Dr. Akinbami Flashcards
ALOPECIA:
a. Total loss of scalp hair called
b. Partial loss of scalp hair called
c. Total body hair loss called
a. ALOPECIA TOTALIS
b. ALOPECIA AREATA
c. ALOPECIA UNIVERSALIS
Scarring alopecia denotes ____ loss
Irreversible Loss
maybe signs of systemic diseases
Treatment of Alopecia (hint: 2)
Treatment difficult
Topical/intralesional steroid
Minoxidil
Which of the Herpes simplex strain is sexually transmitted and causes genital lesions
HSV-2
Prickle cell layer of the epidermis is stratum ______
Stratum spinosum
Skin distribution of Psoriasis is on the symmetrical flexural areas, T/F
FALSE
On the symmetrical extensor area
Skin distribution of Atopic dermatitis is on the asymmetric flexural area, T/F
FALSE
On the Symmetrical flexural areas
What surgical treatment is used for tattoo removal
Dermabrasion
Topical treatment has no systemic toxicity, T/F
FALSE
Reduced systemic toxicity.
Choice of vehicle for local application is as important as choice of the active ingredient, T/F
TRUE
Greases reduce moisture loss while many lotions do the reverse.
Circumscribed flat area of skin discoloration <0.5cm is a _______
Macule
Solid elevation of the skin <5mm is _____
Papule
Solid elevation of the skin exceeding 1cm in diameter is _____
Nodule
Associate the primary skin lesion with the disease condition
a. Lepromatous leprosy
b. Keloids
c. Acne
d. Neurofibromatosis
e. Onchocerciasis
f. Urticaria
g. Herpes simplex
h. Herpes zooster
a. Nodule
b. Plaque
c. Papule
d. Nodule
e. Nodule
f. Wheal
g. Vesicle
h. Vesicle
Pus containing dermal elevation <5mm is _____
Pustle
Nodule filled with compressible fluid or semisolid material is______
Cyst
Associate the secondary skin lesion with the disease condition
a. Seborrheic dermatitis
b. Impetigo
c. Infected dermatitis
d. Psoriasis
e. Onchocerciasis
f. Scabies
a. Scales
b. Crust/scabs
c. Crust/scabs
d. Scales
e. Excoriations
f. Excoriations
In keloids, inflammatory reactions and fibroblasts are much fewer than in scars, T/F
TRUE
Common in pruritic diseases that can present with excoriation are (hint: 5)
Uremia
Scabeis
Urticaria
Obstructive jaundice
onchocerciasis
Mention hypopigmented (hypomelanosis) lesions (hint: 4)
PITYRIASIS ALBA
TINEA VERSICOLOR
SEBORRHEIC DERMATITIS
LEPROSY
Mention Depigmented (Amelanosis) lesions (hint: 5)
ALBINISM
PIEBALDISM
VITILIGO
ONCHOCERCA DERMATITIS
POST BURNS
Mention hyperpigmented (hypermelanosis) lesions (hint: 7)
NAEVI
CAFÉ AU LAIT SPOTS
ECZEMA
MELASMA (CHLOASMA)
FIXED DRUG ERUPTION
LENTIGOS
MALIGNANT MELANOMA
Classic warning signs of skin malignancy are (hint: ABCDE)
A Asymmetry
B Border irregularity
C Colour (Non-uniform-brown, red, black, white)
D Diameter (>6mm)
E Evolving over time
Malignant melanoma is common in dark people, T/F
FALSE
Rare in dark people
Malignant melanoma is related to exposure to sunlight, T/F
TRUE
The 4 types of malignant melanoma recognized are
- Lentigo maligna melanoma
- Superficial spreading melanomas
- Nodular melanoma
- Acral lentiginous melanoma
The form of Malignant melanoma that occurs in black people is
Acral lentiginous melanoma
Treatment of Malignant melanoma (hint: 3)
Wide excision
Nodal dissection
Chemotherapy
Can Chemotherapy be used to treat Malignant melanoma, T/F
TRUE
Seborrheic dermatitis is synonymous to Eczema, T/F
TRUE
Treatment for Seborrheic dermatitis (hint: 3)
Treatment with selenium sulphide or ketoconazole shampoo and 1% hydrocortizone cream
What test do you carry out in a suspected contact dermatitis
Patch test
Patch test may help in identifying offending agent
Lesions of contact dermatitis can never spread, T/F
FALSE
Lesion tends to conform to sites of contact initially but may later spread
Acne affects more females than males, T/F
FALSE
Mention causes of Acne (hint: 5)
PCOS
Cushing’s syndrome
Virilising tumours
Metabolic steroids
Acne vulgaris
Peak age for Acne vulgaris is _____
18
Drug Eruption Types (hint: 6)
1.Maculo-papular/exanthematous.
