Final Step Flashcards
A patient with HIV presents with severe groin pain. What is the most likely diagnosis?
Avascular necrosis of the femoral head. Antiretroviral medications put patients at an increased risk of AVN.
A 65 year old presents complaining of severe pain in his great toe that began when he woke up this morning. It is swollen, red and very tender. What is the most likely diagnosis?
Gout would be number one because of the location, but you might also think about an infection
Scleroderma limited version has five main characteristics for which the CREST acronym is often used. What are those five things?
Calcinosis, Raynaud’s, esophageal dysmotility, sclerodactyly, telangiectasia
Vasculitis with a hepatitis B history should make you think of what diagnosis?
polyarteritis nodosa
A patient presents with knee pain following a soccer game two days ago. He has joint line tenderness medially and feels a locking in the knee from time to time. What two physical exam tests should you do?
This is probably a medial meniscal tear. McMurry and Apley tests would be appropriate.
A positive Apley indicated what diagnosis?
meniscal tear
Which of the four rotator cuff muscles is most commonly injured?
supraspinatus
On physical exam, you notice ulnar deviations and swan neck deformities. What is the most likely diagnosis?
rheumatoid arthritis
What is the name for the 4th and 5th metacarpal fractures that often occur punching a wall.
Boxer’s fracture
A pathology report comes back with positive birefringent crystals. What is the most likely diagnosis?
pseudogout
A 15 year old boy presents complaining of night pain in the pelvis. Since you have no idea what to do, you order an x-ray. The report comes back with a description of a mass with an “onion skin appearance.” What is the most likely diagnosis?
Ewing sarcoma
What is the medical term for golfer’s elbow?
medial epiconylitis
What is the medical term for hunchback?
kyphosis
What is the age range for osteosarcoma? Where are thy most typically found in the body?
Osteosarcoma usually occur in 15-25 year old males and are most commonly found around the knee.
Where are Bouchard’s nodes found?
proximal interphalangeal joint (PIP)
Are most shoulder dislocations anterior or posterior?
anterior
What is the most common fracture in a patient with osteoporosis?
a compression fracture of a vertebral body followed by hip fractures
Which carpal bone has a high rate of nonunion and occult fracture?
scaphoid
A fat pad sign on a lateral x-ray of the elbow has what significance?
it is blood in the joint indicating a fracture even if the fracture line cannot be seen
What is the medical treatment for gout?
allopurinol, colchicine
A positive Phalen and Tinel’s sign indicates what diagnosis?
carpal tunnel
A pathology report comes back showing negatively birefringent crystals. What is the most likely diagnosis?
gout
What fracture is the #1 cause of compartment syndrome?
tibial shaft fracture
A positive Neer’s test indicated what diagnosis?
rotator cuff impingement
You suspect a patient has polyarteritis nodosa. What is the test for a definitive diagnosis and what is the treatment?
biopsy, high dose steroids
What are the four muscles of the rotator cuff?
Commonly referred to as the SITS muscles they are Supraspinatus, Infraspinatus, Teres minor, Subscapularis
What is the most useful physical exam test for diagnosis an ACL tear?
Lachman’s followed by anterior drawer
An African American female presents with malar rash and a positive double-stranded DNA antibody. What is the most likely diagnosis?
lupus
A positive straight leg test indicates what diagnosis?
herniated disc
What test do you do for Sjogren’s syndrome?
Schirmer test
Which way does a Colles fracture angulate: dorsal or volar? What about a Smith fracture?
Colles = Dorsal, Smith = Volar
What is a first line treatment for rheumatoid arthritis?
methotexate
What is the most common knee injury?
medial meniscal tear
What medication is used for patients with lupus?
systemic steroids
A new mother presents with pain over the radial wrist. She has a positive Finkelstein’s test. What is the most likely diagnosis?
de Quervain’s tenosynovitis
A positive Hawkins test indicated what diagnosis?
Rotator cuff impingement
At what age should you begin ordering DEXA scans for male patients? What about female patients?
70 for males, 65 for females
What is the medical term for tennis elbow?
lateral epicondylitis
Tenderness over the anatomical snuffbox is indicative of what fracture?
scaphoid
What is the first line treatment for carpal tunnel?
night splint
46 year old male comes into the ER limping a little on the right side. He states that it felt as though he was kicked in the back of the leg during a soccer game, but clearly no one was behind him. What is the most likely diagnosis?
Achilles tendon rupture
List three medication that may cause lupus.
procainamide, isoniazid, and quinidine
A patient’s lab work shows positive Smith antibody and positive double-stranded DNA antibodies. What is the most likely diagnosis?
Lupus
What is the most common cause of a hip dislocation? Is it usually anterior or posterior?
MVA, posterior
A 95 year old female presents to ER after a fall in her home. Her left leg is shortened and externally rotated. What is the most likely diagnosis?
hip fracture
What ligament is most commonly injured in an ankle sprain?
Anterior talofibular ligament (ATFL)
A patient with a history of hepatitis B presents complaining of bilateral knee pain, fever and weight loss. What is the most likely diagnosis?
polyarteritis nodosa
You recommend bisphosphonates for a patient with osteoporosis. What instruction do you give her for immediately after taking the medication?
remain upright for 30 minutes
A positive crossover test indicates what diagnosis?
acromioclavicular joint injury (AC joint)
A 22 year old male patient presents with what is a clearly a septic knee. He is unable to actively extend his knee. What is the most likely diagnosis?
Neisseria gonorrhoeae
A patient presents to the ER after taking a baseball bat to the knee. He is unable to actively extend his knee. What is the most likely diagnosis?
patella fracture
Where are Heberden’s nodes found?
distal interphalangeal joint (DIP)
What is the best imaging to diagnose osteomyelitis?
Bone scan or MRI
A patient with rheumatoid arthritis is heading to the OR for open reduction and internal fixation of the ankle. In addition to ankle films, what other x-rays should you get?
C-spine, anesthesia will want them due to concerns about instability of C1 and C2
A bamboo spine indicates what diagnosis?
ankylosing spondylitis
Anatomically where are 80% of clavicle fractures located?
middle third
A positive McMurry indicated what diagnosis?
meniscal tear
Anti-Jo 1 antibodies should make you think of what diagnosis?
polymyositis
A patient presents to the ER with saddle anesthesia and loss of bowel and bladder function. What is the most likely diagnosis?
Cauda equina
What would you expect the WBC count to be in the joint fluid of an infected knee?
> 50,000 at a minimum and probably much higher
A patient presents with a painless mass in her right wrist. What is the most likely diagnosis?
ganglion cyst
What will an x-ray show in acute osteomyelitis?
nothing - it will show bone destruction in chronic osteomyelitis
There is a sunburst appearance on x-ray. What is the most likely diagnosis?
osteosarcoma
You think a patient may have an osteoid osteoma due to his complaints of severe night pain. You set him up for an x-ray; but in the meantime what medication do you start him on?
If it is truly an osteoid osteoma ibuprofen will resolve his pain
A positive Finkelstein’s test indicates what diagnosis?
de Quervain’s tenosynovitis
Give the DEXA score for osteopenia and osteoporosis
osteopenia = 1 to 2.4 standard deviations, osteoporosis = 2.5 standard deviations or greater
Carpal tunnel affects what nerve and what parts of the hand?
Median nerve. Thumb, pointer and ring fingers, Thenar wasting is a sign of advanced disease
Patient presents with conjunctivitis, urethritis, arthritis and oral lesions. What is the most likely diagnosis? What other lab might you expect to be positive?
Reactive arthritis, HLA B-27
What is the most common fracture in children?
clavicle
Clicking or locking of the knee indicates what diagnosis?
meniscal tear
Describe the characteristics of a lytic lesion on x-ray.
spiculated, elevated periosteum, bone destruction (think bad, very bad things)
Patient presents with progressive neck and proximal muscle weakness. On physical exam, you see a reddish purple maculopapular rash. Her lab work shows an anti-Jo-1 antibodies. What is the most likely diagnosis?
polymyositis
A patient with a silver-fork deformity on x-ray. What is the most likely diagnosis?
Colles fracture
What is the most common cause of C-spine fractures?
motor vehicle accidents
What uric acid level helps to confirm a diagnosis of gout?
> 7.5
What is another term for podagra?
gout
A patient has a tremor with motion in his hands. What medication might you prescribe?
This patient has an active tremor therefore a beta blocker like propranolol is a good start
A patient complains of muscle weakness and fatigability that improves with rest. What diagnosis should you be thinking of?
Myasthenia gravis
A patient complains of an aching headache which feels like a band around his head. What diagnosis should you be thinking of?
Tension headache
An EEG showing focal rhythmic discharges at the onset of the seizure should make you think of what diagnosis?
Simple partial seizure
A middle age male presents with unilateral periorbital headaches occurring daily for several weeks. These headaches are extremely painful. Which type of headache is most likely cause?
Cluster headahce
Name one abortive drug for migraines.
Triptans (sumatriptan, zolmitriptan), ergotamine
What is the most common cause of dementia?
Alzheimer’s disease, it may be as high as 80%
Duchenne’s and Becker’s muscular dystrophy have what genetic characteristic?
X-linked recessive
What is the age range for Duchenne’s muscular dystrophy?
3-5 years old
A patient presents with lateralized throbbing headache. He is also complaining of nausea, vomiting, and photophobia. What type of headache is most likely?
Migraine
If CT is negative and you still believe there is a stroke what is the next best test to order?
Lumbar puncture
A patient presents with a painful ipsilateral third nerve palsy. What diagnosis should you be thinking of?
Posterior communication artery aneurysm (PComA)
Describe Kernig’s sign
The patient lies supine, flex hip while keeping knee straight. Back pain is positive
A patient presents following a seizure. Just before the seizure she remembers seeing flashing light all around her. What diagnosis should be at the top of your differential?
Complex partial
A patient presents to your office complaining of a tremor in his right hand. He states after a beer it goes away completely. What diagnosis should you be thinking of?
Benign essential tremor or familial tremor
Which nerve root is responsible for the knee jerk reflex?
L3-L4
What cranial nerve is affected with Bell’s palsy?
CN VII
What is the medical treatment for a stroke in which the CT has shown no evidence of a hemorrhage?
Within the first 4 hours and with no contraindications thrombolytics should be given
Alcohol may be a major factor in which encephalopathy?
Wernicke’s
Under what conditions would aspirin or clopidogrel be used following a TIA as prophylaxis?
These are antiplatelet medications. They would be used unless there is a known cardiac etiology for the embolism. Patients with a cardiac cause should use heparin or Coumadin.
An EEG showing generalized spikes and associated slow waves should make you think of what diagnosis?
Generalized or absence seizure
What is the medication of choice for a patient with Tourette’s syndrome?
Haloperidol
What are the most common primary cancer sties for metastasis to the brain?
Lung, breast, kidney
A patient presents with what appears to be an inability to understand speech. Which aphasia should be at the top of your differential?
Wernicke’s aphasia
At what age do symptoms of Huntington’s disease appear?
Around 30 years old
Wilson’s disease is associated with a build up of what mineral?
There is a deficiency of the copper binding protein and therefore a buildup of copper
A patient is brought in following a seizure in which she did not lose consciousness. What diagnosis should you be thinking of?
Simple partial seizure
Which is the most commonly herniated vertebral disc?
L4-L5 followed by L5-S1
A patient presents with signs of a stroke to the ER what is the most important test to get?
CT
A patient presents complaining of the worst headache of his life. What might you expect their blood pressure to be?
Typically this is the description for a subarachnoid hemorrhage. You would expect the blood pressure to be elevated.
A sudden thunderclap headache should make you think of what diagnosis?
Subarachnoid hematoma
Lead pipe or cogwheel rigidity should make you think of what diagnosis?
Parkinson’s disease
A 35-year old patient comes to your office because his wife made him. He has been increasingly irritable and moody. She has also noticed that he is very restless. You order a CT scan which shows cerebral atrophy as well as atrophy of the caudate nucleus. What diagnosis should you be thinking of?
Huntington’s disease
What percentage of strokes are ischemic? What percentage are hemorrhagic?
80%, 20%
Name three medications used to break a seziure?
Diazepam, lorazepam, phenytoin or fosphenytoin
At what percentage of blockage is an endarterectomy indicated?
asymptomatic >70%, symptomatic >60%
Elevated circulating acetylcholine receptor antibodies should make you think of what diagnosis?
Myasthenia gravis
A patient presents with inability to speak and right sided weakness. He seems to understand speech and follows commands well. What type of aphasia should you be thinking of?
Broca’s aphasia
What are the genetic characteristics of Wilson’s disease?
Autosomal recessive, chromosome 13
What four chromosome have been linked to dementia?
1, 14, 19, 21
Decreased GABA and substance P should make you think of what diagnosis?
Huntington’s
What is the defining symptom of Alzheimer’s?
Progressive memory impairment
List three medications used to “treat” multiple sclerosis?
Steroids, interferon beta, copolymer 1
A lumbar puncture for a patient with bacterial meningitis will show elevated or decreased WBCs? glucose? Protein?
Elevated WBCs, decreased glucose and elevated protein
Weakness and numbness in the left hand might be a blockage in which carotid artery?
Right
A resting or pill-rolling tremor should make you think of what diagnosis?
Parkinson’s disease
A patient has an intracranial neoplasms causing auditory illusions, olfactory hallucinations and emotional changes. What lobe is the lesion likely in?
Temporal
A study results comes back with intracellular neurofibrillary tangles and extracellular neuritic plaques. What diagnosis should you be thinking of?
Alzheimer’s disease
Is the ankle jerk reflex of lumbar or sacral origin?
Sacral
What is the most common cause of subarachnoid hemorrhage aside from trauma?
Ruptured cerebral aneurysm
List six medications that can be used for migraine prophylaxis?
Beta blockers, tricyclics, calcium channel blockers, NSAIDs, and valproic acid
There is an MRI result of multiple foci of demyelination in the white matter. What diagnosis should you be thinking of?
Multiple sclerosis
List three drugs that treat cluster headaches.
Oxygen, sumatriptan, butorphanol
A patient presents with weakness that he has felt in his lower legs and now feels in his knees and hip bilaterally. He has decreased deep tendon reflexes. This has been getting progressively worse. What diagnosis should you be thinking of?
Guillain-Barre
What three symptoms are classic for a normal pressure hydrocephalus?
Gait disturbance, dementia, and urinary incontinence
What is the most common primary intracranial neoplasm?
