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NBME's > NBME 11 > Flashcards

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
Q

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

A

hydatidiform moles

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26
Q

third trimester painless vaginal bleeding, placental tissue partially or entirely over internal cervical os

A

placenta previa

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27
Q

gram positive bacillus, can cause bacterial meningitis in infants and elderly
tumbling motility

A

listeria

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28
Q

acute dystonic reactions: D2 antagonist
torticollis, retrocollis, opisthotonos 9arching back), oculogyric crisis (deviation of eyes)

A

haloperidol or fluphenazine
dopamine-cholinergic basal ganglia
tx: diphenydramine or benztropine (anticholinergics)
risk factors: male, young age, recent cocaine use, hx of acute dystonia

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29
Q

jaundice, hyperbilirubinemia, increased serum liver enzymes in pt with previous IV drug use

A

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

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30
Q

refeeding syndrome

A

within 2 weeks of refeeding:
hypo-phoshpatemia hypo-kalemia, hypo-magnesmia
can lead to heart failure, resp failure, arrythmia, seizures

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31
Q

pt with celiacs has super high PTH but low vitamin-D and hypocalcemia and hypophosphatemia

A

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

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32
Q

short digits (brachydactylyl), short stature, developmental delay, round facies

A

osteodystrophy – Albright hereditary osteodystrophy
pseudo-hypo-parathryoidism
impaired reposne of the kidney to parathyroid hormone –> hypocalcemia

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33
Q

Primary hyperparathyroidism
mcc

A

parathyroid adenoma (then hyperplasia, then carcinoma)

subperiosteal bone resporption, renal failure, hyper-ca, hypo-phos

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34
Q

painless jaundice and weight loss

A

pancreatic cancer

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35
Q

Marfans pt sports:

A

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

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36
Q

UTI in age less than 1 yo
next step?

A

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

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37
Q

muscle atonia lost –> violently acting out dreams, sometiems remember dreams + resting tremor

A

Parkinsons
dx: polysomnography showing lack of atonia during REM
tx: safe sleep enviroment, melatonin/clonazepam

(can also see this in lewy body dementia)

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38
Q

CSF: Leukocytes less than 100/mm3 with a predominance of lymphocytes (monocytes) normal or increased protein, normal glucose

A

aseptic (viral) meningitis

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39
Q

heart failure
cvp:
pcwp
svr:
SV:
CO:

A

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

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40
Q

pt with RA prior to srugery what should they get

A

lateral xray of cervical spine in flexion and extension for proper intubation – can lead to paralysis or death if translation instability is present

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41
Q

Vascular tumors
hemangioblastomas of retina and cerebellum
angiomatosis of the skin
can also see: renal clear cell carcinoma, pancreatic tumor, pheochromocytoma

A

VHL
do CT SCAN OF ABDOMEN for kindey, pancreas, adrenals
tx: surgical excision

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42
Q

bloody diarrhea, thrombocytopenia, hemolytic anemia

A

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

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43
Q

pt with fever but bradycardia
bacteremia, rose colored spots on chest and abdomen

A

salmonella typhi

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44
Q

no spleen
what vaccines?

A

meningococcal conjgate (against serotype B) must be given every 5 years

pneumococcal PCV13 PPSV23
annual influenza
Haemophilus influenza type B

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45
Q

mechanical ventilation after 10-14 days
next step?

A

tracheostomy tube – decreased risk for laryngeal injury, better comfort, easier ventilator weaning
complications: tracheal stenosis or tracheomalacia
tracheoarterial fistula
site infection

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46
Q

fever, productive cough, and pulmonary infiltrate
dx
tx

A

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

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47
Q

14M with consistently decreased growth velocity (always 3rd percentile), bone age younger than chronological age, tanner stage 1

A

Constitutional growth delay
pre-puberty but once puberty hits sudden spike in height

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48
Q

short parents, normal gain of height velocity, bone age corresponds to chronological age

A

Familial hereditary short stature

vs constitutional will not see that normal gain of height velocity and bone age is younger

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49
Q

prego with hyperthyroid symptoms and high free thyroxine and low tsh
next step

A

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
Q

scaly patches with alopecia, and patches of alopecia with black dots that represent broken hairs

A

tinea capitis
oral griseofulvin

51
Q

maculopapular rash, morbilliform rash
10days ago recieved MMR vaccine

A

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
Q

erythematous tongue, rash, desquamation of hands and feet
rash is rough, papular, diffuse body

A

scarlet fever (strep pyogenes GAS)

53
Q

Several high fevers can even have seizures,
fevers end, then blanching macular eruption on neck and trunk spread outwards to face and extremities

