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Step 3 Prep > Medicine 4 > Flashcards

Medicine 4 Flashcards

1
Q

11moF comes to ED with parents. Has had fever to 102 for several days and now decreased PO, bilateral conjucntival erythema with watery discharge and erythematous rash that started on the cheeks, now spread to rest of the body
Exam: macolopapular rash on face, trunk and proximal extremities sparing palms and soles. mulitple anterior cervical LN. Several kids at daycare w/ sim illness

A

Rubeola or Measles; vaccine preventable.
Cough, corzya and conjuctivitis; maculopapular rash starts on face–> cephalocaudal spread
Can get Koplik spots on buccal mucosa

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2
Q

2 yo presents with fever and cough for several days, then developed red rash on cheeks and reticular truncal rash

A

Parvovirus

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3
Q

Rough small erythematous lesions on sun exposed areas. Seen in old people
Dx
Tx
risk if left untreated

A

Actinic keratosis
5 fluorouracil, cryotherapy, excision
Squamous cell carcinoma
tx epidural block or decompression

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4
Q

Low back pain that is WORSE with extension, prolongued standing and better when sitting or bending forward. Seen in old people

A

lumbar spinal stenosis

Get MRI for diagnosis

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5
Q

Hypopigmented lesions scattered on body, family hx of bilateral deafness

A

NF-2

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6
Q

Facial port wine stain and leptomeningeal angiomatosis

A

Sturge Weber

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7
Q

Congenital hypopigmented maclues (ash leaf), glial proliferation, several organ hamartomas/cysts

A

Tuberous sclerosis

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8
Q

Pt with cutaneous neurofibromas, unilateral acoustic neuroma, axllary freckles

A

NF-1

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9
Q

Pt with HIV can have transient worsening of symptoms several weeks after initiation of ART due to _____

A

immune reconstitution inflammatory syndrome
From potent immune recovery that quickly occurs after initiation of ART; self limited and requires NO alteration to current therapy

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10
Q

PT comes in with pain and deformity of the wrist. The xray shows fracture of the distal radius.
MCC of this fracture?

A

Colles fx
FOOSH; fall onto outstretched hand; may have concurrent ulnar styloid fracture
Are at increased risk for carpal tunnel syndrome
manage with splint unless >15 to 20 degree angulation then likely reduction

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11
Q

Mom is pregant, on US they notice dilated kidneys, mild thickening of the bladder wall. Later diagnosed with oligohydramnios. Most likely cause?

A

Posterior urethral valves

Dx with voiding cystourethrogram

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12
Q

Pain in anterior knee, worse with climbing or squatting, running, prolonged sitting, has been going on for a few months.
Normal knee exam xray with pain on extension of knee with anterior patellar compression

A

Patellofemoral pain syndrome

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13
Q

Gardener comes in with significant left knee pain. Swelling noted around the anterior knee and localized swelling.

A

Prepatellar bursitis

often complicated by secondary infection; S.Aureus

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14
Q

Women 6 weeks post partum comes in with wt loss, sweating, fatigue and heat intolerance. She has already lost 15 pounds, no menstration. She is tachy to 110, has enlarged and nontender thyroid on exam, no nodules.
TSH <0.01, T4 is elevated and elevated anti-thyroid peroxidase antiB.
Radioactive iodine in thyroid gland is very low.
Dx?

A

Postpartum thyroiditis

Pt has primary hyperthyroidism (low TSH, elvated T4), can tell apart from Hashimoto by RAIU which would be HIGH

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15
Q

Drugs associated with pancreatitis

A

Tylenol/NSAIDS/Mesalamine
Sulfa containing drugs
ABx: isoniazid, tetracyclines, metronidazole, bactrim
AED: Valproic adn carbamazepine
Diuretics: thiazide, furosemide or enalapril/losartan
immunosuppresants: azathioprine, mecercaptopurine, steroids

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16
Q

___ should be stopped on day contrast is given with cardiac cath especially those with renal insufficiency, hepatic dysnfnx or EtOH abuse or CHF due to increased risk for lactic acidosis when combined with large dose IV contrast.

