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Step 2 > HY review #4 Part 2 > Flashcards

HY review #4 Part 2 Flashcards

1
Q

What is the biggest risk factor for the following disorders?
Bladder cancer:
Lung cancer:
Pancreatic cancer:
Prostate cancer:

*Of all the Above, which causes blastic bone lesions?

*Which cancer (listed above or not) can cause both blastic and lytic lesions?

A

Bladder cancer: → smoking
Lung cancer: → smoking
Pancreatic cancer: → smoking
Prostate cancer: → Age

Blastic bone lesions → Prostate cancer

Both blastic and lytic lesions → Breast cancer

Bladder, Lung, Pancreatic cancer → lytic lesions (chew up bone)

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2
Q

-What is the biggest risk factor for Renal cancer?
-What paraneoplastic syndrome is assoc w/ renal cancer ?
-Initial imaging test?
-Next step after imaging?

A

Smoking
[Paraneoplastic: ↑ EPO = ↑ Hct aka 2º Polycythemia]
Initial dx test → CT A/P with contrast
Next step in management → Nephrectomy
──
FYI: Can’t biopsy bc if you rupture it you’ll spread cancer all over.
Same goes for ROTA cancers
(RCC, Ovarian, Testicular, Adrenal)

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3
Q

HY HY HY
43F + BMI is 48.
Has tried 2 hrs of daily exercise and eats a low carb/fat diet.
What is the next best step in the management of this patient?

A

Gastric Bypass
(HY HY HY)

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4
Q

2 main indications for Gastric Bypass:

Does this surgery reduce mortality?

A

BMI> 40
BMI>35 + Co-morbidities (HTN, DM, HF)

Reduce mortality → YES

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5
Q

24 hr history of abdominal pain, severe vomiting, &
no bowel movement 4 years after gastric bypass
Dx/Tx?

A

SBO s/t Adhesions from abdominal surgeries (mcc of SBO)
Tx: NGT and suction

If Peritoneal signs are present = Laparotomy

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6
Q

Fevers and worsening epigastric pain with peritoneal signs 3 days after gastric bypass
dx/tx?

A

Anastomotic leak
Ex-Lap

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7
Q

1 month after Gastric Bypass, the patient returns for follow-up.
She complains of episodes of diarrhea, nausea, and dizziness that occur 2 hrs after she eats a meal.
Dx:
Dx testing:
Tx strategies:
Type of diarrhea:

A

Dumping Syndrome
Gastric Emptying Study (gastric scintigraphy)
Small frequent meal and low-carb diet (less osmotically active)

osmotic diarrhea
──
Rapid gastric emptying → pyloric sphincter is bypassed after surgery → once food enters stomach it goes immediately to the small intestine → this attracts water into intestine →osmotic diarrhea (resolves itself)

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8
Q

Mild bone pain, mild QT prolongation on EKG after gastric bypass surgery, tapping the cheek produces facial muscle spasms.
Dx:
Pathophysiology:
Expected PTH levels:
Tx strategies:

A

Hypocalcemia
s/t Decreased duodenal reabsorption
↑ PTH
Tx: Calcium + VitD supplementation

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9
Q

Shortness of breath and generalized fatigue in a menstruating female 1 year after gastric bypass surgery who was lost to follow up.
Dx:
Pathophysiology:
Tx strategies:

A

Iron def anemia
Poor iron absorption in duodenum
Tx: Iron supp + Orange Juice

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10
Q

What should be supplemented in pts who’ve had a gastric Bypass when they present with SBO symptoms to reduce the risk of neurologic sequelae?

A

Give Thiamine [vit B1]
(bc high risk for Wernickes)

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11
Q

(+) Babinski & Romberg tests (Dorsal column disfunction)
2 years after Gastric Bypass surgery in an individual lost to follow up?
Dx?

A

Vitamin B12 def
(UMN + Dorsal Column sxs = Subacute combined degeneration of the spinal cord s/t B12 deficiency)

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12
Q

Hemidiaphragm elevated after inserting a central line

A

Dmg to Phrenic Nerve (paralysis of diaphragm)

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13
Q

Feeling of ear fullness + vertigo + Tinnitus + episodic hearing loss
dx/tx(2)?

A

Menier’s dz (endolymphatic hydrops)
Tx: Diuretic or Gentamicin ablation of CN8 (when diuretics no work)

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14
Q

Management of rotator cuff injury
1st line/2nd line tx?

