Health Awareness blog

1)
a. True. Most cardiac conditions requiring prophylaxis will fall into this category:
- Congenital cardiac malformations, not falling into the high or negligible risk categories (such as PDA, VSD, ostium primum ASD, bicuspid aortic valve and coarctation).
- Acquired valvular heart disease (such as rheumatic heart disease, valvular stenosis and regurgitation).
- MVP with regurgitation and/or myxomatous leaflets.
- Hypertrophic cardiomyopathy.

b. True.
c. True. The reason erythromycin is no longer recommended is because of GI intolerance and erratic bioavailability, not because of susceptibility patterns
d. False.
e. False. Staphylococcus most often cause acute endocarditis in IVDU. Subacute endocarditis usually caused by streptococci bacteria.

2)
a. True
b. False
c. True
d. True
e. True

3)
a. True. With acute overdose, early symptoms include nausea, vomiting, tinnitus, and hyperventilation. Later symptoms include hyperactivity, fever, confusion, and seizures. Rhabdomyolysis, acute renal failure, and respiratory failure may eventually develop.
b. True.
c. False. The initial management include activated charcoal and alkaline dieresis with extra KCL.
d. True. Hemodialysis may be required to enhance salicylate elimination in patients with severe neurologic impairment, renal or respiratory insufficiency, acidemia despite other measures, or very high serum salicylate levels.
e. False. Usually we give benzodiazepine. However, there is no contraindication to use Phenobarbital in sezure management. The only contraindications are if the patient has acute intermittent porphyria, oversensitivity for barbiturates, prior dependence on barbiturates, severe respiratory insufficiency and hyperkinesias in children.

4)
a. True. It has strong hereditary component.
b. True. Grave’s disease is an autoimmune disease that commonly affects the thyroid and frequently cause it to enlarge its size twice or more.
c. False. Fine tremor, not coarse tremor (6).
d. False
e. True. IV hydrocortisone 100mg/6 hourly or tablet dexamethasone 4mg 6 hourly given to suppress the disease (8).

5)
a. False. New evidence suggests that people who quit smoking may be able to undo some amount of lung damage that smoking causes (3). After 10 years of smoking cessation, risk of lung cancer drops to as little as one-half that of continuing smokers (4).
b. False. They usually presented late.
c. False. The symptoms (of pancoast tumours) are typical of the location of the tumor in the superior sulcus or thoracic inlet adjacent to the eighth cervical nerve roots, the first and second thoracic trunk distribution, the sympathetic chain, and the stellate ganglion. When the tumor extends to the sympathetic chain and stellate ganglion, Horner syndrome and anhidrosis develop on the ipsilateral side of the face and upper extremity (5).
d. True.
e. False. Treatment mainly depends on staging of the cancer. Usually surgery and followed by radiation. Chemotherapy usually is given in combination with other treatment (7).

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Reference:
1. http://www.merck.com/mmpe/sec21/ch326/ch326d.html
2. http://en.wikipedia.org/wiki/Phenobarbital#Contraindications
3. http://quitsmoking.about.com/od/tobaccorelateddiseases/a/CC10.htm
4. http://quitsmoking.about.com/cs/afterquitting/a/longterm.htm
5. http://www.e-radiography.net/radpath/p/pancoast.htm
6. http://en.wikipedia.org/wiki/Graves_disease
7. http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/Patient/page5
8. http://healthaware.eimsnetwork.com/20090721/thyroid-storm-hyperthyroid-crisis/

Choose true/false.

1) Regarding bacterial endocarditis prophylaxis.
a. It is needed in patients with PDA going for tooth extraction. (true/false)
b. Patients already taking antibiotics for another reason (particularly penicillin for rheumatic fever prophylaxis) should be given an agent from a different class for endocarditis prophylaxis. (true/false)
c. Erythromycin based regimen for oral prophylaxis is not recommended because of problem with pharmacokinetics and gastro intestinal tolerability. (true/false)
d. It is not recommended to a patient with hyperthrophic cardiomyopathy. (true/false)
e. Staphylococcus aureus is the most common cause of endocarditis occuring after dental procedure. (true/false)

2) Regarding peptic ulcer disease
a. Gastric ulcer occurs more commonly in older age group as compared to duodenal ulcer. (true/false)
b. Pain in duodenal ulcer characteristically occurs on awakening. (true/false)
c. Aspirin is the most ulcerogenic NSAIDs. (true/false)
d. Antacids accelerate ulcer healing. (true/false)
e. In gastric ulcer, a repeat gastroscopy is suggestive after 4 weeks of treatment. (true/false)

3) In salicylates poisoning
a. Hyperventilation is one of the features. (true/false)
b. It causes prolongation of prothrombin time. (true/false)
c. Administration of activated charcoal is not effective in eliminating salicylates. (true/false)
d. Salicylates are effectively removed by hemodialysis. (true/false)
e. Phenobarbital is contraindicated in the management of seizure. (true/false)

4) Regarding thyrotoxicosis
a. Grave’s disease has familial distribution. (true/fasle)
b. Absence of thyroid enlargement makes the diagnosis of Grave’s disease less likely. (true/false)
c. A coarse tremor of the fingers is characteristic. (true/false)
d. Hypothyroidism is an uncommon complication of radioactive iodine therapy. (true/false)
e. Dexamethasone is used in the management of thyrotoxic crisis. (true/false)

5) Regarding lung cancer
a. The chance of developing lung cancer will return to non smoker level with cessation of smoking. (true/false)
b. The majority of patients are asymptomatic at diagnosis. (true/fasle)
c. Horner’s syndrome is a rare manifestation of Pancoast’s tumour. (true/false)
d. Spinal cord compression is one of the complications. (true/false)
e. Chemotherapy is the treatment of choice for non small cell cancer. (true/false)

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