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119 Cards in this Set
- Front
- Back
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Even though storage iron is abundant, there is decreased amount of iron in erythroblasts, reflecting a defect in the transfer of reticuloendothelial iron to developing red blood cells.
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Anemia of Chronic Disease
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Hemolysis usually is precipitated by an environment oxidant stress, most commonly viral or bacterial infection, through an unknown mechanism. Certain drugs, such as antimalarial agents (primaquine, pamaquine, dapsone), sulfonamides (sulfamethoxazole), phenacetin (Acetaminophen is a metabolite of phenacetin),and Vitamin K, also can trigger hemolysis.
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G6PD
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Give the patient an aspirin, start Heparin and assess for thrombolytic contraindications
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MI
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hormone associated with lactation
stimulated by infant suckling along, oxytocin is made |
prolactin
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rx for new onset DM
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begin by educating him about Diabetes Mellitus, emphasizing the acute and long term microvascular and macrovascular complications (3,4). Emphasizing how many of these complications can at least be slowed down in onset with careful adherence to treating his life-long diabetic condition. You would also set up a dietary consultation with a certified Diabetic nutritionist.
Though he probably looks "chronically" ill he does not have ketones in the urine dipstick test to suggest that he is in D.K.A.. He has Diabetes based on his FSG of 250. His last meal being 8 hours ago, he should of already been euglycemic. Doing a formal glucose-tolerance test would be waste of time and resources. Getting a Hemoglobin A1C would be good to have as a baseline value. |
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a mast cell stabilizer and is used as a PROPHYLACTIC agent in patients with IgE mediated exacerbations.
This is particularly useful in athletes just before an event. Thus, this is not a useful agent in a patient undergoing an acute attack as the mast cells have already degranulated. |
cromolyn
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slowly spreading erythema of the skin due to a temporary dilatation of the capillaries
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flushing
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JVP (jugular venous pressure) is 6 cm H2O and hepatojugular reflex is negative excludes
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RHF
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Hyperuricemia may accompany rapid cell turnover which is a potential complication secondary to the rapid lysis of lymphoma cells after chemotherapy. Slides show
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flat, square plates, which are characteristic of one form of uric acid crystals
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SLE is common in man/woman?
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9 times more common in women
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the patient can't see, can't pee, can't bend the knee" or "can't see, can't pee, can't climb a tree
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Reiter's syndrome/reactive arthritis
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DKA in which diabetes type
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type One
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a form of hemoglobin used primarily to identify the average plasma glucose concentration over prolonged periods of time.
It is formed in a non-enzymatic pathway by hemoglobin's normal exposure to high plasma levels of glucose. <6 is normal |
HbA1c
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define tia
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FOCAL neuro deficit resulting from cerebral ISCHAEMIA, which resolves WITHIN 24 hours
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define stroke
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FOCAL neuro deficit resulting from cerebral ISCHAEMIA, which resolves LONGER than 24 hours
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visuospatial is controlled by which lobe
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right parietal
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surface anatomy of dorsalis pedis artery
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tarsal bone between tendons of extensor hallucis-digitorum longus
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surface anatomy of posterior tibial artery
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between archillles tendon and medial malleolus
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effect of taking nsaid with diuretic
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vasoconstriction reduces gfr on top of diuretic causing renal failure
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hippocampus function
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memory
spatial memory - environment |
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Examine PD
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Inspect - mask, posture flexed, spontaneous movement
Gait/movements - chair-walk-quick turn-stop-start - shuffling, festination, finger tapping, twiddling Tone - cogwheel Face - glabellar tap, monotonous speech, weak upward gaze, seborrhoea, palmomental reflex Writing - migrographia |
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Elicit palmomental reflex
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Using think stick, stroke wrist edge to thumb base, +ve if ipsilateral mentalis muscle twitches
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Steroid s/e
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Gastro - ulcer
Immuno - infection Child - retardation Osteoporosis, Cushing's |
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10 steps of outbreak ix
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1. Prepare for field work
2. Establish the existence of an outbreak 3. Verify the diagnosis 4. Define and identify cases 5. Describe and orient the data in terms of time, place, and person 6. Develop hypotheses 7. Evaluate hypotheses 8. Refine hypotheses and carry out additional studies 9. Implement control and prevention measures 10. Communicate findings |
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Causes of excoriations
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Primary biliary cirrhosis
Cirrhosis Lymphoma Chronic Hep C |
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Examine PD
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Inspect - mask, posture flexed, spontaneous movement
Gait/movements - chair-walk-quick turn-stop-start - shuffling, festination, finger tapping, twiddling Tone - cogwheel Face - glabellar tap, monotonous speech, weak upward gaze, seborrhoea, palmomental reflex Writing - migrographia |
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Elicit palmomental reflex
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Using think stick, stroke wrist edge to thumb base, +ve if ipsilateral mentalis muscle twitches
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Steroid s/e
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Gastro - ulcer
Immuno - infection Child - retardation Osteoporosis, Cushing's |
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10 steps of outbreak ix
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1. Prepare for field work
2. Establish the existence of an outbreak 3. Verify the diagnosis 4. Define and identify cases 5. Describe and orient the data in terms of time, place, and person 6. Develop hypotheses 7. Evaluate hypotheses 8. Refine hypotheses and carry out additional studies 9. Implement control and prevention measures 10. Communicate findings |
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Examine PD
