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229 Cards in this Set
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47 pmh of htn - ED for left-sided chest pain that began while snorting cocaine 1 hour ago BP 170 over 90 101 18 98 % takes alprazolam to calm his nerves which of the following meds is contraindicated |
Metoprolol |
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75- ED with syncope, a&o and in retrospect describes occasional external cp, sob w/ exertion, 110/80, bibasilar rales- which ausculatory finding would exp this? |
A harsh systolic murmur crescendo decrescendo best hears over the right sternal boarder |
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ECG findings indicative of severe hyper k+ in pt with a paced rhythm include? |
QRS widening Failure to capture Sine wave QRS morphology
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AMI in a paced rhythm? |
Can be detected by increased st-segment in a pattern of exaggerated discordance |
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Cp & 190/105, denies drug use/etoh/tobacco. PE=track marks. Best Tx for BP? |
Lorazepam |
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What BP med is used in pregs with htn emergency? |
Labetalol |
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Which medication should be considered if atropine fails in bradycardia? |
Dopamine/epi- beta agonist |
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Common sxs of afib? |
Fatigue |
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Dabigatran increases what bleeding risk |
Gi bleeding |
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59 pmh dm &ami, 5 days ago argued with husband. CC: CP. 1st ecg negative for ischemic changes, trops mildly elevated. Next step? |
Serial ECGs and ck-mb |
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Left cp & sob x 1hr, 85/45, 105, 94%ra. ECG: Next step? |
Percutaneous angioplasty |
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Oh in CCU x 24hrs develops mobitz 1 (2nd°type1 wenckebach), BP remains stable. Next step? |
Arrange for a pacemaker |
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Hypertensive emergency |
Uncontrolled BP that is life threatening. 58 w/ aortic dissection BP 180/120 |
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Admit dizziness, heart monitor=afib w/ rvr mngd with beta blocker, 2Decho= left atrial enlargement. Stable now. Management? |
Continuous rate control plus prolonged anticoagulation |
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Syncope after dinner, +loc 1 minute, rpt CP & Sob pt a. Ecg=? |
Mobitz 2 (2nd° type 2) |
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Chest pressure center of chest, 130/70, 76, 98%, asa+nitro ECG= STE II, III, avf |
Acute inferior MI |
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Placing a magnet on a pacemaker does |
Switched the pacemaker in asynchronous mode |
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3days severe heavy CP this am radiating to left shoulder, cp post walk 20 minutes, better with rest, cp at rest this AM. vss. Dx? |
Unstable angina |
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Acute CP x 45min ECG= inferior stemi 2:1 av block, increased jvp, cta lungs, no murmur. Which tx is a NoNo? |
Nitro |
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Appears apprehensive, sudden onset CP radiates to jaw, 205/110, 90, 20,97%. Diastolic murmur r sternal boarder, cxr= widening mediastinum. Next test? |
Ct scan |
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Chf at a picnic- increased SOB, 185/90, 101, 85%, rales, increased JVP & ble edema. Tx? |
Nitroglycerin |
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Dyspnea, palpitations, hypotension, cool/diaphoretic, bilateral crackles, chest pain. ECG narrow complex irregular Rhythm rate 140 s next step? |
Synchronized cardioversion |
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In patient with moderate pretest probability DVT which of the following is not the diagnostic test |
Moderate sensitivity D-dimer |
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What is the order of ECG changes in an MI? |
Hyperacute t-wave, ST segment elevation, Q wave |
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Syncope during basketball systolic ejection murmur left sternal border and Apex ECG left ventricular hypertrophy and left atrial hypertrophy septal Q wave valsalva makes the murmur? |
Louder increased murmur |
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Acep clinical policy on asymptomatic hypertension. Which patient gets labs in the Ed |
Homeless no insurance |
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Decompensated CHF Home Med Lasix 40 what medication should you give? |
60 mg IV Lasix |
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68 pmh mi/chf- is comfortable at rest, walking to the car= increased sob. What is the nyha class of heart failure? |
Class 3 |
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Sudden onset left side CP with mild SOB woke up with persistent pain increased with inspiration 2 weeks ago 7-hour flight with left-sided calf pain and swelling. ECG changes? |
Tachycardia or nonspecific St- T wave changes |
Suspect PE |
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Which is hypertensive urgency |
Hypertensive urgency is defined as severely elevated BP with no evidence of Target organ damage 65 BP 185/120 with minor arm Lac |
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To decrease Shear Force which medication do you give for an aortic dissection |
Esmolol |
Beta blocker |
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Acute onset substernal chest pain sharp radiates to the back increase when laying down better when sitting up. Lungs CTA. friction rub abdomen benign, negative for edema cxr and Echo unremarkable. What is the management? |
NSAIDs and discharge patient home |
Friction rub equals pericarditis |
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Increased sob, recent episode of gout -not able to move x 1 week- left calf pain tachycardia sharp pain with inspiration chest x-ray negative PE suspected. Next Step? |
Hydrate patient and establish diagnosis with CT PE protocol |
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Which is an increase risk factor for DVT |
History of malignancy |
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Which is a lab finding with CHF(advanced hf) |
Hyponatremia |
Delusional |
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Which =s severe fluid overload on chest x-ray |
Bilateral perihilar consolidation |
Kerley B lines are wrong |
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Which of the following is suggestive of critical ischemia of the right foot |
Ankle brachial index less than 0.3 |
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Which of the following diagnosis does the ultrasound support |
Pneumothorax |
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Increased SOB increased work of breathing, excessive use of respiratory muscles, diminished breath sounds bilaterally without adventitious sounds, 97% room air chest x-ray= |
Flattened diaphragm |
Flattened diaphragm |
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Acute SOB PTA 89%ra, cxr negative, systolic ejection murmur O2 and monitor in place, what is the next step? |
ECG |
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History of cystic fibrosis with multiple CT scans increase SOB rule out pneumothorax which rad study has the highest sensitivity and decreased risk factor for patient |
Ultrasound |
Ultrasound is more sensitive and specific for a pneumothorax than chest x-ray |
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Which organism is most common cause of community-acquired bacterial pneumonia |
Streptococcus pneumoniae |
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Which chest x-ray view would reveal a small pleural effusion |
Lateral decubitus left side down |
You want to trap the fluid on the side of the adventitious breath sounds |
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Site for needle decompression of a tension pneumo |
2nd intercostal midclavicular line |
Needle aspiration front of chest |
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Which ECG finding is the most common in pulmonary embolism |
T wave inversions V1 and V3 |
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Which diagnostic tool is neither sensitive nor specific enough to be helpful in evaluation of a pulmonary embolism |
ABG |
It's not spo2 |
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Dull percussion left lower field decreased tactile fremitus decreased breath sounds and no Voice transmission, cxr obtained. what is the next step? |
Thoracentesis |
Sounds like he has a big pleural effusion |
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Fever cough rhonchi right lung chest x-ray right middle lobe infiltrate treatment? |
Outpatient with po azithromycin |
This is a community-acquired pneumonia |
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Severe asthma exacerbation inpatient treatment with albuterol corticosteroids and? |
Magnesium |
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Chest x-ray and Asthma equals true |
Increased heart rate increase respiratory rate and abnormal breath sounds equals increase probability of radiographic abnormality in acute asthma |
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Cough chills pleuritic chest pain barrel-chested few suizas chest x-ray shows left lower lobe infiltrate and a pleural effusion. Best treatment? |
In patient with Ceftriaxone and azithromycin |
This is a cap Complicated by COPD |
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Which physical exam finding diagnosis pneumonia |
None- no physical exam finding can diagnose pneumonia |
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Which of the following patients has the lowest clinical probability of a diagnosis of PE |
39 year old someday smoker status post uncomplicated appy, 2 months ago |
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Patient with a PE patient had hemorrhagic stroke 2 weeks ago what is the best management |
IVC filter |
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Gero asthma post bronchodilator spirometry |
They may show only partial Airway reversibility |
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True or false? Short-acting beta-agonist iprstropium, and inhaled corticosteroids appear to be safe in pregnancy and outweigh the Maternal-Fetal risk of uncontrolled asthma |
That is true |
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NH pt- Diagnosis of pneumonia antibiotic regimen must cover |
Pseudomonas |
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Free flowing pleural effusion left lower lobe pneumonia thoracentesis shows straw-colored fluid with gram positive diplococci and glucose 32, LDH 1890 what is the next step? |
Tube thoracostomy to drain the effusion |
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Early sign of pneumonia in elderly patient |
Altered mental status |
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Cough increased shortness of breath headache x 3 days mild hypertension facial plethora jvd with prominent veins over anterior chest firm hard supraclavicular lymph nodes heart WNL no edema lungs CTA what is the diagnosis? |
Lung cancer |
