Prevention
Leftovers 1
Psych
Leftovers 2
Misc
100
During a scheduled health maintenance visit, the parents of a 2-month-old child have several questions about potential adverse effects. Which of the following adverse effects has the most often been reported following administration of the pertussis containing vaccine?
A. Prolonged irritability and crying
B. Thrombocytopenia
C. Generalized macular rash and arthralgia
D. Intussusception
E. Localized vesicular rash at the injection site
Prolonged irritability and crying
Contra: encephalopathy within 1 week of vax
Anaphylaxis immediately after vax
Precaution: GBS within 6 weeks after vax
100
A 28-year-old woman is evaluated for a 6-month history of amenorrhea. Medical history is significant for schizophrenia. Her only medication is risperidone.
On physical examination, vital signs are normal. BMI is 28. No breast discharge is evident.
MRI reveals a normal pituitary gland.
Consultation with the patient's psychiatrist confirms that risperidone cannot be discontinued.
Estrodial is 10 pg/ml
FSH is 1 mU/ml
Prolactin 150 mg/ml
TSH 2.2
free thyroxine is 1.2
Which of the following is the most appropriate management?
A. Begin cabergoline
B. Begin estrogen-progesterone replacement therapy
C. Repeat pituitary MRI in 6 months
D. Repeat prolactin measurement in 6 months.
Begin estrogen-progesterone replacement therapy
untreated hyperprolactinemia can lead to hypogonadism and bone loss. estrogen-progesterone replacement is necessary to prevent this.
100
A 23-year-old man is evaluated for fever, abdominal pain, rash, and arthritis of the right knee of 3 days' duration that resolved 1 week ago. He has had more than 20 similar episodes, the last three occurring in the past year. The first episode occurred at age 5 years and presented as abdominal pain; the patient underwent appendectomy, but no appendicitis was found. His paternal grandfather and maternal grandmother had a similar syndrome.
Physical examination findings, including vital signs, are normal.
Laboratory evaluation shows an erythrocyte sedimentation rate of 23 mm/h, a normal serum creatinine level, and 1+ protein on urinalysis.
Which of the following is the most appropriate treatment?
A. Canakinumab
B. Colchicine
C. Indomethacin
D. Prednisone
Colchicine
200
A 3-year-old kid with DD has white lines running across chalky brown discolored and pitted teeth. These are most likely from the following.
A. Pb poisoning
B. Fluorosis
C. Chronic Mercury intoxication
D. Congenital syphilis
E. Chronic arsenic intoxication
Fluorosis
Chronic lead - blue lines along gums and blue/black edge to teeth = Burton's lines
Mercury- causes ulcers and loose teeth
Arsenic - gingivitis and periodontitis
Syphilis- Hutchinson teeth - wide space, peg barrel shape
200
A 7 yo boy goes to the ED after falling out of a tree. On exam, he is arousable when stimulated. His BP is 80/35, HR 140, RR 40. His abdomen is distended, diffusely tender, and rigid. Prominent ecchymoses are noted in the umbilical and flank regions. You suspect a splenic rupture. Which of the following supports your decision?
A. Left shoulder pain
B. A laterally displaced gastric bubble on Xray
C. A scaphoid appearance to the left upper and lower abd quadrants.
D. Evidence of paralysis of left hemidiaphragm on Xray
E. Midsternal CP
Left shoulder pain
300
Following removal from her home d/t neglect, a healthy 4-year-old records show she received Hep B vaccine at birth. Pediarix (DTaP/IPV/HepB), PCV 15, Hib, and rotavirus vaccines at 2 months old and then Dtap/IPV/HepB/Hib/MMR/V at 18 months of age. Which of the following vaccinations should be given this visit?
A. DTaP/IPV/Hep B/MMR, PCV15 or 20, Hep A and Varicella
B. DTaP/IPV/Hep B/MMR, PCV15 or 20, Hib
C. DTaP/IPV/Hep B/MMR, Varicella and Hib
D. DTaP/IPV/Hep B/MMR, PCV15 or 20, Hep A and Rotavirus
E. DTaP/IPV/Hep B/MMR, PCV15 or 20, Varicella and Hib
DTaP/IPV/Hep B/MMR, PCV15 or 20, Hep A and Varicella
300
A 10 yo boy is referred by a school nurse for increase in disruptive behavior. He makes disruptive noises and movements and speaks obscenities. He just started ER Methylphenidate for dx of aDHD. His ADHD have improved. Hx is otherwise normal. On exam, he has repetitive jerking movements, has facial grimaces, and grunts. they are discrete and he can't stop doing them if he wanted to. which of the following is the most appropriate tx modification in this patient?
A. Slowly inc dose of ER Methylphenidate in 10% increments to max dose.
B. Dc Methylphenidate and start Atomoxetine
C. Dc all meds and get psychotherapy
D. Dc ER Methylphenidate and being twice daily SA Methylphenidate
E. Begin Clonidine and continue current dose of Methylphenidate
Begin Clonidine and continue current dose of Methylphenidate
Stimulants can unmask tic d/o.
400
A 68-year-old man is evaluated in the hospital for a 1-month history of nonproductive cough, dyspnea, and constant chest pressure. He is a never-smoker.
On physical examination, blood pressure is 106/62 mm Hg with 18 mm Hg pulsus paradoxus, and pulse rate is 100/min. Central venous pressure is elevated, and heart sounds are distant.
A focused echocardiogram shows a 2-cm circumferential pericardial effusion with evidence of tamponade. Pericardiocentesis yields 650 mL of sanguinous fluid with marked improvement in symptoms.
A transthoracic echocardiogram (apical four-chamber view) after pericardiocentesis is shown (RA = right atrium, RV = right ventricle, LV = left ventricle, EFF = pericardial effusion). A chest CT scan with contrast after pericardiocentesis reveals a 4-mm right middle lobe nodule and a small pericardial effusion with drain in place. A 3 × 3–cm right atrial mass is present, contiguous with the lateral wall of the right atrium.
Which of the following is the most likely diagnosis?
A. Atrial myxoma
B. Bronchogenic carcinoma with cardiac mets
C. Cardiac angiosarcoma
D. Papillary fibroelastoma
Cardiac angiosarcoma
rare. seen in right atrium and associated with sanguinous pericardial effusion
400
A 4 mo old male who is hospitalized for severe bacteremia and sepsis x 2 with 1 picu admit for PNA. Several CBC show WBC of 2.4-3k cells and ANC of < 200. A recent bone marrow shows promyelocytic arrest. Which of the following best describes possible pathophysiology behind the condition?
A. Infiltration of marrow by leukemic blasts
B. Autoantibodies to granulocytes
C. Severe congenital neutropenia
D. GBS infection
E. Vit B12 deficiency
Severe congenital neutropenia
Kostman syndrome
see deficit of myeloid cell maturation and promyelocytic arrest. pt need treated with granulocyte colony stimulating factor.
400
A 9 yo girl is found a scene of a house fire. she is pulseless and apneic. She intubated, had 20 min of CPR, and got a rhythm. in the Ed, she is unresponsive, pupils are dilated and fixed. Her skin is intact. A Carboxyhemoglobin is 40%. She is placed in a hyperbaric chamber bur arrests15 min later. she dies. Her dx and treatment were for CO poisoning. You review the characteristics of poisoning for this pt. What statement is true?
A. Initial therapy for CO poisoning if hyperbaric oxygen.
B. Pt with CO poisoning usually have cherry red skin
C. the odor of CO gas is similar to kerosene.
D. Cyanide poisoning should be considered in a closed space fire with CO poisoning.
E. CO irreversibly binds to Hb, displaces oxygen, and impairs oxygen release.
Cyanide poisoning should be considered in a closed space fire with CO poisoning.
CO symptoms: flu like sx- fever, HA, dizzy, weakness, malaise.
severe sx= seizures, LOC, arrest
Tx is 100% Fi02