Rimikri Med https://med.rimikri.com Online preparation for medical examinations Sun, 24 Dec 2017 09:24:05 +0000 en-US hourly 1 https://wordpress.org/?v=5.4.2 https://i1.wp.com/med.rimikri.com/wcmdri/uploads/2017/05/cropped-logo-Circle-opt-1.png?fit=32%2C32&ssl=1 Rimikri Med https://med.rimikri.com 32 32 140363082 IHD treatment guideline for intern doctors https://med.rimikri.com/ihd-treatment-guideline-for-intern-doctors/ Sun, 24 Dec 2017 09:14:39 +0000 http://med.rimikri.com/?p=1926 The post IHD treatment guideline for intern doctors appeared first on Rimikri Med.

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IHD Treatment Guideline

Treatment:

This is a sample prescription for the intern doctors for the treatment of IHD (STEMI and Non-STEMI). The Brand Names of the drugs mentioned below are from different drug manufacturers of Bangladesh.

Guideline Admission Release
Limit physical activities at least for 12 hours Absolute bed rest
Diet: restrict sodium intake Diet: Soft and liquid
Oxygen in patients with respiratory distress and oxygen saturation ≤94% O2 inhalation 4L/min

stat and SOS

Tab. Aspirin 150-325 mg PO administered as soon as possible on admission.

Tab. Clopidogrel 300 mg stat and followed by 150 mg daily for 1 week and 75 mg daily thereafter.

Tab. LOPIREL PLUS1

4 tabs stat by crushing

then 0+1+0 (a/m)

Tab. LOPIREL PLUS1

0+1+0 (খাবার পর)      – চলবে

Tab. Nitroglycerine 0.3-0.6 mg sublingual Tab. TROCER 2.6 SR2

1+0+1+0

Spray TROCER

2 puffs S/L stat and SOS

Spray TROCER

জিহ্বার নিচে দুই চাপ নিবেন

Continuous treatment with an oral β-blocker reduces long-term mortality Tab. METOPROL XL 50mg3

½+0+ ½

Tab. BETALOC 25mg3

1+0+1                      – চলবে

Tab. ANGINOX 20mg4

1+0+1 (a/m)

Irrespective of serum cholesterol concentrations, all patients should receive statin therapy after acute coronary syndrome Tab. ANZITOR 20mg5

0+0+1

Tab. ANZITOR 10mg5

0+0+1                     – চলবে

If no hypotension or contraindications and uncomplicated MI given Tab. Enalapril 5 mg 2 times a day PO Tab. RAMORIL 2.5mg6

0+0+1

Tab. RAMORIL 2.5mg6

0+0+1                     – চলবে

Tab. NEXUM 20

1+0+1 (b/m)

Tab. NEXUM 20

1+0+1 (খাবার আধা ঘণ্টা পুর্বে)

–  ১৫ দিন

Sedation with a benzodiazepine agent may help if anxiety is present Tab. EPICLON 0.5mg7

0+0+1

Tab. EPICLON 0.5mg7

0+0+1                     – ১৫ দিন

Inj. Enoxaparin 1 mg/kg subcutaneously 12 hourly for 3-5 days Inj. CLEXANE 60mg

1 PFS S/C around the umbilicus BD

If severe pain:

Morphine 15mg diluted with 14mℓ of water for injection or sodium chloride 0.9%. Give 1mℓ/min IV until pain relieved. (Initially, morphine sulphate 5–10 mg)

If within 6 hours of onset of pain and ST segment elevation above baseline or new LBBB on ECG.

Streptokinase 1.5 million IU diluted in 100mℓ dextrose 5% or sodium chloride 0.9% IV over 30–60 minutes.

Inj. STK9 1.5 million IU

Dissolved in 100 cc N/S IV @ 100 microdrops/min

 

 

1 LOPIREL PLUS – Incepta Aspirin + Clopidogrel

75mg + 75mg

2 TROCER 2.6 SR – Incepta

 

Glyceryl Trinitrate (nitroglycerine)
3 METOPROL XL – Beximco (50/100mg)

BETALOC – Drug Int. (25/50 mg)

Metoprolol Tartrate ( blocker). Avoid in pregnancy, asthma, COPD, peripheral vascular disease, heart failure (pulmonary oedema), hypotension (systolic BP < 105 mmHg) or bradycardia (heart rate < 65/min).

