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ismailalmokyad's version from 2018-01-25 04:26

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Question Answer
1-what is the goal of exercise during pregnancy-30 minutes of moderately intense exercise most days of the week
2-what is the benefits of exercise during pregnancy-↓ Gestational diabetes mellitus risk
-↓ Preeclampsia risk
-↓ Cesarean delivery risk
-Shorter postpartum recovery
-Weight management
3-type of recommended exercise during pregnancy1-Walking/running
2-Cycling
3-Yoga
4-Swimming
5-Light-weight strength training
4-type of not recommended exercise during pregnancy1-Scuba diving
2-Contact sports
3-Exercise with falling risk
4-Sky diving
5-what is subacute combined degeneration ?-vit b12 deficiency
-signs of dorsal spinal column dysfunction (eg, impaired vibration, positive Romberg sign)
-signs of lateral corticospinal tract abnormalities (eg, spastic paresis, hyperreflexia)
6-what is b12 deficiency effect on blood-macrocytic anemia
-elevated direct bilirubin.
-because of intramedullary hemolysis. it present with symptoms and signs of hemolytic anemia but with large cell and low reticulocytes
7-what is clinical finding in Pneumocystis jiroveci pneumonia-Indolent (HIV) or acute respiratory failure (immunocompromised)
-Fever
-dry cough
-↓ oxygen levels(hypoxia)
8-how to workup Pneumocystis jiroveci pneumonia-↑ LDH level
-Diffuse reticular infiltrates on imaging
-Induced sputum or BAL (stain)
9-wt is tretment of Pneumocystis jiroveci pneumonia-TMP-SMX
-Prednisone if oxygen levels <70% or if A-a gradient >35
10-how to prevent Pneumocystis jiroveci pneumonia-TMP-SMX
-Antiretrovirals (in HIV)
-alternative if can't tolerate TMP-SMX: dapsone, aerosolized pentamidine, and atovaquone
11-wt level of cd in hiv increase risk of Pneumocystis jiroveci pneumoniaCD4 cell counts <200 cells/mm
12-how to work-up healthcare after potential exposure to TBscreening with tuberculin skin testing or interferon-gamma release assay is required. If initial screening is negative, repeat testing at 8-10 weeks can confirm whether transmission occurred.
13-TB transmission and relation to symptomsvia aerosolized droplets for up to 3 months prior to the onset of symptoms.
14-what is urethral diverticulum and how does it present-The diverticulum is a herniation of the urethral mucosa through the muscle wall into the surrounding tissue.

-Present with
1-dysuria
2-postvoid dribbling
3-dyspareunia
4-anterior vaginal mass.