2. Urticaria +- angioedema/anaphylaxis
3. Exfoliative dermatitis (sulphonamides, carbamazepines)
4. Erythema multiforme major (Steven-Johnson Syndrome)
5. Toxic Epidermal Necrolysis
6. Fixed Drug Eruption
Inflammatory acne is result of host response to the _____
Follicular propionibacterium acne
Treatment of acne
Soap and water wash
T4C 500mg BD x 8/52
Generalized eruption mostly on the trunk, arms & thighs (shirt & short distribution) preceded by Herald patch is _____
Pityriasis Rosea
Causative organism in Pityriasis versicolor
Pityrosporum orbiculare
(Org. Previously called malasezia furfur)
Treatment for Pityriasis alba is _____
Resolves spontaneously over months /years
No treatment required
Treatment of Pityriasis versicolor
Topical imidazole antifungal (Clotrimazole)
Topical selenium sulphide shampoo to affected area@ night, wash following am. Repeat x2 @ weekly interval
Pityriasis alba is associated with _____
Atopy
Management of Callosities is
Keratolytics (5-10% salicylic acid ointment or 10% urea cream)
Callosities is painful, T/F
FALSE
Corns is painful, T/F
TRUE
Treatment of Corns
Attention to foot wears
Keratolytics
Cushioning (Corn pads)
Autosomal dominant hyperkeratosis of palms/soles is______
KERATODERMA
Treatment is Keratolysis
Most common form of skin cancer
Basal cell cancer
Basal cell cancer is mainly on light exposed areas esp. face, T/F
TRUE
The Dermatophytes most commonly involved in Dermatophytosis are (hint: 3)
Microsporum
Trichophyton
Epidermophyton
The following dermatophyte infection and their related affected body parts
a. Tenia barbae
b. T. manus
c. T. cruris
d. T.Capitis
e. T corporis
f. T unguium
g. T, pedis
a. Bearded areas of face & neck
b. Hand(s)
c. Genital, pubic, groin, perineal, perianal (Jock itch)
d. Skin of the scalp, eyebrows, eyelashes
e. Skin of body
f. Toenails or Fingernails (onychomycosis)
g. Foot- soles of feet & interdigital spaces (Athlete’s foot)
Onychomycosis is also called ______
Tinea unguium
Epidermophyton spp. affects mostly the _____ part of the body
Feet
Treatment for dermatophytosis
Treatment by topical/systemic antifungal
Scabies is caused by _______
An itch mite, Sarcoptes scabei
Skin lesions seen in scabies is due to __________
Hypersensitivity reaction to the parasite
The pruritus in scabies occurs mostly at night, T/F
TRUE
Rash in scabies is described at __________
Papulopustular rashes esp.
in interdigital spaces
Flexor surface of the wrist
Elbow and axillary fold
Areolar of breast
Male genitalia, esp. phallus
Along belt line
Buttocks
Treatment for scabies
Bath & scrub lesion wt sponge to open up burrows
25% benzyl benzoate cream/lotion applied from top of patient to bottom
Alternatively, permethrine, malathion, 1% lindane, crotamiton (Eurax) or 10% sulphur ointment is used
Pediculosis is caused by ________
A lice, Pediculus humanus coporis/capitis/pubis
Pediculosis pubis is spread via ______
Direct contact (coitus)
Predisposing factors for Pediculosis (hint: 3)
Overcrowding
Dirty clothing
Poor personal hygiene
Treatment for Pediculosis
1% lindane (gamma benzene hexachloride, BHC)
Applied daily X 2/7 in form of shampoo, cream Or lotion or as combination of shampoo followed by cream or lotion
Disinfect combs, brushes and clothing
Herpes zooster affects posterior Root ganglia, T/F
TRUE
Treatment for Herpes zooster
- Acyclovir (Zovirax)
2.Post herpetic neuralgia
Opiods
TCAs
Carbamazepin
Gabapentin - Steroids may decrease incidence of post herpetic neuralgia, though it does not shorten period of acute pain
Plasmodium spp. is an obligate intracellular protozoa, T/F
TRUE
Which species of plasmodium can persist in the liver as Hypnozoites
P vivax & P ovale
some schizonts persists as HYPNOZOITE in liver and may remain dormant for weeks/months or up to 3yrs
Synchronous release of merozoites occur every 48hrs in P. falciparum, T/F
TRUE
Tertian malaria
Synchronous release of merozoites occur every 48hrs in P. vivax, T/F
TRUE
Tertian malaria
Synchronous release of merozoites occur every 48hrs in P. malariae
FALSE
Quartan malaria(72hrs)
Duration of macrogametocyte & microgametocyte in man lasts for ____days to _____months
7days to 2 months
P. malaria invades only young RBCs & reticulocytes,T/F
FALSE
Invades only aging RBCs
Duration of infection is shortest with P. falciparum, T/F
TRUE
Duration of infection is longest with P. vivax, T/F
FALSE
P. malariae
Which Plasmodium spp. is almost a commensal infection in some adults
P. malariae
Which Plasmodium spp. development is suppressed in patient of HbF, HbS
P. falciparum
Duffy antigen is required for infection with _____ Plasmodium spp.
