npas
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Hey guys..i think the discussions we r doing is really picking up..I can see we have started being more analytical..gr8
I agree with Dr Pumpkin and mazinger on the PCD answer.
I will give more answers later..its almost 11.30 am ...I have to start my routine study..Zainab and Dr Pumpkin,Good that u r pacing up..I thought I was almost finished with lectures of psych when I saw 3 more in an another dvd..has to finish that..has done 50 questions..will do more today.
Sarika,we r discussing nbme questions too other than Zainabs self made questions.
good luck
npas
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| npas
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mazingers nbme2 answers
c]severe combined immunodeficiency syndrome(note the typical opportunistic infections and lab findings..we can also exclude the other options to reach the answer)
A]Amoxicillin does not alter the course of salmonella enteritidis(only indicated if the infant is <3 months,evidence of severe illness or other accompanying conditions like SLE or cardiac/renal disease)
B] metoprolol(decreases mortality)
GL..npas
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| mazinger
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Totally agree with your 3 answers... way to go npas..
Note that the child has recurrent bacterial infections and low Igs levels (deficient humoral adaptative immunity), and he also has a candida infection with a low lymphocite count (deficient cellular adaptative immunity).
I agree that antibiotics are not given in salmonella infections because they dont alter the course of the dzs...
and for the last one let the mortality benefit guide your answers...
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| mazinger
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QS 97:A PATIENT COMES WITH NSTEMI( NON Q MI) COMES TO ER ,WHAT IS THE STEP WISE MANGENT OF THIS PATIENT?
Dont know  sorry 
QS 98:A PATIENT PRESENTS WITH MI IN ER,WHAT IS THE BEST INITIAL DIAGNOSTIC STEP TO DIAGNOSE IT?
Best way to diagnose a MI is EKG then you can support your initial diagnosis with the rising/appearance of enzymes.. Be aware that EKG findings and timing by themselves are sufficient to start trombolytic therapy.
Edited by mazinger on 11/08/06 - 08:14 PM
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| zianab
Forum Elite
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cardiology qs
QS 96: A PATIENT COMES WITH STEMI COMES TO ER,WHAT WILL BE THE STEP WISE MANAGEMENT OF THIS PATIENT?
I AGREE WITH MAZINGER'S ANSWER.CARDIAC ANGIOGRAPHY,CARDIAC CATHETERIZATION AND PCI ,CABG HAS TO BE ADDED IN TREATMENT DEPENDING ON PATIENTS NEED.THE REST IS ANSWERED VERY COMPLETELY.
QS 97:A PATIENT COMES WITH NSTEMI( NON Q MI) COMES TO ER ,WHAT IS THE STEP WISE MANGENT OF THIS PATIENT?
GIVE ANTI ISCHEMIC TREATMENT:
TELEMETRY MONITOR,OXYGEN,NITROGLYCERINE,MORPHINE.
BETA BLOCKERS,.ACEI (DEPENDING ON PATIENTS)
ASPIRIN,CLOPIDOGREL IS AN ALTERNATIVE FOR THOSE WITH TRUE ASPIRIN ALLERGY.
HEPARIN, GP II B AND III B INHIBITORS ARE BENEFICIAL FOR HIGH RISK PATIENTS AND THOSE UNDERGOING PERCUTANEOUS INTERVENSION.
STATINS FOR MAINTANCE THERAPY.
VERY IMP POINT: THROMBOLYTICS ARE NEVER USED IN UNSTABLE ANGINA OR NON ST -ELEVATION MI.THIS IS THE MAIN DIFF FROM STEMI.
DECISION CAN BE MADE ON PATIENT'S CONDITION TO GIVE CONSERVATIVE MEDICAL TREATMENT OR EARLY INVASIVE TREATMENT THAT IS CARDIAC CATHETERIZATION
(PCI OR CABG) IS DONE IN HIGH RISK PATIENTS.
qQS 98:A PATIENT PRESENTS WITH MI IN ER,WHAT IS THE BEST INITIAL DIAGNOSTIC STEP TO DIAGNOSE IT?
ans 98:
PATIENT HISTORY,ECG,CARDIAC MARKERS
Q99:WHAT ARE THE NEXT STEPS IN DIAGNOSIS WHICH ARE TAKEN AFTER THE INITIAL STEP?
ANS 99:NON INVASIVE TECHNIQUES CAN BE USED LATER ON TO DETERMINE EXTENT OF DAMAGE
ECHO CAN BE USED
MYOCARDIAL PERFUSION IMAGING ,THALLIUM 201 OR TECHNITIUM ) IS SENSITIVE FOR REGIONS OF DECREASED PERFUSION.CORONOARY ANGIOGRAPHY CAN BE DONE IF NEEDED.
Stress test should never be done in acute MI patient .
DOBUTAMINE STRESS TEST CAN BE DONE IN MI????( I am not sure about it,please let me know?
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| zianab
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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
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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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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
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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
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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
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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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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
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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
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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
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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
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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: 920
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cool Dr Pumpkin you got them all!
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| mazinger
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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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