NBME 11 Flashcards

1
Q

Heat exhaustion
vs
heat stroke

A

exercise intolerance, increased core body temp, no neuro disturbances

hyperthermia + AMS + neuro deficits

hypernatremia, hyperchloremia, hyperkalemia
tx: remove individual from the heat, remove excess clothing, initiate cooling measures: immersion in cool water or evaporative cooling

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2
Q

rapidly progressive dementia and ataxia with stimulus indiuced or spontaneous myoclonas

A

Creutzfeldt Jakob disease
dx: CSF 14-4-4
autopsy: spongiform degeneration of the cortex
tx: death within one year, hospice, benzo for myoclonus

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3
Q

ethambutal ae

A

optic neuropathy : scotoma, red-green color blindness, blurred vision, partial visioin loss
neutropenia
thrombocytopenia

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4
Q

Isoniazid ae

A

inhibits synthesis of mycolic acids in cell walls
hepatoxic, neurotoxic, B6 pyridoxine deficiency (peripheral nueropathy and sideroblastic anemia)

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5
Q

Pyraxinamide ae

A

hepatoxic
hyper-uricemia
arthralgia

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6
Q

criteria for causation: (4)

A
  • biologic plausibility
  • dose-relationship
  • specificity and strength of association
  • temporal relationship
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7
Q

biological plausibility

A

observed association can be explained by a known biological pathway or mechanism

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8
Q

Specificy of the association
Strenght of the association

A

Specificy: one to one relationship between the exposure and the outcome
risk factor is the cause of ONE disease

Strenght: NEED R value (closer to 1 higher correlation)

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9
Q

Temporal relationship

A

if the exposure is known to precede the outcome
if pt were known to have no cardio dx prior to use of cigarettes then developed cardio dx

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10
Q

Dose-response relationship

A

the positive correlatino found between increased risk for cardiovasc dx and number of cigarettes smoked daily indicates that as the number of cig smoked daily, so does the risk for cardio vasc dz
number of cigs is dose
cardiovasc dz is response

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11
Q

hospital workers or high risk population PPD skin test:

A

greater than 10mm must treat
do xray
if active: quad tx
if latent: isoniazid for 9 months

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12
Q

pt with pneumonia, given abx, then preceded to have developed a parapneumonic effusion and then inot empyema (bacterial infection in pleural space)
next step

A

abx alone wont help, MUST PLACE CHEST TUBE
infusion of tissue plasminogen activator and recombinant deoxyribonuclease (DNAse) and iv abx into pleural space through chest tube
if chest tube fails –> video-assisted thorascopic surgery for decortication and drainage

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13
Q

children with hypertension
next step?

A

renal doppler ultrasound
serum renin and aldosterone
serum/urine metanephrines

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14
Q

on echo: pericardial effusion
collapse of right atrium at end of diastole
collapse of right ventricle in early part of diastole

A

cardiac tamponade
JVD hypotension, distant heart sounds
imapired right ventricular diastolic filling

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15
Q

risk factors any of: family hx of cvd, htn, dm, smoking
USPTF screening for men aged > 35 and women >45

A

lipid studies
tx: statins

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16
Q

anti-depressants with no sexual ae

A

mirtazapine : selective alpha 2 antagonist and serotonin modulator
Bupropion (dopamine and norepi)

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17
Q

ulcerative colitis managment meds

A

1) mesalamine enema , sulfasalazine
2) Corticosteroids: prednisone, Budesonide, hydrocortisone
3) anti-TNF (infliximab)
4) Janus Kinase enzyme inhibitor: Tofactinib

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18
Q

baby (less than 1yr) with recurrent UTI, voiding cystourethrography shows backflow of urine from bladder to renal pelvis
next step?

