Final Step Flashcards
(1193 cards)
1
Q
A patient with HIV presents with severe groin pain. What is the most likely diagnosis?
A
Avascular necrosis of the femoral head. Antiretroviral medications put patients at an increased risk of AVN.
2
Q
A 65 year old presents complaining of severe pain in his great toe that began when he woke up this morning. It is swollen, red and very tender. What is the most likely diagnosis?
A
Gout would be number one because of the location, but you might also think about an infection
3
Q
Scleroderma limited version has five main characteristics for which the CREST acronym is often used. What are those five things?
A
Calcinosis, Raynaud’s, esophageal dysmotility, sclerodactyly, telangiectasia
4
Q
Vasculitis with a hepatitis B history should make you think of what diagnosis?
A
polyarteritis nodosa
5
Q
A patient presents with knee pain following a soccer game two days ago. He has joint line tenderness medially and feels a locking in the knee from time to time. What two physical exam tests should you do?
A
This is probably a medial meniscal tear. McMurry and Apley tests would be appropriate.
6
Q
A positive Apley indicated what diagnosis?
A
meniscal tear
7
Q
Which of the four rotator cuff muscles is most commonly injured?
A
supraspinatus
8
Q
On physical exam, you notice ulnar deviations and swan neck deformities. What is the most likely diagnosis?
A
rheumatoid arthritis
9
Q
What is the name for the 4th and 5th metacarpal fractures that often occur punching a wall.
A
Boxer’s fracture
10
Q
A pathology report comes back with positive birefringent crystals. What is the most likely diagnosis?
A
pseudogout
11
Q
A 15 year old boy presents complaining of night pain in the pelvis. Since you have no idea what to do, you order an x-ray. The report comes back with a description of a mass with an “onion skin appearance.” What is the most likely diagnosis?
A
Ewing sarcoma
12
Q
What is the medical term for golfer’s elbow?
A
medial epiconylitis
13
Q
What is the medical term for hunchback?
A
kyphosis
14
Q
What is the age range for osteosarcoma? Where are thy most typically found in the body?
A
Osteosarcoma usually occur in 15-25 year old males and are most commonly found around the knee.
15
Q
Where are Bouchard’s nodes found?
A
proximal interphalangeal joint (PIP)
16
Q
Are most shoulder dislocations anterior or posterior?
A
anterior
17
Q
What is the most common fracture in a patient with osteoporosis?
A
a compression fracture of a vertebral body followed by hip fractures
18
Q
Which carpal bone has a high rate of nonunion and occult fracture?
A
scaphoid
19
Q
A fat pad sign on a lateral x-ray of the elbow has what significance?
A
it is blood in the joint indicating a fracture even if the fracture line cannot be seen
20
Q
What is the medical treatment for gout?
A
allopurinol, colchicine
21
Q
A positive Phalen and Tinel’s sign indicates what diagnosis?
A
carpal tunnel
22
Q
A pathology report comes back showing negatively birefringent crystals. What is the most likely diagnosis?
A
gout
23
Q
What fracture is the #1 cause of compartment syndrome?
A
tibial shaft fracture
24
Q
A positive Neer’s test indicated what diagnosis?
A
rotator cuff impingement
25
You suspect a patient has polyarteritis nodosa. What is the test for a definitive diagnosis and what is the treatment?
biopsy, high dose steroids
26
What are the four muscles of the rotator cuff?
Commonly referred to as the SITS muscles they are Supraspinatus, Infraspinatus, Teres minor, Subscapularis
27
What is the most useful physical exam test for diagnosis an ACL tear?
Lachman's followed by anterior drawer
28
An African American female presents with malar rash and a positive double-stranded DNA antibody. What is the most likely diagnosis?
lupus
29
A positive straight leg test indicates what diagnosis?
herniated disc
30
What test do you do for Sjogren's syndrome?
Schirmer test
31
Which way does a Colles fracture angulate: dorsal or volar? What about a Smith fracture?
Colles = Dorsal, Smith = Volar
32
What is a first line treatment for rheumatoid arthritis?
methotexate
33
What is the most common knee injury?
medial meniscal tear
34
What medication is used for patients with lupus?
systemic steroids
35
A new mother presents with pain over the radial wrist. She has a positive Finkelstein's test. What is the most likely diagnosis?
de Quervain's tenosynovitis
36
A positive Hawkins test indicated what diagnosis?
Rotator cuff impingement
37
At what age should you begin ordering DEXA scans for male patients? What about female patients?
70 for males, 65 for females
38
What is the medical term for tennis elbow?
lateral epicondylitis
39
Tenderness over the anatomical snuffbox is indicative of what fracture?
scaphoid
40
What is the first line treatment for carpal tunnel?
night splint
41
46 year old male comes into the ER limping a little on the right side. He states that it felt as though he was kicked in the back of the leg during a soccer game, but clearly no one was behind him. What is the most likely diagnosis?
Achilles tendon rupture
42
List three medication that may cause lupus.
procainamide, isoniazid, and quinidine
43
A patient's lab work shows positive Smith antibody and positive double-stranded DNA antibodies. What is the most likely diagnosis?
Lupus
44
What is the most common cause of a hip dislocation? Is it usually anterior or posterior?
