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Step 2 > NBME 6 > Flashcards

NBME 6 Flashcards

1
Q

if someone is getting peritoneal dialysis then has a fever… what do you think of

A

peritonitis so get a gram stain to figure out what is causing the infection

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2
Q

what nerve causes the eyes reactivity to light

A

cranial nerve 2- optic nerve

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3
Q

what to think of when you have cramping abdominal pain with distention and n/v

A

small bowel obstruction

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4
Q

what to think of when you have hyperactive bowel sounds and pneumobilia (gas in the biliary system)

A

gallstone ileus

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5
Q

what to do if pt has potassium level > 6.5

A

give calcium gluconate before they have an arrhythmia and die

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6
Q

patient struggles to let go of something once they grasp it

A

myotonic muscular dystrophy

CTG repeat- cataracts, toupee, gonads small

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7
Q

pt presents with horners syndrome, ipsi face and temp loss, vestibular sings, vertigo, diplopia, diminished gag reflex and cerebellar probs, what do you think of

A

PICA infarct which comes off of the vertebral artery

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8
Q

pregnant pt presents with diarrhea/blood in stool and weird rash, what do you think of

A

IBD

possible Ulcerative Colitis

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9
Q

patient has hallucinations and weird movements (vermicular movements of the tongue and bilateral writhing motions)

A

huntingtons chorea

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10
Q

young pt gets sick a lot with infections and has lots of pus and PMNs found with infections

A

chronic granulomatous disease

  • deficiency of NAPDH Oxidase
  • trap bacteria but cant kill it (impaired phagocytic oxidative metabolism)
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11
Q

hilar lymphadenopathy with fever plus recent travel

A

think TB

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12
Q

post-partum pt presets with high cholesterol, lethargy, boredom, sleep and memory issues, hypernatremia, and weight gain

A

thyroid issue

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13
Q

any sort of abdominal bruit

A

renal artery stenosis likely due to atherosclerosis

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14
Q

what type of casts do you expect with dehydration

A

hyaline casts

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15
Q

what do you think of when you hear widened pulse pressure in adults vs babies

A

adult –> aortic regurg
baby –> PDA
-close the PDA with indomethacin
-keep it open with PGE1 (alprostadil)

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16
Q

why do glucocorticoids increase wbc and pmns

A

glucocorticoid-induced demargination and storage pool release of segmented neutrophils

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17
Q

second most common cause of constrictive pericarditis

A

radiation therapy comes after viral/idiopathic

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18
Q

how to tell the difference b/w bacterial and cryptococcal meningitis

A

CSF glucose will be low in both but wayyyy lower in bacterial meningitis
-bacterial will also present with higher fever (103+) and more toxic appearing pt

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19
Q

lady with increased calcium and hx of cancer… what do you do

A

increased risk of cervical spine compression so be sure to decompress the spinal cord and use a cervical stabilizer

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20
Q

compare and contrast polymyalgia rheumatica and fibromyalgia

A

polymyalgia rheumatica

  • proximal stiffness > pain (normal strength), fever malaise, weight loss
  • associated with giant cell arteritis (increased inflammatory markers)
  • rapid response to steroids

fibromyalgia

  • chronic, widespread musculoskeletal pain with tender points and a little stiffness, poor sleep, cognitive dysfunction
  • treat with regular exercise, antidepresants, neuropathic pain agents
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21
Q

proximal muscle weakness with endomysial inflammation and CT8-T cells
-usually on the shoulders

A

polymyositis

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22
Q

little baby has a problem with heart, liver, and muscles (no splenomegaly) what do you think of?

A

pompe disease
-lysosomal acid alpha-1,4-glucosidase deficiency

*if they have splenomegaly then think of GM1 gangliosidosis

23
Q

severe fasting hypoglycemia with increased glycogen in the liver, gout, and hepatomegaly

A

increased lactate: Von Gierke disease (glucose-6-phophatase deficient)

normal lactate: Cori disease

24
Q

muscle cramps and myoglobinuria and pt has a second-wind phenomenon when exercising due to increased muscular blood flow

A 
McArdle disease (myophosphorylase deficiency)
-muscle cant break down glycogen
25
Q

lytic bone lesions, hypercalcemia, anemia, and rouleaux formation on peripheral blood smear

