part 2 Flashcards
indomethacin as tocolytic can cause what complication?
oligohydramnios
severe HTN in mommy, over 160/110. pulse is 56 and had an episode of emesis. what drug to give?
labetalol is out because of bradycardia, PO nifedipine is out because of emesis. whats left is IV hydralazine
axillary freckling, hyperpigmented spots with smooth borders, seizures. dx and complication?
NF1, optic glioma
NAAT for chlamydia positive, gonnorrhea negative rx? what if gonnorrhea positive and chlamydia negative?
azithro only. if gono positive then azithro and ceftriaxone (because of ceft resistance)
prepatellar bursitis/patellar tendinitis/patellofemoral pain syndrome difference
kneeling/ athletes jumping, on lower part of patella/ women, sitting for long time
caput succadaneum vs cephalohematoma
on scalp vs underneath periosteum and skull. latter stays in one skull bone surface
10 days of persistent cough and nasal discharge and face pain. dx and organism?
acute bacterial rhinosinusitis, non-typeable Haemophilus influenzae
70 yo man with stiffness in neck shoulders and hip for 3 months. elevated ESR, worst in the morning sxs. dx and rx?
polymyalgia rheumatica, corticosteroids
58 yo woman with ESRD underwent renal transplant 2 years ago, tacrolimus in serum is high, AKI. nothing unusual in urinalysis. dx?
calcineurin inhibitor renal toxicity
25 you woman with amaroxis fugax and resistant hypertension. dx? and next step
fibromuscular dysplasia and CT angiography
fibromyalgia mx?
aerobic exercise and good sleep hygiene. and then amitryptiline
52 yo woman with obstructive jaundice sxs but no scleral iceterus, high ALP, hyperlipidemia, no common bile duct dilation. dx and next step?
PBC. do an anti-mitochondrial antibody
COPD exacerbatino –> PEEP –> hypoxemia and decreased breath sounds in one lung–> ?
pneumothorax
acyclovir given then creatinine rises. BUN/Cr is less than 20. dx?
acute tubular necrosis (happens faster than AIN)
24 yo indian man travels back from india and drinks a glass of alcohol on flight. has no anemia but slightly high reticulocyte count and indirect bilirubin. u/s shows splenic infarction. dx?
sickle cell trait. flight or alcohol/dehydration can set it off
57 yo woman with pain on intercourse, vaginal itching, minimal clear discharge. pH is 6.5. dx and rx?
vaginal atrophy because pruritis is not common in bv. also pH is low in atrophy because no lactic acid due to low glycogen production. rx is topical cream
femur fracture surgery, has onset of confusion and hypoxemia and respiratory distress bilateral ground glass opacities, dx?
fat embolism. petichial rash only in 50 percent of cases
succinylcholine in setting of muscular crush injury can cause what complication?
cardiac arrhythmia due to hyperkalemia
2yo girl vomiting, encephalopathy, hepatic dysfunction, cerebral edema after given unknown OTC pain killer. dx?
reye’s syndrome
8 yo boy with HSP has what renal complication? pathophys?
IgA vasculitis causes hematuria in kids. elevated Cr and htn and nephrotic seen in adults with HSP
62 yo with gait unsteadiness, upper motor neuron in lower limbs LMN in upper limbs, electric shock like sensation in spine. no bladder or bowel incontinence. sensation normal. dx?
spinal cord compression. ALS is assymetric and shock sign (lhermette sign is uncommon)
vesicouretral reflux in 6 month old boy with blunting of renal calyces. if untreated, long term complication:
fibrosis/scaring of interstitial space
64 yo man with NSTEMI, is a heavy drinker, and has high cholesterol and triglyceride 465. normal 160. started on statins. rx?
not fibrate but alcohol reduction. statins better for mild triglyceridiema
loss of pain and temp ipsilateral face and contralaterla body, horners syndrome, nystagmus, vertigo. dx?
lateral medullary syndrome, vertebral artery occlusion
trauma ankle sprain. has burning and tingling like crazy. xray shows demineralization. dx?
complex regional pain syndrome
thrombocytopenia on lab test, smear shows clumped platelets, dx?
pseudothrombocytopenia
nodular tender bilateral breasts after cessation of oc pills. dx?
fibrocystic changes
82 yo man with cough sob and fever for 3 days. coughs chokes nasal regurgitation when swallow. next step?
video fluroscopic modiefied barium swallow for oropharygneal dysphagia. EGD for esophageal
34 yo man with frequent headaches, BP 185/105, continuous murmur heard everywhere in the thorax, dx?
coarctations
25 hr old baby boy full term, with hx of CF, has intestinal dilation and no stool in rectal vault. next step? and most likely dx?
contrast enema , meconium ileus.
deep puncture wound, what organisms?
staph aureus and pseudomonas
college girl living alone for first time since two months ago is scared of people breaking in, function disruption. checks on close door multiple times. dx?
adjustment
guy with fever malaise and cough and mild wheezing and crackles with contact history of son with URTI. CXR or treat sxs?
