UWorld CK
Prescribe escitalopram - Pt presents w/ Body dysmorphic disorder -A) Criteria ---1) Preoccupation w/ ≥1 perceived physical defect ---2) Defects not observable or appear slight to others ---3) Repetitive behavior or mental acts performed in response to the preoccupation ---4) Sig distress/impairment ---5) Variable insight (good, poor, absent/delusional, beliefs) TMT -1) High-dose Antidepressants (SSRI) -2) CBT Reassurance & follow-up - Pt clearly exhibits BDD → It is treated w/ high-dose SSRI's
A 18M, presents for evaluation of acne. The pt has seen several doctors for his "huge pimples" & has tried multiple non-Rx meds w/out benefit. He spends hours a day checking his skin in the mirror & researching the latest acne TMTs. He avoids socializing & dating d/t fears of being rejected based on his appearance. The pt purposely styles his hair to conceal his forehead & cheeks. He has no sig PMHx. The pt is wearing a baseball cap & hesitantly removes it. PE shows a small papule on his forehead & a few closed comedones on his nose & chin that are noticeable only on close inspection. Which of the following is the most appropriate MGMT? (Prescribe escitalopram OR Reassurance & follow-up)
Sensorineural hearing loss - Pt presents w/ Periventricular calcifications → consistent w/ CMV (most common congenital infection) -1) Presentation includes: ---a) Microcephaly ---b) Thrombocytopenia ---C Petechiae ---d) Blueberry muffin rash ---e) Jaundice ---f) Hepatosplenomegaly ---g) Seizures -2) Complications ---a) Sensorineural hearing loss (most common) ---b) Dental ---c) Vision (chorioretinitis) TOXOPLASMOSIS 1) Parenchymal calcification 2) Hydrocephalus 3) Chorioretinitis Cataracts & CHF - Most common complication/sequela in Rubella - Presentation includes: --1) PDA (CHF) --2) Cataracts --3) Blueberry muffin rash (dermal erythropoiesis) --4) Pulmonary artery stenosis --5) Post-auricular & occipital lymphadenopathy --No intracranial calcifications
A 2-month-old girl present for an annual visit. The family recently moved to the area, & the pt has not been seen by a health care provider since hospital discharge. She was born via scheduled CS at 39 weeks. Routine prenatal serology was normal. The pt developed jaundice at age 2-days w/ total bili of 11.2. Her 2-year old sister also has a Hx of neonatal jaundice, which required phototherapy. The family has a dog & a cat, both of whom live inside. Wt, Length, & head circumference are in the 5th percentile. There is mild hepatosplenomegaly & jaundice, & cardiac auscultation shows a soft I/VI systolic ejection murmur. US of the head reveals punctuate calcifications around the ventricular margin. For which of the following complications is this pt at greatest? (Cataracts OR CHF OR Sensorineural hearing loss)
Lumbar puncture - Pt has meningitis -A) Presentation ---Presents as a triad of: (however, triad occurs in <50% of pts) -----1) Fever -----2) Nuchal rigidity -----3) Altered mental status *Frequently* 4) Headache -If from Neisseria (which is likely d/t pts age)→ will also present w/: ----1) Petechiae/Purpura (50% of cases) ----2) Myalgias ----3) Septicemia (DIC) -------[Rapidly progressing symptoms is concerning for septicemia (DIC)] Diagnostic 1) Lumbar puncture w/ CSF analysis ----2 sets of blood cultures before TMT 2) CT (prior to LP) → only if signs of ICP TMT 1) Vanco + ceftriaxone/cefotaxime (3rd gen cephalosporin) 2) Vanco + ceftriaxone/cefotaxime + Ampicillin ----(pts >65 & suspected listeria) 3) Vanco + Ceftazidime, cefepime, meropenem ----(Pts w/ recent penetrating head trauma) 3) Dexamethasone ----(for meningitis suspected from s.pneumo) 4 )TMP-SMX ----(used if pt has penicillin allergy) 5) Ampicillin + cefotaxime/aminoglycoside ----(neonates) 6) Rifampin/Cipro/Ceftriaxone ----(Prophylaxis) Give IV fluids & antiemetics, hold for observation - This is the best TMT for suspected gastroenteritis - However, pt has severe myalgias & altered mental status, which makes gastroenteritis unlikely
