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QId: 3993 Pediatrics - Allergy & Immunology

IgA deficiency is associated with autoimmune diseases (celiac disease) and atopy (asthma,
eczema)

QId: 3195 Pediatrics - Allergy & Immunology

in every immunodeficiency
please calculate the B cells, T cells, and check the levels of immunoglobulins.

QId: 12519 Pediatrics - Allergy & Immunology

CVID is associated with autoimmune disorders like RA, thyroid disease

QId: 2134 Pediatrics - Allergy & Immunology

live vaccines are not to be given because of immunodeficiency


the other vaccines cannot elicit an immune response
so there is no use of vaccination

QId: 4686 Medicine - Biostatistics & Epidemiology

to calculate incidence you need to do a cohort study


there is no other way out

QId: 3998 Medicine - Biostatistics & Epidemiology

the two sample t test is a statistical method that is commonly employed to compare the
means of two groups of subjects.

QId: 10763 Medicine - Cardiovascular System


WTF
even cyanide toxicity presents with altered mental status, seizures, lactic acidosis and coma

similar to alcohol withdrawal delirium tremens. but remember alcoholic seizures occur suring
12-48 hours after last intake
so if it is after 5 days - do not think of alcoholic seizures

QId: 6945 Medicine - Cardiovascular System

ADHF:
normal or elevated blood pressure - LMNO
lasix morphine nitroglycerin oxygen (NIV)

hypotension or altered mental status:


LNEO
lasix
norepinephrine
oxygen

QId: 12282 Surgery - Cardiovascular System

local complications of cardiac catheterization:

hematoma: +/- mass, no bruit

pseudoanerysm: bulging pulsatile mass, systolic bruit

AV fistula: no mass, continuous bruit

QId: 4854 Pediatrics - Cardiovascular System

treat viral myocarditis on the ICU due to risk of shock and arrhythmias
treat viral myocarditis by diuretics and inotropes

QId: 12534 Medicine - Cardiovascular System


lol
there are complications of hypertension like left ventricular hypertrophy and hypertensive
retinopathy but no hypertension noted in the clinic

ambulatory blood pressure monitoring is indicated


if the average is >/= 135/85
hypertension can be diagnosed and should be started on treatment

QId: 4682 Medicine - Cardiovascular System

a difference in blood pressure measurements in upper and lower extremity is due to CoA

and generally diff in BP between two upper limbs is considered a clue of aortic dissection

but it can just be due to subclavian stenosis


so do not take difference in BP between two arms as a clue/guide to your diagnosis

QId: 2771 Medicine - Dermatology

photo toxicity is due to the reactive oxygen species that are formed due to the drug

photoallergic reaction is due to UV light changing the structure of the drug molecule
this leads to activation of immune symptoms and eczematous lesions

QId: 4693 Medicine - Dermatology

mupirocin can eradicate MRSA from nares!!!

QId: 3472 Surgery - Dermatology

1. no ulcer
2. ulcer
3. ulcer shows subcutaneous fat
4. ulcer shows bone
non stage-able. ulcer is covered by an eschar which has to be removed for staging

QId: 2778 Pediatrics - Dermatology


why in IDA - the RDW is high

because RBCs are produced throughout the day


and the availability of iron varies with time
hence the variability in size

why in IDA - thrombocytosis


because of the hypoxia the drive for RBC production is high
precursor for both RBC and plat is the same
but iron is not available
so RBC count is LESS but PC is MORE

QId: 3755 Pediatrics - Dermatology

CDM is fine but

if there is cafe au lait spots __ MRI brain


if there is sacral dimple__ Sacral ultrasound

QId: 2774 Medicine - Dermatology

DH can come both before and after the onset of diarrhea

QId: 15962 Surgery - Ear, Nose & Throat (ENT)

candida bhi epiglottitis kar de raha hai


in HIV patients that is

usually it is very severe


so
the treatment is
Anti fungal therapy (Amp -B)
+
vancomycin
+
ceftriaxone

QId: 2190 Medicine - Endocrine, Diabetes & Metabolism


>60 -- BP goal <150/90
<60 -- BP goal <140/90
CKD, DM -- BP goal <140/90
DM with nephropathy -- BP goal try for <130/80

QId: 4124 Obstetrics & Gynecology - Endocrine, Diabetes & Metabolism

so basically
TBG increases
free T decreases
B hCG acts on TSH receptors
Total T increases and Free T comes back to normal
negative feedback
TSH decreases

QId: 12423 Pediatrics - Endocrine, Diabetes & Metabolism

most common complication of infants of diabetic mothers is neonatal hypoglycemia

QId: 4756 Obstetrics & Gynecology - Female Reproductive System & Breast

fecundability is the probability of conception


for which you need a good quality ovum

fecundability decreases starting from the age 35

therefore, even if there are regular periods


there my be infertility

QId: 15189 Obstetrics & Gynecology - Female Reproductive System & Breast

important to note that, in children


vulvar lichen sclerosus is a clinical diagnosis and does not require a vulvar punch biopsy to
rule out malignancy

QId: 14197 Obstetrics & Gynecology - Female Reproductive System & Breast
so
if lichen sclerosus
and abnormal PAP --
it is ca vulva

QId: 4766 Obstetrics & Gynecology - Female Reproductive System & Breast

nowadays culture and microscopy are not used

NAAT is used

if gonococci + chlamydia + azithro + ceftriaxone


if only gonococci + azithro + ceftriaxone (due to emerging ceftriaxone resistance in some
strains)
if only chlamydia + azithro only

QId: 12479 Obstetrics & Gynecology - Female Reproductive System & Breast

chalo
smoker lesbians at least get this one
bacterial vaginosis

QId: 8903 Obstetrics & Gynecology - Female Reproductive System & Breast

what is the protocol of an adnexal mass ?

QId: 3757 Obstetrics & Gynecology - Female Reproductive System & Breast

smoking is proper risk factor

QId: 12052 Obstetrics & Gynecology - Female Reproductive System & Breast
so first
there is an adnexal mass
we do a pelvic ultrasound
we know that there is an ovarian mass
then we do CA 125 (which is not done here)
then we predict the risk of cancer
(in this case there was ovarian mass with ascites, so there is a high chance of malignancy)
if it is high risk for malignancy
exploratory laparotomy and staging

QId: 12063 Obstetrics & Gynecology - Female Reproductive System & Breast

it is very important to differentiate between vulvovaginal atrophy and vulvar lichen sclerosus

QId: 2299 Obstetrics & Gynecology - Female Reproductive System & Breast

so to detect mets
do not do Chest CT do X ray

even if the sensitivity of Ct is higher in detecting mets


thats what we do not want

because it has been seen that


if in a CXR you don't find mets ---> finding them on CT would not change the prognosis

interesting

QId: 15128 Obstetrics & Gynecology - Female Reproductive System & Breast

in the pre-pubertal age


granulosa cell tumors present with precocious puberty

in the elderly age group - peri/post menopausal age group


increased estrogen leads to
breast tissue proliferation leading to fibrocystic changes
endometrial hyperplasia and uterine enlargement

QId: 2392 Obstetrics & Gynecology - Female Reproductive System & Breast
OCPs increase the risk of cervical cancer

OCPs decrease the risk of endometrial and ovarian ca

QId: 4768 Obstetrics & Gynecology - Female Reproductive System & Breast

carboprost is contraindicated in asthma

so then give oxytocin

QId: 3241 Pediatrics - Female Reproductive System & Breast

copper t not only prevents implantation


before that
it is toxic to both the sperm and ova
as a result preventing fertilisation in the first place

QId: 12161 Obstetrics & Gynecology - Female Reproductive System & Breast

vaginal atrophy and vulval lichen sclerosus may present with dryness and pruritis

both osf them may present with dysuria and dysparaeunia

but lichen sclerosus can not involve the vagina


so phrases like - vaginal rugae are absent, intermittent spotting, vaginal petechiae etc will be
s/o vulvovaginal atrophy

QId: 12111 Obstetrics & Gynecology - Female Reproductive System & Breast

bartholin glands cysts are found at the posterior vaginal introitus

skene gland cysts are found in the paraurethral region

gartner duct (remnant of wolfian duct) cyst is found in the upper anterior vagina

QId: 2408 Obstetrics & Gynecology - Female Reproductive System & Breast
generally for post menopausal osteoporosis Bisphophonates are used and is more efficacious
than SERMs
then what are the indications of raloxifene ?
1. intolerance (e.g. pill esophagitis)
2. high risk of invasive breast cancer which can be prevented by giving raloxofene

QId: 12499 Obstetrics & Gynecology - Female Reproductive System & Breast

woa woa woa


for pelvic organ prolapse even in procidentia
surgical and non surgical intervention has similar results

therefore if a patient is a poor surgical risk


use pessaries for her

QId: 2416 Obstetrics & Gynecology - Female Reproductive System & Breast

PID Rx
OPD: i.m. ceftriaoxone + oral doxy

IPD: i.v. cefoxitin or cefotetan + oral doxy


if refractory: i.v. clindamycin + i.v. gentamicin

TOA: add metronidazole

QId: 15136 Obstetrics & Gynecology - Female Reproductive System & Breast

sometimes the only difference between sertoli leydog cell tumor and PCOS is the testosterone
levels

PCOS: there is only hirsutism and no virilisation


SLCT: there is virilisation

QId: 4792 Obstetrics & Gynecology - Female Reproductive System & Breast
suspect syphilis

RPR + TPHA
if negative

empiric i.m. benzathine pn G

repeat RPR @2 weeks to establish baseline titers


repeat RPR @6 months to test for cure

QId: 15710 Surgery - Gastrointestinal & Nutrition

if sliding hernia is symptomatic (reflux symptoms) give PPI


if refractory - nissen fundoplication
if asymptomatic - just observe

QId: 16000 Surgery - Gastrointestinal & Nutrition

only grade IV -- surgical management


grades I II III -- medical management
behavioural and topical analgesics, astringents, hydrocortisone

QId: 2478 Pediatrics - Gastrointestinal & Nutrition

maternal contraindications for breast feeding include


1. active TB within 2 weeks of start of ATT
2. HIV infection (in developed countries)
3. herpetic breast lesions
4. varicella infection <5days prior to or within 2 days of delivery
5. chemo/radio
6. drug abuse/ alcohol

the only infant contraindication of breast feeding


galactosemia

QId: 4817 Pediatrics - Gastrointestinal & Nutrition


babies acquire a lot a fluid in utero and during labour
this is lost in the form of weight
so there is weight loss upto 7% (not more than that)
during the first 5 days of life

breast feeding frequency : 10-20 minutes each breast q4h

QId: 2479 Pediatrics - Gastrointestinal & Nutrition

full term infants need vitamin D supplementation

preterm infants need Iron and Vitamin D supplementation

QId: 16068 Surgery - Gastrointestinal & Nutrition

the only solid liver mass that you diagnose by its appearance on imaging and not by history is
focal nodular hyperplasia
presence of a central scar, arterial flow
associated with anomalous arteries
rest of them
hepatic adenoma (OCPs), etc ...

