tag:blogger.com,1999:blog-56215779802809838202024-03-17T17:42:30.519-07:00Doctors NetworkDr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.comBlogger722125tag:blogger.com,1999:blog-5621577980280983820.post-33447187399677612832022-02-21T11:12:00.006-08:002022-02-21T11:12:55.163-08:00Intralesional glucocorticoid <p> Intralesional glucocorticoid :</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEj0hQzMn7K5zb-8zW-jJw2K8siHuKTLSN69rADJORp45iDCX4fQZQSvqhOVlT04u-wILJWiJIzyAvfiM1AulzNctGQdp-7Jp_AY09zkNlM6DfWlCgo8rnmJkdmc5Yc1qOTprLbS3mVHirBOkf_ERfqBhofWZvMYuBTObhpL6ZY8ryX9tsZG3xNLEew2Yg=s749" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="404" data-original-width="749" height="216" src="https://blogger.googleusercontent.com/img/a/AVvXsEj0hQzMn7K5zb-8zW-jJw2K8siHuKTLSN69rADJORp45iDCX4fQZQSvqhOVlT04u-wILJWiJIzyAvfiM1AulzNctGQdp-7Jp_AY09zkNlM6DfWlCgo8rnmJkdmc5Yc1qOTprLbS3mVHirBOkf_ERfqBhofWZvMYuBTObhpL6ZY8ryX9tsZG3xNLEew2Yg=w400-h216" width="400" /></a></div><br /><br /><p></p><p>Used in Conditions like as follows : </p><p><b>-Dupuytren Contracture</b></p><p><b>-Gout in Renal Failure</b></p><p><b>-Keloids</b></p><p><b>-Alopecia areata</b></p>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com1tag:blogger.com,1999:blog-5621577980280983820.post-33295980510175270512022-02-13T12:30:00.004-08:002022-02-13T12:30:27.788-08:00Etiology and Association of Erythema Nodosum<p><b> </b></p><div class="separator" style="clear: both; text-align: center;"><b><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiC20l4zJygxG3VYLk3xv_mahuZ2xJHvEn_3bqM1v-B1mZ_maW5rsnExGCNW5N5RNK0e01KIHzU2S6weElj86fTBsE1CJFwHC0CkUJxeRdZW1O2NqppYO-RCLIMPuouxh_bR4zGvX1uY8TgZWZaG2MXs9Xbu2OLI2ZUhdoGEJL9kCLDrm4VKhu0KRTA8A=s762" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="660" data-original-width="762" height="346" src="https://blogger.googleusercontent.com/img/a/AVvXsEiC20l4zJygxG3VYLk3xv_mahuZ2xJHvEn_3bqM1v-B1mZ_maW5rsnExGCNW5N5RNK0e01KIHzU2S6weElj86fTBsE1CJFwHC0CkUJxeRdZW1O2NqppYO-RCLIMPuouxh_bR4zGvX1uY8TgZWZaG2MXs9Xbu2OLI2ZUhdoGEJL9kCLDrm4VKhu0KRTA8A=w400-h346" width="400" /></a></b></div><b><br />Causes/association of E Nodosum?</b><p></p><p><span style="color: red;"><b>Sarcoidosis,</b></span></p><p><span style="color: red;"><b>Coccidioidomycosis,</b></span></p><p><span style="color: red;"><b>Histoplasmosis, TB,</b></span></p><p><span style="color: red;"><b>Streptococcal infections,</b></span></p><p><span style="color: red;"><b>Leprosy, inflammatory bowel disease</b></span></p>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com9tag:blogger.com,1999:blog-5621577980280983820.post-10045456534811008322022-02-04T09:03:00.002-08:002022-02-04T09:03:15.740-08:00NEUROLOGY & CARDIOLOGY USMLE FlashCards<p><b> </b></p><div class="separator" style="clear: both; text-align: center;"><b><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgTeh5GHjChXJxX30GktzpOEyTOLtkWwaPfBDQXx5H9bFQ4E1S9BdMcwU52PUzjJOw_kCU6-BxNLhqyXIZxEs_Rdge2NZ-zH94X26twecbnDxzv4U392Zu_WyfCn564-Dn-xpHC-hIfJ9YVgTEKa-UErmYMFUVreBWAVogAYmKS3n0fn1yVRfr7ciYRDg=s1268" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="358" data-original-width="1268" height="90" src="https://blogger.googleusercontent.com/img/a/AVvXsEgTeh5GHjChXJxX30GktzpOEyTOLtkWwaPfBDQXx5H9bFQ4E1S9BdMcwU52PUzjJOw_kCU6-BxNLhqyXIZxEs_Rdge2NZ-zH94X26twecbnDxzv4U392Zu_WyfCn564-Dn-xpHC-hIfJ9YVgTEKa-UErmYMFUVreBWAVogAYmKS3n0fn1yVRfr7ciYRDg=s320" width="320" /></a></b></div><b><br /></b><p></p><p><b><br /></b></p><p><b>......... commonly used to prevent ischemic hypoxia brain injury out of hospital cardiac arrest?</b></p><p><span style="color: red;">Therapeutic hypothermia</span></p><p><b>Brain tumor with estrogen receptors?</b></p><p><span style="color: red;">meningioma</span></p><p><b>The hallmark of prolonged seizure and what the sequelae?</b></p><p><span style="color: red;">5 minutes...cortical laminar necrosis</span></p><p><b>Baby becomes floppy after family traveled to .............. or ................... or ......................? </b></p><p><span style="color: red;">California, Utah, Pennsylvania have been reported</span></p><p><b>BB, Primidone, topiramate, Deep brain stimulation or thalamotomy if all else fails</b></p><p><b>those are Treat for what? </b></p><p><span style="color: red;">essential tremor</span></p><p><b>1st line treatment in pseudotumor cerebri ?. </b></p><p><span style="color: red;">Rx: Acetazolamide ----> 1st line---> inhibit choroid plexus carbonic anhydrase↓ CSF and IH. Add</span></p><p><span style="color: red;">furosemide in pts with continued symptoms</span></p><p><span style="color: red;">Symptoms refractory to medical therapy or those</span></p><p><span style="color: red;">with progressive vision loss----> surgical intervention with optic nerve sheath decompression or</span></p><p><span style="color: red;">lumboperitoneal shunting is recommended.</span></p><p><span style="color: red;">Short-term use of corticosteroids or serial lumbar</span></p><p><span style="color: red;">puncture (LP) can serve as bridging therapy for patients awaiting definitive surgical treatment ---> not</span></p><p><span style="color: red;">recommended as primary intervention due to side effects</span></p><p><b>Subjective restlessness in a patient on antipsychotics...dx and RX?</b></p><p><span style="color: red;">Akathisia</span></p><p><span style="color: red;">beta-blocker ,benzodiazepine</span></p><p><b>Which artery is affected by Wallenberg syndrome? </b></p><p><span style="color: red;">PICA</span></p><p><b>We Add Dexamethasone in meningitis caused by what Bacterial infection?</b></p><p><span style="color: red;">Streptococcus pneumoniae and Haemophilus influenzae</span></p><p><b>MS symptoms last for how long Vs TIA symptoms?</b></p><p><span style="color: red;">For days and week vs less than 24 hours</span></p><p><b>In GBS what is the deep tendon reflex would be?</b></p><p><span style="color: red;">Dec or absent</span></p><p><b>Which Cranial nerve is responsible for Flavor perception?</b></p><p><span style="color: red;">cranial nerve VII</span></p><p><b>DTR that been seen in cyanide toxicity vs Magnesium Toxicity?</b></p><p><span style="color: red;">hyper vs hypo</span></p><p><b>Lyme meningitis is bacterial meningitis so what is WBC predominant?</b></p><p><span style="color: red;">lymphocytes</span></p><p><b>we Dx brain death clinically what is the criteria to Dx it?</b></p><p><span style="color: red;">absent cortical and brain stem functions. but, the spinal cord may still be functioning; therefore, deep tendon reflexes may be present.</span></p><p><b>Pulsus Tardus Parvus where do you see them?</b></p><p><span style="color: red;">AS</span></p><p><b>What is the BB that is CI in prolonged QT syndrome? </b></p><p><span style="color: red;">sotalol</span></p><p><b>MCC of erectile dysfunction post-infarction Patient ?</b></p><p><span style="color: red;">psychogenic</span></p><p><b>What causes the loss of the normal Right axis deviation in infants?</b></p><p><span style="color: red;">Tricuspid atresia</span></p><p><b>Quincke pulse where to see it ?</b></p><p><span style="color: red;">AR</span></p><p><b>what is the EKG looks like in Cardiac tamponade?</b></p><p><span style="color: red;">electrical alternans</span></p>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-5621577980280983820.post-36502636216116387292022-01-26T08:04:00.001-08:002022-01-26T08:33:07.102-08:00Rheumatology and Orthopedics USMLE Flashcards <p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEj2kta6hj7rORpuPFM6Pdqpe3rAJ5YnixHJwAj9PiGVP8bQqAgLJ_tLA2u11Yh2yNybcBwG3Hjzpwxg2c3U-AKBdvtOS4MGqnzYBvKdHSBHvglDAnt9QBhlMUXHsPJAAUKCyIsq_46OhxYcIvAKUxA79fMWmHOCXupkwS7EepmTbTfNYM7tzEiM6L2TAw=s1268" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="359" data-original-width="1268" height="114" src="https://blogger.googleusercontent.com/img/a/AVvXsEj2kta6hj7rORpuPFM6Pdqpe3rAJ5YnixHJwAj9PiGVP8bQqAgLJ_tLA2u11Yh2yNybcBwG3Hjzpwxg2c3U-AKBdvtOS4MGqnzYBvKdHSBHvglDAnt9QBhlMUXHsPJAAUKCyIsq_46OhxYcIvAKUxA79fMWmHOCXupkwS7EepmTbTfNYM7tzEiM6L2TAw=w400-h114" width="400" /></a></div><br /><b><br /></b><p></p><p><b><br /></b></p><p><b>1</b> - <b>Exam that elicits pain for Tennis elbow?</b></p><p><span style="color: red;">Pain with resisted wrist extension and passive flexion</span></p><p><b>2</b> - <b>Exam that elicits pain for Golfer's elbow?</b></p><p><span style="color: red;">Pain with resisted wrist flexion And with passive extension of the wrist</span></p><p><b>3 - Exam for De Quervain's tenosynovitis?</b></p><p><span style="color: red;">passive stretching of affected tendons ( passive ulnar deviation of the wrist ) by grasping flexed thumb into the palm with fingers elicits pain. (Finkelstein's test )</span></p><p><b>4 - Tendons affected in De Quervain's tenosynovitis?</b></p><p><span style="color: red;">Abductor Pollicious Longus and Extensor Pollicious Brevis</span></p><p><b>5 - Tendon affected/degenerated in tennis elbow?</b></p><p><span style="color: red;">Extensor Carpi Radialis Brevis</span></p><p><b>6 - What is Smith's Fx ? how did it happen?</b></p><p><span style="color: red;">Distal Radius Fx after falling on Flexed wrist, with anterior displacement of the distal part of the radius</span></p><p><b>7 - What is Colle's Fx? How did it happen?</b></p><p><span style="color: red;">distal radius Fx with posterior displacement of the distal part of radius and after fall on an outstretched hand</span></p><p><b>8 - Prophylaxis for Pseudo-gout ?</b></p><p><span style="color: red;">colchicine</span></p><p><b>9 - MCC of Osteomyelitis in SCD pt?</b></p><p><span style="color: red;">Salmonella</span></p><p><b>10 - Give 2 Orthopedic Conditions that are Negative Initially on X-ray.?</b></p><p><span style="color: red;">Scaphoid Fx and AVN</span></p><p><b>11 - MC location of Osteomyetlis in adults vs. Children?</b></p><p><span style="color: red;">vertebral body in adults Vs metaphysis of long bones in children</span></p><p><b>12 - Indication for X-ray in Low Back Pain?</b></p><p><span style="color: red;">Osteoprosis / compression Fx</span></p><p><span style="color: red;">Suspect Malignancy</span></p><p><span style="color: red;">A Spondylitis ( i.e Insidious onset, nocturnal, Pain better with movement )</span></p><p><b>13 - Indication For MRI in Low Back Pain Pt?</b></p><p><span style="color: red;">Sensory/ motor deficits</span></p><p><span style="color: red;">Cauda equina syndrome " urine retention Saddle anesthesia" Suspected epidural abscess /infection (e.g fever IV abuse concurrent infection, hemodialysis )</span></p><p><span style="color: red;">Abnormal initial X-Ray too</span></p><p><b>14 - Indication for CT scan in Low Back Pt?</b></p><p><span style="color: red;">Same Indication For MRI if Pt not able to do MRI</span></p><p><b>15 - We check what before hydroxychloroquine sulfate? how often do we check that?</b></p><p><span style="color: red;">baseline ophthalmic exam @ time of start Rx, then annually after 5 years</span></p><p><b>16 - Pain of Trochanteric bursitis elicited by?</b></p><p><span style="color: red;">Sleeping / Pressure on the affected Lateral side and Ext rotation and Resisted abduction</span></p><p><b>17 - MCC of Back pain?</b></p><p><span style="color: red;">Lumbosacral muscle strain</span></p><p><b>18 - Confirmatory test for carpal tunnel syndrome?</b></p><p><span style="color: red;">Nerve conduction study</span></p><p><b>19 - Exam to Dx Cong Hip Dysplasia?</b></p><p><span style="color: red;">Barlow and Ortolani</span></p><p><span style="color: red;">ultrasound after 2 weeks (not before) till 6 months, after six months we can do Xray.</span></p><p><b>20 - What maneuver to do to treat dislocation of the radial head?</b></p><p><span style="color: red;">Supination with Flexion Or hyperpronation of the elbow joint</span></p><p><b>21 - What Joints Spared in Rheumatoid Arthritis?</b></p><p><span style="color: red;">DIP and Sacroiliac lumbar, thoracic vertebrae</span></p><p><b>22 - What is Pathergy where to see it?</b></p><p><span style="color: red;">pustular skin lesions secondary to minor trauma</span></p><p><span style="color: red;">Behçet disease, Crohn's disease</span></p><p><b>23 - Skin finding in Reactive Arthritis?</b></p><p><span style="color: red;">Keratoderma blennorrhagicum & Circinate balanitis</span></p><p><b>24 - Risk F for Pseudogout ( associated with what Diseases )?</b></p><p><span style="color: red;">hemochromatosis and hyperparathyroidism hypothyroidism and DM and Wilson</span></p><p><b>25 - Risk F for torticollis ?</b></p><p><span style="color: red;">Risk factors Related to crowding in the uterus :</span></p><p><span style="color: red;">Multiple gestations, breach Position Oligohydrominous</span></p><p><b>26 - What Conditions/disease Related to intrauterine Position?</b></p><p><span style="color: red;">Metatarsal Adductus, Congenital Muscular torticollis CHD, and Club foot</span></p><p><b>27 - Neer test for?</b></p><p><span style="color: red;">Rotator cuff tendinopathy</span></p><p><b>28 - Pseudothrombophlibitis has been seen in?</b></p><p><span style="color: red;">bakers cyst rupture</span></p><p><b>29 - Hypertension Treatment in Pt with gout?</b></p><p><span style="color: red;">Losartan</span></p><p><b>30 - Which stress fracture needs to be treated with surgery?</b></p><p><span style="color: red;">Anterior tibial, 5th metatarsal</span></p><p>31 - Shin splints vs. tibial stress Fx?</p><p><span style="color: red;">shin splints are anterior leg pain in overweight pt who walk or run.</span></p><p><span style="color: red;">Vs</span></p><p><span style="color: red;">stress Fx is seen in underweight Pt and has localized pain</span>.</p><p><b>32 - 2 cases we have to examine the neck before Anesthesia?</b></p><p><span style="color: red;">Rheumatoid Arthritis, Down Syndrome</span></p><p><b>33 - Rx of gout in Renal F Patient?