Final Step Notecards - 3rd ~500 Flashcards
1
Q
Describe the result of a Weber hearing test in a patient with conductive hearing loss.
A
Patient will report the sound louder in the affected ear.
2
Q
Exophthalmos should make you think of what diagnosis?
A
Hyperthyroidism
3
Q
Which herpesvirus causes Epstein–Barr?
A
Herpes 4
4
Q
A sponge-like prostate on digital rectal exam should make you think of what diagnosis?
A
Prostatitis, but be careful. You can cause sepsis with a digital rectal exam.
5
Q
If you come across a question where the patient has erythema nodosum and an enlarged parotid gland what is the most likely diagnosis?
A
Sarcoidosis
6
Q
An 18 month old is not yet speaking. He does not point to objects. He does not make eye contact with others. What is the most likely diagnosis?
A
Autism
7
Q
Are most pulmonary valve problems congenital or acquired?
A
95% are congenital
8
Q
List three possible causes of prerenal renal failure.
A
CHF, severe dehydration, hemorrhage
9
Q
How do you test for color blindness?
A
Polyarteritis nodosa
10
Q
A patient with a history of hepatitis B presents complaning of bilateral knee pain, fever and weight loss. What is the most likely diagnosis?
A
Ishihara plates
11
Q
A patient presents complaining of a metallic taste in her mouth and dark brown urine. What antibiotic might she be on?
A
Metronidazole (Fagyl)
12
Q
What drug is used for the treatment or prophylaxis of malaria?
A
Chloroquine
13
Q
What is the first line medical treatment for a patient who presents with palpitations and nervousness secondary to hyperthyroidism?
A
Beta Blockers
14
Q
Are ulcers from venous insufficiency painful or painless?
A
Painless
15
Q
What occupations are associated with berylliosis?
A
Aerospace and nuclear plant workers
16
Q
Postmenopausal bleeding is immediately believed to be what diagnosis?
A
Endometrial cancer until proven otherwise.
17
Q
What are the most common primary cancer sites that metastasize to the brain?
A
Lung, breast and kidney
18
Q
List the three most commonly used medical treatments for COPD?
A
Oxygen, ipratropium and albuterol
19
Q
What area of the prostate is affected by BPH?
A
The transitional zone
20
Q
What is the #1 cause of septic arthritis in sexully active young adults?
A
Neisseria gonorrhoeae
21
Q
An EEG showing interictal spikes should make you think of what diagnosis?
A
Complex partial seizure
22
Q
Name two tests you might use to rule out Cushing’s syndrome.
A
24 hour free cortisol urine test and dexamethasone suppression test
23
Q
Elevated circulating acetylcholine receptor antibodies should make you think of what diagnosis?
A
Myasthenia gravis
24
Q
Are the lungs noisy or quiet in COPD?
A
Quiet
25
How do you define 1st degree AV block?
The PR interval is longer than 0.2 seconds or one block on EKG.
26
On EKG, there is an early wide QRS complex with no associated P wave. After that beat, there is a slight pause, and then a normal rhythm continues. What is the term for this one beat?
Premature ventricular contraction
27
A patient presents with a staccato cough but no fever. What is the most likely diagnosis?
Chlamydia pneumoniae
28
What is the gold standard for the diagnosis of cystic fibrosis?
Sweat chloride test
29
Unilateral purulent rhinitis should make you think of what diagnosis?
Foreign body
30
Define the second stage of labor.
Fully dilated to delivery
31
Most gallstones are made of what substance?
Cholesterol
32
What is the most common congenital heart defect?
Ventricular septal defect
33
What is Chvostek's sign?
Tap on facial nerve and get a twitch with low Ca.
34
List four complications of untreated strep throat.
Scarlet fever, glomerulonephritis, rheumatic fever and local abscess
35
A patient complains of severe pleuritic chest pain that is relieved with sitting and leaning forward. What is the most likely diagnosis?
Pericarditis
36
An India ink stain showing cysts should make you think of what diagnosis?
Cryptococcosis
37
What is the first line treatment for a varicocele?
Watchful waiting unless there is a question of fertility.
