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ismailalmokyad's version from 2018-01-25 06:17

Section

Question Answer
1-what is serum sicknessimmune complex-mediated hypersensitivity reaction(type 3). it occurs when abx and antigen form a complex that deposit in tissue and activate complement
2-wt causes of serum sickness disease1- acute HBV. 2-antibiotics (beta-lactam, sulfa)
3-c/p of serum sickness like reactionFever, polyarthritis, and dermatitis(varabile kind of rash), usually resolve when jaundice developed. symptoms 1-2 weeks after exposure.
4-what is ttt of serum sickness like reaction1- remove/avlid offending agent.
2-supportive care.
3-steroid or plasmapheresis if sever.
5-work-up for patient with suspected dermatomyositis1-ANA screening.
2-specific Abx includes
-anti-RO,
-anti-La,
-anti-sm,
-anti-ribonucleoprotein(RNP)
-anti-jo-1(increase chance of lung involvement)
3-chest xray for pt without resp symptoms to look for interstitial lung disease, if resp symptoms or abnormal cxray then do chest ct and PFT. if not clear then to tissue (muscle/skin) biopsy.
6-what is HIV myopathy, how present-proximal muscle weakness is more prominent in the lower extremities and is accompanied by myalgias and muscle tenderness.
7-wt is IbutilideIbutilide is a class III antiarrhythmic drug and is approved for the pharmacologic cardioversion of atrial fibrillation and atrial flutter.
8-wt is bacterial enteritis and wt is the most common pathogen-fever, abd apin and bloody diarrhea (dysentery).
-Most common pathogen are-
1-Salmonella
2-Shigella
3-Escherichia coli (enterohemorrhagic or enteroinvasive)
4-Campylobacter
5-Yersinia.
8-how to treat bacterial enteritis (dysentery) in children1- correct hypovolemia (oral preferred and should contain glucose and electrolytes).
2- avoid abx until pathogen is identified (may prolong symptoms or carriage as with salmonella, may predispose children with E coli O157:H7 to HUS.
3-only use abx before identify pathogen if
1-sever sepsis
2-<3 months duration
3-immunocompromised.
memorize
9-how to workup <1 cm thyroid nodule : if >1 cm, evaluate based on
1-risk of cancer, (eg, family history, past radiation exposure, cervical lymphadenopathy)
2-compressive symptoms (eg, hoarseness, difficulty swallowing)
3-thyroid functional status (ie, euthyroid, hyperthyroid, or hypothyroid).
***in general u/s should be done first and if suspicious for malignancy do fine needle aspiration***
Question Answer
10-wt thyroid nodule U/S finding suggestive of malignancy1-hypoechoic,
2-microcalcifications,
3-internal vascularity
11-what gene affected in MEN type 2autosomal dominant disorder caused by germline mutations involving the RET proto-oncogene located on chromosome 10.
12-wt is disease of MEN 2A1-medullary thyroid cancer (MTC),
2-pheochromocytoma (PCC),
3-hyperparathyroidism (due to parathyroid hyperplasia or multiple adenomas).
13-how to workup pt with medullary thyroid cancer1-calcitonin
2-carcinoembryonic antigen(CEA)
3-neck ultrasound (evaluation for regional metastases)
4-genetic testing for germline RET mutations
5-evaluation for coexisting tumors (hyperparathyroidism, pheochromocytoma)
14-why it is important to look for pheochromocytoma when treating MEN 2A before thyroidectomycan cause life-threatening hemodynamic complications during and after thyroid surgery.
15-how to dx pheochromocytoma (PCC)Plasma-free metanephrines and confirmed with 24-hour urinary fractionated metanephrines, catecholamines, and abdominal imaging.
16-wt is target pre-meal blood sugar level in DMT1between 80 and 120 mg/dL.
17-wt glucose level needed to dx hypoglycemia in normal and T1DMt1dm below 60, normal indivdual with prolong fasting <50
18-how does pulmonary contusion presenttrauma(lead to accumulation of edema and blood in lungs), present with
1-chest pain
2-SOB
3-hemoptysis.
4-symptoms may take up to 24 hours to develops
19-wt is xray finding in lung contusionirregular, localized opacification at the site of injury
20-wt is ARDS-noncardiogenic diffuse and bilateral pulmonary edema that typically results from a systemic disease process (eg, sepsis, pancreatitis) or lung injury (eg, toxic inhalation).
21-how does fat embolism syndrome presentcomplication of long-bone (eg, femur) fracture and can result:
1-respiratory distress with hypoxemia.
2-neurologic symptoms (eg, confusion)
3-petechial rash are often present.
4-Chest x-ray typically shows no airspace disease.
22-how to treat pulmonary contusion and what is the prognosis1-monitor for 24-48 hours.
2-adequate pain control to avoid hypoventilation
3-supportive care to include pulmonary hygiene (eg, chest physiotherapy, suctioning)
4-supplemental oxygen and ventilatory support as needed.

