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430 Cards in this Set
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Dx patient with periorbital swelling, hematuria, and oliguria, hypertensive, and UA showing RBC casts and proteinuria. Low C3 complement. Had strep throat/skin infection 10 days ago.
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Post strep glomerulonephritis.
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Dx patient w hematuria after URI, a few days after infection, with normal complement
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IgA nephorpathy.
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Cause of Kaposi Sarcoma
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HHV 8, human herpesvirus 8
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Common complication in MG patient with too much anticholinergic
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Myasthenia crisis, weakness of resp muscles, need to be intubated, and anticholinesterase. Most common cause is intercurrent infection, need PFTs done.
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Dx patient with pansystolic murmur heard beast at the apex w radiation to the axilla
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mitral regurgitation. Septal murmur will have a thrill, and heard best at left sternal border.
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What causes a soft S1
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among other things, improper closure of the mitral valve in pap muscle tear.
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Dx patient with decreased transperancy of lens of both eyes, loss of retinal details
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cataract, causes blurred vision and glare due to thickening of the lens.
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Something affecting vision
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need to think of macular degeneration
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Metabolic alkalosis forumla
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(0.9*bicarb)+16+/-2= compensated CO2
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Dx test for suspected diverticulitis
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Use abdominal CT. Random, remember that calcium oxalate is common in the sediment, and is not significant unless signs of acute nephrolithiasis.
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Dx older patient who has syncope while urinating or coughing
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situational syncope
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Dx infant born with purulent conjunctivitis, w lid edema, and chemosis
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Gonococcoal conjunctivitis. Happens quickly after birth (2-5 days). Chlamydia is milder and present more than 5 ady after birth.
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Which vaccines should those with HIV not get
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BCG, anthrax, oral typhoid, intranasal influenza, and oral polio. Exceptions are MMR and vericalla, if >200 cd4.
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Tx for patient with mass in liver, diarrhea, after recent travel
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need to think of amoebic mass. Treat with metronidazole, dont need IV, and think of luminal agents like paromomycin.
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Common side effect s/p acute asthma treatment
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Can have problems metabolically. BEta 2 agonists can lead to hypokalemia, giving you muscle weakness, arrythmias, etc. Also tremors palpiations and headaches.
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Dx patient with loss of subcutaenous fat, pallor, hyperkeratosis, iron def. anemia, and foul smelling floating stools
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Celiacs! It is associated wtih anti-endomysial antibodies. Hyperkeratosis is due to lack of Vit A. Bulky foul smelling floatin stool is characteristic of celiac.Will have IgA abs to gliadin.
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Common electrolyte deficiencies in alcoholic patients
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They have hypokalemia, hypomagnesemia, hypophosphatemia. Hypomagnesemia is a common cause of refractory hypokalemia.
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Indication for the use of colloid solution
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It is used for burns or conditions w hypoproteinemia.
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Indication for use of crystalloids
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Saline is a crystalloid solution.
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Dx elderly patient with ecchymoses that occur on the extensor surfaces
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Senile purpura. Usually due to perivascular connective tissue atrophy. No workup needed.
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Albumin correction for calcium
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((4-albmuin)*0.8)+Ca
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T |
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Treatment for trigeminal neuralgia
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Carbamazepine
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Treatment of cluster headache
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sumatriptan and high flow O.
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Tx of choice for prolactinoma
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bromocriptine, and cabergoline. Which are both dopamine agonists.
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Dx patient with dark brown discoloration of colon with lymph follicles shining through as pale patches (melanosis coli)
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factitious diarrhea, due to laxative abuse. 10-20 movements a day. Seen inthose abusing anthraquine laxatives like bisacodyl.
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Tx for goodpasteures
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they have antiglomerular basement antibodies need to do emergent plasmapheresis. This is the most important one to do this for.
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Tx of wegeneres
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cyclophosphamide and steroids
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Todds palsy
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transient paralysis that occurs in the post ictal sate.
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Pathophys of lacunar stroke
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usually due to hyalinosis of the small vessels of the brain. Microatheroma and lipohyalinosis in small penetrating arteries of teh brain. Most common site is the posterior internal capsule, leading to purely motor stroke. ataxis hemiparesis, pure sensory stroke, and mixed sensory motor stroke are others.
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Dx patient with swollen painful eye with fever, pain wtih eye movement, proptosis, and decreased visual acutiy
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orbital cellulitis
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Dx patient with periorbital edema, exopthalmos, chemosis, with fundoscopy showing papilledema and dilated tortuous retinal veins.
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cavernous sinus thrombosis. often bilateral, and often involvemet of CN II resulting in ptosis.
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Dx patient with pain with eye movement, and pupillary changes
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optic neuritis
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MAC prophylaxis in aids patients
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Azithromycin.
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Dx patient with ring shaped scaly patches with central clearing and distinct borders
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tinea corporis, use 2% antifungal, such as terbinafine or grisefulvin. You can use KOH to show hyphae.
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Dx patient with maculopapular rash on the palms and soles, mucuous membranes are involved.
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secondary syphillis should be on diffirential.
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Erythema multiforme,
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think a recent herpes simplex infection.
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Dx patient with numerous oval scaly plaques that follwo the cleavage lines of trunk. Centers of the lesion are crinkled, cigarrete paper like in apearance. There is a herald patch initially
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pityriasis rosea
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Dx patient w severe pain and vision loss, seeing halos around lights, injected pupil, poorly responsive to light, tearing is present, and nausea vomitting. Usually there is a precipitating factor
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acute angle glaucoma. Key is that her pupillary reaction is gone. Similar symptoms could occur in cluster headaches, but the pupillary reaction is preserved.
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Cause of findings in patient with OHS
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Its due to impaired chest wall compliance.
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Dx patient with chorea, mood symptoms, dementia, and family history of similar symptoms at early age.
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huntingtons disease. happens around 30-50 years.
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Tx of patient with acute angle glaucoma
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Mannitol, acetazolamide, pilocarpine or timolol. avoid mydriatic agents like atropine. Narcotics to control the pain. Atropine will dilate the pupil and worsen the glaucoma.
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Function of acetazolamide
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carbonic anhydrase inhibitor, for glaucoma
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ECG characteristic of PE
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S1Q3T3
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Dx patient w intestinal villous atrophy
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Most likely celiac sprue. But need to correlate with diet.
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Tx of restless leg syndrome
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Treated with dopamine agonists. These are pramipexole or ropinerole.
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Dx patient with bilateral lower extremity edema with poor po intake
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usually due to decreased plasma oncotic pressure due to hypoalbuminemia.
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Tx for febrile neutropenic patients
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Empiric antibiotics, either ceftazidime, or cefepime
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Dx patient w severe jaundice and neurologic impairment due to kernicterus (bilirubin encephalopathy). Indirect bili is up to 50, everything else is normal.
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crigler najjar syndrome type 1. need to give phenobarbital.
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Dx patient with bilirubin in teh 20s with no kernicterus or neurologic impairment,
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Crigler najjar syndrome type 2. phenobarbital can be given periodically.
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Dx patient with chronic and mild hyperbilirubinemia of both conjugated and unconjugated without hemolysis, lfts are normal
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rotor syndrome.
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What drug is contraindicated in patients with preexisting lung disease and heart problems
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amiodarone bc of lung toxicity.
