Dr. Muhammad Khalid Saiful

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About Dr. Muhammad Khalid Saiful

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    Advanced Member

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  • Full Name
    Dr. Muhammad Khalid Saifullah

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  • Medical School/College of Graduation
    Chittagong Medical college
  • Speciality
    Family Medicine
  1. D. Implaantable defibrillator. [to protect from sudden death].
  2. D. Laparotomy. [Likely an injury to spleen or liver, if hemodynamically stable we should go for CT abdomen and pelvis but in unstable patient we should not do CT].
  3. E. Left lateral medulla. [This is lateral medullary syndrome or Wallenberg syndrome. Right or left is decided by sensory loss which is contralateral to the lesion (here right arm and leg). So the left lateral medulla is affected].
  4. Already mentioned that hyponatremia and hyperkalemia suggest prerenal azotemia where renal function will be impaired. Can you explain please why you suggest liver function test?
  5. Answer is A. Renal function test. Hyponatremia and hyperkalemia points towards prerenal azotemia from renal under perfusion secondary to dehydration.
  6. C. Potassium level. [diuretics causes lowering of potassium and sodium level. But in terms of adding digoxin answer will be C. potassium level. Explanation: Digoxin toxicity is worsened in states of hypokalemia (low potassium) since digoxin normally binds to the ATPase pump on the same site as potassium.
  7. 82. A 45-year-old man comes to see you recent as his recent blood tests have shown a total cholesterol of 6.2 mmol/L. You ask him to come in so that you can discuss this further. You calculate his Q-risk score to be 23%. He smokes 10 cigarettes a day and has been smoking for the past 20 years. His father died of a heart attack aged 50. His past medical history includes asthma. Which one of the following medications would you ask him to start? a) Atorvastatin 20mg b) Atorvastatin 40mg c) Atorvastatin 80mg d) Simvastatin 10mg e) Simvastatin 20mg Ans. A. Atorvastatin 20mg. Atorvastatin 20mg is a high-intensity statin and should be started as primary prevention against cardiovascular disease. Atorvastatin 80mg is used in secondary prevention. Simvastatin 10mg and 20mg are low-intensity statins. Statin treatment should be combined with lifestyle measures such as increased physical activity, reduction of alcohol intake and adoption of a cardio-protective diet. 83. A newly qualified staff nurse at the local hospital undergoes vaccination against hepatitis B. The following results are obtained three months after completion of the primary course: Anti-HBs 10 - 100 mIU/ml What is the most appropriate course of action? a) Repeat course (i.e. 3 doses) of hepatitis B vaccine b) Repeat anti-HBs level in three months time c) Give a course of hepatitis B immune globulin (HBIG) + one further dose of hepatitis B vaccine d) Give one further dose of hepatitis B vaccine e) Do a HIV test Ans. D. Give one further dose of hepatitis B vaccine. Anti-HBs level (mIU/ml) Response > 100 Indicates adequate response, no further testing required. Should still receive booster at 5 years 10 – 100 Suboptimal response - one additional vaccine dose should be given. If immunocompetent no further testing is required < 10 Non-responder. Test for current or past infection. Give further vaccine course (i.e. 3 doses again) with testing following. If still fails to respond then HBIG would be required for protection if exposed to the virus X 84. A 66-year-old woman reports that during the past 6 months she has had several episodes of a sharp, shooting 'electric shock' like pain on the left side of her face, which occur when she is combing her hair. Given the likely diagnosis which one of the following treatments should be initiated? a) Sodium valproate b) Gabapentin c) Amitriptyline d) Carbamazepine e) Diazepam Ans. D. Carbamazepine. This woman has symptoms typical of trigeminal neuralgia. The first line treatment for this is carbamazepine, which should be started at 100 mg twice daily and slowly titrated up until pain is relieved. X 88. A 24-year-old female comes for review. She was diagnosed with asthma two years ago and is currently using a salbutamol inhaler 100mcg prn combined with beclometasone dipropionate inhaler 200mcg bd. Despite this her asthma is not well controlled. On examination her chest is clear and she has a good inhaler technique. What is the most appropriate next step in management? a) Increase