A

Metformin

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17
Q

7yo presents with leg weakness/tired after soccer practice, otherwise no complaints. On PE you hear a cont systolic murmur on the back in the left interscapular area, has elevated BP in RUE. Vitals and PE otherwise NML.
Dx

A

Coarctation of aorta
you can see rib knotching on CXR with figure “3” sign of aortic narrowing and have hypotension of LE with delayed pulses
Echo to confirm dx

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18
Q

Pulses paradoxus or decline in BP (>10mmg HG) during inspiration occurs in which pathology?

A

tamponade

pt with chest pain, dyspnea, hypoT, JVD, muffled heart sounds

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19
Q

Pt has elevated calcium, elevated parathyroid levels, and lipomas on back with hx of GI bleed.
Suspicious for?

A

MEN1: 3 Ps: parathyroid adenoma/hyperplasia, pancreatic or GI tumor (zolliger ellison) and Pituitary adenoma; associated with lipomas
Need parathyoidectomy if dx <50yo

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20
Q

Primary hyperparthyroidism, Medullary thyroid carcinoma and pheochromocytoma are seen in?

A

MEN 2A

–test for calcitonin (MTC) and metanephrines

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21
Q

MEdullary thyroid cancer, pheo and mucosal neuromas/marfinoid

A

MEN2B

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22
Q 
Pt with jaundice, nausea comes to office. Unclear vaccination hx, multiple sexual partners. 
Hep B surface antiB: Neg
Hep B core antiB IgM +
Hep B core antiB IgG: Neg
Hep B ssurface antigen: +
Hep C antiB: Neg
HIV: Neg
Elevated AST and ALT
Dx?
Tx?
A

Acute Hep B
monitor labs closely; acute liver failure VERY rare and most cases resolve spontaneously
Hospitalize if abnormal coags, septic or HD unstable or >50 yo

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23
Q

What patients with newly dx Hep B get antiviral therapy/

A

immunosuppressed pts, concurrent hep C, severe hepatitis, fulminant hepatic failure

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24
Q

Who recieves Hep B vaccine and immunoglobulin

A

those exposed to known hep B pt or needle stick

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25
When are you dx with chronic hep B?
If you still have not cleared Hep B surfance antigen w/i 6 months of infection
26
What type of arrythmia do pt with hyperthyroidism present with? What do we do for them?
can have supraventricular arrythmias (like a fib) thus should be treated with B blockers to control heart rate while started on tx for their hyperthyroidism which can take weeks
27
Pt with unilateral facial weakness, can't raise eyebrow with drooping of corner of mouth and disappearance of nasolabial fold Dx Tx
Bells palsy; idiopathy CN VII neuropathy INVOLVES the eyebrow. Tx is steroids (even if HSV is implicated)
28
When diverticulitis does not improve with oral outpatient therapy in 2-3 days,what is the next step
repeat CT to eval for complications
29
Goal TSH level while on levothyroxine for small, low risk tumors (papillary)?
Goal dose levothyroxine for target TSH 0.1 to 0.5 for about a year then low normal range (<2.0)
30
How do you handle shoulder dystocia?
Breathe, don't push, elevate the legs and flex the hips with thighs to abdomen (McRoberts), apply suprapubic pressure as next step, episostomy next step and then deliver posterior arm
31
First line treatment for tinea capitis?
ORAL griseofulvin, oral terbinafine also acceptable
32
Necrotizing fasciitis; pain out of proportion, swelling, ertyhema as well as fever and hypotension. Two common causes?
Type I; from trauma or surgery; GAS or strep pyogenes Type II: underlying diabetes or peripheral vascular disease and polymicrobia (Staph, bacteriodes, E.coli) Crepitus = Clostridium perfringes --Pip/Tazo or cabapenem + --Vanc + --Clinda
33
Common side effect of calcium channel blockers (amlodipine
peripheral edema | less SE when combined with ACE inhibitors
34
Pt present with dementia/forgetfulness over the past year and gat instability. Neuro exam notable for spastic paresis and hyperreflexia
Vit B12 deficiency; Subacute combined degeneration with lateral corticospinal tract abnormalities
35
Pt with known T1DM presents with HA, purulent nasal discharge, fever, facial pain and swelling, nasal eschar present with nasal turbinate necrosis. Concern for? Tx?
rhino-orbital cerebral mucormycosis; seen with diabetes and associated with ketoacidosis Tx: liposomal amphotericin B and debridement as well as sinus endoscopy
36
Three positive tests for carpal tunnel syndrome
Phalen (hyperflexion of wrists) Tinel sign (taping over the Median nerve), hand elevation over head all makes symptoms worse Tx: first line is nightime splinting; steroids don't work great; just temporary relief. and last resort is surgery but get nerve conduction study first to assess severity and alt diagnosis
37
Pt is 70 yo having months of morning joint stiffness in hips, shoulders and neck. Has lost about 5 pounds, no headaches, no other complaints. Stiffness gets better throughout the day PE notable for decreased ROM in shoulders and hips ESR of 50, CRP of 3, normocytic anemia Likely Dx? Tx?
Polymyalgia rheumatica LOW dose steroids; most respond w/in 3-5 days --failure to improve leads to alternative dx
38
What disease is polymyalgia rheumatica associated with?
Giant cell arteritis suspect in pt with higher fevers and tenderness over temporal artery, should consider temporal artery Bx if suspect and needs high dose steroids
39
Risk of ____ is increased following renal transplant when on steroids especially in the first few months likely 2/2 to both steroids and calcineurin inhibitors
Diabetes mellitus; increased insulin and gluconeogenesis by new kidneys.
40
Pt with increased wt gain in abdomen with striae, buffalo hump and thin extremities and round face/pleathoric. Urinary cortisol level is 3 times normal, high dose dexamethasone does not suppress cortisol and plasma ACTH levels are undetectable. Next best step?
Get CT of adrenal glands
41
Pt with symptoms of MI comes to ED. EKG shows elevated ST in II, III and aVF which is indicitative of MI in _____ What other features do they present with? How do we treat? What meds should be avoided
II, III, avF = inferior MI; likely Right ventricle. Hypotension, shock or JVD with lear lung fields. Tx dual antiplatelet, statins, anticoag and may need emergent revascularization DO NOT give nitrates, diuretics or opiods; all decrease ventricular preload--> lead to hypotension BOLUS them; they need preload if they have bradycardia; may need atropine or pacing if arrhythmia
42
SLE increases risk of what type of CV disease
increases development of premature coronary atheroscloerosis and CAD. Can cause pericarditis, too but more commonly see friction rub on auscultation and dyspnea
43
