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Chings Notes > Easy to Remember > Flashcards

Easy to Remember Flashcards

1
Q

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

Inv?

A

Plasma Aldosterone to Renin Ratio

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2
Q

Antibiotic - similar to botulism

A

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

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3
Q

Risk Factor for the development of Hypertrophic Pyloric Stenosis?

A

Formula feeding
Male
Caucasian background
FIrstborn
Positive family history

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4
Q

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

A

Maternal Smoking

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5
Q

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

A

Erythromycin
Azithromycin

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6
Q

What are the signs and symptoms of Acromegaly?

A

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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7
Q

Complications of Acromegaly

A

HTN
DM
Cardiomyopathy
Colorectal ca

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8
Q
A
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9
Q

Best single test for the diagnosis for Acromegaly

A

IGF-1

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10
Q

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

A

Oral Glucose tolerance test with
serial GH

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11
Q

What is the preferred initial test for suspected thyroid function?

A

TSH

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12
Q

Foot drop

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

weakness in foot dorsiflexion and foot eversion

A

Common peroneal nerve injury

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13
Q

marked
weakness of inversion of the foot

A

L4 root lesion

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14
Q

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

A

L5 motor nerve root damage

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15
Q

ankle reflexes and sensation of the posterior calf and lateral foot

weakness of plantar flexion

A

S1

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16
Q

Best initial treatment for Parkinson’s disease?

A

Carbidopa/Levodopa

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17
Q

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?

A

Amantadine
Pergolide

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18
Q

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

A

PROM

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19
Q

What are the management of PROM?

A

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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20
Q

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

A

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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21
Q

What are the protective factors for developing uterine fibroid?

A

Smoking
pregnancy

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22
Q

What factors increases estrogen levels and contributes in developing fibroids?

A

Nulliparity
obesity
early menarche

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23
Q

Common area affected by osteoarthritis

A

1st carpometacarpal joint of the thumb

Other joints that are involved:

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24
Q

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

A

Metacarpophalangeal joints and involves the interphalangeal and distal interphalangeal joints

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25
Q

What are commonly involved in Rheumatoid Arthritis?

A

MCP
PIP
(Proximal interphalangeal joints)

Atlantoaxial Joint

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26
Q

Midline upper neck mass
moves with tongue protrusion

A

Thyroglossal cysts

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27
Q

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

A

Branchial Cysts

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28
Q

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?

A

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

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29
Q

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

A

Turner Syndrome

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30
Q

What are the other physical features of Turner Syndrome?

A

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

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31
Q

recurrent fever and chest pain with pleural or pericardial rub

A

Dressler’s Syndrome

  • usually develops 2 to 3 wks ater acute myocardial infarction or heart surgery
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32
Q

best tx for Dressler’s Syndrome

A

Aspirin

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33
Q

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

A

Intestinal malrotation with midgut volvulus

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34
Q

Key sign in diagnosing complete ischemia which requires urgent surgical intervention

A

Paraesthesis
or
Paralysis

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35
Q

most useful test in the evaluation of osteoporosis

A

Serum 25 hydroxy Vitamin D level

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36
Q

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

A

DEXA scan

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37
Q

most commonly affected in Pseudogout

A

knee

can also affect the elbows, ankles and wrists

develops when calcium pyrophosphate dihydrate crystals deposit int he cartilafe of a joint

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38
Q

most common surgical procedure involved in prostate ca

A

Radical Prostatectomy

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39
Q

most common complication of radical prostatectomy

A

Erectile Dysfunction

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40
Q

left sided weakness involving both upper and lower limbs

A

Right sided intracranial lesion

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41
Q

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

A

Infrequent intermittent asthma

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42
Q

tx for Infrequent intermittent asthma

A

inhaled short acting beta2 agonist or SABA

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43
Q

diplopia
upward gaze
numbness below the eye

A

Orbital floor fracture

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44
Q

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

A

Danazol

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45
Q

anaphylaxis in children
dosage and administration

A

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

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46
Q

causes high troponin levels in patients without acute coronary syndrome

A

Pulmonary embolism

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

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47
Q

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

A

breastfeeding

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48
Q

what is the more efficient tx for non-cyclical mastalgia

A

Norethistherone

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49
Q

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

A

Tamoxifen

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50
Q

recommended screening for FBS in non-diabetic individuals

A

every 3 years over the age of 40

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51
Q

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

A

5 yearly

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52
Q

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

A

Vitamin D level and Vitaminb B12

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53
Q

nasal discharge
fever
wheezy cough
inspiratory crackles and expiratory wheeze

A

Acute moderate Bronchiolitis

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54
Q

main tx for bronchiolitis

A

Supportive
appropriate oxygenation and fluid intake

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55
Q

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

A

Septic Arthritis

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56
Q

tx for suspected septic arthritis is

A

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

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57
Q

DIP
Heberden’s nodes

A

Osteoarthritis

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58
Q

MCP
PIP
Heberden’s nodes absent

A

Rheumatoid Arthritis

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59
Q

tx for tremor

A

Primidone

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60
Q

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

A

beta-lactam antibiotics and gentamicin

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61
Q

secondary hyperparathyroidism occurs in patients with

A

Vitamin D Deficiency
Renal failure
Osteomalacia

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62
Q

Common causes of hypercalcemia

A

Sarcoidosis
Malignancies including lymphoma, leukaemia
Hyperparathyroidism
Vitamin D overdose

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63
Q

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

A

Lithium

Dx; Acute Mania

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64
Q

HSIL

A

Refer for colposcopy

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65
Q

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

A

give VZIG
- administer within 72 hrs of exposure

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66
Q

not contraindicated in pregnancy

A

live vaccines
(eg Varicella)

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67
Q

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

A

IgM

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68
Q
A
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69
Q

CI to surgical intervention in esophageal malignancy

A

invasion of tracheobronchial tree

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70
Q

Good indicators of return of spontaneous circulation

A

Check for pupil size and reaction to light

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71
Q

Ovarian cyst 5-7 cm

A

Repeat ultrasound scan
within 3-4 months

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72
Q

ovarian cyst < 5cm

A

Reassurance no further actio needed.

Do not require follow-up

will resolve within 3 menstrual cycles

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73
Q

ovarian cyst > 7 cm

A

Referral gynaecologic

Surgical intervention

surgery of choice:
Laparoscopic Cystectomy

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74
Q

not an indication for surgical intervention in pt with acute pancreatitis

A

Epigastric pain

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75
Q

most common salivary gland cancer

A

Mucoepidermoid carcinoma
20s-50s

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76
Q

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

A

Pleomorphic Adenoma

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77
Q

first trimester bleeding increased the risk of ____

A

Preterm birth at 28-31 weeks

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78
Q

most frequent cause of acquired angioedema

A

ACE inhibitors

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79
Q

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

A

Hereditary angioedema

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80
Q

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

A

Fat embolism

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81
Q

most effective tx for nocturnal enuresis

A

Alarm bell and Pad

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82
Q

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

A

Enoxaparin

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83
Q

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

A

Urinary Albumin-creatinine ratio

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84
Q

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

A

Combined HRT

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85
Q

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

A

Combined HRT

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86
Q

Most urgent requirement in DKA

A

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

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87
Q

most important findings in bronchiolitis in children

A

inspiratory crackles

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88
Q

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

A

Rectus Sheath hematoma

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89
Q

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

A

Warfarin reversal using Vitamin K and Prothrombinex

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90
Q

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

A

Bacterial Meningitis

E coli.

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91
Q

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

A

rapid fluctuating cognition
visual hallucinations
spontaenous motor Parkinsonism

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92
Q

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

A

Continue supportive measures

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

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93
Q

Most appropriate test for investigation of symptomatic or asymptomatic haemochromatosis

A

Iron studies or Serum ferritin levels and transferrin saturation

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94
Q

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

A

Threatened Miscarriage

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95
Q

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.

A

Inevitable Miscarriage

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96
Q

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

A

Incomplete miscarriage

  • most common in the late trimester and early second trimester
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97
Q

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.

A

Missed Miscarriage

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98
Q

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

A

Complete Miscarriage

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99
Q

What supplements are not routinely used in pregnancy?

A

Vitamin A, B and C

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100
Q

What is the iodine dosage recommendation during pregnancy?

A

150 micrograms throughout pregnancy

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101
Q

What is the recommended dose for Folic Acid during pregnancy?

