Random High Yield Flashcards
ANKLE dorsiflexion deficit
or Tibilias Anterior
PATELLAR reflex deficit
L4
BIG TOE Dorsiflexion deficit
L5 - Large toe
Neck of the FIbula
Weak ankle
Weakness and eversion and dorsiflexion of the foot
Pain in the lateral shin area and dorsum of the foot
key - INVERSION SPARED
Peroneal Nerve Injury
tx: Shoe wedging
Neurolysis
Sciatic Nerve supplies 5 spinal nerve roots
L4, L5, S1 S2 S3
The pain is made worse by sneezing, coughing and laughing or a hard bowel movement
Bending backward can also make the pain worse.
Other than pain look out also for numbness and difficulty in walking
Sciatica
Most approp inv in Sciatica
MRI
CT Scan - Alternative
X ray - to see the lordosis
Most common tumor of the adrenal medulla in adults
Derived from chromaffin cells arising from the neuraln crest
Pheochromocytoma
What is the treatment for Pheochromocytoma
Phenoxybenzamine - to avoid a hypertensive crisis
B-blockers - given to slow the heart rate
Tumor surgically removed
<1.5 - <2.5
Osteopenia
Tx: Calcium + Vitamin D
> 2.6
Osteoporosis
tx: Alendronate / Zolindronic Acid
Osteoporosis + low trauma fracture
DEXA first
then
ALENDRONATE
Osteoporosis + PUD
tx
Zolindronic Acid
Osteoporosis tx
Alendronate
OSteoporosis + Breast CA
Tamoxifen / Raloxifen
Severe Osteoporosis + HRT
Give Alendronate
Severe Osteoporosis + HRT
Give Alendronate
First line for Pharmacologic therapy in Osteoporosis
Biphosphonates
Second line therapy for Osteoporosis
Can cause hot flushes and venous thromboembolism
Does not cause endometrial hyperplasia or increase risk of breast c
Raloxifene
Considered first line in patients with a high risk of fracture
Teriparatide
Post menopausal female comes with you with enterocele prolapse and stress incontinence.
What is the management?
Pessary
Post menopausal female comes to you with enterocele prolapse
Pessary
- Pelvic floor exercise is usually for younger people with incontinence
Urethra bulges into Vagina
Urethrocele
Rectum protrudes into vagina
Rectocele
Loop pf small intestine bulges into vagiina (usually posterior wall)
Enterocele
Uterus and cervix descend toward vaginal introitus
Uterine
Cervix remains in vagina
First Degree
Cervix protrudes on coughing / strainiing
Second degree
Uterus lies outside vagina
Third Dedree (Prodicentia)
20F came to you in GP clinic for contraception advice
She gives her mother and sister DVT episode
Best step in the care of this patient?
Do thrombphilia screening
Which would be the best option OCP for a smoker female
Norethisterone
Female with menorrhagia and her consulation is due with a gynecologist , what can you give her till that time
NET
Mentally retarded girl complaining of menorrhagia
Approp contraception?
COCP and if it wont work
then MIRENA
Lady in her 20s with h/o migrainne
Oins and needle sensation
contraception?
POP
Young lady came for contraception
She feels headache
her BP is 130/90
What to prescribe?
POP
Young lady came for contraception advice
Sometimes she feels headache her BP is 130/90
POP
Woman takng OCP containing 30 g estrogen now comes to you with hypertension
What is the next step
POP
10wk pregnant patient comes to you for her first anternatal visit.
Can see the strings of the IUCD
What is your next step
Remove the IUCD now
Hot flushes 3-4 x a day
Vaginal dryness
Atrophic vagintis
She had hysterectomy 10 yrs ago
She has History of DVT
Approp tx?
Low dose transdermal estrogen
Most imp contraindication of OC pill
Breast Cancer
Lady with obesity, hirsutism and PCO asking for contraception
COCP
Missed her pill pn the 7th and 8th day
had unprotected sexual intercouse on the 6th and 7th day
mgt?
