Q20$ Flashcards
Cabg with internal thoracic artery harvests 6 days now has clicking and shifting of chest when moving . PMH-COPD AND diabetics
NBSIM
Surgical exploration and sternal fixation
- sternal dehiscence (sternum separates ) which occurs after cardiac surgery
Management of fat embolism
Supportive (oxygen etc ) if gets bad then intubare
Normal RDW ns microcytic anemia, mentzer index<13 in a 1 year old boy
Thalassemia
9 months ago lady was a ceo And now has difficulty with organization and strategic planning. Stepped down 3 months due to poor performance, localized Neuro findings (asymmetric reflexes and gait abnormalities) subcortical symptoms (urinary frequency and depressed mood) PMH -T2DM and HTN. 23/30 MOCA
DIAGNOSIS
Vascular dementia
NF1 vs NF2
Moi
Gene mutated (chromosome
Main features
NF1
- AD; NF1 TS gene which codes for TS protein called neurofibromin on Ch 17
- cafe au lait spots (by 1 years old and increases as a child
- skin fold freckling in a axillary and inguinal by 5yo
- neurofibromas all over - others appear before these peripheral nerve sheath tumors by preteen / teens
- lisch nodules (freckles on iris ) by 6
NF2; TS protein merlin on CH 22
- bilateral acoustic neuromas
Management of hot tub foliculitis
- pseud
Pseud- supportive ; if persists give oral fluoroquinolone
S. Aureus- bactrim sensitive
MCC of stroke in a kid
Diagnostic
SCD
Dx: hemoglobin electrophoresis
32 yo women unable to conceive after removing iud 13 months ago, regular menses without bloating, fatigue; or cramps. tvus and hysterosalpingogram are normal
NBSIM
Mid luteal phase progesterone level
To confirm ovulation - no molimina symptoms form increased progesterone after ovulation (menses without bloating, fatigue; or cramps) shows anovulatory menses with normal menses bleeding
Over 20 weeks ga delivered stillbirth and no prenatal care. Placenta was pale and big, umbilical cord had areas of necrosis surrounding the vessels.
NBSIM
Obtain syphilis serology
- necrosis due to the fetal inflammatory cells reacting to the infection
Cabg with internal thoracic artery harvests 9 days ago and now separation of lower wound with copious discharge and sternum is stable.
NBSIM
Diagnosis
Treatment
Chest and sternal imaging
- MEDIASTINITis - usually present with fever tachycardia, chest pain, chest wall edema and crepirus and purulent wound discharge but patient can be asymptomatic
- Tx- surgical debridement emergently, tissue cultures, and empiric IV abx
ASTHMA MANAGEMENT
Less than daily- ICS and formoterol PRNor ICs and SABA
most days waking with asthma
ICS and formoterol
Daily symptoms , waking with asthma, Decreased FEV1
ICS (medium to high dose)and formoterol daily
Still uncontrolled
ICS high dose)and formoterol daily plus LAMA
Allogenic stem cell now has copious watery diarrhea at night and unrealized to food and maculopapular generalized rash. C diff and PCR testing for cmv are negative . labs : elevated lft
Cause if the diarrhea
Diagnostic
Treatment
Cd8 t lymphocyte mediated injury (GVHD)
Biopsy (colonoscopy with biopsy after d diff and cmv are ruled out
Tx steroids
48 yo with repeated elevated high bp. BMI 28. Electrolytes NORMAL and no PMH
What other additional testing
Screen for dm
- Uniqlo eval is to find complications of HTN (Ckd) or find comorbid conditions
- 35-70 with BMI >=25 should be screened for dm
After experiencing numbness on right sid e and diagnosed with an ischemic stroke 4 weeks later sensation is returning but now has burning induced by light touch
Location of stroke
Thalamic
- no motor or cranial nerve afEf Ted. Pure sensory stroke
Post mi with EF of 35%
Patient is at risk of sudden death from what
Ventricular arrythmia