</b></p><p><span style="color: red;">Intraarticular Steroid</span></p><p><b>34 - What is the most common stress fracture?</b></p><p><span style="color: red;">2nd metatarsal " March Fx "</span></p><p><b>35 - Which stress fracture needs to be treated with surgery?</b></p><p><span style="color: red;">Anterior tibial, 5th metatarsal</span></p><p><b>36 - Risk F for AVN?</b></p><p><span style="color: red;">Sickle cell</span></p><p><span style="color: red;">Caisson disease "decompression sickness"</span></p><p><span style="color: red;">Steroids</span></p><p><span style="color: red;">SLE,, steroid, antiphospholipid Antibodies syndrome "APLAS", alcohol,</span></p><p><b>37 - Nerve compressed in CTS Vs TTS?</b></p><p><span style="color: red;">Median N Vs Tibila N</span></p><p><b>38 - Staph Aureus tend to Affect Epiphysis T/F?</b></p><p><span style="color: red;">F Metaphysis</span></p><p><b>39 - Osteosarcoma Vs Ewing sarcoma Arise from?</b></p><p><span style="color: red;">Metaphysis vs diaphysis</span></p><p><b>40 - MCC of Acute prepatellar bursitis is?</b></p><p><span style="color: red;">Staph Aureus</span></p><p><b>41 - Anterior Ischemic Optic Neuropathy seen As A SE of Viagra? T/F</b></p><p><span style="color: red;">F we see it in GCA</span></p><p><b>42 - Drugs to avoid in myasthenia vs drugs to avoid in gout?</b></p><p><span style="color: red;">Aminoglycosides, BBs, Azithromycin, quinolones,</span></p><p><span style="color: red;">Vs</span></p><p><span style="color: red;">Thiazides and Aspirin.</span></p><p><b>43 - What is the site where giant cell tumors in the bone arises from?</b></p><p><span style="color: red;">Epiphysis</span></p><p><b>44 - What is Monteggia Fx ?</b></p><p><span style="color: red;">proximal 1/3 ulnar fracture with associated radial head dislocation/instability</span></p><p><b>45 - What is Galeazzi Fx ?</b></p><p><span style="color: red;">distal 1/3 radius shaft fx AND</span></p><p><span style="color: red;">associated distal radioulnar joint (DRUJ) injury</span></p><p><b>46 - What are the malignancy associated with dermatomyositis?</b></p><p><span style="color: red;">Ovarian, colon, pancreas lung stomach</span></p><p><b>47 - Medications Causing Drug-induced SLE with negative Anti histone?</b></p><p><span style="color: red;">Minocycline, Statin, Propylthiouracil</span></p><p><b>48 - What is the most accurate test to diagnose Sarcoidosis?</b></p><p><span style="color: red;">lymph node biopsy</span></p><p><b>49 - What is the treatment for renal osteodystrophy?</b></p><p><span style="color: red;">low phosphate diet, phosphate binders like sevelamer ( ca carbonate).Ca and vit D</span></p><p><b>50 - We provide CBT as Rx for Fibromyalgia T/F?</b></p><p><span style="color: red;">T </span></p>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-5621577980280983820.post-50843491669931736772022-01-24T10:36:00.001-08:002022-01-24T10:36:15.595-08:00NEUROLOGY MULTIPLE CHOICE QUESTIONS (2)<p><b> 1. Which one is not a clinical presentation in Guillain Barre Syndrome?</b></p><p>Ascending paralysis</p><p>Weakness and paresthesias</p><p>Descending paralysis</p><p>Autonomic dysregulation</p><p>- <span style="color: red;">C</span></p><p><b>2</b>. <b>CSF with an increased level of proteins +/- pleocytosis, and diffuse demyelination in nerve conduction studies are seen in:</b></p><p>Multiple Sclerosis</p><p>Amyotrophic Lateral Sclerosis</p><p>Myasthenia Gravis</p><p>Guillain-Barre Syndrome</p><p>-<span style="color: red;"> D</span></p><p><b>3</b>. <b>40 yo man comes to the ED with progressive weakness and paresthesias in his legs, later in his arms over the last few days. In the Physical Exam is seen: SO2 90% (FiO2 21%), slightly dyspneic, lungs clear to auscultation bilaterally, Strength 3/5 in LE bilateral, 4/5 UE bilateral, areflexia in LE bilateral. The patient refers to an episode of diarrhea 3 weeks ago. What is the best initial step?:</b></p><p>IVIG infusion</p><p>Plasmapheresis</p><p>O2+ monitor Peak Inspiratory Pressure and Vital capacity </p><p>Nerve conduction studies</p><p>-<span style="color: red;"> C</span></p><p><b>4. 60 yo man presents with progressive swallowing impairment over the last 15 days, associated with weight loss. Also refers to weakness in his right hand later in his left hand that appeared 2 months ago. Denies pain, fever, night sweats, changes in bowel movements, urinary incontinence, paresthesias, tingling. PE fasciculations in tongue, weakness in UE and LE bilateral, atrophy in LE bilateral, Babinski + bilateral. Which of the following delay disease progression?</b></p><p>CPAP</p><p>Steroids</p><p>Plasmapheresis</p><p>Riluzole</p><p>- <span style="color: red;">D</span></p><p><b>5. In the previous case, this medical condition is characterized for the following, except:</b></p><p>It is a progressive degenerative disease of both upper and lower motor neurons.</p><p>Associated with recent Campylobacter jejuni infection.</p><p>Paresthesias and autonomic dysregulation</p><p>B and C</p><p>-<span style="color: red;"> D</span></p>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-5621577980280983820.post-14662905399503881752022-01-22T08:37:00.003-08:002022-01-22T08:37:32.537-08:00NEUROLOGY MULTIPLE CHOICE QUESTIONS (1)<p> <b> NEUROLOGY</b></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiiRNyLLtZaBhl7t33zNSNb03bAQO_YPOctulUID_5Hv0rlZPcbhqHVbggK7rLilqQ14ySt8yQM-kSJDgwZC31_J5IwJo8Bz0vt3sMUjHQbEoN21SlpzCACVPOrLK54LCBTqkFeRiWqI9UMuziwKqQbtvN2EVlbsykc8rup0VTpca5i3zU2VV05KJMUBg=s1268" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="359" data-original-width="1268" height="182" src="https://blogger.googleusercontent.com/img/a/AVvXsEiiRNyLLtZaBhl7t33zNSNb03bAQO_YPOctulUID_5Hv0rlZPcbhqHVbggK7rLilqQ14ySt8yQM-kSJDgwZC31_J5IwJo8Bz0vt3sMUjHQbEoN21SlpzCACVPOrLK54LCBTqkFeRiWqI9UMuziwKqQbtvN2EVlbsykc8rup0VTpca5i3zU2VV05KJMUBg=w640-h182" width="640" /></a></div><br /><span style="background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt;"><br /></span><p></p><p><span style="background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt;">1.</span><span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><b><span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><span style="background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt;">Most common pathogen involved in Meningitis in Newborns group:</span></b></p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">a)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Listeria monocytogenes</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">b)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Haemophilus influenzae</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">c)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>E. coli</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;">d)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Group B Streptococcus</p><p class="x_MsoNormal" style="-webkit-font-smoothing: antialiased; background-color: white; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt;"><span style="color: red;">D</span></p><p class="x_gmail-MsoListParagraphCxSpFirst" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.5in;">2.<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><b>Most common pathogen involved in Meningitis in teens group:</b></p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">a)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Haemophilus influenza</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">b)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Streptococcus pneumonia</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">c)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Neisseria meningitides</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;">d)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Enterovirus</p><p class="x_MsoNormal" style="-webkit-font-smoothing: antialiased; background-color: white; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt;"><span style="color: red;">C</span></p><p class="x_gmail-MsoListParagraphCxSpFirst" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.5in;">3.<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><b><span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Most common pathogen involved in Meningitis in adults:</b></p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">a)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Enterovirus</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">b)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Neisseria meningitidis</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">c)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Streptococcus pneumonia</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;">d)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Listeria monocytogenes</p><p class="x_MsoNormal" style="-webkit-font-smoothing: antialiased; background-color: white; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt;"><span style="color: red;">C</span></p><p class="x_gmail-MsoListParagraphCxSpFirst" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.5in;">4.<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><b><span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Most common pathogen involved in Meningitis in immunocompromised patients:</b></p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">a)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Herpes simplex virus</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">b)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Cryptococcus spp.</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">c)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Listeria monocytogenes</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;">d)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Gram negative bacilli</p><p class="x_MsoNormal" style="-webkit-font-smoothing: antialiased; background-color: white; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt;"><span style="color: red;">C</span></p><p class="x_gmail-MsoListParagraphCxSpFirst" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.5in;">5.<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><b><span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Best empiric treatment for Bacterial Meningitis in infants < 1 month and hyperbilirubinemia:</b></p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">a)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Vancomycin plus ampicillin plus Cefotaxime</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">b)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Vancomycin plus ampicillin plus Ceftriaxone</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">c)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Gentamicin plus ampicillin plus Cefotaxime</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;">d)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Gentaicin plus ampicillin plus Ceftriaxone</p><p class="x_MsoNormal" style="-webkit-font-smoothing: antialiased; background-color: white; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt;"><span style="color: red;">C</span></p><p class="x_gmail-MsoListParagraphCxSpFirst" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.5in;">6.<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><b><span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Best empiric treatment for Bacterial Meningitis in patients > 1 month to < 50 years:</b></p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">a)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Vancomycin plus ceftriaxone</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">b)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Gentamicin plus ampicillin plus Cefotaxime</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">c)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Gentamicin plus ampicillin plus Ceftriaxone</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;">d)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Vancomycin plus ampicillin</p><p class="x_MsoNormal" style="-webkit-font-smoothing: antialiased; background-color: white; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt;"><span style="color: red;">A</span></p><p class="x_gmail-MsoListParagraphCxSpFirst" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.5in;">7.<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><b>Best empiric treatment for Bacterial Meningitis in patients > 50 years:</b></p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">a)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Gentamicin plus ampicillin</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">b)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Gentamicin plus ampicillin plus vancomycin</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">c)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Vancomycin plus Cefotaxime</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;">d)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Vancomycin plus ampicillin plus ceftriaxone</p><p class="x_MsoNormal" style="-webkit-font-smoothing: antialiased; background-color: white; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt;"><span style="color: red;">D</span></p><p class="x_gmail-MsoListParagraphCxSpFirst" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.5in;">8.<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><b>Patient with contralateral weakness and sensory loss in the face and upper limbs PLUS hemispatial neglect. What is the affected artery?:</b></p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">a)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Anterior cerebral artery in the non-dominant hemisphere</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">b)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Anterior cerebral artery in the dominant hemisphere</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">c)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Middle cerebral artery in the non-dominant hemisphere</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;">d)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Middle cerebral artery in the dominant hemisphere</p><p class="x_MsoNormal" style="-webkit-font-smoothing: antialiased; background-color: white; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt;"><span style="color: red;">C</span></p><p class="x_gmail-MsoListParagraphCxSpFirst" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.5in;">9.