A

5 mg daily 12 wks before conception and during first trimester

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102
Q

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

A

GORD
Gastro-oesophgeal reflux disease

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103
Q

Next best step in the dx of GORD in children

A

Intraluminal impedance combined with ph probe monitoring or ph study

catheter-like nasogastric tube inserted transnasally to allow detection

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104
Q
A
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105
Q

What are the examples of Overvalued ideas

A

Body dysmorphic disorder
Anorexia Nervosa
Hypochrondriasis

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106
Q

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

A

Moderate Risk Category

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107
Q

Screening for moderate risk catefory for colorectal ca

A

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.

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108
Q

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

A

Colonoscopy

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109
Q

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

A

V/Q Scan

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110
Q

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

A

Breast CA

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111
Q

What is the most common cancer in women in Australia?

A

Breast ca

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112
Q

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

A

18-24 months

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113
Q

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

A

5 years

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114
Q

What type of cancer has the worst prognosis?

A

Metastatic breast ca

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115
Q

What type of cancer has the good prognosis?

A

Seminoma of the Testis

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116
Q

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

A

Choriocarcinoma

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117
Q

Most common form of haematological or blood cancer in Australia?

A

Lymphoma

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118
Q

What are the causes of clubbing?
Respi?

A

Bronchiectasis, Ca, abscess

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119
Q

What are the causes of clubbing?
CVS

A

Cyanotic Heart Disease

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120
Q

What are the causes of clubbing?
GIT

A

PSC, IBD

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121
Q

What are the causes of clubbing?
Endocrine

A

Thyroid disorder

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122
Q

What is the sign of Abnormal Mitral valve?

A

Opening Snap

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123
Q

What can be a sign for chronic hypoxia?

A

Clubbed fingers

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124
Q

first line tx for reducing chest pain in acute anterior MI

A

Morphine

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125
Q

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?

A

Heart Failure

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126
Q

Sildenafil is used for?

A

Erectile Dysfunction

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127
Q

What are the tx for BPH?

A

Doxazosin
Tamsulosin - quick acting with low risk of side effects

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128
Q

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

A

Aortic Stenosis

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

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129
Q

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

A

Echocardiography

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130
Q

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

A

Transthoracic echocardiography (TTE)
and
Transesophageal Echocardiography (TEE)

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131
Q

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.

A

TTE

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132
Q

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.

A

TEE

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133
Q

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

A

Benzodiazepine

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134
Q

dark urine
elevated BP
Normal complement levels
Ibuprofen use

Other symptoms:
dec urine output
fatigue
fever
skin rash
HTN - may also be present

A

Acute Interstitial Nephritis

AIN can be caused by NSAIDs (Ibup, infnxs,autoimmune disorders and other toxic exposures)

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135
Q

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

A

IgA Nephropathy

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136
Q

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

A

IgA Nephropathy

The HTN is tx by ACEi/ARBs

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137
Q

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

A

Poststreptococcal Glumeronephritis

The HTN is tx by FUROSEMIDE

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138
Q

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

A

D. Dimer

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139
Q

Primary and most efficient diagnostic modality for identifying and confirming Varicoceles

A

Testicular USG

ninivasive, safe, cost-effective
size, loc, severity

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140
Q

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

A

CT scan

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141
Q

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

A

Kwasaki disease

tx: Aspirin and Immunoglobulins

Complications:
vasculitis leading to coronary artery aneurysm in 17-31% cases

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142
Q

What is to be avoided in Kawasaki disease?

A

Steroid

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143
Q

What to use to detect the aneurysm in Kawasaki?

A

Echocardiography

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144
Q

What is the key symptom of pain associated with gallstones?

A

Right upper quadrant pain

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145
Q

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

A

Nephrotic Syndrome

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146
Q

Mc form of childhood nephrotic Sydnrome in children

A

Idiopathic Nephrotic Syndrome

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147
Q

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

A

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

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148
Q

What is the vaccine used to prevent herpes zoster infxn?

A

Zostavax
(live attenuated vaccine)

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149
Q

Contraindications for Zostavax?

A

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)

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150
Q

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

A

Sodium Valproate

Lamptrigine i

Carbamazepine and Phenytoin may worsen the seizure in JVE

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151
Q

Why is Sodium Valproate contraindicated in pregnancy?