 

4 ANGINOX 20mg – General Pharma Trimetazidine Dihydrochloride (anti-anginal & anti-ischemic drug)
5 ANZITOR – Square (10/20/40mg)

 

Atorvastatin (statin, anti-anginal & anti-ischemic drug)
6 RAMORIL – Incepta (1.5/2.5/5/10mg)

 

Ramipril (ACEi)
7 EPICLON – General (0.5/1/2mg)

 

Clonazepam (Benzodiazepine hypnotic, adjunct anti-epileptic)
8 CLEXANE – Sanofi (20/40/60/80mg)

CLOTINEX – Square (40/60/80mg)

 

 

Enoxaparin (anti-coagulant)
9 STK– Incepta (4500/-)

STREPTASE– Sanofi Aventis (3464/-)

S-KINASE – Popular (3000/-)

 

Streptokinase (fibrinolytics)

 

 

Advice:

Guideline Admission Release
Cessation of smoking Cessation of smoking ধূমপান সম্পূর্ণ বন্ধ।
Initiate or maintain lifestyle modifi cation–weight-control, increased physical activity, alcohol moderation, sodium reduction, and emphasis on increased consumption of fresh fruits, vegetables, and low-fat diary products. পাতে লবণ খাবেন না।
Patient should avoid non steroidal anti-inflammatory drugs like ibuprofen and diclofenac, as they may precipitate angina.
Coronary angiography should be considered with a view to revascularisation in all patients at moderate or high risk

 

 

 

Reference:

  1. Standard treatment guidelines of the Kingdom of Swaziland. Swaziland: Ministry of Health; 2012.
  2. Primary Care 101 Guideline 2013/14: The National Department of Health Private Bag x828 Pretoria 0001; 2013.
  3. Papadakis MA, McPhee SJ, Rabow MW. CURRENT Medical Diagnosis and Treatment 2017: McGraw-Hill Education; 2016.
  4. Walker BR, Colledge NR, Ralston S, Penman ID. Davidson’s Principles and Practice of Medicine: Churchill Livingstone/Elsevier; 2014.

 

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Leprosy https://med.rimikri.com/leprosy-questions/ Wed, 21 Jun 2017 02:31:06 +0000 http://med.rimikri.com/?p=1853 The post Leprosy appeared first on Rimikri Med.

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Leprosy

  • Definition, organs involved, mode of transmission. e45
  • Classify leprosy? H69, e45
  • What are the cardinal features of leprosy? H70
  • Features of tuberculoid leprosy. e46
  • Tuberculoid vs. lepromatous leprosy. e46
  • Paucilacillary vs. multibacillary. e47
  • How can you confirm your diagnosis? H71
  • From where slit skin smear is taken? H72
  • What are the differential diagnoses for leprosy? H73
  • How can you treat leprosy? H74/e48

Others

  • Nerves commonly affected. e48
  • Complications. e48

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Other viral infections https://med.rimikri.com/other-viral-infections/ Tue, 20 Jun 2017 13:32:01 +0000 http://med.rimikri.com/?p=1830 The post Other viral infections appeared first on Rimikri Med.

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Questions on other viral infections

Rubella

  •  Complications. e23

Chicken pox

  •  Organism. am38
  • Some common bullous lesions of skin. e24
  • Lesions produced by chicken pox. e24
  • Stages of lesion in chicken pox. am38

Mumps

  •  Complications*. am38, e24
  • Organism. am37
  • C/F. am37
  • Diagnosis and tx. am38

Dengue

  •  What are the common causes of fever with maculopapular rash? H80
  • What is the causative agent of dengue fever? H81
  • What is the vector of dengue virus? H82
  • What is the habit of biting? H83
  • What is dengue syndrome? H84

Dengue fever

  • What are the criteria of dengue fever? H85
  • How can you treat dengue fever? H86
  • Complications. e29

DHF

  • Dx. e28/am148
  • Mx. e30
  • Who develops DHF? e30

DSS

  • Dx. e28/am149
  • Mx. e29

Extra

  • What are the signs of circulatory failure, shock, don’ts and criteria for discharge in dengue? am152

Herpes zoster

  •  C/F. e33

Rabies

  • Prevention/ management plan after bite. e35
Notes

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Diarrhoea, dehydration and dysentry https://med.rimikri.com/diarrhoea-questions/ Mon, 19 Jun 2017 11:51:51 +0000 http://med.rimikri.com/?p=1815 The post Diarrhoea, dehydration and dysentry appeared first on Rimikri Med.