<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><b>Patient with contralateral weakness and sensory loss in the face and upper limbs PLUS Broca’s aphasia PLUS right homonymous superior quadrantanopia. What is the most likely affected artery?</b></p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">a)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Left posterior cerebral artery</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">b)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Right posterior cerebral artery</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">c)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Right middle cerebral artery</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;">d)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Left middle cerebral artery</p><p class="x_MsoNormal" style="-webkit-font-smoothing: antialiased; background-color: white; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt;"><span style="color: red;">D</span></p><p class="x_gmail-MsoListParagraphCxSpFirst" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.5in;">10.<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><b>Patient with left hypoglossal palsy PLUS right hemiparesis AND right proprioception loss. What is the affected artery?:</b></p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">a)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Left paramedian branch of anterior spinal artery</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">b)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Right paramedian branch of anterior spinal artery</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">c)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Left superior cerebellar artery</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;">d)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Right anterior inferior cerebellar artery</p><p class="x_MsoNormal" style="-webkit-font-smoothing: antialiased; background-color: white; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt;"><span style="color: red;">A</span></p><p class="x_gmail-MsoListParagraphCxSpFirst" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.5in;">11.<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><b><span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>The localization of lesion in Lateral medullary (Wallenberg) syndrome?:</b></p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">a)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Nucleus ambiguus, vestibular nuclei, lateral spinothalamic tract, and inferior cerebellar peduncle</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">b)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Nucleus ambiguus, vestibular nuclei, lateral spinothalamic tract, and superior cerebellar peduncle</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">c)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Nucleus ambiguus, vestibular nuclei, lateral corticospinal tract, and superior cerebellar peduncle</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;">d)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Nucleus ambiguus, vestibular nuclei, anterior corticospinal tract, and inferior cerebellar peduncle</p><p class="x_MsoNormal" style="-webkit-font-smoothing: antialiased; background-color: white; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt;"><span style="color: red;">A</span></p><p class="x_gmail-MsoListParagraphCxSpFirst" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.5in;">12.<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><b>Which artery is occluded in Lateral medullary (Wallenberg) syndrome?:</b></p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">a)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Anterior inferior cerebellar artery (AICA)</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">b)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Posterior inferior cerebellar artery (PICA)</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">c)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Superior cerebellar artery</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;">d)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Anterior spinal artery</p><p class="x_MsoNormal" style="-webkit-font-smoothing: antialiased; background-color: white; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt;"><span style="color: red;">B</span></p><p class="x_gmail-MsoListParagraphCxSpFirst" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.5in;">13.<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><b>Which condition is secondary to occlusion of the Basilar artery?:</b></p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">a)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Lateral pontine syndrome</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">b)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Wallenberg syndrome</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">c)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Dejerine syndrome</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;">d)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Locked-in syndrome</p><p class="x_MsoNormal" style="-webkit-font-smoothing: antialiased; background-color: white; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt;"><span style="color: red;">D</span></p><p class="x_gmail-MsoListParagraphCxSpFirst" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.5in;">14.<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span><b><span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Patient with Lacunar infarcts. What are the affected artery and the risk factors associated with this patient’s condition?:</b></p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">a)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Lenticulostriate artery – Chronic hypertension and thoracic aortic aneurysm</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">b)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Lenticulostriate artery – Chronic hypertension and abdominal aortic aneurysm</p><p class="x_gmail-MsoListParagraphCxSpMiddle" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 0.0001pt 0.75in;">c)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Middle cerebral artery - Chronic hypertension and thoracic aortic aneurysm</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; color: #201f1e; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;">d)<span style="-webkit-font-smoothing: antialiased; border: 0px; color: inherit; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: inherit; font-variant-caps: inherit; font-variant-east-asian: normal; font-variant-ligatures: inherit; font-variant-numeric: normal; font-weight: inherit; line-height: normal; margin: 0px; padding: 0px; vertical-align: baseline;"> </span>Middle cerebral artery - Chronic hypertension and abdominal aortic aneurysm</p><p class="x_gmail-MsoListParagraphCxSpLast" style="-webkit-font-smoothing: antialiased; background-color: white; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8667px; margin: 0in 0in 10pt 0.75in;"><span style="color: red;">A</span></p>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-5621577980280983820.post-76920532056266744422022-01-21T12:04:00.001-08:002022-01-21T12:05:25.837-08:00HEMATOLOGY AND NEUROLOGY MULTIPLE CHOICE QUESTIONS <p><b> </b></p><p><b></b></p><div class="separator" style="clear: both; text-align: center;"><b><a href="https://blogger.googleusercontent.com/img/a/AVvXsEht968o_K1eoJWqEKPQwQQod8AK3PI37qjr-XxTO9sSopZm_pfWXWzTuN7CtCohnLnKyAHx5uOyJ4aoDjjY9tTLPGvpnYw1yqoVf0lW7lous_h0Minh0Orl8YORoqzLvDODYHmv0IUQeXUGox7_fUpAoOBKgaXA5gBaofdv32MZmDOp-Pp2yM1A1sjjdA=s1268" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="359" data-original-width="1268" height="114" src="https://blogger.googleusercontent.com/img/a/AVvXsEht968o_K1eoJWqEKPQwQQod8AK3PI37qjr-XxTO9sSopZm_pfWXWzTuN7CtCohnLnKyAHx5uOyJ4aoDjjY9tTLPGvpnYw1yqoVf0lW7lous_h0Minh0Orl8YORoqzLvDODYHmv0IUQeXUGox7_fUpAoOBKgaXA5gBaofdv32MZmDOp-Pp2yM1A1sjjdA=w400-h114" width="400" /></a></b></div><b> NEUROLOGY </b><b><br /><br /></b><div><b><br /></b></div><div><b><br /></b></div><div><b>All are true about Creutzfeldt-Jakob Disease, except:</b><p></p><p>It is a neurodegenerative disease caused by prions</p><p>Accumulation in the brain of a normal protease-resistant prion protein</p><p>An elevated level of 14-3-3 protein in CSF</p><p>It is subacute dementia with rapid clinical progression </p><p><span style="color: red;">B</span></p><p><b>What is true about Huntington Disease?:</b></p><p>Life expectancy is 20 years from the time of diagnosis</p><p>Multiple abnormal CAG triplet repeats on chromosome 5</p><p>Anticipation is related to less severe disease</p><p>Multi9ple abnormal GAA triplet repeats on chromosome 9</p><p><span style="color: red;">A</span></p><p><b>Patient with Parkinson's Disease, his primary symptom is tremor. Which is the best medication?:</b></p><p>Amantadine</p><p>Benztropine</p><p>Selegiline</p><p>Entacapone</p><p><span style="color: red;">A</span></p><p><b>Mechanism of action of amantadine?:</b></p><p>A weak non-competitive NMDA receptor antagonist</p><p>It blocks the peripheral conversion of levodopa</p><p>Anticholinergic</p><p>MAO-B inhibitor</p><p><span style="color: red;">A</span></p><p><b>Mechanism of action of ropinirole and bromocriptine?:</b></p><p>MAO-B inhibitor</p><p>COMT inhibitor</p><p>Dopamine agonist</p><p>Anticholinergic</p><p><span style="color: red;">C</span></p><p><b>Mechanism of action of Selegiline?:</b></p><p>Anticholinergic</p><p>COMT inhibitor</p><p>Dopamine agonist</p><p>MAO-B inhibitor</p><p><span style="color: red;">D</span></p><p><b>Mechanism of action of Entacapone and tolcapone?:</b></p><p>Anticholinergic</p><p>COMT inhibitor</p><p>Dopamine agonist</p><p>MAO-B inhibitor</p><p><span style="color: red;">B</span></p><p><b>Mechanism of action of Benztropine and trihexyphenidyl?:</b></p><p>Anticholinergic</p><p>COMT inhibitor</p><p>Dopamine agonist</p><p>MAO-B inhibitor</p><p><span style="color: red;">A</span></p><p><b>What is the most often primary cancer in metastatic brain tumors?:</b></p><p>Breast cancer</p><p>GI tract cancer</p><p>Melanoma</p><p>Lung cancer</p><p><span style="color: red;">D</span></p><p><b>Symptoms of increased intracranial pressure?:</b></p><p>Nausea, vomiting, headache, and confusion</p><p>Nausea, vomiting, headache, and diplopia</p><p>Fever, weight loss, and headache</p><p>Headache, fever, and nuchal rigidity</p><p><span style="color: red;">B</span></p><p><b>Diagnostic criteria for Neurofibromatosis 1, except:</b></p><p>Café-au-lait spots</p><p>Optic glioma</p><p>Lisch nodules</p><p>Bilateral vestibular schwannomas</p><p><span style="color: red;">D</span></p><p><b>Patient with a history of Meningioma and neurofibroma. What is the diagnosis?: </b></p><p>Neurofibromatosis 1</p><p>Neurofibromatosis 2</p><p>Tuberous Sclerosis</p><p>Sturge-Weber disease</p><p><span style="color: red;">B</span></p><p><b>What structures are included in the limbic system?:</b></p><p>Caudate, putamen, globus pallidus, substantia nigra, and subthalamic nucleus</p><p>Habenula, habenular commissure, posterior commissure, and the pineal gland</p><p>Subthalamic nucleus, red nucleus, and substantia nigra</p><p>Amygdala, hippocampus, fornix, mammillary bodies, cingulate gyrus, and parahippocampal gyrus</p><p><span style="color: red;">D</span></p><p><b>What structures are included in Basal ganglia?:</b></p><p>Caudate, putamen, globus pallidus, substantia nigra, and subthalamic nucleus</p><p>Habenula, habenular commissure, posterior commissure, and the pineal gland</p><p>Subthalamic nucleus, red nucleus, and substantia nigra</p><p>Amygdala, hippocampus, fornix, mammillary bodies, cingulate gyrus, and parahippocampal gyrus</p><p><span style="color: red;">A</span></p><p><b>What structures are included in the Epithalamus?:</b></p><p>Caudate, putamen, globus pallidus, substantia nigra, and subthalamic nucleus</p><p>Habenula, habenular commissure, posterior commissure, and the pineal gland</p><p>Subthalamic nucleus, red nucleus, and substantia nigra</p><p>Amygdala, hippocampus, fornix, mammillary bodies, cingulate gyrus, and parahippocampal gyrus</p><p><span style="color: red;">B</span></p><p><b>What structures are included in the Subthalamus?:</b></p><p>Caudate, putamen, globus pallidus, substantia nigra, and subthalamic nucleus</p><p>Habenula, habenular commissure, posterior commissure, and the pineal gland</p><p>Subthalamic nucleus, red nucleus, and substantia nigra</p><p>Amygdala, hippocampus, fornix, mammillary bodies, cingulate gyrus, and parahippocampal gyrus</p><p><span style="color: red;">C</span></p><p><b>Pathway in Papez circuit?:</b></p><p>Fornix hippocampus mammillary bodies mammillothalamic tract anterior nucleus of the thalamus thalamocingulate radiation cingulate gyrus hippocampus</p><p>Hippocampus mammillary bodies fornix mammillothalamic tract anterior nucleus of the thalamus thalamocingulate radiation cingulate gyrus hippocampus</p><p>Hippocampus fornix mammillary bodies mammillothalamic tract anterior nucleus of the thalamus thalamocingulate radiation cingulate gyrus hippocampus</p><p>Hippocampus fornix mammillary bodies mammillothalamic tract anterior nucleus of the thalamus cingulate gyrus