Give emergency contraception With Levonogestrel 2x 12 hrs apart
LAdy with obesity, hirsutism and PCO
asking for contraception
COCP
Woman with otosclerosis with hearing aid
What contraceptive method is best for her
IUCD
Female usng 30mg OCP
Presents with continuing painful periods
Want to conceive after 12 to 15 months
What to give her
use 50mg ocp
A patient is asking OCPs
Reports has been experiencing MIGRAINE
PROGESTERONE
H/o migraine with depressive illness
BMI 33, contraceptive method to use?
Condom only
How does microgynon 30 work
In the Hypothalamus
Yasmin oral contraceptive is prefered in Australia because
decrease weight instead of increasing it
After deliery, BREASTFEEDING
What contraption to use?
LEVONORGESTREL
Breastfeeding wants to CONCEIVE again
POP
Patient gaining weight on Olanzapine
Wants to change drug
Which one to give?
Aripiperazole
Loose stools still even after given Metronidazole
tx?
IV Vancomycin
22yo girl wants cervical cancer screening
She is not sexually active
What adv to give
No need
involves dislocation of the radial head as well as a fracture of the prximal ulna
Monteggia Fracture
Isolated fracture of the shaft of the ulna, usually due to a direct blow.
A blow from a nightstick (police baton)
Nightstick Fracture
often occurs following a fall on an outstretched hand
Scaphoid Fracture
Distal Radial fracture often due to a fall on an outstreched hand,
palmar displacement of the wrist rather than dorsal
Reverse Colles Fracture
What nerve can be damaged with Colles Fracture
Median Nerve
What is the ideal position of the forearm in Colles
The cast is applied with the distaln fragment in palmar flexion and ulnar deviation
What is the tx for Smith’s Fracture
Closed reductions and ORIF
Ulna Fracture with dislocation of the Radial Head
Monteggia
Radius fracture with dislocation of the Distal Radioulnar Joint
Galeazzi
Dorsal displacement of Distal Radius fragment
Colles Fracture
Volar displacement of distal radius fragment
Smith Fracture
What is the treatment of Bell’s palsy
Cover the eye
Steroids
Antiviral
no Sparing
Same side
All side affected
Right Side LMNL
Opposite side
Upper face is spared
UMNL
Can’t raise the eyebrow
Can’t close the eye
Cant blow the mouth
Cant smile wide
Facial Nerve
Cannot raise the eyebrow on the Left Side
Cannot Raise the eyebrow in the left side
No pain sensation in the Left side
LMNL
Bells Palsy
If you are suspecting Ceacal cancer
What symptoms could be there
Lethargy or Fatigue
Woman who is under evaluation of cecal carcinoma what is her presentation
Tiredness and Lethargy
Schizo patient, after taking medications for 1 yr she is diabetes positive
What will you check>
Cholesterol Levels
Athlete with twisting knee injury
Now can’t flex the knee beyond a point
Medial Meniscal Injury
Knee is locking in full extension and sometimes his legs gives away
Medial Collateral Ligament Injury
and Medial meniscus injury
Knee Injury after football, patient can’t roatte medially his legs
If thighs are fixed
Left meniscus
Internal rotation of femur on tibia
Medial Meniscus tear
External rotation of femur on tibia
Lateral Meniscus Tear
Direct bloq outside the knee
MCL Injury
Blow to the front of the knee
Direct blow to the anterior tibia in flexed knee
PCL injury
Popping sensation
Positive Antwrior Drawer sign and Lachman’s test
ACL
Direct contact, like tackle
Meniscal tear
Rugby tackle from the side
Direct valgus force to knee
Lateral Side knee
External tibial rotation
pain on medial knee
pseudo-lockiing = hamstring strain
MCL
Renal tumor 5cm
Lower lobe of the kidney
Partial Nephrectomy
if it is more than >7cm = Total Nephrectomy
ANYWHERE
uo to 0.5cm = Passed spontaneously - No intervention
0.5 - 2 cm + ESWL
.>2cm = PCNL
IF THE RENAL STONE IS IN THE LOWER POLE
up to 1 cm - ESWL
1cm-2cm = LASER lithotripsy
>2cm = PCNL
If proxomal Ureteric Stone
up to 1 cm = ESWL
>1cm = PCNL
Distal ureter
if not obstructed > 0.7 cm = :LASER LITHOTRIPSY
Between 0.5-0/7c, stone - Observe with Tamsulosin
What is the acute limb ischaemia warning sign
Paralysis
Syphilis, Alopecia,
Asia trip
Rash on pain
Sole rashes
2ndary syphilis
tx
Benzylpenicillin
Young urethral discharge
case was like typival epididymo orchitis
SX: of frequency, dysuria, frequency discharge , inv?