Vivax
Breastmilk provides protection from Plasmodium spp., how?
B/c it is deficient in PABA
In stable endemic malaria, transmission is generally high, T/F
TRUE
In unstable malaria, herd immunity is low, T/F
TRUE
Define transmission index in malaria
Proportion of infants less than one year with parasitaemia
(microscopic proven parasitemia)
Spleen rate is above 75% in children aged 2-9yrs is Hyperendemicity, T/F
FALSE
Holoendemicity
In Holoendemicity, there is low adult spleen rate, T/F
TRUE
Spleen rate in Mesoendemicity is _____
11-50%
Sporozoites & gametocytes inducee pathologic changes, T/F
FALSE
_________ is associated with the affinity of parasitized RBC for vasular endothelium of capillaries of internal organs
Histidine-rich, falciparum protein knob
Dilutional hyponatremia seen in pathophysiology of malaria is due to ______& _______
Secondary Aldosterone & ADH secretion
Hypoglycemia in pathophysiology of malaria is due to ______
TNF & Impaired gluconeogenesis
Incubation period of plasmodium falciparum is b/w _____to ____days
8 - 20 days
Malaria paroxysm follows rupture of _______
Matured schizonts in RBC
The primary attack of malaria after the IP is characterized by ________
Influenza like syndrome, such as
Asthenia
Arthralgia
Myalgia
Headache, nausea
In tertian malaria, the paroxysm/cycle repeats itself every ______hours
48hrs
Nephrotic syndrome is a delayed complication of which Plasmodium spp.
P. malariae
The gold standard diagnosis for malaria is
Microscopy
Thick film is superior in terms of parasite identification, T/F
TRUE
Thick film superior in terms of parasite identification.
Thin film needed for specie identification
Leishman stain can be used for both thick and thin film, T/F
FALSE
Giemsa for thick & thin films
Leishman for thin film
1-10 parasites per 1 thick film field is how many +
3+
11-100 parasites per 100 thick film field is how many +
2+
Mention the 3 methods of microscopy based diagnosis of malaria
- Blood film exam.
- Quantitative Buffy coat (QBC)
- Benzothiocarboxypurine (BPC) method
_________ is based on detection of parasite specific Histidine-rich protein II
Parasight F antigen based test
Optimal T antigen based test detects ______ in Plasmodium parasite
Lactic dehydrogenase (pLDH)
The 4 types of serological tests to diagnose malaria are
- Indirect Fluorescent antibody Test (IFAT)
- Indirect Heamagglutination Test (IHAT)
- Immunoprecipitation technique (Double gel diffusion test)
- Enzyme linked immunosorbent assay (ELISA)
In uncomplicated malaria, Artemisinine base combination therapy is recommended. Give the 3 combinations & doses
Artemeter-lumefantrine(120 :20)
Artesunate (4mg/kg) + Amodiaquine (10mg/kg)
Artesunate (4mg/kg dly *3days) + Mefloquine 25mg base/kg
If the 3 ACT recommended in uncomplicated malaria fails, give ______
Oral Quinine
Targets for malaria chemoprophylaxis (hint: 5)
- Non-immune travelers to endemic countries
- Returning immigrants to endemic areas
- Pregnant women
- Immunocompromised
- Sickle cell anaemic patients
In malaria chemoprophylaxis in pregnancy (, when should the first dose be commenced and when should the last dose be given
First dose after 16th week’
Last dose not later than one month before EDD
Malaria chemoprophylaxis in Sickle cell disease patient
for children & adult + doses
PROGUANIL
Children 100mg daily
Adult 200 mg daily
Malaria Chemoprophylactic drugs in gen (hint: 3)
Atovaquone/Proguanil (Malarone)
Mefloquine (250mg weekly)
Doxycycline (250mg daily)
Define shock
State of overwhelming systemic reduction in tissue perfusion characterized by decreased cellular oxygen delivery and utilization as well as removal of waste by product of metabolism
N/B: Inadequate tissue perfusion
Hypotension is synonymous to shock, T/F
FALSE
Hypotension, though common in shock, is not synonymous with shock
Which shock has mortality rate of >60%
Cardiogenic shock
List the types of shock
HYPOVOLAEMIC SHOCK
CARDIOGENIC SHOCK
DISTRIBUTIVE SHOCK
OBSTRUCTIVE SHOCK
Anaphylactic shock is an example of distributive shock, T/F
TRUE
Neurogenic shock is an example of obstructive shock, T/F
FALSE
Septic shock is an example of ______ type of shock
Distributive shock
Pulmonary embolism will cause which shock?