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4 days shortness of breath cough copious sputum severe COPD fev1 42% acidotic respiratory distress +accessory muscle use + retractions bilateral diffuse wheezes rhonchi chest x-rays negative for infiltrates what is the treatment to decrease mortality |
BiPAP use of non-invasive positive pressure ventilation |
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Which patient has hcap |
76 inpatient gastroenteritis + dehydration 5 Days 1 month ago |
Hcap is healthcare-associated pneumonia |
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Humira tx RA. CC: pneumonia, 1month ago was inpatient for 1 week for ams and UTI which is recommended by ATS/ idas treatment? |
Vanc, cefepime, Levaquin |
Immunocompromised hcap |
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Tall thin acute onset SOB at rest sharp pain on right side chest increased with inspiration. Next step? |
Chest x-ray |
Spontaneous pneumothorax// tall thin |
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Mild SOB respiratory distress subclavicular retractions scattered wheezes bilateral lungs what is the treatment |
Beta-2 Agonist neb treatment |
Asthma? |
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Per 2005 ATS/idsa which is considered an mdro to Target in the treatment of hcap? |
Mrsa |
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Which of the following are four main classes of RX treatment of pulmonary hypertension |
Endothelium receptor antagonist, calcium channel blockers, phosphodiesterase Inhibitors, prostacyclin analogs |
Pah tx= era+ccb+pde5+pa |
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What is a benefit of using digoxin as an adjuvant treatment in pah? |
Digoxin preserves right ventricle contractility decreases circulating catecholamines and increases resting cardiac output |
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Cystic fibrosis referred for lung transplant patient is concerned about long-term outcome which is the main impediment to long-term survival post lung transplant? |
Bronchiolitis obliterans syndrome BOS |
B o s |
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Nephrolithiasis is strongly associated with which haart Med |
Protease inhibitors |
Nephrolithiasis from PIs |
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Hung from right arm right shoulder pain decreased ROM shoulder is swollen w/o deformity or obvious injury positive pulse can wiggle fingers cannot internally rotate shoulder or raise his arm above his head pinprick= paraesthesia lateral deltoid. Dx? |
Anterior shoulder dislocation and axillary nerve impingement |
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Left wrist pain x 1 month fell 3 months ago from ladder landed on outstretched hand no treatment PMS intact tender to palpation at snuff-box diagnosis? |
Avascular necrosis of the scaphoid |
Tenderness at snuffbox equals scaphoid this is not an acute injury |
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What clinical criteria equals gamekeepers thumb? |
30 degree laxity thumb mCP joint with radial stress |
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Correct physical assessment for median nerve in the hand |
Light Touch 2nd fingertip resistance to thumb opposition |
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Which carpal fracture causes median nerve involvement |
Lunate |
L |
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Which of the following statements regarding glenohumeral dislocations is true |
Most common type is anterior dislocation |
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Right hand swelling pain and erythema * 3 days no trauma travel insect bites sick contact or fever. punctuated lacs over third and fourth mCP what is the treatment |
Admit for IV antibiotics |
Is it a fight bite |
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Wrist pain fell onto out stretched hand-swelling of left wrist- AP and lateral view thin radiolucent transverse line across the distal radius without displacement no angulation no deformity diagnosis? |
Non-displaced radial fracture |
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Right elbow pain x 3 weeks baseball season elbow shows full room in flexion extension supination and pronation no pain on varus or valgus stress dorsiflexion of the right hand against resistance immediately equals pain that is localized to the right elbow lateral side what is the diagnosis |
Lateral epicondylitis |
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Abduction of arm and extend the elbow and external rotation this test is called |
Apprehension test |
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A mallet finger is |
Avulsion fracture of extensor tendon of distal phalanx |
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Monteteggia fracture upper 1/3 of ulna |
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Hemodynamically unstable pelvic ring disruption and positive fast exam Best Next Step |
Consider diagnostic peritoneal aspiration to assess for gross blood in the urine emergent surgery consult and immediate transfer to OR for ex lap with pelvic packing |
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Pain &stiffness right knee x 2 weeks post fall while skiing. Felt knee was locking in a semi Flex position and noted popping sensation. on exam there is tenderness over the medial joint line of the knee marked flexion and extension of the knee and increase pain positive mcmurray's what is the diagnosis |
Medial meniscus tear |
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What percentage of patients with posterior hip dislocation will have a sciatic nerve palsy |
10% |
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What is the only absolute contraindication of a closed hip reduction |
Femoral neck fracture |
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Test of choice to detect an occult pelvic and or hip fracture with a negative plain radiograph |