Physical examination typically reveals a tender anterior wall vaginal mass that expresses bloody, purulent fluid on manipulation of the urethra.
15-how to work-up urethral diverticulum1-Urinalysis
2-Urine culture
3-MRI of the pelvis
4-Transvaginal ultrasound
16-how to treat urethral diverticulum-manual decompression
-needle aspiration
-or surgical repair.
17-what is the most common cause of chronic constipation-impacted stool (most common cause in elders)
-Medications
-Metabolic
-endocrine
-neurologic disease
-Psychosocial stressors (eg, social isolation, immobility)
-Gastrointestinal malignancy
18-what is the alarming symptoms in chronic constipationalarm symptoms of malignancy (eg, weight loss, stool occult blood positive, hematochezia).
19-can parent request sterilization of an intellectually disabled personforced sterilization is considered unethical., so NO
20-what is the prognosis of frontotemporal dementiafatal within 8 years
21-finding of neuroimaging in frontotemporal demeintiaTwo-thirds have frontotemporal atrophy on neuroimaging.
22-how to screen pregnant woman for GSB-Rectovaginal culture at 35-37 weeks gestation
23-what is the indication of penicillin to prevent GBS infection in neonatal1-Prior delivery complicated by neonatal GBS infection
2-GBS bacteriuria or GBS urinary tract infection during current pregnancy (regardless of treatment)
3-GBS-positive rectovaginal culture.
4-Unknown GBS status PLUS any of the following:
-<37 weeks gestation
-Intrapartum fever
-Rupture of amniotic membranes for ≥18 hours
24-what is the main presenting symptoms for hyperaldosteronism (Conn's syndrome).1-hypertension
2-hypokalemia
3-polyuria can be explained by the hypokalemic state, which causes an impaired urinary concentrating
25-how to screen for hyperaldosteronismmeasurement of plasma aldosterone to plasma renin activity ratio, and a ratio of 30 or more is suggestive of excessive aldosterone secretion from the adrenal gland.
26-what disease assocaited with HTN and hypokalemia with suppressed level of both renin and aldosterone ?Suppression of both renin and aldosterone suggests that some other mineralocorticoid like deoxycorticosterone is responsible
27-what is the most common cause of renal artery stenosis and 2ry hypertension-fibromuscular dysplasia, which is predominantly seen in young females.
28-what is symptoms of preseptal (periorbital) cellulitis-eyelid erythema
-swelling
-tenderness
-chemosis
-fever
-leukocytosis
29-what is symptoms of orbital (postseptal) cellulitis.symptoms of perseptal pluse
-proptosis
-ophthalmoplegia
-pain with eye movements
30-what is the most common organism in both periorbital and orpital cellulitisStaphylococcus aureus, Streptococcus pneumoniae, and other streptococci.
31-what is the treatment of orbital cellulitisintravenous antibiotics (eg, vancomycin plus ampicillin-sulbactam)
32-what is the complication of orbital cellulitis and how to manage it ?-Dangerous complications include
1-abscesses within the orbit or brain
2-blindness
3-sinus venous thrombosis.
If orbital abscesses are identified or the patient begins to deteriorate then do orbitotomy
33-what is the most common condition lead to orbital cellulitis-Bacterial sinusitis will usually precede bacterial eye infection
-if impaired host defenses and alarming symptoms think about fungal.
34-what is the alarming symptoms in orbital cellulitis-common in poorly controlled DM and HIV.
-Alarming symptoms:
1-facial numbness
2-septal necrosis
3-does not improve with antibiotics

this should raise suspicion for fungal infection, so sinus drain and culture should be performed
35-how does cavernous sinus thrombosis present-Headache is a common early symptom.
-symptoms of orbital cellulitis.
-Because cranial nerves III, IV, V, and VI pass through the cavernous sinus, which has anastomosis crossing midline, unilateral symptoms (eg, ophthalmoplegia) can rapidly become bilateral.
-Fundoscopy typically reveals papilledema and dilated tortuous retinal veins
36-how does osteomylitis mainly spread in childrenhematogenously
37-what is Initial diagnostic testing for suspected osteomylitis in children1-CBC
2-C-reactive protein & ESR
3-blood culture.
4-X-rays should be obtained to evaluate for alternate causes of pain and the late finding of periosteal reaction/elevation seen in osteomyelitis.
5-MRI has excellent sensitivity for osteomyelitis if the diagnosis is unclear.
38-wt is mc organism causes osteomyelitis in children1-no sickle cell disease gram-positive cocci
-Staph aureus, including MRSA.
2-sickle cell disease increase risk of gram-negative organisms
-Salmonella.

