Uworld Step 3 Synopsis

8/18/2019 Uworld Step 3 Synopsis

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PREPARED BY SANTOSH DHUNGANA

UWORLD SYNOPSIS FIRST: step 3 usmleworld.com

Cardiology

1. Decreasing LDL is ore i! "o !re#en" CAD "$an s"o!!ing so%ing& D'con"rol& HTN con"rol or e(ercise. D' is "$e second os" i!or"an".

). P" *i"$ CH+ on aiodarone coes *i"$ desa",ra"ion and -asal crac%les

!ro-a-ly c$ronic in"ers"i"ial !ne,oni"is& or organi/ing !ne,onia d,e "oaiodarone. 0"s a c,,la"i#e dose e22ec"& and no" de!enden" on -lood le#els.

O"$er adrs are li#er& l,ngs& "$yroid& B' "o(ici"y and s%in c$anges incl,ding

P$o"osensi"i#i"y. S"eroids can -e ,sed 2or se#ere !,l disease.

3. Yo,ng !a"ien" *i"$ sec HTN& os" coon 2inding is a-doinal -r,i"4 5678.Tac$ycardia i2 !$eoc$roocy"oa& -," is less coon.

9. 0n a !a"ien" *i"$ HTN& in a-sence o2 any %no*n CAD& -a-y as!irin is ,seless.

5. All !"s *i"$ s"a-le angina s$o,ld ,ndergo s"ress E:G 2or ris% s"ra"i2ica"ion.

Hig$ ris% !a"ien"s& ie "$ose *i"$ 2ail,re "o inc BP *i"$ e(ercise& ina-ili"y "oco!le"e s"age 0 o2 Br,ce !ro"ocol&& or a!!earance o2 do*nslo!ing or $ori/on"al

ST segen" d,ring e(ercise ;1& s$o,ld ,ndergo cor angiogra!$y& and "$alli,scan "o see #ia-le sal#agea-le yocardi, -e2ore PTCA or CABG.

o angioedea *i"$ ACE0& ARB are no" "$e c$oice dr,gs B -loc%ers are& -eca,se ARB s"ill $a#e lo* ris% o2 ca,sing angioedea. Es!ecially i2

"$e !" $as no co!elling indica"ion "o ,se ACE0& li%e Dia-e"ic Ne!$ro!a"$y.

?. S"ress Ec$o is al*ays ore sensi"i#e "$an s"ress ECG& and can s$o* *all

o"ion a-norali"ies& -," s"ress ECG is s"ill "$e 2irs" c$oice 2or ris% s"ra"i2ica"ionin !"s *i"$ s"a-le angina. 0n !a"ien"s *$o canno" e(ercise& eg d,e "o OA& ,se

do!aine s"ress E:G or Ec$o. Pro-a-ly can ,se adenosine and di!yridaoles"ress E:G>Ec$o "oo.@. Adenosine "$alli,>ses"ai-i scan& Di!yridaole "$alli, !er2,sion>#ia-ili"y

scan -o"$ are c>0 i2 "$e !" $as COPD or as"$a. T$ese are ,sed "o see $y!o!er2,sed

yocardi, d,ring s"ress.16. P$aracological s"ress "es"ing 4and !ro-a-ly radion,clide scan8

are done in "$ose *$o can" e(ercise eg d,e "o OA or '0 or ,ns"a-le angina& and in

"$ose *i"$ a-noral -aseline ECGs li%e LBBB& LH& -aseline ST c$anges& P&

e("ernally !aced $ear"& e"c.11. Aor"ic sclerosis and ES' are noral 2inding in old !a"ien"s.

1). P" *i"$ CH+ is gi#en ACE0 e#en in asy!"oa"ic s"age& ie i2

Ec$o s$o*s lo* E+ B -loc%ers and di,re"ics are added only i2 sy!"oa"ic.0sosor-ide Dini"ra"e i2 e#idence o2 !,l edea. Lo* sodi, die" and di,re"ics i2 !"

$as soe 2l,id re"en"ion.

13. Or"$os"a"ic $y!o"ension eans 2all o2 )6 in sys"olic and 16 in dias"olic

19. era!ail& ,inidine& aiodarone and s!ironolac"one can ca,se

digo(in "o(ici"y& so 2or eg a !" on digo(in coes *i"$ na,sea& #oi"ing& con2,sion

a2"er s"ar"ing #era!ail.


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15. 0n a !" *i"$ $ig$ LDL and TG& "$e 2irs" s"e! is al*ays "arge"ing

LDL *i"$ s"a"in& "$en add 2i-ra"es i2 s"a"in doesn" decrease "$e TG.

C$oles"yraine can increase TG so is con"raindica"ed.1DC'>LH or CAD do Ec$o and S"ress "es".

)=. Long T syndroe& $y!oag& $y!o%al& "$ey ca,se !olyor!$ic

T.)?. P" on *ar2arin *i"$ increased 0NR ,!"o 5 *i"$$old *ar2arin i2

-e"*een 5 and @ gi#e a sall dose o2 #i" % oral& i2 ore "$an )6 only "$en gi#e i#

#i" % or ++P.)@. E("ernal !acea%er eans "e!orary one. 'o-i"/ 00 needs

!eranen" "rans#eno,s !acea%er inser"ion.

36. ',l"i2ocal a"rial "ac$ycardia in COPD& dec : or 'g&aino!$ylline or iso!ro"erenol P *a#e o2 3 or ore or!$ology *i"$ narro*

co!le(es& #aria-le PR and RR al*ays c$ec% !,lse o(ie"ry 2irs" "oo r,le o,"

$y!o(ia correc" ,nderlying ca,se& "$en i2 i" doesn" s,-side gi#e e"o!rolol. 0n

COPD !"s& gi#e #era!ail ins"ead o2 e"o!rolol


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31. HTN crisis can !resen" *i"$ 2las$ !,lonary edea. Adinis"er

or!$ine& o(ygen and lasi(& "$en s"ar" i# ni"roglycerine or ni"ro!r,sside 2or "$e

HTN. Since any $ear" diseases li%e ac,"e 'R or AR can !resen" *i"$ 2las$ PE&

ec#o s$o,ld -e !er2ored. 02 rec,rren" e!isodes o2 2las$ PE and HTN& "$en do

renal d,!le( scan& es! in yo,ng !a"ien"s.

3). A case o2 !os"o! in2erior '0 *i"$ signi2ican" -radycardia 4iesy!"oa"ic& 2or eg ca,sing !,l edea8 s"ar" a"ro!ine 2irs"& and i2 i" is rec,rren"

do "rans#eno,s !acing. Don" do !acing ini"ially as "$e -rady is ,s,ally "ransien".

Don" ,se do!aine or nore!i as "$ey increase cardiac o(ygen deand.T$ro-olysis or $e!arin canno" -e gi#en ,!"o ) *ee%s !os"o!. DONNO ABOUT

PTCA.

33. A+ *i"$ $eodynaic ins"a-ili"y sync$roni/ed cardio#ersion.

Also 2or T. Async$ronised 2or + and Torsades. 0n c$ronic A+ or s"a-le A+& ra"econ"rol *i"$ e"o!rolol or dil"ia/e is !re2erred. Using i# load o2 digo(in "$en

reg,lar digo(in *as "$e idea o2 "$e !as". S"a-le A+ can also -e cardio#er"ed ei"$er

*i"$ de2i-rilla"ion or c$eically *i"$ class 000 dr,gs. Prior an"icoag,la"ion needed

2or cardio#ersion o2 c$ronic A+. Dlta&em is !re2erred as i" $as 2as" OOA and lo*DOA& e(ce!" i2 CH+ or $ear" -loc%& *$ere digo(in is needed. T$e !ro-le *i"$

e#en i# digo(in in ac,"e cases o2 A+ is "$a" i" "a%es $o,rs "o ac".39. ACE0 is "$e DOC in CC+& e#en ore so in elderly *i"$ deen"ia&

in *$o digo(in and s!ironolac"one e"c can ca,se deliri,.

35. Elderly *i"$ ,l"i!le ris% 2ac"ors coing *i"$ an e!isode o2synco!e s$o,ld -e adi""ed 2or con"ino,s ECG oni"oring& "o assess 2or !ossi-le

0CD !laceen" "o !re#en" SCD& as arr$y"$ia is ,s,ally "$e ca,se. Also do cardiac

en/yes "o r,le o," CAD& Ec$o "o see le2" #en"ric,lar 2,nc"ion.

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dr,gs& TCA& $y!o%aleia& sei/,re and s"ro%e.

9). 'e"2orin s$o,ld -e s"o!!ed -e2ore coronary angio or o"$er dye

rela"ed !roced,res "$a" can $ar %idney and ca,se lac"ic acidosis. Also in renal or$e!a"ic 2ail,re& CC2& se!sis and alco$olics.

93. As!irin s$o,ld -e s"o!!ed = d -e2ore os" !roced,res& -,"

needn" -e s"o!!ed 2or coronary angio or ca"$.99. TCA o#erdose is "rea"ed *i"$ sod -icar-. Lidocaine is "$e DOC

2or any #en" ary"$ia "$a" occ,rs. Procainaide& diso!yraide and ,inidine are

e-rane s"a-ili/er& $ence increase TCA "o(ici"y re. Also !!nl is con"raindica"ed&as i" dec cond,c"ion and inc ary"$ogenic !o"en"ial o2 TCA re.

95. P" can res,e se(,al ac"i#i"y < *ee%s a2"er ,nco!lica"ed '0 ie

i2 $e reco#ers *i"$o," any !os" '0 c$es" !ain& CC+ or ary"$ia.

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Cardiac s"ress "es" "o r,le o," 0HD& as i" is "$e os" coon ca,se.

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ins"ead o2 s"ar"ing D:A "rea"en".

13. 0n !a"ien"s *i"$ "$yroid cancer in reission& T9 s,!!leen"a"ion

s$o,ld -e ,sed "o s,!!ress TSH "elow noral range 4ie -e"*een 6.16.38. 02dis"an" e"s& e#en lo*er& "o ,nde"ec"a-le le#els& "$o "$a" increases "$e ris% o2 A+

and -one loss. T3 is only ,sed s$or" "er and ne#er ,sed 2or long "er

anageen" o2 $y!o"$yroidis. Horone s,!!leen" s$o,ld -e "a%en on e!"ys"oac$.

19. 'en"al s"a"e c$ange in elderly al*ays do T+T 2or diagnosing

a!a"$e"ic $y!er"$yroidis.15. A !" on !rednisone 2or RA de#elo!s in2ec"ion and "$en

$y!o"ension ac,"e adrenal ins,22iciency. Adinis"er 2l,id and de(ae"& as i" is

long ac"ing and doesn" in"er2ere *i"$ eas,reen" o2 ser, cor"isols. T$en do

cosyn"ro!in "es". 'ineralocor"icoids aren" ,sed& -eca,se& one "$ey are no"de2icien"& "*o "$ey "a%e a longer "ie "$en ,s" si!ly in2,sing saline.

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o-",nda"ion& and "$e !a"ien" is gi#en readily a-sor-ed car-o a2"er gaining

conscio,sness.

)1. P" on aiodarone can $a#e inc T9 and lo* T3 d,e "o decrease incon#ersion 2ro T9 "o T3. P!nl also does "$a"& -," no" a"enolol. As!irin dis!laces

T9 2ro al-,in& so don" ,se i" as an an"i!yre"ic in "$e "rea"en" o2 "$ryo"o(ic

s"or.)). A+ d,e "o Gra#e disease is "rea"ed li%e any o"$er A+ *i"$ -

-loc%ers and an"icoag,la"ion. So an"i"$yroid dr,g or R0 a-la"ion is no" "$e ans*er.

)3. E22ec" o2 "ig$" glyceic con"rol on icro#asc,lar co!lica"ionsis !ro#ed& -," no" acro#asc,lar. 0" red,ces "$e incidence o2 ne,ro!a"$y& -," "$ere

are con2lic"ing e#idence 2or re#ersing !re#io,s ne,ro!a"$y.

)9. +a$r syndroeI !se,do$y!o!ara"$yroidis& *i"$ Al-rig$"

$eredi"ary os"eodys"ro!$y 4s$or" s"a",re& ro,nd 2acies& s$or" e"acar!als and s$or"nec%8 "$ey $a#e $y!ocalceia *i"$ $y!er!$os!$a"eia& la""er ca,sing -asal

ganglia calci2ica"ion and ca"arac". T$eir PTH is also ele#a"ed. Pa"ien"s *i"$

$y!o!ara *ill $a#e lo* ca& $ig$ !$os!$or,s and also lo* PTH. i" D de2iciency

ca,ses lo* ca and !$os!$or,s -o"$& and inc PTH. Ac,"e $y!er!$os!$a"eia li%e*i"$ r$a-doyolysis& sei/,res& AR+ can ca,se decrease in calci,& -," no -asal

ganglia calci2ica"ion and ca"arac" li%e in c$ronic $y!er!$os!$a"eia.)5. Hy!ercalceia d,e "o sarcoidosis & d,e "o 1a $ydro(ylase

en/ye& #i" D increases& PTH is s,!!ressed& $ence ,rinary calci, is increased.

Trea"en" is gl,cocor"icoid and no" !aidrona"e.)


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3). S,-clinical $y!o"$yroidis "rea" i2 TPO AB !resen"& as "$ey

$a#e $ig$ ra"e o2 con#ersion "o o#er" $y!o"$yroidis. Also "rea" i2 sy!"oa"ic

s,-clinical 4ie inc TSH -," noral T98.33. HTN *i"$ $y!o%aleia do aldos"erone "o renin ra"io "o

di22eren"ia"e $y!o and $y!errenineic $y!eraldos"eronis. 0n Conns syndroe&

"$e ra"io is ;36& *i"$ $ig$ aldos"erone le#el also needed 2or diagnosis& as essen"ialHTN can also s,!!ress renin. Pa"ien"s !resen" *i"$ !oly,ria and !olydi!sia d,e "o

$y!o%aleia ind,ced D0. 02 $y!errenineic& "$en do 'R angio o2 renal ar"eries&

*i"$ 2i-ro,sc,lar dys!lasia gi#ing a -eaded a!!earance& and is "$e os" coonca,se o2 RAS in yo,ng !a"ien"s. S,!!ression o2 -o"$ renin and aldos"erone in a !"

*i"$ $y!o%al and HTN is !ro-a-ly d,e "o a!!aren" ineralocor"icoid e(cess

4A'E8& so o-"ain a ser, cor"isol le#el.

39. P" *i"$ D'& NASH d,e "o $y!erTG& and o-esi"y TOC ise"2orin& as i" ca,ses *" loss&& and $el!2,l in $y!er TG and NASH. Gli"a/ones

are con"raindica"ed as "$ey ca,se *" gain& !ar"ly d,e "o 2l,id re"en"ion& as *ell as

"$ey are $e!a"o"o(ic.

