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Part II

1243. Patients with polycystic ovarian disease are at the risk of developinh type II diabetes.
1244. Ovarian solid tumors discovered incidentally in a multiparous African- american pregnant womed: think of preganancy leutoma. It is often asymptomatic, benign and self self limited condition and requires no treatment.
1245. Mid pelvic contraction which is indicated by prominent ischial spines is an important cause of arrest disorder of dilation.
1246. Lichen sclerosis is usually seen in postmenopausal women but may develop at any age. It presents with pruritis, burning and dyspareunia and is treated with superpotent topical corticosteroid such as clobetasol or halobetosol.
1247. Granuloma inguinale is a STD caused by the bacterium Dovonian granulomatis and characteri zed by an initial papule, which rapidly evolves into papules, which rapidly evolves into a painless ulcer with irregular borders and beefy-red granular base.
1248. Delivery is the definitive treatment of HELLP syndrome in women beyond 34-weeks gestation.
1249. In cases of IUGR, presence of oligohydramnios is an indication for delivery.
1250. Patients with severe placental abruption in labor have to be managed aggressively to insure a rapid vaginal delivery.
1251. Preeclampsia is defined as hypertension occurring in the second trimester of pregnancy and associated with proteinuria. Risk factors include first conception, diabetes, renal failure and extreme of age. The hypertension regresses after delivery.
1252. The most common organism associated with mastitis is S. aureus.
1253. The combination of primary amennorhea, bilateral inguinal masses, and breast development without pubic or axillary hair is strongly suggestive of androgen insensitivity syndrome. A blind vaginal pouch and karyotype of 46XY are other clues. A gonadectomy should be performed to avoid the risk of testicular carcinoma.
1254. Benign glycosuria is a very common finding in pregnant women because of decreased renal threshold. However causes o fdecreased renal threshold have to be ruled out first, which is done with fasting urine glucose measurement.
1255. Contraceptive methods that can be used in the post partum period include sterilization, condoms and minipills.
1256. Early decelerations are secondary to fetal head compression.
1257. Vari able decelerations are secondary to umbilical cord compression.
1258. Late decelerations are secondary to uteroplacent al insufficiency.
1259. A granulocytic leukocytosis called lochia rubra is characteristic of first few days postpartum. After 2-3 days the color becomes paler and the discharge is then named lochia serosa. It then turn yellow or white called lochia Alba.
1260. Diagnosis of lutuael phase defect is confirmed by endometrial biopsy.
1261. Kegel exercise and urethropexy are treatment of stress incontinence.
1262. Reassurance and outpatient follow up is the standard of care in threatened abortion patient.
1263. HCG is hormone secreted by the synctiotrophoblast and is responsible for maintenance of progesterone secretion by preservation of the corpus luteum until the placenta starts producing progesterone on its own.
1264. 2 agonist may worsen the edema by decreas ed water clearance, tachycardia, and increased myocardial workload.
1265. The major cause of death in eclampsia is hemorrhagic stroke.
1266. Vasa previa necessitates immediate C section.
1267. Renal calculi in pregnancy require special consideration because most of the standard investigatory modalities will expose the fetus to radiation. The modality of choice is abdominal or pelvic sonography.
1268. Endometrial biopsy is required in selected patients with DUB to rule out endometrial cancer. These include age >35 years, obese, diabetic or has chronic hypertension.
1269. In pregnant patients, asymptomatic bacteriuria increases the risk of developing cystitis and pyelonephritis more than in the non-pregnant state. E Coli accounts for more than 70 % cases. Treatment consists of -10 days of nitrofurantoin, ampicillin or first generation cephalosporin.
1270. HRT is now only recommended for the short term use of controlling menopausal symptoms. Large studies have shown that the long term use of HRT can slightly increase the risk of coronary heart disease and stroke.
1271. The initial test to assess the ovulatory function is BBT and midluteal progesterone level.
1272. Adenomyosis occurs most frequently in women above 40 and typically presents with severe dysmenorrhea and menorrhagia. The physical exam reveals an enlarged and generally symmetrical uterus.
1273. Endometritis is caused 70% of times by anaerobes. The most appropriate antibiotic combination is clindamycin with either aminoglycoside or ampicillin.
1274. Hypertension in a pregnant female in a setting of massive proteinuria, malar rash, and positive ANA titer is most likely due to SLE which frequently causes glomerulonephritis.
1275. CVS is the best test for detection of for fetal chromosomal abnormalities in the first trimester of pregnancy.
1276. Myocardial perfusion scintigraphy is indicated when the resting ECG makes an exercise test difficult to interpret, if the exercise is contrary to the clinical impression, to localize the region of ischemia, to distinguish ischemic from infarct ed myocardium, to assess vascularization after bypass or angioplasty, and as a prognostic indicator in patients with coronary.
1277. The main pathophysiologic mechanism of Duchenne muscle dystrophy is a mutation in the dystrophin gene that is responsible for the production of the dystrophin.
1278. Muscle phosphorylase is seen in McArdles disease, which is inherited in an autosomal recessive pattern. Patients with this condition typically have a history of exercise intolerance in childhood follosed by recurrent cramps, fatigue and myoglobulinuria in adolescence or early adulthood.
1279. A hexagonal crystal point towards the diagnosis of cystine stones.
1280. If a patient has a history of mania or hypomania, depression should be considered bipolar rather than unipolar, the patient should be started on a mood stabilizer before beginning treatment with an antidepressant.
1281. A simple cyst in the head of the epididymis is a spermatocoele or a epididymal cyst and does not require any intervention if the patient is asymptomatic.
1282. In factitious there is low TSH, low thyroglobulin and a low radioactive iodine uptake.
1283. High radioactive iodine indicates Gravess disease or toxic multinodular goiter, depending on the pattern of the uptake.
1284. Metabolic disturbances such as hypoglycemia and hypocalcemia are common and readily treatable causes of neonatal seizures in the newborn.
1285. Otosclerosis is an autosomal dominant disease in which new, immature bone with abundant vascular channels cause ankylosis of stapedial foot plate. Pregnancy may cause the condition to progress more rapidly.
1286. The length and intensity of an acute exacerbation of MS can be reduced with the administration of glucocorticoids.
1287. ALS is a progressive motor neuron disease that presents with a combination of UMN and LMN. The median survival after diagnosis is 3 to 5 years, with death occurring from respiratory failure.
