34 years female at 28 weeks with cough and difficulty in breathing , she appeared restless and uncomfortable on auscultation of the lung shows bilateral rhnochi, the nail bed and oral mucous membrane appear pale, she is allergic to dust, pollen, mold and animal hair. No hx of smoking. She reports that the symptoms began 2 days perior and started cough with clear color phlegm. All vital normal. What it's the most appropriate initial test?
A- xry
B- Hgh
C- Spirometry
D- ABG
Abdulrahman: The answer is C. This patient clearly has asthma exacerbation during pregnancy. This includes difficulty in breathing, bilateral rhonchi, normal vitals, cough with clear color phlegm, and hx of allergy (related to asthma in the case of atopy). There is a negative history of fever, unilateral auscultation findings, sore throat, fatigability, or a productive cough that is not clear. Asthma is the most common condition affecting the lungs during pregnancy. Up to 8 percent of pregnant women have asthma.
Taghreed: Hacker and Moore: Most patients with asthma have been diagnosed before pregnancy, and pregnancy does not change the criteria for diagnosis (characteristic clinical symptoms combined with abnormal spirometry [decreased FVC/ FEV1 and decreased PF with improvement after acute bronchodilator therapy]).
A- xry
B- Hgh
C- Spirometry
D- ABG
Abdulrahman: The answer is C. This patient clearly has asthma exacerbation during pregnancy. This includes difficulty in breathing, bilateral rhonchi, normal vitals, cough with clear color phlegm, and hx of allergy (related to asthma in the case of atopy). There is a negative history of fever, unilateral auscultation findings, sore throat, fatigability, or a productive cough that is not clear. Asthma is the most common condition affecting the lungs during pregnancy. Up to 8 percent of pregnant women have asthma.
Taghreed: Hacker and Moore: Most patients with asthma have been diagnosed before pregnancy, and pregnancy does not change the criteria for diagnosis (characteristic clinical symptoms combined with abnormal spirometry [decreased FVC/ FEV1 and decreased PF with improvement after acute bronchodilator therapy]).
Patient is Known for Endocrine Disorder Taking 10mg Steroid in Morning 09:00 AM and Another 2 Doses 5mg at 12:00 and 15:00. However, Patient is Working at Morning Shid and Could Not Take Dose at Exactly Same Timing Mentioned. What Would You Advice?
A- Keep Same Doses 09:00, 12:00 and 15:00
B- Keep Morning 09:00 AM Dose and Postpone the 12:00 and 15:00 Dose at Night
C- Keep Morning 09:00 AM Dose and Combine Last Two Doses Together
Better recall: Femal with symptoms then diagnosed with addison’s disease and started on hydrocortisone and flurocortisone At 9:00 12:00 15:00 Then she informed the doctor that she have night shift. What is appropriate??!
A- No change in the treatment plan
B- Emit using cortisone during her night shift
C- Take the first dose at 9:00 then the rest at her night shift
D- Take her first dose at the beginning of night shift then 3 hours later then 6 hours later
Abdulrahman: The answer in this case is D. She should take her first dose after awakening and the other doses after 3 and 6 hours from the first dose. A typical twice-daily regimen consists of taking about two-thirds of the total dose upon arising in the morning and one-third in the afternoon to simulate the normal cortisol circadian rhythm. Most regimens avoid evening doses, because normal subjects secrete little cortisol from about 6 PM to 3 AM.
A- Keep Same Doses 09:00, 12:00 and 15:00
B- Keep Morning 09:00 AM Dose and Postpone the 12:00 and 15:00 Dose at Night
C- Keep Morning 09:00 AM Dose and Combine Last Two Doses Together
Better recall: Femal with symptoms then diagnosed with addison’s disease and started on hydrocortisone and flurocortisone At 9:00 12:00 15:00 Then she informed the doctor that she have night shift. What is appropriate??!
