Medical Conditions and Their Treatments: A Comprehensive Review, Exams of Health sciences

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• Fever with rash of the palm and soles of the feet after camping or hiking in the mountain? Rocky mountain spotted fever treat with Doxycycline, lab test to diagnose PCR (Polymerase chain reaction), the organism that cause is by R. rickettsii
• Lyme disease- rash and tick, the other name is erythema migraine, treated with doxycycline, the organism that causes the disease is Borrelia burgdorferi, Elisa is the confirmatory test and confirm with western test same as HIV ***** Skin is red but it is itchy fine white silver scales “psoriasis”. Treated with topical steroids What if she fell and she was injured. This injured area developed a scab with silver plaque this is called Koebner phenomenon. Let’s say this scaly area was removed and the patient developed pinpoint bleeding this is called Auspitz’s sign
• atopic dermatitis- another name Eczema, allergy and asthma. Treated with topical steroids, you instructed to avoid the hot water, emollient cream base and moisturized your body!!
• Tinea Corporis- Child with ring like itchy rash that slowly enlarge and has central clearance. Treated with antifungal cream. mom took son to barber and he developed an Itchy rash that is in the shape of a circle and is getting bigger. It has central clearing
• Actinic Keratosis- dry round pink to red lesion, they do not heals!! You usually see it in face and sun exposed areas, forehead, ears, nose, face, neck. We treated for small areas with Cryotherapy, big area use 5-fluorouracil. Punch Biopsy gold standard!!
• Seborrheic Keratosis- Black or tan spots (pasted on someone) benign
• 5 years old complaining of itching at night assessment fingers and toes with burrowing “scabies”, you used permethrin cream and wash everything in hot water ***** If you have a patient who is diabetes and has cellulitis, what will be your most concern? Osteomyelitis. Let’s supposed you Treated one leg over and over the patient for cellulitis and it is not clearing up and when the Doppler you don’t hear anything.. you have to rule out DVT.

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Page 2 **Absent pulses of one leg rule out DVT!!

• If skin infection Keflex or penicillin**
• MRSA you give Bactrim, clindamycin or doxycycline.
• You have a patient with mastitis you give penicillin or Keflex for any skin infection. What are the instructions you will give is to continue breastfeed.

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• If some is allergy to penicillin you will give a macrolide (azithromycin)
• Asymetrical, has irregular border, with different color, dark brown, light brown “Melanoma”, Punch Biopsy is the gold standard. Know the presentation
• Moluscum contangious- papules with indurate center, sometimes describe as belly bottom, Dome shaped, white encapsulated rash, itchy you should never see it in the private areas of the children
• Erysipelas it cause by Group A Strep- clear marked lines on the checks (face cellulitis). Treatment with penicillin or Dicloxacillin
• Pearly, waxy, may or may have an ulcerated center… Basal cell carcinoma!
• Acne- treatment is a topical retinoids , returned and said it’s not working, next give ABX (oral tetracycline ), still not working refer to dermatology. Treatment is working but is causing the face to turn red, DO NOT STOP the medication have them use the topical every other day
• Impetigo- honey crusted lesions Treatment: Topical mupirocin ( Bactrobam )
• Pityriasis rosea- herald patch (Christmas tree) found on chest/ abdomen Two possible drug test questions
• Cocaine use- nose bleeding with a deviated septum. She is an IV drug user what cdc recommend you test for? Hepatitis C
• Marijuana – EXCEPT: does not cause low sperm count
• Corneal abrasion- round and irregular
• Macular degeneration- central vision loss 1 st
• Glaucoma, what would you see when you do a funduscopic exam? You will see coping of the optic disc CUP-to DISK
• Acute angle closure glaucoma- sudden, painful, halo, corneal cloudy. Send to ER (won’t lose their sight on my watch, close that door send to ER)

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• Open angle glaucoma- non-painful, slow onset, peripheral vision lost 1 st. can’t drive
• Retinal detachment- halo, flashes of light, closing Curtin

