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A ten year old boy gives history of swelling of body starting from face and more on getting up in the morning cheap rocaltrol 0.25mcg on line medications at 8 weeks pregnant. On examination his blood pressure is normal order 0.25 mcg rocaltrol overnight delivery medicine you can order online, pallor is absent and jugular venous pressure is not raised buy rocaltrol line treatment definition statistics. Key: e Ref: Nephrotic Syndrome (Page 480) Davidson’s Principles and Practice of Medicine purchase rocaltrol 0.25mcg with mastercard medicine zalim lotion. A young girl comes in the cardiology ward with history of breathlessness and palpitations for last one year. After auscultation of precordium cardiology registrar makes diagnosis of mitral stenosis. The most important sign on which this diagnosis is based is: a) Ejection systolic murmur. Key: b Ref: Mitral Stenosis (Page 619) Davidson’s Principles and Practice of Medicine. Key: a Ref: Rheumatic Fever (Page 618) Davidson’s Principles and Practice of Medicine. An old lady presents with history of fever and left sided chest pain for one month. Examination of respiratory system shows decreased chest movements, stony dull percussion note and absent breath sounds on left side. Key: d Ref: Clinical Exam of Respiratory System (Page 649) Davidson’s Principles and Practice of Medicine. A forty year old woman gives history of fever for last three weeks accompanied by dry cough, night sweats and weight loss. Key: a Ref: Tuberculosis (Page 696) Davidson’s Principles and Practice of Medicine. A young girl complains of nocturnal cough and shortness of breath which disturbs her sleep. Key: c Ref: Bronchial Asthma (Page 673) Davidson’s Principles and Practice of Medicine. A fifteen year old girl presents with history of fever, bleeding from gums and pallor for last fifteen days. Key: a Ref: Acute Leukemia (Page 1040) Davidson’s Principles and Practice of Medicine. Which of the following drugs is used in the treatment of hyperkalemia in acute renal failure: a) Amiloride. Key: d Ref: Treatment of Hyperkalemia, Acute Renal Failure Davidson’s Principles and Practice of Medicine. For the patient with history of fever, headache and neck stiffness, the most important investigation is: a) Cerebrospinal fluid examination. Key: a Ref: Meningitis (Page 1224) Davidson’s Principles and Practice of Medicine. The most common risk factor for chronic obstructive pulmonary disease is: a) Air pollution. Key: e Ref: Chronic Obstructive, Pulmonary Disease (Page 678) Davidson’s Principles and Practice of Medicine. Key: a Ref: Cushing’s Syndrome (Page 779) Davidson’s Principles and Practice of Medicine. In a young boy with hypertension, examination of cardiovascular system reveals radio-femoral delay. The most likely cause of hypertension in this patient is: a) Coarctation of aorta. Key: a Ref: Coarctation of the Aorta (Page 637) Davidson’s Principles and Practice of Medicine. The gait of a patient with cog-wheel rigidity and pill rolling tremors is likely to be: a) Drunken. Key: e Ref: Parkinsonism (Page 1218) Davidson’s Principles and Practice of Medicine. An old patient presented in emergency ward with history of weakness of right side of body of rapid onset. The most helpful first line investigation for management of this patient is: a) Cerebral angiography. Key: c Ref: Cerebrovascular Disease (Page 1200) Davidson’s Principles and Practice of Medicine. In a patient of thalessemia peripheral blood film for red cell morphology shows: a) Hypochromic microcytic cells. Key: a Ref: Thalessemia (Page 1038) Davidson’s Principles and Practice of Medicine. Key: b Ref: Pyogenic Liver Abcess (Page 986) Davidson’s Principles and Practice of Medicine. Key: d Ref: Cerebrovascular Disease (Fig: 26:34, Page 1209) Davidson’s Principles and Practice of Medicine. A forty year old man gives history of high grade fever for last one week associated with cough productive of rusty sputum. The anti diabetic agent of choice for a fifty year old obese lady with mild hyperglycemia is: a) Chlorpropamide. Key: d Ref: Oral Anti-Diabetic Drugs (Page 831) Davidson’s Principles and Practice of Medicine. Which of the following characteristic suggests a benign structure of esophagus: a) Anaemia. Key: c Ref: Benign Esophageal Structure (Page 880), Carcinoma of Esophagus (Page 882) Davidson’s Principles and Practice of Medicine. A thirty five year old man presents with history of low grade fever and cough for last three months. Which of the following feature on chest X-ray suggests this diagnosis: a) Cavitation. Key: a Ref: Pulmonary tuberculosis (Page 695) Davidson’s Principles and Practice of Medicine. In a patient with history of shortness of breath, which of the following sign indicates left heart failure: a) Ascites. Key: b Ref: Heart Failure (Page 545) Davidson’s Principles and Practice of Medicine. A fifty year old man is admitted in emergency ward with acute myocardial infarction. Key: d Ref: Myocardial Infarction (Page 595) Davidson’s Principles and Practice of Medicine. A fifty year old smoker presents with history of cough productive of mucoid sputum in every winter for last three years.

