Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NBME's > NBME 10 > Flashcards

NBME 10 Flashcards

1
Q

puberty in girls

A

thelarche: breast development (increased produciton of estrogen and growth of mammary tissue, asymmetry is normal)
pubarche: pubic hair
growth spurt
menarche: menses (estradiol stimulation of the endometrial lining rather than ovulation and can be accompanied by prolonged vaginal spotting)

follow up in 6 months*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

prolong bleeding after circumcision, eczema, thrombocytopenia (low platelets), and recurrent infections of oral thrush, otitis media, pneumococcal bacteremia

increased risk for?

A

Wiskott-Aldrich Syndrome
WAS gene on X chromosome – codes for actin cytoskeleton rearrangment that occurs during interaction between T lymphocytes, antigen-precenting cells, B lymphocytes
–> impaired innate and adaptive immune system

increased risk: autoimmune disease + malignancy: Leukemia*

Encapuslated bacteria + opportunistic pathogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

recurrent viral, bacterial, and fungal infections starting at birth, failure to thrive, and severe lymphopenia with impaired cellular and humoral immunity

A

SCID (x linked) and Adenosine deaminase deficiency (AR)
mutation in Interluekin-2 Receptor gamma chain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

progressive ataxia, telangiectasias, abnormal eye movemnts, decreased immunoglobulin concentrations (leading to recurrent sinopulmonary infections)

A

Ataxia telangiectasia (AR) dna repair defect
somatic mutations accumulate –> lead to protein dysfunction and increased risk: Hodgkin Lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

eczema and cutaneous cold abscesses

A

Hyper-IgE syndrome : defect in the JAK-STAT signaling pathway –> impaired Th17 cel differentiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

thymic aplasia and hypocalcemia (looks like SCID with risk of viral and fungal infections), with cardiac and craniofacial defects

A

DiGeorge syndrome: 22q11 deletion that leads to failure of 3rd and 4th branchial pouches to develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

recurrent BACTERIAL infection and low/absent immunoglobulin concentrations

A

X-linked agammaglobulinemia : mutatition in BTK gene encodes for tyrosine kinase: needed for B lymphocyte development/proliferation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

next step when starting anti-TNF alpha (infliximab)

A

Interferon-gamma release assay (IGRA) or PPD to test for latent TB
TNF-alpha needed to fight off granuloma formation
if positive –> treat for LATENT TB with 9 months of isonizaid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

sickle cell: vaso-occlusive crisis management

A

IV fluids and pain control

children: dactylitis, acute chest syndrome; adults diffuse pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

4 units of blood transfusion + IV crystalloids/colloids, now has dypsnea, pulmonary edema, JVD, widened pulse pressure, HTN

A

Transfusion-Associated Cardiac Overload TACO – fluid overload 2/2 large volume blood transfusions
STOP blood transfusion, minimize IV fluids, then give loop diuretic, O2 or positive pressure ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

pt thinks she has small worms underneath skin, has tried digging them out, no hx of depression/ ah. no illicit drug use

A

delusional parasitosis (delusional disorder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

NMDA receptor antagonist, nystagmus, agitation
next step?
complications to look out for?

A

PCP intoxicaiton - INHIBITS reuptake of dopamine, norepi, and serotonin
stimulates alpha-adrenergic receptors
give benzo’s for agitation
then labs for rhabdomyolysis, hyperthermia, HTN
intubate if comatose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

HSV ENCEPHALITIS
how does it spread?
dx?
tx?

A

HSV-1 from oropharynx to CNS via trigeminal nerve
or
reactivated latent HSV-1 infection
dx: need lumbar puncture: run PCR to detect HSV1
neuroimaging: unilateral or bilateral temporal lobe
tx: IV acyclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

STROKE workup next best step

A

4.5 hours
if less than –> Alteplase thrombolytic tx
if more than –> give aspirin then BP control, statins, and DVT prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

unilateral facial paralysis with loss of right labial fold and unable to wrinkle forehead
next step?

