SEP Revision Flashcards
(451 cards)
1
Q
Describe the cause of a molar pregnancy.
A
A molar pregnancy occurs due to an abnormal fertilization event leading to the growth of abnormal trophoblastic tissue.
2
Q
What are the symptoms of a molar pregnancy?
A
Symptoms include vaginal bleeding, excessive nausea and vomiting, an enlarged uterus, and the passage of grape-like cysts.
3
Q
How is a molar pregnancy typically diagnosed initially?
A
A molar pregnancy is initially investigated using a transvaginal ultrasound to reveal a ‘snowstorm’ pattern and by checking serum hCG levels.
4
Q
What is the best diagnostic test for confirming a molar pregnancy?
A
The best diagnostic test is an ultrasound, which shows characteristic patterns of molar pregnancy, and histopathology following tissue examination.
5
Q
Describe the key differentials between missed abortion, ectopic pregnancy, and normal pregnancy with bleeding.
A
Missed abortion is differentiated by ultrasound findings, ectopic pregnancy often presents with different symptoms and ultrasound findings, while normal pregnancy with bleeding may require careful monitoring and follow-up.
6
Q
What is the initial treatment for removing molar tissue?
A
Evacuation of the uterus using suction curettage is the preferred method for removing molar tissue.
7
Q
How is prophylactic chemotherapy used in the management of high-risk cases?
A
Prophylactic chemotherapy may be considered to prevent the development of gestational trophoblastic neoplasia (GTN) in high-risk cases.
8
Q
Define the step management for molar tissue evacuation.
A
Step management includes performing suction curettage to remove the abnormal tissue, monitoring hCG levels weekly until undetectable, then monthly for 6 months to 1 year, advising against pregnancy during follow-up, and regular monitoring for the development of GTN or persistent trophoblastic disease.
9
Q
What should be done if hCG levels plateau or rise during follow-up?
A
If hCG levels plateau or rise, referral to a specialist for further management, including possible chemotherapy, should be considered.
10
Q
Describe the causes of immediate postoperative fever (0-48 hours)
A
Causes include surgical stress response, atelectasis, and reactions to medications.
11
Q
What is the initial management approach for immediate postoperative fever?
A
Initial management involves close observation of vital signs and providing supportive care like deep breathing exercises, hydration, and pain control.
12
Q
How should acute postoperative fever (Day 3-5) be managed according to RACGP guidelines?
A
Management involves considering causes like UTI, pneumonia, and superficial surgical site infection, and appropriate treatment based on the identified cause.
13
Q
Define atelectasis in the context of postoperative fever
A
Atelectasis refers to the collapse of lung tissue, often triggered by anesthesia and immobility.
14
Q
What should be done if the fever persists during the immediate postoperative period despite initial management?
A
Reassess for missed causes like infections or adverse medication reactions and consider further intervention if needed.
15
Q
Describe the signs of superficial surgical site infection in the context of postoperative fever
A
Signs include redness, warmth, or drainage from the incision site, indicating a possible infection.
16
Q
How can postoperative fever be managed in the immediate postoperative period without further intervention?
A
If the fever resolves spontaneously and there are no signs of infection, continued monitoring is sufficient without additional intervention.
17
Q
What is the significance of urinary tract infection (UTI) in causing acute postoperative fever?
A
UTI is a common cause of fever on Day 3-5 post-surgery, especially in patients with indwelling catheters.
18
Q
Describe the initial management steps for suspected infections postoperatively.
A
Perform urine culture for UTI, chest X-ray for pneumonia, and clinical examination of the surgical site.
19
Q
What is the recommended action if there is a clinical suspicion of infection postoperatively?
A
Start empiric antibiotics and adjust therapy based on culture results.
20
Q
How should antibiotic therapy be managed in postoperative infections?
A
Modify antibiotics based on culture and sensitivity results.
21
Q
What wound care should be provided for a superficial surgical site infection?
A
Appropriate wound care, which may include opening the wound for drainage.
22
Q
What supportive care measures are recommended for postoperative infections like pneumonia?
A
Continue oxygen therapy, fluids for hydration, and antipyretics to manage fever.
23
Q
Where can more detailed guidelines on managing infections be found?
A
RACGP guidelines.
24
Q
What are the potential causes of subacute postoperative fever (Day 5-8)?
A
Surgical site infection, deep venous thrombosis, anastomotic leak.
25
What imaging modalities are recommended for evaluating subacute postoperative fever causes like DVT or abscesses?
Ultrasound for DVT, CT scan for abscesses or anastomotic leaks.
26
What interventions may be necessary based on imaging findings in subacute postoperative fever cases?
Drainage of abscesses or revision surgery.
27
Describe the management approach for delayed postoperative fever after day 8.
Includes comprehensive evaluation, broad-spectrum antibiotics, surgical consultation if needed, targeted antibiotic therapy, and consideration of ICU care for severe cases.
28
What is the recommended management for deep abscesses causing delayed postoperative fever?
May require surgical or radiological drainage.
29
How should antibiotic therapy be approached in cases of delayed postoperative fever?
Continue or start antibiotics based on culture results, focusing on likely pathogens.
30
Define the role of anticoagulation in cases of confirmed DVT postoperatively.
Initiate anticoagulation therapy.
31
What additional resource can provide detailed guidance on post-surgical complications management?
RACGP guidelines.
32
Do you need surgical consultation for delayed postoperative fever management?
May be required for abscess drainage or correction of an anastomotic leak.
33
Describe the causes of delayed postoperative fever after day 8.
Include deep abscesses, anastomotic leak, and sepsis.
34
How should broad-spectrum antibiotics be used in cases of delayed postoperative fever?
Start empirically while awaiting specific culture results.
35
What imaging modality is recommended for comprehensive evaluation in cases of delayed postoperative fever?
CT scan.
36
Define the role of ICU care in managing delayed postoperative fever.
Consider for severe sepsis or systemic infection.
37
Describe post-surgery complications.
Post-surgery complications can arise due to various factors such as the type of surgery, patient's health condition, and perioperative care.
38
are the symptoms of infection post-surgery?
Symptoms of infection include redness, swelling, warmth, fever, pus, or other discharge from the surgical site.
39
How can manifest as a post-surgery complication?
Bleeding can present as excessive bleeding from the incision site or internal bleeding leading to hypotension, tachycardia, or anemia.
40
Define Deep Vein Thrombosis (DVT) in the context of post-surgery complications.
DVT is characterized by pain, swelling, and redness in the limb, typically affecting the legs.
41
What are the signs of Pulmonary Embolism (PE) as a post-surgery complication?
Signs of PE include sudden shortness of breath, chest pain, tachypnea, and hypoxia.
42
Describe Atelectasis as a post-surgery complication.
Atelectasis is marked by shortness of breath, decreased oxygen saturation, fever, and decreased breath sounds.
43
What is Postoperative Nausea and Vomiting (PONV) and how does it manifest post-surgery?
PONV involves symptoms like nausea, vomiting, and dehydration following a surgical procedure.
44
How would you recognize Wound Dehiscence as a post-surgery complication?
Wound dehiscence is identified by the separation of the surgical incision, leading to exposed tissue or organs.
45
Describe the steps involved in the initial investigation of a post-operative patient.
Includes physical examination, blood tests (CBC), and imaging (ultrasound, chest X-ray).
46
What are the recommended blood tests to assess a post-operative patient for infection, anemia, or other abnormalities?
CBC (Complete Blood Count).
47
How can deep vein thrombosis (DVT) be assessed in a post-operative patient?
Doppler ultrasound.
48
Define atelectasis and how it can be diagnosed in a post-operative patient.
Atelectasis is the collapse of lung segments, diagnosed via chest X-ray.
49
What is the best diagnostic test for wound dehiscence in a post-operative patient?
Direct clinical examination.
50
Differentiate between infection and inflammation in a post-operative patient.
Infections typically present with systemic signs like fever.
51
Describe a key differential diagnosis between pulmonary embolism (PE) and myocardial infarction in a post-operative patient.
PE often presents with pleuritic pain and sudden onset dyspnea, while both can have chest pain.
52
Describe the difference between bleeding and hematoma.
Bleeding is ongoing and systemic, while a hematoma is a localized collection of blood.
53
What is the initial treatment for infection after obtaining cultures?
Broad-spectrum antibiotics.
54
How is bleeding initially treated?
Hemostasis, possible blood transfusion, and addressing the cause.
55
What therapy is used for DVT/PE?
Anticoagulation therapy, such as heparin.
56
What interventions are used for atelectasis?
Incentive spirometry, chest physiotherapy, and possibly bronchoscopy.
57
What medications are used for pain management?
Analgesics like paracetamol, opioids if severe.
58
What is the treatment for wound dehiscence if necessary?
Surgical intervention to close the wound.
59
Define hematoma.
A localized collection of blood.
60
What antibiotics are used for infections?
IV cefazolin or piperacillin-tazobactam.