A 20F, presents to the ED in January d/ severe myalgias, fever, headache, & nausea that developed 4 hours ago. She has also had several episodes of non-bloody emesis over the past hour. The pt was feeling well this morning before her symptoms started. She does not smoke, drink, or use drugs. The pt has NKA for meds or otherwise. Temp is 104.5F (40.3C), BP is 100/70, Pulse is 115/min. She is confused & has difficulty concentrating. Lung exam is normal. There is marked tenderness to palpation of the muscles alone her extremities, which are mottled & cool to the touch. CBC reveals a WBC ct of 28K w/ 12% bands. A non-contrast CT is unremarkable. Which of the following is the best next step in MGMT? (Give IV fluids & antiemetics, hold for observation OR Lumbar puncture)
Tonometry - Pt has STEROID-INDUCED open-angle glaucoma → presentation includes: -1) RF's ---Developed impaired vision while using glucocorticoid drops -2) Symptoms ---a) Insidious vision loss of peripheral vision Funduscopy 1) Cupping of optic disc → (but is a late finding & may not be immediate apparent → so may be normal 2) Cornel edema → (causing central blindness) MGMT approach 1) Tonometry → used to measure deformation of the cornea
A 24M presents d/t vision disturbances. The pt a Hx of AS & experienced severe pain & redness of the eyes a month ago. Eval at the time showed acute anterior uveitis & prednisolone drops were prescribed, which the pt still uses. The eye symptoms resolved w/in a week of TMT, but over the past several days the pt has had blurry vision & has needed more light to read. He has also experienced glare while driving at night. The pt has not other chronic med conditions & only takes naproxen PRN. Vitals are normal. Ocular exam shows non-erythematous conjunctiva, clear corneas, & no hypopyon or opacities of the lenses. Funduscopic exam is normal. The remainder of the exam, including neuro, is normal. Which of the following is the most appropriate next step in MGMT? (No further intervention OR Tonometry)
Inhaled bronchodilator - Pt presents w/ Acute bronchitis → which presents w/: -1) RF's ---Preceding viral illness -2) Symptoms include: ---Cough for >5days-3 weeks (± purulent sputum) -----(pt has had cough for 10 days) ---Absent systemic symptoms -----(pt is Afebrile) ---Wheezing/rhonchi ---Chest wall tenderness MGMT 1) Symptomatic TMT → (bronchodilators, NSAID's) 2) CXR → (only when pneumonia is suspected) ----(pt has no signs of fever, i.e, fever, congestion, productive cough)
A 25M presents to the office d/t a dry cough that has persisted since he contracted a URI 10 days ago. The cough is worse at night & is not associated w/ nasal congestion, facial pressure, sore throat, abd discomfort, or vomiting. PMHx is notable for childhood asthma, which the pt "outgrew". All recommended vaccinations are up to date. The pt is afebrile, & other vitals are normal. Nasal & pharyngeal exams are unremarkable. Scattered wheezes are heard on lung auscultation. There are no heart murmurs. Which of the following is the best next step in MGMT of this pt? (CXR OR Inhaled bronchodilator)
Placement of a pelvic binder - Pt presents w/ Shock in setting of pelvic fracture: ---(unstable pelvis palpation & pelvic ring disruption of XR [widened pubic symphysis] - Pt also has signs of retroperitoneal hemorrhage ---flank ecchymosis ---Unstable vitals MGMT 1) Pelvic binder → pts w/ severe pelvic fractures are at ↑ risk for life-threatening hemorrhage → so must prevent w/ pelvic binder Retrograde cysturethrogram - Would be used AFTER pt's vitals were stabilized
A 25M, presents to the ED following a high-speed MVC. The pt is alert & in distress d/t pain. BP is 84/52 & pulse is 130/min. The airway is patent, the trachea is midline, & breath sounds are present bilaterally. Heart sounds are normal. There is bruising across the left chest wall, the lower abd, & the left flank. The abd is soft & mildly tender to palpation diffusely, w/out rebound tenderness. The bony pelvis is unstable to gentle downward pressure. The left lower leg is visibly deformed but distal lower extremity capillary refill is symmetric. There is blood present at the urethral meatus. CXR reveals multiple rib fractures w/out pneumothorax. FAST reveals no pericardial effusion or intraperitoneal free fluid. Portable anteroposterior pelvic XR is shown. In addition to resuscitation w/ IV crystalloid and/or blood products, which of the following is the best next step in MGMT? (Placement of a pelvic binder OR Retrograde cysturethrogram)
