Upload
mahendrenmuthu
View
37
Download
5
Tags:
Embed Size (px)
Citation preview
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
INTERNAL MEDICINE High Yield REVIEW Topics
"For students by Global Institute Of Medical
Sciences"
Quick hit questions first, answers listed
later on.
1) 35 yr female with double vision at the
end of the day, dysphagia, nasal
voice, upp ext weakness, her sx improve
after a nights sleep. Dx?
2) What is MG?
3) Best initial test for MG?
4) What is the specific test for MG?
5) What is the sensitive test for MG?
6) Most accurate test for MG?
7) Tx for MG?
If primary tx fails, what to use (initial
choice) for MG?
9) If initial tx after primary tx fails,
what tx for MG?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
10) Tx for acute MG crisis?
11) Surgical tx for post puberty till age 55
yrs for MG pts?
12) 46 yr male w/ rubbery legs for 2 days,
loss of reflexes bilaterally and
weakness in lower ext. Hx of diarrhea 3 wks
ago. Dx?
13) What is Gullian-Barre Syndrome?
14) Pattern of sensory distribution loss
w/GBS?
15) When to take GBS pt to ICU?
16) What % of GBS pt have prior hx of
infection 1-3 wks ago?
17) Best initial test for GBS?
1 Most accurate test for GBS?
19) Tx for GBS?
20) Acute abortive tx for migraine? If
contraindicated, alternative tx?
21) Prophylactic tx for migraine when to
start n what tx?
22) Pt w/ severe, infrequent migraine
unresponsive to any tx?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
23) Initial tx for tension H/A, what if
refractory?
24) Prophylactic tx for cluster H/A?
25) Most effective tx for acute cluster H/A,
alternative?
26) Central vertigo a)onset b)tinitis,HL
c)diplopia,blindness,dysarthria,weakness
d)nystagmus
27) Peripheral vertigo a)onset b)tinitis,HL
c)diplopia,blindness,dysarthria,weakness
d)nystagmus
2 Triad of Menieres disease?
29) Two most common causes of Menieres dis?
30) Peripheral vertigo associated w/ blunt
ear trauma, air flight, scuba
diving?
31) Symptomatic tx for peripheral vertigo?
If severe?
ANSWERS: Numbers 1-30::::
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
:1) Myasthenia Gravis
2) Dis. Of NMJ, presents with weakness and
fatigue. Ab to Ach receptors ->
dec # of active/functional Ach receptors at
postsynaptic membrane
3) Ach receptor Ab
4) Fatigued muscle weakness plus +Ach
receptor Ab test
5) Edrophonium (Tensilon) test
6) EMG (decremental dec in muscle fiber
content on repetitive nerve
stimulation
7) Anticholinesterase (pyridostigmine)
Immunosuppressive tx with glucocorticoids
9) Azathioprine and steroid combo
10) Plasmapheresis and IVIG
11) Thymectomy
12) Gullian-Barre synd (Acute idiopathic
polyneuropathy)
13) Acute severe polyradiculopathy
w/autoimmune destruction of myelin.
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
Bodys immune system attacks self antigens
(molecular mimicry)
14) Pain, tingling dysthesia. Loss of large
sensory fibers -> loss of
reflexes and proprioception
15) Autoimmune instability (profuse
sweating, postural hypotension, labile
BP, cardiac dysrhythmia)
16) Approx 75%
17) LP (inc protein, no inc in cell count 48
hrs after sx)
1 EMG (demyelination of peripheral nerves)
19) IVIG or plasmapheresis (equally
effective)
20) Sumatriptan PO, IN, SQ (serotonin
agonist) contraindicated in CVD.
Alternative tx: ergotamine
21) Px for migraine when >3x/mo. Tx:
propanolol, timolol, valproic acid &
{methylsergide (for 2-6 wks distended over
6mo, SE: valvular &
retroperitoneal fibrosis)}
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
22) Opioid analgesics
23) Relaxation & NSAIDS, if refractory: musc
relaxants
24) Predinisone, Li, ergotamine,
methylsergide & verapamil
25) 100% oxygen, alternative: sumatriptan
26) Central vertigo a)gradual b)absent
c)present d)pure, vertical, does not
suppress w/fixation &multidirectional
27) Peripheral vertigo a)usually sudden
b)present c)absent
d)mixed,horizontal,suppress
w/fixation,unidirectional
2 Tinitis, hearing loss, episodic vertigo
(1-8 hr)
29) Syphilis & head trauma
30) Perilymphatic fistula
31) Meclizine. If severe: diazepam
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
32) Medical tx for Menieres dis? If fails?
33) Symptomatic tx for vertigo secondary to
labyrinthitis? If severe?
34) Examples of reversible causes of
dementia?
35) Examples of irreversible causes of
dementia?
36) Early presentation of Picks dis?
37) Presentation of Creutzfeldt-Jakob dis?
3 Binswagner dis?
39) Tx for mild-moderate dementia? Other tx?
40) 32 yr female w/numbness & tingling of R
hand began several days ago. Hx
of seeing double 3 yrs ago for 2 days.
Hyperactive reflexes bilaterally and
inc spasticity in lower extremities. Dx?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
41) What is Multiple sclerosis?
42) Triggers that exacerbate MS?
43) Most accurate test for MS?
44) Best initial test for MS?
45) Most sensitive test for MS?
