Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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
Pt with asthma gets sick --> hyperinflated lungs, accessory muslces for respriation | management?
bronchospasm (acute asthma crisis) reversible obstruction of bronchi 2/2 hyperreactivity and airway inflammation O2 + SABA + corticosteroids
26
OSA risk factors BMI > Age > neck circumference > echo? | loud S2 in second left intercostal space
BMI > 35 AGE > 50 NECK > 40 cm **increased pulmonary artery pressure** | pulmonic valve closure -- pulmonary HTN loud S2
27
acute abdominal pain in setting of recent MI, bloody diarrhea
ischemic colitis
28
bloody diarrhea, microangiopathic hemolyic anemia, thrombocytopenia, renal failure
E coloi 0157:H7 (HUS)
29
pt with previous stillborn greater than 32 weeks is now pregnant next step in management
weekly non-stress testing in the third trimester starting at 32 weeks also serial ultrasaonography throughout gestation and screened for medical conditions
30
mucopurulent discharge with pruritis '' ^^^ " + erythematous friable cervix and cervical motion tenderness
vaginitis cervicitis both can be caused by neisseria gonorrhea and chlamydia trachomatis complications: PID or tubo ovarian or intra-abdominal abscess
31
cervical motion tenderness, purulent cervical discharge, uterine and adnexal tenderness --> tubo ovarian or intra-abdominal abscess
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
32
fluctuant swollen cyst - caused by obstruciton of gland outflow if erythema and tenderness to palpation:
bartholin gland cyst bartholin gland abscess
33
pt with hx of pheochromocytoma, now has medullary thyroid carcinoma what does medullary thryoid carcinoma produce ?
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
34
pt with ulcerative colitis -- severe bloody diarrhea, colonoscopy superficial ulcers, biopsy: intracellular inclusion bodies what next?
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)
35
crohns manifestations
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
36
pancreatic adenocarcinoma: painless obstructive jaundice pt also has abdominal aneurysm: should they repair
no, pancreatric adenocarcinoma is poor prognosis with death within one year
37
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?
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)
38
sepsis, hypovolemia, medication or substance-induced hypotension, cardiogenic shock (MI) ANY SORt of decreased perfusion leads to:
ATN sepsis **pigmented granular, muddy brown casts** renal tubular epithelial cells -- bound in a TAMM-HORSFALL (uromodulin) mucoprotein matrix BUN:Cr < 20
39
NO casts but eosinophils in urine
AIN antibiotics, NSAIDS, PPI, infections or autoimmune disorders: sarcoidosis or SLE
40
primary: painless chancre secondary: fever, diffuse maculopapular rash with palms and soles, condylomata lata tertiary: tabes dosralis, aoritis, gummas
syphillis tx: PCN or sensitize if allergic ooorrr doxycycline
41
white-gray flat topped lesions vs verrucuous papules
condyloma lata -- syphillis condyloma aCUMinata verruous
42
pt with SLE OR Sjorgen and pregnant, fetus at risk for?
complet A-V block antibodies: anti-Ro and anti-La cross placenta
43
what month baby has stranger anxiety
6 mo peaks from 7-10mo
44
fever, anemia, thrombocytopenia, neuologic (AMS, confusion), renal failure (Cr elevated), Increased indirect bilirubin and jaundice
Thrombotic Thrombocytopenic Purpura TTP inhibition: ADAMTS13: metalloprotease that degrades vWF tx: PLASMAPHARESIS | leads to microangiopathic hemolytic anemia ## Footnote renal failure from microthrombi (vWF decreased so no platelet adhesion, clumps of RBC's floating around)
45
11 year old boy with 3 yr hx of increasing muscle weakness/atrophy of both shoulders and pelvic girdles + areflexia
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^^
46
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
47
Tinea Capitis d/t Microporum Gypseum Trichophyton Tonsurance, Epidermophyton Floccosum, Microsporum Canis tx: oral antifungal: Griseofulvin or Terbinafine (BOTH hepatoxicity) check LFTs
48
older man with bloody urine, flank pain, weight loss or fever with vague wrist pain, xray: lytic lesion of radius with pathologic fracture
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**
49
osteoarthritis tx
NSAIDs (acetaminophen), intra-articular injections, joint replacement for severe
50
Pregnant pt with Lyme disease sxms: facial droop, ekg av block
early stage of lyme: treat with doxycycline (photosensitivity, discololartion of teeth) later stages: nervous system (facial droop) or heart (av block) --> Ceftriaxone
51
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
Cholesterol embolism increased risk for dislodgment of atherosclerotic cholesterol plaques: cardiac catheterization and aortic dissection tx: supportive
52
peritonsillar abscess: next step?