thalamocingulate radiation hippocampus</p><p><span style="color: red;">C</span></p><p><b>What is the function of the ventromedial nucleus?:</b></p><p>Satiety </p><p>Hunger</p><p>Heat dissipating</p><p>Heat conservation</p><p><span style="color: red;">A</span></p><p><b>What is the function of the anterior hypothalamus?:</b></p><p>Satiety</p><p>Hunger</p><p>Heat dissipating</p><p>Heat conservation</p><p><span style="color: red;">C</span></p><p><b>What is the function of the posterior hypothalamus?:</b></p><p>Satiety</p><p>Hunger</p><p>Heat dissipating</p><p>Heat conservation</p><p><span style="color: red;">D</span></p><p><b>What is the function of the lateral area of the hypothalamus?:</b></p><p>Satiety</p><p>Hunger</p><p>Heat dissipating</p><p>Heat conservation</p><p><span style="color: red;">B</span></p><p><b>What is the function of suprachiasmatic nuclei?:</b></p><p>Heat conservation</p><p>Heat dissipating</p><p>Circadian rhythms</p><p>Synthesis of vasopressin and oxytocin</p><p><span style="color: red;">C</span></p><p><b>What is the function of supraoptic and paraventricular nuclei?:</b></p><p>Heat conservation</p><p>Heat dissipating</p><p>Circadian rhythms</p><p>Synthesis of vasopressin and oxytocin</p><p><span style="color: red;">D</span></p><p><b>The classic triad of Wernicke encephalopathy?:</b></p><p>Encephalopathy, ophthalmoplegia, and ataxia</p><p>Encephalopathy, ophthalmoplegia, and anterograde amnesia</p><p>Encephalopathy, ophthalmoplegia, and retrograde amnesia</p><p>Encephalopathy, horizontal nystagmus, and confabulations</p><p><span style="color: red;">A</span></p><p><b>Signs and symptoms of Korsakoff dementia?:</b></p><p>Encephalopathy, ophthalmoplegia, and ataxia</p><p>Encephalopathy, ophthalmoplegia, ataxia, amnesia, and confabulations</p><p>Encephalopathy, ophthalmoplegia, ataxia, and tremor</p><p>Encephalopathy, ophthalmoplegia, ataxia, and paraplegia</p><p><span style="color: red;">B</span></p><p><b>Which vitamin deficiency causes Wernicke encephalopathy?:</b></p><p>Vitamin B12</p><p>Vitamin B9</p><p>Vitamin B3</p><p>Vitamin B1</p><p><span style="color: red;">D</span></p><p><b>Which vitamin deficiency causes peripheral neuropathy?:</b></p><p>Vitamin B12</p><p>Vitamin B9</p><p>Vitamin B3</p><p>Vitamin B1</p><p><span style="color: red;">A</span></p><p><b>What is the etiology of Closed-Angle Glaucoma?:</b></p><p>Obstruction of drainage pathways by the iris</p><p>Decreased drainage due to damaged trabecular meshwork</p><p>Macular degeneration</p><p>Retinal vascular occlusion</p><p><span style="color: red;">A</span></p><p><b>What is the etiology of Open-Angle Glaucoma?:</b></p><p>Obstruction of drainage pathways by the iris</p><p>Decreased drainage due to damaged trabecular meshwork</p><p>Macular degeneration</p><p>Retinal vascular occlusion</p><p><span style="color: red;">B</span></p><p><b>Treatment for Open-Angle Glaucoma?:</b></p><p>Isoproterenol</p><p>Timolol</p><p>Furosemide</p><p>Atropine</p><p><span style="color: red;">B</span></p><p><b>The lesion in the left optic nerve and defect in the visual field?:</b></p><p>Right anopia</p><p>Right homonymous hemianopsia</p><p>Left homonymous hemianopsia</p><p>Left anopia</p><p><span style="color: red;">D</span></p><p><b>The lesion in the optic chiasm and defect in visual field?:</b></p><p>Central scotoma</p><p>Left hemianopia with macular sparing</p><p>Bitemporal hemianopsia</p><p>Right homonymous hemianopsia</p><p><span style="color: red;">C</span></p><p><b>The lesion in the right optic tract and defect in visual field?:</b></p><p>Right homonymous hemianopsia</p><p>Left homonymous hemianopsia</p><p>Left lower quadrantic anopsia</p><p>Right lower quadrantic anopsia</p><p><span style="color: red;">B</span></p><p><b>The lesion in left dorsal optic radiation?:</b></p><p>Right lower quadrantic anopsia</p><p>Left lower quadrant anopsia</p><p>Right upper quadrantic anopsia</p><p>Left upper quadrantic anopsia</p><p><span style="color: red;">A</span></p><p><b>The lesion in right Meyer Loop and defect in the visual field?</b>:</p><p>Right lower quadrantic anopsia</p><p>Left lower quadrant anopsia</p><p>Right upper quadrantic anopsia</p><p>Left upper quadrantic anopsia</p><p><span style="color: red;">D</span></p><p><b>Left PCA infarction and defect in the visual field?:</b></p><p>Left hemianopsia with macular sparing</p><p>Right hemianopsia with macular sparing</p><p>left lower quadrantic anopsia</p><p>right lower quadrantic anopsia</p><p><span style="color: red;">B</span></p><p><b>Macular degeneration and defect in visual field?:</b></p><p>Hemianopsia with macular sparing</p><p>Upper quadrantic anopsia</p><p>Lower quadrantic anopsia</p><p>Central scotoma</p><p><span style="color: red;">D</span></p><p><b>What is true about central retinal artery occlusion?:</b></p><p>Swollen optic disc with hemorrhages</p><p>Retinal hemorrhages</p><p>Cotton-wool spots</p><p>Cherry-red spot of the fovea</p><p><span style="color: red;">D</span></p><p><b>What is true about central retinal vein occlusion?:</b></p><p>Retinal swelling</p><p>Bloodless retinal arteries</p><p>Cotton-wool spots</p><p>Cherry-red spot</p><p><span style="color: red;">C</span></p><p><b><br /></b></p><p><b> HEMATOLOGY</b></p><p><b><br /></b></p><p><b>Most common coagulation disorder in Ashkenazi Jews?:</b></p><p>Hemophilia A</p><p>Hemophilia B</p><p>Hemophilia C</p><p>Von Willebrand Disease</p><p><span style="color: red;">C</span></p><p><b>Mechanism of action of Heparin?:</b></p><p>Inhibits synthesis of vitamin K-dependent coagulation factors</p><p>Directly inhibit factor Xa</p><p>Inhibits factor II</p><p>Activates antithrombin</p><p><span style="color: red;">D</span></p><p><b>Mechanism of action of Warfarin?:</b></p><p>Inhibits synthesis of vitamin K-dependent coagulation factors</p><p>Directly inhibit factor Xa</p><p>Inhibits factor II</p><p>Activates antithrombin</p><p><span style="color: red;">A</span></p><p><b>Mechanism of action of Apixaban?:</b></p><p>Inhibits synthesis of vitamin K-dependent coagulation factors</p><p>Directly inhibit factor Xa</p><p>Inhibits factor II</p><p>Activates antithrombin</p><p><span style="color: red;">B</span></p><p><b>Mechanism of action of Dabigatran?:</b></p><p>Inhibits synthesis of vitamin K-dependent coagulation factors</p><p>Directly inhibit factor Xa</p><p>Inhibits factor II</p><p>Activates antithrombin</p><p><span style="color: red;">D</span></p><p><b>Mechanism of action of tPA?:</b></p><p>Inhibits synthesis of vitamin K-dependent coagulation factors</p><p>Directly inhibit factor Xa</p><p>Converts plasminogen into plasmin which breaks down fibrin</p><p>Activates antithrombin</p><p><span style="color: red;">C</span></p><p><b>The best initial test in the diagnosis of Hemophilia?</b></p><p>PTT</p><p>Mixing study</p><p>Specific factor assays</p><p>PT</p><p><span style="color: red;">B</span></p><p><b>Most accurate test in the diagnosis of Hemophilia?:</b></p><p>PTT</p><p>Mixing study</p><p>Specific factor assays</p><p>PT</p><p><span style="color: red;">C</span></p><p><b>What is the most common inherited bleeding disorder?:</b></p><p>Von Willebrand Disease</p><p>Hemophilia A</p><p>Bernard-Soulier syndrome</p><p>Glanzmann thrombasthenia</p><p><span style="color: red;">A</span></p><p><b>What is the most common cause of hereditary thromboembolic disease?:</b></p><p>Antithrombin III deficiency</p><p>Protein C deficiency</p><p>Factor V Leiden</p><p>Protein S deficiency</p><p><span style="color: red;">C</span></p><p><b>In which condition is seen decreased agglutination on the ristocetin cofactor assay?</b></p><p>Factor V Leiden</p><p>Von Willebrand disease</p><p>Bernard-Soullier syndrome</p><p>Glanzmann thrombasthenia</p><p><span style="color: red;">B</span></p><p><b>What is the condition caused by a deficiency in GpIIb/IIIa?:</b></p><p> Factor V Leiden</p><p>Von Willebrand disease</p><p>Bernard-Soullier syndrome</p><p>Glanzmann thrombasthenia</p><p><span style="color: red;">D</span></p><p><b>What is the condition caused by a deficiency in GpIb?:</b></p><p>Factor V Leiden</p><p>Von Willebrand disease</p><p>Bernard-Soullier syndrome</p><p>Glanzmann thrombasthenia</p><p><span style="color: red;">C</span></p><p><b>What is the mechanism of action of Clopidogrel and ticlopidine?:</b></p><p>Inhibits ADP receptor</p><p>Inhibits GpIIb/IIIa</p><p>Inhibits COX </p><p>Inhibits factor II</p><p><span style="color: red;">A</span></p><p><b>Lab findings in Von Willebrand disease?:</b></p><p>Increased bleeding time</p><p>Decreased PTT</p><p>Increased PT</p><p>Decreased platelet count</p><p><span style="color: red;">A</span></p><p><b>What is the cause of Idiopathic thrombocytopenic purpura?:</b></p><p>Deficiency of ADAMTS-13</p><p>IgG antibodies against patient’s platelets</p><p>Depletion of clotting factors and platelets</p><p>PF4 antibody </p><p><span style="color: red;">B</span></p><p><b>What is the cause of Thrombotic Thrombocytopenic Purpura?:</b></p><p>Deficiency of ADAMTS-13</p><p>IgG antibodies against patient’s platelets</p><p>Depletion of clotting factors and platelets</p><p>PF4 antibody </p><p><span style="color: red;">A</span></p><p><b>What is the cause of Heparin-induced Thrombocytopenia?:</b></p><p>Deficiency of ADAMTS-13</p><p>IgG antibodies against patient’s platelets</p><p>Depletion of clotting factors and platelets</p><p>PF4 antibody </p><p><span style="color: red;">D</span></p><p><b>What is the cause of tissue necrosis following warfarin administration?:</b></p><p>Vitamin C and S deficiency</p><p>Vitamin K deficiency</p><p>Activation of protein C</p><p>Activation of protein S</p><p><span style="color: red;">A</span></p><p><b>Clinical presentation and lab findings in TTP?:</b></p><p>Hemolytic anemia increased creatinine and low platelets without neurologic symptoms</p><p>Hemolytic anemia increased creatinine, low platelets, increased TP, increased bleeding time</p><p>Hemolytic anemia, increased creatinine, low platelets, seizure, and fever</p><p>Hemolytic anemia, increased creatinine, low platelets, retroperitoneal bleeding, and fever</p><p><span style="color: red;">C</span></p><p><b>Clinical presentation and lab findings in HUS?:</b></p><p>Hemolytic anemia increased creatinine, and low platelets without neurologic symptoms</p><p>Hemolytic anemia increased creatinine, low platelets, increased TP, increased bleeding time</p><p>Hemolytic anemia, increased creatinine, low platelets, seizure, and fever</p><p>Hemolytic anemia, increased creatinine, low platelets, retroperitoneal bleeding, and fever</p><p><span style="color: red;">A</span></p><p><b>Best initial abortive therapy for Migraine?:</b></p><p>Gabapentin </p><p>Triptans</p><p>NSAIDs</p><p>Dihydroergotamine </p><p><span style="color: red;">C</span></p><p><b>Prophylaxis for Migraine includes, except: </b></p><p>a) Propanolol</p><p>b) Amitriptyline</p><p>c) Triptans</p><p>d) Topiramate</p><p><span style="color: red;">C</span></p><p><b>Best initial abortive therapy for Cluster headaches?:</b></p><p>a) 100% O2</p><p>b) NSAIDs</p><p>c) Triptans</p><p>d) Acetaminophen</p><p><span style="color: red;">A</span></p><p><b>Best prophylactic therapy for Cluster headache?:</b></p><p>a) Valproate</p><p>b) Propanolol</p><p>c) Amitriptyline</p><p>d) Verapamil</p><p><span style="color: red;">D</span></p><p><b>A 34-year-old patient presents with severe, shooting pain, 6/10, on the right side of his face. It lasts less than one minute and presents several times during the day. He states the pain is worse after chewing or brushing his teeth. He denies fever, changes in his vision, lacrimation, rhinorrhea, nausea, or vomiting. What is the best explanation for his condition?:</b></p><p>a) Migraine</p><p>b) Trigeminal neuralgia</p><p>c) Cluster headache</p><p>d) Temporal arteritis</p><p><span style="color: red;">B</span></p><p><b>What is the first-line therapy for the condition of the previous patient?:</b></p><p>a) Verapamil</p><p>b) Valproate</p><p>c) Carbamazepine</p><p>d) Steroids</p><p><span style="color: red;">C</span></p><p><b> 37-year-old female patient presents to ED for severe, constant, pressure-like headache (worst pain of my life), 10/10, that started suddenly this morning while she was exercising. The pain is getting worse, doesn’t alleviate with anything. It is associated with nausea, vomiting, photophobia. The physical exam is remarkable for the presence of the Brudzinski sign. What is the best initial step?:</b></p><p>a) Lumbar puncture and CSF analysis</p><p>b) CT scan of the head without contrast</p><p>c) CT scan of the head with contrast</p><p>d) MRI brain</p><p><span style="color: red;">B</span></p><p><b> First-line therapy in children with partial or tonic-clonic seizures?:</b></p><p>a) Levetiracetam</p><p>b) Phenytoin</p><p>c) Carbamazepine</p><p>d) Phenobarbital</p><p><span style="color: red;">D</span></p><p><b>First-line therapy for Absence seizures?:</b></p><p>a) Valproic acid</p><p>b) Levetiracetam</p><p>c) Ethosuximide</p><p>d) Carbamazepine</p><p><span style="color: red;">C</span></p><p><b>Which is the best initial therapy in status epilepticus?:</b></p><p>a) Midazolam</p><p>b) Phenytoin</p><p>c) Phenobarbital</p><p>d) Lorazepam</p><p><span style="color: red;">D</span></p><p><b>A patient is still in status epilepticus after 20 minutes besides the administration of benzodiazepines every 5 minutes, which is the best next step?:</b></p><p>a) Continue benzodiazepine for 20 more minutes</p><p>b) Start Phenytoin</p><p>c) Start Fosphenytoin</p><p>d) Start Phenobarbital</p><p><span style="color: red;">C</span></p><p><b>When is recommended continuous EEG monitoring?:</b></p><p>a) In convulsive status epilepticus</p><p>b) Patient does not wake up after clinically obviously seizures stop</p><p>c) During alcohol withdrawal</p><p>d) During benzodiazepines withdrawal</p><p><span style="color: red;">B</span></p><p><b>A 55-year-old patient presents in ED with sudden severe