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COMLEX Level 2CE > HWK SB3 (-5.5) > Flashcards

HWK SB3 (-5.5) Flashcards

W3 HWK blocks (39,40.5,42,43,45,46,48,49) Missing blocks 40,42,43,46,48,49

1
Q

what are the anti-HTN lifestyle mods?

A

wt loss, exercise, DASH diet (incr fruit/veg, low fat), low salt diet, limit EtOH

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2
Q

if pt w/ HTN on meds presents w/ poor BP control and poor lifestyle, how do you manage their care?

A
  1. lifestye

2. adjust/add meds

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3
Q

when should you suspect endometriosis?

A
  • chronic pelvic pain
  • dysmenorrhea (cramps)
  • deep dyspareunia (pain w/ sex)
  • dyschezia (pain w/ BM)
  • infertility
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4
Q

when should you do a laparoscopy to definitively dx endometriosis?

A

if NSAIDS and OCP fail to resolve s/s

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5
Q

what are pts w/ endometriosis @ incr risk for?

A

infertility

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6
Q

does endometriosis alter the nL menstrual cycle?

A

NO. will not lead to/include 2* amenorrhea in its presentation

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7
Q

how does AR (murmur) present on P/E

A
  • diastolic decrescendo murmur
  • widened pulse pressure (incr SBP, decr DBP)
  • head bobbing
  • water-hammer pulse
  • pistol-shot femoral pulses
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8
Q

how do you position the pt to best hear AR?

A
  • seated and leaning forward

- hold breath after full exhalation

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9
Q

what is the MCC of AR in young pts?

A

congenital bicuspid aortic valve

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10
Q

infant ARDS is caused by what?

A

decr surfactant

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11
Q

what are the RF for decr surfactant?

A
  1. prematurity ***
  2. maternal DM **
  3. male
  4. perinatal asphyxia
  5. csec w/o labor
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12
Q

what factors decr risk of ARDS in infants?

A
  • intrauterine growth restriction
  • maternal HTN
  • PROM
  • *incr stress on the baby –> earlier lung maturity
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13
Q

how do you manage uncomplicated PPROM @ <34wks?

A
  • expectant management
  • latency ABX (ampicillin & azithro)
  • corticosteroids
  • fetal surveillance
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14
Q

how do you manage PPROM @ 34-37wks?

A

+delivery
+GBS ppx (penicillin)
+/-corticosteroids

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15
Q

how do you manage complicated PPROM @ < 34wks?

A
  • delivery
  • IAI tx (ampicillin & gentamicin)
  • corticosteroids
  • Mg if <32 wks
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16
Q

when do you get erosive gastropathy?

A

after ischemia or gastric exposure to EtOH, ASA, cocaine, toxins/meds

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17
Q

will mallory-weiss tears occur w/ the first presentation of n/v

A

not typically

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18
Q

how does loperamide work?

A

decr H2O content of stool –> s/s relief of diarrhea

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19
Q

how does fecal impaction present on p/e

A

+/- distension
+/- diffuse tenderness
+/- palpable mass

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20
Q

b/c fecal impaction can be pretty benign on p/e, what should you key into to suspect this dx?

A

h/o constipation, impaired mobility, decr sens in rectal vault

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21
Q

what are the MCC of acute renal vein thrombosis?

A
  • nephrotic synd
  • malig
  • trauma
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22
Q

how does renal vein thrombosis present?

A
  • hematuria
  • renovascular congestion
  • flank pain
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23
Q

when do people w/ G6PD def present w/ s/s of hemolytic anemia?

A

when they are undergoing incr oxidative stress (think infx)

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24
Q

what meds should be avoided in G6PD def?

A
  • dapsone (d…phenyl sulfone)
  • isobutyl nitrate
  • nitrofurantoin
  • primaquine
  • rasburicase
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25
Q

how does disseminated gonococcal infx present (triad)?

