Reviewing Flashcards

Question

OSTEOPENIA CRITERIA FOR TREATMENT

Answer 1

T score between -1 and -2.5 without minimal trauma fracture Treat with calcium and Vitamin D supplementation and lifestyle modifications:  1200- 1500 mg/day of calcium  800- 2000 IU/day of Vitamin D

Answer 2

 Any man or woman with spine or hip fractures after minimal trauma even if the T score is more than -2.5. Treatment may be initiated without confirmation of low bone mineral density.  No fracture but score < or equal to -2.5 if risk factors are present  Osteoporosis due to secondary causes  Treatment with medications has to be started along with Calcium and Vitamin D supplementation  1200- 1500 mg/day of calcium  800- 2000 IU/day of Vitamin D Notes: Medications increase bone density in the hip approximately by 1-3% and in the spine by 4-8% over 3-4 years

Answer 3

1. Bisphosphonates - Alendronate - Risedronate - Zoledronic Acid 2. Denosumab 3. Strontium ranelate 4. Raloxifene 5. MHT

Answer 4

* Decrease bone loss and increase mineral density. * Measure Vit D and RFT before starting the treatment. * Useful for vertebral & non-vertebral fractures. * Contraindicated in pregnancy because it's teratogenic. * Side Effects: GI discomfort, oesophagitis, and jaw necrosis

Answer 5

- Alendronate - weekly dose - Risedronate - daily/weekly/monthly For 5 to 10 years in postmenopausal women.

Answer 6

Annual infusion for a maximum of 3 years. Used if patients have Oesophagitis. Vitamin D levels should be corrected to 50nmol/L before starting the treatment.

Answer 7

* Monoclonal antibody against osteoclast. * Given as 6 monthly injections subcutaneously for 36 months. * No gastrointestinal side effects. * But increases hypocalcemia.

Answer 8

Given orally 2 grams/day. Should not be given with calcium supplements. Reserved for severe osteoporosis because can cause MI * Contraindications: - DVT - Prolonged immobilisation

Answer 9

* Selective estrogen receptor modulator * Oestrogen-like effect on bone but antagonistic for uterus and breast. * Can be considered as **second-line** treatment for postmenopausal women with osteoporosis at risk of breast cancer. * Reduces risk of vertebral fractures.

Answer 10

In peri or postmenopausal women with osteoporosis associated with other menopausal symptoms

Answer 11

Teriparatide: * Is a recombinant parathyroid hormone. * Stimulates bone-forming cells. * Only if other treatments fail. * Given as daily injections subcutaneously for 18 months. INDICATIONS: > 1 symptomatic new fracture after 12 months of biphosphonate or if T score is ≤-3

Answer 12

All people above 50 years on corticosteroid therapy of 7.5 mg/day for at least 3 months with a T score of -1.5 or less have to be given bisphosphonates for the duration of therapy. * First-line: Alendronate and risedronate with adjuvant Calcium and Vit D. * Second-line: Zoledronic acid.

Answer 13

Raloxifene or Denosumab.

Answer 14

Repeat DEXA in 2 years. Every year if medication is changed, termination of the treatment or high-risk patient.

Answer 15

Repeat DEXA every 2 - 5 years

Answer 16

Normal: 110-160 bpm Fetal tachycardia: > 160 bpm Fetal bradycardia: < 110 bpm. Severe prolonged: < 80 bpm for more than 3 minutes (severe hypoxia)

Answer 17

1. Fetal hypoxia 2. Chorioamnionitis 3. Hyperthyroidism 4. Fetal or maternal anaemia 5. Fetal tachyarrhythmia

Answer 18

100-120 bpm: 1. Postdate gestation 2. Occiput posterior or transverse presentations Severe prolonged: 1. Prolonged cord compression 2. Cord prolapse 3. Epidural and spinal anesthesia 4. Maternal seizures 5. Rapid fetal descent

Answer 19

Normal: 5-25 bpm (Reassuring) Non-reassuring: Less than 5 bpm for 50 min More than 25 bpm for 25 min Abnormal: Less than 5 bpm for more than 50 min More than 25 bpm for more than 25 m Sinusoidal

