Khalifa Medicine Posting

Question 0

Differentiate between upper and lower motor neuron lesion

Answer 0

Upper;
Babinsky sign, exaggerated reflexes(hypereflexia), hypertonia, clonus?, No muscle wasting,

Lower;
Hypotonia, hyporeflexia, fasciculations?, muscle wasting,

Question 1

Examination of patient with one sided weakness

Answer 1

General examination= orientation to time place and person
General appearance = alert, well looking
Examine vitals, CVS and Resp
Neuro= cranial nerves=muscles of face
Limb muscles= proximal to distal
Power, tone and reflexes
Power= ask patient to;
abduct upper arm against ur attempt to adduct it
Flex elbow against pressure
Spread fingers against pressure
Flex at hip joint against pressure
Flex knee against pressure
Check for babinsky sign
Check tendon reflexes

Question 2

What is clonus? And reason for fasciculations

Answer 2

Find out

Question 3

Reason for external rotation and inversion of paralyzed leg in upper motor neurone lesion? And why was patient leaning to the paralyzed side?

Answer 3

Find out

Question 4

Symptoms of hemodynamically unstable Afib

Answer 4

Chest pain, altered state of consciousness and hypotensive

Question 5

Typical MI presentation

Answer 5

Chest pain, radiating to left arm, shoulders, back, or jaw

Associated with nausea and vomiting and sweating

Question 6

ATypical MI presentation

Answer 6

Epigastric pain in inferior wall MI
Silent chest pain in diabetic patients?
Shortness of breath
Dizziness

Question 7

ECG of MI patient

Answer 7

St elevation= more than 2 small squares 
Lead I and aVF =leaflet?
Lead I, II, III, IV = anteroseptal?
Lead V1,V2, = posterior MI?
Read about how to fin the location of the ischemia?

Question 8

Cardiac markers and specificity

Answer 8

CK-MB=specific
Troponin=specific
Myoglobin =not specific
LDH= not specific

Question 9

Timeline an d conc of cardiac markers after MI

Answer 9

Appear. Peak. Remain in blood for.
CK-MB=. After 3-4hrs. 12hrs. 5days
Troponin=. After 4hrs. 12-24hrs. ?
LDH =
Myoglobin =

Question 10

MI treatment

Answer 10

Stabilize pt= give O2
Vasodilator= nitroglycerin
Morphine
Anti platelet
Beta blocker= decreases O2 demand by decreasing contractility
Primary angioplasty within 3hrs of MI or
Thrombolysis= streptokinase or Tissue Plasminogen Activator (t-PA)

Question 11

Disadvantage of thrombolysis with streptokinase

Answer 11

Streptokinase from streptococcus so could express antigens which could lead to anaphylactic shock
Also has high hemorrhagic risk so t-PA preferred

Question 12

Absolute contraindication of thrombolysis

Answer 12

History of hemorrhage
CVA < 6 months, Bleeding peptic ulcer < 6 month
Aortic dissection, dissecting aortic aneurysm

Question 13

Relative contraindications of thrombolysis

Answer 13

Coagulopathies
HTN of > or equal to 180/110mmHg
Pregnancy?= abortion=why?
Diabetic Neuropathy?