morpheus files

[Anonymous]

A 5-year-old boy presents with several days of fever to 104°F, along with bilateral conjunctival injection, a strawberry tongue, red and cracked lips, marked cervical adenopathy, as well as erythema and swelling of both hands and feet. Which of the following is accepted therapy for this illness?
A. penicillin
B. prednisone
C. acetylsalicylic acid
D. azithromycin

Ans: ASA

A 21-year-old woman is a restrained passenger in a high-speed motor vehicle collision and presents with neck, abdominal, and back pain, with normal vital signs. She is 32 weeks’ pregnant. Which of the following statements is incorrect?
A. Fetal monitoring is important to detect early fetal distress.
B. Traumatic placental abruption is almost always associated with vaginal bleeding.
C. Appropriate radiological studies should not be withheld.
D. Ultrasound is not very accurate in detecting placental abruption

Answer: B
In blunt trauma, 50% to 70% of fetal losses result from placental abruption. Fetal mortality in abruption cases is about 50%. Classic clinical findings in placental abruption may include vaginal bleeding, abdominal cramps, uterine tenderness, amniotic fluid leakage, maternal hypovolemia, and fetal distress. However, in some trauma series, up to 60% of placental abruption has no associated vaginal bleeding. Fetal monitoring is a sensitive monitor for fetal distress. Appropriate radiologic studies should never be withheld when necessary to properly care for the mother. Ultrasound is less that 50% accurate in detecting abruption.9

A 6-year-old girl ingests an unknown volume of a pesticide called Sevin(®)(a carbamate anticholine-sterase inhibitor) and presents with clinical evidence of toxicity, including pinpoint pupils, vomiting, diarrhea, severe weakness, and heavy oral secretions. Besides prompt intubation and ventilation, appropriate treatment includes which of the following?
A. atropine
B. methylprednisolone
C. pralidoxime
D. epinephrine

Answer: A
Carbamates are reversible acetylcholinesterase inhibitors that lead to hyperstimulation of nicotinic and muscarinic receptors in the autonomic nervous system. The classic presentation includes hypersecretion from all orifices along with diffuse weakness and various central nervous system manifestations. Supportive care, decontamination, and intravenous atropine in high doses are the mainstays of therapy. Pralidoxime is not indicated for carbamate poisoning.

Which of the following is appropriate initial antihypertensive therapy for the listed hypertensive emergency in a patient with a blood pressure of 210/116 mm Hg?
A. eclampsia—captopril
B. aortic dissection—nitroprusside
C. clonidine withdrawal—phentolamine
D. phentolamine cocaine intoxication—propanolol
Answer: C
Eclampsia is a hypertensive emergency in pregnancy with secondary seizures. Traditionally, it has been treated with magnesium sulfate and intravenous hydrala-zine, although labetalol and nicard-ipine are gaining acceptance as appropriate antihypertensive therapy in this setting. Captopril and other angiotensin-converting enzymes are contraindicated in pregnancy because of increased fetal mortality. Antihypertensive therapy for aortic dissection has as a goal not only blood pressure control but also reduction of cardiac contractility to decrease the shear force from the pulse pressure of each contraction. Beta-blocker therapy with propanolol or the shorter-acting, more titratable esmolol is the therapy of choice. Nitroprus-side is inappropriate initial therapy for aortic dissection because it causes reflex increases in heart rate and cardiac contractility. Cocaine intoxication leads to cate-cholamine excess. The resultant severe hypertension will be increased by beta-blocker therapy alone. Propanolol is contraindicat-ed for initial therapy of cocaine-induced hypertension. Clonidine withdrawal is also a state of cate-cholamine excess and is appropriately treated initially by an alpha-blocker such as phentolamine.4,5

A depressed 28-year-old woman with AIDS and pulmonary tuberculosis presents with recurrent generalized seizures. She has not stopped seizing despite large doses of lorazepam and fosphenytoin 1 g intravenously. Which of the following should be considered quickly in the patient’s care?
A. thiamine
B. sodium bicarbonate
C. vecuronium with ventilatory support
D. pyridoxine
Answer: D
Pyridoxine (vitamin B6) is the antidote of choice for isoniazid toxicity, a cause of intractable seizures unresponsive to standard therapies. An initial dose of 5 g in adults and 1 g in children is indicated in unknown overdose with intractable seizures.6 Paralysis by neuromuscular blocking agents will hide the motor activity but will not protect from the continuous neuronal hyperstimulation of ongoing seizures, and if used, requires ongoing electroencephalogram monitoring.

A 26-year-old man dives into a shallow pool, striking his head on the bottom without loss of consciousness. He presents with severe neck pain, and a cervical immobilization device is placed.What is the most likely fracture?
A. C1 ring fracture
B. C2 pedicle fracture
C. C7 spinous process fracture
D. C3 bilateral facet dislocation
Answer: A
The mechanism described is direct axial load, which is most likely to cause a burst fracture of the ring of the first cervical vertebrae, a Jefferson fracture. The force drives the lateral masses outward, fracturing the anterior and posterior arches of the atlas with disruption of the transverse ligament.14

A 38-year-old man sustained an ankle injury and presents unable to walk. He is tender and swollen at his medial malleolus. He is also tender over the same leg’s fibular head. Which of the following statements is true?
A. If a fibular head fracture is present, surgery may be required.
B. An ace wrap and crutches is appropriate therapy.
C. Fifth metatarsal base fractures are commonly associated.
D. The mechanism of injury is inversion
Answer: A
A proximal fibula fracture associated with a medial malleolus fracture or deltoid ligament tear. The mechanism is ankle eversion with external rotation. A tear in the syndesmosis between the tibia and fibula leads to instability of the ankle on weight bearing. Surgical repair with transsyndesmotic fixation is frequently necessary.11
child typical s/s of rsv and q was tx
a.acetaminophen
b.c.d....all list of antibiotics

old guy told family mem that donot do much on me but give me comfort and now pt has res rate of 8 and family called u
a.are u prepared to die him at home
b.are u sure he told u that
c.this is emergen call 911 now

RECOMMENDATION — Treatment of RSV infection remains limited to supportive therapy, including supplemental oxygen, mechanical ventilation as indicated, and bronchodilators. For immunocompromised patients, RSVIG and inhaled ribavirin should be considered. In particular, early use of inhaled ribavirin should be considered in RSV-infected bone marrow transplant recipients.

Development of a preventive vaccine and additional work on passively administered immunoprophylaxis are areas of active research. Immunoprophylaxis with RSVIG or palivizumab is indicated in specific circumstances in infants with chronic lung disease and/or prematurity.

97.what is the bad prognnostic sign for sarcoidosis
a.ace less than 15..i think it was 15
b.hyper calcemia
c.hilar lymphadeno
Adverse prognostic factors of sarcoidosis include lupus pernio, chronic uveitis, age older than 40 years at onset, chronic hypercalcemia, nephrocalcinosis, black race, progressive pulmonary sarcoidosis, nasal mucosal involvement, cystic bone lesions, neurosarcoidosis, myocardial involvement, and chronic respiratory insufficiency.

An AA patiet with signs and symptoms of Addisons and is in crisis. Whats next best step?

A) IV Cortisol
B) IV Fludrocortisone
C) IV Cortisol+IV Fludrocortisone

i.V. hydrocortisone

What is the Rx of choice for the long term
hydrocortisone + fludrocortisone P.O.


Immediately exclude Interferon Alpha (Keep in mind that the interferon ALpha is used in Rx of chronic viral hepatitis B and C while interferon Beta is used in the Rx of multiple sclerosis).
Since you have to exclude interferon Alpha for MS, exclude the option (all of the above).


Now you left with interferon Beta and prednisone.

When they asked about the Rx for the disease process, they mean the (modifying agents)..Remember the same thing for the Rx of Rheumatoid (NSAIDS vs modifying agents like gold salt, azathioprine ..etc).

FOr MS,

the modifying agent is interferon beta.

FOr the current disease picture, prednisone (to produce a rapid relief of the disease manifestations).

53.15 yr old need kidney, mom and brother sister (age 8 and 9) matched and aunt mathed for bllod group but not hla who do u take kidney from
a.mom
b.brothe
c.aunt
MOM

54.f/u pt is on prednisone,cyclospo atenolol and creatine 1.1 and had cushing features and pt
now came for f/u
creatine 2.2 and htn,chushingoid feature gone what next
a.pt need secong anti htn medi
b.pt has transp regection
54: Incomplete choices, has definitely renal failure, may be transplant rejection ??

A 35-year-old white woman presented with a 2-week history of pruritic papulovesicular rash on both knees. She denied fever or weight loss. Laboratory studies were hematocrit, 30%, mean corpuscular volume, 78 fL, and ferritin, 14 ng/mL. Three stools for occult blood were negative. What’s your most likely associated diagnosis?
Diagnosis?
(Which diagnosis below do you feel is the correct one?)
• AIDS
• Pellagra
• Celiac sprue
• Toxic shock syndrome

Celiac sprue—Celiac sprue is associated with dermatitis herpetiformis. The patient had iron-deficiency anemia without evidence of gastrointestinal blood loss, which may represent latent celiac sprue. Celiac sprue is a fairly common disorder, affecting about 1 in 500 individuals in the United States. The triad of malabsorption, compatible small intestine histology, and improvement with a gluten-free diet is a classic diagnosis of celiac sprue.

