zianab
Forum Elite
Topics: 17
Posts: 282
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CARDIOLOGY QS
Q100:WHAT ARE THE EKG FINDINGS IN PATIENT WITH STEMI?
Q101:WHAT ARE THE EKG FINDINGS IN PATIENT WITH NON STEMI?
Q102:WHAT ARE THE EKG FINDINGS IN UNSTABLE ANGINA PATIENT?WHAT IS THE TREATMENT FOR IT?
Q103:WHAT ARE THE EKG FINDINGS IN STABLE ANGINA PATIENT?WHAT IS THE TREATMENT FOR IT?
Q104:WHAT ARE THE EKG FINDINGS IN PRINZMETTAL'S ANGINA PATIENT?WHAT IS THE TREATMENT FOR IT?
Q105:WHAT ARE THE INDICATIONS OF DOING A DOBUTAMINE STRESS TEST AND WHAT ARE THE CONTRAINDICATIONS TO IT?
Q106:IN WHAT KIND OF CARDIAC DISEASES B BLOCKERS ARE INDICATED AND ARE BENEFICIAL TO USE?
Q107:WHAT ARE THE CONTRAINDICATIONS FOR B BLOCKERS?
Q108:IN WHAT KIND OF CARDIAC DISEASES ACE INHIBITORS ARE INDICATED AND ARE BENEFICIAL TO USE?
Q109:WHAT ARE THE CONTRAINDICATIONS FOR ACEI USE??
Q110:WHAT ARE THE COMPLICATIONS OF MI?PLEASE EXPLAIN EACH IN DETAIL THE
COMPLICATIONS ARE GIVEN QS WISE?
COMLPICATION NO 1 :VENTRICULAR ARRHYTHMIA?HOW WOULD YOU TREAT IT?
QN0111:HOW WOULD YOU TREAT VENTRICULAR TACHCARDIA DEVELOPED AS A COMPLICATION OF MI,PLEASE EXPLAIN IN DETAIL?
Q112:HOW WOULD YOU TREAT VEBTRICULAR FIBRILLATION DEVELOPED AS COMPLICATION OF MI,PLEASE EXPLAIN IN DETAIL?
Q113:HOW WOULD YOU TREAT ACCELERATED IDIOVEBTRICULAR RHYTHM DEVELOPED AS A COMPLICATION OF MI?HOW WOULD YOU TREAT IT?
Q114:HOW WOULD YOU TREAT SUPRAVENTRICULAR ARRHYTHMIA DEVELOPED AFTER MI?PLEASE EXPLAIN IN DETAIL?
Q115:HOW WOULD YOU TREAT BRADYARRHYTHMIA DEVELOPED AS COMPLICATION OF MI?HOW WOULD YOU TREAT IT?
Q116:HOW WOULD YOU TREAT AV B LOCK DEVELOPED AS COMPLICATION OF MI?PLEASE EXPLAIN IN DETAIL?
npas ,mazinger,dr pumkin are you ready to answer????
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| npas
Forum Senior
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Posts: 198
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parameter wrote:
DOBUTAMINE STRESS TEST CAN BE DONE IN MI????( I am not sure about it,please let me know?
I think any type of stress test is absolutely CI in MI..and morover dobutamine is a sympathomimetic which is ionotropic and chronotopic..increases the cardiac output and oxygen demand too..so its an absolute no no in MI..
Q100:WHAT ARE THE EKG FINDINGS IN PATIENT WITH STEMI?
ST elevation and as it evolves it may show a q wave(earlier known as transmural infarctions) in a good percentage of patients..in those who do not develop that its non q wave STEMI.
Q101:WHAT ARE THE EKG FINDINGS IN PATIENT WITH NON STEMI?
ST segment depression and T wave inversion.We can differentiate it from unstable angina by the serum enzyme markers.
Its a looot of questions..will have to answer in instalments
npas
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| npas
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Posts: 198
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Q102:WHAT ARE THE EKG FINDINGS IN UNSTABLE ANGINA PATIENT?WHAT IS THE TREATMENT FOR IT?
UA ekg findings r same as that of NSTEMI..T wave is highly sensitive for ischemia but its less specific..