61
What antiemetics are used for nausea?
Ondansetron, metoclopramide.
62
Describe Restless Leg Syndrome (RLS)
It is a neurological disorder characterized by an uncontrollable urge to move the legs, often due to discomfort, and commonly associated with conditions like iron deficiency or chronic kidney disease.
63
Do individuals with RLS experience uncomfortable sensations in their legs?
Yes, they often experience sensations like tingling or burning in their legs.
64
Define the initial investigation for RLS
It involves a clinical diagnosis based on symptom criteria, including the urge to move legs, worsening at rest, and relief with movement, along with checking iron levels.
65
How can RLS be diagnosed if the symptoms are unclear?
A sleep study (Polysomnography) may be conducted to rule out other sleep disorders.
66
Describe the role of ferritin levels in diagnosing RLS
Ferritin levels are checked to assess iron deficiency, which is often linked to RLS, with levels below 50 µg/L commonly associated with the condition.
67
Describe the difference between peripheral neuropathy and nocturnal leg cramps in terms of symptom relief with movement.
Peripheral neuropathy symptoms are not typically relieved by movement, while nocturnal leg cramps are usually not associated with the urge to move the legs.
68
What are the initial treatment options for Restless Legs Syndrome (RLS) if ferritin levels are low?
Iron supplementation.
69
List some lifestyle modifications recommended for managing Restless Legs Syndrome (RLS).
Regular exercise, good sleep hygiene, avoiding caffeine or alcohol before bedtime.
70
What are the first-line pharmacological treatments for moderate to severe Restless Legs Syndrome (RLS)?
Dopamine agonists like Pramipexole and Ropinirole.
71
When should Gabapentin or Pregabalin be considered in the management of Restless Legs Syndrome (RLS)?
For patients with painful symptoms or those who do not respond to dopamine agonists.
72
Why is regular monitoring important in the management of Restless Legs Syndrome (RLS)?
To adjust treatment and manage potential side effects like augmentation (worsening of symptoms).
73
Pain with Restless leg sybdeome
gapapentine
74
rest leg intermittent symptoms treatment
levodopa
75
Describe the purpose of transdermal estrogen patch in menopausal symptom management.
Delivers systemic estrogen to alleviate vasomotor symptoms and improve vaginal atrophy.
76
What advantage does the transdermal route of estrogen delivery offer over oral estrogen?
Lower risk of thromboembolism and effectiveness in reducing flushing and vaginal symptoms.
77
How does estradiol, whether oral or transdermal, provide relief in menopausal symptoms?
By offering systemic relief of symptoms like hot flashes and vaginal dryness.
78
Describe the purpose of topical estrogen in managing menopausal symptoms.
Primarily targets vaginal symptoms like dryness and dyspareunia but does not address systemic symptoms like flushing.
79
What is a limitation of using topical estrogen for managing menopausal symptoms?
While effective for vaginal symptoms, it is not sufficient for managing systemic menopausal symptoms like flushing.
80
How can the choice of estrogen therapy be adjusted based on symptom severity?
The option can be adjusted by choosing different formulations (oral vs. patch) to offer flexibility in managing both vasomotor and local symptoms.
81
What is the preferred management for a patient needing to address both flushing and vaginal symptoms during menopause?
A transdermal estrogen patch or estradiol would be the most suitable options to relieve vasomotor symptoms while also improving vaginal health.
82
What are some common symptoms of menopause?
Common symptoms of menopause include hot flashes, night sweats, vaginal dryness, mood changes sleep disturbances, irregular periods, and decreased libido.
83
What is the initial investigation for menopause?
The initial investigation for menopause includes assessing symptoms, menstrual history, and general health.
84
How is menopause diagnosed?
Menopause can be diagnosed through clinical symptoms, age, and hormonal levels, with the FSH test being a key diagnostic tool.
85
What are the key differentials for menopause?
Thyroid disorders such as hyperthyroidism or hypothyroidism can mimic menopausal symptoms.
86
Describe the overlap between depression/anxiety and mood changes during menopause.
Depression/anxiety may overlap with mood changes experienced during menopause.
87
Define Premature Ovarian Insufficiency.
Premature Ovarian Insufficiency refers to menopause-like symptoms occurring before the age of 40.
88
What are the initial treatment options for menopausal symptoms?
Initial treatment options include lifestyle modifications, non-hormonal options, and medications.
89
How can lifestyle modifications help manage menopausal symptoms?
Lifestyle modifications such as regular exercise, healthy diet, and maintaining a cool sleeping environment can help manage symptoms.
90
What are some non-hormonal options for symptom relief during menopause?
Non-hormonal options include vaginal lubricants for dryness and SSRIs for mood disturbances and hot flashes.
91
What is Hormone Replacement Therapy (HRT) used for in menopausal treatment?
Hormone Replacement Therapy (HRT) is used for relief of moderate to severe menopausal symptoms.
92
What is the purpose of Step Management in menopausal treatment?
Step Management involves assessing symptoms, discussing lifestyle changes, considering HRT, and exploring non-hormonal therapies.
93
How should menopausal symptoms be monitored in the long term?
Menopausal symptoms should be regularly monitored for osteoporosis and cardiovascular health risks.
94
Do hypertensive encephalopathy commonly cause intracerebral hemorrhage or diffuse brain edema?
Hypertensive encephalopathy is more commonly associated with diffuse brain edema rather than intracerebral hemorrhage.
95
Describe the neurological symptoms associated with hypertensive encephalopathy.
Hypertensive encephalopathy typically leads to diffuse neurological symptoms like confusion, headache, and visual disturbances.
96
Define cerebral amyloid angiopathy.
Cerebral amyloid angiopathy involves the deposition of amyloid in the small and medium-sized blood vessels of the brain, leading to hemorrhages.
97
How does cocaine use relate to the likelihood of cerebral amyloid angiopathy?
Cocaine use is unlikely to be related to cerebral amyloid angiopathy.
98
Describe arteriovenous malformation (AVM) in relation to hemorrhagic strokes.
AVMs can cause hemorrhagic strokes, including subarachnoid hemorrhage.
99
Do AVMs typically result from acute drug use like cocaine?
AVMs are congenital and not typically precipitated by acute drug use like cocaine.
100
Describe the relationship between cocaine use and the risk of aneurysm rupture according to the RACGP perspective.
Cocaine use can lead to a sudden increase in blood pressure, making it more likely to cause an aneurysm to rupture than trigger an AVM hemorrhage.
101
Do coagulopathies due to chronic liver disease commonly lead to subarachnoid hemorrhage (SAH)?
No, coagulopathies associated with chronic liver disease are less likely to cause SAH, especially in a young patient with no history of liver disease but a known history of cocaine use.
102
Define the most likely cause of SAH in a patient with a history of cocaine use according to the RACGP perspective.
The most likely cause of SAH in a patient with a history of cocaine use is a ruptured aneurysm, as cocaine use can lead to sudden and severe increases in blood pressure, precipitating an aneurysm rupture.
103
How does cocaine use affect the risk of aneurysm rupture in the context of acute use?
Cocaine use, due to its potent effects on blood pressure, increases the risk of aneurysm rupture, making it the most likely cause of SAH in the context of acute cocaine use.
104
Do young individuals with a history of cocaine use have a higher risk of intracerebral hemorrhage compared to the general population?
Yes, young individuals with a history of cocaine use have a higher risk of intracerebral hemorrhage due to cocaine-induced vasoconstriction and hypertension.
105
Define hypertensive encephalopathy and its relationship to intracerebral hemorrhage in the context of cocaine use.
Hypertensive encephalopathy is characterized by severe hypertension and can lead to intracerebral hemorrhage, particularly in individuals with a history of cocaine use.
106
How does cocaine-induced vasoconstriction contribute to the development of intracerebral hemorrhage?
Cocaine-induced vasoconstriction can lead to acute elevations in blood pressure, increasing the risk of intracerebral hemorrhage, especially in young individuals with a history of cocaine use.
107
Explain why hypertensive encephalopathy is the most likely cause of intracerebral hemorrhage in a young female with a history of recent cocaine use presenting with a seizure.
The acute hypertensive crisis induced by cocaine, leading to hypertensive encephalopathy, is the most direct and likely cause of intracerebral hemorrhage in this scenario, given the association between cocaine use and elevated blood pressure.
108
Describe the relationship between cocaine use and subarachnoid hemorrhage (SAH).
Cocaine use can lead to the rupture of pre-existing cerebral aneurysms, resulting in SAH due to the intense and sudden increase in blood pressure.
109
Do hypertensive crises caused by cocaine use directly lead to subarachnoid hemorrhage (SAH)?
No, hypertensive crises caused by cocaine use can contribute to the rupture of pre-existing cerebral aneurysms, which then leads to SAH.
110
Define subarachnoid hemorrhage (SAH).
SAH is bleeding into the subarachnoid space between the arachnoid membrane and the pia mater surrounding the brain.