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• Cholesteatoma(cauliflower ear)- malformation of the ear, foul smelling. Treatment- send to ENT
• Stomatitis- ulcerations of the mouth (may see questions like: mom brings baby into the office and won’t eat, assessment ulcers in mouth without any other ulcers on the body). If they mentions ulcer in the mouth, hand and foot, then it is Hand -foot mouth disease
• Papilledema- Optic disc swelling with blurred edges (caused by ICP) most common cause HTN. This is Why we should also ask when their last eye exam
• Hypertension retinopathy- Retinal hemorrhage, AV nicking (artery crosses vein that causes kinking), Copper wiring arterial
• AV nicking- Arteriovenous nicking, also known as AV nicking, is the phenomenon where, on examination of the eye, a small artery (arteriole) is seen crossing a small vein (venule), which results in the compression of the vein with bulging on either side of the crossing. Patient with AV nicking suffer from HTN *Always we will do vision acuity FIRST!! *Diabetic retinopathy- Cotton wool spots, microanyurmisms, retinal hemorrhages
• K o plik spots- rube o la (measles)- presents with fever and 3 C- cough, conjunctivitis, coryza (congestion
• Conductive hearing loss is a blockage , wax build up, foreign body, even if you have an accident and tilt your head and had a bone or something, that is considered conductive hearing loss as well. The sound s can’t get through the tympanic membrane. BC >AC
• Sensorial hearing loss- middle and inner hear problem, it is a disease process. Otoxicity, As we get older we naturally lose our hearing “presbycusis”. As we get older we naturally lose our hearing “presbycusis”. Rhinne test AC>BC
• Meniere disease what kind of symptoms are? vertigo, ringing in the ear, “ nystagmus ”. The maneuver you can do if you suspect someone has Meniere disease is Epley’s maneuver. Shin to shoulder and tilt their head in your hand…they may vomit on you. You give antihistamine
• Weber test- lateralize to the bad affected ear, and Rhine test BC>AC. This is

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Page 6 conduction hearing problem

• Otitis media- caused by strep pneumo (most common). 1 st^ line Treatment- Augmentin, amoxicillin

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Page 7 ***** Ruptured tympanic membrane- blood and pus on pillow case (you know they have ear infection) watch it will heal on own

• Otitis media with effusion (fluid on ear) - treat with decongestant, steroid nasal spray. Treat like allergy. Tympanic membrane looks bulging, shiny , fluid bubble
• Another name for Otitis externa (swimmer ear) cause pseudomonas – tragus pain, red canal. Treatment: cortiscosporin drops (neomycin)
• Xanthelasma- Fat pads around your pats eyes, check lipid panel (high cholesterol, hyperlipidemia) how long will take to resolve.. up to 10 years
• Conjunctivitis: Viral: tearing, little exudate (normally unilateral) Bacterial: lots of exudate, crusty, drainage, eyelid sticking together (normally unilateral) Allergy: stringy, slight tearing, no exudate ( starts bilaterally )
• Mononucleosis- it is cause for Epstein virus. what diagnostic test is used: mono spot also known as heterophile antibody test. They Can go back to regular activity 4-6 weeks once the spleen goes back down. An ultrasound is normally ordered to check the spleen….3 month later come back the patient you treated, they probably caught something else not Mono. We do not give Amoxicillin, augmentin, ampicillin, Not “A” meds
• Viral rhinitis- 1st^ line treatment: intranasal steroid, assessment blue tinged swollen nasal passage way Watery rhinorrhea, corza, mucosa a little red, fever, may or may not have sore throat…. What differential pop up to your head… Allergic Rhinitis … Blue pinch swollen nostril… Rhinitis first line treatment is intranasal Steroids *Afrin and visine is only used for 3 days- do not over use due to rebound stiffness ( rhinitis medicamentosa ) Cardia MR. ASS (Mitral Regurgitation, Aortic stenosis= Systolic S MS. ARD (Mitral Stenosis, Aortic regurgitation=diastolic S1)

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• MI on EKG: ST elevation, presents: N/V SOB, fatigue, weakness, arm/jaw/back pain, crushing pain in chest
• Beta blocker given after MI to reduce cardiac load and slows down the heart to allow healing
• Heart murmurs -Know Location and sound

