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1
Q

SSRI + MAOI (phenelzine)

treatment of serotonin syndrome

A

Washout period of 14 days
Fluoxetine-washout period of 5 weeks
give benzos->cyproheptadine

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2
Q

Acute MR

A

Rupture of papillary muscle (in MI) or chordae tendinae (MVP, connective tissue disease)

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3
Q

velvety skin, atrophic scars, easily bruised, recurrent joint dislocations, scoliosis, hernias

A

Ehlers-Danlos

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4
Q

transmission of lyme from tick

A

attached >36 hours, engorged tick

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5
Q

precautions for patients on long term opioids

A

monitor on database, RANDOM drug screening, frequent follow up

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6
Q

ASD, secundum type

A

R atrium and ventricular dilation
wide and fixed splitting of second heart sound, mid systolic ejection murmur over pulmonary valve, mid diastolic rumble
associated with a fib/flutter

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7
Q

> 30 yo with breast mass

A

mammogram

in anyone, core biopsies only, no FNAs only aspirate simple cysts

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8
Q

Healthy adolescents with upper extremity morning myoclonus and subsequent generalized seizures

treatment

A

juvenile myoclonic epilepsy
EEG- bilateral polyspike and slow wave discharges

Valproic acid (side effects: hepatotoxicity, thrombocytopenia, NTDs, pancreatitis)

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9
Q

Digital injuries

A

tendons (run on anterior surface)

nerves, veins and arteries run on sides of digits

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10
Q

overflow fecal incontinence

treatment

A

impacted stool

disimpaction ffed by enemas

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11
Q

Hydatidiform mole management

complication

A

suction curettage, then contraception and serial b-hcg till undetectable for 6 months

gestational trophoblastic neoplasia->pelvic u/s and cxr->methotrexate to treat

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12
Q

Stone <1cm with no complications

A

alpha blocker, pain control, hydrate, d/c

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13
Q

Bell’s palsy

A

peripheral facial nerve palsy->steroids and artificial tears, eye patching

  • central: forehead is spared
  • bilateral facial palsy->sarcoidosis*
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14
Q

antidepressant induced mania

severe or refractory mania meds

A

discontinue antidepressant
if persistent, start mood stabilizer/ antipsychotic

mood stabilizer + antipsychotic

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15
Q

ear pain+ external auditory vesicles+ ipsilateral facial paralysis

A

ramsay hunt syndrome, vzv

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16
Q

malignant external otitis treatment

A

IV pseudomonal (fluroquinolones) until ESR, CRP normalize, then PO

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17
Q

Adolescent preg, increased risk of

A

fetal complications, preterm, postpartum depression, preeclampsia

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18
Q

Calcitonin elevation after thyroidectomy for MTC

A

Metastatic, obtain CT head and neck->CT abdomen

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19
Q

treated lyme disease in pregnancy

treatment

A

benign
oral amoxicillin, cefuroxime
non preggo-doxycycline

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20
Q

hypothyroidism labs

A

hyponatremia, macrocytosis, bradypsychia

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21
Q

STEMI ECG

A

> 1mm ST elevation in contiguous leads, left bundle branch block
1.5mm ST elevation in V2, V3

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22
Q

tetracycline side effect

A

phototoxicity

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23
Q

isotretinoin precautions

A

2 pregnancy tests, 2 forms of contraception before starting

discontinue all other anti-acne meds

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24
Q

warfarin preggo

A

switch to lovenox in first trimester, continue warfarin in 2nd and third trimesters, unfractionated heparin in last weeks

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25
organophosphate poisoning treatment
atropine, pralidoxime->reactivates acetylcholinesterase | *pyrostigmine->anticholinesterase for treatment of myasthenia gravis*
26
multifollicular ovaries
polycystic ovaries PCOS treatment: OCPs/ progestin IUD (women with anovulation-estrogen excess)
27
COPD prognosis
FEV1 <40%, age
28
diabetes, hypertension, hypokalemia, metabolic alkalosis diagnosis
cushing's dexamethasone suppression test
29
small rough papules fleshy nodule with ulceration
actinic keratosis->squamous cell carcinoma basal cell carcinoma
30
UTI diagnosis treatment physical exam and labs needed
history alone is sufficient Bactrim/nitrofurantoin (Cipro for pyelo) pregnant, pyelo, vaginal infection
31
SBO: air in distal colon no air
partial obstruction, conservative management, surgery in a day if no improvement complete obstruction->surgery
32
Marked increase in creatinine after ACEI
renal artery stenosis
33
diffuse esophageal spasm treatment | systemic sclerosis manometry
CCBs | hypomotility
34
naltrexone
for moderate to severe alcohol use disorder decreases cravings and heavy drinking use in opioid free patients without hepatic dysfunction *disulfiram is for patients who are abstinent and highly motivated*
35
post op hypercapnic and hypoxic respiratory failure, somnolent with decreased resp rate and hypoventilation
residual anesthesia effect
36
Postop atelectasis | treatment
low lung volumes, linear opacifications | CPAP if no secretions, secretions: chest PT and suctioning
37
Choking, >1 yo with complete airway obstruction <1 yo unconscious
abdominal thrusts back blows and chest thrusts CPR
38
dysuria, itching at urethral meatus, urethral discharge
gono vs chlamydia gono: orgs in discharge chlamydia: no orgs in discharge->azithromycin can be m. genitalium->moxifloxacin
39
Untreated celiac disease cancer
enteropathy associated T cell lymphoma abdominal pain, B symptoms, GI bleeding median survival of 10 months
40
Untreated celiac disease cancer
enteropathy associated T cell lymphoma abdominal pain, B symptoms, GI bleeding median survival of 10 months
41
``` Strep agalactiae (GBS) bactiuria during pregnancy acute pyelo in pregnancy ```
amoxicillin now, penicillin prophylaxis during labor | daily antibiotic supression
42
tension headache vs migraine
non throbbing, bilateral, band-like vs throbbing, disabling, aura
43
lithium toxicity causes dialysis
confusion, ataxia, NM excitability volume depletion, thiazides, ACEI, NSAIDs lithium >4/ neurologic symptoms/ AKI hydrate with isotonic saline
44
hyperbilirubinemia and anemia in infancy | hemolytic disease of newborn (ABO incompatibility)
``` G6PD deficiency (day 2-3) within 24 hours ```
45
Dementia labs acetylcholinesterase inhibitors NMDA antagonist
TSH, CBC, CMP, B12 RPR, Vitamin D, folate, CSF if appropriate rivastigmine, donepezil, galantamine memantine
46
Age 65 pneumo vaccine
prevnar first, then PPSV23 in 6-12 months
47
Preggo mania | If SI/HI, not eating
Haldol/ lithium | ECT
48
women who have sex with women at increased risk for
BV and cervical cancer
49
vasovagal syncope management
educate and reassure | only tilt table test if etiology is unclear
50
post bariatric surgery preggo
wait for a year
51
DVT anticoagulation length
If time-limited/ reversible risk factor: 3-6 months
52
hypokalemia ileus, cardiac/neuro complications
replete
53
pancoast tumor complication
non small cell lung cancer shoulder pain, horner's syndrome, hand weakness spinal cord compression
54
length-time bias vs lead time bias
detecting more benign cases vs detecting disease early
55
company sponsorship for conferences
lecturers can accept, attendees can't
56
requests for euthanasia prompted by
loss of sense of autonomy, fear of future suffering
57
pioglitazone side effect
fluid retention | treat with spirinolactone
58
swinging fever and leukocytosis post abdominal surgery
subphrenic abscess->abd u/s
59
lead poisoning labs
CBC, iron, ferritin, rec count
60
lobular carcinoma in situ
nonmalignant->excisional biopsy
61
High fever and severe polyarthralgia abdominal fever fever+leukopenia+thrombocytopenia+elevated aminotransferases
chikungunya typhoid Ehrlichiosis
62
Corneal foreign bodies org
staph
63
Sjogren's cancer
B cell non-Hodgkin's lymphoma | *B symptoms are associated with Hodgkin's lymphoma*
64
Trichomoniasis treatment | if breastfeeding
single dose flagyl | express and discard for 24 hours
65
chlamydia cervicitis treatment
doxycycline
66
GGT elevated alk phos and GGT only hepatic sarcoidosis treatment
liver infiltrative disease steroids
67
Alcoholic ketoacidosis labs | treatment
osmolal and anion gaps | IV dextrose, normal saline, thiamine, CIWA protocol
68
GBS management, first step treatment prognosis
frequent monitoring of TV and NIF IVIG or plasma exchange if nonambulatory if <4 weeks spontaneous recovery, treatment decreases duration
69
Gestational DM screening
24-28 weeks with 1 hour 50g glucose challenge if positive (>140), 3 hour 100 g glucose tolerance test *fasting glucose <95, 2hour test <120*
70
Strong correlation
close to -1 or 1.
71
Elevated c-peptide
endogenous insulin->from insulinoma/ oral hypoglycemic | serum assay for hypoglycemics, then ->imaging
72
Most effective non pharm antihypertensive
weight loss | DASH diet, sodium restriction, decrease alcohol, exercise, smoking cessation
73
lyme arthritis treatment
28 days of amoxicillin/ doxy, refrain from high impact activity
74
thin, homogenous d/c, stippled cells, clue cells, amine odor treatment
BV flagyl/clindamycin, treat to relieve symptoms
75
partial response to antidepressant
add second agent
76
subchorionic hematoma | increased risk of
expectant management spontaneous abortion, abruption placentae, PPROM, preterm labor, preeclampsia, fetal growth restriction, intrauterine fetal demise
77
borderline sodium, hyperkalemia, mild acidosis, prerenal, weight loss, eosinophilia, asthenia
adrenal failure
78
Sickle cell osteo treatment
cover staph and salmonella: (clinda/vanc (covers MRSA) + ceftriaxone)
79
Rh incompatibility
RH- mum may form anti + antibodies when exposed to Rh+ baby. In any subsequent Rh+ preggos, attacks baby. Mum herself remains Rh- not possible in Rh + mum, will never form antibodies
80
Paps
21-30: no HPV | >30: + HPV if desired
81
Phenytoin toxicity
horizontal nystagmus, blurred vision, ataxia, slurred speech, lethargy decrease dose
82
Massive PE can cause hypotension. | right bundle branch block
RV strain, tricuspid regurg
83
Stress incontinence due to | treatment
urethral hypermobility | conservative measures->urethral sling
84
gono conjunctivitis treatment prevention
profuse, purulent eye drainage and swelling at 2-5 days IM cefotaxime topical erythromycin for baby
85
Post-extubation stridor
laryngeal edema, reintubate
86
HELLP treatment
mag sulfate | plasma exchange if AST>2000/ LDH >3000
87
palpable purpura+ fatigue+ arthralgia+ hypocomplementemia+ glomerulonephritis diagnosis treatment
mixed cryoglobulinemia serum cryoglobulin steroids and rituximab
88
toxic thyroid nodule
methimazole, then surgery
89
Adults with intellectual disability decision making
must involve guardian if exists
90
causality
association increases with exposure (dose-response relationship)
91
porphyria cutanea tarda diagnosis treatment
painless blisters, hyperpigmentation, hypertrichosis associated with hep c triggered by ethanol, estrogen urinary uroporphyrins phlebotomy/ hydroxychloroquine/ interferon alpha
92
Hematemesis, left pleural effusion
Esophageal perf, may not find pneumomediastinum | *Mallory-Weiss would not have fever, chest pain or pleural effusion*
93
harsh holosystolic murmur over left sternal border with palpable thrill PDA shunting wide and fixed splitting of S2
VSD Aorta to main pulm artery: increased oxygenated blood in pulm artery ASD
94
labile glucose levels, post prandial fullness, early satiety, autonomic symptoms diagnosis treatment
diabetic gastroparesis emptying study dietary changes, metoclopramide, erythromycin
95
GBS symptoms + sensory level+ bowel/bladder dysfunction diagnosis treatment
transverse myelitis MRI high dose steroids
96
incidentaloma management
measure hormones/metanephrines | if functional/ >4 cm/ malignant features->remove
97
Inflammatory acne refractory to topical retinoid and benzoyl peroxide
add antibiotic
98
photoaging treatment | rosacea antibiotic
tretinoin | metronidazole

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