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Step 3 Flashcards

1
Q

PUD then dysphagia and chest pain

A

E stricture

Diet, lots of chewing and liquids

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2
Q

SLE with chest pan and arrest, what cardiac issue does she have?

A

MI- they have accerlated athersclerosis

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3
Q

GBS asymptomatic bacturia TX now and then what?

A

Penicillin during labor ppx

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4
Q

Most common cause of hemoptysis?

A

Acute bronchitis

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5
Q

reasons to give abxin acute bronchitis in COPD

A

Worsening dyspnea, sputum produciton or purulence. If healthy then its viral dont give anything

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6
Q

<30 breast mass

>30 breast mass

A

US then needle if cyst or core biopsy if malignant looking

Mamorgram to core biopsy

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7
Q

PNA vaccine >65, HIV, CKD, sicklers

<65

A

13 and then 1 week do 23

Just 23 in CHF, COPD, Liver, Smokers, Allocholics, DM2

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8
Q

Diagnosed Lupus and you think lupus nephritis, what next>

A

You need a biopsy to categorize it

Also get complement and asDNA Ab

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9
Q

Delayed motor milestones, hyperreflexic, clonus, leg posturing… what next/.

A

MRI brain for Cerebral palsy

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10
Q

Akasthesia Tx

A

Propanolol

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11
Q

Ethics flow

A

Joint decision>consult an expert> ethic comitte> transfer within hospital> transfer outside

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12
Q

Marine tank, Rapidly worse, Hemorrgahic bullaw/necortizing D x TX

A

Vibrio vulnificus

CFTX Doxy

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13
Q

MIld high LFTs, young owman, Feels fine, heptomegaly- what next?

A

anti smooth muscle anitbodies, ANA for autoimmune heptaitits

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14
Q

at what age do you you take a testicle out if it hasnt dropped?

A

6 months

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15
Q

Tubular adenomas fq
3-10 adenoma or villous fq
>10 adenomas fq
1 polyp with adeenocarcinoma in situ fq

A

5 years
3 years
<3 years
2-3 months

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16
Q

Drug lupus

A

Anti histone

hydral, procain- get ANA testing!

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17
Q

Looks like hepatitc C or B after 1 eek but negative tests so far..

A

Get HCV PCR tests anyway it takes 2-4 weeks

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18
Q

Type 1 vs type 2 error

A

1- false positive (dad is preggo)

2- false negative (telling ellie she isnt preggo)

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19
Q

Hypergluycemia + modd swings + hypoK + increased bicarb= testing

A

dex test to supress free cortisol

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20
Q

feeding goals?

A

30 kcal/kg/day + 1 g protein is solid
less to rpevent refeed
more protein if malnutrition

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21
Q

Pregenancy rashes

A

Cholestasis- hands/feet and generalizeddeliverat 37 weeks, Urso acid and antihistamines, check LFTs

Pregenncy related- itchy to one spot NOT generalized. UV light, oatmeal baths, antihistmaines

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22
Q

pregnancy but looks like ring worm and HSV target?

A

pempigoid gestationis- topical tiamcinolin

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23
Q

PTH stuff

A

hyperPTH-MEN syndromes
HyperCa HypoPO4 (kidney always wins) andit makes you absorb from bone, kidney and gut
watch out for osteoporosis
Take it out even if aysmptomatic most of the time

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24
Q

Snoring maegnemt without OSa symtoms

A

stop smokgn and slcohol

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25
Q

Look slike depression but PCP visit an mentions bad sex life

A

ASK about sex life! number 1 50 + woman thing is vaginal atorphy

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26
Q

Old person with exertional dyspnea, HLD HTN DM2= Next test

A

CAD testing even if it asks you for a TEE- it is getting at an old person with risk factors

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27
Q

kid with decline in school, starting to have sex a lot and any mention of fidgety in the office…

A

sex abuse

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28
Q

Moderate to severe depression . CBT or SSRI difference

A

MOderate to severe, marked imapirment of life and no psycosocial stressors= SSRI first

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29
Q

You think RA but negative markers, X ray evdience of arhtritis and CRP that is elveated… what Rx next

A

MTX

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30
Q

Abdonainl surgery with now CVA tenderness 2 weeks out and a cough get…

A

Abodminal US- subprhenic abscess at shoulder tip

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31
Q

Gross hematuria after 3 days URI

A

iGA nephropathy

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32
Q

Warfarin and amiodarone now on together- what do you do with warfarin?

A

lower by 25-50%

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33
Q

bili of 10 in breastmilk jaundice Tx?

A

conitnue breastfeeding with weekly check ups shoudlgo away in 3 months

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34
Q

TURP complications

A

Ejaculate backwords

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35
Q

TB PPx 2 options

A

INH 9 months

R 4-6 months

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36
Q

If you have a smaller population size are you mor elikley to make a type 1 or type 2 error?

A

Type 2- it needs a high power or large sample size. it wuolnt be as effective in seeing a differnce in the two groups so a false negatve is possible

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37
Q

asyompatic 2 cm incedintalmoa on adrenal gland- whats the next step

A
  1. functional testing to see if it is pheo
    - if it is not and les than 4 cm thand follow up on it

if 4 cm, malignant loking or functional then take it out

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38
Q

ENDo stuff

A

MEN pituaitry tumors and pehos- get brain MRIs

17OH production seenin CAH bc of the lack of enzymes 21 and 11

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39
Q

hypomania pearl

A

see why they are doing so well, they are impuslive and will get married uick

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40
Q

ifromed conset, can it be verbal

A

yes if it is clearly understood. doesnt need to eb uhhsband if it comes down to that

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41
Q

st johns wort

A

anti dperessive, inflammaotyr and wound healing
interacts with drups/Serotnin syndrome
educate on this and companies

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42
Q

Viral ganstoreneritis on fruit juice an dmor ediarrhea?

A

fructose malbsorption bc more osmotic load and more diarrhea, stop the fruit juice

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43
Q

genu varum bwoing of leg deformities ona kid who is otherwise nroaml- check for rickets?

A

no this is nromal and iwll go away if no leg discrepencies and taking vitamin D

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44
Q

mobitz type 2 management ( looks like bigmey + bradycardia?)

A

Pacemaker it goes on to 3rd degree block

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45
Q

Hemorrhagic, umbillicated papulaes in HIV patient, How to make Dx and what is it?

A

Crypto cutaneous and Biopsy

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46
Q

Severe malnutrition management

A

Oral rehydate (not IV-CHF risk) with IVF and glucose and go slow if you ahve to go IV for shock. Avoid high calorie diets at first bc refeeds is fatal.
Marasmus- wasting
Kwashiokor- portien edemaotus

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47
Q

Bites that needs Abx

A

Hands or feets
Cat/human bites (excpet on face)
Immunocpmromised
Body >12 hours or face >24 hours

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48
Q

Good gout anti-htn drug?

A

Losartan

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49
Q

High dose steroids for 2 weeks with Anxiety, dperession for 1 week and modd swings no mania- CBT or lower predisnone?

A

Lower preidsnone- mood symptom from steorids can happen over any duration not just acute psychosis

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50
Q

Lung cancer screenign criteria

A

55-80
>30 pack years quit less than 15 years ago
yearly
stop if they can undergo or want to undergo theray for cancer

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51
Q

does a thiazide retain calcium?

A

yes

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52
Q

how od you diagnose pakrnisons

A

Phys exam first
then MRI if equivocal

start on pramipexole or LEvo/carbisopa

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53
Q

concenusal photophobia, ertyhema nodosum, hilar LA, blurred vision

A

ocular sarcoid

look for ACE levels, hypercalcemia

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54
Q

You think she has psoriatic arthriris- MTX or prednisone

A

MTX!