A

Spina bifida
malformations
coagulopathies

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152
Q

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

A

Aortic Coarctation of Aorta

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153
Q

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

A

Aortic dissection

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154
Q

useful in children with nocturnal enuresis who are going to school camps

can be used oral or nasal eachn night

A

Nasal desmopressin

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155
Q

treatment of choice for primary nocturnal enuresis in all other situations

A

Bed Alarm or Night trainer

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156
Q

Used in cases with persistent enursesis

A

Combination of Desmopressin and the bed alarm

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157
Q

2 most common presentations of IgA nephropathy

A

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

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157
Q

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

A

Poststreptococcal glomerulonephritis

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158
Q

What are the clinical features of PSGN?

A

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

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159
Q

Glomerulonephritis and Haemoptysis

A

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

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160
Q

best screening test for SLE

A

ANA

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161
Q

Most effective treatment of obesity

A

Bariatric Surgery

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162
Q

1st line of treatment of obesity

A

Modification and Pharmacotherapy

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163
Q

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

A

Bariatric Surgery

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164
Q

Examples of Bariatric Surgery

A

Lap-Band
Gastric Stapling
Gastric Bypass Surgery

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165
Q

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

A

Vitamin B 12 def

Vit B12 is not found in plant products, Strict vegetarian excludes all

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166
Q

What are the strong risk factors for Vitamin B12?

A

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

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167
Q

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

A

Postoperative Atelectasis

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

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168
Q

C-Xray finding of Atelectasis

A

loss of right heart border silhouette

  • collapse or incomplete expansion of the lung or a part of the lung
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169
Q

How can you manage Postoperative atelectasis?

A
  1. Removal or impacted secretions by coughing, managed by physiotherapists and involves active chest percussion and breathing exercises
  2. Passive postural drainage
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170
Q

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

A

Folic Acid 5mg a day at least
1 month preconception to 12 wks pregnancy

High dose is recommended for pxs with hx of DM to prevent neural tube defects.

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171
Q

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?

A

Chronic Schizophrenia

negative symptoms of schizophrenia :
apathetic withdrawal, restriction o

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172
Q

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

A

negative symptoms along with blunted affect

173
Q

Symptoms of Major depression

A

Prominent low mood
Hopelessness, helplessness, worthlessness
Guilt
Suicidal ideation

174
Q

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

A

Water

175
Q

Mc congenital CVD in infants

A

VSD

176
Q

Confirmatory test for SLE

A

dsDNA

177
Q

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

A

Hiatus Hernia

2 types:
Sliding and
Paraesophageal Hernias

178
Q

Characterized by the displacement of the GE junction above the diaphargm

A

Type 1 : Sliding Hernia

179
Q

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.

A

Type II hernia

180
Q

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.

A

Type III hiatus hernia

181
Q

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

A

Type IV hiatus hernia

182
Q

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

A

Type 1 Sliding hernia

183
Q

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

A

Type II, III and IV Paraesophageal hernia

184
Q

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

A

Toxin Mediated Inflammatory Response Syndrome

185
Q

TSST-1 is a toxin produced by

A

S. Aureus

186
Q

What are the complications of obesity in pregnancy?

A

Gestational Diabetes
Pre-eclampsia
Sleep Apnea
Macrosomia

187
Q

hypertension
presence of protein in the urine

A

Pre-eclampsia

188
Q

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

A

Olanzapine

189
Q

What is the most common adverse effect of antipsychotic medications?

A

Hyperprolactinemia

190
Q

What are the symptoms of Hyperprolactinemia?

A

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

191
Q

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

A

Bromocriptine

192
Q

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

A

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

193
Q

HSIL

A

Colposcopy including biopsy and Endocervical curettage

194
Q

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

A

Achalasia

195
Q

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

A

Cataract

196
Q

Most common cause of transient neutropenia in children

A

Viral infections (influenza, adenovirus, cytomegalovirus, etc)

197
Q

Delusions
Hallucinations
loosening of association
Disorganized behavior

A

Schizophrenia

198
Q

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

A

Flight of ideas

199
Q

Examples of GLP1 receptor agonists

A

Exenatide
Lixisenatide

200
Q

What causes cervical cancer in women?

A

HPV

201
Q

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?

A

Gardasil

202
Q

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

A

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

203
Q

Stridor presents at rest
tracheal tug
nasal flaring
hypoxia

A

Severe croup

204
Q

Tx of severe croup

A

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

205
Q

Vision impairment which increases with daylight and bright light

A

Cataract

206
Q

Other symptoms of Cataract

A

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

207
Q

Most impt diagnostic feature of achalasia?

