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HY Review #1 Flashcards

1
Q

2 reasons for
Failure to pass nasogastric tube in an infant + Associated defects

A

Esophageal Atresia w/ TE fistula
(VACTERAL)
&
Choanal Atresia
(CHARGE)
─
Vertebral, Atresias, Cardiac, TE fistula, Renal, Anal, Limb defects
─
Coloboma (pupil)
Heart, Atresia (choanal), Retarded (growth), Genital, Ear defects

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2
Q

White pt. (+) FMH
RUQ pain, Splenomegaly, Jaundice, Anemia
↓ Hgb ↑ MCHC
Indirect Hyberbilirubinemia
↓ Haptoglobin
Dx/Tx/Dxt (2)/cx?
Mutation?

A

Hereditary Spherocytosis (AD)
Splenectomy
Osmotic Fragility test/ Eosin 5 Maleimide binding test

Cx: Pigmented Gallstones (s/t hemolysis)
Ankrin/Spectrin mutation– congenital hemolytic disorder

RBCs lack central pallor

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3
Q

Patients present with swelling of the eyelids, lips, and/or tongue.
Cx: laryngeal edema requires intubation
Dx/Tx

A

Hereditary Angioedema
avoidance of triggers (ACE-I)

Bradykinin-mediated → C1 inhibitor
Bradykinin receptor ANTagonists
Kallikrein inhibitors.

Histamine-mediated→ antihistamines, steroids

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4
Q

History of rheumatoid arthritis
multiple lower lobe nodules on CXR
Dx?

A

Caplan Syndrome

(aka Rheumatoid Pneumoconiosis)

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5
Q

Before obtaining surgery, doing sports, or after trauma what is indicated in pts with RA or Ankylosing Spondylitis?

A

Cervical X-Ray

Atlantoaxial instability (C1-C2 Subluxation)

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6
Q

History of rheumatoid arthritis
Splenomegaly
Neutropenia
Dx/Tx?

A

Felty Syndrome
1st: Methotrexate
2nd: TNF 𝛼-Inhibitor
(etanercept, infliximab, adalimumab)

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7
Q

Before starting immunomodulators (TNF inhibitors) for RA, IBD, etc. what do we screen for 1st? (3-4)

Cx associated with immunomodulator use?

A

HBV, TB, HIV, HCV

Cx: Lymphomas

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8
Q

List 2 classic opportunistic infections in pts on TNF inhibitors?

A

Legionella
Listeria Infections (Granulomatous illness)

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9
Q

HY
RA treatment in pregnancy?

A

Hydroxychloroquine

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10
Q

Sudden onset limb pain
absent pulses
h/o recent MI
Dx/Tx/Dxt:

A

Acute Limb Ischemia
IV Heparin (1st)
CT Angiogram (+ct)
Embolectomy (last/definitive tx)

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11
Q

Recent MI & cardiac cath.
transient vision loss (golden spot on fundoscopy)
netlike, purplish discoloration LEs
↑ Cr
(+) Eosinophiluria
Dx?

A

Aortic Atheroembolic disease

(Cholesterol Emboli Syndrome)

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12
Q

Pt suspects they were bitten by a bat. NBSIM?

A

Administer:
Rabies Immune-globulin (in one arm)
Rabies Vaccine (in other arm)

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13
Q

Red urine + flank pain minutes after a blood transfusion begins
Dx/Tx?

T__HSR

A

Hemolytic transfusion rxn
(ABO incompatibility → T2HSR)
Normal Saline (flushes out bad blood)

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14
Q

Respiratory Distress + stridor/wheezing minutes into a blood transfusion
Dx/Tx?
T__HSR

A

Anaphylactic Transfusion rxn
Epinephrine
(IgA deficiency → T1HSR)

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15
Q

Fever and chills 2-3hrs into transfusion reaction
Dx/Tx?

A

Febrile non-hemolytic
(prevent with leukocyte irradiation)
Acetaminophen (anti-pyretic)

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16
Q

If a pt has ANY transfusion reaction what test should be done?

