nbme 7 – Flashcard

when to give acyclovir to pregnant woman?

woman who has hx of herpes, but hasnt had an episode since 6wks ago; now in labor; next step?

15 y/o low back pain x2 mos, dull ache, can't sleep, hx of prednisone for asthma, cushing and hirsute, tenderness to T11-L2 and paravert muscle spasm; CK and ESR nl. dx?

man has 6 hrs after onset of severe flank pain. afebrile, tachy. + CVA and RLQ tender. U/A shows 50-100 RBC's, 3-5 WBC. 2 hrs after morphine, symptoms subside. Next step? what is the diff btwn the UA of nephrolithiasis (kidney stones) vs. pyelonephritis?

elderly woman w/ CKD admitted for PNA, started on ceftriaxone and heparin, HAS POOR ORAL INTAKE, glucose still high even despite insulin adjustments, 2 DAYS LATER HAS PULM ANGIO w/ no PE. 4 days later, Cr is 3.6; what could have prevented acute deterioration of Cr?

widened mediastinum after MVA. what artery is affected? (no matter what vertebral lvl there's a fxr)

32yo F abdominal pain, N/V for 6 hours. Cholesystectomy 2 years ago. Menses wnl, LMP 2 weeks ago. No smoking/drinking. Appears acutely ill. Afeb, tachy, orthostatic hypotension, Exam: guarding with rebound, BS decreased. Labs: NA 146, K 3.3, Ca 8.9, T bili 1, alk phos: 120, AST 64 Amylase 1022. Most appropriate next step to determine cause is measurement of?

47yo F with fever, nausea, vomiting, and severe headache for 24 hours. T 39. Exam shows weakness of right upper extremity and nystagmus, optic fundi cannot be visualized. Kernig sign is present. Most appropriate next step in diagnosis?

6yo boy with cramping abdominal pain & right-sided scrotal pain for 4 hours. Vomited once, distended abdomen. BS decreased, and diffuse tenderness to palpation w/ guarding. Right hemiscrotum discolored with swelling & tenderness superiorly. Left hemiscrotum is wnl. next step in mgmnt?

woman with 5 day history of headache, severe, diffuse abdominal pain, nausea, vomiting. Pain is exacerbated by eating and relieved by vomiting. Vomitus originally had semisolid content with green fluid, and now only contains clear yellow fluid. Hx of Crohn dz treated with prednisone, tapered over the last 2 weeks, mesalamine, and azathioprine. LMP 7 weeks ago. Sex w/ 1 partner, use condoms inconsistently. Temp 38.4, P 120/min, Resp 22/min, BP 90/50. Dry oral mucosa, pale conjunctiva, distended abdomen, diffusely tender and tympanic. Decreased bowel sounds. Pelvic exam is normal. Labs: HCT 31% WBC 15k, amylase 300, lipase 9. Dx? what diff btwn SBO and gastric outlet obstruction?

4yo boy with 3-day hx of cough, fever, runny nose. No wheezing, vomiting, or diarrhea. 75th %ile for height, and 10th %ile for weight. T 37.5. Cap refill is 2 sec. Exam shows clear rhinorrhea. Breath sounds normal. There is a media tab to view the cardiac exam. Dx?

14 mo boy, mother is worried because he is not yet walking on his own. He will stand for several seconds before falling. He can empty raisins from a cup and tries to eat with a spoon. 25th %ile for length and 30th %ile for weight. Exam shows no abnormalities. Most appropriate next step?

27yo M and wife unable to conceive for past 10 mo. Wife conceived from previous marriage, husband with no children. Wife's menses and are normal, and her exam is wnl. Exam of husband shows ill-defined soft masses palpated bilaterally, high in scrotum. Most likely cause of these masses?

8-hour-old newborn develops jaundice and respiratory distress. Born at 39 weeks' following uncomplicated pregnancy and delivery. He is PALE AND EDEMATOUS. HEPATOSPLENO and scattered PETECHIAE. Labs show HB OF 4, total bilirubin of 15, with a direct component of 0.3. Dx?

57yo F with pain over left groin and anterior thigh for past year. Active range of motion of hip joint reproduces pain. 20-degree hip flexion contracture. ESR is 20; pelvic XR shown; Dx?

17yo girl in MVC as unrestrained driver. Arrives on a backboard with C-collar. During attempts to administer 100% O2, patient is combative. Facial trauma and open facial fractures. Chest severely bruised. Makes gurgling sounds when she breathes. Most appropriate initial step in management?

