Easy to Remember Flashcards by Sheila Sarmiento

High blood pressure
Normal levels for other lab test
except low potassium

Inv?

Plasma Aldosterone to Renin Ratio

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Antibiotic - similar to botulism

Gentamicin
(““gento-uwag,genta-botu””)

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Risk Factor for the development of Hypertrophic Pyloric Stenosis?

Formula feeding
Male
Caucasian background
FIrstborn
Positive family history

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Common risk factor for Hypertrophic Pyloric Stenosis?
2-6 wks infants

Maternal Smoking

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Common risk factor for Hypertrophic Pyloric Stenosis?
younger than 2 wks infants

Erythromycin
Azithromycin

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What are the signs and symptoms of Acromegaly?

Coarse Facial Appearance
Spade-like hands
The increase in shoe size
Large tongue
Prognathism
Excessive sweating and oily skin
Features of Pituitary tumour ( hypopituitarism, headaches, bitemporal hemianopia)

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Complications of Acromegaly

HTN
DM
Cardiomyopathy
Colorectal ca

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Best single test for the diagnosis for Acromegaly

IGF-1

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Best single test for the diagnosis for Acromegaly
if the patient has both poorly controlled Type 1 DM and hypothyroidism?

Other factors that causes low Serum IGF1:
malnutrition
liver failure
renal failure
estrogen use

Oral Glucose tolerance test with
serial GH

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What is the preferred initial test for suspected thyroid function?

TSH

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Foot drop

sensory loss over the dorsum of the foot and lateral shin (superficial peroneal nerve)

weakness in foot dorsiflexion and foot eversion

Common peroneal nerve injury

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marked
weakness of inversion of the foot

L4 root lesion

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numbness in the medial foot and the webspace between the first and second toe

L5 motor nerve root damage

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ankle reflexes and sensation of the posterior calf and lateral foot

weakness of plantar flexion

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Best initial treatment for Parkinson’s disease?

Carbidopa/Levodopa

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What is the second line of tx for Parkisons if there is a development of Side effect and reducing the first line meds doesnt help?

Amantadine
Pergolide

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refers to the membrane rupture before the onset of uterine contractions

Classic presentation :
sudden gush of clear or yellow fluid from the vagina

Patient also developed signs of infxn:
Chorioamnionitis
fever
tachycardia
sweating

PROM

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What are the management of PROM?

Admit the patient to the hospital
Measure and monitor WBC and C resactive protein
If no evidence of infxn / fetal distress - continue pregnancy

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What are the management of PROM if there is an evidence of infxn or fetal distress?

Induce labor

Give corticosteroids if delivery is prior to 34 wks of gestation
Give antibiotics for prevention and treatment of infxn

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What are the protective factors for developing uterine fibroid?

Smoking
pregnancy

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What factors increases estrogen levels and contributes in developing fibroids?

Nulliparity
obesity
early menarche

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Common area affected by osteoarthritis

1st carpometacarpal joint of the thumb

Other joints that are involved:

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What is not involved in osteoarthritis that makes it distinguishable from Rheumatoid Arthritis?

Metacarpophalangeal joints and involves the interphalangeal and distal interphalangeal joints

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What are commonly involved in Rheumatoid Arthritis?

MCP PIP (Proximal interphalangeal joints) Atlantoaxial Joint

Midline upper neck mass moves with tongue protrusion

Thyroglossal cysts

Congenital epithelial cysts, Arise on the lateral part of the neck from a failure of obliteration fo the second branchial cleft in the embryonic development

Branchial Cysts

What factors that causes babies to be exposed during birth to to Grp B Strep found normally in the vagina that can lead to meningitis or septicaemia?

Low birth weight Premature Born After prolonged labor Premature rupture of membrane

Characterized by short stature and nonfunctioning ovaries which cause the absence of sexual development and infertility, Poor ovarian function but other sexual and preoductive organs are normal, amenorrhea

Turner Syndrome

What are the other physical features of Turner Syndrome?

Webbing of the neck Puffy hands and feet Coarctation of the aorta Cardiac abnormalities

recurrent fever and chest pain with pleural or pericardial rub

Dressler's Syndrome - usually develops 2 to 3 wks ater acute myocardial infarction or heart surgery

best tx for Dressler's Syndrome

Aspirin

bilious vomiting crampy abdominal pain mild distention passing blood and mucus in the stool

Intestinal malrotation with midgut volvulus

Key sign in diagnosing complete ischemia which requires urgent surgical intervention

Paraesthesis or Paralysis

most useful test in the evaluation of osteoporosis

Serum 25 hydroxy Vitamin D level

most useful index for prediction of increased risk of osteoporosis and fractures

DEXA scan

most commonly affected in Pseudogout

knee ## Footnote can also affect the elbows, ankles and wrists develops when calcium pyrophosphate dihydrate crystals deposit int he cartilafe of a joint

most common surgical procedure involved in prostate ca

Radical Prostatectomy

most common complication of radical prostatectomy

Erectile Dysfunction

left sided weakness involving both upper and lower limbs

Right sided intracranial lesion

A class of asthma, child gets less than 1 episode of asthma in 6 weeks and no symptoms in between flare-ups

Infrequent intermittent asthma

tx for Infrequent intermittent asthma

inhaled short acting beta2 agonist or SABA

diplopia upward gaze numbness below the eye

Orbital floor fracture

breast pain or cyclical mastalgia (cyclical hormonal changes ) common in females 35 to 50 years of age tx?

Danazol

anaphylaxis in children dosage and administration

1:1000 (0.01 ml per kg) IM or IM adrenaline 10 nmicrograms/kg maximum 0.5 ml at lateral thigh every 5 mins

causes high troponin levels in patients without acute coronary syndrome

Pulmonary embolism other causes of troponin elevation: Renal failure Myocarditis Atrial Fibrillation Pulmonary Thromboembolism

what is contraindicated in mothers with hx of HIV due to increase chance of HIV transmission?

breastfeeding

what is the more efficient tx for non-cyclical mastalgia

Norethistherone

it can be used in severe mastalgia, but it causes more severe adverse effects including DVT and endometrial cancer so it is not preferred.

Tamoxifen

recommended screening for FBS in non-diabetic individuals

every 3 years over the age of 40

recommended screening for serum cholesterol in adults over the age of 45

5 yearly

not part of the screening test before age 60 in adults unless they are high risk with these deficiencies

Vitamin D level and Vitaminb B12

nasal discharge fever wheezy cough inspiratory crackles and expiratory wheeze

Acute moderate Bronchiolitis

main tx for bronchiolitis

Supportive appropriate oxygenation and fluid intake

long term steroid use (eg prednisolone) for RA is at high risk for developing

Septic Arthritis

tx for suspected septic arthritis is

IV antibiotics given for 2 wks IV then 6wks oral antibiotics

DIP Heberden's nodes

Osteoarthritis

MCP PIP Heberden's nodes absent

Rheumatoid Arthritis

tx for tremor

Primidone

best tx option for native valve infective endocarditis due to strep org

beta-lactam antibiotics and gentamicin

secondary hyperparathyroidism occurs in patients with

Vitamin D Deficiency Renal failure Osteomalacia

Common causes of hypercalcemia

Sarcoidosis Malignancies including lymphoma, leukaemia Hyperparathyroidism Vitamin D overdose

elevated mood pressured speech agitation flight of ideas over 2 weeks DOC?

