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158 Cards in this Set
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- 3rd side (hint)
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these three suggest post nasal drip:
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patient's recent upper respiratory infection, nasal exudate, and cobblestoning in the posterior pharynx
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tx for postnasal drip
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antihistamine/decongestant
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Three ways to diagnose diabetes
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symptoms of diabetes plus a casual plasma glucose concentration of 200 mg/dL or greater; a 2-hour plasma glucose concentration of 200 mg/dL or greater during an oral glucose tolerance test; and a fasting plasma glucose concentration of 126 mg/dL or greater
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use of Fructosamine in DM
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used to monitor glycemic control. It provides assessment of glycemic control over 3 weeks.
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The infection begins with pustules on a red base that become eroded and confluent. Eventually, the rash evolves into a sharply demarcated, bright red patch (or patches), with small, pustular lesions at the periphery (satellite lesions).
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Cutaneous candidiasis
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Tinea cruris
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subacute and chronic dermatophyte infection of the skin, involving the groin, pubic region, and inner thighs. Most patients who have tinea cruris also have tinea pedis. The condition is recognized as light pink to red papules and thin plaques, with scaling borders. The lesion has an “active border,” meaning that the border has more redness and scaling than the inner portion of the lesion, which may have central clearing.
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ill defined (lack a distinct border), yellowish-red, and are of varying size, and are usually associated with a greasy or dandruff-like scale. It most commonly occurs on the scalp, central face, upper mid-chest, and other oily areas of the body.
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seborrheic dermatitis
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test for cushings dx
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24-hour urinary free cortisol measurement
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rhinitis medicamentosa
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Chronic use of a topical nasal decongestant (for example, oxymetazoline) will result in rebound swelling after the vasoconstriction wears off. This condition can occur after 3 to 4 days of use.
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presentation of rapidly progressive glomerulonephritis
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glomerulonephritis with nephritic urine sediment, acute renal failure developing over a few days to weeks, and glomerular crescents on renal biopsy
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ST segment elevation in leads V2, V3, I, and aVL
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Anterior myocardial infarction
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ST segment elevation in leads I, VL, V5, and V6
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lateral infarction
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Pericarditis can be distinguished from acute infarction by
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the absence of Q waves, the concave and upward slope of the ST segments (infarction is associated with convex upward slope), and the absence of ST segment depression in reciprocal leads.
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ST segment depression and prominent R waves in the anterior precordial leads (V1 through V3).
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posterior MI
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None
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Pericarditis is characterized by
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an elevation of ST segments, with upward concavity in many leads, including standard limb leads. The T wave remains upright at first, except in lead III, where it may be inverted. Later, there is widespread T wave inversion, but by this time, the ST segments have returned to baseline.
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new onset of dyspepsia symptoms after age 50 w/u
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upper endoscopy
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maltese cross on urianalysis
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fat droplet, assoc with nephrotic range proteinuria
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Urinary eosinophils assoc with
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acute interstitial nephritis, rapidly progressive glomerulonephritis, and renal atheroemboli.
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pneumobilia
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air in billiary tract
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The ability to probe a diabetic foot ulcer directly to bone is correlated with
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osteo
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tx for c dif
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metronidazole or oral vancomycin.
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? For diagnosis and control bleeding in a patient with rapid lower gastrointestinal bleeding
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arteriography
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worst prognosis melanomas
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located on the palms and soles
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better prognosis melanomas
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extremities compared with the trunk or face
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Risk factors for drug-resistant S. pneumoniae
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include age greater than 65 years, use of β-lactam antibiotics within the past 3 months, immunosuppression, multiple medical comorbidities, and regular exposure to a child in day care
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Risk factors for enteric gram-negative organisms (lung)
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all of those for S. pneumoniae listed earlier, as well as regular alcohol consumption and residence in a nursing home
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Risk factors for P. aeruginosa
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include bronchiectasis, daily corticosteroid therapy, recent broad-spectrum antibiotic therapy, and severe malnutrition.
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Risk factors for Aspergillus pneumonia
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include prolonged neutropenia or other significant immunosuppression, including human immunodeficiency virus infection.
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Risk factors for anaerobic infections (lung)
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significant witnessed or suspected aspiration
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met prostate cancer tx
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androgen ablation, if/when symptomatic
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single most helpful distinguishing characteristic of tinea corporis
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its peripheral expansion with central clearing, producing an annular lesion.