A

bell palsy - likely viral-mediated inflammation, or immune reaction 2/2 to herpes or herpes zoster, or lyme disease
facial nerve – decreased taste 2/3 anterior tongue, lacrimation
dx: no further testing
tx: glucorcorticoids, or artificial tears to prevent xerophthalmia or corneal abrasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

AMS + Ophthalmoplegia (+nystagmus) + ataxia s/p gastric bypass

A

vitamin B-1 thiamine deficiency
can result in damage/atrophy of mamillary bodies manifests as Wernicke encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

child with unilateral cervical adenopathy with purple hue over mass, excisional biopsy showed multiple granulomas

A

lymphadenitis by mycobacterium avium - intracellulare M. avium common in immunocompromised children (or normal)
r/o bartonella cat scratch or Francisella tularemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

pt with diabetes + BACK PAIN + fever, malaise, fatigue
next step?

A

MRI of spine to confirm vertebral osteomyelitis (likely hematogenous spread from diabetic ulcer)
also do blood cultures and bone biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

22F with swelling on front of right ankle
next best step?

A

Osteosarcoma
next best step: MRI of right tibia

MCC bone cancer in under 30yo usually in LONG bones (distal femur, proximal tibia, distal tibia)
familial cases (retinoblastoma or p53 gene), body dysplasia (osteitis deformans paget disease), fibrous dysplasia nad radiation
xray: destruciton of both medullary and cortical bone as well as sunburst periosteal reaction
MRI to evaluate local invasion and staging
tx: surgical resection + chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

muscle weakness + cramps, abdominal ileus, parasthesia, hyporeflexia

with laxative abuse

A

hypo-Kalemia
can also cause long QT syndrome or torsades depointe (polymorphic ventricular tachycardia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

xray: no pulmonary edema
S4 heard, no peripheral edema
what is contraindicated

A

ST elevation: AVF and I & II
means Right sided MI
especially with symptoms of no L sided MI (pulm edema, peripheral edema)

DO NOT GIVE nitroglycerin or opiods (they are preload-lowering meds) used to treat angina

you want to give IV fluids to maintain CO, then send to coronary reperfusion with PCI or with fibrinolytics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diabetic nephropathy

A

nonenzymatic glycosylation of GBM(thickening) and efferent arterioles(mesangial expansion)
eosinophilic nodular glomerulosclerosis (kimmelstiel-wilson nodules)
initial increase in GFR with microalbuminuria
causes HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

nonhealing ulcer medial aspect of leg
bronze discoloration
woody induration

A

venous insufficiency
retrograde blood flow
venous valves
hemosiderin deposition from extravasated RBCs
chronic edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

pt with HIV CD4+ 650
PPD skin test: 6mm
next step?

A

PPD skin test > 5mm with HIV –> treatment with LATENT TB now – 9 mo isoniazid
no active symtpoms pulmonary or dissiminated infection
if they are under 200 CD4+, then can have a false negative, retest when above 200 CD4+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Pt with asthma gets sick –> hyperinflated lungs, accessory muslces for respriation

management?

A

bronchospasm (acute asthma crisis)
reversible obstruction of bronchi 2/2 hyperreactivity and airway inflammation

O2 + SABA + corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

OSA risk factors
BMI >
Age >
neck circumference >
echo?

loud S2 in second left intercostal space

A

BMI > 35
AGE > 50
NECK > 40 cm
increased pulmonary artery pressure

pulmonic valve closure – pulmonary HTN loud S2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

acute abdominal pain in setting of recent MI, bloody diarrhea

A

ischemic colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

bloody diarrhea, microangiopathic hemolyic anemia, thrombocytopenia, renal failure

A

E coloi 0157:H7 (HUS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

pt with previous stillborn greater than 32 weeks is now pregnant
next step in management

A

weekly non-stress testing in the third trimester starting at 32 weeks

also serial ultrasaonography throughout gestation and screened for medical conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

mucopurulent discharge with pruritis

’’ ^^^ “ + erythematous friable cervix and cervical motion tenderness

A

vaginitis
cervicitis

both can be caused by neisseria gonorrhea and chlamydia trachomatis

complications: PID or tubo ovarian or intra-abdominal abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

cervical motion tenderness, purulent cervical discharge, uterine and adnexal tenderness –> tubo ovarian or intra-abdominal abscess

A

PID – can cause tubo-ovarian or intra-abdominal abscess

d/t chlaymdia or gonorrhea
dx: NAAT
chlamydia: obligate intracellular organism
tx: azithromycin or doxycycline for chlamydia
ceftriaxone for gonorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

fluctuant swollen cyst - caused by obstruciton of gland outflow

if erythema and tenderness to palpation:

A

bartholin gland cyst
bartholin gland abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

pt with hx of pheochromocytoma, now has medullary thyroid carcinoma
what does medullary thryoid carcinoma produce ?