beclometasone dipropionate to 400mcg bd b) Switch steroid to fluticasone propionate c) Trial of leukotriene receptor antagonist d) Add salmeterol e) Add tiotropium Ans. D. Add salmeterol The British Thoracic Society recommend adding a long-acting B2 agonist if there is an inadequate response to the addition of inhaled steroid. The inhaled steroid dose should be increased if there is an inadequate response to the long-acting B2 agonist. X 89. A 72-year-old presents to the surgery complaining of dizziness. An ECG is taken and shows the following: What is the diagnosis? a) Ventricular tachycardia b) Second degree heart block - Mobitz type 2 c) First degree heart block d) Second degree heart block - Mobitz type 1 e) Third degree heart block Ans. E. Third degree heart block. Note how the P waves are not related to the QRS complexes in the ECG - this is the hallmark of third degree (complete) heart block. The QRS complexes represent a ventricular escape rhythm which characteristically has a rate of 35 - 40 bpm. X 90. A 69-year-old man with metastatic prostate cancer presents with worsening pain. He currently takes morphine sulphate 60mg bd but it is decided to convert this to subcutaneous administration as he is frequently vomiting. What is the most appropriate dose of morphine to give over a 24 hour period using a continuous subcutaneous infusion? a) 20mg b) 30mg c) 40mg d) 60mg e) 120mg Ans. D. 60mg. The BNF recommend half the oral dose of morphine in this situation: The equivalent parenteral dose of morphine (subcutaneous, intramuscular, or intravenous) is about half of the oral dose. If the patient becomes unable to swallow, generally morphine is administered as a continuous subcutaneous infusion 91. A 62-year-old female with a history of mitral regurgitation attends her dentist, who intends to perform dental polishing. She is known to be penicillin allergic. What prophylaxis against infective endocarditis should be given? a) Oral doxycycline b) Oral erythromycin c) No antibiotic prophylaxis needed d) Oral ofloxacin e) Oral clindamycin Ans. C. No antibiotic prophyaxis needed. The 2008 NICE guidelines have fundamentally changed the approach to infective endocarditis prophylaxis. 92. Henry, 29, goes to his GP with extensive yellow crusting lesions on his face. The GP correctly diagnoses impetigo and feels that it is severe enough to warrant oral flucloxacillin treatment. Henry also has chronic back pain for which he takes daily NSAIDs. Henry starts passing small volumes of dark urine. What is the likely cause? a) Nephritic syndrome b) Nephrotic syndrome c) Post-streptococcal glomerulonephritis d) Adverse reaction to flucloxacillin e) Interstitial nephritis secondary to anti-inflammatory medication Ans. C. Post-streptococcal glomerulonephritis. The patient in this scenario has post-streptococcal glomerulonephritis. The GP in this scenario correctly diagnosed impetigo in this patient. Impetigo is most commonly caused by either Staphylococcus aureus or Streptococcus pyogenes. Streptococcal infections, most commonly of the skin or pharynx, can result in a condition known as post-streptococcal glomerulonephritis. The exact mechanism is unclear, but it is believed to be a type III hypersensitivity reaction, wherein immune complexes become lodged in the glomerular basement membrane and compliment activation results in destruction of this membrane. 93. A patient who is known to be a heroin user is found collapsed in the waiting room. He is blue around the lips, has a pulse of 60 / min and is taking only occasional breaths. Oxygen is given. What is the most appropriate next step? a) Give a fluid bolus b) Perform an ECG c) Intravenous flumazenil d) Intravenous naloxone e) Intramuscular benzylpenicillin Ans. D. Intravenous naloxone. This patient has respiratory depression secondary to a heroin overdose. Emergency management of opioid overdose: IV or IM naloxone: has a rapid onset and relatively short duration of action 94. A 66-year-old man comes to see you following the results of his 24-hour ambulatory blood pressure monitoring. His average blood pressure was 160/90mmHg, therefore you talk to him about starting antihypertensive treatment. Which one of the following facts about hypertension is true? a) An automatic blood pressure machine may not measure blood pressure accurately if the patient has an irregular pulse b) Blood pressure is higher at night in normotensive people c) Ambulatory blood pressure is considered abnormal if average daytime ABPM > 120/80mmHg d) Ambulatory blood pressure monitoring requires a minimum of 6 readings e) Blood pressure usually increases in the 2nd trimester of pregnancy Ans. A. An automatic blood pressure machine may not measure blood pressure accurately if the patient has an irregular pulse. When measuring blood pressure in people who have an irregular pulse it is important to remember that an automatic blood pressure machine may not measure blood pressure accurately and therefore a manual sphygmomanometer should be used. Blood pressure is lower at night in normotensive people. An ambulatory blood pressure monitoring (ABPM) is considered abnormal if average daytime ABPM is 135/85mmHg. This is based on a minimum of 14 readings.
