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alcohol, smoking,elevated cholesterol, DM and HTN,
which one has strongest association with stroke?
Ans-hypertension---more than 4 times risk.
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sudden onset of severe chest pain,
multiple venous track marks, cardiac enzymes negative,
dx cocaine intoxication:
tx-diazepam IV;
Dont give beta blocker which will aggravate cocaine induced vasoconstriction
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how to differentiate neuropathic claudication present in lumber spinal stenosis and intermittent claudication present in PVD
both cases: classic finding is exacerbation of s/s by walking and relieved by rest.
unlike PVD, neuropathic claudication s/s are positional if the pt is standing still he will have s/s. pain will only be relieved by flexion of spine
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IUGR (intrauterine growth retardation)
how can you differentiate symmetrical and asymmetrical IUGR
ans-just by measuring abdominal circumference.
symmetric- as name suggest--whole body growth is retarded
asymmetric IUGR--ultrasonogram--biparital dm consistent with date but abdominal circumference below 10th percentil--
causes of asymmetry: fetal redistribution of blood flow into the vital organs such as brain, heart, liver and other abd organs. maternal factors are responsible such as HTN, hypoxemia, smoking, vascular disease and toxic exposure.
Symmetric IUGR--growth of both head and body is deficient. usually caused by chromosomal abnormality, congental infection adn anomalies
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answer to previous question is actually glyburide.. apparently his raised ldl is because of increased hbA1c.. his hyperlipidemia is secondary so i guess treat that first.
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secondary hyperlipidemia causes: hypothyroidism, diuretics, dibetes, oral contraceptives, B-blockers, Nephrotic syndrome, CRF.
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nasal discharge for 10 days in a 4 year old child, follicles(big clue) and inflammatory changes in the conjunctiva;
cornea-neovascularization
dx. trachoma tx, tetracycline or erythromycin,
repeated infection will cause scarring of cornea.
DD-herpes simplex keratitis---has photophobia, decreased vision, and pain. dendritic ulcer most common
DD orbital cellulitis--due to infection in paranasal sinus (tenderness), abrupt onset of fever, proptosis and restriciton of extraocular movements;
DD gonococcal conjunctivitis--2-3 days after birth; copius purulent discharge;
DD viral conjunctivitis--red copius watery discharges in children, contaminated swimming pool, caused by adenovirus....
know all conjunctivitis, they are big time favorite for boards
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nice googlelover, when r u planning ur exam. u got yahoo id?
>porphyria cutanea tarda > cutaneous blisters exacerbated by ultraviolet rays, hyperpigmentation and increased hair on the face. Hepatic fibrosis can occur .. accumulation of uroporphyrinogen, which accumulated in the cytoplasm.
>AIP :Autosomal Dominant..more of systemic symptoms, Neurological paralysis, Muscle weakness, ABDOMINAL pain, which is sever and needs opiod analgesics.seizures can occur which are treated by gabapentin. stress,infection, drugs(sulfonamides) can exacerbate AIP.
accumulation of Porphobilinogen. rx: i.v hematin(which inhibits ALA synthatase)
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thanks proven. I am worried about question that is not tagged with nbme. I will probably take exam within few weeks based on my nbme score. Please continue to give your input.
how to prevent disk herniation during heavy lifting: keep the back straight while lifting (bend knees not waist). think about heavy lifting in Olympics.
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how to dx cystine stone
look for family history (uncle has same problem),
hexagonal stone (USMLE loves shape of the stone), positive urinary cyanide nitropruside test
prolem is; defective transport of amino acids such as cystine, lysine, arginine, and ornithine by the brush borders of renal tubular and intestinal epithelial cells. cystine is not soluble in water; so form hard radio-opaque renal stones.
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