Glioma
A 34 year old presents with symptoms which are relapsing and remitting over the past few weeks. These include visual problems and weakness in her right arm. What is the most likely diagnosis?
Multiple sclerosis
List two medications you might use to treat an essential tremor.
Beta blocker (propranolol), primidone
Give two classes of drug therapy for treating Parkinson’s.
Dopaminergic (levodopa), anticholinergics are second line.
A shuffling gait should make you think of what diagnosis?
Parkinson’s disease
You believe a patient has had a stroke. He presents with aphasia, loss of hearing in one ear and loss of vision in his left eye. Is the blockage likely in the anterior or posterior circulation?
Anterior
What is the single most important thing to be concerned about with a patient in status epilepticus?
Airway, followed by management of hyperthermia
Is Huntington’s autosomal dominant or recessive?
dominant
What symptom is associated with a classic migraine?
Having an aura
An EEG showing interictal spikes should make you think of what diagnosis?
Complex partial seizure
Describe Brudzinski’s sign.
When you lift the patient’s head the patient bends his hips.
A slit lamp shows Kayser-Fleischer rings. What diagnosis should you be thinking of?
Wilson’s disease
What seizure medication may cause overgrowth of the gums?
Phenytoin
You are looking for lesions associated with multiple sclerosis. When you order an MRI do you order it with gadolinium or without?
With gadolinium
A patient presents with facial paresis, arm drift, and abnormal speech. What are the first three tests to order?
Thinking of a stroke you order a non-contrast brain CT or MRI, serum glucose, and oxygen saturation.
An 18 month old is not yet speaking. He does not point to objects. He does not make eye contact with others. What diagnosis should you be thinking of?
Autism
How is acute stress disorder different than posttraumatic stress disorder?
Acute stress disorder occurs within 1 month of event and resolves within about a month. PTSD begins at about 1 month after event and can last indefinitely.
During an interview a patient states “I have been anxious for as long as I can remember.” This statement should make you think of what diagnosis?
Generalized anxiety disorder
What is the term for being afraid of being out in a terrible situation with no help available?
Agoraphobia
What medication is clearly contraindicated in anorexia and bulimia?
Bupropion (Wellbutrin) because it can increase risk of seizures
How do you treat alcohol withdrawal?
Benzodiazepines
A patient expresses concern that he can’t trust anyone. That everyone is out to get him, and his problems are all the faults of others. He has help very long grudges due to perceived past wrongs. What diagnosis should you be thinking of?
Paranoid personality disorder
List the four cluster B personality disorders.
“Bad” antisocial, borderline, histrionic, and narcissistic
List the two cluster C personality disorders.
“Sad” avoidant and obsessive compulsive
What is the major concern with using lithium?
It has a very narrow therapeutic window. Blood tests are needed every four weeks.
What two psychiatric issues are more common in males than females?
Autism and ADD, the rest are all either equal or more common in females.
A patient has very strange magical thinking. What diagnosis should you be thinking of?
Schizotypal personality disorder
What causes anorexic patients to have osteopenia?
A decrease in estrogen
A doughnut shaped burn should make you think of what issue?
Abuse, either child or elder
What is necessary to diagnose a patient with bipolar 1?
One manic episode. They do not have to have the depressive episode for the diagnosis.
Are hallucinations normal during a grieving period?
Yes, as long as they are not persistent or intrusive
A patient exhibits all of the characteristics of antisocial personality disorder, but he is only 14 years old. What diagnosis should you be thinking of?
Conduct disorder
A patient complains of having suddenly developed stage fright. It is very important to his career that he is able to speak in front of groups. What medication might you treat with him with?
Beta blocker - propranolol
How long must symptoms occur before diagnosing schizophrenia?
At least six months
What is the term for a chronic mild depression which has lasted greater than two years?
Dysthymia
What type of behavioral therapy works best for borderline patients?
Dialectical behavior therapy
When is the typical onset of Tourette’s syndrome?
3-8 years old
Name three SSRIs.
fluoxetine, paroxetine, sertraline, citalopram, escitalopram, dapoxetine, zimelidine, mesembrine, seproxetine
Borderline personality disorder is on the border of what two psychological disorders?
Neurosis and psychosis
A patient believes that her 15 year old daughter is sleeping with the mailman. She has no evidence of this. She has confronted her daughter who denies it. It is not interfering with her daily activities, but she does spend time thinking about it. What diagnosis should you be thinking of?
Delusional disorder
A patient’s wife complains that he is hypervigilant and has a hyperstartle response. What diagnosis should you be thinking of?
Posttraumatic stress disorder
What is Russel’s sign?
Abraded knuckles from forcing oneself to vomit.
List four symptoms of serotonin syndrome.
Hyperthermia, seizure, mental status change, tremor
How long does menstruation need to be absent before secondary amenorrhea can be diagnosed?
If cycles have been previously normal: 3 months. If cycles have been previously irregular: 6 months.
What medication is often used to treat postpartum depression in a women who is breast feeding?
Sertraline (Zoloft)
What type of hallucinations are most common in schizophrenia auditory, visual, or olfactory?
auditory - hearing voices
What medication is a good place to start treating bipolar 1 or 2?
Lithium
List three positive symptoms of schizophrenia.
Hallucinations, delusions, movement disorder
How long before normal grief resolves?
About one year
A patient is arrogant with an inflated self image. He feels he is special and should be treated that way. What diagnosis should you be thinking of?
Narcissistic personality disorders
List the three cluster A personality disorders.
“Mad” schizoid, schizotypal and paranoid
To be diagnosed with ADD patients must exhibit symptoms before what age?
7 years old
How long must symptoms last before diagnosing ADD?
6 months
What is the generic name for Prozac?
Fluoxetine
A patient complains of acute paralysis in his left arm. This does not seem to bother him, but his wife made him come in. There was no traumatic event. A complete neurologic workup is negative. What diagnosis should you be thinking of?
Conversion disorder
A psychiatric patient presents with confusion, fever, and lead pipe rigidity. What diagnosis should you be thinking of?
Neuroleptic malignant syndrome, this can occur with high dose antipsychotics
Are patient with specific phobias aware they are strange?
Yes
What is the time frame from the fist symptom of withdrawal from alcohol?
Tremor in 8-18 hours
Is obsessive compulsive disorder egosyntonic or ego-dystonic? What about obsessive compulsive personality disorder?
OCD is ego-dystonic. OCPD is egosyntonic.
A spiral fracture should make you think of what issue?
Abuse, either child or elder.
How long does a panic attack typically last?
10-20 minutes
A patient exhibits splitting, seeing others as all good or all bad. What diagnosis should be thinking of?
Borderline personality disorder
A patient’s mother has recommended that he see you. He lives on his own and is a computer programmer. He works from home. He has no friends and seldom leaves the house. She is concerned that he expresses no interest in meeting people and seems perfectly happy to be home alone all the time. What diagnosis should you be thinking of?
Schizoid personality disorder
Waxy flexibility should make you think of what diagnosis?
Catatonic schizophrenia
Posturing should make you think of what diagnosis?
Catatonic depression
Antisocial personality disorder may not be diagnosed until what age?
18 years old
A patient is very concerned that she has breast cancer. In order to reassure her you perform a full workup which is negative. She is still unsatisfied and convinced that she has breast cancer. What diagnosis should you be thinking of?
hypochondriasis
Is anorexia egosyntonic or ego-dystonic? What about bulimia?
Anorexia is egosyntonic. Bulimia is ego-dystonic
When treating psychiatric patients are benzodiazepines used more commonly for acute or chronic treatment?
acute
A 6 year old boy seems to have all of the symptoms of ADD while at school, but at home he has no problems. Does he have ADD?
No, symptoms must occur in both settings for diagnosis
A patient’s mother has recommended that he see you. He lives on his own and is a computer programmer. He works from home. He has no friends and seldom leaves the house. She is concerned that clearly he would like to meet people, but is terrified of doing so. What diagnosis should be thinking of?
Avoidant personality disorder
A patient is very charming during his interview. You note during your interview that he has no concern for hurting or using other people. He seems to show no remorse for any of his actions. What diagnosis should you be thinking of?
Antisocial personality disorder
What is the most common precipitating event for posttraumatic stress disorder in women?
Rape
You have a patient with major depressive disorder. Once his symptoms have completely resolved how long should you continue with treatment?
A six month minimum is recommended due to very high relapse rates.
A 16 year old has just moved schools. He is quiet, moody, and not like himself at all. Within six months he seems to have completely changed back to his previous personality. What diagnosis should you be thinking of?
Adjustment disorder
What two things are needed to make a diagnosis of bipolar 2?
One major depressive episode and one hypomanic episode
A patient of yours always craves attention, often using sex as a tool to gain it. She often acts like a child when she does not get her way? What diagnosis should you be thinking of?
Histrionic personality disorder
At what BMI should a patient be hospitalized for anorexia?
BMI < 17.5 or 20% below appropriate body weight
A sawtooth pattern on EKG should make you think of what diagnosis?
Atrial flutter
List the 4 minor criteria for diagnosing endocarditis.
Fever, embolic event (Janeway lesions or petechiae, splinter hemorrhages), immunological event (Osler nodes, glomerulonephritis), 1 positive blood culture
List three class 1a antiarrhythmics.
Disopyramide, quinidine, procainamide
An RSR prime in leads V5 or V6 should make you think of what diagnosis?
Left bundle branch block
What is the first line IV inotropic agent when dealing with cardiogenic shock?
Dopamine
A blockage of which artery causes an anterior wall MI?
Left anterior descending artery
Following a myocardial infarction, what medication should you be using to treat hypertension?
Beta blocker
Tall peaked P waves should make you think of what diagnosis?
Right atrial enlargement
What is the best patient position to hear aortic regurge and aortic stenosis?
sitting up and leaning forward
An elderly patient presents with dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely diagnosis?
Aortic stenosis
Name one aldosterone antagonist.
Spironolactone, eplerenone
A patient has a GFR of 25 and HTN. Which class should you use, a loop or a thiazide diuretic?
A loop will work no matter how low the GFR is. Thiazides will only work with a GFR over 30.
After a thiazide diuretic, what medication should you start in a hypertensive patient who also has diabetes?
An ACEI or an ARB
Which EKG lead are used to diagnose an anterior wall MI?
V1, V2 and V3
Clot busting drugs should be used within 3 hours of which two cardiac events?
STEMI and new left bundle branch block
On an EKG, you notice a patient has a gradually lengthening PR interval and then a missed QRS complex. The pattern repeats again. What type of AV block is this?
Mobitz I or Wenckebach
Which hyperlipidemia medication may cause flushing?
Niacin
Any ulcers from venous insufficiency painful or painless?
painless
Where do most aortic dissections occur?
the ascending or descending thoracic aorta
What two labs do you want to monitor in a patient on an ACEI?
serum creatinine and serum potassium
What are the three major criteria for endocarditis?
2 positive blood cultures, a positive transesophageal echocardiography, new murmur
Where is disease of the pulmonary valve best heard?
2nd left intercostal space
A continuous murmur most likely involves what area of the heart?
It is most likely a septal defect
Where on your patient should you listen for the murmur associated with an atrial septal defect?
At the left second or third interspace
A patient recently started taking Lipitor. He is now complaining of aches and pains. What test should you order?
Serum creatinine kinase, you’re looking for rhabdomyolysis
A patient complains of severe pleuritic chest pain that is relieved with sitting and leaning forward. What is the most likely diagnosis?
Pericarditis
An EKG shows two premature ventricular contractions. These two QRS waves look very different. What is the term for this?
Multifocal premature ventricular contractions
On EKG there is an early but otherwise normal PQRS complex. After that beat there is a slight pause and then a normal rhythm continues. What is the term for this one beat?
Premature atrial contraction
What side effect might make a patient stop taking an ACEI?
Cough
On physical exam, you hear a harsh systolic murmur along the right sternal border. What is the most likely diagnosis?
Aortic stenosis
An RSR prime in leads V1 or V2 should make you think of what diagnosis?
Right bundle branch block
A patient has just received a cardiac stent. How long will he be on aspirin and clopidogrel?
One year
A beta natriuretic peptide below what level rules out CHF?
< 100
Define orthostatic hypotension
A drop in systolic blood pressure of > 20 mmHg when standing up
Which EKG leads are used to diagnose an anterolateral MI?
V5 and V6
What two leads do you use to determine the axis of the heart?
Lead I and AVF
What medication might you switch to if a patient develops an intolerable cough on an ACEI?
Angiotensin receptor blocker (ARBs)
Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis?
CHF
Both lead I and AVF have positive QRS complexes. Does this represent normal axis, left axis deviation, or right axis deviation?
normal axis
What is the first line medical treatment for torsades de pointes?
Magnesium sulfate
What is the first line medical treatment for pericarditis?
Aspirin and NSAIDs
What is the appropriate treatment for a patent ductus arteriosus.
Indomethacin
What is the first line medical treatment for stage 1 hypertension?
Thiazide diuretic
Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work?
No, a recent change moves mitral valve prolapse from high risk to moderate risk
What is the best test for diagnosing CHF?
Echo
Which lab should be tightly monitored in a patient taking an aldosterone antagonist?
Potassium, they may have hyerkalemia
In a patient with aortic stenosis, will the PMI be medially displace, normal or laterally displaced?
It will be laterally displaced due to left ventricular hypertrophy
Statins are the drug of choice to treat what type of dyslipidemia?
Elevated LDL
Name two things that would constitute a positive stress test.
A drop in blood pressure, a new arrhythmia, an increase in angina symptoms, ST depressions
A patient with mitral valve prolapse will often have what physical characteristics?
Often a thin female
An 82 year old patient complains of headaches and jaw claudication. What is the most likely diagnosis?
Giant cell (temporal) arteritis
What are the three inferior leads?
II, III, and aVF
The EKG shows irregularly irregular narrow QRS waves. What is the most likely diagnosis?
Atrial fibrillation
How do you treat polymyalgia rheumatica?
Low dose prednisone
Which cardiac medication has gynecomastia in its side effect profile?
Spironolactone
Lead I has a QRS that is up and the AVF lead has a QRS complex that is down. Does this represent normal axis, left axis deviation or right axis deviation?
Left axis deviation
Are most pulmonary valve problems congenital or acquired?
95% are congenital
You feel a pulse that seems to be vibrating. What term do you use to describe it?
Thrill
Where is disease of tricuspid valve best heard?
Along the left lower sternal border
What is Tietze syndrome?