Lithium Dx; Acute Mania

HSIL

Refer for colposcopy

IgG negative for varicella (it means she has no immunity against Varicella) so she is susceptible in getting the chicken pox

give VZIG - administer within 72 hrs of exposure

not contraindicated in pregnancy

live vaccines (eg Varicella)

you can measure this if the pregnant woman has contact with chicken pox and she develops atypical symtooms for cp

IgM

CI to surgical intervention in esophageal malignancy

invasion of tracheobronchial tree

Good indicators of return of spontaneous circulation

Check for pupil size and reaction to light

Ovarian cyst 5-7 cm

Repeat ultrasound scan within 3-4 months

ovarian cyst < 5cm

Reassurance no further actio needed. Do not require follow-up will resolve within 3 menstrual cycles

ovarian cyst > 7 cm

Referral gynaecologic Surgical intervention surgery of choice: Laparoscopic Cystectomy

not an indication for surgical intervention in pt with acute pancreatitis

Epigastric pain

most common salivary gland cancer

Mucoepidermoid carcinoma 20s-50s

displacing the earlobe outwards slowly growing lump on the left side of the face

Pleomorphic Adenoma

first trimester bleeding increased the risk of ____

Preterm birth at 28-31 weeks

most frequent cause of acquired angioedema

ACE inhibitors

Urticaria nausea vomiting intestinal obstruction deficiency of C1 inhibitor which is a protein that regulates classical complement activation patheay Autosomal dominant

Hereditary angioedema

common problem following trauma or surgery to the lower limbs evident 24 to 72 hrs after an injury involving the lungs, the brain and the skin altered mentak state, rapid breathing, SOB, dyspnea, low O2 Petechiae Bilateral infiltrates - embolism

Fat embolism

most effective tx for nocturnal enuresis

Alarm bell and Pad

No risk of bleeding Most effective way of reducing the possibility of thromboembolic event during the hospital stay

Enoxaparin

Preferred method for assessment of albuminuria in both diabetes and non-diabetes

Urinary Albumin-creatinine ratio

Menopausal women, hot flushes , her mother has breast cancer 50 years of age women with premature (<40 years) or early (<45 years) of menopause until aged 50

Combined HRT

most effective tx for severe hot flushes and is a reasonable choice in the absence of contraindications

Combined HRT

Most urgent requirement in DKA

Infusion of normal Saline - min of 3L of Saline over the first 5 hours

most important findings in bronchiolitis in children

inspiratory crackles

damage to the superior or inferior epigastric arteries or direct tear of the rectus abdominus muscle

Rectus Sheath hematoma

if there is a significant drop in Hgb or loss of blood requiring blood transfusion - contributing factor is a warfarin-induced coagulopathy

Warfarin reversal using Vitamin K and Prothrombinex

CSF analysis: turbidity, low glucose, elevated proteins and elevated white cells

Bacterial Meningitis E coli.

patients must have at least 2 of the ff for dx of dementia with lewy bodies

rapid fluctuating cognition visual hallucinations spontaenous motor Parkinsonism

management of benzodiazepine (alprazolam) overdose - bradycardia, hypotension and resp failure

Continue supportive measures hypotension and bradycardia - IV fluids and monitoring of vitals until GCS improves and pt is stable

Most appropriate test for investigation of symptomatic or asymptomatic haemochromatosis

Iron studies or Serum ferritin levels and transferrin saturation

Uterine bleeding in the presence of a closed cervix and sonographic visualization of an intrauterine pregnancy with detectabke fetal cardiac activity

Threatened Miscarriage

Cervix dilated increased uterine bleeding present uterine contractions The gestational tissue often can be felt or seen through the cervical os, passage of this tissue typically occurs within a short time.

Inevitable Miscarriage

The membrane may rupture and the fetus may be passed, significant amounts of placental tissues can be retained this resulting to ________. o/e, cervical os open, gestational tissue in cervix, uterine size smaller than expected but not well contracted. U/S: tissue in the uterus severe bleeding to hypo-volemic shock painful cramps/ conbtractions present

Incomplete miscarriage - most common in the late trimester and early second trimester

in-utero death of the embryo or fetus prior to the 20th wk gestation Symptoms associated with early pregnancy - nausea, breast tenderness have abated and they dont fell pregnant anymore. Vaginal bleeding may occur. cervix remains closed u/s - intrauterine gestational sac with or without embryonic fetal pole, but no embryonic / fetal cardiac activity.

Missed Miscarriage

Usually occurs before 12 wks of gestation, entire contents of the uterus is expelled Uterus is small o/e and well contracted with an open or closed cervix scant vaginal bleeding and only mild cramping U/S empty uterus and no-extra uterine gestation

Complete Miscarriage

What supplements are not routinely used in pregnancy?

Vitamin A, B and C

What is the iodine dosage recommendation during pregnancy?

150 micrograms throughout pregnancy

What is the recommended dose for Folic Acid during pregnancy?

5 mg daily 12 wks before conception and during first trimester

failure thrive haematemesis refusal to eat (long hx of vomiting after food and reduced appetite) sleeping problems chronic resp disorders oesophagitis stricture anaemia apnoea life threatening episodes

GORD Gastro-oesophgeal reflux disease

Next best step in the dx of GORD in children

Intraluminal impedance combined with ph probe monitoring or ph study | catheter-like nasogastric tube inserted transnasally to allow detection

What are the examples of Overvalued ideas

Body dysmorphic disorder Anorexia Nervosa Hypochrondriasis

2 first degree relatives diagnosed with colorectal ca (60 and 48 yo)

Moderate Risk Category

Screening for moderate risk catefory for colorectal ca

iFOBT every 2 years from 40-49 years of age, Colonoscopy every 5years from 50-74 years of age, along with Aspirin for at least 2.5 years commencing at age 50 until 70 years of age.

What is not recommended as a screening test for people at average risk of CRC?

Colonoscopy

pt that is at high risk for developing puilmonary embolism and DVT due to pregnancy and long distance flight, best investigation?

V/Q Scan

Second most common cancer to cause death in women after lung cancer in Australia

Breast CA

What is the most common cancer in women in Australia?

Breast ca

The median survival for patients with metastatic (stage IV) breast cancer

18-24 months

40% of women with recurrent or metastatic breast cancer survive at least how many years

5 years

What type of cancer has the worst prognosis?

Metastatic breast ca

What type of cancer has the good prognosis?

