UWORLD2 Flashcards

Question

How do you confirm the diagnosis of gastroparesis? What is the management?

Answer 1

**Assess motility with nuclear gastric emptying study** **Dietary modification** - smaller, more frequent meals with decreased fat and fiber intake If dietary changes alone are not sufficient, **promotility agents such as eryhtromycin or metoclopramide** may be needed

Answer 2

hemoglobin electrophoresis determines which form of sickle cell diseae is present

Answer 3

naltrexone

Answer 4

Acute kidney injury due to myoglobinuria Receive early and agressive isotonic saline infusion to improve volume status and prevent intratubular cast formation.

Answer 5

Markedly elevated creatine kinase levels (usually \>10,000) Blood with no RBC, indicating myoglobinuria.

Answer 6

**Penicillin.** Patients with penicillin allergy require **pencillin desensitization** prior to initating treatment

Answer 7

Systemic necrotizing vasculitis Marked by glomerulonephritis, chronic pneumonitis and recurrent sinusitis/otitis media

Answer 8

**Exposure to cigarette smoke and air pollution** damages the cilia responsible for moving mucus through the sinuses. mucus builds up and obstructs the sinuses, resulting in secondary bacterial growth. other causes -inadequately treated **acute sinusitis, structural abnormalties of the nasal septum or palate, and allergic rhinits**

Answer 9

Retrograde ejaculation

Answer 10

HUMAN: **Eikenella corrodens,** a gram negative anaerobe **Local wound care & Irrigation** **No primary closure (except face)** **Antibotics - Oral amoxicillin/clavulanate)** **consider tetanus booster** **DOG/CATS: Pasteurella multocida.** Due to their pointed, sharp teeth, cats are especially capable of implanting bacteria under the periosteum causing osteomyelitis

Answer 11

**Dietary modifcation** first (increase dietary fiber & water intake, limit cow's milk intake to \<24 oz) Then **ostmotic laxatives.** Causes retention of fluid in the gut lumen and stool, resulting in softer bowel movements. Acute and long-term use of osmotic laxatives is considered safe for pediatric use. Treatment with **stimulant laxatives** (increases peristalsis to promote defecation)or **enemas** (distends the retum and stimulates colonic muscles) is generally reserved for **acute** relief of fecal impact

Answer 12

Alzheimer disease adn vascular dementia

Answer 13

Increases the **serum concentration of thyroid binding globulin (TBG)** in Normal patients, feedback loops promote increased endogenous production of thyroid hormones to compensate for the increased number of boud thyroid hormone molecules. However, patients with hypothyroidism cannot adequately compensate and an **increased dose of levothyroxine** is usually necessary.

Answer 14

**Oral contraceptives** **increase** the serum concentration of **TBG** by promoting its glycosylation (which slows its clearance). Icnreased concentraitons of TBG means more bound T3 and T4 hormones. **Androgens and glucocorticoids** cause the opposite problem since they **decrease TBG.**

Answer 15

Classic triad of **gait disturbance** followed by **impaired cognition and urinary incontinence.** MRI - **ventriculomegaly out of proportion to sulcal enlargement and the abscence of an obstruction.** **Lumbar drainage of the CSF fluid** with pre-post assessement of gait and cognition is helpful in predicting effectiveness of ventriculoperitoneal shunting. If there is no improvement with CSF drainage, VP shunting may not be helpful.

Answer 16

Parent or legal guardian. Adolescents are typically alllowed to give consent for their own care in regards to pregnancy, contraception. STD, substance abuse and emotional illness.

Answer 17

**Elevated ammonia levels** due to underlying precipitating event. A common trigger is **excessive diuresis** which results in: **Hypovolemia** (high urea nitrogen) **hypokalemia** (facitlates conversion of Ammonium to ammonia) and **metabolic alkalosis** - decreases urinary loss of ammonia **Volume and electrolyte repletion first** and using **medications (ex: lactulose) to reduce ammonia levels.**

Answer 18

Sexual dysfunction Switching to the non-SSRI antidepressants bupropion or mirtazapine, augmentation with sidenafil or buprion and cautious dose reduction in patients taking high SSRIs

Answer 19

Osmotic - serum osmolality is \> ~285 Nonosmotic - hypotension, hypovolemia, hypoxia or hypoglyemia

Answer 20

Asymptomatic/Mild symptoms - Fluid restriction Severe symptoms are at high risk of rapid neurolgoic deterioration and death - Hypertonic 3% saline

Answer 21

Tinnitus, restlessness, N/V and mild GI discomfort after a few hours, fever, Metabolic acidosis and hyperventilation

Answer 22

Aimed at eliminating the offending agent through gastric lavage and administration of activated charcoal. Important to determine salicylate serum levels. Values greater than 35 mg/dl indicate significant acidosis and alkalinizaiton of the urine is indicated to enhance aspirin excretion.

Answer 23

A test diagnoses a disease earlier and as a result, the time of diagnosis until death seems prolonged even though there actually is no improvement in survival.

Answer 24

The survival benefits of a screening test are overstated due to the detection of a disportionate number of slowly progressive benign cases.

Answer 25

Presents with **painless hematochezia**, resuling from **outpouching of the colon** walls at points of weakness where the **vasa recta** penetrates the circular muscle layer of the colon. Bleeding occurs as the **exposed artery is injured,** usually from **erosion or trauma.**

Answer 26

Colonic angiodysplasia (AV malformation) decreases the development of dilated, tortuous submucosal vessels and is also a common cause of hematochezia. However, DB is more likely in a patient with a hx of diverticulois and no prediospoing factors for colonic angiodysplasia (ex: End stage renal disease, VWD, aortic stenosis)

Answer 27

small-volume bright red blood that covers the stool.

Answer 28

colonoscopy or tagged RBC scan

Answer 29

Coagulase negative Staphlococcus. Pseudomonas

Answer 30

Both present with hematocheiza and more commonly see in patients over 60. Ischemic colitis is sually associated with adominal pain and bloody diarrhea; Angiodyspagia presents with painless bleeding.

Answer 31

aphthous ulcers, cobblestoning or skip lesions (normal bowel interrupted by areas of disease). rectum is commonly sparred

Answer 32

CD counts \<200 Diffuse bilateral ground glass opacities Trimethoprim-sulfamthoxazole

Answer 33

- Patients with supratherapeutic international normalized INR \<5 on warfarin and no serious bleeding - **HOLD WARFARIN AND RESTART WHEN INR IS THERAPEUTIC** -- Patients with supratherapeutic INR \>or=5 and no serious bleeding - **ORAL VITAMIN K IN ADDITION TO HOLDING THEIR WARFARIN.** Oral vitamin K is preferred route at any supratherapeutic INR unless there is serious bleeding.

Answer 34

**Antithyroid drugs** Mild hyperthyroidism, older age with limited life expectancy, preparaton for radioactive iodine or thyroidectomy **Radioactive iodine** - modteratre to severe with/without opthalmopathy - patient presence in mild hyperthyroidism * \*Give **predisone** along with radioactive idiodne for those with opthalmopahty. concurrent use is less likely to worsen opthamalopathy* **thyroidectomy** - cancer suspicion - Coexisting primary PTH - Pregnant patients who cannot tolerate thionames - severe opthalmopathy - restrosneral goiter with obstrcutive symptoms

Answer 35

**Total T3 and Free T4** (free T3 assays are less well validated and not routinely used) Measurement of TSH does not accurately reflect thyroid functional status as TSH may remain suppressed for several weeks to months following RAI therapy, even when the patient is euthyroid or hypothyroid state.

Answer 36

**hx of sucide attempts** Patients with a previous sucide attempt are 5-6 times more likelyt o make anotehr attempt than those who have not made a previous attempt

Answer 37

**Topical corticosteriods (high potency - Fluocinoide, Betamethasone) -** mild to moderate used for thick plaques on extensor surfaces **Phototherapy** - for extension disease \>10% of body surface area **Methotrexate** - effective for severe psoriasis, psoriatic arthritis, and psoriasis involving the nail **Low potency (hydrocortisone)** may be used on the **face and intertrignious areas** (but are not as effective on extensor areas with thick psoriatic plaques)

Answer 38

Allergic conjunctivitis can also present with bilateral eye redness and watery discharge. However, they also have the **hallmark ocular itching (pruritis)** (not found in viral). In additiona, **allergic conjuncivitis does not cause gritty or burning sensation.**

Answer 39

in contrast to viral conjunctivitis, bacterial conjunctivitis causes a **more profuse purlent discharge that accumulates after being wiped away.** Also, bacterial conjunctivitis generally presents in isolation rather than in the setting of other viral symptoms (rhinorhea, pharyngitis etc)

Answer 40

Eye drainage caused by viral conjunctivits is the primary route of viral shedding. Patients are highly contagious due to the large amount of virus present in the eye discharge. **Children should remain at home, even if they are afrebrile, until their eye drainage has reolved.**

Answer 41

procainamide, hydralazine, minocycline and antiti necrosis factor (TNF) alpha therapy (etanerceipt, infliximab)

Answer 42

tick-borne illness characterstic skin rash & ertyhema migrans at hte site of the bite in the **early** **localized** phase The next phase, **early disseminated disease** - **multiple ertyhema migrans lesions** In addition, **Weeks to months** after inital infection - **neurologic** (ex: peripheral neurophaty, cranial nerve palsies, lymphocitic meningitis) **and/or cardiac involvement** (ex; myopericarditis, AV bock) **Late disease (months to years)** is associated iwth **arthritis** of the large joints and **mild neurological manifestations** (encephalopahty or polyneuropthy)

Answer 43

Creutzfeldt-Jakob disease caused by **abnormal proteins** called **prions**. As the prions build up in cells, the brain slowly shrinks and tissue fills with holes until it resembles a **sponge**. Consequence, those lose the ability to think and move properly and suffer from mmemory loss. It is always fatal, usually within one year of onset of illness **periodic sharp wave complexes** oberved on electroencephalogy and present of **14-3-3 protein** in the CSF.