47yo M with 6-month Hx of progressive weakness that began in his right leg and gradually spread to his other extremities. Mild difficulty swallowing solids and liquids. Exam shows atrophy of right quads and both deltoid muscles and fasciculations in both quad muscles. Babinski sign present bilaterally. EMG and nerve conduction studies are most likely to show?

what dz has short duration, low amplitude motor unit potentials?

What dz has myotonic dyscharges?

43yo M with 3-day Hx of Temp 38.4C, left-sided chest pain, malaise, loss of appetite, and a cough productive of yellow phlegm and SOB. Smoked 2 packs/day for 25y. He appears ill. Pulse 112/min, resp 22/min, BP 118/72. Crackles and wheezes at left base, breath sounds decreased. Increased tactile fremitus and dullness to percussion at left base. CXR shown. Gram neg bacilli and leukocytes on stain. Dx? What bac cause PNA in COPD?

4 days after right hemicolectomy, 67yo F has leakage of serosanguineous fluid b/w incision staples; the dressing is soaked. Meds include corticosteroids for COPD, T 37.5C, pulse 73/min, BP 140/90 Abdominal exam shows distension with minimal incisional tenderness and no erythema. Dx?

anastomic leak sxs

37yo F with alcoholism in ICU for pancreatitis. During first 12 hours, vitals: Pulse 100-130/min; resp 28-36/min; SBP 90-110. 14 liters of crystalloid solution infused to maintain urine output of 30 mL/h. She is intubated for low O2 saturation. Lungs are clear. Pulmonary cath shows: Cardiac index 4.2L/min; CVP 11; PCWP 10. ABG on FiO2 of 60% and PEEP of 10: pH 7.32; Pco2 38; Po2 78. CXR shows bilateral, diffuse, hazy densities with cephalization of the pulmonary vasculature and perihilar fullness. Dx?

42yo F with intermittent loss of urine over past 3 weeks. Sx only after voiding. Pelvic exam shows 3-cm, midline, cystic, tender mass in the mid-third of vagina. U/A is normal. Post void residual volume is 50 mL. Dx?

*Plumber* with pruritic rash on back, moves around under houses during work. lab: 45% neutros, 15 eos, 30 lymphos, 10 monos, serpingous tracks on examination. dx?

57yo F with HTN in ER for 8-hour Hx of nausea, vomiting, diarrhea, abdominal pain, and weakness. Slight blurred vision, double vision, *dry mouth*, and tingling and numbness of her legs. 32 hours ago, consumed pork, shrimp, rice, and home-canned preserves. 1 week ago, had URI that resolved without treatment. T 36.9C, Pulse *64*/min, resp 16/min, BP 124/72. Pulse ox shows O2 saturation of 94%. *Pupils slightly dilated, sluggishly reactive.* Mucous membranes are dry. Normal cardiopulmonary exam. Weakness of oculomotor and facial nerves. Muscle strength 4/5 in lower extremities. DTR 2+. Dx?

72-year-old woman comes to the physician because of an increase in abdominal girth over the past 2 months. She has had a 3.6-kg (8-lb) weight gain during this period despite being unable to finish any meal. She has one martini daily after her 3-mile walk. She underwent lumpectomy and radiation therapy for stage I breast cancer 4 years ago and has been treated with tamoxifen since then. Abdominal examination shows a fluid wave. Pelvic examination shows an 8-cm, fixed, nontender mass in the cul-de-sac. Laboratory studies show normal findings. Which of the following is the most appropriate next step in management?

62yo M with intermittent painless rectal bleeding for 3 weeks. Hx of angina and taking inhaled corticosteroids for COPD. Smoked 1.5 packs daily for 45 years. Vitals normal. Crackles and wheezes bilaterally. Heart sounds normal. Rectal exam shows palpable mass 2-3 cm inside anal verge. Anoscopy shows 5-cm ulcerated mass, bx shows adenocarcinoma. Most appropriate next step in management?

16yo girl comatose next to a suicide note. Unresponsive. Temp 37.2C, p 100/min, resp 28/min, BP 100/66. Pupils reactive to light; doll's eye reflex present. Labs: Na 140, Cl 104, K 3.5, HCO3 6. ABG: pH 7.32, Pco2: 12; Po2: 92. What substance had she used in her suicide attempt?

A previously healthy 82-year-old woman comes to the physician because she is concerned that she has Parkinson disease. Over the past 6 months, she has had occasional difficulty finding the word that she wants to use, and her ability to distinguish smells has decreased. She reports that her reaction time to shifts in posture seems slow, and she needs to use a hand rail to steady herself while walking on stairs. She lives alone and is able to manage her own finances.T he pupils are 3 mm. There is mild reduction of upward gaze and brisk rotatory nystagmus on left lateral gaze. Audiometry shows mild high-frequency hearing loss. There are no tremors or rigidity. Her gait is normal. Her Mini-Mental State Examination score is 29/30. Which of the following neurologic findings warrants further evaluation?

