Gastro Flashcards

Question

***MCQs*** 30-year-old diabetic man with weight loss, ↓ libido, testicular atrophy, infertility, and low testosterone. Dx?

Answer 1

**Secondary Hypogonadism (Hypogonadotropic)** why? ***Low testosterone*** → confirms hypogonadism. ***↓ libido, testicular atrophy, infertility, weight loss*** → classic symptoms. ***Diabetic man*** → diabetes can damage the **hypothalamus/pituitary axis**, especially in poorly controlled or long-standing cases. ***Secondary hypogonadism***: Problem at the hypothalamus or pituitary → ↓ LH and FSH → ↓ testosterone. ***To confirm***: Check **LH and FSH** levels. - If **low or inappropriately normal**, diagnosis = ***secondary hypogonadism***. - If **elevated**, then it's ***primary hypogonadism*** (testicular failure). Extra: Primary hypogonadism is due to a problem in the gonads themselves (testes or ovaries). The gonads fail to produce sex hormones despite normal or elevated stimulation by gonadotropins (LH and FSH). As a result, LH and FSH levels are elevated. * Examples: Klinefelter syndrome, Turner syndrome, mumps orchitis. —-> genetic test * Secondary hypogonadism is caused by a problem in the hypothalamus or pituitary gland, leading to low or inappropriately normal levels of LH and FSH, which results in reduced stimulation of the gonads and low sex hormone production. * Examples: Kallmann syndrome, craniopharyngioma. —-> imiging

Answer 2

Vasopressin challenge test Extra : ***Diagnosis*** 1 - 24-hour urine collection: confirms hypotonic polyuria 2- ***Water deprivation test***: differentiates between: • AVP-D (urine osmolality increases after desmopressin) • AVP-R (no response to desmopressin) • Primary polydipsia (gradual increase in urine osmolality) Treatment ***AVP-D: Desmopressin (synthetic AVP analogue)*** AVP-R (acquired): Treat underlying cause (e.g., stop lithium, correct electrolytes) Consider thiazide diuretics, NSAIDs, or amiloride in selected cases

Answer 3

Circadian Rhythm Change (Jet Lag)

Answer 4

**Focal sensory symptomes** with gaite and balance problem , **monocular vision loss**, diplopia with lateral gaze, sensory abnormalities **Dx** Best initial and most accurate **MRI**, periventricular white matter lesions Acute exacerbation: **methylprednisolone**

Answer 5

brain biopsy Extra: Brain abscess The best initial test is a head CT or MRI. The most accurate test is a brain biopsy. Scan of the brain shows a “ring” or contrast enhancing lesion that will likely have surrounding edema and mass effect. ***Cancer and infection*** are indistinguishable based on an imaging study alone. CSF would be unlikely to be helpful even if it were obtained and ***LP is contraindicated*** because of the possibility of herniation.

Answer 6

Essential tremor

Answer 7

A: Psychogenic tremor

Answer 8

A: Trigeminal neuralgia

Answer 9

A: IUCD (Intrauterine Contraceptive Device) Clinical tip: Always avoid estrogen-containing contraceptives in women with migraine with aura or at high risk of thromboembolism.

Answer 10

A: Bacterial meningitis Extra: ***Bacterial meningitis:*** WBC >1000/µL (neutrophilic), protein ↑↑, glucose ↓ ***Viral meningitis:*** WBC 10–500/µL (lymphocytic), protein normal or ↑, glucose normal ***Fungal meningitis:*** WBC 20–500/µL (lymphocytic), protein ↑, glucose ↓ ***Tuberculous meningitis:*** WBC 30–300/µL (lymphocytic), protein ↑, glucose ↓

Answer 11

❖ Causes • Most cases are idiopathic. • Identified causes: • Lyme disease • Sarcoidosis • Herpes zoster • Tumors ⸻ ❖ Presentation • Bell’s Palsy: Paralysis of the entire side of the face. • Difficulty closing the eye. • Wrinkling forehead is impaired. • Eating is “sloppy” due to inability to close lips. • Stroke: Only the lower half of the face is affected. • Forehead can wrinkle (upper face is bilaterally innervated). ⸻ ❖ Clues for Diagnosis • If the patient can wrinkle forehead on the affected side → worry about stroke. • If the patient cannot wrinkle forehead → it is Bell’s palsy. ⸻ ❖ Additional Features • Hyperacusis: Sounds are louder due to paralysis of stapedius muscle (normally dampens sound). • Taste disturbance: Involves anterior two-thirds of the tongue (supplied by CN VII). ⸻ ❖ Clinical Tip • Look for phrases like: • “Face feels stiff” • “Face is pulled to one side” • These suggest: Bell’s palsy ⸻ ❖ Diagnostic Tests • Usually no test needed due to classic presentation. • If asked: Electromyography and nerve conduction studies are most accurate. ⸻ ❖ Treatment • 60% recover fully without treatment. • Best initial therapy: Prednisone • Acyclovir may be added, but evidence is unclear. ⸻ Let me know if you’d like this turned into flashcards or a table.