CXR. no rhinorrhea/sore throat (viral sxs) with crackiling- can be pneumonia. so just rule out
woman on COCP for 5 years now has HTN. what to do next?
stop ocp
hypercalciuria idiopathic and causing renal stones rx?
thiazide
72 yo man with chest pain. aortic stenosis on echocardiography, aortic valve area is 1.6cm3. what is the cause?
CAD
hyperventilation leading to alkalosis, what is going on in renal tubules?
loss of HCo3, urine is alkaline
neuropsychiatric symptoms plus liver biopsy of inflammation everywhere. dx?
wilsons
diffuse cutaneous vs limited cutaneous systemic sclerosis
both have raynauds and esophageal dysmotility. diffuse has internal organ involvement. limited has vascular involvement. anti-Scl-70(topoisomerase) vs anticentromere (CREST toothpaste)
claw toe in woman. dx?
diabetic neuropathy. imbalance between flexors and extensors due to motor neuron damage
caesarean, postpartum fever unresponsive to antibiotics. no localizing infectius signs. dx?
septic pelvic thrombophlebitis
39 yo woman intense constant abdo pain, fetal variable decelrations. previous history of myomectomy surgery in abdomen, uterine cavity was entered. dx?
uterine rupture. vaginal birth is contraindicated in myomectomy that enters uterus
RA, leukopenia, splenomegaly, dx?
felty
hypercotisolism. first step in algorithm?
dexamethosone suppression test or late night cortisol. then ACTH.
how to differentiate primary ciliary dyskiniesa and CF?
only CF has pancreatic insufficiency
4-5 cm fluctuant mass near anus with mucoid dishcarge? dx?
pilonidal disease
salt wasting baby boy, check what levels?
17-OH progesterone (due to 21-hydroxylase deficiency)
guy with chest abdomen blunt trauma, is hypotensive, tachycardic and elevated neck veins. cardiac contours on xray are normal. small pleural effusion. dx?
cardiac tamponade
65 yo guy has MI, treated with amiodarone, PCI done, good outcome. but now has transaminitis in the 1000s, alp is 114. normal bilirubin. dx?
hepatic ischemia, not amiodarone which presents with cholestasis
patient with serosis given diuretics, precipitates hepatic encephalopathy. mx?
IVFluids, correct potassium, lactulose
boy being treated for strep with penicllin, has fever, urticaria and joint pain. dx?
serum-sickness
internal capsule hemorrhage, which part of brain is nearby
putamen
72 yo smoker with back pain, sudden and severe. prevertebral calcifications on xray. dx?
AAA
52 yo frequent intermittent urinary incontinence and dysuria but no frequency or urgency. a tender 2 cm anterior vaginal mass is present with bloody discharge at urethral meatus on palpation. dx?
urethral diverticulum. UTI has frequency or urgency
24 yo woman at 31 weeks GA with maculopapular rash in the back involving palms and soles. small rash on back a week ago, and it has spread. dx?
syphillis
45 yo man with recent percutatneous liver biopsy presents with RUQ pain and hyperbilirubinemia and hemodynamic instability and anemia. dx?
hemobilia
sickle cell trait has what complication commonly?
hematuria
45 yo woman with proximal muscle weakness and dysphagia. high ESR and creatinine kinase. dx? and rx?
polymyositis, give steroids
29 yo woman with weakness and lightheadedneas, fatigue abdo pain and 10 kg weight loss. hypothyrodism history on levothyroxine, BP 80/50 and HR 110. orthostatic changes. pigmented buccal mucosa. peripheral eosinophilia. mild anemia. dx?
primary adrenal insufficiency
9 yo boy with firm rubbery non-tender tongue nodules. complication in this boy?
thyroid cancer, MEN2B - mucosal neuromas
clavicle fracture, and small hematoma, next step?
