Rosh Flash Card

Question

Management of auricular hematoma?

Answer 1

Tx: drainage + conforming pressure - Acute (< 48 hr) and small (< 2 cm): needle aspiration - Large (> 2 cm) or 48 hrs to 7 days: incision and drainage - > 7 days: referral to ENT/plastic surgeon

Answer 2

Premenstrual syndrome (PMS) is a combination of physical and behavioral symptoms that occur monthly in the luteal phase of a patient’s menstrual cycle. 1–2 weeks prior to menstrual cycle Sleep disturbances, decreased focus, emotional lability, breast tenderness, or HA that resolves after menses begins Treatment is decreased caffeine intake, exercise, stress reduction, NSAIDs, SSRIs, OCPs Symptoms do not hinder personal or professional life (unlike premenstrual dysphoric disorder)

Answer 3

lifestyle modifications, such as regular exercise, relaxation techniques, and dietary changes, including smaller, more frequent meals and reduced consumption of caffeine, salt, alcohol, and simple carbohydrates. In patients whose symptoms are not resolved with lifestyle modifications, pharmacologic therapy with selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, paroxetine, or citalopram is first-line treatment. Patients who do not respond to one SSRI may respond to a different agent, so a trial of a second SSRI should occur prior to moving to second-line treatment options. Additionally, combined oral contraceptives containing drospirenone may be used. SSRIs may be taken daily or during the luteal phase of the menstrual cycle only.

Answer 4

Painless: Chancre (Syphilis) Painful: Chancroid (H. ducreyi) HSV 2: Difference is tender inguinal lymphadenopathy.

Answer 5

3-6 weeks.

Answer 6

Tx: Primary or secondary: IM benzathine penicillin G, 1 dose Tertiary: IM benzathine penicillin G qwk for 3 weeks Primary: painless chancre Secondary: lymphadenopathy, condyloma lata, rash on palms and soles Tertiary: gummas

Answer 7

Canagliflozin and other sodium-glucose cotransporter-2 inhibitor.

Answer 8

Replantation of an amputated appendage is indicated for amputations occurring in children, and for thumb injuries since the thumb is responsible for a significant portion of the function of the hand.

Answer 9

Standard deviation: variability from mean Standard error of the mean: variability between sample mean and true mean Positive skew: mean > median > mode Negative skew: mean < median < mode Null hypothesis (H0): theory that the exposure or intervention that is being studied is not associated with the outcome of interest Type I error: H0 incorrectly rejected (rejecting H0 when it is true) Type II error: H0 incorrectly accepted (failing to reject H0 when it is false) Alpha: probability of type I error Beta: probability of type II error Power: probability of correctly rejecting H0 Increase power and decrease beta: increase sample size, increase expected effect size, increase precision of measurement Confidence interval: range in which real mean expected to fall T-test: compares means of two groups ANOVA: compares means of three groups Chi-square: ≥ 2 percentages or proportions of categorical outcomes P value: measure of the effect of chance within a study

Answer 10

Via face mask at 100% FiO2 at a rate of 8–15 L/min for up to 15 minutes.

Answer 11

Hypothalamic and circadian rhythm dysfunction

Answer 12

Cluster headache

Answer 13

Management includes abortive therapies (e.g., oxygen, sumatriptan, zolmitriptan), prophylaxis (e.g., verapamil), and avoidance of triggers.

Answer 14

Cortical activation with initial brain hyperemia followed by prolonged oligemia

Answer 15

Multifactorial involving peripheral myofascial factors with central nervous system (pain) response and seem related to central sensitization and lowered threshold for pain in the trapezius, frontalis, and temporalis muscles.

Answer 16

PPIs work by inhibiting gastric acid secretion by irreversibly binding to and inhibiting the hydrogen-potassium (H-K) ATPase pump.

Answer 17

Barrett esophagus.

Answer 18

Gastroesophageal reflux disease (GERD), the first line of therapy typically involves the use of proton pump inhibitors (PPIs). PPIs are generally indicated in patients who have either failed twice-daily H2-receptor antagonist (H2RA) therapy (with underlying erosive esophagitis), and/or experience frequent (eg, 2 or more episodes per week; as in this case) or severe symptoms of GERD that impair their quality of life. <2 episode of gerd in a week: H2RA >2 episode in a week: PPI

Answer 19

Due to a rare risk of potentially fatal methemoglobinemia with even one application.

Answer 20

Topical corticosteroids

Answer 21

Few false-positive results

Answer 22

Few false-negative results

Answer 23

Prompt adenotonsillectomy or positive airway pressure therapy with continuous positive airway pressure or bilevel positive airway pressure.

Answer 24

Fluoroquinolones.

Answer 25

Communication, leadership, and human factors consistently remain the most common root causes of sentinel events.

Answer 26

Oophoritis, or inflammation of the ovaries.

Answer 27

Cytologic evidence of elongated macrophages and distinctive multinucleated giant cells, characteristic cells of rheumatoid arthritis, in a background of amorphous debris is diagnostic of rheumatoid pleurisy.

Answer 28

Transudate: Pleura : Serum protein <=0.5 Exudate: >0.5 LDH <=0.6 (Transudate) >0.6 (Exudate)

Answer 29

Autosomal dominant polycystic kidney disease

Answer 30

Serially with computed tomography angiography or magnetic resonance angiography annually for two to three years, then every two to five years thereafter if stable.

Answer 31

Incidence of cerebral aneurysm

Answer 32

21 to 29: Pap every 3 year >30 to 65: Cytology + HPV every 5 year

Answer 33

Doxycycline 100 mg PO BID x 7 days Azithromycin 1 g PO single dose (pregnancy)

Answer 34

On the trunk.

Answer 35

Enterobiasis, or pinworm. Treatment option includes mebendazole, albendazole, or pyrantel pamoate Dose is repeated in 2 weeks

Answer 36

Folic acid (vitamin B9) deficiency.

Answer 37

Serum cobalamin levels will be decreased in a patient with vitamin B12 deficiency anemia.

Answer 38

Intussusception 6 months to 3 years old

Answer 39

Osteosarcoma

Answer 40

The most common opportunistic infection is Pneumocystis pneumonia, which is likely when CD4 counts drop to less than 200 cells/mm3. It can be prevented with trimethoprim-sulfamethoxazole prophylaxis.

Answer 41

Azithromycin is given prophylactically for the prevention of disseminated Mycobacterium avium complex. It is typically seen when CD4 counts drop below 50 cells/mm3.

Answer 42

Itraconazole is given to those at high risk of occupational or communal exposure to Histoplasmosis capsulatum infection and is typically seen at CD counts less than 150 cells/mm3.

Answer 43

They should get the inactivated influenza vaccine annually, however, live-attenuated vaccine is contraindicated in HIV-infected patients.

Answer 44

1. Impaired kidney function with lithium concentration of >4 2. Lithium concentration of >5 3. + Seizure, AMS and dangerous dysrhythmia

Answer 45

Lithium is contraindicated in patients with significant renal impairment, sodium depletion, dehydration, or significant cardiovascular disease.

Answer 46

Hallmark laboratory findings include increased lactate dehydrogenase, reticulocytes, and indirect bilirubin but decreased haptoglobin.

Answer 47

Hereditary spherocytosis.

Answer 48

Cholera and Doxycycline for treatment. Ciprofloxacin, azithromycin, or tetracycline as reasonable alternatives depending on local patterns of susceptibility and resistance.

Answer 49

Serogroups O1 and O139.

Answer 50

Classic clinical manifestations for placental abruption (abruptio placentae) A classic ultrasound finding is a retroplacental hematoma.

Answer 51

Infants who were breech in utero have an increased risk for mild deformations, including developmental dysplasia of the hip. All infants should be screened for developmental dysplasia of the hip using the Ortolani and Barlow maneuvers between birth and 3 months of age. Universal routine screening with ultrasonography is not recommended. However, infants at high risk of developmental dysplasia should have an ultrasonography assessment between four and six weeks of age.

Answer 52

Prominent occiput, frontal bossing, torticollis, upward-slanting eyes, and low-set ears.

Answer 53

Rotary nystagmus.

Answer 54

When using cold water in the ear canal, the fast beating portion of nystagmus moves toward the opposite ear. If warm water is used, the fast beating nystagmus moves toward the ipsilateral ear. The mnemonic COWS is helpful to remember the expected responses with intact brain stem function: Cold Opposite, Warm Same.

Answer 55

A meniscal tear is an injury to either the medial or lateral cartilage layer and is usually due to a “twisting” injury with a planted foot. First-line treatment is NSAIDs and physical therapy; however, early surgical intervention should be considered in young patients with a lack of mobility. An Apley or McMurray test may be positive, but neither of these is very sensitive or specific.

Answer 56

Anterior cruciate ligament (ACL)

Answer 57

Patellofemoral pain syndrome (PFPS)

Answer 58

Joint line tenderness.

Answer 59

Graves’ disease.

Answer 60

Pulmonary fibrosis. Classic manifestations include the onset of dyspnea on exertion with nonproductive cough over a period of several months. Fever, fatigue, myalgias, and arthralgias are usually absent. Chest auscultation typically demonstrates bibasilar crackles. Hallmark findings on high-resolution CT include peripheral (subpleural) bibasilar reticular opacities associated with architectural distortion such as honeycombing and traction bronchiectasis. Prognosis is poor, but pirfenidone and nintedanib appear to slow the course of disease

Answer 61

Asbestosis

Answer 62

Morning stiffness that lasts for at least 30 minutes. Symptoms should be present for a minimum of 6 weeks. More classic joint abnormalities associated with rheumatoid arthritis such as ulnar drift, swan neck, and boutonniere deformities, tend to appear with patients who have chronic disease. Rheumatoid factor, anti-citrullinated protein antibody, C-reactive protein, and erythrocyte sedimentation rate are all recommended laboratory studies to aid in the diagnosis of rheumatoid arthritis. Rheumatoid factor, however, is not specific for rheumatoid arthritis and may be positive in other diseases as well. Patients do not need a positive rheumatoid factor to be diagnosed with rheumatoid arthritis. Anti-citrullinated protein antibody is much more specific for rheumatoid arthritis.

Answer 63

PIP and MCP

Answer 64

Positive anti-double-stranded DNA antibodies, and positive antiphospholipid antibody would coincide with a diagnosis of systemic lupus erythematosus.

Answer 65

Sjögren syndrome

Answer 66

Reactive arthritis.

Answer 67

Evidence of purulence indicates that the patient will require incision and drainage of the infected wound, including debridement of necrotic tissue, followed by dressing of the open wound which can then be closed by secondary intention. Open wound dressings commonly consist of gauze that is moistened with saline before being placed into the wound. The surrounding tissue involvement and systemic signs indicate that this patient also requires a course of antibiotics with broad-spectrum coverage. Although the typical duration of antibiotic therapy for uncomplicated cellulitis is five days, a duration of 14 days is warranted in this patient due to his history of diabetes mellitus. Topical antiseptic adds NO benefit to wound healing over drainage and debridement.

Answer 68

It is due to loss of the substantia nigra with resultant depletion of dopamine.

Answer 69

Clinical findings include tremor, bradykinesia, and rigidity as well as postural instability, shuffling gait, and dementia. Diagnosis of Parkinson disease is clinical.

Answer 70

Antipsychotics and antiemetics.

Answer 71

Guillain-Barré syndrome, an immune-mediated polyneuropathy characterized by acute onset of symmetric ascending paralysis. Unlike botulism, Guillain-Barré syndrome usually also presents with sensory deficits.

Answer 72

Foodborne botulism

Answer 73

Prinzmetal (vasospastic) angina, as they may increase the risk of coronary vasospasm with unopposed alpha-receptor activity.

Answer 74

Beta-blockers

Answer 75

Beta-blockers are classified into two main groups: non-selective, which act on both beta 1 (cardiac muscle) and beta 2 (cardiac muscle, bronchial tissue, peripheral smooth muscle); E.g: Carvedilol, Labetalol and Propranolol and cardioselective, which act primarily on cardiac muscle, although at higher doses, they lose much selectivity). Cardioselective beta-blockers (e.g., atenolol, metoprolol, bisoprolol) are most commonly used in stable ischemic heart disease. Carvedilol (with both alpha- and beta-blockade) is also an effective anti-anginal drug. Dosage is very important in the antianginal efficacy of beta-blockers, as higher doses are often required for maximum benefit. Side effects of beta-blockers include bradycardia, bronchoconstriction, insomnia, fatigue, nightmares, and impotence.

Answer 76

Side effects of beta-blockers include bradycardia, bronchoconstriction, insomnia, fatigue, nightmares, and impotence.

Answer 77

Axial skeletal bones.

Answer 78

Refer to urologist

Answer 79

The diagnosis of diabetes can be made with a fasting plasma glucose level of 126 mg/dL or greater on more than one occasion; a glycosylated hemoglobin A1C level of 6.5% or greater; a random plasma glucose level of 200 mg/dL or greater in a patient with classic symptoms of hyperglycemia; or a 75-g two-hour oral glucose tolerance test with a plasma glucose level of 200 mg/dL or greater.

Answer 80

Children have a body mass index greater than the 85th percentile for age and sex, plus two additional risk factors such as family history, high-risk ethnicity, acanthosis nigricans, polycystic ovary syndrome, hypertension, or dyslipidemia. They should be screened every two years with a fasting plasma glucose test. However, the diagnostic utility of glycosylated hemoglobin A1C is not well-established in children.

Answer 81

Antibodies detected against islet cells, tyrosine phosphatase-like protein, and glutamic acid decarboxylase help distinguish between type 1 and type 2 diabetes mellitus.

Answer 82

Carbonic anhydrase II antibodies

Answer 83

Perinuclear antineutrophil antibodies

Answer 84

Treatment of ulcerative colitis involves medications such as 5-aminosalicylates, steroids, azathioprine, cyclosporine, infliximab or vedolizumab, and surgery including proctocolectomy.

Answer 85

Anxiety and depression.

Answer 86

Imiquimod 5% cream. Low risk site: trunk, limbs, cheeks, forehead, scalp, and neck

Answer 87

Isotretinoin and ethanol.

Answer 88

Conotruncal cardiac anomalies, hypoplastic thymus, and hypocalcemia. (CATCH 22) A: Abnormal face, C: Cleft, H: hypocalcemia Recurrent sinopulmonary infections to severe combined immunodeficiency. Patients may also present with palatal abnormalities and developmental delays. 22q11.2 deletion

Answer 89

Indication for orthopedic consultation or referral for metatarsal shaft fracture. 1. Fractures of multiple metatarsal 2. Displaced fracture near the metatarsal head. 3. Intra articular fracture 4. Displaced fracture of the first metatarsal, even if displacement is minimal, because anatomic position is necessary for optimal weightbearing function. 5. Unstable fracture of the first metatarsal, judged by clinical finding on stress radiograph. 6. Concurrent injury of other structures including injury of the tarsometatarsal that his Lisfranc ligament complex and fracture of other foot or ankle bone.

Answer 90

Severe aortic stenosis is identified by an aortic jet velocity ≥ 4.0 m/s, a mean transvalvular pressure gradient ≥ 40 mm Hg, or an aortic valve area ≤ 1.0 cm2 Valve replacement for severe aortic stenosis is recommended for patients who have symptoms by history or on exercise testing, in asymptomatic patients with left ventricular ejection fraction < 50%, and in patients undergoing other cardiac surgery. Surgical aortic valve replacement and transcatheter aortic valve implantation are the only effective treatments for severe aortic stenosis.

Answer 91

Aortic Stenosis

Answer 92

Esophageal manometry is the most sensitive diagnostic study for the diagnosis of achalasia. Achalasia is a primary esophageal motility disorder characterized by loss of peristalsis in the distal esophagus and a failure of the lower esophageal sphincter to relax with swallowing.

Answer 93

Chagas disease.

Answer 94

Risk factors for both ulcerative colitis and Crohn disease include age in the 20s (ulcerative colitis has another peak in the 50s), positive family history of inflammatory bowel disease, and northern European or Ashkenazi Jewish heritage. Studies have shown a link between gastroenteritis and the immune response thereof to the development of inflammatory bowel disease.

Answer 95

Dextromethorphan is a non-opioid antitussive shown to be effective at decreasing cough symptoms, and guaifenesin is an expectorant with some benefit in decreasing cough frequency and intensity. The combination of dextromethorphan with guaifenesin is beneficial for the management of acute bronchitis.

Answer 96

Tarsal tunnel syndrome, neuropathic pain, and S1 radiculopathy.

Answer 97

Goblet cells

Answer 98

Secrete pulmonary surfactant.

Answer 99

Physiologic jaundice.

Answer 100

Most patients with Gilbert disease are asymptomatic however, jaundice and further elevation of the bilirubin level may occur during periods of stress, fasting, or illness.

Answer 101

Dubin-Johnson and Rotor syndrome both have elevations in conjugated bilirubin levels.

Answer 102

Increased risk of cholelithiasis

Answer 103

Classic pentad. Thrombotic thrombocytopenic purpura

Answer 104

Thrombotic thrombocytopenic purpura

Answer 105

Classic triad HUS Caused by E.Coli O157:H7 (Shiga toxin)

Answer 106

Increased-risk family history is defined by the USPSTF as 1) having two or more first- or second-degree relatives with a history of ovarian cancer or a combination of breast and ovarian cancer, or 2) Ashkenazi Jewish ancestry with a first-degree relative (or two second-degree relatives on the same side of the family) with breast or ovarian cancer.

Answer 107

Radial head fracture

Answer 108

They typically occur in children between 5 and 10 years of age.

Answer 109

Radial Head Fracture

Answer 110

Venous blood lead level of 45 ug/dl higher should be treated.

Answer 111

Oral succimer or IV EDTA

Answer 112

Acquired torsades de pointes

Answer 113

antidysrhythmics, antihistamines, macrolide antibiotics, antifungals). Labs: hypokalemia, hypocalcemia, and hypomagnesemia.

Answer 114

Less than two weeks’ duration.

Answer 115

Radiographically, the presence of a sinus tract is pathognomonic of chronic osteomyelitis. Other radiographic findings include sequestra (separated pieces of dead bone) and involucra (layers of new bone growing from the periosteum).

Answer 116

Charcot arthropathy

Answer 117

A plasma brain natriuretic peptide level of 400 pg/mL or greater is suggestive of restrictive cardiomyopathy rather than constrictive pericarditis.

Answer 118

First, palpation of the left ventricular impulse is usually normal with restrictive cardiomyopathy. In contrast, a nonpalpable impulse is suggestive of constrictive pericarditis. Second, a third heart sound (S3 gallop) is frequently present with restrictive cardiomyopathy because of the abrupt cessation of rapid ventricular filling. This sound is not heard in constrictive pericarditis; instead, a pericardial knock that occurs earlier than a third heart sound can be heard in the majority of patients with constrictive pericarditis.

Answer 119

Nephrotic syndrome.

Answer 120

IgA nephropathy (Berger disease)

Answer 121

Post streptococcal glomerulonephritis

Answer 122

Nephritic Syndrome

Answer 123

Focal segmental glomerulosclerosis. It is the most common primary glomerular disease leading to end-stage kidney disease in the United States.

Answer 124

Patients at greater risk of developing adhesive capsulitis include those with diabetes mellitus, thyroid disease, prolonged immobilization, stroke, and autoimmune disorders.

Answer 125

Episodic therapy is recommended for patients with an identifiable prodrome because initiation during the prodrome stage (burning, numbness and tingling) or within 72 hours of rash onset has been shown to lessen the duration and severity of the lesions. Recommended episodic therapy includes famciclovir 1,500 mg once by mouth or valacyclovir 2 g twice daily for 1 day by mouth. In patients with frequent recurrences, defined as more than four episodes per year and with no identifiable prodrome, chronic suppressive therapy is recommended, which includes valacyclovir 500 mg daily. In this patient with more than four episodes per year, no identifiable prodrome, and presenting within 72 hours of rash onset, the best management option is to treat with valacyclovir 2 g PO bid for 1 day, then suppress with valacyclovir 500 mg PO qd.

Answer 126

Absence of ganglion cells in the submucosal and myenteric plexus.

Answer 127

Hirschsprung disease, or congenital aganglionic megacolon Rectal suction biopsy is the gold standard for diagnosing Hirschsprung disease

Answer 128

Decrease of dopamine released from the basal ganglia

Answer 129

Management includes indomethacin, conservative observation, surgical ligation, or percutaneous transcatheter occlusion

Answer 130

Sodium-glucose cotransporter 2 inhibitors. Sodium-glucose cotransporter 2 inhibitors (e.g., dapagliflozin, canagliflozin, empagliflozin) can increase the risk of hypovolemia since they promote glucose excretion through the kidneys and can result in excess water loss. These medications are recommended to be discontinued 3–4 days before surgery.

Answer 131

Euglycemic diabetic ketoacidosis.

Answer 132

Endometriosis

Answer 133

Nonsteroidal anti-inflammatory drugs such as naproxen are an appropriate first-line treatment for endometriosis.

Answer 134

Prostate cancer.

Answer 135

Microscopy

Answer 136

Plasmodium falciparum.

Answer 137

Cryptococcal meningoencephalitis

Answer 138

Local skin infection at the lumbar site, thrombocytopenia, and vertebral abnormalities.

Answer 139

100% oxygen Sumatriptan

Answer 140

Verapamil.

Answer 141

infantile botulism, foodborne botulism, wound botulism

Answer 142

Typical initial presentation in infants is constipation and poor feeding, followed by hypotonia and weakness.

Answer 143

The toxin acts on presynaptic nerve terminals to block the release of acetylcholine by impairing the exocytosis process.

Answer 144

Reactivated herpes simplex, Mycoplasma pneumonia, and upper respiratory tract infections.

Answer 145

Drugs: sulfa, oral hypoglycemics, anticonvulsants, penicillin, NSAIDs (SOAPS)

Answer 146

Friedreich ataxia

Answer 147

Huntington disease

Answer 148

Selective serotonin reuptake inhibitors (SSRIs) (e.g. escitalopram) are first-line. If patients do not wish to take SSRIs, have failed SSRIs or wish to have contraception as an added benefit, oral contraceptive pills can be used instead.

Answer 149

Systemic disease (e.g., inflammatory bowel disease, hematologic malignancy, arthritis)

Answer 150

Uterine atony DDx: uterine atony, lacerations, retained placenta, abnormally adherent placenta, coagulopathy

Answer 151

Gradual onset of dyspnea on exertion with nonproductive cough.

Answer 152

Prognosis is poor, but two medications, pirfenidone and nintedanib, seem to slow the course of disease

Answer 153

Pelvic X-ray of the sacroiliac joint.

Answer 154

Harsh mid-systolic crescendo-decrescendo murmur. Increase with valsalva and standing up Dercrease with squatting and trendelenburg,

Answer 155

Beta-blockers

Answer 156

0-1 moderate exacerbation (Group A and B) >= 2 moderate exacerbation (Group E)

Answer 157

Group A: Bronchodilator (long acting preferred than short) Group B: LABA + LAMA Group C: LABA + LAMA+ ICS if blood eosinophils >300

Answer 158

Subglottic narrowing is typically seen, commonly called the "steeple sign."

Answer 159

Subacromial condition have a limited active range of motion, but passive range of motion is preserved.

Answer 160

HSV keratitis.

Answer 161

Acyclovir, valacyclovir, and famciclovir.

Answer 162

Persistence of elevated hepatitis B surface antigen (HBsAg) for more than six months.

Answer 163

Acute hepatitis B: HBsAg, Anti-HBc IgM, HBeAg,+ HBV DNA Resolved infection: Anti-HBs, Anti-HBc IgG, +/− HBeAb Vaccinated: Anti-HBs

Answer 164

Thin-walled, unilocular, anechoic, and less than 10 cm in size with smooth, regular borders are considered to be benign cysts

Answer 165

Pseudomembranous colitis (severe inflammation of the inner lining of the bowel).

Answer 166

Nonsevere or severe: oral vancomycin or oral fidaxomicin Fulminant: oral vancomycin with parenteral metronidazole

Answer 167

Such indications include Barrett esophagus, Severe erosive esophagitis, Eosinophilic esophagitis, and high risk for upper gastrointestinal (GI) bleeding. Risk factors for GI bleeding include prior ulcer, Age >65, High-dose NSAID therapy, Concurrent use of aspirin, corticosteroids, or anticoagulants. Such patients should be advised to use PPIs indefinitely.

Answer 168

It is usually due to increased amounts of bile acid remaining in the stool. Bile acid sequestrant such as cholestyramine

Answer 169

Folic acid, 0.4–0.8 mg daily

Answer 170

The Lachman test is the most accurate test for an anterior cruciate ligament (ACL) tear The other two commonly used tests are the anterior drawer test, which has a sensitivity of 38% and a specificity of 81%, and the pivot shift test, which is more technically difficult than the other two tests and has a sensitivity ranging from 24% to 85%. The pivot shift test is effective if done correctly but should not be used alone to diagnose an ACL tear

Answer 171

Treatments to reduce awareness of tinnitus and tinnitus-related distress include cognitive-behavioral therapy, acoustic stimulation, and educational counseling. No medications, supplements, or herbal remedies have been shown to substantially reduce the severity of tinnitus.

Answer 172

Treatment should be based on the patient’s goals and modified based on her desire for fertility. In a patient who is not interested in near-term fertility and whose goal is to control menstrual irregularities, a levonorgestrel IUD is most likely to reduce the frequency, duration, and volume of bleeding. Metformin is used to treat insulin resistance, dietary modifications are used to treat obesity, spironolactone can be used to treat hirsutism or acne, and Clomiphene is used to induce ovulation and fertility.

Answer 173

The 2015 American Geriatrics Society Beers Criteria for potentially inappropriate medication use in older adults >65 years of age states that donepezil use should be avoided in patients with syncope, due to an increased risk of bradycardia. It is Cholinesterase inhibitor. Due to their cholinergic effect, these medications have a vagotonic effect on the sinoatrial and atrioventricular nodes.

Answer 174

Decreased levels of 1,25-dihydroxyvitamin D, hyperphosphatemia, and hypocalcemia in the setting of chronic kidney disease.

Answer 175

A high-pitched holosystolic murmur

Answer 176

Aortic regurgitation.

Answer 177

Mitral stenosis.

Answer 178

Aortic stenosis.

Answer 179

Multiple endocrine neoplasia, type 1 (MEN 1).

Answer 180

Primary hyperparathyroidism.

Answer 181

Antistreptolysin O (ASO) antibody can be used to confirm recent invasive streptococcal infection. Diagnosis of poststreptococcal ASO antibody does not provide a definitive diagnosis, so other tests, including anti-hyaluronidase, anti-deoxyribonuclease B, and anti-streptokinase antibodies, may be needed for confirmation.

Answer 182

An aldosterone antagonist, such as spironolactone or eplerenone, can increase renin and aldosterone levels and should be discontinued 4–6 weeks before obtaining a ratio. Angiotensin receptor blockers and ACE inhibitors can increase renin levels.

Answer 183

Initial complete cognitive and physical rest followed by an individualized graded return to activity

Answer 184

Immediately Transmission generally requires head-to-head contact, as lice cannot survive when separated from their host for more than 24 hours and do not fly or hop. Visible nits are generally present at the time of diagnosis, confirming that the infestation has been present for some time, so immediate isolation from other children would not be expected to change the natural course of events. The American Academy of Pediatrics (AAP) recommends that children found to be infested with lice remain in class but be discouraged from close contact with others until treated appropriately with a pediculicide.

Answer 185

Chest radiograph High risk of malignancy (patient age 40 years or older with at least a 30-pack year smoking history), chest CT should be ordered.

Answer 186

Seronegative spondyloarthropathies, sarcoidosis, syphilis, rheumatoid arthritis, and reactive arthritis.

Answer 187

Esophageal adenocarcinoma has become the predominant type of esophageal cancer in North America and Europe, and gastroesophageal reflux and obesity are the main risk factors.

Answer 188

Oral osmotics such as polyethylene glycol–based solutions are recommended as an appropriate initial approach to constipation in children because they are effective, easy to administer, noninvasive, and well tolerated

Answer 189

Grade 2 or 3 systolic ejection murmur best heard at the upper left sternal border with a wide split fixed S2.

Answer 190

Loud holosystolic murmur

Answer 191

Continuous crescendo-decrescendo murmur

Answer 192

Asymmetric areas of induration on digital rectal exam. Elevated serum PSA (B) and the presence of hematuria on urinalysis (C) may be seen in both prostate cancer and benign prostatic hypertrophy (BPH).

Answer 193

Diffuse idiopathic skeletal hyperostosis

Answer 194

Chest X-ray

Answer 195

Calcaneal stress fracture typically results from trauma, such as from a fall. Plantar fasciitis refers to pain in the plantar region of the foot that is worse when walking, and it is one of the most common causes of heel pain in adults. Physical examination of the affected heel typically produces pain and point tenderness when palpating the heel during dorsiflexion of the toes.

Answer 196

Obesity, prolonged standing, flat feet, and reduced ankle dorsiflexion.

Answer 197

Treatment is only recommended for symptomatic patients because suppression of premature ventricular complexes has not been shown to improve mortality. In the absence of underlying heart disease, offering reassurance and recommended avoidance of triggers is sufficient. If the patient is experiencing frequent premature ventricular complexes that are symptomatic, then treatment with a beta-blocker, such as metoprolol, or a calcium channel blocker is recommended.

Answer 198

The diagnostic cutoff point for type 2 diabetes is a fasting plasma glucose level 126 mg/dL or a hemoglobin A1c >6.5%. The diagnosis requires confirmation by repeat testing or by obtaining both a fasting glucose level and hemoglobin A1c.

Answer 199

Orthostatic blood pressure measurement and an EKG

Answer 200

A serum ferritin level should be ordered.

Answer 201

Typical symptoms and findings of Achilles tendinopathy.

Answer 202

Ospemifene

Answer 203

3- to 6-month course of testosterone specifically for postmenopausal women with low sexual desire.

Answer 204

Initial treatment of blepharitis consists of lid hygiene using warm compresses to remove dried secretions and debris. Mild shampoo can help in this process and aid in keeping the bacterial colonization load down. In severe or recalcitrant cases a topical antibiotic ointment may be applied to the lids. Oral antibiotics can be considered for more severe cases.

Answer 205

Depression in adolescents and adults starting at age 12

Answer 206

HIV screening is recommended in adolescents and adults 15–65 years of age

Answer 207

Secondary to cutaneous IgA and immune complex deposition related to gluten sensitivity, as in celiac disease. The diagnosis is supported by elevated IgA tissue transglutaminase (tTG) antibodies, which is the serology of choice for diagnosing celiac disease. The rash frequently responds well to a gluten-free diet and is classically treated with dapsone.

Answer 208

First-line treatment includes topical salicylic acid or cryotherapy

Answer 209

Almost always present within the first 3 days of life. In addition, the weakness of myasthenia gravis is typically fatigable, meaning it becomes more prominent with repetitive motions.

Answer 210

Dermatitis herpetiformis, type 1 diabetes mellitus, and autoimmune thyroiditis.

Answer 211

Brugada syndrome

Answer 212

Patients with CKD and proteinuria the combination of an ACE inhibitor or an ARB with a diuretic or calcium channel blocker is most effective for lowering morbidity and mortality.

Answer 213

β-Blockers are first-line therapy for antihypertensive therapy and antianginal therapy, whereas calcium channel blockers are second-line agents in patients who are unable to tolerate β-blockers. Calcium channel blockers may also be added as additional therapy when hypertension and angina symptoms are not controlled with β-blockers alone.

Answer 214

Subcutaneous calcitonin can also be useful for relieving pain from vertebral fractures.

Answer 215

Thiazolidinediones (pioglitazone and rosiglitazone)

Answer 216

Sulfonylureas, such as glipizide, glyburide, and glimepiride

Answer 217

Vitamin D supplementation should be started within the first 2 months of life.

Answer 218

Infants who consume less than 1 liter of formula per day need supplementation with 400 IU of vitamin D daily.

Answer 219

The magnitude of the curve at presentation, the potential for future growth, and female sex. Of these factors, curve progression has the most impact on the need for referral versus observation.

Answer 220

Topical minoxidil 2%.

Answer 221

Alopecia Areata Treatment is intralesional corticosteroids

Answer 222

Tx: permethrin 5% (infants > 2 months old) or oral ivermectin (ivermectin not first line in pregnancy or in children < 15 kg)

Answer 223

Oral macrolide such as azithromycin or clarithromycin for five days

Answer 224

No comorbidities: Amoxicillin or Doxycycline or macrolide Comorbidities: Augmentin or Cephalosporin and Macrolide or Fluoroquinolone as monotherapy.

Answer 225

The best predictors of group A streptococcal pharyngitis are included in the modified Centor criteria for patients with symptoms ≤ 3 days: 3 to 14 years of age, absence of cough, tender anterior cervical adenopathy, tonsillar exudates, and fever. One point is given for each criterion, with those over 45 years of age given a score of −1. A rapid antigen detection test should be ordered in patients with a modified Centor score ≥ 2 First-line treatment includes a 10-day course of penicillin or amoxicillin.

Answer 226

The evidence shows that the risk of an opioid overdose increases at the threshold of 50 MME/day.

Answer 227

Anaplastic

Answer 228

While the exact parameters of what is considered large (>0.5 cm diameter) and close (within 2.5 cm of the anal verge) Ultrasonography can accurately and safely detect spinal dysraphism in these cases.

Answer 229

Acute Charcot neuroarthropathy Immobilization is typically required for at least 3–4 months but in some cases may be needed for up to 12 months. Total contact casting, which increases the total surface area of contact to the entire lower extremity, distributing pressure away from the foot.

Answer 230

The initial first-line pharmacologic therapy for temporomandibular disorders is naproxen. Cyclobenzaprine may also be added if there is evidence of muscle spasm. If this is unsuccessful, other options include a trial of amitriptyline or gabapentin.

Answer 231

Management of asymptomatic peripheral artery disease (PAD) should initially be conservative and should include a walking program, smoking cessation, and a healthy diet. Statins should be started for all patients with PAD regardless of their LDL-cholesterol levels. A single antiplatelet agent is recommended for patients with PAD. Both aspirin and clopidogrel are effective in the reduction of stroke, but the combination of the two is recommended only after revascularization surgery.

Answer 232

Effective interventions for weight loss in nursing home patients include providing meals in a pleasant, home-like environment. Avoiding dietary restrictions has low quality evidence of effectiveness.

Answer 233

130/80 mm Hg A blood pressure of 130–139/80–89 mm Hg is classified as stage 1 hypertension and a systolic pressure >140 mm Hg or a diastolic pressure >90 mm Hg is classified as stage 2 hypertension.

Answer 234

The goal fasting blood glucose level in patients with gestational diabetes is <95 mg/dL. The goal 2-hour postprandial glucose level is <120 mg/dL and the goal 1-hour postprandial glucose level is <140 mg/dL.

Answer 235

Symptoms such as recurrent abdominal pain related to defecation, pain related to a change in the frequency of defecation, abdominal bloating and distension, and loose and watery or lumpy and hard stools are used to diagnose functional bowel disorders.

Answer 236

Recurrent or persistent upper respiratory symptoms

Answer 237

Alendronate (Fosamax)

Answer 238

Long-term glucocorticoid therapy, defined as >2.5 mg of prednisone for a duration of 3 months or longer.

Answer 239

Oral bisphosphonates are recommended as first-line agents for preventing glucocorticoid-induced osteoporotic fractures, although intravenous bisphosphonates can be used if patients are unable to use the oral forms. Supplementation of calcium (800–1000 mg) and vitamin D (400–800 IU) is also recommended.

Answer 240

The American College of Rheumatology recommends pharmacologic treatment for these patients, as well as for patients receiving glucocorticoids who have a bone mineral density T-score –2.5 at either the spine or the femoral neck and are either male and 50 years of age or female and postmenopausal.

Answer 241

Scaphoid fracture. When there is a high clinical suspicion for a scaphoid fracture but radiographs are negative, it is reasonable to immobilize in a thumb spica splint and reevaluate in 2 weeks.

Answer 242

Along with initiating the hospital’s protocol for myocardial infarction, immediate treatment should include dual antiplatelet therapy with a 325-mg dose of nonenteric aspirin, a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor), and an anticoagulant (unfractionated heparin or bivalirudin).

Answer 243

Mild alcohol use disorder is defined by the presence of 2–3 of the 11 symptoms documented in the DSM-5, whereas 3–5 symptoms indicate moderate alcohol use disorder and 6 or more symptoms indicate severe alcohol use disorder.

Answer 244

Methylphenidate.

Answer 245

Atomoxetine.

Answer 246

The Framingham criteria can reliably diagnose heart failure if two major or one major and two minor criteria are present.

Answer 247

Hepatitis B, hepatitis C, and tuberculosis.

Answer 248

Treatment consists of anthelmintic therapy which includes albendazole, mebendazole, or pyrantel pamoate.

Answer 249

When genital herpes occurs during pregnancy, the best method of diagnosis is either a tissue culture or a polymerase chain reaction (PCR) test, which is more sensitive

Answer 250

Polyuria occurs in 20%–70% of patients on long-term lithium therapy, even when plasma lithium levels are in the therapeutic range. This is a result of impaired renal concentrating ability that is resistant to vasopressin (nephrogenic diabetes insipidus).

Answer 251

dyspepsia (fullness, bloating, nausea), which can be associated with GERD, testing for and treating H. pylori is expected to be beneficial.

Answer 252

Treatment: Dexamethasone Prevention: Acetazolamide

Answer 253

Dual antiplatelet therapy should extend beyond 1 year for patients with acute coronary syndrome who are not considered at high risk of bleeding, especially those with risk factors associated with high ischemic risk such as diabetes mellitus, peripheral artery disease, left main stenting, or a history of a cardiovascular event. For dual antiplatelet therapy that continues beyond a year, either ticagrelor, 60 mg twice daily, or clopidogrel, 75 mg daily, is recommended in addition to aspirin. The patient’s bleeding and ischemic risk should be reevaluated at least annually. Dual antiplatelet therapy should continue for at least 1 year in patients who are considered at high risk of bleeding. For patients who are at very high risk of bleeding or who experience significant bleeding while on dual antiplatelet therapy, a duration of less than 1 year is recommended.

Answer 254

A diuretic + ACE or ARB inhibitor + β-blocker until his symptoms and the abnormalities seen on the echocardiogram resolve

Answer 255

Radioactive iodine ablation and thyroidectomy with subsequent thyroid hormone replacement are both appropriate treatments for toxic multinodular goiter,

Answer 256

The risk for syphilis infection is highest among men who have sex with men and among persons who are HIV-positive.

Answer 257

Diabetes insipidus (DI) results from insufficient antidiuretic hormone (ADH) production by the hypothalamus (central diabetes insipidus) or from impaired ADH action in the kidney (nephrogenic diabetes insipidus). ADH deficiency results in large amounts of dilute urine.

Answer 258

Current guidelines recommend a target hemoglobin of 11 to 12 g/dL. Treatment with erythropoiesis-stimulating agents should only be initiated when the hemoglobin falls below 10 g/dL

Answer 259

72-hour fecal fat determination Whereas normal fecal fat excretion is less than 6 grams per day, more than 6 grams per day is considered pathological, and patients with steatorrhea typically excrete more than 20 grams per day.

Answer 260

Secretin pancreatic function testing.

Answer 261

Number needed to treat (NNT) = 1 / absolute risk reduction Odds ratio (OR) = odds of the outcome in the exposed group / odds of the outcome in the nonexposed group Relative risk (RR) = event rate in intervention group / event rate in control group Absolute risk reduction = event rate in control group − event rate in intervention group RR reduction = 1 − RR, or absolute risk reduction / event rate in control group Attributable risk = incidence risk among exposed group − incidence risk among nonexposed group Number needed to harm = 1 / attributable risk

Answer 262

Pulsatile tinnitus, unilateral tinnitus, or tinnitus associated with asymmetric hearing loss is more likely to be associated with a pathologic cause. MRI head

Answer 263

Hematocrit, BUN, and creatinine levels are the most useful predictors of the severity of pancreatitis, reflecting the degree of intravascular volume depletion.

Answer 264

Serum Fructosamine correlates well with hemoglobin A1c levels and is recommended instead of hemoglobin A1c for monitoring glucose control in patients with diabetes and hemoglobinopathies.

Answer 265

A spot urine protein/creatinine ratio is now suggested instead of a 24-hour collection of urine.

Answer 266

Dapagliflozin

Answer 267

Serious illness

Answer 268

< 5 mm: likely to pass spontaneously > 8 mm: unlikely to pass

Answer 269

vitamin B12 (cobalamin) deficiency

Answer 270

Detection of beta-2 transferrin

Answer 271

Progesterone.

Answer 272

P wave buried in QRS in SVT

Answer 273

Morning stiffness occurs in rheumatoid arthritis, whereas osteoarthritis symptoms are often worse later in the day after overuse.

Answer 274

Anti-citrullinated peptide antibodies

Answer 275

Amoxicillin-clavulanic acid.

Answer 276

Saliva, central nervous system tissue, or cerebrospinal fluid.

Answer 277

classic triad of congenital toxoplasmosis

Answer 278

spiramycin (< 18 weeks GA) pyrimethamine plus sulfadiazine (≥ 18 weeks GA) Clindamycin contraindicated in pregnancy

Answer 279

Tx: pyrimethamine + sulfadiazine or clindamycin, PLUS leucovorin to prevent myelosuppression Clindamycin contraindicated in pregnancy

Answer 280

Smooth philtrum, shortened palpebral fissures, and a thin vermilion border of the upper lip.

Answer 281

Laboratory studies and radiography warrant consideration if the patient develops secondary sex characteristics before the age of 8, or if her height velocity increases rapidly during the surveillance period.

Answer 282

pheochromocytomas

Answer 283

Secondary causes and renal ultrasonography should be the first choice of imaging in this age group.

