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Step 2 > Missed questions 2 > Flashcards

Missed questions 2 Flashcards

1
Q

Steps in delivering bad news

A

SPIKES
S - set up place, privacy, introductions
P - perception “what do you think is happening?”
I - Invitation to “how much would you like to know?”
K - give knowledge and info
E - empathetic statements, explore feelings, thoughts
S - strategy for follow-up/care

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2
Q

Abdominal mass in kid

  1. NOT cross midline
  2. Crosses midline
A
  1. Wilms - WAGR, US –> CT abd and chest

2. Neuroblastoma - 1st yr of life

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3
Q

Brain mass w/ concentric whorls and psamomma bodies

A

Meningioma

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4
Q

Stealing of objects of low monetary value or NOT needed for personal use

A

Kleptomania = psychotherapy

- shame, guilt –> return or give away items

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5
Q

Tx syphilis in pregnancy

A

PCN - desensitize if needed

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6
Q

Hx UC, watery diarrhea, burning erythematous rash on arms and legs b/l, hyperpigmented like a sunburn, tender + poor concentration, irritable

A

Niacin deficiency/Pellagra

- corn based diets

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7
Q

Dysmenorrhea –> chronic pelvic pain, bleeding, globular enlarged uterus <12wks in multip women over 40 y/o

A

Adenomyosis

  • 50% have concurrent fibroids
  • get bx to exclude endometrial CA

Fibroids = more irregular shaped uterus
- more mass effect sx - constipation, urinary frequency & NOT pain

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8
Q

Infertility, dysparenunia, dysmenorrhea in younger woman

A

Endometriosis

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9
Q

Diffuse thickening of GBM and subepithelial spikes

A

Membranous

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10
Q

Cause of back pain

  1. Normal neuro, negative straight leg
  2. Radiculopathy, possible + straight leg, neuro deficit
  3. Old woman w/ fall
  4. Better w/ activity, rest NOT help
  5. Worse at night, >50, cauda equina possible
  6. IVDU or DM w/ recent infection, fever, exquisite tenderness
A
  1. Mechanical - degen, spasm
  2. Disk herniation
  3. Compression fx
  4. Ankylosing - IBD, reactive, psoriatic = apophyseal joint arthritis
  5. CA
  6. Osteomyelitis
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11
Q

Persistent nosebleeds, ruby papules on lips, clubbing, polycythemia

A

Osler-Weber-Rendu = AVMs

—> shunt blood –> hypoxemia = clubbing and polycythemia, hemoptysis

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12
Q

Newborn w/ diffuse granular CXR, air bronchograms, hypoxemia dx and cause?

A

RDS

- prematurity, DM, C/S, asphyxia

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13
Q

Excess bleeding w/ normal PT, PTT, LFTs, platelet count

Inc Cr, BUN, BT

A

Uremic coagulopathy = renal failure –> platelet dysfxn

Tx = DDAVP which inc VIII & vWF

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14
Q

1st tx step in pt in HCV

A

Liver bx to guide tx

  • severe inflammation and fibrosis –> cirrhosis BUT usually respond better to tx
  • antivirals = peg-IF + ribavirin
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15
Q

HBV & HCV progression to HCC

A 
HBV = w/o cirrhosis
HCV = w/ cirrhosis = get US q6mo
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16
Q

Smoker + clubbing and sudden onset b/l wrist pain

A

Hypertrophic osteoarthropathy

—> CXR for lung CA, TB etc…

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17
Q

Young male w/ pain over heel, iliac crests, tibial tuberosities, shoulder pain stiffness

A

Enthesititis - inflammation where tendon meets bone = ankylosing spondylitis
- Assoc w/ limited spine mobility

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18
Q

Steps in tx of acne

A

Topical retinoids + benzoyl/salicyclic acids

Topical Erythromycin or Clinda

Oral Abx

Oral isotretinoin

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19
Q

Heat stroke vs. Heat exhaustion

A

Stroke = >104, AMS
Exertional –> ICE WATER IMMERSION
Non-exertional –> evaporative cooling

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20
Q

Re-warm cold extremity

A

Warm water

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21
Q

SB resection, TPN, alopecia, no taste, pustular lesions around mouth

A

Zinc deficiency

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22
Q

HTN + hypoK 1st step

A

Measure renin & aldosterone

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23
Q

Dec renin, inc aldo w/ A:R >20 cause, Aldo >15

A

Primary hyperaldosteronism –> adrenal CT

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24
Q

Inc in both renin and aldo w/ A:R ~10

A

Secondary hypseraldosteronism

- diuretic, CHF, renin tumor, coarctation, malignant htn or renovascular htn

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25
Q

HIV pt CD4 <50 w/ yellow-white eye opacities and retinal hemorrhage

A

CMV

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26
Q

HIV pt w/ necrotizing retinitis, white fluffy lesions around retina

A

Toxo

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27
Q

Types of abortion

  1. Bleeding, closed cervix, no heart tones
  2. Cramping, bleeding, open cervix, possible heart tones
  3. Cramping, bleeding, products visualized, open cervix
  4. Bleeding, closed cervix, + heart tones
A
  1. Missed –> Pelvic US –> C&D
  2. Inevitable
  3. Incomplete
  4. Threatened
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28
Q

PAS+ and diastase resistant hepatocyte inclusions

A

alpha-1-antitrypsin

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29
Q

Brief LOC + lip smacking, swallowing, picking + post-ictal confusion, normal EEG

A

Complex partial seizure

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30
Q

EEG 3Hz spike and wave

A

Absence

  • may have automatisms like lip smacking but DONT have post-ictal confusion
  • Atypical is <2.5Hz
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31
Q

Kids, U/L or B/L jerking in the AM

A

Juvenile myoclonic epilepsy - sleep deprivation

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32
Q

EEG slow spike and wave

A

Lennox-Gaustat

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33
Q

Vit D, Ca, Phos, PTH finding in pts with celiac or other intestinal malabsoprtion syndrome

A

Low Vit D d/t malabs –> Low Ca, Phos abs

High PTH

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34
Q

EPS Sx & Tx

  1. Acute neck, mouth, tongue, eye contractions
  2. Restlessness
  3. Tremor, rigidity, bradykinesia, masked face
A
  1. Acute dystonic rxn = benztropine, diphenhydramine
  2. Akasthisia = propanolol
  3. Parkinsonism = anticholinergic or amantadine
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35
Q

Complication in bronchiectasis

A

Hemoptysis

- massive may require bronchial a. embolization

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36
Q

Excessive anxiety over one or more unexplained sx & willing to undergo invasive testing

A

Somatic sx disorder

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37
Q

Fear of having a serious illness despite negative testing and no actual sx

A

Illness anxiety disorder (hypocondriasis)

38
Q

Stress w/ neurologic sx not consistent with any known neurologic disease, person may be indifferent

A

Conversion disorder (functional neurologic sx disorder)

39
Q

Young woman, ovulation induction, hx ovarian cyst w/ sudden R sided pelvic pain, adnexal tenderness, (-) hcg

A

Adnexal torsion –> doppler US –> emergency laparoscopic surgery

40
Q

Type of study w/ 2+ experimental interventions (ACE, BBs) each w/ 2+ variables studied independently (high BP, low BP)

A

Factorial design

41
Q

Type of study where 2 groups try one tx and then switch

A

Cross-over

42
Q

Dec in Non-ionoized/albumin-bound/inactive Ca for every 1g/dL dec in serum albumin

A

0.8mg/dL

43
Q

Hyperreflexia on L, L hemiparesis, eyes deviated to R lesion

A

Right cerebral lobe

Basal ganglia eyes point toward hemiparesis

44
Q

1+ proteinuria, RBCs and RBC casts, normal complement levels, recent URI, #1 GN in adults

A

IgA nephropathy

45
Q

Eosinophiliuria, WBC casts

A

Drug-induced interstitial nephritis

46
Q

Acid-base findings in aspirin toxicity (tinnitus, fever, tachypnea, N/V)

A

Mixed resp alkalosis and metabolic acidosis
pH 7.36
PCO2 22
HCO3- 12

47
Q

CA, PA or UT construction site w/ baby floppy, sluggish, drooling, ptosis, weak suck and gag reflex

A

C. botulinum SPORE ingestion for enviro —> human derived Ig

Toxin in honey —> equine derived Ig

48
Q

Tx for acute thoracic aortic dissections

A

Labetalol

Ascending (type A) = surgery + medical
Descending (type B) = medical alone

49
Q

ARDS pt on vent w/ PEEP 15, FiO2 0.6 –> tachy, SBP 90, inc CVP, absent breath sounds

A

Tension pneumothorax d/t excessive PEP

50
Q

AIDS, chemo pt w/ exophytic purple skin masses w/ a collarette of scale on lower abd + several liver masses + bx —> severe hemorrhage

A

Bartonella - Bacillary angiomatosis

51
Q

Microcytic anemia with normal RDW

A

B-thal

  • microcytosis <75
  • target and tear-drop cells

(Fe has inc RDW)

52
Q

Child fatigued and pallor, recent diarrhea tx w/ medication, purpura and petechiae, low platelets, RF, schistiocytes, giant platelets, inc LDH, indirect bili, retic count, urine w/ RBCs, WBCs, casts

A

HUS = microangiopathic hemolytic anemia

53
Q

SOB, cough, DOE, dec breath sounds, bibasilar crackles occasional wheezes

CHF vs. COPD

A

CHF - resp alkalosis, hypocapnia, hypoxia

COPD - widespread wheezes + resp ACIDOSIS, hypoxia

54
Q

Kid w/ Giardia and recurrent sinopulmonary infections since 6mo

A

abn B-lymphocyte maturation

Lack of IgA = Giardia

55
Q

Kids w/ staph, aspergillius infections

A

CGD - NADPH oxidase

56
Q

Electrolyte abn in SAH or intracranial hemorrhage

A

HypoNa - SIADH-like syndrome, resolves in 1-2wks

57
Q

Complication of nephrotic syndrome, 4+ proteinuria, edema, fatty casts

A

Hypercoagulability (renal vein thrombosis)

  • loss of AT-III, protein C, S
  • inc fibrin, platelet aggregation

Iron deficiency d/t ferritin loss
Vit D deficiency
Dec TBG
Inc infections

58
Q

Hepatitis, etOH, Wilson disease w/ inc PT/INR >1.5, inc bili, inc AST, ALT 10x normal –> dec AST ALT + WORSENING PT/INR

A

Acute liver failure

- PT = #1 prognosticator in ALF

59
Q

Stabbing in R face, ataxia falling to R, miosis, ptosis on R, dec gag reflex, hoarsness, loss of pain and temp on R face + LEFT trunk/limbs

A

Lateral Medullary syndrome

- PICA

60
Q

Weakness of mastication, impaired sensation over face, impaired jaw reflex

A

Lateral Mid-Pons

61
Q

CL arm and leg hemiparesis, tactile and position sense, IL tongue deviation

A

Medial medullary syndrome

62
Q

CL ataxia of trunk and limbs and face

A

Medial pons

63
Q

Drugs post UA/NSTEMI or PCI

A 
Aspirin
BBs
ACE
Statin
Clopidogrel - 30d or 1yr w/ drug stent

LMWH 48hrs/prior to PCI in acute MI

64
Q

Villous atrophy

A

Celiac

- IgA deficiency –> (-) endomysial or tissue transglutaminase ab

65
Q

NST score tx

  1. Oligohydramnios
  2. 8
  3. 6
  4. 4
  5. <4
A
  1. deliver
  2. Normal = repeat in 1 wk
  3. Contraction stress test –> delivery or repeat next day
  4. Lung mature = deliver; Steroids and repeat next day
  5. Deliver
66
Q

Enuresis tx

A 
1st = avoid fluids late, gold stars...
2nd = alarm
3rd = Oral Desmopressin
67
Q

C-D systolic murmur on LSB w/o radiation

A

HOCM = IV septum hypertrophy

68
Q

Defect in tubular HCO3 reabsoprtion

A

RTA-II

- acetazolamide or Fanconi anemia

69
Q

Low tubular ammonium

A

RTA I

- can’t excrete H+ –> no ammonium

70
Q

ASA + nasal blockage + bronchoconstriction

A

ASA sensitivity syndrome (pseudo-allergy) –> inc LTs

–> tx w/ LT-inhibitors

71
Q

Chronic NSAIDs w/ worsening renal function mech

A

Papillary necrosis & TUBULOINTERSTITIAL nephritis

72
Q

RA tx and tests to run before tx

A

1 = MTX - HBV, HCV, TB

> 6mo of symptoms w/ MTX –> TNF-a or possibly hydroxychloroquine or sulfasalazine

73
Q

Angiogram, stent + blue toes, livedo reticularis + ARF + eosinophils but low complement

A

Cholesterol emboli

74
Q

1st step in NEC

A

Abx to prevent sepsis

75
Q

Endocarditis valve abn

A

Mitral REGURG or MVP

76
Q

Adolescent cough to vomit dx and tx

A

Pertussis
Nasopharyngeal culture
Azitho or clarithromycin

77
Q

Smoker, post-prandial pain, FOBT (+) –> adenocarcinoma next step?

A

CT scan

78
Q

Amenorrhea, normal exam, obesity, normal TSH, prolactin, LH, FSH

A

Anovulation d/t obesity, no progesterone = no bleed

79
Q

B/L carpal tunnel 1st step

A

TSH for hypothyroidism

80
Q

Most likely polyp to be cancerous

A

VILLOUS > tubulovillous > tubular adenoma

hyperplastic = non-neoplastic
Hamartomatous = juvenile or peutz-jager
81
Q

HTN <20wks, edema

A

?Mole

Normal US = chronic HTN

82
Q

Tx Hepatic Encephalopathy

A

K+ repletion (hypo –> inc ammonium production)
Lactulose
Rifaximin (if lactulose no work)
Protein + diets

83
Q

HTN urgency

HTN emergency

A

Urgency - >180/120 w/o end organ damage

Emergency

  • Malignant HTN w/ papilledema or retinal hemorrhage
  • HTN ecephalopathy w/ neurologic signs
84
Q

Dx & Tx of Histoplasmosis

A

Dx = urine ag

Tx = Itraconazole or amphotericin B if >103.1

85
Q

Parkinsonism, postural hypotension, impotence, dry mouth/skin, neuro signs

A

Multiple system atrophy

86
Q

Blurred vision now vision loss in 1 eye, subclavicular bruit, HA, high ESR, blurred swollen optic disc

A

Giant cell arteritis –> high-dose steroids

87
Q

Cough, non-caseating granuloma, peratracheal adenopathy

A

Sarcoid = steroids

88
Q

Low O2 mech in PNA

A

V/Q mismatch or shunt

Alveoli filled w/ debris = no O2

89
Q

Periodic sharp waves on EEG

A

Crutzfeld-Jacob

90
Q

Retrosternal pain radiating to back w/ stress and hot or cold food, relieved w/ nitro

A

Esophageal dysmotility

91
Q

Infant w/ dec activity, dec feeding, unable to wake for feedings you should suspect

A

Sepsis

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