Please look up the answer for Q9/7 to Q9/11 under the comments of the respective post.
Q9/12
Greta is aged 69 and has advanced lung cancer. You are called urgently because she has become acutely confused. You note that she appears dehydrated. You order pathology tests and are not surprised to find:
a) Hypokalemia
b) Hyperkalemia
c) Hypocalcemia
d) Hypercalcemia
Q9/13
Marjory L has locally invasive carcinoma of the cervix, which has infiltrated her right femoral nerve. She is experiencing shooting, lancinating pain. Which of the following statements is TRUE?
a) Opioids are contraindicated for this type of pain
b) Anticonvulsants are an appropriate option in this situation
c) A tricyclic antidepressant is the optimal treatment
d) Antiarrhythmics are the drug of choice for this condition
Q9/14
Which of the following statements are consistent with passive immunity? (Select one or more responses)
a) Pre-formed antibodies are injected, and these give immediate but short-term protection.
b) Normal human immunoglobulin (NHIG) is derived from the pooled plasma of blood donors. It contains antibodies to microbial agents which are prevalent in the general population.
c) The protection from passive immunity is transient as the half-life of antibodies is between 3 and 4 weeks.
d) Passive immunity, through specific immunoglobulins, is available to protect individuals against specific microbial agents such as cytomegalovirus (CMV), respiratory syncytial virus (RSV), hepatitis B, rabies and varicella-zoster viruses, plus tetanus and diphtheria toxins.
Q9/15
Vaccine efficacy is a measure of the level of protection against a disease in people who have been vaccinated compared with the attack rate in people who have not been vaccinated. A vaccine efficacy of 100% indicates perfect protection, 0% indicates no protective effect. There are many controlled trials and field studies to show the efficacy of vaccines.
How effective are most vaccinations at preventing disease?
a) 100%. Everyone is protected from a disease by every immunisation.
b) At least 85 - 95% of people are protected from a disease by most immunisations.
c) Approximately 50% of people are protected from a disease by immunisation.
d) Approximately 15% of people are protected from a disease by immunisation, that is why we need so many injections.
Q9/16
If a vaccine requires a course of doses (e.g. adult hepatitis b), and a patient misses a vaccine dose, do you have to start the schedule again?
a) Yes, vaccines will only work if they are given strictly according to the dose schedule.
b) No, generally the immune response memory is preserved and the course can be continued from where it was interrupted.
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6 comments:
12) A
13) B
14) a
15) B
16) A
12 d
13 b
14 a,b
15 b
16 b
12. D
13. C
14 A, B
15 B
16.B
q9/12 D
Q9/13 B
Q9/14 B
Q9/15 B
Q9/16 B
12) The correct answer is
(d). Hypercalcemia
Hypercalcemia is a common feature accompanying advanced lung cancer. It causes confusion, dehydration and constipation.
13) b) Anticonvulsants
This form of pain is called neuropathic pain. It is commonly relatively resistant to treatment with opioids alone, although there is usually at least some response. This pain usually requires agents that modify the rate of transmission of painful stimuli. The preferred first line agents are anticonvulsants such as gabapentin or pregabalin (rather than the older agents such as carbamazepine). Antiarrhythmics such as lidocaine and mexiletine are also effective, but not considered the drug of choice.
Alternatively, agents that alter the way the brain perceives stimuli can be used - examples are tricyclic antidepressants (TCA) and serotonin/norepinephrine reuptake inhibitors (SNRI eg venlafaxine and duloxetine). Sedation can be a problem with TCA so it is not an optimal treatment.
Recent studies suggest that the combination of gabapentin and morphine give more effective analgesia than either drug used alone. There is also evidence of good results using the SNRI duloxetine.
14) all correct
a) Pre-formed antibodies are injected, and these give immediate but short-term protection.
b) Normal human immunoglobulin (NHIG) is derived from the pooled plasma of blood donors. It contains antibodies to microbial agents which are prevalent in the general population.
c) The protection from passive immunity is transient as the half-life of antibodies is between 3 and 4 weeks.
d) Passive immunity, through specific immunoglobulins, is available to protect individuals against specific microbial agents such as cytomegalovirus (CMV), respiratory syncytial virus (RSV), hepatitis B, rabies and varicella-zoster viruses, plus tetanus and diphtheria toxins.
15 b) At least 85 - 95% of people are protected from a disease by most immunisations.
Even when all the doses of a vaccine have been given, not everyone is protected against the disease. Increasingly vaccines are more effective, providing protection to more than 95% of people who have completed the course. Some vaccines (such as Varicella vaccine as a single dose in childhood) are less effective at preventing the disease, but may reduce the severity of the disease in nearly all of the people who receive a complete vaccination course.
16) The correct answer is No.
Although it is best to get all immunisations on time to obtain the best possible protection at the ages that patient is most susceptible - if a patient has fallen behind, there is no need to repeat the doses already received. In fact sometimes they will receive fewer doses as they are in an older age-group (e.g. Hib or childhood Pneumococcal vaccines). The patient or parent/guardian should be informed that the immune response may be somewhat less in some people, if the vaccine course has been significantly delayed.
9/12 answer is D. Explanation is no good. The right explanation is because lung ca will cause hyperparathyroidism as part of the paraneoplastic syndrome
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