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Level 2 COMLEX CE > Level 2 CE > Flashcards

Level 2 CE Flashcards

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1
Q

Damage to the ___ of the brachial plexus, most commonly seen with thoracic outlet syndrome or trauma, would cause numbness/pain in the fourth and fifth digits.

A

lower trunk brachial plexus

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2
Q

The median nerve innervates what muscles?

A 
LOAF:
lumbricals (first and second)
opponens pollicis
abductor pollicis brevis
flexor pollicis brevis.
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3
Q

Presenting sx of tender adenopathy and linear excoriations on the arm with social history of pets (dog, cat, bird) suggest infection from what organism?

A

cat-scratch disease caused by Bartonella henselae.

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4
Q

Gram-negative bacterium causing fever, chills, headache, muscle aches, and a dry cough in humans, especially with social history related to birds.

A

Birds are the natural reservoir for Chlamydia psittaci. The organism is a gram-negative bacterium that causes fever, chills, headache, muscle aches, and a dry cough in humans.

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5
Q

Dx of postterm pregnancy rests on establishment

of ___.

A

the correct gestational age

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6
Q

In otherwise healthy pt w clear microadenoma causing Cushing syndrome, tx of choice: __.

A

transsphenoidal resection of the adenoma

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7
Q

Five major causes of metabolic alkalosis:

A 
Loop diuretics
vomiting
renal insufficiency
hyperaldosteronism (aka Conn syndrome)
antacids
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8
Q

pH, pCO2, and HCO3 findings in a pt with metabolic alkalosis?

A
  • pH elevated (basic)
  • pCO2 elevated (respiratory compensation)
  • Bicarb > 28 (elevated)
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9
Q

Pt presents with asymptomatic hypercalcemia. What is first test to run, and what is indicated if elevated?

A

serum parathyroid hormone; if elevated, indicates dx of primary hyperparathyroidism, which is caused by parathyroid adenoma.

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10
Q

The MCC of hypercalcemia are hyperparathyroidism and __.

A

squamous cell carcinoma, usually of the lung.

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11
Q

Pt w HIV presents with red/purple papules and plaques in the hard palate of the mouth and lower extremities. Dx/etiology/tx?

A

Kaposi sarcoma, HHV-8.
Biopsy to confirm.
Start on antiretrovirals.

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12
Q

Pt presents with ear pain, itching, and pain with mvmt of tragus/pinna. Dx and etiology?

A

Otitis externa

Pseudomonas

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13
Q

Pt presents w ear pain following URI. Exam reveals bulging, erythematous tympanic membrane. Dx/MC etiology/tx?

A

Otitis media;
S pneu, H influ, M cata
Tx: amoxicillin; if mild, may observe for 48-72 hours.

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14
Q

Two possible sequelae of untreated otitis media:

A

mastitis and cholesteatoma

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15
Q

Pt with ear discharge and hearing loss. Exam shows retraction pocket on tympanic membrane.
Dx/Cx/Tx?

A
  • cholesteatoma
  • keratin accumulation
  • surgical removal
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16
Q

Elderly pt with increasing difficulty reading. Fundoscopy reveals yellow deposits clustered around macula in both eyes. Dx?

A

dry age-related macular degeneration

Presents as progressive loss of central vision.

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17
Q

Elderly pt with dry age-related macular degeneration has yellow deposits of extracellular material called ___ around the macula.

A

drusen

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18
Q

Wet age-related macular degeneration is characterized by __.

A

growth of abnormal blood vessels into the subretinal space. These disorganized, leaky vessels lead to abnormal fluid or blood collections, causing rapid vision loss.

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19
Q

Central vision loss is (rapid/slow) in (dry/wet) age-related macular degeneration.

A

rapid in wet

slow in dry

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20
Q

Visual distortion of straight lines (as detected in an Amsler grid) is a cardinal sign of (vision ds) __.

A

wet age-related macular degeneration

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21
Q

Vitamin __ deficiency results in inadequate production of __, which facilitates vision in low-light conditions.

A

rhodopsin

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22
Q

HTN, w or wo hypokalemia, is the hallmark of excess ___ secretion.

A

aldosterone

HTN and hypokalemia are the hallmarks of excess aldosterone secretion.

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23
Q

___ sign is increased pain and involuntary hip/knee flexion with passive neck flexion.

A

Brudzinski’s sign

meningitis

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24
Q

___ sign: increased neck pain and resistance to knee extension when hip flexed to 90 degrees.

A

Kernig’s sign

meningitis

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25
Q

Three steps to initial mgmt of suspected bacterial meningitis:

A

blood cultures;
empiric antibiotics;
empiric corticosteroids.

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26
Q

Clinical features of this syndrome include intellectual disability, classic facial features (long face, large ears, and prominent jaw), and connective tissue abnormalities.

Name ds and dx.

A

Fragile X

Diagnosis by chromosome testing, which reveals CGG repeats.

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27
Q

Classic facial features of fragile X syndrome include ____.

