HIGH yield Flashcards
(171 cards)
1
Q
Tx for Ankylosing Spondylitis
A
NSAIDs- 1st line
INFLAXIMAB, ETANERCEPT, ADALIMUMAB - 2nd line
2
Q
Best initial inv for Ankylosing Spondylitis
A
Xray
3
Q
Accurate inv for Ankylosing Spondylitis
A
MRI
4
Q
Latest New York criteria for dx Ankylosing Spondylitis
A
Xray of Sacroilitis
Limited chest expansion - Normal chest expansion is more than 5 cm
History of inflammatory back pain
Decreased motion of Lumbar spine in both sagittal and frontal planes
5
Q
6As of AS
A
Arthritis
Aortitis
Anterior Uveitis
Atypical Lung Fibrosis
Achilles Tenditis
Age group (Young)
6
Q
Lung ABSCESS - INITIAL Cxr fluid level within the cavity
2wks antibiotic tx - no resolution
What’s next
A
Refer to Surgeon
- Lobectomy ( surgery is needed due to the abscess that drains poorly can cause toxic symptoms and persistent fever)
7
Q
Rusty sputum
Multiple brownish red spot in the foot
Weight Loss
A
TB
8
Q
In leg, ERYTHEMA NODUSUM
A
Dx Sarcoidosis
9
Q
In leg, Erythema NODuSUM + RUSTY SPUTUM
A
Dx TB
10
Q
Foul Smelling SPUTUM - key
thick- walled cavitary lesion
A
Lung Abscess
11
Q
Mobitz type 2 ECG with slow HR
Ultimate treatment?
Initial Treatment
A
Pacemaker - Ultimate tx
Atropine - next or Initial TX
12
Q
Sinus bradycardia
tx?
A
Atropine to increase the heart rate
Pacemaker - definitive treatment
13
Q
Cause of Sinus bradycardia
A
Beta blocker or Calcium blocker excess
14
Q
<60 bpm
lightheadness and Syncope
A
Sinus bradycardia
15
Q
PR interval >200 msec
associated with Increased vagal tone and with B-blocker or CCB use
A
First Degree AV block
16
Q
Drug Effects ( digoxin , B blockers , CCBs)
PR interval is increase until dropped beat ccurs
A
Second Degree AV block (Mobitz I Wenkebach)
tx: Stop the offending drug
17
Q
Unexpected dropped beat
without a change in PR interval
Results from fibrotic disease of the conduction system from a previous septal myocardial infarct
occasionally syncope
A
Second degree AV block ( Mobitz II)
tx Pacemaker placement
18
Q
No electrical communication between the atria and the ventricles
sycope, dizziness, acute heart failure, hypotension, cannon A waves
A
Third degrew AV block (complete)
tx: Pacemaker placement
19
Q
7 days after prostatectomy with fever and chills
cause?
A
Wound infection
20
Q
What to do next when CORONA virus examination is negative
and the patient has cough sometimes dry or sometimes with spit
the sputum
A
CXR
21
Q
Man with free male partner, initial screening including HIV is negative
What to do next
A
Repeat HIV screening 3 months later
22
Q
Menopausal woman - postcoital bleeding
inv?
A
Endometria Biopsy
Dx; Cervical carcinoma
23
Q
Menopausal woman - sexually active
greeny brownish discharge
A
Chlamydia
24
Q
Routine screening for Ovarian Cancer
A
CA-125 or TVS
25
What are the risk factors for Ovarian Cancer
Lower risk - have used the OCPS and carried a pregnancy to term
Higher risk - Presence of breast cancer susceptibility to gene 1 (BRCA1) or BRCA2
26
Mgt of Sickle Cells
Analgesics
27
Pain after walking some distance lower limb impulse after palpable (probably not ischaemic - coz it is usually palpable if it is ischaemic)
bext inv
If MRI not given - then DOPPLER first
MRI
28
Treatment of DVT
Heparin eg ENOXAPARIN
29
Positive Homan's sign
Calf pain on foot dorsiflexion
DVT
30
NO ct
Warfarin taken
Amoxicillin taken
Massive bleeding
Rectus Sheath Hematoma
31
Pt on warfarin
INR 5
Rectus Sheath Haematoma
What is the initial step?
Vitamin K - IV
32
Man with chronic constipation
What will you lead to dx?
Colonoscopy
33
Child with mass on his umbilicus
No tender3
Hernia
34
Narrow QRS complex
HR: 150
SVT
mgt: Vagal maneuver or carotid sinus massage
child mgt: immersion his face on the cold water
DOC: IV Verapamil or Adenosine - if there is asthma - you cannot give ADENOSINE, prefer VERAPAMIL
If unstable case - Mgt will be DC shock or cardioversion - vital stats such as BP very low
35
SOB, 35M, cannot stop his hear from pounding
No other medical problems
Afebrile
HR 214 / min
Dx?
Paroxysmal Supraventicular TAchycardia
36
palpitation + thyroid problem
Ecg shows
Dx: AF
tx: Metoprolol
37
Bilateral hilar lymph nodes - this shows that CXR is done
high ca level
Check ACE level
dx: Sarcoidosis
Other inv:
Xray - Initial
ACEI - next
CT - next
Biopsy - to confirm
38
Heavy smoker, cough and blood streal ,
night sweats, weight loss, CXR was given that upper RIght lobe
Carcinoma
_ if no fever
39
A man with CKD poor GFR, sydpnea + tachycardia + chest pain
Xray - showed wedge shaped opacity
INv?
Dx: Pulmonary Embolism
Inv: V/Q Scan
40
CHF and MI patient die
Primary cause of dead?
Cardiac Arrest
41
pt with hypoglycemia and driving
when can drive again?
ONly drive back 6 wks later
42
Driving Restrictions
cannot go back within 2 wks
AMI
Insertion of Defib
DVT
43
Driving Restrictions
cannot go back within 4 wks
AAA
CABG
44
Driving Restrictions
cannot go back within 2 days if complication free
Angioplasty
45
Driving Restrictions
cannot go back within 6 wks
PE
46
Driving Restrictions
cannot go back within 2 yrs
Chronic Epilepsy
47
Driving Restrictions
cannot go back within 3-6 months
Isolated Seizure
Recently diagnosed Epilepsy
Recurrent seizure
48
Driving Restrictions
cannot go back within 1 yr
Seizure causing accident
49
Driving Restrictions
cannot go back not less than 6-12 months
Visual acuity
50
Huntingtons screening
Bring her back when she turns 16
51
Huntington treatment with depression
Paroxetine
52
Prostate ca
underwent prostatectomy
PSA double rising too quick
Abd CT
53
if patient is less than 50
grandmother has ovarian Ca
what to do?
Nothing
54
60M, history of cirrhosis
DIstended abdomen
Dx: Hepatic Encephalopathy
inv: ammonia
55
Ascitic fluid - polymorphs present
Ceftriaxone
56
Severe UTI
chills, high fever and pain
GFR is low (20ml/min)
Trimethoprim - used in adjusted dose in Renal impairment
in GFR up to 15
57
Jelly fish sting , and has resp distress
What to do next?
Because there is resp distress
- then give O2
58
Used in the ED rescucitation room to assess the chest and abdomen of acutely injured patients
esp those with shock
esp GUNSHOT Wounds with abdominal distenntion with low BP even with GCS is good
FAST scan
- can be done in 2 - 3 min
- non invasive
- - disav: does not defined the injured organ., only the presence of bloos or fluid in the abdomen or pericardium
59
OCP used for 10 years
BMI > 30
Whats the increase risk of what cancer
Breast Ca
60
61
62
63
64
65
Small smooth lump in the vaginal opening
Painful but not discharge
no itchiness
Mgt?
Marsupialization
66
It involves the opening of the Bartholin cyst or abscess and then suturing the edges forming
a permanent open poket or pouch and allowing continued drainage
Performed under General or Local Anestheia
Typically reserved for recurrent cysts or abscesses
Marsupialization
67
INR < 5
Lower warfarin dose
68
INR > 5-9
Administer 1-2.5 mg oral Vitamin K
69
INR > 9
5=10 mg Vitamin K
and hold Warfarin
70
INR > 2o
Hold Warfarin
and administer Vitamin K 10mg
71
It is more sensitive for early Covid - 19 diagnosis than CXR
CT scan
72
Head Injury has low sodium low potassium
What is the cause?
