September 2024 Flashcards
Alcohol Withdrawal Syndrome treatment
Benzodiazepines like diazepam or lorazepam are typically used to manage AWS. Midazolam, as a short-acting benzodiazepine, may also be used in acute settings.
Follicular neoplasm of the thyroid diagnosis
Required ultrasound guided biopsy as it is difficult to distinguish benign from malignant using FNAB
Renal cell carcinoma triad
-gross hematuria
-flank pain
-abdominal mass
3 characteristics of renal masses pointing to malignancy
- completely solid renal masses
- mixed solid and cystic renal lesions
- cystic lesions that enhance with contrast
When is partial nephrectomy indicated? (1)
Renal masses smaller than 7cm
When is total nephrectomy indicated (5)
- tumor size 7cm
- tumor with more central location
- suspected lymph node involvement
- tumor with associated renal vein or IVC thrombus
- direct extension to the ipsilateral adrenal gland
What is done in active surviellance?
CT scan or MRI in 6- to 12- month intervals
Treatment for Anorexia Nervosa (3)
- psychotherapy (individual, family or group)
- nutritional rehab
- olanzapine if severe/refractory
Indications for hospitalization in Anorexia Nervosa (6)
- bradycardia less than 40 or dysrythmia
- hypotension, orthostasis, hypothremia
-electrolyte distrubance and marked dehydration
-organc ompromise
-<70% of expected weight or bmi <15
Primary treatment for bulimia nervosa
Fluoxetine (SSRI)
Circumstances under which renal biopsy might be considered
- patient is not a surgical candidate
- life expectancy is <5 years
- patient requests a definite diagnosis before surgery
Oppositional Defiant Disorder (ODD) vs Conduct Disorder (CD):
- ODD may progress to conduct disorder, but CD involves more severe antisocial behaviors (e.g., aggression toward people or animals, destruction of property, theft).
- ODD does not include aggression or violation of the rights of others, which is seen in conduct disorder.
Gold standard for the diagnosis of kidney scarring and assessment of renal functions
DMSA
Indications of DSMA (4)
- Clinical suspicion of renal injury
- reduced renal function
- suspicion of VUR
- suspicion of obstructive uropathy on ultrasound in older toilet trained children
What are the most commonly seen symptoms of a prodrome schizophrenia (4)
- anxiety
- social isolation
- difficulty making choices
- problems with concentration and attention
Conduct disorders are characterized by (4)
- abusing others physically or sexually
- telling lies
- breaking the law by stealing, vandalizing, lighting fires
- treating people and animals cruelly
Scleroderma (Systemic Sclerosis) definition
Scleroderma, also known as systemic sclerosis,
chronic autoimmune disease
- hardening and tightening of the skin and connective tissues
- can affect not only the skin but also internal organs (lungs, heart, gastrointestinal tract, and kidneys)
Two main types
1. limited cutaneous systemic sclerosis (formerly known as CREST syndrome)
2. diffuse cutaneous systemic sclerosis.
2 types of scleroderma
limited cutaneous systemic sclerosis (formerly known as CREST syndrome) and diffuse cutaneous systemic sclerosis.
Limited Cutaneous Systemic Sclerosis (lcSSc) (CREST syndrome)
Calcinosis: Calcium deposits in the skin and soft tissues.
Raynaud’s phenomenon: Episodic vasospasm of the digits in response to cold or stress, causing white-blue-red discoloration.
Esophageal dysmotility: Difficulty swallowing due to fibrosis of the esophagus.
Sclerodactyly: Thickening and tightening of the skin of the fingers.
Telangiectasias: Dilated blood vessels visible on the skin surface.
Limited vs Diffuse Scleroderma
Limited: Skin thickening is restricted to the hands, face, and distal extremities, with slow progression. Associated with CREST syndrome.
Diffuse: Widespread skin thickening with rapid progression and early organ involvement (lungs, kidneys, heart).
HL VS NHL
ALL vs AML table
Cytogenic analysis of ALL
Philadelphia chromosome (t(9;22)) is associated with a poor prognosis in ALL but is treatable with tyrosine kinase inhibitors.
