HY Review #3 Flashcards
(101 cards)
1
Q
Small bowel obstruction mcc:
Crohn’s disease →
history of abdominal surgery →
A
Crohn’s → Strictures (fibrotic)
abdominal surgery → Adhesions
2
Q
Pancreatic adenocarcinoma is found in the pancreatic head/neck region causes painless jaundice
5-year survival rate less than 5%
Management is with ____
A
palliative care
(pt will die in months. No need for invasive management of other health issues)
3
Q
Bacteria present in shellfish and salt water. Contracted by eating Seafood or via inoculation (wound) while at the beach or in the water.
Causes watery diarrhea, wound infections, septicemia → Necrotizing Fasciitis.
BRF: h/o liver disease or chronic disease (DM)
Dx/Tx?
A
Vibrio Vulnificans
Surgical Debridement of wound + Antibiotics
4
Q
young adult presents with Fever + Neuro deficits, Jaundice, and Petechiae + Renal failure
↓Hct/PLTs
Normal PT/PTT
↑Cr
↑Bilirubin
Dx/Tx?
A
TTP
Plasmapheresis → IvIg
5
Q
Conduct disorder vs Oppositional Defiant Disorder in children
A
Conduct disorder = Physically Aggressive, Stealing, Property Damage (illegal), outright lies
Oppositional Defiant= Angry, Vindictive, Disobedient, Cuts class, threatens w/o physical action
6
Q
1st line tx of tinea capitis is
A
ORAL Griseofulvin
ORAL Terbinafine
7
Q
RCC likes to met to (3)
A
Bone
Brain
Lung
8
Q
Pt presents with L facial droop and Bradycardia
ECG shows AV nodal block
Recently in Wisconsin
Dx/Tx?
A
(LATE) Lyme Dz
Tx: CTX
(Early Lyme dz: Bull’s eye rash + flu sxs → Doxycycline)
9
Q
FEV1/FVC & Peak Expiratory Flow rate levels during and acute asthma attack?
pt has dyspnea, rhonchi (wheezing), & prolonged expiratory phase
± Hyper-resonance and hyperinflation
A
Both decrease
(Obstructive pattern)
10
Q
Fine Inspiratory Crackles
Peripheral Reticular opacities
Clustered cystic airspaces on imaging
dx?
A
Pulmonary Fibrosis
(Interstitial lung disease)
11
Q
Calcified pleural plaque + Pleural effusion
Dx?
BRF?
A
Mesothelioma
(Asbestosis & Tobacco)
12
Q
Elderly pt with acute (2 day) abdominal pain and constipation.
Abdomen is tympanitic & distended
Dx/Tx?
A
Sigmoid Volvulus
(dilated sigmoid colon)
Flexible Sigmoidoscopy
(if uncomplicated)
13
Q
CKD pt’s need to be evaluated for anemia b/c
A
↓ EPO
(should be made by kidneys)
14
Q
FIRST STEP in management of DKA?
A
Normal Saline!
(Then insulin + glucose!)
15
Q
Pts with Marfan should have what 2 yearly screens?
A
Echo
Eye exam
16
Q
Latino/Black, Fat, HIV, IVDU
Edema
+4 proteinuria
>3.5g/day
Dx:
Cx: ___ Pleural Effusion
Prognosis: 50% → ___
A
FSGS
50% → ESRD
Transudative PE
17
Q
Caucasian
Cancer → Lymphoma
mcc of Nephrotic syndrome (world-wide)
+4 proteinuria
>3.5g/day
Dx/ associated antibodies?
A
Membranous Nephropathy
(PLA-2R antibodies)
18
Q
Light chains
± Amyloid
+4 proteinuria
>3.5g/day
A
Nephrotic syndrome
s/t
Multiple Myeloma
19
Q
+3 proteinuria
<3.5g/day
Hematuria
Had URI less than 1w ago
Normal C3/C4
A
IgA Nephropathy
20
Q
+3 proteinuria
<3.5g/day
Hematuria
Had URI (or skin infx) more than 1w ago
low C3 ± C4
A
Post-Streptococcus Glomerular Nephritis
(PSGN)
21
Q
Young Male
Hemoptysis 1st
Hematuria 2nd
Dx?
A
Good Pasture’s (T4 collagen)
→ RPGN
22
Q
+3 proteinuria
<3.5g/day
Hematuria
Hx of Hepatitis B
Low C3/C4
Dx?