A

Direct Coombs TEST
(to see if antibodies caused it)

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17
Q

Classically presents as an elderly female (or person who recently hung out with elderly person)
with malaise, night-sweats, weight loss, and productive cough.
CXR: Lower lobe/ Mid-lobe (hilar) opacities
Dx/Tx?

A

Mycobacterium Avium Complex (MAC) infection
REC: Rifampin + Ethambutol + Clarithromycin
━
aka Lady Windermere Syndrome
Presents very similar to TB
Sputum is acid-fast bacilli (+)
Involves the lower lung lobes (TB involves upper lobes)

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18
Q

Traveler/Inmate/immigrant (India, Phillipines, China, Indonesia)
present with fever, weight loss, night sweats, and a productive cough (with or without hemoptysis)
Sputum is acid-fast (+) pink bacilli
Dx/Tx?

A

Tuberculosis (Active)
RIPE + Vit B6

Rifampin + Isoniazid + Pyrazinamide + Ethambutol

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19
Q

h/o sickle cell disease recent URI
Hb of 2
low reticulocytes
Dx?

A

Aplastic crisis
(s/t Parvo B19)

Typically in a sickle cell crisis there are ↑ Reticulocytes.
If this presents with ↓ reticulocytes consider aplastic crisis s/t Parvo B-19.

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20
Q

Female presents for amenorrhea.
Has T5 Breast+ No Pubic/Axillary hair
Blind Vaginal Pouch
Dx & genotype?

A

Androgen Insensitivity Syndrome (46XY)
testosterone receptor don’t work.

(poor axillary/pubic hair = Testosterone problem)

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21
Q

Soldier returns from deployment with nose papule that has evolved into a centrally ulcerating lesion with a raised erythematous rim
Dx/Tx?

A

Cutaneous Leishmanaiasis
Liposomal Amp-B
(or sodium stibogluconate)

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22
Q

Erythematous rash on the face, neck, and torso 10 mins after an infusion is started for Staph Aureus endocarditis treatment. Dx/Tx?

A

Antibiotic induced infusion reaction
(Red Man Syndrome s/t Vancomycin)
Tx: slow infusion rate + antihistamine

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23
Q

Sudden onset of low back pain,
bowel and bladder dysfunction
Bilateral patellar hyperreflexia & weakness
(+) Babinski
Dx?

A

Conus Medullaris Syndrome

(Acute + UMN sxs)

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24
Q

3w Gradual onset low back pain (radiates to the left thigh)
bladder/bowel dysfunction
saddle anesthesia (S3-S5)
decreased Rectal tone (or erectile dysfunction)
Unilateral, hyporeflexic, LE weakness
Dx?

A

Cauda equina syndrome

(Gradual+ LMN sxs)

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25
Q

Most common cause of death in muscular dystrophy

A

Cardiac dysfunction

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26
Q

Hematologic association with restless legs syndrome? Treatment?

A

Iron deficiency anemia → Willis Eck Bomb Syndrome (restless leg syndrome)
1st line: Pramipexole / Ropinorole (dopamine agonist)
2nd line: Primidone (barbituate)
3rd line: Pre-pregabalin / Gabapentin

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27
Q

Treatment of aggression in individuals with Alzheimer’s?

A

Risperidone

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28
Q

Cardiac effect of Ziprasidone (atypical anti-psychotic)

A

prolongs QT

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29
Q

Tumor marker for hepatoblastomas?
Association?

A

alpha fetal protein (AFP)

associated w/ Beckwith-wiedemann syndrome

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30
Q

Hemodynamically Unstable
Hypernatremia
h/o Bipolar Disorder (well managed)
Dx/Tx?
ppx?

