Practice questions Flashcards
The clinician notices clear fluid draining from the patients nose and periorbital ecchymosis after a blow to the head that occurred 2 days ago. What type of injury does the clinician expect?
A. Epidural Hematoma
B. Subdural Hematoma
C. Basilar Skull Fracture
D. Cerebral Contusion
C. Basilar Skull Fracture
What kind of fractures involve one of the five bones… cribform plate of the ethmoid bone, the orbital plate of the frontal bone, the petrous and squamous portion of the temporal bone, and the sphenoid and occipital bones?
Basilar Skull Fracture
Clinical signs of what may include retroauricular or mastoid ecchymosis (Battle’s sign), periorbital ecchymosis (racoon eyes), cerebral spinal fluid (CSF) leakage from nose (rhinorrhea) and ears (Otorrhea), and hemotympanum (blood behind the tympanic membrane).
Basilar skull fracture
CSF leaks manifested as otorrhea or rhinorrhea are specific characteristic of what?
Basilar skull fracture
Difficulty reading things that are far away. Things look blurry until they are able to get close enough to read clearly.
Myopia (nearsightedness)
Difficulty with near vision is called?
Hyperopia (farsightedness)
Occurs when the lens loses its normal accommodating power and can no longer focus on objects at arm’s length or closer.
Presbyopia (aging sight)
Abnormal early visual development leading to reduced visual acuity in the affected eye.
Amblyopia (lazy eye)
A patient presents with painful red eye, decreased vision, halos around lights, and a headache. Fundoscopic examination reveals cupping of the optic disc. Which of the following diagnostic tests is considered the gold-standard method for diagnosis of this condition?
A. Fluorescein staining
B. Gonioscopy
C. CT of the orbits
D. Slit lamp exam
B Gonioscopy
The gold-standard method to diagnose angle-closure glaucoma?
Gonioscopy
What helps assess for corneal abrasion?
Fluorescein staining
A _____ is preferred with patients with serious traumatic eye injuries.
CT
A ___ ____ exam is the gold standard when assessing the anterior segment of the eye or to facilitate foreign body removal? It can also diagnose conditions such as corneal epithelial defect, keratoconjunctivitis, hyphema, hypopyon, lens dislocation, herpetic infections, and iritis.
Slit Lamp
Which of the following is considered a cause of peripheral vertigo?
A. cerebellar infarction
B. Meniere’s disease
C. Benign paroxysmal positional vertigo
D. Vestibular neuritis
D. Vestibular neuritis
Peripheral vertigo is caused by disorders of the vestibular apparatus of the inner ear or by the inflammation of the ___ ___.
Vestibular nerve (CN VIII)
A patient presents with eye redness and irritation. Visual assessment reveals a triangular (wedge-shaped) thickening of conjunctival tissue that extends onto the corneal surface. This finding is commonly associated with which of the following?
A. Eye trauma
B. Aging-related change
C. Chronic sun exposure
D. Smoking
C. Chronic sun exposure- (specifically associated with ultraviolet light).
Triangular (wedge-shaped) thickening of conjunctival tissue that extends onto the corneal surface?
Pterygium
A patient presents with episodes of sneezing, rhinorrhoea, nasal obstruction, and postnasal drip. The patient appears fatigued with undereye circles noted. Physical assessment is significant for pale boggy nasal turbinates with cobbelstoning along the posterior pharynx. These findings suggest?
A. Blepharitis
B. Rhinitis medicamentosa
C. Sjogren’s syndrome
D. Allergic rhinitis
D. Allergic rhinitis
A chronic autoimmune disorder characterized by decreased function of the lacrimal and salivary glands.
Sjogren’s syndrome
Nasal congestion and discharge as a result ofprolonged (>3 days) use of topical nasal decongestant sprays which cause rebound effect resulting in severe chronic nasal congestion.
Rhinitis medicamentosa
Chronic condition cause by inflammation fo the eyelids (hair follicles, meibomain glands) causing itching and/or irritation?
