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ismailalmokyad's version from 2018-01-22 22:04

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Question Answer
1-What is acquired long QT syndrome (LQTS) ?It developed as result of interaction between medications as Sotalol and azithromycin.
2-How does Torsades de pointes usually starts on the tele ?it commonly precipitated by premature ventricular beats followed by compensatory pause(short-long RR intervals). It can also provoked in pt with bradyarrhythmias(sinus or pauses) referred to as pause-dependent LQTS
3-How to treat patient who had a brief Torsade that terminates spontaneously?recurrence is high and IV magnesium sulfate should be given to avoid vfib and death.
4-How to deal with selective estrogen receptor modulator (raloxifene and tamoxifen) before surgery?It increase VTE and should be discontinued 4 weeks prior to surgery.
5-How does tricyclic antidepressant overdose present ?1-CNS (AMS, delirium, coma, seizures.
2-Resp depression.
3-Anticholinergic effect (dry mouth, blurred vision, dilated pupils, flushing, hyperthermia and urine retention),
4-Cardiotoxic effect, as sinus tachy, hypotension, and arrhythmias)
6-What is the most common cause of death in TCA overdose?cardiotoxic effect as arrhythmias(as result of inhibition of fast sodium channels in his-purkinje tissue which prolong QT)
7-How to treat TCA overdose ?Sodium bicarbonate, it increase serum PH and increase serum sodium. which affect the TCA binding to fast channel and in turn prevent arrhythmias .
9-How to manage blunt thoracic trauma?FAST (focused assessment with sonography in trauma)
10- what lung cancer can cause SIADH and what cancer associated with PrHPT.-SIADH-Small cell carcinoma
-PrHPT-Squamous cell carcinoma
11-how does different lung cancer present on imaging1-Mesothelioma- dyspnea and chest pain, and CXR shows nodular thickening of the pleura and/or obscuring of the diaphragm.

2-Large cell carcinoma (10-15%), on CXR large peripheral mass. Symptoms may include cough and dyspnea. Severe pain may be reported if the parietal pleura or chest wall are infiltrated.

3-Squamous cell carcinoma (25-30%), on CXR: cavitary lesion in a bronchus(central). Symptoms may include cough, dyspnea, wheezing, hemoptysis, and hypercalcemia due to parathyroid like hormone production.

4-small cell carcinoma, Chest x-ray: perihilar mass (central).
12-how to treat hyponatremia 2/2 SIADH1-first water restriction
2-if associated with sodium deficit then add sodium intake, may try diuretics.
3- if all fail then give Demeclocycline (preferred bc less toxic) or lithium to block ADH effect on collecting tube
13- wt cause dumping syndrome, wt is c/p and how to treat itit is a complication of gastrectomy.

C/P liquid and food passage faster into the jejunum. This leads to abdominal pain, diarrhea, nausea and vomiting, as well as some neurovegetative symptoms such as dizziness, generalized sweating, flushing and dyspnea.

TTT: A change in the diet usually relieves the symptoms. A high protein diet, and fractionated, smaller, but more frequent food portions are advised.
14-Infectious mononucleosis cause, c/p, dx, ttt1-Etiology
-Epstein-Barr virus most common

2-Clinical features
-Fever
-Tonsillitis/pharyngitis ± exudates
-Posterior or diffuse cervical lymphadenopathy
-Significant fatigue
-± Hepatosplenomegaly
-± Rash after amoxicillin

3-Diagnostic findings
-Positive heterophile antibody (Monospot) test (25% false-negative rate during 1st week of illness)
-Atypical lymphocytosis
-Transient hepatitis

4-Management
-Avoid sports for >3 weeks (contact sports >4 weeks) due to the risk of splenic rupture
-hydration, nutrition, avoidance of strenuous activity
-NSAID or acetaminophen relive pain
-pt admission and corticosteroids in rare cases when airway obstruction appears imminent.
15-wt is monospot test and wt is paul bunnell testheterophile antibody found in nfectious mononucleosis and agglutinate with erythrocytes from unrelated species (eg, horse erythrocytes in the Monospot test, sheep erythrocytes in the classic Paul-Bunnell test).
16-indication of corticosteroid to treat infectious mononucleosis1-immunocompromised.
2-serious complications:
-aplastic anemia.
-thrombocytopenia.
-overwhelming infection.
3-airway obstruction appears imminent; pt should be admitted and given steroid. (warning signs, SOB while recumbent, tachypnea, and inability to swallow)
17-HIV-associated thrombocytopenia (HIV-TP)is thrombocytopenia associated with HIV and usually asymptomatic and usually no bleeding bc rarely <50000 platelet. usually response very well to ART therapy
18-wt is virologic failure in HIV wt cause it , and what viral load represent a good response to ART therapyVirologic failure is defined as a failure to achieve a viral load (VL) <200 copies/mL within 24 weeks (6 months) of antiretroviral therapy (ART) and may be due to drug resistance or noncompliance.

-After initiating ART therapy viral load expected to decrease as the following
<5,000 copies/mL by 4 weeks (logarithmic drop)
<500 copies/mL by 4 months
<50 copies/mL by 6 months
19-in anaphylaxis reaction is it faster to give epinephrin IM or SCIM
20-subchorionic hematomas causes, c/p, rf,ttt, complication1-Etiology
-Separation of chorion(outer amniotic membrane) from the uterus, so blood between gestational sac and the uterine.

2-Clinical presentation
- most of the time it is incidental finding on ultrasound: Blood collection by gestational sac
-rarely it present with vaginal bleeding

3-Risk factors
-Infertility treatment
-Anticoagulation
-Uterine anomalies
-Recurrent pregnancy loss

4-Management
majority of patients with subchorionic hematomas have uncomplicated pregnancies, and management is expectant; patients can be followed with serial ultrasounds to help provide reassurance.

5-Complications are very rare and can present as
-Spontaneous abortion(<20 week)
-Abruptio placentae
-Preterm premature ROM
-Preterm delivery
21- wt is the primary physical exam finding in patient with pseudotumor cerebri. and how to confirm dx if neededpapilledema, so an ophthalmoscopic examination should be done when dx suspected

LP after imaging (exclud LP contraindication by ct), opening pressure greater than 20-25 cmH2O can help to confirm the diagnosis
22-how to manage pt with nicotine withdrawal symptoms (quite smoking)initial approach for patients wishing to quit smoking is a combination of behavioral and nicotine replacement
2-can use bupropion (contraindication is seizure and eating disorders)(good to decrease weight and for depression)
3-Vareniciline is more effective that bupropion or NRT but possible increase risk of cardiovascular events. it is a must to exclude any active psychiatric issue before starting varenicilline
23-Postoperative atelectasis when does it manifest and how to dx it and how to manage it2-5 days postoperatively; when symptomatic
1-increased work of breathing
2-hypoxemia.
3-ABG results typically reveal an increased alveolar-arterial gradient due to intrapulmonary shunting.
4-Chest x-ray characteristically shows linear opacification in the bilateral lung bases, sometimes with an accompanying shift of structures toward the opacification (if the atelectasis is large).


ttt
1-minimal respiratory secretions, CPAP is often effective.
2-However, those with more copious secretions, such as this patient with cough productive managed with aggressive pulmonary hygiene, including chest physiotherapy and suctioning, rather than CPAP.
24-what is the most common cause of hemoptysisinfection is by far the most common 70%
25-how does bronchiectasis cause hemoptysismucosal inflammation leading to rupture of superficial blood vessels
26-chikungunya fever cause, c/p, dx, ttt-mosquito-borne virus endemic to parts of West Africa ransmission occurs via the Aedes mosquito, which also transmits dengue fever and Zika virus.

c/p
-high fever for 3-5 days followed by sever disabling polyarthralgias, bilateral and symmetric and involve distal joints more than proximal joints.
-incubation period: 3-7 days
-Headache, myalgias, conjunctivitis, maculopapular rash (raised and spotted)
-Lymphopenia, thrombocytopenia, elevated liver enzymes

Dx:
made by polymerase chain reaction

ttt: supportive with fluid, pain meds and acetaminophen. Most cases resolve spontaneously within 1-2 weeks, but approximately 30% of patients develop chronic joint symptoms may require methotrexate
27-Ehrlichiosistick-borne bacterial illness characterized by
1-nonspecific symptoms (eg, malaise, headache)
2-nausea, vomiting
3-cough
4-arthralgia may occur

Most patients also have significant laboratory abnormalities (eg, leukopenia, thrombocytopenia, elevated aminotransferases).
28-Typhoid fever-bacterial Salmonella.
-Manifestations progress slowly and begin with a week of fever (often with temperature-pulse dissociation)
-followed by abdominal pain and cutaneous "rose spots."
-By week 3, hepatosplenomegaly, intestinal bleeding, and intestinal perforation often occur.
29-Cystic fibrosis cause, affected organ, and how to treat pneumonia if developed-AR high in Caucasian population
-pulmonary disease is the major cause of morbidity and mortality.
-Staphylococcus aureus and Pseudomonas aeruginosa are the 2 principle pathogens. so if pneumonia treat with vanc and 2 medication to cover P aeruginosa.
-also affect pancreas insufficiency and GI (meconium ileus), mail infertility

NB antipseudomonal as:
1-Cefepime and ceftazidime
2-amikacin and tobramycin (aminoglycosides)
3-carbapenems
4-certain fluoroquinolones
4-aztreonam,
5-colistin.
30-what fevers cause temperature-pulse dissociationtemperature-pulse dissociation is when HR doesn't increase 8 beat per 1 Celsius, can be seen n typhoid fever and yellow fever
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