1288. CMV causes diarrhea in AIDS patient in wherein distal bowel is involved
1289. Rx Webs in plummer vinson : dilation
1290. Rx Intimal flap of carotid artery: surgery
1291. Rx Ant wall MI: risk of arterial thrombo ; full doses heparin + 3 months of warfarin.
1292. Rx Acute ill and toxic pt with UC : proctosigmo + biopsy
1293. Rx Heat stroke : rapid cooling
1294. Rx progressive back pain + myelopathy: IV dexa --> MRI --> Rx
1295. Metastatic cord compression : Radiotherapy
1296. Rx refractory hydrothorax due to cirrohis : TIPS
1297. Rx Ref ascitis : TIPS
1298. Rx recurrent variceal bleading not responsive to medical Rx : TIPS
1299. Rx TCA poisoning : NaHCO3
1300. Rx diabetic cystopathy: 1- oral bethancol , 2- intermittent catheter
1301. Rx chlamydia : single dose of Azithromycin OR 7 days doxycyclin
1302. Rx neuromalignant syn : Dantrolene or Bromocriptine
1303. Rx atopic dermatitis : prevention of Rx , take short baths.
1304. Rx presbyopia : convex lenses
1305. Rx amblyopia : cover better eye
1306. Rx hyperopia : convex lenses
1307. Rx myopia : concave lenses
1308. Rx beta blocker posioning : recent ingestion= emesis , bradycardia : Atropine--> Isoproterenol- -> glucagon-->pace
1309. Rx beta blocker poisioning : severe bronchospasm : aminophylline or Beta2 agonist.
1310. Rx Isolated duodenal hematoma: NG + parentral nutrition.
1311. Rx for preventing recurrence of HBV after liver transplant : HBV Ig + Lamivudine.
1312. Rx Seizure due to INH toxicity : Pyriodoxine
1313. Rx hyponatremia due to SIADH : water restriction.
1314. Rx Girl infant < 3 months w vaginal bleeding : observation
1315. Rx Slow down progression of DM nephropathy : AceI
1316. Rx epiglottitis : Fiberoptic laryngoscopy in OR ( not in ER)
1317. Rx acute attacks of migrains : Rizatriptan
1318. Rx acute attack of migrains lasts for longer than 48 hours or r frequently recurrent: ergotamine.
1319. Rx anorexia nervosa : hospitalization
1320. Rx prophlaxy against human bites : Amoxi / calvulanate
1321. Rx rhabdomyolysis : osmotic diuresis + bicarbonate
1322. Rx Afib + HF : digoxin
1323. Rx acute rejection: high dose IV steroides.
1324. Rx bipolar disorder: lithium, valporate, OLANZAPINE.
1325. Rx PCP: cotri.
1326. Rx PCP + PaO2 no answer --> esophagoscopy + cytology + biopsy
1330. Rx psuedotumor cerebri : 1-acetazolamide --> no answer --> 2- shunt.
1331. Rx struvite stones : eradication of UT infections.
1332. Rx persistantly elevated ALT level w detectable HBs Ag , HBe Ag and HBV DNA : INF and lamivudine.
1333. Rx febrile neutropenic pt : ceftazidime or cefepime ( add vanco if pt is hypotensive or there is high suspiscion of MRSA)
1334. Rx Isolated systolic HTN: thiazides .
1335. Rx acute attack of cluster headaches : 100% oxygen
1336. Rx prevention of cluster headaches : verapamil
1337. Rx reversing cardiac effects of ca channel blockers : Ca!
1338. Rx Viterous hemorrhage : immediate ophthlamo consultation.
1339. Rx Battery in esophagus : remove it immediatly
1340. Rx Battery in intestine : observe it.
1341. Rx acute bleeding in pts with liver failure : FFP.
1342. Rx OtoSclerosis : Surgery + Sodium Fluoride .
1343. Rx non infalm comedones : topical retionides.
1344. Rx mild inflam acne : benzoyl peroxide , topical antibiotics.
1345. Rx Refractory mania, severe dep , dep in pregnancy , neuroleptic malig synd, catatonic schizo : ECT
1346. Rx Acute attack of hepatic encephalopathy : All dietary protein withheld , oral or rectal lactulose , oral NEOMYCIN.
1347. Rx white reflex in infant : refer to ophthalmo
1348. Rx ST elevation>1 mm in 2 contiguous leads : thrombolytic therapy OR PTCA
1349. Rx New LBBB: thrombolytic therapy.
1350. Rx Trachoma: ORAL tetra or erythromycin.
1351. Rx diabetic nephropathy : protein restriction ( 0.8 g/kg) , don't use AceI if Cr> 2,2.5
1352. Rx Zenker : excision and frequently cricophayngeal myotomy
1353. Rx porcelain gall bladder : cholecystectomy ( risk of carcinoma)
1354. Rx conversion disorder : psychotherapy ( long term benefit )
1355. Rx Dyspepsia w positve breath test : erad H.pylori
1356. Rx Dyspepsia w/o positive breath test : H2 blocker / PPI
1357. Rx fibromuscular dysplasia: percutaneous angioplasty w stent placement.
1358. Rx prophylaxis against MAC : Azithro or clarithro
1359. Rx PBC: ursodeoxycholic
1360. Rx Orbital cellulitis: imm admin of IV antibiotics.
1361. Rx carcinoid synd: can u remove it?( Remove it ) , u can't remove it ? ( use octerotide )
1362. Rx vaginismus: relaxation, Kegel exercis e, insertion training.
1363. Rx Hypertrophic dystrophy of Vulva: steroides.
1364. Rx lichen scleroris : steroids
1365. Rx atrophic vaginitis : estrogen
1366. Rx stable angina + HTN: Beta blocker.
1367. Rx Tremor and rigidity in parkinson : Antichol ( benzotropines)
1368. Rx exercise induced asthma: Beta agon, mast cell stabilizer.
1369. Rx Reiter syn : NSAIDS .
1370. Rx Chronic HCV (HCV RNA presents , ALT inc , chornic hepatitis of at least moderate grade): INF+ Ribaverin.
1371. Rx Lactation Suppression: tight fitting bra, ice packs , analgesics.
1372. Rx non-complinat schizophrenic pt: long acting injectable antipsychotics like fluphenazine and haloperidol.
1373. Rx TIA due to atherosclrosis: ASA
1374. Rx TIA due to emboli from heart: Anticoagulation.
1375. Rx Nocardiosis: sulfonamides.
1376. Rx prophylaxis of getting UTI after intercourse: voiding after intercourse.
1377. Rx met prostate cancer: palliative radiation + anti androgen therapy ( leuprolide )
1378. Rx Actinomycosis : high dose penicillin
1379. Rx RA with erosive joint disease : DMARDS ( MTX, hydroxychlorquine , sulfasalazine , etanercept, azathio)
1380. Rx Met brain tumor: surgery + whole brain radiation.
1381. Rx Dressler: NSAIDS --> no answer: short course of steroides.
1382. Rx PMR : low dose pred
1383. Rx Giant cell: high dose.
1384. Rx cocaine intox: Benzo + ASA + nitrates.
1385. Rx effect of PEEP on CO: inotropic agent or fluids.
1386. Rx RMSF: Doxycycline
1387. Rx De Quervains tensosynovitis: Long acting steroids.
1388. Rx HSV encephalitis: IV acyclo without delay.
1389. Rx ALS: Riluzole
1390. Rx Subdural hematoma w/o midline shift : head elevation , hyperventilation , acetazol amide
1391. Rx Subdural hematoma w midline shift : craniotomy
1392. Rx early syph : Single IM Benz Peni , if allergic Doxy or tetra for 14 days . in pregnancy use peni with desintizator
1393. Rx Acute attack of Gout : use NSAIDs, there may be an option of colchicine but do not mark this option.
1394. Rx prevention of gout attack : allopurinol
1395. Rx GAD: Buspirone
1396. Rx post-term preg : NST + BPP ( twice/weekly ) oligo or late dece or >43 w delivery
1397. Rx Kawas aki in children : ASA ( the only disease u give child ASA inspite of fear of Reye syn)
1398. Rx massive hemoptysis : RIGID broncho
1399. Rx acute vaso-occlusive crisis in sicke cell : Exchange transfusion
1400. Rx Acute dystonia : antihistamine or anticholinergic
1401. Rx Parkinsonism as a result of antipsychotic: Benzo
1402. Rx Akathesia : beta blockers
1403. Rx HEAVY UNREMITTING ENDO HEMORRHAGE : high dose conjugated estrogens
1404. Rx Stress Fx : restricting weight bearing + short leg casts (3 to 4 W)
1405. Rx Met breast cancer + lytic bone disease : IV pamidronate
1406. Rx intertrochanteric Fx of femur : internal fix with sliding screw and plate , early mobilization
1407. Rx Cholangitis : Drain biliary tree with ERCP
1408. Rx Lambert Eaton : plasmapheresis + immunosuppression
1409. Rx Emphysematous cholecystitis : Imm fluid + electrolyte correction + antibiotics + early surgical cholecystectomy
1410. Rx Acute exacerbation of MS: Steroides
1411. Rx Umblical hernia : mostly Observe ( look for few indection of intervention)
1412. Rx Cholestoma: surgical removal
1413. Rx GBS: IVIg, plasmaphresis
1414. Rx Hordeoulum/stye : warm compress no answer after 48 hours incision and drainage
1415. Rx Erysipelas : Peni
1416. Rx Fever in neutropenic pt : Cetazidime / Cefepime
1417. Rx MG crisis: plasmapheresis
1418. Rx Sarcoidosis : systemic steroids.
1419. Rx for prevention of recurrence of renal stone : know them well and also remember that Ca intake must be NORMAL or even INCREASED.
1420. Rx Osgood Schlatter disease: Rest, NSAIDs , brief casting
1421. Rx Molluscum : curettage or application of luquid nitrogens
1422. Rx Amebic liver abscess: metro
1423. Rx Hypochlo met alkalo : 0.9% Nacl , NG suction K supp
1424. Rx Anorexia asso w chemotherapy : Megestro acetate
1425. Rx Tension pneumothorax : needle thoraco
1426. Rx Sensory neuropathy w DM : TCA , Gabapentin , NSAIDs
1427. Rx acute pyeloneph : IV ampi + genta ( empiric )
1428. Rx VT hemo stable : Lido or Amio
1429. Rx prevention of variceal bleeding : beta blocker
1430. Rx pul infection if CF : aminoglyco + antipseudomona
1431. Rx Hydatid cyst : Surgery under cover of Albendazole ( Plz do not aspirate these cysts )
1432. Rx Reflex sympathetic dystrophy: physical therapy, prednisone , ganglion block
1433. Rx Chorioamnionitis :Ampi+ Genta
1434. Rx PCO: combines estro/prog or cyclic prog
1435. Rx Perforation of esophagus: primary closure of esophagus , drainage of mediastinum w/i 6 hours to prevent mediastinitis
1436. Rx Rotator cuff tendonitis : Lido injection
1437. Rx Megacolon: Iv fluids , Antibiotics , bowel rest , Iv cortico
1438. Rx Disseminated histoplasmosis in HIV: IV ampho B + LIFE LONG itraconazole
1439. Rx Pseudomonas : cefepim/ceftazidime
1440. Rx Dystonia : Anti hista , anti chol
1441. Rx AIDS with Dysphagia : 1-2 w of oral fluconazole no answer biopsy
1442. Rx Vipoma : correct dehydration slow diarrhea surgery
1443. Rx Ewings sarcoma : radio/chemo surgery
1444. Rx Croup : use racemic epinephrine before intubating your pt.
1445. Rx Free air under diaphragm : go to OR
1446. Rx Abnormal hemostasis due to uremia : DDAVP, Cryoper, conjugated estro
1447. Rx Pancreatic pseudocyst : only drain them if persist more then 6W or > 5 cm.
1448. Rx Capillary hemangioma: mostly regress by age of 7
1449. Rx Acute torsade de points: Mg replacement
1450. Rx MgSo4 tox: stop MgSo4, give Ca gluconate
1451. Rx CAD + EF30: Bracing.
1530. Rx Scoliosis >40: surgery
1531. Rx Shaft of humerus: closed reduction + hanging cast .
1532. Rx dirty looking wound in pt w less then 3 doses of tet tox: toxoid +Tig ( only situation which u give pt Tig)
1533. Rx uncomplicated Basilar skull fx : head elevation , fluid restriction.
1534. Rx Ludwig Angina: IV peni w coverage for anaerobes
1535. Rx Meconium plug syn : Water soluble contrast enema
1536. Rx Ovarian torsion : surgery
1537. Rx Tubo-ovarian abscess: surgery
1538. Rx volvulus or malrotation: immediate surgery
1539. Rx Transposition of great vessels: keep ductus arteriosus open, go for surgery.
1540. Patients who have Otitis media with effusion lasting longer than 3 months need an audiometry test ot objectively assess the loss of hearing.
1541. The combination of upper thigh and buttock claudication and impotence is highly suggestive of Leriche syndrome. Aortography is the modality of choice to diagnose the condition.
1542. Treatment with penicillin during labor and delivery has shown to be beneficial in the prevention of GBS disease if indicated.
1543. The first line agent for stage 1 hypetension with no other comorbidities is diet, exercise and hdrocholthiazide.
1544. Differentiate schizoaffective disorder and bipolar disorder or major depression with psychotic symptoms. The distinction is made by a required element for diagnosis of schizoaffective symptoms in the absence of mood symptoms for atleast 2 weeks.
1545. Low level of 5-HIAA have been consistently found in the CSF fluid of victims of violent suicide attempts.
1546. Acyclovir inhibits viral DNA synthesis.
1547. Turners syndrome is characteri zed by primary ovarian failure, multiple congenital anomalies, short stature and bilateral streaked ovaries. FSH elevation, greater than LH elevation, is classic for primary ovarian failure ovarian failure in Turner syndrome.
1548. OCPs have been shown to decrease the risk of ovarian and endometrial cancer. Breast cancer does not seem to change with their use. Besides hypertension, OCPs may be associated with other complications including thromboembolism, cerebrovascular disease, MI, gallbladder disease and benign hepatic tumors.
1549. Patients with chorioamnionitis exhibit fever greater than 38 C, uterine tenderness and irritability, elevated WBC count and fetal tachycardia. It is frequently associated with preterm or prolonged rupture of membrane.
1550. Labor should be allowed to proceed in patients with severe congential anomaly incompatible with life.
1551. Depressed DTR is the earliest sign of Mg sulfate toxicity which requires stopping of the Mg Sulfate and administration of calcium gluconate.
1552. Advanced stages of premature labor should be managed more aggressively and tocolysis has to be instituted at once. Mg Sulfate is the drug of choice for tocolysis.
