Download Objectives of Chest pain lecture:

OBJECTIVES OF TUTORIALS
(& some clinical reasoning sessions)
CARDIOLOGY
1.CHEST PAIN:
1. Ability to assess patient with acute chest pain in emergency room
2. Classification and treatment strategies for acute coronary syndrome
3. Diagnosis of ST-segment elevation myopcardial infarction and choice between primary
PCI vs. thrombolysis
4. Highlights on the Diagnosis and treatment of aortic dissection
5. Highlights on the diagnosis and treatment of pulmonary embolism
2. PALPITATION:
1. Ability to assess patient with palpitation in outpatient setting
2. Identify the common and the serious causes of palpitation clinically and by ECG
3. Diagnosis and treatment of atrial fibrillation and flutter
4. ECG findings in premature beats (Atrial and ventricular) Supraventricular tachycardia
(sinus tachycardia, atrial tachycardia, AVRT, AVNRT) and Ventricular tachycardia
3.CARDIAC MURMURS:
1. Pathogenesis of murmur
2. Approach to a patient with cardiac murmur.
 Approach to clinical diagnosis
type of murmur (systolic, diastolic , continuous)
sites (apical, basal, lt.parasternal)
causes (congenital, rheumatic or ischemic).
 Investigations
X-Ray chest
Echo Doppler study
ECG.
Discussion about
MITRAL VALVE LESIONS
AORTIC VALVE LESIONS
REGARDS
1. Pathogenesis
2. Features
3. Investigations
4. Complications
5. Management
Medical
Interventional
Surgical
6. Prophylaxi for infective endocarditis and rheumatic fever
4.HYPERTENSION:
1. Diagnosis of systemic hypertension, Burden in Saudi Arabia
2. Treatment of systemic hypertension
3. Causes and treatment of secondary hypertension
4. Rule of ambulatory BP monitoring
5. Impact of treatment of systemic hypertension on stroke and myocardial infaction
5. HEART FAILURE :




Define Heart failure
Types:
a. According to out put…… High; Low
b. According to chamber….. LVF; RVF; CCF
c. According to cycle….. Systolic; Diastolic
Etiology in young:
Brief about…… Congenital causes
Valvular lesions
Myocarditis
Hypertension
Arrhythmias
Cardiomyopathy
In old:
IHD , HTN & Cardiomyopathy
Approach to a patient with suspected cardiac failure
History
Physical examination
Investigations
CARDIOMYOPATHY
 Define
 Etio
 Types and clinical features
 Criteria for diagnosis of CMP
 Management
6. Fever in Cardiac Patients :

Approach to a patient with suspected cardiac fever
History (IE,Rh.F.,post MI)
Physical examination
Investigations
Infective Endocarditis
 Define
 Etio
 clinical features
 Criteria for diagnosis of IE
 Management
-
Rheumatic fever:
Link of rheumatic fever to streptococcal infection and its prevention.
Elaborate on the major manifestation of rheumatic fever and how to
recognize them.
How to investigate and the manage a patient with possible rheumatic fever
GASTROENTEROLOGY
7. JAUNDICE:
1. Definition of jaundice.
2. Bilirubin metabolism and mechanisms producing jaundice
(Haemolysis,hepatocellular damage or cholestasis).
3. Approach to a patient presenting with jaundice :
 History: To differentiate between types of jaundice.
 Clinical examination for detection of each pathognomic signs e.g.
o Pallor, Splenomegaly (hemolytic J.)
o Hepatocellular failure manifest. (Hepatocellular J.)
o Scratching marks &abdominal mass (obstructive J.)
 Investigation
LFTs, Urine analysis for bilirubin &urobilinogen, Abdominal U/S,
Viral markers
Discussion about:
Hepatitis
Discussion about:
Acute hepatitis
- Etio A,B,C,D,E
- Clinical Stages
- Features
- Diagnosis , Complications
- Management
Chronic hepatitis
- Definition
- Types
Post hepatitic B,C
- clinical picture
- Diagnosis
- Therapy
Autoimmune Hepatitis
Drug Induced Hepatitis
8. Liver Cirrhosis
Definition & Etiology and types
Features
Diagnosis, Complications (e.g. hepatocellular failure –HCC) &
Assess the Severity of Liver Disease
Outline the Prognosis, and Management
Brief about causes of Cirrhosis
- Alcoholic Cirrhosis, Post hepatitis Cirrhosis, Cardiac Cirrhosis,
Biliary Cirrhosis, Hemochromatosis, Hepatolenticular
Degeneration "Wilson dis"
9. CHRONIC DIARRHEA
Define diarrhea:
Classify:
Acute
Chronic
Chronic diarrhea:
Subclassify:
According to cause
Osmotic
Secretory
Motility
Chronic infection
Inflammatory
According to site
Small bowel
Large bowel
Approach to chronic diarrhea:
History…. Age; Diarrhea pattern; Diurnal variation
Relation to meal; Weight Loss; Stool
consistency
Examination …. GPE; Abdomen
Investigations….. CBC
Stool analysis: especially Stool
Osmolal gap
Stool culture
UCE
Ca, Po4, ALP
Albumin
TFT
Sigmoido and colonoscopy
Barium studies
Tests for malabsorption
Fecal fat
D-xylose
Pancreatic function
Jejunal biopsy
H breath test
Discussion:
Celiac disease
Inflammatory bowel disease
Irritable bowel syndrome
10.GASTROINTESTINAL BLEEDING
 Epidemiology. Brief description of sources of GI bleeding and mortality.
 Prognostic factors including clinical(details ) and endoscopic factors
(brief )
 Time of rebleed
 Overview of Causes of GI bleeding.
 Role of acidity in gastrointestinal bleeding
 Goal of therapy and management lines in details for both acute cases and
stable cases
 Incidence of peptic ulcer disease ,common sites ,differences between
erosion and ulceration ,hospitalization rate ,physiological explanation of
ulceration, smoking effect on Peptic ulcer disease
 H pylori bacteriology ,pathology ,incidence of infectivity ,method of
detection with sensitivity and specificity ,line of management and
therapy
 Causes of lower gastrointestinal bleeding and diagnostic modality with
advantages and disadvantages
11.HEART BURN & DYSPHAGIA
HEART BURN:
 Definition of Gastro esophageal reflux disease ,
 Prevalence ,reason for diagnosis ,physiological mechanism of GERD ,
 Hiatus hernia and GERD ,
 Clinical presentation with extra esophageal complication ,
 Diagnostic modality ,timing and differences of outcome of each
modality
 Treatment goals including both non- pharmacological and
pharmacological therapy
 Safety of therapy
 Treatment of persistent symptoms and chronic relapsing condition



Complications of GERD
Principles of surgical therapy and endoscopic therapy
Differential diagnosis
DYSPHAGIA:
 Definition
 Etiology:
(a) Mechanical
(b) Motor

Approach to a patient with Dysphagia
1. History
2. Examination
3. Investigations
Esophagoscopy; Barium Swallow and meal;
Manometry
4. Brief about
a) Achalasia
b) Ca esophagus
NEPHROLOGY
12 .RENAL FAILURE
Introduction to structure and function of kidneys
Definition of Renal failure
Types:
Acute ARF
Chronic CRF
Define ARF
Define Oliguria; Anuria; Azotemia & Uremia
Stages of ARF……………….RIFLE
D/D: Prerenal/Renal/Postrenal ARF
Practical approach to a case of ARF
History
Examination
Investigations:
How to differentiate Pre-renal/Renal/Post-renal?
