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FAMILY MEDICINE > Dr. Akinbami > Flashcards

Dr. Akinbami Flashcards

1
Q

ALOPECIA:
a. Total loss of scalp hair called
b. Partial loss of scalp hair called
c. Total body hair loss called

A

a. ALOPECIA TOTALIS
b. ALOPECIA AREATA
c. ALOPECIA UNIVERSALIS

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2
Q

Scarring alopecia denotes ____ loss

A

Irreversible Loss

maybe signs of systemic diseases

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3
Q

Treatment of Alopecia (hint: 2)

A

Treatment difficult
Topical/intralesional steroid
Minoxidil

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4
Q

Which of the Herpes simplex strain is sexually transmitted and causes genital lesions

A

HSV-2

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5
Q

Prickle cell layer of the epidermis is stratum ______

A

Stratum spinosum

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6
Q

Skin distribution of Psoriasis is on the symmetrical flexural areas, T/F

A

FALSE

On the symmetrical extensor area

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7
Q

Skin distribution of Atopic dermatitis is on the asymmetric flexural area, T/F

A

FALSE

On the Symmetrical flexural areas

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8
Q

What surgical treatment is used for tattoo removal

A

Dermabrasion

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9
Q

Topical treatment has no systemic toxicity, T/F

A

FALSE

Reduced systemic toxicity.

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10
Q

Choice of vehicle for local application is as important as choice of the active ingredient, T/F

A

TRUE

Greases reduce moisture loss while many lotions do the reverse.

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11
Q

Circumscribed flat area of skin discoloration <0.5cm is a _______

A

Macule

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12
Q

Solid elevation of the skin <5mm is _____

A

Papule

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13
Q

Solid elevation of the skin exceeding 1cm in diameter is _____

A

Nodule

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14
Q

Associate the primary skin lesion with the disease condition
a. Lepromatous leprosy
b. Keloids
c. Acne
d. Neurofibromatosis
e. Onchocerciasis
f. Urticaria
g. Herpes simplex
h. Herpes zooster

A

a. Nodule
b. Plaque
c. Papule
d. Nodule
e. Nodule
f. Wheal
g. Vesicle
h. Vesicle

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15
Q

Pus containing dermal elevation <5mm is _____

A

Pustle

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16
Q

Nodule filled with compressible fluid or semisolid material is______

A

Cyst

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17
Q

Associate the secondary skin lesion with the disease condition
a. Seborrheic dermatitis
b. Impetigo
c. Infected dermatitis
d. Psoriasis
e. Onchocerciasis
f. Scabies

A

a. Scales
b. Crust/scabs
c. Crust/scabs
d. Scales
e. Excoriations
f. Excoriations

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18
Q

In keloids, inflammatory reactions and fibroblasts are much fewer than in scars, T/F

A

TRUE

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19
Q

Common in pruritic diseases that can present with excoriation are (hint: 5)

A

Uremia
Scabeis
Urticaria
Obstructive jaundice
onchocerciasis

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20
Q

Mention hypopigmented (hypomelanosis) lesions (hint: 4)

A

PITYRIASIS ALBA
TINEA VERSICOLOR
SEBORRHEIC DERMATITIS
LEPROSY

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21
Q

Mention Depigmented (Amelanosis) lesions (hint: 5)

A

ALBINISM
PIEBALDISM
VITILIGO
ONCHOCERCA DERMATITIS
POST BURNS

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22
Q

Mention hyperpigmented (hypermelanosis) lesions (hint: 7)

A

NAEVI
CAFÉ AU LAIT SPOTS
ECZEMA
MELASMA (CHLOASMA)
FIXED DRUG ERUPTION
LENTIGOS
MALIGNANT MELANOMA

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23
Q

Classic warning signs of skin malignancy are (hint: ABCDE)

A

A Asymmetry
B Border irregularity
C Colour (Non-uniform-brown, red, black, white)
D Diameter (>6mm)
E Evolving over time

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24
Q

Malignant melanoma is common in dark people, T/F

A

FALSE

Rare in dark people

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25
Q

Malignant melanoma is related to exposure to sunlight, T/F

A

TRUE

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26
Q

The 4 types of malignant melanoma recognized are

A
  1. Lentigo maligna melanoma
  2. Superficial spreading melanomas
  3. Nodular melanoma
  4. Acral lentiginous melanoma
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27
Q

The form of Malignant melanoma that occurs in black people is

A

Acral lentiginous melanoma

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28
Q

Treatment of Malignant melanoma (hint: 3)

A

Wide excision
Nodal dissection
Chemotherapy

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29
Q

Can Chemotherapy be used to treat Malignant melanoma, T/F

A

TRUE

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30
Q

Seborrheic dermatitis is synonymous to Eczema, T/F

A

TRUE

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31
Q

Treatment for Seborrheic dermatitis (hint: 3)

A

Treatment with selenium sulphide or ketoconazole shampoo and 1% hydrocortizone cream

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32
Q

What test do you carry out in a suspected contact dermatitis

A

Patch test

Patch test may help in identifying offending agent

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33
Q

Lesions of contact dermatitis can never spread, T/F

A

FALSE

Lesion tends to conform to sites of contact initially but may later spread

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34
Q

Acne affects more females than males, T/F

A

FALSE

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35
Q

Mention causes of Acne (hint: 5)

A

PCOS
Cushing’s syndrome
Virilising tumours
Metabolic steroids
Acne vulgaris

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36
Q

Peak age for Acne vulgaris is _____

A

18

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37
Q

Drug Eruption Types (hint: 6)