46) If MRI is nonconfirmatory but MS
suspicion still high, what test?
47) Tx for relapsing-remitting dis of MS?
4 Tx for secondary progressive dis of MS?
49) If cant tolerate IFN B1b, IFN B1a or
glatiramer acetate?
50) Tx for primary progressive disease of
MS?
51) Tx for acute exacerbation of MS?
52) Tx for MS pt w/ spasticity?
53) Tx for MS pt w/ nocturnal spasticity?
54) Tx for MS pt w/ bladder hyperactivity?
55) Tx for MS pt w/ Urinary retention?
56) Tx for MS pt w/ fatigue?
57) Tx for MS pt w/ erectile dysfunction?
5 What is Parkinsons disease?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
59) Parkinsonism + vertical gaze palsy?
60) Parkinsonism + prominent ataxia?
61) Parkinsonism + prominent orthostatic
hypotension?
62) Parkinson pt w/ intact functional status
(less bradykinesia) < 60 yrs,
initial tx?
63) Parkinson pt w/ intact functional status
(less bradykinesia)> 60 yrs,
initial tx?
64) Parkinson pt w/ compromised function,
initial tx?
65) Tx for late complications of
carbidopa/levodopa (response fluctuations)?
66) Only drug that can arrest progression of
Parkinson dis?
67) Surgical TX for Parkinson pt, when?
Procedure?
6 Test of choice for diagnosing epilepsy?
69) Tx of status epilepticus?
70) When are first time seizures treated
with long-term anticonvulsants?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
71) First line tx for generalized tonic
clonic seizure? If not a choice?
72) First line tx for absence seizures? If
not a choice?
73) First line tx for partial seizures
(complete/partial)? Acceptable
alternatives?
74) Tx of choice for myoclonic and atonic
seizures?
75) CNS SE of phenytoin?
76) Systemic SE of phenytoin?
77) SE of phenobarbitol?
7 SE of valproic acid?
79) SE of lamotrigine?
ANSWERS::::
32) Low salt diet & diuretic. If fails:
surgical decompression
33) Meclizine. If severe: diazepam
34) Hypothyroidism, Vit B12 def, Hep/uremic
encephalopathy, CNS vasculitis,
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
Syphilis, Brain abscess, Brain tumor, Meds
(anticholinergic), Sleep apnea,
Trauma, Subdural hematoma, NPH, Depression
35) Progressive multifocal
leukoencephalopathy, Alzheimers dis,
Dementia w/
Lewy bodies, Frontotemporal degeneration
(Picks dis), Vascular dementia
multiinfarct, Binswanger dis), Creutzfeldt
Jakob dis
36) Personality changes w/visuospatial
sparing
37) Dementia & myoclonus (aggressive wks-mo)
3 Subcortical white matter (slow)
39) Donepezil. Others: anticholinesterase
inhibitors (rivastigmine,
tacrine); discontinue if no improvement in
3-6 mo
40) Multiple sclerosis
41) Inflammatory dis of CNS white matter,
multifactorial (infections, diet,
climatic), focal areas of demyelination
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
42) Infection, trauma, post pregnancy (2- 3
mo after)
43) Brain MRI (inc T2 density, dec T1
density) Gandolinium enhance lesions
till 2-6 wks after exacerbation
44) Brain MRI
45) Brain MRI
46) CSF (mild pleocytosis oral
steroids (taper over 4 wks) If
severe & steroid unresponsive: plasma
exchange
52) baclofen
53) tizandine, diazepam
54) oxybutynin
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
55) bethanechol
56) amantadine or fluoxetine
57) sildenafil acetate
5 Neurologic synd from def of
neurotransmitter dopamine as consequence of
degenerative, vascular or inflammatory
changes in basal ganglia
59) Supranuclear palsy
60) Olivopontocerebellar atrophy
61) Shy Dragger synd
62) Anticholinergic meds
63) Amantadine
64) Carbidopa/levodopa
65) Sustained rel form of carbidopa/levodopa
adding dopamine agonist,
selegiline or COMT inhibitors or restriction
of protein meal to night
66) Selegiline
67) Surgery for who cant tolerate or respond
adequately to medical tx.
Procedures: pallidotomy & thalamotomy
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
68 Electroencephalogram
69) Secure ABC, tx reversible causes,
lorazepam or diazepam (potentiate GABA
recept)-> seizure-> phenytoin or
fosphenytoin (inhibit Na+ dependent AP)->
seizure -> phenytoin/fosphenytoin -> seizure
-> phenobarbitol -> seizure->
phenobarbitol -> seizure -> midazolam or
propofol
70) If Pt has abnormal neurologic exam,
presented w/ status epilepticus, has
strong family hx of seizures, or has
abnormal EEG
71) Valproic acid (inc availability of
GABA). If not a choice, pick
lamotrigine (dec glutamate release)
72) Ethosuximide. Valproic acid
73) Carbamazepine & phenytoin. Valproic acid
& lamotrigine
74) Valproic acid
75) Diplopia, dizziness & ataxia
76) Gum hyperplasia, lymphadenopathy,
hirusitism, rash
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
77) Sedation, ataxia, rash
78 Ataxia, tremor, hepatotoxicity,
thrombocytopenia, GI irritation,
hyponatremia
79) Diplopia, ataxia, rash, Steven-Johnson
syndrome
80) Presentation of occlusion of anterior
cerebral artery?