Answer 44

Decreased levels of acetylcholine due to degeneration of the **basal nucleus of meynert** in the **forebrain** and **diffuse deficiency of choline acetyltransferase,** which is responsible for the synthesis of acetylcholine. Acetylcholineserase inihibitors circumvent this problem by inhibiting ht ecounterregulatory brakdown of acetylcholine, thus increasing the overall level of acetylcholine. **Donepezil** offers benefits in once-a-day dosing ,improving in behavioral and cognitve domans, and has fewer side effects.

Answer 45

IV atropine is indicated in patients with symptomatic bradycardia (ex: hypotension, heart failure) However sinus bradycardia in the absence of a pulse respresent PEA rather than symptomatic bradycaria. Atropine is not used in patients with PEA cardiac arrest. PEA requires prompt cardiopulmonary resuscitaiton aong with epinephrine every 3-5 mins.

Answer 46

**Bedtime bottle use** and **frequent exposure to sugary snacks.** As soon as a child's first teeth erupt, **fluoride toothpaste** should be used judiciously and dental plaque, white spots and cavities should be assessed on examination.

Answer 47

**Pancreatic inflammatory fluid collections** (ex: pancreatic psudocysts).

Answer 48

**Reticulocyte count** Normocytic/normochromic anemia can be caused by two large groups of disorders: **1. Diseases with decreased RBC production** **2. Hemolytic disorders** An **elevated reticulocyte count** indicates **hemolysis** as the cause of anemia. Other findings assoicated with increased RBC destruction should be sought (elevated indirect bilirubin level, decreased haptoglobin, increased LDH, splenomegaly) A low reticulocyte count indicates a hypoproliferative state (renal disease, hypothyroidism and aplastic anemia may be present)

Answer 49

normocytic/normochromic ESR and serum C-reactive protein measurements

Answer 50

**Factor V Veiden** Accounts for approx 40-50% of the inherited thrombophilias.

Answer 51

Rh(D) negative mother & Rh (D) positive father

Answer 52

**Condyloma acuminata** or anogenital warts, is the **most common viral sexually transmited disease in the U.S.** The condition is caused by infection with the HPV. Patients may be **assymptomatic** or **may complain of pruritis, bleeding, burning or tenderness.** These lesions are typically s**kin-colored or pink** and vary in appearance from **smooth flattened papules to verrucous, papilliform growths.** **Pearly penile papules** are a **normal variant** and are **not spread by sexual contact or activity.** These **asymptomatic papules** are more comon in **unciricumcised** males and typically appear as **one or multiple rows of small, flesh-colored, dome-topped or filiform papules** positioned **circumferentially** around the **corona** or **suclucs** of the glans penis.

Answer 53

Most common form of progressive motor neuron disease Presents with **progressive weakness accompanied by both upper and lower motor neuron deficits.** **Inital sign of the disease with LMN involvement is developing asymmetric weakness**, usually first evident distally in one of hte limbs **Lower** (anterior horns in the spinal cord and brainstem neurons) - **atrophy, fasciculations** **Upper** (corticospinal) - **hyperactive reflexes** **Ocular motility, snesory, bowel, blader and cognitive functions are preserved**

Answer 54

presence of **behavioral disturbance and cognitve defects** associated with **clinical or radiograph evidence of a stroke.** The **decline in the level of cognitiion** is relatively **abrupt** and progresses in a **stepwise fashion.**

Answer 55

aka subcortical leukoencephalopathy type of vascular dementia that involves **white matter infracts.** Patients with this disease usually present with **apathy, agitation and bilateral corticospinal or bulbar signs** (diffculty with chewing & swallowing)

Answer 56

plasmapheresis and IV immunoglobulins

Answer 57

BST may compress the cervical cord and produce weakness, fasciculations in the upper libms and spasticity int he legs. The presentation may closely resemble ALS;; however, absence of pain and sensory changes and normal bowel and bladder function favors ALS

Answer 58

Riluzole a glutamate inhibitor. Although it cannot arrest the underlying pathological process, it may prolong the survival and delay the need for tracheostomy.

Answer 59

Strep pyogenes **tonsillar exudates, tender anterior cervical lymphadenopathy and palatal petechaie.** **10-day course of oral penicillin,** helps **prevent acute rheumatic fever.**

Answer 60

**CT scan of the head without contrast** to rule out Subarachnoid hemorrhage (SAH) If CT scan is negative or equioval, a **lumbar puncture (LFP) with CSF analysis** This is helpful if mengiitis is in the differential as it can be **difficult to clinically differentiate between meningitis and subarachnoid hemorrhage.** The **presence of xanthochromia on LP is diagnostic of SAH.** \*Xanthochromia, from the Greek xanthos=yellow and chroma =colour, is the yellowish appearance of cerebrospinal fluid that occurs several hours after bleeding into the subarachnoid space caused by certain medical conditions, most commonly subarachnoid hemorrhage.

Answer 61

rhinorrhea, lacrimation, diarrhea and boady aches. Elevated blood pressure and pulse can also occur. **Opioid agonists (methadone, buprenorphine) or nonopiod agents such as clonidine).** Due to their high level of required supervision, **opiod agonists** hsould be used only for detox in **supervised inpatient or outpatient settings.** **Methadone is preferred over buprenorphine** (also an opiod agonist) due to **potential worsening of withdrawal** from buprenoprhine (from its **parital opiod antgagonist effects**)

Answer 62

recurrence (30% chance) and slight risk for (\<5%) for susequent develop of epilepsy (ex: afebrile seizures) but no effect on intellectual outcome

Answer 63

cortical cataracts and associated macular degeneration. Elderly patients should be througly evalauated for the severity of macular degeneration, as they may not benefit from cateract surgery *Macular degeneration refers to aging of the retinal tissue which comprises the macula. The macula is the area of the retina that provides us with our central vision. When the cells of the macula degenerate it causes blurriness or darkness in our central vision. This is very different from other disease processes, such as glaucoma, which causes visual damage mainly in the periphery. Fortunately, macular degeneration does not tend to affect the side or peripheral vision.*

Answer 64

elevated opening pressure, xanthochoromia (pink/yellowish tint due to hemoglobin degradation products) or consisently elevated RBC count in 4 CSF tubes. An elevated RBC count in the first tube, followed by declining numbers of RBCs with each sucessive tube suggestes traumatic tap.

Answer 65

**“Dry” macular degeneration (atrophic) -** **most common type,** on and **does not involve any bleeding** behind the retina. Vision loss is usually v**ery gradual** and occurs over many years. **“Wet” macular degeneration (exudative) -** accounts for about 10% of all cases. It results when **abnormal blood vessels form in the macula and bleed into the retinal tissues.** It is the bleeding and scarring process that can then result in visual loss. Wet macular degeneration can cause **vision to decline much more rapidly** than the dry type. The loss of vision with wet macular degeneration is usually **more severe** than with the dry type.

Answer 66

Pediatric - Enterovirus and Arbovirus Adults - HSV Most arbovirus infections are zoonosis (transmitted through animal vectors); for this reason these infections are common in the rural areas?

Answer 67

**hypersensitivity disorder** that occurs in patients with **asthma or cystic fibrosis.** Associated with noninvasive colonization of the airways by the Aspergillus species. **Exaggerated IgE and IgG mediated immune system** to the Aspergillus fungus in the context of preexisting asthma **Asthma exacerbations, fleeting infilgrates on lung imaging and central bronchiectasis.**

Answer 68

Glucocorticoids and itraconazole are used to control inflammation and prevent irreversible damage.

Answer 69

Eosionophilc granulomatosis with polyangitis (churg-straus disease) is an uncommon auto-immune vasculitis. It is often associated with diffcult to control asthma. Other clinical findings include allergic rhinitis with nasal polyps, chornic sinusiits, mononeuropathy multiplex, and skin manifestations (ex: granulomas, palpable purpura)

Answer 70

premature discontinuation of dual antiplatelet therapy (aspirin and P2Y receptor blocker) Patients should be aggrestively sceened and counseled for medication compliance to reduce the risk of stent thrombosis.

Answer 71

The **presence of air in the distal colon** makes the **diagnosis of complete obsruction less likely.** **PARTIAL SBO** should be i**nitally managed with observation and supportive treatment.** If the **patient fails to imporve the next 12-24 hours,** early **surgical intervention i**s recommended. **Signs of impending strangulation** (incercareated hernia) **or mescenteric ischemia** should undergo **urgent surgical intervention.**

Answer 72

has narrow therapeutic index and **serum levels greater or equal to 1.5 confirm toxicity.** **Confusion, ataxia, neuromuscular excitablity** **precipitated by volume depletion and drug interations with thiazide diuretics, ACE inhibitors, and NSAIDS.** Ex: thiazide diuretics, such as chlorthalidone, increase sodium excretion in the distal tubule giving slight volume depletion. The resulting increased proximal tubular reabsorption of sodium also promotes lithium reasorbption, leading to lithium toxicity.

Answer 73

IV hydration Lithium toxcity presenting with **severe neurologic symptoms** is an **absolute indication** for urgent hemodialysis. Other indications for hemodialysis include **lithium level \>4 or an increasing lithium level despite saline administration.**

Answer 74

**involuntary leakage of urine due to increaed intrabdominal pressure.** Occurs when **pelvic trauma, loss of pelvic connective tissue or high impact activity** can cause **inadequate urethral support and urethral hypermobility.** **Inital treatment - pelvic floor exercises (kegel) and life style changes** (caffeine restriction, weight loss and smoking cessation) **No improvement** - candidates for **surgical management,** typically a mid-urethral sling procedure.

Answer 75

is one of the major manifestions of **acute rheumatic fever** and is the most commonly acquired chorea in children. It is characterized by **emotional liability** and **irregular, rapid jerking of the face, hands and feet.**

Answer 76

Tourette syndrome is characterized by involuntary motor and vocal tics that begin at age 2-15. The PE is otherwise normal and chorea is not seen.

Answer 77

Penicllin as son as possible to eliminate carriage of Group A streptococcus. Penicllin should be continued until adulthood with the goal of preventing recurrent rheumatic fever.

