Question 1516 hie Management of 365° oki man th ater stent Lastrevaion 201896 4000880 1 rag atgaee 1 sens |§.69 yoo man prosons othe emergoncy department wit) a pana swell et igh Hs cent rmedktons nude meson 00mg & hour or dabetes,valseran aoa da fr hypertension, ‘Sorvestatin Omg day for hyperchestolasa, and warfarin Sg day for choc tal erlaton (One wook oar, ne was trod on amiodarone ator he was dhagnosed wit veircuartachycards (V7) On physical examnaton, ne has lod pressure of 2887, puso rae of 82pm and a temperate of 7.6°C. The le righ s pants, swallen and sgh toner but not warm o 0d. The stfoced lo Grcunforencei Som gee than the unafected ore Which ane othe folowing onions 's the most appropriaie net step n management? Cai eprint ang a ‘loo cute vor INR 200 Commencement of annie, XOe Decrease ne dose of warann Option C is correct | pnlstoien man san ne sauees bya numberof rent contin ue 8 deap vee amos (OT) ‘rata troup Peat patraysapaeasoRereasey Deron tereney Cone that hepa rs een Terety std on amcor rhe on arn aemton hemor ke ans Caen he nm temperate ces saless ike” gnoss ane wie be pte ser vara Ms ess ey Dutt MOSSE nantana bela ne bp of eam aagrses measurement of MRuoUC Dee Nes appopate ‘tal steps ae ratagenae ons gabe an neeased NR Doone he eapete rage 23 mes ‘Sagnoss more cetan noweer na ureoon a edng deepen the presen Reape oe (Option A) Cups Dope wtascund fe assessment pss DT may be ensed hema she oat ty dogosb, wesc (ptons 8nd 0 Boe ie an artes aromescires species lis, Aen ote ah ene mabe els 2a ss he goss ae hese eases ol Ne apyep a Eos eae {opton bose enuctn er cesato f aren maybe conser I eI Shunde abe me mmerapute se ee mn nage 2.01gat= Aap-MEDE X Ee ‘question 1259, hie err the couse of olapse and £6 abnomoltiesin 9 72-year-old man Lastrevsion 20120606 181612 1 rag agae 1 sens 'A72,yoa- 01 man's bought the emergency dopartnent ator Ne colapse wile waking ack home fom shopping. Aer adninstsion of gen, an ECG sip blared emerge which s Shown inthe folowing photograph. Helest er wie 12 months ago andis cently on seaine ‘100mg/daly du to dopression as arosu of compicated ga. One wook bck, he was prescrbod asthranyei fr teatnent of atypical pnouneria. His her modatios include aspirin oral for tatment of scneme heart dseaso (HD), sowasttn Z0nag!day for nspeipidea and man, ‘ich ane ofthe aewing s mest kel to have ea in such preseatston? %OA interaction between asprin and atuomycn xO_ Servaine YOC Aethvomycin and setraine. 00 Azthvonyen. xOE HD Option Cis correct ‘Tne £06 cnr of Torsates pula (TP) ToP a space om of aspect fam of paar ‘enteuar yeaa (PVT ceri mie crea of prongs. nas acral nrgntogh wich ihe cS carpues wt and he Socket Ie Fo!TaP oe dagase, De pablus have evens of tan PVT an prabegston 0 nal prego (ST #00 mse ess recep cs TOP IE & ‘vant ofcenatens nea + Beevoyle Dsurcances. pareuariypotsena,mypsmageescma and moe ray mypoearema Toneyeas * congentt Lng a Sycrone {cart Oseme wen ar comet Nes ve, versa perp ect emerson Hom AF) {Three sexe -more armani hpabyrOdee ard Ua eles wh Yearer sos Nore = Fema gener an ape 6 re ae rk fr taal ong, Cotte stove et. ts pay an pra la mand are pats. Tate ng et hs wh patents coat of proongstont eG sala he nearing ces TP Some eames 6 + srs (amronyen, earthen enmeemye) 1 sss (eg ctanpram esetaopan, senate) 2 ease anmipine mpranne dompranie cop) +s gerarann argent eg naopese,cepraranne) {apes anita (eg rperdone pmoace, qatape Care) + Prot nas ase. ante = Lotepranine WNOTE-enacomoraton etn or mer ofthese gs ao recess or A nal olngston Bam srvatne an SS) 2 tree (a azole) can eaus OT nal ptngan at TaP Ths pater weve tat bron Svar wou ay complete an st haere poe Ae? ‘Sttramycin wes ade. The make e oncomfart nea ccumtine ec of nea actin be tently coe far pret, ‘Tooretcly, atronyn can fesutin OT renal robngton te a mentoned carr on more Ran one dg sn sun eft neque fo tne. Tete atonyen abt (pen D's es ayo have caused Ns freien tos aug cout seine (optonB) Neots alert has bee on setae ie aber ‘rg te wn ra cals 1 ena peng ot koa fet of ape and asin does ttinerease he ee! armen cn {1 anal proengabon (open) Avougn bart ase seh a8 WO option ) canbe cause of GT aa pcan a TP he ean Ss eorcomaat ue oa ratchet an SS te Nn makes HO as ay Wap ns esenae thanthe ug onbon.