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ismailalmokyad's version from 2018-01-15 13:53

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Question Answer
1-Wt is analgesic nephropathy and how it presentit is worsening kidney function 2/2 long heavy ASA or NSAID use that lead to chronic tubular injery and tubulointerstitial nephritis, also ischemia bc of vasoconstricion. c/p can be asymptomatic or present exacly like kidney stone with ua show hematuria, proteinuria and pyuria with white blood cell casts.
2-Colon screening for
-General population
-Single first-degree relative age >60 with colon cancer or adenomatous polyps
Start screening at age 50, options include:
1-Colonoscopy every 10 years
2-gFOBT or FIT every year
3-FIT-DNA every 1-3 years
4-CT colonography every 5 years
5-Flexible sigmoidoscopy every 5 years (or every 10 years combined with annual FIT)

NB(gFOBT = guaiac-based fecal occult blood test; FIT = fecal immunochemical test; FIT-DNA = multitarget stool DNA test.).
3-Colon screening for
1-First-degree relative age <60 with colon cancer or adenomatous polyps
2->2 first-degree relatives with colon cancer or adenomatous polyps at any age
Colonoscopy at age 40 or 10 years before the age of cancer diagnosis in a relative (whichever comes first) Repeat every 3-5 years
4-c/p of infectious mononucleosis ?1-fever
2-extreme fatigue
3-exudative pharyngitis or tonsillitis with exudate
4-lymphadenopathy (including posterior cervical nodes)
5-hepatosplenomegaly.
6-Myalgias
7-anorexia (and resulting weight loss)
8-nausea, or vomiting, possibly due to hepatocellular inflammation.
5-what cell can be seen in peripheral smear of mononucleosisAtypical reactive lymphocytes, characterized by a predominant cytoplasm with an irregular nucleus can be seen with EBV but not specific
6-what cell can be seen in patient with hodgkin lymphomareed-sternberg cell
7-both leukemia and lymphoma and mononeucliosis can have fever, weight loss, LAD and fatigue. so how can clinically differentiatemalignancies dont have throat exudates.
8-what is high risk contact with HIV (prophylaxis recommended)-exposure of vagina, rectum, eye, MM, non intact skin,
-exposure to blood, semen, rectal or vaginal secretions, breast mild, or any boody fluid with blood
9-what is low risk contact with HIV that does not need prophylaxisurine, nasal secretions, salive, sweat, tears (without visible blood)
10-how to treat high risk exposure to HIV3 meds should be started within 72 hours and continued to a month.
11-what is the tretment of SLE1-Hydroxychloroquine is an anti-malarial agent which is particularly effective at improving arthralgias, serositis, and cutaneous symptoms. Hydroxychloroquine may also help to prevent future damage to the kidneys and central nervous system.

2-Low dose prednisone at a dose of 5-15 mg/day may be helpful in the short term to improve the patient's symptoms until the hydroxychloroquine takes full effect.

3-In patients with significant disease involving the kidneys or central nervous system, higher dose prednisone may be needed.

4-A combination of prednisone and cyclophosphamide are typically reserved for patients with more serious manifestations of SLE (e.g. lupus nephritis, central nervous system involvement, and vasculitis).

5-Methotrexate is generally indicated only for patients with significant organ involvement who have had incomplete response to prednisone alone.
12-Why we limited the use of rituximab in SLEit cause progressive multifocal leukoencephalopathy (PML)
13-what is rectocele and how does it present, and wt is the treatment.-Rectum prolapse through posterior vaginal wall.
-Symptoms pelvic pressure, lower back pain, constipation, and fecal incontinence.
-Examination findings include a posterior vaginal mass that increases with the Valsalva maneuver.
-treatment include pelvic floor muscle exercise plus either
1-surgical repair
2-conservative management (eg, pessary placement), which are equally efficacious in symptom improvement.
14-What does C1 esterase inhibitor levels used for? and how does this disease present-it is decreased in hereditary angioedema,

present as angioedema of the throat, tongue, or lips without urticaria. Patients can also have abdominal pain due to angioedema of the intestinal mucosa.
15-what is chronic urticariasymptoms on/off for more than 6 months.
16-Treatment of chronic urticaria ?stepwise approach,
1-initially with a second-generation antihistamine (eg, loratadine, cetirizine) in addition to avoidance of aggravating factors (if identified).

2-if no improvement
-Increased dose of the antihistamine
-an additional first-generation H1 blocker (eg, hydroxyzine)
-a leukotriene receptor antagonist (eg, montelukast)
-H2 blocker (eg, ranitidine)
-or a brief course of oral steroid.

3-still no impromvement than hydroxychloroquine, tacrolimus, omalizumab
17-Prognosis of chronic urticariaself-limited and resolves spontaneously within 2-5 years.
18-what is familial tremor (benign essential tremor and how to treat itmostly AD inherited hand tremor that worsen by using hands or outstretching of the arm. treat with propranolol
18-how to use isotretinoin for nodulocystic acne in female in the reproductive age ?-Require 2 negative pregnancy tests before starting therapy.
-Those who are sexually active must also use 2 concurrent methods of contraception (eg, oral contraceptive pill and condom) a month before, during, and a month after treatment.
-Continue all medications used for less sever acne
19-lipid in isotretinoin tretment and how can family history of hypertriglyceridemia affect the treatment-Can causes transient hypertriglyceridemia, and lipids should be monitored during therapy.
-A family history of hypertriglyceridemia is not a contraindication to initiating therapy, and dyslipidemia rarely requires discontinuation of therapy.
20-What is the abx of choice for prophylaxis in patient with recurrent UTI?1-trimethoprim-sulfamethoxazole,
2-nitrofurantoin,
3-cephalexin
4-ciprofloxacin.
5-if faill the prophylaxis then do renal U/S.
21-Wt is recurrent UTI?2 UTI in 6 months or 3 UTI in a year.
22-Bilateral hearing loss and hypopigmented spots on the backNeurofibromatosis with acoustic neuromas due to proliferation of Schwann cell (schwannomas) which is the cell for myelinization of peripheral nervous system includes cranial nerves.
23-what is pituitary incidentaloma and how to manage it?incidental pituitary tumor with normal labs, usually small and doesn't increase in size, just follow with MRI every 6months to 1 year
23-how does cushing's present ?1-glucocorticoid excess
2-obesity
3-skin changes including atrophy and striae
4-glucose intolerance
5-hypertension.
6-hyperlipidemia
24-Oropharyngeal candidiasis risk factors, c/p, Dx, and treatment?1-Risk factor:
-Antibiotics
-Inhaled corticosteroids
-Systemic chemotherapy.

2-Present as:
-white plaque on his right inner cheek that is easily scraped off with a tongue depressor, revealing underlying hyperemia.

3-dx confirm with potassium hydroxide preparation (or Gram stain) of the mucosal scraping to confirm Candida.

4-treatment with oral nystain wash
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