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ismailalmokyad's version from 2018-01-22 16:13

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Question Answer
1-What is Genetic information nondiscrimination act that was started in 2008?.Employers and health insurance are prohibited from requesting genetic information or requiring a person to be tested. It is also illegal for them to discriminate on the basis of this information.
2- Peutz-Jeghers syndrome(AD) most common cause of death-intussusception (MC cause of mortality)
3- what is gardner sydrome, turcot syndrom, and juvenile polyposisgardner syndrom is colon cancer and osteomas, desmoid, other soft tissue cancer
-turcot syndeome is colon cancer and brain cancer

-JP is colon cancer and multiple hamartomatous polyps
4-What is the treatment of unstable angina/NSEMI?1-dual antiplatelet
2-nitrates
3- BB
4-statins
5- anticoagulant
5-How does secondary hyperparathyroidism developed in CKD?decrease conversion of Vit D decrease Ca+ intestinal absorption and retention of phosphate will also lead to low Ca+, low Ca+ in serum will increase PTH synthesis and lead to secondary hyperpara
6-What is the characteristic labs for secondary hyperparthyroidism ?1-high PTH
2-high Pho
3-low Ca+
4-low 1,25 Vit D.
7-What is tertiary hyperparathyroidism ?with prolong secondary hyperparathyroidism lead to autonomous PTH secreation unresposive to rising calcium level, resulting in hypercalcemia with very high PTH. it associated with bone pain and elevated ALP.
8-what are the indication for parathyroidectomy in tertiary hyperparathyroidism1- persistently elevated Ca+ >10.5, pho, or PTH>800
2- soft tissue calcification of calciphylaxis(vascular calcifiacation with skin necrosis)
3- intractable bone pain or pruritus.
9-posterior urethral valve, cp,-it congenital obstruction of the urethra caused by residual embryologic tissue during genitourinary development in boys.

-c/p
-most identified on antenatal ultrasound, which shows
1-bilateral hydronephrosis
2-thickened and dilated bladder (highly specific)
3-dilated proximal urethra.
-if sever oligohydramnios can result and lead to Potter sequence (pulmonary hypoplasia, flattened facies)
-It can cause recurrent UTI.

Dx: confirmed using a voiding cystourethrogram (VCUG), mainly by visualization of a dilated proximal urethra when the catheter is removed

ttt:
1- place foley
2-when stable cystoscopy allows direct visualization and ablation of the valve, which is curative.
10- what is contrast-induced nephropathy (CIN), why it happen and who is at risk and how to prevent itrefers to AKI seen within 2-3 days of contrast exposure and lasts about 5-7 days. Contrast-induced renal vasoconstriction and to prevent stop all nephrotoxic meds, give fluid before and after contrast.

2-Risk Factors
-CKD with GFR <40 and Cr >1.5
-volume depletion
11-what is subclinical hypothyroidism and when it should be treated-mild elevation in TSH levels (5 to 10) accompanied by normal free T4 levels

-treat if
1-antithyroid antibodies
2-an abnormal lipid profile
3-symptoms of hypothyroidism
4-ovulatory and menstrual dysfunction.
5-TSH became >10
12- anorexia nervosa diagnostic criteria and indication for hospitalization1-Diagnostic criteria
-Significantly low weight for age & sex, BMI <18
-Intense fear of weight gain
-Distorted views of body weight & shape

2-Indications for hospitalization
-Hemodynamic instability:
*****-Pulse <40/min
*****-BP <80/60 mm Hg or lightheadedness
*****-Orthostatic changes
*****-Hypothermia
-Refeeding syndrome:
-Electrolyte derangements
-Dysrhythmia
-Severe edema
-<70% of expected weight or BMI <15 kg/m2
-Acute food refusal
-Suicidality, psychosis
13-c/p of prolactinoma, dx, treatmetnc/p and associated conditions
1-premenopausal women
-olig/amenorrhea, infertility, galactorrhea, hot flushes, osteoporosis(bc it decrease GnRH so decrease LH,FSH so as if she is in menopause)
2-postmenopausal
-mass effect symptoms
3-Men
-infertility, decrease lipido, impotance, gynecomastia.

lab/imaging
-serum prolactine level >200
-rule out renal insufficiency(Cr), hypothyroid (TSH)
-MRI will see the mass

ttt
-dopaime agonist (cabergoline or bromocriptine)
-trans-sphenoidal surgery if no response to meds or mass symptos.
14-toxic shock syndrom c/p, cause, ttt1-hx of foreign bodies as nasal packing or tamponed
2-present with prodrome of fever, chills, and myalgias that evolves into a multisystemic syndrome (eg, hypotension and shock with dermatologic, gastrointestinal, muscular, renal, and/or neurologic findings), some time cane evolves within hours.

