Q Flashcards
A 22-year-old man comes to the emergency department with a persistent, painful erection he has had for the past 6 hours.
The patient has had similar episodes that lasted 1-2 hours but resolved spontaneously. He says his symptoms started this morning without provocation when he woke up. The patient recently started a summer job working outside pouring concrete.
Medical history includes sickle cell disease; he has not taken any medications other than his usual folic acid. The patient does not use alcohol or illicit drugs. On examination, the penis is rigid, and the glans is soft. The scrotum is normal. Which of the following is the most appropriate next step in management? **other management **
O A. Administer a packed red blood cell transfusion
O B. Administer an intravenous beta blocker
O C. Administer-sublingual-nitroglyeerin
O D. Aspirate blood from the corpora cavernosa
O E. Insert a urinary catheter
Aspirate blood from the corpora cavernosa and sympathomimetic drug (like phenylephrine ) to contract cavernous muscle
Causes in scd- dehydration as in this patient, cold alcohol fever
Ep
A 25-year-old man is brought to the emergency department after a syncopal event. His wife reports that they were resting in bed, watching television together, when he suddenly passed out. The patient was unconscious for approximately a minute, during which time there were a few bilateral jerks of the arms and legs. He has never had a similar episode but recently noticed some palpitations at night. The patient has no chronic medical conditions but had a fever as high as 38.3 C (100.9 F along with a mild cough and body aches, throughout the day. Family history is significant for a male cousin who died unexpectedly in his sleep at age 37. Temperature is 38 C (100.4 F), blood pressure is 128/76 mm Hg, and pulse is 98/min, The patient is awake and alert and in no distress. The pupils are equal and reactive to light. The oropharynx is normal.
Breath sounds are normal. No heart murmurs are heard. The extremities are well perfused, with symmetric strength.
Influenza test is positive. Which of the following is the most likely cause of this patient’s syncopal episode?
A rapi
O A. Febrile seizure
O B. Hypertrophie-eardiemyopathy
O C. Orthestatie-hypotension [1%]
O D. Vasevagal-syncepe
O E. Ventrioular-tachyeardia
E. Ventricular tachycardia (Brugada) - triggered by fever and high temp changes the na current in heart
Cardiac syncope due to an arrythmia
- warning signs ——sudden onset without warning symptoms indicates a tachareythmia, occurring at rest which wouldn’t happen with vasovagal or orthostatic, recent palpitations indicates transient arrythmia , sudden death in young family member indicates inherited cardiac conductive syndrome that leads to an ventricular tachycardia (long
Management of primary dysmenorrhea
- sexually active vs non
Non- NSAIDs decreases prostaglandins
Active- OCP
38-year-old woman comes to the office due to abdominal bloating, excessive flatulence, and diarrhea over the past 3 onths. She has 4 or 5 honbloody, loose stools a day, including at night. The patient has a history of obesity and lost 30 kg ; Ib) after undergoing Roux-en-Y gastric bypass surgery 3 years ago. She takes multiple vitamin supplements daily but ha taken antibiotics recently. The patient has not traveled recently or been exposed to anyone with diarrheal illness! sperature is 37 C (98.6 F), blood pressure is 130/84 mm Hg, and pulse is 78/min. BMI is 28 kg/m°. Abdominal mination shows no abnormalities. Which of the following is the most likely cause of this patient’s symptoms? (Rf, management)
A. Bacterial overgrowth
B. Clostridioides diffieile-infectien
C. Dumping-syndrome
D. Irritable bowel syndrome
E. Stomal obstruction
A. Bacterial overgrowth ( small intestinal bacterial overgrowth aka SIBO)
SIBO
- RF: ileocecal removed(so bacteria can enter si)gastric bypass bc blind loop of intestines therefore bacteria can grow ,
Anatomical abnormalities(strictures, surgery, diverticulosis), motility disorders(scleroderma, opioid use and DM), immunodeficiency, chronic pancreatitis , gastric hypochlorydia and PPI use
Symptoms- flatulence, chronic watery diarrhea , bloating , and maybe malabsorption of fat soluble vitamins and Vit b12bc bacterial consumes it) inc folate and Vit k which are produced by the bacteria
Management:
Dx: carbohydrate breath test (lactulose or glucose) to measure hydrogen or methane produced by the bacteria)- if colonic bacteria breaks down no absorbed substrate before 2-3 hours causing rise in breath hydrogen indicates SIBO
2) invasive endoscopy of jejunal aspirate and culture
Tx: empiric antibiotics(rifaximin)
Management of primary polydipsia and inspidus
- cause of di in a child
Water deprivation test or Desmopressin( in kids to avoid hypernatremia)
- primary- adh is inhibited bc of increased water intake. Water deprivation then increases adh and urine becomes concentrated
- inspidus: when doing the test the urine remains dilate
Hereditary nephrogen diabetes inspidus is most common cause when mentioning familial polyuria or polydipsia
Tuberous sclerosis
- pathophysiology
- MOI
- symptoms
- surveillance
Tuberous sclerosis complex
• Mutation (inherited or de novo) in TSC1 or TSC2 gene leads to benign tumors
• Autosomal dominant
• Dermatologic
• Ash-leaf spots (light)
• Angiofibromas of the malar region
