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COMLEX Level 2CE > W5 mock SB (-5) > Flashcards

W5 mock SB (-5) Flashcards

W5 blocks (86-94) Missing blocks 90-94

1
Q

what is nonresponse bias?

A

a type of selection bias that occurs when study participants fail to respond to surveys/ questionnaires

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2
Q

a study called into question due to high % participants lost to f/u could have what kind of bias?

A

attrition bias (selection bias) occurs if lost pts differ significantly from the remaining participants

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3
Q

why do studies try to achieve incr f/u rates?

A

decr potential for attrition bias and thus the chance for over/underestimating the assoc btwn exposure and dz

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4
Q

what % of observations will fall w/in 1, 2, and 3 SD respectively?

A

1 SD = 68%
2 SD = 95%
3 SD = 99.7%

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5
Q

what term describes a pts chance of not truly having a dz after testing negative for the dz?

A

negative predictive value

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6
Q

what term describes a pts chance of truly having a dz after testing positive for the dz?

A

positive predictive value

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7
Q

NPV will vary w/ what and what does this mean?

A
  • will very w/ pre-test probability of a dz
  • high prob = low NPV
  • low prob = high NPV
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8
Q

what are ROC curves used to show?

A

the trade off between sensitivity and specificity @ various cutoff points

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9
Q

a test exhibits what sensitivity and what specificity if it falls on the R end of a ROC curve vs the L end?

A

R end = high sens + low spec
L end = low sens + high spec
(this is opp the charts w/ 2 overlapping bell curves)

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10
Q

what is a hazard ratio?

A

the chance of an event occurring in the tx group compared to in the control group

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11
Q

how do you interpret HR?

A

< 1 - tx has decr risk
> 1 - tx has incr risk
close to 1 = little difference in risk btwn groups

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12
Q

what is risk and how do you calculate it?

A

= the chance of getting a dz over a set period of time

R = #dz / #total @ risk

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13
Q

what measures the added risk attributable to a specific RF?

A

attributable risk % (ARP)

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14
Q

how do you calculate ARP?

A 
ARP = (RISKexp - RISKun) / RISKexp
ARP = (RR - 1) / RR
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15
Q

a urethral meatus located at the coronal margin (ventrally displaced) is characteristic of what condition?

A

hypospadias

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16
Q

in addition to ventral meatus, what other 2 s/s can be seen in hypospadias?

A
  • dorsal hooded foreskin

- chordee (curved penis)

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17
Q

what must be done once clinical dx of hypospadias has been made?

A

urology consult/eval

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18
Q

how does granuloma inguinale present?

A
  • extensive PAINLESS ulcers w/o lymphadenopathy
  • ulcer bases may have granulation tissue
  • G-neg staining Donovan bodies
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19
Q

how does 1* syphilis present?

A

+single painless papule –> nonexudative ulcer w/ indurated borders
+/- mild-mod bilat lymphadenopathy

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20
Q

which test for syphilis is commonly neg in early dz?

A

nontreponemal serology (RPR and VDRL)

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21
Q

pt presents w/ lesion suggestive of 1* syphilis but tests RPR and VDRL neg. what do you?

A

tx emperically w/ IM benzathine penicillin G

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22
Q

what pts should not receive metformin and why?

A
  • acutely ill pts w/ AKI, liver failure or sepsis

- incr risk for lactic acidosis

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23
Q

what is the BG goal in acutely ill pts?

A

140-180 mg/dL

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24
Q

what insulin management plan is recommended for acutely ill pts and why?

A
  • short acting insulin regimen

- long acting plans w/ insulin ggt –> incr risk of hypoglycemia + adverse outcomes

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25
Q

what is diabetes insipidus the leading cause of?

A

euvolemic HYPERnatremia

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26
Q

what meds commonly cause nephrogenic DI?

A
  • litium
  • demeclocycline
  • amphotericin B
  • foscarnet
  • cidofovir
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27
Q

how does nephrogenic DI present?

A
  • polyuria
  • polydipsea
  • euvolemic hyperNa
  • low u. OSM
  • incr s. OSM
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28
Q

how do you tx nephrogenic DI 2/2 lithium use?

A

Na restriction + D/C lithium

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29
Q

how can you distinguish stroke 2/2 L atrial thrombus from stoke 2/2 L atrial myxoma?

A

low F + incr ESR + wt loss = MYXOMA

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30
Q

how will myxomas present?

A
  • stroke (2/2 tumor fragment embolization)
  • middiastolic rumble + decr CO w/ SOB & syncope (2/2 mitral valve obstruc)
  • constitutional s/s = F + wt loss + incr ESR
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31
Q

what is the MC 1* cardiac neoplasm?