35. S,-ac,"e "$yroidi"is "$yro"o(icosis *i"$ !ain2,l "$yroidenlargeen". T" is NSA0D and -e"a -loc%er& and s"eroid rarely i2 se#ere. Since

!re2ored "$yroid $orones are "$e ca,se o2 "$e !ro-le& an"i"$yroid dr,gs and R0are no" e22ec"i#e. 0"s no" di22ic,l" "o di22eren"ia"e 2ro -ac"erial s,!!,ra"i#e

"$ryoidi"is& as in "$e la""er case& !eo!le aren" ,s,ally "$yro"o(ic as i" in#ol#es "$e

cen"er o2 "$e gland& as *ell as USG *ill s$o* ,l"i!le a-scesses.3


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concoi"an" !$eoc$roo. T$en s"ar" "$e !" on al!$a -loc%ade 2or a 2e* *ee%s

-e2ore s,rgery "$en -e"a -loc%ade only a2"er al!$a -loc%ade 4else "$ere *ill -e

#asoo"or crisis8& "$en do s,rgery "o"al "$yroidec"oy *i"$ cen"ral nec%dissec"ion.

91. D' *i"$ a,"onoic dys2,nc"ion& gas"ro!aresis i"s di22ic,l" "o

ad,s" ins,lin -eca,se d,e "o delayed gas"ric e!"ying& !" *ill -e $y!oglyceic ,s" a2"er eal. Pl,s !ro-les o2 !os"!randial -loa"ing and cons"i!a"ion. Trea"en"

is e"oclo!raide& or cisa!ride or ery"$roycin& and sall 2re,en"& lo* 2a"

eals. Cisa!ride is es!ecially s$o*n "o -e -ene2icial& "$o i" is no" 2reely a#aila-led,e "o incidence o2 T !rolonga"ion and Torsades. Las" resor" is 2eeding

e,nos"oy. 'e"oclo!raide can" -e ,sed 2or long d,e "o side e22ec"s and

"ac$y!$yla(is& so cisa!ride is "$e TOC re. Hig$ 2i-er die" *ill increase "$e

cons"i!a"ion.9). Oc"reo"ide can -e gi#en in in"rac"a-le diarr$ea in D'

gas"ro!aresis !a"ien".

93. D' ne,ro!a"$y ai"ry!"iline is "$e DOC& -," since os"

!a"ien"s $a#e $ear" disease also& -e*are ,se ga-a!en"in ins"ead.99. Erec"ile dys2,nc"ion *i"$ noral orning erec"ion i"s

!syc$ological i!o"ence. Erec"ile dys2,nc"ion is ne#er a noral !ar" o2 aging& sodon" "ic% "$a".

95. P" o2 $y!o!ara"$yroidis T" is $ig$ dose o2 #i" D4 calci2erol8

and calci, $ig$ dose -eca,se con#ersion "o calci!o"riol is de2ec"i#e. e don",se calci!o"riol as i" is e(!ensi#e. Calci!o"riol $as a ra!id OOA& and can -e ,sed in

$y!ercalceic crisis& or i2 !" is re2rac"ory "o calci2erol. P"s "$,s "rea"ed *i"$ #i" D

and Ca 2or $y!oPTH ,s,ally de#elo! $ig$ ,rinary e(cre"ion o2 Ca& d,e "o lac% o2

PTH& *$ic$ can lead "o ne!$rocalcinosis. So adding TH0AF0DE no" only $el!sred,ce ,rinary calci,& -," also increases "$e ser, calci, e22ec"i#ely.

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D' 0.

56.

A !a"ien" *i"$ ,n%no*n goi"er ,ndergoes cardiac ca"$& "$en de#elo!s

"$yro"o(icosis i"s iodine ind,ced "$yro"o(icosis. Trea"en" is - -loc%er& or

An"i"$yroid dr,gs or :CLO9& -," RA0U doesn" $el!& as "$e iodine ,!"a%e isred,ced in "$e gland.

51.

P" *i"$ inc TSH 2ollo*ing say& !ne,onia& *i"$ noral T9 -," dec T3& i"s

no" s,-clinical $y!o"$yroidis& i"s EUTHYRO0D S0C: SYNDRO'E 4lo* T3

syndroe8. J,s" 2ollo*,! *i"$ T+T in a 2e* *ee%s. No "rea"en" needed& and no

in#es"iga"ions 2or an"i-odies "oo.5).

T score in DEA is calc,la"ed in co!arison "o $eal"$y ad,l" o2 age )5&

*$ile F score is calc,la"ed in co!arison *i"$ siilar aged ad,l"s. HO classi2iesT -e"*een 1 "o ).5 as os"eo!enia& and -elo* "$a" as os"eo!orosis. 0n a !" *i"$

os"eo!orosis& do CBC>Ca and PO9 le#els 2or secondary ca,ses can do ,rinarycalci,& SPEP& PTH& TSH& N "elo!e!"ide 2or -one resor!"ion and AlP 2or -one

2ora"ion. P"s *i"$ T score )& *i"$ lo* *"& so%ing !a"ien"& or *i"$ 2ragili"y

2ac",res irres!ec"i#e o2 T score& need an"iresor!"i#e "$era!y *i"$ alendrona"e orrisedrona"e& in addi"ion "o #i" D and Ca. E"idrona"e is old and no" ,sed&

Paidrona"e i# is ,sed i2 !" canno" "olera"e oral alendrona"e d,e "o eso!$agi"is.

Calci"onin is no" #ery e22ec"i#e& "eri!ara"ide 4PTH8 is #ery e22ec"i#e -," needs daily

inec"ion and is e(!ensi#e. HRT $as 2allen o," o2 2a#or since )66) d,e "o re!or" o2inc '0& DT& S"ro%e& and -reas" cancer. P" *$o doesn" res!ond *i"$

-i!$os!$ona"es& $as cons"i","ional sy!"os and !allor s$o,ld -e s"rongly

s,s!ec"ed "o $a#e yeloa. 'yeloa cells release OA+4 os"eoclas" ac"i#a"ing2ac"or8.

53.

'edical "$era!y is "$e TOC in !rolac"inoa e#en i2 large and $as e22ec" on

#ision.

59.

P" *i"$ Addisons disease de#elo!s dia-e"es 0 i"s a,"oi,ne !olygland,lar

2ail,re "y!e 00 4Sc$id"s syndroe8& *$ic$ also $as Gra#es& !ernicio,s aneia&

!rea",re o#arian 2ail,re& #i"iligo and celiac disease.55.

Pos"!ar", !a"ien" on $e!arin 2or DT coes *i"$ os"eo!orosis Mdiscon"in,ing -reas"2eeding can $el! re& increasing dose o2 #i" D and Ca isno" as

,c$ $el!2,l.

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Old ale coes *i"$ $i! !ain R s$o*s "$ic% o,"er cor"e( *i"$ sclerosis&

and T scan s$o*s increased ,!"a%e i"s Page"s disease. Bi!$os!$ona"es are

indica"ed i2 in"olera-le !ain& in#ol#e *" -earing -ones& $y!ercalceia& or CC+.Calci"onin and s"eroids are no" ,se2,l.

HAE'>ONC1. P" o2 NHL coes *i"$ e!id,ral s!inal cord co!ression4 radic,lar

!ain8 gi#e $ig$ dose s"eroid& o-"ain an 'R0 "o con2ir diagnosis& "$en s"ar"

RT. 02 only -ac% !ain d,e "o #er"e-ral e"s& only RT. 02 saddle anes"$esia or -o*el -ladder in#ol#een"& iedia"e deco!ressi#e s,rgery.

). Pa"ien" coes *i"$ e"as"a"ic ER>PR cancer *i"$ occ,l" !riary

in -reas" no need 2or ,l"i!le core -io!sy o2 -reas" or R' only do c$eo and

$oronal "$era!y. Tao(i2en is !re2erred& *i"$ 2,l#es"ran" in "$ose no"res!onding "o "ao(i2en. Tras",/,a- 4HERce!"in8 in Her ones.

3. P" *i"$ A'L ge"s ,l"i!le !la"ele" "rans2,sion& s"ill "$e !la"ele"

co,n" doesn" increase i"s called !la"ele" re2rac"oriness& d,e "o

alloi,nisa"ion 42ora"ion o2 an"i!la"ele" an"i-odies8. 02 ini"ial increase in !la"ele" and "$en decrease *i"$in )9 $rs& "$in% D0C or se!sis or ac"i#e -leeding

or an"i!la"ele" dr,gs.9. P" *i"$ l,ng ",or *i"$ +E1 and con"ri-,"ion o2 eac$ l,ng gi#en

"$e -es" ne(" "$ing "o do is s"ill "o do CT s"aging. PET> -one scan can -e ,sed

"oo. CT is -es" as i" gi#es edias"inal and c$es" *all in#asion& e"s "o adrenaland li#er& and can also $el! in CT g,ided -io!sy.

5. SCOI dys!nea& !ersis"en" co,g$& $oarseness& dys!$agia& synco!e&

c$es" and nec% !ain& cyanosis& colla"eral #eins in "$ora(& oc,lar !ro!"osis&

ling,al edea -es" "$ing is CT *i"$ con"ras". 'R0 only i2 dye can" -e ,sed., *i"$ PSA. 02 rising PSA or i2s%ele"al co!lain"s& do -one scan.

@. P"s on "ao(i2en s$o,ld -e screened 2or endoe"rial $y!er!lasia

*i"$ ann,al Pa! and de"ailed $is"ory. TS $as a lo" o2 2alse #e leading "o,nnecessary endo -io!sy& so no" recoended.

16. Pl" "rans2,sion are ,seless in 0TP& as "$ey *ill also -e ra!idly

des"royed. Only ,se in li2e "$rea"ening eergencies as in"racere-ral and

assi#e G0 $eorr$age. S"eroid are "$e TOC in os" cases& *i"$ 00G in


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se#ere cases 4 00G is no" "$e 2irs" ans*er8. Plasa!$eresis is 2or HUS and

TTP.

11. Alco$ol and colon cancer are s"rongly lin%ed "$an reo"e so%ing$is"ory& so -e*are i2 "$e !" is so%ing c,rren"ly. NSA0D and $orone

re!laceen" are !ro"ec"i#e. Alco$ol !ro-a-ly ca,ses "$e ris% -y in"er2ering

*i"$ 2ola"e a-sor!"ion.1). Aong in$eri"ed "$ro-o!$ilia& 2ac"or leiden is "$e os" coon&

don" "ic% an"i!$os!$oli!id syndroe& "$a" is no" in$eri"ed. 'e"$yl

"e"ra$ydro2ola"e red,c"ase gene ,"a"ion is rela"ed "o $oocys"ineia& and isano"$er ris% 2ac"or. Any !a"ien" *i"$ in$eri"ed "$ro-o!$ilia and s!on"aneo,s

"$ro-osis s$o,ld -e on li2elong *ar2arin. Also "$ose *i"$ li2e "$rea"ening

TE li%e assi#e PE& or ,n,s,al si"e li%e esen"eric or cere-ral #eno,s

"$ro-osis s$o,ld also -e on li2elong *ar2arin.13. Priary #s secondary !olycy"$eia BC and !la"ele" co,n" *ill

also increase in "$e 2orer. 02 secondary ca,se is s,s!ec"ed& eg in a !" *i"$

COPD& 2irs" "es" is !,lse o(ie"ry a2"er inial e(er"ion& and slee! s",dy "o

de"erine noc",rnal desa",ra"ion.19. P" *i"$ RA $as !ne,onia and 2o,nd "o $a#e aneia 2erri"in is $ig$

4 can -e d,e "o -o"$ in2ec"ion or d,e "o ACD8& "rans2erring and T0BC are lo*4can -e d,e "o -o"$ 0DA and ACD8. 0n "$ese !a"ien"s& do B' -io!sy "o

di22eren"ia"e ACD and 0DA.

15. P"s re,iring 2re,en" "rans2,sion ig$" de#elo! an"i-odies "o RH&:elly and o"$er an"igens& ca,sing ac,"e "rans2,sion reac"ion. R( is $ydra"ion&

s"o!!ing "rans2,sion. Do!aine and oso"ic di,resis can -e ,sed.

1


13/67

"rea"en" is ERCP and s"en"ing 2or "$e !r,ri",s and a,ndice. PTC only i2

ERCP 2ails. Ursodeo(yc$olic acid doesn" $el! as i" doesn" relie#e "$e

o-s"r,c"ion.)3. P" coes *i"$ diarr$ea& sclero"ic -one lesions& eosino!$ilia and

!e!"ic ,lcer Sys"eic as"ocy"osis.

)9. Lo-,lar C0S o2 -reas" i" is ,l"icen"ric and -ila"eral& so "$e -es""rea"en" is close o-ser#a"ion& ann,al aogra and "ao(i2en *$ic$ $as

s$o*n dec ris% o2 !rogression "o o#er" carcinoa. S,rgery& 02 a" all& $as "o -e

-ila"eral !ro!$ylac"ic as"ec"oy. Local e(cision is ,seless.)5. P" *i"$ ACD lo* iron& $ig$ 2erri"in& noral or lo* "rans2erring and

"rans2errin sa",ra"ion. B' is diagnos"ic& and s$o*s noral or increased iron in

acro!$ages& and decreased no o2 sidero-las"s. Do EPO le#el& i2 i" is lo*& EPO

is "$e "rea"en". 02 EPO is already $ig$& "$en !eriodic -lood "rans2,sion is "$e"rea"en". Pl,s "rea"en" o2 "$e ,nderlying disease *i"$ close 2>, ig$" -e "$e

rig$" ans*er.

)


14/67

). TPNI a#erage need is 36:cal>d and !ro"ein 1g.%g.d& -," in

alno,ris$ed or cri"ically ill !a"ien"s& i"s 3596 and 1.5 res!ec"i#ely.

O#er2eeding leads "o $y!erglyceia& $y!erins,lineia& inc TN+. PEG4!erc," gas"ros"oy8 s$o,ld -e considered i2 !"s need TPN 2or a long "ie.

3. LG0BI ,rgen" colonosco!y is "$e !roced,re o2 c$oice d,e "o diagnos"ic

and "$era!e,"ic ad#an"age. 0+ "$ere is !oor #is,ali/a"ion d,e "o -leeding&"$en do T "agged RBC scan& *$ic$ is -e""er "$an angio "o locali/e "$e

si"e. aso!ressin is in2erior as -leeding rec,rs a2"er s"o!!ing& and i" can

ca,se isc$eic daage "o organs and ary"$ia. Oc"reo"ide *or%s only in#ariceal -leeding. Urgen" colec"oy ig$" -e needed& -," only a2"er

locali/a"ion o2 "$e si"e o2 -leeding.

9. C$ronic !ancrea"i"isI lo* 2a" die" is "$e os" e22ec"i#e e"$od "o s"o!

s"ea"orr$ea& *$ile en/ye s,!!leen" is in2erior.5. 'allory eiss "ear "$a" $as s"o!!ed -leeding needs no in"er#en"ion.

Hia"al $ernia is a #ery 2re,en" !redis!osing 2ac"or 2or "$e "ear& and can

occ,r d,ring -l,n" a-d "ra,a& CPR and endosco!y "oo.

s isdone.

