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nbme13 Flashcards

1
Q

ectopic pregnancy tx

A

smaller and early pregnancy: methotrexate
larger: salpingectomy or evacuation with laparoscopy

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2
Q

how to assess brain death

A

1) neuro exam absent cranial nerves and lack of response to pain stimulus
2) APNEA TEST
3) if still uncertain –> can do EEG or angiography

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3
Q

huge blood transfusion + within 6hours (pt came in earlier that day s/p mva needed blood transfusion) becomes HYPOXIC, hypotension, cyansosis, fever

A

TRALI - transfusion related acute lung injury
cxr will show BILATERAL pulmonary patchy infiltrates unrelated to cardiac dysfunction

tx: noninvasive Positive pressure ventilation or intubation

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4
Q

s/p long bone or pelvic fracture –>
hypoxemia + petechial rash + neuro dysfxn

A

fat embolism

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5
Q

transient ischemic attack (no evidence of infarct)
what to give pt to reduce risk of cerebral infarct

A

aspirin –

vs
warfarin : reduces ischemic stroke with pts with a-fib or a known atrial thrombus

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6
Q

forceps assisted vaginal delivery –> caused cephalohematoma
next step?

A

measure/monitor bilirubin levels
will go away on its own but hemolysis might overwhelm neonates liver

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7
Q

pt underwent pituitary excision and placed on levothryoxine and steroids (TSH and ACTH might be low) but starts gaining weight
what to measure next?

A

Free T4 levels
if its too low that means you need to increase dose of levothyroxine

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8
Q

alcohol use disorder drugs:

A

acamprostate
naltrexone (opioid antagonist – but can cause opioid withdrawal in pt taking hydrocodone)
disulfiram
gabapentin

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9
Q

pt older with wt loss, hyperglycemia, and is overweight

A

insulin resistance
type 2DM can see weight loss initially

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10
Q

agranulocytosis: low leukocyte levels under 1500
what drugs:

A

sulfasalazine
bactrim, methimazole (thryoid), clozapine (antipsychotic)

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11
Q

AR - normal motor development first few months followed by progressive loss of motor skills, muscle spasticity, macrocephaly, cherry red macular spot
dx?
die?

A

tay-sachs
die 2 to 5yo, fatal aspiration pneumonia d/t pharyngeal muscle weakness

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12
Q

4yo a few days ago had a middle ear infection and now with right hip pain
passive range of motion is painful
ESR CRP leukocytes all normal
dx?
next step?

A

transiet synovitis
usually after a viral infection
tx : supprotive with rest and NSAIDS

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12
Q

4yo a few days ago had a middle ear infection and now with right hip pain
passive range of motion is painful
ESR CRP leukocytes all normal
dx?
next step?

A

transiet synovitis
usually after a viral infection
tx : supprotive with rest and NSAIDS

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13
Q

patchy interstitial infiltrates that appear worse than patients symptoms
(diffuse b/l interstitial infiltrates with severe dry cough)

A

mycoplasma pneumonia
tx: macrolide azithromycin

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14
Q

Duchene muscular dystrophy

A

X-R
proximal msucle weakness, hyperlodrosis, calf pseudohypertrophy

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15
Q

Rhabdo labs:

A

hyper-K, hyper-Phos, hyper-URICemia
hypo-Ca
can cause ATN
tx: NS 0.9%

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16
Q

baby gets cyantoic while breast feeding but once they unlatch and start crying it resolves

A

choanal atresia
difficultry breathing through nose, nasal congestion, snoring, recurrent infections

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17
Q

oligohydramnios
d/t :
causes:

A

premature rupture of membranes
uteroplacental insufficiency
congenital: posterior urethral vavles or renal agenesis

flat facial features, limb dyspasia, pulmonary hypoplasia d/t inadequate amniotic fluid-induced lung expantion pOTTERS sequence

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18
Q

polycythemia vera:
what is increased?
erythromelalgia?
tx:

A

leukocytosis + thrombocytosis
hot showers pruritis: mast cell degranulation
increased erythrocyte mass and hematocrit -> can cause hyperviscosity syndrome (blurred vision and headaches(cns) vascular congestion and venous thromboembolism **
episodic burning pain in digits with red/b.ue discoloration d/t blood clot: erythromelalgia
tx:phlebotomy** results in decreased red blood cell mass and blood volume

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19
Q

hereditary spherocytosis:
what two organs?
what two tests?

A

increased INDIRECT bilirubin gallstones –> cholelithiasis
splenic congestion and sequestration
osmotic fragility test
eosin-5’-maleimide: flow cytometry

AD – cytoskeleton proteins: ankyrin, spectrin, band erythrocyte membrane proteins (loss between the inner membrane skeleton and outer lipid bilayer)

tx: splenectomy and cholecystectomy

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20
Q

ovoid and scaly with rim of scale around the leading edge
in darker people can be hyperpigmented with raised

A

pityriasis rosea
usually but not always after viral infection HHV-6/7 (roseola exanthum subitum super high fevers and then a rash)

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21
Q

elderly pt with large, exophytic, cauliflower-like lesion, between vagina and rectum

A

Vulvar carcinoma – squamous cell carcinoma
vulvar nodule, papule, plaque or verrucous carcinoma (cauliflower) that can be locally destructive causing obstruction with no bowel movements
risk factors: HPV, smoking, immunosuprression, chronic inflammation(lichen sclerosus)
dx: biopsy
do imaging of pelvis to check extent of disease
tx: surgical excision + chemotherapy

vs lichen sclerosus: white plaque in oste monpauseal women with thinng and fibrosis of the genital area skin (benign) and can lead to hyperplastic dystrophy (chronic inflammtory changes of vulva)

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22
Q

pt last visit bp in R arm: 165/105
today comes in with R arm:160/100 and L arm: 105/65

A

subclavian artery atherosclerosis
a type of subclavian artery stenosis
risk: age, DM, HLD, HTN, smoking
can be subclavian steal syndrome: blood flows from teh contralateral vertebral artery through basilar artery and then in retrogradedly down the ipsilateral vertebral artery through the affected subclavian artery (can see vertigo, ataxia, nystagmus, syncope after upper extremity exertion)
dx: duplex u/s with color flow
or CT - ANGIOGRAPHY
tx: endovascular : stenting or angioplasty or bypass

vs

children with htn and difference in BP in upper vs lower extremity: coarctation of aorta (systolic mumur)

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23
Q

epiglottitis mgt:

A

endotracheal intubation:
should take place in operating room under direct visualization with laryngoscope in operating room
transfer of patient to operating room
and then give antibiotics (haemophilus influenzaB)

not indirect laryngoscopy since such high threat of airway compromise

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24
Defect in tyrosine kinase --> leads to defect in b lymphocyte maturation -> death of plasma cells and low immunoglobulin concentrations in Ig-M/G/E/A
Brutons X0linked agammaglobulinemia **Decreased B-lymphocyte concentration** recurrent bacterial infections d/t impaired HUMORAL immunity especially after 6 months of life when maternal IgG wane tx: **IVIG and recieve all immunizations except for LIVE VACCINES**
25
X-R Defect in CD40 ligang on t helper cells that interacts with B-lymphocytes to induce class switching of ig's
Hyper-IgM severe pyogenic infections as well as opportunistic infections B and T cells are normal
26
X-R Defect in CD40 ligang on t helper cells that interacts with B-lymphocytes to induce class switching of ig's
Hyper-IgM severe pyogenic infections as well as opportunistic infections B and T cells are normal
27
pt with 3 days bloody watery diarrhea (no travel hx)
Campylobacter jejuni (gram neg comma shaped oxidative positive) most common cause of food poisoning in US self limiting may cause reactive arthritis in pts with HLA-B27 and Guillane Barre syndrome vs Toxigenic Ecoli (watery) vs EHEC ETEC (bloody/watery in contaminated waters while traveling)
28
pt on chemo and now has pancytopenia (low platelets, low leukocyte)
cytotoxic agents: etoposide, irinotecan, doxorubicin, cyclophosphamide, paclitaxel, hydroxurea bactrim, sulfasalazine, methimazole, clozapine tx: stop implicated medication give Granulocyte colony-stimulating factor G-CSF (quicker recovery and shorter duration of hospitalization) vs giving them platelets: only in bleeding under 50,000 and nonbleeding 10,000
29
lumbar spinal stenosis --> compressing nerve roots w/ radiculopathy, back pain radiating to butt and legs, leg numbness, parasthesia, weakness tx?
degenerative joint disease and osteophytosis occurs in AGE or manual labor jobs dx: MRI tx: NSAIDS, PT, and srugery (lumbar laminectomy) vs ibuprofen+bed rest (best rest worsens must go to PT)
30
Bacterial meningitis strep pneumo tx?
IV: vancomycin + ceftriaxone + glucocorticoids csf: neutrophils
31
COPD poor prognosis:
progressive dyspnea on exertion (despite adquate medical therapy) tx: smoking cessation and oxygen (if needed 88% or 55) all inhaled: SABA + LABA + muscarinic antagonist ipratropium + glucocorticoids
32
Parvo b-19 infection in prego
can cause fetal anemia --> presents as fetal tachycardia, high output failure, hydrops fetalis measure serum sepcific IgG and IgM
33
carcinoid tumors produce:
serotonin **histamine**, bradykinin, prostaglandin, substance P, chromogranin epsidoic flushing, diarrhea, sob, metastatic, GI tract or appendix, lung dx: urninary 5-HIAA
34
pt with pleural effusion initially: if after that pulls 1000mL or more of blood then:
tube thoracostomy if greater : massive hemothorax: do a video assisted thoracoscopy or thoracotomy
35
endometritis: risk factors: tx:
recent postpartum fever leukocytosis and uterine tenderness prolonged rupture of membranes, prolonged labor, c/s, bacterial vaginosis, GBSTREP, manual removal of placenta tx: clindamycin and gentamicin
36
bartonella henselae vs kaposi sarcoma
bartonella: (cat bties or hiv) needs doxycycline or erythromycin Neutrophilic inflammation is seen in bacillary angiomatosis. CD4 < 100 kaposi sarcoma: need to be removed Lymphocytic inflammation is seen in Kaposi sarcoma. CD4 <500
37
pt with VUR or ureteral issue whats next best step
percutaneous nephrostomy tube
38
pt with renal failure, gets a new kidney but still has super high PTH and normal/elevated Ca
secondary --> tertiary hyperparathyroidism parathyroid hyperplasia *not adenoma MCC
39
pt with episodes of vision loss, transient and painless
amaurosis fugax retinal ischemia as a result of microembolization of opthalmic artery potential emboli coming from the carotid arteries next step: CAROTID DUPLEX U/S!!
40
Restless leg sydnrome: also test
for IDA ferritin
41
scaphoid fracture risk of :
nonunion avascular necrosis immobilization/splint repeat xray after 2-3weeks
42
heparin induced thrombocytopenia:
anamestic antibody response HIT 2/2 to the production of IgG antibodies agaisnt complex of heparin and platelet factor 4 stop heparin give gatr(direct thrombin inhibitor) or xa (inhibtior) instead
43
biopsy shows epitheloid sarcoma next step?
amputation slow growing malignant/metastatic cacner associated with Li-Fraumeni syndrome chromosome 22q11 has the INI-1 TUMOR SUPPRRESSOR GENE CD 34 + POST OP RADIATION WITH LARGE TUMORS or with positive surgical margins
44
1 y/o with bulky, light colored stools, low weight, big head, paucity of subcutaneous fat and thin hair