Answer 20

1. **Fetal sleeping**: this should last no longer than 40 minutes (this is the most common cause) 2. **Fetal acidosis** (due to hypoxia): more likely if **late decelerations** are also present **Fetal tachycardia** 3. **Drugs**: opiates, benzodiazepines, methyldopa and magnesium sulphate 4. Prematurity: variability is reduced at earlier gestation (**<28 weeks**) 5. **Congenital heart abnormalities**

Answer 21

Accelerations are an abrupt **increase** in the baseline fetal heart rate of **greater than 15 bpm for greater than 15 seconds** The presence of accelerations is **reassuring** Accelerations occurring alongside uterine contractions is a sign of a healthy fetus.

Answer 22

Abrupt **decrease** in the baseline fetal heart rate of **greater than 15 bpm** for **greater than 15 seconds.**

Answer 23

Start when the uterine contraction begins and recover when uterine contraction stops. Physiological due to increased fetal intracranial pressure

Answer 24

Rapid fall in baseline fetal heart rate with a variable recovery phase. Variable in their duration and may not have any relationship to uterine contractions.

Answer 25

1. Reduced amniotic fluid volume 2. Umbilical cord compression

Answer 26

Accelerations before and after a variable deceleration. Indicates the fetus is not yet hypoxic and is adapting to the reduced blood flow. Without the shoulders, suggests the fetus is becoming hypoxic

Answer 27

Variable decelerations can sometimes resolve if the **mother changes position** The presence of persistent variable decelerations indicates the need for close monitoring.

Answer 28

Begin at the peak of uterine contraction and recover after the contraction ends. Indicates: Insufficient blood flow through the uterus and placenta (Danger of fetal hypoxia and acidosis).

Answer 29

o Maternal hypotension o Pre-eclampsia o Uterine hyper-stimulation

Answer 30

The presence of late decelerations is taken seriously and foetal blood sampling for pH is indicated. If foetal blood pH is acidotic it indicates significant foetal hypoxia and the need for emergency C-section.

Answer 31

A deceleration that lasts more than 2 minutes. If it lasts between 2-3 minutes it is classed as **non-reassuring** If it lasts **longer than 3 minutes** it is immediately classed as **abnormal** Action must be taken quickly: Fetal blood sampling or emergency C-section

Answer 32

Variable decelerations with any concerning characteristics in over 50% of contractions for 30 minutes (or less if any maternal or fetal clinical risk factors). Late decelerations for 30 minutes (or less if any maternal or fetal clinical risk factors). Acute bradycardia, or a single prolonged deceleration lasting 3 minutes or more.

Answer 33

This type of pattern is rare, however if present it is very serious. It is associated with high rates of foetal morbidity & mortality It is described as: o A smooth, regular, wave-like pattern o Frequency of around 2-5 cycles a minute o Stable baseline rate around 120-160 bpm o No beat to beat variability

Answer 34

o Severe foetal hypoxia o Severe foetal anaemia o Foetal/maternal haemorrhage Immediate C-section is indicated

Answer 35

FBG: - If ≥7: DM - If 5.5-6.9 ---->OGTT OGTT - If ≥ 11.1: DM - If 7.8-11Retest in a year - if ≤7.7: Retest in 3 years HbA1c: - If ≥6.5: DM - If 6-6.4: retest in 1 year - If ≤5.9 retest in 3 years

Answer 36

People with known impaired fasting glucose/glucose tolerance (‘prediabetes’) Age >40 years >30 years: family history (first-degree relative with T2D), obesity (BMI >30), high-prevalence ethnic groups Age >18 years in Aboriginal and Torres Strait Islander people Previous gestational diabetes People on long-term steroids or antipsychotics Polycystic ovarian syndrome, especially if overweight Previous cardiovascular event The optimal frequency is every 3 years from age 40 years using AUSDRISK If the score is ≥12, do fasting blood glucose or HbA1c. Screen annually in very high-risk groups (including Aboriginal and Torres Strait Islander people and those with prediabetes)