Latest markers of ARF
Management of ARF
Indications for Hemodialysis
Management of some specific causes of ARF
Acute tubular necrosis
Radio-contrast ARF
Acute interstitial nephritis
Definition of CRF and Chronic kidney disease
Stages of renal dysfunction
Etiology: with more stress on common causes of CRF
Manifestations of CRF
Investigations in a case of CRF
Complications of CRF with mechanisms of osteodystrophy
Management of the CRF and its Complications
Renal Replacement therapy
Peritoneal dialysis
Hemodialysis: especially access for Hemodialysis
Renal transplant
Advantages and disadvantages of each method
Causes of death in ESRD with poor prognostic factors
Differentiation of ARF from CRF
13. NEPHROTIC/NEPHRITIC SYNDROME (glomerulonephritis)
Introduction to the Glomerular structure and mechanisms of injury
Define GN
Classification of glomerulonephritides
How the patient may present?
Nephritic
Nephrotic
Nephrotic+Nephritic
Nephritic syndrome components
Sequence of events
Investigations to confirm Nephritic syndrome
An approach to etiology of the nephritic syndrome by investigations
General management
Specific disorders:
Post infectious GN
IgA nephropathy
Brief introduction to
HS purpura
Anti-GBM GN
Nephrotic Syndrome components
Etiology
Complications
Investigations
General management
Specific disorders
Minimal change disease
Membranous GN
Diabetic Nephropathy
Nephrotic+Nephritic presentation
Lupus nephritis
14. Electrolytes imbalance
1. Organize an algorithm on how to diagnose the cause of hyponatremia, hypernatremia,
hypokalemia and hyperkalemia
2. Diagnosis and management of SIADH
3. Diagnosis and management of hypernatremia
4. Diagnosis and management of hyperkalemia
5. Diagnosis and management of hypokalemia
6. Diagnosis and management of hypocalcemia and hypomagnesemia
7. Diagnosis and management of hypercalcemia and hyperphosphatemia
INFECTIOUIS DISEASE
15.PYREXIA OF UNKNOWN ORIGION
Body Temperature
Definition of PUO
Temp
Duration
Investigations
Categories
Classical
Nosocomial
Neutropenic
HIV assoc
Etiology
Infections e.g. T.B
Malignancy
Connective tissue disorders
Miscellaneous
Diagnostic Approach
Management
Discussion about few causes of PUO
Enteric fever
Etio
Transmission
Manifestations
Typhoid
Paratyphoid
Diagnosis
Blood and bone marrow culture
Serology
Treatment
Preventive aspects
Chemoprophylaxis
Vaccination
Brucellosis
Etio
Transmission
Manifestations
Diagnosis
Treatment
Duration of therapy and follow up
Preventive aspect
Malaria
Etio
Transmission
Manifestations
Diagnosis
Treatment
Prophylaxis
In chloroquine sensitive and resistant areas
Complications of falciparum malaria esp. cerebral malaria
and its management.
T.B
-.Recognize pulmonary tuberculosis as one of the most important global public
health problems specially in the era of HIV.
- Define the causative agent, pathogenesis and clinical features of the disease.
- Describe methods for the diagnosis of pulmonary tuberculosis.
- Recognize the importance of appropriate treatment of cases and the prevention of
drug resistance.
16. HIV/AIDS
Case definition
Routes of transmission
Epidemiology
Major risk groups
Causative agent
HIV 1
HIV 2
How virus interacts with body cells
How injury occurs
Incubation/latent period
Clinical features
Systemic
Respiratory
Neurologic
Rheumatologic
Cutaneous
Intestinal
Eye
Suspected malignancies
Laboratory
Antibody detection
Antigen detection
CBC
The suitable investigation to
diagnose AIDS in a suspected case
follow up the case;
Treatment progress
Investigations for suspected infections and malignancies
D/D
Prevention
Primary
Secondary
Risk to health care people and what to do in case of needle stick injury?
Sexual exposure/drug abuse exposure....what to do?
How to prevent vertical transmission?
