Diagnostics

Question 1

Gold Standard Dx Malrotation

Answer 1

Upper GI Series

Question 2

Intrauterine preg

Answer 2

@5 weeks or B-hCG 1000-1500 transvaginal US

Transabdominal Bhcg >6500

Question 3

Extra workup in pregnant DM

Answer 3

EKG
24 hr urine for basline renal fct
HbA1c
Ophthalmologic exam

Question 4

Toxic Megacolon

Answer 4

3+ diagnostic criterion
WBC: >10.5 K
tachy > 120 bpm
Fever >100.4

Definitive: Plain film x-ray

Question 5

PCOS

Answer 5

Free T elevated
LH: FSH >3
Pelvic U/S: bilaterally enlarged cystic ovaries

Question 6

Best initial test for pleural effusion?

Answer 6

Lateral chest xray (dx up as little as 50 mL fluid)

*PA film needs >200mL

Question 7

Presumed bowel perforation?

Answer 7

UPRIGHT chest xray (NOT abdominal film)

Question 8

Osteomyelitis

Answer 8

Bone Xray : FIRST
if it is negative (as osteo takes 2 weeks)..then
MRI or Bone Scan

Question 9

Best first test for

1. ) severe head trauma
2. ) stroke

Answer 9

Non-Con head CT

Question 10

Best first test for intracranial mass lesion?

Answer 10

Contrast head CT

Question 11

Most accurate test for diverticulitis and kidney stones?

Answer 11

CT

Question 12

Best test to look at the pancreas ? (and other retroperitoneal structures?)

Answer 12

Abdominal CT

Question 13

Infective Endocarditis

Answer 13

Do blood cultures before starting antibiotics

Question 14

Dig Toxity workup

Answer 14

EKG and potassium level

Get a digoxin level

Question 15

Cystinuria

Answer 15

Urinary Cyanide Nitroprusside Test

Question 16

Chronic Granulomatous Disease

Answer 16

Nitro-Blue tetrazolium test

Question 17

Cryptococcal Meningitis

Answer 17

India Ink CSF, sabourad agar cx

Question 18

Pulmonary HTN

Answer 18

Gold standard: Right heart catheterization (Swan-ganz)

Question 19

Diagnosis of avascular necrosis

Answer 19

MRI

Question 20

Benign positional verticgo

Answer 20

Normal neuro exam

Dix-Hallpike maneuver yields nystagmus

Question 21

Herpes Encephalitis: Most accurate

Answer 21

PCR of CSF (better than BRAIN bx)

Question 22

Infectious Diarrhea

Answer 22

Best initial: fecal leukocytes (lactoferrin is actually better)
More accurate test: stool culture

Question 23

PID: most accurate test

Answer 23

Laparoscopy

Question 24

Hereditary Angioedema- Best initial test

Answer 24

Low C2, C4, c1 esterase inhibitor

Question 25

WPW: EKG

Answer 25

1. wide QRS 2. short PR 3. delta waves

Question 26

Wilson's Disease

Answer 26

Low serum Ceruloplasmin High Urine Copper DON'T GET A SERUM CU

Question 27

Hemtchromatosis

Answer 27

Ferritin | Bone marrow bx- definitive

Question 28

First-degree AV block + widened QRS

Answer 28

Electrophysiology Studies

Question 29

Suspected valve or septal rupture s/p MI, stable patient

Answer 29

Echo

Question 30

High-dose dexa- suppressible but negative MRI

Answer 30

Superior petrosal vein sample

Question 31

Bacterial antigen test for CNS infxn?

Answer 31

Do this when the patient got abx prior to LP and CSF cx might be falsely negative

Question 32

TB meningitis

Answer 32

Requires acid fast stain on 3 high-volume LPs Centrifuge speciment to concentrate the organisms [just one unspun CSF sample has a sensitivity of 10%]

Question 33

Lyme/Ricketsia

Answer 33

Serologies, ELISA, western blot, PCR

Question 34

Cryptococcus

Answer 34

India Ink (60-70% sensitive), Crypto antigen >95% sensitive

Question 35

Bacterial meningitis

Answer 35

TREATMENT BASED ON CSF CELL WBC COUNT

Question 36

Acyclovir-resistant herpes meningitis

Answer 36

Foscarnet?

Question 37

Best initial test for any hepatidites

Answer 37

IgM + IgG

Question 38

Drop arm test

Answer 38

Rotator Cuff Tear (common with falls on outstretched hands)

Question 39

Scabies

Answer 39

Scrape and magnify

Question 40

Definitive Dx of chicken pox

Answer 40

Tzanck smear - multinucleated Giant Cells

Question 41

E. hystolitica

Answer 41

Needs serologies, stool cx doesn't work

Question 42

Cocaine Intox

Answer 42

Get an EKG first! R/o anything BAD

Question 43

Ischemic Bowel

Answer 43

CT abdomen- best initial | Angiography - most accurate

Question 44

Stress Fractures

Answer 44

CT/MRI (won't show on xray)

Question 45

Hepatocellular Carcinoma

Answer 45

Triple Phase CT

Question 46

Cirrhosis pts

Answer 46

Get RUQ US and AFP, LFT, BMP, and coags for transplant elligibilites