Q5) Flashcards
Stroke with right sided weakness, dizziness, slurred speech with BP OF 225/110. Patient became minimally responsive and developed hyper extension of extremities . Ct shows left sided Intra cerebral hemorrrhage with a midline shift
NBSIM
Intubate and mechanically ventilate
- shift means herniation which can affect respiratory drive so intubate
- hypertensive intracerebeal hemorrhage
Man with schiOaff, Tourette and poly substance use present with confusion , hyperthermia, tachypnea, elevated lactate, low bicarbonate so aG metabolic acidosis, epigastric tenderness with n/v
NBSIM and how to treat
Check salicylate levels
Tx: activated charcoal if pt is alert and happened w/I 2 hours, NAHCO3 for faster excretion, or dialysis for severe cases
14 yo rambles about seeing bags on the ceiling at school . Pops Said she’s been behaving oddly lately, anxious lack of sleep , staring at bedroom walls, joint pain , headaches and poor concentration
NBSIM
Check Ana - mostly like SLE
35 yo diagnosed with UC 8 years ago. Has been asymptomatic since taking mesalamine . Fam history negative for cancer and IVD. When to start colonoscopy? (When start if have family history of CRC before 60and no IND
Start 8 years (8-10) after diagnosis then Q1-3 years
Diabetic complication or neuropathy and nephropathy has big toe ulcer for 4 weeks persisting despite wound care: no redness thensees swelling .
NBSIM
Foot imaging for osteomyelitis- diabetics especially with neuropathy at risk for ulcers and the bacteria colonizing the ulcer can spread to the bone
Pregnant women came for routine prenatal care . BMI 32 , T2DM, HTN with only nausea . Labs: ALK PHOS 145, ALT125, AST 115. RUQ hyper echo genie liver with multiple gallstones without gallbladder thickening and normal CBD .
Cause of abnormal liver studies
Nonalcoholic fatty liver disease due to her PMH
- insulin resistance leads to fat deposition on liver because of lipólisis and FFA uptake
45 year old women with myalgias, proximal muscle weakness , and delayed DTR with elevated Creatine kinase and normal ESR.
NBSIM (+diagnosis)
Hypothyroid myopathy most likely since young so check serum TSH and free T4
I thought it was polymyositis causing the myopathy - usually has elevated ESR and CK and normal DTR
Lady had TAH with BSO has leakage of fluid from incision. After they removed the staples , fatty tissue and loop of bowel protruding from separation of the textual abdominus muscles.
NBSIM
Emergency surgery
- deep dehiscence at risk of strangulation . If nothing was seen on exam then do CT scan of abdomen
Signs of DVT with unilateral leg swelling in women with RA (risk factor) without chest pain or SOB. NBSIM
compression Us (and not CT chest angiogram because no signs of PE bc no sob etc)
Someone whose late term >41 or post term (>42) has oligohydramnios. FHt shows moderate variability , multiple accels and no decels (reactive) and vertex position . Or late or post term with abnormal NST . NBSIM
Induce labor
Complications for late term (>41 ) and >42 weeks for fetus and mom
Fetus - big, uteri placental insuff (oligo or late decels
Mom- PPH, perineal lacs, C-section
Drank Ethylene glycol and now has renal stones.
- what kind of stones
- describe shape
- treatment
Calcium oxalate (envelope or dumbbell shaped!
Tx: fomepizole primary ( inhib alcohol dehydrogenase , next ethanol, dialysis for severe
37 week GA women complaining of leakage of clear fluid anytime she stands from a sitter position and has to change underwear twice daily.treated for chlamydia at 10 weeks. Exam showed scant clear fluid in vagina but no leakage when coughing . Checked for PROM (by doing Vasalva, Nitrazine test negative, no Ferming so PROM was ruled)
Cause?
Stress Urinary incontinence (most common during pregnancy
I ruled incontinence out initially because nothing happening on Vasalva
3 first trimester spontaneous abortions in the last year. Lupus anti coag, antiphospholipid antibody negative, karotype is 46xx. TVUS- submucosal fibrous
NBSIM
Hysteroscopy. Myomectomy - submucosal fibroids can impede growth or implantation
Hypopigmented non itchy non painful patch on left arm without sensation on that arm , tingling and numb left fingers, ulnar nerve thickened and tender at left elbow. Touch and pain absent in left ulnar nerve distribution. Emigrated from SE ASIA to Connecticut. 1 year ago . Symptoms for 2 months
How to confirm diagnosis
Transmitted how
Treatment
Skin biopsy from edge of lesion (leprosy)
Resp droplets
Dapsone and rifampin. (Add clofazimine if severe)
