Smarty PANCE Insta Questions Flashcards
What is the MOST likely causative organism of septic arthritis?
Answer: Staph aureus
- S. aureus is approx. 50%
- Neisseria gonorrhea in sexually active young adults
- Pseudomonas in IV drug users
What electrolyte abnormalities is associated with bulimia nervosa?
Metabolic alkalosis
- self-induced vomiting leads to loss of hydrogen ions and chloride, resulting in higher bicarbonate concentration
What are the two most common etiologies of peptic ulcer disease?
H. pylori and NSAIDs
A 4-year-old is brought to the clinic by his parents for trouble sleeping. For the past few weeks, the patient has woken up multiple times in the night, screaming and crying. The parents have noticed that is his extremely diaphoretic during these episodes. The patient cannot remember any of these events. What is the most likely diagnosis?
Sleep terror disorder
- specifically when patients have nightmares and have severe distress during their nightmares, however they do not recall it at all
A 71 yo male with a history of chronic alcoholism, hypertension, hyperlipidemia, and a previous hip fracture presents to your clinic complaining of worsening right groin and buttock pain. You suspect possible avascular necrosis of the femur. Which of the following types of hip fractures did the patient most likely have in the past?
A. Greater trochanteric fracture
B. Femoral neck fracture
C. Intertrochanteric fracture
D. Subtrochanteric fracture
E. None of the above
Femoral neck fracture
- MC RF is trauma, but patients who have a femoral neck fracture specifically are at higher risk for AVN and non-union
A 62 yo female with a history of obesity and COPD presents to the clinic complaining of her urine “leaking.” She states it occurs when she laughs or coughs. What is the best initial treatment for this patient?
Weight loss and Kegel exercises
What is Nikolsky sign?
Dislodgment of the superficial epidermis by shearing force
What is the most common cause of acute epiglottitis?
Haemophilus influenzae
Which of the following is not considered diagnostic for diabetes mellitus?
A. A1c > 6.5%
B. Fasting plasma glucose > 126 mg/dL x2
C. Plasma glucose > 200 mg/dL after glucose tolerance test
D. Random glasma glucose > 200 mg/dL with hyperglycemic symptoms
E. All are diagnostic
E. All are diagnostic
What is the preferred initial treatment for acute otitis media in a 5 yo with no previous history of otitis media nor risk factors for resistance?
Amoxicillin
Which of the following is not a radiographic finding consistent with osteoarthritis?
A. Joint space narrowing
B. Osteophytes
C. Pencil-in-cup deformity
D. Subchondral cysts
E. Subcondral sclerosis
C. Pencil-in-cup deformity
A 20 yo male just got back to the US from a mission trip to South Asia. He is now having intense, watery, rice-like stools. What is the most likely diagnosis?
Cholera
What is the first-line treatment for papulopustular rosacea?
Topical metronidazole
What is the correct definition of precocious puberty in girls?
Secondary sexual maturation < 8
What disorder is characterized by a scaly, rough erythematous patch that appears on sun-exposed areas?
Actinic keratosis
A 35 yo female with a history of diabetes, hypertension, and COPD presents to the ER complaining of dysuria, suprapubic pain, malaise, and chills. She is febrile. On physical exam he patient has costovertebral angle tenderness. UA is positive for leukocyte esterase, nitrites, and bacteria. CT of abdomen/pelvis is pending. What is the most likely diagnosis?
Acute pyelonephritis
A 10 yo is brought in by his mother. She noticed him not sleeping well and itching is buttock at night. The tape test is positive. What is the best treatment option?
Albendazole
- Enterobiasis is the most common helminthic infection
Which is the biggest risk factor for suicide?
A. Depression
B. Access to gasoline
C. Access to a rope
D. Previous attempt
E. Family history
Previous attempt
What is the most common cause of syncope?
Vasovagal syncope
Rheumatic fever commonly affects which valve?
Mitral valve
What will be elevated first in bacterial meningitis?
CSF WBC with neutrophil predominance
Upon PE of a patient, you note a sacral pressure ulcer with full-thickness skin and tissue loss with exposed muscle and tendon in the ulcer. Which of the following stage is this pressure ulcer at? Stage 1-4
Stage 4
Which class of medications should be avoided in those with Prinzmetal angina?
Beta blockers as they can aggravate symptoms
A 20 yo female presents to the clinic complaining of intense sleepiness during the day and also a desire to fall asleep constantly. She has episodes where she feels paralyzed as she is falling asleep. PE is unremarkable. Which of the following is the best diagnostic test to confirm the most likely diagnosis?
A. CT head without contrast
B. Overnight polysomnography
C. Continuous elevtroencephalogram
D. MBI brain
E. Multiple sleep latency test
E. Multiple sleep latency test
What is the first-line treatment for wet age-related macular degeneration?
VEGF inhibitor injections
What is the most common cause of acute liver failure in the US?
Acetaminophen toxicity
What is considered first line in the long term treatment of panic disorder?
Sertraline (Zoloft)
A 15 yo female with no medical history presents to the ER with AMS. She is tachycardic. Labs revealed a glucose level of 900 mg/dL and elevated beta-hydroxybutyric acid. What acid-base issue would you expect to see?
High anion gap metabolic acidosis
- DKA presents with elevated BG, elevated beta-hydroxybutyric acid, and HAGMA
A 72 yo female with history of osteoporosis and hypothyroidism presents to the ER complaining of a week of fever, terrible diarrhea, and abdominal pain. She ends up in the ICU as she develops septic shock and end-organ failure. Upon talking to the patient, you learn that she lives with her son and his kids. Her son owns a turtle and dog. The patient has been recently helping clean up the turtle’s cage. Stool and blood cultures are obtained. Which culture will likely grow what?
Salmonella
What is the best diagnostic test for a suspected deep neck infection?
A. CT of neck with contrast
B. MRI of neck
C. Lateral radiograph
D. US of neck
E. CBC, ESR, CRP, ferritin
A. CT of neck with contrast
Which of the following is the most common cause of orchitis?
Mumps
Which of the following is one of the most common initial clinical symptoms in multiple sclerosis?