Five days after open splenectomy for ITP, 57yo F has SOB. Only med is morphine. Temp 37.3C, p 80/min, resp 20/min, BP 120/80. Surgical wound appears normal. BS decreased at left lung base. WBC 15.6K, platelets 112k, amylase is 90U/L. Most appropriate next step in management?

67yo M with aching in the calves while walking during the past 2 months, relieved by rest. Decreased pedal pulses. Symptoms due to narrowing of?

72yo M for follow-up exam 4 weeks after 10-day quinolone Rx for UTI. Has been drinking 12 to 15 glasses of water daily to prevent another infection. 30-year hx of schizoaffective d/o. On Reisperidone. Oriented to person but not to place or time. P 80/min, BP 128/60, with no orthostatic changes. Exam shows dry oral mucosa and no JVD. Lungs clear. No peripherla edema. Muscle strength 5/5, sensation intact. Reflexes 1+ bilaterally. Labs: Na 122, K 4, Cl 94, HCO3 22, BUN 16, Cr 1.1; Urine: blood neg, glucose neg, protein neg, sodium 20, osmolality 200. Cause of hyponatremia?

47yo M with 9-mo Hx of constipation and 2-mo hx of blood in stool. Sx partially relieved by stool softeners and laxatives. Has hypercholesterolemia rx with atorvastatin, and had appendectomy at age 26. Vitals normal. Cardiopulmonary, abdomen exam normal. Rectal exam shows external hemorrrhoids. Positive occult blood test. *HCT is 35%*. next step?

A 20-year-old man is brought to the physician by his parents because of auditory hallucinations and bizarre behavior over the past year. He recently dropped out of college and moved back home with his parents. He has not attempted to find a job. He says that he has been feeling strange, "like being in a dream，＇and talks to his great-great-grandfather who died 50 years ago. He was diagnosed with hepatitis A 2 years ago after an episode of jaundice, and he has been treated with thyroxine for hypothyroidism for the past 6 months. His pulse is 68/min, respirations are 10/min, and blood pressure is 100/70 mm Hg. Physical examination shows hyperreflexia of the lower extremities and mild resting tremor of the upper extremities. On mental status examination, his voice is monotonous, his face is immobile, and he seems very anxious. He stares at the physician and barely answers questions. Serum studies show: Total bilirubin1 mg/dl Thyroid-stimulating hormone 1 µU/ml AST 21 U/L, ALT 20 U/L Urine toxicology screening is negative. Which of the following is the most likely diagnosis?

person with mixed cryo, rx?

drugs that cause central DI?

32 y/o F 2 day hx of vomiting, diarrhea, R sided pelvic pain. LMP 3 wks ago. T102, RR 20, HR 100, BP 120/70. Abd exam shows RLQ tenderness w/ rebound. decr BS. Pelvic exam shows R adnexal tenderness. (-) preg. Hgb 12, WBC 15km nl diff; *US SHOWS NO ADNEXAL MASSES.* Dx?

toddler develops chickenpox after visiting his newborn sister at nursery. 6 other newborns were exposed; all the moms have a hx of chickenpox prior to preg. Recommendation to prevent chickenpox in newborns?

*asymp* 60yo M comes in for f/u upper GIB from salicylate-induced ulcer. Upper GI series shows healed ulcer and type 1 (sliding) hiatal hernia. Which of the following is the most appropriate next step in mgmnt?

51 yr old woman had a 15 minute episode of acute R CP and SOB following insertion of a R subclavian catheter for hemodialysis. HR 92, RR 16, BP 114/72 =stable with no orthostatic hypotension. Hb 9. pulse oximetry = 94%. an xray chest shows 10% pneumothorax. the subclavian cathether is in good position. next step?

guy w/ ulcer on anterior surface of leg above ankle x2 wks; hx of mitral valve replacement for RHD. has CHF and DM2. 5cm ulcer w/ 3mm red border. edema from toes to midcalf bilat; feet are *warm*; pulses weakly palpable. scattered crackles heard at bases bilat. dx?

male newborn has bilat clubfoot. term nl preg. did not move extremities after birth and did not cry when he received needle stick in heel. Vigorous and moves UE but not LE. Bladder is palpable and full. dx?

diaper rash mgmnt

spondylosis and spondylolithesis sxs and epi

LVEDP = LA pressure = PCWP = PA diastolic pressure

demyelinating diseases