Pulmonary
Someone diagnosed with asbestosis. What will the imaging show?
Pleural plaques
24 yo healthy person w/ intermittent chest tightness not associated with exercise. No SOB, syncope. Vitals are good. ECG narrow QRS, occasional increase in P-P, unifocal P waves, normal PR intervals. What is the diagnosis?
Sinus arrhythmia
30yo man to ED w/ HA after motorcycle crash, not wearing a helmet. LOC x 5 min, woke and vomited, GCS of 14, diminished DTRs of bilat LEs. Next 6 months, irritable, HA, bad sleep, anxiety, fatigue, trouble concentrating. What's the most likely consequence of injury?
Concussion
65 y/o postmenopausal women to the ED w/ dysuria, frequency, urgency, vaginal bleeding. Donut shaped mass at the anterior wall. What’s the next best step?
Order UA, eval for UTI
Tadalafil indications
ED and BPH
34-year-old morbidly obese patient in office for a hospital follow-up from acute hypercapnic respiratory failure. He c/o tiredness and headache. Is on 2 liters of supplemental oxygen. What is the initial best treatment?
BiPap
68 yo female w/ classic stable angina. What is the best medication (class)?
Beta blockers, important in classic angina, don’t use in prinzmetal angina
36yo male with more hand weakness, constant, can’t button shirt, zip pants, or lift hands over head. Worse gait, walks slow. Bilateral hand weakness and spastic gait on PE. What's the diagnosis?
ALS
8 y/o at family practice w/ 1 day of hematuria, had impetigo 1 month ago. Has mild edema. What’s the diagnosis?
Post-infectious nephropathy
What test confirms congenital ureteropelvic junction obstruction?
Diuretic renography
65-year-old with fatigue, SOB, CP, weight loss, diminished breath sounds and dull percussion. CXR shows pleural thickening, unilateral effusion. What cancer is most likely causing this?
Mesothelioma
6-day old preemie that is less playful, eating less, lives in rural CO, home birth. Edema and cyanosis of BLE. Continuous machine like murmur, bounding pulses, prominent PMI. CXR – enhanced vasculature. Echo shows left to right shunt. What could have prevented this from happening?
Ibuprofen (it’s a PDA)
40yo to ED w/ sudden HA. CT shows AVM. What is true regarding AVMs?
Most common genetic cause is hereditary hemorrhagic telangiectasia
Hypomagnesemia mimics what other electrolyte disturbances?
HypoK and hypoCa
Next best step? 65 yo postmenopausal with dysuria, frequency, urgency, vaginal bleeding
Order a UA to eval for a uti
40-year-old chemotherapy patient with fever, hemoptysis, dyspnea. CXR shows bilateral fluffy infiltrates. Septate hyphae w/ acute single branches on bronchoscopy. What medication?
Voriconazole
69 yo woman with CHF. Weak, dizzy, can’t catch her breath x 4 days, worse today, now with chest pain. ECG – fast, irregularly irregular – A-fib. Pale, diaphoretic, tired, and slow. What’s the next best step?
Synchronized electrical cardioversion
74yo to ED w/ stroke – non con CT negative for hemorrhage – most appropriate treatment?
Immediate tPA infusion
51 y/o w/ AKI 9 days after gentamicin. Elevated Serum creatinine – how do you decrease nephrotoxicity?
give daily dose one every 24 hours –creates a high trough, and then low peaks
What is the best way to treat this patient?
55 yo F with HTN, well controlled asthma. 130/78, 127/77, 135/82.
Allergies: sulfa, ACE, hydrocodone. Take irbesartan, terazosin, albuterol MDI, fluticasone/salmeterol MDI, paroxetine.
Has urinary leakage, cough, sneezes, laughs, regular Kegel exercises past month
d/c terazosin, optimize irbesartan, reassess in one month
14-year-old w/ new onset asthma. Spirometry shows FEV1 is 75% of predicted, normal or slightly decreased FEV1/FVC ratio. Patient has symptoms 2-3x/week is waken up with a cough. Has cough and SOB every day at school. What is the NHLBI guideline treatment?
Medium dose budesonide DPI w/ PRN albuterol MDI
ED – 60yo man with pressure, pain mid chest x 2 hours radiating to neck with nausea. No hx of anything. 94HR, 120/75, ECG – nonspecific ST, T changes in I, aVL, V4-V6. PR is 256ms. Elevated troponin, hes got ASA, nitro and plavix. EF is 55%. What’s the next best step?
Anticoagulate w/ heparin
30yo female w/ increased muscle weakness and trouble swallowing. Isn’t weak when waking, progressive throughout the day. PE – ptosis of Right eye, drooping of right side mouth, no forehead involvement. Nerve stimulation decreased action potentials. Treatment?
Pyridostigmine
18 y/o w/ dark urine, facial swelling, weakness, fatigue, lack of appetite x2/3 days. No fever, dysuria, passage of stones. Sore throat 10 days ago w/ fever of 103. Labs, vitals, PE, blood work and UA results given (long case) heme 4+, RBC casts, 2+ proteinuria, ASO titer positive – what medication would you give?
Loop diuretics for symptomatic therapy of post-strep glomerulonephritis
61 yo with BPH, urinary hesitancy, dribbling, weak and slow urine stream, incomplete voiding. 6 mo with tamsulosin. How to adjust medications?
Add finasteride