GENERAL MEDICINE (INT- 1) ANSWERS.

(2Q.)Myxedema coma?
# Patient will have
 the metabolic abnormalities like - hyponatremia and hypoglycemia.
MANAGEMENT:-
(1)SUPPORTIVE CARE :
*Gentle warming with blankets,broad spectrum antibiotics,high flow oxygen.
* Hydrocortisone (100mg ) IV 8 hrly.
(2).THYROID HORMONE REPLACEMENT:-
* IV T4 (100-150microgm)then (75-100microgm) daily .
*Identify and treat the precipitating cause.
(1Q).Bone density and osteoporosis?
 

BONE DENSITY:-
A measure of the amount of minerals (mostly calcium and phosphorous) contained in a certain volume of bone.
CALCULATION OF BONE DENSITY:-
It may be done using X-rays, dual-energy X-ray absorptiometry (DEXA or DXA), quantitative CT
* Osteoporosis is defined as when bone density falls 2.5 standard deviation below mean for 30 year old nrml reference in that population.
LAB INVESTIGATIONS:-
*URINARY LEVELS OF NTx more than 40 nmol/day.(feature of osteoporosis).
* RADIOGRAPHY OF SPINE AND PELVIS-
  Reduced cortical thickness of bones.
  Increased radiolucency of bones.
  Vertebrae show ,"codfish" appearance.
 Collapse of vertebral body with kyphosis .
TREATMENT:-
* Diet should include 1 gm calcium and 800-1000IU of Vitamin D daily.
* Adequate weight bearing excercises.
* Smoking and alcohol should be stopped .
 *Bisphosphonates  like- (risedronate,alendronate,ibandronate)
*Hormone replacement therapy
*SERMs( Raloxifene)
*Recombinant human parathyroid hormone.
* Salmon calcitonin.(inhibits bone resorption)
* Strontium ranelate.(proliferation of osteoblasts and inhibits osteoclasts).
* Denosumab( inhibit osteoclast formation)
(3Q). Hypertension?
CLINICAL FEATURES OF Hypertension:-
* History of intake of alcohol or drugs( oc pills ,steroids)
* Radiofemoral delay,panic attacks, Recurrent back pain ,UTI , polycystic kidney disease,renal artery stenosis,Cushing syndrome.
COMPLICATIONS:-
* CVA
*Subarchanoid haemorrhage
* Hypertensive encephalopathy.
*Trainsient ischemic attacks 
* Hypertensive retinopathy.
* CAD,Heart failure,left ventricular hypertrophy,aortic aneurysm and dissection.
* Renal failure.
TREATMENT:-
#GENERAL MEASURES:-
# ANTIHYPERTENSIVE DRUG THERAPY:-
* DIURETICS-
( chlorthiazide, hydrochlorthiazide)
*BETA BLOCKERS- 
( Propranolol,metaprolol)
*ACE INHIBITORS-
( Captopril,enalopril)
* ARB s ( telmisartan,losartan)
*CALCIUM CHANNEL BLOCKERS -
(verampamil ,nifidiepine).
* DIRECT VASODILATOR- 
( hydralazine, minoxidil).
5Q. Atrial fibrillation?
* Atria fire the impulses at a rate of 350-600/min
* Variable number of impulses are conducted to ventricles at irregular intervals.
CLINICAL FEATURES:-
*Palpitations,fatigue ,syncope. 
* Irregularly irregular pulse.
* Pulse deficit.
* Absence a waves on JVP.
* Disappearance of S4.
* Hypotension.
ECG FINDINGS:-
Irregularly irregular rhythm of Qrs complex.
Absent P waves.
Small irregular waves.(350-600/min).
TREATMENT:-
* HEMODYNAMIC STABILISATION.
*CONTROL VENTRICULAR RATE.
* RESTORATION OF SINUS RHYTM
* ANTI THROMBOLYTIC THERAPY.
* TREAT THE UNDERLYING CAUSE.
6Q.Megaloblastic anemia?
* Megaloblasts are abnormal erythroblasts seen in bone marrow of patients with defiecncy of vit b12 ,folate or both.
* They are characterized by-
Macro ovalocytes,hypersegmented neutrophils in peripheral smear.
LAB INVESTIGATIONS:-
*HB ,RBC, RETICULOCYTE COUNT ,PLATELET COUNT are reduced.
* INDIRECT BILIRUBIN elevated
* Serum fe, ferritin increased 
* Serum b 12 ,folate reduced.
* MMA elevated.
* Plasma homocysteine- elevated.
TREATMENT:-
SUPPORTIVE THERAPY
SPECIFIC THERAPY
* Vit b 12 and folate therapy.
(7Q)Ascites?
Clinical features:-
*Abdominal distension,fullness of flanks.
*Bloating feeling of abdomen.
*Dyspnea and orthopnoea
*Indigestion and heart burns
*Umbilicus flat or everted.
Serum -ascites albumin gradient ->=1.1gm/dl.( Portal hypertension).
8Q.Approch to pancreatitis?
9Q.Differnces between UMN and LMN lesions?
10Q Indications of dialysis?
A:-* Severe fluid overload
*Refractory hypertension
*Uncontrollable hyperkalemia
*Nausea, vomiting, poor appetite, gastritis with hemorrhage
*Lethargy, malaise, somnolence, stupor, coma, delirium, asterixis, tremor, seizures,
*Pericarditis (risk of hemorrhage or tamponade)
*bleeding diathesis (epistaxis, gastrointestinal (GI) bleeding and etc.)
*Severe metabolic acidosis
*Blood urea nitrogen (BUN) > 70–100 mg/dl
11Q Role of sucralfate in treatment of Erosive gastritis?
12Q Renal manifestations of snake bite?
A: Hematuria, Haemoglobinuria,myoglobinuria,loin pain, Renal failure.

