HY Review #3 Flashcards
Small bowel obstruction mcc:
Crohn’s disease →
history of abdominal surgery →
Crohn’s → Strictures (fibrotic)
abdominal surgery → Adhesions
Pancreatic adenocarcinoma is found in the pancreatic head/neck region causes painless jaundice
5-year survival rate less than 5%
Management is with ____
palliative care
(pt will die in months. No need for invasive management of other health issues)
Bacteria present in shellfish and salt water. Contracted by eating Seafood or via inoculation (wound) while at the beach or in the water.
Causes watery diarrhea, wound infections, septicemia → Necrotizing Fasciitis.
BRF: h/o liver disease or chronic disease (DM)
Dx/Tx?
Vibrio Vulnificans
Surgical Debridement of wound + Antibiotics
young adult presents with Fever + Neuro deficits, Jaundice, and Petechiae + Renal failure
↓Hct/PLTs
Normal PT/PTT
↑Cr
↑Bilirubin
Dx/Tx?
TTP
Plasmapheresis → IvIg
Conduct disorder vs Oppositional Defiant Disorder in children
Conduct disorder = Physically Aggressive, Stealing, Property Damage (illegal), outright lies
Oppositional Defiant= Angry, Vindictive, Disobedient, Cuts class, threatens w/o physical action
1st line tx of tinea capitis is
ORAL Griseofulvin
ORAL Terbinafine
RCC likes to met to (3)
Bone
Brain
Lung
Pt presents with L facial droop and Bradycardia
ECG shows AV nodal block
Recently in Wisconsin
Dx/Tx?
(LATE) Lyme Dz
Tx: CTX
(Early Lyme dz: Bull’s eye rash + flu sxs → Doxycycline)
FEV1/FVC & Peak Expiratory Flow rate levels during and acute asthma attack?
pt has dyspnea, rhonchi (wheezing), & prolonged expiratory phase
± Hyper-resonance and hyperinflation
Both decrease
(Obstructive pattern)
Fine Inspiratory Crackles
Peripheral Reticular opacities
Clustered cystic airspaces on imaging
dx?
Pulmonary Fibrosis
(Interstitial lung disease)
Calcified pleural plaque + Pleural effusion
Dx?
BRF?
Mesothelioma
(Asbestosis & Tobacco)
Elderly pt with acute (2 day) abdominal pain and constipation.
Abdomen is tympanitic & distended
Dx/Tx?
Sigmoid Volvulus
(dilated sigmoid colon)
Flexible Sigmoidoscopy
(if uncomplicated)
CKD pt’s need to be evaluated for anemia b/c
↓ EPO
(should be made by kidneys)
FIRST STEP in management of DKA?
Normal Saline!
(Then insulin + glucose!)
Pts with Marfan should have what 2 yearly screens?
Echo
Eye exam
Latino/Black, Fat, HIV, IVDU
Edema
+4 proteinuria
>3.5g/day
Dx:
Cx: ___ Pleural Effusion
Prognosis: 50% → ___
FSGS
50% → ESRD
Transudative PE
Caucasian
Cancer → Lymphoma
mcc of Nephrotic syndrome (world-wide)
+4 proteinuria
>3.5g/day
Dx/ associated antibodies?
Membranous Nephropathy
(PLA-2R antibodies)
Light chains
± Amyloid
+4 proteinuria
>3.5g/day
Nephrotic syndrome
s/t
Multiple Myeloma
+3 proteinuria
<3.5g/day
Hematuria
Had URI less than 1w ago
Normal C3/C4
IgA Nephropathy
+3 proteinuria
<3.5g/day
Hematuria
Had URI (or skin infx) more than 1w ago
low C3 ± C4
Post-Streptococcus Glomerular Nephritis
(PSGN)
Young Male
Hemoptysis 1st
Hematuria 2nd
Dx?
Good Pasture’s (T4 collagen)
→ RPGN
+3 proteinuria
<3.5g/day
Hematuria
Hx of Hepatitis B
Low C3/C4
Dx?
MPGN
vaginal pH > 4.5
(2)
Bacterial Vaginosis
Trichomonas (red cervix)
tx of vaginal candidiasis (pseudohyphae)
PO Azole
pH ≤ 4.5
Wet prep findings for Trichomonas vs BV?
