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    Disclaimer: All gathered information from Lyme associations, manufactors, physicians and patients experiences are intended for informational purposes only and not intended as a substitute for your personal physician. Nor is any information, suggestions or protocol to be taken as a medical recommendation The use of any treatments is absolutely left to the individual, and we cannot make any warranties or guarantees about their effectiveness. If you have any doubts about these means or procedures, we recommend that you always seek medical advice from your chosen physician! Before starting with any medication, you should do the usual tests on blood, serum, or cerebrospinal fluid (CSF, Liquor cerebrospinalis), joint fluid, stool, sputum and perhaps skin scrapings, to find out which main pathogens may cause your symptoms, instead of starting empirically with any regimen! The diagnosis and treatment of Lyme disease is a very complex and difficult theme, for patients and most physicians, few of whom have any experience with Lyme disease and coinfections. As people afflicted with Lyme are aware, you cannot treat Lyme disease alone, without the help of specialists, so treatment might be just an illusion. There are so many other issues to consider simultaneously, such as titers, kidney and liver values, hypertension, red blood cell count and coagulation issues, diabetes, hormonal level, autoimmune diseases, iron level, albumin, homocysteine, and so on. I don't blame physicians, because they cannot know everything. Aortic Angiography is the answer Contrast angiography remains the criterion standard, most accurately revealing detailed vascular anatomic information. 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. Patients are more likely to have dyspnea or shortness of breath, arrhythmias and palpitations. If you are interested in more PA board review questions like these, please attend our 5-day, 50 hour CME & PANCE/PANRE Board Review in Chicago in September 18-22, 2015 for ONLY $550 (early bird registration). 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. Hypertrophic obstructive cardiomyopathy This patient presents with a systolic murmur that varies with respiration. Diazepam rectally 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. These signs are also accompanied by diarrhea, vomiting, nausea and loss of libido. Sublingual lorazepam (Ativan) The sweat test has been the gold standard diagnostic test for CF for many years. Which of the following therapies has been demonstrated to improve survival and hospital discharge with favorable neurologic outcomes in out of hospital cardiac arrest? A 19 yo woman presents with complaints of DOE and mild fatigue. This makes it likely that the etiology is right sided, and given the location, pulmonary stenosis is more likely than tricuspid regurgitation. Carbamazepine is an effective anticonvulsant, but it cannot be given IV or IM. Antifungal therapy 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. Exercise Stress Test3.) Which of the following would be most helpful in establishing the diagnosis of iron deficiency anemia? When left untreated, this condition can even lead to more health problems, one of which is osteoporosis. The sweat test is a quick, non-invasive, painless test that measures the levels of sodium and chloride excreted in sweat. Time to initial defibrillation Hypothermia has been confirmed as a benefit following out of hospital arrest in 2 studies. Higher-than-normal TIBC may mean: iron deficiency anemia. Aside from sweating, they can also experience pretibial myxedema, tremor and delirium. 8.) A patient complains of abdominal pain, low-grade fever, weight loss, nausea, vomiting and diarrhea. Colonoscopy reveals skip lesions, a cobblestone appearance and deep and longitudinal fissures. She has no significant medical history, does not use tobacco and takes no regular medications. These right sided murmurs vary with respiration because filling of the right heart is influenced by changes in thoracic pressure. IV pentobarbital can be used but because the patient is not currently convulsing, induction of barbiturate coma is not indicated. The presenting symptoms include fever, throat pain, and trismus. Patients with hyperthyroidism may also show some minor ocular symptoms. On exam, her lungs are clear and cardiac exam reveals a II/VI systolic murmur at the 2nd left intercostal space, which varies with inspiration. A 31-year-old man presents with repetitive generalized motor convulsions that continue for 35 minutes until 2 mg of lorazepam are administered intravenously. Ethosuximide is indicated for the treatment of absence but not generalized tonic-clonic seizures. Ultrasonography and computed tomographic scanning are useful in confirming a diagnosis. Two other family members have died of heart disease, one at age 50, the other at 56. 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. What is the most likely diagnosis for this patient? Which of the following should be administered next?? Rectal diazepam is used to abort seizures temporarily, especially in children. Needle aspiration remains the gold standard for diagnosis and treatment of peritonsillar abscess. 2.) A 35 year old woman complains of episodic chest pain that usually lasts for 5-10 minutes, is sometimes related to exercise but sometimes occurs at rest. On physical examination, her BP is 120/70, pulse is 70, and cardiac exam shows a II/VI systolic ejection murmur heard along the left sternal border that increases in intensity when she stands up. ECG shows nonspecific ST segment and T wave abnormalities. 6.) Which of the following is the preferred urgent treatment for an episode of panic disorder with terror and chest pressure?

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