Term
| 23 yo male with recent URI sxs presents c/o chest pain. His pain is worse when lying down and better sitting up and leaning forward. ECG shows widespread ST segment elevation. Dx? |
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Definition
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| 75 yo woman presents to the office with complain of vision loss. Exam reveals a palpable cord in the temporal region. Most helpful initial test to order? |
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Definition
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Term
| Recommended LDL tor educe risk of CAD in a diabetic pt? |
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Definition
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Term
| What is the reason for giving IV mag sulfate to a pt with pre-eclampsia? |
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Definition
| prevention of seizure by increasing the seizure threshold |
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Term
| 53 yo man with h/o HTN presents c/o recent 4/10 left sided chest pain with exertion that is relieved with rest. Heart exam reveals regular rate and rhythm with no S3, S4 or murmur. Lungs are CTA bilat. ECG reveals no acute changes. Most appropriate initial test? |
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Definition
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| 36 yo AA female comes to the clinic for an insurance physical which requires a CXR. She denies any respiratory sxs. Exam of her chest is negative. Xray results show marked LAD in the right paratracheal region. ACE levels are elevated. Most likely dx? |
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Definition
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| 33 year old presents to your office with a c/o right knee injury associated with pain and swelling. He states he was running after his loose dog and suddently stopped, hyperextended his knee, heard a pop, and noticed immediate swelling. On PE, the Lachman test and anterior drawer test demonstates joint laxity. Most likely injury? |
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Definition
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| 22 yo woman comes to the office because her urine is cola colored and she hasnot urinated since yesturday morning. Her past medical hx is significant for pharyngitis two weeks ago. Her mother and grandmother have type 2 diabetes. Her BP is 146/92 mmHg. On PE she has edema of her face and hands. Dx? |
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Definition
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| 15 yo girl hit in the right eye by a golf ball. There is swelling and echymosis of the orbit. She c/o double vision. The right eye doesn't move with downward gaze or right lateral gaze. Dx test that will provide the most information? |
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Definition
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| A 48 yo male with DM presents for routine PE. Of note his BP each of his last two f/u visits was 150/90. Today his BP is 148/88. The pt denies c/o chest pain, change in vision, or headache. Most appropriate management? |
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Definition
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| 68 yo male with a h/o a-fib treated with warfarin (Coumadin) presents to the ED after vomiting large amounds of bright red blood. INR is 3. Most appropriate treatment to rapidly lower the patient's INR? |
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Definition
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| 72 yo farmer comes to the office for eval of a pearly ulcerated papule on his right nostril. The papule has been bleeding off and on for hte past couple weeks. Which of the following findings would be most concerning on the PE of this pt? |
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Definition
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| 24 yo female presents with c/o abd pain, bloating, and chronic diarrhea. She says she felt worse last month while on vacation in Italy. Despite eating well she lost weight. What would be the most appropriate traetment for this pt? |
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Definition
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Term
| Hypoglycemia in an elderly pt with diabetes is most likely to manifest as what sx? |
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Definition
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| An 85 yo nursing home resident presents witha abrupt onset of cough, sore throat, HA, myalgias, and malaise. On exam pt temp is 102F, the rest of the exam is unremarkable. Nasal smear is positive for Influenza B. Tx of choice for this pt? |
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Definition
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| 36 yo female presents for routine PE. She has no current complaints and her only medication is oral contraceptives. The pt is preparing for a trip in Australia and is worried about the long flight as her Mom has a hx of DVT after a long trip several yaers ago. PE reveals BP 110/60. HR 66, regular. Heart is regular rate and rhythm without murmur, lungs are clear to auscultation bilaterally and extremities are without edema. Most appropriate recommendation? |
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Definition
| recommend walking frequently during the flight |
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Term
| 43 yo woman presents with episodes of facial flushing with increased skin temp. followed by the development of tiny papules and pustules primarily on her cheeks and chin. These sxs worsen when she eats spicy food. On exam, telangiectasias are noted along the nasal folds and tiny pustules on both cheeks. Dx? |
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Definition
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| 25 yo male presents to the ED for eval of a wound on his hand. He cut his hand while tearing down a chicken coop. On exam of his right hand you note a dirty 3cm jagged laceration. The pt is unaware of his tetanus immunization status. Besides cleaning and debriding the wound, what is the recommended intervention? |
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Definition
| administer tetanus-diptheria toxoid (Th) and tetanus immune globulin (TIG) |
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Term
| 25 yo female presents for a routine gynecological exam. You palpate a 2cm breast mass in her right breast. Her menstrual period was last week. She has no family hx of breast cancer. What is the modality of choice to further evaluate her breast mass? |
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Definition
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Term
| 60 yo right hand dominant male presents to your office complaining of right shoulder pain and progressively worsening arm weakness. His sxs are aggravated when working above the shoulder level. On PE, there is no evidence of muscle atrophy. He has strong (5/5) adduction of his right shoulder but considerable weakness (1/5) with abduction when raising his arm above his head. Passive range of motion is intact. Dx? |
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Definition
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Term
| Newborn weighs 8 pounds at birth. what would you expect her to weigh at 1 year of age? |
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Definition
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Term
| 3 month old female presents with her Mom for PE. The pts Mom denies any complaints. On exam you note a well developed, well nourished infant in no apparent distress. There is no cyanosis noted. Heart exam reveals a normal S1 with a physiologically split S2. There is a grade III/VI high pitched, harsh pansystolic murmur heard best at teh 3rd and 4th left intercostal spaces with radiation across the precordium. Initial study of choice? |
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Definition
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| 62 yo male smoker presents to the clinic with c/o chronic cough, hemoptysis, and weight loss. Chest CT shows a mass obstructing the bronchus with hilar and mediastinal lymph node abnormalities. Bronchoscopy with biopsy is performed. On reviewing pathology results you explain to the pt that his type fo lung cancer is prone to early hematogenous spread, is rarely amenable to surgical resection and has a very aggressive course. Dx? |
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Definition
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Term
| Otitis externa can be differentiated from uncomplicated otitis media by which of the following PE findings? |
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Definition
| normal pneumatic otoscopy |
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Term
| 20 yo male presents with complaint of brief episodes of rapid heart beat with a sudden onset and offset that have increased in frequency. He admits to associated SOB and lightheadedness. He denies syncope. Electrocardiogram reveals a delta wave prominent in lead II. Which of the following is the most appropriate long term management in this pt? |
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Definition
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Term
| 26 yo woman requests screening after her boyfriend was treated for an STD. On exam you find a painless vulvar ulcer. Most likely dx? |
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Definition
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Term
| 57 yo male recently on a high protein diet presents with an exquisitely tender, erythematous, warm right great toe. Treatment of choice? |
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Definition
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Term
| 55 yo female presents to the clinic with lethargy, fatigue, constipation, and menorrhagia. PE reveals an enlarged thyroid, dry skin, and a haert rate of 50bpm. Lab results show a decrease in free T4, and an elevation in TSH. Dx? |
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Definition
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Term
| Which of the following diagnostic studies is indicated in the eval of an upper GI bleed? |
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Definition
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Term
| 45 yo male presents to the clinic c/o morning slugishness, daytime fatigue, headaches. he admits to drinking two cocktails each evening. His bed partner reports loud cyclical snoring, breath cessation, and admits thrashing movements of his extremities during sleep. BMI is 40. Heart exam reveals regular rate and rhythm without S3, S4, or murmur and lungs are clear to auscultation. Polysomnography shows apneic episodes lasting as long as 60 seconds. Which of the following clinical interventions would most likely provide for the acute cessation of apneic episodes? |
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Definition
| nasal continuous positive airway pressure (CPAP) |
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Term
| 45 yo female presents with her daughter who is concerned because her Mom will not leave the house. The patient descrives feeling anxious in crowds and places where there are no easy means of escape. Most likely dx? |
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Definition
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Term
| Which of the following is a cause of acute kidney failure due to prerenal azotemia? |
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Definition
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Term
| 19 yo male presents to the ED c/o a sudden onset of dyspnea and left sided chest pain. He denies fever, chills, cough, or sore throat. General survey shows that he is 6 foot 2 inches tall and weighs 135 lbs. Vital signs are BP 86/60, Pulse 130, RR 28, temp 98.6. Likely finding on exam of his thorax? |
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Definition
| left-sided hyperresonance |
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Term
| 60 yo female recently discharged after an 8 day hospital stay for pneumonia presents c/o pain and redness in her right arm. The pt thinks this was the area where her IV was placed. The pt denies fever or chills. Exam of the area reveals localized induration, erythema, and tenderness. There is no edema or streaking noted. Most likely dx? |
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Definition
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Term
| 57 yo male with history of HTN presents with acute gouty arthritis. Which of the following antihypertensive classes should be avoided in this pt? |
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Definition
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Term
| 72 yo pt with type 2 diabetes treated with a sulfonylurea is brought into the clinic by her daughter, who provides the pt history. The pt has had a recent URI and excessive diuresis for the past 2 days. She has had decreased oral intake. At the clinic, she becomes increasingly stuporous and lethargic. Most likely dx? |
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Definition
| hyperglycemic hyperosmolar state |
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Term
| 68 yo male presents with jaundice, weight loss, and boring abdominal pain which radiates to the back. The gallbladder is palpable on PE. This finding is consistent with what? |
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Definition
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Term
| 66 yo woman with type 2 DM comes to the office because she has had a painful red patch that has been spreading on her right lower leg over the past 3 days. Her temp is 100.4. PE of her right lower leg reveals a 3cm tender, warm, erythematous, and edematous plaque. MC pathogen? |
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Definition
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Term
| Pt with a hx of chronic venous insufficiency presents for routine follow up. Most likely PE finding? |
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Definition
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Term
| 16 yo nulliparous acutely ill female presents with bilateral lower abdominal pain. She has a temp of 100.4 and on exam has a tender, enlarged left adnexa. Cervical culture is positive for chlamydia. US reveals a complex tubular structure in the left adnexal area. Recommended tx? |
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Definition
| hospitalization with parenteral doxycycline and cefoxitin |
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Term
| 2 yo presents with sudden onset of cough and stridor. On exam the child is afebrile and appears nontoxic with a respiratory rate of 42 breaths per minute. Next step in the eval? |
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Definition
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Term
| 3 yo pt is brought in with a 10 day hx of clear nasal drainage and cough which has now developed into otalgia and fever exceeding 101 degrees for the last 5 days. Mom denies other chronic medical problems. The pt has similar complaints three times in her life. Most likely causative organism? |
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Definition
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Term
| 7 yo is evaluated for episodes of unresponsiveness in which she stares, blinking into space. Episodes last only 10-20 seconds but may happen several times daily. There are no abnormal movements, sensory loss, or headaches reported. First line therapy for this disorder? |
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Definition
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Term
| Which of the following txs is used to reduce the hepatic complications of hemochromotosis? |
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Definition
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Term
| 29 yo female with hx of IV drug abuse presents with ongoing fevers for 3 weeks. She c/o fatigue, worsening dyspnea on exertion, and arthralgias. PE reveals BP 130/60, HR 90 and regular, RR 18 and unlabored. Petechiae are noted beneath her fingernails. Fundoscopic exam reveals exudative lesions in the retina. Heart exam shows regular rate and rhythm, grade II-III/VI systolic murmur noted, with no S3 or S4. Lungs are CTA bilat, and extremities are without edema. Study of choice? |
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Definition
| transesophageal echocardiogram (suspected infective endocarditis) |
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Term
| 18 yo female with DM presents to the ED with altered LOC, deep breathing, and fruity odor to her breath. Which med is indicated for this pt? |
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Definition
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Term
| 69 yo male with a hx of CLL presents to the clinic c/o cough, dyspnea, and production of copious amounts of foul smelling sputum. PE reveals crackles at the lung bases. CXR shows dilated and thickened bronchi that appear as ring-like markings. Most likely dx? |
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Definition
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Term
| Bony and cartilaginous enlargement of distal interphalangeal joints is commonly seen in which medical condition? |
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Definition
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Term
| 9 yo male is brought by his mother who reports the pt has exhibited an extremely negative attitude for the past year. He seems angry much of the time and frequently loses his temper. Arguing over even trivial details is common place and he seems to take delight in annoying his family. His grades and conduct at school remain excellent. He has few friends, though he has never been seen bullying or destroying others' property. Dx? |
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Definition
| oppositional defiant disorder |
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Term
| Pt presents c/o gradual hearing loss over the past 3 months. He admits to use of Q-tips and otherwise doesn't wear ear plugs or palce other foreign objects in his ear. On exam external auditory canals are obstructed with cerumen. After remvoal of cerumen, hearing is equal on both sides. Appropriate counseling of this pt includes what? |
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Definition
| Advise him to discontinue use of cotton swabs |
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Term
| Dysmenorrhea would most likely occur in which of the following pts? |
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Definition
| 35 year old woman with regular cycles |
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Term
| 49 yo female presents complaing of several episodes of chest pain recently. Initial ECG i nthe Ed shows no acute changes. Two hours later, while the pt was having pain, repeat electrocardiogram revealed ST segment elevation in leads II, II, and aVF. Cardiac Cath shows no significant obstruction of the coronary arteries. Treatment of choice? |
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Definition
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Term
| 62 year old male presents with c/o dyspepsia, early satiety, and dysphagia. diagnostic study for initial workup? |
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Definition
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Term
| 6 yo male, recent immigrant from Latin America, is brough to the ED with difficulty swallowing and breathing. On PE you note a gray-tan pseudomembrane in the back of the pharynx. There is also tender cervical LAD. What PE finding is most specific for dx in this pt? |
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Definition
| pseudo-membrane in pharynx |
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Term
| 40 yo male non smoker in good health undergoes a routine CXR for an insurance physical. Results show an isolated, well defined, coin lesion 1cm in size. Which of the following is the next step in teh eval of this problem? |
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Definition
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Term
| Lesions of the optic chiasm will produce what deficit? |
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Definition
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Term
| 75 yo female with a hx of long-standing HTN presents with SOB. On exam you note a diastolic murmur at the left upper sternal border. What maneuver would accentuate this murmur? |
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Definition
| Sitting up and leaning forward |
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Term
| 25 yo female, G2 P1001, presents to your office at 11 wks gestation with vaginal bleeding, mild lower abdominal cramping, and bilateral lower pelvic discomfort. On exam, blood is noted at the dilated cervical os. No tissue is protruding from the cervical os. The uterus by palpation is 8-9 wks gestation. No other abnormalities are found. Likely dx? |
