QUESTION: 121

A pregnant lady comes at 37 weeks with 3+ proteinuria, confusion and Blood pressure 170/110 mmhg.
What is the best step in her management?

Admit and monitor / mgso4 E-Send home
Hydralazine
Deliver the baby immediately
C-section

Answer(s): C

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QUESTION: 122

Hypogammaglobulinemia is often present at the time of the diagnosis.
Which one of the following clinical findings is NOT characteristic of chronic lymphatic leukaemia?

Coombs test is positive in 10-20% of cases
Bone marrow examination is essential to confirm the diagnosis
B-lymphocytes are the leukaemia cell line in the majority of cases
It converts to lymphoma

Answer(s): A

Explanation:

Bone marrow examination is essential to confirm the diagnosis Chronic lymphatic leukaemia (CLL) is characterized by accumulation of small mature lymphocytes in the bone marrow and peripheral blood. The presenting features are persistent lymphocytosis, lymphadenopathy and hepatosplenomegaly.
Hypogammaglobulinemia is often present at the time of the diagnosis. Autoimmune hemolytic anemia occurs in 25% of cases. The diagnosis is usually confirmed on peripheral blood examination; bone marrow examination is rarely needed. Evolution in to a more aggressive disease such as diffuse large cell lymphoma (Richter's syndrome) can occur.

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QUESTION: 123

A 35-year-old car driver crashed into a concrete block without a safety belt on. Thirty minutes after and on the way by ambulance to the hospital he begins to become breathless. On administration of 100% oxygen there is not much improvement in this condition. On arrival at the Emergency Department he has lost consciousness and appears cyanosed with markedly distended jugular veins. Blood pressure 80/40 mmHg Heart rate 120 /min Respiratory rate 34 /min
Temperature 36.6 ֲ°C. Oxygen saturation 60% on room air.
What's immediate action should be taken?

Rapid infusion of crystalloid
IV 0.2 mg adrenaline
Intubation and 100% oxygen
Needle decompression

Answer(s): D

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QUESTION: 124

A 42-year-old man presents with a target shaped rash that has developed over the last several days. He was on a camping trip in the woods last week in Maine.
What is the next best step in management?

Western blot
Doxycycline E-Ceftriaxone
ELISA
Serology for IgM

Answer(s): B

Explanation:

A rash suggestive of Lyme is enough to indicate treatment. A 5-cm-wide targetshaped rash, particularly with a history of camping/hiking, is enough to indicate the need for antibiotic treatment with doxycycline. A characteristic rash is more specific than serology.

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QUESTION: 121

QUESTION: 122

Explanation:

QUESTION: 123

QUESTION: 124

Explanation: