Category Archives: INTERNAL MEDICINE FINALE

Cor pulmonale

How copd leads to cor pulmonale
Hypoxic pulmonary VC
pulmonary vascular remodelling
Lung hyperinflation– compresses the capillaries ( alveolar wall stretches)

REVISION CARDIO

Copied from wallnote.
For revision purposes
Cardiology Question
1) Give the mechanism and clinical significance of pulsus paradoxus?
2) Mechanism and clinical significance of 3rd heart sound to the left of the sternum?
3) Central cyanosis, its mechanism and clinical significance?
4) Clinical features of infective endocarditis?***
portal of entry:
majority unknown, dental, urethral,pelvic,cardiac surgery, strep bovis, iv drugs,
hosp acq
onset: insiduous+fever+malaise
neglected: “syndrome” 8
fever,anemia,tender sternum, tender splenomegaly, cardiac murmur, microscopic hematuria, skin petichae,clubbing
cardiac:
murmur: new or intensified
heart failure: intractable/laceration or perforation of valve
coronary emboli
mycotic aneurysm
extracardiac:(1neuro to sternum,4skin,1spleen,1urine)
neurological complication
tender sternum
skin petichae: conj,mouth, roths spot,janeway
osler nodule
splinter hge
clubbing
splenomegaly
proteinuria/mic hematuria
5) Enumerate causes and the pathogenesis of myocardial ischemia?
6) Clincal features & management of left ventricular failure**
7) Discuss investigation needed for diagnosis of pericardial effusion?***
CXR–>flusk shaped heart/water bottle heart
Echo–>increase pericardial space
ECG–>low amplitude QRS complex
pericardiocentesis (Echo guided)–>to relieve symptoms, C&S
8) Give brief treatment of paroxysmal atrial tachycardia?
9) Etiology and pathogensis of persistent dyspnea in the left heart failure?**
10) Clinical manifestation of cardiac temponade?*****
symptom : Dyspnea, tachycardia, tachypnea
sign : KEPp YB
kussmaul sign
Ewart sign
pulsus paradoxus
the y descent
Beck triad
11) Give treatment of infective endocarditis****
prophylaxic: dental hygiene
oral,oral,, respiratory, esophagus: amoxacillin 2gm PO 1hr b4
GU,GI: high risk–>amox/ampi 2gm IV+gentamycin1.5gm IV 1hr b4->ampi/amox 1gm PO aftr 6hr
mod risk–> ampi/amox 2gm IV b4
active medical: bactericidal,IV, min 4wks
Penicillin G iv 12-20mill U/24hr for 4weeks+-gentamycin 3mg/kg/24hr for 2 weeks
resistant: Vancomycin+gentamycin for 6 weeks
MRSA: native: vancomycin 15 mg/kg iv for 4-6 wks
PVE: VGR (6-2-6 wks)
culture -ve n complicated: Native: Vancomycin+gentamycin
PVE : VGR
12) Discuss briefly the etiology and pathogenesis of congested nect vein?
13) Give etiology and possible mechanism of heart failure?
14) Give etiology and possible mechanism of bradycardias?
15) Clinical features of dissecting aortic aneurysm
16) Treatment of acute myocardial infarction?**
a) AHA guideline if suspect MI–> Morphine, O2, Nitroglycerine, Aspirin
b) General Rx–>hosp, CCU, MONA, clopidogrel&statin, ACEI, B-blocker,LMWH
c) Specific Rx–> if w/in 30min: tPA/streptokinase/urokinase
if w/in 90min: PCI
17) Give clinical picture and complication of aortic valve insufficiency?
18) Etiology, clinical picture and management of left ventricular failure?*****
19) Give etiology and mechanism of angina pain?
20) Clinical picture and complication of constrictive pericarditis?**
CP: symptom
Gradual onset
dypsnea, fatigue, orthopnea
LL edema, abd swelling, discomfort
congestive symp : nausea vomiting
: rt upper quadrant pain
sign: KEPP YA
1) kusmaul sign 5) the y descent
2) Elevated jugular venous pressure 6) Apical impulse impalpable
3) pulsus paradoxus
4) pericardial knock
21) Investigations for ischemic heart disease?
22) Treatment acute rheumatic carditis?
23) Etiology,pathology, clinical manifestation, and treatment for infective endocarditis?
24) Give etiology and mechanism of basal systolic murmurs?
25) Clinical pictures of the acute rheumatic carditis?
26) Investigation for fever in cardiac patient?
27) Investigation needed for hypertension on young age?**
28) How to investigate hypertension?
29) Medical treatment for paroxysmal supraventricular tachycardia?
30) Cardiogenic shock ( ccu )
31) Discuss treatment of atrial fibrillation***
32) Clinical picture, diagnosis and management of acute myocardial infarction?**
33) Enumerate complication of acute myocardial infarction
34) 4 factors that may indicate bad prognosis in acute myocardial infarction?
35) Give short notes on treatment of congestive heart failure?****
36) Causes of hypertension?
37) Mention subacute bacterial endocarditis?
38) Causes & Diagnosis of co pulmonale?**
39) Treatment of acute heart failure?
40) Factor precipitating or aggravating heart failure?
41) Outline complication of mitral valve stenosis?
42) Investigation required in atrial fibrillation?
43) Medical treatment left ventricular failure?
———————————————————
GIVE THE ETIOLOGY & PATHOGENESIS OF:
l-Left ventricular failure
2-Pulmonary hypertension
3-Parenchymal cor pulmonale
4-Rheumatic fever
5-2ry hypertension
6-Renal hypertension
7 -Congested neck veins
8-Diastolic murmur on apex
9.Pulsus paradoxus
10-Continuous dyspnea
11-Bradycardias
12-Basal systolic murmur
13-Basal diastolic murmur
14-Tachycardias
15-Anginal pain
GIVE THE CLINICAL PICTURE OF:
1-Left ventricular failure
2-Anaphylactic shock
3-Pulmonary hypertension
4-Rheumatic fever
5-Mitral stenosis
6-Mitral incompetence
7 -Aortic stenosis
8-Aortic incompetence
9-Infective endocarditis
10-Myocardial infarction
11-Cardiac tamponade
12-Dissecting aortic Aneurysm
13-Constrictive pericarditis
14-Adhesive pericarditis

GIVE THE INVESTIGATIONS NEEDED FOR: u
1-Myocardial infarction
2-Infective endocarditis
3-Rheumatic fever
4-Left ventricular failure 5-Atrial fibrillation
6-Recurrent syncope
7- Hypertension in young
8- Pericardial effusion
GIVE THE TREATMENT O.F:
1-Acute left ventricular failure
2-Atrial fibrillation
3-Infective endocarditis
4-Rheumatic carditis
5-Acute myocardial infarction
6-Acute pulmonary edema
7 -Angina pectoris
8-Paroxysmal Atrial tachycardia
LONG QUESTIONS:
1-Give the etiology, pathophysiology, c/p, and management
of shock
2-Give account on: diagnosis and management of infective endocarditis
3-2ry Hypertension: Cause”s & Diagnostic features of 3 of them
4-Causes, clinical picture, investigations of Rt. & Lt. ventricular failure
5-Give an account on atrial fibrillation (causes, diagnosis & Rx)
6-Pulmonary hypertension (definition, causes, CP & investigations)
Definition: Right ventricular hypertrophy and dilatation secondary to pulmonary hypertension due to disease in the lung vessel and parenchyma and not due to left heart
causes: 1) Increase resistace to flow : large pulmonary artery
a) uni absence/stenosis
b) thromboembolism
: pulmonary vascular bed
a)
7-Mitral stenosis (pathophysiology, CP, complications & investigation)
8-Aortic stenosis (pathophysiology, CP, complications & investigation)
9-Aortic incompetence (pathophysiology, CP, complications & Ix) .’
10-Myocardial infarction (causes, CP, investigations & Rx)
11-Pericardial effusion (causes, CP, investigations & Rx)
12-Clubbing (Causes, grades & pathology) 13-Edema (Causes, mechanism & Diagnosis)

REVISION DIABETES

Past year questions

DIABETIC

1-Lines of treatment hyperTGdemia in diabetic pt (06,08)
2-Give short account on indication of insulin theraphy in type 2 DM
3-Mechanism in neuropathy in DM (95)
4-Cp of hypoglycemic coma (95)
5-Rx of DI (95)
6-Causes and pathogenesis of DKA (96,00)
7-Etiology and phatogenesis if hypoglycemia (02,05,07)
8-Rx of type-2 DM
9-Cardiovascular complication of DM (03)
10-Rx of DKA (03,08)
11-Skin changes in DM (03)
12-Enumerate 6 oral anti-diabetic agents (04,08)
13-Rx of diabetic microalbunuria (05)
14-Medical nutrition theraphy in DM (07)
15- Dx of gestational DM (07)
16-Approach to hyperglycemia pt (08)
17-Discuss non-pharma Mx of DM (08)
18-Features of Diabetic dyslipidemia (08)