Question 1501 of 2943 A 47-year-old woman presents with non-specific malaise and nausea. A routine ECG shows inverted T-waves and her serum electrolytes reveal hypokalaemia. Hypokalaemia can result from which of the following? Single best answer - select one answer only A Acute tubular necrosis B Addison's disease D Pseudo-obstruction — — Ramipril Explanation Addison's disease is caused by adrenal insufficiency causing inadequate aldosterone and hence hyperkalaemia may result. Captopril (an ACE inhibitor) and spironolactone (an aldosterone antagonist) may cause hyperkalaemia. In Conn syndrome, there is excessive production of aldosterone which causes sodium retention and potassium loss. In diabetes insipidus, there is haemconcentration, owing to water loss from insufficient ADH (or reduced response to ADH). Excessive loss of potassium-rich secretions by a villous adenoma can lead to hypokalaemia. Acute tubular necrosis is a cause of acute renal failure and would result in hyperkalaemia.Question 1502 of 294 ‘A swab result from one of your patients shows a gram positive aerobic coccus, which is coagulase negative. Which of the following is the most likely organism? Single best answer question - choose ONE true option only A Staphylococcus aureus B Streptococcus viridans D Streptococcus faecalis — — Enterococcus faecalis Explanation Staphylococcus and streptococcus are both aerobic gram positive cocci, enterococcus faecalis is anaerobic. The presence of the coagulase enzyme is a test to subdivide the staph micro-organisms. Staphylococcus aureus is coagulase positive. Haemolytic groupings are used for Streptococcus.Question 1503 of 2943 Theme: Peripheral nerve injury A Sciatic nerve B Radial nerve C Ulnar nerve D Erb’s palsy E Median nerve F Axillary nerve G Thoracodorsal nerve H Common peroneal nerve For each of the patients below select the most appropriate option from the list above. Each ‘option may be used once, more than once, or not at all. Scenario 1 A 25-year-old man presenting to A&E having been hit from the side in an RTA. On examination you note that he has left foot drop and bruising on his left knee. oN aU Ne Roc cas rec aae Se cene aa © The common peroneal nerve is often injured where it winds around the fibula neck, particularly when a person is hit from the side by a car bumper. Other nerves in the region lie deep and are more protected by muscles. Scenario 2 A 26-year-old construction worker presenting having sustained a severe blow and laceration to the medial aspect of his right forearm just distal to the medial epicondyle. He is complaining of sensation loss along the medial aspect of the affected hand to include the fourth and fifth digits. The patient is also complaining of difficulty forming a strong grip with his right hand. oN aU Ne Roc cas Caen ans © The ulnar nerve lying medial inthe forearm is most likely to be severed in this position Because the median and radial nerves lie more lateral in the forearm they are in anatomical advantage in this scenario.