vertigo, nausea, vomiting, and difficulty standing up. He was diagnosed with URI 10 days ago. The physical exam is remarkable for vertical nystagmus and gait unsteadiness. He has a past history of Hypertension, DM T1, and CHF. What is the best initial step?:</b></p><p>a) Diffusion-weighted MRI</p><p>b) Start meclizine</p><p>c) Start steroids</p><p>d) Start NSAIDs</p><p><span style="color: red;">A</span></p><p><b>In the presentation of Benign Paroxysmal Positional Vertigo, which one is incorrect?:</b></p><p>a) Vertigo lasts < 1 min</p><p>b) It is not associated with hearing loss</p><p>c) Epley maneuver can resolve the symptoms</p><p>d) Meclizine is the best initial therapy</p><p><span style="color: red;">D</span></p><p><b>In Labyrinthitis, which of the following symptoms is incorrect?:</b></p><p>a) Lacking hearing loss</p><p>b) Tinnitus</p><p>c) Ear fullness</p><p>d) Nausea and vomiting</p><p><span style="color: red;">A</span></p><p><b>What is correct about Ménière's disease?:</b></p><p>a) Recurrent episodes of vertigo, tinnitus, nausea, vomiting, and hearing loss</p><p>b) Acute vertigo, nausea, vomiting, and hearing loss after a recent URI</p><p>c) Acute vertigo and nystagmus triggered by changes in head position</p><p>d) Acute vertigo, nausea, vomiting without hearing loss after a recent URI</p><p><span style="color: red;">A</span></p><p><b>What is correct about Vestibular neuritis?:</b></p><p>a) Recurrent episodes of vertigo, tinnitus, nausea, vomiting, and hearing loss</p><p>b) Acute vertigo, nausea, vomiting, and hearing loss after a recent URI</p><p>c) Acute vertigo and nystagmus triggered by changes in head position</p><p>d) Acute vertigo, nausea, vomiting without hearing loss after a recent URI</p><p><span style="color: red;">D</span></p><p><b>Lab findings in Iron Deficiency Anemia?:</b></p><p>High ferritin, high RDW, high TIBC, low serum iron</p><p>Low ferritin, low RDW, high TIBC, low serum iron</p><p>Low ferritin, high RDW, high TIBC, low serum iron</p><p>Low ferritin, low RDW, low TIBC, low serum iron</p><p><span style="color: red;">C</span></p><p><b>Lab findings in Anemia of Chronic Disease?:</b></p><p>High ferritin, low serum iron, normocytic anemia</p><p>Low ferritin, low serum iron, microcytic anemia</p><p>High ferritin, high serum iron, normocytic anemia</p><p>Low ferritin, high serum iron, normocytic anemia</p><p><span style="color: red;">A</span></p><p><b>Lab findings in Megaloblastic Anemia due to B12 deficiency?:</b></p><p>Macrocytic anemia increased MMA and increased homocysteine</p><p>Macrocytic anemia, normal MMA, and increased homocysteine</p><p>Macrocytic anemia, normal MM, and normal homocysteine</p><p>Macrocytic anemia, increased MMA, and normal homocysteine</p><p><span style="color: red;">A</span></p><p><b>Lab findings in Megaloblastic Anemia due to B9 deficiency?:</b></p><p>Macrocytic anemia increased MMA and increased homocysteine</p><p>Macrocytic anemia, normal MMA, and increased homocysteine</p><p>Macrocytic anemia, normal MM, and normal homocysteine</p><p>Macrocytic anemia, increased MMA, and normal homocysteine</p><p><span style="color: red;">B</span></p><p><b>What is the most common cause of osteomyelitis in patients with Sickle Cell Disease?:</b></p><p>S aureus</p><p>Salmonella</p><p>S epidermidis</p><p>Shigella</p><p><span style="color: red;">B</span></p><p><b>What is false about complications in Sickle Cell Disease?:</b></p><p>Splenic sequestration resulting in hypovolemia</p><p>Parvovirus B 19 infection resulting in aplastic crisis</p><p>Low platelets</p><p>Increased PTT</p><p><span style="color: red;">D</span></p><p><b>What is true about Warm Autoimmune Hemolytic Anemia?:</b></p><p>Presence of IgM antibodies</p><p>Presence of IgG antibodies</p><p>It is associated with Mycoplasma pneumonia</p><p>It is associated with Mononucleosis</p><p><span style="color: red;">B</span></p><p><b>What is true about Cold Autoimmune Hemolytic Anemia?:</b></p><p>Presence of IgG antibodies to RBC antigens</p><p>It is associated with Mycoplasma pneumonia</p><p>It is associated with Mononucleosis</p><p>It is associated with SLE</p><p><span style="color: red;">D</span></p><p><b>All are true about Hereditary spherocytosis, except?:</b></p><p>Presence of spherocyte</p><p>Positive osmotic fragility tests</p><p>Negative direct Coombs test</p><p>Positive direct Coombs test</p><p><span style="color: red;">D</span></p><p><b>What is not a cause of Aplastic Anemia?:</b></p><p>HIV infection</p><p>Parvovirus B 19 infection</p><p>Sulfa drugs</p><p>Ciprofloxacin</p><p><span style="color: red;">D</span></p><p><b>What is not true about Thalassemia?:</b></p><p>African, Middle Eastern, and Asian descent are mostly affected</p><p>Microcytic anemia with normal serum iron</p><p>Microcytic anemia with low serum iron</p><p>Most patients with Thalassemia do not require treatment</p><p><span style="color: red;">C</span></p><p><b>What is not present in hyperviscosity syndrome ?:</b></p><p>Easy bruising</p><p>Blurred vision</p><p>Pruritus after a cold bath</p><p>Thrombosis</p><p><span style="color: red;">C</span></p><p><b>What is the best initial test in the diagnosis of Polycythemia Vera?:</b></p><p>JAK 2 mutation</p><p>CBC</p><p>CBC with an ABG and EPO level</p><p>EPO levels</p><p><span style="color: red;">C</span></p></div>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-5621577980280983820.post-658886199422426632022-01-16T11:05:00.003-08:002022-01-16T11:05:32.781-08:00Omicron Variant Symptoms <p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjmjsnP0gHv3fWblzTSV9P-QxOkm0At0DKgSRdL-DZpP8zwfG0gq5ucZkf1ZZTV6pEH65vtLaenCPv_XBdJ1-wKiaTbggWfqmMeigJznzQoLcMIE_0jkMztAABTQGM4vaPrpZn3WXSf9nvGWIQ4Viw5olndbxdIPjbOWyY-DfZAmrYseVBs6eogSTDIeQ=s763" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="513" data-original-width="763" height="269" src="https://blogger.googleusercontent.com/img/a/AVvXsEjmjsnP0gHv3fWblzTSV9P-QxOkm0At0DKgSRdL-DZpP8zwfG0gq5ucZkf1ZZTV6pEH65vtLaenCPv_XBdJ1-wKiaTbggWfqmMeigJznzQoLcMIE_0jkMztAABTQGM4vaPrpZn3WXSf9nvGWIQ4Viw5olndbxdIPjbOWyY-DfZAmrYseVBs6eogSTDIeQ=w400-h269" width="400" /></a></div><br /> <p></p>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-5621577980280983820.post-91947033693436156842022-01-16T10:17:00.003-08:002022-01-16T11:06:34.709-08:00Toxic Megacolon and its Etiology<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjkrVbNl_5t-QhJcpjjwQwhwl4PatQkidONUkHUDq5y-mqsSzFKDrAMgdfVe3t99nJeXMxGIF1Ew-QQkmWMXcmfvNm-LwmK_0ABdnmQDc9mhNAJO-fpAjCL1YK-mgus4mCeK4kqIXYU7vZs9GxIjVWis2n5WWvZhyxUdK_R5bOL2L3c1wskzJGHS8E6bQ=s767" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="533" data-original-width="767" height="278" src="https://blogger.googleusercontent.com/img/a/AVvXsEjkrVbNl_5t-QhJcpjjwQwhwl4PatQkidONUkHUDq5y-mqsSzFKDrAMgdfVe3t99nJeXMxGIF1Ew-QQkmWMXcmfvNm-LwmK_0ABdnmQDc9mhNAJO-fpAjCL1YK-mgus4mCeK4kqIXYU7vZs9GxIjVWis2n5WWvZhyxUdK_R5bOL2L3c1wskzJGHS8E6bQ=w400-h278" width="400" /></a></div><br /> <p></p>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-5621577980280983820.post-21076931708867153032021-11-30T11:42:00.004-08:002021-11-30T11:42:43.828-08:00Upper gi bleeding vs Lower gi bleed 🩸 by Dr Adnan<iframe style="background-image:url(https://i.ytimg.com/vi/en0kT1Ao0to/hqdefault.jpg)" width="480" height="270" src="https://youtube.com/embed/en0kT1Ao0to" frameborder="0"></iframe>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com1tag:blogger.com,1999:blog-5621577980280983820.post-58220260151052068162021-11-24T12:23:00.003-08:002021-11-24T12:23:37.879-08:00MEDICAL MNEMONICS FOR USMLE, PLAB, AMC preparation<iframe style="background-image:url(https://i.ytimg.com/vi/BLKySzwuz6k/hqdefault.jpg)" width="480" height="360" src="https://youtube.com/embed/BLKySzwuz6k" frameborder="0"></iframe>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com1tag:blogger.com,1999:blog-5621577980280983820.post-11101183676126046902021-10-03T17:01:00.004-07:002021-10-03T17:01:48.117-07:00USMLE Antibiotics - High Yield by Dr Adnan part 2<iframe width="480" height="270" src="https://youtube.com/embed/I_mLEwJeKi8" frameborder="0"></iframe>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com1tag:blogger.com,1999:blog-5621577980280983820.post-4711038848952201232021-10-03T17:01:00.002-07:002021-10-03T17:01:32.834-07:00USMLE Antibiotics - High Yield by Dr Adnan part 1<iframe width="480" height="270" src="https://youtube.com/embed/j9vzKz-puwQ" frameborder="0"></iframe>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-5621577980280983820.post-20486640098594650262021-03-15T07:41:00.000-07:002021-03-15T07:41:24.149-07:00<p> <b>Asthma:-</b></p><p>It is a syndrome characterized by airflow obstruction that varies markedly, both spontaneously and with treatment.<br />Symptoms-wheezing, breathlessness, cough, chest tightness<br />Prevalence-10-12% adults, 15% children Developed country>Developing countries</p><p><span style="text-align: center;"><b>Risk Factors</b><br /></span><span style="text-align: center;"><b>Endogenous Factors</b><br /></span><span style="text-align: center;">Genetic predisposition Atopy<br /></span><span style="text-align: center;">Airway<br /></span><span style="text-align: center;">hyperresponsiveness<br /></span><span style="text-align: center;">Gender<br /></span><span style="text-align: center;">Ethnicity? Obesity?<br /></span><span style="text-align: center;">Viral infections<br /></span><span style="text-align: center;"><b>Environmental Factors</b><br /></span><span style="text-align: center;">Indoor allergens Outdoor allergens occupational sensitizers Passive smoking Respiratory infections<br /></span><span style="text-align: center;"><b>Triggers</b>:-<br /></span><span style="text-align: center;"><b>Allergens</b>-Dermatophagoides species(dust mite), environmental</span><span style="text-align: center; white-space: pre;"> </span><span style="text-align: center;">exposure, grass pollen, ragweed, tree pollen, fungal spores, pets furs, cockroaches etc<br /></span><span style="text-align: center;"><b>Virus infection</b>-upper respiratory tract virus such as rhinovirus, respiratory syncytial virus, coronavirus etc<br /></span><span style="text-align: center;">Pharmacological agents-beta blockers, ACE </span><span style="text-align: center;">inhibitors, aspirin<br /></span><span style="text-align: center;">Exercise(may exacerbate )<br /></span><span style="text-align: center;">Physical factors-cold air, hyperventilation<br /></span><span style="text-align: center;">Food<br /></span><span style="text-align: center;">Air pollutants-sulfur dioxide, irritant gases<br /></span><span style="text-align: center;">Irritants-household sprays paint fumes<br /></span><span style="text-align: center;">Occupational factors<br /></span><span style="text-align: center;">Hormonal factors-fall in progesterone thyrotoxicosis<br /></span><span style="text-align: center;">Gastrointestinal reflex<br /></span><span style="text-align: center;">stress<br /></span><span style="text-align: center;"><b>Types of asthma</b>-<br /></span><span style="text-align: center;"><b>Atopic asthma</b>-classical type I IgE mediated hypersensitivity, allergen sensitization, seen from childhood, +ve history of asthma in family, skin test +ve<br /></span><span style="text-align: center;"><b>Non-atopic asthma</b>-no allergen sensitization, no<br /></span><span style="text-align: center;">such history, skin test –ve, virus infection?<br /></span><span style="text-align: center;"><b>Drug induced asthma</b>-sensitive to certain drugs like aspirin, NSAIDS etc<br /></span><span style="text-align: center;"><b>Occupational asthma</b>-stimulants such as fumes, organic and chemical dusts(wood, cotton), gas(toluene), penicillin products etc<br /></span><span style="text-align: center;"><b>Exercise induced asthma</b>-begins after exercise and stops after 30 minutes, worsen in cold and dry climate<br /></span><span style="text-align: center;"><b>pathogenesis</b><br /></span><span style="text-align: center;">pathology<br /></span><span style="text-align: center;">Inflammation<br /></span><span style="text-align: center;">Inflammatory mediators<br /></span><span style="text-align: center;">Effects of inflammation<br /></span><span style="text-align: center;">Airway remodeling<br /></span><span style="text-align: center;">Chronic inflammation of lower airways<br /></span><span style="text-align: center;">Mucosal infiltration of activated eosinophils and T lymphocytes<br /></span><span style="text-align: center;">Thickening of basement membrane<br /></span><span style="text-align: center;">Goblet cell metaplasia<br /></span><span style="text-align: center;">Smooth muscle hypertrophy and thickening<br /></span><span style="text-align: center;">Shedding of epithelium<br /></span><span style="text-align: center;">Occlusion of airway by mucosal plug<br /></span><span style="text-align: center;">Inflammation<br /></span><span style="text-align: center;">Allergic type of inflammation occurs<br /></span><span style="text-align: center;">From trachea to terminal bronchiole<br /></span><span style="text-align: center;">Predominantly in bronchi<br /></span><span style="text-align: center;">Airway hyperresponsiveness<br /></span><span style="text-align: center;">Cells involved in inflammation-mast cell macrophages</span><span style="text-align: center; white-space: pre;"> </span><span style="text-align: center;">dendritic cell</span><span style="text-align: center; white-space: pre;"> </span><span style="text-align: center;">eosinophils neutrophils</span><span style="text-align: center; white-space: pre;"> </span><span style="text-align: center;">T lymphocytes and structural cells<br /></span><span style="text-align: center;"><b>Early phase</b> reaction-mediated by granules release from mast cell, bronchoconstriction, vasodilation and increase permeability<br /></span><span style="text-align: center;"><b>Late phase reaction</b>-inflammation with recruitment of eosinophils, T lymphocytes, neutrophils, macrophages</span><span style="text-align: center; white-space: pre;"> </span><span style="text-align: center;">etc and subsequent release of mediators.