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ismailalmokyad's version from 2018-01-06 19:01

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Question Answer
1-who is at high risk to develop preeclampsia? ahow to prevent it?1-Prior preeclampsia 2-Chronic kidney disease 3-Chronic hypertension 4-Diabetes mellitus 5-Multiple gestation 6-Autoimmune disease. prevent it by low dose daily aspirin initiated at 12 weeks gestation.
2-what cause preeclampsia Preeclampsia is hypothesized to result from abnormal increases in platelet aggregation and vasoconstriction, resulting in placental infarction and ischemia.
3-Vaginal progesterone indication to prevent risk of preterm delivery short cervix (<2 cm) found incidentally on transvaginal ultrasound
4-what are the most common cause of AMS in elders1-medications
2-infections(UTI,CAP)
3-metabolic abnormalities(Hyper or hypoglycemia, hyper or hypothyroidism)
5-wt is apathetic thyrotoxicosisAtypical presentation of hyperthyroidism in older patients characterized by
1-lethargy
2-confusion
3-depression.
6-wt are the Stages in the development of heart failureStage A: High risk for heart failure, but without structural heart disease or symptoms of heart failure (patients with risk factors for diabetes or hypertension, patients exposed to cardiotoxic drugs)

Stage B: Structural heart disease, but without signs or symptoms of heart failure (patients with prior myocardial infarction or valvular heart disease with left ventricular enlargement or low ejection fraction)

Stage C: Structural heart disease with prior or current symptoms of heart failure

Stage D: Heart failure symptoms at rest or refractory end-stage heart failure
7- what is the first and second most common cause of dilated cardiomyopathy?Most cases of dilated cardiomyopathy are idiopathic (or primary), but coronary artery disease (CAD) leading to ischemic cardiomyopathy is the most common secondary etiology
8- what is the first thing to do with patient with unexplained new-onset HF?Evaluate for CAD with stress testing or coronary angiography. Chronic myocardial ischemia often have viable myocardial tissue with reversibly depressed contractility. In these patients, coronary revascularization can lead to improvement in symptoms, systolic function, and long-term mortality.
9- wt is complex regional pain syndrome (CRPS). wt is the presentation?Usually occurring after an injury, CRPS presents with pain out of proportion to the injury, temperature change, edema, abnormal skin color, burning pain to light touch (allodynia).

present in 3 stages.
-Stage 1 includes burning pain, edema, and vasomotor changes in a limb after injury.
-Stage 2 includes progression of edema, skin thickening, and muscle wasting.
-Stage 3 is the most severe and includes limited range of motion and bone demineralization on x-ray

Dx:
1-Autonomic testing measures increase resting sweating.
2-Or MRI looking for the changes mentioned above.

TTT:
1-Regional sympathetic nerve block
2-or intravenous regional anesthesia.
10-wt is Poison ivy contact dermatitis, C/P, ttt?1-Type IV (cell-mediated) hypersensitivity reaction against plant resin or residual plant resin on clothing.

2-C/P:
1-Linear papules and clear, fluid-filled vesicles on exposed areas.
2-Pain and intense pruritus

3-Treatment:
1-removal of contaminated apparel.
2-gentle cleansing
3-cool compress or topical corticosteroid.
4-oral corticosteroid if sever, involving face or genitalia.

NB: it is not histamine mediated and anti-histamine will not work.
11-corrected calcium is usually accurate in most patients. However, direct measurement of ionized calcium is usually more accurate in what conditions1-acid base disorders (acidosis increases ionized calcium, alkalosis decreases ionized calcium)
2-primary hyperparathyroidism
3-chronic kidney disease
4-multiple myeloma (elevated proteins can increase corrected calcium).
12-How to prevent Perinatal hepatitis B infection1-Maternal antiviral therapy in some cases
2-Newborn hepatitis B vaccination & immunoglobulin within 12 hours
3-Routine immunization at 0, 2, and 6 months.
4-Serology ~3 months after 3rd dose of vaccine, usually at age 9 months. If HBsAg is not detected at that time, the infant is uninfected.

