B) Use steroid therapy

Explanation: In rare situations where no other antibiotic is available, steroid therapy is recommended to prevent hypersensitivity reactions, especially in patients with a history of penicillin allergy.

B) Cattle intestines

Explanation: The primary reservoir for Escherichia coli O157 is mainly the intestines of cattle, which can lead to contamination of pasture land and vegetables.

B) Fat-free mass

Explanation: Lean body mass is an approximation of fat-free mass and is not typically used in routine clinical nutrition.

B) Potassium, magnesium, and phosphate

Explanation: The text states that hypokalaemia, hypomagnesaemia, and hypophosphataemia occur as insulin stimulates the cellular uptake of these ions, highlighting the impact of insulin on electrolyte balance.

C) Switch from burning glucose to burning fat

Explanation: The Atkins' diet is based on the principle that the body will switch from burning glucose to burning fat, which is a key aspect of its low-carbohydrate approach to weight loss.

C) 4-5 weeks

Explanation: The ASO titre peaks 4-5 weeks after infection, indicating the immune response to the streptococcal infection, and then levels fall rapidly.

B) Sensitivity 98%, Specificity 94%

Explanation: The sensitivity of PCR for testing HSV-1 and HSV-2 is 98%, and the specificity is 94%, indicating a high level of accuracy in diagnosing these infections.

D) Through direct contact, ingestion of animal products, and arthropod vectors

Explanation: Zoonoses can be transmitted to humans in various ways, including direct contact (e.g., rabies from a dog bite), ingestion of animal products (e.g., campylobacter from chickens), and via arthropod vectors (e.g., Lyme disease from tick bites).

C) Weight-related procedures

Explanation: The term 'bariatric' is derived from a Greek word meaning 'weight' and refers to procedures designed to reduce weight, such as gastric banding and stomach bypass surgeries.

B) Co-trimoxazole

Explanation: Co-trimoxazole is thought to pose a teratogenic risk during the first trimester of pregnancy, making it important to avoid if possible.

B) Broken ‘orange stick’

Explanation: The text suggests using a broken ‘orange stick’ for a specific procedure, indicating its utility in certain medical contexts.

B) Erythromycin

Explanation: Erythromycin is noted as a good IV alternative for treating severe respiratory tract infections, showcasing its effectiveness in such cases.

B) Viable bacteria in the blood

Explanation: Bacteraemia refers to the presence of viable bacteria in the blood, which can occur in various situations, such as after tooth extraction.

C) Phenoxymethylpenicillin

Explanation: Phenoxymethylpenicillin (usually amoxicillin) is the drug of choice for treating streptococcal infections, although resistance to Streptococcus pneumoniae is increasing.

B) Clostridium difficile infection

Explanation: Clostridium difficile is a common problem that can occur mainly after taking antibiotics, as it can cause diarrhea when normal bowel commensals are eliminated.

A) Blood culture

Explanation: Blood culture is a key diagnostic method for certain infections, with a high positive rate of up to 80%, making it a reliable tool in clinical settings.

B) Wernicke–Korsakoff syndrome

Explanation: Wernicke–Korsakoff syndrome is a neurological disorder caused by thiamine deficiency, often seen in chronic alcohol abusers.

C) No definitive reason; bile reflux may play a role

Explanation: There is no clear reason why gastric ulcers are more common on the lesser curve, but bile reflux and the transition between acid-secreting and non-acid-secreting mucosa may contribute.

C) Development of atherosclerosis

Explanation: The text mentions that while the Atkins' diet may lead to short-term weight loss, it may also increase the risk of developing atherosclerosis in the long term, indicating potential cardiovascular risks associated with the diet.

C) Fluid replacement

Explanation: Fluid replacement is vital in the treatment of dengue hemorrhagic fever, as shown in randomized controlled trials that indicated no benefit from other treatments.

C) 30 g/day

Explanation: The text recommends an intake of approximately 30 g/day of total dietary fiber, emphasizing the importance of increasing fruit, vegetables, and wholegrain foods in the diet.

B) Complicating lymphoma of the ileum

Explanation: Long-term drug therapy for Crohn’s disease localized to the ileum carries the risk of complicating lymphoma of the ileum, which is a significant concern for patients undergoing such treatment.

B) PPIs (Proton Pump Inhibitors)

Explanation: PPIs are often used to manage symptoms of gastrointestinal diseases, and in some cases, symptoms may return, necessitating lifelong therapy.

B) It stimulates new bone formation but has no clinical value

Explanation: While fluoride may stimulate new bone formation, it is not considered clinically valuable, and its primary use is in preventing dental caries.

B) Failure of absorption of nutrients

Explanation: Malabsorption describes the body's inability to absorb nutrients effectively, which can lead to malnutrition if severe.

C) Either morning or evening

Explanation: PPIs have a prolonged action lasting over 24 hours, allowing them to be taken either in the morning or evening for optimal effect.

B) Chlamydia infection

Explanation: The text notes that while Fitz-Hugh–Curtis syndrome was originally described as a complication of gonorrhea infection, chlamydia infection is now a much more common cause.

C) Treatment is not recommended

Explanation: The text states that current guidelines do not recommend treatment of male partners for BV, despite trials showing that treatment does not improve clinical outcomes.

