FEB 2024 Flashcards
(129 cards)
1
Q
What is the recommended action if a primigravida woman in labor shows no progression after 4 hours of Syntocin administration and has positive caput and molding?
A
Emergency LSCS (Lower Segment Caesarean Section)
2
Q
What are the key steps in managing a primigravida woman in labor who shows signs of fetal distress?
A
- Continue CTG monitoring if normal.
- Perform fetal blood sampling if CTG is abnormal.
- Proceed to caesarean section if fetal blood sampling indicates compromise.
3
Q
What is the preferred management approach for third trimester singleton pregnancies with vasa previa?
A
Planned cesarean birth at 34+0 to 35+6 weeks
4
Q
What are the risk factors for hospitalization in cases of vasa previa?
A
Short cervix, uterine irritability, vaginal bleeding, history of spontaneous preterm birth, residence more than 15 minutes from hospital
5
Q
What is the treatment for acute toxicity in digoxin overdose?
A
Administer Digibind, manage hyperkalemia, use atropine for bradyarrhythmias, consider pacemakers if necessary.
6
Q
What is the most important diagnostic tool for hyperparathyroidism?
A
Radioactive studies
7
Q
What are the common causes of primary hyperparathyroidism?
A
Mostly due to a solitary parathyroid adenoma
8
Q
What are the steps in managing atrial fibrillation (AF)?
A
- Confirm diagnosis.
- Check for acute reversible cause.
- Decide if rhythm control is suitable.
- Choose treatment pathway (medications, electrical cardioversion, catheter ablation).
9
Q
What are the indications for using Denosumab?
A
Osteoporosis in postmenopausal women, men with osteoporosis, patients receiving certain cancer treatments
10
Q
What is the stepwise approach for managing osteoporosis in postmenopausal women and men aged >50 years?
A
- Assess risk factors.
- Determine treatment based on BMD T-score.
- Implement lifestyle and medical condition modifications.
- Use FRAX tool for fracture risk assessment.
11
Q
What are the side effects of Alendronate?
A
Abdominal pain, nausea, acid reflux, difficulty swallowing, rare bone/joint/muscle pain, esophageal irritation or ulceration, headache, allergic reactions, rare osteonecrosis of the jaw, atypical femur fractures.
12
Q
What are the phases of the first stage of labor?
A
Latent phase: up to 4 cm dilation. Active phase: 4 cm to 10 cm dilation.
13
Q
What is the second stage of labor?
A
From 10 cm dilation until delivery of the placenta.
14
Q
How is hypoactive contractility in the active phase of labor managed?
A
With oxytocin.
15
Q
How is hyperactive contractility in the active phase of labor managed?
A
With sedation.
16
Q
What is the management for a non-engaged second stage of labor?
A
Caesarean section.
17
Q
What is the management for an engaged second stage of labor?
A
Forceps delivery.
18
Q
What is the recommended action if a primigravida woman in labor shows no progression after 4 hours of Syntocin administration and has positive caput and molding?
A
Emergency LSCS (Lower Segment Caesarean Section)
19
Q
What are the key steps in managing a primigravida woman in labor who shows signs of fetal distress?
A
- Continue CTG monitoring if normal.
- Perform fetal blood sampling if CTG is abnormal.
- Proceed to caesarean section if fetal blood sampling indicates compromise.
20
Q
What is the preferred management approach for third trimester singleton pregnancies with vasa previa?
A
Planned cesarean birth at 34+0 to 35+6 weeks
21
Q
What are the risk factors for hospitalization in cases of vasa previa?
A
Short cervix, uterine irritability, vaginal bleeding, history of spontaneous preterm birth, residence more than 15 minutes from hospital
22
Q
What is the treatment for acute toxicity in digoxin overdose?
A
Administer Digibind, manage hyperkalemia, use atropine for bradyarrhythmias, consider pacemakers if necessary.
23
Q
What are the management options for a primigravida woman in labor with no progression after 4 hours and signs of fetal distress?
A
- Wait for 6 hours
- Stop Syntocin Infusion
- Assisted Delivery
- Emergency LSCS
24
Q
What is the recommended action in case of no labor progression and signs of fetal distress or CPD?
A
Emergency LSCS
25
What is the active stage management after dilation?
Artificial rupture
26
What is the management for meconium staining with slow fetal heart rate?
Potential fetal distress
27
What is the procedure for CTG monitoring in labor?
Continue if CTG is normal. Perform fetal blood sampling if CTG is abnormal. Proceed to caesarean section if fetal blood sampling indicates compromise.
28
What is the preferred approach for managing third trimester singleton pregnancies with vasa previa?
Planned cesarean birth at 34+0 to 35+6 weeks
29
What are the risk factors for hospitalization in vasa previa cases?