Pregnancy with AIDS
Management
Principles
When to start therapy
Name the different groups of antiretroviral drugs but limit to most
recommended therapy i.e ZIDO+LAMI+EFA
Important toxic effects of this regimen
ENDOCRINOLOGY
17. GOITER
1. Definition
2. Classification
3. Examples
4. Stages of goiter
5. Features of goiter
6. What a hard thyroid means
7. Approach to goiter
TFT
Scan
Biopsy
8. Management of individual cases
Grave's disease
Multinodular goiter
Hashimoto's thyroiditis
9. Solitary nodule
Investigations
Management
10. Brief about Thyroid malignancies….names; general principles of
management.
18.CUSHING Syndrome..: Pathophysiology and causes
Clinical features
Diagnosis (investigations) &D.D
Treatment
19.ADDISON’S Disease.: Pathophysiology and causes
Clinical features
Diagnosis (investigations)
Treatment
20.Pituitary Disorders:
Pathophysiology and causes
Clinical features of different disorders
Diagnosis (investigations) &D.D
Treatment
Especial discussion about acromegaly
21. HYPERGLYCEMIA
 Normal blood glucose and its regulation
 Causes of hyperglycemia
 Diabetes mellitus
1. Types
2. Pathophysiology
3. Clinical manifestation
4. Investigations
for diagnosis
for follow up
5. Treatment
oral hypoglycemics
insulin therapy
recent advances in treatment
6. Complications
DKA ……. Features, Investigations, Management.
Hypoglycemia
Hyperosmolar non ketotic coma
Nephropathy
Neuropathy
Retinopathy
Diabetic foot
RHEUMATOLOGY
22.MONOARTHRITIS
- How to recognize arthritis.
- Importance of monoarthritis. How urgent it is.
- Identify most important causes of monoarthritis.
septic; gout; systemic presenting with mono e.g RA ; reactive
- Approach to a case of monoarthritis
History
Examination
Investigations
joint aspiration and synovial fluid analysis
xray
Discussion
Septic arthritis
Gouty arthritis
regards Etio
Pathogenesis
Features
Management
acute
long term
23. ARTHRITIS & RASH
Approach to a patient with arthritis and rash
History
Examiantion
Investigations
Brief about common underlying cause
Rheumatic fever
SLE
SLE:
- Identify major manifestations of SLE.
- Major clinical features of SLE.
- Discuss major impact of SLE upon pregnancy and lactation.
- Important complications
- How to investigate a patient of SLE with its major differential diagnosis.
- Outline the major therapeutic options.
24. CHRONIC ARTHRITIS
- Approach to a patient with chronic arthritis.
History
Exam
Investigations
SEROLOGY
RADIOLOGY
Major causes of Chronic Arthritis
RA
SERONEGATIVE:
REACTIVE
PSORIATIC
ANKYLOSING SPONDYLITIS
Discussion about:
RHEUMATOID ARTHRITIS
- Major features
-
Introduce the concept of rheumatoid arthritis as a major cause of disabling
chronic arthritis.
Highlight the importance of early detection of rheumatoid arthritis and the
impact on the outcome of the disease.
Give an outline about how to investigate a patient with arthritis and possible
differential diagnosis.
Major therapeutic option of rheumatoid arthritis.
NSAIDS……cox inhibitors..non-selective
cox-2
DMARDS…..methotrexate; salazopyrines
hydroxychloroquin
Biological……infliximab; adalimumab
etanercept
Role of surgery .
