Samson Flashcards
1
Q
Management of TMJ dysfunction
A
Reassure
2
Q
Hearing loss+swimming+invisible TM
A
Ear wax
3
Q
Management of Barotrauma
A
Refer to ENT
4
Q
Management of Ear wax
A
Olive oil ear drops
5
Q
Advice for doxycycline side effects
A
Take after meals
6
Q
Commonest causes of UTI
A
E. Coli
Proteus
7
Q
First line in hyperkalemia
A
10mls of 10% Calcium gluconate
8
Q
Purpura+arthritis+abdominal pains +GI bleeding+/- Nephritis
A
HSP
9
Q
Hereditary Epistaxis/menorrhagia/joint bleeding
A
Von willebrand
10
Q
Lab features of Von willebrand
A
Normal PT
High aPTT
Prolonged bleeding time
Normal or mildly reduced factor 8 levels
11
Q
Clotting profile in liver disease
A
High PT
High TT
High aPTT
Normal bleeding time
12
Q
Another name for HSP
A
Autoimmune hypersensitivity vasculitis
13
Q
Normal bleeding time
A
1-9 minutes
14
Q
MOA of Von willebrand
A
Impaired platelet aggregation
15
Q
When to transfuse
A
<7g/dl
16
Q
Aplasia+immature blood cells
A
Myeloblastic syndrome
17
Q
Fundal features of CRVO (commoner)
A
Intensely hyperemic
Flame shaped hemorrhages
- Dilated and tortuous retinal veins
Venous congestion is a hallmark of CRVO, with veins appearing swollen and twisted.
- Diffuse retinal hemorrhages
Flame-shaped or dot-and-blot hemorrhages distributed throughout the retina, resembling a “blood and thunder” appearance.
- Optic disc swelling
Edema of the optic disc due to increased venous pressure and ischemia.
- Macular edema
Swelling in the macula, leading to central vision loss, often detected on optical coherence tomography (OCT).
*Additional findings: Cotton wool spots (ischemia-related), neovascularization (in severe ischemic CRVO), and reduced visual acuity.
18
Q
Fundal features of CRAO
A
Pale
Cherry red spots
Central Retinal Artery Occlusion (CRAO) is an ophthalmic emergency caused by a blockage of the central retinal artery, leading to sudden, painless vision loss. The key clinical features of CRAO include:
- Sudden, painless vision loss
Profound loss of vision in the affected eye, often reduced to light perception or worse.
- Pale retina with a cherry-red spot
The retinal ischemia causes whitening (pallor) of the inner retina, with the fovea appearing as a distinct cherry-red spot due to the underlying choroidal blood supply.
- Attenuated retinal vessels
Narrowed and sometimes interrupted retinal arterioles due to the obstruction.
- Relative afferent pupillary defect (RAPD)
Present in cases where the optic nerve is affected, indicating significant retinal ischemia.
