Step 2 Ck Nbme 8

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? 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? 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 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 neurogenic bladder urge incontinence cause and management 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 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 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 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 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 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 -Detrusor hyperactivity -MS -Overflow incontinence -Stress detrusor hyperactivity aka urge incontinence 47 yo comes to the ED 2 hours after onset of pins and needles sensation and weakness in right leg with 2 hour of confusion. He was diving in deep water What is the cause Air embolism (bends) air gets into the SVC and travels to the lungs and present similar to PE in divers it is due to barotrauma and gas is introduced into venous system 72 yo male has 6 non hx of SOB with minimal exertion and has worked as coal minor for most of his life. On PE he has clubbing of fingers and bilateral upper lobe consolidation cause? pneumoconiosis -type of interstitial lung disease fun fact clubbing in the distal phalanx is due to increase in soft tissue PPD 5mm consider positive in who? HIV recent TB exposure CXR consisted with healed TB organ transplantation or immnosuppresntas PPD 10mm consider positive in who ? IV drug users DM Chronic renal failure employees in high risk areas (i.e. nurses) PPD 15mm consider positive in who? in patient with no known risk factors medication for TB prophylaxis INH 22 YO with 2 day hx of nausea diarrhea and has TBili 3.2 with Indirect 2. 8 what is diagnosis of illness Gilbert disease deficiency in serum glucoronosyltransferase Vaccine indicatedin HIV positive pt with CD4 479