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HY Review #1 Part 2 Flashcards

1
Q

Blunt flank or kidney trauma, NBSIM?
1st obtain a(n) _____
if (+) _____
if (–) _____

A

1st → UA
If (+) blood → CT A/P with contrast
If (no) blood → send home

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2
Q

Pain, redness, and swelling behind the L ear.
dx/NBSIM/tx?

A

Acute Mastoiditis
• CT head/temporal bone
CTX (or Levofloxacin)
─
infection from middle ear to mastoid air cells

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3
Q

Recurrent episodes of acute otitis media.
PE reveals non-specific debris behind the tympanic membrane.
(+) chronic, foul smelling discharge from the affected ear.
Dx:
NBSIM:
Tx:
Cx?

A

Cholesteatoma (keratin ball)
CT Head
Surgery
─
bc it damages ossicles → conductive hearing loss

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4
Q

35 M with hx of NF2 presents with a 3 month hx of of progressively worsening morning headaches.
Head CT shows a calcified mass with an enhancing linear projection connected to the dura.
Dx?

FYI: NF2 → (vestibular schwannoma + early onset cataracts)

A

Meningioma
(dural tail described in vignette)

(+ Psammoma bodies → concentric, intracellular calcium swirls)
Neuro sxs based on structures compressed

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5
Q

32F smoker with chest pain worse at night.
Coronary angiography done for past for ST elevations showed <30% occlusion of coronary vessels.
Dx/Tx?

A

Variant Angina (Prinzemetal)
Smoking cessation+ Any CCB

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6
Q

Pt presents after having a TIA
on NBME, what treatment is indicated if,
◆ Pt has h/o A-Fib or a recent MI?
◆ Pt has Atherosclerotic risk factors (3)?

A

Cardioembolic → Warfarin (anti-Coagulant)
Atherosclerotic → Aspirin (anti-Platelet)

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7
Q

Pt with mechanical or bioprosthetic valves in place presents with TIA or Stroke.
Aside from NC-CT Head what other diagnostic work-up is appropriate?

A

Echocardiography (TEE)

To evaluate for Prosthetic valve thrombosis (PVT)

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8
Q

Down syndrome associated oncologic malignancy

A

ALL
(children)

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9
Q

WBC of 400 in a 23F on antithyroid therapy.
Most likely cause?

A

Agranulocytosis
s/t PTU/MMZ

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10
Q

Management of post op hyperglycemia.

A

Basal Bolus insulin regimen
──
◆Basal → long acting (Glargine or Detemir)
◆Bolus w/ meals → rapid-acting (Lispro, Aspart, or Glulycine)

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11
Q

BRF for Multifocal Atrial Tachycardia

A

Smoking

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12
Q

Tx for post MI pericarditis?

A

Aspirin only

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13
Q

Loud diastolic heart sound (after S2, before S1)
Neck veins distend more on inspiration (Kussmaul Sign)
Prominent JVP waves on inspiration
Dx/Tx?

A

Kussmaul Sign = Constrictive Pericarditis (END OF STORY)
Pericardiectomy
Calcified pericardium

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14
Q

12F with Migratory Joint pain and
painless nodules under the skin
↑ ESR/CRP
URI 12 months ago.
Dx/Tx?

A

Rheumatic Fever
NSAIDs + Penicillin
─
Group A Strept infection
(URI + Migratory joint pain = rheumatic fever)

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15
Q

DOC in chronic SLE mgt (+ preventive screening).

A

Hydroxychloroquine
Annual Eye exams bc retinal damage from the med

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16
Q

Arthritis, fever, and pleuritic chest pain after starting hydralazine/isoniazid
Dx?

A

Drug-Induced Lupus (anti-Histone antibodies)

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17
Q

Drug-Induced Lupus
(anti-Histone antibodies)

commonly involved drugs (4)

A

Hydralazine
Isoniazid
Procainamide
TMP-SMX

(other causes: sulfonamides, Etanercept, Isoniazid, Phenytoin)

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18
Q

young person having trouble swallowing solids and liquids
Dx/ NBSIM (3 steps)/ Definitive tx?

