Case Files 31-36 (J) Flashcards
A 12month old boy is brought in by his mother for 6 hours of intermittent inconsolable crying followed by vomiting of bilious emesis. He has been passing a small amount of stool that the mother calls “odd”
What is the most likely diagnosis?
What does this stool look like?
Whats the next diagnostic step?
Whats the next therapeutic step?
Intussusception
the stool will classically be called “currant jelly” stool.
The next step is abdominal xray to rule out a perforation. once confirmed that there is no perforation, you will order a barium enema to diagnose.
You treat this the same way you diagnose it! with an enema.
What is the most common GI obstruction in infants?
Hypertrophic pyloric stenosis.
What is the prototypical patient that presents with pyloric stenosis?
3-6 week old male with non-bilious projectile vomiting and an olive shaped mass in the RUQ
_____% of patients with congenital malrotation will become symptomatic before 1 mo of age.
60%
a one month old baby comes in with bilious vomiting and inconsolable crying. on PE you discover tenderness in the RUQ.
What is the most likely diagnosis?
What is the diagnostic step of choice?
What is the next therapeutic step?
Malrotation
If hemodynamically stable the test of choice is an upper GI series.
Surgery is the only treatment
What is the classic xray finding for an intestinal volvulus?
a “beak-like” appearance with contrast.
What are the “3 Ds” of the forgetful geriatric patient?
Dementia, Delirium, and Depression.
What is in the differential diagnosis of memory loss in the geriatric patient?
The “3 Ds”, stroke, thyroid, syphilis, medications, low B12, and other metabolic conditions.
What is the most widely used screening tool for dementia?
the Folstein MMSE. It has a sensitivity/Specificity for dementia of 87/82 percent
a quick test is the clock test
What are the 6 common areas of mental function affected by dementia?
- Retaining new information (short term memory)
- Complex tasks (paying bills)
- Reasoning (counting backwards by 7)
- Spacial orientation (getting lost)
- language (>7 F words in 1 min)
- Behavior (agitation, confusion, paranoia)
you have an 77 year old patient whose daughter brings her in because over the past 18 months she has progressively been “getting worse” with her short term memory and has been getting lost and frustrated.
What type of dementia is this?
Classic Alzheimer. defined as gradual progression of dysfunction in >1 mental function.
___ is also known as pseudodementia due to it being a common cause of memory disturbance.
Depression
What are the common drugs used to treat Alzheimer?
Donepezil, Galantamine, Rivastigmine, Tacrine, Memantine.
memorize these. Or don’t. I’m not your fucking mom.
you have an 77 year old patient whose daughter brings her in because last week she suddenly began having memory problems. She states that a few days later she began having trouble speaking. Her daughter states that her only medications are lipitor, metformin and HCTZ, and that she still smokes about 1/2 pack a day.
What type of dementia is this?
Vascular Dementia. She has been having strokes. note the sudden onset and “step-wise” progression with every stroke. she has all 4 of the most common risk factors: HTN, HLD, DM, and smoking.
you have an 77 year old patient whose daughter brings her in because for the past 6 months she has been having “episodes” where she is “out of it.” Her daughter describes periods of time where she will simply stare off into space or where she will talk gibberish. She states that her daytime naps have been getting more frequent.
What type of dementia is this?
Lewy Body Dementia. this type of dementia is known for its fluctuations in cognition.
you will classically see episodes of daytime drowsiness, staring off into space, disorganized speech, hallucinations, and parkinsonian extrapyramidal signs (tremor, bradykinesia, rigidity, and postural instability)
you have an 77 year old patient whose daughter brings her in because for the past 6 months she has been having memory loss, frequently falling, and urinary incontinence.
What type of dementia is this?
Normal Pressure Hydrocephalus. A potentially reversible form of dementia.
Classic triad of memory loss, gait ataxia (leading to falls), and urinary incontinence.
you have an 60 year old patient whose daughter brings her in because for the past 6 months she has “completely changed.” “She’s just mean now, and she was never this way before.” On physical exam you notice that she is constantly tapping her foot.
What kind of dementia is this?
Frontotemporal lobe dementia.
Obesity costs $_____ per year world wide in health care and lost production.
$100 BILLION!
not going to be on the test but god damn!
What is the screening tool for obesity?
BMI. Even though it sucks as it is not accurate measure for: CHF, short, tall, pregnant, elderly, athletic/muscular patients.
Obesity is defined as a BMI greater than____.
30
What are the risk factors for obesity?
What is the main contributor to the current epidemic?
lower education, lower SES, cessation of smoking(!)
an increase in caloric intake and a decrease in physical activity. Sorry it’s not “muh genes”
How much weight is needed to lower a patients risk of CVD?
How can that be achieved?
5% that’s it. That’s a 10 lb weight loss for the average american (20 for the average Ft Hood spouse)
a caloric deficit of 500 kcal/day produces a 1 lb/week weight loss. physical activity is an important part but can not produce weight loss alone, dietary changes must be made.
what is the best way to improve insulin sensitivity?
physical activity
Who qualifies for bariatric surgery?
BMI >40 or >35 with comorbid conditions
