Question review Flashcards
Patient is on TPN via central venous line. What is the greatest complication risk?
central line infection
32 year old male brought to the ER due to confusion, headaches, flank pain and hematuria. Ingested windshield cleaning solution. ABG shows what?
anion gap metabolic acidosis
Patient c/o severe weakness and dizziness. 2 episodes of syncope. Mid chest discomfort and left sided neck pain. Previously hiking in CT with sore throat and dry cough. Thready pulses over both radial arteries that disappear with deep inspiration. Dx?
cardiac tamponade
36 y/o female with confusion and agitation. Has temporal encephalitis. What would CSF show?
HSV encephalitis
WBC elevated
neutrophils low
glucose nl
elevated RBC
elevated protein
SOB when climbing stairs, worse on exertion. BP, HR, RR normal at rest. Exam shows bibasilar fine crackles. 36 y/o smoker Spirometry shows FEV1 65, FEV1/FVC 85%. Dx?
restrictive lung disease, lung stiffening due to fibrosis
Patient has protraction of labor, cervix dilates slowly after 5cm. If membranes are still intact what is the next step?
amniotomy
Thoracentesis for male with recent weight loss fatigue and poor appetite shows 1.5L of yellowish pleural fluid. Fluid has protein 4.9, glucose of 40, cell count of 1200, with 90% lymphocytes. What is the cause of the pleural effusion?
TB
Patient with small cell lung Ca complains of HA. Diffuse. JVD shown on exam of lung. No peripheral edema, abd soft nondistended. Diagnosis and which relieves patient’s symptoms?
patient has superior vena cava syndrome from compression of SVC.
radiation treatment
Patient has acute onset confusion and lethargy. History of hepatitis C and alcohol abuse. Abd distended on exam. Bilateral ankle edema. What is the likely diagnosis?
spontaneous bacterial peritonitis.
findings on paracentese are greater than 250 neutrophils
Itching on nkee folds. Physical exam shows tense bullae in her groin, axilla and knee folds. Subepidermal blisters on biopsy. Dx?
bullous pemphigoid
What does treatment of tension pneumothorax do to heart?
increase venous return
Complication from esophageal dilation with hematemesis and pleural effusion with diminished breath sounds on left side? Sx are chest pain, hematemesis and SOB.
esophageal rupture which leads to mediastinitis
Calcifications on pancreatic duct in a 61 year old patient complaining of chronic diarrhea. Greasy appearing bowel movements and lost 20 pounds. What is the cause of the problem?
chronic pancreatitis from alcohol consumption
46 year old female complains of frequent falls, lower extremity weakness, and muscle cramps. Also has HA, and thirst. High blood pressure. Normal neuro findings. Treatment and dx?
primary hyperaldosteronism
spironolactone
elevated phosphate and low calcium with renal dysfunction. Dx and cause?
renal osteodystrophy leading to parathyroid hyperplasia
what are the antibodies for SLE?
positive ANA, positive antiDS DNA, anti smith antibodies
patient has follow up after alcoholic cirrhosis and is on spironolactone and ranitidine. Abd mildly distended and soft. Cirrhosis labs back to normal. What is the best treatment for the patient?
beta blockers to reduce risk of esophageal variceal hemorrhage
nursing home patient complaining of cough and SOB. Has increased lethargy and decreased oral intake. Extremities are warm to the touch with decreased breath sounds over left lung base. FSG 154. ABG shows metabolic acidosis. T 102, BP 70/60. HR 120. Dx? and cause?
early septic shock which causes increased tissue metabolic acid production
38 year old SOB while walking and choking sensation when falling asleep. Bibasilar crackles in lungs with pitting edema in lower extremities. Displacement of PMI. URI 2 weeks ago. Increased risk of?
dilated cardiomyopathy from virus such as coxsackie B
34 year old with rash on elbows adn knees. itchy during spring and fall. silvery scale on plaque. dx?
psoriasis
10 year old boy gets into mother’s cabinet which has acetaminophen and iron. Develops severe colicky abd pain and dizziness. Vomiting with bright red blood and diarrhea with dark green stools. BP 70/60, HR 110. Which drug caused sx?
iron
Treatment of CLL is directed at?
