Final Step Notecards - 3rd ~500 Flashcards
Describe the result of a Weber hearing test in a patient with conductive hearing loss.
Patient will report the sound louder in the affected ear.
Exophthalmos should make you think of what diagnosis?
Hyperthyroidism
Which herpesvirus causes Epstein–Barr?
Herpes 4
A sponge-like prostate on digital rectal exam should make you think of what diagnosis?
Prostatitis, but be careful. You can cause sepsis with a digital rectal exam.
If you come across a question where the patient has erythema nodosum and an enlarged parotid gland what is the most likely diagnosis?
Sarcoidosis
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?
Autism
Are most pulmonary valve problems congenital or acquired?
95% are congenital
List three possible causes of prerenal renal failure.
CHF, severe dehydration, hemorrhage
How do you test for color blindness?
Polyarteritis nodosa
A patient with a history of hepatitis B presents complaning of bilateral knee pain, fever and weight loss. What is the most likely diagnosis?
Ishihara plates
A patient presents complaining of a metallic taste in her mouth and dark brown urine. What antibiotic might she be on?
Metronidazole (Fagyl)
What drug is used for the treatment or prophylaxis of malaria?
Chloroquine
What is the first line medical treatment for a patient who presents with palpitations and nervousness secondary to hyperthyroidism?
Beta Blockers
Are ulcers from venous insufficiency painful or painless?
Painless
What occupations are associated with berylliosis?
Aerospace and nuclear plant workers
Postmenopausal bleeding is immediately believed to be what diagnosis?
Endometrial cancer until proven otherwise.
What are the most common primary cancer sites that metastasize to the brain?
Lung, breast and kidney
List the three most commonly used medical treatments for COPD?
Oxygen, ipratropium and albuterol
What area of the prostate is affected by BPH?
The transitional zone
What is the #1 cause of septic arthritis in sexully active young adults?
Neisseria gonorrhoeae
An EEG showing interictal spikes should make you think of what diagnosis?
Complex partial seizure
Name two tests you might use to rule out Cushing’s syndrome.
24 hour free cortisol urine test and dexamethasone suppression test
Elevated circulating acetylcholine receptor antibodies should make you think of what diagnosis?
Myasthenia gravis
Are the lungs noisy or quiet in COPD?
Quiet
How do you define 1st degree AV block?
The PR interval is longer than 0.2 seconds or one block on EKG.
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
A patient presents with a staccato cough but no fever. What is the most likely diagnosis?
Chlamydia pneumoniae
What is the gold standard for the diagnosis of cystic fibrosis?
Sweat chloride test
Unilateral purulent rhinitis should make you think of what diagnosis?
Foreign body
Define the second stage of labor.
Fully dilated to delivery
Most gallstones are made of what substance?
Cholesterol
What is the most common congenital heart defect?
Ventricular septal defect
What is Chvostek’s sign?
Tap on facial nerve and get a twitch with low Ca.
List four complications of untreated strep throat.
Scarlet fever, glomerulonephritis, rheumatic fever and local abscess
A patient complains of severe pleuritic chest pain that is relieved with sitting and leaning forward. What is the most likely diagnosis?
Pericarditis
An India ink stain showing cysts should make you think of what diagnosis?
Cryptococcosis
What is the first line treatment for a varicocele?
Watchful waiting unless there is a question of fertility.
According to the CDC, what is the range for a normal BMI?
18.5-24.9
What is the first line medical treatment for torsades de pointes?
Magnesium sulfate
What lab test is the gold standard for chlamydia?
Nucleic acid amplification test
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
If a question presents a pregnant woman with anemia what is the most likely diagnosis?
Iron deficiency
List three things that should be in your differential if you hear wheezes on a lung exam?
Asthma, COPD, Bronchitis
A patient without a functioning spleen is more susceptible to what type of organisms?
Encapsulated organisms most commonly Strep pneumoniae and H. Flu.
