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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: MRCGP MCQ Discusion-2 Sun May 26, 2013 5:41 am | |
| We will continue our medicine examination and learning of MRCGP and we hope that you will start sharing with us MRCGP is easy to pass but you must know how you can pass MRCGP. MCQs of MRCGP is the only way to pass. Question -1A76-year-old woman with a history of atrial fibrillation presents with abdominal pain and bloody diarrhoea. On examination her temperature is 37.8ºC, pulse 102 / min and respiratory rate 30 / min. Her abdomen is tender with generalised guarding. Blood tests reveal the following: Hb | 10.9 g/dl | MCV | 76 fl | Plt | 348 * 109/l | WBC | 23.4 * 109/l |
Na+ | 141 mmol/l | K+ | 5.0 mmol/l | Bicarbonate | 14 mmol/l | Urea | 8.0 mmol/l | Creatinine | 118 µmol/l | What is the most likely diagnosis?A-Diverticulitis i B-Mesenteric ischaemiai C-Campylobacter infection D-Ruptured abdominal aortic aneurysm E-Ulcerative colitis ===================================== Join Our Channel in Youtube Medical Learninig Videos
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Sun May 26, 2013 5:44 am | |
| Answer B- Mesenteric ischaemia
The low bicarbonate points to a metabolic acidosis - highly suggestive of mesenteric ischaemia. Mesenteric ischaemia:
Mesenteric ischaemia is primarily caused by arterial embolism resulting in infarction of the colon. It is more likely to occur in areas such as the splenic flexure that are located at the borders of the territory supplied by the superior and inferior mesenteric arteries. Predisposing factors
- increasing age
- atrial fibrillation
- other causes of emboli: endocarditis
- cardiovascular disease risk factors: smoking, hypertension, diabetes
Features
- abdominal pain
- rectal bleeding
- diarrhoea
- fever
- bloods typically show an elevated WBC associated with acidosis
Management
- supportive care
- laparotomy and bowel resection
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Sun May 26, 2013 5:46 am | |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Sun May 26, 2013 5:48 am | |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Sun May 26, 2013 5:52 am | |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Sun May 26, 2013 5:55 am | |
| Answer:A-They are mainly produced by Gram positive bacteria Exotoxins:
Exotoxins are generally released by Gram positive bacteria with the notable exceptions of Vibrio cholerae and some strains of E. coliDiphtheria toxin commonly causes a 'diphtheric membrane' on tonsils caused by necrotic mucosal cells. Systemic distribution may produce necrosis of myocardial, neural and renal tissue. Staph. aureus exotoxins lead to acute gastroenteritis, toxic shock syndrome and Staphylococcal scalded skin syndrome Lockjaw is caused by Clostridium tetani neurotoxin (tetanospasmin) Cholera toxin causes activation of adenylate cyclase leading to increases in cAMP levels, which in turn leads to increased chloride secretion. ===================================== Join Our Channel in Youtube Medical Learninig Videos
===================================== Other Topics:*-MRCGP MCQ Discusion*-John Murtagh's General Practice for MRCGP*-Textbook of Family Medicine by Rakel*-Family Medicine PreTest Self-Assessment And Review, Third Edition |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Sun May 26, 2013 5:58 am | |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Sun May 26, 2013 6:02 am | |
| Answer: C- Lansoprazole + amoxicillin + clarithromycinH. pylori eradication:
- PPI + amoxicillin + clarithromycin, or
- PPI + metronidazole + clarithromycin
The BNF recommends a regimen containing amoxicillin and clarithromycin as first-line therapy. Helicobacter pylori:Helicobacter pylori is a Gram negative bacteria associated with a variety of gastrointestinal problems, principally peptic ulcer disease Associations
- peptic ulcer disease (95% of duodenal ulcers, 75% of gastric ulcers)
- gastric cancer
- B cell lymphoma of MALT tissue (eradication of H pylori results causes regression in 80% of patients)
- atrophic gastritis
The role of H pylori in Gastro-oesophageal reflux disease (GORD) is unclear - there is currently no role in GORD for the eradication of H pylori Management - eradication may be achieved with a 7 day course of
- a proton pump inhibitor + amoxicillin + clarithromycin, or
- a proton pump inhibitor + metronidazole + clarithromycin
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Mon Jun 17, 2013 5:06 pm | |
| Question -5
A 33-year-old woman is prescribed varenicline to help her quit smoking. What is the mechanism of action of varenicline? A-Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist B-Dopamine agonist C-Dopamine antagonist D-Selective serotonin reuptake inhibitor E-Nicotinic receptor partial agonist |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Mon Jun 17, 2013 5:08 pm | |
| The Answer E-Nicotinic receptor partial agonistSmoking cessationNICE released guidance in 2008 on the management of smoking cessation. General points include:
- patients should be offered nicotine replacement therapy (NRT), varenicline or bupropion - NICE state that clinicians should not favour one medication over another
- NRT, varenicline or bupropion should normally be prescribed as part of a commitment to stop smoking on or before a particular date (target stop date)