Seminoma of the Testis

What is the highly malignant germ cell tumour w/c usually follows an Abn pregnancy with a hydatidiform mole?

Choriocarcinoma

Most common form of haematological or blood cancer in Australia?

Lymphoma

What are the causes of clubbing? Respi?

Bronchiectasis, Ca, abscess

What are the causes of clubbing? CVS

Cyanotic Heart Disease

What are the causes of clubbing? GIT

PSC, IBD

What are the causes of clubbing? Endocrine

Thyroid disorder

What is the sign of Abnormal Mitral valve?

Opening Snap

What can be a sign for chronic hypoxia?

Clubbed fingers

first line tx for reducing chest pain in acute anterior MI

Morphine

S3, SOB, difficulty in climbing stairs/household chores, fatigue, cough hypothyroidism hypertension any prior myocardial infarctions, or valvular disease, Expiratory wheezes (due to pulmonary congestion) are all manifestations of?

Heart Failure

Sildenafil is used for?

Erectile Dysfunction

What are the tx for BPH?

Doxazosin Tamsulosin - quick acting with low risk of side effects

atypical chest pain that lasts for more than one hour systolic murmur in the Right second intercostal area that radiates to the carotid

Aortic Stenosis | Symptoms is simlar to MI but the characteristic murmur in the Right seco

What is the most widely used and definitive diagnostic tool used for aortic stenosis?

Echocardiography

What are the 2 types of Echocardiography for the dx of AS?

Transthoracic echocardiography (TTE) and Transesophageal Echocardiography (TEE)

Non-invasive diagnostic test that uses ultrasound waves to create images of the heart from outside of the body. It can provide detailed information about the severity of the stenosis, aortic valve area and other associated abnormalities.

TTE

It is an invasive test that uses a thin, flexible tube with US probe at the tip that is passed down the esophagus to get closer to the heart.

TEE

Tx for long standing schizophrenia, develop hand tremors due to Clozapine and Alcohol use?

Benzodiazepine

dark urine elevated BP Normal complement levels Ibuprofen use Other symptoms: dec urine output fatigue fever skin rash HTN - may also be present

Acute Interstitial Nephritis ## Footnote AIN can be caused by NSAIDs (Ibup, infnxs,autoimmune disorders and other toxic exposures)

chronic kidney disease char by deposition of IgA in the kidney glomeruli

IgA Nephropathy

begins days after the onset of an URTI C3 within normal limits Mesangial deposits

IgA Nephropathy | The HTN is tx by ACEi/ARBs

begins weeks following an streptocoocal infnx inciting illness may be a pharyngitis or a skin infxn C3 and CH50 levels are reduced positive streptozyme test confirms recent GAS infxn

Poststreptococcal Glumeronephritis ## Footnote The HTN is tx by FUROSEMIDE

Acute Upperlimb swelling and pain, then the patio) developed with dyspnoea and pleuritic chest pain

D. Dimer

Primary and most efficient diagnostic modality for identifying and confirming Varicoceles

Testicular USG | ninivasive, safe, cost-effective size, loc, severity

Severe cases for varicocele best modality is? but this one is less commonly used (eg identify the cause of hematuria)

CT scan

Aute onset of high fever Inadequate response to paracetamol Erythema of sole palm, tongue Desquamation of fingertios Redness or crackling of the lips Anterior cervical lymphadebnopathy or tender Mass in the right hypochondrium +/- nonexudatuive conjunctivitis elevated CRP and ESR

Kwasaki disease tx: Aspirin and Immunoglobulins Complications: vasculitis leading to coronary artery aneurysm in 17-31% cases

What is to be avoided in Kawasaki disease?

Steroid

What to use to detect the aneurysm in Kawasaki?

Echocardiography

What is the key symptom of pain associated with gallstones?

Right upper quadrant pain

Proteinuria (nephrotic range) > 50kg per d Hypoalbuminemia serum albumin concentration < 30 g/L +/_ edema and hyperlipidemia

Nephrotic Syndrome

Mc form of childhood nephrotic Sydnrome in children

Idiopathic Nephrotic Syndrome

What are the clinical findings of MCD or Minimal Change disease?

Age younger than 6 years of age Absence of hypertension Absence of hematuria by Addis count Normal complement levels Normal Renal function

What is the vaccine used to prevent herpes zoster infxn?

Zostavax (live attenuated vaccine)

Contraindications for Zostavax?

Severely immunocompromised patients such as patients who is in long term steroids for his rheumatoid arthritis HAematologal malignancy Recipients of haemapoietic stem cell transplantation HIV infxn and immunosuppression (below 15% CD4 lymphocytres)

What is the only effective treatment of the juvenile myoclonic seizure?

Sodium Valproate | Carbamazepine and Phenytoin may worsen the seizure in JVE Lamptrigine i

Why is Sodium Valproate contraindicated in pregnancy?

Spina bifida malformations coagulopathies

hypotension cyanosis resp distress shock with normal or weak upper extremity pulses absent femoral pulses

Aortic Coarctation of Aorta

it is suspected when an abrupt onset of tearing or ripping chest pain is reported

Aortic dissection

useful in children with nocturnal enuresis who are going to school camps can be used oral or nasal eachn night

Nasal desmopressin

treatment of choice for primary nocturnal enuresis in all other situations

Bed Alarm or Night trainer

Used in cases with persistent enursesis

Combination of Desmopressin and the bed alarm

2 most common presentations of IgA nephropathy

Recurrent episodes of macroscopic hematuria Immediately following after an upper respiratory infxn accompanied by proteinuria or persistend microscopic hematuria

Due to impetigo develops 2-6 wks after skin infxn and 1-3 wks after streptococcal pharyngitis.

Poststreptococcal glomerulonephritis

What are the clinical features of PSGN?

Hematuria pyuria red blood cell vasts oedema hypertension and oliguric renal failure

Glomerulonephritis and Haemoptysis

ANti=glomerular basement membrane or (anti-GBM) or Goodpasture Syndrome

best screening test for SLE

ANA

Most effective treatment of obesity

Bariatric Surgery

1st line of treatment of obesity

Modification and Pharmacotherapy

it is recommended in those with BMI > 49 or nore than 35 with comorbidities

Bariatric Surgery

Examples of Bariatric Surgery

Lap-Band Gastric Stapling Gastric Bypass Surgery

vegetarian tiredness and fatigue non-alcoholic and nonsmoker pale\low hemoglobin and MCV

Vitamin B 12 def | Vit B12 is not found in plant products, Strict vegetarian excludes all

What are the strong risk factors for Vitamin B12?

Age more than 65 Gastric bypass surgery or gastric resection (intrinsic factor deficiency) Terminal ileum disease (Crohn's disease) Metformin use Strict vegetarian diet

eg case 24hrs after surgery (noncomplicated cholecystectomy) developed cough and fever

Postoperative Atelectasis ## Footnote Extremely common post-operative complication with a degree of pulmonary collapse occuring after almost every abdominal or trans-thoracic procedure.

