part 3 Flashcards
38 yo guy with schiaoaffective disorder comes with malaise, abdo pain, nasuesa, tremors. LOA. recent change in medication. elevated ALT/AST. what is culprit drug?
valproate
37 yo woman with 7 month history of amenorrhea and galactorrhea. pituitary adenoma found on MRI, 6mm. next step? approach to pit adenoma?
start cabergoline/bromocriptine. If refractory, or if greater than 3 cm, then you can do transsphenoidal surgery. if asx, observe
urinary stone. what warrants urological consult?
AKI, anuria, or urosepsis (fever tachy). or BIG stones greater than 1 cm. ureteral dilation is expected but not absolute indication of referral
60 yo man with 6 month history of back pain, thigh pain, headache. femoral bowing, unilateral hearing loss. dextroscoliosis in thorax, neuro is normal. dx?
paget’s disease of bone. rickets has some malabsorption problem but no hearing loss
2 year old girl with quotidian fever, maculopapular rash worse with fever, and fixed arthritis, dx? leukocytosis, thrombocytosis and elevated ESR, anemia.
systemic JIA
28 yo woman, IV drug user, infective endocarditis, has 2:1 AV block. dx?
Aortic regurg, perivalvular abscess. GOTCHA
6 yo boy with noisy breathing at night and mouth breather by night. gasping for air. weight is 25th percentile. dx?
OSA. kids dont need to be obese, often mouth breathe
violaceous tender indurated nodules on legs after bactrim. dx?
erythema nodosum
patient with visual/tactile bugs crawling hallucinations, skin picking, weight loss, tooth decay. dx?
chronic meth use
12 day old baby with rhinorrhea and wheezing , tachypnea. dx and complication associated with this?
bronchiolitis, and apnea
clean vs “dirty” surgery SSI abx prophylaxis. what to use for clean? if penicillin allergy?
1st line cefazolin (2nd gen ceph) if allergic, vanco or clinda
25 yo with anemia jaundice splenomegaly, spherocytes on film and positive coombs test and no family history. dx?
AIHA
symptomatic hypercalcemia. parathyroid is low. 1,25 vit D is low. dx? if vit d is high then?
hypercalcemia of malignancy/ lymphoma or sarcoidosis
suspected ovarian cancer in postmenopausal female, U/S shows 5 cm cyst. next step?
RMI–> do an CA125- much more specific in postmenopausal women. dont do needle biopsy because can seed
1 year old girl drinks a lot of cows milk, has microcytic anemia. dx? and rx
IDA, give oral iron
epidural done for delivery. now mom 10 days later has neurological symptoms in lower leg and back pain, fever. dx? next stpe
spinal epidural abscess. do urgent MRI
deaf boy and long QT. rx?
propranalol and pacemaker
how does hyperPTH cause HTN?
PTH stimulates zona glomerulosa for aldosterone production. and stiffens arteries?
PPROM in mom with 26 week GA baby. has fever, tachycardia. fetal tachy and purulent discharge from cervix. dx? and next step?
chorioamnioitis deliver NOW
72 yo with T2DM and slight drop in BP on standing has a syncope episode when putting on tie. dx?
vasovagal. carotid massage in elderly very sensitve
vulva pain and pruritis plus wickham’s striae, dx? and rx
lichen planus. steroids
UGIB, with Hb 6.8. given fluids. next step?
give PPI (not famotidine) and also packed red blood cell. whole blood when volume depeleted
oily nonbloody profuse watery stools after trip to lake. dx and patho?
giardia, local epithelial disruption
45 yo white man presents with cough SOB and hemoptysis for 2 days. PMH chronic sinusitis, works for granite company. creatinine increased. bilateral lung nodules on chest imaging. tracheal narrowing and ulceration dx?
WeCeners (granulomatosis with polyangitis)
57 yo woman with postmenopausal bleeding. light spotting she says, and asymtpomatic other wise. normal PE. next step?
Pap smear and endometrial biopsy (usually u/s done first)
63 yo man falls on shoulder, now has weakness on abduction. passively can but active is bad. the intial abduction is bad. drop test is abnormal. dx?
rotator cuff tear. surgical neck fracture/deltoid is best appreciated on full extension, not abduction. also should have tenderness and swelling
if there is a lot of study participants that leave, what kind of bias? surveillance bias, reporting bias, or selection bias?
selection (a type of attrition bias) surveillance is when you get more dx because more check ups. reporting is when subjects don’t report properly
7 yo girl with nasal sinusitis, nasal polyps and loose stools and failure to thrive. grey shiny masses after blowing nose at nasal turbinates. dx?
CF. Primary ciliary dyskinesia does not have GI sxs
town A has more leukemia patients than town B, best research study to use to compare incidence?
cohort
congenital hypothyroid. TSH 110 in baby. mechanism?
thryoid dysgenesis
cocain intoxication. give Bb?
can lead to unopposed alpha stimulation, worsen HTN
tourette’s disorder in kid. rx?
antipsychotic
ovarian torsion in pregnant mom, corpus luteum removed. 8 wk baby. what to do?
supplement progestin
T2DM, morbidly obese guy comes with perianal, scrotal, and abdo skin cellulitis like sxs. there is crepitus though. dx?
fourneiers gangrene
pain when patella is compressed into femoral groove. dx and rx
patellofemoral pain syndrome, NSAIDS and squats
primary amenorrhea at age 16. normal secondary sexual characteristics but no cervix. karyotype XX. dx and investigation to clinch it?
mullerian agenesis. do renal U/S
whistling noise getting worse after rhinoplasty, dx?
nasal septum perforation
5 yo with fever and sore throat, oropharynx has several scattered 1mm vesicles on anteror palatine pillars, several gray ulcers on soft palate and uvula, but nothing on lips, tongue, buccal mucosa. no skin rashes. dx?
herpangina by coxsackie A virus. usually vesicles/ulcers present in oropharynx, while HSV 1 (herpetic gingivostomatis) is present on lips/mouth. and gingiva
16 yo boy with ALL is given chemotherapy. next has renal injury. what electrolyte changes do you expect to see? PO4, K and Ca?
high, high and low. intracellular electrolytes released after lysis
24 yo with hyperemesis later has retrosternal crunching sound every time the heart beats. dx?
boerhave’s syndrome, esophageal perforation
36 yo man with abdo distension, diarrhea, flatulence. also fyi has night sweats, weight loss and arthralgia has oral ulcer as well. and cervical LAD. no skin rash or joint effusions. next step?
test for HIV
34 yo mom with chronic hypertension now has PPH with a soft uterus. what med is contraindicated in this patient? oxytocin, tranexamic acid, methylergonovine, misoprotol, carboprost tromethamine?
option C. hypertension may worsen with this vasoconstrictor. carboprost is contraindicated in asthma
50 yo man with rash, joint pain, malaise and fatigue. has glomerulonephritis, peripheral neuropathy, IV drug user Hep C positive, and a palpble purpura and hepatosplenomegaly. rheumatoid factor is positive and total complement is low. dx?
mixed cryoglobulinemia
most senstive test to pick up diabetic nephropathy, urine albumin to creatinine ratio OR urine dipstick?
UACR. picks up even the smallest proteinuria
64 yo woman with progressive rash. on face, groin and extremities, painful and pruritics. plaques with central clearing. also has diarrhea, and NCNC anemia. glucose level is 176. dx?
glucanoma- causing necrolytic migratory erythema
boy has wheezing and crackles and also hemo unstable after lunch at a family reunion. no rash. mucous membranes normal. do you give albuterol or epinephrine.
epi because involves more than 2 systems (Cardio and respi. others are GI and skin)
patient with bipolar has tremor ataxia and confusion. recently given thiazide. now has GTC. culprit drug?
lithium toxicity
needlestick injury while drawing blood on HIV patient. next step?
serology now and antiretroviral therapy with 3 drugs now. must establish baseline serology ma
painful and decreased visual acuity, eyelid swelling and conjunctivae 5 days after cataract surgery. dx?
postoperative endopthalmitis
69 yo woman on apixaban for AF and has asthma exacerbation with cough. now has acute onset abdo pain with mass on abdo wall worse when coughing/straining. anemia and leukocytosis present. dx?
rectal sheath hematoma (older woman in anticoagulants)
45 yo man with dyspnea on exertion and fatigue. ESRD on dialysis. Hb is normal due to EPO and iron supplementation. AV fistula is distended with strong pulse augmentation. BP is 160/100 pulse 100 and carotid upstroke is brisk. PMI is deviated to left and soft systolic murmur is heard, trace peripheral edema, warm peripheries. what is cause of symptoms?
increased cardiac preload. due to drop in SVR (fistula). BP equals CO x SVR so cardiac output compensates for drop in SVR. increased pulse pressure
18 yo AA male who has polyuria, even after restricting liquids at night. and relative with SCA. afebrile and normotensive. urinalysis shows specific gravity of urine is low ,serum sodium is normal. dx?