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55
Q

painless macules into bullae and quickly into ulcer with red margina and nectoric centers, immunocompromised

A

exthyma gangenosum- IV Abx

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56
Q

acute rash, oral lesions, Mono like illness

A

HIV- HI ag and 1/2 Ab and viral load

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57
Q

chornic alcoholic after a refeed has profound weaknes sin muselces why?

A

Refeed eads to Phospahte shift and possible rhabdo

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58
Q

Chronic diarrhea >4 weeks work up and celiacs

A

Hx
Labs
Stool anyalsyis
villous atrphy and lympgyctes= celiacs

  • diet, give iron, calcium vit D and folic acid
  • Get DXA scan
  • Pnuemcocoall vaccine
  • daposne for skin leasions
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59
Q

Frst time depression at age 65 is at risk for…

A

Akzheimers

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60
Q

Sickle cell with fever and pain- first thing is to..

A

Give IV pain meds

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61
Q

Acute chest synrom Dx criteria and Tx

A

New infiltrates +1 of: fever, hypoxia, Resp distress, Chest pain
Infection, asthma or PE causes it
Start Ceftx, Azithro, pain and fluid control

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62
Q

low thryoid in a baby Tx

A

start right away levo

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63
Q

Absolute No ways in giving OCPs to a young owman

A 
migraine with aura
15 cigs a day AND over 35 yrs old
HTN 160/100
DM2 w/ organ damage
Hx of stoke
<3 weeks postpartum
Brast/liver cancer
CLotting disease
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64
Q

camping and then a GBS picture but no menigintis or fever…

A

Tick paralysis from dermacenotr toxins

remove the tic, no meds

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65
Q

Iron low, D low, calcium low, Phos low

A

Celiacs- malabsorption

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66
Q

Steroids and clacium bon etesting…

A

Add D and calcium and a done density every year for chronci steorids

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67
Q

urethral hyperobility

A

stress incontinence especially in a young female- keilgels and lfiestyle
If it is a sphincter then its vag birth

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68
Q

joint paint 1 week after a URI and now rash on face, and swelling of the hands

A

Parvo B19! Slef limtied

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69
Q

Encephalopathy with lactic acidosis and stroke like episode inheritance

A

Mitochondrial- Only females can trasnmit it and they give it to all theri kids

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70
Q

DKA numbers: if there is still a gap but glucose is <200…

A

Dextrose + fluids and half the insulin

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71
Q

DKA numbers- when do you start to add subQ insulin and how long do you stop the inulin drip?

A

Stop inulin if Gucose <200, anion gap<12, Bicarb >15 and able to eat.
Start subQ inuslinand IV insulin will be stoppped 1-2 hours later.
DOnt do Insulin if K is <3.3
Add K if <5.3
Bicarb if <6.9
Add Po4 if <1 or cardio/pulm probs

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72
Q

PTX diagnosis

A

Quick and best is US
if there is no probability of Tension then Upright Posterior to ant X ray!
No difference in exp vs insp.

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73
Q

Dyhsagia work up

A

If it sound slike upper airwayand cancer fisrt do a fiberoptic layrnogcopy

  1. BArium swallow for upper and lower
  2. EGD if necessary
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74
Q

When do you do peritoneal lavage for hypothermia/.

A

when not responding to heated saling

*most lab abnoramliiies will correct with raising the temp!

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75
Q

AIS

A 
Female with breasts but no period or pubic hair for years.
HIgh testosterone (XY), Pelvic ultraousns with no uterus and blid vaginal pouch and crypt testes
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76
Q

Sex endocrine

A

Const delay puberty= Trevor
Functional hypthalamic amenprrhea- atheletes with weight loss

Mullerian agensis has overias so pubic ahir and sex charciteriscts are there but no uterus

Amenorrhea >15 is abnromal

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77
Q

preggo with hyeprpgomented macules on face after sun exposure….

A

Melasma- wear sunscreen

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78
Q

GBS but with specific level of sensory being out PLus urinary retnetion- get a …

A

MRI-transverse myeltiis

do a LP if there is a non compressive form of myelopathy

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79
Q

Medicare

A

A-inpatientSNIF/hospince
B-outpatiejt, Observation hospital, outpatient surgery/diagnsotics
C-Private health insurance to provide medicare beenfits
D- Drugs

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80
Q

Macroscytosis/hyponatremia and dementia like stuff, rule out…

A

THYRID! b12 and dperession
Syph nto routine but if risk facotrs

CT and MRI recommened down the line too

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81
Q

When to get the police in ED

A

anytime staff or atient safety is at risk

use pharm if descalations fail

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82
Q

HIV during pregnancy

A

COntinue ART tripel therpay thoughout
routine CD4 count and get resistance testing
Dont ROM or fetal eletrode

ART mom + zidovuidine kid + vaginal if <1000 copies
ART + zido mom + ART kid C section if greter than 1000 copies

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83
Q

POstpartum

A

Baby formula fed
Mom contiues art
<1000 copies give the kid zidovudine
>1000 copies give the kid triple AR

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84
Q

when do you not breastfed

A 
HIV
TB untreated
HSV around boobs
On chemo or radiation
Drug abuse
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85
Q

What 3 drugs can you give in resistnat areas iwth p falciparum?

A

Atov-prog
Doxy
mefloquine

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86
Q

acute vs cronic mitral regurg

A

Acute is rupture and sudden

chronic is a leaflet problem chornic dyspnea. 60% EF is nromal

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87
Q

can a Dr go to patietns wedding

A

yes

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88
Q

painless blisters, Hep C, sunexposure causing them, fragiel skin, hyperpigmentation

A

Porphyia Cutanea tarda
Urinary uroporhyrins
Plhebotomy, hydorxy or interferon alpha

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89
Q

Colon cancer screening`

A

<60 years is the cut off and 2 familiy members with polyps or cancer:
If this is met then at risk and start at 40 q3-5 years
or 10 years before the fmaily member Dx (47 yrs old =37 screen)

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90
Q

old persone wiht depressive like symptoms but neck circumference is given and HTN…

A

OSA= sleep study

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91
Q

pulm nodule

A

<3 cm, round, surroudned by lung parenchmay no LN=needs to be stable for 2-3 years for no further wokr up

No imaging to compare to, gorwing, spiculated then you need to CT and then Brocnh them

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92
Q

Pulm nodule

A

BUT! nodules .8 + risk fctors need surgical excision
Questionable=PET for etboalic acitivtty
If it is centrally located a fiberoptic bronch for biopsy is possible

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93
Q

Bilateral nipple dischcarge

A

Normal phsycial exam > US + Mammogram> TSH,bhcg, Prolactin & med check> then discharge hoem if no toher risk factors

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94
Q

Proteinuria with renal failure no RBCs DDx

A 
NSAIDS!
MM would not have protien found in urine
PSGN would have RBCs
HTN would take years
Drug lupus doesnt cause renal failure
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95
Q

How many weeks after MI can y abone?

A

about 3 weeks - after a cardiac cath you have 3-4 weeks of sensitive myocardium - dpedning on exertional syptoms Ect they can bone

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96
Q

WHta is latency period?

A

you see no effect of a medication on mortality and then you see a change in 5 yearswith no change at 3 years

takes tiem for effect to tkick in

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97
Q

Head CT high risk

A 
Coagulaopthy 
agr 65
mechanism
vomiting, severe headache
LOC
Skull Fx
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98
Q

PTU in first or second trimester?

A

First

methemizole is 2nd/3rd trimester

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99
Q

Menignitis

Normal glucose, cell count <500, 50% lympochytes, protein 80-100

A

Aseptic meninigitis

If Abx given before LP gram stain can be negative. HIgh opening pressure, low glucose, lots of PMNS

cruptococcus ag test is very reliable

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100
Q

look slike sundowing with high AST-

A

AWS

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101
Q

Turner syndrome

A

No recurreucre rate
Streak, hrosheow, coarct, Bicupsid, nirmal intellegience

Check with Echo and US for all these things and COarct can be life threatnign

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102
Q

DVT then stroke, what is going on?