Answer 37

*gastrointestinal adverse effects *vitamin B12 deficiency *lactic acidosis (rare) CI: Renal Impairment GFR< 30 and liver impairment

Answer 38

GLITAZONE Side Effects: Weight gain Dyslipidemia, CV disease Osteopenia Pioglitazone: Risk for bladder cancer Rosiglitazone: Edema --->CHF MI, Stroke

Answer 39

GLIFOZIN dapagliflozin empagliflozin ertugliflozin Advantages: weight loss reduce the rate of secondary cardiovascular events, including overall mortality reduce blood pressure slow the progression of kidney disease Side effects: Genital infections (candida) UTI reversible increase in creatinine volume depletion (rare) diabetic ketoacidosis (uncommon), which may occur without hyperglycemia

Answer 40

IDE gliclazide glipizide glibenclamide glimepiride Side effects: HYPOGLYCEMIA Weight gain Dermatological allergic reactions

Answer 41

GLIPTINE alogliptin linagliptin saxagliptin (CI Heart failure) sitagliptin vildagliptin Weith loss avoid in patients with acute pancreatitis or history of pancreatitis Side effects: Headache Mild respiratory and urinary infections Weight neutral Contraindications in Pregnancy and breastfeeding

Answer 42

TIDE dulaglutide exenatide liraglutide Subcutaneous administration Advantages: weight loss improve postprandial glucose control reduce the rate of secondary cardiovascular events, including overall mortality (liraglutide) slow the progression of kidney disease (dulaglutide, liraglutide) CI: * Acute pancreatitis or history of pancreatitis * Family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 (liraglutide) * Severe kidney impairment (dulaglutide, exenatide) * End-stage kidney disease (liraglutide)

Answer 43

∗ Continue breast feeding from affected breast ∗ Place hot washers over breast before starting to feed and cold packs after feeding ∗ Antibiotics: Dicloxacillin Flucloxacillin Cephalexin for 5 days ∗ Analgesics ∗ Check breast feeding technique ∗ Review in 24- 48 h ∗ Basic blood tests and U/S if doubtful of breast abscess or in 48 hours if mastitis is not responding to antibiotics ∗ If Candidial mastitis-Fluconazole orally

Answer 44

3.0-3.9 cm: e/ 24m 4.0-4.5 cm: e/ 12m 4.6-5.0 cm: e/ 6m ≥5.1 cm: e/3m If 1st degree rel has it, 20% risk of getting it. Arrange yearly US from 50yo.

Answer 45

important 9 and 18 months

Answer 46

important 9 and 18 months

Answer 47

important 9 and 18 months

Answer 48

1. Permethrin. If no improv, repeat in 1-2w 2. Benzyl Benzoate 3. Oral cephalexin, top mupirocin if infection

Answer 49

- Primary: Single painless ulcer - Secondary: Generalised nontender lymphadenopathy, rash in palms and soles, patchy alopecia. - Tertiary: Neurosyphilis or cardiosyphilis

Answer 50

FIRST: Darkfield Microscopy BEST: RPR and Treponema pallidum hemagglutination assay (TPHA) Both tests must be (+)

Answer 51

Benzilpenicilline Early syphilis: Single dose Late syphilis: once weekly for 3 weeks Tertiary syphilis: IV 4-hourly for 15 days

Answer 52

- Physiological - Breast milk jaundice - Breastfeed jaundice - Sepsis - Metabolic: * Gilbert’s syndrome * Congenital hypothyroidism * Crigler-Najjar syndrome - Hemolytic: * ABO/Rh incompatibility * Spherocytosis * G6PD deficiency * Sickle cell anemia

Answer 53

1. Biliary atresia 2. Neonatal hepatitis - TORCH infection - Idiopathic - Metabolic: Galactosemia, Wilson, alpha 1antitripsine. **NOTE: Always > 24 h** **Conjugated** bilirubin level **>25** micromol/L because this may indicate **serious liver disease**

Answer 54

* Day 2-14 (> 21 in preterm) * Mild * Diagnosis of exclusion * Resolves in 2w * Rarely exceeds 220 micromol/L