<br /></span><b style="text-align: center;">Mast cell</b><span style="text-align: center;">-activated by IgE dependant mechanism, initiate acute bronchoconstriction action by releasing histamine, prostaglandinD2,leukotrienes etc<br /></span><b style="text-align: center;">Macrophage-</b><span style="text-align: center;">activated by low affinity IgE receptor, produce various inflammatory mediators<br /></span><b style="text-align: center;">Dendritic cell-</b><span style="text-align: center;">macrophage like major APC in airways, TSLP(Thymic stromal lymphopoietin) by epithelial cell induced chemokine release for TH2 cells<br /></span><b style="text-align: center;">Eosinophils-</b><span style="text-align: center;">infiltration is characteristic feature of asthma, activated by IL-5, causes exacerbation of asthma by producing mediators<br /></span><span style="text-align: center;"><b>Neutrophil</b>-activated and infiltration<br /></span><span style="text-align: center;"><b>T cell</b>-release cytokines, causes recruitment of eosinophils, also causes maintenance of mast cells, in asthma TH2 cell produce IL- 5(eosinophil recruitment) IL-4, IL-13(increase IgE production and</span><span style="text-align: center; white-space: pre;"> </span><span style="text-align: center;">mucus secretion).CD4+ cell also involved<br /></span><span style="text-align: center;"><b>Structural cells</b>-epithelial cells(TSLP),<br /></span><span style="text-align: center;">fibroblasts etc<br /></span><span style="text-align: center;"><b>Inflammatory mediators-<br /></b></span><span style="text-align: center;">Histamine, prostaglandin D2, cysteinly leukotrienes-cause smooth muscle contraction, increased microvascular</span><span style="text-align: center; white-space: pre;"> </span><span style="text-align: center;">leakage, increased mucus secretion, act as chemoattractant for inflammatory cells<br /></span><b style="text-align: center;">Cytokines- </b><span style="text-align: center;">IL-4, IL-5, IL-13-causes allergic inflammation, IL-1beta, TNF-alpha-amplification of inflammation, TSLP(Tymic stromal lmphopoietin)- from epithelial cells act as chemoattractant for TH2 cells,</span><span style="text-align: center; white-space: pre;"> </span><span style="text-align: center;">IL-10, IL-12-anti inflammatory<br /></span><b style="text-align: center;">Chemokines</b><span style="text-align: center;">-attract inflammatory cells, Eotaxin(CCL11) attract eosinophil via CCR3 receptor, TARC(CCL17) and</span><span style="text-align: center; white-space: pre;"> </span><span style="text-align: center;">MDC (CCL 22) from epithelial cell attract TH2 cell via CCR4.<br /></span><span style="text-align: center;"><b>Oxidative stress-increase in ROS production<br /></b></span><span style="text-align: center;"><b>NO</b>-act as relaxant but mainly causes<br /></span><span style="text-align: center;">vasodilatation leading to leakage<br /></span><span style="text-align: center;"><b>Transcription factor</b>-NF-kB, activator protein-<br /></span></p><p><b>Effects of inflammation-<br />Epithelium</b>-dysfunction, damage, loss of enzyme, loss of relaxant factors, loss of barrier functio<br /><b>Fibrosis</b>- subepithelial fibrosis, basement membrane thickening, deposition of III and V collagen(by factors release from eosinophil)<br /><b>Smooth muscle</b>- increased responsiveness to constrictor mediators, in chronic cases hypertrophy/hyperplasia by growth factors released by inflammatory mediators<br /><b>Vascular response</b>-vasodilation, angiogenesis, microvascular leakage<br /><b>Mucus hypersecrection</b>- by goblet cell hyperplasia, increase in mucus plug, leading to blocking of airway<br /><b>Neural effect</b>-reflex cholinergic bronchoconstriction by increased muscarinic action</p><p><b>Airway remodeling<br /></b>Several changes can be seen<br />Irreversible narrowing of lumen<br />Decline in lung function<br />Smooth muscle hyperplasia<br />Fibrosis</p><p><b>Summary-<br /></b>Asthma is chronic inflammatory disorder with airway hyperresponsiveness and airway obstruction.<br />various risk factors and triggers<br />Types-atopic and non-atopic<br />Eosinophilic infiltration and thickening of B.M.<br />Hyperplasia<span style="white-space: pre;"> </span>of gland and vasodilatation<br />IgE dependant mast cell activation and release of<br />various mediators<br />Early and late phase reactions with dendritic cell and TH2 cell<br />Various mediators-cytokine, chemokines, PGs etc<br />Epithelium shedding, fibrosis, hypertrophy of muscle<br />and increased permeability<br />Airway remodeling</p><div><br /></div><div style="text-align: center;"><br /><br /></div><p><span style="text-align: center;"></span></p><p style="text-align: center;"><br /></p><div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><br /></div>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-5621577980280983820.post-58236818298334864022021-03-11T06:46:00.000-08:002021-03-11T06:46:02.053-08:00<p><b> Phases of Clinical Trials</b></p><p><b>preclinical Drug Development</b></p><p>Before clinical drug development can begin, many years of preclinical development occur.</p><p>Basic research teams consisting of chemists. pharmacologists, biologists, and biochemists.</p><p>This team identify promising therapeutic categories and classes of compounds.</p><p><b>Animal Testing</b></p><p>Compounds are selected for secondary pharmacology evaluations and toxicology testing in animal models.</p><p>Compound that is pharmacologically active and safe in at least two nonhuman species may then be selected for study in humans.</p><p><b>Investigational New Drug (IND):</b></p><p>Before the drug can be tested in humans, an Investigational New Drug (IND) application must be filed with an appropriate regulatory agency.</p><p>IND contains supporting preclinical information and the</p><p>proposed clinical study designs.</p><p><b>Phases of clinical trials</b></p><p>Development of a new drug in humans is divided into four phases.</p><p>Different phases refer to different types of studies rather than a specific time course of studies.</p><p>The generalized sequence of studies may be tailored to each new drug during development.</p><p><b>Pre-approval segments (Phases 1 through 3).</b></p><p><b>Post-approval segment (Phase 4).</b></p><p><b>Phase 1</b></p><p>Studies that involve normal subjects, are included in Phase 1.</p><p>Phase 1 of the clinical program begins After the regulatory agency has approved the drug for testing in humans.</p><p><b>Goal:</b></p><p>To demonstrate safety in humans.</p><p>To collect sufficient pharmacokinetic/pharmacological information for determination of the dose strength and regimen for Phase 2 studies.</p><p><b>Study Subjects:</b></p><p>Typically conducted in healthy adult subjects.</p><p><b>Other Evidences obtained:</b></p><p>Metabolic profile.</p><p>Adverse events associated with increasing dosages.</p><p>Evidence of efficacy.</p><p>Pharmacokinetic profile…includes information</p><p>about absorption (initial studies has an oral formulation).</p><p>Drug-drug interactions.</p><p>Assessment of bioequivalence of various formulations.</p><p>Dose range and route of administration.</p><p><b>Dosing/Sampling (Phase 1)</b></p><p>The initial dose may be based on animal pharmacology or toxicology data.</p><p>Doses are increased gradually until an adverse event is observed.</p><p>Sampling is done by collecting Blood and urine.</p><p>First Study (single dosing)</p><p>Second Study (Multiple dosing).</p><p><b>Study Design (Phase 1)</b></p><p>Placebo controlled, double-blind(so that the drug effects, such as drug induced can be distinguished from the nondrug effects)</p><p>Escalating single-dose study is initiated.</p><p>Healthy volunteers are recruited.</p><p>Sometimes patients are used (e.g testing anticancer drug that may be too toxic to administer to healthy volunteers).</p><p>Include two or three cohorts, with six or eight subjects receiving the active drug and two subjects receiving placebo.</p><p>The groups may receive alternating dose levels which allow assessment of dose response (i.e., adverse events) relationship.</p><p><b>Study Setting (Phase 1)</b></p><p>Participants in the first study are usually hospitalized or enrolled in a clinic.</p><p>Why???</p><p>Clinical measurements can be performed under controlled conditions.</p><p>Any medical emergency can be handled in the most expeditious manner.</p><p><b>Maximum Tolerated Dose(MTD)</b></p><p>The first study in humans is usually not considered successfully completed until an MTD has been reached.</p><p>Relationship between a clinical event (e.g., emesis) and a particular dose level observed under controlled conditions can provide information that will be extremely useful when designing future trials.<br /></p><p><b>Multiple-dose safety</b></p><p>A multiple-dose safety study typically is initiated once the first study in humans is completed.</p><p><b>Goal</b>:</p><p>To define an MTD with multiple dosing before to initiating well-controlled efficacy testing.</p><p><b>Study Design:</b></p><p>Should simulate actual clinical conditions in as many ways as possible.</p><p>The inclusion of a placebo group is essential to allow the determination of drug-related versus nondrug-related events.</p><p>Dosages, frequency, dose escalations, and dose tapering, should simulate the regimen to be followed in efficacy testing.</p><p><b>Study Duration:</b></p><p>dosing in the second study lasts for 2 weeks.</p><p>length of the study may be increased depending on the pharmacokinetics of the drug.</p><p>if the drug is to be used to treat a chronic condition, a 4-week study duration may be appropriate.</p><p><b>Study Subjects:</b></p><p>minimum enrollment of 24 subjects should be anticipated.</p><p>subjects would be hospitalized for the duration of the study.</p><p><b>Samples:</b></p><p>Blood and urine.</p><p><b>Pharmacokinetic data</b></p><p>To determine:</p><p>whether the pk parameters obtained in the 1st study accurately predicted the multiple dose pharmacokinetic behavior of the drug.</p><p>verification of pharmacokinetic linearity (i.e., dose proportionality of C,,, and AUC)observed in the 1st study.</p><p>whether the drug is subject to autoinduction of clearance upon multidosing.</p><p>Existence and accumulation of metabolites that could not be detected in the previous single-dose study</p><p><b>Demerits of ADR clinical Trials</b></p><p>Pre-marketing trials cannot detect important reactions that occur at rates of 1 in 10,000.</p><p>Only pharmacologically predictable ADRs may be identified in clinical trials.</p><p>ADRs are only assessed by the clinicians who run them so rare/potentially serious ADRs often remain undetected.</p><p><b>ADR’s and Clinical Trials</b></p><p>Evidence of safety must be demonstrated for regulatory authorities to permit marketing.</p><p>The degree of exposure of the drug is an important factor in understanding the toxicologic results of the study.</p><p>However, it is not possible to discover the complete safety profile of a new drug prior to its launch.</p><p>These involves on average 2500 patients.</p><p>Patient selected for ADR detection should be without the multiple disease states or complex drug histories.</p><p><b>Phase 2</b></p><p>Focus on efficacy.</p><p>Pharmacokinetic information obtained in Phase 1 studies is used to optimize the dosage regimen.</p><p>Not as closely monitored as Phase 1 studies.</p><p>Conducted in patients.</p><p>Information Obtained:</p><p>These studies are designed to obtain information</p><p>On:</p><p>Efficacy.</p><p>Pharmacologic effects.</p><p>Pharmacokinetics.</p><p>Efficacy trials (Phase 2)</p><p>Efficacy trials should not to be initiated until the MTD has been defined.</p><p><b>Therapeutic window</b>:</p><p>On completion of the efficacy trial, a therapeutic</p><p>window for plasma drug concentrations can be defined by reviewing the correlation between plasma drug concentrations and key safety and efficacy parameters.</p><p><b>Goal:</b></p><p>To improve efficacy and safety of the drug. </p><p>By individualizing the dosage based upon previous plasma drug concentration profiles in the same patient.</p><p><b>Study Design (Phase 2) </b></p><p>Pharmacokinetic information obtained in healthy volunteers (during phase 1) is key to the design of successful efficacy trials.</p><p>During the planning stage of an efficacy trial, the focus is on the dosage regimen and its relationship to efficacy measurements.</p><p><b>Dosage regimen:</b></p><p>Following information obtained earlier must be considered when choosing an optimal dosage regimen for the study.</p><p><span style="white-space: pre;"> </span>Disease or physiological states of the test patients </p><p><span style="white-space: pre;"> </span>(e.g., organ dysfunction as a function of age).</p><p><span style="white-space: pre;"> </span>concurrent medications (e.g., enzyme inducers or inhibitors).</p><p><span style="white-space: pre;"> </span>Safety data</p><p><b>Phase 3</b></p><p>Phase 3 clinical trials will be initiated if:</p><p>earlier clinical studies establishes: </p><p><span style="white-space: pre;"> </span>Drug’s therapeutic properties.</p><p><span style="white-space: pre;"> </span>Cinical pharmacologic properties.</p><p><span style="white-space: pre;"> </span>Toxicologic properties.</p><p>and if it is still considered to be a promising drug.</p><p><b>Study Subjects:</b></p><p>Phase 3 studies enroll many more patients.</p><p><b>Study Site</b>:</p><p>conducted both in a hospital or controlled setting and in general practice settings.