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
