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37 Cards in this Set

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A concerned mother brings her 12 mo old son to your office for evaluation.
She has questions regarding toilet training and states that her child has no interest in using the potty.
The mother is concerned the child is developing abnormally and would like your opinion on the matter.
Given your expertise, you explain to the pt the appropriate age to begin toilet training starts at:
36 mos
30 mos
18 mos
12 mos
6 mos
18 mos

The recommended age for toilet training is between 18 and 24 mos

6 mos: Sleep through the night, stranger anxiety
12 mos: Pincer grasp, uses a picture book
a 22 yo M presents to your office for his annual exam and appears high.
He is acting stuporous and upon questioning he reveals that he has been experimenting with some illicit "drugs".
He assures you that he is fine to drive home and you allow him to leave.
On his way home he gets into an automobile accident.
Which of the following is a correct statement?
The Dr is not liable because of Nonmaleficence
The Dr is not liable because of Breach of Duty
The Dr is not liable because of Vicarious Liability
The Dr is liable because of Breach of Duty
The Dr is liable because of Vicarious Liability
The Dr is liable because of Breach of Duty

Vicarious Liability pertains to the responsibility a preceptor has when overseeing a student
A 10 yo child is brougt to your office after suffering a spider bite.
The spider was described as being black with a red hourglass-shaped region on the underside of its body.
The immediate treatment needed for this child is:
Fomepizole
Glucagon
Naloxone
Atropine
Calcium gluconate
Calcium gluconate

The tx for black widow spider bite is Antevenom; however, since the venom induces a massive SYMPATHETIC RESPONSE, you must also protect the heart by giving CALCIUM GLUCONATE (similar to hyperkalemia)

Atropine is given along with pralidoxime for ORGANOPHOSPHATE OD
Naloxone is given for OPIATE OD
Glucagon is given for B-BLOCKER OD
Fomepizole is given for METHANOL & ETHYLENE GLYCOL POISONING
A 65 yo black F presents to the ED with SOB and diffuse chest pain.
Her BP is 70/50 and pulse is 50.
PE reveals jugular venous distention that increases with inhalation.
ECG shows ST elevations in leads II, III, and aVF.
The next best step in management is:
Aspirin, isotonic fluid, O2
Cardiac enzymes
Furosemide
Cardiac catheterization
Aspirin, nitrates, and O2
Aspirin, isotonic fluid and O2

This pt has signs of a R ventricular infarct (hypotension, JVD worse with inhalation (Kussmaul sign))
ST elevations in II, III, and aVF indicate acute ischemia in the inferior left ventricular wall, which can be associated with RCA occlusion
R ventricular infarct treatment is DIFFERENT in that you give FLUIDS rather than nitrates (because the BP is very low)

Nitrates and Diuretics are pre-load reducers, which would further reduce CO
Cardiac catheterization is invasive and less invasive measures should be taken first
Cardiac enzymes would come shortly after fluids, aspirin, and O2

The goal of R heart failure treatment is to INCREASE CO
A 39 yo M with a known HIV Hx presents to your office with a sore throat lasting four days.
There is no associated thrush.
On PE, you note the presence of multiple, well circumscribed lesions having a "volcano" appearance, which lie deep in the oral mucosa.
Which initial therapy should be used to treat this pt?
Oral ketoconazole
Oral acyclovir
Oral prednisone
IV foscarnet
IV ganciclovir
Oral acyclovir

It is likely this pt has HSV esophagitis.
HSV lesions are typically well circumscribed and have a "volcano" appearance.
CMV esophagitis would have much larger, shallow ulcers.

