Tx of lice?
What has persistent ST elevations in V1-V3 with RBBB with or without terminal S waves?
Obrien's test is good for what injuries?
SLAP injuries i.e. Superior Labral tear Anterior to Posterior
What is the presentation of mercury poisoning?
Renal insufficiency, MS changes, and tremor with erythematous chapped lips
What is the most sensitive test for acute otitis media? Most specific?
Pneumatic otoscopy, tympanocentesis
What are some high copper foods that Wilsons pts should avoid?
Fish, Mushrooms, cocoa, and nuts
What is weird tx that seems to work for exhibitionism? What is this?
Medroxyprogesterone acetate; when a person needs to expose themselves to others
What is DOC for gas gangrene
What can be seen on physical exam in tachycardia?
Canon A waves also seen in 3 degree heart block due to AV dissociation
How do you tx methemoglobinemia? What is methemoglobin?
IV methylene blue; oxidized heme groups in Fe3+
What is the MC cause of orbital cellulitis? How do you confirm the dx? What is the tx? What if there is an abscess?
Bacterial sinusitis, CT, Admission with IV abx and if there is an abscess it needs surgical drainage (remember orbital cellulitis often has diplopia while preseptal cellulitis does not)
What are the 3 "paired cranial bones"
Temporal, parietal, and frontal (metopic suture)
Where can you go to find out what docs have lawsuits against them?
National Practitioner Database
What is the most you should drop the BP in hypertensive urgency? 4 agents used
No more than 25% because can precipitate ischemia (i.e. nitroprusside, fenoldopam, nicardipine, labetalol)
What is NMDAR encephalitis assoc with?
What is deficient is hemophilia C?
What is the main lethal AE of gentamicin?
What is the most important think to do anytime someone spills a chemical on themselves?
WASH IT OFF, massive irrigation i.e. if someone calls you tell them to wash it first then come to ED
How do you treat symptomatic primary hyperparathyroidism?
Parathyroidectomy, visualize the rogue gland with sestamibi scan
What disorder has chocolate colored blood?
Meghemoglobinemia tx is methylene blue IV
What is the vector for Chikungunya?
What if you place a central line and there is dyspnea with a mill-wheel churning murmur?
Venous air embolism - immediately aspirate catheter and give 100% O2 and put pt with left side down; prevent by trendelenburg
What do you you use to determine if there has been urethral injury in OB GYN surgeries?
Cystoscopy with IV indigo carmine and visualize blue coming from both ureteral orifices
Is an unemancipated minor who is also a parent allowed to make decisions for her baby despite what her parents think?
What are the 4 indications for home O2 in COPD?
SaO2 less than 88, PaO2 less than 55, Hct greater than 55, and evidence of cor pulmonale
Tx of 1) Chorioamnionitis 2) Endometritis s/p pregnancy 3) outpatient PID 4) Inpatient PID
Ampicillin and gentamicin, clindamycin and gentamicin, ceftriaxone IM and doxycycline, IV cefoxitin and IV doxycycline
What is the mgmt of Trigger finger?
Conservative tx first then steroids then release of A1 pulley NOT A2 pulley
What systemic dz is assoc with Trigger finger?
What personality disorder is assoc with ADHD? What hip issue?
Antisocial PD; Legg Calves Perthes go figure
What is the general way of dosing insulin in Type I DM
They get 0.5 to 1 unit per kg total per day. This is divided in half. The first half goes into the basal insulin which controls preprandial glucose levels (goal is 90-130) the second half is split into 3 for each meal and controls postprandial glucose (goal is under 180)
What is the goal UOP?
0.5 ml/kg/hr (or in general, about 35 cc per hour)
What is the stepwise tx of chronic constipation
First increase dietary fiber then add bulking agents like methylcellulose or psyllium, then try osmotic agents like PEG or lactulose, lastly are suppositories and fecal disimpaction
What is the rate of transmission of HIV from a needle stick from an HIV positive pt?
How do you treat Felty's?
Treatment aimed at the underlying RA (RA, neutropenia, splenomegaly) i.e. MTX (check LFT q 3 months)
What are the 5 points of the BPP? What are the possible scores?
Fetal tone, Breathing, movement, AFI, NST you either get a 0 or a 2 (8-10 is reassuring, 6 is equivocal, and 0-4 is very concerning)
What is MEN1 aka?
What position should a pregnant pt involved in trauma be placed?
