☝️
بالنسبة للبرامج ..هذي لقطة شاشة
من تلفوني ، اتذكر البرامج الذي غالبا
تستفيد منهن..
1-AMBOSS
يجيب لك المواضيع بشكل مرتب
وفيه تجميعات تمام👍
2-Medscape
بتستفيد بالاخص في
جرعة العلاجات وبعض الحسابات..👍
3-PDM
ملخص للمراجع مثل Davidson
وغيره ميزته في بعض المواضيع
بيكون مرتب بحيث تقدر تدخل
سريريا وانت منظم افكارك..👍
4-Wikipedia
الجميع عارفها غالبا اي موضوع تبحث
فيها تعطيك عدا جرعة العلاجات مثلا،
احيانا معلوماتها مابتكن موثوقة
وخصوصا النسخة القديمة
لكن بتستفيد .
بالتوفيق 💐

لا احد يروح لأمين لأن النسخه تفيرست عنده وبتحذف اي فلاش يشتبك عنده
..و وهيب مغلق
الان النسخه موجوده بالفلاش و إن شاء الله نرسلها لكم اذا به غدا دوام .
حجم الملف ١٧ قيقا

اختبار الباطنة مستوى خامس دفعة 17 تاريخ 2019-8-10 ...

1-which of the following is not a known complication of polycythemia vera ?
a- Budd-chiari syndrome
b-erythromelalgia
c-marrow fibrosis
d-aplastic anemia

2-all the following consider as feature of CML except :
a-basophilia
b-massive splenomegaly
c-microcytic hypochromic anemia
d-gout

3-all the following side effect of imatinib except :
a-skin rash
b-fluid retention
c-muscle cramp
d-neutrophilia

4-all the following are features of MF except :
a-massive splenomegaly
b-increase marrow cellularity
c-anemia
d-tear drop cells

5-allthe following are common features of HL except :
a-epitrochlear lymphadenopathy
b- B-symptoms
c- contiguous lymphadenopathy
d- pel-ebestein fever

6-all the following are of poor prognosisly of NHL except :
a-  age > 60 yr
b- stage lll or lV
c-low srum LDH
d- more than one extra lymphatic site

7-which of the following is most curable in AML ;
a-M0
b-M1
c-M3
d-M4

8-the managment of acute painful episode of sick cell pt include the following except :
a-hydration
b- analgesic
c-oxygen administration
d-antibiotic if there infection

9-all of the following cause microangiopathic hemolytic anemia except :
a- TTP
b- HVS HUS
c- vasculitis
d- venoms

10- all the following are manifestation of folate deficiency except :
a-reticulocytopnia
b- increase LDH
c- neuropsychiatric manifestation
d- bone marrow hypercellularity

11- all the following feature of IDA except :
a-glossitis
b-koilonychia
c-peripheral neuropathy
d-angular stomatitis

12-rituximabe is amno clonal antibody directed against : 
a-CD20
b-CD9
c-CD5
d-CD23

13-all the following can treat pt with thalasemia except :
a-folic acid
b- iron supplement
c-blood transfusion
d-splenectomy

14- all the following causes of microcytic hypochromic anemia except :
a- IDA
b- B-thalasemia
c- sideroblastic anemia
d-chronic liver disease

15-all the following causes increase CPK except :
a-exercise
b-dermatomyositis polymyositis
c-convulsion
d-myositis with internal malignancy

16-all the following can be differntate rheumatoid arthritis from rheumatic fever :
a-involve large joint commonly
b-symmetrical
c-morning stifness
d-joint deformities

17-the following diseases are associated with ANA and or RF antibodies except :
a-infective endocarditis
b-autoimmune thyroiditis
c-ankylosing spondylitis
d-fiborsing alveolitis

18-all the following can cause acute monoarthritis except :
a-crystal arthritis
b-bacterial infection
c-trauma
d-Rheumatoid arthritis

19-which of the following hematological finding in SLE :
a- lymph node
b- elevated CRP
c- elevated c3, c4 complement
d- elevated ESR

20-all of the following are clinical feature of sjogren's syndrome except :
a-dryness of the mouth
b-renal tubular acidosis
c-dysphagia
d-Hodgki's lymphoma

21-which of the following drugs consider as anti-interleukin (I L I ) :
a- anakinra
b- tocilizumab
c- rituximab
d- infliximab