A

Nephrogenic Diabetes Insipidus (s/t Lithium)
tx: NORMAL SALINE FIRST

ppx → ENAC chanel blocker (Amiloride/Triamterene)

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31
Q

2 HY screenings that should be carried out in cirrhotic patients:

A

Need an annual EGD for risk of Variceals SCREENING
Need every 6m a LIVER U/S to screen for HEPATOCELULAR CARCIOMA

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32
Q

35 M is brought to the ED by police who found him walking leisurely between traffic. Needs help walking to hospital bed
Nystagmus and Severe Hypoglycemia
Dx/NBSIM?

A

IV Thiamine therapy

(always give thiamine before glucose in alcoholic/malnourished pts)

Confusion, Ataxia, Nystagmus → Wernicke’s

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33
Q

≥50F Presents with fatigue + pain and stiffness in the neck, shoulder, and hip muscles.
↑ ↑ ESR
normal CK
Dx/Tx?

A

Polymyalgia rheumatica
low dose of oral glucocorticoids

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34
Q

may resemble early rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE).
However, presents with recent viral infection (low-grade fevers) and joint pain does not have swelling/tenderness. It self resolves.

versus RA and SLE which present as a chronic joint pain with tenderness and swelling.

A

Viral Arthritis

(s/t parvovirus B19)

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35
Q

History of recent stroke now develops pulmonary consolidation
Dx/Tx?

A

Aspiration PNA
Clindamycin (for ANEROBE coverage)

(note that this can progress to an abscess with cavitation)
Anerobes involved: Bacteroides, fusobacterium, or prevotella

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36
Q

What malignancy likes to form cavitary lesions?

A

Squamous Cell lung cancer

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37
Q

Treatment of Lobar PNA in COPD Pt:
If, Gram (+) → (Bug & Drug)
if Gram (–) → (Bug & Drug)

A

Gram (+) → S. Pneumo → Ceftriaxone
Gram (–) → H. Influenza → Ceftriaxone

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38
Q

Fever, RUQ pain
Ultrasound → ExtraHepatic Duct Distended
Dx/Pathophysiology

A

Mirizzi syndrome
Extrinsic compression of hepatic duct by distended cystic duct

in order to make this dx Qstem HAS to say distended heptic duct ± bulging cystic duct

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39
Q

Pt Presents with Confusion, Nystagmus, and Ataxia.
What are they deficient in?

A

Thiamine (Vitamin B1)
need supplementation has Wernicke’s

Wernicke’s is not a B12 deficiency

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40
Q

Pt presents with Bilateral LE paresthesias.
Absent DTRs
Impaired vibration/proprioception bilaterally
Dx/Tx?

A

Vitamin B12 deficiency
Supplementation

(seen in Alcoholics & post Intestine resection s/t stuff like Chron’s)

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41
Q

Basophilic Stippling
Is seen in

A

Lead poisoning

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42
Q

Schistocyte formation s/t

A

mechanical destruction
(MAHA, Hemolysis, Prosthetic Valves)

43
Q

Pt w/ hx of Chron’s presents with numbness or tingling in toes and/or fingers
+ macrocytic anemia
Dx?

A

B12 Deficiency

Chron’s affects terminal illeum → resected → can’t reabsorb Vit B12

Iron- Duodenum
Folate- Jejunum
B12 - Illeum

44
Q

Lateral Brainstem Stroke presentation on NBMEs?

A

Temperature Loss on 1-side of the face (ipsi to lesion)
&
Temperature Loss on the contralateral body
──
CNs affected = ipsilateral brainstem stroke
If it is NOT lateral then it has to be Medial stroke
──
Midbrain → CN 3,4
Pons → CN 5, 6
Medulla → CN 7, 8, 9, 10, 12

45
Q

CN locations:
Midbrain →
Pons →
Medulla →

A

Midbrain → CN 3,4
Pons → CN 5, 6
Medulla → CN 7, 8, 9, 10, 12

46
Q

All loss of sensation and motor functions
Only ocular movements (except for adduction) spared
Dx? Locate Lesion/artery supplying region?