Trich: Motile Protozoa
BV: Epithelium w/Gardnerella (clue cells)
Complication associated with Bacterial Vaginosis?
Pre-Term Labor & Delivery
Non-tender, irregular bulky uterus
Dx
Symptomatic tx:
tx if pregnancy desired:
tx if pregnancy not desired:
Fibroids
OCPs
Myomectomy
Hysterectomy
(leave in copper IUD if not causing problems)
syncopal episode
pallor/sweating before passing out
dx/dxt?
Vasovagal
Tilt-table test
sudden syncope
quick return to baseline
occurred at rest
dx/dxt?
Cardiogenic
Ambulatory ECG
syncopal episode
More than 30m to return to baseline
± repetitive motions/incontinence/tongue biting
dx/dxt?
Neurogenic syncope (Seizures)
EEG
Acute abdominal pain
Sensation issues (Neuro sxs)
Red/purple Urine
Psychiatric sxs (depression/anxiety/dementia etc.)
Usually triggered by physiologic stressor (drugs, illness, fasting)
Dx/tx (3)?
defect?
Acute Intermittent Porphyria (AD)
____
Aminolevulinate Synthase (ALAS) Inhibition
• IV: Hemin + Glucose + Hematin
____
Porphobilinogen deaminase defect
Red Urine
Hyperhydrosis (sweaty)
Skin issues
• Skin lesions on sun-exposed
• Hairy/Hyperpigmentation
Dx/tx?
Test for HY association?
Porphyria Cutanea Tarda (sporadic mutation)
Phlebotomy
test for Hep C
Uroporphynogen decarboxylase defect
Porphyria → Greek word for “Red/Purple”
• Red/Purple pee & skin lesions
Tarda → Late (Tardy)
•Lesions appear later after sun-exposure
T. Bili keeps increasing despite phototherapy
Or T. Bill >25 mg/dL
NBSIM?
partial exchange transfusion
PUV is a urethra problem =
VUR is a ureter problem =
PUV → Bladder distention
VUR → ± Hydronephrosis
(no bladder distention)
if adding Intrinsic Factor fixes the Bl2 def
dx/caused by?
Pernicious Anemia (stomach problem)
s/t Lymphocytic infiltration of the gastric fundus
MALE pt present w/ Dark Urine
Low haptoglobin (Hemolysis)
Problem with sulfa drugs causing oxidative stress
Smear → Heinz bodies (denatured Hb) & Bite cells
dx?
ex) - Primaquine (covers vivax and ovale) or favabeans
G6PD deficiency (XLR - only males)
Oxidative injury to hemoglobin.
Edematous Stillborn with hydrops fetalis & hepatosplenomegaly
dx/patho?
Hb Barts (Thalassemia)
Has 4 gamma chains (missing 4 alphas chains)
Mediterranean country
(Italy, Spain, Greece, Monaco, Portugal)
hepatosplenomegaly
Microcytic anemia
± Facial deformities
General Dx?
Thalassemia
(imbalance in alpha & beta globin gene production)
DIC labs
__PT, __PTT, __PLTs
__ Shistocytes
↑PT, ↑ PTT, ↓ PLTs
↑ Shistocytes
injectable monoclonal antibody that interferes with platelet aggregation
Abciximab (inhibits GP2b/3a)
similar to what dz?
Glanzmann Thrombasthenia (deficiency of GP2B/3A)
Isolated ↑Bleeding time (RCA & PTT nl)
———
Recall
Bernard Soulier Disease (Def GP1B) → (Abn RCA, PTT nl & ↑BT)
Hemo A (F8 def ↑PTT & nl PT)
Hemo B (F9 def ↑PTT & nl PT)
vWB (↑PTT & Bleed Time & Abn RCA)
Little Boy
bleeding into joints
Nose bleeds
Oral mucosa bleeding
dx?
Hemo A (F8 def ↑PTT & nl PT)
get a mixing study
(can also be Hemophilia B, but less common)
Bleeding Time, RCA test & PTT for
vWF disease
Bernard Soulier
Glanzmann Thrombostenia
vWF: ↑Bleeding Time, Abn RCA test, ↑ PTT
Tx: Desmopressin
Bernard Soulier: ↑BT, Abn RCA Test, normal PTT
Glanzmann Thrombostenia: ↑BT, normal RCA Test, normal PTT
HEPARIN is safe to use in pregnancy
MOA?
