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ismailalmokyad's version from 2018-01-27 18:13

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Question Answer
1-what is the major treatable risk factors for ischemic stroke1-hypertension (most important 35% relative risk reduction )
2-diabetes (not reco to go hga1c <7)
2-smoking
4-dyslipidemia.
2-wt is best ASA does to prevent strokeboth 81mg and 325 mg are same no difference proved
3-kerley B lineshorizontal lines representing interstitial edema that indicate pul edema (in heart failure)
4-use of BNP and how does obesity affect itB-type natriuretic peptide <100 pg/mL is often useful in ruling out clinically significant heart failure; however, obesity lowers BNP levels, making the test unreliable in such patients.
5-how does pt with sever Obesity hypoventilation syndrome presentsymptoms of right side heart failure
6-Extraintestinal manifestations of celiac diseaseGeneral
-Fatigue
-Weight loss

Skin
-Dermatitis herpetiformis
-Vitiligo

Musculoskeletal
-Osteopenia/osteoporosis
-Osteomalacia

Hematologic
-Anemia (especially iron-deficient)

Neurologic
-Peripheral neuropathy
-Headache

Endocrine
-Autoimmune thyroiditis (hyper-, hypothyroid)
-Type I diabetes

Psychiatric
-Depression
-Psychosis
8-waht are the 2 abx to dx celiac diseaseanti-endomysial antibody and anti-tissue transglutaminase antibody levels
9-what is Precocious pubertyonset of secondary sex characteristics in boys age <9 and girls age <8.
10-how to diffrentiate central from perpheral percocitycentral (true), due to early maturation of the axis and follow the typical pubertal sequence, starting by breast and testicular development.

peipheral ercocity is due to excess sex hormon form idiopathic, neuro malignant, gonads, or adrenal disease.
12porcelain gallbladder cause, management- calcifications within the gallbladder wall due to chronic cholelithiasis.

- increased risk for gallbladder cancer

-often require prophylactic cholecystectomy if they have symptoms of gallbladder disease (eg, biliary colic) or if punctate calcifications are present. Curvilinear gallbladder calcifications minimally increase cancer risk and generally do not require intervention.
13-most frequent complication of transurethral resection of the prostate which done for BPHRetrograde ejaculation
14-how does phencyclidine (PCP) intoxication present and how to manage it- agitated, combative, or bizarre behaviors usually lasting 8 hours and leading to traumatic injuries, hypertension, tachycardia, ataxia, and prominent nystagmus (including horizontal, vertical, or rotary nystagmus).

- Benzodiazepines (eg, lorazepam) are typically used as a first-line treatment. for sever agitation and violent
-Antipsychotics (eg, haloperidol) are typically used as adjunctive therapy when benzodiazepines fail to adequately control agitation but not first line
15-how does BCG vaccine affect PPDinitially it can be positive up to ~20 mm; serial vaccination, reaction generally wanes with time (eg, <10 mm 10 years after BCG vaccine administration).
16- tender, pulsatile mass in the groin after cardiac cath, dx and treatmentcontained hematoma (pseudoaneurysm), caused by inadequate post-procedural manual compression to achieve arterial hemostasis. tender, pulsatile mass with a systolic bruit, and the diagnosis is confirmed by ultrasonography. Small pseudoaneurysms can be treated withultrasound-guided compression or thrombin injection into the pseudoaneurysm cavity. Larger or rapidly expanding pseudoaneurysms are at risk of rupture and should be managed with surgical repair.
17-what vascular accident prevention can be achieved by tight glycemic control in DM-Microvascular complications as nephropathy and retinopathy will be reduced but the Macrovascular complications as acute myocardial infarction, strok is not established yet
18-how does ovarian torsion present-intermittent pelvic pain followed by an acute onset of moderate to severe pelvic pain, nausea, and vomiting. Fever and leukocytosis indicate possible adnexal necrosis.

-First-line imaging is a pelvic ultrasound with color Doppler, which typically reveals an enlarged, edematous ovary with impaired ovarian blood flow.

-detorsion with emergent surgery if necrosis do salpingo-oophorectomy.
19- how to treat actinic keratosis-20% go to SSC so must treat it

-treat with destroyed with liquid nitrogen cryosurgery or by surgical excision or curettage.

numerous small lesions are present; field therapy (an entire region of the body is treated at once), most commonly used field treatment is 5-fluorouracil cream; it is applied to the entire affected area for a period of 3–6 weeks
20- what is Anovulation bleeding, c/p, tttabsence of ovulation, menstrual cycles lack their regular periodicity, present with prolonged vaginal bleeding with passage of blood clots.

ttt:
-if stable give OCP and high does estrogen, if cant take oral give iv estrogen.
-If contraindication for estrogen (DVT) or not stable do dilation and curettage.
21-how to manage and follow gestational diabetes postpartum?-once deliver (no more placenta hormone to increase insulin resistant) all antihyperglycemiac medication should be stoped. however may be the mother has undiagnosed DM and she also has risk to develop DM in the future.