81) Presentation of occlusion of middle
cerebral artery? If dominant
hemisphere is involved? If non-dominant
hemisphere is involved?
82) Presentation of posterior cerebral
artery? Involvement of penetrating
branches/CN III palsy?
83) Presentation of occlusion of basilar
artery branches? Involvement of
post inferior cerebellar artery?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
84) Presentation of occlusion of major
cerebellar artery?
85) Initial test of choice for
cerebrovascular disease?
86) Most sensitive test to detect blood in
brain?
87) Most accurate test for detecting
cerebral ischemia?
88 Diagnostic workup for pt w/acute ischemic
stroke?
89) Tx for pt who present w/in 3 hrs of
onset of stroke?
90) When is heparin given in acute ischemic
stroke?
91) First line tx for secondary prevention
of ischemic stroke?
92) If aspirin allergic or continue to have
recurrent CVA on aspirin alone?
93) When to recommend carotid
endarterectomy?
94) Most common site of spinal cord
compression?
95) Dx test of choice for SC compression?
When contraindicated?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
96) Plain X-ray abn in what % of SCC?
97) Tx of choice for herniated disc,
epidural abscess, hematoma?
98 Tx of SCC?
99) Px of SCC depends on what factor?
100) E.g., of communicating syringomyelia?
101) E.g., of non-communicating
syringomyelia?
102) Most common site of syringomyelia?
103) Pattern of subacute combined
degeneration (B12 related)
104) Pattern of ant spinal art infarction?
105) Overall 5 yr survival for small cell CA
of lung?
106) Overall 5 yr survival for non-small
cell CA of lung?
107) Smoking hx of 40 pack/yr increases lung
CA risk how many times compared
to normal non-smoker individual?
108) Asbestos exposure increases
bronchiogenic CA risk by how many times?
109) Centrally located lung CA types?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
110) Peripherally located lung CA types?
111) Which lung CA type is associated w/
pleural effusion (w/increase
hylauronidase) Dx?
112) Most common sx of lung CA at time of
dx?
113) What % of squamous cell CA dx is made
by sputum cytology?
114) Best dx procedure for centrally located
lung CA?
115) Best dx procedure for peripherally
located lung CA?
116) Bulls eye lesion?
117) What % of lung tumors w/ malignant
effusion is unresectable?
118) Sx that suggest unresectable lesion of
lung CA?
119) Tx of choice for resectable small cell
lung CA?
120) Tx of choice for resectable non-small
cell lung CA?
121) Tx of effusion associated w/lung CA?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
122) Px after surgical resection of squamous
cell lung CA? If large cell CA
& adenoCA?
Ans
80) Contralateral weakness & sensory loss in
legs > upp ext. Urinary
incontinence, confusion, beh disturbances
81) Contralateral hemiplegia, hemisensory
loss, homonymous hemianopia w/
eyes towards cortical lesion. Dominant:
aphasia. Nondominant: preserved
speech, comprehension w/ confusion & apraxia
w/ spatial & constructional
deficit
82) Contralateral HH, visual hallucinations,
agnosia. Weber synd
(w/contralat hemiplegia), Benedikt synd
(contralat ataxia or athetosis)
83) Locked in synd (paramedian br)
quadrapresis w/ intact vertical eye
movement. Wallenberg synd (ipsilat facial
sensory loss, contralat body
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
sensory loss, vertigo, ataxia, dysarthria,
dysphagia, Horner synd)
84) Vertigo, Vomiting, nystagmus, ipsilat
limb ataxia
85) Non contrast head CT
86) Non contrast head CT
87) Diffusion weighted MRI
88 Echo, carotid duplex, 24 hr holter,
inherited coagulability
89) Tissue plasminogen activator (tPA)
90) Inc risk of recurrent stroke (A fib,
basilar art thrombosis, stroke in
evolution)
91) Aspirin
92) Add dipyridamole or clopidrogel
93) When occlusion >70% of arterial lumen &
lesion is symptomatic
94) Thoracic cord (70%)level as spinal cord
is narrowest at this point
95) MRI of spine. If contraindicated: CT
myelogram
96) 84-94%
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
97) Surgical decompression
98 High dose dexamethasone immediately. For
radiosensitive tumors: RT. For
others: surgical decompression
99) Functional status at time of
presentation (80% who are initially able to
ambulate -> retain function later)
100) Arnold Chiari
101) Spinal cord trauma
102) Cervical cord level
103) Distal paresthesia & weakness of ext
followed by spastic paresis &
ataxia. Combined def of vibration &
proprioception w/ pyramidal signs
(plantar extension & hyperreflexia)
104) Acute onset of flaccid paralysis-
>evolves into spastic paresis over
days-wks. Loss of pain & temp (w/ sparing of
vibration & position sense as
post column is supplied by post spinal art)
105) 5%
106) 8%
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
107) 60-70x
108) 75x
109) squamous cell CA & small cell CA of
lung
110) large cell CA & adeno CA of lung
111) AdenoCA of lung. Often req thoracotomy
w/pleural biopsy
112) Cough (74%) Wt loss (68%)
113) 80%
114) Bronchoscopy (90%) helps in staging
115) Needle aspiration biopsy (40-50%)
116) Granuloma
117) 90%
118) Wt loss >10%, bone pain or other
extrathoracic mets, CNS sx (tx: RT or
chemo), sup vena cava synd, hoarseness,
contralat mediastinal adenopathy,
split-lung test tidal vol
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
120) Chemo & RT or CAP (cyclophosphamide,
adriamycin, platinum)
121) Sclerose w/ tetracycline
122) For squamous lung CA: 30-35%. For large
cell & adeno cell lung CA: 25%
123) Define sleep apnea?
