Medical Finals Quiz - May 2007

(Closing date: 1st June 2007)

With: Dr Rick Plumb, Consultant Physician, Belfast City Hospital

Please take part in our monthly quiz. This quiz is open to all.

This month for the quiz winner, there is a very useful book on "Essential Skills Practice for OSCEs in Medicine" By: Dr. D McCluskey - is divided into 'skills' sections – History Taking, Clinical signs, Clinical Examination, Communication Skills, Therapeutics and Pharmacology, Radiology, Interpretation of Data. Each section includes 15 to 20 OSCEs in question & answer format. This book is very kindly provided by PasTest.

The winner will be picked at random from all entries (ie. does not matter if your answers are correct or not).

In order to contact the winner of the book, please enter your name and email address at the bottom of this page.

The closing date is 1st June 2007.

Learn as you test yourself. Detailed answers with teaching points will be given after you complete this page.

Question 1

A 22 year old girl is brought to the emergency department after allegedly taking 30 x 500mg tablets of paracetamol. Her 4 hour post ingestion serum paracetamol levels are 136 mg/L.

Which of the following conditions would place her in the high risk category and therefore require her to receive the N-acetyl cysteine antidote infusion?

	(a) Concurrent benzodiazepine overdose
	(b) Concurrent codeine overdose
	(c) Past history of anorexia nervosa with current BMI < 20
	(d) Previous paracetamol overdose last year
	(e) Prolonged QT interval on ECG

Question 2

A 66 year old man with a 5 year history of hypertension was found to have a serum potassium level of 6.2 mmol/L on routine testing. This was confirmed on repeat testing.

Which of his other medications are most likely to have contributed to his hyperkalaemia?

	(a) Amlodipine
	(b) Aspirin
	(c) Bendroflumethazide
	(d) Perindopril
	(e) Pravastatin

Question 3

A 64 year old man presented to the emergency department with a cough and shortness of breath. He was commenced on an unknown antibiotic and sent home. Three days later he attends his GP with increased skin pigmentation in the distribution shown.

Which of the following antimicrobial treatments is the likely cause?

	(a) Amoxicillin
	(b) Cefaclor
	(c) Clarithromycin
	(d) Erythromycin
	(e) Levofloxacin

Question 4

Which of the following statements regarding anticoagulant therapy is correct?

	(a) The anticoagulant effect of warfarin is enhanced by antibiotics.
	(b) Heparin promotes thrombin synthesis.
	(c) A large first dose of warfarin produces a rapid onset of anticoagulation effect.
	(d) Vitamin A deficiency impairs blood coagulation and therefore enhances the action of warfarin.
	(e) Warfarin is antagonized by salicylates.

Question 5

One of the following statements is true regarding the area of the renal nephron indicated (by the red arrow) on the above diagram:

	(a) Bumetanide acts here to inhibit passive sodium reabsorption.
	(b) Furosemide exhibits its maximal diuretic effect here.
	(c) Spironolactone acts here to prevent aldosterone-enhanced potassium reabsorption.
	(d) Thiazides act here to affect the corticomedullary concentration gradient.
	(e) Thiazides act here to inhibit active sodium reabsorption.

Question 6
Select which charity medicalfinals.co.uk should next give donations from 2007 to:
StreetReach - provides support services for adults and young people involved in prostitution or sexual exploitation. www.StreetReach.org.uk Treeton church tower - restoration of St Helen's church tower in Treeton, Yorkshire. Treeton partnership projects Tearfund's "Work a Miracle" project - aims to reduce HIV transmission to babies in Africa by giving anti-HIV drugs to the mother just before delivery. www.TearFund.org.uk/Miracle "Shine a Light" - Billy McCrory (52), from Belfast, who has suffered from a heart condition for 10 years, founded Shine A Light in 1997 in order to give children with cancer a better life. Newspaper writeup MIND - leading mental health charity in England and Wales. Works to create a better life for everyone with experience of mental distress. www.mind.org.uk
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