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when to start statins
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Intervention should be pursued for a serum LDL cholesterol level greater than 160 mg/dL, with medication recommended if the level is greater than 190 mg/dL and optional if the level is between 160 and 189 mg/dL
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symptoms warranting upper endoscopy in dyspepsia
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anemia, weight loss, anorexia, recurrent vomiting, dysphagia, and gastrointestinal bleeding.
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who's considered for endocarditis prophylaxis
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Persons with Doppler-demonstrated mitral regurgitation or an audible murmur of mitral regurgitation are considered to be at moderate risk for endocarditis and are candidates for dental prophylaxis, although mitral valve prolapse without regurgitation generally is not considered an indication for prophylaxis.
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when to prophylax dental endocarditis
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one dose of an antibiotic given 1 hour before the procedure.
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None
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urticaria
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red, raised, pruritic papules and plaques, and each individual lesion lasts for less than 24 hours.
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Sweet's syndrome
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uncommon, recurrent skin disease characterized by painful plaques and inflammatory papules, usually associated with systemic symptoms, such as fever and arthralgias. Lesions of Sweet's syndrome may show urticarial plaques, but the individual lesions last for more than 24 hours.
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Patients with diabetes or a history of stroke, coronary artery disease, or peripheral artery disease LDL target
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between 70 and 100 mg/dL
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who gets a pap smear/year
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Women who have multiple sex partners, have a history of abnormal Pap tests, or have recently been diagnosed with a sexually transmitted disease are at higher risk for cervical cancer
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interval for pap smears in low risk pt
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q 3yrs
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when to resect met colon (primary)
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bleeding or obstuction
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tx for met colon adeno
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systemic chemo
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HbA1c goal
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6.5-7
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in DM2, when sulfonourea fails?
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add metformin (sensitizer)
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most effective study for demonstrating a gastrinoma
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octreotide scan
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signs of marihuana use
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panic attacks and gynecomastia
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sympathomimetic syndrome
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include tachycardia, hypertension, hyperthermia, mydriasis, agitation, and psychosis; seen w/cocaine
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treatment of choice for drug-induced seizures
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benzodiazepines
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Patients with primary CNS lymphoma may be treated with
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high-dose methotrexate and brain radiation.
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Patients who are most likely to benefit from ACE inhibitors include
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those with systolic dysfunction, anterior wall myocardial infarction, or clinical evidence of congestive heart failure.
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what to add to asthma tx in addition to steroids
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long acting b inhaler
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peritoneal signs
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fever, abdominal pain, tenderness to palpation, and preferential flexion of the hips and knees
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where Coccidioidomycosis
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southwest
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atlantoaxial subluxation
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hooting pains in her arms, hyperreflexia, and hypertonia secondary to erosion or stretching of the transverse ligament that holds the odontoid process in place anterior to the spinal cord
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tx for restless leg syndrome
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dopa agonist, iron (if def)
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four causes of chest pain that can quickly lead to death:
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acute myocardial infarction, aortic dissection, tension pneumothorax, and pulmonary embolus
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osteoporosis definition
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T score at or below −2.5
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osteopenia def
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T score between –1 and –2.5
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vagal rx vs cardiogenic shock post mi
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in shock: elevated jugular venous pressure, rales, and an S3 gallop
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tx for vagal response post MI
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atropine
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peripheral blood smear shows a nucleated red blood cell
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sickle cell disease and thalassemia, and with marrow-infiltrative diseases, such as myelofibrosis or metastatic cancer
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Actinic keratoses
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1-to 3-mm, elevated, flesh-colored or red papules surrounded by a whitish scale
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classically presents as a pink, pearly or translucent, dome-shaped papule with telangiectasis
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basal cell carcinoma
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appearance of a new varicocele in a man older than 50 years that does not reduce when the patient lies down suggests
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obstruction of the venous drainage
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Which laboratory studies would support prior vaccination for hepatitis B virus?
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Antibody to hepatitis B surface antigen
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elevation in the hemoglobin A2 level is consistent with
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β-thalassemia
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features of Henoch-Schönlein purpura
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joint pain, abdominal pain, rash on the lower extremities showing vasculitis and IgA deposition, and renal disease with nephritic sediment.
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Fructosamine
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is a short-term measure of average blood glucose
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thoracic aorta aneurism Dx with
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helical computed tomography scan
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empiric tx for sbp
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cephalosporin or a fluoroquinolone
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delta–delta
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winter's formula
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bicarb*1.5 + 8 +/- 2
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malaria prophylaxis
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mefloquine, doxycycline, and atovaquone/proguanil
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classic site for hypertensive hemorrhage
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basal ganglia, thalamus/internal capsule, pons, and cerebellum.
