Final Step Notecards - 1st 500 Flashcards
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 is the most likely diagnosis?
Adjustment disorder
What is the prophylactic antibiotic most commonly given before a dental procedure if one is necessary?
Amoxicillin 2 grams po 1 hour before procedure
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.
Name one oral medication that can be used for MRSA.
Linezolid (Zyvox) and Bactrim Digoxin
Which cardiac medication is used to help with cardiac contractility after you have optimized most of the other cardiac medications?
Digoxin
What medication used in hepatitis B infection helps prevent the need for liver transplant?
Lamivudine
How is celiac disease most commonly diagnosed?
Endoscopic biopsy Mononucleosis
A 14 year old field hockey player presents with prominent adenopathy, white purple exudates in the throat and a palpable spleen. What is the most likely diagnosis?
Wernicke’s aphasia
A patient presents with what appears to be an inability to understand speech. Which aphasia should be at the top of your differential?
It is blood in the joint indicating a fracture even if the fracture line cannot be seen.
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.
A corkscrew appearance on barium study should make you think of what diagnosis?
Esophageal spasms
What is the treatment for Turner’s syndrome?
Cyclical estrogen and progesterone
What is the gold standard for diagnosing myocarditis?
Myocardial biopsy
By what age should a child be able to hold up her head?
3 months
On physical exam, you notice ulnar deviations and swan neck deformities. What is the most likely diagnosis?
Rheumatoid arthritis
What is the most accurate way to diagnose urethritis?
Urine PCR
You hear a loud harsh holosystolic murmur in a child. It is heard best at the LLSB. What is the most likely diagnosis?
Ventricular septal defect
The accessory pathway known as the James bundle should make you think of what syndrome?
Lown-Ganong-Levine syndrome
A Blalock procedure is used to correct what congenital heart condition?
Tetralogy of Fallot
What medication can be used to control bleeding due to uterine atony?
Oxytocin (Pitocin)
What is the most common cause of a folate deficiency?
Alcoholism
List three risk factors for placental abruption.
HTN, smoking, AMA, cocaine use, PROM
What ejection fraction is typical for a patient with CHF?
35-40%
What is the major concern with using lithium?
It has a very narrow therapeutic window. Blood tests are needed every four weeks.
List the four most common places lung cancer will metastasize to.
Bone, brain, adrenals and liver
What is the main risk factor for esophagitis?
Immunocompromised patient
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 rythm
List two diagnoses which require antibiotic prophylaxis for “dirty procedures?”
Prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congential cyanotic heart defect
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.
A pregnant woman and cat litter should make you think of what diagnosis?
Toxoplasmosis
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).
What is the most common cause of sudden cardiac death?
Ventricular fibrillation
A positive straight leg test indicates what diagnosis?
Herniated disc
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.
How long must symptoms last before diagnosing ADD?
6 months
What are the two most common organisms responsible for cellulitis?
Strep and Staph
Does total lung capacity go up or down in COPD? What organism causes Lyme disease?
It goes up.
What organism is most commonly responsible for community acquired pneumonia?
Borrelia burgdorferi
An EEG showing focal rhythmic discharges at the onset of the seizure should make you think of what diagnosis?
Strep pneumoniae
What is the normal range for MCV?
Simple partial seizure
A patient’s lab work shows positive Smith antibody and positive double-stranded DNA antibodies. What is the most likely diagnosis?
80-100 Lupus
You hear a continuous machine-like murmur. What is the most likely diagnosis?
Patent ductus arteriosus (PDA)
How do you administer the Weber hearing test?
Tuning fork placed in the middle of the forehead
By what age should a child be able to kick a ball?
24 months
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.
Duchenne’s and Becker’s muscular dystrophy have what genetic characteristic?
X-linked recessive
Why is folic acid given as a prenatal vitamin?
Low folic acid can lead to neural tube defects.
Color blindness is transmitted through what genetic pattern?
Dominant X-linked
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.
List 4 risk factors for endometrial cancer.
Chronic unopposed estrogen, nulliparity, early menarche, late menopause, tamoxifen, DM, obesity, HTN, breast CA, ovarian CA
Tall peaked P waves should make you think of what diagnosis?
Right atrial enlargement
What is the best test to check for H. pylori?
Urea breath test
What it is the recommended treatment for hepatitis C infection?
Pegylated interferon alpha-2
Is a nulliparous or mulitparous woman more likely to get preeclampsia?
Nulliparity is a risk factor for preeclampsia.
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
Acute sinusitis is most commonly caused by which two pathogens?
Strep pneumoniae and haemophilus influenzae
A physical exam finding of egophony should make you think of what diagonsis?
Lobar pneumonia
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
What percentage of diabetes in the US is type 2?
80-90%
What is the treatment for pneumocystis jiroveci pneumonia?
Bactrim
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 feathery border in an eye exam should make you think of what diagnosis?
Fungal infection
List six medications that can be used for migraine prophylaxis?
Beta blockers, tricyclics, calcium channel blockers, NSAIDs and valproic acid
What is the #1 cause of retinal artery occlusion?
Carotid atherosclerotic disease.
What is the formula for calculating estimated date of confinement or due date?
First day of last menstrual period + 7 days - 3 months
The pap smear results on a 23 year old patient come back as atypical squamous cell uncertain significance (ASCUS). What is your next step?
