sheena2005
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here is a mixed group of questions fro quick evaluation.answers are welcome
Q1 what is the diagnostic modality used when U/S is equivocal for choolecystitis?
Q2orgainisms causing diarrrhea in aids patients?
Q3 what is a reynold's pentad?
Q4 what is the most common cause of cushing's syndrome?
Q5 what is the antigen test to confirm the diagnoses of rocky mpountain spotted fever?
Q6 Radiographic bamboo spine is seen in which disease?
Q7 most common primmary malignant tumour of bone is?
Q8 what is the treatment of gullian barre syndrome?
Q9 what are the manifestations of cauda equina syndrome?
Q10 most common cause of female infertility?
ok then good luck guys !!!!
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| sheena2005
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Posts: 257
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I am stuck on the hypertension question posted by mazinger.
hypertension in a young patient with all the labs normal.
i was suspecting renovascular hypertension .if that is the case then we go with either IVP or doppler scan as initial tests than follwed by the gold standerd angiography.which can be supplenented with angioplasty if required.but there is no such thing in the choices.
Conns syndrome, i am confused here becuse i just read npas' post that it could present with normokalemia in 15 %.if that's the case then checking aldosterone does seem correct.
please discuss this further .
For question 5 i think it's E....pulmonary angiogram since that's the gold standard
and for no 8 it's very much like pulmonary embolism.
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| mazinger
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these are nbme's so there are no official right answers..
First question is pulmonay angiography, its key to provide treatment in all patients if they really have a pulmonary embolus. Its a diagnosis you must rule out at all costs..
2nd question is also a PEmbolus physical findings point toward this Dx's...
Third Question I am clueless  , but npas' explanation was very good, after I read it and gave it thought... I think he is right...
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| zianab
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mazigner regarding the hyperaldosteronism diagnisis. I have some things to discuss
in hyper aldosteronism ,there is hypernatremia because of aldosterone.although it can be mild.but aldosterone always causes increase in NA and decrease in potassium.
and if this lady has so severe hyper aldo that her blood presuure is shooting up so high and sodium is completely normal.
normal range for NA IS 136-145.
AND I think that nbme or exam never go for very rare options.they just check the basic ,common concept.
I don't know you guys discuss some more,beause I think there is something wrong in renal vessel.One option could be benign fibromuscular dysplasia which occurs in young women and has reistant hypertension and since in the qs the lady is also young, or could be renal artey stenosis .
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| mazinger
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good point zianab... so let me do some research about this and lets see....
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| dr.pumpkin
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i too was thinking the way zianab is for the ques concerning hyperaldosteronism...the levels of Na r pretty normal ..
??
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| mazinger
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Q86 What are the differences bet/ a stable angina and unstable angina? Clnical differences, pathophysiology, prognosis?
Stable angina is episodic chest pain caused by inadequate oxygenation (atheromatous plaque obstructing the vessel -> noncompliant vessel and increased oxygen requirements) of the myocardium, it is most commonly triggered by increased physical activity, and its relieved by rest and/or nitroglycerin. Its named stable because it is always the same amount (remains stable) of activity-physical stress that triggers the pain, and its releived by the same amount of time to rest and the same amount of nitro.. It is also considered that angina in general last for less than 20 minutes.
Unstable angina usually is preceeded by a history of stable angina, which worsens on severity, it may occurr during resting conditions, lasts longer, it is not releived by rest, and may need more meds.. Unstable angina usually preceeds a MI and its caused by a combination of platelet agreggation and vasospasm without occluding the whole lumen of the vessel.. It may also be accompanied with autonomic signs and symptoms and may last for more than 20 min.
Q87 What are the differences bet/ an unstable angina and a MI? How can you diferentiate these two in a clinical setting? Treatment?
Well, unstable angina ans a MI may LOOK THE SAME in the clinical setting, the only way to be 100% sure which one is it, is by performing an EKG.
Unstable angina ST segment depressions.
MI ST segment elevations in at least 2 contiguous leads or a new onset of LBBB -> except in posterior leads in which there could be ST segment depression in the presence of inferior and lateral MIs.
Treatment -> main differences are that in unstable angina we give heparin and in MI we give trombolitycs -> streptokinase DOC, t-PA needs a concomitant heparin infusion meanwhile streptokinase is administered alone.
Edited by mazinger on 11/03/06 - 08:08 AM
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| npas
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Q88 What are the Diagnostic objectives of performing an exercise treadmill test?
Define a positive test.
In which patients sould you avoid performing this test because they are at increased risk of morbility/mortality during the testing session?
What are the electric disturbances that interfere with the standard EKG reading?
What if a person cannot exercise?
What are the alternatives for these patients?