SLE pt increased risk for this type of cancer. See rapidly enlarging mass in neck or abdomen, get vascular or airway compression
Non-hodgkin lymphoma; diffuse large B cell lymphoma
44
What anti-HTN drugs are considered safe to use with lithium?
Ca channel blockers; amlodipine or verapamil | or loop diuretics
45
Pt with T score of
``` Osteoporosis bisphosphonates (alendornate) ```
46
Pt with T score of -1 to -2.5 have ___ | What are next steps?
Osteopenia Calculate 10 year fracture risk with FRAX; get labs; serum chem, CBC, 25-hydroxyvitamin D Lifestyle; avoid smoking, excessive EtOH, wt bearing exercise, increase Ca and Vit
47
Delayed puberty in boys is defined by lack of testicular enlargement by age ____. Wht is the initial evaluation
Age 14 | Get bone age radiograph, measure FSH, LH, testosterone levels
48
Lights criteria: Pleural protein/serum protein >0.5 OR Pleural LDH/serum LDH >0.6 OR Pleural LDH >2/3 upper limit normal serum LDH
TRANSudative effusion from inflammation | infection, malignancy, CT diesease, PE, pancreatitis, post-CABG
49
Exudative pleural effusion causes
hydrostatic or oncotic pressure | cirrhosis, nephrotic syndrome, heart fail, constrictive pericarditis
50
Initial treatment for hepatic hydrothorax (rt sided transudative pleural effusion in pt w/ decompensated cirrhosis and ascities
Na restric, diuretics, tranjugular hepatic portosystmic shunt (TIPS) if resistant to therapy
51
Pt presents with red eye in setting of cough for several weeks, erythema at limbus (jnx of cornea and sclera), pupil is constricted and c/o blurred vision and eye pain
Anterior uveitis can present with sarcoid; bilateral hilar lymphadenopathy, elevated ACE serum levels, erythema nodosum = systemic inflmmatory dx
52
PT with blurred vision, conjunctival erythema in old person severe eye pain, mid-dilated pupil, N/V
angle closure glaucoma
53
Pt with fluctuating muscle weakness, worsens throughout the day, may have double vision and ptosis, difficulty swallowing or feeling of dysphagia. Dx? Cause? Tx?
Myasthenia gravis= autoimmune dx at neuromscl jnx autoantibodies against acetylcholine receptor **Known association btwn myathenia and thymoma TX: acetylcholinesterase inhibitor; pyridostigmine iv severe IVIG or plasma exchange
54
___- weeks is considered adequate trial of antidepressant medication; goal is full course before other tx options
6 weeks
55
Bone density screening should beging at age ___ in wome w/o RF (low body weight, steroid use, smoking, malabsorptive dx, CF, prior hx hip frax)
65; get DEXA scan * *routine vit D level not recommended uneless pt has osteopenia * *recommend calcium, Vit D intake
56
Pt comes in with fatigue and mild jaundice. Elevated alk phos on routine health insurance screening. Father died of liver dx at age 65. PE notable for xanthelsmata on eyelids, occasionally itchy skin
primary biliary cholangitis: antimitochondrial antiB elevated alk phos, positive AMA for dx tx ursodeoxycholic acid-> transplant if advanced
57
pt is 25 yo, presenting with RUQ pain, elevated LFTs and new onset movement dx
wilsons; low serum ceroplasmin
58
Male, elevated LFTs, hyperpigmented skin, arthropathy and diabetes mellitus. Cardiomyopathy
hemochormatosis; get serum ferritin and transferrin levels
59
Patients with single episode of unipolar depression responsive to tx should remain on therapy for ___ while those w/ recurrent, chronic or severe episodes should consider ____
6 months | 1-3 years or indefinately
60
Feeling restless, urge ot move or can't sit still is common SE of antipyschotics; if you can't lower dose you can add this to treat the akathisia
beta blocker like propranolol
61
What is part of primary initial staging of thyroid cancer?
Once you have US and labs supportive of thyroid cancer | Get US of neck and cervical LN to stage
62
What is tx for small <1cm papillary thyroid tumor? | What if >1cm, metastasis outside thyroid or hx of neck/head radiation exposure?
thyroid lobectomy | >1cm = total thyroidectomy
63
Maternal complication risks for teen pregnancy | Fetal complications
hydatidiform mole, preE, anemia, operative vaginal delivery, pospartum depression Fetal: gastroschisis, preterm birth, LBW, perinatal death and omphalocele
64
Pt with RUQ pain, fever, leukocytosis and + murphy's sign. | US shows stones, no GB wall edema or cystic dilation. Next step?
Need to get a HIDA scan or cholescintigraphy which is >90% specific and sensitive for acute cholecystitis
65
Pt with RUQ pain that resolves, no fever or leukocytosis, you suspect biliary colic. Next step?
NSAIDs and supportive care, can get elective US
66
Management for acute cholecystitis?
urgent laparoscopic cholecystectomy
67
How to distinguish folate from Vit B12 (cobalamin) deficiency?
MMA increased, Homocystine increased = B12 deficiency | MMA normal, Homocyctein increased = Folate