Obstructive shock
Tissue hypoxia sets in when the ratio of oxygen delivery to oxygen consumption is ______
<2:1
Cellular hypoxia causes release of cytokines & secondary inflammatory mediators, T/F
TRUE
Anaerobic glycolysis produces ____ATPs from 1mol of CHO
3 ATPs (21Kcal)
Aerobic glycolysis produces ____ATPs from 1mol of CHO
38 ATPs (266Kcal)
Cellular hypoxia causes SIRS, T/F
TRUE
Shock results when ____% of total blood volume is lost
25%
Which 2 arteriolar vessels are spared in the compensatory arteriolar constriction to shock
coronary & cerebral vessels are spared & vasodilate
The late phase of shock is when decompensation sets in, T/F
TRUE
Decompensation in shock is characterized by _______, _______ & _______
↓coronary perfusion & ↓ myocardial contractility, ↓cerebral blood flow wt confusion, restlessness, coma & death
Signs of successful resuscitation of shock are (hint: 5)
IMPROVED BP
IMPROVED MENTATION
RESOLVING METABOLIC ACIDOSIS
ADEQUATE URINE OUTPUT
IMPROVED SKIN PERFUSION
In airway care in a case of suspected cervical spine injury, which technique do use to reposition the head & neck
Jaw thrust
Features of breathing inadequacy (hint: 3)
Central cyanosis (except in severe anemia)
No breathing heard or felt at the mouth or nose
No activity of respiratory muscles
In AMBU bag ventilation, aim for ____bpm in adults and ____bpm in children (Should be breath cycles per minutes)
aim for 15bpm in adult and 30 bpm in children
Do not interrupt external cardiac massage for more than ___ secs when inserting an Endotracheal tube
20 secs.
In a confirmed acidosis in an event of cardiorespiratory arrest, what should you administer
1mmol/kg of 8.4% NaHCO3
For the following conditions, Mark T/F for those to use a defibrillator to defibrillate
a. Ventricular tachycardia
b. Pulseless electrical activity (PEA)
c. Asystole
d. Ventricular Fibrillation
e. Electromechanical dissociation
f. Normal sinus rhythm
g. No femoral/carotid pulse
a. T
b. F
c. F
d. T
e. F
f. F
g. F
Causes of cardiorespiratory arrest (hint: 6)
Hypoxia
Drug overdose
Myocardial infarction
Pulmonary embolism
Hypovolemia
Electrolyte imbalance
Dose of epinephrine in cardiorespiratory arrest
- IV dose
- When IV is unavailable
Dose:1mg i/v. If no i/v, 2mg in 10mls saline I/T
Repeat x 3
In proven hypokalemia in a case of cardiopulmonary arrest, what do you administer
0.3mmol/Kg IV over 5mins
In proven hypokalemia, IV KCl can be given less than 5 mins, T/F
FALSE
OVER not less than 5min for proven hypokalemia
Drugs & their doses used in cardiorespiratory arrest are (hint: 4-5)
- Epinephrine - Dose: 1mg i/v. If no i/v, 2mg in 10mls saline I/T
Repeat x 3 - Potassium chloride (KCl) - 0.3mmol/kg i/v
- Atropine -1mg i/v (can repeat x3) or 3mg as single dose
- Lidocaine - 1 - 2mg/kg I/V
- 8.4% Sodium bicarbonate (NaHCO3) - 1mmol/kg
Atropine is indicated for use in tachycardia, T/F
FALSE
for bradycardia or asystole
Epinephrine can be given in ventricular fibrillation, T/F
TRUE
Makes electrical defibrillation more likely to succeed in cases of ventricular fibrillation
What drug do you give for ventricular arrhythmias in a case of Cardiorespiratory arrest
Lidocaine
Concerning GCS, eye opening to pain is scored ____
2
In best motor response, abnormal extension is scored ____
2
In best motor response, flexion withdrawal (withdraws from pain) is scored _____
4
In best verbal response, inappropriate words is scored ____
3
The estimated blood loss from pelvic fracture is ___
2-3Litres
The estimated blood loss from femoral fracture is ___
1-2Litres
What class(es) of Antibiotics can prolong Neuromuscular blockade
Aminoglycoside, Tetracycline
In pre-op, ensure PT/INR IS ___
<1.5
In pre-op, switch Warfarin to Heparin, T/F
TRUE
Stop Oral contraceptive pills _____weeks before major & pelvic surgeries and recommence ____weeks post-op if mobile
4 weeks- stop
2 weeks post op if mobile
Suxamethonium can increase plasma potassium, T/F
TRUE
ASA classification of physical status in Pre-op assessment (hint: 5 classes)
Class 1: Normal healthy patient.
