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Step 2 > HY Review #1 Part 2 > Flashcards

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
Q

immunocompromised pt with malaise + dyspnea
CXR shows diffuse, ground glass , interstitial infiltrates.
PaO2 is 57 (hypoxic)
Dx/Tx?

A

Pneumocystis Jirovecii (Interstitial PNA)
TMP-SMX + STEROIDS

(bc PaO2 is less than 70 they NEED a steroid for inflammation)

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26
Q

In an immunocompromised individual
(HIV, TNF inhibitor, immunosuppression, etc)
when are steroids indicated for respiratory distress?

A

when PaO2 is less than 70
they NEED a steroid for inflammation

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27
Q

Female about to beginning valproic acid therapy, what is the next best step in the management of this patient?

A

Get Urine pregnancy test
Valproate is a Teratogen

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28
Q

Dyspnea after surgery + normal PCWP + High CVP
Diagnosis?

A

ARDS (Increased permeability of pulmonary vasculature)
PCWP is wnl (so it’s non-cariogenic)

CVP: 3–6 mm Hg
PCWP: 4-15 mm Hg

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29
Q

Pleural effusions caused by anything that increases hydrostatic pressure or causes loss of protein in urine
(CHF, Cirrhosis, Nephrotic syndrome)

A

Transudative effusion

(Easier to remember than Light’s criteria)

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30
Q

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

A

• 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

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31
Q

Cloudy or straw-colored pleural fluid suggests ___ effusion

A

exudative effusion
(protein rich)

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32
Q

Pleural Glucose that is 60 or more mg/dL suggests ___ effusion

A

transudative effusion

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33
Q

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?

A

Inclusion body myositis
Proximal & Distal muscle weakness myopathy

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34
Q

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?

A

Leukocyte adhesion deficiency
Recurrent Dental Infections
─
Integrin defect:
• Siadyl Lewis X
•CD18
• LFA-1
MAC1

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35
Q

2 NBME diseases associated with recurrent dental infections: (HY)

A

Leukocyte Adhesion Deficiency
Chediak-Higashi

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36
Q

Recurrent infections, Albino (silvery hair/ fair skin and frequently has sunburns), GIANT granules in WBC,

(all you need to know) Diagnosis?
MCC Infection:

A

Chediak-Higashi
Staph. A
Lysosomal transport defect

(Chediaki Highway defect)

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37
Q

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?

A

Hereditary angioedema
Avoid: ACE-I
s/t C1 esterase inhibitor deficiency (AD)
Makes too much Bradykinin (adverse drug rxn)

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38
Q

Pt has recurrent episodes of meningococcal meningitis/ Strept PNA infections.
Dx:?

A

C5-C9 terminal complement defect

FYI (Drug): Eculizumab (inhibits C5 protein) can mimic this disorder

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39
Q

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 →

A

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

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40
Q

1 mo with Failure to Thrive + Recurrent viral/fungal (Oral Thrush) & bacterial infections since birth
CXR: absent thymic shadow
Dx:
Temporary & Definitive Tx:
Deficiency:

A

SCID
Temp tx: IvIg
Definitive tx: Bone Marrow Transplant
Adenosine deaminase deficiency (AR)

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41
Q

6 mo boy with recurrent bacterial infections (pneumonia, otitis media)
and tonsillar hypoplasia
All immunoglobulins are decreased
Dx/Tx?

A

Brutons Agammaglobinemia (XLR)
Tx: IvIg

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42
Q

Brutons Agammaglobinemia (XLR)
Presents at 3-6m when ____ levels fall.
Mutation?

A

maternal IgG
BTK (B-cell Tyrosine Kinase) defect
Hypoplastic Tonsils

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43
Q

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)?

A

CVID (recurrent infections in young adult/teens)
Tx: IvIg
Cx: Auto-immune diseases > Lymphoma

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44
Q

Recurrent P. Jirovecii infections in a 7 mo boy with
reduced levels of all immunoglobulins
Except IgM
Dx/Tx? Deficiency?

