By Guest Chittaranjan Das
Recalls on 15/06/2016
1: Cystic fibrosis in one child sister asking for ownself............. No risk 2: Bankok person with erythyma and patechie, didn’t take malaria prophylaxis....i did typhoid but don’t know 3: S1 damage 4 ECG 5: Cervical smear 6: Insect in ear 7 Incidence rate 500 8: Relative risk 2 9: Dose of trimethoprim in a child...........4ml 10 Uric acid in man with big toe pain............ 11 Scenario of depression .......................fluxetein 12 Bicep tear.........(confusing case) 13 DVT 14 Cardiac temponade triad asked 15 cluster headache..........watery eye .........young man 16 Risk of ectopic pregenancy..........(IUCD) 17 Periorbital swelling in a child after URTI. Investigation ..........CT 18 Man with back pain +intermittent heamaturia......Ca prostate or Ca bladder? 19 Mole on pinna and nodules in neck....BCC or SCC? 20 conn’s syndrome.....hypokalemia and hypertension 21 Cushing (obese lady history of 23 Itp scenario 24 Itp case 2 Recalls 15/06/2016 By Dr Mehrunisa 25 Heamorrides (young girl fresh painless bleeding) 26 UC (Pathology description) 27 Paratent nutrition or gastronomy in a man having swallowing difficulties. 28 Heroin ..OD 29 Ectary...OD 30 Vitilgo in women.......................................pernious anaemia 31 Thiamine infusion in wernikes 32 Menengitits case in a child ( full recovery) 33 COPD case(prudent –sputum e speaks of blood 34 Man with urinary retention .....................catheter 35 Obese man with haitus hernia has hoarness of voice( Where to refer ent or git) 36 TB investigation 37 Infertility case, 32 days regular cycle when to calculate the egg ovalution. ..............25 days 38 Cyanosis in a man ...........(immediate action) 39 Patent ductus arteriosus in a preterm child. 40 Patient during surgery had glucosoria after surgery was normal in FBS. 41 Child at home have fits (urea and electrolytes) 42 Child went blank while talking, teacher says it has happened many times (partial seisure) 43 Elthmoid bone injury 44 Jaundice in a man 45 Child chokes on food ( Back Slaps) 46 Cot death prevention ( spine position) 47 Mass e horseness of voice in anti triangle of neck .............Carotid body fumor) 48 Schizopherinic patient not complaint on oral medication. What is the best long term management ( dept resperidone) Recalls 15/06/2016 By Dr Mehrunisa 49 Patient e severe unilaterial electrical shock like pain in jaw moving upward, corneal reflexes normal.....tx. gabapentin 50 Ceolic disease....inx. 51 menengitis prophylasis of a child.....to family , doctors and nurses attending 52 shipyard worker....how to improve condition ....chemotherapy or pleural effusion 53 ankle swelling cause.....amlodipine 54 pt. was not suicidal now....admit 55 drug of hypertension....Acei 56 butcher stabbed in groin.....normal saline 57 young lady has CIN, what can be done to decrease chances of cervical cancer....stop smoking 58 post natal depression.....mother was having guilt 59 young boy with high blood sugar....FBS 60 impaired glues tolerance test....values were given 61 phrenic nerve damage in stabbed neck injury 62 acoustic nueroma case 63 digoxin toxicity 64 uleratice colitis case.....i did mesalazine 65 copd case management.....NIPPV 66 hypercalcemia....pamidronate 67 melena stools.....inx. 68 ca. Oesophagus tx. Stenting 69 child took paracetamol OD 2 hrs ago, when to check levels.....in 2 hrs 70 lady on depo provera has ammeanorrhea .....check pregnancy test 71 female ovarian surgery...developed shortness of breath....venograpy 72 loss of vision in young girl....conversion disorder 73 lady having agarophobia 74 atrial fib. Aspirin or warfarin Recalls 15/06/2016 By Dr Mehrunisa 75 lady with headache while painting house bruise on temple....inx. CT 76 cereberal malaria inx....thin and thick blood film 77 case of testicular torsion 78 testicular teratoma( pathology picture mentioned of cartilage) 79 lyme disease case with itching.... 