Q no 1 What are the investigation protocol for the patient with cardiac disease ?

Ans : Diagnosis

Q no 2 Define hypertensive crisis ? outline its type and

management strategies .?
Ans ; A hypertensive crisis is a severe increase in blood pressure that can lead to a stroke.
Extremely high blood pressure — a top number (systolic pressure) of 180 millimeters of mercury
(mm Hg) or higher or a bottom number (diastolic pressure) of 120 mm Hg or higher — can
damage blood vessels.

Types Outline
1) Hypertensive urgency
2) Hypertensive emergency
3) Malignant hypertension
 MANAGAMENT
1 Nitroglycerin IV infusion

2 Labetalol IV bolus

3 Hydralazine IV bolus

4 Diuretics

5 Diazoxide

6 Sodium nitroprusside IV infusion

3 Q NO # a 75 year old man with no previous history

of smoking and respiratory disorder is suffering from high grade fiver 103F ,shaking chill
and productive cough with purulent sputum . his respiratory rate is more than 30/min ,he
is cyanosed and complained chest pain . Asculations show bronchial breath sound and
egophony .his blood pressure is 90/60 mmhg
a) Diagnosis
b) Investigations and lab
c) Treatment
Ans: A Pneumonia

B) Diagnosis

Chest X-ray showing

pneumoniaOpen pop-up dialog box
Your doctor will start by asking about your medical history and doing a physical exam,
including listening to your lungs with a stethoscope to check for abnormal bubbling or
crackling sounds that suggest pneumonia.

If pneumonia is suspected, your doctor may recommend the following tests:

 Blood tests. Blood tests are used to confirm an infection and to try to

identify the type of organism causing the infection. However, precise
identification isn't always possible.

 Chest X-ray. This helps your doctor diagnose pneumonia and determine

the extent and location of the infection. However, it can't tell your doctor
what kind of germ is causing the pneumonia.

 Pulse oximetry. This measures the oxygen level in your blood. Pneumonia

can prevent your lungs from moving enough oxygen into your bloodstream.

 Sputum test. A sample of fluid from your lungs (sputum) is taken after a
deep cough and analyzed to help pinpoint the cause of the infection.

Your doctor might order additional tests if you're older than age 65, are in the hospital,
or have serious symptoms or health conditions. These may include:

 CT scan. If your pneumonia isn't clearing as quickly as expected, your

doctor may recommend a chest CT scan to obtain a more detailed image of
your lungs.

 Pleural fluid culture. A fluid sample is taken by putting a needle between

your ribs from the pleural area and analyzed to help determine the type of
infection.
C)

Q no 4 What are causes of acute renal failure?how will you diagnose and
treat the patient with AFR?
ANS: Causes of AFR
Decrese cardiac output

Hemorrhage

Vasodilation decrease of renal arterioles (vasculitis or microangiopatheic hemolytic states )

 Diuresis diarrhea vomiting sweeting

Cardiac shock

GI bleeding

DIAGNOSIS

Acute Kidney Failure Risk Factors

Most of the time, kidney failure happens along with another medical condition or event. If you
fall into any of the following categories, you may have a greater chance of acute kidney failure:

 You’ve been hospitalized for a long time, especially in intensive care.

 You have diabetes.
 You’re elderly.
 You have coronary artery disease.
 You have heart failure or high blood pressure.
 You have chronic kidney or liver disease.

Acute(RENAL) Kidney Failure Diagnosis

Your doctor will start with a physical exam. Then, they’ll order tests of your blood, urine, and
kidneys.
Blood tests. These measure substances in your blood. 