hyposthenuria of SCT (sickle cell trait)
17 yo girl with anorexia is started on nasogastric feeds and on 2nd day develops respi distress and ventricular tachycardia. in shock, crackles in lungs and jugular venous distension. hypokalemia, hypophosphatemia, hypomagnesemia. what led to this?
refeeding syndrome: food given after prolonged starvation causes insulin release, which causes cells to uptake potassium, Mg and PO4. the resulting hypokalemia causes cardiopulmonary failure
35 yo AA guy with nephrotic syndrome, hepatits and HIV negative. obese. heavy proteinuria. dx?
FSGS (most common cause in obese, AA males)
27 yo pregnant woman who recently had a course of abx for cystitis, now has hearing loss on the right side. otoscopy is normal. conduction hearing loss on right side. dx?
NOT abx because it would cause sensorineural. otosclerosis. can present in pregnancy. may not have the red blushing of TM
68 yo man with T2DM, presents with ankle pain and swelling, small tibiotalar joint effusion, chronic calcification of articular cartilage. dx?
pseudogout
19 yo AA man with fatigue and SOBOE, with no other PMH, has NCNC anemia, splenomegaly, jaundice and increased LDH. dx?
NOT SCA because spleen should have infarcted by now and no mention of vasoocclusive crisis
6 hr old girl in respi distress looks plethoric, has high hematocrit and hypoglycemia. dx?
polycythemia, can occur due to intrauterine hypoxemia
52 yo auntie with chest pain and SOB, pleuritic pain, and arthritis. exudative effusion with low glucose. no rashes. ANA negative. dx?
RA
severely burned patient getting fluid resus. poured hot oil on trunk and genitals and legs. what to do next?
urinary catheter
15 yo boy with dysarthra and ataxia. MRI shows atrophy of medulla and dorsal columns of spinal cord. what will he die of most likely? and dx?
cardiac arrythmia/failure. due to HOCM. freidrich ataxia
suppurative parotiis in a 72 yo after laparotomy for IO. how to prevent this?
oral hygiene and fluid intake
hemoglobin is 20.2, EPO is high. ddx?
secondary EPO- hypoxemia, EPO-producing tumors- RCC or HCC
mass at dorsal surface of wrist, aunty mui fong, transilluminates. dx?
ganglion cyst. leave it alone
42 yo woman with elevated ALP, AST ALT normal. is taking a statin. anti mitochondrial antibody is positive with high titers. U/S shows nothing. next step? and dx?
start ursodeoxycholic acid. PBC
xray in child’s wrist shows cortical bulging at the radius, dx? and rx
distal radius buckle fracture. pain control and splint
AECOPD (acute exacerbation of COPD). doesn’t get better with initial stuff. relatviely stable patient. next step?
non-invasive PPV, then intubation if fails or severe sxs develop
capillary blood specimens- fingerstick lead levels is high. 12, when normal is under 5. next step?
venous glucose to rule out false positive from fingerstick. if high/sxs, then give chelation. succimer or EDTA (in emergency)
56 yo man with burning sensation in feet, absent ankle reflexes, loss of vibratory sensation. alcoholic. and construction worker. MMA is normal, HbA1c normal. dx?
alcoholic neuropathy
AF in WPW patient. rx?
procainamide
59 yo guy has distal gastrectomy and now after eating 15-20 mins later has abdo cramps, diarrhea, sweating, weakness, palpitations, nausea, light-headedness. dx and next step?
dumping syndrome. caused by rapid shift of food into duodenum. next step is dietary modification
difference between disruptive mood regulation disorder and intermittent explosive disorder
former is diagnosed before 18 and has anger/irritability in between episodes
randomization in a study controls for what?
confounding factors
23 yo primi mother at 38 weeks GA. has joint stiffness and fatigue for a month, and a erythematous confluent facial rash. baby heart rate tracing shows fetal bradycardia with no accelerations. dx?
heart block due to SLE antibodies that are in fetus now
14 yo with secondary sexual characteristics comes with primary amenorrhea. next step?
reassure. 13 without SSC, 15 with SSC
24 yo woman with frequency, back pain, sharp pulling pain in groin, recurrent nephrolithiasis before pregnancy. renal U/S reveals bilateral hydronephrosis and bilaterally enlarged kidneys. right ureter is more dilated than left. dx? and next step?
reassure, physiologic changes in pregnancy. with recurrent nephrolithiasis you would expect unilateral changes. dextrorotated uterus cause right dilation more than left
40 yo man with sudden onset dysphagia and odynophagia and retrosternal pain, endoscopy shows large ulcer in middle esophagus with normal looking mucosa surrounding it. dx?
pill induced esophagitis
7 yo boy with hair loss. looks completely normal except for patches of hairloss.
alopecia areata (autoimmune dz)
62 yo woman with slowly growing nodule on back of neck, smooth, flesh colored and translucent nodule, central telangiectasia. dx and rx?