C-Xray finding of Atelectasis

loss of right heart border silhouette - collapse or incomplete expansion of the lung or a part of the lung

How can you manage Postoperative atelectasis?

1. Removal or impacted secretions by coughing, managed by physiotherapists and involves active chest percussion and breathing exercises 2. Passive postural drainage

DM well controlled planning to conceive HBA1C 6% What is her Essential Supplement?

Folic Acid 5mg a day at least 1 month preconception to 12 wks pregnancy ## Footnote High dose is recommended for pxs with hx of DM to prevent neural tube defects.

pt isolated herself from the world since teen lives alone and wants to be aloine has no friends refuses to get any help from the family does not have any thought diosder affect is blunt Probable Dx?

Chronic Schizophrenia | negative symptoms of schizophrenia : apathetic withdrawal, restriction o

What features does the Negative symptoms of Schizophrenia sets apart from the Major Depression?

negative symptoms along with blunted affect

Symptoms of Major depression

Prominent low mood Hopelessness, helplessness, worthlessness Guilt Suicidal ideation

What is the first choice for cooling of burn injury in Australia?

Water

Mc congenital CVD in infants

VSD

Confirmatory test for SLE

dsDNA

refers to the herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm

Hiatus Hernia 2 types: Sliding and Paraesophageal Hernias

Characterized by the displacement of the GE junction above the diaphargm

Type 1 : Sliding Hernia

localized defect in the phrenoesophageal membrane where the gastric fundus serves as a lead point of herniation, while the GE junction remains fixed to the preaortic fascia and the median arcuate ligament.

Type II hernia

Have elements of both types I and II hernias and are char by both the GE junction and the fundus herniating through the hiatus. Fundus lies above the GE junction.

Type III hiatus hernia

char by the presence of organs other than the stomach in the hernia sac (eg colon, spleen, pancreas or SI)

Type IV hiatus hernia

It is suspected in pt with symptoms of GERD including heartburn, regurgitation and dysphagia

Type 1 Sliding hernia

is suspected in pts with a hx of surgical dissection of the hiatus and epigastric or substernal pain or fullness, nausea, vomiting

Type II, III and IV Paraesophageal hernia

hypotension, fever, multiorgan involvement women who use tampons Other symptoms: confusion, diarrhea, myalgia, vomiting, syncope rash appearing on the trunk spreading to the palms of the hands and soles of the feet

Toxin Mediated Inflammatory Response Syndrome

TSST-1 is a toxin produced by

S. Aureus

What are the complications of obesity in pregnancy?

Gestational Diabetes Pre-eclampsia Sleep Apnea Macrosomia

hypertension presence of protein in the urine

Pre-eclampsia

The side effects of this antipsychotic medication are: obesity, metabolic problems, hyperprolactinemia

Olanzapine

What is the most common adverse effect of antipsychotic medications?

Hyperprolactinemia

What are the symptoms of Hyperprolactinemia?

Gynaecomastia Galactorrhea Sexual dysfunction Infertility Amenorrhea Long-term problems: Reduced bone mineral density and Osteoporosis

Which is not recommended in the tx of antipsychotics induced hyperprolactinemia as it can increase the behavioral symptoms and worsen the psychosis?

Bromocriptine

Stridor presents at rest Croupy cough increasing irritability and lethargy tachypnea tracheal tug nasal flaring use of accessory muscles hypoxia

Severe Croup tx: Nebulized Adrenaline (1 ml of 1% adrenaline solution mixed with 3 ml of normal saline) mainstay tx: oral steroids when croup is mild or moderate

HSIL

Colposcopy including biopsy and Endocervical curettage

dysphagia for both solids and liquids ( 80% ) regurgitation and weight loss ( 40% )

Achalasia

Reading difficulty difficulty in recognizing faces problem with driving esp at night difficulty with television viewing reduce ability to see in bright light may see haloes around light mostly develop during ageing process, long term and unprotected exposure to UV sunlight, smoking, diabetes and family history

Cataract

Most common cause of transient neutropenia in children

Viral infections (influenza, adenovirus, cytomegalovirus, etc)

Delusions Hallucinations loosening of association Disorganized behavior

Schizophrenia

This is not a symptom of Schizophrenia rather a feature of hypomania as a part of the bipolar presentation

Flight of ideas

Examples of GLP1 receptor agonists

Exenatide Lixisenatide

What causes cervical cancer in women?

HPV

What is the HPV vaccine that has been developed to protect against the 2 high risk HPV types (16 and 18) that causes 70% of cervical cancer in women and 90% HPV relatred cancers in men?

Gardasil

Age of boys and girls to start with the HPV vaccine?

12-13 girls before starting sexual activity before age 26 and boys before age 21

Stridor presents at rest tracheal tug nasal flaring hypoxia

Severe croup

Tx of severe croup

Nebulized Adrenaline (1ml of 1% Adrenaline Solution mixed with 3 ml of normal saline)

Vision impairment which increases with daylight and bright light

Cataract

Other symptoms of Cataract

Problem driving at night Difficulty with television viewing Reduce ability to see in the bright light may see haloes around the light

Most impt diagnostic feature of achalasia?

dysphagia for both solids and liquids

Most common cause of transient neutropenia in children

viral infections

Most common viral infections in neutropenia in children

Influenza, Adenovirus and cytomegalovirus

Abdominal pain in the right iliac fossa

Appendicitis

delusions hallucinations loosening of associations disorganized behavior

Schizophrenia

flight of ideas

Hypomania

gynaecomastia galactorrhea sexual dysfunction infertility amenorrhea

Hyperprolactinaemia

Common adverse effect of antipsychotic medication (prolactin raising atypical antipsychotics include: Risperidone, Paliperidone and Amisulpride)

Hyperprolactinaemia

A dopamine agonist and adding this to Risperidone will increase behavioural symptoms and can worsen psychosis

Bromocriptine

One year talking Risperidone, developed hyperprolactinaemia, what is the most appropriate advice?

Switch to quetiapine and slowly wean off Risperidone

Complications of obesity in pregnancy

Gestational diabetes Pre-eclampsia Sleep apnea Macrosomia not a complication: increased risk of postpartum psychosis

HSIL + HPV 16 and 18

Colposcopy with biopsy

What does the clock drawing test measures?

severity of dementia

Medications that can cause Alopecia

Lithium Valproate Carbamazepine Phenytoin

Treatment of Chlamydial urethritis in pregnancy

Azithromycin 1 g orally

sudden onset of chest pain intense nausea and sweating ECG - ST segment elevation in leads II, III and avF

Myocardial Infarction tx: reperfusion therapy

Pts should be considered for reperfusion therapy only if the ff are present:

Ischaemic symptoms of longer than 20 mins - along with chest pain, SOB, sweating, dizziness, epigastric pain and light-headedness Symptoms commenced within 12 hours ST elevation or new LBBB No contraindications to reperfusion

What are the reperfusion therapy?

