Practice Board Questions

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Hypothermia has been confirmed as a benefit following out of hospital arrest in 2 studies. These trials showed that rapidly cooling to 32-34⁰C and maintaining these temperatures for 12-24 hours decreased in-hospital mortality and patients were 40-85% more likely to have good neurologic outcomes upon hospital discharge. None of these medications have ever demonstrated any effects on neurologic outcomes and only defibrillation within 5 minutes has the greatest likelihood for good neurologic outcomes.

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This patient presents with a systolic murmur that varies with respiration. This makes it likely that the etiology is right sided, and given the location, pulmonary stenosis is more likely than tricuspid regurgitation. These right sided murmurs vary with respiration because filling of the right heart is influenced by changes in thoracic pressure.

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Administration if IV lorazepam should be followed by the administration of phenytoin (or fosphenytoin) to control status epilepticus because the duration of action of lorazepam is limited. Carbamazepine is an effective anticonvulsant, but it cannot be given IV or IM. IV pentobarbital can be used but because the patient is not currently convulsing, induction of barbiturate coma is not indicated. Ethosuximide is indicated for the treatment of absence but not generalized tonic-clonic seizures. Rectal diazepam is used to abort seizures temporarily, especially in children.

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Peritonsillar abscess, the most common deep infection of the head and neck that occurs in adults, is typically formed by a combination of aerobic and anaerobic bacteria. The presenting symptoms include fever, throat pain, and trismus. Ultrasonography and computed tomographic scanning are useful in confirming a diagnosis. Needle aspiration remains the gold standard for diagnosis and treatment of peritonsillar abscess. After performing aspiration, appropriate antibiotic therapy (including penicillin, clindamycin, cephalosporins, or metronidazole) must be initiated. Am Fam Physician. 2002 Jan 1;65(1):93-97.

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Two-dimensional and Doppler echocardiography is the imaging modality of choice to diagnose and determine the severity of aortic stenosis. http://emedicine.medscape.com/article/150638-workup.

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Serum iron is a test that measures how much iron is in your blood. Low serum iron suggests iron deficiency anemia. TIBC is usually higher-than-normal when the body’s iron stores are low. Higher-than-normal TIBC may mean: iron deficiency anemia.  Am J Med. 2008;121:943-948.

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The classic presentation of placenta previa is painless vaginal bleeding. This hemorrhage often stops spontaneously and then recurs with labor. Placenta previa often leads to preterm delivery, with 44% of pregnancies with placenta previa delivered before 37 weeks. Am J Perinatol. Jan 2011;28(1):45-50.

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Individuals suffering from hyperthyroidism exhibit different common symptoms like hair loss, heat intolerance and anxiety. Although patients can experience significant increase in appetite, the loss of weight is evident. Additional signs include fatigue, weakness and muscle aches that affect the entire body. Furthermore, patients can also experience apathy, irritability and hyperactivity. It is also quite common for patients to have polydipsia, polyuria as well as depression. Aside from sweating, they can also experience pretibial myxedema, tremor and delirium. Patients are more likely to have dyspnea or shortness of breath, arrhythmias and palpitations. These signs are also accompanied by diarrhea, vomiting, nausea and loss of libido. When left untreated, this condition can even lead to more health problems, one of which is osteoporosis. Patients with hyperthyroidism may also show some minor ocular symptoms. These include the lid-lag, extra-ocular muscle weakness and eyelid retraction, the last symptom of which is often referred to as the hypothyroid stare.

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The most commonly-prescribed class of drugs for panic disorders are the benzodiazepines (such as clonazepam, lorazepam, alprazolam). Copyright 2012 Mental Health Disorders.

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The sweat test has been the gold standard diagnostic test for CF for many years. The sweat test is a quick, non-invasive, painless test that measures the levels of sodium and chloride excreted in sweat.  Bilton, D (2008).Cystic fibrosis. Medicine. 36, 273-278.

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Low-grade fever, prolonged diarrhea with abdominal pain, weight loss, and generalized fatigability are usually reported in Crohn’s disease. The ulcerations of Crohn’s disease may appear aphthoid, but they could also be deep and serpiginous. Skip areas, a cobblestone appearance, pseudopolyps, and rectal sparing are characteristic findings. http://www.clevelandclinicmeded.com.

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The kidneys normally remove excess potassium from the body. Renal insufficiency can have high potassium levels when the kidneys are not working properly and are less able to get rid of potassium.  Seifter JL. Potassium disorders. In: Goldman L, Schafer, AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 119..

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Osteosarcoma is the most common cancerous (malignant) bone tumor in kids. Osteosarcoma tends to occur in the bones of the Knee, Shin (near the knee) or Thigh (near the knee). Lerner A, Antman KH. Primary and metastatic malignant bone lesions. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 208.

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Otitis externa is usually treated empirically with topical neomycin/polymyxin B/hydrocortisone. The predominant pathogens associated with this infection are Pseudomonas aeruginosa and Staphylococcus aureus. South Med J. 2004 May;97(5):465-71.

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The most recent scientific guideline statements from foundations and societies dealing with diabetes and kidney disease (renal disease) argue for blood pressure goals lower than 130/80 mm/HG. Curr Hypertens Rep. 2011 Dec;13(6):452-455.

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Symptoms of mono include fatigue, sore throat, swollen lymph nodes, and fever. Enlargement of the spleen and inflammation of the liver may also occur. More specific blood tests, such as the monospot and heterophile antibody tests, can confirm the diagnosis of mono. AM J Med 109.7(2000): 531.

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A woman may experience one or several of these symptoms of atrophic vaginitis, to varying degrees: vaginal dryness, pain during sex (dyspareunia), changes in appearance of the labia and vagina (it looks paler and thinner), irritation when wearing certain clothes such as tight jeans or when doing certain activities, an increase in urinary tract infections. MediLexicon, Intl., 20 May. 2010. Web.

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Hypertension is a common comorbidity in patients with diabetes, and adequate control of blood pressure significantly reduces the risk of macrovascular and microvascular complications. Patients with diabetes should achieve a target blood pressure of less than 130/80 mm Hg. The use of angiotensin-converting enzyme inhibitors may slow progression to kidney failure and cardiovascular mortality; these agents are the preferred therapy for managing coexisting diabetes and hypertension. Am Fam Physician.  2008  Dec  1; 78(11):1277-1282.

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Selective serotonin reuptake inhibitors (SSRIs) and venlafaxine are preferred to other antidepressants because of their positive profile as regards side effects. More specifically, the action of SSRIs involves: a) an increase in serotonin in the receptors; b) a reduction in platelet activation; and c) a restoration of heart rate variability. These drugs show a low anticholinergic effect and almost zero arrhythmogenesis. Hellenic J Cardiol 2010; 51: 142-152.

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Although the pneumonia affects the lungs, Legionnaires’ disease is accompanied by symptoms that affect other areas of the body. About half the victims experience diarrhea and a quarter have nausea and vomiting and abdominal pain. World of Microbiology and Immunology, ©2003 Gale Cengage.

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Factors that contribute to the development of reflux esophagitis include the caustic nature of the refluxate, the inability to clear the refluxate from the esophagus, the volume of gastric contents, and local mucosal protective functions. The main symptom of reflux esophagitis is heartburn, with or without regurgitation of gastric contents into the mouth, which worsens on bending over. Health Encyclopedia – Diseases and Conditions.

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Most patients present with unexplained hematuria (gross or microscopic). Some     patients present with anemia, and hematuria is detected during evaluation. Bladder cancer is suspected clinically. Urine cytology, which may detect malignant cells, may be done. Cystoscopy and biopsy of abnormal areas are usually also done initially because these tests are needed even if urine cytology is negative.  The Merck Manual.

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The epiphyses is the end of a long bone that is originally separated from the main bone by a  layer of cartilage but later becomes united to the main bone through ossification. This process results in an epiphyseal scar.  Farlex Medical Dictionary.

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Closed-angle glaucoma accounts for less than 10% of glaucoma cases in the United States, but as many as half of glaucoma cases in other nations (particularly Asian countries). About 10% of patients with closed angles present with acute angle closure crises characterized by sudden ocular pain, seeing halos around lights, red eye, very high intraocular pressure (>30 mmHg), nausea and vomiting, suddenly decreased vision, and a fixed, mid-dilated pupil. It is also associated with an oval pupil in some cases. Acute angle closure is an emergency.  Merck.com. Retrieved 2011-01-24 .

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This constellation of metabolic risk factors is strongly associated with type 2 diabetes mellitus or the risk for this condition. The metabolic risk factors consist of atherogenic dyslipidemia (elevated triglycerides and apolipoprotein B, numerous small LDL particles, and low HDL cholesterol [HDL-C] concentrations), elevated blood pressure, elevated plasma glucose, a prothrombotic state, and a proinflammatory state. December 2005 issue of Critical Pathways in Cardiology .

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The presence of Auer rods in myeloid blasts is considered a hallmark of acute myeloid leukemia. Low Blast Count Myeloid Disorders With Auer Rods, A Clinicopathologic Analysis of 9 CasesMonte S. Willis, MD, PhD,1 Robert W. McKenna, MD,1 LoAnn C. Peterson, MD,2James E. Coad, MD,3 and Steven H. Kroft, MD1 .

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In 2005, the US FDA listed paroxetine (Paxil) as pregnancy category D based on studies demonstrating increased risk of major congenital heart defects from first-trimester exposure. US Food and Drug Administration.. MedWatch safety alerts. Paroxetine HCl-Paxil and generic paroxetine. December 2005. http://www.fda.gov/Safety/MedWatch/ucm152062.htm. Accessed May 14, 2011.

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Somogyi effect is a rebound phenomenon occurring in diabetes: overtreatment with insulin induces hypoglycemia, which initiates the release of epinephrine, ACTH, glucagon, and growth hormone, which stimulate lipolysis, gluconeogenesis, and glycogenolysis, which, in turn, result in a rebound hyperglycemia. Farlex Medical Dictionary.

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Schizoid personality disorder (SPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness and apathy. Affected individuals may simultaneously demonstrate a rich, elaborate and exclusively internal fantasy world. Ball, Jeff. “Schizoid Personality Disorder”. Psychological Care & Healing Treatment Center. 12/18/2010.