19
Q
Bilateral miosis+irregular pupils+non response to light but response to accommodation
A
Iritis/Uveitis
20
Q
Gradual vision loss+inability to read even with glasses
A
Cataract
21
Q
Upper homonymous quandrantanopia
A
Optic radiation -Temporal lobe
22
Q
Lower homonymous quandrantanopia
A
Optic radiation -Parietal lobe
23
Q
Non congruous homonymous hemianopia
A
Optic tract
24
Q
Non congruous homonymous hemianopia
A
Optic tract
25
Congruous homonymous hemianopia
Occipital lobe
26
Management of anterior Uveitis
Prednisolone 0.5% drops 2hrly and cyclopentolate drops
27
Medial canthus painful swelling+purulent discharge following facial injury
Dacrocystitis
28
Flame hemorrhages+ optic disc edema+ painless loss of vision
Vitreous hemorrhage
29
Stages of Hypertensive retinopathy
1. Silver wiring
2. AV nipping
3. Cotton wool spots
30
Stages of Hypertensive retinopathy
1. Silver wiring
2. AV nipping
3. Cotton wool spots
31
Period for CVS
10-15 weeks
32
Period for Amniocentesis
15-18weeks
33
Another name for candidiasis
Moniliasis
34
Management of Stress incontinence
Pelvic floor exercises
Duloxetine
35
Management of Urge incontinence
Bladder training
Anticholinergics e.g. Oxybutinin
36
Test to differentiate types of incontinence
Urodynamic studies
37
Most effective measure in stress incontinence
Weight loss
38
Investigation in osteoporosis
DEXA
39
Prophylaxis for Osteoporosis
Bisphosphonate therapy
40
When to investigate in recurrent miscarriages
At least 3
41
Endometrial thickness for Endometrial cancer
>5mm
42
First line contraceptive in Menorrhagia
IUS
43
Tx. for exercise induced asthma
Na cromoglycate
44
Features of life threatening asthma
PEFR<33%
Oxygen<92%
Silent chest/Cyanosis
Hypotension/Arrhythmia
Exhaustion/altered consciousness
45
Chronic asthma steps
SABA
SABA+LICS
SABA+LICS+LTRA
LICS+LABA+/-LTRA
MART+LICS
MICS+LABA+SABA
HICS+/-Theophylline/Tiotropium
Oral steroid
Mab/immunosuppressant
Asthma Management Steps
1. SABA (Short-acting Beta-agonist):
Example: Salbutamol, Terbutaline
Used for quick relief of symptoms (rescue medication).
No longer recommended as sole treatment for persistent asthma due to risk of exacerbations.
2. SABA + Low-dose ICS (Inhaled Corticosteroid):
Example: Salbutamol + Budesonide/Beclomethasone
ICS controls inflammation and prevents exacerbations. SABA is for symptom relief.
3. SABA + Low-dose ICS + LTRA (Leukotriene Receptor Antagonist):
Example: Montelukast/Zafirlukast added to the above.
Used if symptoms persist despite low-dose ICS or if allergic rhinitis or aspirin-sensitive asthma is present.
4. Low-dose ICS + LABA (Long-acting Beta-agonist) +/- LTRA:
Example: Salmeterol + Fluticasone or Formoterol + Budesonide.
LABA provides long-term bronchodilation, while ICS controls inflammation.
LTRA may still be added for specific cases.
5. MART (Maintenance and Reliever Therapy) with ICS:
Example: Formoterol + Budesonide used as both maintenance and reliever inhaler.
Simplifies therapy and reduces exacerbation risk.
6. Medium-dose ICS + LABA + SABA:
Higher ICS dose + LABA for maintenance, with SABA as rescue therapy.
7. High-dose ICS +/- Theophylline or Tiotropium:
Tiotropium: A long-acting anticholinergic added for severe asthma.
Theophylline: Rarely used due to side effects but may help in refractory cases.
8. Oral Steroids:
Example: Prednisolone for severe, uncontrolled asthma despite high-dose ICS and add-ons.
Long-term use requires monitoring for systemic side effects.
9. MAb (Monoclonal Antibodies)/Immunosuppressants:
Example: Omalizumab (anti-IgE), Mepolizumab (anti-IL-5), or Dupilumab (anti-IL-4).
Used for severe asthma with specific phenotypes (e.g., eosinophilic asthma or allergic asthma).
46
FEV/FVC improvement post salbutamol in asthma
>15%
47
Management of acute exacerbation of COPD
Nebulized salbutamol
Salbutamol
IV Hydrocortisone
48
Low PaO2
High PaCO2
Type 2 Respiratory failure
49
Low PaO2
Normal/low PaCO2
Type 1 respiratory failure
50
Pneumonia after influenza
Staphylococcal pneumonia
51
Pneumonia with confusion/spain/outbreak/hotel
Legionella
52
Pneumonia in Cystic fibrosis
Staph. Aureus
53
Pneumonia in hostels/close population
Mycoplasma
54
Hospital acquired pneumonia<5days post admission
Streptococcus pneumonia
55
Pneumonia with hyponatremia and lymphopenia
Legionella
56
Tx. of choice in legionella pneumonia
Erythromycin
57
Pneumonia in bronchiectasis and Cystic fibrosis
Pseudomonas
58
Pneumonia with green phlegm/COPD
H. Influenza
59
Tx. in Chlamydia Psittaci pneumonia
Doxycycline/tetracycline
60
Mgt of acute STEMI
Management of STEMI
The primary goal is rapid restoration of coronary perfusion.
