Q4( Flashcards
10 year old girl with autoimmune hypothyroidism (on Levo) evaluated for limp and right groin pain for 2 weeks . Frog leg X-ray shown hint
Management
RF
Physis stabilization with screw fixation
RF: hypothy bc no ossification of growth plate (in kids <10 and bilaterally
A 38-year-old man comes to the office for follow-up after his blood pressure was found to be elevated at a health fair. The patient has had no headache, blurry vision, or chest pain. He does not use tobacco, alcohol, or illicit drugs. Temperature is 36.7 C (98.1 F), blood pressure is 148/96 mm Hg in the right arm and 146/94 mm Hg in the left, pulse is 74/min, and respirations are 14/min. BMI is 36 kg/m?, Examination shows a regular heart rate and rhythm with no heart murmurs or carotid and abdominal bruits. Peripheral pulses are 2+ without radiofemoral delay. Breath sounds are normal. ECG is normal, and a
48-hour ambulatory blood pressure monitor shows an average pressure of 138/88 mm Hg. Which of the following is the best next step in management of this patient?
A. Order 24 hour urinary free cortisol
B. Order plasma resine and aldosterone
O C. Order serum creatinine [63%]
O D. Order transtheracie-echoeardiography
Order serum cr
- at time of diagnosis check renal function via cr, electrolytes and urinalysis bc Ckd is risk factor of HTN and vice versa
And also check a1c and lipid panel bc increased CVDA COMPLICATION when you have HTN plus DM and hyperlipidemia
NBSIM or initial bronchodilator for stable COPD if
- less symptoms without excErbation
- more symptoms without excErbation
- higher exacerbation
less symptoms without excErbation (SABA ipratropium OR SAMA)
- more symptoms without excErbation (LABA - formoterol, LAMA- tio
- higher exacerbation LABA LAMA ICS
RC for placenta abruptio
Cocaine , cig , HTN, abdominal trauma
38 yo Gemma with nausea, substernal discomfort feeling of food stuck in chest . Had GERD during pregnancy , chest imaging shows retro cardiac air fluid level . Cause of symptoms
Gastric her autism into the thoracic cavity - paraesophageal hiatal hernia
A- stomach bubble within the thoracic cavity (air fluid level
This patient underwent a laparoscopic appendectomy 10 days ago and now has right upper quadrant pain, fever, nausea leukocytosis, and pulmonary manifestations (shortness of breath, decreased breath sounds hiccups, right-sided effusion), suggesting a
subphrenic abscess
Infections are the most common complication of appendectomy, and risk of intra-abdominal abscess is significantly greater with laparoscopic appendectomy than laparotomy. Manifestations typically include recurrent fever and abdominal symptoms (eg, pain, vomiting) several days after an abdominal operation. Diagnosis usually requires CT scan of the abdomen. Most patients are treated with drainage and intravenous antibiotics
5 year old with 3 day of abdominal pain and diarrhea (water then bloody ) . No travel and no fever
Infection with e. Coli (shiga toxin ecoli STEC) which can possibly lead to HUS in a few weeks
Traveled to Honduras a week ago and now has flulike illness with Lh fever , malaise , nausea and anorexia
HEP A IGM positive
HEP A IGG neg
Treatment (who to treat and give what)
Food prep workers exposed to colleague, child care center, and close personal contacts would get Hep A vaccine if -<41 or immunoglobulin if >41 yo
Initial evaluation for infertility
Semen analysis
Septic pelvic thrombophlebitis
Associated with endometritis with relapsing remitting fever
A 62-year-old woman who works as a high school administrative assistant is brought to the emergency department by her coworker. She states that 2 hours ago she suddenly felt dizzy while sitting at her desk. A short time later, the patient tried to stand to go to the bathroom and felt like she was falling to the left. Her symptoms have been constant and disabling since they started. The dizziness is exacerbated by any movement of the head, and she has a mild posterior headache. Medical history is significant for hypertension. Temperature is 37.2 C (99 F), blood pressure is 160/85 mm Hg, pulse is 78/min, and respirations are 16/min. The patient is awake and alert. Heart and lungs sounds are normal. Strength is 5/5 in the upper and lower extremities bilaterally.
Finger-to-nose and heel-to-shin testing are abnormal on the left. Gait is ataxic. Noncontrast CT
scan of the head is normal. ECG shows normal sinus rhythm. Which of the following is the best next step in management of this patient?