Class2: Patient with mild systemic disease
Class3: Incapacitating severe systemic
disease; not life threatening
Class4: Life threatening severe systemic
disease.
Class5: Moribund patient
For emergency surgery, letter ‘E’ is added, e.g 2E
CXR & ECG are indicated in post-op investigation for patients >5oyrs, T/F
TRUE
Pre-medications in Pre-op (hint: 7 A’s)
Analgesia (Preemptive)
Anxiolysis
Amnesia
Antacid
Antiemesis
Antibiotics
Anti-autonomic
Timing for pre-medication during pre-op
- for PO
- for IM
2HR PRE OP FOR ORAL
1HR PRE OP FOR IM
List Armamentarium you can recall
VISIT NOTE
Inhalational General anesthetics (Hint; DIS HONE)
Desflurane
Isoflurane
Servoflurane
Halothane
Oxygen
Nitrous oxide
Ether
Which of the inhalational general anesthetic has post operational hepatitis as its complication
Halothane
Agents of choice for inhalation induction of anesthesia are _______ & ______-
Desflurane and Servoflurane
Which of the Halogenated Ether causes cough, laryngospasm & breath holding when used as an inhalational anesthetic
Isoflurane
Balanced anesthesia most ensure ______, _______ & ________
analgesia, hypnosis and relaxation
Most popular intravenous induction agent for anesthesia is
Propofol
IV injection of Thiopentone is always painful, T/F
FALSE
The most widely used intravenous agent in developing countries is ______
Ketamine, a Phencyclidine derivative
The average sleep dose of Thiopental barbiturate is ______
5mg/kg IV
Average induction dose of Ketamine is _____
- for IV
- for IM
1-2ml/kg (for IV)
6-8mg/kg (for IM)
Ketamine produces marked increase in salivary secretion necessitating injection of _______
Atropine
When Ketamine is given as the sole anesthetic agent _______ should be given to reduce hallucination, delirium & nightmare
Diazepam
Thiopentone is a potent anticonvulsant, T/F
TRUE
Depolarizing Neuromuscular blockers can be used in paraplegic, T/F
FALSE
Depolarizing Neuromuscular blockers can be used in burns patient, T/F
FALSE
Ketamine can cause bronchoconstriction, T/F
FALSE.
It relaxes the bronchioles instead
The ideal intubating agent is ___
Suxamethonium
B/c of its rapid onset & short duration of action(2-6mins)
If a 2nd dose of Suxamethonium is required what should you give first?
Atropine
2nd dose of Suxamethonium can cause Tacchycardia, T/F
FALSE.
causes Bradycardia
Dose of Suxamethonium is ______
1-1.5mg/kg
2 Examples of Non-Depolarizing Neuromuscular blockers are (
Atracurium, Vecuronium
The drug of choice for General anesthesia in renal & liver failure is _________-
Atracurium
b/c of Hoffman elimination 9spontaneous metabolic elimination)
Which of the classes of NM-blockers/relaxants is indicated for patients with Myasthenia gravis
Non-depolarizing relaxants
When is Rapid Sequence Induction indicated
Used when risk of aspiration is high
Steps in Rapid Sequence Induction
Used where risk of aspiration is high.
