Dr. Iyanam Flashcards
Define Medical history/Medical case history of a patient
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
What is History taking?
A form of doctor-patient interaction which is systematic, that leads to diagnosis & formulation of care plan for the patient
MEDICAL HISTORY OBTAINED DIRECTLY FROM THE PATIENT IT IS CALLED (hint: 2)
ANAMNESIS SELF-REPORTING HISTORY
MEDICAL HISTORY OBTAINED FROM OTHER PEOPLE WHO KNOW THE PATIENT IT IS CALLED (hint: 2)
HETEROANAMNESIS OR COLLATERAL HISTORY
History taking is a form of practical medicine, T/F
TRUE
HOW TO ARRIVE AT DIAGNOSIS:
HISTORY TAKING= ____%
PHYSICAL EXAMINATION=___%
INVESTIGATION=____%
HISTORY TAKING= 60%
PHYSICAL EXAMINATION=20%
INVESTIGATION=20%
The type of history used on patients in emergency situation is _____
Short/Brief history
Add Focused
________ INTERVIEW TECHNIQUE IS USED WHEN IT IS SENSED THAT THE PATIENT IS NOT SPEAKING FREELY OR CLEARLY
CONFRONTATION
________ INTERVIEW TECHNIQUE ENCOURAGES COMMUNICATION BY SPECIFYING THE KIND OF INFORMATION BEING SOUGH USING GESTURES & WORDS
FACILITATION
List Interview techniques in history taking (hint: 6)
- QUESTION
- LISTENING AND SILENCE
- FACILITATION
- CONFRONTATION
- EMPATHETIC RESPONSE
- CLARIFICATION
Obtaining consent before history taking is not essential, T/F
FALSE
What is the part of Biodata YOU(Favour) do forget to obtain
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?
Group of people that will require an Informant during history taking are (hint: 5)
- CHILDREN
- UNCONSCIOUS PATIENT
- VERY OLD ELDERLY
- MENTALLY IMPARED PATIENTS
- PATIENTS WITH SPEECH DIFFICULTY
Presenting/Chief complaint should not be >5, T/F
FALSE
SHOULD NOT BE > 4 COMPLAINTS
Illness experience of a patient includes 4 things, which are
F-FEAR/FEELING
I-IDEA
F-FUNCTIONAL LOSS
E-EXPECTATION
Types of consent (hint: 2)
IMPLIED AND INFORMED CONSENT
Fowler’s position is _______position
Cardiac position
Physical examination is always detailed, T/F
FALSE
EXAMINATION COULD BE
a. BRIEF OR FOCUSED
b. DETAILED OR COMPREHENSIVE
Anthropometry is a part of General P/E, T/F
TRUE
FACTORS THAT INHIBIT MEDICAL HISTORY (HINDRANCE TO PROPER MEDICAL HISTORY TAKING) ARE (hint: 5)
- PHYSICAL INABILITY OF THE PATIENT TO COMMUNICATE WITH THE PHYSICIAN
- RELUCTANCE OF PATIENTS TO DISCLOSE INTIMATE OR UNCONFORTABLE INFORMATION
- TRANSITION TO PHYSICIANS THAT ARE UNFAMILIAR TO THE PATIENT
- CROWDED CONSULTING ROOM- NO PRIVACY
- PHYSICIANS UNFRIENDLY ATTITUDE
N/B: Arrangement is from Patient-induced factor (1, 2, 3) to Doctor-induced factors (4, 5)
A term used in medicine to describe the follow-up medical history of a patient after an illness is _________
CATAMNESIS
Routine medical examination is also known as _______ (hint: 4)
-ANNUAL
-YEARLY MEDICAL EXAMINATION
-OR COMPREHENSIVE OR PREVENTIVE HEALTH EXAMINATION
Concerning Routine medical examination, Mark T/F for the following
a, Therapeutic medicine
b. Regularly done
c. done by Symptomatic patient
a. F - PREVENTIVE
b. TRUE
c. FALSE - ASYMPTOMATIC
A pelvic examination should be carried out in a Routine medical examination, T/F
TRUE
Sensitivity to disease is high in Routine medical examination, T/F
FALSE
Very important things to check during P/E in PRESCHOOL/KINDERGARTEN EXAMINATION are (hint: 4)
VERY IMPORTANT:
-VISION
-HEARING
-BP
-DENTITION AND GUM
The Basic laboratory tests that should be done in Preschool/Kindergarten examination are (hint: 5)
-URINALYSIS
-LEAD POISONING
-GENOTYPE/SICKLING TEST
-CHEST X-RAY
-MANTOUX
Concerning Preschool/Kindergarten examination, the comprehensive Medical Certificate of Fitness should be issued to ______ & ______after the examination
PARENTS AND THE SCHOOL
The General laboratory investigations for Pre-employment medical examination are (hint: 5)
GENERAL –A MINIMUM OF 2 INVESTIGATIONS INCLUDING:
URINALYSIS, CHEST X-RAY, GENOTYPE, BLOOD GROUP, PCV/HB
The validity of a medical report/certificate of fitness lasts for _____month(s)
6 months
Concerning Pre-employment medical examination, declare stable chronic morbidity patient unfit, T/F
FALSE
DECLARE CHRONIC MORBIDITY UNFIT IF IT EXISTS AND IF STABLE, CERTIFY FIT
Concerning Medical Certificate of Fitness ,only the doctor’s name and signature are needed in the report, T/F
FALSE
GET THE REPORT STAMPED WITH OFFICIAL STAMP
Define Periodic medical examination
THIS IS MEDICAL EXAMINATION OF OSTENSIBLY HEALTHY INDIVIDUALS PERFORMED @ PRESCRIBED INTERVALS BY PHYSICIANS
PME IS A FORM OF HEALTH SCREENING
Periodic Medical examination is part of Routine medical exam, T/F
FALSE
In Periodic medical examination, the individual/patient visits the physician when ill, T/F
FALSE
NOTE: THE PATIENTS ARE USUALLY ASYMPTOMATIC OR HAVE NO MEDICAL COMPLAINT
Periodic medical examination is a Non-evidenced-supported screening procedure, T/F
FALSE
PME IS EVIDENCE-SUPPORTED SCREENING PROCEDURES
In Periodic medical examination, interventional benefits may be a part, T/F
TRUE
PME IS EVIDENCE-SUPPORTED SCREENING PROCEDURES WITH INTERVENTION BENEFITS
The increase in life expectancy noticed in developed countries is due to therapeutic care, T/F
FALSE
PREVENTIVE CARE
Chronic heart failure has a 50% mortality within ___years
3 years
