(Test Bank) Clinical Medicine-Saunders Ltd

Kumar,Clark, 2

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Test Bank

2nd Edition

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Test Bank for Clinical Medicine-Saunders Ltd, The downloadable file consists of 323 pages, and the total size of the file is 9.86 MB. Purchase now only for highly discounted price.

Author(s): Kumar, Clark

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1000 Questions & Answers from clinical medicine For Elsevier Commissioning Editor : Ellen Green/Pauline Graham Development Editor: Clive Hewat Project Manager: Kerrie-Anne JarvisDesigner: George AjayiIllustration Manager: Merlyn HarveyProfessor Parveen J Kumar CBE BSc MD FRCP FRCP (Edin) Professor of Medicine and Education, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, and Honorary Consultant Physician and Gastroenterologist, Barts and The London NHS Trust and the Homerton Hospital NHS Foundation Trust, London, UK Dr Michael L Clark MD FRCP Honorary Senior Lecturer, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK Consultant Physician and Gastroenterologist, Princess Grace Hospital, London1000 Questions & Answers Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2011from Clinical Medicine SECOND EDITION © 2011, Elsevier Limited. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the Publishers. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department, 1600 John F. Kennedy Boulevard, Suite 1800, Philadelphia, PA 19103-2899, USA: phone: (/H110011) 215 239 3804; fax: (/H110011) 215 239 3805; or, e-mail: healthpermissions@elsevier.com. You may also complete your request on-line via the Elsevier homepage(http://www.elsevier.com), by selecting ‘Support and contact’ and then ‘Copyright and Permission’. First published 2008 Second edition published 2011 ISBN: 978-0-7020-4436-6British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Notice Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Authors assumes any liability for any injury and/or damage to persons or property arising out or related to any use of the material contained in this book. The Publisher Printed in China The Publisher’s policy is to use paper manufactured from sustainable forestsvContents Acknowledgements vi Preface vii 1 Ethics and communication 1 2 Molecular cell biology and genetic disorders 5 3 Clinical immunology 9 4 Infectious diseases, tropical medicine and sexually transmitted infection 13 5 Nutrition 27 6 Gastrointestinal disease 33 7 Liver, biliary tract and pancreatic disease 48 8 Haematological disease 65 9 Malignant disease 79 10 Rheumatology and bone disease 85 11 Renal disease 102 12 Water, electrolytes and acid-base balance 114 13 Cardiovascular disease 120 14 Respiratory disease 156 15 Intensive care medicine 173 16 Drug therapy and poisoning 177 17 Environmental medicine 185 18 Endocrine disease 187 19 Diabetes mellitus and other disorders of metabolism 198 20 The special senses 216 21 Neurological disease 221 22 Psychological medicine 273 23 Skin disease 286 Index 293viAcknowledgements We would like to thank everyone who has helped in the preparation of this book – especially Ellen Green, who originally commissioned the book from the source questions and answers on the Clinical Medicine website, and other Elsevier staff – Pauline Graham, Clive Hewat, Kerrie-Anne Jarvis, George Ajayi, and Caroline Cockrell. We are also grateful to Ms Jillian Linton, and Sue Beasley who helped prepare the manuscript, and to the copy-editor Eleanor Flood.viiThis book is a compilation of questions, which you, the readers of Clinical Medicine, have sent to us. In this second edition we have replaced some of the older questions with more relevant and up-to-date ones. We have also increased the number of questions in each chapter. We have tried to keep the book as authentic as possible by inserting questions as you have phrased them. It is therefore not a complete coverage of all that is in Clinical Medicine. A number of your questions were quite penetrating and raised issues that were quite unusual. These were quite a challenge to answer! We are told that readers have found the book useful in answering the many intriguing questions that are presented to us by patients every day. We would like to thank all the authors of Clinical Medicine who, with their hard work in producing coherent chapters, made this book possible. The answers to your questions were mainly gleaned from these chapters in Clinical Medicine. We would also like to thank all of you who have sent in questions; these are always extremely helpful in making changes to new editions of Clinical Medicine. Please continue to send in your questions and also your interesting comments to us. We find them all extremely valuable. We hope you find this book helpful and of interest. PJK MLCPrefaceThis page intentionally left blankQUESTIONS Question 1 Regarding medical ethics, if a man is discovered to be hepatitis B or C positive, is it advisable for the physician to inform the wife or sexual contact of the patient? Question 2 Is it unlawful in most countries to limit medical care, particularly by rationing the usage of drugs? Surely rationing must be against the oath we took as doctors to provide the best care available. Question 3 What is meant by QALYs? Is there a difference between quality and quantity of life? Question 4 Are ‘Do not resuscitate’ orders illegal in most countries? Question 5 What is a living will? Question 6 I’ve heard of the Bolam principle but when I mentioned it to my lecturer I was told it was out of date. Could you explain please? Question 7 Why is counselling required before an HIV test can be done on a patient? We don’t counsel patients when we look for a tumour marker to diagnose cancer, which is often more serious for a patient. 