CT angiography. hard signs: bruit and absent pulses. soft signs: hematoma, hemorrhage, neurological deficits. do a CT angio. or else can do closed reduction
32 yo G1P0, 24 weeks GA has hematochezia, tenesmus and abdo pain. intermittent hematochezia in the past. diffusely tender. not infection. dx?
UC
patient on mechanical ventilation has 35%FiO2, PEEP is 4 cm. follows commands. 7.45 pH. CO2 35, O2 83. next step?
spontaneous breathing trial
pathophysiology of fast heart rate in increased cardiac output in hyperthyroidism?
increased sensitivity to catecholamines NOT increased production
30 yo white man with DVT. PT/PTT normal. most likely dx?
factor V leiden- activated protein C resistance. not antithrombin def (this is acqured) and antiphospholipid shoudl affect PT/PTT
tardive dyskinesia, cannot decrease antipsychotic (risperidone), the valbenazine/duetertrabenazine doesn’t work, next step?
switch to clozapine
septic arthritis, started vanco but 2 yo boy won’t get better. next step?
start ceftriaxone (has gram neg coverage as well) septic arhtritis is usually staph aureus so vanco should be good, but if not better, then usually gram neg.
mom with twins 30 wks GA has sudden onset severe epigastric and RUQ pain, vomiting. no fever. tachycardia but no hypotessnino. thrombocytopenia, leukocytosis, hypoglycemia, elevated liver enzymes, hyperbilirubinemia. dx and next step?
acute fatty liver of preganncy, immediate delivery
patient with RA has anemia of chronic disease. how to correct the anemia?
treat underlying disorder with methotrexate. then if refractory, give EPO. If all else fails, RBC packed cells
zenker diverticulum mechanism:
abnormal spasm or diminished relaxation of cricopharyngeal muscles. motor dysfunction basically. not cellular proliferation thats malignancy duh
diabetic foot ulcer. what to do next?
assess for osteomylelities RF (probe to bone test, larger than 2cm, ulcer lasting more than 1 week) then do bone biopsy
fat woman with acne and hirsutism how to distinguish between PCOS, CAH and sertoli-leydig tumor?
PCOS has high androgens but not high enough to cause clitoromegaly, voice deepening, etc. CAH has elevated DHEA and not high testosterone. S-L Tumor has high test
organophosphate poisioning in toddler. vomited over shirt. approach?
ABC, decontamination, remove clothing. then give atropine and pralidoxime (anticholinergic)
encephalopathy and liver failure in kid given aspirin. what to see on biopsy?
microvesicular steatosis. don’t give ASPIRIN
6 yo boy with polyuria and rash and soft tender, non-fluctuant mass on right anterior distal thigh. hypernatremia. skeletal survey shows lytic lesion on distal femur. dx?
langerhans cell histiocytosis
26 yo woman working in healthcare has nocturnal diarrhea constantly. metabolic alkalosis and hypokalemia. colonoscopy shows dark brown mucosal pigmentation in proximal colon, dx?
laxative abuse
multiple gestation preganncy. what to give mother to prevent something?
aspirin to prevent preeclampsia (3X risk in multiple gestation)
pain and paresthesia in the hand worst during dialysis. dx?
carpal tunnel sydnrome
66 yo woman with T2DM and oxycodone use presents with bloating flatulence, abdo discomfort for 6 months, carbohydrate breath testing with glucose is abnormal. dx and rx?
small intestine bacterial overgrowth, use rifaximin
alcoholic with epigastric pain now has ascities rich in total protein and amylase. soruce of this fluid?
pancreatitis
37 yo woman with severe RUQ pain, N/V. thrombocytopenia, transmaintis, hypoglycemia, hyperbilirubinemia, dx?
acute fatty liver of pregnancy
purple mass protruding in the vagina, in woman postpartum, hemo unstable, ddx? what to look out for for each
uterine inversion (uterus fundus not felt and severe abdo pain after pulling on cord), retained placenta (boggy uterus), vaginal hematoma (hypovoelmic shock after LGA infant
CLD patient has ascities, but presents with SOBoe and fatigue. dullness to percussino and decreased breath sounds, lower limb edema mild. what is reason/mechanism for the SOB symptoms?
ascites leaking through defects in the diaphragm, hepatic hydrothorax
otitis media in kid, now has mastoiditis, has headache and vomiting next step?
brain MRI looking for cerebral abscess
breast mass in 35 yo. next step?