C) It increases guanine monophosphate (GMP), promoting relaxation

Explanation: Sildenafil increases GMP levels, similar to the action of NO, thereby promoting relaxation of the lower oesophageal sphincter.

B) Catecholamines and acetylcholine

Explanation: A sting releases catecholamines from the adrenal gland and acetylcholine from postganglionic parasympathetics, which have an effect on cerebral blood flow.

B) Blood culture

Explanation: Blood culture is recommended as it has a positive detection rate of 50%, while significantly raised agglutination titres can remain for 2 years and are not useful for diagnosing relapses.

C) 5 times more likely

Explanation: Patients with reflux oesophagitis are significantly more likely to develop cancer of the oesophagus, with studies indicating they are approximately 5 times more likely than normal individuals.

B) Antibody levels

Explanation: To ensure safety for healthcare workers, it is important to check antibody levels 1–2 weeks after vaccination, confirming the effectiveness of the vaccine.

C) It is suspended

Explanation: The use of sibutramine has been suspended in Europe, indicating concerns about its safety or efficacy.

B) Via a central catheter

Explanation: Parenteral nutrition is typically administered through a central catheter, although specially formulated mixtures can also be used via a peripheral line.

B) Proteins are absorbed as small peptides and some amino acids

Explanation: Unlike carbohydrates, which are hydrolyzed to monosaccharides, proteins are broken down into small peptides and some amino acids before absorption.

C) Beef

Explanation: Beef is classified as red meat, which is typically darker in color compared to white meat like chicken or turkey.

C) Yes, they require dosage adjustment

Explanation: Proton pump inhibitors should be used with caution in patients with renal impairment, as they may require dosage adjustments to avoid potential adverse effects.

C) They stimulate or inhibit gut motility

Explanation: Sympathetic fibers are distributed along the entire length of the gut and their stimulation or inhibition plays a significant role in various aspects of gut motility, including the production of anxiety symptoms such as diarrhea.

B) Areas of columnar epithelium with intestinal metaplasia

Explanation: Barrett’s oesophagus is defined by the presence of areas of columnar epithelium with intestinal metaplasia in the lower oesophagus, replacing the normal squamous epithelium, often due to chronic gastro-oesophageal reflux.

D) By the presence of occult blood

Explanation: Faecal analysis can help distinguish upper from lower GI bleeding through the detection of occult blood, which may indicate bleeding from the upper GI tract.

C) High sensitivity

Explanation: The PCR test for HSV-1 in CSF is known for its high sensitivity, making it a reliable method for confirming the diagnosis of HSV-1 encephalitis.

B) 10%

Explanation: It is stated that approximately 10% of penicillin-sensitive patients may also exhibit allergies to cephalosporins, indicating a cross-reactivity risk.

A) Yes, they fully agree

Explanation: The authors support the use of wooden or dispersible metal pins in reflex hammers to minimize the risk of infection transmission, such as hepatitis B, from patient to patient.

B) IV penicillin

Explanation: In cases of meningococcal septicaemia, it is critical to administer IV penicillin immediately, as minutes count in this life-threatening condition.

B) To help obese patients lose weight for 6 months

Explanation: Balloon insertion is a temporary measure used for 6 months to assist obese patients in losing weight, distinguishing it from more permanent bariatric surgical options.

B) It is rare but could become substantial

Explanation: Currently, human-to-human transmission of the 2009 H1N1 virus is rare, but there is concern that it could become more substantial with changes in viral antigenicity.

D) Yes, by promoting mucus secretion

Explanation: Antacids can enhance mucosal resistance in the gastric mucosa by promoting the secretion of mucus, which acts as a protective barrier against gastric acid.

B) Gastrointestinal cancers

Explanation: The high incidence of gastrointestinal cancers in some countries has been linked to excessive consumption of smoked fish.

B) Ranitidine

Explanation: While neither drug is recommended in pregnancy unless absolutely essential, ranitidine is considered probably safe compared to other options.

C) It can lead to deficiencies in certain microminerals

Explanation: An imbalance in sodium and potassium can disrupt the absorption and metabolism of microminerals, potentially leading to deficiencies.

E) All of the above

Explanation: Drinking alcohol during the daytime can lead to dehydration, cognitive impairment, potential addiction, and disrupted sleep patterns, making it generally inadvisable.

B) No, it is not recommended

Explanation: Long-term use of PPIs in young patients with mild reflux oesophagitis is not recommended as it may lead to unnecessary side effects and complications without clear evidence of benefit in preventing Barrett’s oesophagus.

B) Degree of immunosuppression

Explanation: The occurrence of herpes simplex is related to the degree of immunosuppression, as severe immunosuppression can lead to co-infections with diseases like tuberculosis and herpes simplex.

B) Phenoxymethylpenicillin 250 mg twice daily

Explanation: Phenoxymethylpenicillin is recommended at a dosage of 250 mg twice daily until the age of 20 or for 5 years after the latest attack to prevent recurrence and further cardiac damage in patients with rheumatic fever.