IV Ganciclovir would tx CMV esophagitis
IV Foscarnet is used for Ganciclovir-resistant CMV or Acyclovir-resistant HSV...neither of which are mentioned in the case
Oral Prednisone is used as an adjunct to treatment of esophagitis
Oral Ketoconazole would be used for Candidal esophagitis; however, FLUCONAZOLE is the prefered tx

Dx can be made with BARIUM studies
Followed by an EGD
A 39 yo M with a known HIV Hx presents to your office with a sore throat lasting four days.
There is no associated thrush.
On PE, you note the presence of multiple, well circumscribed lesions having a "volcano" appearance, which lie deep in the oral mucosa.
If the pt had presented with substernal burning accompanied by odynophagia and the presence of giant cells with intracellular inclusions, the most likely organism responsible would be:
Varicella
CMV
Candida
HSV
EBV
CMV

GIANT CELLS with INTRACELLULAR INCLUSIONS is pathomnemonic for CMV
A 22 yo F presents to the ED stating her "heart feels like it is flip flopping."
She is anxious and states she has a major medical school exam tomorrow.
She has had a similar episode prior to final exams last semester.
Exam reveals tachycardia and tachypnea.
The most useful test is a/an:
Plain CXR
Urine metanephrines
TSH
ECG
ABG
ECG

ECG is useful in anxiety attacks to rule out arrhythmias and screen for adverse medication effects such as long QT syndrome.
Even if anxiety is suspected, serious medical conditions should be ruled out first.

ABG may show anxiety response (respiratory alkalosis) but it is not helpful for dx
TSH wouldn't be helpful since it is likely she is having an anxiety attack and not hyperthyroidism
Urine metanephrines wouldn't be helpful because these attacks aren't random (like pheo) but are associated with tests
A 24 yo F with a Hx of chronic SIADH presents to the ED with mental status changes. PE shows a lethargic and confused pt.
Labs show K 4.5, Na 119, Cl 110, Glucose 105, Hct 45.3, Hb 14.8
Ct scan and CXR are normal
Your attending tells you to treat the pt.
You start an IV of 6% hypertonic saline.
Soon after you start the IV your pt loses consciousness, has a seizure and develops quadraparesis.
How could her condition have been prevented?
Fluid restriction
BP control
Infuse saline more rapidly
Use normal saline instead of 6%
Use 9% normal saline instead of 6%
Use normal saline instead of 6%

The pt has central pontine myelinosis (CPM) which is caused by rapid correction of hyponatremia with a hypertonic solution.
0.9% normal saline solution should be used to correct at a rate not to exceed 10mmol/24hr or 0.5mEq/L/hr

9% normal saline is even more hypertonic than 6% and would exacerbate the problems
A 60 yo F presents to the ED with fever, chills, and copious productive cough.
The pt is hospitalized and treated with IV gentamicin but fails to improve.
On PE the pt has bilateral ptosis that she admits worsens in the evening.
She also complains of diplopia and blurry vision that was present for the past year but has become more pronounced since her admission.
The most definitive method to confirm the diagnosis is:
Single fiber electromyography (SFEMG)
Muscle biopsy
CT scan of the thorax
Edrophonium test
Acetylcholine receptor antibody test
SFEMG

The SFEMG is an electrostimulation test which tests for weakening muscular response to repetative electrical stimuli

Acetycholine antibody test is most specific, but it still has a 20% false positive rate
Edrophonium is a good diagnostic test because it has high sensitivity
Muscle biopsy is a poor test because it is reliant upon good biopsy technique
A 2 yo girl is brought to your office by her mother who complains the child "gets into everything in our house."
She wants to know what is the leading cause of death among toddlers.
You proceed to tell her the most common cause of injury-related death in toddlers is:
Falls
Child abuse
Motor vehicle traffic
Electrical burns
Suffocation
Motor vehicle traffic

Most common cause of death by age group:

<1 = 1) suffocation, 2) MV traffic, 3) drowning
1-9 = 1) MV traffic, 2) drowning, 3) fire/burn
10-14 = 1) MV traffic, 2) drowning, 3) other land transport
15-24 = 1) MV traffic, 2) poisoning, 3) drowning
A 12 yo M presents with exercise-induced asthma which has been worsening over the past 3 weeks.
He is not on any medication for his condition.
Prior to exercise, the pt should be instructed to take:
Inhaled long-acting beta 2-agonists
Inhaled corticosteroids
Oral theophylline
Oral leukotriene inhibitor
Inhaled short-acting beta 2-agonists
Inhaled short-acting beta 2-agonists