How do we treat NSTEMI and UA..treatment includes *antiischemic therapy and *antithrombotic th...SIMULTANEOUSLY.
Anti ischemic__
Nitrates(3 doses 5 min apart)
Beta blockers
Morphine
CCBs(if above 2 are not giving result)
Antithrombotic therapy__
asprin/clopidogrel(combinetion in long term)
Heparins or
IV abciximab or eptafibamide.
Invasive therapy(only in high risk patients) with a angiography with in 48 hours with PCI/angioplasty/CABG has been proven to be good.Watchful waiting for the rest.
Psych questions still pending..lemme rush..good luck friends
npas
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| zianab
Forum Elite
Topics: 17
Posts: 282
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dear naps,
thankyou for letting me know about the dobutamine test.How far are you in psychiatry?how many qs have you done for psychiatry??
take care
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| dr.pumpkin
Forum Newbie
Topics: 4
Posts: 168
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QNO#103What are the EKG findings in a stable angina patient and what is the treatment for it ?
during rest ; EKG m/b normal
during ischemia ; flat depression of the ST Segment (> 1 mv lasting 0.08 s) , with T wave flattening or inversion.
TREATMENT ;
during the anginal episode : sublingual nitroglycerine ( 1 tab to be put under tongue , repeat 3-5 min)
prevention of further attacks ; avoidance of aggravating factors
; long acting nitrates ( isosorbide dinitrate/iso. mononitrate/transdermal NTG patch)
; B- blockers ( Ppnl, metoprolol,atenolol)
;CCB`S (nifedipine/diltiazem/verapamil) To be used if B blockers intolerable or contraindicated.
;aspirin/clopidrogel
;Treating dyslipidemia with statins
;CONSIDER REVASCULARISATION ( CABG/PTCA)if needed.
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| dr.pumpkin
Forum Newbie
Topics: 4
Posts: 168
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QNO#104 WHAT ARE THE EKG FINDINGS IN PRINZMETAL`S ANGINA AND ITS TREATMENT?
EKG FINDINGS ; multi lead ST segment elevation. ( diagnosis confrmed by coronary angiography)
TREATMENT ; DURING ACUTE ATTACK
1. multiple doses of SUBLINGUAL NITROGLYCERINE/ IV NITROGLYCERINE
2 short acting CCB ( NIFEDIPINE )
CHRONIC TREATMENT
1.long acting nitrates
2. CCB`S
if stenotic lesions present : consider aggressive mgt with antiplatelts/thrombolytics or even revascularisation
b blockers may even exacerbate the coronary vasospasm so don`t use unless spasm ass. with a fixed stenoses.
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| dr.pumpkin
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Topics: 4
Posts: 168
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QNO#104 INDICATIONS FOR DOING A DOBUTAMINE TEST AND ITS CONTRAINDICATIONS?
INDICATIONS
Done when a patient is unable to do exercise for stress testing , as in the following conditions
1.peripheral vascular disease
2.musculoskelatal disease
3.exertional dyspnoea/ COPD
plzz guys add more indications if u knw them ...
CONTRAINDICATIONS
since dobutamine is a ionotropic n chronotropic don`t use in
1.acute ischemic changes on EKG ; an evolving MI, unstable angina
2.aortic stenosis
3.Idiopathic hypertrophic subaortic stenosis
4.acute congstive heart failure
5.aortic dissection
6.severe uncontrlled hypertension
friends i have a question,, if these are the contraindications to stress testing then what is the way to diagnose an ongoing ischmia in the following conditions?
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| dr.pumpkin
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QNO#106 IN WHAT KIND OF CARDIAC DISEASES ARE B BLOCKERS INDICATED AND BENEFICIAL TO USE ?
