NBME 10 REVIEW COMPLETE SOLUTIONS

NBME 10 REVIEW COMPLETE SOLUTIONS Why do you need to screen for TB before starting TNF -alpha inhibitor TNF -alpha is important for granuloma formation - when you inhibit this, granulomas break down and release contents --> active TB Treatment of sickle cel l pain crisis Aggressive pain control (with opiates and nonopioids), IV fluid resuscitation (to treat hypovolemia), supplemental oxygen Treatment of TACO (transfusion -associated cardiac overload) Oxygen or positive pressure ventilation if necessary Stop tra nsfusion Diuresis Reaction formation defense mechanism Changing an unacceptable impulse into its opposite (i.e. hating your sister --> intense love with buying lots of extravagant gifts for her) Delusional parasitosis treatment Rule out medical causes of symptoms Treat with antipsychotic and psychotherapy Unilateral or bilateral temporal lobe abnormalities on brain MRI, suspect what? HSV encephalitis Signs of HSV encephalitis Fever, AMS, seizure, focal neurologic deficits How to diagnose HSV encephalitis Lumbar puncture --> HSV -1 in CSF When is a stroke patient a candidate for alteplase If symptoms began less than 4.5 hours ago If not a candidate for alteplase, what should a stroke patient get? Aspirin Are anti -coagul ants used in the acute management of stroke? NO! Unilateral cervical lymphadenopathy with overlying purplish hue Mycobacterium lymphadenitis *would see caseating granulomas and organisms on acid -fast stain on biopsy Treatment of Mycobacterium lymphadenit is Surgical excision is definitive Sometimes antibiotics alone is enough in kids - treat with a macrolide and ethambutol with or without rifampin Most common causes of osteomyelitis S. aureus, Strep viridans, aerobic gram -negative bacilli Treatment of osteomyelitis IV antibiotics for 6 -12 weeks Suspected osteosarcoma on X -ray; next steps 1. MRI - evaluate extent of local invasion and allow for local staging 2. Bone biopsy 3. Aggressive surgical resection + chemo Signs of hypocalcemia Perioral paresthesia, carpopedal spasm, laryngospasm, prolonged QT interval Signs of hypomagnesiemia Typically asymptomatic, but if severe can lead to cardiac arrhythmias, seizures or tetany Signs of hyponatremia Nausea, malaise, lethargy, coma, seizures secondary to cerebral edema Signs of hypokalemia Muscle weakness, cramps, ileus, paresthesia, hyporeflexia, cardiac arrhythmias When to give IV fluids when a patient with heart failure, cirrhosis or ESRD has infection (like pneumonia)? If they are showing signs of hypovolemia (i.e. hypotension, AMS) *otherwise, do not give fluids! Right -heart MI on EKG ST elevation in II, III, avF What is contraindicated in right heart MI? Nitrates and opioids (lower preload even further - bad!) Acute management of right heart MI IV fluids !!! heparin, dual antiplatelet therapy, statin