A. vertigo
B. extreme weakness
C. depression
D. arthralgia
E. optic neuritis
E. optic neuritis
What is considered first-line pharmacologic therapy for management of gastroparesis symptoms?
Metoclopramide
What is the significance of melena in gastrointestinal bleeding?
Indicates an upper gastrointestinal source
A 73 yo female presents with facial flushing, wheezing, and watery diarrhea for a few months. Her symptoms are worsened by certain foods. What is the best initial diagnostic study to order for the suspected diagnosis?
5-HIAA in urine
- carcinoid tumors secrete serotonin most commonly at the appendix; can develop into carcinoid syndrome 10% of the time
A 55 yo male presents to clinic complaining of SOB and trouble breathing. He states that this has been going on for a few months. He used to work as a construction worker when he was younger and was exposed to some “bad stuff” out there. A chest radiograph revealed pleural plaques. What is the most likely diagnosis?
Asbestosis
A 61 yo male presents to your clinic complaining of constant ringing in his ears. He denies dizziness, headaches, or any other issue. You start to go through all of the medications he is taking which include lisinopril, metoprolol, aspirin, metformin, levothyroxine, and atorvastatin, Which is most likely the cause?
Aspirin
What is the most common type of benign breast tumor?
Fibroadenoma
A 20 yo male presents with morning back pain and stiffness for the past few months. He says it improves with exercise. Schober test is positive. Lab studies reveal elevated ESR and CRP. What gene is likely to be positive in this patient?
HLA-B27
- Ankylosing spondylitis
A 25 yo female with an unremarkable history presents to your clinic complaining of dull, tight “band-like” headaches that have been happening almost every day for the past few months. Which is the most appropriate medication to prescribe her for prophylactic management?
A. Aspririn/paracetamol/caffeine
B. Naproxen
C. Verapamil
D. Amitriptyline
E. Sumatriptan
Amitriptyline
A “strawberry cervix” is seen in which condition?
Trichomoniasis
At what age is it considered safe to introduce honey to children?
at 12 months
Which of the following is not a RF for penile cancer?
A. HPV infection
B. HIV infection
C. Tobacco abuse
D. Untreated phimosis
E. Circumcision before adulthood
E. Circumcision before adulthood
On PE, you note a few scattered well-circumscribed, brown raised lesion with a “stuck-on” appearance. What is the most likely diagnosis?
Seborrheic keratosis
An 81 yo female presents to the ER with acute onset of low back pain. She complains of bowel dysfunction and loss of sensation over her inner thighs. PE reveals decreased lower extremity reflexes. Which is the best diagnostic test for the likely diagnosis?
MRI of the lumbosacral spine
- suspected dx: Cauda equina syndrome
Which carpal bone has the highest rate of nonunion and is most commonly associated with occult fractures?
Scaphoid
A patient in the hospital admitted for acute exacerbation of HF goes into ventricular fibrillation during your PE. What is the next best step?
Apply pads and defibrillate
How does cranial nerve II palsy present?
Loss of visual acuity and visual field defects
CN II = optic nerve
What is the most common cause of acute dacrocystitis?
Staphylococcus aureus
Where is disease of the pulmonary valve best heard?
Left upper sternal boarder, specifically the 2nd intercostal space
A positive osmotic fragility test is seen in which of the following?
A. Iron deficiency anemia
B. Sickle cell anemia
C. Hereditary spherocytosis
D. G6PD deficiency
E. Thalassemia
C. Hereditary spherocytosis
What is Hereditary spherocytosis?
A disorder characterized by the production of spherically shaped erythrocytes that are more prone to hemolysis.
What is the osmotic fragility test?
Measures the erythrocytes’ ability to withstand hypotonic solutions
- elevated in hereditary spherocytosis
Which of the following differentiates acute stress disorder (ASD) from PTSD?
A. Presence of flashbacks
B. Avoidance of reminders
C. Duration of symptoms
D. Experiencing distress
E. Hyperarousal symptoms
C. Duration of symptoms
- ASD = 3 days and up to 1 month
- PTSD = symptoms persist for more than 1 month
A 5 yo male presents to the clinic with his mom due to a “tender rash on his face.” On PE, you note scattered thin-roofed vesicles around his nose and mouth, as well as yellowish-orange colored crust around his nares. What is the most likely diagnosis?
Impetigo
Which of the following is the most common type of breech presentation?
A. Complete
B. Incomplete
C. Frank
D. Footling
E. None of the above
C. Frank
What is the most important risk factor for cerebral palsy?
Preterm birth
Which of the following is the predominant malaria species in the world?
A. Plasmodium vivax
B. Plasmodium malariae
C. Plasmodium ovale
D. Plasmodium knowlesi
E. Plasmodium falciparum
E. Plasmodium falciparum
Psoriasis is most commonly noted on what location?
Arms and extensor surfaces
Which of the following conditions would have a positive Kussmaul’s sign on PE?
A. Left ventricular failure
B. Pulmonary edema
C. Coarctation of the aorta
D. Constrictive pericarditis
E. Aortic stenosis
D. Constrictive pericarditis
What is Kussmaul’s sign?
It is characterized by an increase in jugular venous pressure (JVP) during inspiration
Pernicious anemia is due to a deficiency of what?
Intrinsic factor
- it is essential for absorption of vitamin B12 at the terminal ileum
Which is not a side effect of lithium?
A. Hyperparathyroidism
B. Hypothyroidism
C. Cognitive fog
D. Tremors
E. All are side effects
E. All are side effects
Which of the following physical findings suggest pernicious anemia?
A. Splenomegaly and hepatomegaly
B. Petechiae and ecchymosis
C. Loss of position and vibratory sensation
D. Cheilosis and koilonychia
C. Loss of position and vibratory sensation
A 59 yo male with a history of HTN, tobacco abuse, and osteoarthritis presents to the ER due to acute, severe left leg pain and numbness for 5 days. He is tachycardic upon arrival (HR 102 bpm, irregularly irregular). On exam, you notice his left leg is cool, without palpable dorsalis pedis or posterior tibial pulses. Imaging demonstrates occlusion of the left common femoral artery. You order IV heparin. Which of the following is best treatment for this patient?