A

Roseola – exanthema subitum
HHV-6

54
Q

pink patches on b/l cheeks slapped cheeks
lacy macular eruptions on trunk and extremities

A

Erythema infectiosum – fifth disease
Parvovirus B19

55
Q

small bony spur protruding from the surface of the bone capped by cartilage, abel to palpate, painless, usually near joints (knee/ankle)

A

osteochondroma
benign – tx not necessary unless interfering with growth or limb deformity (surgery)

56
Q

adolescents: low grade joint pain, swelling, small well defined epiphyseal lesion with sclerotic border

A

chondroblastoma

57
Q

t (11,22) adolescent boys, elevated periosteum layered neocortex formation
usually long bones femur tibia
histo: multiple small round blue cells

A

Ewing sarcoma

58
Q

xray: radiolucent bone lesion, usually proximal femur, can have pain, usually solitary

A

osteoid osteoma

vs osteochondromas (usually multiple, sessile/pedunculated tumor w/ cortex continuous with underlying bone and cartilagenous cap and PAINLESS)

59
Q

ingest substance (plants) mouth pain, generalized burning sensation of skin, abdominal pain, n/v

A

Paraquot poisoning – herbicide plant chemical

60
Q

3cm nontender fluctuant mass external to hymenal ring, adjacent to introtius (posterior vulva underlying mucosa of the vestibule)

A

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
Q

mass internal to hymenal ring and recent obgyn checkup

A

episiotomy inclusion cyst
2/2 to episiotomy

62
Q

skin colored nodules with central punctum can get infected, firm, on vagina

A

sebaceous cyst
firm not fluctulant like bartholyn gland cyst

63
Q

fluctuant swelling near the urethra caused by blockage of the outflow of Skene’s glands

A

Vestibular gland cyst
vs
bartholin gland cysts occur adjacent to the introitus

64
Q

decrescendo murmur that begins after S2 heard at left sternal border

A

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
Q

ectopic endometrial tissue outside of uterus

chronic dysmenorrhea, dyspareunia, dyschezia, infertility

A

endometriosis

66
Q

decerases the risk for future ischemia strokes and all-cause mortality

A

statins

must give after a stroke

67
Q

pt has head trauma mva, continues to be hypotensive even after IV fluids with hypernatremia and urine osmolality of 100

A

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
Q

Hirschsprungs dx

A

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
Q

decreased lung capacity
decreased residual volume
normal fev1
obese and shallow breaths

A

restrictive lung disease

most likely obesity hypoventilation syndrome

rld: ild, ohs, neuromusclar dx like ALS

70
Q

prego at 28 weeks, cervix partialy effaced with uterine contractions every 5 min

A

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
Q
A
72
Q
A

acral lentiginous melanoma

73
Q

prego with HIV
what to give prior or during delivery
what to give neonate

A

zidovudine
PEP + bottle feed only

74
Q

Old pt s/p surgery, opoiates, trauma, now has marked colonic dilation

A

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
Q

pt with lupus flare and lupus pleuritis
tx

A

first NSAIDS
then glucocorticoids

76
Q

failure rate of a test to detect disease when it is present

A

sensitivity
1 - false negative rate

77
Q

Primary prevention strategies:
secondary
tertiary:

A

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
Q

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

A

5yrs

3 years

79
Q

vaginal bleeding with NO open os (closed os)

A

threatened abortion

80
Q

vaginal bleeding and an open os

A

inevitable abortion

incomplete aborition once the passage of products beings

81
Q

passage of all products and closed os

A

complete abortion

82
Q

asymptomatic fetal demise without passage of products

A

missed abortion

83
Q

spontaneous abortion managment

A

medical management: mifepristone and misoprostol TOGETHER (not separate)
or
uterine evacuation with Dilation and suction curettage highest success rate

84
Q

DVT

A

dx: duplex ultrasound (obstructed deep viens, normal superficial veins)
tx: subcutaenous low-molecular weight heparin – enoXaprrin

85
Q

asymptomatic Conjugated hyperbilirubin in abscense of other liver enzymes

A

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
Q

asymptomatic Conjugated hyperbilirubin in abscense of other liver enzymes

A

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
Q

20s-40s with recurrent sinopulmonary (sinus, pulmonary, pneumo, bronchitis) infections and splenomegaly

A

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
Q

inflammation cracking of skin aroudn lips, mouth, tongue

A

riboflavin deficiency b2

89
Q

asthma managmenet
test

A

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
Q

dental procedure with aortive valve replacement

A

amoxicillin
if allergic to PCN: macrolide: clarithromycin

91
Q
A
92
Q

bilateral hilar lymphadenopathy and possible coarse upper lobe-predominant reticular pulmonary opacities (also chronic condition)

A

sarcoidosis

93
Q

immunocompromised with diffuse bilateral infiltrates often prominent around hila

A

Pneumocystis jirovecci
dx: methenamine silver or toluidine blue stains (stains cyst walls fungus yeas like causes pneumo)

tx: bactrim, atovaquone, or pentamidine

94
Q
A
95
Q

Lambert Easton dx?

