Mixed Flashcards
1
Q
STEMI
A
<90 mins: PCI
If not feasible: Thrombolytic Rx
2
Q
Contraindications for Thrombolytic rx
A
Previous ICB
BP > 180/110
Recent major surgery
Aboriginal ( Antibody+ to streptokinase)
3
Q
Dual antiplatelet duration post PCI
A
12 months
4
Q
Prognostic FX for systolic heart failure
A
Raised JVP+ S3 gallop
5
Q
Microangiopathic hemolytic anemia
A
Indirect bilirubin
Decreased haptoglobin
LDH elevated
Schistocytes on PBS
6
Q
HUS
Shiga toxin
A
Renal symptoms predominant with microangiopathic hemolytic anemia
7
Q
von Wiilebrand disease
A
Autosomal dominant
Bleeding 🩸 time increased
Normal platelet
vWF Ag: low in type 1
PTT normal/high
8
Q
vWD rx
A
DDAVP
Factor VIII 8 concentrate
Platelet transfusion only in severe cases
9
Q
Best initial study for oropharyngeal/motility related dysphagia
A
Barium study
10
Q
Hypocalcemia Mx
A
Based on symptoms √
•sympromatic : IV Calcium gluconate
Based on levels ✓
•less than 1.9 : IV Ca gluconate
> 1.9: oral calcium+ vitamin D
11
Q
SCFE
Rx
A
Stop weight bearing
Gentle reduction with pinning
12
Q
Cocaine vs smoking
Effects on foetus
A
Cocaine No anomaly but IVH
Smoking cause anomalies such as IUGR, GI malformations
13
Q
Postural hypotension
Test
A
Initial supine and standing BP:
Less than 10 bpm increased and hypotension: autonomic
+ table tilt test
> 30bpm and hypotension: hypovolemia
> 30bpm increased, NO hypotension: POTS
14
Q
Commonest cause of obstructive jaundice
A
Stone
Periampullary Tumor: head of the pancreas commonest
Strictures
15
Q
Open wound #
CARATXO
A
Clean wound
Analgesia
Reduction by traction
Antibiotics
Tetanus prophylaxis
Xray
Operation theatre
16
Q
OCP with antiepileptics
A
Stop the OCP and use condom
IUCD or Depot MPA
If refused to discontinue OCP:
✓Increase the dose
✓Tricycle phase
17
Q
Implanon, ocp
A
Not advised for patients on antiepileptics as it’s enzyme inducers
18
Q
GBS bacteruria
Vs GBS vaginal swab
A
Bacteruria:Needs treatment (by order wise)
Cephalexin
Nitrofurantoin
Augmentin
Vaginal: normal colonisation, no need Rx
19
Q
GBS bacteruria but asymptomatic
A
Asymptomatic bacteruria needs Abx!!!
20
Q
AV block
A
1: constant pr
2: type 1: pr longer longer drop
Type 2: pr constant & drop
3 constant P-P and constant Q-Q
21
Q
VT pulse +
Hemodynamic unstable
A
Cardioversion
22
Q
JVP normal physiological response
A
Expiratory: rise
Inspiration: drop
23
Q
Pericarditis
A
Reverse in JVP, expiratory: drop inspiration: rise Kussmaul sign
24
Q
Pericarditis
ECG ∆
A
Diffuse ST elevation
Pr depression in lead 1 especially
25
TCA toxicity
Widening qrs complex
Prolonged qt
26
Kussmaul sign
Seen in constrictive pericarditis
✓JVP reversed
✓Edema
✓Congestive hepatomegaly
✓Ascites
27
Patient missed his CHF medications, comes back with hypervolemic sx
Initial: ace (-) to reduce after load
Diuretics to improve symptoms
NOT to give beta blockers yet. To be given once euvolemic only
28
EF reduced/ systolic dysfunction
Hypervolemic
Ace -/ARB
MRA
29
EF reduced/systolic dysfunction
Euvolemic
Ace (-) / ARB
Diuretics or MRA
B- blockers
30
Preserved EF/diastolic dysfunction
Beta blockers
CCB
Diuretics: in congestion cases
31
HOCM
Echo 1st
Rx: beta blockers + verapamil+ dispyramide
Catheter with alcohol to infarct septum
32
Bradycardia
Asymptomatic: reassurance
Symptomatic: initial: IV atropine 1st line 0.6 mg then 0.5mg every-5 mins
IV adrenaline infusion: 2nd line
In ED: temporary pacing with percutaneous or IV pacemaker
Elective permanent pacemaker later
33
AV block
Best initial
Transcutaneous Pacing
34
PSVT symptomatic young man
1st choice: adenosine
2nd: verapamil
3rd: beta blockers
35
AF Stable without decompensated HF:
Beta blockers 1st choice
Add Digoxin of not well controlled
Flecainide for rhythm control
36
AF with decompensated HF
Digoxin initial choice
Avoid beta blockers !!!