QId: 2977 Medicine - Gastrointestinal & Nutrition

so,
if bilirubin is high
think if it is conjugated or unconjugated (directly by looking at lab values or urinalysis)

if it is conjugated, do LFT
if it is AST ALT >ALP -- do serology etc
if it is ALP > AST ALT -- do abdominal USG and antimitochondrial antibodies

QId: 4647 Medicine - Hematology & Oncology


thrombolytics in DVT only if hemodynamically unstable
!! !! !! !! !! !! !! !! !! !! !!

if stable
use heparin/warfarin/factor Xa inhibitors

QId: 15458 Pediatrics - Hematology & Oncology

this question is amazing


patient's origin is mediterranean
but she bleeds profusely during menses
so the patient is at risk for both thalassemia and IDA

now
which test do you do to diagnose the condition? HB elec or Iron studies
Iron studies . why ?
1. she may be having thal but it may be superadded by IDA
2. you can to some extent differentiate between thal and IDA in Iron studies
3. best is: if there is IDA, due to the already less production of Hb, you will get falsely low
HbA2 result.
your test of Hb elec would be false negative.
so first treat the IDA and then diagnose thal

QId: 4654 Medicine - Infectious Diseases

PCT is associated with HCV was known to me


What I learnt from this question is
In chronic hepatitis C infection the LFTs can be normal ..... shittt

QId: 3888 Medicine - Infectious Diseases

So HAV vaccination is given not because the person is immunocompromised in HIV/AIDS.


It's given only if the person is MSM
Or has chronic liver disease which poses him to have a risk of complications.
Let's say the person got HIV from a needle stick injury
There's no need to give it

QId: 3422 Medicine - Infectious Diseases


Gabalentin is indicated for its herpetic neuralgia and not for acute shingles
So there shouldn't be any issue with choosing one between pain control and infection control
Clearly gabapentin cannot relieve pain acutely
So it's infection control

QId: 12427 Medicine - Infectious Diseases

the lymphadenopathy is typically tender in infectious mononucleosis


this patient had non tender lymphadenopathy

QId: 3105 Medicine - Infectious Diseases

give TMP SMX after solid organ transplantation

QId: 4833 Pediatrics - Infectious Diseases

the treatment of viral meningitis is just supportive


fluids
antipyretics

QId: 3660 Pediatrics - Infectious Diseases

all babies should receive topical erythromycin ointment


within 1 hour of birth to prevent gonococcal conjunctivitis
which can even lead to blindness

if the baby develops gonococcal conjunctivitis


give i.m. 3rd generation cephalosporin single dose

QId: 4371 Medicine - Infectious Diseases

an interesting finding is
the high platelet count as a marker of inflammation or stress
and unusually even in the presence of inflammation the leukocyte count is normal

so in OM the PC is high and the ESR CRP is high


QId: 4272 Obstetrics & Gynecology - Infectious Diseases

if you have hep c in pregnancy


you should get vaccinated with hep a and hep b

QId: 3245 Medicine - Infectious Diseases

in this case
what is weird is
vancomycin is being used to cover the cephalosporinase resistant pneumococci and not the
MRSA which we usulally use it for.

QId: 3830 Pediatrics - Infectious Diseases

in children
the most common cause of pneumonia in CF
staph aureus

until 20 years
where pseudomonas has become the major cause

QId: 3670 Pediatrics - Infectious Diseases

HIV testing
<18months - DNA PCR
>18 months- HIV antibody persistence

QId: 2970 Medicine - Infectious Diseases

Bottom line
In the management of hydatid cyst - the threshold for surgery is very low
And the first line management is albendazole plus percutaneous aspiration (if more than 5 cm
or septations present which is most of the times). Make sure use u avoid spillage

While in the management of amobeic liver abscess - surgery is only considered if there has
been a rupture or pressure symptoms or the diagnosis is not clear . And the first line
management is only albendazole plus paramomycin
QId: 3131 Medicine - Infectious Diseases

Malaria has to have the cyclic fevers symptoms


Otherwise keep malaria low in the differential
Even if the patient has hepataosplenomegaly anemia and raised bilirubin and all those things

Consider other differentials

QId: 3443 Pediatrics - Infectious Diseases

if either sydenham's chorea or carditis is present after pharyngitis


and fulfilling the required criteria
it is ARF

QId: 3257 Medicine - Infectious Diseases

Doxycycline is used to treat LYMES because it covers borelia lol obviously


But it also cover anaplasma which is transmitted by the same ixodes tick
So that's an extra advantage

