HIGH yield Flashcards
Tx for Ankylosing Spondylitis
NSAIDs- 1st line
INFLAXIMAB, ETANERCEPT, ADALIMUMAB - 2nd line
Best initial inv for Ankylosing Spondylitis
Xray
Accurate inv for Ankylosing Spondylitis
MRI
Latest New York criteria for dx Ankylosing Spondylitis
Xray of Sacroilitis
Limited chest expansion - Normal chest expansion is more than 5 cm
History of inflammatory back pain
Decreased motion of Lumbar spine in both sagittal and frontal planes
6As of AS
Arthritis
Aortitis
Anterior Uveitis
Atypical Lung Fibrosis
Achilles Tenditis
Age group (Young)
Lung ABSCESS - INITIAL Cxr fluid level within the cavity
2wks antibiotic tx - no resolution
What’s next
Refer to Surgeon
- Lobectomy ( surgery is needed due to the abscess that drains poorly can cause toxic symptoms and persistent fever)
Rusty sputum
Multiple brownish red spot in the foot
Weight Loss
TB
In leg, ERYTHEMA NODUSUM
Dx Sarcoidosis
In leg, Erythema NODuSUM + RUSTY SPUTUM
Dx TB
Foul Smelling SPUTUM - key
thick- walled cavitary lesion
Lung Abscess
Mobitz type 2 ECG with slow HR
Ultimate treatment?
Initial Treatment
Pacemaker - Ultimate tx
Atropine - next or Initial TX
Sinus bradycardia
tx?
Atropine to increase the heart rate
Pacemaker - definitive treatment
Cause of Sinus bradycardia
Beta blocker or Calcium blocker excess
<60 bpm
lightheadness and Syncope
Sinus bradycardia
PR interval >200 msec
associated with Increased vagal tone and with B-blocker or CCB use
First Degree AV block
Drug Effects ( digoxin , B blockers , CCBs)
PR interval is increase until dropped beat ccurs
Second Degree AV block (Mobitz I Wenkebach)
tx: Stop the offending drug
Unexpected dropped beat
without a change in PR interval
Results from fibrotic disease of the conduction system from a previous septal myocardial infarct
occasionally syncope
Second degree AV block ( Mobitz II)
tx Pacemaker placement
No electrical communication between the atria and the ventricles
sycope, dizziness, acute heart failure, hypotension, cannon A waves
Third degrew AV block (complete)
tx: Pacemaker placement
7 days after prostatectomy with fever and chills
cause?
Wound infection
What to do next when CORONA virus examination is negative
and the patient has cough sometimes dry or sometimes with spit
the sputum
CXR
Man with free male partner, initial screening including HIV is negative
What to do next
Repeat HIV screening 3 months later
Menopausal woman - postcoital bleeding
inv?
Endometria Biopsy
Dx; Cervical carcinoma
Menopausal woman - sexually active
greeny brownish discharge
Chlamydia
Routine screening for Ovarian Cancer
CA-125 or TVS
What are the risk factors for Ovarian Cancer
Lower risk - have used the OCPS and carried a pregnancy to term
Higher risk - Presence of breast cancer susceptibility to gene 1 (BRCA1) or BRCA2
Mgt of Sickle Cells
Analgesics
Pain after walking some distance lower limb impulse after palpable (probably not ischaemic - coz it is usually palpable if it is ischaemic)
bext inv
If MRI not given - then DOPPLER first
MRI
Treatment of DVT
Heparin eg ENOXAPARIN
Positive Homan’s sign
Calf pain on foot dorsiflexion
DVT
NO ct
Warfarin taken
Amoxicillin taken
Massive bleeding
Rectus Sheath Hematoma
Pt on warfarin
INR 5
Rectus Sheath Haematoma
What is the initial step?
Vitamin K - IV
Man with chronic constipation
What will you lead to dx?
Colonoscopy
Child with mass on his umbilicus
No tender3
Hernia
Narrow QRS complex
HR: 150
SVT
mgt: Vagal maneuver or carotid sinus massage
child mgt: immersion his face on the cold water
DOC: IV Verapamil or Adenosine - if there is asthma - you cannot give ADENOSINE, prefer VERAPAMIL
If unstable case - Mgt will be DC shock or cardioversion - vital stats such as BP very low
SOB, 35M, cannot stop his hear from pounding
No other medical problems
Afebrile
HR 214 / min
Dx?
Paroxysmal Supraventicular TAchycardia
palpitation + thyroid problem
Ecg shows
Dx: AF
tx: Metoprolol
Bilateral hilar lymph nodes - this shows that CXR is done
high ca level
Check ACE level
dx: Sarcoidosis
Other inv:
Xray - Initial
ACEI - next
CT - next
Biopsy - to confirm
Heavy smoker, cough and blood streal ,
night sweats, weight loss, CXR was given that upper RIght lobe
Carcinoma
_ if no fever
A man with CKD poor GFR, sydpnea + tachycardia + chest pain
Xray - showed wedge shaped opacity
INv?
Dx: Pulmonary Embolism
Inv: V/Q Scan
CHF and MI patient die
Primary cause of dead?
Cardiac Arrest
pt with hypoglycemia and driving
when can drive again?
ONly drive back 6 wks later
Driving Restrictions
cannot go back within 2 wks
AMI
Insertion of Defib
DVT
Driving Restrictions
cannot go back within 4 wks
AAA
CABG
Driving Restrictions
cannot go back within 2 days if complication free
Angioplasty
Driving Restrictions
cannot go back within 6 wks
PE
Driving Restrictions
cannot go back within 2 yrs
Chronic Epilepsy
Driving Restrictions
cannot go back within 3-6 months
Isolated Seizure
Recently diagnosed Epilepsy
Recurrent seizure
Driving Restrictions
cannot go back within 1 yr
Seizure causing accident
Driving Restrictions
cannot go back not less than 6-12 months
Visual acuity
Huntingtons screening
Bring her back when she turns 16
Huntington treatment with depression
Paroxetine
Prostate ca
underwent prostatectomy
PSA double rising too quick
Abd CT
if patient is less than 50
grandmother has ovarian Ca
what to do?
Nothing
60M, history of cirrhosis
DIstended abdomen
Dx: Hepatic Encephalopathy
inv: ammonia
Ascitic fluid - polymorphs present
Ceftriaxone
Severe UTI
chills, high fever and pain
GFR is low (20ml/min)
Trimethoprim - used in adjusted dose in Renal impairment
in GFR up to 15
Jelly fish sting , and has resp distress
What to do next?
Because there is resp distress
- then give O2
Used in the ED rescucitation room to assess the chest and abdomen of acutely injured patients
esp those with shock
esp GUNSHOT Wounds with abdominal distenntion with low BP even with GCS is good
FAST scan
- can be done in 2 - 3 min
- non invasive
- - disav: does not defined the injured organ., only the presence of bloos or fluid in the abdomen or pericardium
OCP used for 10 years
BMI > 30
Whats the increase risk of what cancer
Breast Ca
Small smooth lump in the vaginal opening
Painful but not discharge
no itchiness
Mgt?
Marsupialization
It involves the opening of the Bartholin cyst or abscess and then suturing the edges forming
a permanent open poket or pouch and allowing continued drainage
Performed under General or Local Anestheia
Typically reserved for recurrent cysts or abscesses
Marsupialization
INR < 5
Lower warfarin dose
INR > 5-9
Administer 1-2.5 mg oral Vitamin K