= Map-MEDE X Ee question to 1225 ‘hie \oertyi te response dus for hsones na 62 yee olé marion mute mestons Lastrevsion 20169606 154809 1 rag atgaee 1 see .8.02:yex-otd man presents to your practise complaint of recen-onst shone of breath which ‘wovoht up by pysiea achat. He diabetic and takes metormin and Ysigitazone fr, Nas hyparension cooled on anlapd and metopob. He has ben ls rece sated on srodarone ‘de oopsodes of sustained ventricular tachycardia Which on of tho feling cr is moe They hve cased this ica pcure? esiltazene Oc Enala OD Metoprtl Option Ais correct ‘oFteoptonsrosgtaone more yo ave caused ME cine pee Resetinne (anda) 3 biasldesene aie preached an al aniiabeh agen an ued rmensenentafpe ences neltis Te pray mectaram oaton has tee pots a Be aH orem sin sere Farr ay cri pert onesie Tima ea ar etc heat te sn pens ‘no ten aes rave is firs mine eng fables Case ergy may be cesar Wesmert of ‘Mieton vgn gam poo die od vero as Dee tse cn ery 1 bypetersen Nyssa ech crease talents, OM an OL are er ngs sen 10% eget 0 Hs mento. ‘eng oH weg gan era st essnea ands ry ehous beacon any Setreation eae (Option 6) Hettn an aitypeipyce aint ah aves e's rua mpogyeomi ane ee Stone abdornal pan secteaved pple mack panardcranpe sanalerce, se Dyspnea a kot {pton ¢)Enazpis an angtonsi contr enzyme NAB ACE} ACE! ames tes MeUGD ay cu, Pyperaira fave azunetshesdsne, anes ate yagres et an aves et {pton 0) Sta backs sien 3 neeaocen exacrie engPer aie an estin son an "pins sch as sone tat raemon anc ecena Ths alent Sex nt hve Net hie ans enya S rot to nae ese nhs presentation (option &) anaona sei ao sic win saver averse eat nrg puma tty mat can lear ppnea se. presetegaymlon However monn even eas fw reurea bela he curve [ove clamndone aches tn eer nd rests pumenay cy Then har jel een een se nirnedrce adh pea any ohare on candy ‘Thor several cect ype of pumonay ky cause by anda. esta poeunets he most {amon ober teas canna reumond ae espana synerone af Sy ung mass A non eave ugh ana aysea we ote reset no 7% of pans WD cde nied arena ly Puts cestpan wep ss, eve ate ase can abo ccc oteronces= |A-MEDE: x Question 1215 ‘hie robsbity dross oftnavesweing na S2earté man 1 Fag scngae 1 see |A52.yet of man presents to the emergency department ity complant of swllen tongue fer he had seafood 2routs ago Hs medical istry smart or abet melts or which hes aking ‘metformin 500d 8.hout, hypertension conood on rami andindaparido, and hypercolsterclmis tested vith alorasttn 20m daly He mentions noichng. On examination, he ha stable vt sins with no respon or abdominal sympoms Wich ene ofthe folowing coud be the most key cause this resertaten? OA Araphyians X08 Ct esterase nite: daicency YOC Rami X00. Atovastatn Option Cis correct ‘The sera epeerts 3 as of ngondens manta 36 nie seting rr fet moins sng rewards sey oF ep ngoecana ocala deep dem, unetaneou or unm: sveleg wh emg an su er ‘ceva of nent are (Hood vrceleskge) Depending on ewer aioe pesos (ancien eolaon seconpanesby stew) orar compare opin ‘Angoecenaypealyafos he ravt depend! ous uth ose orev tse sth 35 the fe, ‘angie, toa! uel, eutemaes aa geal aso ay tel Dovel wal (os carat ean) ‘nme inca pure ocak aaomin pan aosiulon, oasis Argoadera oe bowel wl een Presensasadagnost sem + onal in mista nut and esd occur panos ocays 1 asmmnere asain ‘eaten alin grovishnay dependent eso he dy 1 sven spe fre ot ange eect ess of age ecten of apt asc n me pancpnstiogy mere ae mre Man pes of argon Irere are ol sys oer cnc ens cms ceeds iene Nea wneaTs, RN Ke (aeneazed) crosses oat nes or terion andor Mplensin Mae cel ned spe ‘fen begs win mns eros te alpen tule pov 3 ow os an resaNe wih 2-5 ES etniga st anpocuena noe mg be Ntamne. dependent wou dar edcce ot ma cet [Syrmulaten Theis on fe cuze cases oisopthe (opetneote) angaedena Inthe pe arooesea ‘aos need angcecona misty of angodana bet skated wn eter mantotafens tech wo groups stn sigs an symp at an ae ean suche urkara expr anger creuany Sypoms purus ee Tere 2 maepabege tine cause The sna syns usualy deveop ont 2496 fouls anesonewinn 204 das nme peal angoecena eres cel eatcship better te gget ‘pale atsetofsymgans ‘Ts man nas prosrtea wen 2 soon ogo 2 te Sle ranean of andes athe mos! Segre orn rane nace angoedena AMgOeTEN cenerngenyme PNBIETS AC) Sn 35 "apoplrnip nna eraiapn ng peonesp ae the most samennageng are fr tran mies ‘eoindena terse he mote eaae os pesettion vous tebe ACE ap Anions recep titers Abs) eth alsaan and aera er as capi oncing sch resentation be ean ‘evokes ong, {opton a) Atcumn anspmins cane angbecena ea manteaton the sence fara ‘creuajtespraery symtoms ag Uris ares hs dagross makes rapa eH ye Seaton) ree possi (Option) aequed Crenerseontr C18) deer. 0 cae argued angioedema (AE) sae ‘Syncronepesening wa evar epsoacs of aocuena wit uneara Te sjparanes sane: ‘Ssccita i 8 cet pnoproteave astro Le ACE naued argosdena, mess ete Seng ‘rposicns Ua howcer ane pera wth tA ae fen sing fai wth tha mae re ner ‘tan 0 yes Aun ete can Be a gn WMS Man, Say Maes aes oes Stns such as lavas (ption Dn mein option ) ate not assed wih areca, expcity ‘ebratyne-noues pe eterencesfuestonto 210 hie Frobabity dlsros of painful swallen high na 67 year man en mip mesons Lastrevsion 