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54-30. Ver old age woman with anemia and thrombocytopenia and axillary lymph node enlargement: management was asked?Palliative careSteroidradiotherapyCLL55-After administration of Cefazolin a young patint developed allergic reaction in the skin (PIC of multiple red rash on the back).Regarding management of this patint in future with cephalosporin which is correct?1.Cephalosporin other than cefazolin2.No cephalosporin3.neither penicillin and neither cephalosporin4 doxycycline5) ceftriaxoUsing cephalosporines in the future:Cephalosporines as an alternative for penicillins:56- young girl in twenties BMI 29 present with irregular periods:- asked next investigationTSHFSHUSG??? ????? pco??? ??????? ?? ?????? ???? ?? overweight??? ??? ??? ??? ?????? .???? ??? ??????????? ???? ????? ?? ??? ???????? ????? ???? ????.?? ??? ?? ?? ????? ?? fsh,Lh???????? ?? ??????PCOsJM P: 125557-Man in coal mine present with nocturnal cough, heavy smoker on examination everything normal chest clear , cxr normal , what to do next1. Endoscopy2. Ct chest3.repeat cxr aft 6 month4.mriChallenging question…A few tips:Chronic cough?Cough that has been present longer than three weeks is either subacute (three to eight weeks) or chronic (more than eight weeks).?Timing Nocturnal cough → asthma, left ventricular failure, postnasal drip, chronic bronchitis, whooping cough Waking cough → bronchiectasis, chronic bronchitis, G O R D ? three most common causes of chronic cough (Harrison): PND, Asthma, GERD?steps: empirical therapy for GERD (PPI) and PND(antihistamins+/-coamoxiclave), evaluation for asthma???? ???? ?????? ?? ?????? ????????? ?? ???? ?????? ???? ??? ???? ?? ?? ?? ?? ??? ????? ???? ? ???? ??? ?????? ? ... ??? ????? ???? ?? ?? ???? ?? ?? ?? ?? ?? ?? ??? ???? ????? ?? ???? ????.?? ??? ?????? ??? ??? ??? ????? ??????? ?? ?????? ??? ?? ????? ???? ??? ?? ?? ???? ?? ????? ????? ??? ?? ???? ??? ??? ?? ?????? ??? ?? ????? ???? ???? ????? ???? ?? ?? ?? ... ????? ?? ??. ??????? ???? ?? ?? ???? ???? ?? ??? ???? ???? ???? ?? ?? ?? ??????.AsbestosisASBESTOS EXPOSURE may lead to a spectrum of pulmonary disorders:Asbestosis Pleural disease (focal and diffuse benign pleural plaques) Malignancies (non-small cell and small cell carcinoma of the lung as well as malignant mesothelioma)Introduction: Asbestosis specifically refers to the pneumoconiosis caused by inhalation of asbestos fibers. The disease is characterized by slowly progressive, diffuse pulmonary fibrosis.Exposure to asbestos occurs during the mining and milling of the fibers, in industrial applications of asbestos (eg, work with cement, friction materials, insulation, shipbuilding), and in nonoccupational settings with airborne asbestos (eg, regular exposure to soiled work clothes brought home by an asbestos worker, renovation or demolition of asbestos-containing buildings).Clinical findings Most patients who develop asbestosis are asymptomatic for at least 20 to 30 years after the initial exposure.The earliest symptom of asbestosis is usually the insidious onset of breathlessness with exertion, which progresses inexorably even in the absence of further asbestos exposure. Cough, sputum production, and wheezing are unusual. patients may develop bibasilar, fine end-inspiratory crackles (32 to 64 percent) and clubbing (32 to 42 percent) ? Pleural disease: Pleural involvement is a hallmark of asbestos exposure, whereas it is unusual in other interstitial lung disorders. Approximately 50 percent of persons exposed to asbestos develop pleural plaques.ImagingTypical high resolution computed tomography (HRCT) scan findings of asbestosis include: subpleural linear densities of varying length parallel to the pleura, basilar and dorsal lung parenchymal fibrosis, with peribronchiolar, intralobular, and interlobular septal fibrosis, coarse parenchymal bands (2 to 5 cm in length), often contiguous with the pleura, coarse honeycombing in advanced disease, and pleural plaques.DiagnosisThe diagnosis of asbestosis is based on a reliable history of exposure to asbestos with a proper latency period, and/or presence of markers of exposure (eg, pleural plaques or recovery of sufficient quantities of asbestos fibers/bodies in bronchoalveolar lavage or lung tissue); definite