BCC. and narrow margin surgical excision (moh’s if on face)
24 yo woman with pressure like substernal chest pain on exertion. arm blood pressures are different an murmur at 1st right intercostal space and palpable thrill at supra sternal notch. lungs clear. what is mechanism of chest pain? and dx?
increased myocardial oxygen demand. due to supravalvular aortic stenosis causing LVH and coronary artery stenosis
AAA screening?
65-75, once, for men with any smoking history
42 yo man with palpitations has pAF and given antiarrythmics. during treadmill exercise, the QRS prolongs. what drug was he given?
flecanaide (1C antiarrythmics cause use dependence) the faster the heart goes the longer QRS becomes
20 yo sexually active female has recurrent cystitis. e coli. clears it well. next step?
post-coital abx
wilms tumor vs neuroblastoma
former is from 2-5, can often cause hypertension, arises from the kidney. latter is under 2 yo, from adrenals, and HTN not as common
26 yo woman 35 wk GA has painful regular contractions, rupture of membranes show bright red amniotic fluid. fetal heart rate shows sinusoidal pattern. dx?
fetal anemia
38 yo woman with hydatidiform mole with bhcg 50000. after suction curettage, bhcg is 1500. next step? and rationale
monitor b-hcg and contraception for 6 months (rationale: pregnancy raises b-hcg and obscures data) recurrence of b-hcg means gestational trophoblastic disease /chorioCA has arrived. rx this with methotrexate or hysterectomy
unilateral copper colored nipple discharge in 48 yo woman taking antipsychotics. no masses or LAD. dx?
intraductal papilloma. galactorrhea is clear and milky
64 yo man admitted for ischemic colitis, alcoholic. given parenteral nutrition and receiving pip tazo. bleeding happens from venipuncture site. vitals stable. no thrombocytopenia. but PT is very prolonged and PTT slightly prolonged. dx?
Vit K deficiency. liver problem plus parenteral nutrition plus broad spectrum abx means all sources of vit K are hurting. bleeding from venipuncture site can be DIVC but not likely when hemo stable and platelets are normal. PT is deranged more in Vit k def then PTT
intermittent solid dysphagia in 29 yo man. has allergies. dx?
eosinophilic esophagitis
acute bacterial prostatitis what abx?
fluroquinolone or bactrim. not Nitrofurantoin because cannot reach good concentration in the prostate
CSF findings in cryptococcal meningitis and TB meningitis?
high protein low glucose for former, very low glucose for latter
hydroxyurea SE?
myelosuppresioon
28 yo man with abnormal jerky movements of arm, headache, fever, AMS and has HIV , CD4 less than 50. MRI shows multiple ring enhancing lesinos. dx and rx?
toxoplasmosis and leucovorin. Bactrim is for prophylaxis
45 yo woman with renal transplanatation stopped taking bactrim and valgancylovir because of neutropenia. now has pneumonia like illness and gastointestinal bloody diarrhea and mild hepatitis. organism?
CMV. bacteremia
isolated elvated ALP in a elderly man. dx and next step?
paget disease of bone. do xray and radionuclide scan
what tests should be done to determine presence of acute Hep B infection?
HBsAg and Anti-HBc IgM
36 yo woman primigravida, 22 weeks GA, immigrant to US has anemia. male fetus has edematous scalp and nuchal fold, abdomen has a lot of flud, polyhydramnios but fetal size (BPD and femur length) is normal. dx?
alpha thal, hydrops. barts
24 yo man has cough for 2 months. no fever chest pain dyspnea but dull back pain. no neuro deficits. imaging shows pulmonary nodules and retroperiotneal LAD. next step? dx?
testicular CA. do a scrotal u/s
68 yo man with SOBOE, non productive cough for a year. has hTN and OA. travel history extensive in navy but retired 8 years ago. RR 20 O2 sat 94. fine inspiratory crackles at the lung bases. rest of exam is normal. dx? and TLC, FEV1/FVC, DLCO levels?