37
AAA surveillance
3-3.9 : 24 mth
4- 4.5: 12 mth
4.6- 5: 6 mth
> 5: 3 mth
38
AAA indication for surgery
>1cm /year
Male> 5.5
Female> 5.0
Symptomatic
Thoracic> 6.0
39
Acute limb ischemia
Most common Cause?
Thrombosis
40
Acute limb ischemia
Post embolectomy mx
Heparin initiated, then bridging with Warfarin. Once INR of 2-3 achieved, omit heparin
Warfarin for 6 months
*Cardiac origin emboli needs lifelong treatment
41
Perioperative high mod low risk for VTE prophylaxis
Q142
Medical high risk: CASHSTD
42
AF asymptomatic
Aspirin 1st
CHA2DS2 VASc
For Warfarin or NOAC if =/>2
Others eg b blockers if Symptomatic
43
Ace (-) , smoking cessation, statin
ABI< 0.9
For <0.4 : urgent referral to vascular
44
Dazzling with sunlight
Cataract
45
Needle stick injury
Patient status unknown
Medical personnel not immunised
Ivig+ 3 dose hepatitis B vaccine
46
Colonoscopy
Asymptomatic
Cat 1: ifobt every 2 yrs from 45
Cat 2: ifobt every 2 yrs from 40
Cat 3: ifobt every 2 yrs from 35
47
Cat 2
Cat 3
Asymptomatic
Colonoscopy every 5 yrs
Low dose aspirin
48
Definition of category in colon cancer
Cat 1 ✓1fdr or 1 FDR +;1 SDR> 55
Cat 2 ✓1fdr <55 or 2 FDR any age
✓1fdr +2fdr any age
Cat. ✓3fdr or 3sdr ( at least 1 before 55)
49
Parvovirus monitoring in exposed pregnant women
IgG and IgM
If both negative: repeat in 2 weeks
IgG+ IgM - : immune mother ,no need follow up
IgG - IgM + :infected
IgG + IgM+ : recent infection
50
Parvovirus+
1-2 weekly USG for 6-12 weeks look for hydrops
If seen, for umbilical cord sampling and intrauterine blood transfusion may be required
51
Hemochromatosis
Ix
Iron studies: high ferritin, high transfering saturation> 50%
If 1° : gene studies: HFE gene testing
Liver biopsy or CT scan ( Ferriscan) : iron deposits seen
52
Hemochromatosis
Rx
Phlebotomy: weekly then 4l3-4 monthly
✓done prior to liver cirrhosis, good outcome
53
Lithium
Action
Cautions:
Modulation of phosphoinostitol pathway
Nephrogenic DI, thyroid, CKD , Ebstein anomalies
54
Valproic acid
Action
Cautions
- Na channel
Transaminitis, pancreatitis , neural tube and cardiac anomalies, PLT low
55
Lamotrigine
Actions
Cautions
Glutamate inhibition
Steven Johnson syndrome SJS
56
Carbamazepine
Actions
Cautions
Na channel inhibition
Agranulocytosis, SIADH, enzyme inducer
57
Hemangioma liver
✓Most common cause hyperechoic mass on USG
✓CT : hypodense : arterial phase shows uniform enhancement peripherallu
58
Restrictive lung disease
FVC affected
FEV1 normal
59
Obstructive lung disease
FVC : NOT 🚫 affected
FEV1: affected
60
FEV1/FVC LOW
Obstructive lung
61
Normal FEV1/FVC ratio
0.75 - 0.85
62
Ipratropium
Used in acute exacerbations if not relieved by Salbutamol
0-5 yes: 4 puffs 250mcg neb
6-12: 8 puffs 500mcg neb
63
Exercise induced asthma
Montelukast
64
BiPAP or CPAP I'm COPD
Used if Venturi mask doesn't help to increase oxygen to paO2 = 60mmhg
65
Split S2
Seen in AS & MR
66
AS
Elderly, calcified valve
Split S2
Best heard at apex (mimic MR)
Stenotic and calcified valve may cause diastolic murmur at left upper sternal edge
67
Mycoplasma pneumoniae
Atypical, Headache,malaise, cough
CXR: bilateral patchy infiltrates
Rx: Doxycycline 100mg BD 10 to 14 days
68
Hypersensitivity pneumonitis
Sx
Rx
Sudden onset after few hours of exposure to allergen, fever cough, breathlessness, crackles om auscultation
Allergen: mould hay( farmers lungs), bird 💩
Rx: Avoid allergen, steroids
69
Interstitial lung disease
What
Sx
Ix
✓Heterogeneous lung conditions progression to restrictive lung disease
✓sob, dyspnoea,slow course,dry cough, clubbing
✓ x-ray reticonodular(ground glass)
HRCT : honeycomb
70
Mesothelioma
What?
