Hey guys, I needed help with the following questions if anyone could chime in that would be great: (PLEASEEEEE give one line explanation, that will help a LOT. THANK YOU)
1. 27 year old man comes because of 3 hr hx of muscle swelling and tenderness of left thigh following minimal trauma. He has severe hemoph A and has received factor VIII replacement therapy for bleeding episodes since childhood but recently his bleeding has been poorly controlled; increasing doses of VIII have been required to stop his bleeding; platelet count is 125K; APTT is higher than 120. Next step in diagnosis of his recent bleeding?
A. Measurement of bleeding time (I choose idk why)
B. Measurement of factor IX conc.
C. Measurement of thrombin time to detect heparin
D. Platelet function studies
E. Test for factor VIII inhibitor
A higher dose of factor VIII is needed to stop bleeding so there is something going on that directly affects the function of factor VIII, so you want to check for inhibitors, which are IgG against specific coag factors. Plus, it's the only one that makes sense.
2. 82 year old man ventilated in hosp for 48 hrs because of exacerbation of COPD. he passed no urine since removal of urinary catheter 12 hrs ago. Current meds include IV methylprednisolone and albuterol, ipratropium, fluticasone by inhalation. Dx?
A. AIN (I put)
B. Acute urethral obstruction
C. Contrast induced nephropathy
D. ESRD
E. Hepatorenal syn
F. Ischemic ATN (Is it this one?? I feel like an idiot)
G. Rhabdo
H. Prerenal azotemia
Yes, I'm going with ischemic ATN too. I think acute exacerbation of COPD = hypoxia = starved kidneys. It is also the best option out of all of them. AIN is seen more with NSAIDs and beta-lactams, which he isn't on.
3. 27 yo with mental ******ation has increasing intermittent vomiting (within hour of eating; contains partially digested food and no blood) over 3 weeks. Appetite unaffected but he stops eating before completing meal. Had 8 lb weight loss since last visit. Takes phenytoin for seizure disorder. 3x4 cm area of alopecia in right occipitoparietal area of scalp. Abdominal musculature voluntarily contracts with palpation; no organomgaly or masses palpated. Minimal contractures in both upper and lower extremities and increased muscle tone. Dx?
Choices were achalasia, brain tumor, bulimia nervosa, cholecystitis, diabetic gastroparesis, food poisoning, gastric bezoar, gastric carcinoma, pyloric channnel ulcer, small bowel obstruction, drug toxicity, uremia
The fact that he's missing hair and has symptoms of bowel obstruction. Nothing else is close in terms of a better choice.
4. 67 yo with increasing nocturnal incontinence. PMH of HTN for 20 yrs treated with verapamil. Taking amitryptyline for MDD. Bp 158/78. Lower abd distention with diffuse tenderness to palpation. Enlarged, smooth prostate on DRE with no stool in vault. Creat 1.6 and urine shows Protein 1+, WBC 1-2/hpf, RBC 2-4/hpf. Dx?
A. BPH
B. Cauda equina syn
C. Alzheimer
D. NPH
E. UTI (I choose)
This question is a slam dunk. He has an enlarged, smooth prostate. He's on an anticholinergic (TCA) so he's at risk of urinary retention. He also has distention and diffuse TTP in lower abdomen. The only thing they didn't give you was the actual answer. Not to mention he has almost zero symptoms of an infection. Pick A and move along.
5. 74 yo has MI; admitted to hospital to ICU. BP decreased from 148/74 to 80/62. Confused and has cool clammy skin. ABG will show what?
A. Hypoxemia with normal PH
B. Met acidosis
C. met alk
D. Resp Acidosis
E. Resp alkalosis
MI leading to a build up of LA causing a metabolic acidosis. I'm leaning more towards B than A because he is displaying AMS, which shouldn't be seen with a normal pH.
6. 32 yo woman has spontaneous discharge from nipples for 3 months. Prolactin 40, serum TSH within normal range. Recommendation?
A. Application of ice packs to breasts
B. Wearing tight bras
C. Bromocriptine therapy (I didnt choose this bc it was too obvious....?)
D. Tamoxifen therapy
E. Vitamin E therapy
Even though it's terribly obvious, what else would you put? She has galactorrhea s/s to elevated prolactin. So give a DA agonist to inhibit prolactin release. DONE.
7. 23 yo african american male with 2 months hx of pain and swelling above right knee. No hx of trauma or recent fever. Had retinoblastoma in infancy and was treated with enucleation. T 98.6. Exam shows swelling of distal femur. ALP 1350. Xray of right femur shows lytic lesion with perosteal new bone at margins. Dx?
Choices: HyperPTH, Metastatic malig, MM, Osteotis deformans (Paget), Osteoid osteoma, osteomyelitis, osteoporosis, osteosarcoma, sickle cell
RB is associated with Paget. Also the solitary elevated ALP is a give-away as well. Not to mention XR findings of mixed lytic and sclerotic processes. Classic Paget.
8. 22 yo woman with fever, chills, left flank pain. +Nausea/vom, T 102, Pulse 110, abd soft with tenderness to percussion over left flank. Hematocrit 39, leukocyte 22k, rbc 10-20/hpf, WBC 20-50/hpf
Most appropriate pharmacotherapy?
A. oral amoxicillin
B. oral azithromycin (I chose)
C. IV amox
D. IV ceftriaxone
E. IV metronidazole
Pt has acute pyelo with a pretty high white count to boot. You want gram neg coverage and you want it fast. IV Rocephin is what you want.
9. 21 yo with mild cough and runny nose. Cough so bad he has vomitted. Cough is productive of thick green sputum. No fever, chest pain, SOB, He si college student. Vitals normal, sat 98%. dx?
A. Influenza
B. Legionnaires
C. Pertussis
D. Psittacosis
E. Q fever
Cough so bad that you vomit = whooping cough. Even if you didn't know that, you can r/o everything else. No fever or muscle aches so r/o flu. No hx of parrot or barn animals, r/o Psittacosis and Q fever. And no symptoms consistent with Legionnaires (diarrhea, confusion, hyponatremia, recent contact with contaminated water) so r/o Legionnaires.
10. 64 yo woman with DM2 controlled with insulin comes with exertional chest pressure for 3 weeks. Happened when she was walking up and relieved by 5 mins of rest. Second episode occured 1 week ago when she was mowing lawn and relived with 10 min rest. Few more episodes like this have been happening. Examination and ECG show no abnormalities. Next step?
A. Self monitoring of blood glucose conc during next episode of chest pain
B. Dipyridamole-thallium-201 scintigraphy
C. Exercise stress test within 24 hrs (I chose)
D. Antianginal drug therapy now and an exercise stress test in 5 days
E. Admit patient to hospital
Pt has stable angina that is becoming progressively unstable. I'm going with B because this is a 64yo lady that might not be able to perform an exercise stress test. Only 95% sure on this one though, haven't had my cardio rotation yet.
11. 57 yo male with 5 year hx of HTn comes for routine exam. He has 10 year hx of throbbing frontal headaches that occur 1-2 times a month and associated sometimes with nausea and vomiting. Occassionally sees halos around objects during episode. Attributes headaches to stress at work. Only med is enalapril. BMI 32. BP 130/85; Everything elsen ormal except glucose is 265; no ketones.
What is explanation for his high glucose?
A. Cushing
B. Glucagonoma (I chose)
C. Pheo
D. Somatostatinoma
E. DM 2
Intermittent headaches, and the elevated glucose is due to glycogenolysis from adrenergic stimulation from catecholamines.