124) Tx for obstructive sleep apnea?
125) Tx for central sleep apnea?
126) Dx of sleep apnea?
127) ABGs in ARDS?
128) Swan Ganz catheter findings in ARDS?
129) Tx for ARDS?
130) Mortality rates for ARDS?
131) Most common cause of thrombophilia?
132) Pts at inc risk for post op venous
thromboembolism?
133) EKG changes of pulmonary embolism?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
134) First test when PE is suspected?
135) Gold stand to dx PE?
136) Gold stand to dx DVT?
137) Pts w/ PE who dont req angiogram for
dx?
138) Tx for PE?
139) Tx for PE pts who r hemodynamically
unstable? If contraindicated?
140) Tx for hemodynamically stable PE pt
w/contraindication to
anticoagulation or recurrent PE on
anticoagulant?
141) Tx for pregnant pt w/PE or DVT?
142) Epidemiology of silicosis?
143) Epidemiology of asbestosis?
144) Epidemiology of coal miners lung?
145) PFT pattern of pneumoconiosis?
146) Most common CA associated w/
asbestosis?
147) Dx of asbestosis?
148) Main difference b/w asbestosis & acute
silicosis?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
149) How to evaluate silicosis associated
w/TB?
150) CXR findings of asbestosis?
151) CXR findings of silicosis?
152) CXR findings of coal miners lung
(CWP)?
153) Associated immunolgoical abn in CWP?
154) What is Caplan synd?
155) What is Lofgren synd?
156) What is Heerfordt-Waldenstrom synd?
157) Lab findings of sarcoidosis?
158) Definitive dx of sarcoidosis?
159) Px of sarcoidosis?
160) In which sarcoidosis pt, steroids r
mandatory for tx?
161) 57 yr male w/exercise intolerance over
5 mos. No significant past hx.
Over past wk, he gets dyspnea on walking
across room. Never smoked. RR 20,
JVD 9 cm, coarse crackles, clubbing, trace
pedal edema (both legs), CXR:
diffuse reticular disease. Dx? Tx?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
162) Etiology of bronchiectasis (permanent
dilation of small-med bronchi)?
163) Best non-invasive test for
bronchiectasis?
164) Tx for bronchiectasis?
165) When are IV antibiotics
(aminoglycosides, ceftazidime, or
quinolones)
used in bronchiectasis?
166) When is surgical tx considered in
bronciectasis?
167) What % of smokers develops COPD?
168) What % of COPD pts are smokers?
169) Dx test of choice for COPD?
170) First line tx for COPD?
171) Second line tx for COPD?
172) 2 modalities that decease mortality in
COPD pt?
173) COPD + cor pulmonale will benefit from
home O2 tx?
174) When are antibiotics used in COPD?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
175) First line tx for acute exacerbation of
COPD?
176) Best predictor of survival in COPD?
177) When is dyspnea at rest noted?
178) When is dyspnea on exercise noted?
179) Vaccine for COPD pt?
180) Which B agonist used for nocturnal &
exercise induced asthma?
181) Asthmatic pt w/HD in whom B agonist &
theophylline may be dangerous so
what tx?
182) Tx of choice for spontaneous
atelectasis?
183) What 3 criteria have to be present for
transudative effusion?
184) How to proceed in low risk pt w/
pulmonary nodule?
185) How to proceed in high-risk pt w/
pulmonary nodule?
186) How to maintain O2 content (O2 to vital
organs) in critically ill pt?
187) Formula for alveolar-arterial gradient
(useful in assessment of
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
oxygenation)?
188) 60 yr male w/chronic bronchitis develop
persist diarrhea, what acid
base disorder?
189) Markedly obese 24 yr male, what acid
base disorder?
190) 14 yr female w/ severe asthmatic
attack, what acid base disorder?
191) 56 yr female w/ chronic bronchitis is
started on diuretic tx for
peripheral edema resulting in 3kg wt loss,
what acid base disorder?
Ans
123) Cessation of airflow >10 sec at least
10-15x/hr during sleep. Day time
somnolence
124) Wt loss & CPAP (as floppy airway but
adequate ventilation)
125) Acetazolamide, progesterone &
supplemental O2
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
126) Polysomnography
127) Dec PaO2, N or inc PaCo2
128) N C.O. & capillary wedge press, inc
pulm art press
129) Tx underlying dis, PEEP & permissive
hypercapnea
130) 70%
131) Factor V leiden
132) >40 yrs w/hx of DVT or prior PE, pts w/
extensive pelvic or abd surg
for malignant dis or maj orthopedic surg of
lower limbs
133) S1 Q3 T3 (R axis deviation, deep S in
lead 1, Q waves in lead 3,
inverted T waves in lead 3) w/nonspecific RV
strain pattern, sinus
tachycardia
134) V/Q scan
135) Angiogram
136) Venogram
137) Pts w/ high probability V/Q scan & high
or intermediate clinical
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
suspicion for PE should be treated. Any pt
w/ abn V/Q scan and +DVT by US
should also be treated.