A. IV heparin alone
B. Limb amputation
C. Balloon catheter embolectomy
D. Bypass surgery
E. None of the above
C. Balloon catheter embolectomy, for treatment of acute limb ischemia
A 42 yo female with a history of GERD and Crohn’s presents to clinic. About a year ago she had her ileum resected. The patient is now likely to have which of the following?
A. Hyporeflexia and tremors
B. Headaches and fatigue
C. Oral ulcers and bleeding
D. Koilonychia
E. Ataxia and peripheral neuropathy
E. Ataxia and peripheral neuropathy
Vitamin B12 is responsible for myelination of the body’s nervous system and RBC production
A 27 yo male presents to the clinic with SOB, chest pain, and fatigue. His PE is remarkable for a cresendo-decrescendo systolic murmur heard at the apex. An EKG reveals asymmetric septal hypertrophy and left ventricular hypertrophy. Which of the following is the best initial option?
A. Procainamide
B. Hydrochlorothiazide
C. Beta-blockers
D. Aspirin
E. ACE inhibitor
C. Beta-blockers
Tx for hypertrophic CM includes a nondihydropyridine CCBs or beta-blocker and diuretics as needed for volume overload
A 72 yo male presents with an abnormal change in bowel habits and fatigue. His PE is remarkable abdominal mass. His Hgb is 10 mg/dL. Which of the following is likely to be elevated?
A. Alpha-fetoprotein
B. CEA
C. CA-125
D. CA 19-9
E. AAT1
B. CEA
Tumor marker for colorectal cancer
What is the most common presenting symptom for colorectal cancer?
Change in bowel habits (70%)
What is the USPSTF screening recommendation for colorectal cancer?
screening at age 45 for individuals with an average risk
Most cases of Acute Lymphoblastic Leukemia (ALL) are diagnosed between which of the following age ranges?
0-5 years
peak incidence 2-5 yo
What is the therapeutic window for recombinant tissue plasminogen activator (rtPA) in acute ischemic stroke?
Within 4.5 hours of symptoms onset
Which of the following is the best management option of Shigella gastroenteritis in adults?
A. Rehydration and azithromycin
B. Rehydration and loperamide
C. Rifaximin and pepto-bismol
D. Loperamide and pepto-bismol
E. Bactrim and metronidazole
A. Rehydration and azithromycin
Note: antidiarrheals should be avoided
Which of the following is the preferred treatment for a displaced lisfranc injury with evidence of instability?
A. Reassurance and follow-up
B. Cast immobilization
C. Open reduction and rigid internal fixation
D. RICE
E. None of the above
C. Open reduction and rigid internal fixation (ORIF)
What is a lisfranc injury?
A tarsometatarsal fracture-dislocation defined by disruption between the base of the 2nd metatarsal and articulation of the medial cuneiform
What is the treatment of choice for the infection caused by Rickettsia rickettsii?
Doxycycline
A 16 yo male is brought to clinic by his mom and is worried about him. He has set fire to the trash a couple of times over the past year, has been in many fights at school, suspended multiple times for violating school policy, and recently admitted to stealing items from a drug store. Upon talking to the patient, he has no regret or guilt about his behaviors and is even proud of himself. What personality disorder is the patient most at risk for?
Antisocial personality disorder
- those with conduct disorder are at increased risk of developing this disorder
What are 5 of the 9 diseases that can cause a rash on the palms/soles?
- Hand Foot Mouth Disease (coxsackie)
- Syphilis (secondary)
- Janeway lesions from endocarditis
- Kawasaki disease
- Measles
- Toxic shock syndrome
- Reactive arthritis
- Meningococcemia
- Rocky mountain spotted fever; Rickettsia
A 42 yo female presents for an annual PE with some complaints of fatigue and dyspnea. On PE you appreciate a fixed S2 split. What is the most likely diagnosis?
Atrial septal defect
Which is recognized as a risk factor for developing Osgood-Schlatter disease?
A. participation in non-contact sports like swimming
B. A diet high in calcium and vitamin D
C. Males aged 13-18
D. Sedendary lifestyle during adolescence
E. Female gender
C. Males aged 13-18
- affects adolescents during periods of rapid growth with a high prevalence in males 13-18
- caused be repetitive tension of the growth plate at the tibial tuberosity
Repair of an asymptomatic abdominal aortic aneurysm (AAA) is generally indicated in males when it reaches what size?
5.5 cm or greater
5.0 cm in women
A 35 yo female presents to the clinic complaining of insomnia, weight loss, and anxiety. She says she is having more frequent diarrhea. Vitals are unremarkable. On PE, she has a mild hand tremor. Her thyroid gland is also diffusely enlarged. What is the best next step?
Check TSH levels (low) for a suspicion for hyperthyroidism (Grave’s disease)
A 20 yo presents to your clinic with loss of pigmentation on her face and on the back of both arms. She tells you that in the past her condition has improved with photochemotherapy. Which of the following best explains the pathophysiology of her condition?
A. the absence of epidermal melanocytes
B. epidermal barrier dysfunction
C. increased proliferation of keratinocytes
D. destruction of cellular or extracellular adhesion molecules by antibodies
E. none of the above
A. the absence of epidermal melanocytes
What is characteristic of a right bundle branch block?
RSR’ pattern in leads V1/V2
Wide, slurred S waves in lateral leads (V6)
A 19 yo male with a history of uncontrolled diabetes presents to the clinic with a worsening rash in his armpits. On exam, you notice a beefy red patch with scattered erythematous satellite papules and pustules nearby. What is the most likely diagnosis?
Candida infection
Which of the following is not a risk factor for gastric cancer?
A. H. pylori
B. Obesity
C. Diet high in salts and nitrates
D. Nicotine
E. High SES
E. High SES
A risk factor would include low SES
What is the average age of onset of menopause?
51 years old
Which of the following bacteria is most often associated with reactive arthritis in young men?
A. Chlamydia
B. Gonorrhea
C. Salmonella
D. Shigella
E. Yersinia
A. Chlamydia
A 72 yo male with a history of chronic tobacco use and HTN presents to the clinic with dyspnea on exertion for the past few weeks. He also says he was mowing the lawn and had some chest pressure that was relieved with rest. His vitals are stable. Physical and cardiac exam is unimpressive. Which of the following is the best initial diagnostic test?
