
-Typical flexural eczema
-Tx: moisture and wet dressings.

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7
Q
A

telangiectatic lesions on the lower pil are typical of hereditary haemorrhagic telangiectasia (Osler-Weber syndrome)
-AD
-GI bleeding
-Anaemia

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8
Q

A mixture of hard and soft exudates and focal haemorrhages, MC cause

A

DM

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9
Q

Deterioration in vision associated with misty vision suggests

A

Cataract

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10
Q

Complication of chronic otitis media

A

-Cholesteatoma
-Decreased auditory acuity
-Meningitis
-Thrombosis of the lateral venous sinus

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11
Q

Otosclerosis

A

Common cause of late-onset deafness

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12
Q

Palpable and apparent solitary thyroid nodules

A

Multinodular goitre

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13
Q

Wernicke encephalopathy

A

-An altered level of consciousness and brain stem signs, particularly ophthalmoplegia and nystagmus
-Thiamine deficiency associated with alcoholism

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14
Q

There are no clear distinction or no clinical validity between haemarrhage and thrombosis (infarction) in a stroke

A
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15
Q

Disorders of the cerebellum characteristically result in a reduced muscle tone,
possibly due to decreased activity of gamma efferents.

A
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16
Q

Increased musle tone, cause

A

-Lesion along the descending motor pathways (pyramidal tracts, i.e., corticospinal tract and/or corticobulbar tract)
-Motor cortex, brain stem, basal ganglia, internal capsule

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17
Q

Mild degree of carotid stenosis (<30%)

A

Aspirin

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18
Q

An episode of shimmering lights, which spread over her left visual field during a 10 min period, leavingher with blurred vision that resolves after acproximately 30 min.

A

Migrainous aura

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19
Q

Unilateral dilated right pupil that does not respond to light shone into taht eye + absence fo a consensual reflex from that eye (contraction of the left pulpi when eht light is shone into the right eye) indicate

A

Letions of the right optic nerve and the right third nerve (

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20
Q

Recurrent episodes of vertigo and vomiting with progressive hearing loss

A

Ménière disease.

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21
Q

Triad of Hornor syndrome

A

PAM
-Ptosis
-Anhidrosis
-Myosis

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22
Q

Dystrophia myotonica

A

-CTG repeat
-Myotonia
-Skeleton muscle weakness
-Cartract
-Gonadal atrophy
-Frontal balding

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23
Q

Increasing numbness and tingling in both legs and poor bladder and bowel control, next step

A

Urgent myelogram

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24
Q

Charcot-Marie-Tooth disease

A

-Hereditary motor sensory neuropathy (AD)
-Defects in proteins involved in the function and structure of axons and/or the myelin sheath
-Distal muscle weakness and atrophy, sensory deficits, and foot deformities (e.g., high arches, hammer toes).

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25
Q

There is distal wasting and weakness in all limbs, areflexia and glove and stocking sensory loss to all
moedalities

A

Diabetic neuropathy

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26
Q

Lower extremities weakness with depressed reflex

A

Gullain-Barre syndrome

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27
Q

Focal weakness with hyperflexia

A

Spinal cord compression

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28
Q

Mononeuritis multiplex, cause

A

Diabetic microangiopathy, medium-vessel vasculitis, certain granulomatous diseases (e.g., sarcoidosis), amyloidosis, and certain infections (e.g., Lyme disease, leprosy, HIV).

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29
Q

Intoxication as Parkinsonism

A

-Manganese intoxication.
-Phenothiazine intoxication.
-Methyldopa (Aldomet®) intoxication.
-Carbon monoxide intoxication.

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30
Q

Phenytoin intoxication

A

cerebellar dysfunction and ataxia

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31
Q

Tx for post-herpetic neuralgia

A

Amitriptylin (TCA)

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32
Q

Rheumatoid factor

A

Present in more than 95% of pts with rheumatoid nodules

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33
Q

Ankylosing spondylitis

A

Reduces the mobility of the spine and the ribs and will reduce the lung vital capacity.

