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Over 2, questions for the Clinical Problem Solving paper and Professional Dilemma questions of both types. Take a demo Sign up Medical student years Our new Years resource is aimed at students in the early years of medical school. Based around our powerful Knowledge tutor technology it drills into you key facts relating to the clinical sciences. Many of the questions include images, ECGs and x-rays. Please use the buttons below to find out more Take a look More Am I on track to pass? How do I compare to others?

On further questioning it transpires she has primary amenorrhoea. She is also of relatively short stature compared to her sisters.

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Females with an extra X chromosome XXX Phenoxybenzamine is a powerful a -receptor antagonist used in the presurgical management of phaeochromocytoma. Atenolol is a cardioselective b-receptor antagonist, but still has some b2-antagonism and is therefore contraindicated in asthma.

Nebivolol has a vasodilating action in addition to b-blocking effects and may be associated with a lower incidence of erectile dysfunction compared with other b-blocking agents.

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Salbutamol is a b2-agonist used in the treatment of asthma. Agonists potentiate the physiological effects of certain receptors, whereas antagonists block those effects. Another example of antagonism Dr.

Competitive antagonists bind to the site of action for the endogenous receptor ligand and can be displaced, eg prazosin , whereas non-competitive antagonists eg phenoxybenzamine cannot be displaced or have their effects diminished by an endogenous receptor ligand. A partial agonist eg acebutolol may exhibit strong receptor-binding activity, but a limited physiological response.

She sought your opinion because her other physician was recommending iron supplementation iv.

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She has been on nearly continuous iron supplementation therapy ever since her second child was born 23 years ago. Over the years she says her doctors have prescribed her to take anywhere from one to three pills daily, sometimes with vitamin C concomitantly. Although she has never needed a transfusion, she says she has been told that her RBC count has never completely normalized. She is otherwise healthy and has no unusual dietary habits. Her menstrual history reveals relatively normal menstrual periods until about 3 years ago, when she attained menopause.

The patient believes that her mother was also iron deficient. Your physical exam is normal. Laboratory values show a haemoglobin of Deletion of two a-genes results in mild to moderate microcytosis and mild anaemia, rarely with any progression or development of other signs or symptoms.

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It is typically associated with hypothyroidism although there may be a transient thyrotoxicosis in the acute phase. It is 10 times more common in women Features features of hypothyroidism goitre: firm, non-tender anti-thyroid peroxidase and also anti-Tg antibodies 15 Dr.

She is well and clinical examination is unremarkable. A normal clinical examination makes a diagnosis of Cushing's syndrome less likely Primary hyperaldosteronism Primary hyperaldosteronism was previously thought to be most commonly caused by an adrenal adenoma, termed Conn's syndrome.

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Differentiating between the two is important as this determines treatment. Adrenal carcinoma is an extremely rare cause of primary hyperaldosteronism Features hypertension hypokalaemia e. Despite weight loss and therapy with metformin and gliclazide his last HbA1c is 7.

Which one of the following factors would suggest that the patient may benefit from a meglitinide? We suggest reviewing this using the link provided. She undergoes a sigmoidoscopy. A rectal biopsy shows pigment-laden macrophages in the lamina propria.

What is the most likely cause? The pigment laden macrophages suggest that there is melanosis coli. The most common association is with laxatives.

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Venesection is recommended when the serum ferritin reading is over ? Venesection can restore hypothalamic-pituitary-gonadal and can reduce liver fibrosis.

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He also gives a history of episodes of flushing. VIP syndrome is considered by the admitting physician. Which one of the following is a feature of VIPoma syndrome? Melanosis coli 1- Hypoglycaemia 2- Hypokalaemia [ Q: 4 ] MRCPass - Gastroenterology 3- Induction of VIP release by somatostatin A 40 year old man has symptoms of lethargy, joint pains and jaundice which have occurred over the past 8 months.

Four years later he became diabetic and was referred to our hospital clinic. He was noted to be pigmented. Haemochromatosis was confirmed by an iron saturation of What is the recommended management?

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However, venesection is preferred therapy and desferrioxamine infusion another iron chelator can also be used. Initial treatment is directed toward correcting volume and electrolyte abnormalities by using potassium chloride and sodium bicarbonate.

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He complains of fever, rigors and headache. His abdomen was tender in right upper quadrant. Investigations showed: Hb He has lost 2. Which of the following investigations would be of diagnostic value?