If doxy can't be used (children<8, pregnant, lactating mothers) use amoxi


If amoxi allergy- azithromycin
Finally - disseminated disease - i.v. Ceftriaxone

QId: 10301 Medicine - Infectious Diseases

Routine screening is more or less only for HIV


Baki sabka risk/ symptom based hi hai

QId: 4186 Pediatrics - Infectious Diseases


if the patient is immunised
nothing to be done

if not
is the patient pregnant/immunocompromised/neonate ?
give VZIG

if the patient is immunocompetent


give varicella live vaccine

that will be all

QId: 3640 Pediatrics - Infectious Diseases

patients with SCD


have functional asplenia
vaccinations against meningococci pneumococci hemophilus
have to be given
even after vaccination the other strains of pneumococci can cause bacteremia and then sepsis
so in addition to vaccination
give penicillin prophylactically upto the age of 5

QId: 10301 Medicine - Infectious Diseases

HIV is the only sexually transmitted disease that is screened for in general population (15-65)
It has 3 types of screenings
initial screening (for general population 15-65) (before starting treatment for another STD or
TB)
annual screening (for high risk patients)
additional screening (pregnancy, exposure)

Other STDs are tested only when there has been an exposure. Syphilis is also screened only
in pregnant
women and when there has been exposure. It is not screened in the general population
because VDRL has many false positives

QId: 2994 Medicine - Infectious Diseases


The risk factors are ketoacidosis, hematologic malignancy, organ and stem cell transplant...
in hematologic malignancy, use of voriconazole is an independent risk factor for development
of mucormycosis

QId: 4668 Medicine - Infectious Diseases

RF is such a bitch
It can be present in IE as well
It's a part of the immunologic manifestations

QId: 12070 Medicine - Infectious Diseases

do not take hepatitis A lightly

give post exposure prophylaxis to contacts

1. household contact/sexual contacts


2. child care center workers where children or coworkers are infected
3. food preparation workers whose coworkers are infected

QId: 3252 Medicine - Infectious Diseases

the nest way to prevent an OI in HIV is by antiretroviral therapy


adjunctive methods are vaccination or antimicrobial prophylaxis

vaccination - pneumococci meningococci


antomicrobial prophylaxis - can be primary or secondary
primary- eg TMPSMX for PCP
secondary - eg acyclovir for HSV recurrence

QId: 15910 Surgery - Male Reproductive System

hydrocele can be reactive to testicular torsion

QId: 2488 Pediatrics - Miscellaneous (Multisystem)

protruding metopic suture = cri du chat syndrome


QId: 3935 Medicine - Nervous System

in migraine, the threshold for prophylactic therapy is thoda high


in cluster headaches prophylactic therapy is the main management
Verapamil, Lithium

QId: 4900 Medicine - Nervous System

even if you do not suspect any ICSOL and the raised ICP is due to pseudotumor cerebri
the next step
is
imaging
CT/MRI

QId: 12120 Medicine - Nervous System

Symmetric ascending paralysis - consider GBS


Acute descending muscle paralysis - consider food borne botulism

QId: 3630 Medicine - Nervous System

GBS can also be caused by


HHV
Mycoplasma
Haemophilus

QId: 2763 Pediatrics - Nervous System

port wine stain can also occur in klippel-trenaunay syndrome


where they have capillary -venous- lymphatic malformations

the difference from sturge weber syndrome is the location of the stain
in SWS it is in the trigeminal nerve V1 V2 distribution

QId: 3373 Medicine - Nervous System


What the hell
Amantadine is a NMDA receptor antagonist and it is not effective in ALZHEIMERS, typically
used in PD

On the other hand memantine - NMDA receptor antagonist is approved for use in moderate
dementia

I mean
What
The
Fuck

QId: 4702 Medicine - Nervous System

Contrast enhanced is not preferred over NCCT not because the contrast is harmful or
anything ...lol
It's just that the contrast will be confused for ACUTE BLOOD which is as hyper dense

QId: 3817 Pediatrics - Nervous System

in lesch nyhan syndrome


there is accumulation of uric acid and hypoxanthine in urine, blood, and CNS

in CNS it particularly affects the development if dopaminergic pathway


which is responsible for the neuropsychiatric manifestations

QId: 15794 Pediatrics - Nervous System

rett syndrome is characterized by


speech regression
loss of purposeful hand movements
development of stereotypical movements (pill-rolling, kneading, twisting)
gaitabnormalities
periodic breathing abnormalities (hyperventilation f/b hypoventilation)

this periodic breathing may be due to MECP2 mutation leading to abnormal neuromodulation
in the respiratory center.
QId: 4072 Medicine - Nervous System

Good functional performance status, stable extracranial disease, age less than 65 presents
with any kind of brain mets --) do treat it

Now depending on the following factors choose either surgical resection, stereotactocic radio
surgery, or whole brain radiation therapy

If single lesion and If surgically accessible and good surgical candidate --) surgical resection
followed by SRS and/or WBRT

If single lesion and surgically inaccessible --) SRS

If multiple lesions or poor surgical candidate --) WBRT

If overall poor performance status --) WBRT

QId: 3462 Medicine - Nervous System

Very interesting

The patient presents with sharp short lasting pain in the CHEEKS
Which means the pain is bilateral ..... woah
And the most common cause of bilateral trigeminal neuralgia is MS.

