Final Step Notecards - 2nd 500 Flashcards
The baby was delivered several minutes ago. Suddenly there is a increase in blood flow from the vagina and the cord noticeably lengthens. What is the most likely cause of these signs?
Placental separation
List three signs or symptoms which will likely be included in a description of a patient with a pheochromocytoma?
Thin, diaphoretic, tachycardic, agitated and hypertensive
Often caused by chlamydia what is the syndrome characterized by urethritis (or cervicitis), arthritis and conjuctivitis?
Reiter’s syndrome
An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely diagnosis?
Supraventricular tachycardia
What is the treatment for a volvulus in a child?
Barium enema
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.
You suspect a patient has polyarteritis nodosa. What is the test for a definitive diagnosis and what is the treatment?
Biopsy, high dose steroids
A resting or pill-rolling tremor should make you think of what diagnosis?
Parkinson’s disease
What are three medications often combined as a first line treatment for H. pylori?
Omeprazole, clarithromycin and amoxicillin (PPI + 2 Antibioitcs)
What is the treatment goal for a diabetic with hypertension?
130/80
What medication might you use prior to thyroidectomy in a patient with hyperthyroidism?
Methimazole or propylthiouracil (PTU
Is diphtheria a Gram-positive or negative organism?
Gram-positive
How do you treat achalasia?
Loosen up the muscle - botox, dilation or surgery
What is the most specific test for acute cholecystitis?
HIDA
Prolonged expiration (low FEV1) should make you think of what diagnosis?
Asthma or COPD
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)
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
Define inevitable abortion.
Vaginal bleeding, cervix is open, products of conception are still inside
List three medication that may cause lupus.
Procainamide, isoniazid and Quinidine
Hyperpigmentation of the skin along creases should make you think of what diagnosis?
Gram-positive
Are most shoulder dislocations anterior or posterior?
Anterior
What are three things in your differential if you have a paradoxical pulse?
Cardiac tamponade, pericarditis and obstructive lung disease
How long should pressure be applied to treat epistaxis?
15 minutes
What is the term for painful swallowing?
Odynophagia
Cortical adrenal insufficiency is also known as what disease?
Addison’s disease
Currant jelly sputum should make you think of what diagnosis?
Klebsiella pneumoniae
At what age should you begin ordering dexa scans for male patients? What about female patients?
70 for males, 65 for females
What are three treatments for uterine prolapse?
Pessary, Kegel’s maneuvers, surgical repair
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 is Hashimoto’s disease?
An autoimmune cause of hypothyroid
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 is the most likely diagnosis?
Hypochondriasis
Define menorrhagia.
Heavy prolonged menstrual flow
What organism is believed to be the main culprit in creating peptic ulcers?
Helicobacter pylori
A woman presents to the ER concerned she is in preterm labor. What treatment should you begin before even getting any imaging or lab results?
Give IV fluids (most often the patient is suffereing from dehydration).
What are the two main complications of cirrhosis?
Portal HTN & liver insufficiency
A contralateral mediastinal shift should make you think of what diagnosis?
Tension pneumothorax
A thin looking heart and flattened diaphragm on CXR should make you think of what diagnosis?
Emphysema
Are lesions from psoriasis typically found on flexor or extensor surfaces?
Extensor
A cervical biopsy comes back as CIN1. What is the next step?
Repeat pap smear in 6 months and repeat colposcopy in 12 months.
Antisocial personality disorder may not be diagnosed until what age?
18 years old
Nummular eczema is most like what other dermatological disorder?
Atopic dermatitis
What is the best imaging to diagnose osteomyelitis?
Either a bone scan or an MRI will provide the diagnosis.
What is the most common vessel blocked with intestinal ischemia?
Superior mesenteric artery
A CT scan shows ring enhancing lesions in an HIV patient. What is the most likely diagnosis?
Toxoplasmosis
A patient presents with irritated, burning and tearing eyes. You notice some scurf and scales. Where do you begin treatment?
This is blepharitis. Treatment begins with good hygiene and moves on to topical antibiotics if necessary.
What two human papillomaviruses are most responsible for condyloma acuminata?
HPV 6 and 11
A patient was in the woods yesterday and today presents with erythema migrans. What is the most likely diagnosis?
Lyme disease
List 2 risk factors for ovarian cancer.
BRCA1, family history, nulliparity, late menopause, Caucasian, Asian
A cervical biopsy comes back as CIN2 or CIN3. What is your next step?
Excision - LEEP, Cold knife (worry about incompetent cervix), Cryotherapy
Bird-beak esophagus on barium swallow should make you think of what diagnosis?
Achalasia
What are two common predisposing factors for esophageal varices?
Portal HTN and cirrhosis often caused by alcoholism.
What is the best treatment for molluscum contagiosum?
It is self limiting, but can be removed if patient really wants it.
Who is more likely to have an aortic aneurysm males or females?
Males are eight times as likely to have an aortic aneurysm.
A positive Neer’s test indicates what diagnosis?
Rotator cuff impingement Reactive arthritis, HLA B-27
A patient presents with conjunctivitis, urethritis, arthritis and oral lesions. What is the most likely diagnosis? What other lab might you expect to be positive?
Spermatocele
What is the most likely diagnosis for a free floating, painless, cystic mass found posterior and superior to the testis?
Total hysterectomy and bilateral salpingo-oophorectomy
What is the first step of treatment for endometrial cancer?