CD 20 cell surface antigen
patient with sickle cell develops bacteremia, sepsis, pneumonia and possible meningitis. No sign of bone infection. Causative organism is likely?
strep pneumo
tx of infertility from PCOS?
weight loss
then clomiphene and or metformin
patient with pancreatic cancer develops severe itching. Total bili 15.4. Tx?
endoscopic stent placement
Most common cause of exudative pleural effusions without evidency of infection?
malignancy
malignant pleural effusion cause is breast cancer and lung cancer
AA boy 5 year old complains of severe pain in back and thighs. Recent URI and decreased appetitie. anemia with MCV normal. elevated WBC and LDH. Likely dx?
sickle cell occlusive crisis
Treatment for afib?
rate control and anticoag.
DHP CCB or beta blockers for rate control
7 y/o asian boy has soft systolic murmur heard best at left upper sternal border. Wide splitting of second heart sound does not change with respiration. Cause?
ASD, left to right shunting
Cause of elevated BUN, creatinine consistent with renal failure, slightly elevated calcium with bone pain, and normocytic anemia?
multiple myeloma
patient has flattening of nasolabial fold on left and upper and lower extremity weakness on right. Where is the lesion?
pons (look at facial nerve nucleus due to contralateral facial nerve and motor weakness)
3-5 days post MI, patient has SOB, hypotension, tachycardia and holosystolic murmur at left sternal border. Diagnosis?
VSD rupture
Patient has CP, SOB, hypotension, tachycardia, hypoxia. Right heart pressures are elevated. Lungs clear o exam.
PE
63 year old with history of RA presents with acute onset pain in her right hand. Mild temp and pain in monoarticular joint. Dx?
gram positive bacterial infection
What is the cause of meckel’s diverticulum?
ectopic gastric mucosa
Patient has malignancy and presents with elevated LDH, retic count, bilirubin, thrombocytopenia, decreased fibrinogen, increased INR. Dx? What is the cause of the anemia?
DIC which causes microangiopathic hemolytic anemia
Murmur for patient with mitral stenosis?
mid diastolic murmur at the apex
patient with left sided pleural effusion on CXR. After thoracentesis, patient has dizziness diaphoresis, SBP 70, HR 130 and regular in rhythm. Low 02 sat, decreased breath sounds on left. What is the cause of the symptoms?
decreased left ventricular preload
AA patient has urine protein > 3.5, edema, hypoalbuminemia. Cause?
nephrotic syndrome, likely FSGS
Cause of thoracic trauma with airspace opacity on CXR and findings consistent of alveolar fluid on physical exam?
pulmonary contusion
Cause of central obesity, proximal muscle weakness, androgen excess, menstrual irregularities, hypertension, easy bruising, normal reflexes?
Cushing’s syndrome
Quickest way to decrease pain associated with MI?
reduce preload with nitrates by venous dilation
Patient has diastolic murmur with a decrescendo pattern over left sternal border. Cause and dx?
aortic regurg
aortic root dilation or bicuspid aortic valve
Patient with MCV > 100, blood smear shows ovalo macrocytes and neutrophils with reduced segmentation. Renal function is normal. Next step and dx?
myelodysplastic syndrome
bone marrow biopsy
most common postinfectious complication with patient with impetigo? Most common etiology of impetigo?
glomerulonphritis
staph or strep
patient with spherocytosis and enlarged spleen is at risk for?
bilirubin gallstones
Treatment of urge incontinence?
behavioral modifications such as bladder training and timed voiding
HSP is what type of vasculitis?
leukocytoclastic vasculitis with IgA deposition
Patient with opioid intoxication has what findings on ABG?
respiratory acidosis
Paitent with diabetes complains of progressive blurring of her vision, Worse when driving at night and avoids bright lights due to glare. Dx?
lens opacification, cataracts
Cause of thrombocytosis in patient who was involved in MVA with blunt abdominal trauma. History of smoking.
prior surgery, splenic problems
cause of carpal tunnel syndrome in pregnant patient in 3rd trimester?
median nerve entrapment from accumulation of fluid in carpal tunnel
pregnant patient has pulmonary edema demonstrated by hypoxia, tachypnea, and bibasilar crackles. What tocolytics can cause this?
beta agonists
best treatment for familial dysbetalipoproteinemia where the patient develops hypertriglyceridemia
fenofibrate
best way to control/ slow progression of nephropathy in patient who has HLD, type 2 DM, osteoarthritis, HTN?
control blood pressure, likely with ACEI/ARB
cause of painless non itchy rash, fever 3 days ago in under 2 year old child.
HHV6 infection (roseola)
first line therapy of reynaud’s from CREST
CCB
patient on sotalol with random episodes of syncope, no prodrome. Cause?
sotalol prologates QT interval and can cause ventricular arrhythmias
Initial treatment of tosades in patients who are hemodynamically stable?
mg sulfate