A

1.Maculo-papular/exanthematous.
2. Urticaria +- angioedema/anaphylaxis
3. Exfoliative dermatitis (sulphonamides, carbamazepines)
4. Erythema multiforme major (Steven-Johnson Syndrome)
5. Toxic Epidermal Necrolysis
6. Fixed Drug Eruption

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38
Q

Inflammatory acne is result of host response to the _____

A

Follicular propionibacterium acne

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39
Q

Treatment of acne

A

Soap and water wash
T4C 500mg BD x 8/52

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40
Q

Generalized eruption mostly on the trunk, arms & thighs (shirt & short distribution) preceded by Herald patch is _____

A

Pityriasis Rosea

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41
Q

Causative organism in Pityriasis versicolor

A

Pityrosporum orbiculare

(Org. Previously called malasezia furfur)

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42
Q

Treatment for Pityriasis alba is _____

A

Resolves spontaneously over months /years
No treatment required

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43
Q

Treatment of Pityriasis versicolor

A

Topical imidazole antifungal (Clotrimazole)
Topical selenium sulphide shampoo to affected area@ night, wash following am. Repeat x2 @ weekly interval

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44
Q

Pityriasis alba is associated with _____

A

Atopy

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45
Q

Management of Callosities is

A

Keratolytics (5-10% salicylic acid ointment or 10% urea cream)

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46
Q

Callosities is painful, T/F

A

FALSE

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47
Q

Corns is painful, T/F

A

TRUE

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48
Q

Treatment of Corns

A

Attention to foot wears
Keratolytics
Cushioning (Corn pads)

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49
Q

Autosomal dominant hyperkeratosis of palms/soles is______

A

KERATODERMA

Treatment is Keratolysis

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50
Q

Most common form of skin cancer

A

Basal cell cancer

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51
Q

Basal cell cancer is mainly on light exposed areas esp. face, T/F

A

TRUE

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52
Q

The Dermatophytes most commonly involved in Dermatophytosis are (hint: 3)

A

Microsporum
Trichophyton
Epidermophyton

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53
Q

The following dermatophyte infection and their related affected body parts
a. Tenia barbae
b. T. manus
c. T. cruris
d. T.Capitis
e. T corporis
f. T unguium
g. T, pedis

A

a. Bearded areas of face & neck
b. Hand(s)
c. Genital, pubic, groin, perineal, perianal (Jock itch)
d. Skin of the scalp, eyebrows, eyelashes
e. Skin of body
f. Toenails or Fingernails (onychomycosis)
g. Foot- soles of feet & interdigital spaces (Athlete’s foot)

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54
Q

Onychomycosis is also called ______

A

Tinea unguium

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55
Q

Epidermophyton spp. affects mostly the _____ part of the body

A

Feet

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56
Q

Treatment for dermatophytosis

A

Treatment by topical/systemic antifungal

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57
Q

Scabies is caused by _______

A

An itch mite, Sarcoptes scabei

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58
Q

Skin lesions seen in scabies is due to __________

A

Hypersensitivity reaction to the parasite

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59
Q

The pruritus in scabies occurs mostly at night, T/F

A

TRUE

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60
Q

Rash in scabies is described at __________

A

Papulopustular rashes esp.
in interdigital spaces
Flexor surface of the wrist
Elbow and axillary fold
Areolar of breast
Male genitalia, esp. phallus
Along belt line
Buttocks

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61
Q

Treatment for scabies

A

Bath & scrub lesion wt sponge to open up burrows
25% benzyl benzoate cream/lotion applied from top of patient to bottom
Alternatively, permethrine, malathion, 1% lindane, crotamiton (Eurax) or 10% sulphur ointment is used

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62
Q

Pediculosis is caused by ________

A

A lice, Pediculus humanus coporis/capitis/pubis

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63
Q

Pediculosis pubis is spread via ______

A

Direct contact (coitus)

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64
Q

Predisposing factors for Pediculosis (hint: 3)

A

Overcrowding
Dirty clothing
Poor personal hygiene

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65
Q

Treatment for Pediculosis

A

1% lindane (gamma benzene hexachloride, BHC)
Applied daily X 2/7 in form of shampoo, cream Or lotion or as combination of shampoo followed by cream or lotion
Disinfect combs, brushes and clothing

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66
Q

Herpes zooster affects posterior Root ganglia, T/F

A

TRUE

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67
Q

Treatment for Herpes zooster

A
  1. Acyclovir (Zovirax)
    2.Post herpetic neuralgia
    Opiods
    TCAs
    Carbamazepin
    Gabapentin
  2. Steroids may decrease incidence of post herpetic neuralgia, though it does not shorten period of acute pain
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68
Q

Plasmodium spp. is an obligate intracellular protozoa, T/F

A

TRUE

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69
Q

Which species of plasmodium can persist in the liver as Hypnozoites

A

P vivax & P ovale

some schizonts persists as HYPNOZOITE in liver and may remain dormant for weeks/months or up to 3yrs

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70
Q

Synchronous release of merozoites occur every 48hrs in P. falciparum, T/F

A

TRUE

Tertian malaria

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71
Q

Synchronous release of merozoites occur every 48hrs in P. vivax, T/F

A

TRUE

Tertian malaria

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72
Q

Synchronous release of merozoites occur every 48hrs in P. malariae

A

FALSE

Quartan malaria(72hrs)

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73
Q

Duration of macrogametocyte & microgametocyte in man lasts for ____days to _____months

A

7days to 2 months

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74
Q

P. malaria invades only young RBCs & reticulocytes,T/F

A

FALSE

Invades only aging RBCs

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75
Q

Duration of infection is shortest with P. falciparum, T/F

A

TRUE

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76
Q

Duration of infection is longest with P. vivax, T/F

A

FALSE

P. malariae

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77
Q

Which Plasmodium spp. is almost a commensal infection in some adults

A

P. malariae

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78
Q

Which Plasmodium spp. development is suppressed in patient of HbF, HbS

A

P. falciparum

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79
Q

Duffy antigen is required for infection with _____ Plasmodium spp.

