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NBME 8 > nbme 8 > Flashcards

nbme 8 Flashcards

1
Q 
25 M
non radiating chest pain 
smoked cocaine 30 min ago
Hemodynamically stable
EKG - 4mm STEMI V1-V4
Start nitroglycerine and?
A

Aspirin

NOT clopi

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2
Q

2 mo M
going to the beach for 2 weeks
Advise avoidance of sun advise what other protective measure?

A

Use of protective clothing

NOT sunscreen, contraindicated in kids under 6 mo

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3
Q 
37 F
increasing mentral pain x 1 yr
regular 28 day cycles
uterue is soft, tender, consistent with 8 week gestation and no adnexal masses
Dx?
A

Adenomyosis

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4
Q 
67 F
Preop consult for lung surgery
SOB climbing 1 flight of stairs x 4mo
MI complicated by DVT 2 years ago
40 py hx
FEV1 25% of predicted
Venous u/s consistent with chronic DVTs
Stress test - no reversible ischemia
EF 40%
Significant contraindication for surgery?
A

Pre-op eval:

  • Cardio- goldmans EF < 35% MI in last 6 months
  • Resp- PFT-
  • Liver- Childs Pugh
  • Nutrition- Prealbumin
  • Metabolic- Diabetes DKA

PFTs

Gold’s criteria

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5
Q 
52 M 
fever x 3 days
fatigue weakness x 2 months
Diffuse LN, palpable spleen
HCT 26%
WBC 22K, 25% lymph
PLT 68K
What is the mechanism of his illness?
A

Proliferatin of hematopoietic progenitor cells

NOT failure of pluripotent stem cells, EBV, BM fibrosis

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6
Q 
87 M 
problems w/ memory x 6 months
misplaces house keys, forgets items on grocery list
no neuro findings
MSE - aox3, 3 item recall intact
Dx?
A

Normal aging

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7
Q 
42 M
SOB x 3 wks
Breath sounds decrease over L hemithorax
CXR - LUL mass
Bx - uniform small round cells w/ darkly staining nuclei
Tx?
A

Chemotherapy

Small cell - chemo
For lung masses, if they are large enough resect. Not likely to do radiation on the lung

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8
Q

9 M
recurrent cough x 4 months
Teachers say he is disruptive in class
Blinks frequently, facial grimacing, clears his throat frequently
Mom comments he started doing this 3 years ago and doesn’t do it all the time
Dx?

A

Tourette disorder

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9
Q 
37 F
irregular heavy vaginal bleeding x 6 months
LMP 3 wks
BMI 32
Uterus NL size, no adnexal masses
TSH, prolactin WNL
Next step?
A

Endometrial bx

NOT OCP’s, dx is still unclear

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10
Q

32 M
Severe throbbing HA x 3 months
6-12 hr, n/v, photophobia
Most appropriate prophylaxis?

A

Propanolol

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11
Q

7 Mpain and itching of the R ear x 2 days
Forward flexion of pinna = severe pain
Ear canal = erythematous, TM cannot be seen d/t purulent discharge in the ear canal
Next step?

A

Top abx

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12
Q 
22 F
nausea, diarrhea x 2 days
T bili - 3.2
Indirect bili - 2.8
Why does she have hyper bili?
A

Deficiency of serum glucoronosyltransferase

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13
Q 
52 M
severe constant back pain while bowling
220/120, 102
Femoral pulses decreased
WBC - 13.5K
Pain does not resolve with SL nitro
Does improve with IV morphine, lobetalol
Dx?
A

Thoracoabdominal aortic dissection

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14
Q

37 F
12 days s/p orthotopic liver transplant d/t HBV
WBC - 8.5k, 75% PMNs
Alk Phos - 432
AST - 306
bx - mononuclear infiltrate w/ a significant number of eos in the hepatic triads
Dx?

A

Allograft rejection

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15
Q 
9 F
strange behavior x 6 mo
taps feet 3 times when she has bad thoughts
turns lights on and off habitually
Tx?
A

Sertaline (SSRI)

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16
Q 
19 M
tonic clonic seizure x 20 min
excessive thirst, urination x 6 months
Na - 121
Sr Osmo - 250
Ur Osmo - 50
Dx?
A

Psychogenic polydipsia

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17
Q 
57 F
severe diarrhea x 6 d
dx'd with diverticulitis x 2 wks
levofloxacin x 10 days
Why diarrhea?
A

Toxin-induced inflammation of the colonic mucosa

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18
Q 
52 F
T1DM
painless lesion on foot x 1 wk
No ankle reflexes, sensation to pain and touch absent to the knee
How did this happen?
A

Abn pressure distribution caused by sensory neuropathy

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19
Q 
37 F
PMH - asthmas
40 py smoking hx
Meds - NSAIDs, inhaled isoetharine, OCPs
BMI 22
Best recommendation to prevent a stroke?
A

D/c OCP’s

F >35 w/ smoking hx

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20
Q 
37 F
bloody discharge from L breast x 2 mo
bloody dc can be expressed from the L nipple
Mammo - WNL
Dx?
A

Intraductal papilloma

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21
Q

37 F
intermittent pens and needles in R hand x 6 months
resolve after shaking her hand
Becoming more frequent
Pain, temp decreased over R thumb, index, middle fingers
Next step?