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34
Q

Osteoarthritis radiological changes

A

-Affect the distal interphalangeal joints
-Irregular joint space narrowing
-Subchondral sclerosis
-Osteophytes
-Subchondral cyst

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35
Q

A 73-year-old woman who develops a bilateral limb girdle pain, particularly involving the shoulder

A

Polymyalgia rheumatica (increased ESR and CRP with normal CK and negative antibodies

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36
Q

Finger clubbing

A

-Respiratory conditions, such as: Interstitial lung disease, Idiopathic pulmonary fibrosis, Cystic fibrosis, Lung cancer
-Cardiovascular conditions, such as: Cyanotic congenital heart disease
-Infections, such as: Tuberculosis, lung abscesses
-Hypertrophic osteoarthropathy
-IBD

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37
Q

Accentuation of the first heart sound and loud secondary pulmonary sound with presystolic murmur (opening snap)

A

Mitral stenosis

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38
Q

S3 (early diastolic)

A

-Physiological: young individuals (< 40 years of age), athletes, or pregnant women
-Pathological
Chronic mitral regurgitation
Aortic regurgitation
Heart failure (left)
Dilated cardiomyopathy
Thyrotoxicosis

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39
Q

S4 (late diastolic)

A

-Physiological: advanced age
-Pathological if palpable
Ventricular hypertrophy (e.g., hypertension, aortic stenosis, cor pulmonale)
Ischemic cardiomyopathy
Acute myocardial infarction

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40
Q

A 60-year-old man ni cardiac failure due to complete heart block.

A

Insertion of a transvenous pacemaker

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41
Q

Systolic hypertension predisposes to stroke

A

A major (greater than 40%) reduction in stroke rate in the elderly can be achieved by reducing systolic blood pressure.

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42
Q

Haemodynamic changes after pulmonary embolus

A

High right ventricular pressure and high systemic venous pressure

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43
Q

The MC site of a spontaneous rupture of an artherosclerotic aortic aneurysm

A

Abdominal aorta below renal arteries

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44
Q

Fibromuscular hyperplasia of the renal arteries as a cause of hypertension is MC in

A

Young adult females

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45
Q

artherosclerotic plaques and stricture of the renal arteries as a cause of hypertension

A

Increased age in both sexes

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46
Q

Pneumothorax in the right chest

A

Reduction of movement of the right chest
Percussion is more resonant on the right side
The breath sounds are softer

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47
Q

Severe emphysema

A

-Inspiratory indrawing of costal margins
-Diminished cardiac dullness
-Pulsus paradoxus
-Faint breath sounds.

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48
Q

Diffuse expiratory rhonchi

A

COPD

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49
Q

Persistent blood-stained effusion in a 50-year-old man

A

Carcinoma of the lung

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50
Q

PaCO2>=50mmHg + PaO2<=50mmHg

A

Respiratory failure
Tx: controlled oxygen therapy

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51
Q

Retention of CO2, MC cause

A

Chronic bronchitis due to severe generalised airway narrowing

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52
Q

Hypercapnia (increased PaCO2) induces

A

-Peripheral vasodilatation, such as hot dry skin and retinal venous distension
-Vasodilatation of the scalp vells and intracranial and extracerebral vessels, responsible for the headache
-Drowsiness
-Muscle twitching

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53
Q

Respiratory alkalosis

A

Decreased PaCO2, decreased plasma bicarbonate

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54
Q

The sputum in asthma

A

Thick and tenacious

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55
Q

Rust-colored sputum indicate

A

Pneumonia

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56
Q

Foul-smelling spots

A

Lung abscess

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57
Q

Pink and frothy sputum

A

Pulmonary oedema

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58
Q

Clear mucoid sputum

A

Chronic bronchitis

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59
Q

It is usual to have a normal chest X-ray in a pt with pulmonary embolism

A
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60
Q

In a patient presenting with acute asthma who si
clearly unwell, next sequence of investigation

A

Peak expiratory flow reading followed by arterial blood gases and then chest X-ray

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61
Q

MC cause for acute lobar pneumonia

A

Streptococcal pneumonia

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62
Q

Pneumocystis pneumonia (PCP)

A

-Unremarkable physical examination
-Occur late in the course of HVI infection
and si an AIDS-identifying illness
-X-ray: diffuse, bilateral, symmetrical, interstitial infiltrates extending from the perihilar region (butterfly pattern)
-Difusing capacity is commonly affected, resulting ni arterial hypoxia
-Diagnosed by identification of induced sputum, bronchoaveolar lavage and lung tissue biopsy

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63
Q

Mycoplasma pneumonia

A

-Sensitive to erythromycin and tetracycline
-Subclinical hemolytic anemia: associated with elevated cold agglutinin titers (IgM)
-The appearance of the chest X-ray usually suggests a much more severe pneumonia than the clinical state would indicate.