A

cardiac myxoma

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32
Q

what is PCWP and when will it be incr?

A
  • estimate of LV end diastolic pressure

- incr in pts w/ LV systolic and/or diastolic dysf(x)

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33
Q

incr pulmonary artery systolic pressure is diagnostic for what?

A

pulmonary HTN

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34
Q

when is incr portal venous resistance (portan HTN) seen?

A
  • hepatic cirrhosis

- extrahepatic portal vein thrombosis

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35
Q

renal bx confirms clinical dx of minimal change dz. when do you do this confirmatory test?

A

no response to steroid tx

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36
Q

when do you get a real bx in a kid?

A
  • age > 10 yo + nephrotic synd

- suspected min change dz that didn’t respond to steroid

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37
Q

how do you tx minimal change dz?

A

corticosteroids

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38
Q

what is giant cell tumor of bone?

A
  • benign, locally destructive neoplasm

- MC site = epiphysis of long bones

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39
Q

what do giant cell tumors of bone look like on xray?

A

eccentric lytic lesion = “soap bubble” lesions

40
Q

what is osteoid osteoma?

A

benign bone tumor that causes nighttime bone pain that is relieved w/ NSAIDs

41
Q

how does osteoid osteoma appear on xray?

A

sm round radiolucency

42
Q

how do giant cell tumors of bone present?

A
  • local pain, swelling, stiffness and pathologic frx

- uncommon lung mets/malig transformation

43
Q

when do you use PO ABX and/or isotretinoin for acne?

A

severe or recalcitrant acne only

44
Q

how does diaphragmatic rupture appear on CXR?

A

+elevated hemidiaphragm or migration of abd contents into the thoracic cavity
-pleural effusion (won’t see)

45
Q

how does empyema typically present and how long does it take to form?

A
  • F + pleuritic chest pain + sputum production

- unlikely to develope w/in 1 d of hospitalization

46
Q

when might you find gastric contents in the thoracic cavity despite an intact diaphragm?

A

esophageal rupture

47
Q

how do you tx inflammatory acne?

A
  1. topical retinoid + benzoyl peroxide wash
  2. add topical ABX
  3. consider PO ABX (very severe only)
48
Q

what post-void residual vol is expected in significant bladder outlet obstruc?

A

usually > 50mL

49
Q

does BPH typically cause significant proteinuria?

A

no

50
Q

pts w/ DM > 10 yr are @ incr risk of developing what?

A

diabetic microangiopathy, nephropathy and glomerulosclerosis

51
Q

what are the clinical findings of diabetic microangiopathy, nephropathy, and/or glomerulosclerosis 2/2 longterm DM?

A
  • mild/mod proteinuria

- CKD w/ incr Cr

52
Q

how does acute irritant contact dermatitis present?

A

pruritis, erythema, local edema and vesicles

53
Q

how does chronic irritant contact dermatitis present?

A

excoriations, fissuring, hyperkeratosis

54
Q

what causes molluscum contagiosum?

A

pox virus

55
Q

when should you consider HIV testing in a pt w/ molluscum contagiosum?

A

if lesions are widespread and/or involve the face

56
Q

pleural effusion is + for LIGHTs criteria. is it a transudative or exudative effusion?

A

exudative

57
Q

what are some common causes of exudative effusion?

A
  • empyema
  • chylothorax
  • malig
  • TB
58
Q

what are the distinguishing features of exudative pleural fluid 2/2 chylothorax?

A

-milky white
-incr TG
-pH < 7.45
(will meet lights criteria)

59
Q

what are the distinguishing features of exudative pleural fluid 2/2 empyema?

A

-purulent fluid
-PMN-predominance
-POS G stain/culture
-pH < 7.45
(will meet lights criteria)

60
Q

what are the distinguishing features of exudative pleural fluid 2/2 TB?

A

-acid-fast bacterium on stain/culture
-pH<7.45
(will meet lights criteria)

61
Q

when is thrombolytic tx indicated for DVT when there is no PE?

A

massive proximal DVT + significant symptomatic swelling and/or limb ischemia

62
Q

when is thrombolytic therapy typically reserved for?

A

hemodynamically unstable pts w/ PE

63
Q

what are the indications for IVC filter placement?

A
  1. anti-coag C/I (actively bleeding)

2. anti-coag failure (rpt or expanding DVT despite full anti-coagulation)

64
Q

how do you dx intra-amniotic infx (chorioamnionitis)?

A

-maternal F + >= 1 of the following:
fetal tachy for at least 10 min (HR > 160bpm)
maternal incr WBC
purulent amniotic fluid

65
Q

management of PPROM @ < 34wks is typically expectant (steroids + ABX + tocolytics). when would you deliver immediately?

A

suspect chorioamnionitis

66
Q

what i the MCC of anaphylacti transfusion rxn?

A

giving pt w/ IgA def packed RBC unit that has not been depleted of IgA

67
Q

how will anaphylactic transfusion rxn present?

A

resp distress + low BP + s/s of anaphylaxis

68
Q

how does TRALI typically present?

A

-acute hypoxemic resp distress + bilat pulm infiltrates w/in hours of receiving RBC transfusion

69
Q

how do you distinuish TRALI from transfusioni-associated circulatory overload?

A

nL BNP + NO JVD = TRALI

70
Q

which GERD pts get EGD instead of PPI trial?

A
  • alarm s/s

- men age > 50yo + >= 5yr s/s + Ca risk (tobacco use)

71
Q

what are the alarm s/s prompting EGD?

A
  • dysphagia
  • odyophagia
  • wt loss
  • anemia
  • GI bleed
  • recurrent emesis
72
Q

how does ogilvie synd. present?

A
  • severe abd distension and pain
  • vomiting
  • obstipation
73
Q

what are some common causes of ogilvie synd?

A
  • electrolyte abn (decr K, decr Mg)
  • sx
  • neuro dz
  • anti-cholinergic meds
74
Q

how does median n. entrapment @ forearm present?

A

+forearm pain

+sensory loss over entire lat palm and thenar eminence

75
Q

chronic HepC dx is a 2 step process. what are the 2 steps?

A
  1. serologic Ab test

2. confirmatory test = PCR for HepC viral RNA

76
Q

what is the pathophys of carpal tunnel synd 2/2 hypothyroidism?

A

soft tissue enlargement

mucopolysaccharides = mucinous infiltration

77
Q

how do MS s/s present?

A

episodic and affecting multiple, non-contiguous domains

78
Q

how do B-agonists (albuterol) cause intracellular K shift?

A
  1. stimulate NaKATPase and NaKCl2 cotransporter

2. stimulate incr insulin release –> K shift

79
Q

what are some causes of low K?

A
  • intracellular shift
  • GI loss
  • renal K wasting (diuretics and hyperaldosteronism)
80
Q

what is tachycardia-mediated cardiomyopathy?

A

cardiomyopathy 2/2 sustained tachyarrythmia (afib, aflutter, vtach, re-entrant tachy) + prolongued RVR

81
Q

what structural changes can you see in the setting of chronic tachy?

A

LV dilation and myocardial dysf(x)

82
Q

if prednisone use is affecting K levels what will they be?

A

decr

83
Q

bactrim can cause what met derangement 2/2 its effects on the kidney?

A

incr K

84
Q

what is Leriche synd?

A

aortoiliac occlusion

85
Q

how does Leriche synd (aortoiliac occlusion) present?

hint: classic traid

A
  1. bilat hip, thigh and buttock claudication
  2. impotence
  3. absent/diminished femoral pules (can –> symmetric LE atrophy 2/2 chronic ischemia)
86
Q

what conditions can cause ankle edema?

A
  • venous insufficiency
  • renal insufficiency
  • RHF
  • hepatic dz
87
Q

when gas is seen w/in the GB wall, what is the dx and what do you do?

A
  • emphazematous cholecystitis

- emergecy cholecystectomy

88
Q

what is recommended got acute cholecystitis but not emphazematous cholecystitis?

A

ERCP

89
Q

what are the MCCs of delirium in a hospitalized pt?

A
  • toxic metabolic etiology

- infectious etiology

90
Q

what pts are @ incr risk of developing agitated delirium in the hosp?

A

pts w/ dementia

91
Q

what are teh s/e of high dose B-2 agonists?

A
  • tremor
  • palpitations
  • HA
  • weakness, arrhythmia and EKG changes 2/2 hypokalemia
92
Q

in pre-renal AKI 2/2 sepsis + dehydration, what do you expect to see on U/A and why?

A
  • u. Na < 20 (body is retaining Na and H2O)
  • FENA <1% (body is retaining Na and H2O)
  • bland urine sediment (b/c no intrinsic damage or infx)
93
Q

what is not seen in bland urine sediment on U/A?

A

-NO casts, RBC and WBC

94
Q

how/why do nitrates relieve angina and MI pain?

A

systemic vasodilation –> decr preload and decr LVED volume –> decr wall stress –> decr O2 demand –> decr pain

95
Q

what can nitrates do to HR and how do you compensate?

A
  • cause reflex tachycardia

- coadmin w/ BB

COMLEX Level 2CE (23 decks)

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