-With adequate support and monitoring, most patients experience resolution of symptoms within 3-5 days.
23-when and how to treat hypoNA in pt with CHF-Don't treat unless symptomatic or <120.
-treat by limit fluid intake.
-vasopressin receptor antagonist (tolvaptan or any drug end with -vaptan) maybe used.
-never use oral salt tablets.
24-wt medication use to treat DI and what other use for this medicationDesmopressin is a vasopressin analog with a potent antidiuretic effect that is used in the treatment of diabetes insipidus.

-DI
-bedwetting
-hemophilia A
-von Willebrand disease
-high blood urea levels
25-when to use hypertonic saline to treat hyponatremiaused as emergency therapy in patients with severe symptoms due to hyponatremia (eg, seizures, respiratory arrest, coma) or in those with acute hyponatremia with mild symptoms
26-when to use Oral salt tablets for hyponatremia-SIADH not responding to fluid restriction only.
-remember never ever in edematous pt as in CHF
27-wt is clinical symptoms of congenital toxoplasmosisClassic congenital manifestations include
1-eye abnormalities (eg, chorioretinitis)
3-neurologic findings (eg, intracranial calcifications, hydrocephalus)
3-hearing impairment.
28-how to ttt congenital toxoplasmosis-anti parasitic therapy (ie, pyrimethamine and sulfadiazine)
-supplemental folate for a year.
29-rule of iron supplement in treating restless legs syndrome (RLS)if iron level is <75 then give iron as iron deficiency is associated with restless leg syndrome.
30-how to treat restless legs syndrome ?1-non-pharmacologic including:
-Iron replacement therapy
-Mentally stimulating activities (eg, crossword puzzles)
-Avoidance of exacerbating factors (eg, nicotine, alcohol, caffeine).

2-Pharmacological if sever then
-First line dopamine agonists such as pramipexole or ropinirole
-Second-line benzodiazepines only to augment treatment of first line then stop it (eg, clonazepam)

3-gabapentin.
31-condyloma acuminata is caused by HPV and can infect neonate during dlivery, how would the baby present-most of the time no infection to baby, and even if happen baby can clear it.
-rarely lesions develops in the oropharynx, larynx, or trachea at age 2-5 it is called respiratory papillomatosis.
-requires frequent laser surgery to prevent the warts from blocking the baby's breathing passages.
32-how to manage condyloma acuminata during pregnancy and delivery-do nothing and vaginal delivery, except if large and affect passage of baby then surgery or CS.
-Podophyllum is contraindicated during pregnancy as it is associated with birth defects and intrauterine fetal demise.
33-how does metformin affect non-alcoholic steatohepatitisIt has proven to be helpful in patients with hypertriglyceridemia and hepatic steatosis by improving glycemic control and helping to stabilize obesity.
34-what is vertebrobasilar insufficiencyreduced blood flow in the base of the brain, typically secondary to emboli, thrombi, or arterial dissection.
35-how does vertebrobasilar insufficiency presentattacks of vertigo, dizziness, dysarthria, diplopia, and numbness. The vertigo often resolves on its own,
36-risk factor for vertebrobasilar insufficiency1-DM
2-HTN
3-HLD
4-Arrhythmia
5-CAD
7-smoking
37-how does labyrinthitis present-usually follow viral infection (influenza)
-vertigo, tinnitus, nausea, and a loss of balance.
-mild, and often self-limited
38-wt is Cataplexyis a sudden, temporary loss of muscle tone that can result in collapse. It is often caused by intense emotions, including laughter. commonly associated with narcolepsy
39-how does delayed gastric emptying presentnausea, bloating, postprandial fullness, and a succussion
40-how to work up pt with delayed gastric emptying1-first step is to exclude intrinsic mechanical obstruction and mucosal disease via EGD.
2- CT or MRI to exclude external compression. if both normal then
3-do scintigraphic gastric emptying study.
4-Gastroduodenal manometry can also be useful to distinguish between myopathic (eg, amyloidosis) and neuropathic etiologies
41-how to treat gastroparesis1-control hyperglycemia.
2-small, more frequent meals and avoid food high in fat or fiber (slow gastric emptying), also avoid carbonated beverages .
3-if not controlled yet then metoclopramide is first line
4-then erythromycin(erythro only used for 4 weeks (due to the development of tachyphylaxis (decreased pharmacologic response with ongoing use).
42-what is Candida endophthalmitis.candida infection of the eye mainly in immunocompramized patient (neutropenia) specially if central line is placed..
43-wt is fundoycopic finding in candida endophthalmitis?focal, glistening, white, mound-like lesions on the retina that may extend into the vitreous, with resultant vitreous haze.
44-wt is Roth spotsInfective endocarditis may cause microthrombi in the retina with a resultant immune-mediated vasculitis.

