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Diverticulitis with abscess formation.
CT guided percutaneous drainage.
Rash localized to the nipple with an eczematous appearance. Biopsy shows cells with a clear halo around them.
Piagets disease of the breast. She is at a high risk for adenocarcinoma.
Patient with a diaphragmatic hernia develops respiratory distress and is satting 88% on room air.
Intubate. Bag mask is contraindicated in this patient.
Swollen epiglottis on lateral xray
epiglottitis
Subglottal narrowing on lateral xray
Croup.
Hypercalcemia and a lytic bone lesion in a child
Langerhand Histiocytosis.
Contraindications for tDAP vaccine
Anaphylaxis, neurologic deficite, and encephlopathy
How do you find the risk of getting a disease
Divide the number of people with the disease by the total number of people at risk.
Rapid ascending paralysis with no history of a viral illness . Went hiking in colorado. What is the next best step ?
Search for the tick. In tick born paralysis rapid removal of the tick will result in rapid resolution of the symptoms.
Best way to diagnose B12 Deficiency
Methmalonic Acid Levels and Homocysteine Levels
Standing, Valsalva, and leg raises decreases the quality of which murmers ?
All except HCM and MVP
HCM and handgrip ?
Diminishes intensity of murmur because SVR increases lessening the gradient across the aortic valve.
Squatting increases the intensity of which murmurs ?
All except MVP and HCM
Systolic ejection murmur at LLSB with dual carotid upstroke and loud S4.
HCM
What intensifies HCM murmur
Valsalva and standing
What diminishes HCM murmur
Squatting, Lying Down, Straight Leg raise.
ECG finding specific for pericarditis
PR depression.
Chest Pain, Pericardial friction rub, PR depression / ST elevation
Pericarditis, supportive treatment with NSAIDS, Eco for pericardial effusion, watch for tamponade.
Dysfunction in restrictive pericarditis
Rapid filling in early diastole and an abrupt halt in late diastole.
Clinical signs of cirrhosis and distended neck veins
ECG Eco and CT looking for constrictive pericarditis
ECG findings in constrictive pericarditis
Low voltage QRS with T wave flattening.
Becks Triad
Hypotension, Muffled Heart Sounds, JVD.
Workup of Lung Cancer
CXR, CT, Tissue Biopsy
Lung Cancer with SIADH
Small Cell
Lung Cancer with ectopic ACTH
Small Cell
Lung Cancer with Eaton Lambert
SCLC
How do you biopsy peripheral tumors
CT guided needle biopsy
How do you biopsy central tumors
Bronchoscopy or cytologic examination of spitum
Lung cancer with central cavitation
SCC
Peripheral Lunc Cancers
Adeno and LCC
Lunc cancer that narrows the bronchi
SCLC
Hypoxemia with normal A-a gradient
hypoventilation
Hypoxia with normal CO2, responds to 100% O2
V/Q mismatch
2 types of hypoxemic respiratory failure
V/Q mismatch or shunting.
Workup of respiratory failure.
ABG
Hypoxia
PaO2 50
Hypercapnia
Partial Pressure CO2 > 50
What is oxygenation measured by
Saturation %, controlled by FiO2 and PEEP
What is ventilation measured by
PaCO2, controlled by RR and Vt
Hypoxemic respiratory failure
Low PaO2 with a PaCO2 that is either low to normal. Usually by a cause intrinsic to the lung.
Hypercarbic respiratory failure
Defect in mechanical ventilation of the lung. A-a Gradient is normal. Increased physiologic dead space. COPD, Asthma, CF.
Workup of ARDS
CXR
ABG
Pulmonary Artery Catheter
Bronch & BAL
Clinical monitoring of COPD patients
Serial FEV-1, Pulse Ox, Exercise Tolerance.
Workup of COPD
PFT’s
CXR
Alpha-1 AT level
ABG- Chronic resp acidosis with met alkylosis.
Nonproductive cough with viral like diarrhea and eosinophillia
Ascariasis
Retro-orbital pain, rash, myalgias and arthralgias
Dengue Fever
Painful periorbital swelling, sublingual splinter hemorrhages, diarrhea, muscle pain. eosinophillia
Trichinellosis- mexican worm that encysts into stiraited muscle.