A

vesicoureteral reflux
can lead to pyelonephritis which later leads to renal scarring, htn, ckd
give: prophylactic daily antibiotc therapy

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19
Q

pelvic u/s: enlarged endometrial stripe
aub in post-menopausal
aub in premeno with prolonged exposure to estrogen

A

endometrial carcinoma

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20
Q

endometrial glands within the myometrium
large globular boggy diffusely enlarged uterus
transvag u/s : diffusely enlarged uterus, asymmetrical myometrial thickening, loss of endomyometrial border, subednometrial cysts

A

adenomyosis
tx: definitive: hysterectomy
conservative: progesterone IUD
gonadotropin-releasing hormone analogs
aromatase inhibitors

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21
Q

monoamniotic preg
vs
monochorionic preg
complications

A

conjoined twins or cord entaglement

twin twin trasnfusion or selective fetal growth restriction

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22
Q

hyperemesis gravidum management:

A

IV fluids
B6 supplements
antiemetics

usually seen in molar pregnancy so do a pelvic u/s and B-hcg levels

will see ketonuria or ketonemia

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23
Q

fever in pt with sickle cell and no spleen

A

any encapsulated pathogen: haemophilus influenza, neisseria meingitidis, streptococcus pneuomiae, pseudomonas, klebsiella
tx: ceftriaxone

