Evidence-Based Medicine and Clinical Audit

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Questions and Answers

What does a negative test for swan neck deformity indicate in relation to rheumatoid arthritis?

  • It rules out the diagnosis of rheumatoid arthritis. (correct)
  • It indicates the presence of antibodies.
  • It confirms the diagnosis of rheumatoid arthritis.
  • It suggests a poor prognosis.

Which condition is most likely to present with mono-articular symptoms?

  • ankylosing spondylitis
  • primary osteoarthritis
  • reactive arthritis
  • septic arthritis (correct)

In rheumatoid arthritis, the presence of high titres of RF is associated with what prognosis?

  • Moderate prognosis
  • Poor prognosis (correct)
  • Good prognosis
  • Uncertain prognosis

What percentage of patients with psoriatic arthritis present with a positive swan neck deformity?

<p>35% (C)</p> Signup and view all the answers

Which of the following symptoms is NOT commonly associated with rheumatoid arthritis?

<p>Good prognosis (B), Sparing of the cervical spine (C)</p> Signup and view all the answers

What is the most prominent laboratory finding you would expect to see in a patient with severe inflammation?

<p>Leucocytosis (B), Neutrophil leucocytosis (C), Elevated ESR (D)</p> Signup and view all the answers

Which option best describes rheumatoid arthritis in terms of gender prevalence?

<p>More common in females (B)</p> Signup and view all the answers

Which intervention is typically recommended for treating a patient with migratory polyarthritis due to rheumatic fever?

<p>Amoxicillin intravenous (A)</p> Signup and view all the answers

What is the best treatment option for a 40-year-old man with mild polyarthritis and extensive psoriasis?

<p>NSAIDs &amp; corticosteroids (B)</p> Signup and view all the answers

Which pain management option is more likely to help an elderly male with carcinoma of the prostate and painful bony metastasis?

<p>Morphine (B)</p> Signup and view all the answers

Which measurement is considered a good indicator of tissue perfusion?

<p>Urine output (B)</p> Signup and view all the answers

Who must always obtain informed consent?

<p>Surgeon Operating on Patient (A)</p> Signup and view all the answers

What is the maximum pressure for pneumoperitoneum during laparoscopic procedures?

<p>15 mmHg (B)</p> Signup and view all the answers

How will a burn covering 15% of the total body surface area heal if no intervention is done?

<p>Hypertrophic scarring (A)</p> Signup and view all the answers

Which gas is commonly used to create pneumoperitoneum during laparoscopy?

<p>CO2 (B)</p> Signup and view all the answers

What is the total body surface area involved for a patient with burns on both upper arms, front of the chest, abdomen, and head & neck?

<p>35% (C)</p> Signup and view all the answers

Which DMARD is preferred as a first-line agent in treating certain inflammatory conditions?

<p>Leflunomide (B)</p> Signup and view all the answers

When should a Redivac drain be typically removed after a para umbilical hernia operation?

<p>After 5 days (D)</p> Signup and view all the answers

Which option is NOT included in the Mental State Examination (MSE)?

<p>Diagnosis (B)</p> Signup and view all the answers

What is the primary goal in treating a patient with painful bony metastasis from prostate carcinoma?

<p>Manage pain (C)</p> Signup and view all the answers

Which of the following is a somatoform disorder?

<p>Pain disorder (D)</p> Signup and view all the answers

What is a characteristic of deep partial thickness burns?

<p>Potential for hypertrophic scarring (A)</p> Signup and view all the answers

Delusional disorder is characterized by:

<p>Unrealistic fixed beliefs that cannot be changed (A)</p> Signup and view all the answers

Thalassemia is inherited as which type of genetic disorder?

<p>Autosomal Recessive (C)</p> Signup and view all the answers

What is the likely diagnosis for a 75-year-old male with a six-month history of skin pigmentation, tingling sensations, and a CBC showing Hb 7.5g/dl?

<p>Classical Hodgkin's Lymphoma (D)</p> Signup and view all the answers

Which cells are indicative of Classical Hodgkin's Lymphoma in the context of a cervical lymph node biopsy?

<p>Reed-Sternberg Cells (B)</p> Signup and view all the answers

In a case of Non-Hodgkin's Lymphoma, what is the most likely diagnosis for a 32-year-old male presenting with multiple bulky lymph nodes?

<p>Large B Cell Non-Hodgkin's Lymphoma (B)</p> Signup and view all the answers

What laboratory finding is most likely associated with megaloblastic anemia in a patient with a history of rheumatoid arthritis?

<p>Macrocytosis (B)</p> Signup and view all the answers

What might cause sudden shortness of breath and altered sensorium on the third day of chemotherapy in a patient with Non-Hodgkin's Lymphoma?

<p>Pulmonary embolism (B)</p> Signup and view all the answers

In the context of a patient with RBC derivatives, what are Hypersegmented neutrophils typically associated with?

