3CK PART I Flashcards

Question

Type 2 of HIT

Answer 1

Thrombocytopenia - platelets typically decline >30%-50% Timing - onset 5-10 days after heparin initiation or ≤1 day with prior, recent heparin exposure Thrombosis - new thrombosis, progressive thrombosis, or skin necrosis Alternate causes - no other sources for thrombocytopenia are present or likely

Answer 2

unlike Trichloroacetic acid, podophyllin is not indicated for internal use in patients with condyloma acuminata and should not be used during pregnancy. Podophyllin arrests mitosis in metaphase.

Answer 3

RSV is the MCC Metapneumovirus parainfluenza

Answer 4

lachman test - displace the proximal tibia anteriorly when knee flexed 30 degrees

Answer 5

ptes in th 5th decade Glucagon > 500 Weight loss ( catabolic effects of glucagon) Diabetes mellitus ( can be recently diagnosed) Necrolytic migratory erythema ( low aa, hyponutrition) Venous thrombosis 30%

Answer 6

Anti ABCDE + HIV protease inhibitors, methadone, oxycodone ``` Anti Arrhythmics- Class IA and III Antibioticos: macrolides, anti malarials, fluoroquinolone Anti Cychotics: haloperidol, risperidone AntiDepressants: TCAs, SSRIs AntiEmetics: ondansetron ```

Answer 7

Southwestern US and California Pneumonia, meningitis, erythema nodosum arthalgia Earthquake Spherule filled with endospores If local: itraconazole/fluconazole If systemic: amphotericin b

Answer 8

Leuckocytosis with lymphocyte predominance ( > 20,000 with > 50% lymph)

Answer 9

``` Advanced age Previous osteoporotic fracture Lon-term corticosteroid therapy Cigarette Low body weight ( 58 kg) Fx hx of hip fracture Excess alcohol intake Rheumatoid arthritis Secondary osteoporosis prolonged heparin use ```

Answer 10

"memory booster" suggested mechanism is increased cerebral flow SE: MOST IMPORTANT:Risk of bleeding and potentiation of anticoagulant effects - inhibits platelet derived factor. Seizures, headache, restlessness, irritability

Answer 11

patients at risk for preterm delivery at <37 weeks gestation (or <34 weeks gestation in patients with diabetes mellitus). decrease the neonatal morbidity and mortality associated with preterm birth (eg, respiratory distress syndrome).

Answer 12

pregnant women with MS usually have lower disease activity during pregnancy and higher disease activity in the postpartum period.

Answer 13

``` Dx: clinical Xray can show: flat diaphragm Mild cardiomegaly Prominent vascular markings in a sunburst pattern at hilium. Fluid in the interlobar fissures Pleural effusion may be present Alveolar edema—> fluffy densities ``` ABG: Hypoxemia and hypercapnia

Answer 14

baclofen or tizanidine

Answer 15

Crystalline deposits (canaliths) in semi-circular canals->disrupt normal flow of fluid in vestibular system->contradictory signalling from corresponding canals on each side->interpreted as spinning/vertigo sensation Vertigo with positional changes, NO HEARING LOSS

Answer 16

Two phases: First upper respiratory ss: rhinorrhea, nasal congestion, cough Lower Resp ss: wheezing, crackles, respiratory distress, hypoxemia, fever Supportive care: hydration, saline nasal drops , nasal bulb congestion Patients should be advised to avoid other triggers of airway reactivity, particularly cigarette smoke.

Answer 17

AA Naltrexone Acamprosate Disulfiram - short term use, not for heart disease pts

Answer 18

1. ATN- most common;y due to toxins or ischemia 2. AIN 3. Rhabdomyolisis/Hb 4. Crystal deposition ( Ca, uric acid, oxal) 5.Bence Jones prot 6. Strept Aminoglucosides, cisplatin, amphot, NSAIDS ``` Labs: BUN/Creat < 20:1 Osm< 300 Increased FeNa, UNa EXCEPT Contrast agens ( decreased FeNa and UNa) ```

Answer 19

First line is >=3 months Factor X inhibitors -( orally, no need of heparin bridge or lab monitoring) In patients WITHOUT CA is the first line. In patients with Ca --LMWH.

Answer 20

Yes, to screen for asymptomatic implant rupture, which could lead to scarring within the breast

Answer 21

true apnea and pauses in breathing lasting ≥20 seconds; it typically resolves by a corrected gestational age of 37 weeks (ie, at 1 week of life for a 36-week gestation infant).

Answer 22

Estrogen containing are CONTRAINDICATED ``` Progestin-releasing IUD ( decreases blood loss, so preferred in patients with cramps and dysmenorrhea) Copper treatment ( increases blood loss) ```

Answer 23

carotid atherosclerosis disease-- carotid bruit.

Answer 24

Demyelination of peripheral nerve axons

Answer 25

Upper 2/3rds is squamous cellular- often associated to alcohol, tobacco Lower third- Adenocarcinoma- associated to Barret esophagus or GERD.

Answer 26

pelvic radiation and tamoxifen

Answer 27

digoxin b blockers ca channel blockers adenosine These favor conduction through accesory pathway

Answer 28

adrenal crisis by increasing metabolic demand and clearance of glucocorticoids.

Answer 29

noncompressibility

Answer 30

There is inhibition of their activity, leading to bleeding , prolonged BT but NORMAL NUMBER.

Answer 31

gastric ulcer

Answer 32

```

Complex regional pain syndrome o Usually occurs after injury o Pain is out of proportion o Temperature change and skin color o Edema ``` Pathogenesis: injury causing increased sensitivity to sympathetic nerves Abnormal response to and sensation of pain Increased neuropeptide release- allodynia.

Answer 33

Gastrocnemius- soleus complex

Answer 34

Dx: autonomic testing that measures increased resting sweat output or MRI Tto: regional sympathetic nerve block or IV regional anesthesia. Local nerve block

Answer 35

``` Temporal headaches Jaw claudication Polymyalgia rheumatica Arm claudication ( diminished pulses, and bruits in subclavia or axilla) CNS: TIA/stroke, vertigo Anterior ischemic optic neuropathy ```

Answer 36

left main coronary artery originating from the right aortic sinus and the right coronary artery originating from the left aortic sinus. These defects create sharp curvature of the anomalous coronary artery, making it less amenable to high-volume flow. In addition, the anomalous artery passes between the aorta and the pulmonary artery, making it susceptible to external compression during exercise.

Answer 37

plasmapheresis

Answer 38

Group B Streptococcus (GBS) prophylaxis in patients at <37 weeks with an unknown GBS status to prevent neonatal sepsis.

Answer 39

Elevated TSH and normal T4 non-specific ss of hypothyroidism Before treatment always have a good hx and order Anti-TPO antibodies to exclude Hashimoto If patient has any of the following treat with thyroxine: * goiter * hypercholesterolemia * Ss of hypothyroidism * TSH >=20

Answer 40

Varenicline- partial agonist at the alpha4-beta5 subunit of the nicotinic acetylcholine receptor. Nicotine patchees, gum , lozenge, Bupropion (EA: dry mouth, insomnia, headaches)

Answer 41

A. Risk of HF, no structural abnormality B. Structural abnormality, no ss of HF C. Structural abnormality, ss of HF D. HF with ss at rest or night.

Answer 42

``` 2 arteries 1 vein ( most oxygenated- PaO2 30, SatO2 80%) ```

Answer 43

noncaseating granulomas that stain negative for fungi and acid fast bacilli

Answer 44

Classic is 21 alpha hydroxylase def Tto: - Glucocorticoids and mineralocorticoids ( hidrocortisone) - high salt diet - reconstructive surgery for genitalia - psychosocial support

Answer 45

>= 1symptom: postprandial fullness, epigastric pain or burning, early satiety

Answer 46

Weekly biophysical profiles Serial umbilical artery Doppler sonography weekly Serial growth ultrasounds 3-4 weeks

Answer 47

CK,LDH,Aldolase ANA ( 80%), anti-Ro, anti-La, anti-Sm, anti-ribonucleoprotein (RNP), and anti-Jo-1 antibodies.

Answer 48

leukopenia

Answer 49

10 days both to ensure full eradication of bacterial carriage and to prevent rheumatic fever.

Answer 50

Regurarly with aminotransferases, HBV DNA levels, and HBsAg. Aminotransferases usually normalize within 2-8 weeks Patients who havent cleared the HBsAG after 6 months of initial ss, are dx with chronic infection

Answer 51

S1: Mitral and tricuspid valve closure, loudest at mitral area S2: Aortic and pulmonary valve closure.

Answer 52

patients recovery expectation Education to improve patients' understanding of natural history and prognosis may improve the likelihood of returning to work.

Answer 53

Thiazides ACEIs, ARBS Calcium channel blockers B blockers and hydralazine are safe

Answer 54

If patient is symptomatic (eg, chest pain, shortness of breath, hemoptysis). Do A CT Management same as DVT- RIVAROXABAN OR WARFARIN

Answer 55

``` Collect data Identify possible causal factors Identify root cause Make recommendations and implement changes measure the success of changes ```

Answer 56

Preterm labor Low birth weight Acute respiratory distress syndrome

Answer 57

is used as a medication to treat genital warts and plantar warts, including in people with HIV/AIDS. Podophyllin arrests mitosis in metaphase.

Answer 58

ABN Aspirin 325 mg B blocker Nitroglycerin

Answer 59

a single dose of intramuscular penicillin is bactericidal for up to a month and can be given to patients who cannot tolerate oral antibiotics. Azithromycin x 5 days if allergy

Answer 60

systolic -diastolic pressure Pulse pressure is proportional to SV, inverse to arterial compliance

Answer 61

retained keratin plugs in the hair follicles. emollients and topical keratolytics (eg, salicylic acid, urea)

Answer 62

swelling and tenderness in the anterior knee, often with superior displacement of the patella. With a complete tendon rupture, patients cannot actively extend the knee and cannot raise the leg against gravity.

Answer 63

Defect in dynein arm Infertility ( immotile sperm, cilia in fallopian tubes dont move) Situs inversus ( e.g. dextrocardia) Chronic sinusitis Bronchiectasis

Answer 64

IV ceftriaxone, cefepime Once afebrile for 48 hours, patients are placed on oral antibiotics for 10-14 days. After treatment completion, daily suppressive therapy (eg, low-dose nitrofurantoin or cephalexin) is initiated and is maintained until 6 weeks postpartum to prevent recurrence.

Answer 65

everything that decreases flow: aortic stenosis, cardiogenic shock, cardiac tamponade, advanced heart failure

Answer 66

Paroxysmal elevated blood pressure with tachycardia Pounding headaches, palpitations, diaphoresis Hypertension with an adrenal incidentaloma

Answer 67

Viridians streptococci Smaller vegetations on previously damaged valves or congenital valves. Gradual onset

Answer 68

All women 65 or older Postmenopausal women < 65 with on or more risk factors for fracture Men with risk of fracture

Answer 69

Patellar tendon tear/rupture

Answer 70

Hcto >= 65 or Hb > 22 | Is most commonly observed at 2-3 hours of life

Answer 71

increased aldosterone, decreased cortisol ( hypoglycemia) and sex hormones. Patients with HTN ( salt and fluid retention) +hypoK Ambiguous genitalia, no secondary characteristics developed.

Answer 72

SMR = observed number of deaths/expected number of deaths quantifies mortality in a specific group as compared to the general population An SMR of 1.75 indicates that the observed number of deaths among the miners in this study was 1.75 times (or 75%) higher than would be expected if these miners had the same death rate as the standard population.

Answer 73

Monosymptomatic ( only enuresis) | Non-monosymtomatic ( enuresis + lower UT ss)

Answer 74

hepatocellular Carcinoma

Answer 75

Elevating the testicle leads to relief of pain- this occurs in epididymitis

Answer 76

HPA axis suppression is more likely with prolonged (>3 weeks) GC usage, especially at higher doses or with evening administration. In these cases, a gradual taper of GCs is indicated. A lengthy taper of >1 month may be required for patients with very prolonged GC therapy (eg, >1 year). If given < 3 weeks abrupt stop of GCs can be done and would not affect the HPA axis

Answer 77

chronic pain that worsens with activity

Answer 78

AD, Asian pseudo right bundle branch block and ST elevations in V1-V3 HIGH risk for arrythmias and SCD Implantable cardioverter-defibrillator

Answer 79

toxic to fetal cartilage development.

Answer 80

always do first an Xray before tto to see Cobb angle - low/medium risk curve:observation or the use of a back brace - severe scoliosis (Cobb angle ≥40 degrees) requires surgical evaluation for possible spinal fusion given the high risk for progression and future complications (eg, chronic back pain, pulmonary compromise

Answer 81

Ehler Danlos, Marfan Woman with atypical pain, palpitations, panic attack Is better when ventricle filled with blood Tto: avoid dehydration and give b blocker

Answer 82

Bone mineral density depends on the peak bone mass and the rate of bone mass loss. The peak bone mass is higher in men, so men present with osteoporotic lesions 10 years later than women

Answer 83

Opioid agonist: methadone (preferred) or buprenorphine(potential worsening of withdrawal) Nonopioid: clonidine (alpha2 adrenergic agonist) or adjunctive medications (antiemetics, antidiarrheals, benzodiazepines) The choice depends on scenario: opioid requires being in supervised or outpatient Clonidine can be done

Answer 84

repolarization interventricular septium, prominent in hypoK bradycardia hypercalcemia hyperthyroid

Answer 85

increase the risk of hot flashes and VTE

Answer 86

sensory loss over the medial thigh | weakness in leg adduction.

Answer 87

Conscious and able to drink and swallow safely: Administer 0.3 g/kg (10 to 20 g) of a rapidly-absorbed carbohydrate. 15 g is supplied by 3 glucose tablets, a tube of gel with 15 g, 4 oz (120 mL) sweetened fruit juice, 6 oz non-diet soda, or a tablespoon (15 mL) of honey or table sugar. May repeat in 10 to 15 minutes. Altered mental status, unable to swallow, or does not respond to oral glucose administration within 15 minutes: Give an initial IV bolus of glucose of 0.25 g/kg of dextrose (maximum single dose 25 g).Δ The volume and concentration of glucose bolus is infused slowly at 2 to 3 mL per minute and based upon age: 2.5 mL/kg of 10% dextrose solution (D10W) in infants and children up to 12 years of age (10% dextrose is 100 mg/mL) 1 mL/kg of 25% dextrose (D25W) or 0.5 mL/kg of 50% dextrose (D50W) in adolescents (25% dextrose is 250 mg/mL; 50% dextrose is 500 mg/mL) Unable to receive oral glucose and unable to obtain IV access: Give glucagon 0.03 mg/kg IM or SQ (maximum dose 1 mg):◊ Perform blood glucose monitoring every 10 to 15 minutes as the effects of glucagon may be transient Establish vascular access as soon as possible

Answer 88

Thompson test- squeeze the gastrocnemius should cause plant to flex. Patient should be laying prone or knee in a chair. In Achilles rupture there is no plantar flexion DO NOT ASK ACTIVE PLANTAR FLEXION- Pt may use accessory muscles ( ie. fibularis) and falsely reassure they can MRI should be asked if thompson positive.

Answer 89

one or more of the several glands that encircle the anus become blocked and the bacteria within grow unchecked

Answer 90

If the patient exhibit ss mostly due to GERD- heartburn, regurgitation or cough is indicated a trial with PPIS In patients taking COX inhibitors- suspend and give a trial of PPIs during 8 weeks In patients when this is not common assessment depends on 1. Age > 55 years 2. Alarm ss: weight loss, hematemesis, iron deficiency anemia 3. Helicobacter pylori status- if negative, treat with 4-6 weeks PPIs If positive - treat ABCs Patients with age> 55 or alarm signs should undergo an endoscopy

Answer 91

placental insufficiency and impending fetal hypoxia, particularly with concomitant oligohydramnios, and is an indication for delivery

Answer 92

Acute renal failure, hyperK, dry cough, angioedema, skin rash,altered sense of taste

Answer 93

t resolves spontaneously at a rate of approximately 15 percent per year [9,10]. The longer the enuresis persists, the lower the probability that it will spontaneously resolve [7,9].

Answer 94

Immune thrombocytopenia

Answer 95

``` Rh(D) type, antibody screen Hemoglobin/hematocrit, MCV HIV, VDRL/RPR, HBsAg Rubella & varicella immunity Pap test (if screening indicated) Chlamydia PCR Urine culture Dipstick for urine protein ```

Answer 96

``` CO= SV x HR CO= (MAP-RAP)/TPR ``` In early exercise, the CO is maintained by both increased SV and HR In late exercise is maintained by increase in HR

Answer 97

Monoclonal gammopathy: Asymptomatic, may lead to MM NO CRAB findings Develop MM at a rate of 1-2% year ``` Waldenstron: M spike=IgM Hyperviscosity ( diplopia, tinnitus, headache) Neuropathy Bleeding Hepatosplenomegaly LAD ```

Answer 98

Gabapentin, duloxetine

Answer 99

Colonoscopy at 40 or 10 years before his relative and repeat 3-5 years

Answer 100

RF for lead toxicity: * PICA * Houses built < 1978 * Decoration/ toys painted < 1978 * Foreign born children * Low SES

Answer 101

Surfer's ear - irritation due to cold and water leads to bnormal bone growth within the ear canal. - narrowing the canal

Answer 102

Niacin ( B3) ``` 4Ds Dementia Diarrhea Dermatitis Death ``` + red tongue, vomiting, diarrhea insomnia, anxiety, disorientation , delusion.

Answer 103

HTN - fluid and salt retention virilization decreased aldosterone renin decreased( has some glucocorticoid activity)

Answer 104

Small bowel obstruction * Recent surgery ( weeks to years * Increased bowel sounds , abdomen distended * There is no gas in the colon ``` Ileus: Recent surgery ( hours), metabolic abnormalities ( HYPOKALEMIA), MEDS Decreased bowel sounds , abdomen distended There is gas throughout the small and large intestine. ```

Answer 105

MC:Sinus tachycardia Other consistent ECG findings that occur due to right ventricular (RV) strain include new right bundle branch block, atrial arrhythmias, and Q-waves or ST-segment changes in the inferior leads. pulmonary hypertension caused by massive PE often leads to dilation of the tricuspid valve annulus and functional tricuspid valve regurgitation seen on echocardiogram.

Answer 106

AR Defect in transport of NEUTRAL AA by the intestine and renal tubules Def of tryptophan and other aa ``` Usually asymptomatic BUT: Failure to thrive Photosensitivity Ataxia nystagmus -pellagra like ss ``` DX: aminoaciduria Tto: high protein diet nicotinic acid.

Answer 107

Type I : rapidly progressive , most patients die within 10 weeks without treatment Type II: progress more slowly with an average survival of 3-6 months.

Answer 108

> 417 ng/ml

Answer 109

When we test multiple times at a set p value

Answer 110

Urge ( detrusor hyperactivity) urodynamic testing - lifestyle modifications ( time voids and bladder training- establish a baseline interval and gradually increase the time between voids- eventually 3-4 hrs - antimuscarinic medication such as tolterodine, solifenacin, or oxybutynin. - IF PERSISTS DESPITE ABOVE considered for botulinum toxin injections or percutaneous tibial nerve stimulation.

Answer 111

Febrile non-hemolytic transfusion reaction reaction to cytokines released from WBCs in a product that has not been leukoreduced acetaminophen

Answer 112

``` acute onset < 1 week fever seizures altered mental status focal neurological ss - such as hemiparesis, or CN deficits ```

Answer 113

exertional angina, lightheadedness, or syncope; however, some patients experience SCD without any premonitory symptoms. Resting ECG is typically unremarkable.

Answer 114

aortic stenosis

Answer 115

``` adenocarcinoma of the cervix ovaries, lung pancreas bladder stomach. non hodgkin lymphoma ```

Answer 116

Dihydropyridines( amlodipine): peripheral edema Non-dihydropyridine( verapamil, diltiazem): heart block

Answer 117

intravascular hemolysis ( ABO incompatibility) or extravascular hemolysis( host antibody agains antigen on RBC) Direct coombs + plasma hemoglobin >25 hemoglobinuria

Answer 118

a high probability of septum injury and a possible levator palpebrae injury.

Answer 119

intra-articular steroids, NSAIDs, colchicine

Answer 120

``` The fibullaris ( aka peroneos) - longus, brevis, tertius ```

Answer 121

subjects' participation in research, the subsequent awareness of being observed, and the possible impact on behavior. may overestimate the effect of the intervention, and the internal validity of the study

Answer 122

it was started but doesn't complete within 4 years

Answer 123

Measure nonfasting total cholesterol and HDL All men <=35 Women>=45 Also men 20-35 if RF Women 20-45 IF RF If total cholesterol 240 and RF get a complete lipoprotein profile(LDL, TRG)

Answer 124

CT head-- subdural hematoma - mainly in patients with altered mental status. It usually presents as a mixed density pattern ( some regions darker which is more chronic, some regions lighter which are more acute) Once this has been done, skeletal Xray survey first.

Answer 125

Octeotride | Surgical resection

Answer 126

hair loss, scaling, inflammation, scarring, and hypopigmentation of the skin. There may be associated lesions present over the face or extremities.

Answer 127

prokinetic agent that acts as a central and peripheral D2-receptor blocker. akathisia, dystonia, and parkinsonian-like symptoms

Answer 128

Is the most common cause of delayed puberty. Transient defect in GnRH production from hypothalamus Family history , AD , “ late bloomers” in the history Length at birth is normal Length 3-6m downward shift in growth rate but always parallel. 3-4 years grow in a low-normal rate below but parallel to the 3RD PERCENTILE Hallmark is the delayed bone growth. NORMAL GROWTH VELOCITY

Answer 129

NO increased risk to the fetus when the mother receives adequate treatment for Lyme disease with 14-21 days of amoxicillin or cefuroxime. Non-pregnant woman :doxycycline

Answer 130

NMDA receptor antagonist

Answer 131

``` family history of diabetes mellitus, a history of GDM in a previous pregnancy, obesity, multiple gestation, and maternal age >25. ```

Answer 132

AP | with inspiration higher blood to the left meaning that pulmonary valve closes after aorta

Answer 133

Glucocorticoids cause bone loss through different mechanisms: * Decrease Ca absorption in the gut * Cause renal calcium wasting * Direct anti-anabolic effect in the bone * Suppress the release of GnRH—> hypogonadism —> aggravates bone loss

Answer 134

superficial fibular nerve

Answer 135

(right bundle branch block and ST-segment elevation in leads V1-V3) or long QT syndrome (QTc >450 msec in men or >470 msec in women) makes these diagnoses less likely. AD disorder

Answer 136

patients at <32 weeks gestation | provides fetal neuroprotection and decreases the incidence of cerebral palsy.

Answer 137

check state prescription drug monitoring program > random urine checks > schedule frequent follow-ups

Answer 138

retinal artery: amaurosis fugax | retinal vein thrombosis : retinal hemorrhage

Answer 139

1. steroids: children response well, adults late and may relapse 2. IVIG: can raise platelet count in significant bleeding.( macrophages eat the given IgG instead of the one bound to platelets) 3. splenectomy in refractory cases children-if skin manifestations only- observe. If bleeding IVIG, steroids. adults: >=30,000 without bleeding observe. IF <30,000 OR bleeding treat.

Answer 140

Chronic pruritic rash with escoriation and lichnification infants: red crustered lesions in extensor surfaces adults: flexural eczema and liquenification

Answer 141

IV fluids Glucose Partial exchange transfusion

Answer 142

Group B Streptococcus culture

Answer 143

Lateral femoral cutaenous nerve entrapment PURELY SENSORY decreased sensation over the anterolateral thigh without any muscle weakness or deep tendon reflex abnormalities.

