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COMLEX Level 2CE > WE4 mock SB (-4) > Flashcards

WE4 mock SB (-4) Flashcards

WE4 blocks (70-74, F1-4) Missing blocks 70-74, F1(half)

1
Q

why does met acidosis occur in the setting of sepsis?

A

decr O2 to tissues –> incr anaerobic metab –> incr LA –> met acidosis

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2
Q

RTA type leads to what type of met acidosis?

A

non-anion gap met acidosis

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3
Q

what s/s of lactic acidosis 2/2 sepsis will you not see in RTA type 2?

A
  • fever
  • low BP
  • incr HR
  • crackles
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4
Q

new onset CHF (DOE + paroxysmal nocturnal dysp + pulm edema + LE edema) after URI. what is the likely dx = ?

A

dilated cardiomyopathy 2/2 myocarditis

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5
Q

young age + acute HF + CP + arrhythmia. dx = ?

A

HF 2/2 myocarditis

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6
Q

what virus commonly causes myocarditis in developed nations?

A

coxsackie B

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7
Q

which is more common pancreatic or GB ca?

A

pancreatic Ca

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8
Q

which is more likely to present w/ jaundice, pancreatic ca or GB ca?

A

pancreatic Ca

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9
Q

pt presents w/ jaundice + wt loss + vague abd discomfort + incr ALP. suspected dx = ?

A

pancreatic Ca

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10
Q

what labs suggest cholestatic cause of jaundice?

A

incr ALP + incr bili

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11
Q

how does Fe OD present?

A
  • abd pain
  • dark green diarrhea
  • hematemesis
  • shock
  • liver necrosis
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12
Q

what diagnostic findings are expected w/ Fe OD?

A
  • anion gap met acidosis
  • incr s Fe
  • radiopaque pills on xray
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13
Q

why are stools/emesis green/black in Fe OD?

A

Fe tablet disintegration

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14
Q

what sequela may be seen several weeks after Fe OD?

A

SBO 2/2 GI scarring

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15
Q

how does acetominophen OD present?

A
  • n/v

- hepatotoxicity

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16
Q

what GI s/s are uncommon in acetominophen OD?

A

GI bleeding

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17
Q

what GI s/s is expected w/ TCA OD?

A

GI dysmotility

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18
Q

pt presents w/ back pain + subacute illness w/ intermittent F + xray showing pulm (cavitary lesion) and bone (vertebral collapse) involvement. dx = ?

A

systemic TB

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19
Q

what immunosuppressed states incr the risk for latent TB reactivation?

A
  • CKD
  • DM
  • HIV
  • hematologic malig
  • chronic immunosuppression med use
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20
Q

how does skeletal TB present?

A
  • spondylitis (back pain +/-vertebral collapse on xray)
  • arthritis
  • osteomyelitis
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21
Q

how do you distinguish mult myeloma from subacute disseminated TB infx?

A

mult myeloma won’t have subacute F or pulm infiltrates

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22
Q

what types of injury generally cause medial menisal tear vs MCL tear?

A
  • medial meniscal tear 2/2 twisting during strenuous activity or on uneven ground
  • MCL tear 2/2 blow to the lateral knee
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23
Q

how does meniscal tear present?

A
  • joint line tenderness
  • slow onset effusion
  • sensation of instability
  • locking/catching w/ rot and ext while under load
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24
Q

how do ACL tears typically present?

A

rapid onset hemarthrosis w/in min –> hrs of injury

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25
Q

how do you distinguish CML from CLL using labs?

A 
CML = incr WBC w/ incr PMNs
CLL = incr WBC w/ incr lymphocytes
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26
Q

what is the 1st line CML tx targeted @?

A

BCR-ABL tyrosine kinase (imatinib)

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27
Q

what is the 1st line CLL tx targeted @?

A

CD20 antigen (rituximab)

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28
Q

what kind of hyponatremia does SIADH cause?

A

euvolemic

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29
Q

what are the causes of hypovolemic hypoNa?

