What do you give a cancer patient with severe nausea and vomiting? Ans: ONDASTERONE
(Zofran).
Pyloric stenosis causes what metabolic disorder? Ans: Hypochloremic, hypokalemic metabolic
alkalosis, & abdominal ultrasound is diagnostic & confirmatory test
Pt. had a fracture in the arms/clavicle, now is very tachypneic. Ans: FAT EMBOLI
Kid has recurrent ear infection a total of 6 times thus far. What do you do now? Ans: I chose
ENT Tympanectomy. Poss Ans: FA3 pg149 Pts who do not respond to antimicrobial therapy &
develop hearing loss should have tympanostomy tubes placed
Description of kid where clue was “wide eyes” (hypertelorism). Ans: NOONAN SYNDROME,
& is the male version of Turners syndrome. Principal features include congenital heart defect,
short stature, learning problems, indentation of chest, impaired blood clotting, & characteristic
configuration of facial features, cryptorchidism (undescended testicles), hygroma (webbed neck),
clumsiness, MR, easy bruising, VWD, etc.
Pt. with decrease sperm who is a car mechanic with some word I can’t read right now then
the word cause? Ans included: Vinyl, chloride, mercury, lead. Ans: Vinyl chloride
Testicular non-seminous CA T1 was description of pt.’s illness. Ans: NON specific is increased
LDH. Specifically is increased B-HCG & AFP
Neonates gain back their weight at what time period? 1day, 2 day, 3 days, 1 week, 2 weeks? Ans:
2 weeks
Kid got scratched by cat- Pasturella
Nail goes through kid’s sneaker- Pseudomonas
HBV: Birth, 2 & 6 months
DtaP: 2, 4, 6, 15-18 months, & 4-6 yrs old
Hib & PPV: 2, 4, 6, 12-15 months
IPV: 2, 4, 6, months, & 4-6 yrs old
MMR: 12-15 months, & 4-6 yrs old
Varicella: 12-15 months
HAV: 2yrs old
Number of weeks pregnant correlates w B-HCG if >5000 Transabdominal U/S.
If 500 not visible. Transabdominal U/S by 14 weeks
What would be the answer to “flat feet”? Morton’s toe = shortened first metatarsal in relation to
the second metatarsal (long toe). Flat feet is pes planus or fallen arches assoc w plantar
fasciitis & elastin deficiency
Normal total bilirubin 0.1-1.0 mg/dl // Direct bilirubin 0.0-0.3 mg/dl
Spondylolisthesis: anterior displacement of 1 vertebrae in relation to the one below, MC L4-L5,
low back, buttock, thigh pain, Lateral Lumbar X-ray, + vertebral step off sign
Spondylolysis: Fracture of the pars interarticularis WITHOUT anterior displacement of the
vertebral body. Scotty dog collar fracture on Oblique lumbar X ray. YLoLY Oblique
Spondylosis: Degenerative changes within the intervertebral disc & Ankylosing (narrowing,
stenosis) of adjacent vertebral bodies. Ex. Low back pain worse w extension, standing, walking,
& pain is relieved w flexion, sitting.
Choledocholithiasis is gallstones in the common bile duct CBD & often presents w biliary pain,
jaundice, episodic colic, fever, & pancreatitis. Labs show increased alkaline phosphatase & total
bilirubin. AB U/S to screen & ERCP to confirm
Dubin-johnson syndrome: Conjugated (direct) hyperbilirubinemia due to defective liver
excretion, grossly black liver, benign, normal urine coproparphyin
Rotor syndrome: is similar to Dubin but is even milder & does NOT cause black liver increased
urine coproparphyin
Gilberts syndrome: Mildly decreased UDP glucuronyl transferase, asymptomatic, elevated
unconjugated bilirubin without overt hemolysis, assoc w stress, NO clinical consequences
Crigler-Najjar syndrome type I: Absent UDP glucuronyl transferase, presents early in life,
patients die within a few years. Findings: jaundice, Kernicterus (bilirubin deposition in brain),
increased unconjugated bilirubin. Txt plasmapheresis & phototherapy.
