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purpuric rash,not blanching .fever and painful joints
40 year old female with tonsillitis,
Henoch Schonlein Purpura I
What are the clinical diagnosis of HSP?
Arthritis/ arthralgia
Abdominal Pain
Nephritis
Common org involved in HSP?
Group A Streptococcus
What is the initial management for HSP?
Urinalysis
Blood pressure
What is the most common complication of hSP?
Intussusception
What are the medical management of HSP?
Mild:
Bed Rest
Paracetamol - Ibuprofen / Naproxen
Moderate to Severe pain:
Steroids (glucocorticoids) in children
Oral Prednisolone or IV Methylprednisolone
Nontender soft swelling in the neck
Thyroglossal cysts
Anemia, weight loss
Angular stomatitis
Plummer Vinson Syndrome
What is the confirmatory Test for PVS?
Endoscopy
- to identify the presence of esophageal webs
CI in pregnancy, antidepressant
Paroxtine
Safe in pregnancy, for depression
Escitalopram
positive ANA test in a patient with joint pain
Uveitis
The most common presentation is delayed passage of meconium. Other symptoms can include poor feeding, poor weight gain, progressive abdominal distention, and vomiting
Hirschsprung disease
Hirschsprung disease typically presents with severe constipation or signs of intestinal obstruction. In some cases, the disease may present with ongoing symptoms from early childhood or with the development of functional obstruction, fecal impaction, and megacolon in later life
Definitive Diagnostic Test for Hirschsprung disease
Rectal Biopsy
commonly presented as a useful biomarker for the diagnosis or prognosis of AMI.
Serum lactate (SL)
It can present with a wide range of symptoms, including cough, shortness of breath, chest pain, fatigue, fever, weight loss, and skin rash
. A systolic murmur at the apex may be indicative of cardiac involvement in sarcoidosi
Sarcoidosis
s a liver condition that occurs during pregnancy and is characterized by intense itching (pruritus) and abnormal liver function tests
The itching is often worse at night and can be generalized or localized to the hands and feet
Elevated levels of bile acids in the blood are a hallmark
The yellow tinge of the sclera and abnormal liver function tests, including elevated bilirubin and alkaline phosphatase (ALP), are consistent with the diagnosis
Intrahepatic cholestasis of pregnancy
Systolic murmur at 3rd Left intercostal, fixed split, no cyanosis.
ASD
blood film tear drop cells.
Myelofibrosis, which is a serious bone marrow disorder.
A bone marrow biopsy definitive diagnosis
characterized by the absence of discrete P waves, presence of fibrillatory (f) waves, and an irregularly irregular ventricular rhythm
This irregularity in the R-R interval is a key feature
AF
Presence of anti-neutrophil cytoplasmic antibodies (ANCA), which appear in the blood of most people who have active granulomatosis with polyangiitis
ANCA testing can help support the diagnosis, but it is not specific to granulomatosis with polyangiitis and can also be positive in other forms of vasculitis
Wegener’s granulomatosis
anti-glomerular basement membrane (anti-GBM) antibodies, which lead to the development of glomerulonephritis and pulmonary hemorrhage
Goodpasture syndrome
is a kidney disease characterized by the deposition of immunoglobulin A (IgA) in the glomeruli, leading to glomerulonephritis.
IGA nephropathy
Gram stain showing diplococci is a characteristic finding for Neisseria meningitidis, which is a common cause of bacterial meningitis in adults
a) Neisseria meningitidis.
fever, rashes, neck stiffness, and a tonic-clonic fit are consistent with
meningitis
CABG done, c/o dyspnea. Ecg given
Atr flutter with av block
Duputyrens pic given, whats the cause?
Alcohol
Female with Try infertility hx of chlamydia+ (lap view of tubes
shown) best way to conceive? Ivf? Icsi? lui?
Panic attack pt ABG whats pco2 po2 and ph
Colles fracture pic given, way to keep the hand when fixing
Copd pt. Whats the indication for home oxygen? Fev1? Oximetry
<85%?
