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NBME 12 Flashcards

1
Q

CARDIAC amyloidosis

A

only restrictive type will only hear s4

vs

chronic htn leading to CHF can have both S3 AND S4 d/t htn causing hypertrophy

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2
Q

pt with NG tube and cloudy fluid draining from it
next step?

A

CT scan of sinuses
IV abx, remove NG tube d/t bacterial sinus infection

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3
Q

pt gets surgery, given hydromorphone then becomes hypotensive, low resp rate, miosis (3mm pupils)

A

opiod (hydromorphone) intoxication
causing hypercarbia
check ABG anlaysis

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4
Q

acetaminophen:

ibuprofen:

colchicine:

A

acetaminophen: given FIRST initially to pts with osteoarthritis

ibuprofen: given Next to osteoarthritis (as well as topical diclofenac)

Colchicine: given in GOUT! or arthritis

NSAIDS(ibuprofen or colchicine): pseudo gout

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5
Q

prego on lithium, what next?

A

continue taking lithium
fetal cardiac ultrasound (ebsteins: R ventricular atrialization)

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6
Q
A

Neurofibromatosis 1
AD ch17
cutaneous neurofibroma (derived from neural crest cells)
cafe au lait spots (hypo-pigmented)
inguinal/axillary freckling
Lisch nodules – pigmented iris hamartomas
optic gliomas
pheochromoctyoma

**annual: Opthalmic, neurologic, dermatologic, blood pressure monitoring, bone/growth monitoring

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7
Q

7yo girl with precocious puberty and left ovarian mass

next step?

A

surgical resection: left oophorectomy
precocious puberty can be central vs peripheral (this is peripheral)

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8
Q

5yo with recurrent sinusitis, pneumonia, and on imaging:

A

primary ciliary dyskinesia (sinusitis, brochiectasis (bronchitis), inferitiliy, situs invertus)
kartagener
bronchiectasis in image
not able to mucus clearance

vs
wiskot aldrich will see WATER
VS
LAD: will see ELEVATED leekocytes since porblem is adhesion not making it

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9
Q

Repeated neisseria infections

A

compliment deficiency furhter down cascade

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10
Q
A

Slipped capital femoral epiphysis (ages 10-15) and overweight: painful limp, limited ABDuction and internal rotaitn of hiop
can cause avascular necrosis, premature osteoarthritis, gait impairments
tx: surgical stabilization of femoral head

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11
Q

normal S1 but diminished S2
harsh, systolic murmur
weak and delayed peripheral pulses

A

aortic stenosis
pulsus parvus et tardus
S2 from weakened closing of the valve
early onset 40 to 60: congential bicuspid valve or chronic rheumatic heart disease
older than 60: calcification and fibrosis

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12
Q

anal fissures longer than 8 weeks treatment:

A

chronic fissures: surgical repair

acute: topical analgesics, vasodilators, sitz bath

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13
Q

HTN, tachycardia, pupillary dilation, restlessness, euphoria (hallucinations, paranoia)

vs

”” “” + yawning, lacrimation, rhinorrhea, piloerection

A

cocaine intoxicaiton

vs

opioid withdrawal

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14
Q

prego 36 weeks, in labor, moderate blood, mom is A Rh-Negative
serum anti-D antibody titer is positive

fetal heart montior: SINUSOIDAL wave forms

what is most likely causing fetal heart rate pattern?

A

Rh isoimmunization

Rh(D)-negative moms are at high risk of forming anti-Rh(D) antibodies (Rh isoimmunization) – if exposed to blood from a Rh(D)-Positive fetus

it can cause hemolytic anemia – erythroblastosis fetalis (sinusoidal wave forms) 2/2 to Rh isoimmunization

next baby will die

Prevent it by giving RhoGAM at 28 weeks in Rh(D)-negative mothers

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15
Q

Pt who is able to sleep at night totally fine, (might see cataplexy or hallucinations hypno-gogic/pompic) but has daytime somnolence
dx?

