Random High Yield Flashcards by Sheila Sarmiento

ANKLE dorsiflexion deficit
or Tibilias Anterior
PATELLAR reflex deficit

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BIG TOE Dorsiflexion deficit

L5 - Large toe

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Neck of the FIbula
Weak ankle
Weakness and eversion and dorsiflexion of the foot
Pain in the lateral shin area and dorsum of the foot
key - INVERSION SPARED

Peroneal Nerve Injury
tx: Shoe wedging
Neurolysis

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Sciatic Nerve supplies 5 spinal nerve roots

L4, L5, S1 S2 S3

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The pain is made worse by sneezing, coughing and laughing or a hard bowel movement
Bending backward can also make the pain worse.
Other than pain look out also for numbness and difficulty in walking

Sciatica

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Most approp inv in Sciatica

MRI
CT Scan - Alternative
X ray - to see the lordosis

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Most common tumor of the adrenal medulla in adults
Derived from chromaffin cells arising from the neuraln crest

Pheochromocytoma

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What is the treatment for Pheochromocytoma

Phenoxybenzamine - to avoid a hypertensive crisis
B-blockers - given to slow the heart rate
Tumor surgically removed

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<1.5 - <2.5

Osteopenia
Tx: Calcium + Vitamin D

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> 2.6

Osteoporosis
tx: Alendronate / Zolindronic Acid

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Osteoporosis + low trauma fracture

DEXA first
then
ALENDRONATE

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Osteoporosis + PUD
tx

Zolindronic Acid

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Osteoporosis tx

Alendronate

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OSteoporosis + Breast CA

Tamoxifen / Raloxifen

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Severe Osteoporosis + HRT

Give Alendronate

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Severe Osteoporosis + HRT

Give Alendronate

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First line for Pharmacologic therapy in Osteoporosis

Biphosphonates

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Second line therapy for Osteoporosis
Can cause hot flushes and venous thromboembolism
Does not cause endometrial hyperplasia or increase risk of breast c

Raloxifene

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Considered first line in patients with a high risk of fracture

Teriparatide

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Post menopausal female comes with you with enterocele prolapse and stress incontinence.
What is the management?

Pessary

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Post menopausal female comes to you with enterocele prolapse

Pessary
- Pelvic floor exercise is usually for younger people with incontinence

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Urethra bulges into Vagina

Urethrocele

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Rectum protrudes into vagina

Rectocele

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Loop pf small intestine bulges into vagiina (usually posterior wall)

Enterocele

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Uterus and cervix descend toward vaginal introitus

Uterine

Cervix remains in vagina

First Degree

Cervix protrudes on coughing / strainiing

Second degree

Uterus lies outside vagina

Third Dedree (Prodicentia)

20F came to you in GP clinic for contraception advice She gives her mother and sister DVT episode Best step in the care of this patient?

Do thrombphilia screening

Which would be the best option OCP for a smoker female

Norethisterone

Female with menorrhagia and her consulation is due with a gynecologist , what can you give her till that time

NET

Mentally retarded girl complaining of menorrhagia Approp contraception?

COCP and if it wont work then MIRENA

Lady in her 20s with h/o migrainne Oins and needle sensation contraception?

POP

Young lady came for contraception She feels headache her BP is 130/90 What to prescribe?

POP

Young lady came for contraception advice Sometimes she feels headache her BP is 130/90

POP

Woman takng OCP containing 30 g estrogen now comes to you with hypertension What is the next step

POP

10wk pregnant patient comes to you for her first anternatal visit. Can see the strings of the IUCD What is your next step

Remove the IUCD now

Hot flushes 3-4 x a day Vaginal dryness Atrophic vagintis She had hysterectomy 10 yrs ago She has History of DVT Approp tx?

Low dose transdermal estrogen

Most imp contraindication of OC pill

Breast Cancer

Lady with obesity, hirsutism and PCO asking for contraception

COCP

Missed her pill pn the 7th and 8th day had unprotected sexual intercouse on the 6th and 7th day mgt?