A
MPGN
23
Q
vaginal pH > 4.5
(2)
A
Bacterial Vaginosis
Trichomonas (red cervix)
24
Q
tx of vaginal candidiasis (pseudohyphae)
A
PO Azole
pH ≤ 4.5
25
Wet prep findings for Trichomonas vs BV?
Trich: Motile Protozoa
BV: Epithelium w/Gardnerella (clue cells)
26
Complication associated with Bacterial Vaginosis?
Pre-Term Labor & Delivery
27
Non-tender, irregular bulky uterus
Dx
Symptomatic tx:
tx if pregnancy desired:
tx if pregnancy not desired:
Fibroids
OCPs
Myomectomy
Hysterectomy
(leave in copper IUD if not causing problems)
28
syncopal episode
**pallor/sweating before** passing out
dx/dxt?
Vasovagal
Tilt-table test
29
sudden syncope
quick return to baseline
occurred at rest
dx/dxt?
Cardiogenic
Ambulatory ECG
30
syncopal episode
More than 30m to return to baseline
± repetitive motions/incontinence/tongue biting
dx/dxt?
Neurogenic syncope (Seizures)
EEG
31
Acute **abdominal pain**
Sensation issues (**Neuro** sxs)
**Red/purple Urine**
**Psychiatric** sxs (depression/anxiety/dementia etc.)
Usually triggered by physiologic stressor (drugs, illness, fasting)
Dx/tx (3)?
defect?
Acute **Intermittent Porphyria** (AD)
____
Aminolevulinate Synthase (**ALAS**) Inhibition
• IV: **Hemin** + **Glucose** + **Hematin**
____
**Porphobilinogen deaminase** defect
32
Red Urine
Hyperhydrosis (sweaty)
Skin issues
• Skin lesions on sun-exposed
• Hairy/Hyperpigmentation
Dx/tx?
Test for HY association?
**Porphyria Cutanea Tarda** (sporadic mutation)
Phlebotomy
test for **Hep C**
**Uroporphynogen decarboxylase** defect
Porphyria → Greek word for “Red/Purple”
• Red/Purple pee & skin lesions
Tarda → Late (Tardy)
• Lesions appear later after sun-exposure
33
T. Bili keeps increasing despite phototherapy
Or T. Bill >25 mg/dL
NBSIM?
partial exchange transfusion
34
PUV is a urethra problem =
VUR is a ureter problem =
PUV → Bladder distention
VUR → ± Hydronephrosis
(no bladder distention)
35
if adding Intrinsic Factor fixes the Bl2 def
dx/caused by?
Pernicious Anemia (stomach problem)
s/t **Lymphocytic** infiltration of the **gastric fundus**
36
MALE pt present w/ Dark Urine
Low haptoglobin (Hemolysis)
Problem with sulfa drugs causing oxidative stress
Smear → Heinz bodies (denatured Hb) & Bite cells
dx?
ex) - Primaquine (covers vivax and ovale) or favabeans
G6PD deficiency (XLR - only males)
Oxidative injury to hemoglobin.
37
Edematous Stillborn with hydrops fetalis & hepatosplenomegaly
dx/patho?
**Hb Barts** (Thalassemia)
Has **4 gamma** chains (missing 4 alphas chains)
38
**Mediterranean** country
(Italy, Spain, Greece, Monaco, Portugal)
hepatosplenomegaly
**Microcytic anemia**
± Facial deformities
General Dx?
**Thalassemia**
(imbalance in alpha & beta globin gene production)
39
DIC labs
__PT, __PTT, __PLTs
__ Shistocytes
↑PT, ↑ PTT, ↓ PLTs
↑ Shistocytes
40
injectable monoclonal antibody that interferes with platelet aggregation
**Abciximab** (inhibits GP2b/3a)
similar to what dz?
**Glanzmann Thrombasthenia** (deficiency of GP2B/3A)
Isolated ↑Bleeding time (RCA & PTT nl)
———
**Recall**
Bernard Soulier Disease (Def GP1B) → (Abn RCA, PTT nl & ↑BT)
Hemo A (F8 def ↑PTT & nl PT)
Hemo B (F9 def ↑PTT & nl PT)
vWB (↑PTT & Bleed Time & Abn RCA)
41
Little Boy
bleeding into joints
Nose bleeds
Oral mucosa bleeding
dx?
Hemo A (F8 def ↑PTT & nl PT)
get a mixing study
(can also be Hemophilia B, but **less common**)
42
Bleeding Time, RCA test & PTT for
vWF disease
Bernard Soulier
Glanzmann Thrombostenia
**vWF**: ↑Bleeding Time, Abn RCA test, ↑ PTT
Tx: Desmopressin
**Bernard Soulier**: ↑BT, Abn RCA Test, **normal** PTT
**Glanzmann Thrombostenia**: ↑BT, **normal** RCA Test, **normal** PTT
43
HEPARIN is **safe** to use in pregnancy
MOA?