In dermatitis herpetiformis, intensely pruritic papu-lovesicular skin lesions are symmetrically distributed on the extensor surfaces of extremities, the trunk, buttocks, scalp, and neck. The lesions are characterized by im-munoglobulin A deposits in the dermal-epidermal junction. If the proximal small intestine is sampled, almost all patients will have at least a mild mucosal lesion consistent with celiac sprue. Many of these patients have no intestinal symptoms, yet less than 10% of patients with celiac sprue have evidence of dermatitis herpetiformis. Gluten withdrawal eventually reverses the skin lesions in most patients, but treatment of the skin lesions with sulfones fails to reverse the intestinal pathology.


An 88-year-old Asian woman presented with a poor appetite and was unable to walk for a week. The patient had dull, poorly localized bone pain. An examination showed proximal muscle weakness and tenderness to palpation in both upper thighs. Laboratory findings included hematocrit, 30%; albumin, 3 g/dL; alkaline phosphatase, 320 U/L; calcium of 7.7 mg/dL; and phosphorus, 2.2 mg/dL. A dual-energy x-*** ab-sorptiometry scan showed a T score of -2.8 at proximal femur. An x-*** is shown. What’s your diagnosis?
Diagnosis?
• Osteoporosis
• Osteomalacia
• Metastatic bone disease
• Hip fracture
Osteomalacia—Osteomalacia is still prevalent in the United States among the elderly. This is especially true of Asian and other women who wear traditional cloth and consume unfortified foods. Osteomalacia may be caused by vitamin D deficiency (eg, reduced exposure to sunlight, poor nutrition, malabsorption), defective metabolism of vitamin D (eg, chronic liver and renal failure), or drug-induced (eg, dilantin, phenobarbital, rifampin, isoniazid). Daily intake of a multivitamin such as 400 IU of vitamin D often is not adequate to prevent vitamin D deficiency in elderly women.

Clinically, diffuse skeletal pain, proximal muscle weakness, waddling gait, and a propensity to fractures may be noted. Serum alkaline phosphatase is elevated and calcium and phosphorus are usually decreased. Since serum 25(OH)D3 level has a half-life of about 3 weeks, it most accurately reflects vitamin D stores and supports a diagnosis if the level is 15 mg/mL or less A dual-energy x-*** absorptiometry scan is unable to differentiate between osteoporosis and osteomalacia. Radiographic findings include osteopenia and radiolucent bands perpendicular to bone surfaces

A fat pulmpy pig comes to office and Q's you about Orlistat, "Doc what is the MC sideeffect that I can expect from Orlistat"? What do you say?

Orlistats most common side effect is November 2 2003, 8:35 PM

diarrhea(Fatty stools)


6.old guy had s/s of depression wt loss and insmonia
which is best rx
a.trazod
b.paxil
c.doxepin
Low dose t****don is the best in elderly with insomnia November 2 2003, 3:54 PM

SSRIS like peroxitine are only next to T****done, especially in elderly! Because, SSRI's commonly leads to agitation in the elderly and you don't want to see that as a practitioner. Yes, the pt's. current state of morbibidity should be kept in mind before you Rx one; as said in the earlier posting of this thread!

On postoperative urine analysis of a patient, Na was 20 Eq/ml (normal 40-100)..The most likely cause should be:

Pre-renal

Intrinsic (renal)

urine <20 or FeNa <1% is prerenal,,, due to over hydration, BUN >>>> the Creat, Incr Osmol
renal >2o or FeNa >1% is renal eg: ATN


2-week infant with vomiting, hyperkalemia and hyponatremia..D'x?

Congenital aderenal Hyperplasia

Gastroenteritis

Pylroic stenosis

Ans : Gastroenteritis .. the diarrea will cause the loss of HCO3, and thus hte pt will be in met. acidosis and thus H+ will shift into cell and K+ out of cell causing hte Hyper K emia...

both the CAH and Pyloric stenosis will cause Hypo K emia !!!!!!!!!!!!!



2-week infant with vomiting, hypokalemia and hypernatremia..D'x?


Congenital aderenal Hyperplasia

Gastroenteritis

Pylroic stenosis

ansyloric stenosis
vomiting =====>hpochloremic met alk
Diarrhea======>non AG met acidosis with low K


A newborn born with thick yellow meconium covering his face and all his body..The baby is cyanotic...next step:

Endotracheal intubation

Oxygen by nasal cannula

Tracheal suction

ans: endotrachial intubation

most effective therapy is prevention by bulb suctioning of oropharynx of the infant before delivering the rest of the body since most aspiration occur with the initiation of respiration .
his baby is cyanotic , whole body,face covered with meconium ,so we have ti intubate to prevent meconium to pass below vocal cord.

57. Electric Burn on fingers only – painful – after hydration, next step?
a. ABX therapy
b. Tetanus toxoid
c. Nothing

All burn patients should receive TT - also do an ECG to rule out arrythmias

96.old guy had s/s of depression wt loss and insmonia
which is best rx
a.trazod
b.paxil
c.doxepin

a

A 35-year-old white male has had urticaria for 2 months, and he has become very anxious and depressed over his condition.

Which one of the following would be the most appropriate treatment?
Doxepin (Sinequan) daily at bedtime The antidepressant doxepin is useful in patients with chronic urticaria, especially when anxiety or depression is a factor. It has significant H1 antihistaminic activity. Topical steroids and antihistamines are not effective. ACE inhibitors such as enalapril should be avoided in patients with chronic urticaria.
Which one of the following is true regarding the treatment of temporal arteritis?
Right answer: Patients should expect to take medication for 1 to 2 yearsWhen treated early with prednisone, temporal arteritis has an excellent prognosis. Treatment should continue with low doses of prednisone for 1 to 2 years to prevent relapse. Joint involvement with effusion does not occur and there is no need for arthrocentesis. Most patients achieve complete recovery that persists even after medications are withdrawn.

The patient initial brain Ct:-,
Lumbar puncture:+
Which lab, is necessary to follow -up daily?
chem 7---------SAH may lead to hypo nat

Life threatening hemorrahge in a pateint on tPA 9tisue plasminoigen activator), beside discontinuation of tPA, you give:
a- protamine sulphate
b- vit K
c-Aminocaproic acid
t-PA TOXICITY - AMINO CAPROIC ACID (CRYOPRECIPITATE IF THAT CHOICE IS GIVEN

Hemorrahge in a patient with VW disease..next step:
a-DDAVP
b- VW factor concentrate
VON-WILLEBRAND'S DISEASE – DDAVP

Mild hemorrahge in a patient with hemophilia..next step:
a-DDAVP
b-Factor VIII concentrate
c-Fresh frozen plasma
MILD HEMOPHILIA – DDAVP


12 y/o boy with sore throat develop hematuria 3 days after??
IgA
Or Post strep GN

In those patients whose acute GN is the result of a postinfectious cause (ie, PSAGN being the most common), a latent period of 7-21 days between onset of the streptococcal infection and development of clinical GN is characteristic.

The development of clinical nephritis (ie, hematuria and/or edema) either during or within 2-5 days after the onset of a respiratory infection is atypical and suggests the possibility of some other form of GN.

Berger disease or IgA nephropathy usually presents as an episode of gross hematuria occurring during the early stages of a respiratory illness; no latent period exists, and hypertension or edema is uncommon.

Recurrent episodes of gross hematuria, associated with respiratory illnesses, followed by persistent microscopic hematuria, are highly suggestive of IgA nephropathy.

NAS: IgA (Berguer)


nurse put foley...u treat with antibiotics...come back in evening...he points to the penis and says its severe pain here...no fever or leukocytosis...u see a band around the midshaft with swelling?????
a- Do penile shaft dorsal incision
b-discuss cirumscission with the patient
Yes..this is paraphimosis
Circumcission is the best option..so discuss it with the patient! they are the same in regard the time..this is the trick! Circumcission is not that time consuming procedure!

pt. with planter warts .asks which RX not painful
a.laser surgery
b.podophylllin
c.keratolysis
d.cryotherapy
e.trichloracetic acid

A primigravida 28 weeks, Rh negative, husband positive. anti-***** antibody positive, what next
1. give anti-RhD
2. don't give anti-RhD
3. Do amniocentesis.
Anti-***** antibody is irrelevant here, which never causes hemolitic anemia in newborn. In this case, we should give mom Rhogam, which will last about 12 weeks in the blood circulation. This will prevent any immunization of the posible Rh antigen in the mother by the fetus. Atypical antibody mainly means Kell antigen.

In management of Delirium Tremens,
we start with iv lorazepam(ativan)hourly injection prn until sedated.---> once the patient is stabilized, change to po chlordiazepoxide.

Female gets raped by a stranger...She is LEAST likely to get infected by

1. HIV
2. Chlamydia
3. Gonorrhoea
4. Hep B
5. Syphilis
Yes, correct answer is HIV.

Tick was removed by Mommy as soon as she saw
Now what? The child is fine, fine happy:
A) Give him ampi
B) Do nothing
C)GIve him Doxycycline( he is >*8year old)
D)give treatment only if he gets fevr and myalgia and Blah..blah

Doxycycline Drug preferred for oral treatment in all patients except for pregnant and nursing women and children <8 y
I'll choose do nothing.

