Things I Need To Remember 4

Front 1

Bulbar palsy

Back 1

Front 2

Pseudobulbar palsy

Back 2

Front 3

SCD aplastic crises

Back 3

Low Hb

Low reticulocyte

Front 4

SCD sequestration crises

Back 4

Low Hb high reticulocyte

Front 5

Gout Rx

Back 5

Acute attack:

First line- NSAIDs (e.g. Ibuprofen, Naproxen)

Second line- Colchicine

For long-term

Xanthine Oxidase Inhibitors (after 2 weeks of acute attack)

First line - Allopurinol "with NSAIDs and Colchicine coverage"

Second line - Febuxostat-

Front 6

Relative risk of ectopic pregnancy in MIRENA use

Back 6

1:20

Front 7

Contraception in breast cancer

Back 7

Only IUD / Uterine artery ablation (UAA)

If menorrhagia UAA

Front 8

Post contraceptive bleeding rx

Back 8

• <3 months- Reassure

Vaginal Spotting in Depo-Provera/Mirena (Oligomenorrhoea f/b Amenorrhoea)

• >3 months/Problematic Bleed- COCP for 3 months WHILE ON Depo-Provera or Tranexamic acid/Mefenamic acid for 5 days

• Vaginal spotting in COCP

• >3 months- Switch to another contraceptive method

Front 9

Missed pill POP

Back 9

Traditional POP- >3 hours

Desogestrel (Cerazette)- >12 hours late

Action Plan

• Take last pill ASAP even if it means taking two pills

• Continue rest of pack as usual

• Abstain from UPSI for next 48 hours

• Emergency Contraception if UPS after missed pills or in last 48 hours

Front 10

Missed pill cocp

Back 10

1 Pill missed:

1. Take last pill ASAP even if it means taking two pills

2. Continue rest of pack as usual

3. No additional contraceptives required

2 or more Pills missed:

• 1 and 2 + Abstain from UPSI until pills taken for 7 days in a row

• Then look for what pills missed

• if Week 1- Consider Emergency Contraception if UPSI in 1st week or Pill-free interval

Front 11

Ectopic management

Back 11

• Stable- Check beta-hCG

• b-hCG<1400- Wait and observe (unlikely ectopic pregnancy). The foetus may be so small to be observed by USG

• b-hCG>1400- Proceed to Laparoscopy (confirmed ectopic pregnancy)

• hG is not that high>Repeat after 48 hours first (Patient Stable) (Might be Tubal Miscarriage with falling hG)

• Unstable- Urgent Laparotomy (Open Salpingectomy or Salpingostomy)

Front 12

Ectopic rx

Back 12

Medical Mx- Methotrexate

• Hemodynamically stable

• No significant pain

Adnexal mass <35mm with no foetal heart visible

• Serum hCG<5000 IU/Itr (ideally <1500/Itr)

Surgical Mx

• Hemodynamicall unstable (Laparotomy)

• Significant pain

• Ruptured ectopic

• Cannot come for follow up

• Visible heartbeat

Front 13

AFLP

Back 13

ELLP (without Haemolysis) + Decreased Glucose +/- Increased Ammonia

• Dx- Liver Biopsy

Front 14

Stress incontinence Rx drug

Back 14

Duloxetine

Front 15

Urge incontinence Rx drug

Back 15

Anticholinergic - oxybutynin/ tolterodine/ darifenacin

Mirabegron if anticholinergic contraindicated

Front 16

CTG normal and pathological

Back 16

Normal CTG:

• Baseline (bpm)- 110-160

• Variability (bpm) - 5-25

• Decelerations (bpm)- None or early

Pathological:

Acute Bradycardia/ Single prolonged deceleration >3 minutes > Urgent Intervention and Expedite delivery

Front 17

When to conceive after Gestational trophoblastic disease

Back 17

Not until 12 months after completing Rx (chemotherapy)

Not until 6 months after betaHCG counts are normal + barrier contraception

2 weekly screening of urine and serum HCG till normal.

Front 18

Somatization disorder

Back 18

So many symptoms and tests without any physical cause

Patient refuses to believe negative test results

Front 19

Conversion / dissociative disorder

Back 19

Loss of motor or sensory functions without any organic cause

Occurs after an event

Patient doesn't feign it. It's out of their control

Front 20

Ganser syndrome

Back 20

Gangster / prison psychosis

Prisoner fakes symptoms for gain

Front 21

Cotard delusion

Back 21

Already dead

Front 22

Capgras delusion

Back 22

Replaced by an imposter

Front 23

Fregoli delusion

Back 23

Multiple people are actually the same person in disguise

Front 24

Psychoactive drug

Back 24

LSD

Front 25

TCA OD Rx

Back 25

IV NaCl (0.9%) + HCO3 (50-100mL of 8.4%)

