A 17-year-old girl presents with a 6 week history of nausea and abdominal discomfort. Routine blood tests reveal the following:
What is the most likely diagnosis?
Correct Answer C: Alkaline phosphatase is significantly elevated in pregnancy. This would also explain the borderline anaemia.
Alkaline phosphatase: Causes of raised alkaline phosphatase (ALP):
The table below splits the causes according to the calcium level :
A 36-year-old man is reviewed in clinic. He has recently been started on mesalazine 400mg tds for ulcerative colitis.
Which one of the following adverse effects is least likely to be attributable to mesalazine?
Correct Answer E: Oligospermia is seen in patients taking sulphasalazine due to the sulphapyridine moiety, which is not present in mesalazine.
Aminosalicylate drugs:
5-aminosalicyclic acid (5-ASA) is released in the colon and is not absorbed. It acts locally as an antiinflammatory. The mechanism of action is not fully understood but 5-ASA may inhibit prostaglandin synthesis.
Sulphasalazine:
Mesalazine:
Olsalazine:
*Pancreatitis is 7 times more common in patients taking mesalazine than sulfasalazine
A 45-year-old man is admitted to the Emergency Department with severe abdominal pain. He smokes 20 cigarettes a day and drinks approximately 50 units of alcohol per week. He also complains of sudden deterioration in vision. Fundoscopy reveals shows multiple micro infarcts (cotton wool spots).
Which investigation would best confirm the most likely diagnosis?
Correct Answer C: The cotton wool spots seen on fundoscopy represents Purtscher retinopathy. This condition may be seen following head trauma and in conditions such as acute pancreatitis, fat embolization, amniotic fluid embolization, and vasculitic diseases.
Rare features associated with pancreatitis include:
A 27-year-old female is referred to the medical outpatient clinic due to a long history of fatigue and joint pains. An autoimmune screen is done which is positive for smooth muscle antibodies.
What is the most appropriate next investigation?
Correct Answer A: Smooth muscle antibodies are associated with autoimmune hepatitis. Presentation is usually insidious and extrahepatic clinical features are common.
Autoimmune hepatitis: Autoimmune hepatitis is condition of unknown aetiology which is most commonly seen in young females. Recognized associations include other autoimmune disorders, hypergammaglobulinaemia and HLA B8, DR3.
Three types of
have been characterized according to the types of circulating antibodies present:
Features:
Management:
Which one of the following conditions is least likely to develop following hepatitis B infection?
Correct Answer C: Deterioration in patient with hepatitis B - ? hepatocellular carcinoma.
Hepatitis B:
Hepatitis B is a double-stranded DNA virus and is spread through exposure to infected blood or body fluids, including vertical transmission from mother to child. The incubation period is 6-20 weeks.
Immunization against hepatitis B (please see the Greenbook link for more details):
Complications of hepatitis B infection:
Management of hepatitis B:
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