Answer 144

Intraarticular corticosteroid injections

Answer 145

``` EBV Toxoplasmosis Rubella Roseola Viral hepatitis CMV acute HIV infection MUmps ```

Answer 146

Ischemic cardiomyopathy - most have known CAD, however is not uncommon that they dont know . 7%

Answer 147

ADPKD patients are often asymptomatic

Answer 148

mitral/tricuspid regurgitation

Answer 149

1. Chronically transfused patients 2. CMV seronegative at risk patients( AIDS,HIV) 3. Previous febrile non-hemolytic transfusion reaction

Answer 150

If patient is violent-- give BZD ( if BZD doesnt work, restrains may be needed or even haloperidol) If ss are mild- patient is calmed but detached or in withdrawal- low stimulating environment ( with or without BZD)

Answer 151

crescendo decresendo radiates to carotids single soft murmur pulsus parvus et tardus ( weak and delayed) lead to SAD: Syncope, angina, dyspnea on exertion CHF

Answer 152

— Neuromuscular disease - motility disorder--- Barium swallow with barium

Answer 153

increased risk of developing MS (eg, 3%-23% of MS cases are familial) and can be born with lower birth weights.

Answer 154

everything that increases flow: hyperthyroidism, aortic regurgitation, aortic stiffening, OSA ( increased sympathetic tone), Exercise ( transient)

Answer 155

permethrin

Answer 156

Troponin I ( at least 2 troponins 3 hours apart) and serial ECG (30 minutes) .

Answer 157

-anaphylaxis - transfusion related acute lung injury TRALI - primary hypotension reaction - bacterial sepsis

Answer 158

Fecal antigen testing 4 weeks after completing treatment - bismuth and oral antibiotics can lead to false negative results - urea breath testing 4 weeks after completing treatment is also an option but is not as available as fecal antigen

Answer 159

when the study design or analysis does not control for the potential effect these confounders may have on the association under study.

Answer 160

celiac disease pruritic papules and vesicles on extensor surface of the elbows and knees, but also on buttocks and back

Answer 161

Pregnancy-related melasma typically regresses spontaneously within the first year after delivery, although some areas do not completely resolve.

Answer 162

1st line Nifedipino and amlodipine. diltiazem a little not verapamil

Answer 163

qSOFA ( Sequential organ failure assessment) ``` 1 point to: * Respiratory Rare >=22 * Altered mental status * SBP<100 A score >= 2 is likely to be sepsis ```

Answer 164

steroids Disease-modifying drugs (eg, beta-interferon, glatiramer acetate) decrease the frequency of relapses and reduce the development of brain lesions

Answer 165

``` motor weakness, ataxia, or incoordination altered level of consciousness fascial weakness dysphagia dysarhtria ```

Answer 166

An indirect method to measure CO rate of O2 consumption/ ( arterial O2-venous O2)

Answer 167

Can be drained in the office, no need of surgery unless they are too large

Answer 168

Normal >= -1 Osteopenia -1 to -2.5 Osteoporosis =<2.5 Severe: =<2.5 + fragility fracture

Answer 169

ACUTE ( children) viral illness or after immunization IgG against GpIIb/GpIIIa , generated by plasma cell in spleen. macrophage eats the complex. BM with high megakaryocytes, low platelets ( usually < 50)

Answer 170

Parkinson may be complicated by dysphagia and drooling Leading to aspiration pneumonia Do a videofluoroscopy swallow barium Give thickened liquids and modified swallowing techniques

Answer 171

Crystalloids and colloids

Answer 172

NSAIDs( Indomethacin),colchicine, steroids Intraarticular glucocorticoids OR if already on systemic steroids increase the dose

Answer 173

Any 1 factor Coagulopathy: platelets <50,000/mm3, INR >1.5, PTT >2x normal control Mechanical ventilation >48 hours GI bleeding or ulceration in last 12 months Head trauma, spinal cord injury, major burn >2 factors Glucocorticoid therapy >1 week ICU stay Occult GI bleeding >6 days Sepsis

Answer 174

Abscence myenteric plexus in LES-> loss of inhibition so permanent contraction Manometry: Incomplete relaxation in LES and apersitaltic esophagus Dx: barium swallow EGD to rule out malignancy, otherwise normal mucosa Manometry.

Answer 175

```

Colonoscopy every 10 years gFOBT or FIT each year FIT-DNA each 1-3 year CT colonography every 5 years Flexible sigmoidoscopy every 5 years ``` gFOBT:guiac-based fecal occult blood test FIT: fecal immunochemical test FIT-DNA: multitarget stool test

Answer 176

Dx: > 5 It can be assessed through finger stick trst- “ capillary”, but if positive always confirm with a venous sampling. In kids - abdominal X ray to evaluate for lead containing objects or flecks given the exposure

Answer 177

1. In a study comparing treatment A and B against placebo, and they present OR with CI. The confidence intervals did not include 0 which means that the treatments were significantly different from placebo. But now compared A and B we have to se if there is or not overlap 1. If there IS NO OVERLAP— there is a significant difference between the groups 2. If there is OVERLAP, there may or not be statistically difference between the groups.

Answer 178

ESR> 40, SOMETIMES >100 High CRP Normocytic anemia 20% can have normal studie

Answer 179

``` =< 0.9 OR > 1.3 Consult a vascular specialist duplex imaging CT angiography MR angio angiography ``` between 0.9 and 1.3 Exercise test Is abnormal if ABI post-test is decreased by >= 20%

Answer 180

Stop the transfusion aggressively hydrating the patient with normal saline (not Ringer's or dextrose) to treat the hypotension and prevent renal failure.

Answer 181

Evaluate ideation Wish to die, not wake up (passive) Thoughts of killing self (active) Frequency, duration, intensity, controllability Evaluate intent Strength of intent to attempt suicide; ability to control impulsivity Determine how close patient has come to acting on a plan (rehearsal, aborted attempts) Evaluate plan Specific details: Method, time, place, access to means (eg, weapons, pills), preparations (eg, gathering pills, changing will) Lethality of method Likelihood of rescue

Answer 182

Nasopharyngeal laryngoscopy

Answer 183

``` anticholinergics antihistamines baclofen TCAs decongestants CBZ ```

Answer 184

Spinal rotation ≥7 degrees (or ≥5 degrees in overweight children)-->X ray If < 7 --> reassurance differnt to Cobb angle in X ray: ≥10 degrees have scoliosis

Answer 185

poor medical adherence substance abuse ( drugs/alcohol) poor social support cognitive dysfunction Psychosocial factors are as important as medical and surgical to evaluate for organ transplant candidate.

Answer 186

topical antifungals ( selenium sulfide, ketoconazole) topical glucocorticoids topical calcineurin inhibitors ( pimecrolimus) Because is chronic , relapsing disease patients require intermittent re-treatment . eg. topical ketoconazole every 1-2 weeks

Answer 187

Central obesity, facial plethora Proximal muscle weakness, abdominal striae Ecchymosis, amenorrhea/erectile dysfunction Hypertension with adrenal incidentaloma

Answer 188

PAD =< 0.9 First line - Exercise, ASPIRIN, STATIN, HTN & DM modifications second line- if above dont work Cilostazol (selective inhibitor of PDE3) Last: percutaneous revascularization

Answer 189

decrease HR, decrease CO, decrease renin release | - is good in CHF, CAD, Afib

Answer 190

skin growth that occurs in an abnormal location, the middle ear behind the eardrum. It is usually caused by repeated infection that causes an ingrowth of the skin of the eardrum . Cholesteatomas often take the form of a cyst or pouch that sheds layers of old skin that builds up inside the ear.

Answer 191

non structural: slouching ( sitting lazy), no need of treatment easily corrected with position structural: always rule out: spinal infection, fracture, tumor, degeneration special exercises to strengthen and straighten the back; using a back brace or having surgical correction is considered only for chronic pain or significant spinal convexity (>60 degrees)

Answer 192

uncoordinated simulatenous contractions, intermittent chest pain and dysphagia. Manometry : intermittent persistasis , multiple simultaneous contractions.

Answer 193

abrupt onset of fever sore throat malaise absence of upper respiratory symptoms (eg, cough, rhinorrhea, congestion). PE: tonsillar exudates, tender anterior cervical lymphadenopathy, and palatal petechiae.

Answer 194

Raynaud syndrome, ANA, RF, CBC, blood chemistry, urinalysis and measurement of complement levels.

Answer 195

linear: continuous outcome logistic: categorical outcome

Answer 196

SAME AS NORMAL PERSON starting at age 40-50 years (earlier if there are risk factors) per the guidelines.

Answer 197

S. aureus | Group A Strep( pyogenes)

Answer 198

Liver cirrhosis-> portal hypertension—> NO release from splanchnic vasculature—> systemic vasodilation —> decreased of peripheral resistance and BP—> renal hypo perfusion—> activate RAS, sympathetic system and ADH. — worsen volume overload

Answer 199

Echocardiogram acute right ventricular dysfunction, tricuspid annulus dilation, and functional tricuspid valve regurgitation.

Answer 200

Conotruncal abnormalities result from failure of neural crest to migrate

Answer 201

``` hydatiform mole pre-eclampsia anemia operational vaginal delivery postpartum depression ``` D2 Inadequate nutrition and physiologic immaturity

Answer 202

severe thrombocytopenia (platelets <70,000/mm3) or rapidly dropping platelet count (often associated with preeclampsia with severe features). --> risk of spinal epidural hematoma. in this cases intravenous analgesia is an option

Answer 203

tick paralysis meticulous revision of the skin

Answer 204

47 XXY, karyotype gynecomastia and small testes

Answer 205

``` Bradycardia Bronchospasm Insomnia Fatigue may increase TG and decrease HDL Depression sedation may MASK HYPOGLYCEMIC SS IN DM ON INSULIN ```

Answer 206

Esophagoduodenoscopy

Answer 207

1. Deficiency: a. In developing worlds: corn that has not been processed b. in developed countries: alcoholics 2. Carcinoid Syndrome: tryptophan is used to produce 5-OH tryptophan and serotonin rather than Niacin 3. Prolonged consumption of isoniazid: isoniazid decreases pyridoxal phosphate which triggers production of tryptophan. There is no conversion to niacin 4. Hartnup disease: AR , decreased abosrption of tryptophan by intestinal and renal cells. Dx with neutral aa in urine.

Answer 208

SV/EDV normal >=55%

Answer 209

skeletal survey punched-out lytic lesions, diffuse osteopenia, or fractures in nearly 80% of patients. Common sites for lytic lesions include vertebral bodies, skull, thoracic cage, pelvis, and proximal humerus and femur. Other imaging modalities are usually reserved for patients with bone pain and negative initial x-ray skeletal surveys.

Answer 210

Most of the cases is primary- idiopathic Dyspepsia secondary to organic disease — Although there are several organic causes for dyspepsia, the main causes are peptic ulcer disease, gastroesophageal reflux, nonsteroidal anti-inflammatory drug (NSAID)-induced dyspepsia, and gastric malignancy (table 1).

Answer 211

elevations in transaminases > elevation in alkaline phosphatase

Answer 212

Discuss specific benefits/risks of proposed treatment & alternatives Discuss specific risks of refusing treatment Assess decision-making capacity - any physician can assess it, not necessarily a psychiatrist Understands proposed treatment Understands risks of refusing treatment Demonstrates a reasoned basis for leaving against medical advice--The physician should ask the patient to explain the reason for refusing treatment and address any modifiable external influences Discuss follow-up care & option to return to emergency department Notify primary physician, family Document in medical record

Answer 213

GI bleeding, painless RF:aortic stenosis, von Willebrand disease, CKD.

Answer 214

Degeneration of anterior horn cells and motor nuclei of lower brainstem AR

Answer 215

previous suicide attempt

Answer 216

Type I error ( alpha) rejection of the null hypothesis ( false +) — falsely inferring the existence or reality of something that is in fact not real or doesn’t even exist

Answer 217

A: High risk for HF, no structural heart abnormality or ss of HF ( Patients with DM, HTN, cardiotoxic drugs) B. Structural abnormality but no ss ( MI,or valvular disease with Left ventricular enlargement or low EF) C. Structural abnormality with prior or current + SS D. At rest HF or end stage cardiac disease

Answer 218

Increased afterload-->concentric LVH--> decreased LV function. As a result the chamber dilates--> ss and signs of CHF. HTN accelerates atherosclerosis , so high incidence of CAD and PAD

Answer 219

Clinical presentation highly suggestive Arthrocentesis with monosodium urate crystals confirms diagnosis Negatively birefringent, needle-shaped crystals under polarizing light

Answer 220

``` Primary: Klinefelter Secondary: Constitutional delay, malnutrition, chronic illness Hypothyroidism HyperProlactinemia Kallman Sx Craniopharyngioma ```

Answer 221

Give Ca and Vit D supplementation, if just prevention Biphosphonates such as alendronate, are only approved once osteoporosis has established. And treatment would be indicated if DEXA shows T score< 1.5 that continues to rapidly deteriorate.

Answer 222

Poststreptococcal glomerulonephritis | Rheumatic fever

Answer 223

GI stress ulcer ( is not ischemic colitis because it should be hematochezia) ill patients --> uremix toxins, reflux of bile salts into stomach--> alter mucsal layer and risk of ulcer formation. head trauma: increased gastrin secretion--> acid--> risk of ulcer shock: mucosal ischemia leading to ulcerations.

Answer 224

Transthoracic echocardiogram can sometimes make the diagnosis, but it can also miss or inaccurately characterize AAOCA. CT coronary angiography or coronary magnetic resonance angiography provide the best visualization of coronary anatomy, and are the diagnostic tests of choice in patients with suspected AAOCA.

Answer 225

Allocation bias: result from the way subjects are assigned to the treatment and control groups. It may occur when subjects are nonrandomly assigned to the treatment groups of a clinical trial (eg, physicians may preferentially enroll sicker patients into the treatment group). selection bias: study population does not represent the general population

Answer 226

high bilirubin

Answer 227

increased erythropoiesis due to intrauterine hypoxia: Maternal HTN, Smoking, DM; or IUGR Eryhtrocyte transfusion: delayed cord clamp, twin-twin transfusion Genetic or metabolic abnormalities: hypo/hyperthyroidism, genetic trisomies.

Answer 228

Ca channel blockers,

Answer 229

topical corticosteroid

Answer 230

``` rectal exam neuro exam CBC chemestry panel Fasting glucose Lipid profile If hypogonadism or loss of libido -Testosterone, prolactin level, TSH ```

Answer 231

IgG crosses placenta, Antibodies can be transmitted to the baby

Answer 232

``` Tryptophan Phenylalanine Methionine Proline Glycine Isoleucine Alanine Valine Leucine ```

Answer 233

Dronedarone | Amiodarone

Answer 234

MC: Bicuspid aorta | 2nd MC: ASD

Answer 235

radiation tamoxifen use postmenopausal bleeding, uterine growth and irregular

Answer 236

=< 19 years

Answer 237

``` Cerebral aneurysms Hepatic & pancreatic cysts Cardiac valve disorders (mitral valve prolapse, aortic regurgitation) Colonic diverticulosis Ventral & inguinal hernias ```

Answer 238

VAS-> decrease venous return so increases HCM and MVP

Answer 239

confusion, restlessness, tremors, psychosis and AUTONOMIC INSTABILITY ( elevated heart rate, BP and temperature) withdrawal from long or intermediate . peak within days Withdrawal from short ( ATOM- alprazolam, triazolam, oxazepam, mdz) occurs within 24 hrs

Answer 240

Renal doppler US or CT or MRI angiography . BUT RENAL US is preferred in patients with renal insufficiency- due to contrast induced nephropathy.

Answer 241

is regurgitation, can be mitral, tricuspid, aortic

Answer 242

aortic dissection

Answer 243

Hypothyroidism (in the absence of myxedema coma or other severe symptoms) usually only mildly increases the perioperative risk. In life threatening conditions heart disease is better to assume these risks and continue with the surgery as planned

Answer 244

Exercise ECG stress testing is used to evaluate for suspected coronary artery disease; it does not have a role in the evaluation of patients with suspected PH.

Answer 245

Proximal LE>UE + myalgias and muscle tenderness

Answer 246

Postresidual void > 50 men, > 150 women ml urodynamic testing cholinergic agents ( bethanechol), intermittent catheterization

Answer 247

Proximal, UE>LE

Answer 248

spinal lesion can cause paralysis, absent reflexes but SENSATION is likely to be abnormal too. Most common etiologies ( tumor, infection) - progress slowly over days or weeks

Answer 249

F. In infants of diabetic mother, the infant compensates producing insulin.

Answer 250

Age others less important are alcohol, smoking and family hx

Answer 251

measures spine curvature on x-ray and is the gold standard for determining diagnosis and treatment of scoliosis. Cobb angle ≥10 degrees have scoliosis.

Answer 252

Chest X ray( pulmonary edema, cardiomegaly, rule out COPD) ECG Cardiac enzymes to rule out MI Echocardiogram( estimate EF, rule out pericarditis)

Answer 253

``` Kocher criteria for septic arthritis: “WENT" WBCs>12 ESR >40 Non weight bearing T > 38.5 ``` ACUTE PAIN IN SEPTIC ARTHRITIS! Pediatric patients with ≥3 criteria have a high likelihood of septic arthritis (>93%), and immediate joint aspiration is performed to both establish the diagnosis and decompress the joint. Once the diagnosis is confirmed, empiric parenteral antibiotics as well as surgical drainage and debridement of the joint are required.

Answer 254

1. Diastolic Heart failure: HTN leading to left ventricle hypertrophy, restrictive/infiltrative cardiomyopathy, occult CAD 2. Valve disease : Mitral S or R, Aortic S. or R 3. Pericardial disease: constrictive pericarditis, cardiac tamponade 4. High output conditions: Anemia, thyrotoxicosis, beri beri , sepsis, AV fistula

Answer 255

more frequent during the first few months of life peak at 4 months; it is expected to self-resolve by age 12-18 months.

Answer 256

Increased contractility, increased preload ( exercise, overtransfusion, pregnancy, overhydration) Decreased afterload

Answer 257

Besides SOB and CHF associated to all forms of valvular disease: - dysphagia - hoarseness - Afib - Hemoptysis - Opening snap

Answer 258

90 to 120 mL/min/1.73 m2

Answer 259

First try to understand the reasons why he doesnt want to be tested DONT say that if he doesnt this may cause risk to him and partners-- this is judgemental.

Answer 260

Occurs in 1st trimester in kids of moms with pregestational diabetes or chromosomal diseases Presents with cyanosis Often recognized in the second trimester US.

Answer 261

Increased O2 -leads to decreased pulmonary resistance, and decrease in PGs ( due to placental separation)

Answer 262

Exclude CAD, with cardiac testing. -- stress test

Answer 263

Urticaria, flushing, angioedema Within 2-3 hrs of transfusion Caused by recipient IgE antibodies activation

Answer 264

urianalysis ( specific gravidity)

Answer 265

Please Help Edna, Friends Dont Hurt Picornavius Hepadnavirus Flavivirus Deltavirus Hepevirus

Answer 266

Yes, up to 12 weeks after delivery

Answer 267

gout acute inflammatory arthritis affecting the 1st metatarsophalangeal joint or knee.

Answer 268

scoliosis may have a hereditary component, genetic testing is expensive and unnecessary as x-ray determines diagnosis and management.

Answer 269

depression. They can exhibit pseudodementia which is reversible. Before doing a minimental assess for depressive ss.

Answer 270

Endothelin is a potent vasoconstricting hormone that is produced by endothelial cells, and endothelin receptors are abundant in the pulmonary arteries of patients with idiopathic PAH. Endothelin receptor antagonists (eg, bosentan, ambrisentan) --> delayed progression of disease in symptomatic patients with idiopathic PAH.

Answer 271

at least 2 BP readings over a span of 4 or more weeks EXCEPT if the patient presents with moderate-to-severe HTN, inthese patients start treatment ``` To assess end organ damage: Urianalysis K,BUN,Creat Fasting glucose Lipid level ECG ```

Answer 272

NO, discomfort (not significant pain) in the anal area IF significant pain may suggest a different disorder Patients usually develop difficulty with defecation, diarrhea/fecal incontinence, rectal bleeding, and a protruding rectal mass. Symptoms may occur intermittently.

Answer 273

increases the release of factor VIII: von Willebrand factor multimers from endothelium

Answer 274

associated with emotional factors and functional GI disorders.

Answer 275

Stop hormone replacement therapy, substitute for SSRIs( escitalopram) SNRIs and initiate Rivaroxaban

Answer 276

Type II- >=50% platelet count drop from baseline 5-14 days after heparin onset clinically significant due to antibodies against PF4heparin complex to heparin "HIT abs or PF4/Heparin antibodies" Causes THROMBOSIS AND THROMBOCYTOPENIA Necrotic skin lesions at the sites of heparin injection Acute systematic reaction to heparin (anaphylactoid) ``` 4Ts: Thrombosis Thrombocytopenia Timing of the platelet count drop Absence of other causes of thrombocytopenia ```

Answer 277

none resolves by its own, repeat eval postpartum to ensure resolution BUT BECAREFUL BECAUSE THERE ARE CI TO EPIDURAL ANALGESIA IF < 70,000 OR pre-eclampsia

Answer 278

antimuscarinic

Answer 279

when there is non-monosymptomatic enuresis; the patient also refers daytime ss daytime ss= bladder

Answer 280

second and third metacarpophalangeal joints, knees, ankles, and shoulders.

Answer 281

Study it. ``` Order: electrolytes dexamethasone suppression test 24h urine catecholamines metanephrines MVA ``` Surgery if: size >4 cm functional malignant Conservative if none of the above with serial imaging

Answer 282

Antibiotics (especially aminoglycosides) are avoided as they can cause colonic C botulinum to lyse, increasing toxin absorption.

Answer 283

aspirate of the joint - to establish dx and decompress the leg MRI may be used to evaluate the extent of infection prior to surgical debridement. However, ordering an MRI prior to joint aspiration delays treatment as antibiotics are not administered until synovial fluid is obtained.

Answer 284

< 30 years single, rubbery, mobile, well-circumscribed mass in the upper outer breast quadrant. Due to hormonal fluctuation, many patients may experience tenderness a few days prior to menstruation. Tenderness as well as size may improve after menses.

Answer 285

placenta previa, multiple gestation, polyhydramnios, and advanced maternal age (eg, >35).

Answer 286

Occurs in immunosuppressed, usually AIDS Reactivation of polyoma JC virus Neurological deficits including hemiparesis, gait ataxia, visual ss altered mental status

Answer 287

rise in human placental lactogen, a hormone secreted by the placenta that increases fetal glucose supply by inducing maternal insulin resistance. Women with a positive 50-g 1-hour glucose challenge test undergo a subsequent confirmatory 100-g 3-hour glucose tolerance test prior to the diagnosis of gestational diabetes mellitus.

Answer 288

infarction or infection | also anything that leads to dilation

Answer 289

I: Idiopathic PAH : endothelin receptor antagonist (Bosentan), PDE5 inh( Sildenafil), prostanoids ( Epoprostenol) II Due to left heart disease: loop diuretics +ACE/ARB, often b blockers and sometimes aldosterone antagonist III Due to chronic lung disease: O2 and bronchodilators IV Due to thromboembolic occlusion: long term anticoag V: Hematologic processes, metabolic ( glycogen storage), Systemic sarcoidosis

Answer 290

lung cancer, COPD, ASCVD

Answer 291

``` PRETERM BIRTH Gastroschisis Omphalocele low birth weight perinatal death ``` D2 Inadequate nutrition and physiologic immaturity

Answer 292

70,000-150,000 2-3rd trimester hemodilution and o accelerated destruction of platelets

Answer 293

Treatment is often just supportive, meaning that can be done in the OUTPATIENT CLINIC

Answer 294

CT head without contrast If CT negative or equivocal, do an LP

Answer 295

warfarin therapy transiently causes a hypercoagulable state due to rapid declines in protein C levels.

Answer 296

first thing: rigorous blood pressure control with ACEIs. Follow blood pressure & renal function Aggressive control of cardiovascular risk factors, including hypertension End-stage renal disease: Dialysis, renal transplant

Answer 297

S.aureus ( high virulence) | large vegetations in previously normal valves

Answer 298

Hepatic injury ( elevated transaminases) encephalopathy INR > 1.5

Answer 299

Serotonin release assay HIT2: stop all heparin products introduce thrombin inhibitors ( argatroban) or fondaparinux Warfarin is usually started after treatment with a non-heparin anticoagulant and platelet count recovery to > 150,000/µL.

Answer 300

ventricular repolarization T wave inversion may indicate recent MI

Answer 301

Patients age >18 FIRST COUNSELING THEN renal US Genetic testing is not often done, more expensive and often inequivocal.

Answer 302

Increased risk of preterm birth, PROM, preterm labor, chorioamnionitis and post-partum endometritis THERE IS NO RISK OF INTRAUTERINE GROWTH RESTRICTION However treatment has no impact on the incidence of this complications The goal is to relief ss!!

Answer 303

In critically ill patients, early initiation (eg, within 72 hours of ICU admission) is also associated with lower risk of infection. Enteral feeding introduces higher pH tube feeds into the acidic environment of the stomach and may be protective from ulcer formation and bleeding.

Answer 304

heparin ( unfractionate heparin, LMWH) mild, transient drop in platelet count that typically occurs within 2 days of heparin exposure. The platelet nadir is 100,000. Platelet count returns to normal without treatment and continued heparin exposure. It is NOT clinically significant and is NOT associated with thrombosis

Answer 305

Low bone density due to inflammation and osteoporosis/osteopenia can predispose the patient to vertebral fractures Spine fracture leading to injury of the spinal cord Restrictive lung disease

Answer 306

Australia and North West of America ( Washington state) Dermatocentor Andersoni ( Rocky Mountain) and D. Variabilits( American dog tick) Neurotoxins of the tick saliva are transmitted to the host within 4-7 days of being attached

Answer 307

``` Calcitonin CEA ( carcinoembryonic antigen) Neck US( eval regional metastasis) RET mutation gene study Assess for other tumors: parathryroid pheochromocytoma ( plasma free metanephrines, catecholamines and abdominal imaging ```

Answer 308

S.aureus | Tricuspid:

Answer 309

Desmopressin IV- increases release of von-Willebrand factors from endothelium Cryoprecipitate is also an option, but has the risk of infections.

Answer 310

1st LINE: Xanthine oxidase inhibitors ( febuxostat, allopurinol) 2nd line uricosuric agents ( probenecid)

Answer 311

fever, extreme fatigue, exudative pharyngitis or tonsillitis, lymphadenopathy (including posterior cervical nodes) hepatosplenomegaly. Myalgias anorexia (and resulting weight loss), nausea, or vomiting, possibly due to hepatocellular inflammation. Mild palatal petechiae can be present. Atypical lymphocytosis on smear. Positive monospot test

Answer 312

Weight loss Reduce salt intake (2-4 g sodium/day) >=60 and BP<150/90: Non-black: thiazide, ACEI/ARB, CCB, alone or in combination Prehypertension only treat if CKD with or without DM -- ACEI or ARB

Answer 313

antidepressants are safe and effective in treating major depression in patients with CVD bidirectional link between major depression and coronary artery disease, with depression being an independent risk factor for increased morbidity and mortality in cardiovascular disease

Answer 314

Infertility Testicular torsion Inguinal hernia Testicular Ca Surgery before 1 year old optimized potential of fertility and testicular growth Surgical procedure decreases risk of testicular torsion Testicular Ca is decreased but not eliminated after an orchiopexy

Answer 315

tinnitus, and vestibular ss BUT NO HEARING LOSS

Answer 316

males is a QTc above 450 ms; | females, above 470 ms.

Answer 317

Address atherosclerotic RF 1st line: PDE inhibitors (Viagra)- increase cGMP levels --> increase Nitric oxide release--> penile smooth muscle relaxation. taken 30-60min before. Intracavernosal injections of vasoactive agens Vacuum constriction devices testosterone in hypogonadism psychological therapy-reduce anxiety Implants if nothing works

Answer 318

AORTIC ROOT DISEASE: AORTIC REGURGITATION, ANEURYSMAL DILATION OR AORTIC DISSECTION SO ORDER ECHOCARDIOGRAM

Answer 319

scoliosis: lateral S shape of the thoracic and lumbar spine kyphosis: exaggeration of posterior thoracic curvature lordosis: exaggeration of anterior lumbar curvature.

Answer 320

Physicians need to support and encourage the patient to tell the third parties. Physicians are not universally required to disclose the HIV status of patients to involved third parties, but physicians are obliged to report the case to the Department of Public Health

Answer 321

splenic flexure and rectosigmoid area

Answer 322

Purkinje>atria> ventricles>AV node . "PATVAV""

Answer 323

peak volume of oxygen consumption VO2 usually < 14 indicates limited survival and thus favors transplantation

Answer 324

PMR only: low dose oral glucocort( prednisone 10-20mg daily) GCA: intermediate to high dose ( prednisone 20-40 mg/daily) GCA with vision loss: Pulse high dose IV glucocorticoid( methylpred 1000mg/day for 3 days followed by intermediate to high dose oral glucocorticoid).

Answer 325

- ASD secundum type - means that is open with left to right shunt -Pulmonary stenosis

Answer 326

high-flow oxygen through a nonrebreathing mask is generally curative, but patients with severe toxicity may require hyperbaric oxygen.

Answer 327

Sotalol | Dronedarone

Answer 328

athletes who have skin to skin contact, humid environment scaly erythematous pruritic path with centifungal spread and clearing. raised annular borders Firstline/localized : topical clotrimazole, terbinafine Second/extensive oral griseofulvin, terbinafine

Answer 329

continue lithium and add levothyroxine

Answer 330

``` Coxiella Bartonella HACEK Hemophilus Aggregatibacter cardiobacterium eikenella kingella ```

Answer 331

Mitral valve disease, usually mitral valve prolapse with coexisting mitral regurgitation, is the most common valvular abnormality detected in patients with infective endocarditis. - The aortic valve is the second most common cardiac valve involved in IE

Answer 332

Document discussion of consent in the records- even if just verbal. -asking husband to sign is not an option as the discussion is for her health and she is autonomous.

Answer 333

same diagnostic criteria used to diagnose a major depressive episode (>2 weeks of at least 5 of 9 symptoms that include depressed mood plus SIGECAPS: Sleep disturbance loss of Interest, Guilt, low Energy, impaired Concentration, change in Appetite, Psychomotor retardation or agitation, and Suicidal thoughts).

Answer 334

Bowel rest, IV fluids Empiric Abcs Colonic resection if necrosis

Answer 335

Apnea( especially infants < 2 m) Respiratory failure recurrent wheezing throughout childhood Older, full-term, healthy infants and young toddlers typically recover with no complications.

Answer 336

SA>AV> bundle of his/purkinje/ventricles

Answer 337

Mild fever & hemolytic anemia Within 2-10 days after transfusion Positive direct Coombs test, positive new antibody screen Caused by anamnestic antibody response

Answer 338

liver sarcoidosis - occurs in 50-65% of pts

Answer 339

In patients who have ACE inhibitors within minutes Due to bradykinin in blood products . ( normally degraded by ACE)

Answer 340

AntiHbs Anti Hbe Anti Hbc IgG

Answer 341

Riluzole glutamate inhibitor

Answer 342

Topical or intralesional corticosteroids : promotes hair growth. After a steroid injection, new hair growth is usually seen in the next four to six weeks. Education:(1) the disease is usually benign, (2) they can have multiple relapses in spite of treatment, and (3) most patients have normal hair growth within the next one to two years even without treatment.

Answer 343

Hb surface antigen + Hbe antigen + Anti bodyHb core IgM

Answer 344

Dx: Bone marrow biopsy shows >=10% plasma cells Then a skeletal survey should be done to assess the extent of bone involvement and risk fractures

Answer 345

a: atrial contraction against closed tricuspid c: RV contraction, bulging a little into RA x: atrial relaxation v: atrial "villing"--filling y: atrial emptYing

Answer 346

Glucagonoma Starts as a erythematous papule or plaque involving face, perineum or extremities Then over 7-14 days lesions enlarge and central clearing occur. The center is bronzed colored induratied and the borders with blisters, scaly, and crusting. Areas are painful and pruritic Can also occur in mucous membranes- cheilitis, stomatitis, blepharitis.

Answer 347

Aggressive IV fluids- 30 mL/KG of crystalloids given over the first 3 hours of treatment in 500 mL bolus Broad spectrum Abcs within 1 hour of arrival ie. vanco +cefepime ideally blood cultures should be done before abcs.

Answer 348

``` Industrial exposure( mines) Combustion of wool and silk Nitroprussiate ( chronic renal failure, or prolonged or high dose infusions) ```

Answer 349

Prior intracranial hemorrhage (ICH) Known structural cerebral vascular lesion Known malignant intracranial neoplasm Ischemic stroke within 3 months Suspected aortic dissection Active bleeding or bleeding diathesis (excluding menses) Significant closed head trauma or facial trauma within 3 months Intracranial or intraspinal surgery within 2 months Severe uncontrolled hypertension (unresponsive to emergency therapy) For streptokinase, prior treatment within the previous 6 months

Answer 350

LIBMAN- lupus ( both sides of the mitral valve) hypercoagulable state 2ary to malignancy

Answer 351

Familial short stature:----(CD) parents height is short Birth lenght: low-normal to normal --- CD:normal Growth (0-2 years): normal------ delayed Growth ( 2 years to puberty): normal -----delayed Bone age: normal -----delayed timing to puberty: normal-----delayed pubertal growth: rate low-normal--- delayed Adult height: short----normal

Answer 352

incision and drainage. Abcs for patients with DM, immunosuppression, extensive cellulitis, or valvular heart disease.

Answer 353

minimize fluid intake before bedtime restrict sugary/caffeine before sleep Institute a reward system( ie. gold star chart)

Answer 354

fever, fatigue, myalgias, and hepatosplenomegaly weeks after exposure to infection. anemia and thrombocytopenia classically causes cyclical fevers ring forms on the blood smear.

Answer 355

pulmonary arterial pressure >=25 (Normal <20)

Answer 356

" apathetic hyperthyroidism" -- lethargy, apathy, weight loss, myopathy. Thyrotoxicosis may already cause Afib, HF. but because the patient may be on medications signs as tachycardica may not be present. Afib different from normal may present needing escalating doses

Answer 357

deep fibular nerve

Answer 358

Usually self-limited. If patient with symptoms give HIGH DOSE ASPIRIN ( 650 mg TID) -these dont interfere with myocardial healing If persistent: Colchicine, oxycodone Avoid NSAIDS and glucocorticoids because these interfere with myocardial healing and increase risk of free wall rupture or ventricular rupture.

Answer 359

Upper 2/3rds is squamous cellular- often associated to alcohol, tobacco Lower third- Adenocarcinoma- associated to Barret esophagus or GERD. , obesity Endoscopy with biopsy

Answer 360

scaly patch on scalp hair loss with residual black dot predominant in African Americans Manage: KOH exam to document spores TTO: Oral griseofulvin

Answer 361

Although this contagious disease can be spread via shared razors, examination reveals a scattered folliculitis with erythematous papules and pustules,

Answer 362

Presents with constipation, drooling, CN - oculobulbar ss more often ( ptosis bilateral), descending flaccid paralysis Treatment Botulism immunoglobulin.

Answer 363

is better to change to another stimulant. No taper or washout period is needed. The patient can initiate ASAP -- ADJUVANT behavioral therapy is not helpful

Answer 364

low-molecular-weight heparin (LMWH) is considered more efficacious than factor Xa inhibitors.

Answer 365

reassurance ( is not a serious condition) ``` weight loss (in obese patients) avoidance of tight-fitting garments to reduce the pressure on the nerve entrapment area. ```

Answer 366

removal of tick and supportive care

Answer 367

Hypertrophic cardiomyopathy

Answer 368

constrictive pericarditis

Answer 369

Hormone replacement therapy SSRIs ( escitalopram) SNRIs ( venlafaxine)

Answer 370

mid-systolic ejection murmur in R upper sternum- flow passing through the pulmonic valve mid-diastolic rumble- flow passing through tricuspid valve

Answer 371

Chronic ppx, usually > 5 years, weight loss

Answer 372

Unknown | Possibly autoimmune: T-cell infiltration around the hair follicles and the association of other autoimmune conditions

Answer 373

A & E, means they dont have envelope | Not destroyed in the gut

Answer 374

delta wave shorter PR widened QRS

Answer 375

* Immediate risks include DVT, and hospital-acquired infections * Long term risks :fetal loss, pre-eclampsia, gestational diabetes, gestionational HTN. Survival and End stage renal disease rates are similar to those non-donors.

Answer 376

Fever, flank pain, hemoglobinuria & DIC Within 1 hour of transfusion Positive direct coombs test , pink plasma Caused by ABO incompatibility

Answer 377

VSD Can be heard in adult patients. Small restrictive VSDs are associated with a louder murmur, but large nonrestrictive VSDs have a softer and early systolic murmur.

Answer 378

``` Systemic glucocorticoids (prednisone) PLUS antifungal ( Itraconazole/Voriconazole) *fluconazole has limited activity against Aspergillus --not used ``` In some cases Omalizumab ( monoclonal Ab against IgE- may be helpful)

Answer 379

Clinical | Confirmation of Stool C. botulism

Answer 380

ascending paralysis and absent reflexes develops over DAYS OR WEEKS Follows a GI or UR infection

Answer 381

Pulmonary valve stenosis

Answer 382

Most patients are asymptomatic Hematuria Flank pain (nephrolithiasis, infection, cyst rupture, hemorrhage) Clinical signs Hypertension Palpable abdominal masses (usually bilateral) Proteinuria Chronic kidney disease

Answer 383

RV hypertrophy | tricuspid stenosis

Answer 384

Extreme manisfestation of alcohol withdrawal - develops within 1 week of last alcohol~2-4 days - tactile hallucinations, visual hallucinations, confusion, sweating , increased tachycardia, elevated BP - tto bzd

Answer 385

LSH--> increase venous return In inspiration all right sided are increased In expiration all left sided except the HCM and MVP

Answer 386

1. Cardiogenic shock requiring CONTINUOUS inotropic support or use of devices/pumps to maintain perfusion adequate 2. IV Heart failure with ss intractable to medical and surgical ( including devices) therapy 3. Intractable or severe angina ss in pts with coronary artery disease not ameanable to percutaneous tto or surgery 4. Intractable life-threatening arrhythmias

Answer 387

Treatment: MILD ( 5-44):No treatment, but followup with venous sampling in one month MODERATE ( 45-69): DMSA, SUCCIMER SEVERE>=70: Dimercaprol PLUS EDTA

Answer 388

Steinberg Classification Stage Radiographs MRI Images 0 normal normal MRI and bone scan I normal abnormal MRI and/or bone scan II cystic or sclerosis changes abnormal MRI and/or bone scan III crescent sign (subchondral collapse) abnormal MRI and/or bone scan IV flattening of femoral head abnormal MRI and/or bone scan V narrowing of joint abnormal MRI and/or bone scan VI advanced degenerative changes abnormal MRI and/or bone scan

Answer 389

impairment of any or all functions of the gonads including production of testostore and sperm in men, prog and estradiol Primary: high LH& FSH Secondary hypogonadotrophic hypogonadism

Answer 390

Peritonsillar abscess Cervical lymphadenitis Rheumatic Fever Poststrep glomerulonephritis

Answer 391

There is no definitive treatment Acute episode: Vestibular suppressants include: benzodiazepines, which have the advantage of anxiolytic properties for short-term use antihistamines (meclizine and dimenhydrinate) anticholinergics (scopolamine). Promethazine and prochlorperazine if vomiting/nausea associated Long-term: Diuretics ( HCTZ, triamterene) Betahistine ( vasodilator reported to improve microvascular circulation). Interventional: intratympanic gentamicin injection, surgical labyrinthectomy, and vestibular nerve section.

Answer 392

Start heparin IV until therapeutic INR is reached with warfarin. This case cant be considered anticoagulation failure and therefore the IVC filter is not first option

Answer 393

Autoimmune hemolytic anemia and thrombocytopenia ( cross-reactivity of EBV induced antibodies against RBCs and platelets) -2-3 weeks after disease onset Splenic rupture ( not infarction) as a result of trauma ( highest risk within 3 weeks

Answer 394

high dose corticosteroids

Answer 395

Spontaneous resolution independent of the clinical severity. as insulin levels normalize.

Answer 396

a skeletal survey may be performed first.

Answer 397

if associated to celiac, gluten free diet.

Answer 398

``` Anemia Macrocytic( MC)- due to folate def Microcytic -due to GI bleeding LFTS-increased GGT, AST-ALT ratio>2:1 HyperTRG HyperUricemia, hypocalcemia Thiamine def Decreased testosterone level ```

Answer 399

Publication bias

Answer 400

Stimulant doses are typically titrated up on a weekly basis until there is no room for improvement, maximum dose limits are reached, or the patient experiences intolerable side effects. Response to a stimulant can usually be determined within weeks

Answer 401

S.aureus, pseudomona, candida

Answer 402

Naproxen + Colchicine

Answer 403

Rivaroxaban: oral, onset of action 2-4 hours, no need of bridge or monitoring. Should be given for >3 months (3-6 m) in patients with DVT or PE who do not have cancer. Warfarin : 5-7 days for onset. Need to bridge with UFH or LMWH for 5 days. monitoring with INR ( goal is 2-3) and PT

Answer 404

``` I: Idiopathic PAH II Due to left heart disease III Due to chronic lung disease IV Due to thromboembolic occlusion V: Hematologic processes, metabolic ( glycogen storage), Systemic sarcoidosis ```

Answer 405

Rapid and severe rise in BP --> increased cerebral perfusion pressure, --> cerebral edema and hypertensive encephalopathy. insidious onset of headaches, nausea, and vomiting; this can progress to restlessness, confusion, agitation, seizures, and coma. BP HAS TO BE HIGH AT THIS TIME.

Answer 406

Clostridium difficile infection (CDI) and pneumonia.

Answer 407

Fever Tender anterior cervical LAD Tonsillar exudates Absenc of cough 0-1: no testing/treatment 2-3: Rapid strept test 4: empiric oral penicillin or amoxicillin

Answer 408

For breast Ca Decreases osteoporosis in menopause EA: hot flashes, increased

Answer 409

several disease interventions are compared and one of the interventions diagnoses the disease earlier than the others without an effect on the outcome (eg, survival). This would make it appear that the intervention prolonged survival whereas in actuality it only diagnosed the disease sooner.

Answer 410

Obstructive lung disease, hear block, depression

Answer 411

increased respiratory complications respiratory acidosis hypercapnia, hypoxemia hypoventilation ( Xray with atelectasis)

Answer 412

anal fistula- require surgical intervention

Answer 413

family history of intracranial bleed | previous intracranial bleed

Answer 414

S.aureus Group B strep ( S. agalactiae) Gram negative bacilli

Answer 415

Detorsion within 6 hours- viability | After 24 hrs rarely salvageable

Answer 416

Medical - can be reduce with digital pressure * no full thickness prolapse ( just mucosal prolapse) * adequate fiber and fluid intake * pelvic floor m. exercises * Possible biofeedback for fecal incontinence Surgical full thicjness prolapse or sensation of prolapse fecal incontinence and or constipation

Answer 417

Ocular motility, sensory, bowel, bladder, and cognitive functions are preserved,

Answer 418

```

1st trimester: congenital heart disease neural tube defects small left colon syndrome abortion ``` 2-3 trimester ( hyperglycemia and hyperinsulinism) 1. Increased metabolic demand--> fetal hypoxia--> polycythemia 2. Organomegaly 3. neonatal hypoglycemia 4 macrosomy-> shoulder dystocia -> clavicle fracture, vascular plexopathy, perinatal asphyxia 5. increased glycogen--> accumulates with fat in interventricular septum --> hypertrophic cardiomyopathy that can lead to heart failure.

Answer 419

- catecholamines - increased intracellular Ca - Decrease extracellular Na - Digitalis -- block Na/K ATPase --> increase intracellular Na--> alter Na/Ca channel so no Ca is taken out of the cell)

Answer 420

pseudogout | hemochromatosis

Answer 421

duodenal ulcer

Answer 422

Physicians need to support and encourage the patient to tell the third parties. Physicians are obliged to report the case to the Department of Public Health

Answer 423

Post-streptococcal glomerulonephritis typically occurs 1-3 weeks after either a cutaneous or pharyngeal streptococcal infection. Antibiotics are effective for primary prevention of rheumatic fever, but unclear for glomerulonephritis

Answer 424

PHYSIOLOGIC pattern in which apnea occurs for 5-10 seconds followed by rapid shallow breaths. Without stimulation or intervention , a regular rhythm of breathing resumes after several cycles

Answer 425

FSH, LH, testosteron, Prolactin, TSH

Answer 426

``` Infectious mononucleosis (25% false-negative during the first week of illness) ```

Answer 427

Is one of the transfusion reactions that cause hypotension IgA deficient persons Hypotension, dyspnea, bronchospasm, respiratory arrest shock Epinephrine future WASHED transfusion

Answer 428

If a patient has a suspected structural lesion in the upper esophagus is better to ask for a nasopharyngeal laryngoscopy which is less invasive than the esophagoduodenoscopy. Videofluoroscopy with barium swallow is more useful in NM studies, than structural lesions.

Answer 429

calcified or uncompressible vessels additional studies required.

Answer 430

Neonatal polycythemia Repeat the measurement but in peropheral venous blood which is more reliable, less susceptible to changes in T and blood flow

Answer 431

``` MediaN umbilical lig Ligamentum arteriosum Lig venosum fossa ovalis Nucleus pulposus ```

Answer 432

SSRIs, SNRIs

Answer 433

Stress( cough, valsalva): Q TIP test angle >=30 from the horizontal indicates hypermobility positive bladder stress test (ie, leakage of urine with cough on examination). - lifestyle mod - pelvic floor exercises ( Kegel) - Pelvic floor surgery - sling

Answer 434

hyperintense lesions in the brain and/or spinal cord on T2-weighted images. Ovoid-shaped periventricular white matter lesions can be seen in 23%-75% of patients. MRI is superior to CT in evaluating posterior fossa/cerebellar abnormalities and is more sensitive/specific in detecting MS lesions

Answer 435

Penicillin 10 days Decreased symptom severity and duration Prevention of spread to close contacts Prevention of suppurative complications (eg, peritonsillar abscess, cervical lymphadenitis) Prevention of acute rheumatic fever

Answer 436

Systemic fungi Eastern US and Central America Pneumonia, verrucous lesions , bone Broad base budding If local: itraconazole/fluconazole If systemic: amphotericin b

Answer 437

CT scan: Colonic wall thickening, fat stranding | Endoscopy: Edematous & friable mucosa

Answer 438

first trimester: neural tube defects due to the folate antagonist properties of trimethoprim. third trimester: neonatal kernicterus.

Answer 439

1% < 5% - the risk of progression from acute to chronic decreases with age. Perinatal 90%, 1-5 years 10-20%, and adults < 5%

Answer 440

the number of patients that need to be treated in order to prevent or cure one disease or medical condition. Is also a measure of efficacy of a given therapy. NNT= 1/Absolute attributable risk ARR= difference of risk

Answer 441

1. IgA deficiency 2. complement dependent autoimmune hemolytic anemia 3. continued allergic reactions

Answer 442

modest increase in cesarean section and assisted delivery (eg, vacuum, forceps) rates compared to those without MS. Treatment: OK to give corticosteroids in MS exacerbations during pregnancy OK to give disease modifyin drugs in long term EXCEPT eriflunomide and mitoxantrone ( are teratogenic) pregnant women with MS usually have lower disease activity during pregnancy and higher disease activity in the postpartum period.