Ix?
Rx?
✓Recurrent pleural effusions, weight loss,
✓Cancer of pleural wall
✓Thoracoscopic plural biopsy
✓palliative care
71
Can Patient with Previous LSCS go for breech delivery?
Contraindicated !!!
72
Common cause of LSCS in Australia
Past hx of LSCS
73
Hyperemesis gravidarum
IV fluids with metaclopramide
Ondansetron reserved for recurrent cases, hx admission for hyperemesis , not responding to metaclopramide
74
Serotonin syndrome
Name answered: excess serotonin so GI sx predominant diarrhea and CNS sx clonus , hyperreflexia
Common : fever , tachycardia, hpt
75
Colon tumor general sx
Right sided: anemia,fatigue,
Left sided: rectal bleeding, altered bowel habits
76
Acute cholangitis
Initial Rx: IV fluids+IV abx
77
Neuroleptic Malignant Syndrome
✓Neuroleptics: antipsychotic
✓fever , tachycardia hpt
✓Rigidity , WBC, CK high
✓
78
Scoliosis
Causes?
Sx?
Rx?
Idiopathic 75% : child < 10yrs ; adolescent> 10yrs
Non operative
20°: 6 mth r/v
20°-40°: bracing
Surgery:
> 50°
79
Risperidone
Side effects
Rx
✓Galactorrhoea (hyperprolactinemia)
✓ weaning & switch to Quetiapine
80
Adjustment Disorder
Main sx ( compared to PTSD)
✓Intensity of stressor isn't bad as PTSD
✓No re-experiecing traumatic event
✓within 3.mth of onset of stressor
✓significant impairment of occupational functioning
81
Prodromal Schizophrenia
Onset
1st symptom
Early prodrome of psychosis
SX of Early prodrome
SX of late prodrome
✓4 years from pre psychotic prodrome of psychosis
✓Recurrent depression SX
1-2 yrs before psychotic SX occurs:
✓Loss of motivation
✓Social isolation
Late prodrome :
✓paranoid ideation
✓odd beliefs
82
Chronic insomnia
Def
Rx
> 4 weeks
CBT
83
Acute insomnia
BZD: Temazepam
BZD receptor agonists: zolpidem
( no tolerance or dependence)
84
OCD
CBT, response & exposure, SSRI
85
Delirium tremens
Diazepam
86
Age onset of depression < 25, family HX of Bipolar, psychomotor retardation
Bipolar depression
87
% of risk of Schizophrenia in children
Both parents +: 45%
One parent: 13%
NONE: 1%
88
Olanzapine
Side effects
Increase risk of type 2 DM
and Triglycerides level
But normal serum cholesterol level
89
Capgras Syndrome
Known as delusional misidentification syndrome.
False belief close person has been replaced by some identical looking impostor
90
Psychodynamic psychotherapy
OCD, BPD, avoidant personality
91
CBT
Depression, phobia, schizo, anxiety
92
Consent from Mental Health Tribunal
Vs
Consent form higher authority/without consent under duty of care
For ECT
ECT for depressed , with refused Rx and not taking anything orally but stable
Vs
Depressed, hemodynamic unstable poor intake , dehydration
93
Laurence Moon Biedl
Sx
Rx
✓Autosomal recessive
✓Obesity,mental retardation, polydactyly, retinitis pigmentosa, hypogonadism
✓No treatment 😭
94
SSRI and aspirin interaction
Higher risk of bleeding
TCA is preferred antidepressant for these patients
95
DIGFAST 4/7
Fun for 1 week
Mania
Distracted
Impulsive
Grandiosity
Flight of ideas
Appetite
Sleep
Talkative
96
DIGFAST
3/7
No mania or psychosis
Hypomania
97
Positive psychotic symptoms
Rx
Typical antipsychotics
Haloperidol
Chlorpromazine
98
Negative symptoms of schizophrenia
Rx
Atypical antipsychotics
Risperidone
Olanzapine
99
Atypical antipsychotics
R O C A Q A
A : Aripiprazole and Amisulpride
100
Immature defence mechanism
Projection
101
TCA
Side effects
Anticholinergic side effects
Atropine like
102
ECT
Mentally incapacitated ?
Vs
Voluntary for Rx and capable mentally?
✓Refer mental health tribunal
Vs
✓2 doctor: 1 of them psychiatrist agree for ECT
103
Patient on long term hypnotic for insomnia.