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Cause of secondary hypogonodism
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caused by low gonadotropin levels. Check by looking at prolactin levels, which can inhibit the release of GnRH.
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Dx patient with vision loss, photopsia with showers of floaters, and elevated retina wtih folds
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detached retina
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Dx patient wtih sudden loss of vision and onset of floaters, with dark red glow
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vitreous hemorrhage
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Common def. associated with chronic use of phenytoin
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folic acid. also seen in patients who are on methotrexate for along time or trimethoprim. Also primidone and phenobarbital. due to impaired absorption of folic aid int eh small intestine.
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MGMT of patient w UC
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wait 8 years then do colonoscopy every 1 to 2 years.
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Dx patient who presents with GI complaints followed by triad of periorbital edema, myositis, and eosinophilia.
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Trichinellosis, also has subungual hemorrhages and conjunctival or retinal hemorrhages. myositis=muscle pain
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Dx patient with constipation, descending paralysis and resp failuer
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botulism
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greatest Risk factor for variant angina
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smoking
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Indications for 02 therapy in patients with COPD
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Sa02 less than 88% or and Pa02 less than 55. If patient has pulmonary hypertension or hematocrit >55% then you can start at pa02 of <60.
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Indications for steroid use in PCP
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less than 70 paO2 or Aa gradient greater than 35.
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dx 16 patient who recently started isotretinoin, presenting with headache, blurry vision, and papilledema vision loss, and cranial nerve palsy
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pseudotumo cerebri, caused by isotretinoin
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Dx patient CSF finding of moderate wbc elevation *lymphocytes and elevated protein
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viral encephalitis
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Dx patient who has melena, and nocturnal pain taht is releived by eating
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duodenal ulcer. duodenal ulcers are relieved by eating , bc food allows alkali to be released to duodenum and relieve the pain. PPI and antibiotics First line thereapy is amox plus clarithro and ppi.
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Risk factors for pancreatic cancer
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Cigarette smoking is number one. Male se, age, black, cigs, chronic pancreatitis, obesity, dm, family hx, GALL STONES ALC AND COFFEE AER NOT
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Danger of starting folate in cobalamin def.
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You can mask a cobalamin def.
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Dx patient with tremor with intention
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Essential tremor
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Dx patient with a lower frequency tremor, 3-4 hz
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cerebellar dysfunction.
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Resting tremor that improves with activity
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usually due to parkinsons.
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Dx patient with dull tympanic membrance that is hypomobile on pneumatic otoscopy
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non infection effusion
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Dx study of choice for someone with suspected aortic dissectino
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TEE or CT w contrast
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Red to orange urine in someone wtih TB
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due to rifampin use.
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Mechanism of statin induced myopathy
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Decrease in teh synthesis of of non cholesterol products, such CoQ10 production
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Symptoms of herpes zoster
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usually pain first which then progresses to rash. immunocompromised patients are at risk.
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Kussmauls sign
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increase in JVD is indicated of right ventricular failure
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Tx for patient with positive scotch tape test
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Has enterbiasis. Needs albendazole or mebendazole.
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Mechanism of HIT
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Antibodies to heparin platelet factor 4 complex are responsible.
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Location of a lesion with a patient with expressive aphasia
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dominant frontal lobe.
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Dx patient with apraxia, sensory neglect, and anosognosia
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Non dominant parietal lobe.
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Apraxia with dementia
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lewy body dementia
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Complications nephrotic syndrome
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protein malnutrition, iron resistant microcytic hypochromic anemia, increaased susceptibility to infection. importany, VENOUS or ARTERIAL thrombosis. renal vein thrombosis is most common.
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MGMT of patient suspected of acetaminohen toxicity
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take a data pt at 4 hours then at at 6, make sure to get serum levels at 6 hours, which is the most useful. Need to give n acetyl cystein within 8 hours. you would give charcoal however, immediately.
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Familial extreme hypertension
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think pheo, and MENII.
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First line therapy for cocaine induced MI
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benzo, nitrates, and aspirin. Dont give pure beta blockers to people with cocaine, can induce vasoconstriction. Want to give pure alpha blocker, which will not lead to vasoconstriction (just rate control).
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Dx patient w beading ot biliary tree, p anca positive, and UC
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PSC
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First line treatment of aortic dissection
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betablocker.
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Mechanism of HIT
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Antibodies to heparin platelet factor 4 complex are responsible.
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Location of a lesion with a patient with expressive aphasia
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dominant frontal lobe.
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Dx patient with apraxia, sensory neglect, and anosognosia
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Non dominant parietal lobe.
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Apraxia with dementia
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lewy body dementia
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Complications nephrotic syndrome
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protein malnutrition, iron resistant microcytic hypochromic anemia, increaased susceptibility to infection. importany, VENOUS or ARTERIAL thrombosis. renal vein thrombosis is most common.
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MGMT of patient suspected of acetaminohen toxicity
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take a data pt at 4 hours then at at 6, make sure to get serum levels at 6 hours, which is the most useful. Need to give n acetyl cystein within 8 hours. you would give charcoal however, immediately.
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Familial extreme hypertension
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think pheo, and MENII.
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First line therapy for cocaine induced MI
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benzo, nitrates, and aspirin. Dont give pure beta blockers to people with cocaine, can induce vasoconstriction. Want to give pure alpha blocker, which will not lead to vasoconstriction (just rate control).
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Dx patient w beading ot biliary tree, p anca positive, and UC
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PSC
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First line treatment of aortic dissection
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betablocker.
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lesion commonly associated with PBC
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xantelasma.
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What does pronator drift indicate
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indicates an upper motor neuron lesion.
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Hyperkalemia management
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calcium gluconate, insulin and glucose, b2agonist and lasix. in that order. Kayexelate is sodium polystyrene sulfonate.
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Type of arthritis associated with SLE
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is usualy non deformin, invlves the hands, and is migrating. also knees ccan be affected.
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Criteria for behcets
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Recurrent oral ulcers, plus two of the following: eye lesions, retinal vascularization, skin lesions, acneiform nodules and papulosvascular lesions, and positive pathergy test. GI Skeletal vascular systems can be involved.
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Dx patient w urethritis, conjunctivitis, mucocutanous lesions and arthritis, usually following dyseneteric infection or STI.
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Reiters syndome. Mouth lesions can be stomatitis, balantitis, or keratoderma blennorrhagicum.
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Most common form of death in dialysis patients
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CV disease.
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Dx patient who develops SOB and prolonged expirations with history of asthma after being given beta blocker
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Drug side effect. Metop can induce asthma attack in patients with underlysing asthma.
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Dx patient with ataxia, vomitting, occipital headache, gaze palsy, and facial weakness wo hemiparesis
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cerebellar hemorrhage.
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Dx patient with hemiparesis, hemisensory loss, homonymous hemianopsia, stupor and coma
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Putamen hemorrhage. involving the internal capsule.
