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Common qs in medical assessment

5 differential diagnosis for life threatening chest pain


Cardiovascular
Acute coronary syndromes (STE-ACS and NSTE-ACS)
Aortic dissection
Myocarditis (most common cause of sudden death in the young)
Pericarditis
Pulmonary embolism
Other
Tension pneumothorax
Acute chest syndrome (in sickle cell disease)
Boerhaaves syndrome (perforated esophagus)
3 causes of atrial fibrillation

High blood pressure

Heart attacks

Coronary artery disease

Abnormal heart valves

Heart defects you're born with (congenital)

An overactive thyroid gland or other metabolic imbalance

Exposure to stimulants, such as medications, caffeine, tobacco or alcohol

Sick sinus syndrome improper functioning of the heart's natural pacemaker

Lung diseases

Previous heart surgery

Viral infections

Stress due to pneumonia, surgery or other illnesses

Sleep apnea
Acute complications of IE

Myocardial infarction, pericarditis, cardiac arrhythmia


Cardiac valvular insufficiency
Congestive heart failure
Sinus of Valsalva aneurysm
Aortic root or myocardial abscesses
Arterial emboli, infarcts, mycotic aneurysms
Arthritis, myositis
Glomerulonephritis, acute renal failure
Stroke syndromes
Mesenteric or splenic abscess or infarct

Common organism for IE


S aureus causes 17% of early PVE and 12% of late PVE. Corynebacterium,nonenterococcal streptococci, fungi (eg, C
albicans, Candida stellatoidea, Aspergillus species), Legionella, and the HACEK (ie, Haemophilus aphrophilus,
Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae) organisms cause
the remaining cases.

ECG interpretation - VT, SVT, AF, Atrial flutter, LBBB, heart block
ECG interpretation - STEMI, treatment, contraindications for treatment

CONTRAINDICATIONS ABSOLUTE
Active bleeding/aortic dissection
Brain hemorrhage/AV malformation/neoplasm
Stroke

RELATIVE
Risk of bleeding Elevated BP Last 3/12 surgery
Active peptic ulcer/ASA
Traumatic CPR
Internal bleeding (UGIB/UTI) / INR >2
Vascular puncture (non compressible)
Exposure to streptokinase >5days within 12mo)

Normal ECG feature


Antihypertensive drugs: Types v.s Name
5 causes of secondary hypertension
Chronic kidney disease
Sleep apnea
Tumors or other diseases of the adrenal gland
Coarctation of the aorta -- A narrowing of the aorta that you are born with that
can cause high blood pressure in the arms
Pregnancy
Use of birth control pills
Alcohol addiction
Thyroid dysfunction
List down investigation to rule out causes of secondary hypertension

Condition

Screening Test

Chronic kidney disease

Estimated glomerular filtration rate

Coarctation of the aorta

Computed tomography angiography

Cushing syndrome; other states of glucocorticoid


excess (eg, chronic steroid therapy

Dexamethasone suppression test

Drug-induced/drug-related hypertension*

Drug screening

Pheochromocytoma

24-hour urinary metanephrine and normetanephrine

Primary aldosteronism, other states of


mineralocorticoid excess

24-hour urinary aldosterone level, specific mineralocorticoid


tests

Renovascular hypertension

Doppler flow ultrasonography, magnetic resonance


angiography, computed tomography angiography

Sleep apnea

Sleep study with oxygen saturation (screening would also


include the Epworth Sleepiness Scale [ESS])

Thyroid/parathyroid disease

Thyroid stimulating hormone level, serum parathyroid


hormone level

Definition of shock
Shock is defined as a state of cellular and tissue hypoxia due to reduced oxygen delivery and/or increased oxygen
consumption or inadequate oxygen utilization.

5 common causes of shock

Heart conditions (heart attack, heart failure)

Heavy internal or external bleeding, such as from a serious injury or rupture of a blood
vessel

Dehydration, especially when severe or related to heat illness.