A

Vivax

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80
Q

Breastmilk provides protection from Plasmodium spp., how?

A

B/c it is deficient in PABA

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81
Q

In stable endemic malaria, transmission is generally high, T/F

A

TRUE

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82
Q

In unstable malaria, herd immunity is low, T/F

A

TRUE

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83
Q

Define transmission index in malaria

A

Proportion of infants less than one year with parasitaemia
(microscopic proven parasitemia)

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84
Q

Spleen rate is above 75% in children aged 2-9yrs is Hyperendemicity, T/F

A

FALSE

Holoendemicity

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85
Q

In Holoendemicity, there is low adult spleen rate, T/F

A

TRUE

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86
Q

Spleen rate in Mesoendemicity is _____

A

11-50%

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87
Q

Sporozoites & gametocytes inducee pathologic changes, T/F

A

FALSE

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88
Q

_________ is associated with the affinity of parasitized RBC for vasular endothelium of capillaries of internal organs

A

Histidine-rich, falciparum protein knob

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89
Q

Dilutional hyponatremia seen in pathophysiology of malaria is due to ______& _______

A

Secondary Aldosterone & ADH secretion

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90
Q

Hypoglycemia in pathophysiology of malaria is due to ______

A

TNF & Impaired gluconeogenesis

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91
Q

Incubation period of plasmodium falciparum is b/w _____to ____days

A

8 - 20 days

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92
Q

Malaria paroxysm follows rupture of _______

A

Matured schizonts in RBC

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93
Q

The primary attack of malaria after the IP is characterized by ________

A

Influenza like syndrome, such as

Asthenia
Arthralgia
Myalgia
Headache, nausea

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94
Q

In tertian malaria, the paroxysm/cycle repeats itself every ______hours

A

48hrs

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95
Q

Nephrotic syndrome is a delayed complication of which Plasmodium spp.

A

P. malariae

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96
Q

The gold standard diagnosis for malaria is

A

Microscopy

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97
Q

Thick film is superior in terms of parasite identification, T/F

A

TRUE

Thick film superior in terms of parasite identification.
Thin film needed for specie identification

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98
Q

Leishman stain can be used for both thick and thin film, T/F

A

FALSE

Giemsa for thick & thin films
Leishman for thin film

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99
Q

1-10 parasites per 1 thick film field is how many +

A

3+

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100
Q

11-100 parasites per 100 thick film field is how many +

A

2+

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101
Q

Mention the 3 methods of microscopy based diagnosis of malaria

A
  1. Blood film exam.
  2. Quantitative Buffy coat (QBC)
  3. Benzothiocarboxypurine (BPC) method
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102
Q

_________ is based on detection of parasite specific Histidine-rich protein II

A

Parasight F antigen based test

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103
Q

Optimal T antigen based test detects ______ in Plasmodium parasite

A

Lactic dehydrogenase (pLDH)

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104
Q

The 4 types of serological tests to diagnose malaria are

A
  1. Indirect Fluorescent antibody Test (IFAT)
  2. Indirect Heamagglutination Test (IHAT)
  3. Immunoprecipitation technique (Double gel diffusion test)
  4. Enzyme linked immunosorbent assay (ELISA)
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105
Q

In uncomplicated malaria, Artemisinine base combination therapy is recommended. Give the 3 combinations & doses

A

Artemeter-lumefantrine(120 :20)
Artesunate (4mg/kg) + Amodiaquine (10mg/kg)
Artesunate (4mg/kg dly *3days) + Mefloquine 25mg base/kg

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106
Q

If the 3 ACT recommended in uncomplicated malaria fails, give ______

A

Oral Quinine

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107
Q

Targets for malaria chemoprophylaxis (hint: 5)

A
  1. Non-immune travelers to endemic countries
  2. Returning immigrants to endemic areas
  3. Pregnant women
  4. Immunocompromised
  5. Sickle cell anaemic patients
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108
Q

In malaria chemoprophylaxis in pregnancy (, when should the first dose be commenced and when should the last dose be given

A

First dose after 16th week’
Last dose not later than one month before EDD

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109
Q

Malaria chemoprophylaxis in Sickle cell disease patient
for children & adult + doses

A

PROGUANIL
Children 100mg daily
Adult 200 mg daily

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110
Q

Malaria Chemoprophylactic drugs in gen (hint: 3)

A

Atovaquone/Proguanil (Malarone)
Mefloquine (250mg weekly)
Doxycycline (250mg daily)

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111
Q

Define shock

A

State of overwhelming systemic reduction in tissue perfusion characterized by decreased cellular oxygen delivery and utilization as well as removal of waste by product of metabolism

N/B: Inadequate tissue perfusion

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112
Q

Hypotension is synonymous to shock, T/F

A

FALSE

Hypotension, though common in shock, is not synonymous with shock

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113
Q

Which shock has mortality rate of >60%

A

Cardiogenic shock

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114
Q

List the types of shock

A

HYPOVOLAEMIC SHOCK
CARDIOGENIC SHOCK
DISTRIBUTIVE SHOCK
OBSTRUCTIVE SHOCK

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115
Q

Anaphylactic shock is an example of distributive shock, T/F

A

TRUE

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116
Q

Neurogenic shock is an example of obstructive shock, T/F

A

FALSE

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117
Q

Septic shock is an example of ______ type of shock

A

Distributive shock

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118
Q

Pulmonary embolism will cause which shock?