Cytogenic analysis of AML
Acute promyelocytic leukemia (APL) is characterized by the t(15;17) translocation, which involves the PML-RARα fusion gene and responds well to all-trans retinoic acid (ATRA) therapy
Most common childhool leukemia
ALL
Characteristic finding in myeloblasts of AML patients
Auer rods
Pathognomonic findings in lymph node biopsy of hodgkin’s lymphoma
Presence of Reed-Sternberg cells is pathognomonic.
Bilobed nucleus and a classic “owl eye” appearanc
Reed sternberg cells
Irritable hip
LCP
LCP limitation in movement
Internal rotation and abduction
Osteomyelitis definitive diagnostic
MRI of the lumbar area
Osteomyelitis initial diagnostic
Xray
ptosis, miosis, lacrimation, conjunctival injection, rhinorrhea, nasal congestion
cluster headache or migrainious neuralgia
Cluster headache acute attack treatment (first step)
02
Cluster headache treatment if O2 unresponsive
Sumatriptan
Dihydroergoramine
Lidocaine
Cluster headache treatment first line
Verapamil sustained release
Most common cause of epididymoorchitis in sexually active males
Chlamydia
Congenital rheumatologic disease associated with neonatal bradycardia
Neonatal lupus erythematosus
Marker for Neonatal lupus erythematosus
anti RO anti La and/or U1 ribonucleoprotein but 95% montly is positive for anti-Ro
Most common cause of noisy breathing in infancy
Laryngomalacia
- congenital softening of the tissues of the larynx above the vocal cords
Croup or LTB is caused by
parainfluenza virus type 1
seal barking cough and inspiratory stridor
Coup or LTB
Acute bronchiolitis is caused by
RSV
4Ds of Epiglottitis
Distress
Drooling
Dysphonia
Dysphagia
Epiglotitis is caused by
Haemophilus influenzae type b (Hib) bacteria
Hemolysis, painful crises or thrombotic complications in hypoxic conditions (high altitudes or during decompressions)
Heterozygous Sickle cell trait (HbAS)
Presentation of Heterozygous Sickle cell trait (7)
- Hemolysis, painful crises or thrombotic complications in hypoxic conditions (high altitudes or during decompressions)
- rhabdomyolysis and sudden death during exercise
- hyposthenuria or impaired
- inability to concentrate urine
- unilateral hematuria
- renal papillary necrosis
- SOB and central cyanosis
Most common skin cancer in australia
Basal cell CA
2nd most common skin cancer in australia
SCC
Risk factors of SCC
- unprotected exposure to uv rays from the sun or tanning bed
- age over 50
- male gender
- pale skin
- immunosuppression
- personal history of skin ca
- hpv
- precancerous skin lesions such as bowen’s disease and actinic keratosis (AK)
Sudden onset patchy hair loss, no hair growth and normal appearing scalp
alopecia areata
Normal scalp but different lengths of hair observed
Trichotillomania
Flaking and hairs of different lengths and different stages of growth often broken and damaged
Tinea Capitis
Positive pull test
active alopecia
Pathognomonic finding in alopecia but need not always be pressent
exclamation point hairs
Amiodarone + warfarin
Hematoma
Amiodarone + statin
inhibition of cytochrome p450 causing rhabdomyolysis
- myoglubrinuria
- hyperkalemia
- cardiac arrythmia
Measles exclusion
excluded until 4 days after the onset of the rash
Exclusion of contacts of known measles in childcare setting (3)
- immunized contacts of a child with measles do not require exclusion
- non immunized children who have been in contact with a child with measles should be excluded from school. until 14 days after the day the infected child developed the rash
- if immunized with MMR within 72 hours of contact with infected person
Measles vaccination schedule
At 12 months and 18 months
Treatment of Shingles / Herpes Zoster first 72 hours
Antiviral agents
Treatment of Shingles / Herpes Zoster after 72 hours of the onset of vesicles
Tricyclic antidepressants (Amitriptyline) and gabapentin
Left sided hemineglect
Right pareital lobe
Frontal cortex lesions manifestation
disnihibited speech and behavior
primitive reflexes
altered mental status
impaired judgement
contralateral weakness greater in legs than arms
contralateral cortiucal sensory deficits