A

Locked in syndrome
Pons infarction
Pontine Artery

47
Q

Specific gravity in dehydration:

A

> > 1.012 (Magic # to know)

48
Q

Specific gravity in SIADH:

A

> > 1.012 (Magic # to know)

49
Q

Specific gravity in diabetic insipidus:

A

«1.012

50
Q

Guillane Barre treatment

A

PLASMAPHERESIS

51
Q

Fish tank/ reptile cleaner with nodular forearm lesions (looks like sporothrix, but different exposure)
dx/tx?

A

Mycobacterium Marinum
Clarithromycin, Ethambutol, Rifampin

52
Q

DM pt with Necrotic lesion (NOT MIGRATORY) + NEUTROPENIA
Dx/tx (3)?

A

Ecthyma Gangrenousum
(Pseudomonal infection)
FQ, Cefepime, Ceftazidine

53
Q

Nodular infection of the UEs
Pustules/ulcers/red streaks ascending to axilla
Nodules along draining LNs
in a vegetable farmer/landscaper/gardener
Dx/Tx (2)?

A

Sporothrix
PO Itraconazole or Potassium Iodide

54
Q

Impetigo (Honey crusted papules/pustules)
mcc Staph Aureas
Tx?

A

Topical Mupirocin

55
Q

Thyroid nodule noted of Physical Exam.
NBSIM?
After that?

A

TSH levels
Hot Nodule (Low TSH) → RAIU/Scintigraphy
Cold Nodule (normal/High TSH) → Thyroid U/S + FNA

56
Q

Painful Thyroid Goiter
Dx/Tx?

A

DeQuervain/Granulomatous/Subacute thyroiditis

NSAIDs ± steroids

57
Q

Healthcare worker
High T3/T4,
Low Thyroglobulin
Dx?

A

Factitious thyroid hormone medication

58
Q

Most common thyroid cancer → LN spread (do LN dissection) → laminated calcifications (Psammoma bodies)
BRF:

A

Papillary Thyroid cancer
BRF: Radiation to Neck/Chest

59
Q

(>60) Old man + rapidly enlarging neck mass + widely spread thyroid cancer → worst prognosis.
Will likely die.

A

Anaplastic Thyroid cancer

(orphan annie eyes)

60
Q

2nd mcc of thyroid cancer
dx requires lobectomy to see if cancer has broken through capsule HEMATOGENOUS spread (no LN dissection)

A

Follicular Thyroid Cancer

(Lobectomy bc FNA can’t differentiate between benign follicular adenoma)

61
Q

Tumor marker = ↑ Calcitonin [tones down Ca] → hypocalcemia
(+) congo-stain amyloid
Tx: ppx thyroidectomy (parafollicular C cells are cancerous)
MEN2 syndrome association

A

Medullary Thyroid Cancer

62
Q

Boy with recurrent catalase + infections
(Candida, Aspergillus, Nocardia)
Or Staph A. Abscesses
Nitro-blue Tetrazolium test is Negative
Dihydro-rhodamine 123 assay = no change in fluorescence
Dx/tx?

A

Chronic Granulomatous Dz
INF-Y therapy → stimulates MQs & can reduce risk of infection
─
Neutrophils (PMNs) do not work.
NAPDH Oxidase deficiency → No ROS.

63
Q

Old person with Crazy High WBC count
(cells in different stages Myeloid maturation)
↓ Leukocyte Alkaline Phosphatase
↑ Basophils
Dx/Mutation/Tx?

A

CML
Imatinib or Dasatinib
9:22 Philadelphia → BCR-ABL

64
Q

↑ Leukocyte alkaline phosphatase seen in ____.

A

Leukamoid Rxn → s/t infection

65
Q

Recently diagnosed DM + erythematous, necrotic lesions over the distal extremities and groin.
Dx of DM cause & skin findings

A

Glucagonoma
necrolytic migratory erythema
(SUPER HIGH YIELD)

66
Q

69M Smoking Hx presents with weight loss, jaundice, steatorrhea, and dark urine
Palpable, non-tender BUT distended gallbladder.
Dx/NBSIM/Tx?

