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HY Review #2 Flashcards

1
Q

Epigastric pain radiating to the back
Dx/ATx/ChTx?

A

acute pancreatitis

Acute
1st Normal Saline
NSAIDs → Hydromorphone
NGT → Start early Oral feeding as soon as tolerated

Chronic
Insulin (likely has DM)
Pancreo-lipase (pancreatic enzyme replacement therapy)

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2
Q

Imaging finding in Pancreatitis

A

Calcifications in Pancreas

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3
Q

Bad prognostic factors in pancreatitis?
(3)

A

Very High Wbc (>16k)
Low Hb
Hypocalcemia

Indicate → Hemorrhagic Pancreatitis

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4
Q

HTN that has remained poorly responsive to amlodipine, HCTZ, and prazosin therapy.
Labs are notable for: K 2.9L, Bicarb 29H, and Na 139.
Dx/Tx?

A

Conn Syndrome
(Primary hyperaldosteronism s/t adrenal adenoma)

Tx based if unilateral or bilateral
Unilateral ↑ Aldosterone on adrenal vein sampling: → unilateral adrenalectomy

Bilateral → MR antagonist (Spironolactone/Eplerenone)

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5
Q

In Primary hyperaldosteronism (s/t adrenal adenoma)
Renin levels: ___
Angiotensin 1 and 2 levels: ___
PAC/PRA: ___
Response to saline infusion: ___

A

↓ Renin
↓ Ang I & II
↑ >30 (High Aldo/Low Renin = High ratio)

Saline will not suppress aldosterone levels (Diagnostic)

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6
Q

BP is 250/140 with AMS.
NBSIM?

A

HTN emergency
Clevidipine, Nicardipine, Nitroprusside, Labetalol, or
Phentolamine (alpha 1 blocker)

(HTN urgency = no end organ dmg. same tx)

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7
Q

SBO + air in the wall of the biliary tree (Pneumobilia)
Dx/Tx?

A

Gallstone illeus
Entero-lithotomy (incise terminal illeum)

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8
Q

Hypodense hepatic mass with peripheral enhancement (Halo) on arterial phase and centripetal filling on delayed phases.
Dx/NBSIM?

A

Hepatic hemangioma

Liver finding that YOU DO NOT TOUCH

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9
Q

Stellate scar on liver seen abdominal CT
Dx/NBSIM?

A

Focal nodular hyperplasia
DO NOT TOUCH MASS

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10
Q

Heterogeneous enhancement in Liver on CT.
Dx/NBSIM?

A

Hepatic adenoma
Avoid Estrogen containing contraceptives
DO NOT TOUCH

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11
Q

Animal/Human Bite wound
NBSIM?

A

Debride (clean)
Amoxicillin

→ DO NOT stitch closed bc anaerobes present
→allow to heal via secondary intention

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12
Q

MCCOD in refeeding syndrome?

A

HYPOPHOSPHATEMIA

(causes cardiac problems)

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13
Q

RUQ pain, direct hyperbilirubinemia & scleral icterus (jaundiced).
No fever
Dx/NBSIM/Tx (2)?

A

Choledocolithiasis
RUQ abd U/S
If CBD dilated → ERCP → Cholecystectomy

(stone obstructs bile duct trapping bilirubin → jaundice)

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14
Q

RUQ pain, direct hyperbilirubinemia (jaundiced) & FEVER
± AMS & Hypotension
Dx/Tx (2)?

A

Acute Cholangitis
ERCP (diagnostic and therapeutic ) + Ceftriaxone

(Ascending biliary tract infection)

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15
Q

RUQ pain and FEVER
Winces upon deep palpation of the RUQ.
Labs: ↑ wbcs, mild↑AST/ALT
normal bilirubin, ALP/GGT
Dx/Tx?

A

Acute Cholecystitis
RUQ U/S
Cholecystectomy

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16
Q

pt with 30 pack year smoking history with rapidly developing digital clubbing and diffuse joint pain
Dx/NBSIM?

A

Hypertrophic Pulmonary Osteoarthropathy
Chest CT (r/o likely lung cancer; paraneoplastic)

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17
Q

Small Cell Lung Cancer Paraneoplastic Complications:
SIADH causes ____.
Lambert Eaton Myasthenia Syndrome ____.
Bonus: can also cause ____

A

SIADH → Hyponatremic seizures

LEMS → Proximal muscle weakness
(Difficulty combing hair/raising from chair)

Hypercortisolism (Cushing’s Syndrome)

auto anti-bodies against PRE synaptic voltage gated Ca channels

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18
Q

Facial swelling, headaches, and bilateral JVD
Dx/Tx?