Answer 284

Topiramate (Topamax)

Answer 285

Compressive dressings such as an Aircast or Ace bandage, with weight bearing and range-of-motion exercises as tolerated. Minimally displaced (<3 mm) avulsion fractures of the fifth metatarsal tuberosity can be treated with a short leg walking boot. If the displacement is >3 mm, an orthopedic referral is warranted.

Answer 286

The American Academy of Pediatrics, however, recommends routine screening of all newborns with physical examination maneuvers, and targeted screening ultrasonography for infants who were breech in the third trimester, have a family history of DDH, or have a personal history of instability.

Answer 287

Decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within 5 minutes of standing from a supine position

Answer 288

1st line: Fludrocortisone (expands intravascular volume) Midodrine and droxidopa (Northera) act to increase peripheral vascular resistance

Answer 289

Menopausal hormone therapy (estrogen alone or combine with progestin) is the treatment of choice in healthy, symptomatic women who are within 10 years of menopause or younger than age 60 years and who do not have contraindications including a history of breast cancer, coronary heart disease, a previous venous thromboembolic event or stroke, or active liver disease.

Answer 290

Nonhormonal agents such as selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors for symptom management. The only two nonhormonal drugs that are FDA-approved for the treatment of vasomotor symptoms associated with menopause are paroxetine and fezolinetant, a neurokinin B receptor antagonist. Paroxetine can inhibit the conversion of tamoxifen to its active metabolite, so women who are on tamoxifen therapy should consider a different therapy for the management of hot flashes.

Answer 291

4 to 6 weeks.

Answer 292

SGLT2 inhibitor such as empagliflozin.

Answer 293

Ghrelin and somatostatin

Answer 294

Serology by complement fixation and immunodiffusion tests

Answer 295

Uncontrolled pain, constipation, urinary retention, infections (e.g., urinary tract infections), and medication side effects.

Answer 296

Dapagliflozin (Farxiga)

Answer 297

Previously unvaccinated patients ages 6 months to 8 years should receive two doses of either trivalent or quadrivalent vaccine separated by 1 month.

Answer 298

sacroiliac joint dysfunction.

Answer 299

Femoroacetabular impingement

Answer 300

Piriformis syndrome

Answer 301

topical 20% aluminum chloride.

Answer 302

Cancers of the pancreas and stomach have the highest risk of developing venous thromboembolism (VTE) and should receive pharmacologic VTE prophylaxis during hospitalizations.

Answer 303

Such risk factors include obesity, pregnancy, prolonged immobility, recent surgical procedure, trauma, certain medications including hormone therapy and combined oral contraceptives, malignancy, and liver disease. Antiphospholipid syndrome (Beta-2 glycoprotein and cardiolipin, assay of lupus anticoagulant)

Answer 304

There are five main inherited conditions that predispose patients to venous thromboembolism: protein C deficiency, protein S deficiency, antithrombin deficiency, prothrombin gene mutation, and factor V Leiden mutation.

Answer 305

Antithrombin, protein C, and protein S deficiencies.

Answer 306

Cryptosporidium

Answer 307

Chronic watery diarrhea: Cryptosporidium White cottage-cheese lesions: Candida Irremovable white lesions on lateral tongue: hairy leukoplakia (EBV) Pneumonia, CD4 < 200/mm3: PCP TB: CD4 < 200/mm3, may have negative CXR or PPD Ring-enhancing intracranial lesions + focal neurologic deficits: Toxoplasma gondii Ring-enhancing intracranial lesions + AMS: primary CNS lymphoma Meningitis, CD4 < 100/mm3: Cryptococcus Focal neurologic deficits, nonenhancing white matter lesions, CD4 < 200/mm3: PML (JC virus) Retinitis, cotton-wool spots: CMV Dark purple skin or mouth nodules: Kaposi sarcoma Cutaneous: HSV, zoster reactivation

Answer 308

Febrile seizures are most common between the ages of 6 months and 5 years and most commonly occur during the initial spike in temperature. There are two types of febrile seizures: simple and complex. Simple febrile seizures last < 15 minutes, occur once during a single illness, and are nonfocal. Complex febrile seizures are prolonged, recurrent (with more than one seizure during an acute illness), or focal in nature.

Answer 309

The primary event in aortic dissection is a tear in the aortic intima.

Answer 310

BCC: “pearly border” and telangiectatic vessels. SCC: Erythematous or flesh-colored papules or nodules with hyperkeratosis and central erosions or ulcerations.

Answer 311

Topical metronidazole, azelaic acid, or ivermectin is recommended with sodium sulfacetamide as an alternative topical therapy.

Answer 312

normocytic anemia and evidence of renal insufficiency, which can indicate MM.

Answer 313

Breast cancer survivors should undergo a history and physical examination every 3–6 months for the first 3 years after treatment, then every 6–12 months for the next 2 years, and then annually thereafter

Answer 314

beta-thalassemia minor almost always have a hematocrit > 30%, a mean corpuscular volume < 75 fL, and a normal red cell distribution width since cells are hypochromic and microcytic.

Answer 315

Major side effects of amiodarone are as follows: pulmonary toxicity (most commonly interstitial disease, including pulmonary fibrosis), nephrotoxicity (causing or worsening chronic kidney disease), ocular abnormalities (including optic neuropathy and blindness), cardiac toxicity (ventricular dysrhythmias and bradycardia), hepatotoxicity (hepatitis), metabolic dysfunction (including hyper- or hypothyroidism and lipid abnormalities), neurologic abnormalities (tremor, ataxia, neuropathy), and disturbances of the integumentary system. Ocular adverse reactions are the most common adverse effect of amiodarone use, as the drug can cause corneal microdeposits in up to 98% of patients. However, these do not often result in vision changes, and only a small fraction of patients report ocular symptoms with amiodarone therapy. For this reason, ophthalmological surveillance is not required for patients taking amiodarone without ocular symptoms, although all patients should have a baseline eye exam at the start of therapy.

Answer 316

Testicular carcinoma, subfertility and testicular torsion.

Answer 317

Epstein-Barr virus is thought to play a role in the pathogenesis of Hodgkin lymphoma and can be detected in Reed-Sternberg cells.

Answer 318

high-risk wild animal (e.g., bat, raccoon, skunk, bobcat, fox, woodchuck, and coyote) that is not available for testing.

Answer 319

High-resolution CT to establish the diagnosis shows peripheral, bibasilar reticular opacities associated with architectural distortion, including honeycomb changes and traction bronchiectasis. Honeycombing refers to clusters of cystic airspaces approximately 3 to 10 mm in diameter, usually in a subpleural location.

Answer 320

Pleural plaques, especially with linear bands of calcification.

Answer 321

Appendicitis

Answer 322

During the third trimester.

Answer 323

The eruption typically begins with a “herald” patch manifesting as a single round or oval, sharply demarcated, pink or salmon-colored lesion on the neck, chest, or back. It is typically 2 to 5 cm in diameter and becomes scaly and begins to clear centrally, leaving the free edge of the cigarette paper-like scale directed inwards toward the center (“collarette”). 1st: Round to oval patch 2nd: Scaly and clear centrally

Answer 324

Acyclovir and ultraviolet light therapy.

Answer 325

Inhibits reabsorption of sodium, potassium, and chloride ions in the loop of Henle

Answer 326

Simple Number of seizures: 1 Duration: < 15 mins Type: generalized Complex Number of seizures: > 1 in 24 hrs Duration: > 15 mins Type: focal or generalized

Answer 327

Carbonic anhydrase inhibitors

Answer 328

Inhibiting reabsorption of sodium and chloride ions in the distal convoluted tubule

Answer 329

Inhibiting the sodium-potassium transporter in the collecting duct

Answer 330

Hyponatremia, hypokalemia, and hypomagnesemia. Elevated blood urea nitrogen and creatinine are also common.

Answer 331

Topical antifungal agents, such as azoles (econazole cream), allylamines, butenafine, ciclopirox, and tolnaftate, which is administered once or twice per day for one to three weeks. For patients with recalcitrant disease or extensive involvement, systemic treatment with terbinafine, itraconazole, griseofulvin, or fluconazole is recommended. Nystatin ointment should not be used in the treatment of dermatophyte infections as it is not effective. It is used in the treatment of cutaneous and mucocutaneous fungal infections caused by Candida albicans and other susceptible Candida species.

Answer 332

Chronic rhinosinusitis, asthma, and peripheral blood eosinophilia.

Answer 333

Diagnostic criteria ADA: 3-hour 100 g OGTT results > 95 mg/dL fasting, > 180 mg/dL at 1 hour, > 155 mg/dL at 2 hours, or > 140 mg/dL at 3 hours

Answer 334

amoxicillin, consider amoxicillin-clavulanate in otitis-conjunctivitis syndrome

Answer 335

First-generation antipsychotics often cause extrapyramidal symptoms such as tardive dyskinesia, while second-generation antipsychotics are known for weight gain and metabolic disorders.

Answer 336

at least 1 month and < 6 months

Answer 337

psychosis + mania or depression

Answer 338

At least 6 months of a combination of active/prodromal/residual symptoms

Answer 339

All antihistamines effectively reduce sneezing, rhinorrhea and pruritus but they are less effective at treating ocular symptoms and nasal congestion. Whereas intranasal corticosteroid helps with ocular symptoms.

Answer 340

Cetirizine.

Answer 341

Flat affect, lack of energy, inexpressive facial expressions, poverty of speech, and monotone speech.

Answer 342

The medications approved by the US Food and Drug Administration for use in HIV PrEP include oral emtricitabine-tenofovir disoproxil fumarate.

Answer 343

Early intervention with intravenous immune globulin and aspirin therapy has dramatically decreased the frequency of coronary artery aneurysm development.

Answer 344

CRASH and burn: conjunctivitis, rash, adenopathy, strawberry tongue, hand or foot edema, uncontrolled high fever

Answer 345

Positive nitrites and trace leukocytes.

Answer 346

Immune complex-mediated reaction (type III hypersensitivity)

Answer 347

Diagnosis of SLE is based on meeting at least 4 of the 11 criteria malar rash, discoid rash, photosensitivity, oral ulcers, nonerosive arthritis, serositis, kidney disorder, neurologic disorder, hematologic disorder, immunologic disorder, positive antinuclear antibody. The antinuclear antibody (ANA) test is positive in nearly all patients with SLE but is positive in up to 50% of patients who do not have SLE. Therefore, a negative ANA test virtually rules out the diagnosis. A positive test should prompt further evaluation with more specific antibodies, such as anti-dsDNA and anti-Sm antibodies.

Answer 348

Atrioventricular septum (Gerbode defect)

Answer 349

oral trimethoprim-sulfamethoxazole for 21 days. Additionally, patients with Pneumocystis jirovecii pneumonia should start, antiretroviral therapy within two weeks of Pneumocystis treatment.

Answer 350

After exposed clothes are removed, copious water irrigation and calcium are the mainstays of treatment of hydrofluoric acid burns. Applying calcium gluconate gel to the burned area will prevent further toxicity.

Answer 351

Patient satisfaction

Answer 352

It is therefore recommended that women who take levothyroxine daily increase their dose to nine weekly doses (one extra dose on two days of the week). This should be done as soon as the pregnancy is confirmed.

Answer 353

Carcinoid syndrome

Answer 354

Measurement of the 24-hour urinary excretion of the serotonin byproduct 5-hydroxyindoleacetic acid (5-HIAA)

Answer 355

Lewy body dementia.

Answer 356

Associated with an increased risk of malignancy

Answer 357

Smokeless tobacco products

Answer 358

Lateral aspect of the ankle are more likely due to arterial insufficiency Medial aspect of the ankle are more likely due to venous insufficiency

Answer 359

Treatment of venous insufficiency involves gradient compression stockings that provide 30–40 or 40–50 mm Hg of compression at the ankle, with decreasing levels of compression proximally. Leg elevation augments venous return to the heart

Answer 360

bladder cancer.

Answer 361

Examination may reveal paresthesia or pain when the first and fifth metatarsal heads are squeezed together. If an audible click is heard, it is called Mulder sign, representing a fibrotic neuroma.

Answer 362

Lesions over 5 mm in diameter.

Answer 363

proximal, medial and displaced fractures require an urgent orthopedic referral.

Answer 364

If these imaging tests are not available, then X-rays may be repeated in 10 to 14 days while the area is kept immobilized. Nondisplaced distal fractures generally heal well with a thumb spica cast

Answer 365

The newer 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus has a higher sensitivity than the previous criteria and includes a positive ANA with a titer ≥ 1:80 at least once as an obligatory entry criterion.

Answer 366

Hydroxychloroquine reduces disease flares and is the mainstay of treatment. Low-dose glucocorticoids are used to treat most manifestations of lupus.

Answer 367

Primary hyperaldosteronism

Answer 368

Parenteral cefazolin, ceftriaxone, or flucloxacillin. Patients with mild infection may be treated with oral penicillin or amoxicillin, or cephalexin or clindamycin in those with a beta-lactam allergy.

Answer 369

The recommended treatment for oppositional defiant disorder is psychotherapy, particularly therapy for the parents as well as the child.

Answer 370

Calcium pyrophosphate deposition synovitis: Positive Gout: Negative

Answer 371

Dupilumab, an interleukin (IL)-4 receptor alpha antagonist.

Answer 372

Iron deficiency anemia

Answer 373

In children 6 years of age and older who have failed behavioral interventions, desmopressin is recommended as first-line pharmacotherapy.

Answer 374

Intraperitoneal empiric therapy covering both gram-positive and gram-negative organisms should be started in patients using peritoneal dialysis with suspected peritonitis. Gram-positive organisms may be covered by vancomycin or a first-generation cephalosporin, such as cefazolin. Gram-negative organisms may be covered by a third-generation cephalosporin or an aminoglycoside.

Answer 375

Dexlansoprazole

Answer 376

Endoscopy to screen for Barrett esophagus is not routinely recommended, but may be considered in white men 50 years of age or older who have had GERD symptoms for at least 5 years

Answer 377

Patients with significant nighttime reflux symptoms may benefit from omeprazole and sodium bicarbonate because of its effectiveness in controlling nighttime pH.

Answer 378

Hypothyroidism and growth hormone deficiency.

Answer 379

Samter Triad Classic Features: - Asthma - Aspirin sensitivity (e.g., bronchospasm with aspirin use) - Nasal polyps Tx: avoid aspirin and NSAIDs, treat asthma, and manage nasal polyps (e.g., surgery or intranasal steroids)

Answer 380

Salmonella

Answer 381

Three months after treatment or at the next subsequent visit within 12 months of treatment.

Answer 382

antisocial personality disorder strongly overlaps with conduct disorder, the diagnosis of antisocial personality disorder can be made only in persons over the age of 18 years.

Answer 383

Hearing test.

Answer 384

Treatment includes regular aerobic physical activity, serotonin and norepinephrine reuptake inhibitors such as duloxetine or milnacipran, tricyclic antidepressants, antiepileptics such as pregabalin, and muscle relaxants such as cyclobenzaprine to improve pain, fatigue, sleep symptoms, and quality of life.

Answer 385

Adolescence (13-22 years old)

Answer 386

Three weeks for non-contact sports and a minimum of four weeks for contact sports.

Answer 387

Liver enzymes above 500 IU/L, total bilirubin above 4 mg/dL, or amylase above 1,000 IU/L are indicators of choledocholithiasis as the most likely diagnosis.

Answer 388

Avoid giving phosphodiesterase-5 inhibitors to a patient taking nitrates because of the risk of severe hypotension.

Answer 389

Standard therapy for unstable angina consists of beta blockers, nitrates, antiplatelet therapy, statins, and anticoagulation therapy.

Answer 390

Sniffing position

Answer 391

Dermatitis herpetiformis treatment with both dapsone and a gluten-free diet is the initial therapy.

Answer 392

For average-risk patients, Colonoscopy every 10 years, flexible sigmoidoscopy every 10 years plus fecal immunochemical test (FIT) annually, computed tomography colonography every 5 years, home-based guaiac-based fecal occult blood test on three samples annually, fecal immunochemical test annually on a single sample, Combined fecal immunochemical test and DNA methylation assay every 3 years on a single sample. Sigmoidoscopy may be used alone every 5 years if adding a stool-based option is not available.

Answer 393

Options for high-intensity statin therapy include atorvastatin 40 mg and rosuvastatin 20 mg.

Answer 394

Low arterial blood pressure, dilated neck veins, and muffled heart sounds.

Answer 395

Epiglottitis

Answer 396

Neglect is the most common type of child maltreatment in the United States (78.5%)

Answer 397

Rhoo(D) immune globulin 300 mcg is recommended for Rh (D)-negative women at 28 weeks gestation. Rho(D) immune globulin is indicated in all pregnant patients who are Rh-negative Prevention: anti-D globulin at 28 weeks (and within 72 hrs of delivery if infant is Rh+)

Answer 398

Maternal smoking during pregnancy.

Answer 399

The middle third, right behind the left atrium.

Answer 400

Four days to four weeks The delayed reaction is due to formation of drug-specific T cells mediating a cytotoxic reaction against keratinocytes and leading to massive apoptosis, which is believed to be the pathogenesis of Stevens-Johnson syndrome and toxic epidermal necrolysis.

Answer 401

Eight weeks.

Answer 402

Only once in a lifetime, after which protective immunity usually develops.

Answer 403

It is when a patient describes their chest pain by holding their clenched fist over their chest. It is considered to be a sign of ischemic chest pain.

Answer 404

Would prevent the leg from being straightened

Answer 405

Metoprolol succinate, bisoprolol, and carvedilol.

Answer 406

Asymptomatic patients are NYHA class 1. Studies have shown angiotensin-converting enzyme (ACE) inhibitors, like enalapril, reduce mortality in all CHF patients, including NYHA class 1.

Answer 407

Beta blockers also reduce mortality and should be prescribed to NYHA class 2 patients and some class 1 patients.

Answer 408

Combination of isosorbide dinitrate with hydralazine is an option in patients who cannot tolerate ACE inhibitors and ARBs or as an adjunctive therapy in black patients already on ACE inhibitors.

Answer 409

Pulseless: immediate defibrillation Unstable: synchronized cardioversion Stable: procainamide, amiodarone, synchronized cardioversion (especially if refractory)

Answer 410

Neonatal period and between 12–18 years of age.

Answer 411

Ratio of total thyroxine to triiodothyronine usually below 20 (unlike in Graves disease). Patients with subacute thyroiditis will have low uptake of radioactive iodine on their thyroid scan, unlike other hyperthyroid conditions.

Answer 412

Corticosteroids.

Answer 413

Human papillomavirus high-risk type 16.

Answer 414

Gemfibrozil (B) is the only fibrate that should not be used in a patient taking a statin since gemfibrozil enhances the myopathic rhabdomyolysis effect of statins and increases the serum concentration of statins.

Answer 415

Although niacin can reduce triglyceride levels, it is rarely used since fibrates are more potent and have a better side effect profile. Additionally, niacin may worsen glucose tolerance in diabetic patients.

Answer 416

Fenofibrate

Answer 417

Polymyalgia rheumatica

Answer 418

Internal rotation maneuvers such as internal rotation lag testing are best at identifying subscapularis tears

Answer 419

External rotation lag testing is useful at identifying any full-thickness rotator cuff tear, with a particularly high positive likelihood ratio for identifying teres minor and infraspinatus tears

Answer 420

Three to four months of age.

Answer 421

Dyshidrotic eczema

Answer 422

Group B Streptococci (GBS)

Answer 423

Streptococcus pneumoniae

Answer 424

Herpes simplex virus

Answer 425

Psoas sign, obturator sign, Rovsing sign, and absent or decreased bowel sounds.

Answer 426

Topical antifungal medications including topical selenium sulfide and topical zinc pyrithione.

Answer 427

A classic finding in rheumatic heart disease is mitral stenosis

Answer 428

In patients with carditis and persistent valvular disease, the duration of prophylaxis should last 10 years or until 40 years of age, whichever is longer.

Answer 429

10 years or 21 years old (whichever is longer)

Answer 430

5 years or 21 years old (whichever is longer)

Answer 431

Nine days.

Answer 432

R and R’ (secondary R wave) in V1.

Answer 433

QRS complex less than 120 ms and presence of secondary R waves in the right precordial leads.

Answer 434

Internal carotid artery

Answer 435

more than 25% of the joint surface, even when nondisplaced.

Answer 436

Chlamydia trachomatis and Neisseria gonorrhoeae

Answer 437

Ceftriaxone and doxycycline and metronidazole

Answer 438

Pneumonia secondary Methicillin-resistant Staphylococcus aureus

Answer 439

Myositis and rhabdomyolysis.

Answer 440

Hyperkeratosis, parakeratosis, and acanthosis

Answer 441

Hepatic fibrosis

Answer 442

The earliest ECG finding is hyperacute T waves.

