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220 Cards in this Set
- Front
- Back
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EKG findings of hypokalemia
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Flat and broad T waves, PVCs, U waves
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BUN and Cr changes during pregnancy
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Both decrease due to increased GFR
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Management of mild preeclampsia if lungs still immature
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Bed rest/ observe, consider steroids
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When to use mag sulfate and for what?
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During labor (or from admission in severe preeclampsia) and until 24 hours after delivery
Prevent eclamptic seizures |
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Noisy breathing on inspiration in infants + appearance on PEX
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Laryngomalacia (epiglottis rolling in from side to side, i.e. flaccid larynx that collapses during inspiration)
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Rx for laryngomalacia
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Self-resolves by 18mo; hold upright after feeding
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Newborn w/ failure to thrive, bilateral cataracts, jaundice, hypoglycemia: disease and deficiency
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Galactosemia
Galactose-1-phosphate uridyl transferase deficiency |
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Pts w/ galactosemia are at increased risk for
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E.coli sepsis
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Long-term risk of pernicious anemia
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Gastric cancer (due to chronic atrophic gastritis)
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How to monitor for gastric cancer in pernicious anemia pts
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Periodic stool testing for presence of blood
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Rx for early gastric MALT lymphoma
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H. pylori treatment (CHOP only if it fails)
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Sudden vision loss w/ hard to visualize fundus in pt w/ diabetes
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Vitreous hemorrhage
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Risks facing SGA infants (7)
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Hypoxia, asphyxia, meconium aspiration
Hypothermia, hypoglycemia, hypocalcemia Polycythemia |
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Cause of neonatal thyrotoxicosis in a mother with a Hx of thyroidectomy for Graves disease
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Persistence of circulating TSI Abs in mom for several months after surgery that cross the placenta and stimulate fetal thyroid gland
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Rx for Lewy body dementia
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Acetylcholinesterase inhibitors, e.g. rivastigmine
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Other name for Osgood-Schlatter
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Traction apophysitis (of the tibial tubercle)
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XR findings of Osgood-Schlatter
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Lifting of tubercle from shaft and irregularity/ fragmentation of tubercle
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Neonate w/ deafness, PDA or ASD, cataracts, and thrombocytopenia w/ purple skin lesions
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Congenital rubella infection
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Rubella is what type of virus
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Toga virus
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ABG in CHF vs. COPD
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Both have hypoxia
Respiratory alkalosis in CHF Respiratory acidosis in COPD |
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Next diagnostic step for amenorrhea w/ uterus present
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FSH (if increased, need karyotype; if decreased, need cranial MRI)
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Next diagnostic step for amenorrhea w/o uterus present (2)
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Karyotype and serum testosterone to differentiate btwn abnormal Mullerian development (XX and nml) and andorgen insensitivity syndrome (XY and high)
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Side effects of levidopa/carbidopa (4)
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Hallucinations, somnolence, confusion, and dyskinesia (late)
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Cystoscopy findings in interstitial cystitis
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Submucosal petechiae or ulcerations
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Muffled voice: two PEX ways to distinguish btwn epiglottitis and peritonsillar abscess
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Latter has uvular deviation and unilateral LAD
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Pulse ox in pts w/ CO poisoning
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Normal (can't differentiate btwn carboxyhemoglobin and Hb)
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Rx for smoke inhalation with confusion or seizure
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Presume CO poisoning: 100% O2 via non rebreather mask
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Appearance of intestinal atresia on XR (2 types)
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Duodenal atresia: double bubble
Jejunal atresia: triple bubble |
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Failure to pass meconium by 48 hrs
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Hirschsprung disease (congenital aganglionic megacolon)
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2 hrs postpartum w/ low grade fever, leukoytosis, and bloody vaginal discharge w/ firm and non-tender uterus
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Normal (normal lochia starts bloody, then white to yellow)
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Rx for hemophilia A
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Replace factor VIII
or DDAVP (causes release of factor VIII from endothelial cells) for mild cases |
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Risk factors for respiratory distress syndrome (aka hyaline membrane disease) in infants
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Prematurity
Maternal diabetes Male, C-section w/o labor, perinatal asphyxia |
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First line for complicated cystitis
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Fluroquinolone
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Characteristics that make cystitis complicated (5)
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Pregnancy
Very young or old Diabetic I/c Abnormal GU anatomy |
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Most common cause of lower GI hemorrhage
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Diverticulosis
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Diagnostic test for conjugated hyperbili w/ normal transaminases but elevated alk phos
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US or CT
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Pt w/ corneal ulcer/abrasion but no eye pain
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Trigeminal nerve lesion --> corneal anesthesia
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Organism and Rx for pinwowm
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Enterobius vernicularis
Albendazole |
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Lead pipe colon
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UC
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Labs in Crohn's vs. UC
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ASCA frequently positive in Crohn's, pANCA in UC
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Rx for Whipple's disease
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Bactrim or ceftriaxone for 1 yr
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Elderly pt w/ abd pain and double bubble sign on AXR
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Volvulus (bubbles are distal and proximal to volvulus)
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What cells form carcinoid tumors?