38
According to the CDC, what is the range for a normal BMI?
18.5-24.9
39
What is the first line medical treatment for torsades de pointes?
Magnesium sulfate
40
What lab test is the gold standard for chlamydia?
Nucleic acid amplification test
41
A patient presents with a round ulcer in her mouth that is yellow-grey and has a red halo. It is on the buccal mucosa and it is painful. What is the most likely diagnosis?
Aphthous ulcers
42
If a question presents a pregnant woman with anemia what is the most likely diagnosis?
Iron deficiency
43
List three things that should be in your differential if you hear wheezes on a lung exam?
Asthma, COPD, Bronchitis
44
A patient without a functioning spleen is more susceptible to what type of organisms?
Encapsulated organisms most commonly Strep pneumoniae and H. Flu.
45
A patient's mother has recommended that he see you. He lives on his own and is a computer programmer. He works from home. He has no friends and seldom leaves the house. She is concerned that he expresses no interest in meeting people and seems perfectly happy to be home alone all the time. What is the most likely diagnosis?
Schizoid personality disorder
46
An elevated serum amylase and lipase should make you think of what diagnosis?
Pancreatitis
47
What carpal bone has a high rate of nonunion and occult fracture?
Scaphoid
48
The follicular phase of menstruation is dominated by what hormone?
Estrogen
49
Bullae and blebs on CXR should make you think of what diagnosis?
Emphysema
50
Define complete abortion.
Vaginal bleeding, cervix open, products of conception have passed
51
Which is the most commonly affected sinus in acute sinusitis?
Maxillary
52
What is the most common cause of peptic ulcer disease?
H. pylori
53
What is the term for being afraid of being out in a terrible situation with no help available?
Agoraphobia
54
Define pulsus alternans.
EKG waveform changes from beat to beat
55
A bamboo spine indicates what diagnosis?
Ankylosing spondylitis
56
You have a patient with major depressive disorder. Once his symptoms have completely resolved how long should you continue with treatment?
A six month minimum is recomended due to very high relapse rates.
57
Epigastric abdominal pain which radiates to the back should make you think of what diagnosis?
Pancreatitis
58
What is the most likely quadrant for a retinal detachment?
Superior temporal
59
By what age should a child be able to roll over?
4 months
60
What is the first line medical treatment for stage 1 hypertension?
Superior temporal
61
On an EKG, you notice a patient has a gradually lengthening PR interval and then a missed QRS complex. The pattern repeats again. What type of AV block is this?
Mobitz I or Wenckebach
62
Painless bright red blood per rectum should make you think of what diagnosis?
Hemorrhoids
63
Bruises may be purple, green, yellow and brown. How many days old is a yellow bruise?
Purple day 1-5, Green day 5-7, Yellow 7-10, Brown 10-14
64
How is acute stress disorder different than posttraumatic stress disorder?
Acute stress disorder occurs within 1 month of event and resolves within about a month. PTSD begins at about 1 month after event and can last indefinitely.
65
Which viral exanthem often has conjunctivitis as one of it's symptoms?
Measles/Rubeola
66
List three catastrophic complications of a myocardial infarction.
Papillary muscle rupture, myocardial wall rupture and left ventricular aneurysm
67
What is the most common cause of pneumonia in children less than 1 year old?
Respiratory syncytial virus (RSV)
68
A patient on sulfasalazine for an inflammatory bowel disease should be supplemented with what vitamin?
Folate
69
A patient of yours always craves attention, often using sex as a tool to gain it. She often acts like a child when she does not get her way? What is the most likely diagnosis?
Histrionic personality disorder
70
When treating psychiatric patients are benzodiazepines used more commonly for acute or chronic treatment?
Acute
71
On EKG there is an early but otherwise normal PQRS complex. After that beat there is a slight pause and then a normal rhythm continues. What is the term for this one beat?
Premature atrial contraction
72
List two risk factors for cervical cancer.
Multiple sexual partners, smoking
73
Small grouped vesicles on the vermillion border should make you think of what diagnosis?
Herpes
74
What is the most important complication of giant cell arteritis?
