Question Bank

The presentation is classic for Guillain-Barré Syndrome (GBS), often preceded by Campylobacter jejuni infections. Treatment is IVIG or plasma exchange. Corticosteroids are not effective in GBS. Monitoring FVC is crucial as respiratory failure is a major complication requiring ICU admission.

NICE guidelines recommend an antipsychotic (e.g., haloperidol, olanzapine, risperidone, or quetiapine) as first-line treatment for an acute manic episode. Lithium alone may not be sufficient for acute control, and antidepressants like amitriptyline are contraindicated as they can worsen mania.

The patient has signs of severe aortic stenosis (syncope, slow-rising pulse, ESM radiating to carotids). Longstanding aortic stenosis leads to increased afterload and subsequent left ventricular hypertrophy (LVH).

In elderly patients or those with underlying ischaemic heart disease, Levothyroxine should be started at 12.5–25 micrograms to avoid precipitating a myocardial infarction or angina through sudden increases in metabolic demand.

NICE recommends an ACE inhibitor and a beta-blocker as first-line treatment for all patients with heart failure with reduced ejection fraction (HFrEF). While furosemide treats symptoms of congestion, it does not improve mortality like beta-blockers do.

The clinical triad of tremor, bradykinesia, and rigidity is characteristic of Parkinson's Disease. The pathological hallmark is the presence of Lewy bodies (alpha-synuclein aggregates) and the loss of dopaminergic neurons in the substantia nigra pars compacta. Atrophy of the caudate is seen in Huntington's disease.

ACE inhibitors (like ramipril) should be withheld during an AKI as they can impair autoregulation of glomerular blood flow and exacerbate hyperkalaemia, which is already present here. Bisoprolol and statins are generally continued unless there is severe hypotension or rhabdomyolysis.

The clinical picture of fluid loss (vomiting/diarrhoea) combined with hypotension and tachycardia suggests dehydration. The high urea-to-creatinine ratio and negative urinalysis further support a pre-renal cause rather than intrinsic or post-renal damage.

Refeeding syndrome occurs when nutrition is reintroduced to a malnourished patient, leading to insulin release. Insulin causes an intracellular shift of potassium, magnesium, and phosphate, which can lead to cardiac arrhythmias and respiratory failure.

NICE guidelines (CG150) recommend combination therapy with an oral triptan and an NSAID (or paracetamol) for the acute treatment of migraine. Propranolol and amitriptyline are used for prophylaxis, not acute treatment. Subcutaneous triptans are usually reserved for patients with severe vomiting or those who fail oral therapy.