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37 Cards in this Set

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  • Back
Guess the diagnosis?
-39F
-Fever
-Cr bump
-hemolytic anemia
-thrombocytopenia
-neurologic complaint
-TTP (they probably won't give you all 5)
-Clues are pregnant, recent infection, HIV, SLE, or new drug
-Tx with daily plasma exchange & supportive care
- +/- steroids, splenectomy depending on the cause
Guess the diagnosis?
-23yo man
-Non-healing cellulitis
-Abscess or satellite lesion present
-Finished a 5 day antibiotic course
-Likely community acquired MRSA
-Prisoner or athlete is a big clue
-TMP-SMX is appropriate & cost effective (vanc & linezolid are BIG guns, effective but overkill)
Guess the diagnosis?
-40 yo man
-Tender, warm, swollen, erythematous joint
-Takes HCTZ for HTN
-Few systemic complaints
-Gout vs pseudogout
-ETOH is big clue if they give it
-Negative birefringement urate crystals = gout
-Positive birefringement calcium pyrophosphate crystals = pseudogout
Guess the diagnosis?
-83 yo man with HTN & DMII
-Sudden onset left sided hemiparesis & Left hemisensory changes
-Note: What happened and where?
-Internal capsule intracerebral hemorrhage
-These are the lenticulostriate arteries that burst with HTN
Pain with EOM, decrease visual acuity, proptosis and opthalmoplegia?
Orbital cellulitis
What smells are associated with:
1. Cyanide
2. Zinc
3. Tolulene
4. Organophosphate, arsenic, and selenium
5. Hydrogen Sulfate
1. Cyanide = Almonds
2. Zinc = Fishy
3. Tolulene = Glue
4. Organophosphate = Garlic
5. Hydrogen Sulfate = Rodent Eggs
Severe poison ivy contact dermatitis (i.e. the whole leg) is treated with?
14 day ORAL steroid course, benadryl for itching and cool compresses
What is Cushing's triad and what does it suggest?
Cushing's triad : widening pulse pressure (i.e. sky high SBP), irregular breathing, and a reduction of the heart rate.

Suggests ICP or imminent herniation
What is Cushing's triad and what does it suggest?
Cushing's triad : widening pulse pressure (i.e. sky high SBP), irregular breathing, and a reduction of the heart rate.

Suggests ICP or imminent herniation
T or F: It is normal for pregnant women have RLQ pain in the second and third trimesters?
True. More than 50% of pregnant women without appy''s have RLQ pain.
What is the target SBP for
1. Ischemic Stroke
2. Hemorrhagic Stroke
1. Don't lower BP in ischemic stroke unless pt is a tPA candidate or has concomittant MI/dissection/renal failure. High BPs are neuroprotective in this case.

2. Goal SBP s/p hemorrhagic stroke is 140-160 mmHg
66yo F smoker, fatigue, dizzy, Na = 112
SIADH likely d/t small cell lung CA
Healthy pregnant lady gives birth normally and then goes into septic shock w/ DIC?
Amniotic fluid embolism (rare. amniotic fluid enters bloodstream and causes whole body immune response)
Young woman with viral illness and later has tender, oval shaped, non-itchy rash on her shins.

(Bonus for treatment)
Erythema nodosum usually 2/2 strep pneumo or sarcoid.

This is a hypersensativity rxn and treatment is NSAIDs / ASA.
Man stops taking lithium then gets febrile, tachycardic, and wide pulse pressure?
Thyroid storm (lithium has inhibitory effect on release of T4 and abrupt cessation can cause T4 flood)
18 mon old has water stools with no WBCs in the stool in January?
Rotavirus
Any age with coughing, wheezing, absent breath sounds?
Foreign body aspiration
AML pt with weakness, neuro symptoms, and mucosal bleeding?

(Bonus for tx?)
Hyperviscosity syndrome (too many proteins in their blood, treat with plasmapheresis)
Pt has a digit with symmetric swelling throughout, volar tenderness of the digit, keeps digit flexed and has pain when passively extended.
Flexor tenosynovitis (Kanavels four cardinal signs).

IV Abx and hand surgeon consult for possible drainage.
Pt puts their hand somewhere and get a pinprick followed by muscle cramps 1 hour later and then a rigid abdomen after that.
Black widow bit

Supportive care in adults, monitor for signs of CV collapse in kids
Male smoker with pneumonia presentation AND GI symptoms?

(Bonus: How is dx confirmed?)
Legionella PNA (Gram - bacillus, ? stem may include hyponatremia, elevated LFTs, or neuro symptoms)

Diagnosis made by testing urine for antigens
Exertional dyspnea, chest pain, syncope
Aortic Stenosis (systolic murmur to the neck)
Acute MI with new aortic regurge
Ascending aortic dissection until proven otherwise
CHF picture with loud holosystolic murmur
Mitral regurge
STEMI in 3rd trimester pregnancy
Ascending aortic dissection until proven otherwise
Waterhammer pulse and Austin Flint murmur
Aortic regurge

Waterhammer pulse = widened pulse pressure

Austin-Flint murmur = double rumble as blood hits MV leaflet and the LV wall
Exertional dyspnea, chest pain, syncope
Aortic Stenosis (systolic murmur to the neck)
Acute MI with new aortic regurge
Ascending aortic dissection until proven otherwise
CHF picture with loud holosystolic murmur
Mitral regurge
STEMI in 3rd trimester pregnancy
Ascending aortic dissection until proven otherwise
Waterhammer pulse and Austin Flint murmur
Aortic regurge

Waterhammer pulse = widened pulse pressure

Austin-Flint murmur = double rumble as blood hits MV leaflet and the LV wall
Stable pt has wide complex tachycardia with delta wave (bonus for tx)
WPW (may be too tachy to tell its wide)

Treat with procainimide (sync and cardiovert if unstable)
J-wave on EKG
Hypothermia
Otherwise healthy male smoker with no lab abnormalities has painful, friable gingiva w/ intermittent fevers?
ANUG (acute necrotizing ulcerative ginginvitis)
Pt with past AAA graft repair has rectal bleed and abd pain?

(Bonus: cause? Work-up?)
Aortoenteric fistula until proven otherwise.

Caused by S. Aureus or E. Coli on the graft site.

Needs esophagogastroduodenoscopy
Kid with fever that resolved then gets generalized macular rash 4 days later?
Roseola
Scrotum with blue dot?
Testicular APPENDAGE torsion