@. Ac,"e He!B needs only s,!!or"i#e "rea"en"& as os" resol#e on "$eir

o*n. Only c$ronic ac"i#e $e!a"i"is needs lai#,dine and ade2o#ir.

Con#ersion "o c$ronic s"age de!ends on age @67 i2 !erina"al& )6567 i2 -elo* 5 and 57 i2 ad,l". 0n"eres"ingly& i2 PT reains noral d,ring "$e

ac,"e in2ec"ion& "$en "$e in2ec"ion *ill li%ely resol#e *i"$ no se,elae.

16. 0sola"ed gas"ric #arices *i"$o," eso!$ageal #arices in a !"*i"$ c$ronic !ancrea"i"is is d,e "o s!lenic #eno,s "$ro-osis. 0" ay also

!resen" *i"$ noncirr$o"ic !or"al HTN& asci"es& assi#e s!lenoegaly and

$y!ers!lenis. Por"al #ein "$ro-osis is siilar& -," *ill $a#e eso!$ageal#arices also.

11. He!a"ic #enoccl,si#e disease is d,e "o occl,sion o2

"erinal $e!a"ic #en,les and ca,ses !os"sin,soidal !or"al HTN& *i"$

$y!a"oegaly& a,ndice and asci"es. T$is is siilar "o B,dd C$iari& -," in


15/67

"$e la""er "$ere is "$ro-osis o2 aor $e!a"ic #eins.

1). Pse,doe-rano,s en"erocoli"is s,s!ec"I ra!id

i,noassay 2or C di22icile "o(in is #ery !o!,lar& -," i"s sensi"i#i"y is lo*&so "$a" i2 one is nega"i#e& re!ea" i" i2 "$e !re"es" !ro-a-ili"y o2 in2ec"ion is

$ig$. S"ool cy"o"o(in "es" and s"ool c,l",re are o,"da"ed. C,l",re is ,seless

also -eca,se any non"o(igenic s"rains o2 C Di22icile e(is". T" is e"ro. 0+rela!se& again e"ro& co/ rela!se is d,e "o inade,a"e "rea"en" ore "$an

resis"ance. anco i2 ore "$an one rela!se.

13. +e-rile "rans2,sion reac"ion can -e !re#en"ed -y *as$ing"$e cells& ,sing le,%ocy"e de!le"ion 2il"er& and !re2erring !ac%ed RBC "o

*$ole -lood.

19. +irs" "es" in c$ronic diarr$ea is s"ool e(aina"ion 2or

le,cocy"es& !arasi"es& -lood& 2a"& !$& oso"ic ga!.15. D,odenal endosco!ic -io!sy is needed 2or diagnosing

celiac disease& s$o*ing #ill,s -l,n"ing and increased ly!$ocy"ic in2il"ra"e

in "$e ,cosa. A#oid *$ea"& rye and -arley. Can "a%e soya-ean& rice and

corn and !o"a"oes. Pl,s ig$" need "o s,!!leen" iron& 2ola"e and calci,.1


16/67

irre#ersi-le. 0" is -e""er "$an NGT as i" doesn" in"er2ere *i"$ -rea"$ing and

s!eec$& and i" doesn" ca,se sin,si"is "$o ris% o2 as!ira"ion is "$e sae *i"$

-o"$.)9. Pro"ease in$i-i"ors can -e ,sed "o !re#en" ERCP ind,ced

!ancrea"i"is.

)5. C$ild P,g$ cri"eriaIi. Al-,in ).5& ).53.5 and ;3.5 score 1& ) or 3 accordinglyii. Bilir,-in )& )3 and ;3iii. Asci"es None ild and odera"ei#. Delayed PT 15 sec& 151= and ;1= sec#. Ence!$alo!a"$y& none& s"age 1)& or s"age 39

i. Li#er "rans!lan" i2 score is ;=& ie class B or C in c$ild !,g$ classi2ica"ion. Class A is

=

RESP0RATORY

1. Large cell ca o2 l,ng !eri!$eral ass SCC ca#i"ary ass inside

-ronc$,s). S0ADH "rea"en" is *a"er res"ric"ion& *i"$ or *i"$o," sal"

adinis"ra"ion. Di,re"ics can -e ,sed -," *a"c$ 2or $y!ona"reia s$o,ld,s,ally -e gi#en only *i"$ $y!er"onic saline or sal" "a-le"s. 02 "$ese 2ail& "$en

deeclocycline& *$ic$ is !re2erred "o li"$i, d,e "o less side e22ec"& "$o i" is

ne!$ro"o(ic.3. ARDS diagnosis cri"eriaI PCP 1?& PaO)I+iO) )66& and

-ila"eral in2il"ra"es& *i"$ clear l,ng 2ields on e(a re. Trea"en" is ec$anical

#en"ila"ion *i"$ $ig$ 2lo* o(ygen& lo* "idal #ol,e %g and lo* !la"ea,

!ress,re36 *i"$ PEEP o2 516 45 is !$ysiologic !ee!& so s$o,ld -e ore "$an5 $ere8. Lo* "idal #ol,e lii"s "$e -aro"ra,as. S"eroid are no" e22ec"i#e in

ac,"e !$ase& -," ,se2,l in red,cing 2i-ro!roli2era"i#e !$ase o2 ARDS. NO and

!ros"acyclins are no" ,c$ $el!2,l. S$o,ld -e *eaned as soon as !ossi-le "o !re#en" o(ygen "o(ici"y and a"elec"asis. Decrease +iO) grad,ally "o %ee! SaO)

a" @6 and PaO) a-o#e


17/67

?. ar2arin is gi#en 2or 3< o 2or PE "$a" occ,rred in "$e se""ing o2

re#ersi-le ris% 2ac"ors& li%e OCP or io-ili/a"ion < o a"leas" i2 idio!a"$ic&

a"leas" 1) o i2alignancy or an"icardioli!in syndroe inde2ini"ely i2rec,rren" or con"in,ing ris% 2ac"or li%e an"i"$ro-in de2iciency.

@. is "$e 2irs" in#es"iga"ion in s,s!ec"ed PE es! i2 !re"es"

!ro-a-ili"y is $ig$ li%e in io-ili/ed& cancer !a"ien"s& OCP& e"c i2 i" isnega"i#e and s,s!icion is $ig$& "$en do lo*er li- D,!le( "o calc,la"e "$e

!re"es" !ro-a-ili"y o2 PE -e2ore ,!ing "o CT angiogra. P,l angiogra is

"$e gold s"andard& -," no" done ,s,ally. D dier $as $ig$ nega"i#e !redic"i#e#al,e& so soe say i" s$o,ld -e done 2irs" o2 all.

16. OSASI 2irs" r,le o," $y!o"$yroidis& es! i2 "$ere are s,gges"i#e

sy!"os in a !a"ien"& "$en re2er 2or slee! s",dy 4!olysonogra!$y8. 'R0 and

naso!$aryngosco!y -e2ore ,#,lo!ala"o!las"y.11. Sarcoidosis $y!ergaaglo-,lineia& de!ressed CD9I CD? ra"io ie

de!ressed cell edia"ed i,ni"y and ac"i#a"ed $,oral i,ni"y& and

c,"aneo,s anergy is coon. BAL $o*e#er s$o*s $ig$ CD9. Hy!ercalci,ria

is ,c$ ore 2re,en" sign "$en $y!ercalceia& and can ca,sene!$rocalcinosis and CR+

1). edge s$a!ed in2arc"s seen in s,-segen"al PE are seen asHa!"ons $,! in R.

13. Peri!$eral l,ng nod,le ris% o2 alignancy is $ig$ i2 ;3 c& irreg,lar

or s!ec,la"ed -order& re"ic,la"e& !,nc"a"e or eccen"ric calci2ica"ion 4#s reg,lar&concen"ric& laina"ed& cen"ral& di22,se $oogeno,s or !o!corn calci2ica"ion o2

!,l $aar"oa8. Do,-ling "ie o2 -enign lesion is ei"$er less "$an )6 days in

ac,"e condi"ions& or ore "$an 956 days& any"$ing in -e"*een is alignancy& so

c$ec%ing 2or !re#io,s R is al*ays "$e 2irs" s"e!. 02 no earlier R a#aila-le&and c,rren" R is inconcl,si#e& HRCT $as "o -e done& *$ic$ can s$o* "$e

or!$ology and "$e edias"inal node in#ol#een". 02 $ig$ s,s!icion 2or

alignancy a2"er "$is& "$en ATS and e(cisional -io!sy is "$e TOC 2or !eri!$eral nod,le. +NAC is less sensi"i#e& *$ile PET scan $as $ig$ sensi"i#i"y

-," lo* s!eci2ici"y.

19. T$in% carcinoid i2 nonso%ing !a"ien" coes *i"$ rec,rren" !os"o-s"r,c"i#e !ne,onia. +i-ero!"ic endosco!y *i"$ la#age and >or -io!sy is

"$e ne(" -es" s"e!. S!,", cy"ology is #ery insensi"i#e. O"$er ca,ses o2

nonresol#ing !ne,onia are CEP4 c$ronic eosino!$ilic !ne,onia8& al#eolar

!ro"einosis& -ronc$ioli"is o-li"erans organi/ing !ne,onia 4BOOP8.15. 'agsol is no ore recoended 2or as"$a.

1


18/67

+irs" "$in%g "o do is s%in !ric% "es" as i" $as $ig$ NP. 02 i" is !osi"i#e& eas,re

"o"al 0gE and an"i-odies "o As!ergill,s. HRCT is las" "o de"ec" -ronc$iec"asis.

S"eroid is "$e TOC "o !re#en" -ronc$iec"asis and l,ng 2i-rosis.1@. LTOTI PaO)55 on roo air& or SaO)??. Or i2 PaO)


19/67

1. Ra-ies can -e "ransi""ed -y aerosols 2ro -a"s in ca#es. 0" is

,ni#ersally 2a"al once !a"ien"s are sy!"oa"ic.

). H0 !ro!$yla(is indica"ed 2or e(!os,re "o geni"al 2l,ids and -lood& -,"no" ,rine& s*ea"& s!,",& "ears or sali#a.

3. TSS "rea"en" is $ea#y 2l,id loading& *i"$ clindaycin *i"$ or

*i"$o," na2cillin "o !re#en" rec,rrence o2 TSS9. H,an -i"e S"re!& S"a!$& Ei%enella corrodens4 ain one& GNB8&

$eo!$il,s& -ac"eroides& !e!"os"re!"ococc,s& ac"inoyces and

2,so-ac"eri,. Trea"en" is a!icillins,l-ac"a a2"er cleaning"$oro,g$ly. Pas"e,rella ,l"ocida in ca"s and dogs -i"es.

5. Elderly in n,rsing $oe !resen"s *i"$ !ne,onia& and R s$o*s rig$"

lo*er lo-e 2l,22y in2il"ra"e& i"s !ro-a-ly as!ira"ion !ne,onia.


20/67

19. Gl,cosaine ,sed 2or OA can ca,se !ro-le *i"$

gl,cose con"rol in dia-e"ics.

PREENT0E 'ED0C0NE1. Person e(!osed "o ac"i#e TB s$o,ld iedia"ely ge" -aseline PPD&

"$en re!ea" PPD a" 3 *% 3 o "o see con#ersion. 02 con#ersion occ,rs& "$en

CR i2 CR nega"i#e& ono"$era!y *i"$ 0NH !ro!$yla(is& and i2 CR is !osi"i#e& "$en DOTS.

). Close con"ac" o2 eningococcal !a"ien"s s$o,ld recei#e ri2a!in "o

eradica"e !$aryngeal carriage& 2or eg *oan *or%ing in a n,rsery. B," i2 s$ecan "a%e ri2a!in co/ s$e is on OCP& "$en a single dose o2 ci!ro is s,22icien".

Heal"$ care *or%er e(!osed "o s,c$ cases& $o*e#er& don" need i".

3. +as"ing gl,cose "o screen 2or D' is ad#ised in e#eryone a2"er 95

yrs& 3 yrly& or yrly i2 ris% 2ac"ors li%e 2>$& e"a-olic syndroe& A2rican orHis!anic or PCOD is !resen"& or i2 $>o 0GTT or ges"a"ional D'.

9. To"al c$oles"erol ;)66& 2irs" s"e! is "o order a co!le"e li!id !ro2ile&

*$ic$ *ill gi#e HDL and TG. Calc,la"e LDL -y TC4HDLTG>58. Priary

goal is al*ays "rea"ing LDL& so ,se a"or e#en i2 TG is ,c$ $ig$er "$an LDL.Only i2 "$e s"a"in can" con"rol TG *i"$ LDL& "$en add 2i-ra"es. 0n a !" on HRT

and $ig$ TG& $o*e#er& "$e 2irs" s"e! is s"o!!ing "$e HRT.5. 0n2l,en/a #accine a-o#e 56 yrs 4$ o2 ) or

ore 2irs" degree rela"i#es8. Re!ea" ann,ally.

16. +API ideal is "o"al colec"oy -e2ore "$e age o2 )6 yrs.11. So%ing cessa"ion $as 2ar -e""er e22ec" on !re#en"ing os"eo!orosis

"$an e(ercise or dec alco$ol. HRT is no" !re2erred "$ese days d,e "o ris% o2

-reas" and endo cancer and cardio#asc,lar diseases.1). ellness e(aina"ions s$o,ld co,nsel a-o," sa2e se(& #accines&

i!or"ance o2 screening& sea"-el"& e(ercise& *" loss& alco$ol& so%ing and

dr,gs. C$laydia screening in all *oen -elo* )5 *$o are se(,ally ac"i#e& or

a-o#e )5 *i"$ ,l"i!le or ne* se(,al !ar"ner& or !regnan" -elo* )5 yrs.


21/67

Gonorea is #ery ,ncoon "$ese days& so no need o2 screening.

13. Colonosco!y is !re2erred "o +OBT& and s$o,ld -e s"ar"ed a" age 56&

96 i2 2>$ o2 colon cancer& )5 i2 lync$ syndroe and 15 i2 +AP. 4no" s,re.8 re!ea"16 yrly& or 5 yrly i2 sigoidosco!y.

19. Sel2 -reas" e(a $as no -ene2i"& clinical -reas" e(a alone also $as

no -ene2i"& -," s$o,ld -e co-ined *i"$ aogra& a2"er 96 yrs o2 age& "ill=6 yrs. A2"er "$a" "$e !ro-a-ili"y o2 dying 2ro o"$er ca,ses is $ig$er. Re!ea"

1) yrly. Breas" l,! a2"er "$e age o2 35 s$o,ld -e e#al,a"ed *i"$

aogra!$y.15. P"s *i"$ an"i"ry!sin de2iciency s$o,ld -e 2>, 3 on"$ly *i"$

s!iroe"ry. En/ye re!laceen" "$era!y only i2 radiological e#idence o2

!anacinar e!$ysea or i2 "$e !a"ien" is sy!"oa"ic.

