Step 3 Flashcards
(440 cards)
1
Q
PUD then dysphagia and chest pain
A
E stricture
Diet, lots of chewing and liquids
2
Q
SLE with chest pan and arrest, what cardiac issue does she have?
A
MI- they have accerlated athersclerosis
3
Q
GBS asymptomatic bacturia TX now and then what?
A
Penicillin during labor ppx
4
Q
Most common cause of hemoptysis?
A
Acute bronchitis
5
Q
reasons to give abxin acute bronchitis in COPD
A
Worsening dyspnea, sputum produciton or purulence. If healthy then its viral dont give anything
6
Q
<30 breast mass
>30 breast mass
A
US then needle if cyst or core biopsy if malignant looking
Mamorgram to core biopsy
7
Q
PNA vaccine >65, HIV, CKD, sicklers
<65
A
13 and then 1 week do 23
Just 23 in CHF, COPD, Liver, Smokers, Allocholics, DM2
8
Q
Diagnosed Lupus and you think lupus nephritis, what next>
A
You need a biopsy to categorize it
Also get complement and asDNA Ab
9
Q
Delayed motor milestones, hyperreflexic, clonus, leg posturing… what next/.
A
MRI brain for Cerebral palsy
10
Q
Akasthesia Tx
A
Propanolol
11
Q
Ethics flow
A
Joint decision>consult an expert> ethic comitte> transfer within hospital> transfer outside
12
Q
Marine tank, Rapidly worse, Hemorrgahic bullaw/necortizing D x TX
A
Vibrio vulnificus
CFTX Doxy
13
Q
MIld high LFTs, young owman, Feels fine, heptomegaly- what next?
A
anti smooth muscle anitbodies, ANA for autoimmune heptaitits
14
Q
at what age do you you take a testicle out if it hasnt dropped?
A
6 months
15
Q
Tubular adenomas fq
3-10 adenoma or villous fq
>10 adenomas fq
1 polyp with adeenocarcinoma in situ fq
A
5 years
3 years
<3 years
2-3 months
16
Q
Drug lupus
A
Anti histone
hydral, procain- get ANA testing!
17
Q
Looks like hepatitc C or B after 1 eek but negative tests so far..
A
Get HCV PCR tests anyway it takes 2-4 weeks
18
Q
Type 1 vs type 2 error
A
1- false positive (dad is preggo)
2- false negative (telling ellie she isnt preggo)
19
Q
Hypergluycemia + modd swings + hypoK + increased bicarb= testing
A
dex test to supress free cortisol
20
Q
feeding goals?
A
30 kcal/kg/day + 1 g protein is solid
less to rpevent refeed
more protein if malnutrition
21
Q
Pregenancy rashes
A
Cholestasis- hands/feet and generalizeddeliverat 37 weeks, Urso acid and antihistamines, check LFTs
Pregenncy related- itchy to one spot NOT generalized. UV light, oatmeal baths, antihistmaines
22
Q
pregnancy but looks like ring worm and HSV target?
A
pempigoid gestationis- topical tiamcinolin
23
Q
PTH stuff
A
hyperPTH-MEN syndromes
HyperCa HypoPO4 (kidney always wins) andit makes you absorb from bone, kidney and gut
watch out for osteoporosis
Take it out even if aysmptomatic most of the time
24
Q
Snoring maegnemt without OSa symtoms
A
stop smokgn and slcohol
25
Look slike depression but PCP visit an mentions bad sex life
ASK about sex life! number 1 50 + woman thing is vaginal atorphy
26
Old person with exertional dyspnea, HLD HTN DM2= Next test
CAD testing even if it asks you for a TEE- it is getting at an old person with risk factors
27
kid with decline in school, starting to have sex a lot and any mention of fidgety in the office...
sex abuse
28
Moderate to severe depression . CBT or SSRI difference
MOderate to severe, marked imapirment of life and no psycosocial stressors= SSRI first
29
You think RA but negative markers, X ray evdience of arhtritis and CRP that is elveated... what Rx next
MTX
30
Abdonainl surgery with now CVA tenderness 2 weeks out and a cough get...
Abodminal US- subprhenic abscess at shoulder tip
31
Gross hematuria after 3 days URI
iGA nephropathy
32
Warfarin and amiodarone now on together- what do you do with warfarin?
lower by 25-50%
33
bili of 10 in breastmilk jaundice Tx?
conitnue breastfeeding with weekly check ups shoudlgo away in 3 months
34
TURP complications
Ejaculate backwords
35
TB PPx 2 options
INH 9 months
| R 4-6 months
36
If you have a smaller population size are you mor elikley to make a type 1 or type 2 error?
Type 2- it needs a high power or large sample size. it wuolnt be as effective in seeing a differnce in the two groups so a false negatve is possible
37
asyompatic 2 cm incedintalmoa on adrenal gland- whats the next step
1. functional testing to see if it is pheo
- if it is not and les than 4 cm thand follow up on it
if 4 cm, malignant loking or functional then take it out
38
ENDo stuff
MEN pituaitry tumors and pehos- get brain MRIs
| 17OH production seenin CAH bc of the lack of enzymes 21 and 11
39
hypomania pearl
see why they are doing so well, they are impuslive and will get married uick
40
ifromed conset, can it be verbal
yes if it is clearly understood. doesnt need to eb uhhsband if it comes down to that
41
st johns wort
anti dperessive, inflammaotyr and wound healing
interacts with drups/Serotnin syndrome
educate on this and companies
42
Viral ganstoreneritis on fruit juice an dmor ediarrhea?
fructose malbsorption bc more osmotic load and more diarrhea, stop the fruit juice
43
genu varum bwoing of leg deformities ona kid who is otherwise nroaml- check for rickets?
no this is nromal and iwll go away if no leg discrepencies and taking vitamin D
44
mobitz type 2 management ( looks like bigmey + bradycardia?)
Pacemaker it goes on to 3rd degree block
45
Hemorrhagic, umbillicated papulaes in HIV patient, How to make Dx and what is it?
Crypto cutaneous and Biopsy
46
Severe malnutrition management
Oral rehydate (not IV-CHF risk) with IVF and glucose and go slow if you ahve to go IV for shock. Avoid high calorie diets at first bc refeeds is fatal.
Marasmus- wasting
Kwashiokor- portien edemaotus
47
Bites that needs Abx
Hands or feets
Cat/human bites (excpet on face)
Immunocpmromised
Body >12 hours or face >24 hours
48
Good gout anti-htn drug?
Losartan
49
High dose steroids for 2 weeks with Anxiety, dperession for 1 week and modd swings no mania- CBT or lower predisnone?
Lower preidsnone- mood symptom from steorids can happen over any duration not just acute psychosis
50
Lung cancer screenign criteria
55-80
>30 pack years quit less than 15 years ago
yearly
stop if they can undergo or want to undergo theray for cancer
51
does a thiazide retain calcium?
yes
52
how od you diagnose pakrnisons
Phys exam first
then MRI if equivocal
start on pramipexole or LEvo/carbisopa
53
concenusal photophobia, ertyhema nodosum, hilar LA, blurred vision
ocular sarcoid
| look for ACE levels, hypercalcemia
54
You think she has psoriatic arthriris- MTX or prednisone
MTX!
