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amc notes > Handbook Section 3a > Flashcards

Handbook Section 3a Flashcards

1
Q

Common skin lesions, cancers

A

Basal Cell Carcinoma - pearly pink bump/flat area
Squamous Cell Carcinoma - red scaly occasionally tender plaque
Melanoma - Irregular multicolored flat area

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2
Q

Common skin lesions, benign

A

Benign Mole - single colored demarcated brown area
Seborrhoeic Keratosis - Stuck on mole

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3
Q

Neurofibromatosis, general definition

A

Usually diagnosed in childhood, it is a genetic condition characterised by the growth of usually benign neurofibromas

A common sign is ‘café au lait’ spots with vision problems.

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4
Q

Types of neurofibromatosis

A

Neurofibromatosis type 1 (NF1) — the most common form, caused by a change in a gene on chromosome 17, presents with more than 6 cafe au lait spots

Neurofibromatosis type 2 (NF2) — a very rare form, caused by a change in a gene on chromosome 22, found in ears, brain, spinal cord

Schwannomatosis — similar to NF2, but not associated with inner ear tumours and hearing loss, initially presents with random localized pain

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5
Q

Reactive arthritis (Reiter syndrome) triad

A

conjunctivitis, urethritis, arthritis

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6
Q

Cranial nerves (OOOTTA FAG VAH)

A
  1. Olfactory - smell
  2. Optic - Visual acuity
  3. Oculomotor - all eye movement (except SO4, LR6)
  4. Trochlear - SO eye movement (down medial)
  5. Trigeminal - Facial sensation, chewing
  6. Abducens - LR eye movement
  7. Facial - facial muscles (except chewing)
  8. Auditory - hearing and balance
  9. Glossopharyngeal - taste on posterior tongue
  10. Vagus - swallowing
  11. Accessory - shoulder shrug
  12. Hypoglossal - Tongue movement
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7
Q

Common causes of postoperative fever

A

Lung (aspiration, atelectasis)
Infection
Embolism
Drugs

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8
Q

Ulcer types

A

Neuropathic ulcers are painless ulcers over areas of abnormal pressure, often secondary to joint deformity in diabetics

Venous ulcers are shallow ulcers with a granulated base, often with other clinical features of venous insufficiency present

Arterial ulcers are found at distal sites, often with well-defined borders and other evidence of arterial insufficiency

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9
Q

Acute primary angle closure glaucoma, presentation

A

Risk factors
1. Asian
2. Hypermetropia (far sighted)
3. medications that affects the eye

Signs and Symptoms
1. blurred vision
2. haloes
3. eye/brow pain
4. headache
5. red eye
6. nausea and vomiting

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10
Q

Acute primary angle closure glaucoma, examination results

A
  • IOP usually >35mmHg
  • Corneal oedema
  • Mid-dilated, poorly reactive pupil
  • Shallow central and peripheral anterior chamber (AC) in the affected/both eyes
  • Closed angle on gonioscopy
  • Anterior chamber inflammation
  • Signs of previous angle-closure attacks; e.g. peripheral anterior synechiae,
    segmental iris atrophy, glaukomflecken, posterior synechiae or irregular pupil
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11
Q

Acute Primary Angle Closure Glaucoma, Management

A

After history and examination, discuss with specialist if still with doubt

  1. Acetazolamide - carbonic anhydrase inhibitor (WOF renal)
  2. Pilocarpine - muscarinic cholinergic (dry)
  3. Brimonidine - alpha adrenergic (dry)
  4. Timolol - beta blocker
  5. Prednisolone - instant corticosteroids
  6. Mannitol - diuretic
  7. Laser PI

Follow up 1 week or earlier

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12
Q

Brain death confirmation requirements

A

REQUIREMENTS MUST BE SUFFICIENT:
1. severe brain injury.
2. condition is not due to sedatives
3. No other reversible cause of the condition

Two senior doctors must perform separate tests to check if the cranial nerves are working

They also check to see if the person:
1. response to pain
2. response when a light is shone in the pupil of each eye
3. blinks or moves when each eye is touched
4. responds to ice cold water put into the ear canal
5. has a cough or gag (swallowing) reaction
6. can breathe when disconnected from the ventilator

For a person to be certified brain dead, they must show no response to every one of these tests.