MRI |
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Which of the following is true re femoral neck fracture |
Femoral neck fractures are more common in elderly adults with underlying osteoporosis or osteomalacia |
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Varus pressure on a knee that is slightly Flex tests |
Lateral collateral ligament stability |
LCL |
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What is the time limit for hip reduction to reduce the likelihood of avascular necrosis |
6 hours |
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Football player knee pain direct blow to the lateral aspect of his knee RADS are negative for fracture positive effusion physical exam confirms Hemi arthrosis joint instability with valgus stress in 30 degrees of flexion injury |
Rupture of the median collateral ligament |
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To accurately assess a low back injury you must know |
The mechanism of injury |
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MVC right leg is shortened and internally rotated and abducted what is the diagnosis |
Posterior dislocation of the hip |
This happens when a leg is in flexion such as sitting in the car seat the knee hits the dash and pops out of the hip if it is turned in and shortened it's posterior |
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Which exam finding is true |
The cross straight leg exam is specific but not sensitive |
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Which physical exam finding might be found in a right s1nerve root compression |
Loss of right ankle flexion |
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An emergent MRI is indicated |
In a patient with back pain that dribbles urine |
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Soccer player right knee pain and swelling states that earlier in the day he was in a soccer match and was running the ball but stopped abruptly to try and run a new Direction immediate intense knee pain in knee with instant swelling most reliable test |
Lachmann test |
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All of the following except or characteristic of an acute fracture |
Fracture fragments are smooth and corticated |
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Pain L2 through L5 with full range of motion post flag football without injury what is the treatment |
Anti-inflammatory and muscle relaxant |
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Posterior ankle pain sudden onset while playing volleyball positive Thompson test what is the diagnosis |
Achilles tendon rupture |
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Fell off ladder bilateral feet and then down swelling tenderness and ecchymosis to right hind foot what else is true about this injury |
10% associated with compression fracture of the dorsolumbar spine |
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Pain near the malleolus and what indicates need for RADS per the Ottawa ankle rules? |
Bony tenderness at the navicular OR at the base of the 5th metatarsal |
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Hx of lung cancer sudden onset lumbar spine pain x 24hrs. What test differentiates lumbar disc herniation from cauda equine syndrome |
Pain radiating to one buttock |
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Flexion abduction and external rotation with limb discrepancy is seen in what injury |
Anterior dislocation of hip |
Anterior hip dislocation is limb shortening flexed and rotated out |
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Fast exam positive for free fluid in Morrison pouch in unstabilized pelvic trauma what is the cause |
A fast exam cannot determine the source only the presence |
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How much free fluid might collect in the retroperitoneum before it leaks into the intra-abdominal abdominal cavity |
400 to 600 ml |
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How do you stabilize a suspected pelvic ring disruption |
Pelvic compression binder |
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MVC 2 weeks ago has increased headache and decreased level of Consciousness what is the most likely diagnosis |
Subdural hematoma |
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Female history of mg diagnosed with a UTI started on antibiotics patient now has increased weakness able to move arms and legs but difficulty raising head off bed negative inspiratory Force is -17 fvc is 1.2 L she Sob and somewhat somnolent but doesn't seem in severe distress what is your next step |
Strongly consider intubation and review of her meds |
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Low back pain numbness weakness of legs urinary retention MRI of the entire spine shows epidural spinal cord compression at T6 from a metastatic lesion in the epidural space best immediate step |
Administer 100 mg IV dexamethasone |
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Status post subarachnoid hemorrhage patient develops neck stiffness and photophobia this is followed by left-sided weakness and hyperreflexia left plantar response is up going. Md presumes that these effects are related to the sah what is the treatment |
Nimodipine |
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Routine serologic testing in TIA should include all of the following except |
D-dimer |
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What type of headache typically presents with signs and symptoms of severe frequent headaches injected sclera and rhinorrhea |
Cluster |
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What vascular image modality is most sensitive aortic dissection |
CT angiography |