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Neuroectodermal cells that function as amine-precursor-uptake and decarboxylation (APUD) cells
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Rx for local vs. metastatic carcinoid tumors
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Resection; w/ mets, add IFN-alpha, octreotide, and embolization
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Which tumor syndromes are due to a mutation in the APC gene?
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FAP
Gardner's syndrome (like FAP bone and soft tissue tumors) Turcot syndrome (like FAP w/ malignant CNS tumors) |
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Ranson's criteria
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GA LAW
Glucose >200 AST >250 LDH >350 Age >55 WBC >16,000 (3+ indicate increased mortality from acute pancreatitis on admission; he also has criteria for mortality during initial 48hrs) |
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What is Budd-Chiari syndrome?
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Hepatic vein thrombosis 2/2 hypercoagulability
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Paracentesis w/ very high albumin and LDH
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Concern for neoplastic etiology
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Personality change, loss of coordination, dysphagia, jaundice
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Wilson's disease
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Labs in Wilson's isease
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Decreased ceruloplasmin
Increased urinary copper |
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Inheritance of hemochromatosis and Wilson's
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AR
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Rx for Wilson's (4)
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Trientine or penicillamine for copper chelation
Life-long zinc Dietary copper restriction Supplemental vita B6 |
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Mild jaundice following fasting, exercise, or stress w/ mild increase in indirect bili
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Gilbert's (deficiency of glucuronosyl transferase)
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What is Crigler-Najjar syndrome?
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Severe deficiency in glucuronosyltransferase (vs. mild in Gilbert's), indirect bili >5
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Rx for Crigler-Najjar and to prevent what complication?
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Phototherapy, plasmapheresis, calcium phosphate + orlistat
Kernicterus |
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What is kernicterus?
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Deposition of bilirubin in basal ganglia and hippocampus
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What is a Meckel's diverticulum
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Remnant of vitelline duct that exists as outpouching of ileum; may contain ectopic tissue
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Intussusception in an adult
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Cancer until proven otherwise
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3 most common types of neonatal meningitis, in order
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GBS
E. coli Listeria |
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What is ischemia-reperfusion syndrome, and what is a potential complication?
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After 4+ hrs of ischemia, tissues can suffer intracellular and interstitial edema upon reperfusion (i.e. after embolectomy) --> compartment syndrome
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Management of a hip click discovered on PEX of a newborn
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Hip US (XR if >4mo, once bones have ossified and can be visualized)
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Rx for developmental dysplasia of the hips (3)
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Hip (Pavlik) harness
Spica cast Surgical reduction |
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Rx for women in labor w/ placental abruption if she and fetus are stable
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Vaginal delivery w/ augmentation of labor (only section if unstable)
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DDx for HTN in pregnant woman <20wks (2)
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Chronic HTN
Hydatiform mole |
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Main risk factor for placental abruption
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HTN of any kind
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CSF in Guillain Barre
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High protein, otherwise normal
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Headaches and unilateral hemiparesis after acute otitis media
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Brain abscess
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Child w/ macrocytic anemia with overall BM failure, short stature, abnormal thumbs, pigmented areas, strabismus, low-set ears
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Fanconi anemia (--> aplastic anemia)
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Management of pt w/ signs of polymyalgia rheumatica but no signs of temporal arteritis
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Low-dose prednisone (don't need high doses or temporal artery biopsy)
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Main risk of VUR in children
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Renal scarring --> ESRD
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Rx for simple or complex uterine hyperplasia without atypia
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Cyclic progestins
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Rx for uterine hyperplasia w/ atypia
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Hysterectomy
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Most common cause of death in dialysis pts
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CV disease
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Rx for early syphilis
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Single IM dose of benzathine penicillin G
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Rx for early syphilis in pts who are pen-allergic
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Doxy or tetracycline x 14 days
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Choking and regurgitation on first feeding + gastric distention and bilateral atelectasis