Increases the activity of Antithrombin 3.
What medication Binds to an ADP receptor and prevents platelet activation?
Clopidogrel
Which Immunoglobulin cannot cross from maternal circulation in placenta/fetal circulation?
IgM
(baby can’t get IgMs from mom)
Contraindication to adenosine/dipyridamole based stress tests:
Asthma
(drugs above are bronchospastic)
Contraindication to EKG based stress tests
Pre-existing EKG anomaly
Contraindications to exercise based stress tests (4)
Aortic Stenosis
Osteoarthritis
Amputee
Frail elderly
What are the 2 components of stress tests on NBME exams?
-
Stress method
- Exercise
- Pharmacologic (Dobutamine or Adenosine) -
Capturing heart response
- EKG
- ECHO
- Nuclear Medicine (Thallium 201 scan)
How are “flares” of most autoimmune diseases treated on NBME exams? What is the classic tipoff to a disease flare?
IV Steroids (except GBS & scleroderma)
Tipoff → Acute worsening of sxs
Fever (>102ºF) + AMS
dx/tx?
Heat stroke
Normal Saline 1st → evaporative cooling
Heat exhaustion (High temp but No AMS)
same tx tho
Classic bioterrorism organisms on NBME exams? (3)
Anthrax
Botulisms
Small pox
50M h/o chronic alcohol abuse + bloody emesis
Hypotensive + Tachycardic
Dx:
Initial management:
Acute Mgt: (3)
Chronic prophylaxis: (2)
Dx: ruptured esophageal varices
Initial management: Place 2 IVs → Normal Saline (1st) then Transfuse blood
Acute Mgt: Banding or Sclerotherapy
(& IV Octreotide + IV PPI)
Chronic prophylaxis: Beta Blockers (or Spironolactone) + FQ (SBP ppx)
What patients require long term Floroquinilone for SBP ppx?
h/o Varices
h/o SBP
Spontaneous Bacterial Peritonitis is diagnosed via ___?
How is acute SBP treated?
What is SBP ppx long term?
paracentesis (>250 PMNs even if no bacteria found)
Acute tx: CTX or Cefotaxime (2nd line FQ)
Ppx: Fq
What drug classes are used on NBME exams in the management of most bacterial pneumonia?
CTX
Azithromycin
6 Boy
3 mo h/o recurrent fevers and bone pain.
Cranial XR: lytic lesions in his skull
Bone Biopsy: S100+ cells.
Dx:
Histology: Birbeck Granules (tennis rackets)
Lab markers: S100+, CD1A+, Langerin+
Langerhan cell Histocytosis (dendritic cell tumor)
Aside from ST elevations, what is another diagnostic criterion that can be used in establishing an MI diagnosis?
↑ Troponins
+
NEW LBBB (MI until proven otherwise)
Painful skin vesicles in the same stage of healing
Dx
Small Pox (HY HY)
Vaccinia Vaccine (cow pox vaccine) usually military question
Painful skin vesicles in different stages of healing
Dx
VZV (chicken pox)
fever and headaches
CT shows peripheral (temporal lobe) bleed
HSV encephalitis/meningitis
(LP + PCR?)
47F Obese + severe pruritus and pain under her left breast
dx/dxt/tx (2)?
Dx:intertrigo (candidal infx)
Tx: topical Azole/ topical nystatin
—
NBME risk factors: DM, Obese, large breast
Dx testing: wet prep → pseudohyphae (budding yeast)
Absent Gag Reflex = CN9 & 10
another symptom related to these CNs include:
Decreased sensation in the posterior third of the tongue.
Conjugated (Direct) hyperbilirubinemia in a newborn.
Dx/tx?
Biliary atresia
emergent surgery
otherwise liver transplant
Bilateral “cheek” and testicular swelling in a 7 yo boy.
dx/tx
Potential abdominal sequelae?
Mumps virus
supportive care
sequelae → pancreatitis
6 week old kid that was jaundiced at birth with lethargy, hypotonia, poor feeding, and occasional seizures
dx/pahtophys?
Kernicticus
bilirubin deposits in basal ganglia
2 clues jaundice is pathological in newborns ALWAYS.
