These are two different questions .
A pt had TIA which he recovered from. He has a hx of stroke and exam shows HR in sinus rhythm.He is already on aspirin 75mg and anti-HTN drugs. What other action should be taken?
A.Add clopidogrel only
B. Increase dose of aspirin to 300mg
C.Add warfarin
D. Add clopidogrel and statins
E. Add statin only
A 64year old man presents with a history of left sides hemiparesis and slurred speech. He was absolutely fine 6hrs after the episode . What is the most appropriate prophylactic regimen?
A. Aspirin 300mg for 2weeks followed by aspirin 75mg
B. Aspirin 300mg for 2weeks followed by aspririn 75mg and dipyridamole
C. Clopedogrel 75mg
D. Dipyridamole 200mg
E. Aspirin 300mg for 2weeks
A 22year old girl presents with worries fears palpitations insomnia light headidness and reduced memory for the last one year.she is taking fluoxetine 40mg per day and propranolol 10mg twice a day since last two weeks and reports some improvement. What is the single most appropriate psychological therapy for her
A activity planning
B CBT
C desensitization therapy
D exposure therapy
E hypnosis
24year old woman develops wheezing and shortness of breath when exposed to cold air or when exercising These symptoms are getting worse. What is the most appropriate drug for her before exercise ?
A inhaled corticosteroids
B LABA
C LAMA
D SABA
E SAMA
56year old smoker presents with cough for the last 10 years associated with progressive shortness of breath. The cough is usually mucous and occasionally prudent. He wheezes while he talks. Adventitious breath sounds are heard in all lobes. His chest x ray reveals significant bronchial wall thickening. What is the most likely diagnoses in this patient?
A asthma
B emphysema
C chronic bronchitis
D sub-acute bronchitis
E allergic bronchitis
A 64 year old man who has urinary frequency for past 2 years now complains of anuria. He is taking nifedipine and propranolol. What is the mechanism of his anuria?
A. Drug induced
B. Diabetes
C. Enlarged prostate gland
D. High blood pressure
E. Cancer of the bladder
Glomerulonephritides
Knowing a few key facts is the best way to approach the difficult subject of glomerulonephritis:
Membranous glomerulonephritis
• presentation: proteinuria / nephrotic syndrome / chronic kidney disease
• cause: infections, rheumatoid drugs, malignancy
• 1/3 resolve, 1/3 respond to cytotoxics, 1/3 develop chronic kidney disease
IgA nephropathy - aka Berger’s disease, mesangioproliferative GN
• typically young adult with haematuria following an URTI
Diffuse proliferative glomerulonephritis
• classical post-streptococcal glomerulonephritis in child
• presents as nephritic syndrome / acute kidney injury
• most common form of renal disease in SLE
Minimal change disease
• typically a child with nephrotic syndrome (accounts for 80%)
• causes: Hodgkin’s, NSAIDs
• good response to steroids
Focal segmental glomerulosclerosis
• may be idiopathic or secondary to HIV, heroin
• presentation: proteinuria / nephrotic syndrome / chronic kidney disease
Rapidly progressive glomerulonephritis - aka crescentic glomerulonephritis
• rapid onset, often presenting as acute kidney injury
• causes include Goodpasture’s, ANCA positive vasculitis
Mesangiocapillary glomerulonephritis (membranoproliferative)
• type 1: cryoglobulinaemia, hepatitis C
• type 2: partial lipodystrophy
NEW ONSET ATRIAL FIBRILLATION CAUSES
REMEMBER THE MNEMONIC = THE ATRIAL FIBS
(T)hyroid
(H)ypothermia
(E)mbolism (P.E.)
(A)lcohol
(T)rauma (cardiac contusion)
®ecent surgery
(I)schemia
(A)trial enlargement
(L)one or idiopathic
(F)ever, anemia, high-output states
(I)nfarct
(B)ad valves (mitral stenosis)
(S)timulants (cocaine, theophylline, amphetamin, caffeine)
Lithium: side effects LITH:
Leukocytosis
Insipidus [diabetes insipidus, tied to polyuria]
Tremor/ Teratogenesis
Hypothyroidism
Features of normal pressure hydrocephalus (Wet, Wobbly, Wacky)
Wet = urinary incontinence
Wobbly = ataxic gait
Wacky = dementia