A

Obstructive shock

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119
Q

Tissue hypoxia sets in when the ratio of oxygen delivery to oxygen consumption is ______

A

<2:1

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120
Q

Cellular hypoxia causes release of cytokines & secondary inflammatory mediators, T/F

A

TRUE

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121
Q

Anaerobic glycolysis produces ____ATPs from 1mol of CHO

A

3 ATPs (21Kcal)

122
Q

Aerobic glycolysis produces ____ATPs from 1mol of CHO

A

38 ATPs (266Kcal)

123
Q

Cellular hypoxia causes SIRS, T/F

A

TRUE

124
Q

Shock results when ____% of total blood volume is lost

A

25%

125
Q

Which 2 arteriolar vessels are spared in the compensatory arteriolar constriction to shock

A

coronary & cerebral vessels are spared & vasodilate

126
Q

The late phase of shock is when decompensation sets in, T/F

A

TRUE

127
Q

Decompensation in shock is characterized by _______, _______ & _______

A

↓coronary perfusion & ↓ myocardial contractility, ↓cerebral blood flow wt confusion, restlessness, coma & death

128
Q

Signs of successful resuscitation of shock are (hint: 5)

A

IMPROVED BP
IMPROVED MENTATION
RESOLVING METABOLIC ACIDOSIS
ADEQUATE URINE OUTPUT
IMPROVED SKIN PERFUSION

129
Q

In airway care in a case of suspected cervical spine injury, which technique do use to reposition the head & neck

A

Jaw thrust

130
Q

Features of breathing inadequacy (hint: 3)

A

Central cyanosis (except in severe anemia)
No breathing heard or felt at the mouth or nose
No activity of respiratory muscles

131
Q

In AMBU bag ventilation, aim for ____bpm in adults and ____bpm in children (Should be breath cycles per minutes)

A

aim for 15bpm in adult and 30 bpm in children

132
Q

Do not interrupt external cardiac massage for more than ___ secs when inserting an Endotracheal tube

A

20 secs.

133
Q

In a confirmed acidosis in an event of cardiorespiratory arrest, what should you administer

A

1mmol/kg of 8.4% NaHCO3

134
Q

For the following conditions, Mark T/F for those to use a defibrillator to defibrillate
a. Ventricular tachycardia
b. Pulseless electrical activity (PEA)
c. Asystole
d. Ventricular Fibrillation
e. Electromechanical dissociation
f. Normal sinus rhythm
g. No femoral/carotid pulse

A

a. T
b. F
c. F
d. T
e. F
f. F
g. F

135
Q

Causes of cardiorespiratory arrest (hint: 6)

A

Hypoxia
Drug overdose
Myocardial infarction
Pulmonary embolism
Hypovolemia
Electrolyte imbalance

136
Q

Dose of epinephrine in cardiorespiratory arrest
- IV dose
- When IV is unavailable

A

Dose:1mg i/v. If no i/v, 2mg in 10mls saline I/T
Repeat x 3

137
Q

In proven hypokalemia in a case of cardiopulmonary arrest, what do you administer

A

0.3mmol/Kg IV over 5mins

138
Q

In proven hypokalemia, IV KCl can be given less than 5 mins, T/F

A

FALSE

OVER not less than 5min for proven hypokalemia

139
Q

Drugs & their doses used in cardiorespiratory arrest are (hint: 4-5)

A
  1. Epinephrine - Dose: 1mg i/v. If no i/v, 2mg in 10mls saline I/T
    Repeat x 3
  2. Potassium chloride (KCl) - 0.3mmol/kg i/v
  3. Atropine -1mg i/v (can repeat x3) or 3mg as single dose
  4. Lidocaine - 1 - 2mg/kg I/V
  5. 8.4% Sodium bicarbonate (NaHCO3) - 1mmol/kg
140
Q

Atropine is indicated for use in tachycardia, T/F

A

FALSE

for bradycardia or asystole

141
Q

Epinephrine can be given in ventricular fibrillation, T/F

A

TRUE

Makes electrical defibrillation more likely to succeed in cases of ventricular fibrillation

142
Q

What drug do you give for ventricular arrhythmias in a case of Cardiorespiratory arrest

A

Lidocaine

143
Q

Concerning GCS, eye opening to pain is scored ____

A

2

144
Q

In best motor response, abnormal extension is scored ____

A

2

145
Q

In best motor response, flexion withdrawal (withdraws from pain) is scored _____

A

4

146
Q

In best verbal response, inappropriate words is scored ____

A

3

147
Q

The estimated blood loss from pelvic fracture is ___

A

2-3Litres

148
Q

The estimated blood loss from femoral fracture is ___

A

1-2Litres

149
Q

What class(es) of Antibiotics can prolong Neuromuscular blockade

A

Aminoglycoside, Tetracycline

150
Q

In pre-op, ensure PT/INR IS ___

A

<1.5

151
Q

In pre-op, switch Warfarin to Heparin, T/F

A

TRUE

152
Q

Stop Oral contraceptive pills _____weeks before major & pelvic surgeries and recommence ____weeks post-op if mobile