Cholecystitis
A patient presents complaining of right upper quadrant pain 20 minutes after meals. What is the most likely diagnosis?
Carbohydrates
Salivary amylase breaks down what macronutrient? Name the four thyroid cancers.
Papillary, Follicular, Medullary, Anaplastic
A 22 year old male patient presents with what is clearly a septic knee. You also notice lesions on his hands and feet. What is the most likely pathogen?
Neisseria gonorrhoeae
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
What is the most common organism that causes mastitis?
Staph aureus
Blue bloater refers to the characteristic physical exam findings of what disease?
Chronic bronchitis
What is the most common cause of postrenal renal failure?
BPH, postrenal renal failure is secondary to an outflow obstruction
Describe the characteristics of a lytic lesion on x-ray.
Spiculated, elevated periosteum, bone destruction (think bad, very bad things)
What is it called when a patient says “ee” but on auscultion you here “ay”?
Egophony
List two medications commonly used for hypertension in pregnancy.
Methyldopa and labetalol
What is the test to begin with if you suspect a pheochromocytoma?
24 hour urine for catecholamines
At what point during pregnancy is RhoGAM given if it is needed?
28 weeks
What virus causes mumps?
Paramyxovirus
What are two important things you need to tell you patients before putting them on metronidazole?
Stay out of the sun and avoid alcohol.
What medication is most commonly used for long term treatment of GERD?
Proton pump inhibitors - omeprazole, lansoprazole, pantoprazole
Which is associated with painful third trimester bleeding placental abruption or placenta previa?
Placental abruption
Paroxysmal nocturnal dyspnea should make you think of what diagnosis?
CHF
How does ezetimibe work?
Decreases intestinal absorption of cholesterol.
Does mastitis tend to be unilateral or bilateral?
Unilateral and only one quadrant
What is the suffix associated with sulfonylureas?
Ide is the suffix. Examples: glipizide, tolbutamide, tolazamide.
What is the first symptom of a rabies infection?
Pain and anesthesia at the site of the bite
What two blood test can be used to diagnose celiac?
IgA endomysial antibody and IgA tTG antibody
Which problem is an emergency phimosis or paraphimosis?
Paraphimosis
A Westermark sign on CXR should make you think of what diagnosis?
Pulmonary embolism
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 area of the prostate is the primary site for prostate cancer?
The peripheral zone
Syphilis is caused by what organism?
Treponema pallidum
A thumbprint sign on an abdominal film should make you think of what diagnosis?
Intestinal ischemia
A study result comes back with intracellular neurofibrillary tangles and extracellular neuritic plaques. What is the most likely diagnosis?
Alzheimer’s disease
What cranial nerve is affected with Bell’s palsy?
CN VII
What is the medical term for hunchback?
Kyphosis
How do you treat hookworm?
Azoles
G6PD deficiency follows what pattern of inheritance?
X- linked
A painless, clean base chancre should make you think of what diagnosis?
Primary syphilis
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
Define premature birth.
Delivery before 37 weeks.
Extremely pruritic lesions with burrows in runs should make you think of what diagnosis?
Scabies
What organism is the most common cause of otitis media?
Strep pneumonia
Pizza pie retinopathy should make you think of what diagnosis?
Cytomegalovirus (CMV)
A 46 year old male comes into 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
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
How long before normal grief resolves?
About one year
The description of a dew drop on a rose petal should make you think of what diagnosis?
Chickenpox
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.
Honeycombing and tram tracks on the CXR should make you think of what diagnosis?
Bronchiectasis and idopathic pulmonary fibrosis
A slowly growing nodule with a central depression and a pearly border should make you think of what diagnosis?
Basal cell carcinoma
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
What is the treatment for most Mallory-Weiss tears?
Watchful waiting, these will typically resolve within 48 hours.
A middle age male presents with unilateral periorbital headaches occurring daily for several weeks. These headaches are extremely painful. Which type of headache is the most likely cause?
Cluster headache
Spaghetti and meatballs on KOH prep should make you think of what diagnosis?
Tinea versicolor
A U wave on EKG should make you think of what diagnosis?
Hypokalemia
A patient presents with a dense corneal infiltrate and an epithelial defect seen with fluorescein stain. What diagnosis should you be thinking of?
Corneal ulcer
How long after administering a PPD should it be read?
48-72 hours
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 seborrheic keratosis?
It is bengin so there is no need to treat it. Lesions may be removed if unsightly.
Thin, sticky, malodorous vaginal discharge should make you think of what diagnosis?
Bacterial vaginosis
What diagnosis is most likely in an IV drug user with a new heart murmur and fever?
Endocarditis
A pathology report comes back with positive birefringent crystals. What is the most likely diagnosis?
Pseudogout
What is the most common fracture in children?
Clavicle
Which nerve root is responsible for the knee jerk reflex?
L3-L4
A thumbprint sign on x-ray should make you think of what two diagnoses?
Lateral C-spine = epiglottitis, abdominal = intestinal ischemia
What organism causes us to warn pregnant patients to stay away from deli meats and soft cheeses?
Listeria
What is the most common cause of hypoparathyroid?
Post thyroidectomy with the complication of parathyroidectomy.
What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?
Dressler syndrome
Hyperpigmented velvety plaques should make you think of what diagnosis?
Acanthosis nigricans
What oral antibiotic can be used for pseudomonas?
Ciprofloxacin
Imaging is negative for blood, but you strongly believe that there is a subarachnoid hemorrhage. What test can you order that will be definitive?