Answer 55

* Too early < 24 hours of age * Too Long > 10 - 14 days of age (term: 2 weeks / preterm: 3 weeks) * Too high > 220 micromol/L * CONJUGATED Hyperbilirubinemia

Answer 56

Sepsis OR GIT obstruction

Answer 57

**Hemolysis** 1. ABO incompatibility (Most common) - Mother: O group; Child: A or B - Direct Coombs (+) - Peripheral smear: Spherocytes (some) 2. Spherocytosis - Peripheral smear: Predominant spherocytes - Direct Coombs (-) - FBE:↑ MCHC - FxHx: Anemia/spherocytosis/gallstones 3. Sickle Cell - Peripheral smear: Sickle and target cells - Direct Coombs (-) - African descendants 3. Rh incompatibility (Most severe) - Peripheral smear: NO spherocytes - Direct Coombs (+)

Answer 58

G6PD deficiency OR Spherocytosis (FxHx of gall stones)

Answer 59

Biliary obstruction (Biliary atresia)

Answer 60

Polycythaemia

Answer 61

Hepatitis (↑ liver enzymes) OR Metabolic problems (Galactosemia)

Answer 62

- Presentation: since the 1st week - Prolonged Jaundice (> 14 days in term and > 21 in preterm) - Dark urine - Clay-colored stools (even meconium is pale) - Abdominal pain (crying on changing diapers) - Hepatosplenomegaly ( >2cm below costal margin)

Answer 63

Very common Develops within 2-4 days of birth, may peak at 7-15 days of age, and may persist for many weeks. No need to stop breastfeeding

Answer 64

- Shorter lifespan of neonatal red blood cells - Immature liver function at birth - A relatively high concentration of β-glucuronidase in the small intestine

Answer 65

1. Preterm babies (higher bilirubin levels) 2. Exclusive breastfed babies 3. Babies with significant bruising or cephalohaematoma: The breakdown of RBCs within the cephalohaematoma causes higher bilirubin levels and predisposes to jaundice. 4. Previous sibling with neonatal jaundice requiring phototherapy

Answer 66

Percutaneous **biopsy** (gold-standard): **Bile ductular proliferation** (>specific), bile plugging, multinucleated giant cells, focal necrosis of liver parenchyma, extramedullary hemopoiesis, and inflammatory cell infiltrate.

Answer 67

 **listless**  Goitre  prominent tongue  hoarse cry  puffy face  constipation  umbilical hernia  hypothermia  bradycardia  dry skin  failure to thrive

Answer 68

1. Physiological jaundice Most Common cause in the first week: - Term: 50% - Preterm: 80% finishes in 1-2 weeks (preterm 3 weeks) 2. Breast milk jaundice Lasts up to 6 weeks Diagnose: Suspending breastfeeding for 24-48 hrs = ↓ serum bilirubin 3. Neonatal sepsis End of the first week (4-7 days old) Lethargic + jaundice + hepatosplenomegaly ↑ BOTH, Direct and Indirect bilirubin.

Answer 69

1st Hemocultures 2nd ATB: Wich??

Answer 70

Chest pain+SOB+viral infection Kussmaul sign. S4 Gallop: Cardiac Tamponade

Answer 71

1. ECG: - ST elevation except in AVR & V1 - Reciprocal PR 2. CXR: - Pericardial fluid - Pulmonary congestion 3. Echocardiogram: Is diagnostic! Chest FAST scan should be done ASAP. 4. Cardiac CT

Answer 72

- Viral infection: Coxsackie B, CMV, influenza, EBV, COVID, HIV - After a major heart attack or heart surgery: **Dressler syndrome**. - Systemic inflammatory disorders: Lupus, rheumatoid arthritis. - Trauma

Answer 73

Echocardiogram with drainage and culture (Pericardiocentesis)

Answer 74

 Constrictive pericarditis.  Cardiac tamponade

Answer 75

Mild to moderate Pericarditis Colchicine + AAS or Ibuprofen 2nd line: Prednisone If infection: ATBs and drainage

Answer 76

Severe Pericarditis, include admision 1. Cardiac tamponade: Pericardiocentesis 2. Severe, Recurrent or Constrictive: Pericardiectomy

Answer 77

Low blood pressure (weak pulse or narrow pulse pressure) Muffled heart sounds Raised jugular venous pressure.