This is supported by the history of sensory loss a few weeks ago which would have been the
first symptom of MS

QId: 3218 Pediatrics - Nervous System


guidelines are very clear regrading whether or not CT head

may be because the risk of cancers due to CT increases with decreasing age

GCS < 13/ FND, s/o sbasilar skull fractures/seizures..... - admit, CT, close neurological
obsservation every 2 hours

GCS 13-15 - head ache vomiting, brief LOC - no admission - HeadCT to r/o concussion -
send home
or 4-6 hourly neurological examination - if improvement - send home

GCS 15 - completely asymptomatic, non severe mechanism of injury - - send home

QId: 4159 Medicine - Nervous System

Khatarnak baat ye hai ki

In brain death atropine cannot accelerate the heart rate


This is due to the absence of functioning of vagus nerve

Now think why would atropine be ineffective ....?

QId: 2837 Medicine - Nervous System

The interesting part is


There is no vertigo even after severe vestibulopathy
Reason being both sides vestibular organs are equally fucked and so no imbalance between
the inputs from both sides
But instead there is the duniya ghoom rahi hai phenomenon called oscillopsia
Abnormal head thrust test is S/o bilateral vestibulopathy

QId: 15402 Medicine - Nervous System


risk factors of MS are

1. female gender
2. caucasian
3. HLA DRB1
4. cold climate
5. USA, Europe
6. Low vitamin D level
7. smoking

QId: 3622 Medicine - Nervous System

first step in suspected SAH is NCCT head


if it is negative and there is still suspicion of SAH, go for LP to detect RBCs and also
xanthochromia (present for several days after the episode)

After confirming SAH(due to aneurysm), next best step after stabilisation is Cerebral
angiography to detect the aneurysm and coiling, etc

QId: 4513 Medicine - Nervous System

If the abscess is single - due to spread of infection from otitis or sinusitis or mastoiditis

If there are multiple abscesses, it is due to hemtaogenous spread or septic emboli (e.g. IE)

QId: 4271 Pediatrics - Nervous System

every patient of GBS does not develop respiratory failure

but every patient potentially can


so every patient gets serial spirometry

if the FVC <20mL/kg it indicates impending respiratory failure and therefore proceed with
endotracheal intubation

QId: 12248 Medicine - Nervous System


non pharmacological measures to manage delirium include

1. frequent reorientation
2. trained sitter
3. reducing noise and disturbances
4. avoiding physical constraints

QId: 2282 Medicine - Nervous System

severe sensitivity to antipsychotics


even small doses of risperidone can precipitate parkinsonism

QId: 3383 Psychiatry - Nervous System

benzodiazepines in elderly can cause

cognitive impairment
risk of falls
paradoxical agitation

QId: 14962 Psychiatry - Nervous System

parkinson's only
can have dementia
parkinsonism first then dementia
but less likely to have dementia
+/- visual hallucinations

parkinsons plus dementia (PDD)


will have dementia
parkinsonism first then dementia
+/- visual hallucinations

Dementia with lewy body


will have dementia
will have visual hallucinations
will develop parkinsonism
dementia first then parknsonism
QId: 4708 Medicine - Nervous System

Headache that increases on bending/leaning forward can be just cold

But if headache and other symptoms of increased ICH like blurring of vision worsen on
leaning forward/valsalva/coughing... then that's due to the increased ICH

QId: 15653 Surgery - Nervous System

if there is increased minute ventilation from let us say hyperventilation and even then there is
hypercarbia in ABG

consider malignant hyperthermia (if other symptoms are present too )

QId: 2469 Pediatrics - Nervous System

the treatment of infant botulism (descending flaccid paralysis from ingestion of C. botulinum
spores from environmental dust) is human derived botulism immune globulin

the treatment of food borne botulism (descending flaccid paralysis from ingestion of
preformed botulinum toxin) is equine derived botulism antitoxin

QId: 2849 Medicine - Ophthalmology

in viral there is a viral prodrome


in this case a nasopharyngeal prodrome
rhinorrhea sore throat

QId: 2850 Medicine - Ophthalmology

the risk of perioperative complications in cataract is low

no need to hold anticoagulants

QId: 4837 Pediatrics - Poisoning & Environmental Exposure


screening for lead poisoning is generally done by capillary sample (just like for blood glucose)
if it is positive
go for venous blood level
to confirm
as well as decide if chelation therapy is required
because chelation therapy is given only if venous lead level is more than 45mcg/dL

QId: 2655 Pediatrics - Poisoning & Environmental Exposure

abdominal pain
hematemesis
metabolic acidosis
hypovolemic shock

iron poisoning

QId: 4511 Medicine - Poisoning & Environmental Exposure

isopropyl alcohol doesn't increase anion gap but increases the serum osmolar gap

QId: 3690 Medicine - Poisoning & Environmental Exposure

heat stroke -- AMS


heat exhaustion -- no AMS

QId: 3161 Medicine - Poisoning & Environmental Exposure

methanol kills the eyes


ethylene glycol kills the kidneys

QId: 3138 Medicine - Poisoning & Environmental Exposure

qrs interval is prolonged if more than 120ms

but in the setting of tca overdose, >100ms qrs is an indication for iv. sodium bicarbonate
QId: 12038 Obstetrics & Gynecology - Pregnancy, Childbirth & Puerperium