1. Pre- oxygenate with 100% oxygen
2. Sellick’s manoeuvre on induction
3. Short acting muscle relaxant immediately after induction
Intubation
4. Release cricoid pressure
5. Give a longer acting muscle relaxant when suxamethonium wears off
Conductiing anesthetic agents with adrenaline can be used on areas without collateral circulation, T/F
FALSE
Define burns
Coagulation necrosis of skin +/- deeper tissue
Causes of burns (hint: 4)
Dry heat
Electricity
Chemical caustics
Irradiation
Burns occurs most commonly in children, T/F
TRUE
In pathophysiology of burns the initial response is _______ followed by ________
Vasoconstriction (from adrenal release of catecholamines followed by vasodilatation
The adrenal changes/response a systemic response in burns does 2 things
Vasoconstriction via catecholamines
Increase serum glucose (17-OH corticosteroids ensure glcogenolysis,lipolysis and gluconeogenesis)
In serve burns, there is anemia due to _______ & ______-
RBC Diapedesis and Direct red cell destruction
Hemodilutional anemia is usually seen in Full blood count result in Burns, T/F
FALSE
Hemoconcentration
In burns, max. edema obtainable is ___% body weight or ___% of total extracellular fluid
10%
50%
Protein & fluid loss is fastest in the first ___ hrs of post burns
8hrs
Stomach ulcer that occurs a complication of burns is called _______
Curling ulcer
Superficial partial thickness burns without infection usually re-epithelize within ___ weeks
3 weeks
Re-epitheliazation in superficial partial thickness burns is from what structures
Epidermal lining of sweat ducts, sebaceous glands & hair follicle
Re-epitheliazation can occur in deep partial thickness burns, T/F
FALSE
Full thickness burns heals only by ____
Secondary intention or scar formation
Concerning burns classification;
- charring is suggestive of _________
- Blisters is suggestive of ________
- Mottling is suggestive of _________
Mottling suggests deep dermal (deep partial thickness burns)
Charring suggests full thickness (full thickness burns)
Blisters are suggestive of superficial partial thickness burns
Presence of tenderness suggests which burn classification
Partial thickness burns
A deep partial thickness burns with severe edema can present with loss of sensation, T/F
TRUE
Estimation of burns using the Wallace’s Rule of 9 in adult
write it out
Concerning Rule of 7, what population is it used for?
- head is estimated as ____%
- Perineum is estimated as ____%
- Right upper limb is estimated as ___%
Used in children
HEAD 28%
PERINEUM 2%
Right upper limb 7%
Superficial major burns in adult is ___% while in children is ___%
SUPERFICIAL
ADULT >=15%
CHILDREN >=10%
Deep major burns in adult is ___% while in children is ___%
DEEP BURNS
ADULT >=7.5%
CHILDREN >=5%
Classification of burns into Major and Minor burns is based on _______
affected Surface area
List the systemic changes in burns (hint: 7)
- HYPOVOLAEMIA
- ANAEMIA
- ADRENAL CHANGES
- CYTOKINE RELEASE(TNF, IL-1, IL-6)
- METABOLIC CHANGES
- RENAL CHANGES
- SUSCEPTIBILITY TO SEPSIS
Burns is a hypermetabolic state, T/F
TRUE
Susceptibility to sepsis in burns is due to _____ & ______
Depression of cellular & humoral immunological defense
Gut bacterial translocation causing septicaemia
Blood is a type of colloid infusion, T/F
TRUE
Daily maintenance fluid per day in burns mgt is ___ litres
3 Litres
Brook formula for fluid mgt
- for colloids
- for crystalloids
0.5ml colloid/%burn <=50% +
1.5mls crystalloids/kg/%burns +
DAILY MAINTENANCE FLUID PER 24HRS
In Modified Brook formula, both colloids & crystalloids can be used, T/F
FALSE
only Crystalloids can be used
Parkland formula in fluid mgt in Burns is
4mls/kg per % burns <= 50%
In fluid mgt in burns, administer half of the calculated total volume of fluid in the first 8hrs of the second day, T/F
FALSE
In fluid mgt in burns, administer half of fluid in the first 16hrs of the second day , T/F
FALSE
ADMINISTRATION
½ total fluid given in 1st 8hrs post injury
Remaining ½ in the next 16 hours
In 2nd 24hours, ½ of fluid in 1st 24hrs +daily requirement
Concerning wound mgt in burns, clean with _____& _____
cetrimide & warm water under anaesthesia
Blisters in burns wounds should be excised, T/F
FALSE
In the exposure method of wound mgt in burns, which antimicrobial is applied?