ILD. low normal low. NAVY equals asbestos
88 yo man had femoral embolectomy now presents with exquisite calf pain, swollen tense, pain worse on dorsiflexion of ankle. skin cool and shiny, sensation is decreased. unable to move toes. peripheral pulses are normal. dx? recurrent embolism vs DVT vs compartment
compartment. READ THE PROCEDURE DONE, embolectomy means reperfusion of leg. senses and motor disturbance is not common in DVT. pulse should be gone in embolism (ALI)
45 yo guy with 6 months of burning recurrent epigastric pain and diarrhea. and steatorrhea. weight loss. PPI barely helps. stool occult blood positive. OGD shows two duodenal and one jejunal ulcer. why steatorrhea?
pancreatic enzymes are inactivated by excess acid. (gastrin producing tumor ma)
43 yo with fatigue and SOB has no chest pain, nausea vomting or weight loss. had a recent URTI. now BP 98/55, HR 105, elevated JVP and CXR shows cardiomegaly with what I think looks like widened mediastinum? dx and what will be associated PE finding?
pericardial effusion causing cardiac tamponade. the “widended mediastinum” plus cardiomegaly is a water bottle shaped heart looking like pericardial effusion. distant heart sounds is the triad. so point of maximal impulse will not be nonpalpable (answer)
5 yo boy with orbital celluitis, has dental infection, unilateral facial pain on palpation and recurrent otitis media. and insect bite underneat eye. what led to the orbital cellulitis?
sinusitis
16 yo boy with SOBOE, fatigue, no chest pain. has sickle cell disease. frequent hospitalizations for pain crisis and acute chest syndrome. on oxycodone for bone pain. macrocytic anemia with low reticulocyte count. dx?
folate deficiency. state of chronic hemolysis can lead to macrocytic anemia with low reticulocytes. sxs from anemia
18 month old girl with uncomplicated UTI. does better clinically after abx. what to do next?
renal U/S because lower than 2 years old must always get. repeat blood culture and FBC only when no symptomatic improvement
RA complication?
osteoporosis osteopenia, bone fractures
acute otitis media in 5 month old boy. what was risk factor for this?
smoke exposure (cigarret)
42 yo woman with abnormal uterine bleeding, daily breast tenderness and abdo bloating. has 10 cm complex ovarian mass and irregular endometrial stripe. dx and next step?
Granulosa cell tumor causing increased estrogen, which explains AUB, breast pain and endometrial stripe. do endometrial biopsy first
63 yo guy with cough and wheezing and yellow sputum has pneumonia 2 years ago. recently had LOW of 15 lbs and is a heavy smoker and drinker. chest hyperinflation and scattered wheezes. pink puffer. new onset clubbing. cause of clubbing?
lung CA. COPD does not cause clubbing
44 yo man with fever and cough, fatigue and dyspnea on exertion. then develops fever with chills and productive cough. mucosal pallor and ecchymoses. bronchial breath sounds. fever. tachycardia. no LAD or splenomegaly. pancytopenia thats it for labs. dx?
aplastic anemia- acquired deficiency of pluripotent stem cells WTF
25 yo man with right shoulder pain for 3 months. also swelling and pain at heels. tender at heels, iliac crests, tibila tuberosity. dx and cause?
long jong tia bro. but is enthesitis inflmmatino and pain at sites where tendons/ligaments attach to bone. common causes are ankylosing spon and Psoriatric arhtritis.
after 2nd pack of RBC being transfused. woman gets fever tachypnea,SPO2 tnormal. hemo unstable? and hematuria. dx? and next step
acute hemolytic reaction. hematuria not common in anaphylaxis. stop transfusion. give IVF and supportive care
asian american woman gets borborygmi after lactose. next step?
hydrogen breath test. lactose is digested by bacteria- fermentation
asymmetric sensorineural hearing loss with CN V involvemnet. dx?
vestibular schwanomma. can extend to IAM to impinge on CP angle and pons, V and VII can be affected. eustachian tube dysfunction and cholesteatoma is conductive hearing loss
urethral meatus extends to corona on penis ventral aspect. new born baby. father wants circumcision. what next?
do urology study.
thoracic aortic aneurysm what abx to avoid?
fluoroquinolone. you know they can do the achilles thing right
hydroxychloroquine for SLE, SE
retinopathy
65 yo man with ischemic cardiomyopathy, has 2 weeks of progressive SOB and nonproductive cough. patient recently treated with antiarrhythmic for VTachy. jugular veins flat, bilateral inspiratory crackles in lung. no edema. CXR shows bilateral interstitial infiltrate in middle lobes. dx?
