Case 18 question 13-22

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Question 13

Penicillin hypersensitivity is an example of an adverse drug reaction (ADR). Which type of ADR does penicillin hypersensitivity go under using the ABCDE system?

  1. End of use
  2. Delayed
  3. Chronic
  4. Bizarre
  5. Augmented

The correct answer is option d, Bizarre

Bizarre -> Non-dose related~unpredictable (e.g Aspirin inducing Tinnitus)
End of use -> Withdrawal of substance would cause this ADR (e.g opiate withdrawal)
Delayed -> Time-related ADR (e.g tardive dyskinesia due to antipsychotics)
Chronic -> Dose and time related~usually from continuous use (e.g Kidney damage due to sustained use of analgesics)
Augmented -> Dose-related~predictable (Gentamycin inducing ototoxicity)

Question 14

Docusate sodium belongs to a family of medications known as stool softeners. A patient has been prescribed Docusate sodium 50 mg 1 tab PO BD. Which of the following statements accurately describes this patient’s prescription?

  1. 50 mg 1 tab orally at night
  2. 50 mg 1 tab rectally twice daily
  3. 50 mg 1 tab orally when required
  4. 50 mg 1 tab orally twice daily
  5. 50 mg 1 tab rectally three times a day

The correct answer is option d, 50 mg 1 tab orally twice daily

50 mg 1 tab orally twice daily -> PO=orally. BD=bis die=twice daily
50 mg 1 tab orally at night -> Correct way to say this statement would be 50 mg 1 tab PO o.n.
50 mg 1 tab rectally twice daily -> Correct way to say this statement would be 50 mg 1 tab PR BD
50 mg 1 tab orally when required -> Correct way to say this statement would be 50 mg 1 tab PO PRN
50 mg 1 tab rectally three times a day -> Correct way to say this statement would be 50 mg 1 tab PR t.i.d.

Question 15

Which of the following is the major vector carrying malaria?

  1. Aedes Aegyptii mosquitoes
  2. Tsetse fly
  3. Sandfly
  4. Anopheles mosquitoes
  5. Ixodes tick

The correct answer is option d, Anopheles mosquitoes

Anopheles mosquitoes -> main vector for malaria
Aedes Aegyptii mosquitoes -> main vector for Dengue fever, Zika fever, and Yellow fever
Tsetse fly -> main vector for African sleeping sickness (African Trypanosomiasis)
Sandfly -> main vector for Leishmaniasis
Ixodes tick -> main vector for Lyme disease

Question 16

A second year geography students has arrived back to England after travelling to south-east Asia. He presented with swinging fever, jaundice, and headache. He also bean to lose consciousness and develop convulsions. You suspect cerebral involvement at this point. The consultant confirms a malaria diagnosis. He informed you that this is a classic presentation of cerebral malaria.

What would be the most likely causative organism involved?

  1. Plasmodium vivax
  2. Plasmodium ovale
  3. Plasmodium malariae
  4. Plasmodium falciparum
  5. None of the above

The correct answer is option d, Plasmodium falciparum

Plasmodium falciparum -> Cerebral malaria is most commonly due to P. falciparum. A potentially helpful way to remember this is falCIparum=CErebral (both have the sound “see”).
Plasmodium vivax -> will most commonly present with a patient with tertian fever (48-hour periodicity)
Plasmodium ovale -> will most commonly present with a patient with tertian fever (48-hour periodicity)
Plasmodium malariae -> will most commonly present with a patient with quartan fever (72-hour periodicity)
None of the above -> Distractor

Question 17

Which of the following is a nematode that infects humans by invading skin (most commonly via feet) and can present as cutaneous larval migrans?