138) Continuous heparin (5 days) to prolong
PTT to 1.5-2x N, Long term
warfarin (on day 1 to inc PT 1.3-1.5x N;
baseline for 6 mo)
139) Thrombolytic tx (tPA). If contraind:
embolectomy
140) Interrupt IVC Greenfield filter
141) LMWH for 6 mo
142) Workers in mining, quarrying,
tunneling, glass & pottery making, sand
blasting
143) Asbestos exposure in mining, milling,
foundry work, shipyard, asbestos
application to pipes, brake linings,
insulation and boilers
144) Coal dust exposure (amount), high rank
(hardness of coal), high silica
content of inhaled dust
145) Restrictive w/dec DLCO, hypoxemia w/inc
PAO2-PaO2 gradient
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
146) Bronchiogenic CA (adeno or squamous
cell)
147) Lung biopsy: barbell shaped asbestos
fiber
148) In acute silicosis: lung failure in
months
149) Yearly PPD (if >10mm: INH pox for 9 mo)
150) Diffuse or local pleural thickenings,
pleural plaques & calcifications
at diaphragm, pleural effusion common at
lower lung fields
151) Nodules (1-10mm) seen thru out lungs
(prominent in upp lobes), Rare egg
shell calcifications, progressive dis
(densities >10mm) in large masses
152) Small round densities in parenchyma
(upp half of lung), progressive
(densities from 1cm to entire lobe)
153) Inc levels of IgA, IgG, C3, ANA, Rf
154) Rheumatoid nodules in lung periphery in
pt w/RA & coexisting
pneumoconiosis (usually CWP)
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
155) Sarcoid synd: Erythema nodosum,
arthritis, hilar adenopathy
156) F, parotid enlargement, uveitis &
facial palsy
157) Hypercalcemia or hypercalciuria (inc
circulation of vit D produced by
macrophages), nonspecific inc in ACE (60%),
abn in LFT (30%) w/90%
symptomatic pt, skin anergy, PFT N or
restrictive, uveitis & conjunctivitis
(>25%)
158) Biopsy of suspected tissue (non-
caseating granuloma)
159) 80% w/lung inv: stable or resolve
spontaneously, 20% have progressive
dis w/end organ compromise
160) Involvement of CNS, uveitis &
hypercalcemia
161) Idiopathic pulmonary fibrosis. Seen in
5th decade, CT: ground glass
app. PFT: restrictive. Tx: steroid +/-
azathioprine. Px: response to
steroids
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
162) Secondary to repeated pneumonic
processes as TB, fungal, lung abscess,
and pneumonia (focal bronchiectasis) or when
defense mech of lungs are
compromised as CF and immotile cilia synd
(diffuse b)
163) High resolution chest CT
164) Bronchodilators, chest phys tx,
postural drainage, rotating antibiotics
(amox, TMP-SMX, amox, amox/clavulanic acid
when sputum prod inc or mild sx)
165) If significant sx or pneumonia
166) Localized bronchiectasis w/adequate PFT
or massive hemoptysis
167) 10-15%
168) 80-90%
169) PFT (dec FEV1/FVC & FEF 25-75%, inc RV
& TLC,
DLCO dec in emphysema & N in chronic
bronchitis)
170) Anticholinergic (ipratropium bromide;
atrovent)
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
171) B2 agonist (albuterol, terbutaline,
metaproterenol)
172) Home O2 tx & smoking cessation
173) PaO2 < 59mmHg
174) Empirically for acute exacerbation of
COPD: cover H inf & pneumococcus
175) Systemic steroids (slowly taper w/in 2
wks)
176) Check FEV1 after bronchiodilator (If
inc FEV1: better survival, If
faster rate of decline of FEV1: worse px)
177) FEV1 < 25% predicted
178) FEV1 < 50%
179) Pneumococcus/5 yr, Influenza/yr
180) Salmeterol (12hr)
181) Anticholinergic (ipratropium bromide:
takes 90 min to bronchodilate,
has medium potency)
182) Bronchoscopy w/subsequent removal of
mucous plugs
183) LDH effusion
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
184) 50 yr w/smoking hx & nodule->likely
bronchiogenic CA so best dx
procedure is open lung biopsy & removal of
nodule at the same time
186) Keep Hb & C.O. near normal
187) PAO2 PaO2 gradient= 150-1.25 x PCo2-
PaO2 (In N young individual its
5-15 mmHg; increases w/hypoxemia except
hypoventilation & increase altitude)
188) Combined chronic resp acidosis & metab
acidosis
189) Chronic hypercapnia (chronic resp
acidosis or metab acidosis)
superimposed on acute resp acidosis
190) Acute resp acidosis
191) Chronic resp acidosis superimposed on
metabolic alkalosis
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
192) Best initial screening test for renal
artery stenosis?
193) Best noninvasive method to confirm
renal art stenosis?
194) Best invasive method to confirm renal
art stenosis?
195) Best initial tx for renal art stenosis?
196) Dx of primary hyperaldosternosim (Conn
synd)?
197) Tx for Conn synd?
198) Tx for simple kidney cysts?
199) Dx of RTA type I (distal)?
200) Tx for RTA type I (distal)?
201) Dx of RTA type II (proximal)?
202) Tx for RTA type II (proximal)?
203) Dx of RTA type IV
(hyporenin/hypoaldosteronism)?
204) Tx for RTA type IV?