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Page 9 *Mitral regurgitation- loud, harsh blowing (5TH ICS midclavicular line). Radiates to the axillary

• Stenosis- soft, rumbling either mitral or Aortic
• Aortic stenosis (2nd^ ICS right sternal boarder) Radiates to the neck *Grade murmurs (1st^ time you hear a thrill is grade 4) S3 heard in CHF, Pregnant pt (fluid overload) S4 heard in elderly pt (Left Ventricular Hyperthrophy)
• Isolated hypertension (wide blood pressure reading 170/60) Calcium channer blockers CCB NOT IN 1 st^ & 2 nd^ degree heart block
• 1 st^ degree heart block- prolonged PR interval
• PAD- legs hurt at night, poor pulses, intermittent claudication, pain is relieved when elevated, shiny, hairless, cold. In office testing- ( gold standard) ABI- Bad <0.9 >1. calcifications ***** Thiazide- cause issues, most common or important hyperglycemia, hypertriglycerides, and hyperuricemia *Endocarditis- fever, chills, splinter hemorrhages, Janeway lesions (red spots on soles of feet or palms of hands), Osler’s nodes (red tender spots under the skin)
• Before starting a stain check liver function (LFT)
• Pulsus paradoxus- drop in blood pressure during inspiration, 10 pts or great drop. Mostly in Asthma patients
• NSAIDS- why we don’t like to give cardiovascular pt NSAIDS can cause hypertension and CHF, reason
• Diabetic and HTN- give ACE or ARB
• BPH and HTN- alpha blocker hytrin (terazosin HCL)

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• Raynaud’s- common in cold weather, fingers are cold, lose sensation, different color finger tips ( red, blue, pale). Treatment: CCB
• GERD- do NOT give Calciun Channel Blockers b/c cause GERD ***** Pregnant and HTN- DO NOT give ACE or ARB

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Page 11 ***** CHF and HTN- do NOT give CCB

• Metabolic syndrome – triad of symptoms obesity, HLD, HTN, do NOT give thiazide or beta blocker ***** Kidney stone and gout- do NOT give **thiazide *** COPD and Asthma – avoid **beta blockers *** Statin- Do not give/ **avoid grapefruit juice *** TB- seen in X ray upper lobes , Looks like black holes, “cavitations” Immunocompromised or immunosuppresed pt (HIV) 5mm Immigrants, “migrant farmers” or health care works- 10mm Culture and sputum is gold stand for DX *Pneumonia- in X ray seen in middle and Lower lobes
• COPD- 1 st^ line treatment anticholinergic , SABA second choice, LABA , inhaled corticosteroid, refer ***** Asthma- 1 st^ line treatment SABA , low dose inhaled corticosteroid , LABA or Lama , increase inhaled corticosteroid to medium dose
• Pertussis- whopping cough, treat with Azythromycin
• Curve 65- used in a patient to determine readmission to hospital. Curve 65 stands for Confusion, urea (BUN), respiration, BP, Age (65). EXCEPT question *Community acquired pneumonia- Rust colored sputum, Treat Levaquin if 65 or older, if a child amoxicillin (high dose). The organism that causes is Strep Pneumo *AAA- presentation middle age man who smokes, white, male, tearing in the back
• If you hear abdominal bruit? Could be Renal vascular stenosis or Renal Vascular hypertension-

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• Hyperthyroidism- weight loss, tachycardia, anxious, palpations. What is the disease process associated with? Graves disease, you treat with methimazole (Tapazole) and propylithiouracil. If you found a single nodule or multi nodule, what the most concern about? Single.. why? Most likely to be malignant. What do we do with multinodular? We used radioactive iodine therapy and synthroid for life.