55
painless macules into bullae and quickly into ulcer with red margina and nectoric centers, immunocompromised
exthyma gangenosum- IV Abx
56
acute rash, oral lesions, Mono like illness
HIV- HI ag and 1/2 Ab and viral load
57
chornic alcoholic after a refeed has profound weaknes sin muselces why?
Refeed eads to Phospahte shift and possible rhabdo
58
Chronic diarrhea >4 weeks work up and celiacs
Hx
Labs
Stool anyalsyis
villous atrphy and lympgyctes= celiacs
- diet, give iron, calcium vit D and folic acid
- Get DXA scan
- Pnuemcocoall vaccine
- daposne for skin leasions
59
Frst time depression at age 65 is at risk for...
Akzheimers
60
Sickle cell with fever and pain- first thing is to..
Give IV pain meds
61
Acute chest synrom Dx criteria and Tx
New infiltrates +1 of: fever, hypoxia, Resp distress, Chest pain
Infection, asthma or PE causes it
Start Ceftx, Azithro, pain and fluid control
62
low thryoid in a baby Tx
start right away levo
63
Absolute No ways in giving OCPs to a young owman
```
migraine with aura
15 cigs a day AND over 35 yrs old
HTN 160/100
DM2 w/ organ damage
Hx of stoke
<3 weeks postpartum
Brast/liver cancer
CLotting disease
```
64
camping and then a GBS picture but no menigintis or fever...
Tick paralysis from dermacenotr toxins
| remove the tic, no meds
65
Iron low, D low, calcium low, Phos low
Celiacs- malabsorption
66
Steroids and clacium bon etesting...
Add D and calcium and a done density every year for chronci steorids
67
urethral hyperobility
stress incontinence especially in a young female- keilgels and lfiestyle
If it is a sphincter then its vag birth
68
joint paint 1 week after a URI and now rash on face, and swelling of the hands
Parvo B19! Slef limtied
69
Encephalopathy with lactic acidosis and stroke like episode inheritance
Mitochondrial- Only females can trasnmit it and they give it to all theri kids
70
DKA numbers: if there is still a gap but glucose is <200...
Dextrose + fluids and half the insulin
71
DKA numbers- when do you start to add subQ insulin and how long do you stop the inulin drip?
Stop inulin if Gucose <200, anion gap<12, Bicarb >15 and able to eat.
Start subQ inuslinand IV insulin will be stoppped 1-2 hours later.
DOnt do Insulin if K is <3.3
Add K if <5.3
Bicarb if <6.9
Add Po4 if <1 or cardio/pulm probs
72
PTX diagnosis
Quick and best is US
if there is no probability of Tension then Upright Posterior to ant X ray!
No difference in exp vs insp.
73
Dyhsagia work up
If it sound slike upper airwayand cancer fisrt do a fiberoptic layrnogcopy
2. BArium swallow for upper and lower
3. EGD if necessary
74
When do you do peritoneal lavage for hypothermia/.
when not responding to heated saling
| *most lab abnoramliiies will correct with raising the temp!
75
AIS
```
Female with breasts but no period or pubic hair for years.
HIgh testosterone (XY), Pelvic ultraousns with no uterus and blid vaginal pouch and crypt testes
```
76
Sex endocrine
Const delay puberty= Trevor
Functional hypthalamic amenprrhea- atheletes with weight loss
Mullerian agensis has overias so pubic ahir and sex charciteriscts are there but no uterus
Amenorrhea >15 is abnromal
77
preggo with hyeprpgomented macules on face after sun exposure....
Melasma- wear sunscreen
78
GBS but with specific level of sensory being out PLus urinary retnetion- get a ...
MRI-transverse myeltiis
| do a LP if there is a non compressive form of myelopathy
79
Medicare
A-inpatientSNIF/hospince
B-outpatiejt, Observation hospital, outpatient surgery/diagnsotics
C-Private health insurance to provide medicare beenfits
D- Drugs
80
Macroscytosis/hyponatremia and dementia like stuff, rule out...
THYRID! b12 and dperession
Syph nto routine but if risk facotrs
CT and MRI recommened down the line too
81
When to get the police in ED
anytime staff or atient safety is at risk
use pharm if descalations fail
82
HIV during pregnancy
COntinue ART tripel therpay thoughout
routine CD4 count and get resistance testing
Dont ROM or fetal eletrode
ART mom + zidovuidine kid + vaginal if <1000 copies
ART + zido mom + ART kid C section if greter than 1000 copies
83
POstpartum
Baby formula fed
Mom contiues art
<1000 copies give the kid zidovudine
>1000 copies give the kid triple AR
84
when do you not breastfed
```
HIV
TB untreated
HSV around boobs
On chemo or radiation
Drug abuse
```
85
What 3 drugs can you give in resistnat areas iwth p falciparum?
Atov-prog
Doxy
mefloquine
86
acute vs cronic mitral regurg
Acute is rupture and sudden
chronic is a leaflet problem chornic dyspnea. 60% EF is nromal
87
can a Dr go to patietns wedding
yes
88
painless blisters, Hep C, sunexposure causing them, fragiel skin, hyperpigmentation
Porphyia Cutanea tarda
Urinary uroporhyrins
Plhebotomy, hydorxy or interferon alpha
89
Colon cancer screening`
<60 years is the cut off and 2 familiy members with polyps or cancer:
If this is met then at risk and start at 40 q3-5 years
or 10 years before the fmaily member Dx (47 yrs old =37 screen)
90
old persone wiht depressive like symptoms but neck circumference is given and HTN...
OSA= sleep study
91
pulm nodule
<3 cm, round, surroudned by lung parenchmay no LN=needs to be stable for 2-3 years for no further wokr up
No imaging to compare to, gorwing, spiculated then you need to CT and then Brocnh them
92
Pulm nodule
BUT! nodules .8 + risk fctors need surgical excision
Questionable=PET for etboalic acitivtty
If it is centrally located a fiberoptic bronch for biopsy is possible
93
Bilateral nipple dischcarge
Normal phsycial exam > US + Mammogram> TSH,bhcg, Prolactin & med check> then discharge hoem if no toher risk factors
94
Proteinuria with renal failure no RBCs DDx
```
NSAIDS!
MM would not have protien found in urine
PSGN would have RBCs
HTN would take years
Drug lupus doesnt cause renal failure
```
95
How many weeks after MI can y abone?
about 3 weeks - after a cardiac cath you have 3-4 weeks of sensitive myocardium - dpedning on exertional syptoms Ect they can bone
96
WHta is latency period?
you see no effect of a medication on mortality and then you see a change in 5 yearswith no change at 3 years
takes tiem for effect to tkick in
97
Head CT high risk
```
Coagulaopthy
agr 65
mechanism
vomiting, severe headache
LOC
Skull Fx
```
98
PTU in first or second trimester?
First
| methemizole is 2nd/3rd trimester
99
Menignitis
| Normal glucose, cell count <500, 50% lympochytes, protein 80-100
Aseptic meninigitis
If Abx given before LP gram stain can be negative. HIgh opening pressure, low glucose, lots of PMNS
cruptococcus ag test is very reliable
100
look slike sundowing with high AST-
AWS
101
Turner syndrome
No recurreucre rate
Streak, hrosheow, coarct, Bicupsid, nirmal intellegience
Check with Echo and US for all these things and COarct can be life threatnign
102
DVT then stroke, what is going on?
