Q10$ Flashcards
Tardive dyskinesia management. Patient is on Risperidone and lithium for manic episode
Taper and discontinue Risperidone
2nd- switch to clozapine or lower risk ap or valbenazine deutetrabenazine
(No benztropine
Mammogram- speculated mass with coarse calcifications in upper quadrant or right breastX core biospy- foamy macrophages and fat globules
NBSIM
Reassurance and routine follow up - fat necrosis
17 yo with progressive muscle weakness and pain, difficulty making facial expressions . Testicular volume is small for age .
MOI
Other symptoms
MCCOD
AD ctg repeats on DMPK GENE- muscular dystrophies (classic myotonic , Becker xlr
Classic- cardiomyopathy, dysphagia , cataracts, testicular atrophy , frontal hair loss
MCCOD resp or heart failure at 45-55
4 yo girl with headache the. Generalized tonic clinic seizure , muscle strength is decreased in right upper and lower extremities . Follows commands but answers but one word Ct head normal . Appropriate seizure meds and eeg are initiated.
NBSIM
Mri head
- ischemic strike
Management of spasms in MS
Baclofen agonist at gaba b
Tizanidine - alpha agonist
Infant with growth failure <5th percentile. ,non ag metabolic acidosis. Urine ph 7.8
Cause
Type 1 rta- can’t excrete h and can’t reab hco3
25 yo female with6 weeks of pallor, fatigue jaundice splenomegaly, elevated LDH and reticulocyte count .
PBS shows spheroxytes without central pallor . Direct Coombs positive
Diagnosis
Autoimmune hemolytic anemia (warm and not HS
- both are extravascular hemolysis
- hs - negative direct Coombs
4 year old boy with redness itching and white discharge around uncircumcised penis . Was recommended 5 days ago about foreskin hygeine . Still has issues
NBSIM
Potassium hydroxide microscopy
Then topical anti fungal like azole clotrimaze
Screening for dm if child has not recent antibiotic use or no diaper dermatitis
- balanitis (with Cándida infection
Association of which w endocrine disorder with vitiligo (destroyed melanocytes
Autoimmune thyroid diseases
Rhinitis medicamentosa
1 which drug
2. Exam fundido
Oxymetazoline
Beefy red nasal mucosa and no edematpus pale mucosa like in allergic rhinitis
30 week ga has irregular contraction but no vaginal bleeding. FHR (170). Temp 100.4 tenderness to palparían of right lateral flank and rebound guarding o right side of abdomen . Nontender uterus and closed cervix
NBSIM
Immediate surgery for acute appendicitis
- right flank pain or right mid to upper quadrant
Complication and management of monochornionic moniamniotic twins
Monochorionic - 1 placenta so twin to twin transfusion syndrome (polyhydramnios and oligo
Monoamnioric (1 amniotic sac so umbilical cord entangled
Managemntent - close surveillance and C-section at 32-24 weeks
Chrons- Partial ilex resection due p structure and surgeries to fix fistula .
What. Is a possible supplement deficiency and it’s symptoms
What area is it absorbed
Other trace mineral deficiencies and symptoms
Zinc - alopécica, pustular skin rash around mouth and extremes , hypogonadism, impaired wound healing, impaired taste, immune dysfunction
- duodenum and jejunum
Chromium/ impaired glucose control in diabetics
Copper - brittle hair , skin despigmentación, neurological (peripheral neuropathy, anemia, osteoporosis
Selenium- thyroid dysfunction, cardiomyopathy ,
Immune dysfunction
I
56 yo has cholecystectomy 5 weeks ago for emphysematous cholecystiyid kow has 6/7 watery brown stools daily and at night . C diff neg.
