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ismailalmokyad's version from 2018-01-22 22:52

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Question Answer
1-what is tubo-ovarian abscess c/p?is a complication of PID may present as
1-pelvic pain
2-adnexal mass
3-fever
4-leukocytosis.
2-what is Uterine sarcoma? how it present?-leiomyosarcoma is a rare gynecologic malignancy associated with a history of pelvic radiation and tamoxifen use.

-Typical presentation is with
1-postmenopausal or abnormal uterine bleeding
2-Irregularly shaped rapidly enlarging uterus.
3-how treat Endometriosis?Treatment is with
1-NSAIDs
2-oral contraceptives
3-GnRH agonists(Leuprorelin, Leuprolide)
4-surgical resection.
4-How to evaluate a pt with painless monocular vision loss and how to treat and wt is prognosismostly 2/2 central retinal artery occlusion

1-exclude giant cell arteritis (ESR,CRP)
2-carotid artery imaging
3-cardiac evaluation(cardioembolic source)

ttt
1-cause irreversible retinal damage within 90-100 minutes.
2-urgent ophthalmology consultation
3-interventions to lower intraocular pressure (eg, ocular massage, anterior chamber paracentesis, intravenous acetazolamide or mannitol).
4-Long-term management lipid-reducing and antiplatelet agents

-Prognosis is poor in patients with severe vision loss at the time of presentation.
5-Central retinal vein occlusion, c/p and exampainless, acute, or subacute monocular vision loss, may be asymptomatic

-Examination can show tortuous and dilated veins, diffuse hemorrhages, disk swelling, and cotton wool spots.
6-dx of osteomyelitisxray done first, but 55% senstivity and need 2 weeks to be positive.

MRI is 90% sensitive and need only 5 days to be positive, so if pt has symptoms for more than 5 days and mri -ve this is rule out
7- pathogen cause osteomyelitis in DM pt, and how long you should treat-Usually polymicrobial, Staphylococcus aureus are isolated most commonly, but Pseudomonas and anaerobic bacteria (eg, Clostridium) are also frequently involved, particularly when wounds are deep and chronic.

next do bone biopsy with culture and treat for >6 weeks.
8-acute mitral regurgitation causes, c/p, exam, management ?****Etiology
1-Ruptured mitral chordae tendineae from:
-connective tissue disease (eg, Marfan syndrome, Ehlers-Danlos syndrome)
-Mitral valve prolapse
-Infective endocarditis
-Rheumatic heart disease
-Trauma
2-Papillary muscle rupture due to
-MI 3-5 days after the infarct
-trauma

****Clinical features
-Rapid onset of pulmonary edema
-Biventricular heart failure
-Hypotension, cardiogenic shock

****Physical examination
-Diaphoresis, cool extremities
-JVD, pulmonary crackles
-Hyperdynamic cardiac impulse
-Apical decrescendo systolic murmur (often absent)

****Management
-Bedside echocardiogram
-Emergent surgical intervention
9-Ehlers-Danlos syndrome c/pconnective tissue disorder characterized by
1-joint hypermobility,
2-recurrent joint dislocations,
3-hyperextensible skin with easy bruisability
4-delayed healing with atrophic scars.
5 -/+ scoliosis
10-cardiac complication of Ehlers-Danlos syndromeMitral valve prolapse with myxomatous degeneration of the valvular, can lead to rupture of the chordae tendineae and acute mitral valve regurgitation (MR).
11-what is the gens affected in ehler danlos and in marfan syndrome1-Ehlers-Danlos: gen COL5A1 & COL5A2 mutation, AD
2-Marfan: FBN1 mutation AD
12-how to manage pt with toxic thyroid noduleit is hyperactive nodule and pt present with hyperthyroidism
1-first BB for symptoms
2-pretreat with methimazole until thyroid function is normal or close to normal(especially if old or with heart disease)
permanent treatment with surgery or radioactive iodine ablation therapy
13-wt is risk factors, labs, ttt of for iron deficiency anemia in children***Risk factors
1-Prematurity
2-Lead exposure
3-Age <1
-Delayed introduction of solids
(ie, exclusive breastfeeding after 6 months)
-Cow's, soy, or goat's milk
4-Age >1
->24 oz/day cow's milk
-<3 servings/day iron-rich foods

***Diagnosis
1-Screening hemoglobin at age 1
2-Hemoglobin <11 g/dL, ↓ MCV, ↑ RDW
3-after a month of empiric iron supplementation, an increase in hemoglobin ≥1 g/dL supports the diagnosis

***Treatment
-Empiric trial of iron supplementation
-vitamin C facilitates iron absorption
-milk intake to <20 oz
14-wt is lab changes after treating pt with iron deficiency anemia with ironreticulocyte count increase within 1-2 weeks. However it takes about a month for the hematocrit and hemoglobin to increase and a few months to return to regular levels. SO first to improve is RC
15-what is Leriche syndrome and how to manage ittriad of
1-lower-extremity claudication,
2-absent or diminished femoral pulses,
3-and ED.

it is bc of atherosclerosis and usually has risk factors. if suspect it do ankle-brachial index (ABI) if positive do cardiac assessment (stress) before starting ED therapy
16-what is ABO hemolytic disease of neonateinfants with A+ or B+ blood type and mothers with O+ blood type.

The mothers have antibodies against A and B antigens, causing a hemolytic reaction in the newborn when blood is mixed in the peripartum period.
17-lead poisoning RF, C/P, and management***Risk factors
1-Home built before 1978
2-Pica or mouthing behaviors (eg, infants, developmental delay)
3-Sibling with lead poisoning
4-Low socioeconomic status
4-Immigrant or international adoptee

****Clinical features
-May be asymptomatic
-Abdominal pain/constipation
-Cognitive impairment/behavioral problems (eg, ADHD
-Encephalopathy (level >100 μg/dL)

****Management
-Obtain venous sample (if screening performed by capillary sample)
-Environmental surveillance (identify & remove lead sources)
-Notify public health department
-Nutritional counseling
-Chelation therapy if lead level ≥45 ug/dL (doesn't work under 45)

NB:
may have basophilic stippling (cytoplasmic granules within RBCs
may have lead lines in joints xray
may need xray to exclude that child swallow a lead material
18-how to treat Hyperbilirubinemia in children1-Mild (physiologic)
-Maximize breastfeeding (every 2-3 hours)

2-Moderate
-Phototherapy
-Consider formula supplementation, intravenous hydration

3-Severe (bilirubin >20-25 mg/dL)
-patients require aggressive intervention with exchange transfusion
19-what are the indication for ICU admission in DKAsevere DKA (eg, pH <7.1, bicarbonate <5 mEq/L, altered mental status)
20- what is the worse complication occur after treating a DKA and how to prevent itmonitored for signs of cerebral edema such as AMS, lethargy, headache, and vomiting. A head CT should be ordered for patients in whom cerebral edema is suspected.
21-when to do genetic testing for inherited breast cancer-2 1st-degree relatives with breast cancer (including 1 before age 50)
-3 1st- or 2nd-degree relatives with breast cancer
-1st- or 2nd-degree relative with breast and ovarian cancer
-1st-degree relative with bilateral breast cancer
-Breast cancer in a male relative
-Ashkenazi Jewish women with any 1st- or 2nd-degree relative with breast or ovarian cancer
22-how to monitor disease activity in ankylosing spondylitits1. Anteroposterior and lateral views of the lumbar spine
2. Lateral view of the cervical spine
3. Pelvic radiograph, including the sacroiliac joints and hip
4-ESR can also be used.
23-what is the long term complication of ankylosing spondylitisrestrictive lung disease due to the limited costovertebral joint motion and development of apical pulmonary fibrosis.

-no smoking
24-how to prevent progression of ankylosing spondylitis and what is the prognosisRegular aerobic exercises such as swimming, walking, and bicycling improve joint stability, muscle strength, and overall functional status without an increase in the disease activity, also they prevent bone loss

-avoid smoking to avoid lung complication
-keep in mind life expectancy is not reduced with this condition
25-how to manage pt with odynophagia and sensation of fullness after ingestion of foreign body (fishbone)urgent endoscopy should be performed to remove the foreign body and to prevent esophageal perforation.
26-how to manage acute confusional state, also known as delirium in eldersfirst rule out infection UA/Chest xray
then rule out as dehydration, hypo/hypernatremia, infections, hypoglycemia, hypercalcemia, uremia, and liver failure.

if pt danger use haloperidol
27-wt is the most common factor that worsen wrinkles and wt is the treatmentsmoking makes it worse and treatment is Tretinoin as emollient cream
28-Pemphigoid gestationis
causes, c/p, dx, ttt, prognosis
***Pathophysiology
-Autoimmune inflammatory disease
-Antibody reaction to basement membrane

***Presentation
-Occurs during 2nd or 3rd trimester
-Prodromal pruritus
-Periumbilical papules & plaques (looks like tinea)
-Rapid eruption of tense bullae
-Spares mucous membranes

***Diagnosis
-Clinical
-Biopsy if needed

***Treatment
-High-potency topical steroids
-Antihistamines
-if sever or not responsive give oral
***Clinical course
-Resolves after delivery
29-what is Atopic eruption of pregnancydisseminated eczematous or papular rash in patients with a history of atopy (eg, seasonal allergies, atopic dermatitis)
30- Polymorphic eruption of pregnancytypically presents in the third trimester or postpartum. presents with pruritic, erythematous papules that begin within the abdominal striae and often spread to the extremities.
memorize

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