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• Hypothyroidism- If you suspect they have it what king of symptoms you will see, weight gain, tired, dry skin, cold hands. The disease process associated is hassimoto’s , the lab test to confirm it is TPO (Thyroid peroxidase antibody) elevated, the TSH is normal
• HGA1C- 9 or above started basil insulin What pancreas secret? Secrets insulin, amylase and also “Glucagon”
• Fructosamine- name of a sugar test for past 3 to 4 weeks, when you start a new medication, for pregnancy patients. Very expensive test, some insurance doesn’t cover it
• Addison’s disease- Fatigue, “ bronzy or tan skin ”. Check cortisol level (low), sodium(low), potassium (high)
• Cushing- moon face, obese, check cortisol level (high) sodium (high) potassium (low)
• Dawn effect in diabetics- you want to Increase night time insulin. Tend to have a naturally increased morning BS
• Somogyi effects in diabetics- a dip (decrease) in BS during the night 3AM- treatment give bedtime snack or decrease night time insulin
• Triglicerides near 500, treated with Niacin or finofibrates , risk for pancreatitis. A question about Triglicerides 280 or 300, total cholesterol 197, LDL 97, what you do? You still treat the triglycerides first b/c you don’t want to wait to increase, then lifestyles modifications
• GERD- 1 st^ line treatment H2 Blockers
• How you diagnose Barret esophagus? Endoscopic, the worst thing that can happen to someone who has Barrett esophagus is cancer. If the GI doctor is not available you fill the scripts for PPI because you don’t want a break in treatment
• Middle age men when he have a bowel movement like pencil stools.. what differential? Descending colon cancer ***** Kidney function- best lab GFR **GFR and creatinine have an inverse relationship. If GFR up, creatine down and viseversa *AN old lady who says she is dribbling and she never dribble before you run urine test UA b/c probably she has an UTI

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• UA shows greater than > WBC, + NITRAT, WBC cast - think pyelonephritis (if you see WBC cast = pylo)

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Page 15 *UA shows bacteria, large epithelial cells, multi bacteria- think contaminated and get new sample. Urine >100,000 bacteria: contaminated sample use a new one

• You diagnosed someone with stress incontinence you instructed to do kegel exercise 10 sets 10 times a day
• Cranial nerves *Ocular movement- 3,4, *Should movement- 11 *Nose- 1 *Ears- 8 *Bell’s palsy- 7 (facial nerve) *Trigeminal- 5 *Young men Headache the happens at the same time everyday very painful is cluster headache and you treated with high dose oxygen. Prophylactic treatment you gave propranolol, if you want to abort the pain give Imitrex (Sumatriptan). Happens to men and have suicidal risk
• Young woman with headache, photophobia for quite some time Migraine headache and you give prophylactic propranolol, aborting treatment Sumatriptan. How long the migraine headache last 4-72 hours
• How you diagnosed Fibromyalgia- 11 out of 18 points have to be positive for pain over the next 3 months
• Subarachnoid hemorrhage SAH- worst headache of my life, sudden, young people after a car accident, older after a fall couples days ago
• subdural hematoma SDH- diagnosed with CT, mom brings her 13 years old who fell on skateboard and after that he has been confused no following instruction, difficulty talking ***** Dementia or delirium- difference delirium is acute, sudden, reversible, run labs to rule out delirium or dementia: CBC, CMP, UA, TSH, folate, B
• Dementia- 3 types Alzheimer’s - loss of executive function (forget to cook, Vascular - can’t remember how to do things after a stroke (not able to remember how to balance the checkbook after stroke)

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Page 16 Lewy body dementia -postural instability, resting tremor (mimics Parkinson) ***** Mini mental exam used to diagnosis Dementia- score 24 or less

• Polymyalgia rheumatic PMR- Lady with shoulder pain, hip pain, hurt all over for the last 6 month, elevated ESR and CRP. Treat with high dose steroids for 9-12 months. Tapered down the dose when the labs come back to normal. If the questions talks about a patient that has PMR

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Page 17 and all of the sudden abrupt vision loss… what happened? **Temporal arteritis or giant cells, gold standard for biopsy of temporal arteritis or giant cells. *** Iron deficiency Anemia 2 additional labs for investigation… TIBC and ferritin