111
How does cocaine's vasoconstrictive properties contribute to the formation and rupture of aneurysms?
Cocaine's vasoconstrictive properties can increase blood pressure, leading to the rupture of pre-existing cerebral aneurysms.
112
Describe the most likely cause of subarachnoid hemorrhage (SAH) in a young female with a history of cocaine use presenting with a seizure.
The most likely cause is a ruptured aneurysm due to the sudden increase in blood pressure associated with cocaine use.
113
Describe the cause of gout.
Gout is caused by hyperuricemia, which is elevated levels of uric acid in the blood leading to the formation of urate crystals that accumulate in joints.
114
List some risk factors for developing gout.
Genetics, diet high in purines (e.g., red meat, shellfish), obesity, certain medications (e.g., diuretics), and alcohol consumption are risk factors for gout.
115
What are the symptoms of gout?
Symptoms of gout include acute joint pain, swelling and redness in the affected joint, tophi formation, and limited joint mobility during acute attacks.
116
How is gout diagnosed initially?
Gout is initially diagnosed by checking serum uric acid levels, performing joint aspiration for urate crystal detection, and using X-rays to visualize joint damage or tophi in chronic cases.
117
Describe the best diagnostic test for confirming gout.
Joint Aspiration and Synovial Fluid Analysis: Identifies needle-shaped urate crystals.
118
What are the key differentials to consider when diagnosing gout?
Pseudogout (caused by calcium pyrophosphate crystals), Septic Arthritis, Rheumatoid Arthritis.
119
How can NSAIDs be used in the treatment of gout?
First-line treatment to reduce pain and inflammation, best started at the onset of an acute gout attack for quick relief.
120
Define Colchicine and its role in managing gout flares.
Colchicine is used to manage acute flares, especially if NSAIDs are contraindicated or ineffective. Best when taken within 24 hours of an attack onset.
121
What is the role of corticosteroids in treating gout?
Effective for individuals who cannot take NSAIDs or colchicine due to contraindications or intolerance.
122
Describe the use of oral or intra-articular steroids like Prednisone or Triamcinolone in gout management.
They are used for acute attacks, especially in patients with multiple comorbidities.
123
What is the purpose of using Allopurinol in gout management?
It is a xanthine oxidase inhibitor used to lower uric acid levels for long-term management.
124
How should Allopurinol be initiated in gout patients?
It should be started after an acute attack has resolved and is recommended for patients with recurrent or chronic gout.
125
Define Febuxostat and its role in gout treatment.
Febuxostat is an alternative xanthine oxidase inhibitor to Allopurinol, used for long-term uric acid reduction, especially in patients with refractory hyperuricemia.
126
When is Probenecid considered in gout management?
It is considered in patients with under-excretion of uric acid and normal renal function, either added to Allopurinol or used alone if Allopurinol is not tolerated.
127
Describe the cause of Hereditary Spherocytosis.
It is caused by genetic mutations, most commonly autosomal dominant mutations affecting RBC membrane proteins like ankyrin, spectrin, and band 3.
128
What are the symptoms of Hereditary Spherocytosis?
Symptoms include hemolytic anemia (fatigue, pallor, shortness of breath), jaundice (due to increased bilirubin from hemolysis), splenomegaly (enlarged spleen), and gallstones (from chronic hemolysis).
129
How is Hereditary Spherocytosis diagnosed initially?
It is diagnosed initially through a CBC showing anemia with high MCHC and a peripheral smear revealing spherocytes (small, round RBCs without central pallor).
130
Define the best diagnostic tests for Hereditary Spherocytosis.
The best diagnostic tests are the Osmotic Fragility Test, showing increased RBC fragility in hypotonic solutions, and the EMA Binding Test, confirming HS by reduced band 3 protein.
131
Describe the key differentials for Hereditary Spherocytosis.
Key differentials include autoimmune hemolytic anemia (differentiated by a positive Coombs test) and other hemolytic anemias like G6PD deficiency.
132
What is the initial treatment for Hereditary Spherocytosis?
Initial treatment includes folic acid supplementation (1 mg daily) to support RBC production and blood transfusions for severe anemia or aplastic crises.
133
How is Hereditary Spherocytosis managed step by step?
Management involves diagnosis based on clinical findings, lab tests, and possibly genetic testing, supportive care with folic acid and regular monitoring, splenectomy consideration for severe cases to reduce hemolysis, and post-splenectomy care with prophylactic antibiotics and vaccinations.
134
What should be monitored regularly in patients with Hereditary Spherocytosis?
Regular follow-up is needed to monitor for complications like gallstones.
135
Do patients with Hereditary Spherocytosis require blood transfusions?
Yes, blood transfusions may be necessary for severe anemia or aplastic crises in patients with Hereditary Spherocytosis.
136
Describe G6PD Deficiency.
It is an X-linked recessive genetic disorder caused by a deficiency in the enzyme glucose-6-phosphate dehydrogenase, crucial for protecting red blood cells from oxidative damage.
137
Do episodes of hemolytic anemia occur in G6PD Deficiency?
Yes, triggered by certain medications, foods (like fava beans), or infections.
138
Define the best diagnostic test for G6PD Deficiency.
initial blood smear Shows bite cells and Heinz bodies.- Quantitative G6PD enzyme assay to confirm the deficiency.
139
How does G6PD Deficiency differ from Autoimmune Hemolytic Anemia?
G6PD Deficiency has a negative Coombs test, while Autoimmune Hemolytic Anemia has a positive Coombs test.
140
Describe the initial treatment for G6PD Deficiency.
Avoidance of known triggers, supportive care during hemolytic episodes, including hydration, and possibly blood transfusions if severe.
141
What is the management approach for G6PD Deficiency?
Educate patients on avoiding triggers, regular monitoring during infections, and provide genetic counseling for families.
142
Where are the likely primary sites for metastasis to the inguinal lymph nodes?
Anus and rectum (especially distal).
143
What are the primary sites for metastasis to the lungs?
Mediastinal nodes, brain, bones.
144
Where is the primary site for metastasis to the testicles?
Retroperitoneal lymph nodes.
145
What is the primary site for metastasis to the stomach?
Supraclavicular nodes (Virchow’s node), liver.
146
Describe the cause of Polyarteritis Nodosa (PAN)
PAN is a rare, systemic necrotizing vasculitis that affects medium-sized muscular arteries, leading to inflammation and damage to the arterial walls.
147
What are some symptoms of Polyarteritis Nodosa (PAN) related to the skin?
Symptoms include livedo reticularis, subcutaneous nodules, and ulcers.
148
How does Polyarteritis Nodosa (PAN) affect the renal system?
It can lead to hypertension and renal insufficiency due to renal artery involvement.
149
Define Mononeuritis multiplex in the context of Polyarteritis Nodosa (PAN)
It involves asymmetrical peripheral neuropathy.
150
What initial investigations are commonly done for suspected Polyarteritis Nodosa (PAN)?
Blood tests showing elevated ESR/CRP, leukocytosis, and anemia, hepatitis B and C serology, and urinalysis for proteinuria or hematuria.
151
Describe the role of tissue biopsy in diagnosing the condition.
Confirms the diagnosis by showing necrotizing vasculitis in the affected tissues.
152
What is the purpose of angiography in this context?
Identifies aneurysms and stenoses in medium-sized arteries, particularly in the kidneys, liver, and mesenteric arteries.
153
Differentiate Microscopic Polyangiitis from the condition described.
Involves small vessels and is often associated with ANCA positivity.
154
How does Granulomatosis with Polyangiitis differ from the condition discussed?
Primarily affects small vessels and often has granulomatous inflammation.
155
Explain the involvement of Systemic Lupus Erythematosus (SLE) in this scenario.
Can present with similar systemic features but typically involves autoantibodies like ANA.
156
What is the initial treatment approach for the condition?
The overall aim of therapy is to control disease activity. Mild activity can be managed with non-steroidal anti-inflammatory drugs (NSAIDs) or low-dose steroids, but more severe manifestations require prompt treatment with moderate-to-high doses of steroids to minimise organ damage. Steroid-sparing immunosuppressive medications should be considered early to prevent steroid-related morbidities.
Hydroxychloroquine is an effective treatment in SLE, especially for arthritis and rash. Furthermore, it has a protective effect in reducing damage accrual in the long term, and confers a survival benefit in SLE patients. Hydroxychloroquine is well tolerated and, when dosed appropriately, ocular toxicity is very rare.27
157
What are the key medications used in the treatment of this condition?
Prednisone and Cyclophosphamide.
158
How is Prednisone typically administered in the treatment plan?
hydroxyused. Used initially at high doses (e.g., 1 mg/kg/day) to control inflammation. Not work then methotrexate
159
When is Cyclophosphamide specifically used in the treatment regimen?
For more severe cases or as a steroid-sparing agent.
lupus nephritis
160
Describe the step management for PAN treatment.
