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FAMILY MEDICINE > Dr. Iyanam > Flashcards

Dr. Iyanam Flashcards

1
Q

Define Medical history/Medical case history of a patient

A

INFORMATION ON PATIENT’S HEALTH OBTAINED BY THE PHYSICIAN FROM THE PATIENT OR OTHER PERSONS WHO KNOW THE PATIENT THAT ENABLE THE PHYSICIAN TO FORMULATE A DIAGNOSIS AND PROVIDE CARE TO THE PATIENT

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2
Q

What is History taking?

A

A form of doctor-patient interaction which is systematic, that leads to diagnosis & formulation of care plan for the patient

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3
Q

MEDICAL HISTORY OBTAINED DIRECTLY FROM THE PATIENT IT IS CALLED (hint: 2)

A

ANAMNESIS SELF-REPORTING HISTORY

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4
Q

MEDICAL HISTORY OBTAINED FROM OTHER PEOPLE WHO KNOW THE PATIENT IT IS CALLED (hint: 2)

A

HETEROANAMNESIS OR COLLATERAL HISTORY

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5
Q

History taking is a form of practical medicine, T/F

A

TRUE

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6
Q

HOW TO ARRIVE AT DIAGNOSIS:
HISTORY TAKING= ____%
PHYSICAL EXAMINATION=___%
INVESTIGATION=____%

A

HISTORY TAKING= 60%
PHYSICAL EXAMINATION=20%
INVESTIGATION=20%

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7
Q

The type of history used on patients in emergency situation is _____

A

Short/Brief history

Add Focused

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8
Q

________ INTERVIEW TECHNIQUE IS USED WHEN IT IS SENSED THAT THE PATIENT IS NOT SPEAKING FREELY OR CLEARLY

A

CONFRONTATION

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9
Q

________ INTERVIEW TECHNIQUE ENCOURAGES COMMUNICATION BY SPECIFYING THE KIND OF INFORMATION BEING SOUGH USING GESTURES & WORDS

A

FACILITATION

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10
Q

List Interview techniques in history taking (hint: 6)

A
  1. QUESTION
  2. LISTENING AND SILENCE
  3. FACILITATION
  4. CONFRONTATION
  5. EMPATHETIC RESPONSE
  6. CLARIFICATION
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11
Q

Obtaining consent before history taking is not essential, T/F

A

FALSE

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12
Q

What is the part of Biodata YOU(Favour) do forget to obtain

A

WHERE IS THE PATIENT COMING FROM- HOME, CHURCH, ANOTHER FACILITY, POLICE STATION, CORRECTIONAL FACILITY, TBA HOME, BONE SETTER’S PLACE, NATIVE DOCTOR’S PLACE, ETC. FIND OUT AND WHY?

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13
Q

Group of people that will require an Informant during history taking are (hint: 5)

A
  1. CHILDREN
  2. UNCONSCIOUS PATIENT
  3. VERY OLD ELDERLY
  4. MENTALLY IMPARED PATIENTS
  5. PATIENTS WITH SPEECH DIFFICULTY
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14
Q

Presenting/Chief complaint should not be >5, T/F

A

FALSE

SHOULD NOT BE > 4 COMPLAINTS

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15
Q

Illness experience of a patient includes 4 things, which are

A

F-FEAR/FEELING
I-IDEA
F-FUNCTIONAL LOSS
E-EXPECTATION

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16
Q

Types of consent (hint: 2)

A

IMPLIED AND INFORMED CONSENT

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17
Q

Fowler’s position is _______position

A

Cardiac position

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18
Q

Physical examination is always detailed, T/F

A

FALSE

EXAMINATION COULD BE
a. BRIEF OR FOCUSED
b. DETAILED OR COMPREHENSIVE

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19
Q

Anthropometry is a part of General P/E, T/F

A

TRUE

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20
Q

FACTORS THAT INHIBIT MEDICAL HISTORY (HINDRANCE TO PROPER MEDICAL HISTORY TAKING) ARE (hint: 5)

A
  1. PHYSICAL INABILITY OF THE PATIENT TO COMMUNICATE WITH THE PHYSICIAN
  2. RELUCTANCE OF PATIENTS TO DISCLOSE INTIMATE OR UNCONFORTABLE INFORMATION
  3. TRANSITION TO PHYSICIANS THAT ARE UNFAMILIAR TO THE PATIENT
  4. CROWDED CONSULTING ROOM- NO PRIVACY
  5. PHYSICIANS UNFRIENDLY ATTITUDE

N/B: Arrangement is from Patient-induced factor (1, 2, 3) to Doctor-induced factors (4, 5)

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21
Q

A term used in medicine to describe the follow-up medical history of a patient after an illness is _________

A

CATAMNESIS

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22
Q

Routine medical examination is also known as _______ (hint: 4)

A

-ANNUAL
-YEARLY MEDICAL EXAMINATION
-OR COMPREHENSIVE OR PREVENTIVE HEALTH EXAMINATION

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23
Q

Concerning Routine medical examination, Mark T/F for the following
a, Therapeutic medicine
b. Regularly done
c. done by Symptomatic patient

A

a. F - PREVENTIVE
b. TRUE
c. FALSE - ASYMPTOMATIC

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24
Q

A pelvic examination should be carried out in a Routine medical examination, T/F

A

TRUE

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25
Q

Sensitivity to disease is high in Routine medical examination, T/F

A

FALSE

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26
Q

Very important things to check during P/E in PRESCHOOL/KINDERGARTEN EXAMINATION are (hint: 4)

A

VERY IMPORTANT:
-VISION
-HEARING
-BP
-DENTITION AND GUM

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27
Q

The Basic laboratory tests that should be done in Preschool/Kindergarten examination are (hint: 5)

A

-URINALYSIS
-LEAD POISONING
-GENOTYPE/SICKLING TEST
-CHEST X-RAY
-MANTOUX

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28
Q

Concerning Preschool/Kindergarten examination, the comprehensive Medical Certificate of Fitness should be issued to ______ & ______after the examination

A

PARENTS AND THE SCHOOL

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29
Q

The General laboratory investigations for Pre-employment medical examination are (hint: 5)

A

GENERAL –A MINIMUM OF 2 INVESTIGATIONS INCLUDING:
URINALYSIS, CHEST X-RAY, GENOTYPE, BLOOD GROUP, PCV/HB

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30
Q

The validity of a medical report/certificate of fitness lasts for _____month(s)

A

6 months

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31
Q

Concerning Pre-employment medical examination, declare stable chronic morbidity patient unfit, T/F

A

FALSE

DECLARE CHRONIC MORBIDITY UNFIT IF IT EXISTS AND IF STABLE, CERTIFY FIT

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32
Q

Concerning Medical Certificate of Fitness ,only the doctor’s name and signature are needed in the report, T/F

A

FALSE

GET THE REPORT STAMPED WITH OFFICIAL STAMP

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33
Q

Define Periodic medical examination

A

THIS IS MEDICAL EXAMINATION OF OSTENSIBLY HEALTHY INDIVIDUALS PERFORMED @ PRESCRIBED INTERVALS BY PHYSICIANS
PME IS A FORM OF HEALTH SCREENING

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34
Q

Periodic Medical examination is part of Routine medical exam, T/F

A

FALSE

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35
Q

In Periodic medical examination, the individual/patient visits the physician when ill, T/F

A

FALSE

NOTE: THE PATIENTS ARE USUALLY ASYMPTOMATIC OR HAVE NO MEDICAL COMPLAINT

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36
Q

Periodic medical examination is a Non-evidenced-supported screening procedure, T/F

A

FALSE

PME IS EVIDENCE-SUPPORTED SCREENING PROCEDURES

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37
Q

In Periodic medical examination, interventional benefits may be a part, T/F

A

TRUE

PME IS EVIDENCE-SUPPORTED SCREENING PROCEDURES WITH INTERVENTION BENEFITS

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38
Q

The increase in life expectancy noticed in developed countries is due to therapeutic care, T/F