A

Narcolepsy: loss of orexin-A/B (found in hypothalamus that promote wakefulness and inhibit REM sleep)
dx:** multiple sleep latency tests **will see shorter time from wakefulness to initiation of REM sleep
can also do lumbar puncture to measure orexin A in CSF

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16
Q

pt with bipolar on lithium, gets hypothyroid sxms with elvated TSH, anti-thryoid peroxidase antibody is negative

A

lithium induced (ae)
do not stop lithium, just treat hypothyroidism

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17
Q

kidney stones in a kid
dx
size/tx

A

do ultrasound/xray since CT is more radiation

if larger than 6mm –> needs more intervention (lithiotripsy)

if smaller: oral hydration and analgesia

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18
Q

50s with muscle weakness fatigue, bilateral ptosis, cxr: mediastinal mass

Dx?

A

myasthenia gravis
anitbody against nicotinic acetylcholine receptors at neuromuscular junction
thymoma
dx: nerve conduction studies with reptitive stimulation (like lambert eaton)
tx: complete thymectomy, ach-inhibtors with immune modulating therapies

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19
Q

acute chest pain, SOB, hypoxemia
ABG: acute resp alkalosis, hypoxemia, increased A-a gradient
next step?

A

Pulmonary embolism
increased A-a gradient d/t ventilation-perfusion mismatch
dx: CT-A,
thrombolytis and anticoagulants

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20
Q

bone, pain, anemia, hypercalcemia, renal dysfunction
dx?

A

roloux formation RBC aggregation
Multiple myeloma: neoplastic proliferation of plasma cells (overporduce monoclonal immunoglobulin light or heavy chains)
serum protein/urine electrophoresis
diagnosis confirmed with: **bone marrow biopsy

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21
Q

triad: digital clubbing, periostosis (inflamed periosteum of long bones), and severe arthralgia

A

Hypertrophic Pulmonary osteoarthropathy
abnormal fibrovascular proliferation
hypoxemic changes
unilateral lung mass with perihilar lymphadenopathy (malignancy cause but can be d/t anything)

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22
Q

adolescent with high BMI, what can improve mortality next 10 years?

A

weight loss

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23
Q

firm tender erythematous edematous mass on angle of mandible

A

acute suppurative parotitis
mixed oral flora or Staph Aureus
elderly dehydration, poor dentition, low saliva
dx: cliinical, lor with u/s or CT scan further evlauate for complicaitons: abscess/tumor

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24
Q

1 hr after transfucion of PRBC’s pt becomes flushed with fever, but normotensive and normal heart rythm&rate

next step?

A

Febrile nonhemolytic transfusion reaction
release of cytokines from leukocytes during blood product storage (long time storage of blood proudcts)
prevent: prestorage luekoreduction

tx: stop transfusion
give** oral acetaminophen** *pyretics

vs

ibuprofren: can cause gastritric/duodenal ulcers especially if pt already has ulcers

vs

epinephrine, diphenhydramine, methylprednisone – given in anaphylaxis with blood product transfusion in IgA deficiency: wheezing, uritcaria, hypotension, tachy