Answer 12

Ramsay Hunt Syndrome (Herpes Zoster Oticus) Extra: Reactivation of VZV in geniculate ganglion • Involves CN VII (facial nerve) → facial paralysis, taste loss • May involve CN VIII → vertigo, tinnitus, hearing loss • Often associated with vesicular rash in ear or mouth • 📋 Treatment: Acyclovir + Prednisone (early)

Answer 13

S1 radiculopathy

Answer 14

A: L4–L5 (L5 root affected Extra: L1–L2: Hip flexion (e.g. iliopsoas) L3: Knee extension (e.g. quadriceps femoris) L4: Ankle dorsiflexion (e.g. tibialis anterior) L5: Great toe extension (e.g. extensor hallucis longus) S1: Ankle plantarflexion, foot eversion (e.g. gastrocnemius, peroneus longus/brevis) S2: Knee flexion (e.g. hamstrings)

Answer 15

SAH (Subarachnoid Hemorrhage) Key clue: Neck rigidity after trauma → meningeal irritation from blood in subarachnoid space.

Answer 16

Brain CT classic signs of raised intracranial pressure (ICP). —-> Performing a lumbar puncture without first ruling out a mass lesion or raised ICP can precipitate brain herniation, which is life-threatening.

Answer 17

***Pseudomembranous colitis (Clostridioides difficile colitis)*** Extra : Explanation: **Clindamycin is a high-risk antibiotic** for inducing C. difficile infection. Elderly patients are especially susceptible. C. difficile colitis presents with watery diarrhea, sometimes bloody, abdominal pain, fever, and leukocytosis. Diagnosis: **stool test for C. difficile toxins**, or colonoscopy showing pseudomembranes. Treatment includes oral *vancomycin or fidaxomicin*.!

Answer 18

Acute infection, window Extra : Step 1: Check HBsAg (Hepatitis B surface antigen) • If positive: the patient has HBV infection (either acute or chronic) ⸻ Step 2: Look at anti-HBc (Hepatitis B core antibody) • If IgM → acute infection (especially if HBeAg is also positive) • If IgG → chronic infection ⸻ Step 3: If chronic infection, check HBeAg • Positive → active replication (high infectivity) • Negative → inactive carrier (low infectivity) ⸻ 🟣 Special Scenarios If HBsAg is negative Ask: Is it immunity or window period? • Check anti-HBc: • If positive, it’s likely the window period. ⸻ ✅ Immunity Scenarios 1. Anti-HBs (+) and Anti-HBc (+) → Resolved infection 2. Anti-HBs (+) only → Vaccinated ✅ Initial Hepatitis B Screening Panel: 1. HBsAg (Hepatitis B surface antigen) → Detects current infection (acute or chronic) 2. Anti-HBs (HBsAb) (Hepatitis B surface antibody) → Detects immunity (from past infection or vaccination) 3. Anti-HBc (total) (Hepatitis B core antibody – IgG and IgM) → Detects past or current natural infection (not from vaccine)

Answer 19

Depth of the injury ***Needle stick injury transmission risk*** HBV → up to 30% HCV → about 3% HIV → about 0.3%

Answer 20

Supportive care (antipyretics) and avoid contact sports. Extra : Infectious Mononucleosis Most commonly caused by ***Epstein-Barr virus*** Clinical symptoms: low-grade fever, headache, malaise, severe fatigue ***tonsillar exudates*** ***lymphadenopathy*** (more commonly posterior cervical), ***splenomegaly*** “””note”””” ***Maculopapular rash*** after taking antibiotics (especially common with amoxicillin in EBV) Dx: EBV-specific antibody tests, heterophile antibody test (mononuclear spot test, more likely to be positive after second week of illness) Clinical course often self-limiting Tx: supportive care, refrain from ***contact sports*** for ≥ 2–3 weeks postinfection

Answer 21

THICK smear for detection THIN smear for speciation

Answer 22

Acute Leukemia

Answer 23

LMWH note: warfarin teratogenic

Answer 24

**von willebrand disease** extra : von willebrand disease Most common inherited bleeding disorder in the US Typically *autosomal dominant* ***increased mucocutaneous bleeding***, bleeding from minor cuts, gingival bleeding, epistaxis, heavy menstrual bleeding, postpartum hemorrhage, postprocedural bleeding ***Hemostasis test results: isolated prolonged PTT or normal results*** Dx: vWF antigen, ristocetin cofactor activity (platelet-dependent vWF activity), and factor VIII activity aPTT may be prolonged if factor VIII is low Tests assess both amount and function of vWF to determine type and severity Tx: desmopressin acetate for mild cases, recombinant factor VIII or vWF complex infusion for severe cases