A) It is a viral infection

Explanation: Herpes simplex is a viral infection that typically does not lead to chronic infections like tuberculosis or typhoid fever, which are caused by bacteria and can persist in the body for extended periods.

B) No, does not nullify the risk

Explanation: Despite aggressive treatment with H2-blockers or proton pump inhibitors, the increased risk of developing oesophageal cancer in patients with reflux oesophagitis is not nullified.

C) Liver

Explanation: Cholesterol is mainly synthesized in the liver, which plays a crucial role in regulating cholesterol levels in the body.

B) Familial hypercholesterolaemia

Explanation: Familial hypercholesterolaemia is characterized by a reduction in the number of LDL receptors, leading to elevated cholesterol levels in the blood.

B) Oral vaccine with inactivated Inaba and Ogawa strains

Explanation: The text states that the oral vaccine containing inactivated Inaba and Ogawa strains is much better than the injectable cholera vaccine, which provides unreliable protection.

C) It is expensive

Explanation: The main problem with Malarone is its expense, which can limit its accessibility for patients needing malaria prevention or treatment.

C) By reducing gastric acid secretion

Explanation: Omeprazole suppresses Helicobacter pylori by reducing gastric acid secretion, creating an environment less favorable for the bacteria to thrive.

B) Yes, for both omeprazole and H2-blockers

Explanation: Both omeprazole and H2-blockers can lead to rebound hyperacidity upon discontinuation, as the body may overcompensate for the reduced acid production.

B) Inhibits digestive processes

Explanation: The sympathetic nervous system primarily inhibits digestive processes, diverting blood flow away from the gastrointestinal tract during stress or 'fight or flight' responses.

B) Due to chronic gastroesophageal reflux disease (GERD)

Explanation: Barrett’s oesophagus develops as a complication of chronic GERD, where the normal squamous cells of the esophagus are replaced by columnar cells due to prolonged exposure to stomach acid.

A) Intestinal juice

Explanation: Melaena occurs when blood is altered by intestinal juices as it passes through the gastrointestinal tract, leading to the characteristic black, tarry stools.

C) Red cells in the urine for infective endocarditis

Explanation: While haematogenous infections generally do not produce positive urine findings, infections like infective endocarditis can lead to the presence of red cells in the urine.

B) No, it is not usually tested

Explanation: Typically, HSV-2 is not tested for in cases of HSV-1 encephalitis, as the focus is primarily on HSV-1 for this specific condition.

B) No, it is not sensitive

Explanation: Rotavirus is a virus and is not sensitive to antibiotics, which are specifically used for bacterial infections.

A) Yes, it can

Explanation: A scorpion bite can indeed be complicated by ischaemic stroke, as the venom may lead to various systemic effects that can impact blood flow and potentially result in a stroke.

C) It depends on individual patient circumstances

Explanation: The decision between ileal resection and long-term medical therapy for localized Crohn’s disease should be based on individual patient circumstances, weighing the pros and cons of each option.

B) Fluid overload leading to heart failure

Explanation: The refeeding syndrome can cause fluid overload, which may lead to heart failure and acute pulmonary edema in severely malnourished patients.

C) It impairs healing and worsens gastro-oesophageal reflux

Explanation: Smoking is known to impair the healing of peptic ulcers and exacerbate gastro-oesophageal reflux, making it crucial for patients with Crohn's disease to quit smoking.

B) By demonstrating microfilariae in the blood

Explanation: The text states that the definitive diagnosis is made by demonstrating microfilariae in the blood, although absence does not exclude the disease.

C) Gastric ulcers are managed with acid suppression, while duodenal ulcers often require lifestyle changes

Explanation: The management of gastric ulcers typically focuses on acid suppression to promote healing, while duodenal ulcers may also involve lifestyle modifications to reduce risk factors.

C) Because HIV is shed into the cervical/vaginal birth canal

Explanation: The text explains that HIV is shed into the cervical/vaginal birth canal, which is why caesarean sections were previously used, but with effective antiretroviral therapy, this is no longer necessary.

C) Yes, but only for specific conditions

Explanation: While auscultation may not be emphasized in all gastrointestinal disorders, it can provide valuable diagnostic information in specific cases, such as detecting succussion splash or bowel sounds.

D) No, unless symptoms develop

Explanation: It is generally not recommended to treat asymptomatic reflux oesophagitis with acid suppression or antireflux measures unless the patient develops symptoms, as the risks may outweigh the benefits.

D) Lyme disease

Explanation: Lyme disease is not a helminth infection; it is caused by a bacterium transmitted by ticks. The other options are all helminth infections.

C) Beef

Explanation: Red meat includes beef and lamb, distinguishing it from white meats like chicken and turkey.

B) Dengue fever

Explanation: Dengue fever is not associated with ticks; it is primarily transmitted by mosquitoes, while the other diseases listed are known to be tick-borne.

C) Higher dietary cholesterol decreases synthesis

Explanation: The body synthesizes less cholesterol when dietary cholesterol intake is high, indicating a compensatory mechanism to maintain cholesterol balance.

D) Hair loss

Explanation: Hair loss is not a gastrointestinal side effect; the other options are commonly reported side effects that may occur frequently but are often tolerated.

