NBME 6 Flashcards
if someone is getting peritoneal dialysis then has a fever… what do you think of
peritonitis so get a gram stain to figure out what is causing the infection
what nerve causes the eyes reactivity to light
cranial nerve 2- optic nerve
what to think of when you have cramping abdominal pain with distention and n/v
small bowel obstruction
what to think of when you have hyperactive bowel sounds and pneumobilia (gas in the biliary system)
gallstone ileus
what to do if pt has potassium level > 6.5
give calcium gluconate before they have an arrhythmia and die
patient struggles to let go of something once they grasp it
myotonic muscular dystrophy
CTG repeat- cataracts, toupee, gonads small
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
PICA infarct which comes off of the vertebral artery
pregnant pt presents with diarrhea/blood in stool and weird rash, what do you think of
IBD
possible Ulcerative Colitis
patient has hallucinations and weird movements (vermicular movements of the tongue and bilateral writhing motions)
huntingtons chorea
young pt gets sick a lot with infections and has lots of pus and PMNs found with infections
chronic granulomatous disease
- deficiency of NAPDH Oxidase
- trap bacteria but cant kill it (impaired phagocytic oxidative metabolism)
hilar lymphadenopathy with fever plus recent travel
think TB
post-partum pt presets with high cholesterol, lethargy, boredom, sleep and memory issues, hypernatremia, and weight gain
thyroid issue
any sort of abdominal bruit
renal artery stenosis likely due to atherosclerosis
what type of casts do you expect with dehydration
hyaline casts
what do you think of when you hear widened pulse pressure in adults vs babies
adult –> aortic regurg
baby –> PDA
-close the PDA with indomethacin
-keep it open with PGE1 (alprostadil)
why do glucocorticoids increase wbc and pmns
glucocorticoid-induced demargination and storage pool release of segmented neutrophils
second most common cause of constrictive pericarditis
radiation therapy comes after viral/idiopathic
how to tell the difference b/w bacterial and cryptococcal meningitis
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
lady with increased calcium and hx of cancer… what do you do
increased risk of cervical spine compression so be sure to decompress the spinal cord and use a cervical stabilizer
compare and contrast polymyalgia rheumatica and fibromyalgia
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
proximal muscle weakness with endomysial inflammation and CT8-T cells
-usually on the shoulders
polymyositis
little baby has a problem with heart, liver, and muscles (no splenomegaly) what do you think of?
pompe disease
-lysosomal acid alpha-1,4-glucosidase deficiency
*if they have splenomegaly then think of GM1 gangliosidosis
severe fasting hypoglycemia with increased glycogen in the liver, gout, and hepatomegaly
increased lactate: Von Gierke disease (glucose-6-phophatase deficient)
normal lactate: Cori disease
muscle cramps and myoglobinuria and pt has a second-wind phenomenon when exercising due to increased muscular blood flow
McArdle disease (myophosphorylase deficiency) -muscle cant break down glycogen
lytic bone lesions, hypercalcemia, anemia, and rouleaux formation on peripheral blood smear
multiple myeloma
what do hiccups indicate
phrenic nerve irritation
how to manage hyponatremia
if there are no signs of altered mental status treat conservatively with water restriction
-3% saline is only indicated for SYMPTOMATIC severe hypoNa
patient vomiting what do you expect the problem to be
metabolic alkalosis
infant presents with biphasic stridor and wheezing that gets better with neck extension
vascular ring compressing the airway
calcifications in…
- anterior lumbar spine
- lower thoracic spine
- anterior lumbar spine –> atherosclerosis in abdominal aorta (risk factor for AAA)
- anterior lower thoracic spine –> chronic pancreatitis
patient is taking aspirin and ibuprofen and has occasional squamous and epithelial casts, what do you think of
acute interstitial nephritis causing renal papillary necrosis
- intrarenal pattern of injury (BUN/Cr < 20)
- avoidance of analgesics would prevent this
patient has borderline high total lipids (225)
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
how long does someone need to have generalized anxiety before they get the diagnosis
more than 6 months
what to think of with an ABI < 0.9
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)
patient with eosinophilia, hyponatremia, hyperkalemia, lethargy, congusion, hyperpigmentation
Primary Adrenal Insufficiency- (Addisons)
-test with ACTH stimulation test
long acting injectable schizophrenia medication
haloperidol is long acting
-less long acting you can also use risperidone and fluphenazine decanoate
explain a transudative effusion
low protein and leukocyte count with normal glucose
ear problem where abx dont work and there is a shifting of the auricle (down/lateral)
abscess
-use CT to visualize it
what anti-epileptic medication is associated with blood dyscrasias (aplastic anemia and agranulocytosis)
carbamazepine
someone is having a PE, what is your first step
heparin therapy
what is the general rule for median and ulnar nerve injuries
proximal injury- impaired flexion
distal injury- impaired extension
baby pt has a myelomeningocele, what should you maybe look for
myelomeningocele is associated with chiari II malformation which can cause an obstructive hydrocephalus
how to workup post-cholecystectomy RUQ pain
ERCP
accumulation of material in white matter
fatty acids
- very long chain fatty acids
- adrenoleukodystrophy
pediatric hypertension
first-line is always non-pharm intervention
treat with pharm if…
- symptomatic htn
- stage 2 htn without clearly modifiable factor
- any stage htn with ckd or dm
spondylolithesis
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)
sacroiliitis
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
when you put someone on lithium what is the next step
at baseline measure Cr, Ca, UA, BUN, and thyroid function
then monitor TSH q6-12months and supplement with T4 if it causes hypothyroidism
at what triglyceride level should you be concerned for pancreatitis
1000 to 2000 roughly
- upper extremities more muscular and diminished pulses in lower extremities
- midsystolic or continuous systolic murmur that radiates to the back
coarctation of the aorta
-treat with surgical decompression
how to treat acute kidney rejection
steroids + antithymocyte
what drugs to use for hypertensive urgency and emergency
urgency- clonidine
emergency- clevidipine/nicardipine, felodopam, labetalol, nitroprusside
elderly pt with thin vulva and absent labia minora
lichen sclerosis