A. Cardiac catheterization
B. Nuclear stress test
C. Cardiac MRI
D. Chest Xray
E. Echocardiogram
B. Nuclear stress test
Suspecting angina pectoris
What type of virus causes molluscum contangiosum?
Poxvirus
How will molluscum contagiosum virus present?
flesh-colored, waxy, dome-shaped umbilicated papules
What is the preferred treatment of a patient who has an uncomplicated gonorrhea infection?
Ceftriaxone IM x 1
Then doxycycline PO (if chlamydia co-infection has not been ruled out)
What virus causes roseloa infantum?
Human herpesvirus 6
A pathology report comes back with positively birefringent crystals. What is the most likely diagnosis?
Pseudogout
According to current guidelines, what A1c level would indicate a diagnosis of prediabetes?
5.7%
What bacteria causes ance vulgaris?
Cutibacterium acne
What are dysthymia criteria?
Depressed mood for 2 or more years
At least 2 of the following: SIGECAPS
No mania or hypomania ever
A 50 yo female presents with poor appetite, low energy, poor concentration, and feelings of hopelessness on most days for the past 3 years. She denies suicidal ideation. She has never had a past manic episode or hypomanic episode. Which of the following is the best treatment option?
A. Haloperidol
B. Fluoxetine
C. Lorazepam
D. Amitriptyline
E. Risperidone
B. Fluoxetine
SSRIs are first line for dysthymia
A 30 yo female with a history of obesity presents to the clinic with right wrist pain that is worse at night. She also says it feels weak and is “tingling.” The patient says it started hurting more when she started a new office job. On PE, tapping over the palmar surface of the wrist produces an electric sensation along the distribution of the median nerve. Which sign/test is she positive for?
Tinel sign
Positive for carpal tunnel syndrome
A 38 yo HIV-positive male presents to the ER with a dry cough. Vitals are remarkable for tachypnea (30), tachycardia (112), and fever (102.4). Labs show elevated LDH and leukocytosis. CD4 count is pending. CXR demonstrates bilateral interstitial opacities. What is the best initial treatment for this patient?
A. Amantadine
B. Tetracycline
C. Fluconazole
D. Trimethoprim-sulfamethoxazole
E. Ampicillin and doxycycline
D. Trimethoprim-sulfamethoxazole
Pneumocystis pneumonia is an opportunistic fungal infection that occurs in lungs of those that are immunocompromised
What is the first-line treamtent for a patient diagnosed with acute thrombotic thromocytopenic purpura?
Plamsa exchange therapy
What enzymes activity is severely deficient in thrombotic thromocytopenic purpura (TTP)?
ADAMTS13
At what GFR does end-stage renal disease generally occur?
GFR < 15
A 42 yo female with a history alcohol abuse presents to the ER complaining of epigastric pain and nausea. Her lipase is extremely elevated. Which of the following is the most appropriate intervention at this time?
A. Anti-emetics
B. Broad spectrum IV antibiotics
C. IV fluid administration
D. General surgery consult
E. None of the above
C. IV fluid administration
For suspicion for acute pancreatitis
What are the 2 most common causes of acute pancreatitis?
Alcohol abuse and gallstones
An 85 yo male with a history of CKD presents to the ER with muscle cramps. Lab studies reveal potassium of 7.8 mEq/L. EKG shows peaked T waves. Which is the best initial med to give?
A. Insulin
B. Albuterol
C. Furosemide
D. Sodium bicarbonate
E. Calcium gluconate
E. Calcium gluconate
Treatment of hyperkalemia includes
1. stabilizing the resting membrane potential of the myocardium via calcium gluconate
2. shift K intracellularly - beta-agonists, sodium bicarb, insulin
3. removing potassium - diuretics, hemodialysis
What is the most common cause of large bowel obstruction?
Cancer
What is the most common clinical manifestation observed in patients with cerebral palsy?
Spasticity - characterized by increased muscle tone, leading to stiff and awkward movements
What is the main vector for Rocky Mountain Spotted Fever transmission?
Ticks are the main vector for Rickettsia rickettsii transmission
A 16 yo male is brought to clinic by his mom and is worried about him. He has set fire to the trash a couple of times over the past year, has been in many fights at school, suspended multiple times for violating school policy, and recently admitted to stealing items from a drug store. Upon talking to the patient, he has no regret or guilt about his behaviors and is even proud of himself. What is the most likely diagnosis?
Conduct disorder
- younger than 18 years old
- lasts for more than 1 year
- behaviors include: aggression towards people/animals, destruction of property, theft, rule violation, etc.
Carpal tunnel syndrome typically results in pain and paresthesia in which digits of the hand?
Thumb, index, middle, and radial half of the ring finger (median n.)
A 72 yo female with a history of HTN presents to the clinic due to repeated episodes of “dizziness.” She says the room feels like its spinning when the episode occurs; they last about 40 seconds. She states that the episodes are often triggered when she suddenly sits up, moves her head, or lays down. What is the most likely diagnosis?
Benign paroxysmal positional vertigo
An 8 yo female presents to the clinic with her dad complaining of left ear pain and pruritus for the past few days. PE is remarkable for drainage and pain on tragal pressure. The tympanic membrane is not visible. Which is the best treatment option?
A. Amoxicillin PO
B. Neomycin/polymyxin B/hydrocortisone drops
C. Cefepime PO
D. Oral steroids
E. Ciprofloxicin/
dexamethasone drops
E. Ciprofloxicin/
dexamethasone drops
Patient has otitis externa (swimmer’s ear); MC bacteria is Pseudomonas aeruginosa
A 51 yo female on hormone replacement therapy with active cancer presents to the ER with sudden dyspnea and chest pain. Vital signs reveal: BP 122/82, HR 106, RR 20, SpO2 91%, T 98.4. EKG shows inversions in the precordial leads. Which of the following is the most likely diagnosis?
A. Bacterial pneumonia
B. Pneumothorax
C. Acute respiratory distress syndrome
D. Pulmonary embolism
E. Myocardial infarction
Pulmonary embolism
EKG shows: inverse Ts in precordial leads, sinus tach, or the rare S1Q3T3 pattern
A 16 yo male presents with sudden onset of pain and swelling of the anterior part of the neck, along with fever, chills, and a sore throat. On PE, you palpate a tender and swollen thyroid gland with erythematous skin overlying the painful area. Thyroid function tests are normal. Which thyroiditis is the most likely diagnosis?
A. Hashimoto’s
B. Subacute granulomatous
C. Drug-induced
D. Suppurative
E. Subacute lymphocytic
D. Suppurative thyroiditis
A 41 yo male presents to the ER after a construction accident which left him with severe right eye pain and decreased visual acuity. On PE, you notice a teardrop-shaped pupil. What is the most likely diagnosis?
Globe rupture
Which of the following is the most appropriate chronic treatment regimen for Addison’s disease?
A. Oral hydrocortisone and fludrocortisone
B. IV hydrocortisone
C. Oral prednisone only
D. Insulin therapy
E. Thyroxine replacement
A. Oral hydrocortisone and fludrocortisone
Hydrocortisone to replace cortisol and fludrocortisone to replace mineralocorticoid effects
Which of the following medications should be avoided in patients with hypertrophic obstructive cardiomyopathy (HOCM)?
A. Aspirin
B. Digoxin
C. Disopyramide
D. Verapamil
E. Atenolol
B. Digoxin
Digoxin is CU in HOCM because it increases cardiac contractility which may exacerbate outflow obstruction in HOCM
Tetrology of Fallot is characterized by RV failure, an overriding aorta, a ventricular septal defect, and what valvular disorder?
Pulmonary stenosis
Coxsackievirus A16 is known to cause which viral exanthem?
Hand-foot-mouth disease
When does Hand-foot-mouth disease most commonly occur?
summer and early autumn
What is the treatment of Hand-foot-mouth disease?
resolution occurs within 1 week; fever and pain can be managed with ibuprofen or acetaminophen
A 52 yo female with a history of previous abdominal surgeries presents to the ER with nausea, emesis, abdominal pain, and inability to pass gas. On PE, you note abdominal distention and auscultate high-pitched tinkering sounds in the upper abdominal quadrants. Which is the most likely diagnosis?
A. Mesenteric ischemia
B. Diverticulitis
C. Gastric ulcer perforation
D. Small bowel obstruction
E. Ischemic colitis
D. Small bowel obstruction
The MCC of SBO is intraperitoneal adhesions (s/t previous surgeries)
A 40 yo lifelong smoker presents to the primary care clinic complaining of fatigue, cough, and weight loss for the past few months. Labs are remarkable for hyponatremia. CXR reveals a suspicious mass in the left lung? Which is the most likely diagnosis?
A. Squamous cell lung carcinoma
B. Adenocarcinoma of the lung
C. Carcinoid syndrome
D. Small cell lung cancer
E. Miliary tuberculosis
D. Small cell lung cancer
SCC is associated with SIADH
In which of the following scenarios is an antiviral agent not indicated?
A. 32 yo hospitalized for influenza due to severe symptoms
B. 59 yo with hx of CA on chemotherapy who just tested positive for influenza 24 hours ago
C. 25 yo healthy pregnant female who has influenza
D. 80 yo admitted for influenza, now requiring oxygen
E. 48 yo who had flu symptoms 6 days ago
E. 48 yo who had flu symptoms 6 days ago
Which of the following is a common symptom associated with laryngotracheobronchitis (viral croup)?
A. Drooling
B. High fever
C. “Hot potato” voice
D. Barking cough
E. Wheezing
D. Barking cough
Which of the following UA results are suggestive of acute pyelonephritis?
A. Hyaline casts
B. Red cell casts
C. White cell casts
D. Granular casts
E. Fatty casts
C. White cell casts
White cell casts in the urine are indicative of inflammation/infection within the renal tubules
A 53 yo male complains of worsening pain around the base of the thumb and wrist for the past few months. He has picked up tennis and has been playing a lot. He denies numbness, tingling, or trauma to the wrist. On PE, patient has worsened pain when he makes a fist upon ulnar deviation. What is the most likely diagnosis?
De Quervain’s tenosynovitis
Which of the following is used to help confirm the diagnosis of Sjogren’s syndrome?
Schirmer test
Test to determine if the eye produces enough tears (<5 mm is considered dry)
A 4 yo healthy male is brought to the clinic. His mother is concerned because his urine has been red for the past week. On PE, an 8 cm, firm, non-tender abdominal mass that is palpable in the left upper quadrant. It does not cross the midline. UA is positive for RBC, no other abnormalites. Which is the most likely diagnosis?
A. Nephroblastoma
B. Rhabdomyosarcoma
C. Polycystic kidney disease
D. Lymphangioma
E. Mesenteric cyst
A. Nephroblastoma
AKA Wilms tumor
asympt. unilateral abdominal or flank mass (nontender, mobile, does not cross midline!), hematuria, hypertension
A 28 yo with a history of medullary thyroid cancer (s/p recent thyroidectomy) presents to your clinic complaining of muscle cramps and tingling. On PE, you note twitching of the facial muscles when you percuss over the area of the facial nerve. What sign is this and what lab abnormality would you expect to see?
- Chvostek’s vs Trousseau’s sign
- hyper vs hypo calcemia
Chvostek’s sign, hypocalcemia
A 33 yo female presents to your clinic with vulvar pruritis and vaginal discharge. On pelvic exam, you notice a frothy yellow-greenish discharge that is foul-smelling as well as small hemorrhafes visible on the cervix. Which of the following is the preferred treatment?
A. Ceftriaxone
B. Acyclovir
C. Doxycycline
D. Amoxicillin
E. Metronidazole
E. Metronidazole for treatment of Trichomoniasis
A 5 yo presents to your office complaining of scrotal pain and you note swelling of the left testis. What is the appropriate next step?
A. Elevation of scrotum and ice
B. US with Doppler
C. Continued observation
D. CT pelvis
E. Doppler stethoscope evaluation
B. US with Doppler
Concern for testicular torsion, versus epididymitis or hydrocele
In testicular torsion, what key PE findings would you expect?
high-riding testicle
absent cremasteric reflex
What is the cremasteric reflex?