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13
Q

Wernicke encephalopathy, overview

A

Risk factor - alcoholic, Vit B1 (thiamine) deficiency
Complication - Wernicke - Korsakoff syndrome (alcohol related dementia)

Presentation:
1. Eyes (drooping, jerking, double vision)
2. Balance (difficulty standing)
3. Movement (difficulty walking)
4. Consciousness (drowsy/confused, disoriented)

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14
Q

3 major nerves in the arm

A

Front arm
- thumb side (medial nerve)
- pinky side (ulnar nerve)

Back arm (radial nerve)

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15
Q

Cushing’s triad (Increased ICP)

A
  1. bradycardia
  2. irregular respirations
  3. hypertension
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16
Q

Common fractures - artery/vein and nerve injuries
(TORSO and PELVIS)

A

TORSO
Vertebra - Spinal cord, nerve root
Clavicle - Subclavian artery, Brachial plexus

PELVIS
Sacroiliac - Sacral plexus, lumbosacral plexus
Acetabulum - Sciatic

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17
Q

Common fractures - artery and nerve injuries
(UPPER EXTREMITIES)

A
  1. Proximal Humerus - Axillary and brachial artery; Axillary and Suprascapular nerve
  2. Humerus shaft - Brachial artery; Radial, Median and Ulnar nerve
  3. Supracondylar (humerus) - Brachial artery; Median, Anterior interosseous, Radial and Ulnar nerve
  4. Radius/Ulna - Brachial, Axillary and Ulnar artery; Median and Ulnar nerve
  5. Scaphoid - Median nerve (Acute carpal tunnel)
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18
Q

Common fractures - artery and nerve injuries
(LOWER EXTREMITY)

A
  1. Femur - Femoral artery; Femoral nerve
  2. Tibia - Popliteal, Anterior tibial and Posterior tibial artery; Tibial, Superficial peroneal and deep peroneal artery
  3. Fibular head and neck - Peroneal nerve
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19
Q

Stenosing Tenosynovitis (Trigger finger), presentation

A

The first indication of the condition may be slight stiffness or even “clicking” when flexing the finger/thumb especially in the morning, due to an increasing blockage in the finger “pulley” that facilitates movement.

History:
- common in middle aged women
- trauma/surgery
- repetitive work
- some systemic conditions (gout, arthritis,diabetes)

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20
Q

Dupuytren’s contracture, presentation

A

palmar fascia becomes thicker and tighter causing the first sign, one or more nodules on the palm. Over time these nodules get bigger which pulls your fingers towards your palm

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21
Q

De quervain’s tenosynovitis, definition

A

Affecting the extensor pollicis brevis and abductor pollicis longus, inflammation and swelling of the tendon sheaths puts pressure on the adjacent nerves and leads to pain and numbness in the thumb side of the wrist which get worse while making a fist, grasping or gripping things, or turning the wrist

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22
Q

Mallet finger, presentation

A

Caused by forceful flexion to the end of an extended finger, usually occuring in contact or ball-handling sports. The terminal extensor tendon on the dorsum of the finger at the distal interphalangeal joint (DIP) is torn, stretched or avulsed.

Assessment
- Pain, swelling (+ / bruising) on the dorsum of the DIP joint
- Flexed posture of finger tip due to inability to actively extend it
- Passive (by the examiner) extension is usually possible

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23
Q

Inflammatory Myopathies, presentation (Chronic Inflammatory Demyelinating Polyradiculoneuropathy)

A

Triggered autoimmune attack on the nervous system causing:

slow progressive weakness (legs> arms>sensation>cranial nerves)

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24
Q

Inflammatory Myopathies, presentation (Dermatomyositis)

A

inflammation causes

  • skin rash (gottron’s, shawl sign, v sign, nails)
  • muscle weakness (trunk going outward)
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25
Q

Inflammatory Myopathies, presentation (Inclusion Body Myositis)

A

A muscle condition that causes thin and weak muscles

Skeletal muscle weakness and wasting progresses from quadriceps (thigh) to forearm muscles.

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26
Q

Inflammatory Myopathies, presentation (Polymyositis)

A

Connective tissue disease that triggers inflammation and muscular weakness.