If no accelerations -- fetal scalp stimulation to check for fetal acidemia

if variable deceleration -- maternal repositioning, amnio infusion

if any category III FHR tracing -- cesarean section

QId: 15686 Obstetrics & Gynecology - Pregnancy, Childbirth & Puerperium

>/= 1cm cervical dilatation every 2 hours is normal labour progression in the active phase of
labor
no cervical change even after 4 hours of adequate uterine contractions or
no cervical change even after 6 hours of inadequate uterine contractions is termed as labor
arrest disorder
should be managed by cesarean delivery

QId: 11947 Obstetrics & Gynecology - Pregnancy, Childbirth & Puerperium

dont think that now that the uterus is out, let us remove the placenta XD XD

first replace the uterus and then remove the placenta


to avoid the risk of massive hemorrhage

QId: 3337 Obstetrics & Gynecology - Pregnancy, Childbirth & Puerperium

post partum - there is slight amount of red coloured vaginal discharge


that is the decidua - comes out per vaginum in the form of lochia

to isiliye har patient jiska bloody discharge per-vag ho, pelvic USG nahi karna hota

only if PPH + enlarged uterus = pelvic USG indications

QId: 2563 Obstetrics & Gynecology - Pregnancy, Childbirth & Puerperium


differentiation between lupus nephritis and preeclampsia
is difficult

both present with proeteinuria, edema, hypertension

complement levels are low in lupus and associated symptoms like arthralgias, malar rash

QId: 12134 Obstetrics & Gynecology - Pregnancy, Childbirth & Puerperium

the m/c incontinence in pregnancy is SUI

in pregnancy because of positional changes while voiding and uterine enlargement


there can be retrograde vaginal voiding
this can result in a small pool of urine in the posterior vagina that can be appreciated on
speclum examination

QId: 15262 Obstetrics & Gynecology - Pregnancy, Childbirth & Puerperium

placenta produces ALP also now !!!


WTF man

whatever
in Intrahepatic cholestasis
there are no maternal complications
there can be fetal complications but

so we give UDCA and monitor the fetus regularly


if non reassuring at any time --- deliver
if everything's fine but still total bile acids >40micromol/L
deliver
!!

QId: 4915 Obstetrics & Gynecology - Pregnancy, Childbirth & Puerperium

the most important predictor of risk of preterm labor is

cervical length

>20 weeks fetal fibronectin can also be used


QId: 14073 Obstetrics & Gynecology - Pregnancy, Childbirth & Puerperium

if oligohydramnios

you can do vaginal delivery


no need for c section

QId: 15295 Obstetrics & Gynecology - Pregnancy, Childbirth & Puerperium

collapsed skull -- congenital zika syndrome

QId: 3376 Psychiatry - Psychiatric/Behavioral & Substance Abuse

bipolar + schizophrenia with h/o schizophrenia alone


schizoaffective disorder

or it is mood disorder with psychotic features

QId: 2358 Psychiatry - Psychiatric/Behavioral & Substance Abuse

antisocial personality is just a BAD BAD guy

intermittent explosive disorder is just anger issues

QId: 15088 Psychiatry - Psychiatric/Behavioral & Substance Abuse

MDD + psychotic feature is in fact an indication of ECT

but should not be used unless there is active suicidality or refusal to eat or drink

if everything is normal otherwise


use SSRI + Anti psychotics

QId: 12483 Psychiatry - Psychiatric/Behavioral & Substance Abuse


separation anxiety is normal in age group 9-18 months
but is also common to recur during transitions
e.g. starting to go to school

it becomes a disorder when things are excessive


not wanting to go to school , stomach aches , headaches
nightmares
difficulty sleeping alone
etc.

QId: 15145 Psychiatry - Psychiatric/Behavioral & Substance Abuse

MS - most common psychiatric complication is


depression

QId: 14982 Psychiatry - Psychiatric/Behavioral & Substance Abuse

people with binge eating disorder


may or may not be overweight

only if they are overweight


they should be started on behavioral weight loss therapy and stimulant - lisdexamfetamine

otherwise
just cognitive behavioral therapy

QId: 3719 Psychiatry - Psychiatric/Behavioral & Substance Abuse

step 1/FA taught us that conversion disorder is strongly associated with la bella indifferentiae

but it has been shown that this occurs with almost same frequency and hence is not reliable
to differentiate between the two

QId: 15102 Psychiatry - Psychiatric/Behavioral & Substance Abuse


anterior and medial thalami
corpus callosum
korsakoff syndrome

mamillary body atrophy


dorso medial thalami
wernicke's encephalopathy

corpus callosum and surrounding white matter


marchiafava bignami syndrome

QId: 2499 Psychiatry - Psychiatric/Behavioral & Substance Abuse

2nd generation antipsychotics have serotonin antagonism apart from dopamine antagonism
which makes them different from the 1st gen antipsychotics

probably why the risk of EPS is far lesser than in 1st gen antipsychotics

QId: 11884 Psychiatry - Psychiatric/Behavioral & Substance Abuse

antidperessants given in BPD can ppt mania

this risk can be reduced if given along with mood stabilisers

QId: 12145 Psychiatry - Psychiatric/Behavioral & Substance Abuse

so we think drug form of ECT is clozapine

but here is the exception

catatonia is treated by ECT ( or BZDs) and actually worsened by clozapine or any other
antipsychotic