</p><p><b>Goals:</b></p><p>to confirm the therapeutic effects.</p><p><span style="white-space: pre;"> </span>to establish dosage range and interval.</p><p><span style="white-space: pre;"> </span>to assess long-term safety and toxicity.</p><p><span style="white-space: pre;"> </span>to identify less common side effects and AEs <span style="white-space: pre;"> </span>that <span style="white-space: pre;"> </span>develop latently.<span style="white-space: pre;"> </span></p><p><span style="white-space: pre;"> </span>to evaluate/quantify specific effects of the drug, such <span style="white-space: pre;"> </span>as <span style="white-space: pre;"> </span>drowsiness.</p><p><span style="white-space: pre;"> </span>to establish a place for the drug in its therapeutic class.</p><p><span style="white-space: pre;"> </span>to identify the most appropriate population or <span style="white-space: pre;"> </span>subpopulation for the study drug.</p><p><b>Relative safety profiles:</b></p><p><span style="white-space: pre;"> </span>to establish better safety profile of the investigative</p><p><span style="white-space: pre;"> </span>compound as compared to its already available/existing<span style="white-space: pre;"> </span>alternative.</p><p><span style="white-space: pre;"> </span><b>Drug Interactions (Phase 3)</b></p><p>Polytherapy ….high risk of drug-drug interactions,both from pK and pD perspectives.</p><p>Closer inspection of drug interactions is warranted in Phase 3 clinical trials.</p><p>The likelihood of drug interactions and may be predicted from in vitro data.</p><p><b>Evaluation of Drug Interactions </b>:</p><p>The potential for interactions needs to be evaluated from two perspectives:</p><p>potential that the new drug may affect the pharmacokinetics of other drugs</p><p>(depends on the ability of the new drug to affect various enzyme and carrier-mediated clearance processes).</p><p>the potential that other drugs may affect the pharmacokinetics of the new drug.</p><p>(requires knowledge of the components of clearance </p><p><b>General practitioners (phase 3)</b></p><p>Early clinical trials are conducted at university medical centers with specialized physicians.</p><p>General physicians are exposed to study drugs during this phase because they will be the one writing most of the prescriptions post marketing.</p><p>Phase 4</p><p>Phase 1, 2, and 3 studies depends on strict inclusion and exclusion criteria.</p><p>Phase 4 emphasizes on collection of safety information.</p><p>Phase 4 studies employ mainly observational study designs.</p><p>Post marketing surveillance and any additional studies requested by the regulatory agency are conducted during Phase 4.</p><p><b>Data collection (Phase 4)</b></p><p>Is an extensive, scientific exercise.</p><p>Involves:</p><p>Detailed blood work.</p><p>Special laboratory tests.</p><p>Careful physiologic monitoring.</p><p>Patient Population:</p><p>Post marketing studies, however, are often targeted for much larger patient populations (5000- 10,000 or more).<br /></p><p><b>Groups in Clinical Trials</b></p><p>Comparative groups to assess the efficacy and safety of the investigational drug relative to other drugs currently marketed. </p><p><b>Control group</b></p><p>The control groups take either placebo or active medication.<br />Sometimes more than one control group is used in a study.</p><p><b>Cohort group<br /></b>group taking the investigational drug.</p><p><b>Placebo & Active Medication<br /></b>Placebo Should be as similar as possible to the drug being investigated.(e.g., same color. taste. and shape).</p><p>Active medication taken by the control group also should be as similar as possible to the drug being investigated (e.g.. same color, taste, and shape).<br /><b>To maintain the blind:<br /></b>If the formulations cannot be made with similar appearances a placebo of each formulation could be made.<br />So subjects would take one active formulation and the placebo of the other formulation.</p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com2tag:blogger.com,1999:blog-5621577980280983820.post-75137350906620167552021-03-10T06:12:00.003-08:002021-03-10T06:12:56.494-08:00<p> <b>A medication error </b>is:</p><p> </p><p>“Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional , patient or consumer .</p><p>Medication Error</p><p>an estimated 7000 deaths per year are caused by medication errors.</p><p>• More Americans die of medication errors annually than from workplace injuries.</p><p>• Medication harm have a cost, calculated at as much as $2 billion annually.</p><p>Second report,Crossing the quality chasm;A New Health System for the 21st centurey </p><p>Three problem categories introduced.</p><p><b>Misuse</b></p><p><span style="white-space: pre;"> </span>–failures to execute clinical care plans and <span style="white-space: pre;"> </span>procedures properly.<br /><b>Overuse</b></p><p><span style="white-space: pre;"> </span>–use of health care resources and procedures in <span style="white-space: pre;"> </span>the absence of evidence.</p><p><b>Underuse</b></p><p>failure to employ health practices of proven <span style="white-space: pre;"> </span>benefit. </p><p><span style="white-space: pre;"> </span></p><p><b>TYPES OF ERRORS.</b></p><p>A. Wrong drug error.</p><p>B. Extra dose error.</p><p>C. Omission error.</p><p>D. Wrong dose/wrong strength error.</p><p>E. Wrong route error.</p><p>F. Wrong time error.</p><p>G. Wrong dosage form error.</p><p>H. Other.</p><p> <b>Wrong drug error </b></p><p>A drug that was not ordered for a patient was administered.</p><p><b>for example</b>, a patient accidentally received furosemide 40 mg orally. </p><p><b>Extra dose error</b>. </p><p>A patient receives more doses of a drug than were ordered</p><p>a patient received a medication with breakfast for 5 days instead of 3 days</p><p><b>Omission error</b></p><p>drug was not administered as ordered but was skipped.</p><p>patient was supposed to receive digoxin 0.25 mg orally but did not receive the dose. </p><p><b>Wrong dose or wrong strength error </b></p><p>wrong dose of a medicine or the wrong strength is administered</p><p>patient was supposed to receive warfarin .5 mg but received 5 mg instead.</p><p><b>Wrong route error </b></p><p>patient receives a dose of a medication by a route that was not ordered by the physician.</p><p>patient was supposed to receive</p><p>prochlorperazine 10 mg IM but was administered IV. </p><p><b>Wrong time error</b></p><p>patient does not receive a dose of medication at the time at which it was to be administered.</p><p> hospitalized patient with diabetes is scheduled to receive insulin immediately before breakfast but the dose is given 2 hr after breakfast .<br /></p><p><b>Common Error Hazards</b></p><p>Dangerous abbreviations</p><p><b>U, IU: unit (s) </b></p><p> The letter U can easily be misinterpreted as a number (e.g. , 0 or 4) .</p><p>results in serious harm with insulin and heparin</p><p>patient received 66 units of insulin instead of 6 units.</p><p><b>“6U”</b> of regular insulin was misread as 66. </p><p><b>QD, Q.D,qd, q.d. (daily)</b> </p><p>misinterpreted as “QID” or “qid” (four times daily</p><p>resulting in overdoses</p><p><b>Trailing zero</b></p><p>When a dose is ordered and followed with a decimal point and a zero, such as 2.0 mg .</p><p>Decimal point may be missed and an overdose can occur . </p><p>warfarin 2.0 mg may be</p><p>misinterpreted as 20 mg</p><p><b>Lack of leading zero</b></p><p>drug's dose less than 1 mg.</p><p>dose is written without a leading zero.</p><p>digoxin .25 mg instead of digoxin 0.25 mg. <br /></p><p><b>MS,</b></p><p><b>MgSO4<br /></b>abbreviations for morphine sulfate and magnesium sulfate are quite similar and can be confused<br /><b>confusing symbols, abbreviations<br /></b>cc. instead of mL. <br />μg/micrograms<br />HCT for hydrocortisone<br />misinterpreted as a 0.<br />mistaken for mg.<br />misinterpreted as hydrochlorothiazide<br /><b>Sound-a- like or look-a- like drug names<br /></b>Amitriptyline and aminophylline<br />Cisplatin and carboplatin</p>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-5621577980280983820.post-2530875586705913732021-01-12T18:35:00.001-08:002021-01-12T18:36:08.477-08:00COVID-19 Vaccine - Common questions<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-RQ7WcQDpAmA/X_5b65MWMUI/AAAAAAAAL0A/ID3VIFbaaXsD0rsf33IhZCThFncADa5WwCLcBGAsYHQ/s797/COVID%2BVaccine.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="609" data-original-width="797" src="https://1.bp.blogspot.com/-RQ7WcQDpAmA/X_5b65MWMUI/AAAAAAAAL0A/ID3VIFbaaXsD0rsf33IhZCThFncADa5WwCLcBGAsYHQ/s320/COVID%2BVaccine.png" width="320" /></a></div><br /><p></p><p><b>What's New ?</b></p><p>Two vaccines have been approved by the <b>Food and Drug Administraion (FDA)</b> for use against COVID-19: The Pfizer vaccine and Moderna Vaccine.</p><p>These vaccines are being shipped across the U.S. and each state develops its own plan for who will receive the vaccine and when.</p><p>Healthcare workers and patients in long-term care facilities are receiving the vaccine now.</p><p><br /></p><p><b>Key Reminders: </b></p><p><b>The vaccines are safe </b></p><p>Both vaccines were tested on up to 40,000 Volunteers of different races, ethnicities, and health conditions including kidney disease, diabetes, and cancer.</p><p>Both vaccines have gone through a full safety review with no short cuts taken, What has allowed the process to move more quickly is the research community working together on a single goal and the speedy shipment of the vaccines.</p><p>The vaccines are effective. Both vaccines are approximately 95% effective at preventing COVID-19</p><p><br /></p><p><b>When and where can i get the COVID-19 Vaccine?</b></p><p>Order is :</p><p><b>Phase 1a</b> - Healthcare workers and long term care facility residents</p><p><b>Phase 1b</b> - People 75 and older and essential workers</p><p><b>Phase 1c</b> - People 65 to 74 and people 16 to 64 with high risk health condition. </p><p>Where dialysis patients can receive the vaccine is still being determined. </p><p><br /></p><p><b>How many doses of the vaccines are needed to be effective?</b></p><p>The vaccines requires 2 doses, 21-28 days apart. You need both doses.</p><p>You may not be fully protected against COVID-19 until 7 days after the <b>second dose</b>.</p><p><br /></p><p><b>What side effects can i expect after receiving the Pfizer or Moderna vaccine?</b></p><p>Both vaccines may result in mild side effects such as pain at the injection site and feeling tired, which are normal and expected with vaccination.</p><p><br /></p><p><b>Who should NOT get a COVID-19 Vaccine?</b></p><p>The Pfizer vaccine is recommended for most people 16 and older.</p><p>The Moderna vaccine is recommended for most people 18 and older.</p><p>Talk to your doctor if you have had an allergic reaction to a vaccine before.</p>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-5621577980280983820.post-44656787586473458152020-05-30T21:01:00.002-07:002020-05-30T21:02:00.618-07:00Pattern of Calcification in Pulmonary Nodules<b>Pattern of Calcification in Pulmonary Nodules on Radiological Findings :</b><br /><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><br /></div></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-I2WhR1qDpTY/XtMrPByJ0gI/AAAAAAAALw0/yB3n2NPkSCwo3vDirUeB1RMoJ-nMHp4kwCK4BGAsYHg/Pattern%2Bof%2Bcalcification%2Bin%2BPulmonary%2BNodules.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Pattern of Calcification in Pulmonary Nodules on Radiological Findings" border="0" data-original-height="1752" data-original-width="3040" height="368" src="https://1.bp.blogspot.com/-I2WhR1qDpTY/XtMrPByJ0gI/AAAAAAAALw0/yB3n2NPkSCwo3vDirUeB1RMoJ-nMHp4kwCK4BGAsYHg/w640-h368/Pattern%2Bof%2Bcalcification%2Bin%2BPulmonary%2BNodules.png" title="Pattern of Calcification in Pulmonary Nodules" width="640" /></a></div>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com89tag:blogger.com,1999:blog-5621577980280983820.post-89391621303874401662020-03-30T11:54:00.001-07:002020-03-30T11:54:21.095-07:00USMLE - A+ Review Lectures<iframe allowfullscreen="" frameborder="0" height="344" src="https://www.youtube.com/embed/videoseries?list=PLQroNg_dZz1E5GfY70kAoL0u0roJSTBgE" width="425"></iframe>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com15tag:blogger.com,1999:blog-5621577980280983820.post-70416614506150736222020-03-30T11:46:00.000-07:002020-03-30T11:46:09.347-07:00How to Solve USMLE Questions ?<div dir="ltr" style="text-align: left;" trbidi="on">
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Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-5621577980280983820.post-58847574360633622732020-03-23T18:48:00.003-07:002020-03-23T19:04:12.025-07:00COVID-19 Vaccine - Test Kit <div dir="ltr" style="text-align: left;" trbidi="on">
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<span data-offset-key="76b1a-0-0" style="font-family: inherit;">Great news! COVID-19 Caronavirus vaccine ready. Able to cure patient within 3 hours after injection. Hats off to US Scientists.</span></div>
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<span data-offset-key="2a88-0-0" style="font-family: inherit;">Right now Trump announced that Roche Medical Company will launch the vaccine next Sunday, and millions of doses are ready from it !!!</span></div>
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Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com4tag:blogger.com,1999:blog-5621577980280983820.post-87224964980947490462020-03-19T14:29:00.001-07:002020-03-19T14:55:37.903-07:00How to prevent COVID-19 by properly washing hands - A best way to wash h...<div dir="ltr" style="text-align: left;" trbidi="on">
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Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-5621577980280983820.post-22868344256300023582020-02-13T17:26:00.001-08:002020-02-13T17:36:44.262-08:00USMLE QUIZ !<div dir="ltr" style="text-align: left;" trbidi="on">