A

Use of wrist splint

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22
Q

Study demonstrates a 50% reducting in fx with drug X vs placebo. Which piece of data are they referring to?

A

Relative risk reduction

NOT absolute risk reduction

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23
Q 
72 M
DOE x 6 mo
96 p yr hx, coal miner
digital clubbing
SPO2 88%
CXR - b/l upper lobe masses and areas of consolidation
Dx?
A

Pneumoconiosis

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24
Q

77M
PPD > 15 mm
CXR - WNL
Next step

A

Tuberculosis:
PPD
AFB+ RIPE
AFB- CXR+ Isoniazid B6

Isoniazid, vitamin B6

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25
Q 
72 M
Leg weakness x 2 months
Dry mouth, constipation, hand tingling
Receiving radiation for lung cancer
b/l ptosis that worsens w/ upward gaze
He can rise from a chair with his arms folded 
DTRs absent, sensation is intact
What test would establish Dx?
A

Repetitive nerve stimulation (Lambert Eatton)

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26
Q

27 M
Unable to see x 3 hrs
Went to the ER for auditory hallucinations and was given haloperidol
Reg meds - IM fluphenazine q3wks
afebrile, UE held rigidly, neck is rigid, eyes are rotated and fixed superiorly
What is the cause ofh is visual problems?

A

Adverse effects of haloperidol

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27
Q 
27 M
CMV -
HBV Ab -
HCV Ab -
Toxo - 
What vax's should they get?
A

Influenza virus
23 pneumo vax
HBV

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28
Q

32 F
1 yr hx of LL abd cramps 2-3 wkly
BM relieves the pain
Dx?

A

IBS

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29
Q 
72 F
6wks s/p L MCA infarction
frequent dribbling 
Palpable mass in suprapubic area
Why incontinent?
A

Flaccid neurogenic bladder

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30
Q

25 F to discuss risk of Alzheimer’s

strongest predispoosing fact?

A

FHx

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31
Q

72 F
COPD, worsening SOB x 3 mo
Why?

A

constriction of vessels in the lungs

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32
Q 
42 F
BMI 39
Alk Phos - 110
AST - 84
ALT - 69
Dx?
A

NASH

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33
Q 
37 M
chest pain x 1 day
URI 1 wk ago
febrile
2/6 crescendo-descrendo at LSB
Troponin I < 0.04
Dx?
A

Dilated myocarditis—> Cardiomyopathy

Echo

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34
Q 
37 F
SOB x 2 days now occuring at rest
rad/chemo for breast cnacer
75/48, 140
SBP decreaes 15mmHg with deep inspiration
Crackles at lung bases
CXR - cardiomegaly
Dx?
A

Cardiac tamponade

Hypotension, JVD, Pulsus paradoxus

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35
Q

62 M
Undergoing TKR
Does he need prophylactic abx?

A

Parenteral cefazolin

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36
Q 
29 F
becomes agitated while on vent
Ventilator- high pressure alarm
hypotensive, tachy
Breasth sounds diminished
Dx?
A

Barotrauma- PTX

Needle decompression

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37
Q 
23 M
fever, malaise, HA x 5 days
Febrile
nonpruitic, painless, pigmented, maculopapular rash over the palms and soles
How to prevent?
A

Syphilis

Use condoms bro

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38
Q 
27 M
cough, sob x 2 months
weight loss
HBV dx 3 years ago
white plaques on buccal mucosa
What should he be tested for?
A

HIV/AIDs

weight loss and thrush suspicious especially in a pt with a hx of HBV

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39
Q 
25 M
Weakness of both legs, urinary retnetion x 6 hours
Fever, midthoracic back pain x 2 days
febrile
TTP on spinous process
T1DM
Next step?
A

MRI of thoracolumbar spine

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40
Q 
52 M
chest heaviness, L arm pain x 1 hr
occured while lifting blocks
CK - 130
Myoglobin, trop elevated
EKG - PR intervals get longer until QRS is dropped
Dx?
A

Second degree AV block

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41
Q 
72 M
vomitting/diarrhea x 3 days
PMH a fib controlled with dig
hypotensive
abd exam - distention, diffuse TTP w/ guarding
WBC - 20K
Surgery finds black omentum
What caused this?
A

Arterial emboli

from his a fib

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42
Q 
3 F 
coughing, SOB x 30 min
hx of eczema
Unvax
coughing, drooling, difficulty speaking
90% sat RA
edema of the face, hands
retractions, stridor, expiratory wheezes
CXR - subglottic narrowing
Next step?
A

IM epi

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43
Q

42 F
difficulty urinating x 6 mo
sudden urge to void but can only void a small volume
unable to reach a bothroom quickly enough sometimes
PMH - MS
No postvoid residual volume
Dx?

A

Detrusor hyperactivity

NOT MS neuropathy

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44
Q 
47 M 
pins and needles, weakness in R leg 1 hour after confusion
scuba diving earlier today
Diffuse lung crackles
S4 gallop
2/6 systolic ejection murmur over LSB
strength 4/5
Dx?
A

Pulmonary barotrauma

Air embolism (Bends)

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45
Q

12 M
PMH - Marfan
found a new murmur
3/6 late systolic murmur following a click
Fainter w/ shorter duration with squatting
Dx?