A

dysphagia for both solids and liquids

208
Q

Most common cause of transient neutropenia in children

A

viral infections

209
Q

Most common viral infections in neutropenia in children

A

Influenza, Adenovirus and cytomegalovirus

210
Q

Abdominal pain in the right iliac fossa

A

Appendicitis

211
Q

delusions
hallucinations
loosening of associations
disorganized behavior

A

Schizophrenia

212
Q

flight of ideas

A

Hypomania

213
Q

gynaecomastia
galactorrhea
sexual dysfunction
infertility
amenorrhea

A

Hyperprolactinaemia

214
Q

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

A

Hyperprolactinaemia

215
Q

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

A

Bromocriptine

216
Q

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

A

Switch to quetiapine and slowly wean off Risperidone

217
Q

Complications of obesity in pregnancy

A

Gestational diabetes
Pre-eclampsia
Sleep apnea
Macrosomia

not a complication: increased risk of postpartum psychosis

218
Q

HSIL + HPV 16 and 18

A

Colposcopy with biopsy

219
Q

What does the clock drawing test measures?

A

severity of dementia

220
Q

Medications that can cause Alopecia

A

Lithium
Valproate
Carbamazepine
Phenytoin

221
Q

Treatment of Chlamydial urethritis in pregnancy

A

Azithromycin 1 g orally

222
Q

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

A

Myocardial Infarction
tx: reperfusion therapy

223
Q

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

A

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

224
Q

What are the reperfusion therapy?

A

Cardiac Catheterization
- percutaneous coronary intervention
- fibrinolytic therapy

225
Q

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

A

Cardiac catheterization and Angioplasty (PCI)

226
Q

Most common percutaneous coronary intervention during cardiac catheterization

A

Coronary Angiography

227
Q

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

A

Morphine
Glyceryl nitrate
Aspirin

228
Q

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

A

Spinal Cord Compression

229
Q

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

A

Multiple Sclerosis

230
Q

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

A

Redness and Warmth

231
Q

What are the clinical features of Osteoarthritis?

A

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

232
Q

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

A

Thrombotic Thrombocytopenia

233
Q

ADAMTS13

A

TTP

234
Q

expiratory stridor

A

Epiglottitis

235
Q

Symptoms of Epiglottitis

A

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

236
Q

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

A

Hypertension

237
Q

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?

A

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

238
Q

What is contraindicated in pre-eclampsia and eclampsia?

A

Tocolysis or using anti-contraction medications

239
Q

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

A

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

240
Q

If the pt is hemodynamically unstable after a possible splenic injury

A

FAST (Focused Abdominal Sonography for Trauma) ultrasound

241
Q

The incidence of congenital heart disease in the population is

A

1%

242
Q

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

A

2-6%

243
Q

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

A

20-30%

244
Q

Most common cause of UTI in children

A

E coli

245
Q
A
246
Q

Most common contraindications to Zoster vaccine

A

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

247
Q

Management for severe acute asthma attack

A

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

248
Q

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

A

Calcium 1000mg daily

249
Q

fever, R upper quadrant pain, hypotension and tachycardia
leukocytosis, mildly elevated bilirubin
gallbladder sepsis

cause of the septic shock?

A

E. coli

Dx: Acute Infective Cholcecystitis

250
Q

Associated with hypercalcemia

A

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

except Basal Cell carcinoma

251
Q

Confusion Dehydation Nausea and vomiting

A

Hypercalcemia

252
Q

thyrotoxicosis
mild enlargement of the gland

investigation?

A

Ultrasound Thyroid gland

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

253
Q

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

A

A nodule that is producing too much thyroid hormone - hot

If a nodule is composed of cells that do not make thyroid hormone - cold

254
Q

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

A

Acute Post-streptococcal Glomerulonephritis

255
Q

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?

A

Intracranial Bleeding

256
Q

Vomiting
bradycardia
hypertension
drowsiness

this is a sign of

A

Intracranial hemorrhage

257
Q

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.

A

Hypertensive Encephalopathy

258
Q

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

A

Anterior cruciate ligament tear

259
Q

Test for Anterior cruciate ligament rupture?