9days baby with nonbilious vomitting, K+ high Na+ low
diagnosis? Pyloric stenosis? Congen adrenal hyperplasia?
Pyloric Stenosis
SBO xray given pt pcame with feculant vomitting pain etc tachy
at admission 112bpm initial mgt done and KUO then tachy rises to
130 now what to do? Surgery?
2yr old bp pulse unrecodable ecg VT whats mgt? Shock?
Amidarone?
Amidarone?
Pt found in road . V fib. Two shocks given on the way. Still v fib.
Whats next adrenaline? Amiadarone?
Rubella vacc taken two weeks back, now found she is pregnant.
What to do? Serology? Terminate?
10/52 poa mother, asymptic. Her baby got chickenpox what to
do?
Senior collegue studying for specialist exam. Co insomnia and
req for a tamazepam pres from you. What to do? Suggest sleep
techs? Send to his gp?
48 yrs old female, not visited doc for 10 yrs past . Healthy.
Mom has osteoporosis at 65 and breat ca at 76, paternal grandad
colon ca in 70s brother has dm in 50s, what to check on her now?
Mammo? Cervical screening? Colonscopy? Fbs? Dexa scan?
Calculate GCS of a pt eye open to pain, limbs to pain and
incomprehensibe words
Young guy who dropped school. Threat to stab mom. Whats
the resona for behavior?
Chronic cannabis use 07/08/2023
question
Fx of moderate depression what to give?
Venlaxfixine
Most indicative fx of a pt with ectopic fx for urgent
intervention?
Shoulder tip pain
Xray of a child who swallowed coin. What to do?
. A sensorineural loss ques
Answer: audiometry
Image of blacked lower leg, medial malleolus. What is the diagnosis ?
A. Chronic Venous hypertension
B. Arterial insufficiency
C. DM
A. Chronic Venous hypertension
Calculation of Negative Predictive Value
Sudden onset of severe abdominal pain, back pain or renal colic in a patient over 60 years.
Abdominal Aortic Aneurysm Rupture
Sudden severe colicky pain radiated to groin with hematuria + signs of shock
Ruptured Abdominal Aortic Aneurysm
First sign of leak or impending Aortic rupture
back or loin pain
An elderly patient with severe generalized abdominal pain, nausea and diarrhea which may be bloody
Mesenteric Ischaemia
A leg ulcer that fails to heal despite treatment
maybe malignant
Peripheral Neuropathy
1st line treatment
Diabetic Neuropathy
Duloxetine
Peripheral Neuropathy
1st line treatment
All other neuropathies
Amytriptylline / Pregaballin
Peripheral Neuropathy
1st line treatment
Present of BPH with neuropathy
No Aminotriptylline only Imipraminbe/Nortriptylline
Peripheral Neuropathy
1st line treatment
Trigeminal Neuralgia
Carbamazepine
Best Diagnostic Tests for Anemia
Iron Deficiency Anemia
Decrease Ferritin
Best Diagnostic Tests for Anemia
Thalassemia
HB Electrophoresis
Best Diagnostic Tests for Anemia
Lead Poisoning
Lead Level blood in the urine
Best Diagnostic Tests for Anemia
B12 Deficiency
Increased Serum Methylmalonic Acid
Best Diagnostic Tests for Anemia
Folate Deficiency
RBCs Folate Levels
Best Diagnostic Tests for Anemia
Pernicious Anemia
Antibodies against Intrinsic Factor
Best Diagnostic Tests for Anemia
PNH
Cytometry
Best Diagnostic Tests for Anemia
Sickle Cell
Hb Electrophoresis
Best Diagnostic Tests for Anemia
G6PD
RBC Enzyme assay
Best Diagnostic Tests for Anemia
Pyruvate Kinase Disease
RBC Enzyme assay
Best Diagnostic Tests for Anemia
Aplastic Anemia
Bone Marrow Examination
Best Diagnostic Tests for Anemia
Hemolytic Anemia
Decreased Haptoglobin
What is the management for the H pylori Eradication
7 day course of a proton pump inhibitor + Amoxicillin + (Clarithomycin or Metronidazole)
If penicillin - allergic - A proton pump inhibitor + Metronidazole + Clarithromycin
Massive Pericardial Effusion
indurate base and everted edge, are most commonly associated with
Syphilis
Osgood Shlatter Disease
What is the most appropriate diagnosis?