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Both physicians and nurses who work on well-functioning Introduction teams report improved work satisfaction buy rocaltrol line medicine klonopin, less burnout purchase rocaltrol 0.25mcg with mastercard symptoms, im- The culture of health care has changed over the past few proved morale proven 0.25mcg rocaltrol medications descriptions, increased motivation and reduced confict purchase rocaltrol 0.25mcg fast delivery medicine glossary. Well-functioning teams have great professional relationships and good communication with con- potential in delivering excellent patient care and improving sultants and other members of the multidisciplinary team, as patient safety. Poorly functioning teams, particularly those one of the most signifcant factors in improving the resilience with communication problems, can present signifcant risks of physicians. The ability to establish collegial relationships with members of the health care team is essential. Given the many benefts of collegiality, it is important to ad- Physicians must not only work with other health professionals dress potential barriers to good working relationships. Bulgar in a collegial fashion but must also establish good relation- and Bulgar highlight problems that subspecialists encounter in ships with clinicians and faculty members in other specialties. For their part, family phy- Collegiality enables academic interchange and collaboration at sicians frequently point to disparaging comments made about the level of the individual case, in the development of new them by specialist colleagues. We forget that it is impossible if techniques for medical care, and in research activities, improv- not futile to expect one physician to acquire a good working ing outcomes in all of these spheres. It can also be diffcult to be respectful of others when service demands are high, time is short, and we are fatigued from being on call. We accept differences, take risks, function indepen- are often ignorant of the knowledge and skill in other disciplines dently, articulate roles, and tolerate reviews and because we are not educated or trained together. In an exploration of professional relationships • Take the lead in fostering the idea that we are between nurses and physicians, Zelek and Phillips found that all in this together. Smith argue that while assertive nurses resent being put down by doctors, physicians resent being challenged by nurses. Summary Improving interprofessional collegiality Health care has rapidly evolved and is now delivered by teams It is only common sense that treating others with respect will of professionals. Physicians for whom this is a shift in their ac- improve relationships and improve team communication and customed practise style will beneft from refecting on the role effectiveness. Achieving this, however, can be more com- they have with a team of fellow health practitioners. Thus, the development of collegial relationships team and with other specialties fuctuated on the bases of six with team members not only improves care to patients, but key catalysts: authority, education, patient needs, knowledge, also improves the health and satisfaction of all members of resources and time. The perception of ownership: this can include perceived After the resident speaks to the fellow about the situation, ownership of specialized knowledge, technical skills, the fellow offers to speak to the nurse on her behalf. The equipment, clinical territory and even the patient himself resident wanted to deal with this herself so waited until or herself. For example, a nurse described her frustration she and the nurse were alone and raised the issue with the when residents rely on her assessment but when presenting nurse. The resident told the nurse she was surprised and at rounds make it sound as if they have done the assess- angry when her request was ignored and was concerned ment themselves. Trade can be in concrete haviour but did say she saw the resident as “one of them” physical commodities such as equipment and beds, but it and “not as a physician to take charge in an emergency. When they get respect they exchange it for information, knowledge, The resident begins to question her friendliness with the resources and goodwill. Failure to give respect can be met nursing staff and wondered if she needed to set herself with revenge strategies in the form of an embargo of apart from them but decided that she would keep talking trade. Although many sources call for clear policies and procedures so that roles on the team are clear, there are also more subtle Key references rules of the game that will never appear in a manual. The rules resident stated it like this: “Your name can be ruined or made of the game: interprofessional collaboration on the intensive on one