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ismailalmokyad's version from 2018-01-25 05:08

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Question Answer
1-what is barrett's esophagus?metaplastic columnar epithelium in the esophagus replacing normal stratified squamous epithelium.
2-what is the complication of barrett's esophagus?can precede development of adenocarcinoma
3-how barrett's esophagus present on upper endoscopyColumnar epithelium on endoscopy usually appears reddish with a velvet-like texture (salmon-colored); squamous epithelium has a pale and glossy appearance.
4-what is most common cause of death 2/2 steering wheel injuries?(car accident)Aortic injury is the most common cause of sudden death due to steering wheel injuries.
5-what is Periodic breathing in neonate and infants-physiologic breathing pauses of 5-10 seconds followed by rapid, shallow breaths. secondary to recurrent central apnea due to immaturity of the nervous system in infants up to age 6 months.
-no cyanosis, change in tone, abnormal limb/eye movements, espiratory distress picture (eg, retractions, nasal flaring, and persistent tachypnea)
-family reassurance
6-what is Apnea of prematurity?true apnea and pauses in breathing lasting >20 seconds;

it typically resolves by a corrected gestational age of 37 weeks(so if baby is 36 weeks it correct in one week)
7-what is oculovestibular testing for coma?(caloric stimulation), when it is positive and what does it mean?Caloric stimulation of the vestibular apparatus is performed by irrigation of the external auditory canal with cold water.
-A normal response is characterized by a transient, conjugate, slow deviation of gaze to the side of the stimulus (brainstem-mediated), followed by saccadic correction to the midline (cortical correction).
-A caloric response cannot be voluntarily suppressed; therefore, the normal oculovestibular reaction strongly suggests psychogenic coma. if it is abnormal it can mean brain death
8-what is blepharospasm and how does it present and what is the treatment ?-is a form of focal dystonia.
-periodic involuntary eye closure mostly provoked by external stimuli (e.g., bright light or irritants).
-Older women are particularly predisposed.
-Botulinum toxin injections. They can be used for many years without any loss of efficacy or significant side effects.
9-how to differentiate between major depression and normal grievingintermittent periods of sadness that revolve around reminders of the deceased. In contrast, depressed individuals are more likely to have continuous sadness and pervasive anhedonia
10-when GERD pt needs screening for Barrett's esophagus?chronic GERD symptoms and one or more of the following
1-age >50.
2- male sex.
3-white ethnicity.
4-hiatal hernia.
5-increased BMI.
6-intraabdominal body fat distribution.
7-tobacco use.
11-how to manage intestinal metaplasia finding on upper endoscopy of GERD pt?1-if no dysplasia surveillance endoscopy every 3-5 years
2-if low-grade dysplasia on pathology then surveillance endoscopy every 6-12 months or exndoscopic eradiaction,
3-if high grade dysplasia then endoscopy eradiation therapy.
12-Acute cholangitis Clinical presentationFever, jaundice, RUQ pain (Charcot triad) ± Hypotension, AMS (Reynolds pentad)
13-Acute lab findings in cholangitis DiagnosisCholestatic liver function abnormalities
-↑ Direct bilirubin
-↑ alkaline phosphatase
-Mildly ↑ aminotransferases
-Biliary dilation on abdominal ultrasound or CT scan
14-Acute cholangitis Treatment1-Antibiotic coverage of enteric bacteria
2-Biliary drainage by ERCP within 24-48 hours
15-Infection with Escherichia coli O157:H7, cause, c/p , labs1-consumption of contaminated food (eg, undercooked ground beef, lettuce).
2-presents with
-abdominal pain
-fever
-bloody diarrhea.
-Hemolytic uremic syndrome can develop and is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency.
17-what is rosacea, C/P, ppl in risk, and complicationA chronic skin lesion, etiology is unknown but it can be triggered by specific diet(eg spice), it present as erythema in the central face and is often associated with flushing, telangiectasias, and pustules (occasionally). occur mainly in age 30-60 and mainly in light skin, hair and eye color. Periods of exacerbation and remission are expected. most sever complication are ocular rosa.
18-how to treat rosacea ?1-use mild cleansers and sunscreens, avoid med day sun
2-avoidance of factors that trigger as spice food
3-Laser or pulsed light therapy and topical brimonidine can also be considered.
4-For patients with papulopustular rosacea, topical metronidazole (1st), azelaic acid, topical clindamycin, and benzoyl peroxide. Oral antibiotics (eg, metronidazole, tetracyclines) are sometimes required for more severe cases.
19-which complications is most associated with rosaceaOcular rosacea which may include
1-burning or foreign body sensations
2-blepharitis, keratitis
3-conjunctivitis
4-corneal ulcers
5-recurrent chalazion.
if present refer for ophthalmologist
20-what is chalaziongranulomatous inflammation of a meibomian gland and presents as a painless pea-sized nodule within the eyelid.
21-what is complication associated with actinomycosis1-Fistulous tracts,
2-abscesses,
3-sinus tracts
4-fibrosis
22-what is the gram stain of Actinomycosis bacteria-filamentous, branching gram-positive bacterium.
-Examination of abscess fluid shows characteristic yellow "sulfur granules."
23-what is Actinic keratoses and increase risk of what?small scaly lesions found in sun-exposed areas and are caused by excessive ultraviolet (UV) light exposure. They are associated with up to a 20% risk of transformation to squamous cell carcinoma.
24-mucormycosis c/p and complication-Rhinocerebral mucormycosis: fever, headache, reddish and swollen skin over nose and sinuses, dark scabbing in the nose by the eye(s), visual problems, eye(s) swelling, facial pain.