A

FALSE

PREVENTIVE CARE

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39
Q

Chronic heart failure has a 50% mortality within ___years

A

3 years

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40
Q

Chronic Heart failure is characterized by two pathophysiologic factors which are

A

REDUCTION IN CARDIAC OUTPUT
FLUID RETENTION

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41
Q

The classic symptom of Chronic heart failure is _______

A

DYSPNOEA ON EXERTION

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42
Q

Cough in chronic heart failure occurs especially at night, T/F

A

TRUE - Nocturnal cough

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43
Q

There is increased intensity of P2 heart sound in Chronic heart failure, T/F

A

TRUE

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44
Q

Pulsus alterans is absent in chronic heart failure, T/F

A

FALSE

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45
Q

Heart sounds heard in Chronic HF are

A

S3 Gallop- S1, S2, S3

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46
Q

How do you make a diagnosis of Heart failure using Framingham criteria

A

THE FRAMINGHAM CRITERIA FOR THE DIAGNOSIS OF HEART FAILURE CONSISTS OF THE CONCURRENT PRESENCE OF EITHER TWO MAJOR CRITERIA OR ONE MAJOR AND TWO MINOR CRITERIA

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47
Q

Mention the Framingham Major criteria (hint: 11- Use Hx, P/E, INV (Echo, CXR), Post-mortem

A
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48
Q

Mention the Framingham Minor criteria (hint: 7- Use Hx, P/E)

A
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49
Q

In systolic HF, the Left ventricular Ejection fraction is <____%

A

< 40%

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50
Q

Systolic HF is due to ___________

A

SYSTOLIC FAILURE DUE TO AN INADEQUATE PUMPING ACTION OF THE HEART

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51
Q

Diastolic HF is due to ___________

A

DUE TO IMPAIRMENT OF LEFT VENTRICULAR FILLING

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52
Q

The classic heart failure is Diastolic HF, T/F

A

FALSE

Systolic HF

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53
Q

Biventricular Heart failure means _________

A
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54
Q

An elderly with Hypertension will likely have a Diastolic HF, T/F

A

TRUE

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55
Q

ASSESSMENT OF SEVERITY OF HEART FAILURE
CAN BE CONSIDERED FROM 3 DIFFERENT PERSPECTIVES, WHICH ARE

A
  1. DEGREE OF FUNCTIONAL DISABILITY/ DEGREE OF SEVERITY OF SYMPTOMS
  2. DEGREE OF IMPAIRMENT OF CARDIAC FUNCTIONS
  3. DEGREE OF SEVERITY OF THE CONGESTIVE STATE
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56
Q

An indicator of Left ventricular cardiac function is _________

A

Left ventricular Ejection fraction

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57
Q

Classify Heart Failure using the New York Heart classification system (hint: 4 classes)

A

Class I: No limitation of physical activity
Class II: Slight limitation of physical activity
Class III: Marked limitation of physical activity
Class IV: Symptoms occur even at rest; discomfort with any physical activity

NYHA CRITERIA CLASSIFIES BASED ON DEGREE OF FUNCTIONAL DISABILITY

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58
Q

Slight limitation of physical activity is which class in NYHA classification system

A

Class II

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59
Q

Presence of structural heart defect but no symptoms is which stage in the American College of Cardiology/American Heart Association (ACC/AHA) staging system

A

Stage B

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60
Q

Stage Heart failure based on the American College of Cardiology/American Heart Association (ACC/AHA) staging system (hint: 4 stages)

A

Stage A: High risk of heart failure but no structural heart disease or symptoms of heart failure
Stage B: Structural heart disease but no symptoms of heart failure
Stage C: Structural heart disease and symptoms of heart failure
Stage D: Refractory heart failure requiring specialized interventions

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61
Q

The 3 significant risk factors for heart failure are

A

Obesity, DM, HTN

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62
Q

Chest X-ray finding in Heart failure (hint: 5- ABCDE)

A

-A- ALVEOLAR OEDEMA (BAT’S WING)
-B- KELLY-B-LINE(INTERSTITIAL OEDEMA)
-C- CARDIOMEGALY
-D- DILATED/PROMINENT UPPER LOBE VESSELS
-E- PLEURAL EFFUSION

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63
Q

What bio-maker is an indicator for severity of Chronic HF and can be used for prognosis

A

NATRIURETIC PEPTIDE B( BNP)

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64
Q

Serum level of BNP can be used to diagnose Heart failure, T/F

A

TRUE

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65
Q

Serum BNP level of < ___pg/ml excludes heart failure

A

< 100pg/ml

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66
Q

Approach to treatment of heart failure is multidisciplinary, T/F

A

TRUE

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67
Q

In non-pharmacological mgt of heart failure, salt reduction/restriction should be < __ grams/Day or ___to__mmol/Day

A

< 2grams/Day OR 60-100mmol/Day

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68
Q

In advance Heart failure, water restriction is limited to ~____L/Day

A

~1.5L/day

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69
Q

Heart failure patients are recommended 3-yearly echocardiography, T/F

A

FALSE

2- YEARLY ECHOCARDOGRAPHY

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70
Q

Heart failure patient should be given ____ & _____ vaccines

A

VACCINATION, ESP AGAINST RESP INFECTION
PNEUMONIA
INFLUENZA

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71
Q

Device based Heart failure treatment include (hint: 3)

A

IMPLANTABLE CARDIAC DEFRILLATOR
BIVENTRICULAR PACEMAKERS
LEFT VENTRICULAR ASSIST DEVICES

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72
Q

Aim of IMCI

A

To reduce death, illness and disability thereby promoting improved growth and development among children U5 yrs of age

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73
Q

The strategy of IMCI has 3 main components which are?

A
  1. Improving case mgt skill of health care staff
  2. Improving overall health system
  3. Improving family and community health practices
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74
Q

Define Under-5 mortality rate

A

U5MR IS DEFINED AS THE ANNUAL NUMBER OF DEATHS OF CHILDREN UNDER 5 YEARS OF AGE PER 1000 LIVE BIRTHS

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75
Q

U5 mortality is a reflection of a country’s health system and economy, T/F?

A

TRUE

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76
Q

IMCI incorporates Child Survival Strategy which includes (hint: 11)

A

G- GROWTH MONITORING
O- ORAL REHYDRATION THERAPY
B- BREAST FEEDING
I- IMMUNIZATION
F- FAMILY PLANNING
F- FOOD FORTIFICATION
F- FEMALE EDUCATION
E- ESSENTIAL DRUG LIST
T- TREATMENT OF COMMON ILLNESSES/INJURIES
H- HEALTH EDUCATION
E-ENVIRONMENTAL SANITATION

N/B You can put it “THE GOBIFFFE”

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77
Q

Danger signs on physical examination with respect to IMCI (hint: 6)

A

Anemia, Pyrexia, Dehydration, Dyspnea, Wasting, Jaundice

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78
Q

List the steps in IMCI implementation (hint: 6)

A
  1. History taking from parent/care giver
  2. Assess child(examination) for danger signs
  3. Classify the illness
  4. Take decision
  5. Counsel the mother/care giver
  6. Follow up
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79
Q

The commonest symptom that presents to primary care is ______

A

Dyspepsia

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80
Q

Dyspepsia is more common in men, smokers & those taking NSAIDs, T/F

A

FALSE.
Common in women not men

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81
Q

Patients with dyspepsia have poor life expectancy, T/F

A

FALSE

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82
Q

Dyspepsia is associated with poor health-related quality of life, T/F

A

TRUE

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83
Q

The most important contributory factors to dyspepsia are _____&______

A

The presence of H. pylori and use of medications such as NSAIDs

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84
Q

Systemic conditions that can cause dyspepsia (hint: 9)

A

Adrenal insufficiency, congestive heart failure, diabetes mellitus, hyperparathyroidism, intra-abdominal non-gastrointestinal malignancy, myocardial infarction, pregnancy, renal insufficiency, thyroid disease

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85
Q

Draw out NICE model Algorithm for the mgt of dyspepsia

A

Refer to Note

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86
Q

The key investigations in the diagnosis of dyspepsia are ______&______

A

Endoscopy and test for H. Pylori

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87
Q

Functional dyspepsia is a diagnosis of exclusion, T/F?

A

TRUE

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88
Q

What is the mgt of Functional dyspepsia

A

the mental health status of the patients should be evaluated and identifiable co-morbid conditions like depression, anxiety disorder, etc which can further worsen the quality of life, should be identified and treated

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89
Q

PUD majorly affects what part of the GIT? (hint; 3)

A

It affects lower esophagus, stomach or duodenum

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90
Q

List the injurious/damaging factors that play a role in development of PUD (hint: 7)

A

-gastric acid, pepsin, bile acids, NSAIDS, genetics, H. Pylori, ethanol

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91
Q

List the protective factors play a role in preventing of PUD (hint: 8)

A

-mucus, bicarbonate, prostaglandin, mucosal blood flow, alkaline tide, epithelial renewal, hydrophobic layer, epidermal growth factor (EGF)

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92
Q

Ratio of Gastric ulcer to Duodenal ulcer

A

1:4

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93
Q

Family hx is a risk factor of PUD, T/F?