Inner thigh of a male is gently stroked, and the ipsilateral testicle is contracted upwards
A 20 yo college student presents with fever, sore throat, and fatigue. Physical examination reveals posterior cervical lymphadenopathy. Heterophile antibody testing is positive. Which of the following complications is most commonly associated with this infection?
Splenic rupture is rare complication of Epstein-Barr virus infection
**need to avoid contact sports or heavy lifting for several weeks to months
Which of the following is the treatment of choice for tinea capitis?
A. Clomtrimazole
B. Terbinafine
C. Griseofulvin
D. Micafungin
E. Ketoconazole
oral fungal medications; first line is griseofulvin and terbinafine
Which of the following disorders can lead to galactorrhea?
A. Hyperprolactinemia
B. Hyperthyroidism
C. Hypoparathyroidism
D. Adrenal insufficiency
E. None of the above
A. Hyperprolactinemia
What is Murphy’s sign?
Pain during inspiration while deep palpation of right upper quadrant
To diagnose acute cholecystitis
A 28 yo female with a history of anxiety presents to your office complaining of painful sores in her mouth. She denies other symptoms or exacerbating factos. On PE, you notice round ulcerations covered in a gray-white pseudomembrane surrounded by an erythematous halo on the buccal mucosa. What is the most likely diagnosis?
Aphthous ulcers
A painful ulceration of oral mucosa thought to be due to stress-induced rise in salivary cortisol
A 6 month old has a palpable clunk when you apply download pressure while the hip is flexed and adducted? What sign is this?
Barlow sign
Developmental dysplasia of the hip (DDH) defined by subluxation/dislocation of the femoral head, acetabular dysplasia, or hip instability.
What are the top two risk factors of developmental dysplasia of the hip (DDH)?
family history and breech presentation
What is amblyopia?
“Lazy eye”
Reduced visual acuity in one or both eyes that cannot be corrected with lenses
A 35 yo male presents 2 hours after tibial shaft fracture from a fall. Exam shows swollen, tense calf with pain on passive stretch of the tibialis anterior and numbness of the foot dorsum. Which is the most urgent intervention?
A. CT angiography of the leg
B. Fasciotomy
C. Open reduction internal fixation
D. Immobilization in a cast
E. Doppler US exam
B. Fasciotomy
Acute limb swelling and symptoms concerning for an acute compartment syndrome following lover extremity trauma
A 12 yo male presents to your clinic complaining of his head “feeling itchy.” He says he wore his friend’s hat a few days prior and since then has had progressive scalp pruritus. On PE you notice excoriations on the scalp and yellowish-white flakes. Which of the following is the most likely causative organism?
A. Pediculus capitis
B. Pediculus humanus
C. Trichophyton verrucosum
D. Microsporum audouinii
E. Malassezia yeast
A. Pediculus capitis
Lice!!
What is the first line medication for lice?
Permethrin 1% cream rinse
A 42 yo male on lithium presents with polyuria, nocturia, and polydipsia. Lab findings are remarkable for slightly elevated sodium. Which of the following is the most likely diagnosis?
A. Neurogenic diabetes insipidus
B. Nephrogenic diabetes insipidus
C. T2DM
D. SIADH
E. Adrenal insufficiency
B. Nephrogenic diabetes insipidus
Can occur secondary to lithium toxicity, chronic lithium use, pregnancy, inherited disorders, and electrolyte issues.
Which of the following is not true about leukoplakia?
A. Smoking and alcohol are causative factors
B. The plaques cannot be scraped off
C. It is defined by hyperkeratosis of mucus membranes
D. There is no risk of it developing into cancer
E. The plaques are typically white
D. There is no risk of it developing into cancer
The lesions are at risk for becoming squamous cell carcinoma so persistent lesions should be excised
A 25 yo male with a history of cerebral palsy and epilepsy presents to ER via EMS due to tonic-clonic seizure and severe right shoulder pain. Which radiographic sign is most suggestive of a posterior shoulder location.
A. Subcutaneous emphysema
B. Widened acromiclavicular joint
C. Bankart lesions
D. Hill-Sachs lesion
E. Lightbulb sign
E. Lightbulb sign
Posterior dislocations typically occur during seizures or electrical shocks. Light bulb sign is a circular appearance of the humeral head
20 yo female complaining of intense sleepiness during the day and also a desire to fall asleep constantly. She has episodes where she feels paralyzed as she is falling alseep. PE is unremarkable. Which is the best diagnostic test to confirm the most likely diagnosis?
A. CT head without contrast
B. Overnight polysomnography
C. Continuous electroencephalogram
D. MRI of brain
E. Multiple sleep latency test
E. Multiple sleep latency test
for diagnosis of Narcolepsy
characterized by: cataplexy, excessive daytime sleepiness, sleep paralysis, hypnagogic or hypnopompic hallucinations
A 45 yo man presents with painless, rubbery lymohadenopathy, fever, night sweats, and unintentional weight loss over the last three months. Biopsy of lymph node shows Reed-Sternberg cells. What is the most likely diagnosis?
Hodgkin’s lymphoma
painless LAD and B symptoms
Which medication is clearly contraindicated in patients with anorexia and bulimia?
A. Bupropion
B. Fluoxetine
C. Olanzapine
D. Topiramate
E. Sertraline
Bupropion for increased risk of seizures
15 yo male comes to clinic for well-child visit. You notice his arms are extremely long, as well as his fingers. On PE, you also appreciate inward protrusion of the lower and middle part of the sternum. What is this PE finding called?
Pectus excavatum
associated with Marfan syndrome
10 yo with history of otitis media presents to the clinic due to a “bad smell” from his right ear. His mom notices he cannot hear well out of his ear. On PE, you notice a pearly mass behind the tympanic membrane. What is the most likely diagnosis?
Cholesteatoma
CMV pneumonia occurs in a patient with HIV at what CD4 count?
50 cells/mm3
What is the treatment for CMV pneumonia for HIV patients?
IV ganciclovir and IVIG therapy until CD4 count is 100+ cells/mm3
What is the most common cause of death in hemochromatosis?
Hepatocellular carcinoma
What is the inheritance pattern of hemochromatosis?
Autosomal recessive
A mutation of what gene is seen in hemochromatosis?
HFE gene
Which is the most common cause of acute dacryocystitis?
A. H. flu
B. P. aeruginosa
C. S. aureus
D. M. catarrhalis
E. S. pyogenes
C. Staphylococcus aureus
Dacryocystitis is an infection of the lacrimal sac, usually due to an obstruction in the nasolacrimal duct
What diagnostic modality is msot appropriate to confirm the diagnosis of an ectopic pregnancy?
A. Transvaginal US
B. Beta-hCG
C. Diagnostic laparoscopy
D. Magnetic resonance imaging
E. Pelvic examination
A. Transvaginal US
for direct visualization of the gestational sac
What is the most appropriate initial treatment for an external hordeolum?
Warm compress
“stye”
A 73 yo male with history of tobacco abuse, hyperlipidemia, and DM presents to the ED due to loss of vision. He was walking around the house and suddenly lost vision in his left eye. His symptoms resolved once EMS arrived. Vitals unremarkable. Neuro exam shows intact cranial nerves, 5/5 strength in upper and lower extremities. Gait and balance are stable. Non-contrast CT reveals chronic microvascular changes but no acute issue. What is the next best step?
A. Conservative management
B. Heparain drip then oral anticoagulation
C. MRI brain
D. US of neck
E. Systemic tPA
D. Ultrasound of neck
Suspecting amaurosis fugax, commonly from carotid artery disease or giant cell arteritis
All patients will need a non-contrast head CT after
You just really want to make sure the patient did not have a TIA due to a dislodged emboli
A 41 yo female presents to your clinic with pruritic rash. On PE, you notice the lesions are characterized by red macules and edematous papules with a clearing center. The best describes which of the following?
A. Erythema annulare centrifugum
B. Erythema nodosum
C. Erythema multiforme
D. Erythema infectiousium
E. Erythema marginatum
C. Erythema multiforme
target / “bull’s eye” lesions
MCC is infections - 90% of the time HSV is indicated
A 28 yo female with an unremarkable medical history presents to the clinic during the summer complaining of some persistent “dark spots” on her face. On PE, you see irregular light-brown patches on the lateral cheeks and nasolabial folds. Which of the following is the first line initial treatment for the most likely diagnosis?
A. Hydrocychloroquine
B. Systemic steroids
C. Topical hydroquinone 4% cream
D. Oral tranexamic acid
E. Chemical peels
C. Topical hydroquinone 4% cream
For the treatment of melasma, a chronic disorder of hyperpigmentation that typically occurs in women during their reproductive years
Which of the following is the preferred treatment for the autoimmune disorder characterized by autoantibodies against the nicotinic acetylcholine receptors at the neuromuscular junction?
A. Calcium channel blockers
B. Acetylcholinesterase inhibitors
C. High dose benzos
D. Muscle relaxants
E. None of the above
B. Acetylcholinesterase inhibitors
for the suspected diagnosis of myasthenia gravis
avoid beta blockers and aminoglycosides because these medications can cause an MG crisis
A 20 ya male presents with morning back pain and stiffness for the past few months. He says it improves with exercise Schober test is positive. Lab studies reveal elevated ESR and CRP. Which of the following genes is likely to be positive in this patient?
HLA-___?
HLA-B27 for ankylosing spondylitis, an inflammatory arthritis of the spine
In the immediate postoperative period, which type of fluid is most appropriate for routine fluid replacement in a patient who underwent major abdominal surgery?
A. Hypertonic saline
B. 5% dextrose in water
C. 0.9% normal saline
0.45% saline
E. Lactated Ringer’s solution
E. Lactated Ringer’s solution
is often the fluid of choice for routine postoperative fluid replacement following major surgery
closely approximates the composition of extracellular fluid
A patient undergoes a Roux-en-Y gastric bypass for obesity. Which of the following is a potential long-term complication specific to this type of bariatric surgery?
A. Dumping syndrome
B. Cholelithiasis
C. Wound infection
D. Acute renal failure
E. Pulmonary embolism
A. Dumping syndrome
occurs due to rapid gastric emptying, leading to symptoms like N/V/D, dizziness, and tachycardia, typically after eating
What is the MCC of secondary hypertension in adults?
Renal vascular disease
MCCs = atherosclerotic renal artery stenosis and renal failure
Where is the most common location in the GI tract where intussusception takes place?
The junction between the ileum and large intestine (ileocolic region)
What is the MCC of community-acquired bacterial meningitis in adults?
Streptococcus pneumoniae (50%)
Neisseria meningitidis is the 2nd most common at 30%
Which of the following clinical findings would you likely expect in a patient with primary adrenal insufficiency?
A. Hypernatremia, hypokalemia, tired
B. Moon facies, depression, bruising
C. Polyuria, polydipsia, intense thirst
D. Fatique, hyponatremia, hyperpigmentation
E. Hypothermia, bradycardia, goiter
D. Fatique, hyponatremia, hyperpigmentation
Addisons disease
Which is the MCC of chronic kidney disease?
A. Smoking
B. Diabetes
C. Hypertension
D. Diet
E. Autoimmune disease
B. Diabetes
and hypertension is a leading cause/RF
Which of the following antiarrhythmic drugs can be assocaited with hyper or hypothyroidism following long-term use?
A. Amiodarone
B. Verapamil
C. Metoprolol
D. Diltazem
E. Digoxin
A. Amiodarone
iodine-rich composition
Which test is most effective for the diagnosis of carpal tunnel syndrome?
A. MRI
B. Xray
C. Phalen menauver
D. Nerve conduction study
E. Electromyography
D. Nerve conduction study
Phalen menauver is suggestive, but NCS is the most definitive test
What is the term that represents an individual’s innate sense of feeling female, male, androgynous, both, or neither?
Gender identity
Which of the following valvular disorders is most likely to cause hemoptysis?
A. Aoritc regurg
B. Tricuspid regurg
C. Mitral stenosis
D. Pulmonic stenosis
E. Aortic stenosis
C. Mitral stenosis
MCC of MS is rheumatic heart disease which includes symptoms like dyspnea, flushed cheeks, chest pain, and hemoptysis
A mitral stenosis murmur can be described as…
low pitched diastolic rumble at the apex with an opening snap
A 22 yo male is diagnosed with nongonococcal urethritis. Which of the following is the antibiotic regimen of choice?
A. Doxy 100 mg BID x7
B. Ceftiaxone IM 1g x1
C. Azithro 500 mg QD x3
D. Bactrim DS QD x5
E. Levofloxacin 750 mg QD x5
A. Doxycycline 100 mg BID x7 days
MC in young sexually active men
MC: Neisseria gonorrheae and Chlamydia trachomatis
Gonococal = ceftriaxone
Nongonococcal: doxy
A 42 yo male signs up for scuba diving lessons in Hawaii. On his last day of scuba, he rapidly rises to the surface due to a shark nearby. He has sudden left ear pain and starts to feel dizzy. What is the most likely diagnosis?
A. Arterial gas embolism
B. Otitis externa
C. Cerumen impaction
D. Meniere’s disease
E. Ear barotrauma
E. Ear barotrauma
TM becomes distorted and leads to potential hearing loss, discomfort, and injury
Features: pain, vertigo, hearing loss, “pop” sound, dizziness
Most of the time heals spontaneously
Which of the following is the preferred treatment of choice for condylomata acuminata is pregnant patients?
A. Podophyllin
B. Fluorouracil
C. Interferon
D. Podophyllotoxin
E. Trichoroacetic acid
E. Trichoroacetic acid
it has no fetal effects and is not absorbed systemically
Podophyllin, Interferon, Podophyllotoxin should NOT be prescribed during pregnancy
Which of the following is NOT a component of the Apgar score?
A. Activity (muscle tone)
B. Pulse
C. Grimace (relfex irritability)
D. Appearance (skin color)
E. Reactivity
E. Reactivity
What are Apgar scores?
evaluates a newborn’s physical condition at 1 to 5 minutes after birth using:
A = appearance
P = pulse
G = grimace
A = activity
R = respiration
A 68 yo male presents with fatigue, night sweats, and LAD. Blood smear shows smudge cells? What is the most likely diagnosis?
Chronic Lymphocytic Leukemia (CLL)
- over 60 yo
- smudge cells
- B symptoms
Which of the following is NOT an expected clinical manifestation of polyarteritis nodosa?
A. kidney failure
B. livedo reticularis
C. pANCA positive
D. pulmonary fibrosis
E. hypertension
D. Pulmonary fibroids
What key feature distinguishes fibrocystic breast changes from carcinoma?
Fluctuation in size and tenderness with the menstrual cycle are hallmarks of fibrocystic changes
What is the most important risk factor for pterygiums?
UV exposure
Which Glasgow Coma Scale (GCS) score range indicates a severe traumatic brain injury?
A. 3-8
B. 9-12
C. 13-15
D. > 15
A. 3-8
56 yo farmer presents to the clinic complaining of something “weird over his right eye.” On PE, you notice a triangular shaped tissue on the medial part of the conjunctiva. Which of the following is the most likely diagnosis?
A. Keratitis
B. Corneal abrasion
C. Foreign body
D. Arcus senilis
E. Pterygium
E. Pterygium
a thin, triangular wedge of conjunctival tissue that starts medially and grows laterally into the cornea; benign and rarely causes visual problems
When screening for gestational diabetes, if a woman has a positive one-hour glucose challenge test, what is the next step?
A. Start insulin
B. Repeat one-hour test
C. Perform three-hour glucose tolerance test
D. Advise dietary modifications
E. Perform fasting glucose test
C. Perform three-hour glucose tolerance test
What is the treatment of choice for infection caused by Rickettsia rickettsii?
Doxycycline for rocky mountain spotted fever
What is the main vector for Rickettsia rickettsii?
Ticks
40 yo female presents to your clinic for an annual physical but starts complaining about one of her friends who is excessively dependent and clingy. She said her friend relies exclusively on others and has trouble making any decisions of her own. Which of the following is the most likely diagnosis for the patient’s friend?
A. Avoidant PD
B. Schizotypal PD
C. Narcissistic PD
D. Dependent PD
E. None of the above
D. Dependent Personality Disorder
What is polyarteritis nodosa?
Systemic vasculitis of medium-sized vessels that leads to thrombi and microaneurysms
specifically involves the nervous system and GI tract, and spares the lungs
What is the treatment of polyarteritis nodosa?
High dose steroids
What is the causative agent of fifth disease?
Parvovirus B19
What is the classical clinical findings of erythema infectiosum?
slapped cheek appearance
Which of the following is the best first-line treatment for post-menopausal woman with osteoporosis with no pathological features?
A. Bisphosphonates
B. PTH analogs
C. RANKL inhibitors
D. SERMs
E. Calcitonin
Bisphosphonates
What is important for the administration of bisphosphonates?
Should be administered first thing in the AM with no food or drink for at least 30 minutes
Should remain upright for >30 minutes as well
What is the MOA of sulfonyureas?
A. Enhance peripheral insulin sensitivity
B. Inhibit hepatic gluconeogenesis
C. Stimulate insulin release from pancreatic beta cells
D. Decrease intestinal glucose absorption
E. Decrease glucagon secretion
C. Stimulate insulin release from pancreatic beta cells
For a male with an asymptomatic AAA measuring 5.5 cm, what is the most appropriate management strategy?
A. Immediate open surgical repair
B. Endovascular aneurysm repair (EVAR)
C. Serial US monitoring every 6 months
D. Aggressive control of HTN with medication
E. Lifestyle modifications only
B. Endovascular aneurysm repair (EVAR)
surgical repair is recommended for AAAs over 5.5 cm in men, 5.0 cm in women
30 yo female presents with palpitations and atypical chest pain. On Pe, a mid-systolic click followed by a late systolic murmur is heard. What is the diagnosis?
A. aortic stenosis
B. mitral valve prolapse
C. mitral stenosis
D. tricuspid regurgitation
E. aortic regurgitation
B. mitral valve prolapse
A midsystolic click is the hallmark for MVP
- often followed by a late systolic murmur if M.Regurg is present
- best heard at apex
Of lice and scabies, which percentage permethrin is used for each?
Lice - 1%
- educate patients on washing off after 10 minutes and repeating in 9 days
Scabies - 5%
- educate patients about applying to the entire body for 8-10 hours and repeating in 1 week
