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HY Review #3 Flashcards

1
Q

Small bowel obstruction mcc:
Crohn’s disease →
history of abdominal surgery →

A

Crohn’s → Strictures (fibrotic)
abdominal surgery → Adhesions

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2
Q

Pancreatic adenocarcinoma is found in the pancreatic head/neck region causes painless jaundice
5-year survival rate less than 5%
Management is with ____

A

palliative care

(pt will die in months. No need for invasive management of other health issues)

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3
Q

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?

A

Vibrio Vulnificans
Surgical Debridement of wound + Antibiotics

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4
Q

young adult presents with Fever + Neuro deficits, Jaundice, and Petechiae + Renal failure
↓Hct/PLTs
Normal PT/PTT
↑Cr
↑Bilirubin
Dx/Tx?

A

TTP
Plasmapheresis → IvIg

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5
Q

Conduct disorder vs Oppositional Defiant Disorder in children

A

Conduct disorder = Physically Aggressive, Stealing, Property Damage (illegal), outright lies
Oppositional Defiant= Angry, Vindictive, Disobedient, Cuts class, threatens w/o physical action

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6
Q

1st line tx of tinea capitis is

A

ORAL Griseofulvin
ORAL Terbinafine

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7
Q

RCC likes to met to (3)

A

Bone
Brain
Lung

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8
Q

Pt presents with L facial droop and Bradycardia
ECG shows AV nodal block
Recently in Wisconsin
Dx/Tx?

A

(LATE) Lyme Dz
Tx: CTX

(Early Lyme dz: Bull’s eye rash + flu sxs → Doxycycline)

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9
Q

FEV1/FVC & Peak Expiratory Flow rate levels during and acute asthma attack?
pt has dyspnea, rhonchi (wheezing), & prolonged expiratory phase
± Hyper-resonance and hyperinflation

A

Both decrease
(Obstructive pattern)

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10
Q

Fine Inspiratory Crackles
Peripheral Reticular opacities
Clustered cystic airspaces on imaging
dx?

A

Pulmonary Fibrosis
(Interstitial lung disease)

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11
Q

Calcified pleural plaque + Pleural effusion
Dx?
BRF?

A

Mesothelioma

(Asbestosis & Tobacco)

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12
Q

Elderly pt with acute (2 day) abdominal pain and constipation.
Abdomen is tympanitic & distended
Dx/Tx?

A

Sigmoid Volvulus
(dilated sigmoid colon)

Flexible Sigmoidoscopy
(if uncomplicated)

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13
Q

CKD pt’s need to be evaluated for anemia b/c

A

↓ EPO
(should be made by kidneys)

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14
Q

FIRST STEP in management of DKA?

A

Normal Saline!

(Then insulin + glucose!)

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15
Q

Pts with Marfan should have what 2 yearly screens?

A

Echo
Eye exam

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16
Q

Latino/Black, Fat, HIV, IVDU
Edema
+4 proteinuria
>3.5g/day

Dx:
Cx: ___ Pleural Effusion
Prognosis: 50% → ___

A

FSGS
50% → ESRD

Transudative PE

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17
Q

Caucasian
Cancer → Lymphoma
mcc of Nephrotic syndrome (world-wide)
+4 proteinuria
>3.5g/day

Dx/ associated antibodies?

A

Membranous Nephropathy

(PLA-2R antibodies)

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18
Q

Light chains
± Amyloid
+4 proteinuria
>3.5g/day

A

Nephrotic syndrome
s/t
Multiple Myeloma

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19
Q

+3 proteinuria
<3.5g/day
Hematuria
Had URI less than 1w ago
Normal C3/C4

A

IgA Nephropathy

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20
Q

+3 proteinuria
<3.5g/day
Hematuria
Had URI (or skin infx) more than 1w ago

low C3 ± C4

A

Post-Streptococcus Glomerular Nephritis
(PSGN)

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21
Q

Young Male
Hemoptysis 1st
Hematuria 2nd
Dx?

A

Good Pasture’s (T4 collagen)
→ RPGN

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22
Q

+3 proteinuria
<3.5g/day
Hematuria
Hx of Hepatitis B
Low C3/C4
Dx?

A

MPGN

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23
Q

vaginal pH > 4.5
(2)

A

Bacterial Vaginosis
Trichomonas (red cervix)

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24
Q

tx of vaginal candidiasis (pseudohyphae)

A

PO Azole

pH ≤ 4.5

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25
Q

Wet prep findings for Trichomonas vs BV?

A

Trich: Motile Protozoa
BV: Epithelium w/Gardnerella (clue cells)

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26
Q

Complication associated with Bacterial Vaginosis?

