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ismailalmokyad's version from 2018-01-25 19:32

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Question Answer
1-What is autoimmune polyglandular failure?Multiple gland failure 2/2 Autoimmune disease
2-A pt with T1DM suddenly require less insulin, weight loss, fatiguedcheck for other autoimmune conditions as
1-thyroid dysfunction
2-adrenal failure
3-primary hypogonadism
4-atrophic gastritis
5-celiac disease
3-what is labs in Adrenal failure1-weight loss
2-fatigue
3-eosinophilia
4-borderline sodium levels,
5-hyperkalemia
6-mild anion gap acidosis
7-prerenal azotemia
8-and low blood glucose levels.
4-what is the first test for adrenal failure cosyntropin stimulation test
5-what is the labs predictors for sever pancreatitis1-elevated Hct >44% on admission (third spacing).
2-elevated BUN>20 on admission (increase risk of death).
3-elevated C-reactive protein >150 correlate with sever pancreatitis 1-2 days after admission.
4-low serum calcium after 2 days (calcium is depositing in the necrotic pancreas

NB. remember lipase doesn't correlate with disease activity.
6-how to screen for OSASTOP-Bang survey 1 point for each
1-Snoring
2-Excessive daytime tiredness
3-Observed apneas or choking/gasping 4-High blood pressure
5-BMI >35kg/m2
6-Age >50 years
7-Neck size >17 in (>16 in for women)
8-Male gender.

**0-2 points: low risk; 3-4 points: intermediate risk; ≥5 points: high risk**
7-wt is isolated habitual snoringit is snoring with low screening score for OSA.
8-How to manage isolated habitual snoring1- stop smoking
2-stop alcohol.
3- loss weight.
9-wt is DD of pediatric neck mass1-thyroglossal duct cyst.
-medline
-MC neck mass
-present in school age or adolescents
-developed from remnants thyroglossal duct that fail to atrophy after thyroid descends.
-superior displacement with tongue protrusion
-U/S to confirm and to check thyroid gland presence
-excision to avoid infection if the thyroid gland present.

2- dermoid cyst.
-midline
--consist of cutaneous structures (hair follicles, sebaceous gland)
-no displacement with tongue protrusion

3-branchial cleft cyst
-lateral
-from a failure of obliteration of the second branchial cleft
-often associated with sinus tract/fistula

4-lymphadenitis.
-lateral
-Triggered by inflammation from bacteria or viruses
-accompanied by upper respiratory symptoms (eg, rhinorrhea, sore throat).
-tender,warm, erythematous

5-cystic hygroma.
-posterior base or lateral aspect of the neck.
-often identified prenatally but may present at birth as a soft mass
10- what is the effect of antipsychotic on dementia pt- both first and second generation have overall increased risk of death from the use of antipsychotics in patients with dementia.
caused by increase
1-cardiac events
2-stroke
3-falls
4-aspiration pneumonia

to avoid Minimization of dosage and duration of treatment plus continuous reevaluation of symptoms are indicated.
11-what increase risk of breast cancer in men1-BRCA mutations (AD), increase risk to 100 fold and the single greatest risk factor

2-Klinefelter syndrom (extra X) increases the estrogen-to-androgen ratio and results in a 20-fold increase. just in the pt not relatives

3-Hepatic dysfunction, marijuana use, and obesity all increase estrogen-to-androgen ratio but less common
12-what is pearly penile papules-it is benign >1 rows of small, flesh-colored, dome-topped or filiform papules on the penile corona or sulcus. it appears in second or third decade
13- wt is ttt of condylomata acuminata (anogenital warts)topical imiquimod, an immunomodulatory drug, can help speed clearance of the lesions
14- what is transverse myelitis and how does it present and how to treat itRapidly progressive weakness of the lower extremities following an URI, accompanied by
1-sensory loss
2-urinary retention
3- +/- Dull back pain

NB Neurologic examination initially flaccidity and hyporeflexia, but spasticity and hyperreflexia develop subsequently.

