1-congential umblical hernia , asymptomatic :

ttt : 90% disappear spontaneously during the first 5 years of life.

Expectant treatment <2 cm : The child is observed for 2 years, with treatment of any
predisposing factor. if failed surgery .
2- cholera prophlaxis : tetracycline
3- mucopurulent discharge : bacterial conjunctivitis
-The mainstay of medical treatment of bacterial conjunctivitis is topical antibiotic therapy: Sodium
sulfacetamide, gentamicin, tobramycin, neomycin, trimethoprim and polymyxin B combination,
ciprofloxacin, ofloxacin, gatifloxacin, and erythromycin
-Systemic antibiotics are indicated for N gonorrhoeae infant (penicillin G ) , mother and high risk
contacts (ceftriaxone) and chlamydial infections : infant (erythromycin) mother and at-risk contacts
(doxycycline).
4 - 4 drop in one eye : 1 drope in : inferori fornix
5 typical case of acute angle glucoma: by s/s
6-AVN in femoral : perths diseas : ttt - surgical -- traction bracing for 6 y then
surgery
7-Elbow dislocation : posterior fat pad sign
8- siclicosis : 20 degress :
9- HCC : 10 % - with chronic liver ds -never come with smoking
10- Hypopigment in left arm , ulnar nerve hypertophy : - TB - AMYLOSIS( - VITLIGO
LEPROSY
Leprosy is a chronic granulomatous disease principally affecting the skin and peripheral
nervous system , caused by infection with Mycobacterium leprae
S/S : hypopigmented macule with a raised border is often the first cutaneous lesion. Plaques
are also common. Lesions may or may not be hypoesthetic. Lesions on the buttocks often
indicate borderline disease, The most common nerve affected is the posterior tibial nerve ,
Nerve palpation , Eye damage
Dx : -Hypopigmented or reddish patches with definite loss of sensation -Thickened
peripheral nerves -Acid-fast bacilli on skin smears or biopsy material
TTT : Dapsone & rifampin
- Acne : topical antibiotic( clindamycin ) if Non inflammatory . Benzoyl or topical
retinoic acid if inflammatory .
11-HenochSchnlein purpura : capillary , arterioles , veinules .
12- female with problem in school -baldness : (((Trichotillomani )))
13- - -butterd women - : RECURRENT COMPLAINT
14 - mallory weiss syndrome : Resolve spontaneous
15 - pregnant 6 days in CS - staining in her throbs from abdomen : Fascial dehiscence
wound infection and is suggested when excessive discharge from the wound is
present. If a fascial dehiscence is observed, the patient should be taken immediately
to the operating room where the wound can be opened, debrided, and reclosed in a
sterile environment.
16 - Breast feeding 10 month , convulsion ,,,gave her phenoparbital :
weaning 3 weeks - stop - do not stop - after 8 hours
17 - 16 week , polydipsia polyurea , less than 126 mg fasting ,, 6.8 : impaird DM
IFG: ( 6.1-7.0 mmol)
IGT : ( 7.8-11.1 mmol/l, 2h after 75g )
18 CHEST SYNDRME HG 8 RET 20% , VENOOCCLUSIVE : Sickle cell anemia
19 for adult women as prophlaxis : folic acid and Ca
20 - WAVE CONTARACTION IN ABDOMEN : BOWEL OBSTRUCTION
21 - PERITONITIS :
chemical irritation (erosion ) rigidity by paralytic illus - Complicated appendectomy
by anerobe organism
22 post appendectomy prophylaxis : flagyl & ceftiaxone
If simple appendicitis is suspected, a single agent, such as a second-generation cephalosporin (eg,
cefoxitin), or an extended-spectrum penicillin (eg, ampicillin-sulbactam) is adequate.
The most common complication is wound infection, especially with a perforated appendix.
- Metronidazolewith aminoglycoside (eg, gentamicin) : broad gram-negative and anaerobic coverage.
- Aminoglycoside antibiotic for gram-negative coverage.
Cefotetan : Second-generation cephalosporin used as single-drug therapy for broad gram-negative
and anaerobic coverage.
- Cefoxitin : Second-generation cephalosporin indicated as single agent for management of infections
caused by susceptible gram-positive cocci and gram-negative rods.
- Meropenem : Used as a single agent, effective against most gram-positive and gram-negative
bacteria.
23 Osteoporosis : back fracture : most common .
24 - NEW STUDY, COMMON SIDE EFFECT OF ATPICAL PSYCHATRIC MEDICATION :
LIVER CIRROSIS - WEGIGHT GAIN -
25 old man with painless nodules 2 * in left lobe of thyroid Inx :
US - FNA - NUCLEOTIDE STUDY
26 vit C In healing : Collagen
27 - Hypernatrmia : slowly correction to prevent cerebral edema
If hyponatrmia not corrected rapidly : central pontine myelinolysis
(symptoms include paraparesis/quadriparesis, dysarthria, and coma).
28 - Pancreatitis : increase by lying down
29 - Pnumothorax : decompression at the midclavicular line in the second
intercostals spsce.
30 - Flail chest : Dx
31 - MS : optic neuritis painful vision loss
32 - BPH : TRUS IS BETTER THAN PSA - NO ROLE IN PSA - PSA ROLE - BIOPSY
33 50 years , back pain , x ray sowed lytic lesion : bone scan
34 - exaggerated reflex in jaw , no fasculation , difficlty in swallowing :
pseudobulbar palsy