1


22/67

ser#ices can !ro$i-i" $er 2ro re",rning $oe alone.

=. 02 a coe"en" ad,l" *oan says "$a" $er $,s-and *ill sign "$e

consen" "o any s,rgery 2or e(a!le& le" i" -e s$e $as a rig$" "o c$oose $ers,rroga"e. 'eans s,rroga"e are no" only 2or end o2 li2e decisions.

?. PT *$o is diagnosed *i"$ li2e "$rea"ening diseases li%e H,n"ing"on

and Tay Sac$s re2,ses "o "ell $is 2aily& !,""ing o"$er 2aily e-ers andsi-lings a" eo!ardy yo, needn" in2or "$e 2aily& -," a%e "$e !a"ien" sign

"$e re2,sal doc,en".

@. 02 ,l"i!le 2irs" degree rela"i#es disagree on "$e "rea"en" o2 an,nconscio,s !a"ien"& go "o $os!i"al e"$ics -oard& and "$en i2 necessary "o co,r".

16. A s!ecialis" is 2ed ,! *i"$ "$e dr,g see%ing !a"ien" *$o sla!s n,rses

and *an"s "o lea#e $i $e can" do "$a" *i"$o," !rior no"ice and arrangeen" "o

"rans2er $i "o ano"$er s!ecialis". No-ody can lea#e a !a"ien"& $o*e#erdi22ic,l"& in "$e iddle o2 a "rea"en".

11. A de$ydra"ed de!ressed elderly is !ro-a-ly a-,sed 2irs" "$ing "o do

is adi" "o dis"ance 2ro "$e a-,ser and "o re$ydra"e& "$en in2or "$e ad,l"

!ro"ec"ion ser#ices.1). Braindea"$ a-sence o2 res!ira"ory dri#e o22 #en"ila"or 2or a d,ra"ion

"$a" is s,22icien" "o !rod,ce $y!ercar-ic dri#e 4PCO) o2 56


23/67

res!onsi#e& do deco!ression *i"$ ERCP.

9. 'A !" a2"er in",-a"ion doesn" $a#e sa"is2ac"ory o(ygen sa",ra"ion& and on

e(aina"ion $as $y!o#en"ila"ion on one side o2 "$e c$es". T$e 2irs" diagnosiss$o,ld -e -ronc$,s in",-a"ion. So "ry "o c$ec% "$e ETT !laceen"& and *i"$dra* i"

a 2e* c. 02 "$a" doesn" $el! "$e o(ygen sa",ra"ion& "$en "$in% a-o,"

!ne,o"$ora(& and do a needle deco!ression.5. P" *i"$ ac,"e colonic isc$eia are no" d,e "o e-olis li%e esen"ric

isc$eia& -," d,e "o $y!o"ensi#e s"a"e. 0T !resen"s *i"$ la"eralised a-doinal !ain

4!eri,-ilical !ain in esen"ric isc$eia8& and *i"$ $ea"oc$e/ia.


24/67

and leg !aralysis and anes"$esia $e $as e!id,ral a-scess. +irs" s"e! is 'R0 *i"$

gadolini, con"ras". CT yelogra!$y is an al"erna"i#e. An"i-io"ic s$o,ld -e

s"ar"ed& g,ided -y CT as!ira"ion or -io!sy c,l",re. 0edia"e s,rgical e(!lora"ionis needed.

1?. Pne,a"ic co!ression alone is no" s,22icien" in $ig$ ris%

!a"ien"s "o decrease ris% o2 DT& -eca,se "$ey can s"ill $a#e !el#ic #ein DT.1@. 5 renal s"ones !ass s!on"aneo,sly. Reo#al is anda"ed i2

sall -," ca,sing !ersis"en" !ain e#en a2"er analgesics& or i2 ,rose!sis or renal

2ail,re. ESL is !re2erred 2or sall !ro(ial ,re"eric calc,li& *$ile ,re"erosco!y*i"$ laser li"$o"ri!sy 2or large ;1c !ro(ial s"ones.

)6. Pos" co,nica"ing ar"ery ane,rys di!lo!ia& !"osis and

anisocoria. P0CA ane,rys a"a(ia and -,l-ar dys2,nc"ion.

)1. Sca!$oid 2rac",re on !resen"a"ion 2irs" "$ing "o do is no" cas"ing& -," CT or -one scan "o r,le o," 2rac",re. 02 2rac",re is really !resen"& "$en "$,-

s!ica cas" *i"$ *ris" in slig$" radial de#ia"ion and ne,"ral 2le(ion. 'os" coon

co!lica"ion is non,nion and no" AN.

)). Sis"er canno" -e considered legal g,ardian o2 a c$ild so ineergency i2 !aren"s are no" aro,nd& *e s$o,ld "rea" "$e c$ild any*ay& and *e

don" "a%e "$e sis"ers consen".)3. Elderly *i"$ BPH coes *i"$ !ro"r,ding rec"al ,cosa *i"$

-l,is$ discolora"ion and 2rai-ili"y i"s rec"al !rola-!se *i"$ s"rang,la"ion and

gangrene iedia"e s,rgery 4rec"osigoidec"oy8 is needed. 02 no" s"rang,la"ed&can "ry digi"al re!osi"ion ,nder seda"ion& or a!!lica"ion o2 gran,la"ed s,crose "o

decrease "$e edea.

)9. Re2le( sy!a"$e"ic Dys"ro!$y& a%a Co!le( Regional !ain

syndroe 4CRPS8 io-ilisa"ion a2"er s!rain or 2rac",re& ca,sing allodynia&$y!eralgesia& soe edea& c$anges in s%in -lood 2lo* and s,doo"or ac"i#i"y

4s*ea"in8& la"er leading "o a"ro!$yo2 "iss,es. T$is is d,e "o S'P 4sy!a"$e"ically

edia"ed !ain8& ca,sing #asocons"ric"ion and isc$eia. Early "rea"een" *i"$ a -loc%ers li%e !$eno(y-en/aine& c$eical or s,rgical sy!a"$ec"oy *i"$in 3

on"$s and early !$ysio"$era!y $el!s "o red,ce i"s incidence.

)5. Plica syndroe cre!i",s& sna!!ing and e22,sion rela"ed "o !roinen" edial !lica o2 syno#i, *$ic$ ge"s "ra!!ed in "$e %nee oin"&

!resen"ing li%e "orn edial enisc,s or al"rac%ing !a"ella.

)


25/67

ca!s,le can rarely lead "o a 2alse !osi"i#e res,l". 0" doesn" o-sc,re aogra or

decrease i"s sensi"i#i"y.

36. ',l"inod,lar "$yroid in a !a"ien" *i"$ s$or" nec% can -ere"ros"ernal and ca,se sy!"os o2 dys!$agia "rea"een" is s,rgery. 0odine or

"$yro(ine don" $el!& as "$ere is already considera-le 2i-rosis in "$e gland. RA0U

and An"i"$yroid dr,gs can in2ac" ca,se ini"ial enlargeen" o2 "$e gland& so arecon"raindica"ed.

31. Undescended "es"is& or #aricocele can ca,se in2er"ili"y d,e "o "$e

e22ec" o2 "e!era",re on "$e s!era"o/oa& -," no" $y!ogonadis as "$e Leydigcells are no" a22ec"ed.

3). P" *i"$ -ila"eral or rig$" sided #aricocele& or #aricocele "$a"

doesn" disa!!ear in "$e s,!ine !osi"ion& s$o,ld -e in#es"iga"ed 2or clo" or ",or

o-s"r,c"ing "$e in2erior #enaca#a. aricoceles are coon in "$e le2" side d,e "o"$e drainage o2 #eins.

33. 'arc$ 2rac",reI R can -e ,nrear%a-le 2or )9 *%s& so do -one

scan or 'R0

39. P" s$o*ing ,l"iloc,la"ed cys" in !ancreas on C" no need "o doCEA and CA 1@@& as "$ey are #ery nons!eci2ic. Direc"ly send "$e !a"ien" "o

s,rgery.35. Baroe"ric s,rgery i2 B'0 ;96& i2 decreased ,ali"y o2 li2e& eg

OA and se(,al dys2,nc"ion& OSAS& o#een" lii"a"ion or -ri""le dia-e"es.

Bene2i"s o2 gas"ric -y!ass or gas"ric -anding incl,de -e""er D' con"rol& -e""er li!idle#els& slee! i!ro#een"& de!ression decline& e"c.

3


26/67

desoid ",or. E(cision *i"$ a *ide argin o2 resec"ion is "$e TOC.

93. ESL 2or galls"one i2 only 3 or less s"ones& ,rsodeo(yc$olic acid

i2 sall s"ones *i"$ 2,nc"ioning gall -ladder& elec"ro$ydra,lic li"$o"ri!sy is #eryc,-ersoe& and s,rgery is "$e TOC.

99. D,!ing syndroeI $ig$ !ro"ein die" in sall doses and 2re,en"

in"er#al is "$e TOC& lo* car- die"& al!ra/ola $el!s 2or ne,ro#ege"a"i#e sy!"os4di//iness& s*ea"ing and dys!nea8& e"oclo!raide increases gas"ric e!"ying and

e(acer-a"es "$e !ro-le.

95. Re"rograde eac,la"ion is "$e os" coon co!lica"ion o2TURP. Urinary incon"inence and erec"ile dys2,nc"ion are "$e co!lica"ions o2

ner#e daage d,e "o s,!ra!,-ic radical !ros"a"ec"oy& *$ic$ s$o,ld -e done i2 "$e

TURP s!ecien s$o*s e#idence o2 alignancy& e#en i2 only adenocarcinoa in

si", Q 0" s$o,ld -e done *i"$ LN dissec"ion 2ollo*ing sen"inel LN sa!ling ,sing"ec$ne"i, radiola-elling. C$eo& -ical,"aide an"iandrogen "$era!y and radio

are reser#ed 2or ad#anced lesions.

9


27/67

!re#io,s !reecla!sia occ,rred earlier& or !" $as c$ronic renal disease or HTN.

?. 'os" e22ec"i#e s"ra"egy 2or se#ere !reecla!sia is deli#ery& "$o "$e ne(" -es"

s"e! is agsol& as !reecla!sia $as o"$er co!lica"ions -esides sei/,res& andagsol only con"rols "$e sei/,res. 0 $ydrala/ine or la-e"alol 2or BP con"rol. E#en

a2"er ecla!sia occ,rs& agsol is ore -ene2icial "$an !$eny"oin in !re#en"ing

sei/,re. Dia/e!a i2 agsol is c>0& eg d,e "o yas"$enia.@. Re"inal $eorr$age is considered "$e os" oino,s sign o2 !reecla!sia.

Also PG0) dec& TA) inc& NO dec& Endo"$elin inc.

16. +as"ing gl,cose "arge" in GD' is o o2 "$ro-oe-olis or s"ro%e& ac"i#e

li#er disease& $>o es"rogen de!enden" ",or& !regnancy& DUB& so%ers; 35 yrs&

$y!er TG. Rela"i#e c>0 are igraine& !oorly con"rolled HTN and an"icon#,lsan""$era!y. Dia-e"es and 2>$>o alignancy are no" c>i.

)). )67 *oen *i"$ C+ are in2er"ile& d,e "o "$ic% cer#ical ,c,s

and aenorr$ea d,e "o aln,"ri"ion& @57 o2 ale are in2er"ile d,e "o i!aired

de#elo!en" o2 ol22ian d,c"& and !oor s!er "rans!or".


28/67

)3. Ann,al !a! is recoended e#en in les-ian& "$o "$e in"er#al can

-e increased "o ) or 3 yrs a2"er 3 or ore consec,"i#e noral !a!.

)9. Tric$oonas in !os"!ar", !eriod gi#e )g single dose o2e"ron& and *i"$$eld -reas" 2eeding 2or one day. Also "rea" "$e !ar"ner. Local

#aginal "$era!y are less e22icacio,s co/ i" doesn" reac$ "$e ,re"$ra and "$e

!eri,re"$ral glands.)5. S"ress incon"inence al!$a agonis"s li%e ai"ry!"iline can $el! -y

increasing "$e s!$inc"er "one. An"ic$olinergic li%e o(y-,"inin and -io2eed-ac% are

2or ,rge incon"inence.)


29/67

3=. eig$" red,c"ion is "$e TOC 2or PCOD in2er"ili"y. A2"er "$a" is

cloi!$ene& and i2 i" doesn" *or%& "$en gonado"ro!ins. 'e"2orin is no" s",died

eno,g$& so is ,s,ally no" "$e ans*er.3?. Adolescen"s dong co!ly *i"$ OCP os"ly -eca,se o2 concern

o#er *" gain& "$o "$ere is no $ard e#idence.

3@. Tes"ic,lar 2eini/a"ion !" $as -reas" de#elo!en" -," no a(illaryor !,-ic $air& ,nli%e in cons"i","ional delay& *$ere s,c$ async$rono,s delay is no"

2o,nd.

96. La!arosco!y is al*ays "$e 2irs" s"e! in s,s!ec"ed endoe"riosis&"o r,le o," o"$er !a"$ology& and "o see "$e e("en" o2 "$e disease& !l,s i" can -e

"$era!e,"ic "oo *i"$ -i!olar coag,la"ion.

91. Unila"eral ni!!le disc$arge is cancer UPO& so do aogra&

e#en i2 i" is sero,s. 0" can -e 2>-y +NAC or -io!sy& and cy"ology o2 "$e disc$arge i2i" is -loody.

9). CS doesn" $el! *i"$ de"ec"ing NTD& as i" is only 2or cy"ogene"ic

s",dies and doesn" eas,re A+P le#els.

93. NTD needs iedia"e s,rgery "o !re#en" in2ec"ion o2 CNS&2ollo*ed -y or"$o!edic e#al,a"ion "o correc" !a"ien"s !os",re and !roo"e

a-,la"ion.99. All !regnan" *oen s$o,ld -e screened 2or C$laydial

in2ec"ion in "$e 2irs" !rena"al #isi"& and re!ea" in "$ird "ries"er i2 "$e !a"ien" is

-elo* )5 yrs o2 age 4donno *$y8 co/ i" can lead "o endoe"ri"is&c$orioanioni"is& con,nc"i#i"is and !ne,onia in "$e -a-y& !re"er deli#ery&

P0D& ec"o!ic. 02 !osi"i#e& "rea" o"$er *i"$ ery"$roycin -ase 4es"ola"e is c>i8or

ao(icillin 2or = days and 2a"$er *i"$ a/i"$ro single dose.

95. T$e 'CC o2 !os"eno!a,sal -leeding is a"ro!$ic #agini"is& "$enendoe"rial ca& *$ile cer#ical cancer is a #ery rare ca,se.

9


30/67

$ear" l,ng "rans!lan"& or l,ng "rans!lan" *i"$ in"racardiac re!air.

