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11 Cards in this Set
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A 45 yo black patient presents with symptoms of a TIA.
His symptoms completely resolve while in the ER, but he is hospitalized overnight for observation. During the admitting exam, he admits to "bad bones" that have been causing him pain; he attributes it to just getting old. PE is unremarkable. His lab values demonstrate hypercalcemia, anemia, and elevated creatinine and BUN. What do you expect to find on urine dipstick analysis for protein? Elevated levels of protein, representative of Bence-Jones proteins Normal protein levels An absence of protein A visible colored spike indicating an increase in proteins associated with increased monoclonal antibody Excess albumin |
Normal protein levels
This man likely has Multiple Myeloma (bone pain, hypercalcemia (bone breakdown), elevated creatinine and BUN (monoclonal antibodies (Bence-Jones proteins) collecting within the tubules), and TIA (sign of hypercoagulability due to excess protein in the blood)). Urine dipsticks are unable to detect the Bence-Jones proteins, but rather only show a NORMAL protein level |
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A 55 yo male presents with complaints of fatigue.
He is found to have significant splenomegaly. Blood studies indicate low PLT count, low RBC count, and profound lymphocytosis. Blood smear demonstrates mature lymphocytes of normal morphology. What is the treatment for this patient's likely condition? Interferon alpha and appendectomy Chemotherapy Treatment is confined simply to palliative measures Radiation treatment Zidovudine |
Treatment is confined simply to palliative measures
Low PLT count, low RBC count and high WBCs (lymphocytosis) along with splenomegaly is a likely sign of a leukemia. Blood smear shows MATURE LYMPHOCYTES, which is indicative of a chronic leukemia (acutes have immature cell types) In a 55 yo with a chronic leukemia, the most common type is CLL Treatment for CLL is mostly palliative |
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A patient in the ICU is determined to have blood glucose level of 350 and a sodium level of 132.
How would you treat this patient? Give insulin and glucose Give insulin and sodium Give sodium and mannitol Give IV free water Give insulin alone |
Give insulin alone
The pt's Na is thrown off by the elevated glucose because for every 100 mg/dL of glucose above 100, the Na is decreased by 1.6. Also, this patient only requires insulin and not glucose...insulin + glucose would be needed in the treatment of hyperkalemia |
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If the pH is low, the pCO2 is significantly elevated, and bicarbonate is mildly elevated, what could be a possible etiology for this acid-base disturbance?
Benzodiazepine use Hyperthyroidism Vomiting Diarrhea Multi-organ failure |
Benzodiazepine use
Benzos are sedatives and hypnotics, thus they would cause respiratory depression and ultimately an increase in pCO2 Hyperthyroidism will cause an INCREASE in respiratory rate Vomiting will cause an alkalosis Diarrhea would cause a METABOLIC acidosis (not respiratory like this case) Multi-organ failure will result in the release of large quantities of lactic acid, thus causing a METABOLIC acidosis |
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A 48 yo man has presented for a well person visit.
During the exam, it is noted that his right leg is anatomically shorter than the left. He explains that he sustained a crush injury to his leg when he was eight years old, and that is why it is now shorter than the other leg. what type of fracture did he suffer? Salter I Salter II Salter III Salter IV Salter V |
Salter V
A Salet V causes the epiphyseal growth plate to be crushed and can result in stunted growth |
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A 3 yo boy has been diagnosed with acute lymphocytic leukemia (ALL).
Shortly after his diagnosis, he completed a 4 week course of induction chemotherapy. What is the next step in the treatment of this patient? Bone marrow transplantation Chemotherapy over the next two years Intrathecal methotrexate Intravenous antibiotics Observation only |
Intrathecal methotrexate
ALL has a specific 3-step treatment process: induction chemo, consolidation, and maintenance chemo. Induction is administered for 4 weeks with the goal of maximal destruction of neoplastic cells. Consolidation is a one-time treatment of METHOTREXATE with the goal of preventing leukemic occurence or relapse. Maintenance therapy lasts about 2 years with the goal of controlling the disease and eliminating any remaining neoplastic cells. |
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A 15 month old child has been having difficulty walking due to a mal-positioned foot.
PE reveals the right foot to be internally rotated at the ankle; there is nearly a 90 degree rotaiton. Range of motion of the right foot is severely restricted, and the right calf muscles are not adequately developed. What is the most appropriate first treatment for this patient? Casting Exercises to stretch the foot Application of the Ponseti method Surgical repair Watchful waiting |
Application of the Ponseti method
This child has club foot, or congenital talipes equinovarus, characterized by 1) Inversion at the subtalar joint, 2) Talonavicular adduction, 3) Ankle equines (inability to fully dorsifles the ankle). The Ponseti method is a manipulative method used worldwide as the first-line treatment for club foot. Casting is used if the Ponseti method is ineffective. Surgery is required if neither the Ponseti method nor casting works |
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A 26 yo woman presents with complaints of having a sore throat and neck pain.