Answer 443

Topical phenol or Shave excision

Answer 444

Ebstein anomaly

Answer 445

Cerebrospinal fluid polymerase chain reaction testing

Answer 446

Contraindicated Mumps, measles, rubella Varicella (chickenpox) Yellow fever (can be given if risks for yellow fever are felt to outweigh the vaccination risks) BCG Vaccinia (smallpox)

Answer 447

Glomerulonephritis

Answer 448

Nephrotic syndrome

Answer 449

Crescentic glomerulonephritis (rapidly progressive glomerulonephritis) is named for the histologic findings of crescentic formations in the glomeruli as a result of severe injury.

Answer 450

Tx: pain management (e.g., acetaminophen, NSAIDs), physical therapy

Answer 451

Adrenal insufficiency

Answer 452

Tx: airway management and IV antibiotics (third-generation cephalosporin AND antistaphylococcal)

Answer 453

Rotator Cuff Impingement and Tear Supraspinatus (abduction) Infraspinatus (external rotation) Teres minor (external rotation) Subscapularis (internal rotation) Pain with brushing hair or teeth Pain at night when rolling onto shoulder Baseball pitchers

Answer 454

Mitral valve prolapse

Answer 455

Mitral stenosis

Answer 456

Most commonly caused by rheumatic heart disease

Answer 457

Type 1: Progressive PR interval prolongation for several beats preceding a nonconducted P wave, often in a regular pattern (2:1, 3:2) Type 2: PR interval that remains unchanged prior to a P wave that fails to conduct to the ventricles

Answer 458

Beta-blocker or CCB (who cannot tolerate BB)

Answer 459

Increases in intensity with Valsalva maneuver and standing Decreases with squatting and trendelenburg

Answer 460

If the abnormal movements interfere with daily function, consider treating Huntington’s with vesicular monoamine transporter type 2 (VMAT2) inhibitors, such as tetrabenazine and deutetrabenazine.

Answer 461

hyperthyroidism

Answer 462

Low radioiodine uptake.

Answer 463

Trimethoprim-sulfamethoxazole

Answer 464

Stevens-Johnson syndrome.

Answer 465

A brachial plexus injury.

Answer 466

Crohn disease

Answer 467

Doxycycline 100 mg PO BID x 7 days Azithromycin 1 g PO single dose (pregnancy)

Answer 468

Measurement of the head should be taken 3 times and the greatest measurement should be recorded.

Answer 469

Head circumference should be measured in every visit during the first years of life. Cranial sutures fuse around 18 months of age and the majority of head growth is complete by four years of age. Up to 4 years

Answer 470

Length should be measured in this recumbent position (supine) until the age of 2 years or when the patient is able to stand on his or her own.

Answer 471

low Mg, K, Ca

Answer 472

Beta blocker

Answer 473

Referral to urology is indicated in cases of nephrolithiasis or urolithiasis when more than one stone is present, the patient is febrile or showing signs of infection, renal function is impaired, stone passage is prolonged, hydronephrosis is present on imaging, the patient is pregnant, or the stone is larger than 5 mm in diameter.

Answer 474

Diagnosis of CLL is based on a CBC with an absolute B lymphocyte count ≥ 5,000/μL in the peripheral blood that is sustained over 3 months. A peripheral smear should demonstrate a preponderance of small, mature lymphocytes. Flow cytometry with immunophenotyping should then be used to confirm the diagnosis.

Answer 475

CML: Abdominal bloating from splenomegaly, abnormal bleeding related to platelet dysfunction, fatigue and malaise, and weight loss. Testing for the Philadelphia chromosome CLL: Asymptomatic Flow cytometry with immunophenotyping

Answer 476

Serum ferritin > 1.5 times the upper limit of normal is suggestive of nonalcoholic steatohepatitis and advanced fibrosis.

Answer 477

Hyponatremia and hyperkalemia

Answer 478

Tx: hydrocortisone or other glucocorticoid Most patients also require mineralocorticoid (fludrocortisone)

Answer 479

The Family Media Use Plan tool, found on healthychildren.org.

Answer 480

Diabetes mellitus

Answer 481

It is commonly recommended that patients stop warfarin on average five days prior to the procedure. An international normalized ratio level can be checked on these patients, as most surgeons prefer the level to be less than 1.5 prior to the surgery.

Answer 482

Azithromycin, TMP-SMX is second-line

Answer 483

Hypertension

Answer 484

The subtypes include bipolar I, which includes manic, hypomanic, and depressive episodes, and bipolar II, which includes hypomanic and depressive episodes without any manic episodes.

Answer 485

lithium levels should be drawn 12 hours after the last dose is taken to obtain an accurate and meaningful assessment of lithium levels in the body.

Answer 486

Patients with kidney disease and in women during the first trimester of pregnancy.

Answer 487

Thumb spica splint and ibuprofen

Answer 488

Abductor pollicis longus and extensor pollicis brevis tendons

Answer 489

Pulmonary sarcoidosis

Answer 490

Naproxen or another nonsteroidal anti-inflammatory drug (NSAID), when added to opioid treatment, can improve pain relief. Glucocorticoids are also effective in combination with opioids in this setting. Bisphosphonate medications, such as zoledronic acid, cause osteoclast inhibition and can also be used to treat the pain of bony metastases. Nonpharmacologic treatments such as radiation and ultrasound can be effective, especially for localized bone disease.

Answer 491

Monitor progression (Society for Vascular Surgery guidelines) 4.0–4.9 cm: U/S annually 5.0–5.4 cm: U/S every 6 months 5.5 cm surgery

Answer 492

Mirtazapine is a commonly used agent in older patients with depression, especially those with appetite suppression

Answer 493

Risk factors: history of smoking

Answer 494

Radiating lower back pain and pain with lumbar hyperextension (> three weeks) without history of a traumatic event suggests spondylolisthesis.

Answer 495

Spondylolysis: fracture of the pars interarticularis Spondylolisthesis: defects in posterior arch lead to vertebral anterior displacement

Answer 496

Tricuspid stenosis. Seen in RHD

Answer 497

serum triglyceride levels greater than 1000 mg/dL may precipitate bouts of acute pancreatitis.

Answer 498

Associated with gastric cancer, gastric mucosa-associated lymphoid tissue (MALT) lymphoma

Answer 499

The USPSTF recommends beginning biennial screening mammography for breast cancer at 40 years of age.

Answer 500

Required newborn screening includes height and weight measurements, head circumference, hearing examination, congenital cardiac screening, a thorough physical examination, and blood screening, which includes hemoglobin disorders such as sickle cell disease and metabolic disorders such as organic acid metabolism. The hepatitis vaccine is also a universal protocol. All of these tests should be administered before the newborn is discharged home from the hospital.

Answer 501

At 18 and 24 months of age.

Answer 502

Carcinoid syndrome.

Answer 503

5-hydroxytryptophan and histamine.

Answer 504

Glucocorticoids.

Answer 505

Classic Features: Asthma Aspirin sensitivity (e.g., bronchospasm with aspirin use) Nasal polyps

Answer 506

CML: Elevated white blood count with a peripheral smear demonstrating increased numbers of immature cells of the granulocytic series with a “myelocyte bulge.” No lymphocytosis. CLL: Prominent lymphocytosis and frequently have smudge cells

Answer 507

ACE and ARB blockers work by causing vasodilation at the efferent arterioles in the glomerulus, reducing blood pressure, glomerular hydrostatic pressure, protein excretion, and myocardial oxygen demand.

Answer 508

Most achieve spontaneous remission within 6 to 12 months.

Answer 509

Substance use

Answer 510

Ménière disease.

Answer 511

Acute/symptomatic: small increase in sodium often sufficient to resolve symptoms (ex. 2 mEq/L/hour for the first 2–3 hours or 4–6 mEq/L over 6 hours); monitor sodium closely Chronic: correct by 4–6 mEq/L in 24 hours

Answer 512

Hordeolum: Tender, lower eyelid Chalazion: Nontender, upper eyelid

Answer 513

Hypochloremic, hypokalemic metabolic alkalosis secondary to prolonged vomiting.

Answer 514

Patients are diagnosed with gestational diabetes mellitus using the one-step method if they exceed any one of the following thresholds during a 75 g oral glucose challenge test (as in the patient above): Diagnostic criteria ADA: 3-hour 100 g OGTT results > 95 mg/dL fasting, > 180 mg/dL at 1 hour, > 155 mg/dL at 2 hours, or > 140 mg/dL at 3 hours

Answer 515

Universal screening at 24–28 weeks with 1-hour 50 g OGTT

Answer 516

Risk factors associated with the development of gestational diabetes mellitus include a history of impaired glucose tolerance, prepregnancy BMI > 30 kg/m2, older maternal age, and multiple gestation.

Answer 517

Macrosomia, shoulder dystocia, and preeclampsia.

Answer 518

An HbA1C value of ≥ 6.5% or fasting blood glucose ≥ 126 mg/dL is usually diagnostic

Answer 519

topical beta-blockers (timolol), topical alpha-agonists (apraclonidine), carbonic anhydrase inhibitors (acetazolamide)

Answer 520

The goal of surgical and pharmacological treatments is to slow the rate of vision loss by decreasing intraocular pressures. Timolol is a topical beta-blocker that decreases aqueous humor production, leading to decreased intraocular pressures.

Answer 521

Aortic stenosis

Answer 522

treatment of IPF is conditional: nintedanib, a tyrosine kinase inhibitor that targets multiple tyrosine kinases, including vascular endothelial growth factor, fibroblast growth factor, and PDGF receptors; and pirfenidone.

Answer 523

The rash of ehrlichiosis differs from Rocky Mountain spotted fever in that it is a generalized erythematous body rash that peels and resembles a sunburn known as erythroderma, as opposed to the petechial rash involving the hands and soles seen in Rocky Mountain spotted fever.

Answer 524

Doxycycline (start empirically for suspected disease)

Answer 525

persistent esodeviations (“cross-eyed” appearance) beyond 4 months of age should be seen by an ophthalmologist for a comprehensive evaluation.

Answer 526

Retinoblastoma.

Answer 527

mesothelioma

Answer 528

Chest pain

Answer 529

Central retinal vein occlusion is characterized by the acute onset of blurred vision in one eye and is caused by a thrombus within the central retinal vein. In contrast with optic neuritis, the vision loss is painless

Answer 530

Penicillin is recommended as prophylaxis for patients with rheumatic heart disease to prevent future Group A Strep infections, which can lead to recurrence of acute rheumatic fever and worsening heart disease

Answer 531

Adenocarcinoma.

Answer 532

Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker.

Answer 533

Persistent depressive disorder involves more tangible symptoms such as hypo- or hypersomnia and changes in appetite, while depressive personality disorder involves more cognitive symptoms such as feelings of worthlessness and pessimism

Answer 534

Patients with a primary infection often presents with a chancre. The secondary infection involves a diffuse rash. The tertiary infection involves symptoms of aortic insufficiency and central nervous system involvement.

Answer 535

A patient with a left ventricular ejection fraction < 35% and heart failure NYHA Functional Class II or III

Answer 536

Bacterial sinusitis: persistent and not improving (≥ 10 days), worsening or double sickening (≥ 5–6 days); onset of severe symptoms: fever ≥ 39°C (102.2°F) and purulent nasal discharge (≥ 3–4 days at the beginning of illness)

Answer 537

Amoxicillin-clavulanate

Answer 538

High-dose amoxicillin-clavulanate 2,000 mg/125 mg extended-release tablets twice daily.

Answer 539

opioid receptor agonists, such as buprenorphine and methadone, and opioid receptor antagonists, such as naltrexone.

Answer 540

Topical steroids and systemic anti-inflammatory medications (e.g., tetracycline, nicotinamide) are used for mild, localized disease.

Answer 541

ultraviolet irradiation, X-ray therapy, and exposure to some drugs such as furosemide, ibuprofen and other nonsteroidal anti-inflammatory agents, captopril, penicillamine, and antibiotics.

Answer 542

Hip Impingement Femoroacetabular impingement

Answer 543

Auer rods.

Answer 544

Yes, rifaximin can be used with patients with IBS without constipation who fail conservative treatment.

Answer 545

Alpha-blocker (phentolamine, phenoxybenzamine) prior to beta-blockade to prevent unopposed alpha-agonism Surgical resection

Answer 546

Cervical dysplasia

Answer 547

Carcinoma in situ

Answer 548

Long-term use of proton pump inhibitors can be implicated in vitamin and mineral malabsorption (e.g., hypomagnesemia, vitamin B12 deficiency, iron malabsorption), enteric infections including Clostridium difficile colitis, acute interstitial nephritis, development of carcinoid tumors, pneumonia and chronic lung diseases, drug-induced lupus, and increased fracture risk which is highest in the spine, wrist, and hip.

Answer 549

Ischemic hepatitis

Answer 550

The four highly predictive risk factors in adults include expected administration of postoperative opioids, female sex, history of previous postoperative nausea and vomiting or motion sickness, and nonsmoking status.

Answer 551

Conditions which have autoimmune features such as type 1 diabetes mellitus, thyroid disease, juvenile rheumatoid arthritis, dermatitis herpetiformis and autoimmune liver disease are commonly associated with celiac disease.

Answer 552

Bone mineral density.

Answer 553

Schistocytes

Answer 554

Fragmented RBCs seen on peripheral blood smear Indicate intravascular hemolysis Seen in TTP, HUS, DIC

Answer 555

hypertension (often ≥ 180/100 mm Hg) with signs or symptoms of end-organ damage

Answer 556

Tx: acutely reduce MAP by 20–25% using IV antihypertensives (labetalol, hydralazine, or nicardipine) Reduction of MAP > 25% may cause end-organ ischemia

Answer 557

Sx duration > 1 month

Answer 558

Regardless of size, infants of diabetic mothers should initially receive close observation and care. Infants should initiate feedings within one hour after birth.

Answer 559

Type 1 diabetes mellitus.

Answer 560

Vancomycin.

Answer 561

Acute drop in hemoglobin level caused by a transient arrest of erythropoiesis, leading to abrupt reductions in red cell precursors in the bone marrow and a markedly reduced number of reticulocytes in the peripheral blood (reticulocytes < 1.0%).

Answer 562

Aplastic crisis: No reticulocytosis Splenic sequestration: Reticulocytosis

Answer 563

Hydroxyurea.

Answer 564

Risk factors for impaired medical decision-making capacity include age under 18 years or over 85 years, chronic neurologic condition (e.g., Alzheimer disease), chronic psychiatric condition (e.g., depression), low education level, significant cultural or language barrier, acknowledged fear of institutional health care settings.

Answer 565

Viral (mumps, coxsackie, echovirus, rubella, lymphocytic choriomeningitis virus, parvovirus) and bacterial (brucellosis) infections may lead to orchitis in adolescents and children.

Answer 566

Lipodermatosclerosis

Answer 567

Refer to urology if PSA > 4 ng/mL or rapidly rising

Answer 568

Actinic cheilitis.

Answer 569

Potential to progress to squamous cell carcinoma

Answer 570

Creatine kinase

Answer 571

Dx: if delta pressure < 30 mm Hg (diastolic pressure – direct pressure)

Answer 572

Pregnant patients considered to be high risk should consume a diet of folate-rich foods and a daily oral supplement containing 4 mg of folic acid until 12 weeks gestation. Afterwards, folic acid 0.4 mg daily should be continued throughout pregnancy until 4 to 6 weeks postpartum or until the mother stops breastfeeding.

Answer 573

Solid: Stable for 2 years in CT Subsolid: Stable for 5 years In CT Any nodule <6mm.

Answer 574

Hamartomas and infectious granulomas.

Answer 575

The United States Preventive Services Task Force recommends routine screening for C. trachomatis in sexually active women ≤ 24 years of age, and in women 25 years of age or older who are at increased risk for infection.

Answer 576

Decreased serum ferritin, decreased transferrin saturation, increased total iron binding capacity

Answer 577

To relieve dysphagia or airway obstruction due to large cervical spurs.

Answer 578

elevated urinary 5-HIAA (24-hour urine collection)

Answer 579

vitamin B3 (niacin) deficiency, mesenteric and retroperitoneal fibrosis, and carcinoid heart disease.

Answer 580

Most commonly caused by tibia fracture

Answer 581

Thyrotroph adenoma.

Answer 582

Squamous cell carcinoma

Answer 583

postpartum thyroiditis

Answer 584

Physicians sufficiently participating in an AAPM qualify for an annual 5% Medicare Part B incentive two years after the performance year.

Answer 585

Osgood-Schlatter disease.

Answer 586

Lachman test

Answer 587

anterior drawer test: knee to 90 degrees and pulling Lachman test: knee to 30 degrees and pulling

Answer 588

Salicylic acid cryotherapy

Answer 589

Placental abruption

Answer 590

Previous abruption.

Answer 591

Standard treatment for snakebites is ovine- or equine-derived antivenom.

Answer 592

Abduction and external rotation A fall or tackle with the arm in this position can cause an anterior shoulder dislocation.

Answer 593

Lower rates of recurrence

Answer 594

Papillary apocrine metaplasia

Answer 595

Nonproliferative fibrocystic change.

Answer 596

Associated with Turner syndrome, bicuspid aortic valve, and intracranial aneurysms

Answer 597

Hepatitis A, hepatitis B, and pneumococcal vaccinations.

Answer 598

The most appropriate diagnostic imaging for hemodynamically stable patients is CT angiography,

Answer 599

Griseofulvin oral Topical ineffective

Answer 600

Staphylococcus aureus.

Answer 601

Ventricular tachycardia

Answer 602

For patients with symptoms of heart failure and left ventricular outflow tract obstruction, initial monotherapy with a beta-blocker such as nadolol is recommended. nondihydropyridine calcium channel blockers (Verapamil, Diltiazepam) are helpful in the treatment of hypertrophic cardiomyopathy.

Answer 603

Kaposi Sarcoma

Answer 604

Kaposi Sarcoma

Answer 605

Dx: 24-hour urinary excretion of 5-hydroxyindoleacetic acid

Answer 606

Corticosteroids.

Answer 607

Treat adults with doxycycline and third-generation cephalosporins

Answer 608

juvenile dermatomyositis.

Answer 609

Pap test only: screen annually, can begin screening every 3 years after three consecutive negative tests

Answer 610

Annual cotesting.

Answer 611

office-based rubber band ligation for grades I to III is preferred

Answer 612

Topical 0.4% nitroglycerin ointment.

Answer 613

Finger swelling of one digit (hair tourniquet )

Answer 614

Anxiety and depressive disorders.

Answer 615

Angiotensin-converting-enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are the preferred therapeutics.

Answer 616

Recommendations for tetanus prophylaxis depend on the severity of the wound and the number of previous doses the patient has received. Td or Tdap is not used until the patient is > 7 years old. >7 years Tap and tetanus immune globulin <7 years give DTaP vaccine and tetanus immune globulin. Low risk: 10 years High risk: 5 years

Answer 617

Metronidazole is preferred for 10–14 days, but penicillin is acceptable.

Answer 618

prescribe prophylactic azithromycin and administer the Tdap booster dose at 11 years of age.

Answer 619

Alpha-1 adrenergic antagonists end in "sin" (Tamsulosin)

Answer 620

Amyloidosis

Answer 621

Left ventricular wall thickness > 1.5 cm on echocardiogram is diagnostic.

Answer 622

doxycycline in a single dose

Answer 623

tick identified as Ixodes attached for ≥ 36 hours based on engorgement prophylaxis begins within 72 hours of tick removal doxycycline not contraindicated

Answer 624

axial spondyloarthritis

Answer 625

Christmas disease, is caused by a deficiency of factor IX,

Answer 626

Because factor IX (B) has a longer half-life than factor VIII (A), patients with hemophilia B do not require transfusions as often as those with hemophilia A.

Answer 627

factor IX (B) factor VIII (A)

Answer 628

activated partial thromboplastin time

Answer 629

Cefotaxime provides coverage for osteomyelitis caused by Staphylococcus or Salmonella and therefore is appropriate in the initial treatment of this patient. It should be used in addition to vancomycin or clindamycin for coverage of other gram-positive organisms including methicillin-resistant Staphylococcus aureus (MRSA).

Answer 630

Ferritin extremely elevated

Answer 631

Complications: macrophage activation syndrome

Answer 632

Polyarticular (≥ 5 joints) Oligoarticular (1–4 joints, uveitis)

Answer 633

Systemic juvenile idiopathic arthritis

Answer 634

Heinz bodies

Answer 635

fragments of the red cell nucleus that are normally removed by the spleen. splenectomy or hypofunction of the spleen as in sickle cell anemia.

Answer 636

absence of hemoglobin and are characteristic of liver disease, iron deficiency anemia, and hemoglobinopathies such as thalassemia.

Answer 637

Ruptured ovarian cyst

Answer 638

Mittelschmerz

Answer 639

Initial: U/S Gold standard: HIDA

Answer 640

Hydralazine with nitrates

Answer 641

Carvedilol, metoprolol succinate, and bisoprolol.

Answer 642

Pulmonary edema, new or worsening mitral regurgitation, S3 or new or worsening rales, hypotension, bradycardia/tachycardia, and age > 75 years.

Answer 643

unstable angina, non-ST elevation myocardial infarction (NSTEMI), or ST elevation myocardial infarction (STEMI).

