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ismailalmokyad's version from 2018-01-27 19:47

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1-kalmann syndromno breast, no uterus, delayed or absent puberty and an impaired sense of smell. present early with small penis and cryptorchidism or primary amenorrhea. No GnRH cell so low FSH/LF
2-wt are the causes of delayed puberty in boys1-Primary hypogonadism
-Klinefelter syndrome

2-Secondary hypogonadism
-Constitutional
-chronic illness
-malnutrition
-Hypothyroidism
-hyperprolactinemia
-Kallmann syndrome
-Craniopharyngioma
3-what are the c/p of delayed puberty in boys and wt is the intial work up1-Clinical features
-Absent testicular enlargement by age 14
-Delayed growth spurt

2-Initial workup
-FSH, LH, testosterone
-TSH, prolactin
-Bone age radiograph.

NB:
-TRH(increase prolactin) and prolactin decrease the release of GnRH
-dopamine increase GnRH, so dopamine agonist as antipsychotic will decrease GnRH
4-wt is the difference between primary and secondary hypogonadism-primary is failure of the gonadal (elevated FSH/LH)
-secondary is failure of GnRH release (low to normal FSH/LH)
5-wt is the most common cause of delayed pubertyconstitutional delay which is late maturation of the hypothalamic-pituitary-gonadal axis
6-wt is the hemoglobin level that indicate anemia in pregnancy<11 g/dL in the first trimester
<10.5 g/dL in the second trimester
<11 g/dL in the third trimester
7-who is at risk of acquiring HIV post exposure during health care 1-high risk exposure as -percutaneous injury from contaminated needlestick or sharp objet. - mucous membrane as eye or nonintact skin exposure to infected body fluid. 2- the fluid must be high risk too as -high risk with blood, fluid containing blood, semen and vaginal secretion. -possible risk wiht CSF, synovial, pleural, pericardial and amoniotic fluid. NB: body fluid without blood has no risk as urine, vomiting, feces, tears.
8-wt is the recommendation for prostate screeningit is a slow growing cancer, screening is not recommended <55 year old or >70 year old. it also should not be done if life expectance is <10 years. for men age 55-69 one should do PSA (rectal exam is not recommended any more)
9-how does urinary schistosomiasis present, dx and tttit is common in Africa, usually pt is asymptomatic, however may present with urinary symptoms, terminal hematuria, and peripheral eosinophilia, may be with anemia(chronic blood loss). it is a parasitic that infect human from contaminated water. Diagnosis requires the identification of eggs using urine sediment microscopy.

***Treatment with praziquantel is usually curative.
10-wt is vulvodynia, and wt is the treatmentis idiopathic burning vulvar pain > 3 months with normal physical exam. exam has positive q-tip test and pain with labial separatioin, pt manily has dyspareunia and avoid wearing tight fitting clothing. it is a diagnosis of exclusion.

-can be associated with fibromyalgia, IBS, and depression.

-ttt with physotherapy and cognitive behavioural therapy, if both failed one can try Botulinum neurotoxin-A injection (2nd bc it associated with dysphagia and respiratory blockade
11-white area in the valvar areit is lichen sclerosus, lichen planus, or psoriasis treat with topical clobetasol. high steroid. present with intense vulvar pruritus in perimenopausal patients.
12-when does a normal child walks 9-16 months,
13-when does the child rolle6 months
14-how many words should the child say at age 2 year >50 words, should be able to form a sentence of 2 words
15-how to treat acute cholangitis1-aggressive IV fluid.
2-blood cx.
3-broad Abx (eg, piperacillin/tazobactam or ciprofloxacin with metronidazole).
4- ERCP within 24-48 hours
16-how to manage breast simple cyst-if asymptomatic hands off.
-if symptomatic do FNA, If the cyst fluid is nonbloody and/or the cyst resolves after aspiration repeat U/S in 4-6 weeks. if bloody or cystic on US then biopsy to exclude cancer
17-what is the best first step in managing pt not complaint with medications as open ended question, may be he has S/E, or cant pay the medicatioin.
18-wt is the contraception potions and their efficacy-Intrauterine device >99%
-Implant >99%
-Female sterilization >99%
-Male sterilization >99%
-Injection 94%
-CHCs 91% (combined hormonal contraception)
-Condom 82%
-Withdrawal 78%
19-how to treat carbon monoxide poisoning-high-flow 100% oxygen;
-more severe cases may require mechanical ventilation or hyperbaric oxygen therapy.
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