 Creatinine is a waste product in your blood that’s made by muscle activity. Normally,
it’s removed from your blood by your kidneys. But if your kidneys stop working, your
creatinine level rises.
 Urea nitrogen is another waste product in your blood. It’s created when protein from the
foods is broken down. Like creatinine, your kidneys remove this from your blood. When
your kidneys stop working, your urea nitrogen levels rise.
 Serum potassium is a substance found in your blood that balances water levels in your
bloodstream. Kidney disease can cause either high or low potassium levels. 
 Serum sodium is another substance in your blood that helps with fluid balance in your
body.  High sodium levels can mean that your kidneys aren’t working properly because
your body can’t get rid of the right amount of sodium.

Urine tests. Your doctor will check your pee for blood and protein. They’ll also look for certain
electrolytes. The results help your doctor understand what’s causing your kidney failure.
Urine output measurement. This measures how much urine you pass in 24 hours. You will get
a container to take home, pee into, and then return to the lab after a full 24 hours. It can help your
doctor determine why you’re having kidney failure.
Kidney biopsy (renal biopsy) is a procedure where the doctor pushes a thin needle through your
skin and takes a small piece of your kidney to look at under a microscope.  It can show if there is
any damage or disease in your kidney.
Imaging tests. Some tests, like ultrasonography or a CT scan, can show whether your kidneys
are enlarged or there’s a blockage in your urine flow. An angiogram can tell your doctor if
the arteries or veins that lead to your kidneys are blocked. An MRI can show this, too.

Management
 Diet. Your doctor will limit the amount of salt and potassium you get
until your kidneys heal. That’s because both of these substances are
removed from your body through your kidneys. Changing how and
what you eat won’t reverse acute kidney failure. But your doctor may
change your diet while they treat the conditions that caused it. This
may mean treating a health problem like heart failure, taking you off
certain medications, or giving you fluids through an IV if you’re
dehydrated. If your doctor has put you on a low potassium diet,
you’ll need to cut back on high-potassium foods like bananas,
spinach, oranges, potatoes, and tomatoes.  On the other hand, you
can eat more low-potassium foods like apples, strawberries, grapes,
and cauliflower.  
 Medications. Your doctor may prescribe medicines that regulate the
amount of phosphorus and potassium in your blood. When your
kidneys fail, they can’t remove these substances from your body.
Medications won’t help your kidneys, but they may reduce some of
the problems kidney failure causes.
 Dialysis. If your kidney damage is severe enough, you may require
hemodialysis until your kidneys can heal. Dialysis does not help
kidneys heal but takes over the work of kidneys until they do. If your
kidneys don't heal, dialysis could be long-term.

Q NO 5 Causes of acute liver disease ?

Ans ;

1; viral infections
 . hepatitis virus A , B, C, D ,E

. EPSTEIN_ barr virus

Cytomegalovirus

Yellow fever virus

2 non viral infection

Leptospira

Taxoplasama gondi

Q fever

3 poisons

Aflatoxins

Carbon tetrachloride

Mushroom

4 Drugs

Paracetamol

Halothane

5 alcohol

6 other

Pregnancy

Shock

Wilson disease

Q no 6 ; what is grave disease ? enlist clinical feature of

hyperthyroidism
ANS ; Grave disease
Graves' disease is an autoimmune disease that affects the thyroid gland. The gland
produces too much thyroid hormone, a condition known as hyperthyroidism. Thyroid hormones
regulate body temperature, heart rate and metabolism

feature of Clinical hyperthyroidism

Symptoms

Hyperthyroidism can mimic other health problems, which can make it difficult for your
doctor to diagnose. It can also cause a wide variety of signs and symptoms, including:

 Unintentional weight loss, even when your appetite and food intake stay the
same or increase

 Rapid heartbeat (tachycardia) — commonly more than 100 beats a minute

 Irregular heartbeat (arrhythmia)

 Pounding of your heart (palpitations)

 Increased appetite

 Nervousness, anxiety and irritability

 Tremor — usually a fine trembling in your hands and fingers

 Sweating

 Changes in menstrual patterns

 Increased sensitivity to heat

 Changes in bowel patterns, especially more frequent bowel movements

 An enlarged thyroid gland (goiter), which may appear as a swelling at the

base of your neck

 Fatigue, muscle weakness

 Difficulty sleeping

 Skin thinning
  Fine, brittle hair

Q NO 7 detail note on Gastro-intestinal bleeding ?