The pt has EXERCISE-INDUCED asthma
The treatment of choice is a SHORT-ACTING beta 2-agonist
A 28 yo G2P1 female presents to your clinic for follow up.
The pt is currently taking levothyroxine and metoprolol for hyperthyroidism and HTN.
She is concerned these meds will harm her baby.
The most appropriate recommendation regarding the pt's managemetn is to:
Continue levothyroxine but switch metoprolol to labetolol
Continue metoprolol and add captopril
Discontinue metoprolol and substitute losartan
Discontinue the levothyroxine but continue metoprolol
Continue both the levothyroxine and metoprolol with close follow up
Continue levothyroxine but switch metoprolol to labetolol

Levothyroxine is a Class A med.
Antihypertensives should be used with caution and the only acceptable drugs are:
LABETOLOL
METHYLDOPA
HYDRALAZINE
A 24 yo G2P2 asks to be started on birth control pills.
Hx reveals thyroid disease, for which she is poorly compliant with her levothyroxine.
She has missed three of her last four visits to your office.
She tells you that she is fairly positive that she does not want to have any more children.
Which of the following should you recommend?
Combined estrogen-progestin oral pill
Depot medroxyprogesterone acetate
Hysterectomy
Tubal ligation
Copper IUD
Copper IUD

This pt is not COMPLETELY confident that she is done having children, therefore an alternative to tubal or hyster is needed.
Copper IUD can be left in place for up to a year and therefore would be a good choice for this pt
A 24 yo G2P2 asks to be started on birth control pills.
Hx reveals thyroid disease, for which she is poorly compliant with her levothyroxine.
She has missed three of her last four visits to your office.
She tells you that she is fairly positive that she does not want to have any more children.
The pt also tells you that she has heavy vaginal bleeding and passses clots.
Which of the following should you recommend?
Combined estrogen-progestin oral pill
Depot medroxyprogesterone acetate
Hysterectomy
Tubal ligation
Copper IUD
Depot medroxyprogesterone acetate

Progestin has antiestrogen effects, thereby maintaining the endometrium in a state of down-regulation.
NSAIDs are 1st line for menorrhagia, but this was not an option

A LEVONORGESTREL IUD would be ideal for this pt, but it was not an option

Bottom line:
Menorrhagia is managed with NSAIDs (1st), OCPs (2nd), Progestin therapy (3rd)
A military organization is considering stockpiling the smallpox vaccination due to high risk of bioterrorism event.
The vaccination type is:
Attenuated virus
Conjugate
Toxoid
Live vaccinia
Killed virus
Live vaccinia

Live vaccines include: Smallpox, MMR, Zoster, Varicella

Killed = Polio, Hep A, Influenza
Toxoid = Diptheria, Tetanus
Conjugate = H. Influenzae, Pnemonia
Attenuated = MMR
A 70 yo M presents for routine medical care and has no complaints.
A CMP demonstrates the pt is developing kidney failure and a skeletal survey is normal.
A urinalysis reveals significant proteinuria which is confirmed to be due to M proteins secondary to increased IgM levels.
What is the best next step in management?
Radiation
Plasmapharesis
Bone marrow transplant
Chemotherapy
Observation
Observation

The most likely diagnosis is Monoclonal Gammopathy of Undetermined Significance (MGUS).
MGUS is an asymptomatic form of the monoclonal gammopathies (like multiple myeloma)
Pts are typically asymptomatic (whereas MM would have bone pain), it is often discovered during routine lab testing and doesn't require treatment.
Observation is required because the disease may progress to multiple myeloma