A

TRUE

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94
Q

Which blood group is a common risk factor for PUD?

A

Blood group O

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95
Q

Mention the risk factors for PUD (hint: 7 major, 3 minor)

A
  1. male sex
  2. family history
  3. smoking (cause and delay healing)
  4. stress
  5. common in blood group O
  6. nsaids (2-4 times increase in GU and ulcer complications)
  7. H. Pylori: (if absent and no NSAIDS, ulcer unlikely)

Unproven risk factors:
1. corticosteroids
2. alcohol
3. diet

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96
Q

PUD may be silent in the elderly on NSIADs, T/F?

A

TRUE

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97
Q

P/E of a patient with PUD usually yields positive findings, T/F?

A

FALSE

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98
Q

Investigations for PUD (hint:4)

A
  1. Endoscopy (investigation of choice)
  2. Barium studies
  3. Serum gastrin
  4. H. Pylori test
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99
Q

Complications of PUD (hint: 7)

A
  1. Penetration
  2. Perforation
  3. Bleeding →haematemesis & melaena
  4. Pyloric stenosis →obstruction
  5. Anaemia
  6. Oesophageal stenosis
  7. Carcinoma (GU)
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100
Q

Aims of mgt of PUD (hint:4)

A
  1. Relieve symptoms
  2. Accelerate ulcer healing
  3. Prevent complication
  4. Minimize risk of relapse
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101
Q

Define Urinary Tract Infection (UTI)

A

IT IS THE INFECTION OF ANY PART OF THE URINARY TRACT- KIDNEYS, URETERS, BLADDER, URETHRA
INCLUDES INFECTION OF THE PROSTATE- PROSTATITIS

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102
Q

Infection of the prostate (prostatitis) is a part of UTI, T/F?

A

TRUE

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103
Q

UTI occurs most frequently b/w the ages of ___ & ___ in women

A

16 & 35

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104
Q

Rates of asymptomatic bacteriuria increases with age in women, T/F?

A

TRUE

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105
Q

Which type of UTI is the most common cause of nosocomial infection

A

Pyelonephritis

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106
Q

Risk factors for UTI (hint: 25)

A

RISK FACTORS FOR UTI’S:
FEMALE GENDER- ANATOMY-PROXIMITY OF FEMALE URETHRA TO THE VAGINA& ANUS
AGE-↑ WITH ↑AGE
SEXUAL INTERCOURSE-↑ WITH FREQUENCY OF SEX
EXPOSURE TO SPERMICIDE IN FEMALE (IN DIAPHRAGM) & CONDOM
PREGNANCY-↓ IMMUNITY, ↓ESTROGEN
MENOPAUSE
IMMUNOSUPRESSION-↓ HOST DEFENCE
DM-↓IMMUNITY
PREVIOUS INFECTION (PROBABLY POORLY TREATED)
POOR PERINEAL HYGIENE
DEHYDRATION
DELAYED MICTURITION
OBSTRUCTION TO URINARY FLOW
-CONGENITAL ANOMALIES
-CALCULI
-URETERAL OCCLUSION
RESIDUAL URINE IN BLADDER
-NEUROGENIC BLADDER
-URETHRAL STRICTURE
-PROSTATIC HYPERTROPHY
VESICOURETERAL REFLUX
INSTRMENTATION OF URINARY TRACT
-INDWELLING URINARY CATHETER
-CATHETERIZATION
-URETHRAL DILATION
-CYSTOSCOPY

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107
Q

Chronic bacterial prostatitis may cause recurrent UTI in males, T/F?

A

TRUE

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108
Q

Viruses are common causes of UTI in an immunocompetent host, T/F?

A

FALSE.
VIRUSES ARE UNCOMMON CAUSE OF UTI’S IN AN IMMUNOCOMPETENT HOST
THEY ARE INCREASINGLY RECOGNIZED AS THE CAUSE OF LOWER UTI, ESPECIALLY HAEMORRHAGIC CYSTITIS AMONG IMMUNOCOMPROMISED PATIENT

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109
Q

Method of choice for diagnosing Viral LUTI

A

DIAGNOSIS OF VIRAL LUTI’S IS BASED ON MOLECULAR TECHNIQUES AND REAL-TIME POLYMERASE CHAIN REACTION IS OFTEN THE METHOD OF CHOICE

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110
Q

Drug of choice for viral UTI

A

CIDOFOVIR IS BECOMING A DRUG OF CHOICE IN VIRAL UTI’S

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111
Q

Mention mechanisms that maintain the Urinary tract’s sterility (hint: 4)

A
  1. ACIDITY OF URINE
  2. EMPTYING OF THE BLADDER @ MICTURITION
  3. URETEROVESICAL & URETHRAL SPINCTERS
  4. VARIOUS IMMUNOLOGIC & MUCOSAL BARRIER
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112
Q

Routes of infection in UTI are (hint: 3)

A
  1. Direct entry through the urethra
  2. Hematologic route
  3. Lymphatic route
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113
Q

Clinical manifestations of Upper UTI (hint: 11)

A

-HIGH GRADE FEVER
-RIGORS/CHILLS
-VOMITTING
-SWEATING
-HEADACHE
-DIARRHOEA
-LOIN PAIN
-±ABDOMINAL PAIN
-OLIGURIA (IF AKI)
-LOIN TENDERNESS (COSTOVERTEBRAL ANGLE TENDERNESS)
-TACHYCARDIA

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114
Q

Clinical manifestation of Lower UTI (hint: 8)

A

-DYSURIA
-FREQUENCY
-URGENCY
-FEELING OF INCOMPLETE BLADDER EMPTYING
-SUPRAPUPIC PAIN AND TENDERNESS
-±STRANGURY
-HAEMATURIA
-OFFENSIVE URINE

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115
Q

UTI can be diagnosed using a urine dipstick, T/F?

A

TRUE
Typical symptoms + Presence of Leukocyte esterase & Nitrite

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116
Q

In asymptomatic patient, >10^5 CFU/microgram is significant (Asymptomatic bacteriuria), T/F

A

FALSE.
>10.5 CFU ORGANISM/ML

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117
Q

Investigation for UTI are (hint: 3)

A

ALL PATIENTS:
1. DIPSTIC ESTIMATION OF NITRITE, LEUCOCYTE ESTERASE, GLUCOSE
2. MICROSCOPY/CYTOMETRY OF URINE FOR WHITE BLOOD CELLS, ORGANISMS
3. URINE CULTURE

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118
Q

In complicated UTI & also UTI in infants & children what other investigations should you carry out in addition to the basic 3? (hint: 3)

A

-FBC, U/E/C, BLOOD CULTURES

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119
Q

Duration of treatment for uncomplicated LUT infection

A

TREATMENT FOR 3 DAYS IS THE NORM

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120
Q

Drug of choice for initial treatment of LUT infection is _______

A

TRIMETHOPRIM

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121
Q

Antibiotic class that can be used in treatment of UTI in pregnancy (hint: 2)

A

PENINCILLINS AND CEPHALOSPORIN ARE EFFECTIVE/SAFE IN PREGNANCY

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122
Q

Acute pyelonephritis is characterized by a triad of _____, _____ & ______

A

-LOIN PAIN
-FEVER
-TENDERNESS OVER THE KIDNEYS (COSTOVERTEBRAL ANGLE TENDERNESS)

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123
Q

The necrotizing form of pyelonephritis with gas formation is known as __________ and occasionally seen in _____ patients

A

EMPHYSEMATOUS PYELONEPHRITIS IS OCASSIONALLY SEEN IN DM PATIENT

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124
Q

Xanthogranulomatous pyelonephritis is characterized by ________

A

ACCUMULATION OF FOAMY MACROPHAGES

GENERALLY REQUIRES NEPHRECTOMY

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125
Q

Treatment of recurrent or chronic UTI

A

AMOXICILLIN/ CLAVUNATE- 500/125MG (ORALLY)- 12HRLY, OR
TRIMETHOPRIN- 300MG (ORALLY) DLY, OR
CEPHALEXIN- 500MG (ORALLY) 12HRLY,

all for 10-14 days

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126
Q

List the “ALARMS” symptoms in dyspepsia

A

A-NAEMIA
L-OSS OF WEGHT (UNINTENTIONAL)
A-NOREXIA
R-ECENT ONSET OF PROGRESSIVE SYMPTOMS
M-ALAENA/HAEMATEMESIS
S-WALLOWING DIFFICULTY (DYSPHAGIA)