80 IM adrenaline dose in adults 1:1000 81 post traumatic stress disorder case 82 typical case of stroke...with limb weakness nd slurred speech 83 a very detailed case of vomiting asking metabolic change.....hypokalemia 84 alzheimers case...history of falls 85 tension pnuemothorax but options were confusing...needle thorac. Or bilateral bore needle 86 pt. With anxiety took OD of something....cant remember .....propanalol 87 thoracic anuresym 88 pregnant lady with fits given MgSo4 ...agin having fit....MgSO4 bolus 89 child has dirrhoea and vomiting....mx...normal saline over mins 90 child with sever respiratory distresss...sign of detoriation...intercostal resection 91 COPD intial inx.....chest xray 92 4 year child with recurrent swelling of kness and elbows, feels generally unwell,cant take part in sports...inx...ESR 93 lady 34wks pregnant attends ANC, having Hg.111g/l, not sure weather it was low level so i did give ferrous sulphate 94 vesico-uretric-reflex case in a child on cytoscopy....what to advice parants....surgery 95 young female has right hypochondrium....inx hepatitis screening 96 epiglotitis case but very confusing option cant remember 97 fecal impaction case 98 side effects thiazides.....hyponatrimia 99 vestibular neuritis case Recalls 15/06/2016 By Dr Mehrunisa 100 Contraception advice for a woman with menorrhagia....mirena 101 pregnant lady with abdominal pain.....placental abruption 102 pale stool in a pt. I did pancreatic ca. 103 hypertensive british man on thiazides needs a second drug to control his BP...Amlodipine(CCB) 104 a case of pontine hemorrhage (dilated and unresponnsivepupil) 105 a lady with valve replacement...diagnosis of infective endocardiatis...blood culture 106 during operation trocer was inserted b\w umbilicus and ileac spine....which structure is damage....external obliques and aponuosis 107 breast lump FNAC showing benign changes...core biopsy 108 a lady 15 weeks pregnant asking for chromosomal screening time.....15-18 weeks 109 pt. has already left the habbit of alcohol, but going to attend daughter’s wedding wants help to remain away from alcohol.....acamp or disulf or CBT 110 urgent endoscopy case even after resuscitation 111 diabetic pt. Having difficulty in moving....amyotropy 112 pt.with loss of sensation on dorsum of thumb and index finger....nerve damaged radial or medial. 113 Child with cyanosis two weeks post delivery:TOG? 114 cns was forgetfulness and visual helosination? don't remember the answer 115 A scenario of DKA I think,immediate management:insulin and IVF 116 Regarding the question of suspected PE, continue heparin and do CTPA or increase heparin and do CTPA? 117 Women with proptosis,diarrhoea,weight loss etc,with family history of dm and thyroid disorder:appropriate investigation,TFT or anti tissue transglutaminase? 118 Patient with balanitis.......,necessary investigation:FBS? 119 Loss of pulsein popliteal artery and foot arteries. External iliac artery 120 Jaundice,elevated liver enzymes,hepatitis b positive and hep c negative,investigation:? 121 Endo:pt with weight loss,diarrhoea etc:asking for mechanism:Increase catabolism 122 child with proteinuria and swelling of face other symptoms Usg, antibiotics, prednisolone 123 Partial thickness burn with airway...:intubation? 124 A person with metastatic lesions in spine. She is not relşeved by morfine. What do you do most defşnşteve? Bifosfonat or radiotgerapy? İ chose radiotherapy 125 Malodorous non itchy on discharge. Gardrenella? 126 A question on ascites demonstrable by shifting dullness , aspirate clear with low leukocytes. Patient stable clinically . 127 Most important drug?. There was corticosteroid, aziothropine, etc………..Spironolactone 128 in one question the ask treatment of mania ?....Lithium 129 on walking calf pain and may be breathless? option don't remember ?........Duplex or dopler 130 menopause lady with hot flushes …..estrogen progesteron? 131 my understanding there was only 1 q of pneumonia ………..Staphyloccocus 132 deaf mother came with the child to check hearing……… 133 brain stem test………. 134 There was a question....on oesophagoscopy massive inflammation and vague signs of narrowing. Cancer or Barret ? 135 There was a helico Bacter question too…….serology 136 After using some drug rash appeared. Erythema multiforme 137 Spread of chicken pox…..air borne 138 One person with angina. Best definştşve way to diagnose. There was CT ANGİO MYOCARDİUM…..echo 139 4 year old child with wet betting-- behavioral tx 140 Patient 75 year okd. Already on aceinh. Her three measures of bloood pressure are like 158/78 her alecteolytes are ok. What do you choose as next antihypertensşve? 