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COMLEX Level 2CE > QG SB4 (F) > Flashcards

QG SB4 (F) Flashcards

W4 QG blocks (58,61,64,67) Deck is full

1
Q

post-menopausal bleeding is ___ until proven otherwise?

A

cancer

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2
Q

what is the greatest risk factor for SCC of the vagina?

A

smoking

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3
Q

what are the risk factors for vaginal cancer?

A
  1. smoking (prevents viral clearing
    - age > 60 yo
    - HPV (strains 16, 18, 31, 33)
    - DES exposure in utero (clear cell only)
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4
Q

what are the two main strains of HPV that cause cancer?

A

16 and 18

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5
Q

how does endometriosis present?

A
  • pelvic pain
  • abn bleeding
  • 3Ds = dysmenorrhea, dyschezia, dyspareunia
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6
Q

what is genito-pelvic pain/penetration (vaginismus)?

A
  • psych condition in which pt can’t tolerate penetration

- involuntarily CTX of pelvic floor muscles –> pain during attempted penetration

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7
Q

can you do a spec exam w/ vaginisumus?

A

NO (causes severe pain)

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8
Q

painful menses + heavy bleeding. ddx = ?

A
  • uterine leiomyomas

- adenomyosis

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9
Q

how do you tell uterine leiomyomas apart from adenomyosis on p/e?

A 
fibroids = irreg enlarged uterus
adenomyosis = symmetrically enlarged uterus
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10
Q

uterus is boggy. what is your differential dx?

A
  • uterine atony

- adenomyosis

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11
Q

pt presents w/ vaginal pain but there is no external pain on p/e. what do you r/o?

A

vulvodynia

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12
Q

how does pudendal neuralgia present?

A

superficial pain @ vulva, perineum and rectum (pudendal n. distribution)

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13
Q

all women w/in child-bearing age and presenting w/ lower abd pain get test 1st?

A

preg test

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14
Q

you suspect a pt has PMS. how do you dx?

A

s/s diary documenting >= 2mos symp

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15
Q

how does PMS present?

A

dysmenorrhea s/s (w/ alt timeline) + irritability/mood symp

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16
Q

what is the timeline for PMS s/s presentation?

A

onset s/s = 2 wks prior to menses (luteal phase)

resolution = start of menses or w/in few days of start (follicular phase)

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17
Q

how do you tx PMS?

A
  1. SSRI

2. OCP

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18
Q

pt presents w/ heavy bleeding + uterus that is irregularly enlarged on p/e. what is the dx?

A

fibroids

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19
Q

how does chancroid present?

A
  • suppurative lymphadenopathy
  • deep ulcer w/ grey exudate
  • PAINFUL
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20
Q

question state that the pt uses condoms consistently. what is not the dx?

A

STI

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21
Q

question states that there is no inflammation on pelvic exam. what is not the dx?

A

STI

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22
Q

when should you suspect a vesiculovaginal fistula?

A
  • h/o trauma or protracted labor
  • no s/s infx
  • continuous leakage of clear fluid w/ pH > 4.5 +/- odor (from necrotic tissue)
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23
Q

what is aromatase def?

A

inability to convert androgens to estrogens

leads to high T and low estrogen/estrodiol

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24
Q

what is high in PCOS?

A

androgens (T)

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25
Q

what causes 1* dysmenorrhea?

A

incr prostaglandin production

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26
Q

pain, n/v/d w/in the 1st few days of menses = what?

A

1* dysmenorrhea

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27
Q

how do you tx 1* dysmenorrhea?

A
  1. NSAIDs

2. OCPs

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28
Q

how do you tx period type pain/symptoms?

A

pre-mentrual = PMS - tx w/ SSRI

w/ menses = dysmenorrhea - tx w/ NSAIDs

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29
Q

pt presents w/ pre-eclampsia + severe features but is at gestation < 20wks. dx = ?

A

hiatidiform mole

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30
Q

how do you tx hyatidiform mole?

A
  • D&C

- serial B-hCG measurements

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31
Q

young female presents to your office. what is on the diff dx?

A

AI condition

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32
Q

young female presesnts w/ h/o repeated miscarraiges. dx = ?

A

antiphospholipid synd

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33
Q

can you give pregnant women warfarin?

A

NO

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34
Q

antiphospholipid synd problem = ?

A

abn clotting

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35
Q

antiphospholipid synd tx = ?

A

anti-coag (LMWH)

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36
Q

what is oxytocin used for?