Blepharitis
A patient presents with a sensation of aural fullness and decreased hearing. The patient denies significant pain but reports a recent viral infection. Otoscopic examination reveals and intact tympanic membrane with clear yellow fluid behind the TM. Treatment for this condition includes which of the following?
A. Observation and supportive therapy with oral decongestants
B. Treatment with Amoxicillin-clavulanate
C. Topical antibiotic ear drops
D. Immediate referral for ear, nose, and throat evaluation
A. Observation and supportive therapy with oral decongestants.
-Most effusions resolve over 12 weeks.
Which of the following components of the ocular system is the area of highest visual acuity?
A. Fovea centralis
B. Fundus
C. Peripheral retina
D. Optic nerve D
A. Fovea centralis
On an eye exam, it is a dark, flat spot in the exact center of the posterior portion nof the retina.
Macula
In the center of the macula is the ____ ____which contains only cones and is the area of the highest visual acuity or resolution.
Fovea centralis
The ____ of the eye is the interior surface visible by the ophthalmoscopic exam.
Fundus
The ___ ___ is seen as a round sphere with sharp margins on the fundal exam.
Optic nerve
The ____ ____ is a sensory nerve that transmits the neural-visual impulses from the retina to the brain.
Optic nerve (cranial nerve II)
ABCDE screening for melanoma stands for:
A-asymmetry
B-border irregularity
C-color variety
D-diameter >6mm
E-Enlargement
Molluscum contagiosum is caused by the ___ virus?
Poxvirus
Molluscum contagiosum usually resolves in ___ to ___ ___?
6 to 12 months
Verruca vulgaris
common wart
Basal cell cancer
pearly edges, telangiectasis, papule, or central ulceration
An adult patient presents with blood under the nail of the great toe that involves approximately 50% of the nail area. The patient reports dropping a hammer on the toe about 5 hours ago. Which of the following is the recommended next step?
A. Biopsy to r/o melanoma
B. None; no action needed
C. Trephination
D. Nail removal
C. Trephination
Procedure in which a small hole is drilled on top of the nail so that the blood can drain.
Trephination - 18 gauge needle is used to drain the blood to prevent permanent ischemic damage to the nail bed which can lead to permanent loss of the toenail.
Which is a precursor lesion for squamous cell skin cancer?
A. Atopic dermatitis
B. Actinic keratosis
C. Seborrheic keratosis
D. Nevi
Actinic keratosis
Looks like soft warts “pasted” on the skin, most are located on the back and can range in color from tan to black. It does not itch or hurt and is benign.
Seborrheic keratosis
____ ____ is caused by chronic sunlight exposure or chronic indoor tanning (UV rays).
Actinic keratosis (AK) - makes up about 5% to 10% will turn into skin cancer but it can become invasive.
Molluscum contagiosum is caused by:
A. Herpesvirus
B. Poxvirus
C. Staphylococcus aureus
D. Haemophilus influenzae
B. Poxvirus
Staphylococcus aureus (is gram positive or negative)?
gram positive
An older adult patietn with a past medical history of a venous leg ulcer presents with skin erythema, edema, and warmth on their left lower extremity. Purulent drainage is noted. The patient reports recent antibiotic use for CAP. The patient’s vital signs are stable, and there is no concern for systemic illness. Which of the following antibiotic regimes is appropriate for this patient?
A. Trimethoprim-sulfamethoxazole
B. Dicloxacillin
C. Doxycycline
D. Cephalexin
A. Trimethoprim-sulfamethoxazole
This patient has an indication for Methicillin-resistant Staphylococcus aureus (MRSA) coverage d/t their recent antibiotic use.
Patients without severe sepsis with an indication for MRSA coverage should be treated with Bactrim OR amoxicillin plus doxycycline.
Patients without an indication of MRSA coverage can be treated with dicloxacillin, cephalexin, or cefadroxil.
Patient’s presenting with cellulitis, without s/s of sepsis can be managed?
Outpatient with antibiotics
Which of the following is a super-high potency (group 1) topical steroid?
A. Halcinonide cream
B. Mometasone furoate
C. Fluocinolone acetonide
D. Halobetasol propionate
D. Halobetasol propionate (class 1)
Halcinonide is high potency (class 2)
Mometasone furoate is medium potency (class 4)
Fluocinolone acetonide is low potency (class 6)
An older patient who has a history of DM presents with a concern for an outgrowth of skin on their neck. The patient complains that it commonly gets caught on jewelry. This patient is likely presenting with which of the following?
A. Cherry Angioma
B. Nevi
C. Acrochordon
D. LIpoma
C. Acrochordon
Acrochordon
Skin tag (common in adults, especially those with DM).
Commonly occur in areas of friction (neck and axilla).
A patient with a history of severe sunburn presents with asymmetric depigmented macules and patches that are various shades of white. The lesions lack clinical signs of inflammation and are generalized around the face and hands. This presentation suggests which of the following?
A. Vitiligo
B. Psoriasis
C. Seborrheic keratoses
D. Urticaria
A. Viiligo
Erythematous and raised skin lesion with discrete borders.
Urticaria
Which of the following is a palpable lesion measuring <1cm in diameter?
A. Macule
B. Plaque
C. Papule
D. Vesicle
C. Papule
Palpable, discrete lesions measuring <1cm in diameter.
Papules
Nonpalpable lesions measuring <1cm that vary in pigmentation from the surrounding skin.
Macules
Elevated lesions that are >1cm in diameter.
Plaques
Small <1cm in diameter circumscribed skin papules that are filled with clear serous or hemorrhagic fluid.
Vesicles
A patient presents with numerous lesions that started as papules and have progressed to vesicles surrounded by erythema. There are pustules that have broken and formed thick adherent crusts with a golden appearance. The lesions are numerous and generalized on the face. Treatment for these lesions includes which of the following?
A. Topical mupirocin
B. Cephalexin
C. Topical retapamulin
D. Levofloxacin
B. Cephalexin
Topical therapies are (mupirocin, retapamulin) are first line treatments for impetigo if there are limited number of lesions.
Oral therapy is indicated for patients with numerous impetigo lesions. Cephalexin and dicloxacillin are recommended as first line therapy options. Fluoroquinolones (levofloxacin) should be used to treat impetigo (MRSA) resistance .
A patient with a history of a “herald” patch: single oval, sharply delimited, pink-colored lesion on the back that is about 3 cm in diameter. The lesion progressed and central clearing was noted. Christmas tree skin rash pattern is commonly seen in what skin condition?
A. Scabies
B. Chickenpox
C. Cellulitis
D. Pityriasis rosea
Pityriasis rosea
Herpetic whitlow is a viral infection of the hand caused by which of the following?
A. Herpes simplex virus
B. Neisseria Meningitidis
C. Variola virus
D. Varicella zoster virus
A. Herpes simplex virus
An infection caused by Neisseria meningitidis?
Meningococcemia
The causative agent of smallpox?
Variola virus
Primary infection with the varicella zoster virus?
Chickenpox
A patient presents with a rash after camping in the woods. The patient reports that they found a tick on their leg and that the rash started about a week after the bite. The rash is near the popliteal fossa and is warm to the touch and pruritic. Central clearing is noted, suggesting a target or bull’s eye appearance. Treatment includes which of the following?
A. Cephalexin
B. Vancomycin
C. Doxycycline
D. Levofloxacin
C. Doxycycline
The preferred regimen includes (doxycycline , amoxicillin, or cefuroxime).
macules, papules, plaques, nodules, telangiectasis, purpura, pustules, vesicles, wheals, scale, atrophy, and hyperpigmentation.
Primary lesions
Which of the following is a secondary lesion?
A. Plaque
B. Vesicle
C. Pustule
D. Lichenification
D. Lichenification
A patient presents with sharply defined, erythematous plaques with overlying course scales near the extensor elbows and knees. The patient denies joint pain but reports pruritis near the plaques. After removal of the scale, visualization of the pinpoint bleeding is noted. This finding suggests which of the following?
A. Auspitz sign
B. Koebner phenomenon
C. Development of psoriatic arthritis
D. Progression of disease
A. Auspitz sign
The development of skin disease in areas of skin trauma (also seen in lichen planus and vitiligo).
Koebner phenomenon
Patient with psoriasis that presents with joint pain and stiffness.
Psoriatic arthritis (common in patients with psoriasis)
Criteria for burn center referral include partial thickness burns greater than _____ of TBSA.
10%
Partial thickness burns >10%, burns involving the face, hands, feet, genitalia, perineum, or major joints;
Full thickness burns, electrical and chemical burns;
Inhalation injury, burn injury in patients with pre-existing comorbidities, burns and concomitant trauma, children in hospitals without qualified personnel or equipment, burn injury in patients who require special social or rehabilitative interventions.
Require referral to a burn center
Which of the following terms applies to dry skin?
A. Purpura
B. Annular
C. Morbilliform
D. Xerosis
D. Xerosis
Red purple lesions that do not blanch under pressure
Purpura
Figurate lesions with a ring-like morphology.
Annular lesions
Rash that resembles measles, with numerous erythematous macules and papules?
Morbilliform
An adult patient presents after a cooking accident with hot oil. The patient presents with burns to their bilateral anterior arms and upper anterior chest. Using the rule of nines what is the percentage of burned body surface area?
A. 18%
B. 9%
C. 27%
D. 21%
A. 18%
Using the rule of 9’s each anterior arm is 4.5%, and the upper anterior chest is 9%.
A burn that extends deeper into the dermis and damages hair follicles and glandular tissue is classified as:
A. Superficial
B. Superficial partial thickness
C. Deep partial thickness
D. Full thickness
C. Deep partial thickness
Burns that extend into the deeper dermis and damage hair follicles and glandular tissue.
Deep partial-thickness burns
Burns that involve only the epidermal layer of skin.
Superficial burns
Burns that form blisters between the epidermis and dermis.
Superficial partial-thickness burns
Burns extended through and destroy all layers of the dermis and often extend into the underlying subcutaneous tissue.
Full-thickness burns
A child presents with multiple scaly patches with hair loss. Multiple black dots are present at follicular orifices within areas of alopecia. First-line treatment for this condition includes which of the following?
A. Fluconazole
B Ketoconazole
C. Nystatin
D. Griseofulvin
D. Griseofulvin
Tinea manuum is a dermophyte infection that often occurs in the association with:
A. Tinea peds
B. Tinea barbae
C. Tinea capitis
D. Tinea cruris
A. Tinea pedis
The combination of several inflamed follicles into a single inflammatory mass with purulent drainage is:
A. Carbuncle
B. Folliculitis
C. Furuncle
D. Skin abscess
A. Carbuncle
A superficial bacterial infection of the hair follicles with purulent fluid in the epidermis.
Folliculitis
Well-circumscribed, painful, suppurative inflammatory nodule that involves hair follicles and usually occurs from preexisting folliculitis.
Furuncle
A collection of pus within the dermis and underlying skin tissues.
Skin Abscess
Which of the following is an absolute contraindication to wound closure?
A. Deep stab wounds
B. Wounds caused by clean, sharp objects
C. Wounds older than 24 hours that were insufficiently cleansed
D. Wounds with presence of cellulitis or abscess.
D. Wounds with presence of cellulitis or abscess.
Where are the apocrine sweat glands primarily located?
A. Palms of the hands
B. Soles of the feet
C. Forehead
D. Axillary and anogenital areas
D. Axillary and anogenital areas.
Apocrine sweat glands are located mainly in the axilla and groin. Dormant until puberty, they release water, salt, fatty acids, and proteins into hair follicles.
The major sweat glands of the body, widely distributed but greatest in the hands, soles of the feet, and forehead. They help with heat dissipation and thermoregulation.
Eccrine glands
A patient presents after recent camping trip with complaints of fever, headache, malaise, and myalgias. The patient reports a blanching erythematous rash with macules 1to 4mm in size and petechiae. The rash began on the ankles and wrists and is spreading toward the trunk. Based on this presentation, the preferred agent for treatment is which of the following?
A. Chloramphenicol
B. Doxycycline
C. Amoxicillin
D. Clindamycin
B. Doxycycline
The patient is presenting with classic features of RMSF. A petechial or maculopapular rash develops between the third and fifth day of illness in most patients. Doxycycline is the preferred treatment.
Chloramphenicol is the only known alternative agent but is less effective than Doxycycline.
A patient with cutaneous plaques complains of pruritis. The plaques are limited to the bilateral elbows with characteristic thick, silvery scale. Which of the following options should be recommended first?
A. Topical corticosteroids
B. Methotrexate
C. Phototherapy
D. Adalimumab
A. Topical corticosteroids
Patient is presenting with chronic plaque psoriasis.
For patients with moderate to severe plaque psoriasis, what is recommended.
Phototherapy or systemic therapies such as retinoids, methotrexate, cyclosporine, and biologic immune-modifying agents (adalimumab) are recommended.
Which form of psoriasis is often preceded by streptococcal infection?
A. Pustular
B. Chronic plaque
C. Guttate
D. Erythrodermic
C. Guttate
Guttate psoriasis is often preceded by streptococcal infections between 56% to 97% of patients. Other forms are not preceded by streptococcal infection.
An immunocompetent patient who recently finished a course of antibiotics presents with a cottony feeling in the mouth, loss of taste, and pain during swallowing. Upon physical exam, white plaques are noted on the buccal mucosa and the oropharynx. This presentation suggests which of the following?
A. Meningococcemia
B. Oropharyngeal candidiasis
C. Acute pharyngitis
D. Impetigo
B. Oropharyngeal candidiasis
Pustules that have broken and formed thick, adherent crusts with golden appearance.
Impetigo
Sore throat, petechial rash on the trunk and lower portions of the body, fever, nausea, headache, and myalgias.
Meningococcemia
Fever, tonsillar exudates, tender cervical lymphadenopathy, and rash.
Acute pharyngitis
A patient with a history of frequent nail biting presents with a rapid onset of painful erythema and swelling of the proximal and lateral nail folds. The patient denies any past medical history. Physical examination reveals a superficial abscess. Initial treatment includes which of the following?
A. Topical antibiotics
B. Warm water or antiseptic soaks
C. Oral antibiotic therapy with MRSA coverage
D. Incision and drainage
D. Incision and drainage
Risk factors include manicuring, nail biting, and picking at a hangnail. Paronychia with abscess is treated with incision and drainage.
Paronychia without abscess, treatment include?
topical antibiotics and warm water or antiseptic soaks multiple times per day.
Which of the following is considered a high intensity statin?
A. Atorvastatin 10mg
B. Pravastatin 20mg
C. Simvastatin 30mg
D. Rosuvastatin 20mg
D. Rosuvastatin 20mg
High-intensity statins are atorvastatin 40mg to 80mg and rosuvastatin 20mg to 40mg. Atorvastatin 10mg to 20mg is a moderate-intensity statin. Pravastatin 10 to 20mg is a low intensity statin. Simvastatin 20 to 40mg is a moderate intensity statin.
A patient presents with dyspnea and chest discomfort. Physical assessment is significant for jugular venous distention, peripheral edema, ascites, and hepatosplenomegaly. Based on this presentation, a definitive diagnosis can be made by which of the following modalities?
A. Cardiac catheterization
B. Cardiovascular MRI
C. Cardiac CT scan
D. Echocardiography
A. Cardiac catheterization
The patient is presenting with s/s of right sided heart failure (dyspnea, fatigue, chest discomfort, abdominal distension with a positive fluid wave, jugular venous distention, peripheral edema, ascites, hepatosplenomegaly, tricuspid murmur, s3 gallop.
What are triglyceride lowering drugs?
Niacin and fibrates
A patient with severe primary hypercholesterolemia presents for a routine checkup. The patient has been compliant with the prescribed high-intensity statin regimen; however, the low-density lipoprotein cholesterol is 120mg/dL. Which of the following therapies will be added next?
A. Fibrate agent
B. Ezetimibe
C. PCSK9 inhibitor
D. Niacin
B. Ezetimibe
If the LDL remains high adding Ezetimibe is a reasonable next step.
PCSK9 inhibitor can be considered if the LDL level on statin plus ezetimibe remains >/= 100 and the patient has multiple factors that increase risk of atherosclerotic cardiovascular disease.
Combination therapy of an angiotensin-converting enzyme inhibitor with an angiotensin receptor blocker (ARB) or direct renin inhibitor should be avoided due to increased risk for:
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
C. Hyperkalemia
Do not use ACE inhibitors in combination with ARBs or direct renin inhibitors d/t increased risk of hyperkalemia especially in patients with chronic kidney disease or those on potassium supplements or potassium sparing drugs. there is also risk for acute renal failure in patient with severe bilateral artery stenosis.
A patient with chronic kidney disease stage 3 has been recently diagnosed with hypertension. First-line pharmacologic treatment includes which of the following agents?
A. Metoprolol
B. Lisinopril
C. Nifedipine
D. Terazosin
B. Lisinopril
First line therapy for adults with hypertension and CKD stage 3 or higher or stage 1 with albuminuria or elevated albumin-to-creatinine ratio is an ACE inhibitor or an ARB if an ACE is not tolerated.
Which micronutrient should an individual with primary hypertension increase in their diet?
A. Calcium
B. Chloride
C. Potassium
D. Sodium
C. Potassium
Individuals with primary htn should increase potassium aiming for 3500 to 5000 mg/d preferably from dietary sources.
Foods high in potassium (avocados, sweet potatoes (yams), coconut water, bananas, oranges, watermelon, cantaloupe, honeydew, apricots, grapefruit, dark leafy vegetables (spinach, broccoli), and edamame (boiled soybeans).
After antihypertensive therapy is initiated, a patient’s blood pressure should be rechecked after how many months?
A. 1
B. 2
C. 3
D. 4
A. 1 monthq
An older adult male patient who is a smoker is newly diagnosed with primary htn. He has a history of emphysema and second-degree AV block. HIs blood pressure from the previous visit is 145/80 mmHg. During the current visit, his blood pressure is 155/80 mmHg. What is the next step?
A. Start the patient on atenolol (Tenormin) 50mg once a day and reassess in 3 months.
B. Start patient on felodipine (Cabren) 2.5mg once a day and reassess in 2 months
C. Start patient on chlorthalidone (thalitone) 12.5mg daily and reassess in 1 month.
D. Nothing; no action or treatment is needed at this time.
C. Start the patient on chlorthalidone (thalitone) 12.5mg daily and reassess in 1 month
What blood pressure medication should be avoided in patients with emphysema?
Beta blockers such as atenolol (tenormin) cannot be used.
What blood pressure medication is contraindicated in patients with second degree AV block?
Calcium channel blockers such as felodipine (Cabren).
Which of the following is a risk enhancing factor for atherosclerotic cardiovascular disease?
A. Acute kidney injury
B. Low-density lipoprotein cholesterol greater than 140 mg/dL
C. Menopause
D. C-reactive protein (CRP) of 2.0 mg/L or greater
D. C-reactive protein (CRP) of 2.0 mg/L or greater
Risk enhancing ASCVD includes CRP of >/= 2.0 mg/L, CK disease (not acute injury), persistently elevated LDL-C levels of 160 or greater, history of preeclampsia or premature menopause, metabolic syndrome, family history of early ASCVD, Ankle brachial index less than or equal to 0.9 and high risk ethnicity.
