All about the heart
A 5-year-old boy presents with acute L anterior thigh and hip pain. He had a viral URI 7 days ago. The boy has a low grade fever and cannot bear weight, but there is no obvious joint swelling. What is the most likely diagnosis?
Transient (toxic) synovitis. Difficult to distinguish between septic arthritis (WBC >18) and consider hip aspiration
At what CD4 count do you start prophylaxis for PCP?
CD4<200. Use TMP-SMX, dapsone, or atovaquone
22-year-old female presents with a history of palpitations. Currently she denies any dizziness or palpitations. You capture the arrhythmia on the monitor in your office: isolated PACs. She is otherwise healthy, does not take any medications and has no FHx of arrhythmia. How would you treat this patient?
No treatment unless symptomatic. A beta blocker like metoprolol may help to reduce symptomatic PACs
Name 3 of the 5 elements of the Bishop pelvic scoring system
1. Cervical dilation 2. Effacement 3. Fetal station 4. Cervical position 5. Cervical consistency. This is a predictive value for a successful induction. 0-4 (45-50% failure) 5-9 (10% failure) 10-13 (0% failure) If </=5 requires cervical ripening.
15-year-old female cross country runner presents with knee pain that has been gradually increasing since the start of the season 3 weeks ago. The pain is worse with climbing stairs and running. Pain is anterior, mild swelling, positive for crepitus. What is the most likely diagnosis?
Patellofemoral syndrome. Common over use syndrome, F>M, preferred treatment is decreased activity level and quad strengthening exercises
Adhesive capsulitis
Diabetes mellitus
Which NYHA class of CHF is a good candidate for spironolactone (i.e., has shown to reduce mortality)?
Spironolactone has been shown to reduce mortality in patients with NYHA Class 3-4
A 2-year-old male is brought in by mom for not using his right arm. According to mom, the child was unwilling to leave the sand box and a tug of war ensued with mom eventually picking the child by his forearm. What happened?
Radial head subluxation (nursemaid's elbow). Radiographs are usually normal, reduction is the treatment with either hyperpronation or quick supination plus elbow flexion, child should be using the arm normally within minutes
UDS result that is (almost) always true and not a false positive.
Cocaine
Some common medications that cause false-positive results on immunoassay point-of-care tests include: Amphetamines: bupropion, phenylephrine, promethazine, pseudoephedrine, ranitidine, trazodone; Benzodiazepines: sertraline, oxaprozi; Cannabinoids: dronabinol, efavirenz, proton pump inhibitors, NSAIDs; Phencyclidine: dextromethorphan, diphenhydramine, doxylamine, ibuprofen, tramadol, venlafaxine
These are the four medications that have been shown to reduce mortality in patients with congestive heart failure.
Beta blocker, non-selective aldosterone antagonist, ACE/ARB, and SGLT-2 inhibitor.
28-year-old G1P0 at 8 weeks dated by LMP presents to establish care. She is healthy, takes no medications. BP 112/68, HR 76, Temp 36.7, wt 140lbs, height 5'4" (with BMI of 24). She wants to know how much weight she should gain. What do you recommend?
Normal Weight 18.5–24.9: 25–35 lbs (ACOG, 1/2013)
What are the SIRS criteria?
Temp <36C or >38C; HR >90; RR >24 or PaCO2 <32; and Leukocytes >12 or <4 or 10% bands
This is the first-line treatment of urethritis in a 24-year-old male who weighs 152 kg (335 lb), when nucleic acid amplification testing (NAAT) for gonorrhea is positive and Chlamydia testing is negative.
Ceftriaxone 1 g IM
A 55-year-old G0 postmenopausal woman presents for routine follow up. She states that last month she had 2 episodes of vaginal spotting that self resolved. She has no other symptoms. You order a TVUS. At what endometrial thickness is an endometrial biopsy indicated?
>4 mm (per ACOG) >5 mm (per radiological society)
25-year-old male presents with a recent history of a soccer injury. Someone fell on his right foot while trying to steal a ball. The patient was rapidly and forcefully twisted around the fixed foot. Since then, he has had significant pain and swelling of his midfoot. X-rays show a widened space between the first and second metatarsals. What does this patient have?
Lisfranc fracture. This occurs between metatarsals and the tarsal bones; difficult to identify, requires casting and non-weight bearing for 6-8 weeks. Additionally, if >2mm displacement requires ORIF as this could lead to significant long term pain if not identified