ismailalmokyad's version from 2018-01-04 12:22


Question Answer
best single-item Screening question for unhealthy alcohol use?How many times in the past year have you had 5 (4 for women) or more drinks in a day?

**CAGE questionnaire are no longer recommended as an initial screen**
how to treat postmenopausal women with vaginal dryness and dyspareunia.low-dose vaginal estrogen therapy to treat vaginal atrophy.
what causes hypercalciemia with elevated PTH1-primary(or tertiary) hyperparathyroidism
2-familial hpocalciuric hypercalcemia
3- lithium
what causes hypercalcemia with low PTH?1-malignancy,
2-vit d toxicity,
3-granulomatous disease,
4-drug induced (thiazides),
5-milk-alkali syndrom,
7-vit A toxicity,
Why we need to measure urinary calcium in patient with hypercalcemia and elevated PTH?To differentiate familial hypocalciuric hypercalcemia (a rare disorder due to mutations in the calcium-sensing receptor and leading to low urinary calcium excretion) from primary hyperparathyroidism (in which urinary calcium excretion is normal or elevated)
humoral hypercalcemia of malignancy (HHM)which is due to secretion of PTH-related protein (similar to PTH and binds PTH receptors)
Mechanism of hypercalcemia in different malignancies1-PTHrP:
-Squamous cell
-Renal &bladder
-Breast & ovarian (↓ PTH ↑ PTHrP).

2-Bone metastases:
-Multiple myeloma( ↓ PTH & PTHrP ↓ Vitamin D).

-Lymphoma (↑ Calcium absorption ↓ PTH ↑ Vitamin D).
What is the labs findings in DIC1-elevated D-dimer (due to accelerated fibrinolysis)
2-prolonged PT & aPTT (due to depletion of clotting factors)
3-low fibrinogen (due to consumption)
what is thrombotic thrombocytopenic purpura1-thrombocytopenia
2- microangiopathic hemolytic anemia, (elevated LDH).
3- AKI
what is the tretment of Immune thrombocytopenic purpura (ITP)self-limiting in children but usually becomes a chronic disorder in adults.

1-if child
-without bleed just watch
-if bleed then steroid or IVIG.

2-if adult
->3000 and no bleeding just watch
-if <30 or bleed steroid of IVIG (IVIG is faster
-use retoximab if no improvement with steroid or if contraindicated
-splenectomy is last resort.
what are condition assoicated with Acanthosis nigricans1-Insulin resistance
2-GI malignancy
what are condition assoicated with Multiple skin tags1-Insulin resistance
3-Crohn disease (perianal)
what are skin condition assoicated with Hepatitis C1-Porphyria cutanea tarda
2-Cutaneous leukocytoclastic vasculitis (palpable purpura) secondary to cryoglobulinemia
what is skin condition associated with Celiac diseaseDermatitis herpetiformis
what are conditions associated with severe seborrheic dermatitis**scaly patches and red skin, mainly on the scalp**
1-HIV infection
2-Parkinson disease
what skin associated with GI malignancy1-Explosive onset of multiple itchy, seborrheic keratoses
2-Acanthosis nigricans
what skin lesion associated with IBDPyoderma gangrenosum
what are the complication of Cryptorchidism1-Inguinal hernia
2-Testicular torsion
4-Testicular cancer
when does normal testis descend 28 weeks gestation, if it did not decend by 6 months old then referred for orchiopexy
what is chronic diarrheadiarrhea for more than a month
what is the most common causes of chronic diarrhea ?-Irritable bowel syndrome
-chronic infection
-malabsorption syndromes (celiac disease and lactose intolerance)
how to manage chronic diarrhea1-detailed hx
2-routine laboratory
3-stool analysis include somolar gab
stool finding in Lactose intolerance-↑ Stool osmotic gap
-↓ Stool pH
-+Lactose hydrogen breath test
Stool study in chronic pancreatitisGreasy fatty stools
stool study and labs in Celiac disease?-↑ Stool osmotic gap
-Microcytic anemia
-iron deficiency
-Villous atrophy
Small intestinal bacterial overgrowth lab finding1- Macrocytic anemia
2- B12 deficiency
3- +Lactulose breath test
what is Stool osmotic gap and wt does it mean290 mOsm/kg − 2 x (stool Na + stool K) 1-<50 Secretory diarrhea
2-50-125 Indeterminate
3->125 Osmotic diarrhea
Management of celiac disease-Gluten-free diet/education
-Monitor lifelong adherence to gluten-free diet
-supply deficiencies as needed iron, calcium, vitamin D, folic acid & rarely thiamine.
-Prevention of bone loss Increased risk for osteopenia & osteoporosis
-Obtain DXA at diagnosis Repeat in1 year if osteopenia present
-Pneumococcal vaccination.
-Dapsone for Dermatitis herpetiformis
how long does gluten free diet takes to work in celiac disease ?approximately 2-3 weeks after the initiation of a gluten-free diet; however, normalization of the villus architecture can take a few months.
Squamous cell skin cancer treatment ?surgery to see a clear matgin but if cant do surgery then cryotherapy, electrosurgery, and radiation therapy.
what are the cardiovascular manifestation of thyrotoxicosis-SVT (eg, atrial flutter, paroxysmal atrial tachycardia)
-coronary vasospasm
-myocardial ischemia
-congestive heart failure.
how does symptoms of hyperthyroid happensympathetic activity due to increased responsiveness to catecholamines which cause palpitations, tachycardia, anxiety, tremors
how does thyrotoxicosis cause Hyperglycemiaincrease insulin resistance
what is the use of Systemic glucocorticoids in hyperthyroid-it inhibit conversion of T4 to T3 used for

1-life-threatening hyperthyroidism (thyroid storm) which is characterized by tachycardia (eg, >140/min), hyperpyrexia, and AMS

2-also used in subacute (de Quervain) thyroiditis that did not respond to NSAIDs

3-for certain patients with amiodarone-induced thyrotoxicosis.

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