U/S and mammogram THEN biopsy. core- for smaller mass. excision bioopsy for larger
febrile seizure in a kid that warrants further investigatino: (3)
more than 1 in 24 hrs, non-GTC, lasting more than 15 mins
patient with upper abdominal pain with nausea, alleviated by leaning forward, alcoholic and smoker, weight loss. next step? and dx?
abdo CT. pancreatitis
pain during morning run in the foot. dorisflexion of the toes and then palpation of the part of foot between heel and forefoot hurts. dx?
plantar fascitis
29 yo G1P0 at 12 weeks GA comes with some frequency but no dysuria urgency etc. at 10 weeks had asympotmaic bacteriuria and was treated with abx. now next step?
repeat urine culture because 1/3 of patients do not clear even after abx use
uncomplicated cystitis in non-pregnant woman. next step?
oral nitrofurantoin (or bactrim).NO urine culture needed, unless they fail treatment.
athelete who has gynecomastia and irritable mood and eryhtrocytosis. dx?
exogenous sterorid
bloody ascites after multiple paracentesis. dx?
HCC
patient with SLE has thrombosis, cause of this?
antiphospholipid syndrome (prolonged PTT)
23 yo man with pharyngitis, internal jugular vein thrombosis and lung nodules, dx and organism?
lemierre syndrome, fusobacterum
28 yo nulliparous has infertility for 7 months, comes with clear discharge for 2 days. clear mucus at cervical os on examination. dx?
ovulation. cervical mucus plug is for during pregnancy.
depression phase of bipolar disorder, rx?
quetiapine or lurasidone, or lamotrigine/lithium/valproate
hepatits C in pregnancy. true or false? can breastfeed/must have barrier protection in sex/receive hep A/B vaccine if unimmunized/C-section to prevent vertical transmission is indicated
true false true false
34 yo woman with drowsiness and progressive dyspnea. respiratory muscles fatigued, all muscles fatigued, dysphgia, normal reflexes. dx?
myasthenic crisis. GBS and botulism both have preceding respiratory or gastrointestinal symptoms
67 yo white guy with progressive blindness in right eye. on exam the straight lines look blurry. dx?
macular degeneration
SIADH right after surgery, has symptomatic hyponatremia. rx?
hypertonic saline. osmotic demyelination doesn’t happen if it is acute hyponatremia because brain adaptations take 48 hrs
52 hours old girl has IO. no stool in rectal vault. dilated loops of small bowel and paucity of air in colon and rectum. viscous meconium extracted. colon is found to be very narrow. dx? how to differntiate between meconeum ileus and hirschprungs?
meconium ileus. inspissated meconium, small narrow hypoplastic colon, no explosive bowel mvmt after rectal examination, obstruction is at ileum (not rectosigmoid for hirschprungs)
20 yo woman with bilateral sensorineurlal hearing loss and difficulty balancing. mother also had this at 20 yo. dx?
NF 2- vestibular schwanomaa
18 month old girl has rash and blisters all over body, superficial flaccid bullae with nikolsky sign, faicial edema with perioral crusting, single pustule under left naris. no mucosal lesions. dx?
SSSS. bullous impetigo is mini SSSS, TEN has mucosal involvement
high pitched cry in preveious IUGR baby with autonomic dysfunction in 2 day old baby, dx?
maternal heroin use
dementia workup: syphyllis vitamin D folate or B12 pick one.
B12. do TSH, B12, CBC and R/P. the others are directed.
severe knee dislocation after football tackle. palpable dorsalis pedis pulse. reduction surgically done. next step?
ABI to look for popliteal artery damage
LAD infarction. ACS, stent placed. then comes back again with ST elevation in V1-V4. patient not insured and unemployed. dx?
stent thrombosis
guy from arizona goes cave spelunkering and travels to New england. has CXR, bilateral alveolar opacities and hilar LAD. biopsy, granulomas with yeast forms. dx?
histoplasmosis. Coccidio is spherules with endospores
MDD started on fluoxetine, for 2 weeks then comes back with anxiety and insomnia. next step?
reduce dose. wait 6 weeks for it to work. insomnia and anxiety are activating effects
patietn with preeclampsia without severe features get mangesium sulfate and oxytocin. delivered baby, gets PPH, given oxytocin. later she gets seizure, GTC. no FND. hyponatremia. dx?