Lumbar puncture
What is the treatment for ovarian cancer?
Total hysterectomy and bilateral salpingo-oophorectomy. Chemo + radiation.
A Salter-Harris type I fracture affects what area of the bone?
Only the physis (growth plate).
List four risk factors for breast cancer?
BRCA1 or BRCA2 positive, unopposed estrogen, nulliparity, early menarche, late menopause
A lumbar puncture for a patient with bacterial meningitis will show elevated or decreased WBCs? Glucose? Protein?
Elevated WBCs, decreased glucose and elevated protein
At what size induration would a PPD be positive for a healthcare worker?
10mm
Clicking or locking of the knee indicates what diagnosis?
Meniscal tear
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.
Purulent cervical discharge should make you think of what diagnosis?
Neisseria gonorrhoeae
A teardrop lesion after a course of strep throat should make you think of what diagnosis?
Guttate psoriasis
A patient presents with a painful, red nodule on the eyelid. What diagnosis should you be thinking of? What treatment should you begin with?
Hordeolum (sty). Warm compress and progress to topical antibiotics if necessary.
Hyperresonance to percussion should make you think of what diagnosis?
Emphysema, pneumothorax, asthma
What is the term for eyelids that turn out?
Ectropion
What is the accessory pathway associated with Wolff-Parkinson-White syndrome?
The bundle of Kent
List two ectopic tumors that may produce ACTH and give a patient Cushing’s syndrome?
Small cell lung cancer, pancreatic islet cells, thymomas
A CXR shows vascular redistribution and blurred vascular outlines. What is the most likely diagnosis?
CHF
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 is the most likely diagnosis?
Epstein–Barr virus
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
A patient with a history of smoking presents with a new onset hoarsness. This has been persistant for the past two weeks. What is the most likely diagnosis?
Laryngeal squamous cell carcinoma
Which is more likely to pass into the scrotum, a direct or indirect hernia?
Indirect
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.
Rope-like breast mass should make you think of what diagnosis?
Fibrocystic breast mass
List four diagnostic criteria for diabetes?
Random glucose >200, fasting glucose >126, two hour postprandial glucose >200, HgA1c >6.5%
What time frame are we talking about for chronic sinusitis?
> 3 months
What is Schilling’s test used for?
Test for the cause of a B12 deficiency
What are the main side effects of isoniazid?
Hepatitis and peripheral neuropathy
What is the most common preceding event for orbital cellulitis?
URI
A patient has a silver-fork deformity on x-ray. What is the most likely diagnosis?
Colles fracture
What is the first line medication for a patient with symptomatic bradycardia?
Atropine
There is a sunburst appearance on x-ray. What is the most likely diagnosis?
Osteosarcoma
A patient presents with mucopurulent discharge and cervical motion tenderness. What is the most likely diagnosis?
Chlamydia - cervicitis
Would anemia of chronic disease most likely be macrocytic, normocytic or microcytic?
Normocytic
How do you treat a sickle cell crisis?
Fluids, oxygen, pain medication, transfusion may be necessary
List one major risk factor for bladder cancer?
Smoking
What is the initial treatment for active TB?
INH+RIF+PZA+EMB x several months typically followed by INH+RIF once sensativities come back
Asplenism secondary to sickle cell disease increases a patient’s risk for what type of infections?
Capsulated organisms like Strep pneumo and H. flu
What hematological disorder should you think of if the questions talks about the patient eating ice or dirt?
Iron deficiency anemia
How is the first day of the menstrual cycle defined?
The first day of menstrual bleeding is the first day of the cycle.
A lacey pink rash should make you think of what diagnosis?
Erythema infectiosum aka fifth disease aka slapped cheek
An African American teenager presents with avascular necrosis of the his right femoral head. What is the most likely diagnosis?
Sickle cell disease
List the two cluster C personality disorders.
Sad avoidant and obsessive compulsive
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 average age of menopause?
51
Describe Kernig’s sign.
The patient lies supine, flex hip while keeping knee straight. Back pain is positive.
Define missed abortion.
No vaginal bleeding, cervix is closed, products of conception are still inside.
Describe erythema marginatum.
Pink rings on the trunk and inner surfaces of the limbs.
What percentage of strokes are ischemic? What percentage are hemorrhagic?
80%, 20%
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.
What is the mean age for ovarian cancer?
63, you will need to think of this in an older patient with vague abdominal symptoms.
Name one aldosterone antagonist.
Spironolactone, eplerenone
A patient presents with flaky skin in the nasolabial folds and in her hair. What is the most likely diagnosis?
Seborrheic dermatitis
What is the most common way of testing for metamorphopsia?
Amsler grid
During what portion of the menstrual cycle does PMS occur?
By definition it is in the second half and menstruation should relieve the symptoms.
What medication class does metformin (Glucophage) fall into?
Biguanide
What medication(s) are used to treat a postpartum metritis?
Clindamycin and gentamicin together
What disease does Rickettsia rickettsii cause?
Rocky Mountain spotted fever
What are the 5 points of Ranson’s criteria on admission?
older than 55, WBC>16, glucose>200, LDH>350, AST>250
Name three serious reactions a patient may have with the use of vancomycin?
Nephrotoxicity, ototoxicity and Stevens-Johnson syndrome
A positive Hawkins test indicates what diagnosis?
Rotator cuff impingement
What are the three most common cancers to metastasize to the lungs?