A

4 weeks- stop
2 weeks post op if mobile

153
Q

Suxamethonium can increase plasma potassium, T/F

A

TRUE

154
Q

ASA classification of physical status in Pre-op assessment (hint: 5 classes)

A

Class 1: Normal healthy patient.
Class2: Patient with mild systemic disease
Class3: Incapacitating severe systemic
disease; not life threatening
Class4: Life threatening severe systemic
disease.
Class5: Moribund patient

For emergency surgery, letter ‘E’ is added, e.g 2E

155
Q

CXR & ECG are indicated in post-op investigation for patients >5oyrs, T/F

A

TRUE

156
Q

Pre-medications in Pre-op (hint: 7 A’s)

A

Analgesia (Preemptive)
Anxiolysis
Amnesia
Antacid
Antiemesis
Antibiotics
Anti-autonomic

157
Q

Timing for pre-medication during pre-op
- for PO
- for IM

A

2HR PRE OP FOR ORAL
1HR PRE OP FOR IM

158
Q

List Armamentarium you can recall

A

VISIT NOTE

159
Q

Inhalational General anesthetics (Hint; DIS HONE)

A

Desflurane
Isoflurane
Servoflurane
Halothane
Oxygen
Nitrous oxide
Ether

160
Q

Which of the inhalational general anesthetic has post operational hepatitis as its complication

A

Halothane

161
Q

Agents of choice for inhalation induction of anesthesia are _______ & ______-

A

Desflurane and Servoflurane

162
Q

Which of the Halogenated Ether causes cough, laryngospasm & breath holding when used as an inhalational anesthetic

A

Isoflurane

163
Q

Balanced anesthesia most ensure ______, _______ & ________

A

analgesia, hypnosis and relaxation

164
Q

Most popular intravenous induction agent for anesthesia is

A

Propofol

165
Q

IV injection of Thiopentone is always painful, T/F

A

FALSE

166
Q

The most widely used intravenous agent in developing countries is ______

A

Ketamine, a Phencyclidine derivative

167
Q

The average sleep dose of Thiopental barbiturate is ______

A

5mg/kg IV

168
Q

Average induction dose of Ketamine is _____
- for IV
- for IM

A

1-2ml/kg (for IV)
6-8mg/kg (for IM)

169
Q

Ketamine produces marked increase in salivary secretion necessitating injection of _______

A

Atropine

170
Q

When Ketamine is given as the sole anesthetic agent _______ should be given to reduce hallucination, delirium & nightmare

A

Diazepam

171
Q

Thiopentone is a potent anticonvulsant, T/F

A

TRUE

172
Q

Depolarizing Neuromuscular blockers can be used in paraplegic, T/F

A

FALSE

172
Q

Depolarizing Neuromuscular blockers can be used in burns patient, T/F

A

FALSE

173
Q

Ketamine can cause bronchoconstriction, T/F

A

FALSE.

It relaxes the bronchioles instead

174
Q

The ideal intubating agent is ___

A

Suxamethonium

B/c of its rapid onset & short duration of action(2-6mins)

175
Q

If a 2nd dose of Suxamethonium is required what should you give first?

A

Atropine

176
Q

2nd dose of Suxamethonium can cause Tacchycardia, T/F

A

FALSE.

causes Bradycardia

177
Q

Dose of Suxamethonium is ______

A

1-1.5mg/kg

178
Q

2 Examples of Non-Depolarizing Neuromuscular blockers are (

A

Atracurium, Vecuronium

179
Q

The drug of choice for General anesthesia in renal & liver failure is _________-

A

Atracurium

b/c of Hoffman elimination 9spontaneous metabolic elimination)

180
Q

Which of the classes of NM-blockers/relaxants is indicated for patients with Myasthenia gravis

A

Non-depolarizing relaxants

181
Q

When is Rapid Sequence Induction indicated

A

Used when risk of aspiration is high

182
Q

Steps in Rapid Sequence Induction

A

Used where risk of aspiration is high.
1. Pre- oxygenate with 100% oxygen
2. Sellick’s manoeuvre on induction
3. Short acting muscle relaxant immediately after induction
Intubation
4. Release cricoid pressure
5. Give a longer acting muscle relaxant when suxamethonium wears off

183
Q

Conductiing anesthetic agents with adrenaline can be used on areas without collateral circulation, T/F

A

FALSE

184
Q

Define burns

A

Coagulation necrosis of skin +/- deeper tissue

185
Q

Causes of burns (hint: 4)

A

Dry heat
Electricity
Chemical caustics
Irradiation

186
Q

Burns occurs most commonly in children, T/F

A

TRUE

187
Q

In pathophysiology of burns the initial response is _______ followed by ________

A

Vasoconstriction (from adrenal release of catecholamines followed by vasodilatation

188
Q

The adrenal changes/response a systemic response in burns does 2 things

A

Vasoconstriction via catecholamines
Increase serum glucose (17-OH corticosteroids ensure glcogenolysis,lipolysis and gluconeogenesis)

189
Q

In serve burns, there is anemia due to _______ & ______-

A

RBC Diapedesis and Direct red cell destruction

190
Q

Hemodilutional anemia is usually seen in Full blood count result in Burns, T/F

A

FALSE

Hemoconcentration

191
Q

In burns, max. edema obtainable is ___% body weight or ___% of total extracellular fluid