QId: 4063 Psychiatry - Psychiatric/Behavioral & Substance Abuse

OCD
SSRI
QId: 3759 Psychiatry - Psychiatric/Behavioral & Substance Abuse

risk factors for suicide attempt


SAD PERSONS

assessment of risk of suicide and management

suicidal ideation + (wish i was dead/wanna kill myself)


intent + (actually wants to kill himself, going ahead with the idea )
plan + (the method by which he/she will kill themselves)
---> involuntary hospitalisation

ideation + intent + but plan -


break confidentiality and reduce access to potential means

QId: 3190 Psychiatry - Psychiatric/Behavioral & Substance Abuse

diagnosis is clinical
positive urine drug screen is just supportive

but
selegelline
pseudo ephedrine
bupropion
can give false positive drug screen

QId: 15087 Psychiatry - Psychiatric/Behavioral & Substance Abuse

people who have a h/o anxiety


are sensitive to early side effects of SSRI (which have been started for depression Rx) which
include agitation, anxiety, insomnia
if the symptoms arise --> decrease the dose of SSRI

to prevent such side effects - start SSRIs at 1/2 dose in such people

QId: 3845 Medicine - Psychiatric/Behavioral & Substance Abuse


if it's a somatic symptom disorder
all that
scheduling regular visits with the same physician is there
but after forming a good rapport with the patient,
he should be eventually referred to psy for treatment
which is ?
SSRI + CBT

QId: 12548 Psychiatry - Psychiatric/Behavioral & Substance Abuse

pediatric (<18) depression presents with irritability rather than depressed mood

QId: 16051 Psychiatry - Psychiatric/Behavioral & Substance Abuse

parkinson disease can have psychotic symptoms like visual hallucinations and even more
that does not mean you put it under the category of lewy body dementia

if the patient has bradykinesia + resting tremor or cogwheel rigidity you call him parkison -
simple
if the patient has visual hallucinations and dementia you may call him LBD

also in PD with psychosis - dopamine agonists worsen the symptoms more than
levodopa/carbidopa
if psychotic symptoms are predominant - you can use 2nd generation antipsychotics -
quetiapine, pimavanserin

QId: 12253 Psychiatry - Psychiatric/Behavioral & Substance Abuse

in childhood if there are symptoms similar to gender dysphoria, the child may probably grow
out of it and no further evaluation is required

in adolescence if it occurs
it requires a multidisciplinary evaluation
because it is likely to be persistent

QId: 11794 Psychiatry - Psychiatric/Behavioral & Substance Abuse


glue sniffer's rash
peripheral neuropathy from vit b 12 deficiency if nitrous pxide is abused

generally teenagers
usually euphoria, incoherence
sometimes - loss of consciousness - which is very brief

QId: 14991 Psychiatry - Psychiatric/Behavioral & Substance Abuse

one of the characteristic features of dementia with lewy bodies is its extreme sensitivity to
antipsychotic medication

dementia with Lewy Bodies presents with


visualhallucinations
dementia
parkinsonism

for visual hallucinations we would like to give antipsychotics


if high potency ones like risperidone are given, EPS - rigidity and orthostatic hypotension
would ensue
hence, low potency atypical antipsychotics should be used.
e.g. - Quitiapine

QId: 12275 Psychiatry - Psychiatric/Behavioral & Substance Abuse

depression is associated
increased s. cortisol levels
decreased hippocampal volume
decreased REM latency
decreased slow wave sleep

QId: 12481 Psychiatry - Psychiatric/Behavioral & Substance Abuse


when it is only altered mental status
ataxia
slurred speech
it is only BZD

but when vital signs start to derange


suspect more than just BZD
most commonly
BZD + Alcohol

QId: 2360 Psychiatry - Psychiatric/Behavioral & Substance Abuse

if a patient tells you he/she has thoughts about suicide

and it is given in the question stem about the intent and plan of suicide. choose the option
psychiatrichospitalization

if there is no such mention and no details are given - choose the option - perform suicide risk
assessment

QId: 12401 Psychiatry - Psychiatric/Behavioral & Substance Abuse

GAD is treated just as depression as is somatic symptom disorder

another similarity between MDD and GAD is the occurrence of somatic symptoms
and hence somatic symptom disorder is also treated the same way

QId: 15092 Pediatrics - Psychiatric/Behavioral & Substance Abuse

language skill regression due to sever epileptic attacks


is seen in
LANDAUKLEFFNERSYNDROME

but this occurs at the age of 6 years as opposed to similar symptoms in Rett syndrome at the
age of 1-2 years and especially in girls

QId: 12146 Psychiatry - Psychiatric/Behavioral & Substance Abuse


all serotonergic drugs should be stopped 2 weeks prior to starting to a new serotonergic drug
to prevent serotonin syndrome

except for FLUOXETINE


has to stopped 5 weeks prior
due to the longer half life

QId: 11954 Psychiatry - Psychiatric/Behavioral & Substance Abuse

<200 CD4 count


Long standing HIV
subcortical symptoms - difficulty in executing smooth movements - walking etc
early in the disease course

