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ismailalmokyad's version from 2018-01-22 03:45

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Question Answer
1-can pilots take viagraPilots taking Viagra may thus experience an inability to distinguish between the blues and greens, recommended all pilots to wait for a period of at least six hours after taking Viagra before flying a plane.
2-wt is spondyloarthropathiesGroup of disorders characterized by
1-sacroiliitis,
2-peripheral asymmetric oligoarthritis,
3-dactylitis(inflammation of digits),
4-enthesitis(inflammation of the sites where tendons or ligaments insert into the bone)
3-wt is reactive arthritis and wt is c/pit is spondyloarthropathies that present with peripheral asymmetric oligoarthritis, often associated with:
1-Uveitis
2-Urethritis
3-Achilles enthesitis (pain at ligament/tendon insertion site)
4-Dactylitis
5-Keratoderma blennorrhagica
6-Circinate balanitis (penis inflammation)

can't see, can't pee can't clim a tree)
4-what infections associated with reactive arthritis-STD (eg, Chlamydia trachomatis)
-GI(eg, Salmonella, Shigella, Yersinia, Campylobacter).
5-who is the pt at high risk of developing reactive arthritis post chlamydia infectionpt with HLA-b27 positive
6-Serotonin syndrome Causes-Serotonergic medications, especially in combination (eg, SSRI/SNRI, TCA, tramadol)
-Drug interactions: Serotonergic medication & MAOI or linezolid
-Intentional overdose of serotonergic medications
-Serotonergic drugs of abuse (eg, MDMA)
7-Serotonin syndrome Clinical features-Mental status changes (eg, anxiety, agitation, delirium)
-Autonomic dysregulation (eg, diaphoresis, hypertension, tachycardia, hyperthermia, vomiting, diarrhea)
-Neuromuscular hyperactivity (eg, tremor, myoclonus, hyperreflexia)
8-Serotonin syndrome management1-Discontinue all serotonergic medications
2-Supportive care, sedation with benzodiazepines
3-Serotonin antagonist (cyproheptadine) if supportive measures fail
9-what is the recommended washout period for most antiderpressant prior to beginning of MAOI14 days to avoid serotonin syndrome
10-what is the most common cause of subclinical hypothyroidismchronic lymphocytic (Hashimoto) thyroiditis
11-what is blood work up finding in subclinical hypothyroidismElevated TSH (verified on repeat measurement) Normal free T4 Mild symptoms may or may not be present
12-wt is the indication for treatment in subclinical hypothyroidism1-TSH >10 µU/mL

2-TSH 7-9.9 µU/mL
-Age <70: Treat
-Age >70: Treat if convincing hypothyroid symptoms

3-TSH upper limit of normal-6.9 µU/mL
-Age <70: Treat if convincing hypothyroid symptoms, enlarging goiter, or elevated anti-TPO titer
-Age >70: Do not treat (possible harm)
13-what is effect of subclinical hypothyroidism on female in reproductive ageanti-thyroid peroxidase (anti-TPO) antibodies are associated with increased risk for pregnancy loss, even in women who are biochemically euthyroid
14-How to manage pt who is not hemodynamically stable 2/2 UTI complicated by obstruction1-percutaneous nephrostomy(preferred)
2-retrograde ureteral stent.
15-wt is the treatment of sever hyperthyroidism with eye symptoms.radioactive iodine or thyroidectomy with corticosteroids to avoid exacerbation of eye symptoms. in sever ophthalmopathy, steroid is not well studied and one should go with thyroidectomy
16-what is the indications of thyroidectomy instead of radioactive iodine, and thyroidectomy1-large goiters (particularly with obstructive symptoms)
2-suspicion of thyroid cancer,
3-coexisting primary hyperparathyroidism.
4-Thyroidectomy may be used during pregnancy (generally in the 2nd trimester) in patients who develop significant side effects with an antithyroid drug.
5-sever eye symptoms
17-how to follow patient post radioactive iodine-follow only total t3 and free t4.
-pt should become euthyroid in 6 weeks and become hypo in 6 months.
-do not do TSH it is not accurate after RAI
18-wt is the lithium therapeutic does-Therapeutic is 0.8-1.2 mEq/L.
-Serum lithium levels >1.5 mEq/L confirm toxicity
-levels >2.5 mEq/L require emergency management.
20-wt is the indication of hemodialysis in lithium toxicity1-Lithium level >4 mEq/L
2-Lithium level of 2.5-4 mEq/L with severe neurologic symptoms or acute kidney injury
3-A rising lithium level despite appropriate volume resuscitation
21-wt is the difference between viral and allergic conjunctivitisBoth can present with bilateral eye redness and watery discharge. but
1-Allergic conjunctivitis has pruritus
2-Viral conjunctivitis has gritty or burning sensation
22-when does viral conjunctivitis is not infectious anymore?when the eye drainage has resolved

