Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
QId: 2634
Myasthenia Gravis
pupils are 3mm, round, reactive to light. Pt has no ptosis, ocular movements are normal.
Found antibodies directed against nicotinic receptors on the motor endplate.
Q = most appropriate next step in management of pt?
A = CT scan of the chest
causes of exacerbations:
meds: abx: FQ, AG; anesthetics: NM blocking; cardiac meds: Beta blockers, procainamide;
taper immunosuppressive meds; pregnancy/childbrith
Dx = bedside: endrophonium (tensilon) test, ice pack test; Acetylcholine receptor antibodies
(specific); CT scan of chest to eval for THYMOMA
----
wrong:
*cerebral angiogram - in ischemic stroke however,Cerebrovascular disease unlikely in young pt
w/fluctuating diplopia & positive acetylcholine receptor antibodies
QId: 2754
Rough, dry, scaly skin.
Winter months
a/w mild itching but no erythema or exudates
pic image:
Q = diagnosis?
A = Ichthyosis Vulgaris
-----wrong:
*Ichthyosis have atopic dermatitis, can aggravate ss.
Atopic dermatitis cause patchy
*irritant contact dermatitis - from exposure to irritating chemicals: soaps, detergents, solvents
1
Medicine - Dermatology
QId: 3195
Bruton agammaglobulinemia
15month old boy....4 Episodes of otitis media & 2 episodes of lobar pna
WBC 8,000; lymphocyte 2,000
Immunoglobulins
IgG 80; IgA 31mg; IgM 11; IgE 18mg
Q = diagnosis?
A = Bruton agammaglobulinemia
*SCID: severe combined immunodef. by impared T-cell devel & B-cell dysfunct.
Pediatrics - Allergy & Immunology
QId: 3613
Pneumocystic pneumonia PCP & cytomegalovirus (CMV)
ss: fever, malaise, progressive dyspnea on exertion, dry cough, abdominal pain, watery
diarrhea.
-------
wrong:
2
*Cryptosporidium - cause diarrhea in immunosuppressed pts usually doesn't involve lung
*Legionella ss: high fever >102.2, GI ss: diarrhea, lung ss....( NOT BLOODY DIRRHEA!!) CMV
mor common than legionella
QId: 4416
SLE (pancytopenia dec RBC, WBC, plts)
*Dilutional thrombocytopenia - occur in massive blood transfusion needs more packed RBC
transfusions...(have no plts)
QId: 4417
Nocardia
-immunocompromised pt has systemic ss, lung nodules, brain abscess (cause seizures), cx
grows gm +ve...partially acid-fast, filamentous, branching rods.
---wrong:
*Actinomyces - tx pcn G
3
*voriconazole = DOC for aspergillosis
Medicine - Infectious Diseases
QId: 4527
mva.
HoTN. has brusies over chest, collapsed neck veins bilaterally.
CXR: large left hemothorax & a widened, rightward deviating mediastinum
Q = diagnosis?
A = aortic injury
ss: rapid deceleration blunt chest trauma = risk for aortic injury... minority of pts w/aortic injury
have an incomplete or contained rupture
*Containe rupture.
AMS common
*Myocardial contusion - ss: tachycardia, new BBB or arrhythmia a/w sternal; sternal fracture.
QId: 4669
IV drug use or recent incarceration
+ ss: fatigue, fever, wt loss, cough
CXR: diffuse reticulonodular patter (millet seed)
-----
wrong:
*Hodgkin dz ss: painless LNpathy & B sx: fatigue, wt loss, night sweats, mediastinal mass
4
*Mets disease to lung: multiple masses; lymphagitic carcinomatosis (have reticulonodular
appearance)
(fevers...uncommon in mets cancer); multiple rf for TB
*Mycoplasma pneumonia - subacute fever, lung ss: reticulonodular pattern on CXR. (doesn't
cause ss for 2months)...most cases are limited to 2-3wks
Medicine - Infectious Diseases
QId: 4738
3.5cm infrarenal abdominal aortic aneurysm in elderly man.
h/o htn, DM2. meds: thiazide.
smoked 1-2packs of cigs/day.
BP 160/90.
Q = which is a/w highest rate of aneurysm expansion & rupture in pt?