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Questions on diarrhoea

Diarrhoea

  • Define diarrhea? H30, 1e460, am140
  • Classification
  • What are the causes of acute diarrhea? 1e460, am104
  • What are the electrolyte imbalances occurring in acute watery diarrhea? h, 1e461
  • Patient presented with acute watery diarrhea, how will you manage the patient?
  • What are the causes of chronic diarrhea? ie462
  • What is the most common cause of chronic diarrhea? h, ie462
  • Diagnose a case of chronic diarrhora. 1e463
  • Classification and signs/ assessment of dehydration. am104,105
  • What is steatorrhea? h
  • What are the mechanisms responsible for malabsorption? h

Dysentery

  • What is dysentery? e18, am105, h76i
  • What are the causes of bloody diarrhea?
  • Management
    • Amoebic. e19
    • Bacillary. e18, am108, h79i
  • Amoebic vs. bacillary. e20, h78i

Rimikri

SOLVES


Notes

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Presenting problems in gastrointestinal disease https://med.rimikri.com/gastrointestinal-system-presenting-problems/ Mon, 19 Jun 2017 11:49:50 +0000 http://med.rimikri.com/?p=1813 The post Presenting problems in gastrointestinal disease appeared first on Rimikri Med.

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Questions on presenting problems in gastrointestinal disease

Dyspepsia

  • What is dyspepsia? H10
  • What are the alarm features of dyspepsia?

Vomiting

  • What are the neurological causes of vomiting? H12
  • Give the description of vomiting of gastric outlet obstruction, e.g. pyloric stenosis. H13
  • Give the description of vomiting in raised intracranial pressure, e.g. brain tumor.

Hematemesis and melena

  • What is hematemesis? H15
  • What is melena?
  • How can you differentiate between hematemesis and hemoptysis?
  • What are the common causes of hematemesis?
  • What are the clinical features of upper GI bleeding?
  • How much blood is lost to cause postural hypotension?
  • How much blood is lost to produce shock?
  • What are the investigations done in acute upper GI bleeding?
  • What is the management of acute upper GI bleeding?
  • Which etiologies bear the worst prognosis?
  • Mention the criteria of stool in melena?
  • How much blood is required to cause melena?
  • Why is stool black?
  • What are the usual sites for hematemesis and melena?
  • What are the causes of lower GI bleeding?

Diarrhoea

  • Define diarrhea? H30
  • What are the causes of acute diarrhea?
  • What are the electrolyte imbalances occurring in acute watery diarrhea?
  • What are the causes of bloody diarrhea?
  • Patient presented with acute watery diarrhea, how will you manage the patient?
  • What are the causes of chronic diarrhea?
  • What is the most common cause of chronic diarrhea?
  • What is steatorrhea?
  • What are the mechanisms responsible for malabsorption?

Constipation

  • Define constipation. H39
  • What is the most common cause of constipation?
  • What are the neurological causes of constipation?
  • What are the metabolic/endocrine causes of constipation?
  • What are the types of laxative?

Pathological weight loss

  • Tell five common causes of pathological weight loss. h44
  • What do you mean by significant weight loss?
  • What are the causes of weight loss with increased appetite?

Acute abdomen

  • What are the causes of acute abdominal pain (acute abdomen)? H47
  • What are the medical causes of acute abdominal pain (acute abdomen)?
  • What are the causes of abdominal distension?

Rimikri

SOLVES


Notes

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Examination of respiratory system https://med.rimikri.com/examination-of-respiratory-system-questions/ Sat, 17 Jun 2017 16:49:14 +0000 http://med.rimikri.com/?p=1786 The post Examination of respiratory system appeared first on Rimikri Med.

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Questions on examination of respiratory system


Rimikri

SOLVES


Breath sound

What are the causes of bronchial breath sound?