Answer 25

Chancroid ^^^Extra^^^ : Primary Syphilis Sx: painless ulcer that forms 3 weeks post sexual activity and disappears in 3–6 weeks PE: vaginal, anal, or oral ***chancre***- painless, punched-out lesion with a raised margin, lymphadenopathy Dx: darkfield microscopy, RPR/VDRL confirmed by FTA-ABS Caused by spirochete Treponema pallidum Tx: single IM injection of benzathine penicillin Mnemonic: syphi***lis*** is pain***less*** ulcer.

Answer 26

ANA + ***Systemic Lupus Erythematosus (SLE)*** * Risk factors: female sex * **Sx**: fatigue, fever, weight loss, arthritis, ***photosensitivity***, pleuritis, pericarditis, neuropsychiatric symptoms * PE: ***malar*** (butterfly) ***rash spares nasolabial folds***, discoid rash, painless oral ulcers, alopecia, ulnar deviation at MCP joints, swan-neck deformity * Labs * Antinuclear antibody (***ANA***): sensitive, not specific * ***Anti-dsDNA, anti-Smith*** antibodies: specific, not sensitive * Notes: **anti-dsDNA antibody correlates with disease activity, low complement levels seen in flares** * Antiphospholipid antibodies * Proteinuria * Cytopenias * Tx: NSAIDs, steroids, hydroxychloroquine, immunosuppressants (e.g., cyclophosphamide, mycophenolate mofetil, azathioprine, rituximab) * Drug-induced lupus: hydralazine, INH, procainamide, phenytoin, sulfonamides * Antihistone antibody * Recommended contraception: **levonorgestrel IUD**, progestin-only contraceptives (higher thromboembolic risk with estrogen)

Answer 27

**Paget Disease** ^^^Extra:^^^ Paget Disease of Bone (PDB, Osteitis Deformans) Abnormal bone remodeling due to increase in osteoclast activity, followed by increase in osteoblast activity resulting in boney overgrowth Sx: asymptomatic, bone or joint pain, nerve impingement, hearing loss Labs: increased ***serum alkaline phosphatase*** and bone-specific alkaline phosphatase X-ray: bonethickening and enlargement with thickenedcortices CT: pathognomonic sign **osteoporosis circumscripta** Tx: supportive, PT, bisphosphonates

Answer 28

**Temporal Arteritis (Giant Cell Arteritis)** **Risk factors**: age > 50, female sex Sx: **unilateral headache**, jaw claudication, monocular visual loss PE: **tender temporal artery** Lab results: **ESR > 50** mm/hour, ↑ CRP *Dx: temporal artery biopsy* Treatment: high-dose **steroids**, do not wait for biopsy if strong suspicion to prevent **blindness** long term : asprine prevent ischemia Associated with polymyalgia rheumatica complication : visual loss The granulomatous inflammation involves the ***aorta*** in a significant number of cases, therefore, monitoring by periodic imaging of the aortic root via chest X-ray is appropriate for routine surveillance.

Answer 29

Fibrosing Alveolitis Fibrosing Alveolitis and Rheumatoid Arthritis (RA) are closely linked in the context of Rheumatoid Arthritis-associated Interstitial Lung Disease (RA-ILD).

Answer 30

Secondary Prophylaxis for Rheumatic Fever Preferred agent: ***Penicillin G benzathine IM:*** Adults >27 kg: 1.2 million units every 21–28 days Children ≤27 kg: 600,000 units every 21–28 days Alternative (oral): Penicillin V: 250 mg orally twice daily for both adults and children If allergic to penicillin and sulfonamides: ***Azithromycin:*** Adults: 250 mg orally once daily Children: 5 mg/kg orally once daily (up to 250 mg) Erythromycin is an acceptable alternative --- Duration of Therapy After Last Attack ***Rheumatic fever with carditis and residual heart disease (valvular disease):*** Continue for 10 years or until 40 years of age, whichever is longer. Sometimes lifelong prophylaxis is recommended. ***Rheumatic fever with carditis but no residual heart disease:*** Continue for 10 years or until 21 years of age, whichever is longer. ***Rheumatic fever without carditis:*** Continue for 5 years or until 21 years of age, whichever is longer. --- Additional Notes Deep intramuscular penicillin is the preferred method; oral therapy is second-line. A 21-day injection interval is recommended for high-risk or recurrent cases. Penicillin desensitization may be an option in immediate hypersensitivity reactions. Let me know if you need this in a more abbreviated (OLA) format.

