Famco_important_chapters.docx

7/31/2019 Famco_important_chapters.docx

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EMAN AL LAWATI / FAMCO NOTES

Famco important chapters ( third edition)

CNS:

OSCE: headache : page 560 ( remember the points mentioned in the hx and ask for red flags)

: febrile convulsion: page 894 ( remember the points mentioned in the hx)

Always ask for fever and hx of rash ( to rule out meningitis)

Make sure that you ask for the pink card of the child and immunization

Management: put the child in left lateral position during the attack. If the attack lasts for

more than 10 min give him/ her diazepam rectally and take him to the nearest health centre.

Dont forget to mention about the management of fever : give paracetamol 4hrly and ibuprofen

8hrly , tapid sponging .

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For the written exam:

Migraine :

1- You should know about the management of acute attack ( table page 562)2- Prophylaxis (page 563) (MD question)

Headache:

A-cluster headache (page 564-565)

1- You must know the associated symptoms (red watery eye, runny, or blocked nose,drooping eyelid)

2- Learn the management ( rarely asked)Note: usually a clinical case is given and student has to diagnose ( easy )

B- trigeminal neuralgia:

1- You should know the presentation and associated symptoms2- Management ( commonly asked) carbamazepine / gabapentin

C- Temporal headache:

1- You must know the presentation ( 532) typical symptoms2- Labs finding usually raised ESR .

Note: to diagnose temporal headache first check the ESR followed by biopsy.


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WARNING:

Headache is usually asked in EMQs ( extending matching questions) so

make sure that learn it.

ENDOCRINOLOGY:

A- Diabetes mellitus :OSCE: hx taking station or diabetic foot examination

Written exam:

1- You should know the definition of metabolic syndrome2- Glycosylated hemoglobin tells you the average blood sugar control over the

previous 6-8 weeks ( 3 months)

3- You must know everything about the first line oral hypoglycaemic agentsBiguanides given to obese pts ( BMI is an important clue)

Side effects: lactic acidosis

Contraindications: renal, liver , serious heart disease , high alcohol intake

Sulphonylureas : warn about possible hypoglycemia if meals are omitted

Side effects: weight gain ( so dont prescribe for obese pts , again your clue is BMI)

4- Learn about glitazone : rosiglitazone may increase risk of coronary ischemiaPioglitazone: increases insulin sensitivity and reduces total cholesterol

5- You must learn the indications to start insulin ( 369)NOTE: if the question stem mentions that the pt is diabetic, his creatinine is high , and has

hyperlipidemia ( high cholesterol ) then your answer should be pioglitazone ( because high

creatinine levels indicate renal failure so metformin is contraindicated , so pioglitazone can take

care of both high blood sugar and hyperlipidemia ( commonly asked question)

6- Treatment of diabetic diarrhea ( had been asked in one of the end rotation exams)page 366. Tetracycline or codeine phosphate.

7- Treatment of gastric paresis ( page 366) erythromycin/domperidoneB- Thyroid:

1- You should know the Treatment of hyperthyroidism in second trimester:carbimazole .

2- You should know the lab findings of subclinical hypothyroidism ( table page 373 )


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WARNING:

In Any question related to diabetes make sure that you look at the lab values ( if given), and the

BMI.

MUSCULOSKELETAL :

OSCE: -hx taking station , usually RA

- joints examination : knee , shoulder , back

A- Osteoarthritis:1- You should know the risk factors ( post-meniscectomy) page 5202- You must know the symptoms and signs3-

You must know the X-ray findings

4- Learn the management ( first line drug treatment ) page 521 ( commonly askedquestion)

NOTE: if the question stem mentions that the pt had bilateral meniscectomy in the past , and

now complains of knee pain after playing football ( what is your diagnosis) ? your answer should

be osteoarthritis

If the question is about the first line drug treatment of osteoarthritis ( your answer should

be paracetamol)

Usually symptoms and investigations are asked in MCQs , so make sure that you knowthem thoroughly.

(joint pain , +/- stiffness , synovial thickening , deformity , effusion , crepitus , muscle weakness,

wasting , loss of function)

Investigations: reduced joint space , cyst , sclerosis in subchondral bone , and osteophytes . (

remember the pneumonic loss , L: loss of joint space , O: osteophytes , S: subchondral sclerosis ,

S: subchondral cyst ) .


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B- RHEUMTOID ARTHRITIS:1- You must know the symptoms and investigations

NOTE: symptoms : symmetrical small joints involvement , pain, stiffness , swelling ( very

important) , functional loss , joint damage and deformity .