19 f preg. 16 eks her MASP came back as 3 time multipe of median 2.5 reason
a. neural tube defect
b. gestational error
c. abdominal wall defect
Screening for neural tube defects is done in 16 weeks of gestation.

High MSAP indicates U/S to confirm the gestational age, exclude multpile gestation and assess for neural tube defects.

Turner Synd pt. wants to be pregnant your response
a.adopt child
b. if you want pregnancy you need to be on hormonal Rx
c. if you get pregnant you will need amniocentesis
d. you need in vitro fertilization
Just 30 minitues ago, i read Turner's syndrom from emedicine. If they want to be pregnant, they can borrow egg from other women and in vitro fertiliztion.
Their ovaries are streak, but their uterus is ok.

pt with S/P TURP 3 months ago came for routine check up what you see on exam
a.testicular atrophy
b.blood in urine
c.increase psa
d. increase cea
You see for increase in PSA levels -routine follow-up for prostate cancer

28.pt. with Menier's disease c/o vomiting what causing
vomiting
a. cell in middle ear
b.vestibular stimulation
B: this is due to endolymphatic hydrops. NOT due to any cells in the inner ear. It causes vestibular disturbances by changing the electrolyte composition of endolymph (increase potassium) which is also neurotoxic causing temporary hearing loss. Once the electrolyte balance is resolved, the vertigo ends.

30. a kid with buccal FX what impact in future life
Buccal fracture_______ Mal occlusion

You examine pt eye with light in rt eye and pt is c/o pain in left eye:
a.arry.ro pupil
b.uveitis
c.acute angle glaucoma
uveitis!! consensual reflex causes pain.

patient comes with maniacal symptoms He has HBP and CCF treated with Captopril and digitalis, also under treatment for leukemia. Recently he has been treated for ITU with Ampicillin. Which one of the drugs that he used can be responsable for his symptoms
a, ampi
b. captopril
c. digitalis
d. antineoplasics
captopril
Mania can occur by chance association during drug treatment, particularly in patients predisposed to mood disorder. Single case reports are unreliable, and evidence must be sought from large series of treated patients, particularly those with a matched control group. Drugs with a definite propensity to cause manic symptoms include levodopa, corticosteroids and anabolic-androgenic steroids. Antidepressants of the tricyclic and monoamine oxidase inhibitor classes can induce mania in patients with pre-existing bipolar affective disorder. Drugs which are probably capable of inducing mania, but for which the evidence is less scientifically secure, include other dopaminergic anti-Parkinsonian drugs, thyroxine, iproniazid and isoniazid, sympathomimetic drugs, chloroquine, baclofen, alprazolam, captopril, amphetamine and phencyclidine. Other drugs may induce mania rarely and idiosyncratically. Management involves discontinuation or dosage reduction of the suspected drug, if this is medically possible, and treatment of manic symptoms with antipsychotic drugs or lithium.

a 7 yr old kid now crawling while going upstair getting worse every day what is the cause of death if he will die b4 20 yrs..( friedrich ataxia)
a)heart disease
b)pulmonary
c)kidney failure
d)cn
This is DMD classic.
ANSWER: Pulmonary
They typically die of respiratory failure in their 20s to 30s.


What is the most commone side effect after long term use of morphine ??
a. Constipation
b. ileusc. addictio
c. respiration suppression
Morphine can cause all of the listed, but if you are talking about medical therapy side effects, it is common to have constipation with any of the opiates.

Ans. constipation

If this is addressing overdosage I would go with respiratory depression, but since you stated chronic does that mean chronic medical therapy?

which of the following are complications of CF:
a) Hypertension in adulthood
b) Rectal prolapse in infants
c) Esophageal varices
d) Recurrent urinary tract infections
e) Diabetes

rectal prolaps

50 F, cholecystectomy 5 months back, now has epigastric pain, N, V, fever amylase, 14,500 U/L; lipase, 9300 U/L; aspartate aminotransferase, 500 U/L; alanine aminotransferase, 449 U/L; alkaline phosphatase, 420 U/L; total bilirubin, 1.9 mg/dL; calcium, 9.7 mg/dL; triglycerides, 430 mg/dL; and leukocyte count, 16 x 103/mm3.1. Which of the following is the most likely cause of this patient’s pancreatitis?
A. Fluoxetine administration
B. Hypercalcemia
C. Gallstones
D. Hypertriglyceridemia
E. Alcohol abuse

Gallstone

57. 45 y with c/o hematuria. No c/o pain. No constitutionla synptom.
March 13 2003 at 12:09 AM pk (no login)
from IP address 67.25.135.220

--------------------------------------------------------------------------------

fisrt test you will decide to do a.
a. ivp
b. cysto
c. c/s
d. ??

ANSWER IS URINE C/S

APPROACH TO HEMATURIA INVOLVES

STEP 1. URINE ANALYSIS AND DIPSTICK

STEP 2. URINE C/S

IMAGING IS CONTRIBUTORY INFORMATION BUT INITIAL WORKUP MUST BE DONE TO R/O STONE, INFECTION,GLOMERULAR CAUSES, CYSTIS

REF:\

http://www.emedicine.com/ped/topic95...section~workup


http://www.network54.com/Hide/Forum/...eid=1079361308


Tetracyclin-induced photosensitivity skin rash...asked about the treatment? Only medications mentioned. No choice of D/c tetracycline. Plz post the exact treatment..Plz

topical steroids and cool compresses
1. TOPICAL CORTICOSTEROIDS + COOL COMPRESS

2. SUNSCREEN (ONLY IF NOT CAUSTIVE AGENT)

3. AVOID SUNLIGHT, BUT DON'T STOP TAKING MEDICATION



1. 4 y/o kid with close contact for active TB, his
PPD is 4 mm-
rX WITH INH 3 MONTHS THEN REEVALUATE

2. 20 y/o HIV pt close contact with active TB what to
do PPD IS 4 mm (same case with PPD 7 mm)

3. 35 y/o diabetic, close contact with MDR-TB, his ppd
is 10mm. What to do & which drugs should be used ?

4. 45 y/o man last year his PPD was 5 mm this year is
9mm what to do? (same case but this year his PPD IS
11mm)

5. diabetic with 10 mm ppd but he had taken BCG
VACCINE 10 yrs ago

6. Px had clin SSx & X-*** COMPATIBLE w/ TB BUT
NEGATIVE SMEAR AND CULTURE EVEN BY BAL, WHAT TO DO ?


7. Px TO START 4 DRUGS, WHAT ARE THE BASIC LAB EXAMS
TO DO ? HOW TO FOLLOW UP WITH HIM ?

SAME CASE PUT THE PT HAS MDR-TB

8. PREGNANT WITH ACTIVE TB, WHAT TO GIVE & FOR HOW
LONG?

9. NEWBORN HIS MOTHER HAS ACTIVE TB, WHAT TO DO?

UPTODATE:
Contacts with a tuberculin reaction 5 mm should receive a chest radiograph; those without evidence of clinical disease should be evaluated for preventive therapy.
(Isoniazid preventive therapy)

Persons with an initial tuberculin reaction < 5 mm should receive a chest radiograph and be considered for preventive therapy if
(1) circumstances suggest a high probability of infection,
(2) evaluation of other contacts with a similar degree of exposure demonstrates a high prevalence of infection, or
(3) the contact is a child, adolescent, or is immunosuppressed (eg, infected with HIV).

Contacts who are initially skin-test negative should receive a repeat tuberculin skin test 10 to 12 wk after the initial test.
If the repeat skin test remains negative and contact with the source case has been broken, preventive therapy may be stopped.

If the repeat tuberculin test is positive, a chest radiograph should be obtained to exclude disease. If there is no evidence of disease, a full course of preventive therapy should be given.
If the repeat tuberculin test is negative, no further evaluation is indicated for persons with normal immunity.

Contacts with HIV infection should be considered for preventive therapy, regardless of tuberculin skin test results.

Use of BCG vaccination —
Vaccination with BCG is not recommended for widespread use in the United States because of the low risk of infection in the general population, and because BCG vaccine has varied in effectiveness in eight major trials from zero to 76 percent.

However, BCG vaccination is recommended
1.for long-term protection of infants and children with negative tuberculin skin tests
a-who are at high risk of continuing exposure to persons with infectious TB
b-and who cannot be placed on long term preventive therapy,
c-or who are continuously exposed to persons with INH- and RIF-resistant disease.

BCG vaccination should also be considered for tuberculin-negative infants and children in groups in which the rate of new infections exceeds 1 percent/yr and for whom the usual treatment and control programs are not effective.
These groups include persons without regular access to health care, those for whom health care is culturally or socially unacceptable, and groups who have demonstrated an inability to use existing health care.


For pregnant, HIV-negative women, isoniazid given daily or twice weekly for nine or six months is recommended.

For women at risk for progression of LTBI to disease, especially those who are infected with HIV or who have likely been infected recently, initiation of therapy should not be delayed on the basis of pregnancy alone, even during the first trimester.
For women whose risk for active TB is lower, some experts recommend waiting until after delivery to start treatment.

For children and adolescents, isoniazid given either daily or twice weekly for nine months is the recommended regimen.