A

Pre-Term Labor & Delivery

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27
Q

Non-tender, irregular bulky uterus
Dx
Symptomatic tx:
tx if pregnancy desired:
tx if pregnancy not desired:

A

Fibroids
OCPs
Myomectomy
Hysterectomy
(leave in copper IUD if not causing problems)

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28
Q

syncopal episode
pallor/sweating before passing out
dx/dxt?

A

Vasovagal
Tilt-table test

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29
Q

sudden syncope
quick return to baseline
occurred at rest
dx/dxt?

A

Cardiogenic
Ambulatory ECG

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30
Q

syncopal episode
More than 30m to return to baseline
± repetitive motions/incontinence/tongue biting
dx/dxt?

A

Neurogenic syncope (Seizures)
EEG

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31
Q

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?

A

Acute Intermittent Porphyria (AD)
____
Aminolevulinate Synthase (ALAS) Inhibition
• IV: Hemin + Glucose + Hematin
____
Porphobilinogen deaminase defect

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32
Q

Red Urine
Hyperhydrosis (sweaty)
Skin issues
• Skin lesions on sun-exposed
• Hairy/Hyperpigmentation
Dx/tx?
Test for HY association?

A

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

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33
Q

T. Bili keeps increasing despite phototherapy
Or T. Bill >25 mg/dL
NBSIM?

A

partial exchange transfusion

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34
Q

PUV is a urethra problem =
VUR is a ureter problem =

A

PUV → Bladder distention
VUR → ± Hydronephrosis
(no bladder distention)

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35
Q

if adding Intrinsic Factor fixes the Bl2 def
dx/caused by?

A

Pernicious Anemia (stomach problem)

s/t Lymphocytic infiltration of the gastric fundus

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36
Q

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

A

G6PD deficiency (XLR - only males)
Oxidative injury to hemoglobin.

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37
Q

Edematous Stillborn with hydrops fetalis & hepatosplenomegaly
dx/patho?

A

Hb Barts (Thalassemia)
Has 4 gamma chains (missing 4 alphas chains)

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38
Q

Mediterranean country
(Italy, Spain, Greece, Monaco, Portugal)
hepatosplenomegaly
Microcytic anemia
± Facial deformities
General Dx?

A

Thalassemia
(imbalance in alpha & beta globin gene production)

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39
Q

DIC labs
__PT, __PTT, __PLTs
__ Shistocytes

A

↑PT, ↑ PTT, ↓ PLTs
↑ Shistocytes

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40
Q

injectable monoclonal antibody that interferes with platelet aggregation
Abciximab (inhibits GP2b/3a)
similar to what dz?

A

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)

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41
Q

Little Boy
bleeding into joints
Nose bleeds
Oral mucosa bleeding
dx?

A

Hemo A (F8 def ↑PTT & nl PT)
get a mixing study

(can also be Hemophilia B, but less common)

42
Q

Bleeding Time, RCA test & PTT for

vWF disease
Bernard Soulier
Glanzmann Thrombostenia

A

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

43
Q

HEPARIN is safe to use in pregnancy
MOA?

A

Increases the activity of Antithrombin 3.

44
Q

What medication Binds to an ADP receptor and prevents platelet activation?

A

Clopidogrel

45
Q

Which Immunoglobulin cannot cross from maternal circulation in placenta/fetal circulation?

A

IgM

(baby can’t get IgMs from mom)

46
Q

Contraindication to adenosine/dipyridamole based stress tests:

A

Asthma

(drugs above are bronchospastic)

47
Q

Contraindication to EKG based stress tests

A

Pre-existing EKG anomaly

48
Q

Contraindications to exercise based stress tests (4)

A

Aortic Stenosis
Osteoarthritis
Amputee
Frail elderly

49
Q

What are the 2 components of stress tests on NBME exams?

A
  1. Stress method
    - Exercise
    - Pharmacologic (Dobutamine or Adenosine)
  2. Capturing heart response
    - EKG
    - ECHO
    - Nuclear Medicine (Thallium 201 scan)
50
Q

How are “flares” of most autoimmune diseases treated on NBME exams? What is the classic tipoff to a disease flare?

A

IV Steroids (except GBS & scleroderma)
Tipoff → Acute worsening of sxs

51
Q

Fever (>102ºF) + AMS
dx/tx?

A

Heat stroke
Normal Saline 1st → evaporative cooling

Heat exhaustion (High temp but No AMS)
same tx tho

52
Q

Classic bioterrorism organisms on NBME exams? (3)

A

Anthrax
Botulisms
Small pox

53
Q

50M h/o chronic alcohol abuse + bloody emesis
Hypotensive + Tachycardic
Dx:
Initial management:
Acute Mgt: (3)
Chronic prophylaxis: (2)

A

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)

54
Q

What patients require long term Floroquinilone for SBP ppx?

