Medicine Flashcards

Question

Indications of thrombolysis

Answer 1

I/V < 4.5 hrs Large vessel occlusion <6hrs Large deficit after iv thrombolysis- intra arterial thrombectomy <24 hrs

Answer 2

BP >185/110 mmhg Bleeding diasthesis Hemorrhagic cva Major surgery <14 days GI bleed <21 days

Answer 3

Mc hypertension - mc putamen - C/L hemiparesis Thalamus - hemianesthesia Cerebellum - Ataxia, Vertigo Pons - pinpoint pupil, quadriparesis, ↑HR, ↑RR, ↑thermia, ↑hidrosis, deep coma, B/L plantar extensor

Answer 4

Mcc - trauma Mcc spontaneous - berry aneurysm - defect in tunica media AVM C/f Thunderclap headache Neck rigidity with ↓ flexion LOC Re rupture - mcc mortality Vasospasm - mcc morbidity Hydrocephalus Investigation SAH - NCCT Aneurysm - Angiography Xanthochromia in CSF Treatment Surgery - coiling, clipping Nimodipine - (-)Vasospasm Maintain HTN, Hypervolemia, Hemodilution

Answer 5

Mc site: ACA - Acom junction Mc site of rupture: Basilar bifurcation

Answer 6

Rupture of cortical bridging veins Slow progressing deficit CT - concavoconvex opacity

Answer 7

Rupture of MMA Fast progressing deficit Lucid interval (+) CT - Biconvex opacity

Answer 8

Mc ocular > facial(snarling) > skeletal(proximal) DTR(n) Investigation Screening test: Ice pack test Specific test: AchR Antibodies Sensitive test: Single fibre EMG → ↑Jitter Treatment Ach inhibitors - pyridostigmine Immunosuppression: M.crisis - IVIG/Plasmapharesis Thymectomy

Answer 9

Mc ass. Small Cell Ca lung Defect: presynaptic ca2+ channel Weakness: skeletal DTR (-) Treatment: 3,4 DiAmini Pyridine

Answer 10

Amyloidosis: APP(precursor)(chr21)→Aβ42 (enzyme secretase: chr 1, 14) ApoE4(chr19) →(-) excretion Atrophy - temporal & parietal Ammesia Neurofibrillary tangles α severity Senile plaques α Age Tau - neurodegeneration marker Anterograde amnesia Anomic aphasia Apraxia

Answer 11

Capgras syndrome Amnesia Tau proteins

Answer 12

Hakims triad Gait ataxia Urinary incontinence Dementia

Answer 13

AD inheritance Chorea Dementia Box car ventricles Treatment: Tetrabenazine (DA depletor)

Answer 14

Global confusion Ophthalmopathy (1st to improve) Ataxia

Answer 15

Mc - Startle myoclonus Spongiform degeneration Cortical ribboning

Answer 16

Young obese female Headache ↑ICT Papilledema No FND Mc - Idiopathic Iatrogenic - ↑Vit.A ↓CSF absorption Treatment Acetazolamide

Answer 17

Dull aching Depression DOC: TCA

Answer 18

Pulsatile U/L Nausea(+) Aura (+) - classical Aura (-) - common Treatment Triptans (doc) Nsaids CGRP(-) - gepants >4 attacks in a month - Prophylaxis β blockers CCB TCA

Answer 19

Clustered attacks Periorbital pain Lacrimation Treatment O2 @ 10-12L/min x 10 - 15 mins Sumatriptan 6mg s/c Prophylaxis - verapamil

Answer 20

Mcc in adolescent & epidemics - N. Meningitidis Mcc in adults/elderly & CAM - S. Pneumoniae Neonates & elderly - Listeria Kernigs sign Brudzinki sign Fever Headache Neck rigidity CSF - Turbid, ↑cell count(N>L), ↑proteins, ↓↓glucose Treatment Dexa and antibiotics Fever

Answer 21

Basal exudates Tuberculoma Infarct CSF: cobweb appearance, cell count (L>N), ↑↑proteins, ↓glucose Treatment ATT x 12-18 months Steroids x 2 months

Answer 22

Fever Altered sensorium Seizure CSF: Xanthochromic,cell count(L>N), ↑protein, glucose(n)

Answer 23

Agent - Taenia solium Human - definitive host Pig - intermediate host Seizure Headache Hydrocephalus Stages Vesicular Colloid - edema+++ Calcified - edema(-) Treatment Steroids→Albendazole Anti epileptics

