For rahaf

child had meningitis, and he contacted his brother & sister, what will give as prophylaxis ? - penicillin + rifampicin 2 times – penicillin - Ciprofloxacin one dose - Ceftriaxone 3 doses IM

D

70 old male with forgetfulness, progressive gradually for 2 years.. devolop signs of aggression and violence after he was calm ,caring ,and kind: A. Lewi body B. Alzheimer’s C. Vascular dementia

B

i spy with my little eye: Slowly progressive, over ∼ 8–10 years Episodic impairment of memory Characteristic order of language impairment: naming → comprehension → fluency is a clinical diagnosis MRI Diffuse cortical atrophy Hippocampal atrophy CSF ↓ Beta amyloid ↑ Phosphorylated tau Neuritic plaques (amyloid beta peptides, mainly accumulating extracellularly) Neurofibrillary tangles (abnormally phosphorylated tau protein, which accumulates intracellularly)

Alzeheimers disease

May present with abrupt cognitive decline and stepwise deterioration Asymmetric or focal deficits (e.g., hemiparesis) CT/MRI: multiple cortical and lacunar infarcts, white matter lesions

vascular dementia

Steady decline; typically over ∼ 8–10 years but more rapid progression is possible Visual hallucinations and parkinsonian motor disorders Attention impairment MRI Diffuse mild cortical atrophy Atrophy of substantia innominata and mesopontine gray matter SPECT: may reveal decreased occipital perfusion/metabolism Lewy bodies (intracellular aggregations of mainly α-Synuclein)

lewy body

Usually manifests between ages 40–69 Behavioral variant FTD (most common) → early changes in personality, apathy CSF: usually ↑ Aβ 1–42 PET or SPECT to reveal metabolic disorders in the frontal and temporal lobes MRI: atrophy of the frontal and/or temporal lobes Focal cortical atrophy

frontotemporal

Question about Meningitis, a 7-year-old patient infected with a gram- positive diplococcus.Treatment is: - A.Ceftriaxone - B.Penicillin + gentamycin - C.Gentamycin / - D.Gentamycin plus vancomycin\

A

78y/o male presented with change level of consciousness and fever , lumber puncture was doe show CSF gram +ve bacilli , hem catalase +ve , how will you treat ? A-ceftriaxone + vancomycin + steroid B- ceftriaxone + ampicillin + vancomycin C- ceftriaxone + vancomycin + ampicillin D- ampicillin

D

old patient came with subdural hematoma with signs of lateralization imaging revealed 13 mm shifting. his GCS 7/15 then was intubated and resuscitated what to do next A- iv mannitol B- elevate head of bed C-hyperventilate D- urgent craniotomy

D

In a patient with suspected transient Ischemic attack full recovery should take place within: - A. 6 Hours - B. 12 Hours - C. 18 Hours - D. 24 Hours - E. 48 Hours

D

stroke patient developed new weakness on ex papilledema CT finding: hemorrhagic stroke. Most definitive Mx ? 1-Craniotomy and decompression 2-Iv mannitol 3 iv dexa

A

12 year old with testicular pain for 2 days. Vertical testes, tender apex, with skin changes. Most likely diagnosis? A-Epididymo-orchitis, B-torsion of testicular appendix C- testicular torsion

B 4 Diseases that usually comes together in the choices Epididymo-orchitis Testicular torsion Appendicular torsion Inguinal hernia How Can I differentiate? Let’s take them one by one. ◻️ Epididymo-orchitis: - Gradual pain in the scrotum Usually >24h. - Tender edematous cord - Red scroutm - Fever, Dysuria, urethral discharge can be present - High WBCs and inflammatory markers. Mx: Antibiotics. ◻️Testicular torsion: - Scrotal pain less than 12 hours ( مهم ) لانه بعد ١٢ ساعه يصير Necrosis ومايحس بالالم. - Previous episode or trauma. - High riding testis ( Horizontal ) - negative phren sign and absent cremasteric reflex. - Low doppler flow Mx: Surgical exploration ASAP. ◻️Appendicular torsion: - Tenderness over the upper pole - Vertical ( Longitudinal ) testis - Blue dot sign Mx: NSAIDs and Rest. ◻️Inguinal hernia: - Mass extended to the groin.

Which of the following is the most reliable investigation to detect DKA in DM1 patients ? acetoacetate acetone b-hydroxybutric acid c-glucose level

c

patient who presented with signs of stroke and a CT shows subarachanoid hemorrhage. He was resuscitated but he is still hypotensive. What is the next best step? A. Craniotomy and evacuation B. Iv mannito

A

DM obese on life modifications his A1c 8 what to add A-dulaglutide B-DPP-4 inhibitors; C-GLP-1 receptor agonists D-SGLT2 inhibitors; .

D

Patient with hyperthyroidism and palpitations, heat intolerance.next step Propriouracil Methimazole???? Carbimaxole Propranolol?????

d

36 year-old female presented with left neck mass 2x2cm in posterior angle of mandible. US: Normal thyroid, left large LN with cystic component. FNA: All smear shows follicular thyroid What is the most likely diagnosis? A. Metastatic thyroid cancer B. Apparent thyroid C. Ectopic thyroid (in the pathway of thyroid ) D. Thryoglossal cyst

A

unilateral neck swelling in the RT side by investigations : hot thyroid nodule remaining of the gland cold TSH is low, T3, T4 high No LN enlargement (dx hyperthyroidism toxic nodule) What is the initial Treatment? A- antithyroid drug B- RT thyroidectomy C- Hemithyroidectomy D- radioactive iodine

A

11 year old girl with exercise intolerance and weight (did not mention loss or gain) Hx is unremarkable and PE is normal bp:160/100 HR:130 T:36.6 O2: 95 ECHO shows normal heart function and anatomy. What is the most appropriate ? managment? 1- ABG 2-electrolyte level 3-CBC ??? (anemia ) 4-TFT????

4

Cold thyroid nodule 3x3 was removed by thyroid lobectomy , 8mm papillary will defined focus was found distant to the leison, what is the appropriate? A. Complete thyroidectomy B. Follow up 3 months C .RAI

B.

 

If 1cm or above —> A.