Its almost alway 2/2 staph aureus that secrets exotoxin called TSS toxin-1 that lead to widespread activation of T cell which lead to massive cytokine production.

ttt by:
1- remove foreign body
2-extensive fluid replacement (can reach 20L/day)
3-clindamycin(theoretically prevent toxin synthesis)
4-with or without antistaph as vanco, oxacillin or nafcillin (if staph ongoing infection is suspected)
15- skin cellulitis and abscess mc bacteria, c/p, ttt1-cellulitis caused most commonly by strep pyogenes, present as poorly demarcated inflammation, involving deep dermis and SC fat -/+ fever, treatment with MRSA cover if fever or risk factor (hx of MRSA or recent hospitalization)

-abscess mostly 2/2 staph aureus, present with fluctuant, tender nodule, collection of pus within dermis or sc fat -/+ surrounding cellulitis, -/+ fever. Treatment with incision and drainage and systemic MRSA cover if >2 cm or associated with cellulitis). no abx if no cellulitis, fever and <2 cm
16- Refeeding syndromeit is a potentially fatal complication of refeeding (enteral or IV) with nutrition after longe starvation. usually during the first 2 weeks of refeeding .

after feeding with carbohydrates pt will start to release insulin that will drive pho intracellular (to be used for ATP) this may resulting in life life-threatening hypophosphatemia. Potassium, magnesium, and thiamine are also rapidly deleted.

-CHF can develop from a weak, atrophic heart that cannot handle fluid and electrolyte shifts. Patients may develop pulmonary and peripheral edema.
-Inadequate ATP and thiamine contribute to tissue hypoxia, resulting in myocardial dysfunction.
- Hypokalemia and hypomagnesemia predispose to arrhythmias

Management with
1- empiric thiamine repletion and correction of electrolyte abnormalities, especially hypophosphatemia, prior to starting feeds.
2-Caloric intake must be increased gradually with vigilant electrolyte monitoring.
3-Oral phosphate therapy is preferred over the intravenous route as the latter can lead to life-threatening hyperphosphatemia (eg, hypocalcemia, acute renal injury, arrhythmias).
17-what is the most common cause of gastroenteritis in adult and children and how does it present-Norovirus
-spread via fecal-oral contamination
-Norovirus can cause the following:
1-Asymptomatic infection
2-Fever with watery diarrhea - noninflammatory small-bowel process
3-Severe illness - fever, vomiting, headache, and other systemic symptoms

-ttt supportive
18-borderline personality disorder (BPD) c/p-marked instability in mood, self-image, impulse control, and relationships.
-extremes of idealization and devaluation (splitting) as demonstrated by white or black.
-Acute depression, intense anger, and suicidal threats and behavior are often triggered by feelings of rejection(unlike primary mood disorder, this pt mood shift happens in response to stressors and typicaly last for few hours)
-pt has poor response to antidepressients.
-Psychotherapy is the first-line treatment, best evidence for dialectical behavior therapy (DBT) for approximately one year.
19-wt are the common hereditary colorectal cancer syndroms and what cancer usually associated with them, when to screen them1-Hereditary nonpolyposis colorectal cancer (Lynch syndrome)
-Endometrial cancer
-Ovarian cancer
-Gliomas (brain and spinal cord)
-screen at age 25 and every 3-5 years.

