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| * High yield questions for you all.. |
| | #482790 |
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Hi.
I have been studying the past three months doing UW, Kaplan, other question banks, and reading various books and putting notes together. I have some high yield questions that I would like to ask you guys because they are unclear in my head, so this will help everyone out who has the same unclarity.
1. What is the best way to lower cholesterol: exercise -or- eat less red meat/more fish?
2. What causes a cystocele in a post-menopausal woman with incontinence and why?
3. What is the mechanism of pulmonary edema in CHF? What about peripheral edema?
4. Is Myasthenia Gravis a presynaptic or postsynaptic problem? What about Eaten Lambert?
5. Do yo use a voiding cystourethrogram or ultrasound in a kid with UTI? What is the order of clinical approach?
6. An injury where can cause weakness in all five fingers of your hand?
7. Is it normal to have carpal tunnel's syndrome bilaterally? What else can cause weakness in the thumb, index, and middle fingers of both hands simultaneously?
8. How do you treat a patient with pain in his arms and legs, and has sickle cell anemia?
9. Do you give all immunocompromised patients vaccines of encapsulated organisms, or just those lacking a spleen?
10. Do you do a narrow or wide excisional biopsy for a 6mm malignant melanoma?
11. Do you treat Varicella Zoster infection in an old man with oral or IV acyclovir?
12. How can you symptomatically and clinically distinguish Gonorrhea and Chlamydia infection in a male?
13. If someone has pain when they raise their arms while laying supine, and has pain in the legs as well, what is the cause of this?
14. If a man has a cape-like redness below his neck, what is the cause of this?
15. Would do choose to do a DEXA or bone scan in a 60 y/o female with back pain?
16. If a 2-3 month old infant vomits milk once a day, is that normal behavior? Should he be switched to formula?
17. Which condition is MOST commonly associated with Omphalocele: Trisomy 21, 18, or 13?
18. What is the appropriate breast cancer prophylaxis in a woman who has relatives that have had brest cancer?
19. Uterine atony's most likely complication is hemorrhage, but what type of hemorrhage specifically? Asherman's? Sheehan's? something else?
20. If a patient has Kallman's syndrome but only FSH is low, and you only had the option to give Estrogen or Progesterone, which would it be?
21. If a woman in labor who received an epidural now receives ephedrine to normalize the fetal heart rate, what would be the next step in management if she is 5cm dilated? oxytocin? observe? c-section?
22. If a pregnant woman can't feel the baby at 36 weeks pregnant, do you do an ultrasound, gentle speculum, or immediate c-section?
23. If the fetal head is engaged based on station -2 to 2, what does that mean? Do you use forceps or do a c-section?
24. Which OCP is the better choice for a hypertensive woman: combined pill or progesterone only pill? In other words, what is the best medication OCP for her?
25. If a 20 year old female has a family history of ovarian cancer, do you offer her prophylactic OCP's to decrease her risk of ovarian and endometrial cancer, or would you rather screen her first?
26. If a teenager cries, talks backs to her mother and father, sits in her room all day long, and lost 8 pounds in the last 6 months, is she depressed or is this normal behavior?
27. If a 7-8 year old girl doesn't do her homework, sits and daydreams all day, and is reminded to constantly do her chores and homework, is that ADHD? Normal? Narcolepsy? Autism? something else?
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| * Re:High yield questions for you all.. |
| #2019690 |
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Thanks a lot Doc aApple 09 for the great HY uestions posted.
1- I think that the best way to lower cholesterol is the reduction of saturated fat intake is vitally related to reduced low-density lipoprotein cholesterol (LDL-C) levels. In general, replacing fat with complex carbohydrates is helpful. Is very important to eat more fish that will increase HDL and less read meat. Is important to reember that carbohydrates are less calorically dense than fat, this substitution may also help prevent obesity.
Other important facotr here is doing a routine exercise everyday.
2- A cystocele (SIS-tuh-seal) occurs when the wall between a woman's bladder and her vagina weakens and lets the bladder droop into the vagina. This condition may cause discomfort and problems with emptying the bladder.
In some women, a fallen bladder stretches the opening into the urethra urethra (y rē`thrə), canal in most mammals that carries urine from the bladder to the outside of the body; in the male it also serves as a genital duct. , causing urine leakage when the woman coughs, sneezes, laughs, or does any action that puts pressure on the bladder. So a bladder that has dropped from its normal position may cause two kinds of problems-unwanted urine leakage and incomplete emptying of the bladder.