Costochondritis
What is the most important complication of giant cell arteritis?
Blindness
What is the most common congenital heart disease?
Ventricular septal defect
List three medications which may be used for pharmacological stress testing.
Adenosine, dobutamine, dipyridamole and persantine
An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely diagnosis?
Supraventricular tachycardia
A U wave on EKG should make you think of what diagnosis?
Hypokalemia
Tall peaked T waves should make you think of what diagnosis?
Hyperkalemia
What is the best way to diagnose an aortic dissection?
CT
Rheumatic fever most commonly affects which valve?
The mitral valve
A patient complains of pain in his legs when he walks. It goes away after sittings. What term comes to mid for this symptom? What diagnosis is it associated with?
Intermittent claudication caused by peripheral arterial disease
What is the treatment goal for a diabetic with hypertension?
130/80
A question stem includes an IV drug user with a new heart murmur and fever. What is the most likely diagnosis?
Endocarditis
How does ezetimibe work?
Decreases intestinal absorption of cholesterol
A question about Prinzmetal’s angina will often contain what key thing in the patient’s history?
Cocaine use
Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?
Osler nodes
What is the definitive treatment for a patient with recurrent ventricular tachycardia?
Implanted defibrillator
Who is more likely to have an aortic aneurysm males or females?
Males are eight times as likely to have an aortic aneurysm
No matter what medications you use you are having trouble keeping a patient’s blood pressure under control. You also noticed hyperpigmented skin and truncal obesity. What is the most likely diagnosis?
Cushing’s disease
What is the only cyanotic congenital heart disease on the NCCPA blueprint?
Tetralogy of Fallot
A young boy comes into your office. He has elevated blood pressure when taken in his arm, but no femoral pulses can be palpated. What is the most likely diagnosis?
Coarctation of the aorta
What is the most common cause of sudden death?
Ventricular fibrillation
How do you define 1st degree AV block?
The PR interval is longer than 0.2 seconds or one block on EKG
List three congenital heart diseases.
Atrial septal defect (ASD), ventricular septal defect (VSD), coarctation of the aorta, patent ductus arteriosus (PDA), tetralogy of Fallor
A blockage of which artery causes a lateral wall MI?
left circumflex artery
List the six P’s of an ischemic limb.
Pain, paresthesias, pallor, pulselessness, poikilothermia, paralysis
What ejection fraction is typical for a patient with CHF?
35-40%
The accessory pathway known as the James bundle should make you think of what syndrome?
Lown-Ganong-Levine syndrome
What will a CXR show for a patient with an aortic dissection?
Widened mediastinum
A 60 year old male presents to the ER with severe dizziness and back pain. His blood pressure is dropping, and you can feel an abdominal pulsatile mass on physical exam. What is the most likely diagnosis?
Ruptured aortic aneurysm
What medication calls is used to lower triglycerides?
Fibric acid derivatives
On EKG, there is an early wide QRS complex with no associated P wave. After that beat, there is a slight pause, and then a normal rhythm continues. What is the term for this one beat?
Premature ventricular contraction
List three side effects of digoxin.
Nausea/vomiting, anorexia, confusion, arrhythmias (sinus brady, AV block), fatigue, vision disturbances etc.
You hear a loud, hard pulmonary murmur along the left sternal border. What is the most likely diagnosis?
Ventricular septal defect
You are counting boxes from the peak of a QRS wave on an EKG in order to determine the heart rate. What would the heart rate be if the next QRS wave peak were three boxes away? What numbers are associated with the first five boxes?
The answer is 100. The heart rates by counting boxes are 300, 150, 100, 75, 60.
What is the treatment for giant cell arteritis?
High dose prednisone
What is the most common cause of secondary hypertension?
Chronic kidney disease
What is the initial treatment for a myocardial infarction?
MONA - morphine, oxygen, nitroglycerin and aspirin
What is the first line medication for a patient with symptomatic bradycardia?
Atropine
You see regular P waves and regular QRS complexes, but you do not seem to have any correlation to each other. What is the diagnosis?
Third degree AV block
What is the best location to hear problems with the aortic valve?
2nd intercostal space
What is the gold standard for diagnosis of giant cell arteritis?
Biopsy of the temporal artery
If you hear a midsystolic click you should immediately be thinking about what diagnosis?
Mitral vale prolapse
A wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what diagnosis?
Aortic regurgitation
What terms will likely be include in a description of a patient with a pheochromocytoma?
Thin, diaphoretic, tachycardic, agitated
Do loop diuretics causer hyperkalemia or hypokalemia?
Hypokalemia
A boot-shaped heart on CXR should make you think of what congenital heart condition?
Tetralogy of Fallot
A patient presents to the ER in acute CHF. What drug class will likely be the first choice?
Loop diuretics
On auscultation, you hear a hard blowing pansystolic murmur at the apex. What is the most likely diagnosis?
Mitral regurgitation
Define pulsus alternans.
EKG waveform changes from beat to beat
What is the treatment for a patient with a Mobitz II AV block?
Pacemaker
List two risk factors for an aortic dissection?
Hypertension, Marfan’s syndrome, bicuspid aortic valve, pregnancy
You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?
Wolff-Parkinson-White syndrome
Which finding requires immediate attention: left bundle branch block or right bundle branch block?
New left bundle branch block is at STEMI equivalent, Right bundle branch block is usually not a problem.
What is represented by ST segment depressions greater than 1 mm on EKG?
Ischemia
What is the gold standard for diagnosing myocarditis?
Myocardial biopsy
What is the therapeutic range for INR following an organic valve replacement?
2 to 3
Name a common cause of a junctional rhythm.
Digitoxin toxicity
Calf pain should always make you think of what diagnosis?
DVT
What are three things in your differential if you have a paradoxical pulse?
Cardiac tamponade, pericarditis, and pulmonary obstructive lung diseases (think COPD)
What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?
Dressler’s syndrome
What is the most common cause of CHF?
Coronary artery disease
A patient in the ER has no pulse; but on EKG, there are wide irregular “complexes” which are at an irregular rate. They all appear very different from one another. What is the treatment for this patient?
He is in ventricular fibrillation. The treatment is defibrillation
A biphasic P wave should make you think of what diagnosis?
Left atrial enlargement
What is the management of a patient in supraventricular tachycardia?
Vagal maneuvers, carotid massage, adenosine
What class of cardiac medications should be avoided in patients with asthma?
Beta blockers (blocks receptors for bronchodilators)
What is the most common cause of sudden cardiac death?
Ventricular fibrillation
What is the other term for Mobitz type I?
Wenckebach
Giant cell arteritis is associated with what other disease?
Polymyalgia rheumatica
Subacute endocarditis is most commonly caused by what organism?
Strep Viridans
An Osborn or J wave on EKG should make you think of what diagnosis?
Hypothermia
What is the most common cause of an atrial septal defect?
Patent foramen ovale
What is the definitive treatment for cardiac tamponade?
Pericardiocentesis
List the components of Virchow’s triad.
Stress, vascular injury, hypercoagulability
On palpation, what size is normal for the aorta?
Less than 3 cm
A CXR shows a “3” sign with notching of the ribs. What is the most likely diagnosis?
Coarctation of the aorta
What will the heart rate be if the AV node is pacing the heart?
40-60 beats per minute
What lab results will increase the risk of digoxin toxicity?
hypokalemia or hypercalcemia
The heart rate is irregular, so you can’t count boxes between QRS waves to determine heart rate. What is another method you can use to determine rate on an EKG?
Count QRS waves in a six second strip and multiply by 10 to get beats per minute
Give two contraindications for using an ACEI.
Bilateral renal artery stenosis, history of angioedema, pregnancy
A patient presents to the ER with tearing chest pain radiating to his back. What is the most likely diagnosis?
Aortic dissection
What is the accessory pathway associated with Wolff-Parkinson-White syndrome?
The bundle of Kent
What is the most likely diagnosis for a young man who experiences sudden death while playing sports?
Hypertrophic cardiomyopathy
Paroxysmal nocturnal dyspnea should make you think of what diagnosis?
CHF
List three catastrophic complications of a myocardial infarction.
Papillary muscle rupture, myocardial wall rupture and left ventricular aneurysm
Acute endocarditis is most commonly caused by what organism?
Staph aureus
An opening snap on auscultation of the heart should make you think of what diagnosis?
Mitral stenosis
You have a patient with diagnosis of a pheochromocytoma. While waiting for surgery, should you use an alpha blocker or a beta blocker?
Alpha blocker. Never use a pure beta blocker.
What is the most common place for an aortic aneurysm?
In the abdomen and below the renal arteries
You hear a continuous machine-like murmur. What is the most likely diagnosis?
Patent ductus arteriosus (PDA)
A patient complains of severe crushing chest pain. EKG shows ST segment elevations. All labs including troponins and CK-MB are negative. What is the most likely diagnosis?
Prinzmetal’s angina
Define paradoxical pulse.
There is a large difference in pulse pressure between inhalation and exhalation
You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis?
Transesophageal echo
Which cardiac medication is used to help with cardiac contractility after you have optimized most of the other cardiac medications?
Digoxin
What is the gold standard for diagnosing coronary artery disease?
Cardiac catheterization
Are ulcers from arterial insufficiency painful or painless?
Painful
What are the five components of teratology of Fallot?
Ventricular septal defect, right ventricular hypertrophy, right ventricular outflow obstruction (pulmonary valve stenosis), overriding aorta, right sided aortic arch
List two diagnoses which require antibiotic prophylaxis for “dirty procedures”?
prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congenital cyanotic heart defect
What are the two main causes of aortic stenosis?
Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease
An EKG shows a regular rate of 50 beats per minute. The QRS is narrow and there is no visible P wave. What is the most likely diagnosis?
Junctional rhythm
Where is disease of the mitral valve best heard?
At the apex
What is the definitive treatment for atrial flutter?
Radiofrequency catheter ablation
A patient presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all of the leads. What is the most likely diagnosis?
Pericarditis
List two cause of right atrial enlargement.
Pulmonary HTN, severe lung disease, pulmonary valve stenosis
A pathologic S3 is most commonly associated with what diagnosis?
CHF
According to the CDC, what is the range for a normal BMI?
18.5-24.9
You have a patient with pulsus paradoxus. What two diagnosis should you be thinking of?
Cardiac tamponade, pericarditis, pulmonary obstructive lung diseases (think COPD)
A fixed or consistent split S2 should make you think of what diagnosis?
Atrial septal defect
What two antibiotics are used for empiric treatment of endocarditis?
Vancomycin and ceftriaxone together are first line empiric treatment
A Blalock procedure is used to correct what congenital heart condition?
Tetralogy of Fallot
What imaging needs to be done before taking a patient to the OR with an aortic aneurysm?
CT (echo may be used as initial study, but CT is need for surgery)
What two valvular issues do patients with Marfan’s syndrome often have?
Aortic regurgitation and mitral valve prolapse (you can tell them apart by where they are heard)
Name three medication “classes” which are used to reduce LDL?
Statins, ezetimibe, niacin and nicotinic acid
Define stage 1 hypertension according to JNC 7.
Systolic pressure of 140-149 and diastolic of 90-99
What is the heart rate for tachycardia? How about bradycardia?
Tachycardia > 100, bradycardia < 60
The term satellite lesion should make you think of what diagnosis?
Candida diaper rash
Salmon-colored scales should make you think of what diagnosis?
Psoriasis
What are the ABC’s of melanoma?
Asymmetry, border, color, diameter, elevation/irregularity, evolving
Pitting nails are associated with what dermatologic disorder?
Psoriasis
What are the two most common organisms responsible for cellulitis?
Strep and Staph
A herald patch should make you think of what diagnosis ?
Pityriasis rosea
How do you treat pityriasis rosea?
Reassurance
Coin-shaped plaques should make you think of what diagnosis?
Nummular eczema
What is the best lab test for scabies?
Microscopic examination under oil immersion
Honey-colored crusts should make you think of what diagnosis?
Impetigo
What is the treatment for seborrheic keratosis?
It is benign so there is no need to treat it. Lesions may be removed if unsightly
Are lesions from psoriasis typically found on flexor or extensor surfaces?
Extensor
How do you treat lichen simplex chronicus?
Get the patient to stop scratching it
Extremely pruritic lesions with burrows in runs should make you think of what diagnosis?
Scabies
How do you treat a stasis dermatitis?
Compression stockings
A patient with a history of herpes now presents with a target lesions. What is the most likely diagnosis?
Erythema multiforme
A teardrop lesion after a course of strep throat should make you think of what diagnosis?
Guttate psoriasis
Why should actinic keratosis be treated?
It may progress to squamous cell carcinoma
What dermatologic finding is associated with insulin insensitivity?
Acanthosis nigricans
Depigmented patches of skin should make you think of what diagnosis?
Vitiligo
Spaghetti and meatballs on KOH prep should make you think of what diagnosis?
Tinea versicolor
What dermatologic finding is associated with asthma?
Atopic dermatitis
A patient presents with flaky skin in the nasolabial folds and on her scalp. What is the most likely diagnosis?
Seborrheic dermatitis
Tapioca blisters should make you think of what diagnosis?
Dyshidrosis - these are usually on hands and feet
Nummular eczema is most like what other dermatological disorder?
Atopic dermatitis
How do you treat dyshidrosis?
Topical steroids
What is the first step in treating atopic dermatitis?
behavioral modifications - reduce bathing, only use soap on face and genitals, use natural breathable fabrics
What two human papillomaviruses are most responsible for condyloma acuminata?
HPV 6 and 11
What is the treatment for melanoma?
Wide local excision
Where are 90% of basal cell lesions found on the body?
On the head and neck
What is the first line treatment for rosacea?
Metronidazole, tetracycline is probably a close second
Rhinophyma should make you think of what diagnosis?
Acne rosacea
Melasma is most often found in what patient population?
Women of childbearing age
What is the best treatment for molluscum contagiosum?
It is self limiting, but can be removed if patient really wants it
What is the first line treatment for tinea corporis
Topical azoles
A waxy stuck on appearance should make you think of what diagnosis?
Seborrheic keratosis
A Christmas tree pattern should make you think of what diagnosis?
Pityriasis rosea
A positive Auspitz sign should make you think of what diagnosis?
Psoriasis
A 30 year old female presents with pustules on her face that spare the vermillion border. In her history she has been using topical steroids. What is the most likely diagnosis?
Perioral dermatitis
Hyperpigmented velvety plaques should make you think of what diagnosis?