A

Achalasia
NBSIM: Barium Swallow (BME)

THEN
Manometry → EGD + Biopsy (to r/o cancer)

Definitive tx: Myotomy

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19
Q

Acute onset of severe first MTP tenderness (toe), redness, and warmth in a patient being treated for CML
Dx:
Drug triggers:
Antihypertensive of choice:
Acute tx (3 step up tx)
Acute tx with a Cr of 2.5:
Chronic tx:

A

Gout (s/t Tumor Lysis Syndrome)
─
Drug triggers: loops & thiazides
─
Anti- HTN: Losartan (ARB)
─
Acute tx: NSAID → Steroid → Colchicine
Naproxen, Indomethacin, ibuprofen
PO Prednisone
Colchicine c/i if gastric ulcers
─
Acute tx with a Cr of 2.5: Steroid
─
Chronic tx: Allopurinol or Febuxostat or Rasburicase

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20
Q

30F Always tired, hurts everywhere, multiple points of tenderness around the body. Normal ESR & CK.
dx/tx?

A

Fibromyalgia
Pre-gabalin, Gabapentin
Duloxetine/Milnacipram (SNRIs)
TCAs

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21
Q

23M presents in the summer with a 1 year history of hematuria that is more pronounced when he wakes up in the morning.
He occasionally has severe penile and ear pain that responds poorly to naproxen.
Flow cytometry reveals red cells that are negative for GPI anchored proteins.
CBC: ↓↓ Hgb, ↓ PLTs, ↓ WBCs
↑↑↑ Reticulocytosis
─
In addition to Eculizumab therapy, what is the
NBSIM?
Diagnosis? Mutation? Complications?

A

PNH (paroxysymal Nocturnal Hemoglobinuria)
Vaccination against Neisseria Meningitidis.
Cx: Recurrent infections with Neisseria
─ ─ ─
s/t sporadic mutation in PIG-A gene (anogram for GPI-Anchor).
Lack GPI anchors (CD59, GP1) so MAC kills RBCs

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22
Q

Person with UNILATERAL HA + IPSILATERAL eye-findings
dx/Acute & Chronic tx?

A

Cluster Headache
Acute TX: O2 therapy
Chronic Tx: VERAPAMIL or DILTIAZEM (for ppx)

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23
Q

How is severe ophthalmopathy s/t hyperthyroidism treated?

A

Steroids
─
Fibroblast have TSH receptors creating glycosaminoglycans in the eyes/body

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24
Q

Hashimotos (Hypothyroidism)
anti-__& anti-__
antibodies

A

Anti-TPO
Anti-Tgb
(thyroglobulin)

