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ismailalmokyad's version from 2018-01-11 21:03

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Question Answer
1-what cause cleft lipAR, AD or X-linked. AD inheritance, called Van der Woude syndrome.
-can be caused by alcohol

ttt: surgical at three months of age, according to the rule of '10:' 10 lbs of weight, 10 weeks of age, and 10 g of hemoglobin.
2-sickle cell disease
Vaso-occlusive pain episode presentation and management
1-Clinical features
-Acute, severe pain
-Pain at >1 site (eg, dactylitis may be the earliest manifestation)
-± Low-grade fever
-May be triggered (eg, by dehydration)

2-Management
-Analgesics (NSAIDs, opiates)
-Hydration
-Application of heat
-± RBC transfusion

3-prevent with hydroxyurea
3-what opioids contraindicated in children <12 year oldOral codeine and tramadol are contraindicated in children age <12 because ultra-rapid metabolism of codeine and tramadol causes an unpredictably high concentration of the active drug in the body, which can result in respiratory depression and death.
4-wt is the first test to do in elder after a fallpostural stability test. "Get Up and Go" test is commonly used to assess postural stability. stand up from an armless chair without assistance, walk a short distance, turn around, return, and sit down again.
5- Nonsuicidal self-injury-used to cope with distressing affective states and is common in adolescents and young adults.
-occurs impulsively and is preceded by feelings of numbness or intolerable tension.
-not indication for admission but need psych eval
6-what is the most common cause of obesity in childrenovereat
7-indication for hospitalization for pt with HBVsignificant fever or hemodynamic instability, impaired hepatic synthetic function (eg, -abnormal coagulation markers), or signs of fulminant liver failure (eg, encephalopathy, bilirubin >10 mg/dL).
-older, have significant comorbidities, have poor oral intake, or are without social support.
8-indication for antiviral therapy for HBVimmunosuppression, concurrent hepatitis C, severe hepatitis, or fulminant hepatic failure.
9- Pernicious anemia cause, c/p, how to treat and wt complication of ttt*** cause by autoimmune destruction of parietal cells, leading to achlorhydria and decreased production of the intrinsic factor.

***c/p
-posterior and lateral columns 'subacute combined degeneration' leads to ataxia, loss of proprioceptive and vibratory sensations. Severe spasticity, weakness, and peripheral nerve involvement can occur.
-Symptoms and signs are more prominent in the lower than the upper extremities.

labs: macro anemia

ttt-
measure potassium during the first few days of treatment as all potassium wil be uptake by new-formed RBCs very severe and life threatening
10-indication of Abx in COPD exacerbationCOPD exacerbation with any two of the following features:
1-increased sputum purulence,
2-increased sputum volume,
3-increased dyspnea.

-Antibiotics are also recommended for those requiring mechanical ventilation (noninvasive or invasive).
11-TB meningitis c/p, when to suspect it, how to confirm it and wt is the tttc/p
-2-3 weeks of prodromal symptoms (eg, headache, low-grade fever) followed by progressive signs of meningeal irritation (eg, nuchal rigidity, vomiting, confusion).
-CN palsies, coma, and seizures may occur.
-Choroidal tubercles (yellow-white nodules near the optic disc) are often detected via funduscopic examination.

Suspicion when brain imaging reveals basilar meningeal enhancement and CSF examination shows:
1-Elevated protein (>250 mg/dL, generally 100-500 mg/dL)
2-Low glucose (<10 mg/dL)
3-Lymphocytic pleocytosis
4-Elevated adenosine deaminase

Definitive diagnosis requires serial CSF examination for acid-fast bacilli using smear and culture.

TTT
-2 months of 4-drug therapy (isoniazid, rifampin, pyrazinamide, and either a fluoroquinolone or injectable aminoglycoside), followed by 9-12 months of continuation therapy (isoniazid plus rifampin)

-treatment can result in a transient worsening of CNS inflammation, so given 8 weeks of adjuvant glucocorticoid therapy (dexamethasone or prednisone).This significantly reduces morbidity and mortality.
12- erysipelas wt is it, how present, wt bacteria cause it?Is specific form of cellulitis. MC in LE, but face can be involved.
-red, painful, edematous and elevated. A sharp demarcation, may be butterfly pattern.
-hallmark is abrupt onset and the presence of systemic symptoms (fever, chills, malaise, etc).
-Group-A streptococcus is the typical etiologic agent of erysipelas, although sometimes, other beta-hemolytic streptococci are involved.
13- wt is Angiodysplasias and what increase risk of bleeding-it is arteriovenous malformations, common in patients age >60, often discovered incidentally on endoscopy, appearing as small, cherry-red lesions.
- may be due to chronic occlusions of submucosal veins

- bleeding rates are higher with
1-end-stage renal disease (ESRD) may be platelet dysfunction, aortic stenosis, and von Willebrand disease (vWD)
14-indication of IV abx to treat UTI in children1-hemodynamic instability
2-inability to tolerate oral medications (ie, persistent vomiting),
3-or failure of improvement on oral antibiotics.
4-Infants age <2 months are at increased risk of sepsis and should also be initially treated intravenously
15- wt is the indication of US in treating uti in childrenRenal ultrasound is indicated in children with febrile or recurrent UTIs. Imaging should be performed after completion of treatment as renal inflammation during acute illness can lead to false-positive results.
16-risk factor for uti in chilren-Female sex
-Uncircumcised male infants
-Vesicoureteral reflux, anatomic defects
-Dysfunctional voiding(bc of constipation obstruct block urine way out)
-Constipation.
17-ttt of Infectious epididymo-orchitisintramuscular ceftriaxone and 10 days of doxycycline.
18-Organophosphate poisoning mechanism, c/p, managementMechanism
-Inhibition of acetylcholinesterase → cholinergic toxicity

Presentation
-Muscarinic effects: “DUMBELS”
-Defecation
-Urination
-Miosis
-Bronchospasm/bradycardia
-Emesis
-Lacrimation
-Salivation
-Nicotinic effects: Muscle weakness, paralysis, fasciculations
-CNS: Respiratory failure, seizure, coma

Management
-Emergent resuscitation (eg, oxygen, fluids, intubation)
-Atropine competitive antagonist of the acetylcholine muscarinic receptor
-pralidoxime Pralidoxime, an acetylcholinesterase reactivator
-Activated charcoal (if within 1 hour of exposure)
19-how to treat hypoparthyoidism-Vit D high does 100,000 per day bc decrease activation of vit D (no PTH).
-ca should be given
-adjust level of ca to be 8.5-9
-if lower border line serum ca and high urine ca (no PTH so more ca go in urine), then give thiazide diuretic.
20-wt is scleroderma renal crisis, how it present, how to manage it-it happen bc of thickening of renal arterioles vessels bc of scleroderma, so increase activity of angio-aldo system.
-it present mostly with htn emergency, may be with AKI. this why BP should be
monitored in all scleroderma pt.
-unlike all htn with elevated cr the treatment will be with one does of nitroprussid and captopril(it revers renin-aldo and induce vasodilation).
-initially cr may increase but for the long run it will improve renal function.
21-wt is Metoclopromide and wt cns s/e associated with it-Metoclopromide is dopaminergic antagonists used to treat chemotherapy-induced nausea and vomiting.
-common central nervous system effects include akathisia, dystonia, and parkinsonian-like symptoms(extrapyramidal symptoms. )
-no days it is largely replaced by 5 HT3 serotonin receptor antagonists (e.g. ondansetron)
22-who should be treated with oseltamivir for influenza ?1- low risk pt if with <48 hours of influenza symptoms

2- all pt if require hospitalization, have severe or progressive illness, have high risk pt regardless of symptoms timing

high risk pt are
-Age >65
-Women who are pregnant & up to 2 weeks postpartum
-Underlying chronic medical illness (eg, chronic pulmonary, cardiovascular, renal, hepatic)
-Immunosuppression
-Morbid obesity
-Native Americans
-Nursing home or chronic care facility residents
23-how does spinal stenosis present and how to confirm dx-degenerative disease that affects the elderly population
-characterized by increased lumbar pain on extension of the spine and relive by flexion(pt bends forward as when using grocery cart.
-may present with gait disturbance (normal peripheral pulse)

confirm with MRI
24-wt are the types of urine incontinence and wt is the symptoms and causes1- stress
-caused by pelvic trauma as vaginal delivery
-decrease urethral sphincter tone
-increase urethral mobility
-present with leakage with increase intaabdominal pressure as cough or laugh
-treat with Kegel exercise and lifestyle changes such as caffeine restriction, weight loss, and smoking cessation. may be also limit oral fluid.
-if all fail then surgery with mid-urethral sling procedure.

2-overflow
-impaired detrusor contractility or bladder outlet obstruction
-men 2/2 BPH, women as complication of mid-urethral sling procedure.
-present as continuse dribbing, weak stream, incomplete emptying.

3-urge
-2/2 dettrusor hyperactivity
-Sudden, overwhelming urge to urinate
25-how to work-up pailess testicular mass1-us to differetiate testicular for extr-testicular
2- If the lesion appears suspicious on ultrasound, it is followed with CT scan of the abdomen and pelvis (to detect retroperitoneal lymph nodes metastasis) and measurement of serum tumor marker levels (alpha fetoprotein, beta hCG).
3-if not sure do radical inguinal orchiectomy provides the most accurate histological diagnosis.
26-what is androgen insensitivity syndrome, cause, c/p-it is x-linked recessive, mutation of the androgen receptor gene, which makes peripheral tissues unresponsive to androgens.
-present in adolescence with primary amenorrhea
-Breast development is normal, because excess testosterone is aromatized to estrogen. However, no pubic or axillary hair is present
-Diagnostic workup includes pelvic ultrasound, karyotype, and testosterone level. A serum testosterone level in the normal adult male range is characteristic.
27-what is primary amnenorrheadefined as absence of menarche by age 15 if breast development is present or by age 13
28-how to treat trichomoniasis in lactating mother- single-dose oral metronidazole 2 g, bc it enters breast milk and may cause loose stools and candidiasis in exposed infants, breast milk should be expressed and discarded for 24 hours after dose administration.
29-what are the most common malformations associated with Down's syndrome1-endocardial cushion defect
2- duodenal atresia
3-Hirschsprung's disease
4-atlanto-axial instability
5-hypothyroidism.
30-what conditions occurs at higher rate in Down's syndrome-acute leukemia
-Alzheimer-like dementia,
-autism,
-ADHD,
-depressive disorder
-seizure disorder.
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