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Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com1tag:blogger.com,1999:blog-5621577980280983820.post-80191891207689408272019-12-14T14:46:00.000-08:002019-12-14T14:46:05.414-08:00Pancreas Divisum as an indication of Islet transplantation<div dir="ltr" style="text-align: left;" trbidi="on">
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I.<span style="white-space: pre;"> </span>Title<br />
II.<span style="white-space: pre;"> </span><b>Pancreas Divisum as an indication of Islet transplantation </b><br />
III.<span style="white-space: pre;"> </span><b>Abstract</b><br />
IV.<span style="white-space: pre;"> </span><b>Introduction and objective</b><br />
i.<span style="white-space: pre;"> </span>Review cases of pancreas divisum that have been reported in allo- and auto-transplant. <br />
ii.<span style="white-space: pre;"> </span>Normal Pancreas Embryology:<br />
i.<span style="white-space: pre;"> </span>Pancreas gland arises during 5th week of gestation from three overgrowths of the primitive duodenum.<br />
a.<span style="white-space: pre;"> </span>Dorsal pancreatic: the dorsal pancreas form gut is in the midline and later comes to lie in the cavity of the duodenum.<br />
b.<span style="white-space: pre;"> </span>Two caudal ventral buds: the right ventral bud, ventral from gut, develops caudal in association with primitive bile duct to the dorsal and left bud disappear.<br />
c.<span style="white-space: pre;"> </span>The ventral rotates at 7th week posteriorly and then left caudal to dorsal bud.<br />
d.<span style="white-space: pre;"> </span>The duct system fuse together, the dorsal duct form the main duct of the body and tail while the ventral duct (Wirsung’s duct) becomes the main duct for pancreatic secretion coursing through the head and opening into the major papilla in the duodenum. The dorsal duct drains in the duct of Santorini through minor papilla.<br />
ii.<span style="white-space: pre;"> </span>Pancreas Divisum is the most frequent anatomic variation in pancreas. The first description by Joseph Hyrtl (anatomist, 1810-1894).<br />
<br />
<b>a.<span style="white-space: pre;"> </span>Three types:</b><br />
i.<span style="white-space: pre;"> </span>Type I or Classical divisum: failure of fusion between dorsal and ventral. Without fusion, the main pancreatic duct coming from the tail drains to the small papilla. 70 % of population.<br />
ii.<span style="white-space: pre;"> </span>Type II: Dorsal duct (Santorini’s duct) is dominant and the Wirsung’s duct is absent.<br />
iii.<span style="white-space: pre;"> </span>Type III or Incomplete Divisum: small communicating branch is present. 15% of population.<br />
iii.<span style="white-space: pre;"> </span>Pathophysiology: The cause of pancreatitis in Pancreas divisum is because of the dominant dorsal duct drains to the minor papilla orifice which it is small and consequently excessive high intrapancreatic dorsal ductal pressure occurs during active secretion. This may result in inadequate drainage, ductal distension, and pain. The ducts are so sensitive that even low grade hypertension makes the pancreas more prone to injury from alcohol, trauma, and drugs. <br />
iv.<span style="white-space: pre;"> </span>However, the correlation of pancreatitis with Pancreas divisum is very low [1]. Less than 20 percent of patient with pancreas divisum will develop pancreatitis and most of them are asymptomatic. Therefore, the main issue in pancreas divisum is the physiologic of the valve.<br />
v.<span style="white-space: pre;"> </span>[2]Pancreas Divisum diagnosis: MRCP or EU<br />
<br />
<b>vi.<span style="white-space: pre;"> </span>Indication for Islet transplantation: </b><br />
<b>vii.<span style="white-space: pre;"> </span>Islet autotransplant eiologies</b>:<br />
i.<span style="white-space: pre;"> </span>Minnesota Criteria: Definitions (Must have A, B, or C)<br />
A. Chronic pancreatitis with chronic abdominal pain lasting for > 6 months with features consistent with pancreatitis and objective evidence by having one of the following:<br />
<br />
1. Morphological or functional evidence of chronic pancreatitis defined by CT imaging or ERCP evidence of pancreatitis or<br />
2. EUS with 6 of 9 criteria for chronic pancreatitis or<br />
3. At least 2 of the following:<br />
i. T2 weighted MRI with evidence of pancreatic fibrosis, Secretin MRCP or ERCP with findings of chronic pancreatitis<br />
ii. EUS with 4 of 9 criteria positive for pancreatitis<br />
iii. Abnormal exocrine pancreatic function tests as evidence of a peak bicarbonate less than 80or<br />
B. Relapsing acute pancreatitis as defined as both of the following:<br />
1. 3+ episodes of acute pancreatitis with ongoing episodes over 6 months<br />
2. No evidence of gallstone disease or other correctible etiology or<br />
C. Documented hereditary pancreatitis with symptoms<br />
Section II – Indications for TP-IAT A. Chronic pancreatitis or relapsing acute pancreatitis with severe abdominal pain resulting in one of the following:<br />
1. Daily or near daily narcotic dependence for more than 3 months<br />
2. Impaired quality of life as defined as one of the following:<br />
a. Job loss<br />
b. Decreased ability or inability to work or attend school<br />
c. Frequent absences from school<br />
d. Frequent hospitalizations<br />
e. Inability to participate in usual age-appropriate activities<br />
1. Complete evaluation with no reversible cause of chronic pancreatitis or relapsing acute pancreatitis present or untreated<br />
2. Unresponsive to maximal medical therapy and endoscopic therapy<br />
Adequate islet cell function (C-peptide positive non-insulin requiring diabetes or non-diabetic)<br />
<br />
Section III - <b>Contraindications </b><br />
1. Active alcoholism or recent alcoholism (must be abstinent for 6 month with document therapy)<br />
2. Illegal drug use (must be abstinent for 6 month with documented therapy)<br />
3. Pancreatic cancer<br />
4. End-stage pulmonary disease, liver cirrhosis, or severe coronary artery disease<br />
5. Poorly controlled psychiatric illness<br />
6. Inability to comply with a postoperative regimen<br />
7. Patients with IPMN should not receive islet cell autotransplant outside of clinical trial<br />
ii. Criteria of Islet transplantation in chronic pancreatitis:<br />
<br />
1.<span style="white-space: pre;"> </span>The primary indication for TP-IAT is to treat intractable pain in patients with impaired quality of life due to CP or RAP in whom medical, endoscopic, or prior surgical therapy have failed<br />
<br />
2.<span style="white-space: pre;"> </span>TP-IAT should not be performed in patients with active alcoholism, active illicit substance abuse, or untreated/ uncontrolled psychiatric illness that could be expected to impair the patient’s ability to adhere to a complicated medical management plan…Patients with poor support networks have a relative contraindication due to the cost and complexity of managing diabetes and pancreatic enzyme replacement therapies. Recommendation 2B<br />
<br />
3.<span style="white-space: pre;"> </span>TP-IAT should not be performed in patients with specific medical conditions, including: c-peptide negative diabetes, type 1 diabetes, portal vein thrombosis, portal hypertension, significant liver disease, high-risk cardio-pulmonary disease, or known pancreatic cancer. Recommendation D<br />
<br />
4.<span style="white-space: pre;"> </span>There are no studies that specifically evaluate contraindications to this procedure. However, TP and TP-IAT are major surgical procedures, with potential operative complications, a prolonged surgical recovery, and an intensive post-operative regimen that includes management of diabetes mellitus and lifelong enzyme therapy for pancreatic enzyme insufficiency. Recommendation D<br />
<br />
5.<span style="white-space: pre;"> </span>The severity, frequency, and duration of pain symptoms, narcotic requirements, disability/impaired quality of life, residual islet function, rate of disease progression, and age of the patient should be considered in timing of the procedure. Recommendation D<br />
<br />
6.<span style="white-space: pre;"> </span>Patients who meet the inclusion criteria (see above) and who are not excluded should be evaluated by a multi-disciplinary team who will review alternative interventions, assess the likelihood of success in reducing pain and preventing or minimizing diabetes, follow the patient through the procedure and provide guidance for long-term care. Recommendation D.<br />
<br />
7.<span style="white-space: pre;"> </span>Evaluation should include confirming that pancreatitis is the primary diagnosis, determining that the pain is of pancreatic origin, monitoring the presence of diabetes, assessing beta-cell mass, and assessing the patency of the portal venous system, evaluating for liver disease, and determining immunization status. Recommendation D<br />
<br />
8.<span style="white-space: pre;"> </span>CP, chronic pancreatitis; RAP, recurrent acute pancreatitis; TP-IAT, Total Pancreatectomy with Islet Autologous Transplant. aMethods of developing consensus based on the Grading of Recommendations, Assessment, Development, and Evaluation Grid. Recommendation D<br />
To be considered for TP-IAT, patients must meet criteria in sections I and II and have no contraindications (section III).75 CT, computed tomography; ERCP, endoscopic retrograde cholangiopancreatography; EUS, endoscopic ultrasonography; IPMN, intrapancreatic mucinous neoplasm; MRCP, magnetic resonance cholangiopancreatography; MRI, magnetic resonance imaging Tab [ii, iii]<br />
<br />
viii.<span style="white-space: pre;"> </span>Etiologic risk factors associated with chronic pancreatitis: TIGAR-O classification system<br />
<br />
Table 4 Etiologic risk factors associated with chronic pancreatitis: TIGAR-O classification system<br />
Toxic-metabolic<br />
Alcoholic: alcohol is considered as cofactor for pancreatitis instead as an absolute cause. <br />
Tobacco smoking <br />
Hypercalcemia <br />
Hyperparathyroidism <br />
Hyperlipidemia (rare and controversial) <br />
Chronic renal failure <br />
Medications <br />
Phenacetin abuse (possibly from chronic renal insufficiency) <br />
Toxins <br />
Organotin compounds (e.g., DBTC) <br />
Idiopathic<br />
Early onset <br />
Late onset <br />
Tropical <br />
Tropical calcific pancreatitis <br />
Fibrocalculous pancreatic diabetes <br />
Other <br />
Genetic<br />
Autosomal dominant <br />
Cationic trypsinogen (Codon 29 and 122 mutations) <br />
Autosomal recessive/modifier genes <br />
CFTR mutations <br />
SPINK1 mutations <br />
Cationic trypsinogen (codon 16, 22, 23 mutations) <br />
α1-Antitrypsin deficiency (possible) <br />
Autoimmune<br />
Isolated autoimmune chronic pancreatitis <br />
Syndromic autoimmune chronic pancreatitis <br />
Sjögren syndrome–associated chronic pancreatitis <br />
Inflammatory bowel disease–associated chronic pancreatitis <br />
Primary biliary cirrhosis–associated chronic pancreatitis <br />
Recurrent and severe acute pancreatitis<br />
Postnecrotic (severe acute pancreatitis) <br />
Recurrent acute pancreatitis <br />
Vascular diseases/ischemic <br />
Postirradiation <br />
Obstructive<br />
Pancreatic divisum <br />
Sphincter of Oddi disorders (controversial) <br />
Duct obstruction (e.g., tumor) <br />
Preampullary duodenal wall cysts <br />
Posttraumatic pancreatic duct scars <br />
<br />
ix.<span style="white-space: pre;"> </span>According to Melani D. Bellin et al. most common risk factor for patients in children undergoing a TPIAT is the occurrence of predisposing genetic mutations (54%) such as mutations in the trypsinogen gene (PRSSI) which predisposes inappropriate activation of trypsin, loss of trypsin inhibitor function (SPINKI gene mutation), and cystic fibrosis transmembrane (CFTR)gene mutations. Other factors such as pancreas divisum, and idiopathic disease, trauma [3]. <br />
<br />
Background<br />
V.<span style="white-space: pre;"> </span>Description /summary<br />
<br />
<br />
VI.<span style="white-space: pre;"> </span>Management and treatment:<br />
VII.<span style="white-space: pre;"> </span>Discussion<br />
VIII.<span style="white-space: pre;"> </span>Conclusion:<br />
IX.<span style="white-space: pre;"> </span>References<br />
i.<span style="white-space: pre;"> </span>QUEST L, LOMBARD M, Pancreas divisum: opinio divisa, Gut 2000; 47:317-319.<br />
ii.<span style="white-space: pre;"> </span>Bellin MD, Freeman ML, Gelrud A et al. Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest. Pancreatology 2014;14:27-35<br />
iii.<span style="white-space: pre;"> </span>Jaeschke R, Guyatt GH, Dellinger Pet al.Use of GRADE grid to reach decisions on clinicalpractice guidelines when consensus is elusive.BM 2008;337: a744<br />
iv.<span style="white-space: pre;"> </span><br />
<br />
<br />
1.<span style="white-space: pre;"> </span>Muzaffar, A.R., et al., Pancreas divisum in a family with hereditary pancreatitis. Journal of clinical gastroenterology, 1996. 22(1): p. 16-20.<br />
2.<span style="white-space: pre;"> </span>Lowes, J., et al., Obstructive pancreatitis: unusual causes of chronic pancreatitis. BJS, 1988. 75(11): p. 1129-1133.<br />
3.<span style="white-space: pre;"> </span>Bellin, M.D., et al., Pediatric autologous islet transplantation. Current diabetes reports, 2015. 15(10): p. 67.<br />
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Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com6tag:blogger.com,1999:blog-5621577980280983820.post-48063557061165706802019-05-07T14:33:00.000-07:002019-05-07T14:33:02.357-07:00Distal Ulnar Fracture<div dir="ltr" style="text-align: left;" trbidi="on">
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