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47 Cards in this Set
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- Back
Patient with complete bell's palsy->next step? What if has preservation of brow movements at forehead? What if was in Maine recently? |
No workup->po steroids w/in 3 days to improve chance complete recovery (and artificial tears and eye patching) (usually due to zoster reactivation) -Do brain MRI->since central facial palsy worrisome for upper motor neuron/intracranial lesion -check for LYME ELISA |
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15yo AA F, dad died of "ruptured blood vessel", long extrem, scoliosis, 2/6 early diastolic murmur L sternal border, clear lungs=? Cause? Findings? Risk of what? |
Marfan Syndrome -Aut dom due to fibrillin 1 glycoptn defect -skeletal (arachnodactyly, lo upper-to-lower bod ratio, up arm-to-height ratio, pectus deformity, scoliosis/kyphosis, joint hypermobile), Ectopia Lentis, Aortic dilation->regurg->dissection, MVP, spontaneous pneumtx from apical blebs, recurrent hernias, skin striae -Risk of aortic dissection! (do TTE at initial dx and q6mos after) |
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14yo F w/ 2 episodes tonic clonic seizures in 1hr (has h/o epilepsy but recently stopped phenytoin), eyes are open but nonresponsive to commands, slight twitching in mouth and arms -Steps? |
Status Epilepticus (seizure lasting longer than 5-10min) -IV benzo/ativan -fingerstick glucose -urine tox screen -cbc/bmp |
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50yo M w/ knuckle pain worse in morning 1/2 hr, swelling 2nd/3rd MCPs, XR shows calcification triangular ligament, random blood glucose 203, fasting blood glucose 136, normal cbc/bmp/LH/FSH/testosterone/prolactin, no HTN, skin slightly pigmented over face and upper extrem, mild hepatomegaly=? Dx test? |
Hemochromatosis (bronze DM, with osteophytes hook type on MCPs from iron depot) -liver bx is gold standard if elevated |
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Counseling for sun-exposure in high risk patients: |
sunscreen SPF 15 or more, maintain hydration wear clothing/protective behaviors |
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First step in tmt of baby with shaken baby syndrome and concern for head tauma? |
CT scan head first (will eventually need a skeletal survey) but have to rule out subdural hematoma (crescent shaped)->most common |
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6mo old baby has been "spitting up". usually at night, composed of curdled formula, nonbilious, not projectile, infant has decreased appetite but good weight, mildly irritable after feeds=? TMT? |
Gastroesophageal reflux (normal up to 24mos old) -thicken formula with cereal -if fail->then H2 blocker/ranitidine |
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When is CMV answer for CNS findings? When is Herpes? When is Arbovirus? |
ONLY IN HIV/TRANSPLANT/IMMUNOSUPPRESSED -In adults with encephalitis findings -in kids with encephalitis findings |
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Common side effects of OCPs? Copper IUD? others? |
All: breakthru bleeding, breast tenderness Ring: vag irritation Patch: irritation skin or rash at site -longer/heavier menses -bleeding is always the side effect |
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25yo HIV M w/ painful swallowing, burning chest pain, on HAART, failed fluconazole, endoscopy w/ bx showed giant ulcers but no viruses=? |
Esophagitis->trial of antifungal first (since likely candidal) -if fails->endoscopy -giant ulcers w/o virus=Aphthous ulcers TMT: PO prednisone -if CMV (give gancyclvir), if HSV (give acyclovir) |
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When to do rapid strep testing on patient with sore throat? |
Only if 2/4 Centor criteria positive (if only 1/4, high neg predictive value->then supporitve tmt) -tonsillar exudate -tender anterior cerv lymphadenopathy (includes submandibular) -fever -absence of cough |
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Patient with acute asthma exacerbation nonresponsive to inhaled albuterol x4 times -Next step? |
po corticosteroid (DO NOT NEED CXR, INHALED STEROID IS NOT THE ACUTE ANSWER->used longterm) -supplemental O2 to maintain O2 sat >90 -if severe (FEV1 or PEF<40%): add hi-dose inhaled albu + ipratropium neb q20min or continuously for 1hr -if resp arrest/or distress: IV steroid, mech vent and intubate->ICU |
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52yo F going thru menopause with irregular menses=? TMT? Dx criteria? |
Menopausal transition w/ Anovulatory Uterine bleeding (they shouldn't be bleeding at all->amenorrhea >1yr = menopause) -if age =>45 do endometrial biopsy -then treat with OCPS |
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Contraindications for metformin? Patient undergoing cardiac cath-recs? |