Answer 78

Restrictive Cardiomyopathy Diastolic Dysfunction with impaired filling – relaxation Normal Ejection fraction + S4 gallop

Answer 79

1. Young age 2. B-negative blood type 3. Prior history of pericarditis 4. Prior treatment with prednisone

Answer 80

1st LINE: NSAIDs in high doses (aspirin, ibuprofen, naproxen) tapered over 4 to 6 weeks. 2nd LINE: Corticosteroids (prednisone) tapered over a 4-week period 3rd LINE: Colchicine.

Answer 81

Gold Standard: Echocardiogram UNSTABLE patient: bedside ultrasonographic (E-FAST) ECG: Same pattern as pericarditis (global ST segment elevation and T wave inversion)

Answer 82

Cariac Tamponade

Answer 83

Acute (<6w) Chronic (>6w).

Answer 84

Paradoxical: ↑ JVP with insp and ↓ JVP with exp) Means: constrictive and/or cardiac tamponade.

Answer 85

Pericarditis in the context of major heart attack or heart surgery

Answer 86

Acyanotic {Left to the right} 1. VSD - Ventricular Septal Defect* 2. ASD - Atrial Septal Defect 3. PDA - Patent Ductus Arteriosus Cyanotic {Right to the left} 1. TOF - Tetralogy of Fallot 2. HLHD - Hypoplastic Left Heart Dx 3. TGV - Transposition of the great vessels

Answer 87

Most common congenital heart disease. Asoc w/ Turner Sx Presentation age: Infant 5 to 6 weeks Clinical Features: 2-3/6 harsh holosystolic murmur heard along the LSB more prominent with small VSD and absent with very Large VSD SMALL - Moderate: 3-6mm - Asymptomatic - 50% will close spontaneously at 2y Mod - LARGE - Symptomatic & require Sx repair - SOB with feeding & crying - Recurrent chest infections - Heart failure from 3 months of age - FTT

Answer 88

Secundum ASD – Fossa Ovalis, most common Primum ASD – lower in position, more serious Clinical Features: - Initial: NO MURMUR - PS: Systolic ejection murmur - LSB - RV heave. - Fixed widely split S2 (Ao then Pulm Valve closes) - Asymptomatic or easy fatigability or mild growth failure. High risk of developing right heart failure with pulmonary HT

Answer 89

- Persistence of the Ductus Arteriosus (PA to the Aorta) - Normally closes in the 1st wk of life. - Associated with Turner Sx - Associated with Ao coarctation, VSD, and TORCH inf Rubella!!) Clinical Features: - Continuous machinery systolic murmur: Gibson Murmur - Small PDA: Asymptomatic - Large PDA: CHF, growth restriction, and FTT.

Answer 90

Most common cyanotic CHD 1. Pulmonary stenosis (1st worse) 2. VSD (2nd worse) 3. Overriding Ao 4. Right ventricular hypertrophy Clinical Features: - Cyanosis after the neonatal period (4m approx) and progressive - Clubbing fingers(Scharmoth's sing) - Hypoxemic spells (“Tet spells”) - Systolic ejection murmur - LSB (PS)

Answer 91

- LV and aorta are abnormally small (hypoplastic). - Early days (2-7d) of life & need urgent Sx to survive. - HLH is dependent on PDA for survival

Answer 92

The aorta arises from the RV & receives "blue" blood, whilst the Pulmonary Artery arises from the LV. Immediately after birth, and needs urgent treatment. Survival depends on the PDA or the FO remaining open in the early days of life until treatment.

Answer 93

1. The FO can be enlarged with a catheter procedure, called Balloon 2. Septostomy

Answer 94

Hyperoxia Test: ABG after 100% oxygen for 10 minutes. PaO2 will remain low & not rise

Answer 95

TGV: ABG after 100% oxygen for 10 minutes. PaO2 will remain low & not rise ◦ Pulmonary disease (not cyanotic CHD) is suspected if the PaO2 increases to more than 150 mm Hg with oxygen.

