Internal Medicine Of Adolescent And Adulthood

Front 1

Abnormal Uterine Bleeding

Back 1

vol >80 ml, not in cycle 21-28 days

Front 2

Menorrhagia

Back 2

heavy flow or long duration, in normal cycle

Front 3

metrorhagia-irreguler

Back 3

frequent uterine bleeding but not excessive

Front 4

menometrorhagia

Back 4

irreguler non cyclic interval with heavy flow

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Polymenorrhea

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regular bleeding at interval <21days

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Oligomenorrhea

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regular bleeding >35 days cycle

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amenorrhea

Back 7

no uterine bleeding in 6 month

Front 8

Dysfunctional uterine bleeding

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uterine bleeding with no organic disease

Front 9

Treatment Dysfunctional uterine bleeding

Back 9

NSAID

Antifibrinolytic

Oral contraceptive

Danazol

GnRH agonist

Front 10

surgical treatmentDysfunctional uterine bleeding

Back 10

Endometrial ablation

Hysterectomy

Front 11

Post Menopausal Bleeding

Back 11

bleeding from genital tract, 6 month after cessation of menstruation

Front 12

Etiology of post menopausal bleeding

Back 12

estrogen therapy

hipertension

blood disease

anticoagulant therapy

Local causes (malignant)

Front 13

Method of endometrial biopsy

Back 13

fractional uterine curretage

endometrial aspiration

hysteroscopy

Front 14

Functional thyroid gland pathology

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euthyroid

hypothyroid

hyperthyroid

Front 15

diagnosis of thyroid disorder

Back 15

serum TSH

T3/FT3 and T4/FT4

Thyrotropin releasing hormone

Front 16

most accurate and most sensitive test for thyroid funtion

Back 16

serum TSH

Front 17

Sign and symptoms of hypothyroidism

Back 17

•Fatigue, weakness, weight gain, cold intolerance•Coarse, dry hair, dry and rough pale skin, hairloss •Musclecramps and frequent muscle aches •Constipation•Depression, irritability •Memoryloss •Abnormalmenstrual cycles/decreasedlibido

Front 18

Primary hypothyroidism

Back 18

TSH high, FT3/FT4 depressed

Front 19

Secondary hypothyroidism

Back 19

TSH low, FT3/FT4 low

Front 20

Overt hypothyroidism

Back 20

high TSH and FT3

Front 21

Subclinical hypothyroidism

Back 21

TSH high, normal FT4

Front 22

Management of hypothyroidism

Back 22

Thyroid hormone replacement (levothyroxine)

Front 23

treat subclinical hypothyroidism if

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TSH 5-10 mIU/L with symptoms

TSH >10 mIU/L

Front 24

Myxedema coma sign and symptoms

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Below normaltemperature, decreased breathing, low blood pressure, low blood sugar, unresponsiveness, edema anasarka

Front 25

Graves disease

Back 25

abnormal immune response, antibodies agonist of THS receptor --> growth and activation of hormone synthesis

Front 26

Graves disease patognomonis

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Increase thyroid hormone, exophthalmos, goiter

Front 27

Hyperthyroidism diagnosis

Back 27

Nuclearthyroid scintigraphy I131 uptake

TSH-receptorstimulating autoantibody levels (TSIlevels)

Front 28

Wayne index for hypothyroidism

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>19 thyrotoxicosis, 11-19 equivocal, <11 euthyroid

Front 29

Management of hyperthyroidism

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Antithyroid drug (Propylthiouracil)

Front 30

side effect of propylthiouracil

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agranulocytosis

aplastic anemia

Front 31

Thyroid Storm

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manifestation of thyrotoxicosis

Front 32

Scoring system to determine homeostatis compensation of thyroid storm

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burch and wartofsky scoring

Front 33

Management of thyroid storm

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-Fluid replacement and electrolyteimbalance correction

-Inhibition of thyroid hormone production

-Inhibition of thyroid hormone secretion

-Blockade thyroxin conversion

-Blockade sympathetic effect

-Glucose monitoring

Front 34

Cushing syndrome

Back 34

hormonal disorder caused by high level of cortisol

Front 35

Classification of cushing

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ACTH dependent

ACTH independent

Pseudo Cushing

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Sign and symtoms of cushing

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Central obesity

Moon face

buffalo hump

Protuberant abdomen and thin extremities

Oligo/Amenorrhea

Weakness

Headache

Hypertension

Purple Striae

Hyperglycemia

Hypokalemia

Front 37

Treatment of cushing

Back 37

surgery

radiation

chemotherapy

cortisol inhibiting drug

Front 38

Pseudo cushing's

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alcoholism

obesity

depression

Front 39

Addison's disease

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adrenal glands do not produce enough cortisol and aldosteron, mostly caused by autoimmune