A cystocele is mild (grade 1) when the bladder droops only a short way into the vagina. A more severe (grade 2) cystocele means that the bladder has sunk into the vagina far enough to reach the opening of the vagina. The most advanced (grade 3) cystocele occurs when the bladder bulges out through the opening of the vagina.
A cystocele may result from muscle straining while giving birth. Other kinds of straining--such as heavy lifting or repeated straining during bowel movements--may also cause the bladder to fall. The hormone estrogen helps keep the muscles around the vagina strong. When women go through menopause (when they stop having periods), their bodies stop making estrogen, so the muscles around the vagina and bladder may grow weak.
3- Congestive heart failure (CHF) is an imbalance in pump function in which the heart fails to adequately maintain the circulation of blood. The most severe manifestation of CHF, pulmonary edema, develops when this imbalance causes an increase in lung fluid secondary to leakage from pulmonary capillaries into the interstitium and alveoli of the lung.
CHF can be categorized as forward or backward ventricular failure. Backward failure is secondary to elevated systemic venous pressure, whereas left ventricular failure is secondary to reduced forward flow into the aorta and systemic circulation. Furthermore, heart failure can be subdivided into systolic and diastolic dysfunction. Systolic dysfunction is characterized by a dilated left ventricle with impaired contractility, whereas diastolic dysfunction occurs in a normal or intact left ventricle with impaired ability to relax and receive as well as eject blood.
Pathophysiology
Congestive heart failure (CHF) is summarized best as an imbalance in Starling forces or an imbalance in the degree of end-diastolic fiber stretch proportional to the systolic mechanical work expended in an ensuing contraction. This imbalance may be characterized as a malfunction between the mechanisms that keep the interstitium and alveoli dry and the opposing forces that are responsible for fluid transfer to the interstitium.
Maintenance of plasma oncotic pressure (generally about 25 mm Hg) higher than pulmonary capillary pressure (about 7-12 mm Hg), maintenance of connective tissue and cellular barriers relatively impermeable to plasma proteins, and maintenance of an extensive lymphatic system are the mechanisms that keep the interstitium and alveoli dry.
Opposing forces responsible for fluid transfer to the interstitium include pulmonary capillary pressure and plasma oncotic pressure. Under normal circumstances, when fluid is transferred into the lung interstitium with increased lymphatic flow, no increase in interstitial volume occurs. However, when the capacity of lymphatic drainage is exceeded, liquid accumulates in the interstitial spaces surrounding the bronchioles and lung vasculature, thus creating CHF. When increased fluid and pressure cause tracking into the interstitial space around the alveoli and disruption of alveolar membrane junctions, fluid floods the alveoli and leads to pulmonary edema.
According to Perfieral edema: Edema is observable swelling from fluid accumulation in body tissues. Edema most commonly occurs in the feet and legs, where it is referred to as peripheral edema. The swelling is the result of the accumulation of excess fluid under the skin in the spaces within the tissues. All tissues of the body are made up of cells and connective tissues that hold the cells together. This connective tissue around the cells and blood vessels is known as the interstitium. Most of the body's fluids that are found outside of the cells are normally stored in two spaces; the blood vessels (as the "liquid" or serum portion of your blood) and the interstitial spaces (not within the cells
4- Autoantibodies (immunoglobulin G [IgG]) develop against ACh nicotinic postsynaptic receptors for unknown reasons, although certain genotypes are more susceptible.
Lambert-Eaton myasthenic syndrome (LEMS) is a rare disorder of neuromuscular transmission. It is a presynaptic disorder of neuromuscular transmission in which quantal release of acetylcholine (ACh) is impaired, causing a unique set of clinical characteristics, which include proximal muscle weakness, depressed tendon reflexes, posttetanic potentiation, and autonomic changes. The initial presentation can be similar to that of myasthenia gravis, but the progressions of the two diseases have some important differences.
5- tests may include kidney and bladder ultrasound, a voiding cystourethrogram (VCUG), an intravenous pyelogram (IVP), or a nuclear scans with a radioactive material to show how well the kidneys work, the shape of the kidneys, and whether urine empties from the kidneys in a normal way.
Traditionally VCUG has been recommended for infants and children after a first febrile urinary tract infection. This is based on the assumptions that most upper UTIs occur because of urinary bladder infection and that vesicoureteral reflux (VUR) transfers bacteria in the bladder to the kidney.
7- The common causes of carpal tunnel syndrome can be remembered using the mnemonic, MEDIAN TRAP for Myxoedema, Edema, Diabetes mellitus, Idiopathic, Acromegaly, Neoplasm, Trauma, Rheumatoid arthritis, Amyloidosis and Pregnancy.[13]
Reported here in is a patient who developed symptoms of bilateral carpal tunnel syndrome following radioactive iodine induced hypothyroidism.
8- Vasoocclusive crisis is treated with vigorous hydration and analgesics.
Intravenous fluids should be of sufficient quantity to correct dehydration and to replace continuing loss, both insensible and due to fever.
Normal saline and 5% dextrose in saline may be used.
These fluids should be given intravenously, and treatment must be in an inpatient setting.
Pain control is best achieved by the administration of opioids. Morphine is the drug of choice. Morphine dosing has to be individualized (vide infra).
It should be given intravenously, hourly at first. Once the effective dose is established, it should be administered every 3 hours via the intravenous regimen.
After 24-48 hours, as pain is controlled, equivalent doses of sustained-release oral morphine should be given.
When marked improvement occurs, the patient may be discharged home on sustained-release oral morphine, and the dose is reduced gradually over several days.
Morphine elixir can be used to control breakthrough pain.
Chronic pain is managed with long-acting oral morphine preparations and acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).
NSAIDs are particularly effective in reducing deep bone pain. Many patients may require breakthrough oral opiates as well. The weak agents, codeine and hydrocodone, are used first. Sustained-release long-acting oral morphine is reserved for more severe cases.
The addition of tricyclic antidepressants may reduce the dose and need for opiates by interfering with pain perception. Many patients with chronic pain are depressed, and lifting the depression has a salutary effect on the pain.
Hydromorphone may be used but is considerably more expensive.
Meperidine should be avoided.
npharmacological approaches to pain management are very important.
These include physical therapy, heat and cold application, acupuncture and acupressure, hypnosis, and transcutaneous electric nerve stimulation (TENS).
Support groups are also useful.
All of these modalities may have a substantial impact on pain reduction.
Prevention of infection improves chances of survival in SCD.
Penicillin prophylaxis, commencing in infancy and continued until age 5 years or early teens, and the use of a pneumococcal vaccine at age 2 years with a booster dose at age 5 years greatly reduces the frequency of infections with S pneumoniae.
In the adult patient, all infections must be treated promptly with broad-spectrum antibiotics until a causative organism is identified and therapy is tailored according to its antibiotic sensitivity.
I will continue later with the other answers.
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| * Re:High yield questions for you all.. |
| #2019693 |
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Sorry for the errors above.
4- Myasthenia Gravis: Autoantibodies (immunoglobulin G [IgG]) develop against ACh nicotinic postsynaptic receptors for unknown reasons, although certain genotypes are more susceptible.
Lambert-Eaton myasthenic syndrome (LEMS): It is a presynaptic disorder of neuromuscular transmission in which quantal release of acetylcholine (ACh) is impaired, causing a unique set of clinical characteristics, which include proximal muscle weakness, depressed tendon reflexes, posttetanic potentiation, and autonomic changes. The initial presentation can be similar to that of myasthenia gravis, but the progressions of the two diseases have some important differences.
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| * Re:High yield questions for you all.. |
| #2019694 |
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9- Immunocompromised : No live vaccine; but poor response to inactivated
-Avoid live vaccines (oral polio vaccine, varicella, MMR) in immunocompromised and pregnant patients (exception: HIV patients may receive MMR and varicella).
-Pneumococcal polysaccharide vaccine( PPV) should be administered to high-risk groups
-(Sickle cell disease or splenectomy, immunodeficient patients).
SUMMARY OF IMMUNIZATIONS WITH IMMUNE DEFICIENCIES:
Imunodeficiency Contraindications Consider Administering
X-linked OPV, vaccinia and live Measles, Varicella
Agammaglobulinemia bacterial
Severe combined all live vaccines ---
Complement defic. None ---
Phagocytic function live bact. Vaccines ---
HIV/AIDS OPV, vaccinia, BCG MMR, varicella if not severly
Immunocompromized
Malignancy, Live bact. And viral, based ---
Transplantation, on immune status
Immunosuppresive
Or radiation
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| * Re:High yield questions for you all.. |
| #2019953 |
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Thanks for posting. Based on the ones you have answered so far, I will add my input. I don't know if I am right or wrong so I am not disagreeing with you, just sharing my knowledge.
1. I would pick exercise. How much fish are you going to eat or red meat are you going to avoid? The person could also be a vegetarian. I think exercise would be the appropriate answer.
2 and 3.. Agree with your points, those were nice details and appreciated.
4. Agree again with those answers.
5. I am still not sure what you would do first, an ultrasound because it is less invasive? or VCUG?
6. Could brachial plexus injury cause problems in all 5 fingers?
7. Is it normal to get bilateral carpal tunnels? Why did you assume this person had hyperthyroidism?
8. Why would you give fluids as opposed to blood transfusion in someone with Sickle cell and pain in extremities?
9. Agreed with your post.
Anyone else please add comments and help answer the other questions also.. |
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| * Re:High yield questions for you all.. |
| #2020004 |
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1. dunno
2. less estrogen, laxity/loss of suppleness/elasticity of pelvic/perineal tissues, previous childbirths, weakness of muscles, etc-->prolapse of a part of urethra into vagina.
3. increased backpressure-->increased hydrostatic capillary pressure in lung-->transudate. If Rt side fails primarily or seconday to lungs/left heart failure, peripheral edema.
4. MG - post LE - pre
5. depends on number of episodes, i think VCUG preferred. USG only for kidneys.
6. lower trunk of brachial plexus
7. yes, if it's not due to overuse, for eg, pregnancy, GH excess, edema, dialysis-dependent pt.
8. morphine??? u do hydrate, oxygenate him and correct pH, give antibiotics as needed.
9. others too i guess, but especially in those without spleen/functional asplenia, old patients, complement deficiencies
10.
11.
12. gonorrhea - pus-like greenish discharge
13.overactive imagination??? :D? some kind of dural involvement? meningitis?
14. dermatomyositis rash?
15. bone scan. mets are a possibility.
16. yes, normal.
17.
18. taoxifen?
19. hemorrahage from the uterus itself dude. the uterine muscles have a figure of 8 configuration with vesells in the circles of the '8'. When these muscles contract, squeezes shut the blood vessels. If uterine atony, u just keep bleedin'.
20. Estrogen
21.
22. u ask her to drink something really sweet and ask her to feel if the baby's moving. It gives them a sugar high. Else, i guess u would just chk the FHR on an USG, easiest to do!
23.
24. combined??
25. Screen her first??
26. first 2 would be normal behavior, the 3rd makes me wanna choose 'depression'
27. normal. |
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| * Re:High yield questions for you all.. |
| #2025354 |
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1- exercise with diet control
2- decreased estrogen levels post menopause period
3- Cardiogenic pulmonary edema is due to increased capillary hydrostatic pressure secondary to elevated pulmonary venous pressure. (imbalance of starling's forces)
4- MG- post synaptic EL- pre-synaptic
5- VCUG
6- ???Klumpke palsy or damage to C8 and T1 (ulnar and parts of median nerve - the intrinsic muscles of hand affected)
7- MEDIAN TRAP (explained earlier)
8 - IV fluids narcotics and treat infections
9 - immunodeficient and asplenia
10- wide excision based on Breslow depth
Surgical margins of 5 mm - for melanoma in situ
margins of 1 cm - for melanomas up to 1 mm in depth
margin of 2-cm - intermediate thickness (1-4 mm Breslow depth)
Margins of > 2 cm - if greater than 4 mm in thickness
11- Treatment options are based on the patient's age, immune state, duration of symptoms
& presentation. Usually oral acyclovir prescribed. IV acyclovir given for disseminated
OR reactivated VZV infection.
12 - clinically it is difficult to dirrentiate between the 2 and they often coexist in the same person.
13- not sure-
14- are you sure it is cape like redness? cape- like sensory loss - syringomyelia
15 - bone scan better than Dexa (Dexa will only tell you the bone density, where as bone scan can show areas of breakdown or cancer also)
16 - normal
17 - trisomy 18
18- tamoxifen , prophylactic mastectomy or oophorectomy
19 - intra uterine bleed
20 - kallmann syndrome - there is deficiency of both FSH and LH. for FSH defi - give estrogen.
21 - epidural can cause decrease in fetal heart rate, if it is corrected with epinephrine, then just observe.
22- uss
23 - head is engaged when at 0 station...since there is no further hx - how do we decide if forceps or c-section.
24- choice of contraception offered is same as for non hypertensive patient, unless underlying increased risk for thrombosis present- then offer progesterone only contraceptive.
25- screen her first
26- maybe normal
27- maybe normal of ADHD
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