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Q9$ Flashcards

1
Q

65 yo found unresponsive in barn with hypertension, bradycardia and irregular respirations . Fixed pupils and extensor posturing of extremities

Diagnosis

A

Brain Herniation (central
- hypertension, bradycardia and irregular respirations .(Cushing triad)

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2
Q

Complication of delirium

A

Cognitive decline

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3
Q

Outcome of small vs large vsd

A

Small - spontaneously resolves by age 2
Large- diuretics and surgery due to symptoms of heart failure

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4
Q

Management of pityriasis roses

A

Spontaneously resolves or May give symptomatic relief of itching

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5
Q

NBSIM for PCP agitation vs no agitation

A

Benzos (supportive if no agitation)

Hypertension , tachycardia, multidirectional nystagmus

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6
Q

2 yo . 8 days ago had fever, an pain vomiting and watery diarrhea’s. GI symptoms subsided in 3 days but fever persists. Injected sclera and dry red cracked lips , perineal erythema and macular rash

Labs: platelets 540,000 and inc wbc
UA: WHC- 40 and no bacteria
NBSIM

A

IVIG - Kawasaki
- fever >5 days plus 4
- nonspecific GI or resp symptoms precede Kawasaki findings
- sterile pyuria- urinary wbc without bacteria

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7
Q

43 yo man with progressive erectile dysfunction over past year . Fatigue , brownish skin pigmentation especially on face an arms.

AST 78
Alt 80
Fasting glu 130

Increased risk of developing which complications

Diagnosis
Symptoms
Diagnostic
treatment

A

HCC

HEMOCHROMATOSIS
Sxs:
MSk3 arthealgia chondroxalcinosis
Endocrine- hypothyroidism and secondary hypogonadism ; DM
GI: elevated hepatic enzymes with hepatomegaly early and cirrhosis (.
Later)
Infections- listeria, vibrio vulnificus and testeros enterocolitis
Cardiac- restrictive of dCM
Dx: genetic analysis of Hfe mutations
Tx: serial phlebotomy

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8
Q

Bypass surgery 2 years old now has muscle and joint pain with low calcium and high alk phos

Nbsi evaluation

A

Measure 25 hydroxyvitamin d level

Osteomalacia- due to vitamin d deficiency
- malabsorption, intestinal bypass surgery, celiac , chronic liver disease , CKD
- labs low calcium and phosphorous high pth (secondary hyperparathyroidism

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9
Q

68 yo female with born tender groin mass below inguinal ligament and medial to the right femoral artery worsens with standing coughing and valsAlva and improves when laying down. Mass is tympanic to percussion

NBSIM

A

Elective surgical repair (due to risk of incarceration and strangulation)

  • femoral
    Mass is tympanic to percussion( bowel is in the hernia
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10
Q

Post mi patient has MDD

NBSIM

A

Sertraline (low drug - drug interactions)

Not citalopram (qt prolongation dose dependent

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11
Q

NBSIM for crepitues in left clavicular bone of a 5 hour old baby

A

Confirm with X-RAY then Reassurance and gentle handling (heals on 7-10 days)

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12
Q

Complication of vacuum assisted birth

A

Clavicular fracture
Cwphalohematoma (no suture crossing

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13
Q

GDM

Management
Postpartum management
Target bc levels
Screening

A

Managements
1st diet
2nd insulin, glyburide , Metformin

Screening 24-28 weeks
1hr 50g gct
3hr 100 g Gct

Target BG levels
Fasting <965
1hour postprandial -<140
2 hour <120

Postpartum management
Fasting glu at 24-72hour
2gr 75 GTt at6-12 week visit

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14
Q

Management of uterine atony once oxytocin and massages doesn’t work

A

Tranexamic acid

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15
Q

Greenstock fractire (one one side of bone affected). Possible complication

A

None

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16
Q

Pet groomer has unilateral acute cervical lymph adenitis , fever. Mass looks lobulated

NBSIM
BUG

A

Azithryomycin 5days (but some spontaneously resolves

Usually staph aureus or strep, but this bartonella henselae

17
Q

2-5 yo with incidentally found nontender palpable mass in left abdomen, hematuria.