encounter—you have to be very careful, because if you care unit team. The hierarchical model of care that was ac- The doctor whose patient is a physician faces particular chal- cepted in the past is outmoded in today’s patient-centred health lenges. The fundamental principles of the Canadian naturally relate to the patient as a peer, as well as in the role of Medical Association’s Code of Ethics emphasize that the doctor. The patient may be a close colleague, such as a clinician physician is to “[f]irst consider the well-being of the patient” in the department. They may be a distant acquaintance, but one and to “[p]ractice the profession of medicine in a manner who sits on the same board meetings or on the same hospital that treats the patient with dignity and as a person worthy of medical advisory committee. Patients are active participants in their care; they value These possibilities can threaten the treating physician’s ability to autonomy, ready access to information, and participation in be objective. It is important also to appreciate that the that they have a superior knowledge base to rely on when inter- contemporary physician–patient relationship is fduciary in acting with the patient. The following observations take self-doubt, can lead to inadequate care in the form of a poor, each of these features in turn. The physician is responsible for creating an environ- ment of mutual respect and trust. By creating a safe environ- Further, this dual relationship can induce an unspoken expec- ment and earning trust, physicians will enjoy a collaborative tation that special treatment will be provided. Reviewing key tenets sional courtesy has existed within medicine since the time of of informed consent, appropriately sharing information and Hippocrates. This phrase refers to the provision of care to decisions, and inviting patients to share their perspectives and physician colleagues before other patients and/or, in jurisdic- beliefs will promote quality care. Although not an ethical requirement, this practise was established as a means of Privacy. Confdentiality and privacy are critical to the practice assisting those within the profession to access care and sustain of medicine. Professional courtesy does not include treatment of confdentiality and privacy, physicians facilitate the develop- that changes the nature and manner in which the care is pro- ment of a healthy relationship with their patients. This includes for example changes such as providing appointments outside of regular clinic hours or making home Power. The power differential between physician and patient is visits when not warranted. Physicians have extensive knowledge, the The treating physician in this scenario must ensure that they authority to diagnose and treat, and the responsibility to make provide the same high standard of care to the physician patient diffcult recommendations and interventions. This means not letting ful of this power differential and doing all that is reasonable one’s guard down by, for example, allowing physician patients to facilitate patient autonomy, physicians promote a healthy to write their own prescriptions, change the dose of their relationship with their patients. In addition, the treating physician should not assume that the doctor patient is aware of the typical medical management of their condition and thus be less than diligent in obtaining informed consent. A loss of objectivity can threaten viewpoint can lead physicians to negate their own need for the care provided; challenging situations such as communicat- health care, even for periodic monitoring. It is essential that ing bad news, addressing issues of substance use and abuse, or all medical students, residents and practising physicians be identifying concerns regarding compliance with treatment can encouraged to establish a relationship with a family physician become too diffcult to negotiate. This con- nection to a family physician can provide a valuable support Being a physician to physicians requires the capacity to moni- in dealing with the stresses of a medical career and facilitate tor one’s own emotional reactions. In addition, maintaining an open ap- Summary proach to discussing roles and expectations will be benefcial Being a physician in need of care, or being a physician who for both parties. Finally, as with all patients, it is important, with is asked to provide care to another physician, can be diff- the patient’s consent, to involve the patient’s spouse or partner cult scenarios for those involved. Spouses who are not physicians already physician must provide patient-centred care. Physicians must feel isolated when their physician partner is ill, given their lack be caring, listen carefully and communicate clearly, facilitate of medical knowledge.

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