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Definition
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Term
| what lab test should be closely monitored in pts on long term lithium treatment for bipolar disorder? |
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Definition
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Term
| 16 yo female comes to the office because her acne has become more severe and she would like to discuss treatment. She was originally prescribed tropical clindamycin gel 1 yr ago to treat open and closed comedones on her face. Despite regular use of the medication, she now has several comedones and papulopustules across her nose, cheeks, chin, and forehead. Which of the following would be an appropriate additional treatment for moderate acne? |
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Definition
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Term
| 50 yo male with history of alcohol abuse presents with complaint of worsening dyspnea. PE reveals bibasilar rales, evelated JVP, an S3 and lower extremity edema. CXR reveals pulmonary congestion and cardiomyopathy. ECG shows frequent ventricular ectopy. Echo shows left ventricular dilation and an ejection fraction of 30%. Most likely dx? |
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Definition
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Term
| 25 yo female with hx of diarrhea presents to teh ED with Buillian-Barre syndrome. Most likely causative pathogen? |
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Definition
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Term
| 32 yo female presents with an 8 wk history of a burning sensation deep in the chest which starts about 30 minutes after she eats, worsens when she lays down at night. She ahs had some relief with an antacid and denies dysphagia. What intervention would be beneficial? |
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Definition
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Term
| 45 yo female presents c/o the worst HA of her life. Most appropriate initial diagnostic study? |
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Definition
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Term
| Which physical exam finding differentiates allergic rhinitis from other rhinitis etiologies? |
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Definition
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Term
| 56 yo female with a 35 pack year smoking hx presents to the clinic with SOB and cough. On exam she is think with no recent weight loss. She appears uncomfortable, breath sounds are diminished without adventitious sonds. PFT shows a marked increase in TLC and a decreased FEV1. Dx? |
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Definition
| chronic obstructive pulmonary disease |
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Term
| Which of the following Rh genotypes in a mother and father would represent a risk for hemolytic disease of the newborn? |
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Definition
| Mother Rh-negative, Father Rh-positive |
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Term
| 76 yo active female with history of HTN and hypothyroidism presents with c/o palpitations and DOE. On exam vital signs are BP 120/80, HR 76 and irregular, RR 16. Heart exam reveals an irregularly ireggular rhythm without murmur. Lungs are clear to auscultation and extremities are without edema. Most important med for chronic therapy in this pt? |
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Definition
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Term
| 32 yo male presents with a one month hx of weakness, anorexia, and weight loss. On PE he is hypotensive and his skin has diffuse hyperpigmentation. Plasma Cortisol levels drawn at 8am are low. Dx? |
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Definition
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Term
| Antinuclear antigen (ANA) is most commonly associated with and monitors the progress of what disorder? |
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Definition
| systemic lupus erythematosis (SLE) |
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Term
| 72 yo woman presents to your clinic c/o constipation. Which presentation is most concerning? |
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Definition
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Term
| 58 yo male presents for a six week follow up after an acute anterior wall MI. He denies chest pain and SOB. ECG shows persistent ST segment elevation in the anterior leads. Echo reveals a sharply delineated area of scar that bulges paradoxically during systole. Most likely dx? |
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Definition
| left ventricular aneurysm |
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Term
| what is recommended to reduce the risk for perinatal transmission of HIV in a pt with a viral load of > 1000 copies/mL? |
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Definition
| cesarean section prior to onset of labor and rupture of membranes |
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Term
| 48 yo male with a recent episode of nephrolithiasis comes to the office to discuss prevention of further urinary stone disease. What recommendation can reduce recurrence of nephrolithiasis? |
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Definition
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Term
| A 70 yo male is admitted to the ICU with fever, leukocytosis, and purulent sputum. Sputum culture shows methicillin-resistant gram positive cocci in clusters. What medication should be ordered for this pt? |
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Definition
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Term
| 75 yo female with history of CAD and dyslipidemia presents for routien follow up. Physical exam reveals loss of hair on the lower extremities bilaterally with thinning of the skin. Femoral pulses are +2/4 bilaterally, pedal pulses are diminished bilaterally. Ankle brachial index is reduced. what S&S are most likely to be present? |
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Definition
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Term
| 37 yo right handed male presents with daily HA for the past 2 months. They are wrose in the morning and awaken him from sleep. In the past week, he has noticed a tendency to drop things. Neuro exam reveals UE strength 4/5 on right and 5/5 on left. Most appropriate next step? |
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Definition
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Term
| What pt history is typical of RA? |
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Definition
| insidious onset, morning stiffness, symmetrical joint swelling and tenderness |
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Term
| Low molecular weight heparin dosage is based on which of the following? |
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Definition
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Term
| Low molecular weight heparin dosage is based on which of the following? |
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Definition
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Term
| 23 month old male presents to the office with his father who reports the pt has had an acute onset of severe pharyngitis, fever of 103.5, and what sounds like harsh, high pitched breath sounds. His dad states the child has started drooling and seems to be worsening. The child is not presently cyring but has muffled voice sounds. The child has not been immunized due to religious reasons. Next step? |
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Definition
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Term
| On PE of a pregnant pt, what can be considered a normal finding? |
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Definition
| increased second heart sound split with inspiration |
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Term
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Definition
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Term
| 55 yo male with hx of HTN and DM presents to the ED. Pt's wife states tha tthe pt developed progressive irritability and confusion today after c/o a HA. PE reveals BP 230/130 and papilledema. Dx? |
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Definition
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Term
| 19 yo man comes to the office because he has had a fever, frequent urination, urgency, dysuria, and scrotal pain for the past 2 days. On PE, he has a temperature of 101, scrotal swelling, and purulent urethral discharge is visible on penile exam. Gram stain on the discharge shows gram negative intracellular diplococci. Abx of choice? |
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Definition
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Term
| 74 yo male with a hx of CAD and A Fib presents to the clinic for follow up of his SOB. Pts meds include amiodarone, and metoprolol. His CXR reveals patchy ground glass infiltrates. Dx?? |
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Definition
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Term
| Pt demographic at highest risk for anorexia? |
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Definition
single, 20 yo, homosexual male.
Also at high risk are high school wrestlers and ballet dancers. |
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Term
| 58 yo female comes to the office because she noticed a white spot on her tongue. She has a 42 pack yr smoking hx. On exam she has an 8mm white thickened, keratinized lesion on teh ventral tongue. The lesion cannot be removed by rubbing the mucosal surface. Study to confirm the suspected dx? |
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Definition
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Term
| 26 yo male was lifting a heavy object two weeks ago when he felt a sudden onset of low back pain. He describes pain in the low mid back at the belt line aggravated with movement. Radicular sxs are noted in the left buttock down the leg to the dorsal aspect of the foot. He denies any urine or bowel complaints. Most appropriate diagnostic study? |
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Definition
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Term
| Household contacts of a pt with bacterial meningiitis are best treated with which of the following? |
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Definition
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Term
| 45 yo male nonsmoker presents with a 3m hx of difficulty swallowing. He describes the gradual onset of dysphagia for solids and liquids. He now c/o substantial discomfort after eating. Dx? |
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Definition
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Term
| 18 month old with chronic HTN and history of CAD is assessed in the office for routine eval. His HTN is well controlled with metoprolol and HCTZ. ECG reveals U waves. Likely cause of the U waves? |
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Definition
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Term
| When is the recommendation for the next Pap Smear in a 36 yo pt with a hx of 3 consecutive negative annual Pap smears and no hx of cervical dysplasia? |
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Definition
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Term
| What behavior would be most typical for a pt diagnosed with schizoid personality disorder? |
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Definition
| chooses solitary activities |
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Term
| 65 yo male with CAD, HTN, and DM is admitted with dyspnea and LE edema. CXR reveals small bilateral pleural effusions. Echo shows an ejection fraction of 30% with no valvular disease. The pt is treated in the hospital with furosemide and lisinopril. What education should be given to this pt upon discharge to help prevent readmission? |
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Definition
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Term
| 67 yo AA male presents for a new pt eval. Hx reveals aphasic CVA which limits his history. Funduscopic exam reveals an abnormal vessel light reflex described as a silver or copperwire appearance. Where the vessels intersect, there appears to be some nicking. He has no carotid bruits and his cardiac exam is normal. MCC of ocular findings? |
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Definition
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Term
| 14 yo male presents to the ED experiencing a severe asthma attack. His respiratory effort is shallow and he is using accessory muscle to breathe. Auscultation of his chest reveals no audible wheezing. Vital signs include BP 90/60, P 160, RR 52. ABG is orderd. Normal ABG values at your institution are. pH 7.35-7.45, CO2 35-45, pO2 80-95. ABG finding that would suggest the poorest prognosis? |
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Definition
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Term
| 22 yo male presents to the ED c/o right hand pain after punching a brick wall. Pain on ulnar aspect of his hand worsens with touch and movement. On exam you note obvious swelling and tenderness over the dorusm of the right hand proximal to the MCP joint of the fifth digit. Skin is intact. Xray shows fracture of the proximal 5th metacarpal with good alignment. Tx of choice? |
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Definition
| ulnar gutter splint to immobilize the fx site |
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Term
| 22 yo female presents with onset of right eye vision loss 24 hours ago which has partially improved. She has experiences various widespread paresthesias, regional weakness, and fatigue over the past 6 months. Episodes vary in location, severity and duration but invariably lead to recovery. her exam is completely normal but MRI reveals numerous areas of periventricular gadolinium uptake. For this condition, what tx shows the greatest benefit with long term use? |
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Definition
| interferon beta 1a (avonex) |
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Term
| 18 month old male presents with his parents who report symptoms of a barking cough and intermittent stridor that has worsened over the past 12 hours. They note improvement in symptoms when he was taken outdoors to the cool night air. Causative organisim? |
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Definition
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Term
| AA is palced on hydroxoychloroquine (Plaquenil) for travel to Africa. Within 6 wks he presents c/o fatigue. CBC shows anemia. Study of choice? |
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Definition
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Term
| 60 male nonsmoker with h/o CAD presents c/o worsening dyspnea on exertion for 3 wks. He admits to orthopnea and lower extremity edema, but denies chest pain, palpitatinos, and syncope. The pts last echo revealed an ejection fraction of 30%. What are you likely to find on PE? |
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Definition
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Term
| 25 yo female presents with S&S of depression. She doesn't have any other known medical problems. Dx study indicated as part of the initial eval? |
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Definition
| Thyroid Stimulating Hormone (TSH) |
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Term
| 44 yo hairdresser presents to the clinic with a 2 month h/o pain and numness of her left hand that awakens her from sleep. Your exam reveals electric tingling sensations with percussion over the volar surface of the wrist just proximal to the palmar crease and paresthesias noted within 15 seconds of passively flexing the wrist. Initial tx? |
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Definition
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Term
| 34 yo man comes to the urgent care clinic with fever of 102, chills, pernieal pain for the past 2 days. In addition he has difficulty voiding, dysuria, frequency, urgency, and nocturia. Likely PE findings? |
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Definition
| prostate tender, warm, and swollen |
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Term
| Pt was treated for CAP with Augmentin. On day 7 of therapy he develops fulminate diarrhea. The diarrhea is described as greenish and fould smelling. He admits to associated abdominal cramps. Treatment of choice? |
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Definition
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Term
| 48 yo G3P3003 female presents to the office c/o severe secondary dysmenorrhea and menorrhagia over the last 6 months. On PE her uterus feels enlarged and irregular. Which of the following is the most likely dx? |
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Definition
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Term
| MC anatomical location of anterior bleeding from the noce? |
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Definition
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Term
| 9 yo boy comes to the office with his mother to discuss tx for chronic dry skin, and pruritic inflammatory lesions of the flexor surfaces of the neck, hands, and wrists. PMHx is significant for AR in the spring and fall. On PE the skin lesions are excoriated, and lichenified with crusted patches. What strategy can help minimize sxs in this pt? |
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Definition
| avoid rubbing or scratching |
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Term
| 68 yo female with a 30 pack year smoking hx c/o new onset SOB. On PE, dullness is noted on percussion with diminished breath sounds over her left base. CXR shows a new left pleural effusion. Next step in treatment? |
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Definition
| perform diagnostic thoracentesis |
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Term
| 50 yo female has a h/o severe, stabbing pains, lasting only seconds, over the cheek and chin areas. She also experiences intense pain in these areas with chewing, washing her face, and even smiling. Exam reveals no sensory or motor deficits. Head CT and ESR are normal. She has been unresponsive to max doses of carbamazepine. Next best option? |
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Definition
| stereotactic (Gamma Knife) Radiosurgery |
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Term
| 41 yo male with h/o intravenous drug abuse presents to your office with acute, nontraumatic right knee pain, chills, and sweats starting 2 days ago. On PE his temp is 102.9. The right knee is erythematous, edematous, and tender to palptation and range of motion. Plain knee xray reveals soft tissue swelling. Most likely dx? |
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Definition
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| 78 yo male with hx of CAD s/p coronary artery bypass grafting, HTN, and dyslipidemia presents for routine PE. He feels well except for occasional brief episodes of substernal CP with exertion that are relieved with rest. He denies associated dyspnea, nausea, or diaphoresis. PE reveals a BP of 110/70, HR 56 and regular, RR 14 and unlabored. Lungs are CTA bilaterally, heart is bradycardic, but regular with no S3, S4, or murmur. ECG done in the office shows no acute ST-T waves changes. Tx? |
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Definition
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| Pt is evaluated for extreme fears of abandonment and an inability to care for himself throughout his adult life. He avoids disagreements and has difficulty initiating projects or acting on his own thoughts and ideas. Advice and reassurance are sought for even minor daily details. There are no reported suicidal tendencies or signs of self harm. Most likely personality d/o? |
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Definition
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Term
| 52 yo female is dx with CML. Which of the following would you expect to find on PE? |
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Definition
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Term
| Screening for hypothyroidism is indicated for what pt? |
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Definition
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Term
| Construction worker presents with severe eye pain after splashing concrete in his eye. Exam is complicated by the pts difficulty opening his eye. Most appropriate therapy? |
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Definition
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Term
57 yo man is being evaluated for SOB. The following spirometric data are obtained.
