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ismailalmokyad's version from 2017-12-29 11:50

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Question Answer
How does sexual or romantic relationship with patients third parties(patents, guardians, spouses or partners) ?Physician must transfer the patient's care to another physician
What are the red flags for secondary hypertension?1-Sever HTN which is resistant to two medications.
2-HTN that has acutely worsened from a previously stable state.
3-Age of onset before 30.
4-Malignant HTN.
What are the clues that might suggest renovascular HTN (2ndry HTN)1-Hx of atherosclerotic disease.
2-elevated Cr.
3-unilateral renal atrophy.
4- recurrent flash pulmonary edema.
5- abdominal bruit on exam.
What imaging evaluation should be ordered on a patient with moderate risk of renovascular HTN?MRA, CTA, or Doppler ultrasound.
what is Polycythemia vera and how does it present and what mutation is associated with it?chronic myeloproliferative neoplasm often associated with JAK2 mutations. Erythrocytosis is the defining feature; patients also often have aquagenic pruritus, hypertension, and arterial or venous thrombus
what are the fetures of simple renal cyst on ctthin wall, no solid component and no enhancement. Rounded and sharply demarcated.
what are the fetures of renal malignant cyst on ctirregular wall, heterogenous (solid and cystic), and enhancement with contrast.
what is Polycystic kidney disease
who it present and how to dx it.
AD disorder, c/p flank pain, elevated cr, and hematuria. CT reveals bl renal cysts that are rounded, nonenhancing and sharply demarcated. dx made by PKD gene mutation testing. ACE inhibitors reduce risk of renal insufficiency.
wht is the risk of fracutre after fall in elder10-15% risk.
what is the risk of using benzodiazepine in elderincrease falls and increase mortality in older patients
Clinical features of opioid withdrawal1-Gastrointestinal: Nausea, vomiting, diarrhea, cramping, ↑ bowel sounds
2-Cardiac: ↑ Pulse, ↑ blood pressure, diaphoresis
3-Psychological: Insomnia, yawning, dysphoric mood.
4-Other: Myalgias, arthralgias, lacrimation, rhinorrhea, piloerection, mydriasis
how to manage opioid withdrawal-Opioid agonist: Methadone (preferred) or buprenorphine
-Nonopioid: Clonidine or adjunctive medications (antiemetics, antidiarrheals, benzodiazepines)
when to use buprenorphine in opioid withdrawal ?when the patient is already on it and withdrawal started after he missed a does. it is partial agonist and take long to work.
what is flumazenil and what is used fore?it is benzodiazepine antagonist that is used for benzo overdoes.
Guidelines for statin therapy
in
1-Clinically significant ASCVD
2-Acute coronary syndrome
3-Stable angina
4-Arterial revascularization (eg, CABG) Stroke, TIA, PAD
Age <75: High-intensity statin Age >75: Moderate-intensity statin
guidelines for statin therapy if
LDL >190 mg/dL
high-intensity statin
guidlines for statin therapy if age 40-75 wiht DM-10-year ASCVD risk >7.5%: High-intensity statin
-10-year ASCVD risk <7.5%: Moderate-intensity statin
Estimated 10-year ASCVD risk >7.5% (pooled cohort equations)Moderate- to high-intensity statin*
what is high-intensity statin therapyatorvastatin 40-80 mg daily, rosuvastatin 20-40 mg daily
how to medically treat PADasa decrease risk of stroke, statin if age 40-80 regardless of ldl level. control BP.
when to use cilostazol in PADCilostazol is a phosphodiesterase-3 inhibitor that provides symptomatic improvement in some patients with claudication due to PAD; however, initiation of the drug is not recommended until lifestyle modifications
which is better clopidogreal or asa for PAD to prevent stoke ?clopidogril but its not used bc higher risk of bleeding.
treatment of symptomatic peripheral artery disease-Step 1A Risk factor management Smoking cessation Blood pressure & diabetes control Antiplatelet & statin therapy.
-Step 1B Supervised exercise therapy.
-Step 2 Cilostazol (preferred over pentoxifylline).
-Step 3 Revascularization for persistent symptoms Angioplasty ± stent placement Autogenous or synthetic bypass graft
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