Lessons from FORM 5 NBME Flashcards
Is a disorder of RBC membrane proteins that limits the ability of the cell to confrom when passing through small capillary beds
hereditary spherocytosis
Hereditary spherocytosis results in _____________________ anemia caused by extravascular hemolysis
normocytic hemolytic anemia
A ________________________ will reduce the degree of premature RBC consumption in a pt with hereditary spherocytosis
SPlenectomy
_____________________ occurs post transfusion because of the presence of preformed antibodies to donor leukocyte antigens and occasionally from cytokines in the plasma component of the transfused sample. This can range from mild to severe.
Febrile Nonehemolytic transfusion reaction
_______________ occurs when an abnormal fraction of hemoglobin in the blood exists in the ferric form
Methemoglobinemia
A pt is undergoing a cholangiopancreatography with benzocaine spray for analgesia. A few minutes into the procedure she becomes mildly confused and cyanotic. Why would oxygen and administration of methylene blue improve her condition?
Nuchal rigidity in the setting of a brain bleed should point to a hemorrhage where?
Subarachnoid
Reflex observed in the setting of increased intracranial pressure often in the setting of impending herniation
cushings reflex
Immediate treatment to decrease ICP inlcludes administration of _________________ and _________________, hyperventilation, and elevation of the head.
Mannitol and hypertonic saline
______________ commonly presents with symptoms of hearing loss, vertigo, and ataxia. Often slow onset and pregressive over a subacute to chronic period.
Acoustic neuroma, vestibular schwannoma
Has grown over time.
Cavernous hemangioma
Septic arthritis treatment includes IV antibiotics plus ______________________
surgical incision and drainage
Someone with a bicuspid aortic valve is at increased risk for aortic stenosis why?
Calcification of the valve overtime as it is a pathological consequence of mechanical stresses on heart valves and results from repetetive microtrauma.
Firstline antihypertensive medication used to decrease BP in the setting of presumed aortic dissection
labetolol
_______________- ulcers result from repetetive trauma or compression in areas of impaired sensation. These ulvers are commonly seen overlying bony prominences and in cases of peripheral neuropathy from DM.
Neurotrophic ulcer
Why is arteriography indicated after reduction of knee dislocation?
Posterior knee dislocation is highligh associated with arterial injury and additional studies are indicated to prevent delay in dx and tx.
terminal ileum inflammation
crohn
________________-oma cases chronic and profound watery diarrhea, electrolyte disturbances including hypokalemia, hypercalcemia, achlorhydria, alkalosis, flushing, and vasodialation.
VIPoma
How can you tell the difference between a VIPoma versus a glucagonoma vs insulinoma?
So they actually present quite differently.
VIPoma youll have diarrhea and facial flushing and electrolyte disturbances whereas glucagonoma will present with diabetes and a pareneoplastic rash like necrolytic migratory erythma, and weight loss. Insulinoma is sort of nonspecific. Pts will have symptoms of hypoglycemia/hyperglycemia and are often exacerbated by periods of fasting or exercise.
A zenker diverticulum occurs in the ____________, just above the level of the cricopharyngeus muscle
hypopharynx
Mechanism of formation includes an uncoordinated swallowing mechnism which results in muscle spasms of the cricopharyngeus
zenker (pharngoesophageal) diverticulum
pharngoesophageal diverticulum
zenker
A drunk comes in vomitting blood and you see varices and an ulcer on EGD. Pt BP is 90/40, pulse 130, and pt is dizzy. What is the most appropriate next step?
IV FLUIDS AND BLOOD TRANSFUSION
Placement of a transjugular intrahepatic portal shunt would be AFTER YOU GET THEM STABILIZED
You didnt address the immediate life threatening hypovolemia/hemoorhagic shock
COFFEE BEAN= SIGMOID VOLVULUS
What would you expect on labs for mesenteric ischemia?
leakocytosis and increased lactate
What can we give in the setting of exocrine pancreas insufficiency
Pancrelipase
This is just so you remember this exists, you werent exactly wrong but you werent right either
Most common type of nephro/ureterolithiasis
calcium oxalate
Having crohn disease increases a pt’s risk for what kind of nephrolithiasis formation?
CALCIUM OXALATE because their condition increases the absorption of oxalate!!!!!!!!
Why might someone with crohn disease be at increased risk for nephrolithiasis
because they have increased absorption of calcium oxalate
most common cause of unliateral bloody nipple discharge
intraductal papilloma
A pt with BRCA1 mutation wants to decrease their risk of cancer but does not wish to undergo surgery. Why would you NOT recommend simply doing tamoxifen therapy?
Tamoxifen is good for the prevention of breast cancer (not as good as mastectomy) but it has been hypothesized to increase the risk for ovarian cancer throught the development of ovarian cysts.
What is a sure fire way to decrease a pt’s risk of cancer in the setting of someone who has BRCA1 mutations?
Bilat mastectomy and oophorectomy.
Why do we see secondary hyperparathyroidism in pts with end stage renal disease?
Decreased excretion of phsophate leads to hyperphosphatemia leading to hypocalcium leading to upreg of PTH
what do we give to pts with a pheo to prevent hypertensive crisis?
Phenoxybenzamine, an irreversible alpha adrenergic blocker
Why is pitutitary adenoma associated with bitemporal hemianopsia?
Because of its proximity to the optic chiasm.
you didnt get this wrong, im just putting this here to remind you of such things
What kind of fluids do we give in the setting of burns?
ISOTONIC CRYSTALLOID SOLUTION ONLY
NOT COLLOIDS
Brady cardia +Hypotension versus Tachycardia +hypotension
Brady+hypo=neurogenic shock
tachy+hypo= hypovolemic
