Medicine - Miscellaneous 2

Front 1

Migrane abortive therapy

Back 1

1. NSAIDS + prokinetic
2. Triptans (5HT 1b/1d agonist)

• sumatiptan, rizatriptan,

should not use >10 days/ month

Front 2

migrane preventive tx

Back 2

>2 attacks per month

1. beta blockers - propanalol
2. TCA - amitryptaline
3. CCB - flunarizine
4. 5HT agonist - Pizotifen
5. AED - topiramate, valproate
   

Front 3

cluster headache mx

Back 3

abortive

1. 100% O2 6 l/min for 6 min
2. sumatriptan SC or IM
3. short course of steroid

Preventive

1. verapamil
2. lithium
3. topiramate / valproate

Front 4

Anterior spinal artery syndrome

Back 4

supply ant 2/3 of spinal artery

• radicular pain at onset
• sudden para/quadraplagia
• flaccid limbs changes to spastic limbs over days
• areflexia becomes hyperreflaxia over days
• pain, temp, touch pressure loss of sensation
• urinary retension
• preserved vibration and proprioception

Front 5

tabes dorsalis

Back 5

• posterior spinal root and poserior dorsal colum dysfunction
  
• syphilis
• pupillary abnormalitis (argyll robertson)
• areflexia
• joint poition and vibration loss
• sensory ataxia
• can develop charcot joint - due to loss of sensation
• urinary incontinance, impotence, constipation

Front 6

Sub acute combined degenaration of the spinal cord

Back 6

b12 deficiency causes

• diet
• increased need - pregnancy
• defective absrption - pernicious anaemia / gastic sx/ malasoptive syndromes (pancreatitis, tape worm)

spinal cord demylination + later axonal injury

lower cord - post column and lateral column

upper cord - posterior column

Tx

initial tx- 1000 micrograms IM for 3-7 days

then weekly for 4 weeks

maintance for life time

Front 7

subacute combined degeneration of the spinal cord - clinical features

Back 7

clinical features

1. sub acute onset
2. parastheis of extremities
3. numbness, vibration n joint position loss
4. glove n stokin sensory loss
5. distal wasting
6. motor power reduced distally
7. extensor planter reflex
8. unstady and spastic walk
9. rombergs positive - sensory ataxia
10. optic atropy
11. cerebral demylination
12. dementia

Front 8

Bone disease in ckd

Back 8

1. Osteitis fibrosa cystica- bone turnover is increased due to secondary hyperparathyroidism
2. Adynamic bone disease - bone turnover is low. most current cases result from excessive suppression of the parathyroid gland
3. Osteomalacia - bone turnover is also low in combination with an increased volume of unmineralized bone
4. Mixed uremic osteodystrophy

Front 9

Commence antivenom therapyimmediately for the bites of

Back 9

1. Russles
2. cobra
3. krait (both)
4. saw scale

Front 10

do not give antivenom for

Back 10

hump node

green pit

sea snake

Front 11

when to give antivenom

Back 11

its never too late to give antivenom given that there is

systemic envenoming

except in cobra -if half the limb is involved

Front 12

Heart failure Killip classification

Back 12

Killip I - no crackles, no S3

Killip II - crackles in <50% of lung feilds OR S3

Killip III - crackels in >50% of lung feild

Killip IV - cardiogenic shock

Front 13

common nurological signs in wilsons

Back 13

early presentation

• difficulty speaking,
• excessive salivation,
• ataxia,
• masklike facies,
• clumsiness with the hands,
• personality changes
  

late

• dystonia,
• spasticity,
• grand mal seizures,
• rigidity,
• flexion contractures
  

Front 14

caplan syndrome

Back 14

rheumatid arthritis and pneumoconiosis

auscultation - rattling sound

cxr - well defined round nodules

Front 15

causes for reverse splitting

Back 15

electrial delay

- LBBB

anything that causes delayed clouser of A2

- systolic hypertension

- AS

- left ventricular failure

anything that fills pulmonary system sooner

- PDA

Front 16

wide spliting of S2

Back 16

Early A2

• MR
• VSD

delayed P2

• RBBB
• PS
• ASD
• RVF

Front 17

paroxysmal Nocturnal Hemoglobinuria - features

Back 17

haemolytic anaemia

thrombophilia and thrombosis in large vessals

aplastic anaemia / pancytopenia

Front 18

pericarditis ECG

Back 18

• Widespread concave ST elevation (sandle shape) and PR depression throughout most of the limb leads (I, II, III, aVL, aVF) and precordial leads (V2-6).
  
• Reciprocal ST depression and PR elevation in lead aVR (± V1).
  
• Sinus tachycardia is also common in acute pericarditis due to pain and/or pericardial effusion.
  

Front 19

Social history

Back 19

* A- adl
* B - boarding place
* C - caregivers
* D - depression
* E - education
* F - finance
* G - gay / sexual activities
* H - nearest hospital and transportation / habbits
* I - insight