Increases the activity of Antithrombin 3.
44
What medication Binds to an ADP receptor and prevents platelet activation?
Clopidogrel
45
Which Immunoglobulin cannot cross from maternal circulation in placenta/fetal circulation?
IgM
(baby can't get IgMs from mom)
46
Contraindication to **adenosine/dipyridamole** based stress tests:
Asthma
(drugs above are bronchospastic)
47
Contraindication to EKG based stress tests
Pre-existing EKG anomaly
48
Contraindications to exercise based stress tests (4)
Aortic Stenosis
Osteoarthritis
Amputee
Frail elderly
49
What are the 2 components of stress tests on NBME exams?
1. **Stress method**
- Exercise
- Pharmacologic (Dobutamine or Adenosine)
2. **Capturing heart response**
- EKG
- ECHO
- Nuclear Medicine (Thallium 201 scan)
50
How are “flares” of most autoimmune diseases treated on NBME exams? What is the classic tipoff to a disease flare?
IV Steroids (except GBS & scleroderma)
Tipoff → Acute worsening of sxs
51
Fever (>102ºF) + AMS
dx/tx?
Heat stroke
**Normal Saline** 1st → evaporative cooling
Heat exhaustion (High temp but **No AMS**)
same tx tho
52
Classic bioterrorism organisms on NBME exams? (3)
Anthrax
Botulisms
Small pox
53
50M h/o chronic alcohol abuse + bloody emesis
Hypotensive + Tachycardic
Dx:
Initial management:
Acute Mgt: (3)
Chronic prophylaxis: (2)
Dx: ruptured esophageal varices
Initial management: Place 2 IVs → **Normal Saline** (1st) then **Transfuse** blood
Acute Mgt: **Banding** or **Sclerotherapy**
(& IV **Octreotide** + IV **PPI**)
Chronic prophylaxis: **Beta Blockers** (or **Spironolactone**) + **FQ** (SBP ppx)
54
What patients require long term Floroquinilone for SBP ppx?
h/o Varices
h/o SBP
55
Spontaneous Bacterial Peritonitis is diagnosed via ___?
How is acute SBP treated?
What is SBP ppx long term?
paracentesis (>250 PMNs even if no bacteria found)
Acute tx: CTX or Cefotaxime (2nd line FQ)
Ppx: Fq
56
What drug classes are used on NBME exams in the management of most bacterial pneumonia?
CTX
Azithromycin
57
6 Boy
3 mo h/o recurrent fevers and bone pain.
Cranial XR: lytic lesions in his skull
Bone Biopsy: S100+ cells.
Dx:
Histology: Birbeck Granules (tennis rackets)
Lab markers: S100+, CD1A+, Langerin+
Langerhan cell Histocytosis (dendritic cell tumor)
58
Aside from ST elevations, what is another diagnostic criterion that can be used in establishing an MI diagnosis?
↑ Troponins
+
NEW LBBB (MI until proven otherwise)
59
Painful skin vesicles in the **same** stage of healing
Dx
Small Pox (HY HY)
Vaccinia Vaccine (cow pox vaccine) usually military question
60
Painful skin vesicles in **different** stages of healing
Dx
VZV (chicken pox)
61
fever and headaches
CT shows peripheral (temporal lobe) bleed
HSV encephalitis/meningitis
(LP + PCR?)
62
47F Obese + severe pruritus and pain under her left breast
dx/dxt/tx (2)?
Dx:intertrigo (candidal infx)
Tx: topical Azole/ topical nystatin
---
NBME risk factors: DM, Obese, large breast
Dx testing: wet prep → **pseudohyphae** (budding yeast)
63
Absent Gag Reflex = CN9 & 10
another symptom related to these CNs include:
Decreased sensation in the posterior third of the tongue.
64
Conjugated (Direct) hyperbilirubinemia in a newborn.
Dx/tx?
Biliary atresia
emergent **surgery**
otherwise liver transplant
65
Bilateral “cheek” and testicular swelling in a 7 yo boy.
dx/tx
Potential abdominal sequelae?
Mumps virus
supportive care
sequelae → pancreatitis
66
6 week old kid that was **jaundiced at birth** with lethargy, hypotonia, poor feeding, and occasional **seizures**
dx/pahtophys?
