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Questions and Answers
Questions and Answers
What are absolute contraindications to electroconvulsive therapy (ECT)?
What are absolute contraindications to electroconvulsive therapy (ECT)?
There are no absolute contraindications to ECT.
What is the most appropriate initial treatment for community-acquired pneumonia in infants and children?
What is the most appropriate initial treatment for community-acquired pneumonia in infants and children?
High-dose amoxicillin.
At what age is it recommended to introduce solid foods into the diet for normal term infants?
At what age is it recommended to introduce solid foods into the diet for normal term infants?
4-6 months of age.
What is the recommended treatment for midshaft posteromedial tibial stress fractures?
What is the recommended treatment for midshaft posteromedial tibial stress fractures?
What is the most appropriate test to screen for late-onset male hypogonadism?
What is the most appropriate test to screen for late-onset male hypogonadism?
What is the first-line treatment for pediatric HSV-1 infection?
What is the first-line treatment for pediatric HSV-1 infection?
What is the most accurate maneuver for detecting an ACL tear?
What is the most accurate maneuver for detecting an ACL tear?
What is the diagnosis of multiple myeloma based on?
What is the diagnosis of multiple myeloma based on?
What findings are typical of femoral neuropathy?
What findings are typical of femoral neuropathy?
What decreases the risk of cancer for women using low-dose estrogen oral contraceptives?
What decreases the risk of cancer for women using low-dose estrogen oral contraceptives?
What are the clinical hallmarks of polymyalgia rheumatica?
What are the clinical hallmarks of polymyalgia rheumatica?
What are the three subtypes of frontotemporal dementia?
What are the three subtypes of frontotemporal dementia?
What is the hallmark biochemical feature of refeeding syndrome?
What is the hallmark biochemical feature of refeeding syndrome?
What methods can reduce the risk of oral candidiasis with inhaled corticosteroids for asthma?
What methods can reduce the risk of oral candidiasis with inhaled corticosteroids for asthma?
When should laryngoscopy be recommended for hoarseness?
When should laryngoscopy be recommended for hoarseness?
What are some causes of right heart failure?
What are some causes of right heart failure?
What are the metabolites of codeine-containing medications and diazepam?
What are the metabolites of codeine-containing medications and diazepam?
What is the most appropriate initial management of hypercalcemia of malignancy?
What is the most appropriate initial management of hypercalcemia of malignancy?
Why is myomectomy preferred over fibroid embolization in some patients?
Why is myomectomy preferred over fibroid embolization in some patients?
What are the hallmarks of melanosis coli?
What are the hallmarks of melanosis coli?
What happens to the murmur of mitral valve prolapse with the Valsalva maneuver?
What happens to the murmur of mitral valve prolapse with the Valsalva maneuver?
What is the most common hip disorder in 8-15 year-old males and overweight/obese children?
What is the most common hip disorder in 8-15 year-old males and overweight/obese children?
PEG tubes are associated w/ an increase in what?
PEG tubes are associated w/ an increase in what?
What is the highest risk group for colorectal cancer?
What is the highest risk group for colorectal cancer?
What drugs are associated with drug-induced pleural disease/lupus pleuritis?
What drugs are associated with drug-induced pleural disease/lupus pleuritis?
What is the treatment for tachycardia in a patient with a history of Wolff-Parkinson-White syndrome?
What is the treatment for tachycardia in a patient with a history of Wolff-Parkinson-White syndrome?
Is doxycycline contraindicated in pregnancy?
Is doxycycline contraindicated in pregnancy?
Will steady extra caloric intake result in weight gain indefinitely?
Will steady extra caloric intake result in weight gain indefinitely?
What is the initial medical management of asthma?
What is the initial medical management of asthma?
Name some tumor necrosis factor inhibitors and the testing required prior to initiation.
Name some tumor necrosis factor inhibitors and the testing required prior to initiation.
What tests are used to detect HCV antibody and determine active from past infection?
What tests are used to detect HCV antibody and determine active from past infection?
What precautions should be initiated for a patient with an MRSA infection?
What precautions should be initiated for a patient with an MRSA infection?
What procedures should metformin be withheld for and what are the consequences of not doing so?
What procedures should metformin be withheld for and what are the consequences of not doing so?
What are the guidelines on combination therapy for nursing-home acquired pneumonia?
What are the guidelines on combination therapy for nursing-home acquired pneumonia?
Is there significant risk of congenital anomalies from SSRI use in pregnancy?
Is there significant risk of congenital anomalies from SSRI use in pregnancy?
Match the following classic presentations with their condition:
Match the following classic presentations with their condition:
What are the indications for teriparatide?
What are the indications for teriparatide?
What is the most likely infectious agent for acute dysuria, frequency, pyuria with no associated hematuria?
What is the most likely infectious agent for acute dysuria, frequency, pyuria with no associated hematuria?
What do you interpret if a patient takes 14 seconds on the 'Timed Get Up and Go' test?
What do you interpret if a patient takes 14 seconds on the 'Timed Get Up and Go' test?
Match the following gait/balance disorders with their characteristics:
Match the following gait/balance disorders with their characteristics:
What are the CDC recommendations on initiating treatment in a patient with suspected influenza?
What are the CDC recommendations on initiating treatment in a patient with suspected influenza?
What are the recommendations for aspirin use in primary prevention of cardiovascular disease?
What are the recommendations for aspirin use in primary prevention of cardiovascular disease?
Is there sufficient evidence to support the benefit/harm of aspirin use for cardiovascular disease prevention in individuals over 80?
Is there sufficient evidence to support the benefit/harm of aspirin use for cardiovascular disease prevention in individuals over 80?
What populations are recommendations against the use of aspirin?
What populations are recommendations against the use of aspirin?
What is known as 'nursemaid's elbow'?
What is known as 'nursemaid's elbow'?
What is the appropriate management for fever in children under 29 days?
What is the appropriate management for fever in children under 29 days?
What elements are part of the initial emergency department treatment for acute asthma exacerbations in children?
What elements are part of the initial emergency department treatment for acute asthma exacerbations in children?
What is the most common cause of death during the first 6 months of life?
What is the most common cause of death during the first 6 months of life?
What documentation should lead to considering deliberate suffocation?
What documentation should lead to considering deliberate suffocation?
What measures can help reduce calcium oxalate stone formation?
What measures can help reduce calcium oxalate stone formation?
What is the initial imaging modality for suspected stress fractures?
What is the initial imaging modality for suspected stress fractures?
What should you suspect in a patient presenting with metabolic acidosis of unknown cause?
What should you suspect in a patient presenting with metabolic acidosis of unknown cause?
Questions and Answers
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Study Notes
Study Notes
Electroconvulsive Therapy
- No absolute contraindications to electroconvulsive therapy (ECT).
Community-Acquired Pneumonia in Children
- Diagnosis primarily based on history and physical examination.
- Symptoms include fever, cyanosis, and abnormal respiratory findings.
- Outpatient antibiotics appropriate if the child is not toxic, hypoxemic, or distressed.
- High-dose amoxicillin is the preferred treatment.
Introduction of Solid Foods
- Recommended age to introduce solid foods to normal term infants is 4-6 months as the extrusion reflex disappears by 4 months.
Midshaft Posteromedial Tibial Stress Fractures
- Treated using an air stirrup leg brace (Aircast).
Male Hypogonadism Screening
- Total testosterone is the most appropriate initial test for screening late-onset male hypogonadism.
Pediatric HSV-1 Infection
- Acyclovir suspension is the standard treatment.
ACL Tear Detection
- Lachman test is the most accurate for detecting an ACL tear with a sensitivity range of 60%-100%.
- Anterior drawer test shows a sensitivity of 9%-93%.
- Pivot shift test shows sensitivity between 27%-95%.
Diagnosis of Multiple Myeloma
- Diagnosis requires evidence of end-organ impairment like hypercalcemia or renal failure, along with the presence of M protein or monoclonal plasma cells.
Femoral Neuropathy Symptoms
- Weakness in the lower left leg, knee giving way, and discomfort in the anterior thigh are typical symptoms.
- Commonly associated with diabetes mellitus.
Low-Dose Estrogen Oral Contraceptives
- Users have a 50% lower risk of ovarian cancer.
Polymyalgia Rheumatica
- Characterized by pain and stiffness in the shoulder and pelvic girdle with a dramatic corticosteroid response.
Frontotemporal Dementia Subtypes
- Includes behavioral variant, semantic dementia, and progressive nonfluent aphasia.
Refeeding Syndrome Biochemical Feature
- Hypophosphatemia is the hallmark biochemical feature.
Risk Reduction for Oral Candidiasis with Inhaled Corticosteroids
- Rinse mouth after each use of inhaled corticosteroids and use a valved holding chamber.
Laryngoscopy Recommendation for Hoarseness
- Recommended if hoarseness persists beyond 3 months or if a serious cause is suspected.
Causes of Right Heart Failure
- Left heart failure is the most common cause, followed by myocarditis, pulmonic stenosis, and ventricular septal defects.
Metabolites of Medications
- Codeine metabolism results in morphine, while diazepam metabolizes to oxazepam.
Management of Hypercalcemia of Malignancy
- Initial management involves intravenous normal saline.
Myomectomy vs. Fibroid Embolization
- Preference for myomectomy is indicated by the desire for future pregnancy.
Melanosis Coli Characteristics
- Notable by brown to black leopard spotting of the colonic mucosa due to anthraquinone laxative abuse.
Mitral Valve Prolapse and Valsalva Maneuver
- The murmur becomes longer and louder with the Valsalva maneuver.
Common Hip Disorder in Youth
- Slipped capital femoral epiphysis is the most common in males aged 8-15 years and in overweight/obese children.
PEG Tubes and Restraints
- PEG tubes are associated with an increased use of restraints.
Colorectal Cancer Screening Recommendations
- Highest risk group includes those with a first-degree relative diagnosed before age 60 or two second-degree relatives.
- Screening should start at age 40 or 10 years before the earliest diagnosis in the family, with rescreening every 5 years.
Drugs Inducing Pleural Disease
- Medications include hydralazine, procainamide, quinidine, amiodarone, bleomycin, cyclophosphamide, mitomycin, bromocriptine, methotrexate, and minoxidil.
Tachycardia Management in Wolff-Parkinson-White Syndrome
- Procainamide is the treatment of choice.
Doxycycline in Pregnancy
- Contraindicated during the second and third trimesters due to risk of permanent tooth discolouration.
Steady Extra Caloric Intake
- Weight gain will plateau rather than continue indefinitely.
Initial Asthma Management
- Low-dose inhaled corticosteroid daily with short-acting beta agonist (SABA) as needed.
Tumor Necrosis Factor Inhibitors
- Include infliximab, adalimumab, certolizumab pegol, and golimumab, requiring screening for TB, HBV, and HCV before initiation.
HCV Testing Protocol
- Detection through enzyme immunoassay, confirmation with recombinant immunoblot assay, and differentiation of active from past infection via RNA polymerase chain reaction.
MRSA Infection Precautions
- Strict handwashing by staff, visitors, and residents; implement barrier precautions for wounds and medical devices.
Metformin Use and Procedures
- Withhold metformin during procedures that reduce kidney function to prevent lactic acidosis.
Nursing-Home Acquired Pneumonia Treatment
- Recommended combination therapy includes antipseudomonal cephalosporins or carbapenems, antipseudomonal fluoroquinolones or aminoglycosides, and anti-MRSA agents.
SSRIs in Pregnancy
- Generally no significant risk for congenital anomalies except for paroxetine, which increases the risk of cardiac malformations in the first trimester.
Classic Pediatric Presentations
- Pyloric stenosis: palpable mass at 4-6 weeks.
- Choledochal cyst: triad of RUQ pain, jaundice, palpable mass.
- Meckel's diverticulum: painless GI bleeding in infants.
- Intussusception: colicky abdominal pain with palpable mass.
- Intestinal malrotation: bilious vomiting in the first 4 weeks.
Teriparatide Indications
- Used for severe osteoporosis, multiple risk factors, or failed bisphosphonate therapy.
Common Infectious Agents in Urethritis
- Urethritis likely caused by C. trachomatis, N. gonorrhoeae, or HSV if symptoms include dysuria and pyuria but no hematuria.
"Timed Get Up and Go" Test Interpretation
- 14 seconds indicates increased fall risk, while >20 seconds indicates severe gait impairment.
Gait and Balance Disorders Characteristics
- Cautious gait: wide stance and careful movements.
- Cerebellar degeneration: ataxic, wide-based gait.
- Frontal lobe degeneration: "magnetic" gait with hesitation.
- Parkinson's disease: shuffling gait with decreased step length.
- Motor neuropathy: steppage gait, excessive hip and knee flexion.
CDC Influenza Treatment Recommendations
- Initiate antiviral treatment based solely on clinical symptoms.
Aspirin Use for Cardiovascular Disease Prevention
- Recommended for men aged 45-79 for myocardial infarction prevention and women aged 55-79 for ischemic stroke prevention.
Insufficient Evidence for Aspirin Use
- Not enough evidence to recommend aspirin for cardiovascular disease prevention in those older than 80 years.
Aspirin Recommendations AGAINST Use
- Avoid in patients with fever >38.0°C, chest pain, orthopnea, wheezes, or rhonchi.
Nursemaid's Elbow
- Common injury in children under 5, occurring from a sudden upward pull, resulting in subluxation of the radial head.
Fever in Infants Under 29 Days
- Complete sepsis workup and admission required; common pathogens include group B Streptococcus and E. coli, treated with ampicillin and cefotaxime.
Acute Asthma Exacerbation Treatment in Children
- Involves repeated doses of a short-acting β2-agonist, correcting hypoxia, and possibly using IV magnesium sulfate.
Sudden Infant Death Syndrome (SIDS)
- Leading cause of death in infants aged 2-4 months, characterized by specific terminal activities and lividity.
Deliberate Suffocation Risk Indicators
- Consider if documentation includes infants over 6 months, prior sibling deaths, or specific pulmonary evidence.
Calcium Oxalate Stone Formation Prevention
- Low-sodium, restricted-protein diet, increased fluid intake, oxalate restriction, and potassium citrate to raise urinary pH.
Initial Imaging for Stress Fractures
- First-line imaging is plain radiographs; MRI serves as second-line if needed.
Suspecting Ethylene Glycol Poisoning
- Indicators include metabolic acidosis, renal failure, intoxicated appearance without alcohol odor, urinary crystals; treat with fomepizole. Ethylene glycol is found in engine coolant and cleaners.
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