A
  1. polyarthralgias
  2. tenosynovitis
  3. vesiculo-pustular skin lesions
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26
Q

what can mucus plugging lead to?

A

large vol atalectasis (lung collapse) 2/2 airway obstruc

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27
Q

what is seen on CXR w/ mucus plugging?

A
  • atalectasis (entire hemithorax)
  • mediastinal shift towards atalectasis
  • ribs approximate on bad side
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28
Q

how do you distinguish large pleural effusion from large volume atalectasis on CXR?

A
  • pleural effusion = mediastinal shift away

- atalectasis = mediastinal shift towards

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29
Q

what ovarian tumor can present w/ concomittant endometrial hyperplasia/ca?

A

granulosa cell tumors

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30
Q

what are granulosa cell tumors?

A

estradiol-secreting ovarian sex-cord stromal tumors

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31
Q

what must you do prior to tx granulosa cell tumors?

A

check for endometrial hyperplasia/ca (endometrial bx)

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32
Q

why do you not use hysterosalpingogram in adnexal mass eval?

A

will not further define the mass or affecct the management

33
Q

when do you use hysterosalpingogram?

A

infertility w/u

34
Q

what is the most important RF for shoulder dystocia?

A

fetal macrosomia

35
Q

apart from fetal macrosomia, what are other RF for shoulder dystocia? (hint: think what causes big babies?)

A
  • maternal obesity
  • excessive pregnancy weight gain
  • gestational DM
  • post-term delivery (>42wks)
36
Q

how does neuroblastoma present?

A
  • avg age < 2yrs
  • abd mass
  • periorbital ecchymoses
  • spinal cord compression
  • horner synd
  • unilat facial flushing (dry side won’t flush)
37
Q

how does horner synd present?

A
  • ptosis (lid-lag)
  • myosis (pupils constricted)
  • anhydrosis (dry)
38
Q

what are two common childhood brain tumors?

A
  • medulloblastoma

- pilocytic astrocytoma

39
Q

where do medulloblastoma and pilocytic astrocytoma typically arise?

A

cerebellum

40
Q

presentation of medulloblastoma and pilocytic astrocytoma typically involves what?

A

+ataxia
+dysmetria
- (NO) horner synd

41
Q

how should you deliver bad news?

A
  • private setting
  • w/ empathy (duh)
  • stay to answer Qs and concerns when they are ready
  • don’t offer reassurance or guarantees other than that you will be there with them
42
Q

what is Felty synd?

A

complication of seropos RA

43
Q

how does Felty synd present?

A 
RA s/s 
  \+neutropenia
  \+splenomegaly
  \+ incr RF
  \+incr anticitrullinated peptide Ab
44
Q

hypocellular BM is seen in what condition?

A

aplastic anemia

45
Q

what finding of Felty’s synd is atypical in aplastic anemia?

A

splenomegaly

46
Q

what is a major toxicity of Mycophenolate?

A

bone Marrow suppression

47
Q

what are the major toxicities of azatHioprine?

A

dose-related diarrHea, Hepatotoxicity, and leukopenia

48
Q

what are the s/e of cyclosporine?

A
  • nephrotoxic
  • incr K
  • HTN
  • gingeval hyperplasia
  • hirtuism
  • tremor
49
Q

what are the s/e of tacrolimus?

A
  • nephrotoxic
  • incr K
  • HTN
  • tremor
50
Q

what two side effects are seen w/ cyclosporine use but not tacrolimus?

A
  • gingeval hyperplasia

- hirtuism

51
Q

how does Rett synd present?

A
  • nL development until age 6-18mos
  • regression of speech
  • gate disturbance
  • loss of purposeful hand motions + pill rolling
52
Q

how does Angelman synd present?

A
  • delayed development
  • intellectual disability
  • happy
  • jerky gait
  • hypermotoric behaviors
  • hand flapping
53
Q

angelman’s hand presentation?

