HY Review #1 Part 2 Flashcards
Blunt flank or kidney trauma, NBSIM?
1st obtain a(n) _____
if (+) _____
if (–) _____
1st → UA
If (+) blood → CT A/P with contrast
If (no) blood → send home
Pain, redness, and swelling behind the L ear.
dx/NBSIM/tx?
Acute Mastoiditis
• CT head/temporal bone
CTX (or Levofloxacin)
─
infection from middle ear to mastoid air cells
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?
Cholesteatoma (keratin ball)
CT Head
Surgery
─
bc it damages ossicles → conductive hearing loss
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)
Meningioma
(dural tail described in vignette)
(+ Psammoma bodies → concentric, intracellular calcium swirls)
Neuro sxs based on structures compressed
32F smoker with chest pain worse at night.
Coronary angiography done for past for ST elevations showed <30% occlusion of coronary vessels.
Dx/Tx?
Variant Angina (Prinzemetal)
Smoking cessation+ Any CCB
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)?
Cardioembolic → Warfarin (anti-Coagulant)
Atherosclerotic → Aspirin (anti-Platelet)
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?
Echocardiography (TEE)
To evaluate for Prosthetic valve thrombosis (PVT)
Down syndrome associated oncologic malignancy
ALL
(children)
WBC of 400 in a 23F on antithyroid therapy.
Most likely cause?
Agranulocytosis
s/t PTU/MMZ
Management of post op hyperglycemia.
Basal Bolus insulin regimen
──
◆Basal → long acting (Glargine or Detemir)
◆Bolus w/ meals → rapid-acting (Lispro, Aspart, or Glulycine)
BRF for Multifocal Atrial Tachycardia
Smoking
Tx for post MI pericarditis?
Aspirin only
Loud diastolic heart sound (after S2, before S1)
Neck veins distend more on inspiration (Kussmaul Sign)
Prominent JVP waves on inspiration
Dx/Tx?
Kussmaul Sign = Constrictive Pericarditis (END OF STORY)
Pericardiectomy
Calcified pericardium
12F with Migratory Joint pain and
painless nodules under the skin
↑ ESR/CRP
URI 12 months ago.
Dx/Tx?
Rheumatic Fever
NSAIDs + Penicillin
─
Group A Strept infection
(URI + Migratory joint pain = rheumatic fever)
DOC in chronic SLE mgt (+ preventive screening).
Hydroxychloroquine
Annual Eye exams bc retinal damage from the med
Arthritis, fever, and pleuritic chest pain after starting hydralazine/isoniazid
Dx?
Drug-Induced Lupus (anti-Histone antibodies)
Drug-Induced Lupus
(anti-Histone antibodies)
commonly involved drugs (4)
Hydralazine
Isoniazid
Procainamide
TMP-SMX
(other causes: sulfonamides, Etanercept, Isoniazid, Phenytoin)
young person having trouble swallowing solids and liquids
Dx/ NBSIM (3 steps)/ Definitive tx?
Achalasia
NBSIM: Barium Swallow (BME)
THEN
Manometry → EGD + Biopsy (to r/o cancer)
Definitive tx: Myotomy
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:
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
30F Always tired, hurts everywhere, multiple points of tenderness around the body. Normal ESR & CK.
dx/tx?
Fibromyalgia
Pre-gabalin, Gabapentin
Duloxetine/Milnacipram (SNRIs)
TCAs
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?
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
Person with UNILATERAL HA + IPSILATERAL eye-findings
dx/Acute & Chronic tx?
Cluster Headache
Acute TX: O2 therapy
Chronic Tx: VERAPAMIL or DILTIAZEM (for ppx)
How is severe ophthalmopathy s/t hyperthyroidism treated?
Steroids
─
Fibroblast have TSH receptors creating glycosaminoglycans in the eyes/body
Hashimotos (Hypothyroidism)
anti-__& anti-__
antibodies
Anti-TPO
Anti-Tgb
(thyroglobulin)
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)
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
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
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
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)
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
Cloudy or straw-colored pleural fluid suggests ___ effusion
exudative effusion
(protein rich)
Pleural Glucose that is 60 or more mg/dL suggests ___ effusion
transudative effusion
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
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
2 NBME diseases associated with recurrent dental infections: (HY)
Leukocyte Adhesion Deficiency
Chediak-Higashi
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)
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)
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
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
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)
6 mo boy with recurrent bacterial infections (pneumonia, otitis media)
and tonsillar hypoplasia
All immunoglobulins are decreased
Dx/Tx?
Brutons Agammaglobinemia (XLR)
Tx: IvIg
Brutons Agammaglobinemia (XLR)
Presents at 3-6m when ____ levels fall.
Mutation?
maternal IgG
BTK (B-cell Tyrosine Kinase) defect
Hypoplastic Tonsils
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
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