You review a 29-year-old woman who is recovering from a fracture of the right olecranon. Since the fracture she has noticed that the little finger on her right hand is numb.
Which nerve is likely to have been damaged?
Correct Answer A: Ulnar nerve:
Overview:
Motor to:
Sensory to:
Patterns of damage:
Damage at wrist:
Damage at elbow:
Which one of the following is responsible for the activation of aciclovir?
Correct Answer E:
Thymidine kinase phosphorylates aciclovir which then inhibits viral DNA polymerase.
Antiviral agents:
Aciclovir:
Ribavirin:
Interferons:
Amantadine:
Anti-retroviral agent used in HIV:
1- Nucleoside analogue reverse transcriptase inhibitors (NRTI):
2- Protease inhibitors (PI):
3- Non-nucleoside reverse transcriptase inhibitors (NNRTI):
A study looks at adding a new antiplatelet drug in addition to aspirin to patients who've had a stroke. One hundred and seventy patients are enrolled for the study with 120 receiving the new drug in addition to aspirin and the remainder receiving just aspirin. After 5 years 18 people who received the new drug had a further stroke compared to 10 people who just received aspirin.
What is the number needed to treat?
Correct Answer D:
NNT = 1 / Absolute Risk Reduction
Numbers needed to treat and absolute risk reduction:
Numbers needed to treat (NNT) is a measure that indicates how many patients would require an intervention to reduce the expected number of outcomes by one.
It is calculated by 1/(Absolute risk reduction) and is rounded to the next highest whole number.
Experimental event rate (EER) = (Number who had particular outcome with the intervention) / (Total number who had the intervention)
Control event rate (CER) = (Number who had particular outcome with the control/ (Total number who had the control)
Absolute risk reduction = CER-EER or EER-CER?
The absolute risk reduction (ARR) may be calculated by finding the absolute difference between the control event rate (CER) and the experimental event rate (EER). You will often find both versions of the above listed in different sources. In some ways in doesn't matter which you use as you will end up with the same answer but from a technical point of view:
*This may be more accurately termed absolute benefit increase, rather than absolute risk reduction.
A 68-year-old man is admitted with haematemesis. A gastroscopy performed as an inpatient shows a carcinoma which is confirmed on biopsy.
Who is the most appropriate person to inform the patient of the diagnosis?
One of the key aims of the entrance exam is to assess a doctors ability to act in a compassionate and empathetic way. Many of you may recall incidences of patients being told about a cancer diagnosis in inappropriate circumstances.
The most appropriate person to inform the patient is the consultant in this scenario. He/she is currently in charge of their care and will be best placed to answer questions about management and prognosis. The F2 doctor will be less able to do this but will at least be known to the patient.
The doctor who performed the gastroscopy is unlikely to know the patient apart from their brief meeting prior to the procedure. Asking the GP to tell the patient is a 'cop-out' on a number of levels. Firstly the patient may feel that the hospital team 'could not be bothered' to tell him themselves. Secondly it results in an unnecessary delay and thirdly the GP may not be best placed to give information on management and prognosis.
Telling the next-of-kin is the worst option as it breaks confidentiality.
A 90-year-old man is admitted to hospital. He is taking no regular medication. On admission his blood pressure is 170/68 mmHg.
Which one of the following is the main factor which accounts for the large pulse pressure?
Correct Answer C:
Cardiovascular physiology: Left ventricular ejection fraction:
Pulse pressure:
Factors which increase pulse pressure:
Click to expand