A

MVP

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46
Q

A study selects pts 55-75 in New york. What is problematic for their conclusion?

A

Selection bias

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47
Q

32 F
2 days s/p fixation of femoral fx
agitated, petechiae over upper thorax

A

Fat embolism

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48
Q

Study evaluates if A1C >15% predicts diabetic retinopathy. 88% of pts with A1C > 15% have DR
What does this suggest?

A

Positive predictive value is 88%

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49
Q 
Study of efficacy of ELISA in dx'in pneumococcal PNA
100 PNA pts
100 asyx controls
81 of PNA and 5 asyx have positive ELISA
What is the specificity
A

95%

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50
Q 
3day M
difficulty breathing x 1hr
64/40 UE, 36/20 LE, 160, 84 rr
Pale cold extremities w/ mottling
respiratory acidosis
CXR - cardiomegaly, edema
What caused him to crash?
A

Transposition great vessels: Two seperate circ. systems, PDA dependent

Pt PDA closure–> hypoxemia–> Cyanotic
Dx ECHO
Tx Prostaglandin to keep open

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51
Q 
20 M
MVA
pelvic pain, crepitus
Large scrotal hematoma
Xray - b/l fx of the superior and inferior rami
Next step?
A

Urethral involvement- Retrograde urethrography

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52
Q

Kiddo has perioral rash with honey crust

Tx?

A

TOP mupirocin

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53
Q 
47 F
progressive SOB, cough x 1 wk
66 py hx
breathing w/ pursed lips, using accessory m.
Diffuse wheezes
Dx?
A

COPD

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54
Q

16 M
Organophosphate poisoning
Which receptor is most responsible?

A

Peripheral muscarinic receptors

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55
Q 
32 F
sever back pain raditing the outer aspect of the leg to the foot
Worse with bending and pooping
started after lifting her kid
straight leg test +
Dx?
A

Lumbar radiculopathy

NOT low back straing

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56
Q

47 F
pain in R heel worse with ambulation x 3 mo
No trauma
BMI 35
TTP on plantar surface of the heel and medial surface fo the foot
Dorsiflexion produces pain
Xray - bone spur on plantar surface of calcaneus
Dx?

A

Plantar fascitis

-Pain bottom of foot. Hurts morning, gets better with use.

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57
Q 
57 M
small cell carcinoma of the lung declining chemo
Na+ - 128
Osmo appropriate
Next step?
A

Fluid restrict

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58
Q 
11month M
Werdnig-Hoffman muscular atrophy
sore on the back of the head x 4 days
ulcerative lesion w/ a crusted base and slightly raised erythematous edge
Dx?
A

Decubitus ulcer= pressure ulcer

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59
Q

37 M
chest pain x 30 min
cowrer says the guy has been crankly lately
Vitals fine
Diaphoretic, aox3, hypervigilant. Speech rapid, pressured
ST semgment elevation across precordum
dx?

A

Substance induced psychotic disorder

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60
Q 
18 M
n/v abd pain x 24 hr
10lb weight loss x 1 month
95/58, 118, dry
RUQ tenderness
Glucose - 250
ABG
pH - 7.32
PCO2 - 30
PO2 - 105
Dx?
A

DKA

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61
Q 
17 M stab wound at the base of his neck (L)
70/50, 140
Breath sounds diminished on L
Tense pulsatile hematoma
Where is the cardiovascular injury?
A

Subclavian a.

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62
Q 
4 F
Progressive unsteadiness x 1 month
tips over, clumsy when reaching for toys
normal developmental milestones
height 60%, head 95%
Nystagmus on lateral gaze, dysarthria
gait is broad, ataxic
DTR 3+ in LE
Dx?
A

Medulloblastoma

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63
Q 
52 F
T2DM, vomiting x 24hrs
AMS
Na - 127
Glucose - 890
pH - 7.35
PCO2 - 37
PO2 - 100
What AMS?
A

Hyperosmolality

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64
Q

32 F
fever , swelling redness of R forearm x 2 days
noticed red streaking from forearm to elbow 6hours ago
Epitrochlear LN are enlarged
PE - warm erythematous area of edema that is TTP. Warm tender red streak extending from this area to the elbow
No ulcer, fluctuance or palpable cord
Dx?

A

Lymphangitis

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65
Q

30 F
PMH SLE
34 wks gestation
How could her dz affect her baby?

A

Complete AV block

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66
Q 
17 F
SOB, chest pain x 12 hours
recent hospitalization for femoral fx
100/80, 90, rr 30, 88% RA
CXR - pleural effusion
Next step?
A

Fat embolism s/p ortho surg

Spiral CT scan of the chest

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67
Q

2 hour F
Fever
Mom received intrapartum ampicillin d/t uterine tnderness, fever, hx of HSV but no lesions at time of delivery
Next step for baby?