Answer 644

For healthy individuals aged 12 months to 40 years, single-antigen HAV vaccine should be administered. For children younger than 12 months, individuals who are older than 40 years, immunocompromised individuals, individuals with chronic liver disease, and individuals for whom HAV vaccine is contraindicated, IG should be administered.

Answer 645

Dx: anti-HAV IgM

Answer 646

Decreased secretion of ADH is characteristic of AVP-D

Answer 647

Nephrogenic diabetes insipidus is now called arginine vasopressin resistance (AVP-R) and central diabetes insipidus is now called arginine vasopressin deficiency (AVP-D). Patients with AVP-R (nephrogenic diabetes insipidus) are unable to concentrate their urine because of resistance to ADH in the kidney. This can occur with lithium toxicity, renal disease, hypokalemia, hyperglycemia, pregnancy, and as a side effect of a number of other medications including amphotericin B, cidofovir, foscarnet, and ofloxacin. Patients with AVP-D (central diabetes insipidus) typically present with polydipsia and polyuria. Diagnosis of AVP (diabetes insipidus) is confirmed through laboratory testing. Patients with suspected AVP (diabetes insipidus) should have a 24-hour urine collection to assess urine volume, as well as serum electrolytes and glucose, urinary specific gravity, plasma and urine osmolality, and plasma ADH level.

Answer 648

AVP-R (nephrogenic diabetes insipidus)

Answer 649

lithium toxicity, renal disease, hypokalemia, hyperglycemia, pregnancy, and as a side effect of a number of other medications including amphotericin B, cidofovir, foscarnet, and ofloxacin.

Answer 650

Oral erythromycin for 2 weeks.

Answer 651

Neisseria gonorrhoeae has an incubation period of 2 to 5 days. Thick purulent discharge Incubation period for C. trachomatis conjunctivitis is 5 to 14 days after delivery. Mucopurulent ocular discharge

Answer 652

Chloroquine

Answer 653

Atovaquone-proguanil

Answer 654

Artesunate IV

Answer 655

Aspirin, bivalirudin, and ticagrelor

Answer 656

PCI center: < 90 minutes door-to-device time Non-PCI center: transfer for PCI if door-to-device time can be < 120 minutes

Answer 657

Thrombolysis: if PCI is not available or door-to-device time > 120 minutes Administer within 30 minutes, can be given up to 12 hours of symptom onset

Answer 658

Distal radius physeal stress reaction

Answer 659

Treatment may require a cast or forearm-based volar splint immobilization for four to eight weeks in order to resolve symptoms

Answer 660

von Willebrand disease

Answer 661

Coagulation studies show a normal platelet count, a normal prothrombin time, and a normal activated partial thromboplastin time except in cases of significant factor VIII level reduction.

Answer 662

Inevitable abortion Incomplete abortion The rest are closed

Answer 663

First- and Second-Trimester Pregnancy Loss Nomenclature Threatened abortion: vaginal bleeding with closed internal os Inevitable abortion: vaginal bleeding with open os Incomplete abortion: partial passage of POCs Complete abortion: complete passage of POCs Missed abortion: fetal death < 20 weeks without passage of POCs Complications: infection (i.e, septic abortion), hemorrhage

Answer 664

Thyroid-stimulating hormone

Answer 665

Sphenopalatine artery

Answer 666

Nephroblastoma

Answer 667

RCC: Classic triad: Flank pain, Hematuria and palpable abdominal mass Wilms: only palpable abdominal mass. Usually no symptoms

Answer 668

Autoimmune pancreatitis

Answer 669

2000 IU/L is labeled as the human chorionic gonadotropin “discriminatory zone” at most institutions. <2000 monitor in next 48 to 72 hours

Answer 670

Compression ultrasonography

Answer 671

Familial hypercholesterolemia

Answer 672

2 years of age.

Answer 673

Fluticasone.

Answer 674

Polymyalgia rheumatica

Answer 675

Treatment consists of low-dose glucocorticoids and oral prednisone at a dose of 10 to 20 mg/day results in a rapid resolution of symptoms.

Answer 676

>= 6 month

Answer 677

The mainstay of treatment is supportive care and plasma exchange or intravenous immune globulin.

Answer 678

Metformin.

Answer 679

On inspiration with neck extension

Answer 680

Holding aspirin for 7–10 days prior to surgery Continue in adverse cardiovascular disease risk >20%

Answer 681

cardiac tumor (i.e. atrial myxoma)

Answer 682

Synovial fluid aspiration

Answer 683

Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA).

Answer 684

Multiple myeloma.

Answer 685

Radiculopathy in the thoracic or lumbosacral area.

Answer 686

Acromegaly secondary to a pituitary adenoma.

Answer 687

< 5 mm: likely to pass spontaneously > 5 mm: medical expulsive therapy (tamsulosin), urology consultation in certain cases > 10 mm: urology consultation, shock wave lithotripsy, ureteroscopy

Answer 688

masked hypertension

Answer 689

Varicose veins: Leg elevation, compression stockings, endothermal venous ablation Telangiectasias and reticular veins: Surface laser therapy

Answer 690

hydroxychloroquine

Answer 691

>= 60: <150/<90 <60: <140/<90

Answer 692

In any patient whose systolic pressure is more than 20 mm Hg or whose diastolic pressure is more than 10 mm Hg above their target blood pressure.

Answer 693

Catechol-O-methyl transferase (COMT) inhibitors.

Answer 694

reactive arthritis

Answer 695

The enteric bacteria most commonly associated with this disease include Chlamydia, Salmonella, Shigella, Yersinia, Campylobacter, and Clostridium difficil

Answer 696

Mnemonic: can't see (conjunctivitis, uveitis), can't pee (urethritis), can't climb a tree (arthritis)

Answer 697

The mainstay of symptomatic treatment is monotherapy with propranolol or primidone.

Answer 698

Scoliometer measurement

Answer 699

Scoliosis is defined as a lateral curve to the spine that is greater than 10 degrees with vertebral rotation.

Answer 700

For patients with an asymptomatically elevated international normalized ratio (INR) that is < 10, the current recommendation is to hold warfarin therapy temporarily until the INR decreases to the goal level.

Answer 701

No x-ray Hyperpronation method: apply pressure to the radial head and hyperpronating the forearm Supination-flexion method: supinate and fully flex the elbow while applying pressure to the radial head and pulling with gentle traction Reduction by the supination/flexion method (D) results in a higher failure rate.

Answer 702

The contralateral side to the pain.

Answer 703

Atrial septal defect, Eisenmenger syndrome, tetralogy of Fallot, and pulmonic stenosis.

Answer 704

Phenobarbital or propofol.

Answer 705

Fluorescence in situ hybridization (FISH).

Answer 706

Management consists of elevating the head of the bed 30–45° and urgent ophthalmology consult.

Answer 707

Urine chloride concentration. If the value is under 20 mEq/L, the patient will likely respond to IV saline.

Answer 708

Pseudomonas aeruginosa

Answer 709

Radioactive iodine ablation

Answer 710

Suspected mechanisms include mucosal barrier disruptions, visceral hypersensitivity, alterations in gastrointestinal motility, dysfunction of the gut-brain axis, a stress response, and alterations in plasma serotonin levels.

Answer 711

Anemia, rectal bleeding, nocturnal symptoms, weight loss, recent antibiotic use, onset > age 50 years, and family history of colon cancer, celiac disease, or inflammatory bowel disease.

Answer 712

Nephrogenic diabetes insipidus. Nephrogenic diabetes insipidus refers to a decrease in urinary concentrating ability that results from resistance to the action of antidiuretic hormone. Central diabetes insipidus refers to a increase in urinary concentrating ability from antidiuretic hormone.

Answer 713

acute diarrhea with three or more loose stools in 24 hours. Treatment is warranted for patients with clinical symptoms and a positive diagnostic laboratory assay. patients may have positive stool assays for up to six weeks after completion of therapy.

Answer 714

Cystoscopy

Answer 715

A DXA T-score ≤-2.5 is consistent with osteoporosis, whereas a T-score between -1.0 and -2.5 is low bone mass (osteopenia).

Answer 716

Nimodipine

Answer 717

Cerebral vasospasm between 2 days and 2 weeks after the event. administer nimodipine 60 mg PO every 4 hours.

Answer 718

anorexia nervosa.

Answer 719

Type B, flat tympanogram

Answer 720

Treatment consists of extension splinting of the DIP joint for < 12 weeks

Answer 721

Absolute indications for surgery include an open mallet finger injury or volar subluxation of the distal phalanx.

Answer 722

Autosomal dominant inheritance

Answer 723

confirm with staining or PCR of respiratory specimens (induced sputum or BAL)

Answer 724

Epidermoid cysts

Answer 725

Gardner syndrome, a familial adenomatous polyposis of the colon.

Answer 726

Complications: macrophage activation syndrome

Answer 727

congenital adrenal hyperplasia

Answer 728

congenital adrenal hyperplasia with 21-hydroxylase deficiency

Answer 729

17-hydroxyprogesterone.

Answer 730

Hyponatremia and hyperkalemia.

Answer 731

The ratio of the forced expiratory volume in one second (FEV1) to the forced vital capacity (FVC)

Answer 732

Abdominal radiographs will usually show dilated loops of bowel, oftentimes with an absence of colonic gas, but will not show the air-fluid levels seen in small bowel obstruction. I

Answer 733

Acute bronchitis

Answer 734

sick sinus syndrome

Answer 735

Stenosing flexor tenosynovitis, known as trigger finger

Answer 736

Initial treatment of severe disease is usually done with voriconazole

Answer 737

Acute respiratory failure

Answer 738

Type I IgE-mediated hypersensitivity reaction

Answer 739

The treatment of choice is a topical antihistamine with mast cell-stabilizing properties. Examples include olopatadine and azelastine. Ketotifen fumarate (over the counter)

Answer 740

Anterior bleeds: Kiesselbach plexus Posterior bleeds: sphenopalatine artery

Answer 741

Squamous cell carcinoma of the esophagus.

Answer 742

Peutz-Jeghers syndrome

Answer 743

Squamous cell carcinoma of the esophagus is the most common esophageal cancer worldwide, although it is second in prevalence to esophageal adenocarcinoma in resource-rich countries such as the United States.

Answer 744

esophageal adenocarcinoma

Answer 745

The major risk factors for esophageal squamous cell carcinoma are smoking and alcohol use In Adenocarcinoma, the main risk factors include obesity and the presence of Barrett's esophagus due to preexisting gastroesophageal reflux disease.

Answer 746

Prostaglandin E1 (PGE1).

Answer 747

Associated with Turner syndrome, bicuspid aortic valve, and intracranial aneurysms

Answer 748

Thiazide and loop diuretics.

Answer 749

Human herpesvirus 6.

Answer 750

Li-Fraumeni syndrome.

Answer 751

Polyuria, polydipsia, plus weight loss and lethargy are the most common presenting symptoms.

Answer 752

ALWAYS doxycycline, even in children

Answer 753

Hot water immersion for Portuguese man o' war stings Acetic acid immersion for Australian or Indo-Pacific species

Answer 754

Elevated serum levels of 1-3-beta-d-glucan (a cell wall component of Pneumocystis jirovecii).

Answer 755

Riboflavin deficiency. Vitamin B2

Answer 756

Biotin deficiency. Vitamin B7

Answer 757

Niacin deficiency. Vitamin B3

Answer 758

Vitamin C. 4 Hs 1. Hemorrhage 2. Hyperkeratosis 3. Hypochondriasis 4. Hematological abnormalities.

Answer 759

Addison disease. Primary adrenal insufficiency Salt craving, postural hypotension, fatigue, nausea, weight loss, muscle and joint pain, and abdominal pain.

Answer 760

Rotavirus and Cytomegalovirus.

Answer 761

Rheumatic fever and post-streptococcal glomerulonephritis.

Answer 762

Saliva, vomit, brain tissue, nervous tissue, and cerebrospinal fluid are all considered contagious substances for the rabies virus.

Answer 763

Gemfibrozil

Answer 764

These include excessive alcohol intake, untreated diabetes, liver disease, pregnancy, autoimmune disorders, and use of certain medications such as thiazides, beta-blockers, corticosteroids, and antipsychotics.

Answer 765

Estrogen, isotretinoin, bile acid-binding resins, antiretroviral protease inhibitors, and immunosuppressants.

Answer 766

Cholinesterase inhibitor (rivastigmine, donepezil, and galantamine) for symptomatic treatment of cognition and global functioning.

Answer 767

Vitamin A,D,E,K and B12

Answer 768

Mallet is injury to the extensor tendon. Splint for 6 weeks. Orthopedic referral for avulsion fracture.

Answer 769

Tinea capitis

Answer 770

toxic epidermal necrolysis. Toxic epidermal necrolysis typically presents with mucocutaneous lesions that affect > 30% of the body surface area. Treatment consists of immediately discontinuing the inciting agent, and administering corticosteroids, intravenous immunoglobulin, cyclosporine, or tumor necrosis factor inhibitors.

Answer 771

If non-statins are used because of documented statin intolerance or a failure to achieve an expected response with statins, the American College of Cardiology (ACC) recommends ezetimibe as first line therapy, or bile acid sequestrants as second line therapy if the patient cannot tolerate ezetimibe. Ezetimibe is a cholesterol absorption inhibitor that impairs dietary and biliary cholesterol absorption of the intestine.

Answer 772

Treatment is supportive (blood pressure control with IV agents), euvolemia, and nimodipine (prevents vasospasm and other neurologic complications)

Answer 773

Epstein-Barr virus.

Answer 774

Primary hypoparathyroidism.

Answer 775

Vitamin C 500 mg daily for 50 days.

Answer 776

Aplastic anemia

Answer 777

Huntington disease

Answer 778

Treatment of children under the age of six should focus on behavioral therapy. Medications along with behavioral therapy are recommended for patients 6 years of age and older. Psychostimulants are a safe first-line option for these patients who require more than behavioral modification. Examples of this class of medications include dextroamphetamine/amphetamine and methylphenidate.

Answer 779

albendazole, mebendazole, or pyrantel pamoate. Most common helminthic infection in the USA

Answer 780

Sever disease (calcaneal apophysitis)

Answer 781

The traditional treatment of active tuberculosis disease involves 2 months of intensive phase (typically isoniazid, rifampin, pyrazinamide, and ethambutol) followed by 4 months of continuation phase (typically isoniazid and rifampin),

Answer 782

Eculizumab.

Answer 783

systemic sclerosis.

Answer 784

Perform HIV-1/HIV-2 antibody differentiation immunoassay

Answer 785

Treatment of early, mild lactational mastitis includes cold compresses, nonsteroidal anti-inflammatory agents, and continued breastfeeding. Treatment of infective lactational mastitis also includes the addition of an antibiotic. In the setting of low-risk for MRSA, dicloxacillin or cephalexin are the agents of choice. For individuals with beta-lactam hypersensitivity, clindamycin is recommended. If there is a risk for MRSA, trimethoprim-sulfamethoxazole (after the newborn period) or clindamycin should be used.

Answer 786

Cardiovascular disorders

Answer 787

COPD or other pulmonary disease, coronary artery disease, hypomagnesemia, pulmonary hypertension, theophylline toxicity, or valvular heart disease.

Answer 788

Prescribing verapamil is an appropriate option, as verapamil decreases the ventricular rate and is effective at terminating the dysrhythmia in many patients.

Answer 789

Lunate Bone

Answer 790

ceftriaxone + doxycycline + metronidazole cefotetan or cefoxitin + doxycycline clindamycin + gentamicin

Answer 791

Osteoporosis since tenofovir disoproxil fumarate-emtricitabine causes bone loss.

Answer 792

Hep.B, HIV, Renal No LFT its not hepatotoxicity.

Answer 793

urease breath test. any proton pump inhibitors for two weeks before the urease breath test can be performed.

Answer 794

Carcinoid Syndrome Diagnosis is confirmed by a 24-hour urine test, which shows increased levels of 5-hydroxyindoleacetic acid

Answer 795

Posterior rib fracture, metaphyseal fractures, multiple and bilateral fractures, fractures in different stages of healing, vertebral body fractures, fractures of the digits, scapular fractures, sternal fractures, and complex skull fractures are usually seen in child maltreatment or abuse.

Answer 796

Any bruising in infants < 6 months of age, more than one bruise in a premobile infant, and more than two bruises in a crawling child.

Answer 797

The greatest suicide rate is in male patients > 85 years old.

Answer 798

increased LDH and bilirubin, reticulocyte, count and decreased hemoglobin and haptoglobin, direct antiglobulin (Coombs) test

Answer 799

In children, the most common joint is the ankle.

Answer 800

PTT elevated

Answer 801

Medications at risk of causing drug-induced lupus include procainamide, hydralazine, and penicillamine.. Among this procainamide has highest risk

Answer 802

Tibial Fracture

Answer 803

Metabolic acidosis

Answer 804

Metabolic acidosis

Answer 805

Age 6 and older

Answer 806

Age 6 and older

Answer 807

The Advisory Committee on Immunization Practices (ACIP) recommends standard immunization with measles-mumps-rubella vaccine (MMR) at 12 to 15 months of age with a second dose at 4 to 6 years of age. A third dose of MMR is recommended for those at increased risk of mumps due to an outbreak. For those who have already completed a two-dose series of MMR, a third MMR dose is recommended by the ACIP, with priority given to those who have had longer time intervals since their last dose.

Answer 808

Two doses of measles-mumps-rubella vaccine administered at least 28 days apart.

Answer 809

Little to no interest in social relationships or intimacy.

Answer 810

Megestrol acetate

Answer 811

Pseudomonas aeruginosa

Answer 812

Treatment for uncomplicated acute diverticulitis usually consists of bowel rest and selective use of oral antibiotics. Typical outpatient treatment regimens consist of gram-negative rod and anaerobe coverage (e.g., ciprofloxacin, trimethoprim-sulfamethoxazole, amoxicillin-clavulanate) for seven to ten days.

Answer 813

Salmonella

Answer 814

Norovirus.

Answer 815

Hepatomegaly

Answer 816

Alcohol-associated liver disease, nonalcohol-related liver disease, and hepatitis C.

Answer 817

Increased tidal volumes

Answer 818

Spontaneous preterm delivery

Answer 819

Muscle weakness

Answer 820

Laron syndrome

Answer 821

Laboratory studies show decreased insulin growth factor-1 (IGF-1) and normal (or increased) GH levels.

Answer 822

Injuries below L2 typically involve the spinal nerve roots that comprise the cauda equina.

Answer 823

Lung cancer, breast cancer, and multiple myeloma.

Answer 824

A herniated nucleus pulposus is the most common cause of lumbosacral radiculopathy. L4-5 and L5-S1 are the areas most commonly affected because the majority of flexion and extension occur at the lumbosacral joint.

Answer 825

Spondylolysis

Answer 826

Spondylolisthesis

Answer 827

Cervical spine.

Answer 828

Simple febrile seizures are the most common and are characterized by seizures that last less than 15 minutes, have no focal features, and occur once in a 24-hour period.

Answer 829

By increasing mean arterial pressure which triggers a parasympathetic response in the heart. The Valsalva maneuver works by compressing thoracic blood vessels such as the vena cava as well as the cardiac atria, which creates a decrease in cardiac preload and triggers an autonomically-mediated rise in peripheral vascular resistance. This is then followed by a sudden increase in cardiac preload upon termination of the maneuver.

Answer 830

risk factors, such as rheumatoid arthritis, long-term glucocorticoid therapy, previous fragility fracture, risk of falls, low body weight, cigarette smoking, excessive alcohol consumption, parental history of osteoporotic fracture, or factors leading to secondary osteoporosis (inflammatory bowel disease, hypogonadism or premature menopause, chronic liver disease, and malabsorption).

Answer 831

After initiation of an oral bisphosphonate, a follow-up DXA should be performed in 2 years.

Answer 832

Beta-blockers, since they may cause exacerbation of coronary artery vasoconstriction.

Answer 833

Oral contraceptives.

Answer 834

ALWAYS doxycycline, even in children

Answer 835

Routine vaccination involves the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine 5-dose series at 2, 4, 6, and 15–18 months and 4–6 years. At 11–12 years of age, a dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) is routinely recommended, followed by a dose of tetanus and diphtheria toxoids (Td) booster every 10 years.

Answer 836

Anticipatory awakening during the first third of the night may help prevent this parasomnia. If the episodes are more frequent and the parent feels the awakenings are problematic, a benzodiazepine (e.g., clonazepam 0.125 to 0.5 mg) given at bedtime has been shown to be beneficial.

Answer 837

Methylprednisolone 500–1000 mg intravenously daily for three days.

Answer 838

Mean arterial pressure should be lowered by 10 to 20 percent in the first hour. In this particular case, that would correspond to a blood pressure of 200/114 mm Hg. The blood pressure should then be reduced an additional 5 to 15 percent over the next 23 hours.

Answer 839

5-alpha reductase inhibitors such as finasteride and dutasteride. Anticholinergic agents such as tolterodine, oxybutynin, darifenacin, solifenacin, fesoterodine, and trospium can be used together with alpha-1 adrenergic antagonists in patients who have symptoms of benign prostatic hyperplasia in addition to irritative symptoms such as frequency, urgency, and incontinence.

