Cardiac Glycoside Eliminated By Liver

Answer: a-Digitoxin

Digitoxin is metabolized and eliminated by the liver whereas Digoxin is eliminated by the kidneys, so Digitoxin can be used with erratic or impaired renal function.

Bile Acid Sequestrant

Answer: c-Colestyramine

Bile acid sequestrants are a group of resins which prevents certain components of bile acids to be absorbed in the gastrointestinal tract and prevents their enterohepatic circulation.

Treatment of Crohn's Disease

Answer: b and d

Anti-inflammatory drugs are a preferred choice in crohn’s disease, both Prednisone and Budesonide are used in crohn’s disease.

H2 Receptor Antagonist

Answer: c-Nifedipine

Nifedipine is a dihydropyridine calcium channel blocker which is used to treat high blood pressure, angina, Raynaud’s phenomenon and premature labor.

Anti-Foaming Agent In Flatulence

Answer: e-Simethicone

Simethicone is silicone based antifoam which is used to relieve pressure and pain caused by the gas bubbles in the stomach and intestines. It can be used in infants, children and adults.

Warfarin interaction

Answer: c- Vitamin E

Taking Vitamin E along with Warfarin, an anticoagulating medicine increases the chances of bruising and bleeding.

Antimalarial Agent Use In Rheumatoid Arthritis

Answer: b 

Hydrochloroquine is used in the prevention and treatment of certain types of Malaria specifically to chloroquine sensitive Malaria and is used orally. The other uses of Hydrochloroquine are in rheumatoid arthritis, lupus and porphyria cutanea tarda.

5HT1 Agonist In Migraine

Answer: c

Zolmitriptan is used in the treatment of acute migraine headaches with or without aura and cluster headaches. It works as serotonin receptor agonist at 1B and 1D receptor subtypes.

Adenosine Receptor Antagonist

Answer: c

Theophylline binds non-selectively to phosphodiesterase enzyme, inhibits it and increases cAMP levels, activates PKA, inhibits TNF α, inhibits leukotriene synthesis thus reduces inflammation and innate immunity.

Theophylline also binds non-selectively to adenosine receptors acting as adenosine antagonist at A1, A2 and A3 receptors almost equally and thus produces cardiac effects.

Hormone from Posterior Pituitary

Answer: c

Oxytocin is a peptide hormone produced by the hypothalamus and is released by posterior pituitary.

Treatment of CMV Retinitis In AIDS

Answer: e

Foscarnet is used as second line treatment to Ganciclovir and in conditions where there is resistance to Ganciclovir. It has more toxic effects to kidneys, cause seizures due to mineral and electrolytes imbalance.

Paracetamol Poisoning

Answer: e

N-Acetylcysteine (NAC) is used to replenish the stores of antioxidant glutathione in case of accidental overdose of Paracetamol. Cysteamine and Methionine can also be used in paracetamol overdose but it is associated with more adverse effects than Acetylcysteine.

Theory Behind Hormonal Treatments

The hypothalamus causes the pulsed release of gonadotropin releasing hormone (GnRh), which in turn affects the anterior pituitary to produce follicle stimulating hormone and Luteinizing hormone which causes ovaries to produce and release estrogens and progesterone. The end result is to reduce the amount of estrogen that is made or block its action in endometrial cells.

Treatment Aims/Options Of Endometriosis

The aim of treatment is to improve fertility, remove pain and heavy bleeding, remove or reduce the size of endometrial deposits.

The treatment can be by hormonal replacements or by surgery. Surgical treatment by laparoscopic ablation and adhesiolysis can improve fertility. Hormonal treatments is not preferred if fertility problems persists because it may cause ovarian suppression. Surgical removal of endometrial deposits by abdominal hysterectomy, salpingo-oophorectomy or both is conducted when family is complete and fertility is not an issue or all other means of treatments are not applicable. Endometriosis can recur in some women receiving HRT even with bilateral salpingo-oophorectomy.

Diagnosis of Endometriosis

It is diagnosed visually by laparoscopy. MRI can show endometriotic cysts, but not minor lesions. Diagnosis is made around the age of 40. It has genetic inheritance to first, second and third degree relatives. Diagnosis is made when infertility is the issue rather than pain as prevalence. A severe pain at diagnosis is indicative of advanced stage of endometriosis.

Signs and Symptoms of Endometriosis

Presentation varies, it is often cyclic and pain occurs during menstruation, but with time pain is acyclic, pain can occur anytime until the women is pregnant or she is at menopause. Endometriosis is diagnosed when conducting tests for infertility. Women may have advanced lesions with tissue damage and adhesions and are symptomatic.