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1
Q

shoulder dystocia

management

A

inability to deliver anterior shoulder, retraction of fetal head into perineum after it delivers

McRoberts maneuver: thighs against abdomen
suprapubic pressure
zavanelli: push head back in for c/s if all else fails

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2
Q

ALS treatment

A

riluzole

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3
Q

Preggo warts

A

vaginal delivery

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4
Q

Reduction in mortality for quitters vs current smokers

A

within 5 years

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5
Q

microcytic, hypochromic anemia, normal RDW, increased ferritin

A

thalassemia

electrophoresis in both parents

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6
Q

recurrent anemia post EPO in ESRD

A

give iV iron if ferritin <500 and transferrin sat <20%

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7
Q

cortical cataracts associated with

A

macular degeneration

proliferative retinopathy in diabetes

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8
Q

MVP

A

nonejection click, MR
varies in timing depending on body position (venous return)
increases with decreased venous return like HCOM

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9
Q

treat subclinical hyperthyroidism when

A

TSH persistently < 0.1, >65yo, comorbidities

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10
Q

serious bacterial infection in neonates (<28 days)

treatment

A

e. coli, GBS
ampicillin + gentamicin/cefotaxime
*no ceftriaxone or sulfas

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11
Q

allergic bronchopulm aspergillosis

treatment

A

fleeting infiltrates, recurrent asthma exacerbations, central bronchiectasis
peripheral eosinophilia
steroids, itraconazole

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12
Q

TURP (for refractory BPH) complication

A

retrograde ejaculation

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13
Q

Dumping syndrome

treatment

A

complication of gastrectomy, abd pain, diarrhea, N/V, dizziness, sweating, dyspnea
high protein, low carb diet, smaller, more frequent

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14
Q

autoimmune hepatitis
diagnosis
primary biliary cirrhosis
GGT

A

elevated AST/ALT
ANA, anti-smooth muscle
elevated alk phos, antimitochondrial antibodies
cholestasis

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15
Q

C. diff when to give vanc

3rd recurrence

A

fever/WBC>15k/cr >1.5x baseline

vanc ff by oral rifaximin/ fidaxomicin

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16
Q

post TPA BP

A

keep below 185/105

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17
Q

factor V leiden

atrial myxoma

A

VENOUS thrombosis

mitral stenosis, heart failure, a fib, tumor plop, emboli

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18
Q

proteinuria in children

A

rule out orthostatic proteinuria with split urine collection
elevated in daytime only
benign, nothing further

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19
Q

auricular hematoma

bruising over mastoid

A

prompt evacuation to prevent cauliflower ear, prophylactic abx

basilar skull fracture

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20
Q

Fasting glucose DM
Impaired glucose
impaired glucose increases risk for

A

> 126
100-126
CAD

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21
Q

itching and urticarial followed by tense bullae
diagnosis
treatment
pemphigus vulgaris

A

bullous pemphigoid
skin biopsy, serum assay
steroids
flaccid bullae, sloughing, oral lesions

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22
Q

> 6 months with undescended testicle

A

orchiopexy

risk of cancer remains higher

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23
Q

Acne lifestyle interventions

A

avoid vigorous scrubbing, use water-based skin products, ph-neutral detergent cleansers
do not pick lesions

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24
Q

No live vaccines in preggo

A

MMR, varicella, rotavirus

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25
meconium ileus down syndrome gut
cystic fibrosis bilous emesis, abdominal distension dilated loops of small bowel, absent air-fluid levels, right sided ground glass mass duodenal atresia, hirschsprung
26
GDM postpartum
stop insulin | screen at 6 weeks postpartum with 2 hour glucose tolerance test
27
invasive aspergillosis imaging treatment
hemoptysis, cough, pleuritic chest pain nodular disease with surrounding ground glass opacities, cavitations with air fluid levels *legionella-GI symptoms* IV voriconazole
28
cryptorchidism diagnosis
clinical, no imaging
29
DKA ICU
signs of cerebral edema, severe acidosis
30
kava kava adverse effects gingko biloba ginseng
liver failure bleeding headache, insomnia, GI, vaginal bleeding, insomnia
31
opioid withdrawal treatment
methadone/ clonidine
32
hypertonia, hyperreflexia and delayed motor milestones in preterm infant, sustained clonus, scissoring
cerebral palsy, get MRI
33
Acute gout in renal insufficiency
NSAIDs and colchicine CI | oral steroids if polyarticular, CSI if mono articular
34
raloxifene and selective estrogen receptor modulators preop
discontinue 4 weeks before surgery (VTE) hold diuretics and metformin morning of surgery hold ACEI if not being taken for heart failure
35
Ecologic fallacy
applying population level findings to individuals
36
h/o of spontaneous abortions (>3 consecutive), uterine filling defect
uterine septum | resect
37
ACL injury | meniscus
popping ff by rapid hemarthrosis and instability | locking/ catching
38
congenital hypothyroidism
start synthroid ASAP
39
primary ovarian insufficiency treatment
estrogen (+ progesterone if intact uterus) up to age 50
40
croup treatment
mild: humidified air and IM steroids severe: steroids + nebulized epinephrine
41
Preggo UTI treatment | preggo pyelo
nitrofurantoin, cephalexin, augmentin admit, ceftriaxone afebrile for 48 hours->discharge on abx->daily suppressive therapy till 6 weeks postpartum
42
loud S1+ mid diastolic rumble at apex
mitral stenosis | most commonly due to rheumatic heart disease
43
Tinea capitis can cause hair loss. | treatment
oral griseofulvin/ terbinafine
44
Asthma
house dust mites
45
prostate cancer screening if you have to
55-69 yo
46
confounding vs effect modification
variable associated with both exposure and outcome, no change in direction or strength of effect vs third variable changes direction or strength of effect
47
skin tags associated with
obesity, metabolic syndrome, insulin resistance, diabetes
48
persistent rhinosinusitis | complicated sinusitis
5-7 days of PO augmentin | beyond sinuses->imaging
49
Elevated AFP in pregnancy next step
anatomic u/s
50
refractory osteoporosis
screen for multiple myeloma, search for secondary causes | otherwise iv bisphosphonate or teriparatide
51
priaprism treatment nonischemic priaprism
aspiration of corpora cavernosa->injection of phenylephrine angiographic embolization
52
steroid taper
not necessary if administration <3 weeks
53
iron deficiency anemia in infants | Mentzer index
iron deficient milk | MCV/RBC, >13: iron def, otherwise: thalassemia
54
postischemic compartment syndrome
post thrombectomy
55
infectious cause of stroke in young adults | HSV encephalitis
syphilis | hemorrhagic infarction of temporal lobe, RBCs in CSF
56
PEA/ asystole
CPR, epi every 3-5mins | identify underlying cause
57
latent TB resistant to isoniazid
rifampin for 4 months
58
Acoustic neuromas are
schwannomas.
59
Tinea capitis can cause hair loss. | treatment
oral griseofulvin/ terbinafine
60
area under curve (AUC)=
diagnostic accuracy, the larger, the better
61
Anemia of chronic disease in rheumatoid arthritis
TNF-alpha inhibitor | *if on methotrexate->folinic acid*
62
Glasgow score <=8
intubate
63
Elevated AFP in pregnancy next step
repeat test->anatomic u/s | if u/s normal->amniocentesis
64
TCA overdose
sodium bicarb->mag/ lidocaine
65
hematuria evaluation
u/a and culture->imaging->cystoscopy
66
well-diff adenocarcinoma without involvement of stalk or resection margins
removal alone, surveillance
67
bilateral nipple discharge
even though likely benign, evaluate
68
lead toxicity consequences
cognitive impairment and behavioral issues
69
brief shooting back pain provoked by bending forward and straining
nerve root irritation positive straight leg raise test *night pain-alarm symptom*
70
pellagra (niacin deficiency)
dementia, diarrhea, dermatitis, stomatitis, cheilosis
71
Angiodysplasias associated with
ESRD, von Willebrand disease, aortic stenosis
72
superior vena cava syndrome diagnosis
CT neck and chest with contrast
73
Glucagonoma rash (pancreatic tumor)
necrolytic migratory erythema: erythematous, painful, itchy rash clearing from center mild diabetes
74
evidence of gallstones with pancreatitis (no other causes, even if not in CBD)
remove in same hospitalization | if severe disease with organ dysfunction->wait and ERCP
75
urinary incontinence diagnosis
history, exam, u/a
76
diphtheria complications treatment
URI, sore throat, pharyngitis with grey exudates that coalesce into pseudomembrane myocarditis (complete heart block, heart failure), nervous system, kidneys penicillin G, erythromycin
77
melasma treatment
irregularly shaped hyperpigmented macules on the face, associated with pregnancy avoid sun exposure
78
intracranial hemorrhage on warfarin | dabigatran reversal
urgent reversal with prothrombin concentrate and vit k | idarucizimab
79
Adenomatous polyps on sigmoidoscopy
colonoscopy now
80
CAP in kids
strep pneumo, amoxicillin
81
steroid taper
not necessary if administration <3 weeks
82
progressive hip pain and altered gait in obese adolescent diagnosis treatment
slipped capital femoral epiphysis x ray-posterior and inferior displacement (falling ice cream) immediate surgical pinning
83
prolactinoma treatment
first line: dopamine agonists (bromocriptine, cabergoline)
84
Post otitis media treatment serous fluid
may persist for 3 months watchful waiting if unresolving->miringotomy with insertion of tympanostomy tubes
85
Centor criteria
tonsillar exudate, anterior cervical LAD, no cough, fever | test if >=3
86
orbital fat tissue in wound
septum injury, levator palpebrae injury
87
asymptomatic first degree AV block or LVH in athletes
reassure
88
B12 deficiency can cause delirium/ dementia in elderly.
look for pancytopenia, elevated indirect bilirubin
89
DEXA screening beginning at age
65
90
NSTEMI treatment
aspirin, BB, statin, heparin drip, nitro prn | no BB if signs of heart failure
91
Metformin cath
discontinue till 2 days after
92
intractable BPPV | other cause of vertigo
plugging of posterior canal | image
93
EBV smear
atypical lymphocytes
94
polymyalgia rheumatica without arteritis
low dose prednisone
95
Normal hep b series
0,2,6 months | serology should be obtained at 9 months (3 months after last dose) if hep B mother
96
functional constipation in children
diet modifications->osmotic laxative
97
Sensitivity analysis is
Repeating analysis after modifications
98
Actinic keratosis cancer
Squamous cell carcinoma
99
Brain death apnea
8-10 minutes
100
Lewy body dementia on antipsychotics adverse events
Autonomic dysfunction, worsening of disease
101
Closed cervix
Not in labor
102
Fitz Hugh Curtis
PID, RUQ pain, fever, elevated transaminase
103
Thalassemia anemia
Microcytic

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