Random review Q&A Flashcards
Ectopic pregnancy, clinical features-signs and symptoms- just list them out
- Absence of menses
- Irregular vaginal bleeding (spotting)
- Abdominal/shoulder tip pain
- Cervical motion tenderness
- Tachycardia and hypotension
- Palpable adnexal mass (50% of women)
- Absence of IUP on USS, with a positive β-hCG
Risk factors for ectopic pregnancy-5
Anatomic alteration of the fallopian tubes is the main cause of ectopic pregnancy. It may be due to:
A history of PID
Previous ectopic pregnancy
Past surgeries involving the fallopian tubes
Endometriosis
Exposure to DES (diethylstilbestrol) in utero
Bicornuate uterus
Non‑anatomical risk factors
Intrauterine device (IUD)
History of infertility
Hormone therapy
Signs and symptoms of ectopic
Patients usually present with signs and symptoms 4–6 weeks after their last menstrual period.
1) Lower abdominal pain and guarding
2) Vaginal bleeding
3) Signs of pregnancy: amenorrhea, nausea, breast tenderness, frequent urination
4) Tenderness in the area of the ectopic pregnancy
5) Cervical motion tenderness, closed cervix
6) Enlarged uterus
7) Interstitial pregnancies tend to present late, at 7–12 weeks of gestation, because of myometrial distensibility.
What are the 3 options for ectopic pregnancy
Expectant
Medical
Surgery
Indication for surgery
Procedure
Follow up after surgery
Haemodynamically unstable • Signs of rupture • Any β-hCG level • Persistent excessive bleeding • Heterotopic pregnancy
Laparoscopy method of choice
• Laparotomy if:
o Haemodynamically unstable
o Laparoscopy too difficult
• GP 14 days post-surgery • If salpingo(s)tomy, weekly β-hCG until negative • If salpingectomy, urinary β-hCG 3 weeks after surgery • USS if clinically indicated • Optimal conception interval unknown (0–3 months common)
Post-op care for ectopic
Give written information about: • Management option chosen • Expected bleeding/symptoms • Resumption of menstruation • Contraception • Follow-up arrangements
General care considerations • Review histopathology of POC • If indicated, recommend RhD-Ig • Analgesia as required • Communicate information to other care providers (e.g. GP) • Early USS (5–6 weeks) in next pregnancy
Indication for medical management of ectopic
Indications • Haemodynamically stable • No evidence of rupture • No signs of active bleeding • Normal FBC, ELFT
Indications
Uncomplicated ectopic pregnancies
Hemodynamic stability
β-hCG ≤ 5000 mlU/mL
No renal, hepatic, or hematologic diseases
No fetal heartbeat and ectopic mass size < 4 cm
Treatment of choice: methotrexate (MTX)
Peak Expiratory Flow(PEF)- things to do
why is it useful
how long
To perform a peak flow:
1) Stand up straight.
2) Make sure the indicator is at the bottom of the meter.
3) Take a deep breath, filling your lungs completely.
4) Place the mouthpiece in your mouth; lightly bite with your teeth, and close your lips on it.
5) Blast the air out as hard and as fast as possible in a single blow.
6) Record the number that appears on the meter.
7) Repeat these steps 3 times.
8) Record the highest of the 3 readings in an asthma diary. 9) This reading is your or your child’s peak flow.
10) Peak flow monitoring helps measure how much, and when, the airways are changing.
Each morning and evening, record the highest of three peak flows. Take a deep breath, seal your mouth tightly around the mouthpiece, then blow as hard
and as fast as you can. Check the number, re-set the pointer to zero, and repeat two more times.
To find your personal best peak flow, perform peak flows:
Twice a day for 2 weeks;
At the same time in the morning and in the early evening;
Before taking any inhalers, or as instructed by your caregiver.