Answer 78

**Post-extubation stridor and respiratory failure.** *Intubation causes direct damage to the laryngeal mucosa, leading to inflammation that may cause significant edema* **Administer multiple-dose regimen of glucocorticoids prior to extubaion** can prevent laryngeal edema and extubation failure. **Reintubation** should be considered early to secure the airway in all patients with signs of impending respiratory failure.

Answer 79

nictoine replacement, bupropion, and varenicline. **varenicline** - avoid in patients with **unstable psychiatric symptoms or a hx of suicidal ideation** since there are reports that it may increase these symptoms in some patients. **bupropion** - contraindicated in patients with **seizures**

Answer 80

MRI of the foot If CI, then use CT scans (they have greater sensitivity than plain radiographs,b ut are less sensitive than MRI)

Answer 81

**Bone biopsy for culture and sensitiivty** Superficial wound swabs and cultures from debrided tissues are not sufficient. *\*Because diabetic wound colonization rates are high, superficial wound cultures have little predictive value in identifying underlying pathogic organisms and should not be used to guide therapy.*

Answer 82

**Gram Positive cocci** such as **Staph. Aureus** are **isolated most commonly,** but **Pseudomonas aeruginosa** and **anaerobic bacteria (ex: Clostridium)** are also frequently involved, **particlarly when wounds are deep and chronic.**

Answer 83

Proportion of people with a particular condition who end up dying from the condition Mortality rate - probablity of dying from a particular disease in the general population. *A mortality rate — often confused with a CFR — is a measure of the number of deaths (in general, or due to a specific cause) in a population, scaled to the size of that population, per unit of time. (For example, a rate of 50 deaths per 10,000 population in a year resulting from diabetes. The mortality rate, therefore, would be 50:10,000 or 5:1,000.)*

Answer 84

are used to determine if the **observed number of deaths** in a **group exceed what would be expected in a similar group** (ex: similar age, gender) exclusind the variable of interest (ex: smoking status, cholesterol levels).

Answer 85

**Erythomycin, clindamycin** (inflammatory acne), or **azelaic acid** (comedonal acne) - **Category B** **Tropical tretinoin and benzoyl peroixde** should be avoided - **Category C** **Tazarotene and isotretinoin** are potent teratogens that are absolutely CI in pregnancy = **Cateory X**

Answer 86

with **highly active antiretorvial therapy for 28 days** is recommended **Triple drug therapy** is preferred and should be started **within 72 hours of exposure.** Will neeed to **repeat HIV testing in 4-6 weeks.**

Answer 87

**progressive decline in renal function.** The **ideal goal for BP control** in any patient with **Chronic kidney disease, including ADPKD,** is less than **130/80mm Hg.** **Ace Inhibitors** are considered the DOC for controlling HTN and preventing progression of renal failure in these patients.

Answer 88

intracranial berry aneurysms. Routine screening restricted to patietns with a postiive family hx of subarachnoid hemorrage. Good pressure control is also helpful in preventing rupture of the berry aneurysm and subsequent intracranial bleeding.

Answer 89

**Hepatic cysts** Their incidence increases in the 2nd - 5th decades of life, by 5- of age, approx. 70-80% of patietns with ADPKD will have hepatic cysts. Although berry aneurysms have an increased frequently (10-15%) in patients with ADPKD, cyst formation in the brain rare.

Answer 90

Ultrasonography The presence of at least 3-5 cysts in each kidney is require to make a diagnosis of ADPKD.

Answer 91

Increase testosterone Increase Estrogen (peripheral conversion of androgens to estrone in addipose tissue which contributes to chronic anovulation and infertility) --\> Weight loss will help LH/FSH imbalance

Answer 92

**HX of \> or = 2 painless, second-trimester losses** or presentation of **painless advanced cervical dilation** in the **second trimester of the current pregnancy**. **Cerlage placement,** a procedure in which a suture is placed to reinforce the cervix.

Answer 93

Indicated to determine the risk of preterm delivery in patietns with preterm contractions. It does not predict the recurrence of preterm delivery in asymptomatic patients.

Answer 94

**Stones \> or = to 10mm, persistent pain, acute Renal failure or signs of sepsis.** **Antibotics** are indicated in presence of infection. **Stones \<5mm usually pass spontaneously.** **Stones up to 10mm** can be given a **trial of medical therapy** (**gentle hydration, pain control, alpha blockers)** and **do not require hospital admission** if symptoms are controlled.

Answer 95

**Fever, uterine fundal tenderness \>24 hours** after a cesarean delivery; **purulent vaginal discharge.** Broad-spectrum antibiotic regimen - **Clindamycin plus gentamicin** * Clindamycin covers aerobic gram+, gram - rods, and pencillin resistant anaerobes.* * Gentamicin covers gram -, some gram + (staph)* **Treatment is continued until the patietn is afebrile \>or=24 hours.**

Answer 96

Hx of **bacterial vaginosis, Group B strep colonization, prolonged rupture of membranes, protracted laber, operative vaginal delivery and cesarean delivery** either associated with an increased vaginal bacterial load or faciliates the bacterial ascent into the uterus. **Most significant is cesarean delivery.**

Answer 97

**promptly with IV opiods (ex: morphine)** **and should be given within 30 minutes of arrival.** **IV fluids** are indicated for hypovolemic or hypotensive patietns as inital fluid recuscitation. If the BP is normal for age, then pain medications should be given first.

Answer 98

**presence of a new pulmonary infiltrate on chest-xray** and 1 or more of the following: **Fever, hypoxiemia, chest pain, tachypnea, or increased work of breathing.** Inital treatment includes **third genration cephalosporin** (ex: ceftriazone) to cover Strep Pneumo and **macrolide** (ex: azithromycin) to cover Mycoplasma pneumonaie, **pain control and IV fluids.**

Answer 99

0-secs/mins = **Anaphylaxis** minutes to 1 hour = **Acute hemolytic** 1 hour to 6 hours = **Febrile nonhemolytic, TRALI (transfustion related acute lung injury)** Days to 10 days = **Delayed hemolytic**

Answer 100

most common adverse reaction that occurs **within 1-6 hours of transfusion.** Patients usually develop f**ever, chills and malaise without hemolysis.** **Leukoreduction of donor bloood** can prevent febrile nonhemolytic reaction and reduce the risk of **human leukocyte antigen alloimmunization and CMV** (which resides in leukocytes) transmission. * \*When RBC and plasma are seperated from whole blood, small amounts of residual plasma and/or leukocyte debris may remain in the red cell concentrate.* * During blood storage, these leukocytes release cytokines, which when transfused can cuase transient fevers, chills and maliase without hemolysis.*

Answer 101

Residual plasma in Red cell concentrates contains proteins, cincluding immunoglobulin A (IgA). IgA deficient patients develop antibodies against IgA. These antibodies can react with IgA-containing products and induce an anaphylactic reaction (angioedema, hypotension and respiratory distress) that can progress rapidly to loss of consciousness, shock and respiratory failure. To reduce this risk, **red cells should be washed to remove as much of the plasma as possible** for patietns with IgA deficiency prior to allergic tranfusion reaction.

Answer 102

**Immune complex-mediated hypersensitivty reaction (Type III)** Occurs when **circulating antibodies** **combine with antigen** in the blood and tissues and **overload normal clearance** mechanims. This then **activates the complement** and cause disease. Minority of patients with **acute Hep. B infection** develop an S-S like syndrome that is attributed to complement activation by circulating immune complexes compoed of Hep. B surface antigen. Characterized by **fever, polyarthritis and dermatitis.** Other **extrahepatic manifestions** of Hep. B infection explained by circulating immune complexes include **polyarteritis nodosa and glomeruloneprhritis.**

Answer 103

Hypoaldosterism usually presents with **asymptomatic hyperkalemia with mild metabolic acidosis.** **Hyponatremia is generally not seen** unless there is concurrent cortisol insufficiency. In addition, h**yperpigmentation is not seen** as there is **no increased production of ACTH/melandocyte stimulating hormone.**

Answer 104

post-void residual volume (\>200 mL is diagnostic)

Answer 105

**Failure to reject a null hypothesis when it is false.** Depdendent on the **power of the study,** which is **dependent on the sample size.** As the **sample size and power increase,** the likelihood of a **type II error decreases.**

Answer 106

phenomenon whereby a **patient's symptoms are alleviated by an otherwise ineffective treatment (placebo),** most likely due to the **individual expecting the treatment to work.**

Answer 107

Reflects the applicablity of the obtained results beyond the cohort that was study. dependent on the adequacy of the sample. If the sample is representative of the desired population, then the results will generalize.

Answer 108

Intention-to-treat analysis is a technique **used in randomized controlled trials** (RCTs), where **patients are compared--in terms of their final results**--within the groups to which they were initially randomized, independently of receiving the allocated treatment, having dropped out of the study or having violated the initial protocol (for whatever reason). Purpose of of ITT is to **preserve randomization** ***\***Randomized controlled trials often suffer from two major complications, i.e., noncompliance and missing outcomes. One potential solution to this problem is a statistical concept called intention-to-treat (ITT) analysis. ITT analysis includes every subject who is randomized according to randomized treatment assignment.* *It ignores noncompliance, protocol deviations, withdrawal, and anything that happens after randomization.*

Answer 109

**chronic, inflammatory, autoimmune disease** that affects the **skin**, **oral** mucosa, **genital** mucosa, affects mostly **middle age adults.** Characterized by **4 p's" Purple, polygonal, pruritic, papules** Onset is usually acute, affecting the flexor surfaces of the wrists, forearms, and legs. The lesions are often covered by lacy, reticular, white lines known as Wickham striae. A **skin biposy** may be requried to confirm the diagnosis.

Answer 110

High-potency **topical corticosteroids** are first-line therapy for all forms of lichen planus, including cutaneous, genital, and mucosal erosive lesions.

Answer 111

**Advanced liver disease due to Hep. C virus.** Anti-help. C antibodies have been detected in some patietns with LP, but the specific causal relationship between the two has not been established.