VC 105% of predicted
FRC 110% of predicted
RV 128% of predicted
FEV1 67% of predicted
Findings are consistent with what? |
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Definition
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Term
| Pt has just delivered her baby vaginally without difficulty. The pt has a laceration of the vaginal mucosa including the perineal body. On the chart you document this as what type of tear? |
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Definition
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Term
| 36 yo male presents for f/u of his HTN. The pt is currently on 3 anti-HTN meds without improvement of his BP. On exam BP is 170/86 and HR is 60 and regular. Heart exam reveals a regular rate and rhythm without S3, S4, or murmur and his lungs are CTA bilaterally. Abd exam reveals a bruit over his left upper abdomen. Most likely underlying etiology for this pts HTN? |
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Definition
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Term
| 56 yo white post menopausal female had a recent surveillance DEXA bone densitometry. T Score is -2.7 for her right hip. In counseling this pt, in addition to medications, what would you recommend? |
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Definition
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Term
| What term is given to an ocular exam finding where small, irregular pupils are seen that react with near vision but not to light? |
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Definition
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| 63 yo man comes to the office to discuss tx for ED. He is interested in learning more about the medication sildenafil (viagra). He has hx of CAD, asthma and BPH. What med is contraindicated with viagra due to the potential drug interaction? |
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Definition
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| 62 yo female presents to the ED with significant back pain without radiation after lifting a box weighing approximately 15 lbs. She denies any previous trauma or injuries. Past hx includes hysterectomy at age 42 and a 49 pack year smoking hx. Her current weight is 107 lbs. Lumba-sacral spine film indicates a spinal compression fx at teh level of L4. What tx should be performed to futher investigate the findings? |
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Definition
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| 31 yo female c/o diarrhea. She admits to associated weight loss and steatorrhea, but denies melena or hematochezia. Most likely dx? |
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Definition
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Term
| 9 yo pt presents with conjunctivitis after swimming at the local pool. On exam there is visible lid edema with redness of the palpebral conjunctiva, copious watery d/c, and scanty exudate. The sanitation system of the public pool is through the use of a salt water system, therefore, the possibility of chemically induced conjunctivitis is almost non existent. Tx? |
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Definition
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| 36 yo male who is hospitalized because of severe injuries from a MVA develops rapid onset of profound dyspnea. Initial CXR shows a normal heart size with diffuse bilateral infiltrates. F/U CXR shows confluent bilateral infiltrates that spare the costophrenic angles. Best clinical intervention? |
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Definition
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Term
| 16 yo male presents with c/o syncope after basketball practice today. PE revelas a systolic murmur along the left sternal border that increases with valsalva maneuver. An ECG reveals LVH. ECG shows asymmetric left ventricular hypertrophy with a hypercontractile left ventricle. Med of choice? |
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Definition
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Term
| 37 yo right handed landscaper comes to the office for eval of recurrent itching and stinging of the skin on his right hand. PE reveals confluent papules, vesicles, erosions, and crusts on the dorsum of his right hand. Initial dx study of choice? |
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Definition
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Term
| What phase of he female menstrual cycle occurs at the time of elevated estrogen and LH/FSH surge? |
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Definition
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Term
| 27 yo male nonsmoker is dx with upper extremity venous thrombosis. What is the most likely factor abnormality found in this pt? |
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Definition
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Term
| 34 female construction worker presents with episodic blanching of her fingers when exposed to cold weather. The PE of her extremities and digits is normal at this time. Dx? |
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Definition
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| 67 yo Asian male in the ED for acute onset right eye pain. He states he was at the evening premier of a newly released movie when the pain started. He had acute, profound visual loss in the affected eye. The pain was intense enough for him to leave the theatre before the movie's conclusion and present to your location. On exam the eye appears injected and the cornea appears hazy. His pupils are 6mm on the affected side and 3mm on the unaffected side. They respond to light on the unaffected side but not on the affected side. On palpation, the globe feels tense. What hx question is most relevent to support the dx?? |
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Definition
| Visualizing halos around street lights |
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Term
| 80 yo female presents with syncope and recent fatigue and lightheadedness over the past month. She denies CP or dyspnea. PE reveals BP 130/70, HR 40 and regular, RR 16. ECG reveals two P waves before each QRS. Treatment of choice? |
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Definition
| permanent dual chamber pacemaker insertion |
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Term
| Pt describes hx of intermittent and uncontrollable twitching of his right hand that spreads to involve the entire arm after a few minutes. Afterward, the arm is extremely weak. There are no other areas of involvement, sensory deficit or altered consciousness. Most likely seizure dx? |
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Definition
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Term
| 15 yo man comes to the office with acute onset nausea, severe pain, and swelling within the right testis. He has no fever of irritative voiding sxs. Expected PE finding? |
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Definition
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Term
| 56 yo DM male with a 3 month hx of epigastric pain after eating says he gets full really fast now. His test for H Pylori is negative. TOC? |
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Definition
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Term
| Most appropriate management of acute psychosis in pt with schizophrenia? |
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Definition
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Term
| Asx 60 yo female with a 30 pack year smoking hx presents to the clinic requesting a CXR for lung cancer. What do you recommend? |
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Definition
| no testing and referral for smoking cessation |
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Term
| Colpo exam of the cervix of a 38 yo woman with a high grade lesion on Pap smear yields a positive ECC as its only abnormality. Most appropriate next step? |
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Definition
| perform a conization of the cervix |
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Term
| Expected PE finding of a newborn dx with TOF? |
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Definition
| palpable right ventricular lift |
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Term
| What is the rationale for the utilization of beta blocker therapy in a pt with hyperthyroidism? |
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Definition
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Term
| What type of hip fx has the highest risk for AVN and nonunion? |
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Definition
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Term
| You are counseling two newly diagnosed type 2 diabetics about the need for referral to ophthalmology for a dilated funduscopic exam. What is the rationale for this? |
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Definition
| Retinopathy is present in 20% of pts with type 2 DM at time of diagnosis |
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Term
| Pt is evaluated for an overblown sense of self-importance and sense of entitlement. He is described as being arrogant, envious, exploitative, and lacking in empathy. He is prone to mood swings and though he has a productive career in business he has few meaningful personal relationships. Most appropriate management? |
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Definition
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| 54 yo man comes to the urgen care because he was awoken suddenly from his sleep this morning with severe left flank pain radiating to his left testicle with associated nausea and vomiting. He is afebrile and vital signs are normal. He is constantly moving to find a comfortable position. On PE, left flank tenderness is noted with no direct testicular tenderness. UA reveals pH of 5.5 and microscopic hematuria but is otherwise unremarkable. Dx? |
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Definition
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Term
| 18 yo female presents to the office with fever, fatigue and sore throat. PE reveals an erythematous pharynx, cervical LAD, and splenomegaly. CBC reveals an increased WBC count with atypical lymphs, normal hemoglobin and hematocrit and normal platelet count. What additional lab test will help you? |
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Definition
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Term
| 67 yo male with history of mitral valve stenosis undergoes a mechanical valve replacement. Most appropriate duration of anticoagulation therapy if the pt has no other risk factors for thromboembolic events or significant bleeding risk? |
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Definition
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Term
| What nail finding is most consistent with cirrhotic liver disease? |
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Definition
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Term
| 30 yo male presents with sudden onset chills, fever, chest pain, and a cough productive of greenish-brown sputum. On exam his temp is 102. He appears acutely ill and his respirations are shallow. CXR demonstrates left lower lobe consolidation. Most likely PE finding? |
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Definition
| increased tactile fremitus |
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Term
| 26 yo female reports progressive distal to proximal spread of extremity weakness over the last 36 hours without fever, HA, or syncope. Exam reveals symmetrical paresis of the hands and feet with loss of the brachioradialis and Achilles reflexes. Biceps and knee reflexes are present but diminished. Sensory exam is normal. Most likely CSF findings? |
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Definition
| normal glucose, normal WBC count, elevated protein |
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Term
| Which of the following PE findings is present in a 12 wk singleton pregnancy? |
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Definition
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Term
| A blacksmith presents to your clinic after feeling like something went in his eye while he was grinding on a piece of metal. You stain the eye with flouroscein and can visualize uptake with what appears like a deep abrasion. You are unable to visualize any foreign body with your indirect ophthalmoscope. Although he makes an attempt, he c/o some visual loss in that eye. His last tetanus booster was 4 years ago. What is the most appropriate next step in the management of this pt? |
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Definition
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Term
| What history is appropriate for a pt with spnial stenosis? |
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Definition
| gradual onset of back and thigh pain exacerbated by walking and alleviated by sitting |
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Term
| 36 yo female comes to the office beause a mole on her left calf has changed. On PE of the left posterior lower leg there is a 12mm, asymmetrical, variegated blue-black macule with raised pink plaque in the upper half of the lesion. Most appropriate management? |
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Definition
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Term
| 60 yo female with hx of radiation therapy for the tx of cancer presents with progressive dyspnea and fatigue. On exam the pt has lower extremity edema, significant ascites, and an elevated JVP that doesn't fall with inspiration. Heart exam reveals a pericardial knock. Echo shows rapid early filling and reduced mitral inflow velocities with inspiration. Most likely dx? |
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Definition
| constrictive pericarditis |
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Term
| 4 month old infant is brought to the clinic by his mother with c/o cough. Over the past week the cough has changed to persistent staccato, paroxysmal foreceful coughs ending with a loud inspiration. WBC is 20,000 with 72% lymphocytes. Drug of choice? |
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Definition
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Term
| 28 yo female comes to the office with fever, flank pain, and dysuria for the past two days. What UA result is suggestive of acute pyelonephritis? |
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Definition
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Term
| What is the initial tx of choice for inflammatory bowel disease? |
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Definition
| sulfasalazine (azulfidine) |
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Term
| pt traveling to Africa on a church mission trip. The area he is traveling to has a high incidence of chloroquine-resistant malaria. What drug is indicated for prophylaxis? |
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Definition
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Term
| What spinal nerve root is most likely affected in a pt with weak wrist extension, thumb and index finger paresthesias and diminished triceps reflex? |
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Definition
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Term
| 13 yo female presents to the office with right knee and thigh pain and the inability to bear weight since waking yesturday morning. The mother states the child had a fever of 100.9 this morning and continues to be non weight bearing. Exam reveals a warm, erythematous, swollen knee. Which of the following tests would be most beneficial in the dx and treatment of this pt? |
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Definition
| culture of joint aspirate |
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Term
| 59 yo male with hx of HTN and dyslipidemia presents with c/o substernal chest pain for two hours. The pain woke him from sleep, does no radiate, and is associated with nasuea and diaphoresis. ECG reveals ST segment elevation in leads II, III, and aVF. what part of the heart is most likely at risk? |
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Definition
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Term
| a recent Haitian immigrant presents to the clinic for an employment PE before starting work at a local hospital. The pt has a hx of receiving bacilli Calmette-Guerin (BCG) vaccination. Screening for TB for this employee should include what? |
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Definition
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Term
| 33 yo presents with sinusitis unresponsive to 3 varius abx over the past four months. Sinus puncture is performed with culture positive for Aspergillus Fumigatus. Most appropriate tx? |
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Definition
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Term
| Pt with schizophrenia states that newspapers and the television are constantly talking about him though they never mention his name. What best fits this description? |
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Definition
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Term
| You are following a pt in labor at term. You evaluate the fetal monitoring tracing and note the presence of variable, repetitive decelerations in the heart rate. Contractions have a sharp deceleration slope. Recommended tx? |
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Definition
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Term
| 27 yo female presents with 5-6 HA monthly for the past year that are described as severe, throbbing, and initially unilateral. They are associated with nausea, photophobia and phonopohbia. There have been no concomitant sensory or motor deficits. Her PE and brain MRI are normal. Tx to reduce the frequency of HA? |
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Definition
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Term
| 24 yo female presents c/o palpitations described as occasional "skipped beats". The pt denies chest pain, lightheadedness, syncope, or dyspnea. On exam you note a midsystolic click without murmur. Most likely dx? |
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Definition
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Term
| 14 yo male active in sports, has been c/o intermittent anterior right knee pain for several months. He denies any specific injuries. On exam, there is no erythema, swelling, deformities, joint laxity, or crepitus. Palpitation reveals tenderness over the tibial tubercle and bursa of the right knee. Dx? |
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Definition
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Term
| 28 yo man comes to the office for his yearly f/u of testicular cancer. He was successfully treated with an orchiectomy two years ago. What tumor marker can be used to identify early relapse in testicular cancer? |
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Definition
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Term
| 6 yo boy is brought to the peds clinic by his mother for an evaluation of his asthma. He coughs about 3 days out of the week with at least 2-3 nights of coughing. Which of the following is the most appropriate tx? |
