ID, H&O, Psych

Question 1

A 25 yr old primigravida comes in her 1stTM with vaginal itching, gray discharge that coats the vaginal wall on speculum examination. Wet mount reveals numerous epithelial cells coated with bacteria.
Dx?
Mx?

Answer 1

Bacterial vaginosis ( gardenerella)
Oral metronidazole or clindamycin regardless of pregnancy status. ( concerns about using metronidazole in the first TM r not there anymore)

Question 2

Paeudothrombocytopenia is?

Answer 2

Lab error cxd by platelet aggregation in vitro- PS reveals large clamps of platelet, pt is apparently healthy with no personal or family hx of bleeding diathesis

Question 3

A 25 yr old gravida 2 para 1 mother comes at 8wks of gestation. Her blood type is O negative n the fathers is O positive. she received a standard dose(300microgram) antiD at 28wks, as well as 1day after delivery. She had placental abraption during her previous delivery. Her antiD titer is currently 1:32. How’s this explained?

Answer 3

1:32 means that the mother is sensitized . This probably occurred during her previous delivery ( abraption increases the risk n may need a higher dose of antiD)
- kleihauer-Beteke(KB) test is used to determine the dose after procedures or P.Abraption.
Therefore, this mother is sensitized because of inadequate dose of antiD after her 1st delivery.

Question 4

A bipolar woman on valproate wants to conceive n stops taking her OCPs. She says she would like to continue taking her mood meds to avoid hospitalization. How should u go about it?

Answer 4

Stop valproate n start her with lamotrigine

Question 5

A 34 yr old from Mexico comes after coughing up of foamy sputum with a significant amount of bright red blood. CXR shows a dense opacity in the rt upper lobe. 1)What should be the initial step in the mx of this pt?
2) the pt develops coughing episodes n SOB while in the ER n brings up 600ml of blood, fresh blood fills up the ETtube the next step in the mx?

Answer 5

1) Isolate the pt until PTB is ruled out (endemic area, upper lobe involvement.
2) bronchoscopy

Question 6

A pt with a stab injury to the left chest comes to the ER. Decreased breath sounds on the left n normal on the rt. Flat neck veins. Normal heart sounds. Left chest tube is inserted n immediate output is 2000ml blood. The best next step in the mx?

Answer 6

Emergent thoracotomy

Because this pt has massive hemothorax(>=1500ml) tube thoracostomy won’t b sufficient

Question 7

A pt with hematemesis is found to have a Hb of 6 n iv fluids were given n then started on blood transfusion. A few minutes later he develops dyspnea, RR30, BP90/70, PR120, in resp. distress, bilateral crackles, no stridor wheeze, normal heart sounds n flat neck veins. CXR bilateral pulmonary infiltrate.
Most likely Dx?
Mx?

Answer 7

TRALI- transfusion related lung injury.

Stop transfusion n ventilatory support.