ANS; GIT BLEEDING

Gastrointestinal (GI) bleeding is any type of bleeding that starts in your GI tract, also called
your digestive tract. GI bleeding is a symptom of a disease or condition, rather than a disease or
condition itself. Acute GI bleeding is sudden and can sometimes be severe.

CAUSES:

Gastrointestinal bleeding can occur either in the upper or lower gastrointestinal tract. It
can have a number of causes.

Upper GI bleeding

Causes can include:

 Peptic ulcer. This is the most common cause of upper GI bleeding. Peptic ulcers

are sores that develop on the lining of the stomach and upper portion of the small
intestine. Stomach acid, either from bacteria or use of anti-inflammatory drugs,
damages the lining, leading to formation of sores.

 Tears in the lining of the tube that connects your throat to your stomach
(esophagus). Known as Mallory-Weiss tears, they can cause a lot of bleeding.
These are most common in people who drink alcohol to excess.

 Abnormal, enlarged veins in the esophagus (esophageal varices). This

condition occurs most often in people with serious liver disease.

 Esophagitis. This inflammation of the esophagus is most commonly caused by

gastroesophageal reflux disease (GERD).

Lower GI bleeding

Causes can include:

  Diverticular disease. This involves the development of small, bulging pouches in
the digestive tract (diverticulosis). If one or more of the pouches become inflamed
or infected, it's called diverticulitis.

 Inflammatory bowel disease (IBD). This includes ulcerative colitis, which causes

inflammation and sores in the colon and rectum, and Crohn's disease, and
inflammation of the lining of the digestive tract.

 Tumors. Noncanerous (benign) or cancerous tumors of the esophagus, stomach,

colon or rectum can weaken the lining of the digestive tract and cause bleeding.

 Colon polyps. Small clumps of cells that form on the lining of your colon can
cause bleeding. Most are harmless, but some might be cancerous or can become
cancerous if not removed.

 Hemorrhoids. These are swollen veins in your anus or lower rectum, similar to

varicose veins.

 Anal fissures. These are small tears in the lining of the anus.

 Proctitis. Inflammation of the lining of the rectum can cause rectal bleeding.

Symptoms of GI Bleeding

What are the symptoms of GI bleeding?

Symptoms of gastrointestinal (GI) bleeding may include

 black or tarry stool
 bright red blood in vomit
 cramps in the abdomen
 dark or bright red blood mixed with stool
 dizziness or faintness
 feeling tired
 paleness
 shortness of breath
 vomit that looks like coffee grounds
 weakness
Acute bleeding symptoms

You may go into shock if you have acute bleeding. Acute bleeding is an emergency condition. Symptoms of
shock include

 a drop in blood pressure

 little or no urination
 a rapid pulse
 unconsciousness

If you have any symptoms of shock, you or someone should call 911 right away.

Chronic bleeding symptoms

You may develop anemia if you have chronic bleeding. Symptoms of anemia may include feeling tired and
shortness of breath, which can develop over time.

Some people may have occult bleeding. Occult bleeding may be a symptom of inflammation or a disease such
as colorectal cancer  . A simple lab test can detect occult blood in your stool.
NIH external link

Your doctor will take a medical history, including a history of previous bleeding, conduct
a physical exam and possibly order tests. Tests might include:

DIAGNOSIS

 Blood tests. You may need a complete blood count, a test to see how fast
your blood clots, a platelet count and liver function tests.

 Stool tests. Analyzing your stool can help determine the cause of occult
bleeding.

 Nasogastric lavage. A tube is passed through your nose into your stomach
to remove your stomach contents. This might help determine the source of
your bleed.

