Create
Learn
Share

Step3-29

rename
ismailalmokyad's version from 2018-01-07 09:35

Section

Question Answer
1-conditions that requires further evaluation and treatment before
noncardiac surgery
1-Unstable angina or recent MI
2-Decompensated heart failure
3-Significant arrhythmia
4-Symptomatic bradycardia
5-High-grade AV block
6-Supraventricular tachycardia
7-Symptomatic or new-onset VT
8-Severe valvular disease
9-Severe aortic stenosis
10-Symptomatic mitral stenosis
2-what type of hip fracture and how to mange itIntracapsular (femoral head and neck) or extracapsular (intertrochanteric or subtrochanteric).

surgical correction with either arthroplasty (intracapsular)or open reduction with internal fixation (extacapsular). In elderly patients who are stable and ambulatory prior to the fracture, surgery within 48 hours is associated with lower mortality and a lower risk of pressure ulcers and pneumonia
3- Symptoms of acute appendicitis in pregnancy and how to confirm dx.The upward displacement of the appendix by pregnancy results in decreased contact between the appendix, parietal peritoneum, and omentum. Therefore, patients often have no peritoneal signs (eg, no rebound or guarding) and no McBurney point tenderness

to dx: first-line imaging during pregnancy is a graded compression abdominal ultrasound if not inconclusive do MRI. (NB:A CT scan is the first-line imaging in nonpregnant.
4-What is pylephlebitis and what cause it?-it is infective suppurative portal vein thrombosis.

-caused by untreated appendicitis or other intraabdominal or pelvic infections (eg, diverticulitis).

-Clinical features fever, RUQ pain, jaundice, and hepatomegaly.

-Laboratory elevations in ALP and GGT
-imaging (eg, CT scan, ultrasound) reveals the thrombus.
-Polymicrobial bacteremia is common.

-Treatment of pylephlebitis includes prolonged broad-spectrum antibiotic therapy to prevent complications

-Complications including bowel ischemia, portal hypertension, and hepatic abscess.
5-Drugs affecting lithium level ?eliminated exclusively by kidneys and cross cell membrane vis NA/K protein so medication decrease GFR or affect K or Na can lead to toxicity.

1-Drugs that ↑ lithium levels
-Thiazide diuretics
-NSAIDs, except aspirin
-ACE inhibitors & ARBs
-Antibiotics (eg, tetracycline, metronidazole)

2-Drugs that may ↑ or ↓ lithium levels
-Loop diuretics (eg, furosemide)
-Calcium channel blockers (eg, verapamil)

3-Drugs that ↓ lithium levels
-Potassium-sparing diuretics
-Theophylline
6-wt is priapism, c/p, causes, dx, treatment ?painful erection 2/2 impaired outflow from the corpora cavernosa, leading to acidosis, anoxia, and tissue ischemia.

2-Common risk factors for ischemic (low-flow) priapism include
-phosphodiesterase-5 inhibitors (eg, sildenafil), intracavernosal injections (eg, alprostadil),
-certain medications (eg, trazodone)
-sickle cell disease.

Dx: confirmed by blood gas analysis of a corporeal aspirate

treatment:
-Priapism is a medical emergency that can lead to irreversible ischemic injury
-may be terminated with simple interventions (eg, urination, cold compresses)
-lasting >4 hours require invasive treatment, Aspiration of the corpora cavernosa (often followed by irrigation with cold saline) is advised, with intracavernosal injection of an alpha agonist (eg, phenylephrine) if aspiration does not rapidly relieve the symptoms.
7-how to dx spontaneous bacterial peritonitis ?paracentesis show cell count >250.
8-wt is the mechanism of hepatorenal syndrome ?decreased peripheral vascular resistance secondary to splanchnic vasodilation, which can cause the decreased renal perfusion of hepatorenal syndrome. Similarly, volume depletion due to over-diuresis can cause renal dysfunction of a pre-renal etiology.
9-how to work up hepatorenal syndrom and how to treat ?-UA and renal U/S (exclude obstraction)
-it is a dx of exclusion.
-Start by IV fluid if prerenal azotemia, if no improvment it confirm hepatorenal syndrome.

-A combination of octreotide and midodrine or norepinephrine alone can be used if this patient's renal failure does not respond to fluids.
-Albumin should also be continued for at least 2-3 days.
10-how to manage bleeding on patient who have renal dysfunction ?Impaired platelet function should be corrected by
1-correction of anemia
2-administration of desmopressin (first line)
3-dialysis
4-estrogen treatment
5-cryoprecipitate infusion
11-how does desmopressin correct bleeding in renal dysfunction ?It acts by increasing the release of factor VIII:von Willebrand factor from endothelium.
12-what is the lab finding in platelet dysfunction associated with renal dysfunction-Prolonged bleeding time.
-Other coagulation studies, such PT, PTT and platelet count are usually normal.
13-how to manage sever pain that need opioid in patient who have hx of opioid dependencyask for consent as usually they require higher does which may lead to overdose.
14-what are the differential diagnosis for this patient's cola-colored urine following exercise1-exercise-induced hematuria
2-myoglobinuria from rhabdomyolysis
3-hemoglobinuria from RBC trauma.
15-how to work-up cola-colored urine following exercise?look for RBCs if positive this excludes myoglobinuria and hemoglobinuria and confirm exercise induced hematouria, repeat ua in one week to ensure resolution as it is dx of exclusion. Further evaluation would then be necessary if hematuria were still present, particularly in patients over the age of 50.
16-what is catheter-related bloodstream infection (CRBSI)is bactermia related to central line
17-wt is the infection rate in hemodialysis ctheters ?Tunneled hemodialysis catheters are associated with much higher rates of bacteremia (up to 2 episodes a year) than arteriovenous fistula.
18-how to obtain blood cx in patient who has possible CRBSI?-2 sets of blood cultures, ideally one from a peripheral site and one from the central catheter.
-Empiric antibiotic therapy should then be initiated with vancomycin plus cefepime (or gentamicin).
-Catheter removal if indicated
19-what are the indications for central line removal in case of CRBSI?1-Severe sepsis
2-Hemodynamic instability
3-Evidence of metastatic infection (eg, endocarditis)
4-Pus at the exit site of the catheter
5-Continued symptoms after 72 hours of empiric antibiotics.
6-Long-term catheters (in place >14 days) should be removed if positive S aureus, Pseudomonas aeruginosa, or fungi (eg, Candida).
20-how to manage hemodialysis central line after patient recover from CRBSI if central line was not indicated during treatment ?Patients who do not require catheter removal should have the catheter changed over a guidewire (once afebrile and clinically stable if there is no evidence of tunnel tract involvement) or antibiotic lock therapy
21-what is the antimicrobial treatment for infection related to central line ?1-vancomycin plus cefepime (or gentamicin).
2-empiric caspofungin is typically recommended for patients with CRBSI-related sepsis who have any of the following risk factors:
-Total parenteral nutrition
-prolonged use of broad-spectrum antibiotics
-hematological malignancy
-solid organ transplant
-femoral catheterization
-Candida colonization at multiple sites.
22-what is staphylococcus aureus bacteremia related metastatic infectionStaph tend to metastasis to heart valves, lungs, and osteoarticular structures (vertebral osteomylitis, epidural abscess).
23-how to work-up staph aur bactermic patient with no improvement while on treatment?1-Echo for vagitation
2-MRI spine for osteomyelitis (xray negative for 2 weeks) if vertebral osteomylitis confirmed then confirmation requires an open or CT-guided biopsy.
24-when to work for infertility> 12 months of appropriately timed intercourse, for women age >35 evaluate after >6 months
25-when does women ovulation occur after stoping OCPone month
26-what is the indeication of amnioinfusiontreats variable decelerations, that are caused by umbilical cord compression
27-what is ocular melanomatumor arising from the melanocytes within the uvea (iris, ciliary body, and choroid), usually from a choroidal pigmented nevus.
28-how does ocular melanoma present1-asymptomatic for long years and usually incidentally discovered,
2-if symptomatic
-blurry vision
-progressive and painless visual field abnormalities.
-may be floaters
-may be pain (occasionally) if the tumor impinges on the nerves.
29-how to dx ocular melanomaUltrasound of the eye is the most sensitive imaging modality to diagnose the lesion, while MRI is used to document any extrascleral extensions for staging and treatment decisions.
30-37-how to treat ocular melanoma-Asymptomatic patients with small pigmented lesions (diameter <10 mm, thickness <3 mm) often experience an extended period of slow growth, during which they may be safely observed without treatment
-A common protocol is to repeat the examination in 3 months and every 6 months thereafter.
-If Large (diameter >10 mm, thickness >3 mm) choroidal melanomas or those presenting with associated symptoms (eg, eye pain, visual disturbances) have a worse prognosis and will benefit from radiotherapy.
-enucleation is preferred treatment when the tumors are very large, have extrascleral extension, or severe associated pain.
memorize