A

Pancreatic Cancer
CT scan A/P + Contrast (for staging)
If cancer surrounds vessel = inoperable → Hospice
─
Pouvacier Sign
Bad Prognosis only months to live

67
Q

Post splenectomy
104ºF, WBC 23k, BP 60/40.
Dx/Tx?

A

Pneumococcal Sepsis
CTX
─
Strepto Pneumo is the mcc of sepsis in ppl with no spleen (or SCD)

68
Q

Spontaneous bloody nipple d/c:

A

intraductal papilloma (HY)

69
Q

Firm, rubbery, discrete, well circumscribed, mobile, non-tender breast mass in a 25 yo F that grows bigger with the menstrual cycle:

A

Fibroadenoma (responds to Estrogen so grows with period)

70
Q

Multiple breast masses in a 29 yo F that get more painful with the menstrual cycle:

A

Fibrocystic changes
(multiple, contain fluid, get painful with period)

71
Q

Female w/ Eczematoid breast lesion

red, scaly, or vesicular rash affecting the nipple and areola
± itchiness, nipple changes

A

Paget’s disease of breast

72
Q

MC kind of breast cancer:

A

Infiltrative Ductal Carcinoma

73
Q

Erythema, skin edema, and tender breast
± LAD & skin dimpling

A

Inflammatory breast cancer
(Very bad)

74
Q

Breast mass in a female < 30:
Breast mass in a female > 30:

A

< 30: → U/S
> 30: → Mammogram

75
Q

Breast Cancer Screening Guidelines on NBME

A

Mammogram
≥40 y.o. every 1-2 years

76
Q

To determine metastatic potential for a breast malignancy, what is the initial dx test that is performed?

A

Sentinal LN biopsy

→ If negative, done.

77
Q

Sentinal LN biopsy (+) ve, what is your NBSIM?

A

axillary LN dissection

78
Q

Chronic bloody bowel movements ± Recurrent epistaxis
Small vascular malformations visible on the buccal mucosa (mouth, lips) or skin. Dx?

A

Hereditary Hemorrhagic Telangiectasia
(osler-weber-rendu syndrome)

autosomal dominant

79
Q

SUPER HY
Pts presents 3 months (or even days after) after a AAA repair with Hgb of 7.
dx?

A

Aorto-enteric fistula
→ aorta has a fistula to the GI tract directly

80
Q

72 F with a Hb 8.
(+) FOBT
+Ejection murmur radiating to the carotids is heard on auscultation.
Diagnosis?

A

Colonic angiodysplasia (Heyde syndrome)

(Aortic Stenosis murmur + GI bleeding = Heyde)
Calcified valves rip VWF which impairs 1º hemostasis

81
Q

69M with a history of PAD
3 mo hx of of severe LLQ pain worsened with meals
+ Weight-loss
Dx?

A

Chronic mesenteric ischemia
(weight loss due to refusal to eat from pain)

*can also be Chronic Ischemic Colitis

82
Q

69M with a history of PAD ± A-FIB
3 day hx of of severe LLQ pain worsened with meals
+ painful, Bloody diarrhea
Dx?

A

Acute Ischemic colitis

not painful bloody poo → Diverticular bleed

83
Q

Painless, massive bloody bowel movement in a 65 (old) yo F
Dx?

A

Diverticulosis

84
Q

Watery diarrhea, hypokalemia, and achlorhydria:
dx/tx?

A

VIPomas ( ↓ gastric acid, ↓ Cl & ↓ K)
WDHA syndrome (pooping out electrolytes)
Tx: Octreotide

85
Q

Ulcers in unusual small bowel locations (jejunum) :
Dx/Tx?

A

Gastrinoma
(Zollinger Ellison Syndrome)
Tx: PPI

86
Q

Episodic headache and HTN with elevated metanephrines:
Dx/Tx?