Type II is less severe & responds to phenobarbital, which increases liver synthesis
-Biophysical profile 30-40 weeks
-1 hr. fasting glucose 24-26 weeks
-Amniocentesis 15-20 weeks
-Ultrasound 15-20 weeks
IV PYLEOGRAM: Nephrolithiasis, renal calculi, kidney stones are MC calcium OXALATE,
acute onset severe, colicky flank pain that may radiate to the testes or vulva, & is assoc w N/V.
Pts are unable to get comfortable & shift position frequently (as opposed to those w peritonitis
that lie still). An IVP can be used to confirm the dx if there is lack of contrast filling below the
stone. Non-contrast CT of the abdomen & pelvis is the most accurate test for the dx of
nephrolithiasis, but for pregnant woman use U/S so as to avoid radiation exposure
Man in car accident goes through air through window, has abdominal pain and distension. Ans:
RETROGRADE URETHROGRAM. Pelvic injuries/fractures can be assoc w urethral injury.
Make note of blood at the urethral meatus: a high riding “ballotable” prostate; or lack of prostate.
If present, a retrograde urethrogram must be performed to rule out injury before a foley catheter
is placed.
Kid with hand laceration. It was stitched, and pt. came back 2 days later. (After 24-48 hrs ok to
use Neosporin; hydrogen peroxide w water to clean)
Torsades occurs with which drug? Ans: Quinidine, other choices included Metoprolol, Digoxin,
and Procainamide
Which is the highest risk factor for coronary artery disease/heart attack? Ans: LDL
Hospice is for terminal pts w life span 6 months or less, & yes you give up benefits but
medicare will still cover
Pt. with COPD and renal failure = Respiratory acidosis with metabolic alkalosis.
COPD: ABG shows hypoxemia w acute respiratory acidosis (increased Pco2)
Renal failure: Metabolic acidosis w compensation, Increased anion gap
Man with a mass in breast. Mammogram was negative. Ultrasound was indeterminate. What to
do next? Ans: Biopsy
Koliocytosis is associated with? Ans: HPV.
Koliocytosis is also suggestive of cytomegalovirus (CMV) pneumonia.
Pt. has diarrhea after 10 days of ceftriaxone. Answer. Drug induced diarrhea
Pt. is a 5 year old kid who goes in for tonsils and adenoids surgery. Pt. was given 5 liters of
D5W. Specific gravity is 1.030 Na+ 122 all other electrolytes are normal. What is the cause?
Ans included: Overproduction of ADH, overwater.
ALS: A chronic progressive degenerative disease of unknown etiology characterized by loss of
UMN & LMN in the brain & spinal cord (anterior horn cells). Almost always progressive to
respitory failure & death. AKA Lou Gehrig’s disease. Asymmetric slowly progressive
weakness affecting the arms, legs, & CN’s. Some pts initially present w fasciculation’s.
Presents w UMN & OR LMN signs, eye movements & sphincter tone are usually spared.
Clinical presentation is usually diagnostic. EMG/ Nerve conduction studies reveal wide spread
denervation & fibrillation potentials. CT/MRI of the cervical spine to exclude structural lesions.
FA2 pg 233 Amyotrophic lateral sclerosis (ALS)
Poliomyelitis: Cause by poliovirus which is transmitted by the fecal-oral route, replicates in the
oropharynx & small intestine b4 spreading through the bloodstream to the CNS, where it leads to
the destruction of cells in the anterior horn of the spinal cord, leading to LMN destruction.
Malaise, HA, fever, N, AB pain, sore throat. Signs of LMN lesions- muscle weakness &
atrophy, fasciculation’s, fibrillation, & hyporeflexia. CSF w lymphocytic pleocytosis w slight
elevation of protein. Virus recovered from stool or throat.