Answer 31

**Sjögren's disease** Autoimmune disorder most common in women 40-60 years old **assotited with RA**, SLE ... Sx: dry eyes (**xerophthalmia**) and dry mouth (**xerostomia**) Labs: SSA (anti-Ro) or SSB (anti-La) Diagnosis: BEST initial test ***Schirmer test***, MSOT accurate ***salivary gland biopsy*** Mx : water the mouth , artificial tear , pilocarpine and cevimeline ( increas acetylchline) Higher risk of ***lymphoma***

Answer 32

**Ankylosing Spondylitis** (Radiographic Axial Spondyloarthritis) EXTR : Risk factors: male sex, age < 40 Sx: low back pain that is most severe at night and morning stiffness that ***improves with exercise*** PE: limited spinal mobility, decreased lumbar lordosis X-ray: squared vertebral bodies, multiple vertebral fusions ***(bamboo spine)*** Labs: increased ESR, positive HLA-B27 Treatment options include ***NSAIDs, physical therapy, TNF-alpha blockers*** inflilximab Associated with: uveitis, aortitis, IBD, psoriasis, apical pulmonary fibrosis Diseases associated with HLA-B27: PAIR Psoriatic arthritis Ankylosing spondylitis Inflammatory bowel disease Reactive arthritis

Answer 33

**Monosodium Urate Crystals** - needle-shaped crystal with negative birefringence **Gout** Mono- or oligoarticular arthritis caused by uric acid crystals Risk factors: male sex, age > 30 years, obesity, metabolic syndrome, CKD, dietary factors Sx: **podagra** (acute onset of pain in the first MTP) PE: hot, red, tender joint, tophi Lab results: **needle-shaped crystal with negative birefringence, uric acid can be low, normal, or elevated** Treatment Acute: NSAIDs, steroids, colchicine Chronic: **allopurinol** (first line), febuxostat, probenecid Can be **triggered by loop and thiazide diuretics**

Answer 34

**Behçet Syndrome** Etiology: small, medium, large vessel **vasculitis** Presents with recurrent **genital and oral ulcerations,** relapsing uveitis, and other systemic manifestations PE: painful genital and oral ulcers with a necrotic center and surrounding red rim Diagnosis is made clinically Tx: topical steroids, colchicine, immunosuppressive agents

Answer 35

**Polymyalgia Rheumatica** EXTRA: Patient will be a **woman > 50 years old** Proximal muscle (**shoulders, neck, hip girdle**) stiffness and aching, especially in the morning, that improves during the day but worsens after inactivity PE will show symmetrical decreased range of motion in the neck, hips, and especially in the shoulder girdle Labs will show erythrocyte sedimentation rate (**ESR) ≥ 40 mm/hou**r Treatment is low-dose prednisone Strongly associated with giant cell (temporal) arteritis

Answer 36

Chondromalacia patella ^^^EXTRA^^^: = Patellofemoral Pain Syndrome: Overuse disorder Aching anterior knee pain that is worse with loaded flexion (stair climbing, jumping, prolonged sitting) Pain with squatting is the most sensitive sign Tx: activity modification, physical therapy, NSAIDS

Answer 37

Osgood-Schlatter Disease Young adolescent athletes, 10-15 years old Knee pain with activities that cause quadriceps contractions (e.g., running, jumping) PE will show tenderness over the tibial tubercle and withknee extension against resistance Management includes ice, NSAIDs, acetaminophen, quadriceps stretching

Answer 38

🦴 Joint Involvement 1 large joint → 0 points 2–10 large joints → 1 point 1–3 small joints (± large joints) → 2 points 4–10 small joints (± large joints) → 3 points > 10 joints (at least 1 small joint) → 5 points 🧪 Serology (RF & ACPA) Negative RF & ACPA → 0 points Low-positive RF or ACPA → 2 points High-positive RF or ACPA → 3 points 📈 Acute Phase Reactants (CRP, ESR) Normal CRP & ESR → 0 points Abnormal CRP or ESR → 1 point ⏳ Duration of Symptoms <6 weeks → 0 points ≥6 weeks → 1 point If total score ≥6, diagnosis of RA is classified.