Answer 443

decreased concentration of hydrogen peroxide lactobacillus leading to increased vaginal pH - hormonal changes( i.e pregnancy) - menses - sexual activity - abc use - douching

Answer 444

Mechanical obstruction If RF for Ca: Barium swallow followed by possible Endoscopy If no EF: Upper endoscopy

Answer 445

``` ABCCCD Alcohol Wet Beri Beri Coxsackie Cocaine Chagas Doxorubicin ``` ISCHEMIC CARDIOMYOPATHY ( CAD) hemochromatosis pregnancy in third trimester sarcoidosis

Answer 446

Transient tachypnea of the newborn Often presents at birth or within 2 hours post-delivery, and usually resolves within 24 hours. Severe cases may last up to 72 hours.

Answer 447

Sacroiliac Xray, NOT HLA B27 TESTING

Answer 448

Treatment third generation cephalosporins ( cefotaxime) Clinically should improve within 24-78 hrs, and so repeat by the 3rd day the paracentesis Prophylaxis with fluoroquinolone

Answer 449

adhesions and inflammation

Answer 450

In the following patients we would consider treatment- pts with severe or protracted course: * Patients who develop coagulopathy- INR> 1.5 * Persistent ss or marked jaundice ( bilirrubin > 10) for more than 4 weeks of initial ss * immunosuppression * concommitant hep C Ttto: * Is often either TENOFOVIR OR ENTECAVIR as monotherapy- although there are options these are the preferred. * And treatment can be stopped once HBsAg is cleared - 2 tests with 4 weeks difference

Answer 451

Catheter ablation

Answer 452

Three main nerves: tibial ( heel, S1,S2), 4TH 5TH fingers toe with their corresponding planter region is the lateral plantar ( S1,S2), medial plantar (L4,L5)

Answer 453

superficial skin infection but presents with well-demarcated, bright red erythema, classically on the cheeks.

Answer 454

midodrine, octeotride, NE

Answer 455

Amantadine Sleep hygiene Stimulants( methylphenidate, modafinil)

Answer 456

aortic regurgitation and mitral valve prolapse.

Answer 457

nocturnal urinary incontinence in ≥ 5 years | Has never achieved drytime period

Answer 458

Interstitial lung disease Dysphagia Myocarditis Maligancy

Answer 459

May appear at any point of the disease ( even with normal CD4 count) Presents with thrombocytopenia ( < 5% present with < 50,000) . and can have splenomegaly USUALLY doesnt present with bleeding tto: Antiretroviral therapy If patient is bleeding possible treatments include steroids, immune therapy or splenectomy but all have a risk

Answer 460

True decreased urea excretion

Answer 461

Paroxysmal supraventricular arrythmia

Answer 462

Timing voiding Fluid restriction < 2 L/day Anticholinergic ( oxybutinin, tolteridone)

Answer 463

1. Ductus venosus: shunt oxygenated blood from umbilical vein to IVC without passing through liver ( portal circulation) 2. Foramen ovale: sends oxygenated blood coming from the IVC into aorta to supply head and body 3. Ductus arteriosus: deoxygenated blood from SVC passes through the RA-->RV--> main pulmonary artery--> descending aorta. Shunt is due to high fetal pulmonary artery resistance ( due to low fetal O2)

Answer 464

In pre-school age (3-5) the preferred initial treatment is behavioral therapy In >= 6 years the preferred treatment is medication

Answer 465

> 50years old

Answer 466

Yes, hepatitis B immune globulin and hepatitis B vaccine should be administered to all household and sexual contacts who are not known to be immune.

Answer 467

C- HyperCalcemia can be asymptomatic or symptomatic( anorexia, nausea, polyuria, constipation, weakness) TTO: hydration, dexamethasone ( mild), biphosphonates( severe) R- light chain cast nephropaty or deposition disease May require plasmapheresis or dyalsis Anemia- due to kidney damage Bone lesions/fractures- biphosphonates for prevention Hyperviscosity syndrome- nasal or oral bleeding, blurry vision, near ss ( confusion, headache) , heart failure Plasmapheresis for symptomatic patients Thrombosis - risk of arterial ( MI, STROKE) and venous thrombosis

Answer 468

Resistant HTN ( uncontrolled despite treatment of 3 medications, including one diuretic at maximum dose) Malignant HTN Onset of severe HTN (> 180/120) after the age > 55 Severe HTN with diffuse atherosclerosis Recurrent flash pulmonary edema PE: Asymmetric renal size > 1.5 cm Abdominal bruit Unexplained rise in serum creatinine ( > 30%) after starting ACEi or ARBs Imaging: unexplained atrophic kidney

Answer 469

ECG (LVH) TTE ( if unclear --> left heart catheterization) Tto: Diuretics Valve replacement - ballon is not routinely done due to calcification

Answer 470

MRI sensitivity 90% Osteomyelitis-related bone changes are present on MRI <5 days after infection onset; therefore, patients with symptoms for >1 week and a negative MRI are considered "ruled out" for osteomyelitis. CT scans are useful in the diagnosis of osteomyelitis in patients who have contraindications (eg, pacemaker) to MRI.

Answer 471

osteonecrosis of femoral head order MRI

Answer 472

unstable angina/ACS

Answer 473

throat culture (preferred) or rapid antigen testing prior to initiation of antibiotics.

Answer 474

chronic hypercalcemia, hypothyroidism, hemochromatosis

Answer 475

Pulmonary edema due to Pre-eclampsia, so look for other signs ( HTN, Clonus) Peripartum cardiomyopathy ( S3, JVP)

Answer 476

inhibit presynaptic release of ACH

Answer 477

Preterm birth <29 weeks gestation Chronic lung disease of prematurity Hemodynamically significant congenital heart disease

Answer 478

unexpected event causing or putting at risk of death or serious injury.

Answer 479

Hyperviscosity syndrome Plasmapheresis

Answer 480

A soft, single second heart sound (S2) A delayed and diminished carotid pulse ("parvus et tardus") Loud and late-peaking systolic murmur

Answer 481

Systemic glucocorticoids followed immunosuppressant therapy: methotrexate, azathioprine

Answer 482

carotid doppler

Answer 483

Right coronary artery Infarcts may cause nodal dysfunction - arrythmias, bradycardia.

Answer 484

Patients with coronary artery disease are at risk of myocardial ischemia when levothyroxine is first started and the medication should be started very slowly in these patients.

Answer 485

Type I hypersensitivity. Allergy to protein plasma components. Urticaria, hives, wheezing, fever Tx: anti-histamines

Answer 486

Rapid onset of shock, angioedema, urticaria, respiratory distress Within few seconds to minutes Caused by recipient anti IgA antibodies

Answer 487

Decreased bone mass/quality leading to bone fragility and fracture risk . < 2.5 SD Mechanism: failure to attain optimal peak bone mass before age 30, or rate of bone resorption excees rate of bone formation after peak bone mass has been attained.

Answer 488

IV corticosteroids as oral corticosteroids are associated with an increased risk of recurrent optic neuritis Plasmapheresis should be considered in glucocorticoid-refractory patients

Answer 489

tRUE, | and hepatosplenomegaly

Answer 490

Vascular OR. Alzheimer Dementia This is in contrast to those persons who had major depressive disorder in their earlier yeats. Depression is often comorbid with anxiety; however, late-onset depression is not a known risk factor for future development of generalized anxiety disorder.

Answer 491

Suspect in patients with cirrhosis, patients who had peritoneal dialysis or that had a paracentesis for another reason. Presents with fever Abdominal pain/tenderness Altered mental status ( abnormal connect the number test) Hypotension, hypothermia, paralytic blues

Answer 492

History of chronic, severe, poorly controlled hypertension systolic blood pressure >180 mm Hg or diastolic blood pressure >110 mm Hg Traumatic or prolonged (>10 minutes) cardiopulmonary resuscitation (CPR) or major surgery less than 3 weeks previously History of prior ischemic stroke not within the last 3 months Dementia Recent (within 2-4 weeks) internal bleeding Noncompressible vascular punctures Pregnancy Active peptic ulcer Current use of an anticoagulant (eg, warfarin sodium) that has produced an elevated international normalized ratio (INR) higher than 1.7 or a prothrombin time (PT) longer than 15 seconds

Answer 493

complication of GERD that can cause obstructive dysphagia. difficulty swallowing solid food, prolonged and careful chewing, and swallowing small portions. Need to drink more fluids with foods no weight loss, no difficulty drinking fluids.

Answer 494

Macrolides ( Azithromycin)

Answer 495

Amiodarone | Dofetilide

Answer 496

Clinical presentation: QUICK PROGRESSION- OVER HOURS -DAYS Prodrome of fatigue and paresthesias Ataxia, frequent falls, ascending paralysis Absent reflexes no fever SENSATION NORMAL Labs and imaging are normal the toxin produced by Dermacentor ticks may interrupt sodium flux across axonal membranes in selected locations such as the nodes of Ranvier and nerve terminals [15]. This in turn may result in weakness through impairment of neural transmission to motor nerve terminals

Answer 497

Echo CXR ( cardiomegaly in some patients) Tto: Vasodilators: ACEIs and ARBs the best Digoxin or diuretics Valve replacement if heart starts to dilate. ( EF =< 60%)

Answer 498

Iron deposition in tissues HFE gene mutations, but not everyone who has it will develop clinical ss. Severity depends on the extent of iron overload. Ss of iron overload are rare in younger. Ss in men commonly >= 40 Ss in women are later due to menses. Patients have non-specific ss ( fatigue, lethargy, apathy) Iron deposition: In the liver first because blood containing iron absorbed by the GI passes first through the liver, so it is rare to see cardiac or endocrine manifestations without liver being involved. Hepatic: hepatomegaly, increased transaminases, hepatic fibrosis ( may progress to cirrhosis) and Hepatocellular carcinoma Cardiac: dilated cardiomyopathy, heart failure, diastolic dysfunction. Conduction disturbances, sinus node dysfunction, arrhythmias. Endocrine organs: DM, it looks like iron has an affinity to beta cells ( insulin cells) rather than the alpha ( glucagon cells). Hypothyroidism, hypopituitarism, hypogonadism. CNS ARTHROPATHY- may present very similar in terms of morning stiffness, improving as day passes by, meta arpophalages as RA. THE RADIOGRAPHIC FINDINGS ARE ALMOST INDISTINGUISHABLE FROM THE CALCIUM PYROPHOSPHATE . —- rhomboid shape and positive birefringence under polarized light. RX shows findings very similar to pseudogout- narrowing og the joint space, particularly the 2nd and 3rd MCP, along with subchondral sclerosis, curved osteophytes cysts, and osteopenia.

Answer 499

Absence or failure of complete development of secondary sexual characteristics In girls: breasts by 12 yo In boys: testes >=4mL by 14 years old

Answer 500

``` beta blocker, angiotensin-converting enzyme (ACE) inhibitor, aldosterone antagonist, and diuretics. isosorbide dinitrate (along with hydralazine) ``` check image

Answer 501

Clostridium botulinum descending paralysis starting with cranial nerves Afebrile

Answer 502

Normal 120/80 Pre-HTN 140/90 Stage I 140-159/90-99 Stage II 160/100 ``` Urgency --> >=180/100 Emergency: Brain ( cerebral hemorrhage, hypertensive encephalopathy) Hemorragues or exudates, papilledema Aortic dissection Renal failure ```

Answer 503

Fever & chills Within 1-6 hours of transfusion Caused by cytokine accumulation during blood storage

Answer 504

ACEIs- [rptectove effect for kidney

Answer 505

Stress( cough, valsalva): Q TIP test angle >=30 from the horizontal indicates hypermobility - lifestyle mod - pelvic floor exercises ( Kegel) - Pelvic floor surgery - sling Urge ( detrusor hyperactivity) - lifestyle modifications ( timevoids and bladder training- establish a baseline interval and gradually increase time between voids- eventually 3-4 hrs Overflow: cholinergic agents ( bethanecol), intermittent catetherization

Answer 506

Aspergillus-specific IgE | Allergy skin testing for Aspergillus

Answer 507

Due to recurrent central apnea due to immaturity of the CNS in infants up to age 6 months

Answer 508

3 of the following: Homogeneous vaginal discharge( thin, malodorous) ph> 4.5 Amine odor after the application of potassium hydroxide Clue cells ( stippled appearance)

Answer 509

pregnancy test

Answer 510

Skin: flushing ( early), cyanosis ( later) CNS: headache, altered mental status, seizures, coma Heart: Arrhythmias Resp: tachypnea initially, then respiratory depression, pulmonary edema GI: abdominal pain, nausea, vomiting Renal metabolic acidosis ( lactic acidosis), renal failure

Answer 511

Gastrointestinal: nausea, vomiting, diarrhea, cramping, ↑ bowel sounds Cardiac:↑ pulse, ↑ blood pressure, diaphoresis Psychological: insomnia, yawning, dysphoric mood Other: myalgias, arthralgias, lacrimation, rhinorrhea, piloerection, mydriasis

Answer 512

Dx: Clinical and cultures and aspirate are often requested Two: 3-6 months of itraconazole

Answer 513

cardiac tamponade

Answer 514

Normal clearing of fetal lung fluid starts during late gestation and continues through birth and post-delivery. Normally in late gestation the increase of catecholamines and hormones lead to stop secretion of chloride and fluids into the alveoli. And instead lead to increase reabsorption of Na and fluid , the former through AQP5 channels. But in the delayed reabsorption of fetal fluid the fluid accumulates within the alveoli, there is increased permeability and fluid goes to interstitium—> pools in the perivascular tissues and interlobar fissures until it is eventually cleared by lympathics or absorbed into small blood vessels. —( In the RX: you see the fissures of the lung) Excess fluid also leads to decreased lung compliance —increased breath work— tachypnea to compensate. The poor ventilated alveoli leads to hypoxemia and eventually hypercapnia.

Answer 515

cyanide binds to cytochrome oxidase inhibiting mitochondrial oxidative phosphorilase--> decrease ATP, anaerobic metabolism, lactic acidosis.

Answer 516

Interstitial lung disease Myocarditis Malignancy

Answer 517

commonly occurs due to nonocclusive disease in the setting of underlying atherosclerosis and a state of low blood flow. abdominal pain, bloody diarrhea, and fecal urgency as well as leukocytosis, lactic acidosis, and colonic distension or pneumatosis shown on abdominal x-rays.

Answer 518

Normochromic anemia Elevated ESR and CRP Temporal artery biopsy

Answer 519

Type II error ( beta)- failure to reject the null hypothesis ( false negative) — falsely infer the absence or non-existence of something that in fact is real or does exist.

Answer 520

plasma glucose value of ≤40 mg /dL (2.22 mM) at any age (except during the first 48 to 72 hours of life). In newborns, a plasma glucose value of ≤50 mg/dL is an appropriate threshold to distinguish infants who warrant further diagnostic testing. In

Answer 521

3/5: Age > =50 New-onset localized headache with fever and visual disturbances ESR>50 Tenderness or decreased pulse of the temporal artery Temporal artery biopsy showing necrotizing arteritis with mainly mononuclear cells.

Answer 522

UNIQUE! Ballon valvuloplasty because is rheumatic heart disease not calcium deposition Diuretics, NA restriction

Answer 523

Classic Typical location (eg, substernal), quality & duration Provoked by exercise or emotional stress Relieved by rest or nitroglycerin Atypical 2 of the 3 characteristics of classic angina Nonanginal <2 of the 3 characteristics of classic angina

Answer 524

0-24 HF, arrythmias, cardiogenic shock 1-3 ( neutrophils)- PIP 4-7 ( macrophages) - rupture of free wall, interventricular septum months - Ventricular aneurysm, dressler syndrome,

Answer 525

Monoclonal plasma cell cancer IgG( 55%), IgA (25%) > 40-50s CRAB: hypercalcemia, renal insufficiency, anemia ( normocytic), bone lytic lesions/back pain. ``` There is increased risk for infections Primary amyloidosis Punched out lytic bone lesions on Xray Rouleaux formation M SPIKE ON SERUM PROTEIN ELECTROPHORESIS Bence Jones proteins ( Ig light chains in urine) ```

Answer 526

``` systemic lupus erythematosus (SLE)/ antiphospholipid antibody syndrome,, sickle cell disease, chronic renal insufficiency and hemodialysis, trauma, Gaucher's disease, HIV infection, following renal transplantation Caisson's disease. ``` USE OF GLUCOCORTICOIDS (more than 15 to 20 mg/day). ALCOHOL

Answer 527

rv infarct

Answer 528

Bacteria, anaerobe. Is part of the normal oral, GI and reproductive flora Causes OROFACIAL abscesses that drain through sinus tracts— yellow sulfur granules Slow growing nontnder mass that eventually evolve into multiple abscesses Tto penicillin

Answer 529

low back pain, improves with exercise worsens at rest and at night Limited chest expansion and spinal mobility--> restrictive pattern Acute anterior uveitis Hip and buttocks pain. Enthesitis

Answer 530

selective serotonin reuptake inhibitors (SSRIs) (eg, escitalopram) or serotonin-norepinephrine reuptake inhibitors (eg, venlafaxine). exact mechanism for how these medications improve hot flashes is currently unknown, 50%-70% of women who receive this therapy have a reduction in symptoms.

Answer 531

replacement is the definite tto ACE/ARBS or nifedipine ( vasodilators will increase forward flow of blood and delay progression) Loop

Answer 532

measure of excess risk and estimates the proportion of disease among exposed subjects that is attributed to exposure status. (RR-1)/RR

Answer 533

Physicians ATTENDING conferences cannot accept subsidies from industry for travel costs, lodging, or other personal expenses. However, it is permissible for faculty physician LECTURERS to accept reasonable honoraria and/or reimbursement for reasonable travel expenses. LECTURERS MUST FULLY DISCLOSE the name of the company, his/her participation in company-funded research projects, and the nature of financial ties to the company.

Answer 534

Patients with clinically significant ASCVD risk ( ACS, stable angina, CABG, stroke, TIA, PAD) =< 75 high intensity statin > 75 moderate LDL >= 190 - high intensity 40-75 DM If 10 year risk >=7.5 . high intensity If 10 year risk <7.5 moderate intensity Estimated ASCVD >= 7.5 MODERATE TO HIGH

Answer 535

D5W (5% dextrose in water), which consists of 278 mmol/L dextrose D5NS (5% dextrose in normal saline), which, in addition, contains normal saline.

Answer 536

are unilateral sensorineural hearing loss, often in association with tinnitus. Acute vertigo episodes are uncommon due to slow tumor progression Symptoms may also be due to involvement of other cranial nerves. Diagnosis of a CPA tumor is based upon magnetic resonance imaging (MRI) or computed tomography (CT) imaging.

Answer 537

Flecainide | Propafenone

Answer 538

distal pancreas | liver metastasis, although other organs can be involved

Answer 539

due to ultraviolet (UV) radiation exposure that triggers melanocyte proliferation in sun-exposed areas. Sunscreen , minimize sun exposure kin-lightening agents (eg, hydroquinone, azelaic acid) and topical retinoid creams ( CI during pregnancy)

Answer 540

Dx: PMNS>=250 Positive culture for gram negative organisms Protein < 1 g/dl SAAG >= 1.1

Answer 541

aortic rupture Rapid deceleration produces a shearing force along the aortic arch where the aorta is firmly attached: either ligamentum arteriosum, the aortic root, and the diaphragmatic hiatus.

Answer 542

rapidly lower diastolic pressure to 100-105 mm Hg over 2-6 hours, with the total drop in blood pressure being no more than 25% of the initial value. Excessive hypotensive therapy with sudden drop in blood pressure can lead to ischemic events (eg, cerebral ischemia, myocardial infarction), altered mental status, or generalized seizures.

Answer 543

e proximal interphalangeal, metacarpophalangeal, and wrist joints

Answer 544

involve hospital ethics committee

Answer 545

dyspnea on exertion fatigue; chest pain, palpitations, and syncope or near-syncope PE: prominent right ventricular heave, a loud pulmonary component of S2, a holosystolic murmur of tricuspid regurgitation, and signs of right heart failure Chest-x ray reveals prominent pulmonary arteries but no infiltrates.

Answer 546

1. Hypotension( Sepsis, anaphylaxis, blood loss, dehydration) 2. Hypovol ( Burns, pancreatitis, diuretics) 3. Relative hypovolemia ( CHF, pericarditis, cardiac tamponade) 4. Stensois - renal artery stenosis, NSAIDs 5. Hypoalbuminemia, cirrhosis 6. ACEIs 7. Hepatorenal syndrome BUN/Creat > 20:1 FeNA< 1% UNa<20 Osm> 500 HYALINE CASTS

Answer 547

* Nitrofurantoin * Cephalexin * Amoxicillin-clavulanate * Fosfomycin treated empirically with antibiotics for 3-7 days. Because there is a high risk of persistent bacteriuria, a urine culture is repeated for a test of cure one week after treatment completion.

Answer 548

Allergic Bronchopulmonary aspergillosis

Answer 549

digital plethysmography, arterial Doppler ultrasonography or angiography ONLY considered if vascular lesions ( decreased pulses, asymmetric involvement)

Answer 550

First order: TSH and US US -if suspicious findings ( hypoechoic, microcalcification,s internal vascularity) or Ca RF--> FNA -If no suspicious findings or Ca risk--see the TSH If TSH normal or elevated --> FNA If TSH low--> 123 scintigraphy If hot nodule ( hyperfunctioning)- treat hyperthyroidism If cold nodule--> FNA All thyroid nodules > 1 cm on US require a FNA

Answer 551

S1: mitral and tricuspid valve closure S2: aortic and pulmonary valve closure

Answer 552

dual antiplatelet therapy with aspirin and platelet P2Y12 receptor blockers (clopidogrel, prasugrel, or ticagrelor), beta blockers, statins anticoagulant therapy (unfractionated heparin, low-molecular-weight heparin, bivalirudin, or fondaparinux) nitrates can also be given

Answer 553

aqueous solutions of mineral salts or other water-soluble molecules. Normal saline- a solution of sodium chloride at 0.9% concentration, which is close to the concentration in the blood (isotonic) Ringer's lactate or Ringer's acetate is another isotonic solution often used for large-volume fluid replacement. The choice of fluids may also depend on the chemical properties of the medications being given. Glucose (dextrose) Cheaper than colloids

Answer 554

A thoracic or lumbar prominence on forward bend test Spinal rotation ≥7 degrees (or ≥5 degrees in overweight children) may suggest clinically significant scoliosis.

Answer 555

confidence interval (0.25-0.55) does not include the null value.

Answer 556

acute anterior uveitis, cataracts, and cystoid macular edema.

Answer 557

``` Crush injuries Bites on hands or feet Wounds on body >12 hours or on face >24 hours Cat bites (except on face) Human bites (except on face) Bite wounds in immunocompromised hosts ```

Answer 558

1. Cancer ( prostate, cervix) 2. Stone 3. Stricture urethra 4. Retroperitoneal fibrosis BUN/creat > 20:1

Answer 559

polymorphic ventricular tachycardia that can end up as fibrillation Predisposed by prolonged QT, hypo K and hypoMg tto: mg

Answer 560

Is usually used for : Massive blood loss ( trauma or surgery): when there is evidence of low fibrinogen Inherited disorders of fibrinogen Impaired hemostasis in liver disease DIC

Answer 561

Dx is clinical US is not recommended as it is not sensitive and won’t change management If kid< 6 months - observe and follow If child > 6 months- refer to surgical eval as spontaneous testicular descent rarely occurs after this age Surgery before 1 year old optimized potential of fertility and testicular growth Surgical procedure decreases risk of testicular torsion Testicular Ca is decreased but not eliminated after an orchiopexy

Answer 562

Hypertrophic cardiomyopathy 40% --deposit of fat and glycogen Clinically variable-- can present with congestive heart failure. R and L posterior ventricle become hypertrophied BUT most prominent is the interventricular septum ( high insulin receptors) Regardless of severity is transient- resolved within months.

Answer 563

surgical repair | No wait due to risk of necrosis with incarceration

Answer 564

should be wrapped in sterile gauze, moistened with saline and placed in a sealed, sterile plastic bag. the bag should be placed in a chilled container to best preserve it and reduce warm ischemia time. To maintain a temperature of 1-10 C (33.8-50 F), ice should be mixed with saline or sterile water (50/50 mixture) and the digit-containing closed plastic bag should be placed in the mixture.

Answer 565

Hypertrophic cardiomyopathy | Anomalous Aortic origin of coronary artery

Answer 566

``` Renal hypoperfusion (FeNA < 1%) Absence of tubular injury - no RBC , protein or granular casts on urine No improvement in renal function with fluids ```

Answer 567

Primary: never achieved drytime period ( most common) Secondary: Enuresis after a period of at least 6 months of dryness ( usually secondary to stressfull events) Hx, PE, URIANALYSIS to exclude secondary causes ( DM, DKA, Infection) Tto: once urianalysis normal: lifestyle changes enuresis alarm desmopressin changes

Answer 568

atherosclerosis CKD/hemodyalisis Hypotension/hypovolemia

Answer 569

Dilated cardiomyopathy due to CAD- due a stress test

Answer 570

They are associated to CAPSULAR CONTRACTURE ( Causes pain), distortion of shape, implant deflation and rupture. There is no risk of breast carcinoma but there is a slight risk of anaplastic T cell lymphoma There is no association with any connective or autoimmune disease.

Answer 571

splenic abscess

Answer 572

Sertraline and paroxetine patients should continue to breastfeed

Answer 573

MOST COMMON PRESENT IN INFANCY salt wasting ( hypotension) hyperK increased renin activity precocious puberty

Answer 574

fatigue and shortness of breath ``` wide pulse pressure water hammer . pulse - wide, bounding quincke pulse: pulsations of the nails hill sign: BP in legs as much as 40 mmHg above arm BP Head bobbing ```

Answer 575

Fever Roth spots ( exudate, edematous lesions Osler nodules Murmur Janeway lesions Anemia Nail bed hemorrhage Emboli

Answer 576

MRI Hip replacement. Stopping glucocorticosteroids is not an option-- It may lead to more complications in the form of lupus flare and adrenal insufficiency.

Answer 577

```

Type I (90%): without a definable nerve lesion Type II: with a definable nerve lesion ```

Answer 578

failure to decrease de viral load < 200 copies in 24 weeks( 6 months) of antiretroviral therapy. Can be due to drug resistance or non-compliance Patients who have good baseline ( high CD4 , low count) often respond better

Answer 579

Constitutional delay of growth and puberty

Answer 580

can recur in up to one-third of these patients. ``` higher chance of relapse : a longer duration of the disease a more extensive disease involvement of peripheral areas onset prior to puberty. ```

Answer 581

rheumatic fever | pregnant and immigrant : -- 50% increase in plsma that must pass narrow valve

Answer 582

surgical repair leg cannot extend against resistance

Answer 583

Chest x-ray is performed to screen for interstitial lung disease if no pulmonary symptoms are present. In symptomatic patients, or those with abnormal x-ray findings, chest CT and pulmonary function testing are recommended.