For contacts of patients with isoniazid-resistant, rifampin-susceptible TB,
rifampin and pyrazinamide given daily for two months is recommended, and for patients with intolerance to pyrazinamide, rifampin given daily for four months is recommended.

For persons who are likely to be infected with isoniazid- and rifampin-resistant (multidrug) TB and who are at high risk for developing TB
pyrazinamide and ethambutol or
pyrazinamide and a quinolone (ie, levofloxacin or ofloxacin) for 6 to 12 months are recommended.

Immunocompetent contacts may be observed or treated for at least six months, and immunocompromised contacts (eg, HIV-infected persons) should be treated for 12 months.


Parkinson pt started on levodopa/carbidopa. Hyperactive, aitated,also h/o psychosis. Next?

a. Stop levo/carbi
b. Add loraepam
c. Stop antipsychotic
d. Add amantadine

This means that when a parkinson patient develops psychosis (halluciantion/aagressive behavior), the sinemet is the offending drug and should be d/c.


A male on aldomet and Ace inhibitors gets anemia, Hb
decreased. Direct Bilirubin increased.
?
A. Direct coombs test
B. Indirect coombs test
C. ?
D. ?
Direct coomb
this is drug-induced autoimmune hemolytic anemia.. Aldomet (methyldopa) is a famous drug in this...
Usually the RBcs are IgG-coated..That's why direct coomb is positive for IgG.

79 YOF is on Estrogen,warfarin and Lithium. Tongue becomes slurred and she becomes ataxic. what is responsible?
A. Estrogen
B. Warfarin
C. Lithium.
D. ?
Lithium toxicity causes dysarthria with slurred and indistinct speech,and ataxia

Pt on HRT get DVT??
Stop Hrt and start anticoag
continue HRT and start acoag
Ans: Away from the anticoagulant therapy and its interaction with HRT, once the patient gets DVT ==> HRT should be discontinued as it is a factor for causing the venous thrombosis.

So the answer should be d/c HRT.

In gallbladder sludge by u/s and pt is sym with pain fever and has diabetic,next step
a) ct abdomen
b) start antibiotic
c) ercp
d) observation
Start ANBX FOR THESE CHOICES
AND THEN LAP CHOLE DURING THE SAME ADMISSION.
But Kaplan explanation on a Qbank Q is CT March 15 2004, 3:07 PM

“Abd Ct will reveal a thickened gallbladder wall, pericholecystic fluid, gas within the gallbladder, and evidence of surrounding inflammation.”

Abx will come after CT.

Surgery is indicated if there is gangrene or unresponsive cholecystitis.


An inpatient on the medical service, a60 year of female is hospitalized for diverticulosis. the bleeding that is associated with this conditionis due to which of the following?
A.rupture of the diverticulum
B.Infection of the diverticulum
C.venous bleeding
D.erosion of an artery
E. pancreatic calcifications
D March 13 2004, 11:46 PM

intramural artery
Actually at the angles of arteries and bowel thinned out D'tic is the weakest part of the tic from where it gets ruptured so actually The tic itself is nothing to erode the artery but it may happen with its rupture pulling the angulated vessel.
So the blood is ofcourse arterial and then what should we mark is still a dilemma bc bleeding is after the rupture of these multiple tics and there fore bleeding stos spontaneously.from very tiny angulated vessels.

http://www.network54.com/Hide/Forum/...eid=1079197963

A 19-year-old camp counselor presents to the ED complaining of progressive difficulty walking which has developed into ascending, symmetric, flaccid paralysis. He reports taking a long hike through the woods 2 days ago but otherwise has no trauma and has no past medical history. Which of the following actions will likely help you discover the etiology of his symptoms?
a. Careful skin examination
b. Urine drug screen
c. CPK level
d. Forced vital capacity
e. Assay for clostridium botulinum toxin
Ans: A
this looks like a case of tic paralysis.good skin examination will be necessary.LP in this case will be normal and paralysis will be ascending symmetrically because of the toxins secreted by the tic.


A 45-year-old woman with a history of myasthenia gravis presents with severe, generalized weakness. There has been no change in her pyridostigmine dose. A Tensilon test is performed which results in increased muscle weakness. Of the following, which is the MOST IMPORTANT treatment consideration?
a. Closely monitor respiratory status
b. Give atropine and titrate to symptoms
c. Increase patient pyridostigmine
d. Initiate pralidoxime treatment
e. Prepare for possible plasmapharesis


This pyridostigmine toxicity..If you increase its dose, you will worsen the symptoms. The first step is administer atropine..but monitoring resp. status is very important..so i guess the answer is a
THE MOST IMPORT THING TO MONITOR IN MYASTHENIA IS VITAL CAPACITY THUS THE ANSWER IS A, RESP FUNCTION.

A 32-year-old man presents to the ED stating, “I’ve had a stroke.” He states that his face felt “funny” last night and when he awoke this AM he noticed left sided facial droop. On exam he has intact contralateral eye closure to corneal touch and decreased ipsilateral forehead wrinkling. Proper treatement to avoid the primary complication of this disease is which of the following?
a. Antibiotics and steroid ear drops
b. Artificial tears and lid taping at night
c. Liquid diet for 2 weeks
d. Coumadin
e. Prednisone 40 mg per day for 10 days
B
BELL'S PALSY
It is self-limiting. Steroids are of no proven effect.
Eye care is very important till the palsy resolves



A patient with a history of AIDS and HIV encephalopathy is brought in by his partner because of a deterioration in his level of function. On examination his vital signs are normal, he is lethargic, but easily arousable when his name is called. What is the appropriate management in the ED for this patient?
a. Discharge home with a social service referral after advising his partner that HIV encephalopathy is a progressive disease and nothing can be done to alter its course
b. Head CT, LP and admit
c. CBC, UA and Chemistry – if normal discharge home
d. Perform an LP and if the cell count is normal discharge home
e. Obtain a head CT without contrast and if normal discharge home

ANSWER IS HEAD CT, LP, ADMIT PATIENT

THE IMPORTANT THING HERE TO KNOW IS THAT HIV ENCEPH IS A PROGRESSIVE DISEASE. THE PATIENT IS GOING DOWN. IT IS IMPORTANT TO GET A LP TO RULE OUT CMV INFECTION AND GET CT TO R/O TOXOPLASMOSIS.

A 69-year-old woman presents with disheveled appearance, slow movements, impaired cognition, dysarthric speech. Family members have recently come into town and found her in this state. Neighbors relate a slow decline in her functioning over the course of months. Her vital signs are normal. Given this description which of the following is most likely?
a. Alzheimer’s disease
b. Subcortical dementia
c. Pick’s disease
d. Large MCA infarction
e. Delirium
THIS Q IS CLASSIC FOR KICKING A EXAM GOER IN THE BUTT.

DON'T GO ON WHAT THE NEIGHBORS SAY. AT THE CURRENT MOMENT WHEN THE FAMILY STEPPED IN, SHE IS IN THIS STATE. ALZHEIMER'S DOESN'T PRESENT LIKE THIS. IT PRESENTS WITH MEMORY LOSS. THIS PRESENTATION DOESN'T METION ANYTHING ABOUT HER OTHER THEN BEING DELIROUS. ANY UNDERLYING DEMENTIA CAN BE THERE, BUT FOR THAT WE HAVE TO DO A MINI MENTAL EXAM TO DETERMINE MEMORY.
CURRENTLY SHE MAY HAVE POPPED A SEDATIVE, HER ELECTROLYTE MAY BE WACKED OUT. WHO KNOWS.

A 21-year-old man presents to the ED with the complaint of an excruciating headache. He states the headache began immediately post-coital approximately 14 hours prior to arrival. He relates no trauma and has taken multiple doses of OTC pain meds without relief. He rates the pain as an “11” on a scale of 1 – 10. He states he has gotten a headache before during intercourse but never of this magnitude. His neurological exam is normal and his non-contrast head CT is unremarkable. His vital signs are all within normal limits and his pain is controlled to a “5/10” with a dose of ketorolac and phenergan IV. Your plan should be
a. Referral to neurology for workup of cluster headaches
b. Reassurance that post-coital headaches can occur and are benign
c. Lumbar puncture
d. Discharge with prescription for medrol dose pack
e. CT with contrast


the next follow up q is asking after your initial test
came negative what will you advise the patient

ANYWAY, ACCORDING TO VARIOUS WEBSITES, POSTCOITAL HEADACHE IS A MIGRAINE VARIANT (REF: EMEDICINE) THAT CAN PRESENT LIKE A SAH.BUT THE IMPORTANT FACT IN THIS HISTORY IS THAT IT IS NOT HIS FIRST EPISODE AND WILL NOT BE HIS LAST. MOST SAH S/S HAVE NECK STIFFNESS,BRAINSTEM ABN BECAUSE OF HMMGE IN MIDBRAIN, AND ABN NEURO EXAM. THESE TYPE OF HEADACHE USUALLY OCCUR ALONG THE LINES OF MIGRAINE. DO YOU DO LP IN MIGRAINE.

WORKUP INCLUDES:
CT W/O CONTRAST
OBSERVATION FOR DETERIOTING NEUROLOGICAL FUNCTION
REASSURANCE.