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Acinetobacter baumannii tx
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carbapenems
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Seminoma is associated with elevation of
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only β-human chorionic gonadotropin.
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Empiric antimicrobial therapy for pneumococcal meningitis
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vancomycin plus a third-generation cephalosporin (either cefotaxime or ceftriaxone)
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Megestrol acetate therapy
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appetite stim, in cancer cachectic pts
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Gottron's papules
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dermatomyositis, red to purplish plaques on the dorsal hands, more prominent over the joints
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next step in abnormal prostate exam
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biopsy
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inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, spondylitis) morning stiffness usually lasts more than
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30 mins
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First-degree atrioventricular block is associated with a PR interval
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exceeding 0.20 seconds
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diagnostic for ventricular preexcitation by an accessory atrioventricular connection
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short PR interval, a prolonged QRS duration, and slurred onset of the QRS (delta wave) interval
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Triamcinolone ointment is useful in the treatment of
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inflammatory dermatoses
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tb conversion time after exposure
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4 to 7 weeks.
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pe tx duration
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3-6 months
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herapy of choice for Listeria meningitis
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ampicillin or penicillin G, combined with an aminoglycoside.
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Condylomata acuminatum
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HPV
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Condylomata latum
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treponema palludim/syphilis
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Murmurs of dynamic subvalvular left ventricular outflow obstruction associated with hypertrophic cardiomyopathy __________ during Valsalva maneuver.
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increase
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First-degree atrioventricular block is also associated with acute reversible conditions,
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inferior myocardial infarction, rheumatic fever, and digitalis intoxication
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acute management of DM2
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insulin
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age of cancer occurrence for genetic testing
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60
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Systemic inflammatory response syndrome
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two of the following conditions: temperature greater than 38 °C (100.4 °F) or less than 36 °C (96.8 °F), heart rate greater than 90/min, respiration rate greater than 20/min or arterial blood Pco2 less than 32 mm Hg, and leukocyte count greater than 12,000/µL or less than 4000/µL or with more than 10% immature band forms.
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Sepsis
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The systemic inflammatory response to a documented infection. In association with infection, the manifestations of sepsis are the same as those described for SIRS.
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Severe sepsis
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Sepsis associated with organ dysfunction, hypoperfusion, or hypotension
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Septic shock
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A subset of severe sepsis, defined as sepsis-induced hypotension, despite adequate fluid resuscitation, plus the presence of perfusion abnormalities. Patients receiving inotropic or vasopressor agents may no longer be hypotensive by the time they develop hypoperfusion abnormalities or organ dysfunction; however, they would still be considered to have septic shock.
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anterior myocardial infarction
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ST segment elevation in leads V2, V3, I, and aVL
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Inferior myocardial infarction
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ST segment elevation in leads II, III, and VF
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lateral infarction
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ST segment elevation in leads I, VL, V5, and V6
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first-line regimen for chemoprophylaxis for TB
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Isoniazid, 300 mg daily, for 9 months
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Pain that occurs with walking, but not at rest, and “snapping” sensation is characteristic of
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iliotibial band syndrome,
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Meralgia paresthetica
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pressure on the lateral femoral cutaneous nerve as it perforates the fascia of the lateral thigh, and is most common in overweight persons. It may cause pain, but dysesthesia is typically more prominent, and these symptoms are unrelated to activity.
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trochanteric bursitis
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pain of trochanteric bursitis may occur with walking, but is usually most severe when lying on the affected hip. On examination, tenderness is localized over the greater trochanter.
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tx for carpal tunnel, nerve?
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wrist splint, median nerve
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isk factors for stroke in patients who have atrial fibrillation
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history of stroke, a history of myocardial infarction, a history of hypertension, age older than 65 years, and diabetes
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splenic artery pseudoaneurysm is manifested by blood collecting in the ______ side of the abdomen
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left
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gastroduodenal artery pseudoaneurysm is manifested by blood collecting in the ______ side of the abdomen
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right
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which CHF meds not used in pregnancy
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ACE/ARBs
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delta-delta in proximal renal tubular acidosis
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<1
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antidepressant w/o weight gain
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buproprion
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angular cheilitis,
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s characterized by fissuring, erythema, and crusting at the angles of the mouth. It occurs in skin folds exposed to moisture, resulting in macerated skin. Candida overgrowth is common. This lesion is most commonly found in older people with ill-fitting dentures and in patients with mandibular atrophy or conditions associated with excess salivation.
