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Comquest 3

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jmanderson's version from 2017-09-07 01:17

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Question Answer
long-term mgmt- hemochromatosis (bronze db) w/o liver dzchr phlebotomy
short-term mgmt- hemochromatosisdeforxamine (eye/ear d/o w/ long term
mgmt- VT stableamio
mgmt- VT unstablesynch cardiovert
mgmt- 3rd deg heart blockpacemaker
chin deviated to right, temporal bone ER to _________right
dx- high pitched diastolic rumble inc w/ inspirationTS
dx- high pitched diastolic rumble, doesn't inc w/ inspMS
dx- baby chorioretinitis, jaundice, calc basal gangliatoxo
mgmt- toxo as TORCH infxntmp-smx
2 genetic jaundice unconjugatedcrigler najjar (kernicterus), gilbert's (stress)
2 genetic jaundice conjugateddubin johnson (black liver), rotor (benign)
dx- torch infxn, cataracts, hearing loss, cardiac d/orubella
dx- torch w/ cerebral calc and hearing losscmv
dx- torch w/ still birth, frontal bossing, saddle nose, sz, skeletal malft pallidum
ILD pftsnl/inc FEV1/FVC
para w/ SAAG >1.1portal htn (chf, nephrosis, etc)
dx- old pt w/ occult GIB and profound anemiaR side colon ca
dx- ca, hematochezia, change bowel habits/caliperL side colon ca (sigmoid)
o/d- convulsions, confusion/coma, cardiac conduction (qt)TCA (cyclobenzaprine)
dx- b/l hand paresthesia pregn FCTS (phalen)
dx- RUE paresthesia in body builder or breast radiationTOS (adson test)
dx- old pt, dizzy, change vision when head turnedvert art insuff (wallenberg)
ortho test- for GH joint and frozen shoulderapley's scratch
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Question Answer
mc organism- IE s/p prosthetic valve w/i 1 yrStaph epidermidis and aureus
mc organism- IE s/p prosthetic valve >1 yr agoGAS (viridans)
dx- teen, distal limb wk, w/c, dec prop, dec dtrs, tremors, pes cavuscharco marie tooth
who to screen AAAmen smokers 65-75 y/o
ekg- inc qrs amplitude V1-6LVH
etio- LVHvol/pressure overload (HTN)
dx- anal pain and itchinessexternal hemorrhoids
localize MI- STE II, III, avFinferior
what is c/i in R inferior MIntg
dx- db, steatorrhea, pancreas calc on ctchronic pancreatitis
dx- asthma w/ awakening 1-2x/wk and daily cough mod persistent (low ICS, LABA, SABA)
1st line rx- thrombophlebitis NSAIDs
dx- 30 y/o F, gradual symetric jt pain, morning stiff >30 min, spares DIP, valgus kneesRA
dx- pt on antipsychtoics, oculogyric crisis, torticollis, lock jawacute dystonia (benztropine, bzd)
dx- pt on antipsychotics, mo to yrs after rx, involuntary LE movementstardive dyskinesia
2 murmurs that inc w/ valsalva/standingHOCM and MVP
dx- murmur like AS but inc w/ valsalvaHOCM
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Question Answer
hip drop test to eval _________lumbar SB
doc for o/aapap (not asa d/t gib)
coarctation location- b/l ue htn, b/l le hotndistal to L subclavian
mgmt- mom at 42 wk GA, M/F danger, chorio, abruptioninduction (misoprostol, oxytocin, dinoprostone)
labor induction rxoxytocin, misoprostol, dinoprostone
wilsons labs ceruloplasmin, ast/alt, urinary culow ceruloplasmmin, high ast/alt, high urinary cu
brain herniation- fixed pupiluncal
brain herniation- cv and resp compromisetonsillar
mgmt- grossly visible cervical ca lesionbx
mgmt- dysentery via GNBsupportive unless shigella
mgmt- dysentery, GNB, nonmotile no H2S, no lactose fermentcipro (FQ for shigella)
fxr- ulna with dislocated radiusmonteggia
fxr- radius with dislocated ulnagaleazzi
fxr- arm after blocking blow from cop abovenightstick fxr
mcc and mgmt neonatal conjunctivits w/i 1st day of lifechemical (silver nitrate) - reassurance
mcc and mgmt neonatal conjuctivits w/i 2-7 d of lifegonorrhea - im ceftriaxone