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25
pulsatile nontender mass in inguinal region when to do surgery?
femoral artery aneurysm dx: duplex ultrasound of groin or CT-angio symptomatic or larger than >3cm -- surgical artery repair
26
ct scan: intertitial lung pattern FVC: 48% DLCO: 55% dx?
Intersitital lung disease **lung biopsy** vs sarcoidosis can cause ILD: but measuring ACE would not be specific/sensitive enough for diagnosis
27
IgA deficiency next step? tx
can be asymptomatic, recurrent sinopulmonary infections or otitis media, or anaphylactic reaction to Plasma blood tx: only for symptomatic infection or anaphylaxis no intervention indicated at this time
28
partial or complete small bowel obstruction next step?
abdominal x ray : dilated loops with multiple air fluid levels managment: bowel rest, IV hydration, complete obstruction " " + if it does not resolve on its own -- ex lap
29
pt with 3 day pressure in face, itchy eyes, decreased hearing in both ears, inferior nasal turbinates edematous, cobblestone conjuctivae
allergic rhinitis give: anti-histamine loratidine vs bacterial -- will have discharge MRI of the sinuses if pt had recurrent or chronic sinusitis for sinus tumors or fungal infections
30
pt undergoes thyroidectomy hoarsness: airway obstruction and gasping for air:
unilateral laryngeal nerve paralysis bilateral laryngeal nerve paralysis
31
old man, straight lines start to appear curved or wavey, blurring dx
age related macular degeneration drusen: yellow subretinal extracellular deposits of lipoproteinaceous material early: blurring or metamorphopsia (wavy curved) late: nonreversible blindness retinal atrophy or choroidal neovascularization (macular edema exudation or hemorrhage) dx: **DILATED FUNDOSCOPIC EXAM** tx: dry: antioxidants and vitamin wet: injection VEGF
32
pt with recent fall and groin pain, Ulcerative colitis, and xray: pelvis and lower hiop shows moderate loss of joint space and diffuse osteopneia what next?
Osteoporosis/osteopneia next: MRI of the hip to assess for fracture vs dexa: would just show much bone density loss vs this guy has a potential hip fracture tx: weight bearing exercises bisphosphonates inhbit osteoclasts
33
child age 1-3 with acute onset of truncal ataxia, myoclonus, opsoclonus (saccadic intrusion)
neuroblastoma firm nodular mass that crosses midline and diastolic HTN dx: increased catecholamine in serum and urine tx: stage of tumor and MYCN amplificiation
34
pt with asplenia what to do as ppx
penicillin
35
viral infection (hhv6/7) 4-5 days later gets itchy rash trunk:
Piyriasis roseas -- herald patch self resolves 6-8 weeks
36
Pneumococcal vaccination:
for 65+ or ANYONE WITH HIV PCV13 --> PPSV23 (8 weeks later --> and again 5 years alter --> and again age 65)
37
TPN feeding:
causes cholestatic hepatic disease biliary obstruction/fibrosis/inflammation
38
hypertension and proteinuria during pregnancy complication:
preeclampsia abruptio placenta premature separation of placenta fro uterus --> fetal exsanguination
39
CAG chrom4
Hungtington disease
40
**pt with cirrhosis with elevated leukoctyes and neutrophils
spontaneous bacterial peritonitis GIVE IV ABX (ceftriaxone)
41
crohns pt with flare already on ASA what next?
give prednisone or budesonide vs infliximab and methotrex, azathioprin, 6-mercaptopurine (take way longer to start)
42
IBD patient with toxic megacolon next step?
only in IBD associated TM: give **corticosteroids** Bowel rest, NG decompression IV fluids and electrolyte repletion if still persisting symtpoms or peritoneal signs: surgery (subtotal colectomy with end ileostomy)
43
s/p mechanical ventilation what should they do to prevent resp muscle atrophy and insufficiency
physiotherapy, coughing, repositioning sit upright, moving
44
cleft lip chromosomal: syndrome: sequele:
Patau syndrome (trisomy 13) midfacial hypoplasia (treacher collins) Velopharyngeal insufficiency: cleft palate w/ or w/o repair: high pitched, nasal, whistle speech with reduced intelligibility
45
Preterm Premature Rupture of Membrane next steps risk factors complications
PPROM before 37 weeks speculum exam of vagina nitrazine testing and ferning u/s can show residual amniotic fluid risk factors: previous PPROM, vag/cerv infxn, cig smoking comp: preterm delivery give betamethasone to accelerate fetal lung maturity give antibiotcs d/t increased risk of chorioamniotis