 Upper endoscopy. This procedure uses a tiny camera on the end of a long

tube, which is passed through your mouth to enable your doctor to examine
your upper gastrointestinal tract.

 Colonoscopy. This procedure uses a tiny camera on the end of a long

tube, which is passed through your rectum to enable your doctor to examine
your large intestine and rectum.
 Capsule endoscopy. In this procedure, you swallow a vitamin-size capsule
with a tiny camera inside. The capsule travels through your digestive tract
taking thousands of pictures that are sent to a recorder you wear on a belt
around your waist. This enables your doctor to see inside your small
intestine.

 Flexible sigmoidoscopy. A tube with a light and camera is placed in your

rectum to look at your rectum and the last part of the large intestine that
leads to your rectum (sigmoid colon).

 Balloon-assisted enteroscopy. A specialized scope inspects parts of your

small intestine that other tests using an endoscope can't reach. Sometimes,
the source of bleeding can be controlled or treated during this test.

 Angiography. A contrast dye is injected into an artery, and a series of X-

rays are taken to look for and treat bleeding vessels or other abnormalities.

 Imaging tests. A variety of other imaging tests, such as an

abdominal CT scan, might be used to find the source of the bleed.

Management:
Complications

A gastrointestinal bleed can cause:

 Shock

 Anemia

 Death

Q no 8 write a detail note on osteoarthritis including the

clinical features and management plan ?
Ans : Osteoarthritis is characterised by progressive synovial joint
damage resulting in structural changes, pain and reduced function.
It is the most common form of arthritis. Individuals are affected
differently, but pain and functional limitation can significantly affect
quality of life.

The hands, knees and hips are commonly affected by this condition
that leads to cartilage loss and subsequent remodelling of bone.
Management includes addressing modifiable risk factors, analgesia
and joint replacement surgery.

Risk factors 
Osteoarthritis is relatively uncommon before the age of 45, obesity is a
significant modifiable risk factor.

 Age
 Female sex
 Raised BMI
 Joint injury
 Joint malalignment and congenital joint dysplasia
 Genetic factors
 Abnormal or excessive stresses (e.g occupation, exercise) 
Clinical features
Progressive disease may result in several characteristic appearances:

 Heberden’s nodes: bony swellings of DIP

 Bouchard’s nodes: bony swellings of PIP
 Fixed flexion deformity of CMC
 Mucoid cysts: painful peri-articular cysts found on dorsum of the
finger

How is osteoarthritis diagnosed?

There is no blood test for the diagnosis of osteoarthritis. Blood tests are
performed to exclude diseases that can cause secondary osteoarthritis, as
well as to exclude other arthritis conditions that can mimic osteoarthritis.
X-rays of the affected joints are the main way osteoarthritis is identified.
The common X-ray findings of osteoarthritis include loss of joint cartilage,
narrowing of the joint space between adjacent bones, and bone spur
formation. Simple X-ray testing can be very helpful to exclude
other causes of pain in a particular joint as well as assist the decision-
making as to when surgical intervention should be considered.
Management

Osteoarthritis (OA) is a disease of the bone joints that can cause

severe pain and swelling. The cartilage around the ends of your bone joints
wears away over years of use and leaves the bones rubbing against each
other. This can make them inflamed and painful.
Your doctor may ask you to make lifestyle changes like exercise, losing
weight, and changing your eating habits. In addition to those options, there
are several medications that may help you. Some are available over the
counter while others need a prescription. They can be pills, creams, lotions,
or injections.
Here are some of them and how they work:
Analgesics: These are medicines that relieve pain but don't
reduce inflammation. They work to change how your body responds to
pain. Popular options include acetaminophen, tramadol, and
prescription opioids containing hydrocodone or oxycodone. The opioids
can be addictive.
Your maximum daily dosage of acetaminophen should be 4,000
milligrams (mg), if you don't have any liver disease. Too much can cause
liver damage or even death.
Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs reduce
inflammation as well as ease pain. These are some of the most popular
medications given for arthritis. NSAIDs
include aspirin, celecoxib, ibuprofen, and naproxen. They are usually
taken in pill form but may cause stomach upset or bleeding. Make sure to
follow the maximum daily dosage limits for each medication. Some are
also available as creams to rub on your joints (for instance, Aspercreme).
Some NSAIDs may increase your risk of heart disease or stroke. It's
actually recommended that you don't use NSAIDs if you have an ongoing
health condition such as heart disease, liver disease, or kidney disease.
NSAIDs are non-narcotic and non-addictive.