B) Do not drink during the daytime

Explanation: The advice to not drink during the daytime helps shorten the time available for drinking, which can assist individuals in keeping their consumption low.

A) Yes, it significantly decreases absorption

Explanation: The combination of aluminium and magnesium hydroxide can decrease the absorption of omeprazole when co-administered, potentially affecting its effectiveness in relieving heartburn.

B) Eradication therapy

Explanation: A patient with a bleeding peptic ulcer, typically caused by Helicobacter pylori, should undergo eradication therapy, which must be confirmed with a breath test or stool antigen test.

B) It promotes relaxation

Explanation: Nitric oxide (NO) promotes relaxation of the lower oesophageal sphincter by acting on non-adrenergic, non-cholinergic (NANC) inhibitory neurons, which counteracts the excitatory signals.

A) Location and consistency

Explanation: A submandibular salivary gland swelling typically presents as a firm, mobile mass located beneath the jaw, while a swelling of a salivary lymph node is usually softer and may be more tender, located in the lymphatic drainage area.

B) Blood culture

Explanation: Blood culture is the correct method for diagnosing meningococcal septicaemia, as it allows for the identification of the bacteria in the bloodstream.

B) No, it increases bleeding risk

Explanation: It is generally not safe to combine aspirin with PPIs in patients with reflux oesophagitis due to the increased risk of gastrointestinal bleeding, necessitating careful consideration and monitoring.

B) Organisms that transmit diseases through soil

Explanation: Soil transmitters are organisms, often parasites or pathogens, that can be transmitted to humans through contaminated soil, emphasizing the role of the environment in disease transmission.

A) Yes, it can remain positive for years

Explanation: In brucellosis, it is possible for the brucella agglutination test to show results greater than 1/160 even years after successful therapy, indicating that antibodies may persist long after the infection has been treated.

B) Molecular mimicry between M proteins and cardiac antigens

Explanation: The cardiac lesions in rheumatic fever are caused by an immunological response due to molecular mimicry between the M proteins of Streptococcus pyogenes and cardiac myosin and laminin.

B) Virus/antibody immune complexes

Explanation: In dengue fever, platelet destruction is caused by virus/antibody immune complexes binding to the platelet surface, along with a direct toxic effect on bone marrow.

B) Treating osteomyelitis

Explanation: Lincomycin is primarily used in the treatment of osteomyelitis because it is concentrated in bone, although it is not available in the UK.

B) A patient who carries the organism without symptoms for months

Explanation: A chronic carrier is defined as a patient who continues to harbor the organism, typically in the gall bladder, for several months after clinical recovery, without showing symptoms.

D) Regular exercise

Explanation: Regular exercise is not a contributing factor to obesity; rather, a lack of exercise, along with increased food intake, contributes to weight gain.

B) The diagnosis may be incorrect

Explanation: The text suggests that the most likely reason for ineffective treatment with metronidazole is that the diagnosis is wrong, possibly indicating another cause of bloody diarrhea, such as inflammatory bowel disease.

C) Yes, antacids decrease the effectiveness of H2-receptor blockers

Explanation: Antacids can decrease the absorption and effectiveness of H2-receptor blockers when taken together, leading to reduced therapeutic effects.

B) No randomized controlled trials exist

Explanation: There are no randomized controlled trials for royal jelly, and its benefits are suspected to be marginal despite being recommended for various uses.

B) To assess bleeding and obstruction

Explanation: Upper gastrointestinal endoscopy is indicated in peptic ulcer disease primarily to assess for complications such as bleeding and obstruction, providing critical diagnostic information.

B) Triple therapy with a proton pump inhibitor and two antibiotics

Explanation: The currently favored regimen for the eradication of Helicobacter pylori is triple therapy, which includes a proton pump inhibitor along with two antibiotics for one week.

B) Yes, it is safe

Explanation: It is considered safe to administer aspirin to a patient already on a PPI, as PPIs are cytoprotective and can help mitigate potential gastrointestinal side effects.

B) Because of obstruction and inflammation

Explanation: Colorectal carcinoma can lead to obstruction and inflammation in the intestines, which may result in symptoms such as diarrhoea and abdominal pain as the body reacts to the tumor's presence.

C) No, it is appropriate

Explanation: The 2 g × 1 metronidazole dose is commonly used for treating bacterial vaginosis and is considered appropriate for many cases, although individual circumstances may vary, especially in women with frequent recurrences.

B) Bats

Explanation: Bats are identified as the likely host species for certain infectious diseases, highlighting their role in the epidemiology of these diseases.

B) Formation of DNA

Explanation: Vitamin B12 is crucial for the formation of DNA, and its deficiency can lead to atrophy in various epithelial cells, including the tongue.

B) Swallowing air

Explanation: Belching is primarily caused by swallowing air, often as a habit, and is not usually associated with any pathological condition.

B) They are responsible for hangovers

Explanation: Congeners, which are produced during the distillation process of spirits, are thought to contribute significantly to hangovers, with certain drinks like port and bourbon having higher congener content than gin and vodka.

C) 35-40

Explanation: Class II Obesity is classified as having a BMI range of 35-40, indicating a moderate level of obesity and associated risk of comorbidities.