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MVC found next to his vehicle after hitting a tree bystanders state that the man got out of his vehicle after Collision within a few minutes Ms subsequently found the man on the side of the road in the ED his vitals are stable his right pupil is fixed and dilated his head CT shows |
Epidural hematoma |
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Obese daily headache increase with straining during BM and in the a.m. after waking up she also reports tinnitus in her right ear headache without Aura transient blurred vision in the right eye binocular Double Vision on right word gaze with slight limitation of abduction of the right eye visual fields are normal on bedside confrontation testing optic disc have normal appearance neuro exams normal diagnosis |
Idiopathic intracranial hypertension |
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metastatic lesions to the brain most often appear in which location |
At the grey white Junction |
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Primary use of data gathered from multimodal CT scanning in emergent management of a stroke |
Differentiate between ischemic core and penumbra tissue |
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3 weeks post URI increased weakness of the legs over several days, no motor reflexes, 2 days oBS, weakness ascending, he begins to notice increased weakness of hands mild tingling, sensory continue to be normal. workup shows? |
CSF increase high protein |
Guillain Barre |
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New-onset witness 2 minute seizure generalized tonic-clonic no history of infection or other illness or head trauma no pain vital signs stable mental status /cranial nerve/ sensation normal/ labs WNL diagnosis |
Tumor |
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Several month history of bilateral upper and bilateral lower extremity weakness on exam in addition to weakness of several muscle groups he demonstrates atrophy hyperreflexia spasticity of the legs bilateral Babinski sign fasciculations and multiple muscles are also noted his pain and sensation Temp and joint position are intact. Diagnosis? |
Amyotrophic lateral sclerosis |
With ALS sensation is intact With Guillain-Barre a sensation is lost |
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Found unresponsive is shaking able to get him to open his eyes briefly began speaking nonsense and fell back asleep a febrile what should not be done immediately upon arrival to the Ed |
An LP for CSF |
Never do an LP before a CT scan |
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Sudden onset dysarthria left facial weakness left hemiparesis 4 hours post onset BP is 210/100, 2 days status post skin biopsy what's your next step |
Administer labetalol until BP is less than 185 / 110 treated with IV TPA at 0.9 Mg per kg |
This has to be under control in order to give TPA |
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Increase weakness muscle in legs and cramping weakness bue increase difficulty removing Lids from jars and neck stiffness no back pain injury bowel or bladder incontinence. Physical exam atrophy of interosseous muscles decreased strength in hands and feet decrease range of motion in the C spine reflexes are hyperactive and upper extremities sustained clonus in the ankles The Next Step? |
MRI of the C spine |
This is cervical spondylosis you need to focus on decreased strength in the upper extremities next this and her pertinent negatives |
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Hyper-dense artery sign on a non-con CT of the head in an acute ischemic stroke |
An active thrombus |
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The teardrop fracture |
Involves disruption of all three spinal columns |
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The most appropriate term to use when describing an impact to the head that causes an episode of vomiting headache and a GCSE of 15 is |
Mild TBI |
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Weakness of the arms and legs suspected ALS which diagnostic study is critical to diagnosis |
EMG ncv |
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Lateral View CT |
Hangman's fracture |
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What is type of injury is a Jefferson fracture |
Axial loading |
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Best image to diagnose of Jefferson's fracture |
Open mouth odontoid |
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Football tackle of football player reports being knocked backwards hard and the burning sensation and weakness to his arms is neurological deficit of the upper extremities is more pronounced than the lower extremities with scattered sensory losses diagnosis |
Anterior cord |
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Which is not part of the parallel lines of the cervical vertebrae alignment |
Facet line |
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When reviewing the odontoid open mouth you suspect fracture if |
There is a sideways slippage of the atlas and axis |
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Which is true regarding use of anticoagulation in management of cerebral venous sinus thrombosis |
Treatment of cvst with anticoagulation is safe even in the face of hemorrhagic venous infarction |
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I see you unconscious on public bathroom he was awake upon arrival to Ed labs and head CT normal ICU nonverbal but follows commands then he turned suddenly becomes unresponsive bilateral tonic-clonic extension of the trunk Limbs and muscle jerking intervention |
Lorazepam formula mg IV |
He's having a seizure |
