The COMLEX-USA (Comprehensive Osteopathic Medical Licensing Examination of the United States) is a series of standardized medical board exams designed for osteopathic medical students and physicians. Administered by the National Board of Osteopathic Medical Examiners (NBOME), it evaluates candidate...
Tx of acute chest syndrome requiring intubation: - Answers 1)
Exchange transfusion with goal of reducing % of sickle Hgb to <30% to
improve blood flow/O2 delivery to tissues
Note that simple transfusion would not be good enough to change % of
HgbS without markedly increasing Hgb (higher viscosity/clot risk)
In pts with low Hgb <5, simple transfusion + hydration can be sufficient
because it will dilute the HgbS to nearly equal an exchange transfusion
Reynold's pentad is associated with - Answers RUQ pain, fever,
jaundice (charcot triad)
+
new onset confusion and possible septic shock
= ascending cholangitis
Abx treatment for ascending cholangitis - Answers Escherichia,
Klebsiella, Enterobacter...
, Q&A
Piperacillin-Tazobactam
or
Ceftriaxone + Metronidazole
viscerosomatic levels of foregut, midgut, and hindgut - Answers
Foregut: T5-9
-small intestine -->proximal 2/3 of transverse colon
Hindgut: T11-12
- distal 1/3 of transverse colon --> rectosigmoid
Nasopharyngeal carcinoma is is associated with what virus - Answers
EBV (Burkitt lymphoma)
pt presenting with dyspnea, loud P2, and bilateral lung infiltrates ......with hx
of tightening of skin around fingertips, severe GERD, and Raynaud
syndrome - Answers Scleroderma renal crisis (suspect if new onset
HTN and rise of >50% in serum creatinine) --> malignant hypertension with
, Q&A
encephalopathy or retinopathy due to obliteration of the small arterioles and
glomerular destruction
Diffuse cutaneous systemic sclerosis (dcSSc)
vs
Limited cutaneous systemic sclerosis (lcSSc)
vs
Morphea
vs
Systemic sclerosis sine scleroderma - Answers Autoimmune
disease systemic sclerosis has several subsets:
1) dcSSC = "scleroderma"
- will have sclerosis of skin PROXIMAL to wrists
- symptoms can include hypopigmentation of skin, Raynaud's, GERD,
clacinosis cutis, hyperpigmentation, telangiectasia, systemic HTN, renal
failure, pulm HTN, ILD, intestinal dysmotility
2) lcSSc = CREST syndrome
- distinguished by amount of skin thickening --- only involves the HANDS
and minimal of face/neck
- limited skin thickening (generally spares hands and face) WITHOUT
systemic organ involvement
4) Systemic sclerosis sine scleroderma
- GI/lung/renal involvement as SSC but w/o skin thickening
Vasculitis associated with diabetics - Answers Necrobiosis lipoidica
- shiny asymptomatic patches (red brown) on shin that progress to yellow
depressed atrophic plaques
- often painless vasculitis caused by collagen degeneration with
granulomatous response, thickening of blood vessel walls, and fat
deposition
- Management: protect legs with elastic support stockings and leg rest to
prevent trauma/ulceration
Vasculitis associated with heavy tobacco use - Answers Buerger
disease (thromboangiitis obliterans)
- resting pain, ischemic ulcerations, gangrene of digits of hands/feet
Management of ITP - Answers Prednisone, IVIG, rituximab and if
necessary, splenectomy
Etiology of disease: autoimmune (usually after acute infection) in which IgG
Ab bind to platelets and lead to their excessive destruction in the spleen -->
isolated low platelet w/ no significant PMH
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