A

-labor augmentation (stim CTX)

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37
Q

oxytocin leads to fetal descent and dilation. what else might you see?

A

late decels (if uterus squeezes baby too much)

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38
Q

what are the possible causes of hyperemesis gravidarum?

A
  • molar preg

- mult gestation

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39
Q

when does labor enter the active stage?

A

> = 6cm cervical dilation

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40
Q

how strong are adequate CTX?

A

> 200 MVU

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41
Q

what is the expected rate of cervical change in a primigravida in active labor w/ adequate CTX?

A

1 cm/hr

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42
Q

what is the expected rate of cervical change in a primigravida woman in active labor w/o adequate CTX?

A

1 cm/hr

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43
Q

how long do you let a primigravida woman in active labor w/ adequate CTX labor w/o seeing cervical change?

A 
4 hours
(if don't see >= 1cm dilation w/in 4 hrs, you go to c-sec)
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44
Q

how long do you let a primigravida woman in active labor w/o adequate CTX labor w/o seeing cervical change?

A 
6 hours
(if don't see >= 1 cm dilation w/in 6 hrs, you go to c-sec)
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45
Q

active labor + adeq. CTX but no cervical change for 4hr. what do you do?

A

c-sec

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46
Q

active labor + inadeq. CTX and no cervical change for 6hrs. what do you do?

A

c-sec

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47
Q

if baby doesn’t turn on its own, when do you turn baby (from breech or transverse position to vertex)?

A

> 37 wks

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48
Q

why do you wait until > 37 wks to turn baby?

A

ext. cephalic version can cause 1. PROM and 2. placental abruption

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49
Q

how will molar pregancy present?

A
  • incr vomiting

- diff/symmetrical uterine swelling

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50
Q

what do you check at 24-26wks gestation?

A
  • Rh-D
  • HgB
  • DM
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51
Q

how long is a GBS test result good for?

A

5 wks (check @ wk 35)

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52
Q

what can anesthesia cause in a preg woman?

A

urinary retention

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53
Q

h/o trauma –> injury of ___ leads to ___.

A
  • pudendal n.

- loss of urge to urinate (can’t sense bladder fullness)

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54
Q

how does post-partum urinary retention present?

A

inability to void after 6 hrs post-delivery

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55
Q

how do you tx post-partum urinary retention?

A

-catheterize and wait

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56
Q

you do a D&C for molar pregnancy. what must you do next?

A
  • serial B-hCG checks to ensure return to nL (no Ca)

- contraception for AT LEAST 6 mos (if get preg can’t tell if rise in BhCG is due to pregancy or developing cancer)

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57
Q

how does parvovirus B-19 lead to anemia?

A

destroys RBC precursors

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58
Q

what are the potential fetal complications of HELLP?

A
  • IUGR (placental insuff –> decr nutrients –> decr growth)

- oligohydramnios

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59
Q

what 2 things cause decr fetal movement?

A
  • sleeping

- baby is acidotic (decr O2)

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60
Q

if baby is acidotic, how does the body react?

A
  • blood is redirected to the brain to preserve it

- this is done at the expense of the arms

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61
Q

what are considered positive NST results?

A

> = 2 accels (> 15bpm incr lasting 15 sec) w/in 20 min period

62
Q

how do determine type of miscarraige?

A
  1. look at cervix (Is are open)
  2. look at contents (complete = no contents)
  3. look at HR (threatened has FHT; missed does not)
63
Q

what Ca can you see s/p molar preg?

A

gestational trophoblastic neoplasia

64
Q

when do placental acreta, increta, percreta and previa occur?

A

1st trimester

65
Q

PPROM incr the risk of what?

A
  • abruption
  • preterm labor
  • infx (after 18hr s/p ROM)
  • cord prolapse
66
Q

dark rash w/ sun exposure that presents during pregnancy is called what?

A

melasma

67
Q

what does melasma w/u include?

A

nothing. will resolve after delivery

68
Q

where do you see the discolorations in Addison’s dz?

A

all over

69
Q

cushing’s discoloration will also present w/ what?

A

hump

70
Q

how is the hemachromatosis discoloration classically described?

A

bronze

71
Q

severe dehydration –> vascular collapse (shrinkage) –> hard sticks/failed gain of access. what do you do?

A

intraosseous cannulation

72
Q

when is the one time sickle cell pts will present w/ decr retic count?