Acanthosis nigricans
Purple, pruritic, polygonal, papules on physical exam should make you think of what diagnosis?
Lichen planus
Oval patches of hair loss should make you think of what diagnosis?
Alopecia areata
What is the key indicator for the prognosis of melanoma?
Thickness of the lesions
A pearly dome-shaped lesions with a central umbilication should make you think of what diagnosis?
Molluscum contagiousum
Giant cells on a Tzanck smear should make you think of what diagnosis?
Herpes simplex virus
A 5 year old presents in early January with a red itchy rash behind his knees. You notice it on the flexor surfaces of his elbows as well. What is the most likely diagnosis?
Atopic dermatitis
Silvery scales should make you think of what diagnosis?
Psoriasis
What is the first line treatment for genital warts?
Imiquimod (Aldara)
A slowly growing nodule with central depression and a pearly border should make you think of what diagnosis?
Basal cell carcinoma
What is the treatment for a bad brown recluse spider bite?
Debridement, the venom causes tissue necrosis
A double comedone is indicative of what diagnosis?
Hidradenitis suppurativa
Large doughy hands should make you think of what diagnosis?
Gigantism
Cortical adrenal insufficiency is also known as what disease?
Addison’s disease
How do glitazones work?
They improve insulin sensitivity
Pretibial myxedema should make you think of what diagnosis?
Graves’ disease
In Cushing’s disease is ACTH elevated or decreased?
Elevated
In a patient with hyperthyroidism will TSH most likely be elevated or decreased?
Decreased
Positive antithyroid peroxidase and antithyroglobulin antibodies should make you think of what diagnosis?
Hashimoto’s
What is the test to begin with if you suspect a pheochromocytoma?
24 hour urine for catecholamines
Stocking glove anesthesia should make you think of what diagnosis?
Diabetic neuropathy and B12 deficiency neuropathy
Which thyroid cancer is the most aggressive?
Anaplastic
How do sulonylureas work?
They stimulate the produce of insulin
What is the most common thyroid cancer?
Papillary, makes up about 80% of thyroid cancers
How does levothyroxine work?
It is a synthetic T4
What heparin complication is relevant to endocrinology?
Adrenal infarct leading to a Cushing’s syndrome
How often should a diabetic’s HgbA1c be checked and what should it be?
Every three months (remember the life of an RBC is 90-120 days) and it should be below 6.5%
What role does C-peptide play in the diagnosis of diabetes?
It is a marker of insulin production. Elevated C-peptide points to DM 2. Decreased C-peptide points towards DM 1.
During pregnancy which is the preferred treatment of hyperthyroidism PTU or methimazole?
PTU
List four diagnostic criteria for diabetes?
Random glucose > 200, fasting glucose >126, two hour postprandial glucose > 200, HgA1c > 6.5%
What percentage of diabetes in the US is type 2?
80-90%
A 35 year old female presents with heat intolerance, weight loss, and palpitations. What diagnosis should you be thinking of?
Hyperthyroidism
Diabetes insipidus is caused by a deficiency of which hormone?
Vasopressin
Fruity breath should make you think of what diagnosis?
Diabetic ketoacidosis
List the 5 insulins in order of peak efficacy?
Lispro 1-2 hours, Regular 2-4 hours, NPH 5-7 hours, Lente 4-8 hours, Ultralente 8-14 hours
List 4 physical exam findings of Cushing’s syndrome.
Moon face, buffalo hump, purple striae, central obesity, supraclavicular fat pads, easy bruising
What medication class does metformin (Glucophage) fall into?
Biguanide
How do statins work to affect the lipid profile?
They slow the rate limiting step of cholesterol synthesis
What is the treatment for Addison’s disease?
Hydrocortisone or prednisone
Propranolol belongs to what class of medication?
Beta blockers
HLA-DR gene is a marker for what endocrine disorder?
DM type 1
What is the main function of parathyroid hormone?
Increase serum Ca
Is metformin indicated or contraindicated in renal failure?
Contraindicated
What is the best imaging for a thyroid nodule?
Ultrasound
What medication might you use prior to a thyroidectomy in a patient with hyperthyroidim?
Methimazole or propylthiouracil (PTU)
What lipid medication may cause flushing?
Niacin
What is the most common pituitary adenoma?
Prolactinoma
What is Graves’ disease?
The most common cause of hyperthyroidism. It is an autoimmune disease
What is the first line medical treatment for a patient with palpitations and nervousness secondary to hyperthyroidism?
Beta Blockers
What is the least aggressive thyroid cancer?
Papillary
Moans, groans, stones and bones describe symptoms of what endocrine problem?
Hyperparathyroid
How do fibrates work to affect the lipid profile?
They inhibit synthesis of ALDL and elevate lipoprotein lipase
Hyperpigmentation of the skin along creases should make you think of what diagnosis?
Addison’s disease
What is Trousseau’s sign?
Inflate BP cuff and hold for 3 minutes. Patient will low Ca will get carpal tunnel symptoms
What is the most common cause of hypoparathyroid?
Post thyroidectomy with complication of parathyroidectomy
What is Chvostek’s sign?
Tap on facial nerve and get a twitch with low Ca
How does nicotinic acid work to affect the lipid profile?
It inhibits secretion of VLDL
Exophthalmos should make you think of what diagnosis?
Hyperthyroidism
What is the first line medical treatment for a pheochromocytoma?
Alpha blockers
Will ACTH be elevated or decreased in Addison’s disease?
Elevated if the problem is at the adrenal glands
What is the most common cause of DM type 1?
Autoimmune destruction of the islet cells in the pancreas
What life threatening side effect do statins have?
Rhabdomyolysis
List two ectopic tumors that may produce ACTH and give a patient Cushing’s syndrome?
Small cell lung cancer, pancreatic islet cells, thymomas
How does metformin work?
Decreases the hepatic glucose production and increases peripheral glucose uptake
What are the 5 criteria for metabolic syndrome?
HDL < 40 men < 50 females, BP >135/85, Triglycerides > 150, Fasting glucose > 100, Waist > 40 inches in mean > 35 inches in women
Name two tests you might use to rule out Cushing’s syndrome.
24 hour free cortisol urine test and dexamethasone suppression test
A patient presents with erectile dysfunction and complains of some numbness in his feet. On second thought he has noticed significant polyuria and polydipsia. What diagnosis should you be thinking of?
Diabetic neuropathy
How much more potent is T3 than T4?
3-4x
What is included in Whipple’s triad of hypoglycemia?
History of previous hypoglycemia, serum glucose of < 40, immediate recovery upon administration of glucose
What specific breathing pattern is associated with diabetic ketoacidosis?
Kussmaul respirations
What is the suffix associated with sulfonylureas?
ide is the suffix. Examples are glipizide, tolbutamide, tolazamide
What class of medications is the first line for lowering LDL?
Statins
As it related to diabetes, what is the dawn phenomenon?
Reduced insulin response between 5 and 8 am
Does niacin increase or decrease HDL?
Increase
What is Sheehan’s syndrome?
Ischemia of the pituitary due to volume depletion during or after childbirth
What is Hashimoto’s disease?
An autoimmune cause of hypothyroid
Name the four thyroid cancers.
Papillary, Follicular, Medullary, Anaplastic
What class of medications does pioglitazone (Actos) fall into?
Thiazolidinediones also known as glitazones
What is the most common cause of hyperparathyroidism?
Single parathyroid adenoma in 80% of cases
What is the most common cause of hypopituitarism?
Tumor
Typically what is the first medication started in type 2 DM?
Metformin
What two hormones are secreted by the posterior pituitary?
Oxytocin and antidiuretic hormone (ADH, vasopressin)
What is the treatment for myxedema?
Levothyroxine and slow warming
List the four things that suggest group A beta-hemolytic strep in a patient with pharyngitis.
Fever, tender anterior cervical adenopathy, no cough and an exudate in the throat.
What type of hearing loss would be caused by cerumen impaction?
Conductive
How do you treat allergic rhinitis?
Intranasal corticosteroid and antihistamines
Small grouped vesicles on the vermillion border should make you think of what diagnosis?
Herpes
A 45 year old female complains of feeling the ground rolling under her feet at times. What is the most likely diagnosis?
Vertigo
A white oral lesion which cannot be scraped off should make you think of what diagnosis?
Oral leukoplakia
Acute sinusitis is most commonly caused by what two pathogens?
Step pneumoniae and haemaophilus influenzae
List four complications of untreated strep throat
Scarlet fever, glomerulonephritis, rheumatic fever, and local abscess
When is watchful waiting with a diagnosis neuroma an appropriate plan?
This tumor is very slow growing. Watching a small tumors in an elderly patient is appropriate treatment
An x-ray of the skull revels coalescence of mastoid air cells. What is the most likely diagnosis?
Mastoiditis
What does Kiesselbach’s plexus refer to?
A group of vein’s in the anterior nose which bleed a lot
A patient presents with a hot potato or muffled voice. What is the most likely diagnosis?
Peritonsillar abscess
White oral lesions which can be scraped off leaving punctate bleeding should make you think of what diagnosis?
Oral candida
What is the treatment of choice for strep throat?
Penicillin, amoxicillin, erythromycin
How do you administer the Rinne hearing test?
Place the turning fork on the mastoid and then move it next to the ear.
A patient presents with acute onset of continuous severe vertigo for the past five days. He does have a history of URI 2 weeks ago. What is the most likely diagnosis?
Labrynthitis
What type of hearing loss is associated with aging?
Sensory
What virus causes mumps?
Paramyxovirus
What are three possible treatments for peritonsillar abscess?
Needle aspiration, I&D, and tonsillectomy
A child presenting with an erythematous sandpaper rash should make you think of what diagnosis?
Scarlet fever
List the time of year when each of the following allergens is most prominent. Pollen, Grass, Ragweed and Mold.
Pollen from trees and flowers = spring, grasses are the summer, mold and ragweed are fall.
A patient presents with unilateral hearing loss and a decrease in speech discrimination. She has also had difficulty with balance over the past week. What is the most likely diagnosis?
Acoustic neuroma
How long should pressure be applied to treat epistaxis?
15 minutes
A patient presents with several episodes of vertigo over the past few weeks. He has had intermittent unilateral hearing loss and a “blowing” in his ears. What is the most likely diagnosis?
Meniere’s disease
A 14 year old field hockey player presents with prominent adenopathy, white purple exudates in the tort and a palpable spleen. What is the most likely diagnosis?
Mononucleosis
A patient with a history of smoking presents with a new onset hoarseness. This has been persistent for the past two weeks. What is the most likely diagnosis?
Laryngeal squamous cell carcinoma
How do you administer the Weber hearing test?
Tuning fork placed in the middle of the forehead.
Which is the most commonly affected sinus in acute sinusitis?
Maxillary
A patient presents drooling, with stridor and in tripod position. What is the diagnosis and how do you treat it?
Epiglottis is treated with a third generation cephalosporin - ceftriaxone
A patient presents with a round ulcer in her mouth that is yellow-grey and has a red halo. It is on the buccal mucosa and it is painful. What is the most likely diagnosis?
Aphthous ulcers
What time frame are we talking about for chronic sinusitis?
> 3 months
In a patient with sensorineural hearing loss, what will be the results of the Weber test?
The patient will hear the sound louder in the unaffected ear
Describe the result of a Weber hearing test in a patient with conductive hearing loss.
Patient will report the sound louder in the affected ear.
After 10 days of worsening sinusitis what antibiotic should you start?
Augmentin (Amoxicillin/clavulanate)
A patient presents with acute swelling and pain in the cheek that increases at meals. What is the most likely diagnosis?
Sialadenitis (salivary gland infection)
-Staph aureus
Oral herpes is best treated with systemic or topical antivirals?
Topical is the first line. Systemic antivirals will help but are only indicated for severe cases.
Often caused by chlamydia what is the syndrome characterized by urethritis (or cervicitis), arthritis and conjunctivitis?
Reiter’s syndrome
Define phimosis.
Foreskin can not be retracted
Will serum potassium be decreased or elevated in renal failure?
Elevated
Muddy-brown sediment in the urine should make you think of what diagnosis?
Acute tubular necrosis
What are the two most common predisposing factors in the development of chronic renal failure?
HTN and DM
What is the best imaging to tule out testicular torsion?
Doppler U/S for decreased blood flow to the testes
List one major risk factor for bladder cancer?
Smoking
What is the condition where the urethral meatus is not at the tip of the penis?
Hypospadias and in far fewer cases epispadias
Define priapism.
Painful persistence erection.
A urine protein of >3.5 grams/day should make you think of what diagnosis?
Nephrotic syndrome
A 65 year old male presents with frequency. On digital rectal exam you feel an elastic moderately enlarged prostate. What diagnosis should you be thinking of?
BPH
At what age do you begin screening patients for prostate cancer? What two tests are used?
At age 50 an annual digital rectal exam and a PSA are recommended
Tenderness at the costovertebral angle should make you think of what diagnosis?
Pyelonephritis
Both testicles should be descended by what age?
3 months
What is the first line treatment for a varicocele?
Watchful waiting unless there is a question of futility
What is the most common type of kidney stone?
Calcium makes up 85% of kidney stones
An involuntary loss of urine during coughing or laughing is what type of incontinence?
Stress incontinence
What is the first line antibiotic for prostatitis?
Bactrim 4-6 weeks
What is the name of the condition that involves fibrous scar tissue in the penis causing a curvature of the erect penis?
Peyronie’s disease
Which problem is an emergency phimosis or paraphimosis?
Paraphimosis
What is the most accurate way to diagnose urethritis?
Urine PCR
What is the most common type of testicular cancer?
Non-seminoma
List three possible treatments for stress incontinence in women.
Kegels, estrogen therapy, surgical placement of a urethral sling.
Give two major risk factors of erectile dysfunction.
Diabetes, hypertension, depression, coronary artery disease
An ABG shows a pH of 7.2, a bicarb of 25 and a PCO2 of 50. Is this respiratory or metabolic acidosis?
respiratory - CO2 is elebated
What is the normal pH of the blood?
7.35-7.45
A patient who has normal bladder function, but can not get to the bathroom has what type of incontinence?
Functional incontinence
How do you treat urethritis?
Ceftriaxone and doxycycline
What is the first line antibiotic treatment for cystitis?
Bactrim
What is the imaging study of choice if you suspect bladder cancer?
Cystoscopy and biopsy
A kidney stone of less than what size will likely pass on its own?
Less than 5 mm
What is the mot specific imaging modality for diagnosing kidney stones?
CT
Will epididymitis feel better with scrotal elevation?
Yes
Will a spermatocele transilluminate?
Yes
A sponge-like prostate on digital rectal exam should make you think of what diagnosis?
Prostatitis, but be careful. You can cause sepsis with a digital rectal exam.
Define paraphimosis.
Foreskin is retracted and cannot be reduced.
Name the condition in which the head of the penis curves downward or upward, at the junction of the head and shaft of the penis. (Hint: It is often associated with hypospadias.)
Chordee
A PSA above what level should start to make you concerned?
> 4.0
What type of incontinence is often associated with BPH?
Overflow incontinence, the bladder cannot empty sufficiently
List two risk factors for prostate cancer.
Advancing age, African American, positive family history, high fat diet
What is the normal level or serum bicarbonate (HCO3)?
24 mEq/Liter
A 3 year old boy presents with hematuria and a painless palpable abdominal mass. What diagnosis should you be thinking of?
Wilms tumor
Where is the epididymis found?
It is found at the posterior upper pole.
What is considered a normal PCO2?
40 mmHG
What area of the prostate is the primary site for prostate cancer?
The peripheral zone
What area of the prostate is affected by BPH?
The transitional zone
Painless hematuria should make you think of what diagnosis?
Bladder cancer
What is the most likely diagnosis for a free floating, painless cystic mass found posterior and superior to the testes?
Spermatocele
What is the most common organism responsible for prostatitis?
E. coli
What is the treatment for epididymitis?
Ceftriaxone and doxycycline
Feeling a bag of worms in the scrotum should make you think of what diagnosis?
Varicocele
A prostate biopsy consists of how many samples?
6 to 12
A fluid filled painless mass found in the scrotum which transilluminates should make you think of what diagnosis?
Hydrocele
Name the sign which is defined as decreased pain with scrotal elevation?
Prehn’s sign
White blood cell casts should make you think of what diagnosis?
Pyelonephritis
Tea-colored urine with red cell casts should make you think of what diagnosis?
Glomerulonephritis
What is the most common bladder cancer?
Transitional cell cancer
What might you feel on a digital rectal exam of a patient with prostate cancer?
Enlarged prostate, hard nodules within the prostate
What is the most common organism that causes a bladder infection?
E. coli
List three possible causes of prerenal renal failure.
CHF, severe dehydration, hemorrhage
Maltese crosses in the urine should make you think of what diagnosis?
Nephrotic syndrome
What is the mot common cause of post renal failure?
BPH, post renal renal failure is secondary to an outflow obstruction
What hereditary pattern does polycystic kidney disease follow?
Autosomal dominant
What medication classes are prescribed in order to help prevent chronic renal failure in diabetic patients?
ACEIs or ARBs
What age range is typically associated with testicular torsion?
10-20 years old
In a folic acid deficiency anemia the folic acid level is typically below what level?
<150
What is the most common microcytic anemia?
Iron deficiency anemia
If a question presents a pregnant woman with anemia what is the most likely diagnosis?
Iron deficiency
A low retic count and a normal serum ferritin should make you think of what diagnosis?
Anemia of chronic disease
Which anemia should you think of if you see the term Howell-Jolly bodies?
Sickle cell due to the functional asplenia, but it may also show up in folic acid and B12 deficiency
Under normal conditions at what hemoglobin level would you begin to consider a transfusion?
8
You should be thinking alpha thalassemia if the question stem includes which four geographic areas?
Southeast Asia, China, Middle East, Africa
Auer rods are most commonly associated with what disease?
Acute myeloid leukemia
What is pica?
Eating non-food items including ice, paper, dirt, hair
What is Schilling’s test used for?
Test for the cause of a B12 deficiency
An African American teenage presents with avascular necrosis of the his right femoral head. What diagnosis should you be thinking of?
Sickle cell disease
List four disease states in which you may find basophilic stippling.
Lead poisoning, beta or alpha thalassemia, sideroblastic anemia, arsenic poisoning
Would a B12 deficiency anemia most likely be microcytic, normocytic, or macrocytic?
Macrocytic
What molecule binds iron in the blood stream?
Transferrin
Inability to absorb vitamin B12 due to lack of intrinsic factor is what disease?
Pernicious anemia
Does an increase in reticulocytes indicate a decrease or an increase in RBC production?
An increase, reticulocytes are newly released “baby” RBC’s
Will unconjugated bilirubin be high or low in a patient with sickle cell disease?
High
Would anemia of chronic disease most likely be macrocytic, normocytic, or microcytic?
Normocytic
Will the serum ferritin be high or low in a patient with iron deficiency anemia?
It will almost always be low
G6PD deficiency follows what pattern of inheritance?
X-linked
Strict vegans are at risk for what type of anemia?
B12 deficiency anemia
The term Philadelphia chromosome should make you think of what diagnosis?
Chronic myeloid leukemia
Will the retic count be elevated, decreased, or normal in B12 deficiency anemia?
Retic count will be low. Low building blocks means low production.
Stocking glove paresthesias should make you think of what two diagnoses?
B12 deficiency neuropathy and diabetic neuropathy
List the three diagnosis you should be thinking of if a question includes Heinz bodies.
G6PD deficiency anemia, chronic liver disease, alpha thalassmeia
What is the normal range for MCV?
80-100
Will the RBC’s be large, small or normal size in B12 deficient anemia?
Macrocytes
What two main causes should you be thinking of in a macrocytic anemia?
Malnutrition and severe blood loss
Asplenism secondary to sickle cell disease increases a patient’s risk for what type of infections?
Capsulated organisms like Strep pneumonia and H. flu.
Will a hemolytic anemia generally have an elevated or decreased retic count?
Elevated
Iron deficiency anemia will have a serum iron lower than what value?
30
Are target cells seen in mild or severe iron deficiency anemia?
Severe, they are also seen in alpha thalassemia, Chronic liver disease, and asplenia
What does koilonychia refer to?
Spoon-shaped nails which may be found in microcytic anemia
How do you treat a sickle cell crisis?
Fluids, oxygen, pain medication, transfusion may be necessary
Is sickle cell microcytic, macrocytic or normocytic?
Microcytic
What hematological disorder should you think of if the questions talks about the patient eating ice or dirt?
Iron deficiency anemia
A patient of Mediterranean descent is a clue for which type of anemia?
Beta Thalassemia
A leukemia patient has a CT of the liver which shows punched out lesions. What diagnosis should you be thinking of?
Hepatosplenic candida
Rice water stool should make you think of what diagnosis?
Cholera
What is the best test to diagnose malaria?
Peripheral blood smear
What class of antibiotics is sometimes prescribed specifically for its effects on increasing GI mobility?
Macrolides
What are the two important pieces of patient education for anyone diagnose with mononucleosis?
No contact sports (splenic rupture) and no kissing (highly contagious)
A patient ate out last night and today has cramping and bloody diarrhea. What is the most likely organism?
Salmonella
Why can’t you give fluoroquinolones to kids?
They can cause cartilage development problems
What organism causes toxoplasmosis?
Toxoplasma gondii
Which herpesvirus causes Epstein-Barr?
Herpes 4
Owl eye inclusion bodies should make you think of what diagnosis?
Cytomegalovirus (CMV)
A patient complains of a rash on his palms and soles. He has a fever and chills. In conversation he mentions a strange painless chancre he had a few weeks ago. What diagnosis should you be thinking of?
Secondary syphilis. This is the most contagious stage.
What is the current drug of choice for treating MRSA?
Vancomycin
What might happen if you infuse vancomycin too fast?
Red Man syndrome
Syphilis is caused by what organism?
Treponema pallidum
How do you treat hookworms?
Azoles
What are three medications often combined as a first line treatment for H. pylori?
Omeprazole, clarithromycin and amoxicillin (PPI + 2 Antibiotics)
What is the most common prophylactic antibiotic used preoperatively?
Cefazolin = Ancef, Keflex = Cefalexin, The answer is Cefazolin (Ancef)
A painless, clean base chancre should make you think of what diagnosis?
Primary syphilis
What does trismus mean?
Lock jaw, often secondary to tetanus
What organism is the most common cause of an uncomplicated urinary tract infection?
E. Coli
What is the treatment for cholera?
Fluids
A patient presents to the ER with acute progressive weakness, diplopia and a very dry mouth. What organism may be causing this?
Clostridium botulinum
Is Klebsiella gram (+) or gram (-)?
Gram (-)
If you have a patient with positive blood cultures for candida what is the first line drug?
Amphotericin B
What organism is believed to be the main culprit in creating peptic ulcers?
Helicobacter pylori
Any reference to dark field microscopy should make you think of what organism?
Treponema pallidum
How do you treat white oral plaques that can be scraped off?
This is most likely candida. Topical nystatin or oral fluconazole 1 mg are first line choices
What is the current drug of choice for the cytomegalovirus?
Ganciclovir
A patient is bitten by a rabies infected raccoon. On what days do you give human haploid cells?
0, 3, 7, 14, 28
A patient presents complaining of a metallic taste in her mouth and dark brown urine. What antibiotic might she be on?
Metronidazole (Flagyl)
How do you definitively diagnose rabies?
Pathology of the brain of the animal that performed the bit using fluorescent antibody stain
What disease does Rickettsia rickettsii cause?
Rocky Mountain spotted fever
What drug do you use to treat pinworm?
You treat everyone in the house with albendazole. Two weeks later you treat them again.
What is the minimum amount of time needed for a tick to transfer Lyme disease to a human?
24 hours
What is the suffix used for most fluoroquinolone?
Oxacin
A patient being treated with penicillin for a syphilis infection develops fever, chills, muscle pain and headaches. Do you stop treatment?
No this is Jarisch-Herxheimer reaction. The patient must be closely monitored, but it is a response to released endotoxin from the death of the spirochetes and not an allergic reaction.
What drug is used for the treatment or prophylaxis of malaria?
Chloroquine
What organism has been linked to reactive arthritis?
Shigella, also remember that reactive arthritis has a positive HLA-B27
List two macrolides.
Erythromycin, azithromycin, clarithromycin
What is the drug of choice for treating Rocky Mountain spotted fever?
Doxycycline
What is the first symptom of a rabies infection?
Pain and anesthesia at the site of the bite
What is the drug of choice to treat a urethritis caused by neisseria?
Ceftriaxone (Rocephin)
Why aren’t fluoroquinolones used more frequently?
They have lots of side effects
Name one oral medication that can be used for MRSA.
Linezolid (Zyvox) and Bactrim
What is the drug of choice for the treatment of syphilis?
Penicillin
What antibiotic class of choice for chlamydia?
Macrolides
What type of mosquitoes carry malaria?
Anopheles
What is the drug of choice to treat C. difficile?
Metronidazole (Flagyl)
What is the clinical name for whooping cough?
Pertussis
Is pseudomonos gram (+) or gram (-)?
Gram (-)
What are four steps in treating diphtheria?
Antitoxin, penicillin, remove membrane, report the case to the CDC
How do hookworm larvae enter the body?
The penetrate the skin usually through the soles of the feet
Is diphtheria a Gram-positive or negative organism?
Gram-positive
The scotch tape test is used to diagnose what disease?
Pinworm
An HIV patient presents with a nonproductive cough and a CXR showing diffuse interstitial infiltrates. What diagnosis should you be thinking of?
Pneumocystis jiroveci pneumonia (PCJ) formerly known as Pneumocystis pneumonia (PCP)
What is the treatment for a tetanus infections?
Penicillin, immune globulin and supportive care (especially respiratory care)
Pregnant woman and cat little should make you think of what diagnosis?
Toxoplasmosis
A COPD patient has apical cavities and calcified nodes on his CXR. You also discover he has a pet bat and a few birds. What diagnosis should you be thinking of?
Histoplasmosis
What class of antibiotics should you start with for community acquired pneumonia?
Macrolides
What type of organism causes botulism?
A Gram + rod, Clostridium botulinum
What tests are done to screen for HIV?
ELISA, then if positive the diagnosis is confirmed with a Western blot test
Which medication is worse to give a pediatric patient, tetracycline or an aminoglycoside?
Tetracycline
What type of organism causes tetanus?
A Gram + rod, Clostridium tetani
An India ink stain showing cysts should make you think of what diagnosis?
Cryptococcosis
What is the treatment for Shigella?
Bactrim or fluoroquinolones and hydration
What is the drug of choice to treat Lyme disease in kids or pregnant women?
Amoxicillin
A 16 year old girl presents with an exudative sore throat and general malaise. On physical exam you observe some posterior chain lymphadenopathy and mild splenomegaly. What diagnosis should you be thinking of?
Epstein-Barr virus
A Gram-positive organism in chains should make you think of what diagnosis?
Strep
A CT scan shows ring enhancing lesions in an HIV patient. What diagnosis should you be thinking of?
Toxoplasmosis
Diarrhea with blood and mucus should make you think of what diagnosis?
Shigella
Gummas or granulomatous nodules should make you think of what diagnosis?
Tertiary syphilis
How do you treat pneumocystis jiroveci pneumonia (PCJ) formerly known as pneumocystis pneumonia (PCP)?
Bactrim
What organism cause Lyme disease?
Borrelia burgdorferi
What is the best test for diagnosing Rocky Mountain spotted fever?
Indirect immunofluorescent antibodies
A stuck on grey membrane in the pharynx should make you think of what diagnosis?
Diphtheria
Name three serious reactions a patient may have with the use of vancomycin?
Nephrotoxicity, ototoxicity, and Stevens-Johnson syndrome
What antibiotic is most likely to cause C. diff?
Clindamycin
Is staph gram (+) or gram (-)?
Gram (+)
Pizza pie retinopathy should make you think of what diagnosis?
Cytomegalovirus (CMV)
A patient was camping a few days ago and now has a rash that began on his wrists and ankles. What diagnosis should you be thinking of?
Rocky Mountain spotted fever
White curd like vaginal discharge should make you think of what diagnosis?
Vaginal candida infection
Is neisseria gram (+) or gram (-)?
Gram (-)
A gram-negative coccobaccili found in the sputum of patient with pneumonia should make you think of what diagnosis?
H. flu
What is the treatment for pertussis?
Erythromycin x 7 days
What is the drug of choice for toxoplasmosis?
Bactrim
What is the drug of choice for the treatment of Lyme disease?
Doxycicline
What is the treatment for botulism?
Antitoxin
A Gram-negative diplococci should make you think of what diagnosis?