A

long face, large ears, and prominent jaw

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28
Q

Pt with meningitis age 1-24 months.

MC causal organisms and empiric antibiotic tx

A

S pneu, H influ, N meningitis.

Tx: vancomycin & 3rd gen cephalosporin

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29
Q

Pt with meningitis 2-50 yoa.

MC causal organisms and empiric antibiotic tx

A

S pneu
N meningitis.

Tx: vancomycin and 3rd gen cephalosporin

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30
Q

Pt with suspected meningitis.

What patients would receive vanco, ceftriaxone, and ampicillin - and why?

A

Pts > 50 yoa

Vanco for S pneu
Ceftriaxone for N meningitis
Ampicillin for Listeria

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31
Q

Neonates < 1 month old with meningitis.

MC organisms and empiric tx?

A

GBS
E coli
Listeria

ampicillin and cefotaxime

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32
Q

What is appropriate tx for complicated cystitis?

A

fluroquinolone

7-14 days

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33
Q

Urinanalysis with WBC casts suggests dx of __.

A

pyelonephritis

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34
Q

Urinanalysis with RBCs and RBC casts suggests dx of __.

A

glomerulonephritis

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35
Q

Bands are less mature neutrophils. The term “left shift” means bands, aka stabs, are increased, indicating ___ in progress.

A

infection

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36
Q

Pt presents with chest pain, radiating to neck or arm, associated with diaphoresis or nausea.

Dx?

A

Acute coronary syndrome
(unstable angina or acute MI)

diaphoresis = profuse sweating

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37
Q

Pt with orthopnea, paroxysmal nocturnal dyspnea, and lower leg edema?

A

congestive HF

orthopnea = SOB worse when lying down

paroxysmal nocturnal dyspnea = awakening at night with SOB

38
Q

Pt presents with hx of smoking, sx of cough and wheezing improved by bronchodilator inhalers. Dx?

A

COPD

39
Q

Pt with documented ethylene glycol (antifreeze) poisoning. MOA of Tx?

A

Alcohol dehydrogenase inhibitor (fomepizole), which reduces generation of toxic metabolites in the liver.

Bicarb also administered as pt will be in anion-gap metabolic acidosis

40
Q

C. diff colitis vs gastroenteritis

Which has localized pain?

A

C diff colitis pain is localized.

Gastroenteritis pain is diffuse

41
Q

DDx for female pt with suspected appendicitis?

A 
appendicitis
ovarian torsion
diverticulitis
ectopic pregnancy
Crohn's ds
42
Q

DDx for pt with lower extremity swelling and pain?

A
  • DVT/claudication
  • venous insufficiency
  • peripheral artery ds
  • Baker cyst
  • superficial thrombophlebitis
43
Q

DDx for pt with pain on lateral elbow?

A
  • lateral epicondylitis
  • medial epicondylitis
  • gout
  • bursitis
44
Q

DDx pt with neuro deficits?

A
  • TIA or Stroke
  • subarachnoid hemorrhage
  • epidural hemorrhage
  • Bell’s palsy
45
Q

What is the DDx for a health preventative visit?

A
  • smoking cessation
  • hyperlipidemia
  • DM
  • HTN
46
Q

What is the DDx for a patient with benign prostatic hyperplasia?

A
  • BPH
  • prostatitis
  • cystitis
  • prostate cancer
47
Q

What is DDx for pt with RUQ pain?

A
  • biliary colic
  • cholecystitis
  • cholangitis
  • choledochelithiasis
48
Q

Pt presents with chest pain with exercise relieved by rest. Dx?

A
  • stable angina
  • GERD
  • unstable angina
  • MI
49
Q

Pt presents with tingling in hand. DDx?

A
  • carpal tunnel syndrome
  • cervical radiculopathy
  • peripheral neuropathy
  • tenosynovitis
  • cubital tunnel syndrome
50
Q

Pt presents with HA. DDx?

A
  1. migraine headache
  2. tension headache
  3. sleep deprivation headache
  4. somatic dysfunction of the cervical spine
  5. craniosacral somatic dysfunction
51
Q

Pt presents with sinusitis. DDx?

A
  • sinusitis
  • viral URI
  • allergies
  • acute bronchitis
52
Q

Three EKG findings indicative of pulmonary embolism?

A
  • S1Q3T3 (S wave in lead one, Q wave in lead three and INVERTED T-wave in lead three)
  • transient right bundle branch block, -T-wave inversions in V1-V4
53
Q

ST elevation in leads V1-V6. Which artery is involved?

A

left anterior descending

Anterior MI

54
Q

ST elevation in leads II, III, and aVF. Artery and wall affected?

A

Right coronary artery

inferior wall MI

55
Q

ST elevation in leads 1, aVL, V5, and V6. Which wall and artery are affected?

A

Lateral wall MI

Left circumflex artery

56
Q

ST elevation in V7 –V9.
ST depression in V1 –V3 with tall R waves.
Wall and artery affected?