She has had the sore throat for about two weeks, but the neck pain started only a couple of days ago. On PE, a mildly erythematous pharynx is appreciated; no exudates are evident. An asymmetric, firm, tender goiter is appreciated. On asucultation, the lungs are clear and the heart is RRR. Lab values are as follows: WBC 13,500, ESR 38 (norm <20), TSH 0.3 (norm <10) T4 17 (norm 4.2 - 13.0). What is the most likely diagnosis? DeQuervain's thyroiditis Grave's disease Hashimoto's thyroiditis Pregnancy-induced hypothyroidism Plummer's disease |
DeQuervain's thyroiditis aka subacute thyroiditis
This patient clearly has a HYPERthyroidism The key to the question is the sore throat DeQuervain's is typically precipitated by a viral URI leading to an inflammatory response by the thyroid gland. It is thought that viral invasion of the thyroid leads to a hyperactive response and goiter development. The condition is self-limited and usually subsides within 4-6 weeks and treatment is directed toward symptoms |
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A 15 yo teenager presents with comlaints of intense pain in his right anterior thigh.
He has also been having a fever. PE reveals erythema, significant focal edema, and tenderness to palpation over the affected area. X-ray demonstrates an onion-skin type periosteal reaction of the underlying femur. Which of the following is the most appropriate treatment for this patient? IV ABX NSAIDs Chemotherapy, followed by amputation and radiotherapy Incision and drainage Fasciotomy |
Chemotherapy, followed by amputation and radiotherapy
Onion-skin lesions are pathognomonic for EWING SARCOMA Ewing's affectst mostly males <20, lower extremities or pelvis, causes extreme pain, erythema and edema, fever, and tenderness to palpation. Ewing's is extremelly aggressive and relapse rates are very high, therefore treatment involves CHEMO, AMPUTATION, AND RADIOTHERAPY Survival without amputation is <10% IV ABX would be tx for OSTEOMYELITIS, which would show lytic lesions ringed with sclerosis (appears like a bright white outline to the dark lytic lesion) on X-ray |
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A 35 yo male medical student presents to the school health center with severe headache, fever, shaking chills, and extreme lethargy.
He recently returned from a 4-week rotation in Africa. Vitals reveal pyrexia and tachycardia. PE is significant for diaphoreses, splenomegaly, and generalized lymphadenopathy. Lab studies demonstrates anemia, hyperbilirubinemia, with increased indirect bili. H&H are also decreased. What is the most appropriate next diagnostic measure to take? CXR Inspection of skin for evidence of anthropod bites Blood culture Geimsa-stained thick and thin peripheral blood smear The diagnosis can be made now and no further testing is needed; proceed to treatment immediately |
Geimsa-stained thick and thin peripheral blood smear
This patient likely has MALARIA Malaria causes extreme fatigue (punctuated by worsening periods of fatigue and diaphoresis every 2 days), plus HA and fever. Malaria is caused by Plasmodium species (P. Vivax/Ovale=dormant liver form, P. Falciparum=most lethal, severe, daily cycles, P.Malariae=most common form). Malaria infects RBCs, causing massive hemolysis every 2 days resulting in anemia and increased indirect bilirubin |
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A 7 week old female is brought for her well-baby visit.
The mother denies observing any problems, and feels that the baby is doing well. Vitals are within normal limits. PE is unremarkable with the exception of findings procured while examining the hips. When the femur is flexed and adducted with posterior pressure applied, the child's right femur displaces itself from the acetabulum. Additionally, when both legs are flexed at the hip and, at the same time, held together, asymmetric skin folds are appreciated. Ultrasound of the hip demonstrates displacement of the right femoral head from the acetabulum. Shenton's line is not continuous or smooth. What is the most appropriate next step in the management of this child? Brace Closed reduction under general anesthesia No further treatment is required; this condition will resolve spontaneously Open reduction of the hip Close observation |
Brace
The child has developmental dysplasia of the hip (DDH). PE tests include the Ortolani (abduct the leg while placing gentle upward pressure on the greater trochanter), Barlow (adduct the leg at the hip, and then apply gentle pressure on the knees with posterior force), Galeazzi (flex the hips and place both feet next to the buttocks and compair the height of the knees). Many children may have a false DDH within the first 2-4 weeks after birth and should be rechecked in 3-4 weeks. Children less than 6 months but greater than 4 weeks with a Pos DDH require a Pavlik harness Children >6 months require closed reduciton Chidlren >2 years require open reduction |
