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ismailalmokyad's version from 2018-01-25 17:54

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1-A pt was diagnosed with Huntington disease and he ask you not to tell his family member who may be affected with the disease too.you dont tell unless there is a treatment that may improve the outcome in the family member.
2-wt is primary, secondary, tertiary, and quaternary prevention levels.1-primary prevention: is defined as the prevention of risk factors themselves.

2- is defined as an action prevent progression of a disease at its initial stage before irreversible pathological changes take place, thus preventing complications.

3-Tertiary prevention is taking all actions available to limit impairments and disabilities after the condition has already advanced(eg, CABG).

4- Quaternary prevention limit and prevent unnecessary or excessive intervention as done by shared electronic medical record.
3-how to dx menopause > 1 year of amenorrhea.
4-wt is risk factor for endometrial hyperplasia and cancer1-obesity
2-age >45
3-anovulation
4-diabetes mellitus
5-tamoxifine
6-PCOS
7-Early menarch or late menopause

NB: contraceptive that contain both estrogen and progestrone decrease risk of uterine cancer
5-wt is the treatment of anovulatory bleeding (excessive bleeding in the transition to menopause)after excluding hyperplasia and cancer in high risk pts you can use the following.

1-low-dose oral contraceptives
2-cyclic progestins
3-levonorgestrel-containing intrauterine device.

**All of which provide endometrial protection**.
6-Gastroparesis causes1-Diabetes (autonomic neuropathy)
2-Medications (eg, opioids, anticholinergic drugs)
3-Traumatic/postsurgical (eg, vagus nerve injury)
4-Neurologic (eg, multiple sclerosis, spinal cord injury) Idiopathic/postviral
7-Gastroparesis clinical picture1-Nausea & vomiting
2-Early satiety
3-Bloating & abdominal pain
4-Weight loss
5-Labile glucose (diabetics)
6-Epigastric distension & succussion splash on examination
8-Gastroparesis diagnosis1-Exclude obstruction with upper gastrointestinal endoscopy
2-Exclude external compression (if suspected) with CT scan
3-Assess motility with nuclear gastric-emptying study
9-Gastroparesis treatment1-Diet: Frequent small meals with low fat & only soluble fiber
2-Promotility drugs: metoclopramide(1st),Erythromycin
3-Gastric electrical stimulation &/or jejunal feeding tubes for refractory symptoms
10-when to screen for endometrial hyperplasia/ cancer in old lady who is taking Tamoxifen post breast cancerevaluation only if symptoms develop (eg, abnormal uterine bleeding, postmenopausal bleeding).
11-wt is the indications of selective estrogen receptor modulators1-Prevention of breast cancer in high-risk patients
2-Tamoxifen: Adjuvant treatment of breast cancer
3-Raloxifene: Postmenopausal osteoporosis
12-wt is side effects of Selective estrogen receptor modulators1-Hot flashes
2-Venous thromboembolism
3-Endometrial hyperplasia & carcinoma (tamoxifen only)
13-pt with untreated celiac disease who developed abd pain and B symptoms (weight loss, fatigue and fever) wt is dx, c/p, complications and prognosis .enteropathy-associated T-cell lymphoma (EATL), an aggressive hematologic malignancy that primarily affects the proximal jejunum.

-c/p: abdominal pain and B symptoms (eg, weight loss, fatigue, fever).

-Complication Bowel obstruction, bowel perforation, and gastrointestinal bleeding are common as the disease progresses.

-Most patients with EATL present late .

-As such, prognosis poor, median survival of 10 months.
14-Indications for prophylactic anti-D immune globulin administration for Rh(D)-negative patients*1-At 28-32 weeks gestation
2-<72 hours after delivery of Rh(D)-positive infant
3-<72 hours after spontaneous abortion
4-Ectopic pregnancy
5-Threatened abortion
6-Hydatidiform mole
7-Chorionic villus sampling, amniocentesis
8-Abdominal trauma 2nd- & 3rd-trimester bleeding
9-External cephalic version
15-what is the effect of Rh(D) alloimmunization on the neonateCan lead to hemolytic disease. When severe anemia develops in the fetus, it can lead to heart failure and subsequent hydrops fetalis (eg, pleural or pericardial effusion, ascites)
16-when to screen for anti D abx and how to manage if positive and if negativeAt the first prenatal visit and at 28 weeks.