Chemo would be used for long-term treatment of MM
Plasmapharesis would be used for acute treatment of MM
A 24 yo black M with a Hx of HIV presents to your office complaining of decreased urination, anorexia, and fatigue.
PE shows generalized edema but is otherwise normal.
Lab analysis shows hematuria, hypoalbuminemia, LDL 180, HDL 28, TGs 567, BUN 43, and Cr 4.3.
What is the most likely diagnosis?
Membranous nephropathy
Berger's disease
Focal segmental glomerulosclerosis
Acute tubular necrosis
Allergic interstitial nephritis
Focal segmental glomerulosclerosis

This pt. has signs of a NEPHROTIC syndrome (hypoalbuminemia, hyperlipidemia, edema).
FSGS & Membranous are both nephrotic.
FSGS is CLASSICALLY found in Blacks, with HIV, IV drug abuse, or obesity.
Treatment = Prednisone, ACEi/ARB

Membranous nephropathy is CLASSICALLY found in Caucasians (it's the most common cause of Caucasian nephrotic syndrome)
Pts typically have HBV, syphilis, malaria, or gold satls exposure.
"Spike and dome appearance" is caused by IgG and C3 deposits.

Allergic interstitial nephritis is typically caused by drugs (Naficillin/Methicillin, NSAIDs, Phenytoin, Sulfa, Rifampin, Allopurinol, Diuretics)
EOSINOPHILA, RASH & URINARY WBCs are CHARACTERISTIC.

ATN will show GRANULAR ("MUDDY BROWN") CASTS with a urine osm >500, urine Na >20, FEna >2%, BUN/Cr <15

Berger's is a NEPHRITIC syndrome associated with URI or GI infections.
Tx = ACEi/ARBs & glucocorticoids
A 52 yo M develops thick respiratory secretions, associated with a recent diagnosis of an URI.
The pt also complains of upper abdominal discomfort.
Tx with OMM would be most effective if directed toward the:
Pelvic diaphragm
Sphenopalantine ganglion
Superior mesenteric ganglion
Thoracic vertebrae
Celiac ganglion
Sphenopalanteine ganglion

SG treatment will result in thinning of nasal secretions, which will help facilitate healing of the URI.

Celiac ganglion tx will affect viscera at levels T5-T9
Superior mesenteric ganglion will affect viscera at levels T10-T11
A 20 yo F presents to your office with cessation of menses.
The pt reports first getting her period at age 14 and states they have occured monthly ever since until recently.
She denies any spotting or bleeding from her vagina since her last period, which occured 3 months ago.
A urine pregnancy test is performed and found to be negative.
Normal thyroid funciton is confirmed in her initial laboratory work-up.
The next step in management of this patient should include a/an:
Prolactin level
Repeat pregnancy test
FSH & LH levels
Progestin challenge
Estrogen-progesterone challenge
Prolactin level

The correct sequence for secondary amenorrhea is:
BhCG, TSH, Prolactin, Progestin Challenge...
Since pregnancy and thyroid have already been ruled out in this pt, the next step is Prolactin
A 22 yo M presents to his PCP for a routine check-up.
Cardiac examination reveals a systolic murmur that increases in intensity with a Valsalva maneuver.
Upon further questioning he admits that he experiences shortness of breath more readily than his peers when playing college football.
The most appropriate next step is:
Ask about FHx of heart disease
Exercise stress test
Chest radiograph
ECG
Echocardiogram
Ask about FHx of heart disease

The pt has signs of hypertrophic cardiomyopathy (HCM).
HCM is autosomal dominant, therefore there could be a family history
A 22 yo M presents to his PCP for a routine check-up.
Cardiac examination reveals a systolic murmur that increases in intensity with a Valsalva maneuver.
Upon further questioning he admits that he experiences shortness of breath more readily than his peers when playing college football.
To decrease the intensity of his murmur, you should:
Give lidocaine
Give ACEi
Give beta-blockers
Give furosemide
Have the pt stand from a seated position
Give beta-blockers

The murmur of HCM is decreased by increased filling of the left ventricle (i.e. increasing preload).
Beta-blockers slow the heart rate, therefore allowing for an increased preload and therefore decreasing the murmur.

Diuretics and standing will decrease the preload, and increase the murmur.
ACEi decrease preload and afterload, therefore not having any effect on murmur
Lidocaine is used for arrhythmias

HCM murmur can be INCREASED with decreased preload (VALSALVA, DIURETICS, STANDING) and DECREASED with increased preload (SQUATING, BETA-BLOCKERS)
A 40 yo M with a 20 pack year history of smoking presents to the ED complaining of non-productive cough, pleuritic chest pain, dyspnea, HA, diarrhea, myalgias, and nausea for 6 days.
He is febrile and tachycardic.
CXR shows asymmetric bilateral infiltrates.
Labs show Na 127, Cr 2.5.
The most likely etiology is:
S. Pnemoniae pneumonia
S. Aureus pneumonia
Legionella pneumophila pneumonia
Mycoplasma pneumoniae pneumonia
Influenza virus
Legionella pneumonphila pneumonia

This pt has an ATYPICAL PNEUMONIA, which can be caused by either Legionella or Chlamydia.
Legionella is common is smokers, fast onset, diarrhea, HA, confusion, flu-like illness, electrolyte imbalance, acute kidney injury.

Chlamydia has an insideous, slow onset and may have excessive sweating, a cough which progressively worsens, and POSITIVE GOLD AGGLUTININ TESTS

Flu is incorrect based on the CXR
S. Pnemoniae is the most common cause of typical pneumonia, but not atypical
A 13 yo obese M presents to your office with left knee pain for the past 3 weeks, which causes him to limp when ambulating.
The pt admits to playing recreational football but is not involved in organized sports.
There is no reported Hx of trauma.
PE is unremarkable except for limited internal rotation of the hip.
The most likely diagnosis is:
Legg-Calve-Perthes disease
Slipped capital femoral epiphysis
Posterior fibular head
Osgood-Schlatter disease
Septic arthritis
Slipped capital femoral epiphysis (SCFE)

SCFE should be suspected in any obese adolescent with hip/knee pain.
SCFE occurs in kids >10 yo.

Legg-Calve-Perthes presents in a similar fashion, but typically isn't found in kids >10

Osgood-Schlatter involves only the knee and wouldn't have hip restriction
A 26 yo F with schizophrenia presents with restlessness, agitation, and a fixed upward stare.
She states that her eyes hurt and cannot make them look forward.
The most appropriate treatment is:
Metopclopramide
Benztropine
Scopolamine opthalmic
Haloperidol
Dantrolene
Benztropine

This pt has signs of dystonia (prolonged muscle contraction).
Torticollis is another common dystonia due to contraction of the SCM.
This pts dystonia is due to contraction of her eye muscles.
Tx of dystonia is DIPHENHYDRAMINE or BENZTROPINE

Dantrolene would be used for neuroleptic malignant syndrome, which would have presented with FEVER, M RIGIDITY & AUTONIMIC INSTABILITY
Haloperidol would have made her problems worse
Scopolamine opthalmic would paralyze the ciliary muscles and is used for glaucoma
Metoclopramide is used as an antiemetic/gastroprokinetic by blocking the dopamine pathway
A 23 yo F presents complaining of a 2 day Hx of rash involving both lower extremities.
She also reports gingival bleeding.
She states she just got over the flu, but is feeling better.
She takes no meds and her PMH is unremarkable.
CBC shows Hg 14.0, Hct 42%, WBC 7,000, PLT 10,000, PT 10, PTT 35, INR 1.5, fibrinogen and fibrinogen degradation products are WNL.
Which of the following is the most likely diagnosis?
TTP
ITP
DIC
Aplastic anemia
Von Willbrand's disease
ITP

ITP typically follows an ACUTE INFECTION and presents with purpura or petechiae, mucosal bleeding, meno/metorrhagia in females.
It is caused by autoimmune IgG abs binding to PLTs
Glucocorticoids are the first-line treatment

TTP presents in a similar fashion EXCEPT it has neurologic symptoms ("like a T6, like a T6"), renal failure, or symptoms of hemolytic anemia.

DIC is incorrect because fibrinogen and fibrinogen degradation products are WNL
Which of the following represents the calculation for the probability that a screening test will be positive in patients with a disease?
(True Pos x True Neg)/(False Pos x False Neg)
(True Pos)/(True Pos + False Pos)
(True Neg)/(False Pos + True Neg)
(True Neg)/(False Neg + True Neg)
(True Pos)/(True Pos + False Neg)
(True Pos)/(True Pos + False Neg)

This is a screening test, therefore you would want to determine SENSITIVITY

Remember, the 2X2 box is oriented with Positive/Positve along the top and Negative/Negative along the bottom
Disease runs along the X axis and Test result runs along the Y axis
Which of the following represents the calculation for the probability that a patient with a positive test has a disease?
(True Pos x True Neg)/(False Pos x False Neg)
(True Pos)/(True Pos + False Pos)
(True Neg)/(False Pos + True Neg)
(True Neg)/(False Neg + True Neg)
(True Pos)/(True Pos + False Neg)
(True Pos)/(True Pos + False Pos)

This test is attempting to determine the probability that a positive test result is truly positive; therefore we use the PPV test

Remember, the 2X2 box is oriented with Positive/Positve along the top and Negative/Negative along the bottom
Disease runs along the X axis and Test result runs along the Y axis
Which of the following represents the calculation for the probability that a test will be negative in patients without disease?
(True Pos x True Neg)/(False Pos x False Neg)
(True Pos)/(True Pos + False Pos)
(True Neg)/(False Pos + True Neg)
(True Neg)/(False Neg + True Neg)
(True Pos)/(True Pos + False Neg)
(True Neg)/(True Neg + False Positive)

This test is looking to determine the probability that a test will be able to RULE OUT disease in a patient who does not have disease; therefore the SPECIFICITY test is best

Remember, the 2X2 box is oriented with Positive/Positve along the top and Negative/Negative along the bottom
Disease runs along the X axis and Test result runs along the Y axis
Which of the following represents the calculation for the probability that a patient with a negative test does not have a disease?
(True Pos x True Neg)/(False Pos x False Neg)
(True Pos)/(True Pos + False Pos)
(True Neg)/(False Pos + True Neg)
(True Neg)/(False Neg + True Neg)
(True Pos)/(True Pos + False Neg)
(True Neg)/(True Neg + False Neg)

This test is attempting to determine the likelihood that a negative test result actually means the patient does not have disease; therefore the NPV test is best

Remember, the 2X2 box is oriented with Positive/Positve along the top and Negative/Negative along the bottom
Disease runs along the X axis and Test result runs along the Y axis
Which of the following represents the calculation for the odds of exposure among patients with a disease compared with odds of exposure among patients without a disease?
(True Pos x True Neg)/(False Pos x False Neg)
(True Pos)/(True Pos + False Pos)
(True Neg)/(False Pos + True Neg)
(True Neg)/(False Neg + True Neg)
(True Pos)/(True Pos + False Neg)
(True Pos x True Neg)/(False Pos x False Neg)

This is the calculation for an odds ratio

Remember, the 2X2 box is oriented with Positive/Positve along the top and Negative/Negative along the bottom
Disease runs along the X axis and Test result runs along the Y axis
A 58 yo F presents to the hospital complaining of pain and stiffness in her thigh muscles that seem to be worse in the morning.
Her only medication is Sertraline, which was started three weeks ago for major depression.
PE reveals 5/5 muscle strength throughout.
Based on this infomration, the most likely diagnosis is:
Hypothyroidism
Polymyalgia rheumatica
Osteoarthritis
Rheumatoid arthritis
Fibromyalgia
Polymyalgia rheumatica