LP IS INDICATIED IN ANY VARIANT FROM ABOVE, OR FIRST TIME UNDIAGNOSED POST COITAL HEADACHE TO R/O SAH.

MOST IMP. TREATMENT INCLUDES INDOMETHACIN FOR PAIN, PROPANLOL FOR CONTROLLING HYPERTENSION( MOST COMMON UNDERLYING FACTOR)


Three members of a family present to the ED complaining of mild headache. They all state that the headache started during the night and is now a throbbing pain. None are febrile. What is the test that will be most likely to give you a diagnosis?
a. Lumbar puncture
b. Non contrast CT head
c. CBC
d. Acetaminophen level
e. ABG
Ans : e

carbon monoxide poisoning

A 27-year-old man with no past medical history is found down at his parent’s home. He is brought in with CPR in progress and while in PEA initially, the patient’s rhythm degraded into asystole shortly after arrival and remained asystole during a prolonged and unsuccessful resuscitation. When discussing the patient’s death with the family is it important to
a. Tell them as soon as he has passed even if that means doing it over the phone
b. Use comforting words such as “passed on” and “gone home to God” instead of saying “dead” is advised
c. Express empathy by telling the family that you know how they feel
d. Provide detailed information of each procedure performed and each rhythm the patient had
e. The arriving family should be directed to a room far enough away from the resuscitation area to minimize overhearing inadvertent comments

ANS: C

A 50-year-old man is given an IV medication. Shortly after the infusion begins you notice a diffuse red discoloration to his skin. This patient is likely receiving
a. Ketorolac
b. Levofloxacin
c. Methylene blue
d. Thiamine
e. Vancomycin
vancomycin-red man syndrome

The mother of a 7-month of boy tells you that he was in the bath seat in the sink when she turned away to get some soap. She tells you she thinks that he turned and then fell into the hot water. The child has second-degree burns on both feet and ankles to just above the malleoli. Your management is to
a. admit the child and consult child protective services
b. Attempt to corroborate the history by contacting another caretaker
c. Call the state welfare agency to arrange a home visit
d. Teach the mother about burn prevention and water safety
e. Treat the burns and arrange outpatient PT and surgery follow-up

ANS: A
admit the child and contac the child protection services


A pinkish maculopapular rash that first appears on the face and associated with generalized lymphadenopathy including suboccipital and postauricular nodes ,with small reddish dots on the soft palate is typical of
a. Measles
b. Rocky Mountain Spotted Fever
c. Roseola
d. Rubella
e. Rubeola
ANS: D
Rubella (German or three day measles):
agent: togavirus

prodrome: malaise, then suboccipital lymphadenopathy
rash: maculopapular rash that appears on the face and then generalizes, resolving in three to five days.
fever: on first day of rash only
viral exanthem: petechiae on the palate (FORSCHEIMER'S SPOTS)

A 31-year-old woman presents to the ED shortly after the onset of myalgias, low-grade fever and headache. Her head CT was normal and an LP was performed. Her LP results show an RBC count of 4,000 without xanthochromia and a WBC count of 400 (100% lymph). Her CSF to serum glucose ration is 0.2:1 and her protein count is 60. Her gram stain and bacterial antigen testing will not be done for several hours. What are these values consistent with?
a. Traumatic LP
b. Normal CSF
c. Bacterial meningitis
d. Subarachnoid hemorrhage
e. Cryptococcal meningitis

ANS: A

A 45 year old man presents with fever and a fiery red, indurated, edematous lesion on the face. The borders of the lesions are elevated and sharply demarcated. What is the most likely causative agent?
a. Group A streptococcus
b. Hemophilus influenzae
c. Neisseria meningitides
d. Staphylococcus aureus
I think the other choice was herpes .

ANS: A
erysipelas is an acute infection of the dermis by strep. pyogenes. it shows well demarcated erythema, edema, and tenderness. the skin lesions may be preceded by fever, malaise, and flu like symptoms. it usually affects the face, where it may be bilateral, or the lower leg. the lesion has a well defined edge and may blister. the streptococci usually gain entry via a fissure,i.e. behind the ear. systemic, not topical, therapy with a penicillin, or erythromycin for those allergic to penicillin, is the treatment.

What is the next step in the proper management of a 3 cm subcutaneous abscess on the leg of an otherwise healthy 10 year old girl?
a. Antibiotics to cover staphylococcal infection
b. Culture, aspiration, wait for results and treat accordingly
c. Incision and drainage, gram stain and antibiotic to cover likely species
d. Incision and drainage only
e. CBC, blood culture, antibiotics to cover streptococcus

ANS: D
No fever so only I&D,, with fever I&D plus ab.

A 21 year old man has a non pruritic rash on his chest and back, which has been worsening over the summer. On examination there are multiple macular patches of hypopigmentation. What is the most likely diagnosis?
a. Molluscum contagiosum
b. Pityriasis rosea
c. Tinea cruris
d. Tinea versicolor
e. Rocky Mountain Spotted Fever

second q was what is the treatment ?
a.topical antifungal agents
b.no need of treatment
c.topical antibiotic

ANS: D And A
Pityriasis (tinea) versicolor. Appears as slightly pigmented superficial tan scaling plaques of various sizes, primarily on the neck, trunk, and proximal area of the arms. With sun exposure, the infected regions do not tan and appear hypopigmented. Usually caused by Malassezia furfur (Pityrosporum orbiculare). Diagnosis is by clinical exam and KOH preparations of skin scraping. Treatment can be with topical miconazole 2% cream twice daily or washing with zinc or selenium shampoos daily for 2 to 3 weeks. Although not FDA approved, ketoconazole 400 mg in a single dose orally is 97% effective in adults. Have patients exercise to a sweat and not shower for 2 to 4 hours.

A 6 year old child presents with a patch of scaly alopecia for two weeks duration. Wood's lamp examination gives a blue green fluorescence. What is the best treatment?
a. Clotrimazole (Lotrimin) cream
b. Griseofulvin
c. Mupirocin (Bactroban) ointment
d. Systemic steroids
e. Frequent baby shampoo soaks

ANS: Microsporum, tinea capitis
Tx: ???

A 34-year-old female presents to the ED after she is found by her roommate cutting her own arm. Her left arm has several superficial cuts none of which require suturing. She states that she was not depressed and has no suicidal ideations. She spits at the nurse taking care of her but smiles when you walk in the room. She states she has never had a more caring physician than you. She most likely has which personality disorder?
a. Borderline
b. Antisocial
c. Dependent
d. Narcissistic
e. Paranoid

ANS: A

A 52-year-old man presents to the ED in custody with police with blood on his forehead after a fight with a homeless man in a bar. He refuses to tell you any identifying information. He states all you have to do is stitch him up and let him go. During suturing he states he has had enough and wants to go “now.” He most likely has which personality disorder?
a. Borderline
b. Antisocial
c. Dependent
d. Narcissistic
e. Paranoid
ANS: B

A 56-year-old psychology professor presents to the emergency department complaining of total lower extremity paralysis. He states that it happened all of a sudden. He reports complete anesthesia to both lower legs below the knee. His mentation is normal as are his vital signs and laboratory studies. He is calm and pleasant in the ED. The most likely diagnosis is
a. Guillan Barre Syndrome
b. Sciatic Mononeuropathy
c. Conversion disorder
d. Antisocial personality disorder
e. Transverse myelitis

ANS: C

A transferred trauma patient with a known intracranial hemorrhage has a fixed dilated pupil on the right and an upgoing toe on the left. What will a CT scan of the head most probably show?
a. Pontine hemorrhage
b. Subdural hematoma on the left cerebral cortex
c. Subdural hematoma on the right cerebral cortex
d. Subdural hematoma pressing on the left cerebellar cortex
e. Subdural hematoma pressing on the right cerebellar cortex

ANS: C
Unilateral dilated, unreactive pupil :
sign of herniation of the uncus (part of the temporal lobe) and represents a neurosurgical emergency. Pressure on the third nerve after its exit from the midbrain results in failure of parasympathetic innervation to the eye. This pressure on the third nerve can arise from a herniating uncus or an expanding posterior communicating artery aneurysm.

The ipsilteral internal capsule is also compressed thereby causing the contralateral positive Babinsky.


3 wks hx of bloody diarrhea ,wt loss.febrile,dehydrated,distended abdomin ,llq tenderness you suspect ulcerative collitis ,what are your initial investigation EXCEPT
1) stool culture
2)barium enema
3)sigmoidoscopy
4)plain abd x-***
5)serum electrolyte

option 2 - CLOSED March 12 2004, 2:06 PM

1) stool culture - done to exclude infectious colitis
2) barium enemas - of little utility in the evaluation of ulcerative colitis; may precipitate toxic megacolon
3) sigmoidoscopy - the diagnosis is readily established; mucosal appearance is charachterized by edema, friability, mucopus, and erosions.
4) plain abd xray - look for significant colonic dilatation
5) serum electrolytes - not a specific diagnostic test, but given that they are severely dehydrated, it is a must to do this test.