-Positive antibody screening indicates that alloimmunization has already occurred, and anti-D immune globulin is not administered.

-Negative anti-D antibody screening confirms a lack of antigen exposure and is an indication to anti-D prophylaxis at 28 weeks and at postpartum <72 hours after delivery
17-how to screen for multiple myeloma serum and urine protein electrophoresis
18-how to deal with HIV post exposure if the pt present after one month of exposureshould repeat of HIV antigen (p24) and HIV-1/HIV-2 antibodies. Usually it is not positive until one month post exposure.(window period).

-don't medication with antiretroviral if not done during first 72 hours
19wt testing should be ordered before starting antiretroviral medication on newly diagnosed HIV patient1-CD4 count.
2-viral load.
3-HIV genotyping.
4-HBV/HCV (some antiretroviral have dual activity).
5- TB
6-STD(eg, Treponema pallidum, Neisseria gonorrhoeae).
20treatment of acute limb ischemia (present with six P's)first decide if the limb is viable limb, threatened limb, or nonviable limb.

1- All will get IV heparin bolus followed by drip.

2-if Threatended mean irreversible myonecrosis within 4–6 hours and should have emergency surgical revascularization.

3-viable extremity managed with catheter-based thrombolytic therapy or surgical revascularization.

4- pt with nonviable limb will have amputation
21wt is Recurrent pregnancy loss (RPL) refers to >3 consecutive spontaneous abortions at <20 weeks gestation.
22how to manage recurrent pneumonia in the same lobe in a short period1-CT to look for neoplasm obstruction, lung abscess, empyema.
2-Bronchoscopy(if CT not helpful) to look for other causes as TB, fungus, inflammatory conditions mimicking pneumonia.
3- Open lung biopsy if all failed
23wt is Postexposure prophylaxis for sexual assault1-HIV -3-drug regimen (eg, tenofovir-emtricitabine with raltegravir)

2-HBV -Hepatitis B vaccine ± hepatitis B immune globulin

3-Chlamydia -Azithromycin

4-Gonorrhea -Ceftriaxone

5-Trichomonas vaginalis -Metronidazole.

6- offer emergency contraception:
-Ulipristal, an antiprogestin, is the most effective oral emergency contraceptive in assault even if taken up to 5 days after unprotected intercourse
(NP IUD can be placed up to 5 days post sexual act and has a better rate of prevention 99% but it is contraindicated in case of infection as with sexual assault)
24how to treat nonfunctioning pituitary adenoma, which usually arises from the gonadotropin-secreting cells (gonadotrophs)-trans-sphenoidal surgery, which can provide rapid relief of the associated neurologic symptoms and gonadal dysfunction.
-Radiation if the gland was not fully removed
25-cyanide toxicity c/p1- skin:
-flushing,
-cyanosis(later)
2-CNS:
-headache
-AMS -seizures
-coma.
3- cardio:
-arrhythmias.
4-resp:
-tachypnea followed
-resp depression
-pulm edema.
5-GI:
-abd pain
-nausea
-Vomiting.
6-renal -metabolic acidosis (from lactic acidosis)
-renal failure
26-who is at risk to develop cyanide (nitroprusside) toxicity and how to prevent it and treat it1-risk
-chronic renal failure
-those receiving a high-dose or prolonged infusion
2-prevent
-low infusion rates (<2 µg/kg/min)
-short-term usage
-close monitoring
3-Treatment
-cessation of nitroprusside
-administration of sodium thiosulfate.
27-Epiglottitis micro,c/p,xray,manaement, prevention1-Microbiology Haemophilus influenzae type b
2-Clinical features
-Distress (tripod position, sniffing position, stridor)
-Dysphagia, dysphonia
-Drooling
-High fever
4-X-ray "Thumbprint sign" (enlarged epiglottis)
5--Management
-Endotracheal intubation
-IV Antibiotics only after airway is secure
6- prevent by Immunization
28-what is tripod, sniffing positionsitting forward with his neck extended and mouth wide open, found in child with epiglottitis
29-wt is the initial work-up for kidney transplant1- HLA matching and ABO compatibility.
2- better out come if before the onset of dialysis and from a living donor.

siblings who has 1 in 4 chance of full match.
memorize

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