MVA, posterior
45
A 95 year old female presents to ER after a fall in her home. Her left leg is shortened and externally rotated. What is the most likely diagnosis?
hip fracture
46
What ligament is most commonly injured in an ankle sprain?
Anterior talofibular ligament (ATFL)
47
A patient with a history of hepatitis B presents complaining of bilateral knee pain, fever and weight loss. What is the most likely diagnosis?
polyarteritis nodosa
48
You recommend bisphosphonates for a patient with osteoporosis. What instruction do you give her for immediately after taking the medication?
remain upright for 30 minutes
49
A positive crossover test indicates what diagnosis?
acromioclavicular joint injury (AC joint)
50
A 22 year old male patient presents with what is a clearly a septic knee. He is unable to actively extend his knee. What is the most likely diagnosis?
Neisseria gonorrhoeae
51
A patient presents to the ER after taking a baseball bat to the knee. He is unable to actively extend his knee. What is the most likely diagnosis?
patella fracture
52
Where are Heberden's nodes found?
distal interphalangeal joint (DIP)
53
What is the best imaging to diagnose osteomyelitis?
Bone scan or MRI
54
A patient with rheumatoid arthritis is heading to the OR for open reduction and internal fixation of the ankle. In addition to ankle films, what other x-rays should you get?
C-spine, anesthesia will want them due to concerns about instability of C1 and C2
55
A bamboo spine indicates what diagnosis?
ankylosing spondylitis
56
Anatomically where are 80% of clavicle fractures located?
middle third
57
A positive McMurry indicated what diagnosis?
meniscal tear
58
Anti-Jo 1 antibodies should make you think of what diagnosis?
polymyositis
59
A patient presents to the ER with saddle anesthesia and loss of bowel and bladder function. What is the most likely diagnosis?
Cauda equina
60
What would you expect the WBC count to be in the joint fluid of an infected knee?
>50,000 at a minimum and probably much higher
61
A patient presents with a painless mass in her right wrist. What is the most likely diagnosis?
ganglion cyst
62
What will an x-ray show in acute osteomyelitis?
nothing - it will show bone destruction in chronic osteomyelitis
63
There is a sunburst appearance on x-ray. What is the most likely diagnosis?
osteosarcoma
64
You think a patient may have an osteoid osteoma due to his complaints of severe night pain. You set him up for an x-ray; but in the meantime what medication do you start him on?
If it is truly an osteoid osteoma ibuprofen will resolve his pain
65
A positive Finkelstein's test indicates what diagnosis?
de Quervain's tenosynovitis
66
Give the DEXA score for osteopenia and osteoporosis
osteopenia = 1 to 2.4 standard deviations, osteoporosis = 2.5 standard deviations or greater
67
Carpal tunnel affects what nerve and what parts of the hand?
Median nerve. Thumb, pointer and ring fingers, Thenar wasting is a sign of advanced disease
68
Patient presents with conjunctivitis, urethritis, arthritis and oral lesions. What is the most likely diagnosis? What other lab might you expect to be positive?
Reactive arthritis, HLA B-27
69
What is the most common fracture in children?
clavicle
70
Clicking or locking of the knee indicates what diagnosis?
meniscal tear
71
Describe the characteristics of a lytic lesion on x-ray.
spiculated, elevated periosteum, bone destruction (think bad, very bad things)
72
Patient presents with progressive neck and proximal muscle weakness. On physical exam, you see a reddish purple maculopapular rash. Her lab work shows an anti-Jo-1 antibodies. What is the most likely diagnosis?
polymyositis
73
A patient with a silver-fork deformity on x-ray. What is the most likely diagnosis?
Colles fracture
74
What is the most common cause of C-spine fractures?
motor vehicle accidents
75
What uric acid level helps to confirm a diagnosis of gout?
>7.5
76
What is another term for podagra?
gout
77
A patient has a tremor with motion in his hands. What medication might you prescribe?
This patient has an active tremor therefore a beta blocker like propranolol is a good start
78
A patient complains of muscle weakness and fatigability that improves with rest. What diagnosis should you be thinking of?
Myasthenia gravis
79
A patient complains of an aching headache which feels like a band around his head. What diagnosis should you be thinking of?
Tension headache
80
An EEG showing focal rhythmic discharges at the onset of the seizure should make you think of what diagnosis?
Simple partial seizure
81
A middle age male presents with unilateral periorbital headaches occurring daily for several weeks. These headaches are extremely painful. Which type of headache is most likely cause?
Cluster headahce
82
Name one abortive drug for migraines.
Triptans (sumatriptan, zolmitriptan), ergotamine
83
What is the most common cause of dementia?
Alzheimer's disease, it may be as high as 80%
84
Duchenne's and Becker's muscular dystrophy have what genetic characteristic?
X-linked recessive
85
What is the age range for Duchenne's muscular dystrophy?
3-5 years old
86
A patient presents with lateralized throbbing headache. He is also complaining of nausea, vomiting, and photophobia. What type of headache is most likely?
Migraine
87
If CT is negative and you still believe there is a stroke what is the next best test to order?
Lumbar puncture
88
A patient presents with a painful ipsilateral third nerve palsy. What diagnosis should you be thinking of?
