NBME 9

NBME 9 Kid with bed wetting problems + constipation tx? administration of an osmotic laxative Multiple myeloma is marked by proliferation of ______ B cells monoclonal In patients with bipolar disorder that are suffering from acute depression + stopped taking meds, what do you give them? bipolar medication like lithium, lamotrigine, quetiapine, and lurasidone SSRIs in bipolar patients can be bad because? it can precipitate mania or convert depression to mania Patient with afib with a history of TIA or stroke Tx? warfarin Patient without afib with history of TIA or stroke Tx? aspirin T/F: Aspirin and clopidogrel are anticoagulants false 1st line therapy for mild to moderate acne vulgaris Tx? topical retinoids Patient with juvenile idiopathic arthritis may present with what extraarticular manifestation? uveitis (screen with slit-lamp exam) In adults, the presence of a destructive bone lesion is more commonly caused by ______ disease rather than primary bone malignancy metastatic T/F: Osteosarcoma is most common in patients ____ years of age 30 Patients with severe AS with symptoms or systolic dysfunction (EF 50%) should receive what tx? aortic valve replacement Patients with HF (EF 50%) who have AS + asymptomatic in terms of SOB on exertion, should receive what treatment? Afterload reduction 32 yo woman with bcg vaccine as a child + emigrated from China + PPD skin test of 12 mm risk status and next step? High risk; isoniazid 92 yr old with left mandibular mass that has enlarged + x ray is normal + smoker + normal VS next step? biopsy 77 yr old woman with 1 day hx of nausea + vomiting + confusion + has HTN + on diltiazem + BP 160/70 + ox 84% + JVD borderline high + crackles in lungs + S3 + edema + signs of kidney injury Dx and next step? fluid overload; hemodialysis In diabetic patients, foot injuries can be prevented with? wearing shoes when standing or walking In diabetic patients, worsening of foot injuries can be prevented with? daily foot checks 37 yr old woman with no hx of abnormal pap smears + current visit shows pap smear with atypical glandular cells potential dx and next step? endometrial malignancy; colposcopy with endocervical curettage 37 yr old woman with no hx of abnormal pap smears + current visit shows pap smear with atypical glandular cells After colposcopy with endocervical curettage, what can be considered as a next step? hysteroscopy T/F: Neonate that improved with PPV can be taken off of PPV immediately after true If there is suspected FSGS, what is the next step? renal biopsy If there is suspected FSGS, what is the next step after confirming it with renal biopsy? prednisone therapy 1st line tx for Merniere's disease antihistamines (e.g. Meclizine) 2nd line tx for refractory Merniere's disease methylprednisolone T/F: Initial step to controlling allergic rhinitis can include use of pillow and mattress covers true COPD exacerbations can be treated with? supplemental oxygen, SABA, steroids, antibiotics, and nebulizers COPD daily management should include? LABA, tiotropioum, steroids T/F: Oral steroids are the main daily treatment for chronic COPD patients. false T/F: LABA are the main daily treatment for chronic COPD patients. true What chemical can cause osmotic diarrhea, bloating, and abdominal discomfort when used in excessive quantities? sorbitol T/F: Aspartame is commonly associated with diarrhea false Most umbilical hernias regress by ____ years of age 3 Most umbilical hernias that are ____ cm in children 3 years of age are most likely to continue enlarging. 1.5 T/F: CT scan is better for nephrolithiasis than x-ray true Majority of renal calculi are radioopaque and can be visualized with ____ CT Struvite and cystine calculi are ______ renal calculi radiolucent US can be useful for detecting _____ renal calculi radiolucent 24 yr old woman who has fever + diffuse tenderness on bimanual + tender uterus + 28 hours post vaginal delivery potential dx and next step? endometritis; IV abx Risk factors for endometritis post delivery PPROM, prolonged labor, c-section, BV, GBS, manual placental removal Vitamin deficiency associated with Roux-en-Y gastric bypass? Vitamine B1 B1 is primary absorbed where? jejunum Tx for people who have allergies to bee stings and develop anaphylaxis? hymenoptera venom immunotherapy (VIT) T/F: Steroids and antihistamines can be used to prevent anaphylaxis from bee stings false The proportion with a negative test will mostly impact the _______. NPV The proportion with a positive test will mostly impact the _______. PPV The proportion with the lowest false positive rate will have the highest _____ specificity The proportion with the lowest false negative rate will have the highest _____ sensitivity T/F: Most significant risk factor for alzheimer's is advancing age. true T/F: Most significant risk factor for alzheimer's is genetics. false Diagnostic tool for DDH? US Wide QRS complex without identifiable P waves + tachycardic Patient is 72 yrs old + collapsed + hx of heart disease Dx? vtach 1st line tx for STABLE sustained (30 seconds) VT? Class I or III anti-arrhythmics (lidocaine, amiodarone) 1st line tx for unstable sustained (30 seconds) VT? synchronized cardioversion 1st line tx for pulseless sustained (30 seconds) VT? defibrillation ECG with narrow QRS + no p wave in between QRS complexes, just T wave dx? premature atrial contraction T/F: LDL cholesterol is essential for assessing cardiovascular risk false T/F: HDL and total cholesterol can be enough to assess cardiovascular risk. true In patients without risk factors who are aged 40-45 can be screened for cholesterol every ____ 3-5 years 47 yr old post collision + unrestrained + conscious on arrival and followed commands + pulse 110 + BP 90/55 + resuscitated en route with IL of LR + SOB and chest pain + nasogastric tube inserted --- BP 130/70 + x-ray shows fluid at base of left lung field, fluid density at left pleural apex + NG tube deviated to right in upper mediastinal region -- BP 80/40 dx? aortic transection T/F: Eye exam in NF2 patients can be done annually. false T/F:MRI of brain is needed for NF2 patients annually true 62 yr old woman with 6 month hx of increasingly severe left knee pain + no history of trauma + giving away sensation while walking + worse when walking up stairs or sitting in car + tenderness to palpation along patella + sensation decreased over left hallux + BMI 46 dx? chondromalacia patella