Front 40

Symptom of addison's disease

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weakness

anorexia

GI symptoms

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Sign of addison's disease

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Weight loss

Hyperpigmentation

Hypotension

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Lab finding in addison's disease

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Hyponatremia,Hyperkalemia

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Treatment of Addison's disease

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Hydrocortisone, DHEA

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Diagnosis of secondary adrenal insufficiency

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Low ACTH (<5 pg/mL), pituitary athropy has been ruled out

Front 45

Protocol of glucocorticoid dose reduction and withdrawal : >25 mg

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>25 mg, reduction 25%, in days interval

Front 46

Protocol of glucocorticoid dose reduction and withdrawal : >10-25 mg

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2.5 mg, in 7 days

Front 47

Protocol of glucocorticoid dose reduction and withdrawal : <10 mg

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2.5 mg in 15 days

Front 48

Cause of acute adrenocortical insufficiency

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Chronic adrenal insufficiency precipitated by sepsis or surgical stress

Acute haemorrhagic destruction

Rapid withdrawal of chronic steroid administration

Front 49

Clinical feature of acute adrenocortical insufficiency

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Dehydration, hypotension, shock, abdominal pain, nausea, vomitting with history of anorexia and weight loss, unexplained hypoglycemia, unexplained fever

Front 50

Treatment of acute adrenocortical insufficiency

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repletion of glucocorticoid, sodium, and water

Infusion of 5% glucose

bolus IV hydrocortisone 100 mg, continous infusion 10 mg/h or bolus IV 100 mg every 6h

Front 51

Adrenal Cortisol Insufficiency in Acutely Ill Patient

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Rise of cortisol because of altered HPA axis in critical illnesses

Front 52

Sign and symptoms of AICI

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Hypotension, refractory shock, high fever, hyponatremia, hyperkalemia, hypoglycemia

Front 53

Treatment of AICI

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Hydrocortisone or Fludrocortisone

Front 54

Primary aldosteronism

Back 54

excessive aldosterone independently of normal RAA system

Front 55

Cause of primary aldosteronism

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Primary adrenal hyperplasia

Front 56

Clinical manifestation of aldosteronism

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Hypertension, metabolic alkalosis, hypokalemia, hypomagnesemia

Front 57

treatment of aldosteronism cause by adrenal hyperplasia

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spironolactone (aldosterone antagonist)

Front 58

Phaeochromocytoma

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medullary tumor composed of chromaffin cells

Front 59

Clinical feature of phaeochromocytoma

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Hypertension, paroxismal episode of : headaches, diaphoresis, palpitation

Front 60

Treatment of phaeochromocytoma

Back 60

surgery, beta and alpha adrenergic blocking agent

Front 61

Diagnosis of leptospirosis

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Faine's criteria

Front 62

Treatment of leptospirosis

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Mild: docycyline, amoxicillin, ampicilline,

Severe : bencyl penicillin, ampicillin, 3rd G ceftriaxone, cefotaxime

Front 63

Prevention of leptospirosis

Back 63

hygiene, doxyxline 200mg weekly at risked group

Front 64

Rabies is caused by

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Lyssavirus, RNA virus

Front 65

Rabies post exposure prophylaxis

Back 65

Wound cleansing, rabies IG, rabies vaccine

Front 66

Leishmaniasis form in cells

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Amastigot

Front 67

Diagnosis of leishmania

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montenegro skin test, histopathology, direct microscopy, molecular test

Front 68

Treatment of leishmania

Back 68

Pentavalent antimonial, amphotericin B, Paromomycine, Miltefosine, Sitamaquine, Pentamidine

Front 69

Sign and symptoms of trypanosomiasis

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flu like syndrom, with neurological sign and personality alteration, chancre at site of infection

Front 70

T.b rhodesiense

Back 70

progress rapidly

large sore at site of tsetse fever

flu like syndrom- 1-2 weeks

rash

few week invade CNS

death within month

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T. b gambiense

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slower

invade CNS at 1 year

Neurological sign include paralysis

last longer 6-7 year, kills in 3 years

Front 72

Diagnosisof trypanosome

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direct microscopy

Front 73

Criteria for 2nd stage trypanosome

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trypanosoma in CSF, white cell count >= 6, elevated protein, increase of non specific IgM