Silver sulphdiazine
Exposure method is suited for treatment of burns in what body parts (hint: 3)
Suited for treatment of facial burns, perineum &of one side of the body
Indication for stopping exposure method od burns wound mgt
as soon as integrity of eschar is broken
Cracks in the eschar is an indication for stoppage of exposure method in burns wound mgt, T/F
FALSE
Cracks in eschar is dressed with vaseline gauze or sofratulle
Exposure method of burns wound mgt is contraindicated in what burn cases/type of patient
Contraindicated in ambulant outpatient cases
In large burns wounds what should be done
Barrier nurse in large wounds(gown &mask to be worn)
Methods of burns wound mgt are (hint: 2)
Exposure
Occlusion(dressing)
_______ dressing is used for occlusive method
Absorptive dressing
Eschars separate quickly for burns treated by occlusive method, T/F
TRUE
Early eschar excision and skin grafting done within ____hr in stable patients
48hrs
Mention some biological membranes that can be used to temporarily cover extensive burns areas (hint: 4)
Homograft(live donor/fresh cadaver<6hrs)
Xenograft (heterograft of pig skin)
Cultured autologous epidermis
Amniotic membrane
Mention antibiotics that can be used in burns wound mgt (hint: 5)
Silver sulphadiazine
Povidone iodine
honey
Mefenide (sulphamylon)
Silver nitrate
Which antibiotics used in burn wound mgt often painful
Mefenide (sulphamylon)
In mgt of burns outline the steps/care (hint: 9)
- First aid
- ABC of mgt of the critically ill
- FLUID MANAGEMENT
- WOUND MANAGEMENT
- ANTITETANUS PROPHYLAXIS
- ANALGESICS
- PROPHYLACTIC/THERAPEUTIC ANTIBIOTICS
- BLOOD TRANSFUSION AS NEEDED
- NUTRITIONAL SUPPORT(HIGH PROTEIN/HIGH CALORIE)
Paralytic ileus is a complication of burns, T/F
TRUE
Deep venous thrombosis is a complication of burns, T/F
TRUE
Intravascular fluid constitutes ___% of body weight in adults
4%
Ionic contents of the intravascular & interstitial fluids are the same except for the absence of _______ in the interstitial fluid
Protein
Predominant ions in the Extracellular fluids are (hint: 3)
Na+, Cl- , Hco3-
Predominant ions in the Intracellular fluids are (hint: 4)
K+ ,Mg+ , Po4- & SO4-
Endogenous production of water in ___mls in 24hrs
200mls
Concerning water loss from the body in the Tropics, how many mls is lost in 24hrs
-for Pulmonary/skin
-for Urine
-for faeces
1700mls - Pulmonary/skin
1500mls - urine
200mls - faeces
Daily net water requirement in the tropics is
3200ml
Total sodium loss in 24hrs in tropics is ___
140%
Total Potassium loss in 24hrs in tropics is ___
60%
Potassium is excreted from the sweats, T/F
FALSE
For every 1degree Celsius rise in temp __% of daily requirement is added to compensate loss in sweating
12%
Glycogen stores(400g) in the body are used up during the __ day of starvation
First day of starvation
For calorie replacement, the least grams of exogenous glucose a day to reduce gluconeogenesis is ____
100g
Gluconeogenesis of the body using proteins & fat is usually accompanied with attendant ______
Acidosis
Composition of Ringer’s lactate 1Litre
Na+
K+
Ca2+
Cl-
HCO3
RINGER’S LACTATE(1L)
Na+ 130mmol
K+ 4mmol
Ca2+ 4mmol
Cl- 111mmol
HCO3 27mmol
COMPOSITION OF DARROW’S SOLUTION 1 Litre
Na+
K+
Cl-
HCO3
DARROW’S SOLUTION
Na+ 124mmol
K+ 36mmol
Cl- 104mmol
HCO3 56mmol
Composition of 5% DEXTROSE WATER
5g/100mls of solution
COMPOSITION OF NORMAL SALINE (0.9%) IN 1 Litre
Na+
Cl-
NORMAL SALINE (0.9%)
Na+ 154mmol/L
Cl- 154mmol/L
Monitoring of fluid treatment (hint: 9)
HOULY URINE OUTPUT
CATHETERISATION IN VERY ILL PATIENT
EVALUATE SKIN TUGOR/TONGUE MOISTURE
HOULY BP/PULSE
MONITOR JVP
FREQUENT AUSCULTATION OF LUNG BASES
CVP MEASUREMENT
INPUT/OUTPUT CHART TO BE PROPERLY KEPT
SERUM ELECTROLYTE
Fluid of choice in severe diarrhoea after initial resuscitation is _____
Darrow’s solution
_____ is added to sterile blood bag to increase the survival from 21 to 34 days
Adenine enriched CPD (CPDA-1)
Blood is stored at blw ___ to ___degree celsius in blood bank
2 to 6 degree celsius
Blood components that are not viable beyond 24hrs are
Leucocytes & platelets
Clotting factors that can survive for 21days in stored blood (hint: 2)
fibrinogen & factor II
Concerning ABO system, number of possible genotypes are
6 possible genotypes (AA,AB,AO,BO,BB,OO)
In ABO system, the only 4 serologically recognized phenotypes are
(A=42%, B=9%, AB=3%, O=46%)
ABO Preformed antibiotics are IgM, T/F
TRUE
Immune antibodies IgG are produced in response to incompatible blood transfusion are cold antibodies, T/F
FALSE
warm antibodies- b/c they react optimally at 37 degrees celsius
In Rhesus blood group system, there are preformed antibodies, T/F
FALSE
Complication of blood transfusion is broadly divided into 2
Immune and Non immune complications
Pyrogenic reaction in blood transfusion is caused by _____
Caused by pyrogens from bacteria & viruses
Immune complications of blood transfusion (hint: 5)
Haemolytic reactions+- haemoglobinuria
Leucocyte antibodies(HLA/anti-neutrophil antibodies)
Platelet antibodies
Pyrogenic reactions
Plasma reaction
Non immune complications of blood transfusion (hint: 6)
Transmission of infections, including malaria
Circulatory overload
Thrombophlebitis
Air embolism
Transfusion haemosiderosis
Complications due to massive transfusion
Blood transfusion complications that can arise due to massive transfusion (hint: 5)
Hypocalcaemia
Hyperkalaemia
Hypothermia
Persistent bleeding(platelet/coagulation factor loss)
Metabolic acidosis(excess citrate & lactic acid)
Requirements for donor in blood transfusion, mark T/F for the following
- Age <18yrs
- Hb 11g/dL
- Weight 50kg
Age: F
Hb: F
Weight: F
Minimum donation interval is ____ weeks
12 weeks
Maximum donation for a year for an individual is ____
3 per year
Consequences of blood storage (hint: 5)
Hyperkalemia
Depleted leucocytes & platelets
Hypocalcemia
Depleted clotting factors
Lactic acidosis
Cutaneous ulcer around the knee is probably _____
Syphilitic ulcer
Ulcer on the toe/dorusm of feet can be due to DM, T/F
TRUE
Sickle cell ulcer is usually found where?