Shunt form R to L in heart to enter arterial system
103
Herbals/adverse effects
```
Saw palmetto- BPH/bleeding
Kava kava- AnxDepression/liver dont use
St johns wort- depression/no evidence
garlic- cholesterol
EEchiniecea- coldflu/anaphylaxis
blakc cohosh- menopause/liver
ginesng- mental improvement/bleeidng
```
none have shown benefit
104
non purulent cellutlitis - stpah or strep?
Strep pyo
105
Mono
Dx
Tx
airway Tx
Heterophile monospot
Nsaids
Steroids
106
BPH and HTN Rx
Doxasozin alpha blocker will give rleief and lower HTN
107
STEMI criteria for V2 and V3
1.5 in women
2 mm in men >40
2.5 in men<40
108
STEMI
New LBBB w/ clincial correlation
1 mm elevation in all leads except v2/3
-90minutes door to baloon or 120 minutes if need transfer
t wave inversion in antomical area means heart strain (possibly PE)
R prime wave in V1 and widene s in v6=RBBB
109
GBS needing cbc and blood cultutres in newborn
No abx to mom and Premature or ROM >18 hours
| If not, then just watch for 48 hours
110
New ADHD patient
need colattereal info to not let abuse happen
111
PCP complications?
Rhabdo- can cause seizures
RBCs with no RBC casts= myoglobinura
needs FLuids
112
pheyntoin what shoudl you do if you SE?
ANy ort of SNC or vision stuff just reduce the dose!
113
Hidranitis suprivita Tx
recurren tjndouels, cna have pus or serdangouios frianage- chronic inflammaotry dirosred by blocked follicles
All patients need weight loss and to stop smoking
1-topical clinda or steroids
2- (scarrign tracking now)= doxylycine
3- TNF inihivits or srugery
114
WHat is an emergency roder in CCS?
THings you want done BEFORE phsyical exam! think vitals ABC first
115
How to determine HCV active vs chornic infection
1. Ab testing- screen (not sur eif new or chronic or false)
2. NAT or RNA testing (not LFTs)- if positivve tehn give anitvirals
3. liver biopsy for fibrosis and genotype
116
plantar warts
salasicayc acid tx for 2-3 weeks
| if failed then top gun immunos or surgery
117
no concern for AMS, tried many therpaies but terminal illness but is tachcardic and wants to go home- ER or Home?
Home- right to refuse if no AMS
118
NPH Tx
Acetzolamide
LP
or VP shunt
MIler fisher LP test to see if there is improvement- if there is then VP shunt can work for them.
NOT ACE
119
dysnea on exertion, no signs of HF or PE but vascular ocngestion on X ray... get..
Echo for Pulm pressures for pulm HTN
120
time frame on erythem imgrans to devleop?
3 days or more
| <36 hour of tick on skin is no big deal
121
When do you need to wash cells before transfusion?
iGA deficient patients or continued allergic reactions despite antihistamines
122
When do you leukoreduce blood?
| When do you irradiate blood?
AIDS, chronic transfusion, potential trnasplant candidates, previous nonhemolytic fever
BMT or 1st/2nd relative blood
123
what is serumsickness like reaction and when does it happen?
Acute Hep B
New drugs like antibiotics
fever, rash, joitn paint
124
what age is the last month a kid should walk?
16 months
6 months to roll over is fine. stranger danger at 15 months is ok too
125
MM suspected and bone pain, next best test is...
Skeletal surveyr
CT MRI and PET reserved for x ray negavite and still bone pain
watch out for kidney funtction
126
hyperviscoisty syndrome tx
PLEX
| oral, nose bleeding and vertigo, lburry visiona nd headache
127
Nomral EKG, mitral valve repair and CABG 6 months ago- now a bunch of RHF signs and calcifcation on xray near the heart...
COnstriitve pericarditis - NSAIDs or pericardectomy
128
DHT 123 oxidative tests for CGD for what presentation?
adneosine deaminase for what disease?
Abscess
SCID- early on in life
get Igs if lots of infections
129
clahmydia testing and rpeat testing is urine or lesion testing?
Urine
130
reactive arthritis following infection treatment
abx and NSAIDs
131
Pituitary adenomas
Prolactinoma >200 levels! cabergoline first!
prolactin 50, hypogonadism, blurry vision= spehnidal srugery first
132
best way to test for diabetic nueropahty first?
tuning fork test and nerve condsutciton is used to confirm the dx
duloextiine for pain
133
asymptomatic low TSH normal T4 levels, next step...
recheck in 6-8 weeks
134
transfusion trhesholds
7
8 and up if you have stable cornary artery disease
tachy, chest pain, syncope then it doesnt adequatel refelct and mro ebleeding going on
135
low ACTH
dex doesnt suppress
cushings.. enxt step
CT adrenals
MRI brain (or CT chest) if ACTH is hgih !
136
Thyroid nodule
1. US and TSH
2. FNA
B. unelss LOW TSH then get Idoine 123 and then FSH
treat a hto ndouel and ysmptoms with BB and mehtimazole bc liver risk? (PTU better in first timester)
137
girl cuts hereself wihtout intent to kill, what do you do?
OUtatient Psych eval
138
When is accpeting a gift okay
When it is not excessive
not attempted to get prefertianl treatment
a fruitbasket is ok and best for the patient
139
Psych
Acute stress is 3 days to 1 month
PTSD is 1-6 months
Adjutment is nto fitting PTSD but depression and anxiety like symptoms
140
12 horus post stroke with current symptoms and yspahgia need...
Swallow eval!
141
12 hours post stroke not on tpa, need ot give them
Low dose heparin to prevenet DVT s bc they are high risk
142
allergic vs viral conjuvitivits
Burning and sore throat/prodrome= viral
neds itching of eyes for ellergic
contagious aspect resolves when eye dicharge resolves
143
HHS swithced to Subq regular insulin and glucose in the 200s
| need to either increase regualr or add long acting?
add long acting
144
dialysis indications
uremia high
7.1 acidosis
hypervolemia
hyerkalemia
if ATN and still no good UOP but has got a tone of fluids (but not fluid overload jsut euvolemic) you can stop the IVF
145
R sided Hepatic hydothorax POst treatment and refractory treatment
Loops, spiro and low salt
TIPS if not
146
what is swiss cheese model
many holes an dlayers and if they line up then a medical erorr happens
doucle checks and reudndancy to improve
147
TPN- watch out for what lyte problem?
low phosphate and CHF liek sypmtoms
148
MVP murmur
more blodo return the later it is and may disappear the NONEJECTION click an murmur/////??
149
MS
MRI
IV methrylprednsione and then PLEX for refracotires exacerbations
LONG TERM: Interferon
Preggo: C sections vs forceps, higher risk of kdis having it, still use IV methylpred for exacerbations
Muscle spasms are baclofen or tizandiine
150
25 yo w/ 1 cm smooth diticnt round hair loss no scaing or redness
alopecia areta
it will recur
Intralesional steroids (refracotry tacrolimus)
151
Scleroderma extra testing
Echo for cardiac fibrosis?