**Maternal viral load and positive HBeAg is the primary risk factor and directly correlates with the risk of vertical transmission to the infant.
13- Primary CNS lymphoma (PCNSL) c/p, cause, treatment, prognosis?-it is strongly related to EBV in pt with HIV and CD4 count <50.

-C/P: present with confusion, lethargy and stroke like symptoms (eg, focal weakness).

-Dx by CT head whoes well-defined small focal lesion, followed by biposy.

-Treatment is corticosteroid and radiation (induces a rapid response however, does not significantly prolong survival). HAART therapy improves prognosis, especially if increase in CD4 count and decrease in viral load.
14-How to work up Normocytic/normochromic?it is caused by decreased red blood cell production or hemolytic disorders.
order
1-reticulocyte count must be obtained ****
2-elevated indirect bilirubin level
3-decreased haptoglobin
4- increased LDH
5- splenomegaly
15- what is anterior uveitis, wt is the symptoms.Inflammation of the iris and ciliary body. Most cases are due to an underlying infection (eg, AIDS) or systemic inflammatory disease (sarcoidosis).

1-Erythema at the limbus (junction of cornea and sclera)
2-A constricted pupil
3-Blurred vision
4-Moderate eye pain
16- what is the symptoms of angle-closure glaucoma ?1-blurred vision
2-conjunctival erythema
3-severe eye pain
4-mid-dilated pupil
5-headache
6-nausea and vomiting
7-Elder
17-wt is the c/p and risk factor for endophthalmitis-decreased visual acuity
-aching of the affected eye
-conjunctival injection.

Most patients have a severe underlying illness (eg, hospitalization with a central catheter) or recent eye surgery
18- what is Juvenile myoclonic epilepsy, wt is C/P, DX and ttt.-Clinical features:
1-Adolescents
2-Begins as absence seizures
3-Morning myoclonus within the first hour of waking.
4-Generalized tonic-clonic seizures

-Diagnosis
1-Electroencephalogram: Bilateral polyspike & slow wave activity

-Management
1-Valproic acid, lifelong
2-Avoid triggers (eg, alcohol, sleep deprivation).

NB: be awar that observation and reassurance are appropriate for a first unprovoked seizure, but this is not the case here and you should start valporic acid even after first episode
19-what to follow up on patient taking valporic acid1- platelet as it can cause does-related thrombocytopenia so order cbc before starting and follow periodically.

2-it can cause hepatitis so liver enzymes should be measured intermittently

3- it can cause pancreatitis lipase should be obtained in any patient with acute abdominal pain.

4- teratogen that has been linked to neural tube defects; it should be used with caution in women of child-bearing age.
20-wt is the treatment of recurrence of clostridium difficile.1- first recurrence
-metronidazole for non-severe illness
-vancomycine for severe illness

2-second recurrence
-pulsed tapering oral vancomycin for sever illness

3-subsequent relapses
-fidaxomicin
-consider facal microbiota transplant.
21- what is the effect of pregnancy on thyroid labsit increase T4 bc of increase thyroid binding globulin synthesis. this is why you increase the does of thyroxin during pregnancy.
22-management of grave disease pt being treated with methimazole if she become pregnant ?During the first trimester, methimazole is associated with scalp defects, tracheoesophageal fistula, and choanal atresia in the infant, for this reason pt medication should be switched to propylthiouracil during first trimester and switch back to methimazole. during the second and third trimester.
23-how to diagnose condylomata acuminata ?, how to treat it ?Visual inspection with application of acetic acid, lesions should turn white.

1-treatment is usually start by chemical or physical destruction
-Trichloroacetic acid application destroys the lesion by protein coagulation is first line and can be used in mucosal surfaces (internal wart).
-podophyllin can be used on external wart ( it should not be applied to the mucosal surface ). It is also contraindicated in pregnancy.