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64
Q

Pulmonary tuberculosis

A

Acid-fast bacilli in sputum are highly suggestive, but not pathognomonic, for tuberculosis

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65
Q

Anti-inflammatory drugs enhance the analgesic effect of opiates

A

Long-acting alor forms of morphine are preferred for long-term pain relief

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66
Q

Consolidation of lung refers to

A

bronchial breath sound

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67
Q

A ventilation-perfusion lung scan shows the site of pulmonary emboli, next step

A

Immediate Tx: intravenous heparin and oral warfarin
No need for pulmonary angiography

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68
Q

In a patient positive for HIV, a 5 mm induration at 72 h after the injection of 10 lU tuberculin is regarded as a positive result.

A
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69
Q

Plummer-Vinson syndrome (DICE)

A

-Dysphagia
-Iron deficiency anemia
-Carcinoma of the oesophagi
-Esophage web

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70
Q

Esophageal motility disorders

A

-Achalasia
-Diffuse esophageal spasm (no progressive)
-Hypercontractile esophagus (jackhammer esophagus)

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71
Q

CREST syndrome

A

-Calcinosis cutis
-Raynaud phenomenon
-Esophageal hypomotility (systemic sclerosis): smooth muscle atrophy and fibrosis → esophageal dysmotility and decreased lower esophageal sphincter pressure → dysphagia, gastroesophageal reflux, heartburn → aspiration, Barrett esophagus, stricture
-Sclerodactyly
-Telangiectasia

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72
Q

Scleroderma oesophageal hypomobility with painful dysphagia, most appropraite Tx

A

PPIs

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73
Q

Oesophageal reflux

A

Clinical diagnosis

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74
Q

Lactose intolerance can complicate with

A

-Gluten-sensitive enteropathy.
-Viral gastroenteritis in Caucasians
-Crohn disease (regional ileitis).
-Viral gastroenteritis in Chinese

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75
Q

Celiac disease (gluten-sensitive enteropathy, celiac sprue)

A

-Iron deficiency anemia
-Flattened villi without inflammatory cell infiltration
-Response to gluten-free diet is slow (24-36months)
-Long-term risk of intestinal lymphoma

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76
Q

Wilson disease (Hepatolenticular degeneration)

A

-Autosomal recessive mutations in the ATP7B gene (Wilson gene) on chromosome 13
-In younger patients the symptoms are usually neurological and they may present with dystonia and tic-like movements. In older patients cirrhosis is more
common, with the patient presenting with jaundice or hepatic failure
-Reduced serum ceruloplasmin is a diagnostic test but not correlating with severity of the disease

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77
Q

Hepatitis B carriers have a 90-100 fold increased risk of hepatocellular carcinoma compared with non-carriers

A
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78
Q

Nocturnal diarrhoea associated with pain that wakes the patient up in the night suggests

A

An organic bowel disease

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79
Q

Irritable bowel syndrome

A

-Looser and more frequent stools at onset of pain
-Abdominal distension
-Passage of mucus in the stool
-Relief of abdominal pain after defaecation

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80
Q

Red flag symptoms

A

-Nighttime diarrhea and abdominal pain
-fever
-bloody stools
-weight loss
-acute onset of symptoms.

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81
Q

Traveller’s diarrhoea

A

Enterotoxigenic E coli

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82
Q

The type of adenoma most likely to produce a cancer

A

Villous adenoma

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83
Q

A history of 2 weeks of bloody diarrhoea with sigmoidoscopy showing UC, next step

A

Order a stool culture

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84
Q

UC manifestation

A

-Bloody diarrhea, abdominal pain, and tenesmus
-Extraintestinal manifestations include uveitis, primary sclerosing cholangitis (PSC), arthritis, erythema nodosum, and pyoderma gangrenosum.

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85
Q

Cysts of Entamoeba histolytica can be sen inthe stool without an active infection, particularly fi the patient has been in an area ni which amoebic dysentery is endemic.