A

MEND 2A/B
medullary thryoid carcinoma arises from parafollicular C cells and produces Calcitonin
sxms: hypo-calcemia
dx: thryoid US and bx
tx: thyroidectomy and chemoradiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

pt with ulcerative colitis – severe bloody diarrhea, colonoscopy superficial ulcers, biopsy: intracellular inclusion bodies
what next?

A

CMV HHV-5
colitis, retinitis, esophagitis, encephalitis, pneumonia
give **ganciclovir – inhibits viral DNA polymerase (but doesnt need to phophyrlate thymidine kinase like the other -lovir’s do)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

crohns manifestations

A

enterocutaenous fistulas, UVEITIS,
intestinal obstruction from Strictures
bowel perforatio, intra-abdominal abscess, intra-abdominal fistulas
Dx: imaging Bx
fluoroscopic small bowel follow through: narrowing of intestinal lumen usually at terminal ileum, with stricutres or fistulas
tx: NSAIDS - ANTI INFLAMMATORY FIRST
immunomodulators
glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

pancreatic adenocarcinoma: painless obstructive jaundice
pt also has abdominal aneurysm: should they repair

A

no, pancreatric adenocarcinoma is poor prognosis with death within one year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

walking barefoot on beach, or had oysters, shelfish, dock - gets cut
get erythema and hemorrhagic bullae (crepitus) over leg or gets diarreha
then septicemia
what next?

A

vibrio vulnificus gram negative
worse in pt with LIVER problems: alcoholic cirrhosis, hemochromatosis, liver transplant; or in DM or CKD
wound infection, diarrhea, sepsis
can start as mild cellulitis and turn into necrotizing fascitis with feer, pain, crepitus, hemorrhagic bullae
Dx: wound or blood cultures
Tx: IV abx: minocycline or doxycycline + cefoTax or cefTri
then undergo surgical debridement (in order to get rid of infected tissue, vs hyperbaric oxygen therapy for necrotizing soft tissue like in clostridium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

sepsis, hypovolemia, medication or substance-induced hypotension, cardiogenic shock (MI) ANY SORt of decreased perfusion leads to:

A

ATN
sepsis
pigmented granular, muddy brown casts
renal tubular epithelial cells – bound in a TAMM-HORSFALL (uromodulin) mucoprotein matrix
BUN:Cr < 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

NO casts but eosinophils in urine

A

AIN
antibiotics, NSAIDS, PPI, infections or autoimmune disorders: sarcoidosis or SLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

primary: painless chancre
secondary: fever, diffuse maculopapular rash with palms and soles, condylomata lata
tertiary: tabes dosralis, aoritis, gummas

A

syphillis
tx: PCN
or sensitize if allergic
ooorrr doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

white-gray flat topped lesions
vs
verrucuous papules

A

condyloma lata – syphillis

condyloma aCUMinata verruous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

pt with SLE OR Sjorgen and pregnant, fetus at risk for?

A

complet A-V block
antibodies: anti-Ro and anti-La cross placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what month baby has stranger anxiety

A

6 mo
peaks from 7-10mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

fever, anemia, thrombocytopenia, neuologic (AMS, confusion), renal failure (Cr elevated), Increased indirect bilirubin and jaundice

A

Thrombotic Thrombocytopenic Purpura TTP
inhibition: ADAMTS13: metalloprotease that degrades vWF
tx: PLASMAPHARESIS

leads to microangiopathic hemolytic anemia

renal failure from microthrombi (vWF decreased so no platelet adhesion, clumps of RBC’s floating around)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

11 year old boy with 3 yr hx of increasing muscle weakness/atrophy of both shoulders and pelvic girdles + areflexia

A

Juvenile Spinal Muscular Dystrophy
AR mutation in SMN genes at chromosome 5q13: degeneration of motor neurons and proximal muscle weakness, resulting in hypotonia and areflexia
able to walk on their own and then slowly lose function

type 1: hoffman baby dies 2: dubowitz never able to walk 3: welander^^

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q
A

pterygium
benign growth of conjunctival tissue
d/t UV radiation
tx: topical lubrication and REDUCTION OF UV light exposure – wear sunglasses
OR surgical excision
if recurrent: surgery + antimetabolite mitomycin C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q
A

