I hear woods and well demarcated, spreading, pruritic rash and I think poison ivy
Another way to get there: here's no fever but he is v v itchy, so think type IV HSR
Abrupt, sharp line of demarcation, no systemic signs, and mention of environmental exposure should make you think less of strep skin infections
So we're thinking some contact in the forest and we're back at poison ivy or some other allergen
Can treat with antihistamine, but what about prevention? Avoid the woods.
Google bullous poison ivy
A precipitous drop in Hgb effectively rules out malrotation. Overaggressive anticoagulation is associated with intramural hematoma.
This question is tricky. I used to always miss this presentation. This is laterally medullary syndrome- which most of us have memorizes is a PICA infarct. Fun fact, PICA comes off the vertebral artery.
This is how I remember the sx. If this helps at least one person I will be glad I am exposing my twisted brain.
3+5=8 & 9-11 & B-P.
3: Horner's syndrome 5:spinal trigeminal- ipsi face pain and temp loss 8: vestibular signs, vertigo diplopia
9-11: Nucleus ambiguous, diminshed gag, dysphagia B: Cerebellar - inferior cerebellar peduncle, ipsi ataxia P: Contra pain and temp, cuz this shit was so painful to memorize I throw it to the other side.
Widened pulse pressure in an adult is regurg. Widened pulse pressure in a new born is PDA. because the blood is swishing back and forth
(a) ARDS is bilateral
(b) aspiration PNA is too quick (4 hours!) and is usually consolidated
(c) fat embolism is more common with long bone fractures (e.g., femur) -- if you hear chest is bruised, think chest first
(d) hemothorax is usually more acute, but I suppose possible especially if you're thinking flail chest with sharp ribs causing puncture. But, x-ray would be more consolidated
(e) pulmonary contusion fits. You have trauma, initially normal ABG, chest bruising, and unilateral diffuse consolidation a few hours later
Criteria for weaning from ventilator:
I got this based on the causes of post op fever. Mostly just a guess really.
The 5 "W's"
1-2 Days post op: WIND - Lungs - post op atelectasis
3-5 days post op: WATER - UTI
5+ days post op: WALKING - DVT/ PE
7 days post op: WOUND - wound infections
8-15 days post op: WONDER DRUGs - Drug fever
The question says pt is 3 days post op so I just went with prevention of UTI. Uworld says the best way to prevent UTI is to remove catheter as soon as it's not needed.
CF, + family hx of norther european. Lungs with lots of gunk it in that is difficult to remove. recurrent infections
This kid has signs and sx of dehydration Hyaline casts due to hypovolemia resulting in concentrated urine
Viral myocarditis can lead to acute decompensated heart failure. can be d/t parvo, coxsackie or bacterial infections
Irregular periods, acne, and infertility line up with PCOS. Even though you don't palpate any masses on exam. The ovaries aren't necessarily palpably larger. I think of this like normal ovulation cysts that did not rupture properly, because they didn't get the correct signal (LH Surge)
since she has total blindness just in one eye, right optic nerve lesion makes sense. The poor reactivity to light supports this because eyes receive light through optic nerve (CN2)
She has pica. Do a CBC to check for iron deficiency anemia. Microcytic low hgb hct
this is intusseption, with current jelly stools and episodic abdominal pain. Treat with barium enema
2 months can just get their chest up and recognize moms voice. Apparently they can't grab things until 5 months.....glasses off your face
PDA gives continuous machine like murmur that crescendos at S2, so loud S2
Agree with sugaplum;
widened pulse pressure => PDA in newborn or regurg in adult
To and fro murmur = wave like = swishing back and forth = PDA
close with indomethacin
She has signs of a small bowel obstruction. no hx telling us any other cause. With air in the liver, we think that something has recently passed through to make the bile ducts dilate.
Cramping abdominal pain with distention, N/V should make you think SBO
Air-fluid levels in the small bowel but no gas in the colon tells you it's an upper GI issue
Hyperactive bowel sounds + pneumobilia = gallstone ileus
Very few things put air in the liver
Calcifications in anterior lumbar spine = atherosclerosis in abdominal aorta, a risk factor for AAA. Acute onset pain indicates rupture or impending rupture. BP can be low-normal due to tamponade by retroperitoneal location of abdominal aorta.
note: calcifications in anterior lower thoracic spine = chronic pancreatitis
This patient with anemia and extreme hypotension following MVA is bleeding into her pelvis/thighs. She urgently needs isotonic fluids and blood products prior to further workup.
Intractable vomiting results in hypochloremic metabolic alkalosis due to loss of HCl. (B) is the only choice with elevated HCO3-. K+ is low due to elevated aldosterone activity from contraction alkalosis.
