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ismailalmokyad's version from 2018-01-02 10:52

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wt is kyphosis(hunchback), scolliosis, and lordosis (swayback)1-kyphosis is exaggeration of posterior thoracic curvature. 2- scoliosis is lateral S-shaped curvature of the thoracic & lumbar spine. Lordosis is excessive anterior lumbar curvature
how to differentiate kyphosis for postural (normal)back curvature A hump that is easily correctible by voluntary back extension or by lying supine is termed postural (flexible) kyphosis; in contrast, structural kyphosis does not self-correct.
what is the most common type of kyphosis ?postural (flexible) kyphosis which is due to slouching. asymptomatic with no neurologic abnormalities, On lateral radiographs, the angle of spinal convexity is generally normal to slightly increased (20-40 degrees)
wt is structural kyphosis and how does it present-Structural kyphosis is a pathologic abnormality of the spinal column

-Presents with progressive back pain and deformity.

-Although some cases are due to congenital or acquired vertebral anomalies (eg, wedging), it is imperative to exclude potentially dangerous secondary causes (eg, spinal infection, fracture, tumor, degeneration).

-After managing any secondary source,

-treatment of structural kyphosis generally involves special exercises to strengthen and straighten the back; using a back brace or having surgical correction is considered only for chronic pain or significant spinal convexity (>60 degrees)
how to manage breast discharge in women1- if bilateral then do pregnancy test and Galactorrhea evaluation. if unilateral then see age, age <30 do u/s with our without mammogram, but if > or equal to 30 yo then do both us and mammogram.(np Cytology of the breast discharge has low sensitivity and specificity for detecting malignancy, so is not used in its evaluation.)
most common cause of pathologic nipple dischargebenign papillary tumor (ie, papilloma) from the breast duct lining
what is papillomas Papillomas are typically benign but may have associated areas of atypia, ductal carcinoma in situ, and invasive intraductal carcinoma within the lesion. Therefore, patients with pathologic nipple discharge require further evaluation with age-based imaging
differential diagnosis for fever in a returning travelerdepends on geographic epidemiology and is often divided into 3 categories (with some overlap): Early incubation period (<10 days) infections include typhoid fever, dengue fever, chikungunya, influenza, and legionellosis Medium incubation period (1-3 weeks) infections include malaria, typhoid fever, leptospirosis, schistosomiasis, and rickettsial disease Longer incubation period (>3 weeks) infections include tuberculosis, leishmaniasis, and enteric parasitic infections.
how does HIV alter the presentation of TBit increase rate of infection and reactivation latent disease. bc advance HIV doesn't have cell medicated defenses they don't have cavitation and often present with lobar or disseminated infection.
wt is the presentation of TB effusionwith fever, cough, pleurisy, and weight loss
thoracentesis finding in TB effusion Thoracentesis typically reveals a lymphocyte-predominant, exudative effusion. Although malignancy may present with similar findings, an elevated adenosine deaminase level strongly suggests TB. pleural biopsy is often required for diagnosis.
how does bullous pemphigoid present prodrome of itching and urticaria, which was followed by an outbreak of an erythematous rash with tense bullae, In addition to skin symptoms, about 1/3 of patients will develop oral lesions (usually brief).
wt is bullous pemphigoid and wt is associated disease?autoimmune disorder that is more common in elderly patients and has been associated with a number of neurologic conditions including dementia, bipolar disorder, and multiple sclerosis.
how to dx bullous pemphigoid skin biopsy of the margin of a bullous lesion. Serum assay for basement membrane antibodies is also helpful.
how to treat bullous pemphigoid Mild cases may be managed with topical high-potency glucocorticoids, but more severe BP may require oral glucocorticoids. Steroid-sparing drugs for patients with prolonged symptoms include azathioprine, methotrexate, or a combination of antibiotics (eg, tetracycline) with nicotinamide.
who is more susibtable to hypercalcemia due to immobilization typically seen in patients with very high bone turnover (eg, adolescents, Paget disease)
wt is lab finding in pt with hyperca of immobilization 25-hydroxyvitamin D levels are usually normal, although 1,25-dihydroxyvitamin D levels may be low due to the suppressed PTH (PTH stimulates conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D in the kidneys).
how to manage hypercalcemia fluid just like any other hyperCA, Bisphosphonates are useful in decreasing bone resorption and may preserve bone mass in patients who are immobilized for extended periods.