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24
Q

friable ulcerative lesion on cervix painless bleeding

A

cervical cancer

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25
uterine size out of proportion of expected gestational age b hcg super high u/x: diffuse echogenic structures within endometrial cavity along with ovarian theca lutein cysts
hydatidiform moles
26
third trimester painless vaginal bleeding, placental tissue partially or entirely over internal cervical os
placenta previa
27
gram positive bacillus, can cause bacterial meningitis in infants and elderly tumbling motility
listeria
28
acute dystonic reactions: D2 antagonist torticollis, retrocollis, opisthotonos 9arching back), oculogyric crisis (deviation of eyes)
haloperidol or fluphenazine dopamine-cholinergic basal ganglia tx: diphenydramine or benztropine (anticholinergics) risk factors: male, young age, recent cocaine use, hx of acute dystonia
29
jaundice, hyperbilirubinemia, increased serum liver enzymes in pt with previous IV drug use
acute hepatitis d/t viral (hep a, b, c), medications or supplements, autoimmune dz, ischemic injury positive anti-HBc IgM means acute infection anti-smooth muscle antibody found in autoimmune hepaititis: fatigue, wt loss, jaundice, n/v, pruritis, RUQ pain
30
refeeding syndrome
within 2 weeks of refeeding: **hypo-phoshpatemia** hypo-kalemia, hypo-magnesmia can lead to heart failure, resp failure, arrythmia, seizures
31
pt with celiacs has super high PTH but low vitamin-D and hypocalcemia and hypophosphatemia
celiacs --> malabsorption (intraepithelial lymphocytosis, villous atrophy, crypt hyperplasia) --> impaired vitamin D absorption --> hypocalcemia 2/2 **osteomalacia** can also devlop secondary hyper-PTH with hypo-Ca and hypo-Phos next step: DEXA : ASSESS bone density for pt with celiacs and at risk for osteomalacia calcium absorption and bone mineral density imporve after starting gluten free diet
32
short digits (brachydactylyl), short stature, developmental delay, round facies
osteodystrophy -- Albright hereditary osteodystrophy pseudo-hypo-parathryoidism impaired reposne of the kidney to parathyroid hormone --> hypocalcemia
33
Primary hyperparathyroidism mcc
parathyroid adenoma (then hyperplasia, then carcinoma) subperiosteal bone resporption, renal failure, hyper-ca, hypo-phos
34
painless jaundice and weight loss
pancreatic cancer
35
Marfans pt sports:
could do low-moderate intensity sports IF AND ONLY IF they do not have echo evidence: aortic root dilation, mod-to severe MR, or family hx of sudden cardiac death NEVER allowed to do contact sports -- risk for aortic dissection and rupture | annual echo and opthalmic exam in general for pt with marfans
36
UTI in age less than 1 yo next step?
likely d/t congential urinary tract abnormality and might lead to ureteral obstruction and vesicoureteral reflux --> dilation of renal pelvis and calyces and compression/atrophy of renal parenchyma --> hydronephrosis next step ** renal ultrasound** and then **fluoroscopic voiding cystourethrogram** vs IV pyelography: can show renal collecting duct, ureters, bladder --> but exposes child to radiation
37
muscle atonia lost --> violently acting out dreams, sometiems remember dreams + resting tremor
Parkinsons dx: polysomnography showing lack of atonia during REM tx: safe sleep enviroment, melatonin/clonazepam (can also see this in lewy body dementia)
38
CSF: Leukocytes less than 100/mm3 with a predominance of lymphocytes (monocytes) normal or increased protein, normal glucose
aseptic (viral) meningitis
39
heart failure cvp: pcwp svr: SV: CO:
cvp: high pcwp: high svr: high **SV: LOW DECREASED** co: low impaired forward flow of blood -- so body tried to maintain BP for peripheral perfusion by increasing SVR
40
pt with RA prior to srugery what should they get
lateral xray of cervical spine in flexion and extension for proper intubation -- can lead to paralysis or death if translation instability is present
41
Vascular tumors hemangioblastomas of retina and cerebellum angiomatosis of the skin can also see: renal clear cell carcinoma, pancreatic tumor, pheochromocytoma
VHL do CT SCAN OF ABDOMEN for kindey, pancreas, adrenals tx: surgical excision
42
bloody diarrhea, thrombocytopenia, hemolytic anemia
E coli (shiga toxin producing) shiga toxin --> leads to microvascular thrombosis --> platelet consumption and shearing --> form schistocytes elevated LDH thrombosis in renal vasculature --> endothelial damage --> renal injury HUS (hemolytic uremic syndrome) renal failure, thrombocytopenia, microangiopathic hemolytic anemia
43
pt with fever but bradycardia bacteremia, rose colored spots on chest and abdomen
salmonella typhi
44
no spleen what vaccines?
meningococcal conjgate (against serotype B) must be given every 5 years pneumococcal PCV13 PPSV23 annual influenza Haemophilus influenza type B
45
mechanical ventilation after 10-14 days next step?