Answer 112

**Abnormal fertilization** of an **empty ovum** by **either 2 sperm or 1 sperm** whos genome then duplicates. The resulting gestation contains **hypertrophic and hyodropic trophoblastic villi** that cause a marked elevation in the **b-hCG level (\>100,000)** HM is a **premalignant disease** that can develop into **gestational trophoblastic neoplasia** (ex: choriocarcinoma)

Answer 113

**Suction curettage,** after which **serial B-hCG levels are followed** until they are **undetectable for 6 months.** Because pregnancy makes it difficult to determine the signficance of a rising B-hCG level, **contraception is required** during the surveillance period.

Answer 114

Hypoxemia (PaO2/FiO2 \< or = 300 mmHg) and bilateral alveolar infiltrates

Answer 115

**Low tidal volumes** (8 mL/kg of ideal body weight or less) to achieve **plateau pressure \<30 cm H20.** **High PEEP** can help recruit more alveoli and improve oxygenation *\*A high plateau presssure will increase the risk of barotrauma (pneumothorax or pneumomediastinum)*

Answer 116

**PaO2 of 55-80 mmHg** or **SpO2 of 88-95%** O2 saturation of \>95 % increases risk of toxicity (by formation of reactive oxygen species) You can decrease the FiO2.

Answer 117

_Withdrawal:_ **Opiod replacement** (ex: low dose methadone) and **non-opiod symptomatic treatment** (ex: clonidine) *\*Due to legal restrictions that require methadone to be dispensed as part of a methadone maintance program, it may be not be available in the hospital setting.* _Overdose:_ **Naloxone and naltrexone**

Answer 118

in young **children** with **sickle cell disease** as **symmetric swelling and pain of the hands and feet.** Treatment includes **pain control** (ex: oral opiods, NSAIDS), h**ydration and application of heat** \***Hydroxyurea** reduces the frequency of vaso-occusive epsidodes in patients with SCD but may take sveral months to take effect. It is not used in the treatment of acute vaso-occlusive episode.

Answer 119

**ARB Lostartan** has a modest uricosuric effect **Thiazides, loop diuretics and low-dose aspirin.** *Most diuretics including thiazide decrease the fractional excreation rate of urate and should be avoided when possible. Asirpirin decreases renal urate excretion as well.*

Answer 120

**aka acute otitis media or bacterial otitis media.** occurs when the **middle ear caivity** is infected by **bacteria** from the **nasopharnyx.** infection creates pressure annd causes it to bulge. Typically accompanied by fever, pain, and cranikiness and if untreated can be followed by tympanic membrane perforation, leaking pururlent fluid. When it rupture, it relieves pressure and some of the patients pain, with improvement in symptoms such as crankiness. **pain is usually absent** on **manipulation of the pinna; fever and cranikiness followed by purulent drainage from ear**

Answer 121

Bacterial otitis externa is an infection of the outer auditory canal caused by **Pseudomonas aeruginosa.** Althought it does result in **ear pain and purulent ear drainage,** **fever is generally absent, pain on manuipulation of the ear is almost always present** and **episodes generally follow water exposure.** In baterial otitis media, most comomon organism is Group A strep.

Answer 122

**Serous otitis media** occurs when an **effusion is present in the middle ear** canal with **absence of infection and inflammatio.** It typically **follows espisodes of suppurative otitis meidia,** but it is not assoicated with fever, pain, crainkiness, tympatic membrane rupture or purlent discharge.

Answer 123

**Hemolysis, Elevated Liver enzymes, and low platelet count (\<100,000).** Typically occurs at **\>20 weeks gestation** but can a**lso cocur during postpartum period.** **Magneisum sulfate** for seizure prophaylaxis and delivery. **IV antihypternsives (labetal, hydralazine)** are typically indicated for acute control of blood pressure **\> or = to 160/110 mm Hg.**

Answer 124

Having multiple sexual partners

Answer 125

Only a **NORMAL V/Q scan rules out PE.** A **high probablity V/Q scan confirms the PE** **Low-moderate probablity V/Q scan** is **indeterminate** and **necessitaes further diagnostic testing or empiric treatment**

Answer 126

immediate safety of the patient should be secured and **child protective services notificed.** This often **involves hospital admission.** Situations that provide an opportuity for caregiveers to leave with the child should be avoided unti child abuse has been excluded.

Answer 127

Case-control study It generall allows for quick localization of the outbreak source. Correlation studies attempt ot measure associations between multiple variables and are generally conducted via natural observation, surverying or achival research. They develop but do not test hypothesis.

Answer 128

in preschool age or focal lung findings - **AMOXICILLIN (most common cause is strep. pneumo)** versus older age or well appearing with B/L lung findings - **ZITHROMYCIN (most common cause is Mcycoplasma pneumoniae)**

Answer 129

No increased recurrence risk. The risk of 45, X odes not increase with increased maternal age.

Answer 130

HSV encephalitis presents with hemorrhagic infarction of the temporal lobe with elevated RBC seen on CSF analysis. MRI finidngs in encephalitis most frequently show temporal enhancmeent, sometimes with associated mass effect

Answer 131

low grade infection in the subarachnoid space can affect intracranial vessels and potentally result in stroke. confiremd with CSF VDLR testing Tx: pencillin

Answer 132

Lactic acidosis The risk of metformin-induced lactic acidosis increases with hypovolemia, severe liver disease, renal dysfunction or heart failure.

Answer 133

Normal is 10-14 MUDPILES Metanol Uremia DKA Propylene glycol/Paraldehyde Isoniazid/Iron Lactic acidosis Ethylene glycol (antifreeze) Salicylates (asprin)

Answer 134

premature birth, gross motor delay within the first year of life and early hand preference. Physical exam in infancy reveals hypotonia but later progresses to spasticity MRI to look for brain abnormalities

Answer 135

**obtain urinalysis (UA) and urine culture.** UA confirms the presence of hematuria and can differentiate between **infectious** (dysuria, increased urgency --\> give antibiotics), **glomerular** (ex: proteinuria, RBC casts, dysmorphic RBC) --\> evaluate for glomerular causes **extraglomerular** (ex: cancer) --\> do CT, cystocsopy or urine cytology

Answer 136

**PCP** - bilateral _intersitital_ or _aveolar_ infiltrates **Candidia** - airspace **c**onsolidation or cavidtary lesions **S.Aureas** - _multilobar_ cavitary infiltrates **Strep Pneumo**- _lobar_ infiltrates **Pulmonary tuberculous reactivation** - cavitary infilrates in the _upper lobes_ and/or mediastinal lymphadenopathy, pleura effuson and/or military/lobar opacities.

Answer 137

**Alveloar-arterial oxygen gradient \> or = 35 mm H**g **and/or aterial oxygen tension \<70mm on room air** This is used to reduce the risk of intubatin and death.

Answer 138

they are common and should be **managed with early surgery (\<48 hours) in patients who are ambulatory and stable.** *\*advanced age alone is a not a contraindication to surgery, surgery within 48 hours is associated with lower mortality and lower risk of pressure ulcers and pneumonia.* **Nonoperative management** is reserved for those who are **nonambulatory, have advanced dementia or medically unstable**

Answer 139

flushing, a throbbing headache, palpitations, abdominal cramps, diarrhea and oral burning. These typically begin 10-30 minutes after ingesting the fish and are self-limited. patients sometimes describe a bitter taste, but this is not always present.

Answer 140

less common than scombroid poisioning characterized by prominence of neurological symptoms (perioral tingingling, incoordination, weakness, etc)

Answer 141

uterine atony, the failure of the uterus to contract after placental seperation. first line management for uterine atony is bimanual uterine massage and oxytocin infusion.

Answer 142

symtpomatic hypercalcemia, complications (ex: osteoporosis, nephrolithiasis, CKD) or increased risk for complicactions (ex: moderate to severe hypercalemia). In addition, patients age \<50 are likely to develop complications later in life and should undergo parathyriodectomy.

Answer 143

a common cause of acute renal failure in patients with cirrhosis, but should be considered a diagnosis of exclusion. A fluid bolus - failure to respond would be consistent with hepatorenal syndrome Tx: combination of octreotide and midodrine or norephine along with albumin * Midodrine is a systemic vasoconstrictor, and octreotide is an inhibitor of endogenous vasodilator release (which produces splanchnic vasoconstriction); combined therapy theoretically improves renal and systemic hemodynamic* * When patients are treated with norepinephrine, terlipressin, or midodrine plus octreotide, an immediate goal of therapy is to raise the mean arterial pressure by approximately 10 to 15 mmHg to a level of \>82 mmHg.*

Answer 144

**both upper and lower urinary tracts** **CT urogram** is recommended for **upper** tract; **Ultrasound** is an **alternative** test, especially for patients with CKD. **Cystoscopy i**s recommended for evaluation of the **lower** tract, with **urine cytology** as a alternative test for low-risk patients.

Answer 145

**fever, focal bone pain and elevated inflammatory markers.** Patients with **sickle cell disease** should receive empirirc antibotic coverage for **Staph aureus and salmonella.** (need also include **third generation celphalosporin** for the salmonella (cefitriaxone, cefotaxime). Patients with SCD have functional asplenia and is vulnerable to encapsulated organisms. **Healthy children is Staph Aureaus** - low likelihood of MRSA (give nafcillin/oxaccilin or cefazolin) - high liklihood of MRSA (give clindamycin or vanco)

Answer 146

Azithromycin plus ceftriaxone Ceftriaxone covers common causes of CAP (ex: Strep Pneumo) and azithromycin provides coverage for atypical organisms (ex: mycoplasma pneumoniae)

Answer 147

Gestational complications including fetal loss, preeclampsia, gestational diabetes, gestational HTN is is generally recommended that women complete their planned childbearing prior to kidney donation.

Answer 148

potential complication of long bone (femur) fracture and can result in respiratory distress with hypoxemia However, accompanying neurologic symptoms (ex: confusion) and petechial rash are often present and CXR typically shows no airspace disease.