Answer 840

Some clinical similarity with sleep terrors, the patient is usually able to remember the event.

Answer 841

Certain medications can also exacerbate sinus node dysfunction, such as beta blockers, calcium channel blockers, digitalis, and antidysrhythmics.

Answer 842

cephalosporins such as cefixime (a third-generation cephalosporin) are generally considered first-line agents for empiric treatment of UTI in children. Cephalosporins or aminoglycosides such as gentamicin are preferred for empiric treatment of UTI in children who require parenteral therapy.

Answer 843

Doxepin, a tricyclic antidepressant, is approved and can be very effective for managing chronic urticaria that is refractive to treatment with antihistamines.

Answer 844

Initial: U/S Gold standard: HIDA

Answer 845

Whereas all patients aged ≥ 60 years with symptoms of dyspepsia are recommended to undergo endoscopy, patients aged < 60 years with dyspepsia should only undergo endoscopy if they have more than one alarm feature (e.g., weight loss, dysphagia, unexplained anemia, persistent vomiting) or have a rapidly progressing alarm feature (e.g., > 5% loss of usual body weight over 6 to 12 months, as in the patient above).

Answer 846

Human papillomavirus

Answer 847

Maximum colonic diameter greater than 6 cm.

Answer 848

24-hour urine cortisol.

Answer 849

For a patient with a first-time primary spontaneous pneumothorax < 3 cm who is clinically stable, you can administer supplemental oxygen and observe for six hours

Answer 850

For patients with a first-time primary spontaneous pneumothorax > 3 cm but still clinically stable, pleural needle aspiration with closed stopcock or Heimlich valve (B) is recommended.

Answer 851

Recurrent: VATS, pleurodesis in a healthy patient

Answer 852

A fibrate, such as gemfibrozil.

Answer 853

Doxycycline 100 mg orally twice daily for 14 days is recommended for prophylaxis in adults. Ciprofloxacin is an alternative prophylactic antibiotic. For adults, streptomycin is the agent of choice for treatment of all forms of tularemia except meningitis. Gentamicin is the agent of choice for children. For adults with mild or moderate disease, oral doxycycline or ciprofloxacin may be used.

Answer 854

Panacinar emphysema

Answer 855

Difficultly reading without magnification

Answer 856

Early signs and symptoms of autism include no babbling by 9 months, lack of orientation by 12 months, and no spontaneous, meaningful (not repetitive or echolalic) two-word phrases by 24 months.

Answer 857

Antibiotic therapy with excision of the fistula tract and duct

Answer 858

Vitamin B12 deficiency increases with age but is also seen due to dietary deficiencies in resource-limited countries, long-term use of metformin or acid-reducing agents such as proton pump inhibitors and histamine H2 blockers, and autoimmune-mediated pernicious anemia. Other risk factors include Crohn disease, tapeworm infection, surgical resection of the ileum, atrophic gastritis, gastric bypass surgery, alcohol use disorder, vegan/strict vegetarian followers, and genetic transcobalamin deficiency.

Answer 859

Patients with liver disease, cancer, or alcohol use disorder may demonstrate falsely elevated low-normal levels, and results should be interpreted cautiously. Serum methylmalonic acid is a better test of actual vitamin B12 activity and is the appropriate next step to confirm a diagnosis of deficiency.

Answer 860

Decreased vitamin B12 levels lead to an elevation of homocysteine, an amino acid that has been linked to increased risk for dementia, heart disease, ischemic stroke, and osteoporosis.

Answer 861

Oral leukoplakia is pre-cancerous. Associated with HPV. Smokeless tobacco is the main risk factor. Hairy: Not pre-cancerous. Associated with EBV. Seen in almost people with HIV.

Answer 862

The modified Centor criteria consist of absence of a cough (1 point), swollen and tender anterior cervical lymph nodes (1 point), temperature greater than 100.4°F (1 point), tonsillar exudate or swelling (1 point), age 3 to 14 years (1 point), age 14 to 44 (0 points), and age 45 and above (−1 point).

Answer 863

Hypotension with a narrowed pulse pressure, jugular venous distention, and distant heart sounds, all three being associated with acute cardiac tamponade.

Answer 864

Schistosomiasis

Answer 865

Salmonellosis

Answer 866

Campylobacter gastroenteritis

Answer 867

Shigellosis

Answer 868

Fluoroquinolones, especially levofloxacin and ciprofloxacin.

Answer 869

Pyrantel pamoate.

Answer 870

Sensitive test initially (NAAT or GDH) followed by specific test (toxin EIA)

Answer 871

Malignant mesothelioma. It is most frequently derived from mesothelial cells of the pleura. Hx: working in shipbuilding, construction, plumbing

Answer 872

Bibasilar interstitial fibrosis.

Answer 873

Before confirming the diagnosis of bipolar disorder, alternative diagnoses must be ruled out, including substance use, side effect of therapy or medication use, thyroid disorders, Cushing syndrome, diabetes mellitus, and vitamin B12 deficiency. Infectious causes of symptoms resembling mania include herpes encephalitis, human immunodeficiency virus encephalitis, and neurosyphilis.

Answer 874

Breast milk jaundice is thought to result from a factor within breast milk that increases the enterohepatic recirculation of bilirubin. Infants with breast milk jaundice continue to feed, void, grow, and develop normally despite their prolonged jaundice. Breast feeding jaundice: Also known as lactation failure jaundice, results from suboptimal intake of breastmilk. Dark green stools (B), three wet diapers in the past 24 hours (C), and a weight loss of 11% from birth weight (D) are all more consistent with breastfeeding jaundice than breast milk jaundice.

Answer 875

All patients with non-ST elevation acute coronary syndrome should undergo early risk stratification as soon as possible after the diagnosis is made. A higher TIMI risk score correlates with an increased number of events such as all-cause mortality, new or recurrent myocardial infarction, or severe recurrent ischemia requiring revascularization at 14 days.

Answer 876

Acute Palmoplantar Eczema (Dyshidrotic Eczema or Pompholyx)

Answer 877

The treatment for respiratory diphtheria consists of antibiotic therapy; for severe cases, diphtheria antitoxin should be added. The initial antibiotics of choice are either IV erythromycin (500 mg four times daily) or IM procaine penicillin G (300 000 units every 12 hours for patients 10 kg and below, or 600 000 units every 12 hours for patients above 10 kg).

Answer 878

Alpha-methyldopa.The initial starting dose is 250 mg every 8 hours. Labetalol is gaining popularity for use as first-line single-agent therapy but may be associated with fetal growth restriction.

Answer 879

First-line treatment is with topical pediculicides, such as permethrin.

Answer 880

Tx: doxycycline Children: amoxicillin or doxycycline (if used for < 21 days) Pregnant: amoxicillin In severe disease (severe meningitis, encephalitis, carditis): ceftriaxone Prevention after tick bite - doxycycline in a single dose if: tick identified as Ixodes attached for ≥ 36 hours based on engorgement prophylaxis begins within 72 hours of tick removal doxycycline not contraindicated

Answer 881

labyrinthitis. Potential treatments consist of corticosteroids (methylprednisolone), antiviral agents (valacyclovir), and symptomatic treatments (e.g., antiemetics, anticholinergics, benzodiazepines).

Answer 882

Children 6 months through 8 years generally require two doses of influenza vaccine during the first season in which they are vaccinated to optimize immune response, separated by at least 1 month. A single dose of inactivated influenza vaccine administered intramuscularly (A) is recommended for children children ≥ 9 years of age

Answer 883

Mild/moderate psoriasis affects less than 5% of the body surface area and spares the genitals, hands, feet, and face. It is treated with corticosteroids, vitamin D analogs, tazarotene intermittently, or calcineurin inhibitors continuously. Severe psoriasis involves more than 5% of the body surface area or involves the hands, feet, face, or genitals and should be referred to a dermatologist for treatment with vitamin D analogs, systemic therapy, and phototherapy. A rheumatologist can treat arthritis symptoms with tumor necrosis factor inhibitors.

Answer 884

infantile beriberi, a disease caused by deficiency in thiamine (vitamin B1).

Answer 885

Hydroxyurea and L-glutamine are recommended to reduce the frequency and severity of pain.

Answer 886

Patients between 34 and 0/7 – 36 and 6/7 weeks should be administered antibiotics for group B streptococcus prophylaxis and preparations for delivery should be made.

Answer 887

Erysipelas Most commonly caused by Streptococcus pyogenes infection (group A beta-hemolytic Streptococcus pyogenes)

Answer 888

Progestin-only contraceptives.

Answer 889

For those who have not previously received PCV (or vaccine status unknown): one dose of PCV20 or PCV15 should be given If PCV15 is given, administer PPSV23 at least 1 year later (except in patients with certain risk factors when an interval ≥ 8 weeks can be considered) For those who previously received PCV13 but not PPSV23: administer PPSV23 at least 1 year after PCV13

Answer 890

impairment in social interaction and restricted repetitive and stereotyped patterns of behaviors, interests, and activities.

Answer 891

Patients treated with chemotherapy and radiation only should receive the following surveillance: complete blood count every one to two months for three years, then every three to six months for up to five years; echocardiography and electrocardiography every two years; and radionuclide angiography or multiple-gated acquisition scan and Holter monitoring every five years.

Answer 892

Sarcoidosis

Answer 893

Dystrophinopathies The first step in the workup of a child with suspected dystrophinopathies is ordering a creatine kinase level.

Answer 894

First-line therapy for the treatment of esophageal candidiasis is oral fluconazole, with a loading dose of 400 mg followed by 200 to 400 mg daily for two weeks. If the patient does not respond to fluconazole therapy, second-line treatments include voriconazole, posaconazole, and intravenous echinocandins such as caspofungin.

Answer 895

Monoclonal gammopathy of undetermined significance

Answer 896

Chronic Myeloid Leukemia (CML)

Answer 897

Cauda equina syndrome.

Answer 898

Parainfluenza virus type 1

Answer 899

Haemophilus influenzae type b

Answer 900

Vestibular neuritis, Meniere's disease, and otosclerosis.

Answer 901

Nasopharyngeal cancer

Answer 902

The fractures are classified based on their location: (1) the distal aspect of the metatarsal is referred to as a diaphyseal stress fracture, (2) the middle/proximal aspect is referred to as a Jones fracture, and (3) the aspect closest to the ankle is referred to as a tuberosity avulsion fracture.

Answer 903

The acute management of this particular patient includes a posterior short leg splint with nonweight-bearing. The patient should follow up in 3 to 5 days, and then she may be placed in a short leg nonweight-bearing cast for 6 to 8 weeks, the extended healing time being due to the higher risk of nonunion in Jones fractures. A follow-up X-ray should then be performed to assess healing. Referral to an orthopedic surgeon for surgical intervention is recommended for Jones fractures in athletes or high activity-level individuals, fractures with displacement of greater than 2 mm, and fractures with nonunion after 12 weeks of conservative therapy.

Answer 904

50 x 109/L

Answer 905

Intralesional triamcinolone acetonide

Answer 906

long-acting muscarinic antagonist (e.g., tiotropium bromide once daily, aclidinium bromide twice daily) or long-acting beta-2 agonist (e.g., salmeterol twice daily, indacaterol once daily). A short-acting bronchodilator inhaler (e.g., albuterol) can also be prescribed for symptom control as needed.

Answer 907

zanamivir, another neuraminidase inhibitor, at 10 mg inhaled twice daily for five days as an alternative treatment.

Answer 908

Asthma or chronic obstructive pulmonary disease.

Answer 909

Immunoglobulin A antitissue transglutaminase antibody testing and duodenal biopsy

Answer 910

Late manifestations include anion gap metabolic acidosis, hypocalcemia, and kidney failure (secondary to deposition of calcium oxalate crystals in the renal tubules).

Answer 911

fomepizole, a potent competitive alcohol dehydrogenase inhibitor, has replaced ethanol.

Answer 912

A hallmark symptom specific for ciguatera fish poisoning is temperature-related dysesthesias where cold stimuli are perceived as hot or as an uncomfortable sensation.

Answer 913

They should avoid consuming alcohol, caffeine, fish, and nuts for six months due to the risk of triggering a recurrence of symptoms.

Answer 914

keratoacanthoma 1–2 cm dome-shaped nodules with a central keratin-filled crater.

Answer 915

Arborization or ferning of vaginal fluid when viewed under a low-power microscope

Answer 916

Oral antihistamines are typically the first treatment patients will use for allergic rhinosinusitis as they are sold over-the-counter. Second- or third-generation antihistamines are preferred, having fewer central nervous system side effects than those of the first generation. If antihistamines are ineffective, the next line of therapy and most effective single treatment for allergic rhinitis is glucocorticoid nasal sprays with agents such as budesonide, fluticasone propionate, mometasone furoate, and triamcinolone acetonide.

Answer 917

A minimum of three months.

Answer 918

The most appropriate anticoagulant for the treatment of this patient is rivaroxaban. The recommended dose is 15 mg orally twice daily with food for 21 days, then a maintenance dose of 20 mg once daily.

Answer 919

Diuretics and aldosterone antagonists such as spironolactone or eplerenone are the only medication that have been shown to provide benefit to patients with diastolic heart failure, or heart failure with preserved ejection fraction

Answer 920

Jugular venous distention, S3 heart sound, and displaced apical impulse.

Answer 921

Home health aide is available for 3 hours per day, 4 times per week Bereavement support is available for families and caregivers for 13 months after the patient’s death Physician certification that the patient has a terminal illness and is likely to have less than 6 months to live is necessary for eligibility Short-term respite care is available for 5 days every 30 days

Answer 922

Aromatase inhibitor use increases the risk of developing carpal tunnel syndrome.

Answer 923

1. Pathologic: <24 hours of life 2. Physiologic: 2 day to 14 days 3. Breast Milk Jaundice: >2 weeks of life. Baby well appearing. 4. Breast Feeding Jaundice: Lactation failure. Signs of dehydration may include decreased urine output, significant weight loss, persistence of meconium stools, decreased skin turgor, and excessive sleepiness.

Answer 924

Topical corticosteroids such as 1% hydrocortisone.

Answer 925

Low-molecular-weight heparin therapy such as enoxaparin and fondaparinux are good choices for monotherapy in patients with acute pulmonary embolism who are hemodynamically stable. Unfractionated heparin as a treatment for acute pulmonary embolism is preferred in patients with severe renal failure, patients with extensive clot burden, and patients in whom there is a high likelihood that acute reversal of anticoagulation will be needed (e.g., increased risk of bleeding, procedure such as thrombolysis or embolectomy anticipated).

Answer 926

B-cell lymphomas, T-cell lymphomas, Hodgkin lymphoma, and nasopharyngeal carcinomas.

Answer 927

Impairment of short-term memory

Answer 928

Wernicke Encephalopathy Sx: ataxia and confusion PE: nystagmus, lateral rectus palsy

Answer 929

Tricuspid Stenosis

Answer 930

Papillary muscle rupture

Answer 931

ventricular septal defect as a complication of her anterior myocardial infarction.

Answer 932

For infants, breastfeeding is typically limited to 25% or less of total feedings and should be alternated with phenylalanine-free infant formula feedings making up the remaining 75%. Give tyrosine

Answer 933

The most commonly obstructed artery in peripheral artery disease is the superficial femoral artery, located in the anteromedial part of the thigh.

Answer 934

At or below 0.90.

Answer 935

Opioids, benzodiazepines, antivenom (only if severe Sx) Benzodiazepines are used to reduce the severity and frequency of muscle spasms.

Answer 936

Glyburide Metabolites of glyburide are active and have weak hypoglycemic activity. Therefore, the risk of hypoglycemia is higher in patients with chronic kidney disease.

Answer 937

For patients with chronic kidney disease, glipizide or glimepiride are preferred because they are metabolized by the liver and excreted in the urine as inactive metabolites.

Answer 938

Carboprost tromethamine (contraindicated in asthma) Methylergonovine (contraindicated in hypertension, coronary or cerebral artery disease, and Raynaud's syndrome)

Answer 939

Ischemic electrocardiogram changes, cardiovascular collapse, and cardiac arrest.

Answer 940

Once weekly isoniazid plus rifapentine for 3 months, daily rifampin for 4 months, or daily isoniazid plus rifampin for 3 months. Alternative treatment regimens include daily isoniazid for 9 months or for 6 months.

Answer 941

Isoniazid.

Answer 942

increased ferritin and transferrin saturation

Answer 943

Emergent ophthalmology evaluation, topical beta-blockers (timolol), topical alpha-agonists (apraclonidine), carbonic anhydrase inhibitors (acetazolamide), iridotomy

Answer 944

Vomiting and weight loss.

Answer 945

Azithromycin and erythromycin.

Answer 946

The 2019 and 2023 updates of the Beers Criteria were adjusted to move rivaroxaban and dabigatran to the list of medications that should be avoided or used with caution, respectively, in older adults with normal kidney function.

Answer 947

Progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome)

Answer 948

Superior cerebellar peduncle atrophy, which correlates with disease duration.

Answer 949

Basal cell nevus syndrome, long-term immunosuppressive therapy, radiation therapy, and chronic arsenic exposure.

Answer 950

Mefloquine

Answer 951

Plasmodium malariae.

Answer 952

Uncomplicated, chloroquine-sensitive areas - chloroquine Uncomplicated, chloroquine-resistant areas - atovaquone-proguanil Complicated, chloroquine-resistant areas - artesunate IV

Answer 953

USPSTF: screen all patients age 45–75 years, select patients up to age 85 ACG: start screening at age 45 AAFP: start screening at age 50 One first-degree relative with colon cancer or advanced polyp: colonoscopy at age 40, or 10 years earlier than the age at which relative diagnosed Familial adenomatous polyposis: dependent on subtype and risk factors, screening in late childhood to adolescence At least every 1–2 years

Answer 954

Asthma action plan

Answer 955

Ring-shaped trophozoites inside the red blood cells

Answer 956

Pityriasis rosea Treatment is symptomatic with oral antihistamines or topical or oral steroids as the condition is self-limited. More severe cases can be treated with oral acyclovir.

Answer 957

The rash of secondary syphilis may be indistinguishable from pityriasis rosea, especially when no herald patch is present, and a screening test for syphilis, e.g., rapid plasma reagin (RPR) or Venereal Disease Research Laboratory (VDRL)) should be ordered.

Answer 958

Ethylene glycol poisoning is associated with calcium oxalate crystals in the urine.

Answer 959

The presence of eosinophilia which is typically an allergic reaction to medications such as penicillins, sulfa-containing antibiotics and diuretics, nonsteroidal anti-inflammatory drugs, and proton pump inhibitors.

Answer 960

Ehrlichiosis

Answer 961

An elevated total serum insulin growth factor-1 (IGF-I) concentration is extremely useful in the diagnosis of acromegaly.

Answer 962

Mental status (Glasgow Coma Scale), respiratory rate, and systolic blood pressure

Answer 963

Popliteal artery

Answer 964

<0.9 indicates >50% stenosis <0.4 indicates ischemia

Answer 965

superficial femoral artery

Answer 966

Timolol ophthalmic drops Glaucoma is characterized by elevated intraocular pressure that cause progressive damage to the optic nerve.

Answer 967

macular degeneration Vitamin E and vitamin A are often recommended for patients with macular degeneration to help slow disease progression

Answer 968

ECG is the recommended initial test, looking for characteristic changes in the ST-segment to include either downsloping ST-segment elevation in leads V1–V2 or a “saddle-back” ST-segment in leads V1–V2.

Answer 969

Hydromorphone and Fentanyl

Answer 970

The most common clinical manifestation of acute toxoplasmosis is bilateral, symmetrical, nontender cervical adenopathy.

Answer 971

pyrimethamine + sulfadiazine or clindamycin, PLUS leucovorin to prevent myelosuppression Pregnancy: clindamycin contraindicated, spiramycin (< 18 weeks GA), pyrimethamine plus sulfadiazine (≥ 18 weeks GA)

Answer 972

4th or 5th anterior axillary line or 2nd intercostal space in midclavicular line followed by chest tube insertion ENTER ABOVE THE RIB MARGIN

Answer 973

Clopidogrel and aspirin for a minimum of 12 months, and lisinopril, metoprolol, and atorvastatin indefinitely

Answer 974

dilation of the abdominal aorta of at least 3.0 cm.

Answer 975

An ultrasound should be performed every two to three years if the aneurysm is 3.0 to 3.9 cm and Every 6 to 12 months if the aneurysm is 4.0 to 5.4 cm. Patients with an aneurysm greater than 5.4 cm should be referred for elective surgical repair (some guidelines suggest a threshold of 5.0 cm in female patients).

Answer 976

Endoscopic variceal ligation Nonselective beta-blockers (nadolol, propranolol)

Answer 977

This includes limiting the focus of a visit to three key points for each visit, avoiding medical jargon, breaking down instructions into small concrete steps, and assessing for comprehension.