Core needle biopsy - The pts last step was FNA → from here there are two options based on the findings -Option 1 - Bloody aspirate ----2nd more invasive biopsy (Core needle/Open biopsy) Option 2 → Non-bloody aspirate ----a) Cyst revolves → Repeat US in 4-6 weeks ----b) Cyst persists → 2nd more invasive biopsy Breast MRI - Used for two reasons: --1) Screening of BC in high risk PTs (BRCA+) --2) Assessing for BC METs -NOT USED TO EVALUATE NEW MASSES → b/c cannot differentiate between benign/malignant masses)
A 28F, presents d/t a painful breast mass. She first noticed the mass during her last menstrual period, & its size has not changed since then. The pt has no chronic med conditions, & her only med is a daily combined OCP. On exam, there is a palpable, 1.5-cm right breast mass at the 8-o'clock position. The mass is tender, soft, & mobile, & there are no skin changes or galactorrhea. Beast US shows a single, thin-walled, fluid-filled cyst. FNA of the mass reveals clear, yellow, tinged fluid. The mass is still palpable after aspiration. Which of the following is the most appropriate next step in MGMT? (Breast MRI OR Core needle biopsy)
Non-classic CAH - Presents w/: --1) Late-onset --2) Early pubic/axillary hair growth --3) Severe acne -----Scar-forming/ nodulocystic acne --4) Dense Hirsutism & oligomenorrhea in girls -----Abnormal uterine bleeding (often initial presentation) --5) ↑ growth velocity & bone age Ovarian hyperthecosis - Most common in postmenopausal women - Caused by excess ovarian androgen production & presents w/: ---FRANK virilization (Voice deepening) ---Enlarged ovaries Idiopathic hirsutism - Most common cause of excessive hair growth - Not associated w/ elevated androgens → pt would not have irregular menses or severe acne
A 28F, presents of increasing facial hair. The pt discontinued a combined OCP 6 months ago b/c she is trying to conceive. She has since noticed increasing hair on her upper lip & chin that she has tried removing, but it continues to grow back. The pt had regular menses while taking combined OCP's but has not had a menstrual cycle since discontinuing the pills. She has no chronic med conditions & has had no surgeries. The pt's only med is a prenatal vitamin. Temp is 98F (37.6C), BP is 107/98, & pulse is 78/min. BMI is 24. PE shows multiple inflamed pustules & scars in various stages of healing on the cheeks & forehead. There is dense, pigmented hair growth over the upper lip & chin. Pelvic exam shows normal-appearing external genitalia w/no clitoromegaly. The uterus is small, & there are no adnexal masses. Which of the following is the most likely Dx? (Idiopathic hirsutism OR Ovarian hyperthecosis OR Non-classic CAH)
Inferior displacement of the medulla & cerebellum - Describes Arnold-Chiari malformation - Myelomeningocele is associated w/ Arnold-Chiari II malformation -Also associated w/ hydrocephalus (enlarged head circumference & full fontanelle) Hemorrhage In the germinal matrix - Usually seen in premature infant → Unlikely in a term infant (pt is 38 weeks) - Not associated w/ myelomeningocele Diffuse leptomeningeal enhancement - Would be seen in meningitis - Myelomeningocele is Not associated w/ meningitis
A 3-hrs-old-boy, is evaluated in the newborn nursery. The pt was born via spontaneous vaginal delivery to a 25F, G2P2. The mother had no prenatal care & takes no meds. Head circumference is at 90th percentile. Wt is at 25th percentile. Temp 99.1F (37.3C), pulse 140/min, RR 32/min. Per the Ballad score, the pt is at 38 wks gestation. Head exam shows a full fontanelle. The ears are in the normal position. The oropharynx is clear. Cardiopulmonary exam is unremarkable. The abd is soft w/ no organomegaly. Exam of the back shows a large myelomeningocele. Head imaging is most likely to reveal which of the following? (Hemorrhage in the germinal matrix OR Inferior displacement of the medulla & cerebellum OR Diffuse leptomeningeal enhancement)
Chronic cutaneous lupus - AKA discoid lupus erythematous -1) Presents as pruritic, chronic, scaly, irregular, erythematous plaques -2) + Ulceration & central hypo-pigmentation -3) Most common in face, head, & neck Biopsy - Hyperkeratosis, follicular plugging, & perivascular inflammation TMT -1) UV light protection -2) Topical corticosteroids -3) Calcineurin inhibitors (tacrolimus) -4) Oral anti-malarial (hydroxychloroquine) Nummular eczema - Presents w/ Highly pruritic, coin-like, scaly plaques in regions of dry skin on the lower extremities - No scarring or central ulceration/hypo-pigmentation