The step management includes confirming diagnosis, initiating corticosteroids, considering immunosuppressants, addressing associated infections, monitoring for complications, tapering steroids, and regular follow-up.
161
What is the role of antiviral therapy in PAN associated with hepatitis B?
Antiviral therapy is necessary alongside immunosuppressive therapy.
162
How is the diagnosis of PAN confirmed?
Through biopsy and angiography after clinical suspicion.Biopsy of clinically uninvolved tissue is often useless because the disease is focal; biopsy should target sites suggested by clinical evaluation. Samples of subcutaneous tissue, sural nerve, and muscle, if thought to be involved, are preferred to samples from the kidneys or liver; kidney and liver biopsies may be falsely negative because of sampling error and may cause bleeding from unsuspected microaneurysms. Unlike in granulomatosis with polyangiitis (GPA), biopsy is unlikely to show marked parenchymal inflammation.
163
What is the initial treatment for controlling acute symptoms in PAN?
Initiating high-dose prednisone.
164
What should be done in severe cases of PAN or when unresponsive to steroids?
Consider adding immunosuppressants like cyclophosphamide.
165
Define the follow-up protocol for PAN patients.
Regular monitoring of renal function, blood pressure, potential side effects of therapy, and imaging studies to monitor aneurysms and stenoses.
166
Do you taper steroids in PAN treatment? If so, when?
Yes, steroids are gradually tapered once the disease is under control to minimize side effects.
167
Describe the cause of cervical spondylosis.
Age-related degeneration involving wear and tear of cervical discs and osteophyte formation.
168
What are the symptoms of cervical spondylosis?
Neck pain, radiculopathy (pain radiating to arms/hands), myelopathy (weakness, gait disturbance, loss of fine motor skills), headaches (occipital headaches, radiating forward).
169
What is the initial investigation for cervical spondylosis?
Physical exam to check for tenderness, range of motion, and neurological signs; X-ray to show disc space narrowing and osteophytes.
170
How is cervical spondylosis diagnosed?
Best diagnostic test is MRI to evaluate discs, spinal cord, and nerve roots.
171
What are the key differentials for cervical spondylosis?
Herniated disc, rheumatoid arthritis, spinal tumors, differing based on onset, systemic symptoms, and progressive deficits.
172
What is the initial treatment approach for cervical spondylosis?
Conservative management including physical therapy, NSAIDs, and lifestyle modifications; temporary collar use for pain relief.
173
What medications are commonly used in treating cervical spondylosis?
NSAIDs for pain/inflammation (e.g., Ibuprofen), muscle relaxants (e.g., Cyclobenzaprine), Gabapentin/Pregabalin for neuropathic pain.
174
What are the steps in managing cervical spondylosis?
Physical therapy for strengthening, pain management with NSAIDs, lifestyle adjustments (ergonomics, posture), surgical consultation if severe symptoms persist.
175
How should follow-up be conducted for cervical spondylosis patients?
Regular monitoring for symptom progression or new neurological signs.
176
Describe a cervical rib.
An extra rib arising from the cervical spine, usually at C7.
177
What is the cause of a cervical rib?
It is a congenital anomaly.
178
What symptoms can a cervical rib cause?
Thoracic Outlet Syndrome, vascular symptoms like coldness or cyanosis of the hand.
179
What is the initial investigation for a suspected cervical rib?
Physical exam including Adson’s test, neurological and vascular assessment, and X-ray.
180
How is a cervical rib typically diagnosed?
Primarily through X-ray to confirm its presence and assess its size.
181
What is the initial treatment for a cervical rib?
Conservative measures like physical therapy to strengthen shoulder muscles and improve posture.
182
When is surgical removal of a cervical rib considered?
It is considered if there are severe or persistent symptoms.
183
What is the recommended follow-up for a patient with a cervical rib?
Regular assessment to monitor symptoms and prevent progression to severe neurovascular compromise.
184
Describe the ulnar paradox in the context of high ulnar nerve injury.
It refers to a paradoxical presentation where there is less clawing of the hand compared to low ulnar nerve injury due to the simultaneous involvement of both the flexor digitorum profundus (FDP) and lumbricals.
185
What are the symptoms of ulnar paradox in high ulnar nerve injury?
Symptoms include a paradoxical appearance with less clawing of the hand, weakness in intrinsic hand muscles, and weakness in the flexor muscles of the ring and little fingers.
186
How can ulnar paradox be initially investigated?
It can be investigated through a physical exam checking for motor and sensory deficits in the ulnar distribution, as well as nerve conduction studies to assess nerve damage.
187
Define the best diagnostic test for ulnar paradox.
The best diagnostic test is a nerve conduction study/EMG, which confirms the level and severity of ulnar nerve injury.
188
What are the initial treatment options for ulnar paradox?
Initial treatment includes splinting to prevent deformity and improve hand function, as well as physical therapy to maintain hand strength and mobility.
189
What are the surgical options for ulnar paradox in severe cases?
Surgical options may include nerve grafting or transposition, considered when conservative management fails in severe cases.
190
How should follow-up be managed for ulnar paradox patients?
Follow-up should involve regular monitoring and rehabilitation to maximize recovery and hand function.
191
Describe the use of surgery in cancer treatment
Surgery is used in early-stage cancers as the first-line treatment for localized tumors, with curative intent when the cancer is confined to one area, and for palliative purposes to relieve symptoms or prevent complications in advanced cancers.
192
What is an example of surgery in cancer treatment?
An example is breast cancer surgery, which may involve procedures like lumpectomy or mastectomy depending on the extent of the disease.
193
How is radiation therapy used in cancer treatment?
Radiation therapy is used for curative treatment in localized cancers not fully removable by surgery, as adjuvant therapy after surgery to eliminate any remaining cancer cells, and for palliative treatment to relieve symptoms in metastatic or advanced cancers.
194
Describe the use of chemotherapy in cancer treatment
Chemotherapy is used in systemic therapy for cancers that have spread, neoadjuvant therapy before surgery to shrink tumors, adjuvant therapy after surgery to reduce the risk of recurrence, and palliative care to control symptoms in advanced cancers.
195
Do you know when chemotherapy is typically used in cancer treatment?
Chemotherapy is used for cancers that have spread, neoadjuvant therapy before surgery, adjuvant therapy after surgery, and palliative care in advanced cancers.
196
Define neoadjuvant therapy in cancer treatment
Neoadjuvant therapy is treatment given before surgery to shrink tumors, commonly used in breast cancer or rectal cancer cases.
197
How is chemotherapy used in colorectal cancer treatment?
Colorectal cancer is often treated with chemotherapy like FOLFOX or CAPOX in stage III or high-risk stage II disease.
198
Describe the role of chemotherapy in advanced or metastatic cancers
Chemotherapy is used in palliative care to control symptoms and prolong life in advanced or metastatic cancers.
199
Describe the cardiovascular risks associated with transgender individuals.
MTF (male to female) individuals have specific cardiovascular risks that need to be managed, while FTM (female to male) individuals require breast evaluation.
200
How should trauma be managed in patients with a GCS less than 8?
Intubate the patient and consider administering mannitol before transfer if indicated.
201
Define the rtPA protocol for stroke management.
The rtPA protocol involves performing a CT scan first, then administering rtPA if indicated. If the CT is normal but suspicion of stroke remains, a repeat CT or MRI should be done.
202
What are the signs of a posterior stroke?
Signs include dysphagia and contralateral hemianopia.
203
How is lacunar stroke characterized?
Lacunar stroke is characterized by pure motor or sensory deficits.
204
What should be done if stenosis is greater than 70%?
Perform a Doppler study.
205
How should blood pressure be managed in stroke patients?
Blood pressure can be managed with beta-blockers and nitroprusside.
206
What is the CHADS-VASc score used for?
The CHADS-VASc score is used to calculate the need for anticoagulation in patients with atrial fibrillation.
207
How is hypercholesterolemia typically treated?
Hypercholesterolemia is typically treated with statins.
208
What is the recommended treatment for Chlamydia?
Chlamydia is treated with doxycycline.
209
Describe the management of pelvic inflammatory disease (PID).
PID is characterized by cervical motion, uterine, and adnexal tenderness, and is treated with ceftriaxone, doxycycline, and metronidazole.
210
What should be done if surgery is planned within one week for a patient on clopidogrel?
Clopidogrel should be stopped 5-7 days prior to surgery.
211
How should infective endocarditis be diagnosed and treated?
Infective endocarditis requires three blood cultures for diagnosis and is treated empirically with penicillin and cephalosporins.
212
What is the management protocol for postpartum hemorrhage (PPH) if the placenta has been delivered?
Resuscitate with fluids and blood as needed, and ensure the uterus is contracted.
213
How should antepartum hemorrhage be managed?
Position the patient in left lateral, provide high oxygen, IV fluids, and administer corticosteroids at 34 weeks if preterm.
214
What is the initial assessment for suspected tubo-ovarian torsion?
Assess suspicion and use ultrasound or laparoscopy as needed.
