Rapid Review Preview #14 (Day 13)

Question 1

Fall in systolic bp of more than 20 mmHg on inspiration indicates

Answer 1

Pulsus paradoxus; Cardiac tamponade or hyperinflation disorders (e.g., COPD, asthma)

Question 2

Laproscopic finding(s) seen w/ endometriosis

Answer 2

Chocolate cysts or powder burn lesions in peritoneum or on ovarian

Question 3

HTN w/ hypokalemia, hypernatremia, & metabolic alkalosis

Answer 3

Primary hyperaldosteronism (Conn syndrome or b/l adrenal hyperplasia)

Question 4

LDL goal in pt w/ DM

Answer 4

LDL

Question 5

8 yo child MVA, now requires emergency transfusion, parents not present, child states he’s a Jehovah’s witness - next step

Answer 5

In case of emergencies, no parental consent needed (implied or denial overruled and followed up w/ court order) for life-saving intervention

Question 6

25 yo M p/w pain & watery diarrhea after meals, exam shows fistulas between bowel and skin & nodular lesions on tibias - Dx

Answer 6

Crohn’s disease

Question 7

40 yo F p/w discrete area of hair loss on scalp, worsened over weeks - Dx & Tx

Answer 7

Alopecia areata; Observation; Intralesional steroid

Question 8

CSF analysis shows low glucose, elevated neutrophils, and gram positive diplococci

Answer 8

Bacterial meningitis - Streptococcus pneumoniae

Question 9

Classic findings of tertiary syphilis

Answer 9

Tabes dorsalies, positive Romberg, loss of proprioception; Gumma formation (granulomatous disease); Argyll-Robertson pupil; Aortitis (tree-barking of aorta or aneurysms of aortic root, aortic regurgitation)

Question 10

Young child p/w thigh muscle weakness, waddling gait, pronounced calf muscles

Answer 10

Duchenne’s muscular dystrophy

Question 11

Baby girl born breech, found to have asymmetric inguinal skin folds - Dx & Tx

Answer 11

Congenital developmental hip dysplasia; Pavlik harness (maintain hips in abduction so they can heal properly)

Question 12

Head injury, AMS, resolution of AMS for a few hrs, now w/ re-emerging AMS - Dx & Tx

Answer 12

Epidural hematoma (lucid interval) - rupture of middle meningeal artery; Neurosurgical evacuation of hematoma

Question 13

Med given for seizure ppx in severe pre-eclampsia

Answer 13

IV Magnesium sulfate

Question 14

Cause of erythroblastosis fetalis

Answer 14

Maternal antibodies against infant’s Rh+ red blood cells (second pregnancy, Rh- mother)

Question 15

Tx HTN in pheochromocytoma

Answer 15

Alpha blocker first (phenoxybenzamine, phentolamine); Then Beta blocker; NEVER give unopposed beta blocker (can raise bp as get rid of beta2 vasodilation)

Question 16

7 yo M p/w hemarthrosis, lab work shows increased PTT, normal PT & bleeding time

Answer 16

Hemophilia A (VIII) or B (IX); If Hemophilia A, desmopressin can be helpful; Otherwise, in both cases, supplement deficient factor

Question 17

Young child loss of red light reflex

Answer 17

Retinoblastoma

Question 18

22 yo M 4 mo social withdrawal, worsening grades, decreased emotional expression & concrete thinking

Answer 18

Schizophreniform disorder (need 6 mo. to be Schizophrenia)

Question 19

Honeycomb pattern on CT scan of chest - Dx & Tx

Answer 19

Diffuse interstitial pulmonary fibrosis; 3-drug Cocktail - Steroids, Azathioprine (or Cyclophosphamide), N-Acetylcysteine

Question 20

Tall white mall p/w acute short of breath

Answer 20

Spontaneous pneumothorax; If % of pnemothorax not given, allow spontaneous regression, observation w/ serial CXR, give O2 as needed; If >15%, then chest tube placement