A

Shunt form R to L in heart to enter arterial system

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103
Q

Herbals/adverse effects

A 
Saw palmetto- BPH/bleeding
Kava kava- AnxDepression/liver dont use
St johns wort- depression/no evidence
garlic- cholesterol
EEchiniecea- coldflu/anaphylaxis
blakc cohosh- menopause/liver 
ginesng- mental improvement/bleeidng

none have shown benefit

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104
Q

non purulent cellutlitis - stpah or strep?

A

Strep pyo

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105
Q

Mono
Dx
Tx
airway Tx

A

Heterophile monospot
Nsaids
Steroids

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106
Q

BPH and HTN Rx

A

Doxasozin alpha blocker will give rleief and lower HTN

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107
Q

STEMI criteria for V2 and V3

A

1.5 in women
2 mm in men >40
2.5 in men<40

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108
Q

STEMI

A

New LBBB w/ clincial correlation
1 mm elevation in all leads except v2/3
-90minutes door to baloon or 120 minutes if need transfer

t wave inversion in antomical area means heart strain (possibly PE)

R prime wave in V1 and widene s in v6=RBBB

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109
Q

GBS needing cbc and blood cultutres in newborn

A

No abx to mom and Premature or ROM >18 hours

If not, then just watch for 48 hours

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110
Q

New ADHD patient

A

need colattereal info to not let abuse happen

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111
Q

PCP complications?

A

Rhabdo- can cause seizures
RBCs with no RBC casts= myoglobinura
needs FLuids

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112
Q

pheyntoin what shoudl you do if you SE?

A

ANy ort of SNC or vision stuff just reduce the dose!

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113
Q

Hidranitis suprivita Tx

A

recurren tjndouels, cna have pus or serdangouios frianage- chronic inflammaotry dirosred by blocked follicles
All patients need weight loss and to stop smoking
1-topical clinda or steroids
2- (scarrign tracking now)= doxylycine
3- TNF inihivits or srugery

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114
Q

WHat is an emergency roder in CCS?

A

THings you want done BEFORE phsyical exam! think vitals ABC first

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115
Q

How to determine HCV active vs chornic infection

A
  1. Ab testing- screen (not sur eif new or chronic or false)
  2. NAT or RNA testing (not LFTs)- if positivve tehn give anitvirals
  3. liver biopsy for fibrosis and genotype
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116
Q

plantar warts

A

salasicayc acid tx for 2-3 weeks

if failed then top gun immunos or surgery

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117
Q

no concern for AMS, tried many therpaies but terminal illness but is tachcardic and wants to go home- ER or Home?

A

Home- right to refuse if no AMS

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118
Q

NPH Tx
Acetzolamide
LP
or VP shunt

A

MIler fisher LP test to see if there is improvement- if there is then VP shunt can work for them.

NOT ACE

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119
Q

dysnea on exertion, no signs of HF or PE but vascular ocngestion on X ray… get..

A

Echo for Pulm pressures for pulm HTN

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120
Q

time frame on erythem imgrans to devleop?

A

3 days or more

<36 hour of tick on skin is no big deal

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121
Q

When do you need to wash cells before transfusion?

A

iGA deficient patients or continued allergic reactions despite antihistamines

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122
Q

When do you leukoreduce blood?

When do you irradiate blood?

A

AIDS, chronic transfusion, potential trnasplant candidates, previous nonhemolytic fever

BMT or 1st/2nd relative blood

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123
Q

what is serumsickness like reaction and when does it happen?

A

Acute Hep B
New drugs like antibiotics
fever, rash, joitn paint

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124
Q

what age is the last month a kid should walk?

A

16 months

6 months to roll over is fine. stranger danger at 15 months is ok too

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125
Q

MM suspected and bone pain, next best test is…

A

Skeletal surveyr
CT MRI and PET reserved for x ray negavite and still bone pain
watch out for kidney funtction

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126
Q

hyperviscoisty syndrome tx

A

PLEX

oral, nose bleeding and vertigo, lburry visiona nd headache

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127
Q

Nomral EKG, mitral valve repair and CABG 6 months ago- now a bunch of RHF signs and calcifcation on xray near the heart…

A

COnstriitve pericarditis - NSAIDs or pericardectomy

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128
Q

DHT 123 oxidative tests for CGD for what presentation?

adneosine deaminase for what disease?

A

Abscess

SCID- early on in life

get Igs if lots of infections

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129
Q

clahmydia testing and rpeat testing is urine or lesion testing?

A

Urine

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130
Q

reactive arthritis following infection treatment

A

abx and NSAIDs

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131
Q

Pituitary adenomas

A

Prolactinoma >200 levels! cabergoline first!

prolactin 50, hypogonadism, blurry vision= spehnidal srugery first

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132
Q

best way to test for diabetic nueropahty first?

A

tuning fork test and nerve condsutciton is used to confirm the dx

duloextiine for pain

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133
Q

asymptomatic low TSH normal T4 levels, next step…

A

recheck in 6-8 weeks

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134
Q

transfusion trhesholds

A

7
8 and up if you have stable cornary artery disease

tachy, chest pain, syncope then it doesnt adequatel refelct and mro ebleeding going on

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135
Q

low ACTH
dex doesnt suppress
cushings.. enxt step

A

CT adrenals

MRI brain (or CT chest) if ACTH is hgih !

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136
Q

Thyroid nodule

A
  1. US and TSH
  2. FNA
    B. unelss LOW TSH then get Idoine 123 and then FSH

treat a hto ndouel and ysmptoms with BB and mehtimazole bc liver risk? (PTU better in first timester)

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137
Q

girl cuts hereself wihtout intent to kill, what do you do?

A

OUtatient Psych eval

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138
Q

When is accpeting a gift okay

A

When it is not excessive
not attempted to get prefertianl treatment
a fruitbasket is ok and best for the patient

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139
Q

Psych

A

Acute stress is 3 days to 1 month
PTSD is 1-6 months
Adjutment is nto fitting PTSD but depression and anxiety like symptoms

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140
Q

12 horus post stroke with current symptoms and yspahgia need…

A

Swallow eval!

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141
Q

12 hours post stroke not on tpa, need ot give them

A

Low dose heparin to prevenet DVT s bc they are high risk

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142
Q

allergic vs viral conjuvitivits

A

Burning and sore throat/prodrome= viral
neds itching of eyes for ellergic

contagious aspect resolves when eye dicharge resolves

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143
Q

HHS swithced to Subq regular insulin and glucose in the 200s

need to either increase regualr or add long acting?

A

add long acting

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144
Q

dialysis indications

A

uremia high
7.1 acidosis
hypervolemia
hyerkalemia

if ATN and still no good UOP but has got a tone of fluids (but not fluid overload jsut euvolemic) you can stop the IVF

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145
Q

R sided Hepatic hydothorax POst treatment and refractory treatment

A

Loops, spiro and low salt

TIPS if not

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146
Q

what is swiss cheese model

A

many holes an dlayers and if they line up then a medical erorr happens

doucle checks and reudndancy to improve

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147
Q

TPN- watch out for what lyte problem?

A

low phosphate and CHF liek sypmtoms

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148
Q

MVP murmur

A

more blodo return the later it is and may disappear the NONEJECTION click an murmur/////??