Repeat pap smear in 12 months although HPV test is acceptable.
What causes Mallory-Weiss tears?
Forced vomiting or retching (often involving alcohol)
Ghon or Ranke complexes on CXR should make you think of what diagnosis?
TB
During pregnancy which is the prefered treatment of hyperthyroidism PTU or methimazole?
PTU
What are three causes for a postpartum hemorrhage?
Uterine atony, genital laceration, retained placenta
What is the name of the test for dry eyes?
Schirmer’s test
Will serum potassium be decreased or elevated in renal failure?
Elevated
Which lab should be tightly monitored in a patient taking an aldosterone antagonist?
Potassium, they may have hyperkalemia.
What is the definitive treatment for atrial flutter?
Radiofrequency catheter ablation
What medication is often used to treat postpartum depression in a woman who is breast feeding?
Sertraline (Zoloft)
A doughnut shaped burn should make you think of what issue?
Abuse either child or elder
A strawberry cervix with copious yellow/green discharge should make you think of what diagnosis?
Trichomonas vaginitis
During a physical exam of a child, you feel a tubular or sausage-shaped mass. What is the most likely diagnosis?
Intussusception
What is the first line treatment for carpal tunnel?
Night splint
What is the most common cause of a hip dislocation? Is it usually anterior or posterior?
MVA, posterior
Maltese crosses in the urine should make you think of what diagnosis?
Nephrotic syndrome Cystoscopy and biopsy Spermatocele
You place a patient on rifampin. What side effect should you warn her about?
Orange-red discoloration of body fluids
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 is the most likely diagnosis?
Delusional disorder
What two leads do you use to determine the axis of the heart?
Lead I and AVF
What is the other term for Mobitz type I?
Wenckebach
List three possible treatments for stress incontinence in women.
Kegels, estrogen therapy, surgical placement of a urethral sling
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
How do you treat amebiasis?
Metronidazole (Flagyl)
Alcohol may be a major factor in which encephalopathy?
Wernicke’s
List the three diagnosis you should be thinking of if a question includes Heinz bodies.
G6PD deficiency anemia, chronic liver disease, alpha thalassemia
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.
What is the best patient position to hear aortic regurge and aortic stenosis?
Sitting up and leaning forward
List the six P’s of an ischemic limb.
Pain, paresthesias, pallor, pulselessness, poikilothermia, paralysis
Fasting gastrin will be above what level with gastrinoma?
> 150 pg/ml
How do you treat a Trichomonas infection?
Metronidazole
A Gram-positive organism in clusters should make you think of what diagnosis?
Staph
What is the most common cause of postpartum hemorrhage?
Uterine atony
An HIV patient with ground glass appearance on CXR should make you think of what diagnosis?
Pneumocystis jiroveci pneumonia (PJP used to be know as PCP)
Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis?
CHF
Pale and boggy nasal mucosa should make you think of what diagnosis?
Allergic rhinitis Shortness of breath
What is the most common patient complaint with emphysema?
Conversion disorder
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 is the most likely diagnosis?
Ceftriaxone and doxycycline
How do you treat urethritis?
Catatonic depression
Posturing should make you think of what diagnosis?
When you lift the patient’s head the patient bends his hips.
Describe Brudzinski’s sign.
Systolic pressure of 140-159 and diastolic of 90-99
Define stage 1 hypertension according to JNC 7.
Trick question - NEVER do a physical exam on someone with presumed placenta previa.
What is the hallmark physical exam finding for placenta previa?
10-20 years old
How long should you wait for a swallowed marble to pass through the body before considering surgery?
24 hours
A fixed or consistent split S2 should make you think of what diagnosis?
Atrial septal defect
When does quickening occur?
Nulliparous 18-20 weeks, multiparous 14-16 weeks
Oval patches of hair loss should make you think of what diagnosis?
Alopecia areata
Under routine circumstances when should patients begin getting screening colonoscopies?
Age 50
The scotch tape test is used to diagnose what disease?
Pinworm
A child with a fever lasting longer than five days should make you think of what diagnosis?
Kawasaki syndrome
Which heart valve is most associated with rheumatic fever?
Mitral
What is the most common precipitating event for posttraumatic stress disorder in women?
Rape
Hampton’s hump on CXR should make you think of what diagnosis?
Pulmonary embolism
Forchheimer spots are associated with what disease?
Rubella
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 ligament is most commonly injured in an ankle sprain?
Anterior talofibular ligament (ATFL)
What is the treatment for epiglottitis?
2nd or 3rd generation cephalosporin (ceftriaxone), macrolides may also be used (clindamycin)
In Cushing’s disease is ACTH elevated or decreased?
Elevated
What is the #1 cause of small bowel obstruction?
Postoperative adhesions
What Rh combination for mom and dad might cause the mother to create antiboides against the baby’s red blood cells?
Mom Rh-negative and dad Rh- positive
Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?
Osler nodes
What is the most common prophylactic antibiotic used preoperatively?
Cefazolin = Ancef, Keflex = Cefalexin, The answer is Cefazolin (Ancef)
What will an x-ray show in acute osteomyelitis?
Nothing - it will show bone destruction in chronic osteomyelitis.
You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis?
Transesophageal echo
As it relates to diabetics, what is the dawn phenomenon?
