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Exam Code: MCQS
Exam Name: Multiple-choice questions for general practitioner (GP) Doctor
Updated: Apr 10, 2024
Q&As: 249
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VCE
A 65-year woman is found on routine CBC to have a hematocrit of 32 percent (normal 37?2) and an MCV of 70 (normal 80?00). Her stool is heme-negative.
What should you do next?
A. Upper endoscopy
B. Two more stool tests now
C. Barium enema
D. Colonoscopy
Correct Answer: D
Colonoscopy is indicated in all patients > 50 simply as routine screening. Hence, in this case, the patient needs colonoscopy anyway, regardless of what the stool tests show. Another reason to go straight to colonoscopy is the presence of microcytic anemia. Unexplained microcytic anemia in a patient above 50 is most likely caused by colon cancer. Sigmoidoscopy will do nothing to evaluate the right side of the colon and would miss nearly 40 percent of cancers. No matter what a sigmoidoscopy showed, you would need to inspect the right side of the colon. Capsule endoscopy is done to evaluate bleeding when the upper and lower endoscopy are normal and the source of bleeding is likely to be in the small bowel.
A patient who has recently undergone hip fracture repair develops the sudden onset of shortness of breath. His pulse is 110 per minute. The chest is clear to auscultation. Chest x-ray is normal, and the EKG shows sinus tachycardia. ABG shows pH 7.48, pCO2 28, pO2 75.
What is the next best step in management?
A. Spiral CT scan
B. dimers
C. Heparin
D. Angiography
E. Lower extremity Doppler
Correct Answer: C
When the case so clearly suggests a pulmonary embolus with sudden onset of shortness of breath and clear lungs in a patient with a risk factor, the first thing to do after the chest x-ray.
A 45-year-old man on lithium for a bipolar disorder developed congestive heart failure 2 weeks ago. He now presents with drowsiness, nausea, vomiting, blurred vision and coarse tremors.
Which of the following concurrent medications, if taken in combination with lithium, would be most likely to cause these symptoms?
A. Acetazolamide
B. Furosemide
C. Hydrochlorothiazide
D. Spironolactone
Correct Answer: C
Hydrochlorothiazide Approximately 95% of a single dose of lithium is eliminated in the urine. The drug is handled by the kidneys in the same manner as sodium, ie most of the filtered lithium is reabsorbed in the proximal tubule. Hence loading with sodium will increase lithium excretion, while sodium depletion will promote the retention of lithium. All diuretics decrease renal lithium clearance. However, thiazide diuretics cause the greatest retention of lithium amongst all diuretics.
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