Q6) Flashcards
17 year old girl recently broke up with bc, under stress at school and has been sleeping poorly. Mom heard her fall in shower , lates unconscious for 20 minutes . Transported to hospital and was drowsy and confused . FS 100
What would be seen in patient
Tongue biting
Stress and lack of sleep can trigger a generalized tonic clinic seizure
12 year old boy had cough rhinorrhea and sore throat 2 weeks ago x past 2 days fever, worsening pain behind eyes which radiated to right forehead(tenderness when palapating right forehead) woke up this am and vomited. Green nasal discharge from right nose. Neuro wxam normal.
NBSIM
Ct scan of head (orbits and sinuses too?
Acute bacterial rhinosinusitis which bacteria spread to the brain leading to a brain abscess (fever and headache)
Headche and vomiting leans to ICP elevated
How long should most antidepressant s be discontinued before beginning an MAOI to avoid serotonin syndrome? +exception
2 weeks but 5 weeks for Fluoxetine because it has a long half life
Neonatal conjunctivitis’s
timeline symptoms and treatment
- chemical
- gonorrhea (diagnosis
- chlamydia
Chemical <day old - mild irritation after getting the silver nitrate prophylaxis- give eye lubricant
Gonorrhea 2-5 days - very bad eye swelling and ALOTTT of purulent discharge , corneal edema / ulceration
- one IM 3rd gen
- diagnosis (culture gram neg intracelular diplococci on Thayer Martin agar
Chlamydia 5-14 days of age - mild eye swelling , watery serosang or mucopurulent eye discharge
- oral erythromycin
55 yo female with 1 day of worsening sob , blurred vision , dry mouth. Pupils dilated . Neck muscles are weak and muscle strength in UE 4/5. ABG- resp acidosis
Cause of th ABG findings
Impaired neuromuscular transmission
- botulinum poisoning- starts up then down , can affect the diaphragm hence the respiratory distress , descending motor paresis of cn 3,6, 9, 10, autonomic symptoms
Thought maybe MG. Spares pupils
Teen girl with fever , enlarged erythematous tonsils, bilateral cervical lymphadenopathy with mild hepatospleenomegaly . Dad give left over amoxicillin(she’s taken it before) now has maculopapular rash all over body
Diagnosis
Mono
- people with mono who takes ampicillin or Amox can get a rash for unknown reasons
Man with alcohol use disorder found unconscious in park on a cold winter day. VS- sinus Brady, QT 560, 77/38 and Hr 38.
NBSIM hemodynamic status
Active warming
45 yo with recurrent sinusitis and otitis for the past 6 months, auditory canal or oral ulcers, fatigue, mild leukocytosis, anemia, microscopic hematuria (UA showed RBC 20-30) and protein and blood 2+ ) . HIV negative.
NBSIM (other unique symptoms)
Qualitative serum autoantibodies
- Wegner
- c-ANCa (proteinase 3-anca) —->HIV can give FP ANCA so it can be ruled out
- hearing loss, hemoptysis, lívido reticularis, non healing ulcers on skin
36 week GA with Herpes but no lesions
NBSIM
Start her on acyclovir or valacyclovir until delivery (starts at 36 weeks) and if no lesions at time of delivery vaginal delivery
55 yo female , non smoking with chronic copious thick mucus , streaky hemoptysis and 7 antibiotic responsive episodes of foul smelling purulent sputum. CXR shows increased bronchial markings and ring like shadows in middle and lower lung fields.
How to confirm the diagnosis ?
High res CT of chest
- bronchieectasis - mucus attracts bacteria leading to bronchial dilation
33 yo female unable to conceive after 9 months of unprotected sexual with husband . Remote history of chlamydia 10 years ago. Travels 3-4 dates each week but sex around schedule. NBSIM
Timed Intercourse with ovulation predictor kits - LH surge 1 day/36 hours prior to ovulation and egg survives 12-24 hours after ovulation
I PICKED HYSTEROSALPINGOGRAM thinking possible PID but do this later if can’t get pregnant after 1 year
chronic granulomatous disease
-Prophylaxis antibiotic and anti fungal
-what kind of infections
Bactrim
Itraconazole
Cutaneous and pulmonary infections with catalase positive (no cardia , s.aureus, burkholderia, serraría , aspergillosis
Cervical screening guidelines for
Hysterectomy with cervix removed
HIV
Immunosuppressed
>65
Hysterectomy with cervix removed- no if negative other screens and low risk
HIV- onset of sexual intercourse or at time of HIV diagnosis, Q1y until > or = 3 normal
Immunosuppressed -onset of sexual intercourse, Q1y pap with HPV contesting
>65: no if at low risk and negative prior screens
If history of CIN2 or higher screen for 20 years after detection
Continue after 65- if cervical risk factors: a lot of high risk sexual activity, cig, DES, immunosuppressed
76 year old man with chronic constipation and fecal incontinence.