B Blockers are indicated in
1.STABLE ANGINA, UNSTABLE ANGINA ( they decrease heart rate, blood pressure and contractility thus decreasing the myocardial 02 demand)
2.MI ( Prevent reinfarction/prevent sudden ventricular fibrillation/may limit infarct size and have thus reduced early mortality d/t it )
3. CARDIAC ARRYTHMIAS ; supraventricular ( they control the ventricular rate in atrial fibrillation/ flutter)
;supress EXTRASYSTOLES and tachycardia ( esp those mediated adrenergically as durin anesthesia and digitalis induced)
4. CONGESTIVE HEART FAILURE ( they have provided a mortality benefit prob by incresing EF and decreasing ischemia)
CONTRAINDICATIONS
1.bradycardia
2.AV Block
3COPD
4.hypotension
5. may exacerbate prinzmetal`s angina
3.
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| dr.pumpkin
Forum Newbie
Topics: 4
Posts: 168
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NBME QUES.
1# A 42 YR OLD WOMAN G3P3 PRESENTING WITH EPIGASTIC PAIN.....
I think the answer is `B` acute pancreatitis
b cos of the pain`s radiation to the back, highly elevated amylase levels...n the other features ruling out other ds
in c/o acute cholecystitis ( though leukocytosis , gall stones are present ; but gall bladder wall is not thickened , which is seen in acute cholecystitis)
we can rule out viral hepatitis n acute perihepatitis `b`cos of normal AST/ALT Levels,,bilirubin is only mildly elevated...
had it been a duodenal ulcer ( which culd have perforated and presented with leukocytosis, epigastric pain radiating to the back) it wuld have shown only mild elevation in amylase .
ascending cholangitis wuld have presented with high fever,jaundice wid recurrent pain....
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| dr.pumpkin
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QUES#2 a 65 yr old woman presenting with irriatibility...
i think answer is `C`multinodular goitre
the patient is presenting with `hyperthyroidism` , areas showing increased and decreased uptake, also the patient had a neck mass since 10 yrs,,so probably it was a non toxic gotre wich has recently b com toxic.
grave`s ds presents wid thyroidism but is wid increadsed 131I uptake diffusely
if its a thyroiditis ( subacute ),,though it presents with hyperthyroidism , but is transient ie it it is present fr a few weeks n decreased 131I uptake. n wuld not definitely show this much amt of wt loss...
reidel`s thyroditis is fibrosis ,,thus wuld present wid hypothyrodism.
thyroid CA is `cold` on 131 I uptake
toxic adenoma wuld give a localised area of increased uptake..
i m confused as for the T3 THYROTOXICOSIS...
npas,mazinger, zianab...plzzz help out 
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| dr.pumpkin
Forum Newbie
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Posts: 168
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ques#4 a 2 day old infant brought to the physician cos of a generalised rash.....
i think the answer is A , the infant is presenting with erythma toxicum
This rash presnts after the first day of life,,the infant is well ,, has no fever, any other toxic signs ( be sure to rule out STAPHYLOCOCCAL SCALDED SKIN SYNROME)
scraping of rash shows eosinophillia
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| dr.pumpkin
Forum Newbie
Topics: 4
Posts: 168
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ques#5 a 72 yr old man brought wid 2 day history of nausea vomitting n visual disturbances
i think the answer is `E `DRUG TOXICITY (of digoxin)
the patient has stopped taking the potasssium supplements ,,and has developed hypokalemia d/t hydrochlorthiazide..which has led to digoxin toxicity
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| dr.pumpkin
Forum Newbie
Topics: 4
Posts: 168
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hiii npas,,zianab....
how r u both ?? had some probs with my PC ,,so was off the journal for sometime...
npas, have u done ur psych ?? when r u planning to start surgery ?
zianab, wat abt u ? done peds ?
i ve started revising obs frm today,,have done 3 chaps wid questions frm pretest...
guys frm wat sources did u do questions fr OB-GYN ? actually i didnot do questions wen i had given it a first read..
plzzz do look at my answers n help if i have been wrong or missed somthing ..
gud luck n take care...
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| mazinger
Forum Guru
Topics: 46
Posts: 918
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cool Dr Pumpkin you got them all!
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original mazinger z
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| mazinger
Forum Guru
Topics: 46
Posts: 918
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Dr Pumpkin you skipped question #3... If you are not sure, simply guess... I am not 100% sure about q3 anyways..
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original mazinger z
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| npas
Forum Senior
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Gr8 Dr Pumpkin..u have left very little for all of us to fill up..good going ..