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
An elevated serum amylase and lipase should make you think of what diagnosis?
Pancreatitis
What carpal bone has a high rate of nonunion and occult fracture?
Scaphoid
The follicular phase of menstruation is dominated by what hormone?
Estrogen
Bullae and blebs on CXR should make you think of what diagnosis?
Emphysema
Define complete abortion.
Vaginal bleeding, cervix open, products of conception have passed
Which is the most commonly affected sinus in acute sinusitis?
Maxillary
What is the most common cause of peptic ulcer disease?
H. pylori
What is the term for being afraid of being out in a terrible situation with no help available?
Agoraphobia
Define pulsus alternans.
EKG waveform changes from beat to beat
A bamboo spine indicates what diagnosis?
Ankylosing spondylitis
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.
Epigastric abdominal pain which radiates to the back should make you think of what diagnosis?
Pancreatitis
What is the most likely quadrant for a retinal detachment?
Superior temporal
By what age should a child be able to roll over?
4 months
What is the first line medical treatment for stage 1 hypertension?
Superior temporal
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
Painless bright red blood per rectum should make you think of what diagnosis?
Hemorrhoids
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
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.
Which viral exanthem often has conjunctivitis as one of it’s symptoms?
Measles/Rubeola
List three catastrophic complications of a myocardial infarction.
Papillary muscle rupture, myocardial wall rupture and left ventricular aneurysm
What is the most common cause of pneumonia in children less than 1 year old?
Respiratory syncytial virus (RSV)
A patient on sulfasalazine for an inflammatory bowel disease should be supplemented with what vitamin?
Folate
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
When treating psychiatric patients are benzodiazepines used more commonly for acute or chronic treatment?
Acute
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
List two risk factors for cervical cancer.
Multiple sexual partners, smoking
Small grouped vesicles on the vermillion border should make you think of what diagnosis?
Herpes
What is the most important complication of giant cell arteritis?
Blindness
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.
What heparin complication is relevant to endocrinology?
Adrenal infarct leading to a Cushing’s syndrome
What is the term for being farsighted? What type of lens do you use to correct it?
Hyperopia, convex
At what age should a child begin to say momma and dadda?
12 months
A white oral lesion which cannot be scraped off should make you think of what diagnosis?
Oral leukoplakia
How do you treat pneumocystis jiroveci pneumonia (PCJ) formerly known as pneumocystis pneumonia (PCP)?
Bactrim
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
Projectile vomiting should make you think of what diagnosis?
Pyloric stenosis
Pretibial myxedema should make you think of what diagnosis?
Graves Disease
How often should patients with pernicious anemia have a screening endoscopy performed?
Every 5 years looking for signs of gastric carcinoma.
What is first line treatment for rosacea?
Metronidazole, tetracycline is probably a close second.
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
What is the gold standard for the diagnosis of cystic fibrosis?
Sweat chloride test
What is the most common cause of subarachnoid hemorrhage aside from trauma?
Ruptured cerebral aneurysm
Left lower quadrant pain and tenderness should make you think of what diagnosis?
Diverticulitis
A child presents with paroxysmal abdominal pain, nausea, vomiting and diarrhea. What is the most likely diagnosis?
Intussusception
List three congential heart diseases.
Atrial septal defect (ASD), ventricular septal defect (VSD), coarctation of the aorta, patent ductus arteriosus (PDA), tetralogy of Fallot
What are the two important peices of patient education for anyone diagnosed with mononucleosis?
No contact sports (splenic rupture) and no kissing (highly contagious)
What type of organism causes botulism?
A Gram + rod, Clostridium botulinum
What is the defining symptom of Alzheimer’s?
Progressive memory impairment
A patient presents to the ER with saddle anesthesia and loss of bowel and bladder function. What is the most likely diagnosis?
Cauda equina
What is the time frame for the first symptoms of withdrawal from alcohol?
Tremor in 8-18 hrs
Define the first stage of labor.
