Missed Qs

1. Oculogyric crisis is a dystonic reaction and the treatment of choice for dystonia is benztropine or diphenhydramine (procyclidine is another option). Other dystonic symptoms include torticollis, buccolingual crisis, and trismus. They are characterized by intermittent spasmodic or sustained involuntary contractions and are caused by drugs that antagonize the dopamine pathway. Although oculogyric crisis is a less common presentation of dystonic reaction, it still follows the typical signs of dystonia. There is a sustained involuntary contraction (of the eyes) and the patient has a disorder (schizophrenia) that involves medications that are known to cause a dystonic reaction. Knowing the characteristic symptoms of a disease can help you to pick the correct answer when presented with an uncommon presentation.
2. Platelets are stored at room temperature and are the most likely transfusion product to cause bacterial sepsis in humans.
3. Hyperkalemia has been shown to be a useful predictor of morbidity and mortality in patients suffering from acute digoxin toxicity. Hypokalemia should be corrected promptly and may help to improve cardiac glycoside-related arrhythmia. Neither hypo or hypercalcemia are strongly associated with digitalis toxicity. Calcium channel blockers are strictly prohibited in patients suffering from digoxin toxicity because of their ability to further increase digoxin levels in the blood.
4. Wilms tumor is a large abdominal mass originating from the kidney in early childhood. It is often associated with Beckwith-Weidemann syndrome which is characterized by organomegaly, macroglossia, and neonatal hypoglycemia.
5. Elderly patients presenting with meningeal signs, altered mental status, and papilledema on exam after having dental work should be worked-up for pyogenic brain abscess.
6. Manipulation of the occipitolatlantal (OA), atlantoaxial (AA), or C2 joints will influence parasympathetic tone via cranial nerve X.
7. The findings of preeclampsia before 20 weeks, uterine enlargement, disproportional fundal height, and “snowstorm pattern” on ultrasound all point to the diagnosis of complete molar pregnancy. Preeclampsia and uterine enlargement are present in less than 5% of partial molar pregnancies
8. Barrett's esophagus is columnar metaplasia of squamous cells. It is the precursor of adenocarcinoma but is itself benign.
9. In utero exposure to the drug diethylstilbestrol, or DES, has been associated with recurrent painless second-trimester spontaneous abortions due to Mullerian duct abnormalities. In utero exposure to the drug diethylstilbestrol, or DES, has been associated with recurrent painless second-trimester spontaneous abortions due to Mullerian duct abnormalities. In utero exposure to DES carries a high association with the future development of clear cell adenocarcinoma of the vagina.
10. Suspect type 1 complex regional pain syndrome in patients who suffer from continued pain (out of proportion to injury), allodynia, joint stiffness, localized edema,increased hair growth, and vasospasm following injury with no evidence of nerve damage. Unlike CRPS-1, type 2 (aka causalgia) is characterized by more intense pain. Edema is typically widespread, hair growth diminishes, nails become cracked and brittle, osteoporosis becomes severe and diffuse, joints thicken, and muscle atrophy occurs.
11. Nitrates and calcium channel blockers are mainstay therapies for the treatment of variant angina. Nifedipine, amlodipine, verapamil, and diltiazem effectively prevent coronary vasospasm and are preferred in the treatment of variant angina over beta-blockers. Transient ST-segment elevations are a common finding in cases of Prinzmetal (variant) angina, which classically presents as substernal chest pressure both at rest and during activity that worsens in the morning and with smoking. Prinzmetal angina is caused by coronary vasospasm and is typically treated with calcium channel blockers.
12. The gold standard for confirming reflux is 24-hour esophageal pH monitoring. Infant reflux typically presents with symptoms of failure to thrive which is evident in this case. Abdominal ultrasound is the gold standard for confirming pyloric stenosis, however, the absence of projectile vomiting makes this diagnosis unlikely. Also, in pyloric stenosis the patient likely would likely have presented much earlier in life (within 2-4 weeks of birth).
13. Correcting thoracic vertebral somatic dysfunction first can often improve other dysfunctions, especially rib dysfunction. Treat thoracic segments before rib dysfunction, and use counterstrain to treat tenderpoints.
14. Since surgery and oral contraceptive pills are both risk factors for thromboembolism, oral contraceptive pills should be stopped 1 month prior to the surgery, and not restarted until 1 month after the surgery.
15. For direct muscle energy to the ribs, the patient holds their breath against the restriction barrier and the physician will push to counteract this force.
16. Scheuermann's Kyphosis is a rigid curvature. X-ray findings include wedged-shaped vertebra and Schmorl’s nodules.
17. SIADH causes the retention of free water without a change in plasma volume (euvolemic hyponatremia), thus blood pressure generally remains normal.
18. Fluid restriction is the mainstay of treatment for patients who do not show serious neurological signs such as seizures. Normal saline is used for patients in shock. ½ normal saline is maintenance fluid for patients without any fluid abnormalities. Hypertonic saline can be used if fluid restriction is not helpful or the patient is having a seizure with severe hyponatremia