Comquest

Question 1

When should a pregnant patient with preeclampsia w/o severe features be delivered?

Answer 1

37 weeks

Question 2

`At how many gestational weeks should a pregnant pt be delivered with severe preeclampsia or eclampsia?

Answer 2

Once they are at least 34 weeks

Question 3

Which drug is used for the tx of apthous ulcers?

Answer 3

Triamcinolone: topical corticosteroid

Question 4

Between OCD and obsessive-compulsive personality disorder do pt’s find nothing abnormal about their behavior (ego-syntonic)?

Answer 4

Obsessive-compulsive personality disorder

Question 5

In pt with anatomic or functional asplenia which meningococcal vaccines should be given based on age?

Answer 5

• Meningococcal conjugate (MCV4) in pt’s ≤55 yo
• Meningococcal polysaccharide (MPV4) in pt’s ≥56 yo

Question 6

Once learning that a patient on levothyroxine is pregnant, what should be done immediately?

Answer 6

Increase the dose

Question 7

A child presenting between the ages of 18 months - 3 y/o with unilateral or b/l intoeing despite forward-facing patella most likely has what?

Answer 7

Internal tibial rotation

Question 8

An obese child who is learning to walk appears to have both feet facing outward at 90 degree angles when standing; what is the most likely dx?

Answer 8

Femoral retroversion

Question 9

What is the hallmark cardiac ausculation finding associated with atrial septal defects?

Answer 9

Wide, fixed split S2 which may be accompanied by systolic ejection murmur

Question 10

What type of murmur is heard with ventricular septal defects?

Answer 10

Harsh, systolic ejection murmur loudest at the lower left sternal border

Question 11

What is the most likely diagnosis in a patient with increased or persistnt vaginal bleeding more than 2 weeks following a surgical evacuation procedure or delivery without evidence of infection?

Answer 11

Retained products of conception

Question 12

A spontaneous or induced abortion that is complicated by intrauterine infection is known as what?

Answer 12

Septic abortion

Question 13

A pt presenting with sore throat, fever, muffled voice, and trismus (inability to completely open the mouth) most likely has what?

Answer 13

Peritonsillar abscess

Question 14

How does retropharyngeal abscess typically present?

Answer 14

• Young child with neck stiffness w/ an insidious onset, without tonsillar involvement
• Distinguishing feature: discrete mass and generalized swelling within the midline

Question 15

Hemolytic disease of the newborn with pathologic jaundice occurs within 24 hours of birth, most often due to ABO and/or Rh incompatibility and is best diagnosed how initially?

Answer 15

direct Coombs’ test —> then perform phototherapy

Question 16

Which SNRI is FDA approved for use as an analgesic in pt’s with chronic osteoarthritis and contraindiciations to NSAIDs?

Answer 16

Duloxetine

Question 17

What is the most likely diagnosis in a pt with a rapidly growing, solitary, friable, bright red, polypoid papule or nodule with erosion or ulceration that bleeds profusely with very little trauma?

Answer 17

Pyogenic Granuloma

Question 18

What is the recommended age range and frequency for breast cancer screening?

Answer 18

• Age: 50-74 y/o
• Frequency: Every 2 years

Question 19

How is definitive diagnosis of aspirin-exacerbated respiratory disease (AERD) made?

Answer 19

Oral aspirin challenge

Question 20

What is tx of choice in healthy, immunocompetent children older than 2 years of age presenting with mild sx’s suggestive of acute otitis media?

Answer 20

Supportive and symptomatic tx with analgesics i.e., ibuprofen

Question 21

Mobitz type II 2nd degree AV block is most often due to a disturbance where?

Answer 21

His-Purkinje system

Question 22

Children that are 11-12 y/o should receive which vaccines?

Answer 22

• TDap
• Meningococcal CONJUGATE
• HPV nonvalent 2-dose series

Question 23

What is the first line tx for mild to moderate carpal tunnel syndrome?

Answer 23

Neutral wrist splinting

Question 24

Testicular torsion is due to congenital malformation of what?

Answer 24

Processus vaginalis

Question 25

What is the initial step in diagnosis of ADPKD?

Answer 25

Renal **ultrasonography**

Question 26

How is diagnosis of suspected nephrolithiasis made?

Answer 26

**non-contrast CT** of **abdomen**

Question 27

At 9 months a child would be expected to have met which motor, cognitive, social, and language milestones?

Answer 27

- **Motor:** pull up to a stand, cruise around the furniture using 2 hands, grasp objects with 2 fingers and their thumb, and bang 2 blocks together - **Cognitive/social**: have stranger anxiety, play gesture games (peekaboo) and wave bye-bye - **Language**: polysyllabic babbling and speak "mama" non-specifically

Question 28

What is the most common cause of sideroblastic anemia?

Answer 28

Excessive **alcohol**

Question 29

In any suspected case of placenta previa what are the next best steps in management?

Answer 29

Because of the risk of **severe hemorrhage**, should perform **ultrasound** prior to **digital vaginal examination**

Question 30

What is the most common cause of secondary nephrotic syndrome and what is the most common complication?

Answer 30

**Diabetes** **mellitus** and most likely complication is **venous thrombosis**

Question 31

Adolescent who experiencs brief, arrhythmic, involuntary, bilateral upper extremity myoclonic jerks w/o loss of consciousness most likely has what?

Answer 31

- **Juvenile myoclonic epilepsy** - **Valproic acid** = 1st line

Question 32

What is the recommended screening interval for patients with normal lipids and at what age should it begin?

Answer 32

- Every **5 years** - **Men** at **35 y/o** and - **M****en aged 20-35**and**women****aged 20**+ if they are at increased risk for**coronary artery disase**

Question 33

Using Naegele's rule how would you determine a woman's estimated due date if her cycles were 35 days long?

Answer 33

- Using the baseline of a normal **28-day** cycle you add **7 days** + **9 months** - Since this pt has a cycle which is **7 days** longer than normal you add a total of **14 days** **+ 9 months** to the first day of her **LMP**

Question 34

How does diagnostic evaluation for suspected allergic bronchopulmonary aspergillosis begin?

Answer 34

**Total serum IgE test** + **allergy skin prick testing** to evaluate for specific **IgE antibody** to ***Aspergillus fumigatus***

Question 35

Diagnosis of posterior urethral valves is made how?

Answer 35

**Voiding Cystourethrogram**

Question 36

What should be transfused into a patient on Warfarin who develops life-threatening bleeding?

Answer 36

**Vitamin K** and **Fresh Frozen Plasma (FFP)**

Question 37

For cat/dog bites if immunization hx is in question what should be given?

Answer 37

**Tetanus toxoid** and **tetanus immune globin**

Question 38

If pt with cat/dog bite is adequately immunized what vaccine should be given?

Answer 38

**Tetanys toxoid** only

Question 39

What is the best initial step in management of actinic keratosis described as non-pigmented, erythematous, and scaly macules, papules, or plaques which are _not_ tender and _do not_ bleed?

Answer 39

**Cryosurgery**

Question 40

What is the initial tissue sampling technique of choice for non-melanoma skin cancer i.e., basal cell and squamous cell carcinoma?

Answer 40

**Shave biopsy**

Question 41

What is the analgesic of choice during pregnancy?

Answer 41

**Acetaminophen**

Question 42

What is the tumor marker most likely present w/ testicular choriocarcinoma, which are very aggressive with early, widespread hematogenous spread and particularly associated with brain metastases?

Answer 42

**beta-hCG**

Question 43

What are 3 hallmarks of autoimmune hemolytic anemia?

Answer 43

- **Anemia** w/ an **elevated reticulocyte count** - **(+) direct Coombs** - **Spherocytes** on peripheral smear

Question 44

What is the most likely dx in pt with bilateral breast lumps and pain in the upper uter quadrant starting within several days of or prior to menstruation and disappearing afterwards?

Answer 44

**Fibrocystic breast disease**

Question 45

What is the most common presentation of infiltrating ductal carcinoma?

Answer 45

A **painless** breast lump found below the areola w/ **bloody** nipple discharge

Question 46

Which markers on the quad screen during pregnancy will be elevated with trisomy 21?

Answer 46

**Beta-hCG** and **Inhibin A**

Question 47

The diagnosis of Riedel thyroiditis (expanding, painless neck mass with or without sx's of obstruction) is confirmed how?

Answer 47

**Open surgical biopsy**

Question 48

Basal cell carcinoma located in the "H" region of the face is most sucessfully treated w/ what procedure?

Answer 48

**Mohs surgery**: lesion is removed layer by layer with confirmation of clear margins **during** the procedure to minimize scar formation

Question 49

1st line tx for vulvovaginal candidiasis in non-pregnant women?

Answer 49

**Oral Fluconazole**

Question 50

What is the most common cause of an acquired goiter in children and adolescents; how do you work it up?

Answer 50

- **Autoimmune (Hashimoto's) thyroiditis** - **Intial**: via testing for **TSH, free T4**, and **anti-thyroid antibodies**