tracheostomy tube -- decreased risk for laryngeal injury, better comfort, easier ventilator weaning complications: tracheal stenosis or tracheomalacia tracheoarterial fistula site infection
46
fever, productive cough, and pulmonary infiltrate dx tx
Community acquired pneumonia Strep Pneumo, haemop influ, moraxella, mycoplasma pneumo, staph aureus, chlamydophilia pneumo tx: azithromycin, doxycylcine, amoxicillin if have comorbidities: COPD, DM, liver, cardiac, renal dx amoxicillin-clav or levoloxacin expect to get better within 24 to 48 hrs no need for repeat imaging
47
14M with consistently decreased growth velocity (always 3rd percentile), bone age younger than chronological age, tanner stage 1
Constitutional growth delay pre-puberty but once puberty hits sudden spike in height
48
short parents, normal gain of height velocity, bone age corresponds to chronological age
Familial hereditary short stature vs constitutional will not see that normal gain of height velocity and bone age is younger
49
prego with hyperthyroid symptoms and high free thyroxine and low tsh next step
b-blocker for tachycardia and tremor antithryoid meds: Propylthiouracil in 1st trimester (hepatoxic tho) and then Methimazole for the rest (in first trimester can cause fetal aplasia cutis -- absent dermal holes in skin, scalp)
50
scaly patches with alopecia, and patches of alopecia with black dots that represent broken hairs
tinea capitis oral griseofulvin
51
maculopapular rash, morbilliform rash 10days ago recieved MMR vaccine
replication of a live vaccine virus strain **measles** prodromal fever, cough, coryza, conjuctivitis, and confluent maculopapular rash that starts at the head and neck and spreads to trunk (excluding palms and soles) bright red macules with a bluish-white center on buccal mucosa and lymphadenopathy live vaccines can cause fever, rash, transient joint pain this sequeale occurs in 5% of kids who get the vaccine other live vaccines: yellow fever, intranasal influenza, smallpox, varicella-zoster, rotavirus, oral poliovirus since pt is missing other symptoms CCC most likely just d/t recent vaccination
52
erythematous tongue, rash, desquamation of hands and feet rash is rough, papular, diffuse body
scarlet fever (strep pyogenes GAS)
53
Several high fevers can even have seizures, fevers end, then blanching macular eruption on neck and trunk spread outwards to face and extremities
Roseola -- exanthema subitum HHV-6
54
pink patches on b/l cheeks slapped cheeks lacy macular eruptions on trunk and extremities
Erythema infectiosum -- fifth disease Parvovirus B19
55
small bony spur protruding from the surface of the bone capped by cartilage, abel to palpate, painless, usually near joints (knee/ankle)
osteochondroma benign -- tx not necessary unless interfering with growth or limb deformity (surgery)
56
adolescents: low grade joint pain, swelling, small well defined epiphyseal lesion with sclerotic border
chondroblastoma
57
t (11,22) adolescent boys, elevated periosteum layered neocortex formation usually long bones femur tibia histo: multiple small round blue cells
Ewing sarcoma
58
xray: radiolucent bone lesion, usually proximal femur, can have pain, usually solitary
osteoid osteoma vs osteochondromas (usually multiple, sessile/pedunculated tumor w/ cortex continuous with underlying bone and cartilagenous cap and PAINLESS)
59
ingest substance (plants) mouth pain, generalized burning sensation of skin, abdominal pain, n/v
Paraquot poisoning -- herbicide plant chemical
60
3cm nontender fluctuant mass external to hymenal ring, adjacent to introtius (posterior vulva underlying mucosa of the vestibule)
bartholin gland cyst cyst can turn into abscess with polymicrobial skin and enteric flora, sometimes neisseria gonorrhea if 3cm or greater --> incision and drainage vs vestibular will be near the urethra
61
mass internal to hymenal ring and recent obgyn checkup
episiotomy inclusion cyst 2/2 to episiotomy
62
skin colored nodules with central punctum can get infected, firm, on vagina
sebaceous cyst firm not fluctulant like bartholyn gland cyst
63
fluctuant swelling near the urethra caused by blockage of the outflow of Skene's glands
Vestibular gland cyst vs bartholin gland cysts occur adjacent to the introitus
64
decrescendo murmur that begins after S2 heard at left sternal border
aortic regurgitation early diastolic decrescendo murmur best heard in R second intercostal space bisferiens carotid pulsation -- arterial waveform has a double systolic peak with an initial sharp, shortened peak followed by a lower amplitude, broader peak can have left sided cardiac volume overload, such as dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, or completely asymptomatic
65
ectopic endometrial tissue outside of uterus chronic dysmenorrhea, dyspareunia, dyschezia, infertility
endometriosis
66
decerases the risk for future ischemia strokes and all-cause mortality
statins must give after a stroke
67
pt has head trauma mva, continues to be hypotensive even after IV fluids with hypernatremia and urine osmolality of 100