20180614065995 1 rag agae 1 sens ‘AGI. yeaz.old man presents fo your efce complaining ofa paint swolen igh high He as diabetes ‘we canted on metformin S6cmg 12-hour and hypertension fr which he staking saan 25m {2-oxry He is 0 on simvastatin 20 mga hyporcclestrcersa His recent medial istry = Sritcant er atialSbetation (AF) under reaent wth wartarn. One week ag, he was sated on ‘amiodarone ater he was dagresed wih vertical chyarda (VT). On paysial examination, he has blood pressure of 408mg pulse rate of 80pm and a temperature of37 3°. The ight high Pail swoten and ight tender but not warm rr, and has @ creumfoence 4 em greater han nator ne let igh. Which ene of he alow could bee most key cause of hs presentation? %OA Dep vein vomboss (OVN) 08 Druproacton OC Calis OD. Athigh nematoma HOE Rhabeomycsis Option D is correct past swoten ngncan because bya number of arr orate su 2 VT clus aa nenatona ‘Ths peso waa fe eaten ofA Aug mga ya ie devugs ONT (eh ‘ewea wm warn asl) Tsmakes OT pton A alesse yet pose dag ‘teten treugt hpat pateys dessa heossed Doe terdeny Conse tha he patent has en "eect stated on amodarore nhon va, a amatona canals be posbly ann the os none amatanas re afoquet est ceases Boeing enaeey ecu ve arceaguatea pals, ‘razon opton iter rm dun niescon. Oh recten Means an over reactance BF 2 Shige ug mie mfg acon Be eet of ne cup eso urd exdgeaesespnse ate "etm sear ver ey ae been cose te ton beten areas ae mesg ‘teens rouad ete for nore fe nent meer he keg ot ay est Cet (optonc) rears wn am ana aro ote tin. Fever tn pest The aetna no leer and teh tng ol wm anv Ths esc ie hy agra een rate open 8 a eos caeitn cue by ms rs beadcun ad ease of ml cl ‘atc such as yop ae potassium, yeti resus depen af yen kanes an eal auc Rosas of cous pussun fom canagea must celeste hype a ses congeaons Such as cae ayoonas. srs stn as rasan an sivaslan pr fe tabled by ‘jean PESD.GAA(CrPahs) ard anodaone a plete a oceene, Conan ue of ‘rezone aa sans ca sul eteased a) esis nes De elnoed of sa eed saves ‘Sects 25 muscu pan myopaty ar are asconjayss weve ne een of Stn. naes Inazconyoyss. asysione pleserabon Speci Rhabdceyoys ever cases cl Mate 8 retrance | pee eens eee creme eee ater {ptm rcp. uldowmioalscumertsAFP/20y/20100 ado tanQuestion 1119 ‘hie ace rearing smutaneais ne ose aine ad ta, 1 Fag scngae 1 see Janet, 32 yars od has been prescribed sertraline for eatment of her major depression, She comes 0 you for folow-up and admits to taking estasy at occasions. She says that she ake the pillbecause she wants toenjoy more from time to time. Which one a the folowing isa correct ‘adie ta give her inthis egara? YOK senaline and estasy are synergst X08 _Ecstaryis contraindicated n patients on serine. % Oc Thecombnation can lead to reversible psychos 200 Eestany decreases the therapeutic affect of sertraline HOE Ecstasy and senaline have noinceractons Option Ais correct Selecive seotonn rotate hibors SR) ich aera are fst ne mkctone forrest of pression Serotonin tose aeur nen te arnunt tte eetaannrresbeyons the espa nes {oncomtae ur ocean sg ie exaeates ut neeoesrek tsertonn tay Tes ore oe es toa syergetc ste onsrrann sndineene he nekot ean tse cert lick drugs ach ean amphetamine methamphetamine ae eames the gta can ‘enltin eres concertrtion of erotnine tb ‘& menyenedonyAethanpheamine OMA 250 Known 3 9. Bunkuepayehele ‘anphamne wi talon eaphorart and empattognietacogant fe. The fle on serotonin larger than amphetamine or menanphetanine, MDMA causes nresed ease oslo nthe Bd) 2 ata syeris econ SS tough he are ete sect th emianeour uso ean and Si neesee the io ‘rooney net coasts sais, nds vers Hever ee shld be ven pie the conceritar ee OF atidepresants ony moneamneoxdaee innate MAO wner}s 8 Contendeston easy ce (ther contraneatons to ecstasy use oe use of rus metaboiedthrushthe same erence 3s OMA {Wectr20s sun os rRonnor oretee nhit, cadene ad other ones ond estore ron NM ‘shen fours overcome cough medextons NOTE-stusles have howe that cerning estas Sas may reduc the es of Dom etsy 26d Ne SSL mating he wentent th SSRs ss ecb a preveis fom deed ee of a5) 10 Oc‘ueston 19 son hie Contaseatons to CE rites use ‘lateral renal artery stenosis 05 Pregnancy voc cough 8 OD. Angjoedema, Previous allege reation 0 ACE inhibitors Option Cis correct + tr of gems rears of ave even fot et ACE Mion { Pregnncy ve toharmt Fetus) 1 blaeratrena artery senosts 5 Fopetopiccaranyopsthy Acer couth a comman adverse fet of AC Ihiitors aro main cause of on wa Insuhcreumsances edo oC sous be eau othe aug tempertlystapoed ithe symptom parry caoasclr ston af retour. oteronces‘Question 1» 2 Tie eryng he rug nth yea as an averse eet Lastrevsion 2018-0605 189407 1 rag agae 1 sens Wich one af the following masleatons can cause