Answer 584

anything that causes the heart to dilate: MI, HTN , Endocarditis, Marfan, ankylosing spondylitis.

Answer 585

At age 20 , every 5 years Earlier screen recommended in patients with fx hx or obesity

Answer 586

1 month : <5,000 4month: < 500 6 months: < 50

Answer 587

African-American | Osteoporosis ( increases calcium reabsorption)

Answer 588

is nonimmune-mediated caused by heparin-induced platelet clumping arises within 2 days of heparin exposure, results in platelet nadirs >100,000 mm3, and resolves spontaneously over several days without intervention.

Answer 589

MediaL umbilical lig | Ligamentum teres hepatis

Answer 590

Advanced age - MOST SINGLE IMPORTANT Estrogen depletion Women Ca/Vit D def

Answer 591

If asymptomatic elective surgery in 1-2weeks as a treatment delay of >2 weeks after diagnosis doubles the risk of incarceration If incarceration immediate sx

Answer 592

1. recipients of BMT 2. acquired or congenital immunodef 3. transplant from 1st or 2nd degree relatives

Answer 593

``` Crush injury Bites in hands and feet Wounds on the body (>12hrs) or on the face ( >24 hrs) Human bites( except face) Cat bites ( except face) ``` Bite wounds in immunocompromised

Answer 594

HbsAg + HbeAg+ Anti Hbc IgG

Answer 595

mitral/tricuspid regurgitation

Answer 596

sodium thiosulfate

Answer 597

Atrial fibrillation decreased exercise tolerance pulmonary hypertension

Answer 598

ANA ( 80%), anti-Ro, anti-La, anti-Sm, anti-ribonucleoprotein (RNP), and anti-Jo-1 antibodies. Biospy and EMG are only done if there is diagnostic uncertainty.

Answer 599

Infertility Testicular torsion Inguinal hernia Testicular Ca

Answer 600

antimuscarinic

Answer 601

Metronidazole or Clindamycin

Answer 602

GIVEN IF ESTABLISHED OSTEOPOROSIS, FRAGILITY FX, HIGH RISK Biphosphonates ( inhibit resorption-decrease osteoclast activity- binding to hydroxyapathite)- Allendronate, risendronate SE: reflux, esophageal irritation,ulceration PTH therapy increases bone mineral density and reduces risk fracture- due to cost not first line tto max therapy of 24 months due to risk of osteosarcoma Calcitonin not good long term useful short term in women with vertebral compression fx

Answer 603

serial phlebotomies to deplete serum iron stores | Chelating agents

Answer 604

Atherosclerosis Medications- antihypertnesives ( may indirectly lower intracavernosal pressure by virtue of lowering systemic BP) sickle cell disease hx of pelvic or perineal trauma alcohol abuse congenital penile curvature any cause of hypogonadism/low testosterone

Answer 605

Oropharyngeal: difficulty swallowing, often associated with cough, drooling, aspiration Esophageal: sensation of food stuck in the upper or lower chest

Answer 606

The main modalities of treatment include conservative therapy, core decompression, osteotomy, and joint replacement. Total hip replacement is the therapy of choice for stage 4 disease of the femoral head (flattening of the femoral head with joint space narrowing).

Answer 607

Anti Hbe | Anti bodyHb core IgM

Answer 608

1. Topical retinoids, salycilic acid, glycolic acid 2. Topical retinoids PLUS Benzoyl peroxidase 3. Topical Antibiotics ( Erythromycin, clinda) 4. Add oral antibiotics - tetracyclin, doxycycline, minocycline 5. Isotretinoin

Answer 609

Achalasia: Absence myenteric plexus in LES- ( chronic presentation > 5 years) Pseudo: due to esophageal cancer, rapid onset symptoms ( < 6 months), weight loss, alcohol or tobaccco history and > 60

Answer 610

>=2 * Temperature > 38 or < 36 * HR>90 * RR> 20 OR PaCO2< 32 * WBCs> 12,000 or < 4,000 , or > 10%

Answer 611

Aortic stenosis

Answer 612

Hemoglobin/hematocrit Antibody screen if Rh(D) negative 50-g 1-hour GCT

Answer 613

autosomal dominant genetic disorder caused by abnormalities (mutations) in more than eight genes. prevents normal development in various parts of the body. unusual facial feature, short height, bleeding problems , pulmonary valve stenosis.

Answer 614

Weight loss is a common concern by parents- can be solved by giving medications after nutrient dense meals.

Answer 615

glucagon > 500 normocytic normochromic anemia - ( anemia of chronic disease or due to effects of glucagon on erythrocytes) low aa increased gastrin, serotonin, calcitonin, VIP

Answer 616

``` rapidly acting sedative (eg, etomidate, propofol, midazolam) and paralytic agent (eg, succinylcholine, rocuronium) to facilitate emergent intubation while preventing aspiration. ```

Answer 617

Ask in more detail what are the arguments behind. , and also before involving the whole family, When a patient becomes incompetent or unable to participate in decision-making, and has no advanced directive. Physician should identify a surrogate -spouse or next kin.

Answer 618

Management usually include anticoagulation ( e.g. rivaroxaban) and rate-control ( b blockers) Rhythm control is not often used due to SE of antiarrhythmics but it is required in 2 scenarios: * Inability to maintain adequate control heart rate on rate control medications * Persistance of symptomatic episodes ( HF exacerbation on rate control agents)

Answer 619

one or more nonbizarre delusions lasting >1 month in the absence of any mood or other psychotic symptoms.

Answer 620

ANA, RF, CBC, blood chemistry, urinalysis and measurement of complement levels. digital plethysmography, arterial Doppler ultrasonography or angiography should only be considered if vascular lesions (asymmetric involvement, deficient pulses)

Answer 621

Autoimmune disease Chemotherapy Turner syndrom

Answer 622

prompt assessment of other pituitary hormones as well as pituitary imaging (magnetic resonance imaging).

Answer 623

elevated, horizontal testis abscense of cremasteric reflex elevation of the testis doesnt improves the pain

Answer 624

``` Prematurity Cesarean delivery Maternal asthma Gestational DM Obesity ```

Answer 625

no increased overall mortality or reduced life expectancy.

Answer 626

BZD to control ss, once better the BZD has to be tappered gradually

Answer 627

Resp distress & signs of pulmonary edema Within 6 hours of transfusion Caused by donor anti-leukocyte

Answer 628

Dx is clinical US is not recommended as it is not sensitive and won’t change management If kid< 6 months - observe and follow If child > 6 months- refer to surgical eval as spontaneous testicular descent rarely occurs after this age

Answer 629

CO x TPR 2/3 diastolic pressure + 1/3 systolic pressure

Answer 630

Initially: Oral histamines * Avoid factors contributing to itching - excessive hot or dry environments * Regular use of emollients to maintain the skin moisturized relieve pruritus If persist: topical glucocorticoids mild ss - low potency ( hydrocortisone) moderate- high potency ( triamcinolone, bethametasone) Topical glucocorticoids are not recommended for areas: eyelids, face, flexural areas. In these case calcineurin inhibitors such as tacrolimus- may be considered Severe: UV therapy systemic immunosupresants

Answer 631

macrophages eat the given IgG instead of the one bound to platelets

Answer 632

seen in. sarcoidosis Erythema nodosum hilar adenopathy migratory polyarthralgias fever

Answer 633

Every 3 months: Anteroposterior and lateral views of the lumbar spine Lateral view of the cervical spine Pelvic radiograph, including the sacroiliac joints and hip

Answer 634

is the insoluble material that comes out of solution after frozen plasma is thawed at 4°C (between 1 and 6°C). It is rich in certain plasma proteins, especially fibrinogen. comes from fresh frozen plasma. Contains Factor VIII,XIII, vonWF, fibrinogen and fibronectin.

Answer 635

LBBB | Aortic stenosis

Answer 636

Vancomycin, considering that is due to S.aureus, Streptococcus

Answer 637

"blues" that affect 50% of women occurs around day 3, peaks ~5th and resolves after 1-2 weeks no treatment necessary (CBT may be helpful) severe postpartum depression affects 10% of women typically occurs 1-3 weeks after but can occur up to 1 year after will meet criteria for major depression disorder 5/9 SIGECAPS antidepressants (SSRI) + CBT psychosis psychotic thoughts and delusions thoughts of hurting the baby - remove the child/ensure its safety antidepressants, antipsychotics, CBT, admit

Answer 638

Hip pain and limping , arise without a clear precipitant, over days. More common in kids 3-8 years M>F 2:1 THEY ARE WELL APPEARING Fever can occur but is generally LOW OR ABSENT Management is conservative

Answer 639

the abnormality occurs in expiration, pulmonary stenosis, Right bundle branch block

Answer 640

DIAPPERS ``` Delirium Infection ( UTI) Atrophic urethritis/vaginitis Pharmaceuticals ( alpha blockers, diuretics) Psychological (ie. depression) Excessive urine output ( DM, CHF) Restricted mobility ( eg. postsurgery) Stool impactation ```

Answer 641

equine serum heptavalent antitoxin

Answer 642

- daily calcium (1,200 mg/day) - 800 IU of vit D - Weight bearing exercise - Smoking cessation ( accelerates bone mass) > alcohol

Answer 643

``` HypoK hyperuricemia hyperglycemia elevation of cholesterol and triglycerides metabolic alkalosis, hyperUricemia, hypomg ```

Answer 644

azithromycin

Answer 645

Patients with DM can develop acute renal failure due to volume depletion, sepsis, rhabdomyolysis or drugs. If there is acute renal failure PO4 accumulates and couples with Ca- causing hypocalcemia In infants of DM moms ( 2 Mechanisms) 1. Associated with hyperphosphatemia 2. Increased ionized calcio in utero of infants lead to suppressed fetal PTH.

Answer 646

risk of cyanide tox so; low infusion rates < 2 microgr/kg/min short term use close monitoring

Answer 647

Age> 50 Bilateral pain and morning stiffness > 1. month Involvement of 2 of following: neck or torso shoulders or proximal arms proximal hip or thigh constitutional ( fever,malaise, weight loss) PE: Decreased active ROM in shoulders, neck and hip SEEN IN GIANT CELL ARTERITIS

Answer 648

> 45 hx of substance abuse or mental disorder fx hx of substance abuse legal hx

Answer 649

endometriosis, complication infertility

Answer 650

Avoid contact sports for >=3 weeks due to risk of splenic rupture.

Answer 651

inhibit phospholamban ( pentamer in the membrane who inhibits the SERCA to enter Ca+ in the sarcoplasmic reticulum and this contraction)

Answer 652

high risk bite prophylaxis with amoxi-clavulanate

Answer 653

F, there is!

Answer 654

Observe for 1-2 menstrual periods. Is benign and will resolve over time. If persistent US If very large excisional biopsy can be done.

Answer 655

Non-bullous: MC form. papule--> vesicle surroeunded by erythema--> pustules that enlarge and breakdown--> crusted golden appearance. FACE & EXTREMITIES, although multiple they are localized. Bullous: vesicles enlarge--> bullae--> ruptures and leave thin brown crust. Fewer lesions. TRUNK Ecthyma: ulcerative form involving dermis and epidermis. "punched-out" ulcers covered with yellow crust surrounded by raised violaceous margins

Answer 656

abdominal pain, leukocytosis AND fever, nausea, vomiting, NONBLOODY DIARRHEA.

Answer 657

B blockers shorten the QT | Pacemaker

Answer 658

renal disease, creatinine and renal US.

Answer 659

``` glucose control surgical debridement weight off-loading revascularization (if needed), and antibiotic therapy for >6 weeks. ``` Serial inflammatory markers (eg, erythrocyte sedimentation rate) can help confirm treatment response

Answer 660

pseudogout | acute monoarticular arthritis, but the knee joints are more frequently involved than the MTP joints.

Answer 661

``` Strep Group A Infection Infectious mononucleosis ( more systemic ss) ```

Answer 662

S.aureus | S.pyogenes

Answer 663

Oligoclonal bands and elevated IgG index can be seen in >90% of cases

Answer 664

``` CAGE Cut down? Annoyed? Guilty? Eye-opener? ``` MAST(Michigan Alcoholism Screening Tes) 25 item questionnaire

Answer 665

Congenital long QT syndrome - AD, pure cardiac phenotype ( no deafness)

Answer 666

transthoracic echocardiography-estimate the pulmonary artery pressure , evaluates for RH dysfunction Definitive diagnosis with right heart catheterization is required, with mean pulmonary arterial pressure >25 mm Hg providing confirmation.

Answer 667

a previous placenta previa, multiple gestation, prior cesarean delivery, and advanced maternal age.

Answer 668

Doppler US

Answer 669

In < 60 yo , < 140/90 | In>=60 , <150/90

Answer 670

dihydropyridine calcium channel blockers (e.g., nifedipine and amlodipine), as well as diltiazem

Answer 671

Herbal supplement for joint pain Hepatotoxicity

Answer 672

Desmopressin acetate or combined estrogen. The goal is to achieve an hematocrit of 30% to improve bleeding. In this bleeding the number of platelet is normal , so no role of platelet transfusion here.

Answer 673

NORMAL. is measuring saturation whether is O2 or CO2

Answer 674

Glucocorticoids, antiandrogens , some AEDs( phenytoin, phenobarbital, carbamazepine, primidone

Answer 675

discrete, smooth and circular areas of hair loss over the scalp. no associated scaling or inflammation present The hair loss usually develops over a few weeks and has a recurring pattern. Most of the patients will have regrowth of the hair in the involved areas over time

Answer 676

TTO is supportive | O2 canula to maintain saturation > 90%, usually they don’t require more than 4

Answer 677

assess postural stability. patient to stand up from an armless chair without assistance, walk a short distance, turn around, return, and sit down again. If the patient is unsteady or has difficulties during the test, further evaluation is necessary.

Answer 678

Pulmonary embolism

Answer 679

increases in constrictive pericarditis | absent in cardiac tamponade

Answer 680

``` > 50 poor oral intake minimal social support encephalopahty hemodynamic instability impaired hepatic synthesis function - INR >1.5 ```

Answer 681

botulinum toxin injections | percutaneous tibial nerve stimulation.

Answer 682

avoid strenuous physical activity- risk of sudden cardiac death.

Answer 683

symmetrical proximal muscle weakness No/mild pain or muscle tenderness high CK, Aldolase ANA, Anti Jo Biopsy: Endomysial mononuclear infiltrate with patchy necrosis

Answer 684

Aortic foci: AS Pulmonary foci : PS, ASD left 2-3rd intercostal space: AR,PR,HCM Tricuspid foci: TR,TS,ASD,VSD Mitral focus: MVP, MS, MR

Answer 685

Aortic stenosis, left bundle branch block In severe AS, closure of the aortic valve is delayed, which results in nearly simultaneous closure of the aortic and pulmonic valves during inspiration, and is appreciated on examination as a single S2.

Answer 686

Anterior cruciate ligament | Patellar tendon rupture/tear

Answer 687

Iatrogenic- due to treatments of hyperthyroidism, radio iodine thyroidectomy or medications such as lithium Hashimoto ( subclinical hypothyroidism)

Answer 688

There are 4 types depending on the onset of presentation 1- prenatal 2- aka Werdnig Hoffman disease ( Infantile) 3-juvenile 4- adult 1-2 are the most severe forms Dx: Genetic testing. Electromyography and muscle biopsy were once standard, but now with the availability of genetic testing is preferred. Treatment: Nusinersen - antisense oligonucleotide that modifies the splicing of SMN2 gene to increase the producttion of the absent protein.

Answer 689

Peritoneal cause of ascites - tumors or infections Peritoneal mesothelioma, peritoneal carcinomatosis, SLE, TB, SLE, sarcoidosis

Answer 690

amoxi clavulanate as prophylaxis

Answer 691

mitral stenosis

Answer 692

Medications commonly given are methylphenidate Alternatives: atomoxetine. Clonidine is a alpha 2 adrenergic that can be given if the above fails

Answer 693

* Chronic pruritic rash with escoriation and lichnification * Mutation of filligrin and other barrier proteins in skin * Disrupture of skin increases antigen exposure and hypersensitivity * Associated with asthma and allergic rhinitis * Lab findings: High IgE, eosinophilia

Answer 694

suppress endogenous cortisol production through negative feedback on the hypothalamic-pituitary-adrenal (HPA) axis. suppression of the HPA axis -->adrenal insufficiency on discontinuation of glucocorticoids

Answer 695

tibial tuberosity apophysitis Tenderness in tibial tubercle Range of motion and joint stability are normal

Answer 696

Medial collateral ligament (MCL) tears are caused by a direct impact to the lateral knee either laxity of the knee joint when valgus stress is applied or tenderness along the medial joint line

Answer 697

If patient has any of the following: - Has received a macrolide before? - Clarythromycin resistance> 15% or local response rates to clarithromycin therapies <=65? If YES-- Patient will use Bismuth + MTZ+ Tetracycline+PPIs If NO: Ask: the patient allergic to Penicillin? If no: Clarithromycin + Amoxi+PPIs OIf yes, ask if the pateint has received MTZ If patient has received MTZ-- then Bismuth quadruple therapy If not: - Clarythromycin + MTZ+PPIs

Answer 698

1. order 3 blood cultures over the first 30-60 minutes 2. initiate Abcs- if possible specific but otherwise empiric - ie. vancomycin 3. There is no role of antithrombotic therapy. 4. consider catheter removal, indication of surgery

Answer 699

monocular visual loss accompanied by eye pain that worsens with eye movement.

Answer 700

Trichloroacetic acid -destroys the lesion by protein coagulation. The clearance rate is not very high; therefore, repeated applications are usually necessary. Systemic or topical interferon seems also to help Ablative or surgical procedures are considered in patients in whom medical therapy is not effective

Answer 701

Yes, proximal

Answer 702

Immediate bladder decompression using urethral or suprapubic catheter is required to prevent progression and acute renal failure. For most patients, urethral catheterization is attempted prior to consideration of suprapubic catheterization.

Answer 703

1. increase dose of th first agent to max dose 2. Add a second medication ( thiazide, CCBs, ACE inhibitor); if target BP not reached you can increase both doses as necessary until max dose is achieved **If still inadequate despite 2 meds, add a 3rd

Answer 704

Weight loss ( catabolic effects of glucagon) Diabetes mellitus ( can be recently diagnosed) Necrolytic migratory erythema ( low aa, hyponutrition) Venous thrombosis 30% Other less specific Diarrhea ( hyperglucagonemia & secretion of gastrin, VIP, serotonin, calcitonin) Abdominal pain Neuropsychiatric ss 20% -dementia, depression, psychosis Dilated cardiomyopathy

Answer 705

address precipitating factors: hypovolemia, anemia , infection Splanchnic vasoconstrictors: midodrine, octeotride, NE Liver transplant

Answer 706

failure of processus vaginalis to obliterate

Answer 707

Abdominal CT Broad spectrum abcs+/- splenectomy Possible percutaneous drainage in poor surgical candidates

Answer 708

AR sensorineural deafness | Long QT

Answer 709

synovial WBC count of >50,000/mm3

Answer 710

Before prescribing stimulants the Dr. Should do: * Cardiac hx and PE * Baseline Weight * Vital signs A ROUTINE ECG IS NOT RECOMMENDED

Answer 711

Dix-Hallpike maneuver: diagnose BPPV; vertigo and nystagmus are triggered as pt quickly lies back into supine position with head rotated 45 degrees Tto: Epley manuever: canalith repositioning maneuver

Answer 712

Hep B vaccine (within 12-24h), Hep B immune globulin

Answer 713

platelet count <10,000/mm3 active bleeding with a platelet count <50,000/mm3 or planned major surgery with a platelet count <50,000/mm3.

Answer 714

Hemochromatosis

Answer 715

RF: Prematurity and small for gestational age | Is abnormal to have this at birth

Answer 716

asymptomatic patients, a CK level >10 times the upper limit of normal range also evaluate if patient has had statin in the past and tolerated it. Sometimes there are confounding factors such as exercise.

Answer 717

PMNs >250/mm3 Positive culture, often gram-negative organisms (eg, Escherichia coli, Klebsiella) Protein <1 g/dL SAAG >1.1 g/dL

Answer 718

bacterial translocation through the intestine.

Answer 719

Empiric antibiotics - third-generation cephalosporins (eg, cefotaxime) Fluoroquinolones for SBP prophylaxis IV albumin-decrease the incidence of renal failure and reduce mortality in patients with SBP.

Answer 720

SBP is also often associated with renal dysfunction (possibly exacerbated by decreased effective intravascular volume due to cirrhosis and hypoalbuminemia). IV albumin has been shown to decrease the incidence of renal failure and reduce mortality in patients with SBP.

Answer 721

creatinine Model for End-Stage Liver Disease (MELD) score. - bilirubin, INR, and serum creatinine, sodium

Answer 722

The MELD score can be used to determine a patient's 90-day survival and to calculate a patient's priority on the liver transplant list; patients with a higher MELD score take precedence should a suitable donor liver become available. bilirubin, INR, and serum creatinine, sodium

Answer 723

Cognitive-behavioral therapy (CBT) | if doesnt work hypnotic therapy ( be careful in elderly!- falls)

Answer 724

Bronchogenic carcinoma causing bronchial obstruction-- obstruction, no clearance of secretions and pneumonia. *The best diagnostic test for endobronchial obstructive lesions is flexible bronchoscopy. If the question had asked for the next best step in management, then the answer would have been CT scan.

Answer 725

hemoptysis, does not resolve with antibiotics.

Answer 726

flexible bronchoscopy

Answer 727

diffuse alveolar hemorrhage syndromes (Wegner's granulomatosis, Goodpasture's syndrome and other systemic vasculitis).

Answer 728

Age <18 Lack of mental ability to make an informed decision Uncontrolled hypertension, HIV infection, diabetes mellitus Active or partially treated cancer Acute infection High suspicion of donor coercion High suspicion of illegal financial exchange from recipient to donor Uncontrolled psychiatric illness Active substance abuse

Answer 729

chronic overuse rather than acute trauma. pain in the anterior knee, which can be reproduced by extending the knee while compressing the patella (patellofemoral compression test).

Answer 730

Osteoarthritis

Answer 731

Subclinical hypothyroidism

Answer 732

Elevated TSH and normal T4

Answer 733

If TSH > 10: Start levothyroxine If < 10 but upper limit check anti thyroid peroxidase antibody. If positive: treat with levothyroxine No: if patient has goiter, symptomatic, pregnancy,ovulation problems with infertility, and hypercholesterolemia: treat if not monitor- repeat thyroid function tests every 6-12 months

Answer 734

TSH >10 μU/mL or elevated titers of antithyroid peroxidase antibodies or f patient has goiter, symptomatic, pregnancy,ovulation problems with infertility, and hypercholesterolemia

Answer 735

liothyronine ( oral T3 supplement), not very useful because very short half-life-> fluctuations blood levels.

Answer 736

TSH Patients with primary hypothyroidism can have normal circulating T3 levels despite impaired thyroid function because of increased peripheral conversion due to elevated TSH levels. Serum T3 measurement is therefore of limited utility in hypothyroidism.

Answer 737

>=48 hours on mechanical ventilation fever increased requirements of oxygen new patches on X ray

Answer 738

Tracheobronchial aspirate for culture and empiric antibiotics.