Answer 978

Scheuermann (juvenile) kyphosis

Answer 979

Pseudomonas aeruginosa.

Answer 980

Adenocarcinoma

Answer 981

Compartment pressure (direct pressure): 30-40 mm Hg Delta pressure <30 mm Hg Delta pressure: diastolic pressure - direct pressure

Answer 982

Mild: Topical calcineurin inhibitors Moderate to severe: above plus oral tetracycline

Answer 983

Low vision is when a person has a visual acuity of 20/70 or worse, while legal blindness is a visual acuity of 20/200 or worse.

Answer 984

Photocoagulation.

Answer 985

Subacute thyroiditis has a strong association with HLA-B35.

Answer 986

radioactive iodine uptake scan is negative

Answer 987

Negative symptoms in schizophrenia include alogia (poverty of speech), avolition (lack of purposeful action), and affective flattening (decreased emotional reactivity).

Answer 988

Pseudoparkinsonism, akathisia, acute dystonia, and tardive dyskinesia.

Answer 989

Clozapine (Clozaril), Olanzapine (Zyprexa), Risperidone (Risperdal), Paliperidone (Invega), Quetiapine (Seroquel), Aripiprazole (Abilify), Lurasidone (Latuda), and Ziprasidone (Geodon)

Answer 990

Most common causes < 35 years old: N. gonorrhoeae, C. trachomatis > 35 years old: E. coli Tx < 35 years old: ceftriaxone IM and doxycycline > 35 years old: fluoroquinolone or TMP-SMX for 4 weeks

Answer 991

First-line antidepressants include selective serotonin reuptake inhibitors (e.g., escitalopram), serotonin norepinephrine reuptake inhibitors (e.g., venlafaxine), and atypical antidepressants (e.g., bupropion, mirtazapine).

Answer 992

Random plasma glucose ≥ 200 mg/dL in patients with classic symptoms Fasting plasma glucose ≥ 126 mg/dL Glycated hemoglobin (A1C) ≥ 6.5% Plasma glucose ≥ 200 mg/dL 2 hours after a 75 g glucose load during an oral glucose tolerance test (uncommonly performed) Typically two tests required to establish the Dx (in the absence of unequivocal hyperglycemia) Type 1 diabetics also have low C-peptide and insulin levels.

Answer 993

Polymyalgia rheumatica: Aching and stiffness that occurs in the bilateral shoulders and hip-girdle area. Polymyositis: Proximal weakness of the hip flexors and the deltoids bilaterally

Answer 994

Healthy adult, no comorbidities or high risk factor for MRSA or Pseudomonas aeruginosa: Amoxicillin high-dose or doxycycline or macrolide (in areas with <25% resistant) Adult with comorbidities: Combination therapy with amoxicillin–clavulanate or cephalosporin + doxycycline ordered macrolide or respiratory fluoroquinolones monotherapy.

Answer 995

Skin hyperpigmentation

Answer 996

The USPSTF recommends screening mammography for women every 2 years from ages 40–74 years.

Answer 997

polyarteritis nodosa is not associated with antineutrophil cytoplasmic antibodies (ANCA).

Answer 998

Small vessel: Hypersensitivity Vasculitis Immunoglobulin a vasculitis (Henoch-Schonlein Purpura) Goodpasture syndrome Granulomatous with polyangiitis Medium vessel: Polyarthritis nodosa Behcet disease Microscopic polyangiitis Large vessel: Giant cell arteritis Takayasu arthritis

Answer 999

Campylobacter Tx: First-line agents for treatment of Campylobacter gastroenteritis include fluoroquinolones or azithromycin.

Answer 1000

Paroxetine, as it is thought to carry an increased risk of congenital malformations.

Answer 1001

Ulcerative colitis

Answer 1002

Ethanol use

Answer 1003

Sever disease (calcaneal apophysitis)

Answer 1004

patellofemoral pain syndrome patellar grind test

Answer 1005

Anterior cruciate ligament, medial collateral ligament, and medial meniscus.

Answer 1006

Central retinal artery occlusion

Answer 1007

Decongestants and anticholinergic medications.

Answer 1008

Endometriosis

Answer 1009

Number needed to treat (NNT) = 1 / absolute risk reduction Number needed to harm = 1 / attributable risk Odds ratio (OR) = odds of the outcome in the exposed group / odds of the outcome in the nonexposed group Relative risk (RR) = event rate in intervention group / event rate in control group RR reduction = 1 − RR, or absolute risk reduction / event rate in control group Absolute risk reduction = event rate in control group − event rate in intervention group Attributable risk = incidence risk among exposed group − incidence risk among nonexposed group

Answer 1010

Electrodiagnostics, then laboratory testing

Answer 1011

The first step in the evaluation of a thyroid nodule is to order a thyroid-stimulating hormone level. If the thyroid-stimulating hormone level is either normal or high, the current recommendation for nodules > 1 cm is to aspirate for cytologic examination. Clinical follow-up is recommended for nodules < 1 cm. A radionuclide uptake thyroid scan should be ordered to rule out a hyperfunctioning nodule if the thyroid-stimulating hormone level is suppressed.

Answer 1012

It may improve iron stores in the baby.

Answer 1013

Medicare A : Hospital Insurance Medicare B : Medical Insurance Medicare C : Medicare Advantage Plan (Covers Part A and B) Medicare D : Prescription Drug Coverage

Answer 1014

Antibiotics: dicloxacillin, cephalexin, TMP-SMX (MRSA), clindamycin (penicillin allergy) Continue breastfeeding

Answer 1015

Lactational: Dicloxacillin Nonlactational: Augmentin

Answer 1016

Crown-rump length measured in the first trimester

Answer 1017

Propylthiouracil is the preferred agent during the first trimester of pregnancy.

Answer 1018

Administering a uterine relaxant, such as salbutamol, a beta-adrenergic agonist, or nitroglycerin is the first step in managing head entrapment.

Answer 1019

Rod-shaped crystals that are positively birefringent

Answer 1020

Toxoplasmosis

Answer 1021

Vaginal warts can be treated by applying trichloroacetic acid to the lesion

Answer 1022

Defervescence of the fever and then the appearance of a maculopapular rash Roseola is a fairly common pediatric rash that is caused by human herpesvirus 6.

Answer 1023

roseola: Exanthem erythema rubella: German Measles rubeola: Measles

Answer 1024

Mid-reticular dermis to adequately evaluate for invasive disease.

Answer 1025

This patient presents with a gonococcal infection and the treatment of choice is ceftriaxone. Because of the rising coinfection with Chlamydia trachomatis, it is recommended that azithromycin (in pregnancy) or doxycycline (in nonpregnant patients) be added to the treatment regimen in order to treat both organisms.

Answer 1026

Antibiotics are recommended for severe illness (e.g., nine or more stools per day, persistent high fever, need for hospitalization) and to prevent complications for individuals who are at high risk based on age (< 12 months and > 50 years), presence of endovascular abnormalities or implanted prosthetic materials, and immunosuppression status (e.g., organ transplant, malignancy, HIV, sickle cell disease or other hemoglobinopathies, and use of immunosuppressive agents such as corticosteroids). Treatment options include ciprofloxacin and azithromycin.

Answer 1027

children > 5 years of age In children > 6 years of age who have failed behavioral interventions, desmopressin (a synthetic vasopressin analog) is recommended as first-line pharmacotherapy.

Answer 1028

Rheumatic valve disease

Answer 1029

Hepatitis A and B vaccinations

Answer 1030

Cochlear nerve: Hearing and tinnitus Vestibular nerve: Ataxia Facial nerve: Facial paresis

Answer 1031

Administering analgesia for pain and tetanus prophylaxis

Answer 1032

For patients without cirrhosis and with no prior exposure to a direct-acting antiviral medication (including treatment-naïve patients and those who did not benefit from prior treatment with peginterferon plus ribavirin), preferred first-line therapy for chronic HCV genotype 1 infection consists of either glecaprevir and pibrentasvir for 8 weeks, ledipasvir and sofosbuvir for 8 weeks, or sofosbuvir and velpatasvir for 12 weeks.

Answer 1033

A few pharmacologic agents have shown benefit, and glucocorticoids are thought to be the most helpful for palliative care patients with fatigue. They have also shown benefit in the management of anorexia, nausea, and pain in the palliative care setting. Other pharmacologic therapies that have demonstrated benefit include megestrol acetate and psychostimulants (e.g., dextroamphetamine, methylphenidate, modafinil).

Answer 1034

Desmopressin therapy: in children ≥ 7 years, short-term efficacy

Answer 1035

Screening for neural tube defects can be done with a second trimester abdominal ultrasound or a second trimester maternal serum alpha-fetoprotein screening test.

Answer 1036

Progesterone, which causes relaxation of the ureters.

Answer 1037

Congenital cytomegalovirus (CMV) infection

Answer 1038

Benzathine penicillin G 1.2 million units intramuscularly every 4 weeks. An alternative option is penicillin V 250 mg oral twice daily, but there is a higher risk of failure due to nonadherence. Erythromycin, clarithromycin, and azithromycin are options for those who have a penicillin allergy. Rheumatic heart disease with carditis and valvular heart disease: 10 years or until 40 years old (whichever is longer) Rheumatic heart disease with carditis but no valvular heart disease: 10 years or until 21 years old (whichever is longer) Rheumatic heart disease without carditis: 5 years or until 21 years old (whichever is longer)

Answer 1039

torn meniscus

Answer 1040

Dysfunction of the meibomian glands

Answer 1041

Intravenous acetazolamide followed by laser peripheral iridotomy as this is a medical emergency.

Answer 1042

Starburst livedo (painful violaceous plaques that are surrounded by livedo reticularis) is pathognomonic

Answer 1043

Vitamin B12

Answer 1044

VIII (hemophilia A) or factor IX (hemophilia B)

Answer 1045

Von Willebrand's disease and idiopathic thrombocytopenia purpura.

Answer 1046

bleeding time is prolonged in patient with von Willebrand's Disease

Answer 1047

thalassemia.

Answer 1048

Thalassemia.

Answer 1049

(1) room-sharing, without bed-sharing, between parents and infants appears to reduce the risk of SUDI, (2) the use of a pacifier during sleep also appears to reduce the risk of SUDI, (3) breastfeeding has an independent protective effect against SUDI, (4) use of a fan was associated with a 72 percent reduction in SUDI risk and (5) immunization may lower the risk of SUDI.

Answer 1050

Herpes simplex virus type 1 (HSV-1) encephalitis

Answer 1051

Well-defined periodic complexes in synchrony with myoclonic jerks.

Answer 1052

Congenital: beta-blocker, cardiology consult, consider genetic testing and counseling Acquired: stop offending medications, correct electrolyte disturbances, IV magnesium or pacing for torsades de pointes

Answer 1053

Acute myelogenous (myeloid, myelocytic) leukemia (AML)

Answer 1054

Acute Myeloid Leukemia (AML)

Answer 1055

Achondroplasia Macrocephaly, prominent forehead, enlarged anterior fontanel, low nasal bridge, shortened extremities, and a trident deformity of the hands.

Answer 1056

Lymphadenopathy Benign: < 2 cm, soft, tender Concerning: > 2 cm, supraclavicular, rubbery, hard, nontender

Answer 1057

age-related macular degeneration.

Answer 1058

Central: Age-related macular degeneration Peripheral: Glaucoma (Open or Closure)

Answer 1059

Topical antibiotics and pain controls Topical antibiotics, such as erythromycin ointment or trimethoprim-polymyxin B drops, help prevent secondary bacterial infection, particularly in high-risk individuals such as contact lens wearers (who require antipseudomonal coverage like fluoroquinolones).

Answer 1060

Adenomatous polyps

Answer 1061

There is a strong association of eosinophilic esophagitis with allergic conditions such as food allergies, environmental allergies, asthma, and atopic dermatitis.

Answer 1062

Fluticasone, which is sprayed into the patient’s mouth using a metered dose inhaler and then swallowed.

Answer 1063

To reduce the risk of SUID, parents should be counseled to not smoke in the home or near the infant, consider offering a pacifier at naptime and bedtime, avoid bundling or excessive bedding, and place the infant in the supine position while sleeping.

Answer 1064

The male sex has a higher incidence of SUID.

Answer 1065

Treatment typically includes cabergoline or pasireotide. If the cause of Cushing syndrome is a cortisol-secreting adrenal tumor, its removal is required.

Answer 1066

Long-term glucocorticoid therapy.

Answer 1067

Renal parenchymal disease (e.g., glomerulonephritis) and coarctation of the aorta.

Answer 1068

Mitral stenosis is most commonly caused by rheumatic heart disease

Answer 1069

Autism spectrum disorder

Answer 1070

middle ear effusion coupled with signs of middle ear inflammation, such as erythema or bulging of the tympanic membrane. Treatment: Amoxicillin is considered first-line treatment of acute otitis media at a high dose of 80-90 mg/kg per day divided twice daily. Cefdinir is an acceptable alternative if the patient has a penicillin allergy.

Answer 1071

Aggression

Answer 1072

More than 95% of disk herniations occur at L4 or L5.

Answer 1073

L4 root The anterior tibial muscle may be weak, as evidenced by the inability to heel walk. The quadriceps and hip adductor group, both innervated from L2, L3, and L4, also may be weak and, in extended ruptures, atrophic. Reflex testing may reveal a diminished or absent patellar tendon reflex (L2, L3, and L4) or anterior tibial tendon reflex (L4).

Answer 1074

Children 9 to 12 years old who have reached at least 4 feet 9 inches in height

Answer 1075

Two to three weeks after birth.

Answer 1076

Additionally, in the case of yellow fever vaccine, skin testing with the vaccine should be performed and, if negative, vaccine given followed by a thirty-minute post-vaccine monitoring period.

Answer 1077

Visualization, compressibility, flow and reflux measurements, and augmentation

Answer 1078

Creases, pressure areas, and nipples.

Answer 1079

Diagnosis is made by DXA scan: T-score ≤ −2.5 or presence of a fragility fracture Low bone mineral density: T-score −1.0 to −2.5

Answer 1080

high-grade cervical intraepithelial lesions (CIN 2 or 3) should undergo further treatment with a loop electrosurgical excisional procedure (LEEP).

Answer 1081

Postexposure prophylaxis should be initiated within 21 days of the onset of cough in the known case. The macrolide antibiotics including erythromycin, azithromycin, and clarithromycin are the preferred antimicrobial therapies for the treatment and postexposure prophylaxis of pertussis.

Answer 1082

Imiquimod 5% cream.

Answer 1083

Single-fiber electromyography Anti-acetylcholine receptor antibodies are assayed in the plasma of patients suspected to have myasthenia gravis, with a high sensitivity but lower than that of single-fiber EMG. Myasthenia gravis is one of the few neuromuscular diseases in which electromyography (EMG) has a higher specificity for diagnosis than a muscle biopsy.

Answer 1084

Moisturizers are first-line therapy. Lukewarm soaking baths for 15-20 minutes followed by the application of an occlusive emollient to retain moisture provides symptomatic relief. Hydrophilic ointments of varying degrees of viscosity can be used according to the patient’s preference.

Answer 1085

Coagulopathy (platelet count < 50,000/μL, INR > 1.5, or PTT greater than two times the control value) and prolonged mechanical ventilation (greater than 48 hours) are the two highest risk factors for stress ulcers.

Answer 1086

gonadotropin deficiency.

Answer 1087

Aripiprazole and Ziprasidone first-generation typical antipsychotics are mostly associated with low risk of metabolic changes, but they are not often a preferred choice because they carry an increased risk of extrapyramidal symptoms such as tardive dyskinesia and akathisia

Answer 1088

intact uterus, estrogen should be used in combination with a progestin to prevent endometrial hyperplasia No uterus: Estrogen Patients taking combined (estrogen/progestin) therapy are at a significantly increased risk for breast cancer and venous thromboembolism but have a reduced risk of hip fractures.

Answer 1089

Ospemifene.

Answer 1090

5 years or until 21 years of age - ARF without carditis 10 years or until 21 years of age - ARF with carditis without valvular disease 10 years or until 40 years of age - ARF with carditis with valvular disease WHICHEVER IS LONGER

Answer 1091

Clarithromycin

Answer 1092

macrolide plus ethambutol plus rifamycin Consider prophylaxis (azithromycin or clarithromycin) in patients with HIV infection with CD4 < 50 cells/mm3

Answer 1093

Superficial spreading melanoma.

Answer 1094

Bacterial vaginosis is diagnosed by the presence of three out of four Amsel criteria. Amsel criteria include a thin, homogeneous discharge; vaginal pH > 4.5; positive whiff test; and at least 20% clue cells.

Answer 1095

Macrophage activation syndrome

Answer 1096

400–800 mcg daily at least 1 month prior to conception If seizure disorder or prior history of child with neural tube defect, take 4,000 mcg (10× more)

Answer 1097

24 and 48 hours of life

Answer 1098

Water restriction test

Answer 1099

4–12 weeks postpartum two-hour 75-gram oral glucose tolerance test

Answer 1100

Glucocorticoids are most beneficial in the treatment of fatigue related to terminal cancer or palliative care, Megestrol acetate shows benefits in improving the appetite of patients with symptoms due to anorexia or cachexia. Central nervous stimulants such as methylphenidate have demonstrated variable efficacy in treating fatigue in the palliative care setting but are of some benefit in cancer-related fatigue.

Answer 1101

Oral glucose suppression testing Oral glucose tolerance testing is used as the confirmatory test to diagnose acromegaly. If suspected, oral glucose tolerance testing can be completed. The test includes administering 75 grams of oral glucose and measuring growth hormone two hours later. Normally, growth hormone levels increase when there is low blood glucose, resulting in increased glucose synthesis. Therefore, an external glucose load should decrease the growth hormone levels. If the growth hormone level does not decrease to less than 1 ng/mL after glucose administration, a pituitary adenoma is likely.

Answer 1102

Trypsinogen

Answer 1103

Age > 55 years, WBC count > 16,000/µL, glucose > 200 mg/dL, lactate dehydrogenase > 350 U/L, aspartate aminotransferase > 250 U/L.

Answer 1104

1. Red blood cell lifespan is shortened to less than 90 days. 2. Decreased activity of the enzymes of conjugation within the liver. 3. Increased enterohepatic recirculation of bilirubin compared to older children

Answer 1105

conjunctival and nasopharyngeal NAAT If positive, test for Neisseria gonorrhoeae oral azithromycin or erythromycin Topical therapy is not effective

Answer 1106

Student t-test Chi-square test and Fisher exact test are used with categorical variables One-way analysis of variance (ANOVA) is used to compare continuous data when there are three or more groups.

Answer 1107

efficiency of practice, cultural wellness, and personal resilience.

Answer 1108

Patients with ulcerative colitis need yearly Papanicolaou smears, early dual-energy X-ray absorptiometry screening, and screening colonoscopy 8 to 10 years after diagnosis of colitis.

Answer 1109

Low urine osmolality, high serum osmolality

Answer 1110

Intravenous fluids (normal saline) with subsequent insulin administration and electrolyte repletion.

Answer 1111

increase in serum creatinine by ≥ 0.3 mg/dL over 48 hours or an increase to ≥ 1.5 times the presumed baseline creatinine over the past 7 days and a decrease in urine volume to < 0.5 mL/kg/hour over 6 hours.

Answer 1112

Lack of menses and no breast development: 13 years old Lack of menses + breast development: 15 years old

Answer 1113

Endometriosis

Answer 1114

However, cervical length should not be measured before 16 weeks of gestation because the ultrasound cannot adequately distinguish the cervix from the lower uterine segment in early pregnancy.

Answer 1115

short cervix is defined as under 25 mm.

Answer 1116

Colon or GI: CEA Liver: AFP Ovarian: CA 125 Pancreatic: CA 19-9 Testicular: AFP, hCG

Answer 1117

Von Willebrand Disease.

Answer 1118

"hammer finger". mallet fracture Splinting of the DIP joint in the extension position for approximately 8 weeks. Splinting the DIP joint in flexion is inappropriate for any type of fracture. Fractures of the fingers should be splinted in extension position.

Answer 1119

Tobacco (smoked or smokeless)

Answer 1120

Chadwick sign Osiander sign Goodell sign Piskacek sign Hegar sign

Answer 1121

bipolar disorder.

Answer 1122

Haloperidol

Answer 1123

positive symptoms such as hallucinations, delusions, and disorganized speech and negative symptoms such as decreased emotional expression and lack of motivation.

Answer 1124

First-generation antipsychotics such as haloperidol have a higher incidence of extrapyramidal symptoms such as akathisia and dystonia. Second-generation antipsychotics such as lurasidone, olanzapine, quetiapine, risperidone, and ziprasidone cause weight gain, as well as elevations of lipid and glucose levels, which require monitoring.

Answer 1125

Ménière disease is characterized by the triad of sensorineural hearing loss, episodic vertigo, and tinnitus.

Answer 1126

5 years old

Answer 1127

Papillary thyroid cancer

Answer 1128

Features of a solitary pulmonary nodule suggesting malignancy include irregular or spiculated border, no calcification or calcification that is eccentric, ground-glass density, doubling time of one month to one year, size greater than 1 cm, and location in an upper lobe of lung.

