AKT Questions

1. William is 7 years old. He has taken Sodium Valproate for control of absence seizures since diagnosed at the age of 4 years. He has had no known seizures in the past year, and is otherwise well and coping with school socially and academically. At what point should you consider withdrawing Sodium Valproate?

a ) If he has less than three fits per year.
b ) If he has no nocturnal fits for two years.
c ) When he reaches puberty.
d ) If he remains fit-free for a further year.
e ) When he is considering taking driving

Answer: D

2. A 62 year old man falls down the stairs and sustains a hip fracture. A DEXA scan confirms osteoporosis (Femoral neck T <2.5).>

a ) Alendronate
b ) Alendronate + Calcium + Vitamin D
c ) Calcium + Vitamin D
d ) Raloxiphene + Calcium+Vitamin D
e ) Raloxiphene

Answer: B

Grade A evidence exists for the use of Alendronate, Calcium and vitamin D in the treatment of osteoporosis. Primary or idiopathic osteoporosis is much more common than secondary osteoporosis, and has its onset in the 7th or 8th decade. Secondary osteoporosis should be considered and investigated in younger age groups. An holistic approach should be taken to prevention of falls in the elderly, and before considering pharmacoprophylaxis, it is important to remember alcohol abuse, smoking, and immobility as contributors to osteoporosis.

3. A 22 year old woman presents complaining of diffuse muscle and deep bone pain. She says she is sweating profusely. This has come on suddenly. Observing her, she is yawning constantly and is tremulous and agitated. Her pupils are dilated. She is apyrexial. Her chest is clear. She has a tachycardia. Abdominal examination is normal. Surgery urinalysis is negative. She does not smell of alcohol. She denies any drug misuse. What is the single most likely diagnosis?

a ) Diabetic ketoacidosis
b ) Pelvic inflammatory disease
c ) Urinary tract infection
d ) Hyperthyroidism
e ) Acute opiate withdrawal

Answer: E

Although these are all features of a heightened adrenergic reaction – deep bone pain and yawning are typical of opiate withdrawal. Other symptoms of withdrawal can include dilated pupils, diarrhoea, goose bumps, sweating, agitation and tremor.