A

Pheochromacytoma
First Alpha Adrenergic Antagonist
(Phenoxybenazine, Phentolamine)
Second Beta blocker (Labetalol)

Before surgical resection to prevent HTN crisis s/t unopposed adrenergic stimulation from metanephrines causing mass vasoconstriction

87
Q

Trouble smiling on one side of the face
upper and lower face affected
± Prodrome of ear pain
Dx/Tx?

A

Bell’s Palsy
High-dose glucocorticoids

Facial Nerve sheath inflammation (CN 7) s/t reactivation of neurotrophic viruses (herpes simplex virus)

88
Q

37M cyclist has been unable to train for the past 4 days due to leg weakness.
Recent sore throat & rhinorrhea that resolved 10 days ago w/o tx.
Dx:
Tx:
Drug to avoid:
Respiratory monitoring:

A

Guillain-Barré syndrome
Plasmapheresis
Steroids CONTRAINDICATED
Check FEV1 frequently (for Respiratory Failure)

89
Q

51M with a 6 mo hx of numbness and paresthesias in his L foot radiating to L great toe

Dx: ____ nerve injury.

A

Tibial nerve injury

(aka tarsal tunel syndrome)

90
Q

Weakness in “finger spread”
Nerve affected?

A

Ulnar nerve
(interosseous muscle not working)

91
Q

Flattening of the thenar eminence, sensory loss on the ventral (palm) surface of the lateral hand.
Nerve affected/dx?

A

Carpal tunnel syndrome
median nerve

92
Q

Lateral thigh numbness in a basketball player who has required R thigh casting for a sports related injury.
Nerve affected/ dx?

A

Lateral Femoral Cutaneous Nerve
Neuralgia parastetica

93
Q

Painless, intermittently palpable groin mass in an infant:

A

Indirect inguinal hernia

94
Q

Most common kind of hernia in females:
Classically Located ____ the Inguinal ligament
Complications of hernia?

A

Females → Femoral hernia
Location → UNDER Inguinal ligament
Incarceration → emergent surgery

95
Q

Down’s syndrome + failure to pass meconium:
Dx testing:
Associated mutation:

A

Hirschsprung Disease
Rectal Suction Biopsy
RET mutation
─
Failed migration of neuro-crest cells to myenteric plexus cell in the distal colon. No plexi will be seen on bx.

96
Q

Newborn with abdominal viscera to the right of the umbilicus vs through the umbilicus?
Which one is worse?

A

Right of umbilicus → Gastroschesis
(not sealed so bowel can dry out)
Through umbilicus: →Omphalocele
(is sealed in peritoneum bag so bowel wont dry out)
Omphalocele→associated with more congenital defects

97
Q

3 month old + Projectile non-bilious vomiting 30 mins after feeding + Visible peristaltic waves
Dx/Dxt/NBSIM/Tx?

A

Pyloric Stenosis
Ultrasound of abdomen
NBSIM: Correct any electrolyte abnormalities
Tx: Pylo-myotomy

98
Q

NBSIM for BILIOUS vomiting in an infant?

List 4 causes

A

Upper GI Series

Duodenal Atresia
Jejunal Atresia
Biliary Atresia
Midgut Volvulus (malrotation)

99
Q

3M with a painless scrotal mass that transilluminates (fluid) with a pen light.
Dx/Pathophysiology?

A

Hydrocele
Persistent Patency of Procesus Vaginalis

100
Q

Mononeuritis Multiplex classic symptom:
What diagnosis is it found in?

A

Wrist orFoot Drop
Eosinophilic Granulomatosis with Polyangiitis
aka Churg-Strauss

(Small vessel vasculitis)

101
Q

mcc of sepsis in ppl with no spleen (or SCD)

A

Streptooccus Pneumoniae

102
Q

Dysphagia/Hoarse voice post thyroidectomy

A

Dmg to Recurrent Laryngeal Nerve

103
Q

Duodenal Atresia associated with (2)

A

Down Syndrome
VACTERAL

104
Q

Multiple Myeloma Treatment drug

A

Bortezomib
(proteasome inhibitor)

Step 2 (55 decks)

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