<p>Megaloblastic anemia (B)</p> Signup and view all the answers

Which of the following conditions is characterized by a normal white cell count but significant anemia?

<p>Megaloblastic Anemia (C)</p> Signup and view all the answers

What is the relationship between serum ferritin levels and iron deficiency anemia?

<p>Low ferritin levels indicate iron deficiency (D)</p> Signup and view all the answers

What is the best site for X-ray diagnosis of rickets?

<p>Wrist joint (D)</p> Signup and view all the answers

Which vaccine is typically given via intramuscular injection?

<p>Pneumococcal vaccine (B)</p> Signup and view all the answers

At what age is development almost complete?

<p>9 years (A)</p> Signup and view all the answers

According to the WHO, what is the Hb level considered as anemia during the first trimester of pregnancy?

<p>11 g/dl (B)</p> Signup and view all the answers

What is the most likely diagnosis for a 10-year-old child presenting with a limping gait and localized tenderness above the knee?

<p>Acute osteomyelitis (A)</p> Signup and view all the answers

Which hemoglobin level is classified as anemia in the second trimester of pregnancy?

<p>10.5 g/dl (C)</p> Signup and view all the answers

Which option is not typically administered via intramuscular injection?

<p>Rota virus (B)</p> Signup and view all the answers

Which hemoglobin level is considered as anemia during the third trimester of pregnancy?

<p>11 g/dl (A)</p> Signup and view all the answers

Which of the following imaging modalities does NOT use ionizing radiation?

<p>MRI (D)</p> Signup and view all the answers

What is the most likely diagnosis for a 25-year-old pregnant woman with hemoglobin of 7.8 gm/dl and a history of MUD eating?

<p>Iron deficiency anemia (A)</p> Signup and view all the answers

A two-week-old male infant presents with inverted and plantiflexed feet. What is the most probable diagnosis?

<p>Congenital talipes equinovarus (C)</p> Signup and view all the answers

Which condition is characterized by a limit in hip abduction in a child with a limping gait?

<p>Developmental dysplasia of the hip (D)</p> Signup and view all the answers

In X-rays showing a radiolucent lesion in the distal femur, which condition is most likely indicated?

<p>Osteosarcoma (C)</p> Signup and view all the answers

Which of the following is NOT a common form of anemia?

<p>Osteosarcoma (C)</p> Signup and view all the answers

What condition could result in limited abduction and a difference in leg length in children?

<p>Pediatric hip dysplasia (A)</p> Signup and view all the answers

In the case of a female child with a limping gait and a shorter right leg, which diagnosis is most likely?

<p>Congenital hip dislocation (D)</p> Signup and view all the answers

Flashcards

Macrocytosis

A blood condition where red blood cells are larger than average.

Hypersegmented neutrophils

Neutrophils with more than the normal number of lobes in their nuclei, often associated with vitamin deficiencies.

Iron deficiency anemia

Anemia caused by a lack of iron, leading to insufficient red blood cell production.

Megaloblastic anemia

Anemia characterized by large, immature red blood cells due to vitamin B12 or folate deficiency.

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Normocytic anemia

Anemia where red blood cells are of normal size.

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Reed-Sternberg cells

Characteristic abnormal cells found in Classical Hodgkin lymphoma.

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Non-Hodgkin's Lymphoma

Cancer of the lymphatic system, with various types and presentations.

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Large B Cell Non-Hodgkin's Lymphoma

A specific type of non-Hodgkin's lymphoma, involving large B cells.

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Swan Neck Deformity

A condition causing a characteristic bend in the fingers, often associated with rheumatoid arthritis or psoriatic arthritis.

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Rheumatoid Arthritis (RA) Positive

Blood tests showing the presence of antibodies (like IgG or IgM) associated with RA.

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Mono-articular Arthritis

Joint inflammation affecting only one joint, instead of multiple joints.

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Poly-articular Arthritis

Joint inflammation involving multiple joints; the opposite of mono-articular.

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Septic Arthritis

Joint inflammation caused by an infection.

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Carpal Tunnel Syndrome

A condition affecting the wrist, possibly associated with RA.

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Migratory Polyarthritis

Joint inflammation moving from one joint to another over time.

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Rheumatoid factor (RF)

A blood test that checks for antibodies involved in rheumatoid arthritis.

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Informed consent

A process where a patient understands and agrees to a medical procedure after receiving all relevant information.

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Pneumoperitoneum

The inflation of the abdominal cavity with gas, typically CO2, during laparoscopic surgery.

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Laparoscopic surgery

A minimally invasive surgical procedure using a camera and instruments inserted through small incisions.

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Redivac drain

A drainage device inserted during surgery to collect fluid and prevent accumulation in the surgical site.

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Mental State Examination (MSE)

A structured assessment of a patient's psychological and cognitive state.

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Somatoform disorder

A mental health condition where physical symptoms are present, but without a medical explanation.

