11-year-old girl presents With tanner stage one of the pubic hair, she has a flat left breast and the right breast is tender and a small mass
What is the
... [Show More] best next step?
Reassurance
This is normal thelarche and can be asymmetric
Order of maturation in female
Thelarche, pubarcge, growth spurt, menarche
27-year-old man presents with thrombocytopenia, eczema and recurrent infections
Wiskott-Aldrich, WAS gene,
Patient comes in with ulcerative colitis Treated with prednisone mesalamine and much more and the doctor decides to add a regimen, due to the addition of the regimen what should be tested next
Tuberculosis screening, due to initiation of TNF alpha inhibitor
Patient with sickle cell disease comes in with vaso-occlusive crisis it is given pain control what else should be given with the pain control?
Intravenous fluids
Patient with a MI 10 years ago Comes to the hospital due to vomiting. The patient ends up getting a transfusion and 30 minutes later starts developing shortness of breath, what is the most likely cause?
Transfusion associated circulatory overload
Remember: patience with ABO incompatibility present with flank pain and hypotension
Treatment of transfusion associate circulatory overload
Oxygen and positive pressure ventilation And possible directions
Can lead to psychosis, bizarre behavior, agitation, aggression, nystagmus and ataxia
treatment
PCP intoxication
Treatment: IM lorazepam or Midazolam
38-year-old woman comes in due to seizures, MRI demonstrates unilateral or bilateral temporal lobe abnormalities, what is the next best step?
Lumbar puncture: HSV encephalitis
If a patient has stroke like symptoms occurring less than 4 1/2 half hours Without signs of hemorrhage what is administered?
Alteplase
If the patient comes in with a stroke in the amount of time is unknown, with no evidence of hemorrhage what is administered?
Aspirin instead of alteplase
Bell's palsy Presents with facial nerve palsy causing facial paralysis that doesn't spread the forehead, what is the next best step?
Treatment:
It's diagnose clinically, no further testing indicated
Treatment: glucocorticoids and occasionally antiviral therapy
Patient after gastric bypass presents with ataxia, altered mental status and opthalmoplegia including nystagmus, most likely cause?
Vit B1 def
Immunocompetent child with cervical lymphadenitis presents with a purpleish hue, And presence of multiple granulomas on excisional biopsy
Purpleish hue: mycobacterium infection
Patient presents with a 2 cm ulcer on the foot and new mid back pain, what is the most likely cause and what is the next best step to confirm the diagnosis?
Vertebral osteomyelitis, MRI of the lumbar spine.
Can occur through hematogenous spread
Patient with a history of inflammatory joint disease are at increased risk for
Septic arthritis
An x-ray showing periosteal elevation is diagnostics for osteomyelitis, what is the next best step?
MRI before bone biopsy
Patient presents with generalized weakness due to a strict diet and taking laxatives in diuretics to lose weight. What is the cause of her generalized muscle weakness?
Loss of potassium
EKG demonstrating ST elevations in lead to I III and a VF is significant for right sided heart infarction, administration of what is contraindicated in patients?
Nitroglycerin
Patient with long-standing diabetes that initially was poorly controlled presents with urinalysis showing 4+ proteins, asks for what is the mechanism of the patients increase blood pressure
Renal parenchymal disease
What is the proper age for screening individuals for lipid studies
Asymptomatic males over 35 or women over the age of 40 to 45 unless they have a family history of hypercholesteremia or cardiovascular disease in the first degree relative seen early
If you see A ulcer on the medial aspect of the leg, woody induration and dark pigmentation, Even if the ankle brachial index is less than one
Venous insufficiency, the reason ankle brachial index is less than one is because the patient has both peripheral artery disease and Venus insufficiency
Any patient with HIV regardless of CD4 count with a TB screening over 5 mm what is the next best step
Treatment of latent tuberculosis right away
Untreated obstructive sleep apnea can cause both
Systemic and pulmonary artery hypertension
Lead to local inflammatory response and classically presents with fever in lower left quadrant abdominal pain and bloody diarrhea is less frequent
Diverticulitis
Acute abdominal pain in the setting of a recent MI that shows the fuse tenderness most prominent in the left lower quadrant
Ischemic colitis
Beta three agonist used to treat overactive bladder
Mirabegron
Female with a recent fetal demise With a new pregnancy should undergo
Non-stress testing in the third trimester for the next pregnancy
What most likely determines a patient's risk for diabetic nephropathy
Measurement of urine microalbumin concentration
Men 1 tumors
Pituitary, parathyroid, pancreatic
MEN 2A tumors
Medullary carcinoma of the thyroid, pheochromocytoma, parathyroid
Men 2B tumors
Medullary carcinoma of the thyroid, pheochromocytoma, neuroma's
Commonly causes diseases in immunocompromise patients in the setting of severe ulcerative colitis, solid organ or allergenic bone marrow transplant Tatian or HIV/aids. Intracellular inclusion bodies are classically observed
Treatment
CMV colitis treat with ganciclovir or valganciclovir
Attributable risk
AR = [a/a + b] − [c/c + d]
Patient comes in with a severe head injury after a motorcycle collision presents with fixed and dilated pupils unresponsive to all physical and verbal stimuli, no cranial reflexes EEG with no electrical activity. Asks what is the most accurate regarding continuation of mechanical ventilation?
Mechanical ventilation can be withdrawn without patient's families permission due to patient being brain dead
Any patient with new onset of A.fib should undergo
TSH measurement
Crohn's disease can lead to small bowel obstruction due to
Forming small bowel structures
Patient presents with abdominal aneurysm measuring 7 cm and pancreatic Adenocarcinoma, what do you do? Do you fix the aneurysm
No because of the patients poor prognosis
Patient with bacteremia and disseminated intravascular coagulation With hypotension, has an increase in creatinine from 1.5 to 3
ATN
Mainly caused by medication's Such as antibiotics, NSIADs, PPIs, infections or autoimmune disorders
AIN
After dilation and curettage the beta hCG should drop if it drops and goes back up into the thousands what is your diagnosis?
Gestational trophoblastic neoplasia
Pregnant females with SLE or Sjogren are increased risk for what Kind of cardiac issue in the infant
AV block
Patient with anaphylactic shock is treated with epinephrine and
Normal saline
Pentad of patients with TTP pay close attention, what is treatment?
Fever
Altered mental status (confusion)
Thrombocytopenia
Acute kidney injury
Microangiopathic hemolytic anemia
Tx: Plasmapheresis
Treatment of OCD
SSRI
Patient with weakness in shoulders and pelvic girdle with a reflexia and elevated CK
Spinal muscular atrophy
Benign growth of conjunctival tissue that looks like a web/wing over part of the eye or the entire eye what do you recommend to these patients?
Pterygia
Tx: recommend wearing sunglasses
So tinea capitis is a result of fungal infection of the hair that is seen as scaly patches, however it can lead to significant inflammatory response inform what is known as a kerion (boggy texture and swollen appearance)
- trychophyton, epidermophyton, microsporum all cause tunes capitis
Any patient that comes in with mono reticular arthritis severe pain with passive flexion and fever suspect
Septic arthritis Caused by hematogenous infection
First line treatment for osteoarthritis according to NBME
Acetaminophen
Two main effective ways of decreasing blood pressure
DASH diet and weight loss
Aortic dissection/coronary perfusion can lead to petechiae, livedo reticularis blue toe syndrome
Cholesterol emboli [Show Less]