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Definition
| low dose inhaled corticosteroid |
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Term
| male with a hx of alcohol abuse presents with coffee ground emesis. He denies vomiting prior to this episode. Most likely cause? |
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Definition
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Term
| What class of meds has been found most beneficial in the tx of alcoholism not associated with concomitant psychiatric illness? |
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Definition
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Term
| Which of the following lab values would be noted in a pt with primary hyperthyroidism? |
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Definition
| decreased TSH, increased free T4 |
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Term
| 16 yo female presents to the office with a rash. She was healthy until one week ago when she developed a fever, HA, generalized LAD and rash on her trunk. On PE you note an erythematous rash with central clearing. Her left knee is swollen with painful range of motion. She recently returned from Girl Scout Camp. Most likely dx? |
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Definition
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Term
| 10 yo female experiences fever and polyarthralgia. On exam you note a new early diastolic murmur. Lab results are positive for antistreptolysin O. The pt has no known drug allergies. Recommended prophylaxis? |
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Definition
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Term
| Pt is 12 hr post closed reduction of a tibial fx and is in a long leg cast. Despite pain medication the pt c/o unrelieved pain and cannot move his toes. Which of the following is the most appropriate clinical intervention? |
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Definition
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Term
| What is the most appropriate method to rule out vertebrobasilar insufficiency as a cause of recurrent vertigo? |
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Definition
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Term
| 13 yo male with known CF presents to the ED, accompanied by his parents with increased coughing, wheezing, and low grade fever. Rales are audible on auscultation of the lungs. Tx should target which of the following organisms? |
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Definition
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Term
| 68 yo woman comes to the office for eval of urinary incontinence. For the past few months, she has had an intense urgency to urinate, followed by leakage of urine. Most appropriate intervention? |
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Definition
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Term
| What is the recommended initial first trimester screening test for fetal aneuoploidy? |
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Definition
| pregnancy associated plasma protein A, beta hcg, and ultrasound of nuchal transparency |
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Term
| 26 yo pt is brought to the ED after a head on collision. The pt c/o chest pain, dyspnea, and cough. Exam reveals the pt to be tachypneic and tachycardic with a narrow pulse pressure. Jugular Venous distention is noted. ECG reveals nonspecific twave changes and electical alternans. Most appropriate management? |
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Definition
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Term
| 23 yo male comes to the office with an intensely itchy rash, especially at night for the past week. His roommates have similar sxs but have not been evaluated. On PE the wrists, web spaces of the hands, and axillae have thin linear markings, tiny vesicles, and excoriations. Most likely dx? |
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Definition
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Term
| 55 yo male presents with a 3 month hx of progressive weakness in the extremities without associated sensory cahnges or deficits. Exam reveals widespread muscular atrophy, fasiculations and bilateral hyperactive reflexes with Babinski sign. Most likely dx? |
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Definition
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Term
| 5 yo presents with perianal pruritis that is worse at night. Scotch tape is positive for enterbius vermicularis. Treatment of choice? |
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Definition
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Term
| 17 yo female is seen who has a hx of eating large amounts of food at night 3-4 times weekly. These episodes are always followed by extreme guilt and either induced vomiting or hours of strenuous exercise. She excels at work and school and maintains many active relationships. Her PE reveals a normal BMI and an otherise normal exam. Best initial intervention for this pt? |
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Definition
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Term
| prolonged use of a PPI can lead to low levels of which of the following nutrients? |
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Definition
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Term
| 40 yo G3 P3003 female presents c/o dull aching discomfort of her lower extremities, which is worse in the evenings. The pt currently works as a waitress. Exam reveals dilated, tortuous veins beneath the skin in the thight and leg bilaterally. Best initial approach?? |
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Definition
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Term
| 69 yo male presents with c/o increasing dyspnea over the past 6-8 months. The pt denies cough, chest pain, or smoking hx. PE reveals inspiratory crackles at the bases and clubbing of the nails. CXR reveals intersitial fibrosis of the lower lungs, tickened pleura and calcified plaques of the lateral chest wall. PFT shows a restrictive pattern with a decreased diffusing capacity. What info is likely noted in this pts hx? |
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Definition
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Term
| 54 yo type 2 diabetic male presents for f/u eval of previously diagnosed persistent otitis externa. Early in the disease process, a CT scan was obtained secondary to non improvement on abx. results showed osseous erosion of teh floor of the ear canal. He has been on cipro 1000mg twice daily for two months since the CT scan and currently has no further edema, erythema, or exudate from the external auditory canal or surrounding tissue. Tx? |
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Definition
| obtain gallium scan to ensure reduction of inflammatory process |
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Term
| Person with type 2 DM who requires insulin brings in a home monitoring record for review. The current insulin regimen is 15 units of NPH with 5 units of regular in the morning and 10 units of NPH with 5 units of regular in the evening. A trend of elevated blood sugar readings occuring at noon should prompt an insulin increase of which of the following? |
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Definition
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Term
| In which of the following conditions would hcg level be lower than expected for gestational age? |
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Definition
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Term
| 26 yo woman comes to the office for her first prenatal visit at 9 wks gestation. During eval, her UA reveals asx bacteriuria. Abx of choice? |
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Definition
| nitrofurantoin (macrobid) |
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Term
| What PE finding is most specific for acute cholecystitis? |
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Definition
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Term
| Which of the following medications is the initial tx of choice for suppressing the progression of RA? |
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Definition
| methotrexate (rheumatrex) |
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Term
| 60 yo male with hx of HTN presents for routine PE. He has no current complaints. Vital signs are BP of 136/70, HR 60 and regular, RR 14 and unlabored. Heart shows regular rate and rhythm with no S3, S4 or murmur. Lungs are clear to auscultation bilaterally, and the abdomen is soft, nontender. There is a 5cm palpable pulsatile abdominal mass noted. best initial diagnostic study? |
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Definition
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Term
| What is the mechanism of action of salmeterol (serevent) in the tx of asthma? |
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Definition
| relaxing bronchial smooth muscle |
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Term
| 62 yo male chornic smoker is examind for slowly progressive non painful vision loss. visual acuity shwoed 20/150 in both eyes. Extra ocular muscles are intact. Pupils are responsive to direct and concensual stimuli however appear hazy. During funduscopic exam you are unable to visualize the optic disc, cup, or vessels. Most appropriate dx? |
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Definition
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Term
| 47 yo perimenopausal female with vasomotor sxs complains for vulvar itching and copious vaginal discharge wit a rancid odor. PE reeveals erythema of the vulva and petechiae on the cervix. The pH of the vaginal discharge is 5. Tx? |
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Definition
| oral metronidazole (flagyl) |
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Term
| 30 yo female presents with left wrist pain after slipping on the ice while walking to her car. On exam, pain is noted on palpation over the anatomical snuff box. Xray of her wrist shows no identifiable fracture. Tx? |
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Definition
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Term
| In what region of the brain are cerebrovascular lesions most likely to cause post event depressive sxs? |
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Definition
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Term
| 70 yo female with hx of HTN, DM, and hypothyroidism presents with c/o sudden onset of left lower extremity pain. Exam reveals a cool left lower extremity with a mottled appearance. Dorsalis Pedis and posterior tibialis pulses are absent. Most likely dx? |
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Definition
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Term
| 54 yo woman with history of lupus comes to the office with increasing significant peripheral edema over the past four days. Lab findings include marked proteinuria, hypoalbuminemia, and hyperlipidemia. Dx study that is best for determining the cause of the proteinuria? |
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Definition
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Term
| For pts undergoing highly emetogenic chemotherapy regimens, which of teh following would be the first line antiemetic medication? |
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Definition
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Term
| 26 yo female comes to the office for eval of a painful lump on her right buttock for the past week. Initially, it was a firm, tender nodule that has increased in size and tenderness in the past two days. On PE the right buttock, there is a 3cm fluctuant, tender, red nodule. Most appropriate initial intervention? |
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Definition
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Term
| MCV of less than 80 cubic microns is a manifestation of which of the following dx? |
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Definition
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Term
| 55 yo female presents to the Ed with c/o dyspnea, chest pain, and coughing with hemoptysis. PMHx includes breast cancer 5 yrs ago, currently in remission. Vital signs are temp 98.6, BP 150/90, P 110, RR 20. PE shows her right leg swollen with pain on palpation of deep veins. What finding is most suggestive of PE? |
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Definition
| leg swelling and pain with palpation of deep veins |
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Term
| 57 yo male presents with episodic diplopia over the past two months. Sxs progessed over the last two days with the onset of bilateral facial weakness made worse with repeititve use. Weakness improves somewhat with rest. He denies fever, HA, or areas of pain. Exam reveals a nasal voice, drooping eyelids and a normal sensory exam. Most likely dx? |
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Definition
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Term
| Best radiologic study to image the pituitary gland? |
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Definition
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Term
| An otherwise healthy college student presents with c/o cough, malaise, fever, yellow-green nasal discharge and HA for the past 3 wks. She c/o facial pain over the cheeks and while chewing. On exam, the nasal turbinates are erythematous and edematous nearly obstructing the nares bilaterally. She has not been previously evaluated. Most appropriate abx? |
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Definition
| trimethoprim/sulfamethoxazole (bactrim) |
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Term
| 45 yo male presents to the ED c/o sudden onset of tearing chest pain radiating to his back. On exam the pt is HTN and his peripheral pulses are diminished. ECG shows no acute ST-T wave changes. Dx study of choice? |
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Definition
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Term
| 25 yo female with IBS presents with c/o upper and lower extremity discomfort. The pt has pinpoint muscle tenderness over the shoulder girdle, low back, and hips. Med most appropriate for tx? |
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Definition
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Term
| complication of Crohn's disease most frequently requires surgery? |
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Definition
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Term
| Most effective prophylaxis against RSV infection in the general pediatric population? |
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Definition
| proper hand washing techniques |
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Term
| what are the most effective agents in treating somatoform spectrum pain disorder? |
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Definition
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Term
| 73 yo male with chronic renal failure due to longstanding HTN and diabetes is being discharged from the hospital today. Dietary recommendation should be made to prevent further complications and progression of his renal disease? |
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Definition
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Term
| 60 yo male c/o progressive fatigue and dyspnea. On exam his lungs are CTA bilaterally, heart exam reveals regular rate and rhythm without S3, S4, or murmur and extremities show 1+ edema bilaterally. CXR reveals cardiomegaly, ECG shows low voltage and echo shows an ejection fraction of 55% with a small thickened left ventricle that has rapid early filling with diastolic dysfunction. most likely underlying etiology of this pts cardiomyopathy? |
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Definition
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Term
| 22 yo grad student presents with a six month history of abdominal pain relieved with defecation which seems to coincide with her starting PA school. She describes alternating constipation and diarrhea as well as bloating. She denies any recent weight changes. Her only medication is citalopram (celexa). Most likely dx? |
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Definition
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Term
| 30 yo female presents with amenorrhea, proximal muscle weakness, weight gain, and increased emotional lability. Her PE consists of central obesity, full face, and protuberant abdomen with thin extremities. BP is 150/96. Most likely dx? |
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Definition
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Term
| 18 yo young woman comes to the office with a mildly itchy rash on her chest and back for the past two weeks. She noticed an initial area on her back two weeks ago, and now it has spread across her back and chest. On PE, she has several salmon colored plaques with fine scale that follow cleavage lines of the trunk. dx? |
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Definition
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Term
| An O2 saturation of 90% corresponds to what PO2 value? |
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Definition
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Term
| 70 yo male with history of ischemic cardiomyopathy presents with syncopal episode. He denies c/o chest pain, palpitations, or dyspnea. ECG shows no acute ST-T wave changes. Echo reveals an ejection fraction of 25% with no valvular abnormalities. Most appropriate management? |
|
Definition
| implantable cardio-defibrillator |
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Term
| Which of the following is the dx study of choice in the evaluation of Zollinger Ellison Syndrome? |
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Definition
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Term
| Which of the following neurotransmitters is decreased in early Parkinson's disease? |
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Definition
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Term
| What portends the greatest risk for development of breast cancer? |
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Definition
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Term
| In order to help you delay the progression to kidney disease in a DM pt with proteinuria, which of the following would you consider using to treat the pt's HTN? |
|
Definition
| accupril (Quinapril) - ACEI |
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Term
| 58 yo with a 20 pack year hx of tobacco use presents to the ED with sudden onset of severe, progressive, right sided CP and SOB. She denies fever, nausea, and productive cough but reports returning from a mission trip to South Africa yesturday. Her exam reveals tachycardia, tachypnea, clear lung fields, and 3+ edema and erythema of the left leg. Her CXR is normal. Most likely dx? |
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Definition
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Term