215
How is a Mallory-Weiss tear treated?
Treat a Mallory-Weiss tear with IV omeprazole followed by endoscopy, and avoid irritants to prevent worsening.
216
What is the recommended pain management for GERD or ulcers?
Pain management for GERD or ulcers typically involves PPIs like omeprazole for 6-8 weeks.
217
How should chronic pancreatitis be evaluated?
Consider the patient's alcohol history and check for eosinophilic esophagitis if the condition is non-responsive.
218
What is the protocol for rubella vaccination in infants?
Post-infection, wait to vaccinate until recovery, and immunize regardless of exposure status.
219
How should persistent wheeze in infants be interpreted?
Persistent wheeze without fever suggests bronchiolitis.
220
What initial tests should be conducted for thyroid and neck masses?
Start with TSH and ultrasound; MRI and FNA may be needed based on findings.
221
How is SIADH managed?
SIADH is managed with fluid restriction or hypertonic saline based on severity.
222
What are the management options for hyperkalemia?
Hyperkalemia can be managed with insulin, resonium, or sodium bicarbonate depending on ECG changes and acidosis.
223
What should be addressed first in patients with peripheral vascular disease (PVD)?
Address arterial issues before neurological concerns.
224
How is multiple sclerosis managed?
Manage multiple sclerosis with steroids and DMARDs, and monitor residual symptoms with MRI.
225
What are the risks of combining beta blockers with calcium channel blockers?
There is a risk of heart failure and bradycardia.
226
What should be monitored when using ACEI/ARBs with spironolactone?
Monitor for hyperkalemia.
227
What is the risk of combining NSAIDs with amiodarone?
There is a risk of hyperkalemia.
228
What is the bleeding risk associated with aspirin and amiodarone?
Combining aspirin with amiodarone increases the risk of bleeding.
229
Describe the interaction between Furosemide and Amiodarone.
Furosemide and Amiodarone can increase the risk of hypokalemia and QT prolongation.
230
Define the risk associated with Digoxin in the context of hypokalemia.
Hypokalemia increases the risk of Digoxin toxicity.
231
How should thyroid swelling be initially evaluated?
Initial evaluation of thyroid swelling should include TSH and T3/T4 tests, followed by an ultrasound.
232
Do you monitor patients on SSRIs for any specific risks?
Yes, patients on SSRIs, especially males with depressive symptoms and suicidal ideation, should be monitored closely.
233
What is the management approach for Parkinson’s Disease?
Parkinson’s Disease is managed with an initial DaT-SPECT scan for diagnosis, followed by steroids and DMARDs for ongoing treatment.
234
How is hypokalemia managed in patients taking diuretics or Digoxin?
In patients taking diuretics or Digoxin, hypokalemia should be monitored and treatment adjusted as needed.
235
Describe the initial steps in managing post-cholecystectomy complications.
For post-cholecystectomy complications, start with an abdominal ultrasound; if inconclusive, proceed to ERCP.
236
What is the first-line treatment for H. pylori infection?
The first-line treatment for H. pylori infection is triple therapy with clarithromycin, amoxicillin, and a PPI.
237
How should carpal tunnel syndrome be initially assessed?
Carpal tunnel syndrome should be assessed with ultrasound and nerve conduction studies.
238
What is the recommended management for flail chest?
Management for flail chest includes oxygen, morphine, positive pressure, and intubation if required.
239
How is infective endocarditis diagnosed?
Infective endocarditis is diagnosed with fever and a new murmur, confirmed by performing 3 blood cultures.
240
What should be done preoperatively for patients on clopidogrel?
Clopidogrel should be stopped 5-7 days before surgery, unless surgery is on the same day for drug-eluting stent patients, in which case both aspirin and clopidogrel should be continued.
241
What is the focus of preventative medicine?
Preventative medicine focuses on primary prevention through education and campaigns, as well as monitoring and managing chronic conditions.
242
How should spinal cord stenosis be evaluated if red flags are present?
If red flags are present in spinal cord stenosis, a CT scan should be performed, followed by an MRI.
243
What is the management strategy for SIADH?
Management of SIADH includes confirming with decreased serum osmolality, increased urine osmolality, and urine sodium, and may involve fluid restriction or hypertonic saline based on symptoms.
244
What are the initial steps in managing orthopedic trauma?
For orthopedic trauma, management includes imaging, reduction, and considering surgical options as necessary.
245
How should GI bleeds related to GERD or ulcers be managed?
GI bleeds related to GERD or ulcers should be managed with PPIs and follow-up based on severity.
246
Describe the management steps for a car accident in pregnancy.
Resuscitate and monitor fetal heart rate; perform a FAST scan for abdominal trauma and consider C-section if fetal distress is detected.
247
Define postpartum hemorrhage (PPH) management based on placenta delivery status.
If the placenta is delivered, ensure uterine contraction and perform resuscitation if needed; if undelivered, perform uterine massage, give uterotonics, and proceed with further interventions if necessary.
248
How should the placenta be managed if it is delivered?
Administer oxygen, lower the head of the bed, provide IV fluids, and ensure the uterus is contracted.
249
How to manage preeclampsia in pregnancy?
Manage anemia with CBC, follow up with CTG, and perform routine ultrasounds every 2-3 weeks. Corticosteroids are recommended if less than 34 weeks.
250
Describe the management of persistent wheeze in infants.
Persistent wheeze suggests bronchiolitis, especially if no fever is present.
251
What is the management approach for epiglottitis?
Manage with oxygen and prepare for intubation; avoid invasive procedures without consent if the patient is stable.
252
How can alcohol use be addressed in preventive care?
Primary prevention through safe drinking education and campaigns.
253
Define the assessment method for gastric fundoplication.
Use X-ray with Gastrografin for assessment if previously performed.
254
What is the management for syphilis and gonorrhea?
Follow appropriate antibiotic regimens and ensure partner notification and treatment.
255
How is a duodenal ulcer diagnosed and managed?
Diagnosed via endoscopy; manage with appropriate PPIs and H. pylori eradication if indicated.
256
What does projectile vomiting in infants suggest?
It is suggestive of pyloric stenosis and requires surgical consultation.
257
How is atrophic vaginitis treated?
Treated with topical estrogen therapy to alleviate symptoms.
258
What initial tests are performed for thyroid swelling?
Start with TSH and T3/T4 levels, followed by ultrasound (USG) for further evaluation.
259
What should be considered if initial thyroid tests are inconclusive?
Consider fine-needle aspiration (FNA) and possibly biopsy.
260
How is hypercholesterolemia managed?
Managed with statins; consider additional therapies based on cardiovascular risk.
261
What should be done if parents refuse steroid treatment for eczema?
Refer for a second opinion to ensure adequate management.
262
How to approach gynecomastia in males on spironolactone?
If there is no lump but tenderness, consider imaging based on clinical context.
263
What is the isolation protocol for infants with pertussis?
Isolate for 2 weeks from other household members.
264
How should immunizations be managed?
Follow standard guidelines for vaccination, including MMR, post-rubella infection, and consider immune status in special cases.
265
What is the initial management for flail chest?
Start with oxygen, administer morphine for pain, then use positive pressure ventilation and consider intubation if necessary.
266
How to identify and manage mitral valve and VSD murmurs?
Identify distinct murmurs and manage accordingly.
267
Describe the management approach for hyperkalemia without ECG changes.
Manage initially with insulin, followed by resonium, and consider sodium bicarbonate if metabolic acidosis is present.
268
Define the importance of conducting a full blood count (FBC) in relation to iron studies and anemia.
A full blood count (FBC) provides a better understanding of iron levels and helps in evaluating the causes of anemia.
269
How should medications be adjusted for chronic conditions?
Ensure medications like statins and antihypertensives are optimized based on individual patient profiles.
270
Explain the management of bronchiolitis in infants.
Persistent wheeze in a 2-month-old without fever is likely bronchiolitis; manage with supportive care.
271
What are the key considerations for vaccination timing in pediatrics?
Administer vaccines according to age and health status, waiting for resolution of acute symptoms like fever before proceeding.
272
Describe the approach to managing joint and bone injuries.
Always perform a distal neurovascular examination first; manage open fractures with antibiotics and tetanus prophylaxis before surgical intervention.
273
How should antiplatelet therapy be managed after stent placement in patients with atrial fibrillation?
Use a combination of warfarin and clopidogrel; monitor for bleeding and adjust based on patient stability.
274
What is the recommended action for meconium staining and deceleration in labor?
Perform C-section for fetal distress, and use forceps if the cervix is 10 cm dilated.
275
Define the monitoring requirements for psychiatric medications like SSRIs.
Ensure safe use of SSRIs and other psychiatric medications, avoiding combinations that could lead to adverse effects like serotonin syndrome.
276
How should surgery be approached in high-risk cardiovascular patients?
Continue antiplatelet therapy if the surgery is urgent; for elective procedures, manage anticoagulation based on bleeding risk and procedure type.
