Q7$ Flashcards
6’2” has sudden sob while watching television which improves then has sharp cp that’s worse with deep inspiration. CXR- small right apical PTX.
Management
Supplemental oxygen - primary spontaneous Ptx
Needle aspiration or. What tube of large
Child swallowed battery . Circular object with halo sign.
NBSIM
UGi endoscopy
Battery can cause life threatening effects- necrosis etc
No bronchoscopy bc CXR showed its past the eso and there’s no sudden onset respiratory distress
55 yo male with fatiga le bulbar weakness affecting his voice . Changes in speech toward end of his lectures and it becomes more nasally
NBSIM
Acetylcholine receptor antibody assay
MG- bulbar- dysarthria, dysphagia. Trouble with extended chewing like when chewing steak, facial weakness, slurred speech or changes in speech bc palate weakness
Ocular- diplopia
Proximal muscle weakness
Mild trauma after twisting foot after coming out of bathtub in Type 1 diabetic in which monofilament test revealed significant impairment of sensation in both feet. Right foot is swollen, red and warm. VSS plus a febrile. leukocyte yes are normal
XR- mild soft tissue edema but no fracture or dislocation.
NBSIM
Avoidance of weight bearing with use of cast- CHARCOT arthropathy.
If untreated can lead to bone destruction
DM DRUGS Cardio protective and helps with weight loss
SGLT2 i and GLP1 ah- exentáis e and liraglutide
42 yo woman with persistent elevated LFT (ALT AND AST 512 and 452, alk phos 90. Asymptomatic. Pmh- HTN.
Why ?
Interesting labs
Treatment
Autoimmune hepatitis
- elevated ast and alt with large gamma gap (total protein- albumin>4
- asymptomatic or fatigue weight loss abdominal pain, itching , maybe cirrhosis
And May have other AI disorders
- labs- antibodies igg ( anti smooth muscle, anti liver and kidney microtonal type 1 , antinuclear non specific) leads to hyper gamaglolubinemia
Treatment: prednisone and azathioprine
Kid is emotionally withdrawn and doesn’t respond to comfort from caregiver
Reactive attachment disorder
Disinhibites- overly friendly
2 days Postpartum and had an epidura. Now has severe headache with nausea and vomiting when getting out of bed. Feels better when laying down or sleeping. Afevrile, neck stiffness without papilladema
Diagnosis
Treatment
Postdural puncture headache
- anesthesia the dura can be punctured leading to CSF leakage and low CSF pressure with herniation of brain and brain stem
Tx: self limited or epidural blood patch
38 week GA with uterine tenderness and moderate vaginal bleeding. BP 158/96. G
PATIENT IS at greatest risk of developing which complications ?
DIC
- placenta abruptio - tissue factor is released in response to decidua bleeding
21 weeks GA. Bulging bag of fetal parts is protruding through the cervix .
Diagnosis
RF
Treatment
Cervical insuff
RF- collagen defects(Ehlers) , uterine anomalies (separate, bicornuate), coinization , obstetric injury
Treatment- cerclage
Trauma surgery but see a gastric mass consistent with a GIST
What to do?
Do not respect because lack of consent
Long term plan for kids with absence
Dc meds before puberty without any long term complications
58 yo man with repeated hospitalizations for acute heart failure de compensation and recently treated for acute prostatits. Other PMH- CKD Audiometry reveals sensorineural hearing loss.
Cause?
what other medications are ototoxic
Furosemide (frequent hospitalizations
With Ckd )
Aminoglycosides, cisplatin, high dose salicylates
But not Ciprofloxacin
Intoxicated 25 yo fell down stairs head first but no LOC. Somnolent but can follow simple commands. and moves all extremities spontaneously.
NBSI evaluating and ruling out cervical spine injury?
CT scan without contrast
NEXUS (when to do Ct scan for CS injuries
- intoxicated
- AMS
- neurological deficit’s
- spinal tenderness
- distracting injury
But if none don’t do Ct
1 week old Baby with meningitis and impending respiratory failure (cyanosis , apneic. Mom says no tubes down her throat
What to do?
Proceed with intubation
(Bc life threatening)
Initial herpes infection on genitals. If left untreated what happens
Spontaneous resolution within the next week
Acyclovir just shortens the duration and reduces the frequency of recurrences. But does not eliminate recurrences
Newly positive HIV. TSST is 8 mm and clear CXR
Diagnosis
Treatment
Latent Tb
Rifampin and isoniazid weekly for 3 months or daily INH and pyrixodine for 9 months
18 mo boy with productive cough and Ferber. 8 doctor visits in the past year which requires antibiotics for sinusitis and pneumonia. Older bro has similar recurrent infections. Enlarged tonsils.
Point of maximal impulse is displaced to the right side of the chest
Diagnosis
Diasgnostic
Kartagener syndrome
Dx: low nasal no levels
Bronchoscopy and EM visualization of ciliary abnormalities
Genetic testing
Def not Bruton bc tonsils are enlarged
1 day old baby with rapid onset of hypotension, cyanosis and hypoxia not improving with 100% oxygen
Diagnosis
NBSIM
ductal dependent congenital heart defect
Prostaglandin E1 even if pda has already closed
10 month old girl born at 32 weeks brought on because hasn’t stood yet. . Plus herself on the color using her arms and drags her legs
PE- says mama
Mild hypertonic of UE
Bilateral LE are hypertonic with significant resistance to passive extension
Equinovarus deformities of feet
Babinksi pos
Diagnosis
Risk factor
Cerebral palsy
RF- premie
Presents first as gross motor delay
Subtype- spastic , ataxia, dyskinesia - involuntary movements
Myotonic dystrophy
Babies / hypotonia and respiratory distress
Older kids and adults- chronic weakness and pain affecting facial and distal muscles
Muscle wasting
Myotonia (impaired grip release
Speech regression and hair pulling in 18 month old girl
Diagnosis
Diagnostic
Prognosis
Rett syndrome
Dx: DNA analysis for MECP2 gene mutation
Prognosis - middle age life expectancy, seizures , respiratory difficulties reduced mobility , decel of brain growth, sleep disturbances
27 yo female with left adrenal mass with rapidly progressive hirsutism and virilization (clitoromegaly) . Last menses was 12 weeks ago.
DHEAS
TEST
LH
DHEAS and test (high)
Lh (low
Adrenal mass mostly produces dhea (doesn’t really work) which is converted to testosterone and testosterone inhibits lh