A

SVC syndrome
EMERGENT RADIOTHERAPY

(SVC external compression from tumor)

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19
Q

2 mm L sided pupils with a droopy eyelid and L sided hand (or shoulder) pain.
Dx s/t ___

A

Horner Syndrome
s/t Pancoast Tumor ( aka Superior Sulcus Tumor)

Tumor compresses cervical sympathetic chain

TIP: Always check the apical lung tumor in smokers CXR

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20
Q

NBSIM in lung nodule seen on CXR

A

Chest CT

(don’t bother with the old CXR)

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21
Q

How to biopsy Central Lung lesions:

A

Endobronchial ultrasound + biopsy
or
Mediastinoscopy + biopsy

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22
Q

How to biopsy Peripheral Lung lesions?

A

percutaneous CT guided biopsy

(if lesion on the outer edge)

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23
Q

Pt with lung nodule on CXR and pleural effusion
NBSIM?

A

Thoracentesis (w/ cytology)

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24
Q

Where to insert needle when doing a
1. Thoracentesis
2. Nerve Block

A
  1. ABOVE the rib to avoid intercostal bundle under the rib
  2. BELOW the rib to reach the intercostal bundle
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25
Q

Pt has thickened lung pleura and/or hemorrhagic pleural effusions
Dx?

A

Mesothelioma
(cancer of pleura)

(+) Psammoma bodies
(concentric, lamellated microscopic calcifications)

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26
Q

Squamous Cell Lung Cancer treatement?

A

Chemotherapy only

(all other lung cancers can have any treatment)

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27
Q

Major determinant of successful TB tx?

A

Medication Adherence

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28
Q

Pt presents with (+) TB skin test, but negative chest X-ray.

NBSIM?

A

Latent TB
Isoniazid + Vit B6 (9m)

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29
Q

Asymptomatic patient with INR of 9 on Warfarin
NBSIM?

A

prothrombin complex concentrate (PCC)
± oral vitamin K

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30
Q

Pt presents with abdominal pain
Takes chronic Warfarin
Labs: ↓ Hgb 9 & INR 9
Dx?

A

Intra-abdominal hematoma

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31
Q

65M with 6 mo history of progressively worsening dyspnea, dry cough, and bibasilar fine crackles heard on lung auscultation.
Dx/NBSIM?

A

Idopathic pulmonary fibrosis
High Resolution CT Chest

(on NBME: Fine crackles = Fibrotic lung disease)

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32
Q

60M with 1 week h/o of blurry vision and severe headache. PE shows splenomegaly and markedly swollen/tender hand & feet joints with overlying erythema.
Labs: ↓↓↓ Hgb (6.5), ↑↑↑ Plts (900k), ↓↓ WBC (1.2K)
Dx/Tx(2)?

A

Essential Thrombocytosis
Platelet-pharesis + Aspirin

(JAK 2 mutation; hypercoagulable)

– Only one cell line is absurdly high, while all others are low → think myeloproliferative d/o

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33
Q

60M 3 week of worsening pruritus (not improved with diphenhydramine) & worse when showering.
PE shows flushed/roddy pt & spelnomegaly
Labs: ↑↑↑ Hct (70%)
Dx/Tx?

A

Polycythemia Vera (PV)
Phlebotomy

In PV: ↓EPO b/c negative feedback from ↑Hct
(vs paraneoplastic 2º polycythemia where EPO is incr.)

Myeloproliferative d/o + JAK 2 mutation
• PV
• Essential Thrombocythemia
• Myelofribrosis (dry tap/teardrop rbcs)

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34
Q

List 2 common causes of Budd Chiari Syndrome on NBMEs

A

Polycythemia Vera
PNH
(Paroxysmal Nocturnal Hemoglobinuria)

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35
Q

Intermittent & fatigable proximal muscle weakness
(initial evaluation may be normal bc comes & goes)
worsens with repetitive/prolonged motions
improves with rest
± ocular/oral sxs
Dx/Tx

A

Myastenia Gravis
Pyridostigmine (AChE inhibitors)

Auto-ABs to postsynaptic acetylcholine receptors of NMJ

Myasthenic crisis → exacerbation leads to respiratory failure
tx: serial spirometry + IVIg or plasma exchange

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36
Q

Elderly pt presents with Fever + acute LLQ abd pain + change in bowel movements.
Leukocytosis
Dx/NBSIM/Tx(2)?