X-rays: normal periarticular osteoporosis , or soft tissue swelling , loss of joint space, erosion ,

join destruction

C- Crystal induced arthritis:1- Gout : negative birefringent crystals .2- Treatment: if acute attack: NSAIDs , if hx of dyspepsia then drug of choice is

colchicine.

3- Treatment of chronic cases: either probenecid or allopurinol. The drug of choicedepends on the scenario . always look at the lab results , if uric acid excretion is less

than 1g then your answer should be probenecid ( to increase the excretion) . if the

uric acid is more than 1g than drug of choice is allopurinol ( more than 1g means

increased production )

D- Pseudogout :1- You should know the positive findings seen in pts w pseudogout.

NOTE: in pseudogout : X-ray : chondrocalcinosis

Positive birefringent , rhomboid crystals .

DERMATOLOGY:

A- Acne:1- You must know the management of mild , moderate, and sever form of acne (

page621)

NOTE: always start w topical benzoyl peroxide , then topical retinoid , then topical antibiotics ,

then oral antibiotics , and finally for nodular acne oral retinoid is prescribed.

Remember if the question is about severe or nodular acne then your answer should be refer the

pt .

2- You must know when to refer the pt to dermatology. ( page 621)

SEXUAL HEALTH AND CONTRACEPTION:

A- Sexually transmitted disease :1- You must know the treatment of Chlamydia , gonorrhea, and trichomons.


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NOTE: Chlamydia : doxycycline or azithromycin , in pregnancy erythromycin is given.

Trichomonas vaginalis: fishy yellow white discharge , treatment: metronidazole.

Gonorrhoea: ceftriaxone.

B-Hepatits B and C ( very important)

OSCE : static station ( MD , and end rotation exam) : you might be given a lab report showing

elevated liver enzymes

Questions:

What are the abnormal findings ?

What are the most likely etiology ?

Answer: viral hepatitis , toxin induced hepatitis, connective tissue disease.

What is the management?

Viral hepatitis: supportive therapy ( bed rest , fluids)

Connective tissue disease: order RF, ANA

Toxin induced: drug or toxin levels in the blood

Carcinoma: alpha feto protein

Written exam:

1- You must know and understand the viral serology in hep BNote:

-HbsAg : + if less than six months then its an acute infection

-if more than 6 months = chronic infection

-HbeAg: + indicates active infection ( highly infective)

- HbsAb: + means pt has recovered

- HbsAb + and HbsAg (neg): means pt has been immunized ( vaccinated )

- HbsAb+ and HbcAb + and HbsAg neg: means pt has developed immunity post

infection

- exam question ( commonly asked): HbsAg more than 6months+ and HbeAg +

Answer: chronic hepatitis B w high infectivity.


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- If pt has been already vaccinated against hep B and gets a needle prick:There are two options:

A- Check the antibody levels and repeat it after one monthB- Check antibody levels and give a booster dose

Remember : if the antibody levels are less than 10 then a booster dose is required.

Exam question: a staff nurse gets a needle prick while injecting hep B positive pt w ranitidine,

she has been vaccinated 2 years back. How would you manage this case ?

Answer: usually you will find one of the options ( A or B)

- For hep C there is no immediate action to be taken , check current antibodylevels and after 3-4 months.

Chapter 23 pregnancy :

A- UTI in pregnancy ( MD, end rotation exam)- Page 810 : recurrent UTIs in pregnancy should be investigated.

Consider USS, or IVU > 12wk after delivery.

B- Down syndrome screening:- Page 797 ( table) : 11wk , 16wk

Exam question: 16wk: AFP,hCG,uE3, inhibinA

EAR, NOSE , AND THROAT:

A- Otitis externa:- Diagnosis: ear canal appears red, swollen, inflamed.- Management: analgesia ( paracetamol) and ear drops aluminium acetate

,steroids and antibiotics.

B- Otitis media:- Diagnosis: red bulging drum- Management: supportive- When to refer the pt ( very important) if recurrent attacks more than > 4

episodes in 6 mo , or membrane perforation does not heal in less than one

mo refer to ENT

- When to start the antibiotics ( very important) : in children w bilateral otitismedia or acute OM w otorrhoea.

C- Glue ear / secretory otitis media:- Sign: dull concave drum w peripheral visible vessels , +/- fluid levels or air

bubbles behind the drum( MD question) .

D- Mastoditis:- Persistent throbbing earache , remember if ear drum is normal its not

mastoditis .


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- Management: IV antibiotics.E- Deafness:

- Presbyacusis ( MD ,EMQ ) :-

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