General medicine knowledge

Question 1

What are normal CBC values?

Answer 1

Question 2

What are normal clotting profile values?

Answer 2

Question 3

What are normal electrolyte profile

Answer 3

Question 4

What is normal LFT?

Answer 4

Question 5

What is normal renal function test?

Answer 5

Question 5

What is normal arterial blood gas values?

Answer 5

Question 6

What is normal blood total protein, globulin, CK, LDH ESR?

Answer 6

Question 7

What is the classification of gram+ve bacteria (cocci, bacilli –> aerobic, anaerobic)

Answer 7

Question 8

What is the classification of gram-ve bacteria (cocci, bacilli, coccobacilli)?

Answer 8

Question 9

How to differentiate gram+ve cocci?

Answer 9

Question 10

How to differentiate gram+ve bacilli?

Answer 10

Question 11

Differentiating aerobic gram-ve bacilli

Answer 11

Question 12

Differentiating gram-ve coccobacilli

Answer 12

Question 13

What can the groups of penicillins be used for?

Answer 13

Question 14

What can the groups of cephalosporins be used for?

Answer 14

Question 15

What pathogens can macrolides be used against?
What are its AE?

Answer 15

Question 16

What pathogens can tetracyclines be used against?

Answer 16

Question 17

What pathogens can aminoglycosides be used against?
AE?
What pathogens resistant against aminoglycosides?

Answer 17

Question 18

What pathogens can fluoroquinolones be used against?
AE?
What pathogens resistant against fluoroquinolones?

Answer 18

Question 19

What pathogens can carbapenems be used against?
AE?
What pathogens resistant against carbapenems?

Answer 19

Question 20

What is the recommendation for using NSAIDs?

Answer 20

Question 21

What are the typoes of NSAIDs and COX2 inhibitors?
What is moa of NSAID?

Answer 21

Cell membrane phospholipid –> arachidonic acid –> leukotrienes + COX1/COX2
COX1 –> prostaglandins thromboxane (stomach, intestine, kidney, platelets): mucosal protection, renal blood flow and haemostasis
COX2 –> prostaglandins (inflammatory sites, macrophages, synovocytes) inflammation, pain and fever

Question 22

What is AE of NSAIDs?

Answer 22

Question 23

What is AE of COX2 inhibitors?

Answer 23

Question 24

What are the short acting, medium acting and long acting steroids? MoA

Answer 24

Question 25

What is the consequence of corticosteroid withdrawal?

Answer 25

Question 26

What is AE of corticosteroids What are adjuncts for admin of corticosteroids?

Answer 26

Question 27

What are the calcineurin inhibitors? MoA AE

Answer 27

Question 28

What are the antimetabolites used for anti-cancer What are there MoA AE?

Answer 28

Question 29

What IL2 receptor antagonist used for anticancer Moa

Answer 29

Question 30

What are the antimetabolites that are S phase specific? MoA AE

Answer 30

Question 31

What are the mitotic inhibitors that are M phase specific MOA AE

Answer 31

Question 32

What are topoisomerase inhibitors (anti cancer chemo)? Moa AE

Answer 32

Question 33

What are cell cycle non specific drugs? MoA AE

Answer 33

Alkylating agents

Question 34

What are the antitumor antibiotics used in cancer? MoA AE

Answer 34

Question 35

What is normal range of Na+ What is classification of hypernatremia?

Answer 35

normal range = 135-145 mmol/L Serum osmolality = 2Na+ + urea + glucose (normal: 285-295mmol/kg)

Question 36

What are the causes of hypernatremia?

Answer 36

Question 37

What are the signs and symptoms of hyper vs hyponatremia?

Answer 37

Question 38

What is the diagnostic algorithm for hypernatremia?

Answer 38

Question 39

What are the 2 steps in assessing hypernatremia?

Answer 39

Question 40

What is the treatment principles for hypernatremia? Maximum rate of correction in 24 hour period?

Answer 40

Question 41

What is the treatment of hypervoemic/isolvemic/hypovolemic hypernatremia?

Answer 41

Question 42

What is the severity of hypoantremia based on electrolyte level?

Answer 42

Question 43

What is the etiology of hyponatremia?

Answer 43

Question 44

What is the diagnostic algorithm for hyponatremia?

Answer 44

Question 45

What are the 2 steps to assess hyponatremia?

Answer 45

Question 46

What is the treatment objectives of hyponatremia What complications of hyponatremia must you prevent What is max correction and complication if overload?

Answer 46

Question 47

What is the treatment of hyponatremia?

Answer 47

Question 48

What is the rationale for using hypertonic saline, desmopressin and furosemide in managing hyponatremia?

Answer 48

Question 49

What is normal range of K Acid base status Na+K+ ATP pump affected by what drug

Answer 49

Normal range = 3.6-5mmol/L HyperK associated with acidosis, hypoK associated with alkalosis Na+K+ ATPase pump inhibited by drugs such as digoxin --> inhibition of pump leads to failure of active transport of K+ from extracellular space into intracellular compartment

Question 50

What are the causes of hyperK?

