HY review #2 part 2 Flashcards
Irrepressible need to sleep.
Affecting performance at work/school
Naps help
Dx/Dxt/Tx?
CSF findings?
Narcolepsy
Polysomnography
Tx: SCHEDULED NAPS + Stimulants (Modafinil, Dextroamphetamine)
(+) Cataplexy add Sodium Oxybate
CSF: Low levels of Orexin (Hypocretin-1)
Complex motor behaviors during sleep
punching/ kicking in sleep
REM sleep behavior d/o
How should a hospital investigate the death of a 19 yo M who received defibrillation for unstable V-Tach?
Root- cause analysis
(wrong care done → supposed to do SCV)
When a patient makes sexually suggestive comments to the physician or behaves seductively, what should be done on NBMEs?
Use a chaperone when seeing pt
A medical student notices pt has worsening fevers and abdominal pain 3 days post-op.
The student observed one of the residents break the sterile field during surgery and feels it is a direct cause of the infection.
What is the most appropriate action by the student?
Duty to Report
to hospital’s adverse event reporting system
What should be offered to a 45M with Glioblastoma Multiforme who is now completely bed bound, cannot read or write, and is completely dependent on others for his activities of daily living?
Hospice
How can goals of care be established in a palliative medicine setting?
Family meeting
Newborn management of developmental dysplasia of the hip
pavlik harness
Palpable RLQ abdominal mass in a 2 yo child with a 2 day h/o intermittent abdominal pain.
dx/NBSIM?
Intusucception
Air or Contrast Enema
(diagnostic & therapeutic intervention)
Common neurologic complication in a child with Port wine stains on their face
Seizures
Sturge Weber syndrome
(Encephalo Trigeminal Angiomatosis)
Subdural hematoma in a 2 yo child of a 17 yo mom
NBSIM?
Call CPS
child abuse (brain bleed)
Medication that causes persistent erections (Priapism) or Myoclonus
Trazadone
(can cause serotonin syndrome)
Classic pharmacotherapy for uterine atony
Oxytocin
(mcc of PP-hemorrhage)
Classic presentation of Lateral Medullary infarct (Wallenberg syndrome) & affected artery
Vs
Medial Medullary infarct
Lateral Medullary
Ipsilateral pain/temp loss on face + contralateral on body
ipsilateral tongue deviation
Horner’s (ptosis & miosis)
PICA (rarely Vertebral a)
———————
Medial Medullary
Ipsilateral tongue deviation + contralateral Hemiparesis
Anterior Spinal Artery (rarely Vertebral a)
45M obese & skin is “tanned”
PE reveals a bulge just beneath his occiput.
Purple striae over most of his lower abdomen.
The most likely cause of this patient’s problem is?
A hyperfunctioning pituitary adenoma
pituitary bc hyperpigmentation
Cushing Dz s/t Pituitary Adenoma secreting ACTH.
ACTH Dependent b/c Hyperpigmentation (Skin Tan) present
ACTH released with MSH b/c same precursor POM-C.
6M has lethargy + acute onset high fevers
(+) Kernig’s and Brudzinski’s sign
CSF: 6000 WBCs + Neutrophilic + ↓ Glucose+ ↑ Protein
(+) growth on Thayer Martin agar.
3 days after admission, the patient passes away.
Recent CBC showed ↑ PT/PTT/D-dimer
Labs drawn 10s post mortem reveal
__ Cortisol __ ACTH __CRH
dx?
↓ Cortisol ↑ ACTH ↑ CRH
Meningococcal Meningitis
+ DIC s/t Adrenal Hemorrhage (Waterhouse Fredrikson Syndrome) causing 1º adrenal insufficiency (↓ Cortisol; ↑ ACTH)
Pt remains hypotensive s/p multiple boluses of IV Norepinephrine with no improvement in his symptoms.
PMH (+) severe asthma on oral prednisone.
dx/NBSIM
Adrenal insufficiency
Administer high dose dexamethasone and norepinephrine.
s/t Adrenal ATROPHY from chronic Glucocorticoid (Prednisone) use! Give stress dose of steroid.
Dx & __ Ca2+ __ PTH __ Ph
Primary hypoparathyroidism
Primary hyperparathyroidism
Secondary hyperparathyroidism
Tertiary hyperparathyroidism
hypercalcemia of malignancy
Primary hypoparathyroidism
↓ Ca2+ ↓ PTH ↑ Ph
DiGeorge
Thyroidectomy
Primary hyperparathyroidism
↑ Ca2+ ↑ PTH ↓ Ph
Adenoma
MEN 1 & 2A
Secondary hyperparathyroidism
↓ Ca2+ ↑ PTH ↑ Ph
CKD (↓ Vit D also)
1ºVit D def
Tertiary hyperparathyroidism
↑ Ca2+ ↑ PTH ↑ Ph
Kidney Transplant (gland already hypertrophied s/t CKD)
Hypercalcemia of malignancy
↑ Ca2+ ↓ PTH (Ph Varies)
Squamous cell carcinoma
Gonorrhea & Chlamydia
Screening: Women < __ should get ____ NAAT for both.