Cardiac Catheterization - percutaneous coronary intervention - fibrinolytic therapy

What is the gold standard treatment for ST segment elevation of MI?

Cardiac catheterization and Angioplasty (PCI)

Most common percutaneous coronary intervention during cardiac catheterization

Coronary Angiography

What are the medical tx options while patient is being transferred to the cardiac catheter facility?

Morphine Glyceryl nitrate Aspirin

50f, pain midthoracic region, weakness of legs over 2 months, spastic paraparesis

Spinal Cord Compression

Muscle weakness, clonus, spasticity, difficulties with coordination and balance-ataxia, dysarthria, dysphagia, visual problems (nystagmus, optic neuritis, diplopia)

Multiple Sclerosis

68M, ongoing left knee pain, suspected osteoarthritis, which physical finding is not a characteristic of osteoarthritis?

Redness and Warmth

What are the clinical features of Osteoarthritis?

Crepitus Reduce the range of movements wasting of muscles around the joint Peri-articular joint tenderness and joint line tenderness

Acute pancreatitis secondary to alcohol developed thrombocytopenia, low hgb, acute renal failure, persistence fever and hallucinations diagnosis?

Thrombotic Thrombocytopenia

ADAMTS13

TTP

expiratory stridor

Epiglottitis

Symptoms of Epiglottitis

rapid onset of difficulty of breathing drooling inspiratory stridor increased work of breathing absent cough

it is mediated by the increased activity of the renin-angiotensin system

Hypertension

Worsening shoulder pain bilaterally for the last 8 months severe pain meds: paracetamol and nSAIDS, metformin, Lisinorpil painful in every direction Type 2 DM (commonly seen in this disease), HTN and hyperlipidemia Dx? and tx?

Adhesive capsulitis - aka Frozen Shoulder Tx: Oral Prednisolone, 30 mg daily for 3 wks

What is contraindicated in pre-eclampsia and eclampsia?

Tocolysis or using anti-contraction medications

24M, accident playing football, L upper quadrant pain, BP 140/80, HR 80 bpm, RR 18 bpm, O2 sat 98%. Next step of management?

CT abdomen (if the pt is hemodynamically stable after a possible splenic injury) Splenic Trauma - dx

If the pt is hemodynamically unstable after a possible splenic injury

FAST (Focused Abdominal Sonography for Trauma) ultrasound

The incidence of congenital heart disease in the population is

The incidence of congenital heart disease in the family with one child born with heart disease

2-6%

The incidence of congenital heart disease in the family with 2 children born with heart disease

20-30%

Most common cause of UTI in children

E coli

Most common contraindications to Zoster vaccine

Chemotherapy Radiation Therapy Oral Corticosrteroids (asthma, COPD etc) Disease modifying anti-rheumatic drugs (DMARS) Malignant conditions of the reticuloendothelial system (lymphoma, leukemia, Hodgkins) AIDS or HIV infection

Management for severe acute asthma attack

Salbutamol 5mg Nebulized Ipratropium 500mg nebulized Supplemental oxygen to maintain oxygen saturation above 95% Prednisolone 1mg/kg daily for 3-5 days

Which supplement can reduce the risk of pre-eclampsia during this pregnancy?

Calcium 1000mg daily

fever, R upper quadrant pain, hypotension and tachycardia leukocytosis, mildly elevated bilirubin gallbladder sepsis cause of the septic shock?

E. coli Dx: Acute Infective Cholcecystitis

Associated with hypercalcemia

Carcinoma of the lung Multiple Myeloma Renal cell Carcinoma Squamous cell carcinoma of the head and neck except Basal Cell carcinoma

Confusion Dehydation Nausea and vomiting

Hypercalcemia

thyrotoxicosis mild enlargement of the gland investigation?

Ultrasound Thyroid gland (other: radioisotope scan - to differentiate between hot and cold nodule; contraindicated in pregnancy)

What is the difference between a hot and a cold nodule?

A nodule that is producing too much thyroid hormone - hot If a nodule is composed of cells that do not make thyroid hormone - cold

Immune-mediated condition caused by Ab formed during strep throat and skin infxn not treated with antibiotics. facial puffiness peripheral edema both ankles bilateral basal crackles fever, headache, malaise dipstick urinalysis - bloods, proteins

Acute Post-streptococcal Glomerulonephritis

retrosternal chest pain Type 2 DM Hypertension chest pain settles with morphine and metoclopramide but soon after the heparin infusion he started vomiting, HR 50 BP 185/100mmHg, became drowsy with no focal neurological signs. What is the cause?

Intracranial Bleeding

Vomiting bradycardia hypertension drowsiness this is a sign of

Intracranial hemorrhage

Usually associated with higher blood pressure more than 180/120 and has insidious onset. Manifests with a headache, emesis and confusion with restlessness and seizures.

Hypertensive Encephalopathy

Pop in the knee, swelling of the knee Large effusion suspected hemarthrosis

Anterior cruciate ligament tear

Test for Anterior cruciate ligament rupture?

Lachman and Pivot Shift test

Test for PCL injury

Posterior draw test and Posterior sag

Test for Meiscal Injury

McMurray Test

Test for Collateral Ligament injury

Varus and Valgus Stress Tests

Tests for patellar dislocation

Patellar apprehension test

Hematuria, hypertension and palpable kidneys bilaterally Autosominal Dominant Enlarged kidneys

Polycystic Kidney Disease

cola colored urine proteinuria hematuria hypertension oliguria 1-2 wks after streptococcal throat and skin infection nonpalpable nor enlarged kidneys

PSGN

Purulent infection of the renal tubules and results in abscess formation

Pyelonephritis

Most common manifestation is persistent or recurrent macroscopic hematuria. Gross hematuria begins 1 to 2 days after a febrile mucosal (Upper respiratory, sinus, enteral) illness

IgA Nephropathy

Microcytic, hypochromic anaemia

Iron deficiency anaemia

eg case pt brought to the ED He feels that he is about to punch you (+) hallucinations, (+) bizarre delusions What is the next step?

Call the security - pt has expressed his thought of harming the GP next steps 2. Urine drug screen 3. Give haloperidol and call psychia registrar for possible admission as an involuntary patient

Case Upper arm fracture, plaster cast applied around the whole circumference What signs that it will show that the plaster is too tight?

Pain

What is the serious condition that can occur after cast application?

Compartment Syndrome

Earliest sign of comparment syndrome

Increase in pain (throbbing in nature) - often increases as you wiggle the patient's fingers and toes

Short stature (defined as a height below 1st percentile for the age or growth rate Abn slow below the 10th percentile for bone age)

Constitutional Delay of growth and puberty

Diagnosis of Constitutional Delay of growth and puberty

Lack of breast development in girls above 13 years of age Testicular volume less than 4 ml by the age of 14 years of age Often there is a family hx of late onset of puberty in parents or older siblings.