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Tracheoesophageal fistula (esophageal atresia)
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Hypotension and back pain after cardiac cath
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Retroperitoneal bleeding
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Rx and management for retroperitoneal bleeding after cardiac cath (3 scenarios)
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CT A/P to confirm + supportive Rx
If continues or unstable, systemic reversal of anticoagulation If develop neuro deficits in ipsilateral extremity, need urgent decompression of hematoma |
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Female with rapidly developing virilization
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Worry about ovarian or adrenal tumor secreting excessive androgens
Check testosterone and DHEAS |
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Neck swelling, epistaxis, and mass in the posterior nasal cavity
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Nasopharyngeal carcinoma (undifferentiated carcinoma)
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Nasopharyngeal carcinoma is associated with
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EBV
(also smoking and nitrosamine consumption (salted fish)) |
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Rx for Eisenmenger syndrome
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Lung transplant w/ cardiac repair
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Rx for nursemaid's elbow
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Rotate hand and forearm to supinated position w/ pressure over radial head (to reduce annular ligament, which radial head has slipped thru)
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Work-up for suspected pyloric stenosis
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Abdominal US
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Right facial droop w/ absence of forehead furrows indicates
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Peripheral facial nerve palsy (excludes central causes b/c have UMN involvement)
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SOB and prolonged expirations after treatment for MI w/ ASA, LMWH, metoprolol, and captopril
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Beta-2 blockade --> bronchoconstriction in a pt with reactive airway disease
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When to give the VZV vaccine after exposure
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Within 3-5 days
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Who need the VZV Ig and when?
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I/c pts and pregnant woman within 72 hrs of exposure
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Pt w/ chest trauma and hypotension, left-sided hemothorax, and deviation of mediastinum to the right
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Aortic injury
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Rx for RLS
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Dopaminergic agonists (e.g. pramipexole and ropinerole) or levodopa
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Pancreatitis w/ flank and/or periumbilical ecchymoses
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Retroperitoneal hemorrhage (Grey Turner and Cullen signs)
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Embolism where is the most common cause of ocular stroke (aka CRAO)
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Retinal artery (which comes off the ophthalmic artery, which is the first branch of the internal carotid)
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Pt w/ URI, scrotal swelling/ peripheral edema, and purpura on buttocks
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Henoch-Schonlein purpura
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Rx for HSP
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Steroids, monitor renal function
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Risk of HSP
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Intussusception
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Why should beta-blockers be avoided in pts with cocaine intoxication
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Unopposed alpha activation can worsen HTN --> coronary vasospasm
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Why does hypoalbuminemia not cause pulmonary edema?
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Alveolar capillaries have higher permeability to albumin and greater lymphatic flow
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How to distinguish btwn edema from renal vs. cardiac causes
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UA abnormal in renal causes
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Irregular bleeding and menorrhagia in a young girl is likely due to
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Anovulatory cycles
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Management of subcutaneous emphysema 2/2 severe coughing paroxysms
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CXR first to r/o pneumothorax
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Swelling limited to one cranial bone w/o pulsations, indentations, or discoloration: diagnosis and prognosis
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Cephalohematoma; most resolve in weeks to months
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Diffuse ecchymotic scalp swelling that extends across midline and across suture lines
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Caput succedaneum
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How do cirrhosis and CHF cause secondary hyperaldosteronism?
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Hypoperfusion of kidney --> increased renin
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LVEDV in systolic heart failure
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Elevated
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How to distinguish btwn iron deficiency anemia and thalassemia in young children?
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RDW: >20% in iron deficiency anemia, vs. normal in thalassemia
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LP in MS pts
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Normal pressure, cell count, and total protein
Oligoclonal bands and increased IgG index |
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When do infants with GERD need meds?
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Insufficient weight gain
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Two causes of hypersensitivity pneumonitis?