A- No change in the treatment plan
B- Emit using cortisone during her night shift
C- Take the first dose at 9:00 then the rest at her night shift
D- Take her first dose at the beginning of night shift then 3 hours later then 6 hours later
Abdulrahman: The answer in this case is D. She should take her first dose after awakening and the other doses after 3 and 6 hours from the first dose. A typical twice-daily regimen consists of taking about two-thirds of the total dose upon arising in the morning and one-third in the afternoon to simulate the normal cortisol circadian rhythm. Most regimens avoid evening doses, because normal subjects secrete little cortisol from about 6 PM to 3 AM.
eldery k/c of poorly controlled DM comes with ulcers on tip of three of his toes, diminished dorsalis pedis bilaterally, what’s the initial management;
A- Amputation
B- Negative pressure dressing
C- surgical intervention
D- Depridment
Better recall: Male patient diabetic and smoker presented with ulcer on 2nd , 3rd and 4th left foot toes. He gave a history of superficial thrombophlebitis. Upon examination: he has absent dorsalis pedis and posterior tibialis pulse in both limbs , while popliteal pulse was intact. How would you manage the patient?
A- Amputation of toes
B- Longterm anticoagulant
C- Surgical intervention?
D- Ask patient to stop smoking with lifestyle modifications
Abdulrahman: This is most likely a case of Thromboangiitis obliterans (Buerger disease). I would go with Ask patient to stop smoking with lifestyle modifications, since it is an early and very important intervention because he has significant modifiable risk factors (complete cessation of smoking is the single most important therapeutic measure), revascularization is not an option (because small and medium-sized arteries are involved), and his toes are ulcerated and not gangrenous. Gangrenous toes require amputation.
A- Amputation
B- Negative pressure dressing
C- surgical intervention
D- Depridment
Better recall: Male patient diabetic and smoker presented with ulcer on 2nd , 3rd and 4th left foot toes. He gave a history of superficial thrombophlebitis. Upon examination: he has absent dorsalis pedis and posterior tibialis pulse in both limbs , while popliteal pulse was intact. How would you manage the patient?
A- Amputation of toes
B- Longterm anticoagulant
C- Surgical intervention?
D- Ask patient to stop smoking with lifestyle modifications
Abdulrahman: This is most likely a case of Thromboangiitis obliterans (Buerger disease). I would go with Ask patient to stop smoking with lifestyle modifications, since it is an early and very important intervention because he has significant modifiable risk factors (complete cessation of smoking is the single most important therapeutic measure), revascularization is not an option (because small and medium-sized arteries are involved), and his toes are ulcerated and not gangrenous. Gangrenous toes require amputation.
34 Y.O female diagnosed with hyperprolactinemia since one year on cabergoline. Which of the following is an indication for brain MRI in this patient?
A- Blurry vision
B- Bilateral milky breast discharge.
C- Doubled serum prolactin level
D- Amenorrhea
Abdulrahman: The answer is doubled serum prolactin level as an indication for MRI and narrowed vision as an indication for surgery. Blurry vision is incorrect because macroadenoma will cause bilateral homonymous hemianopsia (narrowed vision and not blurry vision). Schwartz: prolactin-secreting tumors (prolactinomas) usually shrink with dopaminergic therapy alone, namely bromocriptine, which inhibits production and secretion of prolactin. Consider surgery for prolactinomas with persistent mass effect or endocrinologic dysfunction in spite of adequate dopamine agonist therapy.
A- Blurry vision
B- Bilateral milky breast discharge.
C- Doubled serum prolactin level
D- Amenorrhea
Abdulrahman: The answer is doubled serum prolactin level as an indication for MRI and narrowed vision as an indication for surgery. Blurry vision is incorrect because macroadenoma will cause bilateral homonymous hemianopsia (narrowed vision and not blurry vision). Schwartz: prolactin-secreting tumors (prolactinomas) usually shrink with dopaminergic therapy alone, namely bromocriptine, which inhibits production and secretion of prolactin. Consider surgery for prolactinomas with persistent mass effect or endocrinologic dysfunction in spite of adequate dopamine agonist therapy.
Pt with medial leg ulcer what is the high risk?