failure to thrive likely to cystic fibrosis deficiency of fat soluble vitamins: ADEK do a sweat chloride test can present with meconium ileus (failure to pass stool after birth) vs dairy allergy would be if pt had bloating flatulance and diarrhea too
45
pt with acute exertional dyspnea, poorly controlled HTN, and ecg shows LVH :
new onset heart failure HTN --> atrial remodeling first step --> LVH caused by chronic increased afterload must do ECHO NEXT
46
white painful patch in mouth that can not be scraped off
oral candidiasis KOH budding yeast with or w/o hyphae can cause dysphagia or oodynophagia tx with oral fluconozole or swish nystatin
47
tx for fronto temporal dementia
serotonergic meds or **Risperidone** to control behavioral problems, irritability, agitation
48
pt gets in car accident then later has really low blood glucose what next step in dx?
72 hour fasting measurement of serum insulin and glucose insulinoma -- hypoglycemia, confusion, sweating, fatigue, weakness, usually after strenous exercise or not eating (long distance drivers without eating) dx: 72hour c-peptide then imaging: CT, MRI, U/s diazoxide can be used to decrease inuslin production until you do surgey to remove it
49
pt taking lithium what labs to run
serum creatinine, fasting glucose, and TSH lithium metabolized by kidneys vs carbamazepine/valproic acid -- check LFT's for liver
50
warfarin induced skin necrosis
wawfarin inhibits hepatic synthesis of factor II (prothrombin), VII, IX, X, and protein C and S usually seen in protein C deficiency patients must stop warfarin switch to low molecular weight heparin give vitamin K and fresh frozen plasma (has protein C)
51
pelvic ultrasound: large partially cystic mass in right ovary with a single echogenic nodule and decreased blood flow
mature cystic teratoma (hair bone teeth) has internal echos causing ovarian torsion must do ovarian cystectomy to prevent future episodes
52
colchicine adverse effect:
diarrhea dont give long term d/t kidney damage and peripheral neuropathy only for acute issues (gout)
53
pt with gout next step?
LIFESTYLE MODIFICAITONS ALWAYS FIRST low purine diet and alcohol cessation shellfish has high purine
54
patient with bone pain, kidney dysfunction, monoclonal gammopathy, lytic lesions on bone what do you see in u/a
multiple myeloma neoplastic plasma cells overproduce monoclonal immunoglobulin depostis its mesangium leads to nephrotic syndrome: large proteins like albumin, plasma lipids gets filtered into urine you will see OVAL FAT BODIES PT WILL HAVE EDEMA, foamy/dark colored urine, hypoalbuminemia, proteinuria
55
phase 1: phase 2: phase 3: phase 4:
phase 1: SAFETY phase 2: efficacy (determines how and why a treatment works) phase 3: effectiveness (in comparison to current standard of care) phase 4: long term
56
Rheumatoid arthritis tests:
sensitive: rheumatoid factor specific: anti-CCP
57
hypothyroid and hypercholesterolism
low thyroid hormone (T3/T4) causes decrease in HMG-coA reductase (enzyme that synthesizes cholesterol) so then body compensates for decreased synthesis by increasing cholesterol absorption from GI tract also hypothyroidism leads to decrease in LDL receptors in the liver tx with levothryoxine
58
family history of reading difficulty, prematurity, poverty, neurodevelopmental conditions (ADHD, prenantal alcohol exposure) risk factors for:
dyslexia
59
urge incontinence vs overflow incontinence vs stress incontinence
urge: detrusor instability/hyperactivity (gotta go rn with leakae oxybutinin) overflow: underactive or flaccid detrusor OR OUTLET OBSTRUCTION (urinary retention) will see increased post-void residual bladder volume (so do a bladder u/s) stress: increased intra-abdominal pressure (cough,laugh,sneeze) weakness of pelvic floor muscles OR urethra hypermobility (pelvic floor exercises)
60
elderly pt on anticoagulants (warfarin), alcohol use, physical abuse, or head trauma with symptoms of pronator drift, oconfusion, neurologic deficits next step
subdural hematoma (crescent shape) non contrast CT tx: ICP management: hyperventilate, elevate bed, CSF fluid craniotomy to excavate hematoma if really large
61
elderly woman + muscle stiffness + temporary vision loss
polymyalgia rheuamtica immediately give high dose steroids (or else will go blind in both eyes) then do a biopsy : granulomatosis vasculitis
62
pt with asymptomatic peripheral vascular disease (absent pulses in right leg, abi <0.9, shiny hairless leg what recommendations:
smoking cessation and exercising to create neovascularization and collateral flow aspirin and statin if had symptoms of claudication : can also give cilostazol (phosphdiesterase inhibitor) or pentoxifyllie vs acute limb ischemia will see absent pulses but also severe pain, parasthesia, pallor, poikilothermia and would then do arteriography of lower extremity

NBME's (8 decks)

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