https://my.clevelandclinic.org/health/articles/4298-peak-flow-meter
Surgery in ectopics
Hemodynamic instability, impending rupture
Risk factors for rupture
Contraindications for MTX treatment: e.g., renal insufficiency
If conservative treatment is unsuccessful
Laparoscopic removal
1) Salpingostomy (tube‑conserving operation)
Risk of persistent ectopic pregnancy
Patients with unruptured tubal pregnancy who do not meet the criteria for conservative treatment
2) Salpingectomy (not function-preserving)
Ruptured tube, heavy bleeding, large ectopic mass
If the patient does not desire future pregnancies → bilateral salpingectomy
PSYCHIATRIC FUNCTIONAL ENQUIRY: MOAPS
M: mood (depression vs euthymia vs mania)
O: organic/substance use, medical illness
A: anxiety (worries, compulsions, obsessions)
P: psychotic symptoms (hallucinations, delusions)
S: safety (risk of suicide: ideation, plan, means)
What is the DERMIS acronym? (definition of Borderline PD)
D: defence mechanisms(i.e. splitting, projecting anger onto all those around them)
E: ego strength lacking, can’t put off instant gratification
R: relationship difficulties
M: mood instability
I: impulsivity
S: ense of self disrupted, suicidality, self harm
Why is it that the negative symptoms are often the most disabling symptoms in the long term picture of schizophrenia?
These are not easily controlled, as anti-psychotic treat the +ve symptoms only.
When is clozapine contraindicated?-5
Previous cardiomyopathy Blood dyscrasias (any pathological condition of blood) Neutropenia Severe renal impairment Liver failure
How do you manage NMS?
- Stop any agents that are thought to be causing
- IV fluids (flush out the CK MM and prevent acute kidney injury)
- O2
- Dantrolene to relieve rigidity
- Anti-pyretics to cool down
…so just think of the symptoms, and how you would individually manage that
What are some differentials for serotonin syndrome?
Neuroleptic malignant syndrome
Substance abuse (cocaine/stimulants)
Infections (sepsis, meningitis)
Malignant hyperthermia
What benzodiazepines bypass the liver and therefore are safer to give without knowing liver function?
LOT
Lorazepam
Oxazepam
Temazepam
Imagine it these benzo are alot for the liver to handle so they bypass it
What is a major distinguishing clinical finding that you have in serotonin syndrome and not in neuroleptic malignant syndrome?
Hyper-reflexia - otherwise it is very similar.
What is the comparison of the therapeutic window of sodium valproate and lithium?
Sodium valproate has a wide therapeutic window - meaning that accidental overdose is uncommon
What diagnoses are important to exclude/consider in somebody presenting with symptoms of panic attack? (Particularly if it is a 1st presentation)
ARDS/pneumonia
PE
Asthma
Diabetic ketoacidosis (kussmaul breathing)
What is a common SSRI used in anxiety?
Escitalopram
What are examples of things that can bring about an adjustment disorder?
What other condition should you keep in mind with Adjustment disorder
Relationship breakdown/divorce
Becoming a parent
Leaving home
Screen for depression and suicide as well
What is the biggest risk with re-feeding syndrome?
Cardiac decompensation, metabolic increase not tolerated by the heart leading to tachycardia and oedema
What is the mechanism of action of EtOH?
Potentiates GABA-A transmission (depressant), increased dopamine in mesolimbic pathway (addictive component)
There are 4 stages of alcohol withdrawal, what are they?
1: ‘shakes’, sweating, cramps, diarrhoea, cramps
2: Seizures (<48 hours)
3. Hallucinations (at 48 hours)
4. DT’s, confusion, delusions, autonomic hyperactivity
When do you give benzos in alcohol withdrawal?
When there is symptomatic withdrawal - i.e. according to the CIWA score
Why is antibiotic therapy not recommended in children with bloody diarrhoea without fever?
If caused by EHEC can lead to haemolytic uremic syndrome
Avoid use of antibiotics and antimotility agents in suspected infection with enterohemorrhagic E. coli, as these agents may increase the likelihood of HUS.
Please discuss the mechanism of citalopram
An SSRI
Block SERT at presynaptic terminal to increase 5-HT at the synaptic cleft.
This increases post synpatic response to serotonin. However, by activating autoreceptors on the presynaptic cleft, it can lead to negative feedback, thus worsening the symptoms iniitally. However, these downregulate eventually, and the response improves.
Note this mechanism is the same for tolerance, except observed on the post synaptic membrane
Foetal and Maternal complications of GDM
Foetal:
Birth trauma (obstructed vaginal delivery) increased need for c-section Macrosomia, organomegaly, polycythaemia, jaundice Hyperinsulinaemia Shoulder dystocia Neonatal hypoglycaemia Increased need for premature delivery ARDS Increased need to c-section IUFD LONG-TERM impaired glucose tolerance, T2DM, obesity
Maternal Miscarriage Preeclampsia Infection Induction of labour Trauma C-section PPH Increased risk of T2DM + HTN Increased risk of hypoglycaemia
Types of rectal prolapse?