C) It depends on the individual

Explanation: The effectiveness of combining sibutramine and orlistat for obesity can vary based on individual responses, making it essential to assess each case separately.

B) It causes inflammation of the tongue

Explanation: Vitamin B12 deficiency can lead to glossitis, which is the inflammation of the tongue, due to its role in maintaining healthy mucous membranes.

B) Blockage of the duct or malignant disease

Explanation: Enlargement of the salivary lymph glands can occur due to infections, malignant diseases, or blockage of the duct, particularly affecting the submandibular gland.

B) No, it is not recommended

Explanation: It is generally not recommended to treat asymptomatic reflux oesophagitis, although some gastroenterologists may choose to treat it to prevent potential long-term complications.

C) Yes, through vegetables and unpasteurized juices

Explanation: Escherichia coli O157 can be spread through various foods, including vegetables and unpasteurized juices, not just meats.

A) Lateral internal sphincterotomy

Explanation: The best surgical technique for a chronic painful anal fissure located sagittally posteriorly is a lateral internal sphincterotomy, which helps relieve pain and promote healing.

E) All of the above

Explanation: Abdominal bloating in IBS patients can be caused by various factors, including excessive fiber intake, food intolerances, stress, and bacterial overgrowth, making it a multifactorial symptom.

B) No, it requires direct contact with blood

Explanation: HIV is not transmitted through food and drinks; it requires direct contact with infected bodily fluids, such as blood, for transmission to occur.

B) Because of bacterial flora disturbance

Explanation: Broad-spectrum antibiotics can disrupt the normal bacterial flora in the large gut that synthesizes vitamin K, leading to deficiency despite the large gut's primary role in absorption being limited to water and salts.

B) By-products of fermentation

Explanation: Congeners are by-products of fermentation found in alcoholic beverages, which can contribute to the flavor and color of the drink, and may also influence hangover severity.

B) Civet cats and other animals

Explanation: The reservoir for SARS includes civet cats, raccoons, ferrets, badgers, and other animals that are sold in markets, indicating a zoonotic transmission.

C) It reduces acid output

Explanation: A highly selective vagotomy reduces acid output, similar to the effect of PPIs, but does not address the underlying issues of gastrointestinal disease.

D) Less than 10%

Explanation: Hypoendemic is defined as having a parasitaemia rate of less than 10%, indicating a low prevalence of the disease in the population.

B) No, there is no evidence

Explanation: There is no known evidence that sodium/potassium imbalance affects microminerals, indicating a lack of interaction.

B) Cysticerci from undercooked pork

Explanation: The text indicates that to get tapeworms, one needs to ingest cysticerci, which are usually obtained from eating undercooked pork.

C) It depends on the individual's health

Explanation: The safety of long-term use of methyltestosterone at 2.5 mg/day can vary based on individual health conditions and should be monitored by a healthcare professional.

B) It strengthens bones and teeth

Explanation: Fluoride plays a crucial role in dental and bone health by enhancing mineralization and making them more resistant to decay.

B) No, there is no indication

Explanation: There is no evidence supporting the long-term use of proton pump inhibitors (PPIs) in patients with mild reflux oesophagitis, as it does not prevent the development of Barrett’s.

B) A disease transmitted from animals to humans

Explanation: Zoonosis refers to diseases that are transmitted from animals to humans, highlighting the interconnection between animal health and human health.

A) Yes, based on symptoms

Explanation: A diagnosis of irritable bowel syndrome (IBS) can be made based on the patient's symptoms without the need for extensive gastrointestinal investigations, especially if there are no alarming signs.

C) They classify the transmission intensity of malaria

Explanation: Holoendemic, mesoendemic, and hyperendemic are terms used to classify the intensity of malaria transmission in a given area, with holoendemic indicating high and stable transmission, mesoendemic indicating moderate transmission, and hyperendemic indicating very high transmission.

D) Clindamycin

Explanation: Clindamycin is often used as an alternative intravenous antibiotic for patients with hypersensitivity to penicillin, providing effective treatment for various infections.

E) All of the above

Explanation: Colonic cancer is more common on the left side due to a combination of dietary factors, anatomical differences, blood supply variations, and stool consistency, which all contribute to the cancer's prevalence in that region.

C) Both diet and endogenous production play significant roles

Explanation: Both dietary intake and endogenous production significantly influence serum cholesterol levels, with each contributing to overall cholesterol balance in the body.

C) Weight of muscles and organs excluding fat

Explanation: Lean body weight refers to the weight of all body components except fat, including muscles, bones, and organs, providing a more accurate measure of body composition than total body weight.

A) Yes, it was withdrawn for safety reasons

Explanation: Cisapride was withdrawn from the market due to safety concerns, particularly the risk of ventricular fibrillation, which posed significant health risks to patients.

A) Yes, it is equally effective

Explanation: Telithromycin has been shown to be as effective as clarithromycin in treating Helicobacter pylori, making it a viable alternative in treatment regimens.

A) Excessive calorie intake after starvation

Explanation: Refeeding syndrome occurs when a person who has been in a state of starvation receives excessive calories, leading to metabolic disturbances and electrolyte imbalances.