  • Muscle weakness develops gradually over the course of a few weeks or months
  • Inflammation may spread to other areas of the body including the heart
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27
Q

ECG rhythms, Heart blocks

A

1st degree
- PR interval >200ms
- benign, usually asymptomatic

2nd degree (Mobitz I - Wenckebach)
- P-R increasingly slows then a QRS is dropped
- benign, usually asymptomatic

2nd degree (Mobitz II)
- P-R is regular, sudden QRS dropped
- benign, usually asymptomatic

3rd degree
- Atria and ventricles is completely separate
- syncope, weakness

TREATMENT
- pacemaker

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28
Q

ECG rhythms, atrial flutter vs fibrillation

A

Flutter
- irregular rapid heartbeat
- sawtooth pattern
Treatment - HR, rhythm, anti emboli, ablation

Fibrillation
- irregular heartbeat, palpitations
- irregularly irregular, 0 pattern

Treatment
maintenance - digoxin, bb,ccb
stable/no HF - betablocker, calcium channel blocker
unstable - amiodarone
dying - cardioversion

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29
Q

ECG rhythms, supraventricular tachycardia

A

Supraventricular Tachycardia
- 140-200 bpm, palpitations, chestpain, syncope
- very slim sinus rhythm

Treatment
- modified valsalva
- carotid sinus massage
- adenosine (CI asthma) (safer)
- verapamil
- cardioversion
- catheter ablation

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30
Q

ECG rhythms, ventricular fibrillation/flutter

A

Ventricular flutter
- saw tooth pattern, 250-300bpm

Ventricular Fibrillation
- irregular sawtooth
Treatment
1st line - atenolol, metoprolol, diltiazem, verapamil
2nd line - digoxin, defibrillation, flecainide( only for normal hearts)

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31
Q

ECG rhythms, ventricular tachycardia

A
  • fat saw tooth

Stable treatment
- procainamide
- amiodarone

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32
Q

Heart pathway, blood

A

Superior/Inferior vena cava
Right atrium
Tricuspid Valve
Right ventricle
Pulmonic valve (inside RV)
Lungs
Pulmonary vein
Left atrium
Mitral valve
Left ventricle
Aortic valve (inside LV)

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33
Q

High risk for ACS, features

A

Ongoing chest pain
Dyspnea
Syncope/presyncope
Palpitations

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34
Q

ACS management

A

Prehospital: Aspirin and sublingual GTN

Serial 12L ECG (10-15mins until pain-free)
Cardiac troponin (or other biomarkers)
Chest x-ray

MONA
morphine
oxygen
nitrates
aspirin
anti-thrombotic

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35
Q

Chronic stable angina, management

A

Goal: relieve angine, prevent cardiovascular events

RELIEF:
Betablockers
Calcium channel antagonists
Short acting nitrates

PREVENT:
Low dose aspirin
statins

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36
Q

Types of pneumothorax

A

Closed - Lungs to pleural cavity
(cavity pressure < atmosphere pressure)

Open - open passage pleural cavity to environment
(cavity pressure = environement)

Tension - one way passage environment to pleural cavity, no exit of air thus increasing tension
(cavity pressure > atmospheric pressure)

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37
Q

Cardiac tamponade vs Tension pneumothorax

A

Only cardiac tamponade and tension pneumothorax produce jugular venous distention with a chest injury. How you tell the difference is by auscultating the lungs. Tamponade will typically reveal clear, bilateral, lung sounds while a tension pneumothorax will not.

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38
Q

Confirming a TB diagnosis case requirement

A

Cases are confirmed via
1. Laboratory
- Culture (except for BCG recipients)
- Nucleic acid amplification test (NAAT) (except for prior or current TB patients)

OR

  1. Clinical evidence
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39
Q

PTB treatment

A

Pyrazinamide
Isoniazid
Rifampicin
Ethambutol

subject to change after culture results

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40
Q

Hospital acquired pneumonia, treament

A

Low risk for MRO (non ICU, ICU<5 days)
- Amoxycillin+clavulanate or Benzylpenicillin+gentamicin
- Pen allergic (ceftriaxone)

High risk for MRO
- piptaz + genta
- Pen allergic (cefepime + genta)