Type one and two. One is just the mucosa protruding past the external anal sphincter. This is more common in children. Two is complete, and involves the full thickness of the wall. and is broken up like this:
First degree: Prolapse includes the mucocutaneous junction.
2nd: Without involvement of the mucocutaneous junction
3rd: Prolapse is internal, concealed or occult. This is otherwise known as an internal intussusception.
What is Hartmann’s Pocuh
This is the junction of the neck of the gallbladder and the cystic duck. THis is where stones fall to be stuck.
Gallstones may lodge in it
What are some risk factors for gallstones you learnt today?
Terminal ileum dmaage, weight loss (learnt why: rapid weight loss leads to excess mobilisation of cholesterol and biliary stassis), TPN (due to impaired gallbladder emptying). I would also imagine dehydration is a risk factor. Remember oestrogen slows the transit of bile in the biliary system which is the pathogenesis of cholestasis in pregnancy.
The patient has a post operative fever,and pain in the RUQ after a cholecystectomy. What is the diagnosis unitl proven otherwise?
Bile duct injury
What is post cholecystectomy syndrome?
Sphincter of Oddi dysfunction. It’s a persistence or recurrence of pain after the cholecystectomy. Alternative explanations include post op adhesions.
Role of USS and CT in pancreatitis?
Role of US is to rule out gallstones, and is commonly used in the first episode of pancreatitis. CT is to assess any complications such as a pseudocyst and to measure the extent of the necrosis. CT best done around the 72 hour mark otherwise it’s known to underestimate the extent of the disease.
how do we divide the management of acute pancreatitis? Describe the steps involved?
→ Treatment with acute pancreatitis is directed four ways: general, local, complications and cause
- General
o Treat fluid loss
• If severe: careful fluid replacement with central venous pressure measurement may be necessary
• Monitor urine output: IDC
o Oxygen, Analgesia
o PPI
o AWS, thiamine
o NBM
o Nutrition- initially fast the patient, enteral nutrition has now been shown to prevent mucosal barrier breakdown and abscess formation → NG feeds if severe
- Local
o There is no specific treatment for the pancreatic inflammation
• Therefore treatment is directed at minimising the progression of the disease and preventing complications
o Antibiotics: imipenem
• Only if they have an infection, not just because they are febrile
• Prophylaxis not shown to be effective
o ERCP
• Early ERCP (<72 hours) versus conservative management extensively studies
• Benefit in cholangitis and obstructive jaundice but there has been conflicting evidence in the remainder of acute pancreatitis
o Laparoscopic cholecystectomy recommended during same admission for all groups
o Necrosectomy
• Indications
• Infected necrosis with septic complications
• Sterile necrosis with progressive deterioration
• Surgical intervention within first 2 weeks carries high mortality
- Complications
o Surgical intervention in pancreatitis is reserved for the treatment of complications and in gallstone pancreatitis for the treatment of the cause
o Severe pancreatitis with infected necrosis: Debriding necrosed tissue necessary
• As seen on a CT or the presence of organisms in tissue that as been aspirated from the pancreas following a percutaneous radiologically guided needle approach
o Pseudocysts: treated via percutaneous or endoscopic techniques or open surgery
o Abscess drainage → percutaneous or open
- Cause
o Gallstones: Cholecystectomy, ERCP
Blood supply of the thyroid gland
Superior thyroid artery is from the external cartoid, the inferior thyroid artery is from the subclavian artery.
Discuss the diabetes cycle of care. What is included in a primary care management plan for T2DM?
Look up guideline
GAD features in DSM?
1) Excessive worry or anixety for most days for more than 6 months which patient finds difficult to control
2) Needs three or more REMDIS features
Restlessness
Easy fatigue
Muscle tension
Difficulty concentrating/ distractibility
Irritability
Sleep disturbance
Causes significant impairment.
Not better explaned by another medical or psyche thin.
Describe refeeding syndrome?