Onset of contractions to full dilation of the cervix.
What is another term for podagra?
Gout
A continuous murmur most likely involves what area of the heart?
It is most likely a septal defect.
How do hookworm larvae enter the body?
They penetrate the skin usually through the soles of the feet.
What class of cardiac medications should be avoided in patients with asthma?
Beta blockers (Blocks receptors for bronchodilators)
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
What is the minimum amount of time needed for a tick to transfer Lyme disease to a human?
24 hours
What age range is the HPV vaccination recommended for?
9 to 26 years old
What is the most common place for an aortic aneurysm?
In the abdomen and below the renal arteries
Severe abdominal pain 30 minutes after a meal should make you think of what diagnosis?
Intestinal ischemia
What is the most common site of an ectopic pregnancy?
Within a fallopian tube
A patient is having seizures along with a mouse- like odor from the urine. What is the most likely diagnosis?
Phenylketonuria
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.
You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?
Wolff-Parkinson-White syndrome
What is the condition where the urethral meatus is not at the tip of the penis?
Hypospadias and in far fewer cases epispadias
Should diverticulitis always be admitted?
No, mild cases can be treated as outpatients with rest and clear fluids.
A patient has pneumonia with rust colored sputum. What is the most likely diagnosis?
Strep pneumonia
What are two things that an anal fissure off midline might suggest?
Crohn’s, syphilis, HIV, neoplasm
What symptom is associated with a classic migraine?
Having an aura
What are the three inferior leads?
II, III and aVF
List the components of Virchow’s triad.
Stasis, vascular injury, hypercoagulability
What fracture is the #1 cause of compartment syndrome?
Tibial shaft fracture
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
What two lung cancers are typically found peripherally on CXR?
Adenocarcinoma and Large cell
You feel a pulse that seems to be vibrating. What term do you use to describe it?
Thrill
What is the single most important thing to be concerned about with a patient in status epilepticus?
Airway, followed by management of hyperthermia
At what age should vaccinations for pneumococcal pneumonia begin?
65 years old
Owl eye inclusion bodies should make you think of what diagnosis?
Cytomegalovirus (CMV)
What is the key indicator for the prognosis of melanoma?
Thickness of the lesion
Rheumatic fever most commonly affects which valve?
The mitral valve
Rhonci or wheezes that clear after coughing suggest what diagnosis?
Bronchitis or atelectasis
Define incomplete abortion.
Vaginal bleeding, cervix is open, products of conception partially passed
Gummas or granulomatous nodules should make you think of what diagnosis?
Tertiary syphilis
Coin-shaped plaques should make you think of what diagnosis?
Nummular Eczema
When performing a decompression for a tension pneumothorax where do you put the needle?
2nd intercostal space at the midclavicular line
What is the treatment for melanoma?
Wide local excision
A patient with primary amenorrhea and a low FSH should make you think of what diagnosis?
Hypothalamic pituitary insufficiency
At what age should a child be able to use a spoon and stack 3-4 blocks?
18 months
Rice water stool should make you think of what diagnosis?
Cholera
Give two risk factors for glaucoma.
African American descent and diabetes
A patient having recently undergone cataract surgery presents complaining of vision loss in the operative eye. What is the most likely diagnosis?
Retinal detachment
What is the drug of choice to treat C. difficile?
Metronidazole (Flagyl)
Calf pain should always make you think of what diagnosis?
DVT
What is the first line antibiotic for otitis media?
Amoxicillin
A fundal exam shows an opalescent retina and boxcarring of arterioles. What is the most likely diagnosis?
Central retinal artery occlusion
Both testicles should be descended by what age?
3 months
Name three SSRI’s
Fluoxetine, paroxetine, sertraline, citalopram, escitalopram, dapoxetine, zimelidine, mesembrine, seproxetine
What four chromosomes have been linked to dementia?
1,14,19,21
What is the drug of choice for the treatment of syphilis?