evidence of interstitial fibrosis (eg, end-inspiratory crackles, reduced lung volumes and/or diffusing capacity, typical radiographic findings, or histologic evidence of interstitial fibrosis); and absence of other causes of diffuse parenchymal lung disease.No specific treatment has been identified for asbestosis. Management includes supportive care with an emphasis on smoking cessation, avoidance of further asbestos exposure, pneumococcal and influenza vaccination, and supplemental oxygen as needed to maintain adequate oxygenation.ILDMesothelioma Sixty percent of patients have right-sided lesions . Mesothelioma occasionally presents with a pleural mass or rind or diffuse pleural thickening in the absence of a pleural effusion. Chest imaging typically shows unilateral pleural thickening and pleural effusion.Only 20 percent of patients with pleural mesothelioma have radiographic signs of asbestosis (such as bibasilar interstitial fibrosis), although most will have evidence of pleural plaques and/or calcifications. Ipsilateral mediastinal shift can be seen secondary to encasement of lung by a thick rind of tumor. Most patients have significant unilateral loss of lung volume. Silicosis Chest imaging ?—?Silica exposure can cause several distinct clinical and radiographic patterns of pulmonary disease. The three main radiographic presentations of silicosis are simple silicosis, progressive massive fibrosis (PMF), and silicoproteinosis. Simple silicosis ?—?Simple silicosis refers to a profusion of small (less than 10 mm in diameter) nodular opacities (nodules). The nodules are generally rounded but can be irregular, and are distributed predominantly in the upper lung zones .Progressive massive fibrosis ?—?Progressive massive fibrosis (PMF, or conglomerate silicosis) occurs when these small opacities gradually enlarge and coalesce to form larger, upper- or mid-zone opacities more than 10 mm in diameter . As these opacities progressively enlarge, the hila are retracted upward in association with upper lobe fibrosis and lower lobe hyperinflation. Hilar adenopathy with prominent calcification is often present. The opacities of PMF can be asymmetrical, and may mimic a neoplastic process. Cavitation may also be present in advanced disease, or in the setting of mycobacterial superinfection. Asbestosis ?small bilateral parenchymal opacities with a multinodular or reticular pattern, often with associated pleural abnormalities, bilateral mid-lung zone plaques on the parietal pleura. ?In the early stages of asbestosis, combined interstitial and pleural involvement may cause a hazy, "ground glass" appearance to the chest radiograph that may blur the diaphragm and heart border, giving rise to the "shaggy heart" sign.?Honeycombing and upper lobe involvement develop in advanced stages of disease.?Hilar and mediastinal lymphadenopathy are not seen with asbestosis and should suggest the presence of another process.?Pleural involvement is a hallmark of asbestos exposure, whereas it is unusual in other interstitial lung disorders. Approximately 50 percent of persons exposed to asbestos develop pleural plaques. Benign asbestos pleural effusions (BAPEs) are usually small and unilateral and occur years before the onset of interstitial diseasePneumoconioses Both coal workers' pneumoconiosis and silicosis may evolve into progressive massive fibrosis or conglomerate masses, yielding multiple pulmonary nodules that range in size from 1 to 10 cm and are usually located in the upper lobes . A background pattern of small nodular opacities is usually apparent and, in 5 percent of cases, accompanying lymph node enlargement with eggshell calcification is present. Calcification and cavitation of these nodules are unusual; however, when they occur, superimposed tuberculosis has to be suspected. Beryllium-associated lung disease can present with multiple pulmonary nodules and mimic the radiologic appearance of sarcoidosis. Caplan’s disease is a combination of rheumatoid arthritis and coal-worker’s pneumoconiosis that manifests multiple pulmonary nodules.58-A pt presented with non productive cough n increasing breathlessness he had been working in coal mine n a chronic smoker for 40 yrs on chest x ray right sided pleural effusion present what is the most likely dx here A silicosis B pneumoconiosis. C mesothelioma D asbestosis (Pleural involvement is a hallmark of asbestos exposure, whereas it is unusual in other interstitial lung disorders. Approximately 50 percent of persons exposed to asbestos develop pleural plaques not plural eff.)