Medial malleolus
Venous ulcers are commonly found at the medial malleolus, T/F
TRUE
Neuropathic ulcers are commonly found at ____
Sole of feet
List specific ulcers (hint: 5)
TB ULCERS
BURULI ULCERS
SYPHYLITIC
YAWS ULCERS
TROPICAL ULCERS
Parts of the body with predilection of TB ulcers are _____, _____ & _______
Neck, Groin, Axilla
Causative agent for Buruli ulcer
Mycobacterium ulcerans
Classification of cutaneous ulcers
A. Specific
B. Non specific
C. Neoplastic
The most common form of skin cancer is _______
Basal cell carcinoma (Rodent ulcer)
What type of medical record system is practiced in UUTH
Centralized
In Decentralized medical record system all data of the patient is available at all time, T/F
FALSE
Uses of medical records (hint: 5)
- To document patients’ course of illness and Rx
- To communicate between health care professionals caring for the patient.
- For continuity of care to the patient.
- For research into specific diseases and treatment.
- Collection of health statistics
Concerning culling, medical records removed from active file room are filed in ________
Secondary storage
Stapes can be used to hold papers together in medical record, T/F
FALSE
A clip or fastener to hold the papers together( Never use staples)
The medical record is the property of the hospital, T/F
TRUE
Master patient index (card index) should contain medical information, T/F
FALSE
Types of medical record (hint: 2)
Active
Inactive
Types of filing methods (hint: 3)
ALPHABETICAL FILING Not Recommended
NUMERIC FILING Training time for staff short
TERMINAL DIGIT FILING
_____ enables records to be found when not on file
Tracer card (Outguide)
Month of attendance on medical record folder indicates whether the record is ACTIVE or INACTIVE, T/F
FALSE
Year of attendance
Five questions to answer before setting up a private practice
WHY
WHERE
WHO
WHAT
HOW
The minimum requirements for setting up a private practice are (hint: 3)
REGISTRABLE MEDICAL DEGREE
FULL REGISTRATION
CERTIFICATION BY THE LOCAL REGULATORY AUTHORITY
HIGHLIGHTS OF PHYSICIAN’S OATH (hint: 13)
- Consecration of Doctor’s life to service of humanity.
- Respect for & gratitude to teachers/colleagues/students
- Practicing with conscience and dignity.
- Patient autonomy to be respected
- Patient’s health takes first consideration.
- Confidentiality, even after death.
- Non-discrimination in patient care.
- Attendance to physician’s health, well being & knowledge.
- Sharing of medical knowledge
- Beneficence (seeking to do good)
- Non-maleficence (Primum, Non Nocere)
- Sanctity of life.
- Veracity (Telling the truth)
Mention the 4 Ethical violations
PROFESSIONAL NEGLIGENCE (unethical act of omission)
MALPRACTICE (act of commission)
MISCONDUCT/IMPROPER CONDUCT
INFAMOUS CONDUCT IN A PROFESSIONAL RESPECT
MDCN functions do not include regulation of alternative medicine, T/F
FALSE
Functions of MDCN (hint: 4)
- To regulate practices of medical & dental profession as well as alternative medicine.
- To determine standard of knowledge and skill of practitioners and raise these from time to time.
- Establish and maintain members registers
- Investigating /disciplinary functions in case of ethical violations (Members of these panels constitute ‘professional brethren of good repute and competence’)
Penalties for ethical violation (hint: 3)
FORMAL WARNING
SUSPENSION FOR A PERIOD OF TIME
DEREGISTRATION