Answer 24

Acute Inflammatory demyelinating polyneuropathy IgG Anti GM1 a/b - schwann cells - demyelination Post infectious - C.jejuni Ascending paralysis Areflexia Absent fever Other forms: AMAN(children), AMSAN(Adults) - IgG Anti GM1 a/b - Nodes of Ranvier - Axonal degeneration (Severe form) Miller Fisher Syndrome - Ataxia, Areflexia, Ophthalmoplegia - Anti GQ1 antibody - demyelination/axonal degeneration Investigation: Nerve conduction - loss of F wave CSF - ↑Albumin, cell count(n) Treatment IVIG/Plasmapharesis within 14 days Steroids not used

Answer 25

U/L optic neuritis Weakness Sensory symptoms Types Relapsing MS 90% Primary progressive MS 10% Secondary progressive MS 2% Investigation: MRI: Dawson fingers CSF: ↑IgG levels, oligoclonal bands VEP: ↑latenct Treatment: Steroids - Acute attack IFN β - DOC Natalizumab - best - ↓relapses

Answer 26

B/L optic neuritis Transverse myelitis Aquaporin 4 antibodies

Answer 27

Dissociated anesthesia - capeflag distribution Cuts spinothalamic Spares posterior column

Answer 28

Saddle anesthesia Knee jerk++ Autonomous Bladder

Answer 29

Areflexia(+) Asymmetrical LMN paralysis

Answer 30

GAA Ataxia Areflexia Extensor plantar Pes cavus - high arched foot Scoliosis ↓Vit E

Answer 31

Ataxia Areflexia Neurosyphilis

Answer 32

Ataxia Areflexia ↓vit b12 Glossitis Peripheral neuritis

Answer 33

Weakness Bladder (n) Fasciculations

Answer 34

ALS SMA Polio

Answer 35

Medial midbrain - PCA III CN - I/L gaze palsy CS - C/L hemiparesis

Answer 36

Medial midbrain - PCA III CN - I/L gaze palsy Red nucleus - dysdiadochokinesia

Answer 37

Medial midbrain - PCA Weber + claude III CN - I/L gaze palsy CS - C/L hemiparesis Red nucleus - dysdiadochokinesia

Answer 38

Lateral midbrain - PCA III CN - I/L gaze palsy SCP - C/L cerebellar ataxia

Answer 39

Medial pons - Basillar A. VI CN diplopia, lateral gaze palsy VII CN facial weakness CS C/L limb weakness

Answer 40

Inferior Medial pons - Basillar A. VI CN - diplopia, lateral gaze palsy VII CN - facial weakness CS - C/L limb weakness Medial lemniscus - proprioception and vibration MLF - IPSILATERAL: ataxia

Answer 41

Lateral pons - AICA SL - CONTRALATERAL: limb weakness, limb pain and temperature MCP - IPSILATERAL: limb ataxia, facial paralysis, hearing loss, vertigo and nystagmus

Answer 42

Medial medullary syndrome - ACA XII - I/L tongue weakness/atrophy ML - C/L vibration and proprioception loss CS - C/L limb weakness

Answer 43

Lateral medullary syndrome - Vertebral>PICA V CN - I/L face pain and temperature VIII CN - vertigo, nystagmus IX, X CN - Nuclues ambiguous - hoarseness, dysphagia, gag reflex SL - C/L pain and temperature ICP - I/L ataxia, past pointing Sympathetic trunk - I/L horner's syndrome

Answer 44

IPSILATERAL: lateral gaze weakness (VI) CONTRALATERAL: limb weakness (CS)

Answer 45

Causes Physiological - pregnancy Drugs - DA(-) & DA depletors Atypical antipsychotic - Resperidone Prolactinoma C/F Galactorrhea Amenorrhea Infertility Bitemporal hemianopia Treatment MRI DOC - cabergoline Pregnancy - bromocriptine Surgery - Transsphenoidal resection

Answer 46

Prognathism Spade like digits Jaw malocclusion CVS - LVH, CAD RS - OSA Endocrine - DM, Goitre Mcc death: MI Investigation: Screening: S. IGF 1 levels Confirmatory: GH suppression test Etiology: MRI Treatment Surgery: Transsphenoidal resection Medical: somatostatins - octreotide, lanreotide GH(-) - Pegvisomant Radiotherapy

Answer 47

↓urine osmolality ↑serum osmolality ↑serum sodium Central DI ADH deficiency Bright spot(-) T/t: Desmopressin Nephrogenic DI ADH resistance ADH stimulation test T/t: thiazide