| 46 yo male is brought to the ED after sustaining burns to his entire right arm and leg in a house fire. What percentage BSA is burned? |
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Definition
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Term
| Whhat imaging modality is most appropriate for the eval of chronic sinusitis? |
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Definition
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Term
| Which of the following is indicated as the firt line tx of an initial case of gouty arthritis? |
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Definition
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Term
| Most sensitive laboratory test to dx HSV? |
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Definition
| polymerase chain reaction (PCR) |
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Term
| DOC for the prevention of Wernicke's Encephalopathy? |
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Definition
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Term
| S3 and S4 gallops are both sign of which type of cardiac abnormality? |
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Definition
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Term
| 48 yo male presents with a mild tremor that seems to increase with stressful situations and subsides when he has a glass of wine with dinner. The pt doesn't demonstrate the tremor at rest but it reappers when he reaches for a pen. Dx? |
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Definition
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Term
| Most likely cause of a false negative PPD? |
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Definition
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Term
| An afebrile 50 yo male presents with an acute onset of an exquisitely painful first MTP joint. Exam reveals a red and swollen joint with tenderness on palpation. Most likely test result? |
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Definition
| negatively birefringent crystals |
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Term
| Elderly man who recently emigrated from a war-torn area of Africa is brought to the clinic by his daughter. She explains that her father's diet was very limited in calories and protein and that he mostly ate corn and very little fresh foods. He has chronic diarrhea and exam reveals pigmented regions on hands, arms, and face and mild dementia. His tongue is smooth and shiny. Dx? |
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Definition
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Term
| 51 yo pt presents for follow up after a recent stroke. Cardiac exam reveals a moderately loud systolic ejection murmur in the 2nd and 3rd interspace parasternally. The second heart sound is fixed and widely split. Dx? |
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Definition
| ventricular septal defect |
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Term
| 15 yo male is brought to the clinic by his father who reports a 2 day hx of low grade fever and coryza. The child awoke this morning with bright red cheeks. PE reveals edematous, confluent plaques over the malar region of the face and reticular rash over the child's extensor surfaces. Most likely dx? |
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Definition
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Term
| In a pt with a low probabilty of PE based on the Wells criteria, what lab study is most helpful in ruling OUT a PE? |
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Definition
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Term
| Which subset of the asx general population should undergo one-time screening for AAA? |
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Definition
| 65 yo healthy male who has smoked since age 20 |
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Term
| Which of the following is the pharmacologic therapy of choice in male pts suffering from mild-moderate gynecomastia? |
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Definition
| Selective Estrogen Receptor Modulators (SERMs) |
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Term
| 4 wk old female is seen for a well child visit. Birth hx is significant for breech presentation and weighing 9 pounds 8 ounces at delivery. What is used to rule out DDH? |
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Definition
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Term
| 72 yo female with hx of DM presents with sudden onset of painless flashing lights and floaters followed by curtain-like vision loss sparing the central vision in the right eye. Most likely dx? |
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Definition
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Term
| Pt presents with a LMP of May 4th. EDC? |
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Definition
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Term
| Empiric tx for infective endocarditis should target which organism? |
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Definition
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Term
| 68 yo women presents with intermittent crampy abdominal pain and vomiting for 6 hrs duration. She feels bloated and denies rectal bleeding. Exam of the abdomen reveals no palpable mass and you note an upper midline scar from previous abdominal surgery. An abd radiograph demonstrates dilated loops of small bowel with air fluid levels. Most likely cause of the pts sxs? |
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Definition
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Term
| 18 yo college freshmen presents to the student health clinlic c/o an outbreak of "athlete's foot" in his dormitory. He has no current signs or symptoms of infection but is asking for advice on how to prevent contracting this condition. Best advice? |
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Definition
| avoid excessive moisture and dry the skin carefully after bathing |
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Term
| 21 yo college student presents with a 3 wk h/o slowly worsening dry cough, generalized fatigue, and most recently low grade fevers. He denies nasal congestion, sore throat, and nausea and has no past hx of pulmonary disease or tobacco use. He does note that many other dorm residents have had similiar sxs over the past 2 months. Exam reveals mild inspiratory crackles but is otherwise normal. CXR is clear and CBC is normal. Most likely causative organism? |
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Definition
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Term
| 22 yo male presents for a physical. On exam you palpate a painless mass that cannot be separated from teh right testicle. Most likely dx? |
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Definition
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Term
| 9 yo presents with increasing SOB while playing basketball recently. On exam, radial pulses are exaggerated while femoral pulsations are weak. CXR shows rib notching and a mildly enlarged heart. Dx? |
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Definition
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Term
| 74 yo male presents with sudden onset of unilateral eye pain. He reports severe bulbar pain, decreased vision of the left eye and nausea. Exam is significantly for decreased visual acuity, marked ciliary injection, and mid-dilated pupil. Most appropriate inital tx? |
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Definition
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Term
| 36 yo truck drive presents with a very tender mass that has develoepd between his buttocks over the past 4 days. Exam shows a small pit like opening in the midline near the occyx which is surrounded by an erythematous halo. The area is exquisitely tender and prsesure produces purulent drainage from the opening. Most likely dx? |
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Definition
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Term
| Which of the following tocolytic agents works by inhibition of calcium influx? |
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Definition
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Term
| 20 yo male is brought to the ED by ambulance for eval of a neck injury after diving into shallow water. A radiograph reveals a moderately displaced C1 atlas fracture. Management? |
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Definition
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Term
| Most effective outpt tx for mycoplasma pneumonia? |
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Definition
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Term
| 58 yo male with HTN, hyperlipidemia, occasional gastritis, and mild OA needs to be started on tamsulosin (Flomax) for symptomatic prostatic hypertrophy. Which of the following meds may result in an adverse reaction in this pt? |
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Definition
Amlodipine (norvasc)
alpha blockers are used for BPH but also for HTN, you would essentially be increasing his anti-HTN therapy |
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Term
| Pt presents 5 days status post thyroidectomy with muscle cramping and AMS. On PE you elicit a positive Chvostek sign. Most likely lab result? |
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Definition
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Term
| 4 yo female presents with a headache and new onset confusion. She was dx with a viral illness 2 weeks ago. Exam reveals petechiae and mild scant purpura on her legs bilaterally. The CBC demonstrates a platelet count of 8000. Most appropriate next step? |
|
Definition
CT scan of the head
(concern of low platelets leading to internal bleeding, r/o intracranial bleed) |
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Term
| 59 yo male with longstanding uncontrolled HTN presents with nausea and a 5 pound weight gain in the last 2 days. He states "my belly is bigger and I can't fasten my pants." Most likely PE exam finding? |
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Definition
| ankle edema and elevated JVP |
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Term
| Which of the following lab tests would differentiate seizure from pseudoseizure? |
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Definition
serum prolactin
(rises briefly after a seizure) |
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Term
| 34 yo female 3 days status post appendectomy c/o mild diffuse abdominal pain with associated N/V. On exam you note diminished bowel sounds. There is generalized abomdinal distention with mild tenderness on palpation. There are no signs of peritoneal inflammation. Abdominal radiograph shows distended gas filled loops of small and large intestine. Abdominal CT scan shows no mechanical obstruction. Most appropriate management? |
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Definition
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Term
| 36 yo pt presents with poor wound healing following sutures to a hand laceration two week prior. She had regular periouds up to 4 months ago, then they ceased unexpectedly. Exam reveals central obesity, a prominent dorso-cerical fat pad and hirsutism. Most likely dx? |
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Definition
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Term
| 28 yo G1 P0 female at 36 wks gestation presents to L&D after she experienced a sudden gush of fluid that soaked her underwear. She admits to urinary frequency, but denies any contractions, vaginal bleeding, or dysuria. Most appropriate next step? |
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Definition
| sterile speculum exam for vaginal pooling and ferning |
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Term
| afebrile 2 yo female presents with a 3 day hx of foul smelling, blood tinged, mucoid drainage from the left nostril. Most likely dx? |
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Definition
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Term
| You are evaluating a pt who was brought in secondary to an acute onset of repeated syncopal episodes. His ECG shows wide QRS complexes with a fixed R-R interval at a rate or 40BPM. The P waves occur with fixed P-P interval at a rate of 70 bpm. The PR interval is variable. Most appropriate initial tx? |
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Definition
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Term
| Which of the following is the most common cause of a transudative pleural effusion? |
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Definition
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Term
| Intial tx of choice for status epilepticus? |
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Definition
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Term
| 22 yo male presents to the behavioral health unit with his family who relate his 5 month dx of delusions and hallucinations. Exam of the pt reveals a flattened affect, disorganized speech and poor hygiene. Most likely dx? |
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Definition
| schizophreniform disorder |
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Term
| 65 yo female presents with new onset of right eyelid droop. On exam ptosis, ipsilateral anyhydrosis, and miosis are noted. Underlying mechanism associated with this presentation? |
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Definition
| disturbance of the cranial sypmathetic innervation |
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Term
| 28 yo female is seen for her 4th documented case of uncomplicated cystitis this year. You recommend prophylaxis with nitrofurantoin (macrodantin) 100mg at bedtime, however she would prefer not to take a daily medication. What alternative dosing schedle can you recommend? |
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Definition
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Term
| Obese 12 yo male presents with a 1 month history of right thigh pain worsened with weight bearing. Exam is normal, however radiographs reveal a posterior and medial displacement of the femoral head. Most likely dx? |
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Definition
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Term
| An intoxicated pt is brought to the ED with a two day history of acute onset of severe fever, chills, and chest pain with frequent cough and dyspnea. His PMHx is significant for a 30 pack year hx of tobacco use, alcoholism for the past 20 years and hypertension. CXR reveals a left lower lobe infiltrate. Most likely causative agent? |
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Definition
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Term
| 35 yo primigravida presents to your office at 16 wks gestation. BP measurements in the first trimester were within normal limits. On PE her BP after 5 minutes of rest is 160/100. A repeat measurement 1 wk later is 154/98. Fundoscopic exam is normal, and no other abnormalities are noted. Most likely dx? |
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Definition
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Term
| Pt presents with c/o headaches during strenuous exercise. 24 hour ambulatory BP readings indicate he is hypertensive with exercise. A CXR reveals mild cardiomegaly. An echo shows an EF of 75% with interventricular septal hypertrophy. Most appropriate initial med? |
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Definition
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Term
| Recommended frequency of retinal screening in a pt with DM2 without evidence of retinopathy? |
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Definition
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Term
| 50 yo female presents with a 2 month hx of fatigue and morning stiffness involving both hands. It's now difficult for her to perform simple tasks at home and work. Exam reveals swelling and warmth of the MCP and PIP, sparing the DIP. Elevation of which lab test would support the suspected dx? |
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Definition
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Term
| 74 yo female presents to the ED with N/V, malaise and confusion. Pt lives alone, but was brought in by her daughter who stopped to visit and noticed the changes in her mother since she had last seen her 48 hrs earlier. Her UA is negative for infection and her BUN:Cr ratio is greater than 20:1. Most likely cause of acute kidney failure? |
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Definition
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Term
| While examining a pt's chest you discover an area with absent breath sounds, increased tactile fremitus, and egophony. Most like dx? |
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Definition
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Term
| Which of the following lab tests should be followed in pts treated with atypical antidepressants? |
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Definition
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Term
| Which of the following clinical pictures best defines AIDS? |
|
Definition
| mycobacterium avium complex with or without evidence of HIV infection |
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Term
| 71 yo male with h/o DM and dyslipidemia presents to the ED with c/o exertional CP for the past 2 hours. He gets some relief with rest but admits to associated N/V and left sided jaw pain. On exam he appears diaphoretic and tachypnic. ECG is unchanged from a previous ECG 1 year ago. His cardiac enzymes are within normal limits. Most appropriate next step? |
|
Definition
| monitor and repeat enzymes and ECG in 4-6 hours |
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Term
| 58 yo male presents with a 4 month h/o instability upon ambulation. Exam reveals resistance to passive movements, mild tremor of the lips and a shuffling gait. Which med is most appropriate? |
|
Definition
| Levodopa/Carbidopa (Sinemet) |
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Term
| 24 yo G2, P1 at 32 wks gestation presents to L&D with contractions. Her previous pregnancy resulted in an uncomplicated term delivery at 37 wks. Which of the following will be most helpful in predicting the likelihood of preterm delivery in this pt? |
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Definition
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Term
| 13 yo pt presents to the ortho surgeon's office for f/u eval for scoliosis. The Cobb Angle is measured at 65 degrees. What is currently indicated? |
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Definition
| Pulmonary Function Testing |
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Term
| 48 yo male with hx of AIDS presents with c/o odynophagia and dysphagia for 1 wk. The pt denies N/V, diarrhea constipation or melena. Endoscopic eval reveals diffuse, linear plaques which are yellowish-white in color and adhere to the esophageal mucosa. Tx of choice? |
|
Definition
| oral fluconazole (diflucan) |
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Term
| Which of the following PE findings is most likely in a pt with anemia, low factor 8 and a prolonged PTT? |
