HY FM from Melhman Medical EXAM Questions AND Correct Answers
- "Step-off" of one vertebra relative to another - ✔✔spondylolisthesis
- "Wait I don't understand. Why would aspirin cause asthma?" -
✔✔arachidonic acid can be shunted down either the cyclooxygenase
or lipoxygenase pathways; if you knock out COX irreversibly by giving
aspirin (or reversibly with another NSAID), more arachidonic acid will
be shunted down the lipoxygenase pathway � more leukotrienes �
more bronchoconstriction
- "Wait, why is bicarb normal in acute asthma attack? Shouldn't it go
low to compensate if CO2 is low?" - ✔✔not enough time for bicarb to
change; takes a minimum of 12-24 hours for renal elimination to have
an effect on serum levels; this is why in altitude sickness, where CO2
is low (due to high RR bc of lower atmospheric O2), azetazolamide
(carbonic anhydrase inhibitor) can be given to increase bicarb loss in
the PCT of the kidney to essentially force a metabolic acidosis to
compensate.
- 11-13-year-old overweight boy with a painful limp; Dx? - ✔✔SCFE; Tx
= surgical pinning - Tissue mass in palm of hand + bent fingers; Dx? �
Dupuytren contracture � seen in alcoholism, diabetes, Norwegian
descent, and epilepsy. Tx is surgical
- 12M + acute asthma episode + given O2 + nebulized albuterol + IV
steroids + his acid-base disturbance is as we talked about above -
,✔✔after 30 minutes, new values are: low O2, normal CO2, normal pH,
normal bicarb; why? � he's getting tired � low O2 means he should
still be hyperventilating, so for CO2 and pH to have normalized means
his RR is decreasing � answer on USMLE = intubate. When O2 and CO2
are both initially down, that's called a type I respiratory failure; then
eventually it will invert, where this patient will have a respiratory
acidosis with low O2, high CO2, low pH, normal bicarb (type II
respiratory failure when O2 and CO2 are the opposite).
- 12M + red urine 1-2 weeks after URTI or skin infection - ✔✔PSGN �
can get it from Group A Strep skin infections
- 12M + red urine 1-3 days after upper respiratory tract infection
(URTI) - ✔✔IgA nephropathy, not PSGN; can also get IgA nephropathy
from GI infections
- 12M has ongoing wheezing episodes + is on albuterol inhaler; next
best step? - ✔✔add low-dose ICS
- 12M has ongoing wheezing episodes + is on albuterol inhaler; what's
most likely to decrease recurrence - ✔✔oral corticosteroids
- 13F has never had a period + has suprapubic mass + nausea +
vomiting; next best step in Mx? - ✔✔answer = do beta-hCG � she's
pregnant; this is HY. Correct, girls can get pregnant without ever
having had a period � must rule out
,- 14F has massive unilateral breast mass + mom is freaking out bc her
sister died of breast cancer - ✔✔answer = follow-up in six months �
virginal breast hypertrophy is normal during puberty
- 15M + 5'11" + plays soccer + knee pain; Dx? - ✔✔Osgood-Schlatter -
>inflammation of patellar ligament at the tibial tuberosity; occurs in
fast-growing, active teenagers; USMLE wants "repeated avulsion
microfractures" as an answer
- 15M has unilateral mass behind his nipple +/- tenderness of it -
✔✔answer = reassurance � physiologic gynecomastia of puberty
(higher androgens are aromatized to estrogens)
- 16M + acutely painful testes + negative cremasteric reflex; Dx? -
✔✔answer = testicular torsion; do Doppler ultrasound followed by
surgical detorsion
- 16M + painful testes + fever + positive cremasteric reflex; Dx? -
✔✔answer = epididymitis
- 16M goes snowboarding all day + takes pain reliever for sore
muscles afterward + next day develops wheezing out on the slopes
again; what's going on? - ✔✔took aspirin + this is Samter triad (now
cumbersomely known as aspirin-exacerbated respiratory disease
[AERD]) � triad of aspirin-induced asthma + aspirin hypersensitivity +
, nasal polyps). Just to be clear, other NSAIDs can precipitate Samter
triad, but the literature + USMLE will make it explicitly about aspirin.
- 16M takes aspirin + gets wheezing; what are we likely to see on
physical exam? - ✔✔answer on USMLE = nasal polyps.
- 17F + painless lateral neck mass + mediastinal mass; Dx? -
✔✔Hodgkin lymphoma
- 17F + really bad period pain + physical exam is normal - ✔✔answer =
primary dysmenorrhea = prostaglandin hypersecretion (PGF2alpha) �
give NSAIDs
- 18F + anorexia + runs long distances + has foot pain; Dx? -
✔✔metatarsal stress fracture
- 2-year-old boy running + playing with 8-year-old sister + they were
holding hands and he fell + now he holds arm pronated by his side;
Dx? - ✔✔nursemaid's elbow � radial head subluxation
- 22F + pain radiating down one arm; Dx? - ✔✔answer = cervical disc
herniation.
- "Step-off" of one vertebra relative to another - ✔✔spondylolisthesis
- "Wait I don't understand. Why would aspirin cause asthma?" -
✔✔arachidonic acid can be shunted down either the cyclooxygenase
or lipoxygenase pathways; if you knock out COX irreversibly by giving
aspirin (or reversibly with another NSAID), more arachidonic acid will
be shunted down the lipoxygenase pathway � more leukotrienes �
more bronchoconstriction
- "Wait, why is bicarb normal in acute asthma attack? Shouldn't it go
low to compensate if CO2 is low?" - ✔✔not enough time for bicarb to
change; takes a minimum of 12-24 hours for renal elimination to have
an effect on serum levels; this is why in altitude sickness, where CO2
is low (due to high RR bc of lower atmospheric O2), azetazolamide
(carbonic anhydrase inhibitor) can be given to increase bicarb loss in
the PCT of the kidney to essentially force a metabolic acidosis to
compensate.
- 11-13-year-old overweight boy with a painful limp; Dx? - ✔✔SCFE; Tx
= surgical pinning - Tissue mass in palm of hand + bent fingers; Dx? �
Dupuytren contracture � seen in alcoholism, diabetes, Norwegian
descent, and epilepsy. Tx is surgical
- 12M + acute asthma episode + given O2 + nebulized albuterol + IV
steroids + his acid-base disturbance is as we talked about above -
,✔✔after 30 minutes, new values are: low O2, normal CO2, normal pH,
normal bicarb; why? � he's getting tired � low O2 means he should
still be hyperventilating, so for CO2 and pH to have normalized means
his RR is decreasing � answer on USMLE = intubate. When O2 and CO2
are both initially down, that's called a type I respiratory failure; then
eventually it will invert, where this patient will have a respiratory
acidosis with low O2, high CO2, low pH, normal bicarb (type II
respiratory failure when O2 and CO2 are the opposite).
- 12M + red urine 1-2 weeks after URTI or skin infection - ✔✔PSGN �
can get it from Group A Strep skin infections
- 12M + red urine 1-3 days after upper respiratory tract infection
(URTI) - ✔✔IgA nephropathy, not PSGN; can also get IgA nephropathy
from GI infections
- 12M has ongoing wheezing episodes + is on albuterol inhaler; next
best step? - ✔✔add low-dose ICS
- 12M has ongoing wheezing episodes + is on albuterol inhaler; what's
most likely to decrease recurrence - ✔✔oral corticosteroids
- 13F has never had a period + has suprapubic mass + nausea +
vomiting; next best step in Mx? - ✔✔answer = do beta-hCG � she's
pregnant; this is HY. Correct, girls can get pregnant without ever
having had a period � must rule out
,- 14F has massive unilateral breast mass + mom is freaking out bc her
sister died of breast cancer - ✔✔answer = follow-up in six months �
virginal breast hypertrophy is normal during puberty
- 15M + 5'11" + plays soccer + knee pain; Dx? - ✔✔Osgood-Schlatter -
>inflammation of patellar ligament at the tibial tuberosity; occurs in
fast-growing, active teenagers; USMLE wants "repeated avulsion
microfractures" as an answer
- 15M has unilateral mass behind his nipple +/- tenderness of it -
✔✔answer = reassurance � physiologic gynecomastia of puberty
(higher androgens are aromatized to estrogens)
- 16M + acutely painful testes + negative cremasteric reflex; Dx? -
✔✔answer = testicular torsion; do Doppler ultrasound followed by
surgical detorsion
- 16M + painful testes + fever + positive cremasteric reflex; Dx? -
✔✔answer = epididymitis
- 16M goes snowboarding all day + takes pain reliever for sore
muscles afterward + next day develops wheezing out on the slopes
again; what's going on? - ✔✔took aspirin + this is Samter triad (now
cumbersomely known as aspirin-exacerbated respiratory disease
[AERD]) � triad of aspirin-induced asthma + aspirin hypersensitivity +
, nasal polyps). Just to be clear, other NSAIDs can precipitate Samter
triad, but the literature + USMLE will make it explicitly about aspirin.
- 16M takes aspirin + gets wheezing; what are we likely to see on
physical exam? - ✔✔answer on USMLE = nasal polyps.
- 17F + painless lateral neck mass + mediastinal mass; Dx? -
✔✔Hodgkin lymphoma
- 17F + really bad period pain + physical exam is normal - ✔✔answer =
primary dysmenorrhea = prostaglandin hypersecretion (PGF2alpha) �
give NSAIDs
- 18F + anorexia + runs long distances + has foot pain; Dx? -
✔✔metatarsal stress fracture
- 2-year-old boy running + playing with 8-year-old sister + they were
holding hands and he fell + now he holds arm pronated by his side;
Dx? - ✔✔nursemaid's elbow � radial head subluxation
- 22F + pain radiating down one arm; Dx? - ✔✔answer = cervical disc
herniation.
