Medicine Workbook 2024 PDF - MIST

MIST - Medical Institute for Screening Test CARDIOVASCULAR DISORDERS ACUTE RHEUMATIC FEVER: Etiology: Age group: Pathogenesis: Areas affected: Manifestations: Modified Jones’ criteria: Low risk Moderate –...

MIST - Medical Institute for Screening Test CARDIOVASCULAR DISORDERS ACUTE RHEUMATIC FEVER: Etiology: Age group: Pathogenesis: Areas affected: Manifestations: Modified Jones’ criteria: Low risk Moderate – High Risk (Incidence > 2 / 1 lakh) Criteria: Major Minor Essential Major criteria: Joints: Type of joints affected: Heart: m/c manifestation:  MIST - Medical Institute for Screening Test Syndenham’s chorea: (Last finding) St. Vitus Dance Features: Named signs: “Milkmaid’s” hand grip; “Darting tongue” sign Minor criteria: 1. 2. 3. 4. Essential criteria: Diagnosis: Management: Treatment + prophylaxis  MIST - Medical Institute for Screening Test Treatment: Drug Duration No carditis – With carditis – With RHD/ surgery – Sequelae of Rheumatic fever in adults: Major target: Types of valvular lesions: Stenosis Regurgitation Arterial pulse: Character is best assessed in: Amplitude is best assessed in: Hyperkinetic Collapsing pulse  MIST - Medical Institute for Screening Test Hypokinetic pulse: Pulsus PARVUS et TARDUS: Others: Pulsus ALTERNANS: PULSUS BISFERIENS: Murmurs: Can murmurs be normal? Diastolic murmurs:  MIST - Medical Institute for Screening Test Other diastolic murmurs: 1. Graham Steel murmur: 2. Carey Coomb’s murmur: Salient features of AR (Aortic regurgitation): 1. Early Diastolic murmur 2. Collapsing pulse 3. Dancing carotids: 4. Quincke’s sign: 5. Femoral artery: SYSTOLIC MURMURS:  MIST - Medical Institute for Screening Test Which is the most common congenital valvular heart disease? Cause: Associations: Features: CONTINUOUS murmurs:  MIST - Medical Institute for Screening Test ECG (Electrocardiogram) 12 lead ECG 3 limb leads 3 Augmented leads 6 chest leads Limb leads: EINTHOVEN leads: Augmented leads: GOLDBERGER leads: Chest leads Artery localisation using ECG leads: Right coronary artery (RCA): Left anterior descending artery (LAD): Left circumflex artery (LCA): Basics:  MIST - Medical Institute for Screening Test Waves in ECG: Rate and Rhythm abnormalities: Bradycardia: Associations: Treatment: Heart blocks:  MIST - Medical Institute for Screening Test TACHYCARDIA: Tachyarrythmias Atrial (Supraventricular) Ventricular Narrow complex (= Supraventricular) tachyarrythmias: Regular Irregular - PSVT - Atrial fibrillation - Mutifocal atrial - Atrial flutter tachycardia - Junctional tachycardia Atrial fibrillation Atrial flutter m/c sustained arrythmia Associations:  MIST - Medical Institute for Screening Test m/c – Treatment: PSVT: (m/c arrythmia in childhood) ECG features: Mechanism:  MIST - Medical Institute for Screening Test Treatment: Stable: Unstable: Scenario: In a 2-year-old child, who presented with fever, tachycardia, PSVT is noted on ECG. Hence i.v adenosine was administered to which the child responded. After stabilisation, repeat ECG shows the following finding. Which condition should be suspected? Treatment: Ventricular Tachyarrythmias Regular Irregular Ventricular tachycardia (VT): Monomorphic VT Polymorphic VT  MIST - Medical Institute for Screening Test Basic steps in CPR:  MIST - Medical Institute for Screening Test ECG CHANGES IN ELECTROLYTE IMBALANCES: HYPERkalemia: Changes Serum K+ level (mEq/L) 5.5 – 6.5 6.5 – 8 >8 HYPOkalemia:  MIST - Medical Institute for Screening Test Cause of death: Hypocalcemia Hypercalcemia INFECTIVE ENDOCARDITIS m/c