Decemeber 2018 – MCQs

Rheumatoid arthritis is an autoimmune disorder that is clinically distinguished from osteoarthritis due to presence of morning stiffness that improves with activity.

Respiratory depression is a major concern that limits the use of proper dosing of opioids in terminally ill. Close monitoring for sedation might help as it precedes respiratory depression and hence allow proper pain control. Ref: Jacobsen R et al. Physician-related barriers to cancer pain management with opioid analgesics: A systematic review

Elevated BMI leads to decreased levels of BNP than expected. All other factors such as female sex, elevated creatinine and low albumin lead to elevated levels of BNP

Pseudogout is due to deposition of calcium pyrophosphate dihydrate in tissues. The synovial fluid analysis would show rhomboid crystals with weak positive birefringence under polarized light. Gout will show negative birefringence.

TUG test is for assessing mobility and risk of falling. Involves getting up from a chair, walking 10 feet, turning and returning to the chair. Assess of time and gait instability. If abnormal, should be referred to physical therapy for evaluation and management. Ref: Herman T et al. Timed Up and Go test. Gerontology 2011;57(3):203-210

Delirium can be caused by a number of medications. The question here is asking which medication from the options has the highest risk of causing delirium. Medications with most risk; Anticholinergics, Benzodiazepines, Dopamine agonists, meperidine Medications with low to med risk; Antibiotics, Anticonvulsants, Antidizzines agents, Antiemetics, Antihypertensives, Antivirals, Corticosteroids, Metoclopramide, Narcotics, Tricyclic antidepressants Ref: Kalish, V. B. (2014). Delirium in older persons. AFP, 90, 3rd ser., 150-158.