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Dx patient with deep coma and pareplegia, pupils are pinpoint and reactive to light. decerebrate rigidity, no horzonat eye movements
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Ponting hemorrhage
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Dx patinet with severe onset of headache w no deficits
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subarachnoid hemorrhage, commonly causes by saccular aneurysm and AVM
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Dx patient with tick bite presenting with hemolysis, hemolytic anemia, jaundice, hemoglobinuria, renal failure, no rash, pt doestn ahve spleen
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Babesiosis, use quinine clinda or atovaquone azithro
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Dx patient who is veterniarian, presenting with flu like syndrome, hepatitis, and pneumonia
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coxiella burnetii
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Indicators of hypovolemia
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Bun:Creat ratio is best, urine sodium is useless if patient is taking diuretic.
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Dx patient presenting with fevers, hypotension, and generalized erythema that desquamates, after nose packing
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toxic shock syndrome. Caused by toxin released by s aureus, acts as superantigen. Classicaly, erythema of palms soles trunk, strawberry tounge, followed by desqmation
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Dx patient with fever, meningitis, vomiting, myalgia, arthralgias, hypotension, with stellate purpuraw central gunmetal color
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acute meningococcemia
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Dx patient with dullness to percussion, bronchial breath sounds, and egopony
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consolidation in the lung.
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Dx patient with dullness to percussion, decreased breath sounds, and decreased tactile fremitus
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pleural effusion
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Dx patient with deep coma and pareplegia, pupils are pinpoint and reactive to light. decerebrate rigidity, no horzonat eye movements
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Ponting hemorrhage
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Dx patinet with severe onset of headache w no deficits
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subarachnoid hemorrhage, commonly causes by saccular aneurysm and AVM
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Dx patient with tick bite presenting with hemolysis, hemolytic anemia, jaundice, hemoglobinuria, renal failure, no rash, pt doestn ahve spleen
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Babesiosis, use quinine clinda or atovaquone azithro
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Dx patient who is veterniarian, presenting with flu like syndrome, hepatitis, and pneumonia
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coxiella burnetii
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Indicators of hypovolemia
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Bun:Creat ratio is best, urine sodium is useless if patient is taking diuretic.
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Dx patient presenting with fevers, hypotension, and generalized erythema that desquamates, after nose packing
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toxic shock syndrome. Caused by toxin released by s aureus, acts as superantigen. Classicaly, erythema of palms soles trunk, strawberry tounge, followed by desqmation
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Dx patient with previous tonsillitis who is presenting with fever headache vomiting and sore throat, with fine pink blanching papules appear on the neck and upper trunk, with flecural accentuation, rough sand paper texture
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scarlet fever
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Dx patient with fever, meningitis, vomiting, myalgia, arthralgias, hypotension, with stellate purpuraw central gunmetal color
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acute meningococcemia
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Dx patient with dullness to percussion, bronchial breath sounds, and egopony
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consolidation in the lung.
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Dx patient with dullness to percussion, decreased breath sounds, and decreased tactile fremitus
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pleural effusion
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normal pleural ph
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7.35-7.64. High amylase would be a pancreatic associated effusion. Glucose less than 60 would pe pneumonia.
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Dx patient with dysesthesia and hemi sensory loss
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Thalamic stroke. hypersensitvity to stimuli is common. This is classlic of a stroke occuring at the VPL nucleus.
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Characteristics of strokes of the medulla
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usually involved the nuclei of the cranial nerve.
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Dx patient with pruritic papules and vesicles over extensor surfaces and anti endomysial antibodies
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dermatitis herpetiformis. Usually have symptoms of GI and malabsorption. Rash associated with celiac is usually dermatitis herptiformis
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Dx patient symmetric erythematous skin lesions, target skin lesions with clear center, usually due to herpes simplex.
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erythema multiforme.
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MGMT of patient suspected of MONO
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due a monospot test!! ITs called a heterophile antibody test. EBV antibody test is second test.
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Treatment of choice for strep throat
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first line is penicillin , then azithrol.
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therapy for patient with suspected HIV
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get testing and treat wtih two or three antiviral immediately.
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Dx test for patient with suspectec acromegaly
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growth hormone test following an oral glucose load
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Bugs associated with aspiration pneumonia
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think gram negative, klebsiella is very ommon. Can cause tissue necoriss, and early abscess formation
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Dx patient with MCP, PIP, and wrist jt pain wtih a low esr
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Not rheumatoid. ore likely viral. IF the symptoms last less than 30 min, then also less likely to be rheum. or if not swelling, abscence of other systemic symptoms. you need arthritis for 6 weeks to diagnose rheym.
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Prevention strategy for gout in patient undergoing chemo
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need to be given prophylactic allopurial
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Used to preven hemorrahgic cystitis by cyclophosphomide
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Mesna.
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Dx patient with weight gain, fatigue, constipation, hoarseness, and memory changes.
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Hypothyroid.
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Most common cancer in smokers with lung cancer
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squamous.
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Cancer associated wtih hypertrophic pulmonary osteoarthropathy
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adeno
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Dx patient with bilateral parotid gland enlargement, two day history of fever, malaise, and foreign
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Mumps. Orchitis is very common complication in mumps. Other complications are asceptic meningigits and encephalitis.
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Dx patient with lower abdominal pain, bloody diarrhea, and tenesmus
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Suspect IBD, need to get plain films to rule out toxic megacolon.
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Dx patient w herpes zoster that causes a bells palsy
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ramsay hunt syndrome.
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Tx of MS flare.
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Glatiramer acetate, an agent used to decrese frequency and severity of exacerbations. It is composed of a synthetic mixture of polypeptides that contain combinations of four amino acids found in myelin basic protein, functions by inducing suppressor T cells that downregulate the T cell mediated immune response to myelin antigens taht underly MS>
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Dx patient in postpartum period presenting with failure of lactation, sparse pubic hair, dry skin and delayed tendon reflexes
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Sheehans syndrome, hypopituitary. Caused by ischemic necrosis of the pituitary gland due to peri partum bleeding.
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What to do when you see a low calcium
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look at albumin, look at phosphate. will tell you where the def is coming from, ie renal, parathyroid, def. etc.
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Medications that should be held before stress testing
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beta blockers, dig, and anti ischemics.
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Dx patient with skin blisters that enlarge and rupture
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impetigo
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Fluphenazine side effect
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a typical antipscyhotic that can cause hypotermia
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Dx patient with renal failure after recent angiography
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cholesterol emboli
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Pathophys of osteomalacia
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def. of vit d leads to decreased calcium, whch inhibits the proper mineralization of bone. sof tbones.
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Dx patienti with small red spots with bluish specks on buccal mucosa
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measles. Causes by paramyxoviurs. The spots are koplik spots.
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parvovirus
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slapped cheek, parvo B19.
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togavirus
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causes rubella, erythematous maculopapular rash with lympadenopathy, poly arthritis adn polyarthalgia
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Herpes virus type 6
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causes roseola infantum, fever, maculopapular rash
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Mechan of heart failure in tamponade
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pressure prevents filling, less preload. cant compensate
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Cause of molluscum
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poxvirus. resolves spontaneously in immunocompetant patients
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Fat femal fertile and over forty
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gallstones.
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Recommendations for people with calculi
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decrease protein/pxalate, decrese sodium, increase fluid, increase calfium.
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How do you relieve symptoms of pulmonary edema
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nitro relieves it by reducing preload.
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major cause of mortality in patients with subarachonid hemorrahge
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vasospasm. Treat with CCBs
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Dx pateint wiht weight loss, gynecomastia, test atrophy, and impotence.