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Asthma is predominantly a disease of inflammation with superimposed bronchospasm, leading to air trapping. As such, the normally resonant thorax becomes hyperresonant, reflecting the less dense quality of the air- filled thoracic tissue, and tactile fremitus is diminished. Additional asthma findings include prolonged expiration phase and hyperinflation reported on the chest x-ray. Prolonged inspiration phase of respiration is usually found in upper airway obstruction such as epiglottis or tonsillar abscess.  Tactile fremitus is typically increased when there is increased lung tissue density in conditions including pneumonia with consolidation.

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Signs and symptoms of esophageal cancer include: difficulty swallowing (dysphagia),weight loss without trying, chest pain/pressure/burning, fatigue, frequent choking while eating, indigestion, heartburn, coughing or hoarseness. http://www.mayoclinic.com/health/esophagealcancer/DS00500/DSECTION=symptoms.

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Nephrotic syndrome is characterized by high protein excretion, peripheral edema, and metabolic abnormalities. Proteinuria in nephrotic syndrome is due to increased permeability of the glomerular basement membrane to albumin and arises in response to alterations in both the size and charge barriers of the glomerular filtration apparatus. Albumin is the predominant protein excreted. Am Fam Physician – 15-NOV-2009; 80(10): 1129-34.

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Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet. As the disease progresses, symptoms often spread to the knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease. There is no one test or physical finding to confirm the diagnosis. Mayo Clinic; Ferri’s Clinical Advisor 2011.

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The standard first-line antibiotic treatment for acute uncomplicated bacterial sinusitis is a 10 – 14 day course of amoxicillin. http://www.umm.edu/patiented/articles/how_acute_sinusitis_treated_000062_8.htm#ixzz2DkIfrVoa.

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Respiratory sinus arrhythmia (RSA) is a naturally occurring variation in heart rate that occurs during a breathing cycle. Heart rate increases during inhalation and decreases during exhalation. A term frequently used to describe a normal heart rhythm in which the heart rate varies by more than 10 beats in a minute. equimedcorp.com/patient-resources/information/glossary/.

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A suspected case of Bacterial Meningitis when CSF examination shows at least one of the following: turbid appearance; leukocytosis (> 100 cells/mm3); leukocytosis (10-100 cells/ mm3) AND either an elevated protein (> 100 mg/dl) or decreased glucose (< 40 mg/dl)  World Health Organization:  http://www.who.int/en/.

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Breast tenderness is often the first sign of pregnancy for many women.  Quickening is defined as the first time you feel your baby move. Since your uterus puts pressure on your bladder most heavily in the third trimester, this means you’ll probably have to go to the bathroom more than you ever did before. www.babyzone.com; www.webmd.com.

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Constrictive pericarditis is most commonly caused by conditions or events that cause inflammation to develop around the heart, including heart surgery, radiation therapy and tuberculosis. A physical exam may show that your neck veins stick out, suggesting increased blood pressure in the area. This is called Kussmaul’s sign. The doctor may note weak or distant heart sounds when listening to your chest with a stethoscope. The physical exam may also reveal liver swelling and fluid in the belly area. Lower extremity edema is common.  Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap75.

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Scabies produces a skin rash composed of small red bumps and blisters and affects specific areas of the body. Scabies may involve the webs between the fingers, the wrists and the backs of the elbows, the knees, around the waist and umbilicus, the axillary folds, the areas around the nipples, the sides and backs of the feet, the genital area, and the buttocks. Textbook descriptions of scabies always mention “burrows” or “tunnels.” Medicine Net.Com 5% permethrin cream: This is the most common treatment for scabies. http://www.aad.org/skin-conditions/dermatology-a-to-z/scabies/diagnosis-treatment.

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While therapy with short bursts of high-dose parenteral steroids is a mainstay of hospital management of acute exacerbations, rapid dosage reduction to the lowest oral dosage possible for long-term management is necessary to minimize long-term side effects. Inhaled ipratropium bromide (Atrovent) and sympathomimetic agents are for most patients the mainstays of therapy to provide relief of bronchospasm. Sympathomimetic agents such as albuterol (Proventil, Ventolin) provide more rapid bronchodilation. Antibiotics are probably helpful only in acute exacerbations of chronic bronchitis. http://www.aafp.org/afp/1998/0515/p2365.html. Mucomyst is used to treat chronic bronchitis. Mucomyst contains the medicine N-acetylcysteine which thins or loosens mucus in the airways or breathing tubes, making it easier to cough up. http://www.patienthealthinternational.com/content/product/mucomyst 

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The symptoms of aortic aneurysm include: pain in the abdomen or back — severe, sudden, persistent, or constant. The pain may spread to the groin, buttocks, or legs. Symptoms include clammy skin, dizziness, nausea/vomiting, rapid heart rate and shock. Ann Intern Med. 2007; 146:735-741.

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Aortic valve stenosis signs and symptoms typically develop when narrowing of the valve is severe and can include: Chest pain (angina) or tightness; Feeling faint or fainting with exertion; Shortness of breath, especially with exertion; Fatigue, especially during times of increased activity; Heart palpitations and heart murmur. http://www.mayoclinic.com/health/aortic-valve-stenosis/DS00418/DSECTION=symptoms.

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Skin involvement in systemic sclerosis can include hair loss, calcium deposits, open sores, swelling, gangrene, changes in skin color, itching, small mouth, swollen or hardened skin on fingers or elsewhere, loss of skin folds  and dry skin. Telangiectasias may appear on the hands or face. Systemic scleroderma and Raynaud’s can cause painful ulcers on the fingers or toes, which are known as digital ulcers.  Sclero.org.

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Drusen are tiny yellow or white deposits in a layer of the retina called Bruchs membrane.  They are the most common early sign of dry age-related macular degeneration. Drusen are made up of lipids. http://www.amd.org/what-is-amd/dry-amd/119-drusen.html.

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Opening Snap of Mitral Valve Stenosis: You can hear the opening snap near the cardiac apex, but more easily appreciate it along the lower left sternal border. Tension in the mitral leaflets and delayed opening of the valve causes a high frequency opening snap in early diastole. The timing of the opening snap is important as it indicates the severity of the lesion.  texasheartinstitute.org and Auscultation.com.

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If weakness of a limb is associated with lower facial weakness on the same side, the problem is above the brainstem, while if there is weakness of muscles on one side of the head and opposite limb, then a lesion in the brainstem is suggested. Monrad-Krohn, G.H. and Refsum, S.: The Clinical Examination of the Nervous System, ed. 12, London, H.K. Lewis & Co.

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Polysomnography, also called a sleep study, is a test used to diagnose sleep disorders. Polysomnography records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study. Mayo Clinic.

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Acute attacks of MS are usually treated with glucocorticoids. Three to seven day courses of intravenous methylprednisolone, 500 to 1000 mg daily, with or without a short prednisone taper, are used most commonly. UpToDate.

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When pregnant women have been bitten by a black widow, it can result in contractions or early labor. According to the American Family Physician, pregnant women should be hospitalized for observation following a black widow bite for risk of threatened abortion. http://www.aafp.org/afp/2007/0315/p869.html.

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Nasal CPAP is the preferred treatment for all sleep disordered breathing including: snoring, upper airway resistance syndrome and obstructive sleep apnea. http://health.ucsd.edu/specialties/sleep/Pages/treatment.aspx.

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The antibiotics that most often lead to C. difficile infections include fluoroquinolones, cephalosporins, clindamycin and penicillins. www.mayoclinic.com/health/c-difficile.

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Over-stimulation of the parasympathetic nervous system can result in low blood pressure, slowed pulse and fatigue.  http://lifeforcetampa.com/Autonomic-Nervous-System.

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It may be hard to diagnose cauda equina syndrome. Symptoms vary and may come on slowly. They also mimic other conditions. Frequent symptoms include: Severe low back pain; pain, numbness, or weakness in one or both legs that causes you to stumble or have trouble getting up from a chair; loss of or altered sensations in your legs, buttocks, inner thighs, backs of your legs, or feet that is severe or gets worse and worse; you may experience this as trouble feeling anything in the areas of your body that would sit in a saddle (called saddle anesthesia); recent problem with bladder or bowel function, such as trouble eliminating urine or waste (retention) or trouble holding it (incontinence). http://www.webmd.com.

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Irritated skin often appears as a rash and skin sores that look like tiny curving tracks. These symptoms are a result of the mite tunneling under the upper layers of the skin. Symptoms are most likely to develop between the fingers and on the palm side of the wrists, on the outside surfaces of the elbows and in the armpits. Prescription permethrin, such as Elimite cream, is the most commonly used medicine to treat scabies.  http://www.webmd.com/skin-problems-and-treatments/tc/scabies.

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Beta blockers have many uses in medicine, chief among these is in the treatment of patients with coronary artery disease (CAD). The benefits provided by beta blockers have made them the drugs of first choice in treating patients with CAD. angina.http://heartdisease.about.com/od/coronaryarterydisease/a/betablockers.htm.

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Patients with middle cerebral artery (MCA) stroke syndrome may have some basic physical findings, as follows. Superior division infarcts lead to contralateral deficits with significant involvement of the upper extremity and face and partial sparing of the contralateral leg and foot. Inferior division infarcts of the dominant hemisphere lead to Wernicke aphasia. Such infarcts on either side yield a superior quadrantanopsia or homonymous hemianopia, depending on the extent of infarction. Right inferior branch infarcts also may lead to a left visual neglect. Finally, resultant temporal lobe damage can lead to an agitated and confused state. http://emedicine.medscape.com.

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Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has traveled from elsewhere in the body through the bloodstream (embolism). Treatment is typically with anticoagulant medication, including heparin and warfarin.  Harrison’s Principles of Internal Medicine (16th ed.). New York, NY: McGraw-Hill. pp. 1561–65..

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Do not take Treximet (generic Sumatriptan) if you are scheduled to have, or have recently undergone, heart bypass (CABG) surgery. http://www.pdrhealth.com. Some of the cardiovascular effects might be severe, including life endangering arrhythmias, Prinzmetal angina pectoris or myocardial infarction. Sumatriptan should not be used in patient with coronary artery disease. http://ic.steadyhealth.com/side_effects_of_sumatriptan.html.