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Delusional disorder

A chronic mental illness characterized by fixed, false beliefs that are not based in reality.

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Hallucination

A false sensory perception experienced in the absence of an external stimulus.

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Gout

A type of arthritis caused by a buildup of uric acid in the joints, leading to inflammation and pain. It commonly affects the big toe.

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Treatment for Gout

Treatment for gout aims to reduce uric acid levels in the body and alleviate pain and inflammation. Medications include colchicine, NSAIDs, and corticosteroids.

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Psoriasis

A chronic skin condition characterized by red, scaly patches, often on the elbows, knees, and scalp.

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Treatment for Psoriasis

Treatment options for psoriasis include topical creams, phototherapy, and systemic medications like methotrexate or biologics.

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Carcinoma of the Prostate

A type of cancer that develops in the prostate gland, a small gland involved in male reproductive function.

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Bone Metastasis

The spread of cancer cells from the primary site (e.g., prostate) to the bones.

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Pain Management for Bone Metastasis

Managing pain from bone metastasis often involves strong pain medications like opioids, radiation therapy, and sometimes bisphosphonates.

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Tissue Perfusion

The delivery of oxygen and nutrients to the tissues through blood circulation.

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Rickets X-ray

The best site to diagnose rickets on an X-ray is the wrist joint.

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Measles Vaccine Route

The Measles vaccine is administered intramuscularly (IM).

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Complete Development Age

Development is almost complete by the age of 7 years.

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Not IM

Rotavirus vaccine is not given by intramuscular injection.

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Anemia in Pregnancy

According to WHO, Anemia in pregnancy is defined by hemoglobin levels below certain thresholds in different trimesters: First trimester: Hb<11.0 g/dl, Second trimester: Hb<10.5 g/dl, Third trimester: Hb<10.5 g/dl.

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Limping Child

A 10-year-old child presenting with limping, fever, and localized tenderness above the knee most likely has septic arthritis.

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Knee Pain in Teen

A 15-year-old male with pain and swelling near the knee joint might have Osteosarcoma, a type of bone cancer.

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Acute Urinary Tract Infection

Acute urinary tract infection (UTI) is a common infection that affects the urinary system.

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What imaging modality doesn't use ionizing radiation?

Magnetic Resonance Imaging (MRI) is the only modality listed that doesn't utilize ionizing radiation. Others like digital radiography, mammography, CT scan, and PET scan all rely on ionizing radiation.

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What condition might a pregnant woman with MUD eating habit and low Hb have?

Iron deficiency anemia is the most likely diagnosis in this case. The pregnant woman's MUD eating habit and low Hb levels indicate iron deficiency.

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What does radio-destructive lesion mean?

A radio-destructive lesion implies destruction of bone tissue, visible on X-rays, often associated with cancerous or infectious processes.

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What distinguishes septic arthritis knee from osteosarcoma?

Septic arthritis knee is an infection of the knee joint, while osteosarcoma is a bone cancer. Both can show radio-destructive lesions but have different causes.

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Two-week-old inverted and planti flexed feet: what is the likely diagnosis?

Congenital talipes equinovarus, also called clubfoot, is a common birth defect where the foot is turned inwards and pointed downward.

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What abnormality is shown with a laterally curved thoracic spine and X-ray showing scoliosis?

Scoliosis is a sideways curvature of the spine, visible on X-ray, often presenting as a lateral curve in the thoracic region.

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What is the probable cause of a limping gait, shorter leg, and limited hip abduction in a child?

This combination of symptoms strongly suggests a possible hip dysplasia, a condition where the hip joint isn't properly formed.

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What is the difference between pes planus and congenital talipes equinovarus?

Pes planus, or flat feet, is a condition where the arch of the foot is flattened. Congenital talipes equinovarus is a birth defect where the foot is turned inwards and pointed downward.

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Study Notes

Evidence-Based Medicine (EBM)

  • EBM is a systematic approach to identifying the most appropriate strategy for managing individual patients.
  • This approach is based on recently published literature, strategies effective in previous patients, analyses of relevant medical literature, and advice given by mentors/colleagues.

Clinical Audit

  • Clinical audit is a structured activity intended to provide new knowledge that's generalizable and suitable for dissemination.
  • It's a process used to create protocols and guidelines based on policy-makers' input, implemented at a national level.
  • It's a quantifiable process for testing hypotheses in clinical practice, and a quality improvement method that aims for higher patient care quality and outcomes.

Evidence-Based Medicine Step

  • The first step in applying EBM concepts to a clinical question is to ask the question.
  • Then, acquiring evidence, appraising the evidence, applying the evidence, and assessing the whole process follow.

Palliative Care

  • Palliative care addresses emotional, physical, and spiritual aspects of patients with serious illnesses.
  • Hospice is a palliative care program focusing on providing care for people who are near the end of life.

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