A = active smoking
strongest predictors of Abdominal Aortic Aneurysm expansion & rupture are large Aneurysm
diameter...rapid expand rate, current SMOKING. size >5.5cm.
----
wrong
*htn has a weak a/w AAA formation & its rate of expansion and rupture.
Medicine - Cardiovascular System
QId: 4772
Massive Embolism (h/o mets cancer....HoTN, shock)
Elderly
BP 80/40mm
Upper & lower limbs cold & clammy
RAP 18 (nml 0-8mmHg)
Pulm artery pressure 43/21mm (nml 15-28/5-16mm)
PCWP 9mm (nml 6-12mmHg)
Q = diagnosis
A = pulmonary embolism
----
wrong:
*Aortic dissection cause syncope...doesn't affect heart hemodynamic.....unless complications:
pericardial tamponade.
*Hypovolemic shock (or vol depleted)...have low Intravascular vol causes decreased RA, PA,
PCWP....SVR is increased to maintain adequate perfusion to vital
*LAD cause anterior MI...can lead to cardiogenic shock; increases PCWP, decr CO, incr SVR
*Septic shock...leads to peripheral vasodilation & decr SVR....low BV to heart cause decr RA,
PA, PCWP (CO incr tissue perfusion)
Medicine - Pulmonary & Critical Care
5
QId: 8815
Postnasal drip, GERD, Asthma account >90% of chronic cough in nonsmokers
Tx = inital empiric: first generation antihistamin CHLORPHENIRAMINE or brompheniramine &
pseudoephedrein
Pt do not respond after 2-3weeks requires more investigation (sinus imaging, pulmonary
function tests, high-resolution CT scan of chest) or empiric sequential therapy for GERD, cough-
variant asthma, chronic sinusitis, non-asthmatic eosinophilic bronchitis
Medicine - Pulmonary & Critical Care
QId: 8871
Refeeding syndrome (chronic starvation & acute refeeding....life threatening in ppl w/anorexia
nervosa)
why: carb ingestion...IV or enteral...causes pancreatic insulin secretion & cell uptake of
phosphorus, K, Mg
(can potentiate cardiac arrhythmias)
Pediatrics - Endocrine, Diabetes & Metabolism
QId: 10904
Meningococcal vaccination
6
18yoM had Crohn disease 3yrs ago.... on methotrexate & adalimumab.
Miningococcal polysacchardie vaccine @age 11
Received all childhood vaccines prior to taht.
Q = vaccines should be recommended for pt?
A = Meningococcal booster dose
----
wrong:
*Live-attenuated vaccines....receive tumor necrosis factor (antagonists -adalimumab)
Medicine - Infectious Diseases
QId: 11894
Panic Disorder
32yoM
sudden heart pounding, SOB, Chest pain, dizziness, shaking.
Episodes last about 10mins.
Pt fears having episodes....
Extensive w/u...found nothing wrong.
Q = likely diagnosis?
A = Panic disorder
---
wrong:
*deveopment of a neur sx is inconsistent w/recognized neuro disease
*Illness anxiety disorder - excessive anxiety about having or acquiring a serious ilness....
multiple somatic ss
Psychiatry - Psychiatric/Behavioral & Substance Abuse
QId: 12056
Ectopic preganancy
ss: abdominal pain, amenorrhea, vagina bleeding; hypovolemic shock in ruptured ectopic
7
pregnancy; cervical motion, adnexal or abdominal tenderness; Palpable adnexal mass
-acute abdomen (eg: guarding w/decreased bowel soudns) likely dt hemoperitoneum from a
ruptured ectopic pregnancy in let uterine cornu
---wrong:
*D&C performed to remove uterine contents for spontaneous or incomplete abortion.
QId: 12204
Tardive Dyskinesia
-moa: dopamine D2 receptor upregulation & supersensitivity results from chronic blockade of
dopamine receptors
Man....sticking out tongue, smacking his lips, twisting body from side to side....
h/o schizoaffective disorder treated w/risperidone
Q = likely underlying cause of pt's sx?
A = Dopamine receptor supersensitivity
QId: 12284
Fetal Growth Restriction
8
wrong
*intraventricular hemorrhage: gestation age <30wks at delivery (resp distress) tachypnea,
grunting & HoTN
*
Obstetrics & Gynecology - Pregnancy, Childbirth & Puerperium