Easy to Remember Flashcards
High blood pressure
Normal levels for other lab test
except low potassium
Inv?
Plasma Aldosterone to Renin Ratio
Antibiotic - similar to botulism
Gentamicin
(““gento-uwag,genta-botu””)
Risk Factor for the development of Hypertrophic Pyloric Stenosis?
Formula feeding
Male
Caucasian background
FIrstborn
Positive family history
Common risk factor for Hypertrophic Pyloric Stenosis?
2-6 wks infants
Maternal Smoking
Common risk factor for Hypertrophic Pyloric Stenosis?
younger than 2 wks infants
Erythromycin
Azithromycin
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)
Complications of Acromegaly
HTN
DM
Cardiomyopathy
Colorectal ca
Best single test for the diagnosis for Acromegaly
IGF-1
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
What is the preferred initial test for suspected thyroid function?
TSH
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
marked
weakness of inversion of the foot
L4 root lesion
numbness in the medial foot and the webspace between the first and second toe
L5 motor nerve root damage
ankle reflexes and sensation of the posterior calf and lateral foot
weakness of plantar flexion
S1
Best initial treatment for Parkinson’s disease?
Carbidopa/Levodopa
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
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
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
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
What are the protective factors for developing uterine fibroid?
Smoking
pregnancy
What factors increases estrogen levels and contributes in developing fibroids?
Nulliparity
obesity
early menarche
Common area affected by osteoarthritis
1st carpometacarpal joint of the thumb
Other joints that are involved:
What is not involved in osteoarthritis that makes it distinguishable from Rheumatoid Arthritis?
Metacarpophalangeal joints and involves the interphalangeal and distal interphalangeal joints
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
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
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
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
Lamptrigine i
Carbamazepine and Phenytoin may worsen the seizure in JVE
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
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?
- Removal or impacted secretions by coughing, managed by physiotherapists and involves active chest percussion and breathing exercises
- 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
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
1%
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
- RIsk taking behaviour - excessive drinking
- irritability and angry behavior
- Distractibility - flirtatious initially and then become angry
- Excessive involvement in some activities -excessive cleansing of the house
- 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
MI
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
MI
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