Front 74

Drug of choice T.b rhodesiense hemolympatic stage

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suramin

Front 75

Drug of choice T.b rhodesiense CNS involvement

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melarsoprol

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T. b. gambiense 1st stage

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pentamidine

Front 77

t. b. gambiense 2nd stage

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eflornithin

Front 78

patognomis of amebiasis usus

Back 78

rasa tidak nyaman diperut

sakit perut terlokalisir di kanan

disentri

demam dan kedinginan

Front 79

patognomonis hepatal amebiasis

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hepatomegali

nyeri hipokondrium kanan atas menyebar ke bahu

demam kedinginan

abses mendesak paru lobus kanan bawah

ikterik

Front 80

diagnosis amebiasis

Back 80

direct microscopy

ELISA

culture

contrast barium

Front 81

Therapy for asymptomatic amebiasis

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diloxanide furoate

Front 82

symptomatic amebiasis treatment

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iodoquinol

metronidazole

Front 83

amebic colitis treatment

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chloroquine

Front 84

Acute amebic dysentry treatment

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emetine hydrochloride

Front 85

ekstraintestinal amebiasis treatment

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metronidazole + dehydroemetine

metronidazole/dehydroemetine + chloroquine

Front 86

therapy for filariasis

Back 86

diethylcarbmazine

ivermectine

Front 87

Non ossifying fibroma

Back 87

asymptomatic, pathologic fracture, metaphysis of long bone

Front 88

Fibrous dysplasia

Back 88

pain

limping

bone enlargement

pathologic fracture

deformity

malignant : fibrosarcoma

Front 89

Radiologic finding in fibrous dysplasia

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ground glass, cystic area in metaphysis/diaphysis of bone

Front 90

Treatment of fibrouss dysplasia

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curretage

bone graft

osteotomy

Front 91

Osteoid sarcoma

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female <30 yo

femur and tibia

complaining persistent pain

pain relieve with salicilate

Front 92

radiologic finding osteoid sarcoma

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small radioluscent area NIDUS

Front 93

Radiologic finding of chondroma

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radioluscent area with calcification at center

Front 94

radiologic finding of osteochondroma

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tumor at metaphysis area

Front 95

radiologic finding in simple bone cyst

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strict border, luscent area at meta and physeal plate, thinning of cortex

Front 96

treatment of simple bone cyst

Back 96

aspiration --> methyl prednisolone

Front 97

Aneurismal bone cyst radiologic finding

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luscent area with strict border

Front 98

Giant cell tumor

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young people, pain and swelling, distal femur-prox tibia, prox humerus, distal radius

Front 99

Radiologic finding of giant cell tumor

Back 99

soap bubble appearance

balloned : thinning of cortex

pushing the sourrounding soft tissue

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Chondrosarcoma

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40-50 yo

male>female

growing slowly

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radiologic finding of chondrosarcoma

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well defined osteolytic, chondroid matrix, and scalloping

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malignant bone tumor resistant to chemo and radio

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chondrosarcoma

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radiologic finding of osteosarcoma

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wide luscent area

codmans triangle

sunburst

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Ewing sarcoma

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bone marrow epithelial cell

10-20 yo

pain, swelling, pyrexia

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radiologic finding of ewing sarcoma

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onion peel effect

destruction

periosteal reaction

ossification

Front 106

Myeloma

Back 106

bone marrow plasma cell

persistent pain, weakness of extremities, anemia, cahexia, LED >>>

Front 107

Lab finding in myeloma

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bence-jones protein

myeloma cell in sternal punction

Front 108

radiologic finding of myeloma

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punched out

Front 109

Metastatic bone tumor radiologic finding

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osteolitic (moth eaten)

Front 110

treatment of uncomplicated cystitis

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trimethroprim/sulfamethoxazole

Front 111

treatment of complicated cystitis

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fluoroquinolone

Front 112

treatment of pyelonephritis

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trimethroprime/sulfamethoxazole/fluoroquinolone

Front 113

treatment of prostatitis

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trimethroprime/sulfamethoxazole

Front 114

treatment for urethritis et causa chlamydia

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azithromycine, doxycyclin

Front 115

treatment for urethritis et causa gonorrhae

Back 115

ceftriaxone, cipro, levofloxacin,

Front 116

symptoms of acute kidney injury

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decrease urin output (70%)

edema

mental changes

heart failure

nausea, vomitting

pruritus

anemia

tachypenic

cool, pale, moist skin

Front 117

finding indicating intrinsic AKI

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dysmorphic RBC

Front 118

Classification for AKI

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RIFLE

Front 119

AKI class : Risk

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serum creatinine >1.5 x, decrease GFR 25%, Urine output <0.5 mL/kg/h for 6 hourr

Front 120

AKI class :Injury

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serum creatinine >2.0 x, decrease GFR 50%, urine output<0.5ml/kg/h for 12 h

Front 121

AKI class : failure

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serum creatinine >3.0/>4mg/dl , decrease GFR 75%, urine output <0.3 mL for 24h, anuria for 12 h

Front 122

AKI class : Loss

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persistent ARF, complete loss of function >4weeks

Front 123

AKI class : End stage

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loss of kidney funtion >3month

Front 124

symptoms of hyperkalemia

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weakness, lethargy, muscle cramps, paresthesia, dysrithmia, hypoactive DTR

Front 125

EKG in hyperkalemia

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tall T, wide QRS, prolonged PR, no P, prolong QT, QRS-T merge

Front 126

treatment of hyperkalemia

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calcium gluconate

Front 127

Chronic Kidney disease symptoms

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malaise, weakness, fatique, nausea, vomitting, anemia, pruritus

Front 128

Thyroid nodule, with Low TSH and high FT4

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Toxic Nodule

Front 129

Thyroid nodule, with High TSH, low FT4, high TPOabs

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Hashimo's thyroiditis

Front 130

Thyroid nodule, with high level/normal TSH, and normal or low FT4

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confirm benign or malignant with FNAB

Front 131

evaluation of thyroid enlargement

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administer levothyroxin, evaluate after 3 month

Front 132

Ginecological tumor with highest mortality

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ovarian cancer

Front 133

Meig's syndrome

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solid tumor, ascites, pleural effusion

Front 134

cause of granuloma inguinale

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basil donovani

Front 135

Limfogranuloma venereum etiology

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LGV virus

Front 136

Cause of chancroid lesion

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basil ducreyi

Front 137

obat pengecil tumor uterus sementara

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GnRH analog (medroxyprogesterone,danazol)

Front 138

Pembagi hernia lateral/medial

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a.v epigastrica inferior

Front 139

Zieman test

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jari 2 : hernia inguinalis lateralis

jari 3 : hernia inguinalis medialis

jari 4 : heria femoralis

Front 140

Antibiotic for tetanus

Back 140

penicilin G, metronidazole

Front 141

Toxin neutralisation for tetanus

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TIG or ATS

Front 142

penghambat neuromuscular untuk tetanus

Back 142

Pancuronium, vacuronium, baclofen

Front 143

Penilaian prognosis tetanus

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dakar score, philip score

Front 144

mastalgia siklis pharmacologic treatment

Back 144

gamolenic acid, danazol, bromocriptine, tamoxifen, goserelin

Front 145

Radioopaque kidney stone

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calcium oxalate, calcium phosphate

Front 146

Poor radioopacity kidney stone

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Magnesium, Apatite, Cystine

Front 147

Radioluscent kidney stone

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uric acid, ammonium urate, xanthine, drug stones

Front 148

management of acute stone colic

Back 148

sodium diclofenac, indomethacine, ibuprofen

Front 149

etiology of pharyngitis

Back 149

hemolytic streptococci

Front 150

antibiotic for pneumonia

Back 150

macrolide/doxycyline without cardiopulmo disease, or beta lactam with cardiopulmo disease

Front 151

treatment of bell's palsy

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corticosteroid and acyclovir

Front 152

Manifestasi cervical HNP C5-C6

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nyeri lengan

Front 153

manifestasi cervical HNP C2-C4

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sakit kepala

Front 154

Most common site of spondylosis

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L5-S1 and L4-L5

Front 155

Pedicle erosion in spinal X-ray

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malignant and extradural tumor

Front 156

Thinning of pedicle and widening of interpedicular space

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longstanding intradural/intramedullary expansion

Front 157

narrow disc space indicate

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disc disease or lumbar spinal stenosis

Front 158

Rouleaux formation is indicating

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multiple myeloma

Front 159

Sign and symptoms of multiple myeloma

Back 159

classic malignancy sign.

CRAB (calcium elevation, renal insufficiency, anemia, bone disease)

Front 160

CML is caused by

Back 160

philadelphia chromosome (fusion of gene BCR-ABL1, t (9;22)

Front 161

Treatment of CML

Back 161

IMATINIB, second line DASATINIB, NILOTINIB