Answer 39

anti CCP = ACPA same RF sensitivity but more specific

Answer 40

1st XR cervical definitive MRI cervical Tip : Rheumatoid arthritis (RA) can involve the cervical spine, especially at the atlantoaxial joint (C1-C2), leading to instability. This can result in spinal cord compression, causing symptoms such as: Neck pain Upper and lower limb weakness Gait disturbance Myelopathy

Answer 41

Diagnostic and Treatment Approach to Hyperlipidemia 🔴 Step 1: Determine Need for Statin Therapy Ask: Does the patient meet any of the following criteria? 1. Clinical ASCVD (CAD, CVA, PAD)? 2. LDL ≥ 190 mg/dL? 3. Age 40–75 years with diabetes and LDL ≥ 70 mg/dL? 4. Age 40–75 years with LDL ≥ 70 mg/dL and 10-year ASCVD risk ≥ 7.5%? ➡️ Yes → Proceed to statin therapy. ➡️ No → Lifestyle modification and reassess risk periodically. 🔴 Step 2: Calculate 10-Year ASCVD Risk Use pooled cohort equations (online calculators or app). Mnemonic for risk factors: SAD CHF * Smoking * Age (>45 M, >55 F) * Diabetes * Cholesterol (elevated LDL or low HDL) * Hypertension * Family history (premature ASCVD) ⸻ 🔴 Step 3: Start Treatment if Indicated A. Initiate: 1. Lifestyle Modifications * Weight reduction * Heart-healthy diet (e.g., DASH, Mediterranean) * Regular physical activity * Smoking cessation 2. High-Intensity Statin Therapy (if indicated): * Atorvastatin 40–80 mg * Rosuvastatin 20–40 mg B. Obtain Baseline Labs: * CK (if muscle symptoms present) * LFTs (baseline for monitoring statin hepatotoxicity) ⸻ 🔴 Step 4: Monitor for Side Effects If symptoms of hepatotoxicity (jaundice, RUQ pain) or rhabdomyolysis (muscle pain): ➡️ Repeat CK and LFTs * ↑ CK, urine myoglobin → suspect rhabdomyolysis * ↑ LFTs → consider hepatotoxicity ➡️ Management * Stop statin temporarily * Reinitiate at lower dose or switch to moderate-intensity statin ⸻ Step 5: Not at LDL Goal After Max Statin Dose? 1. Add Ezetimibe 2. If still not at goal → Add Bile Acid Sequestrant or PCSK9 Inhibitor ⸻ Additional Notes: * Moderate-intensity statin = Atorvastatin 10–20 mg, Rosuvastatin 5–10 mg, Simvastatin 20–40 mg, etc. * Consider non-statin therapies earlier in high-risk patients who are statin intolerant. * Regularly monitor lipids and adherence every 4–12 weeks after initiation, then every 3–12 months. ⸻ Let me know if you want a version specific to primary prevention or secondary prevention separately.

Answer 42

⸻ A: ✅ Yes – renal function determines use. • eGFR ≥ 30 mL/min/1.73 m²: • Initiation allowed • Recommended for renal and cardiovascular protection in CKD and T2DM • eGFR < 30 mL/min/1.73 m²: • Do not initiate • eGFR < 20 mL/min/1.73 m²: • Discontinue

Answer 43

A: Metformin

Answer 44

A: • Insulin (adjust dose to avoid hypoglycemia) • GLP-1 receptor agonists (e.g., liraglutide – monitor tolerance) • DPP-4 inhibitors • Linagliptin: no dose adjustment needed • Sitagliptin, saxagliptin: dose adjustment required • Thiazolidinediones (e.g., pioglitazone – watch for fluid retention) • Short-acting sulfonylureas (e.g., glipizide – caution for hypoglycemia)

Answer 45

✅ B. Current smoking Explanation: • Current smoking is a well-established risk factor for osteoporosis. • Low calcium intake and family history of fragility fractures are also recognized risk factors. • BMI is only a risk when low; a BMI of 27 (as in the vignette) is not

Answer 46

Appropriate self-care of feet

Answer 47

???? Amlodipine

Answer 48

C) Pregabalin (Lyrica) ✅ First-line agent for diabetic neuropathic pain. Well-tolerated and effective in elderly. Requires renal dose adjustment but lacks the anticholinergic burden of TCAs. A) Amitriptyline Effective, but caution in elderly due to anticholinergic side effects (e.g., urinary retention, cognitive effects, orthostatic hypotension). B) Ibuprofen Not effective for neuropathic pain. NSAIDs target nociceptive pain, not neuropathic mechanisms.

Answer 49

**Repeat DEXA after 4 years.** **Osteoporosis** Decline in bone mass that results in increased bone fragility and fracture risk **Risk factors:** female sex, advancing age, chronic **steroid** use, excessive **alcohol** or **tobacco** use, parental **history** of hip * fracture, immobility, history of falls Diagnosis is made by **DXA scan: T-score ≤-2.5 or presence of a fragility fracture** Low bone mineral density: T-score-1.0 to 2.5 Tx Lifestyle: calcium, vitamin D, weight-bearing exercise, smoking cessation First-line pharmacotherapy: ***bisphosphonates*** START medication if : T-score ≤ -2.5 (DXA) at the femoral neck or spine, after appropriate evaluation to exclude secondary causes T-score between 1 and-2.5 at the femoral neck or spine, and a ***10-year probability of hip fracture ≥ 3%*** or a ***10-year probability of any major osteoporosis-related fracture ≥ 20%*** ,based on the United States-adapted WHO algorithm Second line: SERMs, recombinant PTH, denosumab Most common fracture: vertebral body compression fractures USPSTF: ***screening indicated for women ≥ 65 years and postmenopausal women < 65 years with risk factors*** ***Moderate osteopenia (T-score -1.5 to -2.0)***: Repeat screening every 3–5 years. Insufficient evidence to recommend screening in men but can be considered if risk factors present (e.g., androgen deprivation therapy)