Neisseria
Honey and babies should make you think of what diagnosis?
Botulism
Community acquired carditis is most often caused by one of the HACEK organism. List the HACEK organisms.
Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella
A gram-positive organism in clusters should make you think of what diagnosis?
Staph
What is the prophylactic antibiotic most commonly given before a dental procedure if one is necessary?
Amoxicillin 2 grams po 1 hour before procedure
How do you treat amebiasis?
Metronidazole (Flagyl)
You place a patient on rifampin. What side effect should you warn her about?
Orange-red discoloration of body fluids
What organism is most commonly responsible for community acquired pneumonia?
Strep pneumoniase
A diaper rash with satellite lesions should make you think of of what diagnosis?
Candida
Bloody stool with cysts and trophozoites should make you think of what diagnosis?
Amebiasis
What oral antibiotic can be used for pseudomonas?
Ciprofloxacin
A patient presents with ruptured Achilles tendon. He states that he was recently in the hospital for a “blood infection and on a ton of antibiotics.” What antibiotic class may he have been on?
Fluoroquinolones
What medication is used as prophylaxis for meningococcal meningitis?
Rifampin
A patient was in the woods yesterday and today presents with erythema migraines. What diagnosis should you be thinking of?
Lyme disease
At approximately how many weeks pregnant is the uterus at the level of the symphysis pubis?
12 weeks
List 2 risk factors for ovarian cancer.
BRCA1, family history, nulliparity, late menopause, Caucasian, Asian
What is the most common cause of secondary amenorrhea?
Pregnancy
What ethnic background is at an increased risk of fibroids?
African Americans are 5s more likely to have fibroids compared to Caucasian women.
Define the third stage of labor.
Delivery of the baby to delivery of placenta
What is the most popular term for Stein-Leventhal syndrome.
Polycystic ovarian syndrome
Vaginal infection with motile flagellated protozoa should make you think of what diagnosis?
Trichomonas vaginitis
List four risk factors for breast cancer?
BRCA1 or BRCA2 positive, unopposed estrogen, nulliparity, early menarche, late menopause
How is the first day of the menstrual cycle defined?
The first day of menstrual bleeding is the first day of the cycle
A cervical biopsy comes back as CIN1. What is the next step?
Repeat Pap smear in 6 months and repeat colposcopy in 12 months
List two mediation commonly used for hypertension in pregnancy.
Methyldopa and labetalol
If you see the term chocolate cyst, it should make you think of what diagnosis?
Endometrioma
Define abortion.
Delivery of uterine contents before 20 weeks.
Define menorrhagia.
Heavy prolonged menstrual flow
What is a cystocele?
A herniation of the bladder into the vagina
What is the mean age for ovarian cancer?
63, you will need to think of this in an older patient with vague abdominal symptoms
What medication is used to increase surfactant levels and help with lung maturity if you are worried about preterm labor?
Betamethasone
List two risk factors for cervical cancer.
Multiple sexual partners, smoking
Which is associated with painful third trimester bleeding placental abruption or placenta previa?
Placental abruption
List three risk factors for placental abruption.
HTN, smoking, AMA, cocaine use, PROM
What is the classic triad of pre-eclampsia?
HTN, edema and proteinuria
At what age is primary amenorrhea diagnose?
Age 14 if no secondary sex characteristics. Age 16 if some secondary development
What is the karyotype for a patient with Turner’s syndrome?
(45, X) They are missing one sex chromosome
When is it recommended to begin Pap smears?
New guidelines suggest to begin testing women at age 21 and not before
What location within the pelvis is endometriosis most commonly found?
On an ovary
What is the #1 cause of septic arthritis in sexually active young adults?
Neisseria gonorrhoeae
How much time needs to pass before diagnosing secondary amenorrhea?
If cycles have been normal 3 months. If cycles have been irregular 6 months.
Give the definition for preterm labor.
Contractions that open the cervix before 37 weeks.
What would you expect to see on a KOH prep if the patient had vaginal candidiasis?
Pseudohyphae
A physical exam revealing a retroverted uterus or uterosacral ligament nodularity should make you think of what diagnosis?
Endometriosis
How many days after conception is a serum beta-HCG positive?
8
Is FSH high or low in Turner’s syndrome?
High, there are no ovaries to respond to FSH and so there is no negative feedback.
What are two important things you need to tell your patients before putting them on metronidazole?
Stay out of the sun and avoid alcohol
Define missed abortion.
No vaginal bleeding, cervix is closed, production of conception are still inside.
What is the most common organism that causes mastitis?
Staph aureus
Define the first stage of labor.
Onset of contractions to full dilation of the cervix
How do you treat bacterial vaginosis?
Metronidazole x 7 days
About how much weight should a woman gain during pregnancy?
20-35 lbs
Define metrorrhagia.
Bleeding between menstrual cycles
What lab test is the gold standard for chlamydia?
Nucleic acid amplification test
An ovarian cyst that contains hair and teeth should make you think of what diagnosis?
Teratoma
At what point during pregnancy is RhoGAM given if it is needed?
28 weeks
What characteristics of pelvic inflammatory disease will help to differentiate it in a question stem from ectopic pregnancy, appendicitis, ovarian torsion and ovarian cyst?
It will be bilateral pain. Most other common abdominal complaints have unilateral pain.
A description of a young girl with a web neck or wide shield chest should make you think of what diagnosis?
Turner’s syndrome
What organism causes us to warn pregnant patients to stay away from deli meats and soft cheese?
Listeria
What is the most common site of an ectopic pregnancy?
Within a fallopian tube
What are three ways you can check for ruptured membranes?
Ferning pattern on a slide, visualize leakage from the cervix, pooling in the vagina
What is the most common type of ovarian cyst?
Functional cyst - no treatment necessary
A patient believes she is pregnant. You notice the her cervix appears a little blue. What is the name of this sign?
Chadwick’s sign
Grape-like vesicles or a sack of grapes on ultrasound should make you think of what diagnosis?
Hydatidiform mole
Is a nulliparous or mulitparous woman more likely to get preeclampsia?
Nullipartiy is a risk factor for preeclampsia
What is the most common infection following a C-section?
Metritis
Define inevitable abortion.
Vaginal bleeding, cervix is open, products of conception are still inside.
Cottage cheese discharge should make you think of what diagnosis?
Vaginal candidiasis
When does quickening occur?
Nulliparous 18-20 weeks, multiparous 14-16 weeks
What is the first step of treatment for endometrial cancer?
Total hysterectomy and bilateral salpingo-oophorectomy
What age range is the HPV Vaccination recommended for?
9 to 26 years old
What medication can be used to control bleeding due to uterine atony?
Oxytocin (Pitocin)
At how many weeks of pregnancy can chorionic villus sampling be done?
10-13 weeks
A snowstorm appearance on ultrasound should make you think of what diagnosis?
Hydatidiform mole
Gestation diabetes put moms and baby at increased risk of what three things?
Preeclampsia, macrosomia (traumatic birth,) slowing in fetal lung development
What is the most common endometrial cancer?
75% are adenocarcinomas
How do you treat vaginal candida?
Fluconazole po 1 dose or azole cream x 1 week
Define full term
Delivery at 37-42 weeks
Which reproductive cancer carries the highest rate of death in women?
Ovarian cancer
What is the hallmark physical findings for placenta previa?
Trick question - NEVER do a physical exam on someone with presumed placenta previa
The baby was delivered several minutes ago. Suddenly there is an increased in blood flow from the vagina and the cored noticeable lengthens. What is the most likely cause of these signs?
Placental separation
A patient presents with irregular menses, hirsutism and infertility. What is the most likely diagnosis?
Polycystic ovarian syndrome
As part of the antepartum testing a baby has a positive stress test. What does that mean?
They have had two heart rate accelerations in a 20 minute period of 15 bets above baseline for at least 15 seconds. This is a good thing.
Think, sticky, malodorous vaginal discharge should make you think of what diagnosis?
Bacterial vaginosis
What organism is the most common sexually transmitted bacteria?
Chlamydia
Purulent cervical discharge should make you think of what diagnosis?
Neisseria gonorrhoeae
A rope-like breast mass should make you think of what diagnosis?
Fibrocystic breast mass
What is the first line treatment for mastitis?
Dicloxacillin is first line. Cephalexin or erythromycin are second line.
A patient presents with mucopurulent discharge and cervical motion tenderness. What is the most likely diagnosis?
Chlamydia - cervicitis
A 66 year old female patient presents with bouts of nausea, weight loss, and vague abdominal pain. What is the most likely diagnosis?
Ovarian cancer
What is the average age of menopause?
51
What are the five components of the biophysical profile as part of antepartum testing?
A non-stress test, fetal breathing, two gross body movements, fetal tone, amniotic fluid index
The secretory phase of the menstrual cycle (day 14-28) is dominated by what hormone?
Progesterone
What. is the most common cause of postpartum hemorrhage?
Uterine atony
A surge in what hormone leads to ovulation?
Luteinizing hormone (LH)
You have a patient with PCOS who would like to get pregnant. What are two medications you may start her on?
Metformin and Clomid
Early on in pregnancy serial beta-HCG should double over what time period?
every 48-72 hours
What endocrine issue is associated with PCOS?
Insulin insensitivity
The pap smear results on a 23 year old patient come back as atypical squamous cell uncertain significance (ASCUS). What is you next step?
Repeat pap smear in 12 months although HPV test is acceptable
Which four human papillomaviruses are linked to cervical cancer?
HPV 16, 18, 31, and 33
List three risk factors for an ectopic pregnancy.
Previous ectopic, scarred tubes (hx of PID or salpingitis), IUD
A cervical biopsy comes back as CIN2 or CIN3. What is your next step?
Excision - LEEP, Cold knife (worry about incompetent cervix), Cryotherapy
What three labs should you order if you are considering secondary amenorrhea?
beta-HCG, TSH, Prolactin
How do you definitively diagnose endometriosis?
Exploratory laparoscopy
What is the term for when the placenta has implanted directly over the cervical os?
Placenta previa
A unilateral, single, mobile, firm, nontender solid breast mass should make you think of what diagnosis?
Fibroadenoma
At approximately how many weeks pregnant is the uterus at the level of the umbilicus?
20 weeks
Should a breast feeding mother stop breast feeding if she develops mastitis?
Mastitis is not in itself a reason to stop feeding. An abscess would be an indication to stop.
What are three treatments for uterine prolapse?
Pessary, Kegel’s maneuvers, surgical repair
What are two medications used to induce labor?
Cervidil (prostaglandin gel applied to the cervix) which encourages cervical ripening and oxytocin which encourages uterine contractions
Why is folic acid given as a prenatal vitamin?
Low folic acid can lead to neural tube defects.
Interference with work or school is part of which diagnosis, premenstrual syndrome or premenstrual dysphoric disorder?
Premenstrual dysphoric disorder
A patient with primary amenorrhea and a low FSH should make you think of what diagnosis?
Hypothalamic pituitary insufficiency
Define procidentia.
Uterine prolapse beyond the introitus.
What are three causes for a postpartum hemorrhage?
Uterine atony, genital laceration, retained placenta
Why is ovarian cancer so hard to diagnosis?
There are no good markers and the symptoms are very vague
If the pap smear results come back anything other than negative or ASCUS what is your next step?
Coposcopy and biopsy
Define complete abortion.
Vaginal bleeding, cervix open, products of conception have passed
Does mastitis tend to be unilateral or bilateral
Unilateral and only on quadrant
What is the most common uterine tumor?
Leiomyoma, also known as fibroids
Define the second stage of labor.
Fully dilated to delivery
What RH combination for mom and dad might cause the mother to create antibodies against the baby’s red blood cells?
Mom Rh-negative and dad Rh-positive
What is the treatment for ovarian cancer?
Total hysterectomy and bilateral salpingo-oophorectomy. Then chemo and radiation
Clue cells should make you think of what diagnosis?
Bacterial vaginosis
Are fibrocystic breast masses usually bilateral or unilateral?
Bilateral
Postmenopausal bleeding is immediately believed to be what diagnosis?
Endometrial cancer until proven otherwise
What is the formula for calculating estimated date of confinement or due date?
first day of last menstrual period + 7 days - 3 months
How do you treat a Trichomonas infection?
Metronidazole
During what portion of the menstrual cycle does PMS occur?
By definition it is in the second half and menstruation should relieve the symptoms
Define threatened abortion
Vaginal bleeding, closed cervix, products of conception are still inside
A strawberry cervix with copious yellow/green discharge should make you think of what diagnosis?
Trichomonas vaginitis
What is the medical treatment for an early ectopic pregnancy?
Metrotrexate
Define incomplete abortion.
Vaginal bleeding, cervix is open, products of conception partially passed
Since a genetic cause is the number one reason for primary amenorrhea what is one very important test?
Karyotype
Define premature birth.
Delivery before 37 weeks.
What medium do you need to grow out Neisseria gonorrhoeae?
Thayer-Martin
What is the normal range of fetal heart rate?
120-160
The follicular phase of menstruation is dominated by what hormone?
Estrogen
What are two tocolytic medications you should be aware of?
Magnesium sulfate and calcium channel blockers
A women presents to the ER concerned she is in preterm labor. What treatment should you begin before getting any imaging or lab results?
Give IV fluids (most often the patient is suffering from dehydration
At how many weeks of pregnancy can an amniocentesis be done?
15-20 weeks
List 4 risk factors for endometrial cancer.
Chronic unopposed estrogen, nulliparity, early menarche, late menopause, tamoxifen, DM, obesity, HTN, breast cancer, ovarian cancer
What is the treatment for Turner’s syndrome?
Cyclical estoregn and progesterone
What medication(s) are used to treat a postpartum metritis?
Clindamycin and gentamicin together
What is the most common way of testing for metamorphopsia?
Amsler grid
What is the term for bilateral yellow plaques near the eyes?
Xanthelasma
You notice drusen deposits on fundal exam. What diagnosis should you be thinking of?
Macular degeneration
A patient presents saying that he doesn’t seem to need his glasses anymore after 30 years. What is the most likely diagnosis?
Cataract
A patient has metamorphopsia and a central blind spot. What is the most likely diagnosis?
Macular degeneration
What is the term for eyelids that turn in?
Entropion
What should a primary care provider do for a presumed retinal detachment?
Refer and position patient with head down
What is the term for eyelids that turn out?
Ectropion
What is the first thing you should be thinking of if a pediatric patient comes in with blood in the anterior chamber of the eye (hyphema).