gait ataxia
Occipital lobe lesions
contralateral homonymous hemianopsia
cortical blindness
visual agnosia
altered mental status
impaired memory
pulmonary hemorrhage + glomerulonephritis
Goodpasture syndrome
Goodpasture pathophysiology
formation of anti-glomerular basement membrane (anti-GBUM) antibodies that attack the basement membranes of the glomeruli in the kidneys and the alveoli in the lungs
Goodpasture kidney biopsy
cresentric glomerulonephritis
Goodpasture immunofluorescence
linear deposits of IgG along the glomerular basement membrane
Abdominal pain + diarrhea + confusion diagnosis
Serotonin syndrome
SSRO + MAOI (Sertraline + selegiline)
Serotonin syndrome
Melanocytic spots on the buccal mucosa and in the gastrointestinal tract
Peutz-Jegher syndrome
First line medication for treatment of moderate to severe serotonin syndrome
Serotonin antagonist cyproheptadine (antagonist of HT2)
vomiting, abdominal pain and abdominal distention; distended abdomen, non tender; absent bowel sounds
paralytic ileus
Most common cancer in australia
Non melanoma skin cancer
swollen tender and firm hemiscortum with short and thickened spermatic cord plan
Surgery
On warfarin, INR 2-3, high risk surgery plan
cessation of warfarin 4-5 days before surgery and administration of Vitamin K evening before surgery
On warfarin, INR 2-3, high risk surgery; for emergency surgery
FFP or Prothrombinex-vf for rapid reversal
Routine surveillance after breast cancer surgery
Physical examinations every 3 to 6 months for the first 3 years, every 6 to 12 months for years 4 and 5 then annually thereafter
Time for warfarin reversal
5 days maximum
Post treatment mammogram for women who have undergone breast conserving surgery
1 year after initial mammogram, at least 6 months after completion of radiation therapy, then yearly
Pregnancy associated breast cancer
Invasive ductal carcinoma
Invasive ductal carcinoma in the first trimester treatment advice
Terminate pregnancy, mastectomy, chemotherapy and radiotherapy
Absolute contraindications to ACE inhibitors (4)
- history of angioedema regardless of cause (Even if not due to ACE inhibitor)
- pregnancy (due to harm to fetus)
- bilateral renal artery stenosis
- previous allergic reaction to ACE inhibitors
Relative contraindications to ACEI (2)
- Aortic stenosis
- Hypertrophic cardiomyopathy
Common adverse effect of ACEi and the main cause of non complicance
Cough
Criteria for withdrawal of antiepileptics (4)
- seizure free for 2 years
- no epileptic activity on EEG
- no abnormal focal neurological findings on PE and imaging studies
- withdrawal from antiepileptic drugs managed or guided by specialist
School exclusion of chicken pox
Excluded from school or other daycare setting until all blisters are dried out
(usually takes 5 days from the onset of the rash but may be less in previously immunized children)
Preferred method of TB testing for patients who are vaccinated with BCG or are immunocompromised
IGRA
Preferred method of TB testing overall
TST
IGRA as supplemental assay in patients older than 2 years
Next step for a woman positive with hepatitis C antibody titer
PCR test for HCV RNA* and LFT
HIV test **
- Risks of perinatal transmission depends on the presence of HCV RNA
** Concomitant HIV infection increases the risk of transmission
Screening recommendation = at 12 and 18 months of age
Late bleeding post tonsillectomy is most probably caused by
Infection
Chronic seizure driving limitations
Non commercial = 12 months from last seizure
Commercial = 10 years
Childhood epilepsy
No exclusion provided that no siezure has occurred after 11 years of age;
If with seizure after 11 years old, apply general rule unless
Valvular heart disease that has the most significant complication in pregnancy
Mitral Valve Stenosis
Significant heart conditions with high risk of complications in pregnancy (3)
Mitral valve stenosis
grade 3 or 4 heart failure
Atrial fibrillation
DTPA Vaccination recommendations in pregnancy
single dose of dTpa is recommended during every pregnancy, preferably between 20 and 32 weeks gestation.
