1. NBME 4:
2. 2mo infant is exclusively breastfed. What nutritional supplement?:
Oral VitD to prevent rickets
3. What HTN drug causes peripheral edema,
... [Show More] flushing, dizziness?: CCB
eg nifedipine
4. 15yo girl with recurrent candida infections of skin and mucous
membranes since childhood. Dx?: Chronic mucocutaneous candidiasis (T cell
dysfunction)
5. 57yoM with impotence for 1 year rand bronze colored skin. Ferritin
concen- tration is 4050 NG/ml. Increased risk for what complication?: 1.
Liver (primary organ)--hepatocellular carcinoma
2. Others: pancreas (DM), heart (CHF), skin, thyroid (hypo), gonads, joints
(arthri- tis)
6. 87yo's daughter: "we want my mother to receive hospice care at home
but no one wants her to die at home. Can she still have hospice
services?": Yes. Hospice can provide home based care and attempt to transfer
the pt to another site before death.
7. 32yoF with 4d of fever with lymphatic obstruction. PE: the left lower
extremity is diffuse lay red and edematous from just below the knee to the
ankle, with a sharp demarcation separating the erythematous area from the
normal skin at the knee. The erythematous area is painful and
hyperesthetic to touch. The left oral nodes are enlarged and painful. Dx
and cause?: - Erysipelas
- usually caused by group A strep
- Tx: IM or oral penicillin/erythromycin
8. 16yo girl with painful genital lesions or 2d. Lots of sexual partners.
Exam shows two 3x3mm ulcerated lesions on the anterior vaginal vault.
How prevent transmission with new partner?: Consistent condom use (NOT
phar- macological treatment)
9. 37yo primigravid at 25 weeks' gestation with confusion for 12 hours.
Fever and intermittent nausea and vomiting over the past 2 weeks. No
contractions, but decreased fetal movement. Family Hx of T1DM, seizure
disorder. T 38.8, P 168/min, BP 187/84. Mildly enlarged thyroid gland. Lungs
clear. 3/6 systolic ejection murmur. Fetal heart rate 182/min. Labs show: Hb
9.9, platelets 282k, Serum: Na 134, Cl 94, K 2.9, Thyroid-stimulating
hormone 0.01, AST 33, LDH 112, Uric acid 5.4. Dx?: Thyroid storm
- Precipitants: infection, DKA, stress (childbirth, trauma, surgery, illness)
- Sx: fever, tachycardia, agitation, confusion, GI symptoms (n/v/d)
- Tx: supportive therapy with IV fluids, cooling blankets, glucose; PTU ever y2h,
follow with iodine; beta blockers to control HR; dexamethasone to impair t3
from T4
10. 37yo F with 4-month history of numbness, burning, and tingling of the
toes and soles of her feet. 3-year hx of recurrent mouth sores. Numerous
oral apthous ulcers, genital ulcers, and several 2.5-cm red lesions over the
left anterior tibial region. Photophobia. Ankle reflexes are absent.
Proprioception and sensation to pinprick and vibration decreased in lower
ext. Dx?: Behcet syndrome
- autoimmune vasculititc disease
- Sx: recurrent oral and genital ulcerations (usu painful), arthritis (knees, ankles),
eye involvement (uveitis, optic neuritis, conjuncitivitis), CNS involvement
(intracra- nial HTN, meningoencephalitis), fever, wt loss; erythema nodosum-like
lesions, pseudofolliculitis
- Dx: bx
Tx: steroids
*NOT polyarteritis nodosa
- can be associated with hep B, HIV, drug reactions
- Sx: fever, wt loss, myalgias, abdominal pain (bowel angina)
- Dx: bx; elevated ESR and pANCA
- Tx: corticosteroids (if severe, cyclophosphamide)
11. 87yo F with fever for 1 day. Urinary catheter was placed 2 weeks ago.
Has dementia, Alzheimer type, and is unable to communicate verbally. T
37.8 C, P 86/min, BP 120/74. Mucous membranes are moist and pink.
Urinalysis shows: Color cloudy brown, Ph 8.8, Blood 2+, Glucose negative,
Protein
2+, RBC numerous, wbc 20-25, Nitrites 3+, leuk esterase 3+, bacteria many.
Gram stain shows gram-negative bacilli. Which would have prevented?:
Use of incontinence briefs instead of the catheter (NOT changing catheter daily)
12. 32yo M with AIDS with 1-week history of T to 40 C and cough. Current
medications include trimethopim-sulfamethoxazole and three antiretroviral
agents. Moist crackles over right lung base. X-ray of the chest shows an
infiltrate in the right lower lobe. Causal org?: Stretococcus pneumoniae
(NOT Pneumocystitis jiroveci b/c taking prophylactic oral bactrim)
13. 77yo F with lesions on her left arm for the past 2 months. Underwent
modified radical mastectomy of the left breast for breast cancer 20 years [Show Less]