11 Ethics and communicationEthics and communication1 2Question 8 As a junior doctor, I have to attend many multidisciplinary team meetings. I am concerned about the confidentiality of these meetings as they are attended by a diverse group of healthcare workers. Question 9 Is the role of the advocate in a medical interview to help the patient or the doctor? Question 10 We are always asked by our seniors to make sure that the patient has signed the consent form. Isn’t verbal consent enough? Also, for what procedures do I have to get consent, e.g. urinary catheterization in a patient with retention?Ethics and communication 1 3ANSWERS Answer 1 No. The doctor can only give confidential information to the patient. One would expect, however, that the doctor would counsel the patient, giving advice on his sexual behaviour and safe sex. The patient would hopefully discuss the results with his partner. Answer 2 In all healthcare systems, rationing has become inevitable, partly because of the high costs of modern therapies. To be in line with good medical practice, doctors must acknowledge the obligation that, if rationing is unavoidable, it should be carried out in a responsible and justifiable way. Answer 3 QALYs are Quality Adjusted Life Years. These were developed to place a measurable value to the quality and quantity of life. They were used to try and assess the value of different health measures. More recently, the value of ‘quantity’ over quality has been re-emphasized, i.e. a long life of diminished quality could be as worthwhile as a short life of high quality. Answer 4 It is accepted in most countries that ‘futile’ treatment should not be offered. However, all decisions must be made by senior medical staff after discussion with a patient (if competent), other members of the team and family/carers (if the patient lacks mental capacity). Answer 5 This is a written advanced directive made by competent persons prior to incapacitation, when they would be unable to express their wishes for treatment, resuscitation and terminal care, e.g. to refuse tube feeding if they were to become unconscious from a stroke. Answer 6 Following the Bolam case (Bolam v. Friern Hospital Management Committee 1957), a doctor is not guilty of negligence if he or she has acted in accordance with a practice that is accepted as proper by a responsible body of medical personnel skilled in that particular art. More recently, it was held that for a judge to rely on the opinion of a medical expert, the judge has to be satisfied that the expert’s opinion has a logical basis (Bolitho v. City and Hackney Health Authority 1997). This means that judges can now reach their own conclusions.Ethics and communication1 4Further reading Kumar P, Clark M (2009) Clinical Medicine, 7th edn. Edinburgh, Elsevier Saunders, pp. 1–17. Schwartz L et al. (2002) Medical Ethics. Edinburgh, WB Saunders. Answer 7 In the early days of HIV, AIDS was an inevitably fatal condition. It was therefore thought wise to obtain permission and counsel the patient prior to the test. Highly active antiretroviral therapy (HAART) has changed this but counselling is still thought necessary. Your second point is very valid but opinions might change. Answer 8 Your patients must always be informed about the meeting. It should be emphasized that modern medicine involves people from many disciplines. It must be made clear to patients that their confidentiality will be preserved within the team. Reference Fleissig A et al. (2006) Multidiscplinary teams in cancer care. Lancet Oncology 7: 935–943. Answer 9 Both! However, an advocate represents the values, interests and desires of patients and speaks on their behalf. She or he protects their rights, helps with consent, protects patients’ autonomy and ensures that they receive their fair share of resources. From a doctor’s point of view, it is nice to have someone who can interpret patients’ needs. Answer 10 The law in the UK is clear: touching a patient without prior permission is assault or battery. It is therefore essential that the consent (with an explanation of what will be done) is clearly written down and signed. In view of this, really every procedure should have a written consent. However, the Courts will accept the concept of implied consent for minor procedures, such as venepuncture. The example you give is in a grey area and, if in doubt, always get written consent. Further reading Federation of Royal College of Physicians of the UK (FRCP) (2004) Good Medical Practice for Physicians. London, FRCP. General Medical Council (GMC) (2006) Good Medical Practice. London, GMC.QUESTIONS Question 1 As cells grow and regenerate, what mechanism does the body use to get rid of the continuously dying cells? And what kind of cells can’t be replaced once dead? Question 2 I cannot find out why some of the autosomal dominant diseases have a male or female preponderance, e.g. I have never seen a female Marfans. I was attributing it to imprinting but on reading about imprinting in detail it cannot be the case. Question 3 We have been told that some tumours in the colon are associated with microsatellite instability. What does this mean? Question 4 I understand that microarrays are being used to define the molecular abnormality and the prognosis in some patients with leukaemia. What are microarrays? Question 5 Why do mitochondrial diseases cause a myopathy? Question 6 Why do successive generations of patients with some genetic disorders present earlier and with progressively worse symptoms. 52Molecular cell biology and genetic disordersMolecular cell biology and genetic disorders2 6Question 7 Does a normal serum uric acid level exclude the diagnosis of Lesch–Nyhan syndrome? Question 8 How is retinoblastoma an autosomal dominant disease if the mutation of both RB genes is required to express the disease?