Short cervix, uterine irritability, vaginal bleeding, history of spontaneous preterm birth, residence more than 15 minutes from hospital
30
What should be done if any complications are present during vasa previa surveillance?
Prompt cesarean birth
31
What is the management plan if no complications are present during vasa previa surveillance?
Planned cesarean birth at 34+0 to 35+6 weeks
32
When is Digibind indicated for digoxin overdose?
Cardiac arrest, life-threatening dysrhythmia, hyperkalemia (K >5mM), ingestion of >10mg (adult) or >4mg (child), digoxin level >15nM (>12ng/mL)
33
What is the management for acute digoxin toxicity with life-threatening arrhythmias?
Administer Digibind
34
What is the management for bradyarrhythmias in digoxin toxicity?
Atropine, pacemakers
35
What is the most important diagnostic tool for hyperparathyroidism?
Radioactive studies
36
What is the treatment for hyperparathyroidism?
Parathyroidectomy
37
What are the common causes of primary hyperparathyroidism?
Mostly due to a solitary parathyroid adenoma
38
What is the differential diagnosis for primary hyperparathyroidism?
FHH (familial hypocalciuric hypercalcemia)
39
What are the common causes of secondary hyperparathyroidism?
Chronic renal failure, Vitamin D deficiency
40
What is the cause of tertiary hyperparathyroidism?
End-stage renal failure, where parathyroid glands become hyperactive after long-term secondary hyperparathyroidism
41
What is elevated in all types of hyperparathyroidism?
PTH (Parathyroid Hormone)
42
What are the calcium levels in primary and tertiary hyperparathyroidism?
Elevated or normal
43
What are the calcium levels in secondary hyperparathyroidism?
Low or normal
In secondary hyperparathyroidism, calcium levels are usually **low or normal**.
### Why?
- **Cause of Secondary Hyperparathyroidism**: This condition often occurs due to chronic kidney disease (CKD) or vitamin D deficiency, where the body is unable to maintain proper calcium levels.
- **Low Calcium Trigger**: In these cases, the kidneys cannot convert enough vitamin D to its active form, which is necessary for calcium absorption from the gut. Additionally, the kidneys may not be able to excrete phosphate properly, leading to high phosphate levels, which can further lower calcium levels.
- **Parathyroid Response**: When calcium levels drop, the parathyroid glands respond by producing more parathyroid hormone (PTH) to try to raise the calcium levels. However, because the underlying problem (like kidney disease) isn't fixed, this increased PTH doesn't fully correct the calcium level, leading to it being low or at best, normal, but still not sufficiently high.
So, in summary, **calcium levels in secondary hyperparathyroidism are typically low or normal** because the body is trying to compensate for a problem that makes it difficult to maintain adequate calcium levels.
44
What are the phosphate levels in primary hyperparathyroidism?
Low or normal
45
What are the phosphate levels in secondary hyperparathyroidism?
High or normal
46
What are the phosphate levels in tertiary hyperparathyroidism?
Normal
47
What are the vitamin D levels in primary and tertiary hyperparathyroidism?
Low or normal
48
What are the vitamin D levels in secondary hyperparathyroidism?
Significantly low
49
Summarize primary hyperparathyroidism.
Solitary adenoma, elevated PTH and calcium, low/normal phosphate, normal/low vitamin D
50
Summarize secondary hyperparathyroidism.
Chronic renal failure/vitamin D deficiency, elevated PTH, low/normal calcium, high/normal phosphate, low vitamin D
51
Summarize tertiary hyperparathyroidism.
End-stage renal failure, persistently elevated PTH, high calcium, normal phosphate, low/normal vitamin D
52
What are the symptoms of hypercalcemia of malignancy?
Confusion, lethargy, fatigue, anorexia, polyuria, constipation
53
What type of cancer is hypercalcemia of malignancy commonly associated with?
Squamous cell lung cancer
54
What is the first step in treating hypercalcemia of malignancy?
IV fluid
55
What are some symptoms of anorexia?
Ankle edema, hypokalemia, loss of breast
56
What are some characteristics of bulimia?
Child abuse and from obese family
57
What are some characteristics of anorexia?
Athletism
58
What is the first step in managing atrial fibrillation (AF)?
Confirm diagnosis
59
What is the second step in managing AF?
Check for acute reversible cause
60
What is considered if there is a reversible cause of AF?
Treat the reversible cause, then decide on heart rate or rhythm control
61
What is the third step in managing AF?
Decide if rhythm control is suitable
62
Who might benefit more from rhythm control in AF management?
Younger patients, those with significant symptoms, paroxysmal or persistent AF, no significant heart disease or atrial enlargement, clinical heart failure
63
What are the medication options for rhythm control in AF?