NB: sickle cell cause asplenia due to repeated splenic microinfarctions, rendering vulnerability to encapsulated organisms.
39-what is empiric antibiotic therapy for osteomyelitis in children1-if health without sickle cell disease
-Low likelihood of MRSA Nafcillin/oxacillin OR cefazolin
-High likelihood of MRSA Clindamycin OR vancomycin

2-if has sickle cell disease then As above
-PLUS Third-generation cephalosporin (ceftriaxone, cefotaxime)
40-what is Maternal & fetal complications 2/2 to seizures in pregnancy1-Abruptio placentae/hemorrhage
2-Spontaneous abortion
3-Preeclampsia
4-Preterm labor
5-Mortality Injury
41-what is fetal complications from antiepileptics1-Cleft palate
2-Congenital defects
3-Neural tube defects (VI)
4-Skeletal abnormalities.
42-how to manage seizure medicaiton during pregnancey-Valproate is teratogenicity so change to alternative meds 6 months prior to attempts to conceive, However, no changes to the AED regimen should be made after conception, as abrupt changes may trigger seizure activity. Treat by initiating high-dose folic acid (4mg/D not the usual 0.4mg/D) and screening for congenital anomalies (eg, neural tube defects) with serum alpha-fetoprotein and an anatomy ultrasound.
43-can mother breast feed while taking anti seizure medicationsin general yes. but all AEDs may sometimes cause the child to become irritable or sleepy, in these cases, breastfeeding should be discontinued, but it can be attempted again after a week.
All AEDs are excreted into breast milk in variable amounts. It is estimated that ethosuximide reaches 90% of its plasma concentration in milk, whereas valproate reaches 1%-10%.
44-how does lead poisoning presentwith non-specific symptoms such as:
-anorexia,
-decreased activity,
-irritability,
-vague abdominal pain
-insomnia
45-how to work up child with suspicion for lead poisoning-CBC,
-serum iron and ferritin levels,
-reticulocyte count.
-Measuring blood lead levels is crucial for the development of the treatment plan. In patients who require chelation therapy, do BMP and urine analysis.
46-how does reactive arthirits present post chlamydia infection-sterile (cx negative), leukocytosis and inflammatory joint usually 1-2 weeks after infection. a kind of reactive arthritis called Reiter's syndrome, cant see, cant pee cant clime a tree
47-how to work up patient with reactive arthritis post chlamydia infection1-repeat nucleic acid amplification test (NAAT) for chlamydia in urine.
2-Rectal screening for men who have sex with men or in patients with a history of chlamydia proctitis.
48-what is circinate balanitis and what is the prognosis?-painless, shallow ulcers of the glans penis occurs in 20%-40% of patients with reactive arthritis.
-Usually appear within weeks of infection, may persist for several months before spontaneous resolution, unlike the painless lesions of lymphogranuloma venereum (LGV) (resolve within a few days) or syphilis (resolve within 3-6 weeks).
49-what is tibial stress fracture and how does it present-common in athletes and non-athletes who suddenly increase their activity.
-medial tibial stress syndrome ("shin splints") without tibial tenderness; further activity can cause progression to a complete or incomplete fracture, resulting in tibial tenderness on palpation
50-how to dx tibial stress syndromexray low sensitivity may be negative until 4 weeks to become apparent and include bone sclerosis, cortical thickening, periosteal elevation, and visible fracture line
51-how to manage tibial stress syndrome if initial xray is negativetreat based on symptoms but can do MRI, However, MRI findings may be persistently abnormal for up to 1 year after the stress fracture has healed
52-how to manage tibial stress syndromeconservative treatment includes:
1-splinting and reduced weightbearing with a graduated exercise program.
2-Crutches are often advised in the first 1-2 weeks to minimize weightbearing.
3-The rehabilitation regimen may be scheduled over 8-12 weeks, but exercise intensity should be reduced and the regimen prolonged if the patient has recurrent symptoms during treatment.
53-how does digoxin toxicity present1-nausea, vomiting
2-anorexia
3-fatigue
4-confusion
5-visual disturbances
6-cardiac abnormalities.
54-how does verpamil increase risk of digoxin toxicityVerapamil inhibits the renal tubular secretion of digoxin, resulting in almost 70-100% increase in serum digoxin levels.
55-what medication increase risk of digoxin toxicity1-verpamil,
2-quinidine,
3-amiodarone
4-spironolactone
5-captoril (not other ace or arbs)
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