Name 2 syndromes where this can be seen
Bony Syndactyly Involving the second and the third digits
Apert Syndrome and Crouzon Syndrome
This drug is a commonly used treatment for tuberculosis (TB) and can cause peripheral neuropathy, liver damage, and rash as its significant side effects.
Isoniazid
Another commonly used TB medication, can cause a harmless red-orange discoloration of urine, tears, and other bodily fluids. It can also lead to liver toxicity and gastrointestinal upset.
Rifampin,
is used in the initial phase of TB treatment and can cause gastrointestinal upset, liver toxicity, and joint pain.
Pyrazinamide
is also used in the initial phase of TB treatment and can cause optic neuritis, leading to visual disturbances.
Ethambutol
is an injectable medication used for TB and can cause auditory and vestibular (balance) nerve damage that can lead to hearing loss and balance problems.
Streptomycin
These two newer drugs used in multidrug-resistant TB treatment can cause cardiac arrhythmias (irregular heartbeat).
Bedaquiline and Delamanid
Carpal Tunnel Syndrome
Dermatomyositis
What are the clinical features of Dermatomyositis?
What are the investigations for Dermatomyositis?
Duodenal Atresia
A 1 year child presented to paediatric OPD with fever, maculopapular rashes all over the body, coryza, cough and conjunctivitis. What is your diagnosis?
Measles.
Measles is a highly contagious viral infection caused by the measles virus. It is characterized by fever, cough, coryza (inflammation of the mucous membranes in the nose), conjunctivitis (inflammation of the conjunctiva of the eyes), and a maculopapular rash that typically starts on the face and spreads to the rest of the body.
A 3yo old boy presented with fever, vomiting and these skin lesions. He was found to have bacteremia with Neisseria meningitidis? What is the diagnosis?
Meningococcemia with Skin necrosis due to DIC Purpura Fulminans
Baby, 4month, history of hydrocephalus with ventriculoperitoneal shunt. Complaint of abdominal distention on abdominal Xray shows this what’s the most likely diagnosis?
Intestinal Obstruction type Paralytic Ileus due to peritonitis
7yo female skin rash arthritis swollen tender hot colicky abdominal pain with vomiting. Investigation showed CBC normal platelet count platelet function normal coagulation profile. Urine analysis RBS proteinuria positive RBC cast. What is the diagnosis?
HSP
The symptoms presented - skin rash, arthritis, swollen tender joints, colicky abdominal pain with vomiting, and the laboratory findings of proteinuria and RBC casts in urine analysis - are suggestive of Henoch-Schönlein purpura (HSP). HSP is a disease that causes inflammation and leakage of blood in small blood vessels, commonly affecting the skin, joints, intestines, and kidneys. The main symptom is a raised red-purple spotted rash, typically on the legs, feet, and buttocks, along with joint pain and gastrointestinal symptoms
An 81 yo man with a history of atrial fibrillation and hypertension presented after a fall. His medications were Apixaban, Ramipril, bisorolol, Amlodipine and Amiodarone. What is the most likely cause of the skin findings?
Blueman Secondary to Amiodarone
A 1 month old baby with a history of abdominal distention noticed few days after birth. Excessive gas bloating . Passing small amount of stool, often watery. Excessive crying. No history of vomiting. What is the diagnosis?
Hirschsprung’s Disease.