Child abuse until proven otherwise
What is the name for the triangular or wedge shaped growth on the conjunctiva that may interfere with vision?
Pterygium
A patient describes his vision loss as curtain coming down and then going back up. What might the diagnosis be?
Amaurosis fugax
Vision loss described as a curtain coming down should make you think of what diagnosis?
Retinal detachment
A fundal exam shows a cherry-red spot. What is the most likely diagnosis?
Central retinal artery occlusion
Which nerve is involved in herpes zoster ophthalmicus?
Trigeminal nerve, CN 5
A patient presents with a dense corneal infiltrate and an epithelial defect seen with fluorescein stain. What is the most likely diagnosis?
Corneal ulcer
You notice a bowing of the iris on exam. What diagnosis should you be thinking of?
Glaucoma
A patient presents with watery bilateral discharge from the eyes and nontender preauricular adenopathy. What is the most likely diagnosis? What is the most common pathogen?
Viral conjunctivitis, adenovirus
Is glaucoma more prevalent in males or females?
Females 3:1
What is the name of the test for dry eyes?
Schirmer’s test
How do you test for color blindness?
Ishihara plates
What is the #1 cause of retinal artery occlusion?
Carotid atherosclerotic disease
What is the first line treatment for orbital cellulitis?
IV antibiotics, followed by 2 weeks of oral antibiotics
A 19 year old male took an elbow to the face while playing basketball this morning. The whole left side of his face is swollen and he can’t look up. What is the most likely diagnosis?
Orbital fracture
A patient having recently undergone cataract surgery presents complaining of vision loss in the operative eye. What diagnosis should you be thinking of?
Retinal detachment
Your attending asks you to come and see an excellent example of Hutchinson’s sign. What diagnosis does the patient have?
Herpes zoster ophthalmicus
What is the term for being nearsighted? What type of lens do you use to correct it?
Myopia, concave lenses
A dendritic lesion is seen with fluorescein stain. What is the most likely diagnosis?
Herpes keratitis
What are the most common colors lost in color blindness?
Red and green
A CT scan of the head shows broad infiltration of orbital fat. What is the most likely diagnosis?
Orbital cellulitis
What is the yellow, brown fleshy mass on conjunctiva which usually does not interfere with vision?
Pinguecula
In what age range do you expect most commonly find amaurosis fugax?
Patient older than 50
A patient complains of seeing halos and rainbows around lights. She also complains of moderate photophobia. What is the most likely diagnosis?
Glaucoma
A fundal exam shows a cup to disc ratio of >0.5. There are also vessels bending over the disc. What is the most likely diagnosis?
Glaucoma
A patient has a history of multiple stys. He now has a painless nodule on his eyelid and minor conjunctivitis. What is the most likely diagnosis?
Chalazion
A patient presents with a painful, red nodule on the eyelid. What is the most likely diagnosis? What treatment should you being with?
Hordeolum (sty). Warm compress and progress to topical antibiotics if necessary.
A fundal exam shows an opalescent retina and boxcarring of arterioles. What diagnosis should you be thinking of?
Central retinal artery occlusion
A patient presents with unilateral blurriness developing over a few days. Fundal exam shows a “blood and thunder” pattern. What diagnosis should you be thinking of?
Central vein occlusion
A patient presents with pain in one eye. The cornea is hazy and the pupils are fixed. What is the most likely diagnosis?
Glaucoma
A patient presents with sudden painless complete unilateral vision loss. What diagnosis should you be thinking of?
Central retinal artery occlusion
A patient presents with irritated, burning and tearing eyes. You notice some scurg and scales. Where do you begin treatment?
The is blepharitis. Treatment begins with good hygiene and moves on to topical antibiotics if necessary.
A patient with a history of asthma presents complaining of stringy discharge from both eyes and severe swelling around the eyes. What is the most likely diagnosis?
Allergic conjunctivitis
A feathery border in an eye exam shoudl mak you think of what diagnosis?
Fungal infection
What is the term for being farsighted? What type of lens do you use to correct it?
Hyperopia, convex
What is the treatment for subconjunctival hemorrhage?
Reassurance
What is appropriate treatment for central vein occlusion?
Typically self limited. Treat underlying disease.
Color blindness is transmitted through what genetic pattern?
Recessive X-linked
What is tonometry used for?
Determining intraocular pressure
What is the initial treatment for a chemical burn to the eyes?
Irrigate, irrigate, irrigate
A patient in the recovery room following foot surgery is complaining of severe photophobia. She feels as though there is something in her eye. What is the most likely diagnosis?
Corneal abrasion (pt’s scratch their eyes before they are completely awake from anesthesia)
How long after a radiant energy burn do symptoms typically show?
6-12 hours
What should a primary care provider do for presumed central retinal artery occlusion?
Ophthalmic emergency! Refer and intermittent pressure and release of the eye
A college student presents with a little purulent drainage from one eye and nontender preauricular lymphadenopathy. What diagnosis and pathogen should you be thinking of?
Chlamydia conjunctivits
A college student presents with copious purulent drainage from one eye. What diagnosis and pathogen should you be thinking of?
Neisseria conjunctivits
Give two risk factors for glaucoma.
African American decent and diabetes
When treating herpes keratitis should you use topical antiviral, topical steroid or both?
Don’t use steroid. Topical antiviral and refer!
What is the most common preceding event for orbital cellulitis?
URI
What is the most likely quadrant for a retinal detachment?
Superior temporal
What is the most common organism causing pneumonia in COPD patients?
Haemophilus influenzae
Pertussis is most commonly treated with with antibiotic?
Erythromycin
A thumbprint sign on x-ray should make you think of what two diagnosis?
Lateral C-spine = epiglottitis, abdominal = intestinal ischemia
At what size induration would a PPD be positive for a healthcare worker?
10 mm
A thin looking heart and flattened diaphragm on CXR should make you think of what diagnosis?
Emphysema
What CXR finding might make you think of berylliosis?
Diffuse infiltrates with hilar adenopathy
When you step up the diagnosis for intermittent asthma to mild persistent asthma what medication should you add?
An inhaled steroid like fluticasone
Paradoxical pulses may be found in what pulmonary disorder?
Asthma
Oseltamivir (Tamiflu) may be given to children above what age?
1 year old
A college student presents with pneumonia. What two organisms should you be thinking of?
Chlamydia and mycoplasma
What is it called when a patient says “ee” but on auscultion you here “ay”?
Egophony
What two lung cancers are typically found centrally on CXR?
Small cell and squamous cell
A Westermark sign on CXR should make you think of what diagnosis?
Pulmonary embolism
Does total lung capacity go up or down in COPD?
It goes up.
An exudative pleural effusion should make you think of what diagnosis?
TB, lung cancer and pneumonia
List the three most commonly used medical treatments for COPD?
Oxygen, ipratropium, and albuterol
What is the most common cause of bronchiectasis?
Cystic Fibrosis
What is the best test to diagnose bronchiectasis?
CT
Will evidence of TB be seen more frequently in the upper or lower lung lobes on CXR?
Upper
What is the initial treatment for active TB?
INH + RIF + PZA + EMB x several months typically followed by INH + RIF once sensitivities come back
What organism is the most common cause of pneumonia in a patient cystic fibrosis?
Pseudomonas
Dullness to percussion should make you think of what diagnosis?
Lobar pneumonia
What occupations are associated with berylliosis?
Aerospace and nuclear plant workers
What is the gold standard for diagnosis of pleural effusion?
Thoracocentesis
At what age should vaccinations for pneumococcal pneumonia begin?
65 years old
Any question about rabbits and pneumonia should make you think of what diagnosis?
Tularemia
What. is the most common patient complaint with emphysema?
Shortness of breath
If you hear crackles in the lung fields list three pulmonary issues that should be in your differential
Pneumonia, fibrosis, CHF, bronchitis
List 4 medications which may cause asthma.
Beta blockers, NSAIDs, ACEI, ASA
You are treating a patient for TB. He has noticed that his body fluids now have an orange tint. What drugs is most likely causing this?
Rifampin
Prolonged expiration (low FEV1) should make you think of what diagnosis?
Asthma or COPD
Transudative pleural effusions should make you think of what diagnosis?
Congestive heat failure
What are the main side effects of isoniazide?
Hepatitis and peripheral neuropathy
List six extrapulmonary complications of lung cancer.
SPHERE - SVC syndrome, Pancoast tumor, Horner’s syndrome, Endocrine problems, Recurrent laryngeal symptoms, Effusions (exudative)
A physical exam finding of egophony should make you think of what diagnosis?
Lobar pneumonia
Ghon or Ranke complexed on CXR should make you think of what diagnosis?
TB
Zanamivir (Relenza) may be give to children about what age?
7 years old
Does FEV1 go up or down with asthma?
It goes down.
Caseating granulomas should make you think of what diagnosis?
TB
What is the most common cause of pneumonia in children less than 1 year old?
Respiratory syncytial virus (RSV)
A noncaseating granuloma should make you think of what diagnosis?
Sarcoidosis
A young child presents to ER and you see him waiting in tripod position. What is the most likely diagnosis?
Epiglottitis
A barrel chest should make you think of what diagnosis?
Emphysema
When performing a decompression for a tension pneumothorax where do you put the needle?
2nd intercostal space at the midclavicular line
An HIV patient with ground glass appearance on CXR should make you think of what diagnosis?
Pneumocystis jiroveci pneumonia (PJP used to be known as PCP)
An older patient presents with pneumonia and diarrhea. What diagnosis should you be thinking of?
Legionella pneumonia
Currant jelly sputum should make you think of what diagnosis?
Klebisiella pneumoniae
If you see a question with an alcohol who has been diagnosed with pneumonia what is the most likely organism?
Klebsiella pneumoniae
Tympany to percussion should make you think of what diagnosis?
Large pneumothorax
If you see a question with anything to do with pets and the patient has pneumonia, what organism should you be thinking of?
Yersinia pestis
Where is a Pancoast rumor found on CXR?
At the apex of either the right or left lung
You suspect a pneumothorax. What instructions should go along with the order for a CXR?
It should be an end expiratory view in order to look for visceral pleural air
List four indications for the flu vaccine.
Children 6-59 months, pregnant female, healthcare worker, age greater than 50
Mesothelioma is most commonly found in what lung location?
80% are found in the pleural lining
Eggshell opacities on the CXR should make you think of what diagnosis?
Silicosis and coal workers lung
What is erythema nodosum?
Tender red nodules usually found on the shins
Bullae and blebs on CXR should make you think of what diagnosis?
Emphysema
Are the lungs noisy or quiet in COPD?
quiet
A patient without a functioning spleen is more susceptible to what type of organism?
Encapsulated organisms most commonly Strep pneumoniae and H. flu
A pearl formation on CXR should make you think of what diagnosis?
Squamous cell lung cancer
A patient has pneumonia with rust colored sputum. What is the most likely diagnosis?
Strep pneumonia
What happens to total lung capacity in sarcoidosis?
It goes down.
A contralateral mediastinal shift should make you think of what diagnosis?
Tension pneumothorax
Ethambutol has what two major side effects?
Optic neuritis, red green vision loss
What is the treatment for pneumocystis jiroveci pneumonia?
Bactrim
List three caused of decreased tactile fremitus.
COPD, asthma, pleural effusion, pneumothorax
What two lung cancers are typically found peripherally on CXR?
Adenocarcinoma and Large cell
A CXR shows vascular redistribution and blurred vascular outlines. What is the most likely diagnosis?
CHF
Posttussive rales should make you think of what diagnosis?
TB
What are the three most common cancers to metastasize to the lungs?
Breast, liver and colon
List the four most common places lung cancer will metastazie to?
Bone, brain, adrenals, and liver
What is the first line antibiotic for epiglottis?
Third generation cephalosporin - ceftriaxone
Nodular opacities in the upper lung fields should make you think of what diagnosis?
Silicosis
Rhonchi or wheezes that clear after coughing suggest what diagnosis?
Bronchitis or atelectasis
Coal miners lung often shows nodular opacities in what lung fields?
Upper lung fields
A very sick patient with diffuse infiltrates that spare the costophrenic angles should make you think of what diagnosis?
Acute respiratory distress syndrome (ARDS)
Hyperinflation on a CXR as well as eosinophilia on CBC should make you think of what diagnosis?
Asthma
How long are administering a PPD should it be read?
48-72 hours
If you come across a question where the patient has erythema nodosum and an enlarged parotid gland what diagnosis should you be thinking of?
Sarcoidosis
Blue bloaters refers to that characteristic physical exam findings of what disease?
Chronic bronchitis
Hampton’s hump on CXR should make you think of what diagnosis?
Pulmonary embolism
What is the gold standard for the diagnosis of cystic fibrosis?
Sweat chloride test
What CXR finding might make you think of mesothelioma?
Pleural thickening, remember 80% are found in the pleura lining
At what size induration would a PPD be positive for an HIV patient?
5 mm
List three things that should be in your differential if you hear wheezes on a lung exam?
Asthma, COPD, bronchitis
Honeycombing and tram tracks on the CXR should make you think of what diagnosis?
Bronchiectasis and idopathic pulmonary fibrosis
Hyperresonance to percussion should make you think of what diagnosis?
Emphysema, pneumothorax, asthma
What is the likely findings be on a CXR of a patient with asbestosis?
Linear opacities at the bases with pleural plaques
What is the most common cause of peptic ulcer disease?
H. pylori
Steatorrhea should make you think of what diagnsosi?
Pancreatitis
A patient presents complaining of right upper quadrant pain 20 minutes after meals. What is the most likely diagnosis?
Cholecystitis
How do you treat achalasia?
Loosen up the muscle - botox, dilation or surgery
What is the most common vessel blocked with intestinal ischemia?
Superior mesenteric artery
What tumor marker can be used to follow pancreatic cancer?
CA-19-9
What is the #1 cause of small bowel obstruction?
Postoperative adhesions
A patient has had GERD for year. Over the past year, he has noticed an increase in difficulty swallowing his food. This should make you think of what diagnosis?
Esophageal strictures
An elevated serum amylase and lipase should make you think of what diagnosis?
Pancreatitis
What is the main risk factor for esophagitis?
Immunocompromised patient
What is the medical term for feeling like there is a lump in your throat?
Globus
Should diverticulitis always be admitted?
No mil cases can be treated as outpatients with rest and clear fluids
Left lower quadrant pain and tenderness should make you think of what diagnosis?