A

Lachman and Pivot Shift test

260
Q

Test for PCL injury

A

Posterior draw test and Posterior sag

261
Q

Test for Meiscal Injury

A

McMurray Test

262
Q

Test for Collateral Ligament injury

A

Varus and Valgus Stress Tests

263
Q

Tests for patellar dislocation

A

Patellar apprehension test

264
Q

Hematuria, hypertension and palpable kidneys bilaterally
Autosominal Dominant
Enlarged kidneys

A

Polycystic Kidney Disease

265
Q

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

A

PSGN

266
Q

Purulent infection of the renal tubules and results in abscess formation

A

Pyelonephritis

267
Q

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

A

IgA Nephropathy

268
Q

Microcytic, hypochromic anaemia

A

Iron deficiency anaemia

269
Q

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

What is the next step?

A

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

270
Q

Case
Upper arm fracture, plaster cast applied around the whole circumference

What signs that it will show that the plaster is too tight?

A

Pain

271
Q

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

A

Compartment Syndrome

272
Q

Earliest sign of comparment syndrome

A

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

273
Q

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

A

Constitutional Delay of growth and puberty

274
Q

Diagnosis of Constitutional Delay of growth and puberty

A

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.

275
Q

Not seen in hemorrhagic stroke pateints

A

Hypokalemia

276
Q

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

A

He can drive without restriction

277
Q

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

A

Hypothyroidism

278
Q

elevated midnight cortisol in the serum or saliva

CF:
weigh gain, fatigue, moon facies
abnormal menstrual cycles
menorrhagia due to anoulvatory cycles

A

Cushing Syndrome

279
Q

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

A

PCOS

280
Q

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

A

21B hydroxylase deficiency

281
Q

Agoraphobia with shaky hands
and palpitations
reluctant to leave the house

Dx? TX?

A

Anxiety
SSRI and CBT

282
Q

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

A

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

283
Q

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.

A

Bacterial Vaginosis
* relapse rate >50 % within 3 months

284
Q

What is the essential part of the management of Chlamydia?

A

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

285
Q

Tx of Chlamydia

A

1 g Azithromycin or Doxycycline for 7 days

286
Q

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

A

Obstructive Airway disease

287
Q

FEV1/FVC ratio which is either normal or high

A

Restrictive Lung Disease

288
Q

Not a risk factor for isolated spontaneous abortion

A

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

289
Q

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

A

Hyperemesis gravidarum

290
Q

tx of Hyperemesis gravidarum

A

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

291
Q

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

A

Aspirin

292
Q

greenish vaginal fluid

A

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

293
Q

greenish vaginal fluid on amniotomy
Normal cardiotocography

Nxt management?

A

may proceed to spontaneous vaginal delivery

294
Q

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

A

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

295
Q
  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
A

Hypomania

296
Q

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

A

Obsessive Compulsive DIsorder

297
Q

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

A

Histrionic Personality Disorder

298
Q

Childishly stubborn
Argumentative
Egocentric
Deliberately inefficient
Hypercritical of authority figures

A

Passive-Aggressive Personality Disorder

299
Q

Most common cause of Sinus bradycardia in neonates

A

Hypoxia

300
Q

Guidelines for High-risk breast ca patients

A

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

301
Q

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

A

Familial Hypertrophic Cardiomyopathy

302
Q

First line tx for painful peripheral neuropathy

A

Tricyclic Antidepressants

303
Q

Clinical feature of opiod overdose

A

Constricted pupil
bradycardia and decreased level of consciousness

304
Q

What are the examples of opioids

A

Morphine
Codeine
Oxycodone
Fentanyl
Buprenorphine

305
Q

Clinical features of Sympathomimetic poisoning

A

Tachycardia
Sweating
Hypertension
Agitation

306
Q

What are the examples of sympathomimetics?

A

Cocaine
Amphetamines
Ecstacy

307
Q

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

A

Morphineundergone

308
Q

HPV can cause all these subtypes of cancers

A

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

309
Q

Most common presentation of Arthritis in Systemic Lupus Arthritis

A

Symmetrical arthritis of joints in the hands

310
Q

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

A

bladder restraining

311
Q

Most common side effect f short course of steroids

A

Emotional Instability

312
Q

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

A

Superficial spreading melanoma

  • commonest type of melanoma
    presented as irregularly pigmented maculae or plaque
313
Q

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?

A

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

314
Q

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?

A

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

315
Q

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?

A

Whooping cough
- Nasopharyngeal swab and PCR

316
Q

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

A

Anal fissure

317
Q

Most commonly causes Pulmonary hypertension and cor pulmonale

A

Emphysema

318
Q

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)

A

Cor-Pulmonale

319
Q

What is the most common cause of cor pulmonale in Australia

A

Chronic Obstructive Pulmonary Disease

320
Q

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?