**Kernicticus**
bilirubin deposits in **basal ganglia**
67
2 clues jaundice is pathological in newborns ALWAYS.
2 examples
jaundice in first 24hrs of life
(Direct) conjugated hyperbilirubinemia
(Kernicterus & Biliary Atresia)
68
A) 5 yo boy with SNHL(hearing loss) + hematuria (nephritic) + cataracts (eye problems). dx?
B) 5 yo boy with recurrent infections + eczema + thrombocytopenia. dx?
Alport syndrome (type 4 collagen) COL4A5 gene defect
Wiskott- Aldridge syndrome WAS gene mutation
69
9 mo boy + recurrent UTIs
Dx/DxT/tx
Posterior Urethral Valves
Renal u/s ± VCUG
Daily antibiotic ppx
70
Seizure lifestyle modification for NBME exams.
Ketogenic diet
71
7 yo M with 3 day h/o Fever, abdominal pain, **bloody diarrhea**
Labs: Hb 8, Plts 12k, Cr 2.5,
Smear: Schistocytes
Dx:
MCC:
MAHA (↓ PLTs + Renal Failure)
MCC: E.Coli 0157:h7
72
Hyperpigmented macules on the skin,
prior R eye enucleation procedure for a CN2 mass,
multiple posterior **mediastinal masses**
Dx/ MOI/ Chrm __
NF1 (AD)
Chrm 17
(Cafe-au-lait spots + optic glioma + Neurofibromas)
73
Child+ Fever + Seizure (lasting less than __ minutes)
dx/tx?
Febrile seizure (<15m)
Acetaminophen
74
4 yo boy + Fever+ drooling +dysphagia + tripoding.
dx/tx?
Epiglotitis → INTUBATE
(XRAY thumb print sign)
75
**Cystic Fibrosis** is HY
Recurrent mucosal infections (ears, nose, lungs)
Steatorrhea + FTT → Infertility
Gene/chromosome:
Dx testing:
Steatorrhea:
First 48 hrs life cx:
**Pneumonia cause by age:**
<20yo →
>20yo →
CFTR gene mutation (AR)
Sweat chloride test
----
Failure to pass meconium
Steatorrhea = Lipase deficiency (Vit. A,B,D,E,K def)
------
PNA in <20yo = Staph aura
PNA in >20yo= Pseudomonas
76
15 mo F with rhinorrhea, cough for 2 days
Progresses to wheezing & b/l crackles heard on lung auscultation.
Dx/Tx?
Bronchiolitis (RSV)
Supportive care with O2 as needed
77
**Bilateral** thigh/calf pain (worse at night) in a 5 (15) year old M relieved by acetaminophen.
**Unilateral** thigh/calf pain (worse at night) in a 5 (15) year old M relieved by acetaminophen.
Bilateral → Growing pains (child/teen)
Unilateral → **Osteoid Osteoma**
± **bony mass**
78
Peds Ortho stuff (HY)
1. Unstable hip joint in new born
2. <10 yo with limp
3. >10yo with limp
1. Developmental **Dysplasia** → Pavlik Harness
–––
2. **Legg-calvé-perthes** Dz → **Avascular** necrosis of femoral head (**compression/necrosis** of capital femoral **epiphysys**)
Tx: surgery **only if** 6+ yo or 50% + dmg to head
–––
3. **Slipped Capital Femoral Epiphysis** → Slipped femoral head **no** necrosis/compression (**obese**)
Tx: Surgical **pinning** of head
–––
Alphabetical order corresponds to Age
D (infant), L (child), S (pre-teen)
79
BP is 250/140 with AMS.
Dx/Tx (5)?
HTN emergency:
Nitroprusside, Labetalol
Phentolamine (alpha 1 blocker)
Nicardipine or **Clevidipine**
(urgency is the same w/o end organ dmg; but same tx)
80
on NBME test what is the NBSIM in a neonate presenting with **bilious** emesis.
Upper GI Series
(**non-bilious** emesis → U/S)
81
Breast cancer screening guidelines with BRCA1 and 2 mutations
**25-30** =
>30=
25-30 = annual breast **MRI**
>30= annual **MRI + Mammograms**
82
NBSIM of a **>50** yo patient who presents with a **new, chronic headache**
(± worse in AM may improve later in day)
MRI brain + contrast
(screen for brain tumor)
83
Patient started on therapy for HTN who subsequently developed constipation and peripheral edema.
DHP CCB toxicity
84
Dysphagia
Iron Deficiency Anemia
(↓MCV, ↓Hct, ↓Ferritin, ↑TIBC, ↑Transferrin, ↓Transferrin SATs)
esophageal webs
Dx?