tachycarl? Propranolol verapamil Diltiazem. Aa YOD Niedpine OE Metoproo. Option D is correct Propranoll and metoprolol arts let, et acer by nition oar candace ter rect In badearin \verapaianc tianer a non-Shydrpidne cack cane lk (CC Nndyernyeine Cs asi eet a perheral arteries ord mae an card congue stem, They cancause mca tepreston and traayeara Nfepne sa yeroprne Cc. Ths rou of CCE has neal secant fect on th eae yest epresson and radar) bu serif ees on vss walle vasndten, vaseaon ‘multe inhypteneon ie terpeic tet Excess vaseation ane ypeersion seen mowed th Sinsropsmane cbs tan be olbues compensatory aeons Reference,= |A-MEDE: x fuestionio 855 ‘hie Dlgrosnate cause froth in apatent on netgne and soda poate 1 Fag scngae 1 see ‘A 16,year-old gi wi is known case of epilepsy for 5 years, has been started on sodium ‘vaproate and lamotrigine 4 weeks ago ater her previous medications fled to contr her Stairs, She alo has the history of recurtent urinary tact infections (UT with st epode ‘5 weeks ago for which she received aman, Today, she has presented wth a maculopapular rash and fever of 38°C. Which ane ofthe falling the most lly cause of her presentation? OA Adverse drug eacton to sodium valproate, Acro green or a ‘Adverse drug reaction to amoxil OD septicemia XOF _Druginteracion betwasn lamotrigine and zacium valoroate Option Bis correct sy rom mmo to te oct. ond rom ano callie oh to patently estes omelaton and sams nlvemertLametrne te other han. el on ecu nese frequent overs ee, Smuaneausvse oF trae and sadam wrt as See ected th he heter chances sh deeper ash san averse cof amet ors beeen Sys an Buses 2 manta ating ere Thera mg be maculpapuls a often do a osc Lens are ot eer on palpation ut maybe Pre he rashe ntsgiteant era associa yt sympa such 2 ever, ai ee ‘therbeforethe appearance the ash contemporanec, ‘Theres ao amore seus, bt rare fxm of ash that stats 3 a marbifrm ash progressing mare oes ‘apy to ase cower ard inated eythane whole acertuation (at floes arerased apd bargy. Thsras of natgie ote assocates wh complicates sum a5 Steers onsan sjerGMe onc epdernal er TEN) a rug reacton wh eosinophil and ste Symp ORESD, ‘onthe set of one wle he pte son smote. the drugs! be ene sored od ‘refi einon prone {option asada valproate has many potential adverse eet but ash has been avery aed 220 averse reaction ssated wih hs dag Dred asodaton fie ashandsaguen valproate athe et impose cer vey unl, Thee have eon oly fon ports ahd sch aon {Option € Aron and other penis ae among the most commen causes fae ug ean while thepatertistating then. is paterthas compa curse of amon for Me UT sels atone {option oy heels no cue hisory sungesng setts as caus tthe rs frthermere wih Sepvoumia eer fever wouibe eet, {option tan: ot me rau ofaercion beeen Inet and Sedum apostate more butte tomate wth entarcoment by conamiar use of sou vote aes sa ae potently iedvesterng. rune hyperseratvyreaconDatincudes heat abnornalteseosnophia, pal yghosytoshrphadenopaty, and tral gan lett Over td tang et ORES careceraed ylang enc toe week etneen ue, osu ane ease onset 3 probed couse wan requ elses dese the Gsconnuaton of he ‘pet dug an Requet sociation wt be reavato of latent hata herpes Ws ite. + Penron 1 prenbartal {Alps + the ruses commortyasoct ith ORES are suforames party sufosaane dapsone 5 Lymmmadenopsty 300% of patents sen anger) anctndr nse ase ter + Symptons ted to vsceraewoherent _Atleastone ternal orgn vain 90% of pers nth DRESS + er t60.80%) + Hear (eosinophilic myers pra) {sevontestna ae (Sanne, corn ersons, eens + Pancreas ipancret) + Tytidiastamnmne nyt appeaing ofen ate asa sequel of ORES) + bran encephatts ments) * nse pests incense n creat nase) $ Perper ners payers ree) IeferenenB), pun biachaogstueiB-MEDE XK be Question ast ‘hie \vonagemertof paint wh ppt psa rowsness 1 Fag scngae 1 see Catherine, 76 years oi rushed tothe emergency department ofthe lca hospital you work 2 after she was found drowsy. she has end.stage evrian cancer andis on methadone, codeine, paracetamol, naproxen and diazepam fr pain control Oa her way tothe hospital she was given naloxone 04 mg itravenously because she has pinpoint pups. On examination. you nove that herpuple are til pn point sizes but ne las dowry and abe to communist, The feet thing she saysto yous that shes stln severe pan. Which aneo the flloning would be the mest appropriate next step n management? Give her naproxen, “a OB Glue her another dose of naloxone. %OC Give her dazepam (Glue her more methadone for adequate pan contro, Xe Give her morphine, nravencusl. Option B is correct ‘ith methadone and codeine on he drugs opiate overdoses the cause ofhe éronsinss nd pi pot pus unl proven eters Se hasbeen gen naloxone ty paramedics inte ambuance Det pub