A- Dm
B- Htn
C- Age
D- Buerger's disease
Another recall : 35 years old patient come with medial leg ulcer. The most likely diagnosis is:
A- Diabetic
B- Venous hypertension
C- Atherosclerosis
D- Buerger's disease
Abdulrahman: The answer is B, since the only hint in this question is the location of the ulcer (venous ulcer primarily caused by venous HTN). Here is a table with some pictures that can help you to know which type of ulcer it is with the complete question in the exam:
A- Dm
B- Htn
C- Age
D- Buerger's disease
Another recall : 35 years old patient come with medial leg ulcer. The most likely diagnosis is:
A- Diabetic
B- Venous hypertension
C- Atherosclerosis
D- Buerger's disease
Abdulrahman: The answer is B, since the only hint in this question is the location of the ulcer (venous ulcer primarily caused by venous HTN). Here is a table with some pictures that can help you to know which type of ulcer it is with the complete question in the exam:
PT with refractory hypokalemia what is your next step?
A- asses aldosterone and renin ratio
B- start spironolactone
C- check magnesium
D- give another potassium replacement
Abdulrahman: The answer is C, since hypomagnesemia can cause persistent hypocalcemia and hypokalemia if not replenished. There was another question where a patient after thyroidectomy developed hypocalcemia despite calcium replacement. The answer in this case is also to check the magnesium level. This question was also answered by Dr. Thawaba.
Shaya: UTD: cause of the hypokalemia should be identified as quickly as possible, particularly the presence of hypomagnesemia,"measurement of serum magnesium should be considered in patients with hypokalemia and, if present, hypomagnesemia should be treated. "
A- asses aldosterone and renin ratio
B- start spironolactone
C- check magnesium
D- give another potassium replacement
Abdulrahman: The answer is C, since hypomagnesemia can cause persistent hypocalcemia and hypokalemia if not replenished. There was another question where a patient after thyroidectomy developed hypocalcemia despite calcium replacement. The answer in this case is also to check the magnesium level. This question was also answered by Dr. Thawaba.
Shaya: UTD: cause of the hypokalemia should be identified as quickly as possible, particularly the presence of hypomagnesemia,"measurement of serum magnesium should be considered in patients with hypokalemia and, if present, hypomagnesemia should be treated. "
Pt with pancreatitis the most causes of surgical intervention is ?
A-acute Pancreatitis
B-necrotic pancreatitis with sepsis
C-Chronic pancreatitis
Abdulrahman: B. Schwartz: The most common reason for surgical intervention in patients with Acute pancreatitis is to treat pancreatic necrosis.
- Surgical intervention in acute pancreatitis is reserved for patients with infected collections or infected necrosis only, or to relieve an impacted gallstone in the ampulla if endoscopic or radiologic treatments are unavailable or unsuccessful.
- The step-up approach is the standard of care, with initial drainage (percutaneous or endoscopic) followed by minimally invasive necrosectomy (percutaneous or endoscopic), and open necrosectomy only if these approaches fail.
- Debridement of sterile necrosis is rarely, if ever, indicated.
- For chronic pancreatitis, surgery may be recommended if chronic inflammation has caused a blockage in the pancreatic ducts.
A-acute Pancreatitis
B-necrotic pancreatitis with sepsis
C-Chronic pancreatitis
Abdulrahman: B. Schwartz: The most common reason for surgical intervention in patients with Acute pancreatitis is to treat pancreatic necrosis.
- Surgical intervention in acute pancreatitis is reserved for patients with infected collections or infected necrosis only, or to relieve an impacted gallstone in the ampulla if endoscopic or radiologic treatments are unavailable or unsuccessful.
- The step-up approach is the standard of care, with initial drainage (percutaneous or endoscopic) followed by minimally invasive necrosectomy (percutaneous or endoscopic), and open necrosectomy only if these approaches fail.
- Debridement of sterile necrosis is rarely, if ever, indicated.
- For chronic pancreatitis, surgery may be recommended if chronic inflammation has caused a blockage in the pancreatic ducts.
Old patient presents with hematochezia and perianal fullness. Examination showed anal mass 1 cm above the anal verge. Biopsy showed: adenocarcinoma. MRI of the abdomen showed > 3 cm mass with craniocaudal extension with lymphadenopathy. CT showed no metastasis. What is the appropriate management?