Answer 48

↑urine osmolality ↓serum osmolality ↓serum sodium Euvolemia - Vasopressin escape - down regulation of Aquaporin 2 channels

Answer 49

Mcc Iatrogenic Mcc endogenous - pituitary adenoma Mcc ectopic - SCC of Lung C/F ↑protein breakdown, striae, thin skin, fat redistribution (buffalo hump), hypernatremia, hypokalemic alkalosis - ectopic ACTH Investigation Screening - oral dexa challenge test Confirmatory - Low dose dexa test Etiology - high dose dexa test Treatment ACTH(-) - somatostatins Cortisol(-) - Mifepristone ↓cortisol - metyrapone, ketoconazole

Answer 50

Mcc - adrenal hyperplasia Mcc conns - adrenal adenoma C/F Diastolic HTN Hypokalemic alkalosis Investigation Screening test - Aldosterone renin ratio Confirmatory - Saline infusion test Etiology - CT Abdomen Treatment Spironolactone Surgery

Answer 51

Addisons Mcc - autoimmune Mcc in India - TB Pituitary C/F Hypoglycemia Hyponatremia Hypotension Localized hyperpigmentation Investigation ACTH stimulation test Adrenal Ab - Autoimmune CT Abdomen - TB Treatment Suspected addisons - Dexamethasone Autoimmune - hydrocortisone TB - ATT

Answer 52

Type 1: Insulin deficiency, Age <30 yrs, thin Type 2: Insulin resistance, Age >30 yrs, obese C/F Triad Polyuria Polydipsia Wt. Loss Diagnosis RBS >200mg/dL + symptoms FBS >126mg/dL OGTT > 200mg/dL HbA1C >6.5%

Answer 53

Mature onset of diabetes in young ↓insulin secretion 5-15 yrs OHA responsive - sulfonyl ureas Thin

Answer 54

RBS 250-600 mg/dL ↓pH Ketone bodies (+) C/F Vomiting Tachypnea Dehydration Treatment FLIP Fluids - NS Insulin - regular Potassium

Answer 55

RBS 600-1000 mg/dL ↑S. Osmolality Altered sensorium

Answer 56

polyneuropathy - Mc - symmetrical sensory - glove and stocking - t/t pregabalin Mononeuropathy - mc - III CN - pupil sparing Autonomic neuropathy - hypoglycemic unawareness

Answer 57

Hypoglycemia <50 mg/dL Sweating, dizziness Reversal of symptoms on correction

Answer 58

↑TSH, ↓FT3, ↓FT4 Myxedema - ↑GAGs in skin, traps H2O, non pitting edema Alopecia (↓hair follicle stimulation) ↓nail growth Bradycardia Diastolic hypertension Cold intolerance Fatigue Weight gain Constipation Treatment L Thyroxine 1.6 μg/kg/day (lower dose in CAD & elderly) TSH after 6 weeks - target (0.55-2.5) - continue - yearly TSH TSH >2.5 - ↑25μg Supplements - calcium

Answer 59

↓TSH, ↑FT3, ↑FT4 Orange skin Clubbing Alopecia ( hair follicles burnout) Atrial fibrillation Hypertension Heat intolerance Fine tremors Weight loss Exophthalmos Treatment Carbimazole/Propylthiouracil Propranolol Radioiodine

Answer 60

Parathyroid adenoma RCC Breast ca Small cell ca Lung Hematological malignancy ↑Vit. D Abdominal pain Renal calculi Polyuria Treatment IVF + Loop diuretics Bisphosphonates Rank ligand inhibitor - denosumab ( most powerful anti resorptive)

Answer 61

PUKE Calcium ↑PO4 ↑Uric acid ↑K+ ↓Calcium

Answer 62

Most severe Inherited channelopathy - AR (M>F) inhibitory defect in NaK2CL ATPase Mc tubular defect causing deafness Hyperaldosteronemia Failure to thrive Na and H2O loss in urine Hypotension (mc) Hypokalemic Alkalosis 30% - deafness IU - polyhydramnios ★Hypercalciuria - nephrocalcinosis Exclude: loop diuretic use Treatment ★NSAIDs responsive - elevated pgs No cure Worst prognosis

Answer 63

Milder inherited channelopathy - AR inhibitory defect in NaCl co-transporter 20-30 yrs, M = F Loss of Na and H2O in urine Mild dehydration 2° hypomagnesemia: Ileus, Arryhthmia Exclude: Thiazide use Treatment Mg2+ supplementation: reversal and prevention of symptoms Favourable prognosis