A

h/o Varices
h/o SBP

55
Q

Spontaneous Bacterial Peritonitis is diagnosed via ___?

How is acute SBP treated?
What is SBP ppx long term?

A

paracentesis (>250 PMNs even if no bacteria found)
Acute tx: CTX or Cefotaxime (2nd line FQ)
Ppx: Fq

56
Q

What drug classes are used on NBME exams in the management of most bacterial pneumonia?

A

CTX
Azithromycin

57
Q

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+

A

Langerhan cell Histocytosis (dendritic cell tumor)

58
Q

Aside from ST elevations, what is another diagnostic criterion that can be used in establishing an MI diagnosis?

A

↑ Troponins
+
NEW LBBB (MI until proven otherwise)

59
Q

Painful skin vesicles in the same stage of healing
Dx

A

Small Pox (HY HY)
Vaccinia Vaccine (cow pox vaccine) usually military question

60
Q

Painful skin vesicles in different stages of healing
Dx

A

VZV (chicken pox)

61
Q

fever and headaches
CT shows peripheral (temporal lobe) bleed

A

HSV encephalitis/meningitis

(LP + PCR?)

62
Q

47F Obese + severe pruritus and pain under her left breast
dx/dxt/tx (2)?

A

Dx:intertrigo (candidal infx)
Tx: topical Azole/ topical nystatin
—
NBME risk factors: DM, Obese, large breast
Dx testing: wet prep → pseudohyphae (budding yeast)

63
Q

Absent Gag Reflex = CN9 & 10
another symptom related to these CNs include:

A

Decreased sensation in the posterior third of the tongue.

64
Q

Conjugated (Direct) hyperbilirubinemia in a newborn.
Dx/tx?

A

Biliary atresia
emergent surgery

otherwise liver transplant

65
Q

Bilateral “cheek” and testicular swelling in a 7 yo boy.
dx/tx
Potential abdominal sequelae?

A

Mumps virus
supportive care
sequelae → pancreatitis

66
Q

6 week old kid that was jaundiced at birth with lethargy, hypotonia, poor feeding, and occasional seizures
dx/pahtophys?

A

Kernicticus
bilirubin deposits in basal ganglia

67
Q

2 clues jaundice is pathological in newborns ALWAYS.
2 examples

A

jaundice in first 24hrs of life
(Direct) conjugated hyperbilirubinemia

(Kernicterus & Biliary Atresia)

68
Q

A) 5 yo boy with SNHL(hearing loss) + hematuria (nephritic) + cataracts (eye problems). dx?

B) 5 yo boy with recurrent infections + eczema + thrombocytopenia. dx?

A

Alport syndrome (type 4 collagen) COL4A5 gene defect

Wiskott- Aldridge syndrome WAS gene mutation

69
Q

9 mo boy + recurrent UTIs
Dx/DxT/tx

A

Posterior Urethral Valves
Renal u/s ± VCUG
Daily antibiotic ppx

70
Q

Seizure lifestyle modification for NBME exams.

A

Ketogenic diet

71
Q

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:

A

MAHA (↓ PLTs + Renal Failure)
MCC: E.Coli 0157:h7

72
Q

Hyperpigmented macules on the skin,
prior R eye enucleation procedure for a CN2 mass,
multiple posterior mediastinal masses
Dx/ MOI/ Chrm __

A

NF1 (AD)
Chrm 17

(Cafe-au-lait spots + optic glioma + Neurofibromas)

73
Q

Child+ Fever + Seizure (lasting less than __ minutes)
dx/tx?

A

Febrile seizure (<15m)
Acetaminophen

74
Q

4 yo boy + Fever+ drooling +dysphagia + tripoding.
dx/tx?

A

Epiglotitis → INTUBATE

(XRAY thumb print sign)

75
Q

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 →

A

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

76
Q

15 mo F with rhinorrhea, cough for 2 days
Progresses to wheezing & b/l crackles heard on lung auscultation.
Dx/Tx?

A

Bronchiolitis (RSV)
Supportive care with O2 as needed

77
Q

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.

A

Bilateral → Growing pains (child/teen)

Unilateral → Osteoid Osteoma
± bony mass

78
Q

Peds Ortho stuff (HY)
1. Unstable hip joint in new born
2. <10 yo with limp
3. >10yo with limp

A
  1. Developmental Dysplasia → Pavlik Harness
    –––
  2. 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
    –––
  3. 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)
79
Q

BP is 250/140 with AMS.
Dx/Tx (5)?