127
Q

FIRST CHOICE PROPHYLACTIC THERAPY FOR UTI (hint: 2)

A

-Trimethoprim- 100mg @ night
-Nitrofurantoin- 50mg @ night,
all continuously

128
Q

First choice treatment for Pyelonephritis & complicated UTI (with associated systemic toxicity) (hint: 2)

A

-co-amoxiclav- 500/125mg 8hrly
-ciprofloxacin- 500mg 12hrly,

all for 10 days

129
Q

Antibiotic treatment of asymptomatic bacteriuria in pregnancy is given for _____ days

A

7-DAY COURSE OF ANTIBIOTICS

TO PREVENT RISK OF PYELONEPHRITIS, LBW INFANT AND PRE-TERM BIRTH

130
Q

All cases of Asymptomatic bacteriuria should be treated with antibiotics, T/F

A

FALSE

except in Pregnancy

131
Q

UTI preventive measures:
- In Men (hint: 3)
- In women (hint: )

A

IN MEN:
-INSTRUCTION ON PERINEAL HYGIENE
-MORE FREQUENT BLADDER EMPTYING
-POST-INTERCOURSE VOIDING

IN WOMEN:
-FLUID INTAKE OF @ LEAST 2L/DAY
-REGULAR COMPLETE EMPTYING OF BLADDER
-GOOD PERSONAL HYGIENE
-EMPTYING OF THE BLADDER B/4 & AFTER SEXUAL INTERCOURSE

132
Q

Principles of treatment of common animal bites/stings (hint:

A

(a) Debride the affected area where applicable
- washing with soap and water.
(b) Allay pain and anxiety.
(c) Neutralize or dilute chemicals (toxin or venom).
(d) Destroy possible infectious agents.
(e) Administer prophylaxis against tetanus.
(f) Combat anaphylactic reaction where present or developing

133
Q

Bite wounds should be sutured, T/F

A

FALSE

NB. Remember bite wounds should not be sutured!!!

134
Q

Rabies infection can be gotten only from dog bite, T/F

A

FALSE

occurs more in wild animals – foxes, skunks and bats, although domestic animals carry a risk.

135
Q

Rabies virus is carried only by dogs, T/F

A

FALSE

136
Q

The two types of rabies a dog infected with rabies virus may have and their features (hint: 2)

A

Furious rabies- Characterized by agitation and viciousness, followed by paralysis and death
Dumb Rabies – in which paralytic symptoms predominate

137
Q

What is pathognomic of Rabies infection

A

The presence of intracytoplasmic inclusion bodies called Negri bodies in the Cornu Ammonis of the brain is pathognomonic of Rabies

138
Q

CLINICAL FEATURES OF THE RABID DOG (hint: 12)

A
  1. Driveling of thick tenacious saliva
  2. Develops a hoarse voice
  3. Deglutition difficulties
  4. Incontinent of urine and faeces
  5. Hydrophobia and aerophobia
  6. Divergent strabismus and other eye findings including protrusion of the nictitating membrane, myosis & discharge from the medial canthus
  7. Strange or peculiar behaviour.
  8. Restlessness.
  9. Cardinally, the dog’s attitude is one of rage alternating with calmness.
  10. Progressive paralysis of the hind quarters and mandible.
  11. Paraesthesia
  12. Convulsion
139
Q

How do you diagnose rabies in a suspected rabid animal, e.g., dog

A

Fluorescent antibody test or virus isolation from serum of infected animal

140
Q

The best treatment for rabies infection is ______________

A

Prevention

141
Q

Steps in treatment of an individual following a bite of a rabies infected animal (hint: 7)

A
  1. Wash wound vigorously with soap and water.
  2. Irrigate wound with iodine or alcohol
  3. Leave wound un-sutured but maintain haemostasis.
  4. Administer ATS – test dose, then
    - 1,500iu prophylactic dose
    (or 10,000iu therapeutic dose)
  5. Passive Immunization – (a) Human rabies immune globulin (RIG) 20U/kg body weight – half of total dose infiltrated around the wound, the remainder intramuscularly, OR Anti-Rabies serum (ARS) of equine origin 40u/kg – Half total dose infiltrated around wound, remainder intramuscularly
  6. Active immunization:- (a) Human Diploid cell vaccine (HDCV) – 0.1ml intra-dermally on days: 0, 3, 7, 14, 28 and 90th days (WHO recommended) or, (b) Duck Embryo vaccine (DEV)
    Subcutaneously 1ml/day for 21 days, or
    Two 1ml injections/day for 7 days and 1ml injection/day for another 7 days.
  7. If Rabies develops, treatment is symptomatic. Aim at control of respiration, circulation and central nervous system symptoms
142
Q

Concerning prevention of rabies, age of immunization of dog is ____ months

A

six months

143
Q

PRE-EXPOSURE IMMUNIZATION SCHEDULE FOR HUMANS FOR RABIES (hint: can be given in 3 ways. At least attempt 1 schedule, Idan!)

A
  1. Three 1ml intramuscular injections at deltoid area with second injection on 7th day and 3rd dose two or three weeks later
    or,
    2) DEV - Either
    Two 1ml subcut. injections 1 month apart and 3rd dose six months afterwards, or
    Three 1ml doses one week apart and a 4th 1ml dose 3/12 later.

NB. Individuals in repeated or constant exposure must have booster every 2 to 3 years unless antibody titres in the body rises appreciably

144
Q

myo-toxic or cellulo-toxic venom is linked to which family of snakes

A

Hydrophidae (Sea snakes)

145
Q

Venom from Elapidae is __________

A

Neurotoxic

146
Q

Viperidae venom is ______

A

Hematotoxic

147
Q

Treatment of Spider bite (hint: 5)

A
  1. Infiltration with 2 – 5 ml of 1% lignocaine hydrochloride
  2. i.v. Pethidine 50mg if necessary
  3. Subcut. Atropine 0.5mg stat. & prn.
  4. i.v. Calcium gluconate 1.0g stat & prn.
  5. Combat anaphylaxis conventionally
148
Q

Millipedes bite, T/F

A

FALSE

but when handled may discharge a toxic secretion

149
Q

Centipedes bite, T/F

A

TRUE, Painful

Lymphangitis and lymphadenitis do occur following such bites

150
Q

Treatment of Centipede bite (hint: 3)

A

Ice packs to site of bite, local anaesthetic agent infiltration may be required as well as corticosteroids

151
Q

Alcohol disinfectant is indicated for used in irritation of local skin from Millipede secretion, T/F

A

FALSE

Use of alcohol disinfectant should be avoided

152
Q

Treatment of Human bite

A

Cleaning with soap and copious amounts of water is imperative because of increased propensity to infection.
Anti-tetanus prophylaxis is highly indicated.
Antibiotics must be administered.
No Suturing for bite wounds

153
Q

Treatment of Scorpion sting (hint: 5)

A
  1. Infiltration with 2 – 5 ml of 1% lignocaine hydrochloride
  2. i.v. Pethidine 50mg if necessary
  3. Subcut. Atropine 0.5mg stat. & prn.
  4. i.v. Calcium gluconate 1.0g stat & prn.
  5. Combat anaphylaxis conventionally

N/B: same of Treatment of Spider bite

154
Q

Bee stings are alkaline, T/F

A

TRUE

155
Q

Sting of Wasps is acidic, T/F

A

TRUE

156
Q

Sting of Hornets is alkaline, T/F

A

FALSE

157
Q

Sting of Ants is acidic, T/F

A

TRUE

158
Q

Treatment of Bee sting

A

Topical application of vegetable oils to bee sting e.g. palmitic acid or oleic acid (Since Bee stings are alkaline)
In severe sensitivity reactions – Subcut. Adrenaline & Hydrocortisone may be needed

159
Q

Treatment of stings of Wasp, Hornets & ants

A

Topical application of liquid milk to wasp, hornets or ant sting sooths the pain (all acidic)
In severe sensitivity reactions – Subcut. Adrenaline & Hydrocortisone may be needed

160
Q

Generally venomous fish have ______spines covered by venom secreting tissues

A

bony spines

161
Q

Treatment of fish sting

A

Weak solutions of vinegar inactivate nematocysts rapidly and completely.
The affected area should not be rubbed with wet hands or cloth.
Calamine lotion could be applied after the vinegar has dried