A

IV ampicillin + gentamicin

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68
Q 
32 F
fatigue, fever, red bumps, x 2 days
IVDU, sex worker
PE - scattered, erythematous, maculopapular rash over trunk and extremities including palms and soles
general LN
Perlvic exam WNL
Next step?
A

Penicillin G benzathine

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69
Q

1 day M
bilious vomiting x 4 hours
Not passed meconium
sister has CF
Abd Xray - big dilated loops of bowl, no air near rectum
Barium enema - small, empty colon and multiple filling defects in distal ileum
Laparotomy - inspissated tar-like meconium removed from the ileum
How do you manage for future feedings?

A

Pancreatic enzyme

NOT prokinetic agent

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70
Q

9 M
non productive cough exacerbated by exercise, worse at night
What would be his FEV1, FVC, TLC?

A

Asthma

PFT:
FEV1 - decreased
FVC - WNL
TLC - increase

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71
Q 
72 F
increasing difficulty w/ vision
cars have halos at night
PE - yellowing of lenses, optic disc WNL
Dx?
A

Cataracts

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72
Q

52 M severe retching, vomitting x 20 min after eating large meal
L hemithorax is dull to percussion
CXR - effusion on the L
Dx?

A

Perforation of the esophagus

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73
Q

32 F 27 wk gest
painless vaginal bleeding x 6 hours, new pad q2h
16 wk u/s - WNL, posterior fundal placenta
hemodynamically stable
2cm friable ulcer on the cervix
external os - 1cm. internal is closed
Dx?

A

Cervical cancer

NOT abortion/fetal demise, previa

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74
Q

20 M
painful urination and urethral discharge x 1 wk
unprotected sex
Tx?

A

Ceftriaxone + azithromycin

75
Q 
newborn F
severe respiratory distress 2 hrs s/p meconium aspiration 
APGAR at delivery 7, 8
rr 80, grunting, subcostal retractions
Next step?
A

Transient tachypnea of newborn

Supplemental O2 PPV

76
Q 
32 F
weakness in leg x 1 wk
tingling in hands/electic like
visual loss in R eye, pain with movement, scotoma
DTRs 3+, Babinski
MRI - bright spots randomly
Tx?
A

Interferon beta

NOT dexamethasone

77
Q 
2 AA F
numerous water stools x 1 month
adopted 3 wks ago
diet was mostly corn in Africa
skin is thick and rough especially in sun exposed parts
ulcerations of the tongue/mucosa
Blunted affect
She has a deficiency in?
A

Niacin

78
Q 
3 month M
Delayed growth
feeds poorly, turns blue around his lips during feedings
turns blue when crying
pink at rest
3/6 systolic ejection murmur at LSB
Dx?
A

Tetralogy of Fallot

79
Q

37 M
sever abdominal crambs x 24 hr
vomiting and small bowel movements x 2 weeks, constipated x 2 days
PMH Crohn dz
High pitched bowel shounds
upright Xray - multiple air fluid levels, no free air.
Dx?

A

Small bowel stricture

80
Q 
16 F
T1DM
A1C 8%
has microalbuminuria
How do we protect her kidneys?
A

ACEI

To protect kidneys

  1. BP control
  2. Glycemic control
81
Q 
18 M
rash, stuporous x 24 hr
fever/chills HA x 4 days
recently went camping and had all of the exposures
T- 104.9, 80/40, 130, 24
Diffuse erythematous maculopapular rash on trunk, extremities, palms, soles
petechiae, purpura LE
Inspiratory crackles, S3
HCT 32%
WBC - 5.5K
PLT - 20K
Dx?
A

Rocky Mountain spotted fever

82
Q 
27 M 
found uncious
does not improve with naloxone or glucose
Na - 142 
Cl - 102
HCO3 - 12
pH - 7.27
PCO2 - 27
PO2 - 99
Why is he acidodic?
A

Ingested organophosphate (Just looked for the MUDPILE that made sense)

83
Q

19 F
fever, back pain, dysuria x 2 days
febrile, CVA tenderness
UA findings?

A

Key - WBC clump

Blood - trace
protein 1+
RBC 0-5
WBC > 50
no casts
Other - WBC clumps
84
Q

doubly blind RCT has primary endpoint dependent on ER docs subjectively scoring severity of respiratory distress.
What is the flaw?

A

Variability among observes (observer bias)

85
Q 
27 F
8hrs s/p TAH for endometriosis
no urine output
1500mL hemorrhage during surgery
Foley is places and flushes easily
Cr has doubled
U/s - b/l hydronephrosis and no urine in the bladder
What happened?
A

Ureteral ligation

86
Q 
5 M
knee/ankle sweling x 12 hrs after a fall on the playground
FHX + hemophelia
BT - 6 min
PT - 12
PTT - 55, corrects after 1:1 mixing
Dx?
A

Factor VIII deficiency

Factor IX was not an option. Remember if it corrects w/ mixing the defect is d/t deficiency not an inhibitor

87
Q 
62 M 
pain at the base of thumbs and knees x 6 months
Exacerbated w/ exertion
Heberden nodes at DIP
Dx?
A

Degenerative joint dz

88
Q 
25 F
Nurse s/ needle stick
pt has jaundice d/t HBV
nurse had declined HBV vax during employee workup
Next step?
A

HBV IG and HBV vax

89
Q

15 M
chest and L arm pain while sitting in class
SOB, tingling around his mouth, light headed
PMH - asthma
kiddo is struggling in school
O2 Sat 100% RA, CTAB, RRR
Next step?