1.CONFIRM DxOF ANGINA
2.DETERMINE SEVERITY
3.POST MI EVALUATION
IT IS CONTRAINDICATED IN THE FOLLOWING PATIENTS
1.RECENT MYOCARDIAL INFARCTION(WITH IN 2 DAYS)/ACUTE ISCHEMIC CHANGES IN ECG
2.SEVERE PULMONARY OBSTRUCTIVE DISEASE/PULMONARY EMBOLISM/INFARCT
3.SYMPTOMATIC SEVERE AS
4.MYO/PERICARDITIS
5.AORTIC DISSECTION
6.CAN'T EXERCISE AT ALL
7.UNCONTROLLED ARRHYTHMIAS CAUSING SYMPTOMS/HEMODYNAMIC COMPENSATION.
8.ACUTE CHF
9.IDIOPATHIC HYPERTROPHIC SUBAORTIC STENOSIS
10.SEVERE HYPERTENSION(>200sytolic or >110 diastolic)
(last 2 has been given as a relative contraindication in some books..how does it matter any way!!!I have added some extra points..plz note that)
STD INTERFERENCES..IS IT THE ELECTRIC ACTIVITY CANCELLING OUT EACH OTHER ...OR TOO WEAK ACTIVITY OF HEART TO BE DETECTED.!! ..NOT SURE.
WHAT IF PERSON CANNOT EXERCISE..THAT IS
...IF THE PT HAS A PVD
...IF HE HAS SOME SEVERE PULMONARY DISEASE
...MUSCULOSKELETAL DISORDER
WE CAN SIMULATE EXERCISE BY DIPYRIDAMOL/ADENOSINE.
JUST TO ADD...DON'T GIVE DIPYRIDAMOL IN PATIENT ON AMINOPHYLINE..U KNOW WHY >
good luck
npas
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| npas
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[good luck to all][/b]
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| npas
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sorry I was figuring out how to post in bold if ur comp is mac!!!
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| npas
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about that young lady with severe hypertension..i did think of fibro muscular dysplasia of renal vessel..thats the first think that strikes..but then decreased blood should lead to increased renin_ angiotensin and then increased aldosterone...and then hypernatremia in this patient too...so can we use this as a differentiating criteria?!
And don't we need a clue for some imaging..like an abdominal bruit?
But as u told Zainab..ur point makes a looot of sense and both the options have good chances!!Howz paedia going?
Dr Pumpkin...finished with paeds?
happy studying all
npas
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| mazinger
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npas wrote:sorry I was figuring out how to post in bold if ur comp is mac!!!
I also use a mac... switch to plain editor and then use these commands at the begining of the sentence you want to bold and the use at the end of bolded segment...
BTW Im going out of the city for a few days a (major holliday) eventhough Im taking my books with me I wont be able to write anything in this thread..
Good answers npas..
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| npas
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thanku mazinger
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| zianab
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ans 89:
acute symptoms:::
In angia pt treat acute symptoms with oxygen,morphine,sublinguil nitroglycerine,ASA and IV B blockers.Pt with suspected MI should be admitted and monitered until acute MI can be ruled out by SERIAL CARDIAC ENZYMES.
Treat chronic symptoms with nitrates,b blockers ca channel blockers.also do risk factor reduction i.e (smoking,cholesterol,HTN)ACEI used fot HTN .check lipid panel and consider starting statin drug
In MI check on serial cardiac enzymes ,ekg .
Treat acute symptoms as above and emergent angiography and revascularization must be considered.If these are unavailable or pt is not good candidate consider thrombolysis with TPA,urokinase,streptokinase.
IF THERE IS single or double vessel disease with discrete lesions pt is candidate for PTCA.
IF THERE IS 3 vessel disease ,left main disease ,diffuse disease pt is candidate for CABG.
In pt with unstable angina treat acute symptoms same as above in addition glycoprotein ll B AND lll B INHIBITORS CAN BE CONSIDERED.
In addition one can proceed to heprinization,angiography and possible revascularization(ptca vs CABG)
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| dr.pumpkin
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WHAT ARE THE DRUGS THAT REDUCE MORTALITY IN THE PATIENTS WITH STABLE ANGINA AND MI
1.aspirin ( given as long term mgt fr stable angina and MI improves mortality )
2. Beta blockers ( improve mortality after an acute MI and in congestive heart failure )
3. Thrombolytic therapy (improve mortality if given within 1-2 hrs,,though can be used upto 12 hrs)
4.ACE inhibitors ( improve mortality in post MI patients with clinical congeStive heart failure ,LV Dysfunction with EF <40%,anterior wall MI`S n even large infarctions)
5. Statins
HOW DO NITRATES WORK ?
they increase venous dilation : decrease preload { in low doses}
they increase arteriolar dilation : decrease afterload { in medium doses }
also, increase coronary artery flow , thus increase 0xygen supply,
may also dilate collateral channels in presence of coronary stenoses.
