Antipsychotic that can causes parkinsonian like features.
Mental retardation with chewed tips of fingers and portion of lower lip. Serum uric acid is increased.
Decreased hypoxanthine-guanine phosphoribosyltransferase
No increase in detectable serum glucose but increase in hepatic glycogen
Glucose 6 phosphatase deficiency
Fat soluble vitamines need what to be absorbed
Fructose 2,6 bisphosphate in hepatocytes increases what
Glycolysis and phosphofructokinase 1 activity
Sensation of tightness in the chest that gradually increases over 24 hours and last up to 2 days. Audible wheezing and a slight cough that occur during severe episodes
One levonorgestrel tablet now and again in 12 hours
Tx of simple ovarian cyste
Oral contraceptive therapy and second pelvic examination in 6 weeks
Tx thyroid storm in pregnancy with?
B-adrenergic blocking agent
Big baby in DM mother with delayed labor
Diffuse, erythematous, maculopapular rash over the perineum and thighs in menstruating tampon using pt
Decreased external urethral sphincter tone
Older women with lesions on labium majus
Punch bx the affected area
Likely clinical course of 2nd episode of genital herpes
Spontaneous disappearance of the lesion within 1 week
Uterus filled with scattered hyperechoic material,B-hCG 554,367 tx
Suction and curettage
Turner syndrome what should you measure
FSH and LH will be elevated to try to increase the low estrogen
Female with ovarian mass and is developing hair on body and muscle mass
Testosterone secreting tumor
Painful bleeding in pregnancy 3rd trimester
Oral contraceptive + breastfeeding
Decreased protein content in breast milk
11 yo girl with breast and pubic hair at Tanner stage 3
Menarche is imminent
18 hrs after uncomplicated delivery pt spikes temp of 100.4 there are decreased breath sounds heard bilaterally with no crackles orrhonchi
Daily administration of what abx for prophylaxis UTI in female
Female with mild to moderate hair growth over the face, breast and lower abdomen. What is the likely cause?
Increased 5a reductase activity making Dihydrotestosterone (DHT)
DM pt with refractory vulvar itching. KOH shows pseudohyphae and budding yeast. What is the likely cause of failure of tx?
Bicornuate uterus is at risk for?
Pretermlabor and delivery
Menopausal women with a friable, atrophic vaginal mucosa. Scant blood in the vaginal canal. Small blood stain on her underwear during the past 6 months? what is the likely cause
Pt with day hx of pain with urination, intense vaginal itching and watery discharge. Sexually active but does not use condoms. Erythema of the vulva and vagina with yellow gray frothy discharge and a mildly fishy order. What is the cause
Tinnitus and metallic taste in mouth after epidural
Intravascular injection of anesthetic
N/V and moderate to severe pelvic pain that start soon after the onset of menses and last for 48 hour.
Pt with multiple spontantous abortions. Hx of recurrent UTI and single left kidney. What is the likely cause of abortions?
Congenital uterine anomalies
15 yo with severe abdominal pain. During past year had 10 episodes that last 3-5 days. Never had period. A mass is palpated in the suprapubic region of the mid-line. The cervix cannot be visualized because of bluish bulging vaginal tissue that obscures the upper vagina. What is the diagnosis.
Hematocolpos = a condition where the vagina fills with blood /b of combination of menstruation with imperforated hymen.
Pregnant pt with fatigue and nausea. 15 year hx of anemia. Hematocrit has remained at 28% in the past 7 years despite iron supplementation. Next step in management?
hemoglobin electrophoresis to see if she has thalassemia
8 week pregnant pt with episode of bright red vaginal bleeding with no uterine contractions or cramping. U/S shows normal fetal heart activity. What is the dx
32 yo pt male for routine examination. Last office visit was 5 years ago.No personal or family hx of serious illness. What is an appropriate screening test for this pt?
Measurement of serum cholesterol concentration
22 yo with asthma exacerbation due to cold. The most effective pharmacotheray to prevent relapse that week?
Endomysial IgA antibody +
Gluten sensitive enteropathy
77 yo with progressive SOB.Lungs are clear to auscultation. Large superficial venous varicosities on lower extremities and moderate ankle and pedal edema bilaterally. O2 sat 96% at rest and 90% on exertion. X-ray of ches and ECG show no abnormalities. V-P lung scans show 2 subsegmental per fusion defects but no ventilation abnormalities. What is the cause of dyspnea
Recurrent pulmonary emboli
52 yo female with BMI of 52 and knee pain for 6 months. Erythematous, edematous left knee. Joint aspiration shows: straw colored fluid, 0 rbc, 1000 WBC with 90% Nt, no crystals. X-ray shows narrowing of the medial joint space and subchondral bone sclerosis. What should the intervention be?
Sudden onset of unremitting, severe chest pain on the left that radiates to the left arm and back. BP is 90/60. Grade 2/6 diastolic murmur in upper sternal area. Arterial blood gas analysis is normal. ECG shows nonspecific St-T wave changes, and x-ray shows small left pleural effusion. What is the dx
52 yo with shingles. Undergoing chemo and temp of 101. 3. There is rash over the left and right lower quadrant and on back. What is the tx?
62 yo male with 8 month hx of progressive pain and stiffness of hand. There is dark skin. S3 is heard at apex. Mild tenderness over the second and third metacarpophalangeal joints bilaterally without synovial thickening. heberden nodes are present over the distal interphalangeal joints of the index and ring finger. Hgb is 16.RF is -. Glucose is 182. Slight elevation in AST and ALT
Measurement of serum ferritin concentration
Abd u/s that shows a poorly visualize pancreas /b of overlying bowel gas. What is the next step in diagnosis
CT scan of the abdomen
Inability to differentiate smells. No menstrual period in a 19 yo with tanner stage 2 breast.
Regurgitating undigested food after meals in the past 4 months. Vague sensation of solid food stickingin throat and sometimes has heard gurgling when swallowing. No weight loss. What is the next test?
37 yo with f/u for 152/110 bp. K+ of 3.1 = low, Mg2+ of 0.8 = low, HCO of 28 = higher end of normal. Creatinine, sodium and urea are normal. What is the cause of increased BP?
Femor fracture pt now with altered mentation, petechiae over the face, neck and chest. Scattered rhonchi are heard with no crackles or wheezes. What is the dx?
Pt with viral infection symptoms over a week. There is jaundice and liver edge is palpated 1 cm below the right costal margin and is slightly enlarged, smooth and tender to palpation. Lab: bilirubin total – 4.2, Direct -3.6, Alkhosp – 120, AST -350, ALT- 280, LD-410. What is the dx?
Asymptomatic jaundice in a pt after a tiny stressor. Hgb – 16, Bilirubin total-3.5, direct -0.2, Alk phosp -38, AST -14, ALT 12, LD -120. what is the dx?
Healthcare worker with PPD of 17 mm of erythema and 11 mm of induration. Annual PPD over 5 years are normal. X-ray shows no abnormalities. TX?
Administration of isoniazid
32 yo female with 6 weeks of SOB, fatigue and intermittent palpitations. Lungs are clear to ausculation. Normal S1 but S2 is widely split and fixed. A grade 2/6 systolic ejection murmur is heard at the cardiac base. X ray shows right ventricular enlargement, a dilated pulmonary artery, and increased pulmonary vascularity. Likely cause of findings?
Fibrotic obstruction of multiple small pulmonary arteries
Old man that was found unresponsive after 2 days. Has DM and HTN. He is dehydrated. WBC is 16,000 with NT 70%. Na, cl, K and HCO3 are normal. Urea nitrogen is 62 elevated and creatinine is 2.2 elevated. Glucose is 840. What is the cause of the findings?
62 yo man with pain on urination and rectal pain with 1 day hx of fever and chills. voiding only a small amount of urine. Temp is 102.9,. there is severe tenderness of prostate. Urinalysis shows nitrites and leukocyte esterase. What is the tx?
Dilated heart with SOB over the past 6 months. Bilateral basilar crackles. Eco shows dilated left and right ventricles. What is the dx?
37 yo male with 3 months hx of intermittent fever and nonproductive cough and 30lb wt loss. 2 months ago ophthalmologist tx him for left anterior uveitis. Leukocyte is within range. AST 100, alk phosph 200 both slightly elevated. X ray shows hilar adenopathy. Carbon monoxide is 70% of predicted. PPD is negative. What is dx?
HIV pt with lung infection. Dullness to percussion over the left upper posterior thorax, and rhonchi heard over the same area. What will most likely confirm the dx?
Bx and culture of the lung mass
Abx after sigmoid colectomy for perforated diverticulitis?
Levofloxacin and metronidazole
67 yo at 2 week f/u for sigmoid colecotmy for perforated diverticulitis. Has had fever for 2 days. Currently on levofloxacin and metronidazol. Temp is 101.3. Lungs are clear and abd wound is healed. WBC 8400 with 60% Nt. urine normal. What is the likely cause of fever?
Pt with 2 month hx of decreased energy. 7lb wt loss during this time. Laps WBC 7500, Nt 56%, Eos 23%, lymp 14%, Na 128, K 6, What is the next steep in dx?
Three serial test of the stool for ova and parasites
87 yo with fever, chills, lethargy and agitation for 2 days. Temp is 101. Exam = tenderness to lower abd and right costovertebral angle. Lab: wbc 18,000. Urine: RBC 20, WBC 50, Granular cast, Bacteria few. What is the dx?
77 yo with intermittent atrial fibrillation despite cardioversion 2 months ago. No hx of cerebral infarctio nor TIA. What is the drug to prevent cerebral infarction in this pt?
57 yo male with 3 month hx of leg pain that began at the knee and now involves the entire leg. No hx of trauma. There is warmth and tenderness to palpation over the left anterior tibia. Xray shows increased cortical thicknes along the tibia with slight anterior bowing. There is no peristeal reaction. Serum alk phosphatase is 100. Whole body bone scan show several areas of increased uptake, including the tibial region. What is the following likely cause?
Pagets dz = increased bone turn over
Acute gout tx
42 yo with occasional twitching of muscles in all four extremities. Atrophy and weakness of the hands more on the right than left. Deep tendon reflexes are markedly increased in the extremities. Sensory examination shows no abnormalities. Serum CK 355. nerve conduction studies show no abnormalities. Electromyography shows acute and chronic denervation in several muscles of both upper extremities and left lower extremity. What is the dx?
Amyotrophic lateral sclerosis
25 yo male found lying in street while running. Has DM1. Unresponsive with no other abnormalities. What is the next step
Administration of 50% dextrose in water
52 yo male alcoholism unable to move lower extremities for the past 4 hours. He is awake and alert. Slight swelling of lower extremities. He has oliguria with bladder catheterization only yielding a small amount of urine that is + for blood by dipstick. What is the dx?
Pt with breast cancer that is receiving chemo via indwelling CVC. Temp of 102.5, BP 90/50. No erythema around catheter site. Lungs are clear to auscultation. Labs: WBC 3200. Urine rbc 2, wbc 2, bacteria occasional. In addition to ceftazidime, empiric antibiotic therapy should include?
Previously healthy 57 year old man comes to the physician because of increasing pain at multiple sites in his back, arms, and legs. Examinations shows no abnormalities. A bone scan is shown. what is the dx?
Aortic valve replacement
Pt with sepsis BP 90/50, temp 103.6, CVP 15 (n is 5-8) Has been aggressively resuscitated with IV fluids. what is the next step
Systemic broad spectrum abx therapy
Pt has low grade fever and generalized rash for 4 days. Has been receiving cefazolin for chronic osteomyelitis. Temp is 100.8. There is no costovertebral angle tenderness. All labs are normal except rare WBC cast and eosiophils in urine sediment. What is the most likely location of lesions?
Pt with broken femor found 2 days later with bp 88/54, Na 155, glucose 295. What is the next step
IV 0.9 ns
TX herpes infection of the finger?
Bright red papules, vesicles, and bullae,somein linear pattern, on forearms, neck and face. They are oozing vesicles over the wrists. Pt was working in garden. What would have prevented this?
Avoidance of contact with weeds
48 alcoholic male with temp of 101 and BP 90/55. Tenderness with voluntary guarding in left upper quadrant; bowel sounds are absent. Occult blood is +.Serum Ca+ 7.6 (low), albumin 3.5 (n). what is the best dx?
20 yo male with gynecomastia, no sexual interest, 6 ft tall,sparse facial hair and long upper and lower extremities, pubic hair tanner stage 3, testes are small. FSH 50 (H), LH 40 (H), Testosterone 6 (L). what would confirm the dx?
2 weeks after treatment of unexplained fever, 57 yo male develops acute renal failure. Current mdx: acetazolamide, lisinopril, heparin, amikacin, and naproxen. 2+ pitting edema. U/A shows few WBC, epithelial cells and numerous muddy brown cast. Which of the following is most likely the cause of ARF?
Rheumatoid arthritis, splenomegaly and neutropenia or pancytopenia
8 week hx of diarrhea . On exam pt has patchy alopecia on the scalp and hyperkeratotic lesions on the elbows and knees. What is the likely deficiency?
erythematous, fluctuant area of edema in the intergluteal cleft above the sacrum at the midline. Tender to palpation, and there is a small amount of purulent discharge from the a small opening. What is the next step?
37 yo female with sudden onset of nonradiating substernal chest pain that awakened her from sleep. Has had 3 episode over the last year. ECG showed sinus bradycardia with normal axis, normal PR interval and QRS interval of 0.16. There was 2 mm ST segment elevations in leads II, III, and avF with no Q waves. Vital are WNL except HR of 55. What is the likely cause of pain?
Variant angina pectoris aka prinzmetal angina
Pharmacotherapy for urinary incontinence of not able to reach a bathroom quickly enough after feeling the need to void?
73 yo with syncopal episodes with no warning. Next step in diagnosis
Ambulatory ECG monitoring
37 with WBC 23,600, metamyelocytes 5% dx
Chronic myelogenous leukemia
57 yo man with 4 days of progressive SOB and cough of yellow sputum. Has COPD tx with ipratropium. Temp is 98.6. Breath sounds are decreased, scattered rhonchi are heard. O2sat 90%. X ray shows hyperinflation of the lungs. What is the dx?
Head truam now with Na 120 and urine osmo 340. Average urine output is 50 ml/h. Tx?
Farm worker with sudden onset of HA,dizziness, N/V. Pulse 52 and BP 90/60. There is generalized weakness, diaphoresis and pinpoint pupils. What is the mechanism of condition?
Decreased synaptic activity of cholinesterase
Swollen joint. WBC serum is 10,000, and ERS 40. X ray shows degenerative joint dz and osteopenia but not fracture. What is the next step?
Aspiration of the knee joint
47 yo with nonproductive cough for 10 weeks. Never had smokes. X ray shows 3 cm peripheral lesion. What is the most likely dx?
Adenocarcinoma of the lung
15 yo with intermittent fleeting painunder her left breast. Normal s1, s2 with midystolic click. What is the tx?
Pt with intermittent burning chest pain at night that is relieved by sitting up. has a 2/6 holosystolic murmur heard beast at the apex and radiates to the axilla. What is the next step?
Oral administration of an H2 receptor blocking agent
90 yo female with 1 month hx of generalized itching and decreased appetite. Has had 30 year hx of HTN tx with hydrochlorothiazide and atenolol. cognition is intact. WBC 4,000, Na138, K 5.9, Ca 10.2, urea nitrogen 45, creatinine what is the likely cause of the anorexia?
tx of hypercalcimia ca of 13
IV 0.9 saline
DM II pt what additional drug should a pt be on to decrease for diabetic complications?
ACE inhibitor like enalapril
62 yo with 3 months of SOB. There is a slow rising sustained carotid pulse. The apical beat is sustained and inferiorly and laterally displaced on palpation of the chest. A grade 4/6 harsh systolic ejection murmur is heard. What is the likely dx?
Bicuspid aortic vavle
Even if a pt has a new mutation of PKD what is the risk for her children
50% /b it is AD
CHF most likely to show on pleural fluid
Glucose concentration approximately equal to serum glucose concentration
When the upper limit of normal is increased from less than 5% to less than 8% how does that effect sensitivity and specificity
Decreased sensitivity Increased specificity
Pt with confusion and drowsiness. She has breast ca. On arrival she is lethargic and not oriented. She has sunken eyes and dry mucous membranes. Ca is 16. What is the next step?
IV 0.9 saline
During a water depravation test at 0 hrs urine osmo = 200 and serum osmo = 285; at 5 hrs urine osmo = 400 and serum osmo = 300 After desmopressin the urine osmo is 1000. What is the likely dx?
Idiopathic central diabetes insipidus
42 yo male with SOB, nonsmoker. Brother with lung transplant. X ray shows hyperlucent lung fields most prominent at the bases, and flattened diaphragms.
Abnormality of antiprotease resulting in destruction of alveolar supporting sturctures
decreased mean red cell volume
47 yo male alchoholic with 2 weeks of fever and cough productive of brown, foul smelling sputum. poor dentition. Breath sounds are decreased over the lower lung field. X ray shows 3 x 5 cm round lesion with air fluid level. What is the abx?
62 yo female with COPD. Has not had pharmacotherapy yet. Mildly decreased air movement; occasional wheezes are heard. ph 7.42, Pco2 40, PO2 74 what is the next step in management?
37 yo femlae with 6 weeks of puffy eyes and swelling of legs. She has had heavy bleeding, wt gain. Heart sounds are distant. CK is 130, cholesterol is 300. What is the next step in dx?
Measurement of serum thyroid stimulating hormone concentration.
Group B strep prevention in an unknown pt
if delivery has not occurred in 18 hours after eruption of membranes.
Couple trying to conceive over 3 years. She has periods. Has had multiple sexual partners. Pelvic exam shows no abnormalities. What is the next step to do?
HTN in pregnancy
Petechiae on the vaginal mucosa, abundant, foul smelling frothy green discharge in the vaginal vault; no foreign body. Large ectropion on the cervix. What is the next step?
Wet mount preparation of the vaginal fluid
Positive PPD in pregnancy what is the next step?
X-ray of the chest
57 yo with 2 months of vulvar itching. There is a 1 x 1 1/2 cm ulcerated lesion on the inner righ labium majus surrounded by mild erythema. There is no inguinal adenopathy. What is the likely dx
days after c -section, becasue of fetal distress, a hospitalized 42 yr old womanis found unconcious. she has temperature, friction rub, biltaeral wheezing . ABG:
PH – 7.26
PCo2 – 28
Po2 – 60 ( low o2 and po2)
xray shows atelectasis . ECG shows tachycardia with cor pulmonale
PH – 7.26
PCo2 – 28
Po2 – 60 ( low o2 and po2)
xray shows atelectasis . ECG shows tachycardia with cor pulmonale
F/u VDRL or rapid plasma reagin + test with?
Fluorescent treponemal antibody absorption test
Full term pt in labor and the membranes rupture with clear fluid. The fetal heart rate decreases to 90. What is the next step?
23 yo female with RLQ pain for 18 hrs. Period was 6 weeks ago. 3 weeks ago a 5x5x4 cm mass was found in the right adenexa. She is not sexually active. There is tenderness in the RLQ with rebound and guarding. U/S shows a 10 x 8 x 7 right sided mass with cystic and solid components. What is the likely dx?
Torsion of an ovairan cyst
42 yo has amniocentesis which shows 46 xx. At birth the newborn has a phallus and scrotum. What is the likely discrepancy?
Anorexia lab values for hormones
Decreased estrogen and FSH concentrations
Pregnant and work at daycare. Fetus has hydrops. what is the cause
Fetal parvovirus B19 infection
16 yo never had period. Breasts are tanner stage 3. No axilary or pubic hair. vagina is 2 cm in length, there is no uterus. What is the diagnosis?
Androgen insensitivity syndrome they usually present with no sexual hair unlike mullerian agensis they probable would have pubic hair.
Obesity increases the risk of endometrial ca because of what conversion?
Androstenedione to estrone
12 yo female that has had 1 yo of progressive facial hair growth and acne. Breast are tanner stage 1 and axillary and pubic hair is stage 3. Pelvic exam shows a 2 cm vaginal canal, significant clitoromegaly, posterior labioscrotal fusion, and no cervix or palpable uterus. there is bilateral gonads without follicles. What would chromosomal analysis reveal?
46 x, y this is 5 a reductase deficiency
Raw, deep, exquisitely tender ulcer at the introitus with an uneven base and inflamed undermined margines is what organism?
37 yo G8,P8 has vaginal bleeding. Abd exam is normal. Bimanual and rectal examination show a 8 cm mass of the upper cervix and right parametrium. No ovary is palpated separately. A ct scan shows a right hydroureter above the level of the mass. What is the dx?
Squamous cell carcinoma of the cervix
Sexually trasmitted disease like aids how often do you get PAP
1 a year
Diagnosis of endometriosis
Treatment uterine infection after c-sectoin
iV ampicillin and gentamicin
Ruptured membranes at 28 weeks. After administration of intramuscular corticosteroids and IV antibiotics, which of the following is the most appropriate next step in management? The fetus heart rate is 150 with moderate variability.
Second administration of corticosteroids in 24 hours
After placenta is delivered there is a firm pale mass in the lower vagina. The pt develops SOB and BP is 60/40. The uterus cannot be palpated on abd exam. TX /w iv saline does not improve. What is the dx?
Multiple 0.25 cm raised, crusty papules on the posterio rfourchette. Pap smear shows low grade squamous intraepithelial lesions. What is the dx.
Valproic acid is associated with what fetal defect