A

Posterior wall MI.

Right circumflex artery

57
Q

Which cardiac marker is best when checking for reinfarction of cardiac muscle?

A

Troponin I is the most specific but to check for reinfarction use CK-MB since that’s the one that elevates first

58
Q

What are three cardinal symptoms suggestive of aortic dissection?

A
  • pulse and BP differ from side to side

- New diastolic heart murmur

59
Q

Tachycardia or HTN can appear with an acute MI because of increased __.

A

circulating catecholamine levels

60
Q

What is the standard of care tx in pts with acute unstable angina?

A 
MASH BAN
Morphine
Angiography with PCI
Statin
heparin
Beta blocker
aspirin
Nitroglycerin (sublingual)
61
Q

Which 4 conditions preclude beta-blockers in pts with suspected MI?

A
  • hypotensive (e.g. in shock)
  • acute heart failure
  • evidence of high-grade (2nd-3rd degree) heart block
  • active wheezing from asthma
62
Q

In conceptual terms, what causes syncope?

A

People faint when cerebral blood flow is decreased.

63
Q

EKG findings of depressed ST segments and inverse T waves may indicate ___.

A

ischemia of cardiac tissue.

64
Q

Jugular venous distention is an indicator of __.

A

cardiac volume overload.

65
Q

What extra heart sound is associated with increased filling pressures and CHF?

A

S3, early diastole rapid ventricular filling phase

66
Q

What extra heart sound is associated with ventricular hypertrophy?

A

S4 - atrial “kick” in late diastole

67
Q

What heart condition is associated with a crescendo murmur with midsystolic click?

A

mitral valve prolapse

68
Q

Which heart condition is associated with head bobbing?

A

aortic regurgitation

69
Q

The cause of edema in CHF is ___.

A

increased hydrostatic pressure

70
Q

Fatty casts on urinanalysis support dx of __.

A

nephrotic syndrome

71
Q

A muddy brown granular cast on UA supports a dx of __, which can be caused by __.

A

acute tubular necrosis

prolonged hypotension from any cause

72
Q

How does acyclovir cause renal tubular obstruction?

A

The kidney rapidly excretes acyclovir into the urine, but the drug has low urine solubility - thus easily precipitating in renal tubules, causing obstruction and direct renal tubular toxicity. More common with IV acyclovir than oral.

73
Q

Amikacin

Drug class, indication, and ADV?

A

aminoglycoside

Gram-negative infections

potentially nephrotoxic and ototoxic

74
Q

Acyclovir is more likely to cause crystalline nephropathy if ___ is not provided.

A

adequate hydration

75
Q

What is the MCC of gross hematuria in adult smokers > 35 yoa?

A

bladder cancer

76
Q

MCC - and tx - of abnormal hemostasis in pts with chronic renal failure?

A

platelet dysfunction

desmopressin to increase release of von Willebrand factor from endothelial storage.

77
Q

Most important intervention for preventing contrast-induced renal failure?

A

adequate pre-CT IV hydration

78
Q

What is the MC COD in dialysis patients and renal transplant patients?

A

cardiovascular disease

79
Q

Prolonged infusion of (heart med) can cause cyanide poisoning. (antidote)

A

sodium nitroprusside

sodium thiosulfate

80
Q

Treatment for hypovolemic hypernatremia?

A

IV normal saline (0.9%) to start, then switch to 5% dextrose once uvolemia is reached.

81
Q

Tx for lithium-induced diabetes insipidus?

A

salt restriction and stop the lithium

82
Q

Nephropathy is preceded by excess proteinuria, initially ___, which makes ___ an effective screening tool.

A

microalbuminuria

random urine for microalbumin to creatinine ratio.

83
Q

What is the earliest renal anomaly present in pts w DM?

A

glomerular hyperfiltration, which is also mech of injury in these pts. Causes intraglomerular HTN leading to progressive glomerular damage and renal function loss.

84
Q

Breathing sounds of crackles are associated with (2) __.

A

pulmonary edema

PNA

85
Q

Rattling sounds in the airway are called __.

A

rhonchi

86
Q

Wheezing on PE suggests ___, as in (3): __.

A

reactive airways,
as in COPD,
mucus production,
asthma

87
Q

Egophany means ____ and could indicate findings of (1): __.

A

E sounds like A

pulmonary consolidation

88
Q

Positive tactile fremitus means ___, and could indicate findings of (1): __.

A

chest vibrations while speaking are stronger over one area than another

pulmonary consolidation in area of loudness

89
Q

Positive findings of whispered pectoriloquy mean ___, and could indicate (1) __.

A

whisper sounds louder over one area than another

pulmonary consolidation in area of loudness

90
Q

Chest exam reveals areas of dullness to percussion and diminished breath sounds could indicate (1) __.

A

pleural effusion

91
Q

The first test in a suspected acute stroke is __.

A

CT without contrast to rule out hemorrhage.

Level 2 COMLEX CE (3 decks)

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