Chronic Heart failure is characterized by two pathophysiologic factors which are
REDUCTION IN CARDIAC OUTPUT
FLUID RETENTION
The classic symptom of Chronic heart failure is _______
DYSPNOEA ON EXERTION
Cough in chronic heart failure occurs especially at night, T/F
TRUE - Nocturnal cough
There is increased intensity of P2 heart sound in Chronic heart failure, T/F
TRUE
Pulsus alterans is absent in chronic heart failure, T/F
FALSE
Heart sounds heard in Chronic HF are
S3 Gallop- S1, S2, S3
How do you make a diagnosis of Heart failure using Framingham criteria
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
Mention the Framingham Major criteria (hint: 11- Use Hx, P/E, INV (Echo, CXR), Post-mortem
Mention the Framingham Minor criteria (hint: 7- Use Hx, P/E)
In systolic HF, the Left ventricular Ejection fraction is <____%
< 40%
Systolic HF is due to ___________
SYSTOLIC FAILURE DUE TO AN INADEQUATE PUMPING ACTION OF THE HEART
Diastolic HF is due to ___________
DUE TO IMPAIRMENT OF LEFT VENTRICULAR FILLING
The classic heart failure is Diastolic HF, T/F
FALSE
Systolic HF
Biventricular Heart failure means _________
An elderly with Hypertension will likely have a Diastolic HF, T/F
TRUE
ASSESSMENT OF SEVERITY OF HEART FAILURE
CAN BE CONSIDERED FROM 3 DIFFERENT PERSPECTIVES, WHICH ARE
- DEGREE OF FUNCTIONAL DISABILITY/ DEGREE OF SEVERITY OF SYMPTOMS
- DEGREE OF IMPAIRMENT OF CARDIAC FUNCTIONS
- DEGREE OF SEVERITY OF THE CONGESTIVE STATE
An indicator of Left ventricular cardiac function is _________
Left ventricular Ejection fraction
Classify Heart Failure using the New York Heart classification system (hint: 4 classes)
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
Slight limitation of physical activity is which class in NYHA classification system
Class II
Presence of structural heart defect but no symptoms is which stage in the American College of Cardiology/American Heart Association (ACC/AHA) staging system
Stage B
Stage Heart failure based on the American College of Cardiology/American Heart Association (ACC/AHA) staging system (hint: 4 stages)
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
The 3 significant risk factors for heart failure are
Obesity, DM, HTN
Chest X-ray finding in Heart failure (hint: 5- ABCDE)
-A- ALVEOLAR OEDEMA (BAT’S WING)
-B- KELLY-B-LINE(INTERSTITIAL OEDEMA)
-C- CARDIOMEGALY
-D- DILATED/PROMINENT UPPER LOBE VESSELS
-E- PLEURAL EFFUSION
What bio-maker is an indicator for severity of Chronic HF and can be used for prognosis
NATRIURETIC PEPTIDE B( BNP)
Serum level of BNP can be used to diagnose Heart failure, T/F
TRUE
Serum BNP level of < ___pg/ml excludes heart failure
< 100pg/ml
Approach to treatment of heart failure is multidisciplinary, T/F
TRUE
In non-pharmacological mgt of heart failure, salt reduction/restriction should be < __ grams/Day or ___to__mmol/Day
< 2grams/Day OR 60-100mmol/Day
In advance Heart failure, water restriction is limited to ~____L/Day
~1.5L/day
Heart failure patients are recommended 3-yearly echocardiography, T/F
FALSE
2- YEARLY ECHOCARDOGRAPHY
Heart failure patient should be given ____ & _____ vaccines
VACCINATION, ESP AGAINST RESP INFECTION
PNEUMONIA
INFLUENZA
Device based Heart failure treatment include (hint: 3)
IMPLANTABLE CARDIAC DEFRILLATOR
BIVENTRICULAR PACEMAKERS
LEFT VENTRICULAR ASSIST DEVICES
Aim of IMCI
To reduce death, illness and disability thereby promoting improved growth and development among children U5 yrs of age
The strategy of IMCI has 3 main components which are?
- Improving case mgt skill of health care staff
- Improving overall health system
- Improving family and community health practices
Define Under-5 mortality rate
U5MR IS DEFINED AS THE ANNUAL NUMBER OF DEATHS OF CHILDREN UNDER 5 YEARS OF AGE PER 1000 LIVE BIRTHS
U5 mortality is a reflection of a country’s health system and economy, T/F?
TRUE
IMCI incorporates Child Survival Strategy which includes (hint: 11)
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”
Danger signs on physical examination with respect to IMCI (hint: 6)
Anemia, Pyrexia, Dehydration, Dyspnea, Wasting, Jaundice
List the steps in IMCI implementation (hint: 6)
- History taking from parent/care giver
- Assess child(examination) for danger signs
- Classify the illness
- Take decision
- Counsel the mother/care giver
- Follow up
The commonest symptom that presents to primary care is ______
Dyspepsia
Dyspepsia is more common in men, smokers & those taking NSAIDs, T/F
FALSE.
Common in women not men
Patients with dyspepsia have poor life expectancy, T/F
FALSE
Dyspepsia is associated with poor health-related quality of life, T/F
TRUE
The most important contributory factors to dyspepsia are _____&______
The presence of H. pylori and use of medications such as NSAIDs
Systemic conditions that can cause dyspepsia (hint: 9)
Adrenal insufficiency, congestive heart failure, diabetes mellitus, hyperparathyroidism, intra-abdominal non-gastrointestinal malignancy, myocardial infarction, pregnancy, renal insufficiency, thyroid disease
Draw out NICE model Algorithm for the mgt of dyspepsia
Refer to Note
The key investigations in the diagnosis of dyspepsia are ______&______
Endoscopy and test for H. Pylori
Functional dyspepsia is a diagnosis of exclusion, T/F?
