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Step 2 > UW 2/NBME 12 > Flashcards

UW 2/NBME 12 Flashcards

1
Q

subareolar mass
Recently finished breast feeding
Dx?

A

galactocele
(milk retention cyst)

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2
Q

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

A

no w/d bleeding

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3
Q

wider CI = wider range of ___

A

effects on outcome

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4
Q

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.

A

Lyme disease

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5
Q

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

A

serial observation

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6
Q

Intertrigo caused by Candida will appear as pseudohyphae with

A

budding yeast forms

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7
Q

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?

A

Threatened abortions

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

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8
Q

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

A

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

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9
Q

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

A

prothrombin time

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10
Q

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

A

Folate deficiency

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11
Q

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

A

basal ganglia

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12
Q

Serotonin Syndrome: classic triad of

A

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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13
Q

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

A

Entamoeba histolytica colitis
(stool PCR/NAAT)

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14
Q

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

A

Thromboangiitis obliterans (Buerger disease)

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15
Q

AMS with Hypercalcemia & Hyponatremia
Treatment first is with

A

Normal Saline

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16
Q

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

A

prosthetic valve thrombosis
INR 2.5-3.5

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17
Q

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

A

Prosthetic → 2.5 – 3.5

Native → 2.0 – 3.0

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18
Q

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

A

Hydrocele
s/t persistent patency of Procesus Vaginalis

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19
Q

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?

A

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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20
Q

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

A

Epididymitis

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21
Q

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?

A

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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22
Q

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?

A

Varicocele
Dilation of the pampiniform vessel

MCC of scrotal enlargement

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23
Q

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

A

Torsion
Hydrocele
Varicocele
Tumor

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24
Q

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

A

hemochromatosis

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25
Q

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

A

Meningococcal – serogroup B

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26
Q

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

A

wear seat belts
:(

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27
Q

Pt with DM often have ___ incontinence s/t neurogenic bladder

  • infrequent urination
  • incomplete bladder emptying
  • weak urinary stream
A

overflow

28
Q

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

A

Selective IgA deficiency
Sxs tx only (if, any)

29
Q

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

A

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

30
Q

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

A

acute myocarditis

31
Q

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

A

1st: ↓ dose of antipsychotic
2nd: benztropine

32
Q

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

A

Power
type 2 errors

33
Q

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

A

hypothyroidism

34
Q

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

A

Lithium

35
Q

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

A

Abruptio Placentae

36
Q

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

A

cardiovascular disease

37
Q

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

A

Choanal Atresia

CHARGE association

38
Q

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

A

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

39
Q

3 serotonergic medications:

A

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

40
Q

Recently returned from a trip with Fever + Diarrhea + Pulmonary Infiltrate (decreased breath sounds, crackles)

(forget age or risk factors)
dx/tx?

A

Legionella
FQ

41
Q

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.

A

> 1: increase
<1: decreased

42
Q

List 3 SNRIs
List 4 TCAs

A

Duloxetine
Milnacipran
Venlafaxine
𑁋𑁋
Clomipramine
Imipramine
Desipramine
Nortriptyline
Amitriptyline

43
Q

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

A

Nephrogenic DI
Rhabdomyolysis → Acute Renal Failure
Obesity

44
Q

Alcoholic with hypocalcemia + tremor + Hyper-reflexia =

A

Hypomagnesemia

45
Q

pt on ventilator
pO2: 65
PEEP: 10
FiO2: 100% (1.0)
dx?

What can you do to improve survival?

A

ARDS
Hypoxemia with increased PEEP (lowest is 5) and FiO2 (low 30%) needs

Lung protective strategies → low Tidal vol + high PEEP + Prone

46
Q

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

A

8-10 boxes

R Heart MI

47
Q

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

A

YES

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

48
Q

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

A

Substituted judgment

49
Q

surrogate or physician chooses care based on best care evidence

A

Best interest standard

50
Q

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

A

if the pt can’t make decisions for themselves.

If no POA assigned: Spouse >children>parents>siblings

51
Q

Models used for Quality Improvement (2)

A

DMAIC > PDSA cycle

DMAIC =Data-driven improvement model

52
Q

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?

A

Framing bias
Anchoring bias

53
Q

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?

A

Availability bias

54
Q

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

A

Confirmation bias

55
Q

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

A

Premature closure

56
Q

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.

A

Diagnostic momentum

57
Q

___ is better than CAGE for AUD screening

A

AUDIT-C

AUD → High GGT (HY HY HY)

58
Q

Screening tools for inappropriate Rx in the elderly

A

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

59
Q

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

A

time

60
Q

2 mostly likely complications of poor transition of care (or discharging)

what can reduce the risk of complications after transition of care?

A

Readmission
Adverse drug events

↓ Cx: Arrange definitive follow up

61
Q

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

A

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)

62
Q

___ method for nurse-physician or physician-physician communication

A

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

63
Q

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

A

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

64
Q

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

A

failure mode & effects analysis
(FMEA)

65
Q

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

A

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

66
Q

PPE needed for:
Airborne
Droplet
Contact

A

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

Droplet → Gown + Glove + surgical mask

Contact → Gown + Glove

67
Q

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

A
  1. Lean
  2. Six Sigma

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