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| dr.pumpkin
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Q no#91 WHAT ARE THE INDICATIONS FOR THE USE OF CLOPIDROGEL
1. It is indicated in cases of intolerance to aspirin for the management of
: stable angina ( acute n long term management), acute coronary artery syndromes, Acute MI,Long term mngt .
2. added to aspirin after angioplasty
3. Improves graft patency in c/o CABG
4. those with non ST segment elevation MI
how does clopidrogel work ?
it blocks the ADP receptor and the resultanlt platelet aggregation
why is it preffered over ticlopidine
ticlopidine causes neutropenia...
although clopidrogel may cause TTP
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| dr.pumpkin
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Q NO #92 HOW DO YOU DIAGNOSE A MI ?
History of severe, prolonged chest pain ( substernal/ retrosternal ) usu greater than 20 minutes with radiation to left arm, jaw , neck , wid diaphoresis, N/V ,SOB. and, on PHYSICAL EXAM :s4 gallop, brady cardia ( esp in c/o inferior wall MI), OR tachycardia, s3 gallop wid jugular venous distention , or pericardial friction rub or features of cardiogenic shock..
OR MAY BE totally silent ,,and
the following EKG changes :
1.ELEVATED ST segment of 1mm in two contigous leads
2 Q wave/ Inverted T waves
EKG CHANGES IN TIME FASHION
EKG abnormality onset
hyperacute T waves ( in leads facing infarction) immidiately & disppearence in 6-24 hrs
ST segment elevation immidiately & disapearence in 1-6 weeks
Q waves >2mm one or more days & disapp in yrs or
may not disappear at all.
T wave inversion 6-24 hrs & disappear in months to yrs
ENZYME ABNORMALITY ONSET & DISAPPERANCE
1.CK-MB (v.sensitive , specific if Elevates in 4-6 hrs after pain starts, peak
measured within 24-36 hrs) at 12 -24 hrs .
2. TROPONIN ( more specific) elevates within 4-6 hrs n disappears aftr
1-2 wks.
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| dr.pumpkin
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Q NO # 93 needs to be answered
guys,,i think placement of stent is a standard procedure done during PTCA ....i don`t knw abt the specific indication !!! n plzz do answer
what`s the most useful enzyme to diagnose recurrent ischemia ??
thnx all..
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| dr.pumpkin
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stiill stuck up peds !!!! seems i ve developed a `FATAL ATTRACTION ` for this subject !!
sorrry guys for being off the scene fr long!! newys, u all r doing a fab job here...
keep it up!!!
hellloooowww npas n zianab ...hw r u both ??
npas, wen do u plan to start psych ?? hws ur OBG coming along ??
zianab,,let us both finish peds fast!!!!
so,,gud luck to alll...
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| npas
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Dr Pumpkin,I have finished with obs notes..except for infections.. I started psych(just half a lecture)..wasted the whole day. Anyways no chance to study today..tomarow I will start afresh.
Zainab even I have completed very less no: of Qs..I somehow does not finish a q book once I start..let me see how I can do it.
And u both better don't worry about paeds..just imagine..u r finished with medicine,psych and gynae..so u have covered more than half..
We all have to do MORE questions..and lets all increase our pace..
happy studying
npas
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| mazinger
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Dear friends Zianab, dr pumpkin, npas... I havent read the notes from psych and ob gyn.. I was wondering if there is a possiblity I could skip some videos since they take a lot of time and some of them are of them are not 100% useful... So what do you say? Should I skip something? and hit directly to the books??
Regards...
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| dr.pumpkin
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dear mazinger,
i had gone thru the lectures of OB-GYN wid the notes ,, n found them useful..act gyn lect are slow but the way he repeats the stuff ,,it really gets in to ur head  ..it was my first subject so i did put a lot of time in it,,so may be i m biased 
as for the psych lectures,, i think u culd skip them over...she tells all the stuff frm the notes...
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| dr.pumpkin
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Q NO#94 WHAT ARE THE INDICATIONS AND CONTRAINDICATIONS TO DO A THROMBOLYTIC THERAPY ?
QNO#95 WHAT ARE THE COMPLICATIONS THAT COULD OCCUR AFTER AN ACUTE MI , HOW WULD U TREAT THEM ?
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| dr.pumpkin
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dear npas, zianab ..
hw r u doing ? hw did the weekend go ?
me abt to finish with peds ..just the last three chaps left )
npas,,did u listen to all the lectures ?? i have a few lectures missing but still soooo many left to be done...till nw he`s just been telling all that`s given in the notes ...wat do u say ? shuld i go thru them ?
zianab,,how far have u reached ? wat about medicine Q bank ? are u doing that wid harrison`s review ?
so,, guys i ll finish the left over chaps tonite...
gud luck n take care
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