Answer 739

most commonly caused by microaspiration of virulent oropharyngeal organisms (eg, Escherichia coli, Streptococcus species).

Answer 740

Hemochromatosis

Answer 741

iron has more affinitiy to B cells( insulin), than alpha( glucagon)

Answer 742

listeria, vibrio vulnificus, and yersinia enterocolitica

Answer 743

arthropathy: morning stiffness with improvement as day passes. PSEUDOGOUT FINDINGS. RX findings same as pseudogout: narrowing joint space, 2nd-3rd MCP, along with subchondral sclerosis, osteopenia

Answer 744

serum iron studies( increased levels of iron, ferritin, and transferrin saturation. ), then confirm with genetic studies (AR, HFE) liver biopsy generally not done tto: serial phlebotomies

Answer 745

slowly progressive arthropathy affecting the weight-bearing joints of the lower extremities and interphalangeal joints of the hands. Synovial fluid is typically bland, with <2000 cells/mm3, <50% neutrophils, and no crystals.

Answer 746

acute asymmetric arthritis | follows a gastrointestinal or genitourinary infection.

Answer 747

- Potassium hydroxide preparation of nail scrapings shows dermatophytic hyphae and arthrospores. - periodic acid-Schiff staining Tto: Medical indications for treatment : significant pain or functional limitation, history of cellulitis in the affected extremity, or additional risk factors for cellulitis (eg, diabetes). First line: oral terbinafine,oral itraconazole Second line : griseofulvin, fluconazole,Ciclopirox Infection of the fingernails requires 6 weeks of therapy, and infection of the toenails requires 12 weeks.

Answer 748

dermatophyte Trichophyton rubrum. thick brittle discolored nails

Answer 749

if within 6-12 hours of SAH onset : Head CT | If not: LP

Answer 750

ruptured asaccular aneurysm

Answer 751

``` rebleeding (first 24 hours) vasospasm (after 3 days)-from 3-10 days ct angio preferred for detections of vasospasm// NIMODIPINE hydrocephalus.ICP SEIZURES HYPONATREMIA ```

Answer 752

retained CSF blood can take up to 6 hours to degrade and cause xanthochromia; for this reason, LP is most sensitive >6 hours from SAH onset.

Answer 753

high fever (up to 39 C [102 F]) for 3-5 days, followed by severe polyarthralgias. Arthralgias - bilateral and symmetric, distal joints more than proximal joints. The hands, wrists, and ankles are most commonly affected, and the pain may be severe enough to be disabling. Headache, myalgias, conjunctivitis, maculopapular rash Lymphopenia, thrombocytopenia, transaminitis

Answer 754

supportive tto Most cases resolve spontaneously within 2 weeks, but approximately 30%-50% of patients develop chronic joint symptoms( may require methotrexate).

Answer 755

Amblyomma ( lone star Tick), rash rare Monocytes with morulae ( mulberry) fever, nonspecific symptoms (eg, malaise, headache), nausea, vomiting, and cough. leukopenia, thrombocytopenia, elevated aminotransferases arthralgiasare less rare

Answer 756

Monocytes with morulae ( mulberry)

Answer 757

plasmodium falciparum, ovale, vivax or malaria parasites by bite of anopheles mosquito

Answer 758

periodic fever paroxysms cycle can have cold phase ( chills, shivering), hot phase ( febrile), and sweating phase. malaise, headache, N/V, abdominal pain, diarrhea, PETECHIAE, HEPATOMEGALY, JAUNDICE ANEMIA AND THROMBOCYTOPENIA

Answer 759

Thin and think peripheral blood smears.

Answer 760

Salmonella slowly and begin with a week of fever (often with temperature-pulse dissociation- Typically for every 1 degree of fever the pulse increases by 10 beats/min. ), followed by abdominal pain and cutaneous "rose spots." non bloody diarrhea By week 3, hepatosplenomegaly, intestinal bleeding, and intestinal perforation often occur.

Answer 761

hemoglobinopathies HgbS, Hgb C, thalassemia. | partial immunity from previous malarial illnesses

Answer 762

Recent antibiotics ( fluoroquinolones, cluindamycin, penicillins, caphalosporins) Recent hospitalizations Advanced age PPIs use

Answer 763

Intestinal overgrowth Enterotoxin A: watery diarrhea Cytotoxin B: colonic epithelial caell necrosis and fibrin deposition

Answer 764

Fever, abdominal pain, diarrhea, and leukocytosis ( ranges of watery diarrhea to fulminant colitis) White/yellow pseudomembranes on sigmoidoscopy

Answer 765

PCR detection of toxin in stools if PCR negative no need to repeat the test because high sensitive.

Answer 766

Oral vancomycin or Fidamoxicin(usually for recurrent or initial severe presentation) Recurrence : First recurrence: vancomycin PO in a prolonged pulse/tapper (2-8 w) OR Fidamoxicin (if Vanco was used in initial, and 10 days oral) Multiple recurrences: Vancomycin PO followed by rifaximin ( or above regimens) Fecal transplant Fulminant: METRONIDAZOLE IV PLUS HIGH DOSE VACOMYCIN PO OR PR if ileus present . Plus surgical eval.

Answer 767

bactericidal antibiotic for C. difficile Usually for recurrences but can be used in the initial episode if very severe. 10 days oral.

Answer 768

Acute-S.aureus (large vegetations in previously normal valves) Subacute- Strep Viridians( small vegetations in congenital abnormal or diseases valves, also in dental procedures) S. bovis( gallolyticus)- Colon Ca S. epidermidis ( prostethic bands) Non bacterial: marantic endocarditis ( lupus(libmand disease two sides of mitral valve), malignancy)

Answer 769

HACEK pathogens: Hemaophilus, aggregatibacter, cardiobacterium, Eikenella, Kingella

Answer 770

MITRAL But TRICUSPID seen with IV drug: S. aureus, Pseudomonas, Candida

Answer 771

Septic emboli ( cerebral pulmonary, splenic infarct) Mycotic aneurysm Janeway lesions

Answer 772

Osler nodules Roth spots Glomerulonephritis

Answer 773

Empiric tto after obtaining blood cultures: (cover, staph, strep and enterococci)--> VANCOMYCIN Medical vancomycin plus ceftriaxone or gentamicin indications empiric antibiotic therapy for patients with no prosthetic valve often for 4-6 weeks vancomycin plus gentamicin and rifampin indications empiric antibiotic therapy for patients with prosthetic valve often for 4-6 weeks

Answer 774

Dental procedures that involve manipulation of gingival tissue or the periapical region of teeth (eg, routine dental cleaning) or perforation of the oral mucosa AMOXI Respiratory tract procedures that involve incision or biopsy of the respiratory mucosa (eg, tonsillectomy, bronchoscopy with biopsy) AMOXI Surgical placement of prosthetic cardiac material( Staph, Vancomycin) Surgery of infected skin or mucosa( Staph, Vancomycin) GI or Genitourinary procedure with ACTIVE INFECTION. ( ampi, enterococcus)

Answer 775

Prosthetic valve Prior infective endocarditis Structural valve abnormality Repaired/unrepaired heart disease

Answer 776

odds that an outcome will occur in the presence of an exposure divided by the odds that the outcome will occur in the absence of that exposure. OR < 1 means that the exposure is associated with lower odds of the outcome OR = 1 means that the exposure is not associated with the outcome OR > 1 means that the exposure is associated with higher odds of the outcome

Answer 777

``` pruritic planar polygonal purple papules ```

Answer 778

skin biopsy: sawtooth infiltrate of lymphocytes at dermal-epidermal junction

Answer 779

``` -skin: purple papule with angulated (polygonal) border can have vesicles or bullae can result in scarring alopecia -mucosa: white, lacy, reticulated patches in oral mucosa = diagnostic of lichen planus known as Wickham striae nail dystrophic ```

Answer 780

antihistamines for pruritus | topical steroids for localized disease

Answer 781

Lichen planus

Answer 782

CT angiogram of the chest is typically preferred for diagnostic confirmation of acute PE if impaired renal function, intravenous contrast should be avoided. :V/Q scan

Answer 783

+3 points Clinical signs of DVT Alternate diagnosis less likely than PE +1.5 points Previous PE or DVT Heart rate >100 Recent surgery or immobilization +1 point Hemoptysis Cancer Total score ``` ≤4 = PE unlikely >4 = PE likely ```

Answer 784

Discuss specific benefits/risks of proposed treatment & alternatives Discuss specific risks of refusing treatment Assess decision-making capacity Understands proposed treatment Understands risks of refusing treatment Demonstrates a reasoned basis for leaving against medical advice Discuss follow-up care & option to return to emergency department Notify primary physician, family Document in medical record

Answer 785

maternal GBS bacteriuria, a positive rectovaginal culture for GBS (obtained at 35-37 weeks gestation), or a previous infant with invasive GBS disease. A positive rectovaginal culture for GBS during a previous pregnancy is not an indication for prophylaxis in subsequent pregnancies.

Answer 786

if ampicillin, penicillin, or cefazolin is administered >=4 hours before delivery. Vancomycin, clindamycin, or other antibiotics are not considered adequate prophylaxis due to increasing bacterial resistance and slower distribution across the placenta and into the amniotic fluid.

Answer 787

observe 48 hours

Answer 788

if >=37 and ROM < 18 hours is OK to observe. IF NOT the above, CBC, blood culture and observe 48 hrs Antibiotics if the baby is ill or born to mothers with chorio. LP indicated if very ill

Answer 789

Cleft palate Congenital defects Neural tube defects Skeletal abnormalities

Answer 790

``` Abruptio placentae/hemorrhage Spontaneous abortion Preeclampsia Preterm labor Mortality Injury ```

Answer 791

Keep valproate, high dose folate, screen with serum alpha-fetoprotein and an anatomy ultrasound therefore, changing to an alternate regimen should be tried 6 months prior to attempts to conceive. BUT NOT AFTER CONCEPTION THIS APPLY TO ANY AED, ONCE CONCEPTION NO CHANGES

Answer 792

NO. Sedating AEDs (eg, benzodiazepines, phenobarbital) can sometimes cause the child to become irritable or sleepy; in these cases, breastfeeding should be discontinued, but it can be attempted again after a week.

Answer 793

True, so if a patient had an episode at home and arrives to the hospital asymptomatic and ECG doesn't show ischemia, the best thing to do is wait observe, repeat ECG and troponins

Answer 794

TRUE! For patients in whom the initial ECG and troponin findings are unremarkable but there is reasonable suspicion for acute coronary syndrome (ACS), the most appropriate approach is further observation with serial ECG and troponin levels (eg, 3 troponin levels 6 hours apart and several ECGs 30 minutes apart).

Answer 795

Source patients positive for both HBsAg and HBeAg have transmission rates of 40%-60%; those with only HBsAg positivity have reduced transmission rates of 20%-40%

Answer 796

psychiatrist: unethical with current or former non-psychiatris: are unethical if the physician uses or exploits trust, knowledge, emotions, or influence derived from the previous professional relationship." For example, cases in which the physician-patient relationship was brief or relatively impersonal may be acceptable. In these cases, termination of the physician-patient relationship prior to beginning a romantic relationship is critical and should be documented.

Answer 797

inhibition of acetylcholinesterase--> colinergic activity

Answer 798

Muscarinic effects: “DUMBELS” ``` Defecation Urination Miosis Bronchospasm/bradycardia, high secretion Emesis Lacrimation Salivation Nicotinic effects: Muscle weakness, paralysis, fasciculations CNS: Respiratory failure, seizure, coma ```

Answer 799

``` Remove clothing Emergent resuscitation (eg, oxygen, fluids, intubation) Atropine & pralidoxime Activated charcoal (if within 1 hour of exposure) ``` atropine (a competitive inhibitor of acetylcholine) and pralidoxime (a cholinesterase-reactivating agent

Answer 800

ARR = 0.25 - 0.20 = 0.05 (ie, 5%). This means that for every 100 patients who used treatment A, 5 patients showed improvement. NNT = 1/ARR = 1/0.05 = 20. This means that 20 patients need to be treated in order to prevent one multiple sclerosis relapse during the first 6 months of therapy.

Answer 801

1/ARR ARR: Substraction of thr risk of something in the treatment group and the placebo group.

Answer 802

metacarpophalangeal and proximal interphalangeal joints;

Answer 803

distal interphalangeal joints and axial skeleton (ie, spondyloarthropathy with sacroiliitis or spondylitis). Morning stiffness, improve with physical activity

Answer 804

psoriatic arthritis

Answer 805

Enthesitis (inflammation at site of tendon insertion into bone) Dactylitis ("sausage digits") of toe or finger Nail pitting & onycholysis Swelling of the hands or feet with pitting edema

Answer 806

- limited plaque psoriasis (<10% skin involvement) without associated arthritis are managed initially with topical glucocorticoids or vitamin D derivatives (eg, calcipotriene). - Narrowband ultraviolet B light therapy is typically used for widespread plaque psoriasis (eg, >10% of body surface area). - extensive disease or joint involvement require systemic treatment (eg, methotrexate).

Answer 807

as they may trigger pustular psoriasis.

Answer 808

I – Idiopathic/Infections (Ascaris, HIV,Salmonella, Cryptosporidium) G – Gallstones E – Ethanol T – Trauma S – Steroids M – Mumps, malignancy (Pancreatic cancer) A – Autoimmune S – Scorpion sting H – Hypercalcemia, Hypertriglyceridemia (Usually more than 1000mg/dL) E – ERCP D – Drugs ( HCTZ, Bactrim, azathioprine,furosemide, didanosine)

Answer 809

Requires 2 of the following: Characteristic epigastric pain Serum amylase or lipase >3 times normal Imaging findings consistent with pancreatitis( contrast-enhanced CT scan, MRI, ultrasound)

Answer 810

``` Aggressive intravenous volume resuscitation Pain control (eg, hydromorphone) Nothing by mouth until pain resolves, nasojejunal feeds if oral intolerance >3-4 days ```

Answer 811

THink about possible complications: pancreatic necrosis, acute necrotic collection, acute peripancreatic fluid collection, or pancreatic infection (eg, infected necrosis) So do contrast-enhanced CT (CECT) scan of the abdomen.

Answer 812

producing coronary vasodilatation and increasing the coronary flow rate and velocity. In normal coronary vessels, vasodilation increases the blood flow in areas with severe stenosis, there is already a compensatory microvascular dilatation at rest to maintain normal blood flow, so no further increase in the flow occurs. The resulting heterogenous blood flow due to the stenotic or occluded region is detected by radionuclide imaging studies as a perfusion defect.

Answer 813

lateral and posterolateral parts of the left ventricle

Answer 814

anterior wall left ventricle

Answer 815

right ventricle and inferoposterior walls of the left ventricle.

Answer 816

68, 95,99.7

Answer 817

prevention of risk factors themselves.(ie. obesity, htn for cardiovascular disease)

Answer 818

primary: preventing the disease to happen secondary: preventing complications once disease has occurred tertiary: taking all actions available to limit impairments and disabilities. quaternary: mitigate and/or limit the consequences of unnecessary or excessive intervention by the health system.

Answer 819

Situations involving sexual partners who occupy positions of power or authority in relation to the teenage patient should raise concerns for coercion. A physician who finds evidence of abuse or exploitation is obligated to notify the state's child protective services or law enforcement agencies.

Answer 820

``` Fever Tonsillitis/pharyngitis ± exudates Posterior or diffuse cervical lymphadenopathy Significant fatigue ± Hepatosplenomegaly ± Rash after amoxicillin ```

Answer 821

Positive heterophile antibody (Monospot) test (25% false-negative rate during 1st week of illness) Atypical lymphocytosis Transient hepatitis

Answer 822

- Supportive , NSAIDs | - Avoid sports for >3 weeks (contact sports >4 weeks) due to the risk of splenic rupture

Answer 823

admit and start IV corticosteroids.

Answer 824

clindamycin

Answer 825

airway obstruction overwhelming infection aplastic anemia thrombocytopenia in these cases IV corticosteroids are indicated

Answer 826

(IV) fluid support with normal saline and continuous IV insulin. Because insulin promotes potassium entry into the cells, patients may rapidly develop hypokalemia. Potassium should be monitored closely and added to the IV fluids if serum potassium levels are <5.2 mEq/L.

Answer 827

serum glucose is <200 mg/dL, the anion gap is <12 mEq/L, serum bicarbonate is >15 mEq/L, and the patient is able to eat.

Answer 828

the rate of insulin infusion should be halved and dextrose added to the IV fluids to prevent hypoglycemia.

Answer 829

The sodium concentration of IV fluids is determined by the corrected serum sodium (measured sodium + 0.016 [measured glucose – 100]). So 0.9% normal saline should be continued for corrected sodium <135 mEq/L, but half (0.45%) normal saline should be given for corrected sodium >135 mEq/L.

Answer 830

(serum Na – [serum Cl + serum bicarbonate])

Answer 831

IV fluids Rapid infusion of 0.9% normal saline Add dextrose 5% when serum glucose is ≤200 mg/dL Insulin Start continuous IV insulin infusion (hold if K <3.3 mEq/L) Switch to SQ (basal bolus) insulin for the following: able to eat, glucose <200 mg/dL, anion gap <12 mEq/L & serum HCO3 ≥15 mEq/L Overlap SQ & IV insulin by 1-2 hours Potassium Add IV K if serum K+ <5.3 mEq/L (hold if ≥5.3 mEq/L) Nearly all patients' K+ depleted, even with hyperkalemia Bicarbonate Consider for patients with pH ≤6.9 Phosphate Consider for serum phosphate <1.0 mg/dL, cardiac dysfunction, or respiratory depression Monitor serum calcium frequently

Answer 832

Give SQ insulin now and stop insulin infusion in 2 hours.

Answer 833

glucose <200 mg/dL along with 2 of the following: serum anion gap <12 mEq/L, serum bicarbonate >15 mEq/L, and venous pH >7.30.

Answer 834

1. Isoniazid & rifapentine weekly for 3 months under direct observation (not recommended in patients with HIV) 2. Isoniazid monotherapy for 6-9 months 3. Rifampin for 4 months *Pyridoxine is added to prevent neuropathies in patients taking isoniazid who have the following conditions: diabetes, uremia, alcoholism, malnutrition, HIV, pregnancy, or epilepsy.

Answer 835

when 3 consecutive acid-fast bacilli sputum smears are negative (8-24–hour intervals and >1 early morning samples).

Answer 836

risk of peptic ulcer disease ( duodenal 70%, gastric 50%) Gastric cancer MALTL (mucosa associated lymphoid tissue lymphoma) Also: Non peptic ulcer disease, GERD

Answer 837

PPI+Clarithromycin+Amoxicillin for 1-14 days If penicillin allergy change amoxi to MTZ iF High macrolide or metronidazole resistance or Treatment failure after 1 course of therapy: PPI + bismuth + metronidazole + tetracycline for 10-14 days

Answer 838

avoid NSAIDs due to risk of ulcer formation in the setting of H.pylori

Answer 839

inhibits gastric acid secretion and improves mucosal defenses. Has been used to prevent ulcers associated to NSAIDs use Not routinely used in H.pylori

Answer 840

Confirm eradication of H.pylori first before considering other causes. Urea breath test or antigen stool test - should be done after >=4 weeks of treatment completion

Answer 841

1. persistent symptoms 2. H pylori-associated ulcer on endoscopy 3. evidence of an H pylori-associated malignancy (eg, mucosa-associated lymphoid tissue lymphoma).

Answer 842

high clinical suspicion arthrocentesis Even if it is highly suspected clinically, gout should be confirmed with arthrocentesis.

Answer 843

Medications:diuretics, low dose aspirin, immune suppressants Medical history: surgery, trauma, recent hospitalizations, CKD, Organ transplant Lifeestyle: obesity, high protein, high fat, alcohol excess

Answer 844

First line: NSAIDs (Indomethacine, ibuprofen) If CI to NSAIDs: Colchicine Give until 1-2 days after resolution of ss, usually 5-7 days. If none of the above, depends on the joint involvement: > 2 joints consider oral, IV, IM glucocorticoids <2:consider oral, IV, IM glucocorticoids AND INTRAARTICULAR

Answer 845

``` Acute or CKD Congestive HF Peptic ulcer disease NSAIDs sensitivity Currently on anticoag ```

Answer 846

(NSAIDs), because they can cause sodium retention and vasoconstriction and can reduce the effectiveness and increase the toxicity of ACE inhibitors and diuretics

Answer 847

Severe renal or liver disease | Combined with another drug inhibiting CYP450

Answer 848

1.2-mg dose followed by 0.6 mg an hour later. Colchicine can then be continued at 0.6 mg once or twice daily until 2-3 days after symptoms resolve.

Answer 849

Vulgaris: - Potentially fatal - Mediterranean/Jewish - 40-60yo - autoantibodies (IgG) against desmoglein, a component of the desmosome, desmosomes connect keratinocytes in the skin--> separation of epidermidis - Associated conditions: drugs( penicillamine, cephalosporin, captopril), thymoma, myastenia gravis, lupus - Flaccid bullae, NIkolsky sign positive , - INVOLVEMENT ORAL - Antidesmoglein 1,3, and in pathology: IgG or C3 in net-like (reticular) pattern - TTO prednisone Bullous pemphigoid - Hx of eczema and or pruritus before bullae formation - > 70 years of age - auto-antibodies (IgG) against hemidesmosomes in the ---epidermal-dermal junction - main autoantigens are BP180 and BP230 - Associated with drugs (loop diuretics,metformin, neuroleptic),multiple sclerosis, dementia, Parkinson disease - TENSE bullae, negative Nikolsy - Subepidermal blisters - tto: d/c new meds, wound care, steroids.

Answer 850

extension of blister or sloughing of skin with blunt pressure or lateral traction of skin

Answer 851

Borrelia burgdorferi, a spirochete transmitted by the deer tick (Ixodes scapularis)

Answer 852

afebrile and well-appearing, and can bear weight on the affected joint. knee almost always involved tenderness, swelling, decreased range of motion Synovial fluid white blood cell (WBC) count 20,000-60,000/mm³.

Answer 853

enzyme-linked immunosorbent assay, followed by confirmatory Western blot, is obtained.

Answer 854

synovial fluid WBC of 2,000-20,000/mm³ is expected.

Answer 855

most pts are disease free after oral antibiotic

Answer 856

A 28-day course of oral doxycycline or amoxicillin is the recommended treatment. Amoxicillin is indicated for children age <8 and pregnant or lactating women, as doxycycline can cause permanent tooth discoloration and skeletal problems in exposed children and fetus

Answer 857

COPD Cigarette smoking Sleep apnea Heart failure Prior to undergoing an elective procedure, these conditions should be optimized. This typically includes smoking cessation (ideally >4 weeks prior to the procedure) and the treatment of any heart failure or COPD exacerbation.

Answer 858

``` left ventricular ejection fraction <40% NYHA class III-IV heart failure Prior peripartum cardiomyopathy Severe obstructive cardiac lesions Severe pulmonary HTN (Eisenmenger syndrome) Unstable aortic dilation >40 mm ```

Answer 859

first-line options include hysteroscopic sterilization or a subdermal progestin implant. Estrogen-containing contraceptives are contraindicated due to an increased risk of thromboembolism.

Answer 860

Thyroglossal duct cyst Midline Superior displacement with tongue protrusion Dermoid cyst Midline No displacement with tongue protrusion consist of cutaneous structures (eg, hair follicles, sebaceous glands). They are located within the subcutaneous tissue Branchial cleft cyst(remnant) Lateral usually located anterior to the sternocleidomastoid muscle. Often associated with sinus tract/fistula Lymphadenitis Lateral Tender, warm, erythematous

Answer 861

if he is immune: nothing if he is non-immune: HbIG and vaccine, and then following the next 2 doses of Hep B after revaccination alone is insufficient due to the delayed development of neutralizing antibodies. HBIG is needed to obtain immediate antibody activity.

Answer 862

if immune: nothing | if not immune: vaccine

Answer 863

a lumbar puncture to evaluate for neurosyphilis. because treatment for neurosyphilis is different from other syphilis.

Answer 864

painless genital ulcer chancre

Answer 865

``` diffuse rash LAD oral lesions hepatitis condylomata lata ``` Often presents with EARLY NEUROSYPHILIS: Meningitis, ocular ss ( posterior uveitis), visual acuity), and otosyphilis( hearing loss)

Answer 866

Tabesd dorsalis, argyll robertson | Aortic aneurysm, aoric insufficiency

Answer 867

1. Primary, secondary and latent < 1 year: Benzathine penicillin G IM 2.4 million units as a single dose 2. Latent>1 year, unknown, Gummas/CV syphilis: Bezathine penicillin G IM 2.4 millions unit weekly for 3 weeks 3. Neurosyphilis/: Aqueous penicillin G 3-4 million units every 4 hours for 10-14 days.