A 42-year-old white female has a 2-month history of vaginal itching. Another physician
prescribed three courses of antifungal therapy, but the condition persists. The patient says there
has been no discharge, and there are no skin lesions anywhere else. The physical examination is
remarkable only for a lacy white rash on the labia minora.
Which one of the following is the most likely diagnosis?
A) Atrophic vaginitis
B) Lichen planus
C) Contact dermatitis
D) Chronic candidiasis
E) Vaginal adenosis
ANS: lichen planus

A 91-year-old white male presents with a 6-month history of a painless ulcer on the dorsum of the
proximal interphalangeal joint of the second toe. Examination reveals a hallus valgus and a rigid
hammer toe of the second digit. His foot has mild to moderate atrophic skin changes and the
dorsal and posterior tibial pulses are absent.
Appropriate treatment includes which one of the following?

A) Surgical correction of the hammer toe

B) Custom-made shoes to protect the hammer toe

C) Bunionectomy

D) A metatarsal pad
ANS: surgical correction.

You have diagnosed tardive dyskinesia in a 72-year-old white female with schizophrenia. She resides in a nursing home and has been treated with haloperidol (Haldol), 1 mg twice a day, for 5 years. She also has a hiatal hernia.
Which one of the following statements is true regarding this patient?

A) The chances of symptom remission after withdrawal of the haloperidol are better than
for a younger patient
B) Quickly reducing the dosage of haloperidol will lead to prompt worsening of her tardive dyskinesia
C) Long-term metoclopramide (Reglan) would be the best treatment for her hiatal hernia
D) Risperidone (Risperdal) would be more likely than haloperidol to cause tardive
dyskinesia
ANS: C

Which one of the following is considered a contraindication to the use of $-blockers for
congestive heart failure?
A) Mild asthma
B) Symptomatic heart block
C) New York Heart Association (NYHA) Class III heart failure
D) NYHA Class I heart failure in a patient with a history of a previous myocardial
infarction
E) An ejection fraction <30%

ANS: A (?)

A 37-year-old white female who has had silicone breast implants for 17 years is concerned about
the risk of developing joint problems from the implants.
You discuss studies concerning risks of connective tissue disease in women who have silicone
breast implants and
A) recommend that she have her implants removed
B) recommend that she have her implants removed and replaced with saline implants
C) order laboratory testing to check for connective tissue disease
D) assure her that there is no increased risk of connective tissue disease in women with
silicone implants
ANS: D

The parents of a 20-month-old female bring her to your office because she has lost consciousness
twice recently. They describe two episodes where the child was crying vigorously then “turned
purple and passed out.” The child is an otherwise healthy product of a term delivery. There is
no history of head trauma and no family history of seizures or cardiac problems. The episodes are
not associated with fever or other symptoms. Physical examination of the child is normal.
Which one of the following would be most appropriate at this point?
A) Reassurance
B) A CT scan of the brain
C) An EKG and chest radiograph
D) Measurement of serum glucose, electrolytes, and hematocrit
E) Echocardiography
ANS: breath-holding spell (B)

a 54 y/0 AAF with history of copd,cad,and b/l osteoarthritis of knee in need of stress test. Best choices is.

1.treadmill
2.persantine
3.dobutamine.
ANS: 3
How serious is his OA. Treadmill would be the choice if he has mild/moderate OA. Drug-induced stress test is not as sensitive as exercise stress test. I guess probably there is more info mentioned in q.

What is the # 1 drug decreasing MR in post MI
1. ASA
2. B blocker
3. ACE I
ANS: 3

A 54 year old woman complains of hot flashes and night sweats Her last menstrual period was 2 years ago. She also has migraine headaches and a family history of breast cancer via her maternal aunt. What is the appropriate treatment for her?

A. Hysterectomy .
B. Endometrial Biopsy.
C. Medroxyprogesterone Acetate.
D. Estrogen Cream.
E. Estrogen and Progestin therapy
ANS: C
Q2 male divorced ex- alcoholic, brother died, pt wants too, get detoxicated. Found in a state of delirium with cuts and hallucinations,what is the next to check

-blood B12 & Folate
-blood glucose
-serum magnesium
ANS: Glucose. Alcohol causes hypoglycemia.


Cherry red maculae are seen in:
1. Ethanol toxicity
2. Methanol toxicity
3. Salicylate poisoning
4. Diabetic retinopathy
ANS: cherry red macula: Tay sach disease, methanol toxicity, CRAO (central retinal artery occlusion).

Pt c nausea vomitting taking digoxin, stable, k+6.0
(Hyperkalemia not hypokalemia ;worse tox.)
a) give ca gluconate
b) digiband
c) take digoxin levels
Dig toxicity causes hyperkalemia.Pt is having n/v and increase Pottasium.Therefore check dig level.
Hypokalemia predisposes dig toxcity which is not seen in this pt.


xray chest of baby, coin in oesophgus. What will happen?

A. Suffocation
B. Pneumothorax
C. Drolling
D. ?
Airway ==> chocking
Esophagus ==> Drooling (small objects)
Drooling + chocking (large objects).

Thenar atrophy, Numbness in rt. 3+1/2 fingers. How you will prove carpel tunnel syndrome?.

A. Flexion of wrist.
B. Abduction of wrist.
C. Extension of wrist.
D. ?
ANS: a) flexion

57 y male. uncontrolled HTN . came to office. PMG examine and found a bruit at epigasum. You decide to do test to confrim yje Diag.Waht is best test

a. u/s
b. renal duplex scan
c. ct
d. ??
no option of renal aretriogram or captopril test.
ANS: Initial screening include duplex U/S, captopril renal scintigraphy and MRA. Angiography is required for planning an operative strategy. CMDT 2003


17.pt had afib and now had loss of pulse on thumb what now
a.embolectomy
b.warfarin
NONE\ANS: surgical repair

pr had tried smoking preva with nictine patch and now taking about some medication to prevent
give wellbutrin(bupropion

1- pt was on vent u did abg po2 bad and was on fio2 70
a.add peep
b.increase fio2
2- pt was on vent u did abg po2 bad and was on fio2 70. f/u now abg show po2 100 and fio2 was 60 peep was 5
a.decres fio2
b.d/c peep
ans,
a a
Positive end-expiratory pressure
PEEP shifts lung water from the alveoli to the perivascular interstitial space. It does not decrease the total amount of extravascular lung water. It is common to apply physiologic PEEP of 3.0-5.0 cm H2O to prevent decreases in functional residual capacity in those with normal lungs. The reasoning for increasing levels of PEEP in critically ill patients is to provide acceptable oxygenation, and reduce the FiO2 to nontoxic levels (FiO2 <0.5).

a 25 year old lady presents with fatidgue since she was treated with tmp-smx for cystitis. she is on vegetarian diet since 6 months. hb=10., mcv=85, retic count=15%.,cause of anemia
1. anemia due to infection - cystitis does not cause anemia
2. antibiotic - Answer G6PD
3. g.i. blood loss - no indication of that
4. sickle cell anemia - she is not AA
5. vegetarian diet? - Fe defic w/ low MCV not the case here

1.principal called u for 3 kid had dignosed with rubella now what in school
a.gave rubella vaccine to all children
b.gave rub immuno to all childern
c.give rubella vaccine to child who is not immune to it
Ans: all kids have mmr
c

a 2 year old boy is brought to er , becoz he could not use his right arm since he fell. he hold his right arm at his side with his forarm pronated., there is restricted movement of elbow, initial step?
1. passive hypersupination of forearm
2. application of figure of 8 strap
3. administration of analgesics and application of ice
4. aspiration of elbow joint.
5. in place splint immobilization of elbow
ANS: passive hypersupination of forearm





Surgical PT. on TPN(total parentrel nutrition). Trace element urgently needed.
A. Mangnese
B. Selenium
C. Zinc
D. Copper
Zinc is URGENTLY needed during the first week of TPN..
Selenium and iodide are added later..after 4 weeks.

13 YOM, Cystic fibrosis, starts womitting fresh blood.
?
A. A-V malformation
B. Duodenal ulcer
C. Gastritis
D. Oesophageal varices
Cystic-fibrosis associated liver fibrosis => portal hypertension
The answer: Esophageal Varices
If this is real recall, it would be an unfair Q in an unfair exam!

A 26-year-old man is admitted to the hospital after accidental ingestion of corrosive alkali liquid. He denies any past medical or surgical history. The day before admission, he was at a party with his friends where he consumed a lot of alcohol. At the end of the party, he returned home and accidentally ingested corrosive alkali liquid from a bottle, mistaking it for a bottle of water. At the time of admission to the hospital, he complained of substernal chest pain and that he was feeling "really ill". Initial gastrointestinal contrast study with water-soluble contrast did not reveal a gastrointestinal leak or perforation. His vitals are stable with a tachycardia of 90/min. The next best step in management is to
A. continue to observe him in the hospital
B. order a CT scan of the chest
C. order an electrocardiogram
D. order an upper gastrointestinal study with barium
E. perform an upper gastrointestinal endoscopy

ANS: E

Female complaining of Hair falling in groups.On close exam, Hairs are split-ends and oil visible on them. She is also on Lithium.Cause?
A. Lithium***
B. Chemical reaction
C. Oil toxicity
ANS: A

Suspicion of ank. Spondylitis.You are allowed to order only one test.
A. HLA B27
B. ESR
C. X-*** Sacroiliac joint
D. X-*** hand and feet.
Answer is Xray of sacroiliac

old pt major depression with insomenia, Tx drug of choice?
ANS: Antidepressant treatment of the depressed patient with insomnia: Amitryptiline

Rt. knee was hit on lat. side. (+ive) for effusion.
what is injured?
A. Ant. cruciat ligament
B. Post. Cruciate Ligament
C. Med Collateral Ligament
D. Lat. Colateral LIGAMENT

[Anonymous]

Injury to knee from the side +/- effusion. FO rthe Boards - it is ALWAYS Medial COllateral Ligament Tear

The action of oral sulfonylurea compounds is augmented by
dicumarol
thiazides
furosemide (Lasix)
corticosteroids
ANS:Warfarin should NOT be given with sulpha compounds..like sulphonamides (like TMP-SMX) and sulphonaylureas (like glyberide)..

anticholinergic and narcotics r associated with which
of the following urinary incontinence..
a)urge
b)overflow
c)complex incontinence
d)functional
e)stress incontinence.
FUNCTION OF ANITCHOLINGERICS = URINARY RETENTION
SIDE EFFECT OF NARCOTICS= URINARY RETENTION THROUGH DEPRESSION OF CNS

ANSWER: OVERFLOW INCONT.