56. Ges"a"ional "ransien" "$yro"o(icosis 4GTT8 $as ild increase in

2ree T9 and only slig$" decrease in TSH& d,e "o "$e e22ec" o2 $CG on "$yroids"i,la"ion. 02 T+T are noral& and !" $as "y!ical sy!"os o2 $y!er"$yroidis&

s$e !ro-a-ly $as an(ie"y disorder or soe"$ing else. S,-ac,"e ly!$ocy"ic

4!os"!ar",8 "$yroidi"is ca,ses only "ransien" $y!er"$yroidis& and s$o*sred,ced RA0U "es".

51. D'PA is "$e con"race!"i#e o2 c$oice in !" *i"$ D or

$eo!$ilia& as i" decreases "$e ens"r,al 2lo*& ,nli%e 0UD or ini!ill *$ic$increases -leeding. 0" also dec ris% o2 P0D and endoe"rial cancer& and is ,se2,l in

"$ose *i"$ 2i-roid.

5). Do*ns diagnosis increased n,c$al "ransl,cency on USG in 16

*%s& PAPPA in "$e 2irs" "ries"er& ,adr,!le "es"ing 4 *i"$ dieric in$i-in A8 insecond "ries"er& and %aryo"y!ing *i"$ CS in 16 *%s and aniocen"esis in 1<

*%s.

53. A !" recen"ly s"ar"ed on OCP coes *i"$ s!o""ing& ,s" reass,re

$er "$a" is noral -rea%"$ro,g$ -leeding& and no"$ing needs "o -e done. J,s"con"in,e "$e OCP. Soe !a"ien" ay co!lain "$a" "$ere is no *i"$dra*l -leeding.

T$a" is noral "oo& ini"ially. Ad#ice $er "o ,se condos i2 s$e 2orgo" "o "a%e $er !ill 2or )3 days.

59. Clonidine is ,se2,l 2or $o" 2las$es& es! i2 "$ere are any c>0 "o "$e

,se o2 HRT. Proges"in $as also -een s$o*n "o -e e22ec"i#e 2or $o" 2las$es& -,"ca,ses ood dis",r-ances.

55. Any !re"er la-or al*ays adinis"er !ro!$ylac"ic !enicillin 2or

GBS. Also -e"ae"$asone i2 -e"*een )9 "o 39 *%s.

5o HTN& !re"er deli#ery&

!oorly con"rolled D' or sic%le cell aneia.


31/67

and de#elo!en".

0 "o daily aero-ic e(ercise in !regnancy are signi2ican" $ear"

disease& HTN& !reecla!sia& !re"er la-or and PRO'& res"ric"i#e l,ng disease&inco!e"en" cer#i(& "*ins& !lacen"a !re#ia.


32/67

?6. Screening 2or D' s"ar"s a" 95 *i"$ "$ree yearly RBS& 2or li!id

disorder s"ar"s a" 95 i2 no ris% 2ac"or& -," as early as age 1? i2 $as ris% 2ac"or li%e 2>$

o2 '0.?1. A !regnan" o"$er is diagnosed *i"$ sec sy!$ilis in $er second

"ries"er. T$e -a-y *ill -e -orn *i"$ sn,22les& r$agades and ne,rosy!$ilis

42ea",res o2 early congeni"al sy!$ilis8& no" sa-er s$in>H,"c$inson "ee"$& as "$ese areani2es"a"ion o2 la"e congeni"al sy!$ilis. Also can $a#e eningi"is& $ydroce!$al,s&

o!"ic a"ro!$y.

?). 'a"ernal o-esi"y increases "$e ris% o2 NTD& "$o "$e reason is no"%no*n. 0" also increases "$e ris% o2 GD'& acrosoia and s"ill-ir"$& so *" loss

-e2ore conce!"ion is ad#ised.

?3. T,-al liga"ionI 2ail,re ra"e is 57 and no" 6.17& 5)6 7 !"s regre"

la"er doing "$e liga"ion.?9. T$e !resence o2 endocer#ical cells on Pa! is regarded as ade,a"e

sa!ling. 02 "$ese cells are a-sen"& "$en in a no ris% !a"ien"& re!ea"ing ay -e

de2erred "ill ne(" years Pa!. 02 i" is $ig$ ris% !a"ien"& "$en re!ea" iedia"ely.

?5. A2"er an e!isode o2 !yelone!$ri"is in !regnancy& "$e !" s$o,ld -e !," on !ro!$ylac"ic an"i-io"ic 2or "$e res" o2 $er !regnancy.

?i.

?@. 0n a !a"ien" *i"$ !ar"ial s!inal cord "ransac"ion& "$e -igges" "$rea"

d,ring !regnancy is de#elo!ing a,"onoic dysre2le(ia. 0" can ani2es" *i"$alignan" HTN& -rady& ary"$ia& s*ea"ing& res! dis"ress& ,"ero!lacen"al

#asocons"ric"ion& e"c. Pa"ien"s are ,na*are o2 la-or d,e "o a-sence o2 !ain& and

only *ay o2 %no*ing is a-d or leg s!as and SOB "$a" acco!anies la-or.@6. Cran-erry ,ice !re#en"s UT0 -y in$i-i"ing E coli 2ro ad$ering

"o "$e ,rinary e!i"$eli,.

@1. None o2 "$e radioiaging are c>0 in !regnancy e(ce!" 2or

radioac"i#e iaging. T$e odali"y *i"$ $ig$es" e(!os,re "o "$e 2e",s is a -ari,enea& "$en a CT a-doen.

@). Ondanse"ron is e22ec"i#e only i2 gi#en -e2ore c$eo. +or la"e

onse" eesis& e"oclo!raide is ore e22ec"i#e.@3. No al"era"ion in se(,al !rac"ice is needed d,ring !regnancy&

e(ce!" i2 !" $as PRO'& !lacen"a !re#ia or !rea",re la-or $is"ory. E#en s,!ine

!osi"ion is no" c>0 re.@9. C$ronic #es"i-,li"is is a ca,se o2 c$ronic #,l#ar !ain and e("ree

"enderness. T" is lo* dose ai"ry!"iline.

@5. 0+ a H0 elisa coes !osi"i#e& "$e os" i!or"an" 2ac"or o2 "$e

"es" "$a" concerns "$e !a"ien" is "$e PP o2 "$e "es"& ie $o* any *i"$ !osi"i#e "es"


33/67

ac",ally $a#e H0.

@


34/67

!ere"$rin $as s$o*n "o $el!& as deode( i"es are 2re,en"ly 2o,nd in "$e

lesions. Rosacea can -e associa"ed *i"$ con,nc"i#i"is& %era"i"is& c$ala/ion and

scleri"is.5. Ery"$rasa ca,sed -y coryne-ac in,"issi,& re#eals coral red 2l,orescence

in ood la!.

$y!er!igen"a"ion.

?. earing !ro"ec"i#e clo"$ing is ore i!or"an" "$an s,nscreen since c$ild$ood

"o decrease "$e ris% o2 elanoa. S,nscreen *i"$ SP+ 15 $a#e s$o*n "o red,ce"$e incidence o2 only BCC and SCC& no" elanoa.

@. Oral Ter-ina2ine


35/67

$air s"rands o2 #arying leng"$.

PAED0ATR0CS1. DTaP #accine c>0 i2 ana!$yla(is o2 ence!$alo!a"$y *i"$in =d. 02

$ig$ 2e#er& s$oc%& inconsola-le crying and sei/,re *i"$in )9 $rs& "$en gi#e

,nder ca,"ion. T$ere are no con"raindica"ions "o !ne,o& !olio or Hi-#accines.

). ''R c>i se#ere 2e-rile illness& ana!$yla(is "o neoycin or

gela"in& se#ere i,node2iciency 4no" ,s" H0 s"a",s8& "$ro-ocy"o!enia a2"er 2irs" dose& !re#io,s 00G adinis"ra"ion *i"$in 311 o& as i" decreases "$e

e22icacy o2 "$e #accine& !regnancy. 2>$>o sei/,res& -reas"2eeding& TB& PPD

con#ersion& asy!"oa"ic H0 in2ec"ion& allergy "o erc,ry 4"$ierosal8 and

egg are no" considered con"raindica"ions.3. C$eo!ro!$yla(is 2or PPD con#ersion 2ollo*ing con"ac" *i"$

'DR TB i2 resis"an" "o only 0NH& gi#e ri2a!icin 9o or RF )o& i2 resis"an"

"o H and R& gi#e FE or F *i"$ ,inolone 2or 9 "$s.

9. 02 neona"e a" -ir"$ $as !olycy"$eia in ca!illary $eel -lood "es"&"$en re!ea" in #eno,s -lood i2 s"ill ele#a"ed& re!ea" in 1) and )9 $rs& as i"

resol#es on i"s o*n. 02 i" !ersis"s& and "$e c$ild de#elo!s dro*siness& a,ndice&$y!oglyceia& a!nea& $y!o"onia& !oor 2eeding& cyanosis& "$en $ydra"ion and

e(c$ange "rans2,sion is needed.

5. C$ildren need 1366 g calci, daily& so a!ar" 2ro die"& 1gcalci, s,!!leen"a"ion s$o,ld -e done in all. Ad,l"s "y!ically need less&

*$ile "$e re,ireen" in old age again increases.


36/67

-i""en PEP *i"$ 0g and ra-ies #accine is needed& iedia"ely ,nless "$e

anial can -e ca!",red and o-ser#ed 2or signs o2 ra-ies or sacri2iced and

a,"o!sied. PEP s$o,ld -e gi#en *i"$in 5 days& or *i"$ $ead and nec% -i"es&*i"$in 3 days 4=) $rs8

1). one is no" ,sed in neona"al se!sis as i" can dis!lace -ilir,-in and

aggra#a"e se!sis ind,ced c$oles"asis. Sae 2or co"ri. So TOC is a!icillin2or Lis"era 4"$o ,ncoon in US8 and ce2o"a(ie.

13. C$ild coes "o Pedia"rician *i"$ e!iglo""i"is 2irs" "$ing "o do is

arrange 2or a-,lance "o send "o ER& 2or !ossi-le in",-a"ion19. 0n i,noco! !a"ien"s& $er!es /os"er ig$" rese-le HS& so

diagnosis needs PCR or 0+ o2 scra!ing& else "es"s are no" needed 2or diagnosing

/os"er.

15. Noc",rnal s,rge in LH and enlargeen" o2 "es"es are "$e 2irs" signs o2 !,-er"y. Delayed !,-er"y is diagnosed i2 ;19 yrs o2 age. 0" can -e cons"i","ional

i2 !osi"i#e 2aily $is"ory& and -one age is lo*er "$an "r,e age& and o"$er

sys"eic illness are a-sen". P" *i"$ :line2el"er $as noral !,-er"y& -," "$en $e

de#elo!s "es"ic,lar a"ro!$y and $y!ogonadis. Cons"i","ional !,-er"y delaycan -e anaged *i"$ "es"os"erone "$ly i inec"ion 2or 3< o 4s$or" "$era!y

doesn" a22ec" -one gro*"$8& es! 2or !syc$ological reason. HCG *i"$ H'G can -e ,sed in cen"ral $y!ogonadis li%e %allans syndroe or GnRH !,!.

1


37/67

s"ar"ing an"i-io"ics.

)). Syden$as c$orea can !resen" a2"er )?o *i"$ !rona"or dri2"&

delayed !a"ellar re2le(& dec "one& crying or la,g$ing ina!!ro!ria"ely& 2acial er%ing& e"c. "rea"en" is again !enicillin re.

)3. 02 "$ere is icroce!$aly& i" can" -e d,e "o 0UGR& $as "o -e d,e "o

in"ra!ar", in2ec"ions.)9. C$ild$ood A-sence E!ile!sy 4CAE8& $as a good !rognosis& good

res!onse *i"$ "rea"en" and reission *i"$ age& es! i2 GTCS are a-sen". J'E

4,#enile yoclonic e!ile!sy8& -y con"ras" $as a-sence e!isodes *i"$yoclonic ac"i#i"y& and li2e long sei/,res.

)5. A lean and "$in !a"ien" *i"$ secondary aenorr$ea& *i"$ dec a(illary

and !,-ic $air& yalgia& as"$enia& aenorr$ea& a(illary 2rec%ling& i"s !ro-a-ly

no" anore(ia -," Addisons disease. Lac% o2 !,-ic $air !oin"s "o*ard $oronali-alance. Hy!ona"reia& $y!er%aleia& acidosis& $y!erc$loreia are !resen"

in aldos"erone de2iciency also& -," "$e $y!er!igen"a"ion and aenorr$ea

!oin"s "o Addisons.

)


38/67

isc$eic s"ro%e. H- elec"ro!$oresis is "$e D(OC. Ac,"e coronary syndroe in

"$ese !a"ien"s ay -e di22ic,l" "o d>d 2ro ac,"e c$es" syndroe.

39. Alar is ore e22ec"i#e "$an edica"ions in en,resis& es! i2a,gen"ed -y o"$er -e$a#ioral a!!roac$es& and also $as lo*er ra"e o2 rela!ses.

35. Ac,"e -ronc$ioli"is TOC is res!ira"ory isola"ion *i"$

-ronc$odila"ors 4al-,"erol& e!ine!$rine8& $os!i"ali/a"ion i2 $y!o(ic or ,na-le "o2eed 4ng or i# 2eeding8. D( is -y ra!id an"igen de"ec"ion o2 RS in nasal or

!,lonary secre"ions ,sing EL0SA an"igen ca!",re "ec$nology. Serology

doesn" $el! as i" de"ec"s a"ernal an"i-ody. P" $as increased ris% o2 AO'& andas"$a in "$e long r,n. A!neic s!ells are #ery coon in -ronc$ioli"is.

3


39/67

$os!i"ali/a"ion& *aring& correc"ion o2 de$ydra"ion and elec"roly"ies& and NG

2eeding& es! i2 #oi"ing& i!aired conscio,sness and !ain2,l oral ,lcers. Hig$

calorie or !ro"ein s$o,ldn" -e s"ar"ed early as i" can lead "o $ear" 2ail,re& andiron s$o,ldn" -e ,sed in 2irs" *ee% as i" can ca,se G0 ,lcer and o(ida"ion

in,ry.

9=. )o c$ild !resen"s *i"$ !ne,onia& *i"$ in"ers"i"ial !a""ern on R&eosino!$ilia& and ins!ira"ion -e"*een co,g$ 4s"acca"o co,g$8& i"s !ro-a-ly

C$laydia. Searc$ 2or $>o con,nc"i#i"is in "$e neona"al !eriod.

9?. Breas"2eed a ne*-orn e#ery 9 $rs& and *a"c$ 2or $i "o "a%e $is2ingers "o o,"$ "o %no* "$a" $e is $,ngry.

9@. TB' s$o,ld -e "rea"ed 2or 1)on"$s& and ,!"o 1? on"$s i2 resis"an"

s"rain.

56. O!en TB !a"ien"s are considered noncon"agio,s only a2"er 3consec,"i#e nega"i#e s!,", sears& and no" -ased on d,ra"ion o2 recei#ing

"$era!y.