Hirschsprung’s disease is a congenital disorder of the colon that results from the absence or underdevelopment of the ganglion cells in the myenteric and submucosal plexuses of the distal digestive tract. This results in a functional obstruction of the colon and leads to the symptoms described, such as abdominal distention, excessive gas bloating, passing small amounts of stool, often watery, and excessive crying.
The diagnosis of Hirschsprung’s disease is usually suspected based on clinical features and imaging studies, such as contrast enema and rectal suction biopsies.
EBV or Infectious Mononucleosis …
D. No treatment is required for infectious mononucleosis as it is caused by the Epstein-Barr virus, which does not respond to antiviral medications such as Acyclovir. Antibiotics are also not effective against viral infections. Prednisolone may provide some symptom relief but is not necessary for all patients. The primary treatment for infectious mononucleosis is supportive care and management of symptoms.
is an antifungal medication that is effective against candidiasis and is the recommended first-line treatment for recurrent vulvovaginal candidiasis.
Fluconazole
is a type of corticosteroid medication that is commonly used for the long-term management of asthma. It works by reducing inflammation and swelling of the airways, which can help to prevent asthma attacks.
. Inhaled fluticasone
Is a short-acting bronchodilator medication that can be used for quick relief of asthma symptoms during an attack. However, it is not recommended for long-term use as a preventive measure
Inhaled salbutamol
A type of stroke that can cause symptoms such as balance impairment, unsteady gait, and limb ataxia, but would not typically cause significant agraphia, acalculia, or orientation problems.
Cerebellar vermis stroke
A type of stroke that can cause changes in behavior, personality, and executive functions such as decision making and planning, but is less likely to cause severe deficits in language and spatial orientation.
Frontal lobe stroke
A type of stroke that can cause visual disturbances and impairments
Occipital Lobe Damage
What is the scaphoid fracture management?
Non-displaced fractures in the waist or distal pole of the scaphoid can be treated by immobilizing the wrist with a cast for six to 12 weeks. Fractures in the proximal pole, displaced fractures, or those not treated soon after injury require surgical repair.
Kid with limp and fever, history of URTI. With hip movements normal but tender hip. What is the diagnosis?
The clinical presentation of a child with fever, limp, and tenderness over the hip following a recent history of upper respiratory tract infection is suggestive of a transient synovitis.
Transient synovitis is the most common cause of hip pain in children, typically occurring in those aged between 3 to 10 years, and it usually develops after a preceding respiratory or gastrointestinal infection. The child may also have difficulty walking and may have a fever, but the range of motion and hip movement are usually normal.
Photo similar to pyogenic granuloma. Man works in a sheep shearing place. What is the diagnosis?
Orf is a viral skin infection caused by the parapoxvirus, which is typically seen in animals, such as sheep and goats, and can be transmitted to humans through direct contact with infected animals or contaminated equipment. The condition is characterized by a nodular lesion, often with a central crust, that can appear similar to a pyogenic granuloma.
In individuals who come into close contact with sheep, such as farmers, shearers, or veterinarians, orf can be diagnosed based on clinical presentation, history, and physical examination. Diagnosis can be confirmed by viral culture or polymerase chain reaction (PCR) testing.
Picture with ingrown toe nail and infected. First episode. What is the management?
- Warm water soaks: The affected area should be soaked in warm, soapy water for 15-20 minutes, 3-4 times a day to help reduce swelling and infection.
- Antibiotics: If the infection is moderate to severe, an oral antibiotic may be prescribed by a medical professional, which should be taken for the full length of the prescription.
- Elevation: The affected foot should be raised whenever possible to help reduce swelling and improve blood flow to the affected area.
- Pain management: Over-the-counter pain relievers such as acetaminophen or ibuprofen can be used to help manage pain.
- Dressing changes: The affected area should be kept clean and covered with a sterile dressing.
- Nail care: Once the infection has healed, the nail should be trimmed straight across and not too short, and narrow shoes should be avoided.
are the treatment of choice for Guillain-Barre syndrome.
intravenous immunoglobulins (IVIG)