A

Hyper IgM syndrome (XLR)
Tx: IvIg
CD40-Ligand deficiency

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45
Q

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 →

A

SCID
Brutons Agammaglobinemia (XLR)
CVID
Hyper IgM Syndrome (XLR)

46
Q

Child with Recurrent infections with encapsulated organisms (otitis media)
Purpura/Petechiae/ ↓ PLTs
Eczema (skin rash)
Dx/Tx?

A

Wiskott-Aldrich syndrome (XLR)
IvIg

47
Q

Recurrent pyogenic infections +Peripheral neuropathy + Albinism
Peripheral smear shows giant cytoplasmic granules in granulocytes
dx/tx?

A

Chediak-Higashi syndrome
Bone Marrow Transplant

microtubule polymerization dysfunction

48
Q

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?

A

Chronic granulomatous disease (XLR)
IFN-γ therapy
─
Life-long ppx: TMP-SMX
BM Transplant

49
Q

Infant/Child with Recurrent nonsuppurative bacterial infections (skin and mucosal infections)
Delayed separation of the umbilical cord (> 30 days postpartum)
Marked Leukocytosis
Dx?

A

Leukocyte adhesion deficiency type 1 (LAD1)

50
Q

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:

A

Septic Arthritis
Arthrocentisis
Vancomycin (MRSA is mcc)

51
Q

Sexually active young F with skin petechiae + R knee pain (swollen and red) Negative gram stain of fluid.
Dx?

A

Nisseria Gonnorrhea

52
Q

Electromyography (EMG) diagnosis associated with
low amplitude, short duration, polyphasic motor unit potentials:

A

Myopathy

53
Q

EMG diagnosis with fibrillation potentials

A

ALS

54
Q

Proximal shoulder/hip weakness + nl/slightly ↑ CK
EMG is usually normal.
In a 22F on chronic therapy for severe, persistent asthma.

A

Steroid Myopathy
s/t muscle breakdown from Prednisone
(can also be s/t hypercortisolism)

55
Q

45 yo M with a history of ulcerative colitis presents with a 6 month history of pruritus and worsening jaundice.
dx/tx

A

Primary Sclerosing Cholangitis
(assoc with IBD/Auto-immune dz)
Liver Transplant

56
Q

Primary Sclerosing Cholangitis
ANA association
U/S findings (HY)

A

P-ANCA
INTRA & EXTRA HEPATIC ducts are both affected

57
Q

45F with a 6 month history of intense pruritus. CMP is notable for conjugated hyperbilirubinemia.
dx/tx?

A

Primary Biliary Colangitis
Ursodiol (Ursodeoxycholic Acid) → transplant liver

58
Q

Primary Biliary Colangitis
ANA association
U/S findings (HY)

A

anti-mitochondrial antibodies
Only the INTRA HEPATIC bile ducts are affected

59
Q

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?

A

Child + Lymphoma = ALL

60
Q

ALL → Down Syndrome
ALL & CLL → Lymphadenopathy
CML & CLL → Lekocytosis
AML → ____ (No lymphadenopathy, No leukocytosis, No splenomegaly)

A

DIC

61
Q

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?

A

AML = middle age + lymphoma + DIC
All Trans Retinoic Acid

62
Q

AML translocation
Finding on blood smear?

A

15:17 Translocation → Auer Rod on smear triggers coagulation cascade

63
Q

CML translocation

A

9:22 Philadelphia Chromosome → BCR-ABL (Imatinib/Disatinib)

64
Q

On USMLE:
_____: Marked leukocytosis OR normal WBC count + (↓ Hgb & ↓ PLTs)
_____: Normal CBC + B-sxs + Lympadenopathy

A

Leukemia
Lymphoma

65
Q

65M with pancytopenia. A peripheral smear reveals teardrop shaped RBCs
dx?

A

primary myelofibrosis

(Dacrocyte = tear drop) → s/t collagenous bone marrow (Dry Tap)

66
Q

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?

A

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
Q

Eosinophilia + wrist or foot drop
dx/tx?
─
± Heart problems, Asthma

A

Churge Strauss (Eosinophilic GPA)
Steroids + Cyclophosphamide

68
Q

P-Anca + MPO Abs
dx?