Give emergency contraception With Levonogestrel 2x 12 hrs apart

LAdy with obesity, hirsutism and PCO asking for contraception

COCP

Woman with otosclerosis with hearing aid What contraceptive method is best for her

IUCD

Female usng 30mg OCP Presents with continuing painful periods Want to conceive after 12 to 15 months What to give her

use 50mg ocp

A patient is asking OCPs Reports has been experiencing MIGRAINE

PROGESTERONE

H/o migraine with depressive illness BMI 33, contraceptive method to use?

Condom only

How does microgynon 30 work

In the Hypothalamus

Yasmin oral contraceptive is prefered in Australia because

decrease weight instead of increasing it

After deliery, BREASTFEEDING What contraption to use?

LEVONORGESTREL

Breastfeeding wants to CONCEIVE again

POP

Patient gaining weight on Olanzapine Wants to change drug Which one to give?

Aripiperazole

Loose stools still even after given Metronidazole tx?

IV Vancomycin

22yo girl wants cervical cancer screening She is not sexually active What adv to give

No need

involves dislocation of the radial head as well as a fracture of the prximal ulna

Monteggia Fracture

Isolated fracture of the shaft of the ulna, usually due to a direct blow. A blow from a nightstick (police baton)

Nightstick Fracture

often occurs following a fall on an outstretched hand

Scaphoid Fracture

Distal Radial fracture often due to a fall on an outstreched hand, palmar displacement of the wrist rather than dorsal

Reverse Colles Fracture

What nerve can be damaged with Colles Fracture

Median Nerve

What is the ideal position of the forearm in Colles

The cast is applied with the distaln fragment in palmar flexion and ulnar deviation

What is the tx for Smith's Fracture

Closed reductions and ORIF

Ulna Fracture with dislocation of the Radial Head

Monteggia

Radius fracture with dislocation of the Distal Radioulnar Joint

Galeazzi

Dorsal displacement of Distal Radius fragment

Colles Fracture

Volar displacement of distal radius fragment

Smith Fracture

What is the treatment of Bell's palsy

Cover the eye Steroids Antiviral

no Sparing Same side All side affected

Right Side LMNL

Opposite side Upper face is spared

UMNL

Can't raise the eyebrow Can't close the eye Cant blow the mouth Cant smile wide

Facial Nerve

Cannot raise the eyebrow on the Left Side Cannot Raise the eyebrow in the left side No pain sensation in the Left side

LMNL Bells Palsy

If you are suspecting Ceacal cancer What symptoms could be there

Lethargy or Fatigue

Woman who is under evaluation of cecal carcinoma what is her presentation

Tiredness and Lethargy

Schizo patient, after taking medications for 1 yr she is diabetes positive What will you check>

Cholesterol Levels

Athlete with twisting knee injury Now can't flex the knee beyond a point

Medial Meniscal Injury

Knee is locking in full extension and sometimes his legs gives away

Medial Collateral Ligament Injury and Medial meniscus injury

Knee Injury after football, patient can't roatte medially his legs If thighs are fixed

Left meniscus

Internal rotation of femur on tibia

Medial Meniscus tear

External rotation of femur on tibia

Lateral Meniscus Tear

Direct bloq outside the knee

MCL Injury

Blow to the front of the knee Direct blow to the anterior tibia in flexed knee

PCL injury

Popping sensation Positive Antwrior Drawer sign and Lachman's test

ACL

Direct contact, like tackle

Meniscal tear

Rugby tackle from the side Direct valgus force to knee Lateral Side knee External tibial rotation pain on medial knee pseudo-lockiing = hamstring strain

MCL

Renal tumor 5cm Lower lobe of the kidney

Partial Nephrectomy if it is more than >7cm = Total Nephrectomy ANYWHERE uo to 0.5cm = Passed spontaneously - No intervention 0.5 - 2 cm + ESWL .>2cm = PCNL IF THE RENAL STONE IS IN THE LOWER POLE up to 1 cm - ESWL 1cm-2cm = LASER lithotripsy >2cm = PCNL If proxomal Ureteric Stone up to 1 cm = ESWL >1cm = PCNL Distal ureter if not obstructed > 0.7 cm = :LASER LITHOTRIPSY Between 0.5-0/7c, stone - Observe with Tamsulosin