162
Q

Sub cut. adrenaline is indicated for human , T/F

A

FALSE

162
Q

Asthma is an inflammatory disease of the large airway, T/F

A

FALSE

SMALL AIRWAYS

163
Q

The wheeze in Asthma is polyphonic, T/F

A

TRUE

164
Q

Clinical manifestations of asthma are in paroxysms, T/F

A

TRUE

165
Q

Asthma is characterized by episodic, irreversible bronchial obstruction, T/F

A

FALSE

EPISIODIC, REVERSIBLE BRONCHIAL OBSTRUCTION

166
Q

Asthma is due to _____ of tracheobronchial tree to a multiple of intrinsic & extrinsic stimuli

A

HYPER-RESPONSIVENESS

167
Q

All episodes of Asthmatic attack need therapy to be relieved, T/F

A

FALSE- can be relieved Spontaneously

MAY BE RELIEVED SPONTANEOUSLY OR AS A RESULT OF THERAPY

168
Q

Asthma can develop at any age, T/F

A

TRUE

169
Q

Asthma tend to develop between the ages of ___ & ___years

A

Between 2 and 7 years

170
Q

Cough variant asthma is a common presentation of asthma in children, T/F

A

TRUE

171
Q

Asthma is ranked 1st in Nigeria as the most chronic disease in childhood, T/F

A

FALSE

Ranked 2nd. Pulmonary TB ranked 1st

172
Q

_______ drug is the cornerstone of Asthma treatment

A

Corticosteroid (Inhaled)

173
Q

The focus on management of Asthma should be on prompt treatment, T/F

A

FALSE

PREVENTION

174
Q

Types of Asthma

A

Extrinsic asthma
Intrinsic asthma

175
Q

Extrinsic asthma is also called (hint : 2)

A

ATOPIC ASTHMA, EARLY ONSET ASTHMA

176
Q

Intrinsic asthma is also called (hint : 2)

A

NON-ATOPIC ASTHMA, LATE ONSET ASTHMA

177
Q

Intrinsic asthma begins especially in childhood, T/F

A

FALSE

IT CAN BEGIN AT ANY AGE, ESPECIALLY IN THE LATE ADULTHOOD

178
Q

Atopic patients can be identified by _______test

A

Skin sensitive tests

179
Q

Asthmatic inflammatory reactions is characterized by cellular infiltration rich in ________ cells

A

Eosinophils

180
Q

Onset of extrinsic asthma is in childhood, T/F

A

TRUE

181
Q

In Intrinsic asthma there is a role of allergens in the production of the disease, T/F

A

FALSE

182
Q

There are identifiable causes of asthma, T/F

A

FALSE

183
Q

List factors that may trigger an asthmatic attack (hint: 11)

A
184
Q

Triad of Aspirin-sensitive Asthma

A

ASTHMA, NASAL POLYPS & ASPIRIN SENSITIVITY

185
Q

Asthma is a chronic airway inflammation, T/F

A

TRUE

186
Q

Mention the activated cell types that infiltrate the airway during inflammation in asthma (hint: 4)

A

ACTIVATED EOSINOPHILS, MAST CELLS, MACROPHAGES AND T-LYMPHOCYTES

187
Q

Concerning the pathophysiology of Asthma, evidences of Airway Remodeling are (hint: 4)

A
  1. SMOOTH MUSCLE HYPERTROPHY AND HYPERPLASIA – (CAUSE BRONCHIAL SMOOTH MUSCLE CONTRACTION)
  2. GOBLET CELL AND SUB-MUCOSAL GLAND HYPERTROPHY LEADING TO MUCOUS HYPERSECRETION + DENUDATION AND DESQUAMATION OF THE EPITHELIUM FORMING MUCOUS PLUGS ( MUCOUS PLUGS THAT OBSTRUCT THE AIRWAY)
  3. COLLAGEN DEPOSITION CAUSING THICKENEING OF LAMINA RETICULARIS
  4. CELLULAR INFILTRATION, OEDEMA

Results in air wall thickening

188
Q

The classic symptoms of Asthma are (hint: 4)

A

-WHEEZING
-COUGHING ESP @ NIGHT
-TIGHTNESS OF THE CHEST
-BREATHLESSNESS

189
Q

A child with recurrent nocturnal cough should be suspected to have _____

A

Asthma

190
Q

An individual with intermittent dyspnea especially after exercise should be suspected to have _____

A

Asthma

191
Q

Absence of physical signs on P/E of a suspected asthma case excludes the diagnosis of asthma, T/F

A

FALSE

THE ABSENCE OF PHYSICAL SIGNS DOES NOT EXCLUDE A DIAGNOSIS OF ASTHMA

192
Q

On P/E in an asthmatic patient, the following can be seen. Mark T/F
a. Tachypnea
b. Hyperinflated chest
c. Dull percussion note
d. Diminished air entry
e. Widespread monophonic wheeze

A

a. Tachypnea (T)
b. Hyperinflated chest (T)
c. Dull percussion note (F)
d. Diminished air entry (T)
e. Widespread monophonic wheeze (F)

193
Q

Nocturnal asthma is an overnight fall of >___% of the FEV1 or PEFR

A

> 20%

194
Q

Review of Asthma treatment should be done every ___to__ months

A

3 to 6 months

195
Q

When should STEP DOWN in asthma treatment be considered?

A

IF CONTROL IS SUSTAINED FOR 3 MONTHS
Step-wise reduction (step down) in asthma treatment

196
Q

When should STEP UP in asthma treatment be considered?

A

IF CONTROL IS NOT ACHIEVED IN 3 MONTHS
step-wise increase (step up) in asthma treatment

197
Q

Gastric asthma is due to _____

A

GASTRO-OESOPHAGEAL REFLUX (REFLUX-REFLEX)

198
Q

Gastric asthma is treated by giving bronchodilators, T/F

A

FALSE

THIS IS TREATED BY AVOIDING ORAL BRONCHODILATORS AND INSTITUTING ANTI-REFLUX THERAPY

199
Q

Therapy for Exercise-induced asthma is

A

THERAPY WITH PRE-EXERCISE BRONCHODILATORS OR SODIUM CROMOGLYCATE

200
Q

The asthma where patient has no respiratory systems between episodes is called

A

EPISODIC ASTHMA

201
Q

Chronic asthma may stimulate chronic bronchitis, T/F

A

TRUE

202
Q

Characteristics of Status asthmaticus (hint: 6)

A
  1. Altered level of consciousness
  2. Sweating
  3. Tachycardia
  4. Tachypnea
  5. Pulsus paadoxus
  6. Decreased Inspiratory-expiratory raito
203
Q

FEV1/FVC >90% is suggestive of obstructive airway disease, T/F

A

FALSE

Restrictive lung disease

204
Q

FEV1/FVC <70% is suggestive of ____airway disease

A

Obstructive airway disease

205
Q

Total lung volume = ____+ _____

A

Residual volume + Vital capacity

206
Q

The volume of air breath out after the deepest inspiration is ____

A

Vital capacity

207
Q

Spirometry can be performed for all age groups, T/F

A

FALSE

can’t be done in children <6yrs and (maybe adults that have muscular issues)

208
Q

Investigations of asthma (hint: 5)

A
  1. MEASUREMENT OF PEAK EXPIRATORY FLOW RATE (PEFR)
  2. SPOROMETRY
  3. SKIN PRICK TESTING (to measure allergic status in patients with atopy)
  4. INDUCED SPUTUM DIFFERENTIAL EOSINOPHIL COUNT (ASSESSMENT OF EOSINOPHILIC AIRWAY INFLAMMATION)
  5. CHEST X-RAY
  6. EXERCISE CHALLENGE TEST
209
Q

Drugs used to prevent asthma (hint: 3)

A

SODIUM CROMOGLYCATE
NEDOCROMIL SODIUM
KETOTIFEN

210
Q

Management of Acute severe Asthma

A
211
Q

Depending on the ________ of the emergency, mgt may involve multiple levels of care

A

Severity of emergency

212
Q

Define medical emergency (hint: 4 import lines/point

A
  1. ANY CONDITION MANIFESTING ITSELF BY ACUTE SYMPTOMS
  2. OF SUFFICIENT SEVERITY (INCLUDING SEVERE PAIN)
  3. SUCH THAT THE ABSENCE OF IMMEDIATE MEDICAL ATTENTION
  4. COULD REASONABLY PLACE THE PATIENT’S HEALTH IN SERIOUS JEORPARDY, SERIOUS IMPAIRMENT TO BODY FUNCTIONS OR ORGAN DYSFUNCTIONS
213
Q