mcc and mgmt neonatal conjuctivits w/i 5-14 dchlamydia - erythromycin
mcc neonatal conjunctivits w/i 6-14 dviral (hsv)
stage- lymphoma 1 LNI
stage- lymphoma 2+ LN same side diaphragmII
stage- lymphoma 2+ LN opp side diaphragmIII
stage- lymphoma metsIV
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Question Answer
pneumo vax age and types>65, conjugate today -> polysaccharide in 1 yr
SItS mm actionssupraspinatous-abd, infra-ER, teres-ER, subscap-IR
ortho test for supraspinatousdrop arm
ortho tests for biceps tendinitisyergason, speed
dx- hematuria, u/l flank pain, palpable abd massRCC
best test- RCCCT abd
mgmt- new onset afib, no need for shock, CHADS>2hep -> warf
dx and mgmt- vomit after coughwhooping cough, zithromax
mgmt- primary adrenal insuff (low cortisol, high acth)glucorticoid + fludrocortisone
mgmt- secondary adrenal insuff (low cortisol, low acth)glucocorticoid
pH in candida vulvovaginitisnL (~4)
pH in BV and trichhigh (>4.5)
dx- tender red shin nodules a/w young F sarcoid, ibderythema nodosum
dx- rash of lymeserythema migrans
dx- target lesions mucocutaneous after HSVerythema multiforme
DEXA -1 to -2.5osteopenia
DEXA below -2.5osteoporosis
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Question Answer
dx- new onset 10/10 haSAH
LP in SAHxanthocromia (pink/yellow, high P, high RBC)
labor stage- baby coming out2
nL stage 2 labor<2 hr nulli, <1 hr multi (epidural +1hr)
anticoag for UA and NSTEMIheparin
NSTEMI rxBB, ASA, O2, morpine, ntg, heparin (MONA-BASH)
dx- kid w/ low plt, eczema, immunodefwiskott aldrich (XR)
always start syphillis w/u w/ _________RPR or VDRL
scoliosis named for direction of _________apex (R apex -> dexo)
pts have right not to be told truth abt dx- t/f?t
rh- mom, give rhogam at _________28wk
hctz is c/i in _________ and _________dm and gout
s/p surg wound w/o entry into tractsclean
s/p surg wound w/ planned entry into tracts w/o unusual contaminationclean-contaminated
s/p surg wound w/ open, fresh, accidental, surgical woundcontaminated
s/p surg wound w/ old trauamatic wound or pre-existing infxndirty
mgmt- hyperCa crisisIVF!!! -> calcitonin -> +/- lasix or HD
mgmt- chronic hyperCa of malignancy-dronates
ekg- rbb, tachy, s wave I, q and inverted t in IIIPE
omm- CP eyelateral humerus
omm- CP middle earclavicles lateral to ribs
omm- CP sinusrib 1
omm- CP tonsils1st ICS
omm- CP tonguerib 2
mgmt- salicylate tox (met acidosis w/ AG and tinnitus)bicarb urine
mgmt- BB toxremove BB, glucagon
mgmt- TCA toxbicarb urine
mgmt- tpa toxaminocaproic acid
mgmt- hep toxprotamine
mgmt- methemoglobinmethylene blue
mgmt- CO toxO2
pleural effusion in tblymphs>80%, high protein, adenosine deaminase >40
pleural effusion in lymphomachylothorax (white milky TGs)
dx- low ca, low po4, high pthvit D def
dx- low ca, high po4, high pthsecondary hyperpth (renal failure) or pseudohypopth (end organ resistance)
dx- high ca, low po4, low pthcheck pth-rp (ca, scc)
dx- high ca, high po4, low pthca from mets vs high vit D (sarcoid)
dx- low ca, low pthparathyroidectemy
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Question Answer
dx- cyonitic neonate cxr egg on stringtransposition of great vessels (asd, vsd, pda - tx pge and surge)
dx- cyanotic neonate cxr snowmantotal anomalous pulm venous return (tx- pge to keep pfo)
dx- cyanotic neonate cxr cardiomegaly w/ fluid filled lungstruncus arteriosis (single vessel from r/l ventricles)
breastmilk has lowvit d and k
breastmilk decreases incidence of what infxnotitis media
mgmt- zenker'smyotomy
mgmt- rx for prev esoph bleed in varicesBB
mgmt- acute GIB esoph varicesoctreotide (TIPS last resort)
mgmt- rx and application for scabiespermethrin neck down
dx- oa of spinespondylosis
dx- pars break 0-25% slipgrade 1 spondyloslisthesis
dx- pars break 26-50% slipgrade 2 spondylolisthesis