Cystourethrocele (herniation of bladder neck) indicates urethral hypermobility -> stress incontinence. Vaginal delivery is a risk factor.
Don't get Addison's confused with Cushing's!
Young woman with eosinophilia, hyponatremia, hyperkalemia, lethargy, confusion, hyperpigmentation, etc, etc
Think Addison's = Primary Adrenal Insufficiency
Test with ACTH stimulation test
vs Cushing's which you test with dexamethasone suppression test
Normal V/Q scan rules out PE, regardless of pretest probability.
Low-risk V/Q scan in a low-risk patient rules out PE (unusual scenario for V/Q scan since D-dimer also appropriate)
High-risk V/Q scan in a high-risk patient confirms PE (this patient).
Any other combination warrants additional testing with CT angio.
This is diverticulitis (left lower quadrant, high WBC, fever) Best visualized with CT..I think even better with CT w/contrast :)
Myelomeningocele is associated with Chiari II malformation -> obstructive hydrocephalus
ABI<0.9 is diagnostic of peripheral artery disease. First-line treatment is graded exercise program. Revascularization is only indicated for critical limb ischemia (rest pain, non-healing ulcers)
Per FA - drugs for hypertensive emergency are clevidipine/nicardipine, fenoldopam (D1 agonist), labetalol, nitroprusside
There are 4 murmur characteristics described and tetra logy of fallot has 4 problems (PROVe)
Single S1 from reduced pulmonic component (remember, MTAP, MT = S1, AP = S2)
Guess one needs to bank on "hilar lymphadenopathy with fever" here.
Lacking upper lobe findings, I got this one wrong.
I got this wrong too. but thinking more we should think about the travel hx, to TB endemic area. This isn't a hemorrage cuz its been happening for 2 weeks, aspergillous usually settles in TB cavities.
Sjogren syndrome destruction of the salivary glands, dental caries. I looked at UTD and there isn't anything about the vagina being involved, but there is probably some article out there that links it.
The other answer choices didn't make sense
This patient has NAPDH Oxidase deficiency which causes chronic granulation disease. You can trap the bacteria, but you can't make the ROS to kill it. So you just live with a bunch of full trash bags...of bacteria you collected... Most common bugs are catalase positive. S. aureus; Escherichia coli, Candida, Klebsiella, Pseudomonas, Aspergillus;
She is the classic demographic for pulmonary arterial hypertension. Slowly progressive disease. The PE findings support it
This patient has wernicke's encephalopathy secondary to alcohol abuse. The tx is Thiamine, Vit b1. They also can have damage to their mamilary body
AS is strongly associated with HLA-B27 (however, not all patients with HLA-B27 serotype will develop AS)
According to UTD Postpartum thyroiditis is similar clinically and pathogenetically to painless thyroiditis except that, by definition, it occurs in women within one year after parturition (or after spontaneous or induced abortion).
TSH makes sense because she is bradycardic and has poor concentration
Remember, thyroiditis also causes hyperlipidemia
Increased LDL receptors +/- triglycerides due to increased LPL activity
Post-partum + cholesterol + lethargy + boredom + sleep issues + memory = thyroid
Would also expect hypnatremia, weight gain
Postpartum thyroiditis usually hyperthyroid followed by hypothyroid
This kid has nursemaids elbow. Apparently a very simple fix
This patient has signs of internal bleeding Decreased breath sounds--> abdomen filling with fluid, so the diaphragm has to push against increased pressure to get a breath in. Abdominal distension, tachycardic, hypotensive.
hematocrit drop by 12%. think about this. 1% change in hematocrit is 3 units of blood. 1 unit is 500mL. So based on her calculated blood loss, she should have only dropped hct by (1%-2). So I mean it could be underestimated blood loss, but her PE signs point to hemorrage
Giant cell arteritis. These people have inflammation of large and medium vessels, we think carotid arteries mostly, and their branches. The most immedieate concern for these patients is BLINDNESS which can be caused if the retinal artery gets blocked (branch of internal carotid). SO for these people you don't wait for a biopsy you start them on high dose steroids ASAP. mc in >50 white women. But sometimes they like to get interesting with the demographics.
They are taking my buzz words away.......:(
Opening SNAP plus a diastolic rumble.. this is mitral stenosis
This guy has a gallop, not a specific murmur, so it can't be (b) bicuspid AV or (e) MVP
SOB + peripheral edema + JVD + crackles = HF, so that rules out (a) and leaves (c) or (d)
(c): The hypokinesia of the LV apex would be more likely for a distal LAD occlusion or some other post MI HF, but this is a 27M and he had a recent "bad cold," so think viral
(c) diffuse hypokinesia and dilation of the ventricles describes dilated cardiomyopathy, which is especially common after cocksackie B
Treatment is supportive.