Answer 50

USPSTF Screening Recommendations Who to screen: • All women ≥ 65 years of age. • Postmenopausal women < 65 years with ≥ 1 risk factor for osteoporosis: • Low BMI • Parental history of hip fracture • Excess alcohol consumption • Current smoking Who not to screen: • There is insufficient evidence to recommend routine screening in men. However, individual risk factors may warrant evaluation. How to screen: • DXA (dual-energy x-ray absorptiometry) of lumbar spine and hips is the preferred method. • Use tools like FRAX to assess fracture risk and determine need for BMD testing in younger postmenopausal women. ⸻ National Osteoporosis Foundation & AMBOSS Screening Interval Guidance Suggested Repeat DXA Screening Intervals (based on initial T-score): • T-score -2.0 to -2.4: Repeat within 3 years • T-score -1.5 to -1.9: Repeat every 3–5 years • T-score -1.0 to -1.4: Repeat every 5–10 years • T-score > -1.0: Repeat after more than 10 years

Answer 51

Dose: 0.3–0.5 units/kg/day total, split: 50% Basal 50% Bolus (divided among meals) Monitor: FBG, pre-meal, post-meal, bedtime glucose Adjust dose every 3 days by 2 units if above targets Watch for hypoglycemia (glucose <70 mg/dL)

Answer 52

A: Start statin — due to elevated LDL and high-risk family history.

Answer 53

Do GCS assessment in choice no Air way , Breathing , Cvs , so next Neurological assessment

Answer 54

Immediate defibrillator ^^^Extra^^^ ✅ You do unsynchronized defibrillation only in these 2 cases: 1. Pulseless Ventricular Tachycardia (VT) 2. Ventricular Fibrillation (VF) ➡️ Even if the patient is unstable, if they still have a pulse, you do NOT defibrillate, you cardiovert (synchronized) instead. ⸻ 🚫 Never defibrillate (unsynchronized) in: • A patient with a pulse • PEA or asystole • Any bradycardia or supraventricular rhythm • VT with a pulse (even if unstable → use synchronized cardioversion) ⸻ 🔥 Final rule: ✅ Defibrillation = no pulse + VT/VF only 🔄 Cardioversion = unstable but has a pulse + organized rhythm

Answer 55

High osmolarity

Answer 56

CT with contrast

Answer 57

Admission for n-acetylcysteine + When in doubt, start NAC. If the patient presents >8 hours post-ingestion, with high-risk ingestion, or lab delays, do not wait for labs.

Answer 58

**flush out the caustics ( water )** ✅**If the patient meets ALL of the following:** * Asymptomatic * Ingestion is uncertain or of a low-risk substance (e.g., household bleach) * No oral burns → Then: *** Offer clear liquids (e.g., water, milk)** * Observe for several hours → If remains asymptomatic: * Discharge * Consider Upper GI series if dysphagia develops → If symptoms develop (e.g., drooling, pain, vomiting): * Do Endoscopy within 24 hours ⸻ ❌ **If the patient has ANY of the following:** * Any symptoms (e.g., vomiting, drooling, chest/abdominal pain) * Definite ingestion of high-risk caustic substance * Oral burns → Then: * **Do Endoscopy within 24 hours**

Answer 59

**PE** -Pleuritic chest pain with recent SURGERY TIP: Virchow's triad: endothelial injury, stasis of blood, hypercoagulability

Answer 60

Scorpion anti-venom ^^^Extra ^^^ 🦂 Brief Approach to Scorpion Sting ⸻ 1️⃣ Initial Assessment • ABC: Airway, Breathing, Circulation • Vital signs: BP, HR, RR, Temp • Ask about time of sting, species if known, and symptoms. ⸻ 2️⃣ Classify Severity 🔹 Mild (local only): • Pain, erythema, swelling at sting site 🔹 Moderate/Severe (systemic): • Vomiting, abdominal pain • Sweating, salivation, restlessness • Tachycardia, hypertension • Respiratory distress or shock ⸻ 3️⃣ Management ✅ Mild: • Analgesia (e.g. paracetamol, ibuprofen) • Local ice packs • Observe for progression (4–6 hrs) ✅ Moderate to Severe: • Scorpion anti-venom (especially with systemic symptoms) • IV fluids if hypotensive • Benzodiazepines if muscle spasms present • Monitor ECG, vitals, O2 ⸻ 4️⃣ Supportive Measures • Tetanus prophylaxis • Treat complications (e.g. myocarditis, pancreatitis)

Answer 61

A: IV Sodium Nitroprusside (hypertensive emergency with end-organ damage) Acute renal failure=> Fenoldopam

Answer 62

A: IV antihypertensive such as Clevidipine.