A

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
Q

pt with CKD
what should he restrict?

A

intake of phosphorous and potassium

fucked kidneys!!!

ckd prone to volume overload, hyperK, hyperPhos, metabolic acidosis, hyper-PTH, osteodystrophy, anemia(check Hg)

97
Q

uti
uti wiht pyleneprhtis (CVA tenderness)

A

nitrofurantoin

bactrim, ceftriaxone, ciprofloxacin, or amoxicillin/clav

98
Q

pt on valproic acid and has nose bleeds
what needs to be monitored

A

check platelets
can cause leukopenia and thrombocytopneia

99
Q

progesterone challenge

A

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
Q

acute otitis media

vs

mastoiditis

A

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
Q

essential tremor

A

worse with stress, better with aclohol
tx: Propanolol (b-blocker)

102
Q

pt with upper arm acute limb ischemia (pain, pallor, pulseless, parasthesia, paralsis, poikilotheria)

A

do an echo (TEE)
most LIKELY d/t arterial thromboembolism from heart

103
Q

mammogram every 1 to 2 years starting at ___ to ___

A

40 go 74

104
Q

parotid gland mass
next step?

A

excision and drainage

105
Q

pt with crohns started on infliximab
what to follow up with in one month

A

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
Q

when a study demonstrates no difference between nul and alternative hypothesis but in fact there is a difference

A

type II error (beta)
false negative
can be reduced by increasing power through larger sample size and increasing precision in measurements

107
Q

fibrosarcoma painless mass in thigh
next step?

A

soft tissue sarcoma
do a CT of abdomen and chest since it can hematogenously spread all over

108
Q

baby with poor weight gain, back arching after feeding, appears in pain

A

reflux esophagitis
GERD in babies
tx: decreased feed volume while increasing frequency
keeping baby upright 20-30min after feed

109
Q

hypopigmented oval macules or patches + seizure + cognitive dysfunction

A

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
Q

cutaneous neurofibromas, cafe au lait spots, pigmented iris hamartomas, optic gliomas, pheochromocytoma

A

Neurofibromatosis
hyperpigmented spots vs ash leaf is hypopigmented in TS

111
Q

port wine stain

A

Sturge weber
angiomatosis of leptomeninges (leads to seizures, intelectual disability, focal neuro deficits)
episcleral hemangioma (leads to early onset glaucoma)

112
Q

hemangioblastomas of retina and CNS
angiomatosis of skin and mucosa

A

VHL
pheochromocytoma and b/l renal cell carcinoma

113
Q

pt with elevated pth + galactorrea + fam hx of pituitary tumors

A

MEN syndrome 1
pituitary(prolactinoma) pancreatic (insulinoma, glucagoma, VIPoma) parathyroid

bromocriptine for galactorrea
surgical parital (subtotla) resection of parathyorid to decrease PTH

114
Q

hereditary spherocytosis mangement

A

definitive is splenectomy

115
Q

kid with facial angioedema and pulm symptoms

A

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
Q

exacerbate peripheral edema
also facial flushing, headache, gingival hyperplasia

A

calcium channel blockers
nifedpine

117
Q

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:

A

should not take OCPS
espeically greater than 35 and smoking
increased risk of stroke
can use copper IUD instead

118
Q

overactive bladder tx:

vs

overflow incontince tx:

A

oxybutiin

bethanechol (muscarinin agen promotes bladder contraction)
overflow can be d/t obstruction or neuro insult (ms, stroke, dm nephropathy, trauma)

119
Q

oxygen therapy

A

PaO2: 55mm Hg
or
O2 sat: 88% or less

120
Q

age under 5 with high fever and seizure with bulging right tympanic membrane

A

febrile seizure
can be d/t viral or bacterial cns from acute otitis media
give oral anitbiotcs

121
Q

bee sting next step? prevent future rxn?

A

epinephrine
venom immunotherapy – builds tolerance

122
Q

pst menopausal woman with vaginal spotting

A

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

NBME's (8 decks)

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