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AMC September 2024 > September 2024 > Flashcards

September 2024 Flashcards

1
Q

Alcohol Withdrawal Syndrome treatment

A

Benzodiazepines like diazepam or lorazepam are typically used to manage AWS. Midazolam, as a short-acting benzodiazepine, may also be used in acute settings.

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2
Q

Follicular neoplasm of the thyroid diagnosis

A

Required ultrasound guided biopsy as it is difficult to distinguish benign from malignant using FNAB

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3
Q

Renal cell carcinoma triad

A

-gross hematuria
-flank pain
-abdominal mass

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4
Q

3 characteristics of renal masses pointing to malignancy

A
  • completely solid renal masses
  • mixed solid and cystic renal lesions
  • cystic lesions that enhance with contrast
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5
Q

When is partial nephrectomy indicated? (1)

A

Renal masses smaller than 7cm

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6
Q

When is total nephrectomy indicated (5)

A
  • 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
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7
Q

What is done in active surviellance?

A

CT scan or MRI in 6- to 12- month intervals

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8
Q

Treatment for Anorexia Nervosa (3)

A
  • psychotherapy (individual, family or group)
  • nutritional rehab
  • olanzapine if severe/refractory
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9
Q

Indications for hospitalization in Anorexia Nervosa (6)

A
  • bradycardia less than 40 or dysrythmia
  • hypotension, orthostasis, hypothremia
    -electrolyte distrubance and marked dehydration
    -organc ompromise
    -<70% of expected weight or bmi <15
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10
Q

Primary treatment for bulimia nervosa

A

Fluoxetine (SSRI)

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11
Q

Circumstances under which renal biopsy might be considered

A
  • patient is not a surgical candidate
  • life expectancy is <5 years
  • patient requests a definite diagnosis before surgery
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12
Q

Oppositional Defiant Disorder (ODD) vs Conduct Disorder (CD):

A
  • 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.
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13
Q

Gold standard for the diagnosis of kidney scarring and assessment of renal functions

A

DMSA

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14
Q

Indications of DSMA (4)

A
  • Clinical suspicion of renal injury
  • reduced renal function
  • suspicion of VUR
  • suspicion of obstructive uropathy on ultrasound in older toilet trained children
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15
Q

What are the most commonly seen symptoms of a prodrome schizophrenia (4)

A
  • anxiety
  • social isolation
  • difficulty making choices
  • problems with concentration and attention
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16
Q

Conduct disorders are characterized by (4)

A
  • abusing others physically or sexually
  • telling lies
  • breaking the law by stealing, vandalizing, lighting fires
  • treating people and animals cruelly
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17
Q

Scleroderma (Systemic Sclerosis) definition

A

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.

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18
Q

2 types of scleroderma

A

limited cutaneous systemic sclerosis (formerly known as CREST syndrome) and diffuse cutaneous systemic sclerosis.

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19
Q

Limited Cutaneous Systemic Sclerosis (lcSSc) (CREST syndrome)

A

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.

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20
Q

Limited vs Diffuse Scleroderma

A

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).

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21
Q

HL VS NHL

A
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22
Q

ALL vs AML table

A
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23
Q

Cytogenic analysis of ALL

A

Philadelphia chromosome (t(9;22)) is associated with a poor prognosis in ALL but is treatable with tyrosine kinase inhibitors.

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24
Q

Cytogenic analysis of AML

A

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

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25
Q

Most common childhool leukemia

A

ALL

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26
Q

Characteristic finding in myeloblasts of AML patients

A

Auer rods

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27
Q

Pathognomonic findings in lymph node biopsy of hodgkin’s lymphoma

A

Presence of Reed-Sternberg cells is pathognomonic.

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28
Q

Bilobed nucleus and a classic “owl eye” appearanc

A

Reed sternberg cells

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29
Q

Irritable hip

A

LCP

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30
Q

LCP limitation in movement

A

Internal rotation and abduction

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31
Q

Osteomyelitis definitive diagnostic

A

MRI of the lumbar area

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32
Q

Osteomyelitis initial diagnostic

A

Xray

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33
Q

ptosis, miosis, lacrimation, conjunctival injection, rhinorrhea, nasal congestion

A

cluster headache or migrainious neuralgia

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34
Q

Cluster headache acute attack treatment (first step)

A

02

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35
Q

Cluster headache treatment if O2 unresponsive

A

Sumatriptan
Dihydroergoramine
Lidocaine

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36
Q

Cluster headache treatment first line

A

Verapamil sustained release

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37
Q

Most common cause of epididymoorchitis in sexually active males

A

Chlamydia

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38
Q

Congenital rheumatologic disease associated with neonatal bradycardia

A

Neonatal lupus erythematosus

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39
Q

Marker for Neonatal lupus erythematosus

A

anti RO anti La and/or U1 ribonucleoprotein but 95% montly is positive for anti-Ro

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40
Q

Most common cause of noisy breathing in infancy

A

Laryngomalacia

  • congenital softening of the tissues of the larynx above the vocal cords
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41
Q

Croup or LTB is caused by

A

parainfluenza virus type 1

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42
Q

seal barking cough and inspiratory stridor

A

Coup or LTB

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43
Q

Acute bronchiolitis is caused by

A

RSV

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44
Q

4Ds of Epiglottitis

A

Distress
Drooling
Dysphonia
Dysphagia

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45
Q

Epiglotitis is caused by

A

Haemophilus influenzae type b (Hib) bacteria

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46
Q

Hemolysis, painful crises or thrombotic complications in hypoxic conditions (high altitudes or during decompressions)

A

Heterozygous Sickle cell trait (HbAS)

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47
Q

Presentation of Heterozygous Sickle cell trait (7)

A
  • 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
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48
Q

Most common skin cancer in australia

A

Basal cell CA

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49
Q

2nd most common skin cancer in australia

A

SCC

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50
Q

Risk factors of SCC

A
  • 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)
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51
Q

Sudden onset patchy hair loss, no hair growth and normal appearing scalp

A

alopecia areata

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52
Q

Normal scalp but different lengths of hair observed

A

Trichotillomania

53
Q

Flaking and hairs of different lengths and different stages of growth often broken and damaged

A

Tinea Capitis

54
Q

Positive pull test

A

active alopecia

55
Q

Pathognomonic finding in alopecia but need not always be pressent

A

exclamation point hairs

56
Q

Amiodarone + warfarin

A

Hematoma

57
Q

Amiodarone + statin

A

inhibition of cytochrome p450 causing rhabdomyolysis
- myoglubrinuria
- hyperkalemia
- cardiac arrythmia

58
Q

Measles exclusion

A

excluded until 4 days after the onset of the rash

59
Q

Exclusion of contacts of known measles in childcare setting (3)

A
  • 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
60
Q

Measles vaccination schedule

A

At 12 months and 18 months

61
Q

Treatment of Shingles / Herpes Zoster first 72 hours

A

Antiviral agents

62
Q

Treatment of Shingles / Herpes Zoster after 72 hours of the onset of vesicles

A

Tricyclic antidepressants (Amitriptyline) and gabapentin

63
Q

Left sided hemineglect

A

Right pareital lobe

64
Q

Frontal cortex lesions manifestation

A

disnihibited speech and behavior
primitive reflexes
altered mental status
impaired judgement
contralateral weakness greater in legs than arms
contralateral cortiucal sensory deficits
gait ataxia

65
Q

Occipital lobe lesions

A

contralateral homonymous hemianopsia
cortical blindness
visual agnosia
altered mental status
impaired memory

66
Q

pulmonary hemorrhage + glomerulonephritis

A

Goodpasture syndrome

67
Q

Goodpasture pathophysiology

A

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

68
Q

Goodpasture kidney biopsy

A

cresentric glomerulonephritis

69
Q

Goodpasture immunofluorescence

A

linear deposits of IgG along the glomerular basement membrane

70
Q

Abdominal pain + diarrhea + confusion diagnosis

A

Serotonin syndrome

71
Q

SSRO + MAOI (Sertraline + selegiline)

A

Serotonin syndrome

72
Q

Melanocytic spots on the buccal mucosa and in the gastrointestinal tract

A

Peutz-Jegher syndrome

72
Q

First line medication for treatment of moderate to severe serotonin syndrome

A

Serotonin antagonist cyproheptadine (antagonist of HT2)

73
Q

vomiting, abdominal pain and abdominal distention; distended abdomen, non tender; absent bowel sounds

A

paralytic ileus

74
Q

Most common cancer in australia

A

Non melanoma skin cancer

75
Q

swollen tender and firm hemiscortum with short and thickened spermatic cord plan

A

Surgery

76
Q
A
77
Q

On warfarin, INR 2-3, high risk surgery plan

A

cessation of warfarin 4-5 days before surgery and administration of Vitamin K evening before surgery

78
Q

On warfarin, INR 2-3, high risk surgery; for emergency surgery

A

FFP or Prothrombinex-vf for rapid reversal

79
Q

Routine surveillance after breast cancer surgery

A

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

80
Q

Time for warfarin reversal

A

5 days maximum

81
Q

Post treatment mammogram for women who have undergone breast conserving surgery

A

1 year after initial mammogram, at least 6 months after completion of radiation therapy, then yearly

82
Q

Pregnancy associated breast cancer

A

Invasive ductal carcinoma

83
Q

Invasive ductal carcinoma in the first trimester treatment advice

A

Terminate pregnancy, mastectomy, chemotherapy and radiotherapy

84
Q

Absolute contraindications to ACE inhibitors (4)