Refeeding ysndrome is when we have a low phosphate level in the body. There is a low amount intracellularly, because a lot of this is shunted to the serum to bring the levels back up. However, when we give insulin, it cannot be compensated, and all the phosphate is driven intracellularly (we get an exacerbated insulin response with long term starvation). Thus, we get hypophosphataemia. Please note that we can also get hypokalaemia with this
Mechanism of SSRI’s
4 ways it works. It inihibits pre ysnaptic uptake of serotonin. And postsynaptic. First step.
2: Increases serotonin in the synaptic cleft. More serotonin to bind to post synaptic receptors.
3: increased binding at post synapse. this is the antidepressant effect. Pre synaptic receptors get downregulated.
4: Post synaptic receptors also become downregulated which is when side effects decrease.
What are some symptoms aside from cardiac and respiratory symptoms in congenital heart defects? Note remember that they can get a cardiac wheeze
Failure to thrive Poor feeding Developmental delay Diaphoresis Easily fatigued Poor exercise tolerance
You know the management of Kawasaki. Why do we delay the MMR vaccine by 3-6 months?
2% rate of recurrence is something I also need to remember.
We delay it because the immunoglobulins can reduce the effectiveness of the MMR vaccine.
What is Nokolsky sign? What other features are typical of SSSS
How do differentiate from TENS?
When you rub the skin it disintegrates.
They will be in a lot of pain, and they won’t like being in contact with Mum.
It starts as exudation and crusting, which progresses to wrinkling, bullae formation and the exfoliation.
TENS will have mucosal involvement (they have eye involvement). Also note SSSS does not scar because it’s only the epidermis.
Discuss the clinical features of HSP
Palpable purpura with arthritis, arthralgia, abdo pain and / or renal involvement (haematuria, proteinuria, HTN)
Pulmonary + neuro involvement are both rare but may be life threatening if present.
PAAR
HSP and abdominal pain
Remember the abdo pain is in intussuseption.
How would you manage the HSP
Depends if there is mild or moderate/ severe pain.
Mild: subcut oedema managed by bed rest + elevation of the affected area. Paracetamol and NSAID’s.
Mod/ severe: glucocorticoids reduce the duration of joint pain and abdo pain. No impact on long term kidneys.
If there is significant renal, pulmonary, neurological or abdo comp, refer to paeds and consider admission.
Follow up is referral to the GP or paediatrician to identify subsequent renal involvement, monitoring for HTN, proteinuria or macroscopic haematuria.
In symptoms/sign is seen in delirium tremens, however not see in the minor, major and seizure stages of alcohol withdrawal
FEVER
Down syndrome causes in the chromosomal, what are 2 processes in the chromosome
1) Non-disjunction-90%
2) Balanced Robertsonian translocation
scaphoid abdomen and respiratory distress in an infant
Congenital diaphragmatic hernia
What are the other names for erythema infectiousum
Fifth disease/parvovirus/slapped cheek syndrome
What Ix is the most important test for urinary incontinence
Post-voidal residual volume(PVRV)–> normally after peeing 50ml of urine is left in the bladder
Urge incontinence- what is the drug
Oxybutynin- anticholinergic
Helps to calm the overactive bladder- detrusor muscle overactivity
Overflow incontinence
-what happens
Urinary retention
Need a catheter
PVRV- high
Men–> due to BPH
The child presents with bloody diarrhea + NO FEVER
parents say he ate some funny
Diagnosis?
- what should you avoid
- what do you see on the blood film
HUS
Abx should be avoided in HUS
treatment is IV fluids, conservative management
RBC transfusion if needed
Dialysis if renal failure
On blood film, you will see schistocytes due to the Shiga toxins effects
PID think?
Ectopic
Do a beta-hCG as well
Needle decompression of pneumothorax- a landmark for insertion
2nd intercoastal space, midclavicular line
SAH- what kind of CT would you do
NON-contrast
Blood appears white
Contrast appears white
So do a NON-CONTRAST
SAH are given CCB why?
Vasospasm of the blood vessels
Acute pancreatitis criteria
Ranson’s criteria
Treatment-
IV fluid, NBM and morphine
Low-fat diet after getting well
The renal stone best test?