The causes of bronchial breath sound are:

  • 3Cs
    • Consolidation
    • Cavitation
    • Collapse with patent bronchus
  • Fibrosis
* Pre-exam preparation for medicine, HN Sarker
What are the types of breath sound?

The types of breath sound are:

  • Vesicular
  • Vesicular with prolonged expiration
  • Bronchial.
* Pre-exam preparation for medicine, HN Sarker
Andy Tran

Navigate to

Breath sound

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Obstructive pulmonary diseases https://med.rimikri.com/obstructive-pulmonary-diseases-questions/ Sat, 17 Jun 2017 07:30:07 +0000 http://med.rimikri.com/?p=1761 The post Obstructive pulmonary diseases appeared first on Rimikri Med.

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Rimikri

SOLVES


Obstructive pulmonary diseases

What are the obstructive pulmonary diseases?

The obstructive pulmonary diseases are:

  • COPD
  • Bronchial asthma.
* Pre-exam preparation for medicine, HN Sarker
What are the restrictive pulmonary diseases?

The restrictive pulmonary diseases are:

  • Interstitial lung disease
  • Pulmonary fibrosis.
* Pre-exam preparation for medicine, HN Sarker
How can you differentiate obstructive from restrictive lung diseases?
Test Obstructive Restrictive
FEV1 (Forced expiratory volume) ↓ ↓
VC (Vital capacity) ↓ or normal ↓↓
FEV1/VC Normal or ↑
* Pre-exam preparation for medicine, HN Sarker

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Congenital heart disease https://med.rimikri.com/congenital-heart-disease-questions/ Thu, 15 Jun 2017 08:41:21 +0000 http://med.rimikri.com/?p=1694 The post Congenital heart disease appeared first on Rimikri Med.

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Questions on congenital heart disease


Rimikri

SOLVES


Congenital heart disease

Classify congenital heart diseases.

Classification:

Broadly based on the presence or absence of cyanosis in the affected child.

  1. Cyanotic CHD
    • Tetralogy of Fallot (TOF)
    • Transposition of great arteries (TGA)
    • Total anomalous pulmonary venous drainage (TAPVD)
    • Persistent truncus arterious
    • Tricuspid atresia
    • Ebstein anomaly
  2. Acyanotic CHD
    • With left to right shunts
      • VSD (commonest CHD)
      • ASD
      • PDA
    • Without shunt
      • Coarctation of aorta
      • Pulmonary stenosis
      • Aortic stenosis
* Step on to Paediatrics, Md Abid Hossain Mollah, 3rd Edition Page: 120

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Cardiomyopathy https://med.rimikri.com/cardiomyopathy-questions/ Thu, 15 Jun 2017 08:14:12 +0000 http://med.rimikri.com/?p=1686 The post Cardiomyopathy appeared first on Rimikri Med.

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Questions on cardiomyopathy

  • What is cardiomyopathy? H197
  • What are the types of cardiomyopathies? H198

Rimikri

SOLVES


Cardiomyopathy

What is cardiomyopathy?

Cardiomyopathy is defined as “a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation and are due to a variety of causes that frequently are genetic”.

* Pre-exam preparation for medicine, HN Sarker
What are the types of cardiomyopathies?

The types of cardiomyopathies are:

  • Hypertrophic cardiomyopathy
  • Dilated cardiomyopathy
  • Arrhythmogenic right ventricular cardiomyopathy
  • Obliterative cardiomyopathy
  • Restrictive cardiomyopathy

Types of cardiomyopathy - Davidson 637

* Pre-exam preparation for medicine, HN Sarker; Davidson’s Principles and Practice of Medicine, 22nd Edition Page: 634

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Infective endocarditis https://med.rimikri.com/infective-endocarditis-questions/ Tue, 13 Jun 2017 07:32:36 +0000 http://med.rimikri.com/?p=1610 The post Infective endocarditis appeared first on Rimikri Med.

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Questions on infective endocarditis

  • Define infective endocarditis. H177
  • What are the types of infective endocarditis? H178
  • What are the common organisms involved in infective endocarditis? H179
  • What are the peripheral stigmata of infective endocarditis? H180
  • Tell the emperical therapy of infective endocarditis? H181

Rimikri

SOLVES


Definition and Classification
Define infective endocarditis.