Breast, liver and colon
What is the most common pituitary adenoma?
Prolactinoma
What does an Anti-HBc (hep B core antibody) indicate?
Previous or ongoing hepatitis B infection
Describe Grey-Turner’s sign.
Flank ecchymosis often related to pancreatitis
What is the best test for diagnosing CHF?
Echo
List three drugs that treat cluster headaches.
Oxygen, sumatriptan, Stadol (butorphanol)
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
A very sick patient with diffuse infiltrates that spare the costophrenic angles should make you think of what diagnosis?
Acute respiratory distress syndrome (ARDS)
List three medications which may be used for pharmacological stress test.
Adenosine, dobutamine, dipyridamole and Persantine
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
How many days after conception is a serum beta- HCG positive?
8
What is appropriate treatment for central vein occlusion?
Typically self limited. Treat underlying disease.
What is the medical term for tennis elbow?
Lateral epicondylitis
On physical exam, you hear a harsh systolic murmur along the right sternal border. What is the most likely diagnosis?
Aortic stenosis
Should a breast feeding mother stop breast feeding if she develops mastitis?
Mastitis is not a reason to stop breast feeding, but an abscess is.
What is the definitive treatment for cardiac tamponade?
Pericardiocentesis
Define full term.
Delivery at 37-42 weeks
List the time of year when each of the following allergens is most prominent: pollen, grass, mold and ragweed.
Pollen from trees and flowers = spring, grasses are the summer, mold and ragweed are fall
What is the most common cause of hypopituitarism?
Tumor
You have a patient with pulsus paradoxus. What two diagnosis should you be thinking of?
Pericarditis, pericardial effusion and an obstructive lung issue
A patient complains of muscle weakness and fatigability that improves with rest. What is the most likely diagnosis?
Myasthenia gravis
What is the generic name for Prozac?
Fluoxetine
What is the drug of choice for toxoplasmosis?
Bactrim
A patient complains of periumbilical pain which has now moved over McBurney’s point. What is the most likely diagnosis?
Appendicitis
What is Tietze syndrome?
Costochondritis
What is the heart rate for tachycardia? How about bradycardia?
Tachycardia >100, bradycardia <60
A patient complains of pain in his legs when he walks. It goes away after sitting. What term comes to mind for this symptom? What diagnosis is it associated with?
Intermittent claudication. Peripheral arterial disease.
Depigmented patches of skin should make you think of what diagnosis?
Vitiligo
What will the likely findings be on a CXR of a patient with asbestosis?
Linear opacities at the bases with pleural plaques
What medication is clearly contraindicated in anorexia and bulimia?
Bupropion (Wellbutrin) because it can increase risk of seizures.
What is the drug of choice for the treatment of Lyme disease?
Doxycicline
Any question about rabbits and pneumonia should make you think of what diagnosis?
Tularemia
Onion ring fibrosis from a bile duct biopsy should make you think of what diagnosis?
Primary sclerosing cholangitis
What type of behavioral therapy works best for borderline patients?
Dialectical behavior therapy
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 elevated
What two things are needed to make a diagnosis of bipolar 2?
One major depressive episode and one hypomanic episode
A slit lamp shows Kayser-Fleischer rings. What is the most likely diagnosis?
Wilson’s disease
What is the treatment for epididymitis?
Ceftriaxone and doxycycline
What is the most common cause of acute bacterial cholangitis?
Choledocholithiasis
A positive McMurry indicates what diagnosis?
Meniscal tear
A string sign on barium swallow should make think of what diagnosis?
Pyloric stenosis
you have
Often a thin female
A patient with mitral valve prolapse will often what physical characteristics?
Transitional cell cancer
What is the most common bladder cancer?
Anemia of chronic disease
A low retic count and a normal serum ferritin should make you think of what diagnosis?
Hypertension, Marfan’s syndrome, bicuspid aortic valve, pregnancy
List two risk factors for an aortic dissection?
Chlamydia
What organism is the most common sexually transmitted bacteria?
Steroids, interferon beta, copolymer 1
List three medications used to “treat” multiple sclerosis?
This patient has an active tremor. A beta blocker like propranolol is a good start.
A positive Phalen and Tinel’s sign indicates what diagnosis?
Carpal tunnel
Describe how to perform the obturator sign.
The patient is supine and attempts to flex and internally rotate right hip.
Define paradoxical pulse.
There is a large difference in pulse pressure between inhalation and exhalation.
A 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
What class of medications is the first line for lowering LDL?
Statins
What is the best test to diagnose an aortic dissection?
CT
What is represented by ST segment depressions greater than 1mm on EKG?
Ischemia
A patient is having a stroke and there is no evidence of hemorrhage. What is the first line medical treatment?
Within the first 48 hours and with no contraindications thrombolytics should be given.
A Gram-positive organism in chains should make you think of what diagnosis?
Strep
Moans, groans, stones and bones describe symptoms of what endocrine problem?
Hyperparathyroid
What is the first line antibiotic treatment for cystitis?
Bactrim
Honey-colored crusts should make you think of what diagnosis?
Impetigo
Will a spermatocele transillumnate?
Yes
A CT scan of the head shows broad infiltration of orbital fat. What is the most likely diagnosis?
Orbital cellulitis
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 held very long grudges due to perceived past wrongs. What is the most likely diagnosis?
Paranoid personality disorder
Will a patient with achalasia have dysphagia to liquids, solids or both?
Both
What is the imaging study of choice if you suspect bladder cancer?