E) Yes, it can cause electrolyte imbalances

Explanation: Long-term use of magnesium and aluminium hydroxide salts as antacids can lead to serious electrolyte imbalances, particularly in patients with renal impairment, necessitating caution in their use.

B) Lyme disease and Rocky Mountain spotted fever

Explanation: Tick bites can transmit several diseases, including Lyme disease and Rocky Mountain spotted fever, among others.

C) Yes, but only in certain conditions

Explanation: HIV can be transmitted from mother to child during breastfeeding, particularly if the mother is not on antiretroviral therapy or has a high viral load, making it a risk factor for transmission.

B) Presence of fluid or mass

Explanation: Dullness on percussion in Traub’s area may indicate the presence of fluid or a mass, which could suggest underlying pathology.

C) 4–8 weeks

Explanation: Drug manufacturers typically recommend that PPIs be administered for a duration of 4–8 weeks for the treatment of reflux oesophagitis, rather than for life.

B) No, it is not recommended

Explanation: Performing an intradermal skin sensitivity test is not routinely recommended before administering penicillin or cephalosporins, as it may not accurately predict allergic reactions.

B) No, it has no effect

Explanation: Aciclovir does not prevent the development of herpes zoster (shingles) when given during a primary infection; it is primarily used to treat active infections.

B) Boosts immune function

Explanation: Royal jelly is known for its potential health benefits, including boosting immune function and providing various nutrients that may support overall health.

C) It decreases the titre

Explanation: A suitable antibiotic can decrease the ASO titre, as it helps to clear the streptococcal infection, leading to a reduction in the antibody response.

B) Megaloblastic anaemia

Explanation: One of the common causes of anaemia in patients receiving highly active antiretroviral therapy (HAART) is megaloblastic anaemia, particularly associated with the drug zidovudine.

A) Yes, it is very hazardous

Explanation: Administering aspirin to a patient with a history of haematemesis from a peptic ulcer poses significant risks, as aspirin can exacerbate bleeding and ulceration.

C) Low lower oesophageal sphincter pressure

Explanation: Patients with reflux oesophagitis typically exhibit low lower oesophageal sphincter pressure, which contributes to the permanence of reflux events.

A) Yes, to prevent further fall in platelet count

Explanation: Steroids may have a role in the treatment of dengue haemorrhagic fever, particularly in preventing further decline in platelet count.

B) Bacteraemia refers to bacteria in the blood, while septicaemia refers to the presence of toxins in the blood

Explanation: Bacteraemia indicates the presence of bacteria in the bloodstream, while septicaemia involves the presence of toxins, fungi, or viruses, indicating a more severe systemic infection.

B) Surgeries to treat obesity

Explanation: Bariatric surgical procedures are specifically designed to help individuals with obesity lose weight by altering the digestive system, making them a treatment option for severe obesity.

B) Only when there is significant chloroquine resistance

Explanation: Malarone is specifically recommended for malarial prophylaxis when there is significant chloroquine resistance, as it is more effective in such areas compared to chloroquine.

C) Yes, but only if the baby is asymptomatic

Explanation: The MMR vaccine can be administered to HIV-positive infants if they are asymptomatic and have a certain level of immune function, making it safe under specific conditions.

A) The eggs are not viable

Explanation: Patients who ingest eggs from a tapeworm may not develop tapeworms because the eggs may not be viable or capable of developing into adult tapeworms in the human host.

B) There is no benefit in treating the male partner

Explanation: The 7th edition of Kumar and Clark Clinical Medicine indicates that there is no benefit in treating the male partner of a woman diagnosed with an STI unless there are specific indications or symptoms present.

B) No, it is contraindicated

Explanation: It is generally contraindicated to give aspirin to a patient with a history of bleeding peptic ulcer due to the risk of exacerbating the condition.

A) Yes, they are the first choice

Explanation: Penicillins remain the drug of choice for treating streptococcal infections, including those caused by Strep. Pneumoniae, due to their effectiveness.

A) Mutation in the CCR5 receptor

Explanation: Mutations in the gene expressing the CCR5 receptor may impair the entry of HIV into cells, potentially providing some individuals with resistance to infection.

B) Serological agglutination test

Explanation: The serological agglutination test is the best laboratory test to show relapse in brucellosis, as it can indicate the presence of antibodies against the bacteria.

D) Increased platelet destruction and decreased production

Explanation: Thrombocytopenia in dengue is caused by increased destruction of platelets and decreased production due to bone marrow involvement.

C) A low-carbohydrate diet

Explanation: The Atkin’s diet is primarily known as a low-carbohydrate diet that emphasizes protein and fat intake while restricting carbohydrates, aiming for weight loss and improved health.

B) Chronic carriers can transmit the disease

Explanation: Chronic carriers of typhoid fever can continue to shed the bacteria and transmit the disease, leading to recurrent infections in others.

B) No, it can be given via peripheral veins

Explanation: While intravenous nutrition can be given via a central vein, it is not always necessary, as it can also be administered through peripheral veins depending on the patient's needs.

A) Yes, primarily as amino acids

Explanation: Proteins are mostly absorbed from the intestinal lumen into the blood as amino acids, which are the building blocks of proteins and essential for various bodily functions.