Urine Culture
Young man with milky white discharge doe urethra for 2 days
Neisseriadx
Treated with Ceftriaxone 1 g, IM
But he comes back with the same symptoma
Urine analysis diplococci
Reason?
Drug Resistance
A woman presented with back pain
She has mastectomy
Best tx for the pain
Radiation
Paresthesia of the Left upper limb
Dx with Metastatic breast cancer
CT has lesion in frontal lobe
Mgt?
Mets = DEXAmethasone
Patient with lump FNAC shows breast ca
estrogen neg
prog neg
her 2 neu gene BRCA _ve positive with palpable
Sentinal Lymph node biosy
= do that first
Breast Ca
Stafe I and II
Breast Conserving therapy with Sentinel Lymph biopsy followed by Radiation
Stage III Breast Ca
Modified Radiacl Mastectomy with Axillary Lymph nodes dissection
- Chemotherapy plus hormonal therapy
- (Tamoxifen, Anastrozole and Trastuzumab
Stage IV breast ca
Mastectomy
Carcinoma in Situ
Chenotherapy not needed
Bone mets
Local Radiotherapy plus biphosphonates
Brain mets
Local Radiotherapy
In local chest wall lesions
Local Radiotherapy
In liver mets
Chemotherapy
Lung mets
Chemotherapy
Lady with history of breast Ca
Now with back pain
CT of whole spine showed solitary metastatic breast cancer
Lesion in frontal lobe
mgt?
Dexamethasone
Pt with lumpo FNAC show breast ca estrogen negative Progesterone negative
Her 2 neu gene (BRCA +ve) positive with palpable
Mgt?
Sentinel Lymph node biopsy
Breat Ca with back pain
CT whole spine - showed metastatic deposit
Mgt?
Radiotherapy - whole spine so 1 spot
If ER positive tumor
Tamoxifen
if Her 2 positive tumor
Trastuzumab
Worst prognosis
Triple negative
ER receoptor negative,
progesteroone receptor negative (PR)
HER2 neu negative
Mgt ff lumpectomy to destroy any residual tumor cells
Radiation
Induction therapy to reduce the initial tumor burden prior to surgery
Radiation
For small tumours and patients with strong preference for breast conversation
Lumpectomy
followed by radiation
for larger tunours
prior history of chest radiation
Mastectomy
Causes winged scapula
Long thoracic nerve
- nerve injury in mastectomy
causes reduced sensation to upper medial arm
Most common nerve injured
Intercosto brachial nerve
- nerve injury in mastectomy
causes weak adduction and internal rotation
Thoracodorsal Nerve
- nerve injury in mastectomy
Alcohol, agitated in emergency
IV diazepam
1 month baby discharge since day 1
NLD
3rd day discharge from eye baby
Gonorrhea
Hoarseness, reflux, ifnection sahi hogya thai
Chest Xray
Baby preterm O2 decreasing
Pneumothorax
Subclavian tube insertion
BP drops
tracheal deviation
Needle thoracocentesis
After hip surgery how will you give Heparin
Immediately before surgery
Patient done with hip surgery
post ip 38 days heparin taking
mgt
Stop drug
Fever with agitation
Moderate pneumonia
Mgt
Benzylpenicillin
Neuromalignant syndrome
CK increased
Elderly copious sputum
Lobar pneumonia
IV Tcarcillin
Accident
conscious
o2 60
intubate ventilate
Old patient flecion totally fine
Extension pain
Sitting good
Spondylosis or Stenosis
Tx for necrotizing enterocolitis
Ampicillin and gentamicin
low folic acid
howel jolly body
stomatitis
normal bowel
weight loss
inv?