Answer 63

Epinephrine ^^^ Extra ^^^ Pathophysiology • Preexisting IgE antibodies → mast cell degranulation → shock, airway compromise Common Triggers • Adults: Penicillin • Children: Peanut Clinical Presentation (PE) • Skin: Urticaria, flushing • Mucosal tissue: Lip, tongue, uvula swelling • Respiratory: Bronchospasm, dyspnea, stridor • GI: Vomiting, diarrhea, crampy abdominal pain • Cardiovascular: Hypotension or end-organ dysfunction Treatment: Epinephrine • Adults: • 0.3–0.5 mL of 1:1,000 (1 mg/mL) solution IM every 5–15 min • Children: • 0.01 mg/kg of 1:1,000 (1 mg/mL) solution IM every 5–15 min Refractory Hypotension • In patients on beta-blockers: Use glucagon Adjunctive Medications • H1 antagonists • H2 antagonists • Corticosteroids • Beta-2 agonists • Glucagon

Answer 64

A: Rapid rewarming Why? Bradycardia is physiologic in hypothermia and improves with rewarming; meds like atropine are ineffective.

Answer 65

A: Contrast-enhanced CT scan of the abdomen The presence of free fluid suggests intra-abdominal injury (likely splenic), but in stable patients, the next step is contrast-enhanced CT scan to evaluate the source, grade of injury, and to guide further management. • Exploratory laparotomy is indicated in unstable patients or those with peritonitis.

Answer 66

A: Immediate IM epinephrine administration. Note : even before establishing an airway or intubation, unless the patient is in respiratory arrest.

Answer 67

A: ORS / oral hydration therapy ✅

Answer 68

A: Hyperchloremic metabolic acidosis (non-anion gap acidosis due to diarrhea).

Answer 69

Step 1: High-Risk Factors → Image if ANY present * Age ≥ 65 * Dangerous mechanism (e.g., >100 km/h crash, rollover, ejection, fall from ≥3 feet/5 stairs, bicycle collision) * Paresthesias in extremities ➡️ If any = Do imaging ⸻ Step 2: Low-Risk Factors → Can assess ROM if ANY present * Simple rear-end MVC * Ambulatory at any time * Sitting in ED * Delayed onset of neck pain * No midline cervical tenderness ➡️ If none = Image ⸻ Step 3: Assess Active ROM * Can patient rotate neck 45° left and right? ➡️ If cannot = Image ➡️ If can = No imaging needed

Answer 70

Diaphragmatic rupture

Answer 71

A: NSAIDs and encourage activity/stretching (conservative management). Red flags for low back pain (brief list): 1. Age < 18 or > 50 years 2. Immunosuppression 3. History of cancer or weight loss 4. IV drug use 5. Long-term steroid or anticoagulant use 6. Recent infection, trauma, surgery, or spinal anesthesia 7. Night pain or no relief with rest 8. Fever or abnormal vitals 9. Neurologic deficits (e.g., weakness, saddle anesthesia, bladder/bowel dysfunction) 10. Signs of spinal cord or aortic pathology

Answer 72

A: Shoulder sling (conservative management). ^^^Extra^^^ 🔹 Brief Approach to Clavicular Fractures 1. Location of Fracture: • Midshaft (80%) — most common • Distal third • Medial third — rare 2. Displacement: • Non-displaced → Conservative (sling, analgesia, early mobilization) • Displaced or comminuted → Consider orthopedic referral ± surgery ***3. Associated Findings:*** • Open fracture • Neurovascular compromise • Skin tenting or risk of piercing skin ➡ These require urgent surgical evaluation.

Answer 73

A: Osteoarthritis – DIP involvement + Heberden’s node = OA.

Answer 74

A: Osteoporosis with high risk vertebral fracture Key: Glucocorticoid use → trabecular bone loss → vertebral fracture risk

Answer 75

A: Surgical repair Positive Thompson test (no plantar flexion when squeezing the calf)

Answer 76

A: Morton neuroma – interdigital nerve entrapment (3rd web space).