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Ehlers-Danlos syndromes are a group of disorders which share common features including easy bruising, joint hypermobility (loose joints), skin that stretches easily (skin hyperelasticity or laxity), and weakness of tissues. http://www.medicinenet.com/ehlers-danlos_syndrome/article.htm.

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Based on the limited number of studies, dullness to percussion and tactile fremitus are the most useful findings for pleural effusion. Dull chest percussion makes the probability of a pleural effusion much more likely but requires a chest radiograph to confirm the diagnosis. When the pretest probability of pleural effusion is low, the absence of reduced tactile vocal fremitus makes pleural effusion less likely so that a chest radiograph might not be necessary depending on the overall clinical situation. JAMA. 2009 May 20; 301(19):1989.

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Risk factors for the formation of cholesterol gallstones include the following: female gender, being overweight, age > 40, losing a lot of weight quickly on a “crash” or starvation diet, or taking certain medications such as birth control pills or cholesterol lowering drugs. The most common symptom is pain in the right upper part of the abdomen. The pain usually starts within 30 minutes after a fatty or greasy meal. Ultrasound is the best test to examine the gallbladder for stones. http://emedicine.medscape.com/article/774352-overview.

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The hepatojugular reflux sign is useful in diagnosing right ventricular failure. Am J Med 2000 Jul;109(1):59-61.

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Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness. The pain and stiffness often occur in your shoulders, neck, upper arms and hips. Symptoms of polymyalgia rheumatica usually begin quickly, within two weeks. Most people who develop polymyalgia rheumatica are older than 65. It rarely affects people younger than 50. Anti-inflammatory drugs called corticosteroids improve the symptoms of polymyalgia rheumatica, but these drugs require careful monitoring for serious side effects. http://www.mayoclinic.com/health/polymyalgia-rheumatica/DS00441.

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Aspirin contains salicylate, and its effect of temporarily aggravating or causing tinnitus has been known about for many years. Salicylate is recognised as an ototoxic drug. It can induce reversible hearing loss and tinnitus, probably by its action on the outer hair cell system of the cochlea (inner ear). It sometimes causes side-effects such as ringing in the ears, nausea, stomach ache, dizziness, and sweating. You will only suffer permanent damage if you take fairly large doses for quite a long time. In most cases, tinnitus caused by aspirin disappears once you stop taking the aspirin. http://vestcollective.ca/aspirin-tinnitus.php.

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The first EKG sign of hyperkalemia is peaked T waves and usually appears once K level go around 6 meq/L. Emerg Med J 2002; 19:74-77.

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Benign paroxysmal positional vertigo is characterized by brief episodes of mild to intense dizziness. Symptoms of benign paroxysmal positional vertigo are triggered by specific changes in the position of your head, such as tipping your head up or down, and by lying down, turning over or sitting up in bed. You may also feel out of balance when standing or walking. To help relieve benign paroxysmal positional vertigo (BPPV), your doctor, audiologist or physical therapist may treat you with a series of movements known as the canalith repositioning procedure. http://www.mayoclinic.com/health/vertigo/DS00534.

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Elevated serum luteinizing hormone - The emphasis doctors place on the ratio of luteinizing hormone (LH) to follicle stimulating hormone (FSH) varies. Most pre-menopausal women have a ratio close to 1:1. In PCOS, the LH level may rise above the FSH, sometimes significantly. Any case where the LH is higher may be suggestive of PCOS and further investigation may be warranted. Some doctors say that an LH:FSH greater than 2:1 or 3:1 indicates PCOS. http://www.inciid.org/faq.php?cat=infertility101&id=2#80.

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Avoid pregnancy - In pregnant women, ACE inhibitors taken during the first trimester have been reported to cause major congenital malformations, stillbirths, and neonatal deaths. Laurence L. Brunton, ed. (2006). “Chapter 30. Renin and Angiotensin – Edwin K. Jackson”. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. McGraw-Hill.

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A lipoma is a slow-growing, fatty lump that’s most often situated between your skin and the underlying muscle layer. Often a lipoma is easy to identify because it moves readily with slight finger pressure. It’s doughy to touch and usually not tender. You may have more than one lipoma. Lipomas can occur at any age, but they’re most often detected during middle age. http://www.mayoclinic.com/health/lipoma/DS00634.

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Squamous cell carcinoma (SCC) of the lung is more common in men than in women. It is closely correlated with a history of tobacco smoking, more so than most other types of lung cancers. It most often arises centrally in larger bronchi, and while it often metastasizes to locoregional lymph nodes (particularly the hilar nodes) early in its course, it generally disseminates outside the thorax somewhat later than other major types of lung cancer. Tobacco Control 17 (3): 198–204.

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Barrett esophagus refers to an abnormal change (metaplasia) in the cells of the inferior portion of the esophagus. A positive diagnosis generally requires observing specific macroscopic and microscopic changes. The normal squamous epithelium lining of the esophagus is replaced by metaplastic columnar and goblet cells. Columnar epithelium refers to a cell type that is typically found in more distal parts of the gastrointestinal system. Only the presence of goblet cells equates a diagnosis of Barrett esophagus. Dysphagia 8 (3): 276–88.

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Orthostatic hypotension is a condition of abnormal blood pressure regulation upon standing. The blood pressure dramatically decreases, more than 20/10 mm Hg, when rising from a lying down or sitting position to a standing position.Orthostatic hypotension has several causes. Hypovolemia is the most common cause. http://www.bidmc.org/YourHealth/ConditionsAZ.aspx?ChunkID=34315.

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It’s important to have liver function blood tests every 8 to 12 weeks to look for any liver-related side effects. Methotrexate can cause abnormal liver function. It’s important to routinely have blood drawn for liver panels so your doctor can monitor for unwanted side effects. Methotrexate – 10 Things You Should Know; Methotrexate Safety Decreases Unwanted Side Effects By Carol Eustice, About.com.

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Because hypertension can cause damage to the blood vessels in the eyes, the eyes may be checked with an instrument called an ophthalmoscope. The physician will look for thickening, narrowing, or hemorrhages in the blood vessels. http://medical-dictionary.thefreedictionary.com/hypertension.

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The main symptom of pleurisy is pain in the chest. This pain often occurs when you take a deep breath in or out, or cough. Some people feel the pain in the shoulder. Deep breathing, coughing, and chest movement makes the pain worse. When you have pleurisy, the normally smooth surfaces lining the lung (the pleura) become rough. They rub together with each breath, and may produce a rough, grating sound called a “friction rub.” Your health care provider can hear this sound with the stethoscope, or by placing an ear against your chest.Viral infections normally run their course without medications. Patients often can control the pain of pleurisy with acetaminophen or anti-inflammatory drugs such as ibuprofen. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002347/

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Hypertrophic cardiomyopathy: Most cases have a genetic origin, caused by a number of possible  genotypic abnormalities. A variant form of the gene encoding the β-cardiac myosin heavy chain is the most commonly identified cause. Certain mutations may be associated with an increased risk of sudden death. Dilated cardiomyopathy is associated with HIV.   Am J Med - 01-AUG-2008; 121(8): 674-81.

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There is an increased chance of ectopic pregnancy (including tubal and ovarian sites) in women who conceive following CLOMID therapy. products.sanofi.ca/en/clomid.pdf.

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Major clinical signs of thyrotoxicosis  include weight loss (often accompanied by an increased appetite), anxiety, intolerance to heat, hair loss, muscle aches, weakness, fatigue, hyperactivity, irritability, hypoglycemia, apathy, polyuria, polydipsia, delirium, tremor, pretibial myxedema, and sweating. In addition, patients may present with a variety of symptoms such as palpitations and arrhythmias (the notable ones being atrial fibrillation), shortness of breath (dyspnea), loss of libido, amenorrhoea, nausea, vomiting, diarrhea, gynaecomastia and feminization. “Gynaecomastia as a presenting feature of thyrotoxicosis”. Postgrad Med J. 882 (75): 229–31.

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Bipolar symptoms include: euphoria or irritability, excessive talk; racing thoughts, inflated self-esteem, unusual energy; less need for sleep, impulsiveness, a reckless pursuit of gratification (shopping sprees, impetuous travel, more and sometimes promiscuous sex, high-risk business investments, fast driving). WebMD.com/bipolar.

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The most common signs and symptoms of bronchiectasis include: A cough which occurs daily for months, or even years; the cough may get worse when lying on one side; enormous amounts of sputum (phlegm, spit) are produced daily. This is coughed up and spat out. The sputum may contain mucus, trapped particles, and even pus; the sputum may be foul-smelling; wheezing; shortness of breath; clubbing – the flesh under the fingernails and toenails become thicker. The nails curve downward and are shaped like the round part of an upside-down spoon; abnormal lung sounds (when listened to with a stethoscope). http://www.medicalnewstoday.com/releases/185765.php.

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Patients with familial adenomatous polyposis coli (FAP) experience the growth of hundreds to thousands of polyps (an abnormal mushroom-shaped growth of tissue) in the lower intestine (including the colon and rectum). Growth of polyps may be seen in a patient’s upper intestine as well. The number of polyps usually increases with age and they typically grow from 1-2 to 4-5 millimeters in size. Brosens LA, Keller JJ, Offerhaus GJ, et al. Prevention and management of duodenal polyps in familial adenomatous polyposis. Gut. 2005 Jul;54(7):1034-43..

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Indications for Nephrology referral for CKD include; Acute, complex or severe cardiovascular disease, Anemia of CKD, Bone and mineral disorder of CKD, Difficult to manage adverse effects of medications, Hyperkalemia (> 5.5 despite treatment), Refractory proteinuria, resistant hypertension, Stage 4 CKD or unexplained decrease in estimated GFR (>30% over 4 months) National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. AM J Kidney Dis. 2002;39(2 suppl 1):S1-S266.

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A sprain is a stretching or tearing of ligaments — the tough bands of fibrous tissue that connect one bone to another in your joints. The most common location for a sprain is in your ankle.  http://www.mayoclinic.com/health/sprains-and-strains/DS00343.

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Recurrent laryngeal nerves innervate the vocal cords and if injured would cause hoarseness.

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Streptococcus viridans.

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Hemolytic anemia involves the following: Abnormal and accelerated destruction of red cells, increased breakdown of hemoglobin resulting in increased bilirubin and hyperplasia with accelerated production of red cells, reflected by reticulocytosis, and slight macrocytosis in peripheral blood anemias.  Current Medical Diagnosis and Treatment 2009 By Stephen J. McPhee, Maxine A. Papadakis page (436).