A

Churge Strauss (Eosinophilic GPA)
Steroids + Cyclophosphamide

69
Q

C-Anca + against Proteinase 3 (anti PR3)
dx/tx?

A

Wegener’s (GPA)

tx: Steroids + Cyclophosphamide

70
Q

Upper respiratory problems (Nose/throat/eye)
Lung problems
Eye problems (Conjuctivitis)
and Kidney dz RPGN (nephritis)
dx/tx?

A

Wegener’s (GPA)
Steroids + Cyclophosphamide

71
Q

Middle age woman + Abdominal pain + Neuropathy (burning/ tingling of extremity) → segmental aneurysm of arteries (String of beads) on Angiography
dx/tx?
HY association?

A

Polyarteritis Nodosum (PAN)
Antivirals (if s/t HBV) or Steroids

HY association → HBV infection

72
Q

Asian F + absent pulses =
dx/dxt/tx(2)?

A

Takayasu arteritis
MR Angiography
High dose Glucocorticoid
+ MTX

73
Q

Palpable Crepitus of skin lesion
Dx/Bug?

A

Nec. Fasciitis
C. Perfringes
(Gas Gangrene)

74
Q

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:

A

Necrotizing Fasciitis (aka myonecrosis)
(Old + Fever + Muscle pain + Purple/Red lesions)
───
Debride (surgery) + IV Antibiotics (Clindamycin)
───
Polymicrobial (Areobes/ Anaerobes)

75
Q

Skin complication associated with SGLT-2 Inhibitors?

A

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
Q

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?

A

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
Q

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?

A

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
Q

Obese patient + snoring + Fatigue + HTN
Dx/NBSIM/Tx?

A

OSA
Polysomnography
C-PAP

79
Q

In OSA (HTN + Obese+ Snorer)
───
Chronic ___ retainers s/t poor ____
Chronic metabolic derangement?
Compensation?
───
OSA causes Hypoxia which constricts pulmonary vessels.
__ EPO
__ CVP & __ PCWP

A

Chronic CO2 retainers s/t poor Ventilation
Chronic respiratory acidosis + compensated metabolic alkalosis
────
↑ EPO
↑ CVP
Normal PCWP

80
Q

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

A
  • EBV/Mono → young person dz
  • Hodgkin’s → teens or middle age dz
  • B12 folate deficiency
  • CLL → smudge cells + OLD ppl dz
  • CMV
81
Q

Middle age woman + Abdominal pain
+ Neuropathy (burning/ tingling of extremity)
Segmental aneurysm (String of beads) on Angiography
Dx/Dxt(2)?
Spared organ:

A

Polyarteritis Nodosum (PAN)
─
Angiography & Biopsy
─
Lungs spared

82
Q

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)

A

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
Q

↑ Na+
↑ serum Osm
↓ urine Osm
Dx/Tx?

A

Diabetes Insipidus (Excessively peeing out Free water)
First give NS
Central → Desmopressin
Nephrogenic→ Thiazide Diuretic

84
Q

Sarcoidosis + violet colored cheek, nose, ear, lesions:

A

Lupus Pernio
Bad Prognosis
(Malar rash)

85
Q

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?

A

Optic Neuritis (s/t MS)
MRI Brain
IV Steroids

Optho emergency → permanent blindness

86
Q

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?

A

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
Q

Female in her 30s with neuron deficits that come and go
dx/dxt (2)/chronic tx (2) & exacerbation tx?

A

Multiple Sclerosis
MRI brain + spine → periventricular plaques
CSF analysis → Oligoclonal bands
Ch tx: Interferon Beta (IFN- ꞵ) or Glatiramer
Exacerbation tx: IV Steroids

88
Q

Vitamin Supplementation needed in Multiple Sclerosis?