TRUE
What is the mgt of Functional dyspepsia
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
PUD majorly affects what part of the GIT? (hint; 3)
It affects lower esophagus, stomach or duodenum
List the injurious/damaging factors that play a role in development of PUD (hint: 7)
-gastric acid, pepsin, bile acids, NSAIDS, genetics, H. Pylori, ethanol
List the protective factors play a role in preventing of PUD (hint: 8)
-mucus, bicarbonate, prostaglandin, mucosal blood flow, alkaline tide, epithelial renewal, hydrophobic layer, epidermal growth factor (EGF)
Ratio of Gastric ulcer to Duodenal ulcer
1:4
Family hx is a risk factor of PUD, T/F?
TRUE
Which blood group is a common risk factor for PUD?
Blood group O
Mention the risk factors for PUD (hint: 7 major, 3 minor)
- male sex
- family history
- smoking (cause and delay healing)
- stress
- common in blood group O
- nsaids (2-4 times increase in GU and ulcer complications)
- H. Pylori: (if absent and no NSAIDS, ulcer unlikely)
Unproven risk factors:
1. corticosteroids
2. alcohol
3. diet
PUD may be silent in the elderly on NSIADs, T/F?
TRUE
P/E of a patient with PUD usually yields positive findings, T/F?
FALSE
Investigations for PUD (hint:4)
- Endoscopy (investigation of choice)
- Barium studies
- Serum gastrin
- H. Pylori test
Complications of PUD (hint: 7)
- Penetration
- Perforation
- Bleeding →haematemesis & melaena
- Pyloric stenosis →obstruction
- Anaemia
- Oesophageal stenosis
- Carcinoma (GU)
Aims of mgt of PUD (hint:4)
- Relieve symptoms
- Accelerate ulcer healing
- Prevent complication
- Minimize risk of relapse
Define Urinary Tract Infection (UTI)
IT IS THE INFECTION OF ANY PART OF THE URINARY TRACT- KIDNEYS, URETERS, BLADDER, URETHRA
INCLUDES INFECTION OF THE PROSTATE- PROSTATITIS
Infection of the prostate (prostatitis) is a part of UTI, T/F?
TRUE
UTI occurs most frequently b/w the ages of ___ & ___ in women
16 & 35
Rates of asymptomatic bacteriuria increases with age in women, T/F?
TRUE
Which type of UTI is the most common cause of nosocomial infection
Pyelonephritis
Risk factors for UTI (hint: 25)
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
Chronic bacterial prostatitis may cause recurrent UTI in males, T/F?
TRUE
Viruses are common causes of UTI in an immunocompetent host, T/F?
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
Method of choice for diagnosing Viral LUTI
DIAGNOSIS OF VIRAL LUTI’S IS BASED ON MOLECULAR TECHNIQUES AND REAL-TIME POLYMERASE CHAIN REACTION IS OFTEN THE METHOD OF CHOICE
Drug of choice for viral UTI
CIDOFOVIR IS BECOMING A DRUG OF CHOICE IN VIRAL UTI’S
Mention mechanisms that maintain the Urinary tract’s sterility (hint: 4)
- ACIDITY OF URINE
- EMPTYING OF THE BLADDER @ MICTURITION
- URETEROVESICAL & URETHRAL SPINCTERS
- VARIOUS IMMUNOLOGIC & MUCOSAL BARRIER
Routes of infection in UTI are (hint: 3)
- Direct entry through the urethra
- Hematologic route
- Lymphatic route
Clinical manifestations of Upper UTI (hint: 11)
-HIGH GRADE FEVER
-RIGORS/CHILLS
-VOMITTING
-SWEATING
-HEADACHE
-DIARRHOEA
-LOIN PAIN
-±ABDOMINAL PAIN
-OLIGURIA (IF AKI)
-LOIN TENDERNESS (COSTOVERTEBRAL ANGLE TENDERNESS)
-TACHYCARDIA
Clinical manifestation of Lower UTI (hint: 8)
-DYSURIA
-FREQUENCY
-URGENCY
-FEELING OF INCOMPLETE BLADDER EMPTYING
-SUPRAPUPIC PAIN AND TENDERNESS
-±STRANGURY
-HAEMATURIA
-OFFENSIVE URINE
UTI can be diagnosed using a urine dipstick, T/F?
TRUE
Typical symptoms + Presence of Leukocyte esterase & Nitrite
In asymptomatic patient, >10^5 CFU/microgram is significant (Asymptomatic bacteriuria), T/F
FALSE.
>10.5 CFU ORGANISM/ML
Investigation for UTI are (hint: 3)
ALL PATIENTS:
1. DIPSTIC ESTIMATION OF NITRITE, LEUCOCYTE ESTERASE, GLUCOSE
2. MICROSCOPY/CYTOMETRY OF URINE FOR WHITE BLOOD CELLS, ORGANISMS
3. URINE CULTURE
In complicated UTI & also UTI in infants & children what other investigations should you carry out in addition to the basic 3? (hint: 3)
-FBC, U/E/C, BLOOD CULTURES
Duration of treatment for uncomplicated LUT infection
TREATMENT FOR 3 DAYS IS THE NORM
Drug of choice for initial treatment of LUT infection is _______
TRIMETHOPRIM
Antibiotic class that can be used in treatment of UTI in pregnancy (hint: 2)
PENINCILLINS AND CEPHALOSPORIN ARE EFFECTIVE/SAFE IN PREGNANCY
Acute pyelonephritis is characterized by a triad of _____, _____ & ______
-LOIN PAIN
-FEVER
-TENDERNESS OVER THE KIDNEYS (COSTOVERTEBRAL ANGLE TENDERNESS)
The necrotizing form of pyelonephritis with gas formation is known as __________ and occasionally seen in _____ patients
EMPHYSEMATOUS PYELONEPHRITIS IS OCASSIONALLY SEEN IN DM PATIENT
Xanthogranulomatous pyelonephritis is characterized by ________
ACCUMULATION OF FOAMY MACROPHAGES
GENERALLY REQUIRES NEPHRECTOMY
Treatment of recurrent or chronic UTI
AMOXICILLIN/ CLAVUNATE- 500/125MG (ORALLY)- 12HRLY, OR
TRIMETHOPRIN- 300MG (ORALLY) DLY, OR
CEPHALEXIN- 500MG (ORALLY) 12HRLY,
all for 10-14 days
List the “ALARMS” symptoms in dyspepsia
A-NAEMIA
L-OSS OF WEGHT (UNINTENTIONAL)
A-NOREXIA
R-ECENT ONSET OF PROGRESSIVE SYMPTOMS
M-ALAENA/HAEMATEMESIS
S-WALLOWING DIFFICULTY (DYSPHAGIA)
FIRST CHOICE PROPHYLACTIC THERAPY FOR UTI (hint: 2)
-Trimethoprim- 100mg @ night
-Nitrofurantoin- 50mg @ night,
all continuously
First choice treatment for Pyelonephritis & complicated UTI (with associated systemic toxicity) (hint: 2)
-co-amoxiclav- 500/125mg 8hrly
-ciprofloxacin- 500mg 12hrly,
all for 10 days
Antibiotic treatment of asymptomatic bacteriuria in pregnancy is given for _____ days
7-DAY COURSE OF ANTIBIOTICS
TO PREVENT RISK OF PYELONEPHRITIS, LBW INFANT AND PRE-TERM BIRTH
All cases of Asymptomatic bacteriuria should be treated with antibiotics, T/F
FALSE
except in Pregnancy
UTI preventive measures:
- In Men (hint: 3)
- In women (hint: )
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
Principles of treatment of common animal bites/stings (hint:
(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
Bite wounds should be sutured, T/F
FALSE
NB. Remember bite wounds should not be sutured!!!