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Molar pregnancies usually present with painless vaginal bleeding.  The uterus may be larger than expected, or the ovaries may be enlarged. There may also be more vomiting than would be expected. The diagnosis is strongly suggested by ultrasound, but definitive diagnosis requires histopathological examination. On ultrasound, the mole resembles a bunch of grapes (“cluster of grapes” or “honeycombed uterus” or “snow-storm).  Aust N Z J Obstet Gynaecol 23 (2)103–7..

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Hypothyroidism signs and symptom may include: fatigue, increased sensitivity to cold, constipation, dry skin, unexplained weight gain (not weight loss) , heavier than normal or irregular menstrual periods, thinning hair, slowed heart rate and depression. http://www.mayoclinic.com/health/hypothyroidism/DS00353/DSECTION=symptoms.

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Buproprion (Wellbutrin) is contraindicated for treatment of anorexia nervosa because it may exacerbate the anorexic condition and lower the seizure threshold for patients with anorexia..

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Croup may be caused by: viral infection (most common); bacterial infection; allergies; breathing in something that irritates your airway; acid reflux   http://www.nlm.nih.gov/medlineplus/ency/article/000959.htm.

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Iliopsoas sign is right lower-quadrant pain that is produced with either the passive extension of the patient’s right hip (patient lying on left side, with knee in flexion) or by the patient’s active flexion of the right hip while supine. The pain elicited is due to inflammation of the peritoneum overlying the iliopsoas muscles and inflammation of the psoas muscles themselves. Straightening out the leg causes pain because it stretches these muscles, while flexing the hip activates the Iliopsoas and therefore also causes pain. A positive Iliopsoas sign is an indication of appendicitis.  Am J Med Sci (92): 321–46.

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Psychological factors are responsible for about 20% of all cases of erectile dysfunction.  In some cases, the psychological effects of ED may stem from childhood abuse or sexual trauma. However, the most common psychological causes of ED include: stress, anxiety, depression, indifference and low self-esteem.  WebMD.

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The sore points over the body are noticeable in specific areas, such as on the outer side of the elbows, top of the shoulders, upper part of the front of the chest, inner side of the knees, etc. For a definitive diagnosis to be made, many experts say there should be at least eight tender sites present on the body.  Amitriptyline and Fluoxetine are two commonly prescribed medications in fibromyalgia. Amitriptyline must be started at a low dose and slowly built up to the required level.  http://www.netdoctor.co.uk/diseases/facts/fibromyalgia.htm#ixzz2IY8j9Hle.

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Common causes of conductive hearing loss are cerumen impaction and otitis externa. Merck Manual.

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Niacin frequently causes flushing, itching and tingling about 20 minutes after swallowing it. Some doctors suggest taking a low-dose aspirin 30 minutes before niacin to diminish the hot flashes. http://www.peoplespharmacy.com/2012/04/09/niacin-side-effects-hot-flashes-are-nasty/.

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Erythema chronicum migrans refers to the rash often (though not always) seen in the early stage of Lyme disease. It can appear anywhere from one day to one month after a tick bite. This rash does not represent an allergic reaction to the bite, but rather an actual skin infection with the Lyme bacteria, Borrelia burgdorferi sensu lato. . “The clinical assessment, treatment, and prevention of Lyme disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America”. Clin. Infect. Dis. 43 (9): 1089–134.

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The single most common cause of secondary amenorrhea in reproductive age group women is pregnancy.  McIver B, Romanski SA, Nippoldt TB Evaluation and Management of Amenorrhea, Mayo Clinic Proc 1997; 72: 1161-1169..

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The primary cause of gangrene is reduced blood supply to the affected tissues, which results in cell death. Diabetes and long-term smoking increase the risk of suffering from gangrene. “Gangrene – Causes”. NHS Health A–Z. National Health Service.

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St. John’s wort increases a brain chemical called serotonin. Some medications for depression also increase the brain chemical serotonin. Taking St. John’s wort along with these medications for depression might increase serotonin too much and cause serious side effects including heart problems, shivering, and anxiety. Do not take St. John’s wort if you are taking medications for depression. http://www.webmd.com.

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The highest incidence of post-operative complications is between 1 and 3 days after the operation. However, specific complications occur in the following distinct temporal patterns: early post-operative, several days after the operation, throughout the post-operative period, and in the late post-operative period. General post-operative complication occurring immediately: Primary hemorrhage, basal atelectasis: minor lung collapse, hock: blood loss, acute myocardial infarction, pulmonary embolism or septicemia and low urine output: inadequate fluid replacement intra- and post-operatively.  Arch Surg. 2003 Jun;138(6):596-602.

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The stomach absorbs mainly alcohol and some drugs. The small intestine is broken into three sections; the duodenum, jejunum, and ilium respectively. the duodenum absorbs primarily calcium, magnesium, iron, fat-soluble vitamins, and some glucose. The jejunum absorbs fat, sucrose, glucose, lactose, fat-soluble vitamins A & D, water-soluble vitamins B, and certain Proteins and amino acids. the Ilium absorbs water-soluble vitamins like folic acid and B 12. The large intestine absorbs water, potassium, and sodium chloride. wiki.answers.com.

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Testicular torsion has a classic doughnut sign on nuclear medicine testicular scan due to increased uptake of tracer surrounding a photpenic testicle..

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Acute osteomyelitis is the clinical term for a new infection in bone. This infection occurs predominantly in children and is often seeded hematogenously. In adults, osteomyelitis is usually a subacute or chronic infection that develops secondary to an open injury to bone and surrounding soft tissue. The specific organism isolated in bacterial osteomyelitis is often associated with the age of the patient or a common clinical scenario (i.e., trauma or recent surgery). Staphylococcus aureus is implicated in most patients with acute hematogenous osteomyelitis. Am Fam Physician. 2001 Jun 15;63(12):2413-2421..

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Anterior nosebleeds make up more than 90% of all nosebleeds. The bleeding usually originates from a blood vessel on the nasal septum, where a network of vessels converge (Kiesselbach plexus). http://www.emedicinehealth.com/nosebleeds/article_em.htm.

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Increased left ventricular afterload - Thyroid hormone has important effects on cardiac muscle, the peripheral circulation, and the sympathetic nervous system that alter cardiovascular hemodynamics in a predictable way in patients with hyperthyroidism. The main changes are: increases in heart rate, cardiac contractility, systolic and mean pulmonary artery pressure, cardiac output, diastolic relaxation, and myocardial oxygen consumption and reductions in systemic vascular resistance and diastolic pressure. http://www.uptodate.com/contents/cardiovascular-effects-of-hyperthyroidism

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XII - The vitamin K – dependent coagulation proteins are synthesized in the liver and comprise factors II, VII, IX, and X, which have a haemostatic role (i.e., they are procoagulants that arrest and prevent bleeding), and proteins C and S, which have an anticoagulant role (i.e., they inhibit the clotting process).  http://www.fao.org  

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All of the above - If inadequately treated, HG can cause dehydration causing ketosis, renal failure, central pontine myelinolysis, coagulopathy, atrophy, Mallory–Weiss syndrome, hypoglycemia, liver damage with jaundice, malnutrition, Wernicke’s encephalopathy, pneumomediastinum, rhabdomyolysis, deconditioning, deep vein thrombosis, pulmonary embolism, splenic avulsion, and vasospasms of cerebral arteries. Depression is a common secondary complication of HG. Obstet Gynecol. 107 (2 Pt 1): 285–92

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Addisonian crisis, also commonly referred to as adrenal crisis, occurs when the cortisol produced by the adrenal glands is insufficient to meet the body’s acute needs. Hyponatremia occurs in both primary and secondary adrenal insufficiency, although it has different causes.  QJM 2000;93:323–33. [PubMed]

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Side effects of cyclic antidepressants vary somewhat from medication to medication. They can include: Drowsiness, Dry mouth, Blurred vision, Constipation, Urinary retention, Dizziness, Delayed orgasm and low sex drive, particularly in men, Increased heart rate, Disorientation or confusion, Low blood pressure, which can cause lightheadedness, Increased appetite, Fatigue, Headache, Light sensitivity and seizures. http://www.mayoclinic.com[/toggle]

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Continuous Positive Airflow Pressure (CPAP) is the most common treatment for moderate to severe obstructive sleep apnea. http://www.helpguide.org/life/sleep_apnea.htm

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People in good health don’t usually get sick from C. difficile. Your intestines contain millions of bacteria, many of which help protect your body from infection. But when you take an antibiotic to treat an infection, the drug can destroy some of the normal, helpful bacteria as well as the bacteria causing the illness. Without enough healthy bacteria, C. difficile can quickly grow out of control. The antibiotics that most often lead to C. difficile infections include fluoroquinolones, cephalosporins, clindamycin and penicillins.                               http://www.mayoclinic.com/health/c-difficile/DS00736/DSECTION=causes

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Kidney stones also restrict the flow of fluid in the urinary tract. However, taking Flomax can assist in passing stones because when it relaxes the smooth muscle, water can pass through more easily. This may reduce the pain of passing kidney stones and speed up their exit from the body. http://www.ehow.com/how-does_4967565_flomax-work-kidney-stones_.html

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A 24-hour urine uric acid collection may help distinguish overproduction from underexcretion (>800 mg of uric acid/24 hours indicates overproduction). This information determines medical treatmen of recurrent gout attacks.  Kidney Int. 2001;60:266-271.

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The three main etiologies of neonatal conjunctivitis include: • Chemical • Bacterial (C. trachomatis most common) • Viral Chlamydia trachomatis presentation may range from mild hyperemia with scant mucoid discharge to eyelid swelling, chemosis, and pseudomembrane formation. Ophthalmic Epidemiol. 2009 Nov-Dec;16(6):337-45.

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The most common causes of mitral regurgitation in the United States are myxomatous degeneration, chordal rupture, rheumatic heart disease, infective endocarditis, coronary artery disease, and cardiomyopathy. http://www.clevelandclinicmeded.com.

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In the United States, Lyme disease is caused by the bacterium Borrelia burgdorferi, which is carried primarily by deer ticks. http://www.mayoclinic.com.