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25
immunocompromised pt with malaise + dyspnea CXR shows diffuse, **ground glass** , interstitial infiltrates. PaO2 is 57 (hypoxic) Dx/Tx?
Pneumocystis Jirovecii (Interstitial PNA) **TMP-SMX + STEROIDS** (bc PaO2 is less than 70 they NEED a steroid for inflammation)
26
In an immunocompromised individual (HIV, TNF inhibitor, immunosuppression, etc) when are steroids indicated for respiratory distress?
when PaO2 is less than 70 they NEED a steroid for inflammation
27
Female about to beginning valproic acid therapy, what is the next best step in the management of this patient?
Get Urine pregnancy test Valproate is a Teratogen
28
Dyspnea after surgery + normal PCWP + High CVP Diagnosis?
ARDS (Increased permeability of pulmonary vasculature) PCWP is wnl (so it’s non-cariogenic) CVP: 3–6 mm Hg PCWP: 4-15 mm Hg
29
Pleural effusions caused by anything that increases hydrostatic pressure or causes loss of protein in urine (CHF, Cirrhosis, Nephrotic syndrome)
Transudative effusion (Easier to remember than Light’s criteria)
30
Lights criteria is 3 rules you only need to satisfy 2 to answer NBME Qs. Pleural protein/Serum Protein < __ & Pleural LDH/serum LDH <__ ─ ─ ─ If both rules are satisfied it is a _____ effusion If one rule is *not* met it is _____ effusion
• Protein < 0.5 • LDH < 0.6 Both rules met → transudative effusion One rule broken → not transudative (exudative) FYI: Pleural LDH < 187 (aka < 2/3 upper limit of normal for serum LDH which is ~280) is the 3rd rule
31
Cloudy or straw-colored pleural fluid suggests ___ effusion
exudative effusion (protein rich)
32
**Pleural** Glucose that is **60 or more** mg/dL suggests ___ effusion
transudative effusion
33
55M with trouble climbing stairs & shampooing his hair. Has fallen multiple times & has trouble playing the piano. PE: Asymmetric weakness Hands, UE, & LE Creatine kinase is 7x the upper limit of normal. Dx?
Inclusion body myositis Proximal & Distal muscle weakness myopathy
34
3 mo with Fever + periumbilical cellulitis Umbilical stump was surgically removed 7 days prior b/c of **delayed umbilical cord separation**. WBCs >30k Dx/Cx? Defect?
Leukocyte adhesion deficiency **Recurrent Dental Infections** ─ **Integrin** defect: • Siadyl Lewis X • CD18 • LFA-1 MAC1
35
2 NBME diseases associated with recurrent dental infections: (HY)
Leukocyte Adhesion Deficiency Chediak-Higashi
36
Recurrent infections, **Albino** (silvery hair/ fair skin and frequently has sunburns), **GIANT granules** in WBC, (all you need to know) Diagnosis? MCC Infection:
Chediak-Higashi Staph. A **Lysosomal transport** defect (**Chediaki Highway** defect)
37
Severe abdominal pain and lip edema after initiating antihypertensive therapy in a 25F. She has had similar episodes in the past. Father died of respiratory failure & had similar sxs. Dx/Contraindications? Deficiency?
**Hereditary angioedema** Avoid: **ACE-I** s/t **C1 esterase inhibitor deficiency** (AD) Makes too much Bradykinin (adverse drug rxn)
38
Pt has recurrent episodes of **meningococcal meningitis**/ Strept PNA infections. Dx:?
C5-C9 terminal complement defect FYI (Drug): **Eculizumab** (inhibits C5 protein) can mimic this disorder
39
7 mo boy has no thymic shadow on a newborn CXR, his initial postpartum period was complicated by multiple seizures and runs of VTach that required Ca repletion. Dx/Tx? CATCH 22 →
Digeorge (Chrm 22q11 disorder) Tx: **IVIg** & BM transplant + ABs ppx CATCH 22 → Cardiac problems, Abnormal face, Thymic aplasia, **Cleft palate**, Hypocalcemia, Chrm 22. ─ ─ **3rd & 4th pharyngeal pouches** do not form → **No parathyroid glands** = ↓ **PTH** & ↓ **Ca** = Hypocalcemic seizures & V-tach → No thymus = recurrent infections