ADH looks like Oxytocin. a rare side effect of Oxytocin is hyponatremia
23 yo woman with fever and dysuria, sterile pyuria and bladder fullness. several tender ulcerated lesions on labia minora. no cervical friability or mucopurulent discharge, left inguinal tender LAD. dx?
HSV
36 yo woman with vertigo for 2 days after respi illness. taking COCP and has childhood asthma. dx?
vestibular neurtiis
guy trips down stairs and falls on head. should i do imaging to look for cervical fracture? what imaging modality?
yes do CT scan, if there is NSAID Neuro deficit spinal tenderness AMS Intoxication distracting injury
when to put IVC filter
contraindications to anticoagulation or recurrent DVT who failed anticoag
Acute limb ischemia. do CT angiogram? or ABI? or heparin infusion?
heparin. do not delay
5 day old girl with pink stains on diaper. peeling of hands and feet. mild weight loss and acrocyanosis. next step?
nothing. uric acid levels are phsyiologically elevated in babies
aortic dissection. do you need emergent surgery?
if it is Type A, the ascending aorta type. presents with syncope stroke, hypotension, MI, heart failure, asymmetry of BP in upper extremity. and aortic regurg
urinary stone, family history for stones, cyanide-nitroprusside test postive. hexagonal stones. dx?
cystieneuria- the AA transport defect
BPH rx 1st line and 2nd line?
Alpha agonist then 5-alpha reductase (works much slower- prostate size decrease)
37 yo man with neutropenia after stem cell transplant presents with fever hemoptysis and pleuritic chest pain. Chest CT shows bialteral nodular lesions with surrounding ground glass opacity. dx?
invasive aspergillosis (halo sign present) chronic is the fungus ball
REM sleep behavior disorder, kicking/punching druing sleep and dream enactment leads to what complicatino later on?
Parkinsons
65 yo woman with intermittent bloody stools - maroon colored. in between got normal stools. no anemia. has aortic stenosis. colonoscopy not great- could not see too well in right colon because of poor bowel prep. dx?
angiodysplasia. the AS makes the vWF worse or something
placent previa and the mom is in labor now. next step?CS or give anti-D immunoglobulin? mom has no prenatal care
CS because Rhogam can work upto 72 hrs later.
Tet spell baby has repair surgery, and 4 days post op has tachypnea and hypoxemia. Pleural fluid on cxray. thoracentesis results: exudative, high pH, high triglycerides, high lymphocytes. dx?
chyle
COPD patient with exacerbation. given ventilation, antibiotics, bronchodilators and corticosteroids. then appears to improve then gets worse. AMS. next step, dx?
ABG to look for hypercapnia (can be stimulated by oxygen supplementation)
vaginal SCC in patient, greatest risk factor?
smoking, not DES exposure (this is for clear cell adenoCA)
no fetal heart sounds heard. next step?
NOT NST. do an U/S
67 yo man with abdo discomfort and distension, recently had GE and lots of diarrhea. has heart failure, uses diuretics. abdo distened, tympanitic, CT shows diffuse dilation. C.diff negative. dx?
pseudoobstruction due to electrolyte abnormality
5 month old girl FTT, has NAGMA and alkaline urine. dx?
Renal tubular acidosis. poor cellular growth and idvision in acidotic environment
62 yo woman after CABG has skin lesions. bruising on abdomen. patches. receiving heparin for DVT prophylaxis. dx?
HIT
56 yo man POD3, fever, RUQ pain, leukocytosis. slightly elevated liver enzymes. ALP 100, bilirubin normal. dx?
acalculous cholecystiits
postoperative fever, couple hours after cholecystect. cause?
tissue damage
patient who had rash in dermatomal distribution, now its gone but has hyperesthesia in the same region. rx?
not acyclovir but gabapentin (for postherpetic neuralgia
baby born prematurely, how about vaccinations, which age does it follow?
chronologic
papulopustula roacea rx?
topical metronidazole
treated with bactrim 5 days ago, developed influenza like symptoms then rash and blisters that involves mucosa. dx?