A

Diverticulitis
CT A/P
Peritoneal sxs → Colectomy sigmoid
Conservative (bowel rest & analgesia)
or FQ+Metronidazole

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37
Q

Elderly pt presents with acute LLQ abd pain & bloody diarrhea
low-grade fever + mild Leukocytosis
Recent hx of MI or A-fib
Dx/tx (3)?

A

Ischemic Colitis

(supportive care + Abxs + anticoagulation)

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38
Q

Opioid adverse side effects include (3):
Miosis (Constricted pupils)
Sedation (AMS)
Hypotension

A

Constipation
Bradycardia
Depressed respiratory drive

Mnemonic: MS. CBD

Normal rate of Respiration: 12 –16 bpm

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39
Q

Elderly woman presents with painless gross hematuria.
UA significant for many RBCs pHpf.
Cytoscopy reveals bladder mass
Dx/BRF?

A

Transitional cell carcinoma of the Bladder

(mc urinary tract tumor)
presents with painless gross hematuria
BRFs: Smoking, cyclophosphamide &
aniline dyes
(to dye fabric, leather, and wood. Rubber manufacturing)

40
Q

Pelvic unstable s/p MVC
Ecchymosis over the pelvis and scrotum
Blood at the urethral meatus
NBSIM?

A

Retrograde Urethrography
Urethral Injury
━
Urethral injury diagnosis is confirmed via retrograde urethrography before bladder decompression via supra-pubic catheter
(if complete urethral injury) ± surgery.

41
Q

Pelvic unstable s/p MVC
Gross hematuria
no blood at urethral meatus
Dx & Confirmatory test?

A

Cystography is used to evaluate suspected
Bladder rupture

42
Q

Compare Myasthenia Gravis to Lambert Eaton
ABs to what?
Repetitive use causes?

A

MG:
* Fatiguable muscle weakness worse at end of day
*muscle strength worsens with increased use & improves w/ rest
* Antibodies to postsynaptic ACh Receptors → impaired acetylcholine release in the NMJ
─
LE:
*Proximal muscle weakness
* muscle strength improves with repetitive or ongoing use
*Autoantibodies to presynaptic voltage-gated calcium channels → impaired acetylcholine release in the NMJ

43
Q

RUQ abdominal pain +

  1. No Fever + Jaundice (↑ Bilirubin)
  2. Fever + Jaundice (↑ Bilirubin)
  3. No Fever + No Jaundice (nl Bilirubin)
  4. Fever + No Jaundice (nl Bilirubin)

NBSIM → RUQ abdominal U/S

A
  1. Choledocolithiasis → ± ERCP & Cholecystectomy
  2. Acute Cholangitis → ERCP
  3. Cholelithiasis → schedule elective Lap-Chole
  4. Acute Cholecystitis → Cholecystectomy
44
Q

25M with Psych sxs (Depression, Dementia, etc)
Found to have Hepatomegaly & ↑ LFTs
↓ serum ceruloplasmin
± parkinsonism
Dx/Tx?

A

Wilson disease (HepatoLenticular degeneration)
Penicillamine (chelating agent)

Impaired copper excretion → copper accumulates & deposits in the liver, brain, & eyes

good prognosis if found/treated early

Kayser-Fleischer rings: brown copper deposits near iris & ↑ urinary copper excretion

45
Q

87M war-vet
6m, Dyspnea
Lung bx → brown dumb bells (ferruginous bodies)
dx/PFT pattern?

A

Asbestosis
–Osis = Restrictive Lung Disease
F:F ↑/–
(↑F1 & ↓Fc)
A-a: ↑
↓ lung residual volume
↓ complaince =↑ elastance

46
Q

Pt w/ well controlled history of Asthma
receives treatment for acute MI in ED
Has now developed shortness of breath
Why?

A

s/t Beta Blocker for MI in Asthmatic

Not s/t Aspirin bc pt doesn’t have nasal polyps or h/o worsening asthma with NSAIDs.
─
Generally try to avoid beta blockers in asthmatics, but this was an MI so risk/benefit.

47
Q

35F with 8m h/o SOB now worsening
+ R heart strain
+ High Pulm Artery pressures
dx/tx (3)?

A

Idiopathic pulmonary HTN
Bosentan, Ambrisentan (endothelin receptor antagonist)
Sildenafil (PDE inhibitor)
───
s/t BMPR2 mutation
Excess smooth muscle proliferation in arteries

48
Q

49M presenting for erectile dysfunction
MEDS: Prazosin, Metformin, Lisinopril
NBSIM?