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149
Q

MS

A

MRI
IV methrylprednsione and then PLEX for refracotires exacerbations
LONG TERM: Interferon
Preggo: C sections vs forceps, higher risk of kdis having it, still use IV methylpred for exacerbations

Muscle spasms are baclofen or tizandiine

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150
Q

25 yo w/ 1 cm smooth diticnt round hair loss no scaing or redness

A

alopecia areta
it will recur
Intralesional steroids (refracotry tacrolimus)

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151
Q

Scleroderma extra testing

A

Echo for cardiac fibrosis?
PFTs for interstitial fibrosis*** intial tesitng
HTN and renal crisis for kidney

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152
Q

Proximal muscle weakness, 40, on statins for 4 years, ESR 40, LFTs high

A

polymositis need a muscle biopsy
ANA and Anti Jo
Need PFTs
Echo if HF symptoms

statins not after you are on it for 4 years

polymagia rheyamtica is more stiffness

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153
Q

Anorexia and then refeeding syndomre woiht bibasialr cracklers

A

CHF- cant handle fluid and lytes shifts

NEED phosphate and other lytes

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154
Q

vag bleeding, bad pain, hemo unstable =

A

Surgery - no imaging neeeded

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155
Q

hypoNA, hyperk, hyperpigmented, alkalosis- test neeeded?

A

Cortsiol morning and low ACTH

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156
Q

HTN vs HYPOTN CHF exacerbation

A

both get oxygen and loops
HTN:Nitro tolower preload
HYpo: pressor

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157
Q

Menigitis + UMN +/- rash after camping

A

West nile- need IgM ab and uspportive care

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158
Q

type 1 diabetic norml asugars but vimtining a lot bc he is sick
do you keep long acting or do you stop it all and check sugars/

A

Keep long, stop short

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159
Q

looks terrible but doesnt have unstable angina or severere aortic stenosis- surgery or more testing?

A

go on to surgery?

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160
Q

acute mania in a preggo- haloperidol or lamaotigine?

A

haloperidol
lamotrigine for chronic

absoltue risk of ebsteins fo rlltihium is low

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161
Q

chronic fatiuge, LA, Bells palsy, hepaotmegaly, joint pain needs what test and cofnrigaotry test?

A

CXR
LN biopsy
Extrapulmonary sarcoid

uveitits

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162
Q

barotrauma PTX- dsiconnect and bag or chest tube?

A

Chest tube

disocnnect and bag if breath stacking

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163
Q

new psych but marijuana in the UDS…

A

need to rule out deug psycohsis before pshycotic illness

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164
Q

neurosyph can cause

A

sharp shooting pains in legs

pain an dtemp to be out as well

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165
Q

frequesnt trnasfusions and then you cant cross match these people, why?

A

Alloantibodies

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166
Q

looks lik kidney stone, CT is negative, gross ehamturia, lots of NSAIDS

A

NSAID nrophopathy with renal papilla necorsis causing obstruction and renal colic- it can present acutely, with heamturia and pain

Stone, cancer or renal papilla obsturction ]

acute glomerolneihgirits doesnt cause pain
Uretric clacluous wont have AKI

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167
Q

DVTPE with malignancy=Rx

DVTPE No malignancy= rx

A

LMWH
Xa inihbitors

aspirin not needed

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168
Q

DVT and Hormonones RT, next line,,,,

A

SSRI

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169
Q

when to abort a febrile seizure?

A

5 minutes

30% recurrence
3 months ot 6 years old
no long term sequela

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170
Q

Looks like brain death, no reflexes- what do you need to do to ocnfimr it?

A

Apnea test for 8-10 minutes

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171
Q

30 minutes of moderate exercise fo rwomen for preggos- if they are laready 90 minutes intesnse can they continue it?

A

YES

no scuba diving

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172
Q

weight loss, old, vascular risk, epigastric pain after eating fo rmonths…

A

chronic mesenteric ischemia! DC2!

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173
Q

inferior MI and bradyardia that doesnt reposnd to atropjne… need to do what next?

A

Pace them until PCI

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174
Q

KOH (+/- culture if negative) shows fungus of toenail- what first line?

A

Terbinafine!

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175
Q

preventing fat emoblisms

A

Early immoblization and srigical fixation of bones!

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176
Q 
Birth and infections
Pencillin to mom for:
Ampicillin to mom for:
Erythmycin to baby eyes for:
Macrolide for:
A

syph
GBS
prevent gonorrhea
prevent chalmydia in mom - onyl give to baby if they have it

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177
Q

known celiac with recurrent diarrhea needs…

A

deetailed dietary review, not reassurnce and follow up

178
Q

IIH next step

A

Eye exam

then CT and LP

179
Q

MVC with shallow breathing, periperhal cyanosis , anteroir chest bruises

A

Occult flail chest

oxygen, pain, postive pressure ventilation

180
Q

meningitis in a kid need to put on…

A

acuclovir until hepres can be excluded

181
Q

no prodorome liek sweating or pallor and then syncope

A

Cardiogenic or neurogenic

with heart disease it is liekly a run of Vtach and will need obs admit with tele

182
Q

urinary incontinece reverisble causes?

A

alcohol, infection, stool impaction, delirium, medications

183
Q

what does negative anti D ab screen mean?

A

mom hasnt encuntered Rh Anitgen yet, so need ot give Ig at 28 weeks and before dleivery

184
Q

when to reocntruct cleft lip

A

10 pounds, 10 weeks, 10 g hgb

185
Q

diabetes, weird rahs looking like a fungus rahs, diarrhea and letharyg

A

GLucagonoma

186
Q

diarrhea, dementia, dermaitis, cheliosis?

A

Pellagra niacin def

187
Q

SGLT2 inhibotrs with daiabtes, glucose 160 with WGMA?

A

DKA- SE from meds with nromal glucose

188
Q

looks like MEN syndrome with PTH high, take it out first?

A

yes

189
Q

when to skip urtehtra and go suprapubic cath?

A

failed attmept or truama to the area. give ti s shot even if they have a big prostate

190
Q

Thyrpid when to get antiTPO ab s and US?

A

US for a nodule

Abs for TSH high and free t4 normal but hypithyoid like symotoms

191
Q

sublicnical hypothyroidism will have?

A

miscarriages

non pitting edema in the legs will be hypthypid

192
Q

lens dislocation shoudl be associated with?

A

marfans

193
Q

acute onset psychosis things to thimnk about

A
  1. SLE, with joint findings, and other non specific findings- get ANA
  2. Parkinsons, dysotnia, dysarhtria- Slit lamp for copper
  3. abd pain and fam hx= uroprohbilinogen
194
Q

Hepres zoster

A
  1. valacyclovir for 7 days for PHN
  2. Preggo nurse doesnt need Ig or TX bc they need ot be screened for the immunity - give Ig or Tx if preggo or immunocmopromised with out immnity
  3. contact or aersol trnasmission, cover to sto transmission
195
Q

stuck on warts?

A

Seb keratosis

reassurance

196
Q

HIV with infection and then gets wrose but on good meds?

A

Immune reocnstitiuion syptmoms- reassurance and antiimlfmmaorties

197
Q

kids consitpation

A

limit cows milk, osmotic laxatives and fiber

stimunaltns and enemas for acute relfief

198
Q

primary ovarian sufficniency
funcitonal hypothalamic
looks like PCOS with clitomegraly

A

high FSH, low estradiol and before age 40 usually with autoimmune disease
Low all hormones, increase risk of fracture
CAH atypical

199
Q

dacroylitis sickler tx

A

Opiods, nsaids and hydration heat to hands

200
Q

anti HTN med to give photorash?

A

Thiazides

201
Q

Squamos cancer non surgical tx

A

Radiation therapy! cryo and elctro

202
Q

Cocaine STEMI

A

nitro and benzos but after 30 mintues if no help then PCI!! increase risk for plaque thrombosis even in yougn adult

203
Q

whne to add rifaxmin to C diff/

A

mutliple recurrence

ORal vanc and metroidanzole is not recommended anymore unelss cant get vanc!

204
Q

US shows stone but no murphys sign or thickening or fluid…next step

A

HIDA to confirm to lap chole

ERCP if choledocolithiasis! Lap Chole if acute cholecytitis
NSAIDS and home is less than 6 hours to elective

205
Q

can you start metformin with ast alt elevatiosn under 100?