A

aplastic crisis

73
Q

what is a common cause of aplastic crisis in sickle cell pts?

A

parvovirus B19 infx

74
Q

how does congenital dermal melanocytosis present?

A

-flat grey spots
-common in darker ethnicities
(=mongolian spot)

75
Q

what are congenital melanocytic nevi?

A

benign, isolated, hyperpigmented, hairy patches that present w/in the first few months of life

76
Q

cafe au lait spots are seen in what 2 conditions?

A
  • mcune albright synd

- NF

77
Q

how does mccune albright synd present?

A

precocious puberty + cafe au lait spots

78
Q

meningitis can lead to what?

A

neural sequella

79
Q

what are the MC sequella of bacterial meningitis in kids?

A
  • hearing loss

- cerebral palsy

80
Q

which n. is affected leading to hearing loss 2/2 meningitis?

A

CN 8

81
Q

what is the underlying problem in chronic granulomatous dz?

A

recurrent pulm and cutaneous infx w/ catalase-positive oganisms 2/2 failed oxidative burst

82
Q

which 4 bugs are chronic granulomatous dz pts susceptable to?

A
  • staph
  • serratia
  • aspergillous
  • burkholderia
83
Q

pt presents w/ odynophagia + high F + new neck pain + muffled voice (i.e. swelling). dx = ?

A

retropharyngeal abscess

84
Q

pt presents w/ NO stridor. what is not causing their resp s/s?

A

problem w/ the esophagus

85
Q

pt presents w/ a “widened prevertebral space” on xray. what is the dx?

A

retropharygeal abscess

86
Q

what is seen in diptheria?

A

grey pseudomembrane

87
Q

pt presents w/ hoarseness. what nerve is likely affected?

A

recurrent laryngeal n.

88
Q

pt presents w/ a monotone voice. what nerve has been compromised?

A

CN 10 (external branch)

89
Q

what happens to the uvula if the tonsils are messed up?

A

deviates from midline

90
Q

what burn pattern suggests abuse?

A

spared creases

91
Q

the sphincter of odi is affected by what?

A

opioids

92
Q

criglar najar synd leads to what type of hyperbilirubinemia?

A

unconj

93
Q

what is the problem in criglar najar synd?

A

don’t have the enzyme needed to conj bilirubin

94
Q

gilbert synd leads to what kind of hyperbilirubinemia?

A

unconj

95
Q

which two liver dz lead to unconj hyperbilirubinemia?

A
  • crigler najar

- gilbert synd

96
Q

which liver diseases present w/ conj. hyperbilirubinemia?

A
  • dubin johnson synd

- rotor synd

97
Q

how do you tx criglar najar?

A

type 1 (incr = severe) –> tx = plasmapharesis, phototherapy

type 2 –> phenobarbitol

98
Q

phenobarbitol can precipitate what?

A

acute intermittent porphyria

99
Q

why are stools pale?

A

bilirubin isn’t being excreted into the bowel

100
Q

what do the stools look like in biliary atresia?

A

pale stools

101
Q

which nephrotic synd is assoc w/ active HepB infx?

A

membranous nephropathy

102
Q

what will be elevated in an active(infectious) hepB infx?

A

HBeAg

103
Q

what is the MC complication of all nephrotic synd?

A

renal vein thrombosis 2/2 decr antithrombin 3 (hypercoag state)

104
Q

in which congenital cyanotic heart condition will squating make the murmur worse but decr the cyanosis?

A

ToF

105
Q

a kid presents w/ MSK abnormalities. the baby has been mostly breastfed w/ occassional homegrown food supplementation. what MSK abnormality does the kid have and why?

A
  • rickets 2/2 severe vit D def

- kid isn’t getting any vit D supplementation (no OTC source or enriched foods)

106
Q

how do plt problems present?

A
  • mucosal bleeding

- skin changes (petichiae)

107
Q

in fibrinogen dysf(x) (factor 1), what coag study results do you expect?

A

incr PT and incr PTT

108
Q

which clotting factor is fibrinogen?

A

factor 1

109
Q

how does von willebrand dz present?

A
  • low plt

- mucosal bleeding and petechiae

110
Q

1/4 of hemophilia pts have refractory incr aPTT. why?

A

inhibitor developement

111
Q

what is a varicocele?

A

deformed/dilated papiniform plexus w/in L scrotal sac

112
Q

when a pt lays supine, what happens to his varicocele?