Posterior communication artery aneurysm (PComA)
89
Describe Kernig's sign
The patient lies supine, flex hip while keeping knee straight. Back pain is positive
90
A patient presents following a seizure. Just before the seizure she remembers seeing flashing light all around her. What diagnosis should be at the top of your differential?
Complex partial
91
A patient presents to your office complaining of a tremor in his right hand. He states after a beer it goes away completely. What diagnosis should you be thinking of?
Benign essential tremor or familial tremor
92
Which nerve root is responsible for the knee jerk reflex?
L3-L4
93
What cranial nerve is affected with Bell's palsy?
CN VII
94
What is the medical treatment for a stroke in which the CT has shown no evidence of a hemorrhage?
Within the first 4 hours and with no contraindications thrombolytics should be given
95
Alcohol may be a major factor in which encephalopathy?
Wernicke's
96
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.
97
An EEG showing generalized spikes and associated slow waves should make you think of what diagnosis?
Generalized or absence seizure
98
What is the medication of choice for a patient with Tourette's syndrome?
Haloperidol
99
What are the most common primary cancer sties for metastasis to the brain?
Lung, breast, kidney
100
A patient presents with what appears to be an inability to understand speech. Which aphasia should be at the top of your differential?
Wernicke's aphasia
101
At what age do symptoms of Huntington's disease appear?
Around 30 years old
102
Wilson's disease is associated with a build up of what mineral?
There is a deficiency of the copper binding protein and therefore a buildup of copper
103
A patient is brought in following a seizure in which she did not lose consciousness. What diagnosis should you be thinking of?
Simple partial seizure
104
Which is the most commonly herniated vertebral disc?
L4-L5 followed by L5-S1
105
A patient presents with signs of a stroke to the ER what is the most important test to get?
CT
106
A patient presents complaining of the worst headache of his life. What might you expect their blood pressure to be?
Typically this is the description for a subarachnoid hemorrhage. You would expect the blood pressure to be elevated.
107
A sudden thunderclap headache should make you think of what diagnosis?
Subarachnoid hematoma
108
Lead pipe or cogwheel rigidity should make you think of what diagnosis?
Parkinson's disease
109
A 35-year old patient comes to your office because his wife made him. He has been increasingly irritable and moody. She has also noticed that he is very restless. You order a CT scan which shows cerebral atrophy as well as atrophy of the caudate nucleus. What diagnosis should you be thinking of?
Huntington's disease
110
What percentage of strokes are ischemic? What percentage are hemorrhagic?
80%, 20%
111
Name three medications used to break a seziure?
Diazepam, lorazepam, phenytoin or fosphenytoin
112
At what percentage of blockage is an endarterectomy indicated?
asymptomatic >70%, symptomatic >60%
113
Elevated circulating acetylcholine receptor antibodies should make you think of what diagnosis?
Myasthenia gravis
114
A patient presents with inability to speak and right sided weakness. He seems to understand speech and follows commands well. What type of aphasia should you be thinking of?
Broca's aphasia
115
What are the genetic characteristics of Wilson's disease?
Autosomal recessive, chromosome 13
116
What four chromosome have been linked to dementia?
1, 14, 19, 21
117
Decreased GABA and substance P should make you think of what diagnosis?
Huntington's
118
What is the defining symptom of Alzheimer's?
Progressive memory impairment
119
List three medications used to "treat" multiple sclerosis?
Steroids, interferon beta, copolymer 1
120
A lumbar puncture for a patient with bacterial meningitis will show elevated or decreased WBCs? glucose? Protein?
Elevated WBCs, decreased glucose and elevated protein
121
Weakness and numbness in the left hand might be a blockage in which carotid artery?
Right
122
A resting or pill-rolling tremor should make you think of what diagnosis?
Parkinson's disease
123
A patient has an intracranial neoplasms causing auditory illusions, olfactory hallucinations and emotional changes. What lobe is the lesion likely in?
Temporal
124
A study results comes back with intracellular neurofibrillary tangles and extracellular neuritic plaques. What diagnosis should you be thinking of?
Alzheimer's disease
125
Is the ankle jerk reflex of lumbar or sacral origin?
Sacral
126
What is the most common cause of subarachnoid hemorrhage aside from trauma?
Ruptured cerebral aneurysm
127
List six medications that can be used for migraine prophylaxis?
Beta blockers, tricyclics, calcium channel blockers, NSAIDs, and valproic acid
128
There is an MRI result of multiple foci of demyelination in the white matter. What diagnosis should you be thinking of?
Multiple sclerosis
129
List three drugs that treat cluster headaches.
Oxygen, sumatriptan, butorphanol
130
A patient presents with weakness that he has felt in his lower legs and now feels in his knees and hip bilaterally. He has decreased deep tendon reflexes. This has been getting progressively worse. What diagnosis should you be thinking of?
Guillain-Barre
131
What three symptoms are classic for a normal pressure hydrocephalus?
Gait disturbance, dementia, and urinary incontinence
132
What is the most common primary intracranial neoplasm?
Glioma
133
A 34 year old presents with symptoms which are relapsing and remitting over the past few weeks. These include visual problems and weakness in her right arm. What is the most likely diagnosis?
Multiple sclerosis
134
List two medications you might use to treat an essential tremor.
Beta blocker (propranolol), primidone
135
Give two classes of drug therapy for treating Parkinson's.