A
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86
Q

19-year-old female, recently returned from Indonesia, presents with bloody diarrhoea, crampnig abdominal pain, tenesmus and fever, suggesting

A

Shigella infection
-Numerous polymorph leucocytes are usually seen in the stool
-The infection can be diagnosed by Gram stain and stool culture

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87
Q

Most cancers of the large bowel

A

Arise from pre-existing adenomas

88
Q

Cushing disease

A

ACTH secreting microadenoma (<10mm), thereby no mass effect to optic chiasm

89
Q

Clinical featuers of acromegaly

A

-Thick greasy skin.
-Bitemporal hemianopia
-Hypertension
-Cardiomyopathy
-Glycosuria

90
Q

Rapid onset with thyroid pain and palpable tender enlarged thyroid

A

Thyroiditis

91
Q

Subacute thyroiditis

A

-Low thyroid uptake of radioactive iodine

92
Q

Osteoporosis is associated with

A

A low bodyweight, smoking, high alcohol intake and premature menopause.

93
Q

Thiazide diuretics are useful in treating patients with
high-turnover osteoporosis associated with hypercalciuria and secondary
hyperparathyroidism

A
94
Q

The bilirubin is in unconjugated form and therefore does not appear in the urine.

A
95
Q

An ABO-incompatible blood transfusion

A

Fever
Rigors
Hypotension
Back pain
Haemoglobinuria
No bilirubin in urine

96
Q

Pancytopenia and cervical lymph enlargement indicates

A

Acute leukaemia

97
Q

Acute thrombocytopenia

A

-Viral
-Blood transfusion
-Acute rheumatoid arthritis
-Quinine in susceptible

98
Q

First fully establishing the cause of the macrocytosis

A

Serum folate and vitamin B12 levels

99
Q

Macrocytic anémia occurs in

A

-Hypothyroidism.
-Anti-epileptic medication.
-Regional ileitis (Crohn disease)
-Chronic alcoholism.

100
Q

Macrocytic anaemia during pregnancy cause

A

Inadequate intake of folate

101
Q

A male patient whti a mild microcytic anaemia, initial step

A

Estimation of serum iron, ferritin and transferrin.

102
Q

The presence of abnormal liver function tests without jaundice would support the diagnosis of

A

Epstein-Barr (EBV) infection

103
Q

A rash may occur with ampicillin in EBV infection

A
104
Q

Primary effect of ADH

A

Increase the permeability of water in the distal tubules.

105
Q

Patients with cystitis can have negative urine cultures

A

Adenovirus and herpes virus can c a u s e cystitis with a sterile urine.

106
Q

The most common cause for end-stage renal failure in Australia is

A

-Chronic Glomerulonephritis which accounts for approximately 32% of patients presenting for renal replacement therapy.
-DM (20%)
-PKD (10%)
-Analgesic nephropathy (5%)

107
Q

The use of an angiotensin-converting enzyme (ACE) inhibiting medication to

A

Reduce blood pressure can significantly reduce glomerular filtration.

108
Q

Conservative management of nephrolithiasis (D<10mm)

A

-The relief of pain with paracetamol, paracetamol and codeine, or parenteral opiate
-Increasing urinary output by drinking more water
-Waiting expectantly for the stone to be passed
-Usually the stone will be passed and this would be seen by repeating an X-ray within 2 days

109
Q

Hypokalaemia manifestation

A

-Cardiac arrhythmias
-Muscle weakness
-Hyporeflexia
-Gastrointestinal symptoms (e.g., constipation, intestinal stasis)
-Polyuria
-Fatigue.

110
Q

3 days of a combination of meningitis with a well-defined rounded opacity in the lung in a young man

A

Cryptococcosis with cryptococcal meningitis.

111
Q

The presence of a normal or low ASOT does not exclude the diagnosis of post-streptococcal glomerulonephritis.

A
112
Q

Acute poststreptococcal glomerulonephritis

A

-Hypertension and pulmonary oedema are commonly associated with this clinical presentation.
-Urinary sediment containing red cells and hyalin casts suggests acute post- streptococcal glomerulonephritis.
-The treatment is bed rest, diuretic and antihypertensive medication.
-The boy’s family should be screened for Group A haemolytic streptococcus carriers.