This is due to microbial infection of a heart valve (native or prosthetic), the lining of a cardiac chamber or blood vessel, or a congenital anomaly (e.g. septal defect).

* Pre-exam preparation for medicine, HN Sarker
What are the types of infective endocarditis?

The types of endocarditis are:

  1. Acute infective endocarditis
  2. Subacute infective endocarditis
  3. Postoperative infective endocarditis.
* Pre-exam preparation for medicine, HN Sarker
Epidemiology
Etiology and Pathophysiology
What are the common organisms involved in infective endocarditis?
  1. Streptococcus— Viridens group and enterococci.
  2. Staphylococcus—Staphylococcus aureus and coagulase negative
  3. Gram-negative bacilli—Haemophilus anaerobes
  4. Others—Rickettsiae and fungi.
* Pre-exam preparation for medicine, HN Sarker
Clinical Manifestations
Examination
What are the peripheral stigmata of infective endocarditis?

The peripheral stigmata of infective endocarditis are:

  • Clubbing
  • Splinter hemorrhage
  • Osler’s nodes
  • Janeway lesions
  • Purpura
  • Roth’s spots.
* Pre-exam preparation for medicine, HN Sarker

Figure: Clinical features which may be present in endocarditis
* Davidson’s Principles and Practice of Medicine, 22nd Edition Page: 627
Investigations
What investigations do you suggest in endocarditis?

Investigations

  1. Blood culture
    • It is the crucial investigation because it may identify the infection and guide antibiotic therapy.
  2. Echocardiography
    • For detecting and following the progress of vegetations, for assessing valve damage and for detecting abscess formation.
  3. ESR: Elevation
  4. CRP: Measurement of serum CRP is more reliable than the ESR in monitoring progress.
  5. Hb% and PBF: Normocytic normochromic anaemia
  6. CBC: Leucocytosis
  7. Urinalysis:
    • Proteinuria may occur and microscopic haematuria is usually present.
  8. ECG
    • Development of AV block (due to aortic root abscess formation) and occasionally infarction due to emboli.
  9. Chest X-ray
    • Evidence of cardiac failure and cardiomegaly.
* Davidson’s Principles and Practice of Medicine, 22nd Edition Page: 627, 628
Diagnosis
Describe the diagnosis of infective endocarditis (modified Duke criteria).

Diagnosis of infective endocarditis (modified Duke criteria)

Major criteria

  • Positive blood culture
    • Typical organism from two cultures
    • Persistent positive blood cultures taken > 12 hrs apart
    • Three or more positive cultures taken over > 1 hr
  • Endocardial involvement
    • Positive echocardiographic findings of vegetations
    • New valvular regurgitation

Minor criteria

  • Predisposing valvular or cardiac abnormality
  • Intravenous drug misuse
  • Pyrexia ≥ 38°C
  • Embolic phenomenon
  • Vasculitic phenomenon
  • Blood cultures suggestive: organism grown but not achieving major criteria
  • Suggestive echocardiographic findings

Diagnosis

  • Definite endocarditis = two major, or one major and three minor, or five minor
  • Possible endocarditis = one major and one minor, or three minor
* Davidson’s Principles and Practice of Medicine, 22nd Edition Page: 627
Treatment
Tell the emperical therapy of infective endocarditis?
  • Acute—Flucloxacillin and gentamicin.
  • Subacute or indolent—Benzyl penicillin and gentamicin. In those with penicillin allergy, a prosthetic valve or suspected methicillin-resistant Staph. aureus (MRSA)
  • Infection—Triple therapy with vancomycin, gentamicin, and oral rifampicin.
* Pre-exam preparation for medicine, HN Sarker
What are the indications of cardiac surgery in infective endocarditis?

Indications for cardiac surgery in infective endocarditis

  • Heart failure due to valve damage
  • Failure of antibiotic therapy (persistent/uncontrolled infection)
  • Large vegetations on left-sided heart valves with evidence or ‘high risk’ of systemic emboli
  • Abscess formation

N.B. Patients with prosthetic valve endocarditis or fungal endocarditis often require cardiac surgery.

* Davidson’s Principles and Practice of Medicine, 22nd Edition Page: 629
Complications
Notes

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