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41
Q

Atypical pneumonia, treatment

A

Macrolides - Azithromycin, Clarithromycin

Fluoroquinolones - Ciprofloxacin, Levofloxacin

Tetracyclines - Doxycycline, Tetracycline

42
Q

Detecting alcohol problem
(CAGE questionnaire)

A
  • Felt the need to CUT DOWN
  • ANNOYED at the suggestion to cut down
  • felt GUILTY about your drinking
  • needed an EYE OPENER (morning alcohol)

2 or more - alcohol problem

43
Q

Laboratory tests that suggest advanced cirrhosis

A
  1. Low albumin
  2. Raised bilirubin
  3. Raised INR
44
Q

Maddrey’s Discriminant Function for Alcoholic Hepatitis

A
  • Suggests which patients with alcoholic hepatitis may have a poor prognosis and benefit from steroid administration.

Components:
- PT
- Total bilirubin

45
Q

Child-Pugh Score for Cirrhosis Mortality

A
  • estimates cirrhosis severity

Components:
- Total bilirubin
- Albumin
- INR
- Ascites
- Encephalopathy

46
Q

Imaging features of solid liver lesions
(Hepatic hemangioma)

A

ULTRASOUND - well demarcated homogenous hyperechoic mass

CONTRAST CT - well demarcated hypodense mass, peripheral nodular enhancement in early phase, centripetal pattern in late phase

47
Q

Imaging features of solid liver lesions
(Focal nodular hyperplasia)

A

ULTRASOUND - Variable general appearance, central hyperechoic area (scar)

CONTRAST CT SCAN - Isodense on portal venous phase, hyperdense on central scar

48
Q

Imaging features of solid liver lesions
(Hepatocellular Adenoma)

A

ULTRASOUND - heterogenous, hyperechoic lesion

CONTRAST CT SCAN - well demarcated with peripheral enhancement in early phase and centripetal in late phase, appears as high attenuating if with recent bleeding

49
Q

Imaging features of solid liver lesions
(Hepatocellular carcinoma)

A

ULTRASOUND - poorly defined margin, coarse, irregular internal echoes

CONTRAST CT SCAN - hypervascular during the arterial phase, contrast washout in later phase

50
Q

Imaging features of solid liver lesions
(Intrahepatic cholangiocarcinoma)

A

ULTRASOUND - homogenous hypoechoic

CONTRAST CT SCAN - hypodense with rim/peripheral enhancement

51
Q

Imaging features of solid liver lesions
(Liver metastases)

A

ULTRASOUND - multiple lesions, character depends on source

CONTRAST CT SCAN - multiple lesions, character depends on source

52
Q

Acute appendicitis, initial investigations

A
  • urine test (plus pregnancy test)
  • Blood tests (FBC, CRP)

Optional
- Abdominal xray
- UEC (urea, electrolytes, creatinine)
- Ultrasound
- CT scan

53
Q

Acute appendicitis, management

A
  • refer to general surgical team
  • analgesia
  • NBM (nil by mouth)
  • resuscitate
  • rehydrate (over 24 hrs)
  • start IV fluid maintenance
  • antibiotics (if ordered by surgery team, septic)
54
Q

Stomach (gastric) cancer, risk factors

A
  • > 60 yrs old
  • Male
  • Helicobacter pylori infection
  • Gastrectomy
  • Smoking
  • Pernicious anemia
  • Family history (gastric adenocarcinoma, familial adenomatous polyposis, lynch syndrome, stomach proximal polyposis, hereditary diffuse gastric cancer)
  • chronic inflammation of the stomach (chronic gastritis)
  • overweight
  • alcohol intake
  • salt preserved foods
55
Q

Bowel (colorectal) cancer, risk factors

A
  • > 50 yrs of age
  • inflammatory bowel disease
  • bowel polyps
  • history of any bowel cancer
  • family history of bowel cancer or adenomatous polyps
56
Q

Liver cancer, risk factors

A
  • fatty liver disease
  • genetic disorders (haemochromatosis, alpha 1-antitrypsin deficiency)
  • type 2 DM
  • hepatitis B or C
  • alcohol
  • obesity
  • tobacco
  • certain chemicals
57
Q

Oesophageal cancer, risk factors

A
  • tobacco
  • alcohol
  • low fruit and vegetable diet
  • obesity
  • certain chemical fumes
  • family history of gastrointestinal disorders
  • family history of cowden syndrome or peutz-jeghers syndrome
  • medical conditions such as barrett’s oesophagus or GERD
58
Q

