Consider bacterial sinusitis to be analogous to bacterial pneumonia. All are possible, but Strep pneumo is the most common.

Unstable and hypotensive patients after blunt trauma get laparotomies (don’t put an unstable patient in the CT scanner). In addition to saline and blood products, definitive surgery is how you address the C in ABC.

• Middle-aged man found to have elevated blood pressure for the first time, and therefore should be initially managed with a trial of lifestyle modifications

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• Older patient with BPH with signs of an AKI (creatinine increase of at least 0.3) who also has suprapubic distention/tenderness, consistent with post-renal AKI in setting of urinary retention
• Diabetic nephropathy can lead to chronic kidney disease over time, but it wouldn’t develop as quickly as seen in this patient

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• Patient with signs of major depressive disorder (too severe of a presentation for simple adjustment disorder), who should be treated with an anti-depressant, with Bupropion being the only antidepressant listed
• First-line antidepressants: SSRIs, SNRIs, Bupropion, Mirtazapine
• Benefits of bupropion: Mild stimulant effects, patient with comorbid cigarette use, helps patients with weight loss, favorable sexual side effect profile

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• Key idea: All patients should receive an annual flu vaccine
• Patients should get a Tdap vaccine as an adult and then a Td booster every 10 years
• All patients should get pneumococcal vaccines (PCV13 + PPSV23) at age 65, with patients under 65 with relative immunodeficiency or increased risk getting a PPSV23 (chronic heart, lung or liver disease; diabetes; current smokers; alcoholics) and patients under 65 with very high risk getting PCV13 + PPSV23 (CSF leak, sickle cell disease, asplenia, cochlear implants, HIV, chronic kidney disease, organ transplant, etc.)

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• Middle-aged man with HIV presents with progressive pain and difficulty with bowel movements with a DRE showing a palpable mass in the anal canal with central ulceration most consistent with a squamous cell carcinoma
• Key idea: HPV-related squamous cell carcinomas of the cervix, anus and penis are more commonly seen in HIV patients, which is why female patients with HIV should receive annual pap smears (rather than every 3-5 years)

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• Young patient with high-risk sexual behaviors presents with acute fever, sore throat, fatigue, tender/enlarged cervical lymph nodes, increased lymphocytes, and mildly increased LFTs with a negative rapid strep test, most consistent with infectious mononucleosis, which is caused by EBV > CMV

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• Young otherwise healthy woman with episodic headaches, palpitations, and sweating found to have severely elevated blood pressure, most consistent with a pheochromocytoma (tumor of adrenal medulla leading to increased catecholamine production)
• Key idea: Classically leads to episodes of the 5 P’s: elevated blood Pressure, Painful headache, Perspiration, Palpitations and Pallor

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can someone please explain this answer :D

Criteria for weaning from ventilator:

1. O2 sat >= 90% with FiO2<=40% and PEEP<=8
2. pH>7.25
3. Initiating breaths (SIMV allows patient to initiate breaths)

LEAD POISONING IN ADULTS: GI Symptoms: abd pain, constipation (acute) Neuro: Cognitive deficit, Peripheral neuropathy (chronic) Hematological: Anemia

this patient has Signs of chronic lead poisoning: nonspecific symptoms (eg fatigue, irritability, insomnia), HTN, motor and sensory deficits, cognitive defect.

So we check for elevated venous Lead levels and give chelation therapy.

Aren't Pl effusions due to CHF ALWAYS bilteral??

Don't forget your sketchy!

carbamazapine is the anti-epileptic associated with blood dyscrasias, such as aplastic anemia and agranulocytosis

Amoxicillin course has not resolved pain + down/lateral displacement of auricle = abscess symptoms... use CT to visualize

Schizophrenic patients with medication non-compliance need long-acting injectable formulations

I somehow got this confused with which vaccines to give an unvaccinated pregnant woman with chronic hepatitis C (HAV and HBV).

Also I think "health maintenance regimen" was the key phrase here

This distribution of rash in a medical assistant suggests urticaria (Type I HS) from wearing latex gloves.

This boy with AGMA and +ketones in serum has DKA, a common presenting symptom of T1DM due to inadequate insulin production. Serum sodium is normal after adjusting for hyperglycemia.

I was confused why diastolic filling time wouldn't be correct. Hx of Mitral stenosis should mean that it takes longer for her left ventricle to fill up, right, so increased diastolic filling time?

Remember, thyroiditis also causes hyperlipidemia

Increased LDL receptors +/- triglycerides due to increased LPL activity

Post-partum + cholesterol + lethargy + boredom + sleep issues + memory = thyroid

Would also expect hypnatremia, weight gain

Postpartum thyroiditis usually hyperthyroid followed by hypothyroid

Patient has symptoms of SIADH = low Na, which presents with small cell carcinoma of the lung

Clue cells = gardnerella = grayish discharge and does change pH (>4.5)

Others

• Ferning = pregnancy / rupture of membranes, but she does not have male partners, so less likely

• Budding yeast = candida = grayish, but does not change the vaginal pH (<4.5)

• leukocyte sheets = ? Maybe erosive lichen planus / lichenoid vaginitis ?

• Trich = green discharge, does change pH (>4.5)

https://vulvovaginaldisorders.com/the-four-pillars-of-vulvovaginal-diagnosis/table-elevated-ph/#prettyPhoto[6]/0/

honestly someone explain this one to me other than the memory loss is her newest thing and needs to be evaluated. pls

This patient with smoking history has euvolemic hyponatremia iso hilar mass, representing SIADH 2/2 SCLC. No signs of AMS so treat conservatively with water restriction. 3% saline is only indicated for symptomatic severe hypoNa.

Hiccups indicate phrenic nerve irritation.

She met the Centor criteria for empiric antibiotics, why was is culture?

Intractable vomiting results in hypochloremic metabolic alkalosis due to loss of HCl. (B) is the only choice with elevated HCO3-. K+ is low due to elevated aldosterone activity from contraction alkalosis.

Vascular ring presents in infancy with biphasic stridor/wheezing that improves with neck extension. None of the other answer choices would persist for 5 months and still result in a happy, well-nourished baby.

Vascular ring presents in infancy with biphasic stridor/wheezing that improves with neck extension. None of the other answer choices would persist for 5 months and still result in a happy, well-nourished baby.

PDA gives continuous machine like murmur that crescendos at S2, so loud S2

Agree with sugaplum;

widened pulse pressure => PDA in newborn or regurg in adult

To and fro murmur = wave like = swishing back and forth = PDA

close with indomethacin