renal insuff (Cr>1.5), hepatic dz, ETOH abuse, sepsis, severe CHF -stop day b4 and resume 2 days after (since IV iodine contrast with metformin can cause lactic acidosis |
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Differentiate Obsessions from Compulsions: |
Obsessions: persistent intrusive thoughts that pt knows are senseless product of her own mind that cuases distress Compulsions: repetitive intentional BEHAVIOR done to alleviate anxiety |
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Baby being born, head out, but unable to free shoulder=? TMT? |
Shoulder Dystocia BECALM B-breath, don't push, lower head of bed E-elevate legs to McRoberts position (hip flexed in supine) C-call for help A-apply SP pressure to release anterior shoulder L-enlarge vag opening with episiotomy M-maneuvers: deliver posterior arm, Woods corkscrew(pressure baby posterior shoulder anteriorly) or Rubin (posterior & anterior pressure), Gaskin (all fours-mom on hands and knees), Zavanelli (push baby head back in and c-section) |
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Most common cause of recurrent DVTs/PEs in patient with family hx of this? |
Factor V Leiden (most common hereditery thrombophilia) |
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What is the prognosis of childhood abscense epilepsy? EEG pattern? TMT? |
episodes diminish with age (usually starts 4-8yo) and treatment is very effective -generalized 3/sec spike with wave activity -ethosuximide or valproate |
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Workup of palpable breast mass? |
If <30->U/S->if benign features/solid->mammogram, if atypical->core needle bx, if simple cyst->needle aspirate If =>30->mammo+/-u/s->then core bx |
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Ear purulent discharge and ganulation tissue on floor external auditory canal=? What other findings? TMT? |
Pathognemonic for Malignant Otitis Externa (invasive infxn external canal and bones forming skull base, marked pain, purulence, granulation, discharge, floor bone-cartilage jnction, normal tymphanic membrane, usually in elderly/DM/HIV, caused by pseudomonas->can cause osteomyelitis if untreated) -IV cipro or antipseudomonal (piperacillin/ticercillin, ceftazidime) |
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Patients with hospitalizaiton and recent variceal bleeding->most common complication? |
Infection (SBP vs. UTI vs. resp infction/pna), which is why use of ppx abx cipro is recommended |
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25yo AA w/ infertility eval, trying 2 years, menstrual periods irregular, LMP 10 days ago, BMI 31, facial hirsutism, husband semen analysis normal, glucose 98, U/S shows increased ovarian vol bilat=? TMT? Risk of what? |
PCOS (gradual hirsutism, obesity, irregular menses, infertile), increased testosterone Dx Test: elevated Lh/FSH 3:1 ratio, bilat enlarged ovaries on u/s -increased risk of endometrial ca -for infertility: weight loss 1st->clomiphene citrate -for irregular bleeding/hirsutism->OCPs +/-spironolactone |
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Risk factor most important for Pelvic inflammatory dz? |
Multiple sex partners |
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What's the point of the alpha subunit when check thyroid hormones? |
differentiates btwn the TSH-secreting pit adenoma and thyroid hormone resistance syndrome (when TSH, T4, T3 up, if alpha unit elevated, indicates adenoma) |
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Pt with parkinsons on levodopa/carbidopa w/ mask-like facies, hand tremors, bradykinesia, avoids eye contact, and does not want to answer questions, daughter states he wakes up real early which is unusual Next step? |
Add SSRI (do to treat for possible depression before adding another antiparkinson mediction) |
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Type 1 vs Type2 error? |
Type 2 when study fails to reject null (relates to power of study/sample size) Type 1 relates to false positives when you reject null incorrectly |
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24yo M cleaning house w/ GF, found to be lethargic and SOB, wheezing, flushed, miosis, garlic like odor on clothes=? Dx test? TMT? |
Organophosphate poisoning (garlic odor-patho, salivate, lacrimate, urinate, diarrhea, wheeze) -RBC cholinesterase (tells degree of toxicity since they inhibit acetylcholinesterase, usually this aint done) -Atropine initially (most effective is Pralidoxime), remove all clothes and wash pt |
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pregnant woman with hyperpigmentation cheeks=? TMT? |
melasma (occurs in sun-exposed areas), common in preg -sunscreen use, will resolve after delivery, avoid sun exposure |
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24yo M w/ disorientation, restlesness to ED (had opioid overdose one month ago in ED), BP 160/100, HR 120, not oriented, but recalls name, bilat vertical nystagmus=? TMT? |