277
What complications should be monitored in patients with sickle cell anemia?
Be vigilant for complications like acute chest syndrome or stroke; regular monitoring and prophylactic measures are essential.
278
Describe the management of asthma and COPD based on severity.
Use inhaled corticosteroids and bronchodilators based on severity; assess exacerbations carefully and adjust treatment.
279
How should depression and suicide ideation be assessed in patients?
Assess thoroughly for suicide risk; provide appropriate interventions, including hospitalization if necessary.
280
What is the significance of performing gastrointestinal endoscopy?
Use endoscopy to diagnose conditions like Mallory-Weiss tear; perform therapeutic interventions as needed based on findings.
281
Explain the developmental milestone for a 3-year-old child.
A 3-year-old should be able to draw a circle.
282
What should be done if a patient presents with sudden pain and normal ultrasound suggesting ovarian torsion?
Consider immediate laparoscopy.
283
How should hypertension be managed in patients with bilateral renal artery stenosis?
Use ACE inhibitors or ARBs cautiously due to the risk of hyperkalemia.
284
Describe the management of acute hyperkalemia if there are no ECG changes.
Manage with insulin and resonium; use sodium bicarbonate if metabolic acidosis is present.
285
How should epiglottitis be managed in an emergency setting?
Prioritize securing the airway with oxygen and prepare for possible intubation based on severity.
286
Define the treatment approach for balanitis.
Manage with betamethasone for inflammation; use mupirocin if there is pus or evidence of infection.
287
What steps should be taken if iron deficiency is suspected?
Conduct iron studies if anemia is suspected; supplement with iron as needed.
288
How is nephrotic syndrome monitored and managed?
Monitor for complications such as hyperlipidemia and thrombosis; manage with diuretics and anticoagulation as indicated.
289
Describe the differentiation process for renal artery stenosis.
Differentiate between unilateral and bilateral stenosis when choosing antihypertensives (ACE inhibitors/ARBs vs. calcium channel blockers).
290
What is the initial management for acute glaucoma?
Initial management includes acetazolamide (IV or oral) and topical agents such as timolol, pilocarpine, and dexamethasone.
291
How is multiple sclerosis diagnosed and initially treated?
Diagnosed with MRI showing oligoclonal bands; initial treatment with IV steroids, followed by disease-modifying therapies.
292
What should be done to rule out stroke in patients with headaches and neurological symptoms?
Rule out stroke with CT and consider MRI if initial imaging is inconclusive.
293
How should febrile seizures in young children be approached?
If the child presents with high fever and seizures, conduct blood cultures to rule out meningitis and other serious infections.
294
Describe the treatment approach for trachoma based on community prevalence.
Treat based on community prevalence; high prevalence (>20%) requires treating all individuals in affected households.
295
What should be considered if olanzapine causes weight gain in a patient?
Consider switching to aripiprazole or asenapine.
296
How should substance use involving marijuana and benzodiazepines be managed?
Avoid combining marijuana with benzodiazepines due to increased risk of depression.
297
What is the management protocol for placenta in postpartum hemorrhage with a well-contracted uterus?
Inspect for trauma, suture and repair as needed.
298
What actions should be taken for a not well-contracted uterus in postpartum hemorrhage?
Continue uterine massage, administer uterotonics, and consider additional interventions.
299
How should imaging for neck masses be approached in adults?
Adults require CT with contrast and fine needle aspiration (FNA); children may start with ancillary tests and ultrasound.
300
What considerations should be made for surgical preparation in patients on anticoagulants?
Adjust based on the type of surgery and the patient's risk profile.
301
Define the risks associated with anti-phospholipid syndrome during pregnancy.
Decrease in platelet count; monitor closely during pregnancy due to increased risk of thrombosis and pregnancy complications.
302
What is the relationship between PCOS and endometrial cancer?
Be aware of the increased risk of endometrial cancer in patients with polycystic ovary syndrome due to chronic anovulation.
303
Describe the management approach for eosinophilic esophagitis if symptoms persist despite standard GERD treatment.
Consider endoscopy and biopsy.
304
How should you investigate persistent symptoms after cholecystectomy?
Start with abdominal ultrasound and proceed to ERCP if biliary pathology is suspected.
305
Define the initial treatment for hyperkalemia without ECG changes.
Start with insulin to shift potassium intracellularly, followed by resonium for potassium removal.
306
What should be monitored closely in patients on diuretics?
Potassium levels, especially if the patient is on digoxin, to prevent toxicity.
307
Describe the investigation process for vaginal bleeding post-menopause.
Investigate promptly; consider endometrial hyperplasia or cancer if bleeding occurs more than a year post-menopause.
308
How can fall risk be managed in geriatric patients?
Use multifactorial assessments to identify risks and implement preventive strategies.
309
What is the first step in managing fractures?
Always conduct a neurovascular examination first.
310
Define the initial treatment for carpal tunnel syndrome.
Start with conservative treatments like splinting.
311
How can primary prevention campaigns reduce preventable diseases?
Emphasize safe drinking habits and vaccination programs.
312
What should be checked if postpartum hemorrhage continues despite a well-contracted uterus?
Check for coagulation abnormalities.
313
Describe the management for a patient with meconium aspiration syndrome.
Manage with careful monitoring of fetal heart rates; C-section may be necessary if there are signs of fetal distress.
314
How can aortic stenosis be recognized in elderly patients?
By a harsh systolic crescendo-decrescendo murmur at the upper right sternal border.
315
What is the recommended antiplatelet therapy for patients with stents and atrial fibrillation?
Use warfarin and clopidogrel; after six months, continue aspirin alone if surgery is required.
316
How should hyperkalemia be managed in acute settings without ECG changes?
Administer insulin first, followed by resonium, and sodium bicarbonate if metabolic acidosis is present.
317
Describe the management steps for postpartum hemorrhage (PPH) when the uterus is well-contracted but bleeding continues.
Check for coagulation abnormalities.
318
How should uterine massage and uterotonics be used in the management of postpartum hemorrhage (PPH)?
Continue uterine massage and use uterotonics if the uterus is not well-contracted.
319
Define the isolation protocol for infants with pertussis.
Isolate infants with pertussis for two weeks to prevent spread within the household.
320
What is the management approach for Meconium Aspiration Syndrome?
Manage with careful monitoring of fetal heart rates; C-section may be necessary if there are signs of fetal distress such as late decelerations.
321
How can aortic stenosis be recognized in elderly patients?
By a harsh systolic crescendo-decrescendo murmur at the upper right sternal border.
322
Describe the antiplatelet therapy regimen for patients with stents and atrial fibrillation.
Use warfarin and clopidogrel; after six months, continue aspirin alone if surgery is required.
323
What is the initial management for flail chest?
Includes oxygen and pain control with morphine, followed by positive pressure ventilation if needed.
324
How should hyperkalemia be managed in acute settings without ECG changes?
Administer insulin first, followed by resonium, and sodium bicarbonate if metabolic acidosis is present.
325
Define the steps involved in iron studies for anemia.
Perform a full blood count (FBC) and iron studies to determine the cause of anemia; supplement iron as needed.
326
What monitoring is necessary for thrombocytopenia in patients with antiphospholipid syndrome?
Monitor platelet counts closely, particularly during pregnancy or in patients with a history of thrombosis.
327
How should stroke protocols be implemented in emergency medicine?
Administer rtPA within the appropriate window after confirming with CT; if unavailable, start dual antiplatelet therapy with aspirin and clopidogrel.
328
What considerations should be made for trauma management in pregnancy?
Use fetal CTG for monitoring and consider immediate surgical intervention, such as a C-section, if fetal distress is noted.
329
Describe the management options for acute dermatitis when steroid treatment is refused.
Offer a second opinion to explore other management options.
330
What is the initial treatment for balanitis?
Start with topical corticosteroids like betamethasone, and use mupirocin if there is bacterial involvement.
331
How should thiazide diuretics be used in patients with renal calculi and hypercalcemia?
Use cautiously as they can increase calcium levels and potentially exacerbate stone formation.
332
What should be investigated in cases of postmenopausal bleeding?
Investigate promptly to rule out endometrial hyperplasia or malignancy, especially if the patient has been on anticoagulation therapy.
333
How is postpartum hemorrhage managed during vaginal delivery?
Manage by ensuring the uterus is well-contracted, administering uterotonics, and conducting surgical intervention if necessary.
334
What is the first-line treatment for hypercholesterolemia?
Statins are the first-line treatment.
335
Describe the approach to diabetes management in patients.
Use a patient-centered approach, adjusting medications like metformin or insulin based on glycemic control and other comorbidities.
336
How should iron deficiency anemia be confirmed and treated?
Confirm with iron studies and treat with oral iron supplements, monitoring for gastrointestinal side effects.
337
Define the management strategy for osteoarthritis.
Begin with non-pharmacologic interventions like physical therapy and weight management, and use NSAIDs cautiously due to gastrointestinal and cardiovascular risks.