Pseudobulbar palsy results from an upper motor neuron lesion to the corticobulbar pathways in the
pyramidal tract. Patients have difficulty chewing, swallowing and demonstrate slurred speech (often
initial presentation). Individuals with pseudobulbar palsy also demonstrate inappropriate emotional
outbursts.
S/S :
* Speech is slow, thick and indistinct - Gag reflex is normal, exaggerated or absent - Tongue is small,
stiff and spastic - Jaw jerk is brisk - upper motor neuron lesion of the limbs - Dysphagia (difficulty in
swallowing) - Labile affect Dysarthria - Uncontrollable laughing or crying
Bulbar palsy refers to bilateral impairment of function of the lower cranial nerves IX, X, XI and XII,
which occurs due to lower motor neuron lesion either at nuclear or fascicular level in the medulla
oblongata or from bilateral lesions of the lower cranial nerves outside the brainstem.[1]
S/S :
dysphagia (difficulty in swallowing) - difficulty in chewing - nasal regurgitation - slurring of speech -
choking on liquids - Nasal speech lacking in modulation and difficulty with all consonants - Tongue is
atrophic and shows fasciculations - Dribbling of saliva - Weakness of the soft palate, examined by
asking the patient to say aah - The jaw jerk is normal or absent - The gag reflex is absent - lower motor
neuron lesions of the limbs.
------------------
35 H igh senstive & specific for urolithasis : CT scan
36 : most commom complication of parotitis :menigitis
37 : physilogical discharge in femal from vagina : ttt : douching
38 : undescent testis : ttt :nothing to do until 1 year & orchiplexy
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39 : child in ER , with dyspnea , tachy pnea , subepiglottic narrowing in x-ray :
40 : female with breast cancer :before 5 years received chmeotherpy . diagnosed
now CLL , causes of CML : risk factor .
41 : antipsychotic drug side effect for onset :
4 hours: Acute dystonia , 4 days: Akinesia , 4 weeks: Akathisia , 4 months: Tardive
dyskinesia (often permanent)
42 : chronic use of alcohol : first drug to give pt : thiamine .
43 : female with vaginal bleeding , abdominal pain : first Inx :
US Vaginal Examination
44 : breech presentation , 34 weeks ,
External cephalic - internal - wait
45 : not normally palpaple : parotid , submandibular gland , LNs , hyoid bone ,
thyroid .

46 : stroke pt , most a :Polycethmia vera - Sickle ceLl anemia - 2 ry polycethmia .
47 : old mle , back pain , ex is normal : gave him steroid , come again with vesicle
form back to abdomen : VZV
48 : Female , Rt hand , lateral two radial styloid procces pain , since month increase
progreissively , CS , ttt of De Quervain Tenosynovitis +ve Finkelstein test :
Ttt : Nerve decomperrison cast upper joint cast with thumb raised
Initial treatment for DeQuervain's syndrome is nonoperative : first thumb-spica splint , NSAIDS may also be of
value , corticosteriod injection into the first dorsal compartment may provide sustained relief .
- In one study, Weiss et al. reported that injection was just as effective in DeQuervain's syndrome as splinting
alone or splinting combined with injection. In another study of 63 patients, 71% of patients had sustained relief
of their symptoms with one first dorsal compartment injection.

49 : male with auscultation , not clear , left sterna border , scratching sound , vein
distened in neck , muffled heart sound :
Cardiac tamponade percarditis
50 : Acanthosis Nigricans :
Associated with DM, Cushings disease, HAIR-AN syndrome, and obesity.
May also be a paraneoplastic sign of underlying adenocarcinoma (usually
GI). polycystic ovary syndrome

51 :vasoconstrictor nasal medication : rebound phenomen
52 :celiac disease : not cause it : rice&corn - oat - wheel - gluten