113
Q

Septic arthritis causative organisms:

A

Staphylococcus aureus: MC
Streptococci
N. gonorrheae
Gram-negative rods esp. E. coli and P. aeruginosa

114
Q

The most common initial manifestations of HIV infection:

A

A mild influenza-like illness

115
Q

Meningitis in patients with AIDS

A

Cryptococcus neoformans

116
Q

Q fever

A

Inhalation of the Coxiella burnetii from animal carcasses
Ps: inhalation of aerosols from the secretions of livestock or ingestion of raw milk produced by infected animals.

117
Q

Antibiotics implicated/precipitate pseudomembranous colitis

A

High-risk antibiotics (odds ratio ≥ 5)
Clindamycin
Cephalosporins
Fluoroquinolones
Ampicillin

118
Q

Metronidazole is used to treat:

A

-Bacteroides fragilis.
-Giardia lamblia.
-Entamoeba histolytica.
-Trichomonas vaginalis.

119
Q

Toxoplasma gondii, Tx

A

Sulfadiazine
Clindamycin
Pyrimethamine

120
Q

Penicillinase- producing Neisseria gonorrhoea

A

Ceftriaxone

121
Q

Mycoplasma Pneumoniae and Chlamydia trachomatic respond to

A

Tetracycline and erythromycin

122
Q

Giadia lamblia and Gardnerella vaginalis responde to

A

Metronidazole

123
Q

Zero order kinetics

A

-The rate of metabolism and/or elimination remains constant and is independent of the plasma concentration of a drug at steady state (Cp decreases linearly over time)
-such as ethanol, phenytoin, aspirin (at high concentrations)

124
Q

First order kinetics

A

-The rate of metabolism and/or elimination is directly proportional to the plasma concentration of the drug (Cp decreases exponentially over time)
-A plot of the logarithm of the plasma concentration of the drug versus time will be a straight line.

125
Q

Mediation associated with easy bruising

A

-Aspirin
-Indomethacin
-Prednisone.
-Warfarin.

126
Q

Amoxycillin resistance in Escherichia coli is due to

A

A bacterial beta-lactamase breaking down the amoxycillin.

127
Q

Psittacosis Tx

A

Tetracycline
Erythromycin
Chloramphenicol

128
Q

The P450 substrates: Let’s BLOCK THE WAR between STATes with ORAL and PSYCHOlogical tools.

A

beta-BLOCKers
THEophylline
WARfarin
STATins
ORAL contraceptives
antiPSYCHOtics:

129
Q

P450 inducers: ↓ warfarin levels (Chronic Alcoholics Steal Phen-Phen and Never Refuse Greasy Carbs):

A

C - Chronic alcohol use
S - St. John’s wort
P - Phenytoin
P - Phenobarbital
N - Nevirapine
R - Rifampin
G - Griseofulvin
C - Carbamazepine

130
Q

P450 inhibitors can be remembered with “sickfaces.com group”:

A

S - Sulfonamides
I - Isoniazid
C - Cimetidine
K - Ketoconazole
F - Fluconazole
A - Alcohol (binge drinking)
C - Ciprofloxacin
E - Erythromycin
S - Sodium valproate
C - Chloramphenicol
O - Omeprazole
M - Metronidazole
G - Grapefruit juice

131
Q

The statement that the incidence of birth defects in babies of mothers with epilepsy is approximately three-fold higher than in the normal community

A
132
Q

Phenytoin side effect (PHENYTOIN)

A

cytochrome P-450 interaction
Hirsutism
Enlarged gums (gingival hyperplasia)
Nystagmus
Yellow-browning of skin (melasma)
Teratogenicity
Osteomalacia
Interacts with folate
Neuropathy

133
Q

Ataxia, anorexia, nausea and tremulousness, are typical of

A

lithium toxicity

134
Q

Adjuvant chemotherapy improve the survival pts with:

A

-Stage 2 (node positive) breast cancer in premenopausal women
-Advanced colonic and rectal carcinoma (Dukes B and C).

135
Q

Allergic rhinitis

A

-A nasal smear can show a large number of eosinophils.