• Anemia- **gold standard for thalassemia and sickle cell hemoglobin electrophoresis *** Bicep tendon rupture- a young men who goes to gym on regular basis but he is not going because he cannot lift his arm, bulge in arm, unable to lift, painful upper arm/ shoulder. The test you do is the Hook test ***** Scaphoid Fx (Snuff box)- pain, swelling, tenderness over the thumb/ wrist area Place in Thumb splint or cast, patient follow up in 2 weeks and still complaining of pain, get x-ray
• ACL knee stability test- lachman’s and Drawer test
• Meniscus- Mc Murray test
• Osteoarthritis- non weight bearing exercises (swimming, stationary biking) NOT walking. Why we tell them non weight bearing? because it is very painful. They have both nodes Heberden's nodes are bony swellings that form on your hands and Similar swellings located on the lower joints, or the proximal interphalangeal joints, are called Bouchard's nodes. First line treatment Tylenol ***** Osteoporosis weight bearing exercise (walking). First line treatment ….. Fosamax, the instructions are drink with a glass of water and sit upright and seat up for at least 30min once a week to prevent esophagitis. How much calcium they need for day? 1200 mg. And 800 IU of vitamin D. Pregnant patient needs 1000 mg of calcium a day
• Rheumathoid Arthritis- A middle age woman complain of pain symmetrical and takes me a little while more than 60 min to move around. Which other symptoms? Bouchard's nodes, sausage fingers, swan neck. First treatment…. NSAID ***** Stress Fx- shin splint, educate rest, relax (RICE ) and Nsaids

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• Morton’s neuroma- Stepping on a pebble, Burning, numbness sensation 3 to 4 metatarsal. What is the name of the test? Squeeze test or Mulder's click”
• Lumbar stenosis- feels better when sitting

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Page 19 ***** 3 atypical antipsychotic drugs - cause Blood Sugar to increase and to gain weight. Check BMI at least every 3 months Seroquel Zyprexa Risperdal

• Acute serotonin syndrome: overdose serotonin, fever, tachycardia, muscle rigidity, hyperreflexias. No lab work must rule out ***** SSRI -1ST^ line treatment for depression, anxiety, PTSD. Women tend to stop SSRI due to weight gain
• Paxil- causes sexual dysfunction in men (ED) give Wellbutrin along with Paxil to help with ED. The number 1 reason men stop taking SSRI is due to ED.
• Kava Kava Natural herb Anxiety and insomnia
• Patient who are stressed out for a test or something you give Benzo only used short term (Ativan and Xanax)
• No valium or Benadryl to our elderly patient ***** Seasonal affective disorder- common to see depression during winter months. Circadian rhythm is off because the day is getting shorter and night longer, **treat with light or talk therapy, SSRI *** acute prostatitis (prostate warm and boggy) it is mostly cause for an STD, younger than 40. Treated with Rocephin and doxycycline. Older than 40 flu like symptoms, suprapubic pain. Treat with Ciprofloxacin, Levaquin, Levofloxacin. do not stimulate (don’t want to introduce septicemia or bactereumia)
• BPH- rubbery and big (enlarged) Treatment: Proscar helps reduce the size. Remember if they have HTN and BPH treat with Hytrin…. Saw palmetto- natural way to treat BPH
• A mom brings her 7 years old and he is complaining of pain in the scrotum area which is not relieve with elevation. Absent cremasteric reflex …. Testicular torsion, nothing you do will make it feel better, it is a medical emergency within 6 hours need to be in the surgery table.
• Ectopic pregnancy- light to scant bleeding, typically patient with PID

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• Natural estrogen are Isoflavone , Soy, Black Cohosh
• Should never be able to palpate an ovary- if you do get transvaginal ultrasound