Not seen in hemorrhagic stroke pateints

Hypokalemia

Patient diagnosed with BPPV (but no symptoms when sitting upright) When can he drive his car?

He can drive without restriction

Pt presents with menorrhagia fatigue weight gain bradycardia Facial myxedema (puffy appearance) Thinning of the eyebrows) Diminished deep tendon reflexes with delayed relaxation reflexes

Hypothyroidism

elevated midnight cortisol in the serum or saliva CF: weigh gain, fatigue, moon facies abnormal menstrual cycles menorrhagia due to anoulvatory cycles

Cushing Syndrome

elevated LH:FSH ratio weight gain oligo or amenorrhea (not menorrhagia) infertility hirsutism acne vulgaris obesity and other signs of metabolic syndrome

PCOS

affected females would present at birth with female pseudohermaphroditism precocious puberty hypotension (due to salt wasting associated with hypoaldosteronism and hypocortisolism)

21B hydroxylase deficiency

Agoraphobia with shaky hands and palpitations reluctant to leave the house Dx? TX?

Anxiety SSRI and CBT

What is the bedside measure to assess the severity of Asthma?

Use of accessory muscles upon inspiration General appearance, mental state and work of breathing

Fishy, thin, white homogenous and offensive vaginal discharge, clue cells present, vaginal pH more than 4.5, positive whiff test (KOH) It is not a sexually transmitted disease. Seen in sexually active women.

Bacterial Vaginosis * relapse rate >50 % within 3 months

What is the essential part of the management of Chlamydia?

Contact tracing (past partners for 6 months and give their details to the sexual health clinic)

Tx of Chlamydia

1 g Azithromycin or Doxycycline for 7 days

FEV/FVC < 0.70 (normal value is 0.75-0.85)

Obstructive Airway disease

FEV1/FVC ratio which is either normal or high

Restrictive Lung Disease

Not a risk factor for isolated spontaneous abortion

Retroverted uterus Risk factors for spontaenous abortion: Age more than > 35 yo Smoking High doses of caffeine uterine abnormalities like leiomyoma, adhesions Viral infections Thrombophilia Chromosomal Abnormalities

Nausea vomiting weight loss (more than 5% of weight) moderate to severe dehydration ketosis electrolyte abnormalities

Hyperemesis gravidarum

tx of Hyperemesis gravidarum

Temproary suspension of oral intake followed by Gradual resumption Normal saline with additional potassium chloride Antiemetics (metoclopramide) Vitamin B8

No longer recommened for routine use in the primary prevention of CVD in people with diabetes or high absolute CVD risk

Aspirin

greenish vaginal fluid

Meconium staining - Child is in respiratory distress - Fetal Distress of Labour

greenish vaginal fluid on amniotomy Normal cardiotocography Nxt management?

may proceed to spontaneous vaginal delivery

if there is abnormality or variable deceleration on cardiotocography + greenish vaginal fluid on amniotomy Next management?

Fetal Scalp blood Sampling - to see blood pH and lactate level

1. RIsk taking behaviour - excessive drinking 2. irritability and angry behavior 3. Distractibility - flirtatious initially and then become angry 4. Excessive involvement in some activities -excessive cleansing of the house 5. Increased interest in uncharacteristic sexual flirting

Hypomania

Recurrent intrusive thoughts, images or urges (obsessions) that causes anxiety or distress and by repetitive mental or behavioral acts (compulsions) that the individual feels driven to perform

Obsessive Compulsive DIsorder

Self-dramatic, egocentric, immature, seductive and attention seeking

Histrionic Personality Disorder

Childishly stubborn Argumentative Egocentric Deliberately inefficient Hypercritical of authority figures

Passive-Aggressive Personality Disorder

Most common cause of Sinus bradycardia in neonates

Hypoxia

Guidelines for High-risk breast ca patients

Advice referral to a cancer specialist or family cancer clinic for risk assessment, possible genetic testing and management plan

Most common cause of sudden cardiac death in young adults less than 35 years

Familial Hypertrophic Cardiomyopathy

First line tx for painful peripheral neuropathy

Tricyclic Antidepressants

Clinical feature of opiod overdose

Constricted pupil bradycardia and decreased level of consciousness

What are the examples of opioids

Morphine Codeine Oxycodone Fentanyl Buprenorphine

Clinical features of Sympathomimetic poisoning

Tachycardia Sweating Hypertension Agitation

What are the examples of sympathomimetics?

Cocaine Amphetamines Ecstacy

Best pain relief option for long standing asthma and had undergone cholecystectomy

Morphineundergone

HPV can cause all these subtypes of cancers

Cancer of the cervix Cancer of the Oro-pharyngeal cavity Squamous cell carcinoma of anus, penis and vagina Cancer of the uterus Except: esophageal cancer

Most common presentation of Arthritis in Systemic Lupus Arthritis

Symmetrical arthritis of joints in the hands

What is the most appropriate first-line treatment or urge incontinence?

bladder restraining

Most common side effect f short course of steroids

Emotional Instability

History of mole changes in color and size of the mole Diagnosis?

Superficial spreading melanoma - commonest type of melanoma presented as irregularly pigmented maculae or plaque

Eczematous-looking, dry scabbing, red rash of the nipple with ulceration of nipple and areola Mammography and ultrasound showed nipple skin thickening and dilated duct right breast. Diagnosis and management?

Paget's disease of the nipple with suspected diagnosis of ductal carcinoma in situ - conserving wide local excision of the nipple and surrounding area

recurrent swelling affecting face, arms and legs swelling is non-pitting and non-pruritic unable to breath appendectomy because of severe abdominal pain Dx and investigation?

Hereditary Angioedema (teenage onset) C1 and C4 levels - low if present

baby with feeding difficulties baby gags, gaps, turn blue and stops breathing for a few seconds no vomiting after episodes on and off cough and coryza Diagnosis and investigation?

Whooping cough - Nasopharyngeal swab and PCR

Most common cause of bleeding per rectum in 2 and a half child

Anal fissure

Most commonly causes Pulmonary hypertension and cor pulmonale

Emphysema

It refers to the altered structure (hypertrophy or dilatation) and impaired function of the Right ventricle that results from the pulmonary hypertension that is associated with diseases of the lung (chronic Obstructive Pulmonary disease)

Cor-Pulmonale

What is the most common cause of cor pulmonale in Australia

Chronic Obstructive Pulmonary Disease

6wk baby, hx of gradually worseing nonbillous vomiting over the last 2 wks, focrible and baby is eager to have his formula feed after each vomiting. No history of diarrhea Capillary refill is 3 seconds Has not gained weight over the last 2 weeks No jaundice Olive mass palpable at the right upper quadrant when the baby is supine No rash Diagnosis?