Reduced insulin response between 5 and 8 am
If you hear crackles in the lung fields list three pulmonary issues that should be in your differential.
Pneumonia, fibrosis, CHF, Bronchitis
A pathology report comes back showing negatively birefringent crystals. What is the most likely diagnosis?
Gout
Cottage cheese discharge should make you think of what diagnosis?
Vaginal candidiasis
What is the most common organism causing pneumonia in COPD patients?
Haemophilus influenzae
What type of hearing loss would be caused by cerumen impaction?
Conductive
A christmas tree pattern should make you think of what diagnosis?
Pityriasis rosea
What is the age range for Duchenne’s muscular dystrophy?
3-5 years old
A question about Prinzmetal’s angina will often contain what key thing in the patient’s history?
Cocaine use
Will unconjugated bilirubin be high or low in a patient with sickle cell disease?
High
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.
If you have a patient with positive blood cultures for candida what is the first line drug?
Amphotericin B
Would a B12 deficiency anemia most likely be microcytic, normocytic or macrocytic?
Macrocytic
What is the most serious complication of Kawasaki syndrome?
Aortic Aneurysm
Are one half of all adult hernias direct or indirect inguinal hernias?
Indirect inguinal hernias makeup 50% of all adult hernias.
Which way does a Colles fracture angulate: dorsal or volar? What about a Smith fracture?
Colles = Dorsal, Smith = Volar
A patient complains of seeing halos and rainbows around lights. She also complains of moderate photophobia? What is the most likely diagnosis?
Glaucoma
What is the appropriate treatment for a patent ductus arteriosus.
Indomethacin
What is the term for difficulty swallowing?
Dysphagia
An RSR prime in leads V1 or V2 should make you think of what diagnosis?
Right bundle branch block
What is the age range for osteosarcoma? Where are they most typically found in the body?
“Osteosarcoma usually occur in 15-25 year old males and are most commonly found around the knee.”
What medication is used to increase surfactant levels and help with lung maturity if you are worried about preterm labor?
Betamethasone
What is the most specific diagnostic test for peptic ulcer disease?
Endoscopy
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 is the most likely diagnosis?
Secondary syphilis. This is the most contagious stage.
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
What is the first line treatment for pertussis?
Erythromycin
A patient presents with a painful ipsilateral third nerve palsy. What is the most likely diagnosis?
Posterior communicating artery aneurysm (PComA)
Your attending asks you to come and see an excellent example of Hutchinson’s sign. What diagnosis does the patient have?
Herpes zoster ophthalmicus
After 7 days of sinusitis what antibiotic would you start?
Amoxicillin or Bactrim
Is anorexia egosyntonic or ego-dystonic? What about bulimia?
Anorexia is egosyntonic. Bulimia is ego-dystonic.
What is the most common cause of CHF?
Coronary artery disease
What antibiotic class is the class of choice for chlamydia?
Macrolides
A surge in what hormone leads to ovulation?
Luteinizing hormone
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 beats above baseline for at least 15 seconds. This is a good thing.
What organism is the most common cause of pneumonia in a patient with cystic fibrosis?
Pseudomonas
Propranolol belongs to what class of medication?
Beta blockers
Grape-like vesicles or a sack of grapes on ultrasound should make you think of what diagnosis?
Hydatidiform mole
List three positive symptoms of schizophrenia.
Hallucinations, delusions, movement disorders
What is pertussis more commonly referred to as?
Whooping cough
Name three medication “classes” which are indicated for reduction in LDL?
Statins, ezetimibe, niacin and nicotinic acid
How do you treat a stasis dermatitis?
Compression stockings
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 is the yellow, brown fleshy mass on the conjunctiva which usually does not interfere with vision?
Pinguecula
Is an upper respiratory infection which includes hoarseness most likely bacterial or viral?
Viral
Tenderness over the anatomical snuffbox is indicative of what fracture?
Scaphoid
If you have heartburn that does not improve with medication what is the most likely diagnosis?
Gastrinoma
Steatorrhea should make you think of what diagnosis?
Pancreatitis
Describe Barlow’s test.
Adduct and internal rotation of the hips
What two viral hepatitis infections are self limiting?
Hepatitis A and hepatitis E
What is the most common organism that causes a bladder infection?
E. coli
Where are Heberden’s nodes found?
Distal interphalangeal joint (DIP)
What is the leading cause of iron deficiency anemia?
E. coli
A 65 year old male presents with frequency. On digital rectal exam you feel an elastic moderately enlarged prostate. What is the most likely diagnosis?
BPH
What is the most common fracture in a patient with osteoporosis?
A compression fracture of a vertebral body followed by hip fractures.
At approximately how many weeks pregnant is the uterus at the level of the umbilicus?
20 weeks
Following a myocardial infarction, what medication should you be using to treat hypertension?
Beta blocker
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 is the most likely diagnosis?
Histoplasmosis
Since a genetic cause is the number one reason for primary amenorrhea what is one very important test?
Karyotype
“What is the name for the triangular or wedge shaped growth on the conjunctiva that may interfere with vision?”
Pterygium
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
What CXR finding might make you think of mesothelioma?
Pleural thickening, remember 80% are found in the pleura lining
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
With a gastric ulcer are the patient’s symptoms exacerbated or relieved with food?
Exacerbated
Which EKG leads are used to diagnose an anterior wall MI?
