Q.No 2 - Anaphylactic Shock Treatment

• IM delivers faster and more reliable absorption than subcutaneous
• IV adrenaline is reserved for cardiac arrest or refractory cases under close monitoring, as it carries risk of fatal arrhythmias
• Hydrocortisone and antihistamines are adjuncts, NOT life-saving agents
• IV glucose saline has no role as primary treatment

Q.No 3 - Prolonged Paralysis After Succinylcholine

• Repeated doses were given throughout a long procedure
• Atypical or deficient pseudocholinesterase = failure to hydrolyze succinylcholine rapidly
• Result: persistent depolarizing block that mimics a non-depolarizing pattern on monitoring (Phase II block can develop with repeated doses, but the PRIMARY mechanism here is enzyme deficiency)
• The NMB monitor showing a "non-depolarizing pattern" is consistent with Phase II block from repeated succinylcholine, but the root cause is pseudocholinesterase deficiency

Note on option "Development of Phase II block": This is also plausible - repeated succinylcholine can cause Phase II block. However, the question asks for the mechanism responsible for prolonged paralysis in a patient who fails to recover - pseudocholinesterase deficiency is the more fundamental explanation and the classic pharmacology answer.

Q.No 4 - Nocturnal Enuresis Treatment with Tricyclic Antidepressant

• Anticholinergic effect on bladder (reduces detrusor overactivity)
• Possible central effect on sleep arousal
• Alpha-adrenergic effect increasing bladder outlet resistance
• Dose: 25-50 mg at bedtime

Q.No 5 - Drug Holiday in Parkinson's Disease

• Serious risks include: neuroleptic malignant-like syndrome, aspiration pneumonia, deep vein thrombosis, severe immobility, and even death
• It is NOT routinely recommended, is NOT the first-line for wearing-off (dose adjustments, adjuncts like MAO-B inhibitors are preferred), and does NOT safely prevent dyskinesia without hospitalization
• Requires hospitalization and close monitoring when performed

Q.No 6 - Anaemia in Chronic Kidney Disease

• EPO is the primary hormone driving red cell production in the bone marrow
• As GFR falls, EPO production drops progressively
• Iron deficiency can co-exist but causes microcytic anaemia
• Intrinsic factor deficiency causes megaloblastic (macrocytic) anaemia (B12/folate)
• Vitamin B12 deficiency also causes macrocytic anaemia

Q.No 7 - Antiarrhythmic for Acute AV Nodal Tachycardia

⚠️ The image shows Quinidine highlighted green, but this is the wrong answer.

• Adenosine is the drug of choice for acute paroxysmal supraventricular tachycardia (PSVT) including AV nodal reentrant tachycardia (AVNRT) - the most common cause of paroxysmal rapid heart rate in a 16-year-old girl
• Adenosine transiently blocks AV nodal conduction, interrupting the reentrant circuit
• Onset within seconds, half-life ~10 seconds - extremely safe
• Tintinalli's Emergency Medicine: Adenosine for AV nodal-dependent SVT is standard therapy

• Quinidine is a Class IA antiarrhythmic used for atrial flutter/fibrillation, not first-line for acute AVNRT
• It has serious toxicity (cinchonism, QT prolongation, torsades de pointes)

• Amiodarone: reserved for refractory/complex arrhythmias
• Propranolol: can be used for chronic prevention, not first-line acute termination

Summary Table