Rabies infection can be gotten only from dog bite, T/F
FALSE
occurs more in wild animals – foxes, skunks and bats, although domestic animals carry a risk.
Rabies virus is carried only by dogs, T/F
FALSE
The two types of rabies a dog infected with rabies virus may have and their features (hint: 2)
Furious rabies- Characterized by agitation and viciousness, followed by paralysis and death
Dumb Rabies – in which paralytic symptoms predominate
What is pathognomic of Rabies infection
The presence of intracytoplasmic inclusion bodies called Negri bodies in the Cornu Ammonis of the brain is pathognomonic of Rabies
CLINICAL FEATURES OF THE RABID DOG (hint: 12)
- Driveling of thick tenacious saliva
- Develops a hoarse voice
- Deglutition difficulties
- Incontinent of urine and faeces
- Hydrophobia and aerophobia
- Divergent strabismus and other eye findings including protrusion of the nictitating membrane, myosis & discharge from the medial canthus
- Strange or peculiar behaviour.
- Restlessness.
- Cardinally, the dog’s attitude is one of rage alternating with calmness.
- Progressive paralysis of the hind quarters and mandible.
- Paraesthesia
- Convulsion
How do you diagnose rabies in a suspected rabid animal, e.g., dog
Fluorescent antibody test or virus isolation from serum of infected animal
The best treatment for rabies infection is ______________
Prevention
Steps in treatment of an individual following a bite of a rabies infected animal (hint: 7)
- Wash wound vigorously with soap and water.
- Irrigate wound with iodine or alcohol
- Leave wound un-sutured but maintain haemostasis.
- Administer ATS – test dose, then
- 1,500iu prophylactic dose
(or 10,000iu therapeutic dose) - 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
- 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. - If Rabies develops, treatment is symptomatic. Aim at control of respiration, circulation and central nervous system symptoms
Concerning prevention of rabies, age of immunization of dog is ____ months
six months
PRE-EXPOSURE IMMUNIZATION SCHEDULE FOR HUMANS FOR RABIES (hint: can be given in 3 ways. At least attempt 1 schedule, Idan!)
- 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
myo-toxic or cellulo-toxic venom is linked to which family of snakes
Hydrophidae (Sea snakes)
Venom from Elapidae is __________
Neurotoxic
Viperidae venom is ______
Hematotoxic
Treatment of Spider bite (hint: 5)
- Infiltration with 2 – 5 ml of 1% lignocaine hydrochloride
- i.v. Pethidine 50mg if necessary
- Subcut. Atropine 0.5mg stat. & prn.
- i.v. Calcium gluconate 1.0g stat & prn.
- Combat anaphylaxis conventionally
Millipedes bite, T/F
FALSE
but when handled may discharge a toxic secretion
Centipedes bite, T/F
TRUE, Painful
Lymphangitis and lymphadenitis do occur following such bites
Treatment of Centipede bite (hint: 3)
Ice packs to site of bite, local anaesthetic agent infiltration may be required as well as corticosteroids
Alcohol disinfectant is indicated for used in irritation of local skin from Millipede secretion, T/F
FALSE
Use of alcohol disinfectant should be avoided
Treatment of Human bite
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
Treatment of Scorpion sting (hint: 5)
- Infiltration with 2 – 5 ml of 1% lignocaine hydrochloride
- i.v. Pethidine 50mg if necessary
- Subcut. Atropine 0.5mg stat. & prn.
- i.v. Calcium gluconate 1.0g stat & prn.
