NBME 10 Flashcards
What screening needs to be completed before starting TNF-a inhibitor therapy? i.e. for ulcerative colitis
Tuberculosis (due to risk of reactivation with latent infection)
Treatment of sickle cell anemia
Aggressive pain control, rehydration with IV fluids, supplemental oxygen
Shortness of breath after receiving large volume transfusion (4 units)
Transfusion related cardiac overload (TACO)
Young woman with headache for 2 days and confusion followed by seizure (Fever, AMS, seizure, focal neurologic deficits (aphasia, hemiparesis))?
Herpes simplex encephalitis
***temporal lobe findings on imaging
Stroke risk factors and tPA timeline eligibility
smoking, HTN, diabetes, carotid or atherosclerotic disease, hypercoagulability, afib, old age
- less than 4.5 hours- if you don’t know for sure they AIN’T a candidate
Unilateral lymaphadenopathy (single lymph node on neck purplish in hue that expands over weeks to months, biopsy showing granulomas( in immunocompetent child
Mycobacterium spp.
What meds do you avoid in right-sided heart failure?
Nitrates and opioid analgesics
PAD vs. venous insufficiency
PAD: pain better with dangling leg, ulcers on lateral side of leg (distal digits more likely); hair loss/shiny skin
venous insufficiency: pain better with leg elevation, ulcers on medial side of leg (near medial malleolus)
- venous varicosities, bronze discoloration of leg, leg heaviness/swelling
What testing should a pregnant woman with prior intrauterine fetal demise go through?
serial ultrasounds throughout pregnancy, screening for complicating medical conditions, non stress testing starting in 3rd trimester
What test is used to determine diabetic patient’s risk for diabetic nephropathy?
measurement of urine albumin concentration
diabetic nephroapthy begins as microalbuminuria and progresses to macroalbuminuria then to CKD
What can depress the progress of diabetic nephropathy?
ACE inhibitors
Cytomegalovirus presentations in immunocompromised people (severe ulcerative colitis, solid-organ/bone marrow transplantation, HIV/AIDs)
Colitis, retinitis, esophagitis, encephalitis, pneumonia
- *Intracellular inclusion bodies on histologic exam
tx: ganciclovir, acyclovir
Work up for new-onset afib
Tx: diltiazem (non-dihydropiridine CCB), metoprolol, anticoagulation for those with risk of stroke
Should assess for all reversible causes of afib.
Risk for afib: HTN, coronary artery disease, structural heart or valvular disease, PE, lung disorders (COPD, obstructive sleep apnea), stimulant abuse, hyperthyroidism
Initial evaluation: TSH, high amounts of alcohol intake
Acetaminophen or ketorolac for osteoarthritis?
Acetaminophen
Ketorolac is IM or IV so not good long term AND NSAID use not good long term b/c risk gastritis, peptic ulcer disease, diminished kidney function
Normal BMI
18.5-24.9
Multiple cholesterol emboli syndrome
Localized petechiae, lived reticularis, blue toe syndrome from emboli moving from larger arteries to smaller distal arteries (purplish black lesions over toes)
- histology of skin lesions would have needle-shaped clefts
- risk factors for dislodging clots= cardiac catheterization, aortic dissection
- *labs include increased creatinine and eosinophilia
- maltese crosses on UA (lipid droplets)
Initial step in management of peritonsillar abscess?
Immediate need aspiration to prevent airway compromise
- Then start IV antibiotics
Asthma lung study findings
FEV1:FVC ratio:
FEV1:FVC ration= decreased
Increased residual volume/total lung capacity (air trapping)
- decreased peak expiratory flow rate
Restrictive lung disease FEV1:FVC ratio
Increased (decreased compliance leads to greater initial expiratory force)
Most common pathogen of suppurative parotitis?
Staph aureus
Imaging presentation of sigmoid volvulus
Dilated, air-filled sigmoid colon
Patient on chronic steroids for dz w/ either recent surgery, trauma, or infection presenting with hypoglycemia, altered mental status, hyponatremia, tachycardia, and abnormal vasodilation
Consider adrenal crisis
Caustic esophagitis initial work/up and tx
EGD to assess for severity; if mild- liquid diet, if severe- NPO for 72 hours then repeat EGD
- NBME says gastric lavage with NG tube not widely recommended
Patient with hx breast adenocarcinoma presenting with focal to generalized tonic-clonic seizure, gaze preference, right lower facial droop, motor weakness, hypereflexia?
Brain metastasis
**lung, breast, colon, renal cell, melanoma
Person who appears to have gonorrhoeae has negative cultures- what do you do?
Keep current regimen- cultures imperfectly sensitive
Presentation and tx of pericarditis
Positional chest pain when leaning forward; ECG with diffuse ST segment elevations and/or PR segment depressions
- patients with hypotension/hypoxia should be evaluated with Echo to determine if there is pericardial effusion
Tx- high dose aspirin or NSAIDs with colchicine
How to lower likelihood of aspiration in patients with swallowing dysfunction?
Thickened liquids
Postpartum patient with signs of thyroiditis– tx?
Metoprolol/propranolol –> post partum thyroiditis usually presents with hyperthyroidism followed by hypothyroidism or hypothyroidism alone that usually goes away within a year; tx above helps
First line therapies for patients in cardiogenic shock
dobutamine, norepinephrine, dopamine
- at middle doses dopamine stimulates B1 receptors and augments cardiac output
What must be known in order to calculate NPV or PPV?
Disease prevalence; both vary with disease prevalence
TCA overdose sxs and tx
Sxs: confusion, delirium, cardiac toxicity (prolonged QT interval), anticholinergic toxicity (dry mouth, sedation, constipation, hallucinations, delirium, flushed skin, visual disturbances, dilated pupils)
Tx w/ sodium bicarb for cardiac toxicity and IV fluids for hypotension
Tx of acute MS flare vs. outside of flare
Acute: dexamethasone
Outside: interferon beta
Stroke risk factors - by importance level
Age= strongest nonmodifiable risk factor HTN= strongest modifiable risk factor
- smoking, diabetes, atherosclerotic disease, hypercoagulability, afib
Von willebrand disease presentation
mucosal bleeding in setting of normal platelet count, PT time, decreased factor VIII and increased bleeding time
-prolonged PTT can occur sometimes due to decrease in VIII (vwf transports VIII in plasma, degrades rapidly when unbound)
- Hemophilia A and inhibitor to factor VIII would present with MARKEDLY increased PTT
Felty Syndrome
Suspect in patients w/ uncontrolled seropositive RA that present with neutropenia, pleurisy, new-onset fevers, and splenomegaly
- Rituximab= tx of choice
L4 radiculopathy vs common peroneal neuropathy
L4 - Foot dorsiflexion, diminished patellar reflex, decreased sensation over medial aspect of leg
- Peroneal- food dorsiflexion (foot drop), eversion; sensory dorsal foot and LATERAL leg
Who receives antibiotic prophylaxis prior to dental procedures?
Tx- amoxicillin
Previous hx endocarditis, prosthetic valves, unprepared congenital cyanotic heart disease, valvular disease in transplanted heart
Antibiotics contraindicated in pregnancy
Fluroquinolones, tetracyclines
Imaging for PE
Spiral CT (CT angiography) NOT pulmonary angiography
When should tdap vaccine be administered during pregnancy?
Between 27-36 weeks, every pregnancy
***if patient acquires wound at any gestational age and has not had tDAP in 10 years, should receive it then
Risk factors for endometrial cancer?
Age over 45 years, obesity, nulliparity, diabetes, genetics
Patient with hx umbilical artery catheterization presents with persistent hypertension
Renal artery thrombosis –> decreased afferent blood flow–>increased renin–> increased aldosterone–> hypertension
Management of foreign body aspiration
flexible or rigid bronchoscopy
Loperamide
Anti-diarrheal agent
Pituitary micro adenoma causing prolactin secretion
Treat with bromocriptine first and then resect if refractory to tx
