Mehl. Risk factors 3 cardio + pulmo occupational 04-06 (1) Flashcards
(35) 50F + subarachnoid hemorrhage; Q asks biggest risk factor?
HTN - most common overall in general population;
otherwise, if patient has ADPKS or Ehlers-Danlos, those would be more specific.
(36) 82F + wobbly gait for 4 months + head CT shows crescent-shaped bleed; what is biggest risk factor?
diagnosis is subdural hematoma; often slow-accumulating;
elderly have reduced cerebral volume, making superior cerebral (bridging) veins more susceptible to friability; other notable risk factors are alcoholism, dementia (further reduction in brain mass), deceleration injury (car accident or shaken- baby syndrome). There is no lucid interval.
(37) 14M + hits head while skateboarding + loses consciousness briefly + head CT shows biconvex-shaped bleed; what is major risk factor?
head temporal trauma resulting in rupture of middle meningeal artery.
(38) 81M + Alzheimer + recurrent hemorrhagic stroke; what is major risk factor for the bleeds?
Alzheimer -> can lead to amyloid angiopathy, causing intracerebral/intraparenchymal hemorrhage that presents as recurrent hemorrhagic stroke.
(39) 50F + has diabetic foot ulcer; Q asks how this condition could have best been prevented?
wearing comfortable-fitting shoes; wrong answer is nightly foot checks.
This is asked on 2CK NBME. Both are important to prevent foot ulcers, but if both choices are listed together, choose wearing comfortable-fitting shoes.
(40) 62F + smoker + HTN + pain in legs with walking + diminished peripheral pulses + punched-out ulcer on bottom of foot + ankle-brachial indices are reduced; Q asks, in addition to smoking cessation and BP control, which of the following is indicated for this patient?
recommend an exercise/walking program;
diagnosis is peripheral arterial disease (PAD).
(40) Since PAD is caused by atherosclerosis, we’d have the same risk factors as before – i.e.,?3
diabetes > smoking > HTN
(40) Since PAD is caused by atherosclerosis, we’d have the same risk factors as before – i.e., diabetes > smoking > HTN, with the caveat being that if the vignette hyper-emphasizes / pushes one risk factor onto you (e.g., they give you a 12-line paragraph where 10 lines are just about HTN), then obviously choose the emphasized factor.
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(40) PAD HY first step in diagnosis is?
measuring ABIs (<0.9 is diagnostic).
(40) PAD. After low ABIs are measured, the next step, if listed, is doing ?
an exercise stress test to determine exercise tolerance.
(40) PAD. If exercise stress test not listed, answer = recommend walking/exercise program. Do not
choose cilostazol first. This is a wrong answer almost always.
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(41) 51M + brawny edema and hyperpigmentation of lower legs + large, sloughy ulcer at left medial malleolus + peripheral pulses strong + ultrasound confirms diagnosis; Dx?
diagnosis is venous disease.
(41) 51M + brawny edema and hyperpigmentation of lower legs + large, sloughy ulcer at left medial malleolus + peripheral pulses strong + ultrasound confirms diagnosis; Q asks next step in management -> answer?
Compression stockings
(41) Biggest risk factor for venous disease is?
valvular insufficiency (often idiopathic/familial).
(41) venous disease - Dx?
USMLE wants duplex ultrasonography of the legs to diagnose,
(41) venous disease - Dx –> next step?
Ug followed by compression
stockings as next best step.
(41) venous disease.
If patient has active superficial thrombophlebitis (i.e., painful, palpable cord at the ankle), choose what Tx?
subcutaneous enoxaparin, not compression stockings as next best step. This must be treated with heparin, same as DVT. This is easy to get wrong, since compression stockings are the answer almost always for venous disease.
(41) venous disease.
Strong peripheral pulses tells you it’s not arterial disease (hence in this case, venous disease).
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(42) 50M + being treated for Hodgkin + develops cardiomegaly + bilateral crackles; what is most likely risk
factor for this acute presentation?
doxorubicin/Adriamycin causing dilated cardiomyopathy.
(43) 50M + being treated for Hodgkin + develops progressive dry cough + CXR shows reticulonodular pattern; what is most likely risk factor for this acute presentation?
bleomycin causing pulmonary fibrosis; reticular, or reticulonodular, or bilateral granular patterning = “honeycombing” = HY for pulmonary fibrosis.
(44) 50F + being treated for breast cancer + develops cardiomegaly; Q asks biggest risk factor?
trastuzumab causing cardiotoxicity
(45) 44M + worked in shipyard 20 years ago part-time + 6-month history of shortness of breath; CXR shows supra-diaphragmatic soft tissue densities; Q wants diagnosis?
asbestosis;
risk factor is working in construction involving insulation, or shipyards; pleural and supra-diaphragmatic plaques are HY for asbestosis; mesothelioma will present as grossly white cancer that circumferentially envelopes the lungs.
(46) 66M + worked in aerospace industry for 30 years + 1-year Hx of declining pulmonary function; biopsy of lung parenchyma shows non-caseating granulomas; Q asks diagnosis?
Berylliosis;
risk factor is working in aeronautical industry; this is one of the three HY lung conditions causing granulomas (sarcoidosis + berylliosis are both non-caseating; TB is caseating).
(46) Berylliosis - what important to know?
this is one of the three HY lung conditions causing granulomas (sarcoidosis + berylliosis are both non-caseating; TB is caseating).
(47) 32F + smoked for 5 years + loud P2 heart sound + JVD + bullous changes seen on CXR + father died of alcoholic cirrhosis; Q wants risk factor for this patient’s condition?
“deficiency of neutrophil elastase”;
diagnosis is cor pulmonale due to COPD from a1-antitrypsin deficiency; latter leads to pan-acinar emphysema (bullous changes on CXR are buzzy/HY for emphysema); can also cause cirrhosis; vignettes can absolutely mention smoking or alcohol Hx, where patients are at increased/accelerated risk for emphysema and cirrhosis (i.e., 5 years is too fast typically for COPD to develop). The loud P2 means pulmonary hypertension. JVD means we have right heart failure. Since the etiology of the right heart failure is pulmonary (i.e., not left heart), we call it cor pulmonale.
