Lecture Notes on FMG and NEET Questions with Dr. Alam and Dr. Swapnil

Overview

• Dr. Alam: Discussed mainly FMG and NEET questions, mentioning the repetition of questions.
• Dr. Swapnil: Insights on building up difficulty gradually in questions to avoid bounce.
• Interactive Session: Greetings and casual interaction, mentioning effects of certain foods and lipids.

Key Medical Points

Best Interventions for Non-Bleeding Esophageal Varices

• Initial Answer: Endoscopic Management
• Drug of Choice: Beta Blockers (Propranolol or Nadolol)
• For Bleeding Varices: Endoscopic Variceal Ligation
• Drugs for Bleeding Varices: Octreotide Infusion or Terlipressin

First Line Intervention for Bleeding Varices with Hypotension

• Volume Resuscitation: Massive blood transfusion or MBT protocol
• First Test: Ultrasound and then FibroScan (Technical name: Transient Elastography)

FIP Score Components

• Components: SGOT, SGPT, Platelet Count, Age
• MELD Score Components: Bilirubin, INR, Serum Creatinine
• Treatment for Alcoholic Hepatitis: Steroids (Prednisone)
• Severity Index: Maddrey Discriminant Function (MDF)

Diagnosis of Fatty Liver & Treatment

• First Test: Ultrasound
• Test for Severity: FibroScan, also known as Transient Elastography
• VIPoma: Causes secretory diarrhea, non-responsive to fasting, hypokalemia
• Prevention for Spontaneous Bacterial Peritonitis: Norfloxacin

Questions and Discussion Points

Common Mistakes & Correct Answers

• Mallory-Weiss Syndrome: Incorrect if described as tear in mid-esophagus; correct location is around the gastroesophageal junction.
• Diagnosis Tip: US for suspected fatty liver, FibroScan for chronic cases
• Treatment for Hypotensive Bleeding Varices: Start with volume resuscitation

Question Strategy

• Focus on high-yield topics & understand pathophysiological basis
• Commonly repeated question topics should be mastered (e.g., portal hypertension, variceal management)

Disorders Discussion

Wilson's Disease Features

• Features: Wing-beating tremor, high urinary copper, hemolytic episodes
• Non-feature: Cardiomyopathy

Differentiation of Liver Diseases

• Hepatomegaly: Seen with increased HVPG
• Portal Hypertension in Children: Extra-hepatic portal vein obstruction
• Leading Cause in Adults: Alcoholic cirrhosis
• Gilbert's Syndrome: Jaundice post-exercise or drug intake

Malabsorption Syndromes

• Celiac Sprue: Not associated with high albumin or macrocytic anemia
• Key Features: Muscle wasting, edema, steatorrhea, microcytic anemia

Interventional and Treatment Approaches

• Use of Octreotide: For acute variceal bleeding
• Nadolol: For prevention, not acute management
• Choice of Antibiotics: In presence of ascites (e.g., Norfloxacin for prophylaxis)

Closing Remarks

• Importance of mastering repeated question topics
• Clarification on specific student queries related to hepatology and gastroenterology
• Emphasis on using strategic notes and reviewing high-yield topics