PULMONOLOGY
25. HEMOPTYSIS
•
•
•
•
•
•
•
Definition of hemoptysis
Differentiate from Hematemesis
Causes of hemoptysis
Approach to a patient
history
examination
asses the severity
investigation
Management
Complications
Discuss
Bronchiectasis
Bronchial cancer
Regarding
Etiology
Features
Types
Specific investigations
Therapy
26. FEVER, COUGH & CHEST PAIN (PNEUMONIA)

Approach to a patient with suspected pneumonia
History
Examination
Investigations

Pneumonia
Define
Epidemiology
Types
Etiology
Features
Differential diagnosis
Investigations
How to assess the severity of CAP and its indications for Hospitalization
Management
treatment regimens of different types
Complications
27. ACUTE DYPSNEA
 Causes of acute dyspnoea
 Clinical approach to the breathless patient
History
Physical
investigations
 D/D between Cardiac and respiratory causes
 PULMONARY EMBOLISM
Pathophysiology
Risk factors
Presentation
Diagnostic Modalities
Management
Prognosis
 BRONCHIAL ASTHMA (Acute asthma)
Cause
Types
Features


Assesment of severity
Investigations
Management
Acute severe
Long term
Pneumothorax (Def., Causes, Investigation and Treatment)
Pulmonary oedema ( Cardiogenic Vs. non cardiogenic)
28. CHRONIC DYPSNEA
 Diagnostic approach to the patient with Chronic Dyspnea
History
Examination
Investigations
 Causes of chronic dypsnea
Interstitial Lung Diseases
 Definition
 Etiology and pathogenesis
 Clinical picture
 Causes of ILD
 Investigations
 Discuss Idiopathic Pulmonary Fibrosis
COPD
 Definition
 Types
 Etiology
 Pathophysiology
 Features and staging
 Investigations
 Management
29. PLEURAL EFFUSION:
1. Definition
2. How to differentiate Transudative and Exudative Effusion
Light's criteria
3. Causes of Transudative and Exudative Effusion
What is Empyema?
4. Clinical Features
5. Investigations Esp. Pleural Aspiration and biopsy
6. Management
7. Indications of intercostal drainage
HEMATOLOGY
30. ANEMIA/PALLOR
• Define anemia
• Types depending upon
1.RBC morphology
2.Underlying cause
• Approach to a patient with anemia
History
Physical examination
Investigations
• Discuss:
Iron deficiency Anemia
Megaloblastic anemia
Hemolytic anemias
Thalassemia
Sickle cell anemia
G6PD deficiency
Aplastic anemia
List the signs and symptoms of anemia and distinguish between the symptoms of
acute anemia with volume depletion and chronic anemia in the euvolemic state.
Discuss possible eitiologies of the fore mentioned types of anaemias
Recognize characteristics of the fore mentioned types of anaemias
31. CBC
Normal values
RBC, Hb and indices like MCV, MCH, MCHC, RDW
TLC
DLC
Platelets
Briefly discuss
Anemia
Approach to anemia
Leucocytosis
Neutrophilia
Lymphocytosis
Eosinophilia
Monoytosis
Leucopenia
Thrombocytopenia
Define
Causes
Risks at different counts
Leukemias …. Blood picture in AML; CML; ALL; CLL
1. Students will define anemia and discuss how normal values vary with race and
gender
2. Students will interpret the common findings on a CBC; i.e., hemoglobin,
hematocrit, white count, platelet count, MCV, and RDW
3. Students will describe indications for ordering and interpret the results of the
following studies:
A. Reticulocyte count
B. Iron, Ferritin, Transferrin, and TIBC
C. B12, folate, Methylmalonic Acid, Homocysteine
D. LDH, Haptoglobin
E. Hemoglobin Electrophoresis
F. Blood Smear
G. BM Biopsy
4. Students will recognize major findings on peripheral blood smear, including:
A. Hemolysis (schistocytes)
B. Hypersegmented polysegmented neutrophils
C. Microcytosis
D. Macrocytosis
32. BLEEDING DISORDERS
Normal Hemostasis
Approach to a patient with bleeding tendency
History
Examination
Investigations
CBC
Bleeding/clotting time
PT/APTT
What is INR?
Immune Thrombocytopenia
Platelet function disorders
DIC
Hemophilia
Purpura: Define Purpura
Approach to purpuric rash
VIRAL; BACTERIAL; IMMUNOLOGIC; ITP/TTP
Vasculitis:
Define
- How to identify vasculitis (elicitic clues for its recognition).
small vessel
medium vessel
large vessel
-
-
Explain major clinical manifestations based on pathophysiology.
local
systemic
Give an idea about major and most common clinical vascultidis
giant cell arteritis
takayasu arteritis
polyarteritis nodosa
wegener's granulomatosis
henoch schonlein purpura
Investigations in a case of vasculitis.
