Internal medicine review

Which one of the following is not caused by cortisol in the stress response?

1-Anti-inflammatory effects

2-Hypoglycaemia

3-Skeletal muscle protein breakdown

4-Stimulation of lipolysis

5-Mineralocorticoid effect

36-year-old man is brought to the emergency department with new-onset confusion and lethargy. An arterial blood gas reveals findings consistent with an increased anion gap metabolic acidosis. An underlying cause is established, and appropriate treatment is instituted. Within several hours, the patient's mental status improves significantly.

Repeat laboratory studies show an increase in serum bicarbonate and sodium level, a decrease in serum osmolarity, and a drop in serum potassium level.

What treatment was most likely given to this patient?

1-Insulin and normal saline
2-Loop diuretics
3-Mineralocorticoid injection
4-Naloxone
5-Thyroxin therapy

A 65-year-old man with a history of atrial fibrillation has been experiencing irregular heartbeats and his doctor is concerned about the risk of stroke. After discussing various treatment options, they decide to start him on dabigatran to help prevent thromboembolic events.

What is the mechanism of action?

1-Activation of antithrombin
2-Antagonism of vitamin K
3-Direct inhibition of thrombin
4-Inhibition of factor Xa
5-Inhibition of platelet aggregation

An 82-year-old woman presents to your GP surgery complaining of a hoarse voice for the past 2 months. She can't remember if she had a viral infection to begin with and she has tried over the counter remedies with no effect. What would your management be?

1-Tell her it is probably viral and to come back in 3 weeks

2-Red flag referral to ENT

3-Routine referral to ENT

4-Explain that as this has been going on for 8 weeks her voice is unlikely to come back

5-Prescribe some antibiotics and ask her to come back in 3 weeks

A 45-year-old women presents to the emergency department complaining of a high fever and pain around the flank area. She also mentions that she has had mild stinging while passing urine for the last 5 days, but she hasn't passed much urine since she developed a fever yesterday. She has a history of diabetes mellitus type II which has been poorly controlled.

Given the most likely diagnosis, which of the following structures is most at risk of co-infection?

1) Liver

2) Spleen

3) Transverse colon

4) Peritoneum

5) Psoas muscle

A 64-year-old woman presents to the outpatient department with complaints of facial flushing, chronic diarrhoea and difficulty breathing for the last 2 months. You review her previous workup, which includes her biopsy reports that reveal a neuroendocrine tumour. Due to her frail condition, the multidisciplinary team decided that surgery would not be possible. Instead, treatment with octreotide, which is a synthetic version of the hormone somatostatin, is advised.

What cells produce this hormone in normal physiology?

A)D cells of the pancreas and stomach
B)G cells of the stomach
C)I cells of the upper small intestine
D)Parietal cells of the stomach
E)S cells of the upper small intestine

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