Other symptoms, such as morning crusting or eye redness, may persist longer than eye discharge but do not contribute to infectivity
23-what is the congenital s/e of tmp-smxneural tube defect due to folate antagonist
24-how to treat pyelonephritis in pregnancy-treat as any pyelonephritis, hospitalization, IV Abx, switch to PO after 48 hours of being afebrile.(total 14 days of abx)
-after ttt completion use daily suppressive therapy (eg, low-dose nitrofurantoin or cephalexin) is initiated and is maintained until 6 weeks postpartum to prevent recurrence.
15-how to treat gout with renal failure and/or peptic ulcer(risk of gi bleed)avoid NSAID and colchicine and use steroid (single joint use intra-articular vs multiple joint use oral )
16-how to manage pregnant HIV patient with viral load >1000 copies/ml during 3ed trimester- intrapartum IV zidovudine in addition to the HAART regimen.
-CS
17-wt is contraindication of breast feeding1-Maternal
-Active untreated TB
-Maternal HIV infection*
-Herpetic breast lesions
-Active varicella infection
-Chemotherapy or radiation therapy
-Active substance abuse

2-Infant
-Galactosemia
18-what is serious side effect of carbamazepinebone marrow suppression, Patients should be made aware of early symptoms such as fever, mouth ulcers, easy bruising or petechiae, which can be markers of the development of neutropenia, aplastic anemia or thrombocytopenia.
19-wt is first step in baby with recurrent otitis mediaAssess for risk factors:
1-absence of breastfeeding
2-day care attendance
3-pacifier use
4-exposure to secondhand smoke.
20-who is child that need pneumococcal vaccine1-sickle cell anemia
2-cardiac disease
3-cochlear implants
4-asplenia
21-wt is indication for prophylactic antibiotic treatment and tympanovstomy tube placement in recurrent otitis media1->3 episodes in 6 months
2->4 episodes in 12 months
3-high risk for speech and hearing impairment such as children with craniofacial abnormalities or neurodevelopmental disorders
22-how does TPA affect the use of ASA in strokeAntiplatelet (eg, aspirin) therapy should not be used in the first 24 hours after tPA
23-how does optic neuritis of ms presentNearly 50% of MS patients develop optic neuritis, which typically presents with monocular visual loss accompanied by eye pain that worsens with eye movement.
24-wt is the disease modifying drug for msbeta-interferon, glatiramer acetate
25-how to treat ms exacerbation during pregnancyshort-term intravenous glucocorticoids
27-wt is most common complication of ms during pregnancyincrease risk of CS and assisted delivery (eg, vacuum, forceps)
28-can a baby of a mother who has ms develope ms3%-23% of MS cases are familial
29-wt is the treatment of spasticity associated with ms-physical therapy
-massage
-baclofen or tizanidine
30-how to medically treat fatigue associated with MS1-amantadine.
2-stimuants as methylphenidate or modafinil
31-how to treat neuropathic pain assosicated with ms1-gabapentin
2-duloextine
33-how to treat urine incontinence associated with msanticholinergic medication as oxybutynin or tolterodine
34-wt is the treatment of renal cell carcinomaalmost always nephrectomy
35-Symptoms and sign of scombroid poisoningflushing, a throbbing headache, palpitations, abdominal cramps, diarrhea, and oral burning.
-typically 10-30 minutes after ingesting the fish, and are self-limited.
-Physical findings may include skin erythema, wheezing, tachycardia and hypotension.
36-wt causes scombroid poisoningingestion of improperly stored seafood.
37-Risk factors for cerebral venous sinus thrombosisrare, potentially life-threatening condition. Most cases are associated with
1-pregnancy
2-combination estrogen-progestin contraception
3- malignancy
4-infection
5-head trauma.
38-wt is c/p of Cerebral venous sinus thrombosis (CVST)dural sinuses drain csf and venous blood, obstruction causes: Increased ICP, leading to a gradually worsening headache that is maximal on awakening and with Valsalva-like maneuvers (eg, coughing, sneezing)
-Venous congestion of the brain, leading to focal deficits (eg, hemiparesis), seizures, and/or confusion
39-ttt of Cerebral venous sinus thrombosis (CVST)low-molecular-weight heparin
40-dx of Cerebral venous sinus thrombosis (CVST)magnetic resonance venography
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