22-poor prognostic factor in bell's palsy including all the following except :
a- age above 60 yr
b- absence of hyperacusis
c-diminished lactimation
d-associated with DM

22- all the following feature of PICA except :
a- vertigo , nausea , nystagmus
b-Herner's syndrome
c-dysphagia
d-absence of ataxia

23-all of the following causes of thunder clap headache except :
a-subarachnoid Hge
b-meningitis
c-central venous thrombosis
d-trigeminal hearalgia

24-which is of the following drug is used in prophylaxis migraine :
a-ergotamine
b-propronolole
c-narotriptan
d-zolmitriptan

25-all of the following CSF finding in acute bacterial meningitis except :
a-cloudy color
b-1000-5000/mm lymphocyte
c-glucose is decreased
d-protein increase

26- all of the following can be differentiate seizure from syncope except :
a-presence of aura
b-post ictal confusion
c-rapid recovery
d-post ictal headach

الامتحان النصفي

Which of the following is strongly associated with ankylosing spondylitits

A,HLB27

B. HLA B8

c. HLA DR3

d. HLA DR4

A

2- All of the following features of sjogrons syndrome except.

a. Keratoconjunctivitis sincca

b. Xerostomia

C.Negative R.F

d. Positive ANA

C


3- which of the following is not correct feature of disease Reiters disease?

a. Urethritis

b. Arthritis

Keratoderma Blenorrhagica

d. More common in female

D

4-which of the following clinical feature is least suggestive of SLE?

a. Raynaudes phenomenon

b. Alopecia

C. Oral ulcers

D)Sclerodactyly

D

5-Match of the following agent with appropriated side effects

a. Sulfasalazine

b. Gold

a. Pulmonary fibrosis

b. Renal impaire ment

c. Gastritis

C. Methotrexate

d. Bone marrow suppression

e. Retinitis

d. Neproxen

e. Cyclosporine

6. The first line drug for myoclonic epilepsy is:

a. Carbamazepine

b. Phenytoin

C.sodium valproate

d. Clonazepam.

e. Lamotrigine

C

Cranial nerve responsible for movements of the eye

A-Occulomotor (CN )

B- (CN VIR)

C-CN)

D-Ootic ic

C-Vestibular CN V

A

8. Bradykinesia means

A-Decreased reaction time.

B-extreme slowness

C-derease the speed of movement

D-increase resistance to passive range of motion

D-Rigdity

B

.9. Which one of the following drugs is used for treatment of multiple sclerosis

A-a interferon

B-Beta interferon

d.erferon

Inf

B


10. one of the tollowing drugs can be used to prevent migraine attack, exCept:

b. Amitriptyline

c.Propronalol.

Sumatriptan

e. Methysergide

11. Which one of the following features is most associated with temporal lobe lesions?

Astereognosis

GAuditory agnosia

CVisual agnosia

d. Disinhibition

aphasias
e. Broca


12. Which one of the following is least associated with the development of chorea?

a. Heamochromatosis

b. Rheumatic fever

CO poson

SLE

e. Huntington's disease
A

13. Which of the following Parkinson's disease medication-mechanism of action pairs is incor=

a. Carbidopa-dopa-decarboxylase inhibitor

Ropinirole-agonist at D2 and D3 receptors

.Rasagiline-monoamine oxidase type B inhibitor

d. Entacapone-nonspecific monoamine oxidase inhibitor

e. Trihexyphenidy-anticholinergic

14. Which of the following statements regarding side effects of therapies for idiopathic Park

onin

incorrect

a. Anticholinergic agents can cause significant cognitive dysfunction

b. Dopamine agonists carry little risk of impulse control problems unless the patient has a prior his

problems

C. Levodopa can cause extraneous movements, dysSKinesias, and the risk increases with increasing

therapy

d. One of the metabolites of selegiline is methamphetamine, and side effects from it include inson

Sedation is a prominent side effect of dopamine agonists

15. An overwejght 41year-old woman with hypertension, recurrent kidney stones, and in

frequency wishes to begin a preventive medication. Which of the following would be a p-

Propranolol

Topiramate

C. Verapamil

d. Neurontin

e. Magnesium

Antiplatelet treatment for secondary prevention of CVD should be prescribed for people with:

🌸Angina — aspirin 75 mg.
Clopidogrel 75 mg daily should be considered for people unable to take aspirin.

