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177 Cards in this Set
- Front
- Back
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Monotherapy for HTN in African American patients (1st & 2nd choice)
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Thiazides & CCBs
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Managing acute dissection of 1) ascending aorta 2) descending aorta
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1) surgical emergency 2) managed medically: reduce systolic BP with propranolol or labetolol. 2ndly nitroprusside.
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Narrow complex QRS, no apparent P waves, tachycardia
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SVT
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Tx of SVT 1st? 2nd?
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1) Adenosine 2) IV verapamil or BB
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Most common cause of HTN in children < 6 yo
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renal parenchymal disease
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Anti lipid drug that is C/I in CHF
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TZDs
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Who should be screened for an AAA
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male smoker 65-75
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Still's murmur
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Benign murmur of childhood. Lower precordium, systolic, low short tone like a plucked string
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Venous hum
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Continuous low pitched murmur due to collapse of jugular veins and their subsequent fluttering, worse with inspiration
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Patient with acute coronary syndrome AND severe renal disease, which drug must be carefully administered
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enoxaparin eliminated mostly by kidneys. Clopidogrel is what's actually recommended
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Pt with poorly controlled HTN, basilar rales, pitting edema: what test do you order??
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has heart failure, use 2D echo + doppler
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initial tx of claudication
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regular exercise.
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Pt with sx of acute MI, what is an indication for thrombolytic therapy?
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new onset Left BBB. Suggests occlusion of LAD.
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thrombolytics harmful in ischemia or infarction?
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ischemia
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young patient with axillosubclavian vein thrombosis, most likely etiology
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compressive anomaly in thoracic outlet (if old: due to indwelling vein catheter)
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Best initial test for peripheral vascular occlusive disease
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ABI
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Patients with first episode of unprovoked DVT, tx with ?
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LMWH & at least 3 months of warfarin
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Initial tx for severe HTN in pregnancy? 2nd tx?
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Labetalol IV, nifedipine SL
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Preferred for chronic tx of CHF due to LV systolic dysfxn
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ACE inhibitors (hydralazine/ISDN as an alternative)
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Clinical predictors of increased perioperative CV risk for elderly patients
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unstable coronary syndrome, decomp CHF, arrhythmia, severe valvular disease. Others include: mild angina, previous MI, compensated CHF, DM, and RENAL INSUFFICIENCY
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PVD: results of a treadmill arterial flow study that support diagnosis of PVD?
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ankle brachial index difference from baseline after exercise 20 mmhg or more decrease in systolic BP
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Pain that begins immediately upon walking and unrelieved by rest
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peripheral nerve pain
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pain during rest and exercise and presence of swelling & soreness behind knee & in the calf
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baker's cyst
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Reivew HELLP syndrome
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Hemolysis, elevated liver enzymes & low platelet count
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Criteria for severe preeclampsia
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BP 160/110, proteinuria >5g/24h, thrombocytopenia plt ct <100k, liver enzyme elevated, epigastric or RUQ pain, altered mental status
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Prophylaxis of total knee or hip replacement for prophylaxis against deep vein thrombosis?
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enoxaparin (lovenox) 30 mg SC q 12 h
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1st line antibiotic tx for uncomplicated acute otitis media
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amoxicillin
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earliest presenting sx of open angle glaucoma
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tunnel vision
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30-50% of infants from chlamydia positive moms develop??
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conjunctivitis (pneumonia in 10-20%)
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leading cause of blindness over age 65 in usa
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macular degeneration
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dental antibiotic tx first choice? If allergic?
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penicillin. Clindamycin
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when is oral fluoride necessary/not necessary
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by six months in children whose primary water source lacks adequate fluoride
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most common congenital infection & leading cause of congenital hearing loss
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CMV
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bordetella pertussis infection tx
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macrolides (zpak), then tmp/smx
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significant pneumo acquired in a hospital: tx
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something with broad spec, combo ceftazidime & gentamicin
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tx for infant with croup
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dexamethasone//corticosteroids
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Chest xray of a child with meconium aspiration syndrome
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patchy atelectasis
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most common cause of neonatal respiratory distress
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transient tachypnea. Benign. Residual pulm fluid in lungs after delivery.
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RFs for transiet tachypnea in newborn
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csection, macrosomia, male, materal asthma or dm
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Treatment supported by current evidence for acute sinusitis
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oral analgesics. 98% are viral
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community acquired pneumonia treatment primary? If patient has been on that antibiotic in the last __ months?