are 5S pipe and she su rows. These re pores tors he a hat pate oy ot fly everson nsucnstustons pest doses oraloanels eque she ost appropiate het sep 8 management. {opton As key tat raprsen help wth pincotalina pant wha hs taken opatesin excess ores rurmerore reves of at overdo the ma ana mart enporan eer or ow ere fain cont rnaram maybe ere nosey lanes forth pat ance oho oft erg) {optien © Dazepam can ead to more CN depress and rowness mreover Itmay spores the ‘erirtory dre inapatene ho sea anresed =k of rexprotarysipreon ope ie 9 {options 0 anf Gung patent win opiate curds mere cose opts of ny in neta aporoptte oterencets‘question 0s Tie management fn adverse drureacton cause by vencomch Lastrevslon 20161046 113666 1 rag atgaee 1 see During hospital ety of 62:yaar old weman, she devlops pneumonia. Since methicin rastant staphylococcus aureus (MRSA) highly suspected, intravenous vancomycin sstarted After 20, ‘minutes of infusion the patient develops a generalized pric erehematous rash al over he face, toro and arms. She anc within few minutes the ach resave, A quik drug stony rev amiloipine for treatment of her hypertension, Which one of the folowing is correct regarding YB Restart the infusion ata slower at o complains of chest ghtness. The infusions stopped immediately, ethat he on aspirin and XOc Switch ta another antibot OD Never give her vancomycin again, XE Give vancomycin along wth prednisolone. Option B is correct efron, cpp ne1-1 DI = x De fusion sas f ki f ‘hie Dasroengthe cause of» ruta ater ravenous infusion of encom Lastrevsion 20160606 130504 1 rag atgaee 1 see ‘AS6:yeac-old man s admitted othe hospital fr treatment of methilin resistant staphylococcus aureus (MRSA) prumonia, Hels a known case of ypartension and on amp and hydrochlorothlazide, You dei fo stat him on vancomycin. Twenty minutes afte intravenous Infusion of vancomycin arte, he develops a generalized enthematous rash allover his bod. Tare tne respiratory symptom and the ial are thin the normal range. Which ane ofthe followings the most ikely cause ofthis presentation? YOR idiosyncratic drug reaction, X08 Toxeshoek syndrome. Stevensohnson syndrome. X00 Anaphyans, HOE Fred drug eruption Option Ais correct Vancomycin an cause several eres ypes a hypersenstvlyreacton arg Hom aed sen renters to generated cvs claps. Re man Srarome GBS) se est eared adeseeacn. Tis pens presentation e mae consent wth ed man some GS). A. ao calles ed neck sre an eye rate dependent neon reacon ot tre alae ‘ean The ebcogyis unnonn lop B snot ought mele cruzspeicabosies on. Contrasts nergeresons may dessap ith rt mm ominsvon vance sic charatrsedy facing erythema putas unl fecing he upper bay nck andfoce more ‘hon thelower bod Fan and mune pats he bck and ces. pen, anahyptensr tay 39 Oc Fv rary lfestrentene however, severe convex ony an even aria ares ean oe let meds arapyas an present wih symptoms sna to tose severe RMS, Ue RMS. a BE Iiedated eatin to vancamen doe ot Oc th ia dition. Such reaction eequtes rout Sensation Severe a and anya can ose wih anlar Shs an symptoms but wheeze Fespatory tess atemore cannon in anapyans. One eer hardest gan more common MANS ‘nan arapyaes NoTE-sinett may not be pestle te dss napyfas fom severe AMS Cased upen cna presente ns tnt eno he esimed ohare apace se ese romp in ott ‘hug reacion szocated wih enconycn opates andar media ae the mot pled meccaors Some ses sgpet tht he ytopyine etm chanel Dckersrepne may rerese the ek of “ancomyccates averse crusinerection No sentient neraon vith macnn es been epee hs NoTE-o0erposble aves reactors ssodates wn ancmjn wl: + nacional enstons «= Vancomycin gh ous demaroric + Lekoofes,esnopia neuopena 2a immune tnemboetpenia -neuopenatends to oxur ‘lth onger courses Waray. Westy mentoring ofthe whe Bod cel court and ferent eacte Counts ug pronged comnts ncated + brugineced fever -uncommany onc ben peed a cause of dusinduced set «+ neprotoxcy especial in pater receung neptvtoac ugs(eg amieopcosdes or Whaat Fetalinsutceey or teed ramasynacs. esta Nephi s seen oceans= E i i -M DI x Question ss hie management of enfin and abernal amps in apatentsonscene ad selne Lastrevson 20180606 182139 1 rag agae 1 sens |ASyaae ald man, tho lon eleline for treatment of Parknean alesse, cently has been ‘Started an sertraline afte he vias dagnosed with major depression, Today he s Brought tthe ‘emergency department with abdominal pain, dara and confusion, Which one ofthe folowing would be the most appropriate next sep in management? OA Raducesenrating, HoH Rokces. A OC Stop servaine OD Stopeslegtine. YOE stop both seraline and selegline Option Eis correct Sertraineisa selective serotonin euro itor (58) and sekeine sa monaemine xa nhisor [ncn pe. THecombinton ofthe ws