A

avoid Sildenafil (PDE inhibitor)
which is usually tx for ED
BUT this pt is on Prazosin (Vasodilator)
both these drugs combined will tank BP

49
Q

33F presents with severe bleeding from her nose. Started after she tried to “clean out” her nose.
PMH: severe allergies (on fexofenadine)
Dx:
BRF:
Immediate NBSIM:
Most common type:

What if pt also had Hemoptysis/Significant hemorrhage:

Despite initial measures, the patient’s nose continues to bleed profusely. NBSIM?

A

Epistaxis
BRF: nose picking
Tx: Apply pressure to the nose
MC Type: Anterior nose bleed from Kissel-bach plexus

Hemoptysis present: Posterior nose bleed

Persistent bleeding → Electrocautery

50
Q

Potential nasal packing complication:
Genetic cause causing recurrent nose bleeds:

A

Toxic shock syndrome (s/t nasal packing)

Hereditary hemorrhagic telangiectasia (AD)
(aka Osler-Weber-Rendu syndrome)

51
Q

Hereditary hemorrhagic telangiectasia (AD)
(aka Osler-Weber-Rendu syndrome)
HY Cardiovascular complication/mechanism?

A

High-Output Heart Failure

AV malformations result in limited capillaries for gas exchange → tissue hypoxia → triggers ↑ cardiac output → chronically this results in HOHF

52
Q

44M w/ PNA develops
Polyuria, Polydipsia, dry mucus membranes
Hyponatremia
Hyperglycemic (>600)
Dx/Tx (specify 1st & 2nd step)

A

HHS
(Hyperosmolar Hyperglycemic State)
Step 1→ Normal Saline
Step 2 → Insulin infusion

53
Q

K+ regimen rules in HHS
(K+ range → 3.5 – 5.0)
Group 1:
Group 2:
Group 3:

A

< 3.3 → give K+ & NS (No insulin)

3.3 – 5.5 → give K+, NS, & Insulin

> 5.5 → give NS & Insulin (No K+)

54
Q

Per the NBME, how can DM be diagnosed?
Method 1
Method 2:
Method 3:
Method 4:
Can DM be diagnosed on the basis of 1 test result?

A

*Fasting BGL > 125
* A1c > 6.5%
* Oral Glucose Tolerance Test + BGL > 199 (Most Sensitive)
* Polyuria & Polydipsia + BGL > 199

No, Diagnosis requires repeat testing on a another day
(except for A1c test)

55
Q

Per the NBME, how can T1DM be differentiated from
early T2DM by way of C-peptide levels?

A

T↓DM = ↓ C-peptide
T2DM = ↑ C-peptide
────
(↑ bc making lots of insulin that’s being resisted)

56
Q

Macrovascular complications of DM: (4)
Microvascular complications of DM: (3)
────
Best method for reducing the microvascular cx of DM?

A

Macro → MI, PE, DVT, Stroke
Micro → Neuropathy, Retinopathy, Nephropathy
────
↓ Micro Cx → Tight Glycemic control

57
Q

What kind of DM has the strongest genetic concordance?
Strongest predictor of progression to diabetic nephropathy ?
Screening in T1DM vs T2DM?
How
When
Frequency
Management of diabetic nephropathy?

A

Genetic → T2DM
Predictor → Microalbuminuria
Urine albumin to creatinine ratio (>30 = albuminuria)
T1DM Urine alb:cr → 5 years after dx
T2DM Urine alb:cr → at the time of dx
For both screen → Annually
Tx → ACE-I/ ARBs

58
Q

MCC of ESRD in the US:

A

T2DM

59
Q

32M with a h/o T1DM
3 week h/o of numbness in his bilateral feet.
Shake his feet a few times to feel better.
Dx:
Tx, if painful:
Screening guideline in T1DM:
Screening guideline in T2DM:
Screening intervals:

Collapsed midfoot arch on foot XR:

A

Diabetic neuropathy
Tx: Pregabalin, Gabapentin, TCA, SNRIs (Duloxetine)
──
T1DM: → screen 5 years after dx
T2DM: →screen at the time of dx
Screen Annually
──
Collapsed midfoot arch: →Charcot joint s/t neuropathy
(Flat foot & Mal-aligned)

60
Q

T2DM patient develops a foot ulcer.
A sterile probe through the ulcer goes all the way to bone.
Dx/Bugs?