- Combat anaphylaxis conventionally
N/B: same of Treatment of Spider bite
Bee stings are alkaline, T/F
TRUE
Sting of Wasps is acidic, T/F
TRUE
Sting of Hornets is alkaline, T/F
FALSE
Sting of Ants is acidic, T/F
TRUE
Treatment of Bee sting
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
Treatment of stings of Wasp, Hornets & ants
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
Generally venomous fish have ______spines covered by venom secreting tissues
bony spines
Treatment of fish sting
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
Sub cut. adrenaline is indicated for human , T/F
FALSE
Asthma is an inflammatory disease of the large airway, T/F
FALSE
SMALL AIRWAYS
The wheeze in Asthma is polyphonic, T/F
TRUE
Clinical manifestations of asthma are in paroxysms, T/F
TRUE
Asthma is characterized by episodic, irreversible bronchial obstruction, T/F
FALSE
EPISIODIC, REVERSIBLE BRONCHIAL OBSTRUCTION
Asthma is due to _____ of tracheobronchial tree to a multiple of intrinsic & extrinsic stimuli
HYPER-RESPONSIVENESS
All episodes of Asthmatic attack need therapy to be relieved, T/F
FALSE- can be relieved Spontaneously
MAY BE RELIEVED SPONTANEOUSLY OR AS A RESULT OF THERAPY
Asthma can develop at any age, T/F
TRUE
Asthma tend to develop between the ages of ___ & ___years
Between 2 and 7 years
Cough variant asthma is a common presentation of asthma in children, T/F
TRUE
Asthma is ranked 1st in Nigeria as the most chronic disease in childhood, T/F
FALSE
Ranked 2nd. Pulmonary TB ranked 1st
_______ drug is the cornerstone of Asthma treatment
Corticosteroid (Inhaled)
The focus on management of Asthma should be on prompt treatment, T/F
FALSE
PREVENTION
Types of Asthma
Extrinsic asthma
Intrinsic asthma
Extrinsic asthma is also called (hint : 2)
ATOPIC ASTHMA, EARLY ONSET ASTHMA
Intrinsic asthma is also called (hint : 2)
NON-ATOPIC ASTHMA, LATE ONSET ASTHMA
Intrinsic asthma begins especially in childhood, T/F
FALSE
IT CAN BEGIN AT ANY AGE, ESPECIALLY IN THE LATE ADULTHOOD
Atopic patients can be identified by _______test
Skin sensitive tests
Asthmatic inflammatory reactions is characterized by cellular infiltration rich in ________ cells
Eosinophils
Onset of extrinsic asthma is in childhood, T/F
TRUE
In Intrinsic asthma there is a role of allergens in the production of the disease, T/F
FALSE
There are identifiable causes of asthma, T/F
FALSE
List factors that may trigger an asthmatic attack (hint: 11)
Triad of Aspirin-sensitive Asthma
ASTHMA, NASAL POLYPS & ASPIRIN SENSITIVITY
Asthma is a chronic airway inflammation, T/F
TRUE
Mention the activated cell types that infiltrate the airway during inflammation in asthma (hint: 4)
ACTIVATED EOSINOPHILS, MAST CELLS, MACROPHAGES AND T-LYMPHOCYTES
Concerning the pathophysiology of Asthma, evidences of Airway Remodeling are (hint: 4)
- SMOOTH MUSCLE HYPERTROPHY AND HYPERPLASIA – (CAUSE BRONCHIAL SMOOTH MUSCLE CONTRACTION)
- 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)
- COLLAGEN DEPOSITION CAUSING THICKENEING OF LAMINA RETICULARIS
- CELLULAR INFILTRATION, OEDEMA
Results in air wall thickening
The classic symptoms of Asthma are (hint: 4)
-WHEEZING
-COUGHING ESP @ NIGHT
-TIGHTNESS OF THE CHEST
-BREATHLESSNESS
A child with recurrent nocturnal cough should be suspected to have _____
Asthma
An individual with intermittent dyspnea especially after exercise should be suspected to have _____
Asthma
Absence of physical signs on P/E of a suspected asthma case excludes the diagnosis of asthma, T/F
FALSE
THE ABSENCE OF PHYSICAL SIGNS DOES NOT EXCLUDE A DIAGNOSIS OF ASTHMA
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. Tachypnea (T)
b. Hyperinflated chest (T)
c. Dull percussion note (F)
d. Diminished air entry (T)
e. Widespread monophonic wheeze (F)
Nocturnal asthma is an overnight fall of >___% of the FEV1 or PEFR
> 20%
Review of Asthma treatment should be done every ___to__ months
3 to 6 months
When should STEP DOWN in asthma treatment be considered?
IF CONTROL IS SUSTAINED FOR 3 MONTHS
Step-wise reduction (step down) in asthma treatment
When should STEP UP in asthma treatment be considered?
IF CONTROL IS NOT ACHIEVED IN 3 MONTHS
step-wise increase (step up) in asthma treatment
Gastric asthma is due to _____
GASTRO-OESOPHAGEAL REFLUX (REFLUX-REFLEX)
Gastric asthma is treated by giving bronchodilators, T/F
FALSE
THIS IS TREATED BY AVOIDING ORAL BRONCHODILATORS AND INSTITUTING ANTI-REFLUX THERAPY
Therapy for Exercise-induced asthma is
THERAPY WITH PRE-EXERCISE BRONCHODILATORS OR SODIUM CROMOGLYCATE
The asthma where patient has no respiratory systems between episodes is called
EPISODIC ASTHMA
Chronic asthma may stimulate chronic bronchitis, T/F
TRUE
Characteristics of Status asthmaticus (hint: 6)
- Altered level of consciousness
- Sweating
- Tachycardia
- Tachypnea
- Pulsus paadoxus
- Decreased Inspiratory-expiratory raito
FEV1/FVC >90% is suggestive of obstructive airway disease, T/F
FALSE
Restrictive lung disease
FEV1/FVC <70% is suggestive of ____airway disease
Obstructive airway disease
Total lung volume = ____+ _____
Residual volume + Vital capacity
The volume of air breath out after the deepest inspiration is ____
Vital capacity
Spirometry can be performed for all age groups, T/F
FALSE
can’t be done in children <6yrs and (maybe adults that have muscular issues)
Investigations of asthma (hint: 5)
- MEASUREMENT OF PEAK EXPIRATORY FLOW RATE (PEFR)
- SPOROMETRY
- SKIN PRICK TESTING (to measure allergic status in patients with atopy)
- INDUCED SPUTUM DIFFERENTIAL EOSINOPHIL COUNT (ASSESSMENT OF EOSINOPHILIC AIRWAY INFLAMMATION)
- CHEST X-RAY
- EXERCISE CHALLENGE TEST
Drugs used to prevent asthma (hint: 3)
SODIUM CROMOGLYCATE
NEDOCROMIL SODIUM
KETOTIFEN
Management of Acute severe Asthma