Small bowel cancer, risk factors

A
  • crohn’s disease
  • celiac disease
  • animal fat and protein
  • familial adenomatous polyposis
  • lynch syndrome (hereditary nonpolyposis colorectal cancer)
  • peutz-jeghers syndrome
  • cystic fibrosis
  • multiple endocrine neoplasia (MEN 1)
59
Q

Barrett’s oesophagus, endoscopic description

A

A premalignant condition of the oesophagus defined as the presence of metaplastic columnar epithelium, which appears as salmon pink mucosa, extending above the gastro-oesophageal junction (GOJ) and into the tubular oesophagus, thereby replacing the stratified squamous epithelium that normally lines the distal oesophagus.

60
Q

Barrett’s Oesophagus, management

A

Goal is the reduction in the length or area of metaplastic columnar epithelium

Anti-reflux surgery

medical therapy not shown as effective

61
Q

Cause of per rectal bleeding

A
  1. Diverticular disease – most common cause of significant bleeding
  2. Haemorrhoids - most common cause of all cause bleeding
  3. Angiodysplasia
  4. Ischaemia
  5. Neoplastic
  6. Inflammatory – infectious/non infectious
  7. Iatrogenic e.g. polypectomy.
62
Q

Ulcerative Colitis vs Crohn’s disease

A

LOCATION
UC - large intestine
CD - whole GI tract

INFLAMMATION PATTERN
UC - continuous, inner lining only
CD - patchy, entire thickness

BLEEDING
UC - common during BM
CD - uncommon

63
Q

Bile pathway

A

Common hepatic duct (liver)
+
Cystic duct (gallbladder)
=
Common Bile Duct

+
Pancreatic duct
=
END (Duodenum)

64
Q

Lactation Mastitis, management

A

First line antibiotics - Fluocloxacillin, dicloxacillin, cephalexin

Continue frequent feeding on affected breast

if symptoms do not resolve within 2 days
- ultrasound for abscess

65
Q

DM type 2 clinical goals

A

HBA1c (<7%)
Lipids (depends on absolute cvd risk)
Total cholesterol (4 mmol/L)
HDL (>1 mmol/L)
LDL (<2 mmol/L, <1.8 mmo/L - CVD)
Triglycerides (<2.0 mmol/L)
Blood Pressure (<140/90)
Urine Albumin (Women: <3.5mg/mmol, Men: <2.5 mg/mmol)
Vaccination (Influenza, Pneumococcus, dTpa)

66
Q

Diabetes Screening, low risk

A

every 3 years after 40 years old using
Australian type 2 diabetes risk assessment tool (AUSDRISK)

67
Q

Diabetes screening, Aboriginal and Torres straight islander people

A

Annual screening from 18 years of age using
blood testing (fasting plasma glucose, random venous glucose, HBA1c)

68
Q

Thyroid nodule diagnostic tests

A

TSH suppressed - Technetium pertechnetate thyroid scan

TSH not suppressed
- Sonographic risk stratification
Low risk - serial ultrasound
Intermediate risk - Fine needle aspiration, molecular testing
High risk - surgery

69
Q

Idiopathic thrombocytopenic purpura, treatment

A

1st - corticosteroids (prednisone, dexamethasone)
* may add immunoglobulin periprocedurally or as add-on to steroid

2nd line
Diagnosis <12 months
- TPO-RA (avoids infections and splenectomy)
- rituximab (avoids thrombosis)
Diagnosis >12 months
- splenectomy (avoids medications and monitoring)
- TPO-RA
- Rituximab

70
Q

Malaria presentation

A
  • History of travel within 9-14 days
  • Malaria is either benign (vivax, ovale) or malignant (falciparum)
  • fever + chills + headache

P. falciparum
- most likely to progress to severe
P. vivax
- include splenomegaly (with, rarely, splenic rupture)
P. malariae
- include nephrotic syndrome

71
Q

Colovesical Fistula, symptoms

A
  • Pneumaturia (gas in the urine)
  • Fecaluria (fecal matter in the urine)
  • Dysuria (painful upon urinating)
  • Hematuria (blood in the urine)
72
Q