SJS
Crohns disease patient with nephrolithiasis. dx?
oxalate stone
chronic rhinosinusitis, , asthma, bilateral nasal obstruction, discharge, anosmia, recent aspirin induced bronchospasm, dx and a/w
aspirin exacerbated respi disease, nasal polyp
60 year old man, 2 years of chronic cough, worse recently with SOB. spirometry is obstructive picture. CXR prominent bronchovascular markings and mild diaphragm markings. DLCO is 100%. dx?
chronic bronchitis
hyperthroydroid woman, non-tender diffusely enlarged goiter, anti-TPO high. tachycardia now. less than 5 percent RAIU dx and rx?
hashimotos, propranalol
2 yo girl with dysphagia only solid not liquid. has deep impression on esophagus at T4 level on barium esophagography. dx?
congential vascular malformation aortic ring
mucopurelent urethritis, no organism on gram stain. dx?
chlamydia
massive ascities rx?
furosemide and spironlactone
joint pain, chondrocalcinosis, DM and hepatomegaly. dx?
hemachromatosis
dome shaped firm, mobile nodule that regresses and returns. central punctum. dx?
epidermal inclusion cyst
22 yo sexually active woman with intermenstrual spotting presnting with RUQ pain with diffuse lower abdo pain as well. dx?
pelvic inflammatory disease w/ involvement of the hepatic capsule (fitz-hugh curtis)
28 yo woman coming back from hike in appalachian mts now has weakness in shoulder abduction. passive abduction is fine though. shoulder pain as well. no paresthesia/numbness. dx?
suprascapular nerve injury due to backpack compressing on it at suprascapular notch
biliary colic vs acute cholecystis differences?
former has intermittent pain, no leukocytosis, no fever/tachycardia, but liver enzymes normal in both.
72 yo man with acute limb ischemia, has HTN, T2DM, OA and AFib. what could have prevented the ALI?
anti-coagulation. based on CHAD VASC2 score
HIV patient gets PPD. 8mm area of induration. CXR clear. no symptoms. next step?
isoniazid and pyridoxine for 9 months. latent TB
3 month old, flooppy baby, recently moved to Cali bilateral ptosis, sluggish pupillary reflex, copious drool, weak suck and gag. no honey ingestion. dx? and rx
botulinum spores ingestion (even if no honey can be in soil/air) rx is human-derived botulinum Ig
osteomyelitis in kid. in puncture wound. in SCA?
s.aureus. pseudomonas. salmonella
gonorrhea and chlamydia. NAAT finds only one. rx in both situatinos?
gonorrhea give both ceftriaxone and azithro. chlamydia only give azithro. gonorrhea because of antibiotic resistance
45 yo man from China has heart failure sxs. CXR shows ring around heart. dx?
TB. constricitve pericarditis
guy runs 5 miles a day, BMI 17 and has tibial stress fracture. told he can’t exercise and he cries. dx?
anorexia
72 yo aunti presenting with tenesmus and concentric ringed erythematous mass protrudes out of anus on valsalva. dx?
rectal prolapse
indication for hormone replacement therapy in a menopausal woman?
vasomotor sxs. CAD and osteoporosis are not valid indicatinos.
62 yo man with T1DM, HTN, HLD has difficulty walking and pain on left foot, uses cane to walk. deformed ankle. XRAY shows bone loss, osteophytes, extraarticular bone fragments. dx?
charcot joint due to nerve damage!
kid ingested some pills. has abdo pain, diarrhea, hematemesis. and HAGMA.small opacities in stomach and duodenum on xray. dx? what if there was tinnitius?
Iron (Fe) poisioning. if tinnitus, aspirin
IUFD. you break bad news. patient says all i wanted was a baby… what do you do/say?
DONT leave them alone to grieve. stay in the room so patients can express grief to you
abrupt onset cough and wheeze in kid, xray shows hyperinflatino of one lung, mediastinal shift and focal lung exam, dx?
foreign body
asymptomatic MR, LVEF 52%. next step?
surgery to repair. LVEF overestimates due to regurgiatant
ITP. platelet 40000.skin bruises after respi illness. next step?
observation. treat with steroids/IvIG only when mucosal bleeding is present
anal pruritis in 3 yo, brightly demarcated erytehma over perianal area, dx?
perianus streptococcus
lynch syndrome cancers?
colon, endometrial, ovarian
acalculous cholecystitis. clostriudim septicum. nexxt step? how about candidemia?
colonoscopy, opthalmologic eval
cause of hepatorenal syndrome
dilation of splanchic arteries, causing renal hypoperfusion, RAAS system kicks in
