Form 12 CCSSA Specific Things

For a menopausal woman who has an extensive smoking history, she is at greatest risk of dying from cardiovascular disease

For women who experience heavy vaginal bleeding and are found to have thrombocytopenia, the cause of that is immune thrombocytopenic purpura

Congestive heart failure will have both S3 and S4, crackles, and distended jugular veins

Any fetus delivered before 22 to 23 weeks gestation is very likely stillbirth, so resuscitative efforts won’t do any good

If there is cloudy fluid draining around a nasogastric tube, that’s purulent nasal discharge, a sign of sinusitis; the best thing to do is get a CT of the sinuses

Bradypnea in the setting of administering opioids suggests opioid overdose; to confirm, get ABG

Meta analyses are done to increase the power of the overall study

It is safe to use lithium after the first trimester

• You know it causes Ebstein anomaly, but the risk of this is really only during the first trimester; after that, the risk substantially decreases

Sudden onset of any severe headache = subarachnoid hemorrhage; lumbar puncture will show the xanthochromia

The screening for optic gliomas with NF1 is ophthalmic examination

• It’s true NF1 has neurological pathologies but MRI and CT should generally be performed as needed

When there is an ovarian mass that is causing precocious puberty, remove the ovary

If there are recurrent respiratory and sinus infections, it is likely the defect is with the cilia

Because end-of-life decisions are very significant, if a patient makes an end-of-life decision such as cutting off all ventilatory support, need to ensure they have capacity

A diminished S2 is characteristic of aortic stenosis, as it is due to weakened closing; other characteristics include heart failure symptoms like JVD, crackles

E coli O157:H7 is the one that causes bloody diarrhea

• ETEC causes watery diarrhea

Even though galactoceles are diagnosed clinically, fine needle aspiration will help provide further evidence and can also be used to relieve symptoms if the galactocele is symptomatic.

Any sort of pulsatile mass in the inguinal region is a femoral artery aneurysm, and it needs to be surgically repaired

The definitive confirmatory test for interstitial lung disease is lung biopsy

Preoperative surgical interventions such as confirmation of patient identity, procedure, patient positioning, and availability of instruments all help increase reliability because they ensure that the surgical team is well-prepared and organized, thereby minimizing the risk of errors during the procedure.

Unilateral laryngeal nerve injury during a thyroidectomy can lead to vocal cord paralysis, resulting in hoarseness, but bilateral nerve injury will result in severe airway compromise and may necessitate immediate intervention such as tracheostomy.

PSVT appears as needles on EKG; anytime you see very narrow QRS that looks like needles, think about PSVT

Let’s say 20% of people who have a AAA of a certain size will rupture, 50% will die before reaching a hospital, and of those who do reach a hospital, 50% don’t make it

• 50% of patients do reach a hospital, but 50% die, meaning 25% of the patients die in the hospital

• Total, 75% of people die

• 20% have a rupture, and of those 20%, 75% will die, meaning the total mortality likelihood of death will be 0.2×0.75 =0.15

Severe hip and groin pain following a fall with X-ray showing narrowing of joint space and osteopenia is concerning for a hip fracture; MRI is best to confirm

The most common long-term complication of bacterial meningitis in infants is hearing loss

Reproductive features of Turner’s syndrome in women include primary amenorrhea, loss of sexual characteristics, and infertility due to gonadal dysgenesis, which results from the absence or structural abnormality of one of the X chromosomes.

At the time of HIV diagnosis, the vaccines administered are the Hepatitis vaccines, along with the Pneumococcal, Meningococcal, and HiB vaccines; the pneumococcal one should be repeated at least 5 years after the first dose

Between Huntington’s and Wilson’s, Wilson’s will have evidence of the Kayser-Fleischer rings

If peritoneal fluid shows more than 1000 WBCs or 250 neutrophils, it’s SBP

The electrolyte disturbances of anorexia are hypokalemic hypochloremic metabolic alkalosis likely from excessive vomiting

Cleft palate increases the risk of developing velopharyngeal insufficiency due to the inadequate closure of the nasopharyngeal passage during speech, often leading to speech difficulties and resonance issues.

In a patient who has Entamoeba histolytica and is on antibiotics and metronidazole, if they have positive test results for Entameoba, keep the metronidazole only

Hoarseness with an extensive smoking history is suspicious for laryngeal cancer; the first thing to do is indirect laryngoscopy

• CT is done for metastatic evaluation, but laryngoscopy is first

The causes for colovesicular fistula are diverticular disease and IBD; IBD will have the bloody diarrhea

Preoperative evaluation of any RA patient to reduce the risk of complications should include cervical spine X-ray because of the risk of the AA subluxation

Hypothyroidism can cause galactorrhea and hyperprolactinemia

If a patient is on 2 antihypertensives and is still above the target blood pressure range, add a third antihypertensive agent to better manage their condition.

Case series helps describe history, risk factors, clinical findings, and treatments for patients with similar diagnoses

Cardiogenic shock shows cardiomegaly, cool extremities, hypotension with tachycardia, tachypnea, and JVD; the best next thing to do is echocardiography

If an infant is sweating with feedings and is shown to have holosystolic murmur, it’s very likely it’s a VSD

All rotator cuff injuries should at least get a diagnostic MRI

If a patient is confirmed to have indoor allergens through skin testing which are triggers to asthma, the best environmental modification is allergen impermeable mattresses and pillow covers

If there is suprapubic pain/tenderness, urgency, and inability to void, it’s likely BPH especially if an older man

In a pregnant patient who suffered an MVA and is presenting with confusion, get CT head

Separation anxiety is common from 18 months to 3 years

DiGeorge syndrome has hypertelorism and low-set ears, along with other features such as cardiac defects and immune system deficiencies that can impact a patient's overall health.

In a patient with upper GI bleed (black tarry stools), weight loss and malnourishment, think about gastric cancer and get the EGD

If a nodule is found with signs of hyperthyroidism, do the radioactive uptake first

Salicylate toxicity causes respiratory alkalosis with metabolic acidosis

For infected wound sites via trauma from GSW or contamination, delayed wound closure is the best method for wound closure

In DKA, insulin is decreased and glucagon is increased, but catecholamines are also increased because the body is in a state of stress, leading to further aggravation of hyperglycemia and a higher risk of complications.

Symptomatic hyponatremia can be caused by diuretics; if a patient is having these symptoms and is taking a diuretic, stop the diuretic

Teens have a right to confidentiality unless their safety or the safety of others is at risk

Scopalamine helps reduce airway secretions for those who are on hospice

Pregnant patients with appendicitis will not necessarily have the RLQ pain; appendix shifts, so the tenderness can be located anywhere on the right side

Hypoparathyroidism can result from thyroid surgery, and will increase calcium excretion

Antibiotics like TMP-SMX can cause drug-induced neutropenia; stop the antibiotic and check back in a week

Within the 5 Ps for AIN (pencillin, pain [NSAIDs], pee [diuretics], PPIs, and rifamPin), antibiotics like sulfa drugs and ceftriaxone can also cause AIN

If a fine needle biopsy is negative for something that has the signs of breast cancer, excisional biopsy needs to be done

Bloody ear discharge in the setting of ear infection is due to perforated tympanic membrane