October-2020-Recalls part 2 by Dr. tonmoy.pptx

OCTOBER 2020 RECALLS P2
DR.TONMOY DHAR
ALL RIGHTS RESERVED TO SHAHRIAR'S MEDICAL ACADEMY
October bonus recalls

27. Quinsy’s abscess treatment:
1. Needle Aspiration and culture
2. Incision and drainage

Quinsy, also known as a peritonsillar abscess, is a rare and potentially serious complication of tonsillitis.
Signs and symptoms
 a severe and quickly worsening sore throat, usually on one side
 swelling inside the mouth and throat
 difficulty opening your mouth
 pain when swallowing
 difficulty swallowing, which may cause you to drool
 changes to your voice or difficulty speaking
 bad breath
 earache on the affected side
 headache and feeling generally unwell
 difficulty breathing

Medication
You will be given antibiotics to clear the infection. These will usually be given directly into a vein
(intravenously) at first, but you may switch to a short course of tablets or capsules once you are well enough
enough leave hospital. Painkillers, such as paracetamol and ibuprofen, will be given to help ease any pain.
You can continue to take these while you recover at home if necessary. Occasionally, corticosteroid
medication may also be used to help reduce the swelling in your throat.
Surgery and procedures
In many cases, antibiotics alone are not effective, and it may be necessary to drain the pus from the abscess.
abscess. This can be done by:
 needle aspiration – a long, fine needle is used to draw out the pus incision and drainage – a small cut
(incision) is made over the affected area to drain the pus
 a tonsillectomy – an operation to remove your tonsils (this is rarely necessary while you have quinsy, but
is often recommended at least six weeks after you’ve recovered)
You will often remain awake during a needle aspiration or incision and drainage procedure, but you will be
given either a sedative to help you relax and/or a local anaesthetic to numb the area being treated.
Tonsillectomies and some incision and drainage procedures are carried out under general anaesthetic. This
means you will be asleep and won't feel any pain while these procedures are carried out.

28. Man admitted with left ureter stone , that passed spontaneously. investigation showed a 0. 6 cm in right
pelvis , What is the management?
A. Allow spontaneous passage
B. ESWL
C. PCNL

29. Man (i think in his 50’s )presents to the emergency department with complain of loin pain and dark
colored urine. He is on multiple drugs including rivaroxaban. On examination, he is afebrile and there is no
tenderness over the loin, flank or costovertebral angle. A urine test shows 3+ hematuria , WBC +++ with
negativity for protein and nitrite. Which one of the following is the next appropriate step in management?
A Stop rivaroxaban
B IVP
C CT KUB.
D Cystoscopy
E Urine culture.

30. Lady - not pregnant - no dysuria/ frequency , had urine check up (i forgot for what ) UA shows bacteria
+, Colony count 0.1x 10 6/L. What next ?
A. No treatment
B. Cephalexin
C. Some other antibiotic

Urine is normally sterile. However, in the process of collecting the urine, some contamination from skin
bacteria is frequent. For that reason, up to 10,000 colonies of bacteria/ml are considered normal. Greater
than 100,000 colonies/ml represents urinary tract infection. For counts between 10,000 and 100,000, the
culture is indeterminate.

Nitrite tests detect the products of nitrate reductase, an enzyme produced by many bacterial species. These
products are not present normally unless a UTI exists. This test has a sensitivity and specificity of 22% and
94-100%, respectively. The low sensitivity has been attributed to enzyme-deficient bacteria causing
infection or low-grade bacteriuria.
A positive result on the nitrite test is highly specific for UTI, typically because of urease-splitting organisms,
such as Proteus species and, occasionally, E coli; however, it is very insensitive as a screening tool, as only
25% of patients with UTI have a positive nitrite test result.

31. Man with confusion, (no nausea / vomiting). Hemiparesis present. Bp 154/95, PR 80/m. CT showed
tumor, initial management?
A. Amlodipine
B. Steroid
C. Mannitol

These are the most common symptoms of an ICP:
 Headache
 Blurred vision
 Feeling less alert than usual
 Vomiting
 Changes in your behavior
 Weakness or problems with moving or talking
 Lack of energy or sleepiness

EARLY SIGNS OF INCREASED INTRACRANIAL PRESSURE

32. Patient with recurrent abdominal pain radiating to back. nausea, vomiting and bowel motions that are
difficult or stick to toilet. No specific trigger is mentioned . No alcoholism also mentioned. An ECG is
obtained which is normal. Abdominal ultrasound exam is inconclusive. Laboratory tests, including serum
amylase, lipase and troponin, are all within normal parameters. Which one of the following is the most likely
diagnosis?
A. Duodenal ulcer.
B. Esophagitis.
C. Acute coronary syndrome.
D. Pancreatitis.
E. Cholecystitis.

33. A middle aged man (45 i think) came with a sudden severe epigastric pain radiating to back associated
with nausea and vomiting he says he had 2 similar attacks in the last 6 months vital signs were normal
examination reveals a mild tenderness on epigastric region no rebound or guarding , next?
A. Lipase
B. CXR
C. Supine and upright abdominal x-ray
D. Endoscopy

34. A 65-year-old man is being evaluated for assessment of the source of gastrointestinal bleeding after he
presented with complaint of melena .Upper and lower endoscopy and small bowel barium studies were
performed without being able to find the source of bleeding.
He is hemodynamically stable - but he needs 2 blood transfusions a day to keep his Hb at 9. Which one of
the following is the next best step in management?
A Capsule endoscopy.
B Interventional angiography.
C CT angiography.
D Repeat endoscopy.
E Radionuclide imaging.

INDICATION & CONTRAINDICATION OF CAPSULE ENDOSCOPY

October-2020-Recalls part 2 by Dr. tonmoy.pptx

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