On the L side (L lateral decubitus) to take pressure of IVC and prevent further hypotension
When should FHR tracings be monitored in the first stage of labor? Second?
q30 min in first stage; q15 min second stage
Which sacral axis do innominate rotations occur on (i.e. anterior or posterior innominates)
Inferior transverse axes
What is the most common cause of neonatal meningitis?
S. agalactiae is MC followed by E. coli
Alcohol induced nodal pain is pretty specific for what? Tx?
Hodgkin lymphoma; ABVD and if lymphocyte predominant add rituximab
How much protein is in the urine in a day in Alport syndrome?
What are the two most common abx to set off an exacerbation of myasthenia gravis?
Clindamycin and aminoglycosides
What personality disorder is often seen in pts who are currently being abused?
Dependent personality disorder (I got these marks because Im too stupid)
At what Cobb angle in a skeletally immature pt is bracing recommended?
What is the normal dosage of folic acid in pregnant women? What if hx of neural tube defect?
0.4 mg/day, 4 mg/day
What is the delta pressure as pertaining to compartment syndrome? What is desirable?
Diastolic BP minus the compartment pressure; want a high delta pressure
What is the best tx for borderline personality disorder?
Dialectical behavioral therapy
What is the DOC for cutaneous larval migrans? Bug?
Albendazole or thialbendazole (Ancylostoma braziliense)
What is the best OMM for fibromyalgia?
Counterstrain to tenderpoints
What is the post-prandial glucose goal in type I DM on insulin? What if this is not at goal?
less than 180, if the post-prandial insulin is not at goal then you should increase the preprandial rapid acting insulin
What are 2 ways to give fluconazole for vaginal candidiasis? Assoc?
single PO dose or topical dose, DM
Acetazolamide should not be given to pts allergic to what class of drugs
What is the preprandial glucose goal in a type I DM pt on insulin? What if this is not at goal?
90-130, if preprandial not at goal then increase the basal insulin
What is the other name for CRPS II?
What is the Rai staging for CLL
Stage 0 = isolated lymphocytosis greater than 15,000, Stage I = with LAD, Stage II = with splenomegaly, Stage III = with anemia, Stage IV = with thrombocytopenia (Stages correlate with survival)
What is the recommended dose of vitamin D per day? When do sx of hypervitaminosis D begin to show?
800 units per day, 2000 units and sx will be of hypercalcemia so polydipsia, polyuria, and constipation
What is the treatment of choice for metastatic prostate CA
Which drug is actually a disease modifying drug in Alzheimers?
memantine (NMDAR antagonist) because it prevents excitotoxicity and loss of neurons
How do you prevent uric acid stones from forming in the urine
Alkalinizing the urine with citrate, allopurinol should work too
What is Lemierre syndrome?
Septic thrombosis of the internal jugular vein (seen in pts with septic pulmonary emboli)
What are 2 actions of the hamstrings? What innervates the biceps femoris?
Flex knee and extend hip; BOTH the common peroneal and tibial branches of the sciatic
What is the best screening test for suspected pernicious anemia? Confirm?
MMA levels, anti-intrisic factor Ab
What is the mechanism of dermatographism?
It is IgE mediated so assoc with atopy
What is the most common cause of large bowel obstruction?
How do you ppx against MAC pna? Treat?
Azithromycin; Clarithromycin and ethambutol (watch the eyes)
What does nummular eczema look like? How do you diff?
Looks a like lot a dermatophyte but will have a negative KOH test
What is the best 1st line tx for chronic AR?
ACEI or CCB to decrease afterload. Helps the hyperdynamic circulation
What is the most common benign parotid tumor? Followed by?
Pleomorphic adenoma; Warthin tumor (Hurthle cell)
How do you tx epiglottitis?
IV ceftriaxone and vancomycin (MC causes are Hib and S. aureus)
What is a Pel-Ebstein fever?
Seen in Hodgkin lymphoma these are relapsing and remitting fevers
How much is 200 msec on an EKG (i.e. PR interval in first degree AV block)
more than 5 small blocks
What if a pt is not very responsive to sulfonylureas and has low C-peptide?
Start insulin it indicates Beta cell fatigue i.e. not producing much endogenous insulin
Lateral epicondylitis is due to microtears in what tendon?
Extensor carpi radialis brevis
What is the combination of ketorolac, diphenhydramine, and prochlorperazine used for?
abortive med for acute migraine
What is the first line for lichen sclerosis? What if that fails?
Topical glucocorticoids, biologics such as tacrolimus (topical calcineurin inhibitors)
Coffee lid crystals in the UA
Assoc with staghorn calculus these are magnesium ammonium phosphate (struvite) crystals
What is the mgmt of massive pulmonary embolus when heparin is CI?
Surgical embolectomy followed by IVC filter placement
What is the tx of mercury poisoning?
What does stress do to the cranial rhythmic impulse?
Where do you see reciprocal changes in posterior wall STEMIs
V1-V3 i.e. ST depression
What is the deal with pts becoming pregnant when IUD is in place?
If under 12 weeks then remove the IUD, if over 12 weeks leave it in place
What is seen in Brugada syndrome? Who gets it? What is the concern?
Persistent ST elevation in V1-V3 with RBBB pattern with or without terminal S waves. Thailand and Laos men, and risk of sudden death due to Vfib
How should you follow up an abnormal quad screen?
What way is the OA rotated in the CCP?
L then they just alternate
according to EMTALA is a normal term pregnancy a medical emergency?
What are good abortive meds for migraine? Ppx?
triptans (CI if pt on SSRI), propanolol first or topiramate
What is the cause of hypokalemia in multiple myeloma?
Assoc with RTA II (proximal) due to decreased reabsorption of HCO3 with hypokalemia
What is the treatment of choice to increase the CRI?
What is a STEMI in V1-V3
How do you treat hyperthyroidism in pregnancy?
PTU is DOC in first trimester because methimazole causes birth defects but then you transition to methimazole to decrease risk of hepatotoxicity in mom; radioactive iodine is CI in pregnancy
What is contained in cryoprecipitate?
Factor VII, Factor XIII, fibrinogen, fibronectin, and vWF
What are 2 lab tests for lead toxicity?
Lead levels and free erythrocyte protoporphyrin
Which AIDS pts can get pneumococcal vaccination? MMR?
ALL! All IF CD4 is greater than 200
How do you tx hyperviscosity in Waldenstroms macroglobulinemia?
What are 3 indications for surgery in nephrolithiasis?
Complete obstruction, unresolved obstruction, or infected struvite stone
What vaccines should kids with sickle cell get in addition to normal childhood vaccines?
Meningococcus and pneumococcus (trick - there is no parvovirus B19 vaccine)
What cause of bloody diarrhea often has febrile seizures?
What is a subgaleal hemorrhage?
Common in babies delivered by vacuum assistance. It crosses suture lines but is an actual hemorrhage unlike caput succedaneum. A cephalohematoma does NOT cross suture lines
What lab test, if elevated, would suggest chronic lead exposure?
Increased free erythrocyte protoporphyrin
What is the most common cause of hypomagnesemia?
GI losses such as vomiting or diarrhea
What is the best initial tx of nasal polyps?
Intranasal glucocorticoids, surgery for massive polyps
How is HSP treated?
Supportive care and close follow up. Abdominal pain can be tx with NSAIDs and if really refractory can tx with steroids (due to IgA and C3 deposition in Peyer's patch)
What is a SIMPLE febrile seizure?
Lasts less than 15 min, generalized (i.e. nonfocal) and only occurs once in 24 hours
What is congenital dermal melanocytosis?
What drug is DOC for myxedema coma?
What is the most likely cause of of a pt coming back from the Carribean with rash fever, POLYARTHRALGIAS, and lymphopenias and thromobcytopenia?
Chikungunay fever; carried by Aedes mosquito
What are the first, second, and third line agents for status epilepticus?
start with lorazepam, if fail then fosphenytoin, if fail then phenobarbital
When should pts with DM be screened for retinopathy, nephropathy, and neuropathy
annually with ophtho exam, albumin:creatinine ratio, and monofilament test respectively
What viscerosomatic level innervates the adrenals?
What is the best first test to do in painless 3rd trimester bleeding?
Vaginal US so you know where the placenta is prior to doing digital exam
What is Plummer's dz?
Toxic multinodular goite (patchy uptake on thyroid scintigraphy scan)
If a kid swallowed a battery and it was past his esophagus and then later he developed MS changes, tremor and renal insufficiency what should you check? How do you tx?
Mercury levels; Dimercaprol
What osteopathic technique is rather effective for acute otitis media?
What is the radiation exposure cutoff in pregnancy beyond which you worry about fetal issues?
more than 50 milligray
What is the first step after positive 3 hour glucose tolerance test in pregnancy?
Diet and exercise first then insulin
If pt has Reynolds pentad and you suspect ascending cholangitis what is the best screening test? Confirmatory?
Peutz Jehers and Carney syndrome are assoc with which testicular tumors?
Sertoli cell tumors