Initial factors considered to diagnose intrauterine growth restriction
1. Identify mothers at risk: –
→ PIH
→ Chronic Renal Disease
→ BMI↓ & Less wt. gain
→ Infections
2. Sure about gestational age
Mobile Apps for Medical Students
1. Identify mothers at risk: –
→ PIH
→ Chronic Renal Disease
→ BMI↓ & Less wt. gain
→ Infections
2. Sure about gestational age
Diagnosis in non-pregnant female:
1. History: –
→ RPL
→ Only 2nd trimester loss
→Painless dilatation of cervix
→ As the no. of pregnancy loss ↑ POG at which loss occurs↓
2. Hegar dilator no. 8 can pass through Internal Os without Pt. resistance.
3. On hystero cervicography- Funnel Shape
• In hysterocervicography with the help of foleys catheter radiopaque dye is injected.
• In normal pt. as os is closed dye will not come out but in cervical incompetence dye will
ome out and result in funnel shape.
• All these are not a very good method to be performed in non-pregnant females.
Diagnosis in pregnant female:
→ Length of cervix <2.5 cm
→ Dilation of cervix ≥2cm
→ Shape of cervix-U shaped (Normally T shape)
Clinical diagnosis:
1. Arterial/ Venous Thrombosis (Superficial/Deep)
At least 1 Preterm delivery secondary to severe PIH/Uteroplacental insufficiency
Lab Findings:
Presence of IgM / IgG Cardiolipin Antibody Any of these should beresent@2occasions12wksapart
Presence of β2 Micro globulin
Note: In APLA – APTT is prolonged; PT is normal; Russel viper venom time is prolonged.
The diagnosis of gestational diabetes is done by:
2 step approach-By ACOG-American College of Obstetricians and Gynecologists
1 step approach-By WHO & IAD PSG (International association of Diabetes & Pregnancy Study Group)-Recommended by DIPSI (Diabetes in pregnancy study group India).
Carpenter and Coustan Criteria | National Diabetes data group | |
Time | 100 g Glucose Load | 100 g Glucose Load |
Fasting | 95 mg/dl | 105 mg/dl |
1 hour | 180 mg/dl | 190 mg/dl |
2 hours | 155 mg/dl | 165 mg/dl |
3 hours | 140 mg/dl | 145 mg/dl |
→ If out of these any 2 values are abnormal, it is a confirmed case of Diabetes.
OCD is characterized by recurrent obsessive thoughts followed by compulsive acts
Symptoms > 2 Weeks for diagnosis
Lifetime prevalence ~ 2-3%
Depression is the m/c co-morbid condition
Diagnosis of Schizophrenia:
Hallucinations
Disorganized Speech [ Formal thought disorder]
Disorganized or Catatonic behavior
Negative Symptoms
DSM 5
2 or More of above for > 1months [with one from [1], [2] or [3]
Duration of Illness > 6 Months
ICD-10
2 or More of above for > 1months [with one from [1], [2] or [3]
Duration of Illness > 1 Months
Morbid Psychological Processes used for diagnosis are:
History:
Mental status Examination:
Clinical manifestations
Complications
Laboratory diagnosis
In India, facilities for isolation of influenza virus are available at the following institutes:
H1NI influenza pandemic phases:
a. Killed vaccine:
b. Live attenuated vaccines:
c. New Vaccines
Mild problems following inactivated flu vaccine:
Moderate problems following inactivated flu vaccine:
Treatment
Type A
Clinical manifestations
Complications
Pneumonia:
In India, facilities for isolation of influenza virus are available at the following institutes:
H1NI influenza pandemic phases:
a. Killed vaccine:
b. Live attenuated vaccines:
c. New Vaccines
Mild problems following inactivated flu vaccine:
Treatment
Type A & B
Type A
A | Haffkine Institute, Mumbai | |
B | Pasture Institute Coonor, South India | |
C | All India Institute of Medical Sciences, New Delhi | |
D | All India Institute of Hygiene and Public Health, Kolkata. |
A | Haffkine Institute, Mumbai | |
B | Pasture Institute Coonor, South India | |
C | All India Institute of Medical Sciences, New Delhi | |
D | All India Institute of Hygiene and Public Health, Kolkata. |
(A.I Institute of Hygiene and Public Health, Kolkata)
In India, facilities for isolation of influenza virus are available at the following institutes:
1. Govt. of India, Influenza Centre, Pasture Institute, Coonor, South India
2. Haffkine Institute, Mumbai
3. School of Tropical Medicine, Kolkata
4. All India Institute of Medical Sciences, New Delhi
5. Vallabhai Patel Chest Institute, Delhi
6. Armed Forces Medical College, Poona
As per the WHO, H1NI influenza pandemic is in which of the phase descriptions?