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primarily use azithromycin, if patient tx with abs in last 3 months, give fluoroquinolone
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COPD induced hypoxemia treatment that has shown a reduction in mortality
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home oxygen 15hrs or more daily
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Who should receive two doses of influenza vaccine
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children 3-8 years old unless vaccinated previously
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Patient health care worker positive PPD test, whats your next step?
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check again in a week or more.
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young adults routine physical exam how often
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3-5 yrs
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mammograms recommended age
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40
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lead screening age
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6 m to 6 y
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viral vs strep pharyngitis
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strep: fever > 100.4, tonsillar exudates, anterior cervical LAD, no cough
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most common cause of acute vaginitis
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bacterial vaginosis
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treatment of uterine fibroids esp when pregnancy desired
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myomectomy
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most reliable predictor of survival in breast cancer
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stage at time of diagnosis
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fetal ultrasound measurements most accurate at 1) first trimester 2) second trimester 3) third trimester
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1) crown rump length 2) biparietal diameter and femur length 3) biparietal diameter, femur length, and abd circumference
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Late decelerations in fetal monitoring inidicate
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uteroplacental insufficiency
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color doppler flow studies useed to evaluate what in a female new onset LLQ pain
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adnexal or ovarian torision
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ASC for cervical cytology
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atypical squamous cells either: asc-h or asc-us (h= cannot exclude hsil) (us - unknown significance)
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most reliable clinical sx of uterine rupture
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fetal distress. (Classic signs are sudden tearing painv aginal hemorrhage and loss of uterine tone. Not reliable often absence)
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healthy level increases in pregnancy of hCG
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double every 1.4 to 2 days
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most sensitive for diagnosis of bacterial vaginosis: pH of discharge, clue cells, whiff test
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pH of discharge
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most frequently reported sx of vulvar cancer
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longstanding pruritus
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prescribe initial hormonal contraception only after:
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careful review of medical history + BP measurement
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tx of vaginal warts in pregnancy
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cryotherapy
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probability of pregnancy after unprotected intercourse is highest when
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1-2 days before ovulation.
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RF for endometrial cancer?
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persistent hyperestrogenic states such as PCOS.
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patients with PID tx
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Hospitalize 24h with ceftoxin IV and doxy. if cefoxitin is used IM for outpatient, combine with probenecid. If ceftriaxone is used, probenecid not required.
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Vaginal warts tx
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trichloroacetic acid
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Preferred tx for trichomonas? If refractory?
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flagyl 2g in single po dose. If doesn’t work, try again 500 mg BID for 7 days
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shoulder dystocia
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after head, infants ant shoulder cant get past pubic symphysis
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how to manage shoulder dystocia
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maximal flexion and abduction of maternal hips
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definition of post term pregnancy
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has reached 42 w gestation
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Painless bright red vaginal bleeding beyond 24 weeks gestation
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likely placenta previa
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stages of labour
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1) ? 2) complete dilation to delivery 3) delivery of baby to delivery of placenta
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indication that uterine rupture has occurred in VBAC
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fetal bradycardia
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describe how a fibroadenoma of the breast feels
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slow growing, nontender, rubbery, well defined, usually in UOQ
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inevitable abortion
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bleeding open os and no passage of products of conception
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treating asymptomatic chlamydia in pregnancy
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7 day erythromycin or amox or single dose azithromycin
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how to predict spotnaneous preterm delivery
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vaginal fetal fibronectin
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black cohosh
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botanical med used to alleviate menopause sx
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how epidurals affect stages of labor
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longer first & second stage
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tx for enlarging postpartum hematomas adjacent to an episiotomy
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remove sutures/clots and reclose
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sleep walking confusional arousal and sleep terrors occur in what part of sleep
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1-2 hrs after sleep onset, non REM, transition from 1st period of slow wave sleep
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only antidepressant approved for tx of depression in 8-17 year olds
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fluoxetine (prozac)
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ECT has increased risk of cx in patients with what condition?
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recent cerebral hemorrhage, stroke, or ICP. (not pregnancy, seizure d/o, pacemaker)
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antipsychotic given to psychosis secondary to dementia of parkinsons disease
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quetiapine (seroquel). Even the other atypicals have some d2 receptor effect
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Tx for Premenstrual dysphoria
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fluoxetine for last 2 weeks of cycle
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Benzo with shortest half life: flurazepam alprazolam clorazepate diazepam clonazepam
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alprazolam (t12), clonazepam (25) flurazepam, clorazepate, diazepam (t1/2 50 h)
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antipsychotics that associated with hyperglycemia and t2dm
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olanzapine & clozapine
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Terminal patients with depression dying in a few days should be treated with? If longer?