central DI inadequate secretion of ADH (vasopressin) from posterior pituitary leads to decreased concentration of aquaporin channels inserted within principle cells of collecting tubules --> inability to absorb adequate amounts of free water --> dilute urine and increased serum osmolality tx: desmopressin
68
Hirschsprungs dx
dx: barium enema (can have false negative results) rectal manometry (sensitive) rectal suction biopsy (most sensitive and specific) willl show absence of ganglion cells
69
decreased lung capacity decreased residual volume normal fev1 obese and shallow breaths
restrictive lung disease most likely obesity hypoventilation syndrome rld: ild, ohs, neuromusclar dx like ALS
70
prego at 28 weeks, cervix partialy effaced with uterine contractions every 5 min
preterm labor if cervix is 3cm or more, positive fetal fibronectin test if less than 34 weeks: corticosteroids (lung maturity) if less than 32 weeks: magnesium sulfate (cerebral palsy) antibiotics for Group B strep tocolytics: nifedipine, terbutaline to reduce contractions
71
72
acral lentiginous melanoma
73
prego with HIV what to give prior or during delivery what to give neonate
zidovudine PEP + bottle feed only
74
Old pt s/p surgery, opoiates, trauma, now has marked colonic dilation
ogilvie -- colonic pseudo-obstruction increased risk for colonic perforation or ischemia dx; CT or barium contrast enema tx: pro-cholinergic agent neostigmine and colonic decompression perforation --> ex lap
75
pt with lupus flare and lupus pleuritis tx
first NSAIDS then glucocorticoids
76
failure rate of a test to detect disease when it is present
sensitivity 1 - false negative rate
77
Primary prevention strategies: secondary tertiary:
primary: aim to prevent the effects of disease before disease even occurs (obesity -- make city bike lanes and walk trails) secondary: aims to identify disease early in its course through SCREENING efforts tertiary: aims to slow or ameliorate the progression and ocmplications of a disease through thereaputic intervention
78
pts with low risk polyps such as one to two small tubular adenomas -- how often colonoscopy vs more than three polyps with atypical features or larger size or atypical serrated polyps
5yrs 3 years
79
vaginal bleeding with NO open os (closed os)
threatened abortion
80
vaginal bleeding and an open os
inevitable abortion incomplete aborition once the passage of products beings
81
passage of all products and closed os
complete abortion
82
asymptomatic fetal demise without passage of products
missed abortion
83
spontaneous abortion managment
medical management: mifepristone and misoprostol TOGETHER (not separate) or **uterine evacuation with Dilation and suction curettage** highest success rate
84
DVT
dx: duplex ultrasound (obstructed deep viens, normal superficial veins) tx: subcutaenous low-molecular weight heparin -- enoXaprrin
85
asymptomatic Conjugated hyperbilirubin in abscense of other liver enzymes
Dubin Johnson (or roater) defective hepatocellular excretion of conjugated bili into bil canliculi transprotation needs MRP2 (multidrug resistance related protein) pump encoded by the ABCC2 gene no tx necessary
86
asymptomatic Conjugated hyperbilirubin in abscense of other liver enzymes
Dubin Johnson (or roater) defective hepatocellular excretion of conjugated bili into bil canliculi transprotation needs MRP2 (multidrug resistance related protein) pump encoded by the ABCC2 gene no tx necessary
87
20s-40s with recurrent sinopulmonary (sinus, pulmonary, pneumo, bronchitis) infections and splenomegaly
Common Variable ImmunoDeficiency (CVID) increased risk for development of autoimmune dz Rheumatoid arthritis, autoimmune hemolytic anemia, autoimmune thryoid high risk for cancer: Gastric cancer and non-hodgkin lymphoma dx: measure serum immunoglobulins (decreased IgG, IgA, and/or IgM) IMPAIRED B-lymphocytes into plasma cells --> impaired production of Ig's tx: IVIG
88
inflammation cracking of skin aroudn lips, mouth, tongue
riboflavin deficiency b2
89
asthma managmenet test
dx: spirometry or pulmonary function test decreased FEV1 NORMAL FVC increased TLC methacholine challenge (if not actively having symtpoms) bronchodilator: improved FEV1 by at least 12%
90
dental procedure with aortive valve replacement
amoxicillin if allergic to PCN: macrolide: clarithromycin
91
92
bilateral hilar lymphadenopathy and possible coarse upper lobe-predominant reticular pulmonary opacities (also chronic condition)
sarcoidosis
93
immunocompromised with diffuse bilateral infiltrates often prominent around hila
Pneumocystis jirovecci dx: methenamine silver or toluidine blue stains (stains cyst walls fungus yeas like causes pneumo) tx: bactrim, atovaquone, or pentamidine
94
95
Lambert Easton dx?
neuromuscualr junction antibodies to voltage gated calcium channels dx: reptitive nerve stimulation with electromyography nerve conduction studies exercise testing tx: pyridostigmne (for acetycholine symptoms : can have dry mouth, ptosis, constipation)