1553. Septic abortion is managed with cervical and blood sampling, IV antibiotics, and gentle suction curettage.
1554. The screening test for diabetes is 50 gm OGTT.
1555. Local heat, bed rest and NSAIDs are the mainstay of treatment of superficial thrombophelibitis. Anticoagulants are indicated only when clot extends into the deep vein system.
1556. After a thorough history and physical examination, the forst step in the male infertility work up is the sperm count. If the sperm count is abnormal, an endocrine evaluation is carried out.
1557. Estrogen is the treatment of choice for atrophic vaginitis. It should be balanced with progesterone if the uterus is present.
1558. Secondary amennorhea is relatively common in elite female athletes and results from estrogen deficiency.
1559. Management of placenta previa depends on the severity of bleeding and the age of pregnancy. Know how each factor intervenes in management decision. Complete placenta previa needs C. section.
1560. Suction curettage is the treatment of choice for inevitable abortion.
1561. Oral hypoglycemic agents and ACE inhibitors are contraindicated in pregnancy and hydralazine, methyldopa and labetolol are used for hypertension in pregnancy
1562. Uric acid stone dissolve in alkaline medium. The treatment of choice is to alkanize the urine with potassium citrate or potassium bicarbonate.
1563. Patients with Pagets disease or osteitis deformans are often asymptomatic but may present with gross skeletal abnormalities, deafness, nerve compression syndrome, or simply an abnormal alkaline phosphatase level. Treatment is bisphosphonates.
1564. Patients with herpes zoster with significant pain should be given TCA such as desparamine in addition to Herpes Zoster.
1565. Amyloidosis is a syndrome described in drug users who pop their skin with drugs and have resurrent infections. These patients with a nephrotic syndrome with bland urine. They usually have large kidneys.
1566. Lye ingestion can lead to esophageal stricture and carcinoma.
1567. The symptoms of pneumaturia are specific for colovesical fistula.
1568. DiGeorge is best confirmed with PCR based genotyping.
1569. The most common side effect of narcotics is constipation.
1570. Depression is a side effect of interferon in Hep C. It is important to rule out the presence of sucicidal ideation and monitor the symptoms carefully.
1571. All pregnant women should be screened for asmptomatic bacteriuria in pregnancy, and women who demonstrate bacteriuri a (defined as a clean catch, midstream urine specimen with 25,000 to 100,000) should be treated with oral antibiotics.
1572. In adult polycystic disease, two genotypes are encountered, with a majority having a defect at the PKD1 locus on chromosome 16 and the minority having a defect at the PKD2 locus on chromosome 4. The latter had a better prognosis.
1573. Oral hypoglycemic agents and ACE inhibitors are contraindicated in pregnancy. Insulin is used in diabeted mellitus in pregnancy and hydralazine, methyldopa and labetolol are used for hypertension in pregnancy.
1574. Arrest disorder resulting from midpelvic contraction is treated with C-section.
1575. Forceps cannot be used until the cervis is fully dilated.
1576. Therpaeutic rest is advised for prolonged latent phase.
1577. Active phase arrest occurs when dilation fails to progressin the active phase of labor over a period of atleast 2 hours.This may be due to abnormal fetal lie, fetopelvic disproportion, inadequate uterine contractions or cervical anomalies. C section will be the treatment.
1578. ERT increases the requirement for L-thyroxine in patients receiving ERT. The potential cause may include induction o fliver enzymes, increased level of TBG, and an increas ed volume of the distribution of thyroid hormones. In pregnancy, also, thyroid hormone requirement will be increas ed, and the patients should be monitored every 4-6 weeks for dose adjustment.
1579. Know the criteria for hospitalization in PID. A common regime for PID includes cefotetan, cefoxitin plus doxycycline. Criteria for hospitalization are surgical emergency cannot be ruled out, pregnancy, failure to respond to outpatient treatment, suspected noncompliance, nulligravid, severe illness (includes nausea, vomiting) suspected TOA and pelvic abscess.
1580. The management of breech presentation depends on several maternal and fetal factors. And for vaginal delivery to be decided, the mother as well as the fetus should meet strict criteria:

1. Fetus in frank or complete breech.

2. G. age of atleast 36 weeks.
3. Estimated fetal weight between 2500g or 3800g.
4. Flexed fetal head.
5. Adequately large fetal maternal pelvis, as assessed by pelvimetry or tested by a prior delivery.
6. No maternal or fetal indications for cesarean section.
7. Experienced obstretician.

1581. Hypotension is the most common side effect of epidural anesthesia. The cause of hypotension is blood redistribution to lower extremities and venous pooling.
1582. Treatment for overflow incontinence includes cholinergic agents and intermittent self catheterization.
1583. The first step in a patient with secondary ammenorhea is to rule out common situation; that is, pregnancy, then hypothyroidism, and hyperprolactinemia. The subsequent step should be the determination of the patients estrogen status with progestin challenge test.
1584. After the events that are associated with excessive feto-maternal bleed, the failure to correct the dose of anti-D immune globulin may result in maternal alloimmunization.
1585. Lymphogranuloma venerum is a STD caused by Chlamydia trachomatis serotypes L1, L2 and L3 and manifest with generalized malaise, headache and fever with papule, which sunsequently transforms into a painless ulcer and reactive inguinal adenitis. Classic groove sign is usually seen in men and in second stage of the disease.
1586. Prolonged latent phase may be seen in twin pregnancy probably caused by overstretching of the uterus by large uterine content. Oxytocin is administered because of hypocontractile dysfunction.
1587. Painful third trimester vaginal bleeding with normal ultrasound is most likely due to placental abruption.
1588. In placenta previa of the bleeding is still continuing; perform C section as soon as possible even if the pregnancy is not at term.
1589. Edema of the lower extremity in pregnancy is most commonly a benign problem. Preeclampsia should be suspected if the edema is associated with hypertension or proteinuria, or if it is located on the hands and/or face. Know when to order Duplex.
1590. Primary dysmennorhea usually appears 6-12 months after menarche. NSAIDs (increas e prostaglandins) are highly effective for treatment; OC pills inhibit ovulation and also effective.
1591. Neonates of patients with Graves disease treated with surgery are at risk of thyrotoxicosis because of the passage of thyroid stimulating immunoglobulin across the placenta.
1592. In a post menopausal women with vulvar itch and dryness, lichen sclerosis must be suspected. However, vulvar carcinoma in situ must also be differentiated and a biopsy obtained if suspicion is high.
1593. In false labor, progressive cervical changes are absent and all such patient need assurance.
1594. BUN, serum creatinine, and hematocrit are often decreased in pregnant patients, and it is due to a dilutional affect.
1595. Asymptomatic bacteruria occurs when the urine culture grow >100,000 CFU per ml of a single organism in an asymptomatic patient. It is important to promptly treat the infection the infection to prevent progression to pyelonephritis in the pregnant patients.
1596. An antepartum hemorrhage with fetal heart changes, progressing from tachycardia, to bradycardia, to a sinusoidal pattern occurring suddenly after rupture of membranes suggests the diagnosis of vasa previa.