Pts do not have decreased muscle strength, which helps make the diagnosis and distinguish it from other disorders presenting with proximal muscle weakness such as polymyositis.
The pt is also on Sertraline, which is a sign of depression, which is common in pts with polymyalgia rheumatica
A 58 yo F presents to the hospital complaining of pain and stiffness in her thigh muscles that seem to be worse in the morning.
Her only medication is Sertraline, which was started three weeks ago for major depression.
PE reveals 5/5 muscle strength throughout.
Patients suffering from this disorder are most likely to benefit from long term therapy with:
Thyroid hormone replacement
Topical analgesics
NSAIDs
Corticosteroids
Periodic OMT directed at tenderpoints
Corticosteroids

Polymyalgia rheumatica's treatment of choice is corticosteroids
An 18 yo F presents to the clinic because she missed her period.
Her last menstrual period was 8 weeks ago.
Quantitative hCG shows 500.
Pelvic exam reveals a closed non-tender cervix and no adnexal masses.
Transvaginal ultrasound shows no intrauterine pregnancy.
24 hours later her BP drops to 70/50 and she complains of severe abdominal pain.
PE reveals guarding and rebound tenderness.
Which of the following is the next best step?
Salpingostomy
Emergent surgery
IV fluids and observation
Methotrexate
Recheck hCG and CBC
Emergent surgery

The pt has become unstable with an acute abdomen and needs emergent surgery.
A 25 yo M is brought to the ED by a family member after he was witnessed to become unresponsive to family members at the dinner table.
Witnesses state the pt complained of a "wood-burning" smell after which he stopped talking and stared blankly for several minutes.
The pt is now responsive but is confused and complains of sleepiness.
The most likely diagnosis is:
Tonic-clonic seizure
Simple partial seizure
Partial seizure with secondary generalization
Complex partial seizure
Absence seizure
Complex partial seizure

Complex partial seizures have impaired consciousness with automatics (lip-smacking, chewing, olfactory or gustatory hallucinations).
The last 1-3 minutes and is followed by a postictal state.

Simple partial seixures have intact consciousness
Complex partial seizures have impaired consciousness
Absence seizures typically occur in kids and are often described as "staring off into space" and do NOT have a postictal state
A 42 yo construction worker presents to your office with complaint of soreness and progressive swelling of the right heel.
He reports stepping on a rusty nail three weeks ago while at work.
PE reveals an erythematous, warm heel that is extremelly tender to the thouch.
His T is 101.5 in your office.
Plain films of the foot shows evidence of osteomyelitis.
The most likely organism responsible for causing this infection is:
S. Pneaumoniae
Klebsiella pneumoniae
Pseudomonas aeruginosa
Clostridium tetani
S. Epidermidis
Pseudomonas aeruginosa

Pseudomonas is the most common cause of osteomyelitis in pts with a hx of nail-puncture wound.
S. Aureus is the most common cause of osteomyelitis; however, there are several exceptions
A 4 yo boy is rushed to the ED after being suspected of ingesting a AAA battery.
Plain films of the abdomen reveal the presence of the battery in the jejunum.
The child appears healthy and in no distress.
He has had no episodes of emesis and has unremarkable physical examination findings.
The most appropriate treatment at this time is:
Immediate surgical intervention
Oral ipecac to induce vomiting
Observation with blood and urine mercury levels
Flexible fiberoptic bronchoscopy for removal of battery
Rigid fiberoptic bronchoscopy for removal of battery
Observation with blood and urine mercury levels

Batteries in the esophagus should be removed immediately.
Batteries found in the small or large intestines should be observed if the pt remains asymptomatic
A 27 yo F asks you to explain her options regarding contraception.
She states that her boyfrined refuses to use condoms and she recently heard about a shot that she could get every 3 months.
When explaining the use of medroxyprogesterone for contraception, it is important to explain to her the most common side effect of using this medicine is:
Headache
Major depression
Spontanous abortion
Hot flashes
Breast pain
Headache

Common side effects of Depo include: HA, Wt gain, abdominal discomfort, nervousness, and weakness/fatigue