needle aspiration of peritonsillar space, to prevent airway compromise and antibiotic to cover gram positive strep or staph (amoxicillin-sulbactam, clindamycin, vancomycin)
53
asthma FEV1:FVC ratio Peak Expiratory flow rate Residual Volume Total Lung Capacity
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
CT imaging: peribronchial fibrosis, reticular opacities, subpleural thickening
Asbestosis
55
peripheral and basilar honeycombing
Idiopathic pulmonary fibrosis
56
caclicfied pleural plaque with pleural effusion risks: asbestosis and tobacco use
Mesothelioma
57
purulent discharge at Stensen duct --> parotid gland
Staph Aureus
58
sigmoid volvulus bowel obstruction with high pitched sounds, distention, constipation, vomiting
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
pt with CKD -- what should you measure to prevent further complications
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
increases risk for exposing fetus to maternal blood in hiv + mothers
fetal scalp electrode placement
61
postpartum patient with fever and severe uterine tenderness
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
DKA management
**1) 0.9% Normal saline ** 2) insulin + ____ 3) correction of electrolyte abnormalities
63
Schirmer test
Sjorgen dry eyes -- tests for aqueous tear deficiency
64
pt who takes chronic corticosteroids (prednisone), gets an infection, hypotensive, tachy, fever, and hospitalized, what shoudl you give next?
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
child ingests drain cleaner, what next?
esophagoscopy trying to see for any tissue perforation ulceration == chemical burns tx: steroids **do not give charcoal and do not do gastric lavage**
66
patient with marfans what annual checkups?
annual echocardiography for vascular complications aortic root dilation, aneurysm, dissection annual eye exam: ectopia lentis
67
pt with multiple myeloma, most at risk for what infection?
Streptococcus Pneumonia any encapsulated oraganism Strep Pneumo, Haemophilus Influenza, Ecoli, Neisseria Meningitidis, Salmonella typhi, Klebsiella penumonia, Group B streptococcus
68
"multiple" small "vesicles" over inside of the mouth and posterior oropharnyx cerivcal lymphadenopathy mouth pain, fever sore throat, what next?
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
intraepithelial lympocytosis, villous atrophy, crypt hyperplasia
celiacs gliadin protein in wheat products tissue transflutaminase IgA Antibodies can cuase iron deficiency anemia
70
normal uterus with a gestational sac and no cardiac activity
blighted ovum d/t fetal chromosomal abnormalities some will do D/C to look at genetic analysis
71
complicated, exudative pleural effusion with increased LDH and decreased pH and glucose mangt?
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
episodic vertigo and sensorineural hearing loss vs progressive vertigo and sensornieural hearing loss, also facial numbness/parasthesia
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
hx of southwest asia, started off as little papule then increased in size and ulcerates, might have hyperkeratotic eschar
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
pain swelling warmth in knee arthrocentesis: calcium pyrophosphosphate crystals xray: chondrocalcinosis and degenerative joint disease next step?
Pseudogout next step: NSAIDS (anti-inflammatoin): ibuprofen, Colchicine, oral glucocorticoids vs acetaminophen given in osteoarthritis d/t noninflammatory pain
75
glenohumeral joint: internal rotation external rotation when in adducted position external rotation abduction
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
pain in shoulder with both active and passive movement
adhesive capsultitis
77
overhead work or throwing pain: like basketball, volleyball, baseball, football
Labral tear
78
Regular rhythm + narrow QRS complex, tachycardia, light headed, palpitation, diaphoresis, syncope + abrupt onset and termination + triggered by stresss, coffee, alcohol, etc.
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
Irregularly irregular rhythm and polymorphic P wave associated with chronic pulmonary disease
mutlifocal atrial tachycardia
80
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
HOCM
81
after insertion of central venous catheter into subclavian vein, suddenly severe ches pain, dyspnea, agitation next step?
air embolism -- place pt in trendelenburg and left lateral decubitus position, oxygen, fluids
82
foul smelling poop with memory decline endoscopic biopsy: periodic acid-Schiff positive macrophages in lamina propria
Whipples dx endoscopic bx and then lumbar puncture for PCR of CSF for CNS involvmenet tx: ceftriaxone + trimethoprim-sulfa(1year)
83
achalasia moa dx tx
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
antimitochondial antibodies positive with female, jaudnice, pruritis, hypercholesterolemia, increased alk phos, and fat solube deficiencies
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
elevated lipase with RUQ pain, bilious vomiting, periumbilical tenderness
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
direct hyperbilibrubinemia, pale stoole, dark urine, in baby
biliary atresia dx: ultrasound tx: Kasai procedure -- hepato-porto-entero-ostomy
87
post partum bleeding, soft uterus macrosomia, multiple gestations, uterine infection
uterine atony --- failure of the myometrium to contract and compress the placental blood vessels
88
post partum bleeding with using forcepts, manual manipulation of the fetus
genital tract laceration
89
post partum bleeding with no placenta totally delivered
retaiend placenta -- inabiltiy of placental bed to involute
90
post partum bleeding management
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
within one year of pregnancy hyper/hypothryoid symptoms, and antithyroid peroxidase antibodies next step?