PCP intox (vert nyst is patho) -place in quiet environment |
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1positive whiff test= 2pH>4.5= 3pH 3.8-4.2= 4pseudohyphae= 5motile trichomonads= 6clue cells= 7amine odor on KOH= 8thin yellow green= 9thin off white= 10fishy odor= 11frothy discharge= 12vaginal inflammation= 13when to treat partner |
1Bacterial Vaginosis (gardnerella vag)-BV->use flagyl 2BV vs. trichomoniasis (T) 3candida vaginosis (CV)->use fluconazole 4CV 5T->use flagyl 2g once or 7days 500 6BV 7BV 8T 9BV 10BV 11T 12T vs CV 13 only in T |
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MGMT of C.diff? |
if mild-mod (wbc <15, cr <1.5x baseline)->po flagyl if severe->po vanco (if ileus->iv flagyl and rectal vanco instead) ANSWER IS NEVER IV VANCO-doesn't get spread to colon |
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When to do CEA? |
symptomatic carotid stenosis >70% (asx is controversial) |
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Which steroids to use in pregnancy? |
betamethasone or dexamethasone |
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35yo M states excessive daytime sleepiness for months falling asleep at inappropriate times, no other sx
First step? |
Overnight polysomnography->if suspect narcolepsy then multple sleep latency test (narcolepsy treated with methylphenidate +/-antidepressants) |
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What has the highest risk of MALE breast ca? |
Klinefelter's syndrome (47 XXY, hypogonadism, low T, gynecomastia) |
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what treatable risk factor for ischemic stroke in atherosclerotic dz is most effectable if modified? |
HTN! (not smoking, DM, HLD) |
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What is the single most important prognostic factor in patients with COPD? |
FEV1 (if below 40%= severe obstruction) |
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30yo M w/ salmonella enteritis TMT? |
supportive therapy (only need to treat with cipro/bactrim/or ceftiraxone if kid 12mos younger or immunocompromised) |
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What is serum sickness? |
prodrome phase of Hep B->get fever, rash, arthralgias that resolve once jaundice starts, due to type 3 rxn w/ circulating immune complexes (will also see elevated AST/ALT and Tbili) |
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Patient in house fire to ED w/ nausea, HA, AMS, vitals stable=? Sx? Test? TMT? |
Carbon Monoxide poisoning -SOB, lightheaded, HA, disorientated, met acidosis (basically anemia and asphyxiation since COhgb does not release O2 to tissues)->look for an entire family with fatigue and HA after being in home snowed in and feels better shoveling snow -Check CO oximetry (PO2 venous and arterial will be normal, puls ox will show normal Ox sat since can't differentiation CO vs O2hgb) -give 100% O2 |
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Recall bias is also known as? |
Misclassification of exposure (or misclassification of outcome if the survey is asking about what they got disease wise) |
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What meds to give in acute STEMI? |
1. O2 2. Nitrates (don't if hypotn or RV infarct) 3. ASA 162-325 chew + P2Y12 blocker 4. BBlock (not if severe airway dz or brady) 5. Anticoag (esp. if undergoing PCI) 6. intensive statin 7. PCI w/in 90min or TPA w/in 30min NOT CCBs (increase mortality) |
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Criteria for acute Rheum Fever? |
1 Major (JONES: Joints/mig arthritis, Carditis, Nodules/subq, Erythema marginatum, Sydenham chroea) + 2 Minor (fever, arthralgia, hi ESR or CRP, prolonged PR) -late finding: mitral regurg or stenosis -TMT: penicillin (for GAS strep pyo pharyngitis) and will continue to adulthood |
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Fat AA or hispanic kid presents w/ acute R hip pain that started as a little bit 3 wks ago but can't walk now w/ pain to thigh and knee, no injuries, avss, pain on hip external rotation=? TMT? |
SCFE (slipped capital femoral epiphysis) -Immediate internal fixation w/ pins as soon as possible (risk of avascular necrosis if delatyed tmt) |
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Rules of undescended testicle in Male? |
spont descent rare after 6months->do orchiopexy then to decrease risk fertility and torsion -Increased risk of malignancy remains same after surgery |
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5wk old boy in winter to ED w/ intermittent respiratory pauses and cyanosis w/ rhinorrhea and nasal congestion. Father and old sibling had nasal congestion adn rhinorhea. Has bilat crackles and wheezes w/ intermittent apnea=? ML organism? TMT? |
Bronchiolitis (kids <2), esp in winter RSV Supportive care only |
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What seat belt to wear in pregnancy? |
Where the whole thing |