1597. DUB is the most common cause of abnormal uterine bleeding. Due to its benign nature, it is a diagnosis of exclusion. The most common case of DUB in adolescent women is anovulation. After menarche and before menopause it is considered physiologic. IV estrogen is the drug of choice for uncontrolled bleeding.
1598. In pregnant lady with Toxoplasmosis, Spiramycin is the drug of choice in first trimester; however combination of pyrimethamine and sulfadiazine is preferred in second and third trimester. Elective termination of pregnancy is an option in the first trimester of pregnancy.
1599. In complete abortion, the whole conceptus passed through the cervix. The cervix then closes, and pain and uterine contraction subside.
1600. Missed abortion involves a dead fetus that is still retained in the uterus. The diagnosis is suspected when there is disappearance of the nausea and vomiting of early pregnancy, and an arrest of uterine growth.
1601. Risk factors of cervical cancer include young age at first coitus, first pregnancy, high parity, multiple sex partners, a sexual partner with multiple sexual partners, smoking, and low socio-economic status.
1602. Lithium is associated with congenital anomalies, classically Ebsteins anomaly. When a woman is treated with isotretonoin, she should receive strict contraception. Inhaled steroids are okay in pregnancy.
1603. The most common cause of mucopurulent cervicitis is C trachomatis.
1604. Retinal hemorrhage is an extremely ominous sign of preeclampsia.
1605. Patients with placental abruption in labor have to be managed aggressively to insure a rapid vaginal. C section is used only when there are obstrectical indications, or when there is a rapid deterioriation of the state of either the mother or the fetus, and labor is an early stage.
1606. Steroids are used to enhance fetal lung maturity when premature of membranes occur less then 34 weeks of gestation.
1607. The increase in blood pressure that appears before 20 weeks gestation is either chronic hypertension or H mole.
1608. In cases of mild preecl ampsia, if pregnancy is remote from term and/or fetal lungs are not mature yet, the patient is managed with bed rest, salt reduced diet, and close observation.
1609. Cervical dysplasia in a hig risk patient should be investigated with colposcopy.
1610. Excessive use of oxytocin may cause water retention, hyponatremia, and seizures.
1611. Graves disease and migraine headache improve in pregnancy.
1612. Raloxifene is a mixed agonist/antagonist of estrogen receptors. In breast tissue and vaginal tissue, it is an antagonist, whereas in bone tissue it is an agonist and may be used to treat osteoporosis. It increases the risk of thromboembolism.
1613. Patients with testicular feminization syndrome presents with amenorrhea, developed breasts, absent pubic and axillary hair, absent internal reproductive organs and a 46 XY karyotype.
1614. MRKH is the result of mullerian agenesis. Patients have normal secondary sexual chrarcteristics, amennorhea, absent or rudimentary uterus, and a 46, XX karyotype.
1615. Premenopausal women with simple or complex hyperplasia without atypia usually respond to therapy with cyclic progestins. However, all patients should undergorepaet biopsy after 3-6 months. Even if this patient does not want more children, hysterectomy is not indicated.
1616. Clomiphene citrate acts by binding to hypothalamic estrogen receptors and suppressing the inhibitory effect estrogen has on GnRH production.
1617. Epidural anesthesia may cause overflow incontinence as a transient side effect. It is best treated with intermittent catheterization.
1618. RhoGAM is indicated in previously unsensitized Rh-negative women at 28 weeks of gestation, and within 72 hours after any procedure or incident and delivery.
1619. PCOD is characterized by an unbalanced estrogen secretion that may result in endometrial hyperplasia. Patients are treated with combined OC pills or cyclic progestins.
1620. Low back pain is a very common complaint in the third trimesterof preganancy. It is believed to be caused by increas e lumbar lordosis and the relaxation of the ligaments supporting the joints of the pelvic girdle.
1621. All patients with a PPD should undergo a chest x ray in order to exclude active TB before prescribing isoniazid prophylaxis.
1622. If MSAFP are found to be abnormal in pregnancy, the next step is USG.
1623. Labor should be induced in patients with IUFD who develop coagulation abormalities.
1624. Transvaginal ultrasound is more accurate than transabdominal ultrasonogram in diagnosing ectopic pregnancy, and should be performed when beta-HCG levels are below 1500 to 2000.
1625. A young woman with a breast lump can be asked to return after her menstrual period for reexamination if no obvious sign of malignancy are present.
1626. Abdominal circumference is the most effective parameter for estimation of fetal weight in cases of suspected IUGR.
1627. Female offsprings of women who ingested DES during their pregnancy are at increas ed risk of developing clear cell adenocarcinoma of vagina and cervix, as well as cervical anomalies and uterine malformations.
1628. In inevitable abortion, cervix is dilated without passage of the conceptus. It manifests with vaginal bleeding, lower abdominal cramps that may radiate to the back and perineum.
1629. Bed rest and hydration are the first step in stopping uterine contractions in early stages of preterm labor and if the measures fail, tocolytics are indicated.
1630. Tamoxifen decreases the overall mortality in patients with breat cancer by preventing recurrences, and cancer development in the opposite breast. It acts as an agonist on the endometrium and thus increases the risk of endometrial carcinoma.
1631. Graves disease is the most common cause of maternal hyperthyroidism. New onset, significant arrhythmia in a pregnant patient could be from hyperthyroidism. TSH should be ordered as a next step.
1632. All patients with a primary amenorrhea and high FSH levels need to have a karyotype determination.
1633. Granulosa cell tumors produce excessive amounts of estrogen, and can present with precococcious puberty in younger children and postmenopausal bleeding in elderly patients. This has to be differentiated from heterosexual precocious puberty or virilizing symptoms which are usually produced by excessive androgens.
1634. The increased incidence of UTI seen in females is due to shorter length of the urethra.
1635. Anethesia may reduce uterine activity if administered in latent phase.
1636. Patients with Kallmans syndrome have a normal karyotype, and present hypogonadotrophic hypogonadism, eunuchoid stature and anosmia.
1637. In a patient with primary amennorhea: a) FSH measurement should be ordered if there is no breast development b) GnRH stimulation test is the next step if breast development is decreased c) Karyotyping is the next step if breast development is increas ed.
1638. A decreas e in MSAFP and estriol, and an increas e in beta-hCG is typical of Downs syndrome.
1639. Presence of heavy menses, dysmennorhea and enlarged uterus is almost diagnostic of either adenomyosis or fibroid uerus.
1640. In presence of decreased fetal movements, fetal compromise should be suspected, and the best next step in the management in such cases is the performance of a NST.
1641. If any patient has grossly visible, bleeding cervical lesion biopsy should be performed. Pap smear alone is not appropriate. Know and understand the utility and indications of each procedure aimed at screening or diagnosing cervical pre-malignancies.
1642. GnRh stimulation test serves to differentiate between true isosexual and pseudoisosexual precocious puberty.
1643. Once the diagnosis of missed abortion is confirmed, surgical evacuation (D & C) of the uterus has to be performed to avoid serious complications, such as DIC and sepsis and to minimize the extent of the hemorrhage.
1644. Primary ovarian failure results in decreas ed estrogen and increased FSH and LH as a result of loss of feedback inhibition of estrogen and inhibin on these hormones. FSH elevation, more than LH elevation, is diagnostic of primary ovarian failure.