A 35F, presents d/t a rash. For the past year, she has had progressive development of multiple lesions on her face, neck, & central chest associated w/ mild pruritus. The pt otherwise feels well & has no chronic Med conditions. Vitals are normal. Skin exam shows numerous scaly lesions w/ pigment changes & shallow ulcers. Which of the following is the most likely Dx? (Nummular eczema OR Chronic cutaneous lupus)
Autism - Supporting Symptoms include: --1) Preference for solitary play --2) Restricted interests (stacking blocks for hours) --3) Lack of joint attention (not following her mother's gaze to a shared focus) --4) Extreme food selectivity --5) Abnormal sensory sensitivity (CORE FEATURE) -----which manifests as aversion to foods w/ certain taste/textures -----Lack of expected responses to sensory stimuli (not reacting to pain or extreme temps) -----Aversion/fascination w/ certain sounds, sights, or textures (compulsive touching of clothes) --6) Restricted interests ----Often accompanied by repetitive mvmts (rocking back & forth), --7) Impulsive, aggressive outbursts (hitting/screaming) Normal child development - Many children go through a "picky" stage of selective eating -However, children at age 3 should display: ---Joint attention ----(she does not follow her mothers gaze) ---Playing w/ others ----(she stacks blocks on her own for hours) ---Use a range of toys ----(she only plays w/ blocks)
A 3F, presents for eval after she hit a teacher for putting banana slices on her plate. Her mother says, "She's never been aggressive before, but she has always been particular about food. She likes bread & pasta but screams if I put avocado/broccoli on her plate. She's always been pretty easy to take care of - she stacks blocks on her own for hours at a time, which allows me to focus on my 6-week-old." The pt recently started preschool after the birth of a baby sister. She was born at full term w/out complications & has no sig PMHx. The pt is able to kick a ball, draw a circle, pedal a tricycle, & say 4-word phases. Vitals are normal, & she is tracking adequately on growth curves. During the eval, the pt sits in the corner of the room playing w/ blocks. She does not follow her mother's gaze when she points to other toys in the office. When the physician tries to examine her, she begins screaming & rocking backward & forward. Which of the following best explains this pts behavior? (Autism OR Normal child development)
CT scan of brain - Pt most likely has a subarachnoid hemorrhage --1) KEY SYMPTOM → sudden-onset of symptoms ----Sudden-onset severe headache ----Vomiting ----Photophobia ----Brief loss of consciousness ----Neck pain (stiffness) → d/t meningeal irritation ---------(presents as increased resistance & pain to passive neck flexion) ----Low-grade fever MGMT 1) non-contrast CT scan of brain Lumbar puncture - Would be used if pt had meningitis - Meningitis presents w/, neck stiffness, & severe headaches - However, this pt presents w/ dramatic acute onset & rapidly progressive severity of symptoms → which makes meningitis unlikely
A 42F, presents to the ED d/t severe headache. Three hours ago, the pt suddenly began experiencing bilateral headache, which rapidly worsened in severity. She also had neck pain & an episode of vomiting. The pt has had no prior headaches, & PMHx is sig for HTN. She works in a day care. Temp is 100.9F, BP is 154/92, pulse is 102/min. O2 sat is 98% on room air. On PE, the pt appears in obvious discomfort & keeps her eyes closed. She follows simple instructions, & there is no focal weakness or numbness. Funduscopy shows no papilledema. There is increased resistance to passive neck flexion, & it also elicits pain. Which of the following is the best next step in MGMT? (CT scan of brain OR Lumbar puncture)
Dyschidrotic eczema - Presents as recurrent, pruritic, vesicular rash - Primarily affects hands & feet - Associated w/ repeated outbreaks (relapsing/remitting) TMT 1) Lifestyle → Avoid irritants, avoid wet & cold environments 2) Emollients 3) High/Super-high potency corticosteroids (betamethasone diproprionate) Tinea Manuum (image B) - Presents w/ chronic, scaly, irregular/annular patches on hands - Usually unilateral - Typically occurs w/ tinea pedis - Not usually vesicular - Would not cause repeated outbreaks