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Definition
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Term
| Which of the following is the single most important prognostic factor in regard to melanoma? |
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Definition
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Term
| 1 month old infant is bruoght to your office by his mother for routine eval and immunization. Exam reveals a continuous, rough, machinery pansystolic murmur that is best heard in the first and second interspace of the left sternal border associated with a thrill. Most likely dx? |
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Definition
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Term
| What disorder resopnds most readily to tx with Vit D alone? |
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Definition
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Term
| 42to male with chronic c/o heartburn and regurgitation for follow up after undergoing endoscopic eval which shows evidence of Barrett's esophagus. Most serious potential complication in this pt? |
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Definition
| esophogeal adenocarcinoma |
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Term
| Most common extra pulmonary finding in a pt with sarcoidosis? |
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Definition
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Term
| 21 yo male presents to the ED after being struck over the left eye by a baseball. The pt reports excruciating pain, decreased vision, and nausea. the exam is significant for enopthalmos and flattening of the anterior chamber. In addition to ophtho referral, most important emergent management? |
|
Definition
| place rigid shield over eye |
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Term
| HTN, hematuria, and dependent edema are the classic symptomaatic triad of what type of kidney disease? |
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Definition
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Term
| An ambulance transports a pt to your facility from the nursing home with anuria and diminished level of consciousness. Paramedics report a BP of 225/130. Most important medication? |
|
Definition
| nitroprusside sodium (Nipride) |
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Term
| A supervised vasopressin challenge test is a significant part of the diagnostic workup for what endocrine disorder? |
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Definition
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Term
| 59 to otherwise healthy female develops acute dyspnea and CP one week post total abdominal hysterectomy. Most important next step in the management of this pt? |
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Definition
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Term
| At the urging of his wife, 47 yo construction worker presents to your office with a skin lesion. He reports he has had a slowly growing nodule on the side of his nose for the past year or two. It recently develoepd a small central area of erosion. He denies pain, fever, chills, pruritis, and other similar lesions. On PE the lesion is approximately 1 cm as described above with a few telangiectasias. Best dx study? |
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Definition
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Term
| 45 yo female secretary presents with c/o numbness, tingling, and pain in the thumb, index, and third fingers. On exam the patient experiences numbness and tingling while holding her wrists in a flexed position for 60 seconds. Compression of which nerve? |
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Definition
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Term
| What type of kidney stone occurs secondary to infections due to urease-producing bacteria? |
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Definition
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Term
| 11 yo female recent immigrant from Haiti, presents to your office with a 3 day h/o mild sore throat, low grade fever, and malaise. There had been a recent outbreak of diptheria in your area. What PE finding would you expect? |
|
Definition
| gray membrane coating the pharynx |
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Term
| Pt admitted with substernal CP undergoes cardiac cath. Angiography reveals 98% occlusion of the RCA. All other vessels are 100% patent. Most expected ECG finding? |
|
Definition
| ST elevation in leads 2, 3, avF |
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Term
| Which of the following is a characteristic finding on exam of a pt who presents with herpangina? |
|
Definition
| vesicular lesions on the tonsillar fauces |
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Term
| 58 yo truck driver is found to have a positive Romberg test and loss of vibratory sensation in his lower extremities. What anatomic structure is most likely affected? |
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Definition
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Term
| 50 yo female presents with constipation following an episode of tearing pain associated with bleeding while defecating 4 days ago. She admits to a residual throbbing pain and she is afraid to have a bowel movement. On exam you note what appears to be a crack in the epithelium of the anal verge. Most appropriate mangement? |
|
Definition
| fiber supplementation and sitz baths |
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Term
| 70 yo pt presents with c/o chronic worsening SOB for the past few years. He admits to a 60 pack year history of tobacco use but no industrial exposures. Exam reveals a barrel chest, hyperresonant thorax and faint breath and heart sounds. Most likely PFT finding? |
|
Definition
| decreased FEV1, decreased FEV1/FVC ratio |
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Term
| Pt who was recently dx with viral pericarditis now c/o severe dyspnea and non-productive cough with pain over the precordial region. His vital signs reveal a heart rate 130bpm and RR 26. BP is 130/105 but fluctuates with inspiration resulting in a 20mmHg decline in the systolic pressure. Most appropriate therapy? |
|
Definition
| urgent pericardiocentesis |
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Term
| 18 yo G1P0 pt at 32 wks gestation is sent to L&D directly from her OBs office. Her BP on presentation is 162/114, she is hyperreflexic and has 3+ proteinuria on random UA. There is good fetal beat to beat variability with an occasional mild contraction on the uterine monitor. What is the benefit of magnesium in this pt? |
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Definition
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Term
| 25 yo female presents with acute right knee pain with associated dysuria, urgency, and body aches. She admits to an episode of unprotected sex 2 wks ago. Most likely organism to be found on joint aspiration? |
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Definition
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Term
| 30 yo pregnant female presents with anxiety, palpitations, and weight loss. On exam she is diaphoretic, tachycardic, and hyperreflexic. The TSH is lower than normal. Treatment of choice? |
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Definition
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Term
| What sx most commonly indicates diarrhea of an inflammatory etiology? |
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Definition
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Term
| 40 yo female is starting infliximab (Remicade) for the management of RA. This pt should be screened for what prior to initiating this med? |
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Definition
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Term
| What should be screened for in a 35 yo, non smoker dx with emphysema? |
|
Definition
| alpha-1 antitrypsin deficiency |
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Term
| Med that is most appropriate for migraine headache prophylaxis? |
|
Definition
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Term
| 17 yo female preesnts with c/o intermittent abdominal pain associated with frequent episodes of regurgitation of food for the past several months and worsening over the past 12 hours. She maintains a normal weight for her height, however, she seems obsessed with losing weight. On exam she has multiple dental caries, bilateral tenderness of the parotid glands and mild epigastric tenderness. What lab value would you expect to find? |
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Definition
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Term
| What type of hemoglovin in responsible for the development of sickle cell anemia? |
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Definition
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Term
| 48 yo male pt presents with a recent onset of anterior CP. The pain increases with deep breathing and coughing. He says he slept in the recliner last night as his discomfort worsens when he lies down. He also c/o feeling feverish although did not have a thermometer to check his temp. An ECG shows ST elevation in the precordial and limb leads. Additionally you note PR depression predominantly over leads 1, 2, and 3. Past medical hx is significant for pharyngitis diagnosed as mononucleosis about 10 days ago. Most appropriate next step? |
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Definition
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Term
| 67 yo male presents for worsening lower extremity edema. He denies CP, SOB, or history of CHF. On exam the pts lungs are CTA bilaterally and his cardiac exam reveals a RRR. His lower extremity PE is significant for 1+ pitting edema in the mid shin, multiple varicosities, and hyperpigmentation without skin breakdown. His ABI is within normal limits. You explain your concerns to the pt about the development of stasis ulcers. Most important next step? |
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Definition
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Term
| 25 yo G3P2 pt presents for a routine obstetric appointment at 28 wks gestation. Her EDC is based on her LMP. The fundal height is measured at 34cm for this singleton pregnancy. Her weight gain has been normal thus far during pregnancy. What lab or diagnostic test is recommended for further evaluation? |
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Definition
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Term
| Focal ulcerated areas of cartilage with bone eburnation, development of bone cysts, and the presence of osteophytes best demonstrates the pathophysiology of what? |
|
Definition
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Term
| 28 yo male presents with a h/o eye pain and blepharospasm. He reports being splashed in the eyes with an ammonia-based household cleaner. Most important initial step in tx? |
|
Definition
| irrigation with 1-2 liters of normal saline |
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Term
| 43 yo female calls the office stating her husband was recently diagnosed with Hepatitis A. She denies a past hitory of or immunization for this disease and specifically denies recent jaundice, fever, nausea, or abdominal pain. Most appropriate next step? |
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Definition
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Term
| 22 yo college student presents with a 1 day h/o left sided, sharp, and non-radiating chest pain. He describes a recent cold with dry cough, sore throat, and rhinitis starting 5 days ago but all of the sxs are now much improved. He denies fever, palpitations, or dyspnea. Exam reveals normal heart sounds, clear lung fields and no rash or palpable area of tenderness to the chest wall. A CXR is normal. Most likely dx? |
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Definition
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Term
| 14 yo female presents with short stature, growth failure, and physical features consistent with Tanner Stage 1. Her skin is dry and plae and her face shows fine wrinkles. She appears apathetic. This pt most likley has a tumor in which endocrine structure? |
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Definition
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Term
| 35 yo female presents with fatigue and dyspnea on exertion. She has a history of increasingly heavy menstrual periods for the last 8 months. She denies change in stool. Exam reveals HR 102, Temp 97.6, RR 20, BP 100/60, pallor and cheilosis. Peripheral smear demonstrates a hypochromic microcytic anemia and few target cells. Most likely dx? |
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Definition
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Term
| A pt 10 yrs s/p DVT presents with chronic lower exremity edema. Prevention strategy? |
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Definition
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Term
| 86 yo female presents c/o progressive significant vulvar itching. The itching is temporarily relieved with scratching. On exam you note diffue involvement of the vulva with very think, whitish epithelial plaques. In several areas the skin appears cracked and bleeds easily. Most appropriate intervention? |
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Definition
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Term
|
Definition
| renal parenchymal disease |
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Term
| 65 yo male smoker presents with a new onset of hematuria. Most definitive diagnostic study? |
|
Definition
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Term
| In which population is the pneumonoccocal conjugate vaccine (pneumovax) indicated for a pt younger than 65yo? |
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Definition
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Term
| 21 yo female breaks up with her fiance 1 wk prior to her wedding. She is reported missing the next day. She is found in another city far from her home and doesn't recall how she got there. Most likely dx? |
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Definition
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Term
| You are discharging a pt who had an MI with post infarction EF of 35%. You place the pt on the following meds: atorvastatin (lipitor), metoprolol (toprol-XL), aspirin, and nitroglycerin spray. What is also indicated provided there are no contraindications? |
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Definition
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Term
| 65 yo woman is admitted to the hospital for severe abdominal pain and vomiting over the last 6 hours. Her lab findings include: WBC count 19,000, serum triglyceride level 1100, glucose 280. Most likely dx? |
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Definition
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Term
| What PE finding indicates the delivery of the placenta is imminent in the 3rd stage of labor? |
|
Definition
| uterus is higher and more globular in the abdomen |
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Term
| 33 yo female 2 yrs s/p gastric bypass surgery presents to the office with c/o generalized fatigue and paresthesias in her hands. Exam reveals pallor, mild glossitis, and decreased vibratory sense. What lab test is most diagnostic? |
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Definition
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Term
| 22 yo male with h/o chronic low back pain presents with a four month h/o worsening and persistent low back pain, fatigue, and morning stiffness which are relieved with exercise. He also reports intermittent decreased vision and photophobia in his right eye. A lumbar spine series reveals squaring of the vertebral bodies with normal disc space. Most likely dx? |
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Definition
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Term
| 70 yo male presents with right sided vision loss. Exam reveals right homonymous hemianopsia. Most likely location of the suspected lesion? |
|
Definition
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Term
| 45 yo female presents with bowel movements associated with BRB after being dx with a stage 2 hemorrhoid 1 month ago. She has used increased fiber and fluid intake as her primary treatment up to this point. Most appropriate next step? |
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Definition
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Term
| 24 yo pregnant female presents with an abrpt onset of facial weakness and mild disturbance of taste this morning upon awakening. She denies drug use and other neurological complaints. Exam findings include a loss of forehead markings on right. What additional exam finding is likely? |
|
Definition
| ipsilateral restriction of eye closure |
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Term
| 28 yo non smoking black female presents with an 8 wk h/o dry cough, faitgue, and numerous macular-papular lesions on the face. She denies fever, chills, or hemoptysis though she has noticed enlarged, nontender lymph nodes in the neck. Lab tests reveal a normal CBC but her serum ACE level is three times the upper limit of normal. Her CXR reveals bilatearl, hilar adenopathy but is otherwise clear. What medication is most indicated? |
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Definition
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Term
| 16 yo athlete with no past medical history collapses after running 50 yards down the field. He is unreponsive, pulseless, and cyanotic. Most likely cause of this student's collapse? |
|
Definition
| hypertrophic cadriomyopathy |
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Term
| 40 yo female presents with h/o chronic musculoskeletal pain and chronic faigue unrelieved by rest. Palpation produces pain in 11 of the 18 paired trigger points. Which of the following correctly identifies the pathophysiology of her suspected dx? |
|
Definition
| Abnormal sensory processing of pain in the CNS |
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Term
| 23 yo female presents with rhinorrhea, nasal pruritis, and paroxysms of sneezing. She reports no facial pressure or fullness. Pale boggy nasal mucosa is noted on PE. Initial tx of choice? |
|
Definition
| intranasal fluticasone (flonase) |
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|
Term
| 3 wk old infant is evaluated for persistent projectile vomiting described as breast milk without blood or bile. the abdomen is distended befored vomiting and a small, mid epigastric mass is palpable after vomiting. Which of the following is the most appropriate diagnostic study for the evaluation of this pt? |
|
Definition
| upper GI contrast radiographs |
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Term
| 24 yo woman presents to the ED with a several day duration of flu-like syndrome, several small tender ulcers on her vulva and an inability to void. She admits to several sexual contacts in the last 20 days. She denies prior sexually transmitted diseases. Exam reveals the presence of lymphadenopathy. Most likely dx? |
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Definition
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Term
| 65 yo male 5 days s/p MI is evaluated for anterior chest pain. The pain improves with sitting up. The pt has associated fever, leukocytosis, and a pericardial friction rub. Most likely dx? |
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Definition
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Term
| Definitive tx for severe obstructive sleep apnea? |
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Definition
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Term
| 66 yo male presents with a sudden onset of nocturnal pain in the MTP joint of the second digit of his right foot. On exam the area is swollen, red, and exquisitely tender to touch. He remembers one similar episode two years ago after attending his son's wedding. His temp is mildly elevated at 100.5 and he otherwise appears fine. Plain radiograph reveals a rat-bite sign at the affected joint. Dx? |
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Definition
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Term
| You practice routinely screens its male pts for prostate cancer according to the USPSTF guidelines. A 71 yo caucasian male presents with a 50 pack year smoking history, previous treatment for prostatitis, and a paternal uncle with prostate cancer at age 65. He currently is sexually active with multiple female partners, eats a high fat diet, and is being treated for BPH. What increases is risk of developing prostate cancer? |
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Definition
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Term
| 58 yo male presents with a 3 month history of spastic paresis in his legs. Today, he has experiences diplopia on lateral gaze and scotomata in his right eye. Exam reveals decreased visual acuity of the right eye. What MRI finding is likely? |
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Definition
| multifocal white matter disease |
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Term
| What is inidcated as part of the initial management of spinal stenosis? |
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Definition
| nonsteroidal anti-inflammatory |
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Term
| 42 yo female presents with c/o ongoing fatigue, "always feeling cold", and mild constipation. During your diagnostic eval her TSH result is found to be elevated. What skin finding would you expect? |
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Definition
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Term
| 80 yo woman with a 40 pack year smoking history presents with progressive dysphagia for solids over the past 6 months. She states that she ahs often had to regurgitate her food because it "gets stuck". She has had an unintentional weight loss of 20 pounds. Initial diagnostic test of choice? |
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Definition
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Term
| 34 yo male presents with an acute onset of fatigue and dyspnea. He has experienced repeated episodes of near syncope and an unresolved chest discomfort as a "fluttering" sensation over the past 3 hours. His ECG reveals no definable p waves and his R-R interval is irregular. His BP is 88/60. Most appropriate tx? |
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Definition
| sedate for synchronized cardioversion |
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Term
| 57 yo male presents with a 3 day h/o progressive ear pain and drainage. Exam of the pt reveals purulent auricular drainage and marked tenderness of the tragus. Most appropriate tx option? |
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Definition
| topical ciprofloxacin (Cipro) |
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Term
| 30 yo male presents with a 1 wk h/o intermittent left orbital headache. He states that his episodes occur at night and last approximately 1 hour. Exam reveals ptosis, miosis, and dyshidrosis. Most other exam finding is likely to be present? |
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Definition
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Term
| New pt with a h/o HTN on verapamil (calan) presents for routine exam. ECG reveals irregular R-R intervals with narrow QRS complexes. There are no definable P-waves. Most appropriate intervention? |
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Definition
| warfarin (coumadin) therapy |
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Term
| What PE finding is likely in a pt with pleural effusion? |
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Definition
| dull to percussion with decreased tactile fremitus |
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Term
| 6 yo boy is evaluated for nocturnal enuresis. You offer behavioral education and write a prescription for the treatment of choice. Because of that drug's protential side effect you remind the parents that the boy should eat plenty of foods containing what? |
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Definition
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Term
| You are evaluating a 21 yo male pt with a h/o drug problems and multiple arrests. He has had many jobs in the past but doesn't keep them long, due to repetitive fights at work. He has a long history of violating and disregarding teh rights of others. Most likely personality disorder? |
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Definition
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Term
| 66 yo female with a history of DM and HTN presents for routine evaluation. Since beginning her ACEI and diuretic therapy her BP has averaged 135/85. What is the next best step in management? |
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Definition
| increase ACEI to achieve a BP of less than 130/80 |
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Term
| 8 yo female presents with a 5 day history of honey crusted rash beneath her nose. Best treatment option? |
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Definition
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Term
| 62 to male presents with a right hilar mass. Needle-biopsy of the mass reveals the presence of small cell carcinoma and a bone scan reveals the presence of scattered hot spots throughout the skeleton. Most appropriate treatment? |
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Definition
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Term
| A radiograph reveals a fracture of the proximal third of the ulnar diaphysis with an anterior dislocation of the radial head. What type of fx does this describe? |
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Definition
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Term
| Your pt is an 18 yo male with a family hx of MEN1. What screening electrolyte level would you recommend? |
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Definition
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Term
| The corneal light reflex is used to test for the presence of which condition? |
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Definition
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Term
| Which class of medications is considered first line for the treatment of panic disorder? |
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Definition
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Term
| 10 yo AA immigrant presents 2 wks after arriving in the US describing dry eyes and difficulty with night vision. Exam reveals numerous, small white conjunctival patches bilaterally. This pts sxs are most likely due to which deficiency? |
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Definition
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Term
| 13 yo pt is hopsitalized with a fever of 102.5 and a rash. After 36 hrs the rash has rapidly progressed to enlarging macules that appear ring or crescent shaped with central clearing. He also c/o multiple arthralgias involving his ankles, knees, and now his elbows. The ECG shwos evidence of a first degree AV block. Labs were significant for an elevated ESR and leukocytosis. Which PE finding is most likely? |
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Definition
| mitral regurgitation murmur |
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Term
| What is indicated in the treatment for a pt who presents with headache, fever, and faint macular eruptions on the ankles and wrists with several days after returning from a vacation in NC. |
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Definition
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Term
| 7 yo white male presents with a life long history of frequent and commonly complicated, bouts of bronchiectasis and other respiratory tract infections. His past history includes poor weight gain, low exercise endurance, and pancreatitis. Exam reveals a barrel chest and hyperresonance to percussion while a mixed obstructive restrictive pattern is seen on pulmonary function testing. Peribronchial cuffing and increased interstitial markings are noted on chest radiograph. What test would confirm? |
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Definition
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Term
| 18 yo female presents with dysmenorrhea associated with nausea and diarrhea for the last 3 years. She is not taking any medications at this time. Exam reveals a midline, mobile, and non tender uterus of normal size. She has no cervical motion tenderness. Most likely pathophysiology? |
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Definition
| excessive prostaglandin-induced myometrial contraction |
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Term
| 37 yo obese, otherwise healthy female presents with c/o an enlarging painful red mass on her left medial thigh. She had tried over the counter hydrocortisone cream and triple antibiotic ointment without improvement. Exam reveals a 4cm, warm, tender, fluctuant mass with surrounding erythema and no inguinal lymphadenopathy. Most appropriate clinical intervention? |
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Definition
| Incision and drainage, wound culture and oral antibiotic therapy |
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Term
| 35 yo male s/p PDA repair at 5 years of age, presents with low-grade fever, fatigue, and dyspnea worsening over the past 10 days. Prior to the onset of these sxs, he was healthy and free of any complaints. Exam is significant for petechiae on the palate, a high pitched holo systolic murmur heard best at the apex, and splinter hemorrhages on both hands under his fingernails. What is the most appropriate next step in the eval of this pt? |
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Definition
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Term
| A pt who recently immigrated from Southeast Asia presents with a 6 month history of weight loss, frequent cough with hemoptysis and fever. A sputum smear is positive for acid fast bacilli. What lab tests are most important in routine treatment of this condition? |
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Definition
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Term
| An asx 30 year old male with no signficant past medical history presents to the office. He is concerned about his father being diagnosed with colon cancer at the age of 60. Most appropriate health counseling for this pt? |
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Definition
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Term
| 44 yo male preesents as a new pt. He has a hx of HTN, RA, polycystic kidney disease, and seasonal allergies. On review of his current meds, which agent would you consider removeing? |
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Definition
| indomethacin (indocin) - potential for renal toxicity |
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Term
| 12 yo male presents c/o progressive and worsening nnontraumatic left knee and femur pain which began 2 wks ago. Pt now refuses to bear weight on the affected limb. Exam reveals pain with passive motion and a temp of 101. Gram stain of a bone aspiration reveals Staph Aureus. Most likely dx? |
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Definition
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Term
| 74 yo female with mild HTN is brought to the ED after a fall two days ago. The family reports that the pt has had some confusion this morning. Exam reveals left pupillary dilation and decreased strength of teh upper and lower extremity. What diagnostic test should be ordered first? |
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Definition
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Term
| What is required for the initiation and maintenance of the menstrual cycle? |
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Definition
| pulsatile secretion of gonadotropin-releasing hormone (GnRH) |
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Term
| 13 yo male presents with a 2 day history of fatigue and fever. He also c/o recent epistaxis and bleeding gums. Exam demonstrates pale skin with palpable purpura. Lab eval demonstrates pancytopenia with 42% blasts and a positive D-dimer. What treatment regimen is most likely to bring remission? |
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Definition
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Term
| What is the treatment of choice for a Baker's cyst? |
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Definition
| intra-articular injection of corticosteroid |
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Term
| 67 yo pt with a 15 year history of COPD presents with worsening respiratory sxs and abdominal pain. On exam, you observe peripheral edema, jugular venous distention, epigastric pulsations, and tender hepatomegaly. You auscultate a systolic ejection murmur. Echo reveals a dilated right ventricle with decreased EF and a normal appearing left ventricle. Most appropriate dx? |
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Definition
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Term
| 41 yo female presents with RUQ pain. She is febrile and slightly tachycardic. Exam demonstrates abdominal tenderness and abrupt cessation of inspiration wiht palpation under the right costal margin during deep inspiration. Ingestion of what is most likley to have proceeded the onset of this condition? |
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Definition
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Term
| According to Kidney Disease Outcomes Qualitative Initiative (KDOQI) guidelines, dialysis should be started in a nondiabetic pt when the GFR reaches 10mL/min or less, or when serum creatinine rises to which of the following levels? |
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Definition
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Term
| 63 yo female presents with right sided ear fullness and hearing loss. Weber testing lateralizes to the right and Rinne testing shows bone conduction greater than air conduction. Most likely dx? |
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Definition
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Term
| 58 yo female with a h/o controlled HTN is brought to the office after becoming incoherent during lunch 30 minutes ago. Exam reveals a right facial droop and right extremity weakness. A noncontrast head CT is negative for acute hemorrhage and an echo reveals normal sinus rhythm. Most appropriate next step? |
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Definition
| rtPA bolus and IV infusion |
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Term
| 30 yo female with DM type 1 presents for her annual exam with c/o intermittent nausea with occasional vomiting, diarrhea, and abdominal pain wrosening over the past 6 months. She states she has been irritable lately and feels anxious today. Her menses ceased 2 months ago. On PE she is mildly hypotensive. Urine pregnancy test is negative. What else are you likely to find on PE? |
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Definition
| hyperpigmentation over the knuckles |
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Term
| 27 to female is brought to the hospital after being found unconscious with a half-empty bottle of hydrocodone/acetominophen (vicodin) in her hand. Most appropriate tx? |
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Definition
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Term
| 60 yo male with mental status changes presents with his wife reporting his cognitive decline that has worsened over the last several months. Exam reveals that he is alert and oriented x2, has a shuffling gait, a reduced arm swing, and masked facies. He has no delusions but is reacting to visual hallucinations. His affect is flat, thought process reveals blocking. He has deficits in short - and - long term memory and confabulates when answering questions. A previous medical provider gave the pt an antipsychotic medication which caused catatonia. Most likely etiology of his sxs? |
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Definition
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Term
| 46 yo patients presents with a 4 yr h/o worsening cough, SOB, and dyspnea. He admits to bouts of bronchitis 5-6 times yearly but otherwise denies fevers, weight loss, or hemoptysis. He has worked the past 30 years as a sandblaster. His CXR reveals "egg shell" calcification of the hilar lymph nodes and numerous ground glass densities throughout both lung fields. Most likely dx? |
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Definition
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Term
| 67 yo presents as a new pt complaining of progressive dyspnea. Exam reveals 3+ pitting edema of the lower extremities bilaterally and wheezing audible in lower lung fields bilaterally. Most appropriate initial study? |
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Definition
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Term
| 17 yo college student is brought to the ED with a 10 hour history of fever, headache, and increasing listlessness. Exam is significant for a temp of 103, nuchal rigidity, and a petechial rash on the trunk and extremities. Most appropriate initial tx? |
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Definition
| Blood culture and administration of IV fluids and empiric antibiotics |
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Term
| 32 yo male with a h/o schizoaffective disorder was started on a new antipsychotic 12 weeks ago. He pesents with a fever of 102, shaking chills, and rigors. Lab testing is significant for a WBC count of 200. Which of the following antipsychotic agent is the patient most likely taking? |
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Definition
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Term
| 33 yo male presents to the ED reporting progressive distal to proximal upper and lower extremity weakness over the past 24 hours. Exam reveals no muscular atrophy, but absent patellar and biceps reflexes. Sensory exam over the same area is intact. Most likely dx? |
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Definition
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Term
| What is the MCC of sensorineural hearing loss in adults? |