40
1 mo with Failure to Thrive + Recurrent viral/fungal (Oral Thrush) & bacterial infections **since birth** CXR: absent thymic shadow Dx: Temporary & Definitive Tx: Deficiency:
**SCID** Temp tx: **IvIg** Definitive tx: Bone Marrow Transplant Adenosine deaminase deficiency (AR)
41
6 mo boy with recurrent bacterial infections (pneumonia, otitis media) and **tonsillar hypoplasia** **All immunoglobulins are decreased** Dx/Tx?
Brutons Agammaglobinemia (XLR) Tx: IvIg
42
Brutons Agammaglobinemia (XLR) Presents at 3-6m when ____ levels fall. Mutation?
maternal IgG BTK (B-cell Tyrosine Kinase) defect Hypoplastic Tonsils
43
22 yo Caucasian F presents to the ED with a 3 day h/o productive cough, SOB, and high fevers. Hx of recurrent infections (bacterial PNAs) & Celiac's **Reduced levels of IgG, IgA, IgM levels** Dx/Tx? Most important complications of this disorder (2)?
**CVID** (recurrent infections in young adult/teens) Tx: IvIg Cx: Auto-immune diseases > Lymphoma
44
Recurrent P. Jirovecii infections in a 7 mo boy with **reduced levels of all immunoglobulins** *Except* **IgM** Dx/Tx? Deficiency?
Hyper IgM syndrome (XLR) Tx: IvIg CD40-Ligand deficiency
45
Neonate with low IgG, IgA, IgM levels → Infant (3m+) with low IgG, IgA, IgM levels → Young adult with low IgG, IgA, IgM levels → Infant with low IgG, IgA, but *not* IgM →
SCID Brutons Agammaglobinemia (XLR) CVID Hyper IgM Syndrome (XLR)
46
Child with Recurrent infections with encapsulated organisms (otitis media) Purpura/Petechiae/ ↓ PLTs Eczema (skin rash) Dx/Tx?
Wiskott-Aldrich syndrome (XLR) IvIg
47
Recurrent pyogenic infections +Peripheral neuropathy + Albinism Peripheral smear shows **giant cytoplasmic granules** in granulocytes dx/tx?
Chediak-Higashi syndrome **Bone Marrow Transplant** microtubule polymerization dysfunction
48
Child with Recurrent, severe infections with catalase-positive organisms (S. aureus, Nocardia spp., E. coli, Candida, Klebsiella, Pseudomonas, Aspergillus, Serratia) Lymphadenopathy Granulomas/Abscesses of the skin **High levels of Immunoglobulins** dx/tx?
Chronic granulomatous disease (XLR) **IFN-γ therapy** ─ Life-long ppx: TMP-SMX BM Transplant
49
Infant/Child with Recurrent nonsuppurative bacterial infections (skin and mucosal infections) Delayed separation of the umbilical cord (> 30 days postpartum) Marked Leukocytosis Dx?
Leukocyte adhesion deficiency type 1 (LAD1)
50
R knee pain that is worse with **passive** extension of the knee. The knee is swollen and warm with overlying erythema. Dx: Dx testing: Tx:
Septic Arthritis Arthrocentisis Vancomycin (MRSA is mcc)
51
Sexually active young F with skin petechiae + R knee pain (swollen and red) Negative gram stain of fluid. Dx?
Nisseria Gonnorrhea
52
Electromyography (EMG) diagnosis associated with **low** amplitude, **short** duration, **polyphasic** motor unit potentials:
Myopathy
53
EMG diagnosis with **fibrillation** potentials
ALS
54
Proximal shoulder/hip weakness + **nl/slightly ↑** CK EMG is usually normal. In a 22F on chronic therapy for severe, persistent asthma.
Steroid Myopathy s/t muscle breakdown from Prednisone (can also be s/t hypercortisolism)
55
45 yo M with a history of ulcerative colitis presents with a 6 month history of pruritus and worsening jaundice. dx/tx
Primary Sclerosing Cholangitis (assoc with IBD/Auto-immune dz) **Liver Transplant**
56
Primary Sclerosing Cholangitis ANA association U/S findings (HY)
P-ANCA INTRA & EXTRA HEPATIC ducts are **both** affected
57
45F with a 6 month history of intense pruritus. CMP is notable for conjugated hyperbilirubinemia. dx/tx?
Primary Biliary Colangitis Ursodiol (Ursodeoxycholic Acid) → transplant liver
58
Primary Biliary Colangitis ANA association U/S findings (HY)