SIADH
73
Excessive water retention
hyponatremia with continued Urinary Excretion
Urine Osmolarity > serum osmolarity
SIADH
74
What is the treatment for SIADH
Fluid restriction
IV saline
Conivaptan, Tolvaptan and Demeclocyline
75
What is the treatment for DI
Desmopressin
given twice intranasally
76
What are the causes of SIADH
Cancer (lung, lymphomas, kidney, pancreas)
drugs (Carbamazepine and Antipsychotic agents)
77
Polyuria
Nocturia
Compensatory polydipsia
passage of 33-20 L of dilute urine per day
Diabetes Insipidus
78
What is the best initial test for Sarcoidosis
Chest Xray
79
What is the most accurate test for Sarcoidosis
Lymph Node biopsy
80
Drug of choice for Sarcoidosis
Prednisone
81
Had scarred history of appendectomy 10 yrs ago - key
Adhesion
82
Acute limb ischemia, what will you do?
Embolectomy
83
Sickle cells, anemia crisis
What will you give to him?
Analgesics
84
Traumatic Vulvar hematoma
Fall from the bath tub
inv?
CT of pelvis
85
Pedia with jelly fish sting
Screaming in pain
tentacles across both legs
before remooving the tentacles
Vinegar
86
Menopausal symptoms with personal hx of BRCA , HER-2 is negative
What to give
Estrogen only
87
30M, presents with Right Scrotal swelling, Spermatic cord palpated
Firm Mass upper pole of Right Testis
Inv?
Beta HCG
88
What are the painful scrotal mass
Testicular torsion
Epididymitis
Inguinal hernia
testicular tumor
trauma
89
Painless scrotal mass
Testicular tumor
Hydrocele
Inguinal hernia
Spermatocele
Varicocele
Paratesticular tumors
90
63F, driblling, urinary frequency x 12 mons, PE with mild rectocele,
cystocele, moderate uterine Prolapse
Next step?
Surgery
91
Pic of gynecomastia in Adolescence 19 yo
football player asthmatic on salbutamol and fluticasone
What is the cause of Presentation?
Steroids = GYNECOMASTIA SE
Gynecomastia in
15 yo = Physiologica
17 years = Idiopathic
21 + athlete = STEROIDS
92
Abdominal CT dx history of ntermittent abdominal pain which resolves spontaneously
No other remarkable findings?
Hemangioma - correct
93
Weight loss
Cough x 2 wks
Night sweats
Bilateral CLAD
dx?
TB
94
best nonpharmacologic treatment for someone who couldnt sleep at night or has less sleep
Stress Management
95
Volvulus + abdominal Pain + Constipation
Sigmoid volvulus
96
Football sign
premature, bloody stool, pneumatosis intestinalis + feed intolerance
Necrotizing enterocolitis
97
Epigastric hernia sign
best way to evaluate
Cough impulse - Standing position
98
Type of study
best possible evidence
Efficacy
RCT
99
Type of study
Time involvement -
prevalence, Risk FActors, study between, adverse effects
CROSS Sectional
100
Type of study
Incidence
two group exposure
Cohort
101
The type of fracture typically occurs after falling down
on an outstrecthed arm and laning on the back side of the wrist
Smith Fracture
102
Scaphoid Fracture:
in a highly suspected normal Xray of wrist
Scaphoid plaster for 10 days
103
Sphaoid Fracture for undisplaced and stable fractures
6-8 wks in a below - elbow scaphoid cast
104
Scaphoid Fractures
Displaced fractures - required reduction either open or closed
If unstable?
Internal Fixation
105
Variable CTF, 39 wks
no fetal movement
nxt?
Amniotomy - if fetus is dead then extablished labor
106
Abnormal CTG sinusoidal pattern, prolonged bradycardia
C section
107
Normal and Variable CTG
Reassurance
108
In dead fetus
try CTG and to confirm the findings
Try NVD if possible
109
If no detal movements is felt 24 hrs after a normal CTG
nxt?
Induction of labor esp if near term and cervix is favourable
110
Fetal hypoxia, fetal distress
mgt?
C-section
111
Uterus bleeding, tender uterus
No fetal heart sound
Amniotomy - because it is a dead fetus
112
weakness of the left arm
Key - axillary lymph nodes are enlarged but not tender
pet cat is unwell
dx?
Cellulitis
113
ECG shortening of QT intervals
tx?
Hydration
biphosphonates
in Refactory situation - Calcitonin
In Volume overload - Loop Diuretics
In comlplex - Streoids
114
What will help in the diagnosis of bell's palsy
Cannot raise eyebrow in the Left side
115
What lobe is responsible for personality and behavioral changes
Frontal Lobe
116
Anterior Drawer Positive
ACL RUPTURE - with a Popping sound
117
5cm mass in the kidney
What will you do?