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Early symptoms of PCOS include: Few or no menstrual periods. This can range from less than nine menstrual cycles in a year (more than 35 days between cycles) to no menstrual periods. Some women with PCOS have regular periods but are not ovulating every month; Heavy, irregular vaginal bleeding; Hair loss from the scalp and hair growth (hirsutism) on the face, chest, back,stomach, thumbs, or toes; Acne and oily skin, caused by high androgen levels; Depression or mood swings; Weight gain or upper body obesity. This is linked to high androgen levels.  WebMD.

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Tophus is a Latin word means „stone”, in plural is called tophi is a deposit of monosodium urate crystals in people with longstanding high levels of uric acid in the blood. Tophi are most commonly seen in conjunction with the disease of gout, and most people with tophi have already developed gouty symptoms previously. Even though tophi are most commonly found as hard nodules around the fingers, at the tips of the elbows, and around the big toe, tophi nodules can appear anywhere in the body. They have been reported in unexpected areas such as in the ears, vocal cords, or around the spinal cord. http://www.odermatol.com.

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People with paranoid personality disorder are highly suspicious of other people. As a result, people with this condition severely limit their social lives. They often feel that they are in danger, and look for evidence to support their suspicions. People with this disorder have trouble seeing that their distrustfulness is out of proportion to their environment. Common symptoms include:
Concern that other people have hidden motives
Expectation that they will be exploited by others
Inability to work together with others
Social isolation
Detachment
Hostility PubMed

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Symptoms of small cell lung cancer can include:
Persistent cough
Coughing up blood (hemoptysis)
Swelling in the face and neck
Shortness of breath
Wheezing
Repeated episodes of pneumonia or bronchitis
Hoarseness
Fatigue
Unexplained weight loss Clubbing (rounding) of the fingernails; Lung tumors, especially small cell carcinoma, produce SIADH  ectopically.  http://www.ncbi.nlm.nih.gov.

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Malabsorption syndrome refers to a number of disorders in which nutrients from food are not absorbed properly in the small intestine. Malabsorption causes diarrhea, weight loss, and bulky, greasy, extremely foul-smelling stools.  Merck Manual.

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Outpatient oral antibiotic therapy with a fluoroquinolone is successful in most patients with mild uncomplicated pyelonephritis. http://www.aafp.org.

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Rickets is a disorder caused by a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones.   PubMed.

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Vasomotor rhinitis is characterized by prominent symptoms of nasal obstruction, rhinorrhea, and congestion. These symptoms are excessive at times and are exacerbated by certain odors (e.g., perfumes, cigarette smoke, paint fumes, inks); alcohol; spicy foods; emotions; and environmental factors such as temperature, barometric pressure changes, and bright lights. Patients with vasomotor rhinitis are further divided into two subgroups: “runners,” who demonstrate “wet” rhinorrhea; and “dry” patients, who exhibit nasal obstruction and airflow resistance with minimal rhinorrhea. http://www.aafp.org.

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Secondary hypertension (secondary high blood pressure) is high blood pressure that’s caused by another medical condition. Secondary hypertension differs from the usual type of high blood pressure (essential hypertension), which is often referred to simply as high blood pressure. Essential hypertension, also known as primary hypertension, has no clear cause and is thought to be linked to genetics, poor diet, lack of exercise and obesity. http://www.mayoclinic.com.

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Basophilic stippling of red blood cells (BSC) has been noted in lead intoxication since 1899 and has been considered a classic laboratory sign of lead poisoning since that time. http://www.ncbi.nlm.nih.gov.

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Gravid – the number of times a woman’s been pregnant Parity, or births Divided into 4 parts TPAL = term, preterm, abortions, living children ex: G3P1112 could indicate a woman has been pregnant 3 times, had 1 term birth, 1 preterm birth (or miscarriage), 1 abortion, and has 2 living children. tricky ex: G2P1002 could indicate a woman has been pregnant twice (and is currently pregnant), has given birth once to twins at term, and has 2 living children http://www.ohsubooks.com/objectives/index.php?title=Examining_the_Obstetrical_Patient#Links_.26_References.

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Acromegaly is a long-term condition in which there is too much growth hormone and the body tissues get larger over time. Acromegaly occurs in about 6 of every 100,000 adults. It is caused by abnormal production of growth hormone after the skeleton and other organs finish growing. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001364/.

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Haloperidol is noted for its strong early and late extrapyramidal side effects. The risk of the face-disfiguring tardive dyskinesia is around 4% per year in younger patients. Other predisposing factors may be female gender, pre-existing affective disorder, and cerebral dysfunction. Akathisia often manifests itself with anxiety, dysphoria, and an inability to remain motionless. Other side effects include dry mouth, lethargy, restlessness of akathisia, muscle stiffness or cramping, restlessness, tremors, Rabbit syndrome, and weight gain; side effects like these are more likely to occur when the drug is given in high doses and/or during long-term treatment.  The American Journal of Psychiatry 156 (6): 885–90.

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Anaphylaxis is an acute and potentially lethal multi-system allergic reaction. Most consensus guidelines for the past 30 years have held that epinephrine is the drug of choice and the first drug that should be administered in acute anaphylaxis. http://www.ncbi.nlm.nih.gov/pubmed/18691308.

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Computed tomography scan with an oral contrast agent. 

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Red blood cells may stick together and form red blood cell casts. Such casts are indicative of glomerulonephritis, with leakage of RBC’s from glomeruli, or severe tubular damage. http://library.med.utah.edu.

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Heberden’s nodes are hard or bony swellings that can develop in the distal interphalangeal joints (DIP). They are a sign of osteoarthritis and are caused by formation of osteophytes of the articular cartilage in response to repeated trauma at the joint. http://www.whonamedit.com/synd.cfm/37.html.

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Antibiotic regimens for dental procedures status post prosthetic hip replacement include Amoxicillin. If patient is allergic to Penicillins or Ampicillin utilize Cephalexin or Clindamycin. aapd.org.

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Nitrates or beta blockers are usually preferred for initial treatment of angina, and calcium channel blockers may be added if needed. http://www.uptodate.com/contents/angina-treatment-medical-therapy-beyond-the-basics.

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Colleges want to know that their students have been vaccinated against the basics – diptheria, tetanus, measles, mumps and rubella. But increasingly, they want to know that their students have been innoculated against bacterial meningitis too.  About.com.

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Early syphilis causes a mouth or genital ulcer (chancre). This is the hallmark symptom of the first stage. Later stages of syphilis can cause hair loss, headaches, sore throat, and skin rash. Eventually, syphilis can lead to heart and brain damage. http://www.medicinenet.com/syphilis_in_women/article.htm.

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Captopril has been assigned to pregnancy category D by the FDA for use in the second and third trimesters and to pregnancy category C for use in the first trimester. Animal and human data have revealed evidence of embryolethality and teratogenicity associated with ACE inhibitors. There are no controlled data in human pregnancy. Congenital malformations have been reported with the use of ACE inhibitors during the first trimester of pregnancy, while fetal and neonatal toxicity, death, and congenital anomalies have been reported with the use of ACE inhibitors during the second and third trimesters of pregnancy. If the patient becomes pregnant, captopril should be discontinued as soon as possible. Captopril is considered contraindicated during pregnancy.  drugs.com/pregnancy/captopril.

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Candida infection of the skin occurs mostly under pendulous breasts and pannus and in the perineum. The erythematous, pruritic, frequently pustular lesions have a distinct border; smaller satellite lesions provide a clue to the diagnosis of candidiasis.

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Similar problems may also be due to invasion of the nerve by a tumor or after trauma to the neck. A common scenario is paralysis of the left vocal cord due to malignant tumor in the mediastinum affecting the left recurrent laryngeal nerve. The left cord returns to midline where it stays. If the damage is unilateral, the patient may present with voice changes including hoarseness. Schwartz’s Principles of Surgery (9th ed.). McGraw Hill Professional. pp. 1346–1347..

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Staphylococcal food poisoning is an illness of the bowels that causes nausea, vomiting, diarrhea, and dehydration. It is caused by eating foods contaminated with toxins produced by Staphylococcus aureus rather than a true infection with the bacteria. Symptoms usually develop within one to six hours after eating contaminated food. The illness usually lasts for one to three days and resolves on its own. Patients with this illness are not contagious since toxins are not transmitted from one person to another. http://www.medicinenet.com/staph_infection/page2.htm.

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Decreased - During systole, intramuscular blood vessels are compressed and twisted by the contracting heart muscle and blood flow to the left ventricle is at its lowest.  http://ceaccp.oxfordjournals.org/content/5/2/61.full.

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Polymyositis typically affects the muscles closest to the trunk, particularly those in your hips, thighs, shoulders, upper arms and neck. The weakness is symmetrical, meaning it involves muscles on both the left and right sides of your body. The disease worsens over time. As muscle weakness progresses, you might find it difficult to climb stairs, rise from a seated position, lift objects or reach overhead. http://www.mayoclinic.com/health/polymyositis/DS00334/DSECTION=symptoms.

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Hydration, vaporizer, nasal decongestants - Nasal irrigation may help with symptoms of sinus pressure. Decongestant nasal sprays containing for example oxymetazoline may provide relief, but these medications should not be used for more than the recommended period. Longer use may cause rebound sinusitis. Other recommendations include applying a warm, moist cloth to the affected areas several times a day; drinking sufficient fluids in order to thin the mucus; and inhaling low temperature steam two to four times a day. “Sinusitis”. A.D.A.M. Medical Encyclopedia. U.S..

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Recent regulatory and clinical concerns have brought into sharp focus antipsychotic drug-induced QTc interval prolongation, torsades de pointes, and sudden cardiac death. Several new generation (atypical) antipsychotic drugs have either been withdrawn from clinical use or delayed in reaching the marketplace due to these concerns. Because torsades de pointes is rarely found, QTc interval prolongation serves as a surrogate marker for this potentially life-threatening arrhythmia. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC419299/.

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All the above - When the Babinski reflex is present in a child older than 2 years or in an adult, it is often a sign of a brain or nervous system disorder. Disorders may include: Amyotrophic lateral sclerosis, Brain tumor, Meningitis, Multiple sclerosis, Spinal cord injury, defect, or tumor and Stroke. http://www.nlm.nih.gov/medlineplus/ency/article/003294.htm.