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Definition
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Term
| 50 yo male with a h/o alcohol abuse presents c/o nodular thickening in the palmar aspect of the left hand. Exam reveals flexion of the 3rd, 4th, and 5th MCP and PIP joints. What is indicated at this time? |
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Definition
| Referral to a hand surgeon |
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Term
| 68 yo female presents to your office with a 3 day h/o pain around her right rib cage. She denies chest pain, SOB, palpitations, recent injury or trauma. Her past medical history is significant for RA for which she has used etanercept (enbrel) weekly for 4 years. PE is unremarkable. She returns the following day with grouped, vesicular eruptions alng the T5 dermatome. Most likley dx? |
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Definition
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Term
| 22 yo nulliparous female undergoes laparoscopy for progressive dysmenorrhea and chronic pelvic pain. She is found to have minimal chocolate colored cysts on the left ovary which are cauterized at time of surgery. she is not currently sexually active, uses no contraception, but does plant to marry and have children soon. What is the recommended therapy for this pt at this time? |
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Definition
| levonorgestrel and ethinyl estradiol (Seasonique) |
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Term
| You are evaluating a trauma pt who was unrestrained during a head-on collision. His chest struck the steering wheel and he is c/o pain in the per-cordial region. He is SOB and c/o non productive cough since the injury. Vital signs indicate a HR of 140, RR 24, and BP 80/60. His ECG reveals nonspecific T wave changes and low QRS voltage. What imaging modality is most appropriate? |
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Definition
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Term
| 29 yo female presents with a 1 day h/o severe, continuous dizziness with episodes of N/V. She is otherwise healthy with the exception of a recent upper respiratory infection. Most likely cause of her sxs? |
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Definition
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Term
| 17 yo female presents to the ED after injuring her knee in a soccer match earlier today. The injury occurred while suddenly decelerating and cutting in another direction. She heard a pop in the knee and complains the knee now gives out with any twisting motion. What test is the most useful in eliciting the most likely dx? |
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Definition
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Term
| 46 yo pt with a past medical history of a prolactinoma and parathyroid adenoma is brought to the ED at 645am by a family memeber who found her to be diaphoretic and confused. Initial lab studies are normal except for a fasting blood glucose of 35. The pt responds rapidly to IV dextrose. Most approriate long term intervention for this pt? |
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Definition
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Term
| 23 yo Peace Corps volunteer returned from Central America 2 wks ago. She presents with a week long history of intermittent headache and myalgias. Today she is experiencing shaking chills followed by a temp of 103.5 and diaphoresis. She reports she had similar sxs 2 days ago which she thought was the flu. Most likely dx? |
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Definition
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Term
| 56 yo male with history of HTN and alcohol use presents with mid-epigastric and coffee ground emesis since early this morning. The pt denies diarrhea, constipation, or blood in his stools. Endoscopic eval done after admission revealed peptic ulcer disease with active bleeding. Most appropriate therapy to reduce the risk of re-bleeding? |
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Definition
| IV pantoprazole (Protonix) |
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Term
| What lab finding is suggestive of menopause? |
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Definition
| increase in FSH, decrease in estradiol |
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Term
| What PE finding is consistent with chronic aortic regurgitation? |
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Definition
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Term
| 51 yodiabetic female is brought to the ED with c/o fever and chills for the past 24 hours. PE reveals BP 100/70, P 110, RR 18, Temp 102, Pulse Ox 98% on room air. On her right foot you note an area between the 4th and 5th digits that is erythematous, moist, and tender. LAD is present behind the right knee. Next best step in tx? |
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Definition
| admit the pt, obtain blood and wound cultures and treat with IV antibiotics |
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Term
| 79 yo nursing home resident with a h/o DM and HTN is transferred to the ED following an episode of confusion and right arm weakness which resolved after 8 hours. The staff recorded a fingerstick glucose of 102 at the onset of sxs. vital were BP 120/80, HR 78, RR 18, Temp 98.8. Most likely dx? |
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Definition
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Term
| Treatment of choice for pulmonary legionellosis? |
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Definition
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Term
| 35 yo female 2 months s/p gastric bypass surgery develops abdominal cramps, diarrhea, palpitations, sweating, and nausea shortly after eating. Dx? |
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Definition
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Term
| 34 yo male presents for eval after being struck in the left eye by a tennis ball. He reports pain about the eye and numbness of the ipsilateral cheek. The exam is significant for enopthalmos and diplopia noted on upward gaze. Preferred diagnostic test to assess this injury? |
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Definition
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Term
| 21 yo female grad student is brought to the ED by her friend who found the pt sitting in her car in the garage with the motor running. The friend reports that since she broke up with her fiance 2 months ago the pt has become increasingly withdrawn, has had difficulty concentrating, and has lost 10 pounds. Recommended tx? |
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Definition
| inpt tx with meds and psychotherapy |
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Term
| 80 yo male from an assisted living facility is brought in for eval of repeated near syncopal episodes when getting up from a seated position. His past medical history is significant for DM and HTN for which he takes enalapril (vasotec). What would you expect to find on PE? |
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Definition
| drop is SBP of atleast 20mmHg and rise in pulse of more than 15 beats per minute immediately upon arising from a supine position. |
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Term
| 14 yo male athlete presents c/o a painful "bump" on his right lower extremity just below his knee and associated pain during and after activity. Exam of the right leg reveals a prominent tender tibial tubercle. Most likley dx? |
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Definition
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Term
| The devleopmental milestone of speaking 1-3 words should be reached by which of the following ages? |
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Definition
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Term
| 75 yo man with a long history of COPD presents with acute onset of worsening dyspnea, increased productive cough, and marked agitation. While in the ED he becomes lethargic and obtunded. His ABG reveals PaO2 40mmHg, PaCO2 65mmHg, and arterial pH 7.25. Most appropriate management? |
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Definition
| endotracheal intubation and mechanical ventilation |
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Term
| 23 yo female presents with a 3d history of itching and redness of both eyes. She states that her eyes were stuck shut upon awakening. Exam is significant for moderate lid-edema with crusting about the eyelashes. There was no change in visual acuity or significant erythema of the conjunctiva. Definitive tx for this pt? |
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Definition
| erythromycin ophthalmic ointment |
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Term
| A pt with known pemphigus vulgaris presents to the office for eval after skin trauma. You note the superficial detachment of the skin in the area of trauma. The PE finding is known as which of the following? |
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Definition
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Term
| Current recommendations concernign antepartum treatment of antibody negative, Rh-negative women with Rhimmune globulin include which of the following? |
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Definition
| administration at 28 wks gestation to all Rh-negative women |
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Term
| 63 yo pt was admitted with an acute non ST elevation MI 3 days ago confirmed by elevated CK, CK-MB, troponin I, and troponin T. He begins to experience recurrent chest pain. Which lab study is most appropriat to eval his recurrent chest pain? |
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Definition
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Term
| 19 yo female presents with intermittent episodes of loose stools over the past 6-8 months. She admits to crampy abdominal pain and bloating that seems to be associated with her stress level rather than food intake. She denies fever, melena, or nocturnal sxs. exam reveals normoactive bowel sounds and mild lower abdominal tenderness on palpation without rebound tenderness or organomegaly. Treatment of choice? |
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Definition
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Term
| What sx is most commonly seen in the initial presentation of DM2 over DM1? |
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Definition
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Term
| 35 yo female with a recent dx of depression with psychotic features has been placed on a SSRI and an atypical antidepressant. She presents to the office for a 2 wk follow up c/o insomnia. She refuses to sit down, continuously paces and appears anxious. This pt demonstrates which of the following? |
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Definition
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Term
| 73 yo female pt was dx 3 yrs ago with Alzheimer's disease and heart failure. Her 80 yo husband can no longer help feed and bathe her or manage her meds. What suppot service is most appropriate? |
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Definition
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Term
| On a frontal CXR view you notice a visceral pleural line with a radiolucent area devoid of vascular and pulmonary markings on the right side only. dx? |
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Definition
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Term
| You are evaluating a pt who c/o worsening orthopnea and dyspnea on exertion for the past yr. He admits to drinking a 12 pack of beer on a nightly basis for approximately 20 years. PE shows a laterally displaced PMI, audible rales, and an audible S3 on cardiac auscultation. Echocardiogram shows a dilated left ventricle and EF of 35%. Most appropriate counseling to slow the progression of the pts condition? |
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Definition
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Term
| Characteristic finding on exam of a pt who presents with an uncomplicated corneal foreign body? |
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Definition
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Term
| 25 to women has noted an enlarging painful swelling of teh right labia for 3 days. Most likely dx? |
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Definition
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Term
| MCC of arterial emoblization? |
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Definition
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Term
| "Bag of worms" on testicular exam |
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Definition
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Term
| 34 yo women who is new to the practice has a long hx of medical complaints that include almost every organ system. She describes herself as being ill sicne she was a child. she takes a total of 25 perscriptions from multiple providers, including prednisone and multiple pain meds as well as several over the counter meds. You find no abnormalities on comprehensive exam. What is the recommended plan for this pt? |
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Definition
| schedule monthly visits with you |
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Term
| Most appropriate med to delay the progression of osteoporosis? |
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Definition
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Term
| 33 yo male returns from an extended camping trip and c/o 5 wks of mild diarrhea, mostly after breakfast. The stool is described as bulky, greasy, frothy, and malodorous, it is gree of blood or pus. He is afebrile and has upper abdominal discomfort, cramps, distention, and excessive flatus. He has lost several pounds. dx? |
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Definition
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Term
| What non pulmonary PE finding would be most likely in a pt with a large apical lung cancer? |
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Definition
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Term
| Yo are caring for a 35 yo pt with a peripherally inserted central catheter (PICC). There is a progressive linear induration that stretches 3 inches proximal from the AC fossa with associated erythema and tenderness. The PICC line is removed. What additional measures should be taken in the tx of this pt? |
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Definition
| naproxyn sodium (naprosyn) and local heat |
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Term
| A healthy 13 yo male presents with a spontaneous unilateral nosebleed. Most appropriate tx? |
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Definition
| direct pressure to nares for 15 minutes |
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Term
| During a mental status exam of a pt with schizophrenia, you note increased time between the pts comprehension and expression of thoughts. This finding is an increase in what? |
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Definition
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Term
| 28 yo G0P0 female presents with a 2 wk history of pelvic pain and scant vaginal bleeding. She reports a history of regular menses every 28 days, however, her LMP was 37 days ago. On exam her uterus is normal in size. There is a small amount of blood in the vagina. Her left adnexa is somewhat tender. Most likely dx? |
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Definition
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Term
| Most likely CXR finding of adenocarcinoma of the lung? |
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Definition
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Term
| 58 yo male presents for evaluation after an episode of chest pain noted last night after an argument with his wife. The pain lasted about 20 minutes and was described as a tightness and burning sensation in his chest behind the sternum and radiate dto the left shoulder and upper arm. He states the pain improved after he rested. The pt states this is the third such episode during stressful situations this month. Dx? |
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Definition
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Term
| 81 yo long term care facility resident presents to your office with c/o generalized itching over the last several days. She denies use of any new products or ingestion of new foods or meds. Exam is significant for generalized excoriations and burrows in the web spaces of the hands and feet. Test to confirm dx? |
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Definition
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Term
| 32 yo man presents to your office 1 wk following a camping trip to New England. He c/o lwo grade fever, chills, and myalgias. On PE a 3cm erythematous, papular lesion with central clearing is identified on the left thigh. Most appropriate tx? |
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Definition
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Term
| Hallmark finding that is essential to the dx of primary dilated cardiomyopathy? |
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Definition
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Term
| 30 yo pt presents with a three year history of episodic wheezing, dyspnea and dry to minimally productive cough. These episodes are typically wrose at night and during the fall and spring. The pt admits to a long history of allergies and tobacco use. Exam reveals numerous nasal polyps, xerotic skin, and expiratory wheezes in bilateral lung fields. There is no cyanosis or abnoral heart sounds noted. His PFT reveals a low FEV1/FVC ratio. Med that is best to treat an acute exacerbation of this disorder? |
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Definition
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Term
| Fx of the distal 5th metacarpal is most likely to occur after what type of event? |
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Definition
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Term
| During the eval of a post motor vehicle accident pt who incurred blunt abdominal trauma, you notice a Grey-Turner's sign. He undergoes corrective surgery. Most appropriate preventive strategy for this pt? |
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Definition
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Term
| On cardiac auscultation you hear a mid diastolic low pitched mitral murmur heard best at the cardiac apex. The presence of this sound is most characteristic of which valvular abnormality? |
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Definition
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Term
| 25 yo woman c/o bloating, abdominal cramps, and loose stools wiht flatulence. Her sxs seem to occur 1-2 hours after meals containing and dairy products. Most appropriate diagnostic test to confirm your suspicion? |
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Definition
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