338
What is the initial treatment for rheumatoid arthritis?
Start with DMARDs such as methotrexate, and consider adding biologic agents if there is inadequate response.
339
How should hypertension be managed in patients with comorbidities?
Adjust medications based on comorbidities, using ACE inhibitors for patients with diabetes and beta-blockers for those with a history of myocardial infarction.
340
Describe the management of atrial fibrillation.
Assess and manage using anticoagulation therapy guided by the CHADS-VASc score and rhythm control strategies if necessary.
341
What signs should be monitored in chronic liver disease?
Monitor for signs of hepatic decompensation like variceal bleeding or hepatic encephalopathy.
342
How is irritable bowel syndrome (IBS) treated?
Treat based on symptom predominance (constipation, diarrhea, or pain) with dietary modifications and medications such as loperamide or linaclotide.
343
Define the diagnostic criteria for multiple sclerosis.
Diagnose with MRI showing typical demyelinating lesions.
344
What are the secondary prevention strategies for stroke?
Manage risk factors like hypertension, diabetes, and hyperlipidemia, and use antiplatelet agents or anticoagulants as indicated.
345
Describe the focus of end-of-life management in palliative care.
Focus on comfort measures and symptom control, including pain management with opioids and addressing anxiety or dyspnea with appropriate medications.
346
How can medication reconciliation improve patient safety?
Ensure all medications are reviewed at each patient encounter to prevent adverse drug interactions.
347
What interventions can reduce the risk of falls in elderly patients?
Implement multifactorial interventions, particularly in elderly patients, to reduce the risk of falls.
348
Define the importance of immunizations in public health.
Ensure patients are up to date with vaccinations according to age and risk factors.
349
What role do screening programs play in preventive medicine?
Participate in national screening programs for cancers (breast, cervical, colorectal) and other diseases like hypertension and diabetes.
350
How can safe drinking campaigns contribute to public health?
Promote awareness of alcohol consumption guidelines to reduce the risk of liver disease and accidents.
351
What dietary and lifestyle interventions can help prevent chronic diseases?
Encourage patients to adopt healthy eating habits and engage in regular physical activity to prevent obesity, cardiovascular disease, and diabetes.
352
Describe the management strategies for preeclampsia.
Monitor with regular blood pressure checks, urine protein tests, and fetal monitoring; administer corticosteroids if preterm delivery is likely.
353
Define the role of contraceptive counseling in women's health.
Provide information on various contraceptive methods based on the patient's health status and personal preferences.
354
How should cancer screening be approached according to guidelines?
Adhere to guidelines for screening of common cancers (breast, prostate, colorectal, and cervical) based on age and risk factors.
355
What are the management strategies for chemotherapy-induced nausea?
Address chemotherapy-induced nausea with antiemetics and monitor for potential complications like neutropenia.
356
Explain the importance of vaccination schedules in pediatric care.
Ensure adherence to the recommended vaccination schedule to prevent childhood diseases.
357
How is growth and development monitored in pediatric patients?
Regular check-ups to monitor milestones and provide early intervention if developmental delays are identified.
358
Describe the management of acute respiratory distress in critical care.
Use oxygen therapy and escalate to non-invasive or mechanical ventilation if necessary.
359
What protocols are crucial for managing sepsis?
Early recognition and prompt administration of antibiotics and fluids are crucial in managing sepsis.
360
How is bipolar disorder managed in mental health care?
Use mood stabilizers like lithium or valproate; ensure close monitoring for side effects and therapeutic levels.
361
What are the first-line treatments for anxiety disorders?
Cognitive behavioral therapy (CBT) and medications such as SSRIs are first-line treatments for generalized anxiety disorder.
362
Describe the screening process for glaucoma in ophthalmology.
Conduct regular intraocular pressure checks in patients at risk and provide appropriate medical or surgical treatment based on severity.
363
What is the recommended management for diabetic retinopathy?
Annual eye exams for diabetic patients; manage with laser therapy or injections if necessary.
364
How is tuberculosis screened and treated?
Use Mantoux test or IGRA for screening; treat active TB with a combination of antibiotics such as isoniazid, rifampin, pyrazinamide, and ethambutol.
365
What is the approach to HIV management?
Initiate antiretroviral therapy (ART) early and monitor for adherence and side effects.
366
Define polypharmacy management in geriatric care.
Regularly review medication lists in elderly patients to minimize drug interactions and side effects.
367
How is fall risk assessed in elderly patients?
Evaluate for fall risks in elderly patients and implement prevention strategies, including balance exercises and home safety modifications.
368
What is the first-line treatment for allergic rhinitis?
First-line treatment includes antihistamines and nasal corticosteroids. For persistent symptoms, consider allergen immunotherapy.
369
Describe the immediate management steps for anaphylaxis.
Immediate management with intramuscular epinephrine; follow with antihistamines and corticosteroids.
370
How is celiac disease diagnosed and managed?
Diagnose with serology and confirm with a biopsy. Strict adherence to a gluten-free diet is essential for management.
371
What should be monitored in patients with nutritional deficiencies?
Monitor for vitamin and mineral deficiencies, especially in patients with malabsorption syndromes or restrictive diets.
372
Describe the management approach for osteoporosis.
Screen at-risk populations using dual-energy X-ray absorptiometry (DEXA) scans; manage with calcium, vitamin D, and bisphosphonates or other agents as indicated.
373
How is hypothyroidism treated and monitored?
Treat with levothyroxine and monitor thyroid function tests regularly to adjust the dosage.
374
Define the treatment options for acute gout attacks.
Acute attacks are treated with NSAIDs, colchicine, or corticosteroids.
375
What is the chronic management strategy for gout?
Use urate-lowering therapies like allopurinol.
376
Describe the management of lupus.
Monitor for flares and manage with immunosuppressive agents and hydroxychloroquine as maintenance therapy.
377
How should trauma be managed in emergency medicine?
Follow Advanced Trauma Life Support (ATLS) guidelines for initial assessment and stabilization; use imaging and surgical intervention as required.
378
What are the initial steps in burn management?
Begin with cooling and wound care; monitor for signs of infection and systemic complications.
379
Define the management of epilepsy.
Manage with antiepileptic drugs tailored to the type of seizures; consider surgical options for refractory epilepsy.
380
How are migraines treated acutely?
Acute treatment includes NSAIDs or triptans.
381
What preventive measures are considered for chronic migraines?
Consider preventive medications like beta-blockers or antiepileptics.
382
Describe the evaluation process for infertility.
Evaluate both partners and address underlying causes; consider assisted reproductive technologies (ART) if necessary.
383
How should sexually transmitted infections (STIs) be managed?
Screen at-risk populations and provide appropriate antibiotic treatment based on guidelines.
384
What is the management approach for psoriasis?
Manage with topical treatments for mild cases and systemic therapies or biologics for more severe cases.
385
Define the recommended practice for skin cancer detection.
Regular skin checks are recommended for early detection; manage with excision, cryotherapy, or topical agents based on the type and stage.
386
How should poisoning and overdose be addressed?
Immediate assessment and supportive care; use specific antidotes where available and perform gastric decontamination if indicated.
387
What is the diagnostic method for obstructive sleep apnea (OSA)?
Diagnose with a sleep study; manage with CPAP, lifestyle modifications, or surgical interventions as appropriate.
388
How is insomnia initially treated?
Begin with cognitive behavioral therapy for insomnia (CBT-I) and consider medications if non-pharmacological measures are insufficient.
389
Describe the management of chronic obstructive pulmonary disease (COPD).
Manage with bronchodilators, inhaled corticosteroids, and lifestyle changes like smoking cessation; use oxygen therapy for patients with chronic hypoxemia.
390
What is the stepwise approach for asthma management?
Follow a stepwise approach, starting with short-acting bronchodilators and adding long-acting bronchodilators or inhaled corticosteroids based on the severity of symptoms.
391
How should hepatitis B and C be managed?
Screen at-risk individuals, manage with antiviral therapy, and monitor for liver complications; provide vaccinations for hepatitis B if not already immune.
392
What is the recommendation for influenza vaccination?
Annual vaccination is recommended, especially for high-risk groups like the elderly, immunocompromised, and healthcare workers.
393
Describe the diagnostic methods for hydrocephalus.
Imaging techniques such as CT or MRI are used to diagnose hydrocephalus.
394
How is hydrocephalus managed surgically?
Management includes surgical interventions like shunt placement or endoscopic third ventriculostomy.
395
Define subdural hematoma monitoring.
Subdural hematoma is monitored with serial imaging to assess for changes.
396
When should surgical evacuation be considered for a subdural hematoma?
Surgical evacuation is considered if there is significant mass effect or neurological deterioration.
397
Identify symptoms that may suggest adrenal insufficiency.
Unexplained fatigue, hypotension, and electrolyte imbalances may suggest adrenal insufficiency.