Answer 149

Exogenous thyrotoxicosis cna result form the intake of OTC thyroid supplements or an excessive dosing of prescription thyroid medicaiton The activity of the **thryoid gland is suppressed**, with **decreased radioactive iodine uptake and serum thyroglobuin levels.** \*thyroid extracts suppress thyroid follicular activity. The concentration of thyroglobulin (released in small amounts by normal thyroid follicles) is also low due to suppressed follcular ctivity.

Answer 150

**_Graves disease_** - **elevated RAIU** and **elevated thyroglobulin** **_thyroiditis_** - **Low RAIU** and **elevated thyroglobulin** **_Toxic nodular disease_** - **elevated RAIU** with focal uptake pattern (as oppose to diffuse pattern in graves), although a normal RAIU may be seen. **Thyroidglobulin may also be low or normal** as increased release form toxic nodules is offset by decreased release from the remainder of the gland.

Answer 151

conclusions re: cause and effect in a study and aswers the question "are we observing/measuring what we think we are observing/measuring?" Confounding.

Answer 152

detect and effect if that effect exists. power depends on sample size (larger size increases power), effect size (and standard devation) and alpha and beta errors levels.

Answer 153

How generalizabel are the results of hte study to othe populations? For example, a study in middle-aged women would not necessarily generalizable to elderly men.

Answer 154

gag reflex. This may result in aspiration if airways are not protected Consiptiation, followed by letharagy, poor sucking and weak crying

Answer 155

**Trichloroacetic acid application** destroys the lesion by program coagulation. The clearance rate is not very high; therefore repeated applications are usually necessary. **Podophyllin** has similar effect as trichloroacetic acid, but is not indicated for internal use (ex: it should be applied to the mucosal surface). Podophyllin is also contraindicated during pregnancy.

Answer 156

frequently identified on opthalmologic exam done for other reasons. **Asymptomatic** patients with small lesions (diameter \<10mm, thickness \<3mm) may be **managed with close follow up.** **larger choroidoal melanomas** or those presenting with **associated symptoms** (ex: eye pain, visual disturbance) have a worse prognosis and will benefit from **radiotherapy** which has been shown to reduce mortality due to metastic disease. **Enucleation** is considered for **very large tumors or tumors with extrascleral extension.**

Answer 157

complication of acute otitis media that occurs more commonly in patients with recurrent otitis media. Mastoid infection causes ear protrusion and significant tenderness at the mastoid process posterior to the auricle

Answer 158

Pseudomonas is a common cause. Empiric antibotic therpy is a topical flurooquinolone (ex: ofloxacin). A topical glucocorticod (ex: cipro/dexamethasone) may be added to treat inflammation.

Answer 159

reassurance and formula thickening. Prescription medication and surgery are reserved for more severe cases of GER which have failed conservative treatment.

Answer 160

screening for breast cancer with regular mammography should begin at age 40 (every two years) Genetic testing for inherited breast cacner disorders is recommeneded for patients with very high risk of breast cancer.

Answer 161

Peak expiratory flow \<40 of baseline= severe asthma exacerbation 40-69 = moderate asthma exacerbation _Inhaled_ short acting beta agonist are first line treatment regardless of severity. For PEF \<40, give inhaled SABA, plus _Inhaled_ ipratrpium should be given with beta agonists in severe asthma exacerbation. Plus IV glucocorticoids

Answer 162

PEF \>or = 70 for \>1 hour. No distress

Answer 163

selective estrogen modulator stimulates estrogen receptors on bone cells to improve bone density and is used to treat postmenopausal osteoporosis.

Answer 164

Platelet dysfunction. IV Desmopressin It acts by increasing release of factor VIII:von willebrand factor multidimers from the endothelium.

Answer 165

**bleeding** and a potentiation of the effects of anticoagulant therapy through various mechanisms, including the **inhibition of platelet-activating factor.** **\*Gingko** is used by many patients as a "memory" booster because of its suggested propensity for increasing cerebral blood flow.

Answer 166

more severe form of erythema multiforme. Characterized by erosion of mucous membranes, small blisters on purpric macules and aytpical target lesions. Antibotics (ex: sulfonamides, cephalosporins, quinoloines, aminopencillins) and anticonvulsants (ex: lamotrignine, phenytoin, carbamzepine)

Answer 167

can present with **florid** **nephrotic range proteinuria.** **granular casts** NSAIDs causes a **reversible decine in renal blood flow** and **GFR** due to the **inhibition of vasodilatory prostaglandin production.** NSAID can also cause **intersitial nephriitis**

Answer 168

typically composed of **light chains** which are usually **not detected by the dye-reagent strip test used for urine analysis.** **Serum or urine immunoelectrophoresis,** or **detection of Bence Jones in the urine, is necessary to make the diagnosis.**

Answer 169

**Nephritic syndrome** **RBCs or RBC casts in the urine analysis** (indicates glomerular damage) \*nephrotic syndrome involves the loss of a lot of protein, whereas nephritic syndrome involves the loss of a lot of blood.

Answer 170

patients at high risk of HIV exposure should recieve a screening test that combines detection of **HIV antigen (p24)** and **HIV-1/HIV2 antibody.** **False negative**s may occur during the **first 4 weeks** due to low titers of antigen and antibody **(window period)**

Answer 171

Hepatitis B virus as some antiretroviral medications have dual activity against both Hepatitis B virus and HIV. These medications are often used preferentially in patients with both infections.

Answer 172

6 weeks. Encourage patients to keep taking the medication before considering other treatment options.

Answer 173

substance use. Alcohol, stimulants, and opiates can exacerbate depressive symptoms and contribute to poor antidepressant response.

Answer 174

Require treatment with m**ulti-drug therapy and pyridoxine.** Treatment usually involves **3-drug therapy** with **isoniazid** (INH), **Rifampin** (RIF) and **ethamubutol** for **2 months** followed by **INH** and **RIF** for additional **7 months.** **\*All 3 of these medications cross the placenta but are not associated with significant fetal toxicity** \*\***Pyrazimaide**, part of the **4-drug TB** given to **nonpregnant** individuals, is generally **not administered to pregnant patients** due to uncertain **teratogenic** properties and **little** **contribution** to the overall TB efficacy. Pregnant women undergoing treatment for TB should also receive pyridoxine (VIt B6) supplementation to prevent INH-induced neurotoxicity.

Answer 175

CSF to make sure it is not due to neurosyphillis

Answer 176

_Primary, secondary, Early latent (\< 1 year)_ - **Benzathine penicllin G IM in one dose** _Latent, Unknown, gummatous or cardiovascular symphilis -_ **Benzathine penicllin G IM weekly for 3 weeks** _Neurosyphillis_ - **Aqueous pencillin G, IV every 4 hours for 10-14 days** _Congenital syphillis_ - **Aqueous penicillin IV every 8-12 hours for 10 days**

Answer 177

Acute febrile reaction that deveops within 24 hours after initiation of treatment for spirochetal infection (ex: syphillis, leptospirosis, tick-borne spirochetes). Due to innate immunological reaction to the lysis of spirochetes. No prevent available

Answer 178

**open reduction and internal fixation (ORIF)** **ORIF** requires an **incision** be made over the clavicle with subsequent application of a **fixation plate and multiple screws** at the fracture site. **nondisplaced** fractures can usually be managed by **conservative** therapy (ice, analgestics, elbow range of motion exercises and eitehr a sling or figure eight bandage) Management is similar for both adults and children.

Answer 179

should be considered for patients with symptoms of **acute stroke that have been present for \<3-4.5 hours after on the onset of symptoms** **Bleeding risk** (and especially for intracranial hemorrhage), which is a serious concern and a common side effect of tPA administration. Several conditions ,including the presence of active bleeding and hypodensitiy in \>33% of an arterial territory on CT scan, are absolute contraindications to tPA administration.

Answer 180

**heart and neck vessels** to **rule out possible embolic sources.** **Ultrasound** can be used to evaluate for **neck** vasculature, **CT angiogram or MR angiogram** can evaluate both the **neck** **and** **intracranial vasculature.** **Electrocardiogram** is helpful to evaulate for **ischemia** and **arrythmia**, and a **transthoracic** **echocardiogram** is generally recommended to evaluate for the presence of an **intracardiac** **thrombus**.

Answer 181

**Uroporphyrinogen decarboxylase,** an enzyme in the heme pathway **painless blisters, an increased fragility of the skin on the dorsal surface of the hand, facial hypertrichosis and hyperpigmention.** Can be triggered by **ingestion of certain substances (ex: ethanol, estrogens)** and should be discontinued if suspect.

Answer 182

Hepatitis C infection confirmed with elevation fo urinary uroporphyrins. Phlebotomy or hydroxychloroquine may provide relief, as can interferon alpha in those patietns simulatneously affected with Hep. C virus.

Answer 183

non-statiscally significant difference

Answer 184

Canagliflozin Dapaglifozin Empaglifozin lower blood glucose by **increasing renal glucose excretion.** in the proximal tubules. **Vulvovaginal candidias** possibly in the setting of higher urinary glucose levels. Other effects include **polyuria** and **increase urinary tract infections.**

Answer 185

**Linagliptin, sitagliptin, saxagliptin** patients with **hx of pancreatitis** and should be discontinued in patients who develop pancreatitis while on therapy. Some DDP4 inhibitors have also been associated with **hypersensitivity respones**, inlcuding angioedemia

Answer 186

lactic acidosis, flatulence and diarrhea

Answer 187

**slowly progressive frontal lobe dementia** characterized by **speecah abnormalities (logorrhea, echolalia, aphasia, mutism), impaired executive thinking, irritable mood, hyper-oral behavior and disinhibtion.** Neuroimaging studies reveal the classifcal finding of **prominent symmetric atrophy of the frontal and/or temporal lobes.** *\*Lewy body dementia has "halLEWYcinations", and picks disease has personality changes.*

Answer 188

Gliosis, neuronal loss, and swollen neurons that may contain picks' disease, which are silver-staining inclusions.