????????? ???? ???? ?? ??? ??? ????????????????? ?? ?????? ?????? ????59-A middle age man worked in coal mine for 10 years with no history of smoking came with shortness of breath, hemoptysis, Pleural effusion aspirated blood. What is your diagnosis a. Lung ca b. TB c. Mesothelioma60- 38. rs. old woman with secondary amenorrhea, normal BMI, FSH: 55, LH: 54, oestradiol: 77, Prolactin: normal, in USG of ovaries: 3-4 cyst, do not want to conceive, what is the best treatment?a. POPb. menopause hormone therapyc. clomiphened. OCPe. Metformin[Forwarded from Keyvan]?? ???????? ?? ???? ????? POF ?? ???? ???? ??? ??? ???? HRT ???????? ??????????? ???? . ??? ???? ?? ?????? ?????? ????? ???? ?? HRT ?????????? ??????? .??? ?? ?? ????? D ?????? .????? ??????? ?????? ?? ??????????????? ???? ???????? POF ???? ?-??? ?????? ?????? ???? ??? ???? ?????? ?? OCP ?????? .61-55 yr old male came for carcinoma prostate screening.. history of father diagnosed Ca prostate at 55 yr. right now DRE is done which is normal. What to do nextPSA CEAUSGReassure??? ???????? racgp ?????? ??? ?? ???????? ?? ?????? ??????? ??????? ??? ?? ????? ????? ? ????? ?????? ????? ???? ?? ? ?????? ????? ???? ?? ? ???? ????? ?????? ????? ???? ?????? ?? psa ? ?? dre ???? ????? ???62-old women on treatment of schizo having clozapine for her condition now presented with chest pain, palpitation and tachycardia what to do?Clozapine levelEcho?TroponinTachycardia is a common side effect of clozapine treatment that occurs in about 25% of users, especially during dose titration in early treatment. However, it is also a key symptom of myocardial disease. It is therefore essential that patients who have persistent tachycardia at rest, especially in the first two months of treatment, are closely observed for other signs and symptoms of myocarditis/cardiomyopathy. These include palpitations, arrhythmias, symptoms mimicking myocardial infarction, chest pain and other unexplained symptoms of heart failure.63- 34 year female concerned about carcinoma breast as her friend was diagnosed with breast carcinoma. She doesn’t have any symptoms.Mammo nowUsg now??? ???? ?????? ?? ??????? Counsel ???? ?? breast awareness ???. ?????? ???? ??? ?????? ????? ???? ?? ???????? ???? ??? ?? ?? ?? ??? ??? ?? ???? ?? ?? ??? ????????? ???? ????? ???? high risk ????? ???? ????? ??????????? ? ?????? ????? ???. ??? ??? ??? ???? ??? ???? ?? ?? ?? ??? ? ??????? ?? ??? ?? ???? ?? ??????? ?? ?????? ????????? ???????? ??? ?? ?? ??? ????? ????? ? ????? ?????? ???. ?? ?? ??? ?? ????????? ????? ?????.HB 2.048 patients with a family history of breast cancer in more than one blood relative (parents, siblings, grandparents) have a significantly higher likelihood of developing breast cancer than woman with no family history. Regular six month clinical review plus yearly mammography with or without additional ultrasound screening should begin at least five year before the age that the diagnosis was made in her blood relatives. 64- A patient presents with symptoms of dysuria and hematuria.She has a history of weight loss from a few months with malaise.On U/E Rbcs and pus cells present.Your diagnosis?a)Renal cell carcinomab)Renal tuberculosisc)Bladder carcinoma???? ? ??? ???? ?? ?? ?? ?????? ????? ????? ?? ??? ???? ??? ? ... ????? ?????Isolated pyuria ?Uptodate:Assuming no contamination with vaginal secretions, pyuria alone is usually indicative of urinary tract infection (including tuberculosis, in which conventional bacterial cultures may be negative). Sterile pyuria may also suggest an asymptomatic kidney stone or some form of tubulointerstitial disease, such as analgesic nephropathy.NEJM:A recently (within preceding two weeks) treated urinary tract infection (UTI) or inadequately treated UTI.UTI with 'fastidious' organism (an organism that grows only in specially fortified artificial culture media under specific culture conditions) - eg, Neisseria gonorrhoeae.Renal tract tuberculosis.