A
  • 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
85
Q

Relative contraindications to ACEI (2)

A
  • Aortic stenosis
  • Hypertrophic cardiomyopathy
86
Q

Common adverse effect of ACEi and the main cause of non complicance

A

Cough

87
Q

Criteria for withdrawal of antiepileptics (4)

A
  • 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
88
Q

School exclusion of chicken pox

A

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)

89
Q

Preferred method of TB testing for patients who are vaccinated with BCG or are immunocompromised

A

IGRA

90
Q

Preferred method of TB testing overall

A

TST
IGRA as supplemental assay in patients older than 2 years

91
Q

Next step for a woman positive with hepatitis C antibody titer

A

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

92
Q

Late bleeding post tonsillectomy is most probably caused by

A

Infection

93
Q

Chronic seizure driving limitations

A

Non commercial = 12 months from last seizure
Commercial = 10 years

94
Q

Childhood epilepsy

A

No exclusion provided that no siezure has occurred after 11 years of age;
If with seizure after 11 years old, apply general rule unless

95
Q

Valvular heart disease that has the most significant complication in pregnancy

A

Mitral Valve Stenosis

96
Q

Significant heart conditions with high risk of complications in pregnancy (3)

A

Mitral valve stenosis
grade 3 or 4 heart failure
Atrial fibrillation

97
Q

DTPA Vaccination recommendations in pregnancy

A

single dose of dTpa is recommended during every pregnancy, preferably between 20 and 32 weeks gestation.

98
Q

DTPA vaccination schedule

A

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.

99
Q

First line contraceptive choice for women with epilepsy who are on enzyme inducing anti-epileptic drugs

A

Levonorgestrel releasing intrauterine contraceptive device or mirena

100
Q

Neonatal central cyanosis with no murmur

A

Transposition of great arteries

101
Q

5 congenital cyanotic heart disease

A
102
Q

Antiemetic of choice during pregnancy

A

Metoclopramide

103
Q

Severe migraine attacks in pregnancy

A

Codeine

104
Q

Chlamydia must knows

A

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

105
Q

Bacterial vaginosis treatment

A

Oral or vaginal clindamycin or metronidazole

106
Q

Scarring alopecia (3) treatment

A

Central centrifugal scarring alopecia
Dissecting cellulitis of the scalp
Acne keloidalis nuchae

Treatment: long acting oral tetracycline + topical corticosteroids

107
Q

Emeergency contraception/plan B

A

Levonorgestrel 0.7mg/tab 2 doses (12 hours apart
Ethinyl estradiol 100ug/tab BID 12 hours apart. nbgfdsa CVBXNZ

108
Q

Temporal lobe lesions manifestation (2)

A

Olfactory hallucinations
COmplex automatic behaviorisms

109
Q

Occipital lobe lesions

A

visual hallucinations

110
Q

Recurrent vaginal candidiasis treatment

A

Fluconazole 50mg/ OD for remission the 150mg weekly for 2 months

111
Q

Treatment regimen for pulmonary embolism

A

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)

112
Q

Percutaneous needle thoracentesis location

A

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)

113
Q

red urine + very high creatinine kinase + muscle weakness + statin treatment (in the background of erythromycin that can increase the level of statin)

A

rhabdomyolysis

–> next step is to investigate for bladder CA

114
Q

Amoebiasis presentation (3)

A

Dysentery
Enteritis
Hepatitis

115
Q

Egypt + urinary problems (frequency dysuria fever and terminal hematuria) hemospermia pale slightly febrile

A

primary bilharziasis or schistosomiasis

Schistosoma haematobium (urinary)
S. mansoni - GI
S. japonicum - liver disease

116
Q

Child-Pugh classification (portal hypertension) scores

A

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.

117
Q

Child-Pugh classification (portal hypertension)

A

Bilirubin
Albumin
INR
Ascites
Encephalopathy

118
Q

Liver hemangioma description

A

subcortical lesion with early prominent dense enhancement which spreads through the lesion in the late portal venous phase + intermittent RUQ pain

119
Q

primary jejunal lymphoma of the small bowel

A

coeliac disease

120
Q

location of spontaneous primary lymphoma of the small bowel (NOT associated with coeliac disease)

A

terminal ileum

121
Q

DOC treatment of chronic hepatitis B

A

Lamivudine

122
Q

Inguinal ligaments (M-L)

A

Lacunar ligament, Femoral VAN

123
Q

Zenker diverticulum (pharyngeal pouch) (3)

A
  • elderly
  • coughing immediately after a meal and regurgitation of food particles
  • chest infection/pulmonary problems
124
Q

Achalasia pathophysiology

A

increased lower esophageal sphincter tone and failure of relaxation

125
Q
A
126
Q
A
127
Q
A
128
Q

Mucous + blood in feces

A

UC or consider CA depending on age

AMC September 2024 (8 decks)

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