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1. 37 y/o female with erythema of central face associated with flushing in response to change in temperature, emotion and also with consumption of spicy food or alcohol and also presence of telangiectasia. Not pregnant and no other dermatological problems. Diagnosis ? Tx?
2. Herpes Zoster Infection. Tx ? (Option has both Acyclovir and Valacyclovir). Rationale behind picking your answer?
3. 29 y/o male had a URI 3 days back and now presents with myalgias, fever and weakness. Diagnosis? Tx?
4. Screening Recommendations for following;
a) Hypertension
b) Diabetes
c) Hyperlipidemia
d) Colon Cancer
e) Lung Cancer
5. Indiations/Recommendations of Immunizaiton
a) Tentanus
b) Rabies
c) Smallpox
6. Is there a time limit to diagnose a case of Irritable Bowel Syndrome? If yes, how much time is needed?
7. Tx of Mitral regurgitaion with EF 59%
8. Tx of Aortic Regurgitation with LVES Diameter of 60mm and the patient is asymptomatic?
9. Equation/mathematical way to determine LDL value if Total cholesterol, HDL and TG values are given? Side NOte: Very high TG level (more than 400) makes LDL Calculation unreliable. Being said that, how to calculate?
10. What treatment is appropriate for Fungal Endocarditis ?
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1. rosacea, topical metronidazole.
2. um.. valacyclovir (PO) if more serious i.e. eye involved then IV acyclovir?
3. bacterial suprainfection? MC: s.aureus. if MRSA: vanco/clindamycin if sensitive: penicilins.
4a/b/c/ not sure. 30? 30? 50?
d. depends on if FH positive or not. if not, 50. if yes, then 10 years prior or age 40, whichever comes first.
e. smoker over 30 years/actively smoking..55-65 CT--confirm w/ CXR ..if quit more than 15 years ago, no need
5a. tetanus--depends on clean/dirty and if received full vaccinations. if clean and fully vac (less than 10 years)--nothing. clean/not fully vac(greater than1 10 years) --give vaccine only. dirty/vully vac (less than 5 years)--nothing. dirty/unvacc (>5 years)..vaccine + IVIG
b. pt had it prior, nothing..if never had it..give vaccine+IVIG--unsure of this one
c. no clue. as a infant?
6. dx of exclusion..typically female in her 30s. don't think there is a age restriction but yes, underlying psychological factor
7. replace teh value since below 60%.
8. unsure of size, of less than 55% EF then replace.
9. NO CLUE 
10. um.. IV amphotericin B? not sure sorry.
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2. Pick Valacyclovir. Rationale: Acyclovir has a very tedious kind of dosage where as Valacyclovir is 3 times a day.
3. I was going wiht Influenza. So tx in this case of influenza??
4. HTN: BP screening every 2 years in NORMOTENSIVE ADULTS and every year for those with SBP 120-139 or DBP of 80-90
DM: Adults with BMI more than 25 and 1 or more additional risk factors for diabetes, testing for diabetes is recommended. For those without risk facors, testing begins at age 45 .
Lipid: Men more than 35 and women more than 45 (20-45 if there are any CAD risk factors).
5. SMALLPOX : Currently recommended ONLY for those working in laboratories in which they are exposed to the virus.
6. For diagnosing IBS, there should be presence of sign/symptoms for 3 months. Time limit is 3 months.
7. Surgery
8. Surgery
9. LDL is Total chol minus HDL minus TG/5
10. Valve Replavemetn is appropriate for Fungal Endocarditis.
As always, if there is any mistakes or I am misleading in anyway please do correct.
Thanks !!
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ty as always
influenza: past 48hrs, symptomatic tx. less than 48, oseltamivir, zanamivir.
6. ahh you were looking for duration of sxs to be dx as IBD, gotcha!
10. so valve replacement is always the tx for fungal endocarditits? how about bacterial?
i know if its acute bugs..ie causing destruction. staph aureus/strep pneumo--we definitely should replace...how about if subacute? like viridians, s. epidermitis, s.bovis (gallalyticus, , enterococcus )
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ps. replied to e-mail
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Valve replacement is appropriate for fungal endocarditis, HF from valce destruction, Valve ring abscess, Cardiac conduction abnormalities, Persistently positive blood cultures despite abx tx, large or mobile vegetations or Systemic emboli despite adequate Abx therapy.
If theres any left please do add.
Now being said that what is the treatment for Verrucous Endocarditis?
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i didn't know the name so had to google it..libman sack--i know its from SLE and its sterile..so the fact that its sterile/autoimmune replacing valve might not help because it can just happen again. um..im also assuming, once it occurs, you can't reverse the process..so just treat it sxs? ie if heart failure/conduction issues, treat w/ ACEI/betablockers, and etc..(as sxs arise)?
please clarify ty!
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For Verrucous Endocarditis, no treatment is required. Patients should receive endocarditis prophylaxis.
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replied back! hopefully you got it this time, if not im not sure :x hahahaha. i hit the reply back button so it should go through? spam?
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