🌸AF — dual antiplatelet therapy (DAPT) of aspirin 75 mg daily plus clopidogrel 75 mg daily may be suitable for people who are unable or unwilling to take anticoagulants.

🌸ACS which is medically managed — aspirin 75 mg daily plus ticagrelor 90 mg twice a day for 12 months.
PCI for people with ACS — aspirin 75 mg in combination with either ticagrelor 90 mg twice a day, or prasugrel 10 mg daily. Clopidogrel 75 mg daily should be prescribed if prasugrel or ticagrelor are unsuitable.

🌸PCI in people with stable coronary artery disease — aspirin 75 mg daily plus clopidogrel 75 mg daily. Ticagrelor or prasugrel may be considered instead of clopidogrel where appropriate.

🌸ACS who are undergoing coronary artery bypass grafting (CABG) — aspirin 75 mg in combination with ticagrelor 90 mg twice a day, or prasugrel 10 mg daily. Clopidogrel 75 mg daily should be prescribed if prasugrel or ticagrelor are not suitable.

🌸Stroke, or TIA — clopidogrel 75 mg daily is the preferred antiplatelet. Modified-release dipyridamole (200 mg twice a day) should be prescribed with combined with aspirin 75 mg if clopidogrel is unsuitable.

🌸PAD, or multivascular disease — clopidogrel 75 mg daily is the preferred antiplatelet. Aspirin 75 mg alone should be prescribed if clopidogrel is unsuitable.

#ملاحظة :
د/سيف ضريف قال في علاج
Ischemic stroke
من العلاجات بنستخدم
corticosteroids
بينما د/خالد صالح قال نستخدم
Mannitol
واتذكر كان مبرر اهمية استخدامه
بدل corticosteroids
1-The type of edema that is
caused by ischemic stroke
is cytotoxic edema no
vasogenic that response to
steroids.
2-the corticosteroids are
associated with increase
blood sugar which acts one
of most important factors
that increase the size of
infarction.
د/سيف قال ان علاج
Parkinson's dz
مايبدا الا وقد حصل للمريض
اعاقة من المرض ليس بعد التشخيص
مبرر ذلك العلاجات الذي تعطى
للمريض هي علاجات symptomtic
لهذا تجنب الاعراض الجانبية
خصوصا الناتجة من استخدام
العلاجات بعد فترات طويلة
اتذكر د/خالد قال ضروري تبدا
العلاج بشكل مبكر اول ما يتم
التشخيص .
In AMBOSS & current
لما يحصل اعاقة أو مضايقة من المرض
In medscape
Studies demonstrate that
a patient's quality of life deteriorates quickly if treatment
is not instituted at or shortly
after diagnosis .
ثانيا هذا المرض Parkinson's dz
الذي ماهو secondary
غالبا بيحصل فوق سن 60 ..
(ثالثا هذي في الدول العربية
ماعيزور الدكتور الا وهو بيعاني
من severe symptoms ..😅)
طبعا ليس الهدف التنقيص من
د/سيف لا ابدا ..
لكن التنويه لمثل هذي الاشياء .
و لا تنسى من المؤكد انك تتدخل
في غير تخصصك وبالاخص في
الحالات الطارئة الذي ما تسمح
وصول الاخصائي .
بالتوفيق 💐

HLA27
C
D
D sclerodactyly
Methotrexate (BM suppression,
lung fibrosis)
Naproxen (gastritis)
Cyclosporine (renal impairment)
Gold (renal impairment)
Sulfasalazine (BM suppression)
C-sodium valproate
A-oculomotor n
C-decrease the speed of movement.
B-interferon-Beta
Sumatriptan
Auditory agnosia
haemochromatosis

d-entacapone

Sedation is a prominent side
effect of dopamine against

ACE inhibitor لكن غير موجود
D-aplastic anemia
D-gout(no the hyperuricemia
is the cause of gout)
D-neutrophilia
B-increase marrow..
A-epitr..
C-low ..
C-m3
8-oxygen
C-neuro..
C-Peripheral neuropathy
A-CD20
B-iron..
D-chronic liver..
D-..with internal malignancy
A-large joint
تقريبا كان باقي في السؤال except

C-ankylo..
D-RA
B-elevated ESR
D-HL
A-anakinra
B-absence..
D-absence of ataxia
D-trigeminal..
B-propranolol
ربما عاد كان باقي في السؤال DOC

B-....lymphocyte
C-rapid recovery.

