Recalls April 2024 Flashcards
Gastric Cancer and Weight Loss
Gastric cancer is a significant cause of unexplained weight loss in patients, attributed to reduced intake (anorexia, early satiety) and metabolic changes from malignancy.
Down Syndrome
Connected to what brain disease?
Individuals with Down syndrome have an increased risk of Alzheimer’s disease, often developing amyloid plaques and tau tangles by age 40.
Overweight Management: Diet and Exercise
Initial management involves lifestyle changes focusing on caloric intake and physical activity, with structured exercise programs if dietary changes are insufficient.
Vestibular Neuritis: Overview
Vestibular neuritis presents as sudden, severe vertigo without hearing loss, managed with corticosteroids and vestibular rehabilitation therapy.
Benign Paroxysmal Positional Vertigo (BPPV): Positional Preferences
Patients with BPPV avoid quick changes in head position due to vertigo episodes triggered by positional changes.
Transient Synovitis: Initial Workup
Best initial test is Erythrocyte Sedimentation Rate (ESR) to detect inflammation, with joint aspiration if septic arthritis is suspected.
Thyroglossal Cyst: Initial Investigations
Begin with Thyroid Stimulating Hormone (TSH) levels followed by ultrasound for confirmation of the cyst’s characteristics.
Salmonella (non-Typhoidal): Diagnosis and Treatment
Diagnosis involves stool/blood cultures, treated with Ciprofloxacin or Azithromycin.
Cardiac Tamponade vs. Tension Pneumothorax: Differentiation
Cardiac tamponade presents with low BP, muffled heart sounds, and distended neck veins, treated with needle pericardiocentesis. Tension pneumothorax lacks distended neck veins and is managed with needle decompression and chest tube insertion.
Physiologic Jaundice in Neonates: Management
Typically self-limiting, managed with observation and phototherapy if severe, attributed to increased bilirubin from immature liver function.
Osteoporosis Management: Low Trauma Fracture
Begin with DEXA scan to assess bone density, then consider bisphosphonates, calcium, and vitamin D supplements.
Diabetes Screening: Testing Methods
Includes Fasting Blood Glucose (FBG), HbA1c, and Oral Glucose Tolerance Test (OGTT) for confirming diagnoses.
Kallmann Syndrome: Characteristics
Characterized by delayed puberty and anosmia, managed with hormone replacement therapy.
Huntington’s Disease: Clinical Features
Includes behavioral changes, chorea, and cognitive decline, diagnosed via genetic testing for CAG repeat on chromosome 4.
Hydatid Cyst: Cause and Treatment
Caused by Echinococcus granulosus, treated with PAIR (Puncture, Aspiration, Injection, Respiration) procedure and albendazole.
Bartholin Cyst and Abscess
Management includes warm saline for cysts ≤ 2 cm, while abscesses > 3 cm require incision and drainage, possibly with marsupialization or Word catheter.
Insomnia and Depression in 18-Year-Old
Initial management involves lifestyle modifications to improve sleep hygiene and mood stability before considering pharmacotherapy.
Sertraline and Tramadol Interaction
Cease tramadol due to potential serotonin syndrome when combined with high-dose sertraline.
Post-Appendectomy Wound Infection
Signs of erythema, increased pain, and fever post-appendectomy indicate probable wound infection requiring intravenous antibiotics.
Complications Post-Perforated Appendectomy
Consider intra-abdominal abscess in a patient presenting with fever and generalized abdominal discomfort on day 5 post-surgery.
Social Interaction Scenario
Scenario: In a hospital ward, a patient accuses another patient of a different ethnicity of causing discomfort due to prejudice.
Action:
Action: Tell the patient he cannot blame others based on discriminatory beliefs.
Reason: Addressing discriminatory behavior is essential to uphold patient dignity and ensure respectful healthcare interactions.
Parkinson’s Disease with Sigmoid Volvulus
Management:
Next Step: Perform a contrast-enhanced abdominal CT scan.
Reason: To rule out pseudo-obstruction, which may present similarly to sigmoid volvulus in a patient with Parkinson’s disease.
Schizophrenia Patient on Clozapine
Measure clozapine levels to assess therapeutic drug levels and guide further management in a patient presenting with persistent hallucinations.
Menopausal Hormone Therapy (MHT)
Menopausal Hormone Therapy (MHT)
Scenario: A 65-year-old woman who has been on MHT for 15 years is considering discontinuation but experiences severe hot flushes upon attempting to stop.
Management:
Next Step: Continue MHT for another few years.
Reason: Severe hot flushes upon discontinuation suggest ongoing benefit from MHT, balancing risks and benefits for the patient’s comfort and health.
Asymptomatic Bacteriuria Treatment
Treatment is indicated in specific scenarios such as pregnancy, vesicoureteral reflux (VUR), or pyelonephritis; otherwise, observation is often recommended.
COVID-19 Rash Diagnosis
Use COVID-19 PCR test to confirm active infection causing rashes, as CRP test assesses inflammatory rate but is not specific for COVID-19 diagnosis.