A

hand flapping

54
Q

Rett’s synd hand presentation?

A

pill rolling

55
Q

how do external hemorrhoids present?

A
  • purple/dusky color
  • itching/bleeding
  • thrombosed = growing and painful
56
Q

what does pernicious anemia cause and how does it present?

A
  • MCC of vit b12 def
  • macrocytic anemia
  • hypersegmented PMNs
  • mild leukopenia
  • mild thrombocytopenia
  • GLOSSITIS!
57
Q

pt presents w/ a smooth, shiney tongue. what is this called and what are 2 possible dx?

A
  • glossitis
    1. vitB12 def (likely 2/2 pernicious anemia)
    2. vitC def (scurvy)
58
Q

ADHD criteria for dx = ?

A
  • inattentive AND/OR hyperactive s/s >= 6mos
  • onset < 12 yo
  • s/s occur in 2+ settings
59
Q

how does hepatic adenoma present on CT?

A

=centripital enhancement. NO CENTRAL SCAR

60
Q

what is focal nodular hyperplasia?

A

benign liver lesion 2/2 aberant congenital artery

61
Q

what does focal nodular hyperplasia look like on imaging?

A
  • solid mass
  • STELLATE CENTRAL SCAR
  • radiating fibrous bands
62
Q

what is the MC malig to manifest in an upper cervical lymph node?

A

head and neck SCC

63
Q

what is often the 1st/only apparent manifestation of head/neck SCC?

A

palpable painless cervical lymph node

64
Q

where do the vast majority of cervical nodal SCC arise from?

A

mucosal surfaces of the head an neck?

65
Q

what test is best to eval/dx probably SCC of the head/neck?

A

laryngopharynoscopy

66
Q

what are the types of throid ca?

A
  1. papillary
  2. follicular
  3. medullary
  4. anaplastic
    * *NO SCC OF THE THYROID**
67
Q

if decr Ca and decr Mg, what do you do?

A
  • tx underlying cause
  • replace Mg
  • IV Ca (for severe s/s)
68
Q

what group of pts is @ incr risk of decr Ca and decr Mg?

A

alcoholics

69
Q

how does decr Mg –> decr Ca?

A

decr Mg –> decr PTH release –> decr Ca

–> incr PTH resistance –> decr Ca

70
Q

if extracellular deposition of Ca –> decr Ca 2/2 pancreatitis. how will pt present?

A

chronic abd pain + features of pancreatitis

71
Q

how will a sertoli-leydig tumor present?

A
  • rapid onset virilization
  • oligomenorrhea
  • unilat, solid adnexal mass
72
Q

what are s/s of virilization?

A
  • deepening of voice
  • male pattern baldness
  • incr muscle mass
  • clitoromegally
73
Q

what will present w/ sertoli-leydig tumors but not in PCOS that allow you to distinguish btwn the two?

A

SL: marked incr testosterone –> virilization
PCOS: incr testosterone isn’t high enough to cause virilization

74
Q

what should you evaluate for if rapid onset (<1yr) virilization?

A

androgen secreting tumors in ovary or adrenal gland

75
Q

how do you distinguish btwn ovarian and adrenal cause of virilization w/ labs?

A
  • ovarian: incr T, nL DHEAS

- adrenal: nL T, incr DHEAS

76
Q

how do you tx stress incontinence?

A
  1. kegels
  2. pessary
  3. sx (midurethral sling=MC)
77
Q

what bladder dysf(x) is tx w/ antimuscarinics (oxybutinin)?

A 
urge incontinence 
(b/c antimuscarinics tone down bladder activity by causing detrusor relaxation)
78
Q

how do cholinergic agonists (bethanacol) work to tx overflow incontinence?

A

stimulate bladder contraction (force bladder to release urine on command)

79
Q

what group of meds has the opposite effects of antimuscarinic meds?

A

cholinergic agonists

COMLEX Level 2CE (23 decks)

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