A) Antibiotics such as penicillin

Explanation: The recommended treatment for pulmonary anthrax includes antibiotics, with penicillin being one of the primary choices, especially if administered early.

A) Yes, both are safe

Explanation: Both omeprazole and ranitidine are generally considered safe for use during pregnancy, although consultation with a healthcare provider is recommended.

D) Immune response to streptococcal infection

Explanation: The progression from rheumatic fever to chronic rheumatic heart disease is often due to an inappropriate immune response to the initial streptococcal infection, leading to lasting damage.

B) Glucose-6-phosphate activity

Explanation: A test for glucose-6-phosphate activity should be performed before using primaquine, as this medication can cause haemolysis in patients with G6PD deficiency.

B) No, it is not helpful

Explanation: While a white cell count can indicate infection, it is not definitive for diagnosing appendicitis in children, as other conditions can also elevate white blood cell counts.

B) Bacterial infections

Explanation: Haematogenous infections, particularly bacterial infections, can lead to positive findings in urine, indicating the presence of pathogens in the bloodstream that affect the urinary system.

C) Supportive care and hydration

Explanation: The recommended treatment for dengue fever is supportive care and hydration, as there is no specific antiviral treatment available.

B) Rapid public health response

Explanation: The rapid public health response, including quarantine measures and travel restrictions, played a significant role in preventing the widespread transmission of SARS.

C) Sedentary lifestyles and poor dietary choices

Explanation: The rise in obesity among young people is largely attributed to sedentary lifestyles and poor dietary choices, including increased consumption of high-calorie, low-nutrient foods.

B) Testing for HIV antibodies and considering the window period

Explanation: To prevent transfusion of HIV-infected blood, it is crucial to test for HIV antibodies and consider the window period, during which the virus may not be detectable.

B) G6PD deficiency test

Explanation: Before administering primaquine for the treatment of relapsing malaria, it is essential to test for G6PD deficiency, as the drug can cause hemolytic anemia in individuals with this condition.

B) Increased risk of cancer

Explanation: Eating smoked foods has been associated with an increased risk of cancer due to the presence of harmful chemicals formed during the smoking process.

B) Immune-mediated response

Explanation: Migratory polyarthritis in rheumatic heart disease is primarily due to an immune-mediated response to the streptococcal infection, affecting multiple joints.

B) By blood

Explanation: HIV is primarily transmitted through blood, and while it can be present in other fluids, transmission through those is not common, making blood the main vector for the virus.

E) All of the above

Explanation: Multiple rectal ulcers in a young female can be caused by various conditions, including hemorrhoids, Crohn's disease, and anal fissures, making a comprehensive differential diagnosis necessary.

B) Safety varies by trimester and specific antibiotic

Explanation: The safety of antibiotics during pregnancy can vary depending on the trimester and the specific antibiotic, necessitating careful consideration and consultation with healthcare providers.

B) In the left upper quadrant

Explanation: Traub’s area is located in the left upper quadrant of the abdomen, and its significance is often assessed during physical examinations.

C) Yes, some individuals have genetic resistance

Explanation: Some individuals possess genetic factors that confer resistance to HIV infection, allowing them to remain uninfected despite repeated exposure to the virus.

C) A combination of factors including nutritional deficiencies and infections

Explanation: Anaemia in HIV infection can arise from multiple causes, including nutritional deficiencies, opportunistic infections, and the effects of the virus on bone marrow.

C) Yes, but it is rare

Explanation: While perihepatitis is more commonly associated with chlamydial infections, it can also occur in gonorrhoeal infections, although it is considered a rare complication.

C) 2 weeks

Explanation: It typically takes about 2 weeks after vaccination for an individual to become immunized against chickenpox, making them safe to work in infectious areas.

B) No, it can cause irritation

Explanation: Clopidogrel can cause gastric irritation and is not considered gentle on the stomach, especially in patients with a history of gastrointestinal issues.

A) Metronidazole

Explanation: Metronidazole is typically the first treatment of choice for pseudomembranous colitis, although vancomycin may also be used in certain cases.

B) To prevent HIV transmission to the baby

Explanation: A caesarean section is recommended for HIV-positive women to minimize the risk of HIV transmission to the baby during delivery, as vaginal delivery poses a higher risk of exposure.

B) Treating bacterial infections

Explanation: Lincomycin is primarily used to treat certain bacterial infections, particularly those caused by anaerobic bacteria, and is effective in specific clinical scenarios.

A) Blood culture

Explanation: Blood culture is the single most confirmatory diagnostic test for typhoid fever, as it can detect the presence of Salmonella typhi in the bloodstream.

B) The drugs are ineffective against this organism

Explanation: Ciprofloxacin and metronidazole may not relieve Entamoeba histolytica infections because these medications are not effective against this specific protozoan, which often requires different treatment.

B) Overeating; Antacids

Explanation: Overeating is a common cause of belching, and antacids can be used to alleviate the discomfort associated with excessive gas.

A) Morning, to match meal times

Explanation: Omeprazole is best administered in the morning to coincide with meal times, as it effectively reduces acid secretion during the day when food intake is highest.

B) No, but they increase the risk

Explanation: While antibiotics are not required to contract Clostridium difficile infection, their use significantly increases the risk of developing this infection.