A

Osteomyelitis
Polymicrobes

61
Q

51M h/o poorly controlled DM with a 6 mo hx of impaired vision.
Dx:
Screening guideline in T1DM:
Screening guideline in T2DM:
Screening intervals:

A

DM retinopathy
T1DM: → screen 5 years after dx
Screening guideline in T2DM: → screen at time of dx
Screening intervals: Yearly

62
Q

What is the MC complication of DM?

A

DM Neuropathy

63
Q

A diabetic male goes to ophthalmologist for preventive screening.
What is the most likely dx given fundoscopic exam findings?
Cotton wool spots:
Neo-vascularization:
Tx for Neo-vascularization:

A

Cotton wool spots →Non-proliferative retinopathy
Neo-Vasc → Proliferative retinopathy
Tx for Neo-Vasc → Laser photocoagulation

(never use VEG-F inhibitors on test)

64
Q

Sudden onset, painless vision loss in a diabetic:

A

Retinal detachment

65
Q

Abdominal pain radiating from the mid back in a band like distribution:

A

Thoracic Poly-radiculopathy

66
Q

Tx for difficulty maintaining a steady erection:

A

Sildenafil

67
Q

55M h/o poorly controlled T2DM
3 mo hx of N/V and a “fullness” after small meals.
Abdominal imaging reveals no evidence of obstruction.
Dx:
Tx (2):

A

Gastric Paresis (Stomach Neuropathy)
Metoclopramide (D2 blocker- EPS effects)
Erythromycin (Motilin agonist)

68
Q

What kind of diabetic should get a statin?

A

> 40 yo

69
Q

Contraindications to using Hb-A1c test?

A

Hemolytic anemia
(rbcs don’t live long)

70
Q

First line tx for T2DM:
Contraindications to this Med:

A

Weight loss + Metformin

Contraindications: Liver or Kidney disease

(if getting contrast for imaging hold metformin)

71
Q

DM drugs and their side effects
Highest risk of hypoglycemia:
Weight gain:
Weight loss:
Flatulence and diarrhea:

A

Hypoglycemia→sulfonylureas (-rides)
Weight gain → sulfonylureas
Weight loss → SGLT2-I (-ozins) & GLP-1 agonist (liraglutide, Exenatide, -tides)
Flatulence and diarrhea → 𝛼- glucosidase inhibitors
(Acarbose, Miglitol)

72
Q

DM drugs and their side effects
Contraindicated in ischemic cardiomyopathy:
Necrotizing fasciitis of the perineum:
UTIs:
Bicarb of 4 (from lactic acidosis):

A

c/i in cardiomyopathy → TZDs (-glitizones cause fluid retention)
Nec fasc of perineum → SGLT2-I
UTIs: → SGLT2-I
Lactic acidosis → Metformin

73
Q

DM drugs and their mechanisms of action
K channel blocker:
Decreases hepatic gluconeogenesis:
PPAR ɣ activators (↑ glucose uptake):

A

K channel blocker → Sulfonylureas
↓Gluconeogenesis → Metformin
PPAR ɣ → Thiazolidinedione

74
Q

History of MEN2A/B Contraindicated Diabetes Medications?
(2)

A

GLP-1 agonist (–tides)
DPP4 inhibitors (–gliptins)

75
Q

Autoantibodies in T1DM (3)

A

anti-Glutamate Decarboxylase (GAD)
Anti-Insulin
Anti-Islet polypeptide

76
Q

No Question. Just look at it.

A

Now look at this

77
Q

Epidemiology Mnemonic for
Primary Biliary Cirrhosis
vs
Primary Sclerosing Cholangitis

A

PBC → Ursodiol & anti-mitochondrial antibodies (AMA)
Intrahepatic bile duct affected

PSC → Liver Transplant & P-Anca
Extrahepatic + Intrahepatic bile duct affected
Confirm dx → MRCP/ERCP

78
Q

Butterfly rash beneath the nose/lower lip that worsens with sun exposure + chronic joint pain.
────
Dx/Tx:
Rapid ↑ Cr NBSIM:
────
Hb is 8 & + Coombs test:

A

SLE
Hydroxychloroquine
Renal Biopsy (Lupus nephritis)
────
Auto-immune Hemolytic Anemia
(T2HSR s/t ABs against own blood)

79
Q

33F with 3 day h/o dyspnea and abdominal pain.
s/p Cardiac Transplant 8 weeks ago for sarcoidosis
PE → JVD + S3
Labs & EKG normal
Dx/NBSIM?