51. USG is "$e D(OC in CHPS& *$ile AR in d,odenal a"resia or

alro"a"ion. Con"in,o,s nasod,odenal 2eeding can -e ,sed as an al"erna"i#e in"$ose *$o are !oor s,rgical candida"es. Ery"$roycin ,se& eg in !ro!$yla(is

agains" !er",sis& e#en i2 gi#en "o "$e -reas"2eeding o"$er& $as -een s$o*n "oincrease "$e incidence o2 CHPS

5). Cell,li"is is in -e"*een s,-c," "iss,e and 2a"& so local anes"$esia *ill

no" -e $el!2,l& so s$o,ldn" -e ,sed.53. 0 co"ri is "$e "rea"en" in PCP !ne,onia in A0DS !a"ien"& la"er

c$anged "o oral. 0 !en"aidine i2 in"oleran" "o co"ri& and i# "rie"re(a"e i2

in"oleran" "o -o"$. Aerosoli/ed !en"aidine $as lo* e22icacy and s$o,ldn" -e

,sed in "rea"en"& only in !ro!$yla(is. A"o#a,one can -e ,sed "oo.59. +B inges"ion i2 i" is lodged in any eso!$ageal cons"ric"ion& "$en

iedia"e reo#al -y endosco!y or 2l,orosco!y g,idance is indica"ed. 02 i"

$as already gone "o s"oac$& no in"er#en"ion is needed os"ly. Pylorico-s"r,c"ion can !resen" *i"$ !ersis"en" #oi"ing in soe cases.

55. +e-rile sei/,res in


40/67

"$allasseia& as "$e la""er don" !resen" early d,e "o !resence o2 2e"al

$eoglo-in.

5@. A2"er s"ar"ing Ao(ycillin 2or AO'& i2 "$e !ain and 2e#er !ersis"s&"$en i"s "rea"en" 2ail,re s"ar" coao(icla# 2or dr,g resis"an" Pne,o.

Ty!anos"oy and ",-ing is indica"ed i2 O'E !ersis"ing ore "$an 3 on"$s&

se#ere AO'& or i2 rec,rren" AO' des!i"e !ro!$ylac"ic an"i-io"ics *i"$ $al2dose ao(y or s,l2iso(a/ole.


41/67

$y!erin2la"ion and eosino!$ilia.

=5. A c$ild is -ro,g$" *i"$ alco$ol acciden"al !oisoning "$e -igges"

"$rea" is $y!oglyceia. Also cere-ral edea and sei/,re can occ,r.Hy!ocalceia *i"$ ne!$rocalcinosis occ,rs *i"$ an"i2ree/e !oisoning.

=


42/67

*$ic$ is slo*ly gro*ing. 0"s !ro-a-ly 2i-roa"osis coli& *$ic$ i2 no" "rea"ed

*ill ca,se congeni"al "or"icollis. So s"re"c$ing e(ercise is needed& or s,rgery

*i"$ s!lin"ing can -e o22ered i2 e(ercise doesn" $el!. D>d is -ranc$ial cys".@3. A !" coes 2ro Hai"i *i"$ co!le"e i,ni/a"ion 2or *ell c$ild

#isi". He $as go" BCG also. He is asy!"oa"ic& s"ill $e needs a PPD !laced re.

@9. 0n ales


43/67

!lace& only "o!ical an"i-io"ic can -e ,sed 2irs". S*i"c$ "o oral or i# i2 no

res!onse only.

16?. 02 "$e -a-y is $a#ing ro"a#iral diarr$ea& AAP recoends "$a" $e can -e sen" "o daycare i2 $is s"ool can -e con"ained in $is dia!ers and don" s!ill

o#er. Care2,l $and*as$ing *i"$ e"$anol is "$e !re#en"ion. Only -oiling *a"er

*on" $el!. La,ndering clo"$es *ill no" $el! 4i"s 2or sca-ies only8. accine *asde#elo!ed& -," *as associa"ed *i"$ in",ss,sce!"ions.

16@. A c$ild *$o li%es "o -e #ery nea" coes *i"$ cons"i!a"ion. As% a-o,"

*$e"$er $e a#oids sc$ool -a"$roo. T$en do dise!ac"ion o2 s"ool& 2>-y -alanced die" and -e$a#ior odi2ica"ion. 02 i"s Hirsc$s!r,ng& "$en "$e rec",

*ill -e de#oid o2 s"ool& ,nli%e in 2,nc"ional cons"i!a"ion.

116. A !" is diagnosed *i"$ rec,rren" an%le s!rain. On e(aina"ion& "$ere is

a -ony gro*"$ along edial alleol,s. T$is is "alocalcaneal coali"ion. 0ni"ially"$e -ar is ,nossi2ied& -," a2"er ossi2ica"ion i" lii"s s,-"alar o"ion and ca,ses

$eel !ain. 0" needs CT "o diagnose& R *on" s$o*. O-li,e R s$o*s

calcaneona#ic,lar coali"ion $o*e#er. Ree-er CT 2or TC coali"ion.

111. A !erson *i"$ $>o sore "$roa" coes *i"$ g,""a"e !soriasis do ASOand ra!id s"re! "es"ing. Trea"en" *i"$ !enicillin *ill lii" "$e !soriasis also.

11). A !" *i"$ #i" D de2iciency and ar%ed gen, #ar, $e no" only needsdie"ary s,!!leen"& -," also long leg *" -earing R and or"$o cons,l".

113. N,rseaids el-o* d,e "o radial $ead disloca"ion "$o any red,ce i"

*i"$o," any in#es"iga"ion& i"s -e""er "o o-"ain an R "o doc,en" no o"$er2rac",re li%e s,!racondylar 2rac",re or !$yseal se!ara"ion is !resen".

119. PANDAS !edia"ric a,"oi,ne ne,ro!syc$ia"ric disorder associa"ed

*i"$ s"re!"ococcal in2ec"ion. 0" !resen"s *i"$ OCD li%e syndroe and "ics.

Trea"en" is i# an"i-io"ic and 00G.115. Cradle ca! in an in2an" is a "y!e o2 se-orr$eic dera"i"is "rea"en" is

-r,s$ing *i"$ a "oo"$-r,s$ "o reo#e "$e scales& and daily -a"$ *i"$ -a-y

s$a!oo& and a!!lying -a-y oil or oin"en" -e2ore -a"$ing "o reo#e all "$escales. Scales in eye-ro*s can -e reo#ed *i"$ a co""on "i! a!!lica"or di!!ed

in s$a!oo and "$en rinsed *i"$ *a"er. Don" ,se $ig$ !o"ency s"eroids li%e

-e"ae"$asone. 0" can ca,se a"ro!$y& "elangiec"asia& s"eroid acne& gla,coa&ca"arac" and sys"eic a-sor!"ion d,e "o $ig$ s,r2ace "o #ol,e ra"io o2 "$e

in2an"s.

11e& i2 a-,se is s,s!ec"ed& "$en

se!ara"e $i 2ro "$e !aren" and con"ac" "$e a,"$ori"ies.

11=. 0HSS "rea"en" in sy!"oa"ic case is *i"$ nega"i#e ino"ro!es li%e#era!ail or -e"a -loc%er& *$ic$ slo*s "$e $ear" ra"e& *$ic$ allo*s increased

L 2illing& and dec 2orce o2 con"rac"ion& *$ic$ decreases 2lo* #eloci"y and

conse,en"ly decreases "$e degree o2 o-s"r,c"ion. 'yoec"oy o2 "$e se!",is "$e las" resor" in case o2 se#ere $ear" 2ail,re.

11?. Calcaneo#alg,s 2oo" ig$" -e noral in early in2ancy& -," i2 2o,nd a"

) yrs o2 age& or"$o re2erral is needed. By con"ras"& 2la" 2oo"& e"a"ars,s

add,c",s& o#erriding 9"$ "oe or "oe *al%ing are all -enign and don" need


44/67

re2erral.

11@. Neona"al gonococcal con,nc"i#i"is a!ar" 2ro "o!ical an"i-io"ics&

sys"eic an"i-io"ics 2or -o"$ gonorr$ea and claydia s$o,ld -e gi#en.1)6. A !" coes *i"$ s$or" s"a",re& delayed !,-er"y on e(aina"ion& -,"

noral gro*"$ #eloci"y 4eg $eig$" #eloci"y8 do *ris" R 2irs" "o 2ind i2 "$e

-one age coincides *i"$ "$e !,-er"al age 4c$ronological age is no" i!8. 02 i"does&"$en i"s only cons"i","ional delay& and "$e !aren"s $a#e "o reass,red "$a" $e

*ill gain a noral ad,l" $eig$" e#en",ally& de!ending on $is !aren"s 2inal

$eig$".1)1. A < *% -a-y *i"$ -ilio,s eesis& slig$" dis"ension o2 a-doen&

de$ydra"ion s,s!ec" idg," #ol#,l,s. Us,ally "$e clinical !ic",re is so classic

"$a" iaging is no" needed& so "$e TOC a2"er re$ydra"ion is la!aro"oy. Delay

in "rea"en" *ill res,l" in s$or"g," syndroe& and TPN 2or "$e res" o2 li2e& *i"$i"s res,l"an" co!lica"ions li%e li#er cirr$osis. 02 "$e !" is s"a-le eno,g$ 2or

e#al,a"ion& "$en a ,!!er G0 series *i"$ 2ollo* "$r, *ill deons"ra"e "$e

a-noral !osi"ion o2 "$e ligaen" o2 "rie"/.

1)). A !" *i"$ !osi"i#e Barlo* and Or"olani a" -ir"$ needn" do USG as i"is a clinical diagnosis& and USG can -e nega"i#e 2alsely. Rs are ,seless -e2ore

9o as "$e 2eoral $ead is no" ossi2ied. So "$e TOC is !,""ing "$e -a-y in aPa#li% $arness& and "$en or"$o cons,l".

1)3. A c$ild inges"s a -a""ery and is no* s",c% a" id eso!$ag,s le#el. 0T

s$o,ld -e reo#ed& as i" $as corrosi#es. Sae 2or sa2e"y !in. 02 i" is ,s" acoin&"$en *e can do 2>, R "o see i"s sa2e !assage.

1)9. A "oddler coes *i"$ $y!er"$eria& "ac$ycardia& "ac$y!nea& #oi"ing&

dia!$oresis& and $e $as a in"y sell in $is -rea"$. 0"s oil o2 *in"ergreen

inges"ion *i"$ salicyla"e !oisoning.1)5. A c$ild coes *i"$ !in% eye& des,aa"ion o2 $ands and 2ee"&

s"ra*-erry "ong,e i"s :a*asa%i disease. T$roo-ocy"osis is an ac,"e !$ase

reac"ion seen in "$e -lood.1)


45/67

a scien"i2ic "er8

13). R,-ella e#anescen" ras$ "$a" disa!!ears *i"$in "*o or "$ree days& !os"

a,ric,lar and !os"occi!i"al LN. ar"$ri"is in any& 0TP and ence!$ali"is in soe.Congeni"al R,-ella syndroe i2 con"ac"ed d,ring "$e 2irs" "ries"er.

accina"ion a" 1)15 o and "$en a" 111) yrs. Li#e #accine& so c>0 d,ring

!regnancy.133. 0nc,-a"ion !eriod -e"*een con"ac" *i"$ TB !a"ien" and ",-erc,lin s%in

"es" con#ersion is )1) *ee%s.

139. Adission in -,rn in in2an"s is anda"ed i2 BSA ; 167 or 157 inolder c$ild& -," also in cri"ical area in#ol#een" li%e 2ace& $and& !,-ic area&

!erine,& and elec"ric -,rn. Ree-er all scald -,rns are no" a-,ses see i2

"$e !a""ern a"c$es "$e $is"ory or no".

135. P" *i"$ 0DD' can de"eriora"e d,ring $is !,-er"y d,e "o di22eren"$oronal c$anges. Honeyoon !eriod re2ers "o "$ a2"er d( -e2ore ins,lin is

needed.

13d are

%era"osis !ilaris seen *i"$ a"o!ic dera"i"is& and neona"al !,s",lar elanosis

*$ic$ *ill s$o* ne,"ro!$ils& and lea#es a $y!er!igen"ed ac,le *i"$ scales


46/67

a2"er "$e !,s",le r,!",res.

19=. Girl coes *i"$ a !ed,nc,la"ed lesion on $er 2ace 2or a on"$ -leeds

*i"$ scra"c$ing. 0"s !yogenic gran,loa& and is a #asc,lar reac"ion "o in2ec"ion.Trea"en" is des"r,c"ion *i"$ c,re""age or elec"rodessica"ion& li,id ni"rogen or

!,lse laser. 0" rec,rs a2"er "rea"en" .

19?. 'OHS is ,sed in elanoa i2 "iss,e s!aring is a concern& i2rec,rrence in a scar& or loca"ion in !lanes o2 e-roynal 2,sion.

19@. B,llo,s i!e"igo& es!ecially 2ollo*ing o"$er dera"oses or

c$ic%en!o(& are ca,sed -y S"a!$ a,re,s. Trea" *i"$ e"$er "o!ical ,!irocin ororal ce!$alos!orin.

156. A/elaic acid can -e ,sed 2or $y!er!igen"ed lesions li%e

!os"in2laa"ory cases or elasa. Hydro,inone also -loc%s

elanogenesis& -," !rolonged ,se is associa"ed *i"$ yello* -ro*n !eranen" !igen"a"ion& called oc$ronosis.

151. Ca#erno,s $eangioa& e#en only cs *ide& can ca,se D0C and

cons,!"ion coag,lo!a"$y *i"$ "$ro-ocy"o!enia. 0"s called :assa-ac$

'erri"" Syndroe. So early "rea"en" is i!or"an" *i"$ large $eangioa.Ano"$er danger is co!ression o2 #i"al s"r,c",res -y ra!idly gro*ing

$eangioa& li%e eso!$ag,s or "rac$ea.

'0SCELLANEOUS +RO' :APLAN BOO:

1. $en a !" *i"$ RA coes *i"$ erosions on R& "$en $e needsD'ARD 'T is "$e DOC& as i" is c$ea!& -," i" can ca,se $e!a"o"o(ici"y so

oni"or L+T reg,larly and gi#e !yrido(ine *i"$ i" Q Lo* dose !rednisone is

,sed only i2 D'ARD don" s$o* ade,a"e res!onse.

). P"s *i"$ c$ronic $e! C s$o,ldn" -e gi#en iron s,!!leen"a"ion& as"$ey are a" ris% o2 $eosiderosis 2or ,n%no*n ca,se.

3. C$arco" 2oo" in a D' !" *i"$ ne,ro!a"$y s"ar"s ini"ially in ac,"e

in2laa"ory s"age li%e cell,li"is *i"$ *ar"$& ery"$ea& edea *$ic$disa!!ear on ele#a"ing "$e 2oo" *$ic$ is !a"$ognoonic. T$en i" goes in"o

ac,"e s"age *$ere "$ere are !eriar"ic,lar 2rac",res& "$en oin" disloca"ion& "$en

coes s,-ac,"e s"age *i"$ -one resor!"ion and 2inally 2,sion in c$ronic orre!ara"i#e !$ase. T" is "o lii" *" -earing *"$ -races and cas". T$is can -e seen

*i"$ "a-es& and *i"$ !ernicio,s aneia also.

