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NBME's > NBME 12 > Flashcards

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
Q

pulsatile nontender mass in inguinal region
when to do surgery?

A

femoral artery aneurysm
dx: duplex ultrasound of groin or CT-angio

symptomatic or larger than >3cm – surgical artery repair

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26
Q

ct scan: intertitial lung pattern
FVC: 48%
DLCO: 55%
dx?

A

Intersitital lung disease
lung biopsy

vs

sarcoidosis can cause ILD: but measuring ACE would not be specific/sensitive enough for diagnosis

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27
Q

IgA deficiency
next step? tx

A

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

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28
Q

partial or complete small bowel obstruction
next step?

A

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

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29
Q

pt with 3 day pressure in face, itchy eyes, decreased hearing in both ears, inferior nasal turbinates edematous, cobblestone conjuctivae

A

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
Q

pt undergoes thyroidectomy

hoarsness:

airway obstruction and gasping for air:

A

unilateral laryngeal nerve paralysis

bilateral laryngeal nerve paralysis

31
Q

old man, straight lines start to appear curved or wavey, blurring
dx

A

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
Q

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?

A

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
Q

child age 1-3 with acute onset of truncal ataxia, myoclonus, opsoclonus (saccadic intrusion)

A

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
Q

pt with asplenia what to do as ppx

A

penicillin

35
Q

viral infection (hhv6/7) 4-5 days later gets itchy rash
trunk:

A

Piyriasis roseas – herald patch
self resolves 6-8 weeks

36
Q

Pneumococcal vaccination:

A

for 65+

or

ANYONE WITH HIV
PCV13 –> PPSV23 (8 weeks later –> and again 5 years alter –> and again age 65)

37
Q

TPN feeding:

A

causes cholestatic hepatic disease
biliary obstruction/fibrosis/inflammation

38
Q

hypertension and proteinuria during pregnancy
complication:

A

preeclampsia

abruptio placenta
premature separation of placenta fro uterus –> fetal exsanguination

39
Q

CAG chrom4

A

Hungtington disease

40
Q

**pt with cirrhosis with elevated leukoctyes and neutrophils

A

spontaneous bacterial peritonitis

GIVE IV ABX (ceftriaxone)

41
Q

crohns pt with flare already on ASA
what next?

A

give prednisone or budesonide

vs infliximab and methotrex, azathioprin, 6-mercaptopurine (take way longer to start)

42
Q

IBD patient with toxic megacolon
next step?

A

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
Q

s/p mechanical ventilation
what should they do to prevent resp muscle atrophy and insufficiency

A

physiotherapy, coughing, repositioning sit upright, moving

44
Q

cleft lip
chromosomal:
syndrome:
sequele:

A

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
Q

Preterm Premature Rupture of Membrane
next steps
risk factors
complications

A

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
Q

forcing function

A

stops error occuring in hospitals
need verification step or intermediary step first
staff to enter pts id to open blood lock

47
Q

Entamoeba histolytica
key features
dx
tx

A

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
Q

hoarsness, vocal changes, in pt with history of smoking

A

laryngeal carcinoma

dx: indirect laryngoscopy

49
Q

older pt with no hx of IBD, has passing air and fecal material in urination, long standing constipation

A

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
Q

pt with sympotms of sciatica

w/ pain over piriformis
w/o

A

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
Q

irregular menstrual periods, acne, facial hair
increased LH to FSH
increased androgen (testosterone) production

A

PCOS
associated with acanthosis nigrans insulin resistance
tx: weight loss and OCPs
spironolactone or ketoconozale for hirstuitism

52
Q

prolactin level : > premenopausal
> postmenopausal
check what?

A

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
Q
A

seborrheic keratosis
look stuck on appearance
age
can be associated with leser-trelat == GI cancer

tx: no tx necessary, no diagnostic study needed

54
Q

rapid correction of hyponatremia

A

demylination of pons
pontine myelinolysis

55
Q

fever, cyanosis, hypo-tension, hypoxemia after receiving PRBC

A

transfusion related acute lung injury
stop trasnfusion
give oxygen either Noninvasive positive pressure ventilation or ibutanion

56
Q

Hypo-Ca, hyper-Phos, Hyper-K, Hyper-Uricemia
s/p getting chemo

A

Tumor lysis syndrome
preventive: IV hydration with Allopurinal or rasburicase

57
Q

mydriasis bowel sounds decreased, flushed skin, tachycardia
overdose:

A

TCA’s
tx: sodium bicarb

can also see wide QRS tachycardia

58
Q

asymptomatic hemorrhagic cyst

A

repeat u/s in 6 weeks
does not need to be removed unless persistent or symtpomatic

can resolve on its own

59
Q

starting menopause with hot flashes
next step?

A

start hormone therapy for 3-5 years
not more d/t prolonged unopposed estrogen: increase risk for endometrial cancer, CVD, breast cancer

60
Q

Renal artery stenosis (even in children) midabdominal bruit
treatment

A

CCBs or ANGIOPLASTY if failed CCBs

61
Q

CVSD greater than 10%

A

start statin

62
Q

diificulty performind overhead tasks, rising from seated position, climbing stairs

A

polymyositis

63
Q

right sided lower abdominal pain. 2 weeks ago had period, guarding over RLQ, U/S small amount of fluid in pelvis

A

Mittelschmerz
peritoneal irritation in setting of (middle of cycle aka 2 weeks after period)looks like appendicits

64
Q

limb prosthesis – has ulcer

A

refitting prosthetic sock
pressure injury: decubitus ulcer

close of follow up for healing wound d/t possible infections

65
Q

anion gap metabolic acidosis with respiratory alkalosis d/t hyperventilation

A

salicylate toxicity
tx: alkalinize with sodium bicarb

66
Q

traumatic wounds and infected intraabdominal fascia (like midline abdominal fascia) should be ____ to reduce risk of postop infection

A

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
Q

DKA
insulin:
glucagon:
catecholamines:

A

insulin: low
glucagon: high
catecholamines: high

vs

pancreatic resection or tumor where insulin and glucagon would both be low

68
Q

pt with sepsis but also constant loud breathing and secretions
next step?

A

scopolamine(patch) or glycopyrollate(wont cross BBB causing agitation, delirium, seizures)

69
Q

Eoisinophils in urine when started on ceftriaxone

A

AIN
stop ceftriaxone

70
Q

post menopausal with a hard immoble mass
FNA showed no abnormalities
next step?

A

excisional biopsy
chance for breast cancer is high so just remove the whole thing for analysis

NBME's (8 decks)

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