A
  • extrarenal = v/d, burns, pancreatitis
  • renal = diuretics, mineralocorticoid def
  • decr circ vol = CHF, cirrhosis
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30
Q

what are the MCCs of sepsis in sickle cell pts?

A
  1. s pneumo

2. H influ type B

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31
Q

what is the MCC of PNA in sickle cell pts?

A

s pneumo

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32
Q

what are the MCCs of osteomyelitis in sickle cell pts?

A
  • s aureus

- salmonella

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33
Q

what is the MCC of meningitis in sickle cell pts?

A

s pneumo

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34
Q

what conditions require infective endocarditis ppx?

A

high risk conditions =

  • prosthetic heart valves
  • prev infective endocarditis
  • structural abn in heart transplant
  • congenital cyanotic heart defect (unrepaired + residual defect)
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35
Q

what procedures warrant infective endocarditis ppx in high risk pts?

A
  • gingival manipulation
  • resp tract incision
  • GI/GU procedure (active infx only)
  • sx of infected skin/muscle
  • placement of prosthetic cardiac material
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36
Q

infective endocarditis ppx is not recommended for pts w/ what conditions?

A
  • MVP
  • acquired valvular defects (RHDz)
  • low risk cong heart dz (bicuspid aortic valve, ASD)
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37
Q

is infective endocarditis ppx recommended for dental procedures in MVP pts?

A

no

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38
Q

increasing the cutoff value for a dx test will do what to sensitivity and specificity?

A 
decr sensitivity (incr FN
incr specificity (decr FP)
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39
Q

how does acute dystonia present?

A

sudden sustained contraction of the neck, mouth, tongue, and eyes

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40
Q

how does akathisia present?

A
  • restlessness

- inability to sit still

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41
Q

how does parkinsonism present?

A

-gradual onset resting tremor, rigidity, and bradykinesia (gait, speech, slow start)

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42
Q

how does tardive dyskinesia present?

A
  • gradual onset (after > 6mos use)

- dyskinesia of mouth, face, trunk and extremities

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43
Q

how do you tx tardive dyskinesia?

A
  • valbenazine

- deutetrabenazine

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44
Q

how would valvular regurg be depicted on doppler flow tracings?

A

pressure tracing on opp side of line as nL (b/c flow is retrograde)

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45
Q

how would vavular stenosis be depicted on doppler flow tracing?

A

pressure tracing would look exaggerated (b/c flow is nL direction but more forceful)

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46
Q

how might atyp acute cholecystitis pain present?

A

mid-epigastric w/ radiation to the back

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47
Q

F and WBC are not commonly seen in peptic ulcer dz unless what?

A

perforation has occured

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48
Q

how does peptic ulcer perforation present?

A
  • decr BP + peritoneal signs
  • F + incr WBC
  • dyspepsia
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49
Q

what is a common comp of humeral midshaft frx?

A

radial n. injury

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50
Q

how would radial n. injury 2/2 humeral frx present?

A
  • weak wrist and finger extension

- dorsum of hand decreased sensation

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51
Q

what type of humeral frx can lead to medial n. injury?

A

suprachondylar frx

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52
Q

what tx can be done to relieve s/s of CBD obstruction 2/2 advanced pancreatic adenoCa?

A

endoscopic CBD stent placement

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53
Q

pruritis 2/2 ___ can be improved w/ ursodeoxycholic acid?

A

intrahepatic cholestasis

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54
Q

which 2 types of meds can be used to control HR in afib?

A
  • BB

- nondihydrapyrimadine CCB (diltiazem and verapamil)

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55
Q

which 2 components are needed to form clots?

A
  • fibrin

- platelets

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56
Q

which is the more important component of venous clot formation?

A

fibrin

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57
Q

which is the more important component of arterial clot formation?

A

platelets

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58
Q

when do you choose antiplatelet over anticoag therapy?

A

to prevent clots 2/2 endothelial damage (e.g. MI)

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59
Q

when do you choose anticoag over antiplatelet therapy?

A

to prevent clots 2/2 statis (DVT)

60
Q

what are the 2 types of anti-thrombotic?

A
  • antiplatelets

- anticoagulants

61
Q

what drugs are anti-platelets?

A
  1. ASA

2. P2Y12 inhib (clopidogrel, prasugrel, ticagrelor)

62
Q

what drugs are considered anti-coagulants?

A
  • heparin/LMWH
  • warfarin
  • factor 10a inhib
63
Q

when do you give antiplatelet vs anticoag for afib?

A

CHADS2VASC 0 = ASA
CHADS2VASC 1 = ASA or anticoag
CHADS2VASC 2+ = anticoag

64
Q

renal insuf 2/2 glomerular injury will likely present w. what?

A

protenuria and/or hematuria

65
Q

how does mult. myeloma lead to decr renal f(x)?

A

causes renal tubular damage

66
Q

unstable trinucleotide (CGG) rept on FMR1 gene (x chromosome) is diagnostic for what?

A

fragile x synd

67
Q

how does fragile x synd present?

A
  • delayed milestones
  • features of autism
  • intellectual disability
  • long face
  • big testes
68
Q

when hould sodt restraints be used?

A

as a last resort for delirious pts whose safety is in jeapordy

69
Q

what do decr CO + incr RA pressure + incr RV pressure + incr pulm artery pressure + nL PCWP suggest?

A

PE (incr resistance before lungs but what makes it back to heart is nL)

70
Q

what is a comp of thoracentesis that manifests as rapid re-accumulation of effusion + SOB + hemodynamic instability?

A

hemothorax

71
Q

w/ hemothorax what change will be seen @ the heart?

A

decr LV preload

72
Q

how does hypothyroid myopathy typically present?

A

= painful

73
Q

how does cushing synd present?

A
  • central obesity
  • proximal m. weakness
  • HTN
  • abn bleeding
  • purple striae
  • glucose intolerance
  • depression/anxiety
74
Q

what is the 1* mechanism by which nitrates relieve ischemic chest pain?

A

venodilation

75
Q

what is the classic triad for spinal epidural abscess?

A
  1. F
  2. back pain
  3. neuro s/s
76
Q

what will glucocorticoids do if given to pt w/ spinal epidural abscess?

A

worsen the infx

77
Q

what are the MCC pharyngitis in kids?

A

viruses

78
Q

child presents w/ pharyngitis + vesicles on uvula/soft palate/tonsillar pillars (i.e. vesicular pharyngitis). dx = ?

A

herpangina

79
Q

what causes herpangina?

A

coxsackie A = MC

80
Q

how do you tx herpangina?

A
  • reassurance + supportive care

- will resolve w/in 1 week

81
Q

if decr BP leads to decr SVR, will cardiac index be incr/decr/nL?

A

incr (to compensate)

82
Q

in septic shock, will PCWP be incr/decr/nL?

A

decr/nL depending on the extent of preload reduction (2/2 low BP)

83
Q

incr cardiac index + decr SVR + incr PCWP + decr mixed v O2. likely dx = ?

A

high output heart failure

84
Q

what 2 findings can be seen on p/e of high output HF?

A
  • bounding pulses

- systolic bruit

85
Q

granulomatosis w/ polyangiitis (wegners) presents w/ rapidly progressive GN + lung nodules/cavitation + what URI and what skin manifestations?

A
  • URI = sinusitis/otitis, saddle-nose

- skin = livedo reticularis, non-healing ulcers

86
Q

pts w/ new onset psychosis and depression should have what lab checked especially if physical s/s are also present?

A

TSH level

87
Q

what is the pathophysiologic process that leads to DKA?

A

decr insulin –> incr catacholamines–> incr lipolysis of peripheral fat stores –> fatty acid break down to ketones in the liver

88
Q

when/why do you see incr real excretion of ketoacids in DKA pt?

A

during tx (this is the result of IVF admin)

89
Q

when do you transition from insulin gtt + K to subQ insulin during treatment of a DKA pt?

A

when the anion gap closes and metabolic acidosis resolves

90
Q

pregnant pt presents highly susp for PE but V/Q perfusion scan result = low probability PE. what do you do?

A

extra testing = CTA +/- LE dopplers

91
Q

what is the only V/Q scan result that can r/o PE if there is high clinical suspicion?

A

nL V/Q scan

92
Q

what is efavirenz?

A

non-nucleoside RT inhibitor

93
Q

what are some early s/e of efavirenz therapy?

A

neuropsych s/s (insomnia w/ vivid dreams, depression, and anxiety)

94
Q

what are the tx for urge incontinence?

A
  • lifestyle mods
  • bladder training
  • antimuscarinics (oxybutinin)
95
Q

what are alpha-adrenergic antag used to tx?

A

bladder outlet obstruction 2/2 BPH

96
Q

what is the 1st line tx for urge incontinence?

hint: think non-pharm tx

A

bladder training

97
Q

what is fetal fibronectin used to detect?

A

incr risk of pre-term delivery (if incr @ 24-34 wks)

98
Q

what is the kleihauer-betke test used for?

A
  • tests for fetomaternal hemorrhage 2/2 placental abruption or abd trauma
  • used to determine Rhogam dosing
99
Q

what is the w/u for painless vaginal bleeding during pregnancy?

A
  1. FHT (r/o vasa previa)

2. transABD U/S (locate placenta)

100
Q

pt presents w/ recent h/o blunt chest trauma + tachy + hemodynamic STABILITY. CXR shows mediastinal widening. what do you do?

A

chest CTA (to help w/ surgical planning)

101
Q

resp depression 2/2 opiod OD involves decr RR and what change in tidal volume?

A

decr

102
Q

coadmin of triptan w/ erot derivative or 2nd dose triptan can lead to what complication and why?

A

prolongued vasospasm –> high serotonin receptor activation –> severe HTN –> MI or stroke

103
Q

how do cataracts present?

A
  • painless blurring vision
  • glare
  • halos around lights
  • decr distance vision (myopic shift)
  • opacification
104
Q

how do cataracts look on physical exam?

A
  • decr red reflex

- decr retinal detail

105
Q

what is reactive (2*) thrombocytosis?

A

incr plts 2/2 incr cytokines 2/2 inflamm state (infx, sx, malig)

106
Q

how does essential (1*) thrombocytosis typically present?

A

persistent incr plt

>600k + thombosis + hemorrhage

107
Q

pt presents w/ mild thrombocytopenia w/ h/o abd sx 2/2 blunt abd trauma. dx = ?

A

2* (reactive) thrombocytosis likely 2/2 splenectomy

108
Q

striate palmar xanthomas (yellow streaks on palms) are a classic finding in what dz?

A

severely high TG 2/2 familial dysbetalipoproteinemia

109
Q

ETOH use + incr TG leads to incr risk of what?

A

pancreatitis

110
Q

milky opalescent blood samples are/suggest what?

A
  • grossly lipemic serum samples

- suggest severe hyperTG

111
Q

child age < 2 yo presents w/ 3-5d high fever followed by a blanching pink/red maculopapular rash. dx = ?

A

roseola infantum

112
Q

what causes roseola infantum?

A

HHV-6

113
Q

what does coxsackie A normally cause?

A
  • hand foot and mouth dz

- herpangina

114
Q

when doe the fever occur that’s related to coxsackie A infx?

A

w/ the rash

115
Q

OCPs decrease the risk of what 2 Ca?

A
  • endometrial

- ovarian

116
Q

long term OCP use has been shown to slightly incr the risk for what 2 Ca?

A
  • cervical

- breast

117
Q

pt presents w/ h/o afib + sotalol use. what arrhythmia is likely causing the pt to experience sudden syncopal events?

A

torsades de pointes (i.e. polymorphic ventricular tachycardia)

118
Q

pts w/ multiple sclerosis freq develop what eye condition?

A

optic neuritis

119
Q

what is the uhthoff phenom?

A

exacerbation of MS (or other demylinating neuro cond.) s/s 2/2 heat exposure

120
Q

when is cholestasis expected in a pt on TPN?

A

w/ TPN use > 2wks

121
Q

what serious comp of TPN use is seen early on (1st week)?

A

bloodstream infx

122
Q

immunocomp pt presents w/ F + rapidly progressive skin lesion that develops into nontender nodule w/ necrotic center. dx = ?

A

ecthyma gangrenosum

123
Q

what is ecthyma gangrenosum assoc w/?

A

pseudomonas bacteremia

124
Q

pt presents w/ thready pulses that disappear w/ deep inspiration. what is this called?

A

pulsus paradoxus

125
Q

pt presents w/ chest discomfort + weakness and dizziness (low CO) + pulsus paradoxus + h/o recent viral illness. Ddx = ?

A
  • cardiac tamponade

- large pericardial effusion

126
Q

how does CMV encephalitis present clinically?

A
  • F + HA + seizures + AMS + stupor

- imaging shows frontotemporal abn

127
Q

what PFT results suggest restrictive lung dz?

A
  • decr TLC + decr FVC + decr FEV1

- nL FEV1 / FVC ratio

128
Q

what PFT results suggest obstructive lung dz?

A
  • incr TLC + nL FVC + decr FEV1

- decr FEV1 / FVC ratio

129
Q

PFT alue < X% = decr. what is x?

A

80%

130
Q

bibasillar, fine, “velcro-like” crackles +/- digital clubbing suggest what dx?

A

pulm fibrosis

131
Q

pt presents w/ cushings s/s + lung mass. what is the likely cause?

A

paraneoplastic synd (incr ACTH) assoc w/ small cell lung Ca

132
Q

ACTH is what kind of molecule?

A

polypeptide hormone

133
Q

if cortisol is being overproduced by the adrenal glands in 1* cushing, what symp won’t you see and why?

A
  • hyperpigmentation

- high cortisol feeds back to inhib ACTH release

134
Q

what rate of cervical change is expected during active labor (>= 6-10 cm dilation)?

A

> = 1 cm/ 2hrs

135
Q

how do you manage protracted active labor (< 1 cm/2 hr cervical change) if CTX are weak?

A

admin oxytocin

136
Q

what meds should afib pt w/ CHADS2VASC >= 2 receive?

A

anti-coag

137
Q

what does CHADS2-VASC stand for?

A 
CHADS2-VASC
   CHF               +1
   HTN               +1
   Age >=75      +2
   DM                +1
   Stroke/TIA    +2
   Vasc dz         +1
   Age 65-74    +1
   Sc sex = F     +1
138
Q

how does pleural fluid look in TB infx?

A
  • exudative (pH < 7.45, meets lights criteria)
  • protein > 4 g/dL
  • WBC incr lymphocyte predom
  • glucose < 60 mg/dL
139
Q

superior vena cava synd is a potential complication of what malignancy?

A

lung Ca and lymphoma

140
Q

how does superior vena cava synd present?

A
  • HA
  • facial edema
  • incr JVP w/o peripheral edema
141
Q

what is the 1st line tx for superior vena cava synd?

A

radiation

142
Q

how do you prevent asp pneumonia?

A
  • diet mod if pt has dysphagia

- raise the head of the bed to 30-45*

143
Q

do NG tubes incr/decr risk of asp PNA?

A

incr risk

144
Q

how do brain mets lesions look on imaging?

A

well circumscribed enhancing lesions surrounded by vasogenic edema @ white-grey matter junctions

145
Q

how do gliomas present on MRI?

A

enhancing solitary lesions w/ irreg borders

146
Q

what are gliomas?

A

tumors arising from glial cell proliferation

147
Q

what is the MC 1* CNS tumor in adults?

A

glioma

COMLEX Level 2CE (23 decks)

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