snore most common ase of earn snore Sercronnsyarme a ote fe vesting conn sso with created Serotonergic acuta "Me cert neous stem. ts seen wth etapevic madison se nadvenerreacon between SUS 2a sal. pasning «+ Come entire conn. aptation hypemaria, Iypetacvy retessnese {ecSromstre=hypehermayaesng tonya, Pyperteton myers fui ser 1 hcurmusssr eure eons epomtaneovsingableoeuarhypeefns ypertna soa emor NoTE-rypeanna and conus are aay syetal ard ae cen much mote Gamat elowe nts Typha Secon precuser Tig ES Tr arian eae TERS SETAE |r mean tH Tramadol Treat ‘apheiainas and wares | 1 ST ease reupala pial anes areas Spswer ‘aoa may bea oie abo eculous supportive creistheminstay of therapy. Once eon nome suspected the most Important managerers to stop all sot rps ocean cae be an tat. tet precgtare be ade aminered Inthe pesene cf sodominl pain tea ad confine. serotonin s ery. th sealed Selene shuld be stcppedas the most impart nl mareaeret Irma eaters equ, ne saetnin artogonst pronepatine antagonist of 2] woudbethe nt. Tne maccton or tester ot modest oceveresercnn sym, ae srincomaujourna207E7tersor‘Question 19 Py Tie Contalndsatonsto AE nor use Last revision amedcoten4ie 1 rag atgaee 1 sens During 2 routine vie, 2 S0:year ld weman with a T0:yaarhstay of type 2 labetes mati e found tohave a bood pressure of145/90mmg. Further assessment reveals mkcrlbuminuria. The patients planes to be started on ACEinbors. Which one othe falling wouldbe an absolute contraindication to use of an ACE inhibitor inthis patient? | previous history of angloneurai edema Renal ncufcincy. asthma X00 Altory of racent myccardal infarction HOE Acardac eection fraction of 25%. Option Ais correct argerensin convert ney initiers are drugs of chee dabeti pets who develop hyperersion Even nnermotense dabts whe develon mcrosbumina ACE inh onéotensn ere kes (ants are rong recmmended ACE nts eine te anstesnconertingeneyme Tek ‘avon ana conseuery decreases nortan pessreo the glomus caiares, The decreased srr presse tne somerset er poten emravaatonint somenise nd ONnE down fen rte at when abet nephropty rcs. The onl abate onsen ou of thi dug le are pregrancy provou angoedera flowing se FACE nhitorsandhypersesay tomar ACE whee {option » Atough ACE inxs xe sssdted wth ceeased GFR, te Dent ot deayed rogesonto ‘ena ature auweigs te unser reaucionnGFRin the ang un ower th iter reducten GFR, ‘therpreexstigeratavealtat ACE nor wee relate contrandaon ta using gle, {option © Aste nota corralndationto usec ACE Ibe. {options 0 ana fy Myocardial farcion andrea fare date essa ae aman mai leans ot eterencet‘Question 19 Py Tie Contalndsatonsto AE nor use Last revision amedcoten4ie 1 rag atgaee 1 sens During 2 routine vie, 2 S0:year ld weman with a T0:yaarhstay of type 2 labetes mati e found tohave a bood pressure of145/90mmg. Further assessment reveals mkcrlbuminuria. The patients planes to be started on ACEinbors. Which one othe falling wouldbe an absolute contraindication to use of an ACE inhibitor inthis patient? | previous history of angloneurai edema Renal ncufcincy. asthma X00 Altory of racent myccardal infarction HOE Acardac eection fraction of 25%. Option Ais correct argerensin convert ney initiers are drugs of chee dabeti pets who develop hyperersion Even nnermotense dabts whe develon mcrosbumina ACE inh onéotensn ere kes (ants are rong recmmended ACE nts eine te anstesnconertingeneyme Tek ‘avon ana conseuery decreases nortan pessreo the glomus caiares, The decreased srr presse tne somerset er poten emravaatonint somenise nd ONnE down fen rte at when abet nephropty rcs. The onl abate onsen ou of thi dug le are pregrancy provou angoedera flowing se FACE nhitorsandhypersesay tomar ACE whee {option » Atough ACE inxs xe sssdted wth ceeased GFR, te Dent ot deayed rogesonto ‘ena ature auweigs te unser reaucionnGFRin the ang un ower th iter reducten GFR, ‘therpreexstigeratavealtat ACE nor wee relate contrandaon ta using gle, {option © Aste nota corralndationto usec ACE Ibe. {options 0 ana fy Myocardial farcion andrea fare date essa ae aman mai leans ot eterencet‘Question 1» ” Tie severe fects of nal corceerlds Last revision znre0c46 130150 1 rag agae 1 sens _Amethar brings herS:yar old boy to your practice fr consultation, He has recent been started on FLxotidet (fluicasone propionate) inhaler, hourly, after he was dlagnosed wih asthma, She ‘ants to kaw abou the adverse effects of this drug. Which one of the follovang not an adverse effec ofthis medication? near growth retardation, anc @ Oc Oseoporesis OD Webghegan steomaada, Option Eis correct Long term led cotcosterl usein stat patents assed wth mero completions These ‘ompltons cane eal oem + byohona reaseness ‘ese sors ttc an be easly managed by rag the mous nd ggg wh ae er se