NBME 7 Flashcards
what is mupirocin
topical treatment for impetigo
what is triamcinilone
glucocorticoid topical treatment
how does a pt with diabetes insipidus present
hypernatremia with dilute urine and polyuria
what do you give to someone in an acute gout flare
you start with NSAIDs and try Celecoxib and then Indomethacin
if those dont work then move on glucocorticoids
pts with Crohns disease comes in with abdominal pain, n/v, and tender abdomen
likely due to stricture from crohns
-creating a small bowel obstruction
patient who looks like it might be pyelo but they have pain thats reponsive to morphine, what do you think of
kidney stone
what should you look at if an inpatient person suddenly has a decrease in renal function
check to see if they had any angiography or anything with contrast done cause this can mess up the kidney
-prevent kidney damage by these with extra hydration
what is becks triad and how do you treat it
becks triad: hypotension, JVD, muffled heart sounds (also electrical alternans)
- this is for cardiac tamponade
- treat it surgically by creating a pericardial window to drain the fluid
whatre the PAIR diseases (spondyloarthopathies)
Psoriatic arthritis: arthritis and nail pitting
Ankylosing spondylitis: back pain with morning stiffness relieved by exercise (bamboo spine)
IBD-related: enteroarthropathies, bilateral arthritis
Reactive arthritis: cant pee, climb a tree, see
what part of the aorta is most likely to get ruptured in a accel-decel MVA
thoracic aorta
baby to be born from someone who has herpes (no active lesions)
- give acyclovir at 36 weeks
- if they have active lesions then do c-section
- if no active lesions then do vaginal birth
drug intoxication in a person with nystagmus… what drug do you think of
PCP
when a pt has an infection what happens to glucose
increases in the blood stream so you have a higher need for insulin (if diabetic)
any sort of dental work mentioned in a person with an artificial valve, what do you think of
strep viridans
what electrolyte abnormality can cause PVCs
hypokalemia
-especially in someone taking digoxin cause there is more digoxin binding to Na/K pump leading to cardiac dysfunction
just b/c a pt had a cholecystectomy doesnt mean they wont have a residual stone, what do you do if this person develops RUQ pain, fever, and jaundice?
this is charcots triad for acute cholangitis
-get ERCP
-if they also had altered mental status and hypotension that would be reynolds pentad
thoracostomy vs cricothyrotomy
thoracostomy = chest tube cricothyrotomy = throat tube to establish airway
how long does staph aureus food poisoning last
resolves within 24 hours
cramping abdominal pain and watery stool for 4 days with no pmns in the poop
ETEC
also possibly vibrio, cereus, or giardia depending on the story
patient with lyme disease and you want to protect the heart, what do you give
amoxicillin to treat the lyme disease
give doxy as first line unless its not an option or its a pregnant lady or child under 8
compare and contrast ABO vs Rh incompatibility in newborns with jaundice and high bilirubin levels
ABO incompatibility is not as severe as Rh cause ABO antibodies are IgM and dont cross the placenta but Rh is IgG and does cross the placenta
-if they say anything about an edematous baby then think Rh incompatibility cause it could be hydrops (caused by Rh)
sensation of bugs crawling on you (delusional paratosis) with skin picking or scratching is from what drug
methamphetamines
-treat w/ benzos
what do you think about in a boy pt who keeps getting sick with encapsulated organisms
x-linked brutons agammaglobulinemia
-problem with b-lymphocytes and plasma cells, you have none that can actually make the immunglobulins
SHiN for encapsulated organisms (strep pneumo, haemophilis influenza, neisseria)
pt has a history of abscesses with catalase + organisms
chronic granulomatous disease
- NADPH deficiency
- problem with neutrophils
what are the only 2 systolic murmurs
mitral regurg
aortic stenosis
patients with multiple myeloma have increased risk of what types of infections
anything encapsulated
- strep pneumo
- H. influenza
- neisseria
acute stress disorder vs PTSD
same thing but acute stress disorder is 3 days to 1 month and PTSD is longer than 1 month
pt presents with fever, RUQ pain, mild scleral icterus, and positive murphys sign with a normal sized common bile duct
acute cholecystitis
-cholangitis would have negative murphys and a dilated common bile duct with a high alk phos