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Dec O2, Inc CO2, Dec pH - When a patient stops breathing, they are unable to breath in Oxygen and breath off CO2.  Because CO2 is an acid, this will cause the pH to decrease.   .http://www.globalrph.com/abg_analysis.htm.

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Reye’s syndrome is a potentially fatal disease that has numerous detrimental effects to many organs, especially the brain and liver. The disease causes fatty liver with minimal inflammation and severe encephalopathy. “Reye syndrome” at Dorland’s Medical Dictionary.

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Superficial spreading melanoma is by far the most common type, accounting for about 70 percent of all cases. This is the one most often seen in young people. As the name suggests, this melanoma grows along the top layer of the skin for a fairly long time before penetrating more deeply. http://www.skincancer.org/skin-cancer-information/melanoma/types-of-melanoma.

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One pleural effusions accumulate 300 ml of fluid, there are usually detectable clinical signs in the patient, such as decreased movement of the chest on the affected side, stony dullness to percussion over the fluid, diminished breath sounds on the affected side, decreased vocal resonance and fremitus (though this is an inconsistent and unreliable sign), and pleural friction rub. “Does this patient have a pleural effusion?”. JAMA 301 (3): 309–17.

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Generally, a person is considered to be constipated when bowel movements result in passage of small amounts of hard, dry stool, usually fewer than three times a week, but this is only a very approximate standard.  Ariahealth.org.

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Hemoptysis - Common anxiety signs and symptoms include: feeling apprehensive, feeling powerless, having a sense of impending danger, panic or doom, having an increased heart rate, hyperventilation, sweating, trembling and feeling weak or tired.  mayoclinic.com.

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In the hand, osteoarthritis most often develops in three sites: at the base of the thumb, where the thumb and wrist come together (the trapezio-metacarpal, or basilar, joint), at the end joint closest to the finger tip (the distal interphalangeal or DIP joint) and at the middle joint of a finger (the proximal interphalangeal or PIP joint). http://www.assh.org/Public/HandConditions/Pages/ArthritisOsteoarthritis.aspx.

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Pityriasis rosea typically begins with a large, slightly raised, scaly patch “herald patch” on your back, chest or abdomen. Before the herald patch appears, some people experience a sore throat or fever. A few days to a few weeks after the herald patch appears, you may notice smaller scaly spots across your back, chest or abdomen that resemble a pine-tree pattern. The rash can cause itching, which is occasionally severe. http://www.mayoclinic.com/health/pityriasis-rosea/DS00720/DSECTION=symptoms.

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Hyperuricemia is a relatively common finding in patients treated with a loop or thiazide diuretic and may, over a period of time, lead to gouty arthritis. http://www.uptodate.com/contents/diuretic-induced-hyperuricemia-and-gout.

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L5 radiculopathy is the most common radiculopathy affecting the lumbosacral spine. It often presents with back pain that radiates down the lateral aspect of the leg into the foot. On examination, strength can be reduced in foot dorsiflexion, toe extension, foot inversion, and foot eversion. http://www.physiologie.uni-mainz.de/physio/mittmann/ThalFallZ3.pdf

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Chronic bronchitis is defined by how long a person has a cough with daily phlegm production. It involves a frequent cough that persists for more than two years and, for at least three continuous months, produces phlegm. The most common cause of chronic bronchitis is smoking. http://www.mayoclinic.org/medical-edge-newspaper-2011/apr-15b.html.

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All forms of Guillain–Barré syndrome are autoimmune diseases, due to an immune response to foreign antigens (such as infectious agents) that is mistargeted at host nerve tissues instead, a phenomenon called molecular mimicry. The most common antecedent infection is the bacterium Campylobacter jejuni followed by cytomegalovirus.

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Atopic dermatitis is a chronic disease with periods of remissions and exacerbations. Hypopigmentation and hyperpigmentation can occur, which can cause great anxiety in parents. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/atopic-dermatitis/

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Alpha 1-antitrypsin deficiency (α1-antitrypsin deficiency, A1AD) is a genetic disorder that causes defective production of alpha 1-antitrypsin (A1AT), leading to decreased A1AT activity in the blood and lungs, and deposition of excessive abnormal A1AT protein in liver cells. Severe A1AT deficiency causes panacinar emphysema or COPD in adult life in many people with the condition. “Alpha1-antitrypsin deficiency”. Lancet 365 (9478): 2225–36.

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Prolapsed Hemorrhoid Treatment is typically handled surgically because of the inherent severity of the condition and the nature of its symptoms. In such cases, where the hemorrhoid has externalized, a Hemorroidectomy may be performed. The procedure consists of surgically excising, or removing, the hemorrhoid, and is noted for the long duration of its recovery time and the severity of pain that accompanies it. http://www.hemorrhoidinformationcenter.com/prolapsed-hemorrhoids-symptoms-and-treatment/

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Signs of classical cardiac tamponade include three signs, known as Beck’s triad. Hypotension occurs because of decreased stroke volume, jugular-venous distension due to impaired venous return to the heart, and muffled heart sounds due to fluid inside the pericardium. Other signs of tamponade include pulsus paradoxus (a drop of at least 10mmHg in arterial blood pressure on inspiration), and ST segment changes on the electrocardiogram, which may also show low voltage QRS complexes, decreased urine output, as well as general signs & symptoms of shock (such as tachycardia, breathlessness and decreasing level of consciousness). “Cardiac Tamponade Treatment & Management”. Medscape

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The ESR is increased by any cause or focus of inflammation. The ESR is increased in pregnancy, inflammation, anemia or rheumatoid arthritis, and decreased in polycythemia, sickle cell anemia, hereditary spherocytosis, and congestive heart failure. It may be increased in kidney cancer. http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm

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Leukoplakia is a condition where areas of keratosis appear as adherent white patches on the mucous membranes of the oral cavity. www.mayoclinic.com

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In many cases, a bicuspid aortic valve will cause no problems. However BAV may become calcified later in life, which may lead to varying degrees of severity of aortic stenosis that will manifest murmurs. If the leaflets do not close correctly, aortic regurgitation can occur. If these become severe enough, they may require heart surgery. People with BAV may become tired more easily than those with normal valvular function and have difficulty maintaining stamina for cardio-intensive activities-due to poor heart performance. The heart is put under more stress in order to either pump more blood through a stenotic valve or attempt to circulate regurgitation blood through a leaking valve. J Am Coll Cardiol. 44 (1): 138–143

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If a physical exam is done during a cluster attack, the exam will usually reveal Horner syndrome (one-sided eyelid drooping or a small pupil). These symptoms will not be present at other times. No other nervous system (neurological) changes will be seen. http://www.nlm.nih.gov/medlineplus/ency/article/000786.htm

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Placental abruption is most likely in the last 12 weeks before birth. Classic signs and symptoms of placental abruption include: vaginal bleeding, abdominal pain, back pain, uterine tenderness and rapid uterine contractions. http://www.mayoclinic.com/health/placentalabruption/DS00623/DSECTION=symptoms

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Abnormalities or damage to the heart’s structure are the most common cause of atrial fibrillation. Possible causes of atrial fibrillation include:
High blood pressure
Heart attacks
Abnormal heart valves
Heart defects you’re born with (congenital)
An overactive thyroid gland or other metabolic imbalance
Exposure to stimulants, such as medications, caffeine or tobacco, or to alcohol
Sick sinus syndrome — functioning of the heart’s natural pacemaker
Emphysema or other lung diseases
Previous heart surgery
Viral infections
Stress due to pneumonia, surgery or other illnesses
Sleep apnea
http://www.mayoclinic.com/health/atrial-fibrillation/DS00291/DSECTION=causes

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Actinic keratosis treatment options may include:
Freezing (cryotherapy)
Creams or ointments. Some topical medications contain fluorouracil (Carac, Fluoroplex, Efudex), a chemotherapy drug. Chemical peeling. This involves applying one or more chemical solutions — trichloroacetic acid (Tri-Chlor)

http://www.mayoclinic.com/health/actinic-keratosis/DS00568/DSECTION=treatments-and-drugs

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Factors that may cause malabsorption syndrome include: antibiotic use; conditions such as celiac disease, chronic pancreatitis, cystic fibrosis and dairy protein allergies; birth defects or diseases of gall bladder, liver or pancrease; damage to the intestine and radiation therapy. http://www.healthline.com/health/malabsorption#Causes

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Abdominal pain is typically the first sign of intussusception. Other common signs of intussusception include vomiting, diarrhea, and bloody/mucus stools. On occasion, children will present with a mass in their belly as well. You would start with a barium enema which fixes intussusception 90% of the time. If this does not work or the intestine is torn, surgery will be required.
https://www.mayoclinic.org/diseases-conditions/intussusception/symptoms-causes/syc-20351452

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The physical findings of HCM are associated with the dynamic outflow obstruction that is often present with this disease. Upon auscultation, the heart murmur will sound similar to the murmur of aortic stenosis. However, a murmur due to HCM will increase in intensity with any maneuver that decreases the volume of blood in the left ventricle (such as standing abruptly or the strain phase of a Valsalva maneuver). Administration of amyl nitrite will also accentuate the murmur by decreasing venous return to the heart. Classically, the murmur is also loudest at the left parasternal edge, 4th intercostal space, rather than in the aortic area. Maron BJ (Mar 2002). “Hypertrophic cardiomyopathy: a systematic review”. JAMA 287 (10): 1308–20.