Answer 189

Lewy Body - second most common form of neuroegenerative dementia after Alzhemier rdisease. It is gradually a progressive dementia associated with **varying cognitive function and alertnes**s, **persistent visual hallucinations and some motor features of parkinsonism** (ex: rigidity, intention tremor). Falls are common. Microscopic fiindings in the brainsteam and cortext include **lewy bodies**, which are cytoplasmic inclusions.

Answer 190

**Streptococcus agalactiae** (group B Streptococcus GBS) is a common colonizing organism in the GI and genital tracts, is the **most common cause of neonatal infection** (ex: meningitis, pneumonia, sepsis) **within the first week of life** **GIVE when:** **the pregnancy is preterm (\<37 weeks),** if they develop an **inrapartum fever,** or if they have **rupture of the membranes \>or =18 hours.**

Answer 191

Pencillin which is initatated at least 4 hours prior to delivery

Answer 192

Coxsackie Group A virus Vesicles on the posterior oropharynx. Fever, systemic symptoms. Dx: Clinical Tx: Symptoms resolve in one week. Supportive (hydration and analgesics)

Answer 193

**Both have tonsillar exudates, and fever** GROUP **A** STREP: **_anterior_** cervical lympadenopathy INFECTIOUS MONO -**_diffuse_** cervical lympahdenopathy **+/- hepatosplenomeglay**

Answer 194

**Aphthous stomatitis (canker sores) -** Recurrent ulcers on the **_anterior_** oral mucosa; **NO fever or systemic symptoms** **Herpangina** - vesicles & ulcers on **_posterior_** oropharynx, **fever** **herpes gingivostomatitis** - Vesicles & Ulcers on **_anterior_** oral mucosa & **around** **mouth**; **fever**

Answer 195

**failure of the processus vaginalis to obliterate.** **surgically repaired as early as possible.** They do not resolve with age. The risk of potential complications, including incarceration, is particularly high if it remains unrepaired during the first few months of life.

Answer 196

further investigation to evaluate for chronic infection. 1. persistent infection, 2. cleared infection or 3. false positive antibody test **diagnosis of chronic HCV** requires both a **positive serologic test** and a confirmatory nucleic acid test to **confirm HCV RNA in the blood** (indicates ongoing active disease)

Answer 197

form of **seronegative spondyloarthritis** clinically associated with inflammatory back pain, additive or migratory **oligoarthritis**, and extra-articular symptoms that typically follow a **gastrointestinal or urogenital infection** by a minimum of 1 to a maximum of 3-6 weeks. microbial tests and blood or synovial fluid cultures are **negative, and only serum antibodies are detected.** The presence of **large joint oligoarthritis, urogenital tract infection, and uveitis** characterizes **Reiter's syndrome** as a clinical subtype.

Answer 198

Clinical symptoms are different from septic arthritis which manifests with fever, systemic signs of infection, and monoarthritis.

Answer 199

HLA-B27 positive. The cause of this increased risk is not entirely clear.

Answer 200

**Gonadotropin-releasing hormone, LH, and estradiol** leading to symptoms of **hypogonadism** including hot flashes, vaginal dryness and potentially **osteoposis** if left untreated Dopamine agonist such as cabergoline (inhibits prolactin secretion and cause regression of tumor size)

Answer 201

**symmetric proximal muscle weakness, elevated muscle enzymes and highly characteristic skin lesion**s (gottron's papules, heliotroe rash) **Clinical features and serum antibody testing** **ANA** screening - inital test of choice Specific antibody testing: **Anti-Rho, anti-La, anti-sm, anti-Jo-1, anti-ribonucleoprotein (RNP)**

Answer 202

cancer screening due to an increased risk of malignancy. symptoms of dermatomyositis may resolve if the cancer is treated successfully.

Answer 203

**sudden, sustained contraction of the neck mouth tongue, eye muscles** **anticholinergic (Benztropine) or antihistamine (dihenhydramine)** diphenhydramine is an antihistamine with significant anticholinergic activity

Answer 204

_Akathisia_ - inability to sit still **Beta blocker (propanolol) or bnezodiazepine (lorazepam)** _Parkinsonism_ - tremor, rigidity, bradykinesia **Benztropine (anticholinergic) or amantadine** _Tardive dyskinesia_ - Dyskinesia of the mouth, face, trunk and extremitis. Gradual onsest after prolonged therapy **No definitive treatment, but clozapine may help**

Answer 205

\<50 copies/mL

Answer 206

pencillin and intramuscular corticosteriod (ex: bethamethasone) administration. Corticosteriod helps decrease risk for neonatal respiratory complications and decreases NICU admission rate.

Answer 207

**Need diagnosis to be confirmed with throat culture or rapid antigen testing first.** The rapid strep antigen test is highly specific and antibotic treatment can be initated after a positive test. **(rule in strep)** How due to the test poors sensitivity, throat cultures must be obtained after all negative RSAT in children. **Throat cultures are not necessary if the RSAT is positive.**

Answer 208

from unrecognized bite or scratch Hydrophobia **Universally fatal once the patients are symptomatic.** Treatment is primarily palliative and most patients suffer from coma and death within weeks of illness onset. post exposure prophlyaxis with rabies immunoglobulin can prevent the onset of the disease; it is not helpful after the onset of clinical manifestations.

Answer 209

External beam radiation therapy

Answer 210

1. presence of low back pain & stiffness for more than a 3 month duration that improves with exercise or activity 2. limiation of the range of motion of the lumbar spine 3. limitation of the chest expansion relative to normal values Plain x ray of the sacroiliac joint (shows evidence of sacroilitis)

Answer 211

Radiographs and acute phase reactants (ex: ESR)

Answer 212

**a**cute anterior uveitis, **a**ortic regurgitation **a**pical pulmonary fibrosis Ig**A** nephropathy Restrictive **l**ung disease

Answer 213

white lesions that are easily removed with scrapping. HIV infection with a fourth generation HIV test (p24 antigen and HIV-1/HIV-2 antibody)

Answer 214

elderly with DM and in HIV patients severe pain and presence of granulation tissue on the floor of hte external auditory canal at the bone-cartilage junction. Psudomonas aeruginosa

Answer 215

aka Herpes zoster oticus ear manifestaiton of reactivated VZV. Ear pain, vesicles in the external auditional canal and ipsilateral facial paralysis.

Answer 216

IV Fluroquinoolines (ciptrofloxacin), anti-psudomonal penicillins (piperacillin, ticarcillin), third generation cephalosporoins (ceftazidimine) are all effective in treatment

Answer 217

**Benzodizepine therapy** and should be administered for seizure lasting \> or = to 5 minutes. Noncompliance, electrolyte abnormalties, sleep deprevation, and intercurrent illnesses **Fosphenytoin** **Barbituites** (ex: phenobabital) should be administered if status eplepticus has persisted despited adminstration of benzodiazepines or phenytoin derivaties. Barbituties are long acting and often result in respiratory depression and sedation, therefore otehr agents should be tried first.

Answer 218

alpha adrengic antagonist (urethral relaxation) Anticholinergics, opiates, CCB (urinary retntion/overflow) Diuretics (excess urine production)

Answer 219

connection to family, pregnancy and responsiblity for children

Answer 220

**Dementia and subacute combined degeneration** Signs of **dorsal spinal column dysfunction** (impaired vibration, positive romberg sign) and l**ateral corticospinal tract abnormalities** (ex: spastic paresis, hyperrefexia) which are **fairly specific for SCD.**

Answer 221

**Ineffective erythropoiesis.** Defective DNA synthesis with megaloblastic transformation of bone marrow and intramedullary hemolysis. Although intense **erythroid hyperplasia** occurs, the erythroid cells do not mature normally and subsequently die in the bone marrow. Markers of **hemolytic anemia** (*ex; elevated LDH, low haptoglobin, indirect hyperbilirubinemia)* may become evident, but re**ticulocyte response is typically absent** in such patients.

Answer 222

decreased renal erythopoietin other causes or anemia (ex; iron def) Less than \<10g/dL ERSD patietns with transferin saturation of \< or = 30% and ferritin *\*Oral iron is inferior to intravenous iron in patients on hemodialysis, in part because elevated serum levels of hepcidin prevent intestinal absorption of iron. Increased levels of hepcidin also impair the normal recycling of iron through the reticuloendothelial system. \**

Answer 223

**pre-school children (3-5)** - nonpharmacoloical treatment (behavior therapy) versus **older children (= or \>6) -** pharmacotherapy as first line treatment

Answer 224

comprehensive cardiac history and exmination, baseline weight and vital signs. *\*If hx and physical exam shows no cardiac disease, rougtine ECG screening is not indicated.*

Answer 225

can be treated with an **alternate ADHD medication**, including other **stimulants** (ex: mixed amphetamine salts). Other options include **nonstimulant medication** such as atomoxetine or an alpha-2-adrenergic agonist. **No tapering or washout is needed**, and the patient can be switched immediately from one stimulant to another.

Answer 226

**erythematous plaques with loose, greasy-looking scales on the scalp ("dandruff"), central face, and ears.** SD predominately affects areas with heavy concentraiton of sebaceous glands, including the scalp (where it is referred to as "dandruff"), central face (eyebrows and nasolabial fods) and ears. Treatment options: **topical antifungals (**ex: ketocoazole, selnium sulfide), **keratolytic agents** (salicyclic acid), **coal tar, topical glucorticoids and topical calcineurin inhibitors** (ex: pimecrolimus and tacrolimus).

Answer 227

_Seborrheic dermatiti_s - Topic antifungals (ex: ketoconazole, selnium sulfide), topical glucocorticods, topical calcineurin inhibitors (pimeecrolimus) _Tinea capitis/corporis_ **-** dermatophyte infection most comonly seen in **children**, which cause **annular plaques with peripheral scalling and central clearing** **Grisofulvin is not effective against Malassezia species and can worsen SD**

Answer 228

Chronic relapsing condition. Inital treatmetn can provide significant improvement in symptoms, but patients usually benefit from intermittent re-treatment.

Answer 229

**absolute neutrophil counts** due to the **increased risk of developing neutropenia/agranulocytosis.** Clozabepine is highly effective antipyschotic reserved for the treatmetn of refractory schizophrenia and schizoaffective disorder. It is **not used as first-line** due to its association with neutorophenia/agranulocytosis. It must be prescribd through a central patient registry that requires mandatory monitoring of the absolute neutrophil count.

Answer 230

thyroid and kidney function. Creatinine and thyroid tests are monitored periodically (ex: 3-6 months) in lithium-treated patients due to risks of hypothyroidism and renal toxicity.

Answer 231

**hypokalemia and hypochloremic metabolic alkalosis** secondary to the loss of gastric hypochloric acid, although electrolyte imbalances are seen less often now taht the diagnosis is made earlier.

Answer 232

Erythromycin (usually given as an postexposure prophylaxis for pertusis)

Answer 233

**painless proximal muscle weakness** and **elevated muscle enzymes** (ex: CK, transaminases) and **inflammatory markers** (ex: C-reactive protein). Peak incidence ocurs **40-50** **Inflammatory myopathy triggered by unknown, possibilty viral, antigens** Muscle weakness may manifest as **difficult climbing stairs, getting in or out of the chair or car, or working with the arms overhead.** Dermatomyositis is a similar disorder but with charasteric skin manifestations.

Answer 234

Antinuclear antibodies, anti-jo-1 muscle biopsy

Answer 235

Stain myopathy typically presents with mild muscular pain, athough patients may occasionally expenerience severe myopathy with elevated creatine kinase levels. However, **statin myopathy is not classically associated with joint pain** and usually occurs in the **first few months of therapy.**

Answer 236

Myasthenia gravis typically causes fatigability (ie noraml intial muscle strength that fades with repeated use) rather than weakness, although proximal muscle symptoms may resemble polymositis. However, most patients have **facial/oculobulbar symptoms and muscle enzymes are normal.**

Answer 237

very rare in younger patients (age \<50), and typically causes stiffness and pain rather than painless weakness.

Answer 238

Muscle biopsy is characterized by **endomysial inflammatory infiltrate** consisting predominantly of **CD8+ T cells** that invade healthy muscle fibres expressing the MHC-I antigen

Answer 239

**Young to middle age women** chronic **widespread pain** fatigue, impaired concentration **tenderness at trigger points** (ex: mid trapezius, costcohondral junction) Diagnosis: \> or = to 3 months of symptosm with widespread pain index or symptom severity score **Normal lab values**

Answer 240

Fibromyalgia - Normal labs Polymyositis - Elevated muscle enzymes (ex: Creatine kinase, aldolase, AST Polymyalgia Rheumatica - Elevated ESR, C-reactive Protein Erythrocyte Sedimentation Rate - measures how quickly red blood cells fall to the bottom of a test tube; elevated in inflammatory conditions such as infection or rheumatologic diseases C Reactive Protein (CRP): a protein that also can be elevated in inflammation Creatine Phosphokinase (CPK or CK): muscle enzyme that can be elevated in autoimmune diseases that affect the muscles such as polymyositis or due to medication toxicity (such as from statins used to treat high cholesterol)

Answer 241

pulmonary complications, including intersitial lung disease, infection and drug induced pneumonitis and respiratory muscle weakness. Interstital lung disease can be identified on high-resolution CT imaging as ground-glass oppacities, reticular changes, honeycombing or patchy consolidation. PFT shows decreased FVC, TLC and Diffusing capacity

Answer 242

are those that origniate inthe venous system and enter the arterial system via an intracardiac shunt. They are a more common cause of stroke in the young than in the elderly echocardiogram with bubble study will reveal an intracardiac shunt. \*Typically embolic strokes occur when a mural thrombus from the LA or plaue from carotid artery embolizes and lodges in the cerebral circulation. Howver patients may develop embolic strokes with origins in the venous system as well. This can occur when an intracardiac communcation like Patietn foramen ovale or ASD is present and allows a disloged venous clot to travel into the arterial circulation.

Answer 243

**Shoulder pain** (50-90%), **Horner syndrome** (15-50%) and **hand muscle atrophy and weakness** (10-20%). Asymmetric lower-extremity Deep tendor reflexes, espeically in the setting of back pain suggests that the tumor has spread to the spinal cord. **Spinal cord compression** deveops in 25% of patients with pancoast tumor during the course of the disease and may result in paraplegia. **Early recognition and appropriate therapy are imperative to preserve neuroligc function and patient autonmy.** Horner Syndrome - ipsilateral ptosis, miosis, enopthalmos & anhidrosis) from involvement of the paravertebral sympathetic chain (considered a poor prognositic sign but is not immediately dangerous)

Answer 244

Strict glycemic control.

Answer 245

narrow complex tachycardia with **regular R-R intervals** and may show **retrograde P waves** that are tpically interverted in the inferior leads.

Answer 246

experimental study design that utliizes \> or =2 interventions and all combinations of these interventions. Ex: 2 main interventions (antioxidants or glutatmine supplementation) resulting in 4 possible study arms: gltuatmine supplemenation, antioxidant supplementation, both or neither.

Answer 247

form of retrospective observation study in which subsets of controls are matched to cases and analyzed for variable of i nterest.

Answer 248

seeks to determine whether an intervention works in real life conditions. This is contrasted with an explanatory study, which seeks to address whether an intervention works in optiomal conditions and how/why it does or does not work.

Answer 249

three months of age, according to the rule of '10', 10 lbs of weight, 10 weeks of age 10 g of hemoglobin

Answer 250

clieft lip with or without cleft palate is typically a multifactorial disorder. Has been associated with use of teratogenic agents during preganncy and modes of the inheritance can be AD, AR and X-linked.

Answer 251

acute **presynaptic neurmosuclar junction disorder** caused by infection with **Clostridium botulium** **Inhibits release of Ach into the synaptic cleft** in both autonomic and somatic nerveous system. Paitents develop **bulbar and descending limb weakness** with **absent reflexes** and **autonomic dysfunction** (exL: blurry vision due to accomodation fialure and impaired pupillary responses) **but preserved senation.** **\***leads to inability to achieve threshold end postsynaptic potential (action potential). Leads to ultimately neuromuscular junction failure and subsequent weakness (limb and/or bulbar). Leads to autonomic dys

Answer 252

**first bowel movement = meconium,** thick black tarry stool that occurs the **first 48 hours of life** and sometimes during childbirth (ex: meconium-stained amniotic fluid). After this, an **exclusively breasfed newborn is 6-10 times daily** or approx, **one soft, yellow-green stool per episode of feeding.** **After the first month**, the stooling freq. in some infants **decreases to 1 episode every 1-2 days** or less, with some having o**nly 1 or 2 bowel movements per week.** **Formula fed infants** tend to have **solid stool consistency** compared to nursing babies nad generally have a **frequency of 1 or 2 movements** per day.

Answer 253

excess production of prostaglandin F2a. 2-4 month trial of NSAID (such as naproxen) - treats the underlying ethiology as they are prostaglandin inhibitors. Should be taken 2-3 days prior to the onset of menses and continued througout the menstrual cycle. If pain does not subside, OCP should be added.

Answer 254

Idiopathic intracranial hypertension, aka pseudotumor cerebri Opthalmoscopic exam - papilledema A negative neuroimaging study (except an empty stella) and elevated opening pressure on lumbar puncture can help confirm the diagnosis. (opening presure gerater than 20-25 cm H20)

Answer 255

55-80 with \> or = 30 pack year smoking hx and who currently smoke or qui within the last 15 years. Screening is associated with 20% relative reduction in mortality risk but a false positve rate of nearly 96%

Answer 256

Presents with pain out of proportion to other findings, swelling & erythema. Fever and hypotension are common. Healthy - group A streptococcus Immunocompromised - Pseudomonas patients with poor circulation (DM) - S. Aureus

Answer 257

C perfringens - capable of causing necrotizing fascitis, either in isolation or combination with other bacteria. Affected areas generally have crepitus on examination due to gas production by Clostridia. C perfringens is not as commonly isolated as group A streptococci.

Answer 258

Surgical exploration and debridment, appropriate IV antibotics and hemodynamic support. Therapy should not be delayed to obtained imaining or lab studies. Broad spectrum therapy is indicated until cause agent are known Once culture info is available, antibitoic therpy should be narrowed based on pathogens. **Piperacillin/tazobacteam or carbapenem** (ex: impimem or meropenem) will cover **Group A Streptococcus and anaerobes.** **Vancomycin** will cover **Staphylococcus Aureus,** including methicllin resistant isolates **Clindamycin** is added to **inhibit toxin formation** by **streptococci/staphylococci.**

Answer 259

recommended, but women do retain the right to refuse testing.

Answer 260

sulfonamides, therefore hydrochloriathiazides use can cuase photosensitivity rash, and treatment of this rash includes discontinuation of the thiazide, use of the sunscreen and avoiding sun exposure

Answer 261

**Irritant contact dermatitis** Chronic exposure to mild irritants, such as solvents and detergents, can result in pruritis, erythema, hyperkeratosis and fissuring of the hands. Occlusion of the irritants under rubber gloves is a typical cuase of ICD in health care workers.