9. +irs" "$ing "o do in a ne* onse" A+ is TSH eas,reen".

5. 0n2erior 'i !a"ien" de#elo!s -rady and $y!o"ension d,e "o SA nodes,!!ression& 2irs" "$ing "o do is gi#e a"ro!ine. 02 i" doesn" $el! in 3 doses 4"o"al

) g8& "$en "e!orary !acea%er is indica"ed. ol,e re!laceen" and

do-,"aine i2 $y!o"ension doesn" correc" e#en a2"er correc"ing "$e -radycardia.


47/67

or an"ralin 40ngra regien8 can -e ,sed& -," i2 "$ere are sys"eic and oin"

in#ol#een"s& "$en "$e -es" "$ing is "o s"ar" 'T.

@. Uns"a-le angina is "$e d( i2 !" coes *i"$ c$es" !ain and s>s o22ail,re& li%e s9& rales& edea& e"c s"ar"ing $e!arin is "$e TOC. Be2ore

disc$arge& do a s"ress "es"ing "o ,an"i2y "$e ris%. Coronary angio is no"

indica"ed in all angina& only in "$ose *$o re!or" sy!"os des!i"e aggressi#eanageen". S"a"ins& as!irin& - -loc%ers& ACE0& BP con"rol and so%ing

cessa"ion $a#e s$o*n "o increase li2es!an in !"s *i"$ angina& -," no" ni"ra"es.

16. T$yroid nod,les "$a" are no" !al!a-le -," 2o,nd on CT or USG needonly 2>,& no +NA or 2>, CT. "$yroid scan is indica"ed only i2 $y!er2,nc"ioning

nod,le& no" in asy!"oa"ic nod,les.

11. P" *i"$ !ancrea"i"is de#elo!s 2e#er !ro!"ly "a%e -lood c,l",re and

s"ar" an"i-io"ics 4a!igen"ae"ro8& only "$en do CT "o see 2or any necrosis& i2necrosis is !resen" and !" is 2e-rile& "$en do CT g,ided as!ira"ion 2or c,l",re o2

"$e !ancrea"ic necro"ic a"erial.

1). G,""a"e !soriasis can occ,r a2"er S"re!"o "$roa" in2ec"ion.

13. A !" *i"$ ,adri!legia canno" as% 2or #ol,n"ary re2,sal o2 2l,id and2ood& $e can -e 2orce 2ed& co/ ,adri!legia is nei"$er a "erinal condi"ion& nor a

!rogressi#e one.19. ALT ele#a"ion asy!"oa"ic& need only 2>, a2"er soe on"$s& o"$er

in#es"iga"ions are *arran"ed only i2 ;35 "ies raised& i2 "$ere are e#idence o2

c$ronic li#er disease& or $as !ersis"en" ele#a"ion on 2,r"$er "es"ing. 02 no cleardiagnosis a2"er serology 2or #ir,ses& and a,"oi,ne screen and USG& "$en *e

$a#e "o do li#er -io!sy.

15. Ha!"on $,! is "$e o!aci"y d,e "o in"ranecro"ic $eorr$age seen

in R a2"er PE.1


48/67

2irs" "al% "o !a"ien" as "o *$a" in2ora"ion $e *an"s yo, "o di#,lge. 02 !" doesn"

*an" any in2ora"ion "o -e gi#en& s"ill a!!ear in "$e co,r" -," don" say

any"$ing a-o," "$e !a"ien".)3. A !" ge""ing $ydro"$era!y 2or ar"$ri"is !resen"s *i"$ i"c$y s%in i"s

as"ea"o"ic dera"i"is& a%a (ero"ic ec/ea "rea"en" is "o a#oid "$e

$ydro"$era!y.)9. B,"c$er de#elo!s -rig$" red lesion d,e "o an acciden"al c," on $and&

*i"$ #esicles and soo"$ s$iny !la,es& i"s Eryse!aloid d,e "o Erysi!elo"$ri(.

Trea"en" is !enicillin oral& or Ery"$ro *i"$ ri2a!icin i2 !" canno" "olera"e !enicillin. De-rideen" is no" needed.

)5. 0i!ene lo*ers sei/,re "$res$old

)


49/67

3=. Heocc,l" "es" !osi"i#e in an elderly !a"ien" *i"$ $eorr$oid can

s"ill -e d,e "o colonic !oly! or alignancy so colonosco!y is s"ill indica"ed

3?. A !" on al!ra/ola 2or an(ie"y 2or yrs coes *i"$ BFD o#erdose2l,a/enil s$o,ldn" -e ,sed in !"s *i"$ !$ysical de!endence as i" can

!reci!i"a"e sei/,res. +l,a/enil is only ,se2,l in ac,"e o#erdose cases.

3@. P" *$o is no" -raindead -," *$o is cer"ain ne#er "o reco#er $is2,nc"ions& and *$o can ne#er -e *eaned o22 #en"ila"or& can -e discon"in,ed& on

gro,nds o2 +UT0L0TY.

96. A PT on "rea"en" 2or !yelone!$ri"is doesn" res!ond "o an"i-io"icsdo CT "o r,le o," !erine!$ric a-scess.

91. Con"ac" dera"i"is "rea"en" is oral !rednisolone& es! i2 $ands and

2ace are in#ol#ed& as yo, can" ,se !o"en" s"eroid o#er "$ose si"es.

'e"$yl!rednisone can -e ,sed in lo* dose *i"$ ac,"e "a!er& -," s$o,ldn" -ere!ea"ed 2or 2ear o2 signi2ican" re-o,nd 2lares.

9). P" on ris!eridone& elderly& can ca,se c$ronic 2ecal i!ac"ion and

o#er2lo* diarr$ea& "rea"en" o2 cons"i!a"ion -y 2i-er s,!!leen"a"ion is "$e

"rea"en" o2 c$oice. 'ineral oil is c>0 as i" can ca,se li!oid !ne,onia d,e "oas!ira"ion& as *ell as rec"al lea%age. 'ag sal"s can ca,se e(cess and dangero,s

2l,id s$i2"s in elderly.93. P" *i"$ rec,rren" o,"-rea% o2 $er!es geni"alis& s$o,ld -e !," on long

"er acyclo#ir oral. A2"er a-o," a year& discon"in,e "o see "$e 2re,ency o2

o,"-rea%& and i2 "$e 2re,ency $as decreased considera-ly& "$en s"o! "$e dr,g.Li2elong "rea"en" is no" needed. P" s$o,ld ,se -arrier con"race!"ion "o !re#en"

"ransission.

99. A !" *i"$ sy!"os o2 !ne,onia -," $as noral R re$ydra"e $i

and "$en re!ea" "$e R. T$e !ne,onia ig$" s$o* ,!.95. Da"a is gi#en 2or e22ec" o2 dr,g in lo*ering BP& *i"$ ean& edian

and SD. T$en as%ed "o 2ind "$e degree o2 -ene2i" o2 a !a"ien". 02 "$e ean is

#ery di22eren" 2ro edian& "$en i" is a s%e*ed dis"ri-,"ion& so "$e r,le o2con2idence in"er#al doesn" a!!ly& so "$e ans*er *o,ld -e canno" -e

de"erined 2ro "$e gi#en da"a.

9


50/67

!syc$ogenic gai" dis",r-ance.

5). S"ye needs only an"i-io"ic dro!s and *ar co!resses no" 0ND

53. 0n a eningi"is s,s!ec"& 2irs" "$ing "o do is s"ar"ing an"i-io"ic& "$en CT"o r,le o," ass lesion li%e a-scess& and "$en only do LP.

59. A !" coes *i"$ $eadac$e. E(aina"ion is noral. Yo, cons,l" a

ne,rologis" on !$one& $e as%s "o disc$arge "$e !" on analgesic. La"er "$e !" dieso2 ane,rys. T$e co,r" *ill indic" "$e ne,rologis" i2 $e $as direc"ly s!o%en

*i"$ "$e !" o#er "$e !$one& co/ "$a" *ill a%e "$e doc"or !" in rela"ion& else

$e $as no lia-ili"y.55. i2e caring 2or a deen"ed $,s-and !ro#iding res!i"e 2or "$e *i2e

4*i"$ ,se o2 $oe ser#ices or n,rsing $oe 2or a s$or" !eriod o2 "ie8 can

delay !eranen" adission o2 "$e !" in"o a n,rsing $oe re.

5s o2 in2ec"ion or s"one& "$en de"ailed

in#es"iga"ion is no" needed8. Ne(" s"e! is cys"osco!y and "$en ,rine cy"ology.3. Clinda and gen"a is "$e TOC 2or !os"!ar", endoe"ri"is& co/ e"ro isn" "o -e ,sed

in -reas"2eeding& "$o i" can -e ,sed in !regnancy *i"$ ca,"ion.

9. +or condyloa ac,ina"a& T)* acid and no" !odo!$yllin& co/ "$e la""er s$o,ldn" -ea!!lied "o ,cosal s,r2ace.

5. P'DD 4dys!$oric disorder8 is "$e se#ere 2or o2 P'S 157 are resis"an" "o

2l,o(e"ine& in "$ose cases alpra&olam is "$e second line dr,g.


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can gi#e NS.

ETH0CS

?. 0llegal iigran" *i"$ TB *orries i2 $e is re!or"ed "o "$e $eal"$ de!ar"en"&"$en i" *ill in2or "$e iigra"ion ser#ices and de!or" $i. Tell $i "$a" $eal"$

ser#ice de!ar"en" doesn" need or send iigra"ion s"a",s.

@. P" in !ersis"en" #ege"a"i#e s"age and 'ODS yo, are no" re,ired "o do any"rea"en" li%e dialysis *$ic$ yo, "$in% is 2,"ile& e#en i2 i" is agains" "$e 2ailys

*is$es.

16. P" *i"$ sy!$ilis $as ,l"i!le se(,al !ar"ners. S$o,ld "$e doc"orin2or "$e !ar"ners No& $e s$o,ld re!or" i" "o "$e De!ar"en" o2 Heal"$ Ser#ices&

and DHS *ill in2or "$e !ar"ners -y ail or !$one "$a" "$ere is a !,-lic $eal"$

"$rea"& -," i" *ill ne#er re#eal "$e nae o2 "$e !erson. 02 "$e con"ac"s call "$e

doc"or& "$e doc"or is also no" o-liged "o "ell "$e. Also "$e !a"ien" can re2,se "ogi#e o," "$e nae o2 $is con"ac"s& and *e can" do any"$ing a-o," "$a".

11. Any co,!le ,ndergoing 0+ can sell "$eir s!er or o#a& or dona"e

"$e& -," can" sell "$e e-ryo can only dona"e i".

1). E!loyers $a#e no rig$" "o order "es"s li%eAPC gene *i"$o," "$econsen" o2 "$e !a"ien". So i2 a !a"ien" coes *i"$ s,c$ 2or "o 2ill o,"& as% "$e

!a"ien" i2 $e *an"s "$e "es" done and "$e res,l" re!or"ed.13. Yo, see a !" o2 CC+ is no" on -e"a -loc%er "$e a""ending says "o

yo,&0 a in "$is -,siness long eno,g$ "o %no*.$a" "o do Re!or" "o "$e c$ie2

o2 s"a22.19. A !" coes *i"$ g,ns$o" *o,nd re!or" "o "$e !olice e#en i2 "$e

!a"ien" disagrees& 2or "$e sa2e"y o2 "$e socie"y.

15. A !" is -raindead *$o s$o,ld as% $is 2aily 2or organ dona"ion

T$e organ dona"ion ne"*or%& and no" "$e !$ysicians loo%ing a2"er $i as "$e la""er *ill -e con2lic" o2 in"eres" on o,r !ar".

1


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o#erridden -y *ill and s$ir" isn" considered as a *ill.

)1. A !" "ried "o %ill $isel2 -y s"ri%ing $is car on a "ree& and is no*

re2,sing s,rgery "o s"o! $is -leeding. $a" "o do Do "$e s,rgery. A !a"ien" inac,"e s"ress& and *$o a""e!"s "o %ill $isel2& is NOT co!e"en" "o a%e $is o*n

decisions. T$era!y can c$ange $is ind la"er& so sa#e $i 2irs". T$a"s "$e sae

logic *$y s,icidal !a"ien"s can -e de"ained agains" "$eir *ill.)). A !" is re2,sing "o "ell $is di#orced *i2e and %ids "$a" $e $as +AP.

$a" s$o,ld yo, do 0n2or "$e *i2eQQ Con2iden"iali"y ends *$en s- else *o,ld

-e $ared.)3. A !a"ien" *an"ing roan"ic rela"ion *i"$ yo, say& 0 can" da"e

yo, no*& ay-e 0 can a2"er yo, ge" a ne* doc"or. A"leas" "$e doc"or !a"ien"

rela"ions$i! $as "o end -e2ore yo, can da"e $er.

)9. A -,s dri#er *i"$ s!,", TB consis"en"ly re2,ses "o "a%eDOTS. $a" "o do Reo#e "$e !a"ien" 2ro $is d,"y and incarcera"e and "rea"

$i in "$e $os!i"al "ill $is s!,", is clear& as $e is eo!ardi/ing "$e $eal"$ o2

o"$ers.

)5. A !" $as no $eal"$care !ro(y or li#ing *ill and ge"s ,nconscio,s"$ere is no agreeen" aong "$e 2aily e-ers a-o," "$e -es" s"e! in

anageen". $a" "o do Go "o e"$ics coi""ee& and "$en "o "$e co,r" i2necessary.

)


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con"rol is "$e os" i!or"an" in !re#en"ing cardio#asc,lar or-idi"y.

3e !ro2ile s"ar" $i on ser"raline and no" nor"ry!"iline or

ii!raine& as "$e la""er $a#e i!ro#ed sa2e"y co!ared "o ai"ry!"iline& -," s"ill are no"

as good as SSR0. TCAs are less !re2erred in elderly also co/ "$ey are a" $ig$ ris% o2s,icide.

9


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59. D' !a"ien"s can $a#e emp#'sematous p'elo!ep#rts d,e "o E coli

and :le-siella *i"$ gas !resen" in !erine!$ric area. Ne!$rec"oy is iedia"ely

*arran"ed.55. Cie"idine& Pro-enicid and Trie"$o!ri ca,se in$i-i"ion o2 ",-,lar

secre"ion o2 crea"inine& ca,sing isola"ed rise o2 creat!!e in "$e ser,& *i"$ noral

BUNQ5dl o2gl,cose a-o#e noral& add 4.7 mmol,l to t#e Na concen"ra"ion. So in "$ese !a"ien"s

$ydra"ion s$o,ld -e *i"$ #al$ NS.


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!osi"i#i"y ra"e. 0+ i" coes !osi"i#e& and "$e !a"ien" $as no sy!"os& no need "o 2ollo*

,! *i"$ dsDNA "oo.


