NBME 9 Flashcards
s/p transplant MRI shows mass: biopsy shows: proliferation of monocolonal B lymphocytes
Post-transplant lymphoproliferative disorder (PTLD)
in transplant pts on high doses of immunosuppressives
EBV reactivation of virus that evaded T lymphocytes (usually causes mononucleoisis)
tx: decrease immunosuppressives
bone pain, anemia, hypercalcemia, kidney dysfunction, and lytic bone lesions
Multiple Myeloma
**Monoclonal B-lymphocytes **
B-lymphocytes are precursors to plasma cells: neoplastic proliferation of single plasma cells clone: –monoclonal immunoglobulin spike on protein electrophoresis Gamma– M-protein spike
diagnosis confirmed: Bone marrow biopsy with at least 10% plasma cells
2 weeks of jaundice hepatosplenomegaly, hematocrit 20% and reticulocyte 10%
increased: Biliverdin, Indirect Bili, LDH, reticulocytes
hemolysis occuring
either intravascular: release of free hemoglobin into circulation
or
extravascular: within spleen adn reticuloendothelial system through macrophages
erythrocyte turnover lysis:
free hemoglobin broken down –> iron and heme
heme broken down –> biliverdin and indirect bilirubin (increased)
also LDH inside erythrocytes so hemolysis –> increase lDH
hemolysis leads to anemia –> induces bone marrow to increase production of erythrocytes –> making more immature erythrocytes (reticulocytes)
torticollis (head tilted to the side and down), retrocollis (head tilted back), opisthotonos (arching of the back), and oculogyric crisis (deviation of the eyes)
Dystonia
D2 Antagonist: haloperidol, fluphenazine
dopaminergic-cholinergic pathways of the basal ganglia
– Risk factors for development include male sex, young age, recent cocaine use, and hx of previous dystonia.
tx: diphendyramine or benztropine: anticholinergics
should exclude neuroleptic malignant syndrome
Specific phobia criteria:
more than 6 months
distress or social/occupational impairement
anxiety with exposure or anticipation of stimulus
tx: long term CBT
short term benzos
bipolar depression meds:
lamotrigine, quetiapine, lurasidone
lithium carbonate
If pt previously taking med – just restart them on previous meds (if they stopped for no reason)
emotional !ability, disinhibition, sedation, slurred speech, and ataxia, normally reactive pupils
chronic: slow respirations, hypoglycemia and ketoacidosis
alcohol intoxication
malnutrtion
(also called ethanol)
tx: repleating vitamins and electrolytes, IV fluids, supportive
can lead to coma so intubation
floppy baby
dx?
Botulism: NMJ clostridium botulinism
gram positive spore-forming obligate anaerobe
cleaves SNARE proteins preventing release of Acetylcholine
infants: raw honey, canned foods, pork, or SOIL DUST SPORES inhale
dx: reptitive nerve stimulation study electromyography (improves with stimulation
tx: immunoglobulin, supportive care, mechanical ventilation
pt with afib has storke
what would prevent a stroke?
anticoagulation: WARFARIN
w/ recent use of antibiotics ear infection
candidiasis
diaper rash
red macerated thin plaques with satellite papules – vs dermatitis
oral: thick white plaques on the tongue or buccal mucosa that can be scraped off with a tongue blade
risk factor: recent use of antibitiocs
tx : topical nystatin
comedomal and papular acne
tx
first line: mild/mod acne
topical retinoid
apply over entire involved area to prevent new comedones instead of spot treatment on existing lesions
septic arthritis
painful swollen right telbow with fever
STAPH AUERUES
under age 16: joint pain
can also have: uveitis, lymphadenopathy, rash
positive ANA
negative RH
Juvenile rheumatoid(idiopathic) arthritis
oligoarticular disease: few than five joints (usually knee) + ANA positive
polyarticular: more than five joints (interphalangeal joints) + nevative ANA
UVIETITIS
so do slit lamb examination
tx; NSAIDS, methotrexate
uveitis: cataract surgery
tumor in metacarpals and fingers, painless
multiple in one extremity
multiple with soft tissue angiomas
enchodroma
Ollier disease
Maffucci syndrome
observation benign
spiculated lung lesion + fractured femur with radiolucent defect with focal breaching of cortex laterally
adenocarcinoma
metastasis (spiculation) to bone
right groin pain, flexion and extension limited ROM, xray: lytic and sclerotic lesions of femoral head
osteonecrosis
avascular necrosis
painful degeneration
associted with alcohol use, fractures/dislocation, corticosteroids use, sickle cell disease, bisphophonates, gaucher disease
idiopathic osteonecrosis: Legg-calve perthes: children 4-10
gold standard dx: MRI
tx: surgery and PT
chronic venous insufficiency
reddish-brown hyperpigmentation below the knee
post-phlebitic syndrome post-thrombotic syndrome
occurs usually after DVT
new head, neck, mandibular angle mass
greater than 2 weeks
fixed mobility
firm texture
hx of prior cancer or immunocompromised
next step?
Fine needle aspiration to see if its cancer
urethral hypermobility
cottin tipped applicator with greater than 30 degrees deviation
stress incontinece
Si also caused by urethrocele or cystocele
appendicitis symtpoms in pt who is prego
next step?
ex lap
usually would need to do CT but since shes prego you cant
chronic dysmenorrhea, dyspareunia, dyschezia, and infertility
that are with the hormonal cycle
u/s homogenous internal echoes
Endometriosis
endometrial glands and stroma outside of the uterus
Subsequent fibrosis can cause palpable nodularity of the posterior uterus and cul-de-sac along with fixation of the uterus to nearby structures making it immobile
gold-standard for the diagnosis of endometriosis is a diagnostic laparoscopy
vs leiomyomma myoma fibroids – will see solid mass on u/s
diabetic neuropathy foot ulcer
Screening for neuropathy is performed yearly using a monofilament test.
prevention: wear protetctive shoes when moving standing or walking (because they wont notice if they injure themselves)
a metric of overall disease burden, which takes into account not only the years of life lost because of death but also the years of healthy life lost as a result of disability, thus incorporating morbidity and mortality into one metric.
disability-adjusted life years DALY
vs
Years of potential life lost (YPLL) would take into account the increased mortality rate that accompanied the change in legislation but not the impact of increased morbidity in nonlethal traumas.
motorcycle wearing helmet or not
pap smear shows atypical glandular cells
next step?
colposcopy with endocervical curettage
also in age older than 35: endometrial biopsy recommended
Cytologic study of cells collected from the cervix is recommended every 3 years in women aged 21 to 29 years
every 5 years in conjunction with human papillomavirus co-testing (every 3 years if co- testing is not performed) in women aged 30 to 65 years.