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The above patient continues to have seizures post initial intervention what is the next treatment |
Phenytoin 18 mg per kg IV |
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Severe sudden onset headache and vomiting CT shows sah most common cause? |
Aneurysmal rupture |
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The most reliable method for distinguishing between sah and traumatic spinal tap is the presence of |
Xanthochromia |
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Patient on Warfarin Falls while in hospital difficult to arouse new right hemiparesis and intracranial hemorrhage is suspected best initial rad |
Head CT non-con |
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The most sensitive brain image for detecting cytotoxic edema formation in early ischemia is |
Diffusion-weighted MRI |
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Progressive weakness of extremities over one week further Evolution and arms face and chest eventually she is intubated and sent to the ICU nerve and EMG widespread demyelination which treatment speeds recovery |
Plasma exchange or IVIG |
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Deficit of what component of the GCS have the strongest correlation with poor outcomes and a patient with a TBI |
Best motor response |
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Which signs and symptoms tend to be predictive of Tia |
Loss of sensation |
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High speed MVC bruises on the head and comatose head ct - for focal lesion what is the likely diagnosis |
Diffuse axonal injury |
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Physical exam withdraws from noxious stimuli only right pupil 10mm unresponsive to light left people 5mm reactive which is contraindicated |
LP |
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Right arm weakness * 90 minutes pmh hypertension and long smoking history BP 215 / 118 physical exam anxious mildly aphasic 2/5 decreased sensation right upper extremity CT head within normal limits 2 hours post on set which is the most appropriate Next Step |
Labetalol IV push BP should be less than 185 / 110 |
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Severe TBI with fixed and dilated pupils flexion posturing what is the target etco2 post appropriate ventilatory management |
30 mm HG |
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Early goal-directed therapy for management of severe sepsis or septic shock involves maximizing preload afterload and contractility to balance O2 delivery with demand for 6 hours of resuscitation for sepsis induced hypoperfusion which represents Target numbers |
Scvo2 greater than 70% map greater than 65 |
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Urosepsis ICU status post 12-hour 6L IVF and levo drip SBP greater than 90 a c vent 12/8 peep 5/ fio2 50 O2 sat decrease to 90% even with increased fio2 80 -abg's shows respiratory acidosis and pulmonary pressure Peak Under Pressure to 40 what do you do |
Decreased tidal volume to six ml/kg minute ventilation |
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Which is the most rapid accurate easily reversible means of assessing a patient's fluid responsiveness |
Passive leg raise with cardiac output monitor |
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Which hemodynamic profile is most consistent with hemorrhagic shock |
Svo2 38% CVP 1 mmhg and cardiac index 1.2 |
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Massive GI bleed transfusion truth |
Use of crystalloid should be ideally restricted to the initial phase of resuscitation |
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Antibiotics in the setting of a GI bleed in cirrhotic patients decreases what |
Spontaneous bacterial peritonitis |
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Which of the following two principles are the basis for formal logical treatment of ards |
Decrease pulmonary edema and reversing O2 exchange issues |
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What is the major factor in the development of stress-related mucosal disease in the ICU |
S p l a n c h i n i c hypoperfusion |
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Kleihauer bet ke test is for |
Rh factor of mother |
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What are two strong independent risk factors for stress-related mucosal bleeding |
Mechanical ventilation and coagulopathy |
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Post fluid resuscitation a septic patient has a CVP of nine a map of 60 hct of 26 in an scvo2 of 65 antibiotics plus what treatment is expected |
Norepinephrine and prbc transfuse to HCT of 30% |
If the h c t is 26 then the hemoglobin is less than 7 and you have to transfuse |
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4 hours Post in fusion of two units ffp patient is short of breath febrile tachycardic hypotensive and 86% on 100% non rebreather abg's show he's acidotic what is the treatment |
Need for intubation and mechanical ventilation |
This is trali |
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Which is contraindicated for the tips for esophageal varices |
Right heart failure and severe hepatic encephalopathy |
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In regard to the stabilization in monitoring a patient with massive upper GI bleed which is true |
Continuous heart and pulse monitoring are required |
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Which of the following emerging treatments for ards shows a pivotal role regarding repairing lung injury |
Keratinocyte growth factor |
Kgf |
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disadvantage of propofol is |
Dose related hypotension |
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Which of the statements best describes Berlin definition of ards |
Acute development of bilateral infiltrates on chest x-ray and atrial wedge pressure less than 18 with no evidence of heart failure |
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Cerebral perfusion pressure level associated with cerebral ischemia |
25 to 50 |
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Alteration in ABG related to lower temperatures |
The partial pressure values will be falsely elevated by 5 for every 1 degree below 37 |
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Which Med mitigate or terminate the shiver response |
Magnesium propofol Fentanyl and meperidine |
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Ketoconazol May benefit ards |
Ketoconazole is beneficial related to anti-inflammatory properties |
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Chronic epigastric pain PUD to the e d with four hours severe diffuse abdominal pain emesis with intermittent streaks of blood denies bloody stool mild to stress evidence of peritonitis guarding and rigidity what is the test to diagnose this |
Abdominal CT |
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Etco2 of less than 10 during Cardiac Arrest is |
Predictive of a very low likelihood of rosc when measured during CPR 20 minutes into code |
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Airway assessment most likely to be accomplished in an unresponsive patient or uncooperative patient |
Thyromental distance |
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Assessment data for a patient with traumatic brain injury include ICP of 15 which will likely improve the CPP |
250 ml of physiologic saline |
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Neuromuscular Block in RSI |
Relaxation of vocal cord muscles |
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Which vent parameters measure the amount of dynamic hyperinflation |
Total peep flow in expiratory hold maneuver |
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Pressure control ventilation decrease in compliance will trigger |
High pressure alarm |
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High Pap and high Pplat is associated with |
Pneumothorax |
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Which of the following clinical scenarios best describes propofol related to infusion syndrome |
Renal failure acidosis hypertriglyceridemia and rabdomiolisis |
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Pplat best represents which |
Alveolar pressure at the end of inspiration |
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Which score equals light sedation Rass |
0 and -2 |
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What is a potential side effect of versed |
Dose-dependent hypotension |
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Adverse effect of precedex |
Bradycardia |
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Which of the following drugs is first in RSI |
Sedation ketamine |
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Patient with hypoxic respiratory failure RTS how to improve patient O2 saturation |
Increase the peak end expiratory pressure |
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Patient with sickle cell disease painful crisis are associated with decrease in hemoglobin |
Is false |
Cell crisis equal sickle-cell Clump cells not from anemia |
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Patient with vaso-occlusive crisis what is the treatment to prevent ACS |
Incentive spirometry |
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Lab test that can be used to objectively determine if a patient has a truly painful episode with sickle cell disease |
There is no reliable test to ID painful episodes |
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Which of the following best characterizes sickle cell trait |
Hematuria is one of the most common complaints |
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Retic counts should be obtained during initial evaluation of sickle cell disease to |
Diagnose aplastic crisis |
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Most common cause of acute chest ACS in adults with sickle cell disease |
Infection |
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Patient with antiphospholipid syndrome what is the treatment |
Plasmapheresis aspirin Warfarin heparin |
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A restrictive transfusion strategy |
Employees a hemoglobin threshold of less than 6 to 8 |
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Macrocytic normochromic is diagnosed in older male patient what is the next step |
Vitamin B12 and RBC folate levels |
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Stable and unstable should have the same hemoglobin thresholds |
It's false they're not the same |
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Erythropoiesis stimulation agent FDA approved for perioperative treatment of anemia |
Epoetin Alpha |
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Male with iron deficiency anemia would have the following |
Hematocrit 22 serum iron 18 MCV 70 increase transferrin decrease ferritin |
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Female who is recovering from mycoplasma pneumoniae with increased weakness hemoglobin of 9 and MCV of 110 test for hemolytic anemia |
Reticulocyte count in blood smear |
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Which test is increased in iron deficiency anemia |
Tibc total iron binding capacity |
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Howell Jolly bodies are expected in adults with |
Sickle cell anemia |
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Anemia of chronic disease lab results |