Plummer Vinson Syndrome
85
Compare:
Cholinergic Toxidrome
Anti-Cholinergic Toxidrome
**Cholinergic Toxidrome**
↑ Ach (Pyridostigmine, Pilocarpine, Bethanachol)
**DUMBELLS**
Diarrhea
Urination
Miosis
Bradycardia/ Bronchoconstriction (wheezing)
Emesis
Lethargy
Lacrimation
Sweaty/Salivation (Drooling)
------
**Anti-cholinergic Toxidrome**
↓ Ach (Atropine, Ipratropium, Oxybutynin )
Fast as a fiddle: Tachycardia
Dry as a bone (dry mucous memb)
Full as a flask (urinary retention/constipation)
Blind as a Bat (Mydriasis)
Red as a beet (flushed skin)
Mad as a hatter (AMS)
86
23 M recent blunt force trauma to leg now has pain over area
& a hard, palpable mass in the involved extremity.
Dx?
myositis ossificans
(collagen repairs creating bone not muscle)
87
40+ yo w/ DM who was recently started on statin now has Increased Cr and dark/red urine.
statin myopathy → rhabdomyolysis
88
Pharmacologic agents on NBMEs with the following side effects
Crystalline nephropathy (3):
Pancreatitis (4):
Crystalline → Acyclovir, Topiramate, Indinavir (HIV)
─
Pancreatitis→ GLP-1 agonist, DPP4 inhibitors, Stavudine/Didanosine (HIV drugs)
─
(C/I in MEN syndrome)
89
Alopecia arreata tx?
(typically seen in pts with h/o auto-immune d/o)
inject steroid in lesions
90
Mechanism behind infertility in a patient with decreased day 25 progesterone
Anovulation
(no corpus leuteum making P2)
91
Fever + Anemia (MAHA)
↓ Plts (Petechiae)
Renal Failure
± Neuro Deficits
Dx/Tx (2)?
TTP
Plasmapheresis
2nd line: IvIg
92
____ can cause supratheurapeutic INR if on warfarin bc decreased warfarin degradation = warfarin toxicity
TMP-SMX
93
Drugs causing HYPERKALEMIA
(ABC-ST)
ACE/ARBs
Beta blockers
Cyclosporin
Spironolactone/Eplerenone
TMP-SMX
Amiloride/triamterene
94
Compare/Contrast
Nephroblastoma
Neuroblastoma
95
Seizures in children (Dx/Tx)
<2yo + EEG w/ chaotic irregular background (Hypsarrhythmia) + milestone regressions ± Tuberous Sclerosis.
─
3-5 yo + has different seizures types + prone to status epilepticus + Bad prognosis
─
>10 yo + jerking seizures worse in AM/when waking up; tonic-clonic
─
Any age + starring spells + 3Hz spikes/ slow wave on EEG
<2yo: West syndrome (infantile spasms) → ACTH
─
3-5yo: Lennox Gastaut → Valproate
─
>10yo: Juvenile myoclonic epilepsy → Valproate
─
Absence seizures→ Ethosuximide or CCB (type T)
96
Type of Diarrhea caused by
Cholera
Lactose Intolerence
Celiac's (T-cell lymphoma)
Secretory (Ions)
Osmotic (osmotically active)
Malabsorptive (enteric villi)
97
Liver and Lung problems
Dx:
Cx: ____
Worsens morbidity/mortality: SMOKING
Associated vasculitis: _________
Classic microscopy findings: ________
alpha 1 anti-trypsin deficiency (anti-protease)
**Pan**acinar emphysema (upper lobes)
Wegener’s (GPA)
PAS (+) hepatocytes
(P acid schiff stain)
98
New born + FTT + poor feeding + seizures
Sweet smelling urine or earwax
dx/tx? Potentially curative tx?
Maple Syrup Disease
diet low in isoleucine, Leucine, Valine
Liver transplant
─
I LIV for sweet Maple Syrup
(mutation in **branched chain** keto-acid dehydrogenase)
99
HTN in a child (> 140/90)
NBSIM?
Renal Doppler U/S
(renal a issue)
100
Per NBME
mechanism of Renal Failure in Ketorolac use?
NSAID inhibits Cox = ↓ Prostaglandin = Afferent a. Constriction =
↓ GFR & HSP
PDA→ Prostaglandin dilates afferent (NSAIDs constrict)
ACE → ACE constricts efferent (ACE-I dilates)
101
to rule in a diagnosis the test must be very ____.
Specific