NOT advanced heart failure (no edema/ distended JVP) it is amiodarone tox
68 yo man patient with LUTS and enlarged prostate. next step?
NOT U/S but urinalysis.
woman getting epidural 20 mins later has perioral numbness, metallic taste in mouth and GTC. dx?
epidural (bupivacaine) toxicity, inhibiting the inhibitory pathways leading to CNS hyperactivity
renal calculi present. prevention advice?
increased fluids, decreased sodium, normal ca
frequent complication of rib fracture and how to prevent it
atelectasis and pneumonia due to shallow breathing. so give pain control
26 yo man with cerebella mass on MRI, has retinal hemangioblastoma and renal cysts. dx?
HARP- renal cysts are premalignant. VHL syndrome
post term gestation (42 weeks) is highest risk for?
oligohydramnios and placental insufficiency
15 yo guy who has LOC and perioral rash. confused. what drug?
inhalants
caustic ingestion next steps?
assess for perforation then do OGD
66 yo man with T2Dm has hyperkalemia, BUN/cr 20, NAGMA and slight renal injury. dx?
renal tubular acidosis
PCV 13 (conjugate) or PCV 23 (polysaccharide) recommendation? for patient with CLD?
over 65, give PCV 13 then PCV 23. and under 65 with high risk coniditions as well. For patients with CLD, heart/lung disease, DM/ smoking) only give PCV 23 then PCV 13 followed by PCV 23 after 65.
65 yo man with nephrolithiaisis, has gout and obesty and metaboic syndrome. urine pH is low. dx?
uric acid
carcinoid syndrome. what nutrient is missing?
niacin
newborn with jaundice and hepatomegaly, SGA. microcephaly and periventricular calcification. dx?
CMV
49 yo woman with dysphagia solid food. crackers and breads. water helps to swallow.some LOW. eye drops for dryness. PE shows oral thrush, dental caries, firm submandibular nodules. dx?
sjrogens, do anti-ro la/ssa ssb
is it septic arthritis? is it transient synovitis? fever , not willing to walk, next step?
bilateral U/S, with or without arhtrocentesises
severe hypotension after chest stab wound. massive hemothorax. 2000ml after chest tube insertion. next step?
emergent thoracostomy
56 yo with SOBOE 6 months after MI. has distended jugular veins, bibasilar crackles, lower extremity pitting edema. BP 144/86, HR 52. ECG shows deep q waves and V1-V4 ST elevation. dx?
left ventricular aneurysm. it is NOT RV failure because of evidence of pulm edema as well as you would expect hypotension and 2,3,Avf St elevation
30 yo woman has URTI then barotrauma while flying. blood on finger while scratching ear canal. hearing loss persistent since three days ago. next step?
reassure
5 yo girl with itchy private parts at night, perianal erythema, vulvar erythematous. dx?
pinworm
recurrent infections everywhere. Ig is all low. CD4 and CD8 positive cells are low. dx?
SCID. CVID is Xlinked Agammaglobulinemia toned down a bit
paracentesis shows ascities albumin is 3.8 serum albumin is 2.5. what is cause?
3.8 - 2.5 is 1.3. SAAG (serum to ascities albumin gradient) greater than 1.1 is transudative fluid
64 yo woman with ESRD on dialysis is getting EPO and iron supplementatino has hypertensive crisis. reason for this?
EPO worsens hypertensino
OSA patient with BMI 48 kg/m2, JVD difficult to assess because of neck fat. bilateral pitting edema but clear lungs. comes because of SOB. dx? and what is O2, CO2, EPO, HCO3, Cl- levels?
obesity hypoventilation syndrome. low, high, high, high, low. (bicarb and chloride exchnager)
patient with UC now has elevated ALP and fatigue. lower left abdo pain and ANCA positive dx?