A

10%
50%

192
Q

Protein & fluid loss is fastest in the first ___ hrs of post burns

A

8hrs

193
Q

Stomach ulcer that occurs a complication of burns is called _______

A

Curling ulcer

194
Q

Superficial partial thickness burns without infection usually re-epithelize within ___ weeks

A

3 weeks

195
Q

Re-epitheliazation in superficial partial thickness burns is from what structures

A

Epidermal lining of sweat ducts, sebaceous glands & hair follicle

196
Q

Re-epitheliazation can occur in deep partial thickness burns, T/F

A

FALSE

197
Q

Full thickness burns heals only by ____

A

Secondary intention or scar formation

198
Q

Concerning burns classification;
- charring is suggestive of _________
- Blisters is suggestive of ________
- Mottling is suggestive of _________

A

Mottling suggests deep dermal (deep partial thickness burns)
Charring suggests full thickness (full thickness burns)
Blisters are suggestive of superficial partial thickness burns

199
Q

Presence of tenderness suggests which burn classification

A

Partial thickness burns

200
Q

A deep partial thickness burns with severe edema can present with loss of sensation, T/F

A

TRUE

201
Q

Estimation of burns using the Wallace’s Rule of 9 in adult

A

write it out

202
Q

Concerning Rule of 7, what population is it used for?
- head is estimated as ____%
- Perineum is estimated as ____%
- Right upper limb is estimated as ___%

A

Used in children
HEAD 28%
PERINEUM 2%
Right upper limb 7%

203
Q

Superficial major burns in adult is ___% while in children is ___%

A

SUPERFICIAL
ADULT >=15%
CHILDREN >=10%

204
Q

Deep major burns in adult is ___% while in children is ___%

A

DEEP BURNS
ADULT >=7.5%
CHILDREN >=5%

205
Q

Classification of burns into Major and Minor burns is based on _______

A

affected Surface area

206
Q

List the systemic changes in burns (hint: 7)

A
  1. HYPOVOLAEMIA
  2. ANAEMIA
  3. ADRENAL CHANGES
  4. CYTOKINE RELEASE(TNF, IL-1, IL-6)
  5. METABOLIC CHANGES
  6. RENAL CHANGES
  7. SUSCEPTIBILITY TO SEPSIS
207
Q

Burns is a hypermetabolic state, T/F

A

TRUE

208
Q

Susceptibility to sepsis in burns is due to _____ & ______

A

Depression of cellular & humoral immunological defense
Gut bacterial translocation causing septicaemia

209
Q

Blood is a type of colloid infusion, T/F

A

TRUE

210
Q

Daily maintenance fluid per day in burns mgt is ___ litres

A

3 Litres

211
Q

Brook formula for fluid mgt
- for colloids
- for crystalloids

A

0.5ml colloid/%burn <=50% +
1.5mls crystalloids/kg/%burns +

DAILY MAINTENANCE FLUID PER 24HRS

212
Q

In Modified Brook formula, both colloids & crystalloids can be used, T/F

A

FALSE

only Crystalloids can be used

213
Q

Parkland formula in fluid mgt in Burns is

A

4mls/kg per % burns <= 50%

214
Q

In fluid mgt in burns, administer half of the calculated total volume of fluid in the first 8hrs of the second day, T/F

A

FALSE

215
Q

In fluid mgt in burns, administer half of fluid in the first 16hrs of the second day , T/F

A

FALSE

ADMINISTRATION
½ total fluid given in 1st 8hrs post injury
Remaining ½ in the next 16 hours
In 2nd 24hours, ½ of fluid in 1st 24hrs +daily requirement

216
Q

Concerning wound mgt in burns, clean with _____& _____

A

cetrimide & warm water under anaesthesia

217
Q

Blisters in burns wounds should be excised, T/F

A

FALSE

218
Q

In the exposure method of wound mgt in burns, which antimicrobial is applied?

A

Silver sulphdiazine

219
Q

Exposure method is suited for treatment of burns in what body parts (hint: 3)

A

Suited for treatment of facial burns, perineum &of one side of the body

220
Q

Indication for stopping exposure method od burns wound mgt

A

as soon as integrity of eschar is broken

221
Q

Cracks in the eschar is an indication for stoppage of exposure method in burns wound mgt, T/F

A

FALSE
Cracks in eschar is dressed with vaseline gauze or sofratulle

222
Q

Exposure method of burns wound mgt is contraindicated in what burn cases/type of patient

A

Contraindicated in ambulant outpatient cases

223
Q

In large burns wounds what should be done

A

Barrier nurse in large wounds(gown &mask to be worn)

224
Q

Methods of burns wound mgt are (hint: 2)

A

Exposure
Occlusion(dressing)

225
Q

_______ dressing is used for occlusive method

A

Absorptive dressing

226
Q

Eschars separate quickly for burns treated by occlusive method, T/F

A

TRUE

227
Q

Early eschar excision and skin grafting done within ____hr in stable patients

A

48hrs

228
Q

Mention some biological membranes that can be used to temporarily cover extensive burns areas (hint: 4)

A

Homograft(live donor/fresh cadaver<6hrs)
Xenograft (heterograft of pig skin)
Cultured autologous epidermis
Amniotic membrane

229
Q

Mention antibiotics that can be used in burns wound mgt (hint: 5)