anti-mitochondrial antibodies Only the INTRA HEPATIC bile ducts are affected
59
5 yo F presents with a 6 week history of weight loss and fever. CBC is notable for pancytopenia. Cytologic studies reveal TDT (+)ve cells. PE is notable for diffuse cervical lymphadenopathy Dx?
Child + Lymphoma = **ALL**
60
ALL → Down Syndrome ALL & CLL → Lymphadenopathy CML & CLL → Lekocytosis AML → ____ (No lymphadenopathy, No leukocytosis, No splenomegaly)
DIC
61
55 yo M is on chemotherapy for a hematologic malignancy. Plt count is 40K Low, D-dimers are elevated, he is bleeding from every IV Site dx/tx?
**AML** = middle age + lymphoma + DIC All Trans Retinoic Acid
62
AML translocation Finding on blood smear?
15:17 Translocation → Auer Rod on smear triggers coagulation cascade
63
CML translocation
9:22 Philadelphia Chromosome → BCR-ABL (Imatinib/Disatinib)
64
On USMLE: _____: Marked leukocytosis OR normal WBC count + (↓ Hgb & ↓ PLTs) _____: Normal CBC + B-sxs + Lympadenopathy
Leukemia Lymphoma
65
65M with pancytopenia. A peripheral smear reveals teardrop shaped RBCs dx?
primary myelofibrosis (Dacrocyte = tear drop) → s/t collagenous bone marrow (Dry Tap)
66
45 yo Caucasian F presenting with worsening epigastric pain and vomiting. She was diagnosed with H.Pylori gastritis 3 mo ago and completed triple therapy. EGD with this admission is notable for persistent gastric ulcers and a large posterior **antral ulcer with raised edges**. dx/Dxt/tx?
Dx: Maltoma aka MALT-Lymphoma (gastric tumor s/t H. Pylori infection) Dxt: EGD + Biopsy (Germinal Centers) Tx: H. Pylori eradication therapy Test of cure: Urea Breath test
67
**Eosinophilia** + **wrist or  foot drop** dx/tx? ─ ± Heart problems, Asthma
Churge Strauss (Eosinophilic GPA) Steroids + Cyclophosphamide
68
P-Anca + MPO Abs dx?
Churge Strauss (Eosinophilic GPA) Steroids + Cyclophosphamide
69
C-Anca + against Proteinase 3 (anti PR3) dx/tx?
Wegener’s (GPA) tx: Steroids + Cyclophosphamide
70
Upper respiratory problems (Nose/throat/eye) Lung problems Eye problems (Conjuctivitis) and Kidney dz RPGN (nephritis) dx/tx?
Wegener’s (GPA) Steroids + Cyclophosphamide
71
Middle age woman + Abdominal pain + Neuropathy (burning/ tingling of extremity) → segmental aneurysm of arteries (String of beads) on Angiography dx/tx? HY association?
Polyarteritis Nodosum (PAN) Antivirals (if s/t HBV) or Steroids HY association → **HBV** infection
72
Asian F + absent pulses = dx/dxt/tx(2)?
Takayasu arteritis MR Angiography High dose Glucocorticoid + MTX
73
Palpable Crepitus of skin lesion Dx/Bug?
Nec. Fasciitis C. Perfringes (Gas Gangrene)
74
65F with Fever + L thigh is swollen and exquisitely tender muscle. Exam notable for **red and purple** splotches on the L thigh. Disproportionate level of pain ± CK high Dx/Tx? Bug pattern:
**Necrotizing Fasciitis** (aka **myonecrosis**) (Old + Fever + Muscle pain + Purple/Red lesions) ─── Debride (surgery) + IV Antibiotics (**Clindamycin**) ─── Polymicrobial (Areobes/ Anaerobes)
75
Skin complication associated with SGLT-2 Inhibitors?
Forneir’s gangrene → Nec fasciitis in ass/groin It ↑ urinary glucose excretion hence making the perineum a warm, sugary place bacteria will thrive in.
76
66 F presents with Right **shoulder pain** for the past 1 week. +Pain over L shin. PE is notable for a palpable “step-off” on the left shoulder. Vitals wnl. Labs show ↓ Hb, Hct, PLTs ↑ Creatinine, Calcium Dx/NBSIM/Tx?
Multiple Myeloma Spep/Upep Bortezomib ─── >60 OLD + ↑ Calcium High + Renal problems + Anemia + Bone pain = CRAB symptoms = MM) SPEP → **Raloux** formation (RBCs stacked) Tx: proteasome inhibitor
77
65M 40 year smoking hx CXR: spiculated cavitary lesion in the L upper lung lobe. Bronchoscopy + biopsy: Dysplastic, undifferentiated, (+) keratin cells CT A/P & Head + PET imaging is negative Dx/NBSIM?