A

yes

206
Q

kid cavities

A

As long floruide is in your diet you are good, dont feed the kid int he middle night or a bunch of snacks

207
Q

Vag bleeding steps

A

Stable- OCPS with estrogen

Unstable- IV estorgen to DC if that doesnt work

208
Q

When to putt anticoagulant on for a fib less than 48 hours?

A 
CHADSVASC 2+
CHF
HTN
AGE 75 2
DM
Stroke 2
Vascualr dz
A 65 1
Female
209
Q

PVD Tx

A

Aspirin, statin and lifestyle, exercise
Cilostazole if that fails
even if 90% stenosis, need a trials of 1 and 2 steps first

210
Q

Preop surgical testing

A

PFTs needed for lung surgery, dyspnea orprop COPD control if unlkown status- NOT needed for other surgeries
6 min walk test for heart surgery
*stop skoking 4 weeks prior to surgery!!

211
Q

NOT CHF with orthopnea?

A

ALS diaphgram paralyss

212
Q

HHS

A

FLuids then insulin after bit and and dont lower K levels wihtout changes!

213
Q

Next step for refracotry HTN

A

MRI renal arteries

214
Q

Old dude with hip pain and tech scan uptake in skull, scap and hip
scleortic lesions and thickened cortex

A

Pagets disease

Bisphosphos

215
Q

Looks like polycthemia vera but RBC in urine?

A

RCC need ct scan- take it out

216
Q

Septic arthritis kids

A

Tap it
Vanc! for step staph

hip is not PSGN

217
Q

Thyroid

A

BB and then mehtamizole if symtpoms dont go away in thryotxiciosis with nodules (espiecally in older ppl pr heart disease)

Prednsonse if amiodarone

218
Q

THryoid storm drugs

A 
PPID
Prop
PTU
Idodie
Dex
219
Q

schizoprhenia with negative symtposm on a first gen antisphcotic next step

A

Skills trianing not a second gen

220
Q

possible cord comrpession Steorids mri or MRI surgery?

A

Steroids first

221
Q

nail fold incfection

A

paronychia- warm and abx

222
Q

Labor

A

Active with good contractions is 4 hours and without is 6 hours arrest of descent. shoudl change about 1 cm every 2 hours. Add oxytocin if not good ocntracitons in 2 hours or amnitoomy

if variabel decels then do amnioinfusion for umbilcal cord compression

223
Q

diarrhea

A

Giaradia, MC world wide of foul melling, watery diarrhea and belching

ROtavirus, MC <2 yrs old

Norovirus- curiships

ETEC- occurs within days of expirsure

224
Q

cepahlohemoatom vs caput

A

caput cosses suture lines is more superifcial

225
Q

conduct vs opp defienat vs antisocial

A

codnuct is <18 years old

Opp defiant wihtiut cruelty towards other jsut rules

226
Q

Hip dysplasia

A
  1. Leg length discrpeciancy, gluteal fold assymtpetry
  2. US dont need x ray, to surgery
  3. pavlik harness 3 months then goes away
227
Q

MDD w/ psycotic features first line…

A

ECT!

228
Q

allergic rhinits tx and SE

A

INtransal steroids

epistaxis

229
Q

6+ weeks of urninary urgency and pain that feels better with voiding…

A

intersittial cystitis and normal UA

Lifestyle, avoid triggers like caffeine, blaadder traiing , Amitrtipalyine, Anlgegisc

230
Q

IRB need to re submit

A

yes for every8ihngn

231
Q

Hb a1c 6.7% in a 82 year …

A

Decrease regimen, less strict in old ppl between 7-8 %

232
Q

what age stop screening colo cancer

A

75 years old with no fam hisotry and asynptomatic

82 yr old with last screenign 12 years ago… is OK\

150/90 over 80 years ol

233
Q

preggo woth new HF?

A

periportem cardiomyopathy

loops and nitrates

234
Q

Mallory weis tear and Hiatal hernia tx/

A

Nothing

not even sucralfate

235
Q

What is scarlet fever

A

strep throat + strwaberry tongue and sandpaper rash due to extotoxin

236
Q

parvo rash

A

face flushing and it does have trunk and extrmeities involveemnt

237
Q

schizo with acute psycosis first step

A

checm p bmpp to medically clear him

then give him a dose of what he nromally takes a t home even if it is a first generation

238
Q

caleiac

A

Fam hisotry or auto ummune

Short, FTT, abd pain an d bloating, Villous atrophy

239
Q

Lupus in pregnancy

A
  1. montor for heart defects

2. contnue to take hydorxychloriquine

240
Q

ADHD SE meds

A
  1. HTN and not increased risk of substanc eabus e
241
Q

LOw acth and low t4 get a …

A

Brain MRI for putuartry

before starting levothryoxine need to get ACTH test

242
Q

accelrated renal disease risk facotrs

A

proteinuria
hyperglycemia
htn

243
Q

New ACE with mild bump in Cr?

A

its fine

244
Q

Oral communciation or digital is the best way ?

A

oral

245
Q

Hypo K, HyperCl
Kidney stones
Uinre ph above 5.5

A

RTA1, cant secrete H ions so alkaline urine

hypercaciruia and stones

246
Q

multiple small painful ulcers/

A

chancorid

Azithro or CFTX

247
Q

If there is a parasite in the answers always check for…

A

EOS!

248
Q

Breast PAIN

A
  1. Cycliucal, bilateral and no mass=obserce
    2 not cylcical and focla pain but no mass=Mammography
  2. not, focal and mass=biopsy
249
Q

Vaccines

A

No autism

fever can happen but low risk adverse effects

250
Q

ED

A

eight loss

251
Q

case cotnrol studies

A

Specific outcome already and then compared to those who do not have the otucome

252
Q

3 , <3 cm, thin, smooth, water lie, non enchanicng, himogenous renal cysts need…

A

no further motnitoring

253
Q

external vs internal validiity

A

External make sit more gernalizabilit, and mor elik the orld so a less ocntroled study = pragmaitc trials! large diverse

INternal =causlaity, tightly contorlled = Explanotry , small ontorlled efficacy trials!

cross over design switches treatment gorups
nested case controle-outcome of interest in a chohrot study retrospecitve observational

254
Q

Risk of one is 60 and the other is 40 what is th einkcrease in risk?

A

.6/.4=1.5

100% - 150% = 50% increase in risk

255
Q

phsyical abuse, ask abotu why thye ar wiht him or where can they go?

A

where cna they go

256
Q

anorexia first line

A

CBT

257
Q

Menopause moderate ot severe (not lifestlye mild with vitamin E)

A
  1. COntraindicatied to Estorgens? if yes SSRI, hx of clot

2. NO than give Estorgen only if hysterectomy and E AND P if theyhave a utereus

258
Q

Looks liek warts but umbicated center around dick

A

Mullscum cotagiosim - look for other STDs and cryoptherapy

COndyloma
Lata- syphylis with raised gray painless lesions on gooch and mouth with LA and malsis
accuminata- genital warts

259
Q

calf painand refusla to walk in viral syndrome

A

viral mysotis with elevarted CK

260
Q

iga Nehropahty vs drug indiced interstial nephrities

A

iga= 3 days after

- ain is eos, nsiads,urticaria, aki, pyuria- give steroids

261
Q

agorpahobia or happens anywhere for panic?

A

anywhere

262
Q

abscess vs cellutlis

A

Stpah vs strep

263
Q

AAA age range

A

65-75

264
Q

15 month old with down syndrome has enciparesis an docnitopation

A

hirschpung, surgery

265
Q

kid with small joint on effusion on a US (first test) an dlow inflammaotry markers..

A

nsaids this is transient synovitis

266
Q

increased vaginal discharge not smelly or inflamed

A

leukorrhea, normal

267
Q

ADHD

A

give drugs if over 6 years old

get teacher and parents evlauations in first!

