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
