part 4 Flashcards
year after cholecystectomy, 52 yo obese woman has gallstone pain, no jaundice, but elevated ALP and AST/ALT. mild common bile duct dilation. dx and next step?
post-cholecystect syndrome, do ERCP
hyperosmolar hyperketotic state, potassium is 4.8. given fluids and insulin. next step?
give IV potassium, if lower than 5.3
high-voltage QRS complexes, st depression at lateral leads, lateral T wave inversion. and nose bleeding and headaches, BP is high in 29 yo old. dx?
coarctation
cervical spinal cord atrophy and weakness in limbs, high arching foot. dx?
freiderich’s ataxia- trinucleotide repaet
16 yo boy with fever and sore throat, severe myalgia, mottling of skin of legs, non-suppurative pharyngitis, severe pain. dx?
meningococcemia
crohn’s disease, with fractures. what do you expect on calcium, phosphorus, PTH levels?
low low high. vitamin D def
HAGMA with envelope shaped urine crystals. dx?
ethylene glycol poisoing
hypocalcemia and hyper PTH. next step?
vitamin D levels
severe watery diarrhea and flushing and electrolyte abnormality (hypokalemia), 3 cm pancreatic tail mass. dx?
VIPoma
65 yo woman with low bone density, given alendronate then takes antacid for gERD. has hypercalcemia, high HCO3 and hypomagnesemia and hypophosphatemia., creatinine is slightly higher than before. what is cause of hyper Ca?
milk-alkali syndrome
empyema vs parapnuemonic (uncomplicated) effusion
WBC >50000, pH less than 7.2, glucose less than 60
46 yo man with severe MVA has RUQ pain, pericholecystic fluid, no stones, diestneded bowels. dx?
acalculous cholecystitis (severe injury/disease, presents like gallbladder obstruction/infectino)
baby with umbilical cord cut by kitchen scissors, DIY delivery, and honey mixed in formula. now is hyperreflexic and neck stiffness, and stridor. no vaccinations for mother and child. dx?
tetanus
PPROM is a/w what other obsetric complication?
placental abruptuion, infection, PTLabour
56 yo man has septic shock, critical condition. now has occult stool blood. dx?
stress ulcer
cervical spine injury and paralysis. respi distress. next step?
intubate
35 yo woman with dysphagia, episodic retrosternal pain that radiates to back, lasts 15 mins each time, triggered by hot and cold food or emotion. next step? and dx?
esophageal manometry for diffuse esophageal spasm
cancer related cachexia and HIV cachexia what to give to stimulate appetite
progesterone analog and synthetic cannabinoid, respectively
15 day old baby with bilious vomiting and abdo distension. abdo xray shows no gas. then next step? and dx?
malrotation and volvulus, do a UPPER GI series (barium swallow)
trastuzumab toxicity?
cardio
AFib, aflutter where are they generated in the heart
pulmonary vein ostia, tricuspid annulus
painful vesicular hand rash in sexually active person. dx?
herpetic whitlow
PCP pneumonia with o2 92% and PaO2 54, rx?
bactrim and corticosteroids (if below PaO2 below 70, o2 is below 92, or if AA gradient is greater than 35
pregnant woman 36 weeks, has had herpes simplex virus in the past. mx?
give acyclovir prophylaxis until delivery, even without symptoms. if vesicles, then CS
triphasic scratchy sound on heart auscultation and PR depression diffusely. rx? and dx
acute pericarditis, give colchicine and NSAID
obese, breathless, hypercapnia acidosis, dx?
obesity hypoventilation syndrome
47 yo wth facial nerve palsy, parotid sweeling bilaterally and hypercalcemia and enlarged cervical LAD, fatigue and low grade fevers. dx?
sarcoidosis
anterior mediastinal mass, AFP and B-HCG elevated. dx?
mixed germ cell tumor, not seminoma (AFP normal in seminoma)
mild UC, rx?
mesalamine enema. oral mesalamine for more extensive. then infliximab for moderate to severe
rheumatic fever a year ago. rx?
give penicillin prophylaxis for 5 years
13 yo girl starting to get nodulocystic acne and clitoral protrusion and bilateral masses in the labia majorum. dx?
5-alpha reductase deficiency
alcoholic who came in for GTC, has discrepancy between urnialyasis and urine microscopy (blood is 2 plus but no RBC on UFEME), hyperkalemia. acute renal injury. dx?
rhabdomyolysis
dizziness episodes. taking amitryptiline. dx?
orthostatic
malnoursihed kid has NCNC anemia, angular chelitis and dermatitis. dx?
riboflavin (B2) def
HIV and IVDU, nodular infiltrates in lungs on Ct. dx?
staph aureus from IE emboli
Td or TdaP in adults?
give Td then Tdap at least once as an adult. as in alternate between these two
constricve pericarditis or amyloidosis?
latter has LV thickness, and nephrotic range proteinuria
HIV prophylactic drugs?
give bactrim if CD4 below 200. for PCP and toxo. azithro for MAC and itraconazole for histo no need anymore. acyclovir also no need
cholecystitis. surgery when?
wihtin 72 hours
MG with preeclampsia and GBS. what should you not give.
mag sulf. give valproic acid instead
depression and diabetic neuropathy. rx?
duloxetine (SNRI
known vasa previa has bloody show, fetal heart rate 100. mother is fine. next step?
crash C/S
postpartum endometritis rx?
clinda and gentamycin
lithium toxicity. symptomatic. rx?
dialysis
graves disease what treatment option makes the opthalmopathy worse?
RAIU
pancreatitis and hypotension. what is cause?
panc enzymes leading to increased vascular permeability
claw hand and horners syndrome from shoulder dystocia. where is the lesion?
C8 and T1- klumpke
alternative to doxycycline in lyme disease (pregnant, lactating, or under 8 years old)
amox
preeclampsia in patient under 20 wks gestation. dx?
hydatitidform mole
acute angle closure glaucoma in PD tremor. what is culprit drug?
trihexyphenidyl (anticholinergic)
precocious puberty and LH is low, dx?
peripheral precocious puberty –> non-classic CAH
LLQ pain, sterile pyuria, subacute onset. dx?
diverticulitis
catatonia rx
benzo
marfans and fair hair and stroke. dx?
homocysteienuria
grey mucous patches, sore throat and malaise, epitroclear LAD, genital LAD. dx?
secondary syphylliss
mild rash and fever, posterior LAD, rash from face to body, erythematous papules on soft palate. dx?
rubella
exogenous hyperthyroid how do you confirm?
low serum thyroglobulin
MG, dx made by AchR antibodies. then what?
CT scan of chest, to look for thymoma
GA 8weeks, no fetal pole and decreasing b-hcg. dx?
missed abortion
leukocyte greater than 50000, and leukocyte alkaline phosphatase score is high. dx?
leukemoid reaction
fever, thrombocytopenia, MAHA, neurologic changes renal failure, in a young guy dx?
TTP