A

Vitamin D

89
Q

Which illness is treated with
IFN ꞵ
IFN 𝛼
IFN ɣ

A

IFN ꞵ → Multiple Sclerosis

IFN 𝛼 → Hep C

IFN ɣ → Chronic Granulomatous Dz (immune d/o)

90
Q

Budd Chiari Syndrome (aka Hepatic vein thrombosis)
can be caused by (2)

Manifestations → Tender hepatomegaly, Ascites, Abd distention ± Jaundice

A

Polycythemia Vera (s/t thrombosis of Hepatic Vein)
PNH

91
Q

22 M in a MVA 2 hrs ago. Now in the ER with
mild SOB, ↓ PaO2 and b/l pulmonary interstitial infiltrates.

A

pulmonary contusion
s/t blunt force trauma to chest/lungs

(Recent Impact trauma + infiltrates on CXR = pulm contusion)

92
Q

22 M in a MVA 2 hrs ago. Now in the ER with
mild SOB, Chest pain, normal lungs/heart on CXR
dx/Mgt?

A

Myocardial contusion
s/t blunt force cardiac injury
Place on Telemetry/Cardiac Monitoring
Monitor EKG + Troponin

93
Q

Pt admitted for Myocardial contusion & placed on telemetry/continuous cardiac monitoring
EKG &/or Troponin are worsening a few hours later
NBSIM?

A

Cardiac Surgery

94
Q

Pt becomes comatose and has blown pupils.

They recently received continuous insulin therapy for A glucose of 907.

Dx/Pathophys?

A

Cerebral edema
s/t fast correction of hyperglycemia

95
Q

Mcc of death in pts presenting with DKA or HHS

A

Cerebral edema
s/t fast correction of glucose

96
Q

DKA vs HHNS bicarb differences

A

DKA ↓ Bicarb (<20)

HHS ↑/nl Bicarb (>20)

97
Q

Diagnosis & Treatment for the following disease permutations?

Serum Osmolality & Urine Osmolality
* ↓ & ↓
* ↓ & ↑
* ↑ & ↓

A

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
Q

Sarcoidosis + tender, erythematous nodules on the shins

A

Erythema Nodosum

99
Q

21F presents with 2 weeks of fatigue and malaise
+ painful cervical Lymphadenopathy
+ Splenomegaly
LN biopsy → paracortical zone hyperplasia.
dx/potential cx?

A

EBV
Burkitts lymphoma (8:14)
Nasopharyngeal carcinoma (south china)

100
Q

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.

A

9:22 → CML
15:17 → AML
12:21 → ALL
8:14 → Burkitt’s
2:14 → CLL

101
Q

Per the NBME, what kind of drug is used for
breast cancer chemoprophylaxis in women
< 50 yo
vs
> 50 yo

A

Less than 50 → Tamoxifen (E2 antagonist in breast)
Older than 50 → Anastrozole, Letrozole (aromatase inhibitor)

102
Q

Tamoxifen vs Raloxifen
MOA?

A

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
Q

How are HER2+ breast malignancies treated?
How is this drug toxicity compared to daunorubicin/doxorubicin?

A

Trastuzumab (HER2+) → Reversible Dilated Cardiomyopathy
──

Daunorubicin/Doxorubicin → Irreversible Dilated cardiomyopathy which can be prevent with Dexerazoxane

104
Q

How is BPH treated
acutely?
long term?

A

Prazosin, Tamsulosin (alpha blocker)
──
Finasteride, Dutasteride (5-𝛼 reductase Inhibitor)
to ↓ DHT
──
if all fails surgery (Trans Urethral Prostate Resection)

105
Q

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?

A

Hodgkins Lymphoma (CD15/30+)

Increased survival in patients with:
* Large numbers of lymphoid cells w/in tumor stroma
* Lymphocyte predominant lymphoma

106
Q

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?

A

Low magnesium

kidney transporter that reabsorb Ca2+ & K+ do not work w/o Mg

107
Q

3 causes of Nephrogenic Diabetes Insipidus

A

Hypercalcemia
Lithium
Demeclocycline

108
Q

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.

A

ADPKD
+Cyst in the liver and kidneys → Flank pain & hematuria
+ Aneurysm in circle of willis → SAH (worst HA ever)
+ Mitral Valve Prolapse

109
Q

Nephrotic syndrome cause ___ loss leading to a hypercoagulable state.

A

Antithrombin 3

110
Q

15M w/ leg swelling & cloudy urine
dx/tx/EM findings?

A

Minimal Change Dz
tx: Steroids
EM: Podocyte effacement

Step 2 (55 decks)

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