abdominal aortic aneurysm size: 4 to 5.4 cm: screen with usg every 6 to 12 months Elective repair of aneurysm if size more than 5.5 cm or growth of aneurysm is more than 0.5 cm in 6 month or AAA is associated with peripheral arterial disease or aneurysm
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cocaine-induced MI cocaine due to sympathetic overactivity causes hypertension. cocaine also activates platelets leading to thrombus formation and MI. therefore, aspirin is prescribed in cocaine induced MI. schedule patient for PCI. Benzodiazepine is first line treatment. if patient's pain is not relieving ,then you can give CCB but do not give beta blocker. we can give phentolamine for persistent hypertension.
psychiatry 1. definition of major depression : if 5 out of 9 symptoms persist for more than 2 weeks symptoms can be remembered with mnemonics: low mood SIGECAPS S-sleep I-loss of interest G-guilty/ worthlessness E-lack of energy C- concentration/ attention A-Appetite loss P-psychomotor changes S-suicidality Low mood In adjustment disorder, the precipitant can be anything except bereavement. what is the difference between normal grief vs major depression? In normal grief about the death of a loved one, the idea ruminates around that loved one only. she may think she would have died with her loved ones. She can feel auditory/visual hallucinations of her loved ones. But these do not significantly impair daily life functioning. these episodes occur intermittently but in major depression, these symptoms are persistent. In major depression, there is greater social and occupational dysfunction. 2. How to differentiate schizoaffective disorder from mood disorder with psychotic feat...
Treatment of ADHD first-line treatment is drugs in children aged 6 and above. In children below 6 years, the first line of treatment is behavioral therapy. Among drugs, first, try stimulants (amphetamine/ methylphenidate). Second-line options are atomoxetine and clonidine. what is the mechanism of action of atomoxetine norepinephrine reuptake inhibitor How to titrate the dose of the stimulant? we should titrate it every week until max dose is reached or the patient experiences intolerable side effects. H ow long to wait to see whether the stimulant will be effective? its effect is seen within 1 week. if the patient does not feel improvement within 1 week, change to alternate medications. what are the features of stimulant toxicity? diaphoresis, mydriasis, tachycardia, hypertension, dilated pupil, anxiety, agitation, psychosis, decreased appetite cannabis intoxication also causes tachycardia, and hypertension; then how to differentiate it from stimulant toxicity? in cannabis ...
Difference between serotonin syndrome (SS) and neurolept malignant syndrome (NMS): in SS, a patient has neuromuscular hyperactivity (hyperreflexia, myoclonus, ocular clonus) instead of bradykinesia and rigidity in NMS. Fluoxetine has a half-life of 5 weeks, so, before switching to MAOi, wait for 5 weeks because it will cause serotonin syndrome.
HPV vaccination in boys/ girls: Vaccination at 9-12 years of age (if missed then can take till 26 years of age) what are the conditions where it can be given after 26 years of age? answer: HCPs who are involved in surgery of HPV wounds; people who have not been previously exposed to HPV due to few sexual partners schedule of vaccination: under 15 years of age: 2 vaccinations at 6 months apart if the age is more than 15 years or immunocompromised patients, give 3 vaccination: 0, 1-2month and 6 month
Ethics practice in medicine 1. if any colleague is doing substance abuse, this must be reported to the state licensing board because the primary aim is to maintain patient safety. 2. if any patient gives a gift to a physician with some expectation that he will give me preference, do not accept the gift. otherwise, physicians can accept inexpensive gifts. 3. if any intoxicated patient comes to the ER and needs emergency treatment but the patient denies treatment, then sedate him and do an investigation and treatment. Because the patient is not currently in a state of being able to make the correct decision. so, assume that his decision will be further treatment and go ahead without consent.
Health insurance system in the USA 1. Medicare 2. Medicaid 3. Medicare-Medicaid (Medi-Medi) 4. Medigap (medicare supplemental insurance) Medicare: it is for people aged more than 65; physically or mentally disabled, with end-stage renal disease, and only certain neurodegenerative diseases (e.g. amyotrophic lateral sclerosis). It has 4 parts: A, B, C, D part A covers inpatient services part B covers outpatient services, outpatient surgery, and preventive care. part C (medicare advantage): this is provided by private insurance companies and it includes both inpatient and outpatient expenses PART D covers prescription drugs Medi-medi includes very low-income seniors, disabled who qualify for both Medicare and Medicaid. Medigap covers expenses not covered by parts A, B, and D. It covers copays and deductibles.
How to distinguish CSF findings whether it is a traumatic lumbar puncture or subarachnoid hemorrhage? if xanthochromia (degenerated RBC) is present, it is due to subarachnoid hemorrhage because it takes more than 2 hours for the degeneration of RBC. If frank blood is present then the RBC: WBC ratio is 700 -1000: 1
function of lobes of the cerebrum: nondominant parietal lobe: constructional apraxia, dressing apraxia Dominant parietal lobe: acalculia, inability to recognize fingers, inability to write, inability to identify or distinguish left/ right side of body. nondominant temporal lobe: impaired perception of complex sounds (auditory agnosia) Dominant temporal lobe: difficulty expressing their thoughts in a meaningful manner, Wernicke aphasia
Hungry bone syndrome it occurs between 2-4 days after parathyroidectomy. initially, when PTH was high, there was an outflux of calcium from bone into the blood. After parathyroidectomy, calcium starts to influx into the bone. serum calcium falls to nadir between 2-4 days postoperatively. what are the risk factors for Hungary bone syndrome? severe hyperparathyroidism, vitamin D deficiency, and severe bone disease. All these conditions have a high bone turnover rate.
Brainstem infarction pons is divided into mid pons and inferior pons; lateral side and medial side. This division is based on blood supply. infarction of medial pons causes ataxic hemiparesis (contralateral hemiparesis of limbs and ipsilateral paresis of facial muscles and ataxia due to involvement of middle cerebellar peduncle). There may also be a loss of sensation of touch and position sense. Infarction of lateral part of mid pons causes involvement of sensory and motor division of cranial nerve five (weakness of masticatory muscles, diminished jaw jerk) Infarction of the lateral part of the inferior pons causes involvement of cranial nerves seven and eight. Infarction of the medial part of medulla oblongata causes alternate hypoglossal hemiplegia (tongue deviates toward the side of the lesion and limb paresis occurs on the opposite side). there is also a loss of vibration and proprioception on the contralateral side. Infarction of the lateral part of medulla oblongata causes H...
CRANIAL TUMORS Pinealoma: vertical gaze palsy, loss of optokinetic nystagmus and pupil reflex, ataxia headache due to obstructive hydrocephalus Some pineal tumors are germinoma and secrete hcg which can cause precocious puberty in prepubertal males. craniopharyngioma: associated with diabetes inspidus and absence of one or more pituitary hormones. Frontal lobe tumor associated with Foster-Kennedy syndrome (optic atrophy on the side of the tumor and papilledema on the contralateral side)