46
forcing function
stops error occuring in hospitals need verification step or intermediary step first staff to enter pts id to open blood lock
47
Entamoeba histolytica key features dx tx
cysts invade mucosa and can cause hepatic abscess dx: stool microscopy cysts peripheral blood smear trophozoits colonoscopy: flask shaped mucosal ulcers tx: **metronidazole** or tinidazole or antifungal paromycin or iodoquinol
48
hoarsness, vocal changes, in pt with history of smoking
laryngeal carcinoma dx: indirect laryngoscopy
49
older pt with no hx of IBD, has passing air and fecal material in urination, long standing constipation
diverticular disease can lead to colovesical fistula dx: contrast CT tx: antibiotics and surgery vs IBD crohns fistula -- must have previous hx of it and usually younger than 30yo
50
pt with sympotms of sciatica w/ pain over piriformis w/o
piriformis syndrome vs lumbar disc herniation usually you dont need to do further testing: just PT if there is muscle weakness: nerve condoction or electromyography
51
irregular menstrual periods, acne, facial hair increased LH to FSH increased androgen (testosterone) production
PCOS associated with acanthosis nigrans insulin resistance tx: weight loss and OCPs spironolactone or ketoconozale for hirstuitism
52
prolactin level : > premenopausal > postmenopausal check what?
30> premeno 20 >post meno check TSH (since prolactin is positively regulated by TSH-releasing hormone and in states of hypothyroidism) also dopamine blocking medications tx hypothyroidism and prolactinemia will stop
53
seborrheic keratosis look stuck on appearance **age** can be associated with leser-trelat == GI cancer tx: no tx necessary, no diagnostic study needed
54
rapid correction of hyponatremia
demylination of pons pontine myelinolysis
55
fever, cyanosis, hypo-tension, hypoxemia after receiving PRBC
transfusion related acute lung injury stop trasnfusion give oxygen either Noninvasive positive pressure ventilation or ibutanion
56
Hypo-Ca, hyper-Phos, Hyper-K, Hyper-Uricemia s/p getting chemo
Tumor lysis syndrome preventive: IV hydration with **Allopurinal** or rasburicase
57
mydriasis bowel sounds decreased, flushed skin, tachycardia overdose:
TCA's tx: sodium bicarb can also see wide QRS tachycardia
58
asymptomatic hemorrhagic cyst
repeat u/s in 6 weeks does not need to be removed unless persistent or symtpomatic can resolve on its own
59
starting menopause with hot flashes next step?
start hormone therapy for 3-5 years not more d/t prolonged unopposed estrogen: increase risk for endometrial cancer, CVD, breast cancer
60
Renal artery stenosis (even in children) midabdominal bruit treatment
CCBs or **ANGIOPLASTY** if failed CCBs
61
CVSD greater than 10%
start statin
62
diificulty performind overhead tasks, rising from seated position, climbing stairs
polymyositis
63
right sided lower abdominal pain. 2 weeks ago had period, guarding over RLQ, U/S small amount of fluid in pelvis
Mittelschmerz peritoneal irritation in setting of (middle of cycle aka 2 weeks after period)looks like appendicits
64
limb prosthesis -- has ulcer
refitting prosthetic sock pressure injury: decubitus ulcer close of follow up for healing wound d/t possible infections
65
anion gap metabolic acidosis with respiratory alkalosis d/t hyperventilation
salicylate toxicity tx: alkalinize with sodium bicarb
66
traumatic wounds and infected intraabdominal fascia (like midline abdominal fascia) should be ____ to reduce risk of postop infection
delayed primary closure: (like that drunk driver) when you leave the icision site open, with negative pressure owund tx, infected tissue can drain out also if necessary: can do further irrgation and debridement
67
DKA insulin: glucagon: catecholamines:
insulin: low glucagon: high catecholamines: high vs pancreatic resection or tumor where insulin and glucagon would both be low
68
pt with sepsis but also constant loud breathing and secretions next step?
scopolamine(patch) or glycopyrollate(wont cross BBB causing agitation, delirium, seizures)
69
Eoisinophils in urine when started on ceftriaxone
AIN stop ceftriaxone
70
post menopausal with a hard immoble mass FNA showed no abnormalities next step?
excisional biopsy chance for breast cancer is high so just remove the whole thing for analysis

NBME's (8 decks)

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