affected valve: Pathology: Etiology (Organisms): Overall m/c: In childhood m/c: Prosthetic (Artificial) valve endocarditis: Early onset Late onset I.V drug abusers: Clinical types of Infective endocarditis Acute Subacte HACEK group: Haemophilus species, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae  MIST - Medical Institute for Screening Test Features: I. Fever II. Embolic (vascular) phenomenon: III. Immunological manifestations: (Immune complex deposition): IV. Other: Criteria for diagnosis: DUKE’s criteria Management: Treatment Prophylaxis  MIST - Medical Institute for Screening Test HYPERTENSION: m/c cause: m/c secondary cause: Congenital cause: Features: Untreated hypertension: END ORGAN DAMAGE Treatment: (DASH diet) Restrict salt intake Decrease fat/ dairy food products Drugs: A B C D Role of β blockers: Drugs in pregnancy: Very high BP Hypertensive Emergency (‘Crisis’) Hypertensive Urgency  MIST - Medical Institute for Screening Test Medications: Target: decrease BP to 160/100 mm Hg over 2 hours CORONARY ARTERY DISEASE: m/c cause: Pathogenesis: Non modifiable Risk factors: Modifiable Risk factors : (Syndrome ‘X’) Newer marker of Atherosclerosis: Plaque progression:  MIST - Medical Institute for Screening Test Characteristic feature: ANGINA D/D angina pain: ACUTE CORONARY SYNDROMES: (ACS) = Angina at rest  MIST - Medical Institute for Screening Test Overall BEST marker: Marker for Re – infarction: First marker to increase following MI: Last to increase: ECG findings: Treatment: (ACS): Immediate treatment Definitive treatment Secondary prevention: Complications: 1. m/c cause of sudden death following MI:  MIST - Medical Institute for Screening Test 2. Myocardial rupture 3. LV aneurysm 4. Heart failure Late complication: DRESSLER’S syndrome Management of STABLE angina: “Stress” testing: PRINTZMETAL/ VASOSPASTIC/ VARIANT Angina: CARDIOMYOPATHY: M/C type: DILATED CARDIOMYOPATHY (DCM): m/c – idiopathic Features:  MIST - Medical Institute for Screening Test NYHA grading of dyspnea: Investigations: Chest X ray: Echocardiography: Role of BNP: Management of Cardiac failure: Acute Chronic L M N O P HOCM: Typical presentation: Usually genetic defect: β MHC defect  MIST - Medical Institute for Screening Test Basic defect: Pulse: Murmur: Reason for sudden death: Treatment: Medical Surgical RESTRICTIVE CARDIOMYOPATHY = Restriction to ventricular filling Usually due to infiltrative disorders: Special condition: Loeffler’s Endocarditis PERICARDIAL DISORDERS Acute Pericarditis: Causes: Idiopathic Infections: ECG: “Concave up” ST elevation:  MIST - Medical Institute for Screening Test Treatment: PERICARDIAL TAMPONADE: Beck’s triad: Nature of pulse: Pulsus paradoxus: - Cardiac tamponade - Acute severe asthma - Severe heart failure Emergency management: CONSTRICTIVE PERICARDITIS: 2 characteristic findings: Kussmaul’s sign:  MIST - Medical Institute for Screening Test Pericardial Knock Best investigation: Treatment:  MIST - Medical Institute for Screening Test RESPIRATORY DISORDERS PULMONARY (LUNG) FUNCTION tests: Forced inspiration expiration (6 sec) FEV1/FVC Ratio [Tiffeneau’s index] = Obstructive Restrictive FEV1/FVC PEFR TLC RV DLCO Respiratory disorders: examples Obstructive Restrictive ✓ Asthma Parenchymal: ✓ COPD ✓ Interstitial lung disorders ✓ Bronchiectasis ✓ Cystic fibrosis Extra parenchymal: ✓ Bronchiolitis ✓ Neuromuscular disorders ▪ Diaphragmatic palsy ▪ Guillain Barre syndrome ✓ Chest wall disorders ▪ kyphoscoliosis  MIST - Medical Institute for Screening Test Flow volume curve: Normal: Pathological conditions: COPD (Chronic Obstructive Pulmonary Disease) 1. Emphysema 2. Chronic bronchitis Main feature is airflow limitation = Obstruction  MIST - Medical Institute for Screening Test Risk factors: 1. 