Define Emergency from an Observer’s point of view

A

ANY CONDITION PERCEIVED BY A PRUDENT LAY PERSON OR SOMEONE ON BEHALF OF THE PATIENT AS REQUIRING IMMEDIATE MEDICAL OR SURGICAL TREATMENT

214
Q

Any response to medical emergency situation will depend on 4 factors

A

-THE SITUATION AROUND THE EMERGENCY
-THE PATIENT INVOLVED
-THE AVAILABILITY OF RESOURCES
-LOCATION OF THE EMERGENCY

215
Q

EVERY PATIENT HAS THE RIGHT TO BE INFORMED BY THE HOSPITAL OF HIS RIGHT TO RECEIVE EMERGENCY SERVICES, T/F

A

TRUE

216
Q

Mention the General principles/steps in mgt of medical emergencies (more of like emergencies in general)

A

A. Primary survey/Preliminary assessment
1. Airway + cervical spine protection
2. Breathing + ventilation control
3. Circulation/hemorrhage control
4. Disability
5. Exposure

B. Secondary survey
1. Quick history from the relatives
2. Urgent investigations needed to confirm certain conditions (e.g., RBS)

c. Ensure resuscitation & stability

D. Detailed history, examination & investigation

217
Q

In the ‘D’ in Primary survey of medial emergency, what do you assess/check for (hint: 2 things)

A
  1. Level of consciousness
    a. AVPU - (for quick assessment)
    b. GCS - (if there is time)
  2. Pupils - size, equality & reactivity
218
Q

Concerning the Primary survey in medical emergency mgt, be cautious to avoid ______ when exposing the patient for proper assessment

A

Hypothermia

219
Q

Concerning emergency mgt, for the medical practitioner to be prepared mentally & physically, he needs to ____, ____ & ______

A

PLAN, EQUIP & PRACTISE

220
Q

Mention the vital skills in emergency mgt (hint: 7)

A

1) RAPID INTRAVENOUS ACCESS- DIRECT OR CUT DOWN
2) CPR (INCLUDING UPPER AIRWAY RELIEF, INTUBATION, VENTILATION, TREATMENT OF CARDIAC ARRHTHMIAS/DEFIBRILLATION)
3) CRICOTHYROIDOTOMY
4) ARREST OF HAEMORRHAGE
5) KNOWLEDGE OF USAGE OF COMMON EMERGENCY DRUGS
6) SKIL IN THE USE OF BASIC MEDICAL EQUIPMENT
7) KNOWLEDGE OF BASIC MEDICAL/SURGICAL PROCEDURES
-PASSAGE OF URINARY CATHETER
-PASSAGE OF NG-TUBE
-RELIEF OF TENSION PNEUMOTHORAX
-RELIEF OF HAEMOTHORAX, ETC

221
Q

IN EMERGENCY, CONSIDER __________ FIRST & FOREMOST IN A PATIENT WITH ABDOMINAL PAIN WHO COLLAPSES (@ TOILET)

A

INTRA-ABDOMINAL BLEEDING

222
Q

IN EMERGENCY, ACUTE CHEST PAIN REPRESENTS __________UNTIL PROVEN OTHERWISE

A

MYOCARDIAL INFARCTION

223
Q

IN EMERGENCY, ALWAYS EXCLUDE _________ IN A CHILD WITH A SUDDEN ONSET OF RESPIRATORY DISTRESS & PALLOR

A

ACUTE EPIGLOTTITIS

224
Q

IN EMERGENCY, ALWAYS CONSIDER THE POSSIBILITY OF _________ IN A PATIENT WITH PAST HISTORY OF ALLERGIES

A

ACUTE ANAPHYLAXIS

225
Q

IN EMERGENCY, ALWAYS CONSIDER _________ IN ANY WOMAN OF CHILD BEARING AGE PRESENTING WITH ACUTE ABDOMINAL PAIN

A

ECTOPIC PREGNANCY

226
Q

IN EMERGENCY, IF A PATIENT IS FOUND CYANOTIC, ALWAYS CONSIDER_________ FIRST

A

UPPER AIRWAY OBSTRUCTION

227
Q

IN EMERGENCY, CONSIDER_____________ FORMOST IN AN ADULT WITH SUDDEN COLLAPSE OR DIZZINESS

A

VENTRICULLAR FIBRILLATION OR OTHER ARRHYTHMIAS

228
Q

DEFINE EMERGENCY MANAGEMENT SYSTEM-TRIAGE

A

THIS REFERS TO EVALUATION AND CATEGORIZATION OF THE SICK OR WOUNDED WHEN THERE ARE INSUFFICIENT RESOURCES FOR MEDICAL CARE OF EVERYONE @ ONCE

229
Q

Triage applies only in the Accident & emergency unit, T/F

A

FALSE

MASS CASUALTY, CROWDED EMERGENCY ROOMS AND WALKING-IN-CLINICS

230
Q

IN A WALK-IN-CLINIC OR EMERGENCY DEPARTMENT, AN INTERVIEW WITH A DOCTOR IS A KNOWN FIRST STEP TO RECEIVING CARE. T/F

A

TRIAGE NURSE

231
Q

The START triage system group victims into 3 categories, T/F

A

FALSE - 4

THE DISEASED WHO ARE BEYOND HELP
-THE INJURED WHO COULD BE HELPED BY IMMEDIATE TRANSPORTATION
-THE INJURED WITH LESS SEVERE INJURIES WHOSE EVACUATION CAN BE DELAYED
-THOSE WITH MINOR INJURIES WHO MAY NOT REQUIRE URGENT CARE

232
Q

Using the Colour coding Triage system, assign colour tags to the following situations
a. THE “WALKING WOUNDED” PATIENT WHO WILL NOT NEED IMMEDIATE
MEDICAL CARE TREATMENT
b. THOSE WHO CANNOT SURVIVE WITHOUT IMMEDIATE TREATMENT BUT HAVE THE CHANCE OF SURVIVAL IF TREATED
c. THOSE WITH MINOR INJURIES FOR WHO A DOCTOR ‘S ATTENTION MAY NOT BE REQUIRED
d. THE DISEASED AND FOR THOSE WHOSE INJURIES ARE SO EXTENSIVE THEY WILL NOT BE ABLE TO SURVIVE, GIVEN THE CARE THAT IS AVAILABLE
e. THOSE THEIR CONDITION IS STABLE FOR THE MOMENT AND THEY ARE NOT IN IMMEDIATE DANGER OF DEATH

A

a. GREEN TAG (WAIT) - i.e., in Reserved
b. RED TAG (IMMEDIATE)
c. WHITE TAGS (DISMISS)
d. BLACK TAGS (EXPECTANT)
e. YELLOW TAG (OBSERVATION) - REQUIRE OBSERVATION AND POSSIBLY RE-TRIAGE

233
Q

Major causes of Under-5 deaths in Nigeria (List top 5)

A
  1. Neonatal diseases/complications
  2. Respiratory tract infection/Pneumonia
  3. Diarrhoeal diseases
  4. Malaria
  5. Measles
  6. Injuries
  7. HIV/AIDS
  8. OTHERS
234
Q

Improving routine immunization (RI) coverage would reduce child mortality, T/F

A

TRUE

235
Q

Childhood immunization falls under 2nd UN-SDG, T/F

A

FALSE

3RD GOAL OF UNITED NATIONS SUSTAINABLE DEVELOPING GOALS (UN-SDGs)

236
Q

Importance of Immunization (hint: 5)

A
  1. IT IS A PREVENTIVE MEDICINE
  2. ERADICATION AND ELIMINATION OF SOME DISEASE.
  3. IT PROVIDES HERDS IMMUNITY
  4. IT PROMOTES HEALTH AND OPTIMAL GROWTH AND DEVELOPMENT IN CHILDREN
  5. IT IS A COMPONENT OF CHILD SURVIVAL STRATEGY.
237
Q

Factors affecting Routine Immunization in Nigeria (hint: 6)

A
  1. MISPERCEPTIONS OF ROUTINE IMMUNIZATION.
  2. INFLUENCE OF RELIGION.
  3. INADEQUATE COLD CHAIN EQUIPMENT.
  4. POLITICAL PROBLEMS
  5. REJECTION OF ROUTINE IMMUNIZATION-FEAR AND CONFUSION, LOW CONFIDENCE AND LACK OF TRUST.
  6. SHORTAGE OF VACCINES AND IMMUNIZATION SUPPLIES
238
Q