Cystoscopy and biopsy
Is Klebsiella gram (+) or gram (-)?
Gram (-)
What is the most common cause of lower GI bleed?
Diverticulosis
Tall peaked T waves should make you think of what diagnosis?
Hyperkalemia
A boot-shaped heart on CXR should make you think of what diagnosis?
Tetralogy of Fallot
How do you treat dyshidrosis?
Topical steroids Haloperidol
What is the medication of choice for a patient with Tourette’s syndrome?
New left bundle branch block is a STEMI equivalent. Right bundle branch block is usually not a problem.
Which finding requires immediate attention: left bundle branch block or right bundle branch block?
Abuse, either child or elder
What is the treatment for subconjunctival hemorrhage?
Reassurance
A beta natriuretic peptide below what level rules out CHF?
< 100
If you are looking for lesions associated with multiple sclerosis and you order an MRI do you order with gadolinium or without?
With gadolinium
Which four human papillomaviruses are linked to cervical cancer?
HPV 16, 18, 31 and 33
A 15 year old overweight boy presents to your office limping with knee pain. What is the most likely diagnosis?
Slipped capital femoral epiphysis
No matter what medications you use you are having trouble keeping a patient’s blood pressure under control. You also notice hyperpigmented skin and truncal obesity. What is the most likely diagnosis?
Cushing’s disease
Large doughy hands should make you think of what diagnosis?
Gigantism
How do you treat vaginal candida?
Fluconazole po 1 dose or azole cream x 1 week
A pearl formation on CXR should make you think of what diagnosis?
Squamous cell lung cancer
A patient has very strange magical thinking. What is the most likely diagnosis?
Schizotypal personality disorder
What is the most common cause of C-spine fractures?
Motor vehicle accidents
What are the two most common causes of pancreatitis?
Cholelithiasis and ETOH
Why should actinic keratosis be treated?
It may progress to squamous cell carcinoma.
An older patient presents with pneumonia and diarrhea. What is the most likely diagnosis?
Legionella pneumonia
German measles is also known as what disease?
Rubella
Which cardiac medication has gynecomastia in its side effect profile?
Spironolactone
Which is the most commonly herniated vertebral disc?
L4-L5 followed by L5-S1
What antibiotic is most likely to cause C. diff?
Clindamycin
Is obsessive compulsive disorder egosyntonic or ego-dystonic? What about obsessive compulsive personality disorder?
OCD is ego-dystonic. OCPD is egosyntonic.
Does an increase in reticulocytes indicate a decrease or an increase in RBC production?
An increase, reticulocytes are newly released “baby” RBC’s
A patient ate out last night and today has cramping and bloody diarrhea. What is the most likely organism?
Salmonella
At what age should an infant begin cooing?
2 months
Atypical or walking pneumonia is caused by what pathogen?
mycoplasma
A patient describes his vision loss as a curtain coming down and then going back up. What might the diagnosis be?
Amaurosis fugax
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 apply tests would be appropriate.
By what age should a child be able to walk?
12 months
How do statins work to affect the lipid profile?
They slow the rate limiting step of cholesterol synthesis.
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
An EEG showing generalized spikes and associated slow waves should make you think of what diagnosis?
Generalized or absence seizure
What is the treatment for botulism?
Antitoxin
Vasculitis with a hepatitis B history should make you think of what diagnosis?
Polyarteritis nodosa
What is Russell’s sign?
Abraded knuckles from forcing oneself to vomit.
What is the more popular term for Stein-Leventhal syndrome?
Polycystic ovarian syndrome
A patient was camping a few days ago and now has a rash that began on his wrists and ankles. What is the most likely diagnosis?
Polyarteritis nodosa
What is the best location to hear problems with the aortic valve?
2nd right intercostal space
List the three cluster A personality disorders.
Mad schizoid, schizotypal and paranoid
What type of organism is tetanus?
A Gram + rod, Clostridium tetani
What three labs should you order if you are considering secondary amenorrhea?
beta-HCG, TSH, Prolactin
There is an MRI result of multiple foci of demyelination in the white matter. What is the most likely diagnosis?
Multiple sclerosis
An elderly patient presents with dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely diagnosis?
Aortic stenosis
How do you treat bacterial vaginosis?
Metronidazole x 7 days
A palpable olive-shaped epigastric mass in a one month old should make you think of what diagnosis?
Pyloric stenosis
Where is the epididymis found?
It is found at the posterior upper pole.
List three risk factors for an ectopic pregnancy.
Previous ectopic, scarred tubes (hx of PID or salpingitis), IUD
A gastrinoma is also known as what syndrome?
Zollinger-Ellison syndrome
A college student presents with pneumonia. What two organisms should you be thinking of?
Chlamydia and mycoplasma
Any reference to dark field microscopy should make you think of what organism?
Treponema pallidum
What is the imaging modality of choice for pancreatitis?
CT
A child presenting with an erythematous sandpaper rash should make you think of what diagnosis?
Scarlet fever
In a patient with hyperthyroidism will TSH most likely be elevated or decreased?
Decreased
Stocking glove should make you think of what diagnosis?
Diabetic neuropathy and B12 deficiency neuropathy
Posttussive rales should make you think of what diagnosis?
TB
What does Kiesselbach’s plexus refer to?
A group of vein’s in the anterior nose which bleed a lot
What is the medical term for feeling like there is a lump in your throat?