Pencillin
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
A patient complains of regurgitating undigested food several hours after a meal. What is the most likely diagnosis?
Zenker’s diverticulum
A patient presents to the ER with tearing chest pain radiating to his back. What is the most likely diagnosis?
Aortic dissection
What class of medications does pioglitazone (Actos) fall into?
Thiazolidinediones also known as glitazones
“What should a primary care provider do for a presumed retinal detachment?”
Refer & position patient with head down
What medication might you switch to if a patient develops an intolerable cough on an ACEI?
Angiotensin receptor blocker (ARBs)
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%
How do you treat polymyalgia rheumatica?
Low dose prednisone
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.
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.
Does niacin increase or decrease HDL?
Increase
How do you administer the Rinne hearing test?
Place the tuning fork on the mastoid and then move it next to the ear.
A 3 year old boy presents with hematuria and a painless palpable abdominal mass. What is the most likely diagnosis?
Wilms tumor
A positive Apley indicates what diagnosis?
Meniscal tear
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
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.
A noncaseating granuloma should make you think of what diagnosis?
Sarcoidosis
A patient presents saying that he doesn’t seem to need his glasses anymore after 30 yrs. What is the most likely diagnosis?
Cataract
What are four steps in treating diphtheria?
Antitoxin, penicillin, remove membrane, report the case to the CDC
Crohn’s is found where in the GI tract?
It can be from esophagus to anus
The secretory phase of the menstrual cycle (day 14-28) is dominated by what hormone?
Progesterone
The term satellite lesion should make you think of what diagnosis?
Candida diaper rash
An x-ray of the skull reveals coalescence of mastoid air cells. What is the most likely diagnosis?
Mastoiditis
A musical vibratory murmur best heard at the apex in a child should make you think of what diagnosis?
Still’s murmur
What is the most common cause of secondary hypertension?
Chronic kidney disease
Tenderness at the costovertebral angle should make you think of what diagnosis?
Pyelonephritis
A patient’s wife complains that he is hypervigilant and has a hyperstartle response. What is the most likely diagnosis?
Posttraumatic stress disorder
What is the drug of choice to treat Lyme disease in kids or pregnant women?
Amoxicillin
What does HBsAg (hep B surface antigen) indicate?
Active Hep B infection
Give two contraindications for using an ACEI.
Bilateral renal artery stenosis, history of angioedema, pregnancy
Pain with movement of the pinna or tragus should make you think of what diagnosis?
Otitis externa
Are hallucinations normal during a normal grieving period?
Yes, as long as they are not persistent or intrusive.
What is a first line treatment for rheumatoid arthritis?
Methotrexate
List three class 1a antiarrhythmics.
Disopyramide, quinidine, procainamide
Does adenocarcinoma arise from the proximal or distal esophagus?
Distal
List four indications for the flu vaccine.
Child 6-59 months, pregnant female, healthcare worker, age greater than 50
When you step up the diagnosis from intermittent asthma to mild persistent asthma what medication should you add?
An inhaled steroid like fluticasone
What medication is used as prophylaxis for meningococcal meningits?
Rifampin
What test do you do for Sjogren’s syndrome?
Schirmer test Varicocele
Feeling a bag of worms in the scrotum should make you think of what diagnosis?
Varicocele
What drug do you use to treat pinworm?
You treat everyone in the house with albendazole. Two weeks later you treat them again.
What is the most specific imaging modality for diagnosing kidney stones?
CT
Diarrhea with blood and mucus should make you think of what diagnosis?
Shigella
What is the only cyanotic congenital heart disease on the NCCPA blueprint?
Tetralogy of Fallot
Will the RBC’s be large, small or normal size in a B12 deficient anemia?
Macrocytes
A patient describes his vision loss as curtain coming down and then going back up. What might the diagnosis be?
Amaurosis fugax
What is the treatment for epiglottitis?
2nd or 3rd generation cephalosporins (ceftriaxone), macrolides may also be used (clindamycin)