في SLE يكن ال CRP طبيعي
واذا ارتفع يكون لسبب اخر مثل infection.
Decrease in C3, C4(especially in active dz).
Increase in ESR .

#ملاحظة:
الدكتور محمد قاسم بيركز
على الاعراض الجانبية للعلاجات
وغالبا عتحصل المطلوب
اذا اطلعت عليهن من long case
لانه اذا جابهن بيطرح منه .

The European Society of Cardiology (ESC),and National Institute for Health and Care Excellence (NICE) guidelines recommend that if the patient has a CHA2DS2-VASc score of 2 and above, oral anticoagulation therapy (OAC) with a Vitamin K Antagonist (VKA, e.g. warfarin with target INR of 2-3) or one of the non-VKA oral anticoagulant drugs (NOACs, e.g. dabigatran, rivaroxaban, edoxaban, or apixaban) is recommended.

أهم المواضيع الي ركز عليها الدكتور في Mysthenia gravis
#myasthenic crisis is the exacerbation of symptoms of myasthenia gravis. May be severe and require artificial ventilation in 10% cases. The patient with bulbar and respiratory involvement are prone to respiratory infection. It may occur in patients who are getting no or inadequate treatment, due to low dose or
following development of drug resistance. Precipitating factors are exertion, extremes of temperature, respiratory infection and surgery. The patient should be closely monitored for pulmonary function and should be treated in ICU. Treatment includes:
1-Respiratory assistance and pulmonary physiotherapy
2-Stop all cholinesterase inhibitors
3_Plasmapheresis or IV immunoglobulin
4_Antibiotic, if there is infection

#cholinergic crisis
Overdose of
anticholinesterase drugs may cause cholinergic crisis, which is due to depolarization block of motor end plates. Features of cholinergic crisis are muscle fasciculation, paralysis, pallor, sweating, excessive salivation, lacrimation, bronchial secretion, small pupil (meiosis), abdominal colic, diarrhea, urinary incontinence, etc.
There may be respiratory insufficiency, confusion and collapse. Infection, diarrhea, aminoglycoside,
penicillamine, steroid, etc may precipitate the crisis. Edrophonium should be avoided in these patients.

#differentiate between myasthenic crisis and cholinergic crisis :
A. The clinical features are as above. In both cases, patient complains of weakness.
1-But muscarinic features are present only in cholinergic crisis, but absent in myasthenic crisis.
2-Pupil in constricted or small in cholinergic crisis, but normal in myasthenic crisis.
3-In myasthenic crisis—edrophonium causes quick improvement.

#treat MG :
. As follows:
1. Symptomatic: Anticholinesterase drugs, e.g. pyridostigmine 60 mg tablet (4 to 16 tablets in divided
doses up to five times a day). Duration of action is 3 to 4 hours. It prolongs the action of
acetylcholine by inhibiting the action of acetylcholinesterase (side effects—overdose can cause cholinergic crisis
2. Definitive:
a)Thymectomy—for all patients with thymoma and thymic hyperplasia.
b)Plasmapheresis—given in severe myasthenia or myasthenic crisis or preoperative preparation.
A course of 5 exchanges, each of 3 to 4 liters fluid is given over a period of 2 weeks.
c)I.v immunoglobulin: It is an alternative to plasma exchange in short-term treatment
of severe myasthenia. Usual dose is 0.4 g/kg daily for 5 days. Improvement occurs in 70% cases.
d)Steroid: Initially there may be marked exacerbation of myasthenic symptoms and treatment
should be initiated in hospital. To minimize the side effect, low dose prednisolone initially 5
mg/day, increase 5 mg/week up to 1 mg/kg. Continued for 1 to 3 months, then gradually
modified to an alternate day regimen over the course of additional 1 to 3 months. On remission,
reduce the dose (may take months). About 70% patients improve with steroid. Azathioprine
may be added (2.5 mg/kg daily) or weekly methotrexate may be given. Sometimes, IV
methylprednisolone may be tried.
E)Other immunosuppressive agents, e.g. azathioprine (2.5 mg/kg daily), mycophenolate

#drugs should be avoided in MG :
Aminoglycoside, penicillamine, ciprofloxacin, quinine, antiarrhythmic drug
# drug which can cause myasthenia gravis :
Penicillamine, (IFN-α also).