ALL THE OTHER INCONTENCES CAUSE INCREASE URINATION.

ANTICHOL AND NARCOTICS CAUSE A FALSE OVERFLOW INCONT THAT CAN BE CORRECTED BY STOPPING THE DRUG.

xray chest of baby, coin in oesophgus. What will happen?

A. Suffocation
B. Pneumothorax
C. Drolling
Choking occurs if the body is in the airway or if it is in the esophagus but large enough to compress the adjacent airway. Therefore, let's close this recall as follows..keep it in your mind to pick up the answer according to what you find in the Q:
Airway ==> chocking
Esophagus ==> Drooling (small objects)
Drooling + chocking (large objects).

Thenar atrophy, Numbness in rt. 3+1/2 fingers. How you will prove carpel tunnel syndrome?.
A. Flexion of wrist.
B. Abduction of wrist.
C. Extension of wrist.
ANS: A

Kid, fracture of clavicle.
A. Closed reduction
B. Open reduction
C. fifgure of 8
ANS: Sling it

79 YOF is on Estrogen,warfarin and Lithium. Tongue becomes slurred and she becomes ataxic. what is responsible?

A. Estrogen
B. Warfarin
C. Lithium.
D. ?
ANS: C

Tetracyclin-induced photosensitivity skin rash...asked about the treatment? Only medications mentioned. No choice of D/c tetracycline. Plz post the exact treatment..Plz
TOPICAL CORTICOSTEROIDS + COOL COMPRESS


Which one of the following would be considered first-line therapy for mild to moderately severe psoriasis?
Phototherapy using ultraviolet B light
Methotrexate
Etretinate (Tegison)
Betamethasone dipropionate (Diprolene, Alphatrex)
#1 doc -- Topical steroids; betamethasone, clobetasol, halobetasol
If not responding --> UV light
If no response --> MTX

An 82-year-old white male presents with 48 hours of fever and delirium. He has a 6-week history of a hot, swollen knee, poor appetite, weakness, and weight loss.

His past history includes type 2 diabetes mellitus, polymyalgia rheumatica, degenerative arthritis, and paroxysmal atrial fibrillation. His only medication is low-dose steroids for the polymyalgia rheumatica. He is febrile, appears chronically ill, has atrial fibrillation with an uncontrolled ventricular rate of 180/min, and has an acute arthritis of his left knee. Physical examination and laboratory studies reveal a serum glucose of 440 mg/dL, anemia of chronic disease, and Staphylococcus aureus septic arthritis with bacteremia.

Results of thyroid function tests, done as part of his tachycardia evaluation, were as follows:

Thyroxine by radio-immunoassay..........0.9 mcg/dL (N 4-12)
T3 resin uptake (T3RU)..................61% (N 25-35)
Free thyroxine index(T7)................0.55 mcg/dL (N 1.8-6.0)
Thyroid stimulating hormone.............2.7 ng/mL (N < 5)
Triiodothyronine (T3)...................23 ng/dL (N 75-195
TRH stimulation test....................response within normal limits

There is no history of thyroid disease, he has no goiter, and a T4 level done 4 months ago was 8.4 mcg/dL. The most likely diagnosis is



A. Sick euthyroid syndrome
B. Thyroxine binding globulin (TBG) deficiency syndrome
C. Primary hypothyroidism
D. Pituitary infarction
E. Thyroxine binding globulin deficiency syndrome

Euthyroid Sick Syndrome
Euthyroid Sick Syndrome is defined in the online Merck Manual. According to that definition, here is how Euthyroid Sick Syndrome and Wilson's Thyroid Syndrome compare:

Euthyroid Sick Syndrome / Wilson's Thyroid Syndrome
Probably due to decreased T4 to T3 conversion= Yes / Yes
Thyroid Blood Tests= Always Abnormal / Typically Normal
Low Thyroid Symptoms = None / Severe
Persists after non-thyroid stress or illness has passed= No / Yes
Treated= No / Yes, reversible

Other than having one thing in common, Euthyroid Sick Syndrome and Wilson's Thyroid Syndrome are almost complete opposites. Euthyroid Sick Syndrome is all about abnormal thyroid blood tests in patients without low thyroid symptoms. The condition is not considered to need treatment because there are no symptoms and the tests go back to normal when the stressful illness has passed. On the other hand, Wilson's Thyroid Syndrome causes severe low thyroid symptoms and is undiagnosable with thyroid blood tests. The symptoms can persist for years after a stressful illness and can worsen with subsequent stresses. Without treatment patients may suffer indefinitely. WTS is reversible and often responds dramatically well to proper T3 therapy.


Which one of the following is a common source of exposure to formaldehyde?
Arc welding
Urethane foam insulation
Emissions from copying equipment
Photo supplies
Refrigeration
ANS: Urethane foam insulation

STABLE Pt with A fib with rapid ventricular response what is the best treatment??
A) digitalis
B) Cardioversion
C) Procainamide
D) Warfarin
E) Thrombolytic therapy
The goal is to bring down the vent rate first and then start heparin
So Ans: = Digoxin
(If verapamil is there, I would choose that


best test to confirm rupture of memberanes: pool, nitrazine, fern? POOL

9. med student with meningitits: prophylaxis with cipro or rifampin?
Ans: rifampin

10. chil vomit and diarrhea 5-6x, 2-3 percent hydrated...IV or oral fluids?
answer; oral fluids

12. can't sit stand with antipsychotics should decr dose or give b blockers?
answer: beta blockers for akathasia

Rt. knee was hit on lat. side. (+ive) for effusion. what is injured?
A. Ant. cruciat ligament
B. Post. Cruciate Ligament
C. Med Collateral Ligament
D. Lat. Colateral LIGAMENT
Football/Soccer player injury - MCL tear
Meniscus tear can be associated and there can be joint effusions



am posting new recalls..paying back to this forum and Naz in particular..

1.A neonate with jiterness.. possible cause:
a) Hypocalcemia b) hypoglycemia.

2. A neonate with scaphoid abdomen and resp.
distress..possible cause:
a) Diaphragmatic paralysis b) diaphragmatic hernia

3. A neonate with Erb’s palsy..Prognosis?
a) Will recover spontaneously. b) Will recover with
splinting.

4. A neonate with scalp swelling..The swelling is
confined to the skull sutures..cause?
a) cephalohematoma b) caput saccedanum

5. A neonate with febrile seizure secondary to Otitis
media…During his stay in the hospital, the neonate
will:
a) need seizure prohphylaxis b) unlikely to have
another febrile seizure c) Head CT scan should be
done.

6. Pic of impetigo around the lip…Looks very similar
to herpes! The clue was tender submandibular lymph
nodes…asked about the diagnosis.

7. Pic of atypical lymphocytes seen in a patient who
received blood transfusion. Monospot test negative.
Asked about the treatment? observe only..(CMV
infection).

8. Patient with brain death..you have to document in
the patient's chart that:

a) Two EEG 48 hours apart were baseleine.
b) Brainstem and cerebral reflexes are irreversibly
absent.
c) Irreversible absent cerebral blood flow on cerebral
doppler scanning.