Answer 868

Aqueous penicillin G 50,000 units/kg/dose IV every 8-12 hours for 10 days.

Answer 869

Patients who develop an acute febrile syndrome within 24 hours of initial treatment for a spirochetal infection (eg, syphilis, leptospirosis, tick-borne spirochetes) lysis of spirochestes-> release of bacterial proteins-> trigger innate response.

Answer 870

No effective prevention technique, self-limited, resolve in 48 hrs. Can give acetaminophen during the reaction.

Answer 871

The Jarisch-Herxheimer reaction is not mediated by mast cells or basophils so antihistamine therapy is ineffective. Corticosteroids have also not been shown to prevent or improve symptoms.

Answer 872

have fever, dysuria, urinary frequency, and cloudy urine rectal examination typically reveals a warm, edematous, and very tender prostate (unlike urinary tract infection). treatment is to decompress bladder and start empiric antibiotic TMP/SMX, ciproflox

Answer 873

2-3 days after procedure and lasts 5-7 days. Caused by vasocontriction. Prevention with NaCL fluids before and after the procedure. N-acetylcysteine has also been used to prevent CIN but has not been shown to be superior to intravenous saline or sodium bicarbonate.

Answer 874

>=4 months

Answer 875

include microscopic stool examination for leukocytes and parasites, occult blood, pH, staining for fat, and electrolyte analysis for calculating the osmotic gap.

Answer 876

Lactose intolerance Chronic pancreatitis Celiac disease Small intestinal bacterial overgrowth

Answer 877

Diarrhea after lactose-containing meals ↑ Stool osmotic gap ↓ Stool pH + Lactose hydrogen breath test

Answer 878

290 mOsm/kg − 2 x (stool Na + stool K) <50: Secretory diarrhea 50-125: Indeterminate >125: Osmotic diarrhea

Answer 879

lactose intolerance, celiac

Answer 880

↑ Stool osmotic gap Microcytic anemia, iron deficiency Villous atrophy

Answer 881

Macrocytic anemia, B12 deficiency | + Lactulose breath test

Answer 882

increase in native and non-native bacterial flora that cause increased fermentation, inflammation and malabsorption. Normally small intestine contains minimal bacterial colonization due to gastric acidity and peristalsis This can be triggered by: 1. Anatomical abnormalities( strictures, surgery) 2. Motility disorders ( DM, scleroderma) 3. Other causes( end stage renal disease, AIDs, cirrhosis, chronic pancreatitis)

Answer 883

Endoscopy ( gold standard) with jejunal aspirate showing > 10 ^5 organisms Glucose breath hydrogen test ``` TTO: 7-10 days of antibiotics ( rifamixin, amoxi=clav) Avoid antimotiliity(narcotics) dietary changes( low carbs) metochlopramide ```

Answer 884

villous atrophy, loss of the normal villus architecture, intraepithelial lymphocytic infiltrates, and crypt hyperplasia

Answer 885

due to increased capillary permeability leading to hemoconcentration, pleural effusion, and ascites. Circulatory failure can develop with significant plasma leakage and is sometimes referred to as dengue shock syndrome. Patients typically have marked thrombocytopenia (<100,000/mm3) and prolonged fever.

Answer 886

Circulatory failure/hemorrhagic shock

Answer 887

``` Classic: Flulike febrile illness with marked myalgias & joint pains ("break-bone fever") Retro-orbital pain Rash ("white islands in sea of red") transaminitis, LAD, pharyngeal erythema ``` ``` Hemorrhagic Increased vascular permeability Thrombocytopenia (<100,000/mm3) Spontaneous bleeding → shock Positive tourniquet test (petechiae after sphygmomanometer cuff inflation for 5 minutes) ```

Answer 888

cerebral edema

Answer 889

intestinal perforation

Answer 890

gradually with rising fever, chills, relative bradycardia, abdominal pain, and rose spots (faint salmon-colored macules on the trunk and abdomen).

Answer 891

``` Systemic and GI ss ( nausea, emesis) Conjunctival suffusion Hepatosplenomegaly +/- LAD Muscle tenderness, arthralgias Jaundice ( Weil Sx: icteric leptospirosis) ```

Answer 892

the organism inhibits pigment transfer to keratinocytes and makes the affected skin paler than the unaffected tanned skin. Lesions may occasionally exhibit hyperpigmentation compared to surrounding skin due to a localized mild inflammatory response.

Answer 893

``` Pityriasis Rosea -post-viral -herald patch, small pink/tan -trunk and proximal extremities -associated to URI, HSV 6-7 -KOH to rule out tinea Lesions heal 4-12 weeks ``` Tinea versicolor - fungal infection - malssezia species - multiple, often coalescing small circular macular that vary in color - rash + prominent in the summer - MC in upper trunk - KOH

Answer 894

- fungal infection - malssezia species - multiple, often coalescing small circular macular that vary in color - rash + prominent in the summer - MC in upper trunk - KOH

Answer 895

First line: topical anti-fungal therapy. With extensive disease or recalcitrant infection, oral antifungals (ketoconazole, itraconazole, or fluconazole) are preferred

Answer 896

``` post-viral -herald patch, small pink/tan -trunk and proximal extremities -associated to URI, HSV 6-7 -KOH to rule out tinea Lesions heal 4-12 weeks ```

Answer 897

preserve randomization avoid effects of crossover and dropout IT DOES NOT AFFECT PLACEBO EFFECT

Answer 898

Inadequate power.

Answer 899

< 3 months: S.aureus, GBS -, gram - bacilli | > 3 months: S. aureus, GBS

Answer 900

↑ WBC, ESR, CRP Blood culture Joint aspiration (synovial WBC count of >50,000/mm3) Effusion on ultrasound/MRI

Answer 901

Joint drainage & debridement | IV antibiotics

Answer 902

positive Barlow and Ortolani tests with hip dislocation limited hip abduction, and asymmetric gluteal/inguinal folds. Ultrasound would not show effusion.

Answer 903

children age 3-12 insidious-onset hip pain and limp. Deformity of the femoral head is seen on radiograph and MRI. Inflammatory markers are not generally elevated.

Answer 904

a hip effusion, children age 3-8, often following a viral illness normal or only mildly elevated inflammatory markers.

Answer 905

The hazard ratio (HR) is defined as the likelihood of an event occurring in a treatment group relative to the control group. The null value for HR is 1.0. A HR <1.0 indicates an event is less likely to occur in a treatment group than the control group.

Answer 906

HR is similar to relative risk (RR), except that RR is usually calculated at the end of a study (or other defined endpoint) to convey the risk of an event occurring within that time frame. In contrast, HRs are a measure of the instantaneous risk of an event occurring, usually during a subset of the total study period.

Answer 907

isotretinoin, all-trans-retinoic acid, minocycline, tetracycline, cimetidine, corticosteroids, danazol, tamoxifen, levothyroxine, lithium, nitrofurantoin).

Answer 908

hypoparathyroidism, hypothyroidism, adrenal insufficiency, Cushing disease

Answer 909

FEVER ``` Fever Encephalopathy Vitals unstable Enzymes increased Rigidity Myoglobulinuria ```

Answer 910

TTO: Dantrolene

Answer 911

1. Try to wean the dose, if this doesnt work or is already done 2. B blocker: propanolol . Benztropine and benzodiazepines have also been used.

Answer 912

First line: naltrexone, a mu opioid receptor antagonist, Second line acamprosate, a glutamate modulator.

Answer 913

patients taking opioids and in those with acute hepatitis or liver failure.

Answer 914

phenytoin, carbamazepine, ethosuximide, phenobarbital, topiramate by inducing cytochrome P450 system in the liver and lead to increased OCP metabolism, thus decreasing contraceptive efficacy.

Answer 915

Pregnancy AEDs can decrease the efficacy of OCPs by increasing their metabolism,

Answer 916

gabapentin and valproate.

Answer 917

intrauterine adhesions and endometritis | presents with cyclic abdominal pain and amenorrhea immediately after the procedure

Answer 918

True Neurosyphilis can occur at any time following Treponema pallidum infection.

Answer 919

either a combination of rash with tenosynovitis and non-purulent polyarthralgia or lone purulent polyarthritis.

Answer 920

compression of the median nerve as it passes under the transverse carpal ligament in the wrist. relieved by shaking the hands ("flick sign") or running them under warm water.

Answer 921

Phalen test (hyperflexion) Tinel sign (tapping over the nerve in the carpal tunnel) Hand elevation test (holding the hand over the head) Reverse Phalen test (hyperextension of the wrist)

Answer 922

Mild: nightime splint Moderate severe- if after 6 months of conservative measures it persists or there are neurologic changes surgery is an option corticosteroids could be considered if splint fail.

Answer 923

NOT USEFUL

Answer 924

Clinical but EMG ( Nerve conduction studies) can also be done to confirm in preparation of surgery or if ss are uncertain

Answer 925

leukocyte esterase on dipstick analysis or >5 WBC/hpf on microscopy

Answer 926

proportion of people with a particular condition who end up dying from the condition. mortality rate: probability of dying from a particular disease in the general population

Answer 927

proportion of people in whom an illness develops out of the total population at risk for the disease.

Answer 928

are used to determine if the observed number of deaths in a group exceeds what would be expected in a similar group (eg, similar age, gender) excluding the variable of interest (eg, smoking status, cholesterol levels). They are calculated using mortality rates for the general population to determine the number of expected deaths, which are then compared

Answer 929

Snoring Excessive daytime tiredness Observed apneas or choking/gasping High blood pressure BMI >35 kg/m2 Age >50 Neck size: men >17 in (40), women >16 in Male gender High negative predictive value If < 3 OSA LESS likely.

Answer 930

Smoking cessation and elimination of alcohol intake before bedtime are preferred initial management strategies for snoring.

Answer 931

Tension pneumothorax

Answer 932

chest tube Needle decompression is not needed as so far is not tension pneumothorax. If tension pneumothorax there is needle decompression followed by chest tube.

Answer 933

grow rapidly but spontaneously regress by age 5-8. no treatment, but sometimes due to size propanolol

Answer 934

brain-dead organ donor is to maintain a euvolemic, normotensive, and normothermic (or mildly hypothermic) state. Patients often receive intravenous fluids, desmopressin, and pressor support.

Answer 935

Central diabetes insipidus, which can increase urine output to >1000 mL/hr and cause volume depletion Systemic hypotension due to loss of sympathetic tone (and volume depletion) Hypothermia

Answer 936

hypersensitivity reaction in patients with cystic fibrosis or asthma causes bronchiectasis and eosinophilia non-invasive develops recurrent exacerbations with fever, malaise, cough with brownish mucoid sputum, wheezing, or symptoms of bronchial obstruction. Chest X ray upper lobe opacities, atelectasis due to mucus plugging, and signs of bronchiectasis such as bronchial wall thickening.

Answer 937

Eosinophilia Positive skin test for Aspergillus Positive Aspergillus-specific IgG Elevated Aspergillus-specific & total IgE NOT BRONCHOALVEOLAR LAVAGE

Answer 938

directed at acutely stopping the underlying inflammation and decreasing fungal burden to reduce the risk of recurrence. Systemic glucocorticoids first line! Antifungal therapy with either itraconazole or voriconazole ( reduce fungal load and requirements of glucocorticoids) fluconazole has limited activity against Aspergillus so not given

Answer 939

Ascaris lumbricoides, Enterobius vermicularis

Answer 940

IV fluid hydration (ISOTONIC SALINE). There is dehydration due to osmoric diuresis due to glucose.

Answer 941

Pts tend to have high extracellular K due to lack of insulin, but the reality is that there is depletion caused by increased urinary excretion-- SO AGGRESIVE DECREASE IN K IS NOT RECOMMENDED Na levels can be increased or decreased,and either way may affect mental status

Answer 942

vesicular rash on the palms and/or soles that is associated with pruritus, redness, and scaling. The sides of the digits may also be involved, but lesions on the trunk are not typ

Answer 943

TRUE Common triggers include metals (eg, nickel), cleaning products, and a variety of chemicals used in rubber, plastic, and leather processing.

Answer 944

anemia inflammatory arthropathy ( ESR, CRP) Hypothyroid myopathy Some cases myositis with CK

Answer 945

``` Widespread MUSCULOSKELETAL PAIN fatigue impaired attention and concentration psychiatric disturbances( anixety, depression) ss> 3 months. ``` multiple tenderness points abscence of joint/muscle infallmation

Answer 946

↑ Levothyroxine dose 30% at time of positive pregnancy test | Measure TSH every 4 weeks & adjust levothyroxine dose to trimester-specific TSH norms

Answer 947

BhCG stimulates TSH receptors -- > high T3, T4 Increase in thyroglobulin Feedback suppression of TSH **For this reason increase dose of levothyroxine, and check every 4 weeks TSH

Answer 948

penetration of the hair shaft into interfollicular skin, either through the lateral wall of the follicle (transfollicular penetration) or by curving back down into the skin after exiting the follicle (extrafollicular penetration). most prevalent in black men who have tightly curled facial hair.

Answer 949

hyperpigmentation, secondary bacterial infection, and (occasionally) keloid formation

Answer 950

D/C shaving it will resolve in a couple of weeks After this other techniques like single razor blade, warm compresses before shaving, or Chemical depilatories, laser hair removal, and topical eflornithine (which slows hair growth)

Answer 951

SSRIs If it fails a second trial of SSRI can be tried. If it fails and the patient doesnt want to get pregnant, oral contraceptive is also an option.

Answer 952

primarily mood and anxiety disorders developing depression

Answer 953

alloantibodies.

Answer 954

``` Clinically significant ASCVD Acute coronary syndrome Stable angina Arterial revascularization (eg, CABG) Stroke, TIA, PAD Then: Age ≤75: High-intensity statin Age >75: Moderate-intensity statin ``` LDL ≥190 mg/dL Then: High-intensity statin Age 40-75 with diabetes Then: 10-year ASCVD risk ≥7.5%: High-intensity statin 10-year ASCVD risk <7.5%: Moderate-intensity statin Estimated 10-year ASCVD risk ≥7.5% then Moderate- to high-intensity statin*

Answer 955

double rib fractures in more than one site paradoxical movement of chest muscular spasm and pain as well as pulmonary contusions, which lead to hypoxemia and increased work of breathing. tachypnea and tachycardia, with shallow breathing, anterior chest bruises, and signs of inadequate ventilation (cyanosis)

Answer 956

Uncomplicated cases : supplemental oxygen, noninvasive positive-pressure ventilation, and medications for pain control. Severe cases may require mechanical ventilation and surgical stabilization

Answer 957

screening with tuberculin skin testing or interferon-gamma release assay is required. If initial screening is negative, repeat testing at 8-10 weeks can confirm whether transmission occurred.( the screenings can be negative up to 8 weeks) If screening for TB is positive, chest x-ray and sputum testing for acid-fast bacilli are required to evaluate for active TB. If both of these additional tests are negative (and no symptoms of TB are present), patients are usually treated for latent TB with isoniazid and pyridoxine

Answer 958

≥ 5 mm HIV recent Tb exposure chest radiographic findings consisted of healed Tb infection organ transplantation or on immunosuppressants ≥ 10 mm injection drug users diabetes chronic renal failure employees in high-risk settings (e.g., physicians and nurses) ≥ 15 mm considered a positive test in patients with no known risk factors

Answer 959

airborne isolation, use of N95 mask

Answer 960

Treponema pallidum spirochetes directly damage the dorsal sensory roots Secondary degeneration of the dorsal columns Clinical findings Sensory ataxia Lancinating pains Neurogenic urinary incontinence Associated with Argyll Robertson pupils

Answer 961

document verbal agreement and start treatment. Husband should not be used as surrogate decision maker.

Answer 962

YES! Although pregnant women should not receive live virus vaccines due to the theoretical risk of fetal infection, the risk of contracting an infection from a recipient of a live virus vaccine is very low.

Answer 963

Polio | Hepatitis A

Answer 964

Diphtheria, tetanus

Answer 965

Measles Mumps Rubella Varicella

Answer 966

``` Hepatitis B Pertussis Haemophilus influenzae type B Pneumococcal Meningococcal Human papillomavirus Influenza (injection) ```

Answer 967

Most glucagonomas are malignant and have metastasis, mainly in the liver, at the time of diagnosis

Answer 968

Low dose chest CT scan , yearly 55-80 years old Patients that have a history of >=30 years AND is currently smoking or quit smoking within the last 15 years.

Answer 969

Age >80 OR Patient successfully quit smoking for ≥15 years OR Patient has other medical conditions that significantly limit life expectancy or ability/willingness to undergo lung cancer surgery

Answer 970

↓ Bone mineral density ↑ Total cholesterol ↑ Triglycerides Treatment Increased caloric intake Estrogen Calcium & vitamin D

Answer 971

genital pain, scarring, infection, infertility, and difficulty with coitus and/or vaginal delivery.

Answer 972

a sensorineural hearing impairment in elderly individuals. Usually, the disease is gradually progressive, and initially affects the high-frequency range of hearing.

Answer 973

decreased ability to discriminate speech is especially obvious in a noisy, distracting environment. one to one conversation is ok. The speech discrimination score may be normal in these patients; however, introducing background noise can reveal the hearing loss.

Answer 974

BONE MARROW SUPPRESSION early symptoms such as fever, mouth ulcers, easy bruising or petechiae, which can be markers of the development of neutropenia, aplastic anemia or thrombocytopenia. Elderly patients are also at risk of SIADH. Because of some mild anticholinergic effects, there is a risk of glaucoma, urinary retention or constipation.

Answer 975

A confidence interval that crosses the null value or a P-value >α error cutoff (typically 0.05) denotes a result that is not statistically significant.

Answer 976

``` Crush injuries Bites on hands or feet Wounds on body >12 hours or on face >24 hours Cat bites (except on face) Human bites (except on face) Bite wounds in immunocompromised hosts ```

Answer 977

leave them open to heal by secondary intention The face is an exception due to its excellent, redundant vascular supply and cosmetic importance.

Answer 978

can be sutured unless they are >24 hours old.

Answer 979

Clindamycin and gentamicin Is a polymicrobial infection Clindamycin covers aerobic gram-positive cocci and penicillin-resistant anaerobes. Gentamicin covers gram-negative and some gram-positive bacteria (eg, Staphylococcus). Treatment is continued until the patient is afebrile for ≥24 hours.

Answer 980

ampi +genta

Answer 981

Cefoxitin plus doxycycline

Answer 982

THE MOST IS THE ROUTE OF DELIVERY- CESAREAN!!particularly when performed after labor commences or after rupture of membranes. ``` Other RF Cesarean delivery Chorioamnionitis Group B Streptococcus colonization Prolonged rupture of membranes Operative vaginal delivery Preterm (<37 weeks) and post-term (>42 weeks) gestations ```

Answer 983

Fever >24 hours postpartum Uterine fundal tenderness Purulent lochia

Answer 984

< 20 weeks Advanced maternal age Previous spontaneous abortion Substance abuse

Answer 985

``` Consider Rho(D) immune globulin Pathology examination ``` tto Expectant Medical induction (misoprostol) Suction curettage if infection or hemodynamic instability

Answer 986

``` Small joints (PIP, MCP, MTP); spares DIP joints Cervical spine involvement: subluxation, cord compression ```

Answer 987

order RF *, and start ibuprofen/naproxen( while diagnostic workup) *Anti CCP, CRP, ESR can be ordered

Answer 988

RA is chronic, often has palpable synovitis at palpation Parvovirus often improves by 3-6 weeks.

Answer 989

order ANA, if positive DsANA

Answer 990

A positive assay for RF or CCP antibodies is associated with accelerated joint destruction, whereas patients who are negative for both RF and CCP antibodies (seronegative RA) often have a less aggressive course. Is good to have CRP or ESR which would be high. If that's the case can be started on Methrotexate

Answer 991

folate antimetabolite that targets rapidly proliferating cells. It inhibits dihydrofolate reductase, blocking synthesis of purines and impairing replication of DNA. Major side effects include hepatotoxicity, stomatitis, and bone marrow suppression.

Answer 992

hepatic function

Answer 993

folic acid

Answer 994

initial leukocyte count is typically normal thrombocytopenia, hyponatremia transaminitis

Answer 995

Rickettsia rickettsii infection Transmitted by tick bite Peaks in summer

Answer 996

Rickettsia serology Skin biopsy Doxycycline for everyone, including children and pregnant women.

Answer 997

Fever, headache, myalgias , arthralgia THEN 2-6 DAYS AFTER: erythematous macules on the wrists and ankles that then spread to the rest of the body AND EVOLVE TO PETECHIAE Oklahoma and North Carolina have the highest incidence.

Answer 998

encephalitis, pulmonary edema, arrhythmia | So treat empirically before awaiting for confirmatory tests

Answer 999

Amoxicillin

Answer 1000

fever, headache, and a petechial/purpuric rash. | Intense myalgias

Answer 1001

Ceftriaxone

Answer 1002

Mother: continue ART Infant (maternal viral load ≤1,000 copies/mL): zidovudine Infant (maternal viral load >1,000 copies/mL): multidrug ART

Answer 1003

Avoid artificial ROM, fetal scalp electrode, operative vaginal delivery Viral load ≤1,000 copies/mL: ART + vaginal delivery Viral load >1,000 copies/mL: ART + zidovudine + cesarean delivery

Answer 1004

``` Active untreated tuberculosis HIV infection* Herpetic breast lesions Active varicella infection Chemotherapy or radiation therapy Active substance abuse Galactosemia ```

Answer 1005

anaphylaxis to neomycin anaphylaxis to gelatin pregnancy immunosuppressed state

Answer 1006

YES After varicella vaccine, vaccinated individuals should be monitored for a rash and isolated if one develops. if rash develops the kid need to be isolated from the immunisupressed member until rash clears. an the member should receive IG

Answer 1007

Exposure and response prevention therapy, a specific form of cognitive-behavioral therapy (CBT), is considered first-line psychotherapy for OCD SSRIs can also be used

Answer 1008

Borderline disorder

Answer 1009

depressive disorders

Answer 1010

traces problems back to their origins in childhood

Answer 1011

pain in spinal stenosis increases with extension of the spine and decreases with flexion of the spine.

Answer 1012

primary bile salts produced in liver --> excreted to intestine where bacteria transform them to secondary bile salts. Conditions that cause excess of secondary bile salt cause diarrhea

Answer 1013

post-cholecystectomy post ileal resection short bowel syndrome

Answer 1014

Cholestyramine: bile salt-binding resin that sequesters excess bile salts and is often effective against this form of diarrhea.

Answer 1015

cryoglobulinemia

Answer 1016

Palpable purpura Weakness Arthralgias elevated rheumatoid factor and hypocomplementemia. Approximately 20% of patients develop glomerulonephritis

Answer 1017

Hyperviscosity syndrome resulting from cryoglobulins (single or mixed immunoglobulins) in the blood Pathogenesis proteins, mainly immunoglobulins, precipitate at cold temperatures- deposit of immune complex within small and medium vascular wall. IgM antibody (but different from cold agglutinin disease) deposition often against anti-hepatitis C IgG precipitated clumps can block blood vessels

Answer 1018

``` most commonly underlying hepatitis C ( history of IV drug use) less commonly hepatitis B endocarditis Sjogren's syndrome multiple myeloma MGUS lymphoproliferative disorder ```

Answer 1019

serum cryoglobulin levels. Treatment of underlying disease -Hep C antiviral Initial immunosuppressive therapy – stabilizes end-organ damage (eg, glomerulonephritis) using rituximab plus prednisone **ojo is not extended immunosuppresive therapy, is just to halt end organ damage.

Answer 1020

patients with Cushing's disease who underwent bilateral adrenalectomy due to bilateral adrenal hyperplasia due to enlarging ACTH tumor. ( loss of feedback from adrenal) Hyperpigmentation Amenorrhea Expansion of pituitary tumor, causing hemianopia MRI and plasma ACTH levels are required for making the diagnosis.