Colovesical Fistula, causes

A
  • cancer
  • IBD
  • surgery
  • radiation therapy
  • diverticulitis
73
Q

Renal colic, diagnostic tests

A
  • Urine dipstick
  • Urine microscopy and culture
  • X ray KUB (less radiation)
    or CT scan (Gold standard)
    or Ultrasound (only for specific stones)
74
Q

Renal colic management

A
  • Majority of stones will pass within 6 months

5-7mm stones, passable at 60%
Analgesia (NSAID)
Repeat imaging at 4 wks
Refer to urologist (high risk for complications, >7mm stones, still present after 3 weeks)
Surgery (pending urologist)

75
Q

Prostate cancer management

A

Modified Whitmore and Jewett staging

A1 (focal, microscopic)
- observation (usually for life expectancy <10 years independent of the prostate cancer)

A2/B (within the capsule)
- Radical prostatectomy (risk for incontinence and impotence), radiotherapy (risk for bowel damage), observation

C (beyond capsule/seminal vesicle invasion)
- radiotherapy, chemical ablation

D (Distant Metastasis/ pelvic lymph node invasion)
- Androgen ablation (such as orchidectomy, LHRH agonists, antiandrogens, total androgenic blockade, radiotherapy, strontium-89)

76
Q

Urinary retention, acute vs chronic

A

Acute - cannot urinate at all, requires immediate emergency management
Chronic - cannot completely empty the bladder

77
Q

Urinary retention, investigations

A
  • Physical examination
  • post voidal residual management (ultrasound)

OPTIONAL
- cystoscopy
- CT scan
- urodynamic tests
- electromyography

78
Q

Crush syndrome characteristics

A

Rhabdomyolysis
Lactic acidosis
Hyperkalaemia
Renal failure
Shock
Dysrhythmia

79
Q

Hyperkalaemia, investigation

A

Serum electrolytes
ECG
KFT
FBC
Venous blood gas
Glucose

ECG CHANGES
5.5 - 6.5 peaked T waves
6.5 - 7.5 loss P wave
>7.5 wide QRS
>8.0 Sine wave, VT, VF

80
Q

Hyperkalaemia, treatment

A
  • Calcium gluconate
  • Salbutamol
  • IV fluids (optional bicarbonate)
  • Insulin or Glucose
  • Remove potassium from bowel
  • Dialysis
  • Treat cause
81
Q

Trace element deficiency, presentation

A

Zinc - hair/nail/skin changes, infection, wound healing, sight/taste loss
Selenium - muscle weakness, mental fog, hair loss
Copper - anemia, osteoporosis, thyroid problem, hypopigmented skin
Cobalt - anemia, vit b12 deficiency
Magnesium - vit k deficiency

82
Q

Q fever (Coxiella burnetii), transmission

A
  • contaminated aerosol/dust (animal residue)
  • injury with contaminated objects
  • unpasteurised milk consumption
83
Q

Q fever, investigation

A

Definitive
- nucleic acid testing
- Antibody to antigen level (only for absence of vaccination)
- Culture (discouraged)

Suggestive
- IgM (only for absence of vaccination)

84
Q

Q fever, treatment

A

If clinically suspected, start treatment

  • Doxycycline x 2 weeks

Pregnant women
- Trimethoprim + Sulfamethoxazole

85
Q

Cellulitis, management

A

No penicillin allergy, no known MRSA
* Abscess/boil/wound - Dicloxacillin, Flucloxacillin
* Erysipelas/non purulent - Phenoxymethylpenicillin

With non severe penicillin allergy, no known MRSA - Cephalexin

With immediate/severe penicillin allergy, MRSA
* depends on culture and sensitivity
* First line - Clindamycin
* Clindamycin resistant - Trimethoprim + Sulfamethoxazole

86
Q

Lithium therapy overview

A
  • used for bipolar
  • steady state achieved at 4-5 days
  • monitor every 3-6 months

SHORT TERM SIDE EFFECTS
- tremor, fatigue, diarrhoea, thirst, polyuria, nv

LONG TERM SIDE EFFECTS
KIDNEY (Diabetes Insipidus, ESRD)
THYROID (Hypothyroidism)
PARATHYROID (Inc PTH)
WT gain (1-2kg)
TERATOGENIC