A- Concurrent chemo radiation
B- APR
C- LAR
Better recall: A 45 - year old patient complains of perianal swelling, fresh bleeding per rectum and weight loss over the last 3 months on examination, there is a mass 1 cm from the anal verge. She has no obstructive symptoms (see report), Biopsy: Adenocarcinoma. MRI abdomen: Localized lesion with craniocaudal extension of 3 cm with associated lymphadenopathy. 110/70 mmHg 96 / min 18 / min 36.6 ° C CT scan chest: No evidence of metastasis. Which of the following is the most appropriate treatment?
A- Diversion colostomy
B- Low anterior resection
C- Concurrent chemoradiation
D- Abdominoperineal resection
Abdulrahman: This topic is difficult and controversial, because some people prefer pre surgery chemoradiation, while others prefer post-surgery chemoradiation. I would go with concurrent chemoradiation. The management of adenocarcinomas arising in the anal canal should follow the same principles as those applied to the treatment of rectal cancer. For most patients this will include resection and either preoperative or postoperative fluoropyrimidine-based chemoradiotherapy. This recommendation is consistent with guidelines from the NCCN. Others prefer an approach that includes preoperative chemoradiotherapy plus 12 to 16 weeks of oxaliplatin-based chemotherapy prior to surgery, which is termed "total neoadjuvant therapy".
Taghreed: schwartz: Adenocarcinoma of the anus is extremely rare and usually represents downward spread of a low rectal adenocarcinoma. Adenocarcinoma may occasionally arise from the anal glands or may develop in a chronic fistula. Radical resection, usually after neoadjuvant chemoradiation, is usually required.
A- Concurrent chemo radiation
B- APR
C- LAR
Better recall: A 45 - year old patient complains of perianal swelling, fresh bleeding per rectum and weight loss over the last 3 months on examination, there is a mass 1 cm from the anal verge. She has no obstructive symptoms (see report), Biopsy: Adenocarcinoma. MRI abdomen: Localized lesion with craniocaudal extension of 3 cm with associated lymphadenopathy. 110/70 mmHg 96 / min 18 / min 36.6 ° C CT scan chest: No evidence of metastasis. Which of the following is the most appropriate treatment?
A- Diversion colostomy
B- Low anterior resection
C- Concurrent chemoradiation
D- Abdominoperineal resection
Abdulrahman: This topic is difficult and controversial, because some people prefer pre surgery chemoradiation, while others prefer post-surgery chemoradiation. I would go with concurrent chemoradiation. The management of adenocarcinomas arising in the anal canal should follow the same principles as those applied to the treatment of rectal cancer. For most patients this will include resection and either preoperative or postoperative fluoropyrimidine-based chemoradiotherapy. This recommendation is consistent with guidelines from the NCCN. Others prefer an approach that includes preoperative chemoradiotherapy plus 12 to 16 weeks of oxaliplatin-based chemotherapy prior to surgery, which is termed "total neoadjuvant therapy".
Taghreed: schwartz: Adenocarcinoma of the anus is extremely rare and usually represents downward spread of a low rectal adenocarcinoma. Adenocarcinoma may occasionally arise from the anal glands or may develop in a chronic fistula. Radical resection, usually after neoadjuvant chemoradiation, is usually required.
Vulvar lesion at 5 o'clock, inflammatory changes up to cervix, red , edematus :
A- Carbuncle
B- Bartholin
C- SCC
D- furuncle
Could be this question: 38-year-old women is seen for the evaluation of a swelling in her right vulva. She has also noted pain in this area when walking and during coitus. On examination a
mildly tender fluctuant mass was noticed just outside the introits in the right
vulva. What is the most likely diagnosis?
Abdulrahman: The answer is Bartholin’s abscess. Bartholin’s glands are normally located located at the 5-o’clock and 7-o’clock position. When infected (abscess), they are usually unilateral, tender, and are surrounded by edema and erythema.
A- Carbuncle
B- Bartholin
C- SCC
D- furuncle
Could be this question: 38-year-old women is seen for the evaluation of a swelling in her right vulva. She has also noted pain in this area when walking and during coitus. On examination a
mildly tender fluctuant mass was noticed just outside the introits in the right
vulva. What is the most likely diagnosis?