Stool- neg for leukocyte
NBSIM
Cholestyramine (other cole drugs )
- bule acid diarrhea- without gallbladder bile gets released into the small intestine Willy nilly and it can’t resbalen all so some gets to the colon causing secretory diarrhea (nocturnal too)
67 yo has worsenribg dull aching pain in right groin for 2 weeks. No trauma or overuse. Pmh-osteoporosis on alendronate for 7 years. MRI- sub trochanter Uc region of right femur has fracture. Dexa - bone density has improved compared To 5 years ago
Cause of fracture
Medications adverse effect (Bisphosphonates use >5 years can prevent appropriate bone turnover so go on 3-5 year old drug holiday after 5 years of use
3 hour old with curvature of underdeveloped phallus with urethral meat is at base. (Hyposp) . Labiosacrel folds are fused and gonads are not palpable. Elevated 17 hydroxyprogestetone level.
Karotype
46 XX
-cah 21 (boys normal or hypervirilized big phallus
Karotype
Pelvic us - any female internal
Check electrolytes if salt wasting 21 def
3 yo boy with deficient serum sis if Uc antibody rutera to tetanus , diphtheria, h influenzae type b and pneumococcus.
What additional test
Flow cytometry of peripheral blood- reduced cd19+ B cells in brutons
Also low levels of plasma cells
When to do head Ct scan without contrast in kids
AMS
LOC
severe mechanism of injury
Vomiting or severe headache
Skins of basilar fracture
18 yo old girl attends college in north Carolina’s fever , headache,, n/v for 3 days , severe hypotension, tachycardia , poorly arousable (shock )x maculopapilar rash with petechiae on hands feet , trunk. Bilateral tales (pulmonary edema
Csf minimal leukocyte Elva te, minimal protein elevation, normal glucose
Cause
Interesting labs
Dx
Treatment
Rmsf rickettsia
- labs: hyponatremia due to inc adh
Low platelets
High ast alt
Dx: skin biopsy or rickets is serology
Tx doxycycline
Meningitis (dramatic leukocytosis >1000, high protein, low glucose
18 month old both from Uganda has splenomegaly with left sided abdominal tenderness and signs of anemia (fatigue, pale mucosa, 2/6 systolic ejection flow murmur ) . Anterior cervixal lymph nodes and bilateral distal pulses are weak
How to establish diagnosis
Treatment
Hemoglobin electrophoresis
- scd and splenic sequestration (sickled rbc are trapped there so slot of blood there so hgb drops drastically and reticulocytes increases as a result) spleen enlarged and shock (weak pulses
Tx - isotonic fluid resuscitation (na)
Rbc transfusion
Sick sinus syndrome in 80 yo
- ekg finding
- treatment
Sinus Brady and drop in sinus nodal activa cardiac conduction system degeneration due to age usually
Tx: pacemaker
Patient with poorly controlled diabetics , nag metabolic acidosis , Hyperkalemia
Cause
Rta 4 - aldosterone deficiency so no h or k excretion ; poor controlled diabetes
35 yo women with turners has severe chest pain migrating to epigastric region to. Back. With associated abdominal pain pain and nausea/vomitingX Bp160/94. Elevated serum amylase. No contrast abdomen Ct shows dilated bowel loops
NBSI evaluation
CT angiography of chest and abdomen
- aortic dissection
- complication- dissection spread ti mesenteric artery leading to intestinal ischemia so dilated bowels and oop abdominal pain and elevated amylase
widespread Times corporis risk factors
Treatment t
Dm , systemic glucocorticoid, HIV so do hiv screening test
Oral azole
3 month old spitting up undigested breast milk . But is eager to feed every 3 hours and or irritable. Growth charts are normal .
NSIM
give Vit d to babies being breast fed
- baby has GER due to immature LES(smoking reduces les pressure)
Tx- burp, sit them up while feeding, breast feeding protects against GER, frequent small meals
73 yo old with oa on naproxen with microcytic anemia
ESR 15 normal
Serum fe
Ferritin
TIBC
Transferrin saturation
Ida (naproxen can lead to peptic ulcers or gastritis
Serum fe low
Ferritin low
TIBC high
Transferrin saturation low
I chose ACD (but inflammatory markers are normal
Thalassemia iron studies
Acd tibc
Serum fe high
Ferritin high
TIBC low
Transferrin saturation high
MCV very low compared to IDA AND ACD
Acd TIBC low