1- amlodipine 2- frusemide 3- losartan…..amlodipine 141 Girl with low levels of paracetamol OD, not suicidal. My answer liason pshyciatry. 142 Child with fever etc..features of neonatal sepsis.admit and give anbiotics 143 Fever with non blaching rash...meningococcal sepsis? 144 A patient LEFT ILIAC pain with a single big biliary stone,…………..lap cholestectomy 145 Big stone was in pelvi -ureteric junction = obstructed = laparotomy 146 Woman with intermenstrual spotting taking cocp and has ectropion not bleeding on touch ..the best invx is colposcopy . 147 Female with inflammatory change pap smear but no pelvic pain or discharge ..swab or repeat 6 months later...?? 148 A case of Rigth hydronepfrosis. Left kidney was removed before . What do you do? Nefrostomy or percutaneous nephron 149 Investigation for osteoporotic fracture ………… nuclear medicine of bone 150 Female with mobile cystic mass in left iliac fossa ..ovarian cyst torsion 151 Breast lump FNAC C3 (probably begnin ) next step Reassure? Core biopsy? 152 one question PE?......... Increase LMWH + arrange for CTPA ? OR Keep the same dose LMWH + CTPA 153 Eye question:bacterial conjunctivitis….. TOPICAL ANTIBIOTIC eye drop? 154 Testis:acute epididymoirchitis 155 Elderly with months of incontinence,had excoriation,something dragging,initial management?............ Urodynamic studies 156 palpitaion for 12 hour then now again for to hours to confirm the diagnose ……….. troponin 157 What about this 16 girl with anorexia nervosa ..admit or assess under mental health team………..ADMIT 158 Psychiatry :man with symptoms of moderate depression but no suicidal intent.olanzapine? 159 was there any question acoustic neuroma ………..MRI Brain 160 One previous miscarriage in first trimester,now bleeding pv.aspirin with heparin?or normal Antenatal……..Admit or aspirin and heparin 161 treatment of benzodiazipine at home don't remember man or women per rectal…… 162 Sudden breathlessness after hip replacement/surgery:fat embolism 163 Family wants to know about Alzheimer :progressive cognitive impairment. 164 there was a question after burn?..............secure the air ways………. 165 Jerking in leg with Loc:……………complex partial seizure 166 Child from Ghana. 6 weeks after. Took prophylactic. 167 SIADH case 168 Surgery:………….scenario of ruptured aorta 169 10 paracetamol suicide attempt an elderly man ………… phchiatry assessment? 170 A man had rash after footbball game. He has histıry of eczema . What do u do? Oral chlorpheniramine 171 There was a question about a person on thiazide after a surgery has sudden pain in his knee. What investigation would you do...1. joint aspiration……2 Serum uric acid… 172 PID case tx asked…….ofloxacin and metromidazole. 173 Patient treating dyspepsia for 10 years with no treatment,presenting to you for the first time,investigation:helicobacter antigen ,endoscopy or urea breathe test. 174 Adrenaline given with local anaesthetic………Augments effect. 175 ns was forgetfulness and visual helosination?...Lewy dementia 176 pt with occasional spherocytes and high reticulocytes…… Direct comb test 177 pt on gliclazide management before surgery what to do Stop oral drugs 3 days before Stop on day of operation Start gki before operation 178 values of raised Hb and pcb what hormone I check Erythropoietin 179 asthmatic child develop rash what give Chlorphenaramine, epinephrine 180 scenario of Polycstic kidney disease I think inv Usg 181 scenario of liver disease with ascites. What to do. Spirionalactone 182 Ca bladder case 183 case hyadatiform mole
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A client with pulmonary edema has been on diuretic therapy. The client has an order for additional furosemide (Lasix) in the amount of 40 mg IV push. Knowing that the client also will be started on Digoxin (Lanoxin), a nurse checks the client’s most recent:
A Digoxin level
B Sodium level
C Potassium level
D Creatinine level
Answer and explanation?
A 3 days old neonate has presented with the ho vomiting for last 24 hours. serum measurement is showing hyponatremia and Hyperkalaemia. What will you do next to make your presumable Dx?
a. Renal function test.
b. Liver function test.
c. Heel Prick blood spot sample
d. Plain abdominal film
e. Coagulation profile
Answer and explanation please?