Infection (septic shock)

Severe allergic reaction (anaphylactic shock)

Spinal injuries (neurogenic shock)

Burns

Persistent vomiting or diarrhea

Features of life threatening / severe asthma


Near fatal asthma

Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures

Life-threatening asthma

Any one of the following in a patient with severe asthma


PEF <33% best or predicted
SpO2 < 92%
PaO2 < 8 kPa
Normal PaCO2 (4.66.0 kPa)
Silent chest
Cyanosis
Feeble respiratory effort

Bradycardia
Dysrrhythmia
Hypotension
Exhaustion
Confusion
Coma
Acute severe asthma

Any one of:


PEF 3350% best or predicted
Respiratory rate 25 min1
Heart rate 110 min1

5 clinical features of status asthmaticus


Persistent shortness of breath
The inability to speak in full sentences
Breathlessness even while lying down
Chest that feels closed
Bluish tint to your lips
Agitation, confusion, or an inability to concentrate
Hunched shoulders and strained abdominal and neck muscles
A need to sit or stand up to breathe more easily

Management of asthma, severe asthma, life threatening asthma


Clubbing definition and causes
bulbous uniform swelling of the soft tissue of the terminal phalanx of a digit with subsequent loss of the normal angle
between the nail and the nail bed.

Heart defects that are present at birth (congenital)


Chronic lung infections that occur in people with bronchiectasis, cystic fibrosis, or
lung abscess
Infection of the lining of the heart chambers and heart valves (infectious endocarditis). This

can be caused by bacteria, fungi, or other infectious substances

Lung disorders in which the deep lung tissues become swollen and then scarred (interstitial
lung disease)

Lights criteria
Fluid is exudate if one of the following Lights criteria is present: [1, 2, 3, 4]

Effusion protein/serum protein ratio greater than 0.5


Effusion lactate dehydrogenase (LDH)/serum LDH ratio greater than 0.6
Effusion LDH level greater than two-thirds the upper limit of the laboratory's reference range of serum LDH

ABG interpretation
X-ray interpretation pneumothorax, pleural effusion, lobar pneumonia
X-ray (pleural effusion)
Describe findings from CXR
Diagnosis left side pleural effusion
5 possible cause

Altered permeability of the pleural membranes (eg, inflammation, malignancy, pulmonary embolus)
Reduction in intravascular oncotic pressure (eg, hypoalbuminemia due to nephrotic syndrome or cirrhosis)

Increased capillary permeability or vascular disruption (eg, trauma, malignancy, inflammation, infection, pulmonary
infarction, drug hypersensitivity, uremia, pancreatitis)
Increased capillary hydrostatic pressure in the systemic and/or pulmonary circulation (eg, congestive heart failure,
superior vena cava syndrome)
Reduction of pressure in the pleural space, preventing full lung expansion or "trapped lung" (eg, extensive
atelectasis, mesothelioma)
Decreased lymphatic drainage or complete blockage, including thoracic duct obstruction or rupture (eg, malignancy,
trauma)
Increased peritoneal fluid, with migration across the diaphragm via the lymphatics or structural defect (eg, cirrhosis,
peritoneal dialysis)
Movement of fluid from pulmonary edema across the visceral pleura
Persistent increase in pleural fluid oncotic pressure from an existing pleural effusion, causing further fluid
accumulation

X-Ray (Lobar Pneumonia)


Describe findings from CXR
Common organisms
Streptococcus pneumoniae, also called pneumococcus, Haemophilus influenzae and Moraxella catarrhalis.
Mycobacterium tuberculosis, the tubercle bacillus, may also cause lobar pneumonia if pulmonary tuberculosis is not
treated promptly.

Treatment
OHA types (4) with examples each
3 Microvascular complications of DM, how to screen / investigate for each
diabetic nephropathy, neuropathy, and retinopathy

The diagnosis of nephropathy is initially based on development of microalbuminuria. Microalbuminuria is defined as an albumin
excretion rate of 20 to 200 g/min. Because the average daily albumin excretion rate can vary by 40%, it is recommended that
three urine collections be made over several weeks before making this diagnosis. Overt nephropathy is defined as an albumin
excretion rate greater than 300 mg in 24 hours. This is associated with a linear decline in glomerular filtration rate (GFR) ranging
from 0.1 to 2.4 mL/min/month.
Diagnosis of retinopathy is based on finding the diagnostic signs of retinopathy on eye examinations as discussed earlier.
The diagnosis of neuropathy is based on presence of weakness or diminished sensation as described earlier. These findings can
be confirmed with nerve conduction studies.