205) EKG in hyperkalemia?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
206) Tx of hyperkalemia?
207) What is Bartter synd?
208) EKG findings of hypokalemia?
209) Tx of hypokalemia?
210) Tx for hypernatremia? For CDI? For NDI?
211) Dx of hyponatremia?
212) Tx of hyponatremia? Mild (approx 120-
130)? Moderate (approx 110-120)?
Severe (
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
222) TX for cryoglobulins IgM & IgG
deposits?
223) Tx for HSP?
224) Tx for Wegners granulomatosis?
225) Dx of analgesic nephropathies?
226) Tx of choice for TSS?
227) Dx of blastomycosis?
228) Tx for blastomycosis? Severe? Mild?
229) Best dx test for toxoplasmosis?
230) Best initial test for CNS toxo lesion
in AIDS pt?
231) Dx of RMSF? Tx?
232) When to start triple tx for HIV pt?
233) When to give AIDS pt prophylaxis for
PCP? What? When to discontinue?
234) When to give MAI px to AIDS pt? What?
How to dx MAI in HIV pt? Tx?
235) Prophylaxis for toxo in AIDS?
236) Tx for cryptococcus in AIDS?
237) Best dx test /specific dx for
myocarditis?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
238) Ultimate dx for gas gangrene?
239) Tx of gas gangrene?
240) Initial dx test for brain abscess?
241) Most accurate test for brain abscess?
242) Most common cause of encephalitis?
243) Most specific & sensitive test for HSV
encephalitis?
244) What type of meningitits in pt w/hx of
neurosurgery?
245) Best initial test for meningitis?
246) DIC associated w/ which leukemia type?
247) Tx for DIC?
248) Tx for hemophilia A?
249) Most common cause of congenital
disorder of hemostasis?
250) Dx of vWD?
251) Tx for vWD?
252) Dx of ITP?
253) Tx of ITP?
254) Virus/bacteria associated w/ Non
Hodgkin lymphoma?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
255) % Location of cervical/supraclavicular
nodes in NHL?
256) Initial dx for NHL & HL?
257) Tx for stage I A & II A of HL & NHL?
258) Tx for stages IB, IIB, III & IV of NHL?
259) Tx of relapses of NHL?
260) % Location to cervical/supraclavicular
nodes in HL?
261) Tx for stages IB, IIB, III & IV of HL?
262) Which HL has good prognosis?
263) Dx of CML?
264) Tx of CML?
265) Confirmatory dx of acute leukemia?
266) Differentiation b/w different types of
acute leukemia?
267) Tx of acute leukemia?
268) Common causes of death in PNH?
269) Defect in PNH?
270) Dx of PNH?
271) TX of PNH?
272) Defect in hereditary spherocytosis?
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
273) Dx of heredietary spherocytosis?
274) Tx of heredietary spherocytosis?
275) Specific dx for autoimmune, cold-
agglutinin & drug induced hemolytic
anemia?
276) Staging for HL & NHL?
277) Etiology of MGUS?
278) Dx of MGUS?
279) Sx of hyperviscosity synd associated
w/MM?
280) Confirmatory dx for MM?
281) Tx for MM? Young pt? Old pt?
282) Staging & survival for CLL?
283) Dx of CLL?
284) TX of CLL?
285) Dx of aplastic anemia?
286) Tx of aplastic anemia?
287) Genetic association of CML?
Ans:
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
192) Abd US & captopril renogram
193) Captopril renogram
194) Arteriogram
195) PC transluminal angioplasty
196) Inc aldosterone in urine & blood
197) If adenoma: surgical resection; If
hyperplasia: spironolactone
198) If smooth walled w/ no debri in cyst:
no further dx or tx; If cysts w/
irregular walls or debri inside cyst:
aspirate (R/O malignancy)
199) Acid load test; give NH4Cl (should
lower urine pH secondary to inc H+)
but in type I, pH remains high. Serum HCO3-
=10
200) PO HCO3- as HCO3- reabsorption still
works. K+ replacement
201) Pts unable to absorb IV HCO3- load &
have basic urine in presence of
academia
202) K+ replacement, thiazide diuretics,
very large amounts of HCO3-
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
203) High urine Na+ w/ PO salt restriction
204) Fludrocortisone
205) Peaked T waves, wide QRS, short QT or
prolonged PR interval
206) CaCl, NaHCO3-, Glucose & insulin,
diuretic, B agonist, Kayexalate
(w/sorbitol), dialysis
207) Primary inability to reabsorb NaCl from
loop of Henle-> High renin,
high aldosterone, N BP
208) U wave, T wave flattening
209) Correct underlying dis, IV K+ max 10-20
mEq/hr, K+ PO 200-400 mg/point
of K+ decrease gut regulates absorption,
half N or NS
210) Isotonic IV fluids. For CDI: correct
dis, give ADH. For NDI: correct
dis, diuretics or NSAIDS
211) Urine Osmolality > Serum Osmolality w/U
Na+>40
212) Mild: fluid restriction
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
hypertonic saline; Chronic: Li &
demeclocycline
213) Erythropoietin & transfusions
214) Vit D, phosphate binders (Amphojel), Ca
rep
215) Restrict protein, K, PO4, Mg & give Vit
D, CaCo3, DDAVP (for bleeding)
216) Hyperkalemia, acidosis, fluid OL,
pericarditis, encephalopathy
217) After pharyngitis or strep skin infect-
> smoky urine (hematuria,
proteinuria) w/HTN & edema. Inc ASLO, AHT
(antihyaluronidase) & dec C3
218) Plasmapheresis (remove circulating Ab)
combined w/ steroids &
cyclophosphamide
219) Membranoproliferative (immune deposits
& dec complement)
220) None as self-limited. Sometimes
steroids
221) Plasmapheresis & steroids
222) Plasma exchange
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
223) Non-specific tx. For refractory cases:
steroids
224) Cytotoxics & steroids