Nephrectomy
118
>7cm paracentral, central
stage 4 disease
Ipsilateral Adrenal Gland
Total
119
If solitary kidney along with above condition
Nephron Sparing
120
Stone in the kidney 0.5 cm
Mgt?
Observation
121
Ischemic leg warning sign
Paralysis
122
Indication of Urgent Embolectomy
Paralysis
123
Chlamydia, urethral dischrge, dysuria, frequeny
inv?
Urine Culture
124
Breast lump
her2 n poitive
more than 2 places,
Bony metastasis
Radiotherapy
125
low Na
Low BP
High K
Addison
126
normal Ca, raised ALP
Paget disease
127
hyperthyroidism
anti TSH
grave Disease
128
Secondary gain
Malingering
129
Splitting phenomenon
Borderline Personality
130
Depressed , low mood > 2 years
Dysthmic
131
SIGECAP 2 wks
MDD
132
Alcoholic, agitated
IV Diazepam
133
Eye dischage
Day 1 - Chemical Conjunctivitis
1st week - Gonorrjea
>7-21 - Chlamydia
> 21 - HSV
134
3rd day discharge from eye baby
Diplococci.... Gonorrhea
135
Hoarseness, reflux, infection resolved
Pancoast Tumor
136
term
Transient Tachypnea of the Newborn
137
RDS or Hyaline Membrane
Premature
138
Post term
Meconium aspiration
139
Subclavian tube insertion
BP drops
Tracheal deviation
DX
tension Pneumothorax
mgt: Needle throacentesis
140
After hip surgery how will you give the Warfarin
Ideally it should be 12 -24hrs
141
Patient done with hip surgery, post op 38 days heparin taking
Stop drug as it is > 35 days now
if mobilised - stop drug immediately
If no mention of physio - check blood - APTT
142
CCB + metformin
Hypoglycemia
143
SSRI + SIADH
Hyponatremia
144
SSRI + CCB
Hypotension with Tachycardia
145
Fever , elevated enzymes
Vital unstable, encephalopathy , rigidity of muscles
tx?
Dantrolene
146
Dripping poor urine stream on exam bilateral enlarged prostate
inv?
PSA
147
Pneumonia
with fever and agitatio = Moderate Pneumonia
tx
Benzylpenicillin only if vomiting otherwise Amoxicillin
Mild = Amox
mod = Oral Amo = Iv B pen if oral is issue
Severe = Ceftriaxone and Flucloxacillin - Erythromycin/ Vancomycin
148
Tx for Bronchiectasis with superimposed Lobar pneumonia
IV Ticarcillin
149
man dizziness , hearing good, nystagmus
BPPV
150
Accident, chest injury , morphine, conscious
Intubate and ventilate
151
1st stage of labour < 2 cm Os dilatation and -1 station
reassurance
152
Uterine rupture can't appreciate FHR
C section
153
Psych patient treated with Olanzapine
Aripiprazole
154
Nursing home patient. thinking nurse is putting worms in food
Dx
Brief Pyschotic Disorder
155
Man in ED with drug overdose, he was in the Garden
Wake upwith agitation
hx of divorce
wants to die
Involuntary admission
156
Suicidal patient
needs to be seen alone by the GP
157
TOnic clonic seizure in hospital with 02 Mask
next?
Lateral Position
158
3cm breast mass with ER +ve
no LV enlargement
Next?
Tamoxifen
159
Tonic clonic seizure at hospital, recurrent on going seizure O2 and mask given
IV diazepam
160
Breast Cancer all receptors present - 3 cm mass, estrogen receptor positive
initial mgt
Tamoxifen
161
Vertigo 3 days, no tinnitus
Nystagmus positive nausea
Noviral condition
BPPV
162
rubbery LN
Chemo
163
You are a Register, anesthetist always sleepiing
Notify the head of the surgery
164
Old female, epigastric pain, no lipase
no abnormality in US
Esophagitis
165
Female, INR, wrfarin overdose
No bleeding, no bruising
mgt
Cease Warfarin and Observation
166
Low Na+ pnly
all other normal
Urine osmolarity also normal
Dx?
Delusional Hyponatremia
167
Protei +1
Male middle age
next?
Early morning urine sample
168
Stiffness of the hand
GFR not good
cause?
Methotrexate - used in RA
169
Female , ANA +, Antirho +
la +
What will you give
Oral Prenisolone followed by monoclonal antibodies
170
Dry eye
Sjogren
171
3 kids, fishclip, 5 days flooding
fresh bleeding
tx?
Mirena / IUD