NBSIM
Treatment t
Evaluate for fecal impaction
Tx- first manually break up Doo doo then use enema
Bowel regimen (laxatives and change in diet
5 year old boy with chronic foul smelling purulent drainage from one ear. Tympanic membrane is scarred with large perforation . Transient improvement with oral antibiotics. Had cholesatoma which was removed
What organism cause the infection
Pseudomonas (s.aureus ) maybe fungal
- chronic suppuration (pus) Ottis media - can lead to choleas toma and Eustachian tube problems
- tx oto topical fluoroquinolone
13 year old came from SE Asia recently . Recalls a time when she had febrile illness a year ago with pain and swelling in knees and wrists and was treated with NSAIDs and symptoms went away. No symptoms since. Also has a Holosystolic murmur at apex.
Most appropriate treatment and screening
IM Pen G and monitor for 6-12 months for signs of LV dysfunction due to the MR )
patients with a history of RF can get it again and it can progress to RHD so need antibiotic prophylaxis every 4 weeks to prevent recurrence
- timing depends on servity
Uncomplicated - Q4 weeks for 5 years or until 21 whichever is longer
CARDITIS - Q4 weeks for 10 years or until 21 whichever is longe
Carditis and valvular disease Q4 weeks for 10 years or until 40 whichever is longe
32 yo with signs of MDD but craves salty pretzels or potato chips , post 33 pounds and has decreased axillary and pubic hair , loss of libido
How to establish diagnosis ?
Cosyntriphin stimulation test - low production of cortisol is a positive test
Primary adrenal insufficency due to AU destruction of the adrenal - low cortisol leads o psychiatric manifestations and androgen deficiency leads to low libido and suppressed secondary sexual characteristics
Some 40 year old lady was just diagnosed weird adenomyosis last month. Period started yesterday , pain is more severe and radiates to the LLQ. On bimanual exam the left adnexa is tender.
NBSIM
Diagnostic laparoscopy immediately
Ovarian torsion is a clinixal diagnosis
Divine says do US then lap . Even if US is negative. That doesn’t rule out the torsion
3 week old in NICU born premie was intubares now on nasal cannula has bilious emesis , distended abdomen with hupoacyive bowel sounds, leukocytosis and metabolic acidosis . Nasogastric feeds. Appears lethargic .TEMP 96. Yellow seedy stool
Imaging findings
Abdominal X-ray with air in the bowel wall and portal veins
- nEC —inflammation of the bowel wall and gas producing bacteria grows there’s . Hypothermic and lethargic may not see bloody stool yet
Hydroxyurea
- when is it given to SCD patients
- complication
- what can it be given with
Recurrent vasoocculusive crises , history of ACÁ, severe symptomatic anemia
-give with penicillin until 5 yo, folate, vaccination
- myelosuppreasion (any of the pancytopenia labs
Euthyroid sick syndrome
- pathophysiology
- labs for early and severe
T3
T4
TSH
Reverse T3
Decreased peripheral conversion. Of T4 to T3
Mild
T3 low
T4 normal
TSH normal
Reverse T3 high
Severe
T3 low
T4 low
TSH low
Reverse T3 high
30 year old women with weakness in hands and can’t grip mug or open jaws. Bilateral upper extremities have impaired pain and temperature sensation. Moderate wasting of small muscles of hand
Diagnosis
Diagnostic
Treatment t
Syringomyelia
MRI
SURGERY
5p year old man is a traffic controller in an underground parking garage complaining of occasional daytime headaches dizziness nausea. 2 pack daily smoker for past 25 years . Abnormal lab: HCT is elevated at 60%
What’s responsible for condition. V
Carb oxyhemoglobin- car exhaust and the cigarettes
-co poisoning
- co has higher o2 affinity therefor why hypoxia so inc production of epo
3 days after laparoscopic cholecystectomy patient is hypoxix at 90%. Decreased breath sounds at base. ABG- resp alkalosis:
Why?
How to prevent this
Impaired cough and shallow breathing
- atelectasis - pain so shallow breathing and weak cough
- prevent by pain management , deep breathing, IS , mobilization
Exercise induced bronchoconstriction
Diagnosis
Treatment
Dx: FEV1 decreases >15% after exercise
Tx: inhaled corticosteroids and beta agonist 10 minutes before exercise