dx- pars break 50-75% slipgrade 3 spondylolisthesis
dx- pars break >75% slipgrade 4 spondylolisthesis
dx- break parsspondylolysis
ppx- meningitis spread to prev close contact via _________rifampin, fq, ceftriaxone for nasopharynx spread
urobilinogen in urine means _________excess conjugated bili (duby, rotor, hemolysis, cirrhosis)
reduced UDPGT means _________excess unconjugated bili (crigler najar, gilbert's)
rx to increase breastmilkDA antagonist (metoclopromide)
DA agonistsbromocriptine, cabergoline (for high prl, parkinson's)
epidural hematoma ct and arteryconvex (lens), middle meningial
epidural hematoma s/swalk talk and die
best test to dx otitis mediapneumatic otoscope
centrilobar emphysema on cxrhyperlucency at apices
mgmt- stress incontinencesling, kegel's
mgmt- urge incontinence (overactive bladder)anti-Ach (oxybutynin)
mgmt- neurogenic bladder (overflow)bethenecol if mild, in-out-cath if severe
1st PE anticoag lengthhep->warfarin for 3-6 mo
h/o mult PE anticoag lengthwarfarrin for life
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Question Answer
dx- FAT-RN (fever, anemia, thrombocytopenia, renal failure, neuro sx)TTP-HUS
dx- abd pain out of proportion, h/o low CO and vasopressorsnon occlusive mesenteric ischemia (ischemic colitis)
mcc mesenteric ischemiaarterial embolism
key dx diff btw anorexia and bulemiaanorexia has wt loss (purging in either)
mc benign liver tumorcavernous hemangioma
mgmt- cavernous hepatic hemangioma >5cm or sxsurgery
mgmt- cavernous hepatic hemangioma <5cm or asxw+w
dx- entrapment of ulnar nerve (4th 5th digit) from medial elbow, tinel -cubital tunnel syn
dx- entrapment of ulnar nerve (4th 5th digit) from wrist, tinel +guyon's canal synd
path- mesenteric ischemia in pt w/ ocp, infxn, ca, pancreatitisvenous thrombosis
mgmt- mesenteric ischemia in acute arterial dzpapaverine (vasodilator)
mgmt- mesenteric ischemia in embolic dztpa or streptokinase
mgmt- mesenteric ischemia in venous thrombosis (ca, ocp)heparin
mgmt- mesenteric ischemia with dead bowelemergent lap
pump handle ribs and inhalation me1-5, flex head
bucket handle ribs and inhalation me6-10, sb and reach for knee
w/d- bradycardia, insomnia, ha, inc appetiti, wt gain, dep mood, anxietynicotine
w/d- diaphoresis, tachycardia, htn, tactile hallucinationsetoh (first 12 hr)
w/d- visual hallucinations, disorientation, tachycardia, htn, low grade fever, agitationDT (etoh >24 hr)
w/d- dilated pupils, rhinorrhea, insomnia, sweat, abd pain, lacrimation, diarrheaopeiate
dx- short stature, cafe au lait, precocious puberty, bone lesions, endocrine d/omcune-albright
vWF dz, deep or superficial bleedingsuperficial bleeds
dx- chronic productive cough, dyspnea, hemoptysis, young, h/o severe pulm infxnbronchiectasis
dx test- bronchiectasishigh resolution CT
mgmt- fibroidsGnRH agonists, myomectomy (if wants baby), hysterectomy (if no baby wanted)
labs- pth, ca, po4, alk phosph in esrd pt w/ bone painosteitis fibros cystica (high pth, high ca, low po4, high alk phosph)
low risk moms take _________ mg folate and high risk take _________ mg0.4 mg, 4 mg
systemic fungal infx- bones lungs and skin, midwestblastomycosis
1st mgmt- UC5-ASA, mesalimine, sulfasalazine
definitive mgmt- UCcolectomy
dx test of choice diverticulosiscolonoscopy
MEN1 with parathyroid, pituitary and _________pancreatic islet cells (dm like dz)
dx- kid, cafe au lait, renal anomaly, microcephaly, short, bone marrow failure (anemia)fanconi anemia
IVF for burns <24 hr and >24 hrLR <24 hr, D5 >24 hr
w/u for achalasia orderbarium swallow -> manomotry -> egd w/ bx
cardiogenic shock CO, pcwp, SVRlow CO, high pcwp, high SVR
pcwp high only in _________ shockcardiogenic
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