Abdulrahman: The answer is Bartholin’s abscess. Bartholin’s glands are normally located located at the 5-o’clock and 7-o’clock position. When infected (abscess), they are usually unilateral, tender, and are surrounded by edema and erythema.
30 weeks gestamon , she has lower abdominal pain with no bleeding or leaking if we suspect preterm labor , which of the following will confirm preterm labor ?
A- History will be enough to confirm preterm labor
B- Presence of contracaons in the CTG
C- Pelvic examinaaon
D- cervix length
Better recall or another similar question: A mother presented to the clinic at 30 weeks gestation with +ve uterine contractions 4 in 10mins With no bleeding and Leakage. CTG is normal and reactive. Which of the following will confirm preterm labor?
A- Cervical dilatation exam
B- History alone is enough for diagnosis
C- CTG is diagnostic
D- No leakage means no preterm labor
Abdulrahman: The answer is cervical dilation through pelvic examination. All the other options are clearly incorrect. UTD: labor is defined as regular and painful uterine contractions that cause progressive dilation & effacement of the cervix. No contractions = not in labor, thus it’s essential to identify the presence of contraction on CTG (missing in the first question). Presence of contractions only could indicate false labor (Braxton Hicks). Braxton Hicks are irregular in frequency, less intense and usually go away if you change positions. They are the body's way of getting ready for labor, but it doesn't mean labor is coming.
A- History will be enough to confirm preterm labor
B- Presence of contracaons in the CTG
C- Pelvic examinaaon
D- cervix length
Better recall or another similar question: A mother presented to the clinic at 30 weeks gestation with +ve uterine contractions 4 in 10mins With no bleeding and Leakage. CTG is normal and reactive. Which of the following will confirm preterm labor?
A- Cervical dilatation exam
B- History alone is enough for diagnosis
C- CTG is diagnostic
D- No leakage means no preterm labor
Abdulrahman: The answer is cervical dilation through pelvic examination. All the other options are clearly incorrect. UTD: labor is defined as regular and painful uterine contractions that cause progressive dilation & effacement of the cervix. No contractions = not in labor, thus it’s essential to identify the presence of contraction on CTG (missing in the first question). Presence of contractions only could indicate false labor (Braxton Hicks). Braxton Hicks are irregular in frequency, less intense and usually go away if you change positions. They are the body's way of getting ready for labor, but it doesn't mean labor is coming.
Smoker and obese female pament on combined OCP, at imagining there is 4x4 cm hepamc hemangioma. What is the most important thing to advise the pt.?
A- Decrease high carbohydrate and faJy meals
B- Stop smoking
C- Eat diet rich in fiber
D- Stop OCP
Another recall or similar question: 28 y/o male, obese and smoker diagnosed with right hepatic hemangioma 4*4 cm. What will you tell the patient ?
A- Stop smoking
B- Avoid high carb and fat meal
C- Avoid high physical exercise
D- Weight loss
Abdulrahman: For the first question, stopping OCP is very beneficial in cases of adenoma only. Although according to UTD: While there is no definitive strategy for prevention, living a healthy lifestyle, smoking cessation, a nutritious diet, and in particular limiting alcohol intake can all contribute to overall health and increased quality of life. Sex hormone-mimicking medications (e.g., OCPs) can cause the hemangioma to grow. I would go with stopping OCP, because estrogen can influence the lesion to grow (although the risk of rupture is similar for pregnant and nonpregnant women). As for the second question, patients with hepatic hemangioma should avoid high physical exercise to avoid the risk of rupture.
A- Decrease high carbohydrate and faJy meals
B- Stop smoking
C- Eat diet rich in fiber
D- Stop OCP
Another recall or similar question: 28 y/o male, obese and smoker diagnosed with right hepatic hemangioma 4*4 cm. What will you tell the patient ?
A- Stop smoking
B- Avoid high carb and fat meal
C- Avoid high physical exercise
D- Weight loss
Abdulrahman: For the first question, stopping OCP is very beneficial in cases of adenoma only. Although according to UTD: While there is no definitive strategy for prevention, living a healthy lifestyle, smoking cessation, a nutritious diet, and in particular limiting alcohol intake can all contribute to overall health and increased quality of life. Sex hormone-mimicking medications (e.g., OCPs) can cause the hemangioma to grow. I would go with stopping OCP, because estrogen can influence the lesion to grow (although the risk of rupture is similar for pregnant and nonpregnant women). As for the second question, patients with hepatic hemangioma should avoid high physical exercise to avoid the risk of rupture.
