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Missed questions 2 Flashcards

1
Q

Steps in delivering bad news

A

SPIKES
S - set up place, privacy, introductions
P - perception “what do you think is happening?”
I - Invitation to “how much would you like to know?”
K - give knowledge and info
E - empathetic statements, explore feelings, thoughts
S - strategy for follow-up/care

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2
Q

Abdominal mass in kid

  1. NOT cross midline
  2. Crosses midline
A
  1. Wilms - WAGR, US –> CT abd and chest

2. Neuroblastoma - 1st yr of life

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3
Q

Brain mass w/ concentric whorls and psamomma bodies

A

Meningioma

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4
Q

Stealing of objects of low monetary value or NOT needed for personal use

A

Kleptomania = psychotherapy

- shame, guilt –> return or give away items

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5
Q

Tx syphilis in pregnancy

A

PCN - desensitize if needed

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6
Q

Hx UC, watery diarrhea, burning erythematous rash on arms and legs b/l, hyperpigmented like a sunburn, tender + poor concentration, irritable

A

Niacin deficiency/Pellagra

- corn based diets

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7
Q

Dysmenorrhea –> chronic pelvic pain, bleeding, globular enlarged uterus <12wks in multip women over 40 y/o

A

Adenomyosis

  • 50% have concurrent fibroids
  • get bx to exclude endometrial CA

Fibroids = more irregular shaped uterus
- more mass effect sx - constipation, urinary frequency & NOT pain

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8
Q

Infertility, dysparenunia, dysmenorrhea in younger woman

A

Endometriosis

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9
Q

Diffuse thickening of GBM and subepithelial spikes

A

Membranous

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10
Q

Cause of back pain

  1. Normal neuro, negative straight leg
  2. Radiculopathy, possible + straight leg, neuro deficit
  3. Old woman w/ fall
  4. Better w/ activity, rest NOT help
  5. Worse at night, >50, cauda equina possible
  6. IVDU or DM w/ recent infection, fever, exquisite tenderness
A
  1. Mechanical - degen, spasm
  2. Disk herniation
  3. Compression fx
  4. Ankylosing - IBD, reactive, psoriatic = apophyseal joint arthritis
  5. CA
  6. Osteomyelitis
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11
Q

Persistent nosebleeds, ruby papules on lips, clubbing, polycythemia

A

Osler-Weber-Rendu = AVMs

—> shunt blood –> hypoxemia = clubbing and polycythemia, hemoptysis

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12
Q

Newborn w/ diffuse granular CXR, air bronchograms, hypoxemia dx and cause?

A

RDS

- prematurity, DM, C/S, asphyxia

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13
Q

Excess bleeding w/ normal PT, PTT, LFTs, platelet count

Inc Cr, BUN, BT

A

Uremic coagulopathy = renal failure –> platelet dysfxn

Tx = DDAVP which inc VIII & vWF

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14
Q

1st tx step in pt in HCV

A

Liver bx to guide tx

  • severe inflammation and fibrosis –> cirrhosis BUT usually respond better to tx
  • antivirals = peg-IF + ribavirin
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15
Q

HBV & HCV progression to HCC

A 
HBV = w/o cirrhosis
HCV = w/ cirrhosis = get US q6mo
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16
Q

Smoker + clubbing and sudden onset b/l wrist pain

A

Hypertrophic osteoarthropathy

—> CXR for lung CA, TB etc…

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17
Q

Young male w/ pain over heel, iliac crests, tibial tuberosities, shoulder pain stiffness

A

Enthesititis - inflammation where tendon meets bone = ankylosing spondylitis
- Assoc w/ limited spine mobility

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18
Q

Steps in tx of acne

A

Topical retinoids + benzoyl/salicyclic acids

Topical Erythromycin or Clinda

Oral Abx

Oral isotretinoin

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19
Q

Heat stroke vs. Heat exhaustion

A

Stroke = >104, AMS
Exertional –> ICE WATER IMMERSION
Non-exertional –> evaporative cooling

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20
Q

Re-warm cold extremity

A

Warm water

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21
Q

SB resection, TPN, alopecia, no taste, pustular lesions around mouth

A

Zinc deficiency

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22
Q

HTN + hypoK 1st step

A

Measure renin & aldosterone

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23
Q

Dec renin, inc aldo w/ A:R >20 cause, Aldo >15

A

Primary hyperaldosteronism –> adrenal CT

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24
Q

Inc in both renin and aldo w/ A:R ~10

A

Secondary hypseraldosteronism

- diuretic, CHF, renin tumor, coarctation, malignant htn or renovascular htn

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25
HIV pt CD4 <50 w/ yellow-white eye opacities and retinal hemorrhage
CMV
26
HIV pt w/ necrotizing retinitis, white fluffy lesions around retina
Toxo
27
Types of abortion 1. Bleeding, closed cervix, no heart tones 2. Cramping, bleeding, open cervix, possible heart tones 3. Cramping, bleeding, products visualized, open cervix 4. Bleeding, closed cervix, + heart tones
1. Missed --> Pelvic US --> C&D 2. Inevitable 3. Incomplete 4. Threatened
28
PAS+ and diastase resistant hepatocyte inclusions
alpha-1-antitrypsin
29
Brief LOC + lip smacking, swallowing, picking + post-ictal confusion, normal EEG
Complex partial seizure
30
EEG 3Hz spike and wave
Absence - may have automatisms like lip smacking but DONT have post-ictal confusion - Atypical is <2.5Hz
31
Kids, U/L or B/L jerking in the AM
Juvenile myoclonic epilepsy - sleep deprivation
32
EEG slow spike and wave
Lennox-Gaustat
33
Vit D, Ca, Phos, PTH finding in pts with celiac or other intestinal malabsoprtion syndrome
Low Vit D d/t malabs --> Low Ca, Phos abs | High PTH
34
EPS Sx & Tx 1. Acute neck, mouth, tongue, eye contractions 2. Restlessness 3. Tremor, rigidity, bradykinesia, masked face
1. Acute dystonic rxn = benztropine, diphenhydramine 2. Akasthisia = propanolol 3. Parkinsonism = anticholinergic or amantadine
35
Complication in bronchiectasis
Hemoptysis | - massive may require bronchial a. embolization
36
Excessive anxiety over one or more unexplained sx & willing to undergo invasive testing
Somatic sx disorder
37
Fear of having a serious illness despite negative testing and no actual sx
Illness anxiety disorder (hypocondriasis)
38
Stress w/ neurologic sx not consistent with any known neurologic disease, person may be indifferent
Conversion disorder (functional neurologic sx disorder)
39
Young woman, ovulation induction, hx ovarian cyst w/ sudden R sided pelvic pain, adnexal tenderness, (-) hcg
Adnexal torsion --> doppler US --> emergency laparoscopic surgery
40
Type of study w/ 2+ experimental interventions (ACE, BBs) each w/ 2+ variables studied independently (high BP, low BP)
Factorial design
41
Type of study where 2 groups try one tx and then switch
Cross-over
42
Dec in Non-ionoized/albumin-bound/inactive Ca for every 1g/dL dec in serum albumin
0.8mg/dL
43
Hyperreflexia on L, L hemiparesis, eyes deviated to R lesion
Right cerebral lobe Basal ganglia eyes point toward hemiparesis
44
1+ proteinuria, RBCs and RBC casts, normal complement levels, recent URI, #1 GN in adults
IgA nephropathy
45
Eosinophiliuria, WBC casts
Drug-induced interstitial nephritis
46
Acid-base findings in aspirin toxicity (tinnitus, fever, tachypnea, N/V)
Mixed resp alkalosis and metabolic acidosis pH 7.36 PCO2 22 HCO3- 12
47
CA, PA or UT construction site w/ baby floppy, sluggish, drooling, ptosis, weak suck and gag reflex
C. botulinum SPORE ingestion for enviro ---> human derived Ig Toxin in honey ---> equine derived Ig
48
Tx for acute thoracic aortic dissections
Labetalol Ascending (type A) = surgery + medical Descending (type B) = medical alone
49
ARDS pt on vent w/ PEEP 15, FiO2 0.6 --> tachy, SBP 90, inc CVP, absent breath sounds
Tension pneumothorax d/t excessive PEP
50
AIDS, chemo pt w/ exophytic purple skin masses w/ a collarette of scale on lower abd + several liver masses + bx ---> severe hemorrhage
Bartonella - Bacillary angiomatosis
51
Microcytic anemia with normal RDW
B-thal - microcytosis <75 - target and tear-drop cells (Fe has inc RDW)
52
Child fatigued and pallor, recent diarrhea tx w/ medication, purpura and petechiae, low platelets, RF, schistiocytes, giant platelets, inc LDH, indirect bili, retic count, urine w/ RBCs, WBCs, casts
HUS = microangiopathic hemolytic anemia
53
SOB, cough, DOE, dec breath sounds, bibasilar crackles occasional wheezes CHF vs. COPD
CHF - resp alkalosis, hypocapnia, hypoxia COPD - widespread wheezes + resp ACIDOSIS, hypoxia
54
Kid w/ Giardia and recurrent sinopulmonary infections since 6mo
abn B-lymphocyte maturation Lack of IgA = Giardia
55
Kids w/ staph, aspergillius infections
CGD - NADPH oxidase
56
Electrolyte abn in SAH or intracranial hemorrhage
HypoNa - SIADH-like syndrome, resolves in 1-2wks
57
Complication of nephrotic syndrome, 4+ proteinuria, edema, fatty casts
Hypercoagulability (renal vein thrombosis) - loss of AT-III, protein C, S - inc fibrin, platelet aggregation Iron deficiency d/t ferritin loss Vit D deficiency Dec TBG Inc infections
58
Hepatitis, etOH, Wilson disease w/ inc PT/INR >1.5, inc bili, inc AST, ALT 10x normal --> dec AST ALT + WORSENING PT/INR
Acute liver failure | - PT = #1 prognosticator in ALF
59
Stabbing in R face, ataxia falling to R, miosis, ptosis on R, dec gag reflex, hoarsness, loss of pain and temp on R face + LEFT trunk/limbs
Lateral Medullary syndrome | - PICA
60
Weakness of mastication, impaired sensation over face, impaired jaw reflex
Lateral Mid-Pons
61
CL arm and leg hemiparesis, tactile and position sense, IL tongue deviation
Medial medullary syndrome
62
CL ataxia of trunk and limbs and face
Medial pons
63
Drugs post UA/NSTEMI or PCI
``` Aspirin BBs ACE Statin Clopidogrel - 30d or 1yr w/ drug stent ``` LMWH 48hrs/prior to PCI in acute MI
64
Villous atrophy
Celiac | - IgA deficiency --> (-) endomysial or tissue transglutaminase ab
65
NST score tx 1. Oligohydramnios 2. 8 3. 6 4. 4 5. <4
1. deliver 2. Normal = repeat in 1 wk 3. Contraction stress test --> delivery or repeat next day 4. Lung mature = deliver; Steroids and repeat next day 5. Deliver
66
Enuresis tx
``` 1st = avoid fluids late, gold stars... 2nd = alarm 3rd = Oral Desmopressin ```
67
C-D systolic murmur on LSB w/o radiation
HOCM = IV septum hypertrophy
68
Defect in tubular HCO3 reabsoprtion
RTA-II | - acetazolamide or Fanconi anemia
69
Low tubular ammonium
RTA I | - can't excrete H+ --> no ammonium
70
ASA + nasal blockage + bronchoconstriction
ASA sensitivity syndrome (pseudo-allergy) --> inc LTs | --> tx w/ LT-inhibitors
71
Chronic NSAIDs w/ worsening renal function mech
Papillary necrosis & TUBULOINTERSTITIAL nephritis
72
RA tx and tests to run before tx
#1 = MTX - HBV, HCV, TB >6mo of symptoms w/ MTX --> TNF-a or possibly hydroxychloroquine or sulfasalazine
73
Angiogram, stent + blue toes, livedo reticularis + ARF + eosinophils but low complement
Cholesterol emboli
74
1st step in NEC
Abx to prevent sepsis
75
Endocarditis valve abn
Mitral REGURG or MVP
76
Adolescent cough to vomit dx and tx
Pertussis Nasopharyngeal culture Azitho or clarithromycin
77
Smoker, post-prandial pain, FOBT (+) --> adenocarcinoma next step?
CT scan
78
Amenorrhea, normal exam, obesity, normal TSH, prolactin, LH, FSH
Anovulation d/t obesity, no progesterone = no bleed
79
B/L carpal tunnel 1st step
TSH for hypothyroidism
80
Most likely polyp to be cancerous
VILLOUS > tubulovillous > tubular adenoma ``` hyperplastic = non-neoplastic Hamartomatous = juvenile or peutz-jager ```
81
HTN <20wks, edema
?Mole | Normal US = chronic HTN
82
Tx Hepatic Encephalopathy
K+ repletion (hypo --> inc ammonium production) Lactulose Rifaximin (if lactulose no work) Protein + diets
83
HTN urgency | HTN emergency
Urgency - >180/120 w/o end organ damage Emergency - Malignant HTN w/ papilledema or retinal hemorrhage - HTN ecephalopathy w/ neurologic signs
84
Dx & Tx of Histoplasmosis
Dx = urine ag Tx = Itraconazole or amphotericin B if >103.1
85
Parkinsonism, postural hypotension, impotence, dry mouth/skin, neuro signs
Multiple system atrophy
86
Blurred vision now vision loss in 1 eye, subclavicular bruit, HA, high ESR, blurred swollen optic disc
Giant cell arteritis --> high-dose steroids
87
Cough, non-caseating granuloma, peratracheal adenopathy
Sarcoid = steroids
88
Low O2 mech in PNA
V/Q mismatch or shunt Alveoli filled w/ debris = no O2
89
Periodic sharp waves on EEG
Crutzfeld-Jacob
90
Retrosternal pain radiating to back w/ stress and hot or cold food, relieved w/ nitro
Esophageal dysmotility
91
Infant w/ dec activity, dec feeding, unable to wake for feedings you should suspect
Sepsis

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