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• Post Menopausal lady with vaginal bleeding… order a transvaginal ultrasound and endometrial biopsy to rule out uterine cancer or endometrial cancer
• Low-grade squamous intraepithelial lesion (LSIL)—LSIL means that the cervical cells show changes that are mildly abnormal. LSIL usually is caused by an HPV infection that often goes away on its own. Just watch if you are 25+ will do biopsy
• A high-grade squamous intraepithelial lesion is sometimes called moderate or severe dysplasia. Also called HSIL. 21-24 going to have a biopsy colposcopy, if you are 25 or older leep procedure
• Vaginal exam and visualized on microscope squamous epithelial cell with stippling appearance no lactobacillus and whole lot of WBC… Bacterial Vaginosis!! Treated with Flagyl (metronidazole) instructed NO Alcohol!!
• Vaginal exam with strawberry cervix with green bubbly vaginal discharge… Trichomonas’s treat with Flagyl
• Vaginal dryness- painful sex, atrophy, can cause tears Treatment: topical estrogen
• Trichomoniasis- Gray, green, bubbly discharge, strawberry cervix, mobile cellular organism seen on slide Treatment: Flagyl
• Galactorrhea- Producing milking when not pregnant- check prolactin levels
• Prolactinoma -a benign tumor in your pituitary gland that produces too much prolactin
• 1 st^ treatment for UTI- Macrobid (Nitrofurantoin)
• CD4 count drop below 200.. patient has AIDS or the treatment it is not working. You will see one or the other. Treatment is prophylactically Bactrim daily to prevent pneumonia *Gonorrhea- treatment azithromycin and rocephin
• What is the treatment for chlamydia? Azithromycin

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• PID, untready STD, and epididymitis- if not treated can cause infertility
• Screening test for Syphilis - VDRL RPR, confirm FTA-ABS. Syphilis treated with Penicillin, if PCN allergy give Azithromycin

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• Fifth disease- slap cheek, lacy rash, B19- parvo virus causes 5th^ disease. What you tell mom if pregnant? Stay away because can fetal demise
• Positive signs of pregnancy- heard fetal heart tone, seen on ultrasound (as a provider can verify)
• Probable signs of pregnancy : chadwick, goodell signs
• Presumptive signs of pregnancy- anything that mom said! Mom felt kicking
• Estimated due date Add 9 months and 7 days ***** Fundus is located above the symphysis pubis- **12 weeks *** Fundus between the pubis and below the umbilicus **16 weeks *** Fundus at umbilicus 20 weeks
• More than 2cm off in measurement- order ultrasound
• Abruptio Placenta- painful bleeding, abdomen rock hard, extreme pain, baby needs to get out NOW!
• Placenta Previa- non-painful bleeding, noticed in 2-3 trimester. Instructions are to to stick anything down there NOT even your husband (NO SEX) Normally seen after sex
• AFP (alpha fetal protein) drawn at 16-20 weeks.
• Rhogam given at 28 weeks and 72 hours after delivery
• Tdap will not be given under age 7
• HPV given as young as 9
• Red reflex is good thing, if absent red reflex is indicative of cataracts, elderly night vision issue

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• Retinoblastoma white reflex indicates Retinoblastoma, “leukocoria” is the medical terminology used is the test.
• Neuroblastoma found in the small glands on top of the kidneys (adrenal glands) crosses the midline. Which one does not crosses the midline? Nephroblastoma (Wilm’s Tumor)

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• 15 or 16years old and hasn’t start the period have secondary sex characteristics … Primary amenorrhea
• 13 years old boy soccer player complaining of knee pain, full range of motion without any clinical finding on examination “Osgood-Schlatter disease” (overuse of the joint) ***** Legg–Calvé–Perthes disease (LCPD- “Osteonecrosis”- Limping, uneven lengths. Lack of blood flow to the femoral head decreases. Positive Trendelenburg test
• Slip capital Femoral - Formal head slips out of sock without any reason, one hip higher than the other, limping, instructed do not ambulate and send it to the emergency
• Marfan syndrome- arms are longer than legs- Mitral Valve Prolapse clipping
• Sickle cell- give all vaccine on time
• Heterogeneous- you have a 25% chance of carrying the disease 4 Hour live review!! Patient with osteoarthritis and develop heart failure, which drug cause that? NSAIds ***** Stress Fx- shin splint, educate rest, relax (RICE ) and Nsaids
• AFP (alpha fetal protein) drawn at 16-20 weeks.
• Curve 65- used in a patient to determine readmission to hospital. Curve 65 stands for Confusion, urea (BUN), respiration, BP, Age (65). EXCEPT question like breath sounds Community acquired pneumonia- Rust colored sputum, with comorbidity Treat Levaquin if 65 or older, if a child amoxicillin (high dose). The organism that causes is Strep Pneumo