What is the acute limb ischaemia warning sign

Paralysis

Syphilis, Alopecia, Asia trip Rash on pain Sole rashes 2ndary syphilis tx

Benzylpenicillin

Young urethral discharge case was like typival epididymo orchitis SX: of frequency, dysuria, frequency discharge , inv?

Urine Culture

Young man with milky white discharge doe urethra for 2 days Neisseriadx Treated with Ceftriaxone 1 g, IM But he comes back with the same symptoma Urine analysis diplococci Reason?

Drug Resistance

A woman presented with back pain She has mastectomy Best tx for the pain

Radiation

Paresthesia of the Left upper limb Dx with Metastatic breast cancer CT has lesion in frontal lobe Mgt?

Mets = DEXAmethasone

Patient with lump FNAC shows breast ca estrogen neg prog neg her 2 neu gene BRCA _ve positive with palpable

Sentinal Lymph node biosy = do that first

Breast Ca Stafe I and II

Breast Conserving therapy with Sentinel Lymph biopsy followed by Radiation

Stage III Breast Ca

Modified Radiacl Mastectomy with Axillary Lymph nodes dissection - Chemotherapy plus hormonal therapy - (Tamoxifen, Anastrozole and Trastuzumab

Stage IV breast ca

Mastectomy

Carcinoma in Situ

Chenotherapy not needed

Bone mets

Local Radiotherapy plus biphosphonates

Brain mets

Local Radiotherapy

In local chest wall lesions

Local Radiotherapy

In liver mets

Chemotherapy

Lung mets

Chemotherapy

Lady with history of breast Ca Now with back pain CT of whole spine showed solitary metastatic breast cancer Lesion in frontal lobe mgt?

Dexamethasone

Pt with lumpo FNAC show breast ca estrogen negative Progesterone negative Her 2 neu gene (BRCA +ve) positive with palpable Mgt?

Sentinel Lymph node biopsy

Breat Ca with back pain CT whole spine - showed metastatic deposit Mgt?

Radiotherapy - whole spine so 1 spot

If ER positive tumor

Tamoxifen

if Her 2 positive tumor

Trastuzumab

Worst prognosis

Triple negative ER receoptor negative, progesteroone receptor negative (PR) HER2 neu negative

Mgt ff lumpectomy to destroy any residual tumor cells

Radiation

Induction therapy to reduce the initial tumor burden prior to surgery

Radiation

For small tumours and patients with strong preference for breast conversation

Lumpectomy followed by radiation

for larger tunours prior history of chest radiation

Mastectomy

Causes winged scapula

Long thoracic nerve - nerve injury in mastectomy

causes reduced sensation to upper medial arm Most common nerve injured

Intercosto brachial nerve - nerve injury in mastectomy

causes weak adduction and internal rotation

Thoracodorsal Nerve - nerve injury in mastectomy

Alcohol, agitated in emergency

IV diazepam

1 month baby discharge since day 1

NLD

3rd day discharge from eye baby

Gonorrhea

Hoarseness, reflux, ifnection sahi hogya thai

Chest Xray

Baby preterm O2 decreasing

Pneumothorax

Subclavian tube insertion BP drops tracheal deviation

Needle thoracocentesis

After hip surgery how will you give Heparin

Immediately before surgery

Patient done with hip surgery post ip 38 days heparin taking mgt

Stop drug

Fever with agitation Moderate pneumonia Mgt

Benzylpenicillin

Neuromalignant syndrome

CK increased

Elderly copious sputum Lobar pneumonia

IV Tcarcillin

Accident conscious o2 60

intubate ventilate

Old patient flecion totally fine Extension pain Sitting good

Spondylosis or Stenosis

Tx for necrotizing enterocolitis

Ampicillin and gentamicin

low folic acid howel jolly body stomatitis normal bowel weight loss inv?