Menopause diagnosis? Which hormone? Ans: √FSH (Menopause has ↑FSH & LH)
F/U TX: 1st line psychosexual, 2nd line Estrogen other answers were hormones
Grading Scale
Cantu (1991)
American Academy of Neurology
(1997)
Grade 1
No LOC
PTA < 30 minutes
Transient confusion; no LOC;
symptoms resolve in < 15 minutes
Grade 2
LOC < 5 minutes
PTA > 30 minutes but < 24 hours
Transient confusion; no LOC;
symptoms last > 15 minutes
Grade 3
LOC > 5 minutes or PTA > 24
hours
LOC of any duration
LOC = Loss of Consciousness
PTA = Post Traumatic Amnesia
Return To Play Criteria
Severity
1st Concussion
2nd Concussion
3rd Concussion
Grade 1
Return if no symptoms
on exertion
Return in 2 weeks if no
symptoms past week
Terminate season; return
next season if no
symptoms
Grade 2
Return if no symptoms
for 7 days
Must sit out at least 30
days; may return if no
symptoms for 7 days;
consider terminating
season
Terminate season; return
next season if no
symptoms
Grade 3
Must sit out at least 30
days; return when no
symptoms for 7 days
Terminate season; return
next season if no
symptoms
Consider retirement
-2nd degree Mobitz type I Wenckebach: progressive lengthening of the PR interval until a beat
is dropped (a P wave NOT followed by a QRS complex), PR then resets; usually asymptomatic.
Can be caused by drug effect (digoxin, B-blocker, CCB)
- 2nd degree Mobitz type II: dropped beats that are NOT preceded by a change in the length of
the PR interval (as in type I). (Unexpected dropped beat WITHOUT a change in PR interval). It
is often found as 2:1 block, where there are 2 P waves to 1 QRS response. May progress to 3rd
degree block. Results from fibrotic disease of the conduction system or previous Septal MI,
occasionally syncope or progression to 3rd degree AV block. Pacemaker placement even if they
are asymptomatic.
Fetal decelerations:
Early: due to fetal (cephalic) head compression & vagal nerve stimulation
Variable: due to umbilical cord compression, change mothers position, back to side
Late: due to uteroplacental insufficiency & fetal hypoxemia, possibly due to abruption or
hypotension. Further testing for reassurance is necessary. If late decels are repetitive & severe,
or bradycardia develops deliver the baby ASAP, immediate C-section.
((EVL=HCU =Early/variable/late=head/cord/uteroplacental))
Pityriasis Rosea pic of leg with red and induration. A mild self limited cutaneous eruption
assoc w HHV-6, usually seen in kids who present w pruritus, characterized by diffuse eruption of
round to oval erythematous papules & plaques covered w fine cigarette paper white scale, often
found on the trunk & proximal extremities. A Christmas tree pattern is seen on the trunk w
classic herald patch (a solitary patch that precedes the rest of the rash)
Next step for pt. with sausage shaped mass. Ans: I chose abdominal ultrasound
Intussusception The MCC of bowel obstruction in the 1st 2yrs of life. M>F, Risk factors
include Meckels diverticulum, intestinal lymphoma (>6yrs old), Henoch-Schonlein purpura,
parasites, polyps, adenovirus, or rotavirus infxn, celiac disease, & CF. Presents w abrupt onset
colicky Ab pain in apparently healthy kids, often w drawing up of the legs (knees drawn up to
chest) & vomiting. Classic triad Ab pain, vomiting, & blood per rectum, red currant jelly stool,
lethargy, fever, Ab tenderness, + stool guaiac, & palpable Sausage shaped RUQ Ab mass.
Abdominal plain films (showing small bowel obstruction) & ultrasound may be helpful. Air
contrast barium enema is diagnostic & often curative. If the kid is unstable or enema reduction is
unsuccessful, perform surgical reduction & resection of gangrenous bowel.
Gonorrhea causes which of the following? Ans: infertility
Diazepam is good for the txt of sz disorder, status epi, muscle spasm, EtoH withdrawal, anxiety,
& pre-op sedation
Calcium gluconate is good for the txt of emgt hypocalcemia, life threatening arrhythmias,
hypermagnesmia adjunct, CCB overdose, & osteoporosis prevention
What to do with a patient with baseline Creatinine of 2.3, which is now 8.0? Ans: Dialysis