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Vasculitis is a serious complication of rheumatoid arthritis. While rheumatoid arthritis affects the body’s joints, vasculitis is a condition in which blood vessels become inflamed. When blood vessels become inflamed, they may become weakened and increase in size, or become narrowed, sometimes to the point of stopping blood flow. The blood vessels most often involved are arteries that bring blood to the skin, nerves, and internal organs. Veins can also be involved. http://my.clevelandclinic.org/orthopaedics-rheumatology/diseases-conditions/hic-rheumatoid-vasculitis.aspx

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An NG tube is meant to be used only on a short-term basis. Using a temporary NG tube for too long can lead to sinusitis, infections, and ulcerations on the tissue of your sinuses, throat, esophagus, or stomach. For long-term tube feedings, a doctor may wish to perform minor surgery and insert a gastrostomy tube. http://www.healthline.com/health/nasogastric-intubation-and-feeding#Risks

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Antibiotics utilized for treating infective endocarditis include: aminoglycosides, glycopeptides, beta lactams. The American Heart Association (AHA) advises ceftriaxone for the penicillin-allergic patient—but this should only be used for allergy other than immediate-type hypersensitivity because of the risk of cross-sensitivity with penicillin. http://jac.oxfordjournals.org/content/54/6/971.full

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Endocarditis Prophylaxis is Recommended for People Only with the Following Conditions;
Prosthetic cardiac valves (including bioprosthetic and homograft valves)
Previous bacterial endocarditis
Unrepaired cyanotic congenital heart disease (CHD), including palliative shunts and conduits
Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter, but only during the 1st six months after the procedure
Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device Cardiac transplantation recipients who develop cardiac valvulopathy
Procedures for Which Prophylaxis is Recommended for People with the Above Conditions
Dental Procedures All dental procedures that involve the manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/endopro.htm

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Genital warts (or condylomata acuminata, venereal warts, anal warts and anogenital warts) are symptoms of a highly contagious sexually transmitted disease caused by some types of human papillomavirus (HPV). American family physician 82 (10): 1209–13.

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Peripheral neuropathy, paresthesia, myopathy, mental confusion and mental fatigue are all common presentations in the postoperative phase of thyroidectomy patients. http://tulane.edu/som/departments/neurology/programs

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Several different types of medications are used to treat generalized anxiety disorder. Benzodiazapines such as Lorazepam are the most common for acute generalized anxiety disorder followed by maintenance with an SSRI or Buspirone. http://www.mayoclinic.com/health/generalized-anxiety-disorder

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The chest radiograph, which is abnormal in most patients with bronchiectasis, in combination with the clinical findings may be sufficient to establish the diagnosis. Suspicious but not diagnostic radiographic findings include platelike atelectasis, dilated and thickened airways (tram or parallel lines; ring shadows on cross section), and irregular peripheral opacities that may represent mucopurulent plugs. http://cfuk22.blogspot.com/2010/09/bronchiectasis-atelectasis-cysts-and_15.html

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People who may want to talk to their doctors about screening for hepatitis B infection include:
Anyone who lives with a person who has hepatitis B infection
Anyone who has had sex with a person who has hepatitis B infection
with an unexplained, abnormal liver enzyme test
Anyone infected with HIV
Immigrants, including internationally adopted children, from areas of the world where hepatitis B is more common, including Asia, the Pacific Islands, Africa and Eastern Europe
People who inject drugs
Inmates
Men who have sex with men
People who have one or both parents from an area of the world where hepatitis B is more common
People who receive kidney dialysis
People who take medications that suppress the immune system, such as anti-rejection medications used after an organ transplant
Pregnant women

http://www.mayoclinic.com/health/hepatitis-b/DS00398/DSECTION=tests-and-diagnosis

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Ammonia, which is produced by the body when proteins are digested, is one of the harmful substances that is normally made harmless by the liver. Liver failure or damage will elevate blood ammonia levels. http://www.nlm.nih.gov

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Compartment syndrome causes severe pain that does not go away when you take pain medicine or raise the affected area. In more severe cases, symptoms may include:
Decreased sensation
Numbness and tingling
Paleness of skin
Severe pain that gets worse with passive movement
Weakness
Fasciotomy is needed immediately. Delaying surgery can lead to permanent damage.
Long surgical cuts are made through the muscle tissue to relieve the pressure. The wounds can be left open (covered with a sterile dressing) and closed during a second surgery, usually 48 – 72 hours later. http://health.nytimes.com

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Of the lesions listed the only intraoral lesion which presents with no pain is leukoplakia.  Candidiasis can be scrapped away where leukoplakia cannot.  Perioral is a skin disease with multiple small pustules and papules localized to the perioral skin.  Chewing smoking tobacco is the most common causative factor with approximately 80% of persons diagnosed with leukoplakia.

www.mayoclinic.org/diseases-conditions/leukoplakia/

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Vascular dementia- Clinical presentation and physical exam findings may be similar among these selections, howver with a history of chronic hypertension a vascular cause would be most suspect.

www.mayoclinic.org/diseases-conditions/vascular-dementia/

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Iron deficiency anemia (IDA) is the most common cause of microcytosis.  Identifying an underlying cause is dependent on the patient age and sex.  Nutritional deficiency is common among children with IDA, while menstruating women loss iron through menstrual blood loss.  Men and post-menopausal women with IDA require further work-up to include a detailed gastrointestinal investigation to rule out a gastrointestinal malignancy.

www.aafp.org/afp/2010/1101/p1117.html

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Polycystic ovary syndrome

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Angiotensin-converting enzyme inhibitor therapy has been associated with increased insulin sensitivity leading to possible lower blood glucose levels (www.ncbi.nlm.nih.gov/pubmed)

Hydrochlorothiazide’s exact mechanism of causing hyperglycemia is not clearly understood, but it has been implicated in contributing new onset diabetes in as few as 9-18 weeks starting therapy (spectrum.diabetesjournals.org)

Pheochromocytoma may lead to hyperglycemia by secreting epinephrine which inhibits insulin secretion and increases glucagon secretion (www.diapedia.org)

Cirrhosis leads to hepatic insulin resistance (World J Gastroenterol.Jan 21, 2009; 15(3): 280-288)

Cushing’s disease leads to increase cortisol levels which oppose the action of insulin and lead to hyperglycemia (clinical.diabetesjournals.org)

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Verenicline

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Pleurodesis

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Insulin

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Alpha-fetoprotein

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Rheumatoid arthritis

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Topical NSAIDS and oral analgesics are acceptable options for pain control

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Tetralogy of Fallot

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Chronic hemodialysis

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Inducing labor

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High calcium, low phosphorus and high alkaline phosphatase levels

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Prednisone

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Steroids

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Hepatitis B infection The most common subtype to likely cause anal squamous cell carcinoma is HPV-16. Since your immunity is already suppressed with HIV infection, it increases one’s risk of developing anal squamous cell carcinoma. Anal intercourse can result in tearing of the tissue in the anus allowing bacteria and viruses such as HIV, HPV to enter . Genital warts are unlikely to cause anal cancer but people who have had a history of them are more likely to get anal cancer as they are more likely to be infected with high-risk subtypes of HPV leading to anal cancer.

https://www.cancer.org/cancer/anal-cancer/causes-risks-prevention/risk-factors.html

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Inappropriate anti-diuretic hormone syndrome

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Greenstick fracture

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Doxycycline had many FDA approved clinical uses.  It is used in the treatment Rosacea, Lyme Disease, Anthrax, STD prevention after sexual assult and more.  While it is approved for malaria prophylaxis, it is not approved as a single agent for the the treatment of malaria. Doxycycline should not be used alone for initial treatment of malaria, even when the parasite is doxycycline-sensitive, because the antimalarial effect of doxycycline is delayed.

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Approved first-line therapies for early disseminated Lymes disease (Erythema migrans) include Doxycycline 100 bid, Amoxicillin 500mg tid, or cefuroxime 500 mg bid, all for 14 days. Macrolide antibiotics like clarithromycin should not be used first-line as they are not as effective.

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While Lyme Carditis is rare, it can occur weeks after early disseminated Lyme disease. The most common clinical feature of Lyme Carditis is Atrioventricular conduction blocks. Most of the time the AV block is short lived but patients should be hospitalization and require IV antibiotics if the PR interval is > 300 milliseconds.

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Lyme serology should NOT be performed on patients who have erythema migrans (they should all be treated) or in patients who do not have symptoms consistent with Lyme disease (pt with tick attached for 4 hours, in most cases, tick must be attached for 36-48 hours before Lyme disease bacterium can be transmitted). Of the choices, only thefrequent camper in Wisconsin who presents with bells palsy should undergo Lyme serology. Lyme disease is known to possibly cause facial paralysis .

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Both A&B are correct. C is incorrect because the guidelines state that the tick has to have been attached for 36 hours.

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Mild Mitral Regurgitation is defined as < 30 mL/beat, Moderate Mitral Regurgitation is defined as 30-59 mL/beat and Severe Mitral Regurgitation is defined as ≥ 60 mL/beat.

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Contraindications for hydralazine include dissecting aortic aneurysm and rheumatic heart disease (also known as mitral stenosis.  Severe coronary artery disease is a possible contraindication. Because hydralazine decreases systemic vascular resistance (afterload), it actually improves forward heart flow and is a indication for severe mitral regurgitation.

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BNP levels can be increased with CHF, Chronic Kidney Disease, Sepsis, Severe Pulmonary Hypertension, Coronary Heart Disease and Valvular Heart Disease.  Patients with obesity can actually have low BNP levels.

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The most common primary cardiac tumor in adults is a Myxoma.  The second most common primary cardiac tumor in adults is a papillary fibroelastoma.

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All of the above are associated with severe mitral regurgitation except that the murmur becomes louder with standing maneuver. An increase in cardiac volume normally makes a mitral regurgitation murmur louder.  Maneuvers that will increase the cardiac volume for a short period of time includes: raising the legs and squatting down.  Standing will decrease the cardiac volume for a short period (and decrease the murmur) as all the volume will go to the lower extremities

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New treatment guidelines for gout recommend decreasing uric acid levels to less than 6.0 mg/dL .

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Risk factors for gout include (A&B) thiazide diurectics, niacin and seafood. Protective factors for gout include: coffee, dairy products and low BMI.

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FDA indications for colchicine include taking two tablets at onset and one tablet one hour later. The maximum dose in one hour is 1.8mg.

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Migraine and Cluster Headaches (A&B) are indications for sumitriptan. Basilar and Hemiplegic headaches are contraindications.

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Migraine and Cluster Headaches (A&B) are indications for sumitriptan. Basilar and Hemiplegic headaches are contraindications.

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Migraine and Cluster Headaches (A&B) are indications for sumitriptan. Basilar and Hemiplegic headaches are contraindications.

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The number one type of diagnosed primary brain tumor is Glioma making up 54-60% of tumors. Gliomas can be either benign or malignant and include: ependymomas, astrocytomas including glioblastoma multiforme, oligodendrogliomas and mixed gliomas .

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The recommended maximum daily dose for oral sumitriptan is 200mg. The recommended maximum daily dose for nasal sumitriptan is 40mg. The recommended maximum daily dose for subQ sumitriptan is 12mg. 