PSC
74 yo man with lung cancer now presents with urinary incontinence, saddle anesthesia, weakenss in bilateral lower limbs, decreased knee reflexes, patchy area of lower limb sensation numbness. neurolocalization?
cauda equina syndrome, not conus medullaris or spinal cord because cauda equina is LMN signs
systemic scleoriss what causes the esophageal dysmotility?
smooth muscle atrophy and fibrosis
3 yo girl with fall and hit head, no alarming features, do U/S? CT non contrast? or send home?
send home
13 yo girl, rectal pain, cyclic, and amenorrhea. has firm smooth mass protruding out of vagina. dx?
imperforate hymen. sarcoma botryoidies is grape like mass with bleeding
hyperpigmentation during pregnancy on the face
melasma
1st time seizure workup?
electrolyte, toxic and ECG
31 yo man with joint pain everywhere, urethritis and mouth ulcers and enthesitis. knee arhtrocentesis is normal. dx?and rx?
reactive arthritis. triad is oligoarthritis, urethritis and conjunctivitis. and pentad is enthesitis and mucocutaneous lesions. NSAIDS
29 yo woman with knee pain and swelling. xray shows soap bubble like lytic lesion dx?
giant cell tumor of bone
primary adrenal insufficiency suspected. next steps?
8 am cortisol and ACTH stimulation test
myasthenic crisis. patient intubated. next step?
plasmapherisis or IViG or corticosteroids
PBC, a/w complication which one?
osteomalacia
64 yo man with CABG 6 weeks ago now presents with deep pleuritic chest pain.fever, leukocytosis. tachycardia. dx?
dressler’s pericarditis
6 month old girl with poor feeding and recurrent respi infections, has to and fro murmur at second left intercostal space, loud S2 and bounding pulses and widened pulse pressure. dx?
PDA
32 yo woman with dysmenorrhea nad acne. with infertility. horomnes normal. dx?
PCOS. CLINICAL and biochemical
urge vs overflow incontinence. how to distinguish
post void residual volume
hyperacute acute chronic transplant rejection mx?
remove, increase steroids, remove
21 yo guy comes to ask for renewal of opioids with hip pain, reduced range of motion. labs are normal. xray is normal. is this guy malingering?
nah. known complication of known diseas
kid has puncture wound needs tetanus vaccine. mom agrees dad disagrees. next step?
give it. one parent consent required only for appropriate treatment
sensorineural hearing loss in a 5 yo boy. normal looking. is it noise exposure or congenital infection?
CMV
6 mm calculus in left ureter. medical mx? besides pain control, hydration
tamsulosin (alpha blocker) is sm muscle relaxant at bladder neck, ureter and prostate. furosemide causes stones
sjrogens syndrome, what complication of the eye? and why
corneal ulceration because of hyperosmotic state of eye/cornea due to not lacrimation
anti-HCV positive but HCV DNA negative. dx?
cleared HCV
47 yo man with new T2DM, cholesterol is borderline. rx?
lifestyle plus statin (CVD risk in patients with diabetes over 40
Rhogam given in first pregnancy at 28 weeks and again after delivery complicated by placental abruption. now pregnant again. alloimmunization. present. what went wrong?
adequate dose not given the 2nd time after delivery
asx postmenopausal woman has pap smear and endometrial cells found. next step?
endometrial biopsy in women over 45 or postmenopausal
47 yo woman with SLE has fatigue, weight loss of 5 kg and low grade fevers. takes hydroxychloroqquine. vitals normal, cervical and axillary LAD. LDH is very increased. mild anemia. dx?
non-hodgkin’s lymphoma
6 month old boy who vomited after feeds. has deep abdo pain and undescended testses. dx?
testicular torsion
19 yo woman with recurrent headaches and hypertension. both arms high BP, pulses equal in all 4. subauricular bruit. dx?
fibromuscular dyslasia
68 yo man with CABG. POD 1 has confusion and decreased urine output. hypotension. tachycardia. cool extremities. lungs clear. ECG nonspecific. equalization of cardiac chamber pressures. dx?
tamponade
cystic hygroma and brachial cleft cyst and thyroglossal cyst locations
back of neck, anterior to SCM after URTI, and midline
27 yo man with recurrent nosebleeds, and ruby papules on lip has clubbing and increased hematocrit. dx and what is causing the increased hematocrit?
osler-weber-rendu. hereditary telangiectasia. look for AVM in lungs
pancytopenai/thrombocytopenia in SLE mechanism of this?
autoimmune destruction.. platelets is ITP
48 yo man with CVRF has ear discomfort in the morning, and then later found to have semi-facial droop and unable to close eyes and drink from straw, loss of nasolabial fold etc. next step?
prednisone. prodromal symptom of auricular pain
acute , unilateral cervical LAD in 8 yo. has aneaerobic bacteria inside. most common cause/RF for this?
dental hygiene crap
GN with normal completment levels 4 days after URTI. dx?