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Aerosolized bird droppings and molds associated w/ farming (bird fancier's and farmer's lungs)
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Rx for hypersensitivity pneumonitis
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Antigen avoidance
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Management of diarrhea in an HIV pt (3)
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Stool culture
Exam for ova and parasites C. diff test |
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Burst fracture of vertebrae with b/l loss of motor function, pain, and temperature below the lesion
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Anterior cord syndrome
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Fever, leukocytosis, painful defection, and diarrhea w/ tender/fluctuant mass palpable with tip of finger on rectal exam
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Pelvic abscess in rectovesical pouch
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Risk of asymptomatic bacteriuria early in pregnancy
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Pyelo, which can --> septicemia, preterm labor, and low birth weight
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Young pt w/ a crescendo-decrescendo systolic murmur along left sternal border w/o carotid radiation
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HOCM (interventricular septal hypertrophy)
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Vaccinations for preterm infants should be given according to what age?
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Chronologic age
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Exception for vaccination rule for preemies
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Kids should be 2kg before receiving first HBV vaccine
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Most common cause of congenital hypothyroidism in the US
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Thyroid dysgenesis
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What is a threatened abortion?
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Hemorrhage before 20th week w/ live fetus; closed cervix, no passage of fetal tissue, active FHR
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Sharply demarcated, erythematous, edematous, tender skin lesion w/ raised borders
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Erysipelas
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What is erysipelas?
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Specific type of cellulitis w/ inflammation of the superficial dermis --> prominent swelling
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Common causative agent of erysipelas
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Group A strep (S. pyogenes)
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Which congenital bowel protrusion is covered by a protective membrane?
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Omphalocele (gastroschisis is not)
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Preop management of gastroschisis and omphalocele
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Sterile wrapping of bowel and insert orogastric tube
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Jejunal ulcer indicates
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Zollinger-Ellison syndrome/ gastrinoma
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Why does steatorrhea develop in gastrinoma pts?
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Increased production of stomach acid inactivates pancreatic enzymes
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Rapidly progressive ascending paralysis, absence of fever, absence of sensory abnormalities, and normal CSF
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Tick-borne paralysis (GBS usually has sensory loss and cytoalbuminologic dissociation)
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Rx for tick-borne paralysis
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Removal of tick --> rapid improvement
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Rx for MI w/ pulmonary edema
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Furosemide (+MONA, without beta blockers b/c of CHF)
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3 primary manifestations of Chagas disease
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Megacolon
Megaesophagus Cardiac disease |
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Long-term neuro sequelae of bacterial meningitis (5)
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Hearing loss
Seizures Spasticity/ paresis Loss of cognitive functions Mental retardation |
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Vitiligo + macrocytic anemia
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Pernicious anemia (vitiligo indicates at risk for other autoimmune conditions)
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Dementia with visual hallucinations
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Lewy body dementia
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S/p trauma w/ hypoxemia, unilateral decreased breath sounds and irregular alveolar infiltrate on CXR
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Pulmonary contusion
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Long bone fracture followed by tachycardia, hypotension, thrombocytopenia, and petechiae
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Fat embolism
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Most serious complication of Kawasaki disease
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Coronary artery aneurysm (--> MI)
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Weight gain, poor sleep, HTN, hypokalemia, hyperglycemia
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Cushing's syndrome
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Headaches and paralysis of vertical gaze
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Parinaud's syndrome from pinealoma
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What is rubeola?
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Measles
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Child w/ fever first, then rash that spares the face
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Sixth disease (b/c is HHV6) or roseola or exanthema subitum
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Most common cause of infantile febrile seizures
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Roseola/ HHV6
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Electrolyte abnormalities in refeeding syndrome if TPN is started too fast
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Hypo K, Mg, and Phos
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CSF findings in herpes encephalitis (WBC, RBC, protein, glucose)
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Lymphocytic pleocytosis,
Increased RBC Increased protein Normal glucose (vs. decreased in tuberculosis or other chronic bacterial meningitis) |
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Most common cause of lumbar spinal stenosis
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OA of the spine
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Exudative effusion w/ very high total protein (>4)
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Tuberculosis
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At what CD4 count is HAART typically started?
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<350
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When is Bactrim prophylaxis indicated for HIV+ pts?
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CD4 count <200
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Rx for malignancy-related SVC syndrome
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Radiation therapy
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How does tension pneumo cause hypotension?