PFTs for interstitial fibrosis*** intial tesitng
HTN and renal crisis for kidney
152
Proximal muscle weakness, 40, on statins for 4 years, ESR 40, LFTs high
polymositis need a muscle biopsy
ANA and Anti Jo
Need PFTs
Echo if HF symptoms
statins not after you are on it for 4 years
polymagia rheyamtica is more stiffness
153
Anorexia and then refeeding syndomre woiht bibasialr cracklers
CHF- cant handle fluid and lytes shifts
| NEED phosphate and other lytes
154
vag bleeding, bad pain, hemo unstable =
Surgery - no imaging neeeded
155
hypoNA, hyperk, hyperpigmented, alkalosis- test neeeded?
Cortsiol morning and low ACTH
156
HTN vs HYPOTN CHF exacerbation
both get oxygen and loops
HTN:Nitro tolower preload
HYpo: pressor
157
Menigitis + UMN +/- rash after camping
West nile- need IgM ab and uspportive care
158
type 1 diabetic norml asugars but vimtining a lot bc he is sick
do you keep long acting or do you stop it all and check sugars/
Keep long, stop short
159
looks terrible but doesnt have unstable angina or severere aortic stenosis- surgery or more testing?
go on to surgery?
160
acute mania in a preggo- haloperidol or lamaotigine?
haloperidol
lamotrigine for chronic
absoltue risk of ebsteins fo rlltihium is low
161
chronic fatiuge, LA, Bells palsy, hepaotmegaly, joint pain needs what test and cofnrigaotry test?
CXR
LN biopsy
Extrapulmonary sarcoid
uveitits
162
barotrauma PTX- dsiconnect and bag or chest tube?
Chest tube
disocnnect and bag if breath stacking
163
new psych but marijuana in the UDS...
need to rule out deug psycohsis before pshycotic illness
164
neurosyph can cause
sharp shooting pains in legs
| pain an dtemp to be out as well
165
frequesnt trnasfusions and then you cant cross match these people, why?
Alloantibodies
166
looks lik kidney stone, CT is negative, gross ehamturia, lots of NSAIDS
NSAID nrophopathy with renal papilla necorsis causing obstruction and renal colic- it can present acutely, with heamturia and pain
Stone, cancer or renal papilla obsturction ]
acute glomerolneihgirits doesnt cause pain
Uretric clacluous wont have AKI
167
DVTPE with malignancy=Rx
| DVTPE No malignancy= rx
LMWH
Xa inihbitors
aspirin not needed
168
DVT and Hormonones RT, next line,,,,
SSRI
169
when to abort a febrile seizure?
5 minutes
30% recurrence
3 months ot 6 years old
no long term sequela
170
Looks like brain death, no reflexes- what do you need to do to ocnfimr it?
Apnea test for 8-10 minutes
171
30 minutes of moderate exercise fo rwomen for preggos- if they are laready 90 minutes intesnse can they continue it?
YES
| no scuba diving
172
weight loss, old, vascular risk, epigastric pain after eating fo rmonths...
chronic mesenteric ischemia! DC2!
173
inferior MI and bradyardia that doesnt reposnd to atropjne... need to do what next?
Pace them until PCI
174
KOH (+/- culture if negative) shows fungus of toenail- what first line?
Terbinafine!
175
preventing fat emoblisms
Early immoblization and srigical fixation of bones!
176
```
Birth and infections
Pencillin to mom for:
Ampicillin to mom for:
Erythmycin to baby eyes for:
Macrolide for:
```
syph
GBS
prevent gonorrhea
prevent chalmydia in mom - onyl give to baby if they have it
177
known celiac with recurrent diarrhea needs...
deetailed dietary review, not reassurnce and follow up
178
IIH next step
Eye exam
| then CT and LP
179
MVC with shallow breathing, periperhal cyanosis , anteroir chest bruises
Occult flail chest
| oxygen, pain, postive pressure ventilation
180
meningitis in a kid need to put on...
acuclovir until hepres can be excluded
181
no prodorome liek sweating or pallor and then syncope
Cardiogenic or neurogenic
| with heart disease it is liekly a run of Vtach and will need obs admit with tele
182
urinary incontinece reverisble causes?
alcohol, infection, stool impaction, delirium, medications
183
what does negative anti D ab screen mean?
mom hasnt encuntered Rh Anitgen yet, so need ot give Ig at 28 weeks and before dleivery
184
when to reocntruct cleft lip
10 pounds, 10 weeks, 10 g hgb
185
diabetes, weird rahs looking like a fungus rahs, diarrhea and letharyg
GLucagonoma
186
diarrhea, dementia, dermaitis, cheliosis?
Pellagra niacin def
187
SGLT2 inhibotrs with daiabtes, glucose 160 with WGMA?
DKA- SE from meds with nromal glucose
188
looks like MEN syndrome with PTH high, take it out first?
yes
189
when to skip urtehtra and go suprapubic cath?
failed attmept or truama to the area. give ti s shot even if they have a big prostate
190
Thyrpid when to get antiTPO ab s and US?
US for a nodule
| Abs for TSH high and free t4 normal but hypithyoid like symotoms
191
sublicnical hypothyroidism will have?
miscarriages
| non pitting edema in the legs will be hypthypid
192
lens dislocation shoudl be associated with?
marfans
193
acute onset psychosis things to thimnk about
1. SLE, with joint findings, and other non specific findings- get ANA
2. Parkinsons, dysotnia, dysarhtria- Slit lamp for copper
2. abd pain and fam hx= uroprohbilinogen
194
Hepres zoster
1. valacyclovir for 7 days for PHN
2. Preggo nurse doesnt need Ig or TX bc they need ot be screened for the immunity - give Ig or Tx if preggo or immunocmopromised with out immnity
3. contact or aersol trnasmission, cover to sto transmission
195
stuck on warts?
Seb keratosis
| reassurance
196
HIV with infection and then gets wrose but on good meds?
Immune reocnstitiuion syptmoms- reassurance and antiimlfmmaorties
197
kids consitpation
limit cows milk, osmotic laxatives and fiber
| stimunaltns and enemas for acute relfief
198
primary ovarian sufficniency
funcitonal hypothalamic
looks like PCOS with clitomegraly
high FSH, low estradiol and before age 40 usually with autoimmune disease
Low all hormones, increase risk of fracture
CAH atypical
199
dacroylitis sickler tx
Opiods, nsaids and hydration heat to hands
200
anti HTN med to give photorash?
Thiazides
201
Squamos cancer non surgical tx
Radiation therapy! cryo and elctro
202
Cocaine STEMI
nitro and benzos but after 30 mintues if no help then PCI!! increase risk for plaque thrombosis even in yougn adult
203
whne to add rifaxmin to C diff/
mutliple recurrence
| ORal vanc and metroidanzole is not recommended anymore unelss cant get vanc!