A

Silver sulphadiazine
Povidone iodine
honey
Mefenide (sulphamylon)
Silver nitrate

230
Q

Which antibiotics used in burn wound mgt often painful

A

Mefenide (sulphamylon)

231
Q

In mgt of burns outline the steps/care (hint: 9)

A
  1. First aid
  2. ABC of mgt of the critically ill
  3. FLUID MANAGEMENT
  4. WOUND MANAGEMENT
  5. ANTITETANUS PROPHYLAXIS
  6. ANALGESICS
  7. PROPHYLACTIC/THERAPEUTIC ANTIBIOTICS
  8. BLOOD TRANSFUSION AS NEEDED
  9. NUTRITIONAL SUPPORT(HIGH PROTEIN/HIGH CALORIE)
232
Q

Paralytic ileus is a complication of burns, T/F

A

TRUE

233
Q

Deep venous thrombosis is a complication of burns, T/F

A

TRUE

234
Q

Intravascular fluid constitutes ___% of body weight in adults

A

4%

235
Q

Ionic contents of the intravascular & interstitial fluids are the same except for the absence of _______ in the interstitial fluid

A

Protein

236
Q

Predominant ions in the Extracellular fluids are (hint: 3)

A

Na+, Cl- , Hco3-

237
Q

Predominant ions in the Intracellular fluids are (hint: 4)

A

K+ ,Mg+ , Po4- & SO4-

238
Q

Endogenous production of water in ___mls in 24hrs

A

200mls

239
Q

Concerning water loss from the body in the Tropics, how many mls is lost in 24hrs
-for Pulmonary/skin
-for Urine
-for faeces

A

1700mls - Pulmonary/skin
1500mls - urine
200mls - faeces

240
Q

Daily net water requirement in the tropics is

A

3200ml

241
Q

Total sodium loss in 24hrs in tropics is ___

A

140%

242
Q

Total Potassium loss in 24hrs in tropics is ___

A

60%

243
Q

Potassium is excreted from the sweats, T/F

A

FALSE

244
Q

For every 1degree Celsius rise in temp __% of daily requirement is added to compensate loss in sweating

A

12%

245
Q

Glycogen stores(400g) in the body are used up during the __ day of starvation

A

First day of starvation

246
Q

For calorie replacement, the least grams of exogenous glucose a day to reduce gluconeogenesis is ____

A

100g

247
Q

Gluconeogenesis of the body using proteins & fat is usually accompanied with attendant ______

A

Acidosis

248
Q

Composition of Ringer’s lactate 1Litre
Na+
K+
Ca2+
Cl-
HCO3

A

RINGER’S LACTATE(1L)
Na+ 130mmol
K+ 4mmol
Ca2+ 4mmol
Cl- 111mmol
HCO3 27mmol

249
Q

COMPOSITION OF DARROW’S SOLUTION 1 Litre
Na+
K+
Cl-
HCO3

A

DARROW’S SOLUTION
Na+ 124mmol
K+ 36mmol
Cl- 104mmol
HCO3 56mmol

250
Q

Composition of 5% DEXTROSE WATER

A

5g/100mls of solution

251
Q

COMPOSITION OF NORMAL SALINE (0.9%) IN 1 Litre
Na+
Cl-

A

NORMAL SALINE (0.9%)
Na+ 154mmol/L
Cl- 154mmol/L

252
Q

Monitoring of fluid treatment (hint: 9)

A

HOULY URINE OUTPUT
CATHETERISATION IN VERY ILL PATIENT
EVALUATE SKIN TUGOR/TONGUE MOISTURE
HOULY BP/PULSE
MONITOR JVP
FREQUENT AUSCULTATION OF LUNG BASES
CVP MEASUREMENT
INPUT/OUTPUT CHART TO BE PROPERLY KEPT
SERUM ELECTROLYTE

253
Q

Fluid of choice in severe diarrhoea after initial resuscitation is _____

A

Darrow’s solution

254
Q

_____ is added to sterile blood bag to increase the survival from 21 to 34 days

A

Adenine enriched CPD (CPDA-1)

255
Q

Blood is stored at blw ___ to ___degree celsius in blood bank

A

2 to 6 degree celsius

256
Q

Blood components that are not viable beyond 24hrs are

A

Leucocytes & platelets

257
Q

Clotting factors that can survive for 21days in stored blood (hint: 2)

A

fibrinogen & factor II

258
Q

Concerning ABO system, number of possible genotypes are

A

6 possible genotypes (AA,AB,AO,BO,BB,OO)

259
Q

In ABO system, the only 4 serologically recognized phenotypes are

A

(A=42%, B=9%, AB=3%, O=46%)

260
Q

ABO Preformed antibiotics are IgM, T/F

A

TRUE

261
Q

Immune antibodies IgG are produced in response to incompatible blood transfusion are cold antibodies, T/F

A

FALSE
warm antibodies- b/c they react optimally at 37 degrees celsius

262
Q

In Rhesus blood group system, there are preformed antibodies, T/F

A

FALSE

263
Q

Complication of blood transfusion is broadly divided into 2

A

Immune and Non immune complications

264
Q

Pyrogenic reaction in blood transfusion is caused by _____

A

Caused by pyrogens from bacteria & viruses

265
Q

Immune complications of blood transfusion (hint: 5)

A

Haemolytic reactions+- haemoglobinuria
Leucocyte antibodies(HLA/anti-neutrophil antibodies)
Platelet antibodies
Pyrogenic reactions
Plasma reaction