Answer to the 3rd one..the pt with nausea,vomiting..taking drugs for arrhythmia and hypertension
I think it is "drug toxicity"..the man has been taking thiazide diuretics..he was prone to develop hypokalemia..the nausea and vomiting could have been due to the another side effect 'hypercalcemia'(may be)..
gl
npas
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| npas
Forum Senior
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I'am finished with psych..done up to 100 qs..now doing paedia qs..will start surgery only on monday..till then its only qs.I'am losing my pace every now and then.
Hope Zainab has finished with paedia..Dr Pumpkin..howz ur obs gynae revision going on? R u listening to lectures again?
Dr Mazinger..keep posting qs.
GL to all
npas
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| mazinger
Forum Guru
Topics: 46
Posts: 918
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npas I agree with the drug toxicity as an answer for question #5... But none of us has given a answer for question #3, so I'll be the first to answer (really is more like guessing).Since I am not a 100% sure any scientifical suggestions will be highly appreciated and ranked above my hunch... and I think the answer is C: congestive heart failure.
Why? pulmonary rales, plus tachypnea and SOB are indicative of left heart sided failure, and we may also note jvd which also points for right sided heart failure.. there is also Gallop S3 (I am always confused with this galloping things), from my perspective it all points to CHF since there's nothing else in the vignette pointing anywhere else...
So dear Doctors what are your opinions? I will be glad to read them..
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original mazinger z
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| npas
Forum Senior
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I agree with u Mazinger.But how did u rule out Pulmonary embolism?I mean can u please explain me some clear differences between the 2.
good luck
npas
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| mazinger
Forum Guru
Topics: 46
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I made it mainly by the physical findings ---> diffuse pulmonary crackles as the main key which are absent in PE, ventilation is normal in PE patients or could be absent is the presence of a pleural effusion.....
Regards
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original mazinger z
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| mazinger
Forum Guru
Topics: 46
Posts: 918
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NEW NBMES
1. A previously healthy 2-year-old boy is brought
to the physician
20 minutes after an episode of cyanosis and loss of
consciousness that
lasted 3 minutes. The symptoms occurred after his
mother scolded him
for climbing onto the dining room table. The mother
says that the child
began to cry, let out a deep sigh, stopped breathing,
and jerked his
arms and legs back and forth. On arrival, he is alert
and active.
Neurologic examination shows no focal findings. Which
of the following is
the most appropriate next step in management?
A) Reassurance
B) Electroencephalography
C) CT scan of the head
D) Anticonvulsant therapy
E) Lumbar puncture
2. A 25-year-old woman comes to the physician
because of "spells"
characterized by sweating, palpitations, and shortness
of breath that
have awakened her at night several times over the past
3 months. She
resigned from her job as a sales clerk 6 months ago
and now works from home
as a telemarketer. She recently began going to the
grocery store late
at night because she is too nervous around people.
She says that she
has been feeling sad lately. On mental status
examination, she is fully
oriented, and her range of affect is full. Which of
the following is
the most likely diagnosis?
A) Adjustment disorder with anxiety
B) Adjustment disorder with depressed mood
C) Dysthymic disorder
D) Generalized anxiety disorder
E) Major depressive disorder
F) Panic disorder with agoraphobia
G) Post-traumatic stress disorder
3 A 4-year-old boy is brought for a well-child
examination. He
uses two-word phrases, can say his first name but not
his last name, and
cannot identify colors. He is just beginning toilet
training. His
7-year-old sister has a learning disability and
attends special education
classes. Genital development is Tanner stage 1;
testes are large.
Which of the following is the most appropriate next
step in diagnosis?
A) Reexamination in 6 months
B) Thyroid function tests
C) DNA testing
D) Measurement of bone age
E) CT scan of the head
4. A 27-year-old primigravid woman at 12 weeks'
gestation comes to
the emergency department 2 hours after the sudden
onset of bright red
vaginal bleeding. She has not had abdominal cramping.
Pelvic
examination shows a small amount of brownish blood in
the posterior fornix of
the vagina. The cervix is closed. The uterus is
palpable 3 cm above the
pelvic brim. Fetal heart tones are easily audible at
167/min by
Doppler. Which of the following is the most likely
diagnosis?
