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ismailalmokyad's version from 2018-01-25 05:40

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Question Answer
1-what is clinical feature of systemic sclerosis ?1-Systemic: Fatigue, weakness
2-Skin: Telangiectasia, sclerodactyly, digital ulcers, calcinosis cutis
3-Extremities: Arthralgias, contractures, myalgias
4-Gastrointestinal: Esophageal dysmotility, dysphagia, dyspepsia Vascular:
5-Raynaud phenomenon
what is Serology in systemic sclerosis1-Antinuclear antibody
2-Anti-topoisomerase I (anti-Scl-70) antibody
3-Anticentromere antibody
Complications of systemic sclerosis1-Lung: Interstitial lung disease, pulmonary arterial HTN
2-Kidney: HTN, scleroderma renal crisis (oliguria, thrombocytopenia, microangiopathic hemolytic anemia.)
3-Heart: Myocardial fibrosis, pericarditis, pericardial effusion
how does scleroderma present (severity?)1-localized cutaneous disease.
2-limited cutaneous systemic sclerosis (CREST syndrom).
3- diffuse cutaneous systemic scleroderma.
what is CREST symdrome?(CREST syndrome, which includes calcinosis cutis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias)
how does diffuse cutaneous scleroderma presentIncludes more diffuse skin involvement than CREST, as well as involvement of the
1-lungs
2-kidneys
3-gastrointestinal tract
why we do PFTs in scleroderma and what is the most common finding in CREST and diffuse scleroderma pulmonary hypertension (more commonly seen with CREST syndrome) and interstitial lung disease (more commonly seen with diffuse cutaneous disease).
how to differentiate pulm htn from interstitial lung disease in scleroderma in PFTsinterstitial decrease both TLC and DLCO where in Pulm HTN decrease in DLCO but normal TLC
a patient with scleroderma is complaining of bloating,abdominal pain and diarrhea, wt is dx and how to confirm ?small intestinal bacterial overgrowth. confirm with hydrogen breath test.
how to dx asthma exacerbation a >20% drop in peak expiratory flow.
wt is most common cause of asthma exacerbation viral URT infection
what is the first treatment of patient with asthma exacerbation1- start with short acting beta agonist as (albuterol 2 treatment of 2-6 puffs 20 min apart or nebulizer.
2-if symptom persist start systemic corticosteroids(prednisone 40mg daily for 5-10 days).
what is the lower cut off serum ferritin level ?<15 are iron deficient, this number is 60% sensitive and the patient can be iron deficient with lower border line of normal as 25 for example
what is the most common congenital heart disease in adultbicuspid aortic valve affecting about 1% of the general population, followed by ASD
what is the prevalence of aortic dilation with bicuspid aortic valve 20-80%
what is etiology of mallory-weiss tear1-Upper gastrointestinal mucosal tear caused by forceful vomiting (↑ intragastric pressure)
2-Submucosal arterial or venous plexus bleeding
what is etiology of boerhaave syndrome1-Esophageal transmural tear Caused by forceful vomiting (↑ intragastric pressure)
2-Esophageal air/fluid leakage into the mediastinum & pleura
Clinical presentation of mallory-weiss syndrome1-Vomiting & retching
2-Hematemesis
3-Epigastric pain
clinical presentation of boerhaave syndrome1-Vomiting & retching
2-Chest & upper abdominal pain
3-Fever, dyspnea & septic shock rapidly ensue
what is symptoms of boerhaave syndrome dyspnea, odynophagia, epigastric pain, and shoulder pain, and acute mediastinitis
wt is mc location of boerhaave syndrome tearMost tears occur in the distal third of the esophagus
what is the best initial test for esophageal perforation esophagogram with water-soluble contrast
Primary dysmenorrhea EtiologyExcessive prostaglandin production that stimulate uterine contraction (abdominal pain) and may stimulate GI (nausea, vomiting, bloating and diarrhea)
Primary dysmenorrhea risk factors1-Age <30
2-BMI <20 kg/m2
3-Tobacco use
4-Menarche at age <12
5-Heavy/long menstrual periods
6-Sexual abuse
Primary dysmenorrhea c/pPain first 2-3 days of menses Nausea, vomiting, diarrhea Normal pelvic examination
Primary dysmenorrhea management1-NSAIDs (at or before symptoms starts)
2- Combination oral contraceptives
fibroadenoma, wt age, c/p, and management1-<30 year of age
2-c/p: single, unilateral, mobile, well-cirumscribed mass, increase in size prior to menses.
3-TTT: observation for 1-2 cycles. and reassurance, u/s for persistent mass or older patient.
what is Fibrocystic breast changes1-Palpable clusters of small masses or areas of thickening that are similar in both breasts.
2-The associated breast pain is bilateral and generalized, with an increase in pain prior to menstrual onset.
how to dx chronic mesenteric ischemia1-CT angiogram
2-MR angiogram
3-duplex ultrasound
how to treat squamous cell carcinoma of the glottis T1a(lesion on one vocal cord)Radiation or Laser excision with a CO2 laser(both is effective and reserve voice.
what is vocal squamous cell carcinoma staging-T1 (confined to vocal cords) and some
-T2 (tumor extending to the supraglottis or subglottis with impaired vocal cord mobility)
-T3 (tumor confined to the larynx with vocal cord fixation)
-T4 lesions (tumor invading through the thyroid cartilage or with direct extralaryngeal spread).
how to treat squamous cell carcinoma of the glottis t3As an attempt to preserve the larynx, induction chemotherapy followed by radiation
how to treat squamous cell carcinoma of the glottis t4Total laryngectomy
when to treat T1 or T2 squamous cell carcinoma of vocal cord with surgery1-T1 lesions that failed to respond to radiotherapy
2-recurrent T1 lesions.
wt is plantar warts (verrucae), c/p, who is at risk, transmission, dx, ttt1-it is skin wart most likely 2/2 HPV.

2-present as single or multiple hyperkeratotic papules on the sole of the foot.

3-high risk
-occupations (eg, meat, poultry, and fish handlers),
-it can transmit by skin contact with incubation period of 2-6 months.
-present more extensive in pt with atopic dermatitis or immunosupressed.

4-Dx clinically or by scrapings confirm dx by showing thrombosed capillaries (called seed). shave biopsy rarely needed.

5-ttt by applying salicylic acid for 3 days then use sand paper(take 2-3 weeks to become apparent, Treatment is continued for 1-2 weeks after clinical resolution to eradicate the virus and prevent recurrence). alternative is liquid nitrogen cryotherapy (can burn, avoid in dark skin ppt bc of hypopigmentation.
what is the treatment of tinea pedis (between nails fungal infection)topical miconazole
DSM-5 for Tourette disorder> 1tics for >1 year
-Motor: Facial grimacing, blinking, head/neck jerking, shoulder shrugging, tongue protrusion, sniffing.
-Vocal: Grunts, snorts, throat clearing, barking, yelling, coprolalia (obscenities) Onset age <18

***>1 year and before age of 18***
ttt of tourette disorder1-Antipsychotics
2-Alpha-2 adrenergic receptor agonists (Clonidine)
3-Behavioral therapy
what conditions associated with tourette disorder1-attention-deficit hyperactivity disorder
2-obsessive-compulsive disorder
what cancer assoicated with dermatomyositisAdenocarcinoma of the cervix, ovaries, lung, pancreas, bladder, and stomach.
what screening should be done in all newly diagnosed dermatomyositisscreening for cancer.
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