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COMLEX Level 2CE > WE3 mock SB (-6) > Flashcards

WE3 mock SB (-6) Flashcards

WE3 blocks (50-57) Missing blocks 52-57

1
Q

how do you dx obesity hypoventilation synd?

A
  • BMI > 30
  • daytime hypercapnea (paCO2 > 45)
  • no alt cause of decr RR
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2
Q

pt notes dyspnea on exertion but has clear lungs and min LE edema. what is likely NOT causing the DOE?

A

L heart failure

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3
Q

what is the timeline for delusional disorder vs paranoid personality disorder?

A

delusional disorder >=1 mos

PPD = pervasive and longterm

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4
Q

what does HELLP stand for?

A 
HELLP
   Hemolysis
   Elevated
   LFTs
   Low
   Plts
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5
Q

what causes the abd pain in HELLP?

A

liver capsule (glisson) distension 2/2 liver edema

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6
Q

what are the clinical features of HELLP synd?

A
  • n/v, RUQ pain

- pre-eclampsia

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7
Q

how does acute fatty liver of pregnancy present?

A
  • n/v, RUQ pain
  • incr LFTs
  • extrahepatic complications = incr WBC, decr BG, AKI)
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8
Q

what are the dx criteria for kawasaki dz?

A 
fever >= 5 d
>= 4 of the following
   conjunctivitis
   mucositis (strawberry tongue)
   rash (thrunk --> extremities)
   edema (extremities)
   cervical lymphadenopathy
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9
Q

how does the kawasaki rash differ from the measles and rubella rashes?

A

kawasaki: spreads trunk –> extremity
measles: spreads head –> trunk –> extremity
rubella: spreads head –> trunk –> extremity

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10
Q

how do you distinguish measles from rubella on clinical presentation?

A

measles = F + 4Cs + fine, pink, maculopap rash from face–> trunk

rubella = low F + lymphadenopathy + fine, pink, maculopap rash from face –> trunk

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11
Q

what are the 4Cs of measles?

A
  • cough
  • coryza
  • conjunctivitis
  • Koplic spots
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12
Q

how do you distinguish scarlet fever from kawasaki dz?

A

scarlet fever the rash will be concentrated over skin folds & there will be no conjunctival injection or extremity swelling

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13
Q

what is the most important pathogenic factor of metabolic syndrome?

A

insulin resistance

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14
Q

pt presents w/ metabolic synd + insulin resistance. what are they at risk for?

A
  • HTN
  • DM
  • dyslipidemia
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15
Q

what are the dx criteria of metabolic synd?

A
  1. abd obesity
  2. fasting BG >100-110
  3. BP > 130/80
  4. TG > 150
  5. HDL (< 40 M or < 50 F)
    * *must meet >=3/5 criteria
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16
Q

what are the indications for urgent ex lap?

A
  • hemodynamic instability
  • peritonitis/acute abd
  • evisceration (exposed bowel)
  • blood from NG tube or on rectal exam
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17
Q

what is the pathogenesis of PSGN?

A

immune complex deposition in the mesangium & BM s/p GAS impetigo or pharyngitis

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18
Q

what is the timeline for IgA nephropathy vs PSGN?

A

IgA nephropathy = during or w/in days of URI

PSGN = wks after GAS infx

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19
Q

what is alport synd?

A

inherited (MC = xlinked) T4 collagen defect –> glomerular dz

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20
Q

how does alport synd present?

A
  • microscopic/gross hematuria
  • sensorineural hearing loss
  • occular defects
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21
Q

how does intracranial HTN present?

A
  • HA (worse at night)
  • n/v
  • AMS
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22
Q

is ICP the same as intracranial HTN?

A

no

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23
Q

how do you decr ICP?

A
  • manitol
  • incr RR (induce hypocapnea)
  • acetazolamide
  • trendelenberg positioning
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24
Q

what is the cushing reflex?

A

HTN + low HR + AMS

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25
Q

what does + cushing reflex suggest?

A

brain stem compression

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26
Q

how does acute angle closed glaucoma typically present?