A

Shoulder strengthening exercises

2nd line: inject steroids

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15
Q

Teenager presents with rapid onset and offset neuro deficit or consciousness (resolves within seconds to an hour). Perioral rash noted on exam.

Dx?

A

inhalant abuse (Glue, Taulene)
neuro deficits → pass out → wake up and are okay

FYI: can cause Parkinson sxs

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16
Q

Histological correlate of ARDS

A

Diffuse alveolar damage

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17
Q

Enlarging breast mass in a 55 yo F on hormone replacement therapy. NBSIM?

A

c/f Breast cancer
get Mammogram
Then stop HRT

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18
Q

2 modes of emergency contraception.
Which is most effective?

A

Copper IUD (better)
Uripristol (Plan B)

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19
Q

Rising Cr and K after starting candesartan.
Diagnosis?

A

Renal Artery Stenosis
───
(this is how it is tested)
Glomerulus is drained by efferent arteriole
In Renal a stenosis you bring in less blood via afferent a. to glomerulus → thus lowering Hydrostatic pressure.
→ Adding an ACE-I or ARB → dilates the efferent arterial → further reducing hydrostatic pressure in glomerular capillaries → resulting in ↓ GFR and ↑ Cr

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20
Q

Neurologic sxs present in a pt with a hx of small bowel resection
Diagnosis (cause of sxs)?

A

Vitamin B12 deficiency
(especially if Crohn’s hx)

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21
Q

2 yo boy that screams and cries profusely when he begins kindergarten.

A

Separation anxiety
Provide reassurance

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22
Q

Predominant mode of physician compensation in the US

A

Fee for Service

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23
Q

Method of CMS (center for medicare services) physician reimbursement that emphasizes quality improvement

A

→ Value- Based Care

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24
Q

Classic drugs used in the management of HIT on NBMEs?

A

Direct Thrombin (2a) inhibitors (agatroban, dabigatran)
───
or rarely Factor 10 inhibitor (apixiban)

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25
Q

40 yo obese F presents with painful draining lesions under the axilla that have not responded to 1st and 2nd line treatment.

Dx/NBSIM/ List the 1st & 2nd line tx
What Glands affected?

A

Hidradenitis Supparativa

1st Antibiotics (Topical Clindamycin or PO Tetracycline)
2nd Steroid injection
NBSIM IS 3rd line tx, Surgery

apocrine sweat glands are inflamed

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26
Q

Most susceptible region of colon to infarction from vessel thrombosis/systemic hypoperfusion

A

Left Colic Flexure (Splenic flexure) watershed area of supply

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27
Q

Right heart failure s/t Pulmonary HTN, COPD, CF, OSA etc.

A

Cor Pulmonale
(RHF s/t pulmonary cause)

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28
Q

Management of seborrheic dermatitis

A

Selenium sulfide shampoo

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29
Q

Most common location of a carcinoid mass?
Spreads to ____ becoming symptomatic.

A

Appendix

Spreads to Liver causing sxs:
Flushing
Wheezing
Diarrhea
RH valve issues
high levels of 5-HIAA

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30
Q

Most important nutritional intervention in the treatment of hemorrhoids

A

add FIBER

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31
Q

E’lyte abnormalities found in a patient vomiting.

A

Hypocholermic, hypokalemia metabolic alkalosis
(volume depletion causes high aldosterone)

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32
Q

Risk of a boy becoming a hemophiliac if his mom is a carrier and his dad is not.

A

50%

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33
Q

Perioral cyanosis 3 hrs after receiving bupivacaine in an axillary nerve block
dx/tx?

A

Methemoglobinemia
Tx: Methylene Blue

SaO2 low + PaO2 nl
───
CN poisoning = SaO2 nl + PaO2 nl
CO poisoning = SaO2 low + PaO2 nl

34
Q

What should be done on NBMEs in a HIV negative individual who is a partner of a HIV+ individual?

A

Pre-Exposure ppx
Emtriatabine + Tenofovir
± Raltegravir

35
Q

Treatment of herpetic whitlow?

A

PO Acyclovir

36
Q

Diagnostic test for BP-Positional Vertigo.

& Treatment maneuvers

A

Dxt: Dix-Hall Pike test
Tx: Epley or Semont Manuever

37
Q

In a patient with a stroke, what is the Blood Pressure value you should aim to stay below of?

