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
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