#Diagnosis
1-Clinical.
2-Pharmcological
3-Srology
4-Radiology
5-Neurophyisology

antibody in MG
١)Serum acetylcholine receptor antibody (anti-AChR antibody, found in 80 to 90% patients with
generalized myasthenia gravis. In pure ocular MG, this is present in 50%)
2) Serum anti-MuSK antibody (antibody against muscle specific receptor tyrosine kinase, present
with predominantly bulbar, facial and neck muscle involvement). It is positive in anti-AChR antibody negative patient and in pure ocular MG

In phyromicologic test of MG:
1)edrophonium for ocular myasthenia
2)neostigmine for general myasthenia gravis

Radiology :
1) Chest X-ray (to exclude bronchial carcinoma)
2)CXR right lateral view and CT scan of chest (to exclude thymoma

(للّي يشتي)....
مجرّد Introductionبسيطة من د. محمد المقرمي

#Psychiatry

Mohammad Aldailami:
إختبار الباطنة النصفي-الدفعة 20-2022

Choose the best answer for each of the following questions:

1)The most specific antibody in SLE is:
a-AntiRo/La
b-Anti-Smith
c-ANA
d-Anti-DNA.

2)The most common ocular manifestation of Rheumatoid arthritis is:
a-Scleritis
b-Episcleritis
c-Scleromalacia
d-Sjögren’s syndrome.

3)Which of the following organs is mostly involved in systemic sclerosis:
a-Esophagus
b-Stomach
c-Ilium
d-Colon.

4)Commonest cause of death in SLE is:
a-CAD
b-Infections
c-Atherosclerosis
d-Lupus nephritis.

5)Match each of the following ocular manifestations to their rheumatic diseases that cause them:

a-Corneal melt
b-Ischemic optic atrophy
c-Anterior uveitis
d-Vascular retinal disease

1-SLE
2-Ankylosing spondylitis
3-Rheumatoid arthritis
4-Temporal arteritis

6)The most sensitive antibody in SLE is:
a-AntiRo/La
b-Anti-Smith
c-ANA
d-Anti-DNA.

7)All of the following are causes of increased CPK EXCEPT:
a-Myocardial infarction
b-Motor neuron disease
c-Polymyalgia rheumatica
d-Polymyositis
e-Carnitine palmitoyltransferase deficiency.

8)Which is the commonest cause of ocular monoblindness "transient amaurosis fugax" ?:
a-Ipsilateral internal carotid artery atherosclerosis
b-Temporal arteritis
c-Ophthalmic artery spasm
d-Hypotension

9)Which of the following is least associated with PD:
a-Anosmia
b-Rapid eye movement with dream disturbance
c-Oculogyric crisis
d-Depression.

10)Which of the following is least likely to increase the risk for stroke in a patient with atrial fibrillation:
a-Congestive heart failure
b-Hypertension
c-Diabetes
d-Age 60 years


11)The drug that causes Polycystic ovary syndrome and fatal hemorrhagic pancreatitis is:
a-Phenobarbitone
b-Valproic acid
c-Phenytoin
d-Oxcarbazepine.

12)Trihexyphenidyl which is used in PD, what is the mechanism of action of it?
a-Catecholamine-O-methyltransferase inhibitor
b-Monoamine oxidase inhibitor
c-Dopamine agonist
d-Muscarinic receptor antagonist .

13)Which of the following is typically associated with migraine without aura than migraine with aura:
a-Generalized Cortical spread
b-Prominent visual symptoms
c-Associated with menstrual cycle
d-Increased risk of ischemic stroke.

14)Patients with which of the following conditions are most likely to have asymmetric facial weakness?
A. Fascioscapulohumeral dystrophy
B. Myasthenia gravis
C. Myotonic dystrophy
D. Oculopharyngeal dystrophy

15)Most focal seizures in adults arise from which area?
A. Frontal lobe
B. Temporal lobe
C. Parietal lobe
D. Occipital lobe

16)Which of the following is least associated with relapse of MS:
a-Fever
b-Exercise
c-Pregnancy
d-Urinary tract infection.

17)Which of the following drugs is safest during pregnancy in MS:
a-Fingolimod
b-Glatiramer acetate
c-Cladribine
d-Natalizumab.

Best wishes.✨

🔺 ملف أمسكيو #نيرولوجي_باطنة
#neurology