398
How is adrenal insufficiency confirmed?
Adrenal insufficiency is confirmed with an ACTH stimulation test.
399
What is the management approach for adrenal insufficiency?
Management involves glucocorticoid replacement therapy.
400
Describe the diagnostic process for hyperthyroidism.
Hyperthyroidism is diagnosed using TSH and free T4 levels.
401
What are the treatment options for hyperthyroidism?
Treatment options include antithyroid medications, radioactive iodine, or surgery depending on severity and patient preference.
402
How is dementia evaluated?
Dementia is evaluated through standardized cognitive function tests.
403
What medications are used to manage dementia?
Cognitive enhancers like donepezil are used to manage dementia.
404
How can falls and fractures be prevented in the elderly?
Prevention includes fall risk assessments and interventions like balance exercises and home safety modifications.
405
What is the importance of monitoring INR in anticoagulation management?
Monitoring INR is crucial for patients on warfarin to adjust dosing based on target range and patient-specific factors.
406
How should a drug overdose be managed?
Management involves identifying the substance involved, providing supportive care, and administering specific antidotes when available.
407
What are the management options for benign prostatic hyperplasia (BPH)?
Management options include alpha-blockers, 5-alpha-reductase inhibitors, and surgical options like TURP for significant obstruction.
408
How are urinary tract infections (UTIs) diagnosed?
UTIs are diagnosed with urinalysis and culture.
409
What is the management approach for heat-related illnesses?
Management includes recognizing signs of heat exhaustion and heatstroke, and applying cooling measures and hydration.
410
How can cold-related injuries be prevented?
Prevention involves educating patients on appropriate clothing and behavior in cold weather.
411
Define the diagnostic criteria for fibromyalgia.
Fibromyalgia is diagnosed based on clinical criteria.
412
What is the management strategy for fibromyalgia?
Management includes a combination of medications like duloxetine, exercise, and cognitive behavioral therapy.
413
How is polymyalgia rheumatica treated?
Polymyalgia rheumatica is treated with low-dose corticosteroids and monitored for symptoms of giant cell arteritis.
414
What is the indication for coronary artery bypass grafting (CABG)?
CABG is indicated in severe coronary artery disease, especially with left main coronary artery involvement or multivessel disease.
415
What postoperative care is required after CABG?
Postoperative care includes anticoagulation and cardiac rehabilitation.
416
How should hip fractures in the elderly be managed?
Prompt surgical intervention improves outcomes, with post-operative care focusing on early mobilization and osteoporosis management.
417
What are the management strategies for acute sinusitis?
Acute sinusitis is managed with saline nasal irrigation and decongestants, with antibiotics considered if symptoms persist beyond 10 days.
418
How is hearing loss evaluated?
Hearing loss is evaluated through audiometry to differentiate between conductive and sensorineural types.
419
What is the focus of palliative care in symptom control?
Palliative care focuses on managing pain, nausea, breathlessness, and anxiety using appropriate medications.
420
Describe the importance of Advanced Care Planning in patient care.
Advanced Care Planning encourages discussions about goals of care, advance directives, and do-not-resuscitate (DNR) orders to ensure patient preferences are respected.
421
How should cataracts be managed according to ophthalmology guidelines?
Cataracts should be managed with regular eye exams, and cataract surgery should be considered when vision impairment affects daily activities.
422
Define Age-Related Macular Degeneration (AMD) treatment options.
For wet AMD, anti-VEGF injections are used, and close monitoring for disease progression is essential; lifestyle modifications such as smoking cessation and protective eyewear are also recommended.
423
What is the approach to managing Diabetes Mellitus?
Management involves adjusting treatment regimens based on hemoglobin A1c levels, using insulin or oral hypoglycemics as appropriate, and monitoring for complications like neuropathy, nephropathy, and retinopathy.
424
How is Hyperparathyroidism monitored and treated?
Hyperparathyroidism is monitored by checking calcium and parathyroid hormone levels; surgical intervention may be considered if there is evidence of osteoporosis, kidney stones, or symptomatic hypercalcemia.
425
Describe the management protocols for Acute Coronary Syndrome (ACS).
Management includes rapid assessment and the use of aspirin, nitroglycerin, beta-blockers, and reperfusion therapy as indicated.
426
What immediate action should be taken in cases of Anaphylactic Shock?
Administer epinephrine immediately and follow with supportive care, including intravenous fluids and antihistamines.
427
How should COVID-19 be managed according to current guidelines?
Management includes following guidelines for testing, isolation, and treatment, utilizing antivirals or monoclonal antibodies in eligible patients.
428
Describe the importance of regular screening for sexually transmitted infections (STIs).
Regular screening is crucial for sexually active individuals, especially those in high-risk groups, to detect infections early and prevent reinfection and spread.
429
How should confirmed cases of STIs be treated?
Confirmed cases of STIs should be treated with appropriate antibiotics, and partner notification and treatment should be ensured to prevent reinfection.
430
Define the role of antiretroviral therapy (ART) in HIV management.
Early initiation of ART is crucial for managing HIV, and regular monitoring of viral load and CD4 counts is necessary to assess treatment efficacy and adjust therapy.
431
What is the baseline therapy for managing Systemic Lupus Erythematosus (SLE)?
Hydroxychloroquine is used as a baseline therapy for managing Systemic Lupus Erythematosus (SLE).
432
How are acute flares of SLE managed?
Acute flares of SLE are managed with corticosteroids, and immunosuppressive agents like azathioprine or mycophenolate may be considered for severe disease manifestations.
433
Describe the management strategies for osteoarthritis.
Management strategies for osteoarthritis include weight management, physical therapy, NSAIDs for pain relief, and intra-articular corticosteroids for exacerbations.
434
What medications are commonly used in heart failure management?
Heart failure management commonly includes a combination of ACE inhibitors, beta-blockers, diuretics, and mineralocorticoid receptor antagonists based on the stage and severity.
435
How is a myocardial infarction (MI) immediately managed?
Immediate management of a myocardial infarction includes the MONA protocol (morphine, oxygen, nitrates, aspirin) and reperfusion therapy with PCI or fibrinolysis, depending on timing and availability.
436
Define the purpose of developmental surveillance in pediatrics.
Developmental surveillance involves regular check-ups to monitor developmental milestones in children to ensure they are meeting expected growth and development targets.
437
Describe the approach to managing pediatric asthma.
A stepwise approach is used, starting with as-needed bronchodilators and progressing to inhaled corticosteroids or leukotriene modifiers as needed for control.
438
Define the management strategies for Inflammatory Bowel Disease (IBD).
Management includes the use of aminosalicylates, corticosteroids, immunomodulators, and biologics, tailored to the severity of the disease and patient response.
439
How should hepatic encephalopathy be managed?
Management involves using lactulose and rifaximin, monitoring ammonia levels, and adjusting treatment based on clinical response.
440
Do initial management strategies for nephrolithiasis include?
Initial management includes pain control and hydration, with possible medical expulsion therapy or surgical intervention depending on the size and location of the stones.
441
Describe the control measures for hypertension in chronic kidney disease (CKD).
Control hypertension with ACE inhibitors or ARBs, along with diuretics and lifestyle modifications to slow the progression of kidney disease.
442
How can symptoms of Polycystic Ovary Syndrome (PCOS) be addressed?
Symptoms can be managed with oral contraceptives for menstrual regulation and metformin for insulin resistance, along with lifestyle modifications for weight management.
443
Define the lab tests used to differentiate between thyroid disorders.
Appropriate lab tests include TSH and T4 to differentiate between hypo- and hyperthyroidism.
444
What is the importance of early intervention services?
Early intervention services should be provided for any delays or abnormalities detected.
445
Describe the management options for hypothyroidism and hyperthyroidism.
Hypothyroidism is managed with levothyroxine, while hyperthyroidism can be treated with antithyroid drugs, radioactive iodine, or surgery.
446
Define the screening recommendations for breast cancer.
Breast cancer screening includes mammography based on age and risk factors.
447
How is colorectal cancer screened and treated?
Colorectal cancer screening begins with colonoscopy at age 50 or earlier for high-risk individuals; treatment depends on the stage and may include surgery, chemotherapy, and radiation.
448
What is the approach to managing shock in emergency care?
Shock management involves identifying the type (hypovolemic, cardiogenic, distributive) and initiating appropriate resuscitation with fluids, vasopressors, and treating underlying causes.
449
Describe the evaluation process for head trauma.
Head trauma is evaluated with a CT scan if indicated by clinical findings, and management may include supportive care or surgical intervention based on severity.
450
How should anemia be managed?
Anemia management involves diagnosing the type (e.g., iron deficiency, B12 deficiency) and treating the underlying cause while providing appropriate supplementation or dietary advice.
451
What steps are taken to evaluate and manage thrombophilia?
Thrombophilia evaluation includes assessing for hereditary or acquired conditions that predispose to clotting, with management tailored to the patient's risk profile using anticoagulation.