-which drug can be given
CT scan
NOT X-RAY
Thiazide diuretic can help- reabsorption of calcium in the urine
What happens to the estrogen and FSH during ovarian failure
Can because of amenorrhea
and seen in MENOPAUSE
FSH is increased due to the negative feedback mechanisms
Typical facial features of Down’s
1) upward slanting palpebral fissures, epicanthus
2) small oral cavity with a large tongue: protruding
3) a flattened nose
5 A’s of Down syndrome
Advanced maternal age, duodenal Atresia, Atrioventricular septal defect, AML/ALL, Alzheimer disease
Complications of giant cell arteritis
1) Blindness
2) Aortic dissection
3) Aortic aneurysms
Complications of giant cell arteritis
1) Blindness
2) Aortic dissection
3) Aortic aneurysms
Permanent vision loss: ∼ 20–30% if giant cell arteritis is left untreated
Cerebral ischemia (e.g., transient ischemic attack and stroke): < 2% of cases
Aortic aneurysm and/or dissection: ∼ 10–20% of patients
Acute complication of pancreatitis
ARDS
What is the difference between cardioversion and defibrillation?
Cardioversion: energy delivered synchronized to QRS complex that minimizes likelihood of shock occurring during repolarization
*** DO NOT do in Vfib
vs
Defibrillation: unsychronized: random in cycle shock
- indicated in Vfib
Beck’s triad
HYPOtension
Distended neck veins
muffled heart sounds
Bacteria causes of endocarditis
- valves/ catheters/ implanted devices
- drug users
- dental work
- nosocomial UTIs
- Colon carcinoma, inflammatory bowel
- Staph Aureus: implanted devices/ valves + IV DRUG USE
- Viridans strep: dental work, respiratory tract incision/ biopsy
- Epidermis: same as aureus but no IVD
- Enterococci: nosocomial UTI
- Strep gallolyticus/ bovis= GI
- Fungi: immunocompromised, catheters, prolonged AB
What mood stabilizer can cause pancreatitis
Sodium valproate
+ pain with straight leg raise
herniated disc
What is the most common lung cancer in patients exposed to asbestos?
Bronchogenic adenocarcinoma
Dumping syndrome
Late complication of gastric bypass surgery
- rapid onset OSMOTIC diarrhea after ingestion of carb-heavy meals
- hx of travel/ immunosuppression
What is a common sequelae of gastrectomy?
B12 deficiency: due to IF deficiency
- shiny tongue, pale palmar crease
- impaired DNA synthesis
- due to increased immature megaloblasts produced–> jaundice, increased LDH, increased unconjugated billi
What is a common sequela of gastrectomy?
B12 deficiency: due to IF deficiency
- shiny tongue, pale palmar crease
- impaired DNA synthesis
- due to increased immature megaloblasts produced–> jaundice, increased LDH, increased unconjugated billi
Which glaucoma is an emergency
Acute angle
Schilling test for vitamin b12 deficiency
If there is IF factor deficiency
Remember what vitamin deficiency is highly associated with fat malabsorption
Vitamin K deficiency
KADE
Why is vitamin k deficiency dangerous is neonates
Vitamin K deficiency–> haemorrhagic disease of the newborn
Why is vitamin k deficiency dangerous is neonates
Vitamin K deficiency–> haemorrhagic disease of the newborn
Hence we give Vitamin K needles
Breast milk is deficient in vitamin K
Beta 1 and beta 2 receptors are located in
1- heart( 1 heart)
2- lungs(2 lungs)
Acute pyelonephritis eTG treatment(mild)
For empirical therapy of nonsevere pyelonephritis in adults while awaiting the results of investigations, use:
amoxicillin+clavulanate
For adults with penicillin hypersensitivity, use: ciprofloxacin
CVD claudication relief- which drug
Cilostazol is an antiplatelet drug and a vasodilator.
Antiplalete drugs are given as well- aspirin and clopidogrel
Alzheimer’s disease is widely recognized by the 5 A’s which include
Amnesia, Anomia, Apraxia, Agnosia, and Aphasia.
Anomia is the inability to remember names of everyday objects.
Agnosia is characterized as the inability to recognize a familiar object, tastes, sounds, and other sensations.
Apraxia causes patients with this disorder to have difficulty with skilled movements and/or speech.