[2] Chlamydial urethritis.False negative culture due to contamination with antiseptic.Contamination of the sample with vaginal leukocytes.Interstitial nephritis: sarcoidosis (lymphocytes not neutrophils).Urinary tract stones.Renal papillary necrosis: diabetes, sickle cell disease, analgesic nephropathy.Urinary tract neoplasm, including renal cancer and bladder cancer.Polycystic kidneys.Interstitial cystitis.Prostatitis.Kawasaki disease.[3] Other reported associations include appendicitis and systemic lupus erythematosus65-78 yrs man with chest heavines at rest st elevation in v3 v4 best treatment?A. AspirinB. Aspirin clopidogrelC. ThrombolysisD. HeparinE. PCI66- old pt. with long history of constipation, taking laxatives now presented with mild pain for 48 hr.mild destination vomiting , physical exam is normal. diagnosis ?a.fecal impactionb.ca colonc.diveticlosisd. sig. volvoluse. psedo obs.67-A 77 yrs woman low back pain hx of colon cancer surgery 5 yrs ago tenderness at T7_T8 no hx of trauma elevated both parathyroid hormone and ALK.ph dx?A. Malignant metastasisB. MMC. Musculoskeletal back painD. Vertebral fixE. Disc prolapse68-scenaro of hyperkalemia pt present with confusion,K?was?6.5,urea and CR also very high.next1.urgent hemodialysis2.rectal calcium resonium3.5%dextrose with insulin 10 unit????? ??? ??? ????? ????? ??? ? ???? ???????. ??? ???? ?? ????? ?? ??? ??? ???? ????? ?? ????69-Pt is feeling confused and tired since one week. Has diarrhoea in the last 24 hrs. taken to the hospital. Is on perindopril , indapamide and some more. Has hyponatremia = 120.why?and all others normala- siadhb- diarrhoeal illness c- indapamided- perindoprilC (thiazide) is the cause of electrolyte disturbance and also can cause postural hypotension,70-4 yrs. old boy comes with intermittent abdominal pain. Usually it last for 12 hours, the pain goes away spontaneously. Also pain in left flank. What help for dx?a Ct abdomenb Erect and supine x-ray c USG abdomen (kidney not abdomen)c Micturition cystogramd Barium meal and follow through71-? 22 yr old lady presented to u n requested for ovarien ca screening as her friend is just dx with ovarian ca. What will u advise her?A.USGB.CA 125??C.Both USG & CA 125D.laparoscopy72-Px with low right costal margin pain, irradiating to the back , fever, local tenderness there but not abd guarding. Dyspnea, cough, no sputum, malaise, no weight loss, previous history of being in influenza epidemic area . What is possible Dx?1- subfrenic abscess j2- empyema3- cholecystitis4- pancreatitisempyema?Common clinical features of bacterial pneumonia with parapneumonic effusion include cough, fever, pleuritic chest pain, dyspnea, and sputum production. However, patients may only have one or two of these symptoms. In general, the presenting symptoms, other than pleuritic pain and duration of fever, are not helpful in determining which patients have pneumonia versus pneumonia with a parapneumonic effusion or empyema. Patients with empyema may report a longer course with several days of fever and malaise rather than hours. ?Physical examination may identify the presence of pleural fluid when the fine or coarse crackles, egophony (also known as e to a changes), and increased fremitus (palpable asymmetric increase in vibration with speech) typical of consolidation are replaced by decreased breath sounds and decreased fremitus. Occasionally, egophony will still be present at the upper edge of the effusion. Dullness to percussion is a potential feature of lung consolidation from pneumonia and pleural effusion. These findings are helpful when present; however, they are often absent so radiographic imaging is crucial to the complete evaluation. ?In patients with a thoracic empyema documented by the presence of pleural pus (eg, category 4) ( table 1 ), we recommend prompt drainage of any remaining pleural fluid rather than observation ( Grade 1B ). Acceptable initial methods for pleural drainage include tube thoracostomy and video-assisted thoracoscopic surgery (VATS) with debridement. The latter may be preferred in patients with multiple loculations and a thick pleural peel.?When tube thoracostomy is used for initial drainage of an empyema, a chest CT scan should be obtained within 24 hours after chest tube placement to document appropriate placement