1645. Endoscopy is the next step in evaluation of a patient with GERD and painful swallowing.
1646. Gallium scintigraphy has a higher positive predicitive value than CT in detection of lymphoma.
1647. Hypoplastic left heart will have the following: No murmur, precordial hyperactivity, loud second heart sound.
1648. The presence of hemangioblastomas and an angiomatous lesion of retina are diagnostic of von Hippel-Lindau syndrome.
1649. Psychogenic seizures are characterized by lack of organized bilateral clonic jerks. Patients usually have asynchronous, alternating limb movement with suggestive pelvic thrusting.
1650. The tuberculoid form of leprosy is characterized by a vigorous form of immune response. Nerve involvement in leprosy is usually present before skin involvement.
1651. In relapsing polychondritis, chronic inflammation causes destruction of the supportive matrix around the tracheobronchial tree, and collapse on expiration is exaggerated. The result on pulmonary flow loop is slow flow on expiration.
1652. In tuberous sclerosis, during infancy, the common presentation is with infantile spasm. The characteristic EEG pattern is called hypsarrythmia. The use of ACTH may be effective in decreasing infantile spasm due to overproduction of CRH leading to excess excitability.
1653. Major veins at the base of neck have negative pressure during inspiration and, if injured at that moment, will suck air rather than bleed. The air embolism then leads to sudden death.
1654. Peritonitis in a patient with CAPD (Continous Ambulatory Peritoneal Dialysis) is usually due to Gram Positive organism.
1655. ARDS is characterized by PaO2 /FiO2 of less than 200.
1656. Diabetic cardiomyopathy is one of the causes of left ventricular hypertrophy and diastolic dysfunction.
1657. Normal labor and delivery is characterized by a lowering of fetal pH as the labor progresses. pH of 7.04, 7.05 and 7.06 are considered indications for immediately delivery.
1658. Erosio interdigitalis blastomycetica, a form of candiasis seen as an oval shaped area of macerated area white skin on the webs between and extending on the side of the fingers, is cuased by prolonged exposure to water.
1659. The major extra renal complications of APKD are: cerebral aneurysm, hepatic cyst, cardiac valve disease, colocin diverticula and abdominal and inguinal hernia.
1660. Ectopia lentis is a condition in which the lens is displaced upward, occurs in 50-70% of patients with Marfans.
1661. Onychomycosis is extremely diffi cult to treat with topical agents, the most effective agents are oral terbinafine or itraconozole
1662. Modern definition of agoraphobia is a fear of panic attacks in situations from which it would be difficult to remove oneself.
1663. In a patient with hemarthosis, with low factor VIII levels and an elevated PTT the possible diagnoses are congential hemophilia A and acquired anti-factor VIII antibodies. In order to differentiate between these two entities, a mixing study should be performed. In this test, the PTT is measured after the patients serum is mixed with normal serum. In the case of congenital hemophilia A, a mixing study will normalize the PTT because the normal serum has factor VIII. In the acquired anti-factor VIII antibody patient, the PTT will normalize with mixing.
1664. Atypical chest pain is the most common symptom associated with mitral valve prolapse.
1665. The first-line pharmacological agents of choice for the management of AOP (Apnea of Prematurity) are methylxanthines (caffine and theophylline) which acts to stimulate respiratory neurons.
1666. Treatment of any at risk pregnancy for 21-Hydroxylase deficiency is to start the administration of dexamethasone to the mother no later than the sixth week of pregnancy, and then perfom chorionic villus sampling between 10 and 12 weeks.
1667. Antibiotics are indicated for a cat bite at any location and any hand bite. For prophylaxis, one would use dicloxacillin for 3-5 days for a cat bite or penicillin V for 3-5 days for a cat bite on hand. If the wound is infected (pasturella multocida), then either penicillin or tetracycline is used.
1668. RTA 4 is frequently seen in patients with mild to moderate renal insufficiency due to diabetic nephropathy. Other causes include primary adrenal insufficiency, diabetes mellitus, renal insufficiency, effects of NSAIDs and ACE inhibitors, and potassium sparing diuretics.
1669. Chronic type A gastritis is immunologically mediated and is associated with an elevated level of parietal cell antibody. Thus, acid secretion is reduced.
1670. HOCM management: a) No symptoms: echocardiography and exercise testing b) Chest pain or dyspnea: echocardiography and exercise testing, then medical therapy (beta blockers, ca channel blocker); if symptoms persists coronary angiography c) Syncope and presyncope: echocardiography, holter monitoring, and cardiac angiography; consider electrophysiologic study d) Cardiac arrest: Full cardiac evaluation echocardiography, Holter monitoring, electropysiologic testing, and cardiac catheterization.
1671. Primary open angle glaucoma has several risk factors, including elevated intraocular pressure, black race, family history, and diabetes mellitus. Screening for individuals who have any of these risk factors should occur every year after the age of 40 years, according to the America Ophthalmology Society.
1672. The most common cause of mumps in pre-pubertal children is meningoencephalitis.
1673. Surgical management is the definitive treatment of toxic megacolon.
1674. Alkaptonuria is a deficiency in the enzyme homogentistic acid dioxygenase. The pigmented, polymerized form of homogentisic acid has a propensity for joints, especially the lumbar spine. It causes degenerative changes of these joints and can lead to significant morbidity. This accumulation in connective tissue is called as ochronosis.
1675. In spinal motor atrophy or Werdnig- Hoffman disease the simplest most definitive diagnostic test is molecular genetic marker in the blood for the survivor motor neuron gene (SMN).
1676. A spinal cord disorder should be considered in any patient with bilateral motor and sensory dysfunction in the extremities in the absence of signs or symptoms of brain or brainstem dysfunction.
2. Spinal cord compression due to epidural metastasis is a neurologic emergency for which urgent MRI of the entire spine is appropriate.
3. Vert ebral artery dissection typically presents with neck or head pain, Horner's syndrome, dysarthria, dysphagia, decreased pain and temperature sensation, dysmetria, ataxia, and vertigo.
4. Magnetic resonance angiography is a sensitive diagnostic test for vertebral artery dissection as a cause of stroke.
5. Juvenile myoclonic epilepsy is a primary, genetic, generalized epilepsy that typically manifests with myoclonic jerks followed by a generalized tonicclonic seizure
6. GuillainBarr syndrome is characterized by proximal and distal weakness, autonomic symptoms, cranial nerve involvement, and respiratory failure.
7. Treatment of GuillainBarr syndrome with either intravenous immunoglobulin or plasmapheresis is indicated in patients who cannot walk independently or who have impaired respiratory function or rapidly progressive weakness.
8. Small, stable, asymptomatic meningiomas can be followed with serial neuroimaging.
9. In large, symptomatic, or progressive meningiomas, surgical resection offers an 80% chance of cure.
10. Personality change, lost initiative, and slowing of thought, with relative preservation of recent memory, suggest frontotemporal dementia.
11. Frontotemporal dementia is usually associated with disproportionate atrophy of the anterior frontal and temporal lobes, a finding that is usually clearly demonstrated on MRI.