Answer 1129

Parainfluenza virus type 1.

Answer 1130

Methicillin-sensitive Staphylococcus aureus

Answer 1131

Treatment typically consists of topical therapy with brimonidine. For moderate cases, topical metronidazole, azelaic acid, or topical ivermectin can be used.

Answer 1132

Behavioral therapy is the mainstay of initial treatment for children < 6 years of age.

Answer 1133

In addition to stimulants and atomoxetine, what other class of medications is recommended in the management of children ≥ 6 years of age with attention-deficit/hyperactivity disorder?

Answer 1134

Plasma fractionated metanephrines (B) is used in diagnosing patients at high risk for pheochromocytoma (i.e., family history of pheochromocytoma, history of multiple endocrine neoplasia type 2, history of previous resection of pheochromocytoma). low risk for pheochromocytoma (i.e., resistant hypertension; episodic palpitations, diaphoresis, and headache; no past medical history or family history of pheochromocytoma), 24-hour urine testing for fractionated metanephrines and catecholamines is considered the diagnostic test of choice. A test is considered positive if one or more of the following results are seen: normetanephrine > 900 mcg/24 hours, metanephrine > 400 mcg/24 hours, norepinephrine > 170 mcg/24 hours, epinephrine > 35 mcg/24 hours, or dopamine > 700 mcg/24 hours.

Answer 1135

RBBB: Predominantly positive QRS in lead V1 Wide S in leads I and V6 LBBB: Large R wave in lead 1 Negative wave QS or rS in lead V1

Answer 1136

RBBB: Predominantly positive QRS in lead V1 Wide S in leads I and V6 LBBB: Large R wave in lead 1 Negative wave QS or rS in lead V1

Answer 1137

Anterior The mechanism of injury is generally due to a blow to the arm that is abducted, externally rotated, and extended.

Answer 1138

Pulmonary contusion

Answer 1139

In general, stimulants are the first-line agents for ADHD unless the patient has a history of substance use or lives with a household member who has a history of substance use. In patients with a coexisting tic disorder, the use of an alpha-2 adrenergic agonist (e.g., guanfacine or clonidine) may be warranted. Alpha-2 adrenergic agonists are also used when children respond poorly to a trial of stimulants or atomoxetine, have unacceptable side effects, or have significant coexisting conditions.

Answer 1140

Risk increases in those with household or sexual contact with a person infected with HAV, patients who use intravenous drugs, men who have sex with men, people living in or traveling to an area with poor sanitation, and those with exposure to daycare and residential institutions.

Answer 1141

According to the 2018 guidelines on statin therapy set forth by the ACC/AHA, adults aged 40 to 75 years are recommended to initiate moderate-intensity statin therapy if their ASCVD risk is at least 5% but lower than 20%. Adults with an ASCVD risk of 20% or more, and adults with an LDL-C of 190 mg/dL or more with any ASCVD level, are recommended to initiate high-intensity statin therapy.

Answer 1142

Black Widow Spiders: Neurotoxic Brown recluse spiders: hemolytic and cytotoxic

Answer 1143

Heart failure with preserved ejection fraction is confirmed in the presence of diastolic dysfunction and normal left ventricular ejection fraction (≥ 50%).

Answer 1144

Combined resistance and endurance training.

Answer 1145

Mefloquine or Chloroquine

Answer 1146

Screening : fourth-generation combination antigen-antibody immunoassay, which can detect the presence of IgM and IgG antibodies for both HIV-1 and HIV-2 and the presence of HIV-1 p24 antigen. Acute HIV infection: RNA viral load and combined antigen-antibody immunoassay simultaneously.

Answer 1147

Prazosin has been shown to be the most effective treatment option for sleep disturbances and nightmares associated with PTSD in both children and adults. If there is no sleep disturbances or nightmares then SSRI

Answer 1148

anti-Smith antibody is the most specific (about 98%) for the diagnosis of SLE, but it is not sensitive (40–65%).

Answer 1149

A plasma glucose level < 50 mg/dL in the first 48 hours of life and < 60 mg/dL thereafter constitutes hypoglycemia in the newborn. patient (< 1 year of age) should be administered 2–5 mL/kg of 10% dextrose (D10). 1-8 years: 25% >8 years: 50%

Answer 1150

Hepatic fibrosis is seen in autosomal recessive polycystic kidney disease (ARPKD)

Answer 1151

Renal cell carcinoma is a complication of tuberous sclerosis complex.

Answer 1152

Atomoxetine is a non-stimulant medication Clonidine and guanfacine are alpha-2-adrenergic agonists, medications commonly used in pediatric attention deficit hyperactivity disorder (ADHD), usually as third-line agents or in conjunction with stimulant therapy

Answer 1153

Generally, surgical repair is recommended if the patient is symptomatic, or if the aneurysm is 5.5 cm or larger in diameter or expands more than 5 mm in six months.

Answer 1154

no macrocephaly in hypochondroplasia

Answer 1155

Asymptomatic individuals with a first-degree relative diagnosed with colorectal cancer or an advanced adenoma (high-grade dysplasia, ≥ 10 mm, or villous elements) < 60 years of age or two first-degree relatives diagnosed at any age should receive a screening colonoscopy every 5 years starting at age 40 years or 10 years before the relative's age when diagnosed, whichever comes first. USPSTF: screen all patients age 45–75 years, select patients up to age 85

Answer 1156

abnormal acetabulum and proximal femur which results in instability of the hip The Ortolani maneuver demonstrates that the dislocated hip is easily reducible. The Barlow maneuver demonstrates that a reduced hip is easily dislocatable.

Answer 1157

Loop diuretics (e.g., furosemide) are the cornerstone of treatment for cardiac amyloidosis. Aldosterone antagonist medications (e.g., spironolactone) may be added to loop diuretics without significant adverse effects.

Answer 1158

Dabigatran has a reversal agent called idarucizumab.

Answer 1159

Staphylococcus aureus

Answer 1160

Commonly caused by group A Streptococcus or Staphylococcus aureus

Answer 1161

Antimitochondrial antibodies (AMA)

Answer 1162

Alkaline phosphatase, and it is often significantly elevated.

Answer 1163

Borrelia burgdorferi

Answer 1164

peripheral seventh cranial nerve.

Answer 1165

Clinically, one is able to distinguish a peripheral from a central cause of facial motor weakness by involvement of the forehead in a peripheral palsy.

Answer 1166

Ramsay Hunt syndrome caused by herpes zoster.

Answer 1167

The induction phase of therapy typically consists of two weeks of intravenous amphotericin and oral flucytosine. If the patient responds favorably to treatment, then the induction agents may be discontinued and the consolidation phase of therapy may begin. Fluconazole 400 mg orally should be taken daily for eight weeks. After induction and consolidation phases are complete, maintenance therapy with oral fluconazole 200 mg daily should be continued for one year. IV amphotericin and oral flucytosine: 2 weeks Fluconazole 400 mg orally: 8 weeks Fluconazole 200 mg orally: Daily for 1 year

Answer 1168

undetectable viral load on antiretroviral therapy for at least three months, have a CD4 count greater than 100 cells/microL, and have taken at least one year of maintenance treatment with an azole (e.g., fluconazole 200 mg daily orally). Treatement: CD4 count < 100/µL

Answer 1169

Decreased pulmonary blood flow to the lungs or right-to-left shunting of desaturated blood into the systemic circulation The classic cyanotic CHDs include the 5 “t’s” – truncous arteriosus, transposition of the great vessels, tetralogy of Fallot, total anomalous pulmonary venous return, and tricuspid atresia.

Answer 1170

Mnemonic: PROVe: pulmonic stenosis, right ventricular hypertrophy, overriding aorta, VSD

Answer 1171

Clindamycin.

Answer 1172

Non-neurogenic chronic urinary retention is defined by the American Urological Association (AUA) as an elevated postvoid residual of > 300 mL that has persisted for at least 6 months documented on two or more separate occasions

Answer 1173

upper dermis and superficial lymphatics. Classic descriptions include “butterfly” involvement of the face, lymphangitis, and skin having an orange peel texture (“peau d’orange”). A distinguishing feature is involvement of the ear (Milian’s ear sign) because this region does not contain deeper dermis tissue.

Answer 1174

Erysipelas: Upper dermis and superficial lymphatics Cellulitis: Dermis and subcutaneous fat

Answer 1175

Myelosuppression

Answer 1176

For patients with severe immunosuppression, immunization with live attenuated vaccines should be postponed until the CD4 cell count reaches at least 200 cells/microL.

Answer 1177

Sinus tachycardia is the most common finding on ECG in the setting of pulmonary embolism. The most common findings are tachycardia and nonspecific ST-segment and T-wave changes. Abnormalities historically considered to be suggestive of pulmonary embolism include S1-Q3-T3 pattern, right ventricular strain, and a new incomplete right bundle branch block; however, these are seen infrequently in less than 10% of patients.

Answer 1178

Loratadine 10 mg once daily or cetirizine 10 mg once daily.

Answer 1179

muscle relaxants like vecuronium and succinylcholine, vancomycin, radiocontrast media, and narcotics like codeine, morphine, and dextromethorphan cause urticaria via direct mast cell degranulation by a non-IgE-mediated mechanism.

Answer 1180

According to guidelines from the International Society of Hypertension (ISH), the diagnosis of hypertension can be made in patients with an average blood pressure > 130/80 mm Hg on 24-hr ambulatory blood pressure monitoring or a blood pressure > 140/90 mm Hg on at least two office visits (or average of three visits) over a period of weeks to months.

Answer 1181

The results of the ACCOMPLISH trial showed that the combination of an ACE inhibitor (or ARB) and a DHP-CCB is more effective than a combination that contains a thiazide, although thiazide-like diuretics were shown to be superior to thiazides.

Answer 1182

Patients with atrial fibrillation of more than 48 hours duration should receive at least three weeks of anticoagulation with a non-vitamin K oral anticoagulant (NOAC) prior to an attempt at cardioversion.

Answer 1183

Tizanidine is not considered a medication that should be avoided in older people.

Answer 1184

Treatment of palliative care patients with an ESA is restricted to those with chronic kidney disease (in whom red blood cell transfusion should be avoided), those who are being treated for human immunodeficiency virus infection, or those who are receiving palliative myelosuppressive chemotherapy for cancer.

Answer 1185

Nephrotic syndrome. Treatment consists of angiotensin-converting enzyme inhibitors and loop diuretics.

Answer 1186

Central retinal artery occlusion

Answer 1187

Central retinal artery or vein occlusion, macular degeneration

Answer 1188

Pheochromocytoma. neuroendocrine catecholamine-secreting tumors that arise from the adrenal medulla. Diagnosis is typically made by measuring urinary and plasma metanephrines and catecholamines. Treatment consists of alpha-adrenergic blockers, such as phenoxybenzamine.

Answer 1189

The middle meatus.

Answer 1190

Spherocytosis is the only disorder that will cause an increase in mean corpuscular hemoglobin concentration (MCHC)

Answer 1191

Oral lichen planus

Answer 1192

Psychotherapy

Answer 1193

all live vaccines should be avoided during pregnancy. Human papillomavirus (HPV) is not a live vaccine, but is contraindicated because safety has not been established during pregnancy.

Answer 1194

Necrotizing panniculitis.

Answer 1195

Serologic antibody testing

Answer 1196

Class III: harm recommendation, level of evidence B-R

Answer 1197

Bracing is recommended for patients with Cobb angles of 30°–39° Surgery should be discussed for patients with Cobb angles ≥ 50°

Answer 1198

Diagnosis: Clinical exam is sufficient if left-sided and disappears when recumbent. If right-sided or present when supine, U/S needed to look for secondary causes

Answer 1199

Acetaminophen

Answer 1200

Vitamin B1 (Riboflavin)

Answer 1201

Occupational asthma

Answer 1202

Treatment modalities target the symptoms of rosacea and mainly include laser light therapy, topical vasoconstrictors, and topical anti-inflammatory medications.

Answer 1203

Carvedilol.

Answer 1204

Malignancy

Answer 1205

Voriconazole

Answer 1206

causes painful posterior pharyngeal lesions that do not bleed

Answer 1207

ulcerative lesions of the gingiva and mucous membranes of the mouth, often with perioral vesicular lesions and lymphadenopathy.

Answer 1208

one or more delusions for at least one month and criteria for schizophrenia has never been met.

Answer 1209

aripiprazole or ziprasidone.

Answer 1210

include past infection or known colonization with MRSA, recent hospitalization or surgery, residence in a long-term care facility, hemodialysis, or HIV infection.

Answer 1211

uncomplicated cellulitis, which options can include cephalexin 500 mg orally four times daily, dicloxacillin 500 mg orally four times daily, or amoxicillin 875 mg orally twice daily. The preferred period of treatment is 5-6 days, as long as there are signs of improvement within that time, although longer durations of treatment (up to 14 days)

Answer 1212

Arthrocentesis of the joint

Answer 1213

paroxetine is associated with greater anticholinergic effects and should be avoided in older patients. strong anticholinergic adverse effects. Fluoxetine should also be avoided because of possible agitation or overstimulation.

Answer 1214

clozapine and olanzapine

Answer 1215

Anterior cruciate ligament, medial collateral ligament, and medial meniscus.

Answer 1216

Mnemonic: MDs don't lie Medial to IEA: Direct Lateral to IEA: indirect

Answer 1217

Norepinephrine

Answer 1218

beta-hemolytic streptococci (most commonly group A Streptococcus or Streptococcus pyogenes)

Answer 1219

Multiphasic CT urography with and without intravenous contrast

Answer 1220

Alanine aminotransferase

Answer 1221

painless loss of vision, floaters, flashing lights, curtain-lowering sensation

Answer 1222

beta-hCG, AFP, or LDH may be elevated based on tumor type

Answer 1223

Internal: proximal to the dentate line External: distal to the dentate line

Answer 1224

Tx: benzodiazepines, cyproheptadine, removing the offending agent(s)

Answer 1225

Urge incontinence

Answer 1226

Bilious: Intestinal Malrotation Non-bilious: Pylori stenosis

Answer 1227

acute pancreatitis, a glucose > 200 mg/dL on admission to the hospital is associated with a higher mortality rate.

Answer 1228

Bradykinin, Oxygen and NSAID Open: Prostaglandin E1

Answer 1229

Open: Prostaglandin E1 Close: Bradykinin, Oxygen and NSAID

Answer 1230

Miconazole or clotrimazole.

Answer 1231

topical nystatin or clotrimazole for 7 to 14 days

Answer 1232

postoperative fever is due to medications (e.g., antimicrobial agents or heparin). Other medications linked to febrile drug reactions include beta-lactam antibiotics, H2 blockers, phenytoin, sulfa-containing medications, and procainamide.

Answer 1233

Probe-to-bone test

Answer 1234

Vertebral compression fractures

Answer 1235

Attention-deficit/hyperactivity disorder

Answer 1236

CD19, CD20 (usually weak), and CD23

Answer 1237

Greater than 5,000/microL B lymphocytes.

Answer 1238

Polycythemia vera

Answer 1239

Primary myelofibrosis

Answer 1240

>70% stenosis

Answer 1241

SSRIs and venlafaxine are considered first-line medications for the treatment of PTSD.

Answer 1242

nonsolid “ground glass” appearance, a size >6 mm, noncalcified lesions, a lesion size or volume doubling time between 1 month and 1 year, and irregular or spiculated borders

Answer 1243

antiepileptic drugs, long-term heparin, cyclosporine, tacrolimus, aromatase inhibitors, glucocorticoids, gonadotropin-releasing hormone agonists, thiazolidinediones, excessive doses of levothyroxine, proton pump inhibitors, SSRIs, parenteral nutrients, medroxyprogesterone contraceptives, methotrexate, and aluminum antacids.

Answer 1244

When both doxepin and extended-release melatonin fail to provide benefit, a member of the Z-drug class should be tried next. Among the Z-drugs only eszopiclone provides an early peak onset and a long half-life, with a 1-hour approximate time to peak and a 6-hour half-life. While zaleplon has an equally short time to peak of 1 hour, it also has a 1 hour half-life.

Answer 1245

two-dose series of recombinant zoster vaccine for all adults age 19 and older with HIV. Vaccination against meningococcal bacteria A, C, W, and Y (MenACWY) is also recommended, and meningococcal B (MenB) vaccination is only recommended based on the presence of other risk factors, including asplenia, complement deficiency, treatment with complement inhibitors, or risk due to outbreaks

Answer 1246

Topical NSAIDs such as diclofenac are the first-line pharmacologic treatment for mastalgia. Danazol is the only drug that is approved by the FDA for treatment of mastalgia, but it is poorly tolerated due to menorrhagia, muscle cramps, weight gain, and other androgenic effects. Goserelin is only indicated for severe, refractory mastalgia. Tamoxifen is more effective and better tolerated than danazol, but is associated with hot flashes, vaginal discharge, venous thromboembolism, endometrial cancer, and teratogenicity.

Answer 1247

Cholinesterase inhibitor: Donepezil, rivastigmine, galantamine NMDA receptor antagonist: Memantine Dopamine agonist: Bromocriptine

Answer 1248

Alzheimer Disease

Answer 1249

Non-nutritive sweeteners contain few or no calories. According to the American Diabetes Association, non-nutritive sweeteners may be acceptable to use instead of nutritive sweeteners such as sucrose. They should be used in moderation if they are used.

Answer 1250

Presence of two of four cardinal symptoms. Nasal drainage, nasal obstruction, facial pain or pressure, and hyposmia or anosmia, along with objective signs on examination or radiographic studies.

Answer 1251

Sulfonylureas such as glimepiride and glyburide are associated with a high risk of hypoglycemia and should be avoided in these patients. Metformin should be avoided in those with a glomerular filtration rate <30 mL/min/1.73 m2. Pioglitazone should also be avoided in chronic kidney disease due to the risk of fluid retention and precipitating heart failure.

Answer 1252

Antihypertensives such as calcium channel blockers and methyldopa may cause galactorrhea, SSRIs are responsible for 95% of medication-induced galactorrhea cases.

Answer 1253

Carbamazepine

Answer 1254

topical corticosteroid and topical calcipotriene (Most good option) Another option would be to add topical tazarotene to the topical corticosteroid.

Answer 1255

The annual failure rate of combined oral contraceptive pills with typical use is 7%. 0.2% for the levonorgestrel IUD, 4% for injectable progestin, 13% for male condoms, and 22% for the withdrawal method.

Answer 1256

The Confusion Assessment Method

Answer 1257

decrease both the acquisition and transmission of drug-resistant tuberculosis and to increase treatment success in HIV-positive patients.

Answer 1258

Lateral internal sphincterotomy

Answer 1259

Plasma aldosterone concentration to plasma renin activity ratio

Answer 1260

recommended test for this condition is a 25-hydroxyvitamin D level. A 1,25-dihydroxyvitamin D level is recommended to monitor, not diagnose

Answer 1261

Oral contraceptive pills or pregnancy

Answer 1262

HIV DNA PCR assay

Answer 1263

HIV-1/HIV-2 differentiation immunoassay.

Answer 1264

3 days of trimethoprim/sulfamethoxazole, 160/800 mg twice daily.

Answer 1265

In addition to aspirin, a high-intensity statin, and sublingual nitroglycerin as needed, patients with chronic stable angina may be treated with β-blockers, calcium channel blockers, and/or long-acting nitrates.

Answer 1266

Symptoms develop because of ulnar nerve compression in the upper extremity, leading to sensory paresthesias in the ulnar digits and intrinsic muscular weakness.

Answer 1267

Syncope does not typically involve a post-ictal period or prolonged confusion, which is characteristic of seizures.

Answer 1268

HPV vaccine doses for children ages 11–14. Children in this age group need only two doses of HPV vaccine 6–12 months apart. However, if they received two doses of HPV vaccine less than 5 months apart, they still need to have the third dose.

Answer 1269

Hypersensitivity Reaction Type I: anaphylactic, IgE mediated Type II: cytotoxic, IgG and IgM antibodies, complement activation Type III: immune complex mediated, complement activation Type IV: cell mediated, T cells

Answer 1270

Eosinophilic esophagitis should be suspected in patients with symptoms of gastroesophageal reflux that are resistant to proton pump inhibitor therapy. It is treated with fluticasone for 6 to 8 weeks. The medication is administered using a metered dose inhaler without a spacer which is sprayed into the patient’s mouth and then swallowed.

Answer 1271

Predominance of microcytes

Answer 1272

Rotavirus vaccine has age restrictions and should not be initiated after 14 weeks and 6 days of age. In addition, the rotavirus series must be complete by 8 months of age.

Answer 1273

Villous adenomas carry a threefold increased risk for becoming malignant compared with other adenomatous types such as tubular or tubulovillous adenomas.

Answer 1274

ciprofloxacin, 500 mg orally one time; azithromycin, 500 mg orally one time; ceftriaxone, 250 mg intramuscularly one time; or rifampin, 600 mg orally twice daily for 2 days. Treatment should begin as soon as possible after exposure but no later than 14 days.