ismailalmokyad's version from 2018-01-22 14:56


Question Answer
1-Can HIV positive child attend school?.yes, family doesn't need to tell the school
2-What is tabes dorsalis ? and how it present?It is late Neurosyphilis. It involves the posterior spinal columns and nerve roots.This will result in impaired vibration/proprioception, sensory ataxia, and instability during the ronberg test.
3-What is the clinical findings in tabes dorsalis?1-sensory ataxia,
2-lancinating pains(stabbing sensations)
3-neurogenic urinary incontinence,
4-argyll robertson pupils.
4-What is the pathogenesis of tapes dorsalis?treponema pallidum spirochetes diretly damage the dorsal sensory roots.
5-Who is at high risk to develop tapes dorsalis?1-men who have sex with men
2-HIV positive pts. remember HIV positive develop neurosyphilis more rapidly.
6-labs findings in Autioimmune hepatitis?1-Elevated AST and ALT
2-normal or near normal ALP
3-normal bilirubin.
7-What is the AB in auntoimmune hepatitis?1-ANA
2-Anti-smooth muscle antibodies (against actin)
8-What are the autoimmune conditions associated with autoimmune hepatitis?1-arthritis
2-erythema nodosum
7-sicca syndrome.
9-what is the AB in primary biliary cirrhosis? and how does LFTs present in this case-antimitochondrial antibodies
-elevated ALP rather than elvated aminotransferase
10-what is the use of gamma-glutamyl transferase(GGT)?to differentiate whether elevated alkaline phosphatase level is from liver or bone
11-how and when, alpha-1 antitrypsin manifestation appears?-appears as progressive liver disease and emphysema
-in the first two decades of life
12-Gold standard imaging to dx sclerosing cholangitis and what disease is strongly associated with SC?ERCP has better resolution than MR cholangiopraphy and usually seen in pts with UC.
13-What is cardiac stent thrombosis and what cause ituncommon but potentially fatal complication of coronary artery stenting with most events occurring within 30 days of stent placement. The premature cessation of dual antiplatelet therapy with aspirin and platelet p2y receptor blocker(clopidogrel, prasugrel, ticagrelor) is most important risk factor for stent thrombosis.
14-what is most common cause of decrease vision in elderly patientcortical cataracts and associated macular degeneration.
15-flail chest c/p, ttt?c/p
1-muscular spasm and pain
2-pulmonary contusions (hypoxemia and increased work of breathing).
3-paradoxical or segmental chest wall movement will typically make the diagnosis of flail chest obvious(not always positive)

1-uncomplicated may be ttt without surgery and only with aggressive pulmonary toilet including facemask oxygen, CPAP, and chest physiotherapy and adequate analgesi
2- if sever, ttt with mechanical ventilation and surgical intervention
16-Indications for stress ulcer prophylaxisAny 1 factor of the following
1-Coagulopathy: platelets <50,000/mm3, INR >1.5, PTT >2x normal control
2-Mechanical ventilation >48 hours
3-GI bleeding or ulceration in last 12 months
4-Head trauma, spinal cord injury, major burn

or any 2 or more factors of the following.
1-Glucocorticoid therapy
2->1 week ICU stay
3-Occult GI bleeding >6 days
17-how does head trauma, shock, critical illness cause gi ulcers

where most of these ulcers occurs during hospital stay
1-Critically ill patients may have uremic toxins and reflux of bile salts into the stomach; both can disrupt the protective glycoprotein layer

2-Head trauma causes increased gastrin secretion, leading to parietal cell stimulation and acid secretion.

3-Shock is associated with mucosal ischemia leading to ulcerations

first 72 hours and tend to be located in the proximal stomach. Ulcerations occurring later in the hospital course tend to be located in the duodenum.
18- what is hirschsprung disease, how it present, dx, ttt, and associated conditions ?-absence of ganglion cells on rectal mucosal

-present by
1-Failure to pass meconium
2-abdominal distension
3-poor feeding
4-bilious emesis.

