Q13$

Question 1

Chemotherapy and now neutropenic fever

Leukocytes-690 with 20% neutrophils

Initial therapy (+what bug) and calculate the ANC

Answer 1

Pip- tazo to tear get pseudomonas

ANC leukocyte neutrophils -number (138) which is severe

Question 2

61 yo lady with osteoporosis on vitamin d, calcium, alendronate has persisten elevated BP

What antihypertensive drug

Answer 2

Thiazide. - good for patients with osteoporosis because it increases calcium reabsorption

Question 3

DID management

Answer 3

Teauma focused psychotherapy

Question 4

Dry , Fish like scales on calves . Mom and his younger sister have the same condition. Has increased lines on palms.

Diagnosis
Pathophysiology
Treatment

Answer 4

Ichthyosis vulgaris
- mutation of filaggrin gene (impaired epidermal barrier)
- Tx: long baths to remove scales, moisturize, keratolytics(urea, alphahydroxyacid, salicylic acid

Question 5

Biliary atresia
Diagnosis
Treatment

Total bili
Direct bili
Ggt
Alk phos
Reticulocyte

Answer 5

Total bili inc
Direct bili inc
Ggt inc
Alk phos inc
Reticulocyte. Normal no hemolysis

Dx- abdominal US( triangular cord wig which is fibrous remnants above portal hepatis; small or absent gallbladder
Liver biopsy or Intra operative cholangiography is definitive

Tx- hepatoporoenteeostomy Jasso procedure
Liver transplant

Question 6

Presenting with headache , ocular pain, nausea and decreased visual acuity . Conjunctival injection and mid dilated pupil

Diagnosis
Diagnostic treatment t

Answer 6

Acute closure glaucoma
Dx: tonometry - measure iop
Fonios copy- measure corneal angle

Tx: iv acetazolamide and láser iridotomy and others

Question 7

Patient with wvd and takes Desmopressin just now on first 2 days of menses. Now has nausea , dizziness and headache.

NBSIM

Answer 7

Serum electrolytes
- Desmopressin is an ADH analog so it can lead to SIADH then hyponatremia which is causing symptoms

Question 8

Blunt cardiac injury with persistent sinus tachycardia with frequent pvc

NBSIM

Answer 8

TTE - looks for any myocardial dysfunction and or structural injuries

Question 9

In past couple of days 72 yo female have been taken OTC meds for cold symptoms and now has a storms, pmh- afib plus others and on warfarin. INR5.2

NBSIM

Answer 9

Give prothrombin complex plus vitamin k
- warfarin induced Intra cerebral hemorrhage due to the phenylephrine or acetaminophen containing cold meds because they potentials warfarin

Question 10

2 mo with fever , inconsolable and pain with hip movement, leukocytosis . Sits with hip flexed abducted and externally roared

Diagnosis

Answer 10

Septic arthritis

Question 11

Patient with afib not on anticoagulant because of GIB has severe abdominal pain, vomiting, leukocytosis and AG metabolic acidosis

Diagnosis
Diagnostic
Treatment

Answer 11

Chronic mesenteric ischemia
- afib lead to thrombus which embolizes the sma leading to small bowel ischemia.
-abdominal exam is benign so POP to exam
- dx- CT mesenteric angiography
-Tx: NG decompression, IVD, anticoag, broad spectrum antibioricsb

Question 12

HIV patient who is homeless with cd4-50 with fever night sweats fatigue? Hypodense liver , small reddish purple paules that became large nodules

Diagnosis
Other symptoms
Treatment

Answer 12

Bartonella henselae
- cd4<100, can occur with cat scratch , homelessness, severe immunocompromised
- fatigue fever night sweats, skin lesions, can spread to liver cns and bone
- dx- tissue biopsy
Tx- doxycycline or erythromycin

Question 13

Who should be given prophylaxis Asa to prevent preeclampsia

Answer 13

Diabetes
Ckd
Multiple gestation
Autoimmune disease

Plus chronic hypertension and Prior ho duh

Question 14

Unilateral persistent nasal discharge in 5 yo boy with HIV

Cause

Answer 14

Foreign body obstruction.

(Not acute bacterial rhinosinusitis which is bilateral