• Shagreen patches (textured skin )
• Neurologic
Clinical features
• CNS lesions (eg, subependymal tumors)
• Epilepsy (eg, infantile spasms)
• Intellectual disability
• Autism & behavioral disorders (eg, hyperactivity)
• Cardiovascular: rhabdomyomas (asymptomatic or cause murmurs, arrythmia or heart failure ) ; present large by regresses on its own in infancy
• Renal: angiomyolipomas
• Tumor screening
• Regular skin & eye examinations
• Serial MRI of the brain & kidney
Surveillance
• Baseline echocardiography & serial ECG
Baseline electroencephalography
• Neuropsychiatric screening
NF1
- MOI
- symptoms
AD
HYPERPIGMENTED cafe au lait, optic gliomas, freckling of axillary and inguinal, scoliosis, neurofibromas , pseudoarthrosis , seizures and ID
Endometriosis vs adenomyosis symptoms
Both have chronic pelvic pain and dysmenorrhea but uterus findings are different
- a - endometrial gland accumulation causes a diffusely symmetric (globular enlargement by endometriosis the uterus is non tender and small
Post exposure prophylaxis after sexual assault
Doxy, ceft and metronidazole against trich and chlam/gonorrhea
A 16-year-old boy is brought to the office due to right knee swelling. He first noticed it after soccer practice a few days ago but does not recall injuring the knee. The joint feels stiff and is not painful. The patient spent the summer at a soccer camp r Maine. He is sexually active with his girlfriend and uses condoms. Vital signs are normal. The patient can bear weight and has a grossly normal gait. Examination of the right knee shows palpable warmth and a large effusion. It is minimally tender to palpation. Range-of-motion testing shows decreased flexion of the right knee compared with the left. All other joints are normal. Plain radiographs reveal no bony deformity. Aspiration yields yellow, translucent fluid with a leukocyte count of 15,000/mm’ (50% heutrophils) and no organisms on Gram stain. Which of the following is the most likely cause of this patient’s knee swelling? (**symptoms , diagnostic and treatment **
A. Borrelia burgdorferi infection
B. Disseminated-gonococcal infection
C. Prior Chlamydia trachomatis infection
D. Prior streptococcal throat infection
O E. Staphylococcal joint infection
Lyme
Minnesota and Wisconsin included
Early localized
(days to 1 month)
Erythema migrañs
Fatigue, headache
Myalgia, arthralgia
Early disseminated
Multiple erythema migrans
• Unilateral/bilateral cranial nerve palsy (eg. CN VII)
(weeks to months)
• Meningitis
Carditis (eg, AV block)
• Migratory arthralgia
Late
(months to years)
Arthritis( oligoarticular)
• Encephalitis
Peripheral neuropathy
Diagnosic
Synovial fluid analysis - 10k- 25K leukocyte with negative gram stain and culture
- enzyme immunoassorbwnt assay and western blot for confirmation
Tx: oral doxycycline
Synovial fluid analysis
- Lyme disease
- gonorrhea
- staphylococcal
Lyme - 10K-25K leukocyte (50% neutrophils with neg gram stain and culture; no systemic symptoms, acute monoatticular; minimally painful
Gonorrhea- acute a febrile oligoarticular or chronic polyartiuclar ; painful
>25K leukocyte and a lot of neutrophils and May or May not have positive gram stain
StaphyloccoL - painful ; leukocyte >50K and positive gram stain
5-year-old woman comes to the office due to insomnia and fatigue that began shortly after her divorce was finalized a year The patient used to sleep 7-8 hours without difficulty; however, over the past year she has had increasing difficulty falling ep and started drinking 2-3 glasses of wine before bedtime to help. Despite falling asleep more quickly, she has recently ad to regularly wake up around 3:00 AM. Her symptoms have progressively worsened and she now lies awake for al hours in the middle of the night, thinking and worrying about her future, but she rarely experiences anxiety during the She reports mild difficulty with concentration and no change in appetite. The patient experiences occasional brief ss and lonelihess. She has recently started showing up late for work and has stopped attending her weekly exercise Medical history includes hypothyroidism, treated with levothyroxine, and gastrosophageal reflux disease, diagnosed 3 ago and treated with famotidine. Temperature is 37.2 C (99 F), blood pressure is 140/90 mm Hg, pulse is 90/min, and ons are 12/min. Physical examination shows a mild tremor but no other abnormalities. Laboratory results are as
Hgb 11.4
Mean corpuscular 106
Blood urea nitrogen 20
Creatinine normal
AST 85
Alt 42
Which of the following is the most likely diagnosis in this patient?
O A. Adjustment disorder [5%
O B. Alcohol use disorder
C. Anxiety disorder due to another medical condition
O D. Generalized anxiety disorder
O E. Insomnia disorder
O F. Persistent depressive-diserder (elysthymie)
Alcohol use disorder
->65 : >7 drinks in a week or >3 in a day (men less than 65 >14 drinks in a week or >4 drinks in a day
- 14 drinks per week , AST:ALT 2:1, tremors, macrocytosis, tardiness, impaired functioning, recent diagnosis with GERD AND HTN, sleep disturbance and anxiety (usually sell help for this first this indicates withdrawal
Anterior uveitis causes
Herpes, todo
Sarcoidosis
Spondyliarthriirs
IBD
Diagnostic for carotid artery dissection
CT or MR angiography
Initial diagnostic test for Cushing
Overnight Low dose dexa suppression
24 hour urinary free cortisol
Late night salivary cortisol
- 2 needs to be abnormal so do two