Major management steps for vasculitis.
A clinical approach for a patient suspected to have vasculitis.
33. LYMPHADENOPATHY



What is Lymphadenopathy?
Approach to a patient with generalized Lymphadenopathy?
Causes:
Infections
Malignancies
Autoimmune disorders
Lipid storage disorders
Drugs
History
Examination: Node characteristics
Investigations
Indications of LN biopsy
Lymphoma
Define
Classification
Some comments about the various classification systems of NHL like
WHO, REAL.
Epidemiology and etiology: brief
How to differentiate Hodgkin and NHL?
Features
Investigations
Staging
Management
Most common regimens according to the type

Prognosis
Leukemia
Define
Types ;- Acute, Chronic
Features
Investigations
Management
Prognosis
34. WEIGHT LOSS:


Definition of unintentional weight loss
Etiology: weight loss with adequate food intake
Weight loss with inadequate (diminished) food intake
Social
Psychological
Organic…..
 Malignancy
 Infections
 Endocrine
 GI causes
 Medications

Evaluation
Documentation
History
Examination
Investigations
NEUROLOGY
35 .SEIZURE
What is a seizure
Types of seizure….. motor; sensory; behavioral
Approach to a patient with recurrent seizures
Possible causes of seizures…. Metabolic; Vascular; exogenous
Infectious; Inflammatory
Definition of epilepsy
Classification of epilepsy
Features of each type
Esp. the phases of a grand mal seizure
Factors precipitating a seizure
Differential diagnosis
Investigations
Special emphasis on the indications and yield of EEG; CT and
MRI
Management
When to start the antiepileptic drugs
How to manage a motor seizure in ER
Among the antiepileptic drugs
Valporate; carbamazepine; Phenobarbital
Ethosuximide; Lamotrigine; Topiramate
Adverse effects of these drugs
Precautions in an epileptic e.g Regulations regarding driving;
Choice of profession
36.HEMIPLEGIA/WEAKNESS :Approach to a patient with weakness of neuromuscular origion
Upper motor neuron disease……chronic; acute
Lower motor neuron disease
Disease of peripheral nerves
Disease of neuromuscular junction
Disease of muscles
Then discuss Hemiplegia:Definition
Etiology
Clinical picture of Hemiplegia at different levels.
INVESTIGATIONS:
Intracranial/spine…… CT, MRI
Peripheral……. CBC; ESR; muscle enzymes; Protein electrophoresis
ANA; TFT; HIV; Heavy metal screen
NMJ…..Tensilon test
EMG
Muscle biopsy
Discuss:
STROKE
Define
Types
Risk factors
Etiology
Also causes of a stroke in a young person
TIA
CEREBRAL INFARCT
HAEMORRHAGE…… intracerebral; subarachnoid
Localization of lesion
Investigations
CT why preferred?
Other relevant investigations e.g CBC, ESR, RBS etc
Management
General
Specific
INFARCT
Thrombolytic?
Antiplatelet?
ACE inhibitors?
Target BP?
Mannitol?