A |
phase 3 |
|
B |
phase 4 |
|
C |
phase 5 |
|
D |
phase 6 |
As per the WHO, H1NI influenza pandemic is in which of the phase descriptions?
A |
phase 3 |
|
B |
phase 4 |
|
C |
phase 5 |
|
D |
phase 6 |
In the 2009 revision of the phase descriptions, WHO has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans.
Phase 1 no viruses circulating among animals have been reported to cause infections in humans.
In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.
In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver
Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.
Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent.
Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.
There has been an outbreak of H1N1 influenza in your locality. You are the medical officer of the health centre. A 11 month old child of a woman, who had died due to H1N1 has been brought to you with symptoms of URTI. Which of the following is the appropriate antiviral regime of the child?
A |
Oseltamivir 3 mg/kg BID x 5 days |
|
B |
Oseltamivir 2 mg/kg BID x 5 days |
|
C |
Zanamivir 10 mg BID x 5 days |
|
D |
Zanamivir 5mg BID x 5 days |
There has been an outbreak of H1N1 influenza in your locality. You are the medical officer of the health centre. A 11 month old child of a woman, who had died due to H1N1 has been brought to you with symptoms of URTI. Which of the following is the appropriate antiviral regime of the child?
A |
Oseltamivir 3 mg/kg BID x 5 days |
|
B |
Oseltamivir 2 mg/kg BID x 5 days |
|
C |
Zanamivir 10 mg BID x 5 days |
|
D |
Zanamivir 5mg BID x 5 days |
Zanamivir is indicated in individuals > 5 year of age only. The dose is 5 mg inhalation (twice) two times a day for 5 days.
Recommended dose of Oseltamavir for a 9 month old baby for treating swine flu is:
A |
2 mg/ kg twice daily for five days |
|
B |
2.5 mg/ kg twice daily for five days |
|
C |
3 mg/ kg twice daily for five days |
|
D |
3.5 mg/ kg twice daily for five days |
Recommended dose of Oseltamavir for a 9 month old baby for treating swine flu is:
A |
2 mg/ kg twice daily for five days |
|
B |
2.5 mg/ kg twice daily for five days |
|
C |
3 mg/ kg twice daily for five days |
|
D |
3.5 mg/ kg twice daily for five days |
Recommended dose of Oseltamavir:
age | dose |
0-1 month | 2 mg/ kg twice daily for five days |
>1-3 month | 2.5 mg/ kg twice daily for five days |
3-12 month | 3 mg/ kg twice daily for five days |
For infants older than 1 year of age and for children 2 to 12 years of age recommended doses are as follows:
24-40 kg – 60 mg orally twice a day for 5 days
>40kg – 75 mg orally twice a day for 5 days
Ref: Park’s textbook of Preventive and Social Medicine, 21stedition, page-148
Influenza vaccines is administered
A |
Subcutaneosly |
|
B |
Intradermal |
|
C |
Nasal drops |
|
D |
a and c |
Influenza vaccines is administered
A |
Subcutaneosly |
|
B |
Intradermal |
|
C |
Nasal drops |
|
D |
a and c |
Ans. is ‘a’ i.e., Subcutaneously; ‘c’ i.e., Nasal drops
1. Immunization
Three types of vaccines are available :most commonly used
• Used subcutaneously Administered as nasal drops
a) Split virus vaccine ( sub-virion vaccine)
b) Recombinant vaccine
c) Neuraminidase vaccine
2. Chemoprophylaxis
Type A Amantadine and rimantidine
Both Type A & B —> Zamamivir, Osteltamivir
Avian influenza is treated by-
A |
Amantadine |
|
B |
Ribavarin |
|
C |
Interferon |
|
D |
Oseltamivir |
Avian influenza is treated by-
A |
Amantadine |
|
B |
Ribavarin |
|
C |
Interferon |
|
D |
Oseltamivir |
Ans. is ‘d’ i.e., Oseltamivir
o Avian influenza or bird flu is a contagious disease of animal caused by viruses that normally infect only birds and less commonly pigs.
o On rare occaions, avian influenza viruses cross the species barrier to infect humans.
o Two drugs are commonly used for avian influenza :- i) Oseltamivir, ii) Zonamivir
o Both of these are neuraminidase inhibitors.
Newer Influenza vaccine –
A |
Split-virus vaccine |
|
B |
Neuraminidase |
|
C |
Live attennuated vaccine |
|
D |
a and b |
Newer Influenza vaccine –
A |
Split-virus vaccine |
|
B |
Neuraminidase |
|
C |
Live attennuated vaccine |
|
D |
a and b |
Ans. is ‘a’ i.e., Split-virus vaccine & ‘b’ i.e., Neuraminidase
Swine Flu pandemic in 2009 was caused due to which strain:
September 2010
A |
H1N1 |
|
B |
H3N1 |
|
C |
H5N1 |
|
D |
H7N1 |
Swine Flu pandemic in 2009 was caused due to which strain:
September 2010
A |
H1N1 |
|
B |
H3N1 |
|
C |
H5N1 |
|
D |
H7N1 |
Ans. A: H1N1
Swine flu is also known as swine influenza, hog flu and pig flu.
