U world questions Flashcards
Patient presents with recent BMT with fever, dyspnea and dry cough. CT shows pulmonary nodule with ‘halo sign’ i upper lobe. Most likely Dx?
Aspergillosis
Patient from Missouri comes in with cough, fever and tiredness. On CXR you see hilar adenopathy and areas of pneumonitis. Whats the dx?
Histoplasmosis
more in mid-atlantic and central US
you can see chronic pulmonary histo or disseminated hiso in HIV pts
Patient comes in from Wisco and has not felt great recently. Complains of cough and likes to hike through woods and moutains. What form of mycosis could he have and where else would it present?
Blasto; may present in lung, skin, joints and prostate
endemic in north central and south central us
Patient comes in with 10 lb unintentional wt loss, fever, fatigue and dry cough with pleuritic chest pain. you notice nodules on both arms and erythema multiform on his lets. What could pt be suffering from?
Coccidiomycosis; more in southwest
common to have cutaneous findings like erythema multiform or nodosum and arthralgias
What congenital associations do we see with Rubella (German measels)
How does this present in adults vs children?
Congenital: sensorineural hearing loss, intellect disability, cardiac anomalies and cataracts
Children: low fever, conjuctivitis/corzya/cervical lymph and forschheimer spots with a more cephalocaudal spread of blanching maculopapular rash sparing palms and hands
Adults: same a kiddos; low fever with rash PLUS arthralgias
Patient comes in complaining of intermittent substernal chest pain, can’t swallow solids or liquids and lasts seconds to minutes. No change in wt with normal ECG and no past history of drug use. What could this be and what is the tx?
Diffuse esophageal spasm
see corckscrew pattern on esophagram.
First line is CCB like diltiazam
Patient that comes into clinic in the fall age 55 wonders about vaccines he needs. He is about to head on vacation and wants to make sure hes up to date. He had a Td booster at age 42 and is uncertain about his previous vaccintion hx. Recommendations?
What if he was diabetic?
What if he was asplenic/immunocompromised?
Give him Tdap as all adults over 19 should at some point have the Tdap in place of the Td booster and then Td every 10 yrs he should get intramuscular influenza each fall He does not need a pneumococcal vaccine yet till he hits 65 then will need the 13 followed by 23 If diabetic (or chronic condition) give him 23 alone prior to turning 65 if he has sever illness (asplenic or SSD, HIV) give 13 and 23
What symptoms are seen in pts with nasal polyps?
What conditions are associated with them?
Sxs: recurrent nasal discharge/congestion and food tasting bland. PE shows bilateral grey, glistening mucoid masses in cavities
Can be associated with Aspirin exacerbated respiratory disease (AERD); often seen with polyps
In a patient with bipolar mood disorder with mixed manic and depressive symptoms, what is an ideal maintence therapy to place him or her on?
Lithium OR valproate +
Second gen antipsychotic (like quetiapine)
**avoid antidepressants in maintence bc may cause mood destabalizations
If a patient is experiencing a miscarriage at about 10 weeks, when is it appropriate to manage this surgically (D and C) vs expectantly
Expectant if patient is stable and okay with it
Once patient is not stable (hGB
What happens to the following values in Fe defienct anemia MCV RDW RBCs Smear Iron Studies
Fe deficient MCV: decreased RDW: increased RBCs: Decreased Smear: microcytosis with hypochromia Iron studies: low Fe, low ferritin, elevated TBC
What happens to the following labs in thalessemias MCW RDW RBCs Peripheral smear Serum Iron
Thallessemia MCW: decreased RDW: normal RBCs: normal smear: target cells Iron studies: normal/elevated iron and ferritin
Most common causes of anion gap metabolic acidosis
Lactic acidosis ketoacidodos Methanol/formaldehyde ingestion ethylene glycol ingestion salicylate poisoning (asa) Uremia (pt with ESRD and impaired excreation of H+)
Friable papules or plaques seen in immunocompromised pts often associated with fever and systemic sx of mucosa or visceral organs
Bacillary angiomatosis
At what point do we see pneumocycstisis jiroveci in AIDS pts?
What do we use to prevent it?
once pt has it, what do we tx it with?
CD4
What parasite can cause leukopenia, thrombocytopenia and symptoms of fever, myalgia, AMS and malaise without rash in a human?
How do they get it?
Human monocytic ehrlichiosis from lone star tick in south east and south central US
*see intracytoplasmic morulae in monocytes and treat patients with Doxycyline while confirming!
70 yoM presents with altered consiousness, disorganized speech and visual hallucinations. PE shows increased LE tone with downgoing babinski. Dx and tx?
Lewy body dementia; alpha synuclein proteins; seenin substantia nigra, locus ceruleus, dorsal raphe.
Tx motor sx with acetycholinesterase inhibitors (rivastigmine) and possible atypical antipsychotics
how do nitrates cause relief in pts experiencing angina?
direct vascular smooth relaxation–> systemic venodilation with increase in peripheral capacitance. Systemic vasoD and decrease cardiac preload ultimately decrease LVED and ES volume thus REDUCE left ventricular systolic wall stress thus decrease O2 demand
36 weeker presents with moderate vaginal bleeding. PE shows firm and tender uterus, 2 cm dilated with baby in breech. Mom has diet controlled GDM and is a current smoker. What is likely going on with mom?
What complications is she at risk for?
Placental abruption (seperation of placenta from decidua) RF: maternal HTN, preeclampsia, abdominal trauama, cocaine/tobacco use, prior abruption Complications for mom: hypovolemic shock and DIC
What conditions are associated with umbilical hernias in newborns?
how do you manage an umbilical hernia 1.5 cm?
associated with AA race, premature birth, ehlers danlos, Beckwith Wiedemann, and hypothyroidism
most close by 5 yrs old otherwise operate
>1.5 cm then may need to operate
slowly progressive neurodegen disease; memory loss–> problems with lang/visuospatial
alzeihmers
Progressive personality change (disinhibition or personality change) with occiasional mood swings
FTD
Cognitive fluctuaitons, visual hallucinations, parkinsonisms
Lewy body
Initial ataxia–> followed by dementia and urinary incontinece and you will not see FNDs on exam
Normopressure hyrdo
Stepwise decline in function, early executive dysfunction with cerebral infarct in white or deep matter (lacunar infarct with RF of hypertension and hyperlipidemia)
Vascular dementia
What organisms are responsible for early onset prosthetic joint infection?
Staph aureus and pseudomonas
What organism is more responsible for a subacute presentation of delayed onset prosthetic joint infection?
Staphy epidermidis; need to remove prosthesis
bone cancer that causes unilateral limb pain, worse at night and responds to NSAIDS
osteoid osteoma (looks like a hole in a bone)
diastolc decresedo mumur begins immediately at A2 high pitched and blowing quality. best heard at LS border in 3rd and 4th intercostal space. Heard best when you have patient lean forward and hold breath in expiration
Aortic regurg
Causes: RHD, endocarditis, bicuspid valve, trauma, myxomatous, ankylosing spondylitis
wide, fixe split of second heart sound. hear ejection systolic murmur over the left second intercostal space
ASD