A

Clearly, the something is wrong with her new heart
She got it 2m ago and now it is not working (heart failure)

Dx: Acute Rejection → Biopsy heart (Echo guided)
(less than year)

80
Q

Perioral cyanosis + normal SaO2?
dx/tx (3)/drugs causing this (3)?
BRF?

A

Methemoglobinemia (drug induced)
* TMP-SMX
* Nitrates (for MI/Chest pain) → BRF
* Dapsone (for leprosy or dermatitis herpetiformis)

Methylene blue + vit C + Cimetidine (H2 blocker)

81
Q

What is the biggest RF for ARDS?

What is the biggest RF for DIC?

BRF Vit K deficiency in hospitalized pt (bleeding gums/nose)?

A

Sepsis
Sepsis
Broad-spectrum ABX

82
Q

BRF bladder CA (transitional cell carcinoma)

BRF for squamous cell bladder cancer

A

Smoking

Schistosoma haematobium

83
Q

What’s the BRF Budd Chiari
s/t hepatic vein thrombosis

A

Polycythemia vera

(PNH is a cause, but not BRF. Other causes are hyper-coagulable states)

84
Q

Renal Cell Carcinoma
Paraneoplastic syndrome →
Can cause →
Histology →
Most likely mets →
Most important predictor of prognosis →

A

Paraneoplastic→ EPO ↑ Hct
Causes → L varicocele
Histology → clear cells
Mets → lungs
Pprognosis = renal vein involvement to systemic circulation

85
Q

OSA (obstructive sleep apnea) BRF by age
Kid →
Adults →

A

Kid → adenotonsillar hypertrophy
Adults → obesity

86
Q

MCC of CAH = 21 Hydroxylase deficiency
HY overall Lab finding

__ Aldosterone (associated 3 labs?)
__ Cortisol = (associated symptom?)
__ DHEA
*Girls → ____
* Boys → ____

A

↑ ↑ 17 Hydroxy Progesterone

↓ Aldosterone
(hyponatremia, hyperkalemia, met acidosis)
—-
↓ Cortisol
(Hyperpigmentation s/t ↑ MSH/ACTH)
—–
↑ ↑ DHEA
Girl → Virilized
Boys → Super boys (peripheral precocious puberty)

87
Q

Mirena IUD (Progestin)
thickens cervical mucus
c/i (2)

A

Breast cancer hx
STI <6m ago

88
Q

Copper IUD
oxidizes sperms
c/i (3)

A

Wilson disease (copper excess d/o)
STI <6m ago
heavy menses hx

89
Q

REVIEW:
Total cycle length (–) 14 (luteal phase length)
= follicular phase length

A

Total cycle length (–) 14 (luteal phase length)
= follicular phase length

90
Q

Pt gets biopsy on day X of cycle
how do you know if pt was in the follicular (proliferative) vs luteal (secretory) phase

A

Total cycle length (–) 14 (luteal phase length)
= follicular phase length

If X is in last 14 days of cycle → luteal phase
ex: 30 day cycle → 1-16d Follicular & 17-30 Luteal)

91
Q

Withdrawal/ Challenge test: to localize amenorrhea
P2 given & w/d bleeds = (+) test
No w/d bleeding after P2 = (–) test → NBSIM?

A

give E2 then P2
and see if they w/d bleed then

92
Q

Pt receives P2 and has w/d bleeding
why?

A

Anovulation

(ex: PCOS)

93
Q

Pt receives E2 then P2 and has w/d bleeding
why?

A

Estrogen deficiency

(Ex: Turner syndrome & Primary Ovarian Failure: ovaries don’t work don’t make E2 or P2 so both will be low.)

94
Q

Pt receives P2 and does not w/d bleed.
Pt then receives E2 & P2 and still does not bleed
why?

A

Decidua Basalis (endometrial stem cells) are missing

(Ex: Asherman syndrome (Synechial) s/t recurrent dilation and curettage → scrape off stem cells)

95
Q

3 Causes of bilious emesis → get upper GI series
Duodenal Atresia → ___ Bubble
Jejunal Atresia → ___ Bubble
Midgut volvulus → Mal-rotation of midgut around ___

A

Duodenal = Double
Jejunum = Triple
Malrotation around SMA

96
Q

Meckle’s diverticulum
failed obliteration of the ___ (terminal illeum)
Painless bloody stools In first few years of life s/t ___ mucosa
dxt/tx?

A

vitelline duct
ectopic gastric mucosa

Dxt: TC-99m scan (Meckle’s scan)
Tx: Surgery

Step 2 (55 decks)

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