Globus
A patient presents with irregular menses, hirsutism and infertility. What is the most likely diagnosis?
Polycystic ovarian syndrome
A Gram-negative diplococci should make you think of what diagnosis?
Neisseria
Caseating granulomas should make you think of what diagnosis?
TB
What are the 5 criteria for metabolic syndrome?
HDL 135/85, Triglycerides >150, Fasting glucose >100, Waist >40 inches in men >35 inches in women
How do you definitively diagnose endometriosis?
Exploratory laparoscopy
A college student presents with copious purulent drainage from one eye. What is the most likely diagnosis?
Neisseria
What is the best imaging to rule out testicular torsion?
Doppler U/S for decreased blood flow to the testes
How long does a panic attack typically last?
10-20 minutes
Lead pipe or cogwheel rigidity should make you think of what diagnosis?
Parkinson’s disease
Is metformin indicated or contraindicated in renal failure?
Contraindicated
A pathologic S3 is most commonly associated with what diagnosis?
CHF
Pitting nails are associated with what dermatologic disorder?
Psoriasis
Gestational diabetes puts mom and baby at increased risk of for what three things?
Preeclampsia, macrosomia (traumatic birth), slowing in fetal lung development
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.
What is the first line medical treatment for a pheochromocytoma?
Alpha blocker. You should never use a pure beta blocker.
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 ethnic background is at an increased risk of fibroids?
African Americans are 5x more likely to have fibroids compared to Caucasian women.
Are fibrocystic breast masses usually bilateral or unilateral?
Bilateral
How do you treat a patient with respiratory syncytial virus?
Albuterol, steroids and fluids
List six extrapulmonary complications of lung cancer.
SPHERE - SVC syndrome, Pancoast tumor, Horner’s syndrome, Endocrine problems, Recurrent laryngeal symptoms, Effusions (exudative)
What tumor marker can be used to follow pancreatic cancer?
CA-19-9
What is the most common type of ovarian cyst?
Functional cyst - no treatment necessary.
What is the gold standard for diagnosis of giant cell arteritis?
Biopsy of the temporal artery
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 main function of parathyroid hormone?
Increase serum Ca
What class of medication is first line to treat inflammatory bowel disease in the maintenance phase?
5-ASA products - sulfasalazine, mesalamine
A patient who is asymptomatic should consider having an endarterectomy at what percent blockage of the carotid artery? How about in a symptomatic patient?
70% in an asymptomatic patient and greater than 60% in a symptomatic patient.
What is the most common location for a pancreatic tumor?
75% occur in the head of the pancreas.
What will a CXR show for a patient with an aortic dissection?
Widened mediastinum
Auer rods are most commonly associated with what disease?
Acute myeloid leukemia
How do you treat allergic rhinitis?
Intranasal corticosteroid and antihistamines
What class of antibiotics should you start with for community acquired pneumonia?
Macrolides
What is the most common type of kidney stone?
Calcium makes up 85% of kidney stones.
What will the heart rate be if the AV node is pacing the heart?
40-60 beats per minute
What is Sheehan’s syndrome?
Ischemia of the pituitary due to volume depletion during or after childbirth.
The EKG shows irregularly irregular narrow QRS waves. What diagnosis should you be thinking of?
Atrial fibrillation
About how much weight should a woman gain during pregnancy?
20-35 lbs
What is the first line antibiotic for prostatitis?
Bactrim 4-6 weeks
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 & C2.
What is the most common congenital heart disease?
Ventricular septal defect
What is the classic triad of pre-eclampsia?
HTN, edema and proteinuria
Is peptic ulcer disease more common in the duodenum or the stomach?
Duodenum
What is the most common primary intracranial neoplasm?
Glioma
What type of hearing loss is associated with aging?
Sensory
Give two classes of drug therapy for treating Parkinson’s.
Dopaminergic (levodopa), anticholinergics are second line
What is the least aggressive thyroid cancer?
Papillary
A patient presents with weakness that he has felt in his lower legs and now feels in his knees and hips bilaterally. He has decreased deep tendon reflexes. This has been getting progressively worse. What is the most likely diagnosis?
Guillain-Barre
Where is disease of the pulmonary valve best heard?
2nd left intercostal space
Hyperinflation on a CXR as well as eosinophilia on CBC should make you think of what diagnosis?
Asthma
Which are more painful, hemorrhoids above or below the dentate line?
Below, internal hemorrhoids are not painful.
List two macrolides.
Erythromycin, azithromycin, clarithromycin
Iron deficiency anemia will have a serum iron lower than what value?
30
What are the first three steps of managing pancreatitis?
NPO, pain control, fluids
Rhinophyma should make you think of what diagnosis?
Acne rosacea
Define abortion.
Delivery of uterine contents before 20 weeks.
What type of incontinence is often associated with BPH?
Overflow incontinence, the bladder cannot empty sufficiently
Statins are the drug of choice to treat what type of dyslipidemia?
Elevated LDL
A psychiatric patient presents with confusion, fever and lead pipe rigidity. What is the most likely diagnosis?
Neuroleptic malignant syndrome, this can occur with high dose antipsychotics.
You notice a bowing of the iris on exam. What is the most likely diagnosis?
Glaucoma
What is the best imaging study for acute appendicitis?
CT
What is Graves’ disease?
The most common cause of hyperthyroidism. It is an autoimmune disease.
Acute endocarditis is most commonly caused by what organism?
Staph aureus
What disease is defined as an immunologic response to gluten?