Tinea Capitis
d/t Microporum Gypseum
Trichophyton Tonsurance, Epidermophyton Floccosum, Microsporum Canis
tx: oral antifungal: Griseofulvin or Terbinafine (BOTH hepatoxicity) check LFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

older man with bloody urine, flank pain, weight loss or fever
with vague wrist pain, xray: lytic lesion of radius with pathologic fracture

A

Renal Cell Carcinoma
older, male smokers – may show polycythemia or hypercalcemia
paraneoplastic syndrome: Erythropoietin or Parathyroid hormone related peptide
Dx: CT
spreads hematogenously: lung brain bone metastatic diseas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

osteoarthritis tx

A

NSAIDs (acetaminophen), intra-articular injections, joint replacement for severe

50
Q

Pregnant pt with Lyme disease sxms: facial droop, ekg av block

A

early stage of lyme: treat with doxycycline (photosensitivity, discololartion of teeth)

later stages: nervous system (facial droop) or heart (av block) –> Ceftriaxone

51
Q

pt with aortic aneurysm, livedo reticularis (dusky blue toes) petechiae, renal dysfunctions
labs: leukocytosis with Eosinophilia
skin lesions histo: biconvex needle-shaped clefts within arterial lumen left by dissolved cholesterol crystals

A

Cholesterol embolism
increased risk for dislodgment of atherosclerotic cholesterol plaques: cardiac catheterization and aortic dissection
tx: supportive

52
Q

peritonsillar abscess: next step?

A

needle aspiration of peritonsillar space, to prevent airway compromise
and antibiotic to cover gram positive strep or staph (amoxicillin-sulbactam, clindamycin, vancomycin)

53
Q

asthma
FEV1:FVC ratio
Peak Expiratory flow rate
Residual Volume
Total Lung Capacity

A

obstruction of bronchi 2/2 hyperreactivity and airway inflammation
can show decreased lung density (hyperresonance to percussion, diminished tactile fremitus, hyperinflation of chest)
FEV1:FVC ratio – decreased
Peak Expiratory flow rate – decreased (obstructed airways)
Residual Volume – increased
Total Lung Capacity – increased

54
Q

CT imaging: peribronchial fibrosis, reticular opacities, subpleural thickening

A

Asbestosis

55
Q

peripheral and basilar honeycombing

A

Idiopathic pulmonary fibrosis

56
Q

caclicfied pleural plaque with pleural effusion
risks: asbestosis and tobacco use

A

Mesothelioma

57
Q

purulent discharge at Stensen duct –> parotid gland

A

Staph Aureus

58
Q

sigmoid volvulus bowel obstruction with high pitched sounds, distention, constipation, vomiting

A

dilation of sigmoid colon, rotates around its mesentary, air filled sigmoid colon
without sepsis or bowel necrosis: flexible sigmoidoscopy
with sepsis or bowel necrosis: surgery

59
Q

pt with CKD – what should you measure to prevent further complications

A

measure hemoglobin to monitor for anemia
in states of hypoxia kidneys secrete epo to stimulate Bone marrow to make more erythrocytes
in CKD – kidneys dont make enough Erythropoietin so bone marrow doesnt know enough to make more, causing anemia normocytic

60
Q

increases risk for exposing fetus to maternal blood in hiv + mothers

A

fetal scalp electrode placement

61
Q

postpartum patient with fever and severe uterine tenderness

A

postpartum endometritis
typicaly polymicrobial infection aerobes+ anaerobes
risks: prolonged labor, premature/prolonged rupture of membranes, c-section, Bacterial Vaginosis, GBS, manual removal of placenta
tx: clindamycin or gentamicin

62
Q

DKA management

A

**1) 0.9% Normal saline **
2) insulin + ____
3) correction of electrolyte abnormalities

63
Q

Schirmer test

A

Sjorgen dry eyes – tests for aqueous tear deficiency

64
Q

pt who takes chronic corticosteroids (prednisone), gets an infection, hypotensive, tachy, fever, and hospitalized, what shoudl you give next?

