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ismailalmokyad's version from 2018-01-22 23:36

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Question Answer
1-What is adolescent idiopathic scoliosis?.Most common type of scoliosis. During puberty, a period of rapid growth, the spine may grow asymmetrically, resulting in a lateral curvature of the spine
2-How to Dx Scoliosis?1-Thoracic or lumbar prominence on forward bend test is the most sensitive examination finding for scoliosis.

2-If positive then scoliometer is placed along the spine, measuring the angle of trunk rotation. Spinal rotation ≥7 degrees (or ≥5 degrees in overweight children) may suggest clinically significant scoliosis.

3-Abnormal scoliometry or obvious deformity on examination necessitates poster-anterior and lateral x-rays of the spine to confirm the diagnosis.
3-When to do MRI on evaluation of scoliosis.if Secondary cause of scoliosis (eg, tumor, spina bifida) is suspected based on red flags such as pain, rapidly progressive scoliosis, or neurologic deficits (eg, weakness, abnormal reflexes).
4-What is the clinical significant of posteroanterior and lateral x-rays in evaluating scoliosisto measure cobb angle, if < 10 considered a variant of normal and require no follow up unless pain or neurological symptoms).
5-How to treat scoliosis1-Xray cobb angle >10 is positive, then assess for risk for curve progression, if low/mild risk use back brace. if high surgery

2-xray cobb angle > or equ to 40 require surgical evaluation of spinal fusion.
6-What is the complication of sever untreated scoliosis?1-Chronic back pain
2-Neurology symptoms
3-Pulmonary compromise
7-what cause sporotrichosis?caused by dimorphic fungus found in soil and decaying plant matter, affect ppl engage in outdoor activities.
8-How does sporotrichosis present?Painless papule at the site of inoculation, which soon ulcerates and drains a non-purulent, odorless fluid. Over days, similar lesions usually develop along the proximal lymphatic chain
9-How to dx sporotrichosis and how to treat it?-dx with hx and physical are sufficient but cx from fluid are typically obtained.

-TTT with 3-6 months of itraconazole.
10-What is blastomycosis and how to treat itFungal infection that primarily affects the lungs (pneumonia) but may cause verrucous skin lesions with heaped-up borders
-incubation is 20-100 day
- with antifungal for 6 months and recovery is usually complete.
11-what is cervicofacial actinomycosis ?-bacterial infection near the jaw.
-c/p: slow-growing, non-tender mass that evolves into multiple abscesses, fistulas and sinus tracks that drain thick, yellow, serous discharge and granules.
12-what is coccidioidomycosisFungal infection that primarily affects
1-lungs (community-acquired pneumonia)
2-central nervous system
3-may occasionally skin soft tissue abscesses
4-erythema nodeosa

usually self limited, but can cause disseminated infection in immunodeficient, pts need treatment with ketoconazole
13-What is Histoplasmosis? what is disseminated histoplasmosis?-Fungus that primarily affects the lungs but may occasionally cause a progressive extrapulmonary infection.

-Disseminated histoplasmosis may be associated with nodular, papular, or plaque-like skin lesions, usually have systemic symptoms (eg, fever, fatigue, weight loss) and are clinically ill.
14-when to expect paradoxical emboli and how to confirm dx ?-In pt with DVT developed stroke
-dx by transthoracic or transesophageal echocardiogram with a bubble study will reveal such an intracardiac shunt.
15-What is epidemiology of Vibrio vulnificusGram-negative, free-living in marine environments human affected post ingestion (oysters) or wound infection

***↑ Risk in those with liver disease*** (cirrhosis, hepatitis)
16-What is manifestations for vibrio vulnificus?1-Rapidly progressive septic shock (often <12 hours)
2-bullous lesions
3-Cellulitis
4-hemorrhagic bullae
5-necrotizing fasciitis
17-How to dx and treat vibrio vulnificus1-Dx with hx and physical
2-Blood & wound cultures

-Treatment is empirical as highly fatal, treat with Intravenous ceftriaxone and doxycycline
18-who is high risk patient for colorectal cancer ?1-First-degree relatives diagnosed before age 60 with colorectal cancer or advanced adenomatous polyps (size >1 cm, villous features, or high-grade dysplasia).

2-Patients with >2 first-degree relatives with colorectal cancer or advanced adenoma at any age.
19-Pain and tenderness at the anatomic snuffbox after falling on outstretched hand.Scaphoid fracture, which is the most common carpal bone fracture, caused by forceful dorsiflexion at the wrist.
20-How to dx scaphoid fracturex-rays of the wrist in full pronation and ulnar deviation to better expose the scaphoid.

Initial x-rays can be negative if the fracture is compressed or minimally displaced.
21-how to dx pt with scaphoid fracture who has normal hand xray?1-MRI (or CT scan) of the wrist
2-Repeat radiographs in 7-14 days
3-Radioscintigraphy bone scan in 3-5 days
22-what are the indications for surgery in scaphoid fracture ?1-tilt of the lunate
2-fracture displaced >1 mm
3-nonunion during follow-up
4-osteonecrosis
5-scapholunate dissociation
23-What are the most common complication of scaphoid fracturenonunion and avascular necrosis due to compromise blood supply. Proximal fractures of the scaphoid require longer immobilization (up to 12 weeks) for adequate healing.
24-how does alcoholic ketoacidosis present (c/p) and labs?-AMS
-ketonuria
-normal or mildly elevated glucose
-increased anion and osmolar gap.
25-how to treat alcoholic ketoacidosisdextrose normal saline (without insulin) and iv thiamin.

dextrose lead to increase insulin secretion which lead to the metabolism of ketone bodies to bicarbonate.
26-what is the most sensitive antibody to detect SLEanti-dsDNA
27-wt is most sensitive antibody for CREST (variant of scleroderma)anti-centromer antibodies
28-wt is most sesitive antibodies for primary biliary cirrhosis (PBC)Anti-mitochondrial antibodies
29-what antibodies correlate with SLE disease activity and can be use for follow up course of diseaseant-dsDNA, it is also associated with higher risk of developing lupus nephritis.
30-how to confirm a diagnosis in patient with suspected SAHCt head if negative (the case in 10% cases) then do LP looking for xanthochromia (diagnostic )
31-how to manage opioid withdrawal symptoms-If welling to be enrolled in a program then methadone
-If not then clonidine, antiemetics, diarrhea and benzos)
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