A) Abruptio placentae
B) Ectopic pregnancy
C) Incomplete abortion
D) Placenta previa
E) Threatened abortion
F) Normal pregnancy
5. A 72-year-old woman comes for a routine health
maintenance
examination. She has a 3-year history of occasional
loss of small amounts
of urine when she coughs or sneezes. She has had no
pain or burning
with urination. She has hypertension treated with
daily
hydrochlorothiazide. She underwent an appendectomy at
the age of 10 years. She has
three children and had uncomplicated pregnancies.
Examination shows no
abnormalities except for a moderate cystocele. Which
of the following is
the most likely cause of this patient's urinary
symptoms?
A) Chronic infectious trigonitis
B) Large intravesical calculus
C) Obstetric trauma
D) Polycystic kidney disease
E) Spastic neurogenic bladder
6. A 42-year-old woman, gravida 2, para 2, has had
increasing
fatigue, dyspnea, orthopnea, and paroxysmal nocturnal
dyspnea over the past
2 days. She has had several episodes of hemoptysis;
she had one
episode of pulmonary edema during pregnancy 2 years
ago. A loud S1, a
snapping sound in diastole, and a rumbling diastolic
murmur are heard at the
apex. Which of the following is the most likely cause
of her
condition?
A) Atrial myxoma
B) Bicuspid aortic valve
C) Postpartum cardiomyopathy
D) Rheumatic heart disease
E) Viral myocarditis
7. A 35-year-old woman is brought to the emergency
department by
her family because of shortness of breath, tightness
in her chest, and
palpitations for 2 hours. Over the past 11 months,
she has had five
similar episodes; during the last episode 3 weeks ago,
she was treated with
an intravenous medication that caused conversion to
sinus rhythm. Her
blood pressure is 95/60 mm Hg, and pulse is 165/min
and regular. The
lungs are clear to auscultation. Which of the
following is the most
likely underlying dysrhythmia?
A) Accelerated idioventricular rhythm
B) Accelerated junctional rhythm
C) Atrial fibrillation
D) Multifocal atrial tachycardia
E) Normal sinus rhythm
F) Paroxysmal supraventricular tachycardia
G) Premature supraventricular beats
H) Premature ventricular beats
I) Sick sinus syndrome
J) Sinus bradycardia
K) Sinus tachycardia
L) Ventricular fibrillation
M) Ventricular tachycardia
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original mazinger z
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| sheeezooo
Forum Guru
Topics: 30
Posts: 343
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wow.great work u guys..very helpful..
thanks
good luck
___________________
if u hold up your head with a smile on your face and are truely thankful,u are blessed because the majority can, but most do not..
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| dr.pumpkin
Forum Newbie
Topics: 4
Posts: 168
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hi frns...
had less of studies this weekend...had gone for a movie yesterday, n l`l hanging out n defitelay felt sooo much better away from the books ...
zianab, npas thats great tht cos we can all start with surgery now!!!
npas,,yeah i started wid OB cos i was dreading that i d forgotten most of it ,,,but have left it in the middle...i ll first cover surgery n then continue wid 2nd read of all subjects...wat source are u covering fr the peds questions npas ??
zianab,,have u done peds questions? hw many did u do ?
frns lets all do cardio questions too,,,( they wuld be feeling neglected nw...)
so,,gud luck to us all....
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| dr.pumpkin
Forum Newbie
Topics: 4
Posts: 168
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dear mazinger,,
yeah..i too am thinking it as CHF..but i think i ll not much comfortable whilre ruling out other options...i think i ll do more research n find out
zianab,, nw the nbme`s r waiting fr u
wuld be posting answers soon...
take care all...
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| dr.pumpkin
Forum Newbie
Topics: 4
Posts: 168
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dear frns i have a doubt ....
what is to be done in a child with respiratory distress after many attempts at intubation have failed ??
TRACHEOSTOMY / CRICOTHYROIDECTOMY
notes mention tracheostomy ,,whereas while i was doing questions it mentioned cricothyroidectomy...
plzzz help me with this confusion....
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