  8. 1. A 22-year-old man presents with a three week history of diarrhoea. He says his bowels have not been right for the past few months and he frequently has to run to the toilet. These symptoms had seemed to be improving up until three weeks ago. For the past week he has also been passing some blood in the stool and reports the feeling of incomplete evacuation after going. He has lost no weight and has a good appetite. Examination of his abdomen demonstrates mild tenderness in the left lower quadrant but no guarding. What is the most likely diagnosis? a) Diverticulitis b) Colorectal cancer c) Crohn's disease d) Ulcerative colitis e) Infective diarrhea Ans. D. Ulcerative colitis. Ulcerative colitis (UC) is a form of inflammatory bowel disease. Inflammation always starts at rectum (hence it is the most common site for UC), never spreads beyond ileocaecal valve and is continuous. The peak incidence of ulcerative colitis is in people aged 15-25 years and in those aged 55-65 years. The initial presentation is usually following insidious and intermittent symptoms. Features include: • bloody diarrhoea • urgency • tenesmus • abdominal pain, particularly in the left lower quadrant 2. A 35-year-old woman has been advised to come and see you by her dentist. Ten days ago she had a tooth extraction but unfortunately bled profusely post-procedure, necessitating transfer to the local maxillofacial unit for suturing. She reports no history of bleeding previously and is otherwise well. What is the most likely diagnosis? a) Von Willebrand's disease b) Factor V Leiden c) Factor IX deficiency d) Haemophilia e) Antiphospholipid syndrome Ans. A. Von Willebrand’s disease. Not much is given away by this history but it is important to pick up on prolonged bleeding following dental extraction. The most likely diagnosis when considering this patient is von Willebrand's disease which is an autosomal dominant condition and is one of the commonest bleeding disorders. Most cases are mild, with bleeding after only mild injury, particularly mucosal membrane injuries. The condition is due to a reduction or structural abnormality of von Willebrand's factor, which has the dual role of promoting normal platelet function and stabilising coagulation factor VIII. von Willebrand's disease can give normal results on screening tests, and diagnosis may require specialist investigation and assay of von Willebrand Factor . Most patients with mild disease respond to desmopressin (DDAVP), but clotting factor concentrates are needed for a minority.
  9. Version 1.0.0

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    1700 files explained by Dr. Khalid Saifullah (Question 1 to question 1707) Updated as on 27 Jan 17
  10. In this patient heart rate is 90/min. So rate control is controversial though rate control is preferred in >65yrs of age. So we can think for rhythm control amiodarone or flecainide can be used. As amiodarone has significant side effects I shall think for use of Flecainide. [To tell the truth i'm not sure of this questions answer]!
  11. If long acting reversible contraceptive is preferred by patient then IUCD, If not then COCP [Assuming there is no other complaints other than heart failure]!
  12. According to NICE, cut offs for iron supplements: at booking (8-10 weeks)- if less than 11 at 28 weeks and further- if less than 10.5 if less than these values=> give iron So for this patient option D. None is correct! Rattling means obviously hearable. As suction didn't help it is unlikely bronchial or oropharyngeal secretion for which Hyoscine is sometimes effective! It may be some clogged bronchial secretion which may get some benefit from Normal saline 0.9% nebulization. Likely answer is A. Normal saline 0.9% nebulizers. As no ischemia and syncopal attack from VT best option to keep this elderly patient from risk of sudden death is D. Implantable defibrillator.
  13. Welcome doctor!