268
Q

Hepatic encalpothy tx

A

remoe the drug like a benzo and give lacutlose, fluids, lytes

269
Q

Stopping paorxtine abruptly can cause…

A

Disocntinuiation syndrome that looks like the flu and anxiety, restart it

270
Q

what does cincalcet do?

A

Reduce Ca and PTH in hyperPTH

271
Q

High calcium treatment

A

IVF and Calcitonin shrot term

Zolendorni acid long term

272
Q

WIll vitmain D be low or hgih in boen mets hypercalcemia?

A

Low

High in Lymphoma

273
Q

Looks just like mania but vital signs jacked up

A

cocoaine

274
Q

MC of chromosomal abnromality

A

Chromosomes

275
Q

Tx for hto tub folliclulits?

A

No tx, 1 week go away

276
Q

Scooped out flow volume loop to the left?

A

COPD
right is Restrictive and stright
tracheal stensois is a big glob in the middle

277
Q

Bradycardia, fatigue, lightheaded, confusion…

A

SSS
Defb and antiarrythmics
RBBB or dorpped p waves from fiborsis of SA node

278
Q

Big ol soft tissue knob on th ebakc of elbow is

A

olecranon bursitits- need to aspirate the fluid for infection and possible abx

279
Q

Alcohol or NSAID sin crease Bp

A

NSAIDs unless you drink more than 2 drinks per day

280
Q

herpes PPx for delivery

A

give acylovir at 36 weeks on and c section if acrive lesions

281
Q

Can ITP have anemia. Tx

A

yes- look for a chronic blood loss liek periods tho

Steoirds if less than 30K
IVIG and plateltes if hemorrhage

282
Q

vEEG with shaking no abnromalites for seizures…

A

psychiatric eval

283
Q

HIV, transaminitis, pancytoneia, honeycomb lungs…

A

milairy TB mycobacterium tuberclousina
Get a liver biopsy
RIPE! still for myocplasma

284
Q

<2 kid with tonnnns of water diarrhea ….

A

Roatvirus, get the vaccine

285
Q

kid looks great, 10% in weight and 20 in height….

A

reassure and nrw foods,

<5% is FTT

286
Q

Daytime wheezing and chest tightness in a 47 yo chronic cough nest text…

A

methacholine for new asthma

287
Q

Nomral eye pressures, periphery viusal loss, OPtic cup and dis ratio is high .

A

Open angle glaucoma, same meds for clsoed angle

can have high pressures in eye too

288
Q

old lady with abdminal fullness an dbloating next step

A

surgery for ovarian cancer

OCP to prevent this

289
Q

Preggo exposired to parvo next step

A

get Ab testing for + Igg and - Igm to shwo she is not infected or else hydrops
IVIG to treat

290
Q

3 things to prevent ventilatory PNA

A
  1. semirecumbent in 45 degrees
  2. minimize sedaion
  3. ETT w/ sublgottic drainage

no abx ppx, antispetics for oral decomnatmination, avoid ppi in low risk patients, chaneg circuti only if dirty

291
Q

lap choel with abdomianl pain now…

A

retained stone, need ercp

292
Q

postmenopausal belleding

A

endo cancer need TVUS

Atrophy is negative and topeical estogen cream

293
Q

high calciumand recurrent sotnes need to do what to prevent them

A

limit oxalte and proetin anmials

294
Q

Syncope with RBBB and Left fasicular block

A

Transient AV block

Cardio syncope
VT
SSS
AV block
Aortic stenosis 
lytes
295
Q

3 yo with FND and sickle cell disease next step…

A

Intracrania US for stroke to ransfusion therapy

296
Q

monochroionic, diamonitoic risk

A

twin tiwn transfusion syndrome by shapring one placemtna and one baby stealing the blood , possibly fatal

297
Q

OSA complications

A

CAD, arrythmias, heart failure and htn

298
Q

ARDS tx

A 
low TV
PEEP! 15-25
not plateu, should be <30 plateu
RR <35
FIo2 <60
Pao2 goal 55-80
299
Q

SBT requiremtnes

A

fio2<40
pH 7.25 or higher
abiltiy to pull breaths

300
Q

hypothelamic amenorrhea tesint tnext step

A

DXA

301
Q

Scar on X ray for TB needs

A

INH for 9 months
or INH and R for 3 motnhs
Rfamoin for 4 months

302
Q

Bipolar with depression, dotn presribe him..

A

SSRI monotherpay it wil induce mania

needs lithium and zyprexa

303
Q

HIT 1 dx and tx

A

Nadirs of 100K by plateket aggregation - not immune. not a big drop. Nothing to do

304
Q

HIT 2 4 Ts

A

Thrmovcytopenia- 30-50% drop
timin-5-10 days post heparin (<1 day sometimes)
thrmobosis and skin necrosis
Tx- stop heparin, argatroban, PF4 ab sent

305
Q

Kind of looksliek MRV but sinus drinatge, DM2, febrile proptosis

A

Mucor- needs surgery

306
Q

Sickle cell immediate tx for splenic sequestraions?

A
  1. IVF
  2. then RBC transfusion
  3. splenctomy after criss is down
307
Q

How to BEST dx acute glaucoma and risk fcotrs for it/

A

Gonisocpy

OTC phenyleprhine and antochonilergic s

308
Q

Heart block with brady crdia. look for lymes disease!

A

rash 1 month ago type of thing

309
Q

resp distress end of life patient, give…

A

opiods

310
Q

C diff with WBC over 15 and AKI need to get….

A

Abd imaging to look for toxic megacolon and perf

311
Q

ICU old due now has unexplained fevers after 5 days,…and gall baldder stuff… tx

A

Aclaculous cholyctisits- needs a perc drain

312
Q

MOderate variabiltiy without accels in non lanor patient, keep or go home?

A

observe and get BPP need accel

313
Q

opiod constiaption prevention?

A

senna docusate

Methylnlatrexone in refrscotry cases

314
Q

PPH with mass at the vagina…

A

Stop oxytocin and put the uterus back in- uertine inversion
if nto inversion then normal PPh

Hemo stable nto reposnidng to emds= artery embolixation
unstable= surgery hysterectomy

315
Q

Polycythemia in newbrns what to monitor

A

GLucose and bili
from delayed cord clamping
self limited

316
Q

Chronic rectal dialtion in kids

A

form consitoation bc they hold their poops in

if increase weight gain then not CFTR

317
Q

Sickle cell trait and exercise

A

stop and break for hydration . normal life expectanct and HbA over S, nromal Hgb and rretic count . can get rhado from sprots

318
Q

Weight loss, tremor, amenorrhea, umbilicus mass Female

A

Hydatiform mole, Suction curretage

319
Q

FRAIL and tx

A

faitgue
rsistance weakness
ambulaotry dysfunciton
mutliple illness chronic]loss of weight

Get upand go test and blood owkr and make sure they ex4ercise and diet

320
Q

Alcohol abouse and now weakness, no DTRs, weak

A

low phospahte

321
Q

Exericse near syncope in young 22 year old next step

A

Echo for HOCM

exercise EKG to straify after

322
Q

Otitis externa vs media pathogens

A

Psueomonas and staph outside- topicla floruquinilone and steroids

strep pneumo, moraxella and h flu inside

323
Q

Depressed mood you need to find out i f they have ever had…

A

Mania, if bipolar then dont give SSRI , and give lamotrigine

Anticonsualnt and antispsycotic 2nd generation

324
Q

olanzipine an dclozapine checks need

A

glusoe and eight gain

325
Q

Normal clinclaly but creptisu after bipap

A

Repeat x ray for pbarotruma, SL

326
Q

BPH symtoms work up

A

UA
PSA!!!!
rectal

327
Q

progestin iompant or OCPs /

A

Progestin iomplant 99% vs 91%

even more effective thn IUD???