Answer 96

- Small VSD: No physical restrictions, reassurance, periodic follow-up & endocarditis prophylaxis. - Symptomatic VSD: Medical treatment initially with afterload reducers & diuretics. - Indications for Surgical Closure:  Large VSD w/ medically uncontrolled symptomatology & continued FTT.  Ages 6-12 mo w/ large VSD & Pulmonary HT

Answer 97

* Surgical or device closure for Secundum ASD * Closure performed between ages 2 & 5 years * Sx correction is done earlier in children w/ CHF or significant pulmonary HTN.  NOT Endocarditis prophylaxis

Answer 98

1. Indomethacin 2. Surgical: Ligation or catheter closure by insertion of a device or embolization coils.

Answer 99

Corrective Sx at about 6 months

Answer 100

Step 1: < 8 yo Modified Valsalva manoeuvre > 8 yo Carotid massage Step 2: Adenosine x 2 (2min) Step 3: Verapamile x 2 (30 min) Step 3: Direct current (DC) cardioversion or pharmacological cardioversion (amiodarone or overdrive pacing may be required. Recurrent: Ablation or amiodarone

Answer 101

Echinococcus tape worm

Answer 102

Triphasic abdominal CT Triphasic abdominal CT Cyst aspiration

Answer 103

Albendazole

Answer 104

Pituitary tumors Tumors compressing hypothalamus Sheehan syndrome Thyroid releasing hormone (TRH) resistance TRH deficiency Lymphocytic hypophysitis Radiation therapy to the brain Drugs such as dopamine, prednisone, or opioids

Answer 105

- Claudication (pain w/ exercise and relieved by rest), if pain at rest: RED FLAG - Shiny hairless legs - Muscles atrophied

Answer 106

– Rest Pain – Ischemic ulceration – Gangrene – Claudication symptoms are limiting day to life, work, and there is no improvement with exercises, risk factor modifications and medical management after 6 M.

Answer 107

1. Measure ABI 2. Duplex US (often the only imaging required to plan endovascular interventions)

Answer 108

CT Angiography w/ contrast (Contraindicated in RF)

Answer 109

ABI: 1-1.4: Normal 0.9: Borderline. Nothing <0.9: Risk factor management - Smoke cessation - Antiplatelets (aspirin or clopidogrel) - Statins (even in the absence of dyslipidemia) - ACE Inhibitors or ARBs. - Supervised exercise program. The beta-blockers should be avoided until and unless they are commenced for cardioprotection. For mixed ulcers (Do not use compression bandage if ABI <0.8) <0.4: Urgent referral

Answer 110

– Endovascular angioplasty or stenting – Open surgical reconstruction by bypass or endarterectomy.

Answer 111

- Context of a patient with: Thrombosis (most common cause) or Embolus from AF. 1. Acute onset of progressive PAIN: - Calf: Common femoral art / Superficial femoral art (MC site of occlusion). - Buttock: Common iliac/external iliac Thrombosis. 2. Pulselessness. 3. Pallor. 4. Paresthesia. 5. Paralysis: - Foot drop = Peroneal nerve paralysis. - Most reliable sign requiring Emergency Qx intervention.

Answer 112

1. Excersice ABI 2. CT angiogram (Emergency Qx intervention) can be MRI also 3. Duplex US for contrast Contraindications

Answer 113

Digital subtraction arteriography or just arteriography

Answer 114

Golden time: 4 hrs 1. IV Unfractionated Heparin: 5000 IU then 1250IU/hour. APTT guides further adjustment. 2. Surgical treatment: - Embolectomy: Can cause reperfusion injury (HyperK, metab acid, myoglobinuria, increased CK). Keep pt hydrated and perfused. Can Be: A) Angioplasty (Endovascular): Short obstruction (<10 cm) Aorto-Illiac location B) Bypass (grafting) Long obstruction (> 10 cm) Location: Infra Popliteal or Common femoral artery Chronic total oclusion - Amputation is required only if there are irreversible ischemic changes. 3. After acute, give warfarin for 3-6m