Blindness
75
Under what conditions would aspirin or clopidogrel be used following a TIA as prophylaxis?
These are antiplatelet medications. They would be used unless there is a known cardiac etiology for the embolism. Patients with a cardiac cause should use heparin or Coumadin.
76
What heparin complication is relevant to endocrinology?
Adrenal infarct leading to a Cushing's syndrome
77
What is the term for being farsighted? What type of lens do you use to correct it?
Hyperopia, convex
78
At what age should a child begin to say momma and dadda?
12 months
79
A white oral lesion which cannot be scraped off should make you think of what diagnosis?
Oral leukoplakia
80
How do you treat pneumocystis jiroveci pneumonia (PCJ) formerly known as pneumocystis pneumonia (PCP)?
Bactrim
81
A 30 year old African American woman presents with dysphagia. You notice she also has thickened skin. A barium swallow demonstrates the absence of peristalsis. What is the most likely diagnosis?
Scleroderma
82
Projectile vomiting should make you think of what diagnosis?
Pyloric stenosis
83
Pretibial myxedema should make you think of what diagnosis?
Graves Disease
84
How often should patients with pernicious anemia have a screening endoscopy performed?
Every 5 years looking for signs of gastric carcinoma.
85
What is first line treatment for rosacea?
Metronidazole, tetracycline is probably a close second.
86
A patient complains of having suddenly developed stage fright. It is very important to his career that he be able to speak in front of groups. What medication might you treat him with?
Beta blocker - propranolol
87
What is the gold standard for the diagnosis of cystic fibrosis?
Sweat chloride test
88
What is the most common cause of subarachnoid hemorrhage aside from trauma?
Ruptured cerebral aneurysm
89
Left lower quadrant pain and tenderness should make you think of what diagnosis?
Diverticulitis
90
A child presents with paroxysmal abdominal pain, nausea, vomiting and diarrhea. What is the most likely diagnosis?
Intussusception
91
List three congential heart diseases.
Atrial septal defect (ASD), ventricular septal defect (VSD), coarctation of the aorta, patent ductus arteriosus (PDA), tetralogy of Fallot
92
What are the two important peices of patient education for anyone diagnosed with mononucleosis?
No contact sports (splenic rupture) and no kissing (highly contagious)
93
What type of organism causes botulism?
A Gram + rod, Clostridium botulinum
94
What is the defining symptom of Alzheimer's?
Progressive memory impairment
95
A patient presents to the ER with saddle anesthesia and loss of bowel and bladder function. What is the most likely diagnosis?
Cauda equina
96
What is the time frame for the first symptoms of withdrawal from alcohol?
Tremor in 8-18 hrs
97
Define the first stage of labor.
Onset of contractions to full dilation of the cervix.
98
What is another term for podagra?
Gout
99
A continuous murmur most likely involves what area of the heart?
It is most likely a septal defect.
100
How do hookworm larvae enter the body?
They penetrate the skin usually through the soles of the feet.
101
What class of cardiac medications should be avoided in patients with asthma?
Beta blockers (Blocks receptors for bronchodilators)
102
A patient's mother has recommended that he see you. He lives on his own and is a computer programmer. He works from home. He has no friends and seldom leaves the house. She is concerned that clearly he would like to meet people, but he is terrified of doing so. What is the most likely diagnosis?
Avoidant personality disorder
103
What is the minimum amount of time needed for a tick to transfer Lyme disease to a human?
24 hours
104
What age range is the HPV vaccination recommended for?
9 to 26 years old
105
What is the most common place for an aortic aneurysm?
In the abdomen and below the renal arteries
106
Severe abdominal pain 30 minutes after a meal should make you think of what diagnosis?
Intestinal ischemia
107
What is the most common site of an ectopic pregnancy?
Within a fallopian tube
108
A patient is having seizures along with a mouse- like odor from the urine. What is the most likely diagnosis?
Phenylketonuria
109
At what age do you begin screening patients for prostate cancer? What two tests are used?
At age 50 an annual digital rectal exam and a PSA are recommended.
110
You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?
Wolff-Parkinson-White syndrome
111
What is the condition where the urethral meatus is not at the tip of the penis?
