Internal assessment-1

https://medicinedepartment.blogspot.com/2021/10/mbbs-2017-batch-oct-2021-internal.html?m=1

Question-1

Define bone density? How is it measured? What are the causes, clinical features ,diagnosis and management of osteoporosis?

Ans: 

 

 

 

  

Bone density is the amount of bone mineral in bone tissue( mass of mineral per volume of bone)

Measured by DEXA( dual energy  x ray absorptiometry)

Question-2

What is myxedema coma? Describe its clinical features,diagnosis,treatment for myxdema coma?

Ans:    

  

 

 Treatment:

Supportive care-

Gentle warming with blankets,Broad spectrum antibiotics,high flow oxygen,and if required assisted ventilation

Correction of hyponatremia and hypoglycemia

Hydrocortisone (100mg ivsly,8hrly)is required due to increased metabolic stress

Thyroid hormone replacement-

T4- initially 100-150Micro gm and then 75-100 MCG iv is recommended

T4- - orally ina dose of 300mcg start followed by 100-300mcg daily

Treat precipitating causes

Question-3

What is the diagnostic approach  of young onset hypertension and its treatment?

Ans:

Question-4

How do you clinically localise the anatomical level of lesion in spinal cord diseases?

Ans:

Question-5

Causes,diagnosis, and treatment  of atrial fibrillation?

Ans:

 

 

Causes; Rheumatic heart disease, ischemic heart disease, hypertension, thyrotoxicosis, congenital heart disesase, cardiomyopathy, pericardial diseases,rare causes; alcohol, pulmonary embolism

Symptoms; palpitations,fatigue,syncope, 

Signs; irregularly irregular pulse

Absence of waves on jvp, hypotension,disappearance of psa of mid diastolic murmur of mitral stenosis

Disappearance of fourth heart sound

Diagnosis;

ECG; irregularly irregular rhythm of qrs complexes

Absent p waves

Small irregular waves at state of 350-600/minute 

Complications ; syncope,angina, thromboembolism

Hypotension.

Management;

Goals; 

Hemodynamic stabilization

Control of ventricular rate

Restoration of sinus rhythm

Treatment of underlying cause

1) if pt s clinical status is severely compromised synchronised dc cardioversion is treatment of choice

2) if pts cardioversion is not severely compromised treatment is in 2steps

*Slowing ventricular rate with  diltiazem,verapamil,digoxin

Amiodarone; 150mg over 10 minutes followed by 1mg / minute over 6hrs and0.5mg/minute for another 18hrs

A/E; hepatic toxicity, pulmonary toxicity, thyroid dysfunction

2(converting rhythm to normal sinus rhythm

Pharmacological cardioversion to sinus rhythm with quinidine,flecanide

*Antithrombotic therapy

*Aspirin

*Refractory cases are managed with catheter ablation therapy

Question -6 

Describe about megaloblastic anemia?

Ans:

 

  

 

Question-7 :

What are the causes ,pathogenesis, and differential diagnosis of ascites?

Ans:

 

causes of ascites

Hepatic cirrhosis,

*Malignant; hepatic, peritoneal

*Infection; tuberculosis,bacterial peritonitis

*Hypoproteinemia; Nephrotic syndrome, malnutrition

*Cardiac failure, constrictive pericarditis

*Hepatic venous obstruction; budd-chiari syndrome,veno occlusive disease

*Pancreatitis

*Lymphatic obstruction-chylous ascites

In common; meigs syndrome, vasculitis, Hypothyroidism,

Pathogenesis;

Ascites occurs due to imbalance between formation and resorption of peritoneal fluid.in cirrhosis of liver ascites is due to

* Portal hypertension

*Renal changes; increased sodium and water resorption.thre is stimulation of RAAS,increased ADH release and decreased release of natriuretic hormone or third factor

*Imbalance between formation and removal of hepatic and gut lymph

*Hypoalbunemia

*Elevated Padma vasopressin and epinephrine levels in response to volume depleted state accenuates renal and vascular factors

Differential diagnosis;

Acute liver failure,cirrhosis, budd-chiari syndrome,dilated cardiomyopathy, alcoholic hepatitis, biliary disease

Question -8

Approach to acute pancreatitis?

Ans:

 

 

 

Question-9

 Mention the differences between UMN and LMN lesions?

Ans:

UMN lesions;

*Weakness; voluntary movements are disturbed; distal predominant

Tone; hypertonia( claspknife spasticity)

*Reflex (tendon); increased,

*Reflex (superficial); absent or decreased

Plantar response; extensor

*Muscle atrophy; disuse

*Fasciculations ; absent

*Bilateral movements; spared

(Eyes,face,jaw,neck)

*Reaction of degeneration; absent

* Nerve conduction; normal

LMN lesions

Weakness;  paralysis of muscles supplied by that segment or nerve proximalpredominant

Tone; hypotonia

*Reflex (tendon); decreased or absent

*Reflex (superficial); absent or decreased

Plantar response; flexor or absent

*Muscle atrophy; marked

*Fasciculations ; often present

*Bilateral movements; affected

(Eyes,face,jaw,neck)

*Reaction of degeneration; present

* Nerve conduction; abnormal

Question-10

Indications of hemodialysis?

Ans:

Question-11

Role of sucralfate in treatment of erosion gastritis?

Ans:

Sucralfate is used to treat and prevent duodenal ulcers and other conditions . It works by forming a barrier or coat over the ulcer. This protects the ulcer from the acid of the stomach, allowing it to heal. Sucralfate contains an aluminum salt.

Question-12

Mention renal manifestations of snake bite?

Ans:

-Hematuria

-Hemoglobinuria

-Myoglobinuria

-Loin pain

-Renal failure

Question-13

Causes of portal hypertension?

Ans:

Question -14

Clinical features of downs syndrome?

Ans:

  

Craniofacial and musculoskeletal;

Flat nasal bridge,flat face,brachycephaly,malformed large ears,hypertelorism,slanting eyes with epicanthic folds, protruding furrowed tongue

Broad short neck,simian crease,short stature,hypotonia

Increased space b/w first and second toes(sandal gap)

✓Brain; increased frequency of sleep apnea syndrome,mental retardation,Adhd,autism

✓Heart; ASD,VSD,tetralogy of fallot

✓Git;. Oesophageal or duodenal atresia,imperforate anus

✓Reproductive;males are sterile

✓endocrine; Hypothyroidism,type-1DM

✓Bone marrow; increased incidence of acute leukemia

 

Question-15

Post streptococcus glomerulonephritis complications?

Ans:

-susceptibility to infections

- acute left ventricular failure

-hypertensive encephalopathy

-fluid and electrolyte imbalance

-Acute renal failure

-Nephrotic syndrome

-chronic glomerulonephritis

Question-16

Causes  of cervical myelopathy?

Ans:

• Rheumatoid arthritis of the neck.
• Whiplash injury or other cervical spine trauma.
• Spinal infections.
• Spinal tumors and cancers
• Spondylosis
• Spinal cord compression or squeezed.