Hypertrophic pyloric stenosis - dx Metabolic abnormality seen in this patient - Hypochloraemic Hypokalemic Metabolic Acidosis

it blocks the transmission through the AV nodes

Adenosine

tx of choice for Paroxysmal Supraventricular tachycardia

Adenosine

Short half life 10-15 seconds Contraindicated in patients with asthma

Adenosine

Treatment of choice for ventricular tachycardia

Shock

Deviation of the trachea away from the side of the tension, a hyper expanded chest, an increased in percussion

Tension Pneumothroax

Elevated conjugated bilirubin, Elevated WBCS and Normal hemoglobin Increased alanine aminotransferase and Aspartate Aminotransferase Lipase and amylase elevbated What is the next step?

ERCP Acute Pancreatitis

What drugs would antagonize the effect of Donepezil?

Anticholinergic drugs - Amitryptilline - Promethazine - Oxybutynin

Alternative drug for women with postmenopausal osteoporosis it reduces the postmenopausal bone loss

Raloxifene

What is the antidote for heparin and is used to reverse toxic effect of haprin on coagulation factors Xa and IIa?

Protamine Sulphate

Used to reverse the Warfarin effects on coagulation system

Vitamin K

Not a feature of hypocalcemia

delayed reflexes

What are the clinical features of hypocalcemia?

Paresthesias and numbness of the fingertips and perioral area Chovtek's sign: twitching of the ipsilateral facial musculature (perioral, nasal and eye muscles) by tapping over cranial nerve VII at the ear Trousseau's sign: carpal spasm induced by inflation of the blood pressure cuff around the arm Tetany is seen in severe hypocalcemia Diminished to absent tendon reflexes.

case: Screening serum marker for hepatoma with chronic hepatitis C for the last 20 years

Alpha fetoprotrein

serum marker for ovarian cancer and should be combined with transvaginal ultrasound for early detection of ovarian cancer in high-risk groups

CA125

A medication that is safe up to 32 wks of gestation but beyond that would lead to premature closure of the fetal ductus arteriosus , delay labour and birth, oligohydramnios

NSAIDS

Safe in pregnancy

codein, paracetamol, metoclopramide long term codein - can cause dependence in the mother and withdrawal signs in the baby

51 m patient, came to the GP clinic for evaluation of a lesion in the cheek, that changed in colour and in size. Next management?

Refer to plastic surgeon

Gold standard for the treatment of melanoma skin cancer

Excision Biopsy

decreased level of conciousness, vomiting and seizures dilated pupils, hypotension and tachycardia Was taking venlafaxine 3 wks ago for severe deepression (heavy dose and has suicidal intention) Next choice of medication?

Mirtazapine - safe in overdose together with Reboxetine - can be considered alternative tx for depression in high-risk suicidal patients In the case: overdose with venlafaxine or venlafaxine toxicity

Mild normocytic normochromic anaemia mild hyponatremia, normal serum potassium, primary hypothyroidism

Myexdema coma

It is defined as severe hypothyroidism leading to decreased mental status, hypothermia and other symptoms related to slowing of function in multiple organs. It can occur as a consequence of severe long-standing hypothyroidism or be precipitated by an acute event such as infection, myocardial infarction, cold exposure, or the administraion of sedative drugs especially opiods.

Myxedema coma

What are the hallmarks of myexdema coma?

Decreased mental status and hypothermia

A headache that occurs that occurs every time one day before the onset of menses. Pain starts from the occipital area and spreads towards the left frontal region Aggaravted by walking Irritable and sensitive to light What is the cause?

Menstrual Migraine

Headache that involves the forehead and temples bilaterally with radiation to the occiput. Aggravated by stress and relieved by alcohol. Not associated with nausea, vomiting and photophobia

Tension Headache

Characterized by paroxysmal clusters of unilateral headache which is retro-orbital in location and is associated with rhinorrhea and lacrimation. Occurs always on the same side. Aggravated by alcohol.

Cluster Headache

Characterized by inflammation of extra-cranial vessels and may involve the intracranial vessels especially opthalmic artery leading to irreversible blindness.

Cluster headache

inflammation of extra-cranial vessels and may involve the intracranial vessels especially the opthalmic artery leading to the irreversible blindness, complaints of throbbing pain unilaterally in the temporal region and scalp and is tender with or without loss of temporal artery pulsation. Pts > 50 years of age. ESR elevated.

Temporal Arteritis

Non-bilious vomiting over the last 2 weeks forcible vomiting eager to have his formula after each vomit no jaundice olive mass palpable at the right upper quadrant no rash Diagnosis? Metabolic Abrnomality seen in this patient?

Pyloric Stenosis Hypochloraemic Hypokalaemic Metaboic Akalosis

Tired, epigastric pain and weight loss Found a supraclavicular lymph node enlargement

Pacreatic cancer

What are the clinical manifestation of hypercalcemia

constipation, anorexia, vomiting, abdominal pain and ileus

62M, acute onset of pain and loss of function of the posterior aspect of the lower leg while playing squash in a tournament. USG shows a tendon lesion. What medication that can lead to this condition?

Ciprofloxacin Pt has rupture of the Achilles tendon/ Complications of the use of Fluoroquinoloone antibiotics in patients >60 years.

It can help in the wound healing of a nonhealing diabetic foot ulders in the presence of peripheral vascular disease

Revascularization

Restless leg syndrome Which of the drug would not increase his symptoms of restless legs

Pramipexole

3 months history of pain in the fingers of both hands No history of fever or other systemic illness fingers are stiff in the morning and eases during the day swelling and tenderness of proximal interphalangeal joins of both hands Elevation of CSR, CRP and normal FBC. First line of treatment?

Juvenile Rheumatoid Arthritis Tx: NSAIDs Other symptoms: morning stiffness joint swelling and joint pain (not bone) limp, morning limp especially deterioration in functioning (writing, gross motor skills)

The most significant risk for ovarian cancer is the 2 genes

BRCA1 and BRCA2

past medical hx of alcohol abuse developed gross tremors, agitation and hallucinations tx?

Benzodiazepine Dx: Delirium tremens

Most common feature of pre-eclampsia

Proteinuria

No hx of active tb perfomed tubeerculin test and it showed induration of 10 mm in 72 hrs What is the next step?

Inform the mother that BCG should be avoided in this situation

The male partner has atrophy of the vas deferens. What will be the investigation to determine the cause, they are trying to conceive with her partner

Sweat Chloride test

Which one of the ff conditions is associated with an increased risk of coeliac disease?

Type 2 DM

Risk factor for developing the celiac disease

Sjogren Syndrome IgA Nephropathy Down Syndrome Turner's syndrome IgA deficiency

Warfarin is indicated to use in

Post coronary bypass surgery

Contraindication in the use of Warfarin

Warfarin Uncontrolled hypertension History of INtracranial bleeding Liver disease with impaired synthetic functions Pregnancy

Which doesn't help in the prognosis of patients with heart failure

Jugular Venous pressure

Élevated Liver enzymes - Aspartate Aminotransferase, Alkaline Phosphatase and Alanine Aminotransferase. Serum cholesterol elevate investigation?