Flecainide, Sotalol, Amiodarone
64
What procedure can be used for rhythm control in AF?
Electrical cardioversion, Catheter ablation
65
What are the medication options for rate control in AF?
Beta Blockers, Non-dihydropyridine Calcium Channel Blockers, Digoxin
66
What procedure can be used if medications don't work for rate control in AF?
AV Node Ablation +/- Permanent Pacemaker
67
What is a nihilistic delusion?
Belief that one's career or life has to end
68
What is the initial assessment for children with head injuries?
GCS ≤ 13: High-risk, immediate attention. GCS 14-15: Further assessment needed.
69
What are the risk factors for intracranial injury in all children?
GCS 14 or signs of altered mental status, abnormal neurological exam, severe mechanism of injury, post-traumatic seizures.
70
What are the risk factors for intracranial injury in children < 2 years?
Palpable skull fracture, non-frontal scalp hematoma, history of loss of consciousness (LOC) > 5 seconds, severe headache.
71
What are the risk factors for intracranial injury in children ≥ 2 years?
Signs of base of skull fracture, history of LOC, history of vomiting, severe headache.
72
What is the observation protocol for children with head injuries and risk factors?
Observe up to 4 hours.
73
What is the observation protocol for children with head injuries and no risk factors?
No observation needed.
74
What is the action plan for high-risk head injury cases?
Immediate head CT.
75
What is the action plan for intermediate-risk head injury cases?
Senior clinician review, consider head CT or further observation.
76
What is the action plan for low-risk head injury cases?
Senior clinician review, observe or consider discharge.
77
What is the action plan for very low-risk head injury cases?
Discharge with advice.
78
What are the post-CT steps if CT is normal or shows a non-displaced skull fracture and GCS 15?
Senior clinician reassesses for further concerns. Discharge with advice if no concerns. Continue observation or consult neurosurgery if concerns.
79
What are the post-CT steps if CT is abnormal or other complications are present?
Consult neurosurgery and admit the patient.
80
Why is the initial assessment important in children with head injuries?
Identifies immediate high-risk patients.
81
Why is assessing risk factors important in children with head injuries?
Determines the necessity and urgency of further observation or imaging.
82
Why is observation/reassessment important in children with head injuries?
Ensures that any delayed symptoms are caught early.
83
Why is classifying risk important in children with head injuries?
Provides a clear action plan based on the level of risk.
84
Why are post-CT steps important in children with head injuries?
Ensures appropriate follow-up based on imaging results.
85
Why is consulting and admitting important in severe head injury cases?
Ensures that severe cases receive specialized care promptly.
86
When is parumbilical and gastric hernia surgery typically performed?
After 6 months of surgery.
87
When is surgery for undescended testes typically performed?
3-6 months.
88
What is the management for Category 1 exposure (Mammal or Bat)?
Non-Immune: Vaccinate with 4 doses of IM rabies vaccine on days 0, 3, 7, and 14. Previously Immunized: Vaccinate with 2 additional doses on days 0 and 3. HRIG: Not indicated.
89
What is the management for Category 2 exposure (Mammal)?
Non-Immune: Vaccinate with 4 doses of IM rabies vaccine on days 0, 3, 7, and 14. Previously Immunized: Vaccinate with 2 additional doses on days 0 and 3. HRIG: Not indicated.
90
What is the management for Category 3 exposure (Mammal or Bat)?
Non-Immune: Administer HRIG as soon as possible, then vaccinate with 4 doses of IM rabies vaccine on days 0, 3, 7, and 14. Previously Immunized: Vaccinate with 1 dose of HRIG as soon as possible, then 4 doses of IM rabies vaccine on days 0, 3, 7, and 14.
91
What is the recommended management for exposure to blood, urine, or feces of an animal?
Category 1 exposure management: Non-Immune: Vaccinate with 4 doses of IM rabies vaccine on days 0, 3, 7, and 14. Previously Immunized: Vaccinate with 2 additional doses on days 0 and 3. HRIG: Not indicated.
92
What is the recommended management for minor scratches or abrasions without bleeding?
Category 2 exposure management: Non-Immune: Vaccinate with 4 doses of IM rabies vaccine on days 0, 3, 7, and 14. Previously Immunized: Vaccinate with 2 additional doses on days 0 and 3. HRIG: Not indicated.
93
What is the recommended management for transdermal bites or scratches, or contamination of mucous membrane or broken skin with animal saliva (licks)?
Category 3 exposure management: Non-Immune: Administer HRIG as soon as possible, then vaccinate with 4 doses of IM rabies vaccine on days 0, 3, 7, and 14. Previously Immunized: Vaccinate with 1 dose of HRIG as soon as possible, then 4 doses of IM rabies vaccine on days 0, 3, 7, and 14.