Mention the Live attenuated vaccines (hint: 8)

A

Measles, Mumps, Rubella, BCG, OPV, Varicella Zooster, Rota virus vaccines

(MY BOyZ R) Addition- Thyphoid vaccine

239
Q

All vaccines are Thermosensitive, T/F

A

TRUE

240
Q

All vaccines are Photosensitive, T/F

A

FALSE

241
Q

Mention 4 vaccines that are Photosensitive (i.e., stored in dark glass vials)

A

Measles, Mumps, Rubella, BCG vaccines

242
Q

Mention the components of the New Immunization schedule (hint: Birth, 6wks, 10wks, 14wks, 9months, 15-18months, 24months, 12-24months, Girls(>=13yrs)

A

Visit the Material and your Note

243
Q

According to the New NPI, Thyphoid vaccine is given in ____month

A

24 months

244
Q

Human Papilloma virus vaccine should be commenced in girls at ____age

A

13 years of age

245
Q

According the NPI schedule, BCG vaccine should be taken on or before 5months of life, T/F

A

FALSE

SCHEDULE- @ BIRTH, OR AS SOON AS POSSIBLE WITHIN THE FIRST 3 MONTHS AFTER BIRTH

246
Q

BCG vaccine is contraindicated in ____ babies

A

BABIES OR INFANTS SHOWING SYMPTOMS OF HIV INFECTION

247
Q

Storage temperature for vaccines is between ___ & ___ degree Celsius

A

+2 ‘C to +8’C (degree Celsius)

248
Q

Rota virus vaccine schedule dose in NPI is 3, T/F

A

FALSE - 2

SCHEDULE-2 DOSES @ 6 & 10 WEEKS

249
Q

Route for administering Rota virus vaccine is _____

A

Oral drop (1.5ml)

250
Q

3rd dose of Tetanus toxoid confer a protection for _____ yrs

A

5years

251
Q

Define cold chain vaccine system

A

IT IS A SYSTEM OF TRANSPORTING AND STORING VACCINES WITHIN WHO RECOMMENDED TEMPERATURE RANGES, FROM THE POINT OF MANUFACTURE TO THE POINT OF ADMINISTRATION

252
Q

Procurement of vaccine through UNICEF to the National cold vaccine store is on a monthly basis, T/F

A

FALSE.

Procurement of vaccine is on a QUARETERLY basis for National Central cold store, Zonal cold stores and States cold stores

253
Q

Procurement of vaccine through the State cold vaccine store is on a monthly basis, T/F

A

TRUE

254
Q

REQUIREMENTS FOR AN IDEAL SUTURE

A
255
Q

Classes of Drugs used in Asthma treatment (hint: 8)

A
  1. B2-ADRENOCEPTOR AGONISTS- BRONCHODILATOR (-SABA- SALBUTAMOL; LABA- SALMETEROL, FOMOTER)
  2. ANTI-CHOLINERGIC- RELAXES SMOOTH MUSCLES OF BRONCHIOLES- BRONCHODILATORS, (Eg. IPATROPIUM, TIOTROPIUM, ETC)
  3. METHYL XANTHINES - AMINOPHYLLINE- BRONCHODILATOR- METABOLISED TO THEOPHYLLINE-
  4. CORTICOSTEROIDS- ANTI-INFLAMMATORY, AVAILABLE :
    -ORAL FORM (PREDNISOLONE), INJECTABLE (HYDROCORTISONE), INHALER (BECLOMETASONE)
  5. LEUKOTRIENE- RECEPTOR ANTAGONIST ( e.g MONTELUKAST, ZARFIRLUKAST)
  6. 5-LIPOXYGENASE INHIBITOR - ZILEUTON
  7. ANTI-IgE MONOCLONAL ANTI-BODY - OMALIZUBAB
  8. CROMOGLYGATE- ALWAYS INHALED- USED AS PROPHYLAXIS IN MILD AND EXERCISE-INDUCED ASTHMA. (NOTE: IT MAY PRECIPITATE ASTHMA)
256
Q

Asthma class of drug primarily reserved for severe asthma is _______

A

5-LIPOXYGENASE INHIBITOR - ZILEUTON

257
Q

For classification of Severity of Asthma, describe STEP 1
INTERMITTENT asthma (Day-time symptoms, Night-time symptoms, PFR: Predicted & Variability)

A

Day-time symptoms: < 1 TIME A WEEK, ASYMPTOMATIC AND NORMAL PEF BETWEEN ATTACKS

Night-time symptoms: ≤ 2 TIMES A MONTH

PFR: ≥ 80% PREDICTED, VARIABILITY < 20%

258
Q

For classification of Severity of Asthma, describe STEP 2 MILD PERSISTENT asthma (Day-time symptoms, Night-time symptoms, PFR: Predicted & Variability)

A

Day-time symptoms: ≥ 1 TIME A WEEK BUT < 1 TIME A DAY

Night-time symptoms: > 2 TIMES A MONTH

PFR: ≥ 80% PREDICTED, VARIABILITY 20-30%

259
Q

For classification of Severity of Asthma, describe STEP 3 MODERATE PERSISTENT asthma (Day-time symptoms, Night-time symptoms, PFR: Predicted & Variability)

A

Day-time symptoms: DAILY USE, ᵦ₂ AGONIST, DAILY ATTACK AFFECTS ACTIVITY

Night-time symptoms: > 1 TIME A WEEK

PFR: >60% - <80% PREDICTED, VARIABILITY > 30%

260
Q

For classification of Severity of Asthma, describe STEP 4 SEVERE PERSISTENT asthma (Day-time symptoms, Night-time symptoms, PFR: Predicted & Variability)

A

Day-time symptoms: CONTINUOUS LIMITED PHYSICAL ACTIVITY

Night-time symptoms: FREQUENT

PFR: ≤ 60% PREDICTED, VARIABILITY >30%

261
Q

Normal value for FEV1/FVC is ___ to ___%

A

75-85%

262
Q

Normal value for FEVI is ____

A

> = 80%

263
Q

FEV1/FVC <70% is suggestive of _____

A

Obstructive Lung Disease (COPD & Asthma)

264
Q

In COPD, airflow obstruction is fully reversible, T/F

A

FLASE

COPD IS A RESPIRATORY DISEASE CHARACTERISED BY AIRFLOW OBSTRUCTION THAT IS NOT FULLY REVERSIBLE

265
Q

COPD is characterised by ____ & ______

A

persistent respiratory symptoms and airflow limitation

266
Q

Define COPD according to GOLD

A

a common, preventable and treatable disease, that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and / or alveolar abnormalities usually caused by significant exposure to noxious particles

267
Q

COPD IS NOT ASSOCIATED WITH ABNORMAL INFLAMMATORY RESPONSE OF THE LUNGS TO NOXIOUS PARTICLES OR GAS, T/F

A

FALSE

IT IS ALSO ASSOCIATED WITH ABNORMAL INFLAMMATORY RESPONSE

268
Q

Chronic bronchitis is the presence of cough with expectoration on most days for at least 2 months for more than 3 consecutive years, T/F

A

FALSE

COUGH WITH EXPECTORATION ON MOST DAYS FOR @LEAST 3 MONTHS A YEAR FOR MORE THAN TWO CONSECUTIVE YEARS

269
Q

EMPHYSEMA IS PERMANENT DILATATION AND DESTRUCTION OF LUNGS TISSUE DISTAL TO THE ________

A

TERMINAL BRONCHIOLES

270
Q

In Alpha-1-antitrypsin deficiency, emphysema develops at a younger age especially in smokers, T/F

A

TRUE

271
Q

In Centriacinar emphysema, there is predominant involvement of the upper lobe & apices of the lung, T/F

A

TRUE

272
Q

Centriacinar emphysema is commonly seen associated with Chronic bronchitis, T/F

A

TRUE

273
Q

_______ type of emphysema is associated with Alpha-1-antitrypsin deficiency

A

Panacinar emphysema

274
Q

The panacinar emphysema is predominant in the upper lung lobe & apices, T/F

A

FALSE

PREDOMINANT IN LOWER BASAL ZONES

275
Q

The type of emphysema that often causes spontaneous pneumothorax is _____

A

PARASEPTAL EMPHYSEMA

IT’S FOUND NEAR THE PLEURA AND OFTEN CAUSES SPONTANEOUS PNEUMOTHORAX

276
Q

Paraseptal emphysema involves only the middle portion of the acinus, T/F

A

FALSE

INVOLVES ONLY THE DISTAL ACINUS

277
Q

Mention the 4 types of Emphysema

A

CENTRIACINAR EMPHYSEMA
PANACINAR EMPHYSEMA
PARASEPTAL EMPHYSEMA
IRREGULAR EMPHYSEMA

278
Q

Mediastinal emphysema manifests as __________

A

Subcutaneous emphysema

THE ESCAPED AIR TRACKS UP INTO THE SUBCUTANEOUS TISSUES OF THE NECK , MANIFESTING AS SUBCUTANEOUS EMPHYSEMA

279
Q

Mediastinal emphysema can occur in which conditions (hint: 3)