68
Pt with macorcytic anemia, neuropysch changes and ataxia, and delirium.
Vit B 12 deficiency
69
Microbiology of impetigo | Complications of impetigo
Group A strep (Pyogenes) or Staph | PSGN
70
Pt comes in with rash on cheek; warm, well demarcated and painful. You suspect this skin infection
erysipelas
71
Clozapine can be used in schizophrenia refractive to other medication trials. What SE needs to be closely monitored?
Neutropenia and agranulocytosis
72
When taking lithium what labs need to be monitored
thyroid and kidney function
73
Small head bleed commonly seen after vaginal delivery, does not cross suture lines Increased risk for calcificaiton later as well as hyperbili
cephalohematoma
74
This organism associated with pneumonia, high fevers and GI symptoms as well prior to respiratory symptoms
Legionella
75
Pt with HA, fever, sore throat, cough and dypsnea. CXR showing patchy interstitial infiltrates
Mycoplasma
76
Pt with HIV has CD4 <200, over course of weeks develops cough, dypsnea adn on CXR see interstitial pulmonary infiltrate
Pneumocystis pneumonia
77
Pt with fatigue and weight loss as well as iron deficient anemia. Family hx of hypoT. Vitiligo present as well as osteopenia and vit D deficiency
suspect celiacs, get TTG | can get this even in absence of GI symptoms
78
Slipped caital femoral epiphysis cause of hip pain in fat kids... Dx with ____ and tx with ____
xray; posteriorly displaced femoral head | Surgical pinning
79
Pt with 3 mo of headache and now unsteady gait. In 20s. On PE has impaired upward gaze and loss of optokinetic nystagmus but EOM are WNL. Falls to both sides on tandem gait. rest of exam WNL
Pineal tumor Parinauds syndrome= loss pupillary reaction, vertical gaze paralysis and loss of optokinetic nystagmus with ataxia HA from obstructive hydrocephalus *can secreate HCG and cause precocious pubutery in males
80
Pt with months of HA, new onset DI
Craniopharyngioma | -also associated with deficiency of other ant.pit hormones
81
Pt who is feeling well comes in and found to have TSH of 9 and normal T4 Consistent with?
subclinical hypothyroidsm | You can get anti-TPO measurement (at risk of developing overt hypothyroidism)
82
What pts with subclinical hypothyroidism require treatment?
``` antithyroid antiB prsent abnormal lipid profile symptoms of hypoT ovulatory and menstral dysfnx TSH >10 ```
83
Bitemporal hemianopsia and hyper pigmentation following adrenalectomy for Cushings is suggestive of Nelsons syndrome which is
pit microadenoma w/ suprasellar extension Get MRI and check plasma ACTH (very high!) Tx with surgery or radiation
84
AST and ALT elevated | BUT AST more so elevated
alcoholic fatty liver
85
Both AST and ALT about 4times upper limit normal
NASH
86
AST and ALT about 25 times upper limit
acute viral or toxin mediated hepatitis w/ jaundice
87
AST and ALT 50 times upper limit
ischemic hepatitis (shock liver, ischemic hepatopahty)
88
Pt presents with abnormal LFTs on screening labs. Mild elevation of AST, ALT and alk phos and normal bili levels with mild hepatomegaly on exam. She is 30 yo w/ family hx of thyroid dx
Suspect autoimmune hepatitis; get antinuclear antiB and antismooth msucle antibodies *may also have arthritis, erythema nodosum, thyroidtiis, pleurisy, pericarditis and anemia
89
Antinuclear antiB | Antismooth muscle antiB
autoimmune hepatitis
90
Pt presents with elevated alk phos. What lab can you get to see if this is from liver or bone?
GGT
91
Severe Aortic stenosis is defined by echo showing aortic jet velocity > ___m/sec or mean transvalularl gradient >____ mmHg or valve area
>4.0 >40m/sec valve <1.0cm2
92
Tx for severe or symptomatic (syncope) AS?
aortic valve replacement improves long term survival
93
Harsh crescendo decrescendo murmur with second heart sound soft with inaudible S2,
Aortic stenosis; severe
94
Pt with fever, headache, mylagia with splenomegaly. Labs with thrombocytopenia and recent travel to africa about 2 wks ago
malaria; plasmodium falciparum; get peripheral smear to dx | should be on antimicrobial prophylaxsis prior to travel
95
Woman with GDM delivers a healthy baby. She was on insulin during pregnancy. What is next step for insulin mangement/management of DM?
Stop insulin and glucose tolerance test at follow up | resolves w/ delivery of placenta
96
contraindications to MMR
pregnant immunodeficient anaphylaxsis to prior
97
Recommended counseling for pt on AED who are pregnant or plan on becoming pregnant
Pregnant: do NOT switch AEDs during pregancy, take high dose folic acid and get screened with alpha fetoprotein and US
98
can you breastfeed while on AEDs?
heck yep
99
emergent tx for heart fail exacerbation; | pt presents with cough, crackles, edema, signs of LV hypertrophy
Oxygen, IV diuretics, may need IV vasodialation if having high BPs (nitroglycerin or nitroprusside) and inadquate response to diuretics
100
Olanzapine is a great antipyschotic for schizophrenia but has this back side effect
weight gain
101
What oral med commonly Rx for acne can cause severe sunburn due to increased photosensitivity?
Doxycycline
102
Features of tourettes
Both multiple motor and >1 or at least 1 vocal tic lasting > 1 year Motor: facial grimance, blinks, jerks, shrugging, sniffing Vocal: grunt, throat clearing, bark, yell, coprolalia
103
Tx for tourettes
Behavioral Antidopamingeric: tetrabenzine antipyschotis; 2nd gen = risperidone, arippirazole or Alpha 2 adrenergic receptor agonists= clonidine or guanfacine
104
Fe deficiency anemia in infants present after 6 months in predominately breast fed infant w/o Fe foods or if introduced to cow mild too early What do you see on labs
anemia Low MCV Elevated RBC width Mentzer index >13 (MCV/RBC)
105
management of acute aortic dissection
1. pain control (morphine) 2. IV B blockers with goal HR <60 3. If still high BP >120 give sodium nitroprusside Emergent repair
106
Pt has hx of HTN comes in with sharp stabbing chest pain feels like tearing to back of chest. His right arm SBP is >30 when compared to left. ECG shows T wave inversion V5/6
Acute aortic dissection
107
Pt with painless blisters on back of hands after being outside; areas look like they have increased fragility, has hyperpigmentation of face. Mom had something similar
porphyria cutanea tarda Triggers: OCP, Hep C (STOP OR Tx these) Confirm dx with elevated urinary uroporphyrins Tx phelbotomy, hydroxychloriquine
108
Pt with chronic Hep C should ahve which two vaccines?
Hep B and Hep A as you can develop acute hepatitis with either; if titers are low or no prior hep A vaccine, give it as well as test for HIV
109
Pt with discrete, itchy (pruitic) polygonal shaped purple plaques and papules! Where else besides wrist do we see this? Dx? Additional tests?
Lichen planus Buccal mucosa = whitis lacy pattern or wickman straie in mouth adn can be on genitals Dx skin biopsy Test for Hep C; anti-hep C antiB; theres' an association
110
Patient's with acute variceal bleeding are at risk for...
bacterial infections; specifically SBP as well as respiratory and aspiration pneumonia
111
MCC of unilateral chronic adenitis in children. Can also be associated with ocular redness and develope in supprative LN
Cat scratch or bartonella
112
Mosquito born illness causes high fevers and severe polyarthralgias; bilateral and symmetric esp wrists, hands, ankles. occurs 3-7 days after bite but arthralgias can persist chronically
Chikungunya
113
SLE nephritis presents with renal dysnfx, proteinuria and RBC casts... what are next steps once you suspect this?
get renal Bx; need to classify before deciding thearpy; there are 6 stages
114
Tx for Diffuse lupus nephritis; stage IV (most common and has hematuria, proteinuria with HTN and low GFR)
Steroids and cyclophosphamide or mycophenolate mofetil; | tx for stage III and stage IV
115
How do we monitor response to therapy for lupus nephritis
Anti-DS DNA antiB levels and Complement levels
116
MCC of post partum fever; uterine tenderness, high fever, and increased risk if prlongued labor, Csection or mult vaginal exams or chorio during labor. Dx Tx
endometritis | Gentamicin and Clinda
117
Pt presents with intrapartum fever, dx with chorio. AntiBx treatment of choice?
Amp + Gent
118
Pt presents with PID. Tx?
Doxy + Cefoxitin | Also give CTX and azithro to tx empirically for cervicitis
119
Patient with exercise induced hypothalamic amenorrhea present with amenorrhea, infertility, in setting of strenous exercse/restrict calories. What happens to GnRH, LH/FSH and estrogen levels? Bone mineral density? Triglycerides and cholesterol What study needs to be obtained?
Decrease of all hormones Decreased bone mineral density Increased TG and cholesterol Need Bone Mineral density scan d/t increased risk of bone fx.
120
Pt with neutropenia is started on TPN and antiBx in setting of fever and weight loss (has cancer). New onset eye pain and decreased vision. Eye exam showing focal glistening white lesions extending into vitreous
Candida endophthalmitis | Tx: vitrectomy (if vitreous extension) and IV amphotericin B
121
Pt with mild elevating of Ca (10.8) with normal/high level of PTH and low urinary Ca excreation
Familial hypocalciuric hyperCa of FHH; autosomal dominant
122
Tx for plantar warts
Topical salicylic acid and takes at least 2-3 weeks to resolve
123
Factors considered in MELD (Model for End Stage Liver Dx) scoring; used to assess 90 day mortality and transplant candidates
bilirubin, INR, creatinine, sodium
124
Pt with suspected ingestion. Violent and bizzare behaviors. PE with HTN, tachycardia, prominent nystagmus. Drug? Tx?
PCP | Give benzos; can do antipychotics if those fail

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