Dopaminergic (levodopa), anticholinergics are second line.
136
A shuffling gait should make you think of what diagnosis?
Parkinson's disease
137
You believe a patient has had a stroke. He presents with aphasia, loss of hearing in one ear and loss of vision in his left eye. Is the blockage likely in the anterior or posterior circulation?
Anterior
138
What is the single most important thing to be concerned about with a patient in status epilepticus?
Airway, followed by management of hyperthermia
139
Is Huntington's autosomal dominant or recessive?
dominant
140
What symptom is associated with a classic migraine?
Having an aura
141
An EEG showing interictal spikes should make you think of what diagnosis?
Complex partial seizure
142
Describe Brudzinski's sign.
When you lift the patient's head the patient bends his hips.
143
A slit lamp shows Kayser-Fleischer rings. What diagnosis should you be thinking of?
Wilson's disease
144
What seizure medication may cause overgrowth of the gums?
Phenytoin
145
You are looking for lesions associated with multiple sclerosis. When you order an MRI do you order it with gadolinium or without?
With gadolinium
146
A patient presents with facial paresis, arm drift, and abnormal speech. What are the first three tests to order?
Thinking of a stroke you order a non-contrast brain CT or MRI, serum glucose, and oxygen saturation.
147
An 18 month old is not yet speaking. He does not point to objects. He does not make eye contact with others. What diagnosis should you be thinking of?
Autism
148
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.
149
During an interview a patient states "I have been anxious for as long as I can remember." This statement should make you think of what diagnosis?
Generalized anxiety disorder
150
What is the term for being afraid of being out in a terrible situation with no help available?
Agoraphobia
151
What medication is clearly contraindicated in anorexia and bulimia?
Bupropion (Wellbutrin) because it can increase risk of seizures
152
How do you treat alcohol withdrawal?
Benzodiazepines
153
A patient expresses concern that he can't trust anyone. That everyone is out to get him, and his problems are all the faults of others. He has help very long grudges due to perceived past wrongs. What diagnosis should you be thinking of?
Paranoid personality disorder
154
List the four cluster B personality disorders.
"Bad" antisocial, borderline, histrionic, and narcissistic
155
List the two cluster C personality disorders.
"Sad" avoidant and obsessive compulsive
156
What is the major concern with using lithium?
It has a very narrow therapeutic window. Blood tests are needed every four weeks.
157
What two psychiatric issues are more common in males than females?
Autism and ADD, the rest are all either equal or more common in females.
158
A patient has very strange magical thinking. What diagnosis should you be thinking of?
Schizotypal personality disorder
159
What causes anorexic patients to have osteopenia?
A decrease in estrogen
160
A doughnut shaped burn should make you think of what issue?
Abuse, either child or elder
161
What is necessary to diagnose a patient with bipolar 1?
One manic episode. They do not have to have the depressive episode for the diagnosis.
162
Are hallucinations normal during a grieving period?
Yes, as long as they are not persistent or intrusive
163
A patient exhibits all of the characteristics of antisocial personality disorder, but he is only 14 years old. What diagnosis should you be thinking of?
Conduct disorder
164
A patient complains of having suddenly developed stage fright. It is very important to his career that he is able to speak in front of groups. What medication might you treat with him with?
Beta blocker - propranolol
165
How long must symptoms occur before diagnosing schizophrenia?
At least six months
166
What is the term for a chronic mild depression which has lasted greater than two years?
Dysthymia
167
What type of behavioral therapy works best for borderline patients?
Dialectical behavior therapy
168
When is the typical onset of Tourette's syndrome?
3-8 years old
169
Name three SSRIs.
fluoxetine, paroxetine, sertraline, citalopram, escitalopram, dapoxetine, zimelidine, mesembrine, seproxetine
170
Borderline personality disorder is on the border of what two psychological disorders?
Neurosis and psychosis
171
A patient believes that her 15 year old daughter is sleeping with the mailman. She has no evidence of this. She has confronted her daughter who denies it. It is not interfering with her daily activities, but she does spend time thinking about it. What diagnosis should you be thinking of?
Delusional disorder
172
A patient's wife complains that he is hypervigilant and has a hyperstartle response. What diagnosis should you be thinking of?
Posttraumatic stress disorder
173
What is Russel's sign?
Abraded knuckles from forcing oneself to vomit.
174
List four symptoms of serotonin syndrome.
Hyperthermia, seizure, mental status change, tremor
175
How long does menstruation need to be absent before secondary amenorrhea can be diagnosed?
If cycles have been previously normal: 3 months. If cycles have been previously irregular: 6 months.
176
What medication is often used to treat postpartum depression in a women who is breast feeding?
Sertraline (Zoloft)
177
What type of hallucinations are most common in schizophrenia auditory, visual, or olfactory?
auditory - hearing voices
178
What medication is a good place to start treating bipolar 1 or 2?
Lithium
179
List three positive symptoms of schizophrenia.
Hallucinations, delusions, movement disorder
180
How long before normal grief resolves?
About one year
181
A patient is arrogant with an inflated self image. He feels he is special and should be treated that way. What diagnosis should you be thinking of?
Narcissistic personality disorders
182
List the three cluster A personality disorders.