Multisystem Inflammatory Syndrome in Children (MIS-C)
Occurs post-COVID-19 due to an overreaction of the immune system, presenting with rashes and systemic inflammation.
Vitamin D Deficiency
Cholecalciferol (vitamin D3) supplementation is used to correct low levels, particularly in individuals with limited sun exposure.
Thyroid Cyst
Smooth, fluctuant mass in the neck that moves with swallowing; managed with observation or aspiration if symptomatic.
Dominant Nodule in Multinodular Goiter
Discrete, firm thyroid mass that may or may not move with swallowing; managed with observation or biopsy if suspicious.
True Solitary Nodule (Thyroid Adenoma)
Painless or minimally painful thyroid mass that may have compressive symptoms; managed with observation or biopsy if symptomatic.
Thyroid Cancer
Rapidly growing, firm thyroid nodule with potential fixation to surrounding structures; managed with surgery, radioactive iodine therapy, or hormone therapy.
Hashimoto Thyroiditis
Symmetrical goiter with autoimmune history; managed with thyroid hormone replacement therapy.
Lymph Node Enlargement
Discrete, mobile, possibly tender mass in the neck associated with recent infections; managed with investigation and treatment of underlying infection or observation.
Salmonella (non-Typhoidal)
Faecal-oral transmission causing acute diarrhea, nausea, vomiting, abdominal pain; managed with culture stool/blood and treated with Ciprofloxacin or Azithromycin.
Shigella
Traveler’s diarrhea pathogen causing severe diarrhea with blood; managed with Ciprofloxacin or Azithromycin for severe cases. 2-3 days
E. coli (Traveler’s Diarrhea)
Ingestion of contaminated food/water causing watery diarrhea with blood, fever, cramps; managed with fluid, rest, and Ciprofloxacin for severe cases
no organanomegaly 3-5 days - Bali Bali Belly.
Campylobacter jejuni
Transmitted via raw/undercooked meat or contact with farm animals, causing traveler’s diarrhea; managed conservatively, Ciprofloxacin for severe cases. 2-5 days
Fever in BPH after Catheterization
Initiate antibiotics due to high risk of urinary tract infection post-catheterization.
Impetigo with Fever
Manage with Cephalexin to treat the bacterial skin infection exacerbated by fever.
Large VSD in Infants
Fatigue after feeding without cyanosis due to large shunt; no murmur usually present.
DIC (Disseminated Intravascular Coagulation)
Fever, low platelets, prolonged bleeding time, prolonged PTT, and presence of schistocytes indicate DIC.
ITP (Immune Thrombocytopenic Purpura)
No fever, low platelets, prolonged bleeding time, normal PTT, and absence of schistocytes indicate ITP. NORMAL ptt means no problem with clotting cascade
TTP (Thrombotic Thrombocytopenic Purpura)
Fever, low platelets, prolonged bleeding time, normal PTT, and presence of schistocytes indicate TTP.
HUS (Hemolytic Uremic Syndrome)
No fever, low platelets, prolonged bleeding time, normal PTT, and presence of schistocytes indicate HUS.
Physiologic Jaundice in Newborns
Occurs days 3-5, indirect bilirubin, peaks ~9 mg/dL, resolves after day 5; monitor and observe unless severe.
Breast Milk Jaundice in Newborns
Occurs around 2 weeks, indirect bilirubin, continues breastfeeding, monitor and observe unless severe.
Zoledronic Acid in Osteoporosis
Used when bisphosphonates are contraindicated in the management of osteoporosis.e.g peptic ulcer
Tamoxifen vs. Raloxifene in Osteoporosis
Tamoxifen preferred for breast cancer with osteoporosis treatment.
Testing for Diabetes
Fasting Blood Glucose (FBG) and HbA1c are used to determine likelihood of diabetes, with OGTT for confirmation if needed.
Kallmann Syndrome
Characterized by delayed puberty, anosmia, and hormone replacement therapy for management.
Huntington’s Disease
Autosomal dominant inheritance with CAG repeat on chromosome 4, presenting with behavioral changes, chorea, and cognitive decline.
Hydatid Cyst (Echinococcus granulosus)
Caused by Echinococcus granulosus; managed with PAIR (Puncture, Aspiration, Injection, Respiration) and albendazole.
Cardiac Tamponade vs. Tension Pneumothorax
Differentiated by physical examination findings such as low BP, muffled heart sounds, and distended neck veins vs. absent breath sounds and flat neck veins.
Diabetes Screening Guidelines
FBG < 5.5 mmol/L unlikely for diabetes, 5.5-6.9 mmol/L possible, ≥ 7.0 mmol/L likely; HbA1c < 6.0% unlikely, 6.0-6.4% high risk, ≥ 6.5% likely; OGTT for confirmation.
Post-Appendectomy Complications
Consider intra-abdominal abscess in patients presenting with fever post-surgery.