A

multiple myeloma

26
Q

what do hiccups indicate

A

phrenic nerve irritation

27
Q

how to manage hyponatremia

A

if there are no signs of altered mental status treat conservatively with water restriction
-3% saline is only indicated for SYMPTOMATIC severe hypoNa

28
Q

patient vomiting what do you expect the problem to be

A

metabolic alkalosis

29
Q

infant presents with biphasic stridor and wheezing that gets better with neck extension

A

vascular ring compressing the airway

30
Q

calcifications in…

  • anterior lumbar spine
  • lower thoracic spine
A
  • anterior lumbar spine –> atherosclerosis in abdominal aorta (risk factor for AAA)
  • anterior lower thoracic spine –> chronic pancreatitis
31
Q

patient is taking aspirin and ibuprofen and has occasional squamous and epithelial casts, what do you think of

A

acute interstitial nephritis causing renal papillary necrosis

  • intrarenal pattern of injury (BUN/Cr < 20)
  • avoidance of analgesics would prevent this
32
Q

patient has borderline high total lipids (225)

A

get FASTING lipid profile then if needed to step 1 diet (decrease fats, calories, cholesterol) and then step 2 diet (more aggressive diet than step 1)

*note: only variable that changes with diet is triglycerides

33
Q

how long does someone need to have generalized anxiety before they get the diagnosis

A

more than 6 months

34
Q

what to think of with an ABI < 0.9

A

diagnostic of peripheral artery disease

  • first line treatment is graded exercise program
  • revascularization is only indicated for critical limb ischemia (rest pain and non-healing ulcers)
35
Q

patient with eosinophilia, hyponatremia, hyperkalemia, lethargy, congusion, hyperpigmentation

A

Primary Adrenal Insufficiency- (Addisons)

-test with ACTH stimulation test

36
Q

long acting injectable schizophrenia medication

A

haloperidol is long acting

-less long acting you can also use risperidone and fluphenazine decanoate

37
Q

explain a transudative effusion

A

low protein and leukocyte count with normal glucose

38
Q

ear problem where abx dont work and there is a shifting of the auricle (down/lateral)

A

abscess

-use CT to visualize it

39
Q

what anti-epileptic medication is associated with blood dyscrasias (aplastic anemia and agranulocytosis)

A

carbamazepine

40
Q

someone is having a PE, what is your first step

A

heparin therapy

41
Q

what is the general rule for median and ulnar nerve injuries

A

proximal injury- impaired flexion

distal injury- impaired extension

42
Q

baby pt has a myelomeningocele, what should you maybe look for

A

myelomeningocele is associated with chiari II malformation which can cause an obstructive hydrocephalus

43
Q

how to workup post-cholecystectomy RUQ pain

A

ERCP

44
Q

accumulation of material in white matter

A

fatty acids

  • very long chain fatty acids
  • adrenoleukodystrophy
45
Q

pediatric hypertension

A

first-line is always non-pharm intervention

treat with pharm if…

  1. symptomatic htn
  2. stage 2 htn without clearly modifiable factor
  3. any stage htn with ckd or dm
46
Q

spondylolithesis

A

when the spine is kinda forward and there is a little fracture then it breaks and causes the spine to shift forward a bit (usually lower back)

47
Q

sacroiliitis

A

inflammation of one or both of the sacroiliac joints where the lower spine and pelvis connect

  • can cause pain the butt/lower back and can extend down one or both legs
  • can become worse with prolonged standing or stair climbing
48
Q

when you put someone on lithium what is the next step

A

at baseline measure Cr, Ca, UA, BUN, and thyroid function

then monitor TSH q6-12months and supplement with T4 if it causes hypothyroidism

49
Q

at what triglyceride level should you be concerned for pancreatitis

A

1000 to 2000 roughly

50
Q
  • upper extremities more muscular and diminished pulses in lower extremities
  • midsystolic or continuous systolic murmur that radiates to the back
A

coarctation of the aorta

-treat with surgical decompression

51
Q

how to treat acute kidney rejection

A

steroids + antithymocyte

52
Q

what drugs to use for hypertensive urgency and emergency

A

urgency- clonidine

emergency- clevidipine/nicardipine, felodopam, labetalol, nitroprusside

53
Q

elderly pt with thin vulva and absent labia minora

A

lichen sclerosis

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