204
US shows stone but no murphys sign or thickening or fluid...next step
HIDA to confirm to lap chole
ERCP if choledocolithiasis! Lap Chole if acute cholecytitis
NSAIDS and home is less than 6 hours to elective
205
can you start metformin with ast alt elevatiosn under 100?
yes
206
kid cavities
As long floruide is in your diet you are good, dont feed the kid int he middle night or a bunch of snacks
207
Vag bleeding steps
Stable- OCPS with estrogen
| Unstable- IV estorgen to DC if that doesnt work
208
When to putt anticoagulant on for a fib less than 48 hours?
```
CHADSVASC 2+
CHF
HTN
AGE 75 2
DM
Stroke 2
Vascualr dz
A 65 1
Female
```
209
PVD Tx
Aspirin, statin and lifestyle, exercise
Cilostazole if that fails
even if 90% stenosis, need a trials of 1 and 2 steps first
210
Preop surgical testing
PFTs needed for lung surgery, dyspnea orprop COPD control if unlkown status- NOT needed for other surgeries
6 min walk test for heart surgery
*stop skoking 4 weeks prior to surgery!!
211
NOT CHF with orthopnea?
ALS diaphgram paralyss
212
HHS
FLuids then insulin after bit and and dont lower K levels wihtout changes!
213
Next step for refracotry HTN
MRI renal arteries
214
Old dude with hip pain and tech scan uptake in skull, scap and hip
scleortic lesions and thickened cortex
Pagets disease
| Bisphosphos
215
Looks like polycthemia vera but RBC in urine?
RCC need ct scan- take it out
216
Septic arthritis kids
Tap it
Vanc! for step staph
hip is not PSGN
217
Thyroid
BB and then mehtamizole if symtpoms dont go away in thryotxiciosis with nodules (espiecally in older ppl pr heart disease)
Prednsonse if amiodarone
218
THryoid storm drugs
```
PPID
Prop
PTU
Idodie
Dex
```
219
schizoprhenia with negative symtposm on a first gen antisphcotic next step
Skills trianing not a second gen
220
possible cord comrpession Steorids mri or MRI surgery?
Steroids first
221
nail fold incfection
paronychia- warm and abx
222
Labor
Active with good contractions is 4 hours and without is 6 hours arrest of descent. shoudl change about 1 cm every 2 hours. Add oxytocin if not good ocntracitons in 2 hours or amnitoomy
if variabel decels then do amnioinfusion for umbilcal cord compression
223
diarrhea
Giaradia, MC world wide of foul melling, watery diarrhea and belching
ROtavirus, MC <2 yrs old
Norovirus- curiships
ETEC- occurs within days of expirsure
224
cepahlohemoatom vs caput
caput cosses suture lines is more superifcial
225
conduct vs opp defienat vs antisocial
codnuct is <18 years old
| Opp defiant wihtiut cruelty towards other jsut rules
226
Hip dysplasia
1. Leg length discrpeciancy, gluteal fold assymtpetry
2. US dont need x ray, to surgery
3. pavlik harness 3 months then goes away
227
MDD w/ psycotic features first line...
ECT!
228
allergic rhinits tx and SE
INtransal steroids
| epistaxis
229
6+ weeks of urninary urgency and pain that feels better with voiding...
intersittial cystitis and normal UA
| Lifestyle, avoid triggers like caffeine, blaadder traiing , Amitrtipalyine, Anlgegisc
230
IRB need to re submit
yes for every8ihngn
231
Hb a1c 6.7% in a 82 year ...
Decrease regimen, less strict in old ppl between 7-8 %
232
what age stop screening colo cancer
75 years old with no fam hisotry and asynptomatic
82 yr old with last screenign 12 years ago... is OK\
150/90 over 80 years ol
233
preggo woth new HF?
periportem cardiomyopathy
| loops and nitrates
234
Mallory weis tear and Hiatal hernia tx/
Nothing
| not even sucralfate
235
What is scarlet fever
strep throat + strwaberry tongue and sandpaper rash due to extotoxin
236
parvo rash
face flushing and it does have trunk and extrmeities involveemnt
237
schizo with acute psycosis first step
checm p bmpp to medically clear him
then give him a dose of what he nromally takes a t home even if it is a first generation
238
caleiac
Fam hisotry or auto ummune
| Short, FTT, abd pain an d bloating, Villous atrophy
239
Lupus in pregnancy
1. montor for heart defects
| 2. contnue to take hydorxychloriquine
240
ADHD SE meds
1. HTN and not increased risk of substanc eabus e
241
LOw acth and low t4 get a ...
Brain MRI for putuartry
before starting levothryoxine need to get ACTH test
242
accelrated renal disease risk facotrs
proteinuria
hyperglycemia
htn
243
New ACE with mild bump in Cr?
its fine
244
Oral communciation or digital is the best way ?
oral
245
Hypo K, HyperCl
Kidney stones
Uinre ph above 5.5
RTA1, cant secrete H ions so alkaline urine
| hypercaciruia and stones
246
multiple small painful ulcers/
chancorid
| Azithro or CFTX
247
If there is a parasite in the answers always check for...
EOS!
248
Breast PAIN
1. Cycliucal, bilateral and no mass=obserce
2 not cylcical and focla pain but no mass=Mammography
3. not, focal and mass=biopsy
249
Vaccines
No autism
| fever can happen but low risk adverse effects
250
ED
eight loss
251
case cotnrol studies
Specific outcome already and then compared to those who do not have the otucome
252
3 , <3 cm, thin, smooth, water lie, non enchanicng, himogenous renal cysts need...
no further motnitoring
253
external vs internal validiity
External make sit more gernalizabilit, and mor elik the orld so a less ocntroled study = pragmaitc trials! large diverse
INternal =causlaity, tightly contorlled = Explanotry , small ontorlled efficacy trials!
cross over design switches treatment gorups
nested case controle-outcome of interest in a chohrot study retrospecitve observational
254
Risk of one is 60 and the other is 40 what is th einkcrease in risk?
.6/.4=1.5
| 100% - 150% = 50% increase in risk
255
phsyical abuse, ask abotu why thye ar wiht him or where can they go?
where cna they go
256
anorexia first line
CBT
257
Menopause moderate ot severe (not lifestlye mild with vitamin E)
1. COntraindicatied to Estorgens? if yes SSRI, hx of clot
| 2. NO than give Estorgen only if hysterectomy and E AND P if theyhave a utereus
258
Looks liek warts but umbicated center around dick
Mullscum cotagiosim - look for other STDs and cryoptherapy
COndyloma
Lata- syphylis with raised gray painless lesions on gooch and mouth with LA and malsis
accuminata- genital warts
259
calf painand refusla to walk in viral syndrome
viral mysotis with elevarted CK
260
iga Nehropahty vs drug indiced interstial nephrities
iga= 3 days after
| - ain is eos, nsiads,urticaria, aki, pyuria- give steroids
261
agorpahobia or happens anywhere for panic?
anywhere
262
abscess vs cellutlis
Stpah vs strep
263
AAA age range
65-75
264
15 month old with down syndrome has enciparesis an docnitopation
hirschpung, surgery
265
kid with small joint on effusion on a US (first test) an dlow inflammaotry markers..
nsaids this is transient synovitis
266
increased vaginal discharge not smelly or inflamed
leukorrhea, normal
267
ADHD
give drugs if over 6 years old
| get teacher and parents evlauations in first!