Q no 9 What is meningitis ? How will you manage patients

with meningitis ?
ANS

Meningitis is an inflammation (swelling) of the protective membranes covering the brain
and spinal cord. A bacterial or viral infection of the fluid surrounding the brain and spinal cord
usually causes the swelling.

Diagnosis

Your family doctor or pediatrician can diagnose meningitis based on a medical history, a
physical exam and certain diagnostic tests. During the exam, your doctor may check for
signs of infection around the head, ears, throat and skin along the spine.
You or your child may undergo the following diagnostic tests:

 Blood cultures. A blood sample is placed in a special dish to see if it grows

microorganisms, particularly bacteria. A sample may also be placed on a slide and
stained (Gram's stain), then studied under a microscope to see whether bacteria
are present.

 Imaging. Computerized tomography (CT) or magnetic resonance imaging (MRI)

scans of the head may show swelling or inflammation. X-rays or CT scans of the
chest or sinuses also may show infection that may be associated with meningitis.

 Spinal tap (lumbar puncture). For a definitive diagnosis of meningitis,

you'll need a spinal tap to collect cerebrospinal fluid (CSF). In people with
meningitis, the CSF often shows a low sugar (glucose) level along with an
increased white blood cell count and increased protein.

CSF analysis may also help your doctor identify which

bacterium caused the meningitis. If your doctor
suspects viral meningitis, he or she may order a DNA-
based test known as a polymerase chain reaction
(PCR) amplification or a test to check for antibodies
against certain viruses to determine the specific
cause and proper treatment. Treatment

The treatment depends on the type of meningitis you or your child has.

Bacterial meningitis

Acute bacterial meningitis must be treated immediately with intravenous antibiotics and
sometimes corticosteroids. This helps to ensure recovery and reduce the risk of
complications, such as brain swelling and seizures.

The antibiotic or combination of antibiotics depends on the type of bacteria causing the
infection. Your doctor may recommend a broad-spectrum antibiotic until he or she can
determine the exact cause of the meningitis.
Your doctor may drain any infected sinuses or mastoids — the bones behind the outer
ear that connect to the middle ear.

Viral meningitis

Antibiotics can't cure viral meningitis, and most cases improve on their own in several
weeks. Treatment of mild cases of viral meningitis usually includes:

 Bed rest

 Plenty of fluids

 Over-the-counter pain medications to help reduce fever and relieve body aches

Your doctor may prescribe corticosteroids to reduce swelling in the brain, and an
anticonvulsant medication to control seizures. If a herpes virus caused your meningitis,
an antiviral medication is available.

Other types of meningitis

If the cause of your meningitis is unknown, your doctor may start antiviral and antibiotic
treatment while the cause is determined.

Treatment for chronic meningitis is based on the underlying cause. Antifungal

medications treat fungal meningitis, and a combination of specific antibiotics can treat
tuberculous meningitis. However, these medications can have serious side effects, so
treatment may be deferred until a laboratory can confirm that the cause is fungal.

Noninfectious meningitis due to allergic reaction or autoimmune disease may be treated

with corticosteroids. In some cases, no treatment may be required because the
condition can resolve on its own. Cancer-related meningitis requires therapy for the
specific cancer.

 CT scan

 Lumbar puncture (spinal tap)

  X-ray

By sadam Hussain