266
Q

Non immune complications of blood transfusion (hint: 6)

A

Transmission of infections, including malaria
Circulatory overload
Thrombophlebitis
Air embolism
Transfusion haemosiderosis
Complications due to massive transfusion

267
Q

Blood transfusion complications that can arise due to massive transfusion (hint: 5)

A

Hypocalcaemia
Hyperkalaemia
Hypothermia
Persistent bleeding(platelet/coagulation factor loss)
Metabolic acidosis(excess citrate & lactic acid)

268
Q

Requirements for donor in blood transfusion, mark T/F for the following
- Age <18yrs
- Hb 11g/dL
- Weight 50kg

A

Age: F
Hb: F
Weight: F

269
Q

Minimum donation interval is ____ weeks

A

12 weeks

270
Q

Maximum donation for a year for an individual is ____

A

3 per year

271
Q

Consequences of blood storage (hint: 5)

A

Hyperkalemia
Depleted leucocytes & platelets
Hypocalcemia
Depleted clotting factors
Lactic acidosis

272
Q

Cutaneous ulcer around the knee is probably _____

A

Syphilitic ulcer

273
Q

Ulcer on the toe/dorusm of feet can be due to DM, T/F

A

TRUE

274
Q

Sickle cell ulcer is usually found where?

A

Medial malleolus

275
Q

Venous ulcers are commonly found at the medial malleolus, T/F

A

TRUE

276
Q

Neuropathic ulcers are commonly found at ____

A

Sole of feet

277
Q

List specific ulcers (hint: 5)

A

TB ULCERS
BURULI ULCERS
SYPHYLITIC
YAWS ULCERS
TROPICAL ULCERS

278
Q

Parts of the body with predilection of TB ulcers are _____, _____ & _______

A

Neck, Groin, Axilla

279
Q

Causative agent for Buruli ulcer

A

Mycobacterium ulcerans

280
Q

Classification of cutaneous ulcers

A

A. Specific
B. Non specific
C. Neoplastic

281
Q

The most common form of skin cancer is _______

A

Basal cell carcinoma (Rodent ulcer)

282
Q

What type of medical record system is practiced in UUTH

A

Centralized

283
Q

In Decentralized medical record system all data of the patient is available at all time, T/F

A

FALSE

284
Q

Uses of medical records (hint: 5)

A
  1. To document patients’ course of illness and Rx
  2. To communicate between health care professionals caring for the patient.
  3. For continuity of care to the patient.
  4. For research into specific diseases and treatment.
  5. Collection of health statistics
285
Q

Concerning culling, medical records removed from active file room are filed in ________

A

Secondary storage

286
Q

Stapes can be used to hold papers together in medical record, T/F

A

FALSE
A clip or fastener to hold the papers together( Never use staples)

287
Q

The medical record is the property of the hospital, T/F

A

TRUE

288
Q

Master patient index (card index) should contain medical information, T/F

A

FALSE

289
Q

Types of medical record (hint: 2)

A

Active
Inactive

290
Q

Types of filing methods (hint: 3)

A

ALPHABETICAL FILING Not Recommended
NUMERIC FILING Training time for staff short
TERMINAL DIGIT FILING

291
Q

_____ enables records to be found when not on file

A

Tracer card (Outguide)

292
Q

Month of attendance on medical record folder indicates whether the record is ACTIVE or INACTIVE, T/F

A

FALSE

Year of attendance

293
Q

Five questions to answer before setting up a private practice

A

WHY
WHERE
WHO
WHAT
HOW

294
Q

The minimum requirements for setting up a private practice are (hint: 3)

A

REGISTRABLE MEDICAL DEGREE
FULL REGISTRATION
CERTIFICATION BY THE LOCAL REGULATORY AUTHORITY

295
Q

HIGHLIGHTS OF PHYSICIAN’S OATH (hint: 13)

A
  1. Consecration of Doctor’s life to service of humanity.
  2. Respect for & gratitude to teachers/colleagues/students
  3. Practicing with conscience and dignity.
  4. Patient autonomy to be respected
  5. Patient’s health takes first consideration.
  6. Confidentiality, even after death.
  7. Non-discrimination in patient care.
  8. Attendance to physician’s health, well being & knowledge.
  9. Sharing of medical knowledge
  10. Beneficence (seeking to do good)
  11. Non-maleficence (Primum, Non Nocere)
  12. Sanctity of life.
  13. Veracity (Telling the truth)
296
Q

Mention the 4 Ethical violations

A

PROFESSIONAL NEGLIGENCE (unethical act of omission)
MALPRACTICE (act of commission)
MISCONDUCT/IMPROPER CONDUCT
INFAMOUS CONDUCT IN A PROFESSIONAL RESPECT

297
Q

MDCN functions do not include regulation of alternative medicine, T/F

A

FALSE

298
Q

Functions of MDCN (hint: 4)

A
  1. To regulate practices of medical & dental profession as well as alternative medicine.
  2. To determine standard of knowledge and skill of practitioners and raise these from time to time.
  3. Establish and maintain members registers
  4. Investigating /disciplinary functions in case of ethical violations (Members of these panels constitute ‘professional brethren of good repute and competence’)
299
Q

Penalties for ethical violation (hint: 3)

A

FORMAL WARNING
SUSPENSION FOR A PERIOD OF TIME
DEREGISTRATION

300
Q
A

FAMILY MEDICINE (7 decks)

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