of the tube and assess drainage. For patients who do not have good drainage of empyema fluid from a well-placed chest tube, we suggest intrapleural administration of a combination of tissue plasminogen activator (TPA) 10 mg and deoxyribonuclease (DNase) 5 mg, twice daily for three days rather than no intrapleural therapy or either agent alone.?Continued failure of adequate pleural drainage should prompt thoracoscopy or thoracotomy to lyse adhesions, fully drain the pleural space, and optimize chest tube placement. The choice between thoracoscopic debridement and decortication depends on several factors; those favoring decortication include more adhesions, greater visceral pleural thickness, and larger empyema cavity size.Lung abscess necrotizing pneumonia:fever, cough, and sputum production putrid or sour-tasting sputum.A lung abscess is typically diagnosed when a chest radiograph reveals a pulmonary infiltrate with a cavity, indicating tissue necrosis.The only methods available for obtaining uncontaminated specimens are transtracheal aspirates (TTA), transthoracic needle aspirates (TTNA), pleural fluid, and blood cultures. clindamycin (600 mg IV every eight hours, followed by 150 to 300 mg orally four times daily)Other drugs: ampicillin-sulbactam 3 g IV every six hours), penicillin plus metronidazole , or a carbapenem.We suggest continuing antibiotic treatment until the chest x-ray shows a small, stable residual lesion or is clear. This generally requires several months of treatment.Subphrenic abscessPus under a patient's diaphragm has usually spread there from somewhere else in his abdomen. A subphrenic abscess may be secondary to: (1) Peritonitis, either local or general, following a perforated peptic (11.2) or a typhoid ulcer (31.8), or appendicitis (12.1), or PID (6.6) or infection following Caesarean section (18.11). (2) An injury which has ruptured a hollow viscus and contaminated his peritoneal cavity (66.2). (3) A laparotomy during which his peritoneal cavity was contaminated (9.2). (4) A ruptured amoebic liver abscess (31.12).characterized by an accumulation of infected fluid between the diaphragm, the liver and the spleen.[1] This abscess develops after surgical operations like bowel perforation or splenectomy. Presents with cough, increased respiratory rate with shallow respiration, basal atelectasis, or pneumonia ,diminished or absent breath sounds, hiccups, dullness in percussion, tenderness over the 8th–11th ribs, fever, chills, anorexia and shoulder tip pain on the affected side. Lack of treatment or misdiagnosis could quickly lead to sepsis, septic shock, and death.[2] It is also associated with peritonitisCommon clinical features of bacterial pneumonia with parapneumonic effusion include cough, fever, pleuritic chest pain, dyspnea, and sputum production.TX: drnage + AB (6-8 w)73-42 years old olive skin man came to your gp practice he came to u becoz of Tv advertisement of melanoma,no family history,no symptom.you reassured him,patient said if he feel any symptom he ll come for check up but instead of that what u ll recommened him for follow up???A.every 6 month B.2 yearly C.5 yearlyD.put him on regular medication...E(NO OPTION OF NO SCRENNING) advised for sun protection and no need for routine screening just self-examination of the skin 74-A 2 month old diagnosed with meningitis.LP shows turbid CSF .glucose less than half normal.No organism seen on gram stain.What is the most likely organism?A.GBS2B.Ecoli3.Herpes virus4.CMVBoth can cause meningitis in this age group (Neonatal period), but GBS is more common than E.coli so A here. Both can be seen on gram stain…75-60 yrs female known cade of DM and HF was operated for cholecystectomy . On second post operative day she went to toilet . After coming from toilet she collapsed on floor . Exam pr 44 bp 80/46. She recovered immediately after treatment .dx?A. Septic shockB. CardiogenicC. VasovagalD. HypoglycemiaE. Hypovolemic76- 50 yrs old man having sex with prostitutes every night, going to the club, and investing all his money in risky real estate, and having insomnia. Mirtazapine Na valproate Resperidone????? ??????- ?? ?????? ??? ?????? ??? ?? ????????? ? ????????? ??? .?