What drug should be used in achieving this goal?

A

<220/120 (permissive HTN)

Labetalol

—-
FYI: AHA guidelines say stroke pts not qualified for TpA or thrombectomy are allowed permissive HTN to < 22/120. Pts who are qualified should have BP lowered to <185/110 before treatment is initiated.

In acute ischemic stroke pt with cardiac comorbidities may need emergent BP reduction no more than 15% of initial BP within 24 hrs)

38
Q

Long time smoker with bilateral calf pain
Dx/Dxt/tx(3)?

A

Peripheral Artery Disease
1st → do ABI
*if less than 0.7 = PAD confirmed
*if ABI is ↑/wnl → Toe Brachial Index → Monkeberg Calcific sclerosis
Tx strategies:
1st line: Supervised walking/ exercise program
2nd line: Cilastozole (antiplatelet + vasodilator)
3rd line→ get CT Angio of extremity for Surgical planning

39
Q

If pt with suspected PAD has an
Elevated or Normal ABI
NBSIM/Dx?

(Normal ABI: 0.9 –1.4)

A

Toe Brachial Index
Monkeberg Calcific sclerosis

40
Q

Pt presents with calf pain on exertion + Buttock pain + Erectile Dysfunction.
Dx?

A

Aorto-iliac disease
(aka Leriche syndrome)

41
Q

Pt diagnosed with PAD and started on supervised exercise program.
NBSIM?

A

start a STATIN
to prevent CVD events
──

(technically, they also need an Aspirin, but NBME doesn’t care)

42
Q

Treatment for pancreatitis s/t hyperTG

A

Fibrates

43
Q

Sudden onset severe chest pain
Widened mediastinum
Left Pleural effusion
± Hoarse voice

Dx/ NBSIM (if pt is stable vs unstable)

A

Aortic Dissection
unstable: TEE
stable: CT Angio chest
───
R. Laryngeal n. dmg → vocal cord paralysis, respiratory failure, hoarse voice

44
Q

Management of Aortic Dissection
Type A → ascending aorta ± descending aorta involved
Type B → only descending involved

A

A → Surgery + Beta blocker

B → Beta blocker + Observation

(labetalol, sotalol, metoprolol)

45
Q

Aortic Dissection BRFs (~4)

A

HTN
Marfans
Ehler’s danlos
3º Syphilis (Aortitis)

46
Q

Infertility in a Cystic Fibrosis male vs Cystic Fibrosis female is due to what?

A

Male → Agenesis of Vas Defrens
Female → Thick Cervical Mucus

47
Q

Female with Benign adnexal mass, ascites & pleural effusion (TRIAD)
Sxs resolve after resection of mass

Dx?

A

Meig’s Syndrome

48
Q

5F child + foul smelling vaginal discharge
↑ Wbcs
Dx?

A

Vaginal Foreign Body

(kids do the grossest things)

49
Q

Loss of peripheral vision first then central vision
dx?

A

Glaucoma

Risk factors include → Steroid use + Diabetes

50
Q

Loss of central vision first then peripheral vision
dx?

A

Macular Degeneration

51
Q

Presents with headache, eye pain, nausea, and decreased visual acuity.
Exam → Red eye + Rock Hard , Firm Eyeball + fixed, mid-dilated pupil
dx/tx(2)?

A

Angle Closure Glaucoma
Muscarinic Agonist (Pilocarpine)
+
Laser Iridotomy

52
Q

Contraindicated exam in pt’s with Acute Angle- Closure Glaucoma?

A

Dilated Eye Exams
───
pupillary dilation from anticholinergic medications (Tolterodine), sympathomimetics, or low ambient light.

53
Q

Open Angle Glaucoma (Chronic)
Treatment options (4)

A
  • Prostoglandin analogs (Latanoprost, Bimatoprost)
  • Alpha 2 agonist (Aproclonidine, Brimonidine)
  • Beta Blocker (Timolol)
  • CAH inhibitor (Acetazolamide, Dorzolamide)
    ───
    Prostaglandin analogs dilate canal of schlemm to incr drainage → it also increases eye-lash growth :)
54
Q

33 F presents with a 12 hour history of severe groin pain.
Recently received Cefazolin for an infection.
Urine pH 7.1 (basic)
CT pelvis → Large stone in renal pelvis
Dx/Bug/NBSIM?