Depending on the ________ of the emergency, mgt may involve multiple levels of care
Severity of emergency
Define medical emergency (hint: 4 import lines/point
- ANY CONDITION MANIFESTING ITSELF BY ACUTE SYMPTOMS
- OF SUFFICIENT SEVERITY (INCLUDING SEVERE PAIN)
- SUCH THAT THE ABSENCE OF IMMEDIATE MEDICAL ATTENTION
- COULD REASONABLY PLACE THE PATIENT’S HEALTH IN SERIOUS JEORPARDY, SERIOUS IMPAIRMENT TO BODY FUNCTIONS OR ORGAN DYSFUNCTIONS
Define Emergency from an Observer’s point of view
ANY CONDITION PERCEIVED BY A PRUDENT LAY PERSON OR SOMEONE ON BEHALF OF THE PATIENT AS REQUIRING IMMEDIATE MEDICAL OR SURGICAL TREATMENT
Any response to medical emergency situation will depend on 4 factors
-THE SITUATION AROUND THE EMERGENCY
-THE PATIENT INVOLVED
-THE AVAILABILITY OF RESOURCES
-LOCATION OF THE EMERGENCY
EVERY PATIENT HAS THE RIGHT TO BE INFORMED BY THE HOSPITAL OF HIS RIGHT TO RECEIVE EMERGENCY SERVICES, T/F
TRUE
Mention the General principles/steps in mgt of medical emergencies (more of like emergencies in general)
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
In the ‘D’ in Primary survey of medial emergency, what do you assess/check for (hint: 2 things)
- Level of consciousness
a. AVPU - (for quick assessment)
b. GCS - (if there is time) - Pupils - size, equality & reactivity
Concerning the Primary survey in medical emergency mgt, be cautious to avoid ______ when exposing the patient for proper assessment
Hypothermia
Concerning emergency mgt, for the medical practitioner to be prepared mentally & physically, he needs to ____, ____ & ______
PLAN, EQUIP & PRACTISE
Mention the vital skills in emergency mgt (hint: 7)
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
IN EMERGENCY, CONSIDER __________ FIRST & FOREMOST IN A PATIENT WITH ABDOMINAL PAIN WHO COLLAPSES (@ TOILET)
INTRA-ABDOMINAL BLEEDING
IN EMERGENCY, ACUTE CHEST PAIN REPRESENTS __________UNTIL PROVEN OTHERWISE
MYOCARDIAL INFARCTION
IN EMERGENCY, ALWAYS EXCLUDE _________ IN A CHILD WITH A SUDDEN ONSET OF RESPIRATORY DISTRESS & PALLOR
ACUTE EPIGLOTTITIS
IN EMERGENCY, ALWAYS CONSIDER THE POSSIBILITY OF _________ IN A PATIENT WITH PAST HISTORY OF ALLERGIES
ACUTE ANAPHYLAXIS
IN EMERGENCY, ALWAYS CONSIDER _________ IN ANY WOMAN OF CHILD BEARING AGE PRESENTING WITH ACUTE ABDOMINAL PAIN
ECTOPIC PREGNANCY
IN EMERGENCY, IF A PATIENT IS FOUND CYANOTIC, ALWAYS CONSIDER_________ FIRST
UPPER AIRWAY OBSTRUCTION
IN EMERGENCY, CONSIDER_____________ FORMOST IN AN ADULT WITH SUDDEN COLLAPSE OR DIZZINESS
VENTRICULLAR FIBRILLATION OR OTHER ARRHYTHMIAS
DEFINE EMERGENCY MANAGEMENT SYSTEM-TRIAGE
THIS REFERS TO EVALUATION AND CATEGORIZATION OF THE SICK OR WOUNDED WHEN THERE ARE INSUFFICIENT RESOURCES FOR MEDICAL CARE OF EVERYONE @ ONCE
Triage applies only in the Accident & emergency unit, T/F
FALSE
MASS CASUALTY, CROWDED EMERGENCY ROOMS AND WALKING-IN-CLINICS
IN A WALK-IN-CLINIC OR EMERGENCY DEPARTMENT, AN INTERVIEW WITH A DOCTOR IS A KNOWN FIRST STEP TO RECEIVING CARE. T/F
TRIAGE NURSE
The START triage system group victims into 3 categories, T/F
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
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. 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
Major causes of Under-5 deaths in Nigeria (List top 5)
- Neonatal diseases/complications
- Respiratory tract infection/Pneumonia
- Diarrhoeal diseases
- Malaria
- Measles
- Injuries
- HIV/AIDS
- OTHERS
Improving routine immunization (RI) coverage would reduce child mortality, T/F
TRUE
Childhood immunization falls under 2nd UN-SDG, T/F
FALSE
3RD GOAL OF UNITED NATIONS SUSTAINABLE DEVELOPING GOALS (UN-SDGs)
Importance of Immunization (hint: 5)
- IT IS A PREVENTIVE MEDICINE
- ERADICATION AND ELIMINATION OF SOME DISEASE.
- IT PROVIDES HERDS IMMUNITY
- IT PROMOTES HEALTH AND OPTIMAL GROWTH AND DEVELOPMENT IN CHILDREN
- IT IS A COMPONENT OF CHILD SURVIVAL STRATEGY.
Factors affecting Routine Immunization in Nigeria (hint: 6)
- MISPERCEPTIONS OF ROUTINE IMMUNIZATION.
- INFLUENCE OF RELIGION.
- INADEQUATE COLD CHAIN EQUIPMENT.
- POLITICAL PROBLEMS
- REJECTION OF ROUTINE IMMUNIZATION-FEAR AND CONFUSION, LOW CONFIDENCE AND LACK OF TRUST.
- SHORTAGE OF VACCINES AND IMMUNIZATION SUPPLIES
Mention the Live attenuated vaccines (hint: 8)
Measles, Mumps, Rubella, BCG, OPV, Varicella Zooster, Rota virus vaccines
(MY BOyZ R) Addition- Thyphoid vaccine
All vaccines are Thermosensitive, T/F
TRUE
All vaccines are Photosensitive, T/F
FALSE
Mention 4 vaccines that are Photosensitive (i.e., stored in dark glass vials)
Measles, Mumps, Rubella, BCG vaccines
Mention the components of the New Immunization schedule (hint: Birth, 6wks, 10wks, 14wks, 9months, 15-18months, 24months, 12-24months, Girls(>=13yrs)
Visit the Material and your Note
According to the New NPI, Thyphoid vaccine is given in ____month
24 months
Human Papilloma virus vaccine should be commenced in girls at ____age
13 years of age
According the NPI schedule, BCG vaccine should be taken on or before 5months of life, T/F
FALSE
SCHEDULE- @ BIRTH, OR AS SOON AS POSSIBLE WITHIN THE FIRST 3 MONTHS AFTER BIRTH
BCG vaccine is contraindicated in ____ babies
BABIES OR INFANTS SHOWING SYMPTOMS OF HIV INFECTION
Storage temperature for vaccines is between ___ & ___ degree Celsius
+2 ‘C to +8’C (degree Celsius)
Rota virus vaccine schedule dose in NPI is 3, T/F
FALSE - 2
SCHEDULE-2 DOSES @ 6 & 10 WEEKS
Route for administering Rota virus vaccine is _____
Oral drop (1.5ml)
3rd dose of Tetanus toxoid confer a protection for _____ yrs
5years
Define cold chain vaccine system
IT IS A SYSTEM OF TRANSPORTING AND STORING VACCINES WITHIN WHO RECOMMENDED TEMPERATURE RANGES, FROM THE POINT OF MANUFACTURE TO THE POINT OF ADMINISTRATION
Procurement of vaccine through UNICEF to the National cold vaccine store is on a monthly basis, T/F
FALSE.