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Inspect - mask, posture flexed, spontaneous movement
Gait/movements - chair-walk-quick turn-stop-start - shuffling, festination, finger tapping, twiddling Tone - cogwheel Face - glabellar tap, monotonous speech, weak upward gaze, seborrhoea, palmomental reflex Writing - migrographia |
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Causes of excoriations
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Primary biliary cirrhosis
Cirrhosis Lymphoma Chronic Hep C |
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Elicit palmomental reflex
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Using think stick, stroke wrist edge to thumb base, +ve if ipsilateral mentalis muscle twitches
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Steroid s/e
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Gastro - ulcer
Immuno - infection Child - retardation Osteoporosis, Cushing's |
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10 steps of outbreak ix
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1. Prepare for field work
2. Establish the existence of an outbreak 3. Verify the diagnosis 4. Define and identify cases 5. Describe and orient the data in terms of time, place, and person 6. Develop hypotheses 7. Evaluate hypotheses 8. Refine hypotheses and carry out additional studies 9. Implement control and prevention measures 10. Communicate findings |
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4 systems of chest pain
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CVS - ihd, pericarditis, aa, pe
RS - pleurisy, tumours MSK - muscle, bone Neuro - zoster |
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Time difference in ihd chest pain
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angina <20min
mi >30min |
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Relief difference in ihd chest pain
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angina - rest, stn
mi - opioid/heroin |
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chest pain associated with vomit, sob, sympathetic over-activity, panic
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mi
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why impending doom in mi
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myocardial muscle necrosis -> hypotension -> shock
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causes of pleurisy
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infection - viral, bacterial
infiltration - tumour sarcoidosis ra |
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which tumour causing rs pain?
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mesothelioma - arise in pleura
bronchogenic - after spread |
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auscultation of pleurisy
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friction rub
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areas of depigmentation is
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previous vesicular eruption of zoster
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chest pain @ peripheral chest
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pe
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chest pain - tight, crushing
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ihd
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chest pain - sharp
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pericarditis
pe |
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chest pain - tearing
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aa
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chest pain scale difference of ihd
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angina - 5
mi - 10 |
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chest pain radiation for aa
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posterior - scapulae to down back
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chest pain for days
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pericarditis
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chest pain onset no particular time
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pericarditis
pe |
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sx of angina pectoris
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exe
food - blood flow up stress - hr-peripheral resistance up cold - peripheral resistance up a.decubitus - rem sleep |
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rx a.pectoris
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snap
acute - gtn tablets, nitrolingual spray prophy - isosorbide mononitrate, beta blocker, ca blocker f/up - drug gives pain-free? |
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isosorbide mononitrate downs
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peripheral resistance -> downs o2 demand
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beta blocker slows
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HR -> downs contraction force = -ve inotropic
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ca blocker downs
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presis -> downs contraction force = -ve inotropic
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Define MI
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blood supply to coronary arteries interrupted -> myocardial necrosis
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Cause of mi
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atheromatous plaque -> thrombus/embolus
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sx of mi
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shocked, unwell, anaemic
sweating, cold, clammy skin fast-weak pulse, reduced bp, lvf |
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5 cardiac enzymes
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ckmb
ck ast ldh troponins |
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elevated troponin indicates
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critical ischaemia
cardiac muscle wall necrosis |
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troponin elevation degree corresponds to
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damage amount
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rx mi
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pain - morphine, antiemetic (cyclizine), o2
thrombolytic - streptokinase, tpa |
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excellent answer to rx mi
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give adequate pain relief -> o2 by inhalation -> treat complications
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immediate-early-late complications of mi
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immediate - asystolic arrest, vt, lvf
early - lvf, arrythmia late - lvt, aneurysm of ventricle |
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define ventricular failure
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fn impaired -> blood congestion in pulmonary v -> p.oedema
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causes of ventricular failure
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ihd
rhythm disorder valvular disease |
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auscultation characteristic of p.oedema
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fine creps at lung bases extending up to mid-zones
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rx acute ventricular failure
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o2 by inhalation
diuretic aminophylline |
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theophylline for rs
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relax bronchial smooth mm
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rx subacute ventricular failure
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diuretic - down work
correct rhythm electrolyte balance - potassium acei - down load |
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sx of heart failure
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displaced apex beat
hs3 basal creps rhf sign |
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rx af
