COMLEX 2 Review Deck Flashcards
(102 cards)
1
Q
Posterior hip dislocations most often occur when a patient…
A
Bends over to pick something up off the floor
-Patients usually have a history of total hip replacement, which increases the risk.
2
Q
Aortic dissection presents with:
A
SBP difference >20 mmHg
CXR findings of pleural effusion and slightly widened mediastinum
3
Q
When aortic dissection is suspected, the gold standard for diagnosis is:
A
CT angiography
4
Q
Primary CNS lymphoma can occur in AIDS patients when the CD4 count is:
A
< 50 cells/mcL
5
Q
Primary CNS lymphoma is associated with…
A
EBV - CSF with be + for EBV
6
Q
Multiple masses on MRI in a patient with HIV and CD4 count <200 is indicative of:
A
Toxoplasmosis
7
Q
Ompahlocele, or protrusion of abdominal contents at the midline which are covered in a membrane, is associated with:
A
Beckwith-Wiedemann syndrome, trisomy 13 (Patau), and trisomy 18 (Edwards) (chromosomal abnormalities)
8
Q
Beckwith-Wiedemann syndrome is
A
An overgrowth disorder (macrosomia, macroglossia) characterized by an increased incidence of childhood cancers (esp. Wilms tumor) and congenital abnormalities (omphalocele)
9
Q
Gastroschisis [is/is not] associated with chromosomal abnormalities.
A
Is NOT - no peritoneum will cover the abdominal contents
10
Q
Congenital umbilical hernia is associated with:
A
Congenital hypothyroidism
Trisomy 21
11
Q
Tyrosine kinase inhibitors (dasatinib and imatinib) are first line treatment for
A
CML
12
Q
Chronic myeloid leukemia will appear as … on blood smear and CBC with differential.
A
Leukocytosis, thrombocytopenia, and myelogenous proliferation (increased basophils and neutrophils)
13
Q
The abnormal gene and gene product found in CML is:
A
Gene: Philadelphia chromosome
Gene Product: BCR-ABL1 tyrosine kinase
14
Q
Hyperkalemia presents with:
A
Skeletal muscle weakness and arrhythmia
15
Q
Medications that can cause hyperkalemia include:
A
ACEI/ARBs, NSAIDs, and Bactrim
16
Q
Patients with Wilson disease (copper accumulation) will present with:
A
Liver abnormalities - jaundice, elevated LFTs, ascites, enlarged liver
Neurologic symptoms - tremors, dystonia, abnormal gait
17
Q
Treatment of Wilson disease, copper toxicity, is…
A
Penicillamine
18
Q
Innominate rotation occurs around the ___ axis.
A
Inferior transverse axis (S4 level): responsible for innominate motion
(Inferior = Innominate)
19
Q
Respiratory and craniosacral rotation occurs around the ___ axis.
A
Superior transverse axis (S2 level): responsible for respiratory and craniosacral motions
(Superior = Sacral)
20
Q
Postural motion occurs around the __ axis.
A
Middle transverse axis (S3 level): responsible for postural motion
21
Q
Dynamic motion occurs around the __ axis.
A
Oblique axis (left or right): responsible for dynamic motion
22
Q
Medicare Part A covers…
A
Hospital stays, SNFs, and hospices
23
Q
Medicare Part B covers…
A
Outpatient care services, medical supplies, and diagnostic testing
24
Q
Mitral stenosis is a late complication of
A
Rheumatic heart disease
25
Echo findings associated with mitral stenosis are
Increased LA pressure and LA dilation
Increased PCWP
Increased pressure in pulmonary arteries, veins, and capillaries
LV diastolic pressure is usually normal
26
The Parkland burn formula, used to estimate fluid replacement in burn victims, is
% BSA (body surface area affected) x weight (kg) x 4 (mL/kg)
1/2 administered in first 8 hours
1/2 administered in next 16 hours
27
Explain the Rule of 9s for burn victims
```
Head = 9%
Chest = 18%
Back = 18%
Upper extremities (18%):
Right arm (anterior and posterior) = 9%
Left arm (anterior and posterior) = 9%
Lower extremities (36%):
Right leg (anterior and posterior) = 18%
Left leg (anterior and posterior) = 18%
Perineum = 1%
```
28
A Stanford A aortic dissection, involving the ascending aorta +/- arch and descending aorta, requires:
Emergency surgical consultation
29
The Ann Arbor staging system is used to stage:
Lymphomas, classically Hodgkin lymphoma
| -#LN, B symptoms present, and does disease cross the diaphragm
30
The Rai and Binet staging symptoms are used to stage patients with:
Chronic lymphocytic leukemia
| -body burden of lymphocytes (Rai) and LN site involvement (Binet)
31
Patients with oculomotor nerve palsy (CN III palsy) present with:
Down and out gaze - superior oblique and lateral rectus intact
Diplopia
32
A patient presenting with CN III palsy and blown pupil (decreased sympathetic output) suggests:
A space occupying lesion such as PCA aneurysm or uncal herniation - these are features of brainstem or intracranial compression
33
Post-streptococcal glomerulonephritis presents as __ on light microscopy and immunfluorescence.
"Lumpy bumpy" appearance on light microscopy, diffuse C3 deposition on immunofluorescence
34
Goodpasture's syndrome (presenting with pulmonary hemorrhage and crescentic GN) will show as __ on immunofluorescence due to __.
Linear deposition of IgG; anti-glomerular basement membrane antibodies
35
Minimal change disease will show as __ on light microscopy and __ on EM.
Normal; loss of foot processes of podocytes
36
Patients with diabetic nephropathy will have __ in glomerular capillaries.
Kimmelstiel-Wilson nodules - hyaline deposition
37
Membranoproliferative glomerulonephritis is characterized by __ on light microscopy.
Splitting of the basement membrane
38
Adenocarcinoma of the lung will present as __ on __ stains.
Glandular formation with mucin production; periodic acid-Schiff
39
Budd-Chiari syndrome is __.
a thrombus in the portal hepatic vein leading to occlusion of hepatic venous outflow
40
The gold standard for diagnosis of Budd-Chiari syndrome is __, but the initial imaging choice is __.
Venography; doppler ultrasonography
41
Epiglottitis presents as __ in patients who have not been completely vaccinated.
hoarseness/muffled voice, stridor, and drooling
42
On imaging, epiglottitis will present as __.
The thumbprint sign - represents the swollen epiglottis
43
Epiglottitis is most commonly caused by __.
Haemophilus influenzae type b, a gram - coccobacillus - much more rare now due to vaccine availability
44
Patients with Wernicke encephalopathy will present with __.
ataxia, confusion, and ophthalmoplegia (most commonly horizontal nystagmus)
45
Versus Wernicke encephalopathy, Korsakoff syndrome is __ and will present with __.
Irreversible; confabulations
46
Delirium tremens will usually present __ and present with __.
3-5 days after cessation of alcohol; autonomic hyperactivity (tachycardia, HTN, anxiety, diaphoresis), visual hallucinations, confusion, and incontinence
47
In elderly patients with leg length discrepancy, the initial heel lift on the side of the short leg should be __. In younger, more flexible patients, the initial heel lift should be __.
1.5 mm; 3.2 mm
48
When treating the leg length discrepancy, the full heel lift height should measure __.
1/2 to 3/4 of the discrepancy
49
Unstable patients who are in ventricular tachycardia should be managed with __.
Synchronized cardioversion
-Defibrillation is indicated in patients with VF or pulseless VTach
50
For patients over 35 years with epididymitis, initial treatment should be __. Patients under 35 years should be treated with __.
Over 35 = cipro
| Under 35 or at high risk of STDs = CTX and doxy
51
Waterhouse-Friederichsen syndrome is __.
Bilateral hemorrhagic necrosis or infarction of the adrenal cortex due to a coagulopathy (e.g. DIC secondary to meningococcemia)
52
An availability bias is __.
Use of recent examples/experiences in forming a clinical impression instead of a careful assessment of the data
53
An aggregate bias is __.
The mistaken belief that population (eg, aggregate) data does not apply to the individual patient scenario leading a physician to ignore guidelines
54
An anchoring bias is __.
Clinical decisions based on initial judgment/impression and failing to change from initial impression/diagnosis despite additional information
55
A commission bias is __.
The tendency towards action rather than inaction
56
A confirmation bias is __.
Gathering and interpretation of medical data which confirms the diagnosis, to the exclusion of conflicting information
57
A framing bias is __.
Decision/judgment made based on how a problem/situation is presented
58
A hindsight bias is __.
When knowledge of the outcome influences perception of past events, hindering understanding or critical appraisal of events (e.g. physician simply concludes they "knew it all along" and does not critically evaluate the situation)
59
An omission bias is __.
The tendency towards inaction rather than action based on fear of being held responsible for the outcome
60
A recency bias is __.
Using recent instead of older information, even if the older information is more relevant
61
A regret bias is __.
Overestimating the possibility of a diagnosis with devastating consequences in order to eliminate potential regret if the diagnosis is missed
62
A search-satisfying error bias is __.
Discontinuing the search for the answer once any finding has been discovered
63
A sunk-cost effect is __.
Physicians continue to commit to a diagnosis because there has been a large amount of time, energy and resources devoted to a diagnosis
64
A phyllodes breast tumor will present as __.
A rapidly growing mass that manifests as large in size
65
Inflammatory breast cancer will present as __.
Diffuse erythema and edema (peau d'orange)
66
A tartrate-resistance acid phosphatase (TRAP) stain is used to diagnose __.
Hairy cell leukemia
67
Rett syndrome is associated with a mutation in __, which usually occurs sporadically.
Methyl-CpG binding protein 2 (MeCP2)
68
Fragile X syndrome presents as __.
```
Long, narrow face
Prominent forehead and chin
Large ears
Testicular enlargement
Developmental delay/intellectual disability
```
69
The mutation in Fragile X syndrome is an x-linked disorder where a __.
CGG trinucleotide repeat disrupts the FMR1 gene (loss-of-function mutation)
70
Trisomy 21 usually occurs due to __.
Meiotic nondisjunction - failure of two members of a chromosome pair to separate during one another during meiosis
71
Prader-Willi syndrome is caused by a deletion of a __ chromosome on chromosome __.
Paternal; 15
72
Angelman syndrome is caused by a deletion of a __ chromosome on chromosome __.
Maternal; 15
73
Which segment of the sacrum allows the firm attachment of the dura mater to move during craniosacral motion?
S2
74
The most common infectious agents that can lead to cold agglutinin autoimmune hemolytic anemia are __.
Mycoplasma pneumoniae and EBV
75
To diagnose carcinoid syndrome (an excess of serotonin due to a neuroendocrine tumor), the best initial test is __.
Urinary 5-hydroxyindoleacetic acid (5 HIAA) - a metabolite of serotonin
76
Hypocalcemia will present with __ and __ on EKG.
Carpal spasms after inflation of a BP cuff (Trousseau's sign); prolongation of the QT interval
77
Hypokalemia will present with __ on EKG.
U waves
78
In Downs syndrome, AFP and Estriol will be __ and b-hCG and inhibin A will be __ on quad screening.
AFP and Estriol = decreased
| b-hCG and inhibin A = increased
79
In Trisomy 18 (Edwards) and Trisomy 13 (Patau), AFP will be __.
Decreased
80
Trisomy 18 will present with __ on quad screen.
Decreased levels of AFP and inhibin A
81
Neural tube defects will present with __ on quad screen.
increased AFP
82
Alport syndrome (hearing loss and glomerulonephritis) is caused by __.
an absence of collagen type IV alpha-5 chains
| -X-linked disorder (males)
83
Ovarian cancer is associated with which tumor marker?
CA 125
84
Pancreatic cancer is associated with which tumor marker?
CA-19-9
85
Medullary thyroid cancer is associated with which tumor marker?
Calcitonin
86
Dysgerminomas are associated with which tumor marker?
b-hCG and LDH
87
Colon cancer is associated with which tumor marker?
CEA
88
Thiamine deficiency (B1) is associated with __.
Wernicke encephalopathy/ Korsakoff syndrome and beriberi (wet and dry - heart failure)
89
Riboflavin deficiency (B2) is associated with __.
The 2 C's - cheilitis and corneal vascularization
90
Niacin deficiency (B3) is associated with __.
Pellagra (the 4 D's) - dermatitis, diarrhea, dementia, death
91
Pyridoxine deficiency (B6) is associated with __.
Peripheral neuropathy, microcytic anemia, glossitis (supplement with INH)
92
Biotin deficiency (B7) is associated with __.
Dermatitis around the eyes, nose, mouth, conjunctivitis
| -eating raw egg whites binds and causes deficiency
93
Folate deficiency (B9) is associated with __.
Macrocytic anemia without significant neurologic findings, mouth ulcers
94
Cyanocobalamin deficiency (B12) is associated with __.
Subacute combined degeneration (neurologic symptoms), macrocytic anemia, psychosis, glossitis
95
Fetal fibronectin is __.
A marker used to assess the likelihood of preterm labor between 22-34 weeks - indicates placental disruption and increased risk of preterm delivery within 7 days
96
Croup (laryngotracheobronchitis) is caused by __ and presents with __.
Parainfluenza virus; Barking cough
97
In a patient with croup, imaging will show __.
Steeple sign
98
Versus schizotypal personality disorder, patients with schizoid personality disorder show __.
A pervasive detachment from others and lack of emotional expression
99
HCV gains entry into hepatic cells by __.
Coating itself with LDL or VLDL
100
Patients with hemophilia A will present with __ PT and __ PTT. Clinically, patients will have __.
Normal PT, Prolonged PTT; hemoarthrosis
101
Patients with von willebrand disease will present with a prolonged __ because __.
PTT; vWF is important in preventing FVIII from degrading
102
The Q angle is measured by __. A normal Q angle is __.
The Q angle is the angle created by two intersecting lines drawn from the ASIS through the middle of the patella and tibial tuberosity through the middle of the patella. The normal range of the Q angle is 14-17º in women.