12. Elevation of the cerebrospinal fluid 14-3-3 protein in a patient with rapidly progressive dementia and normal structural imaging suggests CreutzfeldtJakob disease.
13. Treatment with interferon- beta decreases the incidence of additional attacks in patients with monosymptomatic demyelination, including optic neuritis and myelopathy.
14. Propranolol and primidone are first-line drugs in the treatment of essential tremor (postural and action tremor).
15. The diagnosis of Parkinson's disease requires the presence of at least two of the following: tremor at rest, bradykinesia, rigidity, and postural reflex abnormality.
16. The characteristics of migraine headache without aura include worsening of the headache with movement, limitation of activities, and photo- and phonophobia
17. Transverse myelitis is an acute or subacute demyelinative or inflammatory disorder of the spinal cord that causes motor, sensory, and autonomic dysfunction below a spinal cord level.
18. High-dose intravenous corticosteroids are indicated for initial treatment of acute transverse myelitis.
19. Secondary prevention of cardioembolic stroke consists of warfarin with a target INR of 2.0 to 3.0.
20. Heparin has no established role in the acute treatment of stroke.
21. The manifestations of partial seizures depend on their neuroanatomic location.
22. Frontal seizures are brief and are usually not associated with aura or postictal confusion.
23. Hereditary sensorimotor neuropathy is an autosomal dominant disorder that usually presents with clumsiness or difficulty running in the first decade of life.
24. Hereditary sensorimotor neuropathy is characterized by distal muscle atrophy, weakness, and sensory loss associated with high arches (pes cavus) and hammertoes
25. Cell type and tumor grade are the most important determinants of survival in glioma.
26. Higher-grade gliomas are more aggressive than lower grade.
27. Alzheimer's disease is characterized by primary dementia with prominent amnesia.
28. Dementia with Lewy bodies, characterized by fluctuating cognition, parkinsonism, and/or visual hallucinations, often coexists with Alzheimer's disease.
29. All patients with relapsing multiple sclerosis should be considered for immunomodulatory therapy with either a form of interferon-beta or glatiramer acetate.
30. Adult-onset idiopathic dystonia is usually focal or segmental and does not generalize to other parts of the body.
31. Botulinum toxin injections can correct the abnormal posture and alleviate the pain associated with cervical dystonia.
32. Approximately 20% of patients with migraine have headache with aura, that is, neurologic problems such as visual hallucinations or numbness or tingling before or during headache.
33. Lhermitte's sign, an electri c shocklike sensation down the neck, back, or extremities occurring with neck flexion, is a helpful historical clue to a cervical spinal cord disorder.
34. Cervical spondylosis is a chronic disorder of degenerative and hypertrophic changes of the vertebrae, ligaments, and disks that may narrow the spinal canal and cause cervical spinal cord compression.
35. In patients with stroke not eligible for thrombolytic therapy, aspirin modestly reduces both the short-term risk of recurrent stroke and the long-term risk of stroke-related death and disability.
36. In patients with acute stroke, thrombolytic therapy must be started within 3 hours of the onset of symptoms or of the time the patient was last known to be well.
37. Elderly patients may be particularly sensitive to the cognitive, motor, and coordination side effects of phenytoin, even if the serum phenytoin level is in the therapeutic range.
38. Gabapentin, lamotrigine, and carbamazepine are equally effective at controlling partial onset seizures in the elderly, but gabapentin and lamotrigine are better tolerated.
39. Peripheral nervous system vasculitis usually presents with asymmetric weakness and sensory loss in specific nerve distributions.
40. In an elderly patient with recurrent glioblastoma and poor performance status, referral for hospice care is preferable to additional antitumor treatment.
41. The three specific criteria for dementia with Lewy bodies are fluctuating encephalopathy, parkinsonism, and visual hallucinations.
42. A centrally acting anticholinesterase agent may alleviate the inattention, hallucinations, and fluctuating encephalopathy of dementia with Lewy bodies.
43. Women taking immunomodulatory treatment for multiple sclerosis should use effective contraception, or if they want to become pregnant, stop therapy several months before attempting to conceive.
44. Involuntary brief, irregular, unpredictable movements fleeting from one body part to another are hallmarks of chorea.
45. Chorea can occur as a hereditary and degenerative disease or secondary to drugs, metabolic disorders, infections, immune-mediated diseases, and vascular lesions.
46. Tension-type headache is distinguished from migraine by the fact that patients with tension headache are not disabled and can carry out activities of daily living in a normal, expedient manner.
47. Vitamin B12 deficiency can cause dysfunction of the posterior columns and corticospinal tracts of the spinal cord, causing paresthesias, loss of vibration and position sense, sensory ataxia, weakness, and upper motor neuron signs.
48. Neurologic signs of vitamin B12 deficiency may manifest in the absence of hematologic signs of vitamin B12 deficiency.
49. In a patient with a transient ischemic attack, carotid artery ultrasonography showing a >50% stenosis of the internal carotid artery may be an indication for carotid endarterectomy.
50. A single antiepileptic drug should be used in pregnant women with epilepsy; multiple drug therapy increases the risk for birth defects.
51. Chronic inflammatory demyelinating polyneuropathy, the chronic form of GuillainBarr syndrome, is charact erized by proximal and distal weakness, areflexia, and distal sensory loss.
52. Chronic inflammatory demyelinating polyneuropathy progresses in a stepwise or relapsing course for at least 8 weeks and can occur early in the course of HIV infection.
53. In a young patient with totally resected low-grade glioma, postsurgical management consists of observation with serial neuroimaging.
54. Vascul ar dementia is suggested by a history of vascular risk factors, abrupt onset with subsequent improvement, periventricular white matter ischemia
247. Restrictive cardiomyopathy is a late complication of radiation therapy.
248. A normal left ventricular wall thickness in radiation-induced restrictive cardiomyopathy helps to differentiate this entity from other cardiomyopathies characterized by ventricular hypertrophy.
249. In asymptomatic patients with chronic aortic regurgitation, surgery should be considered when left ventricular ejection fraction drops below 60% or the left ventricular systolic dimension reaches 55 mm.
250. In asymptomatic patients with aortic regurgitation, nifedipine may delay the timing of surgical intervention.
251. Aortic coarctation is associated with a continuous murmur (often posterior thorax) and elevated but equal blood pressure in both upper extremities.
252. A bicuspid aortic valve is often seen in association with aortic coarct ation, presenting with aortic regurgitation or aortic stenosis.
253. Physical findings of mitral regurgitation include holosystolic murmur at the apex radiating to the axilla, without respiratory variation.
254. In healthy adults, premature ventricular contractions are common and are not a cause for concern.
255. Suppression of premature ventricular contractions is indicated only in patients with severe and disabling symptoms.
256. Smoking, hypertension, advanced age, and male sex are risk factors for abdominal aortic aneurysm.
257. Most abdominal aortic aneurysms are asymptomatic, but abdominal pain is the most common symptom.
258. Patients at high risk for a subsequent coronary event after a myocardial infarction include those with multivessel coronary artery disease, anterior myocardial infarction, or a left ventricular ejection fraction 0.5 cm/year) increas e in aneurysm size.