"Mad" schizoid, schizotypal and paranoid
183
To be diagnosed with ADD patients must exhibit symptoms before what age?
7 years old
184
How long must symptoms last before diagnosing ADD?
6 months
185
What is the generic name for Prozac?
Fluoxetine
186
A patient complains of acute paralysis in his left arm. This does not seem to bother him, but his wife made him come in. There was no traumatic event. A complete neurologic workup is negative. What diagnosis should you be thinking of?
Conversion disorder
187
A psychiatric patient presents with confusion, fever, and lead pipe rigidity. What diagnosis should you be thinking of?
Neuroleptic malignant syndrome, this can occur with high dose antipsychotics
188
Are patient with specific phobias aware they are strange?
Yes
189
What is the time frame from the fist symptom of withdrawal from alcohol?
Tremor in 8-18 hours
190
Is obsessive compulsive disorder egosyntonic or ego-dystonic? What about obsessive compulsive personality disorder?
OCD is ego-dystonic. OCPD is egosyntonic.
191
A spiral fracture should make you think of what issue?
Abuse, either child or elder.
192
How long does a panic attack typically last?
10-20 minutes
193
A patient exhibits splitting, seeing others as all good or all bad. What diagnosis should be thinking of?
Borderline personality disorder
194
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 diagnosis should you be thinking of?
Schizoid personality disorder
195
Waxy flexibility should make you think of what diagnosis?
Catatonic schizophrenia
196
Posturing should make you think of what diagnosis?
Catatonic depression
197
Antisocial personality disorder may not be diagnosed until what age?
18 years old
198
A patient is very concerned that she has breast cancer. In order to reassure her you perform a full workup which is negative. She is still unsatisfied and convinced that she has breast cancer. What diagnosis should you be thinking of?
hypochondriasis
199
Is anorexia egosyntonic or ego-dystonic? What about bulimia?
Anorexia is egosyntonic. Bulimia is ego-dystonic
200
When treating psychiatric patients are benzodiazepines used more commonly for acute or chronic treatment?
acute
201
A 6 year old boy seems to have all of the symptoms of ADD while at school, but at home he has no problems. Does he have ADD?
No, symptoms must occur in both settings for diagnosis
202
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 is terrified of doing so. What diagnosis should be thinking of?
Avoidant personality disorder
203
A patient is very charming during his interview. You note during your interview that he has no concern for hurting or using other people. He seems to show no remorse for any of his actions. What diagnosis should you be thinking of?
Antisocial personality disorder
204
What is the most common precipitating event for posttraumatic stress disorder in women?
Rape
205
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 recommended due to very high relapse rates.
206
A 16 year old has just moved schools. He is quiet, moody, and not like himself at all. Within six months he seems to have completely changed back to his previous personality. What diagnosis should you be thinking of?
Adjustment disorder
207
What two things are needed to make a diagnosis of bipolar 2?
One major depressive episode and one hypomanic episode
208
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 diagnosis should you be thinking of?
Histrionic personality disorder
209
At what BMI should a patient be hospitalized for anorexia?
BMI < 17.5 or 20% below appropriate body weight
210
A sawtooth pattern on EKG should make you think of what diagnosis?
Atrial flutter
211
List the 4 minor criteria for diagnosing endocarditis.
Fever, embolic event (Janeway lesions or petechiae, splinter hemorrhages), immunological event (Osler nodes, glomerulonephritis), 1 positive blood culture
212
List three class 1a antiarrhythmics.
Disopyramide, quinidine, procainamide
213
An RSR prime in leads V5 or V6 should make you think of what diagnosis?
Left bundle branch block
214
What is the first line IV inotropic agent when dealing with cardiogenic shock?
Dopamine
215
A blockage of which artery causes an anterior wall MI?
Left anterior descending artery
216
Following a myocardial infarction, what medication should you be using to treat hypertension?
Beta blocker
217
Tall peaked P waves should make you think of what diagnosis?
Right atrial enlargement
218
What is the best patient position to hear aortic regurge and aortic stenosis?
sitting up and leaning forward
219
An elderly patient presents with dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely diagnosis?
Aortic stenosis
220
Name one aldosterone antagonist.
Spironolactone, eplerenone
221
A patient has a GFR of 25 and HTN. Which class should you use, a loop or a thiazide diuretic?
A loop will work no matter how low the GFR is. Thiazides will only work with a GFR over 30.
222
After a thiazide diuretic, what medication should you start in a hypertensive patient who also has diabetes?
An ACEI or an ARB
223
Which EKG lead are used to diagnose an anterior wall MI?
V1, V2 and V3
224
Clot busting drugs should be used within 3 hours of which two cardiac events?
STEMI and new left bundle branch block
225
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
226
Which hyperlipidemia medication may cause flushing?
Niacin
227
Any ulcers from venous insufficiency painful or painless?
painless
228
Where do most aortic dissections occur?
the ascending or descending thoracic aorta
229
What two labs do you want to monitor in a patient on an ACEI?
serum creatinine and serum potassium
230
What are the three major criteria for endocarditis?
2 positive blood cultures, a positive transesophageal echocardiography, new murmur
231
Where is disease of the pulmonary valve best heard?
2nd left intercostal space
232
A continuous murmur most likely involves what area of the heart?
It is most likely a septal defect
233
Where on your patient should you listen for the murmur associated with an atrial septal defect?
At the left second or third interspace
234
A patient recently started taking Lipitor. He is now complaining of aches and pains. What test should you order?
Serum creatinine kinase, you're looking for rhabdomyolysis
235
A patient complains of severe pleuritic chest pain that is relieved with sitting and leaning forward. What is the most likely diagnosis?
Pericarditis
236
An EKG shows two premature ventricular contractions. These two QRS waves look very different. What is the term for this?
Multifocal premature ventricular contractions
237
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
238
What side effect might make a patient stop taking an ACEI?
Cough
239
On physical exam, you hear a harsh systolic murmur along the right sternal border. What is the most likely diagnosis?
Aortic stenosis
240
An RSR prime in leads V1 or V2 should make you think of what diagnosis?
Right bundle branch block
241
A patient has just received a cardiac stent. How long will he be on aspirin and clopidogrel?
One year
242
A beta natriuretic peptide below what level rules out CHF?
< 100
243
Define orthostatic hypotension
A drop in systolic blood pressure of > 20 mmHg when standing up
244
Which EKG leads are used to diagnose an anterolateral MI?
V5 and V6
245
What two leads do you use to determine the axis of the heart?
Lead I and AVF
246
What medication might you switch to if a patient develops an intolerable cough on an ACEI?
Angiotensin receptor blocker (ARBs)
247
Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis?
CHF
248
Both lead I and AVF have positive QRS complexes. Does this represent normal axis, left axis deviation, or right axis deviation?
normal axis
249
What is the first line medical treatment for torsades de pointes?
Magnesium sulfate
250
What is the first line medical treatment for pericarditis?
Aspirin and NSAIDs
251
What is the appropriate treatment for a patent ductus arteriosus.
Indomethacin
252
What is the first line medical treatment for stage 1 hypertension?
Thiazide diuretic
253
Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work?
No, a recent change moves mitral valve prolapse from high risk to moderate risk
254
What is the best test for diagnosing CHF?
Echo
255
Which lab should be tightly monitored in a patient taking an aldosterone antagonist?
Potassium, they may have hyerkalemia
256
In a patient with aortic stenosis, will the PMI be medially displace, normal or laterally displaced?
It will be laterally displaced due to left ventricular hypertrophy
257
Statins are the drug of choice to treat what type of dyslipidemia?
Elevated LDL
258
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
259
A patient with mitral valve prolapse will often have what physical characteristics?
Often a thin female
260
An 82 year old patient complains of headaches and jaw claudication. What is the most likely diagnosis?
Giant cell (temporal) arteritis
261
What are the three inferior leads?
II, III, and aVF
262
The EKG shows irregularly irregular narrow QRS waves. What is the most likely diagnosis?
Atrial fibrillation
263
How do you treat polymyalgia rheumatica?
Low dose prednisone
264
Which cardiac medication has gynecomastia in its side effect profile?
Spironolactone
265
Lead I has a QRS that is up and the AVF lead has a QRS complex that is down. Does this represent normal axis, left axis deviation or right axis deviation?
Left axis deviation
266
Are most pulmonary valve problems congenital or acquired?
95% are congenital
267
You feel a pulse that seems to be vibrating. What term do you use to describe it?
Thrill
268
Where is disease of tricuspid valve best heard?
Along the left lower sternal border
269
What is Tietze syndrome?
Costochondritis
270
What is the most important complication of giant cell arteritis?
Blindness
271
What is the most common congenital heart disease?
Ventricular septal defect
272
List three medications which may be used for pharmacological stress testing.
Adenosine, dobutamine, dipyridamole and persantine
273
An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely diagnosis?
Supraventricular tachycardia
274
A U wave on EKG should make you think of what diagnosis?
Hypokalemia
275
Tall peaked T waves should make you think of what diagnosis?
Hyperkalemia
276
What is the best way to diagnose an aortic dissection?
CT
277
Rheumatic fever most commonly affects which valve?
The mitral valve
278
A patient complains of pain in his legs when he walks. It goes away after sittings. What term comes to mid for this symptom? What diagnosis is it associated with?
Intermittent claudication caused by peripheral arterial disease
279
What is the treatment goal for a diabetic with hypertension?
130/80
280
A question stem includes an IV drug user with a new heart murmur and fever. What is the most likely diagnosis?
Endocarditis
281
How does ezetimibe work?
Decreases intestinal absorption of cholesterol
282
A question about Prinzmetal's angina will often contain what key thing in the patient's history?
Cocaine use
283
Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?
Osler nodes
284
What is the definitive treatment for a patient with recurrent ventricular tachycardia?
Implanted defibrillator
285
Who is more likely to have an aortic aneurysm males or females?
Males are eight times as likely to have an aortic aneurysm
286
No matter what medications you use you are having trouble keeping a patient's blood pressure under control. You also noticed hyperpigmented skin and truncal obesity. What is the most likely diagnosis?
Cushing's disease
287
What is the only cyanotic congenital heart disease on the NCCPA blueprint?
Tetralogy of Fallot
288
A young boy comes into your office. He has elevated blood pressure when taken in his arm, but no femoral pulses can be palpated. What is the most likely diagnosis?