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High intrathoracic pressure --> decreased venous return
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Worst complication of esophageal dilation (for achalasia)
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Esophageal rupture --> mediastinitis
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Difference btwn a Mallory Weiss tear and a Boerhaave's tear
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Partial thickness vs. full thickness (latter can lead to mediastinitis)
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Foot with shiny, thin, hairless skin and a nonhealing ulcer
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Peripheral vascular disease
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Rx for primary hyperaldosteronism due to adrenal hyperplasia
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Mineralocorticoid receptor antagonist (aldosterone antagonist) e.g. spironolactone
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Why do gastric bypass pts have an increased incidence of gall stones?
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Rapid weight loss postop --> increased bile concentration
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Rx for gastric bypass pts postop to decrease risk of gallstone development
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Prophylactic ursodeoxycholic acid for 6mo
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Finding on UA that would indicate renal tubular dysfunction
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Granular casts
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Anti-centromere Abs
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Limited scleroderma (CREST)
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Peritoneal irritation indicates what type of pain?
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Somatic (easier to localize that visceral pain, which is more diffuse/ crampy, e.g. in SBO)
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Rx for neurogenic blaccer/ overflow incontinence
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Cholinergic agonist (e.g. bethanechol)
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Rx for urge incontinence
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Muscarinic antagonists
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Why do septic pts have a metabolic acidosis?
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Hypoxemia --> lactic acidosis
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Rx for symptomatic CLL and its mechanism
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Rituximab (monoclonal Ab against CD20 antigen on B lymphocytes)
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Cause of hyponatremia w/ urine sodium <10
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Intravascular volume depletion 2/2 extrarenal loses (e.g. diarrhea, vomiting)
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Most common cause of bacteremia in sicklers
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Strep pneumo
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Who needs prophy Abx before dental procedures (3)?
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Prosthetic heart valves
Prior history of infective endocarditis Unrepaired congenital heart disease |
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Acute Rx for extrapyramidal symptoms
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Anticholinergic meds
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Common complication of humeral midshaft fractures
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Radial nerve injury
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Diarrhea w/ abd pain and eosinophilia: diagnosis and management
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Parasitic infection: serial stool exams for ova and parasites
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Most common mechanism by which multiple myeloma causes kidney failure
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Toxic effect of light chain casts on renal tubules
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Management of low-grade squamous intraepithelial lesion found on Pap
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Colpo w/ targeted biopsy
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Vaginal pH in three causes of vulvovagintiis
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Candida: normal (4-4.5)
Trich and BV: elevated (>4.5) |
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Type of anemia seen in DIC
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Microangiopathic hemolytic anemia
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PEX in testicular torsion
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Swelling and tenderness with absence of cremasteric reflex
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PEX sign to differentiate torsion from epididymitis
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Prehn's sign (relief of pain with testicular elevation) indicates epididymitis
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Most common cause of nephrotic syndrome in adults?
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FSGS
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Infant w/ bilious vomiting and on upper GI has corkscrew shaped and rightwardly displaced duodenum
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Intestinal malrotation --> midgut volvulus
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Why does pyloric stenosis cause nonbilious vomiting?
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Obstruction is proximal to entrance of common bile duct into duodenum
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Most common pathogen associated w/ epidural abscess and Rx
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S. aureus; start with vanc
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Another name for Churg-Strauss syndrome and two nearly universal findings
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Eosinophilic vasculitis
Asthma and eosinophilia |
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Blood smear w/ ovalo-macrocytes and neutrophils w/ reduced segmentation
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Myelodysplastic syndrome
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Most common postinfectious complication of impetigo
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Glomerulonephritis
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Rx for prolactinoma (class and 2 examples)
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Dopamine agonist, e.g. cabergoline and bromocriptine
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Cause of acidosis in DKA
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No longer producing insulin, so breakdown of fatty acids in the liver to make ketones for use as an alternate energy source
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HIV med that causes insomnia with vivid, bizarre dreams
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Efavirenz (NNRTI)
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Skin biopsy findings in HSP
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Leukocytoclastic vasculitis w/ extensive IgA deposition
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Labia majora mass w/ pain on walking, sitting, and sex: diagnosis and management
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Bartholin's gland abscess
I&D |
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Migraine med that cannot be combined w/ triptans and why not
