UW 2/NBME 12 Flashcards
subareolar mass
Recently finished breast feeding
Dx?
galactocele
(milk retention cyst)
functional hypothalamic amenorrhea (FHA)
↓ FSH
Results of progesterone challenge test?
no w/d bleeding
wider CI = wider range of ___
effects on outcome
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
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
Intertrigo caused by Candida will appear as pseudohyphae with
budding yeast forms
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)
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.
Acute liver failure is characterized by the triad of
elevated aminotransferases,
hepatic encephalopathy,
and prolonged ____
in a patient without underlying liver disease
prothrombin time
Myelomeningocele (spina bifida), the most common type of neural tube defect (NTD) s/t ____.
Folate deficiency
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
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).
Pt who recently traveled to Philippines presents with 3 weeks of bloody-mucoid diarrhea and abdominal pain.
Dx?
Entamoeba histolytica colitis
(stool PCR/NAAT)
Age <45
Ongoing or recent smoking history
Distal limb ischemia, gangrene, ulceration due to nonatherosclerotic occlusion, thrombosis
dx?
Thromboangiitis obliterans (Buerger disease)
AMS with Hypercalcemia & Hyponatremia
Treatment first is with
Normal Saline
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
Warfarin INR goal for:
*Prosthetic valves
*Native valve dysfunction
Prosthetic → 2.5 – 3.5
Native → 2.0 – 3.0
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
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
Painful swelling ± induration of testes
± urethral discharge
Positive Prehn sign (testes elevation alleviates pain)
dx?
Epididymitis
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)
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
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
Presents with liver failure, diabetes, arthritis, hyperpigmentation, heart failure ± gonadal atrophy
typically diagnosed in men > 40 yo
hemochromatosis
____ 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
- Lean
- Six Sigma