136
Q

Anti-smooth muscle antibodies

A

Autoimmune hepatitis

137
Q

A young man who has developed a tendency to suffer frequent episodes of normal bacterial infections indicates:

A

Hypogammaglobulinaemia
-recurrent intravenous infusions of
immunoglobulin

138
Q

Sturge-Weber Syndrom (SSTURGGE-Weber)

A

Sporadic
Port-wine Stain (Tx with laser)
Tram-Track calcifications
Unilateral
Recurrent strokes or seizures
Glaucoma
GNAQ gene
Epilepsy

139
Q

Demarcated discoid lesions typical of a Microsporum canis fungal infection
(ring-worm’), Tx

A

Appropriate treatment would be an imidazole antifungal cream (miconazole, clotrimazole) and systemic antifungals (griseofulvin).

140
Q

Psoriasis is made worse by the use of…

A

-Lithium
-Beta-adrenergic Blocking Agents
-Antimalarial drugs
-NSAIDs
-The withdrawal of systemic steroids

141
Q

The loss of memory and self-care skills in a 75-year-old could not be regarded as the normal ageing process

A
142
Q

A previously well 58-year old man complains of a period of loss of memory for 8 h after his regular morning swim, possible causes:

A

-Vertebrobasilar insufficiency
-Complex partial seizures

143
Q

Parkinson disease features (TRAP)

A

Tremor, Rigidity, Akinesia, and Postural instability
Dribbling and excessive salivation

144
Q

Myoclonic jerk

A

-Normal sleep
-Epilepsy
-Subacute encephalitis
-Uraemia
-Creutzfeldt-Jacob disease

145
Q

Occlusion of left MCA

A

-Dysphagia
-Constructional apraxia

146
Q

Tremor that occurs only on activity and is not present at rest

A

Benign essential tremor
Exaggerated physiological tremor occurs in hyperthyroidism

147
Q

The response to painful stimuli in someone with a diazepam overdose indicates a moderate level of coma

A

Shallow and slow respirations due to the direct respiratory depression

148
Q

Central scotoma

A

Optic neuritis

149
Q

Enlarged blind spot

A

Papilloedema

150
Q

Constricted visual fields

A

Glaucoma

151
Q

Spastic paraparesis causes

A

Cervical spondylosis.

152
Q

Peripheral neuritis

A

-Nitrofurantoin
-Isoniazid
-Vincristine

153
Q

Mononeuritis multiplex, common causes:

A

-Diabetic microangiopathy
-Medium-vessel vasculitis
-Certain granulomatous diseases (e.g., sarcoidosis)
-Amyloidosis
-Certain infections (e.g., Lyme disease, leprosy, HIV)

154
Q

Wasting and weakness of all the small muscles of the right hand

A

Klumpke palsy
-Spondylitic compression of the 1 nerve root
-Cervical rib
-Apical lung carcinoma

155
Q

Carbamazepine to treat

A

-Complex partial seizures
-Generalised tonic clonic seizures
-Trigeminal neuralgia

156
Q

Prochlorperazine to treat

A

Vertigo

157
Q

Osteoporosis

A

-More common in women than in men
-Usually associated with a normal serum calcium

158
Q

Gout as a complication of

A

-Polycythaemia vera
-Myelofibrosis.

159
Q

Rickets

A

-Prominent costochondral junctions
-Increased serum alkaline phosphatase

160
Q

Cardiac tamponade

A

-The blood pressure falls with inspiration
-The jugular venous pressure is usually raised

161
Q

Mitral valve prolapse

A

-May become the site of infective endocarditis
-Cause systemic embolism

162
Q

Complication with VSD

A

-Left-right shunt
-Diagnosed by cardiac ultrasound
-Increased pulmonary vascular markings seen on X-ray

163
Q

A hypertensive pt with AF, tachycardia and CCF, Tx

A

-Digitalis
-ACEi (lower BP, reduce sodium and water retention)

164
Q

Acute myocardial infarction with hypotension and tachycardia

A

-Pain relieve with narcotics
-Thrombolytic medication
-Fluids to control BP

165
Q

A 30-year-old male smoker on no medical therapy, height 170 cm, weight 100 kg, has a b i o d pressure of 170/96 mmHg. Silver wiring is present in the optic fundi.
Twelve-lead ECG. serum electrolytes and serum creatinine are normal.