2-Familial adenomatous polyposis(AD)
-Upper gastrointestinal cancer
-Thyroid cancer
-Desmoids (connective tissue present as deep painless masses, usually reoccur after removal)& osteomas(bone or eye cancers) if present called gardner syndrome
-Medulloblastoma(base of the skull)
-screen at age 12 ever 1-2 years

3-Peutz-Jeghers syndrome(AD)
-start as hyperpigmented macules on the lips and oral mucosa (melanosis)
-Hamartomatous polyps all over GI but rarely convert to cancer
-risk of cancers include
1--Upper gastrointestinal cancer
2--Breast cancer
3--Pancreatic cancer
4--testicular and ovarian cancer
20-familial adenomatous polyposis (FAP) causes, c/p, associated conditions and screening guidlins ?-caused by mutations in the adenomatous polyposis coli tumor suppressor gene.
-present as develop >1,000 polyps. Polyposis typically begins in the second or third decade of life, and symptoms preceding colon involvement are often vague and nonspecific.

1-almost all pt develops cancer by age 45, so begin screening for colon cancer with sigmoidoscopy or colonoscopy starting at age 10-12, followed by annual

2-increase risk of gastric and duodenal tumors, screening upper endoscopy should be performed at the time of diagnosis and repeated every 3-5 years.

3-has increase risk of follicular and papillary thyroid neoplasms (they do not change TSH), do annual thyroid ultrasound screening
21-wt cause hereditary nonpolyposis colorectal cancer (HNPCC) (Lynch syndrome)-microsatellite instability due to a mutation in DNA mismatch repair genes
22-when to test pt post possible HIV exposure-first treat with antiretroviral therapy for 4 weeks
-repeat testing at 6 weeks and 4 months to evaluate for seroconversion.
23- febrile seizure risk factor, dx criteria, management, and prognosis1-Risk factors
-Fever from mild viral/bacterial illness
-Family history

2-Diagnostic criteria
-Typically age 3 months to 6 years(due to nervous system immaturity)
-No previous afebrile seizure
-No meningitis or encephalitis
-No acute metabolic cause

3-Management
-Abortive therapy (>5 minutes)
-Reassurance

4-Prognosis
-Normal development/intelligence
-~30% risk of recurrence
-<5% risk of epilepsy
24-positive Babinski is normal until wt age?normal until age 2.
25- untreated HIV has widespread skin papules with umbilication, wt is the cause, wt CD count,c/p,dxcutaneous cryptococcosis caused by Cryptococcus neoformans is an encapsulated yeast
-affect pt CD<100
-lesions tend to arise quickly and mainly affect head and neck, present as papules with central umbilication resemble molluscum contagiosum, A small area of central hemorrhage or necrosis is an important diagnostic clue.
-Disseminated infections also often affect the liver, lymph nodes, peritoneum, adrenal glands, and eyes.

dx by skin biopsy histopathological examination after staining (eg, periodic acid-Schiff or Gömöri methenamine silver nitrate) typically reveals hyperplasia of the overlying dermis with underlying granulomas surrounding encapsulated yeasts.

ttt: exactly like maningitis one treated with >2 weeks of intravenous amphotericin B and oral flucytosine followed by a year of oral fluconazole (higher dose for 8 weeks, then maintenance).
26- how does Disseminated Mycobacterium avium complex present in hiv ptin patients with advanced AIDS that usually manifests with fever, night sweats, abdominal pain, diarrhea, and weight loss (no skin lesions)
27-pt who has hyperactive deep tendon reflexes post surgery, wt is the most common cause ?hypocalcemia occurs post surgery due to volume expansion and hypoalbuminemia,
28-wt is hand-foot-mouth disease, cause, c/p and management1-cause
-Coxsackievirus infection
-Direct contact with respiratory, oral, vesicular secretions
-Fecal-oral transmission
-spread quickly through daycare centers, schools, and camps.

2-Clinical features
-Fever, malaise, poor oral intake
-Painful vesicles/ulcers on anterior oral mucosa
-Macules/papules/vesicles on palms, soles, buttocks

3-Management
-Supportive: Hydration, pain control
-self-resolve within a week
-handwashing is extremely important as the virus can be contagious for several weeks after rash resolution.

NB: herpangina is caused by coxsackievirus A, present with similar symptoms but the oral ulcers are located posteriorly in the oral cavity
29-wt is roseola infantum and how it presetn1-Caused by Human HSV 6
2-high fever followed by the appearance of a rash once the fever resolves.
3-Rash begins on the neck/trunk and it is extensive and red
30-common s/e of CCB1- most common peripheral edema (usually after 6 months of ttt)
2-headache
3-flushing
4-dizziness.
memorize

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