225) Sterile pyuria, hematuria, flank pain,
mild proteinuria, hx (need 1g/d
for 1-3 yrs)
226) Naficillin/oxacillin, restoration of
hypovolemic shock, removal of
toxin
227) Isolation of fungus in sputum, pus,
biopsy
228) Severe: prolonged amphotericin (8-12
wks); mild:
itraconazole/ketoconazole (6-12 mo)
229) Visualize parasite in tissue & fluid
(serology is the most common
method used)
230) Contrast Head CT or MRI, pt is given
10-14 days of tx, then re-scan, if
lesion shrinks->dx confirmed
231) Specific serology: biopsy of skin
lesion. Doxycycline
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
232) CD455,000
233) CD4200
>6mo
234) CD4
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
240) Head CT w/contrast
241) MRI
242) HSV
243) PCR for HSV has 98% sensitivity & >95%
specificity
244) Staph aureus
245) Head CT
246) Promyelocytic leukemia (M3)
247) FFP & sometimes platelets, correct
underlying dis
248) Desmopressin (DDAVP) pre-op for mild
pts. Factor 8 for severe pts.
249) VWD
250) Abn Ristocetin platelet agg test, low
vW factor (aka factor VIII), inc
BT, maybe inc PTT
251) Pre-op DDAVP for mild pts, VWF
replacement for severe cases
252) Superficial bleeding, thrombocytopenia,
N spleen, Antiplatelet Ab (high
sensitivity w/poor specificity), Bone marrow
filled w/ megakaryocytes, N
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
peripheral smear & creatinine (R/O HUS, TTP,
DIC)
253) Initially prednisone (mostly). IF
platelet splenectomy. If
platelet IVIG or Rhogam initially. If no
response to IVIG or steroids in life
threatening condition-> platelet transfusion
(very rare)
254) HIV, EBV, HTLV-1, H. pylori
255) Only 10-20%
256) Excisional lymph node biopsy
257) Radiation
258) Combination chemo; Initial CHOP
(cyclophosphamide, hydroxy-adriamycin,
oncovin (vincristine), prednisone)
259) Autologous bone marrow transplant
260) 80-90%
261) Combination chemo ABVD (adriamycin
(doxorubicin), bleomycin,
vinblastine, dacarbazine)
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
262) Lymphocyte predominant HL
263) Inc WBC (predominantly neutrophils),
blasts absent or IFA
initially, if fails-> hydroxyurea (dec #
of cells); specific tx: Gleevec (tyrosine
kinase inhibitor)
265) Bone marrow biopsy: >30% blasts
266) Monoclonal Ab
267) Initially chemo-> 99.9% remission->
consolidate -> transplant; Initial
chemo for AML: cytosine arabinoside &
daunorubicin or idarubicin; Initial
chemo for ALL: Daunorubicin, vincristine,
prednisone & asparginase;
Promyelocytic leukemia: Add Vit A derivative
(ATRA); CNS px for ALL:
intrathecal methotrexate
268) Thrombosis of hep veins (Budd Chiari)
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
269) RBC memb defect in PIG-A
270) Specific: Sugar water test, Ham test,
decrease DAF (decay accelerating
factor)
271) If severe blood loss: Fe rep; If severe
for unclear reasons: steroids;
For thrombosis: anticoagulation
272) AD loss of spectrin (splenomegaly,
jaundice, anemia)
273) Sensitive: Osmotic fragility test, Inc
MCHC, -ve Coombs test
274) Chronic folate rep; If more severe
anemia: splenomegaly
275) Coombs test (smear will show
spherocytosis)
276) Stage I: 1 lymphatic gp; Stage II: 2
lymphatic gp on same side of
diaphragm; Stage III: lymphatic gp on both
sides of diaphragm or inv of any
extra lymphatic gp contiguous to primary
nodal site; Stage IV: widespread
dis w/ different extralymphatic sites as
bone marrow or liver
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
277) Unknown cause. 1% of population>50 yrs
& in 3% of those >70yrs
278) Inc monoclonal spike of SPEP (lower
than MM), N creatinine, Ca, Hb, inc
total protein, no lytic lesion, bone marrow:
10% plasma cell
281) Pre-op chemo VAD (vincristine,
adriamycin, dexamethasone). Young pts:
autologous bone marrow transp; Older pts:
melphalan & prednisone
282) Stage 0: lymphocytosis; Stage I:
lymphadenopathy; Stage II:
splenomegaly; Stage III: anemia; Stage IV:
thrombocytopenia
283) Inc WBC (80-90% lymphocytes), CD19,
smudge cells
284) None for stage 0-II if asx; If stage I-
II w/sx: chemo; Initial tx:
chlorambucil w/prednisone; if dont work:
fludarabine
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
285) CBC: pancytopenia; confirm w/bone
marrow biopsy: hypoplastic fat filled
w/no abn cells
286) When pt
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
A. contact his wife anonymously and tell her
that she has been exposed to
HIV
B. contact the appropriate government health
agency and report your findings
C. promise him that as his doctor you will
respect his privacy and maintain
confidentiality
D. promise him that you will keep the
results confidential if he agrees to
use condoms with his wife
E. try to persuade him to voluntarily
discuss the issue with his wife
The correct answer is E. Physicians must
violate confidentiality and warn
third persons about the danger of HIV
infection if the patient is unwilling
to inform the person himself. Before
informing third parties, the physician
should try to do everything possible to
persuade the patient to voluntarily
discuss the issue with their partner. If the
physician believes that an
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
individual may really be saved from a deadly
infection, confidentiality
should be violated.
A 3 and a half y/o boy presents with fever,
irritability, and erythema of
the hands and feet for the past week. His
mother has been giving him aspirin
to reduce his temperature. P/E on admission
showed a T=39.7 C (103.4 F),
bilateral conjunctival injection, an
enlarged right-sided cervical lymph
node (1.8-cm), fissured lips, a red tongue
with red papillae, pharyngeal
hyperemia, erythematous and edematous palms
and soles, and a confluent,
blanching erythematous rash on the trunk. IV
fluids were started, the
aspirin therapy was continued. Laboratory
studies show ESR= 28mm/h Plt=
490,000/mm3. The patient is extremely
uncomfortable and now shows
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
desquamation of the fingers and toes. The
most appropriate therapy at this
time is:
A. corticosteroids
B. ibuprofen
C. intravenous gammaglobulin
D. oxacillin
E. penicillin V
The correct answer is C. This patient most
likely has Kawasaki disease,
which is treated with aspirin and
intravenous gammaglobulin. The disease is
characterized by a high fever for longer
than 5 days, bilateral conjunctival
injection, fissured lips, a "strawberry
tongue", mucosal change in the oral
pharynx, erythematous and edematous palms
and soles with desquamation, a
polymorphous rash, cervical lymphadenopathy,
an elevated erythrocyte
sedimentation rate, and thrombocytosis. The
most important complication is
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
coronary artery aneurysms, which may be
prevented by early treatment with
aspirin and intravenous gammaglobulin. An
echocardiogram is necessary to
evaluate cardiac involvement.
41 y/o woman with a Hx of similar attacks of
epigastric abdominal pain in
the past was admitted to the hospital with a
Dx of gallstone pancreatitis.
She was NPO and IV fluid started. On the
evening of admission day, the
patient is noted to have T=103.3 F. Her BP &
HR are within normal range. Her
abdomen is diffusely tender to palpation
with guarding. Whats the most
appropriate management at this time?
A. draw blood cultures and await results
B. draw blood cultures and initiate
ampicillin, gentamicin, and
metronidazole therapy
C. draw blood, urine, and sputum cultures
and await results
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
D. obtain an urgent abdominal CT scan
E. start ampicillin, gentamicin, and
metronidazole therapy
The correct answer is B. The most
appropriate management at this time is to
draw blood cultures and initiate ampicillin,
gentamicin, and metronidazole
therapy. Intravenous antibiotics are only
indicated if there is evidence of
pancreatic necrosis or if the patient
develops a fever after the diagnosis
of pancreatitis is made. There is a
substantial amount of clinical
literature validating this approach to
treating pancreatitis. The
appropriate sequence of events is to draw
blood cultures prior to initiating
therapy in order to maximize chances of
detecting an organism.
A 24.6 hour old male infant is noted to have
some peculiar jerking movements
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
of the right foot and arm. His axillary
temperature an hour before was
36.2"C. The physical examination reveals no
unusual findings except that he
appears small and premature. His birth
weight was 2,550 g. The mother's and
infant' s history show that he was the
second of twins born after 37 weeks'
gestation, presented in transverse position
and his heart rate had dropped
to 80 per minute 10 minutes prior to birth,
with documented fetal hypoxia.
He had an Apgar score of 3 at 1 minute and 7
at 5 minutes. The mother had
nausea and vomiting during pregnancy for
which she was given vitamin B6. She
had mild preeclampsia at delivery.
*** Which is the most likely diagnosis?
a) Brain tumor
b) Hypoxemia in utero and possibly during
delivery
c) Cerebral trauma during delivery
d) Vitamin B6 dependency
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
e) None of the above
*** In the diagnostic work-up, you may
obtain the following tests or
procedures, EXCEPT:
a) CT scan of the head
b) Lumbar puncture for examination and
culture of spinal fluid
c) Electroencephalography
d) Serology for toxoplasmosis
e) Blood levels of sugar and calcium
answers are B & D
Hypoxemia is the leading cause of seizures
considering the history of drop
in fetal heart rate and low Apgar score at 1
minute. Hypoglycemia,
hypocalcemia, vitamin B6 dependency, and
meningitis are possible causes of
seizures but unlikely and should be ruled
out. Some cerebral anomaly is
possible. Incidence of congenital
malformations is higher in twins than , in
Dr.G.Bhanu Prakash www.mbbsinchina.us www.gims-org.com
Facebook : www.facebook.com/doctorbhanuprakash
singletons, and central nervous system
malformations lead all others in
frequency. Brain tumors at this age are rare
and usually present with
recurrent vomiting and not with seizures.