Step 2 CK NBME 8
42 YO male presents with SOB for 3 weeks -Breath sounds decreased over left hemithorax
-CXR shows mass involving the left upper and lower lobe -Biopsy shows uniform small round cells with darkly staining nuclei What is initial tx? - correct answer Small cell lung cancer -initial therapy is chemotherapy bc surgery has limited role given that these tumors are nonresectable
27 YO male with cough , SOB, weight loss in 6 mons. PE shows A/P Cervical LAD and white plaques over buccal mucosa -CXR shows diffuse bilateral infiltrates diagnosis? - correct answer AIDS
-pt has oral thrush, clear aids defining illness
25 YO woman wants to discuss risk for dementia
which of the following has greatest predisposing risk?
-fmhx
-gender
-head injury -low educational level -smoking - correct answer family hx 72 YO woman undergoing rehab s/p 6 weeks after cerebral infarction. Has urinary dribbling and palpable smooth mass in supra public area
-UA shows 3-5 squamous epithelial cells/hpf type of urinary incontinence - correct answer neurogenic bladder
urge incontinence cause and management - correct answer due to detrusor instability (think older nursing home patient) having the sudden urge to void but only goes a little bit manage with exercises first then anticholinergic medications
Stress incontinence cause and diagnosis - correct answer weakness of pelvic diaphragm (think women with multiple babies) urine with physical movement manage with Kegel exercises, estrogen therapy, pessary, surgery (midurethral sling)
overflow incontinence cause and diagnosis - correct answer inadequate bladder contraction (think older person with neurologic deficit like DM or stroke) self Cath, cholinergic meds(increase contraction) , alpha blockers (decrease sphincter resistance)
52 Yo mane comes because of 3 day fever, diffuse cervical LAD and liver edge is 2cm below right costal margin, spleen is 2 cm below. HCT 26%
Put 68,000/mm3
What is the cause - correct answer myeloproliferative disorder like polycythemia vera
tx with phlebotomy so that other cell lines can grow and you can decrease HCT
52 YO male brought to ER due to searing back pain radiating to CVA
BP 220/120
drinks lots of beer given IV morphine and labetalol which decrease pain cause, test with highest sensitivity - correct answer thoracoabdominal aortic dissection use TEE(especially with unstable patient) CT is good too
25 Yo male brought in for 1 hour of non radiating chest pain, he smoked crack cocaine 30 min before the onset What is initial pharmacotherapy - correct answer Aspirin
42 YO G4P4 with 6 mon hx of difficulty urinating. She has MS and optic neuritis which resolved after treatment. No neurological findings, no post residual volume, UA is negative What is causing her difficulty to urinate?
-chronic UTI
42 YO male presents with SOB for 3 weeks -Breath sounds decreased over left hemithorax
-CXR shows mass involving the left upper and lower lobe -Biopsy shows uniform small round cells with darkly staining nuclei What is initial tx? - correct answer Small cell lung cancer -initial therapy is chemotherapy bc surgery has limited role given that these tumors are nonresectable
27 YO male with cough , SOB, weight loss in 6 mons. PE shows A/P Cervical LAD and white plaques over buccal mucosa -CXR shows diffuse bilateral infiltrates diagnosis? - correct answer AIDS
-pt has oral thrush, clear aids defining illness
25 YO woman wants to discuss risk for dementia
which of the following has greatest predisposing risk?
-fmhx
-gender
-head injury -low educational level -smoking - correct answer family hx 72 YO woman undergoing rehab s/p 6 weeks after cerebral infarction. Has urinary dribbling and palpable smooth mass in supra public area
-UA shows 3-5 squamous epithelial cells/hpf type of urinary incontinence - correct answer neurogenic bladder
urge incontinence cause and management - correct answer due to detrusor instability (think older nursing home patient) having the sudden urge to void but only goes a little bit manage with exercises first then anticholinergic medications
Stress incontinence cause and diagnosis - correct answer weakness of pelvic diaphragm (think women with multiple babies) urine with physical movement manage with Kegel exercises, estrogen therapy, pessary, surgery (midurethral sling)
overflow incontinence cause and diagnosis - correct answer inadequate bladder contraction (think older person with neurologic deficit like DM or stroke) self Cath, cholinergic meds(increase contraction) , alpha blockers (decrease sphincter resistance)
52 Yo mane comes because of 3 day fever, diffuse cervical LAD and liver edge is 2cm below right costal margin, spleen is 2 cm below. HCT 26%
Put 68,000/mm3
What is the cause - correct answer myeloproliferative disorder like polycythemia vera
tx with phlebotomy so that other cell lines can grow and you can decrease HCT
52 YO male brought to ER due to searing back pain radiating to CVA
BP 220/120
drinks lots of beer given IV morphine and labetalol which decrease pain cause, test with highest sensitivity - correct answer thoracoabdominal aortic dissection use TEE(especially with unstable patient) CT is good too
25 Yo male brought in for 1 hour of non radiating chest pain, he smoked crack cocaine 30 min before the onset What is initial pharmacotherapy - correct answer Aspirin
42 YO G4P4 with 6 mon hx of difficulty urinating. She has MS and optic neuritis which resolved after treatment. No neurological findings, no post residual volume, UA is negative What is causing her difficulty to urinate?
-chronic UTI