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Chronic liver disease. Estrogen stays in blood longer than it should, also found in liver failure is hypothalamic pituitary dysfunction.
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pathogen of lyme disease
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borrhelia burgdoferi
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HDL goal in patient with MI
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needs to be above 40. In order to increase it, you can give nicotonic acid.
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Patient had inferior MI, how do you manage after
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Nitrates and beta blockers are contraindicated in the setting of AS, PDE use, or right ventricula infarct. RV infracts present with clear lung feilds. hypotension is seen, with increase JVD, thus thigns that reduce the preload further affet the problem.
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Screening in patients with PID
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should be screened for HIV, syph, hep B, and cervical cancer. and hep c if drug use.
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Purpose of tzanck smear
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use for HSV infection.
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Treatment of choice for spincter of oddi dysfunction following cholecystectomy
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ERCP with sphincterotomy
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Dx patient wtih sudden onset of eye pain, photophobia, and mid dilated pupil
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acute glaucoma, need tonometry to check it out. Other symptoms include eye pain, headache, nausea, heard and fleshy eye, non reactive mid dilated pupil.
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Pain from gastric ulcers does what with food
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gets worse, pain from duodenal ulcers get better w food.
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Patient with scares due to acne
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start isotretinoin!
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Dx patient with mass in the pancreas and is having diarrhea
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VIPoma. They produce vasoactive intestinal peptide, whicc cause diarrhea, hypokalemia, and decrease acid in teh stomach.
|
|
|
Positive prussian blue stain
|
indicates presence of hemosiderin, found in urine during hemolytic episodes. Bite cells in G6pd, due to heinz bodies that attach to the RBC membrane.
|
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|
Dx patient with dendriform ulcers in teh corneea, vesicular rash in teh periorbital region and lid margins
|
herpes zoster otpthalmicus.
|
|
|
Dx patient with dendritis ulcer, clear vesicles in teh cornea
|
herpes simplex keratitis
|
|
|
Dx patient with pale voluminous foul smelling stool
|
Fat malabsorption secondary to chronic pancreatitis.
|
|
|
Indications for AV replacement
|
1. symptomatic AS 2. AS undergoing CABG 3. AS with poor lv systolic function, hypertrophy, or valve are <0.6
|
|
|
Conditions leading to anasarca
|
usually due to organ failure or hypoalbuminemia. also primary kidney disease. Many RBC in urine think kidney process.
|
|
|
Causes of severe pulsus paradoxus
|
severe asthma, cardiac tamponade, or tension pneumo
|
|
|
Dx patient with proximal interphalangeal joints are swollen and fingertip pain
|
IE.
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|
|
Dx patient w asthma whos symptoms only occure at night
|
Think GERD, give trial of PPI.
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|
|
Dx patient w schistocytes, decreased haptoglobin, and increased LDH and Bili
|
MAHA
|
|
|
Type of rash associated with celiac sprue
|
dermatitis herpetiformis, which is treated with dapsone. Dont use high potency steroids.
|
|
|
Dx patient w hyperthyroidism wwith low weith and desire to lose weight
|
factitious thyrotoxcosis, you see follicular atrophy picture.
|
|
|
Orpahn annie nuclei
|
papillary thyroid cancer. most common form of thyroid cancer, good prognosis.
|
|
|
Picture of thryoid in graves
|
diffuse hyperplasia. w thyroid receptor antibodies.
|
|
|
Picture of hashis thyroiditis
|
diffuse lymphocytic infliltrate,
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|
|
Patient with a limited neurologic deficit and hypertesion
|
lacunar stroke.
|
|
|
4 types of lacunar syndromes
|
pure motor hemiparesis, pure sensory, ataxic hemiapresis, dyastrhia clumsy hand syndrome
|
|
|
Bilateral abdominal masses
|
almost always PKD. never adrenal masses. use ultrasound to confrim. PKD can cause hypertension, assoc w cerebral anuerysms.
|
|
|
Pt with pustular lesions of the extremities and migratory polyarthralgisas
|
disseminiated gonoccocemia Blod cultres are usually negative.
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|
|
Criteria for definition of death/brain dead
|
absent cranial nerve reflexes, fixed and dilated pupils, no spontaneous breaths, and agreement of two physicians
|
|
|
Reed steinberg cells
|
hodgkins disease
|
|
|
Patient w hepatocytes that stain with PAS rection and resist digestion diastase
|
alpha one antitrypsin def.
|
|
|
Criteria for someone w neutropenia
|
Less than 500 ANC, and a temp that is higher than 101.3 (38.3), or a sustained temp of 100.4 (38).
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|
Dx patient with mucocutaneous blistering characterized by flaccid bullae and IgG deposits intercellular in the epidermis.
|
PV, pemphigus vulgaris, autoantibodies are formed against desmoglein, and adhesion molecule.
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|
Dx patient w tesne blisters, w IgG and c3 deposits in the dermal epidermal junction
|
bullous pemphigoid. mouth is rearely affected
|
|
|
Dx patient with pruritic papules, vesicles over the elbows, knees, w IgA deposits along teh dermal papillae. Anti endomysial antibodies in patients.
|
Celiac sprue rash.
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|
|
Young erson with diarrhea, shallow ulcers in the mouth, and rlq pain
|
crohns
|
|
|
Neoplams in teh pulmonary apex that leads to horner syndrome,
|
superior sulcus tumor. Its called a pancoast tumor when it affects teh brachial plexus.
|
|
|
Dx patient with a leukocytosis and a high leukocyte alk phos
|
Leukomoid reaction. Happens due to severe infection. In CML, the leuk alk phos is low.
|
|
|
Comorbidity of porcelain gallbladder
|
Cancer! Requires resection. Most common cancer is adenocarcinoma.
|
|
|
Mechanism of hypoxemia with a PNA patient
|
what happens is that they have increased right to left shunt when blood rushes there.
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|
|
Dx patient IV drug user, cardiac disease on ECG, and proteinuria
|
Think Endocarditis.
|
|
|
MGMT of patient w newly diagnosed gastric cancer
|
CT scan to evaluate extent of disease.
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|
|
Dx patient w cranial enlargement, hearing loss, headaches
|
Think Pagets disease. Abnormal bone remodeling, osteclast resotion and then remodleeing. Leading to a mosaic patter of bone. Alk phos will be elevated, presence of urinary n telopeptide.
|
|
|
Treatment of mucormycosis
|
surgical debridement and amphotericin
|
|
|
Best screening test for an acute hep B infection
|
HbsAg, and antiHBc
|
|
|
EKG changes in digitalis toxicity
|
atrial tachycardia with AV block. Leads to ectopy in atria or ventricles. Look for ectopy occuring with AB block.
|
|
|
How to treat transplant failure
|
treat with steroids. Alos use rapid institution.
|
|
|
Dx patient with positive cyanide nitroprusside test
|
patient has cystinuria
|
|
|
whats the diff between gonorrhea and chlamydial cervicitis
|
one will have bacteriuria and the other wont.
|
|
|
Mgmt of recurrent chalazion
|
You need to do histopath, bc there can be underlying sebaceous carcinoma. Meibomian gland. Basal cell is the most common malignancy of this area.
|
|
|
What causes a variety of teh systemic manifestations of hypothyroidism
|
its the accumulation of matrix substances.
|
|
|
What does warfarin inhibit
|
works by inhibitng the synthesis of vit k dep factors, II, VII, IX, X, and protein c and s.
|
|
|
Study of choice for multile sclerosis
|
MRI
|
|
|
Dx patient with pain, bullae formation, and skin necrosis, involving the breasts, buttocks, thighs, and abdomen are commonly involved
|
Warfarin induced skin necrosis
|
|
|
What is the most frequent precipitant of GBS
|
campylobacter jejuni
|
|
|
Pathophys of patient with wilson disease
|
Remember patient wtih kayser fleischer rings, low serum ceruloplasmin and increased copper excretion. These ring are brownis or gray green rings of fine granula copper deposits in the cornea. This happens wtih hepatolenticular degeneration. Can cause neuropsych symptoms, personality changes. Associated wtih fanconi syndrome, Treat w copper chelator oral zinc, d-penicillamine or tirentine.