- ?? ?????????? ????? ?? ???????? ????? ?????? ??? ?????? ? ???? ??????????? ??? ??? ? ?? ?????????? ??? .? ?? ?? ???? ? ?? ?? ???? ? ? ??????? ?? ??????? ??? ??? ???? ?? ????? ????? ? ???? ?? ????? ???? ???? ???? ?? ?????? ???? . ????? :??? ???? ??? ????????? ? ????????? ??? ????? ?? ?? ????? ? ??? ??????? ??? ????? ????? ??? ?????? ???? ?????????? ?? ????? ????? ????? ????? ????????? ????? ???????? ? ?????? ??? ? ????? ?????? ?? ???? ????????? ???? .??? ???? ??? ??? ????? ?? ?????? ??? ????????? ? ????????? ???? ???? ????????? ?? ?????? ???? ??? ??? ??? ?????? ????????? ??? ?? ?? ??? ???? ?????? ???? ?? ??? ?????? .??? ???????? ???????? ???? ?? ?? ?? ???? ? ? ? ? ????? ?? ??? ???? .? ????? ?? ????? ?????? ????? ??? ?? ???? ?? ????????? ? ????????? ?? ?????? ????? ?? ?????? ??? ?? ?????? ???? . ??? ?? ????? ????? ???????? ?? ?? ????? ????? (???? ??? ??????) ?????? ?? .77-? A patient with HBsAg positive, which is the highest risk for developing HCC?a. Alcholb. Cirrhosisc.?HB?e?Ag78-Which of the following is not a risk factor for the development and progression of diabetic retinopathy?A.PregnancyB.HypothyroidismC.AnaemiaD.HypertensionE.DyslipidemiaThe increased risk of retinopathy and nephropathy observed in diabetic patients with subclinical hypothyroidism provides evidence in favor of screening patients with type 2 diabetes for thyroid dysfunction and treating when present.79-An Old lady have undergone pinning for femur fracture, now what appropriate advice during discharge-AlendronateDEXA ( not bone scan)Heparin IV for 6 monthWarfarin for 6 monthI have fixed myself on my recall, which was the same as this one but had enoxaparine and pain killers as an option. you are right that alendronate is given without doing DEXA but the problem is - is the question asking what you will give on discharge or what you will advice? We do not advice alenronate but prescribe. So it will depend what we are asked in the question.80-.female Postmenupausal and with vaginal bleed .pap smear no endocervical cell seen.Repeat papColposcopyNothingLLETZ??? ???? ????? ???? ????? !???? ?? ????? ?? ???? ???? ?? ???? ???? inadequate???? ? ???? ?????? ?????? ???? ???? ?? ?? postmenopause??????? ???? ?????? ?? ???? ????? ???? ? ????? ????? ???? ???? ??? ?????? ?? ???? ???? ???? ??? ??? ???????? ???? ????? ??? ????? ?81- Mx of obese 9 y/o with obese family.-Strict exercise-Exercise + diet to maintain weight-Obesity will disappear during puberty- prescribe diet regimen-replace soft drinks with fruit juice82- Sudden vomiting dysphagia and epigastric pain in patient who had previous gastric?fundiplication?asking invBarium swallowXray (next fallow through stydy either by barium or gastrografin diatrizoate)CTUSGMost common complication dysphasia due to tight stricture82.1- pt with sudden severe epigastric pain, vomiting, hx of gastric ligation 6 months ago. next?1. urgent surgery2. barrium swallow3. ct scanComplication: obstructionA simple x-ray is the first diagnostic modality and could be carried on upon clinical findings to barium swallow (c/I in perforation) , CT and …83. 68 yr old lady came for a routine visit and tells you that she is going to become nanny. Which vaccination will you advise for her ?a.?DTPab. Hemophilus influenza vaccin.c. Pneumococcal vaccin. with history of chronic progressive constipation since 3 month and recently took diclofenac for back pain. Diagnosis was asked.VolvulusCa colonB.....more likely as we have one of three red flags here ...but still we need the age85-Girl had flu 2 days now with fever 38.5 head he photophobia neck stiffness. Mononuclear cells 260 rbc 200 n neuro 10A) Observe analgesia is all what is required (exact statement)B)Give antiviral until diagnosis further confirmedC) MRI to rule Out SAN86-A 2 month old baby had severe bleeding from frenulum after hitting coffe table.Which is the investigation you will do next?a) APTTb)Factor 9c)Platelet count and morphology??? ???????? ?????????? ????? ????? ????.????????? ?? ?????? ???????:ptt ? BT ???.?? ???? ??? ??? pt ????? ?????.?? ??? ???????? ???? ?? ?????? ??? ???????? ??? ?? ????? ?? ???? ???? ?????? ??? ?????? ? ????????? ?????? ????? ????? ???.87-A 55 year old builder came with weakness of his left hand and leg not lasting for 12 minutes, same complaints couple of weeks back. he is taking only Aspirin, no other drug, what will