Decrease iron decrease total iron binding capacity increase serum ferritin |
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Most likely to be given to patients with sickle cell |
Folate |
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A a female with SLE with acute onset lethargy and jaundice and splenomegaly what does the blood smear look like |
spherocytes |
Balls |
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Thrombocytopenia with microangiopathy hemolytic anemia febrile confused increase creatinine increase LDH what's the diagnosis |
TTP |
The Terrible pentad |
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Chief complaint of constipation anemia with out upper GI complaints no GI history labs are hemoglobin 10mm cv72 serum iron for tibc for 50 saturation 1% ferritin 10 next best step |
The colonoscopy |
A 55 year old man with constipation and anemia probably has rectal or colon cancer |
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Treatment for ITP is |
IVIG |
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Diagnosis associated with reuleaux formations |
Multiple myeloma |
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I see you sepsis 103° WBC 4006 10% bands 15% what is the absolute neutrophil count |
1 or 1000 mm |
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Hodgkin's disease is confirmed by |
The presence of reed-sternberg cells in lymph node tissue |
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Diagnosis criteria for multiple myeloma include all except |
Hypocalcemia |
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52 year old early satiety and fatigue * 5 months no significant history no other complaints palpable spleen elevated platelets elevated WBC shows Philadelphia chromosomes |
Chronic myelogenous leukemia |
CML middle-aged adult Philadelphia chromosome high platelet count high white count |
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First line treatment tumor lysis syndrome |
IV normal saline |
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Chief complaint 50 year female vague pain , constipation, sense of fullness in lower abdomen the abdomen is non-tender but there is Shifting dullness to percussion Next Step |
Pelvic exam |
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68 year old diagnosed with acute leukemia and is undergoing induction of chemo last cycle develop neutropenia with an absolute neutrophil count of 350 which has resolved appropriate treatment |
Use granulocyte colony-stimulating Factor prophylactically |
G-csf |
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Diabetic bronze skin cirrhosis of the liver presents with right upper quadrant pain serum elk Foss elevated 15 pound weight loss what's the next step |
Obtain alpha-fetoprotein level and CT scan to rule out hepatoma |
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66 female chronic lymphocytic leukemia with a stable white count of 6270 she is in patient with pneumococcal pneumonia third time within 12 months lab finding is most likely |
Hypogammaglobulinemia |
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43cc fatigue night sweats and itching x 2 months pe shows diffuse non tender lymph node adenopathy including some super clavicular at Patrol clear and scalene nodes CBC and cam within normal limits chest x-ray positive for hilar lymphadenopathy what is the next step |
Excisional lymph node biopsy |
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60 year old male no sxs is found to have leukocytosis on pre-op CBC p e n palpable spleen tip 2 cm below the costal margin rubbery lymph nodes up to 1.5 cm in size axillary and inguinal hemoglobin is 13.3 leukocytes 40,000 platelets is238 smear small lymphocytes and smudge cells what's the diagnosis |
Chronic lymphocytic leukemia |
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69 male weight loss back pain 2 months hyperglycemia with a fasting glucose of 153 without nocturia decrease appetite mild constipation back pain is constant physical exam he is pale no scleral icterus Labs mild normal anemia lfts and renal within normal limits diagnostic study |
CT scan of abdomen with IV contrast |
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Test ordered on all febrile neutropenia patients in the e d |
What are blood cultures |
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Which of the following patients is most at risk for multiple myeloma |
BJ 62 year old male farmer who uses pesticides and herbicides |
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Auer rods may be found in patients with |
AML acute myelogenous leukemia |
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Which of the following is an acceptable empiric antibiotic regimen for neutropenic patient with fever and high-risk features |
Cefepime |
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Tumor lysis is associated with all of the following except |
Hypercalcemia |
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Which neutropenic fever plus Vancomycin to empiric treatment |
Patient with erythema noted around mediport |
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12 lead ECG |
No stemi incomplete right bundle branch pattern |
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A L L |
Increase lymphocytes immature average age 10 + tat Tx: a r a - c cytarabine |
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CML |
Increase neutrophils age 40ish Philadelphia chromosome treatment inmatinab |
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AML |
Increase neutrophil 50ish immature Auer rods myeloperoxidase aTra vitamin A |
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CLL |
Lymphocytes Mature 80ish No treatment |
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