2 examples
jaundice in first 24hrs of life
(Direct) conjugated hyperbilirubinemia
(Kernicterus & Biliary Atresia)
A) 5 yo boy with SNHL(hearing loss) + hematuria (nephritic) + cataracts (eye problems). dx?
B) 5 yo boy with recurrent infections + eczema + thrombocytopenia. dx?
Alport syndrome (type 4 collagen) COL4A5 gene defect
Wiskott- Aldridge syndrome WAS gene mutation
9 mo boy + recurrent UTIs
Dx/DxT/tx
Posterior Urethral Valves
Renal u/s ± VCUG
Daily antibiotic ppx
Seizure lifestyle modification for NBME exams.
Ketogenic diet
7 yo M with 3 day h/o Fever, abdominal pain, bloody diarrhea
Labs: Hb 8, Plts 12k, Cr 2.5,
Smear: Schistocytes
Dx:
MCC:
MAHA (↓ PLTs + Renal Failure)
MCC: E.Coli 0157:h7
Hyperpigmented macules on the skin,
prior R eye enucleation procedure for a CN2 mass,
multiple posterior mediastinal masses
Dx/ MOI/ Chrm __
NF1 (AD)
Chrm 17
(Cafe-au-lait spots + optic glioma + Neurofibromas)
Child+ Fever + Seizure (lasting less than __ minutes)
dx/tx?
Febrile seizure (<15m)
Acetaminophen
4 yo boy + Fever+ drooling +dysphagia + tripoding.
dx/tx?
Epiglotitis → INTUBATE
(XRAY thumb print sign)
Cystic Fibrosis is HY
Recurrent mucosal infections (ears, nose, lungs)
Steatorrhea + FTT → Infertility
Gene/chromosome:
Dx testing:
Steatorrhea:
First 48 hrs life cx:
Pneumonia cause by age:
<20yo →
>20yo →
CFTR gene mutation (AR)
Sweat chloride test
—-
Failure to pass meconium
Steatorrhea = Lipase deficiency (Vit. A,B,D,E,K def)
——
PNA in <20yo = Staph aura
PNA in >20yo= Pseudomonas
15 mo F with rhinorrhea, cough for 2 days
Progresses to wheezing & b/l crackles heard on lung auscultation.
Dx/Tx?
Bronchiolitis (RSV)
Supportive care with O2 as needed
Bilateral thigh/calf pain (worse at night) in a 5 (15) year old M relieved by acetaminophen.
Unilateral thigh/calf pain (worse at night) in a 5 (15) year old M relieved by acetaminophen.
Bilateral → Growing pains (child/teen)
Unilateral → Osteoid Osteoma
± bony mass
Peds Ortho stuff (HY)
1. Unstable hip joint in new born
2. <10 yo with limp
3. >10yo with limp
- Developmental Dysplasia → Pavlik Harness
––– -
Legg-calvé-perthes Dz → Avascular necrosis of femoral head (compression/necrosis of capital femoral epiphysys)
Tx: surgery only if 6+ yo or 50% + dmg to head
––– -
Slipped Capital Femoral Epiphysis → Slipped femoral head no necrosis/compression (obese)
Tx: Surgical pinning of head
–––
Alphabetical order corresponds to Age
D (infant), L (child), S (pre-teen)
BP is 250/140 with AMS.
Dx/Tx (5)?
HTN emergency:
Nitroprusside, Labetalol
Phentolamine (alpha 1 blocker)
Nicardipine or Clevidipine
(urgency is the same w/o end organ dmg; but same tx)
on NBME test what is the NBSIM in a neonate presenting with bilious emesis.
Upper GI Series
(non-bilious emesis → U/S)
Breast cancer screening guidelines with BRCA1 and 2 mutations
25-30 =
>30=
25-30 = annual breast MRI
>30= annual MRI + Mammograms
NBSIM of a >50 yo patient who presents with a new, chronic headache
(± worse in AM may improve later in day)
MRI brain + contrast
(screen for brain tumor)
Patient started on therapy for HTN who subsequently developed constipation and peripheral edema.
DHP CCB toxicity
Dysphagia
Iron Deficiency Anemia
(↓MCV, ↓Hct, ↓Ferritin, ↑TIBC, ↑Transferrin, ↓Transferrin SATs)
esophageal webs
Dx?