  1. Ascaris lumbricoides
  2. Hookworms
  3. Schistosoma manoni
  4. Giardia lamblia
  5. Taenia solium

The correct answer is option b, Hookworms

Ascaris lumbricoides -> transmitted via faecal-oral route.
Schistosoma manoni -> It does penetrate skin but it’s not a nematode (it’s a trematode).
Giardia lamblia -> transmitted via faecal-oral route and it’s also not a nematode (it’s a protozoa).
Taenia solium -> Transmitted via faecal-oral route and it’s also not a nematode (it’s a cestode)

Question 18

Which of the following antiprotozoal drugs works by blocking the detoxification of heme into hemozoin?

  1. Amphotericin B
  2. Chloroquine
  3. Terbinafine
  4. Primaquine
  5. Atovaquone

The correct answer is option b, Chloroquine

Chloroquine -> By blocking the detoxification of heme into hemozoin, it results in build up of heme which is toxic to parasites.
Amphotericin B -> Antifungal (not antiprotozoal) and it’s mechanism of action is by binding to ergosterol (which is unique to fungi) forming membrane pores which allows leakage of electrolytes.
Terbinafine -> Antifungal (not antiprotozoal) and it’s mechanism of action is by inhibiting fungal enzyme squalene epoxidase.
Primaquine -> Mechanism of action not completely understood, but it’s thought to be involved as a respiratory chain inhibitor. Main thing to know about this is that it’s the only treatment for P. vivax/ovale
Atovaquone -> Inhibits pyrmidine synthesis

Question 19

Which antihelmintic drug works by increasing Ca2+ permeability of helminth cell membrane causing paralysis and detachment?

  1. Ivermectin
  2. Mebendazole
  3. Albendazole
  4. Praziquantel
  5. Pyrantel

The correct answer is option d, Praziquantel

Ivermectin -> Not completely understood but thought to interfere with polarization of nerve and muscles cells in susceptible parasites resulting in paralysis
Mebendazole -> Inhibits microtubule formation
Albendazole -> Inhibits glucose uptake by susceptible parasites
Pyrantel -> polarizes neuromuscular junctions

Question 20

Severe dengue shock (DSS) is a potentially lethal complication which can develop from dengue infections. From the choices below, which of the following is considered a sign of severe dengue shock (DSS)?

  1. Abdominal tenderness
  2. Leukopenia
  3. Fluid accumulation with respiratory disease
  4. Lethargy
  5. Increase in haematocrit concurrent with rapid decrease in platelet count

The correct answer is option c, Fluid accumulation with respiratory disease

Fluid accumulation with respiratory disease -> ”Severe Dengue Shock”~DSS)
Abdominal tenderness -> This is considred a warning sign, however it isn’t one of the signs of DSS= “Dengue with warning signs”
Leukopenia -> This sign goes under “Dengue without warning signs”
Lethargy -> This is considred a warning sign, however it isn’t one of the signs of DSS= “Dengue with warning signs
Increase in haematocrit concurrent with rapid decrease in platelet count -> This is considred a warning sign, however it isn’t one of the signs of DSS= “Dengue with warning signs”

Question 21

Prescriptions, regardless if it is written in hospital or primary care have the same basic requirements. Which of the following is NOT a legal requirement to be in a prescription form:

  1. Age of patients (who are ≥18 of age)
  2. Have an appropriate date
  3. Address of the prescriber
  4. Name and address of patient
  5. Be written or printed legibly in ink

The correct answer is option a, Age of patients (who are ≥18 of age)

Age of patients (who are ≥18 of age) -> Age is a legal requirement if patient is under 12 years old.
Have an appropriate date -> Legal requirement
Address of the prescriber -> Legal requirement
Name and address of patient -> Legal requirement
Be written or printed legibly in ink -> Legal requirement

Question 22

Romana’s sign is characteristic of the acute stage of Chagas disease caused by Trypanosoma cruzi. What’s the most accurate description of Romana’s sign?

  1. Abdominal pain with facial swelling
  2. Hepatosplenomegaly
  3. Central chest pain when coughing
  4. Unilateral orbital swelling
  5. Bilateral orbital swelling

The correct answer is option d, Unilateral orbital swelling

Credits

  • 13-22 (Rayan Alfuhaid, 3rd year)