wt is the three main conditions that must be ruled out before dx of dementia hypothyroidism, vitamin B12 deficiency, and depression as
how to preform apnea test Baseline normal PaCO2 and PaO2 are required; apnea tests should be avoided in chronic CO2 retainers. Patients should be pre-oxygenated and then disconnected from the ventilator. Absence of a respiratory response (in a typical observation period of 8−10 minutes) with a PaCO2 >60 mm Hg (or >20 mm Hg from baseline) and a final arterial pH of <7.28 are considered a positive apnea test.
how does diaphragmatic paralysis as in ALS affect respiration present with shortness of breath that is worse in the supine position(confused with cardio causes). paradoxical abdominal wall retraction during inspiration when the patient is lying supine, which occurs because the diaphragm is not contracting. A sniff test using fluoroscopy can be helpful in confirming the diagnosis.
how to manage pt with DKA who has glucose of <200 but still has anion gap add dextrose to the fluid and continue insulin drip until gap normalize
in DKA Criteria for transition from intravenous (IV) to SQ insulininclude glucose <200 mg/dL along with 2 of the following: serum anion gap <12 mEq/L, serum bicarbonate >15 mEq/L, and venous pH >7.30. to do the transition one should start sc insluin for 2 hours before stopping the insulin drip.
Neonatal displaced clavicular fracture risk factors Fetal macrosomia (maternal diabetes, post-term pregnancy) Instrumental delivery (vacuum or forceps) Shoulder dystocia
Neonatal displaced clavicular fracture c/pCrying/pain with passive motion of affected extremity Crepitus over clavicle Asymmetric Moro reflex
Neonatal displaced clavicular fracture dxx ray
Neonatal displaced clavicular fracture ttt1-Reassurance
2-Gentle handling
3-Analgesics
4-Place affected arm in a long-sleeved garment & pin sleeve to chest with elbow flexed at 90 degrees
anomalous aortic origin of a coronary artery (AAOCA) is one of the most commo cause of sudden death in age <35 yo, so wt is the two type ?Two types of AAOCA commonly associated with SCD are the left main coronary artery originating from the right aortic sinus and the right coronary artery originating from the left aortic sinus.
how does pt with AAOCA present exertional angina, lightheadedness, or syncope; however, some patients experience SCD without any premonitory symptoms
how to dx AAOCAResting ECG is typically unremarkable. Transthoracic echocardiogram can sometimes make the diagnosis, but it can also miss or inaccurately characterize AAOCA. CT coronary angiography or coronary magnetic resonance angiography provide the best visualization of coronary anatomy, and are the diagnostic tests of choice in patients with suspected AAOCA.
wt is Brugada syndromeECG findings for Brugada syndrome (right bundle branch block and ST-segment elevation in leads V1-V3)
wt is seborrheic keratosis (SK)benign epidermal tumor due to proliferation of immature keratinocytes.
how does seborrheic keratosis present after age 50 and are more common in fair-skinned individuals, single or multiple lesions that are well-demarcated, pigmented, round or oval, and have a dull or verrucous surface with a "stuck-on" appearance. Typical locations include the face, upper extremities, and trunk. SKs can be asymptomatic or cause pruritus, pain, or bleeding (especially with friction against clothing or jewelry)
wt is the clinical amplication of Explosive onset of multiple pruritic seborrheic keratosis (Leser-Trélat sign)associated with malignancies (especially lung and gastrointestinal tumors)
how to dx seborrheic keratosis clinically but may need biopsy
how to treat seborrheic keratosis no treatment but symptomatic or cosmetically disfiguring lesions can be treated with cryotherapy or removed by curettage/shave excision or electrodessication
how long should you treat major depression with medications 1-single episode of major depressive disorder should continue antidepressant treatment for approximately 6 months following acute response (referred to as "continuation phase treatment"). 2- Patients with a history of multiple episodes (recurrent major depressive disorder), chronic episodes (>2 years), strong family history, or severe episodes (eg, suicide attempt) should be considered for maintenance treatment. This typically involves continuing antidepressant medication for 1-3 years following remission to reduce the risk of recurrence. 3- Patients with a history of highly recurrent (eg, > 3 lifetime episodes) and very severe, chronic major depressive episodes may need to continue maintenance treatment indefinitely.
how to manage pt with elevated clacitonin after dissection for medullary thyroid cancer1-CT scan of the neck and chest with or without high-resolution ultrasound of the neck is recommended as the next step to look for metastatic disease.