2. 3. Pathogenesis:  MIST - Medical Institute for Screening Test EMPHYSEMA: Types: Features: (clinical & radiological): Complication:  MIST - Medical Institute for Screening Test CHRONIC BRONCHITIS: Management: (Irreversible condition – only symptomatic treatment) 1. 2. 3. Drugs: Exacerbations: Best Parameter (for monitoring/ follow up/ prediction of survival) Pursed lip breathing:  MIST - Medical Institute for Screening Test ASTHMA: MAIN features: 1. Bronchoconstriction 2. Recurrent 3. Reversible Types: Extrinsic Intrinsic SAMTER’S triad: Management: (Based on severity) Intermittent Persistent Mild Moderate Severe Medications: Relievers Controllers  MIST - Medical Institute for Screening Test Examples of inhaled steroids: Step wise management: Drug delivery devices: Management of acute exacerbations:  MIST - Medical Institute for Screening Test BRONCHIECTASIS = permanent dilatation of bronchi Usually due to previous lung problems Genetic defects: Kartagener’s syndrome: Other: Features: Investigation of choice: Treatment: - Mucolytics, hydration - Physiotherapy - Antibiotics  MIST - Medical Institute for Screening Test INTERSTITIAL LUNG DISEASES: 1. Idiopathic pulmonary fibrosis 2.Occupational 3. Drug associated : Non specific interstitial pneumonitis 4. DIP (Desquamative interstitial pneumonitis) 5. Connective tissue disorders, Sarcoidosis Clinical features (common): Imaging of choice: Best diagnostic investigation: PNEUMOCONIOSIS: Silicosis Asbestosis = Miner’s/ Grinder’s disease Types Area affected: Affects Lower lobes Highly fibrogenic Lesions: m/c: pleural plaque  MIST - Medical Institute for Screening Test Chest X ray: Complications: Coal worker’s pneumoconiosis: Other types: Bagassosis – Sugarcane Simple Complicated Byssinosis – Cotton Stannosis – Tin Siderosis - Iron CAPLAN syndrome: PNEUMONIA: Classification Typical Atypical Immunocompromised host  MIST - Medical Institute for Screening Test 1. Community Acquired (HAP): 2. Hospital Acquired (Nosocomial): 3. Health care associated pneumonia (HCAP): 4. Ventilator associated pneumonia (VAP): Characteristic x ray patterns: Organism related characteristics: Pneumococci (Strep. Pneumoniae) Klebsiella pneumoniae Staph. aureus  MIST - Medical Institute for Screening Test Mycoplasma Legionella HIV and organisms causing pneumonia: (based on CD4 counts) < 500 / µ L < 200 / µ L < 50/ µ L Clinical findings in pneumonia: (Lobar consolidation) Percussion Breath sounds Others Management: Based on CURB – 65 SCORE A new scoring system is PSI C U R B 65  MIST - Medical Institute for Screening Test Management based on CURB score Score 0–1 2 3 or more Place of management Antibiotics PLEURAL EFFUSION: Normal volume of pleural fluid: Types Transudate Exudate Usually B/L Usually U/L Exudate as well as transudate:  MIST - Medical Institute for Screening Test Pleural fluid analysis: Transudate Exudate (LIGHT’S criteria) Pleural fluid protein/serum protein Pleural fluid LDH/serum LDH Pleural fluid LDH (in comparison to serum LDH) Low glucose in pleural fluid : Best investigation for TB pleural effusion: X ray features: Best investigation for detecting minimal pleural effusion: Management:  MIST - Medical Institute for Screening Test Pneumonia with pleural effusion Syn-pneumonic effusion Para-pneumonic effusion Empyema Synpneumonic effusion Parapneumonic effusion pH Suspect empyema in a pneumonia patient Culture/ when fever persists even after 5 days of Gram stain appropriate antibiotic LDH (U/L) treatment Sugar (g/dL) Management:  MIST - Medical Institute for Screening Test Scenario: “A 65-year-old lady suddenly dies 7 days after a surgery of femur fracture suddenly dies while having lunch in the ward. What would be the most likely cause?” Source: 1. 