A

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

321
Q

it blocks the transmission through the AV nodes

A

Adenosine

322
Q

tx of choice for Paroxysmal Supraventricular tachycardia

A

Adenosine

323
Q

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

A

Adenosine

324
Q

Treatment of choice for ventricular tachycardia

A

Shock

325
Q

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

A

Tension Pneumothroax

326
Q

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

A

ERCP
Acute Pancreatitis

327
Q

What drugs would antagonize the effect of Donepezil?

A

Anticholinergic drugs
- Amitryptilline
- Promethazine
- Oxybutynin

328
Q

Alternative drug for women with postmenopausal osteoporosis

it reduces the postmenopausal bone loss

A

Raloxifene

329
Q

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

A

Protamine Sulphate

330
Q

Used to reverse the Warfarin effects on coagulation system

A

Vitamin K

331
Q

Not a feature of hypocalcemia

A

delayed reflexes

332
Q

What are the clinical features of hypocalcemia?

A

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.

333
Q

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

A

Alpha fetoprotrein

334
Q

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

A

CA125

335
Q

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

A

NSAIDS

336
Q

Safe in pregnancy

A

codein, paracetamol, metoclopramide

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

337
Q

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?

A

Refer to plastic surgeon

338
Q

Gold standard for the treatment of melanoma skin cancer

A

Excision Biopsy

339
Q

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?

A

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

340
Q

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

A

Myexdema coma

341
Q

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.

A

Myxedema coma

342
Q

What are the hallmarks of myexdema coma?

A

Decreased mental status and hypothermia

343
Q

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?

A

Menstrual Migraine

344
Q

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

A

Tension Headache

345
Q

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.

A

Cluster Headache

346
Q

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

A

Cluster headache

347
Q

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.

A

Temporal Arteritis

348
Q

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?

A

Pyloric Stenosis
Hypochloraemic Hypokalaemic Metaboic Akalosis

349
Q

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

A

Pacreatic cancer

350
Q

What are the clinical manifestation of hypercalcemia

A

constipation, anorexia, vomiting, abdominal pain and ileus

351
Q

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?

A

Ciprofloxacin

Pt has rupture of the Achilles tendon/

Complications of the use of Fluoroquinoloone antibiotics in patients >60 years.

352
Q

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

A

Revascularization

353
Q

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

A

Pramipexole

354
Q

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?

A

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)

355
Q

The most significant risk for ovarian cancer is the 2 genes

A

BRCA1 and BRCA2

356
Q

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

A

Benzodiazepine
Dx: Delirium tremens

357
Q

Most common feature of pre-eclampsia

A

Proteinuria

358
Q

No hx of active tb
perfomed tubeerculin test and it showed induration of 10 mm in 72 hrs

What is the next step?

A

Inform the mother that BCG should be avoided in this situation

359
Q

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

A

Sweat Chloride test

360
Q

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

A

Type 2 DM

361
Q

Risk factor for developing the celiac disease

A

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

362
Q

Warfarin is indicated to use in

A

Post coronary bypass surgery

363
Q

Contraindication in the use of Warfarin

A

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

364
Q

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

A

Jugular Venous pressure

365
Q

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

investigation?

A

ERCP with biliary manometry
dx: post cholecystectomy syndrome

366
Q

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

A

Polycythemia vera

367
Q

70 grl, photophobia and throbbing headache
dx and tx?

A

Migraine
Ibuprofen

368
Q

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

A

Laryngomalacia

369
Q

Barking cough and inspiratory stridor
Parainfluenza type 1

A

Croup

370
Q

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

A

Bronchiolitis
tx: Supportive with O2 hydration

371
Q

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?