A

Breathe into a paper bag

NO lorazepam

90
Q

52 M HIV+
severe rectal pain, bleeding w/ defecation x 6 wks
on HAART
illicit drug abuse
DRE - palpable mass in the anal canal
Anoscopy - 1.5 cm mass at anal verge w/ central ulceration and oozing blood
Dx?

A

Squamous cell carcinoma

NOT Anal fissure

91
Q 
21 F
fever, sore throat, fatigue x 3 days
LN, pharyngeal exudate
WBC 11K, 46% PMNs 44% lymphocytes
AST - 87
ALt - 64
Strep -
Dx?
A

EBV

92
Q 
17mo M
PMH - SCD
T 105 x 1 day
Takes penicillin ppx, UTD on vax
spleen palp
Hgb - 9.8
WBC - 18.7 K, 65% PMNs
Tx?
A

IV ceftriaxone

bacterimia in SCD - s. pneumo or H. flu

93
Q 
37 F
T1DM
L ear pain, drainage x 4days
recent swimming while camping
T - 101.3
ear canal is erythematous, swollen w/ purulent fluid draining from the canl.  TM cannot be visualized
etiology?
A

Pseudamonas infection

94
Q 
10 M
pale recently
Nec enterocolitis as a baby and resected part of ileum
Macrocytic anemia
What is the deficiency?
A

Vit B12

DJI
FeFBro

95
Q

Newborn w/ ambiguous genitalia
no palp gonads
46, XX karyotype
Serum 17 hydroxyprogesterone is increased
virilization is d/t which enzyme deficiency?

A

21-hydroxylase

96
Q

47 F
increasing eye pain and bulging of eyes x 2 months
exophtalmost
sclera are injected
MRI - enlargement of EOM but not the tendinous insertions
Dx?

A

Graves dz

97
Q 
23 F
urinary frequency, dysuria x 3 days
frequent UTIs x 6 months
uses diaphragm for contraceptive, post coital voiding, increased fluid intake
How can she decrease future URI risk?
A

Switch to a different contraceptive method

98
Q 
12 M
vommiting, abd pain w/ sudden onset
Exacerbated by eating
afebrile, stable
epigastric tenderness
Decreased Bowel sounds
on IV morphine d/t femoral fx d/t MVA
Next step?
A

CT scan

suspicious for SBO, appendicitis, ileus etc

99
Q 
42 F
increased dysphagia d/t dry mouth x 1 yr
swelling of cheeks, increased cavities
slightly red eyes
chapped lips
Next step?
A

Serum ANA

100
Q 
57 F
increasing joint pain, especially in knees x 4 yrs
worse w/ walking, mornign stiffness
nodules over DIP joints
crepitus
What would be seen on xray?
A

Osteophytes

NOT erosions

101
Q

3 F
Intermittent progressive knee pain x 6wks
afebrile
ESR - 55
ANA +, RF -
Greatest risk for developing what in the next 2 years?

A

Reiters syndrom
-Uveitis, urethritis, arthritis
-Associated with connective tissue diseases (e.g., sarcoidosis, ankylosing spondylitis, Reiter syndrome, and IBD)
NOT CHF, fibrosis, scoliosis, sub Q nodules

102
Q 
32 M
12 yr hx of productive cough with occasional hemoptysis
Nasal polyps
experiatory wheezes
clubbing
FEV1/FVC 59%
CXR - hyperinflation
sputum culture - Pseudomonas
Pathophys?
A

ABN Cl channel in airway epithelium

103
Q 
37 F
vaginal bleeding 2 hrs s/p forcep delivery
Uterine fundus at umbilicus
placenta was delivered intact
Why is she bleeding?
A

Genital tract laceration

104
Q 
42 F 
low grade fever, HA, facial swelling x 3 days
T1DM
T-102
TTP over maxillary sinus
CT scan of sinus - opacity of the R sinus
Mild ketoacidosis
Next step?
A

Mucormycosis

Bx and culture of sinus mucosa for fungus
Surgical debridement, Amphotericin

105
Q 
3 F
fever, irritability x 7 days
T - 101.7
b/l LN, injected sclera w/o exudate
erythematous papular rash over perineum
Hgb - 10.2
PLT - 285K
Ua - 50 WBC
Tx?
A

IVIG

Kawasaki

106
Q 
72 M 
constipation x 6 wks
PMH - stage III Squamous cell carcinoma
Ca - 12.8
Why is his calcium so high?
A

Lung Squamous cell carcinoma

Paraneoplastic:
Increased parathyroid hormone related peptide concentration

107
Q 
67 F
excessive fatigue x 6 months
RA treated w/ MTX, NSAIDs
HCt - 32%
MCV - 72
Iron - 20
TIBC 200 (NL 250-400)
Transferrin Sat 10% (NL 20-50%)
most likely cause of her anemia?
A

Chronic inflammation

108
Q

RCT
40 participants, 20 into each arm
Despite promising data p=0.1
Why did the study fail?