A

Staghorn Calculi
Proteus Mirabilis (Ureas bugs → makes urine basic)
Surgical Removal of stone

~normal urine pH: 5– 7
(approaching these values is concerning)

55
Q

Aside from not moving position for long periods of time what else is a big risk factor for the development of Pressure (Decubitus) ulcers and their impaired healing?

NBSIM if muscle or bone are visible in the ulcer?

A

Poor protein/nutrition
Caloric Nutritional Support is necessary for wound healing

Debride Ulcer

————-

FYI: poor nutrition impairs wound healing after surgeries too

56
Q

23 yo Norwegian immigrant presents with a 6 hr history of severe RUQ pain & N/V.
Physical exam: tachycardia & scleral icterus
↓ Hct is 24%
↑ Total bilirubin 8 (Indirect>direct)
Multiple family members have required blood transfusions
Patient is up to date on the pneumococcal, meningococcal, and H.Flu vaccine series.
Dx/Tx?

A

Hereditary Spherocytosis (AD)
Splenectomy

(Autosomal Dominant congenital hemolytic disorder → RBC are vulnerable to osmotic stress)

Negative Coombs test in HS eliminates autoimmune Hemolytic Anemia

note: TTP is also coombs Negative however HS has ↑MHHC unlike TTP

57
Q

Hereditary Spherocytosis (AD)
results from a mutation in __ & ___ proteins
resulting in excessive hemolysis of RBCs by splenic macrophages (MQs).

A

SPECTRIN
ANKRIN
(band proteins)

58
Q

Finding can be seen in Cushing dz and Addison’s dz

A

Hyperpigmentation

59
Q

Cushing Syndrome: Adrenal cortex adenoma
Buffalo Hump & Moon Faces
__ Cortisol & __ ACTH

Addison: Adrenal insufficiency
Hyperpigmentation, Fatigue, GI sxs
Hyperkalemia/Hyponatremia (low Aldo)
↓ Bicarb
__ Cortisol & __ ACTH
+ one unique lab value in Addison’s that may be given?

A

Cushing: ↑ Cortisol & ↓ ACTH
Addison: ↓ Cortisol & ↑ ACTH
+ ↑ Eosinophils

60
Q

Diagnostic test for pt w/ suspected Addison’s dz?

Treatment for Addison’s (2)?

A

Cosynotropin (synthetic ACTH analog) test
If Cortisol does not rise = confirms Addison’s dz

Tx: Hydrocortisone (Replaces cortisol) & Fludricortisone (replaces Aldosterone)

61
Q

Diagnostic Steps for suspected Cushing’s dz

1st: Confirm they have adrenal excess (3)

2nd: Get serum ACTH levels to see if
-↓ ACTH Independent → NBSIM
- ↑ ACTH Dependent → NBSIM

A

1st pick one test

-Dexamethasone suppression (cortisol will not suppress)
-24hr urine cortisol
-Late night salivary cortisol
——————
2nd is it ACTH Independent or Dependent

↓ ACTH (independent) = adrenal adenoma making cortisol → CT or MRI Abdomen/Adrenals

↑ ACTH (dependent) = pituitary or lung tumor secreting too much ACTH → High Dose Dexamethasone suppression test
———
Results of high dose Dex test

↓ Cortisol → Pituitary adenoma making ACTH (Cushing’s dz) → MRI Brain

↑ Cortisol → Paraneoplastic disorder (Small Cell Lung Cancer) → Chest CT

62
Q

Acute cholangitis Pentad:
____ + ____ + ____ + RUQ pain + Jaundice

Labs/Imaging findings :
↑ Direct Bilirubin
↑ LFTs
± Anion gap metabolic acidosis s/t LDH in sepsis.
Dilated CBD

Tx ?

A

Fever + Hypotension + AMS

Tx: ERCP

63
Q

Abdominal Pain + N/V

Abdominal x-ray shows dilated loops of small bowel and air in the intrahepatic bile ducts
Dx/Tx?

A

gallstone ileus (s/t biliary-enteric fistula)
Enterolithotomy

a form of mechanical small bowel obstruction causing pneumobilia (air in the biliary tree)

64
Q

infection of the gallbladder wall with gas-forming bacteria &
Air within the gallbladder wall
Requires emergency cholecystectomy
Dx? Risk factors (2)

A

emphysematous cholecystitis
BRF: DM, Atherosclerosis
(Clostridium, E. coli )

65
Q

Teenager with episodic jaundice provoked by physiologic stress like illness or hunger.
No RUQ pain
↑ Unconjugated (Indirect) bilirubin
Normal LFTs/CBC

Dx?

