Q15$ Flashcards
PPH 1 week after delivery. Underwent prolonged induction of labor complicated by Intra amniotic infection and baby was 10lbs. Bleeding through pad every hour v with lots of closets
Diagnosis
retained POC
Secondary late PPH (Intra amniotic infection, large baby, prolonged labor )
- retained POC- D and c
- postpartum endometritis - uteri tonics
- placental site subinvolution- uterus doesn’t go back to size ; broad spectrum abx
76 yo with 2 days of weakness and low energy . Pmh of hfpef. One week ago was admitted for recompensares hf. ECG shows long qt at segment depression and flattened t waves mZ
Most likely cause
Hypokalemia due to furosemide
- Potassium helps dilate arteriolas that supply skeletal muscles so if no k skeletal muscles have ischemia causing weakness
Alcoholic gets leg laceration but the wound margins are poorly approximates. Gingiva is receded and bleeds easily to touch. BMI 18.8
Why does he have poor wound healing
Nutritional deficiency- vitamin c
Patient wants to get pregnant and takes levothyroxine
What to recommend
Increase the dose when she gets pregnant
- estrogen stimulates tbg and HCg stimulates the tsh to make thyroid hormones so less thyroid hormones are free bc bounded
Management of shingles
Systemic acyclovir therapy
Management of stroke in scd
Plasmapheresis
26 yo women monocular vision loss, pain with eye movement , washed out color vision. Aferente pupillary defect (swing light from good to bad bad eye dilated
Diagnosis
Diagnostic
Treatment t
Optic neuritis - hints at Ms
Dx- so hints at Ms do MRI of orbits and brain
Tx: IV corticosteroids
Rosacea mama gent
Avoid triggers (sun etoh
Topical metronidazole for papulopustular
Laser or topical brimonidine alpha 2 agonist for erythematotelangiectactic type
Recent spinal anesthesia and now has urinary retentionC diminished sensation in legs and weakness of right foot. Also back pain. On chronic antiplatelet therapy.
Diagnosis
Diagnostic
Treatment
Spinal epidural hematoma lead to casida equina
- seen in patients on anticoagulants
-dx: MRI OF SPine
TX: laminectomy
Pregnant lady has pyelo and was started on IV ceftriaxone. 48 hours later doing better and is age tule . Urine culture grew ecoli and sensitive to cephalexin, fosfomycin, nitrofurantoin, bactrim
Most appropriate oral antibiotic
Cephalexin
Pyelo
start with iv broad then oral for 5-24 days to eliminate from kidney renal collecting duxts and lower urinary tract
- can’t use nitrofurantoin bc can’t achieve good concentration in the urine but it’s good for cystitis. bactrim is good for cystitis but can cause kernicterus in third trimester so avoid it
Adverse effects of tamoxifen (raloxifene good adverse effect
Hot flashes - anti estrogenic in cns so can’t thermoregulate well
Endometrial hyperplasia/ cancer
Uterine sarcoma
Venous thromboembolism
R- osteoporosis
Left lower quadrant abdominal pain with n/v, hasn’t pooped but passed gas. Positive leukocyte esterase negative moriré, urgency and frequency
Diagnosis
Diverticulitis - can irritate the bladder
Admitted 10 days ago for his a creatures and Ct showed necrosis hence acute necrotizing pancreatitis. Now has fever AMS , shock . Flanks are tympanic
NBSIM
Treatment
Ct of abdomen - if negative aspirate and culture the necrotic pancreatic material
Acute necrotizing pancreatic - necrotic part is sterile originally and 7-10 days later bacteria like ecoli and pseudomonas can collect causing gas within the necrotic parts
Tx: IV antibiotic therapy debridment
65 yo with fever productive cough and right love infiltrate has lymphadenopathy and severe leukocytosis (24,000) mostly lymphocytes plus anemia and thrombocytopenia
Blood cultures sent. NBSIM
Flow cytometry if the peripheral blood
- chronic lymphocytic leukemia and because of ineffective immunoglobulins have infections
4 week old drinks cow milk formula has bloody streaked stools
Cause
Prognosis
Non I’ve mediated allergic reaction - food protein induced allergic proctocolitis
—-protein causes eosinophilic inflammation of the colon and rectum
- self limited and by age 1 can tolerate products that triggered them as a newborn
Associated nutritional deficiency is itv breath holding spell
IDA
3 hour old pulse ox is 75% and appears cyanotic . Breath sounds are normal . On 100% Pa02 is 43
NBSIM
Pa02 is 43 so think cyanotic congenital heart disease . If pa02 improved it would be a pulmonary pathology like meconium aspiration pulmonary hypoplasia
NBSIM- ECHO
Interesting antibody seen in scleroderma
Anti rna polymerase III
23 yo with intact dentition has prolonged severe sore throat, high fever , pain with swallowing , neck pain, swelling along the sternocleidomastoid muscle . Vs- hypotension tachy cardiac , febrile 104. CXR - lung nodules and some nodules with cavitation. Duplex is shows left internal jugular vein thrombosis
Organism
Lemierre syndrome
- gram negative anaerobe like Fusobacterium necrophorum. Starts with tonsillitis or complication from dental work or mastoiditis. And rhe. Can cause internal jugular thrombosis
-prolonged severe sore throat, high fever , pain with swallowing , neck pain, swelling along the sternocleidomastoid muscle .
-infects the internal jugular vein and thromboembolism can go other places like the lung leading to nodules and respiratory symptoms
Dx: culture form blood or pus
Tx: Supportive airway management with IV antibiotics and maybe surgery (ID) if no response to antibiotics
Term newborn without prenatal care now has grunting nasal flaring and cyanosis of mucous membranes (82% satting) . CXR interpretation was air filled loops of bowel on left and heart shifting to the right . Scaphoid / flat abdomen and barrel shaped chest . Heart sounds loudest on right
Cause
Diagnostic
Treatment
Congenital diaphragmatic hernia
Dx: CXR but should be seen at prenatal visits
Tx: initial is intubation with cautious ventilation and gastric decompression
Correction Surgery urgently
Heart sounds loudest on right because heart is deviated
Alcoholic tested for pancreatitis now says he can’t get enough air . A febrile but CXR shows bilateral diffuse alveolar opacities
Which treatment strategy decreases risk of in hospital mortality
Preventing alveolar overdistension
- ards caused by pancreatitis; low tidal volume ventilation to ventilate the non collapsed alveoli . Higher volume van stretch already damaged alveoli therefore further lung injury
Food management. In burn victim
Enteral immediately - helps prevent sepsis etc