Celiac
Name a common cause of a junctional rhythm.
Digitoxin toxicity
A CXR shows a “3” sign with notching of the ribs. What is the most likely diagnosis?
Coarctation of the aorta
Pertussis is most commonly treated with what antibiotic?
Erythromycin
A urine protein of >3.5 grams/day should make you think of what diagnosis?
Nephrotic syndrome
What is the only cyanotic congenital heart disease on the NCCPA blueprint?
Tetralogy of Fallot
If you see the term chocolate cyst it should make you think of what diagnosis?
Endometrioma
A patient has just received a cardiac stent. How long will he be on aspirin and clopidogrel?
One year
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)
What medium do you need to grow out Neisseria gonorrhoeae?
Thayer-Martin
What is the treatment for giant cell arteritis?
High dose prednisone
In a folic acid deficiency anemia the folic acid level is typically below what level?
<150
Will the retic count be elevated, decreased or normal in a B12 deficient anemia?
Retic count will be low. Low building blocks means low production.
Is surgery curative for Crohn’s or ulcerative colitis?
Ulcerative colitis
What organism has been linked to reactive arthritis?
Shigella, also remember that reactive arthritis has a positive HLA-B27.
A blockage of which artery causes an anterior wall MI?
Left anterior descending artery
What two antibiotics are used for empiric treatment of endocarditis?
Vancomycin and ceftriaxone together are first line empiric treatment
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
Give two major risk factors for erectile dysfunction
Diabetes, hypertension, depression, coronary artery disease
A fundal exam shows a cherry-red spot. What diagnosis should you be thinking of?
Central retinal artery occlusion 90% of patients are older than 50.
Colorectal cancer patients are almost all older than what age?
A decrease in estrogen
What causes anorexic patients to have osteopenia? By what age should a child be able to sit up? Define metrorrhagia.
6 months
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 is the most likely diagnosis?
Bleeding between menstrual cycles
List two medications you might use to treat an essential tremor.
Antisocial personality disorder
What uric acid level helps to confirm a diagnosis of gout?
Beta blocker (propranolol), primidone >7.5
What is the normal level of serum bicarbonate (HCO3)?
24 mEq/Liter
What is the therapeutic range for INR following a mechanical valve replacement?
2.5-3.5
Inability to absorb vitamin B12 due to lack of intrinsic factor is what disease?
Pernicious anemia
List three side effects of digoxin.
Nausea/vomiting, anorexia, confusion, arrhythmias (sinus brady, AV block), fatigue, vision disturbances etc.
Which EKG leads are used to diagnose an anterolateral MI?
V5 and V6
On palpation, what size is normal for the aorta?
Less than 3 cm Atrial septal defect An ACEI or an ARB
After a thiazide diuretic, what medication should you start in a hypertensive patient who also has diabetes?
Atrial septal defect
Give the definition for preterm labor.
An ACEI or an ARB
What is pica?
Contractions that open the cervix before 37 weeks.
You suspect a pneumothorax. What instructions should go along with the order for a CXR?
Eating non-food items including ice, paper, dirt, hair.
List two common offending agents for pill induced esophagitis?
It should be an end expiratory view in order to look for visceral pleural air.
A patient has a GFR of 25 and HTN. Which class should you use, a loop or a thiazide diuretic?
NSAIDS, KCl, iron, antibiotics
What is the most common cause of bronchiectasis?
A loop will work no matter how low the GFR is. Thiazides will only work with a GFR over 30.
What does trismus mean?
Cystic Fibrosis
At what size induration would a PPD be positive for an HIV patient?
Lock jaw, often secondary to tetanus 5mm
What is the term for when the placenta has implanted directly over the cervical os?
Placenta previa
What treatment should be started for asymptomatic diverticulosis?
None
A patient presents drooling, with stridor and in tripod position. What is the diagnosis, and how do you treat it?
You treat epiglottitis with a second or third generation cephalosporin like cefuroxime or ceftriaxone.
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
What hereditary pattern does polycystic kidney disease follow?
Autosomal dominant
What is the most common cause of secondary amenorrhea?
Pregnancy
What is the most common location for an anal fissure?
Posterior midline
What endocrine issue is associated with PCOS?
Insulin insensitivity
An epigastric olive-shaped mass should make you think of what diagnosis?
Pyloric stenosis
What does Anti-HBs (hep B surface antibody) indicate?
Recovery from infection or immunization to hepatitis B
What type of hallucinations are most common in schizophrenia auditory, visual or olfactory?
Auditory - hearing voices
Painless hematuria should make you think of what diagnosis?
Bladder cancer
Pica is often related to what type of anemia?
Iron deficiency anemia
Will epididymitis feel better with scrotal elevation?
Yes
What does koilonychia refer to?
Spoon-shaped nails. This may be found in microcytic anemia.
Name the sign which is defined as decreased pain with scrotal elevation?
Prehn’s sign
Name two fibric acid derivatives.
Fenofibrate and gemfibrozil
What is the most common organism responsible for prostatitis?
E. coli
What is the most common type of testicular cancer?
Nonseminoma
What are three ways you can check for ruptured membranes?
Ferning pattern on a slide, visualize leakage from the cervix, pooling in the vagina
An exudative pleural effusion should make you think of what diagnosis?
TB, Lung cancer
Define procidentia.
Uterine prolapse beyond the introitus
An EKG shows two premature ventricular contractions. These two QRS waves look very different. What is the term for this?
Multifocal premature ventricular contractions
What is the term for an abscess in the sacrococcygeal cleft?
Pilonidal disease
List two causes of right atrial enlargement.
Pulmonary HTN, severe lung disease, pulmonary valve stenosis
How much time needs to pass before diagnosing secondary amenorrhea?
If cycles have been normal 3 months. If cycles have been irregular 6 months.
An ovarian cyst that contains hair and teeth should make you think of what diagnosis?
Teratoma
A patient presents with lateralized throbbing headache. He is also complaining of nausea, vomiting and photophobia. What type of headache is most likely?
Migraine
What is the suffix used for most fluoroquinolones?
Oxacin
There are vaccines for which two versions of hepatitis?
Hepatitis A and hepatitis B
A prostate biopsy consists of how many samples?
6 to 12
What is the first line of treatment for an anal fissure?
Fluid and fiber
List the five major Jones criteria for diagnosing rheumatic fever.
Polyarthritis, carditis, subcuticular nodes, erythema marginatum, chorea
How do you definitively diagnose rabies?
Pathology of the brain of the animal that performed the bite using fluorescent antibody stain.
An endoscopy for presumed esophagitis shows several solitary deep ulcers. What is the most likely diagnosis?
Cytomegalovirus
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
A kidney stone of less than what size will likely pass on its own?
Less than 5 mm
Why can’t you give fluoroquinolones to kids?
They can cause cartilage development problems.
What is the term for bilateral yellow plaques near the eyes?
Xanthelasma
What is the best test to diagnose malaria?
Peripheral blood smear
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
In a patient with aortic stenosis, will the PMI be medially displaced, normal or laterally displaced?
It will be laterally displaced due to left ventricular hypertrophy.
Diabetes insipidus is caused by a deficiency of which hormone?
Vasopressin
Why aren’t fluoroquinolones used more frequently?
They have lots of side effects.
Where on your patient should you listen for the murmur associated with an atrial septal defect?
At the left second or third interspace
What is a common symptom that goes along with chest pain for GERD patients?
Dry cough
Is glaucoma more prevalent in males or females?
Females 3:1
What is the most common knee injury?
Medial meniscal tear
What is the management of a patient in supraventricular tachycardia?
Vagal maneuvers, carotid massage, adenosine
Interference with work or school is part of which diagnosis, premenstrual syndrome or premenstrual dysphoric disorder?
Premenstrual dysphoric disorder
What is the normal range of fetal heart rate?
120-160
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 first line treatment for orbital cellulitis?
IV antibiotics, followed by 2 weeks of oral antibiotics
What is Trousseau’s sign?
Inflate BP cuff and hold for 3 minutes. Patient with low Ca will get carpel tunnel symptoms.
Define orthostatic hypotension.
A drop in systolic blood pressure of >20 mmhg when standing up.
What is the current drug of choice for treating MRSA?
Vancomycin
Which reproductive cancer carries the highest rates of death in women?
Ovarian cancer
A patient of Mediterranean descent is a clue for which type of anemia?
Beta thalassemia
If the pap smear results come back anything other than negative or ASCUS what is your next step?
Colposcopy and biopsy
A premature infant with hyaline membrane disease will have what appearance on CXR?
Bilateral atelectasis or ground glass appearance
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
Transudative pleural effusions should make you think of what diagnosis?
Congestive heart failure
What is the first line IV inotropic agent when dealing with cardiogenic shock?
Dopamine
Where are 90% of basal cell lesions found on the body?
On the head and neck
What is Charcot’s triad?
RUQ pain, fever, jaundice
What is the current drug of choice for the cytomegalovirus?
Ganciclovir
What are the five components of tetralogy of Fallot?
Ventricular septal defect, right ventricular hypertrophy, right ventricular outflow obstruction (pulmonary valve stenosis), overriding aorta, right sided aortic arch
A patient who has normal bladder function, but can not get to the bathroom has what type of incontinence?
Functional incontinence
What is the most common location of colorectal cancer?
Cecum about 38%
Is Huntington’s autosomal dominant or recessive?
Dominant
What is included in Whipple’s triad of hypoglycemia?
History of previous hypoglycemia, serum glucose of <40, immediate recovery upon administration of glucose
How does nicotinic acid work to affect the lipid profile?
It inhibits secretion of VLDL.
Anti-Jo-1 antibodies should make you think of what diagnosis?
Polymyositis
If you see a question with an alcoholic who has been diagnosed with pneumonia what is the most likely organism?
Klebsiella pneumoniae
How do glitazones work?
They improve insulin sensitivity.
What are three possible treatments for peritonsillar abscess?
Needle aspiration, I&D and tonsillectomy
How do sulfonylureas work?
They stimulate the production of insulin.
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.
What medication is a good place to start treating bipolar 1 or 2?
Lithium
What is the drug of choice for treating Rocky Mountain spotted fever?
Doxycycline
What is the first step in treating GERD?
Lifestyle modification
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
Is neisseria gram (+) or gram (-)?
Gram (-)
How do you treat lichen simplex chronicus?
Get the patient to stop scratching it.
Where is a Pancoast tumor found on CXR?
At the apex of either the right or left lung
What is the gold standard for diagnosis of a pleural effusion?
Thoracocentesis
How do you treat an H. pylori infection?
PPI + 2 antibiotics, commonly omeprazole + clarithromycin and amoxicillin or PPI +metronidazole + tetracycline