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psychostimulates like methylphenidate. SSRIs if living longer
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why no meperidine to elderly
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can accumulate and cause seizures
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an anticonvulsant that can cause secondary osteoporosis
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phenytoin
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When to supplement vit d in baby
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2 months until has 500 mL/day of formula or milk with vit D to prevent rickets
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Cereal started at what age
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4-6 months
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In addition to calcium and vitamin D supplementation, patients who are beginning long-term treatment with prednisone (≥3 months at a dosage ≥5 mg/day) should also receive
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bisphosphonate therapy
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Overt hypothyroidism & LDL levels
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elevates LDL
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S/E of lithium
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hypothyroidism, NDI, elevates calcium by elevating PTH
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Delayed gastric emptying in diabetics exacerbated by what meds
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exenatide (byetta) any amylin analogues and GLP-1s
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Red flags for thyroid cancer
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male, <20 or >65, rapid growth, dysphagia, neck pain, hoarseness, family history, history of radiation, hard fixed nodule > 4 cm, cervical LAD
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most likely etiology of child with bone age delayed relative to height age and chronologic age
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hypothyroidism
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low ferritin means
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low iron stored
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indications for PThyroid surgery when PTH is high and calcium high
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kidney stones, age < 50, serum calcium > 1 mg/dL above normal, reduced bone density
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double bubble sign baby
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volvulus
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Rotavirus vaccine rotateq given when.
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first dose b/w 6-12 weeks, 3 doses by 32 weeks
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cause of infantile colic
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unknown
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diagnosing peritonitis via paracentesis
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neutrophil > 250/mL
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vaccinated nurse is exposed to hep b what do you do
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test for HBV antibody; inadequate levels should be boosted by HBIG & HBV vaccine booster
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CA-125
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ovarian cancer
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CEA
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colon, esoph, hepatic cancers. Esp in adenocarcinoma
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melanosis coli 1) describe 2) caused by
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1) black/brown mucosa discolouration in colon. 2) fecal stasis & anthracene cathartics
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leading cause of bacterial diarrhea in the US
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campylobacter jejuni
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tx of thrombosed hemorrhoid
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elliptical excision
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Primary tx for symptomatic mvp
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propranolol
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infant: On examination, abnormal findings are confined to the skin, including her face, trunk, and proximal extremities, which have macules, papules, and pustules that are all 2–3 mm in diameter. Her palms and soles are spared. A stain of a pustular smear shows numerous eosinophils.
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erythema toxicum neonatorum
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Tx of choice for altitude sickness? In a pt with sulfa allergy?
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1) acetazolamide 2) dexamethasone
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most common drug cause of acute interstitial nephritis
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antibiotis (ceph, sulfa, pen)
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horse chestnut seed extract can be used for
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varicose veins
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Most common cause of erythema multiforme
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HSV
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Pyogenic tenosynovitis tx 1) early w/in 48 hrs 2) late
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1) splint and antibiotics 2) surgical drainage and antibiotics
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3 follow up options for pap smears with ASC-US
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1) Repeat 2 at 6 months 2) culposcopy 3) reflex hpv testing
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long term use of omeprazole side effects
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increased risk of c diff, less b12 absorbed and less calcium absorbed, and CA-pneumonia
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abnormal vaginal bleeding in a woman > 35
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must have an endometrial assessment to exclude endometrial hyperplasia or cancer.
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chronic plaque psoriasis requests topical treatment. Which one of the following topical therapies would be most effective and have the fewest adverse effects?
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high potency corticosteroids
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Add what to patients unresponsive to antidepressant monotherapy
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low dose lithium or T3
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Intertrigo is? Tx?
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inflamm of skinfolds, often with secondary bacterial fungal infections. Tx erythromycin
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Hydroxychloroquine can be used for what other than malaria
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rheumatoid arthritis slow down
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weakness of lower left leg giving way of knee and discomfort in anterior thigh in DM pt
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femoral neuropathy
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low dose estrogen oral contraceptives decrease risk of what cancer?
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ovarian
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Pain and stiffness in shoulder and pelvic girdle
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polymyalgia rheumatica
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tx of polymyalgia rheumatica
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corticosteroids
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halmark biochem feature of refeeding syndrome
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hypophosphatemia
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pt desires future pregnancy what is preferred method to remove fibroids?