V1, V2 and V3
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
A 45 year old female complains of feeling the ground rolling under her feet at times. What is the most likely diagnosis?
Vertigo
At what BMI should a patient be hospitalized for anorexia?
BMI of <17.5 or 20% below appropriate body weight
How do fibrates work to affect the lipid profile? Describe Courvoisier’s sign.
They inhibit synthesis of VLDL and elevate lipoprotein lipase.
Describe Courvoisier’s sign.
Nontender, palpable gallbladder which may indicate pancreatic neoplasm.
When is the typical onset of Tourette’s syndrome?
3-8 years old
You are treating a patient for TB. He has noticed that his body fluids now have an orange tint. What drug is most likely causing this?
Rifampin
Will evidence of TB be seen more frequently in the upper or lower lung lobes on CXR?
Upper
List three causes of decreased tactile fremitus.
COPD, Asthma, pleural effusion, pneumothorax
At approximately how many weeks pregnant is the uterus at the level of the symphysis pubis?
12 weeks
What are the ABC’s of melanoma?
Asymmetry, border, color, diameter, elevation/irregularity, evolving
What life threatening side effect do statins have?
Rhabdomyolysis
What two hormones are secreted by the posterior pituitary?
Oxytocin and antidiuretic hormone (ADH, vasopressin)
Define paraphimosis.
Foreskin is retracted and cannot be reduced.
Borderline personality disorder is on the border of what two psychological disorders?
Neurosis and psychosis
Does FEV1 go up or down with asthma?
It goes down
A biphasic P wave should make you think of what diagnosis?
Left atrial enlargement
What is the treatment for a tetanus infections?
Penicillin, immune globulin and supportive care (especially respiratory support)
What are the genetic characteristics of Wilson’s disease?
Autosomal recessive, chromosome 13
How does metformin work?
Decreases the hepatic glucose production and increases peripheral glucose uptake
Where is disease of the tricuspid valve best heard?
Along the left lower sternal border
Giant cells on a Tzanck smear should make you think of what diagnosis?
Herpes simplex virus
A positive Finkelstein’s test indicates what diagnosis?
de Quervain’s tenosynovitis
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. You should never use a pure beta blocker.
What medication is used for patients with lupus?
Systemic steroids
Bloody stool with cysts and trophozoites should make you think of what diagnosis?
Amebiasis
Pearly dome-shaped lesion with a central umbilication should make you think of what diagnosis?
Molluscum contagiousum
What is the x-ray finding that supports diagnosis of a slipped capital femoral epiphysis?
Ice cream falling of the cone
An opening snap on auscultation of the heart should make you think of what diagnosis?
Mitral Stenosis
Eggshell opacities on the CXR should make you think of what diagnosis?
Silicosis
How much fiber should you normally get in a day?
About 30 grams
How long must symptoms occur before diagnosing schizophrenia?
At least six months
What is the normal pH of the blood?
7.35-7.45
To be diagnosed with ADD patients must exhibit symptoms before what age?
7 years old
What are the three major criteria for endocarditis?
2 positive blood cultures, a positive transesophageal echocardiography, new murmur
What is the treatment for cholera?
Fluids
Which lipid medication may cause flushing?
Niacin
A patient believes she is pregnant. You notice that her cervix appears a little blue. What is the name of this sign?
Chadwick’s Sign
A sudden thunderclap headache should make you think of what diagnosis?
Subarachnoid hematoma
What is the treatment for pertussis?
Erythromycin x 7 days
What are the two most common causes of epididymitis?
Neisseria gonorrhea and chlamydia
Under normal conditions at what hemoglobin level would you begin to consider a transfusion?
8
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
What is the most common endometrial cancer?
75% are adenocarcinomas
What characteristic 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 blockage of which artery causes a lateral wall MI?
Left circumflex artery
What are two tocolytic medications you should be aware of?
Magnesium sulfate and calcium channel blockers
Vision loss described as curtain coming down should make you think of what diagnosis?
Retinal detachment
Carpal tunnel affects what nerve and what parts of the hand?
Median nerve. Thumb, pointer and ring fingers. Thenar wasting is sign of advanced disease.
Define phimosis.
Foreskin can not be retracted.
An HIV patient presents with a nonproductive cough and a CXR showing diffuse interstitial infiltrates. What is the most likely diagnosis?
Pneumocystis jiroveci pneumonia (PCJ) formerly known as Pneumocystis pneumonia (PCP)
Do loop diuretics cause hyperkalemia or hypokalemia?
Hypokalemia
White blood cell casts should make you think of what diagnosis?
Pyelonephritis
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
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.
What medication class is used to lower triglycerides?
Fibric acid derivatives
List the four cluster B personality disorders.
Bad antisocial, borderline, histrionic and narcissistic
An 82 year old patient complains of headaches and jaw claudication. What is the most likely diagnosis?
Giant cell (temporal) arteritis
What specific breathing pattern is associated with diabetic ketoacidosis?
Kussmaul respirations
What is Reynold’s pentad and why does it matter?
Charcot’s triad + hypotension + altered mental status. It indicates high risk of sepsis.
What class of antibiotics is sometimes prescribed specifically for its effects on increasing GI motility?
Macrolides
A Gram-negative coccobaccili found in the sputum of patient with pneumonia should make you think of what diagonsis?
