Q9$ Flashcards
65 yo found unresponsive in barn with hypertension, bradycardia and irregular respirations . Fixed pupils and extensor posturing of extremities
Diagnosis
Brain Herniation (central
- hypertension, bradycardia and irregular respirations .(Cushing triad)
Complication of delirium
Cognitive decline
Outcome of small vs large vsd
Small - spontaneously resolves by age 2
Large- diuretics and surgery due to symptoms of heart failure
Management of pityriasis roses
Spontaneously resolves or May give symptomatic relief of itching
NBSIM for PCP agitation vs no agitation
Benzos (supportive if no agitation)
Hypertension , tachycardia, multidirectional nystagmus
2 yo . 8 days ago had fever, an pain vomiting and watery diarrhea’s. GI symptoms subsided in 3 days but fever persists. Injected sclera and dry red cracked lips , perineal erythema and macular rash
Labs: platelets 540,000 and inc wbc
UA: WHC- 40 and no bacteria
NBSIM
IVIG - Kawasaki
- fever >5 days plus 4
- nonspecific GI or resp symptoms precede Kawasaki findings
- sterile pyuria- urinary wbc without bacteria
43 yo man with progressive erectile dysfunction over past year . Fatigue , brownish skin pigmentation especially on face an arms.
AST 78
Alt 80
Fasting glu 130
Increased risk of developing which complications
Diagnosis
Symptoms
Diagnostic
treatment
HCC
HEMOCHROMATOSIS
Sxs:
MSk3 arthealgia chondroxalcinosis
Endocrine- hypothyroidism and secondary hypogonadism ; DM
GI: elevated hepatic enzymes with hepatomegaly early and cirrhosis (.
Later)
Infections- listeria, vibrio vulnificus and testeros enterocolitis
Cardiac- restrictive of dCM
Dx: genetic analysis of Hfe mutations
Tx: serial phlebotomy
Bypass surgery 2 years old now has muscle and joint pain with low calcium and high alk phos
Nbsi evaluation
Measure 25 hydroxyvitamin d level
Osteomalacia- due to vitamin d deficiency
- malabsorption, intestinal bypass surgery, celiac , chronic liver disease , CKD
- labs low calcium and phosphorous high pth (secondary hyperparathyroidism
68 yo female with born tender groin mass below inguinal ligament and medial to the right femoral artery worsens with standing coughing and valsAlva and improves when laying down. Mass is tympanic to percussion
NBSIM
Elective surgical repair (due to risk of incarceration and strangulation)
- femoral
Mass is tympanic to percussion( bowel is in the hernia
Post mi patient has MDD
NBSIM
Sertraline (low drug - drug interactions)
Not citalopram (qt prolongation dose dependent
NBSIM for crepitues in left clavicular bone of a 5 hour old baby
Confirm with X-RAY then Reassurance and gentle handling (heals on 7-10 days)
Complication of vacuum assisted birth
Clavicular fracture
Cwphalohematoma (no suture crossing
GDM
Management
Postpartum management
Target bc levels
Screening
Managements
1st diet
2nd insulin, glyburide , Metformin
Screening 24-28 weeks
1hr 50g gct
3hr 100 g Gct
Target BG levels
Fasting <965
1hour postprandial -<140
2 hour <120
Postpartum management
Fasting glu at 24-72hour
2gr 75 GTt at6-12 week visit
Management of uterine atony once oxytocin and massages doesn’t work
Tranexamic acid
Greenstock fractire (one one side of bone affected). Possible complication
None
Pet groomer has unilateral acute cervical lymph adenitis , fever. Mass looks lobulated
NBSIM
BUG
Azithryomycin 5days (but some spontaneously resolves
Usually staph aureus or strep, but this bartonella henselae
2-5 yo with incidentally found nontender palpable mass in left abdomen, hematuria.
Diagnosis
Diagnostic
Treatment
Wilms nephroblastoma
Abdominal US
Surgery and chemo ( radiation if late stage
Location of origin of embolus causing PE
Proximal /thigh- femoral popilireal, iliac veins
Management of 38 yo female has AUB (intermenstrual spotting) even on combined OCP.
Usually <45 with AUB start them on OCP so they have progesterone to shed the endometrium. If <45 and OCP doesn’t work need to endometrial biopsy bc the proliferation of the endometrial can persist to cancer
Management of thyroglobulin duct cyst
So thyroid imaging preop because maybe only functioning thyroid tissue the person has . Then can surgically removed because risk of recurrent infections
24 yo with 2 months of cough not resolved by OTC cough meds and pulmonary nodules and retroperitoneal lymphadenopathy. Plus now has back pain.
What would establish the primary source. Of the patients current findings
Scrotal Us
Testicular cancer
- painless mass or presents as metastic disease. Spreads through regional lymphatics hence the retroperitoneal lymphadenopathy. retroperitoneal lymphadenopathy then compresses nearby structures hence back pai.
2y year old has tonic closure of eyes when penlight or headlights flashes in face . History of asymptomatic sarcoidosis.
Diagnosis
Treatment
Focal dystonia subset called blepharospasm
- idiopathic, Parkinson’s or ap
Tx: avoid triggers and wear dark glasses
Severe cases (botulinum toxin injection
7 year old c/o nocturnal enuresis, high Bp, behavioral concerns (inattention impulsivity at school and mood changes. Tonsillar hypertrophy
NBSIM
Obtain nocturnal Polysomnography (OSA)
- adhd like symptoms are like adults daytime fatigue
Patient started on disease modifying drug for RA AND NOW has painful oral ulcers, elevated total bili, alk phos and alt ast. What’s cause of symptoms?
other adverse effects
Medication induced inhibitor of DNA synthesis- Mtx
- cytopenias , stomatitis
24 yo female with 4 week history of joint pain in multiple MCP joints of both hands , with some lesser pain in wrists knees and elbows had intermittent fevers and now is a febrile. Pe- no swelling bc, re seas, warmth. Normal hand X-ray. Married with young kids
Diagnosis
Treatment
Viral arthritis
- due to parvo symmetric poly articular
- weakly positive rf or ANA
- dx: B19 igm antibodies in competent/previous infection (IgG antibodies
NAAT B19 DNA in compromised / reactivación of previous infections
Tx: self limited
A febrile and watery to bloody diarrhea
Shigella toxin producing E. coli (STEC)
Drinks alcohol daily and now AMS, GI irritation with pain and vomiting , ocular involvement ( vision impaired and. Abnormal eye exam, fixed mydriasis , bicarb of 6 , ag metab acidosis
NBSIM
Dialysis
Fomepizole inhibit alcohol dehydrogenase (preferred, ethanol competes with adhase, soufiuknbicarb iv for acidemia and hemodialysis for severe cases
3 yo girl with unknown small puncture wounds on forearm and drooling , difficulty swallowing , facial grimacing
Diagnosis
Tx
Rabies
Vaccine and immunoglobulin
- fear of liquids , fear of drafts of air
18 yo male with syncopec looks smaller and younger than age, bradycardia , prolonged qt interval, echo shows vencteixular wall thickness and reduced chamber volumes
Diagnosis
Other heart symptoms
Anorexia
- reduced chamber volumes so small fixed stroke volume and impaired cardiac output, small pericardial effusion, elevated HDL, MVP