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myomectomy
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patellofemoral pain syndrome often characterized by
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inadequate hip abductor and core strength
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closely monitor what function in pts with E coli O:157
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renal for hemolytic uremic syndrome
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tx for upper extremity DVT
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SC LMWH 5d + Warfarin po 3m
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Depressed, insomnia, and wt loss: best tx
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mirtazapine
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normal PFTs with flattened inspiratory loop
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consider vocal cord dysfxn
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Sudden onset severe abd pain, vomiting, diarrhea from cardiac emboli. Diagnostic test?
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Celiac & mesenteric arteriography. SMA embolization likely
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Threshold for prophylactic plt transfusion
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10,000/microL
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Which medications have best evidence for preventing HIP FRACTURE
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Alendronate, risedronate, zoledronic acid.
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Ovulation induction in PCOS
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metformin (&clomiphene)
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Pneumocystis jerovecii 1) prophylaxis 2) acute tx
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1) pentamidine 2) Bactrim + corticosteroids
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Scaphoid fracture tx 1) prox 1/3 2) distal 1/3
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1) prox: loss of circ, slow to heal: refer to orthopedist 2) distal: thumb spica cast.
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Treatments for acute exacerbation of COPD
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o2, antibiotics, bronchodilators, systemic corticosteroids
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Pts requiring pneumovax before age 65
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chronic cardiac or pulm disease, diabetes, asplenia, liver disease or CKD, and again 5 yrs after
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well controlled asthma <12 years old
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rule of 2s: Do not need prn albuterol > 2 times/week, premedicating before exercise is not counted.
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sexual abuse history in females correlated with what disorders
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gastointestinal lifelong/functional
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In addition to compression therapy, what is an effective adjunct tx for venous ulcers?
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pentoxifylline. (also aspirin).
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Earliest and most specific sign of autism
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delayed attainment of social skill milestones
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Chronic neck pain - best diagnostic test? If it's negative?
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Cervical spine series, then MRI
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Tx for PE
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LMWH (or heparin or fondaparinux) for 5 days, stop if INR >2.0 for at least 24 h.
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Fever, knee pain swelling, diffuse abd pain, palpable purpuric rash
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HSP
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Long term prognosis of HSP
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renal involvement
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DM drug causes weight loss
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metformin and exenatide
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Pes anserine bursitis tenderness
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over medial proximal tibia
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Use of what can help IBS sx
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peppermint oil
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Severe headache, LP shows increased CSF pressure, no other abnormalities 1) dx 2) major neuro effect
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1) pseudotumor cerebri or idiopathic intracranial HTN 2) visual loss
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Gastric bypass surgery requirements
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BMI > 40, or 35-40 with comorbidities. Clearance by mental health professional.
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IV magnesium for what arrythymia
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torsades de piontes
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Mild prodrome, ovoid salmon coloured herald patch followed by rash
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pityriasis rosea
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Initial tx of choice for ascites visible by abd distension
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diuretics spironolactone with salt restriction
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Osteoporosis screen in men what age
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>70
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CCB ingestion by a child
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pediatric ICU observation
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Tx for intermittent claudication that inhibits PDE
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cilostazol
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Mainstay tx for allergic rhinitis
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intranasal corticosteroids
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Enlarged tongue (macroglossia) possible causes
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amyloidosis, down syndrome, hemangioma/lymphangioma, acromegaly, cretanism
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"Bald" tongue possible causes
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xerostomia, pernicious anemia, iron deficiency anemia, pellagra, syphilis
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Bilateral nipple pain with & b/w feedings after initial soreness has resolved is usu due to?
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candida
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Tx for otitis media
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amoxicillin for 10 days.
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Low risk pts for a fib
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aspirin 81-325 mg daily
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rate control in a fib
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amiodarone
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Infants having <1 L formula/day need vit D?
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yes. 400 IU/day
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CA-MRSA infection tx
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doxycycline
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Essential tremor tx if patient intolerant to beta blockers?
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primidone.
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DM med that is safe in CKD
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glipizide
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What diagnostic testing requires you to withhold metformin use
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CT angiography
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newborn, 1 mm pustules with flat area of erythemia on face, trunk, upper arms. Not appearing ill
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erythema toxicum neonatorum
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target glucose level in critically ill pt
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140-180
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Duration of antiplt therapy for 1) drug eluting coronary art stent 2) bare metal 3) sirolimus eluting
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1) 1 year 2) 1 months 3) 3 months
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intrahepatic cholestasis of pregnancy 1) sx 2) tx
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1) pruritis on palms/soles -> rest of body, elevated bile acids & liver enzymes 2) URSODIOL
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