A

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

372
Q

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

A

HSP

373
Q

Bruising + oral bleeding + epistaxis

A

ITO

374
Q

Prostate cancer

A

Psa

375
Q

Pyogenic infection and bacterial endocarditis

A

Infective endocarditis

376
Q

Menorrhagia
Bruising
Increased bleeding

Incisions
Dental
Mucosal

A

VWD

377
Q

Spontaneous harmarthrosis
Muscle bleeds
Delayed bleeding

A

Haemophilia A

378
Q

Deficiency of Coagulation Factor Ix

A

Haemophilia B
CHRISTMAS DISEASE

379
Q

Friction rub

A

Pericarditis

380
Q

Basal crackles

A

Cardiac Failure

381
Q

Apical systolic murmur

A

MVP

382
Q

Apical systolic murmur

A

MVP

383
Q

Aortic diastolic murmur

A

Proximal Dissection
AORTIC REGURGITATION

384
Q

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

A

Pleuritis

385
Q

Severe knee-like intermittent chest pain and adjacent upper abdominal pain

“Devil’s grip”

A

Epidemic Pleurodynia
Or Bornholm Disease

386
Q

Friction rub
Tachycardia
Paradoxical pulse

Aggravated by cough and deep inspiration
Worse on lying flat
And relieved by sitting up and leaning forward.

A

Acute Pericarditis

387
Q

What are the investigations for Acute Pericarditis

A

ECG
CXR
Echocardiography

388
Q

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

A

Spontaneous Pneumothorax

389
Q

Crushing vice-like burning

A

MI

390
Q

Aching
Tightness
Burning

A

ANGINA

391
Q

Retrosternam
LATERAL CHEST (pleuritic)

A

Pulmonary Embolus

392
Q

Front to back to chest
Down back to abdomen and arms

A

Aortic Dissection

393
Q

Atherosclerosis
Hypertension
Marfans

A

Aortic Dissection

394
Q

Phlebitis
Calf pain
Surgery
Immobility

A

Pulmonary Embolus

395
Q

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

Deep retrosternal

A

MI

396
Q

Gallop rhythm
Murmur of Mu
Basal Crackles

A

Myocardial Infarction

397
Q

Syncope
Pallor
Hemiparesis
Paraplegia

A

Aortic Dissection

398
Q

Widening of the mediastinum

A

Aortic Dissection

399
Q

S2, S3, S4

A

Pulmonary Embolus

400
Q

Normal or ST Depression

A

Angina

401
Q

S1 Q3 T3

A

Pulmonary Embolus

402
Q

Q waves
ST elevation
T inversion

A

Myocardial Infarction

403
Q

Pallor
Nausea
Vomiting
Dyspnoea
Syncope

A

Myocardial Infarction

404
Q

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

A

Angina

405
Q

Dyspnoea
Syncope
Sweating
Vomiting
Cyanosis
Agitation
Haemostasis
Tachycardia

A

Pulmonary Embolus

406
Q

Adventitious sound
R acisdeviation

A

Pulmonary embolus

407
Q

Diagnostic test for myocardial infarction

A

Serum enzymes
TROPONIN t or I
cardiac scanning

408
Q

Diagnostic test for angina

A

Stress ECG
Coronary Angiography
Technetium scanning enzymes

409
Q

Diagnostic test for Pulmonary Embolism

A

Lung scanning
CT pulmonary angiography
VQ scan

410
Q

Diagnostic test for Aortid dissection

A

TOE
Ultrasound
AORTIC angiography
CT SCAN

411
Q

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

A

Gastro-oesophageal reflux

412
Q

If the pain is sudden onset after the endoscopy

A

Oesophageal rupture

413
Q

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

Relieved by standing antacids

A

Acid reflux

414
Q

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

A

Oesophageal spasm

415
Q

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

A

Peptic ulcer

416
Q

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

A

Gallbladder disease

417
Q

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

A

Da Costa Syndrome

418
Q

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.

A

Takotsubo cardiomyopathy

419
Q

What is the treatment for Takotsubo cardiomyopathy?

A

ASPIRIN
BETA BLOCKERS
ACE INHIBITORS

420
Q

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

A

Stable angjna

421
Q

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

A

Unstable angina

422
Q

Pain occurs when lying flat and is relieved by sitting up

A

Decubitus angina

423
Q

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

A

Variant angina or Prinzmental Anguna or Spadm Angina

424
Q

What is the treatment for acute attack and episodic angina

A

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

425
Q

Prevention of moderate stable angina

A

Beta blocker
Metoprolol
Glyeryl trinitate.
Isosorbide mononitrate

426
Q

Treatment for Refractory stable angina

A

Consider adding nicorandil 5mg
Or
Ivabradine

427
Q

Treatment for unstable angina

A

May need I’ve nitrate therapy

428
Q

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.

A

Dyscheiza

429
Q

What is the most common factor of constipation in children?

A

Diet

Chings Notes (39 decks)

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