- prescription of NRT, varenicline or bupropion should be sufficient to last only until 2 weeks after the target stop date. Normally, this will be after 2 weeks of NRT therapy, and 3-4 weeks for varenicline and bupropion, to allow for the different methods of administration and mode of action. Further prescriptions should be given only to people who have demonstrated that their quit attempt is continuing
- if unsuccessful using NRT, varenicline or bupropion, do not offer a repeat prescription within 6 months unless special circumstances have intervened
- do not offer NRT, varenicline or bupropion in any combination
Nicotine replacement therapy
- adverse effects include nausea & vomiting, headaches and flu-like symptoms
- NICE recommend offering a combination of nicotine patches and another form of NRT (such as gum, inhalator, lozenge or nasal spray) to people who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past
Varenicline
- a nicotinic receptor partial agonist
- should be started 1 week before the patients target date to stop
- the recommended course of treatment is 12 weeks (but patients should be monitored regularly and treatment only continued if not smoking)
- has been shown in studies to be more effective than bupropion
- nausea is the most common adverse effect. Other common problems include headache, insomnia, abnormal dreams
- varenicline should be used with caution in patients with a history of depression or self-harm. There are ongoing studies looking at the risk of suicidal behaviour in patients taking varenicline
- contraindicated in pregnancy and breast feeding
Bupropion
- a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
- should be started 1 to 2 weeks before the patients target date to stop
- small risk of seizures (1 in 1,000)
- contraindicated in epilepsy, pregnancy and breast feeding. Having an eating disorder is a relative contraindication
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===================================== Other Topics:*-MRCGP MCQ Discusion*-John Murtagh's General Practice for MRCGP*-Textbook of Family Medicine by Rakel*-Family Medicine PreTest Self-Assessment And Review, Third Edition |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Mon Jun 17, 2013 5:15 pm | |
| Question -6
Which of the following is not known to cause acute pancreatitis? A-Hypocalcaemia B-Hypothermia C-Mumps D-Hypertriglyceridaemia E-Steroids |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Mon Jun 17, 2013 5:20 pm | |
| Answer: A- HypocalcaemiaHypercalcaemia, not hypocalcaemia is a recognised cause of acute pancreatitis Acute pancreatitis: causesThe vast majority of cases in the UK are caused by gallstones and alcohol Popular mnemonic is GET SMASHED
- Gallstones
- Ethanol
- Trauma
- Steroids
- Mumps (other viruses include Coxsackie B)
- Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
- Scorpion venom
- Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
- ERCP
- Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
*pancreatitis is 7 times more common in patients taking mesalazine than sulfasalazin ===================================== Join Our Channel in Youtube Medical Learninig Videos
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Mon Jun 17, 2013 5:38 pm | |
| Question -7 What is the most appropriate time to take blood samples for therapeutic monitoring of digoxin levels? A-At any time B-At least 6 hours after last dose C-At least 2 hours after last dose D-Immediately after last dose E-At least 4 hours after last dose
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Mon Jun 17, 2013 5:39 pm | |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Sat Jun 29, 2013 10:14 am | |
| Question -8 A 54-year-old female presents with fatigue and xerostomia. Bloods tests reveal the following: Hb 13.9 g/dl WBC 6.1 *109/l Platelets 246 *109/l Bilirubin 33 µmol/l ALP 292 u/l ALT 47 u/l What is the most likely diagnosis? A. Systemic lupus erythematous B. Infectious mononucleosis C. Primary biliary cirrhosis D. Autoimmune hepatitis E. Sjogren's syndrome |
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Admin Admin
Posts : 589 Birthday : 1973-03-20 Join date : 2011-03-27 Age : 51 Job/hobbies : Doctor
| Subject: Re: MRCGP MCQ Discusion-2 Sat Jun 29, 2013 10:18 am | |
| Primary biliary cirrhosis - the M rule IgM anti-Mitochondrial antibodies, M2 subtype Middle aged females The dry mouth is this patient is due to sicca syndrome, which occurs in 70% of cases of primary biliary cirrhosis. The cholestatic liver function tests point towards primary biliary cirrhosis rather than Sjogren's syndrome Primary biliary cirrhosis is chronic liver disorder typically seen in middle-aged females (female:male ratio of 9:1). The aetiology is not fully understood although it is thought to be an autoimmune condition. Interlobular bile ducts become damaged by a chronic inflammatory process causing progressive cholestasis, which may eventually progress to cirrhosis. The classic presentation is itching in a middle-aged woman Clinical features early: may be asymptomatic (e.g. raised ALP on routine LFTs) or fatigue, pruritus cholestatic jaundice hyperpigmentation, especially over pressure points xanthelasmas, xanthomata also: clubbing, hepatosplenomegaly late: may progress to liver failure Complications malabsorption: osteomalacia, coagulopathy sicca syndrome occurs in 70% of cases portal hypertension: ascites, variceal haemorrhage hepatocellular cancer (20-fold increased risk)
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