A 43M, presents d/t a rash. He has a 1-wk Hx of a blistering rash on his hands associated w/ severe pruritus. The pt had a similar rash twice in the previous 2 months that resolved w/ peeling of the skin on his hands. He has had no changes in household products & no occupational chemical exposure. PMHx is unremarkable. Exam shows a vesicular rash on his hands (shown Image A is goes w/ correct answer; Image B goes w/ incorrect answer). Which of the following is the most likely Dx? (Dyschidrotic eczema OR Tinea manuum)
DI - Pt has a HYPER-natremia w/ normal K+ - Hyper natremia is caused by: --1) Central/nephrogenic DI --2) Tumor (aldosterone/renin) SIADH/Impaired thirst perception (psychogenic polydipsia) - Pt would have HYPO-natremia
A 44F, presents d/t excessive thirst & urination. She has to get up several times at night to urinate. 2 months ago, she was Dx'd w/ DM II, which she manages w/ diet & exercise. BP is 134/78, & pulse is 88/min. BMMI is 32. The remainder of the exam is unremarkable. Labs show: - Na+--------------------147 -K+-----------------------4 -Cl-----------------------106 -HCO3-------------------26 -BUN---------------------26 -Creatinine---------------1.1 -Glucose-----------------112 -Ca+----------------------9.8 -Serum Osm-------------305 -Urine Osm--------------180 -Urine specific gravity---1.001 Which of the following is the most likely cause for this pts excessive thirst & urination? (DI OR SIADH OR Impaired thirst perception)
Cervical radiculopathy - Presents w/ -A) RF's ----1) Middle age ----2) Repetitive mvmts (playing golf) -B) Presentation --1) Pain in the neck & upper extremities --2) Sensory & motor deficits --3) Diminished reflexes --4) Shoulder abduction relief test → Both Diagnostic & therapeutic -----Reduces the tension on the impinged nerve root & improvement of radicular symptoms when the hand is placed on the top of head Cervical muscle strain - Would present w/ local findings - Would not present w/ diminished reflexes, arm weakness, or positive shoulder abduction test
A 54M, presents d/t right shoulder & arm pain. His symptoms began 3 days ago after playing golf for several hours. The pt states that his right arm feels weak, especially when lifting objects. He has no sig PMHx & takes no meds. PE shows spasm of cervical paraspinal muscles. There is mild weakness on right elbow flexion, & the biceps reflex is decreased on the right. The pain improves when the pt is instructed to lift the right arm above the head & rest the hand on top of his head. Which of the following is the most likely Dx? (Cervical muscle strain OR Cervical radiculopathy)
There are several possibilities, some of which are potential serious. A colonoscopy is the best way to know for sure - The doctor should convey an appropriate sense of clinical uncertainty ---(in this case, the level of uncertainty is high -2) This statement explains WHY the colonoscopy is necessary Colonoscopy is routine in these situations. We can discuss this more accurately once we have the results - This statement does not explain why a colonoscopy is necessary
A 59M, presents for a preventive visit. He feels well but has experienced an unexpected 5-lbs (2.3-kg) wt loss in the last 2-months. The pt has a 40-py smoking Hx & PMHx is otherwise unremarkable. PE is normal. Fecal occult blood testing & positive colonoscopy is advised. The pt asks, "A colonoscopy, that sounds serious! Do you think I have cancer?" Which of the following is the most appropriate response to this pts question? (Colonoscopy is routine in these situations. We can discuss this more accurately once we have the results OR There are several possibilities, some of which are potentially serious. A colonoscopy is the best way to know for sure)
Increased CSF fluid production - Pt presents w/ an enlarged mass in the ventricles on MRI → most likely a choroid plexus papilloma - Most common in kids - Most commonly presents as interventricular mass - Causes increased CSF production Decreased CSF absorption - Most commonly d/t a dural sinus thrombosis - Most common in adults - Would not present w/ interventricular mass