patient at a summer camp or dorm or some closed off space with people then gets sick and has altered mental status
think meningococcemia
what could the following things cause:
- sepsis
- aminoglycosides
- ischemia/hypotension
- heavy metals, radiocontrast
- ethylene glycol
- rhabdomyolysis
acute tubular necrosis
what do you look for to see if its aspirin toxicity
fast respirations, tinnitus, kidney damage (increased creatinine)
-otherwise you can try to look for a mixed anion gap metabolic acidosis with significant respiratory alkalosis
young boy with tibial tubercle pain, what do you think of
osgood shlatter (repeated microfractures at tendon insertion site)
patient has nipple peeling, scaling, cracking but no mass
pagets disease of breast
-50% have negative mammogram and no calcifications
a little breast discharge that is non-spontaneous, non-bloody with minimal discharge and normal physical exam and images
physiologic discharge
history of increased activity, localized pain to anterior chest that worsens with deep movement and coughing, there is tenderness to palpation of the affected area
costochondritis
-self-limiting and will resolve within weeks to a year
how to treat mom with + GBS if she is(nt) allergic to penicillin
no allergy: IV penicillin G
mild allergy: cefazolin
severe allergy: clindamycin/erythromycin
how to treat lead poisoning
chelation or EDTA (calcium disodium edetate)
young pt with recurrent facial swelling (angioedema) with a family history of the same thing
-also presents with colicky abdominal pain and GI symptoms
C1 esterase inhibitor deficiency
-leads to impaired bradykinin breakdown
what arteries are you concerned about for each of these areas if the pt presents with claudication
foot only
calf only
thigh and calf
butt, thigh, calf, with possible impotence
foot only: tibulofibular
calf claudication: femoropopliteal artery
thigh and calf claudication: external iliac artery
gluteal/thigh/calf claudication (possible impotence): aortoiliac artery
what does wernicke-korsakoffs look like
Classic triad
- Ataxia
- Confusion
- Ophthalmoplegia
If you see confabulation, personality change, memory loss then its Korsakoffs and the memory loss is permanent
patient with panic attack in MRI, how to help them…
give them a benzo before going in again
compare and contrast arterial vs venous stasis/insufficiency
arterial
- claudication
- shiny hairless legs
- necrosis at the tips of the toes
venous
- ulcers on the medial aspect of the legs
- lower extremity edema
- pulses still palpable even if weak
when to give a newborn varicella prophylaxis
only if the mother developed varicella less than 5 days before delivery or even up to 2 days after delivery
-if so then prophylax the newborn with immunglobin
what is spondylolithesis
palpable step-off and lateral x-ray shows forward slippage of one of the key vertebral bodies
pain with spinal extension
right subclavian catheter placed… what is on your mind
pneumothorax
cerebral palsy vs spinal dysraphism
cerebral palsy
- presents in childhood with missed milestones
- comorbid seizures and intellectual disability
- abnormal muscle tone
spinal dysraphism
- presents at birth with foot deformities
- lower limb paralysis and numbness with a full bladder
- spinal cord injury affecting lower extremities –> neural tube defect
next step if pt isnt responding to iv fluids and is bleeding
give them blood products
supraclavicular node plus splenomegaly, what do you think of
hodgkins lymphoma
-associated with pruritis on NBME exams cause of increased lactate dehydrogenase
how does retinal detachment present
flashes and floaters, curtain drawn down then monocular vision loss
how does macular degeneration present
older pt with loss of central vision and a straight line appears curved
how does disseminated gonococcemia present
dermatitis, oligoarthritis, enthesitis OR monoarticular septic arthritis
what to think of when a pt has cervical motion tenderness
PID or ectopic pregnancy
-if PID think of fever, pharyngeal erythema, RLQ and cervical motion tenderness- will a negative pregnancy test
what are propylthiouracil and methimazole used for
they are used to treat hyperthyroidism by clocking thyroid peroxidase
how does a zinc deficiency present
alopecia, dermatitis, scaly skin around eyes and mouth, abnormal taste, impaired wound healing
how does copper deficiency present
hematologic abnormalities (microcytic anemia, leukopenia) and myeloneuropathy