A

Gilbert syndrome
No treatment required

↓ UDP glucuronosyltransferase activity = ↓ conjugation of bilirubin

66
Q

Pregnant patient
Acute Jaundice
Hypoglycemia
Fulminant liver failure & DIC
dx?

A

Acute fatty liver of pregnancy

67
Q

pRBC transfusions are recommended in acute GI bleeds for patients with hemoglobin <__ g/dL.

A

Hgb < 7

68
Q

Elderly pt + anemia + FOBT (+)
NBSIM?

A

Colonoscopy

69
Q

chronic (>2w) diarrhea + Anemia + ↑ESR/CRP
Dx/NBSIM?

A

Inflammatory bowel disease (IBD)
(Crohn disease, Ulcerative colitis)

Colonoscopy

70
Q

Elderly Pt + worsening LLQ pain + peritoneal signs
(rebound, rigidity, guarding)

Free air under diaphragm (KUB)

Dx?

A

Diverticular Perforation

71
Q

Elderly + chronic constipation + anemia + intermittent painless blood in stool/hematochezia
dx/NBSIM?

A

Diverticulosis (causing Diverticular Bleeds)
Colonoscopy

mcc of lower GI bleeds in adults

72
Q

Elderly pt + fever + LLQ abdominal pain + recent change in bowel habits
Labs
↑ Wbcs ± ↓ Hb
↑ BUN + Cr
↑ ESR/CRP
(+) FOBT

± tender, palpable mass
± Pyuria

Dx/NBSIM/Contraindicated test?

A

Diverticulitis
CT abdomen with IV contrast
colonoscopy is contraindicated

colonoscopy recommended 6–8 weeks after the resolution to r/o malignancy

73
Q

Typically asymptomatic but occasionally presents in elderly pt as changes in bowel habits + abdominal discomfort (usually LLQ sigmoid)

A

Diverticulosis

can result in diverticular bleed
+ anemia
+ Hematochezia
± abdominal pain

74
Q

hepatocellular pattern of liver injury (elevated AST/ALT, normal ALP).

List 7 causes for this pattern of liver injury

A

Viral Hepatitis
Alcoholic Hepatitis
nonalcoholic fatty liver disease (NAFLD)
Autoimmune Hepatitis
drug-induced liver injury
Ischemic hepatic Injury
Wilson dz
Hemochromatosis

75
Q

Intermittent scleral icterus + ↑ Direct Bilirubin + normal LFTs
dark granular pigments in hepatocytes
dx?

A

Dubin-Johnson syndrome

Impaired hepatic excretion of conjugated bilirubin

76
Q

Diabetes + Arthralgias + hyperpigmentation
↑LFTs
dx/tx?

A

Hemochromatosis (hepatic iron overload)
tx: Phlebotomy

Can be seen in Post-Menopausal women b/c no monthly bleeding (biological phlebotomy lol)

77
Q

anti- ADAMTS-13 antibodies are present

Thus there is not enough ADAMTS-13 around to combine w/ vWF Matalloprotease in order to inactivate vWF resulting in _______ .

Dx/finish describing the rest of the dz pathology

A

TTP
vWF is always active → ↓PLTs

(auto-immune dz)

78
Q

Fever + Neuro sxs +Hemolytic Anemia
+ Shistocytes (due to MAHA)
↓ PLTs ↑ Cr

dx/tx(2)?

A

TTP
1. Plasmapheresis
2. IvIg

79
Q
  1. How does TMP-SMX cause Hyperkalemia?
  2. How does it impede the degradation of Warfarin
A
  1. Sodium Channel blocker
  2. CYP2C9 inhibitor (which breaks down Warfarin)
    -↑ Warfarin
    -↑ INR (supratherapeutic)
80
Q

List one cause of Secretory Diarrhea
HY on NBME

A

Cholera Toxin
(Adenylate Cyclase)

81
Q

List one cause of Osmotic Diarrhea
HY on NBME

A

Lactose Intolerence
Dumping syndrome

82
Q

Enteric cancer associated with Celiac Dz (gluten-intolerence)

A

T-cell Lymphoma

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