Hypospadias and in far fewer cases epispadias
112
Should diverticulitis always be admitted?
No, mild cases can be treated as outpatients with rest and clear fluids.
113
A patient has pneumonia with rust colored sputum. What is the most likely diagnosis?
Strep pneumonia
114
What are two things that an anal fissure off midline might suggest?
Crohn's, syphilis, HIV, neoplasm
115
What symptom is associated with a classic migraine?
Having an aura
116
What are the three inferior leads?
II, III and aVF
117
List the components of Virchow's triad.
Stasis, vascular injury, hypercoagulability
118
What fracture is the #1 cause of compartment syndrome?
Tibial shaft fracture
119
A patient has had GERD for years. Over the past year, he has noticed an increase in difficulty swallowing his food. This should make you think of what diagnosis?
Esophageal strictures
120
What two lung cancers are typically found peripherally on CXR?
Adenocarcinoma and Large cell
121
You feel a pulse that seems to be vibrating. What term do you use to describe it?
Thrill
122
What is the single most important thing to be concerned about with a patient in status epilepticus?
Airway, followed by management of hyperthermia
123
At what age should vaccinations for pneumococcal pneumonia begin?
65 years old
124
Owl eye inclusion bodies should make you think of what diagnosis?
Cytomegalovirus (CMV)
125
What is the key indicator for the prognosis of melanoma?
Thickness of the lesion
126
Rheumatic fever most commonly affects which valve?
The mitral valve
127
Rhonci or wheezes that clear after coughing suggest what diagnosis?
Bronchitis or atelectasis
128
Define incomplete abortion.
Vaginal bleeding, cervix is open, products of conception partially passed
129
Gummas or granulomatous nodules should make you think of what diagnosis?
Tertiary syphilis
130
Coin-shaped plaques should make you think of what diagnosis?
Nummular Eczema
131
When performing a decompression for a tension pneumothorax where do you put the needle?
2nd intercostal space at the midclavicular line
132
What is the treatment for melanoma?
Wide local excision
133
A patient with primary amenorrhea and a low FSH should make you think of what diagnosis?
Hypothalamic pituitary insufficiency
134
At what age should a child be able to use a spoon and stack 3-4 blocks?
18 months
135
Rice water stool should make you think of what diagnosis?
Cholera
136
Give two risk factors for glaucoma.
African American descent and diabetes
137
A patient having recently undergone cataract surgery presents complaining of vision loss in the operative eye. What is the most likely diagnosis?
Retinal detachment
138
What is the drug of choice to treat C. difficile?
Metronidazole (Flagyl)
139
Calf pain should always make you think of what diagnosis?
DVT
140
What is the first line antibiotic for otitis media?
Amoxicillin
141
A fundal exam shows an opalescent retina and boxcarring of arterioles. What is the most likely diagnosis?
Central retinal artery occlusion
142
Both testicles should be descended by what age?
3 months
143
Name three SSRI's
Fluoxetine, paroxetine, sertraline, citalopram, escitalopram, dapoxetine, zimelidine, mesembrine, seproxetine
144
What four chromosomes have been linked to dementia?
1,14,19,21
145
What is the drug of choice for the treatment of syphilis?
Pencillin
146
A 66 year old female patient presents with bouts of nausea, weight loss and vague abdominal pain. What is the most likely diagnosis?
Ovarian cancer
147
A patient complains of regurgitating undigested food several hours after a meal. What is the most likely diagnosis?
Zenker's diverticulum
148
A patient presents to the ER with tearing chest pain radiating to his back. What is the most likely diagnosis?
Aortic dissection
149
What class of medications does pioglitazone (Actos) fall into?
Thiazolidinediones also known as glitazones
150
"What should a primary care provider do for a presumed retinal detachment?"
Refer & position patient with head down
151
What medication might you switch to if a patient develops an intolerable cough on an ACEI?
Angiotensin receptor blocker (ARBs)
152
How often should a diabetic's HgbA1c be checked and what should it be?
Every three months (remember the life of an RBC is 90-120 days) and it should be below 6.5%
153
How do you treat polymyalgia rheumatica?