post partum thryoiditis autoimmune give metoprolol/propanolol for symtpoms start on levothryoxine
92
abnormal uterine bleeding with symmetrically enalrged BOGGY uterus
adenomyosis
93
abnromal uterine bleeding, heavy prolonged mestrual periods, miscariage and infertility irregular shaped uterus
Leiomyomata uteri -- fibroids estrogen responsive - get larger with pregnancy, decrease with menopause tx: NSAIDS, COMBINED OCPS, mymoectomy or hysterectomy in severe cases
94
human placental lactogen
made by placenta increases insulin resistance -- results in gestational diabetes
95
"electric like" sensation down spine, tingling, weakness, visual loss, epsidoic comes and goes
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
RISK FACTOR FOR ISCHEMIC STROKE:
HTN is strongest modifiable **AGE** ********** is the strongest non modifyable for every decade after age 55, stroke risk doubles
97
Scaly, erythematous rash around nose and eyebrows, dandruf | associated with?
seborrheic dermatitis malessezia tx: topical ketoconozale shapoo or selenium sulfide or zinc pyrithione **SUDDEN ERRUPTION -- CHECK FOR HIV**
98
third trimester vaginal bleeding PAINLESS next step avoid
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
maternal diabetes or pre=eclampsia put fetus at risk of hypoxemia what test?
contraction stress test
100
child with b/l injected sclera, erythematous papular rash, erythema and tender hands and feet, fever for 5+ days risk of: tx:
mucocutaneous lymph node syndrome -- kawasaki risk of: MI or coronary artery aneurysm tx: high dose aspirin or IV immunoglobulin *fuck reyes*
101
decreased factor 8 and increased bleeding time mucosal bleeding with normal plt count and prothrobin time increased partial thromblastin time PTT tx?
von willebrand disease subendothelial lining impaired platelet adherence tx: desmopressin (release of vwf from endothelial cells)
102
pregnant patient with bipolar what drug do you give them?
lamotrigine
103
lithium level > 2.5 what next?
hemodyalisis + IV fluids
104
immunedeficiency
105
thrombocytopenia and cutaneous bruising with no other abnormalities
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
pt with hx of headaches, for 1 year takes acetaminophen (or any other headache meds) with caffeine, still has headaches
medication overuse headaches stop taking meds
107
anencephaly MCC: folate deficiency (also auses caudal neural tube defects (spina bifida) also: trimethoprim and antiepileptics can cause anenceaphly
108
blunt trauma to the eye, right eye with pooling blood in the anterior chamber
Hyphema = can cause increase in intraocular pressure by clogging trabecullar meshwork within first five days: can rebleed
109
Rheumatoid arthritis + new onset fevers, pleurisy, neutropenia, splenomegaly
Felty syndrome increased risk for non-hodgkin lymphoma tx: methotrexate + rituximab (cd20)
110
next step in pulmonary embolism
Spiral CT scan CT angiography
111
causes of hypovolemia leading to AKI what will see on labs?
Hypovolemia 2/2 vomiting and diarreha sepsis hypotension cardiogenic shock decreased urine fractional excretion of sodium < 1% Increased BUN:Cr > 20
112
prego weeks 27-36 what vaccine ?
Tdap _ REGARDLESS with EACH pregnancy PROMOTES PLACENTal transfer of antibodies to fetus
113
at 15-18 weeks gestation, abnormal prenatal quad screen what next? complications
amniocentesis (to detect chromosomal abnormalities) Premature rupture of membranes, fetal injury/demise, and infection to mother/fetus
114
women over 45 with abnormal uterine bleeding what nexxt?
endometrial biopsy
115
pt with type 1 DM what annual screening?
lipid screening
116
pt with type 1 DM what annual screening?
lipid screening
117
pt with lyme tic attached for less than 24 to 36 hours what next
reassurance and follow up if more than 36 hours --> ppx doxycline or if neuro/brain symptoms ceftriaxone
118
panic disorder treatment
long term: SSRI short term mgt: benzo
119
neonate had umbilical artery catheter placed to monitor bp several weeks later what expect to see on labs?
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
most effective birth control after pregnancy safe with breast feeding:
IUD horomonal or copper

NBME's (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions