Q17$ Flashcards
Car set
Age and what re commendation
0-4 y- rear facing (or earlier if outgrows height or weight limitation - even if legs are bent
2-8 - forward
5-12- booster
9-adults seat belt
55 yo man complaining of ED despite normal libido. Pmh of HTN and high cholesterol and takes meds . Vs today- Bp 160/200. BMI 45
Labs
Hemoglobin 19 (high)
Hematocrit 57% (high
What’s the cause of the increased hematocrit
Increased epo
He has OSA - it doesn’t have to present with sleep disturbances it can present with ED or HTN. During sleep, hypoxemiateiggers the kidney to produce epo
Non bloody (can be bloody ) diarrhea after party with associated vomiting and fever. PCR- positive for salmonella
Should antibiotics be given
No bc non typhoidal which is self limited
It can cause extended asymptomatic salmonella carriage
Non typhoidal ; undercooked poultry or eggs
typhoidal would have rose spots ; Poor sanitation; can cause iba así e disease like bacteremia endocarditis osteomyelitis ; give antibiotics especially if super young ; immunocompromised, other disorders SCD
21 yo female just got back from Asia yesterday on a 3 month trip and me had headache unrelieved by meds with associated hypotension, tachycardia , high fever, diffuse red macular rash also on palms and soles. On fifth day of Meneses and uses tampons and pads due to heavy bleeds
Which microorganism is responsible
Staph aureus- TSS
18 yo had regular menses but now has heavy bleeding daily with clots. Dilation and curettage post op pathology showed endometrial hyperplasia without atypia . BMI 44
NBSIM
Progesterone releasing IUD
- obesity leads to unopposed estrogen
- don’t do endometrial ablation because it doesn’t prevent further endometrial proliferation but it can cause adhesions which inhibit fertility and endometrial exams later in life
Treat radial head subluxation
Hyperprotonatok of forearm
Supination of forearm and flexion of elbow
Fever and pharyngitis in 5 yo (3-10uo) who is supposed to start fall school in 2 weeks. Soft palate , tonsils
and uvula had gray shallow ulcers/vesicles
Diagnosis
Treatment
Herpangina- cox A
Treatment : supportive
6 mo- 5yo has fever pharyngitis and cluster of ulcers/ vesicles on lips and anterior oral cavity (tongue , gingiva hard palate, buc al mucosa
Diagsnosis
Treatment
Herpetic gingivostomatitis- hsv1
Treatment: oral acyclovir
65 yo smoker male with 2 CK peripheral , round lesion is found in the right lower lung lobe that is surrounded by lung parenchyma. Borders are irregular without calcification
NBSIM
Recommend surgical excision (biopsy
> 0.8 cm , older, smoker , family history , irregular borders are high probability for malignancy so diagnosis with biopsy or surgical excision
Sputum cytology is not sensitive enough
Stroke like symptoms . CT shows hemorrhage. BP 220/110. NBSIM
Give IV antihypertensive (like nicardipine
- hemorrhagic stroke hep systolic BP 140-160
Reverse anticoag
Regulate the ICP
4 yo boy feel 5 ft down the stairs nd hit his head. Walked and talked normally afterwards but then developed headache and vomiting minutes latter then become unresponsive . One pupil is dilated and unreactive and the other is normal with normal reflex
Cause
Treatment
Epidural (MMA) look fine then rapidly deteriorate
- symptoms of elevated ICP (headache and vomiting ) worsening intracranial hypertension can lead to uncap herniatio. Leading to ipsilateral pupillary dilation due to CN 3 compression and contralateral hemiparesis (compress ipsilateral cerebral peduncle)
Tx:emergency craniotomy
AA woman with CREAT has exertional sob, syncope and presyncope (lightheadedness(
Which would be seen on physical exam
Pulmonary arterial hypertension (hyperplasia of the intimas smooth muscle layer of the pulmonary arteries )- right ventricular failure which leads to the symptoms above
- RV heave (impulse palpated to the left of the sternum due to enlargement
- loud pulmonary component of S2
- right heart failure symptoms such as hepatomegaly or peripheral Edema
Calcineurin inhibitors (cyclosporine and tacrolimus) adverse effects
Nephrotoxix - vasoconstriction leading to reversible AKI
HYPERKALEMIA
HYPERTENSION- vasoconstriction
NEUROTOXICITY- tremor mostly (seizures , visual disturbances possible
Hyperglycemia- prevent release of insulin
GINGIVAL HUPERTEOPHY, HIRSUTISM, ALOPECIA
GI DISTURBANCES
Infection and increase risk of cancers because immunosuppressive
Ivdu has fever, aortic valve vegetation, middle cerebral infarction. IV antibiotics and blood cultures are obtained
NBSIM
Evaluate for aortic valve surgery
AVOID thrombolytics which isn’t the case for ischemic strikes because higher risk of Intracerebral hemorrhage
- cardioembolic Ischemic stroke due to native valve IE
10 week ga with T1DM on insulin, proteinuria 2+, 144/88, Cr is 1.4 and baseline is 1.2
Cause
Diabetic neuropathy - also caused the HTN
- dkd- glu causes dilation of aff and constriction of eff leading to hyperfiltrayiob . Loss of podocytes and changes to the basement membrane so loss of albumin in urine . During pregnancy GFR increased leading to more proteins are permeable through the GBM so pregnancy worsens DOD