Chronic cough (Over 4 mo) with minimal white sputum production. Wakes the patient up at night. CXR is normal, next step ?
PFT’s. A cough that wakes a patient up at night is typically asthma. Metacholine challenge test or trial of inhaled glucocortacoids.
Post op from abdominal aortic aneurysm repair, how do you prevent post op pneumonia ?
Spirometry, even if you thing the incision may have been made through the ribs.
Constipation, Back pain, anemia, inc. ESR, and renal dysfunction.
MM. The hypercalcemia from bone lysis can cause constipation.
Lady is found unconscious laying face down with a body temp of 90. She is taking fluphenazine and amytriptline
Fluphenazine can disrupt thermoregulation and induce hypothermia.
Painful Necrotizing retinitis in HIV patient
HSV retinitis.
Painless retinitis with fluffy granular lesions in HIV patient
CMV retinitis
Td and Tdap recomendations for HIV patients
Tdap once in their adult life followed by Td booster q10 years.
Difference between CVID and SCID
CVID has some B cells.
Diagnostic criteria for X-Linked Agammaglobinemia
- Recurrent bacterial infections within the first 5 years of life
- IgG IgM and IgA are 2SD below normal
- Absent Immunoglobins and poor response to vaccines.
- Less than 2% CD19+ b cells in circulation
Young child with eczema, thrombocytopenia, and recurrent encapsulated infections
Wilscott Aldrich syndrome, X Linked recessive. Low IgM, High IgA and IgE levels.
Nitroblue terazolium test
Chronic Granulamatous disease.
Acute dyspnea and difficulty swallowing in a patient with numerous allergies.
Aspiration of something they are allergic to which induces bronchioconstriction.
Patient had a seizure and now is holding her arm adducted and internally rotated. What type of dislocation ?
Posterior.
Patient with bells palsy, how can you tell if the lesion is in the pons or downstream ?
In the pons the facial nerve will spare the forhead.
How do you differentiate MGUS from MM ?
MGUS does not have hypercalcemia, lytic bone lesions, hypercalcemia
Concerns with a pregnant woman with chronic Hep C
Acute hepatitis with chronic Hep C will most likely be fatal. Thus vaccinate with live attenuated strain of vaccine for Hep A and Hep B.
How do you differentiate leukmoid reaction from CML ?
Increased Leukocyte alkyline phosphatase score in Leukmoid reaction.
Baby with cutaneous lesions on hands and soles, hepatomegaly, jaundice, anemia, rinorrhea.
Syphillis
Patient with DKA or HHS. What is the deal with their K levels.
K is moved out of the cells in reponse to acidosis and is lost due to the osmotic diuresis of glucose. Thus, they are total K depleted but have a normal value.
Patient with RA develops nephrotic syndrome, Why?
RA predisposes the patient to amyloidosis.
MM also predisposes patients to developing amyloidosis.
Idiopathic Intercranial HPTN, first line treatment is repeated LP or Acetazolamide
Acetazolamide + / - Furosamide.
Rash, Periorbital Edema, and Proximal extensor weakness. Scaley papules on the joints.
Dermatomyositis. Anti Jo-1 and Anti-M2. Look for malignancy
Patient on an Anti-TB regimen has mild elevation in LFT’s (
Continue the drugs. Side affect of isoniazid.
Tests to prove hereditary spherocytosis.
Acidified glycerol test and eosine-5-malenide test. Increased MCHC due to acellular dehydration and membrane loss.
CD 55 and CD 59 are used to diagnose ?
PNH
Low Hb, reticulocytosis, and + coombs/ acidified glycerol
Autoimmune hemolytic anemia.
Patient with nephrotic syndrome develops sudden flank pain and gross hematuria
Renal Vein thrombosis secondary to AT3 loss in the urine. THis is most commonly found with membranous nephropathy.
Upper respiratory tract infection, patient then develops microscopic hematuria and proteinurea
IgA nephropathy.
Baby born with decreased activity horse cry and jaundice. super high TSH and low T4
Thyroid hypoplasia.