TOXICITY - chronic neural toxicity
- lethargy
- drowsiness
- muscle weakness
- hand tremor

87
Q

Organ timeframes in storage

A

Heart - 4-6 hours
Lungs - 4-6 hours
Liver - 8-12 hours
Kidney - 24-36 hours

88
Q

Top 3 most frequent cause of death in transplant recipients

A
  1. Cancer (19%) - Kaposi sarcoma, etc
  2. Rejection (18%)
  3. Infection (17%)
89
Q

Anaesthesia risk classification (ASA)

A

ASA I - normal completely healthy
ASA II - with mild systemic disease
ASA III - with severe systemic disease
ASA IV - with constant threat to life
ASA V - not expected to survive without surgery
ASA VI - brain dead

90
Q

Epidemiology computation, Test results

A

Prevalence = concerned case/total included popn
Sensitivity = TP/All with disease
Specificity = TN/All without the disease
Positive Predictive Value = TP/All positive results
Negative Predictive Value = TN/All negative results

TP = true positive
TN = true negative

91
Q

Epidemiology, rates computation

A

BASIC
Rate = in 1 year, unless specified
Rate = Total Cases/ Total population

Mortality rate = deaths/ midyear popn

Birth rate = births/ midyear popn

Fertility rate = live births/ mid year popn of fertile women, 15-44 years old

Infant mortality rate = Infant deaths without stillbirths/ live births in a year

Perinatal mortality rate = infant deaths with stillbirths/ total births in a year

Neonatal mortality rate = neonate deaths/ live births in a year

92
Q

Examples of single gene conditions

A

AD - huntington, familial hypercholesterolaemia
AR - cystic fibrosis, phenylketonuria, sickle cell anaemia
XR - duchenne muscular dystrophy, haemophilia
XD - vit D resistant rickets

93
Q

Cervical Ectropion, management

A
  • no treatment unless with significant symptoms
  • unremarkable tests

Optional treatments
- Change to nonhormonal contraceptives
- Cautery
- Laser
- Microwave tissue coagulation
- Alpha intereron suppository
- Polydeoxyribonucleotide vaginal suppository
- Boric acid vaginal suppository
- Autologous platelet-rich plasma application
- Focused ultrasound

94
Q

Antihypertensive drugs allowed in pregnancy

A

Hydralazine
Labetalol
Methyldopa
Nifedipine
Prazosin

95
Q

Regular menstrual cycle, by day

A

Day 1 - Menstruation, lasts 3-7 days
Day ? - Follicular phase, lasts 13-14 days
Day 14 - Ovulation, egg survives 24hrs
Day 15 - Luteal phase
Day 28 - End of cycle (Range 28-35 days)

96
Q

Natural family planning methods

A

Cervical mucous/ Billings method
- no sex until 3 “dry” days have passed
Ovulation sign - clear stretchy mucous

Temperature method
- no sex until 3 subsequent temp rise

Symptothermal methods
- combines mucous and temp methods

Calendar/Rhythm method
- Based on the shortest and longest cycle out of three
Shortest cycle days - 21 = start of fertility
Longest cycle days - 10 = end of fertility

97
Q

Endometriosis, presentation

A

Suspect endometriosis if with 1 or more of:
- infertility
- persistent pelvic pain
- significant dysmenorrhoea
- deep pain during or after sex
- period related or cyclical GI symptoms
- period related or cyclical GUT symptoms

98
Q

Physiological ovarian cysts on ultrasound

A
  1. Follicular - unilocular, thin walled, anechoic contents
  2. Corpus luteum - thick walled, hyperechoic spider web contents
  3. Peritoneal Pseudocysts - irregular walled, flapping multilocular, thin walled cystic contents
99
Q

Risk of malignancy, ultrasound factors

A
  • irregular solid tumors
  • ascites
  • > 4 papillary structures
  • irregular multilocular solid tumour with largest diameter >10cm
  • very good blood flow
100
Q

Ovarian mass, tumor markers

A

Serum Ca125 - Common screening test
Human epididymis protein 4
Alpha-feta protein (AFP)
Human chorionic gonadotropin (hCG)
Lactate dehydrogenase (LDH)
Carcinoembryonic antigen (CEA)
Cancer antigen 19.9 (Ca19.9)

amc notes (6 decks)

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