Diagnosis
Diagnostic
Treatment

A

Wilms nephroblastoma
Abdominal US
Surgery and chemo ( radiation if late stage

18
Q

Location of origin of embolus causing PE

A

Proximal /thigh- femoral popilireal, iliac veins

19
Q

Management of 38 yo female has AUB (intermenstrual spotting) even on combined OCP.

A

Usually <45 with AUB start them on OCP so they have progesterone to shed the endometrium. If <45 and OCP doesn’t work need to endometrial biopsy bc the proliferation of the endometrial can persist to cancer

20
Q

Management of thyroglobulin duct cyst

A

So thyroid imaging preop because maybe only functioning thyroid tissue the person has . Then can surgically removed because risk of recurrent infections

21
Q

24 yo with 2 months of cough not resolved by OTC cough meds and pulmonary nodules and retroperitoneal lymphadenopathy. Plus now has back pain.

What would establish the primary source. Of the patients current findings

A

Scrotal Us

Testicular cancer
- painless mass or presents as metastic disease. Spreads through regional lymphatics hence the retroperitoneal lymphadenopathy. retroperitoneal lymphadenopathy then compresses nearby structures hence back pai.

22
Q

2y year old has tonic closure of eyes when penlight or headlights flashes in face . History of asymptomatic sarcoidosis.

Diagnosis
Treatment

A

Focal dystonia subset called blepharospasm

  • idiopathic, Parkinson’s or ap
    Tx: avoid triggers and wear dark glasses
    Severe cases (botulinum toxin injection
23
Q

7 year old c/o nocturnal enuresis, high Bp, behavioral concerns (inattention impulsivity at school and mood changes. Tonsillar hypertrophy

NBSIM

A

Obtain nocturnal Polysomnography (OSA)
- adhd like symptoms are like adults daytime fatigue

24
Q

Patient started on disease modifying drug for RA AND NOW has painful oral ulcers, elevated total bili, alk phos and alt ast. What’s cause of symptoms?
other adverse effects

A

Medication induced inhibitor of DNA synthesis- Mtx

  • cytopenias , stomatitis
25
Q

24 yo female with 4 week history of joint pain in multiple MCP joints of both hands , with some lesser pain in wrists knees and elbows had intermittent fevers and now is a febrile. Pe- no swelling bc, re seas, warmth. Normal hand X-ray. Married with young kids

Diagnosis
Treatment

A

Viral arthritis
- due to parvo symmetric poly articular
- weakly positive rf or ANA
- dx: B19 igm antibodies in competent/previous infection (IgG antibodies
NAAT B19 DNA in compromised / reactivación of previous infections
Tx: self limited

26
Q

A febrile and watery to bloody diarrhea

A

Shigella toxin producing E. coli (STEC)

27
Q

Drinks alcohol daily and now AMS, GI irritation with pain and vomiting , ocular involvement ( vision impaired and. Abnormal eye exam, fixed mydriasis , bicarb of 6 , ag metab acidosis

NBSIM

A

Dialysis

Fomepizole inhibit alcohol dehydrogenase (preferred, ethanol competes with adhase, soufiuknbicarb iv for acidemia and hemodialysis for severe cases

28
Q

3 yo girl with unknown small puncture wounds on forearm and drooling , difficulty swallowing , facial grimacing

Diagnosis
Tx

A

Rabies
Vaccine and immunoglobulin

  • fear of liquids , fear of drafts of air
29
Q

18 yo male with syncopec looks smaller and younger than age, bradycardia , prolonged qt interval, echo shows vencteixular wall thickness and reduced chamber volumes

Diagnosis

Other heart symptoms

A

Anorexia
- reduced chamber volumes so small fixed stroke volume and impaired cardiac output, small pericardial effusion, elevated HDL, MVP

S (30 decks)

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