Kussmaul respirations
A patient presents to the ER in acute CHF. What drug class will likely be the first choice?
Loop diuretics
Define priapism
Painful persistent erection
Are ulcers from arterial insufficiency painful or painless?
Painful
An African American female presents with malar rash and a positive double-stranded DNA antibody. What is the most likely diagnosis?
Lupus
A patient presents with a ruptured Achilles tendon. He states he 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
Clue cells should make you think of what diagnosis?
Bacterial vaginosis
Which medication is worse to give to a pediatric patient, tetracycline or an aminoglycoside?
Tetracycline
How long after a radiant energy burn do symptoms typically show?
6-12 hours
What dermatologic finding is associated with insulin insensitivity?
Acanthosis nigricans
White curd like vaginal discharge should make you think of what diagnosis?
Vaginal candida infection
Is sickle cell microcytic, macrocytic or normocytic?
Microcytic
Tapioca blisters should make you think of what diagnosis?
Dyshidrosis - these are usually on the hands and feet
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 conjunctivitis
When is it recommended to begin pap smears?
Guidelines suggest beginning at age 21 regardless of sexual history.
At what age is primary amenorrhea diagnosed?
Age 14 if no secondary sex characteristics. Age 16 if some secondary development.
What is the name for the 4th and 5th metacarpal fractures that often result from throwing a punch?
Boxer’s fracture
What is the medical term for lazy eye?
Amblyopia
What tests are done to screen for HIV?
ELISA and then if the positive diagnosis is confirmed with a Western blot test
A herald patch should make you think of what diagnosis?
Pityriasis rosea
Oseltamivir (Tamiflu) may be given to children above what age?
1 year old
A 30 year old female presents with pustules on her face that spare the vermilion border. In her history she has been using topical steroids. What is the most likely diagnosis?
Perioral dermatitis
What does ERCP stand for?
endoscopic retrograde cholangiopancreatography
Define pellagra?
Niacin (B3) deficiency Cytomegalovirus
Where is disease of the mitral valve best heard?
At the apex
At how many weeks of pregnancy can chorionic villus sampling be done?
10-13 weeks
What is the most common infection following a C-section?
Metritis
You have a patient with PCOS who would like to get pregnant. What are two medications you may start her on?
Metformin and Clomid
What is the most useful physical exam test for diagnosing an ACL tear?
Lachman’s, followed by anterior drawer
The term Philadelphia chromosome should make you think of what diagnosis?
Chronic myeloid leukemia
What two lung cancers are typically found centrally on CXR?
Small cell and squamous cell
Honey and babies should make you think of what diagnosis?
Botulism
Anatomically where are 80% of clavicle fractures located?
Middle third
What molecule binds iron in the blood stream?
Transferrin
What is the medical term for cross-eyed?
Strabismus
Fruity breath should make you think of what diagnosis?
Diabetic ketoacidosis
An RSR prime in leads V5 or V6 should make you think of what diagnosis?
Left bundle branch block
What dermatologic finding is associated with asthma?
Atopic dermatitis
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
An endoscopy for presumed esophagitis shows multiple shallow ulcers. What is the most likely diagnosis?
Herpes simplex virus
A snowstorm appearance on ultrasound should make you think of what diagnosis?
Hydatidiform mole
List two risk factors for prostate cancer.
Advancing age, African American, positive family history, high fat diet
Zanamivir (Relenza) may be giv to children above what age?
7 years old
At what age should a child begin to feed himself?
6 months
What type of mosquitoes carry malaria?
Anopheles
What is the most likely diagnosis for a young man who experiences sudden death while playing sports?
Hypertrophic cardiomyopathy
What is the treatment for a bad brown recluse spider bite?
Debridement, the venom causes tissue necrosis.
What antibiotic is the first line treatment for mycoplasma pneumonia?
A macrolide (azithromycin or erythromycin)
Decreased GABA and substance P should make you think of what diagnosis?
Huntington’s
What is the most common thyroid cancer?
Papillary makes up about 80% of thyroid cancers.
Currant jelly stool should make you think of what diagnosis?
Intussusception
Melasma is most often found in what patient population?
Women of childbearing age
Paradoxical pulses may be found in what pulmonary disorder?
Asthma
Currant jelly stool should make you think of what diagnosis?
Intussusception
A barrel chest should make you think of what diagnosis?
Emphysema
A physical exam revealing a retroverted uterus or uterosacral ligament nodularity should make you think of what diagnosis?
Endometriosis
Dullness to percussion should make you think of what diagonsis?
Lobar pneumonia
A positive Auspitz sign should make you think of what diagnosis?
Psoriasis
What is the best test for diagnosing Rocky Mountain spotted fever?
Indirect immunofluorescent antibodies
A dendritic lesion is seen with fluorescein stain. What is the most likely diagnosis?
Herpes keratitis
A fluid filled painless mass found in the scrotum which transilluminates should make you think of what diagnosis?
Hydrocele
Tea-colored urine with red cell casts should make you think of what diagnosis?
Glomerulonephritis
When is watchful waiting with a diagnosis of acoustic neuroma an appropriate plan?
This tumor is very slow growing. Watching a small tumor in an elderly patient is appropriate treatment.
Strict vegans are at risk for what type of anemia?