Answer 77

A: Sciatic nerve injury 🧠 Clue: Think about the nerve close to the hip joint responsible for dorsiflexion. The sciatic nerve gives rise to the common peroneal nerve, which controls: • Dorsiflexion of the foot (via deep peroneal nerve) • Eversion (via superficial peroneal nerve)

Answer 78

A: Radial head subluxation (Nursemaid’s elbow) ^^^Extra^^^ Pulled Elbow (Radial Head Subluxation, Nursemaid Elbow) Child 1-4 years old Most commonly caused by longitudinal traction on a pronated forearm while the elbow is extended History of being pulled up by the wrist PE: the affected arm is held close to the body in a flexed and pronated position ***Dx : clinically , try 2 - 3 time to fix it , if not do XR*** Tx Hyperpronation method: apply pressure to the radial head and hyperpronating the forearm Supination-flexion method: supinate and fully flex the elbow while applying pressure to the radial head and pulling with gentle traction

Answer 79

A: Immobilizing boot shoes (D) why not XR ?

Answer 80

EXTRA^^: Ankle Sprain Lateral most common, medial and high ankle sprains more severe History of ankle inversion for lateral sprain PE: pain and swelling ***Ottawa Ankle Rules to determine imaging*** Imaging will show partial or complete tearing of ligaments ***Most commonly injured anterior talofibular ligament (ATFL)*** Treatments: RICE therapy (lacking formal studies), functional bracing, functional rehabilitation Consider whether a syndesmotic (high) sprain is present and immobilize with non-weight-bearing Emerging treatments: MEAT (movement, exercise, analgesia, treatment) or MOVE (movement, options, vary, ease

Answer 81

A: Ulnar nerve injury Ulnar: abduction of finger Radial : wriest extension Median : thump toward little finger

Answer 82

A: Lumbar spinal stenosis. ^^^EXTRA : Spinal Stenosis Risk factors: age > 60 years Low back pain and stiffness when walking that is relieved when leaning forward Radicular symptoms, neurogenic claudication Diagnosis is made by MRI Most commonly caused by narrowing of the lumbar spinal canal with compression of the nerve roots Management includes physical therapy, steroid injections (lack of evidence of benefit), surgery

Answer 83

A: Arch support (→ plantar fasciitis).

Answer 84

A: Costochondritis Clue: Localized pain reproducible on palpation without systemic signs.

Answer 85

A: Immobilize for 2–3 weeks followed by physiotherapy.

Answer 86

A: Referral for surgical release of the contracture. 📌 Condition Overview: Dupuytren Contracture 👨‍⚕️ What is it? ***Progressive fibrosis of the palmar aponeurosis***, leading to flexion contractures of fingers—most often the ring and little fingers. 🧬 Risk Factors: 👴 Age >50 👨‍👦 Family history 🍷 Alcohol 🚬 Smoking 🩺 Diabetes Symptoms: • Painless nodule or thickened band in palm • Gradual flexion contracture of affected fingers • ↓ Hand function 🔍 When to Treat: • MCP contracture >30° • Any PIP joint involvement • Functional impairment 🛠️ Treatment: • Surgical release (fasciectomy or fasciotomy) in moderate to severe cases • Collagenase injection may be used in early stages (less common)

Answer 87

A: ACL tear

Answer 88

✅ Mammogram 📝 Explanation: • Mammogram: every 2 years (due now) • Lipid profile: every 4–6 years if low risk (not yet due) • Colonoscopy: every 10 years (last done 4 years ago) • Chest X-ray: not recommended routinely in asymptomatic patients

Answer 89

A: Referral for BRCA mutation testing. 🧬 Testing is recommended if breast cancer is diagnosed before age 50 in a close relative, especially if multiple family members are affected. Genetic testing (BRCA) is appropriate in such cases even before age 40.

Answer 90

A: Avoid uncooked vegetables Why? Prevents ingestion of E. histolytica cysts via contaminated food.

Answer 91

A: Ciprofloxacin (for moderate/severe or dysenteric diarrhea). ???

Answer 92

A: Stroke rehabilitation program (improves function and prevents disability).

Answer 93

A: Hepatitis A vaccine (HAV) – due to endemic risk via contaminated food/water.

Answer 94

A: No vaccine needed 📌 Tdap/Td only if >10 yrs for minor wounds; >5 yrs for dirty wounds.

Answer 95

A: Amoxicillin-clavulanate (Augmentin) 🧫 Covers common pathogens like Pasteurella, Staph aureus, anaerobes. Extraaaaaa: If the patient had prior complete rabies vaccination: * Do NOT give rabies immunoglobulin (RIG) * Give only 2 doses of rabies vaccine on day 0 and day * No need for the full 4-dose series * No need for RIG, even if it’s a high-risk bite

Answer 96

A: Lipid profile 🧠 Assesses cardiovascular risk early due to modifiable and hereditary factors.

Gastro Flashcards

(128 cards)