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139 Cards in this Set
- Front
- Back
When should you vaccinate a pregnant woman against MMR?
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Immediately after delivery
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Minimum age to vaccinate against influenza?
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6 months
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What is the maximum recommended age for HPV vaccine?
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26+
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When should you start screening a chronic smoker for lung cancer by CT or CXR?
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Never
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At what age should routine mammograms be recommended?
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50
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What cardiac evalulation should be done for an obese type 2 DM prior to invasive surgery?
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Noninvasive stress test
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What antibiotic should be used for prophylaxis against traveler's diarrhea?
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NONE
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What should you recommend to a woman who has elevated BP secondary to OCP?
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Switch to barrier method
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What is your recommendation to a woman who missed an OCP pill and had sex in the past 5 days vs greater than 5 days ago?
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Less than 5 days: emergency contraception; greater: double pill
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Best way to motivate someone to stop smoking?
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Provide evidence of positive results of stopping
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What should a physician do when treatment is futile?
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Stop treatment, let patient die
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What drug is great at relieving dyspnea?
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Opiates
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How should you treat fatigue in a person with end stage cancer?
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Methylphenidate
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What is a reliable sign that death is imminent in a terminal patient?
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Decreased communication
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What medication is good for treating a death rattle?
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Atropine
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Guideline for alcohol intake in men, women, and elderly?
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Mne: 14 per week, no more than 4 per occasion; women: 7 per week, no more than 3 per occasion; elderly: 1 per day
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What quality of pain is most likely to suggest a need for emergent evaluation?
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Rapid onset
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What are alarm symptoms that indicate upper endoscopy?
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Dysphagia, odynophagia, weight loss, bleeding, vomiting
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What is the initial test for cholecystitits? Choledocholithiasis?
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Ultrasound; ERCP
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Is alcohol abuse or gallstones the most common cause of pancreatitis?
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Gallstones
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Patient has atypical squamous cells of undetermined significance and a positive HPV; next step of management?
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Colposcopy
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What is the treatment for early Lyme? Late lyme?
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Doxycycline 14-21 days; ceftriaxone IV 2-3 weeks
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What bug tends to have a distribution located at waist, on wrists, and in between fingers?
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Scabies
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What is the likely distribution of flea bites vs bedbugs?
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Fleas: clusters of 3 on legs; bedbugs: upper body
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Deep cat bite to hand; management?
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Hospitalization
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How do you differentiate a fibroadenoma from fibrocystic change?
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Adenoma is painless; fibrocystic painful on palpation
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Solid nonmobile breast mass with a negative mammogram; management?
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Ultrasound and biopsy
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What ECG feature is most suggestive of acute MI?
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ST elevation > 1 mm
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Best laxative to use for chronic constipation?
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Psyllium (bulk forming)
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Best laxative to use for acute constipation?
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Bisacodyl (motility)
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Most common cause of chronic cough in nonsmokers? Smokers?
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Postnasal drip from allergic rhinitis ; chronic bronchitis
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Best treatment for postbronchitis cough?
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Oral steroid taper
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What is the Dix-Hallpike manuever used to determine? What are the two result types?
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Central vs peripheral vertigo cause (stroke vs bpv); if nystagmus is immediate and change in direction with mild sx it is STROKE, if nystagmus is delayed onest by 3-10 seconds with same directiona nd severe symptoms it's peripehral (BPV)
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Most likely dx in a woman with back pain, urinary frequency, hematuria, dysuria, no fever?
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Acute bacterial cystitis
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When do you nee dto do a urine culture in simple cystitis?
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When dipstick is negative
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Woman has recurrent UTIs after sex; tx?
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Single dose antibiotic after sex
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Acute onset urinary frequency, urgency, moderate bnack pain in a male; febrile and acutiely illw ith no penile discharge; dx?
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Acute prostatitis
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Initial treatment for TMJ?
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NSAIDs
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What are common medications that cause peripheral edema?
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NSAIDs, beta blockers, CCBs
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Bilateral edema in patient with noraml heart and liver; dx?
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Nephrotic syndroem; do urinalysis
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23 y/o woman presents with fatigue, lack of energy/tiredness but no hypersomnolence or weakness; dx?
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Depression
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How do you treat external vs internal hemrrhoids?
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Internal: banding; external: excision
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What antidepressant can be used for migraine prophylaxis?
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TCA
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What drug is used for cluster headache prophylaxis?
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CCBs
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Bilateral headache that lasts several days, pressure around forehead, not sensitive to sound; dx? Tx?
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Tension headache; NSAID
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Painless hematuria in an adult; dx?
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Bladder cancer
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Best drug for middle of the night insomnia?