HAEMORRHAGE
Complications
Aspiration
SIADH
DVT
37.FEVER AND HEADACHE
Meningitis
Etiology
Source and transmission
Features with signs of meningeal irritation
Investigations
LP and CSF analysis with findings in viral; bacterial;
Tuberculous meningitis
Treatment
Complications
Encephalitis
Etiology
Source and transmission
Features
Investigations
LP and CSF analysis and PCR
CT
Treatment
Complications
38.COMA
Glasgow Coma Scale
Causes of coma…….Craniocerebral trauma
Metabolic…….Exogenous
Endogenous…Endocrine; renal; hepatic;
Respiratory; Electrolyte and
Acid base disorders
CVA
Infection…. CNS and sepsis
SOL
Psychiatric
Seizure disorders
How to differentiate
Supratentorial lesions
Infratentorial lesions
Mid brain; pons; medulla;. Cerebellum
Metabolic encephalopathy
Psychogenic coma
Approach
ABC
History
Examination
Labs ….. CBC; urine; PT; Toxicology screen; ABG; Urea;
Creatinine; Electrolytes; LFT;
ECG; CXR; LP; MRI
General management
39.EXTRA-PYRAMIDAL DISORDERS
Introduction to Motor system
Pyramidal and extra-pyramidal system
Basal ganglia
Classification of extra-pyramidal disorders
[Hypo-kinetic and Hyper-kinetic]
Tremors
Chorea
Athetosis
Hemiballismus
An approach to movement disorders
Discuss Parkinsonism in detail
Briefly discuss:
Essential tremors
Huntington’s disease
Sydenham chorea
Wilson’s disease
Acute Dystonia
Tardive dyskinesia
40. PERIPHERAL NERVE DISORDERS
Classification
Etiology of Polyneuropathy
Clinical features
Approach to peripheral neuropathies
Differential diagnosis
Investigations
Introduction to NCS and EMG
Investigations to find cause
General treatment
Discuss:
Guillian Barre syndrome
Diabetic neuropathy
Bell's palsy
Carpal tunnel syndrome
41. Myopathies & Muscular dystrophies
To understand major categories of muscle disease and the clinical differences
between
them.
To be able to use appropriately the different diagnostic tools to diagnose muscle
diseases.
To recognize the major pathologic features of myopathic muscle.
42. Multiple sclerosis (MS)
Epidemiology
How to diagnose a case of MS (clinical picture, investigations)
Treatment
43.HEADACHE
Possible causes of Headache
Intracranial
Extracranial
Neuralgias
Approach to a patient with headache
History….age;
sex;
duration: single episode of severe headache
subacute
recurrent
chronic
location;
quality of ache;
prodrome;
Associated symptoms;
ppt factors
relieving factors;
diurnal variation;
family
GPE
Neurologic exam
Investigations
Visual acuity; field
Fundus
Paranasal sinus study
CT or MRI
LP
Red flags in headache
Discuss
MIGRAINE…..Define; Types; Presentation; ppt factors;
Management of acute attack
Analgesic antiemetic
Ergotamine
Sumatriptan and zolmitiptan
Prophylaxis
Ca channel blocker esp. flunarazine
Beta blocker
Valproate
CLUSTER HEADACHE
SOME INVESTIGATIONAL SESSIONS TOPICS
44. ECG
How to read ECG
Rate
Rhythm
P wave
QRS axis and voltage
Evaluate chamber enlargement/ hypertrophy
ST segment examination
ECG2:
1. Approach of bradyarrhythmia
2. ECG findings on heart block ( 1st, second and third degree)
3. review on ECG finding on STEMI, VT and SVT
4. ECG findings on electrolytes imbalance, such as hyperkalemia
45. LFT
Normal bilirubin metabolism
Normal liver functions
Interpretation
Bilirubin
ALT
AST
ALP
GGT
PT
A/G ratio
Identify:
Patterns of Liver function abnormality
Predominantly conjugated hyperbilirubinemia
Predominantly unconjugated hyperbilirubinemia
Mixed hyperbilirubinemia
Pre-hepatic; hepatic; post-hepatic
46. ARTERIAL BLOOD GAS ANALYSIS
Define pH, acid and base/alkali
Physiology of the acid base regulation
Normal acid base parameters
Analysis of ABG report to identify the primary acid base disorders
Meaning of compensation and hints to identify mixed acid base disorders
Causes of primary acid base disorders:
Metabolic acidosis
Respiratory acidosis
Metabolic alkalosis
Respiratory alkalosis
47- PULMONARY FUNCTION TESTS :
- Indications
- Contraindications
- PFT Procedures
- Definitions of Tidal volume, Inspiratory and Expiratory reserve
volumes, Vital capacity, Residual volume, Total lung capacity, FVC, FEV1, FEF
25%-75%,
- Interpretation of Spirometry
Obstructive or restrictive
Assessment of severity