sje secs semi overeat are fr es oman and maybe sen nthae on ong erm gh de ned conto + renal suppression 1 one ies toxeopenis ond osteoprons) 1 incensed te ofeataret formation Netanole changes aertlon f sco andi matte) 1 ec nar arom cieren Poehatreatene Petrone,‘Question 19 22 hie EG chractersts associated th pan ice Last revision sareccoc rset 1 rag atgaee 1 see Wich one af the felling tenet an ECG naling aesaclated ith digoxin ues? Prolonged QT interval Prolonged PRinteral OC InvertedTwaves. X00 Ventricular bigemiry. ST depression. Option Ais correct Thee are benign ECG changes sociated therapies of aoa ck 1. enave ranges sun as ater orien 2 oTetenalstoneng 3. Soap apper ance ot ST eget wi segment peso + FrequentPuCeeepecayn x ckheo-the mas semmon artis 5 Supravenr ar acorns + Avec incuag PR inteallengening in cepee AY Bock) $ junaional escape tins + Proungaton of FRtenat $ euavectonal wera’ aeycaria weh an aerating ans of he CAS compe ae butte mas sec £6 nding goes Probongston FT ier srt an EG esture of gon ue oy‘Question 19 2s ‘hie Features of ond act obo adenosine 1 Fag scngae 1 see ‘Which one ofthe following statements i correct about adenesne? OR locks impulse transmission through atroventricuar (AW node, X08 Ithssa shor halflife of 1015 mints, %OC _ tttsnotcontainlcated in asthmati patents 200 iletefrettine therapy fr ventneular tachycardias HOE does mot reduce hear rate Option Ais correct senna s the eatmentf choke or rarouconplx sora acres a, Themechansm ‘foci yranienlosog of mpuse ransmissn troueh AV noe, it es re econ myoses or cter part ofthe cara condute system, Tehafe short and 10 Tsescnds eno shen 3 bus fotowes by sane sh efit edacerthe her ateandimprove cao cuput nce the her rate sawed oun. + secon hr degre Aleck (cept pater wth uncioneg artifical pcemsker 1 Srusnode decose cho ack hus ydrome or symptomatic as rar escet parts “ata onetoningatils paeerte) 1 komm pereensthiyf adenosne‘Question 1» 2m hie contandsatons to trofbone Last revision smeccc e243 1 rag agae 1 sens ‘A Toyyae old man presents to tha emergengy department for an engalng central hast pan that started about | hour ago. Hehasthe history of recurrent chest pars that are brought on with fever and relieved wth rest and type labetes melts. Further asesement establishes the {agnasis of unstable angina, You start him on asi, clopidogrel, heparin and ger rnivate, The or-al cardologlst advises that you start hm on troflban aswell ft srt contaldsted Which one ofthe following isnot a contrindicaton fr ticofsan? YOR NonsT elevation myocardial infarction X05 Acute percards Vasculis. X00 Aomicassection XE History f mtraerana necpaem, Option Ais correct “Trofban and abcd ace scogrteinIaahbtos Tel mcharism of actions preventing fa fom Daigo plates by occupying gycopcaten as receptors They may be ncated Management of unstable aga of NSTEML paula eal cardiac cetera planes 1 aston of stroke wit 0a any star of nema soe ‘Kanno tintacania dese (ag neem, atesavenou marten aneuyem) 1 ewes recent te ees 20 ys af wane cay eleva ein leg gases ‘ecings nt hypertension ‘ rrrombootopene patel coun -1o0a0orn deerersf platelet unten 1 Coting daurnces(e:prothrontintme=1 3 mes narmslor ik. ‘Traumatic orprovacs cardepumenany esisctabon. ran bps erihotioy wth the past {hee popte aceon pe mothe 1 Ueno hypenension Te" 70 men He) etre own ior ofascuis + Suspeced zoe assecton + remarmage retnopaty S vemboyaemerpy 1 cuentas or aus matncesenersorbeedeng steams anindaton fore of ras nt onthe. eterences= ap-MEDE X Ee question 228 hie ‘he ost common patios EC fdnsin ritiptsine ordre Lastrevsion 2018-0606 04718 1 rag agae 1 sens Wich one af he following le tha most camman patologe ECG abnormality In intocaton wth amisipyine? ver hard 408 og 8 os a £06 arin et rena HOE Premature ventricular convactons Option 8 is correct ‘dering of complexes probably he mest prominent pathol CG abnormally intents Intonestd wi vce anigepesant Funreted. ts cnlend ovenesar taco an ‘errata Roriaion Othe pose abnormalities cde ar ceein appoueately of patent ard are the mos! common cause of death «+ Srustacearda det archolners fet of TAs orobaly the mostcommon bela CS fh Teainowenton, Notes protean »10omssasscated wan a30m chance oSezue Wen QRS> IEDM tere a sO "ik seoue acy Pramstre errr contractions aptlon Bis therost commen ECG abnariysenin tents th‘Question 1» a hie cortralndsatons tontite ve Last revision seeccosteani8 1 rag agae 1 sens Inuhich one of te eloingconstons nates ar cntrinseated? ‘Chron let ventricular faue. ‘Unstable angina pects, cate lef ventricular faire. OD. Myocardial infarction YOE Hypotension Option Eis correct + puserate ve 100 pm $ Sst lod presse less han smn or mre than 30mnigurder the tasne 5 Rentventeubrinarenon 1 ryperogni