When suitable to continue further?
✓aware he/she dependent on it
✓No adverse events to the medicine
✓Reduction program unsuccessful
✓Reduction program was against the patient's wish
104
Break off relationship
Lonely
> 3mths of exposure to stressor
Lasts upto 6 mth
Adjustment Disorder
105
Grief
Usually LOSS of someone or property
106
USG findings of chronic pancreatitis
Remember calcification*
pancreatic duct calcifications, ductal dilation, enlargement of the pancreas and fluid collection.
107
Fetal alcohol syndrome features
Small teeth and faulty enamel
108
Transient synovitis
Rx
First rest and then analgesia
109
Hypoglycemia in child
glucose is with a bolus of intravenous dextrose 10%, 2.5 to 5 mL/Kg followed by 0.03 to 0.05 mL/Kg/minute until the patient is stable.
110
IV Dextrose 50% not given to child
High serum osmolarity and death
111
Fat embolism
24 to 72 hours after the insult, and involve lungs, brain and skin,
112
1° spontaneous pneumothorax
<15% : observe r/V in 24 hrs
> 15% : needle aspiration
If > 3L\symptomatic/distance chest wall and pleura > 2cm : chest tube+ underwater seal
113
2° spontaneous pneumothorax
Need admit
<15° : needle aspiration
> 15° : chest tube+ underwater seal
114
Traumatic pneumothorax
<15°: observe
> 15° : chest tube+ underwater seal
115
UTI in male less than 35 sexually active
Organism
Chlamydia
116
UTI in children/male > 35
E.coli other coliform organism
117
Cushing
Causes?
Test?
✓Pituitary ACTH 70%, adrenal 15%, ACTH peptide from lung10%,
1mg dexamethasone suppression
24hr urinary cortisol
Serum ACTH
High dose suppression
MRI, petrous venous sampling
118
Cushing
SX?
Rx?
Psychosis,poor concentration
HPT
ED in male, irregular menses
Moon facies, buffalo hump
Hyperglycemia, polyuria
Osteoporosis
119
Most important test for azoospermia
Hormone tested?
Level ?
FSH
2.5 times or more increase in serum FSH level indicates irreversible testicular failure. FSH is the most important endocrine test in assessment of male infertility.
120
Occult GI bleeding
Active, hemodynamic stable: CTA
Inactive, minimal bleeding: capsular endoscopy
121
Life threatening GI bleeding
Interventional angiography
122
CKD patients with pulmonary embolism
Rx
Unfractioned heparin
123
Cervical motion tenderness +
Ectopic pregnancy or PID
Ectopic pregnancy: transvaginal ultrasound
PID: cervical swab
124
Jaundice, wt loss, abd mass
Initial ix
USG
125
Abd pain, wt loss, no jaundice
Initial ix?
CT scan
126
Oral bisphosphonates
✓< -2.5 dexa scan
✓< -1.5 with minimal
traumafracture
✓Age> 70 yrs old
✓On daily steroid > 7.5mg/day
127
Sickle cell disease
Autosomal recessive
Bone infarction main symptom
HbS mutated
Vaso occlusive crisis or hemolysis under stress i.e hypoxia, dehydration, acidosis
Renal
Spleen
Gall bladder
Femoral head AVN
Rx: IV fluid, oxygen, pain relief
Exchange transfusion, blood transfusion, BM transplant
Hydroxyurea
128
INR
Bleeding 🩸
>1.5 life threatening: vit K+ prothrombinex+ FFP
> 2 significant bleed but not life threatening: vitamin K+ prothrombinex/ FFP ( if prothrombinex NA)
Any INR with minimal bleeding: omit Warfarin, observe for 1 day and see INR is within therapeutic range
If high risk of bleeding , vitamin K to be given esp INR> 4.5
129
INR above therapeutic range
No bleeding
Stop Warfarin
INR < 4.5: omit Warfarin, observe INR into therapeutic range, give reduced dose
INR > 4.5-10: omit Warfarin, vitamin K, observe INR into therapeutic range,
INR > 10:
130
Fibroadenoma> 3 cm
Remove
131
Fibroadenoma
Age> 40
Remove biopsy
132
Polycythemia vera 4P
Pruritic, plethora, pressure, phlebotomy
Mutations Jak 2
RBC excessive amount
Hyperviscosity
Plethoric
Pruritus after shower
133
Budd Chiari
Normal albumin
Elevated liver enzymes
Obstruction at hepatic vein
Abd pain ascites
134
COVID
Asymptomatic
Mild
Mod: viral pneumonia
Severe: spo2 < 94 lung > 50%
Critical : resp failure,,mods