A

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

(urgency is the same w/o end organ dmg; but same tx)

80
Q

on NBME test what is the NBSIM in a neonate presenting with bilious emesis.

A

Upper GI Series

(non-bilious emesis → U/S)

81
Q

Breast cancer screening guidelines with BRCA1 and 2 mutations
25-30 =
>30=

A

25-30 = annual breast MRI
>30= annual MRI + Mammograms

82
Q

NBSIM of a >50 yo patient who presents with a new, chronic headache
(± worse in AM may improve later in day)

A

MRI brain + contrast
(screen for brain tumor)

83
Q

Patient started on therapy for HTN who subsequently developed constipation and peripheral edema.

A

DHP CCB toxicity

84
Q

Dysphagia
Iron Deficiency Anemia
(↓MCV, ↓Hct, ↓Ferritin, ↑TIBC, ↑Transferrin, ↓Transferrin SATs)
esophageal webs
Dx?

A

Plummer Vinson Syndrome

85
Q

Compare:
Cholinergic Toxidrome
Anti-Cholinergic Toxidrome

A

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)

86
Q

23 M recent blunt force trauma to leg now has pain over area
& a hard, palpable mass in the involved extremity.
Dx?

A

myositis ossificans

(collagen repairs creating bone not muscle)

87
Q

40+ yo w/ DM who was recently started on statin now has Increased Cr and dark/red urine.

A

statin myopathy → rhabdomyolysis

88
Q

Pharmacologic agents on NBMEs with the following side effects

Crystalline nephropathy (3):
Pancreatitis (4):

A

Crystalline → Acyclovir, Topiramate, Indinavir (HIV)
─
Pancreatitis→ GLP-1 agonist, DPP4 inhibitors, Stavudine/Didanosine (HIV drugs)
─
(C/I in MEN syndrome)

89
Q

Alopecia arreata tx?
(typically seen in pts with h/o auto-immune d/o)

A

inject steroid in lesions

90
Q

Mechanism behind infertility in a patient with decreased day 25 progesterone

A

Anovulation
(no corpus leuteum making P2)

91
Q

Fever + Anemia (MAHA)
↓ Plts (Petechiae)
Renal Failure
± Neuro Deficits
Dx/Tx (2)?

A

TTP
Plasmapheresis
2nd line: IvIg

92
Q

____ can cause supratheurapeutic INR if on warfarin bc decreased warfarin degradation = warfarin toxicity

A

TMP-SMX

93
Q

Drugs causing HYPERKALEMIA
(ABC-ST)

A

ACE/ARBs
Beta blockers
Cyclosporin
Spironolactone/Eplerenone
TMP-SMX

Amiloride/triamterene

94
Q

Compare/Contrast
Nephroblastoma
Neuroblastoma

A
95
Q

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

A

<2yo: West syndrome (infantile spasms) → ACTH
─
3-5yo: Lennox Gastaut → Valproate
─
>10yo: Juvenile myoclonic epilepsy → Valproate
─
Absence seizures→ Ethosuximide or CCB (type T)

96
Q

Type of Diarrhea caused by
Cholera
Lactose Intolerence
Celiac’s (T-cell lymphoma)

A

Secretory (Ions)
Osmotic (osmotically active)
Malabsorptive (enteric villi)

97
Q

Liver and Lung problems
Dx:
Cx: ____
Worsens morbidity/mortality: SMOKING
Associated vasculitis: _________
Classic microscopy findings: ________

A

alpha 1 anti-trypsin deficiency (anti-protease)
Panacinar emphysema (upper lobes)
Wegener’s (GPA)
PAS (+) hepatocytes
(P acid schiff stain)

98
Q

New born + FTT + poor feeding + seizures
Sweet smelling urine or earwax
dx/tx? Potentially curative tx?

A

Maple Syrup Disease
diet low in isoleucine, Leucine, Valine
Liver transplant
─
I LIV for sweet Maple Syrup
(mutation in branched chain keto-acid dehydrogenase)

99
Q

HTN in a child (> 140/90)
NBSIM?

A

Renal Doppler U/S

(renal a issue)

100
Q

Per NBME
mechanism of Renal Failure in Ketorolac use?

A

NSAID inhibits Cox = ↓ Prostaglandin = Afferent a. Constriction =
↓ GFR & HSP

PDA→ Prostaglandin dilates afferent (NSAIDs constrict)
ACE → ACE constricts efferent (ACE-I dilates)

101
Q

to rule in a diagnosis the test must be very ____.

A

Specific

Step 2 (55 decks)

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