Squamous cell lung cancer → Resection get **Preoperative PFTs** **FEV1> 1L** before surgical lung resection ─── NBME Tip: Before cutting out a piece of their shitty lungs make sure FEV1 >1L
78
Obese patient + snoring + Fatigue + HTN Dx/NBSIM/Tx?
OSA Polysomnography C-PAP
79
In **OSA** (HTN + Obese+ Snorer) ─── Chronic ___ retainers s/t poor ____ Chronic metabolic derangement? Compensation? ─── OSA causes Hypoxia which constricts pulmonary vessels. __ EPO __ CVP & __ PCWP
Chronic CO2 retainers s/t poor Ventilation Chronic respiratory acidosis + **compensated metabolic alkalosis** ──── ↑ EPO ↑ CVP Normal PCWP
80
Name the diagnosis: * **Atypical T cells** on a blood smear. * B Cells with Reed Sternberg morphologies. * Hypersegmented neutrophils * **CD5+ B** lymphocytes with weakened cell membranes. * Epithelial cells with **intranuclear inclusions**
* EBV/Mono → young person dz * Hodgkin’s → teens or middle age dz * B12 folate deficiency * CLL → smudge cells + OLD ppl dz * CMV
81
Middle age woman + Abdominal pain + Neuropathy (burning/ tingling of extremity) Segmental aneurysm (String of beads) on Angiography Dx/Dxt(2)? Spared organ:
Polyarteritis Nodosum (PAN) ─ Angiography & Biopsy ─ **Lungs** spared
82
25 y.o. AA female with 6 mo hx of dyspnea and dry cough. + Pertinent Labs: ↑ LDH, Calcium, Vit D & **ACE** Dx/Tx (if symptomatic)
Sarcoidosis if SYMPTOMATIC give oral **steroids** ── Non-caseating granulomas + Macrophages expressing **excess 1 alpha hydroxylate** making excess Vit D and reabsorbing too much enteric calcium
83
↑ Na+ ↑ serum Osm ↓ urine Osm Dx/Tx?
Diabetes Insipidus (Excessively peeing out Free water) **First give NS** Central → Desmopressin Nephrogenic→ Thiazide Diuretic
84
Sarcoidosis + violet colored cheek, nose, ear, lesions:
Lupus Pernio Bad Prognosis (Malar rash)
85
Female in her 30s with neuron deficits that come and go + sudden eye pain w/ movement and vision loss dx/dxt/tx for eye sxs?
Optic Neuritis (s/t MS) MRI Brain IV Steroids Optho emergency → permanent blindness
86
Female in her 30s with neuron deficits that come and go with R eye nystagmus when looking Right + Left eye is not adducting towards Right side dx/lesion?
Intra-nuclear Ophthalmoplegia (s/t MS) lesion → Left MLF Lesion is ipsilateral to the eye that is not adducting (can be bilateral too tho)
87
Female in her 30s with neuron deficits that come and go dx/dxt (2)/chronic tx (2) & exacerbation tx?
Multiple Sclerosis MRI brain + spine → periventricular plaques CSF analysis → Oligoclonal bands Ch tx: Interferon Beta (IFN- ꞵ) or **Glatiramer** Exacerbation tx: IV Steroids
88
Vitamin Supplementation needed in Multiple Sclerosis?
Vitamin D
89
Which illness is treated with IFN ꞵ IFN 𝛼 IFN ɣ
IFN ꞵ → Multiple Sclerosis IFN 𝛼 → Hep C IFN ɣ → Chronic Granulomatous Dz (immune d/o)
90
Budd Chiari Syndrome (aka Hepatic vein thrombosis) can be caused by (2) Manifestations → **Tender hepatomegaly**, Ascites, Abd distention ± Jaundice
Polycythemia Vera (s/t thrombosis of Hepatic Vein) PNH
91
22 M in a MVA 2 hrs ago. Now in the ER with mild SOB, ↓ PaO2 and b/l pulmonary interstitial infiltrates.
pulmonary contusion s/t blunt force trauma to chest/lungs (Recent Impact trauma + infiltrates on CXR = pulm contusion)
92
22 M in a MVA 2 hrs ago. Now in the ER with mild SOB, Chest pain, normal lungs/heart on CXR dx/Mgt?
Myocardial contusion s/t blunt force cardiac injury Place on Telemetry/Cardiac Monitoring Monitor EKG + Troponin
93
Pt admitted for Myocardial contusion & placed on telemetry/continuous cardiac monitoring EKG &/or Troponin are worsening a few hours later NBSIM?
Cardiac Surgery
94
