Other Flashcards
what is Apneustic breathing
deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release and the end-inspiration pause before expiration
Deficiency of what factor may predispose a person to recurrent thrombosis?
Protein C
Deficiency of pro-coagulants causes bleeding diathesis while deficiency of anti-coagulants causes recurrent episodes of thrombosis. Protein C is a potent anti-coagulant. Both protein C and co-factor protein S are vitamin K dependent peptides. Protein C, which is produced by the liver, is a powerful naturally occurring anti-coagulant and is activated by thrombin. Thrombin (a powerful pro-coagulant) activates protein C after binding with a factor known as thrombomodulin. Activated protein C digests factor VIIIA and Va. Protein S is produced by endothelial cells and acts as a co-factor for protein C.
42yo woman comes to the clinic for routine physical. she has no specific concerns, but on ROS acknowledges that she has recently been getting tired easily. The pateint also has occasional palpitations, which she describes as a “fast heartbeat”. vital signs are normal. cadiac auscultation reveals a nonejection click and systolic murmur that vary in timing depending on body position. which of the following is the most likely cause of the pts exam findings?
Mitral valve prolapse
MVP typically reveals nonejection click due to snapping of mitral chordae as the valve cusps extend into the atrium during systole. followe by a systolic murmur of mitral regurg.
with increased venous return (squatting, supine leg raise) the LV end-diastolic volume is relatively high and critical point at which prolapse occurs is reached late in systole or may not be reached at all (disappearance of click)
in contrast, maneuvers that decrease venous return (valsalva, standing) resulvs in low LV end-distolic value where click or murmur is heard
28yo kindergarden teacher comes to the office due to gritty sensation and discharge form right eye for 3 days. she has had rhinorrhea, mild sore throat and intermittent fever. temp is 100.2 today. eye exam with mild injection and granular appearance of tarsal conjunctiva of right eye with profuse watery discharge. nasal mucosa is normal and pharynx has mild erythema without exudates. what is the best next step in management?
cool, moist compress
likely viral conjunctivitis. tx is conservative
47yo male comes to the office for intermittent rectal pain and bleeding. six months ago, pt first noticed small amount of blood on toilet paper after wiping. He self-treated with laxatives and sitz baths but symptoms persisted. pt has HIV and does not take antiretroviral meds consistently. he has had receptive anal intercouse in the past but not sincce these symptoms began. vitals are normal. anal exam with tender, 3-cm ulcer at posterior anal verge with indurated base that bleeds with light palpation. two firm, non-tender lymph nodes present at right side of groin. what is the most likely dx?
Anal cancer
pt with HIV and several months of anal pain and bleeding with evidence of anal ulcer and painless lymphadenoapthy is suggestive of anal cancer. develosp primarily from squamous epithelial cells due to HPV infection. b/c of immunosuppression and increased prevalence of multiple HPV serotypes, risk is greatest in men who have receptire anal intercourse and/or advanced HIV
a patient who previously had signs of delirium while in the hospital is at an increased risk for what?
cognitive decline
Short term: disorientation, falls, imobility, pressure ulcers, dehydration, aspiration pneumonia, prolonged hospitalization.
long term: persistent delirium, nursing home placement
permanent: cognitive decline/dementa. death ~20% mortality at 6 months
32yo, previously healthy female comes to the office due to several weeks of anxiety, palpitations, excessive sweating, and thinning hair. symptoms have progressively worsened and interfere significantly with daily activities. BP is 130/70 and pulse 104. PE, lid lag, mod exopthalmos, and fine tremor of outstretched hand are present. after dx is made, propranolol is prescribed for immediate symptom control.
which symptom is most likely to persist in this pt despite therapy?
exopthalmos
graves disease