Coarctation of the aorta
289
What is the most common cause of sudden death?
Ventricular fibrillation
290
How do you define 1st degree AV block?
The PR interval is longer than 0.2 seconds or one block on EKG
291
List three congenital heart diseases.
Atrial septal defect (ASD), ventricular septal defect (VSD), coarctation of the aorta, patent ductus arteriosus (PDA), tetralogy of Fallor
292
A blockage of which artery causes a lateral wall MI?
left circumflex artery
293
List the six P's of an ischemic limb.
Pain, paresthesias, pallor, pulselessness, poikilothermia, paralysis
294
What ejection fraction is typical for a patient with CHF?
35-40%
295
The accessory pathway known as the James bundle should make you think of what syndrome?
Lown-Ganong-Levine syndrome
296
What will a CXR show for a patient with an aortic dissection?
Widened mediastinum
297
A 60 year old male presents to the ER with severe dizziness and back pain. His blood pressure is dropping, and you can feel an abdominal pulsatile mass on physical exam. What is the most likely diagnosis?
Ruptured aortic aneurysm
298
What medication calls is used to lower triglycerides?
Fibric acid derivatives
299
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
300
List three side effects of digoxin.
Nausea/vomiting, anorexia, confusion, arrhythmias (sinus brady, AV block), fatigue, vision disturbances etc.
301
You hear a loud, hard pulmonary murmur along the left sternal border. What is the most likely diagnosis?
Ventricular septal defect
302
You are counting boxes from the peak of a QRS wave on an EKG in order to determine the heart rate. What would the heart rate be if the next QRS wave peak were three boxes away? What numbers are associated with the first five boxes?
The answer is 100. The heart rates by counting boxes are 300, 150, 100, 75, 60.
303
What is the treatment for giant cell arteritis?
High dose prednisone
304
What is the most common cause of secondary hypertension?
Chronic kidney disease
305
What is the initial treatment for a myocardial infarction?
MONA - morphine, oxygen, nitroglycerin and aspirin
306
What is the first line medication for a patient with symptomatic bradycardia?
Atropine
307
You see regular P waves and regular QRS complexes, but you do not seem to have any correlation to each other. What is the diagnosis?
Third degree AV block
308
What is the best location to hear problems with the aortic valve?
2nd intercostal space
309
What is the gold standard for diagnosis of giant cell arteritis?
Biopsy of the temporal artery
310
If you hear a midsystolic click you should immediately be thinking about what diagnosis?
Mitral vale prolapse
311
A wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what diagnosis?
Aortic regurgitation
312
What terms will likely be include in a description of a patient with a pheochromocytoma?
Thin, diaphoretic, tachycardic, agitated
313
Do loop diuretics causer hyperkalemia or hypokalemia?
Hypokalemia
314
A boot-shaped heart on CXR should make you think of what congenital heart condition?
Tetralogy of Fallot
315
A patient presents to the ER in acute CHF. What drug class will likely be the first choice?
Loop diuretics
316
On auscultation, you hear a hard blowing pansystolic murmur at the apex. What is the most likely diagnosis?
Mitral regurgitation
317
Define pulsus alternans.
EKG waveform changes from beat to beat
318
What is the treatment for a patient with a Mobitz II AV block?
Pacemaker
319
List two risk factors for an aortic dissection?
Hypertension, Marfan's syndrome, bicuspid aortic valve, pregnancy
320
You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?
Wolff-Parkinson-White syndrome
321
Which finding requires immediate attention: left bundle branch block or right bundle branch block?
New left bundle branch block is at STEMI equivalent, Right bundle branch block is usually not a problem.
322
What is represented by ST segment depressions greater than 1 mm on EKG?
Ischemia
323
What is the gold standard for diagnosing myocarditis?
Myocardial biopsy
324
What is the therapeutic range for INR following an organic valve replacement?
2 to 3
325
Name a common cause of a junctional rhythm.
Digitoxin toxicity
326
Calf pain should always make you think of what diagnosis?
DVT
327
What are three things in your differential if you have a paradoxical pulse?
Cardiac tamponade, pericarditis, and pulmonary obstructive lung diseases (think COPD)
328
What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?
Dressler's syndrome
329
What is the most common cause of CHF?
Coronary artery disease
330
A patient in the ER has no pulse; but on EKG, there are wide irregular "complexes" which are at an irregular rate. They all appear very different from one another. What is the treatment for this patient?
He is in ventricular fibrillation. The treatment is defibrillation
331
A biphasic P wave should make you think of what diagnosis?
Left atrial enlargement
332
What is the management of a patient in supraventricular tachycardia?
Vagal maneuvers, carotid massage, adenosine
333
What class of cardiac medications should be avoided in patients with asthma?
Beta blockers (blocks receptors for bronchodilators)
334
What is the most common cause of sudden cardiac death?
Ventricular fibrillation
335
What is the other term for Mobitz type I?
Wenckebach
336
Giant cell arteritis is associated with what other disease?
Polymyalgia rheumatica
337
Subacute endocarditis is most commonly caused by what organism?
Strep Viridans
338
An Osborn or J wave on EKG should make you think of what diagnosis?
Hypothermia
339
What is the most common cause of an atrial septal defect?
Patent foramen ovale
340
What is the definitive treatment for cardiac tamponade?