IgA nephropathy. not nephrotic. it is nephritic sigh
elderly man taking tamsulosin and alprazolam, because ataxic, angry and confused afterwards. which drug
benzo
60 yo woman with THBSO at 52 yo now has dry vagina, pathcy erthema, labia minora retracted, presents with urinary incontinence, dysruia and nocturia. not stress, not overflow. dx?
estrogen deficiency, can cause incontinence
false positive for drug screen for PCP?
dextromethorphan
peritonsilar abscess, next step?
drain with peritonsillar aspiration then abx
back pain worse at night lying down in middle aged man, weight loss. dx?
pancreatic body/tail CA
2 day old boy with no prenatal care vomits up feeds, has weight gain despite poor urine voiding, pulmonary hypoplasia causingrespiratory distress. dx?
posterior urethral valves
5 yo girl with joint pain and rash, knees then ankles then rash on back, had a sore throat a few weeks ago. esr and crp elevated. dx?
JONES- migratory joint pain, nodules, erythema marginatum, sydenhams
3 yo boy with acute tender cervical LAD. abx?
clindamycin
60 yo man with syncope and AS, what heart sound do you hear? soft single S2 or early peaking systolic murmur? explain
soft single S2. soft because heavily calcified valves, not as elastic. single because usually A2 closes before S2 (due to higher pressure buildup in A2) but now together because A2 takes longer. It is also NOT early peaking, but late peaking in severe AS because more pressure needed to open the highly stenotic valve
43 yo woman who comes with abdo pain and dark urine. labs show cytopenia, hemolytic anemia, and hepatic thrombosis. dx?
PNH. you get hypercoagulable state in autoimmune anemias
scleroderma reanl crisis: malignant HTN, acute renal failure. what do you see on peripheral smear?
schistocytes
unilateral adrenal adenoma (aldosterone-secreting) patient does not want to go through surgery. next step?
MRA- eplerenone
waldenstrom macroglobulinemia
excessive IgM and end organ damage. hyperviscosity, neurotpathy, cryoglobulinemia
27 yo woman who works at daycare has symmetric polyarthropathy that is acute for 10 days. ill-defined rash on back. dx?
parvovirus. SLE more chronic
54 yo woman with fatigue. and peripheral neuropathy. has macrocytic anemia. what is she at risk of ?
gastric CA dude
respiratory distress after a CVP catheter removal. dx and mx?
venous air embolism. move patient to left lateral decubitus and give high flow O2
painless 3rd trimester bloody show. transient bloody discharge, doppler has no fetal heart tone. dx?
vasa previa. placenta previa is mother’s blood so a lot of blood, hypotension and tachy. but vasa is fetus blood. not much, but causes fetal exsanguination
28 yo woman with infertility, has hcg injection for ovulation induction. presents with N/V abdo pain, distension and persistnet vomiting. sinus tachy, decreased breath sounds. elevated HCG, pelvic U/S small uterus with thin endometrium, bilateral enlarged ovaries with multple cysts , large amount of free fluid in abdomen. dx?
ovarian hyperstimulation syndrome
28 yo man with solid testicular mass, hypoechoic on u/s. next step?
don’t biopsy, just radical orchiectomy it
diffuse vs periventricular calcifications dx?
toxo vs CMV
upper airway cough syndrome, chronic cough, non-smoker. rx?
chopeniramen
22 yo with recent travel to mexico, 4 days of fever, double vision, periorbital edema, nausea vomiting, eosinophilia, subungual splinter hemorrhages, CK is high. dx?
trichenellosis
57 yo smoker with hematuria. has fever and fatigue. unilateral varicocele that fails to empty when recumbent. high Hb and platelets. dx and next step?
RCC and CT abdo
36 yo woman has prolactinoma for awhile, taking cabergoline. suddenly she has severe headache and bitemporal hemianopsia and weak nausea and dizzy. hypotension and orthostatic hypotension. dx?
pituitary apoplexy
58 yo man with CAD and HTN attempts suicide has hypotension, AV block and sinus bradycardia. given IVF and atropine, no improvement next step?
glucagon
cushingoid appearance in 66 yo man taking steroid for long time but now stopped. what abnormality do you see?
central adrenal insufficiency. it shuts down the whole ssytem. central AI also doesn’t have hyponatremia because RAAS system is autonomous and intact
second stage of labor arrest. next step? fundal pressure or vaccum?
vaccum
farmer in misssisipi has erythema nodusm and hilar adenopathy and non caseating granuloma, given corticosteroids and then deteriorates. dx?
histo
fever tinnitus and tachypnea in suicide attempt overdose on meds. what acid base?
mixed