Women > __, only screen if they have “risk factors” like multiple sex partners, immunocompromised etc.
Treatment if:
Neither bug has been ruled out:
Gonorrhea (w/ruled out chlamydia):
Chlamydia (w/ruled out gonorrhea):
<24 sexually active → annual NAAT
> 24 screen if high risk
Neither ruled out: CTX + Doxycycline (or Azithromycin, 2nd line)
Gonorrhea (chlamydia r/o): Ceftriaxone
Chlamydia (gonorrhea r/o): Doxycycline (or Azithromycin)
BRF for encopresis (fecal incontinence) :
Ages:
Tx:
BRF → Constipation
Ages >4 yo
Tx → Stool softener
3 yo M Has been known to have hand flapping behavior
PE is notable for a large jaw.
He has restricted social interests.
Dx:
MOI:
Mutation:
Prognosis:
Cardiac problem:
GI Problem:
Fragile X
Mode of Inheritance: XLD
FMRI gene → CGG tri-nucleotide repeat
Normal life expectancy
Cardiac: MVP
GI: GERD
(FYI Alports the other XLD of the only 2 tested)
BRF for inherited intellectual disability:
Fragile X
52M 3 days after cardiac catheterization for an LAD infarct (recent MI), begins to complain of R sided UE and R lower facial weakness.
Dx:
Pathophysiology:
MC cardiac cath complication:
Common cause of this complication:
Other PMH that could have cause this:
Left MCA stroke (Face + UE)
s/t Blood Stasis (forms emboli)
MC cath cx: Re-Stenosis
Cause: Medication non-Adherence
Other PMH: A-Fib
23 yo Nigerian M with a 3 day history of increased urination and red urine. Has been admitted multiple times in the past for severe pain in his hands and feet.
Dx/Tx (3)?
Painless hematuria:
Pathophysiology:
Blood smear:
Sickle Cell Disease (SCD)
Hydroxy urea + Folate + Penicillin until age 5
Painless hematuria: Renal papillary necrosis
(s/t sickled cells occluding papilla)
Valine replaces Glutamic acid Beta Globin
Howell Jolly bodies → RBC w/ a single purple dot (nuclear remnants)
Insidious onset of R hip pain + h/o Sickle Cell Disease (SCD):
Avascular Necrosis of Femoral Head
MCC sepsis/meningitis in Sickle Cell Disease (SCD):
Streptococcus Pneumo
Common vitamin deficiency in Sickle Cell Disease (SCD):
Folate Deficiency (s/t high RBC turn-over uses up folate)
Bone pain and fever + h/o SCD:
Salmonella osteomyelitis
RUQ pain worsened by meals in pt with SCD:
Indirect bilirubin gallstones (pigmented)
SCD pt with 5 day h/o worsening SOB & a low retic count?
aplastic crisis
———
Hemolysis causes high reticular count
but low retics & low hb suggest aplastic crisis (likely s/t Parvo B19 )
Supracondyle (elbow) fx:
nerve? sensation?
other causes of this nerve being dmg?
Median n. Dmg
↓ sensation lateral palm + thumb/index/middle finger
↓ flexion of above fingers
(carpal tunnel compression → distal)
Medial Epicondyle fx:
nerve? sensation?
Ulnar n. Dmg
↓ grip strength, wrist flexion, finger spread
↓ sensation medial palm + 4th/5th fingers + hypothenar
Cubital Tunnel Syndrome
Anatomical snuffbox tenderness:
fx/tx/cx?
Scaphoid fracture
Thumb spica cast
(prevents Avascular necrosis)
Neutropenic pt + Fevers despite broad ABs treatment
CT chest → focal consolidation surrounded by ground glass opacity
Dx/Tx (2)?
Invasive aspergillosis (Halo sign)
Voriconazole → Amp B
Pt presents with cough + hemoptysis + ↑ Eosinophilia/IgE
CXR: mass in old TB cavitation
Dx/Tx?
Aspergilloma
Surgical Resection of mass
(This can also have asymptomatic presentation)
53M with Diabetes has a wood-like induration of the skin on extremities that spares the digits after a recent spinal MRI
Dx & BRF?
Description: Shiny, Thickened & Hyperpigmented.
Hard to the touch.
Nephrogenic systemic Fibrosis
(s/t Gadolinium based contrast for MRI)
BRF: CKD
───
Looks like scleroderma, but recent exposure to contrast gives away answer.
staggering gait in childhood
HOCM
Scoliosis
dx/defect?
Friedreich ataxia (AR)
GAA repeats