A

-SEVERE BRONCHIAL ASTHMA
-RUPTURE OF EMPHYSEMATOUS BULLAE
-RUPTURE OF OESOPHAGUS

280
Q

Age of onset of Chronic bronchitis is the 6th decade,T/F

A

FALSE - 5th

6th for Emphysema

281
Q

Respiratory insufficiency is more common in emphysema, T/F

A

FALSE

282
Q

THE CHEST XRAY FINDING IN CHRONIC BRONCHITIS INCREASED BRONCHOVASCULAR MARKINS, SMALL HEART, T/F

A

FALSE

INCREASED BRONCHOVASCULAR MARKINS, LARGE HEART

283
Q

Concerning COPD, Pulmonary hypertension is more common in Emphysema compared to Chronic bronchitis

A

FALSE

284
Q

COPD is more common in younger people, T/F

A

FALSE

285
Q

Consider COPD in patients > ___ years with a risk factor for COPD(generally smoking) + >= 1 respiratory symptom

A

> 35years

286
Q

In P/E in a COPD patient, there is increased Cricosternal distance, T/F

A

FALSE

↓CRICOSTERNAL DISTANCE

287
Q

STOPS FOR BREATH AFTER WALKING 100M OR AFTER A FEW MINUTES ON LEVEL GROUND IS GRADE ___ IN THE MRC DYSPNOEA SCALE

A

GRADE 3

288
Q

Spirometry measures functional lung volume, T/F

A

TRUE

289
Q

In COPD, only FEV1 is reduced, T/F

A

FALSE- FVC is also reduced

FEV1 IS REDUCED MORE THAN FVC

290
Q

Total lung capacity & Residual volume are increased in obstructive lung disease, T/F

A

TRUE

291
Q

Chest X-ray features in COPD (hint: 6)

A

HYPERINFLATION
>6 ANTERIOR RIBS SEEN ABOVE DIAPHRAGM IN MID-CLAVICULAR LINE
FLAT HEMI-DIAPHRAGM
LARGE CENTRAL PULMONARY ARTERIES
↓PERIPHERAL VASCULAR MARKINGS
BULLAE

292
Q

Early onset COPD or COPD with associated is likely _____

A

Alpha-1-Antitrypsin deficiency Emphysema

293
Q

Classification of Severity of COPD is based on _____

A

Post bronchodilator FEV1

294
Q

Non-pharmacological therapy in COPD (hint: 5)

A

1) SMOKING CEASSATION- MOST IMPORTANT
-ASSESS WILLINGNESS TO QUIT SMOKING- ADVICE, ASSIST, AND ARRANGE TO FOLLOW UP
2) VACCINATION- ALL PATIENTS WITH COPD SHOULD HAVE INFLUENZA AND PNEUMOCOCCAL VACCINATION
3) EXERCISE-LACK OF EXERCISE ↓ FEV1
4) NUTRITION-WEIGHT REDUCTION IN OBESE PATIENTS IMPROVES EXERCISE TOLERANCE
5) SCREEN FOR DEPRESSION

295
Q

AIDS REMAINS THE 2ND LEADING CAUSE OF DISEASE BURDEN WORLWIDE, T/F

A

TRUE

296
Q

Key Populations that are at increased risk at contracting HIV are (hint: 5)

A
  1. men who have sex with men (gay men)
  2. people who inject drugs
  3. people in prisons and other closed settings
  4. sex workers and their clients
  5. transgender people
297
Q

Exposure to HIV infected person fluid lead to risk of contracting infection which is dependent on certain factors (hint: 4)

A

INTEGRITY OF EXPOSED SITE
TYPE OF FLUID
VOLUME OF FLUID
VIRAL LOAD

298
Q

HIV can enter a new host either as _____ or _____

A

As a free virus or within cells

299
Q

Mode of spread or Route of transmission of HIV are (hint: 3)

A
  1. SEXUAL (MALE TO MALE, HETEROSEXUAL AND ORAL)
  2. PARENTERAL (BLOOD OR BLOOD PRODUCT RECIPIENTS, INJECTION DRUG USERS AND THOSE EXPERIENCING OCCUPATIONAL INJURY)
  3. VERTICAL
300
Q

HIV is a double stranded retrovirus, T/F

A

FALSE

301
Q

HIV is a DNA retrovirus

A

FALSE

RNA retrovirus

302
Q

HIV is a retro virus of _____virus family

A

Lenti virus family

303
Q

_________ predicts the progression of HIV to AIDS

A

The number of circulating viruses (Viral load)

304
Q

The cornerstone in the mgt of HIV/AIDS is ______

A

HIGHLY ACTIVE ANTI-RETROVIRAL THERAPY (HAART) AND IT IS THE CONERSTONE OF MANAGEMENT

305
Q

In Perinatal HIV prevention, Routine ‘Opt-in’ antenatal HIV testing is recommended, T/F

A

FALSE

Routine ‘Opt-out’

306
Q

Concerning prevention of HIV (stating the Primary/ Secondary/ Tertiary levels)
- for Sexual route of transmission

A

SEXUAL:
1. COMPREHENSIVE SEX EDUCATION PROGRAMES IN SCHOOLS
2. PUBLIC AWARENESS CAMPAIGNS FOR HIV
3. EARLY ACCESSIBLE/DISCREET TESTING CENTRES
4. SAFE SEXUAL PRACTICES (AVOIDING PENETRATIVE INTERCOURSE, DELAYING 5. COITACHE/SEXUAL DEBUT, CONDOM USE, FEWER SEXUAL PARTNERS)
6. TARGETING SAFE SEX METHODS TO HIGHER RISK GROUPS
7. CONTROL OF STI’S
8. EFFECTIVE TREATMENT OF HIV-INFECTED INDIVIDUALS
9. POST-SEXUAL EXPOSURE PROPHYLAXIS

307
Q

Concerning prevention of HIV (stating the Primary/ Secondary/ Tertiary levels)
- for Parenteral route of transmission

A

PARENTERAL:
1. BLOOD PRODUCT TRANSFUSION: DONOR QUESTIONNAIRE, ROUTINE SCREENING OF DONATED BLOOD, BLOOD SUBSTITUTES
2. INJECTION DRUG USE: EDUCATION, NEEDLE/SYRINGE EXCHANGE AVOIDANCE

308
Q

Concerning prevention of HIV (stating the Primary/ Secondary/ Tertiary levels)
- for Perinatal & Vertical route of transmission

A

PERINATAL:
1. ROUTINE ‘OPT-OUT’ ANTE-NATAL HIV TESTING
2. PRECONCEPTION FAMILY PLANNING IF HIV-SEROPOSITIVE
3. MEASURES TO REDUCE VERTICAL TRANSMISSION

309
Q

Concerning prevention of HIV (stating the Primary/ Secondary/ Tertiary levels)
- for Occupational transmission

A

OCCUPATIONAL:
1.EDUCATION/TRAINING: UNIVERSAL PRECAUTIONS: NEEDLE STICK AVOIDANCE
2. POST-EXPOSURE PROPHYLAXIS

310
Q

Strategies to end AIDS (hint: 3)

A

1)HIV CARE CONTINUUM: (has 5 steps)
2)TREAT ALL/TEST AND TREAT
3) TARGET 95-95-95

311
Q

Mention the 5 steps for HIV care continuum

A
  1. -DIAGNOSIS OF HIV INFECTION
  2. -LINKAGE TO HIV MEDICAL CARE
  3. -RECEIPT OF HIV MEDICAL CARE
  4. -RETENTION IN HIV MEDICAL CARE
  5. -ACHIEVEMENT AND MAINTENANCE OF VIRAL SUPPRESSION
312
Q

UNIVERSAL ART FOR ALL HIV-INFECTED TB PATIENTS SHOULD BE GIVEN WITHIN__ WEEKS OF INITIATION OF ANTI-TB THERAPY

A

8 weeks

FAMILY MEDICINE (7 decks)

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