307. Severe hemolytic anemia in a patient with a mechanical valve suggests paravalvular leakage due to partial dehiscence of the valve or infection.
308. Prosthetic valve dehiscence or dysfunction should be suspected in patients that develop symptoms of congestive heart failure, particularly if these symptoms occur in the first 6 months following surgery.
309. Right ventricular infarction is a cause of hypotension following inferior infarction and typically requires appropriate volume infusion.
310. Right ventricular infarction should be suspected as a cause of hypotension when findings of right heart failure coincide with an absence of evidence of pulmonary congestion.
311. Implantation of a cardioverter- defibrillator is an important prophylactic treatment in patients with hypertrophic cardiomyopathy and high risk for sudden death.
312. Clinical features that predict high risk for sudden death in patients with hypertrophic cardiomyopathy include family history of sudden death, syncope, marked left ventricular septal hypertrophy, nonsustained ventricular tachycardia, and exertional hypotension.
313. Papillary muscle rupture and ventricular septal defect are recognized mechanical complications that occur early after myocardial infarction.
314. Both papillary muscle rupture and ventricular septal defect present with hypotension and acute dyspnea.
315. Annual echocardiography is appropriate in a patient with asymptomatic severe mitral regurgitation.
316. The timing of surgery for severe mitral regurgitation is based on symptoms and measures of left ventricular size and systolic function.
317. Classic features of Marfan's syndrome includes tall stature, high arched palate, joint hypermobility, scoliosis, and positive wrist sign.
318. Patients with Marfan's syndrome are at increas ed risk for asymptomatic thoracic aortic aneurysm and associated aortic valve incompetence.
319. Intravenous amiodarone is the drug of choice for shock-resistant ventricular fibrillation.
320. The risk of coronary artery disease in diabetic patients is 2 to 4 times higher than in nondiabetic patients.
321. The pretest likelihood of disease should be calculated using available algorithms in patients with coronary risk factors.a
322. In patients with chest pain and intermediate risk of coronary artery disease, non-invasive testing is indicated.
323. Patients with chest pain and low coronary artery disease risk with a normal electrocardiogram and a normal exercise electrocardiogram can be discharged without coronary angiography.
324. Although uncommon, left atrial myxoma should be considered in young patients with embolic stroke.
325. Echocardiography is an important imaging modality for diagnosis of an intracardi ac tumor.
326. Women with Marfan syndrome are at increased risk of aortic dissection during pregnancy.
327. Aortic dissection should be considered in the differential diagnosis of chest pain in pregnancy.
328. The tachycardia rate in atrioventricular nodal reentrant tachycardia is typically 160180/min with the P wave buried in the QRS complex.
329. If atrioventricular nodal reentrant tachycardia does not respond to vagal maneuvers, adenosine is the treatment of choice
330. Continuous effective anticoagulation is needed throughout pregnancy in women with mechanical heart valves.
331. Radiofrequency catheter ablation is the most effective treatment for atrioventricular nodal reentrant tachycardia.
332. Calcium-channel blockers may be used for prophylaxis of recurrent atrioventricular nodal reentrant tachycardia but are less effective than radiofrequency catheter ablation.
333. The cardiac output is low in primary cardiogenic shock, and inotropic agents may be needed to augment myocardial contractility and thus cardiac output.
334. Exercise (or pharmacologic) stress testing is the most sensitive noninvasive method to establish the diagnosis of coronary artery disease.
335. Exercise (or pharmacologic) stress cardiac imaging can be used to evaluate for coronary artery disease if the resting electrocardiogram is abnormal.
336. The role of electron-beam CT coronary calcium scores is not yet established in the assessment of coronary artery disease.
337. Prolonged immobility followed by a stroke or transient ischemic attack should raise the suspicion of a paradoxical embolism.
338. Transesophageal echocardiography is the test of choice to confirm the diagnosis of a suspected patent foramen ovale or cardiac source of embolus.
339. Systemic lupus erythematosus is a cause of premature atherosclerotic coronary disease.
340. Other causes of acute myocardial infarction in young persons include coronary spasm, embolic coronary occlusion, and Kawas aki's disease.
341. High risk patients that require a heparin anticoagulation bridge after stopping warfarin prior to surgery include those with a mitral mechanical valve, atrial fibrillation, or previous embolism.
342. Low risk patients do not require a heparin bridge after stopping warfarin prior to surgery and include patients with a bileaflet aortic valve and no other high risk features.
343. Aspirin alone is not a sufficient replacement for warfarin, and is used only as a chronic adjunct in patients who manifest systemic emboli despite therapeutic warfarin therapy.
344. Radial-femoral delay is a characteristic physical finding in aortic coarct ation.
345. Bicuspid aortic valves are common in patients with aortic coarctation and are associated with a systolic ejection click and systolic murmur noted over the aortic area.
346. Elevated B-type natriuretic peptide levels occur with renal failure, acute coronary syndrome or myocardial infarction, and acute volume or pressure overload.
347. Adenosine is the treatment of choice for narrow-complex tachycardia.
348. Neither adenosine nor other atrioventricular nodal blocking agents should be given to patients with preexcited tachycardias.
349. Procainamide is the drug of choice for wide-complex tachycardia of unclear etiology.
350. Coronary angiography is indicated in patients with a history of unstable angina or non-ST-elevation myocardial infarction.
351. In patients with a high pretest probability of coronary artery disease, a negative stress test result is most likely to be false.
352. Spinal stenosis is characterized by pain with standing or walking that is relieved by sitting or bending forward and is further supported by a normal ABI.
353. Leg ischemia is characteri zed by pain with exertion and with a decrease in ABI of at least 20 % with exercise.
354. The use of angiotensin-converting enzyme inhibitors should be avoided during pregnancy.
355. Hydralazine and nitrates are the vasodilators of choice to treat heart failure during pregnancy.
356. Induction of mild hypothermia improves outcomes in comatose survivors of out-of-hospital cardiac arrest.
357. Aortic valve replacement is recommended once symptom onset occurs, regardless of patient age.
358. Symptom onset in aortic stenosis is often insidious and may include exertional dyspnea.
359. Alcoholic cardiomyopathy is a dilated cardiomyopathy.
360. Therapy for alcoholic cardiomyopathy must include total abstinence from alcohol.
361. In chronic angina, coronary artery bypass graft surgery is indicated for patients refractory to medical therapy; a large area of ischemic myocardium; high-risk coronary anatomy; and reduced left ventricular systolic function.
362. Atrial tachycardia with variable block is a classic electrocardiographic finding in digitalis toxicity.
363. The first-line treatment for life-threatening digitalis toxicity is administration of digoxin-specific antibody fragments.
364. Iron deficiency is a common cause for dyspnea and fatigue in patients with cyanotic heart disease.
365. The most common cause of iron deficiency in patients with cyanotic heart disease is recurrent phlebotomy.
366. Mitral valve surgery is indicated for symptomatic patients with chronic, severe mitral regurgitation.
367. In asymptomatic patients with chronic, severe mitral regurgitation, criteria for mitral valve surgery include an end-systolic dimension >45 mm, an end-diastolic dimension >60 mm, and an ejection fraction