A

-Stop smoking
-Moderate salt and alcohol
-Check cholesterol and fasting blood sugar

166
Q

Adrenergic beta-blocking agents can exacerbate the symptoms of peripheral vascular disease and reduce claudication distance; and should be used with caution in symptomatic patients.

A
167
Q

Warfarin reduces the risk of recurrent stroke in patients with atrial fibrillation by up to 85%, aspirin by approximately 54%.

A
168
Q

The left ventricular hypertrophy increases the
risk of developing heart failure, myocardial ischaemia, myocardial infarction and stroke

A
169
Q

Complication of acute myocardial infraction with a new systolic murmur

A

-Papillary muscle dysfunction
-Papillary muscle rupture
-VSD

170
Q

Side effect of ACEi

A

A non-productive cough that can occur at anytime after the commencement of the therapy

171
Q

Digoxin

A

-Digoxin given daily (with a half-life of 24 h) would take 3-5 days before a steady state level is achieved
-Verapamil increases the half-life of digoxin
-Digoxin binds to cholestyramine and this will reduce digoxin available for absorption

172
Q

Severe central chest pain, radiating through to the back in a hypertensive patient

A

Acute dissection of the aorta, Tx
-Anti-hypertensive
-CT

173
Q

Unstable angina Tx

A

-Admission to a coronary care unit for monitoring
-Aspirin
-Intravenous heparin

174
Q

PH 7.22, PaO2 40mmHg, PaCO2 34mmHg

A

-Superimposed acute left ventricular failure with pulmonary oedema
-Acute bacteraemic shock
-Lactic acidosis is a likely associated finding

175
Q

Occupational asthma, causes:

A

-Toluene di- isocyanate
-Western red cedar dust
-Flour

176
Q

Dyspnoea reflects

A

nAn awareness of increased effort with breathing.

177
Q

Auscultation of the chest

A

-Bronchial breathing is typically heard at the top of a pleural effusion
-Bronchial breathing is heard over consolidated lungs

178
Q

Bronchogenic carcinoma

A

-Present with hypokalaemia
-30% survive 5 years and 15% survive 10 years

179
Q

Small cell carcinoma of the lung

A

-At diagnosis, most patients have metastases beyond the hilar lymph nodes
-Associated with cerebellar degeneration.

180
Q

Sarcoidosis

A

-Erythema nodosum is a typical skin manifestation
-Spontaneous resolution is usual.

181
Q

idiopathic pulmonary fibrosis

A

-Finger clubbing
-Inspiratory crepitations
-Increased neutrophil and eosinophil count in a alveolar washings

182
Q

To prevent long-term worsening of chonic bronchitis in smokers

A

Cease cigarettes

183
Q

Barrett oesophage

A

-Nonkeratinized stratified squamous epithelium is replaced by nonciliated columnar epithelium and goblet cells (intestinal metaplasia, Barrett metaplasia)
-Gastro-oesophageal reflux
-Predisposes to oesophageal cancer.

184
Q

Hepatitis A infection

A

-Fulminant hepatitis can occur
-Faecal shedding of the virus usually diminishes with onset of clinical disease
-Pooled gamma-globulin, if given within 2 weeks of exposure, will reduce the attack rate markedly
-Parenteral transmission is uncommon
-The infection does not become chronic.

185
Q

There is no difference between the effectiveness of plasma-derived vaccines and recombinant vaccines

A

Recombinant vaccines can be used to boost immunity after primary immunisation with plasma-derived vaccine.

186
Q

Chronic pancreatitis

A

Diabetes due to impared endocrine function usually require relatively low doses of insulin

187
Q

Chemosensitive malignancies

A

-Small cell lung cancer
-Lymphoma
-Testicular cancer
-Breast cancer

188
Q

Gynaecomastia

A

-Normal variant in normal aging
-Side effect of Spironolactone, histamine H2 receptor antagonist
-Common in men with cirrhosis

189
Q

The MC cause of raiseed serum prolactin

A

Pituitary microadenoma (leess than 10mm), normal skull X-ray

190
Q

Adrenal cortical failure (primary adrenal insufficiency, Addison disease) cause

A

-Autoimmune
-Infection (Tuberculosis, CMV, histoplasmosis)
-Hemaerrahge
-Infratration (Tumor, amylodosis, Hemachromotosis)
-Adrenolectomy
-Impaired activity of enzymes that are responsible for cortisol synthesis (eg, Cortisol synthesis inhibitors, 21β-hydroxylase deficiency
-Vitamin B5 deficiency

191
Q

The increased blood pressure associated with phaeochromocytoma may be intermittent or the blood pressure may be raised continuously, even fi other symptoms are episodic.