D) 6 months

Explanation: The antistreptolysin-O (ASO) titre can remain positive for up to 6 months after a streptococcal infection, indicating a previous infection.

C) It doubles the risk

Explanation: Breast-feeding is known to double the risk of mother-to-child transmission of HIV infection, highlighting the importance of considering feeding methods in HIV-positive mothers.

D) The mother's blood is contained

Explanation: During a caesarean section, the surgical procedure allows for better containment of the mother's blood, reducing the risk of HIV transmission to the baby compared to vaginal delivery.

B) Bariatric surgery

Explanation: Bariatric surgery is generally considered more effective than a balloon inserted into the stomach for patients with marked obesity, as it leads to more significant and sustained weight loss.

C) Yes, but rarely

Explanation: Human-to-human transmission of the H5N1 avian influenza virus has been described, but it occurs rarely compared to animal-to-human transmission.

A) Yes, definitely

Explanation: A highly selective vagotomy may benefit patients with reflux oesophagitis due to a hiatus hernia who are not responsive to PPIs, as it can reduce acid secretion.

A) They are ineffective against viruses

Explanation: Antibiotics are not effective against viral infections like rotavirus, which is why they are not allowed in the treatment of such diseases.

A) Yes, they are harmful

Explanation: NSAIDs can be harmful to the stomach even when taken parenterally, as they can still lead to gastric irritation and ulceration.

A) Yes, they interact negatively

Explanation: There is a potential drug interaction between NSAIDs and PPIs, as NSAIDs can increase the risk of gastrointestinal bleeding, while PPIs are used to protect the gastric lining.

A) Yes, it can affect multiple organs

Explanation: Ulcerative colitis can indeed cause symptoms outside the large bowel, including mouth ulcers, which can lead to confusion regarding its systemic effects.

B) No, there is no such drug

Explanation: Currently, there is no oral drug specifically designed to prevent penicillin hypersensitivity reactions, making it crucial for patients to avoid penicillin if they have a known allergy.

A) It is more effective than oral vaccines

Explanation: Some recommend parenteral vaccination with a killed suspension of Vibrio cholerae because it may provide a more robust immune response compared to oral vaccines, especially in certain populations.

C) Yes, but only in tropical pulmonary eosinophilia cases

Explanation: There is a basis for treating patients for filariasis according to eosinophil count, particularly in cases of tropical pulmonary eosinophilia, where elevated eosinophil levels can indicate the need for treatment.

A) Higher acid secretion in that area

Explanation: Gastric ulcers are more common along the lesser curve near the pylorus due to higher acid secretion, which can damage the gastric mucosa.

B) Malabsorption is a cause of malnutrition

Explanation: Malabsorption refers to the body's inability to absorb nutrients effectively, which can lead to malnutrition, a condition resulting from inadequate nutrient intake.

B) Long-term antibiotics

Explanation: The World Health Organization recommends long-term antibiotic prophylaxis to prevent rheumatic fever following a streptococcal throat infection.

A) Yes, and it has genetic predispositions

Explanation: Crohn’s disease is considered an autoimmune disease, and while genetics play a significant role, other environmental factors may also contribute to its development.

A) Yes, they have more common side effects

Explanation: Statins are known to have more common side effects, such as muscle pain and digestive issues, in addition to the rare but severe side effect of myositis.

B) No, there are several others

Explanation: MRSA is a significant hospital-acquired infection, but it is not the only major one; there are various other pathogens that can cause hospital-acquired infections.

C) Both

Explanation: Rheumatic fever has both infectious and immunological aetiologies, as it is triggered by a streptococcal infection and involves an immune response.

B) They help to reduce gastric acid secretion

Explanation: PPIs are administered to reduce gastric acid secretion, which can help stabilize the gastrointestinal environment and potentially minimize further bleeding, even if the source is not identified.

C) It often leads to chronic blood loss

Explanation: Carcinoma of the ascending colon typically causes more anaemia due to chronic blood loss, while carcinoma of the descending colon is more likely to cause obstruction features.

B) Yes, alcohol has a proven toxic effect on the brain

Explanation: Research indicates a relationship between alcohol intake and brain disease, with evidence showing that alcohol can have toxic effects on brain health.

B) No, it is ineffective

Explanation: Sulpiride is not considered effective in the treatment of peptic ulcers or GORD, as it does not address the underlying causes of these conditions.

B) 6-38 days

Explanation: The window period for HIV RNA detection in blood-donor screening is now thought to be between 6 and 38 days, which is crucial for understanding the timing of HIV transmission through transfusions.

A) Yes, they can trigger severe reactions

Explanation: For patients with coeliac disease, even small amounts of gluten can be harmful and trigger adverse reactions, as their immune system reacts negatively to gluten.

B) Increased awareness and better diagnostic methods

Explanation: The rising incidence of coeliac disease is often attributed to increased awareness and improved diagnostic techniques, leading to more cases being identified that may have previously gone undiagnosed.

B) It plugs the offending diverticulum

Explanation: An 'instant' barium enema can help arrest persistent bleeding by physically plugging the diverticulum that is causing the bleeding, thus providing a temporary solution.