Small Bowel biopsy - celiac

Patient on Methotrexate and Prednisolone complaining of mouth and tongue ulcer tx?

Folic Acid

Treatment of Chlamydia

Azithromycin

Treatment of Acute Gout

Allo/morpine

Treatment of Colle's fracture

Plaster

Treatment of DVT in pregnancy

Stocking / LMWH

Treatment dose of recurrent gout

Allopurinol 25 mg 100 mg 200 mg

Location of movement in MVA patients

Paradoxical breathing

20 yo boy came what will you do for screening opportunities

Acute Limb ischemia inv

Duple

Septic arthirits tx

IV antibiotics

Acute limb ischemia inv

DUPLE

Septic arthritis treatment

IV antibiotics

Patients taking statins and HTN medications and has pain on shoulder asking the cause

Drug induce Myositis

Child with pneumonia Xray with pleural effusion asking after giving antibiotic what to do next>?

Pleural Drain

Scenario of moderate crouo (Chest Wall restriction) asking treatment

IV adrenaline

Scenario of Anaphylactic Schock asking for treatment

Adrenaline

Pt with Parkinson disease and shcizo taking Lithium now complaining of hand tremor

Decrease Lithium and add Parkinsons Drug

Child with failure to thrive before weight was 70th percentile now is 30TH percentile asking for diagnosis

Child with Bilateral eye discharge after birth asking causes

Gonorheea / Lacrimal Duct Obstruction

Another meningitis scenario and CSF analysis was there (High protein normal glucose) neutrophilis was there asking for treatment

Antibiotic or Antifungal

Rash on thigh Loose stools history for 10 years With excessive flatulence Antilian negative Inv?

Colonoscopy

BUlky pale offensive frothy greasy stools stools difficult to flush down the tpilet weight loss failure to thrive increased fecal fat glossitis Signs of multiple vitamin deficiencies HYppochromic or megalobastic anemia dx?

Malabsorption

Triad of weight losss + diarrhea + Abdominal bloading + iron or folatre deficiency

Celiac Disease

What is the first test for Celiac Disease

TTG - Antiendomysial antibody - IgA antigliadin Antibody

What is the most accurate diagnostic test for celiac disease

Small Bowel Biopsy

Child with impetigo with crusting Antibiotic was started and cant cover all the plaster Mother is asking the GP when the child can go back to school

24 hr after starting the antibiotic

Molluscum contagiosum how to prevent the contact?

Avoid swimming with hot water

No contraction and couldnt feel the fetal movement 2 days ago On auscultation the pregnant woman is fine mgt

Ask her to drink icy drink and check the CTG again in 4 hrs

HFM disease Mother is so worried when the child can go back to the day care

When all the blisters dried

Swelling in front of the ear and movable not firm, inflamed, painful when you swallowing or chering inv?

USG

old lady dall on outstretched hand Xray given mgt?

Open reduction and fixation

34wks gestation with abdominal pain and bleeding per vagina 800ml, uterus tense and tender Fetal heart rate not heard Mgt

Amniotomy

Cervix still the same Fetal head same position Amiotic fluid are gone Mgt

Immediate Cs

18wks age opf gestation uterus size 32 wks

Polyhydramnios

Regularly using Marijuana He doesnt reply when being asked and mood is not stab;e Mgt?

Fluoxetine

Old man on multiple drug like Metformin, Diuretic, Perndopril. SSRI etc Hyponatremia What is the cause of Hyponatremia?

Fluoxetine

The old man change his behaviour recently 2 wks ago he had multople fall and kept forgettinng and became aggressive What is the Dx?

VAscular Dementia

motor dysfunction with visual hallucinations that (overlaps with parkinsons)

Lewy Body Dementia

Predominant memory problems

Alzheimers

A man got dripping and symmetrical enlargment of the prostate Show a bit od UTI feature What test will you get the Dx and treatment

Urinalysis

Child 4yo with UTI drug of choice

Cephalexin

Women with UTI 28 wks pregnant asking for tx?