1. Immediate Assessment and Diagnosis
Perform ECG: Confirm STEMI by identifying ST-segment elevation in two or more contiguous leads.
Assess symptoms: Chest pain >20 minutes, sweating, nausea, or dyspnea.
Perform risk stratification: Consider hemodynamic stability, comorbidities, and contraindications.
2. Initial Treatment
MONA Approach (where appropriate):
Morphine: For pain relief (IV with antiemetics if needed).
Oxygen: Only if SpO₂ <94% or evidence of hypoxia.
Nitrates: Sublingual or IV for chest pain, unless hypotensive.
Aspirin: 300 mg loading dose (chewed or dissolved).
Second antiplatelet:
Add clopidogrel, ticagrelor, or prasugrel (preferred unless contraindicated).
3. Reperfusion Therapy
Primary Percutaneous Coronary Intervention (PPCI):
Preferred within 120 minutes of first medical contact.
Administer heparin or a GP IIb/IIIa inhibitor during the procedure.
Fibrinolysis:
If PPCI cannot be performed within 120 minutes, administer fibrinolysis (e.g., tenecteplase) and transfer for rescue PCI if needed.
4. Post-Reperfusion Care
Dual antiplatelet therapy (DAPT): Aspirin + ticagrelor/prasugrel (for 12 months).
Beta-blockers: To reduce myocardial workload and prevent arrhythmias.
ACE inhibitors/ARBs: To improve outcomes, particularly in those with reduced left ventricular ejection fraction (LVEF).
Statins: High-intensity statins (e.g., atorvastatin 80 mg).
Lifestyle advice: Smoking cessation, diet, and exercise counseling.
61
Mgt of ACS without ST elevation
Aspirin
Morphine
GTN spray
Fondaparinux
Ticagrelor/Clopidogrel
Management of NSTEMI
The primary goals are to alleviate symptoms, prevent myocardial damage, and reduce long-term cardiovascular risk.
1. Initial Assessment
Perform ECG: Identify ST-depression, T-wave inversion, or no clear changes.
Assess for high-risk features: Elevated troponins, recurrent ischemia, hemodynamic instability.
2. Initial Treatment
MONA Approach (as in STEMI, but no fibrinolysis).
Dual antiplatelet therapy (DAPT):
Aspirin 300 mg + clopidogrel/ticagrelor.
Anticoagulation:
Offer fondaparinux unless contraindicated. Use unfractionated heparin (UFH) if PCI is planned.
3. Risk Stratification
Use scoring systems like GRACE or TIMI to guide further management:
High-risk patients: Immediate invasive strategy (coronary angiography within 24 hours).
Intermediate-risk patients: Invasive strategy within 72 hours.
Low-risk patients: Conservative approach with medical therapy and delayed testing.
4. Definitive Management
Coronary Angiography and Revascularization:
PCI or coronary artery bypass graft (CABG) depending on findings.
Medications for secondary prevention (as in STEMI):
DAPT, beta-blockers, ACE inhibitors/ARBs, statins, and possibly aldosterone antagonists.
62
PCI window
120minutes
63
Past PCI window?