2. 3. Risk factors: Immobilization Thrombophilia Inherited Acquired Pathophysiology:  MIST - Medical Institute for Screening Test Clinical suspicion is the most important step in identification. The Wells' Criteria is a risk stratification score to estimate probability of PTE. X ray features:  MIST - Medical Institute for Screening Test ECG: Right heart strain pattern: S1Q3T3 Most Specific/ Best test: Others: Role of D – Dimer: Treatment Hemodynamically stable Hemodynamically unstable C/I for Anticoagulation: - h/o intracranial bleed - h/o stroke/ neurosurgery/ trauma - Brain tumor/ any space occupying lesion  MIST - Medical Institute for Screening Test Scenario: A middle aged male is undergoing treatment for Gram negative sepsis.He was stable at admission and showed improvement after starting treatment. On Day 3, he develops severe respiratory distress with worsening hypoxemia. Chest X ray (which was initially normal) now shows bilateral diffuse opacities.Diagnosis? BERLIN’S criteria: A chronic smoker develops blood-tinged sputum while coughing. While evaluation workup is normal. Which of the following should be the next step in evaluation? a) Bronchoscopy b) Repeat CXR c) CT chest d) Sputum test  MIST - Medical Institute for Screening Test NEUROLOGICAL DISORDERS: HEADACHE: Types of primary headache: 1. 2. 3. TENSION headache: Characteristic feature: Reason: Treatment:  MIST - Medical Institute for Screening Test MIGRAINE: Rule of 5 – 4 -3 – 2- 1 5 – 4 – 2 – 1 – Treatment: Prophylaxis Rest, avoid triggers  MIST - Medical Institute for Screening Test Cluster Headache: Location: Horner’s syndrome: No triggers; Additional features: Treatment: INTRACRANIAL BLEEDS TRAUMA related Non Trauma related SUBARACHNOID HEMORRHAGE:  MIST - Medical Institute for Screening Test BERRY ANEURYSM: m/c site: Risk factors for rupture: Features of SAH: - “Worst” Headache in life Investigation: Imaging: CSF examination:  MIST - Medical Institute for Screening Test Complications: 1. Vasospasm 2. Hydrocephalus 3. Re rupture 4. Inappropriate ADH release m/c cranial nerve involved in Berry aneurysm: m/c cranial nerve involved in raised ICT: Treatment: 1. Measures to decrease ICP 2. Maintain systolic BP: (range) 3. 4. Treatment of Berry aneurysm: Extra (epi) dural haemorrhage Subdural haemorrhage  MIST - Medical Institute for Screening Test Treatment: Scenario: A patient is admitted to ICU following a RTA. He is in a comatose state. NCCT of head reveals no significant findings. Probable diagnosis? Investigation of choice: m/c site:  MIST - Medical Institute for Screening Test Raised ICT: features: In severe cases: CUSHING’S TRIAD: MAP – ICT = CPP CUSHING’S REFLEX: Management of raised ICT: Position: Drug:  MIST - Medical Institute for Screening Test Hyperventilation: Sedatives Control of seizures: Complication of uncontrolled raised ICT: Uncal herniations: 3 major effects:  MIST - Medical Institute for Screening Test Normal Pressure Hydrocephalus Pseudotumor cerebri (NPH) Treatment: CSF pressure Ventricular size Hydrocephalus NPH Pseudotumor cerebri  MIST - Medical Institute for Screening Test DEMENTIA: CAUSES: IRREVERSIBLE REVERSIBLE ALZHEIMER’S DISEASE: Risk factors: Features: 5 ‘A’ s  MIST - Medical Institute for Screening Test Treatment: PARKINSON’S DISEASE: Basic pathology: Factors: Features: Treatment:  MIST - Medical Institute for Screening Test DEMENTIA pugilistica: Reason: Features: HUNTINGTON’S DISEASE: Inherited disease HD gene mutation:  MIST - Medical Institute for Screening Test Features: Phenomenon of “ANTICIPATION” Treatment: Dopamine depletor Dopamine receptor antagonist CEREBROVASCULAR ACCIDENTS: STROKE TIA Stroke Duration Brain imaging  MIST - Medical Institute for Screening Test Etiology: Ischemia Hemorrhage How to quickly recognise STROKE? Features:  MIST - Medical Institute for Screening Test Localisation based on features: Important association with pinpoint pupils: 4 “P”s 1. 2. 3. 4. Speech defects – Aphasia: Broca’ aphasia Wernicke’s aphasia Area affected Defect  MIST - Medical Institute for Screening Test Initial Investigation: Treatment of ischemic stroke: - Supportive treatment Brainstem Stroke syndromes: MIDBRAIN SYNDROMES: due to occlusion of:  MIST - Medical Institute for Screening Test LATERAL MEDULLARY SYNDROME (WALLENBERG SYNDROME) Due to occlusion of: Upper and lower motor neurons:  MIST - Medical Institute for Screening Test UMN lesions LMN lesions Paralysis Muscle atrophy Deep tendon reflexes Fasciculation/ Fibrillation Babinski’s sign MOTOR NEURON DISEASE: ALS: (Amyotrophic lateral sclerosis): Upper limbs Lower limbs Cranial Nerves – “Patient feels trapped Sensation: inside his own body” Mentation: Bowel/ bladder function:  MIST - Medical Institute for Screening Test Cause of death: Drugs in management: MOTOR UNIT: NEUROPATHY MYOPATHY Pattern of weakness Fasciculation Deep tendon reflexes Sensory signs Disorders involving Myelin:  MIST - Medical Institute for Screening Test Guillain Barre syndrome : AIDP: Post infectious condition: Characteristic feature: AFP: Cranial nerves: Sensory disturbances: Autonomic disturbances: Which features are not usually seen? Diagnosis: Best investigation:  MIST - Medical Institute for Screening Test CSF analysis: Treatment: MULTIPLE SCLEROSIS: Target antigens: Characteristic feature is “Multiple neurological deficits that cannot be explained by one lesion” Features: Diagnosis: T2W MRI CSF examination: Treatment:  MIST - Medical Institute for Screening Test Neuromuscular junction disorder: MYASTHENIA GRAVIS Autoimmune disorder Association: Muscles affected: Most important/ CHARACTERISTIC feature: Testing: Screening Diagnostic  MIST - Medical Institute for Screening Test Treatment: LAMBERT EATON SYNDROME: MYASTHENIA LAMBERT EATON GRAVIS SYNDROME ANTIBODIES ASSOCIATION EXERCISE REPETITIVE NERVE STIMULATION  MIST - Medical Institute for Screening Test HEMISECTION OF SPINAL CORD: BROWN SEQUARD SYNDROME IPSILATERAL SIDE CONTRALATERAL SIDE SCENARIO: A 45-year-old man is brought to the emergency department with 1–2 days of fever, headache, nausea, and vomiting. On physical examination he is found to have neck stiffness and photophobia. Diagnosis?  MIST - Medical Institute for Screening Test Meningitis Vs Encephalitis Fever Headache Seizures Cortical involvement Signs of meningeal irritation CSF analysis Etiology: Bacteria Virus Tuberculosis m/c cause of meningitis in HIV infected patients: CSF analysis: Normal Bacterial Viral TB CSF pressure 50 – 180 mm H20 Appearance Clear Cells 0 – 5 / µL (Lymphocytes) Protein 20 – 45 mg/ dL  MIST - Medical Institute for Screening Test Sugars 40 – 70 mg/dL CSF/ serum 0.6 glucose Treatment: The most common long-term neurologic deficit from bacterial meningitis is?