Front 26

OPP poisoning rx

Back 26

Pralidoxime

Front 27

Fine tremors caused by which drug

Back 27

Sodium valproate

Front 28

Pregnant and Still taking Lithium

Back 28

Check plasma lithium levels Monthly till 36 weeks of pregnancy & Weekly till birth

Front 29

Drugs not used with Lithium

Back 29

NSAIDs(especially Ibuprofen)

Aspirin

Diuretics

SSRI

Front 30

Tardive dyskinesia Rx

Back 30

Give depot injection of atypical antipsychotics ( risperidone/ olanzapine)

NOT ORAL

Front 31

Cervicitis Rx

Back 31

Chlamydia

Doxycycline 100mg BD 7 DAYS

Or

azithromycin 1G P/O fb 500mg for 2 days

Gonorrhea

Ceftriaxone 1gm IM single dose

Or

Ciprofloxacin 500 p/o single dose

Front 32

PID RX

Back 32

Opd

Ofloxacin + metronidazole

Inpatient

CDM

Front 33

Endometrial cancer

Sx

Ix

Back 33

Female >51

With post menopausal bleeding

Ix

Transvaginal ultrasound

If endometrial thickness > 4 mm do hysteroscopy with endometrial biopsy (definitive)

Progesterone reduces the risk of endometrial cancer

Front 34

Early amenorrhea and premature ovarian failure

Back 34

Premature ovarian failure <40 year old

Early menopause 40-50 year old

Front 35

Ectopic investigation

Back 35

Initial - urine pregnancy test

If positive - transvaginal ultrasound

If ultrasound shows empty uterus - beta HCG (If stable) (1400)

Emergency laparotomy (if unstable)

If HCG is not that high repeat after 48 hours could be tubal miscarriage

Front 36

Miscarriage Vs still birth

Back 36

Miscarriage before 24 weeks

Still birth after 24 weeks

Front 37

Hyperemesis gravidarum rx

Back 37

FAST

fluids

Antiemetic

Steroids

Thiamine

Front 38

Initial Ix in placenta previa and abruption

Back 38

Abruption - CTG

previa - TVUS

Front 39

Hypertension terms in pregnancy

Back 39

Chronic htn - before 20 wk

Gestational htn - new htn after 20 wks without significant proteinuria

Preeclampsia - new htn after 20 wks with proteinuria

-24 hour urine protein >_0.3g

-pcr >_30mg

-acr >_ 8mg

Severe preeclampsia -

Bp > 160/110

Or preeclampsia with recurring severe headaches, scotoma, epigastric pain with bad labs.

HELLP

Eclampsia

Front 40

Pregnancy htn and asthma rx

Back 40

No labetalol

Give CCB

Nifedipine

Front 41

Colorectal Cancer Screening:

Back 41

V Fecal Immunochemical Test (FIT).

V 60-74 YO every 2 years.

Front 42

Breast cancer screening

Back 42

(Mammogram).

50-70 YO every 3 years.

Those with high risk > 40-70 YO annually.

Front 43

Breast cancer screening

Back 43

(Mammogram).

50-70 YO every 3 years.

Those with high risk > 40-70 YO annually.

Front 44

Cervical (Cervix) Cancer Screening:

Back 44

(Pap smear - Cervical smear: Cytology, HPV)

25-49 YO - every 3 years.

50-64 - every 5 years.

Front 45

Pregnant and still taking Lithium?

Back 45

Check levels Monthly till 36 weeks and then weekly till birth

Can cause ebstein anomaly and floppy baby syndrome

Front 46

Serotonin syndrome cause

Back 46

SSRI

Fluoxetine

Citalopram

Sertaline

Front 47

Neuroleptic malignant syndrome cause

Back 47

Metaclopramide

Haloperidol

Clozapine

Risperidone

Front 48

Genetic disorder with chorea and cognitive impairment

Back 48

Huntington's

Autosomal dominant

Jerky involuntary movement

Front 49

Akathisia cause

Back 49

Fidgeting, inability to sit still

Due to long term use of antipsychotics (risperidone)

Front 50

ADHD Rx

Back 50

Children

Methylphenidate (first line)

ADHD-focused group parent-training programme

Adults

Lisdexamfetamine or Methylphenidate first line in adults

СВТ

With Insomnia?