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Of the choices, only Upper Motor Lesions can increase Deep Tendon Reflexes. Deep Tendon Reflexes are decreases with: peripheral neuropathy (most common cause), diabetes mellitus, alcoholism, amyloidoisis, uremia, vitamin deficiencies (pellagra, beriberi), pernicious anemia, and toxins (lead, arsenic, isoniazid).

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Vasodilating triggers of migraines include Alcohol and Nitroglycerine (A&B). Ergotamine is a known vasoconstrictor.

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In adults and children over 8, normal opening CSF pressure is < 200. Obese patients may have pressures up to 250 mm H20. Intracranial hypertension is diagnostic when the CSF opening pressure is > 250 mm H2O. 

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Contraindications for sumitriptan include Ischemic heart disease, Cerebrovascular syndromes (strokes, TIA), and Uncontrolled hypertension (All the above). Other contraindications include: peripheral vascular disease, severe hepatic impairment, use within 24 hours of ergotamine derivaties, management of hemiplegic or basilar migraine, and concurrent administration or within 2 weeks of discontinuing an MAO type A inhibitor.

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Most meningiomas are Benign (92%) and Asymptomatic (A&B). Schwanomas are a type of nerve sheath tumor and NOT a type of meningioma.

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Drug interactions with sumitriptan that give a Risk X and should be AVOIDED indclude Ergot derivaties and MAO Inhibitors(A&B). Drug interactions with sumitriptan that give a Risk C and therapy should be monitored include: antipsychotics, metoclopramide, and serotonin modulators.

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Bitemporal hemianopia is a symptom the can occur with Pituitary adenmas, if they are large enough to push on the optic chiasm.

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Influenza vaccination should NOT be given if patients have an egg allergy.  Measles, Mumps, & Rubella (MMR), varicalla, and polio vaccines should be avoided if patient has a neomycin allergy.

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Measles, Mumps, & Rubella (MMR) vaccine should NOT be given at the 2, 4, and 6 months but rather at one year (12-15 months) and repeated at 4-6 years. The following vaccines can be given at 2, 4, and 6 months:

• DTAP: 5 doses with last 2 at 15-18 months and 4-6 years
• Haemophilus influenzae B: 4 doses with last dose at 12-15 months
• Pneumococcal: 4 doses with last dose at 12-15 months
• Polio: 4 doses with last dose at 4-6 years
• Rotavirus: 2 or 3 doses at 2, 4, and/or 6 months

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Acetaminophen is more commonly known around the world at paracetamol.  In adults, the maximum daily dose of acetaminophen/paracetamol is 4 grams, usually divided 325 or 650 mg PO/PR every 4-6 hours PRN.  In infants and children, the maximum daily dose of acetaminophen/paracetamol is 2.6 grams, usually divided 10-15 mg/kg/dose every 4-6 hours PRN. 

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In May of 2012, the CDC changed their definition of a “blood lead level of concern” in children from 10 μg/dL to 5 μg/dL.  What did not change was their recommendation of chelation therapy that should be started when the child’s lead level is 45 μg/dL or higher.

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The only medication recommended to treat pertussis in children less than 1 month is Azithromycin at a dose of 10mg/kg/day.   Clarithromycin and Erythromycin are appropriate treatments but are not recommended for children under one month.  Bactrim is contraindicated for children less than 2 months.  Vancomycin is not an appropriate treatment for pertussis.

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Possible adverse reactions with Gentamicin include: pain at the injection site and thromophlebitis (~1%). Less common adverse reactions include Nephrotoxicity, Neurotoxicity and Suprainfections of other bacteria or fungi with prolonged use. Hepatotoxicity is not an adverse reaction with Gentamicin.

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Prostate cancer cells are responsive to testosterone withdrawal. Total androgen blockade can be accomplished by the administration of luteinizing hormone-releasing hormone antagonists and drugs that would block the biosynthetic pathway of testosterone production. Tamoxifen is an antiestrogen agent that does not have a role in the treatment of prostate cancer. Both saw palmetto and finasteride are used for BPH and do not have significant effects on prostate cancer cells.

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An elevated level of serum intact PTH, in the absence of renal failure or other cause of secondary hyperparathyroidism, is strong evidence for primary hyperparathyroidism. A high normal PTH is also compatible with primary hyperparathyroidism because the PTH should be suppressed due to the hypercalcemia and is, there fore, inappropriately elevated. In hypercalcemia of other causes (e.g., with cancer, sarcoidosis, or excessive vitamin D intake), the PTH level is suppressed by the hypercalcemia nd is low (or normal).

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Propranolol is a beta blocker and beta blockers form the antiarrhythmic group II.

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Transdermal nitroglycerin can sustain blood levels for as long as 24 hours but because tolerance can occur, it is recommended that the patch be removed after 10 to 12 hours to allow recovery of sensitivity. Esmolol (IV), amyl nitrite, and sublingual nitroglycerin all have short durations of actions. Hydralazine may actually precipitate an anginal attack.

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Numerous studies show that Beta blockers such as Metoprolol help prevent cardiac arrhythmias that occur related to myocardial infarctions. None of the other medications listed have been proven to be more effective.

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Increased sympathetic nervous system activity occurs if clonidine is abruptly stopped after prolonged administration causing uncontrolled elevation in blood pressure. Patients should be slowly weaned from clonidine while other antihypertensive medications are initiated.

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Heart failure usually causes a decrease in cardiac output and the body will naturally try to compensate by sympathetic stimulation. Beta blockers such as metoprolol prevent this increased heart rate and renin release. Enalapril is an ACE-inhibitor that will actually increase renin release. Digoxin slows the heart rate because of its vagomimetic effects, but does not affect renin release. Dopamine and Dobutamine are positive inotropic medications and neither decreases heart rate or affects renin release.

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The primary producer of circulating free fatty acids is lipolysis in adipose tissue. The liver normally utilized these free fatty acids as a major precursor for triacylglycerol synthesis. Niacin strongly inhibits adipose lipolysis and hence decreases the free fatty acids needed in liver triacylglycerol synthesis and VLDL production.

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Acetazolamine is a carbonic anhydrase inhibitor that is used prophylactically for severaly days before an ascent above 10,000 feet. This treatment helps prevent nausea and cerbral and pulmonary complications associated with acute mountain sickness.

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Because older inhalers contain an ozone-depleating chlorofluorocarbon propellant they are being discontinued by the FDA. Proair HFA is the is the NEW formulary of albuterol sulfate that contains the environmentally friendly hydrofluoroalkanes.

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A&B, both Salmeterol and Formoterol are long long-acting B2-agonists. Omalizumab is a recombinant DNA-derived monoclonal antibody that selectively binds to human immunoglobulin E (IgE), and may be used to treat moderate to severe allergic asthma in patiients who are poorly controlled with conventional therapy.

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Lactic Acidosis is the most dangerous adverse effect of metformin administration with death resulting in approximately 50 percent of individuals who develop lactic acidosis while on this drug. Metformin does not induce insulin production; thus, administration does not result in hypoglycemic events. Some nausea, vomiting, and diarrhea may develop but is usually not severe AND N/V/D is not specific to metformin. Metformin does not induce sleepiness.

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Serious adverse effects of oral contraceptives include A&B, thromboembolic complications (DVT), stroke, and myocardial infarction. These risks are increased in women who smoke. Early or mid-cycle bleeding are effects of estrogen deficiency.

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Typically, first generation OTC antihistamines have a sedating effect because of passage into the CNS. However, in some individuals, especially infants and children, paradoxical CNS stimulation occurs and is manifested by excitement, euphoria, restlessness, and confusion. For this reason, use of first generation OTC antihistamines has declines, and second generation product usage has increased. Reye’s syndrome is a systemic response to a virus. First generation OTC antihistamines do not exhibit a cholinergic effects and do not commonly cause nausea or diarrhea.

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Excessive ingestion of TCAs result in life-threatening cardiac arrhythmias with wide QRS complex tachycardia. TCA overdose can induce seiures, but they are typically not life-threatening. TCAs do not cause an elevation in body temperature, metabolic acidosis or pulmonary fibrosis.

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None of the above. Prolonged use of a proton pump inhibitor (PPI) can lead to hypomagnesemia as noted by the FDA. While most patients who take PPIs for a long time do not develop hypomagnesemia, about 30 cases of severe hypomagnesemia have been reported in long-term PPI users. When the PPI was stopped, serum magnesium levels returned to normal in less than 2 weeks. The exact mechanism is unknown. Patients also taking other drugs that cause hypomagnesemia, such as diuretics and digoxin, may be at increased risk.

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All the above. Hypomagnesemia is often accompanied by hypocalcemia and hypokalemia. Patients with hypomagnesemia often do not have symptoms but they may include muscle weakness, tremor, muscle cramps, carpopedal spasm, tetany, seizures, and cardiac conduction disturbances and arrhythmias.

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Acetaminophen may mask a post-operative fever that could be a sign of infection due to its antipyretic effects. IV acetaminophen does not affect respiratory depression and has not been associated with hepatotoxicity, but overdose can cause serious or fatal hepatic injury. IV analgesic adult dosage is 1000mg q6h or 650 mg q4hr (max: 4,000 mg/d). Given in conjunction with an opiod for moderate to severe pain, it has been shown to have an opiod-sparing effect.

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Painless solid tumors in the testes are testicular caner until proven otherwise. Nonhematogenous testicular tumors are divided into 2 categories – germ cell tumors (seminoma, nonseminoma [embryonal, choriocarcinoma, teratoma, teratocarcinoma, yolk sac tumors]) and nongerm cell tumors (Leydig cell or Sertoli cell). There is no mass within the testis with torsion. Epididymitis presents with a painful tender testis.

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The most common cause of primary mediastinal tumor is a neurogenic tumor (20-25%), and 10% are malignant (more likely in children). They usually arise form an intercostal nerve or sympathetic ganglion. Varieties of neurogenic turmors include schwannoma, neurofibroma, ganglioneuroma, and neuroblastoma. Next in frequency (of primary mediastinal tumors) are thymoma, congenital cysts, and lymphoma.

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A sliding hernia refers to the peritoneum that slides along with the hernia in its passage along the cord. The viscus forms part of the wall of the sac. The peritoneum should not be removed from the bowel wall, because devascularization may occur.