ERCP with biliary manometry dx: post cholecystectomy syndrome

Pruritus on hot bath, vertigo, tinnitus, headache, visual disturbances and transient ischemic strokes

Polycythemia vera

70 grl, photophobia and throbbing headache dx and tx?

Migraine Ibuprofen

2wk child with noisy breathing which gets worse when the baby is lying on his back

Laryngomalacia

Barking cough and inspiratory stridor Parainfluenza type 1

Croup

Acute viral infection of the lower respiratory tract affecting infants less than 24 months and is characterized by respiratory distress, wheezing and crackles

Bronchiolitis tx: Supportive with O2 hydration

82M. dysphagia for solids and liquids able to tolerate solid food and there has been no episodes of bolus impaction denied having dyspepsia symptom oesophageal manometry = demonstrates increased tertiary wave activity and decreased the amplitude of contractions Dx?

Presbyoesophagus - term used to describe the manifestations of a degenerating motor function in the aging esophagus

It affects the small vessels producing leukocytoplastic vasculitis Rash- hands arms and trunks Arthritis Abdominal.pain Scrotal involvement Deposition of IgA Melena Intususseption Scrotal involvement

HSP

Bruising + oral bleeding + epistaxis

ITO

Prostate cancer

Psa

Pyogenic infection and bacterial endocarditis

Infective endocarditis

Menorrhagia Bruising Increased bleeding Incisions Dental Mucosal

VWD

Spontaneous harmarthrosis Muscle bleeds Delayed bleeding

Haemophilia A

Deficiency of Coagulation Factor Ix

Haemophilia B CHRISTMAS DISEASE

Friction rub

Pericarditis

Basal crackles

Cardiac Failure

Apical systolic murmur

MVP

Apical systolic murmur

MVP

Aortic diastolic murmur

Proximal Dissection AORTIC REGURGITATION

Inflammation of the pleura due to underlying pneumonia pulmonary infarction, tumour infiltration, Connective tissue disease

Pleuritis

Severe knee-like intermittent chest pain and adjacent upper abdominal pain "Devil's grip"

Epidemic Pleurodynia Or Bornholm Disease

Friction rub Tachycardia Paradoxical pulse Aggravated by cough and deep inspiration Worse on lying flat And relieved by sitting up and leaning forward.

Acute Pericarditis

What are the investigations for Acute Pericarditis

ECG CXR Echocardiography

Hallmark is emphysema Acute onset of pleuritic pain and dyspnoea in a person with history of asthma or emphysema

Spontaneous Pneumothorax

Crushing vice-like burning

Aching Tightness Burning

ANGINA

Retrosternam LATERAL CHEST (pleuritic)

Pulmonary Embolus

Front to back to chest Down back to abdomen and arms

Aortic Dissection

Atherosclerosis Hypertension Marfans

Aortic Dissection

Phlebitis Calf pain Surgery Immobility

Pulmonary Embolus

Pain tadiati in f ro the throat/lower jaw Left arm *often Right arm *uncommon Back *uncommon Deep retrosternal

Gallop rhythm Murmur of Mu Basal Crackles

Myocardial Infarction

Syncope Pallor Hemiparesis Paraplegia

Aortic Dissection

Widening of the mediastinum

Aortic Dissection

S2, S3, S4

Pulmonary Embolus

Normal or ST Depression

Angina

S1 Q3 T3

Pulmonary Embolus

Q waves ST elevation T inversion

Myocardial Infarction

Pallor Nausea Vomiting Dyspnoea Syncope

Myocardial Infarction

Strangling in throat Variable arrthymias S3 during attacks Normal or ST depression

Angina

Dyspnoea Syncope Sweating Vomiting Cyanosis Agitation Haemostasis Tachycardia

Pulmonary Embolus

Adventitious sound R acisdeviation

Pulmonary embolus

Diagnostic test for myocardial infarction

Serum enzymes TROPONIN t or I cardiac scanning

Diagnostic test for angina

Stress ECG Coronary Angiography Technetium scanning enzymes

Diagnostic test for Pulmonary Embolism

Lung scanning CT pulmonary angiography VQ scan

Diagnostic test for Aortid dissection

TOE Ultrasound AORTIC angiography CT SCAN

It can cause oesophagitis characterised by a burning epigastric or retrosternal.pain that may radiate to the jaw

Gastro-oesophageal reflux

If the pain is sudden onset after the endoscopy

Oesophageal rupture

Epigastric Radiating to the retrosternal throat Burning pain with heavy metals , wine or coffee and lying or bending Relieved by standing antacids

Acid reflux

Deep retrostern Radiating to the back Precipitated by eating hot or cold food or drinks Relived by antispasmodic and nitroglycerin

Oesophageal spasm

Deep retrosternal.pain Radiating to the back Precipitated by eating Gnawing pain Relived by antacids

Peptic ulcer

Right hypochondrium pain Radiating below the right scapular Tip right shoulder Precipitated by fatty food

Gallbladder disease

It is a recurrent attack ks of stabbinfleft-sided submammary pain, usually associated with anxiety and depression.

Da Costa Syndrome

Presents with acute chest pain and shortness of breath. It mimics an acute myocardial Infarction and shortness of breath. It is caused by catecholamine discharge following an emotionally stressful event, resulting in apical left ventricular ballooning.

Takotsubo cardiomyopathy

What is the treatment for Takotsubo cardiomyopathy?

ASPIRIN BETA BLOCKERS ACE INHIBITORS

Pain occurs with exertion and is usually predictable with no symptoms change during the past month

Stable angjna

Also referred to as crescendo angina or pre infarct anginaand acute coronary insufficiency. It may lead to complete infarction with relief of symptoms.

Unstable angina

Pain occurs when lying flat and is relieved by sitting up

Decubitus angina

Pain occurs at rest and without apparent cause. Associated with typical transient ECG changes of ST elevation It is caused by coronary artery spasm

Variant angina or Prinzmental Anguna or Spadm Angina

What is the treatment for acute attack and episodic angina

GLYERYL trinitrate 300-600 mcg tab subliminally, Max 1800 mcg Or GlycerYl nitrate SL 400 mcg metered dose sprat 1 spray repeat 5 mins if pain persists Or Isosorbide denigrate 5mg subliminally Or aspirin 150 mg Or nifedipine 5mg

Prevention of moderate stable angina

Beta blocker Metoprolol Glyeryl trinitate. Isosorbide mononitrate

Treatment for Refractory stable angina

Consider adding nicorandil 5mg Or Ivabradine

Treatment for unstable angina

May need I've nitrate therapy

Lazy bowel Is the teem used to describe a rectum rhat has become unresponsive to faecal content and this usually follows repeated ignoring of calls ro defecate.

Dyscheiza

What is the most common factor of constipation in children?

Diet