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Q10$ Flashcards

1
Q

Tardive dyskinesia management. Patient is on Risperidone and lithium for manic episode

A

Taper and discontinue Risperidone
2nd- switch to clozapine or lower risk ap or valbenazine deutetrabenazine

(No benztropine

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2
Q

Mammogram- speculated mass with coarse calcifications in upper quadrant or right breastX core biospy- foamy macrophages and fat globules

NBSIM

A

Reassurance and routine follow up - fat necrosis

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3
Q

17 yo with progressive muscle weakness and pain, difficulty making facial expressions . Testicular volume is small for age .

MOI
Other symptoms
MCCOD

A

AD ctg repeats on DMPK GENE- muscular dystrophies (classic myotonic , Becker xlr

Classic- cardiomyopathy, dysphagia , cataracts, testicular atrophy , frontal hair loss

MCCOD resp or heart failure at 45-55

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4
Q

4 yo girl with headache the. Generalized tonic clinic seizure , muscle strength is decreased in right upper and lower extremities . Follows commands but answers but one word Ct head normal . Appropriate seizure meds and eeg are initiated.

NBSIM

A

Mri head
- ischemic strike

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5
Q

Management of spasms in MS

A

Baclofen agonist at gaba b
Tizanidine - alpha agonist

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6
Q

Infant with growth failure <5th percentile. ,non ag metabolic acidosis. Urine ph 7.8

Cause

A

Type 1 rta- can’t excrete h and can’t reab hco3

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7
Q

25 yo female with6 weeks of pallor, fatigue jaundice splenomegaly, elevated LDH and reticulocyte count .

PBS shows spheroxytes without central pallor . Direct Coombs positive

Diagnosis

A

Autoimmune hemolytic anemia (warm and not HS

  • both are extravascular hemolysis
  • hs - negative direct Coombs
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8
Q

4 year old boy with redness itching and white discharge around uncircumcised penis . Was recommended 5 days ago about foreskin hygeine . Still has issues

NBSIM

A

Potassium hydroxide microscopy
Then topical anti fungal like azole clotrimaze
Screening for dm if child has not recent antibiotic use or no diaper dermatitis

  • balanitis (with Cándida infection
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9
Q

Association of which w endocrine disorder with vitiligo (destroyed melanocytes

A

Autoimmune thyroid diseases

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10
Q

Rhinitis medicamentosa
1 which drug
2. Exam fundido

A

Oxymetazoline
Beefy red nasal mucosa and no edematpus pale mucosa like in allergic rhinitis

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11
Q

30 week ga has irregular contraction but no vaginal bleeding. FHR (170). Temp 100.4 tenderness to palparían of right lateral flank and rebound guarding o right side of abdomen . Nontender uterus and closed cervix

NBSIM

A

Immediate surgery for acute appendicitis

  • right flank pain or right mid to upper quadrant
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12
Q

Complication and management of monochornionic moniamniotic twins

A

Monochorionic - 1 placenta so twin to twin transfusion syndrome (polyhydramnios and oligo

Monoamnioric (1 amniotic sac so umbilical cord entangled

Managemntent - close surveillance and C-section at 32-24 weeks

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13
Q

Chrons- Partial ilex resection due p structure and surgeries to fix fistula .

What. Is a possible supplement deficiency and it’s symptoms

What area is it absorbed

Other trace mineral deficiencies and symptoms

A

Zinc - alopécica, pustular skin rash around mouth and extremes , hypogonadism, impaired wound healing, impaired taste, immune dysfunction
- duodenum and jejunum

Chromium/ impaired glucose control in diabetics
Copper - brittle hair , skin despigmentación, neurological (peripheral neuropathy, anemia, osteoporosis

Selenium- thyroid dysfunction, cardiomyopathy ,
Immune dysfunction
I

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14
Q

56 yo has cholecystectomy 5 weeks ago for emphysematous cholecystiyid kow has 6/7 watery brown stools daily and at night . C diff neg.