A
  • age > 60

- HA + decr vision + red eye + mydriasis + poor reactivity to light

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27
Q

what type of heart failure can constrictive pericarditis cause?

A

R heart failure

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28
Q

how does cardiac amyloidosis look on ECHO?

A
  • incr vent. wall thickness

- nL/nondilated LV cavity

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29
Q

what commonly causes non-pupil sparing CN3 palsies

A

compression 2/2 aneurysm

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30
Q

what commonly causes pupil sparing CN3 palsies?

A

microvasc ischemia (DM, HTN, incr lipids)

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31
Q

even w/ eye involvement, what will be nL in Graves dz?

A

pupils

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32
Q

pupillary constriction is controlled by ____

A

parasymp fibers of the outside of the CN3 fasicles

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33
Q

what do the diff fibers of CN3 control?

A

parasymp fibers = pupillary constriction (low P/high S = dilation)
symp fibers = motor control

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34
Q

decr sympathetic stim to the eye via CN3 will lead to what?

A
  • ptosis

- “down and out” gaze

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35
Q

which eye muscles are controlled by CN4 and CN6?

A
  • CN4 = superior oblique
  • CN6 = lateral rectus

(SO4 LR6)

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36
Q

paralysis of what muscle leads to ptosis

A

levator palpebral superioris

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37
Q

aneurysm will more likely lead to ___ compared to ___ findings?

A

parasymp (mydriasis) > symp (ptosis, down and out gaze)

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38
Q

how are the CN3 fibers organized?

A

sympathetic core w/ parasymp sheath

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39
Q

h/o recent URI + sudden onset cardiac failure in an otherwise healthy pt suggests what?

A

dilated cardiomyopathy 2/2 viral myocarditis

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40
Q

what virus “commonly” causes dilated cardiomyopathy?

A

coxsackie virus B

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41
Q

is concentric hypertrophy of the heart seen in chronic or acute setting?

A

chronic (2/2 HTN or AS)

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42
Q

is exxentric hypertrophy of the heart seen in chronic or acute setting?

A

chronic (2/2 valve regurg)

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43
Q

what are the most important pathogenic factors in development of zenker diverticulum?

A
  • upper esophageal sphincter dysf(x)

- esophageal dysmotility

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44
Q

how does parkinsonian tremor present/

A
  • resting tremor (resolves w/ movement)

- starts in 1 extremity then spreads

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45
Q

bradykinesia includes what?

A
  • festinating gate
  • diff initiating movement
  • hypomimia (masked facies)
  • hypophonia (soft voice)
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46
Q

what is a festinating gait?

A
  • broad based shuffling gait w/o arm swing

- seen in parkinson’s dz

47
Q

how does the postural instability assoc w/ parkinson’s present?

A
  • loss of balance w/ stopping/turning abruptly
  • flexed atrial posture
  • freq falls
  • loss of balance when nudged from stationary bipedal stance
48
Q

is imaging needed to dx parkinson’s?

A

no (can help to r/o other things though)

49
Q

how do granulosa cell tumors present on histo?

A

call-exner bodies

GRANdma INHibited me from CALLing my EX

50
Q

what do you need for clinical dx of parkinson dz?

A
  • resting tremor
  • rigidity
  • bradykinesia (gate, voice, face, slow to start)
  • *2/3 criteria
51
Q

how does invasive vs chronic pulm aspergillosis present on imaging?

A 
invasive = ground glass opacities (nodules + halo sign)
chronic = cavity +/- fungus ball
52
Q

apical ground glass opacities + triad (F + pleuritic CP + hemoptysis) = what?

A

invasive aspergillosis

53
Q

what metabolic abns can be caused by hypothyroidism?

A
  • hyperlipidemia
  • low Na
  • asymp incr CK
  • asymp incr LFTs
54
Q

what does erysiperlas look like?

A
  • raised, sharply demarcated
  • rapid onset
  • F (early on)
55
Q

what is the MCC of erysipelas?

A

s pyogenes

56
Q

what is erysipelas vs cellulitis?