• First line- Sleep hygiene

• Second line- Melatonin

Front 51

GAD first line Rx

Back 51

Sertaline

Front 52

Pneumonia consolidation

Back 52

Staph causes Cavitation

• Klebsiella- Cavitation Upper Lobes

• Strep causes Lobar Consolidation

• Mycoplasma causes Patchy Consolidation

• Legionella- Bi-Basal Consolidation

Front 53

Aspiration pneumonia rx

Back 53

Amoxicillin + metronidazole

Front 54

Legionella pneumonia rx

Back 54

Macrolides

Front 55

Pneumothorax rx

Back 55

Unstable- 02>Needle decompression>ID

Stable- CXR

Primary

• < 2cm - Conservative (02)

• >2cm (or distressed)- Aspirate with Needle

• (Aspirate with Needle is different than Needle decompression)

Secondary

• <1cm- Conservative

• 1-2cm- Aspirate with Needle

• >2cm- ICD

Front 56

Carbon monoxide poisoning rx

Back 56

Conscious

• 100% 02 via tight-fitting mask with an 02 reservoir

Unconscious + Hypotensive (SBP<100)

• Intubate and Ventilate with IPPV

Soot in Mouth- Intubate

Front 57

Flail chest Rx

Back 57

Mx

• Stable + Normal Sp02 = Analgesia (e.g. intercostal block)

• Unstable = ABC > Analgesia (High flow 02 then Analgesia)

• Drowsy, Laboured breathing, Worsening RR = Intubate (usually with double lumen endotracheal tube)

Front 58

Atelectasis

Back 58

Post op complication within 72 hours

Front 59

Asthma exacerbation management in adults

Back 59

Oxygen - salbutamol - steroids

If life threatening

Salbutamol back to back.

Add ipratropium bromide

Mgso4

Front 60

Asthma exacerbation in children rx

Back 60

Oxygen - salbutamol - ipratropium - steroids (oral then IV)

If life threatening not improving

IV salbutamol/ IV Aminophylline / IV Mgso4

Front 61

Tumor lysis syndrome ix

Back 61

Serum urate (uric acid only)

Front 62

Smudge cells in

Back 62

Cll

Front 63

Aeur rods in which leukemia

Back 63

Aml

Front 64

Hodgkin and non Hodgkin age groups

Back 64

Hodgkin bimodal

Less than 25 and greater than 55

Non Hodgkin 25-40

Front 65

Atresia

Back 65

No Gastric Bubbles- Oesophageal Atresia

Single Bubble- Gastric/ Pyloric Atresia

Double Bubble (Double bubble sign: esophagus + Stomach)- Duodenal Atresia OR Malrotation and Volvulus

Triple Bubble Sign- Jejunal Atresia

Front 66

Pylori. Stenosis acid base

Back 66

Metabolic alkalosis hypokalaemia hypocholeremic

Front 67

Malrotation and Volvulus

Back 67

• Bilious vomit + Blood in Stool

• Ix-Xray- Double Bubble Sign, Barium Enema

• Rx- ABCDE>NGT>S

Front 68

Pyloric stenosis

Back 68

• Projectile Non-Bilious Vomit + Want to feed + Metabolic Alkalosis (Hypokalemia + Hypochloraemia) + Almond size mass

• Ix- First SE, Then- USG (Pylorus thickening)

• Rx- Electrolve correction>NGT>Ramsted Pylorotomy

Front 69

Pyloric stenosis

Back 69

• Projectile Non-Bilious Vomit + Want to feed + Metabolic Alkalosis (Hypokalemia + Hypochloraemia) + Almond size mass

• Ix- First SE, Then- USG (Pylorus thickening)

• Rx- Electrolve correction>NGT>Ramsted Pylorotomy

Front 70

Intussusception

Back 70

• Paroxysmal Colicky pain + Child crying + Sausage shaped mass + Red Currant Jelly/Blood stained stool

• Ix- USG- Target Doughnut sign

• Rx- Air/Barium Enema Insufflation> Sx

Front 71

Meckels diverticulum

Back 71

• Painless bleed + Rule of 2- 2 year, 2 inch, 2cm away from ileocecal valve

• Ix- Radioisotope scan>Laparotomy

• Rx- Sx

Front 72

Cystic Fibrosis

Back 72

• Gene- 7 CFTR

• Echogenic bowel on US+ Meconium Ileus + Bilious Vomit

Front 73

Necrotising enterocolitis

Back 73

• ABCD in a Premature Baby= Air in bowel wall + Bloody stools + Cannot tolerate feeds + Distension in Premature Baby + Vomiting +Hypoactive

• Ix- X-Ray Abdomen

• Rx

Air in bowel/ Distended loops- Stop feed + IV Fluids + Systemic Abs

• Pneumoperitoneum- Emergency Laparotomy

Front 74

GERD

Back 74

• Does not want to feed + Non-Proiectile Bilious vomit

• Rx- Reduce amount but increase frequency> Gaviscon> PPI H2 blocker

Front 75

Nephrotic syndrome features

Back 75

Nephrotic Syndrome-

Triad of-

Proteinuria (>3g/24hr- Frothy Urine),

Hypoalbuminemia (<30g/L),

Oedema;