B12 deficiency anemia
What are the most common colors lost in color blindness?
Red and green
A patient presents with unilateral blurriness developing over a few days. Fundal exam shows a “blood and thunder” pattern. What is the most likely diagnosis?
Central vein occlusion
What might happen if you infuse vancomycin too fast?
Red Man syndrom
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
Give the DEXA score for osteopenia and osteoporosis.
Osteopenia = 1 to 2.4 standard deviations, osteoporosis = 2.5 standard deviations or greater
Will ACTH be elevated or decreased in Addison’s disease?
Elevated if the problem is at the adrenal glands.
What is the definitive treatment for a patient with recurrent ventricular tachycardia?
Implanted defibrillator
A patient is brought in following a seizure in which she did not lose consciousness. What is the most likely diagnosis?
Ruptured aortic aneurysm
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 most common cause of dementia?
Alzheimer’s disease, it may be as high as 80%.
HLA-DR gene is a marker for what endocrine disorder?
DM type 1
At what age do symptoms of Huntington’s disease appear?
Around 30 years old
You hear a loud, harsh pulmonary murmur along the left sternal border. What is the most likely diagnosis?
Ventricular septal defect
White oral lesions which can be scraped off leaving punctate bleeding should make you think of what diagnosis?
Oral candida
A unilateral, single, mobile, firm, nontender solid breast mass should make you think of what diagnosis?
Fibroadenoma
What is the most common cause of DM type 1?
Autoimmune destruction of the islet cells in the pancreas
What is a cystocele?
A herniation of the bladder into the vagina.
What is the term for eyelids that turn in?
Entropion
Are target cells seen in mild or severe iron deficiency anemia?
Severe, they are also seen in alpha thalassemia, chronic liver disease and asplenia.
An Osborn or J wave on EKG should make you think of what diagnosis?
Hypothermia
Name three medications used to break a seizure?
Diazepam, lorazepam, phenytoin or fosphenytoin.
What organism causes toxoplasmosis?
Toxoplasma gondii
Giant cell arteritis is associated with what other disease?
Polymyalgia rheumatica
A patient presents with a painless mass in her right wrist. What is the most likely diagnosis?
Ganglion cyst
What is the first line treatment for mastitis?
Dicloxacillin is first line. Cephalexin or erythromycin are second line.
What is the diagnostic test of choice for Zenker’s diverticulum?
Barium swallow will show the diverticulum.
What are the two most common predisposing factors in the development of chronic renal failure?
HTN and DM
A child with bulky greasy stool should make you think of what diagnosis?
Cystic fibrosis
Describe how to perform the psoas sign.
The patient is supine and attempts to raise the right leg against resistance.
What is the most common uterine tumor?
Leiomyoma, also known as fibroids
What location within the pelvis is endometriosis most commonly found?
On an ovary
What is the initial treatment for a myocardial infarction?
MONA - morphine, oxygen, nitroglycerin and aspirin
A stuck on grey membrane in the pharynx should make you think of what diagnosis?
Diphtheria
An abdominal exam with pain out of proportion to the exam should make you think of what diagnosis?
Intestinal ischemia
A patient presents with sudden painless complete unilateral vision loss. What is the most likely diagnosis?
Central retinal artery occlusion
What is tonometry used for?
Determining intraocular pressure
Muddy-brown sediment in the urine should make you think of what diagnosis?
Acute tubular necrosis
Are patients with specific phobias aware they are strange?
Yes
Name one abortive drug for migraines.
Triptans (sumatriptan, zolmitriptan), ergotamine
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
A patient presents to your office complaining of a tremor in his right hand. He states after a beer it goes away completely. What is the most likely diagnosis?
Benign essential tremor or familial tremor
What CXR finding might make you think of berylliosis?
Diffuse infiltrates with hilar adenopathy
Vaginal infection with motile flagellated protozoa should make you think of what diagnosis?
Trichomonas vaginitis
What siezure medication may cause overgrowth of the gums?
Phenytoin
Tympany to percussion should make you think of what diagonsis?
Large pneuomthorax
A patient presents with pain in one eye. The cornea is hazy and the pupils are fixed. What is the most likely diagnosis?
Glaucoma
What is the treatment for a patient with a Mobitz II AV block?
Pacemaker
You see regular P waves and regular QRS complexes, but they do not seem to have any correlation to each other. What is the diagnosis?
Third degree AV block
Where do most aortic dissections occur?
The ascending or descending thoracic aorta
What medical treatment is given for a gastrinoma?
Proton pump inhibitors
What is the clinical name for whooping cough?
Pertussis
What two labs do you want to monitor in a patient on an ACEI?
Serum creatinine and serum potassium
In what age range do you expect to most commonly find amaurosis fugax?
Patients older than 50
An involuntary loss of urine during coughing or laughing is what type of incontinence?
Stress incontinence
Which thyroid cancer is the most aggressive?
Anaplastic
Define threatened abortion.
Vaginal bleeding, closed cervix, products of conception are still inside
How much more potent is T3 than T4?
3-4x
List four disease states in which you may find basophilic stippling.
Lead poisoning, beta or alpha thalassemia, sideroblastic anemia, arsenic poisoning
What is the most common cause of hyperparathyroidism?
Single parathyroid adenoma in 80% of cases.
Is staph gram (+) or gram (-)?