Diverticulitis
What is the most common cause of a folate deficiency?
Alcoholism
Define pellagra?
Niacin (B3) deficiency
What are two common predisposing factors for esophageal varices?
Portal HTN and cirrhosis often caused by alcoholism
Describe Grey-Turner’s sign.
Flank ecchymosis often related to pancreatitis
What is the most common location of colorectal cancer?
Cecum about 38%
At what age and how often should fecal occult blood tests be performed as a screening tool?
Beginning at age 50, and they should be done every year
A patient complains of periumbilical pain which has now moved over McBurney’s point. What is the most likely diagnosis?
Appendicitis
Is peptic ulcer disease more common in the duodenum or the stomach?
Duodenum
Projectile vomiting should make you think of what diagnosis?
Pyloric stenosis
Does adenocarcinoma rise from the proximal or distal esophagus?
Distal
What treatment should be started for asymptomatic diverticulosis?
None
What is the imaging modality of choice for pancreatitis?
CT
What does ERCP stand for?
Endoscopic retrograde cholangiopancreatography
Epigastric abdominal pain which radiates to the back should make you think of what diagnosis?
Pancreatitis
What is the term for an abscess in the sacrococcygeal cleft?
Pilonidal disease
Salivary amylase breaks down what macronutrient?
Carbohydrates
What is the most common cause of acute bacterial cholangitis?
Choledocholithiasis
What is the leading cause of iron deficiency anemia?
Chronic GI bleed
What is Reynold’s pentad and why does it matter?
Charcot’s triad + hypotension + altered mental status. It indicated high risk of sepsis.
Bird-beak esophagus on barium swallow should make you think of what diagnosis?
Achalasia
What is the best test to check for H. pylori?
Urea breath test
What is the recommended treatment for hepatitis C infection?
Pegylated interferon alpha-2
An endoscopy for presumed esophagitis shows multiple shallow ulcers. What is the most likely diagnosis?
Herpes simplex virus
What medication is most commonly used for long term treatment for GERD?
Proton pump inhibitors - omeprazole, lansoprazole, pantoprazole
What tumor marker may be used for liver cancer?
alpha-Fetoprotein
A corkscrew appearance on barium study should make you think of what diagnosis?
Esophageal spasms
What class of medication is first line to treat inflammatory bowel disease in the maintenance phase?
5-ASA products - sulfasalazine, mesalamine
Crohn’s is found where in the GI tract?
It can be from esophagus to anus
What is the name of the sign when a patient shows inhibited inspiration with pressure over the RUQ? What diagnosis does it suggest?
Murphy’s sign, Cholecystitis
What medication used in hepatitis B infection helps prevent the need for liver transplant?
Lamivudine
Currant jelly stool should make you think of what diagnosis?
Intussusception
What does HBsAg (hep B surface antigen) indicate?
Active Hep B infection
How often should patients with pernicious anemia have a screening endoscopy performed?
Every 5 years looking for signs of gastric carcinoma
What are the two main complications of cirrhosis?
Portal HTN and liver insufficiency
Are one half of all adult hernias direct or indirect inguinal hernias?
Indirect inguinal hernias makeup 50% of all adult hernias
Is surgery curative for Crohn’s or ulcerative colitis?
Ulcerative colitis
An abdominal exam with pain out of proportion to the exam should make you think of what diagnosis?
Intestinal ischemia
What is the best imaging study for acute appendicitis?
CT
What is a common symptom that goes along with chest pain for GERD patients?
Dry cough
A gastrinoma is also known as what syndrome?
Zollinger-Ellison syndrome
Will a patient with achalasia have dysphagia to liquids, solid or both?
Both
Describe Cullen’s sign
Umbilical ecchymosis often related to pancreatitis
What are the first three steps of managing pancreatitis?
NPO, pain control, fluids
Pica is often related to what type of anemia?
Iron deficiency anemia
Fasting gastrin will be above what level with gastronoma?
> 150 pq/ml
A patient complains of regurgitating undigested food several hours after a meal. What diagnosis should you be thinking of?
Zenker’s diverticulum
Under routine circumstances when should patient begin getting screening colonoscopies?
Age 50
How is celiac disease most commonly diagnosed?
Endoscopic biopsy
An epigastric olive-shaped mass should make you think of what diagnosis?
Pyloric stenosis
How much fiber should you normally get in a day?
about 30 grams
Air fluid levels on abdominal x-ray should make you think of what diagnosis?
Bowel obstruction
What is the most specific test for acute cholecystitis?
HIDA
Painless bright red blood per rectum should make you think of what diagnosis?
Hemorrhoids
What is the diagnostic test of choice for Zenker’s diverticulum?
Barium swallow will show the diverticulum
A patient on sulfasalazine for an inflammatory bowel disease should be supplemented with what vitamin?
Folate
What are the 5 points of Ranson’s criteria on admission?
Older than 55, nWBC>16, glucose>200, LDH>350, AST>250
What is the most common location for an anal fissure?
Posterior midline
With a gastric ulcer are the patient’s symptoms exacerbated or relieved with food?
Exacerbated
What will the bowel sounds be early on in a small bowel obstruction? What will they be later on?
Early they are hyperactive. Late they are absent.
A thumbprint sign on an abdominal film should make you think of what diagnosis?
Intestinal ischemia
What is the first step in treating GERD?
Lifestyle modification
Which NSAID has the highest rate of peptic ulceration?
Naproxen
What is the most common location for a pancreatic tumor?
75% occur in the head of the pancreas
What is the term for difficulty swallowing?
Dysphagia
If you have heartburn that does not improve with medication what diagnosis should you be thinking about?
Gastrinoma
Severe abdominal pain 30 minutes after a meal should make you think of what diagnosis?
Intestinal ischemia
Describe Courvoisier’s sign.
Nontender, palpable gallbladder which may indicate pancreatic neoplasm
What disease is defined as an immunologic response to gluten?
Celiac
What is the most specific diagnostic test for peptic ulcer disease?
Endoscopy
What is a good beta blocker to reduce portal HTN?
Propranolol
What is the treatment for most Mallory-Weiss tears?
Watchful waiting, these will typically resolve within 48 hours
Describe how to perform the obturator sign.
The patient is supine and attempts to flex and internally rotate right hip.
There are vaccines for which two versions of hepatitis?
Hepatitis A and hepatitis B
Describe the Psoas sign.
The patient is supine and attempt to raise the right leg against resistance.
What is the only curative therapy for gastric adenocarcinoma?
Surgical resection
What does an Anti-HBc (hep B core antibody) indicate?
Previous or ongoing hepatitis B infection
What is the gold standard for diagnosis and treatment of bile duct stones?
ERCP
How do you treat an H. pylori infection?
PPI + 2 antibiotics, commonly omeprazole + clarithromycin and amoxicillin or PPI + metronidazole + tetracycline
Colrectal cancer patients are almost all older than what age?
90% of patients are older than 50
What two viral hepatitis infections are self limiting?
Hepatitis A and hepatitis E
An endoscopy for presumed esophagitis shows several solitary deep ulcers. What is the most likely diagnosis?
Cytomegalovirus
What is the most likely to pass into the scrotum, a direct or indirect hernia?
Indirect
What are the two most common causes of pancreatitis?
Cholelithiasis and ETOH
What is the most common anorectal problem affecting patients over 50?
Hemorrhoids
Most gallstones are made of what substance?
Cholesterol
What does Anti-HBs (hep B surface antibody) indicate?
Recovery from infection or immunization to hepatitis B
A colonoscopy that shows cobblestone or skip lesions make you think of what diagnosis?
Crohn’s disease
What is the term for painful swallowing?
Odynophagia
A 30 year old African American woman presents with dysphagia. You notice she also has thickened skin. A barium swallow demonstrates the absence of peristalsis. What is the most likely diagnosis?
Scleroderma
What is the most common cause of lower GI bleed?
Diverticulosis
What causes Mallory-Weiss tears?
Forced vomiting or retching (often involving alcohol)
What two blood test can be used to diagnose celiac?
IgA endomysial antibody and IgA tTG antibody
Which are more painful, hemorrhoids above or below the dentate line?
Below, internal hemorrhoids are not painful
A string sign on barium swallow should make you think of what diagnosis?
Pyloric stenosis
Onion ring fibrosis from a bile duct biopsy should make you think of what diagnosis?
Primary sclerosing cholangitis
A patient presents with unproductive retching, acute localized epigastric distention and inability to pass a nasogastric tube. What is the most likely diagnosis?
Gastric volvulus
In order to contract hepatitis D what must you already have?
Hepatitis B
What is Charcot’s triad?
RUQ pain, fever, jaundice
What is the first line of treatment for an anal fissure?
Fluid and fiber
What are two treatments you should consider for esophageal strictures?
dilation of the esophagus and long term PPIs
What medical treatment is given for a gastrinoma?
Proton pump inhibitors
Atypical or walking pneumonia is caused by what pathogen?
Mycoplasma
A child with a fever lasting longer than five days should make you think of what diagnosis?
Kawasaki syndrome
A widely split fixed S2 should make you think of what diagnosis?
Atrial septal defect
List the five major Jones criteria for diagnosing rheumatic fever.
Polyarthritis, carditis, subcuticular nodes, erythema marginatum, chorea
Pale and boggy nasal mucosa should make you think of what diagnosis?
Allergic rhinitis
What organism is the most common cause of otitis media?
Strep pneumonia
Which viral exanthem often has conjunctivitis as one of it’s symptoms?
Measles/Rubeola
By what age should a child be able to roll over?
4 months
What is the x-ray finding that supports diagnosis of a slipped capital femoral epiphysis?
Ice cream falling of the cone
A CXR finding of notched ribs in a child should make you think of what diagnosis?
Coarctation of the aorta
Bruises may be purple, green, yellow, and brown. How many days old is a yellow bruise?
Purple day 1-5, Green Day 5-7, Yellow 7-10, Brown 10-14
A 4 year old boy presents between October and March with wheezing, coughing, a runny nose and increased respiratory rate. What is the most likely pathogen?
Respiratory syncytial virus
A child with bulky greasy stool should make you think of what diagnosis?
Cystic fibrosis
Describe erythema marginatum.
Pink rings on the trunk and inner surfaces of the limbs.
A palpable olive-shaped epigastric mass in one month should make you think of what diagnosis?
Pyloric stenosis
German measles is also known as what disease?
Rubella
By what age should a child be able to hold up her head?
3 months
At what age should a child begin to say momma and dadda?
12 months
What is the medical term for cross-eyed?
Strabismus
What is the first line treatment for pertussis?
Erythromycin
Koplik spots are white clustered lesions on the buccal mucosa. What virus are they pathognomonic for?
Measles/Rubeola
How long should you wait for a swallowed marble to pass through the body before considering surgery?
24 hours
In an upper respiratory infection which includes hoarseness most likely bacterial or viral?
Viral
In order to diagnose rheumatic fever what one thing must you have?
Evidence of a strep infection either positive titer or positive culture. In addition to that you need 2 major criteria or 1 major and 2 minor criteria
What is the treatment for a volvulus in a child?
Barium enema
What antibiotic is the first line treatment for mycoplasma pneumonia?
A macrolide, erythromycin or azithromycin
What is pertussis more commonly referred to as?
Whooping cough
A 15 year old overweight boy presents to your office limping with knee pain. What is the most likely diagnosis?
Slipped capital femoral epiphysis
A premature infant with hyaline membrane disease will have what appearance on CXR?
Bilateral atelectasis or ground glass appearance
A Salter-Harris type III fracture affects what area of the bone?
The physis (growth plate) as well as the epiphysis
Unilateral purulent rhinitis should make you think of what diagnosis?
Foreign body
Describe Barlow’s test
Adduct and internal rotation of the hips
By what age should a child be able to sit up?
6 months
At what age should a child be able to use a spoon and stack 3-4 blocks?
18 months
If you believe there may be a foreign body obstructing a child’s breathing what type of CXR should you order?
Expiratory view looking for hyperinflation due to air trapping
Currant jelly stool should make you think of what diagnosis?
Intussusception
A child presents with paroxysmal abdominal pain, nausea, vomiting and diarrhea. What diagnosis should you be thinking of?
Intussusception
At what age should a child begin to feed himself?
6 months
A lacey pink rash on the face of a child should make you think of what diagnosis?
Erythema infectiosum aka fifth disease aka slapped cheek
Pain with movement of the pinna or tarsus should make you think of what diagnosis?
Otitis externa
What is the first line antibiotic for otitis media?
Amoxicillin
What is the gold standard for the diagnosis of cystic fibrosis?
Sweat chloride test
Which heart valve is most associated with rheumatic fever?
Mitral
By what age should a child be able to kick a ball?
24 months
What is the most common congenital heart defect?
Ventricular septal defect
How do treat a patient with respiratory syncytial virus?
Albuterol, steroids, and fluids
By what age should a child be able to walk?
12 months
You hear a loud harsh holosystolic murmur in a child. It is heard best at the LLSB. What diagnosis should you be thinking of?
Ventricular septal defect
The description of a dew drop on a rose petal should make you think of what diagnosis?
Chickenpox
Forchheimer spots are associated with what disease?
Rubella
A patient is having seizures along with a mouse-like odor from the urine. What diagnosis should make you be thinking of?
Phenylketonuria
A child presents with painful ulcers in his mouth. On physical exam you find more of the same type of ulcers on his feet and hands. What virus is most likely causing these symptoms?
Coxsackie virus
What is the most common cause of an upper respiratory tract infection?
Rhinovirus
Nasal polyps should make you think of what diagnosis?
Cystic fibrosis
A Salter-Harris type I fracture affects what are of the bone?
Only the physis (growth plate)
A patient presents with a staccato cough but no fever. What diagnosis should you be thinking of?
Chlamydia pneumoniae
Describe the pattern of weight gain in an infant over the following periods: week one, 6 months, 12 months, 3 year old, and 4 year old
Newborns lose 10% of their birth weight initially but are back to birth weight at 10 days, 6 m = 2x, 12m =3x birthweight, 3 y/o = 30 lbs x 30 inches, 4 y/o = 40 lbs x 40 inches
What is the medical term for lazy eye?
Amblyopia
At what age should an infant begin cooing?
2 months
During a physical exam of a child, you feel a tubular or sausage-shaped mass. What diagnosis should you be thinking of?
Intussusception
A musical vibratory murmur best hear at the apex in a child should make you think of what diagnosis?
Still’s murmur