Small Bowel biopsy
- celiac
Patient on Methotrexate and Prednisolone complaining of mouth and tongue ulcer
tx?
Folic Acid
Treatment of Chlamydia
Azithromycin
Treatment of Acute Gout
Allo/morpine
Treatment of Colle’s fracture
Plaster
Treatment of DVT in pregnancy
Stocking / LMWH
Treatment dose of recurrent gout
Allopurinol 25 mg
100 mg
200 mg
Location of movement in MVA patients
Paradoxical breathing
20 yo boy came what will you do for screening opportunities
BP
Acute Limb ischemia
inv
Duple
Septic arthirits tx
IV antibiotics
Acute limb ischemia
inv
DUPLE
Septic arthritis treatment
IV antibiotics
Patients taking statins and HTN medications and has pain on shoulder asking the cause
Drug induce Myositis
Child with pneumonia
Xray with pleural effusion
asking after giving antibiotic what to do next>?
Pleural Drain
Scenario of moderate crouo
(Chest Wall restriction) asking treatment
IV adrenaline
Scenario of Anaphylactic Schock asking for treatment
Adrenaline
Pt with Parkinson disease and shcizo
taking Lithium now complaining of hand tremor
Decrease Lithium and add Parkinsons Drug
Child with failure to thrive before weight was 70th percentile now is 30TH percentile asking for diagnosis
CF
Child with Bilateral eye discharge after birth asking causes
Gonorheea / Lacrimal Duct Obstruction
Another meningitis scenario and CSF analysis was there
(High protein normal glucose) neutrophilis was there asking for treatment
Antibiotic
or Antifungal
Rash on thigh
Loose stools history for 10 years
With excessive flatulence
Antilian negative
Inv?
Colonoscopy
BUlky pale offensive frothy greasy stools
stools difficult to flush down the tpilet
weight loss
failure to thrive
increased fecal fat
glossitis
Signs of multiple vitamin deficiencies
HYppochromic or megalobastic anemia
dx?
Malabsorption
Triad of weight losss + diarrhea + Abdominal bloading + iron or folatre deficiency
Celiac Disease
What is the first test for Celiac Disease
TTG - Antiendomysial antibody - IgA antigliadin Antibody
What is the most accurate diagnostic test for celiac disease
Small Bowel Biopsy
Child with impetigo with crusting
Antibiotic was started and cant cover all the plaster
Mother is asking the GP when the child can go back to school
24 hr after starting the antibiotic
Molluscum contagiosum
how to prevent the contact?
Avoid swimming with hot water
No contraction and couldnt feel the fetal movement 2 days ago
On auscultation the pregnant woman is fine
mgt
Ask her to drink icy drink and check the CTG again in 4 hrs
HFM disease
Mother is so worried when the child can go back to the day care
When all the blisters dried
Swelling in front of the ear and movable not firm, inflamed, painful when you swallowing or chering
inv?
USG
old lady dall on outstretched hand
Xray given
mgt?
Open reduction and fixation
34wks gestation with abdominal pain and bleeding per vagina 800ml,
uterus tense and tender
Fetal heart rate not heard
Mgt
Amniotomy
Cervix still the same
Fetal head same position
Amiotic fluid are gone
Mgt
Immediate Cs
18wks age opf gestation
uterus size 32 wks
Polyhydramnios
Regularly using Marijuana
He doesnt reply when being asked
and mood is not stab;e
Mgt?
Fluoxetine
Old man on multiple drug like Metformin, Diuretic, Perndopril. SSRI etc
Hyponatremia
What is the cause of Hyponatremia?
Fluoxetine
The old man change his behaviour recently
2 wks ago he had multople fall and kept forgettinng and became aggressive
What is the Dx?
VAscular Dementia
motor dysfunction with visual hallucinations that (overlaps with parkinsons)
Lewy Body Dementia
Predominant memory problems
Alzheimers
A man got dripping and symmetrical enlargment of the prostate
Show a bit od UTI feature What test will you get the Dx and treatment
Urinalysis
Child 4yo with UTI
drug of choice
Cephalexin
Women with UTI 28 wks pregnant asking for tx?
Cephalexin
A young woman had an injury to his knee in a hame
sustaining pain and then swelling of the affected knee
Hear that poppin sound when he pkay game
He couldnt finish his game
ACL
Syphilis treat,emt
backpacker go travel around the world
been to asia come with rash on hand and foot, alopecia
What is the tx?
Benzathine Pen
FB removal in the right eye
Complains of blurring of vision in the Left eye
Irregular Red Reflex on eye examination
Cause
Retinal Detachment
bilateral fine crackles
raised JVP
ECG confirms ATRIAL FIBRILLATION
Mgt?
Synchronized DC Cardioversion
Treatment for inflammatory joint pain in multiple areas
Who also has renal failure
Contraindicated in this patient?
Methotrexate
minor stroke + dementia
VAscular dementia
contraindication of COCP
Smoking
mooon face
Cushing’s Disease
episodes of starring in space
with lip smacking and limb movement
tx
Sodium Valproate
1
Third degree block
Stop Metoprolol
URTI + blood in his urine
Iga Nepropathy
brownish greenish discharge
Gonorrhea
postcoital bleeding
cervical ectropion
R facial weakness
history of ear pain
odd taste in the mouth
R facial nerve paralysis
Ramsay Hunt Syndrome
if there is tetanus vaccine 5 years ago next mgt?
Immunoglobulin
Serum calcium high, high PTH
Parathyroid adenoma
What do you need for the Diagnosis for PCOS symptoms
FSH: LH
Blood reveal a microcystic hypochromic anemia
irond deficiency anemia
tiredness and Increased shortness of brreath
inv?
Colonoscopy
How do you manage the trachoma outbreak
Treatment of contacts
LEft Side of the body sudden onset of carotid bruit
Left carotid artery stenosis - 40-50%
Right carotid artery 50-60%
BP 180/110
CHolestrol lebvel 5.6
Mgt?
Antiplatelet Therapy
Man presents with vertigo + dysphagia + loss of tough and sensation of the opposite side of the body
Ipsilateral Horner’s syndrome
Where is the lesion?
Vertebral artery
cold rash
purpuric or pale center
dx?
Herpes Simplex virus
tenderness in her back L4-L5
restrictions in the movement of extension adn flexion rotations
What will yoiu give beside analgesic?
SPinal Xray - 50
Keep active - 40
CHest infection
gained weight
admitted with impetigo
decreased 1kg
diagnosis?
Cystic Fibrosis
loin pain, hematuria
nxt step?
Xray, KUB
In acute Renal failure with a potassium of 6.8 mmol
ECG shows tall tented T waves
Commenced on Cardiac monitoring and is given insulin destrose infusion and Salbutamol nebulizers
tx?
Calcium Gluconate
acute onset pain in the lower back with urinary symproms
significant weight loss
DRE - irregular prostate
next inv?
TRUS
cough and nasal discharge
noisy cougjh
dx?
Acute laryngeotracehobronchitis
Neck stiffness and meningitis sign start 3 days ago
CXR shows well defined round opacity in the middle right lung
cause?
Aspergillus
menses pain and heavy flow
tx?
Mefenamic acid
decreased HB with cyclic menorrhagia
next?
Levonorgestrel releasing IUD
X
BMI 32
striae and pigmentation on her neck and axillary region
she has amenorrhea
striae on abdomen
dx?
Metabolic Syndrome
obese woman with hirsutism and hypertension
what is the elvated level on her?
Cortisol
rash and rouleaux on blood test
diagnosis?
Wald Enstrom’s macroglubulinemia
Urine protein and hematuria with 3-4 renal cysts seen on USG
Helicobacter pylori with triple therapy
hypertensive
Dx?
PKD
Postpartum bleeding after 14 hrs deliver
complete placenta
no lochia, oerineal tear does not require sutures
comes with heavy bleeding on the 5th day
what is the cause?
Perineal wound
No history of travel,
stool with blood and mucus
no fever and no use of medications
Diagnostic suspicion?
Crohn’s Disease
Previous history of ulcerative colitis develops pruritus
noticed sclera becoming yellow
LFTS are deranged and her ANCA is positive
What is the diagnosis?
Primary sclerosing cholangitis
Agitated, sweaty, pupil dilatation
Which drug would be responsible?
Methamphetamine
Causes of recurrent ischiorectal abscess in the absence of any git symptoms?
Anal fistula
PSA becomes 3.0 (Normal <4.0
Prostate is enlarged and regular
adenocar of Gleason 4 datge
mgt?
Radical Prostatectomy
femoral pulse not palpable
dorsalis pedis is palpable
ABI 0.3
best way to diagnose?
Arteriography
Admitted for AF
after developed severe abdominal pain, nausea and vomiting
passed bloody stool
inv?
Serum Lipase
ABd CT found 2 cm stone in the upper pole of the kidney
What to do
Extracorpeal Shock Wave Lithotripsy
colicky abdominal pain and anorexia
tenderness all over the abdomen with guarding
dx?
Perforated Appendicitis
45yo obese, diabetic and hypertensive woman came to you with a soft mass in the epigastrium
What is your advice for long term management?\
A. mesh herniorrhaphy
B. Weight reduction
B. Weight reduction - 1st step
sudden onset of red and swollen nontender scrotum including penis and perineum
testis is norma’l
dx?
Idiopathic scrotal edema
poor feeding and bile stained vomiting
passing meconium on day 4 of birth
mild jaundice and abdominal distension and is irritable
abdomen is distended and tender
dx?
Hirschprung’s disease
if the case has GCS
inv?
CT SCan
central scotoma
dx?
Macular degeneration
cherry red spot
CRAO
history of surgery for achalasia
hoarseness and dysphagia
mass in the thoracic inlet
diagnosis?
Cancer of the larynx
ZX
acute pain and earache R side of the face
with preauricular swelling omn the R
tender on palpation bilaterally
dx?
Mumps
IF family has colon ca then siblings has ureteral ca
What dx related to the man ?
Lynch syndrome
if there is 6cm laceration in the anterior part of the tibia
tibia grossly deformed and distal pulsations were absent
mgt?
Debridement
swelling in front of the neck in the anterior triangle
hoarseness and difficulty in breathing esp when lying on his back
Multinodular goiter with retrosternal extension
severe chest pain which occur after bouts of vomiting on examination and there is dullness over the left lower lobe of the lung
inv?
Gastrograffin swallow
4yo blood stained in underwear
mgt?
Report for sexual abuse
child with 3cm lump under mandible angle
painless
no lymphadenopathy
no fever
inv
Review in 1 week
pinpoint lesions on the trunk and limbs of lesions were nonblanchable
Mgt?
ITP
neck stiffness and anterior fontanelle full
Mgt and Dx
Viral meningitis
tx: Oral paracetamol
baby born at term suddenly collpased and severely dyspneic
no murmur hear on cardiac auscultation
dx?
Hypoplastic Left Heart
hypotonia, areflexia in all four limb feeing difficult, can’t control the head
Dx?
Spinal Muscular Atrophy
cough, fever, rhinitis and rash
complains of chest pain during cough
What is the diagnosis?
Viral Pneumonia
pain and drooling saliva
ingests washing detergent
complications?
Esophageal Stricture
pain and stiffness in her pelvic and shoulder girdle
complains of painful mastication
ESR 95mm
Dx?
Polymyalgia Rheumatica
(difference vs Statin induced myopathy - ESR om SIM is low)
3 organic causes of Panic Attack
Hyperthyroidism
Phaeochromocytoma
Hypoglycemia
“feels something wrong in his body
“Panic Attack
opacity with well defined round margin in the middle zone of the RIght Lung or “halo sign”
dx?
Aspergillus or the most common infection after renal transplant
excruiciating retrosternal chest pain that radiates to the back
pain as sharp and worsens with swallowing
Med hx significant for naorexia nervosa
inv?
Gastrograffin swallow
fasciculation and weakness in both arms with absent reflexes
Motor neuron disease
if CO2 is increasing and O2 is decreasing
mgt
CPAP