COPD can have what on FBC
Hct increase, PCV due to increase EPO production
Pernicious anemia
- what are the two antibodies
- Associated with autoimmune
- Increase the risk of ______ cancer
Antiparietal cell antibodies: target gastric parietal cells
Causes ↓ acid production and atrophic gastritis
↓ Intrinsic factor production → ↓ vitamin B12 absorption in terminal ileum
Anti-IF antibodies: bind intrinsic factor and block the vitamin B12 binding site
Associated with other autoimmune diseases (e.g., hypothyroidism, vitiligo)
Increases the risk of gastric cancer
Always consider vitamin_______ deficiency when evaluating patients with dementia!
B12
The triad of clinical findings occurring in HUS consists of
1 ) Low platelets (i.e., thrombocytopenia)
Petechiae, purpura
Mucosal bleeding
Prolonged bleeding after minor cuts
2) Microangiopathic hemolytic anemia
Fatigue, dyspnea, and pallor
Jaundice
3) Impaired renal function
Hematuria, proteinuria
Oliguria, anuria
In which condition is ESR important(Dr. Poorinima) said this
Temporal arteritis
2 types of stroke
1) Brain ischemia- nearly 70%- local thrombosis or embolization
2) Haemorrhage- ICH and SAH
Make sure you ask in any OSCE to ask about the history about both–> subarachnoid features
Most common cause of ICH and SAH
Hypertension
What are some history question/clinical evaluation of a stroke
Sudden development of focal neurological sign/symptom
FAST( face, arms and speech and Time is brain)
Usually U/L arm, leg weakness, or U/L Sensory symptoms
Decrease vision in one eye (esp. amaurosis fugax)
Sudden confusion, difficulty in understanding or speech
Sudden problem with coordination, walking, dizziness
Sudden onset of headache-Thunderclap headache
HISTORY TAKING- MIMICS OF TIAs/STROKES-5
Migraines with aura Seizures-Todd’s Palsy Hypoglycemia/HHS as well( MAKE SURE TO DO BSL--> can definitely mimic hypoglycemia) Syncope TGA Demyelination-MS Conversion disorder
TIA risk assessment - score is what?
why should we do this score?
ABCD2 score
Estimates the risk of stroke after a suspected transient ischemic attack (TIA).
Age- >60 BP-140/90 Clinical features of the TIA Duration-< 10 min, 10-60, 60+ Diabetes
Post-herpetic neuralgia
They have allodynia and hyper-analgesia
Gabapentin
Amitriptyline(TCA)
OSCE about stroke, what will you say
-outline the management pathway
Follow the stroke pathway in the hospital
TIME IS BRAIN
Assess immediately if eligible for reperfusion
Time of onset/last seen well
Imp- Time window for IV thrombolysis- 4.5hrs
Urgent CT head –
1. To rule out bleed
2. Well-formed infarct
Time window period for IV thrombolysis is
4.5 hours
Whats the agent for IV THROMBOLYSIS
Agent- tPA (Recombinant Tissue Plasminogen activator/alteplase)
Contraindications for IV thrombolysis/TPA-there is a alot, tell me 5
5 to remember-
1) active bleeding diathesis at the time
2) recent surgery(2 weeks)
3) severe uncontrolled HTN( can use anti-HTN)
4) ICH, SAH
5) Current anticoagulant use with an INR >1.7
ICH,SAH
Presence of well formed infarct
Recent (within 3months) intracranial or intraspinal surgery or serious head trauma;
Presence of intracranial conditions that may increase the risk of bleeding (eg, AVM, Tumors,
Aneurysm)
Known bleeding diathesis
Severe uncontrolled hypertension
Active internal bleeding
Infective endocarditis
Stroke known or suspected to be associated with aortic arch dissection
Major surgery within 2weeks
GI or urinary tract hemorrhage within 3weeks
Glucose level <50 or >400mg/dL
Platelet count <100,000/mm3
Current anticoagulant use with an INR >1.7
Therapeutic doses of LMWH received within 24hours
Current use of a NOACs with evidence of anticoagulant effect by laboratory tests
such as aPTT, INR, ECT, TT, or appropriate factor Xa activity assay
People with _______ should have their swallowing screened within 4hours of arrival at the hospital and before being given any oral food, fluid or medication
People with acute stroke should have their swallowing screened within 4hours of
arrival at hospital and before being given any oral food, fluid or medication
DVT prophylaxis with a stroke patient who are immobile?