-screen 1-3 days postpartum with fasting blood glucoses
-screen at 1.5-3 months postpartum with a 2-hour oral glucose tolerance test.
-screen every 3 years as they are at increased risk of developing type 2 diabetes mellitus.
22- what is the comlication of imperforate hymen,retrograde menses through the fallopian tubes and lead to intraabdominal adhesive disease. treatment is with a hymenectomy.
23-neurofibromatosis type 1 and 2 presentation-NF-2 AD, Hypopigmented (cafe-au-lait) spots
-NF-1 AD, hyperpigmented cafe-au-lait spots
24-how to treat Pressure (decubitus) ulcersstage 1 and 2 just keep moist with dressing
stage 3 and 4 need debridement of devitalized (ie, necrotic) tissue, and specialized wound dressings
25-wt is tick paralysis.-Tick paralysis is a rare, potentially life-threatening disorder caused by Rocky Mountain wood tick
-Neurotoxins in the tick saliva are transmitted to the host over 4-7 days of tick attachment and result in:
1-A brief prodrome of fatigue and paresthesias
2-Gait ataxia and ascending paralysis that develop over hours
3-Absent deep tendon reflexes
4-Fever is typically absent and sensation is rarely affected. Laboratory and imaging studies are usually normal.

Dx
-Patients with suspected tick paralysis require a meticulous skin examination to identify the tick.

ttt
-Tick removal eliminates the precipitating neurotoxin and usually results in significant clinical improvement within a few hours
26-Ecthyma gangrenosumPseudomonas aeruginosa bacteremia in patients with immunocompromise (eg, neutropenia, immunosuppressant medications), it is common with central line

-present with painless, red macules that rapidly progress to pustules/bullae and then quickly evolve into gangrenous ulcers with raised violaceous margins.
-The anogenital area, axilla, and extremities are most commonly multiple lesions may occur. Fever and signs of systemic illness are typically present.

-ttt by 2 antipseudomonal as beta-lactam (eg, piperacillin-tazobactam) and aminoglycoside (eg, gentamicin).
27Childhood absence epilepsy
c/p, dx, associated conditions, and ttt
1-Clinical features
Sudden impairment of consciousness (staring spells)
Preserved muscle tone
Unresponsive to stimulation
Short duration (<20 seconds)
Simple automatisms frequent
Provoked by hyperventilation
Many episodes per day

2-Diagnosis
EEG: ~3 Hz spike & wave discharges

3-Comorbidities
Attention deficit hyperactivity disorder
Anxiety
Depression

4-Treatment
-Ethosuximide
-spontaneously remits by early puberty with no major long-term sequelae.
28-how to treat HCV infection1-sofosbuvir-velpatasvir
2-prevent further liver damage.
- vaccination against HAV and HBV if they do not have preexisting immunity.
3-counseling on substance abuse and alcohol cessation.
4-screening for complications and comorbidities, including liver fibrosis, renal disease, and extrahepatic manifestations (eg, cryoglobulinemia).
29 DiphtheriaEpidemiology
Toxigenic strains of Corynebacterium diphtheriae
Children age <15
Diphtheria toxoid vaccine significantly ↓ risk

Manifestations
Fever, malaise, sore throat
Pharyngitis – grey patches/pseudomembrane (bleeds with scraping)
Cervical lymphadenopathy
Toxin-mediated myocarditis, neuritis, kidney disease

Diagnosis
Culture from respiratory secretions
Toxin assay (to prove toxigenic)

Treatment
Erythromycin or penicillin G
Diphtheria antitoxin (if severe)
30- varicella-zoster virus (VZV) timing, containdication and how to manage if one of the family is postransplant-live-attenuated vaccine that is administered typically in 2 doses: the first at age 12–15 months and the second at age 4–6 years.
-the presence of posttransplant patient at the home of the vaccinate pt is not containdicatin for vaccination.
-after vaccination one should monitor for the developnet of rash. if rash appears give the postransplant family member a dose of Varicella immunoglobulin (VariZIG)

the absolute containdication for this vaccine is
-anphylaxis to neomycin
-anphylaxis to gelatin
-pregnancy
-immunodeficient
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