Answer 262

weight below 5% or down trending weight % crossing 2 or more major percentiles (ex: 50th, 25th, 10th)

Answer 263

Type of acute respiratory distress syndrome (ARDS) caused by **reactivation of receipt neutrophils by donor antibodies.** (activating factor ex: antibody to HLA antigen) in tranfused blood product (triggers neutrophils to release inflammatory substances). The pulmonary capillaries are damaged, leading to fluid dleaskage and diffuse pulmonary dedema. Patietns present with hypoxemic respiratory failure **within 6 hours of blood product administration.** **Neurocognitive defects, impaired muscle strength and lung function, psychiatric illness -** (up to 50% of survivors may have neurocognitive impaired neurocognitive function)

Answer 264

consolidated omnibus budget reconcilation act patients who have left their employer may continue to receive benefits on their previous employers group health insurance. The benefits are provided for a limited period under circumstances (ex: transition between jobs, death, or divorce)

Answer 265

_Part A_ - **inpatient**, skill nursing facilitles (limited) & hospice/home health cae _Part B-_ **outpatient**, preventive care, outpatient diagnostics (labs, xrays) _Part C_- **Medicare advantage**, allows private health insurance companies to provide medicare benefits _Part D_: prescription **drug coverage**, provided by private insurance companies with government contracts \*Medicare advantage plans are privately contracted insurance plans that are collectively known as part C. These plans provide inpatient and outpatient services as an alternative to parts A & B. Enrolles are resticted to a limited provieder network but benefits from lower out of pocket-costs and additional value-added services (ex: quality improvement programs)

Answer 266

bilateral retinal hemorrhage

Answer 267

also known as Medicare-Medicaid are very low income seniors or disabled individuals who quality for both standard medicare and medicaid benefits

Answer 268

medicare supplement insurance plan optional supplemental plan that covers copays, deductibles and other servces not covered by parts & B; they do not cover medications

Answer 269

**TSH serum level and thyriod ultrasound** Patients with **suspicious findings on US** should **undergo FNA** with cytology of the nodule Patients with **normal or high TSH - FNA** Patients with **low TSH should have radionucleide thyroid scan (hot or cold). Do FNA on cold. Hot - treat for Hyperthyroidism.**

Answer 270

US of the neck and cervical lymph nodes Patients with a small (\<1cm) papillary thyroid tumor may be treated with thyroid lobectomy. Total thyroidectomy is recommended for tumors \> or = to 1cm in diameter, tumor extenstion outside the thyroid, distant metases and in patients with hx of head or neck radiation exposure.

Answer 271

CT of the head

Answer 272

primilary seen in men characterized by episodic headaches 1-8 times a day occuring over a period of weeks. Pain is typically **orbital, supraorbital, or temporal** as well as **unilateral** and **severe**. patients have restless agitaiton and autonomic symptoms of the **ipsilateral trigeminal branch such as lacrimnation, conjunctival injection, rhinorrhea and nasal congestion.**

Answer 273

migrane headaches cause unilateral orbital headache that improve with resting in a dark quiet room (to reduce phonophobia and photophobia). However migranes are typically not associated with trigeminal autonomic hyperactivity.

Answer 274

Tension type heaache are usually bilaterail, band like and nonthrobbing. Cluster has episodic, unilateral, orbial headaches associaed with autonomic symptoms

Answer 275

Verapamil 100% oxygen inhalation by nonrebreathing fask mask. Administered for 15 minutes and provides significant relief in \>70% of patients

Answer 276

inodmethacin (NSAID) Propanolol

Answer 277

bartonella henselae, gram neg bacillius skin lesion followed by regional lympadenopathy (within 1-2 weeks) following cat scratch or bite Azithromycin (effective against bartonella)

Answer 278

HIV positive with **CD4 count count \<200** is at risk fo**r Pneumocystis Pneumonia.** Sputum induction or bronchoscopy with lavage is used for diagnosis. However presentation in patients with **HIV is subacute (**ex: 3 weeks of low grade fever and nonproductive cough) rather than acute and chest xray typically reveals **intersitial infiltrates** rather than nodular opacties.

Answer 279

infective endocarditis that is most commonly right sided and involves the tricuspid valve Echocardiography (Trasthoratic initally, followed by transesophagel if needed) is used for diagnosis. Staph Aureaus. High fever and the emboli shows up on chest xray as multiple nodular opacities that my have evidence of cavitation.

Answer 280

oropharyngeal dysphagia swallow evaluation which can be performed at bedside

Answer 281

HTN up to a **blood pressure of 220/120 i**s generally permitted in patietns who **did not receive thrombolytic therapy**, as this allows appropriate **perfusion of borderline ischemic regions** in the brain. Patients who **received** **thrombolysis** should be managed more conservatively with blood pressure maintained at **\<185/105 for at least 24 hours t**o minimize **risk of intracranial hemorrhage** (the precise lower limit of blood pressure is unclear)

Answer 282

when there is evidence of atrial fibrillation leading to embolic stroke.

Answer 283

DVT and subsequent PE Low dose heparin or LMWH

Answer 284

pooling data from several studies increases statistical power (ex: the ability to detect a diff in outcome of interests between groups, if such a diff exists).

Answer 285

Iron deficiency - RDW is increased and RBC is decreased, microcytosis, hypochromia,, low ferritin Thalaseemia minor - RDW is normal and RBC is normal (almost all RBCs are uniformally small), Target cells, mildly elevated ferritin due to increased RBC turnover

Answer 286

Physiologic anemia of pregnancy is characterized by mild, normocytis, normochromic anemia. This results from greater expansion of PV relative to increase in RBC mass (ie, dilutional anemia). The nadir typically occurs during late second to early third trimeser

Answer 287

metaplastic columnar epithelium in the esophagus replacing normal stratified squamous epithelium. Endoscopy - columnar epithelium usually appears as reddish with velvet-like structure (salmon colored), squamous epithelium has pale and glossy appearance.

Answer 288

1. require no further screening 2. Surveillance endoscopy in 3-5 years 3. surveillance endoscopy every 6-12 months or endoscopic eradication therapy. 4. endoscopic eradication therapty (ex: ablation, mucosal resection)

Answer 289

_Infant botulism_ - Human-derived botulism immune globulin (ex: ingestion of environment dust containing soil spores of Clostridium botulism) _Foodborne botulism_ - Equine-dervived botulism antitoxin (ex: canned fruit, vegs, fish - preformed toxin) _Guillain-Barre syndrome_ - Pooled human immune globulin

Answer 290

normal free thyroxine (T4) level with elevated TSH hypothyroid symptoms, pregnancy, infertiility or ovulatory disfunction, goiter, positive antithyroid antibody titers and TSH \>10

Answer 291

excesss sympathetic activity BB to control symptoms and HR *\*Antithyroid, radiodine ablation, thyroidecy interventions take several weeks and so patients should be initally treated with BB to manage symptoms caused by excessive sympathetic activity.*

Answer 292

should attend school in a normal manner and may play sports. Any disclosure of HIV status by the family is voluntary

Answer 293

cat feces, undercooked meat, contaiminated soil **eye abnormalities** (ex: chorioretinitis), **neurologic findings** (ex: intracranial calficiations, hydrocephalus) and **hearing impairement**

Answer 294

Rubella infection in **pregnancy** is more commonly **symptomatic** (fever, maculopapular rash) than toxoplamosis infection. Congenital rubella typically manifests as congenital **heart** **defects**, eye abnormalities, and hearing impairment. **Intracranial calfications are not seen.**

Answer 295

**PFT** There are at risk for lung involvement, including Pulmonary HTN or intersitial lung disease. PFT help establish a pulmonary diagnosis, guide furher workup and track progression of disease Intersitial lung disease - decline in both TLC and DLCO wherease Pul. HTN - greater drop in DLCO and relatively preserved TLC

Answer 296

common superfical fungal infection of the foot with pruritic eyrthematous and well demarcated lesions mild cases may be treated with topical agents and more severe or associated onchomycosis require oral antifungals (ex: oral terbafine) \*griseofulvin is less effective than terbafine and rquires longer treatment

Answer 297

psychogenic coma A normal response is characterized by a transient, conjugate, slow devation of the gaze to the side of the stimulus (brainstem mediated) followed by saccardic correction to the midline (Cortical correction).

Answer 298

warfarin is the most effective anticoagulant, but due to its teratogenicty (bone and cartilatge and fetal bleeding), it is **replaced with LMWH in the first trimester.** Paients with **high risk of thromboemoblism (ex: those with mechanic heart valves) may receive warfarin in the 2nd or 3rd trimester.** **Unfractionated hepatrin** is the anticoagulant of choice **preceding delivery** due to its **rapid reversibility**

Answer 299

Can have atypical presentation including right sided abdominal pain with no peritoneal signs or mcburney point tenderness. In atypical presentaitons, imaging with a graded compression abd. ultrasound is indicated Nonpregnant- CT

Answer 300

Pylephlebiits, an infection of the suppurative portal vein thrombosis (portal venous drains the majority of the GIT; infections associated with this system can lead to localized thrombophlebitis that can extend to the portal vein)

Answer 301

In contrast to the femoral nerve injury, the **medial calf and arch of the foot may be spared in sciatic nerve injury** seconary to the preserved innervation of by the saphenous nerve (branch of the femoral nerve). The knee jerk is normal but the ankle jerk is unobtainable. Weakness affecting most of the lwower leg musculaature, including the hamstrings. Hip flexion, extension, abduction adduction and knee extension are normal. The most common cause of compression or injury to the sciatic nerve in this region is trauma which includes hip dislocation, fracture or replacement. Other ethiologies include wayward buttock injections, compression by external sources (ex: prolonged sitting) and deepseating mass in the pelvis (ex: hematoma0

Answer 302

acute foot drop accompanied by weakness in foot dorsiflexion and eversion. In additiona, the patient may also complain of paresthesia and/or sensory loss of over the dorsum of the food and lateral shin (superifical peroneal nerve territory). The injury is usually located at the knee on the lateral aspect of the fibular head

Answer 303

inability to extend the knee, loss of knee jerk reflex sensory loss over anterior and medal aspects of the thigh, medial aspect of the shin and arch of the foot

Answer 304

scalp swelling located above the periosteum, crosses stuture line most commonly developing afer prolonged labor or vaccum assisted delivery does not require treatment and resolves within teh first few days

Answer 305

cephalohematoma subperioteal bleed, takes several weeks to resolve and incontrast to subglaeal hemorrhage and caput succedaneum, it does not cross suture lines. cephalohematoma Can lead to hyperbilirubinemmia secondardy to RBC breadkown during resolution. Less commonly, they may calcificy or ossify, leadin to cell deformation

Answer 306

vaccum-assisted deliveries bleeding occurs between the scalp and periosteum, and rapid expansion is potentally fatal due to massive blood loss and hypovolemic shock Mgmt includes continous monitoring in ICU with volume replacement and seriel CBC and coagulation studies.