UW 2/NBME 12 Flashcards by Stephanie Escobar

subareolar mass
Recently finished breast feeding
Dx?

galactocele
(milk retention cyst)

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functional hypothalamic amenorrhea (FHA)
↓ FSH
Results of progesterone challenge test?

no w/d bleeding

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wider CI = wider range of ___

effects on outcome

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Facial nerve palsy (bilateral droop) is a common manifestation of early disseminated ___ and may occur alone or in combination with multiple erythema migrans lesions, systemic flu-like symptoms, and/or cardiac manifestations.

Lyme disease

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Infantile hemangiomas are benign, vascular tumors that present as bright red, raised nodules that proliferate in early infancy. Management of uncomplicated hemangiomas is

serial observation

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Intertrigo caused by Candida will appear as pseudohyphae with

budding yeast forms

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Present with vaginal bleeding, a closed cervix, and a fetus with a normal heart rate on ultrasound. Management is expectant with reassurance & f/u ultrasounds.
dx?

Threatened abortions

(Suction curettage is indicated when pt is hemodynamically unstable, or septic)

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Elderly pt with acute headache, nausea, eye pain, vision loss, and an afferent pupillary defect (no dilation).
dx?

Angle-closure glaucoma
↑ intraocular pressure from impaired aqueous humor drainage.

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Acute liver failure is characterized by the triad of
elevated aminotransferases,
hepatic encephalopathy,
and prolonged ____
in a patient without underlying liver disease

prothrombin time

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Myelomeningocele (spina bifida), the most common type of neural tube defect (NTD) s/t ____.

Folate deficiency

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Uncal herniation may be caused by mass effect from ____ hemorrhage.

Symptoms of uncal herniation include
*dilated, nonreactive ipsilateral pupil,
* contralateral extensor posturing
*respiratory compromise/irregular
* coma

basal ganglia

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Serotonin Syndrome: classic triad of

mental status changes** (anxiety, restlessness, agitated delirium),
**autonomic dysregulation (diaphoresis, tachycardia, hypertension, hyperthermia)
*neuromuscular hyperactivity (hyperreflexia, tremor, rigidity, myoclonus, ocular clonus [slow, continuous, horizontal eye movements], bilateral Babinski signs).

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Pt who recently traveled to Philippines presents with 3 weeks of bloody-mucoid diarrhea and abdominal pain.
Dx?

Entamoeba histolytica colitis
(stool PCR/NAAT)

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Age <45
Ongoing or recent smoking history
Distal limb ischemia, gangrene, ulceration due to nonatherosclerotic occlusion, thrombosis
dx?

Thromboangiitis obliterans (Buerger disease)

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AMS with Hypercalcemia & Hyponatremia
Treatment first is with

Normal Saline

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Inadequate warfarin anticoagulation is the BRF for ____ of a mechanical heart valve
Present with heart failure symptoms.
Goal INR is ____.

prosthetic valve thrombosis
INR 2.5-3.5

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Warfarin INR goal for:
*Prosthetic valves
*Native valve dysfunction

Prosthetic → 2.5 – 3.5

Native → 2.0 – 3.0

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3 yo M with a painless scrotal mass that transilluminates (fluid) with a pen light.
Dx/Pathophysiology?

Hydrocele
s/t persistent patency of Procesus Vaginalis

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7 yo M presents with acute lower abdominal pain with N/V &
stroking inner thigh does not cause testes to elevate (Absent cremasteric reflex)

Dx/Tx/Pathophys?

Testicular Torsion

Surgical reduction (untwisting) and orchidopexy (anchor testes to scrotum inner lining)

Twisting of the spermatic cord due to inadequate fixation of the lower pole of the testis to the tunica vaginalis
───
Other presentations/signs:
Abrupt onset of severe testicular pain
Swollen/Tender Testes
Scrotal elevation (high-riding testis)
Abnormal position of the testis

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Painful swelling ± induration of testes
± urethral discharge
Positive Prehn sign (testes elevation alleviates pain)
dx?

Epididymitis

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30M presents with painless, slow growing mass for 2 months.
Pt describe a “heavy” sensation in the testis
PE → palpable mass in scrotum that does not transilluminate
Regional lymphadenopathy present
dx/dxt (3)
contraindicated test?