A

CD EF
Cellulitis = infx of Deep dermis or SUBQ fat
Erysipelas = infx of superFicial dermis or lymph

57
Q

MCC of non-purulent vs purulent cellulitis = ?

A 
non-purulent = MSSA/ s pyogenes
purulent = MSSA/MRSA
58
Q

how does lead poisoning present?

A
  • neuropsych (neuropathy)
  • GI (abd pain, constipation)
  • general s/s (fatigue)
  • *also HTN, nephropathy, hyperuricemia, microcytic anemia w/ basophilic stippling
59
Q

how do you tx lead poisoning?

A

calcium disodium EDTA

60
Q

how does acute angle closure glaucoma present?

A
  • painful monocular vision loss
  • HA
  • n/v
61
Q

how does amaurosis fugax present?

A
  • painless rapid, transient, monocular vision loss

- “curtain descending”

62
Q

what is a common cause of amaurosis fugax?

A

retinal ischemia 2/2 ipsilat CAS w/ emboli

63
Q

how does optic neuritis present?

A

+ monocular vision loss

+pain w/ eye movement

64
Q

what are the MCCs of meningitis in kids?

A

age < 1mos = GBS, e coli, listeria, HSV

age >= 1mos = s pneumo, n meningitidis

65
Q

what is a nL ankle brachial index?

A

0.91 - 1.3

66
Q

what do below nL and above nL ABI measures signify?

A 
below nL (<0.91) = PAD
above nL (>1.3) = calcified/non-compressible vessels
67
Q

what is ABI?

A

SBP @ ankle / SBP @ arm

68
Q

how to manage preterm labor?

A

< 32 wks = steroid + ABX + tocolytics + Mg
32-34 wks = steroid + ABX + tocolytics
34-36 wks = steroid + ABX

69
Q

if dementia w/ lewy-bodies pt presents w/ psychosis, what do you give them?

A
  • trial of LOW POTENCY 2ng gen antipsychotic (QUETIAPINE)

- be careful. there is a chance this will make them worse

70
Q

what is the MCC of atraumatic hip pain & limp in kids?

A

transient synovitis

71
Q

what tests are used to distinguish btwn transient synovitis and septic arthritis?

A

bilat U/S + arthrocentesis

72
Q

what conditions lead to transudative pleural effusion?

A

cirrhosis, CHF, complications of peritoneal dialysis, nephrotic synd

73
Q

what conditions lead to exudative pleural effusion?

A

infx, malig, inflam dz, CABG, PE

74
Q

pt presents w/ unilat pleural effusion. what do you suspect?

A

malig

75
Q

what are LIGHTS criteria for dx exudative pleural effusion?

A
  • PF protein / s protein > 0.5
  • PF LDH / s LDH > 0.6
  • PF LDH > 2/3 ULN LDH
76
Q

what is nL pleural fluid pH?

A

pH = 7.6

77
Q

exudative pleural fluid will have what pH?

A

pH = 7.3-7.45 (inflam) or pH < 7.3 (empyema or tumor)

78
Q

transudative pleural fluid will have what pH?

A

pH = 7.4 - 7.55

79
Q

what are the tx options for uterine fibroids?

A
  • OCP

- uterine myomectomy

80
Q

what is the formal name for uterine fibroids?

A

uterine leiomyoma

81
Q

how do you manage a pregnant pt found to have HSIL on pap smear mid pregnancy?

A

+immediate colposcopy

+/- f/u w/ loop excision

82
Q

how do you manage HSIL lesions?

A
  1. immediate colposcopy
  2. immediate loop excision
    * *can skip 1 if pt is not pregnant
83
Q

how does diverticulitis present?

A
  • LLQ pain
  • n/v/d/c
  • bladder s/s or sterile pyuria
84
Q

what is sterile pyuria?

A

U/A = leuk esterase + and nitrate -

85
Q

how does the pain assoc w/ diverticulitis & SBO differ?

A 
divertic = dull, persistent LLQ pain
SBO = crampy periumbilical pain
86
Q

how do diverticulitis and SBO present differently on auscultation?

A 
divertic = nL BS
SBO = incr, tinkling BS
87
Q

what is hemi-neglect synd?

A
  • ignoring one side of a space

- L side ignored in a R handed indiv

88
Q

what causes hemi-neglect?

A

damage to the non-dominant parietal lobe

R parietal lobe in R handed person

89
Q

if a person is L handed which is there dominant lobe?

A

R lobe = dominant

90
Q

what area is responsible for spatial organization?

A

non-dominant pariental lobe

91
Q

in pts presenting w/ inf STEMI and profound HYPOtension after receiving nitrates, what underlying issue do you suspect?

A

RV MI

STEMI leads 2, 3, avF

92
Q

how should R vent STEMI be managed?

A
  • NO nitrates
  • IV NS bollus for severe HYPOtension
  • otherwise nL STEMI care
93
Q

what is SOC managment of an acute STEMI?

A
  • dual antiplatelet
  • statins
  • anticoag
  • BB
  • nitrates
  • PCI w/in 90min of arrival
94
Q

what is typically found on EKG in cardiac tamponade?

A

+/- electrical alternans

NOT 3 contig lead ST elevations

95
Q

what is the 1st test for dx & risk stratification in suspected stable ischemic heart dz?

A

stress EKG

96
Q

what are the MCC of acute bacterial rhinosinusitis?

A
  1. nontypable H influ
  2. S pneumo
  3. M catarrhalis
97
Q

infants presenting in the 1st few wks of lie w/ trismus, spasms and hypertonicity likely have what?

A

neonatal tetanus 2/2 umbilical stump infx

98
Q

how do you tx neonatal tetanus?

A

ABX + tetanus IgG

99
Q

pt presents w/ liver abscess + recent h/o dysentary and travel abroad. what should you expect?

A

amebiasis

100
Q

how do you tx amebiasis?

A
  1. metronidazole (= empirix for abscess)
  2. luminal agent (= wipe out colonization)
  3. cyst drainage if infx persists
101
Q

when do you give rabies post-exposure ppx?

A
  • animal is unavailable
  • animal is symptomatic
  • *otherwise wait and watch animal
102
Q

what is included in rabies PE Ppx?

A

rabies vaccine + rabies IgG

103
Q

what infectious dz are screened for at 1st visit (pregnancy)?

A

STD = HIV, HepB, Chlamydia, Syphillis

104
Q

when do you screen for GBS?

A

35-37 wks

105
Q

how will kids w/ psychosis present?

A
  • marked changes in f(x) across mult domains (decr social skills, decr grades)
  • psychoticc s/s
  • neg s/s (social withdrawal, lack of motivation)
106
Q

what vaccines are recommended in liver dz?

A
  • Tdap/Td Q10yr (nL)
  • influ Q1yr (nL)
  • PPSV23 x1
  • PCV13 –> PPSV23 @ age > 65
  • HAV + titers
  • HBV + titers
107
Q

BPH s/s + blood or pain w/ ejaculation. dx = ?

A

chronic prostatitis

108
Q

how do gastrinoma present?

A

dyspepsia + chronic diarrhea + wt loss

109
Q

how does H pylori infx typically present?

A
  • dyspepsia
  • post-prandial fullness
  • nausea
  • *can see PM pain 2/2 circadian acid secretion
110
Q

how does ethylene glycol poisoning present?

A
  • flank pain
  • hematuria/oliguria
  • CN palsies
  • tetany (2/2 low Ca)
111
Q

what will be seen on U/A w/ ethylene glycol poisoning?

A
  • Ca oxalate crystals

- blood

112
Q

how do you tx ethylene glycol poisoning?

A
  1. fomepizole or ethanol (to inhib EtOH dehydrogenase)
  2. NaHCO3 (to rev. acidosis)
  3. Hemodialysis (to step renal failure)
113
Q

pernicious anemia is associated w/ what 2 conditions?

A
  • MCC of vit B12 def
  • gastric adenoca
  • gastric carcinoid

COMLEX Level 2CE (23 decks)

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