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Ergotamine: can result in prolonged vasospasm due to overactivation of 5-HT receptors
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Blurry vision that is worse at night (glare)
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Cataract (lens opacification)
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Tocolytic given to pregnant woman in preterm labor followed by hypoxia, tachypnea, and bibasilar crackles: med and rare side effect
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Beta agonist for tocolysis --> pulmonary edema
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Rx for torsades de pointes
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IV mag sulfate (effective in preventing further episodes even if pt has normal mag level)
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Newborn with paralysis of one hand and ipsilateral Horner's syndrome
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Klumpke's paralysis (brachial palsy)
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Pathophys of tamponade
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Ventricles can't expand, so lower preload --> lower CO
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Most common site of hypertensive hemorrhages
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Putamen
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Trauma to the soft palate can cause what 2 complications
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Internal carotid artery dissection or compression (dislodging a thrombus), both of which --> stroke
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Appearance of steroid-induced acne
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Monomorphous pink papules w/o comedones
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Most common cause of death in acute MI (and its mechanism)
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Complex ventricular arrhythmia due to reentry
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Most common causes of syringomyelia (2) and pathophys
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Arnold Chiari malformations and prior spinal cord injuries
(both disrupt CSF drainage --> fluid filled cavity) |
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5 findings in anorexic pts
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Osteoporosis
Elevated cholesterol/ carotene Prolonged QT --> arrhythmias Euthyroid sick syndrome Hypothalamic-pituitary dysfxn |
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Rx for bed wetting (1st and 2nd line)
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Desmopressin, then imipramine
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Most serious side effect of hydroxychloroquine
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Retinopathy
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Increasing gastric residual volume in a preterm neonate
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Necrotizing enterocolitis
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HIV pt w/ ring-enhancing cerebral mass, + toxo serology, and EBV DNA in the CSF
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Primary CNS lymphoma (latter finding is specific, whereas toxo serology is not)
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Most common side effect associated with olanzapine toxicity
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Weight gain/ metabolic syndrome
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Fatal risk associated with meningococcemia (name, cause, and presentation)
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Waterhouse-Friderichsen syndrome (sudden vasomotor collapse and skin rash due to adrenal hemorrhage)
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Congenital infection with chorioretinitis, hydrocephalus, and intracranial calcifications
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Toxoplasmosis
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Why do the elderly develop orthostatic hypotension?
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Decreased baroreceptor responsiveness
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Differential for T-wave inversion (5)
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MI
Myocarditis Old pericarditis Myocardial contusion Dig toxicity |
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Child w/ wide-based/unsteady gait, cervical and cerebellar atrophy, and myocarditis/cardiomyopathy
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Friedreich Ataxia
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Rx for early Parkinson's in a young pt
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Anticholinergics, e.g. trihexyphenidyl
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Child w/ back pain and a step off at the lumbosacral area
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Spondylolisthesis (developmental disorder w/ forward slip of vertebrae; can lead to neurologic dysfunction, e.g. urinary incontinence)
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Hypotonia, hepatosplenomegaly, LAD, cherry red macula
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Niemann-Pick disease (deficiency of sphingomyelinase)
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Hyperacusis, MR, seizures, cherry red macula, withOUT hepatosplenomegaly or LAD
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Tay-Sachs disease (hexosaminidase A deficiency)
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Female athlete triad + foot pain
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Stress fracture
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Child w/ rash, arthralgias, abd pain, and renal disease
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HSP (IgA mediated vasculitis of small vessels)
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Difference btwn complete and partial DI
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Urine osmolality <300 in complete (often<100), and 300-600 in partial
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2 benign conditions (normal LFTs, no treatment necessary) that cause a conjugated hyperbilirubinemia
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Rotor syndrome (defective storage)
Dubin-Johnson syndrome (black liver) |
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Mild unconjugated hyperbilirubinemia provoked by fasting, stress, or illness
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Gilbert's syndrome
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Two med classes for Alzheimer's and examples
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Acetylcholinesterase inhibitors, e.g. donepezil (Aricept), rivastigmine, galantamine
NMDA antagonists, e.g. memantine (Namenda) |
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DiGeorge Syndrome
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CATCH-22
Cyanotic heart disease Abnormal facies Thymic aplasia Cleft palate Hypocalcemia/hypoparathyroidism Microdeletion of 22q11 |
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5 parameters for metabolic syndrome (need 3/5)
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Abdominal obesity (>40 men, >35 women)
Impaired fasting glucose HTN (>130) Hypertriglyceridemia (>150) Low HDL (<40 men, <50 women) |
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Most common cause of trisomies
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Nondisjunction during meiosis of maternal germ cells
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