94
What is the recommended management for lateral epicondyle injury?
Counter brace.
95
What does decreased visual acuity in the upper temporal parts of the visual field, along with very high prolactin levels and a normal MRI suggest?
Possible prolactinoma.
96
What should be done for further evaluation of a suspected prolactinoma?
Conduct formal visual field testing.
97
What is the management approach for a patient with a prolactinoma?
Refer to an endocrinologist, consider medical therapy with dopamine agonists (cabergoline or bromocriptine).
98
What are important points for patient education and monitoring in prolactinoma?
Educate the patient about the condition, its management, and the importance of compliance with medication. Arrange regular follow-up to monitor prolactin levels, visual acuity, and visual fields.
99
What lifestyle considerations should be taken into account for a patient with a prolactinoma?
Advise against heavy lifting or strenuous activities that could increase intra-abdominal pressure.
100
What visual field defect is associated with a pituitary adenoma (prolactinoma)?
Bitemporal hemianopia
101
What does macular sparing indicate?
Occipital lesion
102
What does no macular sparing indicate?
Optic tract lesion
103
What does mono vision indicate?
Optic nerve lesion
104
What does central scotoma indicate?
Retinal lesion
105
What are the metabolic side effects of atypical antipsychotics?
Weight gain, dyslipidemia, increased risk of diabetes
106
What are the neurological side effects of atypical antipsychotics?
Extrapyramidal symptoms (EPS), prolonged QT interval
107
What are the endocrine side effects of atypical antipsychotics?
Hyperprolactinemia, irregular menstrual cycles
108
What are some other common side effects of atypical antipsychotics?
Sedation, orthostatic hypotension
109
What are some rare but serious side effects of atypical antipsychotics?
Neuroleptic malignant syndrome (NMS), tardive dyskinesia
110
What is the mechanism of action of Denosumab?
Inhibits RANK ligand, increasing bone density
Use when creatine low
111
How is Denosumab administered?
Subcutaneous injection every 6 months
112
What are the indications for Denosumab?
Osteoporosis in postmenopausal women, men with osteoporosis, patients receiving certain cancer treatments
113
What are the common side effects of Denosumab?
Back pain, musculoskeletal pain, infections
114
What are some less common but serious risks of Denosumab?
Osteonecrosis of the jaw, atypical femur fractures
115
What monitoring is required for patients on Denosumab?
Regular dental exams
116
What are the very high-risk criteria for osteoporosis?
T-score ≤ -3.0, recent fracture within 2 years, history of 2 or more fragility fractures, clinical risk factors like corticosteroid use, low BMI, recurrent falls, FRAX result indicating MOF risk ≥ 30% or Hip fracture risk ≥ 4.5%
117
What is required for minimal trauma fractures in osteoporosis?
Hip or vertebral fracture requires DXA to establish bone mineral density (BMD)
118
What is the management for osteoporosis with a T-score ≤ -2.5?
Treat with bisphosphonates (oral/IV), denosumab, or hormonal therapy as appropriate
119
What is the management for low bone density with a T-score ≤ -1.5?
Monitor closely and investigate for other causes of fracture
120
What is the management for low bone density with a T-score between -1.5 and -2.5?
Check FRAX result to assess fracture risk, implement falls prevention strategies, weight-bearing exercises, and dietary modifications
121
What are the non-modifiable risk factors for osteoporosis?
Age ≥ 70 years, parental history of hip fracture
122
What lifestyle and medical conditions should be addressed to reduce osteoporosis risk?
Falls, poor balance, low physical activity, low body weight, muscle mass, protein/calcium malnutrition, vitamin D insufficiency, smoking, alcohol intake
123
What medical conditions and medications increase the risk of osteoporosis?
Early menopause, hypogonadism, coeliac disease, rheumatoid arthritis, hyperparathyroidism, hyperthyroidism, diabetes, chronic liver or kidney disease, myeloma, organ/bone marrow transplant, HIV, glucocorticoids, excess thyroid hormone replacement, androgen deprivation therapy, aromatase inhibitors
124
What tools and practices are recommended for monitoring osteoporosis?
Use FRAX tool, regular DXA scans, emphasize falls prevention strategies, weight-bearing and resistance exercises, balanced diet
125
What are the gastrointestinal side effects of Alendronate?
Abdominal pain, nausea, acid reflux, difficulty swallowing
126
What are the musculoskeletal side effects of Alendronate?
Rarely causes bone, joint, or muscle pain
127
What are the esophageal side effects of Alendronate?
Irritation or ulceration of the esophagus
128
What are some other side effects of Alendronate?
Headache, allergic reactions like rash
129
What are the long-term concerns with Alendronate?
Potential risk of rare but serious side effects like osteonecrosis of the jaw or atypical femur fractures