9. The next question..

The relatives noticed some movements in the legs..most
likely Spinal reflexes after brain death..You tell the
relatives:

a) These movements are inconsistent with brain death
and withdraw your braindeath announcement.
b) Normal finding after brain death

10. DIC..the important finding on peripheral smear:
a) Howell-Jolly bodies
b) schistocytes
c) Heinz bodies
d) poikilocytes

11. Pic of intracelluar gram negative organisms..asked
about the rx? most likely gonorrhea..

12. Nodules on the distal part of fingers in 70 yo
women complaining of multiple joint pain..these
nodules mostly likely:
a) Heberden's nodules
b) Bouchard nodules
C) Xanthomatous nodules

13. Three questions on Jehova's witnesses ethics!.

14. Hyperreflexia in post-operative patient..There can
be disturbance in which electrolyte level?

a) K
b) Na
c) Mg
d) HCO3

15. HGSIL on pap smear..next step? answer: colposcopy

16. The most common complication of cone biopsy
procedure?
a) Dysparenia b) Bleeding

17. Dementia patient with enlarged prostate (BPH)..He
soils his clothes with urine..The cause of this urine
incontinence? a)His dementia b) His BPH

18. Patient with breast cancer.She is on chemotherapy.
Has behavior changes. CT shows multiple brain
metastasis..next step?
a) additional chemo
b) Brain radiation

19. Scabies pic..asked about the rx? answer;
permethrin.
answers March 24 2004, 1:55 PM

1.A neonate with jiterness.. possible cause:
a) Hypocalcemia b) hypoglycemia.
Answer: HYpoglycemia
http://www.sadap.org.za/edl/paed/16.2.asp

2.2. A neonate with scaphoid abdomen and resp.
distress..possible cause:
a) Diaphragmatic paralysis b) diaphragmatic hernia
answer: diaphragmatic hernia
http://www.amershamhealth.com/medcyc...CONGENITAL.asp

3. A neonate with Erb’s palsy..Prognosis?
a) Will recover spontaneously. b) Will recover with
splinting.
Answer: doesn't recover spontaneously and will require some surgery later. So choose (b)

4. 4. A neonate with scalp swelling..The swelling is
confined to the skull sutures..cause?
a) cephalohematoma b) caput saccedanum
answer: cepholohematoma (ref: crush page 3)

5. A neonate with febrile seizure secondary to Otitis
media…During his stay in the hospital, the neonate
will:
a) need seizure prohphylaxis b) unlikely to have
another febrile seizure c) Head CT scan should be
done.
answer :b

8. Patient with brain death..you have to document in
the patient's chart that:

a) Two EEG 48 hours apart were baseleine.
b) Brainstem and cerebral reflexes are irreversibly
absent.
c) Irreversible absent cerebral blood flow on cerebral
doppler scanning.
answer: b
http://www.medstudents.com.br/neuro/neuro5.htm

9. The next question..

The relatives noticed some movements in the legs..most
likely Spinal reflexes after brain death..You tell the
relatives:

a) These movements are inconsistent with brain death
and withdraw your braindeath announcement.
b) Normal finding after brain death
answer: normal

12. Nodules on the distal part of fingers in 70 yo
women complaining of multiple joint pain..these
nodules mostly likely:
a) Heberden's nodules
b) Bouchard nodules
C) Xanthomatous nodules
answer: a
Bouchards=proximal (BP)

14. Hyperreflexia in post-operative patient..There can
be disturbance in which electrolyte level?

a) K
b) Na
c) Mg
d) HCO3
answer: Na (ref: crush page 99)

16. The most common complication of cone biopsy
procedure?
a) Dysparenia b) Bleeding
answer: bleeding

18. Patient with breast cancer.She is on chemotherapy.
Has behavior changes. CT shows multiple brain
metastasis..next step?
a) additional chemo
b) Brain radiation
answer: chemo, sometimes hormonal. Not radiation

17. Dementia patient with enlarged prostate (BPH)..He
soils his clothes with urine..The cause of this urine
incontinence? a)His dementia b) His BPH

UNSURE


more here..for Vitger, Julia!..


20. Pic of CLL. ALL,AML and CML were listed in the options. Know how to differentiate between them on the smear. Great pathologists like Vitger know that.

21. 19 year old girl raped..came to your office. You did the appropriate physical exam. Told you “I want to go home to take shower”. She doesn’t want to charge the person who raped her.

a)Try to admit her as taking shower may remove important evidences of her rape...(I think they mean her the DNA in the semen/sperms )
b) let her go as she declined charging the guilty who raped her.
Agree with SSS!
17. Dementia patient with enlarged prostate (BPH)..He
soils his clothes with urine..The cause of this urine
incontinence? a)His dementia b) His BPH

I would pick BPH here, no ref yet, but I think pts with BPH commonly have postvoidal dripping

The raped girl I think have to be let go, due to pt autonomy, she decided not to charge...
Not sure on this one.
Thanks again!


A nursing home patient became agitated, nurse calls u , how to manage
A)give haldol
B)4 point restraint
c)check vitals and pulse o2
d)give benzodiazapine

next qs.

nurse did as u said, pt is still agitated

A) order ua
b)oerder chest x ***
c)oerder psych consult
d)order full metoblic panel
e)order haldol

next qs,,, nurse follwed ur orders as u said, she calls u back in 15-20 minutes, patient is combative now

1)give low dose haldol
2)4 point restraint
3)isolate the patinet
4)give benzodiazapine
5) transfer pt to different nursing home


A old lady admitted to hospital due to Pelvic fracture, she was using TEMAZEPAM , now day 2-3 she is agitated with restlessness, BP mildly high, Increase Heart rate
what next

a)give short acting benzo
b)give haldol
c)methadone
d)Fentanyl Patch
e)hydrocodone

next qs... how could u have prevented this FALL and fracture in this PATIENT.


ANSWER is ...shud have avoid temazepam in this patient


old lady , upset and angry, because her PCP is away , u covering for ur friend, she calls you and has some complaints about PAIN. records are not available, Patient doesnt seem to be a drug seeker from the history
what will u do
a)give acetaminophen with tylenol
b)evaluate the patient now
c)give long acting morphine
d)inquire more about the complaints ( pain )


Q) old guy with pancreatitis, hx of alcohol abuse, what is the best test to diagnose his condition
amylase
lipase
lft
CT
ultrasound

q) Old lady with hx of dementia in hospital for some reason, agitated x 24 hours, family is in the hospital, daughter says MY mom gets like this (agitated ) whenever she is in hospital, she is ok at home most of the time
what will u suggest

a)no visitation allowed
b)do Ct scan
c)give haldol
d)restriant
e)illuminate (LIGHTS) the room


A old lady with fall and fracture in icu x three days,
u decided to dc the patient which place will provide the most benifit in long term
a)general ward
B)rehab ward
c)skilled nursing home
d)dc home with home health aid
e)Nursing home

A nursing home patient became agitated, nurse calls u , how to manage
\c)check vitals and pulse o2
next qs.
nurse did as u said, pt is still agitated
d)order full metoblic panel
next qs,,, nurse follwed ur orders as u said, she calls u back in 15-20 minutes, patient is combative now
1)give low dose haldol
A old lady admitted to hospital due to Pelvic fracture, she was using TEMAZEPAM , now day 2-3 she is agitated with restlessness, BP mildly high, Increase Heart rate
what next
a)give short acting benzo
next qs... how could u have prevented this FALL and fracture in this PATIENT.


ANSWER is ...shud have avoid temazepam in this patient
old lady , upset and angry, because her PCP is away , u covering for ur friend, she calls you and has some complaints about PAIN. records are not available, Patient doesnt seem to be a drug seeker from the history
what will u do
b)evaluate the patient now
Q) old guy with pancreatitis, hx of alcohol abuse, what is the best test to diagnose his condition
lipase
q) Old lady with hx of dementia in hospital for some reason, agitated x 24 hours, family is in the hospital, daughter says MY mom gets like this (agitated ) whenever she is in hospital, she is ok at home most of the time
what will u suggest
c)give haldol
A old lady with fall and fracture in icu x three days,
u decided to dc the patient which place will provide the most benifit in long term
a)general ward
last 2 questions
ANSWERS:
Iluminate the room
D/C Home with VNS
------------------------------------------------------------

Q)patient with PMS symptom what medication u will prescribe... symptoms are bother some,
OCP
SERTRALINE/fluoxitine
NSAID

PAtient with dysmenorrhea on NSAID , still having pains , interferring with her job during those days,
next
A)ocp
b)reassure
c)pain meds with codiene during mensutral cycle
d)ultrasound of the pelvis/abdomen
e)quit sexual activities

1.ssri.
2.ocp


a teenager comes with mother for f/u of asthma , her asthma symptoms are poorly controleld lately , few acute attacks in past few wks, on exam u noticed ciggrate SMELL from her clothes, mother is also nervous, what will u do

a)Talk to mom privately
b)talk to patient privately
c) tell patient YOUR smoking habit is not good for asthma
d)talk about smoking and its effect on asthma ( no mentioning of alone or together)
e) tell mother this is all because of smoking
Q)Patient wants to quick smoking,,,,, what med,,,,ans bupriopione
Q) patient with peripheral vascular disease he smokes… most important management is
Graded exercise
Meds
Quit smoking
Surgery

Q)A teenager comes for f/u with mother, mother is upset because her daughter started smoking, daughter is using her ciggarates and smokes with her best friend outside of the home, what will u do
a)Ask mom to talk to daughter’s friend MOM
b)Ask mom to lock her ciggys
c)Ask mom not to let her socialize with that friend
d)Tell mom chances of her daughter;s quiting smoking are SLIM , while she continues to smoke

Q) a child with recurrent otitis media, now in office with mother, u find out mother is a heavy smoker, last otitis was 2 wks ago, kid is ok now
what next
a)child will become HEARING impaired eventually
b)treat with antibiotics (prophylaxix)
c)Discuss and refer to tube placement
d)ask mom to quit/ Avoid smoking.

a teenager comes with mother for f/u of asthma , her asthma symptoms are poorly controleld lately , few acute attacks in past few wks, on exam u noticed ciggrate SMELL from her clothes, mother is also nervous, what will u do
a)Talk to mom privately
b)talk to patient privately
c) tell patient YOUR smoking habit is not good for asthma
d)talk about s