Procurement of vaccine is on a QUARETERLY basis for National Central cold store, Zonal cold stores and States cold stores
Procurement of vaccine through the State cold vaccine store is on a monthly basis, T/F
TRUE
REQUIREMENTS FOR AN IDEAL SUTURE
Classes of Drugs used in Asthma treatment (hint: 8)
- B2-ADRENOCEPTOR AGONISTS- BRONCHODILATOR (-SABA- SALBUTAMOL; LABA- SALMETEROL, FOMOTER)
- ANTI-CHOLINERGIC- RELAXES SMOOTH MUSCLES OF BRONCHIOLES- BRONCHODILATORS, (Eg. IPATROPIUM, TIOTROPIUM, ETC)
- METHYL XANTHINES - AMINOPHYLLINE- BRONCHODILATOR- METABOLISED TO THEOPHYLLINE-
- CORTICOSTEROIDS- ANTI-INFLAMMATORY, AVAILABLE :
-ORAL FORM (PREDNISOLONE), INJECTABLE (HYDROCORTISONE), INHALER (BECLOMETASONE) - LEUKOTRIENE- RECEPTOR ANTAGONIST ( e.g MONTELUKAST, ZARFIRLUKAST)
- 5-LIPOXYGENASE INHIBITOR - ZILEUTON
- ANTI-IgE MONOCLONAL ANTI-BODY - OMALIZUBAB
- CROMOGLYGATE- ALWAYS INHALED- USED AS PROPHYLAXIS IN MILD AND EXERCISE-INDUCED ASTHMA. (NOTE: IT MAY PRECIPITATE ASTHMA)
Asthma class of drug primarily reserved for severe asthma is _______
5-LIPOXYGENASE INHIBITOR - ZILEUTON
For classification of Severity of Asthma, describe STEP 1
INTERMITTENT asthma (Day-time symptoms, Night-time symptoms, PFR: Predicted & Variability)
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%
For classification of Severity of Asthma, describe STEP 2 MILD PERSISTENT asthma (Day-time symptoms, Night-time symptoms, PFR: Predicted & Variability)
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%
For classification of Severity of Asthma, describe STEP 3 MODERATE PERSISTENT asthma (Day-time symptoms, Night-time symptoms, PFR: Predicted & Variability)
Day-time symptoms: DAILY USE, ᵦ₂ AGONIST, DAILY ATTACK AFFECTS ACTIVITY
Night-time symptoms: > 1 TIME A WEEK
PFR: >60% - <80% PREDICTED, VARIABILITY > 30%
For classification of Severity of Asthma, describe STEP 4 SEVERE PERSISTENT asthma (Day-time symptoms, Night-time symptoms, PFR: Predicted & Variability)
Day-time symptoms: CONTINUOUS LIMITED PHYSICAL ACTIVITY
Night-time symptoms: FREQUENT
PFR: ≤ 60% PREDICTED, VARIABILITY >30%
Normal value for FEV1/FVC is ___ to ___%
75-85%
Normal value for FEVI is ____
> = 80%
FEV1/FVC <70% is suggestive of _____
Obstructive Lung Disease (COPD & Asthma)
In COPD, airflow obstruction is fully reversible, T/F
FLASE
COPD IS A RESPIRATORY DISEASE CHARACTERISED BY AIRFLOW OBSTRUCTION THAT IS NOT FULLY REVERSIBLE
COPD is characterised by ____ & ______
persistent respiratory symptoms and airflow limitation
Define COPD according to GOLD
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
COPD IS NOT ASSOCIATED WITH ABNORMAL INFLAMMATORY RESPONSE OF THE LUNGS TO NOXIOUS PARTICLES OR GAS, T/F
FALSE
IT IS ALSO ASSOCIATED WITH ABNORMAL INFLAMMATORY RESPONSE
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
FALSE
COUGH WITH EXPECTORATION ON MOST DAYS FOR @LEAST 3 MONTHS A YEAR FOR MORE THAN TWO CONSECUTIVE YEARS
EMPHYSEMA IS PERMANENT DILATATION AND DESTRUCTION OF LUNGS TISSUE DISTAL TO THE ________
TERMINAL BRONCHIOLES
In Alpha-1-antitrypsin deficiency, emphysema develops at a younger age especially in smokers, T/F
TRUE
In Centriacinar emphysema, there is predominant involvement of the upper lobe & apices of the lung, T/F
TRUE
Centriacinar emphysema is commonly seen associated with Chronic bronchitis, T/F
TRUE
_______ type of emphysema is associated with Alpha-1-antitrypsin deficiency
Panacinar emphysema
The panacinar emphysema is predominant in the upper lung lobe & apices, T/F
FALSE
PREDOMINANT IN LOWER BASAL ZONES
The type of emphysema that often causes spontaneous pneumothorax is _____
PARASEPTAL EMPHYSEMA
IT’S FOUND NEAR THE PLEURA AND OFTEN CAUSES SPONTANEOUS PNEUMOTHORAX
Paraseptal emphysema involves only the middle portion of the acinus, T/F
FALSE
INVOLVES ONLY THE DISTAL ACINUS
Mention the 4 types of Emphysema
CENTRIACINAR EMPHYSEMA
PANACINAR EMPHYSEMA
PARASEPTAL EMPHYSEMA
IRREGULAR EMPHYSEMA
Mediastinal emphysema manifests as __________
Subcutaneous emphysema
THE ESCAPED AIR TRACKS UP INTO THE SUBCUTANEOUS TISSUES OF THE NECK , MANIFESTING AS SUBCUTANEOUS EMPHYSEMA
Mediastinal emphysema can occur in which conditions (hint: 3)
-SEVERE BRONCHIAL ASTHMA
-RUPTURE OF EMPHYSEMATOUS BULLAE
-RUPTURE OF OESOPHAGUS
