q8$ Flashcards
Sudden chest pain with sweating and left arm numbness. EKG- NSR with T wave inversion in leads V1-V4. Normal troponin level,
NBSIM
Iv Heparin (unstable or NSTEMI
(Not exercise stress - do if stable
33 yo women has multiple tender pink to reddish nodules below the knee (looks like a mosquito bite and pain in Her ankles for 1 week. No cough or sob
NBSIM
Chest X-RAY
ERYthema nodosum
- can be seen in sarcoidosis (non caseating granulosas) TB, streptococcal infection, histoplasmosis and IBD, behcet
- do CXR to rule out sarcoidosis and tb . Even though the patient has no pulmonary symptoms sarcoidosis still can’t be ruled out
56 yo women with RA bumped left leg on a chair and the. Developed a painful papule which has now rapidly enlarged and became a huge draining ulcer
Cause
Pathophysiology
Diagnostic
Treatment
Pyoderma gangrenosum
IncreSe sun patients with underlying systemic inflammatory disorder
Biopsy - neutrophils
Tx: local or systemic glucocorticoids
52 yo male with symptomatic hyper calcemia (constiparían, nephrolitjiasis last year) and now has pain and swelling of his right knee
What would be the arthrocenteis results
Rhomboid shaped
Guy has primary hyperparathyroidism and CPPD IS A complication.
2 year old had abrupt onset dysphagia, drooling and vomiting after eating a sausage . Eaophagoscophy ahowes occlusion of the esophageal Lumen with impacted food . . This is the second good impaction. Only problems with solids and not liquids . Growth started stalling at 9 months (eating more solid foods)
Cause
Congenital vascular malformation
- vascular ring
Middle age man has wisdom of severe anal pain months ago but resolved spontaneously after 2 days. Now has foul smelling discharge in his underwear and occasional park with defecation. No prior PMH. Indurated pustule like lesion close to the anal verge
NBSIM
Diagnosis
RF
Surgical evaluation
Anorectal fistula due to ruptured perianal abscess
- can arise from ruptured perianal abscess, chrons (comes from chrons give antibiotics
-
76 yo women with HTN has intermittent palpitations for 6 months lasting 1 hour one weekly and when tired. Echo- la enlargement and lvh, WF 65%. ECG- NSR
FURTHER WORKUO WILL REVEAL WHAT
Paroxysmal (intermittent) Afib
- due to HTN which lead to lvh. And lvh lead to atrial enlargement and therefore afib
- ECG can show NSR at times
Patient with history of necrotizing acute pancreatitis due to alcohol, unintentional weight loss, epigastric postprandial pain not improved with PPI, and steatorrhea
What else would you see
Decrease fecal elastase or low trypsinogen
- pancreatic enzyme so if pancreas is destroyed the exocrine functioning is destroyed as well
- chronic pancreatitis
Als patient sleeping more and more confused, feels tired and has headaches . CXR- atelectasis
NBSI evaluating
ABG analysis to check for resp insufficiency
- sleeping leads to more respiratory insufficiency (already have decreased accessory muscles while sleeping and pharyngeal muscles are weak and relaxed) so resembles OSA with the daytime fatigue and headaches .
Developed cognitive impairment due to the hyper Sonia
Management of Benito pelvic pain/penetration
Desensitization therapy or kegel
45 yo female with femoral neck fracture and bilateral subperiosteal resorption in the setting of CKD
MOST appropriate diagnostic test to order
PTH
Secondary hyperparathyroidism- decreased formation of active form of vitamin d , low ca because bounded to the high phosphate. High PTH leads to patética fibrosa cystic a which causes fractures , reduced bone mineralization and marrow fibrosis
2 year old boy had rhinorrhea and nasal congestion a week ago which spontaneously resolved and. Ow has fever and respiratory distress. Mobile anterior cervical lymph nodes. S3 . 3/6 Holosystolic murmur at apex . Scattered wheezing persists despite bronchodilator. Hepatomegaly
Diagnosis
Diagnostic
Treatment
Viral myocarditis
- viral pro drone precedes illness (chest pain and respiratory distress from acute left heart failure and pulmonary edema
Dcm with MR lead to s3 and Holosystolic.
Hepatomegaly due to the right heart failure
Dx
CXR: cardio megalo and pulmonary edema
EKG sinus tachycardia
Echo global hypokinesis with decreased EF
CLJNIXAL
ENDOMYOCARDIAL BIOPSY (good ). Inflammation and necrosis
Tx - diuretics inotropes
IVIG
BASICALLY supportive
3 yo girl with right knee swelling for 2 months . Initially thought because play fighting with bro. Knee is not painful but is swollen and warm. limp in am and resolves at night
No fever or rashes
Posssible complications
Uveitis- can lead to irreversible vision loss
oligoarticular JRA
- limp in am and resolves at night
No fever or rash
Management of subacute thyroiditis
Dequervain
Supportive with BBL and NSAIDs
Teen girl with exertion Al sob with eight sided cardiac enlargement
Oxygen saturations (%)
IIVC-69
RA- 84
RV 85
Pul artery - 85
Diag
Partial not total Anomalous pulmonary venous return - some of pulmonary veins send blood to the SVc or the RA instead of the LA. May have ASD