Testicular Tumor
High-resolution CT AP & Chest
Tumor Markers: AFP & hCG
Orchiectomy

Biopsy contraindicated b/c risk of tumor seeding!
───
AFP → Yolk sac tumor (young boys, aggressive)
hCG → Choriocarcinoma (most aggressive, brain/lung mets)

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27M presents with L sided swelling & dull pain of the scrotum.
Symptoms worse at the end of work day where he stands all day as security guard.
PE → pain worsens with Valsalva + scrotum does not transilluminate + palpable soft bands in the affected scrotum
Dx/Pathopys?

Varicocele
Dilation of the pampiniform vessel

MCC of scrotal enlargement

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Testicular Diagnosis:
Testes unfixed to tunica vaginalis (+) Transillumination
Patent processus vaginalis (+) Transillumination
Dilated pampiniform vessels (–) Transillumination
Solid palpable mass in scrotum (–) Transillumination

Torsion
Hydrocele
Varicocele
Tumor

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Presents with liver failure, diabetes, arthritis, hyperpigmentation, heart failure ± gonadal atrophy
typically diagnosed in men > 40 yo

hemochromatosis

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____ vaccine for all pts >10 yo going off to **college/military** (communal living spaces) or pt's with **asplenia**

Meningococcal – serogroup B

MCCOD in **teens and young adults** is accidental death usually s/t MVA. **Greatest impact on mortality** is encouraging this population to ___

wear **seat belts** :(

Pt with DM often have ___ incontinence s/t **neurogenic bladder** * infrequent urination * incomplete bladder emptying * weak urinary stream

overflow

Young male child, since birth Recurrent PNA /AOM → tympanostomy tubes Anaphylactic reaction to blood transfusion Isolated ↓ IgA Low weight (FTT) dx/tx

Selective IgA deficiency Sxs tx only (if, any)

Claudication, pulsatile non-tender groin Mass Cx: acute limb ischemia, rupture, distal embolism Dxt: Duplex U/S or CT Angiography dx/tx

Femoral artery aneurysm Surgical arterial repair → **symptomatic or ≥3cm**

Recent viral infection → new unexplained heart failure (HFrEF) dx

acute myocarditis

Antipsychotic induced parkinsonism treatment 1st line: 2nd line:

1st: ↓ dose of antipsychotic 2nd: benztropine

Meta-analysis increases the ___ of the study by reducing risk of ___

Power type 2 errors

Congenital ____ presents in the first few months of life with feeding difficulties, lethargy, **constipation, macroglossia, hypotonia** myxedematous face, umbilical hernia and/or hypothermia,

hypothyroidism

[**med**] induced **hypothyroidism** and goiter rarely, hyperthyroidism/ autoimmune thyroiditis

Lithium

Preeclampsia can lead to **placental insufficiency** → **fetal growth restriction**. it also increases the risk for [cx].

Abruptio Placentae

Post-menopausal women are at increased risk of death s/t ____

cardiovascular disease

Blue at Rest Pink with Tears Failure to Pass NGT Dx?

Choanal Atresia CHARGE association

Management: Multiple Sclerosis exacerbation → Guillain-Barré syndrome → Myasthenia gravis crisis → (2)

MS exacerbation → **IV Steroids** GBS → **Plasmapheresis** Myasthenic crisis → **IvIg → Plasma exchange**

3 serotonergic medications:

Venlafaxine (SNRI) Tramadol (analgesic) Trazadone (sleep aid)

Recently returned from a trip with Fever + **Diarrhea** + **Pulmonary Infiltrate** (decreased breath sounds, crackles) (forget age or risk factors) dx/tx?

Legionella FQ

For **relative risk** and **odds ratios** Values > 1 indicate ___ risk or higher odds. Values <1 indicate a ___ risk or lower odds. Confidence intervals containing the number 1 indicate the results are **not significant/ different.**

>1: increase <1: decreased

List 3 SNRIs List 4 TCAs

Duloxetine Milnacipran Venlafaxine 𑁋𑁋 Clomipramine Imipramine Desipramine Nortriptyline Amitriptyline

Hypercalcemia can cause ___ Heat strokes can cause ___ BRF for Osteoarthritis is ____

Nephrogenic DI Rhabdomyolysis → Acute Renal Failure Obesity

Alcoholic with **hypocalcemia** + tremor + Hyper-reflexia =

Hypomagnesemia

pt on ventilator pO2: 65 PEEP: 10 FiO2: 100% (1.0) dx? What can you do to improve survival?

ARDS Hypoxemia with increased PEEP (lowest is 5) and FiO2 (low 30%) needs **Lung protective** strategies → low Tidal vol + high PEEP + Prone

Complete AV Heart Block 3º → QRS separated by ___ boxes Can be caused by ___ (b/c AV node in **right atrium**)

8-10 boxes R Heart MI

Pt is being treated for cancer with **intent to cure/life-prolonging therapy** Can they receive palliative care?

YES Contrast with **hospice** which does **not** allow life-prolonging tx only comfort care

family/friend/partner decides on care based on what **they think** pt wants

Substituted judgment

surrogate or physician chooses care based on best care **evidence**

Best interest standard

Pt previously designated someone as their **Healthcare Power of Attorney** They will make decisions on the pt’s behalf ____.

if the pt can’t make decisions for themselves. If no POA assigned: Spouse >children>parents>siblings

Models used for Quality Improvement (2)

DMAIC > PDSA cycle DMAIC =Data-driven improvement model

Doctor see's pt was last diagnosed with x. Decides to diagnose pt with x again. or Dr settles on a diagnosis early, through initial impressions of classic sxs bias?

Framing bias Anchoring bias

Dr only considers an uncommon cause in classic presentation b/c they recently saw that uncommon cause in another pt w/ same sxs. or Ordering unnecessary test b/c of a recently **missed** dx. bias?

Availability bias

Dr makes a diagnosis but **overlooks evidence** that points to different diagnosis. bias?

Confirmation bias

Decides on diagnosis based on initial impression or Ends workup prematurely / Starts treatment without work-up Diagnostic error?

Premature closure

Dr considers a diagnosis earlier on, works that dx up but the initial results do not point to initial diagnosis Dr continues to do more tests that could confirm that initial diagnosis.

Diagnostic momentum

___ is better than CAGE for AUD screening

AUDIT-C AUD → **High GGT** (HY HY HY)

Screening tools for inappropriate Rx in the elderly

**STOPP** criteria > BEERS criteria 𑁋𑁋𑁋 50% adverse drug events s/t (IOWA) Insulin, Opioids, Warfarin, Antiplatelets

MC type of medication error? → Administering med at the wrong ___

time

2 mostly likely **complications** of poor transition of care (or discharging) what can **reduce the risk of complications** after transition of care?

Readmission Adverse drug events ↓ Cx: Arrange definitive **follow up**

How to Reduce error in pt handoffs (discontinuity of care)?

I-PASS method I = illness severity (**sickest pt 1st**) P = pt summary A = action list (**to-dos** for the night team) S = situation awareness (**if-then** statements) S = synthesis by receiver (**read back** from new team)

___ method for **nurse-physician** or **physician-physician** communication

SBARR method S = situation B = background A = assessment R = recommendation/response

High value care (HY) Value = (____) / (____)

Value = (service x quality) /cost Service & Quality directly proportional to value Cost is inversely proportional to value

used to optimize a **new protocol** or process Finds errors in problem **before** error occurs → **Prospective** review “Ways in which something might fail?” → **Cause** analysis “Consequences of failures?” → **Effects** analysis

failure mode & effects analysis (FMEA)

RETROSPECTIVE TOOL Looks at error **after** it occurs then analyzes what caused the error

Root cause analysis (Fishbones/Ishikawa) list **categories/causes** the error

PPE needed for: Airborne Droplet Contact

Airborne → Gown + Glove + N95/Respirator (HCW + Pt use mask) Droplet → Gown + Glove + surgical mask Contact → Gown + Glove

Quality improvement models: 1. Streamlines flow to ↓ waste & inefficiency 2. Implements new process to eliminate errors or incidences

1. Lean 2. Six Sigma