Gram (+)
What are the two main causes of aortic stenosis?
Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease
You notice drusen deposits on fundal exam. What is the most likely diagnosis?
Macular degeneration
List the 5 insulins in order of peak efficacy?
Lispro 1-2 hrs, Regular 2-4 hrs, NPH 5-7 hrs, Lente 4-8 hrs, Ultralente 8-14 hrs
What would you expect to see on a KOH prep if the patient had vaginal candidiasis?
Pseudohyphae
Will a hemolytic anemia generally have an elevated or decreased retic count?
Elevated
Define the third stage of labor.
Delivery of baby to delivery of placenta
How do you treat alcohol withdrawal
Benzodiazepines
What is the treatment for myxedema?
Levothyroxine and slow warming
What is the therapeutic range for INR following an organic valve replacement?
2 to 3
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 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 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
A patient exhibits splitting, seeing others as all good or all bad. What is the most likely diagnosis?
Borderline personality disorder
What is the medical treatment for gout?
Allopurinol, colchicine
In order to contract hepatitis D what must you already have?
Hepatitis B
A CXR finding of notched ribs in a child should make you think of what diagnosis?
Coarctation of the aorta
A leukemia patient has a CT of the liver which shows punched out lesions. What diagnosis should you be thinking of?
Hepatosplenic candida
What two main causes should you be thinking of in a macrocytic anemia?
Malnutrition and severe blood loss
Where are Bouchard’s nodes found?
Proximal interphalangeal joint (PIP)
What is the first line treatment for tinea corporis?
Topical azoles
Which of the four rotator cuff muscles is most commonly injured?
Supraspinatus
What three symptoms are classic for a normal pressure hydrocephalus?
Gait disturbance, dementia and urinary incontinence
What is the treatment of choice for strep throat? List 4 medications which may cause asthma.
Penicllin, amoxicillin, erythromycin
A patient has metamorphopsia and a central blind spot. What is the most likely diagnosis?
Beta blockers, NSAIDS, ACEI, ASA
A PSA above what level should start to make you concerned?
Topical azoles
A patient has an intracranial neoplasm causing auditory illusions, olfactory hallucinations and emotional changes. What lobe is the lesion likely in?
> 4.0 Temporal
What is the first line medical treatment for pericarditis?
Aspirin and NSAIDS
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 is the most likely diagnosis?
Topical azoles
A diaper rash with satellite lesions should make you think of what diagnosis?
Candida
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
Coal miners lung often shows nodular opacities in what lung fields?
Upper lung fields
What is the gold standard for diagnosing coronary artery disease?
Cardiac catheterization
What are two treatments you should consider for esophageal strictures?
Dilation of the esophagus and long term PPIs.
Community acquired carditis is most often caused by one of the HACEK organisms. List the HACEK organisms.
Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella
When treating herpes keratitis should you use topical antiviral, topical steroid or both?
Don’t use steroids. Topical antiviral and refer!
List four symptoms of serotonin syndrome.
Hyperthermia!, seizure, mental status change, tremor
What is the karyotype for patient with Turner’s syndrome?
(45, X) They are missing one sex chromosome.
What happens to total lung capacity in sarcoidosis?
It goes down
Which hyperlipidemia medication may cause flushing?
Niacin
A double comedone is indicative of what diagnosis?
Hidradenitis suppurativa
A positive crossover test indicates what diagnosis?
Acromioclavicular joint injury (AC joint)
Silvery scales should make you think of what diagnosis?
Psoriasis
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 tumor marker may be used for liver cancer?
alpha-Fetoprotein
A patient complains of an aching headache which feels like a band around his head. What is the most likely diagnosis?
Tension Headache
What is considered a normal PCO2? What is the best lab test for scabies?
40mmHG Respiratory - CO2 is elevated
Nasal polyps should make you think of what diagnosis?
Microscopic examination under oil immersion
A new mother presents with pain over the radial wrist. She has a positive Finkelstein’s test. What is the most likely diagnosis?
Cystic fibrosis
What is erythema nodosum?
de Quervain’s tenosynovitis
What is the most common anorectal problem affecting patients over 50?
Tender red nodules usually found on the shins.
You should be thinking alpha thalassemia if the question stem includes which four geographic areas?
Hemorrhoids
What is the most common cause of an upper respiratory tract infection?
Southeast Asia, China, Middle East, Africa
What is the drug of choice to treat a urethritis caused by neisseria?
Rhinovirus
What is the medical treatment for an early ectopic pregnancy?
Ceftriaxone (Rocephin)
A Salter-Harris type III fracture affects what area of the bone?
Methotrexate
What is the treatment for Addison’s disease?
The physis (growth plate) as well as the epiphysis
What is the term for a chronic mild depression which has lasted greater than two years?
Hydrocortisone or prednisone Dysthymia
Which NSAID has the highest rate of peptic ulceration?
Naproxen
What is the only curative therapy for gastric adenocarcinoma?
Surgical resection
What should a primary care provider do for presumed central retinal artery occlusion?
Ophthalmic emergency! Refer and intermittent pressure and release of the eye.
What is a good beta blocker to reduce portal HTN?
Propranolol
A waxy stuck on appearance should make you think of what diagnosis?
Seborrheic keratosis
A sawtooth pattern on EKG should make you think of what diagnosis?