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digoxin
amiodarone dc cardioversion |
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pathological palpitations are associated with
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dizziness
chest pain sob syncope |
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mitral stenosis is sequel to
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rf
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why recurrent respiratory infection in mitral stenosis
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congested oedematous lungs prone to bacterial infection
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hs of mitral stenosis
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loud hs1 -> normal hs2 -〉opening snap
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rx mitral stenosis
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prophy ab
digoxin echo - severity valvotomy/mv replacement |
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causes of mr
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lvf -> mv ring dilatation
rheumatic heart disease mi complication ihd -> papillary mm dysfunction |
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why soft hs1 in mr
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mv fail to close
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mr is louder on
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expiration
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rx mr
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lvf
rhythm prophy ab valve replacement |
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causes of as
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calcified
rhd |
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sx of as
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outflow obstructed -> downs co -> weak skeletal mm, tired -> lv hypertrophy
angina syncope |
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characteristic murmur of as
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harsh crescendo-decrescendo
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ecg of as
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marked lvh
lbbb |
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causes of ar
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htn
rheumatic fever ct - ra, marfan's |
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sx of ar
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sob
a.pectoris |
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ecg of ar
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lvh
lad lbbb |
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sx of pe
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pleuritic chest pain
cough - blood sob tachycardia jvp e +ve hepatojugular reflux |
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ix of pe
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ct lungs
pulmo angiography v/q mistmatch - ventilated not perfused |
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rx pe
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anticoags
embolectomy thrombolysis |
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single swollen leg + pain on wt bearing might be
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dvt
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vein abnormalities prone to dvt
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constituents -> coag
flow rate -> stasis - immobile wall - inflammation, tumour press |
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ix dvt
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doppler venography
venogram using contrast |
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ex dvt
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swelling - diameter of calf-thigh compared to other side
temp warm skin dysky red pitting oedema calf mm, tibia - tender popliteal v - clot foot dorsiflex - pain |
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rx dvt
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heparin
pain relief oral anticoag - inr 3 check malignancy if recurrent |
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collapsing
plateau bisferiens pulses in |
ar collapse
as plateau ar/s bisferiens |
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causes of af
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ihd
rhd mvd hyperT |
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causes of bradycardia
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beta blocker
hypoT complete heart block |
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5 alphabets of venous pulsation
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a-c-x-v-y
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whats a-c-x-v-y
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atrial contraction
tricuspid valve closure atrial relaxation ventricular contraction ventricular filling |
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does venous pulse change with inspiration
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increases
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no a-wave in venous pulsation suggest
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af
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ddx of unilateral swollen leg
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dvt
ruptured baker's cyst cellulitis |
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ddx of bilaterail swollen leg
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oedema - rvf, renal disease, malabsorption, protein-losing enteropathy, liver disease, fluid overload
myxoedema lymphoedema |
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rx oedema
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diuretic
salt-free albumin |
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mucopolysaccharide accumulate causing leg swelling
non-pitting hypothyroidism |
myxoedema
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lymph accumulate in dependent parts
congenital absence impaired fn - recurrent infection, surgery, trauma, malignancy infiltration non pitting |
lymhoedema
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rx lymphoedema
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underlying cause
elevate leg compression stock diuretic little beneft as fluid cannot reach circulation to be excreted |
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why diuretic little benefit for lymphoedema
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fluid cannot reach circulation to be excreted
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define htn
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2 sd above mean of age/sex matched
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formulas of bp, co
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hr x sv = co
co x pr = bp |
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which 3 classes based on for htn drug
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hr - beta blocker
sv - diuretic, beta blocker pr - ca blocker, acei, angio II blocker, nitrates |
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how to use 3 classes of htn drug
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single -> not controlled add second drug with different moa -> third class
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pathophysiology of essential htn
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increased vascular tone in small arteries, arterioles -> increased pr
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sx of htn
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bp up
lvh - thrusting apex beat, ecg change hs4 hypertensive retinopathy |
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3 causes of cardiac arrest
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asystolic arrest
vt vf |
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define cardiac arrest
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no co sufficient to maintain life
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