NBME 7 Flashcards
Tx and prevention for gout?
Tx: NSAIDS (ibuprofen/indomethacin), or colchicine if NSAIDS intolerable
Prevention: allopurinol
SOB for 8hrs, inspiratory crackles, JVD and distant heart sounds, x-ray shows cardiomegaly, EKG w/ alternating amplitude of QRS, next step?
Pericardial window - drains pericardial effusion into pleural cavity
23yo asymptomatic, preemployment eval, PPD 16mm, no prior PPD and no exposure, x-ray w/o abnormalities, sputum samples show no acid-fast bacilli, next steps?
Tx latent TB now
16yo girl, different opinion on activities, mother does not want to confide, dad does not know all, mgmt?
Family therapy - all parties are not on the same page
27yoM, unable to conceive, exam shows ill-defined soft masses palpated bilaterally, high in the scrotum, dx?
Bilateral varicoceles (varicoceles and infertility)
Homeless man, jaundice, 20 year history alcoholism, low magnesium, other lab findings?
Decreased calcium. Alcoholism -> low mag -> low PTH -> dec calcium
ALS EMG and nerve conduction studies findings?
Fibrillation potentials in multiple muscle of multiple extremities
Serosanguineous fluid between incision staples, large amount of fluid, minimal incision tenderness and no erythema
Wound dehiscence (if minimal fluid than normal)
More TB proph
Pneumococcal vaccine
Digoxin toxicity?
Arrythmias, PVC/V-tach/V-fib, nausea/vomiting/visual symptoms, hyperK (but this question had low K)
14yo boy, 6mo left knee pain, exacerbated by activity especially jumping. No hx of direct injury, he has grown 3 inches over the past 6 mo, older brother had similar symptoms, normal gait, range of motion of hips/knees are full and symmetric; tenderness and swelling over the left tibial tubercle, no joint effusion and knee joint is stable, MOA?
Repeated microfracture at the tendon site - Osgood Schlatter
18yoF, fever, mild productive cough, sore throat, general malaise, and anorexia for 5 weeks; exudative pharyngitis w/ whitish membrane, prominent cervical lymphadenopathy, splenomegaly, dx?
EBV
Least invasive management for aspiration pneumonia?
Elevation of head of the bed
19yo AA man p/w 9month hx of 6-12 hr episodes intermittent watery diarrhea a/w abdl cramps and bloatoing; diarrhea after meals since 12, no other abnormalities, dx?
Lactose intolerance (not celiac - other deficiencies would be present)
Flesh colored papules w/ central umbilication over face, neck, back, and chest, in adults vs kids?
Molloscum contagiosum - harmless virus in kids. If found in adults - considered STD -> consider HIV antibody testing
2+ nonpitting edema, dec DTR, uninterested/forgetfullness/responds slow to questions, hyponatremia, dx?
Hypothyroidism (pretibial myxedema)
Aortic dissection, pressures or HR management?
IV labetalol
Hyponatremia, euvolemic, dec serum osm, inc urine osm
SIADH - too much ADH, body holds on to water (low serum osm) while inappropriately concentrating urine
1st line tx for BPH (difficulty starting urinary stream and dribbling)
Finasteride
Asymptomatic type 1 (sliding) hiatal hernia, tx?
Observation -> symptoms? then antacids or H2 receptor antagnoist -> lastly lap nissen fundoplication
Low back pain for 4 months, present throughout day but most severe in mornin, dull ache w/ stiffness in the morning, right SI joint tenderness w/ paravertebral muscle spasm and dec flexion at waist, ESR is inc, dx?
Ankylosing spondylitis
Diabetes insipidus
ADH not being produced (central) or kidneys unresponsive to ADH - peeing a lot, urine is dilute, this is hypovolemic hypernatremia
57yoF, inc pain in left groin and anterior thigh over the past year, active range of motion of hip joint reporudces pain, 20 deg hip flexion contracture, ESR 20, dx?
Osteoarthritis
OCP, dec risk of what?
Ovarian, breast, endometrial
Lead poisoning tx?
Calcium disodium edetate
Otherwise healthy 37yoM, 3 month low back pain, NSAIDs help, forward flexion is normal w/o pain, hyperextension increases pain, strength/sensation/reflexes normal; picture of lateral x-ray showing vertebral body slipping forward, dx?
Spondylolisthesis
62yoW severe upper back pain, progressive weakness of both legs, tingling in legs and feet, episodes of urinary incontinence -> underwent mastectomy six months ago, bad LE muscle/sensation/brisk DTR, positibe Babinski, dx and mgmt?
Mets to spine, radiation therapy
Pathophys of emphysema?
X-ray shows thin walled cystic spaces w/ some air-fluid levels, look for destruction and dilation of distal airways