A 6-month-old boy presents for routine care. He cannot sit unsupported & his mother is concerned that his head is large for his age. For the last week, that pt has napped more frequently & vomited at the end of sleep. Ht & Wt are at the 25th percentile. Head circumference is at the 95th percentile (increased from the 50th percentile at birth & the 75th percentile at age 4 months. The anterior fontanelle is bulging. MRI is shown. Which of the following is the most likely cause of this pts condition? (Increased CSF fluid production OR Decreased CSF absorption)
Inability to metabolize galactose to glucose - Pt most likely has galactosemia -1) Presentation ---a) Jaundice ---b) Hepatomegaly ---c) Vomiting & poor feeding (failure to thrive) ---d) Cataracts -2) Associated ---a) Increased risk of E.coli sepsis MGMT 1) Galactose-free diet (soy-based formula) Single amino acid substitution w/in the beta glucose chain - Describes Sickle cell disease - May present w/ Splenomegaly → however, does not present w/ above symptoms
A 7-day-old African American boy is being evaluated in the hospital. He was admitted yesterday for sepsis after being brought to the ED w/ fever & vomiting. The pt is receiving IV antibiotics, & blood cultures grew E.coli. He has been breastfeeding prior pt admission, but feeds are being held d/t vomiting. The pt was born at term, & there were no complications during the pregnancy & delivery. Temp 100.8F (38.2C) & pulse 158/min. Exam shows jaundice. The liver is palpable 4-cm below the costal margin. Labs show: - Hb----------------------12 (N 13.4-19.9) - MCV--------------------98 ( 88-123) - Plts----------------------260K - Leukos------------------15K - MCHC-------------------33% - Total bili-----------------13 - Direct bili----------------2 - AST----------------------182 (N 47-150) - ALT----------------------160 (N 13-45) - Direct Coombs----------neg Which of the following is the most likely cause for this pts condition? (Inability to metabolize galactose to glucose OR Single amino acid substitution w/in the beta globing chain)
Parkinsons - Pt does not meet the criteria for Dementia → therefore he cannot have Dementia w/ Lewy bodies Dementia w/ Lewy bodies - Criteria for Dx includes → Dementia + 2/4 of the following --1) Parkinsonism --2) Hallucinations --3) REM sleep disorder --4) Fluctuating cognition/Cognitive impairment -The pt MUST HAVE dementia → however he does not meet the criteria for dementia b/c he has a NORMAL Montreal cognitive assessment (29/30)
A 71M, presents to the office d/t "strange vision". He lives alone & has not seen a doc in 30 years. The pt says, "I started seeing children playing in my yard in the evenings about 2-months ago. What's weird is that my closest neighbors are 2 miles away, & I rarely have anyone visit." He says that this was not too disturbing; however, about a month ago, he started seeing animals scampering throughout the house despite not owning any pets, which caused more alarm. The pt is not forgetful & still drives, goes grocery shopping, prepares meals, & takes care of chores around the house. He says his energy is "not what it used to be," & he has lost his balance a few times but has not fallen. The pt also states that he does not like to socialize but adds that he has "always been like that." He is unaware of any medical diagnoses. Temp is 98.8F (37.1C), BP is 138/89, pulse is 78/min, RR are 14/min. The pt scores a 29/30 on Montreal cognitive assessment. Gait is steady but slow. He has a tremor at rest that is most prominent in the right hand. Reflexes are 3+ on the right hand & 2+ on the left hand, & there is resistance to passive mvmt in all limbs which is worse on the right. Which of the following is the most likely Dx? (Dementia w/ Lewy bodies OR Parkinsons) )
Oral anticoagulation therapy - Pt has A-flutter → carries a similar risk for arterial thromboembolism as A-fib - MGMT includes: --1) Chronic anticoagulation → pt has multiple RF's for arterial thromboembolism, including: -----a) Hx of CAD -----b) Hx of DM II -----c) Hx of smoking --2) Ablation → this increases the risk of thromboembolism in this pt ----It should be preceded by several weeks of anticoagulation therapy
A 76M, w/ CAD presents to the office for a follow-up 6 months after an uncomplicated CABG. The exertional chest pain that was bothering him before the surgery has completely resolved. He reports no palpitations, SOB, light-headedness, or syncope. PMHx is sig for HTN, DM II, & gout. Meds include low-dose aspirin, metoprolol, & rosuvastatin. He has a 30-py smoking Hx but quit 5-years ago. The pt does not drink or use drugs. PE shows an irregular pulse. The chest surgical incision is well healed. There are no heart murmurs, & the lungs are clear to auscultation. There is no peripheral edema. ECG is shown. Which of the following is the best MGMT for this pt? (AV nodal slow pathway ablation OR Oral anticoagulation therapy)