Plummer Vinson Syndrome
Compare:
Cholinergic Toxidrome
Anti-Cholinergic Toxidrome
Cholinergic Toxidrome
↑ Ach (Pyridostigmine, Pilocarpine, Bethanachol)
DUMBELLS
Diarrhea
Urination
Miosis
Bradycardia/ Bronchoconstriction (wheezing)
Emesis
Lethargy
Lacrimation
Sweaty/Salivation (Drooling)
——
Anti-cholinergic Toxidrome
↓ Ach (Atropine, Ipratropium, Oxybutynin )
Fast as a fiddle: Tachycardia
Dry as a bone (dry mucous memb)
Full as a flask (urinary retention/constipation)
Blind as a Bat (Mydriasis)
Red as a beet (flushed skin)
Mad as a hatter (AMS)
23 M recent blunt force trauma to leg now has pain over area
& a hard, palpable mass in the involved extremity.
Dx?
myositis ossificans
(collagen repairs creating bone not muscle)
40+ yo w/ DM who was recently started on statin now has Increased Cr and dark/red urine.
statin myopathy → rhabdomyolysis
Pharmacologic agents on NBMEs with the following side effects
Crystalline nephropathy (3):
Pancreatitis (4):
Crystalline → Acyclovir, Topiramate, Indinavir (HIV)
─
Pancreatitis→ GLP-1 agonist, DPP4 inhibitors, Stavudine/Didanosine (HIV drugs)
─
(C/I in MEN syndrome)
Alopecia arreata tx?
(typically seen in pts with h/o auto-immune d/o)
inject steroid in lesions
Mechanism behind infertility in a patient with decreased day 25 progesterone
Anovulation
(no corpus leuteum making P2)
Fever + Anemia (MAHA)
↓ Plts (Petechiae)
Renal Failure
± Neuro Deficits
Dx/Tx (2)?
TTP
Plasmapheresis
2nd line: IvIg
____ can cause supratheurapeutic INR if on warfarin bc decreased warfarin degradation = warfarin toxicity
TMP-SMX
Drugs causing HYPERKALEMIA
(ABC-ST)
ACE/ARBs
Beta blockers
Cyclosporin
Spironolactone/Eplerenone
TMP-SMX
Amiloride/triamterene
Compare/Contrast
Nephroblastoma
Neuroblastoma
Seizures in children (Dx/Tx)
<2yo + EEG w/ chaotic irregular background (Hypsarrhythmia) + milestone regressions ± Tuberous Sclerosis.
─
3-5 yo + has different seizures types + prone to status epilepticus + Bad prognosis
─
>10 yo + jerking seizures worse in AM/when waking up; tonic-clonic
─
Any age + starring spells + 3Hz spikes/ slow wave on EEG
<2yo: West syndrome (infantile spasms) → ACTH
─
3-5yo: Lennox Gastaut → Valproate
─
>10yo: Juvenile myoclonic epilepsy → Valproate
─
Absence seizures→ Ethosuximide or CCB (type T)
Type of Diarrhea caused by
Cholera
Lactose Intolerence
Celiac’s (T-cell lymphoma)
Secretory (Ions)
Osmotic (osmotically active)
Malabsorptive (enteric villi)
Liver and Lung problems
Dx:
Cx: ____
Worsens morbidity/mortality: SMOKING
Associated vasculitis: _________
Classic microscopy findings: ________
alpha 1 anti-trypsin deficiency (anti-protease)
Panacinar emphysema (upper lobes)
Wegener’s (GPA)
PAS (+) hepatocytes
(P acid schiff stain)
New born + FTT + poor feeding + seizures
Sweet smelling urine or earwax
dx/tx? Potentially curative tx?
Maple Syrup Disease
diet low in isoleucine, Leucine, Valine
Liver transplant
─
I LIV for sweet Maple Syrup
(mutation in branched chain keto-acid dehydrogenase)
HTN in a child (> 140/90)
NBSIM?
Renal Doppler U/S
(renal a issue)
Per NBME
mechanism of Renal Failure in Ketorolac use?
NSAID inhibits Cox = ↓ Prostaglandin = Afferent a. Constriction =
↓ GFR & HSP
PDA→ Prostaglandin dilates afferent (NSAIDs constrict)
ACE → ACE constricts efferent (ACE-I dilates)
to rule in a diagnosis the test must be very ____.
Specific