Thrombolytics+Heparin
64
Skin rash+positive glass test (non blanching)
Meningitis
65
Normal child with multiple vomiting improved when upright
GERD
66
Fever+vomiting+failure to thrive+no diarrhea
UTI
67
Vaginal discharge in a child (non sexually active)
Foreign body
68
First line tx. for enuresis<5yrs
Behavioral modification
69
First line long term tx. for enuresis
Enuresis alarm
70
Enuresis TX in sleep overs
Desmopressin
71
Another name for breath holding spells
Reflexic anoxic seizures
72
AD+recurrent LOC/pallor from childhood+sudden death
Long QT syndrome
73
Seizures in infants+abnormal EEG+abnormal development
Infantile spasms
74
Continuous machinery murmur+bounding pulse
PDA
75
Newborn head circumference
34.5cm
76
Microcephaly+short palpebral features+hx of alcohol
Fetal alcohol syndrome
77
Indistinct nasal speech+wake at night+tiredness during the day
Adenoids
78
Test for allergies
Radioallergosorbent test (RAST)
79
Mgt for Chest pain of 12hrs+normal ECG
Admit
80
Mgt for Chest pain 2 days ago+ normal ECG
Same day assessment by specialist
81
Mgt for central Chest pain of >20mins
Admit
82
Mgt for Chest pain and SOB for 2 days+weight loss
Specialist clinic within 2 weeks
83
Mgt for central Chest pain relieved by rest
Routine referral to cardiologist
84
Why auscultate in angina?
Aortic stenosis
85
Angina at rest+transient ST elevation
Prinzmetal's angina
86
Central chest pain radiating to scapular/intrascapular area
Aortic dissection
87
Palpitations that require admission
Ventricular tachycardia
Persistent SVT
Unstable
88
Mgt for Palpitations 2 days ago, precipitated by exercise, resolves with rest
Refer urgently to cardiologist
89
Mgt for past Palpitations with family hx of sudden cardiac death
Refer urgently to cardiologist
90
Mgt for non current palpitations+AS+normal ECG
Refer routinely to cardiologist
91
Drug of choice for AF+HF
Digoxin
92
Mgt steps for AF
B blockers/CCB
Digoxin
Cardioversion
93
Chaotic broad complex tachycardia+no pulse
VF
94
Regular narrow complex tachycardia+saw tooth appearance+ rate>150 + absent p waves
Atrial flutter
95
ECG features of digoxin toxicity
Down slopping ST segment
Inverted T waves
96
Alterations btw tachycardia and bradycardia
Sick sinus syndrome
97
Until proven otherwise, palpitations or arrhythmias within 48hrs post MI is always ...
Ventricular tachycardia
98
Tx. for VT
Amiodarone
99
Mgt. Steps for SVT
Valsalva manoeuvre/ carotid massage
Adenosine
Electrical cardioversion
100
Normal cholesterol levels
<200mg/dl (5.17mmol/l)
101
Rheumatic fever+mid diastolic murmur
MS
102
Murmur in IV drug users
TR
103
Murmur with bounding/water hammer pulse
Aortic regurgitation
104
HbA1c target in diet modification
48mmol/mol (6.5%)
105
HbA1c target in non hypoglycemic drugs e.g. metformin
48mmol/mol (6.5%)
106
HbA1c target in hypoglycemic drugs e.g. sulfonylureas
53mmol/mol (7%)
107
Thiazolidinediones example
Pioglitazone
108
Contraindications to thiazolidinediones
CCF
Previous/active bladder Ca.
Osteoporosis
109
DPP4 inhibitors examples
Sitagliptin, linagliptin, Saxagliptin
110
SGLT2 inhibitors
Canagliflozin, dapagliflozin, empagliflozin
111
eGFR contraindications of Metformin
eGFR<30ml/min in Metformin SR
eGFR<45ml/min in Metformin MR
112
Metformin use in surgery
Stop 48hrs before surgery
Recommence at least 48hrs after surgery
113
GLP analogue examples
Exenatide
114
Poorly managed DM with BMI >30
Intensify lifestyle modification and metformin
115
PUD unresponsive to PPI + recurrent hypoglycemia
Insulinoma
116
Proteinuria values
ACR>30mg/mmol
Albumin>200mg/l
Protein>300mg/day
117
Erectile dysfunction is what type of neuropathy?
Autonomic neuropathy
118
Micro albuminuria values
ACR>2.5/3.5mg/mmol
Albumin>20mg/l
119
Normal serum creatinine level
60-110mmol/l
120
Drug for central DI
Desmopressin
121
Drug for Nephrogenic DI
Bendroflumethiazide/NSAIDs
122
What type of DI does lithium cause?