you advice him other than usual Mx (October 16 recalls)a) Do not do strenuous exerciseb) Do not drive for 6 monthsc) Add warfarin(if AF presents)d) Add more antiplatelet (if coexisting of CAD)e)endartrectomy(if >50% obstruction an life expectancy more than 5 year)Secondary preventive therapy:Blood pressure lowering is the most important action due to decrease future risk of stroke whether first or subsequent episode. Best done by ACEi (alone or in combination with a diuretic) but all other antihypertensive drugs are found to be effective (except BB).All stroke and TIA patients, whether normotensive or hypertensive, should receive blood pressure lowering therapy, unless contraindicated by symptomatic hypotension.New blood pressure lowering should be commenced before discharge for those with stroke or TIA, or soon after TIA if the patient is not admitted.Antiplatelet therapy: significantly reduce the risk of subsequent vascular events including stroke, MI or vascular death. It has a little adverse effect due to increasing risk of hemorrhage, but the benefits outweigh the risks.Aspirin reduce the risk of vascular events by 13%, lowest effective dose is 30 mg daily. Combination of aspirin(75-162mg) and clopidogrel(75 mg) or extended release dipyridamole has no net benefit compared with clopidogrel or aspirin alone. Combined therapy should be used in coexisting acute coronery disease or recent coronary stent.Anticoagulation therapy for secondry prevention for people with ischemic stroke or TIA from presumed arterial origin should not be routinely used. It is usually used for patients with ischemic stroke who have AF and in TIA patients who have no signs of intracranial hemorrhage on CT or MRI.Cholesterol lowering: therapy with statin should be used for all patients with ischaemic stroke or TIA but shouldn’t be used routinely for hemorrhagic stroke.?? ??? ???????? ??????? ???? TIA ???? ??????? private ??? ?? ??? ? ???? ??? ?? ?? ???? advisory ??? ???? ??????? ???? ? ??? ?????? ?????? ???? ? ???? ?????. ??? ???? ???? stroke? ???? ????? (????? ????) ? ? ??? (???? ????? ??? ????? ? ?????? ? ????).???? acute MI : ? ???? / ? ???????? CABG : ? ???? / ? ??????? seizure ?? ???? ??? : ?? ??? / ?? ??? ????.88-Patient had sex with HIV positive person, comes for a test with the symptom of rash ,NO lymphadenopathy in stem, splenomegaly.Western blot and Elisa negative, what would you do next for diagnosis?b.EBV testc.CMV testd.Repeat HIV??? ????? ?????? ????? ???? ?? ?????? ????? ?? ????..? ????? ???? ?? ??? ????? ? ????? ???? ?? ?????..?? ????? ???? ?????? ??? ?? ??? ??? ??? ???? ???? ?? ???? ????? ??? ? ??? ??? ????? ???? next , ?? ?? ??? ??? ?? ebv ?? ?? ???? ?? ?????? ??? ?????? ????? ????A negative HIV immunoassay and negative virologic test(RNA or P24) strongly suggests that HIV infection has not been acquired. In the case of very recent high-risk exposures when HIV transmission remains a concern, repeat testing in one to two weeks (especially if symptoms of acute HIV develop) is warranted. A negative HIV immunoassay and a positive virologic test suggest early HIV infection. Similarly, a positive HIV immunoassay with a negative or indeterminate Western blot and positive virologic test suggest early HIV infection. In these situations, however, an RNA level <10,000 copies/mL may represent a false positive viral test and the viral load test should be immediately repeated on a new blood specimen. A second positive virologic test suggests HIV infection, which a repeat serologic test several weeks later to evaluate for seroconversion can confirm.A positive HIV immunoassay, Western blot, and virologic test suggest established HIV infection. This does not exclude the possibility of recent infection and seroconversion, but unless the patient had a negative serologic test performed within the preceding six months, the timing of infection cannot be confirmed by routine laboratory testing. In such situations, the diagnosis of early HIV infection is presumptively made on the basis of exposure history and clinical presentation. ? 89-WOF is least useful for prevention of osteoporosis in postmenopausal woman?a. HRTb. Tamoxifenc. Alendronated. Calciume. Regular exercise ................
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