Question Bank

NICE guidelines recommend either a beta-blocker (e.g., atenolol/bisoprolol) or a calcium channel blocker (e.g., diltiazem/verapamil) as first-line treatment for stable angina. Long-acting nitrates and others are reserved for second-line or combination therapy.

The primary treatment for acute pancreatitis is supportive care, with aggressive IV fluid resuscitation (crystalloids) being the most critical step to prevent organ failure and necrosis. Amylase >3x the upper limit of normal is diagnostic. Antibiotics and surgery are not indicated in the initial phase unless infection is proven.

Staphylococcus aureus is the most common cause of acute infective endocarditis, particularly in IV drug users. The murmur described is tricuspid regurgitation (right-sided), which is characteristic of endocarditis in this patient group.

Low pH (<7.35) and high pCO2 (>6.0 kPa) indicate respiratory acidosis (Type 2 failure). The elevated bicarbonate (29 mmol/L) suggests the body has begun to compensate (chronic/partially compensated), but the pH remains acidotic.

NICE guidelines state that the gold standard for diagnosing coeliac disease in adults is an OGD with duodenal biopsies showing villous atrophy. Serology (anti-tTG) is a screening tool, and biopsies must be performed while the patient is still consuming gluten. Colonoscopy is used for IBD, not coeliac disease.

NICE guidelines recommend an ACE inhibitor (like Ramipril) or an ARB as first-line therapy for patients with CKD and diabetes, or for those with an ACR >30 mg/mmol (or >3 if they have diabetes), due to their renoprotective effects.

The patient has Subacute Combined Degeneration of the Cord due to B12 deficiency (Pernicious Anaemia). For patients with B12 deficiency and neurological involvement, the BNF/NICE guidance recommends 1mg IM hydroxocobalamin every other day until there is no further improvement in symptoms. The standard maintenance dose of 1mg every 3 months is only for those without neurological symptoms.

The clinical picture of pain relieved by defecation, bloating, and altered bowel habit in the absence of inflammatory markers (normal CRP/ESR) or weight loss/anaemia is characteristic of Irritable Bowel Syndrome (IBS). Diagnosis is clinical once other conditions (Coeliac, IBD) are excluded.

Acute Tubular Necrosis (ATN) is often caused by prolonged ischaemia (e.g., hypotension/shock during surgery). The presence of 'muddy brown' casts in the urine is highly pathognomonic for ATN compared to simple pre-renal azotaemia.

Squamous cell carcinoma is often centrally located and is classically associated with paraneoplastic hypercalcaemia due to the secretion of parathyroid hormone-related protein (PTHrP).

NICE recommends 5 days of oral prednisolone (30mg) for COPD exacerbations and a course of antibiotics if sputum is purulent. Current guidelines have moved away from longer 10-14 day courses of steroids to reduce side effects.

According to UK national DKA guidelines, resolution is defined by pH >7.3, bicarbonate >18 mmol/L, and ketones <0.6 mmol/L. Glucose often normalizes before the metabolic acidosis resolves; therefore, glucose monitoring alone is insufficient for stopping the insulin infusion.

Cotard syndrome is a nihilistic delusion where patients believe they are dead, do not exist, or have lost internal organs. Capgras and Fregoli are delusional misidentification syndromes, while De Clerambault is the delusion that another person is in love with the patient.

His CHA2DS2-VASc score is 3 (Age >=75 = 2 points, Diabetes = 1 point). Anticoagulation (DOAC like apixaban) is indicated for men with a score of 1 or more, and recommended for a score of 2 or more; aspirin is no longer used for stroke prevention in AF.

The patient likely has Autosomal Dominant Polycystic Kidney Disease (ADPKD). There is a significant association between ADPKD and intracranial berry aneurysms, which can lead to subarachnoid haemorrhage (explaining her father's early death).

Unilateral sensorineural hearing loss and tinnitus are red flags for a vestibular schwannoma (acoustic neuroma). Gadolinium-enhanced MRI of the internal auditory meatus is the gold-standard investigation. CT is less sensitive for small lesions in the cerebellopontine angle.

This patient has acute severe asthma. For all patients with acute asthma, NICE/BTS guidelines require the early administration of systemic steroids (40-50mg prednisolone orally). IV steroids are reserved for those unable to swallow or vomit; oral is equally effective.

This patient is experiencing delirium tremens, a severe form of alcohol withdrawal. NICE recommends a symptom-triggered or fixed-dose regimen of a benzodiazepine, such as chlordiazepoxide or diazepam, to manage withdrawal symptoms and prevent seizures.

Goodpasture's syndrome (Anti-GBM disease) presents with the combination of pulmonary haemorrhage and rapidly progressive glomerulonephritis. It is characterised by anti-GBM antibodies and a linear pattern of IgG deposition.

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.

For a patient with hypoglycaemia who is conscious but cannot safely swallow (no safe swallow or uncooperative), IM Glucagon is the treatment of choice in the community. Oral options are unsafe due to aspiration risk, and IV access is rarely available outside a hospital setting.

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 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.

For distal ulcerative colitis (proctitis or proctosigmoiditis), NICE recommends a topical (rectal) 5-ASA as first-line induction therapy. If remission is not achieved within 4 weeks, an oral 5-ASA may be added. Steroids are used for flares but are not the preferred first-line for mild distal disease.

Acute Chest Syndrome (ACS) is defined in Sickle Cell patients as a new infiltrate on CXR accompanied by fever and/or respiratory symptoms (hypoxia, cough, tachypnoea). It is a medical emergency requiring oxygen, analgesia, antibiotics, and often exchange transfusion. While infection often triggers ACS, the clinical constellation defines the syndrome rather than simple pneumonia.