Patient known hypertensive on lisinopril and amlodipine, recently diagnosed as TB What you will do
A- decrease lisinopril dose
B- stop amlodipine
C- increase lisinopril
D- stop rifampicin
Better recall: 45 YO male known hypertensive (on lisinopril 20 mg and amlodipine 5 mg) and recent Hx of thromboembolism (on warfarin 2mg) presented with productive cough and hemoptysis for 2 months. MTB-PCR is +ve. He was started on first line anti TB medications. Which of the following adjustment should be made to his medications?
A- Decrease lisinopril dose
B- Increase warfarin dose
C- Increase amlodipine dose
D- Stop rifampicin.
Abdulrahman: The answer is increase the warfarin the doss and increase lisinopril in the first question (approved by Om-Alqurra). Rifampicin will decrease the serum concentration of amlodipine, lisinopril, and warfarin due to the induction of cytochrome P450 (increase metabolism), which will cause worsening of the patient’s hypertension.
A- decrease lisinopril dose
B- stop amlodipine
C- increase lisinopril
D- stop rifampicin
Better recall: 45 YO male known hypertensive (on lisinopril 20 mg and amlodipine 5 mg) and recent Hx of thromboembolism (on warfarin 2mg) presented with productive cough and hemoptysis for 2 months. MTB-PCR is +ve. He was started on first line anti TB medications. Which of the following adjustment should be made to his medications?
A- Decrease lisinopril dose
B- Increase warfarin dose
C- Increase amlodipine dose
D- Stop rifampicin.
Abdulrahman: The answer is increase the warfarin the doss and increase lisinopril in the first question (approved by Om-Alqurra). Rifampicin will decrease the serum concentration of amlodipine, lisinopril, and warfarin due to the induction of cytochrome P450 (increase metabolism), which will cause worsening of the patient’s hypertension.
A case with hypokalemia and hypocalcemia with flat T wave , other labs show very high urea and creatinine. What is the next management?
A- Dextrose
B- Ca gluconate
C- Ca resonium
D-Renal replacement
Abdulrahman: This patient most likely has an acute kidney injury (AKI) or chronic kidney injury (CKD) that worsened. Acute hypocalcemia can be life-threatening, so we need to stabilize the cardiac membrane as fast as possible with calcium gluconate. Choice D is incorrect because the patient doesn’t have absolute indications for renal replacement therapy (Dialysis):-
1- Refractory hypervolemia
2- Refractory acidosis
3- Refractory hyperkalemia
4- Uremic manifestations (uremic encephalopathy or uremic pericarditis)
5- Intoxication (patient received medicine overdose)
A- Dextrose
B- Ca gluconate
C- Ca resonium
D-Renal replacement
Abdulrahman: This patient most likely has an acute kidney injury (AKI) or chronic kidney injury (CKD) that worsened. Acute hypocalcemia can be life-threatening, so we need to stabilize the cardiac membrane as fast as possible with calcium gluconate. Choice D is incorrect because the patient doesn’t have absolute indications for renal replacement therapy (Dialysis):-
1- Refractory hypervolemia
2- Refractory acidosis
3- Refractory hyperkalemia
4- Uremic manifestations (uremic encephalopathy or uremic pericarditis)
5- Intoxication (patient received medicine overdose)
Quick Recall pinned «✨ First question Pediatric, known case of congestive heart failure and hypertension presented with dyspnea on exertion And decreased exercise tolerance X ray showed cardiomyopathy: A- stat iv frusemide B- digoxin C- reassure as this is expected of disease…»
4 months baby born preterm 33 weeks due to emergency cescrian section regarding his vaccines what is the most appropriate protocol to follow?