328
Q

sexual assalut pregangancy contraception and tx

A

uliprostl - ant progesterone and after up to 5 days effective
copper IUD too up to 5 days but nto if cervititis

Cftx, azitho, HIV meds, metronidazole and hep B based on vaccination status

metro no if no organisms seen!
no need to give penicllin, repeat testing for it tho

329
Q

Ventilator PNA next step

A

Culutre then Abx broad

330
Q

VZV shoudl e givne if sinbling is immunocpromised

A

no Ig necessary for sibling

331
Q

antithyroid peroxidase antibodies…

A

hashimotos thyroiditis hypothyridism of high TSH and low T4

332
Q

Rapidly exmapnding neck mass with hypothyroidism, can feel inferoir border nd plethroa when arsma above head…

A

Thyroid lymphoma, RAPID, old and hx of hashitmotos

333
Q

need ot disclose HIV status to school?

A

no

334
Q

Thyrid cancer

A

medulalry- MEN, c cells, HIHG CALCITONIN!

335
Q

match small cell and squamose cell
SIADH
PTHrp

A

Samll cell- SIADH (water resitrction))

Squamos- PTHrp suamos is a PUSSY

336
Q

Kidney stone and pregnancy work up

A

TVUS and renal US

then MR urgram or tx empricially

337
Q

shoudl you wiehg in dialy to lose weight

A

yes

puthealthy foods on the ocunter

338
Q

Post partum thyrditis

A

HyperTSh with nontender goiter within weeks to 1 year of reggo, destruction of follucles to lead to low throyd soon
Thyrid peroxidase Ab (like hashimotos)

IF there is RAIU and high uptake then GRAVES, no uptake is this

339
Q

Negative stress test=

A

<1% risk in 1 year

diesnt exculde CAD

340
Q

looks liek divertiulutis with hx of it and now you ahve dialted colon on x ray and edema on flex sig..

A

Acute ishcemia
look at risk fcotrs, blood bowel movement where div. is +/-
doest have to be occlusive and super painful but low flow ot water shed LLQ

341
Q

STEMIa nd cath 2 weeks ago with repeat steami, biggest risk to make thi shappen is

A

not taking your Clopidgrel

342
Q

tx of fungla foot

A

oral terbinafine

343
Q

Rashe

A

Lichen simplex chronicus- anxiety ans excoriated plaques
Dushiditoitc fdermatitis- itchy, vesicaur dry rash on plamsa nd soles
psories- mild itchis with silver scaled palqeus

344
Q

lichen slceorsus risk…

A

vuvlar cancer
smoker
itchy
dysparunia

345
Q

DM1 with 5k run, stop or lessen lispri?

A

Dont skip the dose, jsut lessen it. Type 1 at risk for DKA

if longer than an hour exercise than decrease basal dose the night before

346
Q

IDA anemia is older male…

A

clonoscopy

347
Q

Painful and large LN for 2 weeks, eyes feel dry and hurt Tx adn dx

A

Cat scrath disease, Azithromycin and slef limtied, fever is +/-
parinaud syrndrome

348
Q

twin pregnancy and first baby is breech

A

C section

other eay around and maybe ok

349
Q

zyrtec or avoid the cat first

A

no cat

350
Q

Hx of cirrhosis with now hypTN and AKI, next step to diagnose

A

Heatorenal syndrome, Bolus fluids to make sur eits not just pre renal volume down

351
Q

Tx heatorenal syndrome

A

albumin, octreotide and midorine

352
Q

Heptorenal syndrome Path

A

Arterial vasodilatation in the splanchnic circulation, which is triggered by portal hypertension, appears to play a central role in the hemodynamic changes and the decline in renal function in cirrhosis [1-3]. The presumed mechanism is increased production or activity of vasodilators, mainly in the splanchnic circulation, with nitric oxide
GFR lowers, cardiac output rises and hypoTN sets in even thoe the RAAS is activated and synptathetics are kciked in

353
Q

Cause and spread of mullcuosum contagiousosum

A

pox virus
skin to skin
HIV testing

354
Q

dorsal hands red puruple plaques?

A

dermatoyosis form gorttons papules autoimmune

355
Q

insulin resistance skin

A

tags,acanthosis nigrans in the armpits, xanlrthsma

356
Q

asymptoimaitc hyercalcmerima with low urinary Ca//

A

Casr familial, observe

357
Q

metronidazole safe in lacatation?

A

no, pump and dump

358
Q

Depression on SSRI for 8 weeks with poor sex and little nenefit….
good benefit and poor sex?

A

swithc to buoprioin or mirtazpiine

add buporopion or sildenafil

359
Q

Hep B in infants with Hep b mom

A

0, 1 , 6 months and Ig at birth

Check Serology at 9 months

360
Q

HTN and then give ACe and now AKI..

A

Renal artyer stneosis from increase RAAS and take it away and les gfr

361
Q

on levo and tkaing OCPs and now hypthyroid… why

A

need higher dose of levothyroxie to saturate the binding sites , plasma protein stuff

362
Q

ortho hypotn and upper gi bleed next step

A

ENDO not CT

363
Q

dengue fever, retororbital pain, white rash,

A

cap permability and risk for ciruclaotry and resp failure, spntaneous bleeding

Tx supportive
low plateltes and

364
Q

Massive henmorrhage needs more… postpartum

A

Rhogam, if nto enough then doesnt work

365
Q

multiple dermatomes shingles precautiosn

A

airborne and ocntact

366
Q

Looks like lyme but no rash and goes to carribean, joitn pain, malaise

A

chinkungya fever, no fever sometimes resent. Jints are bilateral and all over. supportive

367
Q

ADHF management, diuretics or BB?

A

NOT BB, diruetics intial theray alone iwht oxygenation, IV nitro

if iti is PNA then obvious CXR and fever

368
Q

3 drugs to make folci acid anemia

A

Bactrim, MTX, phenyotin, GIVE foliINIC acid, nto folci acid, stronger or leucovorin

369
Q

first line for insominia

A

CBT

zolpeidem is for acute and it is non benzo but same SE

370
Q

HIT 2

A

Serotnon release assay
argoatroban

warfin necoris sbut if you need it then you need to wait until platees back over 150

371
Q

Seizures and regnancy on Depakote

A

continue depakote and screen and give folic acid

YOU CAN breast feed on antieplicts if the benefits out wiehg the risk

372
Q

dude, headaches, visual distubances, retina lflame hemrorhges and stuff, on isoretinoin

A

Pseudotumor cerberri

373
Q

ssri to pehneylzie time period

A

5 weeks, SSSS

374
Q

Hypothyroidism and surgery

A

increase post op risk but not much, still do surgery

dont start levo bc eill iwncrease mycoardial demand

375
Q

heparin is 10a and 2a= UFH, use in renal patients

LMWH is Xa less 2a=enoxaparin, no PTT

A

Only use warfarin in 2nd and 3rd trimester is mechanicla heart valve

376
Q

FOlic acid amoutn and when to start?

When to go to genetic speiclaist?