268
Hepatic encalpothy tx
remoe the drug like a benzo and give lacutlose, fluids, lytes
269
Stopping paorxtine abruptly can cause...
Disocntinuiation syndrome that looks like the flu and anxiety, restart it
270
what does cincalcet do?
Reduce Ca and PTH in hyperPTH
271
High calcium treatment
IVF and Calcitonin shrot term
| Zolendorni acid long term
272
WIll vitmain D be low or hgih in boen mets hypercalcemia?
Low
High in Lymphoma
273
Looks just like mania but vital signs jacked up
cocoaine
274
MC of chromosomal abnromality
Chromosomes
275
Tx for hto tub folliclulits?
No tx, 1 week go away
276
Scooped out flow volume loop to the left?
COPD
right is Restrictive and stright
tracheal stensois is a big glob in the middle
277
Bradycardia, fatigue, lightheaded, confusion...
SSS
Defb and antiarrythmics
RBBB or dorpped p waves from fiborsis of SA node
278
Big ol soft tissue knob on th ebakc of elbow is
olecranon bursitits- need to aspirate the fluid for infection and possible abx
279
Alcohol or NSAID sin crease Bp
NSAIDs unless you drink more than 2 drinks per day
280
herpes PPx for delivery
give acylovir at 36 weeks on and c section if acrive lesions
281
Can ITP have anemia. Tx
yes- look for a chronic blood loss liek periods tho
Steoirds if less than 30K
IVIG and plateltes if hemorrhage
282
vEEG with shaking no abnromalites for seizures...
psychiatric eval
283
HIV, transaminitis, pancytoneia, honeycomb lungs...
milairy TB mycobacterium tuberclousina
Get a liver biopsy
RIPE! still for myocplasma
284
<2 kid with tonnnns of water diarrhea ....
Roatvirus, get the vaccine
285
kid looks great, 10% in weight and 20 in height....
reassure and nrw foods,
| <5% is FTT
286
Daytime wheezing and chest tightness in a 47 yo chronic cough nest text...
methacholine for new asthma
287
Nomral eye pressures, periphery viusal loss, OPtic cup and dis ratio is high .
Open angle glaucoma, same meds for clsoed angle
| can have high pressures in eye too
288
old lady with abdminal fullness an dbloating next step
surgery for ovarian cancer
OCP to prevent this
289
Preggo exposired to parvo next step
get Ab testing for + Igg and - Igm to shwo she is not infected or else hydrops
IVIG to treat
290
3 things to prevent ventilatory PNA
1. semirecumbent in 45 degrees
2. minimize sedaion
3. ETT w/ sublgottic drainage
no abx ppx, antispetics for oral decomnatmination, avoid ppi in low risk patients, chaneg circuti only if dirty
291
lap choel with abdomianl pain now...
retained stone, need ercp
292
postmenopausal belleding
endo cancer need TVUS
| Atrophy is negative and topeical estogen cream
293
high calciumand recurrent sotnes need to do what to prevent them
limit oxalte and proetin anmials
294
Syncope with RBBB and Left fasicular block
Transient AV block
```
Cardio syncope
VT
SSS
AV block
Aortic stenosis
lytes
```
295
3 yo with FND and sickle cell disease next step...
Intracrania US for stroke to ransfusion therapy
296
monochroionic, diamonitoic risk
twin tiwn transfusion syndrome by shapring one placemtna and one baby stealing the blood , possibly fatal
297
OSA complications
CAD, arrythmias, heart failure and htn
298
ARDS tx
```
low TV
PEEP! 15-25
not plateu, should be <30 plateu
RR <35
FIo2 <60
Pao2 goal 55-80
```
299
SBT requiremtnes
fio2<40
pH 7.25 or higher
abiltiy to pull breaths
300
hypothelamic amenorrhea tesint tnext step
DXA
301
Scar on X ray for TB needs
INH for 9 months
or INH and R for 3 motnhs
Rfamoin for 4 months
302
Bipolar with depression, dotn presribe him..
SSRI monotherpay it wil induce mania
| needs lithium and zyprexa
303
HIT 1 dx and tx
Nadirs of 100K by plateket aggregation - not immune. not a big drop. Nothing to do
304
HIT 2 4 Ts
Thrmovcytopenia- 30-50% drop
timin-5-10 days post heparin (<1 day sometimes)
thrmobosis and skin necrosis
Tx- stop heparin, argatroban, PF4 ab sent
305
Kind of looksliek MRV but sinus drinatge, DM2, febrile proptosis
Mucor- needs surgery
306
Sickle cell immediate tx for splenic sequestraions?
1. IVF
2. then RBC transfusion
3. splenctomy after criss is down
307
How to BEST dx acute glaucoma and risk fcotrs for it/
Gonisocpy
| OTC phenyleprhine and antochonilergic s
308
Heart block with brady crdia. look for lymes disease!
rash 1 month ago type of thing
309
resp distress end of life patient, give...
opiods
310
C diff with WBC over 15 and AKI need to get....
Abd imaging to look for toxic megacolon and perf
311
ICU old due now has unexplained fevers after 5 days,...and gall baldder stuff... tx
Aclaculous cholyctisits- needs a perc drain
312
MOderate variabiltiy without accels in non lanor patient, keep or go home?
observe and get BPP need accel
313
opiod constiaption prevention?
senna docusate
| Methylnlatrexone in refrscotry cases
314
PPH with mass at the vagina...
Stop oxytocin and put the uterus back in- uertine inversion
if nto inversion then normal PPh
Hemo stable nto reposnidng to emds= artery embolixation
unstable= surgery hysterectomy
315
Polycythemia in newbrns what to monitor
GLucose and bili
from delayed cord clamping
self limited
316
Chronic rectal dialtion in kids
form consitoation bc they hold their poops in
if increase weight gain then not CFTR
317
Sickle cell trait and exercise
stop and break for hydration . normal life expectanct and HbA over S, nromal Hgb and rretic count . can get rhado from sprots
318
Weight loss, tremor, amenorrhea, umbilicus mass Female
Hydatiform mole, Suction curretage
319
FRAIL and tx
faitgue
rsistance weakness
ambulaotry dysfunciton
mutliple illness chronic]loss of weight
Get upand go test and blood owkr and make sure they ex4ercise and diet
320
Alcohol abouse and now weakness, no DTRs, weak
low phospahte
321
Exericse near syncope in young 22 year old next step
Echo for HOCM
| exercise EKG to straify after
322
Otitis externa vs media pathogens
Psueomonas and staph outside- topicla floruquinilone and steroids
strep pneumo, moraxella and h flu inside
323
Depressed mood you need to find out i f they have ever had...
Mania, if bipolar then dont give SSRI , and give lamotrigine
| Anticonsualnt and antispsycotic 2nd generation
324
olanzipine an dclozapine checks need
glusoe and eight gain
325
Normal clinclaly but creptisu after bipap
Repeat x ray for pbarotruma, SL
326
BPH symtoms work up
UA
PSA!!!!
rectal
327
progestin iompant or OCPs /
Progestin iomplant 99% vs 91%
| even more effective thn IUD???