A

Low statistical power

109
Q

37 F
intermittent HA, palpitations, sweating x 6 mo
180/104
why is she HTN?

A

increased catecholamine production

110
Q 
22F 
RLQ pain x 12 hours
LMP 8 wks ago
Bhcg - 2430
TVUS - 3cm complex R adnexal mass, no gestational sac in  the uterus or fluid in the cul-de-sac
Next step?
A

MTX therapy

111
Q 
25 M
low back pain x 6 mo
trouble getting going in the morning
ROM limited to 30 degress, straigh leg -ve
strength DTR's intact
Initial step in diagnosis?
A

Xray of SI joint

NOT measure ESR

112
Q

18 F
dysphagia x 3 mo, weight loss
Barium swallow - dilated esophagus w/ narrowing at GE junction
Dx?

A

Achlasia

113
Q

52F
intermittent abd cramps, diarrhea x 2 months
increased milk intake to prevent osteoperosis
Lactose hydrogen breath test +
Pathophys?

A

Decreased lactose activity in the brush border

114
Q

42 M
facial grimicing, poor articulation of speech x 3 months
irrational behavior, chronic fidgeting x 1 yr
disjointed, poorly coordinated gait
MSE - 19
Pathophys?

A

Atrophy of the caudate nucleus

Huntington’s

115
Q 
27 M
Palpitations, heat intolerance x 1 wk
Enlarged tender thyroid gland
TSH - 0.02
T4 - 15
T3 - 210
Uptake is less than 1 wk
Pathophys?
A

Release of preformed thyroid hormone

116
Q

Nurse
PPD > 12mm
CXR NL
Next step?

A

Isoniazid therapy only

NOT I + R

117
Q 
23 F
SOB, fatigue, light headed x 10 days
URI 6 wks ago
lungs CTAB
CXR - hilar opacifications b/l
Echo - NL valves but general hypokinesis
CI = 1.4
Dx?
A

Post viral myocarditis

Pt heart failure
Dx ECHO, CXR
Tx Supportice

118
Q 
13 M 
decreased hearing at high frequencies b/l during school screening test
multiple OM's, uses headphones
Exam - WNL
What caused his hearing loss/
A

Exposure to high decibel sounds

119
Q

19 M
believes his internal organs have been replaced with a womans organs
hallucinations
Dysregulation of which NT?

A

Dopamine

120
Q 
77 M
decreased appetite x 10 wks
weight loss
interview consistent with depression
What do you need to ask?
A

SI

121
Q

12 M
CRF d/t GN x 2 yrs
Takes a ACEI
How can mom minimize complications of his renal failure?

A

Restrict intake of phosphorus

122
Q

14 M
obese w/ new limp
SCFE on Xray
How do you manage?

A

Pin fixation

123
Q

4month M

What is the strongest predisposing factor for asthma?

A

FamHx

124
Q 
82 F
sudden onset constant pain in her foot x 2 hours
A fib, S3
L foot is cold, pulses absent
Next step?
A

Acute Limb ischemia

Dx US doppler, Arteriogram
Tx Heparin therapy

no pulses = arterial

125
Q 
13 M
concerns for delayed puberty
25th %
growth charts show linear growth since birth
genitalia T2, pubes T1
Next step?
A

Reassurance that his pubertal development is normal

126
Q 
57 F
tenderness and swelling of her calf x 2 days 
Pain increases w/ weight bearing
40pyhx
PE - superficial varicosities b/l
tenderness induration erythema and thickening in a linear distribution along medial aspect just below the L knee to ankle
pulses 2+ b/l
Dx?
A

Superficial Thrombophlebitis

Virchow’s triad

NOT varicose veins, thromboangiitis obliterans

127
Q

21 M
New dx of Hodgkin lymphoma
He asks - what are my chances?
What do you say?

A

Tell me more about what you want to know

128
Q

47 M
fever, cough, sputum x 6 days
first episode occured after exploring caves
CT - cavitory lesion in RUL, LN in the mediastinum b/l, several small scattered indeterminate nodules b/l. Some are calcified
Dx?

A

Histoplasmosis

129
Q

22 F, 10 wks gest
vaginal bleeding x 4 hrs and fetal parts in the os
Given a paracervical block with lidocaine prior to D&C
5 min later - numbness of lips and twitching of hands
99% sat
What caused this?

A

Lidocaine therapy

130
Q 
54 M
impotence, decreased libido, abd pain x 3 months
increased thirst, nacturia, weight loss
Feels he is more than lately
spider angiomata
Fasting glucose 350
AST 80
ALT 100
Gucosuria
Bx would show?
A

Increased iron stores in the hepatocytes

131
Q

RCT determines a new treatment has a 17% improvement in cure rate vs TAU
p = 0.0002
95% CI = 8, 26
How do you interpret this?

A

There is a 95% probability that the difference between the cure rates is between 8% and 26%

132
Q

67 F
episode of blindness 2 days ago, lasted 15 min
vision loss began at the top and gradually involved the entire visual field
NL vision now
fundoscopic exam show NL fundus
Next step?

A

carotid duplex u/s

133
Q

62 M cramping pain in his left calf while walking x 2 months
improves w/ rest
decreased pulses
next step?

A

Peripheral vascular disease-
Claudication

Dx ABI
Tx Stent vs Surg vs meds vs amputation

134
Q 
23 F
irregular mensus, facial hair x 18 months
35-60 day intervals
BMI 33
She is a trisk of developing?
A

DM

135
Q 
87 F
dypnes x 2 days
aphashia since a cerebral infarction x 6 months
RLL consolidaton on CXR
Tx?
A

Aspiration Pneumonia

Clindamycin

Good choice in anaerobes

136
Q

62 M
productive vough
84pyhx
hospitalized for PNA, improved with bronchodilators
What isthe next preventative measure that he needs?

A

Plyvalent influenza vax annually

NOT Tdap, H flu, HBV, polyvalent pneumovax annually

137
Q 
67 M 
lesion on his chest x 2 wks
landscaper
ulcerated base and a shiny slightly raised border
Next step?
A

Excisional bx with narrow margin

NOT punch bx

138
Q

22 F
pain at R wrist, worth with lifting 2mo son x 2 mo
ulanr deviation produces pain, TTP at radial styloid
Patho phys?

A

Inflammation w/ithin the first dorsal extensor tendon compartment

139
Q 
52 M
Frequent HA's
170/104
abdominal bruit
Cr - 1.6
Next step?
A

MR angio of the renal arteries

140
Q 
66 F
lower abd pain, fulness x 1 wk
dysuria, pneumaturia x 1 day
TTP LLQ
Dx?
A

Diverticulosis

141
Q 
42 F
increasing thirst x 6 mo
hx of bipolar, tx w/ lithium
Na - 146
Sr osmo - 280
Ur osmo - 200

After 2 hr water deprivation
sr osmo - 295
Ur osmo - 250
Mechanism?

A

nephrogenic DI
Resistance of kidneys to ADH

2 hour deprivation ur osmo should be >600

142
Q 
52 M
pain at the base of scrotum, pain, AMS x 2 day
T2DM, poor control
T - 102.5
bullae over scrotum and crepitus of perineum
WBC - 16K w/ L shift
glucose - 415
Started on insulin, abx
What else does he need?
A

Surgical debridement

143
Q 
62 F
f/u 3 wks after starting lisinopril
SBP improved 30 mmHg
Systoic bruit over abdomen
Why is her BP improved?
A

Mechanism of lisinoprol- ACE inhibitor

Decreased circulating Angiotensin II

144
Q 
5 F
fatigue, blood in urine x 1 day
strep 2 weeks ago
U/A 4+ protein, many RBCs
Dx?
A

PSGN

145
Q

4 M
fever, cough, runny nose x 3 days
Split S2

Dx?

A

URI

146
Q 
27 M
bloody stools x 4 days; 8-10 QD x 1 month
abdominal fullness
T 101.2, 90/60
abdomen distended, TTP on upper quadrants
BS decreased
Xray shows dilation of transverse colon
Dx?
A

Toxic megacolon

147
Q 
27 F, 6 wks gestation
PMH T2DM, controlled with metformin BID
Fasting glucose 100-115
2hr post prandial 150-180
Should her regiment change?
A

Yes, switch to insulin

1hr post prandial < 140
2hr post prandial < 120

148
Q 
57 M
found unconcious
PMH HTN, ACEI HCTZ
180/90
4mm pupil b/l
CT - big bright spot
What caused this?
A

HTN

NOT cerebral amyloid

149
Q

52 F
Burning pain over her ribs x 2 days
Also a mild vesicular rash
Tx?

A

po acyclovir

150
Q 
82 F
SOB x 6 hours
85/50, 90% RA
4cm JVD
Crackles over lung base b/l
S3 w/ 1/6 systolic murmur at LSB
EKG - T wave elevations
Dx?
A

Acute MI

151
Q 
37 F
HA x 3 mo
190/105
Renal arteriography shows 80% obstructive lesion on the L
L renal v. renin assays show 1.5:1
Dx?
A

Renovascular HTN

152
Q

47 M
sedentary, BMI 23
150/94
Recommend dietary changes and?

A

Schedule a f/u in 1 mo

Check BP

NOT f/u in 12 months, weight loss, HCTZ, ACEI

153
Q 
32 F, 10 wks gest
PMH HTN treated w/ labetolol
140/94
24 hr excretion - 342 mg protein
She is at risk for which OB complication?
A

Abruptio placentae

154
Q 
52 M
progressive fatigue x 4 months
falls asleep randomly
BMI 35
Hgb - 18.8
Next step?
A

polysomnography

155
Q 
32 M
progressive fatigue x 2 mo
urine is dark
PMH UC, mesalamine
mild jaundice, mild scleral icterus
T bili - 3.2
Alk Phose - 432
AST - 65
ALT - 58
Dx?
A

Primary sclerosing cholangitis

Biliary is for bitches

156
Q 
2 M
swallowed a liquid under the sink
Crying
ulcerations on the lips, mucosa, pharyns
What did he drink?
A

Drain cleaner

157
Q 
19 F
elevated serum alpha fetoprotein
LMP 18 wks
2.8 x median
Next step?
A

U/s to confirm gestational age

There wasn’t a great amnio option

158
Q 
57 M 
lethargy x 3 hrs
PMH - myasthenia gravis s/p thymectomy but continues to have syx
b/l ptosis, breath sounds decreased
pH - 7.19
PCO2 - 70
PO2 - 70 
HCO3 - 25
Why his acid base disorder?
A