Answer 1021

complications of anticoagulation, contraindications to anticoagulation ( i.e peptic ulcer disease), or failure of anticoagulation in the setting of a known DVT or PE

Answer 1022

Osteopenia :T-score −1 to −2.5 Osteoporosis:T-score −2.5 or less OR history of fragility fracture** TEST WITH dual-energy x-ray absorptiometry.

Answer 1023

OCD and ADH NOT DEPRESSION

Answer 1024

1.Both multiple motor & ≥1 vocal tics (not necessarily concurrent, >1 year) Motor: Facial grimacing, blinking, head/neck jerking, shoulder shrugging, tongue protrusion, sniffing Vocal: Grunting, snorting, throat clearing, barking, yelling, coprolalia (obscenities) 2.Onset age <18

Answer 1025

1.Behavioral therapy (habit reversal training) 2.Antidopaminergic agents Tetrabenazine (dopamine depleter) Antipsychotics (receptor blockers) 3.Alpha-2 adrenergic receptor agonists

Answer 1026

dsDNA good to evaluate course Anti-dsDNA antibody levels have also been associated with the development of lupus nephritis

Answer 1027

scleroderma

Answer 1028

primary biliary cirrhosis (PBC),

Answer 1029

seen in LUPUS

Answer 1030

correlated with a butterfly photosensitivity rash and other cutaneous manifestations of SLE as well as interstitial lung disease and congenital heart block. However, it is not considered as reliable as anti-dsDNA antibodies.

Answer 1031

Prednisone and hydroxycloroquine Hydroxychloroquine is an anti-malarial agent that is particularly effective at improving arthralgias, serositis, and cutaneous symptoms in SLE. Low dose, short-term prednisone may be used in patients with acute mild manifestations of SLE, whereas higher dose steroids or other immunosuppressants are typically reserved for patients with more severe, solid-organ manifestations.

Answer 1032

1. Airway obstruction/edema ( immediate) 2. Residual effect of anesthesia ( immediate)-decreased respiratory drive and arousal 3. Bronchospasm 4. Pneumonia (1-5) 5. Atelectasis (2-5) 6. PE

Answer 1033

hypoxemia due to intrapulmonary shunting, the hypoxemia fails to correct with supplemental oxygen and the A-a gradient is typically elevated. Usually, present 2-5 days following surgery

Answer 1034

It is the ratio of observed to expected number of deaths in a specific group of the general population under the assumption that mortality rates for the group are the same as those for the general population. A confidence interval (CI) that does not include the null value (1.0 for SMRs) indicates a statistically significant difference between the observed and expected number of deaths.

Answer 1035

Working populations are generally healthier than the general population and often exhibit lower mortality rates.

Answer 1036

Mean is 12 | Range is age 9-16 months.

Answer 1037

onset of secondary sex characteristics in boys age <9 and girls age <8.

Answer 1038

First bone age. If advanced then either central vs. peripheral. Order LH If LH high : central and it can be due to a tumor or idiopathic ( so MRI needed to distinguish both) - in this case patients will present with enlarged testes If LH decreased: peripheral (adrenal, gonads, or external cause)

Answer 1039

Both are due to 21 hydroxylase deficiency Nonclassic: reduced 21-hydroxylase activity acne and early pubic (and axillary) hair development. Boys have normal-sized testes, but girls often have hirsutism and menstrual irregularities. Although stature is tall in childhood, advanced bone age may result in short stature in adulthood due to early closure of the epiphyseal plates.NON SALT WASTING Classic

Answer 1040

elevated 17-hydroxyprogesterone on ACTH stimulation test. Treatment is with hydrocortisone.

Answer 1041

surgery Radioactive ablation may enlarged the thyroid External beam radiation has no role in treatment

Answer 1042

premature coronary atherosclerosis

Answer 1043

caused by residual embryologic tissue during genitourinary development in boys.

Answer 1044

dilation of bladder, thickened bladder wall, bilateral hydronephrosis. this leads to an obstructive pattern. If obstruction is severe --> oligohydramnios can result and cause Potter sequence--> pulmonary hypoplasia flattened fascies

Answer 1045

pulmonary hypoplasia flattened fascies

Answer 1046

formation of multiple ureteric buds during kidney formation. may be asymptomatic, have recurrent UTIs or even unilateral hydronephrosis

Answer 1047

voiding cystourethrogram diagnosis is confirmed by visualization of a dilated posterior urethra when the catheter is removed (the catheter keeps the valve open and must be removed before the end of imaging).

Answer 1048

Place a foley catheter to relieve obstruction partially. When conditions stabilized cystoscopy allows direct visualization and ablation of the valve, which is curative.

Answer 1049

Cognitive-behavioral therapy and interpersonal psychotherapy

Answer 1050

1. In HIV patients: onset of sexual intercourse, diagnosis, annually until >=3 are normal, then every 3 years. 2. Immunosuppressed (SLE, organ transplant): onset of sexual activity, annually with pap smear and co-test hpv

Answer 1051

NO. at 21 years old every 3 years. except immunocompromised patients test is not started in< 21 yo.

Answer 1052

Cytology every 3 years or every 5 years pap smear and HPV

Answer 1053

at >=65 or hysterectomy.

Answer 1054

is often just the pap smear every 3 years

Answer 1055

capsular contracture, implant deflation, and rupture. These are not associated with increased risk of cancer, rheumatologic conditions, autoimmune etc.

Answer 1056

regular, same as for non implant person All women aged 50-74 should have mammograms every 1-2 years 10 years earlier if a first degree relative they recommended magnetic resonance imaging every 2 or 3 years over the lifetime of the implant to screen for asymptomatic implant rupture, which could lead to scarring within the breast.

Answer 1057

none, there is not enough data

Answer 1058

Streptococcus pneumoniae Nontypeable Haemophilus influenzae Moraxella catarrhalis

Answer 1059

Bulging TM | Middle ear effusion plus TM inflammation (eg, fever, otalgia, erythema)

Answer 1060

Initial: Amoxicillin | 2nd-line: Amoxicillin-clavulanic acid

Answer 1061

S.pneumoniae Infection that develops >2 weeks later is usually due to different pathogens.

Answer 1062

nontypeable H influenzae.

Answer 1063

nonpurulent (rather than purulent) conjunctivitis, pharyngitis, upper respiratory infection, and gastroenteritis, otitis

Answer 1064

10-day course of high-dose amoxicillin

Answer 1065

persistent treatment failure has persistent effusion for >3 months or has >3 episodes of AOM in 6 months (or >4 in a year),

Answer 1066

exhibit magical beliefs, eccentric behavior & thinking, unusual perceptual experiences

Answer 1067

acute stress disorder: PTSD ss Lasting >=3 days & <1 month PTSD >1m Adjustment disroder: trigger can be of any severity and usually generates anxiety/depression but no psychiatric components.

Answer 1068

Erythromycin ointment

Answer 1069

oral azithromycin or erythromycin

Answer 1070

headaches that last <180 minutes and occur 1-8 times a day over a period of weeks. orbital, supraorbital, or temporal and always unilateral. ipsilateral autonomic symptoms such as ptosis, miosis, lacrimation, conjunctival injection, rhinorrhea, and nasal congestion.

Answer 1071

for those who have > 2 month of ss Verapamil 240 mg to start

Answer 1072

Carbamazepine

Answer 1073

100% O2 by a nonrebreathing facial mask. This treatment is administered for >15 minutes and provides significant relief in >70% of patients.

Answer 1074

endometriossis

Answer 1075

``` Rewarming for hypothermia Antibiotics for presumed systemic infection Rehydration Oral rehydration solution preferred Intravenous fluids if in shock Refeed cautiously ``` oral rehydration is the preferred method of rehydration. An orogastric or nasogastric tube IV should be avoided due to the risk of fluid overload and heart failure Feeding should be started cautiously due to risk of refeeding syndrome

Answer 1076

euglycemic DKA glucose < 250 euDKA in patients taking SGLT2 inhibitors can be triggered by prolonged fasting, major illness, intense exercise, excessive alcohol intake, or an abrupt reduction in concurrent insulin dose. These conditions further lower the insulin-to-glucagon ratio and exacerbate relative insulin deficiency to the point of stimulating ketogenesis. ``` Hyperkalemia Hyperlipidemia Symptomatic hypotension Acute kidney injury UTI ```

Answer 1077

lower blood glucose by reducing reabsorption of glucose in the kidney, which leads to a low insulin-to-glucagon ratio because high blood glucose levels are the primary stimulus for insulin release.

Answer 1078

TRUE, just osteopenia, osteoporosis, breast and vaginal atrophy, mild hypercholesterolemia, and infertility.

Answer 1079

uterine sarcoma

Answer 1080

Pelvic radiation Tamoxifen use Postmenopausal patients

Answer 1081

Rh(D)-negative mother develops antibodies against Rh(D) antigen. can lead to hemolytic disease of an Rh(D)-positive newborn and/or fetus; maternal IgG anti-D antibodies cross the placenta and destroy fetal red blood cells. When severe anemia develops in the fetus, it can lead to heart failure and subsequent hydrops fetalis (

Answer 1082

prenatal visit and at 28 weeks positive: alloimmunization has occurred and anti D Ig is not needed negative: at 28 and then <72 hours after delivery

Answer 1083

``` At 28-32 weeks gestation <72 hours after delivery of Rh(D)-positive infant <72 hours after spontaneous abortion Ectopic pregnancy Threatened abortion Hydatidiform mole Chorionic villus sampling, amniocentesis Abdominal trauma 2nd- & 3rd-trimester bleeding External cephalic version ```

Answer 1084

Examine potential reversible causes.

Answer 1085

``` Delirium Infection (eg, UTI) Atrophic urethritis/vaginitis Pharmaceuticals (eg, alpha blockers, diuretics) Psychological (eg, depression) Excessive urine output (eg, diabetes mellitus, CHF) Restricted mobility (eg, postsurgery) Stool impaction ```

Answer 1086

Alpha-adrenergic antagonists (urethral relaxation) Anticholinergics, opiates, calcium channel blockers (urinary retention/overflow) Diuretics (excess urine production)

Answer 1087

if complaint doesnt seem acute dont send to the ED, | and say that they can schedule an appointment in the morning.

Answer 1088

hystrionic personality

Answer 1089

both can exhibit attention-seeking, manipulative behavior, and rapidly shifting emotions. BUT borderline exhibit self-injurious and suicidal behavior, intense anger, chronic feelings of emptiness, and identity disturbance

Answer 1090

SVT refers supraventricular tachycardia with abrupt onset and offset and regular ventricular response, including atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), and atrial tachycardia. --- reentrant circuit SVT- retrograde P waves(atrial depolarization follows ventricular), that are inverted in the inferior leads Sinus tach- normal P waves and onset is gradual

Answer 1091

Wolff-Parkinson-White (WPW) pattern, which is commonly associated with the development of atrioventricular reentrant tachycardia (AVRT).

Answer 1092

Constrictive pericarditis

Answer 1093

Idiopathic or viral cardiac surgery or radiation therapy TB pericarditis

Answer 1094

may be not specific (i.e. tachycardia) or show atrial fib or low voltage QRS NOT THE TYPICAL PATTERN FOR PERICARDITIS

Answer 1095

thyroid dysfunction hepatotoxicity, cardiac bradyarrhythmias, chronic interstitial pneumonitis, neurologic symptoms (eg, ataxia, peripheral neuropathy), blue-gray skin discoloration, and visual disturbances

Answer 1096

mood changes, feeling depressed and then angry there will be other ss including worsened acne and hirsutism MEN: decreased testicular size and sperm count, gynecomastia WOMEN :Ovarian dysfunction ERYTHROCYTOSis, hepatic dysfunction, altered lipid profiles,

Answer 1097

numerous periods of hypomanic and depressive symptoms that occur over at least 2 years.

Answer 1098

agitation, aggressiveness, and psychosis.

Answer 1099

Coxsackie A Summer age 3-10 drooling, fever, sore throat, vesicles in soft palate and tonsillar pillars saline gargles, analgesics, and antipyretics HAND WASHING CAN PREVENT OUTBRAKES

Answer 1100

subphrenic abscess, DEVELOPS 14-21 days after Surgery. SO ORDER AN ABDOMINAL US TO ASSESS THIS!

Answer 1101

SURGERY , cryotherapy, electrosurgery, and radiation therapy.

Answer 1102

basal cell carcinoma: locally invasive, no metastasis , pearly nodule with telangiectasis , palydasing nuclei. upper face and upper lip. Mohs surgery squamous cell carcinoma:sun, scars, burns, immunosuppresse.Ulcerative lesions, tto: surgery, radiation, cryotherapy.

Answer 1103

episodic headache, sweating, and tachycardia

Answer 1104

24-hour fractionated urinary metanephrines and catecholamine levels AND plasma fractioned metanephrines Twenty-four-hour urinary vanillylmandelic acid excretion has a much lower sensitivity and specificity compared with 24-hour urinary fractionated metanephrine and so is not preffered.

Answer 1105

MRI of abdomen Patients with negative abdominal imaging usually require further testing, such as the metaiodobenzylguanidine scan. Removal of the tumor is performed only after adequate preoperative control of blood pressure for 10-14 days with an alpha blocker, and intravascular fluid volume repletion with liberal fluid and salt. Beta blockers are given only to patients with adequate and complete alpha blockade.

Answer 1106

alpha blockers first, then b blockers

Answer 1107

bolus of IV fluids no need of dopamine.

Answer 1108

polysomnography include multiple spontaneous awakenings and reduced sleep efficiency (total sleep time divided by total recording time) and latency of rapid eye movement (REM) sleep =<5 15 min

Answer 1109

modafinil- stimulant

Answer 1110

serotonin-norepinephrine reuptake inhibitor (eg, venlafaxine) or selective serotonin reuptake inhibitor, and a tricyclic antidepressant- because the cataplexy is triggered by emotional distress Sodium oxybate (the salt form of gamma-hydroxybutyrate) can improve nocturnal sleep, relieve excessive daytime sleepiness and has anti-cataplectic properties; however, it is rarely used due to abuse potential and restrictive regulations.

Answer 1111

postpartum blues 5 days postpartum and resolves within 2 weeks. postpartum depression >=2 weeks + SIGECAPS

Answer 1112

Sertraline and paroxetine

Answer 1113

Arthrocentesis is both diagnostic and therapeutic. Give empiric antibodies-- vanco MRI IS NOT DONE BEFORE ARTHROCENTESIS because can delay treatment.

Answer 1114

Vancomycin

Answer 1115

Age <3 months: Staphylococcus aureus, group B Streptococcus, gram-negative bacilli Age ≥3 months: Staphylococcus aureus, group A Streptococcus

Answer 1116

Systemic antibiotics are indicated for wounds complicated by deep infection (eg, cellulitis, osteomyelitis).

Answer 1117

If not involvement of subcutaneous tissue --occlusive, semipermeable changes If fullthickness -- DEBRIDEMENT ABCs are only used if suspected overinfection

Answer 1118

Start levothyroxine immediately to prevent cognitive decline. Order ultrasound of the thyroid Refer to endocrinology **initially most infants lack clinical signs of hypothyroidism at birth as maternal T4 crosses the placenta

Answer 1119

Infants with congenital hypothyroidism may experience permanent intellectual disability if hormone replacement is not initiated by age 2 weeks

Answer 1120

weight below the 5th percentile or down-trending weight percentiles crossing 2 or more major percentiles (eg, 50th, 25th, 10th).

Answer 1121

inadequate calorie intake secondary to psychosocial stressors.

Answer 1122

Pregnancy test

Answer 1123

Nitrofurantoin for 5 days (avoid in suspected pyelonephritis or creatinine clearance <60 mL/min) Trimethoprim-sulfamethoxazole for 3 days (avoid if local resistance rate >20%) Fosfomycin single dose pregnants: cephalexin, fosfomycin, and amoxicillin-clavulanate,

Answer 1124

fluoroquinolones 5-14 days, ampo/gentfor severe cases

Answer 1125

6 weeks. we have to wait until there without doing changes

Answer 1126

- evaluate VS - Order labs to assess organic causes psychotrophics are NOT the first line, always study potential underlying causes first

Answer 1127

- patients with a single episode: for 6 months following acute response (referred to as "continuation phase treatment"). The dosage that achieved response should be maintained and not reduced - history of multiple episodes (recurrent major depressive disorder), chronic episodes (≥2 years), strong family history, or severe episodes (eg, suicide attempt) should be considered for maintenance treatment.-->1-3 years following remission to prevent recurrence highly recurrent (eg, ≥3 lifetime episodes) and very severe, chronic major depressive episodes may need to continue maintenance treatment indefinitely.

Answer 1128

MRI of the side. **not bilaterall, no x rays.

Answer 1129

conservative therapy, core decompression, osteotomy, and joint replacement. Total hip replacement is the therapy of choice for stage 4 disease of the femoral head (flattening of the femoral head with joint space narrowing).

Answer 1130

dementia (ie, progressive cognitive decline that causes functional impairment) when ≥2 of the following 4 clinical features are present: Fluctuating cognition (eg, alertness, attention) Visual hallucinations Parkinsonism Rapid eye movement sleep behavior disorder (ie, loss of normal rapid eye movement sleep atonia)-dream enactment.

Answer 1131

cholinesterase inhibitors (Donepezil)for cognitive impairment, carbidopa-levodopa for parkinsonism, and melatonin for REM sleep behavior disorder. Quetiapine can be given for hallucinations

Answer 1132

QUETIAPINE IS PREFERRED OVER Risperidone for hallucinations Some patients are extremely sensitive: worsening of confusion, parkinsonism, or autonomic dysfunction ( orthostatic hypotension).

Answer 1133

parent-child behavioral therapy

Answer 1134

initial treatment with nonpharmacological interventions (behavior therapy) in preschool-age children (3-5). If therapy fails medication can be used. Older children (age >6) may receive pharmacotherapy as a first-line treatment.

Answer 1135

Cardiac history and physical exam NO NEED FOR ECG

Answer 1136

switch to another ADHD med, mixed amphetamines salts other non-stimulant options: atomoxetine, clonidine

Answer 1137

No tapering or washout is needed, and the patient can be switched immediately from one stimulant to another.

Answer 1138

Methylphenidate, mixed amphetamine salts | non stimulants: atomoxetine and clonidine

Answer 1139

PTHRP--( Squamous cell, renal&bladder, breast and ovary) Bone metastasis (Breast,Multiple myeloma)- increse osteolysis increased vit D -- lymphomas.

Answer 1140

in primary hyperpara--> Ca is high but < 12 usually In malignancy the Ca are VERY HIGH

Answer 1141

B blockers Metoprolol, atenolol or non dihydropyridine Ca blockers: , diltiazem, verapamil)

Answer 1142

Empty stomach with water at least 30-60 min before breakfast If taking Ca and iron, these should be separated for at least 3-4 hours

Answer 1143

G6PD deficiency

Answer 1144

G6PD deficiency

Answer 1145

G6PD assay detects the production of NADPH which is low.

Answer 1146

Hereditary spherocytosis

Answer 1147

XL Asian, African, or Middle Eastern descent Neonatal unconjugated hyperbilirubinemia Jaundice & anemia day of life 2-3 Acute hemolytic episode Secondary to oxidative stress (eg, fava beans, sulfa drugs) Jaundice, pallor, dark urine, abdominal/back pain

Answer 1148

Repeat after the acute episode. The acute episode usually lasts 1-2 weeks after the removal of offendant agent

Answer 1149

thalassemia and sickle cell disease

Answer 1150

women >=65 or < 65 if risk factors ( low body weight, current smoking, family history of hip fracture, use of glucocorticoids)

Answer 1151

Low bone mass with a history of fragility fracture Bone density criteria for osteoporosis (T-score 20% or hip fracture >3% based on the FRAX risk calculator

Answer 1152

full thickness, and partial thickness Superficial ones doesnt require and there is a risk of allergic contact dermatitis and antibiotic resistance

Answer 1153

in the distal upper extremities pronounced with outstretching of the ar increases at the end of an activity or movement.

Answer 1154

It does not affect life expectancy The symptoms won't resolve COMPLETELY with medications and WONT cause disability, and WONT resolve

Answer 1155

propanolol

Answer 1156

Rounded opacity ≤3 cm in diameter (>3 cm is considered a "mass") Surrounded by pulmonary parenchyma No associated lymph node enlargement

Answer 1157

compare previous x-rays or CT scans; a nodule with stable size and appearance over 2-3 years has a low risk for malignancy and requires no further workup. If change in size or no previous imaging CT chest partially solid (heterogenous) or has a spiculated (spikes radiating from the surface), rather than rounded, surface is more likely to be malignant.

Answer 1158

partially solid (heterogenous) or has a spiculated (spikes radiating from the surface), rather than rounded, surface is more likely to be malignant.

Answer 1159

Nodules >0.8 cm that are intermediate or high probability for malignancy due to RF (ie, ≥5% probability) based on these factors require tissue diagnosis with biopsy or surgical excision.

Answer 1160

Ocular motility, sensory, bowel, bladder, and cognitive functions are preserved, even with advanced disease.

Answer 1161

glutamate inhibitor

Answer 1162

NO!! THERE IS NO FLARE. AND THE UNIQUE TTO IS RILUZOLE

Answer 1163

NSAIDs ( Indomethacine) HOWEVER in patients with CKD or bleeding --> INTRA-ARTICULAR GLUCOCOSRTICOSTEROIDS. ) Colchicine should be avoided in patients with renal failure.

Answer 1164

FIRST: steroids are only used above NSAIDs if the patients have CKD or blood loss. Intra-articular steroid is given if involvement of just one articulation Oral prednisone if >1 joint involved.

Answer 1165

FEV1 remains as the single most important factor in determining the prognosis of patients with COPD. A FEV1 below 40% of predicted indicates severe obstruction. Residual volume is NOT

Answer 1166

Ejection fraction

Answer 1167

Radionuclide ventriculography

Answer 1168

FIRST the antibody IF Then if negative, schilling test.

Answer 1169

antibody to gastric parietal cell leads to ineffective secretion of IF leads to vitamin B12 deficiency due to decreased uptake in terminal ileum accompanied by achlorhydria and atrophic gastritis( ABSENT RUGAE IN THE FUNDUS)

Answer 1170

caused by autoimmune aggression against gastric mucosa mainly directed against oxyntic cells and intrinsic factor. glandular atrophy, intestinal metaplasia and inflammation. Atrophy affects mainly the gastric body and fundus.

Answer 1171

Schwann cells

Answer 1172

Acute bronchitis

Answer 1173

Precending Upper respiratory infection (90% viral) cough for >5 days to 3 weeks (± purulent sputum) Absent systemic findings (eg, fever, chills) Wheezing or rhonchi, chest wall tenderness **yellow and green sputum represent sloughing of epithelial cells and not bacteria they can have crackles that disappear with coughind due to mobilization of sputum.

Answer 1174

Symptomatic management, there is no benefit of antibiotics.

Answer 1175

Expectant management as long as he has reassuring tracings. The cervix often contracts a little bit with delivery of the first kid, then it opens again.

Answer 1176

``` May present as patch of telangiectasias at birth Proliferation: Age 0-1 Bright red, raised nodule Involution: Age 1-9 Deeper red/violet, regression in size ```

Answer 1177

combines detection of HIV antigen (p24) and HIV-1/HIV-2 antibodies. at 4 weeks of infection, before there is likelihood that is negative.

Answer 1178

<72 hours after exposure (ideally within 1-2 hours).

Answer 1179

at 4 weeks of infection, before there is likelihood that is negative.

Answer 1180

Hep B, some antivirals have dual action. ** also test for Hep C, TB and other STIs

Answer 1181

CT FIRST!!!! BEFORE LP if negative CT

Answer 1182

clonidine or adjunctive medications (antiemetics, antidiarrheals, benzodiazepines)

Answer 1183

methadone (preferred) or buprenorphine

Answer 1184

Gastrointestinal: nausea, vomiting, diarrhea, cramping, ↑ bowel sounds

Answer 1185

Cardiac:↑ pulse, ↑ blood pressure, diaphoresis

Answer 1186

insomnia, yawning, dysphoric mood

Answer 1187

patient raise his arms over his head for up to 60 seconds. The presence of facial plethora or engorgement of neck veins is strongly suggestive that the thyroid is the source of the patient's obstructive symptoms.

Answer 1188

``` Glucose >200 mg/dL Bicarbonate <15 mEq/L pH <7.3 Anion gap >14 Serum/urine ketones ```

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3CK PART I Flashcards

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