2-If no lesion is identified, then an abdominal CT scan and bone scan may be required.

3- Octreotide or PET scan may be helpful if CT scans are negative despite the presence of elevated calcitonin levels.
wt is the indication of rhythm control in pt with afib Inability to maintain adequate heart rate control with rate-control agents Persistence of symptomatic episodes (eg, heart failure exacerbation) on rate-control agents
preferred antiarrhythmic agents in patients with AF and left ventricular (LV) systolic dysfunction with ejection fraction <35%Amiodarone or dofetilide
wt to monitor before and while on amiodarone Monitoring for evidence of pulmonary, thyroid, and hepatic toxicity is needed in patients taking chronic amiodarone.
wt is benefit of combined estrogen/progesterone menopausal hormone therapyMenopausal symptoms (eg, hot flashes, vaginal atrophy) Bone mass/fractures Colon cancer Type 2 diabetes mellitus All-cause mortality (age <60)
wt is s/e of combined estrogen/progesterone menopausal hormone therapyVenous thromboembolism Breast cancer Coronary heart disease (age >60) Stroke Gall bladder disease
wt is neutral effect of combined estrogen/progesterone menopausal hormone therapyCognition/dementia Endometrial cancer (increased with unopposed estrogen) Ovarian cancer All-cause mortality (age >60)
wt RBCs cound in LP indicate accidental damage of blood vessel A RBC count exceeding 6,000/mm3 may indicate traumatic LP, but SAH should be ruled out. also WBCs will be elevated but as one WBC is present per 750-1000 RBCs. The protein level is elevated in the presence of traumatic LP, and the glucose level is typically high.
wt is Routine prenatal laboratory tests in initial prenatal visit Rh(D) type, antibody screen Hemoglobin/hematocrit, MCV HIV, VDRL/RPR, HBsAg Rubella & varicella immunity Pap test (if screening indicated) Chlamydia PCR Urine culture Urine protein 24-28 weeks
wt is Routine prenatal laboratory tests in 24-28 weeksHemoglobin/hematocrit Antibody screen if Rh(D) negative 50-g 1-hour GCT
wt is Routine prenatal laboratory tests in 35-37 weeksGroup B Streptococcus culture
how to dx Gestational thrombocytopeniaAsymptomatic 2nd-3rd trimester of pregnancy Platelet count 70,000-150,000/mm3 No history of thrombocytopenia No associated fetal thrombocytopenia Resolution after delivery
wt is pathophysiology of Gestational thrombocytopeniaHemodilution Accelerated destruction of platelets
how to treat Gestational thrombocytopeniaSerial complete blood counts Repeat evaluation postpartum to ensure resolution
Contraindications to neuraxial analgesia (LP analgesic) in thrombocytopenic severe thrombocytopenia (platelets <70,000/mm3) or rapidly dropping platelet count (often associated with preeclampsia with severe features).
wt is the classification of pulmonary HTNPulmonary arterial hypertension (WHO group 1) Due to left-sided heart disease (group 2) Due to chronic lung disease (eg, COPD, ILD) (group 3) Due to chronic thromboembolic disease (group 4) Due to other causes (eg, sarcoidosis) (group 5)
wt is c/p of pulmonary HTN Dyspnea, fatigue/weakness Exertional angina, syncope Abdominal distension/pain
wt is sign of pulm htnLeft parasternal lift, right ventricular heave Loud P2, right-sided S3 Pansystolic murmur of tricuspid regurgitation JVD, ascites, peripheral edema, hepatomegaly
wt is characteristic chest xray finding in pulm HTN Chest x-ray characteristically reveals enlargement of the main pulmonary arteries with attenuation of peripheral arteries.
how to workup pt with pulm htn initial evaluation with transthoracic echocardiography, Definitive diagnosis with right heart catheterization is required, with mean pulmonary arterial pressure >25 mm Hg providing confirmation.
wt is the treatment of primary pulm htn Endothelin receptor antagonists (eg, bosentan, ambrisentan) have demonstrated delayed progression of disease in symptomatic patients with idiopathic PAH. Other advanced therapies available for patients with idiopathic PAH include phosphodiesterase-5 inhibitors (eg, sildenafil, tadalafil) and prostacyclin pathway agonists (eg, epoprostenol, treprostinil, iloprost). For patients with a positive vasoreactive test during right heart catheterization, calcium channel blockers (eg, long-acting nifedipine) are another option.
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