Joness criteria for Rheumatic fever


Diagnostic : 1 Required Criteria and 2 Major Criteria and 0 Minor Criteria
Diagnostic : 1 Required Criteria and 1 Major Criteria and 2 Minor Criteria
Required Criteria
Evidence of antecedent Strep infection: ASO / Strep antibodies / Strep group A throat
culture / Recent scarlet fever / anti-deoxyribonuclease B / anti-hyaluronidase
Major Diagnostic Criteria
Carditis
Polyarthritis
Chorea
Erythema marginatum

Subcutaneous Nodules
Minor Diagnostic Criteria
Fever
Arthralgia
Previous rheumatic fever or rheumatic heart disease
Acute phase reactions: ESR / CRP / Leukocytosis
Prolonged PR interval

Dengue Phases

Dengue pt headache causes


Name 2 gram +ve organism and 2 gram ve organism

The proteobacteria are a major group of gram-negative bacteria, including Escherichia coli (E.
coli), Salmonella, Shigella, and
other Enterobacteriaceae,Pseudomonas, Moraxella, Helicobacter, Stenotrophomonas, Bdellovibrio, acetic acid
bacteria, Legionella etc. Other notable groups of gram-negative bacteria include
the cyanobacteria, spirochaetes, green sulfur, and green non-sulfur bacteria.

Give the name of infection / disease caused by each bacteria mentioned above
Give one example of antibiotics for gram +ve bacteria
Aminoglycosides vancomycin
Give one examples of antibiotic for gram ve bacteria
Physical sign of liver cirrhosis
3 causes of liver cirrhosis
3 Complication of liver cirrhosis
Hypokalaemia Causes & management
Hypokalaemia ECG changes
Hyperkalaemia Causes & management
Hyperkalaemia ECG changes
Hypercalcaemia causes
One Emergency & important management for hyperCa2+
2 causes of pathological fracture
5 most Common primary tumour that cause bone mets
Fundoscopy interpretation: Hypertensive retinopathy & Diabetic retinopathy
http://www.optometry.co.uk/uploads/exams/articles/cet_02_09_2011_otoole.pdf
What is glasgow coma scale and write down each components

CT brain interpretation subdural hemorrhage


CT brain (subdural hemorrhage)
Describe findings from CT brain
Diagnosis (right ? region subdural hemorrhage)
What is your management in emergency department
Write down 4 blood products that you know
Complications of blood transfusion

CASE SCENARIO
67 years old, kco DM, HPT, c/o epigastric pain, vomiting etc. no diarrhoea and etc.
Three urgent investigations that you will ask for.
A man came to ED with profuse sweating and ., symptoms started 1 hr ago,
a) What is the findings of ECG ( ST elevation, LBBB, Tall tented T wave)
b) What is your diagnosis ( anterior MI, STEMI )
c) What is your urgent management for this pt.

18yo, chest pain.. (pericarditis)


a) Describe ECG findings
b) Ddx for this chest pain
c) Causes of ST elevation
d) Causes of the condition
A 56 yrs. old man came to ED, complaint of shortness of breath, chest pain when coughing. He was a
chronic smoker. SP02 85 % RA, pain not relieved by analgesia. A canister of combivent found in his
pocket.
a) Describe the cxr (tension pneumothorax)
b) ABG (type 1 respiratory failure)
c) What is your urgent management
d) What is your further management
e) What is the cause

60yo, malay with underlying DM for 20years, poorly controlled, latest HbA1c is 9%, on 2 types OHA
and just added s/c insulatard 16U ON.
Hpt diagnosed 6 years ago, on 2 types of antiHPT. Patient also diagnosed rheumatoid arthritis for
20years and on using painkiller frequently whenever she had pain, with history of taking traditional
medication.
Patient developed SOB and bilateral lower limb swelling for 2 weeks, associated with lethargy, feeling
unwell,
(ABG given)
a) Interpret the ABG
b) What are the causes for the above ABG result, please state two.
c) What is the condition he has?
d) What is the cause for the condition he had in (c).
e) List 3 important investigations u want to do
f) State 3 other examination / complication you want to look for.

Patient 14yo, uncontrolled GM, urine ketone positive.., fever 40 degrees, tachycardia HR 130bpm,
Bp lowish 80/60mmHg, neck stiffness.
a) List down current issues
b) Interpret ABG
c) Outline management
d) Causes of low BP
e) Causes of neck stiffness
f) How to investigate neck stiffness.
HONK
a) How to calculate serum osmolarity
b) treatment
20 years old malay lady presented with joint pain + stiffness 2/52, worsen for 3/7, associated with fever
1/52
On examination, She had facial rash, oral ulcer
a) What is the most likely diagnosis
b) What are the other features that can be found for your answer in the above question, please
state 5.
c) What are the investigation u want to do, please state 5.
d) What are the complication that may occur for this disease, state 5.
16yo, GCS 5/15, list down 10 causes for coma
Addisonian crisis

To take Consent
Indication(s)
Risk and benefit
How is the procedure carry out (roughly)
How to take a consent for OGDS
How to take a consent for Lumbar Puncture
How to take a consent for BMAT

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