Low dose prednisone
154
Is FSH high or low in Turner's syndrome?
High, there are no ovaries to respond to FSH and so there is no negative feedback.
155
What are two medications used to induce labor?
Cervidil (Prostoglandin gel applied to the cervix) which encourages cervical rippening and oxytocin which encourages uterine contractions.
156
Does niacin increase or decrease HDL?
Increase
157
How do you administer the Rinne hearing test?
Place the tuning fork on the mastoid and then move it next to the ear.
158
A 3 year old boy presents with hematuria and a painless palpable abdominal mass. What is the most likely diagnosis?
Wilms tumor
159
A positive Apley indicates what diagnosis?
Meniscal tear
160
Name two things that would constitute a positive stress test.
A drop in blood pressure, a new arrhythmia, an increase in angina symptoms, ST depressions
161
Which anemia should you think of if you see the term Howell-Jolly bodies?
Sickle cell due to the functional asplenia, but it may also show up in folic acid deficiency.
162
A noncaseating granuloma should make you think of what diagnosis?
Sarcoidosis
163
A patient presents saying that he doesn't seem to need his glasses anymore after 30 yrs. What is the most likely diagnosis?
Cataract
164
What are four steps in treating diphtheria?
Antitoxin, penicillin, remove membrane, report the case to the CDC
165
Crohn's is found where in the GI tract?
It can be from esophagus to anus
166
The secretory phase of the menstrual cycle (day 14-28) is dominated by what hormone?
Progesterone
167
The term satellite lesion should make you think of what diagnosis?
Candida diaper rash
168
An x-ray of the skull reveals coalescence of mastoid air cells. What is the most likely diagnosis?
Mastoiditis
169
A musical vibratory murmur best heard at the apex in a child should make you think of what diagnosis?
Still's murmur
170
What is the most common cause of secondary hypertension?
Chronic kidney disease
171
Tenderness at the costovertebral angle should make you think of what diagnosis?
Pyelonephritis
172
A patient's wife complains that he is hypervigilant and has a hyperstartle response. What is the most likely diagnosis?
Posttraumatic stress disorder
173
What is the drug of choice to treat Lyme disease in kids or pregnant women?
Amoxicillin
174
What does HBsAg (hep B surface antigen) indicate?
Active Hep B infection
175
Give two contraindications for using an ACEI.
Bilateral renal artery stenosis, history of angioedema, pregnancy
176
Pain with movement of the pinna or tragus should make you think of what diagnosis?
Otitis externa
177
Are hallucinations normal during a normal grieving period?
Yes, as long as they are not persistent or intrusive.
178
What is a first line treatment for rheumatoid arthritis?
Methotrexate
179
List three class 1a antiarrhythmics.
Disopyramide, quinidine, procainamide
180
Does adenocarcinoma arise from the proximal or distal esophagus?
Distal
181
List four indications for the flu vaccine.
Child 6-59 months, pregnant female, healthcare worker, age greater than 50
182
When you step up the diagnosis from intermittent asthma to mild persistent asthma what medication should you add?
An inhaled steroid like fluticasone
183
What medication is used as prophylaxis for meningococcal meningits?
Rifampin
184
What test do you do for Sjogren's syndrome?
Schirmer test Varicocele
185
Feeling a bag of worms in the scrotum should make you think of what diagnosis?
Varicocele
186
What drug do you use to treat pinworm?
You treat everyone in the house with albendazole. Two weeks later you treat them again.
187
What is the most specific imaging modality for diagnosing kidney stones?
CT
188
Diarrhea with blood and mucus should make you think of what diagnosis?
Shigella
189
What is the only cyanotic congenital heart disease on the NCCPA blueprint?
Tetralogy of Fallot
190
Will the RBC's be large, small or normal size in a B12 deficient anemia?
Macrocytes
191
A patient describes his vision loss as curtain coming down and then going back up. What might the diagnosis be?
Amaurosis fugax
192
What is the treatment for epiglottitis?
2nd or 3rd generation cephalosporins (ceftriaxone), macrolides may also be used (clindamycin)