cardamopany. ‘ mepastenas tten stent inte pas 2¢ Nos or taal othe past ys. ‘oft ven oto. ony stnson sa cenriecatont ate ue ther option ar nat nk atone Reference), =Question se Tie ‘Further management of pat overdose based on AG ests Lastrevsion 2018460610314, 1 rag agae 1 sens |ASoyyae old man brought tthe emergency department after he va foun drowsy and confusedin his house by his son According to his on, he ison paracetama, indomethacin, ‘metoprolol an oxycodene. On examination, he awry and hardly arousbe andhas 3 pulse rate of Gt bpm, blood preseure of S065 mig reepatory rate of breaths pr miaute and temperature of36.1°C Hs pupls are laterally constricted. With he provsional diagnosis of plate overdose, ne sgn naloxone 04mg intravenously and a blood sample fr ABG Is drawn Fe sstarted on oxygen 6 min by nasal prongs. The ABG results back and is follows: 1 F202: 1ommHg = Paco2: 65mg spk 731 ea cox 26meq ‘Which one of the following would be the most appropriate next step in management? Reduce the oxygen ow. Give him more doses of naloxone. OC Repeat the ABG X00 Dram bled fr opiate eve mubation and ventilation. Option Bis correct ‘Test ol that souls note theater pressure of he oxygen tat above 100mg Tere are ‘ny wo cenate fan lvted PaO) above 100 mms |. parventatenofighcencentaten cxgen 2 Sampingerors- thre ean 3 buble te Blood sae the 7202 wife elevated a eve Spprnimss ots oupenpertr ot roan moe) mise he Poo ety deren, Inne patent samping ear te cute ofthe Ac rsang Deni te cane wae Ryans ot tiagenths PacOz nas cps tobe nama reve crepe nae dept ths pene oxyzen ml on [ASG hes sll hyponc du to superessd resort dive therefore the net bes stp in maagerent wou Deghirg te ptt more nla ts count he supeese eet pate on espn ve and ering espa atecr 2 beats et mint of Mgr. nthe earne te pore shouldbe ‘enulta wi bagart mas atached toe nye. ifrverslofnormaltresthngwith maximum dos of bsone snot achive. er danse shoul be conser, to tleone ast ae the espn tae of he per NNoTE-Inappcsmngto a paetiath apne okrdse he et een zenegra pany th Seurngan any auton ophangeslesrstone ane suppement ongen snsexatehng an intanenous ine Te nestugerstep sna etravenos nwone, The pobre soul receive sted entltan wth bag and mas attache 10% oxen url heart espa ates reached 2 breaths {opton A lets potenthaspecerb ane 9 recoory rat of beens berminte.aredctonih fnaen fo leuk nceereraton ois conaion. {option Repeating tbe AG maybe cated ae ueament wh further doses raloone {optlen 0) nit nel maszremente ot cated inthis ent {option xunason an venation at spat not essary unless cated eters te casee eterences nemberHOG per1-1 DI = M4B-MEDEX, [| =e me susie cee ee 1 Fag scngae 1 see ‘Which ane ofthe following medications wil not cause serotonin sydrome if given alongwith selective serotonin reuptake Inhibitors (SRS OA Tryptophan OC — Modobemide. a (CHorpromazine Oe Uwe. Option D is correct Seren sare a potent fe tvetenig condo ssodaed with cea serstanarge actuyn "he cerzal nervous system. ts seen wth etapeic madison se nadverert acon between SS “+ cose entre conson.agttlonhpomanis, hyperactive {ossnom ores hypernermasetng teen, rypertenson mya fh heres 1 hcurmmussareoure eons pomtaneovsngablloauanhyperefen hypertena aa emer NoTE-typetona and conus areata ymmetral and aecfen mich more cramatenhelowe ts einer Serotonin precursor ‘Bi howetne selne aera) Tan serotonin reoake “Tec arbaepressans apna ‘mip nore.) daenercebnctte ‘ionoarine oaase ARTS BY (mocobemie Stine.) [nab metal of 7 Fane Tea aaa Tamar Tr aon I ‘Baprone art serotonin ago eS and TESS SAT eae ree pial antares os piswet ako -ay be aoe above rgromazie ca Hz aceptr stages ued tor Weatmen seen some. nt oes nat ‘oauringe i aevelopment 2! seatann sarome, Management of erotnin yaar «+ Astconerg rugs snl topped atone andcate stab akan that race recente Inadvertent aarinstres ‘Tose wan moderato severe seotnerie sper shou be admitted the host. Thse wh hypernarmirenure semesonta nee + Rega monitoring of tmperatre pu, bloodpressure and win outpst + ine patents hyethemic the terrae hou agree be ered ang ool ter ors Ieepac ant even probs ond vertiaton| + ezsaaepnes maybe use convo senses and muscle hypracaty + specictreaent of peterson usa rot required ‘The seston antagonist ypanepacne ste elie nasieaton errs ot moderate to see Serotonin smdrone at ital does of agi en oly Tas canbe epese a 2 outs eee. Cipchenadine sould te dscontiued fresno responce afte ta ose of ng, here a esponse [may be conten aces coses upto mBayleg upto dmg EMOW (ther sugested mesaton aeclorprmaane ns propre butthese ues a asocate th more averse fet aeons desea, chorramne ray emer ppresate ours than er ‘ovone seve agents See can causehypoterion paves must rece Suter lume KOON eterencets