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!troprussde *i"$o," -e"a -loc%ade& as i" ca,ses re2le( "ac$ycardia *$ic$ can increase

"$e dissec"ion.

?9. An ad,l" coes *i"$ synco!e& $as no o"$er ris% 2ac"ors "$e 2irs" "$ing "odo is no" Hol"er -," a si!le $( and e( and an ECG Q

?5. 0n all !a"ien"s *i"$ "orsades& gi#e agsol irres!ec"i#e o2 "$e agnesi,

le#el. 02 agsol canno" !re#en" "$e rec,rrence& "$en do "rans#eno,s "e!orary !acing.?


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coro!ar' a!%o& and no" s"ress "es"ing& es!ecially i2 "$e !" is dia-e"ic& co/ dia-e"ics $a#e

a #ery e("ensi#e coronary -loc%ade.

163. 02 0NR is $ig$ in a !" on *ar2arin& -," no" a-o#e 5& "$en only $olding "$eCo,adin 2or a 2e* days *ill do. Hig$er "$an "$a" needs oral vt > . ++P and i# #i" : is

only needed i2 "$e !" is ac"i#ely -leeding.

169. Red,cing LDL is "$e os" e22ec"i#e *ay o2 decreasing "$e CAD ris%& BP con"rolcoes second& "$en D' con"rol and so%ing cessa"ion. B," D' is "$e single os"

i!or"an" !redic"or o2 -ad cardio#asc,lar o,"coe& s"ill %l'cemc co!trol #as!9t "ee!proved "o -e ,c$ ,se2,l. T$a"s *$y D' is ca"egori/ed as CAD e,i#alen".165. 0n a !" *i"$ s,-clinical $y!o"$yroidis& do an"i"$yroid an"i-odies. 02 "$ey are

!osi"i#e& "$en e#en s,-clinical disease needs "$yro(ine re!laceen".

16


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11=. T1 laryngeal ",or is "rea"ed *i"$ RT ainly& "o !reser#e "$e #ocal cord.

E(cision *i"$ CO) laser can -e done "oo. (emlar'!%ectom' $or TC or "$ose in#ol#ing

an"erior coiss,re. 0n "3& ind,c"ion c#emot#erap' $,"' RT can -e "ried "o !reser#e "$ec& and i2 i" 2ails& "$en total lar'!%ectom' s$o,ld -e done.

11?. O"i"is e("erna *i"$ lo"s o2 *a( 2irs" s"e! is "o clean "$e *a( and de-ris *i"$

cer,en *ire loo! or co""on s*a-Q 0rriga"ion only i2 T' is #isi-le and in"ac". Only "$en"o!ical an"i-io"ics.

11@. A !" coes *i"$ allergic r$ini"is "$e -es" ne(" s"e! is "o do !asal c'tolo%' reQ

Eosino!$ils !oin" "o allergic r$ini"is& and i2 a-sen"& !oin" "o #asoo"or r$ini"is Q1)6. A !a"ien"s sees "o -e -rain dead& -," $as $y!o"$yroidis& or elec"roly"e

anoaly or $y!o"$eria in s,c$ !a"ien"s in *$o "$e cri"eria is no" e"& do tec#!etum"ra! per$uso! scan as "$e second con2ira"ory "es" a!ar" 2ro "$e a!nea "es" and

caloric "es"ing and CT. O"$er secondary "es"s "$a" can -e ,sed are ++0 carotd Doppler0

cere"ral a!%o%rap#'0 a!d evo1ed pote!tal ! meda! !erveQ

1)1. U!rig$" s,!ine !osi"ion is ore e22ec"i#e "$an le2" la"eral in !re#en"ing as!ira"ion

in coa.

1)). Tic% -orne !aralysis a2"er $i%ing in "$e *oods can rese-le GBS d( is -y2inding "ic% a2"er care2,l s%in e(aina"ion. Eg Roc%y 'o,n"ain *ood "ic% and Aerican

dog "ic%.1)3. A !" *$o is $y!o"$eric or in s#oc1 or $e!a"ic or renal 2ail,re can $a#e severe

#'pocalcema *$en -eing "rans2,sed -lood& as "$e ci"ra"e canno" -e e"a-oli/ed -y "$e

li#er and "$e %idney.1)9. Headac$e doesn" need cT or 'R0 ,nless i" is de-ili"a"ing& or doesn" iro#e

*i"$ a!!ro!ria"e edica"ion& or s"ar"s a2"er e(er"ion li%e se(& es!ecially in elderly.

1)5. P"s on disease odi2ying dr,gs 2or 'S li%e gla"iraer or in"er2eron s$o,ld -e

,sing con"race!"i#es& as "$ese dr,gs are s$o*n "o -e "era"ogenic. 'S !a"ien"s *$o !resen"ini"ially *i"$ only se!sor' or optc s'mptoms #ave %ood pro%!oss "$an o"$er

!resen"a"ion.a. A !" *i"$ "erinal cancer 4and C$eyne S"o%es8 res!ira"ion s$o,ldn" -e res,sci"a"ed&

on gro,nds o2 2,"ili"y. -. S"ar" sele%l!e 2irs" in !a"ien"s *i"$ ild sy!"os o2 Par%insonis i" dela's t#e

pro%resso! o$ dsa"lt'. 0" is a disease odi2ying dr,g. 02 i"s e22ec"i#enessdecreases&"$en add levodopa. Aan"adine and "ri$e(i!$enidyl are no" "$e 2irs"

c$oice.

IOST*TISTI)S

4. S,icide ra"es in !$ysicians are 2o,nd "o -e $ig$er "$an in general !,-lic.

T$is is -eca,se o2 "$e con2o,nding -y $ig$ socioeconoic s"a",s. To 2ind

"$e "r,e e22ec"& *e $a#e "o calc,la"e "$e ad8usted rates& a%a s"andardi/edra"es.). One s",dy 2o,nd $ig$ ris% o2 colorec"al ca in "$ose *$o cons,e sa",ra"ed 2a"

4RR98. $a" !ercen"age o2 colon ca can -e a""ri-,"ed "o 2a" cons,!"ion ARP91>9=57. A""ri-,"a-le ris% !ercen" indica"es "$e e(cess ris% in e(!osed !o!,la"ion "$a" is

e(!lained -y "$e ris% 2ac"or.

3. Tig$"er "$e con2idence in"er#al& ore !recise is "$e s",dy. 0ncreasing "$e sa!le si/eincreases "$e precso! o2 "$e s",dy& -," i" doesn" a22ec" "$e acc,racy. *ccurac' a!d


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valdt' re!resen" "$e eas,re o2 sys"ea"ic -ias. Acc,racy is *$en "es"re"es" relia-ili"y

is good. Wder t#e )I0 more accurate a!d less precse s t#e test.

9. Sampl!% "as sa!le is no" re!resen"a"i#e o2 "$e !o!,la"ion. Eg !redic"ing !o!,la"ion !re#alence -y $os!i"al s",dies @er1eso!a! "as8& !eo!le incl,ded in "$e

s",dy are signi2ican"ly di22eren" 2ro "$ose no" in "$e s",dy@ No!2respo!de!t "as8. Ho*

"o !re#en" i" Ra!domsato!5. Res!onden" -ias *$en "$e o,"coe is o-"ained -y "$e !a"ien"s res!onse and no" -y

o-ec"i#e s".


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cl,es in "$e ,es"ion s"e.

G8 Osolar ga! and ,sing "$is conce!" "o iden"i2y "$e e"iology in e"a-olic

acidosis and in "o(icology.

'eori/e "$e 2ollo*ing 2or,lasI

18 Anion ga! 4Na8V4Cl84Hco38W

Noral ga! is 9 "o 1).

Anion ga! grea"er "$an 1) indica"es increased anion ga! e"a-olic acidosis. T$is

indica"es "$e !resence o2 a 2oreign s,-s"ance ca,sing acid-ase i-alance.

02 "$ere is acidosis 4 lo* -icar- ; It is important to know the distinction because

the causes of increased gap metabolic acidosis are different from non-gapacidosis. So, once you know whether the gap is increased or not, you can further

focus only on the relevant causes.

)auses o$ I!creased ap *cdoss @


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A logical a!!roac$ $ere is "o loo% a" "$e ,rine Na. 02 ,rine Na is lo* 4 *$ic$

yo, *o,ld e(!ec" in de$ydra"ion& diarr$ea e"c8& ,rine anion ga! "ends "o -e ore

nega"i#e and !oin"s "o*ards G0 losses 4 s,c$ as diarr$ea8So& a UAG 16 4 ore nega"i#e ga!8 indica"es a G0 ca,se 2or Non Ga!

Acidosis *$ere as a UAG ; 16 indica"es a Renal T,-,lar Acidosis.

I$ 'ou #ave d$$cult' remem"er!% t#s0 remem"er !eGUT ve 2 !e%atveU* ! "owel @UTA causes.

Re!al Tu"ular *cdoss @ RT*A

A noral ga! e"a-olic acidosis *i"$ !osi"i#e ,rine anion ga! 4 UAG8 co,ld -e

d,e "o RTA. T$ere are di22eren" "y!es o2 RTA.

Ty!e 1 4 dis"al8

Ty!e ) 4!ro(ial8Ty!e 9 4$y!orenineic $y!oaldos"eronis8

On "$e e(a& once yo, iden"i2y a e"a-olic acidosis and "$en iden"i2y an RTA&

yo, *ill -e "es"ed on "$e e"iology o2 "$a" RTA. So& i" is i!or"an" "o %no* $o* "odi22eren"ia"e -e"*een di22eren" RTAs and "$eir ca,ses.

To d$$ere!tate "etwee! varous RT*s0 $rst loo1 at t#e serum potassum. I$

>G s #%# ! a! RT* 0 t#s s most l1el' T'pe - @ "ecause low aldostero!e

causes decreased re!al e;creto! o$ acd a!d potsssumA I$ t#e potassum s

!ormal or low0 t#e! t#e RT* could "e T'pe 4 @DstalA or T'pe II @Pro;malA.

You wll !eed to loo1 at t#e ur!e p( to d$$ere!tate "etwee! Dstal a!d

Pro;mal RT*. Remem"er t#at Dstal RT* ca! !ever acd$' t#e ur!e so0

t#e Ur!e p( s !ever less t#a! /./. So0 $ a


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Ide!t$'!%


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resprator' al1aloss co2e;ste!t wt# meta"olc acdoss 4 one e(a!le o2

s,c$ i(ed disorder is Salc'late to;ct'8 .

A I$ measured PcoC s #%#er t#a! e;pected PcoC0 t#at mea!s 'our pate!t

s reta!!% )oC w#c# mea!s #e #as a co2e;ste!t Resprator' acdoss alo!%

wt# meta"olc acdoss 4 egI )ardac arrest can ca,se s,c$ i(ed acidosis -eca,se red,ced res!ira"ory dri#e ca,ses CO) re"en"ion leading "o res!ira"ory

acidosis *$ere as s$oc% -eca,se o2 cardiac arres" ca,ses lac"ic acidosis *$ic$ is

e"a-olic acidosis8.

e%: 02 Hc63 is 1


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T$e ini"ial o22ice "es" "$a" *e ,se "o de"ec" $ea",ria is XDpstc1 X. Di!s"ic% is

$ig$ly sensi"i#e -," no" s!eci2ic. +alse nega"i#es are #ery rare -," 2alse !osi"i#esare coon. Di!s"ic% de"ec"s XBLOODX -," i" does no" say *$e"$er "$is X-loodX

is an RBC or a Pigen". Ree-er "$a" !igen"s s,c$ as yoglo-in 4 as in

r$a-doyolysis8 or Heoglo-in 4 as in $eoglo-in,ria& Blac% *a"er 2e#er8 cans"ain as XBloodX on di!s"ic%. So& !lease do !ot a,"oa"ically ass,e "$a"

e#ery"$ing "$a" s"ains as X-loodX on a di!s"ic% is an RBC. 0n order "o %no* i2

"$ere is "r,e $ea",ria& "$e ne(" s"e! is "o do ,rine icrosco!y. 02 "$e ,rinere#eals RBCs "$en "$ere is "r,e $ea",ria. Ho*e#er& i2 "$e di!s"ic% reads X-loodX

and i2 "$e ,rine did no" re#eal RBCs on icrosco!y "$en yo, are dealing *i"$ a

!igen" ei"$er yoglo-in,ria 4 r$a-doyolysis8 or $eoglo-in,ria. A" "$is

!oin"& i2 "$e CP: is also ele#a"ed i" s,gges"s "$a" "$e e"iology o2 -lood on "$edi!s"ic% is R$a-doyolysis.

So& a di!s"ic% $ea",ria s$o,ld al*ays -e con2ired *i"$ ,rine icrosco!yQ

02 di!s"ic% is nega"i#e 2or -lood& i" e(cl,des a-noral $ea",ria 4 2alsenega"i#e

res,l"s are ,n,s,al *i"$ di!s"ic% "es"ing8.

e!%! causes o$ JRedJ ur!e "ut !e%atve dpstc1 test 0n soe condi"ions&yo, ay see a red ,rine rese-ling XGross $ea",riaX -," di!s"ic% is nega"i#e

2or -lood. T#s s#ould !ot "e called #ematura. T#s s 8ust redds#dscolorato! o$ ur!e.Occ,rs in I

a8 0nges"ion o2 red !igen"ed 2oods 4 egI -ee"s& -erries& r$,-ar-s& !a!ri%a8

-8 Dr,gs li%e R$amp! or P$ena/o!yridine deri#a"i#es 4 ree-er "$ese dr,gs

only ca,se reddis$ ,rine -," NOT a !osi"i#e di!s"ic%8.c8 Diseases s,c$ as XPorp#'raX

)auses o$ a Postve Dpstc1 "ut !o true (ematuraI Here Di!s"ic% s"ains !osi"i#e 2or -lood -," no RBCs in "$e ,rine

a8 'yoglo-in,ria 4 R$a-doyolysis& #igoro,s e(ercise8

-8 Heoglo-in,ria 4 0n"ra#asc,lar $eolysis8

0s "$e Hea",ria associa"ed *i"$ !ain Unders"and "$e ca,ses o2 !ainless

$ea",ria are di22eren" 2ro !ain2,l $ea",ria. Painless $ea",ria is o2"en 2ro

",ors o2 "$e ,rinary "rac"& -ladder cancer or gloer,lone!$ri"is. Pain2,l$ea",ria is o2"en associa"ed *i"$ ,roli"$iasis 4 renal calc,li8 or in2laa"ion>

in2ec"ion o2 "$e -ladder 4 Cys"i"is8.

$a" *ill -e "$e a!!roac$ "o iden"i2y "$e so,rce o2 Hea",ria T$e *or% ,! 2or

$ea",ria ay in#ol#e in#asi#e and e(!ensi#e a!!roac$es. So& i" is i!or"an" "o

de"erine "$e na",

Uworld Step 3 Synopsis

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