Pt becomes comatose and has blown pupils. They recently received continuous insulin therapy for A glucose of 907. Dx/Pathophys?
Cerebral edema s/t fast correction of hyperglycemia
95
Mcc of death in pts presenting with DKA or HHS
Cerebral edema s/t fast correction of glucose
96
DKA vs HHNS bicarb differences
DKA ↓ Bicarb (<20) HHS ↑/nl Bicarb (>20)
97
Diagnosis & **Treatment** for the following disease permutations? **Serum** Osmolality & **Urine** Osmolality * ↓ & ↓ * ↓ & ↑ * ↑ & ↓
**Serum** Osmolality & **Urine** Osmolality * ↓ & ↓ Psychogenic Polydipsia → Fluid Restriction * ↓ & ↑ SIADH (↓Na)→ Fluid Restriction * ↑ & ↓ Diabetes Insipidus (↑Na) → Central or Nephro CDI → Desmopressin (ADH analog) NDI → Thiazide diuretic
98
Sarcoidosis + tender, erythematous nodules on the shins
Erythema Nodosum
99
21F presents with 2 weeks of fatigue and malaise + **painful** cervical Lymphadenopathy + Splenomegaly LN biopsy → paracortical zone hyperplasia. dx/potential cx?
EBV Burkitts lymphoma (8:14) Nasopharyngeal carcinoma (south china)
100
A leukemia 9:22 translocation. A lymphoma 15:17 translocation. A leukemia 12:21 translocation. A lymphoma 8:14 translocation. A leukemia 2:14 translocation.
9:22 → CML 15:17 → AML 12:21 → ALL 8:14 → Burkitt's 2:14 → CLL
101
Per the NBME, what kind of drug is used for **breast cancer chemoprophylaxis** in women < 50 yo vs > 50 yo
Less than 50 → Tamoxifen (E2 antagonist in breast) Older than 50 → Anastrozole, Letrozole (aromatase inhibitor)
102
Tamoxifen vs Raloxifen MOA?
**Tamoxifen** → E2 antagonist in breast & E2 **agonist** in uterus → ↑ risk of endometrial cancer → Used for breast cancer ppx **Raloxifene** → E2 antagonist in breast/uterus & E2 **agonist** in bone → ↑ risk of hypercoagulation cx → post-menopause osteoporosis therapy
103
How are HER2+ breast malignancies treated? How is this drug toxicity compared to daunorubicin/doxorubicin?
Trastuzumab (HER2+) → **Reversible** Dilated Cardiomyopathy ── Daunorubicin/Doxorubicin → **Irreversible** Dilated cardiomyopathy which can be prevent with **Dexerazoxane**
104
How is BPH treated acutely? long term?
**Prazosin, Tamsulosin** (alpha blocker) ── **Finasteride, Dutasteride** (5-𝛼 reductase Inhibitor) to ↓ DHT ── if all fails surgery (**Trans Urethral Prostate Resection**)
105
53F + firm, non tender mass in the anterolateral neck + low grade fevers, 6 months + unintended weight loss. Tissue biopsy → CD15/30+ B cells Dx/ ↑survival factor?
Hodgkins Lymphoma (CD15/30+) Increased survival in patients with: * Large numbers of lymphoid cells w/in tumor stroma * **Lymphocyte predominant** lymphoma
106
65F is complaining of tingling in her upper and lower extremities but has now progressed to having multiple “blackout” episodes over the last few hours. EKG → Flat T waves + U waves in multiple leads. CBC → Hypocalcemia & Hypokalemia Aggressive efforts are made to replete these electrolytes with no improvement in symptoms. Why?
Low magnesium kidney transporter that reabsorb Ca2+ & K+ do not work w/o Mg
107
3 causes of Nephrogenic Diabetes Insipidus
Hypercalcemia Lithium Demeclocycline
108
44M rarely goes to doctor presents with HTN, hematuria, and mildly ↑ AST/ALT (Kidney & Liver problems) (+) FMH sudden death of father at 49yo s/t neuro cause. Dx?/List 2 possible cc for this pt.
**ADPKD** +Cyst in the liver and kidneys → Flank pain & hematuria + Aneurysm in circle of willis → SAH (worst HA ever) + Mitral Valve Prolapse
109
Nephrotic syndrome cause ___ loss leading to a **hypercoagulable** state.
Antithrombin 3
110
15M w/ leg swelling & cloudy urine dx/tx/EM findings?
Minimal Change Dz tx: Steroids EM: Podocyte effacement

Step 2 (55 decks)

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