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|
|
Loss of pain and temperature sensation at the t10 region, wheres teh lesions
|
spinothalamic tract, on the contralateral side, two levels below.
|
|
|
Common side effects of thiazide diuretics
|
hyperglycemia, incresead LDL cholesterol, and TGs, hyponatremia, hypokalemia, and hypercalcemia
|
|
|
Dx holosystolic murmur that radiates to the axilla
|
mitral regurg. Lead to a fib.
|
|
|
Most common predisposing factor
|
aortic dissection
|
|
|
Dx patient with morning stiffness, deformity, dactylitis (Sausage digit) and nail involvement are common.
|
Psoriatic arthritis. 5-30% of psoriasis. You use NSAIDs, anti-TNF agents and methotrexate are used for treatment of psoriatic arhtiritis. Dont use steroids.
|
|
|
Indications for initiation of dialysis
|
uremic pericarditis! Fluid overload not responsive to medical treatment, hyperkalemia, refractory metabolic acidosis
|
|
|
Contraindications for dialysis
|
chronic disease, irreversivble dementia
|
|
|
How do you reverse opioid intoxication
|
Naloxone
|
|
|
Hematuria at the start of urination
|
indicates urethral damage
|
|
|
Hematuria at the end of rination
|
bladder or prostate
|
|
|
Hematuria throughout urination
|
kidney or ureters.
|
|
|
Tx for acute MS
|
steroids. second line is glatiramer acetate
|
|
|
Tx strategy for acute ingestion of lye
|
Need to scope them first. People present with restrosternal pain, hypersalivation,. Gastrogrfain study should be performed.
|
|
|
Electrical alternans
|
Tamponade. Patient has hypotension, tachycardia, and distended jugular veins.
|
|
|
Mgmt for patient with suspected ZE
|
they need serum gastrin levels taken. greater than 1000 is diagnostic. Then they can have a secretin stimulation test.
|
|
|
Common side effect of acyclovir
|
crystalline nephropathy, need hydration
|
|
|
hallucinations followed by parkinsoniasm. REM problems. or sensitivity to neuroleptic
|
lewy body disease
|
|
|
Suspected achalasia management
|
NEed to get imagine, then scope them, due to presence of pseudoachalaisa secondary to neoplasm.
|
|
|
Painful erections
|
priapism. Trazadone.
|
|
|
Causes of priapism
|
sickle cell disease, perineal or genital trauma, neurogenic lesions, medications
|
|
|
Problem with hemi neglect
|
involves teh parietal lobe, non dominant
|
|
|
TSH levels in secondary thyroidism
|
Patient will have low thyroxine levels, and low TSH levels. ALso found in tertiary.
|
|
|
subclinical hypothyroidism
|
mildly elevated TSH with normal thyroid levels.
|
|
|
Patient w increased T3 and T4 and normal tsh
|
they have resitance to hormones. Disease of thyroid gland, primary hypothyroidism, pituitary gland secondary hypothyroidism, and hypothalamsu is tertiary.
|
|
|
DDx of erythema nodosum
|
Associated sarcoid, TB, histo, recent strep infection, or IBD. Common in patients who are AA.
|
|
|
most common cause of ascites
|
portal hypertensio
|
|
|
Boggy prostate
|
Acute prostatitis, ned to get a mid stream urine sample.
|
|
|
Wedge shaped infarct
|
PE.
|
|
|
Dx patient with focal pain, fever, chills, and eleveated ESR
|
prostatitis.
|
|
|
Dx patient w intermittent flank pain, hematuria, UTIs, and nephrolithiasis
|
PKD>
|
|
|
What happens in SIADH with saline infusion
|
the urine osmolality goes u. If Uosm is greater than serum, siadh, Sosm is less than 270, u concentration greater than 20, absecence of hypovolemia,
|
|
|
Dx patient with hypercalcemia, metabolic alkalosis, and renal insuficiency
|
Milk alkali syndrome. Happens when you take in calcium adn alkali for PUD. Lots of calcium can do it.
|
|
|
Dx patient with high blood pressure, insulin resistance, hypokalemia, and cushingoind appearance
|
ADdreanl cortical disease. Too many steroids increases glucose. STeroids lead to insulin resistance!
|
|
|
Best advice for protecting against melanoma
|
Wearing extra clothing. Other risk factors include tanning beds, blond and bue eyes, PUVA therapy. SPF15-30 doesnt help.
|
|
|
Side effects of metforming
|
lactic acidosis in the setting of acute renal failure. DC it.
|
|
|
Dx patient with extreme bradychardia, AV block, hypotension, and diffuse wheezing indicates...
|
beta blocker over dose. Can also leed to cold clammy hands, and hypoglycemia. Glucagon needs to be administered, increasing levels of cAM and higher levels of intracellulra calcium, augmenting cardiac contractility.
|
|
|
Common cause of GI bleeding over the age of 65
|
angiodysplasia.
|
|
|
Resting tremor that improves w intention
|
parkinsons
|
|
|
tremor that is worse at goal directed movement
|
essential tremor. Treatment is beta blocker or primidone or topiramate.
|
|
|
Reversing the effects of a high PT
|
need to give FFP. Protamine sulphate only works for prolonged PTT.
|
|
|
Dx patient w cough dyspnea, hemoptysis, and kidney failure w dysmorphic red cells
|
Goodpastures.
|
|
|
Dx patient wi acid fast, gram positive branching rods
|
Nocardia asteroides. Treat wtih bactrim. TB would not be branching and would not stain on gram stain.
|
|
|
Dx patient who has anaerobic gram positive branching rod, affetcing the cervicovacia area and sin stracts, w sulfur granules
|
Actinomyces. Treat w penicillin G.
|
|
|
Dx patient with angioma like blood vessel growths in HIV patient
|
Bartonella in bacillary angiomatosis
|
|
|
Type of gout you get if you have hyperparathyroidism
|
pseudogout.
|
|
|
ACID BASE picture in someone w aspirin toxicity
|
mized respiratory alkalosis and metabolic acidosis.
|
|
|
Type of anemia associated with OA
|
Iron def. anemia, NOT anemia of chornic disease. NSAIDS are a common cause of iron def. anemia per gi blood loss.
|
|
|
Side effect of HIT
|
patients are THROMBOTIC, and thus are at risk for clots not bleeds.
|
|
|
Patient with RA is at risk for what other arthropathy
|
they are at risk for OA as well. Fever is common in RA,
|
|
|
Genetics of HOCM
|
autosomal dominant.
|
|
|
Type of gait in parkinsons
|
they have a shuffling gait, IE a hypokinetic gaint.
|
|
|
MGMT of patient w status epilepticus
|
treat w benzo first, then try phenytoin, but if lasting 5-10 minutes thing about intubating as well to maintain airway.
|
|
|
Hip findings in patient w OA
|
they have limited ative and passive internal and external rotation of the hi. No tenderness to palpation.
|
|
|
Pain of trochanteric bursitis
|
is localized over the lateral hip and is worsened by palpation.
|
|
|
MGMT of patient w bone mets due to prostate cancer
|
first do orchiectomy, then radiation therapy, then etidronate disodium
|
|
|
MOst common complication of peptic ulcer disease
|
Hemorrhage.
|
|
|
Dx patient w cysts with egg shell calcifcation
|
A hydatid cyst. Due to infection from echinoccocus granulossu. Also treat w albendazole
|
|
|
Dx patient w corneal vesicles and dendritic ulcers
|
herpes simplex keratitis
|
|
|
Dx patient w itching in the periorbital region and a vesicular rash in teh distribution of crani nerve. there is conjunctivitis and corneal ulcers
|
Herpes zoster ophthalmicus
|
|
|
Prolonged QRS interval suggests what kind of arrhytmia
|
a brady arrhytmia. A prolonged QT interval would be suggestive of a tachyarrhymtia.
|
|
|
Type of exudate w PE
|
usually always exudative.
|
|
|
Dx patient w loss of monocular vision, w optic disk swelling, retinal hemorrhage, dilated veins, and cotton wool spots
|
Central vein occlusion.
|
|
|
Dx patient w painless loss of vision in one eya and fundoscopic exam that has pallor of the optic disk, cherry red fovea, and boxcar segmentation
|
Central artery occlusion.
|
|
|
IV Drug user murmurs
|
Have right sided murmurs, which increase in strenght w inspiration.
|
|
|
MOst common cause of urinary retention in elderly males
|
enlarged prostate. Other caues of retention are neurogenic bladder and detrusser muscle underactivity.
|
|
|
Most common electrolyte abnormalities with cushing syndrome
|
hypokalemia and hypernatremia
|
|
|
Dx patient with cafe au lait spots, axillary freckels, and lisch nodules of the iris, and bony lesions, neurofibroma
|
NF 1
|
|
|
Dx patient w brain tumors and bilateral acoustic neuromas
|
NF 2.
|
|
|
Port wine stain in teh V1 distribution
|
Sturge weber syndrome.
|
|
|
Dx patient w ash leaf hypopigmentation, cardiac rhabody, kidney angioleiomyomas, mental retardation, and seizures
|
Tuberous sclerosis
|
|
|
Dx patient with many monobolasts, leukocytosis, promonocytes, and monocytes
|
Acute monocytes leukemia. Negative auer rods.
|
|
|
Dx patient w loss of monocular vision, w optic disk swelling, retinal hemorrhage, dilated veins, and cotton wool spots
|
Central vein occlusion.
|
|
|
Dx patient w painless loss of vision in one eya and fundoscopic exam that has pallor of the optic disk, cherry red fovea, and boxcar segmentation
|
Central artery occlusion.
|
|
|
IV Drug user murmurs
|
Have right sided murmurs, which increase in strenght w inspiration.
|
|
|
MOst common cause of urinary retention in elderly males
|
enlarged prostate. Other caues of retention are neurogenic bladder and detrusser muscle underactivity.
|
|
|
Most common electrolyte abnormalities with cushing syndrome
|
hypokalemia and hypernatremia
|
|
|
Dx patient with cafe au lait spots, axillary freckels, and lisch nodules of the iris, and bony lesions, neurofibroma
|
NF 1
|
|
|
Dx patient w brain tumors and bilateral acoustic neuromas
|
NF 2.
|
|
|
Port wine stain in teh V1 distribution
|
Sturge weber syndrome.
|
|
|
Dx patient w ash leaf hypopigmentation, cardiac rhabody, kidney angioleiomyomas, mental retardation, and seizures
|
Tuberous sclerosis
|
|
|
Dx patient with many monobolasts, leukocytosis, promonocytes, and monocytes
|
Acute monocytes leukemia. Negative auer rods.
|
|
|
Mechanism of action of NPH
|
due to decreased CSF absorption.
|
|
|
Role of Dapsone in AIDS patients
|
used as prophylaxis for PCP pneumonia, second line to bactrim.
|
|
|
Findings in a patient with secondary adrenal insufficiency due to pituitary tumor.
|
Patient will have weakness fatigue, eosinophilia, lymphocytosis and irribability due to glucocorticoid deficiency and hypothyroidism
|
|
|
Hyperpigmentiation of skin and mucous membranes is characteristic of what
|
primary adrenal insufficiency
|
|
|
Mgmt of patient with a stye
|
warm compresses, dont need to biopsy it
|
|
|
Most important way to prevent gouty attackts
|
Cessation of alcohol, and low purine diet
|
|
|
Most common physical finding in patient with hemophilia
|
hemarthroses. Second most likely is spontaneous bruises.
|
|
|
Mgmt of paitent who was treated for intraepithelial lesion
|
every 6 month of colposcopy and curretage until 3 negatives are obtained then resume annual screening
|
|
|
Dx patient with maculopapular rash, posterior cervical and posterior auricular lymphadenopathies and polyarthralgias
|
Rubella
|
|
|
Most sensitive way of diagnosing histo
|
Urine antigen.
|
|
|
Dx patient with fever weight loss night sweats, CD4<100, nausea, vomitting, classic finding also are lymphadenopathy and hepatosplenomegaly
|
these are the findings with histo
|
|
|
Drug of choice for histo
|
itraconazole.
|
|
|
Test of choice for suspected GERD
|
24 hour PH recording.
|
|
|
Drugs for HOCM
|
beta blockers, then CCBs
|
|
|
Tx for patient with MALT lymphoma
|
treat with antibiotics.
|
|
|
Dx patient with on purulent vesicels on teh finger
|
herpetic whitlow. Most commoly seen in patients with genital herpes, or helath care workers. Positive tzanch smear is also seen. Treat with bacitracin for econdary infection.s
|
|
|
Wedge in ARDS
|
is usually normal.
|
|
|
Recurrent bacterial infections
|
Indicates a humoral immmunity infection, need to get IgG measuraments
|
|
|
Dx patient w increased Retics, increased billi, negative coombs, and spherocytes
|
Need to be thinking heridatary spherocytosis. The test of choice is osmotic fragility.
|
|
|
Indication for sugar water test
|
done for PNH
|
|
|
Ideal way to diagnose C diff
|
use cytotoxin assay in teh stool, must faster. Very sensitive test for it.
|
|
|
Major toxicity of cyclosporine
|
nephrotoxicity, hyperkalemia, hypertension, gum hypertorphy, hirsutism, and tremor. TAC does alot of the saem except for hirsutism and gum hypertrophy
|
|
|
Azathioprine itox
|
diarrhea, leukopenia, hepatotoxicity
|
|
|
Mycophenalate toxicity
|
leads to bone marrow suppression
|
|
|
Effusion associated with acute pancreatitis
|
left sided pleural effusion.
|
|
|
Dx patient w anterolateral bowinng of the femur
|
Has Pagets disease. Caused by osteoclast hyperfunction.
|
|
|
Drugs that increase Dig toxicity
|
Verapimil does it, leading ot nausea, anorexia, and vomitting.
|
|
|
When do you prophylax for histo
|
When patient is an endemic lace for histo, give them itraconizole.
|
|
|
Classic complication of subarachnoid hemorrhage
|
hyponatremia. Cerebral salt wasting syndrome, due to secretion of vassopressin and increased BNP which leads to salt wasting.
|
|
|
First study of choice for suspected pancreatitis
|
need to get the US first, then confirm with the CT.
|
|
|
Most common cause of acute epididymitis
|
usually due to E coli.
|
|
|
Dx patient with sudden SOB, hypotension, tachycardia, tracheal deviation, and unilateral breath sounds
|
tension pneumo. All these would be the same in a PE, except for the abscence of breath sounds. The hypotension and is a results of the compression.
|
|
|
Treatment for hairy cell leukemia
|
cladribine, has a positive TRAP stain, bone marrow becomes fibrotic leading to a dry tap
|
|
|
Which androgens are produced specifically by the adrenals
|
ONly DHEA-S. The others, are also produced by ovaries and testicles. if there was no mass you could look for ACTH.
|
|
|
Thenar eminence wasting
|
Carpel tunnel syndrome
|
|
|
Dx patient with back pain, anemia, renal dysfunction, and elevated ESR
|
think multiple myeloma. Hypercalcemia can manifest as constipation, anorexia, weakness, increased urination, nuerological abnormalities.
|
|
|
Hearing loss associated with aging
|
Prebycusis.
|
|
|
Dx patient with bony overgrowth of the stapes, begins with low frequency hearing loss, and found in middle aged individuals
|
otosclerosis
|
|
|
Dx patient with hypochromic and normochronic RBCs
|
Sideroblastic anemia. Can be causes by isoniazid, this will stimulate an iron def. anemia. Treat with pyridoxine (vit B6).
|
|
|
Gynecomastia, test. atrophy, decreased body hair, spider angiomas, and palmar erythema
|
caused by hyperestrogenism
|
|
|
Dx 12 yo patient with peripheral granulation and skin debris, and drainage resistant to abx.
|
cholesteatomas. Retraction pockets of the tympanic membrane also.
|
|
|
Feeling of the head spinning when getting up or moving
|
labarynth dysfunction usually BPPV
|
|
|
Treatment of uncomplicated cystitis
|
bactrim or nitrofurantoin. The complicatd part is in people who are pregnant, young old, diabete, et. Then get urine cultures.
|
|
|
Major cause of diarrhea in HIV with count less than 180
|
think cryptosporidium parvum. Oocytes in the stool, acid fast.
|
|
|
Tx for undiagnosed pleural effusion
|
Is thoracentesis, unless you for sure know its HF.
|
|
|
Dx patient with anisocoria, ciliary injection, ptosis, and impaired adduction
|
Trigeminal nerve. Corneal staining defect refers to a ulcer, and if you cant feel it thats V1 thats affected.
|
|
|
How to dx lactose intolerance
|
you use a hydrogen breath test,which should be positive. Positive stool test for reducing substances, low stool pH and increased osmotic gap. The hydrogen level goes up because there is bacterial carbohydrate metabolism going on .
|
|
|
Co morbidities of vitiligo
|
Assocaited with pernicious anemia, autoimmune thyroid disorder, DM I, adrenal insufficiency, hypopituitarism, and alopecia areata
|
|
|
Dx patient with epistaxis, localized mass, and bony errosion
|
has angiofibroma until proven otherwise.
|
|
|
Dx patient with elevated HCG and elevated AFP presenting with a mass in the mediastinum
|
Has germ cell tumor.
|
|
|
Dx patient with pale velvety macules that dont tan, and scale on scraping
|
Tinea versicolor. A superficial fungal infection of the skin, caused by malassezia furfur, Treat with selenium sulfide, or ketoconazole shampoo
|
|
|
Dx patient with cough, erythema nodosum, anterior uveitis, and arthritis
|
Sarcoid
|
|
|
Dx patient post MI w persistant changes on ECG
|
Has a ventricular aneurysm. Can lead to mitral regurg. Happens about days to months after MI>
|
|
|
Treatments for MS
|
acute would be steroids, then would be interferon beta, and then would be the glatiramer acetate.
|
|
|
Treatment for hepatic hydrothorax
|
Start with salt rest and diuretics, then use TIPS if its refractory.
|
|
|
Dx patient with mono picture, no cervical lympadenopahty, and negative mono spot test.
|
CMV mono. Wil have basophilic lymphocytes with a vacuolated appearance. Presents wo pharyngitis and cervical lymphadenopathy.
|
|
|
Dx patient with IgM spike and hyperviscosity of blood.
|
Get bruises, night sweats, visula problems, headaches dissiness. MM has IgG or IgA.
|
|
|
Tx for non surgical cholelithiasis
|
Fat fertil female and forty. Great with ursodeoxycholid acid and fat restriction. Decrease cholesterol content of bile by reducing hepatic seretion and itnestinal reabsorption of cholesterol.
|
|
|
Initial test for suspected primary hyperaldosteronism
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PA:PRA ratio is used. Over 30 is diagnositic. Then you use saline or oral salt loading to see if aldosterone is suppressed.
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Ohio and missiipii valley disease
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histoplasmsis. and central america. and ass w bird or guano droppings.
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Dx patient w hyperglycemia, necrolytic migratory erythema, and diarrhea
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glucagonoma. also weigh loss.
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Preferred treatment of graves
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radioactive iodine theray. avoid in pregnancy and opthalmopathy.
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Dx patient 40-50, with elevated ESR and creatnine kinase, and proximal muscle wekaness
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polymyositis
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Maneuvers that decrease venous return
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will decrease preload, and icnrease the intensity of HOCM.
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Manuevers that increase pre load
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squatting, handgrip, recumbency, leg raising
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Handgrip in AS vs MR
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handgrip will make AS murmur softer, and MR louder.
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Absence seizure
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Petit Mal seisure. Cessation of mental activity, can occur many times a day.
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Consequences of norepi to fingers
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can lead to ischemia of the distal fingers and toes secondary to vasospasm.
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Murmur of aortic regurg
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is early diastolic, chest xray will reveal a widened mediastinum
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Most ocommon cause of abnormal hemostasis in patients w CRF
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platelet dysfunction. BT is lonng. DDAVP is treatment of choice, which will increase factor VIII:von willebrand factor multimers.
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Dx patient w urine osmolality that is less than serum osmolality
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This is usually due to DI. in order to treat you need to first do a water deprivation test, which will increase urine if its psychogenic and wont if its DI. Then to tel teh diff of central vs nephro, give them desmo, to see if it changes.
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Patient with foot drop.
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due to neuropathy, L5 is common, damaging the peroneal nerve.
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Comorbidites of infectious mono
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associated wtih autoimmune hemolytic anemia, and thrombocytopenia 2-3 weeks after.
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Comon causes of pancreatitis
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diuretics, IBD drugs, immunosuppressives, valproic acid, didanosine/pentamidine, antibitics.
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Dx patient with pneumonia w GI symptoms, hyponatremia, LFT abnormaliteis
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legionella
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Use dependence antiarrytmics
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flecainide and calss IV medications. CCB prolons the PR intereval, not QRS.
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If pen light doesnt reveal conjunctival abrasions what do you do next?
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You need to get a fluorescein examination. NEver use MRI, since it can dislodge the object.
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Dx patient with elevated alk phos and evidence of bone remodeling
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pagets disease. will have normal calcium.
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Resp alkalosis in pregnancy
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is normal.
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Dx patient with honey colored exudates and crusts
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impetigo. Starts as an erythematous macule. Staph or strep.
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Characteristic features of crohns disease
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has non caseating granulomas. Crypt absecess are UC, along with pseudopolyps.
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Perianal disease, cobblestone appearance of colon, creeping fat, transmural lesion
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CD
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Tx of choice for HSC encepahlitis
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IV acyclovir.
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BLue toe syndrome
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due to cholesterol emboli after a cath procedure
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Sediment consisting of protein, WBCs, and WBC casts
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tubulointerstital nephritis. in glomerulonephritis youre more likely to see edema, hematuria, and rbc casts, hypertension.
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Elevated CA125
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usually due to ovarian cancer.
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Non tender solitary nodules of the head and neck w smoking history
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think squamos cell carcinoma
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mechanism of orthostatic hypotension in the elderly
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usually due decreasing baroreceptor sensitivity.
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Why is there a decreased level of glucose in exudative effusion
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usually due to the high WBC count in the pleural fluid, due to the metabolic acitivity of the bacteria
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Blood tinged sputum managemetn
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if first time, and no suspicion of other malignancy, just observation is ok.
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Treatment of alcoholic patient w ataxia, confusion, and opthalmoplegia
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wernickes. give thiamin before sugar.
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Comorbidity of pernicious anemia
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increase risk for gastric cancer. Patients develop atrophic gastritis. increase the risk for carcinoid tumors.
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Indications for tube thoracostomy
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ph less than 7.2 or glucose less than 60.
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SE of levodopa/carbidpa
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hallucinationa
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Abx for cat bite
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you should take amox/clavulanate. Deep puncture wound is the fear, and can lead to pasteurela multocida,
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Dementia vs old aging
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loss of adl, others are concerned about thier memory problems, decline for recent events, word finding problems, get lost, unable to perate appliances, limited interest in social acitivites, abnormal minimental
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SE of hydroxychloroquine
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GI distress, visual disturbances, hemolysis in G6PD.
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SE of methotrexate
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WOrks by inhibiting dihyrofolate reductase. Common side effect is macrocytic anemia. Nausea, stomatitis, rash, hepatoxciity, interstitial lung disease, alopecia, fever
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Dx patient w small cell carcinoma leading to proximal weakness, and loss of deep tendon reflexes.
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This is eaton lambert syndrome. Results from autoantibodies against voltage gated calcium channels in the presynspatic notor nerve ternimals.Tx is plasmapheresis and immunosuppressive therapy.
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First sign of diabetic nephropathy
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glomerular hyperfiltration. Thickening of the membrane is the next step. Then mesangial expansion, and finaly sclerosis.
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Indications for dialysis
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1. refratory hyperkalemia, resistant volume overlaod, metabolic acidosis, uremic pericarditis, uremic encepalopathy, coagulopathy due to renal failure
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Tx for HIT
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stop LMWH and heparin, start on daparoid and a direct thrombin inhibitor.
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Mechanisms of infection resistance in patients wo spleen
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These patients lack spleen and cant phagocytose organisms properly, due to impaired antibody mediated opsonization in phagocytosis
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Suspected hyperandrogenism workup
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need to get testosterone levels and DHEAS levels
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Chloride sensitive vs chloride resistant metabolic acidosis
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Chloride sensitive (hypochloremi, saline responsive) and chloride resistant (normo chloremic, saline unresponsive) metabolic alkalosis. In chloride sensitive, urine chloride is low, and there are signs of volume depletion, and is indicative of volume contraction, leading to bicarb retention, h loss and k loss. Urne chloride is low bc body is taking up NACL. This is auses by diuretis or loss of gastric seretions like vomitting.
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Mechanism of Type IV hypersensitivity
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cell mediated, delayed type. host must be sensitized first.
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Tx for patient w heat stroke
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evaporation cooling of the patient.
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Dx patient w miosis, bradychardia, and hypotension
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opiod toxicity.
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Dx patient w aspirin ingestion, persistent nasal blockage, and episodes of bronchochonstriction.
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pseudo allergic reaction due to aspirin sensitivity syndrome. Treat w leukotriene antagonists. Too many leukotrienes lead to bronchoconstriction and polyp formation.
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Dx patient w some kind of fungal infection who has cutaneous disease of verruous or ulcerative nature w a blue color.
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blastomycsis.
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Dx gardnere with subcutaneous infetion
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sporotrichosis.
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skin disorder associated with parkinsonism
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seb derm. you can use antifungals for this.
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Tx for patient with cold leg
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need to do an ECHO to rule out thrombus in the left ventricle.
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Dx patient with smudge cells
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CLL. need to do flow cytometry to figure out what is going on.
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PPD of 6 in patient with HIV w neg CXray
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you need prophylaxis w isonizaid and pyridoxine. Pyridoxine is added to the regimen to prevent possible neuropathy caused by isoniazid.
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SE of isoniazid.
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Can cause a neuropathy, and a hepatitis.
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Best way to evaluate patient with acute hepatitis
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LFTs and viral serology
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Best way to evaluate chronic hepatitis
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liver biopsy
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What causes shingles
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varicella zoster
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Dx patient w mouth ulcers, enthesitis, low back pain, after a GU infection,a febrile
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reiter syndrome, treat w nsaids. Gonochocal arthritis will not have enthesitis, mouth ulcers, or back pain.
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Do you ever use oral antibiotics for endocarditis
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NO
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Dx patient w smoke inhalation and presenting with headache, nausea, and abdominal discomfer, with pink, red skin hue
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CO poisoning. If they were blue they have methemoglobinemia.
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Someone w bitter almond breath
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cyanide posioning.
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Dx 6 year old with diffuse erythematous rash that is sand paper like
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stap scalded skin syndrome. also bullae, nikolsky sign, facial edema, perioral crusthing, and dehydration
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TCA overdose effets on EKG
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leads to QRS lengthening. TCA causes hyperthermia, seizures, and hypotension, dilated pupils, flushed and dry skin, and ileua. Treat w sodiium bicarbonate.
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Murmurs causes by ischemia
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diastolic dysfunction, such as an atrial gallop (fourt sound)
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Dx patient w fungal infection that has exposure to bats, palatal ulcers,
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histo
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Dx patient with decrease calcium, increased phosphate, increased potassium, and increased uric acid
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tumo lysis syndromde. Common in poorly differentiated lymphomas, and leukemias. Treat w allopurinol.
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Patient w TARGET CELLS
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thallasemia.
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