Stool- neg for leukocyte

NBSIM

A

Cholestyramine (other cole drugs )
- bule acid diarrhea- without gallbladder bile gets released into the small intestine Willy nilly and it can’t resbalen all so some gets to the colon causing secretory diarrhea (nocturnal too)

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15
Q

67 yo has worsenribg dull aching pain in right groin for 2 weeks. No trauma or overuse. Pmh-osteoporosis on alendronate for 7 years. MRI- sub trochanter Uc region of right femur has fracture. Dexa - bone density has improved compared To 5 years ago

Cause of fracture

A

Medications adverse effect (Bisphosphonates use >5 years can prevent appropriate bone turnover so go on 3-5 year old drug holiday after 5 years of use

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16
Q

3 hour old with curvature of underdeveloped phallus with urethral meat is at base. (Hyposp) . Labiosacrel folds are fused and gonads are not palpable. Elevated 17 hydroxyprogestetone level.

Karotype

A

46 XX
-cah 21 (boys normal or hypervirilized big phallus

Karotype
Pelvic us - any female internal
Check electrolytes if salt wasting 21 def

17
Q

3 yo boy with deficient serum sis if Uc antibody rutera to tetanus , diphtheria, h influenzae type b and pneumococcus.

What additional test

A

Flow cytometry of peripheral blood- reduced cd19+ B cells in brutons

Also low levels of plasma cells

18
Q

When to do head Ct scan without contrast in kids

A

AMS
LOC
severe mechanism of injury
Vomiting or severe headache
Skins of basilar fracture

19
Q

18 yo old girl attends college in north Carolina’s fever , headache,, n/v for 3 days , severe hypotension, tachycardia , poorly arousable (shock )x maculopapilar rash with petechiae on hands feet , trunk. Bilateral tales (pulmonary edema

Csf minimal leukocyte Elva te, minimal protein elevation, normal glucose

Cause
Interesting labs
Dx
Treatment

A

Rmsf rickettsia
- labs: hyponatremia due to inc adh
Low platelets
High ast alt
Dx: skin biopsy or rickets is serology
Tx doxycycline

Meningitis (dramatic leukocytosis >1000, high protein, low glucose

20
Q

18 month old both from Uganda has splenomegaly with left sided abdominal tenderness and signs of anemia (fatigue, pale mucosa, 2/6 systolic ejection flow murmur ) . Anterior cervixal lymph nodes and bilateral distal pulses are weak

How to establish diagnosis
Treatment

A

Hemoglobin electrophoresis
- scd and splenic sequestration (sickled rbc are trapped there so slot of blood there so hgb drops drastically and reticulocytes increases as a result) spleen enlarged and shock (weak pulses

Tx - isotonic fluid resuscitation (na)
Rbc transfusion

21
Q

Sick sinus syndrome in 80 yo
- ekg finding
- treatment

A

Sinus Brady and drop in sinus nodal activa cardiac conduction system degeneration due to age usually

Tx: pacemaker

22
Q

Patient with poorly controlled diabetics , nag metabolic acidosis , Hyperkalemia

Cause

A

Rta 4 - aldosterone deficiency so no h or k excretion ; poor controlled diabetes

23
Q

35 yo women with turners has severe chest pain migrating to epigastric region to. Back. With associated abdominal pain pain and nausea/vomitingX Bp160/94. Elevated serum amylase. No contrast abdomen Ct shows dilated bowel loops

NBSI evaluation

A

CT angiography of chest and abdomen
- aortic dissection
- complication- dissection spread ti mesenteric artery leading to intestinal ischemia so dilated bowels and oop abdominal pain and elevated amylase

24
Q

widespread Times corporis risk factors
Treatment t

A

Dm , systemic glucocorticoid, HIV so do hiv screening test

Oral azole

25
Q

3 month old spitting up undigested breast milk . But is eager to feed every 3 hours and or irritable. Growth charts are normal .

NSIM

A

give Vit d to babies being breast fed

  • baby has GER due to immature LES(smoking reduces les pressure)
    Tx- burp, sit them up while feeding, breast feeding protects against GER, frequent small meals
26
Q

73 yo old with oa on naproxen with microcytic anemia

ESR 15 normal
Serum fe
Ferritin
TIBC
Transferrin saturation

A

Ida (naproxen can lead to peptic ulcers or gastritis

Serum fe low
Ferritin low
TIBC high
Transferrin saturation low

I chose ACD (but inflammatory markers are normal

27
Q

Thalassemia iron studies

Acd tibc

A

Serum fe high
Ferritin high
TIBC low
Transferrin saturation high
MCV very low compared to IDA AND ACD

Acd TIBC low

S (30 decks)

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