Cephalexin

A young woman had an injury to his knee in a hame sustaining pain and then swelling of the affected knee Hear that poppin sound when he pkay game He couldnt finish his game

ACL

Syphilis treat,emt backpacker go travel around the world been to asia come with rash on hand and foot, alopecia What is the tx?

Benzathine Pen

FB removal in the right eye Complains of blurring of vision in the Left eye Irregular Red Reflex on eye examination Cause

Retinal Detachment

bilateral fine crackles raised JVP ECG confirms ATRIAL FIBRILLATION Mgt?

Synchronized DC Cardioversion

Treatment for inflammatory joint pain in multiple areas Who also has renal failure Contraindicated in this patient?

Methotrexate

minor stroke + dementia

VAscular dementia

contraindication of COCP

Smoking

mooon face

Cushing's Disease

episodes of starring in space with lip smacking and limb movement tx

Sodium Valproate

# 1 Third degree block

Stop Metoprolol

URTI + blood in his urine

Iga Nepropathy

brownish greenish discharge

Gonorrhea

postcoital bleeding

cervical ectropion

R facial weakness history of ear pain odd taste in the mouth R facial nerve paralysis

Ramsay Hunt Syndrome

if there is tetanus vaccine 5 years ago next mgt?

Immunoglobulin

Serum calcium high, high PTH

Parathyroid adenoma

What do you need for the Diagnosis for PCOS symptoms

FSH: LH

Blood reveal a microcystic hypochromic anemia irond deficiency anemia tiredness and Increased shortness of brreath inv?

Colonoscopy

How do you manage the trachoma outbreak

Treatment of contacts

LEft Side of the body sudden onset of carotid bruit Left carotid artery stenosis - 40-50% Right carotid artery 50-60% BP 180/110 CHolestrol lebvel 5.6 Mgt?

Antiplatelet Therapy

Man presents with vertigo + dysphagia + loss of tough and sensation of the opposite side of the body Ipsilateral Horner's syndrome Where is the lesion?

Vertebral artery

cold rash purpuric or pale center dx?

Herpes Simplex virus

tenderness in her back L4-L5 restrictions in the movement of extension adn flexion rotations What will yoiu give beside analgesic?

SPinal Xray - 50 Keep active - 40

CHest infection gained weight admitted with impetigo decreased 1kg diagnosis?

Cystic Fibrosis

loin pain, hematuria nxt step?

Xray, KUB

In acute Renal failure with a potassium of 6.8 mmol ECG shows tall tented T waves Commenced on Cardiac monitoring and is given insulin destrose infusion and Salbutamol nebulizers tx?

Calcium Gluconate

acute onset pain in the lower back with urinary symproms significant weight loss DRE - irregular prostate next inv?

TRUS

cough and nasal discharge noisy cougjh dx?

Acute laryngeotracehobronchitis

Neck stiffness and meningitis sign start 3 days ago CXR shows well defined round opacity in the middle right lung cause?

Aspergillus

menses pain and heavy flow tx?

Mefenamic acid

decreased HB with cyclic menorrhagia next?

Levonorgestrel releasing IUD

# X BMI 32 striae and pigmentation on her neck and axillary region she has amenorrhea striae on abdomen dx?

Metabolic Syndrome

obese woman with hirsutism and hypertension what is the elvated level on her?

Cortisol

rash and rouleaux on blood test diagnosis?

Wald Enstrom's macroglubulinemia

Urine protein and hematuria with 3-4 renal cysts seen on USG Helicobacter pylori with triple therapy hypertensive Dx?

PKD

Postpartum bleeding after 14 hrs deliver complete placenta no lochia, oerineal tear does not require sutures comes with heavy bleeding on the 5th day what is the cause?

Perineal wound

No history of travel, stool with blood and mucus no fever and no use of medications Diagnostic suspicion?

Crohn's Disease

Previous history of ulcerative colitis develops pruritus noticed sclera becoming yellow LFTS are deranged and her ANCA is positive What is the diagnosis?

Primary sclerosing cholangitis

Agitated, sweaty, pupil dilatation Which drug would be responsible?

Methamphetamine

Causes of recurrent ischiorectal abscess in the absence of any git symptoms?

Anal fistula

PSA becomes 3.0 (Normal <4.0 Prostate is enlarged and regular adenocar of Gleason 4 datge mgt?

Radical Prostatectomy

femoral pulse not palpable dorsalis pedis is palpable ABI 0.3 best way to diagnose?

Arteriography

Admitted for AF after developed severe abdominal pain, nausea and vomiting passed bloody stool inv?

Serum Lipase

ABd CT found 2 cm stone in the upper pole of the kidney What to do

Extracorpeal Shock Wave Lithotripsy

colicky abdominal pain and anorexia tenderness all over the abdomen with guarding dx?

Perforated Appendicitis

45yo obese, diabetic and hypertensive woman came to you with a soft mass in the epigastrium What is your advice for long term management?\ A. mesh herniorrhaphy B. Weight reduction

B. Weight reduction - 1st step

sudden onset of red and swollen nontender scrotum including penis and perineum testis is norma'l dx?

Idiopathic scrotal edema

poor feeding and bile stained vomiting passing meconium on day 4 of birth mild jaundice and abdominal distension and is irritable abdomen is distended and tender dx?

Hirschprung's disease

if the case has GCS inv?

CT SCan

central scotoma dx?

Macular degeneration

cherry red spot

CRAO

history of surgery for achalasia hoarseness and dysphagia mass in the thoracic inlet diagnosis?

Cancer of the larynx

# ZX acute pain and earache R side of the face with preauricular swelling omn the R tender on palpation bilaterally dx?

Mumps

IF family has colon ca then siblings has ureteral ca What dx related to the man ?

Lynch syndrome

if there is 6cm laceration in the anterior part of the tibia tibia grossly deformed and distal pulsations were absent mgt?

Debridement

swelling in front of the neck in the anterior triangle hoarseness and difficulty in breathing esp when lying on his back

Multinodular goiter with retrosternal extension

severe chest pain which occur after bouts of vomiting on examination and there is dullness over the left lower lobe of the lung inv?

Gastrograffin swallow

4yo blood stained in underwear mgt?

Report for sexual abuse

child with 3cm lump under mandible angle painless no lymphadenopathy no fever inv

Review in 1 week

pinpoint lesions on the trunk and limbs of lesions were nonblanchable Mgt?

ITP

neck stiffness and anterior fontanelle full Mgt and Dx

Viral meningitis tx: Oral paracetamol

baby born at term suddenly collpased and severely dyspneic no murmur hear on cardiac auscultation dx?

Hypoplastic Left Heart

hypotonia, areflexia in all four limb feeing difficult, can't control the head Dx?

Spinal Muscular Atrophy

cough, fever, rhinitis and rash complains of chest pain during cough What is the diagnosis?

Viral Pneumonia

pain and drooling saliva ingests washing detergent complications?

Esophageal Stricture

pain and stiffness in her pelvic and shoulder girdle complains of painful mastication ESR 95mm Dx?

Polymyalgia Rheumatica (difference vs Statin induced myopathy - ESR om SIM is low)

3 organic causes of Panic Attack

Hyperthyroidism Phaeochromocytoma Hypoglycemia

"feels something wrong in his body

"Panic Attack

opacity with well defined round margin in the middle zone of the RIght Lung or "halo sign" dx?

Aspergillus or the most common infection after renal transplant

excruiciating retrosternal chest pain that radiates to the back pain as sharp and worsens with swallowing Med hx significant for naorexia nervosa inv?

Gastrograffin swallow

fasciculation and weakness in both arms with absent reflexes

Motor neuron disease

if CO2 is increasing and O2 is decreasing mgt

CPAP