Administer intravenous alteplase
- left Cerebella’r ischemic stroke : sudden vertigo with other neurological signs ( ataxia or dysmetria, postural instability fall yo side of lesion, headache
Six days after a cesarean delivery, a 25-year-old woman comes to the emergency department with nausea, vomiting, and abdominal pain. The patient developed a sharp, right-sided abdominal pain 12 hours ago that has been increasing in severity. and she now has persistent nausea and vomiting. She has had no sick contacts, hematemesis, dysuria, or hematuria. Her last bowel movement was yesterday, with no blood in the stool. The patient has no chronic medical conditions and has had no surgeries other than the recent cesarean delivery. Temperature is 38.3 C (101 F), blood pressure is 110/70 mm Hg, pulse is 98/min, and respirations are 18/min. The surgical incision has minimal serosanguineous discharge with no associated fluctuance or mass. Abdominal examination shows tenderness over the right lower quadrant. There is guarding and rebound tenderness. Bowel sounds are decreased, Speculum examination shows no purulent discharge. The uterus is 14-week sized and nontender. Hemoglobin is 9.6 g/dL and leukocyte count is 21,000/mm. Which of the following is the most likely diagnosis in this patient?
Acute appendicitis
A 78-year-old man is brought to the emergency department after he passed out while working in his garden. He is now alert and oriented. The patient has chest and neck pain that developed suddenly just prior to the syncopal episode. Over the past week, he has had a cough, chest tightness, and whitish sputum production. Medical history is significant for long-standing hypertension, hyperlipidemia, and type 2 diabetes mellitus. The patient has never smoked cigarettes. Temperature is 373 C
(99.2 F), blood pressure is 144/92 mm Hg in the right arm and 142/90 mm Hg in the left arm, and pulse is 109/min. ECG shows sinus tachycardia, voltage criteria for left ventricular hypertrophy, and no ST-segment or T-wave changes. Chest x-ray is shown in the exhibit. Cardiac enzymes are normal. Which of the following is the best next step in management of this patient?
Obtain CT angiography of the aorta (CT aortography) - aortic dissection triggered by cough ; leads to syncope sometimes
À6-year-old boy is brought to the office with a 10-day history of thick and persistent nasal discharge, nasal congestion, and cough. He has had no associated vomiting, headache, or earache. The patient has mild, persistent asthma for which he uses an inhaled corticosteroid. Temperature is 37.2 C (98.9 F), pulse is 90/min, and respirations are 15/min. Physical examination reveals yellow mucus dripping in the posterior nasopharynx. Tympanic membranes are clear bilaterally. Nasal.
turbinates are red and swollen.
Maxillary sinuses are tender to palpation. Heart sounds are normal and the lungs are clear to
auscultation bilaterally. Skin examination shows no rashes. Which of the following organisms is the most likely cause of this patient’s condition? treatment
most common RF complications
O A. Aspergillue-fumigatue
O B. Nontypeable Haemophilus influenzae
O C. Pseudomonas acruginosa
O D. Rhizopuo-arrhizue (
O E. Staphylococcus aureus ()
O F. Streptococcus pyogenes
Acute bacterial rhinosinusitis caused by H influenza mórasela less likely now with s. Pneu
- cough and nasal discharge for >10 days without improving , or severe onset (102.2 or greater and drainage 3 or more days or worse if symptoms following initial improvement (1 of the 3
- Tx- observation or amox- clay if severe or worsening symptoms
- most common risk factor viral uri , allergic rhinitis
- complications: brain abscess, meningitis, periorbital/orbital cellulitis
A 17-year-old boy comes to the emergency department due to palpitations. He has had prior episodes of “chest fluttering* that were short-lived, but this episode is sustalined. He is preparing for school examinations and has a high level of stress.
The patient appears diaphoretic and uncomfortable on examination. Blood pressure is 110/75 mm Hg and pulse is 210/min.
Pulse oximetry is 99% on room air. An ECG is Immediately obtained and shows a regular, narrow complex tachycardia. An intravenous bolus of medication is administered and results in abrupt cessation of the fachycardia. A follow-up ECG is shown in the exhibit. Which of the following is the most likely underlying cause of this patient’s current condition?
A. Accessery-atrioventricular
pathway (
B. Gecaine use
C. Dilated cardiomyopathy
D. Hyperthyroidism
E. Hypokalemia
Accessery-atrioventricular
pathway
- premature atrial or ventricular contraction creates a atrioventricular reentrant tachycardia circuit involving pathway and AV node . Vasalva and adenosine which pt received slows conducution through the AV node and restless sinus rhythm but can cause vfib
Multiple arrythmia s seen with WPW- so May not see quintessential wide qrs or short pr or delta wave