-exudative, edematous retinal hemorrhages with pale centers.
45-Candida endophthalmitis treatmentis a vision-threatening infection and must be treated aggressively. systemic antifungals such as
1-amphotericin B
2-intravitreal antifungal injection
3-vitrectomy (if vitrous is invloved).
-4-6 weeks of treatment is required
46-wt is treatment of prolactinomas.always start with dopaminergic agonists (bromocriptine and cabergoline), even if there is a vision symptoms, then monitor
1-visual field
2-prolactin
3-MRI of head for tumor size.
**Transphenoidal and transcranial surgery is rarely required**
47-wt is red flags for back pain"red flags" associated with increased risk of systemic disease in back pain
1-nighttime pain
2-age >50
3-unexplained weight loss
4-history of malignancy
48-how to manage back pain with red flag but without symptoms of cord compression ?start with back xray and ESR
-if normal follow in one month and if no improvment do MRI
-if abnormal do MRI now.
49-wt is dry eye and mouth of Sjogren's syndrome are called-keratoconjunctivitis sicca
-xerostomia
50-wt Antibodies associated with Sjogren's syndromeAnti-Ro-SSA and anti-La/SSB antibodies in 50% of cases
51wt test can confirm the dx of keratoconjunctivitis sicca of Sjogren's syndromSchimer test Filter paper
52-clinical significant of neck LAD in pt with sjogren's syndromeSjogren's results in polyclonal B cell activation and infiltration of the salivary glands, result in B-cell lymphoma(non-hodgkin's) in some patients. (prevelance is 5%)
53-wt the first symptoms of NPHgait > cognitive > incontinence
54-how to manage NPH ptMiller Fisher test(LP tap test)
-evaluates gait speed, stride length, verbal memory, and visual attention before and after removal of 30-50 mL of CSF. If improv then patient will most likely benefit from ventriculoperitoneal shunt.
55-how to manage UTI in pregnancyDo urine culture to all pts, repeat urine cx after a week of completion of abx. (eg, test of cure).
56-wt is the rule of Nitrofurantoin for uti in pregnancyNitrofurantoin can be used in the second and early third trimesters, but is avoided in the first trimester due to a risk of orofacial clefts and in the late third trimester due to an association with neonatal hemolytic anemia.
57-how does impetigo infection presentpainful, nonpruritic, erythematous pustules that subsequently develop a classic, thick honey-colored crusting.
58-treatment of impetigoTopical antibiotics (eg, mupirocin) alone can treat isolated, small areas of infection, whereas oral antibiotics (eg, cephalexin) are warranted for extensive infection.
59-how does erysipelas presentit is a superficial infection, presents with well-demarcated, bright red erythema, classically on the cheeks.
60-how to treat htn in goutACEs/ARBs, no diuretics
61-hwo to treat htn in CKDace/arbs
memorize

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