13Q Causes of portal hypertension?
A:- Prehepatic - portal vein thrombosis,splenic vein thrombosis.
Intra hepatic- liver cirrhosis,primary biliary cirrhosis,Alcoholic hepatitis,Wilson's disease.
Extra hepatic - Hepatic vein thrombosis,IVC occlusion,Chronic right ventricular failure.


14 Q .Downs syndrome?
A:-     It is a autosomal abnormality,Trisomy21.
C/F:- flat nasal bridge ,hypertelorism,broadand short neck,short stature,hypotonia,Tetrollgy of fallot,ASD ,VSD,Sandal gap,simian crease,Mental retardation.


15Q.poststreptococcal Glomerulo nephritis?
A:- Causes-Multi system diseases, Infections diseases,Primary glomerular diseases.
C/F-Hematuria,oliguria, oedema, hypertension,RBC casts in urine, proteinuria,uremia.
Treatment:- supportive treatment
ANTIBIOTICS, DIALYSIS.
(16Q)Cervical myelopathy causes?
A:-* Rheumatoid arthritis of the neck.
*Whiplash injury or other cervical spine trauma.
*Spinal infections.
*Spinal tumors and cancers.
















Popular posts from this blog

A 67Yr Old male with burning micturition and decreased urine output.

Image
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box". A 67 year old male, weaver by occupation came to causality with  #CHEIF COMPLAINTS: -  (1)Decreased urine output, (2) Burning micturition and (3) Lethargy since 15 days. #HOPI: *Patient was apparently asymptonatic one year back ,then he started experiencing altered sleep cycle. *He was also experiencing episodes of   Nocturia in this one year.  *Patient had c/o    urinary I ncontinence  since 1 year.  *Patient had recurrent episodes of UTI (in t...
Read more

80 yr old with fever and cough.

Image
This is online E-blog, to discuss our patient de-identified health data shared after taking her guardian's signed informed consent. Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve the patients clinical problem with current best evidence based input. This E-blog also reflects my patient's centred online learning portfolio. I have been given this case to solve in an attempt to understand the topic of "Patient Clinical Data Analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan. Our 80yr old male patient came to the opd with chief complaints of 1.fever since 7 days. 2.Dry cough since 5 days. HOPI :- Patient was Apparently asymptomatic 7 days back then he developed fever which is on &Off  ,also has dry cough since 5 days  No headache,No burning mictur...
Read more