المساعد الشخصي الرقمي

مشاهدة النسخة كاملة : نماذج الأسئلة و الإجابات و التوضيحات الخاصة بإمتحان الهيئة السعودية للتخصصات الطبية تخصص الطب العام وغيرة


الفارس الأحمر
27-03-2011, 03:51 PM
بسم الله الرحمن الرحيم
اما بعد فهذه بعض نماذج الاسئلة الخاصة بإمتحان الهيئه السعودية للتخصصات الطبية لإمتحان الطب العام انشرها هنا راجيا من الله ان يستفيد منها جميع الطلبه و الاطباء و ان لا ينسوني من دعائهم و ستعرض إن شاء الله مقسمه بحسب المادة ...

و سأبدأ باسئله علم النفس


1-A 65-year-old male with hypertension, congestive heart failure, and peptic ulcer disease came to your office for his regular blood pressure check. Although his blood pressure is now under control, he complains of an nability to maintain an erection. He currently is taking propranolol, verapamil, hydrochlorothiazide, and ranitidine. On examination his blood pressure is 125/76 mmHg. His pulse is 56 and regular. The rest of the cardiovascular examination and the rest of the physical examination are normal. Which of the following generally considered to be the MOST common cause of sexual dysfunction?
A. Pharmacological agents.
B. Panic disorder.
C. Generalized anxiety disorder (GAD).
D. Major depressive disorder (MDD).
E. Dysthymic disorder.


2- a 43 yrs. old female pt. presented to ER with H/O : paralysis of both lower limbs and parasthesia in both upper limbs since 2 hours ago .. she was seen lying on stretcher & unable to move her lower limbs (neurologist was called but he couldn't relate her clinical findings 2 any medical disease !!! ) when history was taken , she was beaten by her husband … the most likely diagnosis is :
a- complicated anxiety disorder d- psychogenic paralysis
b- somatization disorder e- hypochondriasis
c- conversion disorder

- the best treatment for the previous case is :
a- benzodiazepines
b- phenothiazine
c- monoamine oxidase inhibitor
d- selective serotonin reuptake inhibitor
e- supportive psychotherapy

-A 43 yo female , presented to ER with paralysis of both LL and parasthesia in both TJL for 2 hours ,She was lying on a stretcher unable to move her LL ( neurologis could not relate her clinical findings 2 any medical disease .Hx showed she was beaten by her husband .The Dx is:
a. Complicated anxiety disorder
b. Somatization disorder
c. Conversion disorder
d. Psychogenic paralysis
e. Hypochondriasis

-The best Rx for the previous case is:
a. Benzodiazipines
b. Phenothiazine
c. MAOI
d. SSRIs
e. Supportive psychotherapy



According to the DSM IV, the diagnosis of psychogenic paralysis has both neurological and psychiatric aspects. Indeed, the picture may occur in the context of several psychiatric conditions, of which the most frequent are:
(i) Conversion disorder with motor symptoms or defects ,or
(ii) Factitious disorder ,or
(iii) Malingering .

For the psychiatric diagnosis, the task is to disentangle the personal, psychological, social and cultural context onto which the symptoms/signs impinge . The neurodiagnosis is by exclusion, since it is based on the fact that “the symptom or deficit cannot, after appropriate investigation, be fully explained by a general medical condition, or by the direct effects of a substance” . The problem then arises as to what can be held as an “appropriate investigation”, since patients present with a rather heterogeneous background and a variety of findings. Their history, symptoms and signs may often be”so intriguing as to require accurate reflections” .

Conversion disorder
symptoms or deficits affecting voluntary motor or sensory function that suggest a neurologic or other general medical condition. Yet, following a thorough evaluation, which includes a detailed neurologic examination and appropriate laboratory and radiographic diagnostic tests, no neurologic explanation exists for the symptoms, or the examination findings are inconsistent with the complaint. In other words, symptoms of an organic medical disorder or disturbance in normal neurologic functioning exist that are not referable to an organic medical or neurologic cause.1
Common examples of conversion symptoms include blindness, diplopia, paralysis, dystonia, psychogenic nonepileptic seizures (PNES), anesthesia, aphonia, amnesia, dementia, unresponsiveness, swallowing difficulties, motor tics, hallucinations, pseudocyesis and difficulty walking.


No specific pharmacologic therapy is available for conversion disorder; however, medications for comorbid mood and anxiety disorders should be considered. Care should be taken to avoid dependence-producing psychotropic agents.

3- a 28 yrs. old lady , C/O: chest pain, breathlessness and feeling that she'll die soon .. O/E : just slight tachycardia .. otherwise unremarkable .. the most likely diagnosis is:
a- panic disorder

Panic disorder is characterized by the spontaneous and unexpected occurrence of panic attacks, the frequency of which can vary from several attacks per day to only a few attacks per year. Panic attacks can occur in other anxiety disorders but occur without discernible predictable precipitant in panic disorder.criteria for panic disorder, panic attacks must be associated with more than 1 month of subsequent persistent worry about (1) having another attack, (2) consequences of the attack, or (3) significant behavioral changes related to the attack.
Panic attacks are a period of intense fear in which 4 of 13 defined symptoms develop abruptly and peak rapidly less than 10 minutes from symptom onset. To make the diagnosis of panic disorder, panic attacks cannot directly or physiologically result from substance use, medical conditions, or another psychiatric disorder.
The DSM-IV-TR delineates the following potential symptom manifestations of a panic attack:
• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Sense of shortness of breath or smothering
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Derealization or depersonalization (feeling detached from oneself)
• Fear of losing control or going crazy
• Fear of dying
• Numbness or tingling sensations
• Chills or hot flashes

Panic disorder often coexists with mood disorders, with mood symptoms potentially following the onset of panic attacks. Lifetime prevalence rates of major depression may be as much as 50-60%. These patients may be at higher risk of suicide attempts. Alcohol and other substance use disorders are also frequent sequelae of panic disorder.

Pharmacotherapy
Selective serotonin reuptake inhibitors (SSRIs) are generally used as first-line agents, followed remotely by tricyclics. Benzodiazepines can achieve long-term control but should be reserved for patients with refractory panic disorder and should generate a psychiatric referral for pharmacologic management review and potentially a psychotherapist for any additional nonpharmacologic treatment options.
Fluoxetine (Prozac) can be used (especially if panic disorder occurs with depression); however, patients may poorly tolerate it initially because it may initially increase anxiety, except at very low starting doses. Fluoxetine has a long half-life, making it a good choice in marginally compliant patients.

Cognitive and behavioral psychotherapy
Cognitive and behavioral psychotherapy can be used alone or in addition to pharmacotherapy. The combination approach yields superior results for most patients compared to either single modality.

4- a 65 yrs old lady came to your clinic with Hx of 5 days insomnia and crying ( since her husband died ) the best Tx. For her is :
a- Lorazepam
b- Fluoxetine
c- chlorpromazine
d- haloperidol

Acute stress reaction
This occurs in individuals without any other psychiatric disorder, in response to exceptional physical and/or psychological stress. While severe, such a reaction usually subsides within days. The stress may be an overwhelming traumatic experience (e.g. accident, battle, physical assault, rape) or a sudden change in the social circumstances of the individual, such as a bereavement. Individual vulnerability and coping capacity play a role in the occurrence and severity of an acute stress reaction, as evidenced by the fact that not all people exposed to exceptional stress develop symptoms. Symptoms usually include an initial state of feeling ‘dazed’ or numb, with inability to comprehend the situation. This state may be followed either by further withdrawal from the situation or by anxiety and overactivity. No treatments beyond reassurance and support are normally necessary.
Anxiety disorders are common psychiatric disorders. Many patients with anxiety disorders experience physical symptoms related to anxiety and subsequently visit their primary care providers. Despite the high prevalence rates of these anxiety disorders, they often are underrecognized and undertreated clinical problems. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) classifies the anxiety disorders into the following categories:1
• Anxiety due to a general medical condition
• Substance-induced anxiety disorder
• Generalized anxiety
• Panic disorder
• Acute stress disorder
• Posttraumatic stress disorder (PTSD)
• Adjustment disorder with anxious features
• Social phobia
• Obsessive-compulsive disorder (OCD)
• Specific phobias
The management of individual anxiety disorders is dependent on the specific diagnosis.
Selective serotonin reuptake inhibitors (SSRIs) are helpful in a variety of anxiety disorders, including generalized anxiety disorder, panic disorder, OCD, and social phobia.
Antidepressant agents are the drugs of choice in the treatment of anxiety disorders, particularly the newer agents that have a safer adverse effect profile and higher ease of use than the older tricyclic agents; however, benzodiazepines often are used as adjunct treatment.
Some anticonvulsant medications, such as divalproex and gabapentin, may have a role in the treatment of anxiety disorders, especially in patients with high potential for abusing benzodiazepines.
Older antidepressants, such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) also are effective in the treatment of some anxiety disorders. Caution in their use is warranted due to their higher toxicity and potential lethality in overdose. Their use should be limited to cases where SSRIs are ineffective or cannot be afforded. MAOIs may be especially indicated in treatment-refractory panic disorder. Clomipramine (Anafranil, a tricyclic agent) has a US Food and Drug Administration (FDA) indication in the treatment of OCD and is the only tricyclic agent effective in the treatment of this condition. Indeed, it can be effective in cases refractory to treatment with SSRI agents. MAOI agents also may have a role in the treatment of certain subtypes of OCD refractory to conventional treatment, such as patients with symmetry obsessions or associated panic attacks.
The FDA has granted specific indications to the following disorders and agents: generalized anxiety disorder (venlafaxine, buspirone, escitalopram, paroxetine, duloxetine), social phobia (paroxetine, sertraline, venlafaxine), OCD (fluoxetine, sertraline, paroxetine, fluvoxamine), and PTSD (sertraline, paroxetine).


Initial pharmacotherapy: All antidepressants on the market are potentially effective. Usually, 2-6 weeks at a therapeutic dose level are needed to observe a clinical response. The choice of medication should be guided by anticipated safety and tolerability, which aid in compliance; physician familiarity, which aids in patient education and anticipation of adverse effects; and history of prior treatments. Treatment failures often are caused not by clinical resistance, but by medication noncompliance, inadequate duration of therapy, or inadequate dosing.
• SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro). This group has the advantage of ease of dosing and low toxicity in overdose. Common adverse effects include GI upset, sexual dysfunction, and changes in energy level (ie, fatigue, restlessness).
• Escitalopram has been shown to have superior efficacy to other antidepressants in the treatment of more severe depression.5
• Escitalopram has also been shown to be at least as effective as SNRIs and better tolerated, even in severe depression.6
• Selective serotonin/norepinephrine reuptake inhibitors (SNRIs) include venlafaxine (Effexor) and duloxetine (Cymbalta). Safety, tolerability, and side effect profiles are similar to that of the SSRIs, with the exception that the SNRIs have been associated (rarely) with a sustained rise in blood pressure. SNRIs can be used as first-line agents, particularly in patients with significant fatigue or pain syndromes associated with the episode of depression. The SNRIs also have an important role as second-line agents in patients who have not responded to SSRIs. Venlafaxine and duloxetine are discussed in more detail in the Medication section.

Lorazepam, initially marketed under the brand names Ativan and Temesta, is a benzodiazepine drug with short to medium duration of action. It has all five intrinsic benzodiazepine effects: anxiolytic, amnesic, sedative/hypnotic, anticonvulsant and muscle relaxant.[4] Long-term use of benzodiazepines is associated with tolerance, dependence, a benzodiazepine withdrawal syndrome as well as cognitive impairments which may not completely reverse after cessation of treatment; however, for most patients cognitive impairment is not severe.[5] It is a powerful anxiolytic, and, since its introduction in 1977, lorazepam's principal use has been in treating the symptom of anxiety. Among benzodiazepines, lorazepam has a relatively high addictive potential.[6]
Indications
1987 Ativan advertisement. "In a world where certainties are few...no wonder Ativan (lorazepam)C-IV is prescribed by so many caring clinicians."
Lorazepam has relatively potent anxiolytic effects and its best-known indication is the short-term management of severe chronic anxiety, though in fact the FDA advises against this usage.[7] It is fast acting, and useful in treating fast onset panic anxiety.[8]
Lorazepam has strong sedative/hypnotic effects, and the duration of clinical effects from a single dose makes it an appropriate choice for the short-term treatment of insomnia, in particular in the presence of severe anxiety. Withdrawal symptoms, including rebound insomnia and rebound anxiety, may occur after only 7 days' administration of lorazepam.[9]
Its relatively potent amnesic effect,[4] with its anxiolytic and sedative effects, makes lorazepam useful as premedication. It is given before a general anaesthetic to reduce the amount of anaesthetic agent required, or before unpleasant awake procedures, such as in dentistry or endoscopies, to reduce anxiety, to increase compliance, and to induce amnesia for the procedure. Oral lorazepam is given 90 to 120 minutes before procedures, and intravenous lorazepam as late as 10 minutes before procedures.[10][11][12] Lorazepam is sometimes used as an alternative to midazolam in palliative sedation.[13]

Fluoxetine (trade name Prozac) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. Fluoxetine is approved for the treatment of major depression (including pediatric depression), obsessive-compulsive disorder (in both adult and pediatric populations), bulimia nervosa, panic disorder and premenstrual dysphoric disorder.[1] Despite the availability of newer agents, it remains extremely popular. Over 22.2 million prescriptions for generic formulations of fluoxetine were filled in the United States in 2007, making it the third most prescribed antidepressant.[2]
Indications
Fluoxetine has been approved by the FDA for the treatment of major depression, obsessive compulsive disorder, bulimia nervosa and panic disorder.[12] Fluoxetine was shown to be effective for depression in 6-week long double-blind controlled trials where it also alleviated anxiety and improved sleep. Fluoxetine was better than placebo for the prevention of depression recurrence when the patients, who originally responded to fluoxetine, were treated for a further 38 weeks. Efficacy of fluoxetine for geriatric as well as pediatric depression was also demonstrated in placebo-controlled trials.[12]
The peculiar pharmacokinetics of fluoxetine with its brain levels rising extremely slowly over at least first 5 weeks of treatment (see Pharmacokinetics) makes it unclear whether the 20-mg/day optimal dose established in the short term (6-8 weeks) trials is applicable for the longer term supportive treatment. One 60-mg dose of fluoxetine per week was found to be equivalent to 20 mg/day for the continuation treatment of responders to 20 mg/day of fluoxetine.[13][14] Furthermore, 5 mg/day fluoxetine was shown to be better than placebo and similar to 20 mg/day,[15] and one weekly dose of 80 mg fluoxetine was equivalent to 60 mg/day fluoxetine or 150 mg/day amitriptyline.[14] Furthermore, increase of the dose to 60 mg/day in non-responders from 20 mg/day brought no additional benefits as compared to continuing the 20 mg/day treatment.[15]
Among the common adverse effects associated with fluoxetine and listed in the prescribing information, the effects with the greatest difference from placebo are nausea (22% vs 9% for placebo), insomnia (19% vs 10% for placebo), somnolence (12% vs 5% for placebo), anorexia (10% vs 3% for placebo), anxiety (12% vs 6% for placebo), nervousness (13% vs 8% for placebo), asthenia (11% vs 6% for placebo) and tremor (9% vs 2% for placebo). Those that most often resulted in interruption of the treatment were anxiety, insomnia, and nervousness (1-2% each), and in pediatric trials—mania (2%).[12][18][19] Similarly to other SSRIs, sexual side effects are common with fluoxetine; they include anorgasmia and reduced libido.[20]


Chlorpromazine (as chlorpromazine hydrochloride, abbreviated CPZ, marketed in the US as Thorazine, as Largactil in Europe) is the oldest typical antipsychotic. The molecular structure is 2-chloro-10-(3-dimethylaminopropyl)-phenothiazine. Synthesized on December 11, 1950, chlorpromazine was the first drug developed with specific antipsychotic action. Its use has been described as the single biggest advance in psychiatric treatment, dramatically improving the prognosis of patients in psychiatric hospitals worldwide. It was the prototype for the phenothiazine class, which later grew to comprise several other agents. It is now used less commonly than the newer atypical antipsychotics such as olanzapine, quetiapine, and risperidone.
Chlorpromazine works on a variety of receptors in the central nervous system, producing anticholinergic, antidopaminergic, antihistaminic, and antiadrenergic effects. Its anticholinergic properties cause constipation, sedation, and hypotension and relieve nausea. It also has anxiolytic (anxiety-relieving) properties. Its antidopaminergic properties can cause extrapyramidal symptoms such as akathisia (restlessness), dystonia, and Parkinsonism. Chlorpromazine inhibits clathrin-mediated endocytosis.[1] Chlorpromazine is known to cause tardive dyskinesia, which can be irreversible.[2] It is often administered in acute settings as a syrup, which has a faster onset of action than tablets. Subcutaneous injection is not advised, and administration is limited to severe hiccups, surgery, and tetanus.[3]

5- Good prognosis factors in schizophrenia are all the following, except:
a. Good premorbid adjustment.
b. Acute onset.
c. Male.
d. Family hx. Of mood disorder.

- Good prognostic features in schizophrenia include all but ONE of the following:
A. Good premorbid adjustment.
B. Acute onset.
C. Male gender.
D. Family history of mood disorder.

6- Good prognostic factor for pt with schizophrenia is
1) +ve family history
2) No previous cause
3) Prominent affective symptoms
4) Gradual onset
5) Flat mood

- pt with schizophrenia, the best prognostic sign is:
a) Gradual onset
b) Family history of schizophrenia
c) Age of the patient
d) Coincidence of other psychological problems

Affective Symptoms
Mood or emotional responses dissonant with or inappropriate to the behavior and/or stimulus.

Early onset of illness, family history of schizophrenia, structural brain abnormalities, and prominent cognitive symptoms are associated with poor prognosis.
Sex
The prevalence of schizophrenia is about the same in men and women. The onset of schizophrenia is later and the symptomatology is less severe in women than in men. This may be because of the antidopaminergic influence of estrogen.

History
• Information about the medical and psychiatric history of the family, details about pregnancy and early childhood, history of travel, and history of medications and substance abuse are all important. This information is helpful in ruling out other causes of psychotic symptoms.
• The patient usually had an unexceptional childhood but began to experience a noticeable change in personality and a decrease in academic, social, and interpersonal functioning during mid-to-late adolescence. In retrospect, family members may describe the person with schizophrenia as a physically clumsy and emotionally aloof child. The child may have been anxious and preferred to play by himself or herself. The child may have been late to learn to walk and may have been a bedwetter.4,5
• Usually, 1-2 years pass between the onset of these vague symptoms and the first visit to a psychiatrist.6
• The first psychotic episode usually occurs between the late teenage years and mid 30s.
• The symptoms of schizophrenia may be divided into the following 4 domains:
1. Positive symptoms: These include psychotic symptoms, such as hallucinations, which are usually auditory; delusions; and disorganized speech and behavior.
2. Negative symptoms: These include a decrease in emotional range, poverty of speech, loss of interests, and loss of drive. The person with schizophrenia has tremendous inertia.
3. Cognitive symptoms: These include neurocognitive deficits, such as deficits in working memory and attention and executive functions such as the ability to organize and abstract. Patients also have difficulty understanding nuances and subtleties of interpersonal cues and relationships. A new initiative from the National Institutes of Mental Health, known as Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) is a collaboration between various programs to develop tools for measuring cognition in clinical trials and aiding drug development that is targeted at these symptoms.
4. Mood symptoms: Schizophrenia patients often seem cheerful or sad in a way that does not make sense to others. They often are depressed.

PROGNOSIS: Outcome may be worse in people with insidious onset and delayed initial treatment, social isolation, or a strong family history; in people living in industrialised countries; in men; and in people who misuse drugs.


Good Prognosis :

Bad prognosis

1. Late onset
2. Obvious precipitating factors
3. Acute onset
4. Good premorbid social , sexual & work histories
5. Mood(Affective) disorder symptoms (especially depressive disorders )
6. Married
7. Family history of mood disorders
8. Good support systems
9. Positive symptoms 1. Young onset
2. No precipitating factors
3. Insidious onset
4. Poor premorbid social , sexual & work histories
5. Withdrawn , Autistic behavior

6. Single , divorced or widowed
7. Family history of schizophrenia
8. Poor support systems
9. Negative symptoms
10. Neurological signs & symptoms
11. History of perinatal trauma
12. No remissions in 3 years
13. Many relapses
14. History of assaultiveness



Diagnosis
SYMPTOMS OF SCHIZOPHRENIA
First-rank symptoms of acute schizophrenia
• A = Auditory hallucinations-second or third person/écho de la pensée
• B = Broadcasting, insertion/withdrawal of thoughts
• C = Controlled feelings, impulses or acts ('passivity' experiences/phenomena)
• D = Delusional perception (a particular experience is bizarrely interpreted)
Symptoms of chronic schizophrenia (negative symptoms)
• Flattened (blunted) affect
• Apathy and loss of drive (avolition)
• Social isolation
• Poverty of speech
• Poor self-care

7- Criteria of major depressive illness:
a. Late morning awaking.
b. Hallucination with flight of ideas.
c. High self-steam.
d. Overeating. change in appetite
e. Decrease of eye contact in conversation.

- Characteristic feature of major depressive illness is:
A. Late morning awakening.
B. Hallucination and flight of ideas.
C. High self-esteem.
D. Over-eating.
E. Decreased eye contact during conversation.

History
The DSM-IV-TR diagnostic criteria for a major depressive episode are as follows:
A. At least 5 of the following, during the same 2-week period, representing a change from previous functioning; must include either (a) or (b):
(a) Depressed mood
(b) Diminished interest or pleasure
(c) Significant weight loss or gain change in appetite
(d) Insomnia or hypersomnia
(e) Psychomotor agitation or retardation
(f) Fatigue or loss of energy
(g) Feelings of worthlessness
(h) Diminished ability to think or concentrate; indecisiveness
(i) Recurrent thoughts of death, suicidal ideation, suicide attempt, or specific plan for suicide
B. Symptoms do not meet criteria for a mixed episode (ie, meets criteria for both manic and depressive episode).
C. Symptoms cause clinically significant distress or impairment of functioning.
D. Symptoms are not due to the direct physiologic effects of a substance or a general medical condition.
E. Symptoms are not better accounted for by bereavement, ie, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

8- Severe postpartum depression mostly associated with:
-Decrease socioeconomic class.
-Emotional separation between the patient & his mother.
-Past Hx of depression.
-1st birth delivery.
-Poor wt gain during pregnancy.

During the postpartum period, up to 85% of women experience some type of mood disturbance. For most women, symptoms are transient and relatively mild (ie, postpartum blues); however, 10-15% of women experience a more disabling and persistent form of depression and 0.1-0.2% of women experience postpartum psychosis.1,2,3,4

Predicting who is at risk for postpartum psychiatric illness is difficult. Individuals at greatest risk often have
1. a prior history of postpartum depression or psychosis,
2. personal or family history of mood disorder, or
3. depression during the current pregnancy.
4. Other risk factors include inadequate social supports,
5. marital dissatisfaction or discord, and
6. recent negative life events such as a death in the family,
7. financial difficulties, or loss of employment.5,1

9- a 20 year old lady thinks that she’s fat although her height and weight are ok:
a) Bulimia
b) Aneroxia nervosa
c) Depression

10-A male presented with headache , tinnitus and nausea thinking that he has a brain tumor. He had just secured a job in a prestigious company and he thinks that he might not meet it’s standards. CNS exam, CT all within normal What is the Diagnosis:
a. Generalized Anxiety disoreder
b. Hypochondriasis
c. Conversion reaction
d. Panic attack

Conversion disorder: Usually characterized by self-limited symptoms that affect voluntary motor or sensory systems and suggest a neurologic disorder but are not consistent with anatomic structures. Age of onset is 10–40. Preceded by stress.

■ Hypochondriasis: A chronic preoccupation with or fear of having a serious medical disease that is not relieved by appropriate evaluation or reassurance. Usually begins in early adulthood.

11-Delusion
a)perception of sensation in absence of an external stimulus
b)mis interpretation of stimulus
c)false belief not in accordance of a persons culture
d)manifestation of...
e)unconscious inhibition of..

Delusional Disorder
A chronic disorder of delusions (fixed false beliefs) that form a coherent system characterized by a certain level of plausibility. An uncommon disorder, with a prevalence of 0.01–0.05%.

SYMPTOMS
■ Presents with highly specific delusions forming a coherent belief system that seems somewhat plausible.
■ Patients are otherwise normal and maintain a high level of functioning.

DIFFERENTIAL
■ Schizophrenia: Associated with more functional impairment, auditory hallucinations, and thought disorders.
■ Substance-induced delusions: Seen primarily with CNS stimulants such as cannabis and amphetamines.
■ Medical conditions: Include thyroid disorders, Huntington’s disease, Parkinson’s disease, Alzheimer’s disease, CVAs, metabolic causes (uremia, hepatic encephalopathy, hypercalcemia), alcohol withdrawal, and other causes of delirium.

TREATMENT
■ Patients are often resistant to treatment or medications.
■ The first goal is to create a strong physician-patient alliance. Avoid directly challenging the patient’s beliefs, but do not pretend to be in full acceptance of the delusions.
■ Low-dose antipsychotics are indicated (atypicals such as olanzapine or risperidone are preferred). Antidepressants, especially clomipramine, may be helpful.
■ The goal of medications is to help the patient avoid acting on the delusion.

12-A.. . year old lady presented to you and told you that she knows she has cancer in her stomach. She visited 6 doctors before you & had an ultrasound done... times & barium meal... times No one believes what she said & told you that you’re the last doctor she’s going to see before seeiking herbal medicine .whats the diagnosis?
a)generalized anxiety
b) panic attack
c) conversion reaction
d) hypochondriasis
e) anxiety

■ Somatization disorder: A chronic disorder characterized by multiple clinically significant symptoms that vary over time and are not explained by medical findings. Patients usually have an extensive treatment history with age of onset < 30. Has a higher prevalence in women.

■ Conversion disorder: Usually characterized by self-limited symptoms that affect voluntary motor or sensory systems and suggest a neurologic disorder but are not consistent with anatomic structures. Age of onset is 10–40. Preceded by stress.

■ Hypochondriasis: A chronic preoccupation with or fear of having a serious medical disease that is not relieved by appropriate evaluation or reassurance. Usually begins in early adulthood.

13- Facial nerve when it exits the tempromandibular joint and enter parotid gland it passes:
a) Deep to retromandibular vein
b) Deep to internal carotid artery
c) Superficial to retromandibular vein and ext. carotid artery (It is the most lateral structure within parotid gland)
d) Deep to ext. carotid artery
e) Between ext. carotid artery and retromandibular vessels

14- Sciatica:
a) Never associated with sensory loss
b) May be associated with calf muscle weakness
c) Do not cause pain with leg elevation
d) Causes increased lumbar lordosis



15- Definition of status epilepticus:
a) Generalized tonic clonic seizure more than 15 minutes
b) Seizure more than 30 minutes without regains consciousness inbetween
c) Absence seizure for more than 15 minutes

continuous unremitting seizure lasting longer than 30 minutes [1], or recurrent seizures without regaining consciousness between seizures for greater than 30 minutes (or shorter with medical intervention). It is always considered a medical emergency.

16- A 26-year-old patient came to your office with recurrent episodes of binge eating (approximately four times a week) after which she vomits to prevent weight gain. She says that “she has no control” over these episodes and becomes depressed because of her inability to control herself. These episodes have been occurring for the past 2 years. She also admits using self- induced vomiting, laxatives, and diuretics to lose weight. On examination, the patient’s blood pressure is 110/70 mmHg and her pulse is 72 and regular. She is not in apparent distress. Her physical examination is entirely normal. What is the MOST likely diagnosis in this patient?
A. Borderline personality disorder.
B. Anorexia nervosa.
C. Bulimia nervosa.
D. Masked depression.
E. Generalized anxiety disorder.

-anorexia nervosa, all true except:
a) lethargy
b) langue hair
c) amenorrhea
d) young female

Eating Disorders
Teenagers and younger children continue to develop eating disorders at an alarming rate. The spectrum of eating disorders includes anorexia nervosa, bulimia nervosa, eating disorders not otherwise specified, and binge-eating disorder. The relationship between biology and environment in the development of eating disorders is complex. Contributing factors appear to include growing influence by the media (television, magazines, movies, videos), in which thin young woman are often depicted as the norm. Anorexia and bulimia are distinguished as follows:

■ Anorexia nervosa: Diagnosis requires four diagnostic criteria as defined in the DSM-IV:
1. Refusal to maintain weight within a normal range for height and age (more than 15% below ideal body weight).
2. Fear of weight gain.
3. Severe body image disturbance (body image is the predominant measure of self-worth, along with denial of the seriousness of the illness).
4. In postmenarchal females, absence of the menstrual cycle, or amenorrhea (3 cycles).

■ Bulimia: Defined as episodic and uncontrolled ingestion of large quantities of food followed by recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, diuretic or cathartic use, strict dieting, or vigorous exercise.

SYMPTOMS
■ Anorexia: Amenorrhea, depression, fatigue, weakness, hair loss, bone pain, constipation, abdominal pain.
■ Bulimia: Normal or near-normal body weight, mouth sores, dental caries, heartburn, muscle cramps and fainting, hair loss, easy bruising, intolerance to cold, menstrual irregularity, abuse of diuretics and laxatives, misuse of diet pills (palpitations and anxiety), frequent vomiting (resulting in throat irritation and pharyngeal trauma).

EXAM
■ Assess vitals to evaluate for bradycardia, hypotension, or orthostatic hypotension.
■ Perform a detailed physical and dental exam, including height, weight, and BMI.
■ Anorexia: Signs include brittle hair and nails; dry, scaly skin; loss of subcutaneous fat; fine facial and body hair (lanugo hair); and breast and vaginal atrophy.
■ Bulimia: Signs include a callused finger (Russell’s sign; results when the finger is used to induce vomiting), dry skin, periodontal disease, and sialadenosis (swelling of the parotid glands).
■ Obtain a psychiatric history to assess for substance abuse and mood/anxiety/ personality disorders.
■ Ask about suicidal ideation.

DIAGNOSIS
■ Explore body image, exercise regimen, eating habits, sexual history, current and past medication use, diuretic and laxative use, binging and purging behavior, and substance use.
■ Obtain electrolytes, CBC, LFTs, and ECG to evaluate for arrhythmias and electrolyte disturbance.

TREATMENT
■ The goal is restoration of normal body weight and eating habits along with resolution of psychological difficulties.
■ Behavioral therapy: Intensive psychotherapy and family therapy.
■ Pharmacotherapy: TCAs, SSRIs, lithium carbonate.
■ Enteral or parenteral feeding in patients with severe malnutrition.
■ Hospitalization as indicated in cases of severe malnutrition or failed outpatient therapy.

COMPLICATIONS
Severe malnutrition, cardiac arrhythmias, suicide attempt, osteopenia, heart failure, dental disease.

17- A 23-year-old female came to your office with a chief complaint of having “a peculiarly jaw”. She tells you that she has seen a number of plastic surgeons about this problem, but “every one has refused to do anything”. On examination, there is no protrusion that you can see, and it appears to you that she has a completely normal jaw and face. Although the physical examination is completely normal, she appears depressed. What is the MOST likely diagnosis in this patient?
A. Dysthymia.
B. Major depressive disorder (MDD) with somatic concerns.
C. Somatization disorder.
D. Body dysmorphic disorder.
E. Hypochondriasis.
S
SOMATOFORM DISORDERS
A group of psychiatric disorders that share the common feature of overimportance of physical symptoms (with no clear medical etiology) in a patient’s life. This often  a feeling of being misunderstood by health providers. Somatization can inappropriate workups, hospitalizations, and procedures (up to $30 billion per year). Somatoform disorders are motivated by inner psychic gain; symptoms are unintentional or involuntary and are precipitated by stress.

SYMPTOMS Generally categorized as follows:
1. Somatization disorder: A chronic disorder characterized by multiple clinically significant symptoms that vary over time and are not explained by medical findings. Patients usually have an extensive treatment history with age of onset < 30. Has a higher prevalence in women.

2. Conversion disorder: Usually characterized by self-limited symptoms that affect voluntary motor or sensory systems and suggest a neurologic disorder but are not consistent with anatomic structures. Age of onset is 10–40. Preceded by stress.

3. Hypochondriasis: A chronic preoccupation with or fear of having a serious medical disease that is not relieved by appropriate evaluation or reassurance. Usually begins in early adulthood.

4. Body dysmorphic disorder: Chronic preoccupation with an imagined defect in physical appearance; usually begins in adolescence.

5. Chronic pain syndrome: An often chronic condition in which pain without an identified organic cause is the central feature.

DIFFERENTIAL
1. Malingering: Motivated by external gain; symptoms are intentional with poor cooperation in evaluation.
2. Factitious disorder: Motivated by assumption of the sick role, in which symptoms are fabricated or self-inflicted. Histories are often vague, and patients go from hospital to hospital seeking care.

DIAGNOSIS
A careful assessment and evaluation should be performed using standard medical workups, with an emphasis on avoiding exhaustive and unnecessary testing.

TREATMENT
1. Stress empathy along with the importance of establishing and maintaining a strong 1° care relationship.
2. Avoid stratifying the diagnosis as mental or physical; address in “stress” terms or emphasize the mind-body connection.
3. Co-morbid psychiatric disorders should be addressed and treated.
4. Consider a psychiatry referral to provide a framework for treatment (not to take the place of the 1° care provider).
5. Individual or group therapy may be of benefit, as may stress identification and reduction.
6. Prevent iatrogenesis by limiting workup and treatments to objective findings (not complaints).

18- A 29-year-old waiter consulted you regarding what he describes as “an intense fear” before he begins his nightly performance. He tells you that it is only a matter of time before he “makes a real major mistake”. What is the MOST likely diagnosis in this patient?
A. A specific phobia.
B. A social phobia.
C. A mixed phobia.
D. Panic disorder without agoraphobia.
E. Panic disorder with agoraphobia.

Phobic (anxiety) disorders
Phobias are common conditions in which intense fear is triggered by a stimulus, or group of stimuli, that are predictable
and normally cause no particular concern to others (e.g. agoraphobia, claustrophobia, social phobia). This leads to
avoidance of the stimulus (Box 22.13). The patient knows that the fear is irrational, but cannot control it.

The prevalence
of all phobias is 8%, with many patients having more than one. Many phobias of ‘medical’ stimuli exist (e.g. of doctors,
dentists, hospitals, vomit, blood and injections) which affect the patient’s ability to receive adequate healthcare.

Aetiology
Phobias may be caused by classical conditioning, in which a response (fear and avoidance) becomes conditioned to a
previously benign stimulus (a lift), often after an initiating emotional shock (being stuck in a lift). In children, phobias
can arise through imagined threats (e.g. stories of ghosts told in the playground). Women have twice the prevalence of
most phobias than men. Phobias aggregate in families, with increasing evidence of the importance of genetic factors
being published.

Agoraphobia
Translated as ‘fear of the market place’, this common phobia (4% prevalence) presents as a fear of being away from home, with avoidance of travelling, walking down a road and supermarkets being common cues. This can be a very disabling condition, since the patient can be too unwell to ever leave home, particularly by themselves. It is often associated with claustrophobia, a fear of enclosed spaces.

Social phobia
This is the fear and avoidance of social situations: crowds, strangers, parties and meetings. Public speaking would be
the sufferer’s worst nightmare. It is suffered by 2% of the population.

Simple phobias
The commonest is the phobia of spiders (arachnophobia), particularly in women. The prevalence of simple phobias is
7% in the general population. Other common phobias include insects, moths, bats, dogs, snakes, heights, thunderstorms
and the dark. Children are particularly phobic about the dark, ghosts and burglars, but the large majority grow out of these fears.

Treatment of anxiety disorders

Psychological treatments
For many people with brief episodes of an anxiety disorder,a discussion with a doctor concerning the nature of anxiety
is usually sufficient.
■ Relaxation techniques can be effective in mild/moderate anxiety. Relaxation can be achieved in many ways,
including complementary techniques such as meditationand yoga. Conventional relaxation training involves
slowing down the rate of breathing, muscle relaxation and mental imagery.

Anxiety management training involves two stages.
In the first stage, verbal cues and mental imagery are used to arouse anxiety to demonstrate the link with symptoms.
In the second stage, the patient is trained to reduce this anxiety by relaxation, distraction and reassuring

self-statements.
■ Biofeedback is useful for showing patients that they are not relaxed, even when they fail to recognize it, having
become so used to anxiety. Biofeedback involves feeding back to the patient a physiological measure that is abnormal in anxiety. These measures may include electrical resistance of the skin of the palm, heart rate, muscle electromyography or breathing pattern.
■ Behaviour therapies are treatments that are intended to change behaviour and thus symptoms. The most common and successful behaviour therapy (with 80% success in some phobias) is graded exposure, otherwise known as systematic desensitization.
First, the patient rates the phobia into a hierarchy or ‘ladder’ of worsening fears (e.g. in agoraphobia: walking to the
front door with a coat on; walking out into the garden; walking to the end of the road). Second, the patient
practises exposure to the least fearful stimulus until no fear is felt. The patient then moves ‘up the ladder’ of
fears until they are cured.
■ Cognitive behaviour therapy (CBT) (see p. 1204) is the treatment of choice for panic disorder and general
anxiety disorder because the therapist and patient need to identify the mental cues (thoughts and memories) that
may subtly provoke exacerbations of anxiety or panic attacks. CBT also allows identification and alteration of
the patient’s ‘schema’, or way of looking at themselves and their situation, that feeds anxiety.

Drug treatments
Initial ‘drug’ treatment should involve advice to gradually cease taking anxiogenic recreational drugs such as caffeine
and alcohol (which can cause a rebound anxiety and withdrawal). Prescribed drugs used in the treatment of anxiety
can be divided into two groups: those that act primarily on the central nervous system, and those that block peripheral
autonomic receptors.

■ Benzodiazepines are centrally acting anxiolytic drugs. They bind to specific receptors that stimulate release of the inhibitory transmitter γ-aminobutyric acid (GABA). Diazepam (5 mg twice daily, up to 10 mg three times daily in severe cases), alprazolam (250–500 μg three times daily) and chlordiazepoxide have relatively long half-lives (20–40 hours) and are used as anti-anxiety drugs in the short term. Side-effects include sedation and memory problems, and patients should be advised not to drive while on treatment. They can cause dependence and tolerance within 4–6 weeks, particularly in dependent personalities. The withdrawal syndrome (Table 22.14) can occur after just 3 weeks of continuous use and is particularly severe when high doses have been given for a longer time. Thus, if a benzodiazepine drug is prescribed for anxiety, it should be given in as low a dose as possible, preferably on an ‘as necessary’ basis, and for not more than 2–4 weeks. A withdrawal programme from chronic use includes changing the drug to the long-acting
diazepam, followed by a very gradual reduction in dosage.

■ Most SSRIs (e.g. fluoxetine, paroxetine, sertraline, escitalopram, citalopram) are useful symptomatic treatments for general anxiety and panic disorders, as well as some phobias (social phobia). Imipramine and clomipramine are alternative symptomatic treatments for panic disorder and GAD. Treatment response is often delayed several weeks; a trial of treatment should last 3 months.

■ Many of the symptoms of anxiety are due to an increased or sustained release of epinephrine (adrenaline) and norepinephrine (noradrenaline) from the adrenal medulla and sympathetic nerves. Thus, betablockers such as propranolol (20–40 mg two or three times daily) are effective in reducing peripheral symptoms such as palpitations, tremor and tachycardia, but do not help central symptoms such as anxiety.

19- Known risk factors for suicide include all the following except :
A. Repeated attempts at self injury.
B. Male sex.
C. Symptoms of depression with guilt.
D. Drug and alcohol dependence.
E. If the doctor asked the patient about suicide.


20-hypochondriasis, all true except:
a) more common in medical students in conversion disorders Symptoms and signs often reflect a patient’s ideas about illness.
b) less common in male
c) more common in lower social class
d) defined as morbid preoccupation of one’s body or health

Hypochondriasis
The conspicuous feature is a preoccupation with an assumed serious disease and its consequences. Patients commonly believe that they suffer from cancer or AIDS, or some other serious condition. Characteristically, such patients repeatedly request laboratory and other investigations to either prove they are ill or reassure themselves that they are well. Such reassurance rarely lasts long before another cycle of worry and requests begins. The symptom of hypochondriasis may be secondary to or associated with a variety of psychiatric disorders, particularly depressive and anxiety disorders. Occasionally the hypochondriasis is delusional, secondary to schizophrenia or a depressive psychosis . Hypochondriasis may coexist with physical disease but the diagnostic point is that the patient’s concern is disproportionate and unjustified.

21- all are speech disorders except:
a) Stuttering
b) Mumping
c) Cluttering
d) Palilia

Speech disorders or speech impediments are a type of communication disorders where 'normal' speech is disrupted. This can mean stuttering, lisps, etc. Someone who is totally unable to speak due to a speech disorder is considered mute.

Classifying speech into normal and disordered is more problematic than it first seems. By a strict classification, only 5% to 10% of the population has a completely normal manner of speaking (with respect to all parameters) and healthy voice; all others suffer from one disorder or another.
1. Stuttering is quite common.[citation needed]
2. Cluttering, a speech disorder that has similarities to stuttering.
3. Dysprosody is the rarest neurological speech disorder. It is characterized by alterations in intensity, in the timing of utterance segments, and in rhythm, cadency, and intonation of words. The changes to the duration, the fundamental frequency, and the intensity of tonic and atonic syllables of the sentences spoken, deprive an individual's particular speech of its characteristics. The cause of dysprosody is usually associated with neurological pathologies such as brain vascular accidents, cranioencephalic traumatisms, and brain tumors.[1]
4. Speech sound disorders involve difficulty in producing specific speech sounds (most often certain consonant, such as /s/ or /r/), and are subdivided into articulation disorders (also called phonetic disorders) and phonemic disorders. Articulation disorders are characterized by difficulty learning to physically produce sounds. Phonemic disorders are characterized by difficulty in learning the sound distinctions of a language, so that one sound may be used in place of many. However, it is not uncommon for a single person to have a mixed speech sound disorder with both phonemic and phonetic components.
5. Voice disorders are impairments, often physical, that involve the function of the larynx or vocal resonance.
6. Dysarthria is a weakness or paralysis of speech muscles caused by damage to the nerves and/or brain. Dysarthria is often caused by strokes, parkinsons disease, ALS, head or neck injuries, surgical accident, or cerebral palsy.
7. Apraxia of speech may result from stroke or be developmental, and involves inconsistent production speech sounds and rearranging of sounds in a word ("potato" may become "topato" and next "totapo"). Production of words becomes more difficult with effort, but common phrases may sometimes be spoken spontaneously without effort. It is now considered unlikely the childhood apraxia of speech and acquired apraxia of speech are the same thing, though they share many characteristics.

Types Of Speech Disorders


22-family behavior toward schizophrenic pt affect prognosis adversely:
a) double binding
b) over emotion behavior
c) schismatic parents
d) projective identification
A double bind is a dilemma in communication in which an individual (or group) receives two or more conflicting messages, with one message negating the other. This creates a situation in which a successful response to one message results in a failed response to the other, so that the person will be automatically wrong regardless of response. The nature of a double bind is that the person cannot confront the inherent dilemma, and therefore can neither comment on the conflict, nor resolve it, nor opt out of the situation.
Because Double Bind Theory was originally presented in the context of schizophrenia it has sometimes mistakenly been assumed that Bateson and his colleagues were proposing that double binds could cause an organic brain disorder if imposed on young children or people with unstable or "weak" personalities. But a careful reading of the papers in Section III of Steps to an Ecology of Mind (Form and Pathology in Relationship) makes clear that such cases would involve a programming dysfunction, i.e. a learned pattern of dysfunctional thinking. And of course creating a situation in which the victim couldn't make a comment or "metacommunicative statement" about their dilemma would (in theory) escalate their mental anxiety and potentially cause a crisis.
Today, DBT is correctly understood as an example of Bateson's approach to the complexities of communication.
23-known risk factor of suicide include all of the following except:
a) depression
b) previous self attempt
c) females less than males
d) drug and alcohol dependence
e) if doctor ask the pt any suicidal attempt


24-all of the following precipitate seizure except:
a) hypourecemia
b) hypokalemia
c) hypophosphatemia
d) hypocalcemia
e) hypoglycemia

Hypouricemia is not a medical condition itself (i.e., it is benign), but it is a useful medical sign. Usually hypouricemia is due to drugs and toxic agents, sometimes it is due to diet or genetics, and rarely it is due to an underlying medical condition. When one of these causal medical conditions is present, hypouricemia is a common sign.

25- A 25 yr old pt presented with headache, avoidance of light & resist flexion of neck, next step is:
a) EEG
b) C-spine X-ray
c) Phonation
d) None of the above

CT head or lubmar pucture as it is suspected case of meningitis


26- Peripheral neuropathy can occur in all EXCEPT:
a) Lead poisoning.
b) DM.
c) Gentamycin. Ototoxicity & Nephrotoxicity
d) INH (anti-TB).

Peripheral neuropathy and CNS effects are associated with the use of isoniazid




27-breath holding attacks:
a) mostly in children between 5-10 years
b) usually prevented by diazepam
c) may presdipose to generalized convulsion
d) increase the risk of epilepsy
e) characteristically come with no preceding emotional upset

40-Breath holds attacks:
A-Mostly in children between 5-10 years.
B-Usually prevented by diazepam.
C-May predisposes a generallzed convulsion.
D-lncreases the risk of epilepsy later on.
E-Characteristically comes with no preceding emotional upset.

A breath-holding spell is an episode in which the child stops breathing and loses consciousness for a short period immediately after a frightening or emotionally upsetting event or a painful experience.
• Breath-holding spells usually are triggered by physically painful or emotionally upsetting events.
• Typical symptoms include paleness, stoppage of breathing, loss of consciousness, and seizures.
• Tantrums may be prevented by distracting the child and avoiding situations that trigger the spells.

Breath-holding spells occur in 5% of otherwise healthy children. They usually begin in the first year of life and peak at age 2. They disappear by age 4 in 50% of children and by age 8 in about 83% of children. Breath-holding spells can take one of two forms.

The cyanotic form of breath-holding, which is most common, is initiated subconsciously by young children often as a component of a temper tantrum or in response to a scolding or other upsetting event. Episodes peak at about 2 years and are rare after 5 years. Typically, the child cries out (without necessarily being aware they are doing so), breathes out, and then stops breathing. Shortly afterward, the skin begins to turn blue, and the child becomes unconscious. A brief seizure may occur. After a few seconds, breathing resumes and normal skin color and consciousness return. It may be possible to interrupt the episode by placing a cold rag on the child's face when the spell begins. Despite the frightening nature of the episode, the parents must try to avoid reinforcing the initiating behavior. Parents should not avoid providing appropriate structure for children out of fear of causing spells. Distracting children and avoiding situations that lead to tantrums are the best ways of preventing and treating these spells. Cyanotic breath-holding spells respond to treatment with iron supplements, even when the child does not have iron-deficiency anemia, and to treatment for obstructive sleep apnea.

The pallid form typically follows a painful experience, such as falling and banging the head or being suddenly startled. The brain sends out a signal (via the vagus nerve) that severely slows the heart rate, causing loss of consciousness. Thus, in this form, the loss of consciousness and stoppage of breathing (which are both temporary) result from a nerve response to being startled that leads to slowing of the heart.
The child stops breathing, rapidly loses consciousness, and becomes pale and limp. A seizure and incontinence may occur. The heart typically beats very slowly during a spell. After the spell, the heart speeds up again, breathing restarts, and consciousness returns without any treatment. Because this form is rare, further diagnostic evaluation and treatment may be needed if the spells occur often.


28- Regarding antidepressant side effects, all of the following are true except:
a- Anticholinergic side effect tend to improve with time
b- Sedation can be tolerated by prolonged use
c- Small doses should be started in elderly
d- Fluoxetine is safe drug to use in elderly

29- One of the following is secondary presenting complaint in patient with
panic attack disorder:
a- Dizziness
b- Epigastric pain
c- Tachycardia
d- Chest pain
e- Phobia

Panic Disorder
Characterized by recurrent unexpected panic attacks, with fear of additional ones occurring. Prevalence is up to 3.5% with a 2:1 female-to-male predominance. Onset is from late adolescence through the third decade of life.

SYMPTOMS
■ Characterized by episodes of abrupt anxiety that peak after 10 minutes and are associated with several features of autonomic arousal.
■ Must include at least four of the following features of autonomic arousal:
1. palpitations,
2. tachycardia,
3. chest discomfort,
4. shortness of breath,
5. nausea,
6. a choking sensation,
7. trembling,
8. dizziness,
9. paresthesias,
10. sweating,
11. chills,
12. hot flashes,
13. dissociation, and
14. fear of losing control or dying.

DIFFERENTIAL
■ Psychiatric:
■ PTSD: Must have a precipitating traumatic event.
■ Generalized anxiety disorder: Characterized by continuous anxiety
but no discrete attacks.
■ Medical:
■ Endocrine: Hypoglycemia, hyperthyroidism, pheochromocytoma.
■ Cardiac: Arrhythmia, MI.
■ Pulmonary: COPD, asthma, pulmonary embolus.
■ Pharmacologic: Side effects of medications (e.g., SSRIs, albuterol); acute
intoxication.

DIAGNOSIS
Rule out medical causes first (e.g., ECG, CXR, metabolic panel).

TREATMENT
■ Behavioral: CBT.
■ Pharmacologic: SSRIs (fluoxetine, sertraline, paroxetine), benzodiazepines.

39- Indication for CT brain for dementia, all true except:
- Younger than 60 years old
- After head trauma
- Progressive dementia over 3 years

الفارس الأحمر
27-03-2011, 03:55 PM
و هذه بعض الأسئله المتعلقة بالطب الباطني

1- An 80 year old gentleman presented to ER with Hx of decreased urine stream, hesitancy, urgency & frequency. What is the cause?
a. Stricture
b. Benign prostate hypertrophy
c. Narrowing of the external meatus
ci. Urethral stone

2-A 12 year old female brought by her mother to ER after ingestion of unknown number of paracetamol tablets. Clinically she is stable. Blood paracetamol level suggest toxicity. The most appropriate treatment is:
a. N-acetylcestine


3-A 62 year old male known to have BA (Bronchial asthma). Hx for 1 month on bronchodilator + beclomethasone had given thiophylline. Side effects of thiophylline is:
a. GI upset
b. Diarrhea
C. Facial flushing
d. Cardiac arrhythmia

• Xanthines can be used for the relief of reversible airways obstruction in patients with COPD. The reversible component of this disease is often small, so they will be limited in their effect. When the patient is well, perform lung function tests and determine the degree of reversibility.
• Xanthines can cause cardiac arrhythmias; take particular care in patients with existing cardiac disease.
• Xanthines lower the seizure threshold; avoid them in patients with epilepsy.
• Xanthines are metabolized by the liver; reduce the dose in hepatic insufficiency.
• There is no specific dosage reduction in renal insufficiency but take care if it is severe. These patients are at greater risk of seizures.
• Xanthines have not been shown to be safe in pregnancy; avoid giving them unless essential. Use in the third trimester can cause neonatal irritability and apnoea.
• Theophylline is subject to large number of metabolic drug interactions; take care to check for these.

4- The effectiveness of ventilation during CPR is measured by:
a. Chest rise
b. Pulse oximeter
c. Pulse acceleration

5-A 27 years old male with tonic clonic seizures in the ER, 20 mg Diazepam was given and the convulsion did not stop . what will be given?
a. Diazepam till dose of 40mg
b. Phenytoin
c. Phenobarbitone

Treatment of status epilepticus
• Status epilepticus is defined as a seizure that lasts for more than 30 minutes, or when repeated seizures occur over 30 minutes without full recovery in between.
• Whenever a seizure continues for longer than a few seconds you should aim to stop it as soon as possible.
• Give intravenous glucose 1–2 mL/kg if the seizure is due to hypoglycaemia.
o If the patient is withdrawing from alcohol, give B vitamins first (e.g. Pabrinex&Acirc;®, 1 pair of ampoules).
• A benzodiazepine is the first-line drug treatment, but do not forget other basic measures such as securing the airway (place the patient in the recovery position; do not put anything in their mouth) and giving oxygen.
• Give either:
o Lorazepam 0.07 mg/kg (usually 4 mg in adults) by intravenous injection over 2 minutes. Repeat the dose once after 10–20 minutes, if required, or
o Diazepam 10-20 mg by injection over 2 - 4 minutes. Maximum dose 40 mg.
o If intravenous access is not possible, diazepam is available as a solution for rectal administration.
o Note that the emulsion formulation (Diazemuls&Acirc;®) is less irritant than other formulations for intravenous administration.
• Ensure that adequate resuscitation facilities are available; in particular, be prepared to deal with respiratory compromise as a result of benzodiazepine use.
• If the seizure continues beyond 10 minutes, give intravenous phenytoin.
o If the patient has not been taking phenytoin, the loading dose is 18 mg/kg (usual adult dose 1.0–1.5 g) by intravenous infusion (50 mg/min). Flush the line after infusion.
o If the patient has been taking phenytoin consider either:
• A lower loading dose (10 mg/kg; 500 mg –1.0 g total) or
• Another drug, such as sodium valproate.
• If this is unsuccessful, transfer to ITU and seek expert advice.
6-patient presented in ER with Low BP, distended Jugular veins, muffled heart sounds, brusies over sterna area Dx is:
a) Cardiac tamponade

7-whats the ratio of ventilation to chest compression in a one person CPR?
a) 2 ventilation & 30 compression at rate of 80-1 00/min
b)l ventilation & 15 compression at rate of 80-1 00/mm
c)2 ventilation & 7 compression at rate of 80-1 00/mm
d)1 ventilation & 7 compression at rate of 80-1 00/mm
e)3 ventilation & 15 compression at rate of 80-1 00/mm

8- A 55-year-old man presented to emergency room with central abdominal pain radiating to his back. Examination showed localized central abdominal tenderness. Chest X-ray and back .Xray were normal. Your MOST likely diagnosis is:
A. Perforated duodenal ulcer.
B. Acute cholecystitis.
C. Acute appendicitis.
D. Acute pancreatitis.
E. Diverticulitis.



9- A 43-year-old man is brought to the emergency department after a motor vehicle accident involving a head-on collision. He mentioned that he is having headache and dizziness. During his overnight admission for observation, he developed polyuria and his serum sodium level rises to 151 meq/L. All of the following tests are indicated EXCEPT:
A. Overnight dehydration test.
B. Measurement of response to desmopressin (dOAVP).
C. MRI scan of the head.
D. Measurement of morning cortisol level.
E. Measurement of plasma and urine osmolality.

DIABETES INSIPIDUS
Etiology Diabetes insipidus (DI) results from abnormalities of AVP production from the hypothalamus or AVP action in the kidney. AVP deficiency is characterized by production of large amounts of dilute urine.
In central DI, insufficient AVP is released in response to physiologic stimuli.

Causes include
Acquired (head trauma; neoplastic or inflammatory conditions affecting the posterior pituitary),
congenital, and genetic disorders,
but almost half of cases are idiopathic.
In gestational DI, increased metabolism of plasma AVP by an aminopeptidase produced by the placenta leads to a deficiency of AVP during pregnancy.
Primary polydipsia results in secondary insufficiencies of AVP due to inhibition of AVP secretion by excessive fluid intake.
Nephrogenic DI can be genetic or acquired from drug exposure (lithium, demeclocycline, amphotericin B), metabolic conditions (hypercalcemia), or renal damage.

Clinical Features Symptoms include polyuria, excessive thirst, and polydipsia, with a 24-h urine output of >50 (mL/kg)/day and a urine osmolality that is less than that of serum (<300 mosmol/kg; specific gravity <1.010). Clinical or laboratory signs of dehydration, including hypernatremia, occur only if the pt simultaneously has a thirst defect or does not have access to water. Other etiologies of hypernatremia are described in Chap. 2.

Diagnosis DI must be differentiated from other etiologies of polyuria (Chap.57).
Unless an inappropriately dilute urine is present in the setting of serum hyperosmolality,
a fluid deprivation test is used to make the diagnosis of DI. This test should be started in the morning, and body weight, plasma osmolality, sodium concentration, and urine volume and osmolality should be measured hourly. The test should be stopped when body weight decreases by 5% or plasma osmolality/sodium exceed the upper limit of normal.

TTT
If the urine osmolality is <300 mosmol/kg with serum hyperosmolality, desmopressin (0.03 μg/kg SC) should be administered with repeat measurement of urine osmolality 1–2 h later. An increase of >50% indicates severe pituitary DI, whereas a smaller or absent response suggests nephrogenic DI. Measurement of AVP levels before and after fluid deprivation may be required to diagnose partial DI. Occasionally, hypertonic saline infusion may be required if fluid deprivation does not achieve the requisite level of hypertonic dehydration.

Pituitary DI can be treated with desmopressin (DDAVP) subcutaneously (1–2 μg once or twice per day), via nasal spray (10–20 μg two or three times a day), or orally (100–400 μg two or three times a day), with recommendations to drink to thirst. Symptoms of nephrogenic DI may be ameliorated by treatment with a thiazide diuretic and/or amiloride in conjunction with a low-sodium diet, or with prostaglandin synthesis inhibitors (e.g., indomethacin).

10- 15-year-old Saudi boy presented to ER with fever, skin rash and shock. He was resuscitated and admitted to isolation ward with strong suspicion of meningococcal meningitis. LP confirmed the diagnosis. One of the following statements is TRUE
A. Patient should be isolated in —ve pressure room
B. Prophylaxis treatment should be given to all staff and patient were in ER when the patient was there .
C. Ciprofloxacin 500 mg once is an acceptable chemotherapy
D. Meiningococci are transmitted by contact only
E. Meningococci are resistant to penicillin



11- Patient presented to ER with dyspnea, right-sided chest pain, engorged neck veins and weak heart sounds. Auscultation: no air entry over the right lung. The treatment is:
A. I .V fluids, pain killer and oxygen
B. Aspiration of pericardium
C. Respiratory stimulant
D. Intubation
E. Immediate needle aspiration and chest tube

12-gastric lavage:
a) ineffective after 12 hrs Paracemamol intake
b) indicated with paraffin oil
c) used more in semiconscious pt than induced vomiting
d) Pt should be in RT side

13- management of anaphylactic shock all of the following, EXCEPT:
a) I.V.F
b) 100% 02
c) corticosteroid may be if no other drug
d)…
E)…

Treatment
Prehospital Care
• Prehospital patients with symptoms of severe anaphylaxis should first receive standard interventions. Interventions include high-flow oxygen, cardiac monitoring, and IV access. These measures are appropriate for an asymptomatic patient who has a history of serious reaction and has been re-exposed to the inciting agent. Additional treatment depends upon the condition of the patient and the severity of the reaction. Measures beyond basic life support (BLS) are not necessary for patients with purely local reactions.
• Immediately assess airway patency due to the potential for compromise secondary to edema or bronchospasm. Active airway intervention may be difficult due to laryngeal or oropharyngeal edema. In this circumstance, it may be preferable to defer intubation attempts, and instead ventilate with a bag/valve/mask apparatus while awaiting medications to take effect. In extreme circumstances, cricothyrotomy or catheter jet ventilation may be lifesaving. Inhaled beta-agonists are used to counteract bronchospasm and should be administered to patients who are wheezing.
• The IV line should be of large caliber due to the potential requirement for large-volume IV fluid resuscitation. Isotonic crystalloid solutions (ie, normal saline, Ringer lactate) are preferred. A keep vein open (KVO) rate is appropriate for patients with stable vital signs and only cutaneous manifestations. If hypotension or tachycardia is present, administer a fluid bolus of 20 mg/kg for children and 1 L for adults. Further fluid therapy depends on patient response. Large volumes may be required in the profoundly hypotensive patient.
• Administer epinephrine to patients with systemic manifestations of anaphylaxis. With mild cutaneous reactions, an antihistamine alone may be sufficient, thus the potential adverse effects of epinephrine can be avoided. Patients on beta-blocker medications may not respond to epinephrine. In these cases, glucagon may be useful. The Medication section describes dosage, routes of administration, and contraindications for medications discussed in this section. Antihistamines (eg, H1 blockers), such as diphenhydramine (Benadryl) are important and should be administered for all patients with anaphylaxis or generalized urticaria.
• Corticosteroids are used in anaphylaxis primarily to decrease the incidence and severity of delayed or biphasic reactions. Corticosteroids may not influence the acute course of the disease; therefore, they have a lower priority than epinephrine and antihistamines.
Emergency Department Care
• ED care begins with standard monitoring and treatment, including oxygen, cardiac monitoring, and a large-bore IV with isotonic crystalloid solution. Further intervention depends on severity of reaction and affected organ system(s).
• Rapidly assess airway patency in patients with systemic signs or symptoms. If required, intubation may be difficult to achieve because of upper airway or facial edema. Standard rapid sequence induction (RSI) techniques can be used but may cause loss of the airway in a patient whose airway anatomy is altered by edema. Epinephrine may rapidly reverse airway compromise, and bag/valve/mask ventilation may be effective in the interim when intubation is not possible. Surgical airway intervention using standard cricothyrotomy is an option when orotracheal intubation or bag/valve/mask ventilation is not effective.
o Wheezing or stridor indicates bronchospasm or mucosal edema. Treatment with epinephrine and inhaled beta-agonists is effective for these indications.
o Recommendations to treat refractory bronchospasm with corticosteroids have been made because of their effectiveness in reactive airway disease. As in asthma therapy, onset of action is delayed for several hours. Aminophylline also has been recommended for bronchospasm in anaphylaxis and may be more rapidly effective than corticosteroids.
• Hypotension in anaphylaxis usually is due to vasodilatation and capillary fluid leakage. Epinephrine is the primary pharmacologic treatment for these findings. H1-blocking antihistamines also may have a role in reversing hypotension. Some authors also recommend H2-blocking agents. Large volume fluid resuscitation with isotonic crystalloid often is needed to support the circulation in patients with cardiovascular manifestations of anaphylaxis.
o Refractory hypotension first should be treated with large volumes of crystalloid and repeated doses of epinephrine or a continuous epinephrine infusion. If this is not effective, other pressors with alpha-adrenergic activity, such as levarterenol (Levophed) or dopamine, may be considered. Cases of effective use of military antishock trousers (MAST) for refractory hypotension have been reported.
o Mediators of anaphylaxis are not considered to have direct myocardial toxicity. In patients with preexisting heart disease, ischemic myocardial dysfunction may occur due to hypotension and hypoxia. Epinephrine still may be necessary in patients with severe anaphylaxis, but remember the potential for exacerbating ischemia. If pulmonary congestion or evidence of cardiac ischemia is present, fluid resuscitation should be approached more cautiously.
o Patients taking beta-blockers may be resistant to the effects of epinephrine. Larger than usual doses may be needed. Glucagon may be effective in this circumstance, because it increases intracellular cyclic adenosine monophosphate (cAMP) levels by a mechanism that does not depend upon beta-receptors.
• Cutaneous effects of anaphylaxis are uncomfortable but not life threatening. Patients often respond promptly to epinephrine and H1 antihistamines. Some authors state that corticosteroids help prevent recurrence of symptoms (both cutaneous and systemic) that may occur 6-8 hours after successful treatment (so-called biphasic reaction). H2 blockers may have an added effect.
• GI symptoms in anaphylaxis may respond to H1 antihistamines and epinephrine.
• Disposition: Disposition of patients with anaphylaxis depends upon the severity of the initial reaction and the response to treatment. Patients with non–life-threatening symptoms may be observed for 4-6 hours after successful treatment and then discharged. Patients who have refractory or very severe anaphylaxis (with cardiovascular and/or severe respiratory symptoms) should be admitted or treated and observed for a longer period in the ED or an observation area.
• Bradykinin-mediated angioedema (including angioedema due to ACEI): Antihistamines and corticosteroids are probably not effective. Epinephrine may be tried in severe cases, but airway intervention may be needed.
• After discharge care
o Patients with cardiovascular and/or respiratory symptoms who have an environmental trigger likely to be encountered after discharge should carry self-injectable epinephrine after discharge. Referral to an allergist should be considered.
o In cases on angioedema due to ACEI, the offending drug should be stopped and drugs of this class are contraindicated in the future. Patients should either be prescribed an antihypertensive of a different class or be referred for primary care follow-up.
• Diagnosis and management guidelines are available from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and Joint Council of Allergy, Asthma, and Immunology.8

14- All of the following are signs of allergy to local anesthesia, EXCEPT:
a) laryngeal spasm
b) urticaria
c) lowBP
d) bronchospasm
e)…………..

15- gastric aspiration
a) cuffed NGT may prevent aspiration

16- All of the following are true about paracetamol poisoning, except:
a) Metabolic acidosis.
b) Hypoglycemia.
c) Bronchospasm.
d) Liver Failure.
e) Acute renal tubular necrosis

Overdose
Clinical effects of overdose
The following effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)¾not necessarily inclusive:

Acute
Gastrointestinal upset (diarrhea, loss of appetite, nausea or vomiting, stomach cramps or pain); increased sweating
Note: Although gastrointestinal upset and increased sweating often do not occur, they sometimes occur within 6 to 14 hours after ingestion of an overdose and persist for about 24 hours.

Chronic
Hepatotoxicity (pain, tenderness, and/or swelling in upper abdominal area)¾may occur 2 to 4 days after the overdose is ingested
Note: The first indications of overdosage may be signs and symptoms of possible liver damage and abnormalities in liver function tests, which may not occur until 2 to 4 days after ingestion of the overdose. Maximal changes in liver function tests usually occur 3 to 5 days after ingestion of the overdose.
Overt hepatic disease or failure may occur 4 to 6 days after ingestion of the overdose.
Hepatic encephalopathy (with mental changes, confusion, agitation, or stupor), convulsions, respiratory depression, coma, cerebral edema, coagulation defects, gastrointestinal bleeding, disseminated intravascular coagulation, hypoglycemia, metabolic acidosis, cardiac arrhythmias, and cardiovascular collapse may occur.

Renal tubular necrosis leading to renal failure (signs may include bloody or cloudy urine and sudden decrease in amount of urine) has also been reported in acetaminophen overdose, usually, but not exclusively, in conjunction with acetaminophen-induced hepatotoxicity.

Treatment of overdose
To decrease absorption¾May include emptying the stomach via induction of emesis or gastric lavage.
Removing activated charcoal (if used) by gastric lavage may be advisable. Although activated charcoal is recommended in cases of mixed drug overdose, it may interfere with absorption of orally administered acetylcysteine (antidote used to protect against acetaminophen-induced hepatotoxicity) and decrease its efficacy.
To enhance elimination¾Instituting hemodialysis or hemoperfusion to remove acetaminophen from the circulation may be beneficial if acetylcysteine administration cannot be instituted within 24 hours following ingestion of a massive acetaminophen overdose. However, the efficacy of such treatment in preventing acetaminophen-induced hepatotoxicity is not known.

Specific treatment¾Use of acetylcysteine. It is recommended that acetylcysteine administration be instituted as soon as possible after ingestion of an overdose has been reported, without waiting for the results of plasma acetaminophen determinations or other laboratory tests. Acetylcysteine is most effective if treatment is started within 10 to 12 hours after ingestion of the overdose; however it may be of some benefit if treatment is started within 24 hours. See the package insert or Acetylcysteine (Systemic) monograph for specific dosing guidelines for use of this product.
Monitoring¾May include determining plasma acetaminophen concentration at least 4 hours following ingestion of the overdose. Determinations performed prior to this time are not reliable for assessing potential hepatotoxicity. Initial plasma concentrations above 150 mcg per mL (993 micromoles/L) at 4 hours, 100 mcg per mL (662 micromoles/L) at 6 hours, 70 mcg per mL (463.4 micromoles/L) at 8 hours, 50 mcg per mL (331 micromoles/L) at 10 hours, 20 mcg per mL (132.4 micromoles/L) at 15 hours, 8 mcg per mL (53 micromoles/L) at 20 hours, or 3.5 mcg per mL (23.2 micromoles/L) at 24 hours postingestion indicate possible hepatotoxicity and the need for completing the full course of acetylcysteine treatment. If the initial determination indicates a plasma concentration below those listed at the times indicated, cessation of acetylcysteine therapy can be considered. However, some clinicians advise that more than one determination should be performed to ascertain peak absorption and half-life of acetaminophen prior to considering discontinuation of acetylcysteine.
Performing liver function tests (serum aspartate aminotransferase [AST; SGOT], serum alanine aminotransferase [ALT; SGPT], prothrombin time, and bilirubin) at 24-hour intervals for at least 96 hours postingestion if the plasma acetaminophen concentration indicates potential hepatotoxicity. If no abnormalities are detected within 96 hours, further determinations are not needed.
Monitoring renal and cardiac function and administering appropriate therapy as required.
Supportive care¾May include maintaining fluid and electrolyte balance, correcting hypoglycemia, and administering vitamin K 1 (if prothrombin time ratio exceeds 1.5) and fresh frozen plasma or clotting factor concentrate (if prothrombin time ratio exceeds 3.0).Patients in whom intentional overdose is known or suspected should be referred for psychiatric consultation.


17 -In a patient with anaphylactic shock, all are correct treatments EXCEPT:
a) Epinephrine.
b) Hydralazine.
c) Adrenaline.
d) Aminophilline.

Hypertension (treatment)Hydralazine is indicated orally for the treatment of hypertension

18- Gastric lavage is contraindicated:
a. Aspirin.
b. Cleaning solution.
c. Vitamin E.
d. bean.

S H O 0 O Q
27-03-2011, 07:37 PM
يعطيك الف عافيه

على نماذج الاسئله


الف شكر لك


:و:

غفوة ألم
27-03-2011, 09:43 PM
يعطيك العافية :f:

د / أحمد الجيزاني
28-03-2011, 02:49 AM
من هذا الموضوع المقترح من الفارس الأحمر أقترح على كل من لدية نماذج أسئلة في المجال الطبي (أطباء ,صيادلة ,تمريض ......الخ ) طرحها هنا للأهمية لأن أختبار البرومترك صعب جداً

http://www.jazan4u.com/vb/uploaded/16526_11288294539.gif

ღ.معالي الوزيرهـ.ღ
28-03-2011, 12:53 PM
الله يوفق الكل -=-

الفارس الأحمر
28-03-2011, 01:14 PM
بسم الله الرحمن الرحيم
هذه بعض أسئلة الجلدية Dermatology



1- Which one of the following component causes contact dermatitis in children?
a- Citric acid
b- Cinnamon
c-poison ivy
d- ... (name of very strange tree which is very unrecognizable)
Causes
The causes of contact dermatitis are innumerable and increase daily. The items listed below are some of the more common causes and may help expand the list of possible etiologies, which might need to be researched. Items identified in the history can be further researched either in the medical literature or in one of the extensive textbooks on contact dermatitis.
• Irritant contact dermatitis
o Irritant contact dermatitis is a direct local cytotoxic effect of an irritant on the cells of the epidermis, with a subsequent inflammatory response in the dermis.
o Examples of irritants include acids; alkalis (eg, sodium, potassium, ammonium, calcium hydroxide compounds), which are frequently associated with hand eczemas following exposure to soaps, detergents, bleaches, ammonia preparations, lye, drain pipe cleaners, toilet bowl cleaners, or oven cleansers; bromine and chlorine, which are commonly used in hot tubs and swimming pools; and hydrocarbons such as crude petroleum, lubricating oils, and cutting oils. Long-term exposure may cause pruritus, folliculitis, calcifications, or acneiform eruptions. Creosote, asphalt, and other tar products may result in melanoderma. Creosote is a contact irritant, sensitizer, and photosensitizer.
o Irritant dermatitis from plants usually occurs after exposure to a particular part of the plant, and the degree of toxicity may vary with the season, type of exposure, stage of maturity of the plant, and locality.
o The spurge plant family includes the most plants capable of producing irritant contact dermatitis and includes the poinsettia, crown-of-thorns, candelabra cactus, and pencil tree. These plants contain a highly irritating white milky sap that may cause erythema, desquamation, and bulla formation. Calcium oxalate is an irritant found in a number of plants, including Dieffenbachia, daffodils, hyacinths, and pineapples.
• Allergic contact dermatitis
o This type of dermatitis is an acquired type IV hypersensitivity response generated after exposure to an allergen.
o Causes include plants of the family Anacardiaceae (eg, poison ivy, poison oak, poison sumac, mango), nickel sulfate (eg, earrings, buckles, zippers, buttons, metal clips, various metal alloys), potassium dichromate (eg, cements, household cleansers, leather, some matches, paints, antirust products), formaldehyde (common preservative in creams), ethylenediamine (eg, dyes, medications), mercaptobenzothiazole (eg, rubber), thiram (eg, fungicides), and paraphenylenediamine (PPD) (eg, hair dyes, photographic chemicals, "black" Henna tattoos).
 Henna extract has long been used as a stain or dye that produces a temporary tattoo when applied to the skin.
 Sensitivity to ordinary henna tattoos that are brown in color is rare. However, PPD may be added to henna extract to darken the tattoo and reduce fixation time.
 PPD in the black henna tattoo mixture is at a significantly higher concentration than is found in commercial hair dye preparations and can induce severe sensitivity to PPD and severe allergic reactions.
o In almost all studies, nickel is the most common allergen and is even more common in females. Depending on the study population, the most common allergens following nickel are fragrance mix, rubber accelerators, thimerosal, paraphenylenediamine, cobalt, lanolin, and neomycin.
o Allergic reaction to topical steroids used to treat eczema is not rare. As with any topical therapy, it may initially be soothing, but if the eczema continues to worsen, the patient may have developed a sensitivity to the active ingredient or a preservative. In patients suspected of having corticosteroid allergy, patch testing confirms allergy in 10%.
o As mentioned above, harsh soaps most commonly cause an irritant reaction, but allergic reactions to perfumes, dyes, lanolin, deodorants, or antiperspirants can occur.
• Allergic plant dermatitis
o The family Anacardiaceae, which includes poison ivy, probably accounts for more cases of allergic contact dermatitis than all other plant families combined. The antigen in these plants is in an oleoresin known as urushiol (you-ROO-shee-ol).
o In poison ivy and poison oak, the antigen in urushiol is pentadecylcatechol. Slight molecular variations in catechols may result in large variations in the degree of antigenicity. Poison ivy and poison oak sap contains a near maximal percentage of the most allergenic catechols.
o Uninjured plants do not induce dermatitis. The plant must be injured or bruised before the oleoresin containing the urushiol can contact the skin. Smoke from burning plants may cause a severe dermatitis. All parts of the plant are antigenic, and under controlled conditions, more than 70% of the population in the United States reacts to the urushiol in poison ivy and oak.
o The plant family Anacardiaceae contains other species that also contain urushiol and cross-react with poison ivy. Mango contact dermatitis develops most commonly in the perioral region and on the hands and results from exposure to the peel, not the juice. Poison sumac is highly antigenic, resulting in severe contact dermatitis in sensitized patients.
• Photo contact dermatitis
o Symptoms occur as a result of direct exposure of skin to a photosensitizing agent followed by direct sun exposure.
o Many plants are known to cause a phototoxic response. These include the citrus family (eg, limes), the mulberry family (eg, figs), and the Umbelliferae family (eg, parsnip, celery). Lime juice exposure is most common when limes are squeezed into beverages. Excess juice dribbles down the arm or neck. Sun exposure of this lime juice produces linear streaks of dermatitis or hyperpigmentation. Perfumes also are common sources of photo contact dermatitis.
• Contact urticaria
o Agents that can produce allergic contact urticaria include silk, wool, rubber, animal hair, dander, saliva, serum, seminal fluid, cockroaches, moths, insect stings, milk, eggs, fish, meat, fruits, potatoes, beer, penicillin, neomycin, nickel, formaldehyde, and rubber.
o Contact urticaria from rubber occurs almost exclusively from the use of rubber gloves. Nonimmunologic contact urticaria results in local edema and erythema. It is more common than the immunologic mechanism.
o Agents that produce nonimmunologic contact urticaria include jellyfish; Portuguese man-of-war; balsam of Peru; caterpillar hair; moths; insect stings; benzoic, sorbic, cinnamic, or nicotinic acid; and nettles (plants). In one report, 18 out of 20 children aged 1-4 years developed perioral contact urticaria after smearing food around their mouths.7 This was traced to sorbic acid and benzoic acid in a salad dressing.
o Contact urticaria must be distinguished from environmentally associated urticaria, including cold urticaria, cholinergic urticaria, dermatographism, pressure urticaria, aquagenic pruritus, aquagenic urticaria, solar urticaria, heat urticaria, papular urticaria, and exercise-induced urticaria.
• Contact reactions to pharmacologically active agents: Most of these reactions are produced by plants in the family Urticaceae (eg, stinging nettles).
2- Hirsutism associated with which of the following?
a. Anorexia
b.Juvenile hypothyroidism
c. Digoxin Toxicity
d. C/o citrate??
Hirsutism is a human hair growth and development disorder that affects approximately 5 percent to 15 percent women. Its main signs are dense, coarse and excess hair growth in a male-like pattern in various body parts of women, like in the face, neck, chest, lower abdomen etc. At least 5 percent of women of reproductive age suffer from this ailment. Hirsutism is the cause of substantial social and psychological agony, apart from the associated ailments and risks.
Drug induced hirsutism is a rare cause and other causes of this disease must be ruled out before it is confirmed. First let us check out the three sets of causes of hirsutism to understand the drug induced type better:
1. Androgenic causes.
2. Idiopathic hirsutism.
3. Nonandrogenic factors are the one’s that are not related to disproportionate androgen activity. Under this category comes the drug induced type of hirsutism.
Androgenic causes: They are mainly a result of androgen excess disorder, since this hormone plays a vital role in the production and development of human hair. Among the androgenic causes, the Polycystic Ovarian Syndrome (PCOS) is the most common and accounts for 70–80% of hirsute cases. The rarer syndromes and their percentage of prevalence are as below:
• Hyperandrogenism - 6.8%
• Hypothyroidism - 0.7%
• The hyperandrogenic insulin-resistant acanthosis nigricans syndrome (HAIR-AN) - 3 %
• 21-hydroxylase non-classic I adrenal hyperplasia (late-onset CAH) - 1.6%
• 21-hydroxylase-deficient congenital adrenal hyperplasia - 0.7%
• Hyperprolactinemia - 0.3%
• Androgenic tumors - 0.2%
• Cushing’s syndrome - 0-1%
Idiopathic hirsutism: The idiopathic cause is traced in 4.7 percent patients and its associated symptoms are hirsutism and probable overactive 5a-reductase action in skin and hair follicle. However, menses are regular.
Non-androgenic causes: They are less prevalent and can be divided in the following forms:
1. Unnecessary hair growth of acromegalics.
2. Coarsening of the hairs associated with chronic skin problems, since a major function of the hair is to protect the skin
3. Non-androgenic anabolic drugs often cause a general increase of many tissues, particularly hair. This can also result in vellus hypertrichosis and not hirsutism. To evaluate this cause a detailed drug history must be conducted. The process must include clinical investigations about the use of the following drugs (exogenous pharmacologic agents) that cause hirsutism as a probable side effect:
• Danazol (Danocrine)
• Norplant
• Metoclopramide (Reglan)
• Anabolic steroids
• Methyldopa (Aldomet)
• Phenothiazines
• Progestins
• Reserpine (Serpasil)
• Testosterone
• Oral contraceptives (OCs) that contain levonorgestrel, norethindrone and norgestrel induce more powerful androgen activity, while those that include ethynodiol diacetate, norgestimate and desogestrel have lesser androgenic activity.
• Some drugs that also result in hyperprolactinemia can also cause hirsutism.
However, one must exclude the possibility of vellus hypertrichosis, that is also often medication related, before confirming a case of drug induced hirsutism.
3- A 70-year-old patient presented with a skin lesion in the left thigh for many years. This lesion is black, size lx1 cm. It started to be more pigmented with bleeding. You will advice:
A. Cryotherapy.
B. Incisional biopsy.
C. Wide excision.
D. Immunotherapy.
E. Radiotherapy.

WARNING SIGNS OF MELANOMA
A common warning sign of melanoma is change. Melanoma often begins in or near an existing mole. A change to the shape, color, or diameter of a mole can be a warning sign of melanoma. Other changes that could indicate melanoma include a mole that becomes painful, or begins to bleed or itch.
DIAGNOSIS AND TREATMENT
Diagnosis begins with the dermatologist examining the suspicious lesion. If this visual examination leads the dermatologist to suspect melanoma or another type of skin cancer, the dermatologist will perform a biopsy. This is the only way to know with certainty if the lesion is melanoma or another type of skin cancer.

A biopsy is a simple procedure that a dermatologist can perform in the office. To perform a biopsy, a dermatologist will numb the area and remove the entire lesion, or a portion of it, so that the tissue can be examined under a microscope. If melanoma cells are visible under the microscope, the diagnosis is melanoma.
14) You have received the computed tomography (CT) scan report on a 34-year-old mother of three who had a malignant melanoma removed 3 years ago. Originally, it was a Clerk’s level I and the prognosis was excellent. The patient came to your office 1 week ago complaining of chest pain and abdominal pain. A CT scan of the chest and abdomen revealed metastatic lesions throughout the lungs and the abdomen. She is in your office, and you have to deliver the bad news of the significant spread of the cancer. The FIRST step in breaking news is to:
A. Deliver the news all in one blow and get it over with as quickly as is humanly possible.
B. Fire a ‘warning shot” that some bad news is coming.
C. Find out how must the patient knows.
D. Find out how much the patient wants to know it.
E. Tell the patient not to worry.


37- 42years old male presented with history of sudden appearance of rash – maculopapular rash – including the sole,& the palm, the most likely diagnosis is :
a- syphilis
b- erethyma nodosum
c- erythema marginatum
d- pitryasis rocae
e- drug induced

13. Most common association with acanthosis negricans (one):
• hodgkin lymphoma.
• non-hodgkin lymphoma.
• internal malignancy.
• DM.
• insulin resistance.
Acanthosis nigricans is divided into 2 broad categories, benign and malignant.
• Patients with the benign form of acanthosis nigricans experience very few, if any, complications of their skin lesions. However, many of these patients have an underlying insulin-resistant state that is the cause of their acanthosis nigricans. The severity of the insulin resistance is highly variable and ranges from an incidental finding after routine blood studies to overt diabetes mellitus. The severity of skin findings may parallel the degree of insulin resistance, and a partial resolution may occur with treatment of the insulin-resistant state. Insulin resistance is the most common association of acanthosis nigricans in the younger age population.
• Malignant acanthosis nigricans is associated with significant complications because the underlying malignancy is often an aggressive tumor. Average survival time of patients with signs of malignant acanthosis nigricans is 2 years, although cases in which patients have survived for up to 12 years have been reported. In older patients with new-onset acanthosis nigricans, most have an associated internal malignancy.
14. Xanthoma:
• on lateral aspect of the upper eyelid.
• hard plaque.
• around arterioles.
• is not related to hyperlipidemia.
• deposited in dermis.
xanthoma
a papule, nodule or plaque in the skin due to lipid deposits; the color of a xanthoma is usually yellow, but may be brown, reddish, or cream. Microscopically, the lesions show light cells with foamy protoplasm (foam cells, xanthoma cells). They occur most commonly in White Leghorn chickens and rarely in other species.
The formation of xanthomas may indicate an underlying disease, usually related to abnormal metabolism of lipids, including cholesterol. In reptiles they are associated with high cholesterol diets.
• Xanthelasma palpebrarum is the most common of the xanthomas. The lesions are asymptomatic and usually bilateral and symmetric. The lesions are soft, velvety, yellow, flat, polygonal papules around the eyelids. Xanthelasmas are most common in the upper eyelid near the inner canthus. Usually, the lesions have evolved for several months and enlarged slowly from a small papule. Xanthelasma may be associated with hyperlipidemia. When associated with hyperlipidemia, any type of primary hyperlipoproteinemia can be present. Some secondary hyperlipoproteinemias, such as cholestasis, may also be associated with xanthelasmas.

Xanthelasma. Courtesy of Duke University Medical Center.
• Tuberous xanthomas are firm, painless, red-yellow nodules (see Media File 3). The lesions can coalesce to form multilobated tumors. Tuberous xanthomas usually develop in pressure areas, such as the extensor surfaces of the knees, the elbows, and the buttocks. Tuberous xanthomas are particularly associated with hypercholesterolemia and increased levels of LDL. They can be associated with familial dysbetalipoproteinemia and familial hypercholesterolemia, and they may be present in some of the secondary hyperlipidemias (eg, nephrotic syndrome, hypothyroidism).

Tuberous xanthomas. Courtesy of Duke University Medical Center.
• Tendinous xanthomas appear as slowly enlarging subcutaneous nodules related to the tendons or the ligaments. The most common locations are the extensor tendons of the hands, the feet, and the Achilles tendons. The lesions are often related to trauma. Tendinous xanthomas are associated with severe hypercholesterolemia and elevated LDL levels, particularly in the type IIa form. They can also be associated with some of the secondary hyperlipidemias, such as cholestasis.
• Eruptive xanthomas most commonly arise over the buttocks, the shoulders, and the extensor surfaces of the extremities. Rarely, the oral mucosa or the face may be affected. The lesions typically erupt as crops of small, red-yellow papules on an erythematous base (see Media File 2), and they may spontaneously resolve over weeks. Pruritus is common, and the lesions may be tender. Eruptive xanthomas are associated with hypertriglyceridemia, particularly that associated with types I, IV, and V (high concentrations of VLDL and chylomicrons). They may also appear in secondary hyperlipidemias, particularly in diabetes.2

Eruptive xanthomas. Courtesy of Duke University Medical Center.
• Plane xanthomas are mostly macular and rarely form elevated lesions. They can occur in any site. Involvement of the palmar creases is characteristic of type III dysbetalipoproteinemia. They can also be associated with secondary hyperlipidemias, especially in cholestasis. Generalized plane xanthomas can cover large areas of the face, the neck, and the thorax, and the flexures can also be involved. They may be associated with monoclonal gammopathy and hyperlipidemia, particularly hypertriglyceridemia.
• Xanthoma disseminatum and verruciform xanthoma are particular forms of xanthomas that occur in normolipemic patients.3 Xanthoma disseminatum develops in adults as red-yellow papules and nodules with a predilection for the flexures. Characteristically, the mucosa of the upper part of the aerodigestive tract is involved. It has a benign clinical course and usually resolves spontaneously. Verruciform xanthoma predominantly occurs in the oral cavity of adults as a single papillomatous yellow lesion. Verruciform xanthoma is considered to be a reactive condition with benign behavior, and it is treated with local excision.
Causes

26. A middle aged man having black spots on his thigh for years, it is starting to become more black with bloody discharge, the best management is to:
• wide excision.
• incisional Bx.
• cryotherapy.
• radiotherapy.
• immunotherapy.

• 2- 45 y.o man, sudden eruption all over the body with palm and foot involvement. Most likely Dx is:
a. Syphilis
b. Erythema multiforme “most probably”
c. Erythema nodosum
d. Fixed drug eruption ??
e. Pityriasis rosea
Erythema multiforme
o Sudden onset of rapidly progressive, symmetrical, and cutaneous and/or mucocutaneous lesions, with concentric color changes in some or all lesions
o Centripetal spread
o Burning sensation in affected areas
o Pruritus generally absent
o Nonspecific prodromal symptoms suggestive of a viral syndrome in at least 50% of cases, usually 1-14 days before skin lesions develop. Symptoms may include fever, malaise, myalgias, arthralgias, headache, sore throat, cough, nausea, vomiting, and diarrhea.
• SJS/TEN
o Generalized cutaneous and/or mucocutaneous lesions with blisters
o May include symptoms of fever, malaise, myalgias, arthralgias, headache, sore throat, cough, nausea, vomiting, and diarrhea
o Oral pain, which may be severe enough to result in difficulty eating, drinking, or opening the mouth
o Eye pain, edema, and drainage
o Breathing difficulty resulting from tracheobronchial involvement
o Dysuria
Physical
• Erythema multiforme
o Symmetrically distributed, erythematous, expanding macules or papules evolve into classic iris or target lesions, with bright red borders and central petechiae, vesicles, or purpura.
o Lesions may coalesce and become generalized.
o Vesiculobullous lesions develop within preexisting macules, papules, or wheals.
o Rash favors palms and soles, dorsum of the hands, and extensor surfaces of extremities and face.
o Postinflammatory hyperpigmentation or hypopigmentation may occur.
o Eye involvement occurs in 10% of EM cases, mostly bilateral purulent conjunctivitis with increased lacrimation.
o Mucous membrane blistering occurs in about 25% of cases of EM, is usually mild, and typically involves the oral cavity.
• SJS/TEN
o Fever is common.
o Skin findings may be similar to EM but often are more variable and severe. Inflammatory vesiculobullous lesions, often with hemorrhage and necrosis, are typical. Fixed macules and target lesions may be larger and more confluent than in EM.
o Facial edema or central facial involvement
o Mucous membranes are strongly affected, most commonly mouth, lips, and bulbar conjunctivae; less often, anogenital mucosae are affected. Lips may be edematous, bloody, or crusted. A minimum of 2 mucosal surfaces must be involved; 3 mucosal surfaces are involved in about 40% of cases.
o Blisters or epidermal detachment less than 10% BSA for SJS and more than 30% for TEN; the outer layer of the epidermis separates readily from the basal layer with lateral pressure (positive Nikolsky sign).
o Bullae and shallow ulcers resembling aphthous ulcers are common. When bullae rupture, mucosal lesions become deeply erythematous erosions, often covered by gray pseudomembranous exudates.
o Salivation often is increased.
o Nasopharynx, respiratory tract, GI tract, and genitourinary (GU) tract are sometimes affected.
o Genital involvement consists of hemorrhagic, bullous inflammation; urinary retention and phimosis may occur.
o Eye involvement occurs in approximately 85% of cases. These range from hyperemia to extensive pseudomembrane formation. Synechiae between eyelid and conjunctiva often occurs. Keratitis and corneal erosions are less frequent.

17-A 12 yr old female, non pruritic annular eruption in the it foot for 8 months, looks pale and not scaling. Had no response to 6 wks of miconazole.
a. Discoid lupus erythramatosis d. Granulomatous annulare
b. Erythema nodosum e. Choricum marginatum
c. Tinea corporis

Granuloma annulare (GA) is a benign inflammatory dermatosis.
Granuloma annulare is relatively common disease that occurs in all age groups, but it is rare in infancy. Granuloma annulare is characterized clinically by dermal papules and annular plaques. The precise cause of granuloma annulare is unknown. Histological examination reveals foci of degenerative collagen associated with palisaded granulomatous inflammation.

The following clinical variants are recognized:
• Localized granuloma annulare: This is the most common form. Localized granuloma annulare is characterized by skin-colored to violaceous lesions up to 5 cm in diameter. Usually, the epidermis has attenuated surface markings. Annular rings with solitary firm papules or nodules may be present. Localized granuloma annulare has a predilection for the feet, ankles, lower limbs, and wrists.
• Generalized granuloma annulare: This form occurs predominantly in adults. The trunk is usually involved, as well as the neck, extremities, face, scalp, palms, and soles. Lesions range from widespread papules to annular plaques to large, discolored patches with a variety of coloration from yellow to violaceous.
• Subcutaneous granuloma annulare1,2 : This form occurs predominantly in children. Subcutaneous granuloma annulare is characterized by firm or hard asymptomatic nodules in the deep dermis or subcutaneous tissues, with individual lesions measuring from 5 mm to 4 cm in diameter. They are prevalent on the anterotibial plateau, ankles, dorsal feet, buttocks, hands, scalp, and eyelids.
• Perforating granuloma annulare3 : This form is very rare. Perforating granuloma annulare is usually localized to the dorsal hands and fingers or may be generalized on the trunk and extremities. A variety of superficial umbilicated papules develop, with or without a discharge, that heal with scarring.
Arcuate dermal erythema: This is an uncommon form of granuloma annulare that manifests as infiltrated erythematous patches that may form large, hyperpigmented rings with central
.

Pathophysiology
Proposed pathogenic mechanisms for granuloma annulare include cell-mediated immunity (type IV), immune complex vasculitis, and an abnormality of tissue monocytes. Some other possible mechanisms include primary degeneration of connective tissue leading to granulomatous inflammation, lymphocyte-mediated immune reaction with macrophage activation, and cytokine-mediated degradation of connective tissue.
Frequency
The frequency of granuloma annulare is in the general population is unknown. Granuloma annulare does not favor a particular race, ethnic group, or geographical area.
• Localized granuloma annulare is the most common among the various subtypes.
• Of all patients with granuloma annulare, 9-15% have the generalized variant.
• Perforating granuloma annulare has been reported to have a prevalence of 5% among granuloma annulare subtypes; further, reports suggest that this variant may be more common in the Hawaiian Islands.
Mortality/Morbidity
Most cases of granuloma annulare resolve without adverse medical sequelae.
Sex
Women are affected by granuloma annulare twice as often as men.
Age
• Localized granuloma annulare is most commonly found in children and in adults younger than 30 years.
• Generalized granuloma annulare demonstrates a bimodal age distribution, occurring in patients younger than 10 years and in patients aged 30-60 years.
• Although subcutaneous granuloma annulare can occur in adults, it is predominantly a disease of otherwise healthy children, who are typically aged 2-10 years.
• Similarly, perforating granuloma annulare most often affects children.

Medical Care
Localized granuloma annulare

Localized granuloma annulare (GA) is not often symptomatic and it has a tendency towards spontaneous resolution. Reassurance is often all that is necessary. Painful or disfiguring lesions have been treated by various methods, although the level of evidence supporting these methods is low.

Localized lesions have been treated with potent topical corticosteroids with or without occlusion for 4-6 weeks, as well as with intralesional corticosteroids with varying total doses of steroid.

Cryotherapy using liquid nitrogen or nitrous oxide as refrigerants has been shown in a prospective, uncontrolled trial to be an effective treatment for localized granuloma annulare. Secondary dyschromia may be a complication of cryotherapy.11

Other anecdotes of therapeutic efficacy in both localized and generalized granuloma annulare involve tacrolimus and pimecrolimus12,13,14 and imiquimod cream.15,16

Generalized granuloma annulare

Generalized granuloma annulare tends to be more persistent and unsightly. Treatment of the generalized disease is unfortunately fraught with a lack of consistently effective options. While the treatment of choice remains to be defined, the available literature supports the use of isotretinoin or phototherapy with oral psoralen and UV-A (PUVA) as first-line options for generalized granuloma annulare.17,18

Piaserico et al report successful therapy for long-standing generalized granuloma annulare using methyl aminolevulinate photodynamic therapy.19 Weisenseel et al reported moderate success with photodynamic therapy using 20% 5-aminolevulinic acid (ALA) gel.20

Marcus et al report on 6 patients with granuloma annulare that was refractory to standard treatment. The patients were treated with monthly combination therapy including rifampin at 600 mg, ofloxacin at 400 mg, and minocycline hydrochloride at 100 mg monthly for 3 months. Three to 5 months after the initiation of treatment, the plaques were cleared completely. Postinflammatory hyperpigmentation was reported by some patients. Although the treatment was successful, the authors suggested further studies may be needed to confirm this combination therapy as a successful option for recalcitrant granuloma annulare.21

Other anecdotal reports and small series describe successful treatment with dapsone, systemic steroids, pentoxifylline, hydroxychloroquine, cyclosporine, fumaric esters, interferon-gamma, potassium iodide, nicotinamide, etanercept, infliximab, adalimumab, and efalizumab.22,23
• ng.

11- Female pt developed lesions on the cheeck & nose and diagnosed as Rosacea. Rx is:
a) Amoxacillin
b) Tetracycline

Rosacea is a common condition characterized by symptoms of facial flushing and a spectrum of clinical signs, including erythema, telangiectasia, coarseness of skin, and an inflammatory papulopustular eruption resembling acne.
36.Cellulitis oc Treatment
Medical Care
Before the initiation of therapy, the triggering factors that exacerbate the patient's rosacea should be identified and avoided if possible. These factors may be unique to each individual patient. Common triggering factors include hot or cold temperatures, wind, hot drinks, caffeine, exercise, spicy food, alcohol, emotions, topical products that irritate the skin and decrease the barrier, or medications that cause flushing.9,10 Some patients find that regular facial massage reduces lymphedema. Rosacea fulminans is treated with moderately high doses of prednisolone (30-60 mg/d) followed by oral isotretinoin.
Sunscreen11
The use of daily broad-spectrum sunscreen is recommended for all patients with rosacea. A sunscreen that protects against both UV-A and UV-B light should be selected. Physical blockers such as titanium dioxide and zinc oxide are well tolerated. Additionally, the sunscreen should contain protective silicones such as dimethicone or cyclomethicone. Green-tinted sunscreens can provide coverage of the erythema.
The patient is encouraged to avoid astringents, toners, menthols, camphor, waterproof cosmetics requiring solvents for removal, or products containing sodium lauryl sulfate.
Laser12
Nonablative laser is effective against rosacea by remodeling of the dermal connective tissue and improving the epidermal barrier. The major disadvantage of this therapy is its cost because it is not covered by insurance. It requires 1-3 treatments 4-8 weeks apart to achieve the best results.
Vascular lasers are the mainstay of rosacea therapy. These include pulsed dye laser (585 or 595 nm), the potassium-titanyl-phosphate laser (532 nm), and the diode-pumped frequency-doubled laser (532 nm). These wavelengths allow selective absorption by oxyhemoglobin, leading to vessel reduction with minimal damage to surrounding tissue or scarring. To be effective against deeper facial vessels, longer wavelengths of lasers are required, including the diode laser (810 nm), the long-pulsed Alexandrite laser (755 nm), and the long-pulsed Nd:YAG laser (1064 nm).
Intense pulsed-light therapy is a multichromatic laser with different targets, including melanin and hemoglobin. Therefore, it is also useful for facial rejuvenation, affecting vascular lesions, pigmented lesions, and hair.
Surgical Care
Permanent telangiectasia may be treated by electrosurgery or the 585-nm pulsed dye laser. However, facial erythema is not improved, and new telangiectasias develop with the passage of time. Cosmetic improvement of rhinophyma may be produced by mechanical dermabrasion, carbon dioxide laser peel, and surgical shave techniques.
Diet
Dietary modulation should aim at avoidance of triggers.
Medication
The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Topical metronidazole is commonly used as a first-line agent. Topical azelaic acid, sulfacetamide products, and topical acne medications are also commonly used. Retinoids are advocated by some authorities.13,14,15

In addition to the agents listed below, anecdotal evidence indicates effective treatment of rosacea with medications that reduce flushing, including beta-blockers, clonidine, naloxone, ondansetron, and selective serotonin reuptake inhibitors.
Oral contraceptive therapy has been helpful in patients who provide historical information of worsening rosacea with their hormonal cycle.

Dapsone has been used in severe, refractory rosacea, and dapsone has been particularly beneficial for patients who cannot take isotretinoin.16
Immunosuppressants
These agents inhibit immune reactions resulting from diverse stimuli.17

Tacrolimus (Protopic) ointment 0.1% or 0.03%
Mechanism of action in atopic dermatitis not known. Reduces itching and inflammation by suppressing release of cytokines from T cells. Also inhibits transcription of genes encoding IL-3, IL-4, IL-5, GM-CSF, and TNF-alpha, all of which are involved in early stages of T-cell activation. Additionally, may inhibit release of preformed mediators from skin mast cells and basophils, and may down-regulate expression of FCeRI on Langerhans cells. Can be used in patients as young as 2 y. Drugs of this class are more expensive than topical corticosteroids. Available as ointment in concentrations of 0.03% and 0.1%. Indicated only after other treatment options have failed.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
Apply thin layer to affected skin areas bid.
Pediatric
<2 years: Not established
2-15 years: Apply 0.03% ointment bid to affected area(s)
>15 years: Administer as adults
Short-term and intermittent use only
• Dosing
• Interactions
• Contraindications
• Precautions
None reported
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity to tacrolimus or components of ointment
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Patients may experience a burning sensation during first few days of application; may cause rosacealike eruption, and patients must be monitored; skin can become photosensitive, and patients should be cautioned about exposure to direct or artificial sunlight and to use sunscreen; safety and efficacy in infected atopic dermatitis is not known; application under occlusion, which may promote systemic exposure, has not been evaluated (do not use with occlusive dressings)
Absorption following topical applications is minimal (relative to systemic administration), but tacrolimus is excreted in human milk and, thus, a decision should be made whether to discontinue nursing or to discontinue drug, taking into account importance of drug to mother (potential for serious adverse reactions in nursing infants should also be a concern)
Caution with conditions that suppress immune system (eg, AIDS, cancer); possible risk of lymph node or skin cancer based on animal studies and a small number of patients; may increase risk of viral infections; other adverse effects include headache, sore throat, flulike symptoms, fever, and cough
Antibiotics
Since the 1950s, oral antibiotics have been prescribed off label for treatment because microorganisms were thought to be the underlying cause of disease. In current practice, experts do not believe bacterial infection plays a part in the pathogenesis of rosacea; however, the observed clinical benefits of oral antibiotics have allowed this treatment option to remain in favor for both physicians and patients. Since 2006, nonantibiotic dosing of doxycycline has become first-line treatment for many clinicians. In many cases, oral and topical antibiotics are used in combination; the oral treatment is eventually withdrawn and the topical treatment is used alone as maintenance therapy.16

Azithromycin (Zithromax)
Semisynthetic macrolide antibiotic that reversibly binds to P site of 50S ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein synthesis by stimulating dissociation of peptidyl tRNA from ribosomes, causing bacterial growth inhibition.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
500 mg PO on day 1, followed by 250 mg PO qd for next 4 d
Pediatric
Not established
• Dosing
• Interactions
• Contraindications
• Precautions
Toxicity increases with coadministration of fluconazole and pimozide; effects decrease and adverse GI effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, carbamazepine, ergot alkaloids, triazolam, and HMG-CoA reductase inhibitors
Plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmias and increases in QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents; decreases metabolism of repaglinide, thus increasing serum levels and effects
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity; coadministration of pimozide; hepatic impairment
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Site reactions can occur with IV route; bacterial or fungal overgrowth may result from prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in patients with impaired hepatic function or prolonged QT intervals

Metronidazole gel 0.75% or 1% (MetroGel, Noritate, Flagyl, Protostat)
Imidazole ring–based antibiotic active against various anaerobic bacteria and protozoa.
Oral metronidazole has been shown to be beneficial against papules and pustules of acne rosacea.
Topical applications are helpful for mild disease and as an adjuvant to systemic therapy.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
Oral: 200 mg bid
Topical: Wash affected area and apply a thin film to affected area bid
Pediatric
Oral: 15-35 mg/kg/d divided q8h
Topical: Apply as in adults
• Dosing
• Interactions
• Contraindications
• Precautions
May increase toxicity of anticoagulants, lithium, and phenytoin; cimetidine may increase toxicity of metronidazole; disulfiram reaction may occur with orally ingested ethanol
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in hepatic disease; monitor for seizures and development of peripheral neuropathy; gel dosage form is for external use only; do not apply directly to eyes

Erythromycin (E.E.S., E-Mycin, Eryc, Ery-Tab) tab or 2% topical solution
Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections.
In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose.
Can be used when tetracyclines are not tolerated or are contraindicated.
Used for the treatment of ocular rosacea.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
Oral: 500 mg bid
Topical: Apply to affected area bid for 2 wk
Pediatric
Oral: 30-50 mg/kg/d divided qid
Topical: Apply as in adults
• Dosing
• Interactions
• Contraindications
• Precautions
None reported
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Discontinue if irritation or sensitivity occurs

Fusidic acid (Fucithalmic)
Ophthalmic susp as 10 mg/g (1%) (0.2 g) unit-dose, without preservative; 3 g and 5 g in multidose contains benzalkonium chloride.
For the treatment of ocular rosacea. Topical antibacterial that inhibits bacterial protein synthesis, causing bacterial death. Rosacea may respond to topical fusidic acid for at least 3 mo.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
Apply to affected area bid for 2 wk
Pediatric
Apply as in adults
• Dosing
• Interactions
• Contraindications
• Precautions
None reported
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Discontinue if irritation or sensitivity occur

Clindamycin lotion or gel 1%
Semisynthetic antibiotic produced by 7(S)-chloro substitution of 7(R)-hydroxyl group of parent compound lincomycin. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Widely distributes in body without penetration of CNS. Protein bound and excreted by liver and kidneys.
Upon application to skin, drug is converted to active component, which inhibits the microorganism.
Available as topical solution, lotion, or gel for external use. Solution contains equivalent of 10 mg/mL clindamycin.
Effective against mild-to-moderate papulopustular rosacea.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
Apply to affected area qd
Pediatric
Apply as in adults
• Dosing
• Interactions
• Contraindications
• Precautions
None reported
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Prolonged use may result in overgrowth of nonsusceptible organisms (eg, fungi); discontinue use if superinfection occurs

Tetracycline (Sumycin)
Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s). Has anti-inflammatory activity. Improvement is evident within 2-4 mo after commencement of therapy.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
250 mg PO qd to 500 mg PO tid
Pediatric
<8 years: Not recommended
>8 years: 25-50 mg/kg/d (10-20 mg/lb) PO qid
• Dosing
• Interactions
• Contraindications
• Precautions
Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; tetracyclines can increase hypoprothrombinemic effects of anticoagulants
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity; severe hepatic dysfunction
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines

Minocycline (Dynacin, Minocin)
Treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
50-100 mg PO qd/bid
Pediatric
<8 years: Not recommended
>8 years: 4 mg/kg PO initially, followed by 2 mg/kg q12h
• Dosing
• Interactions
• Contraindications
• Precautions
Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity; severe hepatic dysfunction
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines; hepatitis or lupuslike syndromes may occur

Doxycycline (Oracea, Bio-Tab, Doryx, Periostat, Vibramycin)
Broad-spectrum, synthetically derived, bacteriostatic antibiotic in tetracycline class. Almost completely absorbed, concentrates in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations.
Inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. May block dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
40-100 mg PO qd/bid
Pediatric
<8 years: Not recommended
>8 years: 2-5 mg/kg/d PO in 1-2 divided doses; not to exceed 200 mg/d
• Dosing
• Interactions
• Contraindications
• Precautions
Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants.
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity; severe hepatic dysfunction
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines

Clarithromycin (Biaxin)
Semisynthetic macrolide antibiotic that reversibly binds to P site of 50S ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein synthesis by stimulating dissociation of peptidyl tRNA from ribosomes, causing bacterial growth inhibition.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
250 mg PO bid
Pediatric
Not established
• Dosing
• Interactions
• Contraindications
• Precautions
Coadministration with pimozide, cisapride, or moxifloxacin may increase risk of malignant arrhythmias; toxicity increases with coadministration of fluconazole or pimozide; effects decrease and adverse GI effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, carbamazepine, ergot alkaloids, triazolam, and HMG-CoA reductase inhibitors
Plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmias and increases in QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents; decreases metabolism of repaglinide, thus increasing serum levels and effects
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity; coadministration with pimozide, ergot derivatives, or cisapride
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Bacterial or fungal overgrowth may result from prolonged antibiotic use; may increase hepatic enzyme levels and cholestatic jaundice; caution in patients with prolonged QT intervals or pneumonia; give half dose or increase dosing interval if CrCl <30 mL/min; caution in hospitalized, geriatric, or debilitated patients
Retinoids
These agents decrease the cohesiveness of abnormal hyperproliferative keratinocytes and may reduce the potential for malignant degeneration. They modulate keratinocyte differentiation, and they have been shown to reduce the risk of skin cancer formation in patients who have undergone renal transplantation.

Tretinoin (Avita, Retin-A, Retin-A Micro)
Structurally related to vitamin A. May be helpful for recalcitrant disease, but recurrence is common. Long-term, low-dose therapy may be suitable for selected patients.
May cause skin irritation in some patients. Has been linked to promotion of angiogenesis; however, has not demonstrated increased telangiectasias.
Inhibits microcomedo formation and eliminates lesions. Makes keratinocytes in sebaceous follicles less adherent and easier to remove. Available as 0.025%, 0.05%, and 0.1% creams. Available also as 0.01% and 0.025% gels.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
Begin with lowest concentration and increase as tolerated; apply hs or qod; lower frequency of application if irritation develops
Pediatric
<12 years: Not established
>12 years: Apply as in adults
• Dosing
• Interactions
• Contraindications
• Precautions
Toxicity may occur with vitamin A coadministration; toxicity increased when coadministered with sulfur, benzoyl peroxide, resorcinol, or any product with strong drying effects; phototoxicity increased when coadministered with tetracyclines, fluoroquinolones, or thiazides
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with excessive sunlight exposure; burning, stinging, peeling, pruritus, or erythema has been reported at site of application; caution with eczema (may cause severe irritation); avoid contact with mucous membranes, mouth, and angles of nose

Isotretinoin (Accutane)
Oral agent that treats serious dermatologic conditions. Synthetic 13-cis isomer of naturally occurring tretinoin (trans -retinoic acid). May be helpful for recalcitrant disease, but recurrence is common. Long-term, low-dose therapy may be suitable for selected patients.
A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
0.5-1 mg/kg/d PO divided bid for 4 mo
Pediatric
Not established
• Dosing
• Interactions
• Contraindications
• Precautions
Toxicity may occur with vitamin A coadministration; pseudotumor cerebri or papilledema may occur when coadministered with tetracyclines; may reduce plasma levels of carbamazepine and contraceptive efficacy
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
May decrease night vision; inflammatory bowel disease may occur; may be associated with development of hepatitis; occasional exaggerated healing response of acne lesions (excessive granulation with crusting) may occur
Diabetes patients may experience problems in controlling blood glucose while on isotretinoin; avoid exposure to UV light or sunlight until tolerance achieved; discontinue treatment if rectal bleeding, abdominal pain, or severe diarrhea occur
Mood swings or depression may occur; caution if history of depression
Corticosteroids
These agents are relatively contraindicated, except as a short course in rosacea fulminans.

Prednisolone (AK-Pred, Delta-Cortef, Articulose-50, Econopred)
Moderately high doses may be helpful in rosacea fulminans. Decreases inflammation by suppressing migration of PMN leukocytes and reducing capillary permeability. Use in combination with isotretinoin. Rosacea fulminans is treated with moderately high doses of prednisolone (30-60 mg/d) followed by oral isotretinoin.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
30-60 mg PO qd
Pediatric
0.1-2 mg/kg/d PO qd or divided tid/qid
• Dosing
• Interactions
• Contraindications
• Precautions
Decreases effects of salicylates and toxoids (for immunizations); phenytoin, carbamazepine, barbiturates, and rifampin decrease effects
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity; viral, fungal, or tubercular skin lesions
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hyperthyroidism, osteoporosis, cirrhosis, nonspecific ulcerative colitis, peptic ulcer, diabetes mellitus, and myasthenia gravis
Antihypertensive agents
Potassium-sparing diuretics can be used to reduce morbidity.

Spironolactone (Aldactone)
Competes with aldosterone for receptor sites in distal renal tubules, increasing water excretion while retaining potassium and hydrogen ions.
Aldosterone inhibitors help block the renin-angiotensin system and help prevent potassium loss in distal tubules. The body conserves potassium, and less oral potassium supplementation is needed.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
50 mg PO qd
Pediatric
Not established
• Dosing
• Interactions
• Contraindications
• Precautions
May decrease effect of anticoagulants; potassium and potassium-sparing diuretics may increase toxicity of spironolactone
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity; anuria; renal failure; hyperkalemia
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in renal and hepatic impairment
Acne Products
Some products in this category can be effective in patients with papules, pustules, and the phymatous and glandular types of rosacea.

Benzoyl peroxide (Benoxyl, Benzac, Oxy-5, Fostex)
Free-radical oxygen is released upon administration and oxidizes bacterial proteins in sebaceous follicles, decreasing quantity of irritating free fatty acids and of anaerobic bacteria. Converted on skin into benzoic acid, which has keratolytic and comedolytic effects. However, can be quite irritating in patients with barrier dysfunction and can cause further erythema. Available over the counter and by prescription.
Available in 2.5%, 5%, and 10% gels, lotions, creams, or washes.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
Apply sparingly qd; gradually increase to bid/tid prn; reduce dose, frequency, or concentration if excessive dryness or peeling occurs
Pediatric
Not established
• Dosing
• Interactions
• Contraindications
• Precautions
Potentiates adverse effects of tretinoin
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Avoid contact with lips, eyelids, mucous membranes, and eyes; for external use only; discontinue if swelling, burning, or excessive dryness occurs

Azelaic acid (Azelex, Finacea)
Available in 2 strengths azelaic acid 15% gel (Finacea) or azelaic acid 20% cream (Azelex). Effective against mild-to-moderate papulopustular rosacea. Can be used twice daily as initial treatment. May reduce production of ROS by neutrophils. Some patients report transient burning or stinging.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
Wash area and apply sparingly bid; duration of use can vary from person to person and depends on severity of acne
Pediatric
Not established
• Dosing
• Interactions
• Contraindications
• Precautions
None reported
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Avoid contact with eyes; discontinue use if severe irritation develops

Sodium sulfacetamide and sulfur (Plexion, Clenia, Rosanil wash, Rosula gel or wash, Rosac cream, Sulfacet-R lotion, Clarifoam EF)
Contains 5% sulfur and 10% sodium sulfacetamide. Used topically for acne rosacea. Sodium sulfacetamide has antibacterial properties, whereas sulfur is considered an antiseptic with keratolytic action.
curring about the face in young children (6-24 months) and
associated with fever and purple skin discoloration is MOST often caused by:
a)group A beta haemolytic streptococci
b)heamophilis influenza type B
c)slreptococcus pneumoniae
d)streptococcus aureus
e)pseudomonas
The term "cellulitis" is commonly used to indicate a nonnecrotizing inflammation of the dermis and hypodermis related to acute infection that does not involve the fascia or muscles, and that is characterized by localized pain, swelling, tenderness, erythema, and warmth.
Pathophysiology
Cellulitis usually follows a break in the skin, such as a fissure, cut, laceration, insect bite, or puncture wound. Facial cellulitis of odontogenic origin may also occur. Patients with toe web intertrigo and/or tinea pedis and those with lymphatic obstruction, venous insufficiency, pressure ulcers, and obesity are particularly vulnerable to recurrent episodes of cellulitis. Organisms on the skin and its appendages gain entrance to the dermis and multiply to cause cellulitis.
The vast majority of cases are caused by Streptococcus pyogenes or Staphylococcus aureus. Occasionally, cellulitis may be caused by the emergence of subjacent osteomyelitis. Cellulitis may rarely result from the metastatic seeding of an organism from a distant focus of infection, especially in immunocompromised individuals. This is particularly common in cellulitis due to Streptococcus pneumoniae and marine vibrios. Neisseria meningitidis, Pseudomonas aeruginosa, Brucella species, and Legionella species have also been reported as rare causes of cellulitis resulting from hematogenous spread.5
Frequency
United States
Because cellulitis is not a reportable disease, the exact prevalence is uncertain; however, it is a relatively common infection. A 2006 study found an incidence rate of 24.6 cases per 1000 person-years.6 In a large epidemiological hospital-based study on skin, soft tissue, bone, and joint infections, 37.3% patients were identified as having cellulitis.7
International
Cellulitis has been found to account for approximately 3% of emergency medical consultations at one United Kingdom district general hospital.
Mortality/Morbidity
Cellulitis generally is a localized infection. Most patients treated appropriately recover completely. Mortality is rare (5%) but may occur in neglected cases or when cellulitis is due to highly virulent organisms (eg, P aeruginosa). Factors associated with an increased risk of death are the presence of concurrent illness (eg, congestive heart failure, morbid obesity, hypoalbuminemia, renal insufficiency) or complications (eg, shock).8
Race
No racial predilection has been noted.
Sex
No predilection for either sex is usually reported, although a higher incidence among males has been reported in some studies.6,9
Age
No age predilection is usually described; however, studies found a higher incidence of cellulitis in general among individuals older than 45 years.2,6,9 Moreover, cellulitis at certain anatomic sites may show a predilection for persons in certain age groups.
• Facial cellulitis is more common in children younger than 3 years.
• Perianal cellulitis is predominantly a disease of children.10
Clinical
History
The incubation period is somewhat organism dependent. Postoperative cellulitis at the surgical site due to group A beta-hemolytic streptococci may develop rather rapidly. On the other hand, cellulitis due to staphylococci usually is delayed in onset.
• Patients report local pain and swelling at the site of cellulitis.
• The patient may report a history of trauma to the site. Severe bacterial cellulitis may occur as a postsurgical complication, such as following hip replacement11 or liposuction, or secondary to lymphatic occlusion following either radical mastectomy12,13 or conservative breast surgery14 ; impaired lymphatic drainage and edema are also considered predisposing factors to leg cellulitis following saphenous vein resection for coronary artery bypass.15 However, cellulitis may follow a trivial injury to the skin (eg, scratch, abrasion, animal bite, intravenous or subcutaneous drug injection, body piercing).16,17,18 Cellulitis has also rarely been reported as a possible postprocedural complication of radiation therapy.19
• Fever is common, and chills may be noted, particularly if suppuration has occurred.
• Malaise may be present.
Medical Care
Patients with mild cases of cellulitis may be treated in an outpatient setting. Oral agents with activity against staphylococci and streptococci (eg, dicloxacillin or flucloxacillin, cephalexin, cefuroxime axetil, erythromycin, clindamycin, cotrimoxazole, amoxicillin/clavulanate) are usually effective for the treatment of cellulitis in immunocompetent hosts.3 Levofloxacin may also represent an alternative, but the prevalence of resistant strains has increased and fluoroquinolones are best reserved for organisms with sensitivity demonstrated by culture.4,70
Severely ill patients and those unresponsive to standard oral antibiotic therapy should be treated with intravenous antibiotics in the hospital. This is also recommended in immunosuppressed individuals, in those with facial cellulitis, and in any patients with a clinically significant concurrent condition, including lymphedema and cardiac, hepatic, or renal failure. Additionally, consider hospitalization when laboratory investigations reveal elevated creatinine, creatine phosphokinase, or C-reactive protein and/or low serum bicarbonate levels or marked left-shift polymorphonuclear neutrophils.4

Elevating limbs with cellulitis expedites resolution of the swelling. Cool sterile saline dressings may be used to remove purulent discharge from any open lesion.
• Usually, cellulitis is presumed to be due to staphylococci or streptococci infection and is treated with antibiotics (eg, nafcillin, cefazolin). Other options in allergic patients include clindamycin or vancomycin. Ceftriaxone may be useful in the outpatient setting because it can be administered once daily.71
• Agents with a broader spectrum of activity are recommended in selected patients, such as diabetic patients.51
• More specific antibiotic therapy may be indicated in patients who develop cellulitis in special settings (eg, after a human or animal bite, exposure to potentially contaminated fresh water or seawater).51 Treatment of cellulitis caused by uncommon organisms, such as Vibrio species or gram-negative bacteria, should be individualized to those recovered organisms.72 In general, these organisms require treatment with drugs other than those discussed above. For instance, cellulitis due to Vibrio infection may be treated with tetracyclines, chloramphenicol, or aminoglycosides.73
• Cutaneous cellulitis and soft tissue infections due to community-acquired MRSA represent an emerging problem also among patients who lack traditional risk factors.25
o In such cases, management with standard gram-positive antibiotics may be ineffective, also because concomitant multiresistance to other antibiotics widely used in common empiric therapy, including erythromycin, may occur. Bacterial strains are usually susceptible to gentamicin, tetracyclines, rifampin, trimethoprim/sulfamethoxazole, and vancomycin.55,74 Clindamycin may be used in areas where inducible resistance is not prevalent. Daptomycin may also represent a cost-effective alternative for complicated skin infections.75
o A randomized, open-label, comparator-controlled, multicenter, multinational study has demonstrated the efficacy of linezolid therapy and its superiority to vancomycin in the management of skin and soft tissue infections, including cellulitis, due to MRSA.76 However, bacterial culture is still considered essential in order to determine the antibiotic susceptibility of the bacterial isolate and to adjust the systemic antimicrobial therapy according to sensitivity data.
• If mycologic investigations performed to rule out tinea pedis as a possible cause of recurrent episodes of cellulitis detect the presence of fungal infection in toe webs or feet, treatment with topical antifungals is recommended. With severe chronic changes or if onychomycosis is providing a source for repeated infection, oral antifungals such as itraconazole or terbinafine may be considered.
Surgical Care
Incision and drainage are indicated if suppuration has occurred.

43) Which of the following is MOST commonly seen in patients with acanthosis nigricans?
A. An underlying internal cancer.
B. An underlying non-Hodgkin’s lymphoma.
C. An insulin resistant state.
D. Diabetes mellitus.
E. An underlying Hodgkin’s lymphoma.

11-the following drugs can be used for acne treatment except:
a-ethinyl estradiol
b-retin A
c-vitA
d-erythromycin ointment
e-azelenic acid

Acne vulgaris(treatment) *The triphasic formulation of norgestimate and ethinyl estradiol is indicated to treat moderate acne vulgaris in females 15 years of age or older who need contraception and whose acne is unresponsive to other antiacne therapy 40.


Copyright© 2001 Micromedex, Inc. All rights reserved.
5 Treatment
Medical Care
Treatment should be directed toward the known pathogenic factors involved in acne. These include follicular hyperproliferation, excess sebum, P acnes, and inflammation. The grade and severity of the acne help in determining which of the following treatments, alone or in combination, is most appropriate. When a topical or systemic antibiotic is used, it should be used in conjunction with benzoyl peroxide to reduce the emergence of resistance.
Topical treatments
Topical retinoids are comedolytic and anti-inflammatory. They normalize follicular hyperproliferation and hyperkeratinization. Topical retinoids reduce the numbers of microcomedones, comedones, and inflammatory lesions. They may be used alone or in combination with other acne medications. The most commonly prescribed topical retinoids for acne vulgaris include adapalene, tazarotene, and tretinoin. These retinoids should be applied once daily to clean, dry skin, but they may need to be applied less frequently if irritation occurs. Skin irritation with peeling and redness may be associated with the early use of topical retinoids. The use of mild, nondrying cleansers and noncomedogenic moisturizers may help reduce this irritation. Alternate-day dosing may be used if irritation persists. Topical retinoids thin the stratum corneum, and they have been associated with sun sensitivity. Instruct patients about sun protection. Also see Sunscreens and Photoprotection.
Topical antibiotics are mainly used for their role against Propionibacterium acnes. They may also have anti-inflammatory properties. Topical antibiotics are not comedolytic, and bacterial resistance may develop to any of these agents. The development of resistance is lessened if topical antibiotics are used in combination with benzoyl peroxide.18 Commonly prescribed topical antibiotics for acne vulgaris include erythromycin and clindamycin alone or in combination with benzoyl peroxide. Clindamycin and erythromycin are available in a variety of topical agents. They may be applied once or twice a day. Gels and solutions may be more irritating than creams or lotions. Clindamycin has maintained better efficacy than erythromycin.
Benzoyl peroxide products are also effective against P acnes, and bacterial resistance to benzoyl peroxide has not been reported.19 Benzoyl peroxide products are available over the counter and by prescription in a variety of topical forms, including soaps, washes, lotions, creams, and gels. Benzoyl peroxide products may be used once or twice a day. These agents may occasionally cause a true allergic contact dermatitis. More often, an irritant contact dermatitis develops, especially if used with tretinoin or when accompanied by aggressive washing methods. If intensive erythema and pruritus develop, a patch test with benzoyl peroxide is indicated to rule out allergic contact dermatitis.
Systemic treatments
Systemic antibiotics are a mainstay in the treatment of acne vulgaris. These agents have anti-inflammatory properties, and they are effective against P acnes. The tetracycline group of antibiotics is commonly prescribed for acne. The more lipophilic antibiotics, such as doxycycline and minocycline, are generally more effective than tetracycline. Greater efficacy may also be due to less P acnes resistance to minocycline. However, P acnes resistance is becoming more common with all classes of antibiotics currently used to treat acne vulgaris.20 P acnes resistance to erythromycin has greatly reduced its usefulness in the treatment of acne. Subantimicrobial therapy or concurrent treatment with topical benzoyl peroxide may reduce the emergence of resistant strains.
Other antibiotics, including trimethoprim alone or in combination with sulfamethoxazole, and azithromycin, reportedly are helpful.21,22
Some hormonal therapies may be effective in the treatment of acne vulgaris. Oral contraceptives increase sex hormone–binding globulin, resulting in an overall decrease in circulating free testosterone. Combination birth control pills have shown efficacy in the treatment of acne vulgaris.23,24,25,26
Spironolactone may also be used in the treatment of acne vulgaris.27 Spironolactone binds the androgen receptor and reduces androgen production. Adverse effects include dizziness, breast tenderness, and dysmenorrhea. Dysmenorrhea may be lessened by coadministration with an oral contraceptive. Periodic evaluation of blood pressure and potassium levels is appropriate. Pregnancy must be avoided while taking spironolactone because of the risk of feminization of the male fetus.
Isotretinoin is a systemic retinoid that is highly effective in the treatment of severe, recalcitrant acne vulgaris. Isotretinoin causes normalization of epidermal differentiation, depresses sebum excretion by 70%, is anti-inflammatory, and even reduces the presence of P acnes. Isotretinoin therapy should be initiated at a dose of 0.5 mg/kg/d for 4 weeks and increased as tolerated until a cumulative dose of 120-150 mg/kg is achieved. Coadministration with steroids at the onset of therapy may be useful in severe cases to prevent initial worsening.
• Isotretinoin is a teratogen, and pregnancy must be avoided. Contraception counseling is mandatory, and 2 negative pregnancy test results are required prior to the initiation of therapy in women of childbearing potential. The baseline laboratory examination should also include cholesterol and triglyceride assessment, hepatic transaminase levels, and a CBC count. Pregnancy tests and laboratory examinations should be repeated monthly during treatment.
• Associated mood changes and depression have been reported during treatment. Although a cause-and-effect relationship has not been established, patients should be informed of this potential effect and must sign a consent form acknowledging they are aware of this potential risk.28,29
• A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.
• While using isotretinoin, the patient is considered at high risk for abnormal healing and the development of excessive granulation tissue following procedures. Many dermatologists delay elective procedures, such as dermabrasion or laser resurfacing (eg, with carbon dioxide laser or erbium:YAG laser), for up to 1 year after completion of therapy. Other procedures to be avoided during therapy include tattoos, piercings, leg waxing, and other epilation procedures.


Acne with reactive hyperpigmentation; before treatment.


Acne with reactive hyperpigmentation; after treatment.
[ CLOSE WINDOW ]

A summary of the American Academy of Dermatology treatment guidelines, Guidelines of care for acne vulgaris management, may be of interest.30 Also see the Medscape Acne Resource Center.
Surgical Care
• Procedural treatments include manual extraction of comedones and intralesional steroid injections.
• Additionally, some patients may benefit from superficial peels that use glycolic or salicylic acid.
• Phototherapy using red light or blue light and photodynamic therapy are being assessed as potential treatments for acne.31,32
• The usefulness of some fractional laser treatments in the management of acne is also being evaluated.
Consultations
If the patient is feeling depressed while taking isotretinoin, refer him or her to a specialist for help.
Diet
Diet therapy has been suggested. Drs Kligman, Fulton, and Plewig performed a study on chocolate, having teenage patients with acne consume 1 bar of chocolate each day. Some of the patients improved and some worsened, but the vast majority were unchanged. This study helped decrease the emphasis on diet as a causal factor in acne vulgaris. However, investigators always returned to the diet question. Data suggest that the westernization of certain Native American populations and the consumption of unhealthy "junk" foods (eg, potato chips, soft drinks) has had a negative impact on general and skin health, resulting acne flares.

Investigators have also focused on a low-glycemic diet to avoid stress from high-carbohydrate diets and to reduce insulin levels. Studies have been encouraging,33 so the author recommends the "South Beach Diet"34 and provides patients with the glycemic index of foods. The author recommends that acne patients eat nothing higher than 70 on the glycemic index.
• 1. Scabies infestation, all true except:-
- Rarely involve head and neck
- 5% lindane is effective
- Benzobenzoates is equally effective to 5% lindane
- Itching occurs 1 week after infestation
prim Scabies is caused by a microscopic (<1 mm) mite called Sarcoptes scabiei var. hominis. The scabies mite causes symptoms when it digs a little tunnel below the skin (referred to as a burrow) and causes a type of allergic reaction. If the person has never been exposed to scabies before, he or she may not show symptoms until four to six weeks after the initial infestation. Individuals who have been exposed in the past usually show symptoms within a few days.ary lesions of scabies
o Burrows, papules, pustules, nodules, occasionally urticarial papules and plaques14 located between web space of fingers, flexor aspects of the wrists, axilla, antecubital area, abdomen, umbilicus, genital and gluteal areas, and feet15


o Burrows
 A short elevated pink or gray, straight or tortuous line, serpiginous (S-shaped) track in the superficial epidermis, with a small vesicle at the tip is known as a burrow; this is pathognomonic of scabies infestation.14
 A burrow appears as a thin (approximately the width of a human hair), short (perhaps 2-3 mm in length), gray brown, wavy channel on the skin.
• In women, the nipples and areola of the breasts often are affected.
• In men, red papules or nodules on the penile glans, shaft, and scrotum are typical of scabies.

Scabies on the penis. Courtesy of William D. James, MD.



o Compared with adults, scabies in infants and young children tend to be more disseminated and, while the head and face usually are spared in adults, they may be affected in the very young.
o Geriatric scabies demonstrates a propensity for the back, often appearing as excoriations.
o Occasionally, the mite is visible to the naked eye as a small white dot.
o A small vesicle or papule may appear at the end of the burrow, where the mite enters the skin.
o Nodular scabies may erupt on covered parts of the body as either few or many lesions. They are characterized by firm, red nodules approximately 0.5 cm or larger. These can form during or after the infestation has been treated. Usually no organisms are found in the lesions. The nodules are suspected to represent an immune reaction to the scabetic antigens.6
o Norwegian scabies presents with extensive crusting of the skin with thick, hyperkeratotic scales overlying the elbows, knees, palms, and soles.
o Bullous lesions may be observed in immunocompromised patients.
o Canine scabies does not exhibit the classic burrow. Instead, papules and vesicles are the most prominent lesions surfacing on the arms, chest, abdomen, and thighs.
• Secondary lesions that may occur include urticaria, impetigo, and eczematous plaques.16
Pyoderma: One study found aerobic and anaerobic bacteria were grown from specimens obtained from children with secondary infections. Aerobes were present in 47% of children: Staphylococcus aureus, group A streptococci, and Pseudomonas aeruginosa. Anaerobes were found to be present in 20% of children: Peptostreptococcus, Prevotella, and Porphyromonas species. Mixed anaerobic- Mode of transmission
Transmission of scabies is predominantly through direct skin-to-skin contact, and for this reason, scabies has been considered a sexually transmitted disease. Those at high risk include men who have sex with men and men with sexual contacts.4 A person infested with mites can spread scabies even if he or she is asymptomatic.1 There may be a prolonged interval (up to 10 wk) between the primary infection, when the patient becomes contagious, and the onset of clinical manifestations.5 It is less frequently transmitted by indirect contact through fomites such as infested bedding or clothing. However, the greater the number of parasites on a person, as in crusted scabies, the more likely that indirect contact will transmit the disease.
o aerobic flora were present in 33% of patients.1
Treatment
Emergency Department Care
• Prescribe an appropriate scabicide (eg, permethrin, lindane).
• Provide relief of symptoms.
o Itching may persist for 1-2 weeks, even following successful treatment. Pruritus may be alleviated partially with an oral antihistamine, such as hydroxyzine hydrochloride (Atarax), diphenhydramine hydrochloride (Benadryl), or cyproheptadine hydrochloride (Periactin), or with a short course of topical or oral steroids.
o The rash is often misdiagnosed and treated with only steroids, and long-term use with steroids can cause crusting and diffuse erythema.15
• Treat secondary infections with the appropriate antibiotics.
• Treat household members and close personal contacts.
• Notify infection control personnel and a dermatologist when an epidemic in a nursing home or a hospital is suspected.
• Provide reassurance that scabies is not a reflection of poor personal hygiene.
Consultations
Consultation with a dermatologist or an infectious disease specialist may be required for severe, refractory scabies or for disseminated scabies in patients who are immunocompromised. Caution must be exercised when treating pregnant patients and children.
Medication
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Scabicides
Treatment options include either topical or oral medication. Topical options include permethrin cream (drug of choice), lindane, benzyl benzoate, crotamiton lotion and cream, sulfur, Tea tree oil, or oil of the leaves of Lippia multiflora Moldenke, a shrub found growing in West Africa Savannah. Oral options include ivermectin (not approved by FDA for treatment of scabies). A second course of treatment is often recommended 7-10 days later because of some developing larvae that may survive the initial treatment.15
Special population recommendations are as follows:3
• Infants - Permethrin 5% cream (>2 months age) (Ivermectin and lindane contraindicated)
• Children - Permethrin 5% cream, benzyl benzoate 12.5%
• Pregnant and breastfeeding women - 6% sulfur (Ivermectin, permethrin, and lindane contraindicated)
• Crusted or Norwegian scabies - Oral ivermectin (may require 3-7 doses, or in combination with a topical scabicide depending on the severity of the infection5 ); hyperkeratosis treated with a keratolytic agent (5-10% salicylic acid in petrolatum) improves penetration of the topical agent5
The Centers for Disease Control and Prevention recommends treatment with either permethrin lindane or ivermectin. Permethrin is the drug of choice in the United States and the United Kingdom, but it is not available in France. In some studies, it has been shown to be more effective than a single dose of oral ivermectin, although it has equivalent efficacy when 2 doses of ivermectin are used at time zero and 2 weeks later. In severe cases, a topical medication may be used with oral medication (ivermectin).
A 2007 Cochrane Review that focused on interventions for treating scabies recommended the following:18
• Topical permethrin appeared to be the most effective treatment for scabies.
• Topical permethrin appeared more effective than oral ivermectin, topical lindane, and topical crotamiton.
Drug resistance is emerging as a concern with repeated administration.
• Clinical resistance has not been documented for permethrin use, but it has been documented in 2 people with crusted scabies who had repeated regimens of multiple doses of ivermectin.5

Permethrin cream 5% (Elimite)
CDC recommends as first-line treatment.
Drug of choice particularly for infants >2 months old and small children.
Highly effective, minimally absorbed and minimally toxic.15
Even after successful treatment, post scabietic nodules and pruritus may persist for months. In vitro resistance and treatment failures have been documented. Most expensive of all topical scabicides.3
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
Apply 30 g to entire body from chin to toes; shower off the medication 8-14 h after initial application; repeat in 7 d if necessary
Pediatric
Apply as in adults; can apply to head and neck in children <5 y; not recommended for children <2 mo
• Dosing
• Interactions
• Contraindications
• Precautions
None reported
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Avoid contact with the mouth, eye, and nose; may transiently exacerbate redness, swelling, and itching

Lindane 1% (Kwell, gamma benzene hexachloride)
Stimulates nervous system of parasite, causing seizures and death. Considered second-line treatment if other agents fail or are not tolerated. Not very safe in children due to transcutaneous absorption leading to neurotoxicity. The systemic absorption rate of lindane is 10 times greater than permethrin, and its serum levels are more than 40 times higher.14 Overall, permethrin is a safer choice.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
Apply a thin layer on cool dry skin from chin to toes (estimated dermal absorption factor 10-20%), and shower off 6-10 h later; do not leave on skin for more than 12 h; repeat in 1 wk
Pediatric
Not recommended
• Dosing
• Interactions
• Contraindications
• Precautions
Oil-based hairdressings may increase toxicity
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity; neonates; acutely swollen skin or damaged skin; Norwegian scabies
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution if history of seizures; do not apply to eyes, face, or mucous membranes; caution if history of keratinization/ichthyosis disorders, or any condition that has altered skin integrity due to the increased systemic absorption

Sulfur in petrolatum (2 -10%, with 6% preferred, cream or ointment)
Not FDA approved for treatment of scabies. The oldest antiscabietic. One of a few scabicidal treatments that may be used safely in very small children (<2 mo) and in pregnant women.14,19 Sulfur is messy, malodorous, stains clothes, and requires repeat applications, thus reducing compliance.19 Sulfur should only be used when a patient cannot tolerate permethrin, lindane, or ivermectin.19 It is inexpensive and can be used for mass therapy in resource-poor economies.19
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
Apply to entire body below the head on 3 successive nights and bathe 24 h after each application
Pediatric
Apply as in adults
• Dosing
• Interactions
• Contraindications
• Precautions
None reported
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions

Crotamiton 10% cream or lotion (Eurax)
For the treatment of scabies. Mechanism of action is unknown. Weak antipruritic agent. Success rates vary 50-70%.3
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
Apply thin layer on to skin of entire body from neck to toes; repeat in 24 h; take a cleansing bath 48 h after last application; may need to apply twice daily for 5 consecutive days after bathing and changing clothes3
Pediatric
Apply as in adults
• Dosing
• Interactions
• Contraindications
• Precautions
None reported
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity; can cause seizures
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Do not apply to face, urethral meatus, eyes, mucous membranes, or swollen skin; can cause seizures

Benzyl benzoate
Ester of benzoic acid and benzyl alcohol. Neurotoxic to mites. Not available in the United States4 and not FDA approved as a scabicide, but used in Europe. Cheaper alternative to other treatments.3
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
Use 25% emulsion; apply below neck 3 times within 24 h without an intervening bath
Pediatric
May reduce adult dose to 12.5% or less due to stinging
• Dosing
• Interactions
• Contraindications
• Precautions
None reported
• Dosing
• Interactions
• Contraindications
• Precautions
Documented hypersensitivity; pregnancy, breastfeeding women; infants and children <2 y
• Dosing
• Interactions
• Contraindications
• Precautions
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
May cause stinging

Ivermectin (Mectizan, Stromectol)
Binds selectively with glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, resulting in paralysis and cell death. Half-life is 16 h; metabolized in liver. Single oral dose has similar efficacy to permethrin and may be most successful in patients with immunodeficiency or crusted scabies,16 and in patients with skin conditions that should not use topical medications. Not FDA approved for the treatment of scabies.
• Dosing
• Interactions
• Contraindications
• Precautions
Adult
150-200 mcg/kg/d (0.2 mg/kg) PO once; may repeat in 10-14 d; commercially available as 3 mg tab
Pediatric
<5 years: Not recommended
>5 years: Administer as in adults
52. All of the following cause photosensitivity except:
- Lithium
- Propranolol
- Tetracycline
- Chloropromazine
- Chloropropamide


54. Blistering skin rash is a feature of the following dermatoses except:
- Erythema herpiticum
- Erythema multiforme
- Sulphonamide allergy
- Erythema nodosum

59.Dysplastic nevus syndrome all of the following are true except:
- Autosomal dominant
- Without family history of melanoma, risk of malignant transformation in 0.6% as whole life risk

Atypical moles can be inherited or sporadic. Formal genetic analysis has suggested an autosomal dominant mode of inheritance but genetic studies have not shown consistent data.

• A personal or family history of melanoma is more predictive for the future development of a melanoma than is the number of atypical moles.
• Among whites in the United States, the lifetime risk of developing a cutaneous melanoma is approximately 0.6%, or 1 in 150 individuals. In some studies of patients with FAMM, the overall lifetime risk of melanoma has been estimated to be 100%.23
• The risk of melanoma is greater for those individuals who have 1 relative with melanoma than for those with no affected relative. The lifetime risk of melanoma may approach 100% in individuals with atypical moles who are from families prone to melanoma (ie, families having 2 or more first-degree relatives with melanoma).
• Individuals who have nevi with clinical or histologic characteristics of atypical moles but no family history of atypical moles or melanoma might also be at an increased risk for the development of melanoma. Several prospective studies have demonstrated that patients with atypical moles without an obvious family history of melanoma have an increased risk for the occurrence of melanoma.19,24 However, the relative risks for melanoma are lower than in those individuals with a clear family history of melanoma. Thus, the presence of atypical moles (sporadic or familial) may identify patients at increased risk for melanoma, much like fair skin or UV exposure.

61. Psoralin ultraviolet ray A (PUVA) all of the following are true except:
- useful in vitiligo
- contraindicated in SLE
- Used to treat some childhood intractable dermatosis
- Increase the risk of basal and squamous cell cancer



The Answers: one by one - الواحد تلو الأخر -
(( 1---- c , 2---b , 3---c , 14---c , 37---e , 13---2 , 14 --- e , 26---a , 2----b , 17----d , 11--b , 43---c , 11----c , 1---d , 52---a , 54---d , 61---c )))






و دمتم سالمين

د / أحمد الجيزاني
10-06-2011, 02:58 AM
صيادلة

-أي من الأدوية التالية يستخدم لعلاج ضغط الدم؟ (Inderal)
2-إلى أي مجموعة ينتمي الدواء التالي Atenolol؟ ( مجموعة B-Blockers)
3-الي أي مجموعة ينتمي الدواء التالي Spironolactone؟ Diuretcs))
4-ماهو المضاد الحيوي المناسب للحوامل؟ (Amoxil)
5-أي من الادوية الخاصة للضغط يمكن أعطائها الحامل؟ (Methyldopa)
6-ماهو الدواء المستخدم في علاج الاميبيا الجيارديا؟ (Metronidazole)flagyl
7-ماهو الاسم العلمي لفيتامين B1؟ (Thiamine)
8-أذكر أسم دواء لا يعطى لمريض مصاب بالربو؟
9-ماهي المدة العلاجية أو مدة علاج مرض السل T.B؟ من 6 أشهر الى 9 أشهر
10-مامعنى OTC؟ الأدوية التي تصرف بدون وصفة طبية أي الادوية الاوصفية
11-ماهو الترياق Antidote المستخدم للــWarfarin ؟ (Vitamin K)
12-أذكر أسم دواء يعطى OTC؟
13-ماهو الاسم العلمي للــ Capotine؟ (Captopril)
14-ماهو الأسم العلمي للــ Flagyl ؟ (Metronidazole)
15-أي من الادوية التالية يستخدم في علاج الأيدز H.I.V؟(Zidovudine)
16-ماهو الأسم العلمي لدواء Prozac؟ (Fluxotine)
17-على ماذا يحتوي المحلول ORS؟
18-ماهي درجة حفظ الانسولين؟ (في الثلاجة بدرجة حرارة من 2-8 مئوية)
19-مالون البول للأشخاص الدين يتناولون Rifampicin؟(يصبح لونه أحمر)
20-مانسبة الهيموجلوبين في الدم؟ (في الرجال من 13.5-16.5 & وفي النساء من 12.5-15.5)
21-ماذا يعني الاختصار q.i.d ؟ (جرعة واحد أربع مرات كل أربع وعشرون ساعة)
22-وصفة طبية تحتوي على Diclofenac Sodium بماذا تنصح المريض ؟(بأن يأخذ العلاج بعد الأكل)
23-ما أسم الناقل لمرض الملاريا؟ ( البعوض)
24-وصفه تحتوي على Prednsolone يؤخذ على النحو التالي
1X Tid X 3 days
1X Bid X 3 days
1X qid X 3 days
كم عدد الأقراص التي تصرفها للمريض؟ (18 قرص)
25-إمراءة أرادت ان تحمل وكانت تتناول دواء Neostigmine ماهي المدة التي يجب عليها أن تتوقف عن أستعمال الدواء قبل الحمل؟ (مدة التوقف هي أسبوعين)
26-ماذا يعالج الدواء Acyclovir ؟ ( الألتهابات الفيروسات)
27-ماهو الأسم العلمي لفيتامين سي؟ (Ascorbic Acid)
28-ماهو الدواء الذي يقوم بالقضاء على دودة الإسكارس ؟ (Mebendazole)
29-ماهي الطريقة التي يكون فيها الدواء 100% في الجسم؟ (بالوريد I.V )
30-ماهي طريقة حفظ اللقاحات؟ (تحفظ في الثلاجة)
31-مامعنى كلمة التحذيرات الموجودة على الدواء باللغة الانجليزية؟( Precautions)
32-كم عدد جرعات التطعيم لإلتهاب الكبد الوقائي؟ ( ثلاث مرات في السنة)
33-أذكر أربعة من الفيتامينات التي تذوب في الدهون؟ (Vit.K,Vit.D,Vit.E,Vit.A)
34-ماهي الجرعة القصوى للباراسيتامول؟ (أربعة جرام لكل يوم "أي 8 أقراص كل يوم")
35-لماذا تستخدم سلفات الباريوم؟ (وسيطة للأشعة)
36-اللعاب يقوم بتحويل الأكل الى ؟ ( مالتوز)
37-ماهي الجرعة القصوى للــ Captopril؟ (150 ملجم في اليوم" أي قرصين 25 ملجم ثلاث مرات )
38-أذكر الفيتامينات الذوابة في الماء؟ (Vit.c,Vit.B)
39-لتجنب أمتصاص المزيد من الدواء السام يعطى المريض ؟ ( الفحم الطبي "Charcoal”(
40-يستخدم مرضى السكري (النوع الثاني TypeII) مجموعة؟ ( Sulphonyl urea)
41-يستخدم دواء الثيوفللين في حالة ؟ ( موسع للقصبات الهوائية Bronchodilator)
42-مريض السكري المعتمد على الأنسولين يعطى فقط ؟ (إنسولين)
43-أي من الادوية التالية لايعطى في حالة الحمل؟ (Ciprofloxacine)
44-Cefaclor ينتمي لأحد المجاميع Cephalosporine فما هو الجيل؟ ( للجيل الثاني)
45-ماهو الأسم العلمي لدواء Voltaren وماهو أستخدامة؟ ( Diclofenac Sodium يستخدم في حالات روماتيزم المفاصل)
46-ماهو الأسم العلمي لدواءZantac وماهو استخدامة؟ ( Ranitidine يستخدم في حالة قرحة المعدة والحموضة)
47-من الادوية التالية يسبب السمية للكبد؟ ( باراسيتامول)
48-أي من الادوية التالية يسبب السمية الكلوية؟ ( جنتامايسين)
49-ماهو استخدام الدواء Sumatriptan؟ ( يستخدم لعلاج الشقيقة "الصداع النصفي" (
50-ماهو استخدام الدواء Nitrofurantoin ؟ ( يستخدم في حالة إلتهاب المجاري البوليةU.T.I.)
51-ماهو استخدام دواء Cimitidine ؟ ( في حالة قرحة المعدة والإثنى عشر)
52-ماهو الاسم العلمي لمستحضر Ventolin وماهو استخدامة؟ ( Sulbatamol" يستخدم في حالة الربو وموسع للشعب الهوائية)
53-ماهو الدواء المستخدم في حالة الجفاف نتيجة الأسهال؟ (محلول الجفاف O.R.S)
54-أذكر أربعة أدوية تستخدم في علاج مرضى السل؟
55-ماهو الدواء المستخدم في حالة نقص Thyroid Hormones؟ ( دواء Thyroxine Sodium)
56-ماهو المستحضر المستخدم في حال زيادة Thyroid Hormones؟ ( Carbimazole& Propylthioracil)
57-ماهي الحالة التي يستخدم فيها عقار Gliclazide وما أسمة التجاري؟ ( يستخدم لمرضى السكر واسمة التجاري Diamicron)
58-ماهو الأسم التجاري لعقار Nifedipine؟ ( Adalat)
59-ماهو الاسم العلمي لمستحضر Augmentin؟ (ِAmoxicillin – Clavulanate potassium)
60-ماهو الأسم العلمي لمستحضر Co-trimoxazol؟ ( Sulfamethoxazole-Trimethoprim)
61-أذكر أسم مستحضرين من مجموعة Aminoglycoside؟
62-أذكر خمسة من الأشكال الصيدلانية؟
63-أذكر الأسم التجاري لعقار Clarihromycin؟ (Klacid)
64-ماهو الترياق Antidoteلعقار الهيبارين؟ (Protamin Sulphate)
65-أذكر الأسم العلمي للــVit.B6؟ (Pyridoxine)
66-ماهو أستخدام عقار Acetazolamide وماهو اسمة التجاري؟ ( يستخدم في علاج حالات الجلوكوما Diamox)
67-مامعنى الاختصارات التالية Susp,Sol,Syr,Cap,Drup,Oint
68- متى لا نستطيع وصف الأسبرين للمريض ؟ ( أذا كان يعاني من قرحة أو حموضة)
69-مالفرق بين الاموكسيل والاوجومنتين ؟
70-مامعنى المصطلحات التالية "Bid,I.V,Amp.SOS”?
71-ماذا تعني النسبة Dextrose 5%؟ ( محلول دكستروز يحتوي على5 ملجرام لكل 100مل)
72-مالأسم العلمي لمستحضر Aspirin؟ (Acetylsalicylic Acid)
73-أذكر ثلاث طرق لنظام الترتيب الصيدلية؟ ( حسب الاحرف الابجدية , الشكل الصيدلاني , حسب الأستعمال)
74-لماذا يستخدم عقار Metoclopramide وماهو اسمة التجاري؟ (يستخدم في علاج حالات القيء واسمة التجاري Plasil, Prempiran)
75-ماذا يمكن ان يستخدم في علاج حالات الإمساك ؟ ( تحاميل Glycerin)
76-اعطي الاسم العلمي للمستحضرات التالية " Captopril ,Cephlexin,Allopurinol,Capoten ,Keflex,Zyloric؟
77-أذكر اسمين من الاسماء العلمية من مجموعة الـPenicillin؟
78-مامعنى المصطلح التالي G.I.T و T.B ؟
79-أذا كان لديك دواء وكتب علية يحفظ في درجة حرارة 59 فهرنهاتية فكم تكون درجة الحفظ بالدرجة المئوية ؟ ( الدرجة المئوية = الدرجة الفهرنهايتية –32X 5/9
=(59-32) X 5 ÷ 9=15 درجة مئوية)
80-ماهو الأسم العلمي لمستحضر Lasix وما أستخدامة؟ ( Frusemide واستخدامة مدر للبول)
81- ماهو استخدام عقار Simvastatin وماهو اسمة التجاري؟ ( يستخدم لتقليل نسبة الكوليسترول في الدم واسمة التجاري Zocor)
82-اذكر اسم عقار من مجموعة تتراسايكلين؟
83-ماهي درجة حرارة الثلاجة وماهي درجة حرارة الغرفة لحفظ الادوية؟ ( في الثلاجة من 2-8 درجة مئوية , وفي الغرفة من 15-25 درجة مئوية )
84-مامعنى الاختصار O.R.S ؟
85-مامعنى الاختصار NSAIDs؟
86-ماهو استخدام عقار Metformin؟
87-أذكر ثلاث استخدامات للــ Aspirin؟
88- أذكر أثنين من كل جيل لمجموعة السيفالوسبورينات؟
89-اي من الادوية التاليةيستخدم في علاج الضغط؟ Diltazem
90-الي اي مجموعة ينتمي الدواء Atenolol؟Bblockers
91-الى اي مجموعة ينتمي spironolocton? من المدرات البولية الحافضة للبوتاسيوم
92-اي من الادوية الخاصة للضغط يمكن اعطائة للحوامل؟ methyldopa
93-اي من الخواص التالية من خواص Mannitol? مدر بولي ولايعطى عن طريق الفم ويعطىI.V . I.M
94-ماهو المضاد المناسب للحوامل؟ Amoxicillin
95-ماهو الاسم العلمي للFLAGYL? هو metronidazole
96-ماهو الدواء المستخدمفي علاج الاميباء GARDIASIS? هو metronidazole
97-lماهو الترياق المستخدم للWarfarin? هو vitamin k
98-ماهو الاسم العلمي لفيتامين B1? هو THIAMINE
99-ماهي الادوية التي لاتعطى في حالة الربو؟BRUFEN,ASPIRIN,VOLTAREN, ADOL
100-ماهي المدة لعلاج مرض السل T.B? هي ستة اشهر
101-اي من الاتي يعطى بدون وصفة (OTC)? المسكنات البسيطة SIMPLE ANALGESIC
102-مأهي أشهرالمسكنات شيوعا؟
السالسيلات salicylates
البارستامول paracetamol
ايبوبرفين ibuprofen
دايكلوفيناك Diclofenac

د / أحمد الجيزاني
10-06-2011, 02:59 AM
-مأهي الاثار الاجانبيه لasprin?
تخريش البطانة المعدية
واضعاف قدرة الدم على التخثر
أما جرعاته الكبيرة فقد تسبب القيء والغثيان وطنين الاذن والتحسس
وتضعف قدرة الدم على التخثر
104-مأهي لمسكنات المخدرة شائعة الاستعمال?
كوديين codeine
بثيدين pethidine
مورفين morphine
105-ماهي ادوية المهدئات والمنومات الباربيتوية؟
PHENOBARITONE
AMYLLOBARBITONE
SECOBARBITAL
106-مأهي المهدئات الصغرى المزيله للقلق؟
Diazepam
Nitrazepam
Chlordiazepoxiiide
107-مأهي الادويه الغير ضاره خلال فترة الحمل؟
الباراسيتامول.
سلفات المغنزيوم.
الأنسولين.
الميتوكلوبراميد.
الميكليزين.
البيريدوكسين.
كلورفينيرامين.
التربروليدين.
البنسلين.
الأموكسيسللين.
الكلافونيك اسيد.
السيفالوسبورينات.
الأمبيسيللين.
الأربثرومايسين.
الببراسيللين.
اللوبيراميد.
الليفوتيروكسين.
أدويه الحديد.
أدويه المغنيزيوم.
108-الادوية وماهي استخدماتها؟
Actifed >>> للحساسية و النشلة
Adalat 20mg >>> للضغط
Aldomet >>> للضغط
Amydramine >>> طـارد للبلغم
/ Anti Hemoproct ointment
suppository >>> تحاميل و مرهم للبواسير
Aspirin 100 " Baby aspirin " >>> مسيل للدم
Aspirin 300 >>> مسكن قوي للألم
Atrovent solution >>> سائل يستخدم للربو (الكمام)
Beconase >>> بخاخ للأنف
Becotide >>> بخاخ للربو
Bepanthin cream / ointment >>> للحروق+ الصغار
Betamethasone 1% >>> كورتيزون للحساسية " موضعي "
Bezalip >>> لعلاج الدهون " غير الكولسترول "
Boldolaxine >>> ملين
Brufen 400mg >>> مسكن " لا يستخدم مع ادوية الحموضة "
Buscopan >>> لعلاج المقص و التقلصات بالبطن
Cafergot >>> للصداع النصفي
Canasten Cream >>> كريم للفطريات بين الأصابع
Canasten sloution >>> سائل للفطريات داخل الأذن
canasten supp. >>> تحاميل مهبلية للفطريات
Capoten >>> للضغط
Calaflam >>> مسكن قوي للأسنان
Chloramphinicol eye drop / ointment >>> قطرات للعين و مرهم للقمص
Claritin >>> للحساسية و الأنفلونزا
Daflon >>> للدوالي
Daktarin solution / supp. / cream >>> سائل و تحاميل و كريم للفطريات
Daonil >>> للتحكم بالسكر و تنظيمه داخل الجسم
Naphcon eye drop >>> قطرة للعين بحساسية العين و احتقانها
Dilzem >>> للضغط
Dulcolax / lactulose >>> ملين
Duphelac >>> ملين أسمونزي " يحتوي على السكر
Dusputalin >>> للقولون العصبي
Eltroxin 25mg / 50mg / 100mg >>> للغدة الدرقية
Fefol >>> حبوب مقوية للحديد بالدم " ثلاثية
Ferros Sulphate >>> ثنائية
109-مأهي المضادات التي تعمل على الغلاف الخارجي للبكترياBacterial Cell Wall؟
- بنسلين Penicillin
- سيفلوسبورين Cephalosporin
- فانكوميسين Vancomycin
- سيكلوسبرين Cyclosporine
110-مأهي مضادات تعمل على الغلاف الداخلي للبكتريا Bacterial Cell Membrane؟
نيستاتين Nystatin
111-لايقاف صناعة البروتين Protein Synthesis ؟
- ستربتوميسين Streptomycin
- كاناميسين Kanamycin
- أرثروميسين Erythromycin
- ريفامبيسين Rifampicin
- سبترين Septrin
112-مأهي استعمالات السلفا؟
1- علاج الحمى الشوكية .
2- علاج التهاب المسالك البولية .
3- علاج الاسهال .
4- علاج التهاب العين , و التراكوما .
5- علاج الحروق .
6- علاج التهاب القلون المزمن .
113-ما الفرق بين المستحلبات والمعلقات ؟
ج- المستحلبات : هي عبارة عن سائلين غرويين مع بعضهما ويكون جزيئات منتشرة على الاخر بشكل غير متجانس
المعلقات : عبارة عن جزيئات مادة صلبة منتشرة على سطح سائل بشكل غير ذائب
114-ما الفرق بين الأستايل سالسيلك اسيد و الباراسيتامول ؟
الاستايل سالسيلك اسيد :
1- خافض للحرارة 2- مسكن للالم 3- مضاد للالتهاب
الباراسيتامول :
1- خافض للحرارة 2- مسكن للالم
114-ما الفرق بين الاموكسيل و الاوقمنتين ؟
الاموكسيل : مضاد حيوي مشتق من بنسلين
الاوقمنتين : عبارة عن : اموكسيل + كلافينولانك اسيد
115-ما الفرق بين المراهم والكريمات ؟
ج- المراهم :
1- القاعدة لا تذوب في الماء
2- دهنية
3- w-o
الكريمات :
1- القاعدة تذوب في الماء
2- غير دهنية
3- o-w
116-هذي ادويه بعض الاجهزه في الجسم؟
أدوية الجهاز الهضمي :
مضادات الحموضة – مضادات الدوبامين - مثبطات مضخة البروتون – مثبطات مستقبل الهستامين 2 – مماثلات البروستاغلاندين – الواقيات الخلوية . الملينات – مضادات التشنج – مضادات الإسهال – مفرزات العصارة الصفراء – المسكنات المركزية .
أدوية الجهاز القلبي الوعائي :
حاصرات المستقبل بيتا - حاصرات قنوات الكالسيوم – المدرات – الغليكوزيدات القلبية – مضادات اللانظميات - مركبات النترات – مضادات الذبحة الصدرية - المقبضات الوعائية – المرخيات الوعائية – مثبطات الانزيم المحول للأنغيوتنسين – حاصرات مستقبل الأنغيوتنسين – حاصرات ألفا – مضادات التخثر – الهيبارين – مضادات الصفيحات – محللات الفيبرين – مخفضات الدسم – الستاتينات -
أدوية الجهاز العصبي المركزي :
المنومات – المخدرات – مضادات الذهان – مضادات الإقياء – مضادات الصرع (الاختلاجات) – المنبهات – الباربيتوريات –البنزوديازبين – مضادات الدوبامين– مضادات الهستامين – مشابهات الكولين –مضادات الكولين - مضادات السيروتونين – الكانابينودات – الأفيونات .
الأدوية المخدرة :
المسكنات : (المسكنات غير الستيروئيدية - الأفيونات - ) - المخدرات الموضعية – المخدرات العامة – المنومات ( المثبطات ) - أدوية الصداع النصفي ( الشقيقة ) .
أدوية الجهاز العضلي الهيكلي :
أدوية العين :
مضادات جرثومية : مضادات الالتهاب : مضادات الزرق : مضادات الحساسية :


أدوية الأنف و الأذن و الحنجرة :
أدوية الجهاز التنفسي :
الموسعات القصبية – مضادات السعال – الحالات المخاطية – حاصرات بيتا – مضادات الكولين – الستيروئيدات .
أدوية الغدد الصم :
أندروجينات - مضادات الأندروجين - الكورتيزونات - هرمونات النمو - الأنسولين - مضادات السكري – الهرمونات الدرقية – ادوية مضادات الدرق – مماثلات الفازوبريسين
أدوية الجهاز البولي:

أدوية الجهاز التناسلي :
مانعات الحمل – المضادات الفطرية - مضادات الانتانات المهبلية - المقويات الجنسية
الأدوية الجلدية :
الأدوية المضادة للأحياء الممرضة :
المضادات الحيوية – المضادات الفيروسية – المضادات الفطرية -
أدوية المناعة :
أدويةالإضطرابات التحسسية :
أدوية الإضطرابات الورمية :
117-مأهي ادوية السكر وماهي اهميه استخدامها؟
* الانسولين :
يعتبر الانسولين من أهم الهرمونات الموجودة في جسم الإنسان حيث يعمل كمصدر للطاقة اللازمة لعملية النمو في الكائن الحي, يعمل الانسولين كوسيط لتسهيل نقل السكر من الدم الى خلايا العضلات، خلايا الكبد، وخلايا الانسجة الدهنية.
يهدف العلاج بالانسولين لتعويض نقص هرمون الانسولين بعد ان اصاب المريض خلل في غدة البنكرياس وعجزت عن إفراز الكميات الضرورية لاستهلاك كمية السكر في جسم ذلك المريض فالانسولين يعمل على المحافظة على توازن السكر في الدم وتثبيط توليد الكيتونات إضافة الى المحافظة على صحة مريض السكر من المضاعفات الناتجة من مرض السكر.

* انواع الانسولين:
يمكن تقسيم الانسولين الأكثر تداولا الى:
انسولين سريع المفعول (صافي) وهو سريع الامتصاص وقصير الأجل.
أنسولين معتدل المفعول (عكر) وهو بطيء الامتصاص وفترة مكوثه معتدلة.
أنسولين طويل المفعول (الترا) وامتصاصه بطيء جدا وهو طويل الأجل
أنسولين مخلوط (عكر + صافي بنسبة ثابتة 50:50 أو 30:70)
كما يمكن خلط الأنسولين بنسب ثابتة من الانسولين سريع المفعول ومعتدل المفعول بحسب طلب الطبيب المعالج وتختلف هذه الانسولينات من الناحية الدوائية من حيث بداية المفعول، أعلى تركيز، وفترة تواجد في الدم (كما في الجدول المنشور)
ويعمل الانسولين كمصدر لحرق الوقود واستغلال هذه العملية لبناء الكائن الحي، لذلك فإن تأثير الأنسولين ومفعوله الحيوي بالإضافة لنسبة امتصاصه بعد حقنه تحت الجلد يعتمد على عوامل عديدة,,كما هو موضح فى الجدول المنشور .

لأدوية التي تعطى عن طريق الفم:
تنقسم هذه الادوية الى المجموعات التالية:
مجموعة السلفونيل يوريا Sulfonylurea
مجموعة البيقونيد Biquanide
مجموعة مثبطات إنزيم ألفا - جليكوزيديز Oc- Glucosidase Inhibitors
مجموعة ثيو زيليدين دايون Thiozolidinedione
مجموعة السلفونيل يوريا Sulfonylurea
وهي مجموعة الأدوية الأكثر شيوعا واستعمالا من قبل مرضى السكر, تعتبر أفضل الأدوية التي تعطى عن طريق الفم من الناحية الاقتصادية والدوائية، تعمل هذه الأدوية بتنبيه البنكرياس لإفراز الأنسولين.
أهم الآثار الجانبية لهذه الأدوية أنها تعمل على تخفيض حاد للسكر بالدم وبخاصة عند اولئك المرضى الذين لا يتناولون وجبة الطعام بعد حبة الدواء, تؤخذهذه الأدوية قبل تناول وجبة الأكل.

أمثلة على مجموعة السلفونيل يوريا Sulfonylurea
جلبنكلاميد 5ملجم Glibenclamide وأشهر الماركات:
داياتاب Diatab من الشركة الدوائية السعودية.
جلبيل Glibil من شركة الحكمة الأردنية.
داونيل Daonil من شركة هوكست الألمانية
اوقلوكون Euglocon من شركة بهرنجر الألمانية.
جليبزيد 5ملجم Glipizide وأشهر الماركات:
ميندياب Minidiab من شركة كارلو أربا الإيطالية.
جليكلازيد 80ملجم Gliclazide وأشهر الماركات:
دايميكرون Dimicron من شركة سيرفير الفرنسية.
118-ماهي مجموعات ادوية مرض السكر؟
مجموعة البيقونيد Biquanide
تستخدم هذه المجموعة عند بداية الشعور بمرض السكر، تعمل هذه الأدوية:
* تنشيط استهلاك السكر في النهايات الطرفية.
* تقلل تحليل السكر وخروجه من الكلية.
* تزيد استهلاك الامعاء للسكر.
يتم تناول الحبوب بعد وجبة الأكل.
مثال لهذه المجموعة:
ميتفورمين 500 ملجم و850ملجم Metformin وأشهر ماركة جلوكوفاج Glucofage

مجموعة مثبطات إنزيم ألفا - جليكوزيديز A - Glucosidase Inhibitors
تستخدم هذه المجموعة لتقليل ارتفاع السكر الناتج بعد تناول الأكل عن طريق تثبيط هذا الإنزيم.
أهم الآثار الجانبية لهذه الأدوية أنها تعمل على تخمر السكر بالأمعاء وبالتالي تؤدي إلى زيادة في الغازات ومضايقات في البطن.
مثال لهذه المجموعة 50ملجم و100ملجم Acarbose وأشهر ماركة جلوكوباي Glucobay.

مجموعة ثيوزيليدين دايون Thiozolidinedione
تعتبر هذه المجموعة أحدث أدوية السكر وتعمل:
* زيادة حساسية الأنسولين للالتصاق بمستقبلات الخلية.
* تقلل كمية السكر الناتج من الكبد وذلك بتقليل عملية تحليل السكريات الى سكريات سهلة الامتصاص.
ما زالت هذه المجموعة في بداية الاستعمال وبعضها شديد السمية للدم والكبد بالإضافة الى تأثيراتها الجانبية للقلب،
مثال لهذه المجموعة:
تروقلايتازون 200 ملجم Troglitazone واشهر ماركة ريزولين Rezulin.
119-ما هو الـ آي ان آر (INR)؟
ويسمى مقياس مدى السيولة للدم (International Normalized Ratio). ولهذا الاختبار مدى هو2 إلى 3 في أكثر الحالات و2.5 إلى 3.5 لحالات عمليات الصمام الصناعي القلبي. وبتأثر فعالية الدواء يتأثر هذا الاختبار. كلما قلت قيمة الاختبار قلت السيولة و العكس صحيح.
120-متى تعطي الجرعة فعاليتها؟
تبدأ فعالية الوارفارين (Warfarin) بعد 6 ساعات من الجرعة الأولى و تصل إلى أقصى فعالية بعد 72 أو 96 ساعة وتستمر الفعالية للوارفارين (Warfarin) حتى خمسة أيام.
120-متى تعطي الجرعة فعاليتها؟
تبدأ فعالية الوارفارين (Warfarin) بعد 6 ساعات من الجرعة الأولى و تصل إلى أقصى فعالية بعد 72 أو 96 ساعة وتستمر الفعالية للوارفارين (Warfarin) حتى خمسة أيام.
121-ما هي الأعراض الجانبية المتوقعة للوارفارين (Warfarin)؟
فيما يلي الأعراض الجانبية الدارجة عند استخدام الوارفارين (Warfarin) ولا تلزم ايقاف تناول الدواء. ولكن عند ظهور أعراض خطيرة أو استمرار هذه الأعراض يجب مراجعة مقدمي الرعاية الصحية:

صداع أو غثيان أو ضعف عام.
نزيف الدم من الأماكن المجروحة.
نزيف الدم من اللثة عند تفريشها.
ظهور بقع غامقة على الجلد من غير أسباب معروفة.
ظهور اللون الحمر أو البني الغامق في البول أو البراز. ( يفضل مراجعة الطبيب عند ظهور هذه الأعراض )
خروج دم مع القيء. ( يفضل مراجعة الطبيب عند ظهور هذه الأعراض )
121-ما هي موانع تناول الوارفارين (Warfarin) ؟
الحمل أو التخطيط على الحمل. ويجب إخبار مقدمي الرعاية الصحية عند التخطيط للحمل.
إصابة المريض بقرحة مسببه للنزيف دموي من الأحشاء.
الحساسية ضد الدواء. يجب إخبار مقدمي الرعاية الصحية عن ذلك.
122-الأدوية التي تؤثر على فعالية الوارفارين (Warfarin)؟
الاسبيرين(aspirin).
البنادول(acetaminophin).
ايبوبروفين(ibuprofen).
نابروكسين(naproxen).
المضادات الحيوية بشكل عام (يجب مناقشة مقدمي الرعاية الصحية قبل تناولها).
123-مأهي الادويه التي تعالج الكحة الجافه؟
a-دكسترومثروفان(Dextromethorphan )
b-ترايبروليدين(triprolidine)
124-مأهي مضادات الهستامين؟
Diphenhydramine
cetirizine
loratadine
125-مأهي الية عمل ال(salbutamol)(ventolin)?
التأثير المباشر على مستقبلات ب2 في العضلات الملساء ممايؤدي الاتوسيع القصبات
الهوائيه ولايؤثرعلى القلب اوظغط الدم
126-مأهي استخدمات ال(salbutamol)(ventolin)؟
1-علاج الربو
2-تثبيت الحمل في الثلاث الاشهر الاخيرة
127-مأهي الية عمل ال(Theophylline)ومأهي استخدماته واعراضه؟
أليه عمله:يتنافس مع الادينوسين ويثبط مستقبلاته وهذا يؤدي الى استرخاء العضلات
الملساء.
استخدماته:
1-الربو.
2-الالتهاب الشعبي المزمن.
3-انتفاخ الرئه.
3-مرض انسدادالرئوي المزمن.
128-أعراضة الجانبيه:
1-غثيان .قي.نزيف دموي بالمعده.
2-ارق .قلق وانفعال نتيجة cns
3-انخفاض ظغط الدم خاصة بعد الحقن الوريدي(i.v)
129-ماهي وظيفة عمل دواء ال(Disinil)?
يستخدم للدوخة مثل ركوب السفينه
130-مأهي ألية عمل ال(بروفين)(Iprofen)?
يثبط تصنيع البروستاجلادين عن طريق تنشيط انزيم(cox)(cycloygenase)?
131-مأهي الية عمل البارستيمول(parcetmol)?
يثبط تصنيع البروستاجلادين عن طريق تنشيط انزيم(cox3)(cycloygenase
132-مأهي الية عمل الموبك(mobic)?
يثبط تصنيع البروستاجلادين عن طريق تنشيط انزيم(cox2)(cycloygenase
133-كيف تستخدم اكياس الmovicolاوnormacolاوflaggel?
تخلط بالماء وهي الياف للمعده.
134-مأهو دواء الدايجوكسين(Digoxine)?
ينشط عظله القلب ويـأخدمرة وحده يوميا
135-مأهي امرأض الجهاز التنفسي؟
1-الكحه الجافه 2-الكحه المصاحبه بالبلغم
136-مأهي مسببات الآلتهاب؟
1-ميكانيكيه:الظربه.الجروح .الصدمات
2-كيميائيه:الآحماض القلويه
3-أورام خبيثه:السرطان
4-تحسسيه:بسبب الحقن لمواد قد يكون الحسم حساس لها
137-مأهو دواء هيدروكسيديوريا(Hydroxyurea)?
علاج الانيما ويستخدم لسرطان الدم.
138-ماهو دواء ال(tomoxifen)?
لعلاج سرطان الثدي.
139-لماذا يعطي دواء الباسكوبان(Buscopan)?
1-المغص.........2.الالام الجنب
140-مأهي ادوية مرض السكري؟
1-الانسولين
2-METFORMIN
3-DIMICRON
141-لماذا يستخدم دواء الكابترويل(Captopril)?
للظغط والقلب
142-مأهي الاثار الجانبيه للبنسلين؟
1-الحكه الجلديه
2-الحساسيه المفرطه
143-متى يأخد ال(Ventolien)?
يأخد بختين سوى كل 12ساعه
144-مأهي أنواع المسكنات؟
1-المخدرة
2-الغير مخدره
3-الغير ستيروديه
145-مأهي المسكنات المخدرة؟
1-قلويات الافيون
2-مشتقات المروفين النصف المصنعه
3-مشتقات المروفين المصنعه
146-مأهي الاعراض الجانبيه اسبرين(asprin)?
1-اضطربات هظميه
2-طنين بالاذن
3-سميه في خلايا الكبد
147-مأهي خطورة استخدام اسبرين(asprin)?
الاطفال التي تقل اعمارهم عن 13سنه.
والذين لديهم حساسيه من الاسبرين.
148-مأهي خطورة استخدام البروفين(iburofen)?
المرضى الذي يعاني من تقرحات المعده
امرضى الذين لديهم حساسيه من البروفين
اي دواء من نفس المجموعه.
149-مأهي الاعراض الجانبيه للفولترين(Voltaren)?
اضطربات هظميه.
طفح جلدي.
ارتفاع في انزيمات الكبد.
150-ماهي خطورة دواء ال(meloxicam)(mobic)?
الحمل والرضاعه.
الاطفال الذين تقل اعمارهم عن 15عام.
القصورالكبدي الشديد.
القرحه المعديه الشديده.
151-مأهي المضادات الحيويه التي تثبط جدار الخليه البكتريه؟
1-البنسلين
2=الفانكوميسن
3-السيفالوسبورين.
152-ماهي الاثار الجانبية للبنسلين؟
الحساسيه الزائده
الحكه الجلديه
153-ماذا يحصل عند زياده الاسبرين(asprin)?
قرحه معديه
154-مأهي الادويه الموثرة على الفيروسات؟
1-inh
2-rifamcin
155-ماهي الادويه التي تخفظ الظغط؟
1-capoten
2-enalapril
3-coversyl
156-مأهي مجموعات الآدويه عبى الجنين؟
المجوعهA:الابحاث والتجارب التي على الانسان وليس لها ضرر.
المجموعهb:الابحاث والتجارب التي على الحيوان وعدم وجود خطوره على الجنين
المجموعهD:لايوجد لها درسات كافيه.
المجموعه x:تثبت ضررها على الجنين وتعارض على الحمل.
157-ماهي مجموعات مرض السكري؟
FIRST
1-Dymelor
2-Diabiesr
SECOND
1-Minidiab
2-Dimicron
3-Donil
THIRD
1-Amaryl

د / أحمد الجيزاني
10-06-2011, 02:59 AM
-مأهي الاثار الاجانبيه لasprin?
تخريش البطانة المعدية
واضعاف قدرة الدم على التخثر
أما جرعاته الكبيرة فقد تسبب القيء والغثيان وطنين الاذن والتحسس
وتضعف قدرة الدم على التخثر
104-مأهي لمسكنات المخدرة شائعة الاستعمال?
كوديين codeine
بثيدين pethidine
مورفين morphine
105-ماهي ادوية المهدئات والمنومات الباربيتوية؟
PHENOBARITONE
AMYLLOBARBITONE
SECOBARBITAL
106-مأهي المهدئات الصغرى المزيله للقلق؟
Diazepam
Nitrazepam
Chlordiazepoxiiide
107-مأهي الادويه الغير ضاره خلال فترة الحمل؟
الباراسيتامول.
سلفات المغنزيوم.
الأنسولين.
الميتوكلوبراميد.
الميكليزين.
البيريدوكسين.
كلورفينيرامين.
التربروليدين.
البنسلين.
الأموكسيسللين.
الكلافونيك اسيد.
السيفالوسبورينات.
الأمبيسيللين.
الأربثرومايسين.
الببراسيللين.
اللوبيراميد.
الليفوتيروكسين.
أدويه الحديد.
أدويه المغنيزيوم.
108-الادوية وماهي استخدماتها؟
Actifed >>> للحساسية و النشلة
Adalat 20mg >>> للضغط
Aldomet >>> للضغط
Amydramine >>> طـارد للبلغم
/ Anti Hemoproct ointment
suppository >>> تحاميل و مرهم للبواسير
Aspirin 100 " Baby aspirin " >>> مسيل للدم
Aspirin 300 >>> مسكن قوي للألم
Atrovent solution >>> سائل يستخدم للربو (الكمام)
Beconase >>> بخاخ للأنف
Becotide >>> بخاخ للربو
Bepanthin cream / ointment >>> للحروق+ الصغار
Betamethasone 1% >>> كورتيزون للحساسية " موضعي "
Bezalip >>> لعلاج الدهون " غير الكولسترول "
Boldolaxine >>> ملين
Brufen 400mg >>> مسكن " لا يستخدم مع ادوية الحموضة "
Buscopan >>> لعلاج المقص و التقلصات بالبطن
Cafergot >>> للصداع النصفي
Canasten Cream >>> كريم للفطريات بين الأصابع
Canasten sloution >>> سائل للفطريات داخل الأذن
canasten supp. >>> تحاميل مهبلية للفطريات
Capoten >>> للضغط
Calaflam >>> مسكن قوي للأسنان
Chloramphinicol eye drop / ointment >>> قطرات للعين و مرهم للقمص
Claritin >>> للحساسية و الأنفلونزا
Daflon >>> للدوالي
Daktarin solution / supp. / cream >>> سائل و تحاميل و كريم للفطريات
Daonil >>> للتحكم بالسكر و تنظيمه داخل الجسم
Naphcon eye drop >>> قطرة للعين بحساسية العين و احتقانها
Dilzem >>> للضغط
Dulcolax / lactulose >>> ملين
Duphelac >>> ملين أسمونزي " يحتوي على السكر
Dusputalin >>> للقولون العصبي
Eltroxin 25mg / 50mg / 100mg >>> للغدة الدرقية
Fefol >>> حبوب مقوية للحديد بالدم " ثلاثية
Ferros Sulphate >>> ثنائية
109-مأهي المضادات التي تعمل على الغلاف الخارجي للبكترياBacterial Cell Wall؟
- بنسلين Penicillin
- سيفلوسبورين Cephalosporin
- فانكوميسين Vancomycin
- سيكلوسبرين Cyclosporine
110-مأهي مضادات تعمل على الغلاف الداخلي للبكتريا Bacterial Cell Membrane؟
نيستاتين Nystatin
111-لايقاف صناعة البروتين Protein Synthesis ؟
- ستربتوميسين Streptomycin
- كاناميسين Kanamycin
- أرثروميسين Erythromycin
- ريفامبيسين Rifampicin
- سبترين Septrin
112-مأهي استعمالات السلفا؟
1- علاج الحمى الشوكية .
2- علاج التهاب المسالك البولية .
3- علاج الاسهال .
4- علاج التهاب العين , و التراكوما .
5- علاج الحروق .
6- علاج التهاب القلون المزمن .
113-ما الفرق بين المستحلبات والمعلقات ؟
ج- المستحلبات : هي عبارة عن سائلين غرويين مع بعضهما ويكون جزيئات منتشرة على الاخر بشكل غير متجانس
المعلقات : عبارة عن جزيئات مادة صلبة منتشرة على سطح سائل بشكل غير ذائب
114-ما الفرق بين الأستايل سالسيلك اسيد و الباراسيتامول ؟
الاستايل سالسيلك اسيد :
1- خافض للحرارة 2- مسكن للالم 3- مضاد للالتهاب
الباراسيتامول :
1- خافض للحرارة 2- مسكن للالم
114-ما الفرق بين الاموكسيل و الاوقمنتين ؟
الاموكسيل : مضاد حيوي مشتق من بنسلين
الاوقمنتين : عبارة عن : اموكسيل + كلافينولانك اسيد
115-ما الفرق بين المراهم والكريمات ؟
ج- المراهم :
1- القاعدة لا تذوب في الماء
2- دهنية
3- w-o
الكريمات :
1- القاعدة تذوب في الماء
2- غير دهنية
3- o-w
116-هذي ادويه بعض الاجهزه في الجسم؟
أدوية الجهاز الهضمي :
مضادات الحموضة – مضادات الدوبامين - مثبطات مضخة البروتون – مثبطات مستقبل الهستامين 2 – مماثلات البروستاغلاندين – الواقيات الخلوية . الملينات – مضادات التشنج – مضادات الإسهال – مفرزات العصارة الصفراء – المسكنات المركزية .
أدوية الجهاز القلبي الوعائي :
حاصرات المستقبل بيتا - حاصرات قنوات الكالسيوم – المدرات – الغليكوزيدات القلبية – مضادات اللانظميات - مركبات النترات – مضادات الذبحة الصدرية - المقبضات الوعائية – المرخيات الوعائية – مثبطات الانزيم المحول للأنغيوتنسين – حاصرات مستقبل الأنغيوتنسين – حاصرات ألفا – مضادات التخثر – الهيبارين – مضادات الصفيحات – محللات الفيبرين – مخفضات الدسم – الستاتينات -
أدوية الجهاز العصبي المركزي :
المنومات – المخدرات – مضادات الذهان – مضادات الإقياء – مضادات الصرع (الاختلاجات) – المنبهات – الباربيتوريات –البنزوديازبين – مضادات الدوبامين– مضادات الهستامين – مشابهات الكولين –مضادات الكولين - مضادات السيروتونين – الكانابينودات – الأفيونات .
الأدوية المخدرة :
المسكنات : (المسكنات غير الستيروئيدية - الأفيونات - ) - المخدرات الموضعية – المخدرات العامة – المنومات ( المثبطات ) - أدوية الصداع النصفي ( الشقيقة ) .
أدوية الجهاز العضلي الهيكلي :
أدوية العين :
مضادات جرثومية : مضادات الالتهاب : مضادات الزرق : مضادات الحساسية :


أدوية الأنف و الأذن و الحنجرة :
أدوية الجهاز التنفسي :
الموسعات القصبية – مضادات السعال – الحالات المخاطية – حاصرات بيتا – مضادات الكولين – الستيروئيدات .
أدوية الغدد الصم :
أندروجينات - مضادات الأندروجين - الكورتيزونات - هرمونات النمو - الأنسولين - مضادات السكري – الهرمونات الدرقية – ادوية مضادات الدرق – مماثلات الفازوبريسين
أدوية الجهاز البولي:

أدوية الجهاز التناسلي :
مانعات الحمل – المضادات الفطرية - مضادات الانتانات المهبلية - المقويات الجنسية
الأدوية الجلدية :
الأدوية المضادة للأحياء الممرضة :
المضادات الحيوية – المضادات الفيروسية – المضادات الفطرية -
أدوية المناعة :
أدويةالإضطرابات التحسسية :
أدوية الإضطرابات الورمية :
117-مأهي ادوية السكر وماهي اهميه استخدامها؟
* الانسولين :
يعتبر الانسولين من أهم الهرمونات الموجودة في جسم الإنسان حيث يعمل كمصدر للطاقة اللازمة لعملية النمو في الكائن الحي, يعمل الانسولين كوسيط لتسهيل نقل السكر من الدم الى خلايا العضلات، خلايا الكبد، وخلايا الانسجة الدهنية.
يهدف العلاج بالانسولين لتعويض نقص هرمون الانسولين بعد ان اصاب المريض خلل في غدة البنكرياس وعجزت عن إفراز الكميات الضرورية لاستهلاك كمية السكر في جسم ذلك المريض فالانسولين يعمل على المحافظة على توازن السكر في الدم وتثبيط توليد الكيتونات إضافة الى المحافظة على صحة مريض السكر من المضاعفات الناتجة من مرض السكر.

* انواع الانسولين:
يمكن تقسيم الانسولين الأكثر تداولا الى:
انسولين سريع المفعول (صافي) وهو سريع الامتصاص وقصير الأجل.
أنسولين معتدل المفعول (عكر) وهو بطيء الامتصاص وفترة مكوثه معتدلة.
أنسولين طويل المفعول (الترا) وامتصاصه بطيء جدا وهو طويل الأجل
أنسولين مخلوط (عكر + صافي بنسبة ثابتة 50:50 أو 30:70)
كما يمكن خلط الأنسولين بنسب ثابتة من الانسولين سريع المفعول ومعتدل المفعول بحسب طلب الطبيب المعالج وتختلف هذه الانسولينات من الناحية الدوائية من حيث بداية المفعول، أعلى تركيز، وفترة تواجد في الدم (كما في الجدول المنشور)
ويعمل الانسولين كمصدر لحرق الوقود واستغلال هذه العملية لبناء الكائن الحي، لذلك فإن تأثير الأنسولين ومفعوله الحيوي بالإضافة لنسبة امتصاصه بعد حقنه تحت الجلد يعتمد على عوامل عديدة,,كما هو موضح فى الجدول المنشور .

لأدوية التي تعطى عن طريق الفم:
تنقسم هذه الادوية الى المجموعات التالية:
مجموعة السلفونيل يوريا Sulfonylurea
مجموعة البيقونيد Biquanide
مجموعة مثبطات إنزيم ألفا - جليكوزيديز Oc- Glucosidase Inhibitors
مجموعة ثيو زيليدين دايون Thiozolidinedione
مجموعة السلفونيل يوريا Sulfonylurea
وهي مجموعة الأدوية الأكثر شيوعا واستعمالا من قبل مرضى السكر, تعتبر أفضل الأدوية التي تعطى عن طريق الفم من الناحية الاقتصادية والدوائية، تعمل هذه الأدوية بتنبيه البنكرياس لإفراز الأنسولين.
أهم الآثار الجانبية لهذه الأدوية أنها تعمل على تخفيض حاد للسكر بالدم وبخاصة عند اولئك المرضى الذين لا يتناولون وجبة الطعام بعد حبة الدواء, تؤخذهذه الأدوية قبل تناول وجبة الأكل.

أمثلة على مجموعة السلفونيل يوريا Sulfonylurea
جلبنكلاميد 5ملجم Glibenclamide وأشهر الماركات:
داياتاب Diatab من الشركة الدوائية السعودية.
جلبيل Glibil من شركة الحكمة الأردنية.
داونيل Daonil من شركة هوكست الألمانية
اوقلوكون Euglocon من شركة بهرنجر الألمانية.
جليبزيد 5ملجم Glipizide وأشهر الماركات:
ميندياب Minidiab من شركة كارلو أربا الإيطالية.
جليكلازيد 80ملجم Gliclazide وأشهر الماركات:
دايميكرون Dimicron من شركة سيرفير الفرنسية.
118-ماهي مجموعات ادوية مرض السكر؟
مجموعة البيقونيد Biquanide
تستخدم هذه المجموعة عند بداية الشعور بمرض السكر، تعمل هذه الأدوية:
* تنشيط استهلاك السكر في النهايات الطرفية.
* تقلل تحليل السكر وخروجه من الكلية.
* تزيد استهلاك الامعاء للسكر.
يتم تناول الحبوب بعد وجبة الأكل.
مثال لهذه المجموعة:
ميتفورمين 500 ملجم و850ملجم Metformin وأشهر ماركة جلوكوفاج Glucofage

مجموعة مثبطات إنزيم ألفا - جليكوزيديز A - Glucosidase Inhibitors
تستخدم هذه المجموعة لتقليل ارتفاع السكر الناتج بعد تناول الأكل عن طريق تثبيط هذا الإنزيم.
أهم الآثار الجانبية لهذه الأدوية أنها تعمل على تخمر السكر بالأمعاء وبالتالي تؤدي إلى زيادة في الغازات ومضايقات في البطن.
مثال لهذه المجموعة 50ملجم و100ملجم Acarbose وأشهر ماركة جلوكوباي Glucobay.

مجموعة ثيوزيليدين دايون Thiozolidinedione
تعتبر هذه المجموعة أحدث أدوية السكر وتعمل:
* زيادة حساسية الأنسولين للالتصاق بمستقبلات الخلية.
* تقلل كمية السكر الناتج من الكبد وذلك بتقليل عملية تحليل السكريات الى سكريات سهلة الامتصاص.
ما زالت هذه المجموعة في بداية الاستعمال وبعضها شديد السمية للدم والكبد بالإضافة الى تأثيراتها الجانبية للقلب،
مثال لهذه المجموعة:
تروقلايتازون 200 ملجم Troglitazone واشهر ماركة ريزولين Rezulin.
119-ما هو الـ آي ان آر (INR)؟
ويسمى مقياس مدى السيولة للدم (International Normalized Ratio). ولهذا الاختبار مدى هو2 إلى 3 في أكثر الحالات و2.5 إلى 3.5 لحالات عمليات الصمام الصناعي القلبي. وبتأثر فعالية الدواء يتأثر هذا الاختبار. كلما قلت قيمة الاختبار قلت السيولة و العكس صحيح.
120-متى تعطي الجرعة فعاليتها؟
تبدأ فعالية الوارفارين (Warfarin) بعد 6 ساعات من الجرعة الأولى و تصل إلى أقصى فعالية بعد 72 أو 96 ساعة وتستمر الفعالية للوارفارين (Warfarin) حتى خمسة أيام.
120-متى تعطي الجرعة فعاليتها؟
تبدأ فعالية الوارفارين (Warfarin) بعد 6 ساعات من الجرعة الأولى و تصل إلى أقصى فعالية بعد 72 أو 96 ساعة وتستمر الفعالية للوارفارين (Warfarin) حتى خمسة أيام.
121-ما هي الأعراض الجانبية المتوقعة للوارفارين (Warfarin)؟
فيما يلي الأعراض الجانبية الدارجة عند استخدام الوارفارين (Warfarin) ولا تلزم ايقاف تناول الدواء. ولكن عند ظهور أعراض خطيرة أو استمرار هذه الأعراض يجب مراجعة مقدمي الرعاية الصحية:

صداع أو غثيان أو ضعف عام.
نزيف الدم من الأماكن المجروحة.
نزيف الدم من اللثة عند تفريشها.
ظهور بقع غامقة على الجلد من غير أسباب معروفة.
ظهور اللون الحمر أو البني الغامق في البول أو البراز. ( يفضل مراجعة الطبيب عند ظهور هذه الأعراض )
خروج دم مع القيء. ( يفضل مراجعة الطبيب عند ظهور هذه الأعراض )
121-ما هي موانع تناول الوارفارين (Warfarin) ؟
الحمل أو التخطيط على الحمل. ويجب إخبار مقدمي الرعاية الصحية عند التخطيط للحمل.
إصابة المريض بقرحة مسببه للنزيف دموي من الأحشاء.
الحساسية ضد الدواء. يجب إخبار مقدمي الرعاية الصحية عن ذلك.
122-الأدوية التي تؤثر على فعالية الوارفارين (Warfarin)؟
الاسبيرين(aspirin).
البنادول(acetaminophin).
ايبوبروفين(ibuprofen).
نابروكسين(naproxen).
المضادات الحيوية بشكل عام (يجب مناقشة مقدمي الرعاية الصحية قبل تناولها).
123-مأهي الادويه التي تعالج الكحة الجافه؟
a-دكسترومثروفان(Dextromethorphan )
b-ترايبروليدين(triprolidine)
124-مأهي مضادات الهستامين؟
Diphenhydramine
cetirizine
loratadine
125-مأهي الية عمل ال(salbutamol)(ventolin)?
التأثير المباشر على مستقبلات ب2 في العضلات الملساء ممايؤدي الاتوسيع القصبات
الهوائيه ولايؤثرعلى القلب اوظغط الدم
126-مأهي استخدمات ال(salbutamol)(ventolin)؟
1-علاج الربو
2-تثبيت الحمل في الثلاث الاشهر الاخيرة
127-مأهي الية عمل ال(Theophylline)ومأهي استخدماته واعراضه؟
أليه عمله:يتنافس مع الادينوسين ويثبط مستقبلاته وهذا يؤدي الى استرخاء العضلات
الملساء.
استخدماته:
1-الربو.
2-الالتهاب الشعبي المزمن.
3-انتفاخ الرئه.
3-مرض انسدادالرئوي المزمن.
128-أعراضة الجانبيه:
1-غثيان .قي.نزيف دموي بالمعده.
2-ارق .قلق وانفعال نتيجة cns
3-انخفاض ظغط الدم خاصة بعد الحقن الوريدي(i.v)
129-ماهي وظيفة عمل دواء ال(Disinil)?
يستخدم للدوخة مثل ركوب السفينه
130-مأهي ألية عمل ال(بروفين)(Iprofen)?
يثبط تصنيع البروستاجلادين عن طريق تنشيط انزيم(cox)(cycloygenase)?
131-مأهي الية عمل البارستيمول(parcetmol)?
يثبط تصنيع البروستاجلادين عن طريق تنشيط انزيم(cox3)(cycloygenase
132-مأهي الية عمل الموبك(mobic)?
يثبط تصنيع البروستاجلادين عن طريق تنشيط انزيم(cox2)(cycloygenase
133-كيف تستخدم اكياس الmovicolاوnormacolاوflaggel?
تخلط بالماء وهي الياف للمعده.
134-مأهو دواء الدايجوكسين(Digoxine)?
ينشط عظله القلب ويـأخدمرة وحده يوميا
135-مأهي امرأض الجهاز التنفسي؟
1-الكحه الجافه 2-الكحه المصاحبه بالبلغم
136-مأهي مسببات الآلتهاب؟
1-ميكانيكيه:الظربه.الجروح .الصدمات
2-كيميائيه:الآحماض القلويه
3-أورام خبيثه:السرطان
4-تحسسيه:بسبب الحقن لمواد قد يكون الحسم حساس لها
137-مأهو دواء هيدروكسيديوريا(Hydroxyurea)?
علاج الانيما ويستخدم لسرطان الدم.
138-ماهو دواء ال(tomoxifen)?
لعلاج سرطان الثدي.
139-لماذا يعطي دواء الباسكوبان(Buscopan)?
1-المغص.........2.الالام الجنب
140-مأهي ادوية مرض السكري؟
1-الانسولين
2-METFORMIN
3-DIMICRON
141-لماذا يستخدم دواء الكابترويل(Captopril)?
للظغط والقلب
142-مأهي الاثار الجانبيه للبنسلين؟
1-الحكه الجلديه
2-الحساسيه المفرطه
143-متى يأخد ال(Ventolien)?
يأخد بختين سوى كل 12ساعه
144-مأهي أنواع المسكنات؟
1-المخدرة
2-الغير مخدره
3-الغير ستيروديه
145-مأهي المسكنات المخدرة؟
1-قلويات الافيون
2-مشتقات المروفين النصف المصنعه
3-مشتقات المروفين المصنعه
146-مأهي الاعراض الجانبيه اسبرين(asprin)?
1-اضطربات هظميه
2-طنين بالاذن
3-سميه في خلايا الكبد
147-مأهي خطورة استخدام اسبرين(asprin)?
الاطفال التي تقل اعمارهم عن 13سنه.
والذين لديهم حساسيه من الاسبرين.
148-مأهي خطورة استخدام البروفين(iburofen)?
المرضى الذي يعاني من تقرحات المعده
امرضى الذين لديهم حساسيه من البروفين
اي دواء من نفس المجموعه.
149-مأهي الاعراض الجانبيه للفولترين(Voltaren)?
اضطربات هظميه.
طفح جلدي.
ارتفاع في انزيمات الكبد.
150-ماهي خطورة دواء ال(meloxicam)(mobic)?
الحمل والرضاعه.
الاطفال الذين تقل اعمارهم عن 15عام.
القصورالكبدي الشديد.
القرحه المعديه الشديده.
151-مأهي المضادات الحيويه التي تثبط جدار الخليه البكتريه؟
1-البنسلين
2=الفانكوميسن
3-السيفالوسبورين.
152-ماهي الاثار الجانبية للبنسلين؟
الحساسيه الزائده
الحكه الجلديه
153-ماذا يحصل عند زياده الاسبرين(asprin)?
قرحه معديه
154-مأهي الادويه الموثرة على الفيروسات؟
1-inh
2-rifamcin
155-ماهي الادويه التي تخفظ الظغط؟
1-capoten
2-enalapril
3-coversyl
156-مأهي مجموعات الآدويه عبى الجنين؟
المجوعهA:الابحاث والتجارب التي على الانسان وليس لها ضرر.
المجموعهb:الابحاث والتجارب التي على الحيوان وعدم وجود خطوره على الجنين
المجموعهD:لايوجد لها درسات كافيه.
المجموعه x:تثبت ضررها على الجنين وتعارض على الحمل.
157-ماهي مجموعات مرض السكري؟
FIRST
1-Dymelor
2-Diabiesr
SECOND
1-Minidiab
2-Dimicron
3-Donil
THIRD
1-Amaryl

د / أحمد الجيزاني
10-06-2011, 02:59 AM
-مأهي الاثار الاجانبيه لasprin?
تخريش البطانة المعدية
واضعاف قدرة الدم على التخثر
أما جرعاته الكبيرة فقد تسبب القيء والغثيان وطنين الاذن والتحسس
وتضعف قدرة الدم على التخثر
104-مأهي لمسكنات المخدرة شائعة الاستعمال?
كوديين codeine
بثيدين pethidine
مورفين morphine
105-ماهي ادوية المهدئات والمنومات الباربيتوية؟
PHENOBARITONE
AMYLLOBARBITONE
SECOBARBITAL
106-مأهي المهدئات الصغرى المزيله للقلق؟
Diazepam
Nitrazepam
Chlordiazepoxiiide
107-مأهي الادويه الغير ضاره خلال فترة الحمل؟
الباراسيتامول.
سلفات المغنزيوم.
الأنسولين.
الميتوكلوبراميد.
الميكليزين.
البيريدوكسين.
كلورفينيرامين.
التربروليدين.
البنسلين.
الأموكسيسللين.
الكلافونيك اسيد.
السيفالوسبورينات.
الأمبيسيللين.
الأربثرومايسين.
الببراسيللين.
اللوبيراميد.
الليفوتيروكسين.
أدويه الحديد.
أدويه المغنيزيوم.
108-الادوية وماهي استخدماتها؟
Actifed >>> للحساسية و النشلة
Adalat 20mg >>> للضغط
Aldomet >>> للضغط
Amydramine >>> طـارد للبلغم
/ Anti Hemoproct ointment
suppository >>> تحاميل و مرهم للبواسير
Aspirin 100 " Baby aspirin " >>> مسيل للدم
Aspirin 300 >>> مسكن قوي للألم
Atrovent solution >>> سائل يستخدم للربو (الكمام)
Beconase >>> بخاخ للأنف
Becotide >>> بخاخ للربو
Bepanthin cream / ointment >>> للحروق+ الصغار
Betamethasone 1% >>> كورتيزون للحساسية " موضعي "
Bezalip >>> لعلاج الدهون " غير الكولسترول "
Boldolaxine >>> ملين
Brufen 400mg >>> مسكن " لا يستخدم مع ادوية الحموضة "
Buscopan >>> لعلاج المقص و التقلصات بالبطن
Cafergot >>> للصداع النصفي
Canasten Cream >>> كريم للفطريات بين الأصابع
Canasten sloution >>> سائل للفطريات داخل الأذن
canasten supp. >>> تحاميل مهبلية للفطريات
Capoten >>> للضغط
Calaflam >>> مسكن قوي للأسنان
Chloramphinicol eye drop / ointment >>> قطرات للعين و مرهم للقمص
Claritin >>> للحساسية و الأنفلونزا
Daflon >>> للدوالي
Daktarin solution / supp. / cream >>> سائل و تحاميل و كريم للفطريات
Daonil >>> للتحكم بالسكر و تنظيمه داخل الجسم
Naphcon eye drop >>> قطرة للعين بحساسية العين و احتقانها
Dilzem >>> للضغط
Dulcolax / lactulose >>> ملين
Duphelac >>> ملين أسمونزي " يحتوي على السكر
Dusputalin >>> للقولون العصبي
Eltroxin 25mg / 50mg / 100mg >>> للغدة الدرقية
Fefol >>> حبوب مقوية للحديد بالدم " ثلاثية
Ferros Sulphate >>> ثنائية
109-مأهي المضادات التي تعمل على الغلاف الخارجي للبكترياBacterial Cell Wall؟
- بنسلين Penicillin
- سيفلوسبورين Cephalosporin
- فانكوميسين Vancomycin
- سيكلوسبرين Cyclosporine
110-مأهي مضادات تعمل على الغلاف الداخلي للبكتريا Bacterial Cell Membrane؟
نيستاتين Nystatin
111-لايقاف صناعة البروتين Protein Synthesis ؟
- ستربتوميسين Streptomycin
- كاناميسين Kanamycin
- أرثروميسين Erythromycin
- ريفامبيسين Rifampicin
- سبترين Septrin
112-مأهي استعمالات السلفا؟
1- علاج الحمى الشوكية .
2- علاج التهاب المسالك البولية .
3- علاج الاسهال .
4- علاج التهاب العين , و التراكوما .
5- علاج الحروق .
6- علاج التهاب القلون المزمن .
113-ما الفرق بين المستحلبات والمعلقات ؟
ج- المستحلبات : هي عبارة عن سائلين غرويين مع بعضهما ويكون جزيئات منتشرة على الاخر بشكل غير متجانس
المعلقات : عبارة عن جزيئات مادة صلبة منتشرة على سطح سائل بشكل غير ذائب
114-ما الفرق بين الأستايل سالسيلك اسيد و الباراسيتامول ؟
الاستايل سالسيلك اسيد :
1- خافض للحرارة 2- مسكن للالم 3- مضاد للالتهاب
الباراسيتامول :
1- خافض للحرارة 2- مسكن للالم
114-ما الفرق بين الاموكسيل و الاوقمنتين ؟
الاموكسيل : مضاد حيوي مشتق من بنسلين
الاوقمنتين : عبارة عن : اموكسيل + كلافينولانك اسيد
115-ما الفرق بين المراهم والكريمات ؟
ج- المراهم :
1- القاعدة لا تذوب في الماء
2- دهنية
3- w-o
الكريمات :
1- القاعدة تذوب في الماء
2- غير دهنية
3- o-w
116-هذي ادويه بعض الاجهزه في الجسم؟
أدوية الجهاز الهضمي :
مضادات الحموضة – مضادات الدوبامين - مثبطات مضخة البروتون – مثبطات مستقبل الهستامين 2 – مماثلات البروستاغلاندين – الواقيات الخلوية . الملينات – مضادات التشنج – مضادات الإسهال – مفرزات العصارة الصفراء – المسكنات المركزية .
أدوية الجهاز القلبي الوعائي :
حاصرات المستقبل بيتا - حاصرات قنوات الكالسيوم – المدرات – الغليكوزيدات القلبية – مضادات اللانظميات - مركبات النترات – مضادات الذبحة الصدرية - المقبضات الوعائية – المرخيات الوعائية – مثبطات الانزيم المحول للأنغيوتنسين – حاصرات مستقبل الأنغيوتنسين – حاصرات ألفا – مضادات التخثر – الهيبارين – مضادات الصفيحات – محللات الفيبرين – مخفضات الدسم – الستاتينات -
أدوية الجهاز العصبي المركزي :
المنومات – المخدرات – مضادات الذهان – مضادات الإقياء – مضادات الصرع (الاختلاجات) – المنبهات – الباربيتوريات –البنزوديازبين – مضادات الدوبامين– مضادات الهستامين – مشابهات الكولين –مضادات الكولين - مضادات السيروتونين – الكانابينودات – الأفيونات .
الأدوية المخدرة :
المسكنات : (المسكنات غير الستيروئيدية - الأفيونات - ) - المخدرات الموضعية – المخدرات العامة – المنومات ( المثبطات ) - أدوية الصداع النصفي ( الشقيقة ) .
أدوية الجهاز العضلي الهيكلي :
أدوية العين :
مضادات جرثومية : مضادات الالتهاب : مضادات الزرق : مضادات الحساسية :


أدوية الأنف و الأذن و الحنجرة :
أدوية الجهاز التنفسي :
الموسعات القصبية – مضادات السعال – الحالات المخاطية – حاصرات بيتا – مضادات الكولين – الستيروئيدات .
أدوية الغدد الصم :
أندروجينات - مضادات الأندروجين - الكورتيزونات - هرمونات النمو - الأنسولين - مضادات السكري – الهرمونات الدرقية – ادوية مضادات الدرق – مماثلات الفازوبريسين
أدوية الجهاز البولي:

أدوية الجهاز التناسلي :
مانعات الحمل – المضادات الفطرية - مضادات الانتانات المهبلية - المقويات الجنسية
الأدوية الجلدية :
الأدوية المضادة للأحياء الممرضة :
المضادات الحيوية – المضادات الفيروسية – المضادات الفطرية -
أدوية المناعة :
أدويةالإضطرابات التحسسية :
أدوية الإضطرابات الورمية :
117-مأهي ادوية السكر وماهي اهميه استخدامها؟
* الانسولين :
يعتبر الانسولين من أهم الهرمونات الموجودة في جسم الإنسان حيث يعمل كمصدر للطاقة اللازمة لعملية النمو في الكائن الحي, يعمل الانسولين كوسيط لتسهيل نقل السكر من الدم الى خلايا العضلات، خلايا الكبد، وخلايا الانسجة الدهنية.
يهدف العلاج بالانسولين لتعويض نقص هرمون الانسولين بعد ان اصاب المريض خلل في غدة البنكرياس وعجزت عن إفراز الكميات الضرورية لاستهلاك كمية السكر في جسم ذلك المريض فالانسولين يعمل على المحافظة على توازن السكر في الدم وتثبيط توليد الكيتونات إضافة الى المحافظة على صحة مريض السكر من المضاعفات الناتجة من مرض السكر.

* انواع الانسولين:
يمكن تقسيم الانسولين الأكثر تداولا الى:
انسولين سريع المفعول (صافي) وهو سريع الامتصاص وقصير الأجل.
أنسولين معتدل المفعول (عكر) وهو بطيء الامتصاص وفترة مكوثه معتدلة.
أنسولين طويل المفعول (الترا) وامتصاصه بطيء جدا وهو طويل الأجل
أنسولين مخلوط (عكر + صافي بنسبة ثابتة 50:50 أو 30:70)
كما يمكن خلط الأنسولين بنسب ثابتة من الانسولين سريع المفعول ومعتدل المفعول بحسب طلب الطبيب المعالج وتختلف هذه الانسولينات من الناحية الدوائية من حيث بداية المفعول، أعلى تركيز، وفترة تواجد في الدم (كما في الجدول المنشور)
ويعمل الانسولين كمصدر لحرق الوقود واستغلال هذه العملية لبناء الكائن الحي، لذلك فإن تأثير الأنسولين ومفعوله الحيوي بالإضافة لنسبة امتصاصه بعد حقنه تحت الجلد يعتمد على عوامل عديدة,,كما هو موضح فى الجدول المنشور .

لأدوية التي تعطى عن طريق الفم:
تنقسم هذه الادوية الى المجموعات التالية:
مجموعة السلفونيل يوريا Sulfonylurea
مجموعة البيقونيد Biquanide
مجموعة مثبطات إنزيم ألفا - جليكوزيديز Oc- Glucosidase Inhibitors
مجموعة ثيو زيليدين دايون Thiozolidinedione
مجموعة السلفونيل يوريا Sulfonylurea
وهي مجموعة الأدوية الأكثر شيوعا واستعمالا من قبل مرضى السكر, تعتبر أفضل الأدوية التي تعطى عن طريق الفم من الناحية الاقتصادية والدوائية، تعمل هذه الأدوية بتنبيه البنكرياس لإفراز الأنسولين.
أهم الآثار الجانبية لهذه الأدوية أنها تعمل على تخفيض حاد للسكر بالدم وبخاصة عند اولئك المرضى الذين لا يتناولون وجبة الطعام بعد حبة الدواء, تؤخذهذه الأدوية قبل تناول وجبة الأكل.

أمثلة على مجموعة السلفونيل يوريا Sulfonylurea
جلبنكلاميد 5ملجم Glibenclamide وأشهر الماركات:
داياتاب Diatab من الشركة الدوائية السعودية.
جلبيل Glibil من شركة الحكمة الأردنية.
داونيل Daonil من شركة هوكست الألمانية
اوقلوكون Euglocon من شركة بهرنجر الألمانية.
جليبزيد 5ملجم Glipizide وأشهر الماركات:
ميندياب Minidiab من شركة كارلو أربا الإيطالية.
جليكلازيد 80ملجم Gliclazide وأشهر الماركات:
دايميكرون Dimicron من شركة سيرفير الفرنسية.
118-ماهي مجموعات ادوية مرض السكر؟
مجموعة البيقونيد Biquanide
تستخدم هذه المجموعة عند بداية الشعور بمرض السكر، تعمل هذه الأدوية:
* تنشيط استهلاك السكر في النهايات الطرفية.
* تقلل تحليل السكر وخروجه من الكلية.
* تزيد استهلاك الامعاء للسكر.
يتم تناول الحبوب بعد وجبة الأكل.
مثال لهذه المجموعة:
ميتفورمين 500 ملجم و850ملجم Metformin وأشهر ماركة جلوكوفاج Glucofage

مجموعة مثبطات إنزيم ألفا - جليكوزيديز A - Glucosidase Inhibitors
تستخدم هذه المجموعة لتقليل ارتفاع السكر الناتج بعد تناول الأكل عن طريق تثبيط هذا الإنزيم.
أهم الآثار الجانبية لهذه الأدوية أنها تعمل على تخمر السكر بالأمعاء وبالتالي تؤدي إلى زيادة في الغازات ومضايقات في البطن.
مثال لهذه المجموعة 50ملجم و100ملجم Acarbose وأشهر ماركة جلوكوباي Glucobay.

مجموعة ثيوزيليدين دايون Thiozolidinedione
تعتبر هذه المجموعة أحدث أدوية السكر وتعمل:
* زيادة حساسية الأنسولين للالتصاق بمستقبلات الخلية.
* تقلل كمية السكر الناتج من الكبد وذلك بتقليل عملية تحليل السكريات الى سكريات سهلة الامتصاص.
ما زالت هذه المجموعة في بداية الاستعمال وبعضها شديد السمية للدم والكبد بالإضافة الى تأثيراتها الجانبية للقلب،
مثال لهذه المجموعة:
تروقلايتازون 200 ملجم Troglitazone واشهر ماركة ريزولين Rezulin.
119-ما هو الـ آي ان آر (INR)؟
ويسمى مقياس مدى السيولة للدم (International Normalized Ratio). ولهذا الاختبار مدى هو2 إلى 3 في أكثر الحالات و2.5 إلى 3.5 لحالات عمليات الصمام الصناعي القلبي. وبتأثر فعالية الدواء يتأثر هذا الاختبار. كلما قلت قيمة الاختبار قلت السيولة و العكس صحيح.
120-متى تعطي الجرعة فعاليتها؟
تبدأ فعالية الوارفارين (Warfarin) بعد 6 ساعات من الجرعة الأولى و تصل إلى أقصى فعالية بعد 72 أو 96 ساعة وتستمر الفعالية للوارفارين (Warfarin) حتى خمسة أيام.
120-متى تعطي الجرعة فعاليتها؟
تبدأ فعالية الوارفارين (Warfarin) بعد 6 ساعات من الجرعة الأولى و تصل إلى أقصى فعالية بعد 72 أو 96 ساعة وتستمر الفعالية للوارفارين (Warfarin) حتى خمسة أيام.
121-ما هي الأعراض الجانبية المتوقعة للوارفارين (Warfarin)؟
فيما يلي الأعراض الجانبية الدارجة عند استخدام الوارفارين (Warfarin) ولا تلزم ايقاف تناول الدواء. ولكن عند ظهور أعراض خطيرة أو استمرار هذه الأعراض يجب مراجعة مقدمي الرعاية الصحية:

صداع أو غثيان أو ضعف عام.
نزيف الدم من الأماكن المجروحة.
نزيف الدم من اللثة عند تفريشها.
ظهور بقع غامقة على الجلد من غير أسباب معروفة.
ظهور اللون الحمر أو البني الغامق في البول أو البراز. ( يفضل مراجعة الطبيب عند ظهور هذه الأعراض )
خروج دم مع القيء. ( يفضل مراجعة الطبيب عند ظهور هذه الأعراض )
121-ما هي موانع تناول الوارفارين (Warfarin) ؟
الحمل أو التخطيط على الحمل. ويجب إخبار مقدمي الرعاية الصحية عند التخطيط للحمل.
إصابة المريض بقرحة مسببه للنزيف دموي من الأحشاء.
الحساسية ضد الدواء. يجب إخبار مقدمي الرعاية الصحية عن ذلك.
122-الأدوية التي تؤثر على فعالية الوارفارين (Warfarin)؟
الاسبيرين(aspirin).
البنادول(acetaminophin).
ايبوبروفين(ibuprofen).
نابروكسين(naproxen).
المضادات الحيوية بشكل عام (يجب مناقشة مقدمي الرعاية الصحية قبل تناولها).
123-مأهي الادويه التي تعالج الكحة الجافه؟
a-دكسترومثروفان(Dextromethorphan )
b-ترايبروليدين(triprolidine)
124-مأهي مضادات الهستامين؟
Diphenhydramine
cetirizine
loratadine
125-مأهي الية عمل ال(salbutamol)(ventolin)?
التأثير المباشر على مستقبلات ب2 في العضلات الملساء ممايؤدي الاتوسيع القصبات
الهوائيه ولايؤثرعلى القلب اوظغط الدم
126-مأهي استخدمات ال(salbutamol)(ventolin)؟
1-علاج الربو
2-تثبيت الحمل في الثلاث الاشهر الاخيرة
127-مأهي الية عمل ال(Theophylline)ومأهي استخدماته واعراضه؟
أليه عمله:يتنافس مع الادينوسين ويثبط مستقبلاته وهذا يؤدي الى استرخاء العضلات
الملساء.
استخدماته:
1-الربو.
2-الالتهاب الشعبي المزمن.
3-انتفاخ الرئه.
3-مرض انسدادالرئوي المزمن.
128-أعراضة الجانبيه:
1-غثيان .قي.نزيف دموي بالمعده.
2-ارق .قلق وانفعال نتيجة cns
3-انخفاض ظغط الدم خاصة بعد الحقن الوريدي(i.v)
129-ماهي وظيفة عمل دواء ال(Disinil)?
يستخدم للدوخة مثل ركوب السفينه
130-مأهي ألية عمل ال(بروفين)(Iprofen)?
يثبط تصنيع البروستاجلادين عن طريق تنشيط انزيم(cox)(cycloygenase)?
131-مأهي الية عمل البارستيمول(parcetmol)?
يثبط تصنيع البروستاجلادين عن طريق تنشيط انزيم(cox3)(cycloygenase
132-مأهي الية عمل الموبك(mobic)?
يثبط تصنيع البروستاجلادين عن طريق تنشيط انزيم(cox2)(cycloygenase
133-كيف تستخدم اكياس الmovicolاوnormacolاوflaggel?
تخلط بالماء وهي الياف للمعده.
134-مأهو دواء الدايجوكسين(Digoxine)?
ينشط عظله القلب ويـأخدمرة وحده يوميا
135-مأهي امرأض الجهاز التنفسي؟
1-الكحه الجافه 2-الكحه المصاحبه بالبلغم
136-مأهي مسببات الآلتهاب؟
1-ميكانيكيه:الظربه.الجروح .الصدمات
2-كيميائيه:الآحماض القلويه
3-أورام خبيثه:السرطان
4-تحسسيه:بسبب الحقن لمواد قد يكون الحسم حساس لها
137-مأهو دواء هيدروكسيديوريا(Hydroxyurea)?
علاج الانيما ويستخدم لسرطان الدم.
138-ماهو دواء ال(tomoxifen)?
لعلاج سرطان الثدي.
139-لماذا يعطي دواء الباسكوبان(Buscopan)?
1-المغص.........2.الالام الجنب
140-مأهي ادوية مرض السكري؟
1-الانسولين
2-METFORMIN
3-DIMICRON
141-لماذا يستخدم دواء الكابترويل(Captopril)?
للظغط والقلب
142-مأهي الاثار الجانبيه للبنسلين؟
1-الحكه الجلديه
2-الحساسيه المفرطه
143-متى يأخد ال(Ventolien)?
يأخد بختين سوى كل 12ساعه
144-مأهي أنواع المسكنات؟
1-المخدرة
2-الغير مخدره
3-الغير ستيروديه
145-مأهي المسكنات المخدرة؟
1-قلويات الافيون
2-مشتقات المروفين النصف المصنعه
3-مشتقات المروفين المصنعه
146-مأهي الاعراض الجانبيه اسبرين(asprin)?
1-اضطربات هظميه
2-طنين بالاذن
3-سميه في خلايا الكبد
147-مأهي خطورة استخدام اسبرين(asprin)?
الاطفال التي تقل اعمارهم عن 13سنه.
والذين لديهم حساسيه من الاسبرين.
148-مأهي خطورة استخدام البروفين(iburofen)?
المرضى الذي يعاني من تقرحات المعده
امرضى الذين لديهم حساسيه من البروفين
اي دواء من نفس المجموعه.
149-مأهي الاعراض الجانبيه للفولترين(Voltaren)?
اضطربات هظميه.
طفح جلدي.
ارتفاع في انزيمات الكبد.
150-ماهي خطورة دواء ال(meloxicam)(mobic)?
الحمل والرضاعه.
الاطفال الذين تقل اعمارهم عن 15عام.
القصورالكبدي الشديد.
القرحه المعديه الشديده.
151-مأهي المضادات الحيويه التي تثبط جدار الخليه البكتريه؟
1-البنسلين
2=الفانكوميسن
3-السيفالوسبورين.
152-ماهي الاثار الجانبية للبنسلين؟
الحساسيه الزائده
الحكه الجلديه
153-ماذا يحصل عند زياده الاسبرين(asprin)?
قرحه معديه
154-مأهي الادويه الموثرة على الفيروسات؟
1-inh
2-rifamcin
155-ماهي الادويه التي تخفظ الظغط؟
1-capoten
2-enalapril
3-coversyl
156-مأهي مجموعات الآدويه عبى الجنين؟
المجوعهA:الابحاث والتجارب التي على الانسان وليس لها ضرر.
المجموعهb:الابحاث والتجارب التي على الحيوان وعدم وجود خطوره على الجنين
المجموعهD:لايوجد لها درسات كافيه.
المجموعه x:تثبت ضررها على الجنين وتعارض على الحمل.
157-ماهي مجموعات مرض السكري؟
FIRST
1-Dymelor
2-Diabiesr
SECOND
1-Minidiab
2-Dimicron
3-Donil
THIRD
1-Amaryl

د / أحمد الجيزاني
10-06-2011, 03:04 AM
Which one of the following is taken orally
a-Estrogen
b- Estrogen gluconate
c- Estrogen malate
d- all of the above




All of the following are controlled drugs except
a- steroids
b- promidon
c- diazepam
d- imipenem




T.B. should be treated with
a- ingle drug to avoid resistance
b- two drugs to shorten therapy period
c- three drugs to ensure eradication of micro-organism
d- non of the above




The responsibility of pharmacist in hospital is
a- administration of drug
b- deal with patient
c- deal with drug interaction
d- notice effect of drug




All of the following abbreviations are correct except
a- stat: immediately , soon
b- tsp: tablespoonful
c- p.r.n.: if needed
d- p.r.: rectally




Duiretic which is more potent than others is
a- furesemide
b- torasemide
c- ethacrynic acid
d- bumetanide




Food poisoning caused by
a- viruses
b- bacteria
c- worms
d- all of the above




If patient asking for decongestant, the best choice is
a- astimazole
b- loratidine
c- terfenadine
d- all of the above




When patient comes to you with prescription of penicilline - sulphonamide you should ask him
a- to avoid taking drug with food
b- at ovoid taking drug with milk
c- if he is an allergic to this drug
d- all of the above




Acitretin is used for
a- oral treatment of sever forms of psoriasis and disorders of keratinization
b- leprosy
c- tuberculosis
d- non of the above




Dapson is the drug of choice in treatment of
a- migraine
b- tuberculosis
c- leprosy
d-all of the above




sulphonyl urea action is
a- stimulation of insulin secretion from beta cells pancreas
b- depression of glucagons secretion by alpha cells of pancreas
c- increase number of insulin receptors
d- all of the above



All of the following are macrolides except
a- erythromycin
b- clarithromycin
c- roxithromycin
d- sisomycin



All of the following are H2 receptor blockers except
a- famotidine
b-omeprazole
c-cimetidine
d- astemizole



The more advanced technique for peptic ulcer treatment is
a- use one drug H2 blocker
b- use two drugs H2 blocker
c- use three drugs one of them is antibiotic
d- all of the above



Hypercalcemia is the toxic effect of
a- vit.A
b- vit.D
c- vit.E
d- vit.K



Old patient suffering from osteo-arthritis takes
a- aspirine
b- paracetamol 250 mg q.i.d.
c- paracetamol 500 mg q.i.d.
d- non of the above



Old patient suffering from osteo-arthritis and PUD takes
a- aspirine
b- paracetamol 250 mg q.i.d.
c- paracetamol 500 mg q.i.d.
d- paracetamol 2 * 500 mg q.i.d.



One of the following drugs cannot be used with acute diarrhea
a- metronidazole
b- loperamide HCl
c- tetracycline
d- diloxinide fauvite



Plasma conc. Of drug in all body is
a- rate of absorption
b- rate of distribution
c- rate of binding
d- therapeutic volume



Procainamide interfere with sod. channel in arrythmia
a- nephedipine
b- captopri
c- propranolol
d- quinidine





The administration of drugs during pregnancy, the risk factor X means
a- the drug is contra-indicated during pregnancy
b- the drug is affecting the fetus with small effect
c- the drug should be used with caution during pregnancy
d- all of the above





All of the following drugs have antiviral activity except
a- amantadine
b- acyclovir
c- azazafrin
d- azasalazine





pseudomembraneous colitis is a side effect of
a-vancomycin
b- clindamycin
c- reserpine
d- INH





Thyroid hormone is
a- growth hormone
b- temperature control hormone
c- metabolic hormone
d- all of the above





The following statements are wrong about domperidone except
a- anti-emetic without CNS effect
b- anticoagulant
c- anti-emetic with sever CNS effect
d- non of the above





All of the following are chronic disease except
a- eczyma
b- psoriasis
c- chiken-box
d- scarbies





Regular insulin should be
a- cloudy, thickened & shows some sticky particles
b- clear, colorless & watery in consistence
c- clear dumps change into turbid by gentle shaking
d- non of the above





Nitrofurantion is indicated for
a- viral infection
b- UTI
c- GIT infection
d- URTI





Which of these drugs is used as topical eye ointment
a- amikacin
b- netlimicin
c- streptomycin
d- tobramycin


The relationship between the pharmacist & the patient is based on
a- trust
b- benefit
c- friendship
d- all of the above




A children of 10 kg, accidently swallow 10 tablets of aspirin 100 mg and his father get you, you can advise him to
a- go to hospital
b- giva a midicine
c- ignore the case
d- non of the above





when you store drug at low temperature, you must consider the following


a- storage of dusting powder below 0 degree centigrade causes the accomulation of granules
b- storage of cream and ointment below 0 degree centigrade causes cracking


c- storage of insuline below 0 degree centigrade causes aggregarion of insulin
d- all of the above




The duretic which is used with captipril is
a- aldactone
b- furosemide
c- hydrochlorothiazide
d- non of the above




Patien takes ventoline inhaler as 2 puffs 6 hourly, you advise him to
a- take 2 puffs every 6 hours
b- shake before use and take2 puffs every 6 hours
c- take a puff then breath out and take the other puff
d- take a puff then wait a minute and take the other puff then drink water




Anticox II is better than NSAIDs in
a- action
b- lower GIT toxicity
c- lower nephrotoxicity
d- lower hepatotoxicity




The drug which isn't used in acute amoebiasis is
a- metronidazole


b- gentamicin
c- tetracycline
d- diloxanide




Renal impairment patient should adjust dose intervals of the following drugs except
a- propranolol
b- digoxin
c- lidocaine
d- gentamicin




The drugs which has osmotic pressure greater than the blood or saline 0.9% called
a- isotonic
b- hypotonic
c- hypertonic
d- non of the above




When you use loop diuretics there is a drop in
a- potassium
b- sodium
c- calcium
d- sugar



You have 50:500 (w/v) stock solution. How many milliliters you take from it to prepare 2 liters of 50:2000 (w/v) solution
a- 2000
b- 1500
c- 500
d- non of the above




You should keep the prescription of narcotics in the pharmacy for
a- two year
b- three years
c- four years
d- five years




Depakot is better than depakine in
a- action
b- low GIT toxicity
c- low nephrotoxicity
d- low hepatotoxicity




The neurotransmitter released when we use parasympathomimetics is
a- acetylcholine
b- epinephrine
c- dopamine
d- norepinephrine




Nitroderm 5TTS means that it releases
a- 5 mg per hours
b- 5 mg per 24 hour
c- 5 mg per weak
d- non of the above




Intra-osseus injection means
a- pleural injection
b- inject in bone marrow
c- superfacial muscle mass injection
d- non of the above




8 ounses means
a- 60 ml
b- 120 ml
c- 240 ml
d- non of the above




Hormonal replacement therapy decreases
a- cardiac disease
b- cancer disease
c- cancer disease without major side effects
d- non of the above




Type of insulin that cannot be taken I.V is
a- NBH
b- regular insulin
c- 30/70type
d- non of the above




Viagra is contra-indicated with
a- nitoglycerin
b- insulin
c- penicillin
d- miconazole



All of the following are ACEI except
a- captopril
b- enalopril
c- zarapril
d- lisinopril




All of the following are antiarrhythmic except
a- lidpcaine
b- procainamide
c- amitryptalin
d- propranolol




Patient with CHF takes 5 drugs, to assure his complaine
a- discuss major side effect of drugs with him
b- explain long term complications of the disease if not treated
c- tell him to stop drug intake
d- non of the above




Child 2 monthes has runny nose and his temperature is 39 C you advise him to
a- go to emergency department
b- give him paracetamol + actiefed
c- give him amoxil suspension
d- all of the above




The faster preparation in action than others is
a- suspension
b- solution
c- tablet
d- capsule




Patient ask you about orange tablet with code of102, you search in
a- martindale
b- SNF 1992
c- SPF
D- all of the above




Calciferol is
a- 1,2 dihydroxy calciferol
b- 1,3 dihydroxy calciferol
c- 1,25 dihydroxy calciferol
d- non of the above




To prevent more toxicity of digoxin we use antidote which is
a- charcoal
b- saline
c- digbind
d- digotoxin




Isomack 20 mg tablet taken at twice orally at time interval between
a- 8 am - 8 pm
a- 11 am - 11 pm
a- 8 am - 11 pm
a- 11 am - 8 pm




Roaccutan is prescibed to female patient of 22 years old you
a- ask her if she is pregnant
b- consult doctor
c- give her the drug directly
d- non of the above

Patient takes phenytoin and his hair be less growth, you advise him to
a- stop drug administration
b- take another drug
c- go to doctor
d- this is the normal side effect



One of the following is not NSAID
a- xefo
b- parafon
c- voltic
d- non of the above



Olive oil + water + Asq, gives
a- solution
b- colloid
c- suspension
d- emulsion



Modern method to treat asthma is to use
a- long acting bronchodilator only
b- long acting bronchodilator + corticosteroid
c- corticosteroid for long peroid of time
d- short acting bronchodilator + corticosteroid



The drug of choice for treatment of head lice is
a- pyrethrin
b- imidazole
c- DDT
d- primidone



The preparation used as otic drop for dewaxing
a- 5% glycerin bicarbonate
b- 5% alcoholic bicarbonate
c- 5% glycerin magnesia
d- 5% glycerin phenol



SNF is an abbreviation for
a- safe and nice formulary
b- seasonal national formulary
c- saudi national formulary
d- non of the above



Grain equals
a- .065 mg
b- .065 g
c- .65 mg
d- .65 g



Micromedex is
a- computer software to manage pharmacy
b- computer software show drug side effect, interactions and doses
c- computer software covers all FDA approved medications
d- b & c



Which one of the following is natural emulsifying agent
a- methyl cellulose
b- sodium carboxy methyl cellulose
c- acacia
d- all of the above

د / أحمد الجيزاني
10-06-2011, 03:07 AM
1- The major action of sodium chromoglyca
te is :
a-mast cell stabilization b-bronchodilator 2 @
c-prostaglandins modifier d-leukotrienes modifier e-non of the above
2-The action of histamine is :
a-capillary constriction b-elevation of blood pressure
c-stimulation of gastric secretion @
d-skeletal muscle paralysis e-slowing the heart rate
3-One of the following antibiotics is resistant to penicillinase :
a-penicillin V
b-penicillin G
c-floxapen ( flucloxacillin @
d-ampicillin
e-amoxicillin
4- Inderal is :
a-similar in action to ergotamine
b-similar in action to tubocurarine
c-used as an antihistamine
d-pure b -adrenergic receptor blocker @
a and b – adrenergic receptor blockere-
5- Rifampicin is indicated for treatment of :
a-impaired fat absorption b-pulmonary emboli
c-tuberculosis d-neoplastic disorders @
e-psoriasis
6- Which of the following is selective b1 blocker ?
a-labetalol but it is non selective b blocker @
b-terazosine
c-cloridine d-captopril
e-verapamil
7- The latabbreviation for " After Meals " is :
a- a.c. b- a.a. @ c- p.c. d- i.c. e- c.c.
8- The latin abbreviation for " Four Times Daily " is :
a- a.c. b- a.a. c- p.c. @ d- q.i.d e- c.c.
9- The latin abbreviation for " Every Night " is :
a- a.c. @ b- o.n. c- p.c. d- i.c. e- c.c.
10- Erythroped A :
a-is effective against G +ve Cocci >>and G –ve bacteria
b-is a macrolide antibioticc-can increase g.i.t. motility
d-could be used in pregnant women if need
e-all of the above
11- For the treatment of anaphylactic shock use :
a-salbutamol b-diphenhydramine
c-acetazolamide @ d-epinephrine
e-aminophylline
12- Allopurinol is used as :
a-analgesic agent b-uricosuric agent (as probenecid),
c-antiinflamatory agent d-antipyretic agent
e-agent which increases renal tubular reabsorption @
Allopurinol inhibits xanthine oxidase, reducing the conversion of
hypoxanthine and xanthine to uric acid and resulting in direct inhibition
of purine biosynthesis due to elevated oxypurine concentration (negative
feedback). Oxypurinol also inhibits xanthine oxidase. So anyway you have
dramatically decreased uric acid concentrations, decreased renal tubular
transport of uric acid, and then the side effect of increased tubular
reabsorption of calcium. بصراحة محتار......مش عارف الاجابة
13- Which of the following is NOT betamethasone side effect ?
a-cataract @ b-hypoglycemia
c-skeletal muscle weakness d-sodium retention
e-lowered resistance to infections
14- A disease which is due to viral infection :
a-poliomyelitis b-rabies
c-chicken pox d-herpes
e-all of the above@:
- The mechanism of action of atropine is15
a-muscarinic antagonist b-muscarinic agonist @
c-nicotinic antagonist d-nicotinic agonist
e-non of the above
16- Myocardial muscle tissue property to generate electrical is :
a-inotropy b-chronotropy
c-automaticity d-contractility @
e-non of the above
17- The heart`s dominant pacemaker is :
a- AV node @ b- SA node
c-pukinje fiber d-internodal pathways
e-non of the above
18- Adenosine is used for :
a-ventricular arrythmias b-atrial bradycardia
c-supraventricular tachycardia @
d-supraventricular bradycardia
e-non of the above
19- Adenosine P produces which of the following :
a-facial flushing
b-dyspnea c-marked tachycardia @
d- a and b
e- a , b and c
هدا السؤال كمان حيرني كتير ... ياريت ال عنده اجابة أكيدة يحكيلنا عليها
20- Which of the following is responcible for buffering
a-magnesium b-chloride @ c-bicarbonates
d-potassium e-troponin

21- Respiratory acidosis is due to :
a- O2 removal b- O2 retention
c- CO2 removal @ d- CO2 retention
e-non of the above
22- Which of the following is NOT colloid solution ?
a-albumin 5% @ b-ringer`s solution
c-dextran d-beta starch
e-albumin 20%
23- The term shock signifies :
a-hyperperfusion @ b-hypoperfusion c-tachycardia
d-bradycardia e-non of the above
24- In treatment of shock , which of the following should be considered?
a-airway control b-IV of crystalloid solution
c-dopamine to support blood pressure
d-monitor heart rhythm @ e-all of the above
25- Which of the following is released by bacterial infection?(…. by bacterial cell wall during there growth)
a-endotoxin @ b-exotoxin c-antibiotics
d-cytotoxin e-non of the above
26- the amount of water in adult male is about:
a-25% @ b-60% c-80% d-10% e-17%
27- Which of the following are causes of oedema?
a-increase hydrostatic pressure
b-decrease oncotic pressure
c-increase capillary permeability
d- a and b @ e- a , b and c
28- Patients prescribed non reversible monoamine oxidase inhibitor should be advised not to consume food containing tyramine because this combination causes:
a-postural hypotension b-hallucinations
c-anaphylactic shock
d-muscle weakness and tremor
e-acute adrenergic crisis including sever hypertention @
29- Concerning COX 2 inhibitors , which is NOT true?
a-they have lower risk gastric adverse reactions
b-good evidence about their effectiveness
c-cardiac toxicity is a recent concern of this class
d-they usually administrated twice daily
e-combination with non selective agents give more effective action 30- In the treatment of osteoporosis which of the following is NOT true?
a-alendronate should be taken 60 min. before breakfast @
b-Ca and vit. D are essential
c-hormone replacement therapy should be considered
d-outcome should be assessed with periodic bone density
e-raloxifeno is selective oestrogen modulatoR]
31- Which of the following is the first choice in acute gout?
a-allopurinol b-indomethacin @ c-colchicine d-probencid e-sulfinylpyrazone
32- Which of the following is NOT a risk factor for osteoparalysis?
a-minimal exercise b-low calcium intake
c-male gender d-family history @
e-minimal exposure to sunlight
33- Early symptoms of aspirin poisoning are :
a-lethergy & fatigue b-skin rash & headache
c-throbbing headache & dizziness
d-fluid retention hypotension @ e-ringing in the ears & blurred vision
34- Which of the following is NOT true about infiximab
a-IL-1 blockerb-used for treatment of severe rheumatoid arthritis c-may increase risk of @ infections
d-administered as IV infusione-postadministration reactions include fever & chills
35- A disease modifying drugs in rheumatoid arthritis:
a-gold preparations b-hydroxychloroquine
c-methotrexate d- a and b
e- a , b and c @
36- A patient who is admitted through the E.R. with an initial diagnosis :
a-slow ventricular response using verapamil
b-start lidocaine infusion
c- considered anticoagulation with warfarine
d- a and b e- b and c
مش فاهم السؤال ومش عارف احله
37- Which of the following is true about surgical prophylaxis ?
a-it is given to treat surgery associated infections @
b-it is given to reduce the possibility of surgical site infectionc-should always be given regardless type of surgery
d-should be continued for 7 days after surgery
e-all are true
تأكدوا من الاجابة لأني مش متأكدمنها
38- Goals of diabetes mellitus management include :
a-reduce onset of complications
b-control symptoms of diabetes
c-near normal glycemic control and HBA1c
d- a and b @ e- a , b and c
39- When dosing insulin which of the following is true?
a-initial dose 0.6 u / kg / day split 2/3 a.m and 1/3 p.m
b-regular NPH ratio is 1 : 1 or 1 : 2
c-dose may need to be increased during acute illness d- b and c e- a , b and c @
تأكدوا من الاجابة
40- What first line agent may be considered for an obese type 2 ?
a-glyburinid b-insulin @c-metformin
d-nateglinid e-repaglinid
41- When diagnosis of diabetes to be considered :
a-WBC count with differential
b-oral glucose tolerance test c- HBA1c
d- a and b
e- b and c @
42- A 4 mg dose of lorazepam administered to a adult will act as :
a-analgesic @ b-hypnotic c-diuretic
d-antihistaminic e-antiulcerant
43- The usual daily dose of phenytoin in the range of:
a- 300-600 g
b- 1-5 mg
c- 15-60 mg
d- 300-600 mg e- 1-2 mg@
44- The drug of choice to control pain during acute myocardial infarction is :
a-naloxone b-bethidine @ c-morphine
d-celecoxib e-naproxen
45- What is a major contraindication to the use of an OTC sympathomimetic drug
a-gastric ulcer b-uncontrolled hypotension
c-severe asthma d-rheumatoid arthritis
e-hypertension @
46-Category C in FDA for drug used in pregnancy :
a- controlled studies fail to demonstrate a risk to the fetus in the trimester and there is no evidence of risk in later trimester
b- fetal risk NOT demonstrated in animal studies but there are no controlled studies in pregnant women or animal reproduction studies have shown an adverse effect that was NOT confirmed in controlled studies in women during trimester
c-either animal study have revealed adverse effect on the fetus and there are no controlled @human studies or studies in animal and women are not available
d- There is positive evidence of human fetal risk but the benefits of use in pregnant woman may be acceptable despite the risk
47- What advice would you give to a patient prescribed rifampicin?
a-take this medication with food or milk
b-avoid multivitamine preparations during treatment
c-avoid taking paracetamol during treatment
d-possible discolouration of skin is of no importance
e-this medication may cause discolouration of urine@
48- Correct method of parentral administration of potassium is :
a-fast I.V. injection
b-slow I.V. injection c-I.M. injection@
d-IP(intraperitoneal) injection
49- Which of the following drugs exhibits dose dependant pharmaceutical therapeutic doses ?
a-Na valproate @ b-phenytoin c-lithium
d-quinidine e-carbamazepine
50- Which route of administration would provide the most rapid onset of action response to morphine ?
a-oral b-S.C. @ c-I.V. d-I.M. e-rectal
51- The long term administration of thiazide diuretics requires :
a- K+ b- Na+ c- Ca@++
d- CO3 e- acetate
52- Propranolol is often prescribed with hydralazine to
a-reduce the reflex tachycardia@
b-prevent the accumulation of hydralazine
c-prevent systemic lupus ( SLE ) due to hydralazine
d-prevent oedema e-increase absorption of hydralazine
53- Fifty micrograms equals:
a-50000 ( nanogrames ) g b- 0.05 ( micrograms ) g @
c- 0.0005 g
d- a and b
e- a and c
54- The ability of a liquid to dissolve is :
a-hydrophilicity @ b-miscibility
c-immiscibility d-solubility equilibrium
e-solvation energy
55- These are non aqueous pharmaceutical solutions:
a-otic soln. , mouth washes and nasal soln.
b-essences , collodions an elixirsc-gargles , douches and irrigation soln. @
d-syrups , mucillages and collodions
e-enemas , liniments and spirits
56- A solution is made by dissolving 17.52 g of NaCl exactly 2000 ml. What is the molarity of this solution?
a- 3.33
b- 0.15 c- 1.60 x 10 -4 @
d- 0.30
e-3.00 x 10 -4
57- Which of the following is NOT correct ?
a-glitazones are ineffective as mono therapy
b-GIT disturbance are common side effects of glycosidase inhibitors
c-start with small dose of oral agent and triturate up to 1-2 weeks
d@-life style modification should not be enforced if an oral agent to be startede-lisepro is rapid acting insulin to be dosed immediately before meals

58- In CHF management the following is not correct:
a-ACEIs such as lisinopril improves left ventricular function and reduces mortality
-blocker such as carvidailol may have beneficialb- effect in selected patient
c@-spironolactone should be avoided because of the great risk of hypokalemiad-non drug therapy includes appropriate fluid and dietary sodium-restriction
e-symptomatic improvement is one of the major assessment criteria for proper therapy
59- When concidering drug therapy for hypertention , which is true?
a-combination of drugs always preferred
b-hydralazine is first line therapy in young hypertension
c-furosemide should be administrated before meal to improve absorption
d@-beta-blokers should be avoided in asthmatic patient e- ACEIs are recommended in pregnant women
60- Which of the following is NOT a primary literature
a-gournal of pharmacy practice
b-applied therapeutic & clinical use of drugc-new England Journal of medicine@
d-Loncet e- JAMA
مش عارف الاجابة....مجرد تخمين
61- Which of the following is NOT used in theophylline toxicity management :
a-symptomatic control of seizures with benzodiazepine
b-activated charcoal to enhance elimination
-blockerc- for tachycardia
d-control vomiting with metoclopramide
e-methylphenidate to reduce excessive sedation@
62- Regarding the use of ACEIs :
a-associated hypokalemia could be avoided by giving K-supplement
b-effective in reducing proteinurea in diabetic patient
c@-most common side effect is chronic dry coughd-a good first line treatment for hypertensive diabetic
e-dose should be started low and triturated gradually upward in need

63- References to check compatibility of drugs in parentral administration:
a- MERCK Index
b-handbook on injectable drugs
c-micro comedix
d- a and b
كمان هدا ماعندي فكرة عنه...بس احتمال الاختيار التاني
e- b and c
64- Regarding treatment of digoxin toxicity:
a-verify time of last time
b-check Mg and K levels and correct if needed c-monitor ECG@
d-no antidote for digoxin e-supportive care
65- When a CNS depressant is prescribed , which of the following is NOT taken at the same time?
a-analgesic @ b-verapamil c-aspirin
d-diphenhydramine e-orange juice
66- The antimalarial to avoid glucose-6-phosphate dehydrogenase :
a-primaquine b-quinine c-chloroguanide
أعتقد ان السؤال طالب الأدوية التي يجب ان يتجنبها المريض
والله اعلم
67-We can prepare 100 ml of 12% MgCl by taking…….
68-The following is NOT characteristic of solution:
a-thermodynamically stable
b-composed of two or more component that exist in one phase
c-homogenous
d@-the solvent and solute can be separated by filtratione-solute doesn`t precipitate as time passes

د / أحمد الجيزاني
10-06-2011, 03:39 AM
1- The major action of sodium chromoglyca
te is :
a-mast cell stabilization b-bronchodilator 2 @
c-prostaglandins modifier d-leukotrienes modifier e-non of the above
2-The action of histamine is :
a-capillary constriction b-elevation of blood pressure
c-stimulation of gastric secretion @
d-skeletal muscle paralysis e-slowing the heart rate
3-One of the following antibiotics is resistant to penicillinase :
a-penicillin V
b-penicillin G
c-floxapen ( flucloxacillin @
d-ampicillin
e-amoxicillin
4- Inderal is :
a-similar in action to ergotamine
b-similar in action to tubocurarine
c-used as an antihistamine
d-pure b -adrenergic receptor blocker @
a and b – adrenergic receptor blockere-
5- Rifampicin is indicated for treatment of :
a-impaired fat absorption b-pulmonary emboli
c-tuberculosis d-neoplastic disorders @
e-psoriasis
6- Which of the following is selective b1 blocker ?
a-labetalol but it is non selective b blocker @
b-terazosine
c-cloridine d-captopril
e-verapamil
7- The latabbreviation for " After Meals " is :
a- a.c. b- a.a. @ c- p.c. d- i.c. e- c.c.
8- The latin abbreviation for " Four Times Daily " is :
a- a.c. b- a.a. c- p.c. @ d- q.i.d e- c.c.
9- The latin abbreviation for " Every Night " is :
a- a.c. @ b- o.n. c- p.c. d- i.c. e- c.c.
10- Erythroped A :
a-is effective against G +ve Cocci >>and G –ve bacteria
b-is a macrolide antibioticc-can increase g.i.t. motility
d-could be used in pregnant women if need
e-all of the above
11- For the treatment of anaphylactic shock use :
a-salbutamol b-diphenhydramine
c-acetazolamide @ d-epinephrine
e-aminophylline
12- Allopurinol is used as :
a-analgesic agent b-uricosuric agent (as probenecid),
c-antiinflamatory agent d-antipyretic agent
e-agent which increases renal tubular reabsorption @
Allopurinol inhibits xanthine oxidase, reducing the conversion of
hypoxanthine and xanthine to uric acid and resulting in direct inhibition
of purine biosynthesis due to elevated oxypurine concentration (negative
feedback). Oxypurinol also inhibits xanthine oxidase. So anyway you have
dramatically decreased uric acid concentrations, decreased renal tubular
transport of uric acid, and then the side effect of increased tubular
reabsorption of calcium. بصراحة محتار......مش عارف الاجابة
13- Which of the following is NOT betamethasone side effect ?
a-cataract @ b-hypoglycemia
c-skeletal muscle weakness d-sodium retention
e-lowered resistance to infections
14- A disease which is due to viral infection :
a-poliomyelitis b-rabies
c-chicken pox d-herpes
e-all of the above@:
- The mechanism of action of atropine is15
a-muscarinic antagonist b-muscarinic agonist @
c-nicotinic antagonist d-nicotinic agonist
e-non of the above
16- Myocardial muscle tissue property to generate electrical is :
a-inotropy b-chronotropy
c-automaticity d-contractility @
e-non of the above
17- The heart`s dominant pacemaker is :
a- AV node @ b- SA node
c-pukinje fiber d-internodal pathways
e-non of the above
18- Adenosine is used for :
a-ventricular arrythmias b-atrial bradycardia
c-supraventricular tachycardia @
d-supraventricular bradycardia
e-non of the above
19- Adenosine P produces which of the following :
a-facial flushing
b-dyspnea c-marked tachycardia @
d- a and b
e- a , b and c
هدا السؤال كمان حيرني كتير ... ياريت ال عنده اجابة أكيدة يحكيلنا عليها
20- Which of the following is responcible for buffering
a-magnesium b-chloride @ c-bicarbonates
d-potassium e-troponin

21- Respiratory acidosis is due to :
a- O2 removal b- O2 retention
c- CO2 removal @ d- CO2 retention
e-non of the above
22- Which of the following is NOT colloid solution ?
a-albumin 5% @ b-ringer`s solution
c-dextran d-beta starch
e-albumin 20%
23- The term shock signifies :
a-hyperperfusion @ b-hypoperfusion c-tachycardia
d-bradycardia e-non of the above
24- In treatment of shock , which of the following should be considered?
a-airway control b-IV of crystalloid solution
c-dopamine to support blood pressure
d-monitor heart rhythm @ e-all of the above
25- Which of the following is released by bacterial infection?(…. by bacterial cell wall during there growth)
a-endotoxin @ b-exotoxin c-antibiotics
d-cytotoxin e-non of the above
26- the amount of water in adult male is about:
a-25% @ b-60% c-80% d-10% e-17%
27- Which of the following are causes of oedema?
a-increase hydrostatic pressure
b-decrease oncotic pressure
c-increase capillary permeability
d- a and b @ e- a , b and c
28- Patients prescribed non reversible monoamine oxidase inhibitor should be advised not to consume food containing tyramine because this combination causes:
a-postural hypotension b-hallucinations
c-anaphylactic shock
d-muscle weakness and tremor
e-acute adrenergic crisis including sever hypertention @
29- Concerning COX 2 inhibitors , which is NOT true?
a-they have lower risk gastric adverse reactions
b-good evidence about their effectiveness
c-cardiac toxicity is a recent concern of this class
d-they usually administrated twice daily
e-combination with non selective agents give more effective action 30- In the treatment of osteoporosis which of the following is NOT true?
a-alendronate should be taken 60 min. before breakfast @
b-Ca and vit. D are essential
c-hormone replacement therapy should be considered
d-outcome should be assessed with periodic bone density
e-raloxifeno is selective oestrogen modulatoR]
31- Which of the following is the first choice in acute gout?
a-allopurinol b-indomethacin @ c-colchicine d-probencid e-sulfinylpyrazone
32- Which of the following is NOT a risk factor for osteoparalysis?
a-minimal exercise b-low calcium intake
c-male gender d-family history @
e-minimal exposure to sunlight
33- Early symptoms of aspirin poisoning are :
a-lethergy & fatigue b-skin rash & headache
c-throbbing headache & dizziness
d-fluid retention hypotension @ e-ringing in the ears & blurred vision
34- Which of the following is NOT true about infiximab
a-IL-1 blockerb-used for treatment of severe rheumatoid arthritis c-may increase risk of @ infections
d-administered as IV infusione-postadministration reactions include fever & chills
35- A disease modifying drugs in rheumatoid arthritis:
a-gold preparations b-hydroxychloroquine
c-methotrexate d- a and b
e- a , b and c @
36- A patient who is admitted through the E.R. with an initial diagnosis :
a-slow ventricular response using verapamil
b-start lidocaine infusion
c- considered anticoagulation with warfarine
d- a and b e- b and c
مش فاهم السؤال ومش عارف احله
37- Which of the following is true about surgical prophylaxis ?
a-it is given to treat surgery associated infections @
b-it is given to reduce the possibility of surgical site infectionc-should always be given regardless type of surgery
d-should be continued for 7 days after surgery
e-all are true
تأكدوا من الاجابة لأني مش متأكدمنها
38- Goals of diabetes mellitus management include :
a-reduce onset of complications
b-control symptoms of diabetes
c-near normal glycemic control and HBA1c
d- a and b @ e- a , b and c
39- When dosing insulin which of the following is true?
a-initial dose 0.6 u / kg / day split 2/3 a.m and 1/3 p.m
b-regular NPH ratio is 1 : 1 or 1 : 2
c-dose may need to be increased during acute illness d- b and c e- a , b and c @
تأكدوا من الاجابة
40- What first line agent may be considered for an obese type 2 ?
a-glyburinid b-insulin @c-metformin
d-nateglinid e-repaglinid
41- When diagnosis of diabetes to be considered :
a-WBC count with differential
b-oral glucose tolerance test c- HBA1c
d- a and b
e- b and c @
42- A 4 mg dose of lorazepam administered to a adult will act as :
a-analgesic @ b-hypnotic c-diuretic
d-antihistaminic e-antiulcerant
43- The usual daily dose of phenytoin in the range of:
a- 300-600 g
b- 1-5 mg
c- 15-60 mg
d- 300-600 mg e- 1-2 mg@
44- The drug of choice to control pain during acute myocardial infarction is :
a-naloxone b-bethidine @ c-morphine
d-celecoxib e-naproxen
45- What is a major contraindication to the use of an OTC sympathomimetic drug
a-gastric ulcer b-uncontrolled hypotension
c-severe asthma d-rheumatoid arthritis
e-hypertension @
46-Category C in FDA for drug used in pregnancy :
a- controlled studies fail to demonstrate a risk to the fetus in the trimester and there is no evidence of risk in later trimester
b- fetal risk NOT demonstrated in animal studies but there are no controlled studies in pregnant women or animal reproduction studies have shown an adverse effect that was NOT confirmed in controlled studies in women during trimester
c-either animal study have revealed adverse effect on the fetus and there are no controlled @human studies or studies in animal and women are not available
d- There is positive evidence of human fetal risk but the benefits of use in pregnant woman may be acceptable despite the risk
47- What advice would you give to a patient prescribed rifampicin?
a-take this medication with food or milk
b-avoid multivitamine preparations during treatment
c-avoid taking paracetamol during treatment
d-possible discolouration of skin is of no importance
e-this medication may cause discolouration of urine@
48- Correct method of parentral administration of potassium is :
a-fast I.V. injection
b-slow I.V. injection c-I.M. injection@
d-IP(intraperitoneal) injection
49- Which of the following drugs exhibits dose dependant pharmaceutical therapeutic doses ?
a-Na valproate @ b-phenytoin c-lithium
d-quinidine e-carbamazepine
50- Which route of administration would provide the most rapid onset of action response to morphine ?
a-oral b-S.C. @ c-I.V. d-I.M. e-rectal
51- The long term administration of thiazide diuretics requires :
a- K+ b- Na+ c- Ca@++
d- CO3 e- acetate
52- Propranolol is often prescribed with hydralazine to
a-reduce the reflex tachycardia@
b-prevent the accumulation of hydralazine
c-prevent systemic lupus ( SLE ) due to hydralazine
d-prevent oedema e-increase absorption of hydralazine
53- Fifty micrograms equals:
a-50000 ( nanogrames ) g b- 0.05 ( micrograms ) g @
c- 0.0005 g
d- a and b
e- a and c
54- The ability of a liquid to dissolve is :
a-hydrophilicity @ b-miscibility
c-immiscibility d-solubility equilibrium
e-solvation energy
55- These are non aqueous pharmaceutical solutions:
a-otic soln. , mouth washes and nasal soln.
b-essences , collodions an elixirsc-gargles , douches and irrigation soln. @
d-syrups , mucillages and collodions
e-enemas , liniments and spirits
56- A solution is made by dissolving 17.52 g of NaCl exactly 2000 ml. What is the molarity of this solution?
a- 3.33
b- 0.15 c- 1.60 x 10 -4 @
d- 0.30
e-3.00 x 10 -4
57- Which of the following is NOT correct ?
a-glitazones are ineffective as mono therapy
b-GIT disturbance are common side effects of glycosidase inhibitors
c-start with small dose of oral agent and triturate up to 1-2 weeks
d@-life style modification should not be enforced if an oral agent to be startede-lisepro is rapid acting insulin to be dosed immediately before meals

58- In CHF management the following is not correct:
a-ACEIs such as lisinopril improves left ventricular function and reduces mortality
-blocker such as carvidailol may have beneficialb- effect in selected patient
c@-spironolactone should be avoided because of the great risk of hypokalemiad-non drug therapy includes appropriate fluid and dietary sodium-restriction
e-symptomatic improvement is one of the major assessment criteria for proper therapy
59- When concidering drug therapy for hypertention , which is true?
a-combination of drugs always preferred
b-hydralazine is first line therapy in young hypertension
c-furosemide should be administrated before meal to improve absorption
d@-beta-blokers should be avoided in asthmatic patient e- ACEIs are recommended in pregnant women
60- Which of the following is NOT a primary literature
a-gournal of pharmacy practice
b-applied therapeutic & clinical use of drugc-new England Journal of medicine@
d-Loncet e- JAMA
مش عارف الاجابة....مجرد تخمين
61- Which of the following is NOT used in theophylline toxicity management :
a-symptomatic control of seizures with benzodiazepine
b-activated charcoal to enhance elimination
-blockerc- for tachycardia
d-control vomiting with metoclopramide
e-methylphenidate to reduce excessive sedation@
62- Regarding the use of ACEIs :
a-associated hypokalemia could be avoided by giving K-supplement
b-effective in reducing proteinurea in diabetic patient
c@-most common side effect is chronic dry coughd-a good first line treatment for hypertensive diabetic
e-dose should be started low and triturated gradually upward in need

63- References to check compatibility of drugs in parentral administration:
a- MERCK Index
b-handbook on injectable drugs
c-micro comedix
d- a and b
كمان هدا ماعندي فكرة عنه...بس احتمال الاختيار التاني
e- b and c
64- Regarding treatment of digoxin toxicity:
a-verify time of last time
b-check Mg and K levels and correct if needed c-monitor ECG@
d-no antidote for digoxin e-supportive care
65- When a CNS depressant is prescribed , which of the following is NOT taken at the same time?
a-analgesic @ b-verapamil c-aspirin
d-diphenhydramine e-orange juice
66- The antimalarial to avoid glucose-6-phosphate dehydrogenase :
a-primaquine b-quinine c-chloroguanide
أعتقد ان السؤال طالب الأدوية التي يجب ان يتجنبها المريض
والله اعلم
67-We can prepare 100 ml of 12% MgCl by taking…….
68-The following is NOT characteristic of solution:
a-thermodynamically stable
b-composed of two or more component that exist in one phase
c-homogenous
d@-the solvent and solute can be separated by filtratione-solute doesn`t precipitate as time passes

د / أحمد الجيزاني
10-06-2011, 03:40 AM
ا.....مامعنى1) qqd 5) , qd 4) , 4 times daily3) , pc 2) , o.n .......
6) generic name of zinopril ؟ lisinopril .....
7) half life of drug is 7 days , كل كم يوم تعطي الجرعة للمريض ؟ مرة اسبوعيا , كل يوم . مرتين في اليوم, 3مرات , 4 مرات .....
8) diltiazim classifid as : ca channel blocker ....
9)B carotine is precursop of : retinol , thiamine , riboflavin , pyridoxine , calcefirol
10) electrical property which produce impulses called :
conduction , automaticity , velocity , excitability .........
11) another name of true solution :
homogeneous , heterogenous , emultion ...........
12) what is false about ophthalmic product using as single dose :
كان من أحد الاختيارات should contain preservative ...اعتقد هو الاجابة الصحيحة .....
13) solving liqiud in another liquid is called :
miscibility , immiscibility , disolving energy , solubility ......
14) how mg of substance X must added to 2000 gm of 10% substance X solution in order to prepare 25% of substance x solution ؟؟؟
a) 10000
b) 400
c) 40
d) 10
e) 0.4
أنا ماعرفت أحل المسألة هدي ابدا..........
15) how microgram needed from drug , if 0.1 gm in ml , if 5 one tspfull doses contain 7.5 gm of drug ???f
a) 0.0005
b) 0.5
c) 500
d) 1.5
e) 1500
أنا طلع معي رقم غير كل الأرقام .....فاخترت 1500 لأنه أقرب رقم له....ومابعرف اذا الاجابة صحيحة أو لأ ...
16) مسألة سهلة جدا
17) مسألة واضحة
18 ) مسألة مباشرة
19) infusion of hypotonic solution in blood cause :
a) shriniking of blood cell
b) hemolysis
c) hyperglycemia
d) hypoglycemia
e) b + d
طبعا الاجابة b .......
20) نفس السؤال السابق لكن عن hypertonic ونفس الختيارات ......... والاجابة تكون a.....
21) when 1 part of substance require 10000 parts of solvent , it called :
very soluble , soluble , sparingly soluble , slighty soluble , insoluble ......
الاجابة slighty .......
22) which solution is colloid solution ?? ringer solution
23) tests required fordiabetic patient :
a) oral glucose test
b) HBa1c
c) WBC count
d) a+ c
e) all of above
24) patient given rifampicin , what advice him :
urine discoloration will happened
25) denaturation will happened in body for which compunds????f
penicillin , protien , lipid , carbohydrate , ............
26) major metabolism proccess in GIT is
hydrolysis , acetylation , oxidation , conjucation ,
الاجابة hydrolysis
27) in ovulation day , level of which is highest : progesterone , FSH , BOTH , LUTEINIZING HORMONE ........
28) About side effects of hydralazine
مو متذكر الاحتيارات ولا عارف الاجابة الصحيحة
29) about side effects of prozasin
30) dosage form of nitroglycren when used in malignant hypertension ???
IV , IM , S.C , infusion , transdermal ........
31) drug induced lupus like syndrom is associated with antihypertinsive ???
minixidil , hydralazine , dioxide , nitroprusside Na , acebutol .........
32) hypothirodism cause : weight gain , hypoglycemia , low body temp ...........
33) about ACE I mechanism of action as antihypertension ???
act on serotonin receptor , on dopamine receptor , inhibition of converting angiotensin I to angiotensin II ........
34) About definition of first pass effect
, it increase with : increase rate of absorption , increase biotransformation ,both ,
increase pka
35) metal used in rheumatoid arthiritis : gold
36) drug cause or consider pressor
37) low density lipoprotien act as :
carrer cholestrol in plasma , transport fatty acid , good lipoprotien

b00002
21-11-2011, 07:47 PM
مششششششششكورين على المعلومات القيمه لاختبار الهيئه الطبيه بس اي عبقري راح يذاكر كل دي
علشان كده الطلبه والطالبات الي يتقدمون لاختبار الهيئه يدخلون 100 طالب وطالبه ويمكن اكثر الي ينجحون باالكثير 3او 4 طلاب ايش الحكايه افيدوني للاهميه بليز!!!!!!!!!!!!!! رحم الله صاحب الكرويت وبارك باولاده

محمد ابوجبل
21-11-2011, 09:58 PM
يعطيك الف عافيه
معلومات رووعه
ننتظرلمساتك بشوق دوما
دمت بسعآدهـ :f:

دكتور حازم
06-03-2012, 03:22 AM
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جزاك الله خير الجزاء
واجزل لك الثواب
على الطرح المفيد
تقبل الله منا ومنكم
صالــــح الاعمــــــال
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Veidestiquida
20-08-2012, 01:36 AM
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دكتور حازم

دكتور حازم
21-08-2012, 01:47 AM
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دكتور حازم
21-08-2012, 02:15 AM
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