Treat with high does IV steroid
15- when a female with a hx of mitral stenosis 2/2 RF present with acute or subacute dyspnea ?do pregnancy test as it can worsen the MS symptoms bc of volume overload.
16-pt admitted 2/2 variceal bleeding is at increase risk of what complication during hospital stay1-infection most common (ppx with fluoroquinolone may be helpful)
-UTI
-SBP
-URI and pneumonia

2-hepatic encephalopathy

3-renal failure
17- what are absolute contraindication for combined hormonal contraceptives1-Migraine with aura (pt already has increase risk of stroke)
2->15 cigarettes/day PLUS age >35
3-Hypertension >160/100 mm Hg
4-Heart disease
5-Diabetes mellitus with end-organ damage
6-History of thromboembolic disease
7-Antiphospholipid-antibody syndrome
8-History of stroke
9-Breast cancer
10-Cirrhosis & liver cancer
11-Major surgery with prolonged immobilization
12-Use <3 weeks postpartum
18-What are Combined hormonal contraceptivesinclude
1-estrogen/progestin pills
2-transdermal patch
3-vaginal ring
19-how does Combination oral contraceptives affect ovarian and endometrial cancerdecrease the risk of ovarian and endometrial cancer. but increase risk of breast cancer
20- clinical signs of HIT*** heparin >5 days with any of the following.
1-platelet count reduction>50% from base line
2-arterial or venous thrombosis
3-necrotic skin lesions at heparin injection site
4-acute systemic reaction after heparin.
21-how to diagnose and evaluate pt with HIT-serotonin release assay(Gold standard)
-start treatment before confirming
22-what is the treatment of HIT1-stop all heparin
2-start a direct thrombin inhibitor(eg, argatroban, bivalirudin) or foundaparinux.
3- Avoid warfarin until platelet > 150,000/µL.
23-wt is benign (physiologic) nipple discharge, causes and treatmenttypically bilateral, multiductal, nonbloody, and expressed only with manipulation of the breast.

Common etiologies include
1-endocrine abnormalities (eg, hyperprolactinemia, thyroid disease(TRH increase TSH and prolacin)
2-medications (eg, antipsychotics, gastric motility agents)
3-stress,
4-excessive breast/nipple stimulation.

NP: no treatment needed. Persistent or bothersome benign nipple discharge may be an indication for duct excision.
24- how to evaluate nipple discharge-first exclude malignancy by U/S and if >30 year old add mammography.
-if normal then undergo a galactorrhea evaluation which include
1-prolacin level
2-thyroid level
25-wt is dengue fever and how it present- it is viral infection spread by mosquito
-present as
1-acute fever
2-headache
3-retro-orbital pain
4-cervical LAD
5-pharyngeal erythema
6-joint/muscle pain
7-macular rash all over
8-thrombocytopenia hemorrhagic tendencies (petechiae with pressure)
9-leukopenia (low WBCs)
10-elevated liver aminotransferases.
11- may go to serious Dengue hemorrhagic fever (DHF)
26-Dengue hemorrhagic fever (DHF)increased capillary permeability leading to:
1-hemoconcentration
2-pleural effusion
3-ascites.

Circulatory failure can develop with significant plasma leakage and is sometimes referred to as dengue shock syndrome.

Patients typically have marked thrombocytopenia (<100,000/mm3) and prolonged fever.
27- hand contact dermatitis vs Tinea manuumcontact usually b/l while Tinea manuum usually unilateral
28- how does Anterior uveitis (iritis) present and how to confirm dx1-pain
2-redness
3-variable visual loss
4-constricted and irregular pupil.

to distinguish form other cuases of red eye: visualize the anterior segment of the eye with slit lamp examination, If leukocytes are seen it is diagnostic.

ttt with antimicrobial for viral or bacteral and topical corticosteroid for non-infection.
29-how does infection keratitis presentsevere photophobia and difficulty in keeping the affected eye open. Penlight examination reveals a corneal opacity or infiltrate.
30- what is the most common cause of fecal incontinence in elder. and how to treat itfecal impaction due to liquid stool overflow around impact stool within the rectum.

ttt
1-manual disimpaction
2-enema or suppository to empty colon
3-aggressive oral regiment to prevent recurrence.
memorize

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