A
192
Q

A sore throat and a tender enlarged gland with thyrotoxicosis in the context of a recent viral infection

A

Subacute thyroiditis

193
Q

Side effect of high dose oestrogen oral contraceptives

A

-Increased incidence of thrombosis
-Migraine
-Hypertension

194
Q

Changing in old male sexual activity

A

-More direct stimulation of the penis to achieve an erection
-Lengthened refractory period between erections
-Decreased volume of semenHowever
-Neither an alteration in the ability to enjoy sexual activity
-Nor a tendency to ejaculate prematurely.

195
Q

Increased ESR in

A

-IgG myeloma
-Acute inflammation (eg, subacute bacterial endocarditis and gout)

196
Q

Autosomal dominant

A

-ADPKD
-NF-1, NF-2
-Congenital spherocytosis

197
Q

Hypercalcaemia cause/etiology

A

-PTH mediate
-Malignancy (lung, breast, bladder, lymphoma, leukemia, multiple myloma, metastasis cancer)
-Granumatous disorder (eg, sarcoidosis)
-Medication (eg, thiazide diuretics)
-Thyroxitosis
-Long term of immobilisation
-Adrenal insufficiency

198
Q

Tetracycline to treat

A

-Plasmodium falciparum malaria
-Brucellosis
-Q fever
-Non-gonococcal urethritis

199
Q

Pt with neutropenia is at risk of

A

-Staphy aureus
-Pseudo aeruginosa
-Klebsiella pneumoniae

200
Q

Hydatid disease

A

Ingestion of parasite ova from an infested egg

201
Q

Levodopa side effect

A

Confusion

202
Q

Amantading side effect

A

visual halluciation

203
Q

Propranolol side effect

A

Nightmare

204
Q

Haloperidol

A

Tardive dyskinesis

205
Q

Chlorpromazine

A

Parkinsonism

206
Q

Digoxin

A

-It is effective in controlling the ventricular rate in atrial fibrillation.
-The presence of hypokalaemia may potentiate the effects of digoxin
-The presence of hypercalcaemia may potentiate the effects of digoxin

207
Q

ACEi

A

Reduce the rate of subsequent ischaemic events in patients with impaired left ventricular function after myocardial infarction.

208
Q

Side effect of high-dose corticosteroids

A

Short term
-Mood changes
-Hypokalaemia
-Hyperglycaemia
Long term
-Insomnia
-Increased Appetite
-Fluid retention
-Avascular necrosis of bone

209
Q

Amphotericin B side effect

A

-Hypokalaemia
-Nephrotoxicity
-Bone marrow suppresion, anaemia
-Arrythmia
-Hypotension

210
Q

Dose modification in the presence of chronic renal failure

A

-Digoxin
-Paracetamol

211
Q

Major tranquillisers (phenothiazine and butyrophenones) are likely causes of the following involuntary movements

A

-Dystonic attacks (oculogyric crises)
-Hand tremor at rest.
-Inability to sit still (akathisia)

212
Q

Clinical conditions amenable to palliative irradiation

A

-Superior vena caval obstruction
-Bony pain
-Tumor fungation
-Chronic debilitating haemarrhage

213
Q

Long-term treatment with immunosuppression cause complications such as

A

-Skin cancer
-Increased infective risk
-Aseptic bone necrosis
-Cataracts

214
Q

HIV-related neurological manifestations

A

-Acute demyelinating neuropathy, similar to the Guillain-Barré neuropathy
-Dementia
-Peripheral neuropathy

215
Q

Secondary ITP associated with:
Autoimmune disorders

A

-SLE
-Malignancy: lymphoma, leukemia (particularly CLL)
-Infection: HIV, HCV
-Drugs: e.g., quinine,; vaccines

216
Q

The most common cause of severe acute urticaria is

A

Food allergy, with shell fish, crustaceans and nuts .

ACMMCQ-my Qbank (4 decks)

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