-Pulmonary (lung) mucormycosis: fever, coughing sometimes with bloody or dark fluid production, shortness of breath.

-Cerebral venous thrombosis
25-what is manifestaitons of Chlamydia & gonorrhea in women1-Asymptomatic (most common)
2-Cervicitis
3-Urethritis
4-PID
5-Perihepatitis (Fitz-Hugh-Curtis syndrome)
26-how to dx Chlamydia & gonorrhea in womenNucleic acid amplification testing
27-how to treat Chlamydia & gonorrhea in women1-Treatment Empiric: Azithromycin + ceftriaxone
2-Confirmed chlamydia: Azithromycin
3-Confirmed gonorrhea: Azithromycin + ceftriaxone
28-what is complication of chlamydia and gonorrhea in womenComplications includes
1-Pelvic inflammatory disease
2-Ectopic pregnancy
3-Infertility
4-Pharyngitis
29-when to screen for chlamydia trachomatis during pregnancy-All pregnant patients are routinely screened for chlamydia via nucleic acid amplification testing (NAAT) at the initial prenatal visit.

-High-risk patients (eg, age <25, multiple partners) undergo screening again in the late third trimester.

-In addition, patients with symptoms suggestive of acute cervicitis, such as postcoital spotting and mucopurulent cervical discharge, are tested with NAAT at any time.
30-what is risk factor for Chlamydia, and how does it affect screening a pregnant woman1-Age <25
2-History of sexually transmitted infection
3-Recent new partner
4-History of multiple partners
5-History of unprotected intercourse.

if present test the patient again for chlamydia at third trimester
31-Obstetric complications of Chlamydia in pregnancy1-Preterm premature rupture of membranes
2-Preterm labor
3-Postpartum endometritis
32-new born complications of chlamydia1-Neonatal conjunctivitis after 14-30 days
2-Neonatal pneumonia
33-Treatment Chlamydia in pregnancyAzithromycin. All sexual partners are also treated to prevent reinfection, then
1-test for cure in 3-4 weeks after treatment
2-retested 3 months after treatment to exclude reinfection.
34-what cause focal radioiodine uptake (ie, a "hot" nodule in a "cold" thyroid background)hyperfunctioning adenoma.
35-Patchy radioiodine uptaketoxic multinodular goiter
36-what cause Diffusely increased radioiodine uptakeGraves disease, which is due to thyrotropin receptor autoantibodies that stimulate iodine uptake and thyroid hormone synthesis.
37-What is the treatment of subacute thyroiditis (ST)it is a self-limited condition. Treatment is primarily supportive with NSAIDs and beta blocker (eg, propranolol, atenolol) to minimize the hyperadrenergic symptoms of thyrotoxicosis (eg, sweating, palpitations).
40-what is Suppurative infection of the thyroid gland (infectious thyroiditis)-rare condition
-high-grade fever and pain at the thyroid.
-thyroid abscess on PE or U/S
-euthyroid labs
-Bacterial thyroid infections are treated with systemic antibiotics, and surgical drainage may be required.
41-what increase mortality rate in Untreated cases of acromegalythreefold increase of cardiovascular disease, this leading cause of the increased mortality rate
42-how does upper airway cough syndrome (UACS) (postnasal drip) present1-chronic cough
2-rhinorrhea
3-oropharyngeal cobblestoning on exam
43-what is Tracheomalaciaweakness of the walls of the trachea leading to expiratory airway collapse. Patients often have coughing and shortness of breath as well as stridor on physical examination.
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