328
sexual assalut pregangancy contraception and tx
uliprostl - ant progesterone and after up to 5 days effective
copper IUD too up to 5 days but nto if cervititis
Cftx, azitho, HIV meds, metronidazole and hep B based on vaccination status
metro no if no organisms seen!
no need to give penicllin, repeat testing for it tho
329
Ventilator PNA next step
Culutre then Abx broad
330
VZV shoudl e givne if sinbling is immunocpromised
no Ig necessary for sibling
331
antithyroid peroxidase antibodies...
hashimotos thyroiditis hypothyridism of high TSH and low T4
332
Rapidly exmapnding neck mass with hypothyroidism, can feel inferoir border nd plethroa when arsma above head...
Thyroid lymphoma, RAPID, old and hx of hashitmotos
333
need ot disclose HIV status to school?
no
334
Thyrid cancer
medulalry- MEN, c cells, HIHG CALCITONIN!
335
match small cell and squamose cell
SIADH
PTHrp
Samll cell- SIADH (water resitrction))
| Squamos- PTHrp suamos is a PUSSY
336
Kidney stone and pregnancy work up
TVUS and renal US
| then MR urgram or tx empricially
337
shoudl you wiehg in dialy to lose weight
yes
| puthealthy foods on the ocunter
338
Post partum thyrditis
HyperTSh with nontender goiter within weeks to 1 year of reggo, destruction of follucles to lead to low throyd soon
Thyrid peroxidase Ab (like hashimotos)
IF there is RAIU and high uptake then GRAVES, no uptake is this
339
Negative stress test=
<1% risk in 1 year
| diesnt exculde CAD
340
looks liek divertiulutis with hx of it and now you ahve dialted colon on x ray and edema on flex sig..
Acute ishcemia
look at risk fcotrs, blood bowel movement where div. is +/-
doest have to be occlusive and super painful but low flow ot water shed LLQ
341
STEMIa nd cath 2 weeks ago with repeat steami, biggest risk to make thi shappen is
not taking your Clopidgrel
342
tx of fungla foot
oral terbinafine
343
Rashe
Lichen simplex chronicus- anxiety ans excoriated plaques
Dushiditoitc fdermatitis- itchy, vesicaur dry rash on plamsa nd soles
psories- mild itchis with silver scaled palqeus
344
lichen slceorsus risk...
vuvlar cancer
smoker
itchy
dysparunia
345
DM1 with 5k run, stop or lessen lispri?
Dont skip the dose, jsut lessen it. Type 1 at risk for DKA
if longer than an hour exercise than decrease basal dose the night before
346
IDA anemia is older male...
clonoscopy
347
Painful and large LN for 2 weeks, eyes feel dry and hurt Tx adn dx
Cat scrath disease, Azithromycin and slef limtied, fever is +/-
parinaud syrndrome
348
twin pregnancy and first baby is breech
C section
| other eay around and maybe ok
349
zyrtec or avoid the cat first
no cat
350
Hx of cirrhosis with now hypTN and AKI, next step to diagnose
Heatorenal syndrome, Bolus fluids to make sur eits not just pre renal volume down
351
Tx heatorenal syndrome
albumin, octreotide and midorine
352
Heptorenal syndrome Path
Arterial vasodilatation in the splanchnic circulation, which is triggered by portal hypertension, appears to play a central role in the hemodynamic changes and the decline in renal function in cirrhosis [1-3]. The presumed mechanism is increased production or activity of vasodilators, mainly in the splanchnic circulation, with nitric oxide
GFR lowers, cardiac output rises and hypoTN sets in even thoe the RAAS is activated and synptathetics are kciked in
353
Cause and spread of mullcuosum contagiousosum
pox virus
skin to skin
HIV testing
354
dorsal hands red puruple plaques?
dermatoyosis form gorttons papules autoimmune
355
insulin resistance skin
tags,acanthosis nigrans in the armpits, xanlrthsma
356
asymptoimaitc hyercalcmerima with low urinary Ca//
Casr familial, observe
357
metronidazole safe in lacatation?
no, pump and dump
358
Depression on SSRI for 8 weeks with poor sex and little nenefit....
good benefit and poor sex?
swithc to buoprioin or mirtazpiine
add buporopion or sildenafil
359
Hep B in infants with Hep b mom
0, 1 , 6 months and Ig at birth
| Check Serology at 9 months
360
HTN and then give ACe and now AKI..
Renal artyer stneosis from increase RAAS and take it away and les gfr
361
on levo and tkaing OCPs and now hypthyroid... why
need higher dose of levothyroxie to saturate the binding sites , plasma protein stuff
362
ortho hypotn and upper gi bleed next step
ENDO not CT
363
dengue fever, retororbital pain, white rash,
cap permability and risk for ciruclaotry and resp failure, spntaneous bleeding
Tx supportive
low plateltes and
364
Massive henmorrhage needs more... postpartum
Rhogam, if nto enough then doesnt work
365
multiple dermatomes shingles precautiosn
airborne and ocntact
366
Looks like lyme but no rash and goes to carribean, joitn pain, malaise
chinkungya fever, no fever sometimes resent. Jints are bilateral and all over. supportive
367
ADHF management, diuretics or BB?
NOT BB, diruetics intial theray alone iwht oxygenation, IV nitro
if iti is PNA then obvious CXR and fever
368
3 drugs to make folci acid anemia
Bactrim, MTX, phenyotin, GIVE foliINIC acid, nto folci acid, stronger or leucovorin
369
first line for insominia
CBT
| zolpeidem is for acute and it is non benzo but same SE
370
HIT 2
Serotnon release assay
argoatroban
warfin necoris sbut if you need it then you need to wait until platees back over 150
371
Seizures and regnancy on Depakote
continue depakote and screen and give folic acid
| YOU CAN breast feed on antieplicts if the benefits out wiehg the risk
372
dude, headaches, visual distubances, retina lflame hemrorhges and stuff, on isoretinoin
Pseudotumor cerberri
373
ssri to pehneylzie time period
5 weeks, SSSS
374
Hypothyroidism and surgery
increase post op risk but not much, still do surgery
| dont start levo bc eill iwncrease mycoardial demand
375
heparin is 10a and 2a= UFH, use in renal patients
| LMWH is Xa less 2a=enoxaparin, no PTT
Only use warfarin in 2nd and 3rd trimester is mechanicla heart valve
376
FOlic acid amoutn and when to start?
| When to go to genetic speiclaist?
.4 1 month before. 4 mg daily if NTD in the past
3 spontaneous abortions
377
pancreatitis risk faotrs for worse outcome
APACHE 2 and SIRS socres
| or singles of Age, obesity, BUN 20 andCRP and HCT over 44 bc of hemoconrtation
378
MHT stuff
Good: All cause mortlaity benefit under 60, DM2, Fx/bone mass
Bad for: CAD >60, stoke, breast cancer and clot
endo increased nless there is rogesterone and ovairan is neutral? no mortlaity benefit over 60
379
TBI risk facotr <2
No frontal scal hematoma, 3 ft mechanism
>2 is basilar skull fx and vomiting
380
VSD, fixed spltting or hoosystolic murmur
murmur,
| splitting is ASD
381
bleeding and ITP tx
IVIG, direct antiglobulin negative
petechia is mild
epsitaxis si worse
382
mildly high thyrid levesl on mehtamizole...
stay the course, dont risk hypothryoudsm
383
Sex with HIV drugs
72 hours for 28 days. If after 72 hours not helpful and just re test them to make sur ehtye have itand get Hep B testing before starting ART
need 2 NRTI and 1 reltegravir
384
Positive interferon with negative CXR
INH 9 months
385
Puberty nromal age
idioapathic premature
CAH
9
isalte pubic hair without boen age or acne
Bone age, acne, pubic hair +, low 21OH, give hyrdocortiosn
386
CN, menigitis signs, ocular signs, palm rash, afebrile
Secodnary neurosyph
387
demenait plus spastic paresis, hyperreflexia
B12
388
Funal infeciton of scal needs topical or oral
oral G or T
389
clozapine testing
Neutropenia
390
COPD with MAT, accessory muscle use COPD exaceration needs
BIpAP and lyte rpelacement not anticoagulation
391
warts transmitted is condyloma...
acuminata, turns whit ei with acid, first line is Trichloacetic acid
Can use pdophyllin but not on insde for preggo
imiquad is immunologic
392
rhabdo on statins need to check CK first or jsut restart them
check first
393
acne first line startes mild
avoid vigous scrubs, water ased skin stuff and ph neurtal cleaners
Vit E used to prevent scarring
Diet not soley advised for acne, dont pick the zits
394
PID risk factors
1. lots of sexual partners
| 2. Previosu PID #2
395
acitnic keraotisis tx
5FU
396
HIPPA can be violated when there i safety or health ejopardized
k
397
old recurrent falls, deccreased vision and cataracts
macualr degenration
398
still give hromones to dead oragn donor
yes keep them aliv as nromal
399
is adenosmysos uniform or not on exam
yes unifomr, fiboroids is irregular
400
HEart failure hypoantremia Tx
restirc water then go to Vaptan blockers for ADH
401
guatemela, transient couhg, abdomina bloating and blood in stool
aldendazole
402
HFM coxsackie tx
supportive
403
no repsosnse or SE on psyhc meds, increae or switch
switch
404
MC foreign body bacteria
staph
405
Hep B post exposure
Ig and vaccine
406
```
Breast mass that is simple and had a US and FNA is:
Bloody
Non bloody
simple and non tender
complex
```
1. Biopsy or more imaging
2. repeat US in 4 weeks
3. observe
4. biopsy
407
young ollege kid with a bunch of weif symptoms and fever
HIV
408
COPD Gas exhange explained, great
Hypoxemia in chronic obstructive pulmonary disease (COPD) is primarily caused by ventilation/perfusion (V/Q) mismatch. The emphysematous component of COPD causes airflow limitation due to loss of elastic tissue and small bronchiolar collapse, and chronic bronchitis contributes to airflow limitation as well. COPD exacerbation causes further airflow limitation due to mucus plugging and bronchospasm. The result is numerous localized areas of lung that have a low V/Q ratio, which is the major cause of hypoxemia in patients with COPD. These poorly ventilated lung regions (low V/Q regions) undergo hypoxic vasoconstriction to improve overall gas exchange efficiency, but nonetheless still have a low V/Q ratio. Despite restricted airflow, supplemental oxygen (O2) is able to successfully reach the alveoli in these regions, resulting in an increase in Q (due to alleviation of hypoxic vasoconstriction) and improved gas exchange to the blood (improved hypoxemia).
Emphysema also leads to areas of lung that have a high V/Q ratio (dead space ventilation) due to destruction of the alveolar-capillary interface, but these regions play a relatively minor role in hypoxemia and are more important in the development of hypercapnia. Supplemental O2 also increases V in high V/Q lung regions; however, as Q does not increase significantly (and the O2-carrying capacity of existing Q is essentially maxed out), the ability to improve hypoxemia from these regions is minimal (Choice C)
409
When does pooping frequency begin to lower
1 month, it is normal and only 1 a day or every other day i sokay
410
Early lymes disease
serology isnt posiitve yet, lcincial Dx
bullseye is confluent still
give doxy
ceftriaxone if severe mennignitis type symptoms
411
TSH 0 and t4 mildly high with no symptoms, when do you teat with meds/
65 years old
CAD
osteoproosi
take out a hige goiter if compressing, not raidactive didoine
412
diffuse thyorid uptak with thyrtopin recpetor antibbies
Graves
413
SAAG >1=
```
caue of ascites
POrtal HTN (CHF or crrhosis or hepatitis)
<1= ovarian cancer, pancreatitis, nperhtotic syndrom
```
414
varucose vein tx
compressiong and leg evleationg for 3-6 months to scleroothrepy to leg an dcomplications leads to surgery ligation
415
Does fever and heached= LP on boardss
no
416
small volume blood out of butt-
| diverticular bleed
internal hemorrhois of sumucosa
painless hematochezia of artery even if it stops- should top on its own>colonsocpy>embolization>surgery
417
Genital warts and pregnancy can you V delvier
yes
418
Low back pain, nromal acitivty or exerice rogra?
exericse program is better
419
complex breast cyst need
core biopsy
LCIS- is core exiciosn
420
Gy doesnt want to knwo if he has huntingotns
they have aright not know unless it involves a treeatable condition of a child bc knwoeldge may give you depression
421
Hip surgery
1. stable and ambulatory = <48 hours
| 2. non ambulaotry and demnted or suntable- non operatvie
422
do kids grow out of ADHD and is there risk of substance abuse?
NO
| YES
423
Vit amin B2 defienicy ribolfalvin
glossitis
424
Anti thryoud peroxidase
in graves and hashtimots
425
Testicualr SU reveals fracture----
surgery
426
Bone oss an dpsot menipaual tretment in the setting of cancer 18 months ago...
Estorgen and progesterone if have uterus
427
PCOS OCPs
progestin IUDs
428
septic shock
lysis of bacteria and the endotoxin is roaming aorund ... maybe add lcinda?
429
COPD prognostic factor
FEV1
430
Screening for OSteoprosis
>65
or < 65 + smokes, low BMI, fam hx, steorid use
431
Bisphosphos given to which pts?
Fragiltiy fracutre
- 2.5
- 1-- -2.5 w/ 10 year probavilty >20 or hip fx >3%
432
Wide fixef splti with loud systolic murmur over P site?
ASD, overflo into the valvr
433
pseudofollicultis barbae
stop shaving
434
OCPs breahtru or weight gain?
breatk thru, nto weight gain
435
best predictor of change?
failure and willing ness to press on
436
Choking infant
partial- allow to cough or gag
cyanotic < 1 year is back and then chest over knee
>1 year isheimlich or lean forward thrusts
437
preggo, MVC, she looks great, baby looks great, Rh negative needs
Kleinharu betke test to see if and how much alloimmunization is needed
438
SI w/ no intent do you
Get a suicide ocntract?
SSRI and outpatient?
hospitalize?
SSRI outpatient
439
How to diagnose DM2
Sympatomatic: 1. a1c 6.5%, fasting 8 hr tet >126, glucose tolerance or random glucose >200
No symptoms= repeat the same test another time
440
PMH HOCM with fam hx of sudden cardiac death
ICD, skip Medical to >alcohol ablation
or if VT and reccurent exertioanl syncope