Nephrogenic
123
Normal serum prolactin level
<400mU/l
124
Primary hyperparathyroidism
High PTH
High Ca2+
Low PO4
125
Secondary Hyperparathyroidism
High PTH
Low Ca2+
Low PO4
126
Tertiary Hyperparathyroidism
High PTH
High Ca2+
High PO4
127
High ALP + Normal Ca2+
Paget's disease
128
Features of Cushing + undetectable plasma ACTH
Adrenal adenoma
129
Investigation steps in Cushing's
24hr urinary cortisol
48hr DEXA suppression test
Plasma ACTH
High dose suppression test/Adrenal CT
Pituitary MRI/General CT
130
ACS management
Management of STEMI
The primary goal is rapid restoration of coronary perfusion.
1. Immediate Assessment and Diagnosis
Perform ECG: Confirm STEMI by identifying ST-segment elevation in two or more contiguous leads.
Assess symptoms: Chest pain >20 minutes, sweating, nausea, or dyspnea.
Perform risk stratification: Consider hemodynamic stability, comorbidities, and contraindications.
2. Initial Treatment
MONA Approach (where appropriate):
Morphine: For pain relief (IV with antiemetics if needed).
Oxygen: Only if SpO₂ <94% or evidence of hypoxia.
Nitrates: Sublingual or IV for chest pain, unless hypotensive.
Aspirin: 300 mg loading dose (chewed or dissolved).
Second antiplatelet:
Add clopidogrel, ticagrelor, or prasugrel (preferred unless contraindicated).
3. Reperfusion Therapy
Primary Percutaneous Coronary Intervention (PPCI):
Preferred within 120 minutes of first medical contact.
Administer heparin or a GP IIb/IIIa inhibitor during the procedure.
Fibrinolysis:
If PPCI cannot be performed within 120 minutes, administer fibrinolysis (e.g., tenecteplase) and transfer for rescue PCI if needed.
4. Post-Reperfusion Care
Dual antiplatelet therapy (DAPT): Aspirin + ticagrelor/prasugrel (for 12 months).
Beta-blockers: To reduce myocardial workload and prevent arrhythmias.
ACE inhibitors/ARBs: To improve outcomes, particularly in those with reduced left ventricular ejection fraction (LVEF).
Statins: High-intensity statins (e.g., atorvastatin 80 mg).
Lifestyle advice: Smoking cessation, diet, and exercise counseling.
---
Management of NSTEMI
The primary goals are to alleviate symptoms, prevent myocardial damage, and reduce long-term cardiovascular risk.
1. Initial Assessment
Perform ECG: Identify ST-depression, T-wave inversion, or no clear changes.
Assess for high-risk features: Elevated troponins, recurrent ischemia, hemodynamic instability.
2. Initial Treatment
MONA Approach (as in STEMI, but no fibrinolysis).
Dual antiplatelet therapy (DAPT):
Aspirin 300 mg + clopidogrel/ticagrelor.
Anticoagulation:
Offer fondaparinux unless contraindicated. Use unfractionated heparin (UFH) if PCI is planned.
3. Risk Stratification
Use scoring systems like GRACE or TIMI to guide further management:
High-risk patients: Immediate invasive strategy (coronary angiography within 24 hours).
Intermediate-risk patients: Invasive strategy within 72 hours.
Low-risk patients: Conservative approach with medical therapy and delayed testing.
4. Definitive Management
Coronary Angiography and Revascularization:
PCI or coronary artery bypass graft (CABG) depending on findings.
Medications for secondary prevention (as in STEMI):
DAPT, beta-blockers, ACE inhibitors/ARBs, statins, and possibly aldosterone antagonists.
---
Key Differences Between STEMI and NSTEMI Management
1. Reperfusion therapy (PPCI or fibrinolysis) is immediate in STEMI but not routinely performed in NSTEMI unless high-risk.
2. NSTEMI emphasizes risk stratification to guide invasive strategies.
3. Both require long-term secondary prevention strategies.