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Zaleplon
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Asymptomatic bacturia in elderly woman; management?
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Do nothing
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Urge to void folowed by involuntary los sof urine; dx?
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Urge incontinence (common in elderly)
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Treatrment of choice for urge incontinence?
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Oxybutynin (anticholinergic)
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Treatment of choice for stress incontinence?
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Muscle strengthing; alpha agonsits (pseudoephedrine)
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What antihypertensive medication causes urinary urgency? Just leakage?
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Urgency = beta blockers; leakage = alpha blockers
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When should you do MRCP?
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Choledocholithiasis with negative ultrasound
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14 y/o female with no seondary sexual development; dx?
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Gonadal dysgenesis
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Female with elevated DHEA and testosterone; next step in management?
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Ultrasound of ovaries, CT of adrenals
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Hyperalert confusion is a withdrawal symptom from what drug?
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Alcohol
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Should you do a CT or MRI for a spinal disc herniation?
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MRI
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When should you get a C-spine radiography?
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After any major MVA, regardless of symptoms
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Neck compression test (pt turns head toward side of pain while tester exerts downward pressure) that displays only discomfort; dx?
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Mechanical neck pain
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What is Spurling test produces sx in uppe rextremity?
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Nerve root injury
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What differentiates PSVT from Afib?
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Rapid and regular vs rapid and irregular rates
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32 y/o woman with skipped heart beats and normal ECG; next step in management?
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Reassurance
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What imaginag test is most sensitive for endometriosis?
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MRI > ultrasound
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Patient has recurrent pharynigits and positive strep test; thought to be colonized; but is currently assymptomatic; tx?
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Do nothing, carrier state doesn't have need for treatment
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Four features of strep pharyngitis screen?
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Tonsillar exudates, anterior cervical LAD, lack of cough, fever
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Most common cause of epididymitis in a sexually active young adult? Monogomous older adult?
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C. trach vs gram negatives (enterobacter)
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Does not washing your face aggravate acne?
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No
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Treatment of mild acne? Moderate acne? Severe acne?
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Mild: antibiotics, benzoyl, retiniods (all topical); moderate: oral antibiotics, topical retinoids/benz; severe: oral isotretinoin
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What medication should be discontinued when a patient starts isotretinoin? Why?
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Tetracyclines; both cause pseudotumor cerebri
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Best treatment for severe rosacea?
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Oral antibiotics
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How do you differentiate a keratoacanthoma from basal cell carcinoma?
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Keratoacanthoma occurs over weeks, basal cell is very slow growing
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Best treatment for localized psoriasis? Generalized psoriasis?
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Local: topical steroids; systemic: methotrexate/retinoids
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Most common cause of impetigo in a child?
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S. aureus > GAS
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Treatment of hot tub folliculitis?
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Reassurance and follow up; self limited
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Pt with bacterial conjunctivitis fails topical cipro treatment; next step?'
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Oral TMP-SMX for MRSA
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A cyclist presents with lateral knee pain; dx?
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Illeotibial band syndrome
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Pt has twisting injury of knee, a pop, and immediate effusion but can still bear weight; dx?
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ACL tear
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When should you get an X-ray for an ankle sprain?
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Patient unable to walk, tenderness over malleoli and tibi/afibula, tenderness over 5th metertasral; midfoot tenderness
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Best initial test for a patient with syncope?
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ECG
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When should you do a tilt table test in syncope workup?
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Negative ECG, 24 hour holter mointoring
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What is the only Parkinson's drug that delays progression rather than provide purely symptomatic relief?
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Selegiline
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Most common cause of rhinorrhea, low grade fever, and wheezing in an infant?
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Viral URI
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Patient has first episode of wheezing; best initial test?
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CXR
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Most sensitive and specific tests for alcohol abuse?
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Sensitive: GGT: specific: mcv
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22 y/o man has low back pain, no traumatic event, no pain w/ movement, no radiation; dx?
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Spondylolithesis
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Person with seizure disorder and unstable angina wants to quit smoking; best therapy?
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Varencicline (buprpropion contraindicated for seizures, nicotine patch contraindicated for unstable angia)
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Pt has asthma symptoms 4 times a week; what type of asthma is this?
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Mild
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Most common cause of back pain in patients younger than 26?
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Spondylolisthesis
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Before going to opiods, what should you add to NSAIDs for chronic low back pain?
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TCAs
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Best test to detect renal insufficiency?
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Lower GFR
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First sign of chronic renal failure?
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Anemia
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Patient is having pain despite long acting opiods; next step?
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Don't increase dose, switch to new opiod
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First like treatment of CHF
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are ACE inhibitors
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What is the effect of donepezil on the progression of Alzheimer's?
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no effect
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What is the lowest blood pressure at which ACE-I can be used w/ diabetics?
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100
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Does exercise or weight loss have a greater effect on HDL levels?
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Exercise
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What is post exposure prophylaxis for HIV need stick?
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At least 2 drugs + immediate testing for HIV antibodies
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How often should women with HIV be screened w/ PAP smears?
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Every 6 months
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What is the initial therapy for a patient with stage I vs II HTN?
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I: HCTZ; I: two drug therapy (HCTZ + ACE)
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Patient has newly diagnosed HTN, best next test to perform?
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ECG
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What diuretic combination lowers stroke risk?
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ACE + HCTZ
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What osteporosis tx has anaglesic effects/
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Calcitonin
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Drug of choice for PTSD?
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SSRIs
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What blood tests should be done before DX of ADHD?
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TSH, serum lead, blood chemistry
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What are the two most common sx of hyperthyroidism?
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Tachycardia, fatigue
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Safest stimulatant laxative?
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Senna
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Chlorine resistant organisms?
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Cryptosporidium, Giardia, entamoeba
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20 year old w/ fatigue, weightloss, fever, diarrhea for 2 months, palpable RLQ mass; dx?
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Croh'ns disease
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22 year old female, weight loss, mild abdominal pain, significant diarrhea of 2months duration; anemia; dx?
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Celiac disease
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Common non-gastric presentations of Celiac disease?
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Anemia, osteporosis
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Most likely complication after gastric bypass surgery?
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Iron and B12 deficeincy
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Painful vesicular rash in a wrestler; dx?
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Herpes gladitorum
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What's the difference between urge and stress incontinence?
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Stress: due to positional movement/cough/sneeze; urge: lack of desire to urinate, become distended
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Woman with temperature instability 24 hours after treatment for pyelo; what do you do?
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Continue current treatment until 72 hours; then check for obstruction/abscess
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Female w/ dysuria nad pyuria in presence of negative culture for uropathegens; dx? Tx?
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Urethral syndrome due to chlamydia/ureaplasm; tx w/ doxycycline/levofloxacin
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Elevated LDL levels are associated with what thyroid condition?
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Hypothyroidism
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What antidiabetic medication is contraindicated w/ gastroparesis?
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Exenatide
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When should women be screened for gestational diabetes?
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24-28 weeks
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What should you do with hypothyroidism associated with infection/major surgery?
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Monitor; follow up after recovery (likely not true hypothyroid)
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What are indications for cardiac resynchronization therapy with CHF?
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At maximum medical therapy with ejection fraction <30%, LV ED diameter > 55, QRS > 130 msec
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What is the benefit of omega-3 fat?
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Decreased sudden cardiac death
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Gudeline for screening abdominal aortic aneurysms?
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Male 65-75 who have ever smoked
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What anticoagulant should have dosage reduction w/ renal failure?
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Enoxaparin
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What does new onset LBBB indicate?
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LAD occlusion; indication for thrombolytic therapy
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Recent MI with new onset LBBB
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Thrombolytic therapy (LAD occlusion)
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Significant predictor of peri/intraoperative arrhythmia?
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CHF, vetnricular ectopy, hx of smoking
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At what size do you operate on AAA?
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5.5 cm
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Contraindications for beta blockers in heart failure?
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Hemodynamic instability, heart block, bradycardia, and severe asthma
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What drug is contraindicated with cocaine induced arrhythmias?
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Beta blockers (exacerbate vasoconstriction)
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What condition is contraindicated w/ cilostazol?
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CHF
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Presentation of a periplymphatic fistula; cause?
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Vertigo not associated w/ nausea, vomiting, or positional changes that is aggravated by sneezing/coughing; caused by barotrauma (scuba diving)
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Discrete, round, yellow-white despits in the retina; dx?
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Macular degeneration
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Leading cause of blindness over age 65?
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Age-related macular degeneraiton
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Tarsal coalition
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is the fusion of two or more tarsal bones. It occurs in mid-to late adolescence and is bilateral in 50% of those affected. Pain occurs around the ankle, and there is decreased range of motion of the hindfoot and pain on foot inversion on examination.
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Os trigonum
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Results from non-ossification of cartilage. It usually is unilateral and causes palpable tenderness of the heel.
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Sever’s apophysitis
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is inflammation of the calcaneal apophysis, and causes pain in the heel.
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Plantar fasciitis
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causes tenderness over the anteromedial heel.
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Navicular stress fractures
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are tender over the dorsomedial navicular.
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What can aggravate the pain of lumbar spinal stenosis?
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Walking downhill, spine extension
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