1- first do xray to rule out free air and to evaluate bowel gas pattern.
2-contrast enema to delineate the level of obstruction. The classic finding for is a transition zone between a normal or narrow caliber rectosigmoid (aganglionic segment) and a normally innervated but markedly dilated descending colon.
3-confirm with biopsy that show absence of ganglion cells on rectal mucosal

-Treatment consists of surgical resection of the aganglionic segment followed by anastomosis of normal bowel to the anus

-assocaited conditions:
Up to 25% of patients with HD have another congenital anomaly (eg, renal) and approximately 10% of patients with HD have a chromosomal defect (eg, Down syndrome).
19- how to manage pnumonia in pediatric pt1- if preschool age or focal lung finding on imaging---> most likely sterp pneumoniae and treat with high does amoxacillin

2-if older child or well-appearing with bilateral lung finding on imagning the most likely mycoplasma pneumonia and treat with azithromycin

3-if in the first days of life, think chlaymedia and treat with erythromycin
20-what is the appropriate insertion depth for ETT21 cm (8.3 in) for women and 23 cm (9 in) for men.
21-pneumothorax while on vent c/p, dx and manage1-tachycardia
4-decreased or absent breath sounds
5- drop in measured tidal volume due to an increase in airway resistance.
6- if tension pneumothorax low BP, JVD, and tracheal deviation.

-Dx with
1-Bedside ultrasound
2-or chest x-ray demonstrates a pleural line with an absence of distal lung markings.

1- Needle decompression is appropriate emergency treatment of a tension pneumothorax
2- if no tension pneumothorax then start by placement of a chest tube
22-what cause TTP, c/p, labs, ttt-↓ ADAMTS13 level (plasma metalloprotease)→ uncleaved vWF multimers → platelet trapping & activation
-Acquired (autoantibody) or hereditary

-Clinical features
1-Hemolytic anemia (↑ LDH, ↓ haptoglobin) with schistocytes
2-Thrombocytopenia (↑ bleeding time, normal PT/PTT)
3-Sometimes with:
-Renal failure
-Neurologic manifestations

1-Plasma exchange
23-what is the most common cause of congenital adrenal hyperplasiaautosomal recessive inheritance of 21-hydroxylase deficiency.
24-what is galactosemia1-AR disorder characterized by the inability to digest galactose due to deficiency of galactose-1-uridyl transferase.
-vomiting after ingestion of breast milk or cow's milk
25-wt is steroid 5 alph reductase deficiencyrare AR disorder that can cause 46,XY individuals to have external female-appearing genitalia, with clitoromegaly in some patients. Affected 46,XX patients have normal external female genitalia
26- how to manage Foreign body ingestion in children1-start with xray to locate the foreign body.
2-if low risk as coin and asymptomatic, follow weekly with xray to ensure pass of foreign body.
3-if did not pass spontaneously or if high risk objects (eg, button batteries, magnets, sharp items) this will require removal with endoscopy.
4- if retrosternal pain, drooling, or refusal to eat (symptomatic esophagus) or if vomiting or abdominal pain (symptomatic gastric) then start with endoscopy without x ray.
27-infantile hemangioma c/p, management, and complications1-May present as patch of telangiectasias at birth
-Proliferation: (increase size) Age 0-1 that time it looks as Bright red, raised nodule
-Involution:(regress) Age 1-9 that time it looks Deeper red/violet.

-Topical beta blocker (eg, propranolol) for ulcerated or cosmetically sensitive areas (eg, face), rarely needs surgical intervention.

-Vision impairment if near eye
-Life threatening if near airway
28-wt is Erythema toxicum neonatorumis a benign, asymptomatic rash that presents with erythematous papules and pustules in the first 2 weeks of life(usually 2-3 days old). Lesions may appear and disappear but typically resolve within a week.
29- what is Nevus flammeus and nevus simplexvascular lesions that present at birth.
1-Nevus flammeus, or port-wine stains, are uncommon, blanchable, red capillary malformations that are usually unilateral and do not cross midline.

NB: Sturge-Weber is nevus flammeus and leptomeningeal vascular malformations (seizure and weakness) MRI is indicated for evaluation.

2-Nevus simplex are blanchable pink patches that usually fade with time and are classically located on the eyelids, glabella, and nape of the neck.

NB:most spontaneous resolve by 2 years old, if not then pulsed dye laser
30-indication to add Bupropion to SSRI in treating depressionit can reverse many of the SSRI sexual side effects.

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