A

.4 1 month before. 4 mg daily if NTD in the past

3 spontaneous abortions

377
Q

pancreatitis risk faotrs for worse outcome

A

APACHE 2 and SIRS socres

or singles of Age, obesity, BUN 20 andCRP and HCT over 44 bc of hemoconrtation

378
Q

MHT stuff

A

Good: All cause mortlaity benefit under 60, DM2, Fx/bone mass
Bad for: CAD >60, stoke, breast cancer and clot

endo increased nless there is rogesterone and ovairan is neutral? no mortlaity benefit over 60

379
Q

TBI risk facotr <2

A

No frontal scal hematoma, 3 ft mechanism

> 2 is basilar skull fx and vomiting

380
Q

VSD, fixed spltting or hoosystolic murmur

A

murmur,

splitting is ASD

381
Q

bleeding and ITP tx

A

IVIG, direct antiglobulin negative

petechia is mild
epsitaxis si worse

382
Q

mildly high thyrid levesl on mehtamizole…

A

stay the course, dont risk hypothryoudsm

383
Q

Sex with HIV drugs

A

72 hours for 28 days. If after 72 hours not helpful and just re test them to make sur ehtye have itand get Hep B testing before starting ART
need 2 NRTI and 1 reltegravir

384
Q

Positive interferon with negative CXR

A

INH 9 months

385
Q

Puberty nromal age
idioapathic premature
CAH

A

9
isalte pubic hair without boen age or acne
Bone age, acne, pubic hair +, low 21OH, give hyrdocortiosn

386
Q

CN, menigitis signs, ocular signs, palm rash, afebrile

A

Secodnary neurosyph

387
Q

demenait plus spastic paresis, hyperreflexia

A

B12

388
Q

Funal infeciton of scal needs topical or oral

A

oral G or T

389
Q

clozapine testing

A

Neutropenia

390
Q

COPD with MAT, accessory muscle use COPD exaceration needs

A

BIpAP and lyte rpelacement not anticoagulation

391
Q

warts transmitted is condyloma…

A

acuminata, turns whit ei with acid, first line is Trichloacetic acid

Can use pdophyllin but not on insde for preggo
imiquad is immunologic

392
Q

rhabdo on statins need to check CK first or jsut restart them

A

check first

393
Q

acne first line startes mild

A

avoid vigous scrubs, water ased skin stuff and ph neurtal cleaners
Vit E used to prevent scarring
Diet not soley advised for acne, dont pick the zits

394
Q

PID risk factors

A
  1. lots of sexual partners

2. Previosu PID #2

395
Q

acitnic keraotisis tx

A

5FU

396
Q

HIPPA can be violated when there i safety or health ejopardized

A

k

397
Q

old recurrent falls, deccreased vision and cataracts

A

macualr degenration

398
Q

still give hromones to dead oragn donor

A

yes keep them aliv as nromal

399
Q

is adenosmysos uniform or not on exam

A

yes unifomr, fiboroids is irregular

400
Q

HEart failure hypoantremia Tx

A

restirc water then go to Vaptan blockers for ADH

401
Q

guatemela, transient couhg, abdomina bloating and blood in stool

A

aldendazole

402
Q

HFM coxsackie tx

A

supportive

403
Q

no repsosnse or SE on psyhc meds, increae or switch

A

switch

404
Q

MC foreign body bacteria

A

staph

405
Q

Hep B post exposure

A

Ig and vaccine

406
Q 
Breast mass that is simple and had a US and FNA is:
Bloody
Non bloody
simple and non tender
complex
A
  1. Biopsy or more imaging
  2. repeat US in 4 weeks
  3. observe
  4. biopsy
407
Q

young ollege kid with a bunch of weif symptoms and fever

A

HIV

408
Q

COPD Gas exhange explained, great

A

Hypoxemia in chronic obstructive pulmonary disease (COPD) is primarily caused by ventilation/perfusion (V/Q) mismatch. The emphysematous component of COPD causes airflow limitation due to loss of elastic tissue and small bronchiolar collapse, and chronic bronchitis contributes to airflow limitation as well. COPD exacerbation causes further airflow limitation due to mucus plugging and bronchospasm. The result is numerous localized areas of lung that have a low V/Q ratio, which is the major cause of hypoxemia in patients with COPD. These poorly ventilated lung regions (low V/Q regions) undergo hypoxic vasoconstriction to improve overall gas exchange efficiency, but nonetheless still have a low V/Q ratio. Despite restricted airflow, supplemental oxygen (O2) is able to successfully reach the alveoli in these regions, resulting in an increase in Q (due to alleviation of hypoxic vasoconstriction) and improved gas exchange to the blood (improved hypoxemia).

Emphysema also leads to areas of lung that have a high V/Q ratio (dead space ventilation) due to destruction of the alveolar-capillary interface, but these regions play a relatively minor role in hypoxemia and are more important in the development of hypercapnia. Supplemental O2 also increases V in high V/Q lung regions; however, as Q does not increase significantly (and the O2-carrying capacity of existing Q is essentially maxed out), the ability to improve hypoxemia from these regions is minimal (Choice C)

409
Q

When does pooping frequency begin to lower

A

1 month, it is normal and only 1 a day or every other day i sokay

410
Q

Early lymes disease

A

serology isnt posiitve yet, lcincial Dx
bullseye is confluent still
give doxy
ceftriaxone if severe mennignitis type symptoms

411
Q

TSH 0 and t4 mildly high with no symptoms, when do you teat with meds/

A

65 years old
CAD
osteoproosi

take out a hige goiter if compressing, not raidactive didoine

412
Q

diffuse thyorid uptak with thyrtopin recpetor antibbies

A

Graves

413
Q

SAAG >1=

A 
caue of ascites
POrtal HTN (CHF or crrhosis or hepatitis)
<1= ovarian cancer, pancreatitis, nperhtotic syndrom
414
Q

varucose vein tx

A

compressiong and leg evleationg for 3-6 months to scleroothrepy to leg an dcomplications leads to surgery ligation

415
Q

Does fever and heached= LP on boardss

A

no

416
Q

small volume blood out of butt-

diverticular bleed

A

internal hemorrhois of sumucosa

painless hematochezia of artery even if it stops- should top on its own>colonsocpy>embolization>surgery

417
Q

Genital warts and pregnancy can you V delvier

A

yes

418
Q

Low back pain, nromal acitivty or exerice rogra?

A

exericse program is better

419
Q

complex breast cyst need

A

core biopsy

LCIS- is core exiciosn

420
Q

Gy doesnt want to knwo if he has huntingotns

A

they have aright not know unless it involves a treeatable condition of a child bc knwoeldge may give you depression

421
Q

Hip surgery

A
  1. stable and ambulatory = <48 hours

2. non ambulaotry and demnted or suntable- non operatvie

422
Q

do kids grow out of ADHD and is there risk of substance abuse?

A

NO

YES

423
Q

Vit amin B2 defienicy ribolfalvin

A

glossitis

424
Q

Anti thryoud peroxidase

A

in graves and hashtimots

425
Q

Testicualr SU reveals fracture—-

A

surgery

426
Q

Bone oss an dpsot menipaual tretment in the setting of cancer 18 months ago…

A

Estorgen and progesterone if have uterus

427
Q

PCOS OCPs

A

progestin IUDs

428
Q

septic shock

A

lysis of bacteria and the endotoxin is roaming aorund … maybe add lcinda?

429
Q

COPD prognostic factor

A

FEV1

430
Q

Screening for OSteoprosis

A

> 65

or < 65 + smokes, low BMI, fam hx, steorid use

431
Q

Bisphosphos given to which pts?

A

Fragiltiy fracutre

  • 2.5
  • 1– -2.5 w/ 10 year probavilty >20 or hip fx >3%
432
Q

Wide fixef splti with loud systolic murmur over P site?

A

ASD, overflo into the valvr

433
Q

pseudofollicultis barbae

A

stop shaving

434
Q

OCPs breahtru or weight gain?

A

breatk thru, nto weight gain

435
Q

best predictor of change?

A

failure and willing ness to press on

436
Q

Choking infant

A

partial- allow to cough or gag

cyanotic < 1 year is back and then chest over knee
>1 year isheimlich or lean forward thrusts

437
Q

preggo, MVC, she looks great, baby looks great, Rh negative needs

A

Kleinharu betke test to see if and how much alloimmunization is needed

438
Q

SI w/ no intent do you
Get a suicide ocntract?
SSRI and outpatient?
hospitalize?

A

SSRI outpatient

439
Q

How to diagnose DM2

A

Sympatomatic: 1. a1c 6.5%, fasting 8 hr tet >126, glucose tolerance or random glucose >200
No symptoms= repeat the same test another time

440
Q

PMH HOCM with fam hx of sudden cardiac death

A

ICD, skip Medical to >alcohol ablation

or if VT and reccurent exertioanl syncope

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