HIV associated dementia


(a category in HAND)

QId: 4869 Psychiatry - Psychiatric/Behavioral & Substance Abuse

if sleep terrors become impairing


give low dose benzodiazepines (e.g. clonazepam)

QId: 3191 Psychiatry - Psychiatric/Behavioral & Substance Abuse

if PCP go for BZD

QId: 8913 Psychiatry - Psychiatric/Behavioral & Substance Abuse

people with depression can come to you with complains of physical symptoms
psychiatric evaluation of symptoms is necessary

people get depressed due to a medical disorder


(mood disorder due to a medical condition e.g. OSA)

people with acute depression should be check for subs abuse

QId: 12384 Psychiatry - Psychiatric/Behavioral & Substance Abuse


beware
acute onset depression symptoms
check for subs abuse

QId: 2495 Psychiatry - Psychiatric/Behavioral & Substance Abuse

lithium
valproate
lamotrigine
quitiapine

are the drugs used for Bipolar disorder


1st line therapy is lithium/valproate + second gen antipsychotic (Quetiapine)

QId: 15035 Psychiatry - Psychiatric/Behavioral & Substance Abuse

pressured speech uninterruptable - mania


disorganised and rambling speech - psychosis

QId: 15089 Psychiatry - Psychiatric/Behavioral & Substance Abuse

indications of hospitalization in anorexia nervosa include:

BMI <15kg/m2
marked vital signs
cardiac failure
electrolyte abnormality
acute suicidality
acute food refusal
lack of response to outpatient treatment

indications for antidepressants in anorexia nervosa:

severe comorbid depression


anxiety that persists despite weight restoration

indications for antipsychotics (olanzapine)

severe/refractory anorexia nervosa


QId: 3843 Psychiatry - Psychiatric/Behavioral & Substance Abuse

single episode unipolar major depression


continuous phase of 6 months after remission and then start the taper

recurrent major depressive disorder/ single episode >= 2 years/ single or multiple episodes
with suicide attempts
maintenance phase X 1-3 years @ continuous phase dose
and then start taper

>=3 episodes of major depressive disorder


maintenance phase @ continuous phase dose X life-long

QId: 12466 Psychiatry - Psychiatric/Behavioral & Substance Abuse

antidepressant withdrawal presents with anxiety, depressive exacerbations (e.g. insomnia,


loss of appetite)
but half life of SSRI is around 4-6 days

BZD withdrawal presents with anxiety, insomnia, tremor, psychomotor agitation and
dysphoria.
but half life is just 12 hours
so they can have withdrawal even if a day's meds are missed

QId: 11898 Psychiatry - Psychiatric/Behavioral & Substance Abuse

acute dystonia tardive dyskineia benztropine valbenazine


diphenhydramine

akathasia
propanolol
benztropine
benzodiazepines (not 1st line)

parkinsonism
benztropine
amantadine
QId: 15083 Psychiatry - Psychiatric/Behavioral & Substance Abuse

venlafaxine can cause dose dependent hypertension

but only sustained levels of high BP warrant discontinuation


so monitoring is required

and people with pre exsiting hypertension


it is better to not start them on this drug but can start with minimal dose and titrate ...

QId: 3020 Medicine - Pulmonary & Critical Care

in ARDS
PaO2/FiO2 ratio <300 mmHg
A-a gradient is high (intrapulmonary shunting)
P-arterial pressure is high
PCWP is normal

QId: 2297 Medicine - Pulmonary & Critical Care

complicaitons of positive pressure ventilation -


alveolar damage
pneumothorax
hypotension

QId: 2821 Medicine - Renal, Urinary Systems & Electrolytes

post ictal lactic acidosis (AG metab ac)


typically resolves within 90 minutes

so repeat ABG after 2 hours

QId: 3942 Medicine - Renal, Urinary Systems & Electrolytes


fibrosis/sclerosis of afferent arteriole, glomerular tuft and then efferent arteriole is
characteristic of hypertensive nephropathy. (2nd most common cause of ESRD)

basement membrane thickening, mesangial expansion and fibrosis is characteristic of diabetic


nephropathy. (most common cause of ESRD)

QId: 3335 Surgery - Renal, Urinary Systems & Electrolytes

if hematuria has no clear cause (infection, calculus, GN)


go for cystoscopy

QId: 15922 Pediatrics - Renal, Urinary Systems & Electrolytes

primary varciocele generally subsides when supine


if it does not
suspect secondary varicocele

in a young child - wilm's tumor for e.g.

QId: 14026 Medicine - Rheumatology/Orthopedics & Sports

plantar fasciitis is not only pain after first steps


also after prolonged standing or walking

QId: 3404 Pediatrics - Rheumatology/Orthopedics & Sports

LCP disease can also result in proximal thigh atrophy and trendelenburg sign may be positive

QId: 4857 Pediatrics - Rheumatology/Orthopedics & Sports

joint pain following 4 weeks after a viral infection

child is otherwise normal

transient synovitis
QId: 12059 Medicine - Rheumatology/Orthopedics & Sports

low back pain (no other diagnosis) : if its <3 weeks moderate activity and NSAIDs are
enough, because the pain is going to go away
but if the pain is >12 weeks - it is more likely to persist and recur
they need proper exercise therapy