2-Systemic or topical interferon is a form of immunotherapy that can be used to treat genital wart.

3-Ablative or surgical procedures are considered in patients in whom medical therapy is not effective.
24- how to manage patient with chest pain 2/2 cocaine intoxication?Focus on reducing myocardial oxygen demand and improving the oxygen supply. Because BB is contraindicated, IV benzodiaepines as given PRN to reduce sympathetic outflow and to alleviate HTN, tachycardia and coronary vasoconstricton. Nirtoglycrine is given to reduce BP and left ventricular wall stress. Aspirin is given bc cocaine stimulates platelet activity.

After previous mentioned interventions, if ST elevation persist pt should be taken immediately to the cath.

NP: Oral calcium channel blockers (eg, amlodipine) can be added to benzodiazepines and nitroglycerin to relieve myocardial ischemia in patients with cocaine intoxication and minimal ECG changes.
25- what cause Molluscum contagiosum (MC),self-limited, localized skin infection caused by a poxvirus.
small skin-colored papules with indented centers that may occur anywhere except the palms and soles.

Transmission is through skin-to-skin contact (especially during sex) or contact with contaminated fomites.

HIV testing should be considered in patients with MC, especially for lesions that are widespread or involve the face.

it is self-limited but can be treated with physical destruction via curettage/cryotherapy or chemical removal with topical agents (eg, podophyllotoxin).
26- what is Gottron's papulesred/purple papules or plaques associated with dermatomyositis. These typically involve the dorsal and radial surfaces of the metacarpophalangeal joints, proximal interphalangeal joints, and proximal phalanx.
27-what skin lesion assocaitted with increase insulin resistanceskin tags, acanthosis nigricans, and xanthelasma.
28- metformin's side effects, wt is the contraindications for use and how to manage metformin in a pt going for cath.gastrointestinal upset (eg, nausea, abdominal pain, diarrhea), decreased intestinal vitamin B12 absorption, and lactic acidosis (can be fetal and usually develops in patient with CKD or liver disease)

Metformine is containdicated in
1- Cr >1.5
2-liver disease
3-alcohol abuse
4-sepsis
5-CHF

BC of increase risk of lactic acidosis if given with iodine contrast it should be discontinued one day prior to cath and restarted 2 days after cath.
29- Breast feeding failure jaundice VS breast milk jaundice ?1- Breastfeeding failure jaundice: first week of life, 2/2 decrease bilirubin elimination and increased enterohepatic circulation. baby has signs of dehydration and has suboptimal breastfeeding.

2-Breast milk jaundice: starts at age 2-5 days peaks at 2 weeks, 2/2 high level of B-glucuronidase in breast milk which will deconjugates intestinal bilirubin and allows for increased intestinal absorption and enterohepatic circulation of bilirubin.. no dehydration and adequate breastfeeding. for treatment Parents should be reassured that the prognosis is good with spontaneous resolution by age 3 months. and the mother should continue breastfeeding.
30- what is most common cause of hyperparathyroidism, symptoms, dx, and treatment?1-Etiology
-Parathyroid adenoma (most common), hyperplasia,
carcinoma
-Increased risk in MEN types 1 & 2A

2-Symptoms
-Asymptomatic (most common)
-Mild, nonspecific symptoms (eg, fatigue, constipation)
-Abdominal pain, renal stones, bone pain, neuropsychiatric
symptoms

3-Diagnostic findings
-Hypercalcemia
-Elevated or inappropriately normal PTH
-Elevated 24-hour urinary calcium excretion
I
ndications for
parathyroidectomy

-Age <50
-Symptomatic hypercalcemia( bone pain, abdominal pain, psychiatric symptoms)
-Complications: Osteoporosis (T-score <−2.5, fragility
fracture), nephrolithiasis/calcinosis, CKD (GFR <60 mL/min)
Elevated risk of complications: Calcium >1 mg/dL above
normal, urinary calcium excretion >400 mg/day
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