Flashcards in nbme Deck (47):
young otherwise healthy female presents with 2 day h/o F/C, L flank pain, N/V, leukocytosis, many WBCs in urine, initial ABX?
IV 3rd gen cephalasporin (ie ceftriaxone, cefotaxime, ceftazidime) for acute complicated pyelo (vomiting so must give IV not oral)
pt presents w severe substernal chest pain, worse w inspiration, she is bent over at waist to decr pain, a short harsh diastolic sound is heard, nml lung sounds, no fever, RR and pulse are both upper nml, most likely Dx?
woman in 50s presents w 2month h/o pain/swelling in knees, also has stiffness- worse in AM, nml WBC count, ESR of 50, x-ray of knees shows osteopenia and subcartliganeous cysts around the joints, joint space intact.. Dx? Tx?
Middle aged man presents with weight gain, incr space btwn teeth, he appears tall w big feet and frontal bossing.. measurement of what will confirm Dx?
serum IGF-1 (to confirm suspected Acromegaly)
cephalization of pulm vessels?
vessels in upper chest become more prominent d/t pulm HTN
Pt with poorly controlled HTN presents with SOB and wheezing for 2 days, has S3 gallop, 4+ pedal edema, JVD, crackles and wheezes, CXR shows cardiomegaly and cephalization of pulm vessels, SOB is due to?
pulm edema d/t CHF
middle aged alcoholic is brought to ER 1hr after being found passed out in park, lateral gaze defect, wide based ataxic gate, BAC less than 0.1 .. need to administer?
Vit B1 ie thiamine (must give thiamine before glucose!!!)
Previously healthy college student presents w productive cough and runny nose for 2 weeks, feels well btwn coughing episodes, has vomited from coughing so much, no fever, stable vitals, nml lung exam, most likely Dx?
young adult w severe Hemophilia A has received factor VIII replacement since childhood, recently his bleeding has been poorly controlled, requiring more factor VIII to stop episodes, has nml platelet count and prolonged aPTT, next to to Dx cause of incr bleeding?
test for factor VIII inhibitor (vie Bethesda assay), should suspect inhibitor when bleeding episodes are refractory to usual therapy (would not need measure factor VIII conc b/c that is already known to be low in these pts)
young adult has polyuria, blurred vision and rapid breathing for 1 day, is tachycardic and tachypneic, nml Na and K, HCO3 of 18, glucose 783, what is most likely cause of their acidosis?
accumulation of beta-hydroxybutyric acid (DKA)
baseline ECG changes in some pts make stress ECG nondiagnostic since the baseline changes interfere with Dx of MI, thus these pts need what kind of test?
stress ECHO which can detect ischemia by new wall motion abnormalities (or stress radionuclide MPI)
initial therapy of severe hypercalcemia (ie greater than 14) ?
Volume expansion w isotonic saline (0.9% saline), calcitonin and bisphosphonate (ie Zoledronic acid or pamidronate)
pt with MDD presents w nocturnal incontinence 1mo after starting amitriptyline.. on exam he has lower abd distension, moderately enlarged smooth prostate, neuro intact, Cr of 1.6 .. cause of nocturnal incontinence is likely?
BPH combined with anticholinergic effects of TCA causing overflow incontinence
midshaft fracture of humerus causes wrist drop due to injury of what n.?
Pt in 60s presents w pain in fingertips, plethora, and splenomegaly, labs: elevated Hb, WBCs, platelets, Po2 of 92, O2 sat 94.. likely Dx? next step in Mx?
c/b rapid onset of severe vertigo, N/V, gait instability, possible unilateral hearing loss.. possible nystagmus and falls but no other neuro S/Sxs?
Vestibular Neuritis, or if there are hearing changes- known as Labyrinthitis
rash, fever, eosinophil-ia/-uria, WBC casts, some WBCs, RBCs and protein also in urine
acute interstitial nephritis
how does hypertrophic obstructive cardiomyopathy murmur change with valsalva?
defined by the presence of heavy proteinuria (more than 3.5g/24hrs), hypoalbuminemia (less than 3g/dL), and peripheral edema ?
(hyperlipidemia and thrombotic disease are also frequently observed)
syndrome that falls inbetween the cognitive changes seen with aging and dementia
mild cognitive impairment
Calcified pleural plaques in shipyard worker .. buzzwords for?
middle-aged adult is brought to ER after collapsing at restaurant, Pt is very tachycardic, tachypneic and hypoTNsive, has labored breathing, diffuse bronchospasm and coughs continuously.. most likely Dx?
Pt with UC presents with jaundice, fatigue and pruritus, has elevated bili, Alk phos, ALT, prolonged PT, is neg for Hep .. most likely Dx?
Primary SCLEROSING cholangitis (about 90% of pts with PSC also have UC)
elderly man has syncopal episodes that occur without warning, no h/o illness, no meds, no exam findings.. next step in Dx?
ambulatory ECG monitoring
Mx of pilonidal cyst/sinus?
first I and D, likely to recur, pts w chronic or recurrent disease need excision of sinus and all tracts
Tx of hypotonic hyponatremia: if mild (Na 120-130mmol/L)?
if mod (Na 110-120mmol/L)?
if severe (Na less than 110 OR if symptomatic)?
mild- fluid restriction
Mod- loop diuretics, give w saline (to prevent renal conc of urine d/t high ADH)
Severe- hypertonic saline (but dont incr Na more than 8mmol/L in first 24hrs)
A middle age pt on methylprednisolone for SLE presents with hip pain that started a couple months ago, is worse with weight bearing, pain with active and passive mvmt, walks w limp.. most likely Dx?
osteonecrosis (AKA avascular/ischemic necrosis) - biggest RF is high dose corticosteroid use and SLE is another RF (can be bilateral)
these markers indicate what: HBsAg neg
pt is immune due to vaccination
these markers indicate what: HBsAg neg
pt is immune due to natural infection (had acute hep B infection that has resolved)
these markers indicate what: HBsAg neg
pt never had vaccine, is either in the window period when HbsAg drops and anti-HBs isn't detected yet or had acute Hep B a long time ago and anti-HBs no longer detectable or has chronic hep B but HBsAg level is too low for detection
most appropriate pharmacotherapy for woman with urge incontinence?
1st line pharmacotherapy for mild to med Sxs of BPH? (class and drug)
alpha-1-adrenergic antagonists ie terazosin, doxazosin, tamsulosin, alfuzosin
these can be used for BPH by decreasing size of prostate, take 6-12mos to work
5alpha reductase inhibitors ie finasteride, dutasteride
clinical Dx that should be suspected in pts with RA, neutropenia and splenomegaly (the RA is usually severe, long-standing and seropositive for both rheumatoid factor and anti-CCP)? the splenomegaly results in what other hematologic findings?
splenic sequestration results in anemia and thrombocytopenia
pleural fluid is exudative if it meets any 1 of these 3 lights criteria
pleural fluid protein/serum protein greater than 0.5;
pleural fluid LDH/serumLDH greater than 0.6;
pleural fluid LDH more than 60 (2/3 of upper limit of nml)
chylothorax? the fluid will be what color and contain high content of?
chyle/lymphatic fluid in pleural space from disruption/obstruction of thoracic duct or its tributaries;
typically milky, triglycerides (more than 110mg/dL)
previously healthy man presents w HA, confusion, temp of 100.2, BP 140/86, mild icterus, Hg 8.4, thrombocytopenia, leukopenia, elevated BUN and Cr, smear shows fragmented RBCs, PT is nml, next step in Mx?
immediate plasma exchange this pt has TTP (Pentad: renal insuff, neuro manifs, fever, thrombocytopenia, microangiopathic anemia)
these should be used to reduce the risk of systemic thromboembolism in pts w Afib w CHADSVASc score of 2 or more
warfarin or non-Vit-K antagonist anticoagulants (apixaban, dabigatran, rivoxaban)
illness c/b arthralgias, weight loss, fever, diarrhea, possible skin pigmentation, PAS-positive lamina propria of small intestine is classic Bx finding
65yo F presents w back pain, found to have anemia, slightly elevated Calcium, incr BUN and Cr, urine sediment is bland except for a few granular casts, most likely cause?
Multiple myeloma- pts often have fatigue, weight loss bone pain, hypercalcemia, anemia, monoclonal protein accumulates and deposits in renal tubules as granular casts can eventually lead to nephrotic Sy
highly malignant tumor MC in femur then tibia or humerus, typically in 1st or 2nd decades of life, central lytic lesion? classic radiographic appearance?
Ewings sarcoma; central lytic lesion w endosteal scalloping "onion-skin" then "moth-eaten"
first step in Mx of symptomatic sinus bradycardia in adults
MC malignancy Dxed in pts exposed to asbestos?
MC OB complication in pts w vonWillebrand disease is?
presents w postcoital bleeding, mucopurulent discharge, and a friable cervix? empiric Tx?
Acute cervicitis MC d/t chlamydia and gonorrheae;
ceftriaxone and azithromycin/doxy
first line Txs for ascites d/t cirrhosis?
furosemide and spironolactone