Continue med indefinitely w/ regular follow-ups - Pts w/ schizophrenia have a increased risk of relapse if medication is stopped Add short acting benzo as needed for anxiety - Pts w/ schizophrenia have anxiety → especially during & immediately following an acute psychotic episode - MGMT of anxiety includes psychosocial approaches - Pts w/ schizophrenia have increased risk of abuse w/ Benzo's
A Pt is Dx'd with schizophrenia & is started on TMT. At her 1-month follow-up, she is no longer hearing voices, is much less paranoid, & is able to go outside the house; however, she still has periods of anxiety & has been reluctant to look for work. She continues to take the med as prescribed. Which of the following is the most appropriate TMT recommendation for this pt? (Add short acting benzo as needed for anxiety OR Continue med for 6-months then gradually taper off OR Continue med indefinitely w/ regular follow-ups)
Droplet - Used for ---1) Bacterial → Neisseria, H.influenza type B, Mycoplasma pneumoniae ---2) Viral → influenza, adenovirus Contact -1) Multi-drug resistant organisms → MRSA, VRE -2) Enteric → C.diff, E.coli (0157:H7) -3) Parasitic (scabies) -4) Viral (RSV) Airborne -1) Bacterial → TB -2) Viral → Varicella, SARS, measles
A pt presents w/ an infection w/ Neisseria. Which of the following isolation types is most appropriate for this pts infection? (Contact OR Droplet OR Airborne)
Water deprivation test - Pt most like has Primary Polydipsia Vs Diabetes insidious → the water deprivation test is needed to differentiate them → results are: --1) DI ----Urine remains dilute (<300 Osm) following water deprivation -Young children, hereditary nephrogenic DI are the most common causes --2) Primary polydipsia ----Urine gets concentrated Oral glucose tolerance test - The pt has normal glucose, so this would not help
An 8-year-old boy presents d/t a 2-month Hx of excessive urination. The parents report that the boy is sometimes irritable & restless & has been drinking excessive amounts of water. He has had normal growth w/ achievement of all expected milestones & takes no meds. The pts maternal grandfather tends to drink excessive amounts of water. Vitals reveal tachycardia. On PE, mucous membranes are dry. Neuro exam shows no focal deficits. Labs show: - Na+---------------------143 - K+-----------------------4.2 - Cl-----------------------100 - HCO3------------------24 - BUN--------------------30 - Creatinine--------------1.0 - Ca+----------------------9.2 - Glucose-----------------100 Urine - Specific gravity---------1.001 - Protein-------------------n/a - Blood--------------------neg - Glucose-----------------neg - Ketones------------------neg - Nitrites-------------------neg - Bacteria------------------neg - WBC's--------------------1/2 Urine Osm is 120. Which of the following is the most appropriate next step in MGMT? (Water deprivation test OR Oral glucose tolerance test)
Femoral neck fracture -1) Presentation ---a) Shortened limb ------(usually occurs as a result of femoral neck fracture OR intertrochanteric fracture) -2) External rotation (classic finding) -3) Most common fracture in elderly d/t falls TMT 1- Arthroplasty/open reduction w/ internal fixation w/in 48 hours Posterior hip dislocation - Presents w/ ADDUCTION & INTERNAL ROTATION at hip - Usually occurs as a result of dashboard injury
An 84F, w/ AZ dementia presents to the ED for evaluation after refusing to get out of bed. She has been known to wander the halls at her facility, & a nursing aide reported finding her on the floor next to her bed earlier that day. Vitals are normal. On exam, the pt is in pain. Her right leg appears shorter than the left leg. She is able to wiggle her toes but has sig external rotation of the RLE compared to the left. There is no evidence of head trauma & the lower leg compartments are soft. Which of the following is the most likely Dx? (Femoral neck fracture OR Posterior hip dislocation)
CBT SSRI - TMT for PTSD → but only when CBT is unavailable
What is the TMT for acute stress disorder? (CBT OR SSRI)