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tx for HSV encephalitis
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IV acyclovir
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a sawtooth pattern is present in leads II, III, and VF
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a flutter
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influenza vaccination
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yearly
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Coal tar is a treatment for
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psoriasis
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C-ANCA correlates best with
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Wegener's granulomatosis
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P-ANCA correlates with
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microscopic polyangiitis and Churg-Strauss syndrome.
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Anserine bursitis
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finding of focal tenderness on the upper, inner tibia, about 5 cm distal to the medial articular line of the knee.
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empiric tx for TB
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Isoniazid, rifampin, ethambutol, and pyrazinamide
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indications for total knee replacement in patients with osteoarthritis
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pain and limitation of function to a degree sufficient to interfere with enjoyment of life.
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mild persistent asthma
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symptoms that recur more than 2 days per week and more than twice per month at night
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erythroplakia
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velvety, red mucosal abnormality
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time for tPA intervention in stroke
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within 3 hrs of last seen normal
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prophylaxis for people at high risk for influenza
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vaccine + 2 weeks of amantadine
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LBBB
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m in v4, paradoxically split s2
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tx for excersice asthma
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albuterol before
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In the absence of cor pulmonale, oxygen is prescribed when the Pao2 is
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55 mm Hg or less.
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findings most predictive of the clinical outcome in cryptococcus meningitis in HIV
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intracranial pressure
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when to treat hypomagnesemia
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Mg<1, symptomatic; necessary to correct other lites
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ruptured baker's cyst mimics
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DVT
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preprandial target glucose values in DM1
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80 to 120 mg/dL
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bedtime values of glucose in DM1
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100 to 140 mg/dL
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Tx for cocaine tachy
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diazepam
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Manage acute atrial fibrillation associated with hemodynamic compromise
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zap/cardiovert
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diagnosis of bone met lesions to r/o spine compression
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MRI
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vegetative state
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ondition of complete unawareness of the self or the environment, accompanied by sleep–wake cycles and preservation of brain stem and hypothalamic autonomic functions
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normal TSH
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.5-5
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De Quervain's tenosynovitis
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pain localized to the lateral wrist over the distal radius and a positive Finkelstein's test
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two important conditions in which hypertrophic osteoarthropathy can be seen
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Neoplasm (pulmonary, gastrointestinal, lymphoma) and infection
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the serum-to-ascites albumin gradient in ascites from cirrhosis
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>1.1
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most likely noncompressive cause of right upper lumbar radiculoneuropathy
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diabetes
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recommendation to perform coronary angiography in patients who have undergone successful thrombolysis and meet the following criteria:
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esidual myocardial ischemia (post–myocardial infarction angina, provocable ischemia on stress testing), hemodynamic instability, or clinical heart failure, with an ejection fraction of less than 40%.
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It is usually associated with a 24-hour urinary potassium excretion greater than 30 meq in the setting of a serum potassium concentration less than 3.0 meq/L
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primary hyperaldo
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most common organisms infecting the airways of patients with bronchiectasis
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Pseudomonas aeruginosa and Staphylococcus aureus
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empiric antibiotic treatment directed at P. aeruginosa
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fluoroquinolone and an aminoglycoside
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tx for alcohol dependance
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Naltrexone
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tx for varicella pneumonia
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IV acyclovir
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competitively inhibit creatinine secretion in the distal tubule
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Trimethoprim and other organic cations, such as cimetidine,
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rotator subacromial bursitis (or cuff tendonitis)
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tenderness over the supraspinatus tendon, nocturnal pain, and pain on abduction past 40 degrees.
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treatment for actinic keratosis
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Topical 5-fluorouracil
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empiric therapy for treatment of community-acquired pneumonia for patients in the intensive care unit
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recommend either cephalosporin/macrolide or cephalosporin/fluoroquinolone combinations
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Rocky Mountain spotted fever
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fevers, chills, and a petechial rash, which are characteristic of a rickettsial infection.
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when paliative chemo in met lung adeno
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if pt oob>50%
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tx for anthrax w/CNS involvement
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ciprofloxacin, doxycycline, clindamycin, and vancomycin
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DVT prophylaxis for post op DVT
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3 months warfarin
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target cholesterol <130
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h/o smoking, a high-density lipoprotein cholesterol level of less than 40 mg/dL, or a family history of premature coronary artery disease
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target cholesterol <160
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just high LDL
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