Acute respiratory failure

d/t myasthanic crisis

159
Q 
52 F
eats out every night
protects her heat with 4-5 glasses of wine QD
BMI 26
T cholesterol - 205
AST 65
HDL 70
DEXA osteoperosis
What do you recommend?
A

Decrease alcohol intake

NOT decrease saturated fat, decrease Na, Take MV w/ Fe, Take K+

160
Q 
21 M
sudden blindness in L eye
Under a lot of stress at school
Exam looks fine, but decreased sensation on L side
Next step?
A

pysch assessment

161
Q

16 M
wants to be circumcised
How do you answer?

A

Circumcision cannot be done w/o parental consent

162
Q

62 M
Dx’d w/ pancreatic adenocarcinoma and several mets
also 7 cm AAA
What should you do about the aneurysm?

A

It should not be repaired because of the pt’s poor prognosis

163
Q 
22 F
heavy menstrual bleeding, bruising x 2 months
PLT 20k
BM bx - megakaryocytes
Tx w/ prednisone x 1 wk and not PLT 90K
What is causing this?
A

antiplatelet IgG Ab’s

164
Q

37 F
wants b/l tubal ligation
What will she be at increased risk for after the procedure?

A

Ectopic pregnancy

165
Q

72 M
gradually increasing pain in hip and thighs x 2yrs
improves w/ leaning forward, worse with extending back
Dx?

A

Spinal stenosis

166
Q 
5M
refuses to bear weight on R leg x 24 hrs
T - 102.6
WBC 18K
ESR 50
Dx?
A

Septic arthritis

febril febril febrile

Juvenile RA- 6 weeks or more

167
Q 
67 M 
malaise, nausea, bloating, pruritis x 3wks
suprapubic distention/tenderness
enlarged, nontender prostate
BUN - 93
Cr - 6.7
increased from studies 2 months ago
What caused his renal findings?
A

Postrenal obstructive uropathy

168
Q

82 F
AMS, T 102, 82/60, 108
Why is she hypotensive?

A

Peripheral vasodilatin (Septic shock)

169
Q 
20 M 
PMH Wilsons dz
hair loss, decreased taste, poor healing
pathcy alopecia, testicular atrophy
He has a deficiency in?
A

Zinc

170
Q

15 M
irritable mood since breaking up w/ girlfriend
All depressive syx
Tx?

A

Bupropion (only SSRI/SNRI option

171
Q 
57 F
R sided abd pain x 8 hours
On warfarin for hx of DVT
6 cm mass lateral to the umbilicus on the R
Dx?
A

Rectus sheath hematoma

bleeding into her abdominal wall and on wafarin

172
Q 
2wk newborn
fever cough x 3 days
T 100, 104
She has a big sail shaped thing in her R lung field
What is that?
A

Her thymus

Tots NL

173
Q 
15 M
lesion on his R buttck growindcg in size
wrestling team
annular lesion with erythematous margins and well defined raised edges
Etiology?
A

Trichophytun ruburm (only fungal option)

174
Q

42 F 14 wks gest
cervic closed, uterus consistent w/ 6 wk gest size
U/s - gestational sac w/ no cardiac activity
Dx?

A

Blightened ovum

when a fertilized egg attaches to the endometrium but an embryo never develops

175
Q 
25 F
urinary frequency, dysuris despite tx with bactrim and macrobid
Sexually active
mildly erythematous, tender urethra
Purulent material can be expressed from the periurethral glands
nontender cervix, uterus
cervix is friable and bleeds easily 
Dx?
A

chlamydia trachomatis infection

no Cervical motion tenderness in acute infection

176
Q

32 F 30 wks gest
bright red spotting x 6 hours
Her first two pregnancies resulted in c section.
What is she at increased risk for during this infection?

A

Placenta accreta

177
Q

42 F
Nontender R sided neck lump x 1 month
What would establish the dx?

A

FNA

NOT thyroid fxn tests or scintography
These are helpful but doesn’t give the actual dx

178
Q 
52 F
irregular menses
22 to 45 day intervals
occasional vag dryness
Next step?
A

Reassurance

no measuring estrogen, estrogen therapy, OCP, or endometrial bx

179
Q

Newborn F
2/6 systolic murmur best heard over midback
redundant skin at nape of neck
edema of the dorsum of the hands and feet
Dx?

A

Gonadal dysgenesis (45,X; Turner syndrome)

180
Q 
8hr M
regurg's first feeding
drools constantly
no urine or BM
intercostal retraction
How do you dx?
A

Esophageal atresia

Insert radiopaque NG tube

181
Q 
newborn F
cyanotic 1 hr after birth
60% sat does not improve with Oxygen
3/6 systolic ejection murmur best heard at apex
Next step?
A

Transition of Great vessels

IV prostaglandin

Keep the DA open

182
Q

38 F
n/v/d x 6 hrs
potluck 8 hrs ago
Most likely etiology?

A

Staph aureus

Preformed toxin = quick onset

183
Q

67 F
L sided facial drooping, L hand weakness x 10 min
now asyx
has had episodes of 5-10 min vision loss x 2weeks
Next stop?

A

Carotid duplex U/s

NBME 8 (1 decks)

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