In immobile stroke patients, intermittent pneumatic compression (IPC) is recommended over routine care to reduce the risk of DVT.
Pulsus parodoxus
= fall in systemic arterial pressure by >10 during inspiration
can be seen in ACCC- 4 which are
Asthma
COPD
Croup
Cardiac tamponade
Idiopathic intracranial HTN
- who gets it
- clinical features
- what can be seen on neuro exam
- what is the single drug can be given to cure it
overweight women of childbearing age
Sx: headache, transient vision loss, pulsatile tinnitus, diplopia
PE: Papilledema, peripheral visual field defect, CN 6 palsy
Diagnosis: MRI +/_ MRV
*** LP with high opening pressure
TX: stop offending meds, weight loss
+ acetazolamide
2 medications that can trigger asthma
1) Aspirin
2) Non-selective beta blockers
Treatment of choice for PBC
UDS
Parietal lobe hemorrhage in setting of Alzheimer’s
Cerebral amyloid angiopathy(CAA)- mentioned in stroke lecture
- # 1 cause of spontaneous lobar hemorrhage in >60 yo
- beta amyloid deposition (associated with Alzheimers)
which disease do you see chondrocalcinosis in?
Hemochromatosis
Pseudogout
treatment of Idiopathic intracranial hypertension(IIH)
Acetazolamide
- inhibits choroid plexus carbonic anhydrase
What is the main side effect of antithyroid drugs?
Agranulocytosis
Methimazole: 1st trimester teratogen
PTU: hepatic failure, ANCA vasculitis
Nerve root compression by herniated disc
- guy moving heavy boxes, feels a pop
- straight leg raise
Lumbosacral radiculopathy (sciatica)
Tx: NSAIDs
Nerve root compression by herniated disc
- guy moving heavy boxes, feels a pop
- straight leg raise
diagnosis and treatment
Lumbosacral radiculopathy (sciatica)
Tx: NSAIDs
Guillan Barre Syndrome treatment
IVIG
UMN/ pyramidal/ horticospinal tract disease
pronator drift u-world
4 T’s score of HITT
Thrombocytopenia
Timing of platelet count fall
Thrombosis or other sequence
Other cause of thrombocytopenia
Menier’s disease triad-SVT
Sensorineural hearing loss
Vertigo
Tinnitus
Kernig’s sign
Patient is supine
Hip is flexed
Knee cannot be extended
Brudzinski sign
Neck rigidity sign
When the neck is flexed
automatically the knees and thighs are brought together
Treatment for glaucoma
Damage to the optic nerve
Intraocular pressure–> do an ocular tonometry
1) Timolol( beta-blocker eye drops)
2) Pilocarpine
3) Mannitol–> osmotic diuretic
Neurological symptoms of vitamin b12 deficiency
1) weakness of extremities
2) Positional and vibrating sensations
3) Gait ataxia
–> all these three will result in subacute combined degeneration of the spinal cord
Polycystic kidney disease + bleeding in the brain think
Rupture of cerebral(berry) aneurysms cause it can cause SAH
- 3 most common causative organisms of sore throat in adult male
- 4 other organisms you would consider
a. Group A streptococcus
b. Streptococcus pneumoniae
c. Fusobacterium necrophorum
a. Syphilis
b. HIV
c. Chlamydia/gonorrhoea
d. Mycoplasma tuberculosis and M. avium complex
e. A long list of weird and wonderful names
4 must rule out condition in a child who is unwell
1) UTI
2) GERD
3) otitis media
4) Meningitis
5) Raised ICP
Why vomiting in lithium?
Uremic symptoms–> vomiting
Pink frothy sputum like cough
Pulmonary edema–> probably due to cardiogenic(L sided heart failure)
Most common cause of nephrotic syndrome in children
Idiopathic nephrotic syndrome
How long after C-section is VBAC indicated
18 months
SSSS treatment- everything
IV antibiotics
Penicillinase-resistant penicillins are the drug of choice: nafcillin, oxacillin
In areas with high community-acquired MRSA prevalence (or in patients who do not respond to treatment): vancomycin
Supportive care
Fluid rehydration as indicated
Supportive skincare: emollients, covering denuded areas
NSAIDs as indicated for pain and fever
Fat kid with joint problems get
SUFE
The person with celiacs what do they need to be screened for
Osteoporosis
Cullen’s and Grey Turner’s sign pathophysiology
Cullen’s – pancreatic enzymes tracked along falciform ligament and digested subcut tissues around umbilicus
Grey Turners – subcut tracking of inflammatory, peripancreatic exudate from pancreatic area of retroperitoneum.
4 reasons for Cullen’s sign and grey turner’s sign
1) Ruptured AAA
2) acute pancreatitis
3) ruptured ectopic
4) bleeding from blunt abdominal trauma
Why do you get ascites with pancreatitis?
Pancreatic ascites occurs when pancreatic secretions collect in the peritoneum as a result of a pancreatic duct injury
Best time to operate when pregnant
2nd trimester if needed
like if there is cholecystitis
Umbilical hernia
Most children with an umbilical hernia require no intervention. As the baby is only 3 weeks old,
may expect to initially increase in size (does for the first few months) but & >90% close by 2 years.
Manually reduce
Can have surgery & >2 due to cosmetic reasons, also note increased incarceration risk as adult.
4 causes of undescended testes
1) Idiopathic/unknown cause
2) Premature baby
3) Hormonal
4) environmental–> smoking and drug exposure
Phimosis
- cause
- treatment
Balanitis – inflammation of the glans penis
–> Other
o Scar tissue in distal foreskin – preventing retraction (trying to forcibly retract)
o Congenital
Topical steroid creams 0.05% betamethasone cream used twice daily for 2-4 weeeks
o Gently retract foreskin without causing discomfort – apply thick layer
Soaking in warm bath – slowly retract
Surgical
o Circumcision
o Dorsal slit
*6 signs of SOL on examination- girl who is complaining of headaches
Aunty has brain tumor
Ophthalmoscope – papilledema Myosis – fixed dilated pupil Nystagmus Meningism Nuchal rigidity Weakness/changes in sensation
4 key features of heart failure you would ask parents about
Failure to thrive
Short and frequent feeds
Diaphoresis
Increased respiratory effort
4 features of heart failure in children
Vital signs Dysmorphic features Heart sounds--> S3/S4 hepatomegaly Odema Femoral pulses
Myelomeningocele- what formation
HAS
which protein can be increased prenatal
Hydrocephalus
Arnold Chiari II malformation–> cerebellum tonsillation through the foramen magnum
Scoliosis
Celiac disease causes what kind of anaemia
Celiac disease can cause damage to the small intestine with iron, folate, and vitamin b12 are absorbed
What supplements should be given for celiac disease
Gluten free diet
Folate and vitamin b12 supplements
iron
vitamin D and calcium as well
Celiac disease can cause damage to the small intestine with iron, folate, and vitamin b12 are absorbed
3 types of therapies in lung cancer
Immunotherapy
Targeted therapy
Chemotherapy
Aromatase inhibitor- the biggest side effect
Bone mineral density decrease
What are the side effect of immunotherapy(lung cancer)
- what is the treatment
- what is the 2 biggest side effects we are worried about
High dose steroid or Infliximab
Colitis
Thyroid
- CD10 phenotype
- Auer rods
- Philadelphia Chromosome
ALL
AML
CML
Conn’s sydrome-what do you get
2/3 caused by aldosterone secreting adenoma. Hypertensive with low potassium
GPMP and TCA
GP management plan- gives you 5 visit
review the GPMP in 6 months
What is the MHTP
Mental health treatment plan
10 individual sessions
after 6 reviews with GP and then you get the next 4
Macrovascular complication- ABC
microvascular complications
A- HbA1C
B-BP- 130/80
C- cholesterol
CVD, PVD and stroke-macro
Mirco–> eyes, kidney and feet
Diabetic distress questionnaire is called what?
PAID tool or DDS2
diabetes distress screening scale
What are the components of MMSE-
ORAL-CR
Orientation Registration Attention Language Calculation Recall
Less than 24 is concerning
Less than 12- SEVERE dementia
Digoxin MoA
-how does help in Atrial fibrillation
Digoxin binds to and inhibits the sodium/potassium-ATPase (sodium pump) within the plasma membrane of cardiac myocytes. This inhibition increases the intracellular sodium content which in turn increases the intracellular calcium content which leads to increased cardiac contractility–> IONOTROPE
AF–> increase vagal stimulation–> decrease in SA and AV node conduction–> helps in AF
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