Answer 50

Question 51

What are SS of hyperK?

Answer 51

Question 52

What are SS of hypoK?

Answer 52

Question 53

What is the diagnostic algorithm for hyperK?

Answer 53

Question 54

What are the steps involved in finding out dx for hyperK?

Answer 54

Step 1: exclusion of pseudohyperkalemia, drug induced hyperK and other rrare causes Repeat K+ once if in suspiciion PseudohyperK: hemolysis of aged sample, thrombocytosis, leukocytosis, EDTA contamination, drug induced hyperK (IV/oral K+ supplement, K+ sparing diuretics), rare cuases (tumor lysis syndrome, hyperkalemic periodic paralysis) Step 2: assess plasma HCO3- leve. decreased HCO3-. test for anion gap (Na++K+ -CL- -HCO3-). Increased anion gap: diabetic ketoacidosis, renal failure. Normal anion gap --> go step 3 Step 3: assess plasma creatinine level. Increased plasma creatinine: renal failure. normal plasma creatinine: go step 4 Step 4: assess ACTH stimulation test by short synacthen test blunted or absent response: addisons disease, congenital adrenal hyperplasia (21hydroxylase deficiency) Normal response --> Go step 5 Step 5: spot renin and aldosterone

Question 55

What is the treatment modalities for hyperkalemia?

Answer 55

Question 56

What is treatment of urgent hyperkalemia?

Answer 56

* 10% calcium gluconate 10ml IV oer 2-3 mins. Repeat if no effect in 5 mins. Onset = 1-3 mins, duration =30-60 mins MoA: calcium antagonizes the membrane actions of hyperK and prevents hypocalcemia which increases cardiotoxicity of hypoerK * Dextrose insulin infusion: 250ml D10 or 50ml D50 along with 8-10 units Actrapid HM (short acting regular human insulin) over 30 mins and repeat every 4-6 hours if necessary, Onset = 30mins; duration = 4-6 hours Insulin shifts K+ into cells by enhancing Na+K+ATPase pump in skeletal muscle. Glucose is given with insulin to precent hypoglycemia. Insulin can be given alone if serum glucose is high. * Sodium bicarbonate: 100-150ml of 8.4% NaHCO3 over 30-60 mins. Onset = 5-10 mins, duration = 2 hours MoA: shift K+ into cells. Raise systemic pH with NaHCO3 results in H+ released from cells as part of buffering reaction * B-adrenergic agonists. 10-20mg salbutamol in 3ml NS by nebulizer. Onset = 15-30 mins, duration = 2-3 hours. MoA: increases activity of Na+K+ ATpase pump in skeletal muscle (shifts k+ into cells0 * Loop diuretics: furosemide 40-80mg IV bolus Increased urinary K+ loss --> inhibits Na+K+2Cl- cotransporter in the apical membrane which decreases Na+ K+ reabsorption * GI cation exchange resins: resonium A/C 15-50mg oral Q4-6h or as retention enema Increases GI k+ loss. Binds K+ in the GIT in exchange for other cations such as Na+ or Ca2+ before the resin is passed from the body * Haemodialysis preferred (over peritoneal dialysis): indicated in hyperK patients with severe renal impairment and preferable over GI cation exchange resins if patient has functioning vascular access for dialysis

Question 57

What is treatment of chronic hyperK?

Answer 57

 Low K+ diet < 2 g/day  Diuretics = Furosemide/ Hydrochlorothiazide  Correction of metabolic acidosis with sodium bicarbonate 300 – 900 mg tds (10 – 30 mmol/day)  Fludrocortisone 0.1 – 0.2 mg daily for Type IV RTA

Question 58

What is definition of hypoK What is normal range

Answer 58

* Normal range = 3.6 – 5.0 * Plasma K+ < 3.0 mmol/L * Serum K+ < 3.5 mmol/L

Question 59

What are the causes of hypoK?

Answer 59

Question 60

What is the diagnostic algorithm for hypoK?

Answer 60

Question 61

What are the steps to assess hypoK and ddx?

Answer 61

Question 62

What is the treatment principle of hypoK What dosage form Premixed K+ containing solutions for maintenance IV infusion

Answer 62

Question 63

What is the treatment regimen of hypoK based on serum and ECG changes?

Answer 63

Question 64

What are the treatment choices for hypoK?

Answer 64

* KCL 2 reasons: patients with hypoK and metabolic alkalosis are often Cl- depleted Faster rate of correction compared with other preparation * KHO3-/potassium citrate: indicated in patients with hypoK and metabolic acidosis --> RTA and diarrhea * K+ sparing diuretics: indicated in patients in which hypoK due to renal K+ wasting in which K+ supplement may not be sufficiently effective. Aldosterone antagonist: spironolactone Renal epithelial Na+ channel inhibitors = amiloride/triamterene