A- give him vaccine according to his chronological age
B- give him vaccines by his correct gestational age
C- delay all vaccines
D- other
Abdulrahman: The answer is A. Correcting the age (choice B) is done when growth charting and checking developmental milestones (not in vaccinating). Here are the reasons to delay the vaccines:
A- give him vaccine according to his chronological age
B- give him vaccines by his correct gestational age
C- delay all vaccines
D- other
Abdulrahman: The answer is A. Correcting the age (choice B) is done when growth charting and checking developmental milestones (not in vaccinating). Here are the reasons to delay the vaccines:
Heroin addict want to start a program to eliminate the addiction, which drug would you choose ?
A- Naloxone
B- Methadone
Abdulrahman: The answer is B. Pharmacologic therapy for heroin addiction focuses on ameliorating withdrawal symptoms and reducing cravings. Methadone (long-acting) maintenance therapy has been the standard of care for more than 30 years. Naloxone (short-acting) is an antidote that is used in intoxication. Methadone, a long-acting opioid agonist, binds to and occupies mu-opioid receptors, preventing withdrawal symptoms for 24 hours or longer, reduces craving for opioids, and, by maintaining high levels of opioid tolerance, reduces the euphoric effects of subsequent illicit opioid use.
A- Naloxone
B- Methadone
Abdulrahman: The answer is B. Pharmacologic therapy for heroin addiction focuses on ameliorating withdrawal symptoms and reducing cravings. Methadone (long-acting) maintenance therapy has been the standard of care for more than 30 years. Naloxone (short-acting) is an antidote that is used in intoxication. Methadone, a long-acting opioid agonist, binds to and occupies mu-opioid receptors, preventing withdrawal symptoms for 24 hours or longer, reduces craving for opioids, and, by maintaining high levels of opioid tolerance, reduces the euphoric effects of subsequent illicit opioid use.
During the influenza season, the supply of recombinant influenza vaccine (RIV4) is limited. Who gets the priority of receiving the vaccine?
A) School children
B) Pregnant woman
C) Isolated hypertension adults
D) Iron deficiency anemia children
Abdulrahman: The answer is B according to the CDC. Williams + UTD: Vaccinate all women who will be pregnant during flu season. Vaccinate high-risk women prior to flu season. They all should receive the inactivated influenza vaccine as soon as it becomes available and before onset of influenza activity in the community, regardless of their stage of pregnancy. CDC: Emphasis should be placed on targeting vaccines to high-risk groups. Those groups include:
- Healthy children aged 6 to 23 months
- People 65 years and older
- Pregnant women in their second or third trimester during the flu season
- Anyone 2 years or older who has a chronic health condition.
A) School children
B) Pregnant woman
C) Isolated hypertension adults
D) Iron deficiency anemia children
Abdulrahman: The answer is B according to the CDC. Williams + UTD: Vaccinate all women who will be pregnant during flu season. Vaccinate high-risk women prior to flu season. They all should receive the inactivated influenza vaccine as soon as it becomes available and before onset of influenza activity in the community, regardless of their stage of pregnancy. CDC: Emphasis should be placed on targeting vaccines to high-risk groups. Those groups include:
- Healthy children aged 6 to 23 months
- People 65 years and older
- Pregnant women in their second or third trimester during the flu season
- Anyone 2 years or older who has a chronic health condition.
A 47 year old male with 12 hour pain in first metatarsal joint with swelling and tenderness. Temperate 38 C. Cause of Presentation?
A) Disseminated Gonococcus
B) Staphylococcus Aureus
C) Monosodium Urate Crystals
D) Calcium Pyrophosphate Crystals
Abdulrahman: This question is very vague, since both infection and gout can cause fever. We cannot differentiate between septic arthritis and gout without arthrocentesis. Although in this case, the hint is that the location of the pain (first metatarsal joint). I would go with C. Here’s a table that will help you distinguish Gout (Choice C) from pseudogout (D) in the full question.
A) Disseminated Gonococcus
B) Staphylococcus Aureus
C) Monosodium Urate Crystals
D) Calcium Pyrophosphate Crystals
Abdulrahman: This question is very vague, since both infection and gout can cause fever. We cannot differentiate between septic arthritis and gout without arthrocentesis. Although in this case, the hint is that the location of the pain (first metatarsal joint). I would go with C. Here’s a table that will help you distinguish Gout (Choice C) from pseudogout (D) in the full question.