Age of onset of Chronic bronchitis is the 6th decade,T/F
FALSE - 5th
6th for Emphysema
Respiratory insufficiency is more common in emphysema, T/F
FALSE
THE CHEST XRAY FINDING IN CHRONIC BRONCHITIS INCREASED BRONCHOVASCULAR MARKINS, SMALL HEART, T/F
FALSE
INCREASED BRONCHOVASCULAR MARKINS, LARGE HEART
Concerning COPD, Pulmonary hypertension is more common in Emphysema compared to Chronic bronchitis
FALSE
COPD is more common in younger people, T/F
FALSE
Consider COPD in patients > ___ years with a risk factor for COPD(generally smoking) + >= 1 respiratory symptom
> 35years
In P/E in a COPD patient, there is increased Cricosternal distance, T/F
FALSE
↓CRICOSTERNAL DISTANCE
STOPS FOR BREATH AFTER WALKING 100M OR AFTER A FEW MINUTES ON LEVEL GROUND IS GRADE ___ IN THE MRC DYSPNOEA SCALE
GRADE 3
Spirometry measures functional lung volume, T/F
TRUE
In COPD, only FEV1 is reduced, T/F
FALSE- FVC is also reduced
FEV1 IS REDUCED MORE THAN FVC
Total lung capacity & Residual volume are increased in obstructive lung disease, T/F
TRUE
Chest X-ray features in COPD (hint: 6)
HYPERINFLATION
>6 ANTERIOR RIBS SEEN ABOVE DIAPHRAGM IN MID-CLAVICULAR LINE
FLAT HEMI-DIAPHRAGM
LARGE CENTRAL PULMONARY ARTERIES
↓PERIPHERAL VASCULAR MARKINGS
BULLAE
Early onset COPD or COPD with associated is likely _____
Alpha-1-Antitrypsin deficiency Emphysema
Classification of Severity of COPD is based on _____
Post bronchodilator FEV1
Non-pharmacological therapy in COPD (hint: 5)
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
AIDS REMAINS THE 2ND LEADING CAUSE OF DISEASE BURDEN WORLWIDE, T/F
TRUE
Key Populations that are at increased risk at contracting HIV are (hint: 5)
- men who have sex with men (gay men)
- people who inject drugs
- people in prisons and other closed settings
- sex workers and their clients
- transgender people
Exposure to HIV infected person fluid lead to risk of contracting infection which is dependent on certain factors (hint: 4)
INTEGRITY OF EXPOSED SITE
TYPE OF FLUID
VOLUME OF FLUID
VIRAL LOAD
HIV can enter a new host either as _____ or _____
As a free virus or within cells
Mode of spread or Route of transmission of HIV are (hint: 3)
- SEXUAL (MALE TO MALE, HETEROSEXUAL AND ORAL)
- PARENTERAL (BLOOD OR BLOOD PRODUCT RECIPIENTS, INJECTION DRUG USERS AND THOSE EXPERIENCING OCCUPATIONAL INJURY)
- VERTICAL
HIV is a double stranded retrovirus, T/F
FALSE
HIV is a DNA retrovirus
FALSE
RNA retrovirus
HIV is a retro virus of _____virus family
Lenti virus family
_________ predicts the progression of HIV to AIDS
The number of circulating viruses (Viral load)
The cornerstone in the mgt of HIV/AIDS is ______
HIGHLY ACTIVE ANTI-RETROVIRAL THERAPY (HAART) AND IT IS THE CONERSTONE OF MANAGEMENT
In Perinatal HIV prevention, Routine ‘Opt-in’ antenatal HIV testing is recommended, T/F
FALSE
Routine ‘Opt-out’
Concerning prevention of HIV (stating the Primary/ Secondary/ Tertiary levels)
- for Sexual route of transmission
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
Concerning prevention of HIV (stating the Primary/ Secondary/ Tertiary levels)
- for Parenteral route of transmission
PARENTERAL:
1. BLOOD PRODUCT TRANSFUSION: DONOR QUESTIONNAIRE, ROUTINE SCREENING OF DONATED BLOOD, BLOOD SUBSTITUTES
2. INJECTION DRUG USE: EDUCATION, NEEDLE/SYRINGE EXCHANGE AVOIDANCE
Concerning prevention of HIV (stating the Primary/ Secondary/ Tertiary levels)
- for Perinatal & Vertical route of transmission
PERINATAL:
1. ROUTINE ‘OPT-OUT’ ANTE-NATAL HIV TESTING
2. PRECONCEPTION FAMILY PLANNING IF HIV-SEROPOSITIVE
3. MEASURES TO REDUCE VERTICAL TRANSMISSION
Concerning prevention of HIV (stating the Primary/ Secondary/ Tertiary levels)
- for Occupational transmission
OCCUPATIONAL:
1.EDUCATION/TRAINING: UNIVERSAL PRECAUTIONS: NEEDLE STICK AVOIDANCE
2. POST-EXPOSURE PROPHYLAXIS
Strategies to end AIDS (hint: 3)
1)HIV CARE CONTINUUM: (has 5 steps)
2)TREAT ALL/TEST AND TREAT
3) TARGET 95-95-95
Mention the 5 steps for HIV care continuum
- -DIAGNOSIS OF HIV INFECTION
- -LINKAGE TO HIV MEDICAL CARE
- -RECEIPT OF HIV MEDICAL CARE
- -RETENTION IN HIV MEDICAL CARE
- -ACHIEVEMENT AND MAINTENANCE OF VIRAL SUPPRESSION
UNIVERSAL ART FOR ALL HIV-INFECTED TB PATIENTS SHOULD BE GIVEN WITHIN__ WEEKS OF INITIATION OF ANTI-TB THERAPY
8 weeks