A

it disappears

113
Q

pt presents w/ R sided testicular mass that looks like a varicocele but doesn’t disappear when the pt lays supine. what do you suspect?

A

cancer

114
Q

what is another name for wilm’s tumor?

A

nephroblastoma?

115
Q

pheochromocytoma is seen in adults. what is the equivalent in kids?

A

neuroblastoma

116
Q

other than providing supportive care, how do you treat measles?

A

give vitamin A

117
Q

child presents w/ h/o hoarding and abuse. what dx do you suspect?

A

reactive attachment disorder

118
Q

who do children belong to?

A

the state

119
Q

if parent says no to life saving tx for their child, what do you do?

A

provide lifesaving tx anyway

120
Q

what diseases cause rashes on the palms and soles?

A

Kawasaki

  • coxsackie A
  • RMSF
  • sypilis
  • SSSS (kids)
  • scarlet fever
  • streptobacillus
  • TSS (adults)
121
Q

how does Reye synd present?

A
  • vomiting
  • encephalopathy
  • liver dysf(x)
  • abn behavior
  • seizures
  • lethargy
  • H/O ASA use in kid
122
Q

why is breast feeding better?

A

human milk protein absorbs better and improves gastric emptying

123
Q

what is the age cutoff for ADHD?

A

dx before age 12

124
Q

pt presents w/ cough that leads to vomiting + incr WBC (lymphocyte predom). dx = ?

A

pertussis

125
Q

why does pertussis present w/ a lymphocyte predom incr WBC when it is caused by a bacteria?

A

intracellular bacteria triggers lymphoctyte response instead of PMNs

126
Q

pt presents w/ bleeding + petechiae. what is your ddx?

A
  1. von willebrand

2. plt problem

127
Q

what is the problem w/ von willebrand dz?

A

plt adhesion problem (von Willebrand = sticky man)

128
Q

what is pathoneumonic for autism spectrum disorder?

A

NO eye contact

129
Q

what is speech sound disorder?

A

articulation disorder

130
Q

what is language disorder?

A

persistent difficulty comprehending and producing spoken and written language

131
Q

what is childhood onset fluency disorder?

A

stuttering

132
Q

what is herpangina?

A

mouth blisters seen w/ coxsackie A infx

133
Q

vit C def presents how?

A

-gingivitis
-hemorrahage
-corkscrew hair
(SCURVY)

134
Q

how does vit B2 (riboflavin) def present?

A

angular chelotis, stomatitis and glossitis
+normocytic anemia
+seborheic dermatitis (w/ eyelash crusties)

135
Q

other than vit B2 (riboflavin), what other vit B def leads to chelotis, stomatitis and glossitis?

A

vit B6 (pyridoxine)

136
Q

how does osteoid osteoma present?

A
  • bone pain at night
  • pain resolves w/ NSAIDS
  • benign round radiolucency on xray
137
Q

how does ewing sarcoma present?

A
  • moth-eaten appearance on xray
  • onion skinning (cortical layers) on xray
  • pain @ night
  • no response to NSAIDS
  • located in diaphysis
138
Q

how does osteosarcoma present on xray?

A
  • sunburst

- codmans triangle

139
Q

how does giant cell tumor present on xray?

A

soap bubble tumor

140
Q

if DM before 20 wk gestation, what happens to baby?

A

-organ malformations (including pancreas)

141
Q

what 2 bugs cause impetigo?

A
  1. s aurues

2. s pyogenes

142
Q

how do you tx impetigo?

A

mupirocin

143
Q

what is a possible complication of impetigo caused by s pyogenes?

A

PSGN

144
Q

how does s aureus spread?

A

hematogenously

145
Q

what 2 organisms do you suspect if pt presents w/ a bine infx?

A
  1. s aureus

2. salmonella

146
Q

how does BM look in ALL?

A

hypercellular w/ >25% blasts

147
Q

CAH-21 hydroxyprogesterone def can affect M and F. what is the karyotype if pt presents w/ virualization?

A

46 XX

148
Q

CAH-21 hydroxyprogesterone def can affect M and F. what is the karyotype if pt presents w/ precocious puberty?

A

46 XY

149
Q

what is selective mutism?

A

-an anxiety disorder wherein the pt refuses to speak in specific social settings (i.e. school)

150
Q

pt presents w/ F + rash (salmon patch) + arthritis. dx = ?

A

systemic juvenile idiopathic arthritis

COMLEX Level 2CE (23 decks)

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