Atrial flutter
Ethambutol has what two major side effects?
Optic neuritis, red green vision loss
How does levothyroxine work?
It is a synthetic T4
How do you treat pityriasis rosea?
Reassurance
How long does menstration 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.
A patient is arrogant with an inflated self image. He feels he is special and should be treated that way. What is the most likely diagnosis?
Narcissistic personality disorder
Will the serum ferritin be high or low in a patient with iron deficient anemia?
It will almost always be low
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
What organism is the most common cause of an uncomplicated urinary tract infection?
E. Coli
Is the ankle jerk reflex of lumbar or sacral origin? What is the best test to diagnose bronchiectasis?
Sacral
Koplik spots are white clustered lesions on the buccal mucosa. What virus are they pathognomonic for?
CT Measles/Rubeola
Air fluid levels on abdominal x-ray should make you think of what diagnosis?
Bowel obstruction
Typically what is the first medication started in type 2 DM?
Metformin
What is the first step in treating atopic dermatitis?
Behavioral modifications - reduce bathing, only use soap on face and genitals, use natural breathable fabrics
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.
Subacute endocarditis is most commonly caused by what organism?
Strep Viridans
What is the treatment for Shigella?
Bactrim or fluoroquinolones and hydration.
On auscultation, you hear a harsh blowing pansystolic murmur at the apex. What is the most likely diagnosis?
Mitral regurgitation
What lab result will increase the risk of digoxin toxicity?
Hypokalemia or hypercalcemia
Which nerve is involved in herpes zoster ophthalmicus?
Trigeminal nerve, CN 5
Describe the pattern of weight gain in an infant over the following time periods: week one, 6 months, 12 months, 3 years old and 4 years old.
Newborns lose 10% of their birth weight initially but are back to birth weight at 10 days, 6m = 2x birth weight, 12m = 3x birthweight,3 y/o= 30 lbs & 30 inches, 4 y/o = 40 lbs & 40 inches
Why is ovarian cancer so hard to diagnose?
There are no good markers and the symptoms are very vague.
Stocking glove paresthesias should make you think of what two diagnoses?
B12 deficiency neuropathy and diabetic neuropathy
Describe Cullen’s sign.
Umbilical ecchymosis often related to pancreatitis.
A 35 year old female presents with heat intolerance, weight loss and palpitations. What is the most likely diagnosis?
Hyperthyroidism
A patient exhibits all of the characteristics of antisocial personality disorder, but he is only 14 years old. What is the most likely diagnosis?
Conduct disorder
What is the most common cause of an atrial septal defect?
Patent foramen ovale
A widely split fixed S2 should make you think of what diagnosis?
Atrial septal defect
Waxy flexibility should make you think of what diagnosis?
Catatonic schizophrenia
Weakness and numbness in the left hand might be a blockage in which carotid artery?
Right
A patient with a history of herpes now presents with a target lesion. What is the most likely diagnosis?
Erythema multiforme
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.
If you hear a midsystolic click you should immediately be thinking about what diagnosis?
Mitral valve prolapse
A shuffling gait should make you think of what diagnosis?
Parkinson’s disease
What is the most common microcytic anemia?
Iron deficiency anemia
Nodular opacities in the upper lung fields should make you think of what diagnosis?
Silicosis
If you see a question with anything to do with rats and the patient has pneumonia, what organism should you be thinking of?
Yersinia pestis
Purple, pruritic, polygonal, papules on physical exam should make you think of what diagnosis?
Lichen planus
A patient is bitten by a rabies infected raccoon. On what days do you give human diploid cells?
0, 3, 7, 14, 28
What is the initial treatment for a chemical burn to the eyes?
Irrigate, irrigate, irrigate
Clot busting drugs should be used within 3 hours of which two cardiac events?
STEMI and new left bundle branch block
Positive antithyroid peroxidase and antithyroglobulin antibodies should make you think of what diagnosis?
Hashimoto’s
Is pseudomonas gram (+) or gram (-)?
Gram (-)
Early on in pregnancy serial beta-HCG should double over what time period?
every 48-72 hours
Mesothelioma is most commonly found in what lung location?
80% are found in the pleural lining
A patient presents with a hot potato or muffled voice. What is the most likely diagnosis?
Peritonsillar abscess
A patient presents to the ER with acute progessive weakness, diplopia and a very dry mouth. What organism may be causing this?
Clostridium botulinum
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.
What is the first line treatment for genital warts?
Imiquimod (Aldara)
What side effect might make a patient stop taking an ACEI?
Cough
At how many weeks of pregnancy can an amniocentesis be done?
15-20 weeks
What is the term for being nearsighted? What type of lens do you use to correct it?
Myopia, concave lenses
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.
A young child presents to ER and you see him waiting in tripod position. What is the most likely diagnosis?
Epiglottitis
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.
List 4 physical exam findings for Cushing’s syndrome.
Moon face, buffalo hump, purple striae, central obesity, supraclavicular fat pads, easy bruising
What medicaton classes are prescribed in order to help prevent chronic renal failure in diabetic patients?
ACEIs or ARBs
What is the best imaging for a thyroid nodule?
Ultrasound
Salmon-colored scales should make you think of what diagnosis?
Psoriasis
A colonoscopy that shows cobblestone or skip lesions should make you think of what diagnosis?
Crohn’s disease