DTPA vaccination schedule
At 6 weeks – First dose of DTPa (Diphtheria-Tetanus-acellular Pertussis) - maybe at 2 months
At 4 months – Second dose of DTPa
At 6 months – Third dose of DTPa
At 18 months – Fourth dose of DTPa
At 4 years – Fifth dose of DTPa
—–
At 12-13 years (Year 7) – A booster dose with dTpa (reduced dose diphtheria-tetanus-acellular pertussis) as part of the school-based vaccination program.
First line contraceptive choice for women with epilepsy who are on enzyme inducing anti-epileptic drugs
Levonorgestrel releasing intrauterine contraceptive device or mirena
Neonatal central cyanosis with no murmur
Transposition of great arteries
5 congenital cyanotic heart disease
Antiemetic of choice during pregnancy
Metoclopramide
Severe migraine attacks in pregnancy
Codeine
Chlamydia must knows
Sexual contacts during the proceeding 60 days should be either treated empirically or tested for infection and treated if positive
Avoid sexual intercourse for 7 days after initiation of treatment
Bacterial vaginosis treatment
Oral or vaginal clindamycin or metronidazole
Scarring alopecia (3) treatment
Central centrifugal scarring alopecia
Dissecting cellulitis of the scalp
Acne keloidalis nuchae
Treatment: long acting oral tetracycline + topical corticosteroids
Emeergency contraception/plan B
Levonorgestrel 0.7mg/tab 2 doses (12 hours apart
Ethinyl estradiol 100ug/tab BID 12 hours apart. nbgfdsa CVBXNZ
Temporal lobe lesions manifestation (2)
Olfactory hallucinations
COmplex automatic behaviorisms
Occipital lobe lesions
visual hallucinations
Recurrent vaginal candidiasis treatment
Fluconazole 50mg/ OD for remission the 150mg weekly for 2 months
Treatment regimen for pulmonary embolism
D/ C OCP, treat with heparion for 1 week (3-7 adays) with warfarin for 3-6 months (take effect after 3 days of use)
Percutaneous needle thoracentesis location
2nd left intercostal space (the one below the manubriosternal angle of Louis) in the midclavicular line (which will avoid risk to the descending internal mammary artery just lateral to the sterunum)
red urine + very high creatinine kinase + muscle weakness + statin treatment (in the background of erythromycin that can increase the level of statin)
rhabdomyolysis
–> next step is to investigate for bladder CA
Amoebiasis presentation (3)
Dysentery
Enteritis
Hepatitis
Egypt + urinary problems (frequency dysuria fever and terminal hematuria) hemospermia pale slightly febrile
primary bilharziasis or schistosomiasis
Schistosoma haematobium (urinary)
S. mansoni - GI
S. japonicum - liver disease
Child-Pugh classification (portal hypertension) scores
Child-Pugh A (score 5-6): Mild disease, well-compensated cirrhosis.
Child-Pugh B (score 7-9): Moderately severe disease, significant functional compromise.
Child-Pugh C (score 10-15): Severe disease, decompensated cirrhosis, poor prognosis.
Child-Pugh classification (portal hypertension)
Bilirubin
Albumin
INR
Ascites
Encephalopathy
Liver hemangioma description
subcortical lesion with early prominent dense enhancement which spreads through the lesion in the late portal venous phase + intermittent RUQ pain
primary jejunal lymphoma of the small bowel
coeliac disease
location of spontaneous primary lymphoma of the small bowel (NOT associated with coeliac disease)
terminal ileum
DOC treatment of chronic hepatitis B
Lamivudine
Inguinal ligaments (M-L)
Lacunar ligament, Femoral VAN
Zenker diverticulum (pharyngeal pouch) (3)
- elderly
- coughing immediately after a meal and regurgitation of food particles
- chest infection/pulmonary problems
Achalasia pathophysiology
increased lower esophageal sphincter tone and failure of relaxation
Mucous + blood in feces
UC or consider CA depending on age