96
pt with CKD what should he restrict?
intake of phosphorous and potassium fucked kidneys!!! ckd prone to volume overload, hyperK, hyperPhos, metabolic acidosis, hyper-PTH, osteodystrophy, anemia(check Hg)
97
uti uti wiht pyleneprhtis (CVA tenderness)
nitrofurantoin bactrim, ceftriaxone, ciprofloxacin, or amoxicillin/clav
98
pt on valproic acid and has nose bleeds what needs to be monitored
check platelets can cause leukopenia and thrombocytopneia
99
progesterone challenge
if withdrawal progesteron results in endometrial bleeding: normal estrogen but inappropriate timing of her hormonal cycle to cause ovulation if no bleeding: deficiency of estrogen (primary ovarian failure), outflow obstruction, or hypothalamic pituitary dysfunction
100
acute otitis media vs mastoiditis
tx: oral amocilin tx: IV vancomycin +/- surgery must do CT temporal bone often occurs as a sequeale of acute otitis media : bacterial infection of mastoid air cells of temporal bone
101
essential tremor
worse with stress, better with aclohol tx: Propanolol (b-blocker)
102
pt with upper arm acute limb ischemia (pain, pallor, pulseless, parasthesia, paralsis, poikilotheria)
do an echo (TEE) most LIKELY d/t arterial thromboembolism from heart
103
mammogram every 1 to 2 years starting at ___ to ___
40 go 74
104
parotid gland mass next step?
excision and drainage
105
pt with crohns started on infliximab what to follow up with in one month
CBC ae: anemia (same as azathioprine another crohns drug causes pancytopenia) tnf-alpha inhibtor prior to starting rule out Tb with igra or ppd
106
when a study demonstrates no difference between nul and alternative hypothesis but in fact there is a difference
type II error (beta) false negative can be reduced by increasing power through larger sample size and increasing precision in measurements
107
fibrosarcoma painless mass in thigh next step?
soft tissue sarcoma do a CT of abdomen and chest since it can hematogenously spread all over
108
baby with poor weight gain, back arching after feeding, appears in pain
reflux esophagitis GERD in babies tx: decreased feed volume while increasing frequency keeping baby upright 20-30min after feed
109
hypopigmented oval macules or patches + seizure + cognitive dysfunction
Tuberous Sclerosis AD hamartomas in CNS ash leaf spots -- hypopigments angiofibromas on face fibrous plaques on forhead ungal fibromas around nails shagreen patch (lower back) CNS: glionueronal (cortical fibers) hamartomas or sub ependymal noduls/giant cell tumors **cardiac rhabdomyomas (mitral regurg) or renal angiomyolipomas** CAN lead to malignancy of soft tissues, brain, kidney
110
cutaneous neurofibromas, cafe au lait spots, pigmented iris hamartomas, optic gliomas, pheochromocytoma
Neurofibromatosis hyperpigmented spots vs ash leaf is hypopigmented in TS
111
port wine stain
Sturge weber angiomatosis of leptomeninges (leads to seizures, intelectual disability, focal neuro deficits) episcleral hemangioma (leads to early onset glaucoma)
112
hemangioblastomas of retina and CNS angiomatosis of skin and mucosa
VHL pheochromocytoma and b/l renal cell carcinoma
113
pt with elevated pth + galactorrea + fam hx of pituitary tumors
MEN syndrome 1 pituitary(prolactinoma) pancreatic (insulinoma, glucagoma, VIPoma) parathyroid bromocriptine for galactorrea surgical parital (subtotla) resection of parathyorid to decrease PTH
114
hereditary spherocytosis mangement
definitive is splenectomy
115
kid with facial angioedema and pulm symptoms
hereditary angioedema edema c1-esterase inhibitor deficiency over production of bradykinin (dont give them ace inhibtiors) will see low c4 and c1 esterase inhibtior (pulm sxms d/t resp vasodilation)
116
exacerbate peripheral edema also facial flushing, headache, gingival hyperplasia
calcium channel blockers nifedpine
117
pt greater than 35 and smoking more than 15 cig daily uncontrolled htn hx of hypercoagubility (or thromboembolism or storke) or hx of migraine with aura, breast or liver cancer) should not:
should not take OCPS espeically greater than 35 and smoking increased risk of stroke can use copper IUD instead
118
overactive bladder tx: vs overflow incontince tx:
oxybutiin bethanechol (muscarinin agen promotes bladder contraction) overflow can be d/t obstruction or neuro insult (ms, stroke, dm nephropathy, trauma)
119
oxygen therapy
PaO2: 55mm Hg or O2 sat: 88% or less
120
age under 5 with high fever and seizure with bulging right tympanic membrane
febrile seizure can be d/t viral or bacterial cns from acute otitis media give oral anitbiotcs
121
bee sting next step? prevent future rxn?
epinephrine venom immunotherapy -- builds tolerance
122
pst menopausal woman with vaginal spotting
can be endometrial carcinoma must do endometrial biopsy pelvic u/s: thickened endometrial stripe with endometrial hyperlamsia (should be 4mm or less in post menopausal) tx: hysterectomy with b/l salpino-oophorectomy followed by adjuvant chemotherapy