A

Corticosteroids
d/t adrenal crisis
exogenous corticosteroids –> b/l adrenal atrophy: diminished production of ACTH from pituitary and decrease in native production of corticosteroids
will see hypoglycemia, AMS, hyponatremia, tachycardia and vasodilation Hypotension.

65
Q

child ingests drain cleaner, what next?

A

esophagoscopy
trying to see for any tissue perforation ulceration == chemical burns
tx: steroids
do not give charcoal and do not do gastric lavage

66
Q

patient with marfans what annual checkups?

A

annual echocardiography for vascular complications aortic root dilation, aneurysm, dissection
annual eye exam: ectopia lentis

67
Q

pt with multiple myeloma, most at risk for what infection?

A

Streptococcus Pneumonia
any encapsulated oraganism
Strep Pneumo, Haemophilus Influenza, Ecoli, Neisseria Meningitidis, Salmonella typhi, Klebsiella penumonia, Group B streptococcus

68
Q

“multiple” small “vesicles” over inside of the mouth and posterior oropharnyx
cerivcal lymphadenopathy mouth pain, fever sore throat, what next?

A

HSV 1 or 2
cerivcal lymphadenopathy and vesicular eruption
Tzank smear with Giemsa stain
PCR test on open vesicle
tx: acylcovir or valacylcovir within 72 hours of symtpoms onset
infectious while sores remain open and draining

69
Q

intraepithelial lympocytosis, villous atrophy, crypt hyperplasia

A

celiacs
gliadin protein in wheat products
tissue transflutaminase IgA Antibodies
can cuase iron deficiency anemia

70
Q

normal uterus with a gestational sac and no cardiac activity

A

blighted ovum
d/t fetal chromosomal abnormalities
some will do D/C to look at genetic analysis

71
Q

complicated, exudative pleural effusion with increased LDH and decreased pH and glucose
mangt?

A

empyema
strep pneumo lobar pneumonia, complicated by a parapneumonic pleural infection, infected by penuonoccal bacteria and produce pus
iv abx
thoracentesis
placement of chest tube

72
Q

episodic vertigo and sensorineural hearing loss
vs
progressive vertigo and sensornieural hearing loss, also facial numbness/parasthesia

A

Meniere disease is episodic (d/t acumulation of pressure in endolympoh of inner ear)

Acoustic neuroma vestibular schwannoma is porgressive and with trigeminal nerve symptoms

73
Q

hx of southwest asia, started off as little papule then increased in size and ulcerates, might have hyperkeratotic eschar

A

Leishmaniasis
wil see amastigotes within macrophages on blood smear or tissue bx
d/t sand fly

vs anthrax – 14 days small papule, ulcerates and has eschar (but no sw asia hx)

74
Q

pain swelling warmth in knee
arthrocentesis: calcium pyrophosphosphate crystals
xray: chondrocalcinosis and degenerative joint disease
next step?

A

Pseudogout
next step: NSAIDS (anti-inflammatoin): ibuprofen, Colchicine, oral glucocorticoids

vs acetaminophen given in osteoarthritis d/t noninflammatory pain

75
Q

glenohumeral joint:
internal rotation
external rotation when in adducted position
external rotation
abduction

A

internal rotation: subscapularis
external rotation when in adducted position: teres minor
external rotation: infraspinatus
abduction: supraspinatus most common tear
positive with drop arm test if torn

76
Q

pain in shoulder with both active and passive movement

A

adhesive capsultitis

77
Q

overhead work or throwing pain: like basketball, volleyball, baseball, football

A

Labral tear

78
Q

Regular rhythm + narrow QRS complex, tachycardia, light headed, palpitation, diaphoresis, syncope + abrupt onset and termination + triggered by stresss, coffee, alcohol, etc.

A

Atrioventricular Nodal Reentrant tachychardia AVNRT
structural defects in His-Purkinje causing reentrant pathway (like in WPW)
allows impulse to go in retrograde fashion through the AV node setting up reentry circuit

mangenet:
vagal maneuvers
adenosine
CCBs or B-blockers
UNSTABLE: cardioversion

vs irregular : afib

79
Q

Irregularly irregular rhythm and polymorphic P wave
associated with chronic pulmonary disease

A

mutlifocal atrial tachycardia

80
Q

murmur becomes louder with valsalva maneuver, decreases with LV filling and worsens the outflow tract obstruction
LV hypertrophy with large amplitude Swaves in right precordial leads and increased R wave in amplitude in V6

A

HOCM

81
Q

after insertion of central venous catheter into subclavian vein, suddenly severe ches pain, dyspnea, agitation
next step?

A

air embolism – place pt in trendelenburg and left lateral decubitus position, oxygen, fluids

82
Q

foul smelling poop with memory decline
endoscopic biopsy: periodic acid-Schiff positive macrophages in lamina propria

A

Whipples
dx endoscopic bx and then lumbar puncture for PCR of CSF for CNS involvmenet
tx: ceftriaxone + trimethoprim-sulfa(1year)

83
Q

achalasia
moa
dx
tx

A

impaired neuromuscular transmission and impaired relaxation of lower esophageal spincter
destruction of nerves in myenteric plexus impaires nitric oxide production –> prevents mooth muscle relaxation, unable to relax the LES
dysphagia, oodynophagia, wt loss, reflux, regurg food, halitosis difficulty swallowing liquids and solids
dx: first barium swallow(bird beak sign) then esophageal manometry
tx: pneumatic AIR dilation or injection of botulinism toxin to relax LES

84
Q

antimitochondial antibodies positive with female, jaudnice, pruritis, hypercholesterolemia, increased alk phos, and fat solube deficiencies

A

primary biliary cirrhosis: destruction of intrahepatic bile ducts
tx ursodeoxycholic acid: improves biliary excretion (inhibits cholesterol secretion into bile, improving biliary excretion)
also used to tx biliary colic, PBC, intrahepatic cholestasis of pregnancy

85
Q

elevated lipase with RUQ pain, bilious vomiting, periumbilical tenderness

A

lithogenic bile
acute pancreatitis 2/2 to eitehr gallstones or heavy alcohol consumption
lithogenic bile make gallstones –> pass through cystic duct to common bile duct and can obstruct, stopping pancreatic flow
tx: ERCP to retreive obstructing gallstone

86
Q

direct hyperbilibrubinemia, pale stoole, dark urine, in baby

A

biliary atresia
dx: ultrasound
tx: Kasai procedure – hepato-porto-entero-ostomy

87
Q

post partum bleeding, soft uterus
macrosomia, multiple gestations, uterine infection

A

uterine atony — failure of the myometrium to contract and compress the placental blood vessels

88
Q

post partum bleeding with using forcepts, manual manipulation of the fetus

A

genital tract laceration

89
Q

post partum bleeding with no placenta totally delivered

A

retaiend placenta – inabiltiy of placental bed to involute

90
Q

post partum bleeding management

A

IV fluids and blood, uterine massage, uterotonic mediations,examination of vagina and cervix, manual extraction of retaiend prodcuct if present on u/s,
uncontrolled hemorrhage: d&c, uterine vessel embolization, hysterectomy

91
Q

within one year of pregnancy hyper/hypothryoid symptoms, and antithyroid peroxidase antibodies
next step?

A

post partum thryoiditis
autoimmune
give metoprolol/propanolol for symtpoms
start on levothryoxine

92
Q

abnormal uterine bleeding with symmetrically enalrged BOGGY uterus

A

adenomyosis

93
Q

abnromal uterine bleeding, heavy prolonged mestrual periods, miscariage and infertility
irregular shaped uterus

A

Leiomyomata uteri – fibroids
estrogen responsive - get larger with pregnancy, decrease with menopause
tx: NSAIDS, COMBINED OCPS, mymoectomy or hysterectomy in severe cases

94
Q

human placental lactogen

A

made by placenta increases insulin resistance – results in gestational diabetes

95
Q

“electric like” sensation down spine, tingling, weakness, visual loss, epsidoic comes and goes

A

MS
treatment: corticosteroids for symptomatic flares
long term: interferon beta or monoclonal antibodies

eye symptoms: optic neuritis: central scotoma, afferent pupillary defect, pale optic disc on exam
Lhermitte sign: shock sensation with neck flexion
MRI white matter hyperintensiites in periventricular, cortex, subcortical region, cerebellum or spine
oligonclonal bands of immunolgubilins – CSF

96
Q

RISK FACTOR FOR ISCHEMIC STROKE:

A

HTN is strongest modifiable
AGE ** is the strongest non modifyable
for every decade after age 55, stroke risk doubles

97
Q

Scaly, erythematous rash around nose and eyebrows, dandruf

associated with?

A

seborrheic dermatitis
malessezia
tx: topical ketoconozale shapoo
or selenium sulfide or zinc pyrithione
SUDDEN ERRUPTION – CHECK FOR HIV

98
Q

third trimester vaginal bleeding PAINLESS
next step
avoid

A

placenta previa
pelvic ultrasound
avoid digital cervical exam
risk factors: uterine scarring, previous D&C, previous C section, multiparity
if persists into trimester then must do csection

99
Q

maternal diabetes or pre=eclampsia
put fetus at risk of hypoxemia
what test?

A

contraction stress test

100
Q

child with b/l injected sclera, erythematous papular rash, erythema and tender hands and feet, fever for 5+ days
risk of:
tx:

A

mucocutaneous lymph node syndrome – kawasaki
risk of: MI or coronary artery aneurysm
tx: high dose aspirin or IV immunoglobulin
fuck reyes

101
Q

decreased factor 8 and increased bleeding time
mucosal bleeding with normal plt count and prothrobin time
increased partial thromblastin time PTT
tx?

A

von willebrand disease
subendothelial lining impaired platelet adherence
tx: desmopressin (release of vwf from endothelial cells)

102
Q

pregnant patient with bipolar what drug do you give them?

A

lamotrigine

103
Q

lithium level > 2.5 what next?

A

hemodyalisis + IV fluids

104
Q

immunedeficiency

A
105
Q

thrombocytopenia and cutaneous bruising with no other abnormalities

A

Immune Thrombocytopenic purpura
platelet destruction: anti-Gp2b/3a Antibody – bind to platelet and result in their opsonization
macrophages in the spleen phagocytize the platelet-antibody complex
chronic: first with steroids, then IV IG

bone marrow: increased number of megakaryocytes

106
Q

pt with hx of headaches, for 1 year takes acetaminophen (or any other headache meds) with caffeine, still has headaches

A

medication overuse headaches
stop taking meds

107
Q
A

anencephaly
MCC: folate deficiency (also auses caudal neural tube defects (spina bifida)

also: trimethoprim and antiepileptics can cause anenceaphly

108
Q

blunt trauma to the eye, right eye with pooling blood in the anterior chamber

A

Hyphema = can cause increase in intraocular pressure by clogging trabecullar meshwork

within first five days: can rebleed

109
Q

Rheumatoid arthritis + new onset fevers, pleurisy, neutropenia, splenomegaly

A

Felty syndrome
increased risk for non-hodgkin lymphoma
tx: methotrexate + rituximab (cd20)

110
Q

next step in pulmonary embolism

A

Spiral CT scan
CT angiography

111
Q

causes of hypovolemia leading to AKI
what will see on labs?

A

Hypovolemia 2/2 vomiting and diarreha
sepsis
hypotension
cardiogenic shock
decreased urine fractional excretion of sodium < 1%
Increased BUN:Cr > 20

112
Q

prego weeks 27-36 what vaccine ?

A

Tdap _ REGARDLESS with EACH pregnancy
PROMOTES PLACENTal transfer of antibodies to fetus

113
Q

at 15-18 weeks gestation, abnormal prenatal quad screen
what next?
complications

A

amniocentesis (to detect chromosomal abnormalities)
Premature rupture of membranes, fetal injury/demise, and infection to mother/fetus

114
Q

women over 45 with abnormal uterine bleeding
what nexxt?

A

endometrial biopsy

115
Q

pt with type 1 DM
what annual screening?

A

lipid screening

116
Q

pt with type 1 DM
what annual screening?

A

lipid screening

117
Q

pt with lyme tic attached for less than 24 to 36 hours
what next

A

reassurance and follow up
if more than 36 hours –> ppx doxycline or if neuro/brain symptoms ceftriaxone

118
Q

panic disorder treatment

A

long term: SSRI
short term mgt: benzo

119
Q

neonate had umbilical artery catheter placed to monitor bp
several weeks later what expect to see on labs?

A

increased renin and aldosterone
umbilical artery catheter can cause renal artery thrombosis, can present up to several weeks after removed
occlusion decreases afferent blood flow to the affected kidney and increases JG renin production

120
Q

most effective birth control after pregnancy safe with breast feeding:

A

IUD
horomonal or copper

NBME's (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions