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A 50-year-old man had a mechanical aortic-valve replacement for severe aortic stenosis,
and was discharged home 10 days later. Two weeks later, he started feeling unwell and had
lethargy, nausea and pyrexia of 38.3 C. Echocardiography showed vegetations on the
aortic valve. Which of the following is the most likely causative organism?
A. Enterococci
B. Group D streptococci
C. Haemophilus influenzae
D. Staphylococcus epidermidis Correct Answer
E. Streptococcus viridans
Qn.2
Members of the viridans group of streptococci are the commonest cause of subacute
endocarditis on native valves. These commensals of the upper respiratory tract may enter
the bloodstream on chewing, tooth brushing or at the time of dental treatment.
Staphylococcus aureus is a common cause of acute endocarditis originating from skin
infections, abscesses, vascular access sites or intravenous drug misuse. Staphylococcus
epidermidis is the most common organism causing postoperative endocarditis following
cardiac surgery.
Qn.3
A. Hydralazine
B. Labetolol
C. Methyldopa Correct Answer
D. Nifedipine
E. Ramipril
Although any of the options from A to D can be used in pre-eclampsia, the drug of choice
still is methyldopa, because of its long and reliable track record. So, in most centres,
hydralazine, labetolol and nifedipine are mainly used as second-line drugs. ACE inhibitors
are contraindicated in pregnancy because they can cause oligohydramnios, renal failure
and intrauterine death.
Qn.4
Carotid sinus baroreceptors consist of sensory nerve endings located in the internal carotid
artery just above the bifurcation of the common carotid artery. Cardioinhibitory carotid
sinus hypersensitivity is defined as cardiac asystole of > 3 s. The pure vasodepressor type
is defined as a systolic blood pressure drop of > 50 mmHg (in the absence of significant
bradycardia). A mixed type consists of a combination of cardioinhibitory and vasodepressor
responses. As AV block can occur during the periods of hypersensitive carotid reflex, some
form of ventricular pacing, with or without atrial pacing, is generally required. The
mechanism responsible for carotid sinus hypersensitivity is unknown, but possibilities
include a high level of resting vagal tone, hyperresponsiveness to acetylcholine or an
excessive release of acetylcholine.
Qn.5
A. Type I hyperlipoproteinaemia
B. Type II hyperlipoproteinaemia
C. Type III hyperlipoproteinaemia Correct Answer
D. Type IV hyperlipoproteinaemia
E. Type V hyperlipoproteinaemia