In 2009 the media labeled as “swine flu” the flu caused by 2009’s new strain of swine-origin A/H1N1 pandemic virus just as it had earlier dubbed as “avian flu” flu caused by the recent Asian-linage HPAI (High Pathogenic Avian Influenza) H5N1 strain that is still endemic in many wild bird species in several countries.
True about influenza ‑
A |
Incubation period 2-3 weeks |
|
B |
Most infections are subclinical |
|
C |
Type-A virus causes Reye’s syndrome |
|
D |
Pandemic is caused by Type-B virus |
True about influenza ‑
A |
Incubation period 2-3 weeks |
|
B |
Most infections are subclinical |
|
C |
Type-A virus causes Reye’s syndrome |
|
D |
Pandemic is caused by Type-B virus |
Ans. is ‘b’ i.e., Most infections are subclinical
Influenza
In a child who is allergic to egg, which vaccine should be avoided ‑
A |
Measles |
|
B |
MMR |
|
C |
Influenza |
|
D |
DPT |
In a child who is allergic to egg, which vaccine should be avoided ‑
A |
Measles |
|
B |
MMR |
|
C |
Influenza |
|
D |
DPT |
Ans. is ‘c’ i.e., Influenza
A pandemic of H1N1 is suspected when?
A |
Cases occur within 2 weeks period |
|
B |
Cases are spread over 5 or more cities |
|
C |
At least one or more laboratory confirmed H1N1 case |
|
D |
25 or more people are affected |
A pandemic of H1N1 is suspected when?
A |
Cases occur within 2 weeks period |
|
B |
Cases are spread over 5 or more cities |
|
C |
At least one or more laboratory confirmed H1N1 case |
|
D |
25 or more people are affected |
Ans. b. Cases are spread over 5 or more cities
School closure is recommended during an outbreak of swine flu. All of the following support this except:
A |
Closure of school will not lead to reduction in contact between children |
|
B |
Children are the most common affected population by swine flu |
|
C |
Increased rates of transmission due to more opportunities for contact |
|
D |
Playing together of students increases transmission |
School closure is recommended during an outbreak of swine flu. All of the following support this except:
A |
Closure of school will not lead to reduction in contact between children |
|
B |
Children are the most common affected population by swine flu |
|
C |
Increased rates of transmission due to more opportunities for contact |
|
D |
Playing together of students increases transmission |
Ans. a. Closure of school will not lead to reduction in contact between children
It was estimated that school holidays reduced the reproduction number of Influenza H1N1 by 14-27% in different regions of India, relative to levels seen outside holiday periods. This work reinforces studies showing the significant impact of school holidays on spread of pandemic influenza virus, and by inference the role of contact patterns in children on transmission.’- http://www.ncbi.nlm.nih.gov/pubmed/24267871 Transmission dynamics of the 2009 influenza A (H1N1) pandemic in India: the impact of holiday-related school closure. J Epidemics
A 70-year-old female suffered from an attack of influenza but refused to take the vaccine. She subsequently developed pneumonia and died in 5 days. What is the most common cause of post-influenza pneumonia?
A |
Staphylococcus aureus |
|
B |
Legionella pneumophila |
|
C |
Measles |
|
D |
Cytomegalovirus |
A 70-year-old female suffered from an attack of influenza but refused to take the vaccine. She subsequently developed pneumonia and died in 5 days. What is the most common cause of post-influenza pneumonia?
A |
Staphylococcus aureus |
|
B |
Legionella pneumophila |
|
C |
Measles |
|
D |
Cytomegalovirus |
Ans. a. Staphylococcus aureus
Staphylococcus aureus is the most common cause of post-influenza pneumonia.
`Secondary Bacterial Pneumonia follows Acute Influenza: Improvement of the patient’s condition over 2-3 days is followed by a reappearance of fever along with clinical signs and symptoms of bacterial pneumonia, including cough, production of purulent sputum, and physical and x-ray signs of consolidation. The most common bacterial pathogens in this setting are Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae— organisms that can colonize the nasopharynx and that cause infection in the wake of changes in bronchopulmonary defenses
Secondary Bacterial Pneumonia follows Acute Influenza
Influenza vaccine cause ‑
A |
Local swelling |
|
B |
Fever |
|
C |
Itching |
|
D |
All of above |
Influenza vaccine cause ‑
A |
Local swelling |
|
B |
Fever |
|
C |
Itching |
|
D |
All of above |
Ans. is ‘d’ i.e., All of above
Mild problems following inactivated flu vaccine:
Moderate problems following inactivated flu vaccine:
Problems that could happen after any vaccine: