NBME 9 Flashcards
7 year old boy with 1 month history of urinary incontinence (daytime enuresis) and passage of hard, painful stools. Treatment?
Osmotic laxative; stool accumulates and applies pressure to bladder
-**desmopressin used for constipation 2/2 diabetes insipidus
22 year old woman w/ 2 week history yellowing skin, increasing SOB, scleral icterus, jaundice, increased reticulocytes - Bilirubin, LDH, Alk phos trends
- Hemolytic anemia
- Increased indirect bilirubin - unconjugated bilirubin from lysed RBCs
- increased LDH - lysed RBCs
- normal alk phos
27 year old man hx of schizophrenia on olanzapine brought to ED for episodes of agitation. Given haloperidol which resolved agitation but subsequently was agitated and holding arms rigidly at his side. Treatment?
- diphenhydramine (or benztropine)- anticholinergic med that restores balance in dopaminergic/cholinergic pathways
- *patient having acute dystonic reaction to antipsychotic dopamine antagonists (haloperidol)
Patients with atrial fibrillation should be started on what type of therapy?
Those without afib but with TIA or stroke?
Anticoagulation i.e. warfarin
Aspirin or clopidogrel (anti platelet agents)
47 year old with 12-hour hx spinning sensation that worsens when he closes his eyes. Hearing is normal. Horizontal-rotary nystagmus present. What does he have?
-Vestibular neuritis (inflammation of vestibular portio 8th cranial nerve usually post-infectious)
Menieres disease would present with episodic vertigo, hearing loss, and tinnitus.
Indication for topical mupirocin
Superficial bacterial infections like impetigo
Treatment for candidal diaper rash?
Nystatin
**look for satellite lesions; use of abx= higher risk for development
Juvenile Rheumatoid Arthritis (before age 16)
- Subtypes
- extraarticular manifestations
Oligoarticular disease - fewer than 5 joints and ANA positivity Polyarticular disease - greater than 5 joints, negative ANA Systemic disease (still's disease) - variable joint involvement, rash, quotidian fever, serositis
-Uveitis (slit lamp exam), rash, lymphadenopathy
Management of stable supraventricular tachycardia (regular, narrow complex)
Adenosine (short-active blockade of AV node), vagal maneuvers
- can also use B blockers/CCBs
Indication of Amiodarone
Ventricular and refractory supra ventricular tachycardias
What kind of murmur does Aortic stenosis present with?
Treatment of severe Aortic stenosis
- systolic crescendo-decrescendo murmur with radiation to carotids best heard at upper right sternal border
- Valve replacement
72 yo man w/ PMHx DVT 8 months ago presents with 3 month hx of swelling and discoloration of leg, edema, discomfort.
- Postphlebitic aka post-thrombotic syndrome characterized by venous insufficiency s/p DVT.
- *edema, skin pigmentation, pain, vein dilation, venous ulcer formation weeks to months after DVT
vs. thrombophlebitis= inflammation w/ underlying thrombus, superficial phlebitis= painful, erythematous, palpable thickened cord along affected vein
Initial management of MALT lymphoma
MALT lymphoma due to H. Pylori infection (B lymphocytes stimulated by T Lymphocytes reactive to H. Pylori) –> tx= eradication of H. Pylori therefore:
- Antibiotics - usually resolves condition
- Refractory disease- radiotherapy or immunotherapy (rituximab)
Next step in management for 27 yo woman who has been on PPI at max dose over 6 months for GERD without control of sxs.
24 hour esophageal pH monitoring= gold standard to diagnose GERD and may identify people who have not yet developed esophagitis
- patients that do not respond to PPI may require surgery (Nissen fundiplication)
Lab findings in a man with alcoholic hepatitis which is frequently accompanied by cholestasis
- disproportionate rise in alk phos vs ALT/AST, high bilirubin, and high GGT
Cause of stress incontinence
Cause of urge incontinence
Cause of overflow incontinence
- weakness of pelvic floor muscles – urethral incompetence (loss of support of urethra)
- detrusor instability/overactive bladder (treat with oxybutynin)
- neurogenic bladder; spinal cord injury–> urinary retention and overflow incontinence
Pregnant woman with peritoneal signs 2/2 appendicitis. Management?
Exploratory laparotomy even though she’s pregnant; do not get CT first
Positive predictive value and negative predictive value calculation
Sensitivity and specificity calculation
PPV: true positives/(true positives + false positives)
NPV: true negatives/(true negatives + false negatives)
**horizontal
Sensitivity: True positive/(true positive + false negative)
Specificity: True negative/(true negative + false positive)
**vertical
Tx of BPH in patient with orthostatic hypotension
Finasteride over a1-blocker i.e. tamsulosin) b/c tamsulosin would worsen orthostatic hypotension
- first line is usually a1 blocker
Which nephropathy is associated with HIV, sickle cell disease, and opioid abuse and how is it diagnosed?
FSGS - kidney biopsy
*urine cytology is for urinary tract malignancy
6 year old boy brought in with hair loss and lump on his scalp with concomitant lymphadenopathy- diagnosis?
Tinea capitus– trichophyton tonsurans
Presentation and diagnosis of osteosarcoma
Usually with pain and swelling but can also present with fragility fracture. ** causes bony destruction presenting as cortical/periosteal irregularity and elevation on x-ray
- biopsy of bony lesion necessary for diagnosis (though MRI may precede this)
Woman with abdominal cramps and loose stools/flatulence who eats sugar free gum and diet soda; what is the causative agent?
Sorbitol- can be used as a laxative; osmotic effect b/c poorly absorbed in small bowel
Outcome of untreated childhood umbilical hernia?
Progressive enlargement of umbilical ring
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