Answer 64

Inherited channelopathy - AD stimulatory defect in NaCl co-transporter 20-30 yrs, M = F Hyperkalemic metabolic acidosis Hypertension S. Aldosterone (n) Pseudohypoaldosteronism Treatment Thiazide responsive: Palliative

Answer 65

Inherited channelopathy - AD stimulation ENaC (mimics ↑aldo) 20 - 30 yrs M = F S. Aldosterone undetectable Pseudohyperaldosteronism Young onset Hypertension Hypokalemic metabolic acidosis Edema Exclude: steroid use Incidental diagnosis Treatment DOC: Amiloride Best prognosis

Answer 66

eGFR = (140 - Age) x weight(kgs) / 72 x S.creatinine

Answer 67

Best formula - CKD EPI formula Inulin clearance - Ideal for GFR Preferred: eGFR Stages 1)90-120ml/min - Asymptomatic 2) 60-89 ml/min 3) 30-59 ml/min 4) 15-29 ml/min 5) <15 ml/min Treatment 1,2 - Microalbuminuria(30-300mg) and reversible stages: Control risk factors Avoid nephrotoxic drugs (nsaids) Ensure adequate hydration DOC: ACE inhibitors (to prevent capillary endothelial damage) 3,4,5: Gross albuminuria(>300mg) and irreversible stages: Erythropoietin Correct mineral homeostasis Renal replacement therapy AV fistula Hep B vaccination Diuretics 1,2,3: Loop diuretics 4,5: loop diuretics+ Metalazone Finrenone - new selective mineralocorticoid receptor antagonist - ↓risk of ↑K+ - in stages 1&2 to prevent progression

Answer 68

Berger's disease 20-30 yrs, M>F Rec. Gross hematutia <1 week of URTI Synpharyngitic nephropathy ↑IgA Complement (n) IgA predominant Granular deposits Least risk of RPGN <1% Best prognosis

Answer 69

Mc in India School children Classic nephritis, 1-3 weeks after sore throat Anti DNAase(mc) ASO(30%) IgG predominant Granular deposits 1-5% risk of RPGN 2nd best prognosis

Answer 70

Pulmonary renal syndrome 30-50 yrs, M=F Hematuria Hemoptysis +Any other organ(skin in child - HSP) ANCA(+) Pauci immune 30-70% risk of RPGN 2nd worst prognosis

Answer 71

Pulmonary renal syndrome Anti basement membrane disease 30-50 yrs, M=F Hematuria Hemoptysis α3 subunit of type 4 collagen Anti GBM(+) Linear deposits >90% risk of RPGN worst prognosis

Answer 72

URTI - Acute rheumatic fever, PSGN Skin - only PSGN

Answer 73

α5 subunit of type 4 collagen Hematuria Deafness Lens defect

Answer 74

Homogeneous - Anti dsDNA/ histone Ab - SLE Speckled - Anti ro/la, anti jo, anti u1 RNP Nucleolar - Anti topoisomerase 1 Ab Centromere - Anti centromere Ab

Answer 75

SLICC criteria ANA Anti Smith (most specific - rim pattern) Anti dsDNA APLA DCT Serum C3 Eular - except DCT other 5

Answer 76

20-40 yrs, ★F>M Symmetrical polyarthritis in small joints Mc ocular - 2° sicca Mc ILD - UIP Mc valve defect - MR Mcc death - HF Treatment DMARDs

Answer 77

20-40 yrs M=F Symmetrical polyarthritis + DIP joint 85% preceeded by skin and nail changes(oncholysis★ - peeling) Treatment NSAIDS

Answer 78

20-40 yrs M=F Asymmetrical Shoulder and elbow joint Mc preceded by diarrhea Rare/specific skin manifestation - pyoderma gangrenosum Treatment NSAIDS

Answer 79

20-40 yrs M=F Asymmetrical Shoulder and elbow joint Mc preceded by diarrhea Rare/specific skin manifestation - pyoderma gangrenosum Treatment NSAIDS

Answer 80

20-40 yrs M=F Post infective Asymmetrical Knee and ankle joint Mc preceded by Chlamydia uti Rare/specific: Keratoderma blenorrhagicum(soles and palms) Treatment NSAIDS

Answer 81

All EIM - mc in CD>UC Except Pyoderma gangrenosum - only mc in UC

Answer 82

Methotrexate - most potent Sulfasalazine - safe in pregnancy HCQ - Safest in pregnancy Together - Synergistic

Answer 83

Necrotizing Granulomatous vasculitis Hematuria Hemoptysis URT involvement - mc Skin rash Ocular★ - pathognomic - pan uveitis cANCA/PR3 (+) Lung biopsy Treatment - cyclophosphamide 70% risk of RPGN

Answer 84

Granulomatous vasculitis Eosinophilia Allergic rhinitis Adult onset asthma - mc pANCA/Anti-MPO Eosinophilic infiltrates on skin biopsy 30% risk of RPGN

Answer 85

Mimics PAN Good response to steroids 10-15% risk of RPGN

Answer 86

NAGMA + Low UCl- + High urine AG UpH >5.5 Most severe Mc inherited <10yrs, M>F Short stature Nephrocalcinosis

Answer 87

NAGMA + Low UCl- + High urine AG UpH <5.5 Milder Fanconi's triad Glycosuria Aminoaciduria Phosphaturia

Answer 88

NAGMA + Low UCl- + High urine AG UpH <5.5 Milder Rare CA-2 gene Mc cerebral calcification Osteopetrosis - 30% Marble brain & bone disease

Answer 89

Hyperkalemic RTA NAGMA + Low UCl- + High urine AG UpH <5.5 Mildest Most common RTA Mc acquired RTA >50 yrs, M=F Early CKD: >25 ml/min Drugs ACEi/ARB/K+ sparing diuretics/Trimethoprim

Answer 90

Metabolic acidosis Renal failure

Answer 91

Given: Cefepime Piptaz Meropenem Not given: Linezolid

Answer 92

Pontine osmotic myelinolysis - Quadriplegia, rigidity, aphonia

Answer 93

Total Na deficit: (140 - pt.Na) x body water(0.6 x wt for males and 0.5 x wt for females) Na. to be given in 1st 24 hrs = (Desired Na. After 24 hrs - initial pt Na. Conc) x body water Na in the first 24 hours: Acute: 8 - 10 meq Chronic: 4 - 6 meq

Answer 94

pH <7.25 Unarousable coma Glucose <40 mg S.creatine >3mg/dL ARDS SBP <80mmhg

Answer 95

Insulin (fastest) Salbutamol Calcium gluconate - cardiac stability

Answer 96

L glutamine - antioxidant Voxelotor - ↑Hb oxygenation Hydroxyurea - ↑HbF

Answer 97

<6 stools/day - Mid to moderate Distal - 5ASA PR Pancolitis - 5ASA oral Refractory - Prednisolone Maintanence - Azathioprine Severe - IV methyl prednisolone

Answer 98

Waist circumference ↑BP ↑Glucose ↑TGs ↓HDL

Answer 99

Warning signs Persistent vomiting Hepatomegaly Severe abdominal pain Severity Plasma leakage causing respiratory symptoms (pleural effusion) Severe bleeding Organ dysfunction - ALT >1000 or mental confusion

Answer 100

Risk of thromboembolism in non rheumatic atrial fibrillation Congestive heart failure: 1 History of hypertension: 1 Age >75: 2 Age 65-75: 1 Diabetes: 1 Stroke: 2 Sex Female: 1 Vascular event: 1 Warfarin indicated when score>=2

Answer 101

Unrelated to disease activity Gall stones Renal calculi Primary sclerosing cholangitis Chronic active hepatitis Sacroilitis Related to disease activity Erythema nodosum Pyoderma gangrenosum Arthropathy Eye complications Aphthous ulcer Amyloidosis

Answer 102

Mild(<4) to moderate (4-6) Budesonide - ileal release Moderate to severe(7-10) - Oral prednisolone

Answer 103

Pre-existing ACTH secreting pituitary tumor after B/L adrenalectomy for cushing's syndrome →rapid growth of tumor due to loss of negative feedback Bitemporal hemianopia Hyperpigmentation Treatment TSR Pasireotide/Octreotide (statins) Radiotherapy/Radiosurgery

Answer 104

Triad Fat malabsorption Migratory Arthritis Dementia Biopsy - PAS positive macrophages containing small bacilli D Xylose test (+) Schilling test (+)

Answer 105

↑pain sensitivity Cognitive defect Disturbed sleep Anti polymer antibody

Answer 106

Irritable bowel syndrome • Essential: Abdominal pain > 1day/week for >3 months ( symptom onset >6 months) + ≥2 of 3 • ↑Pain by defecation • change in stool frequency • change in stool consistency Not seen in IBS - wt loss, blood in stools, nocturnal diarrhoea