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Esophagus finding in Diffuse esophageal spasm?
achalasia
- rhythmic contractions and normal LES-corkscrew esophagus
- LES has high tone it does not relax and absence of peristalsis with birds peak
- Scleroderma loss of peristalsis but has low tone-incompetent
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difference between achalasia and scleroderma
- achalasia has increase LES tone-no regurg
- scleroderma has decreased LES tone- regurg
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is complementary and alternative medicine allowed with conventional medicine
yes but it must be given along with traditional therapy and it may not interfere with it
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most common cause of occupational hand dermatitis
irritant contact dermatitis
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rx for occupation hand dermatitis
- avoidance agents
- emollients
- topical glucocorticoids
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what kind of inguinal hernia kids get?
adults
kids- indirect due to process vaginallis not obliterating
adults- direct- due to abdominal muscles weakness
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when are hernias operated on in an infant
as soon as possible
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what is important in forming a therapeutic relationship with a psychotic patient
permitting patient to have privacy and interpersonal distance
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stroke in a young patient with hx of syphilis
meningovascular syphilis
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number 1 rx for heart stroke
evaporative cooling
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rx for h.pylori
3 drugs, PPI, clarithromycin and amoxacillin , substitutue with metro in PCN allergic patients
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poor prognosis in a patient with PE
+ troponin
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when is hemoptysis significant and should be further worked up
>600cc/24hrs
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when do you do UA to rule out medical problem in kids with incomplete urinary incontinence
if they're >5 yo
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if someone was around pt is TB, and if they test -ve on PPD, next step
repeat PPD in 3 months
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intermittent acute vertigo, hearing loos, tinnitus is caused by
meniere's disease
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next step in arrest of labor for 3 hours
c-section
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most common cause of arrest of labor
cephalopelvic disproportion
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difference between aspiration pneumonia vs pneumonitis
- pneumonitis presents acutely within hours
- aspiration pneumonia presents within 1 to 5 days
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how do you differentiate between pre-renal azotomia vs ATN
BUN/Cr ration and muddy brown casts in the UA
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gene affected in marfans
fibrillin
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all pateints with marfans should have what screening
echo or CT to look for aortic root disease
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patient with confgenital heart problems like HCM and marfans should be counseled against
strenous exercise
-
differential dx of delayed gastric emptying
obstruction or impaired mobility
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how do you rule out obstruction caused delayed gastric emptying
EGD vs barium swallow
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how do you evaluate for impaired mobility caused delayed gastric emptying
nuclear gastric emptying study
-
best analgesic for sickle cell crises
morphine
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most common cause of acute chest syndrome in kids
infection, must cover with abx
-
rx for pagets disease
bisphosphonates or calcitonin
-
next step when suspecting pagets disease
ALP and calcium
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what do you order for Pagets disease
- ALP
- Ca
- Â Phosphagte
- urinary hydroxyproline
- Bone scan
-
PICA artery involvement
ipsilateral face and contralateral face
-
locked in syndrome with what artery
basilar artery
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diff between PICA and AICA vs Ant. spinal
PICA-lateral medullary- hoarseness, dysphagia, ipsi face and contra body
- AICS- lateral Pons- loss of ipsi face sensation
- Ant spinal has motor weakness, upper and lower limbs
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PCA occlusion produces what deficits
contralateral heminopia with macular sparing
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post communicating artery aneurysm can cause what
CN 3 lesion- down and out
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