Pericardiocentesis
341
List the components of Virchow's triad.
Stress, vascular injury, hypercoagulability
342
On palpation, what size is normal for the aorta?
Less than 3 cm
343
A CXR shows a "3" sign with notching of the ribs. What is the most likely diagnosis?
Coarctation of the aorta
344
What will the heart rate be if the AV node is pacing the heart?
40-60 beats per minute
345
What lab results will increase the risk of digoxin toxicity?
hypokalemia or hypercalcemia
346
The heart rate is irregular, so you can't count boxes between QRS waves to determine heart rate. What is another method you can use to determine rate on an EKG?
Count QRS waves in a six second strip and multiply by 10 to get beats per minute
347
Give two contraindications for using an ACEI.
Bilateral renal artery stenosis, history of angioedema, pregnancy
348
A patient presents to the ER with tearing chest pain radiating to his back. What is the most likely diagnosis?
Aortic dissection
349
What is the accessory pathway associated with Wolff-Parkinson-White syndrome?
The bundle of Kent
350
What is the most likely diagnosis for a young man who experiences sudden death while playing sports?
Hypertrophic cardiomyopathy
351
Paroxysmal nocturnal dyspnea should make you think of what diagnosis?
CHF
352
List three catastrophic complications of a myocardial infarction.
Papillary muscle rupture, myocardial wall rupture and left ventricular aneurysm
353
Acute endocarditis is most commonly caused by what organism?
Staph aureus
354
An opening snap on auscultation of the heart should make you think of what diagnosis?
Mitral stenosis
355
You have a patient with diagnosis of a pheochromocytoma. While waiting for surgery, should you use an alpha blocker or a beta blocker?
Alpha blocker. Never use a pure beta blocker.
356
What is the most common place for an aortic aneurysm?
In the abdomen and below the renal arteries
357
You hear a continuous machine-like murmur. What is the most likely diagnosis?
Patent ductus arteriosus (PDA)
358
A patient complains of severe crushing chest pain. EKG shows ST segment elevations. All labs including troponins and CK-MB are negative. What is the most likely diagnosis?
Prinzmetal's angina
359
Define paradoxical pulse.
There is a large difference in pulse pressure between inhalation and exhalation
360
You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis?
Transesophageal echo
361
Which cardiac medication is used to help with cardiac contractility after you have optimized most of the other cardiac medications?
Digoxin
362
What is the gold standard for diagnosing coronary artery disease?
Cardiac catheterization
363
Are ulcers from arterial insufficiency painful or painless?
Painful
364
What are the five components of teratology of Fallot?
Ventricular septal defect, right ventricular hypertrophy, right ventricular outflow obstruction (pulmonary valve stenosis), overriding aorta, right sided aortic arch
365
List two diagnoses which require antibiotic prophylaxis for "dirty procedures"?
prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congenital cyanotic heart defect
366
What are the two main causes of aortic stenosis?
Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease
367
An EKG shows a regular rate of 50 beats per minute. The QRS is narrow and there is no visible P wave. What is the most likely diagnosis?
Junctional rhythm
368
Where is disease of the mitral valve best heard?
At the apex
369
What is the definitive treatment for atrial flutter?
Radiofrequency catheter ablation
370
A patient presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all of the leads. What is the most likely diagnosis?
Pericarditis
371
List two cause of right atrial enlargement.
Pulmonary HTN, severe lung disease, pulmonary valve stenosis
372
A pathologic S3 is most commonly associated with what diagnosis?
CHF
373
According to the CDC, what is the range for a normal BMI?
18.5-24.9
374
You have a patient with pulsus paradoxus. What two diagnosis should you be thinking of?
Cardiac tamponade, pericarditis, pulmonary obstructive lung diseases (think COPD)
375
A fixed or consistent split S2 should make you think of what diagnosis?
Atrial septal defect
376
What two antibiotics are used for empiric treatment of endocarditis?
Vancomycin and ceftriaxone together are first line empiric treatment
377
A Blalock procedure is used to correct what congenital heart condition?
Tetralogy of Fallot
378
What imaging needs to be done before taking a patient to the OR with an aortic aneurysm?
CT (echo may be used as initial study, but CT is need for surgery)
379
What two valvular issues do patients with Marfan's syndrome often have?
Aortic regurgitation and mitral valve prolapse (you can tell them apart by where they are heard)
380
Name three medication "classes" which are used to reduce LDL?
Statins, ezetimibe, niacin and nicotinic acid
381
Define stage 1 hypertension according to JNC 7.
Systolic pressure of 140-149 and diastolic of 90-99
382
What is the heart rate for tachycardia? How about bradycardia?
Tachycardia > 100, bradycardia < 60
383
The term satellite lesion should make you think of what diagnosis?
Candida diaper rash
384
Salmon-colored scales should make you think of what diagnosis?
Psoriasis
385
What are the ABC's of melanoma?
Asymmetry, border, color, diameter, elevation/irregularity, evolving
386
Pitting nails are associated with what dermatologic disorder?
Psoriasis
387
What are the two most common organisms responsible for cellulitis?
Strep and Staph
388
A herald patch should make you think of what diagnosis ?
Pityriasis rosea
389
How do you treat pityriasis rosea?
Reassurance
390
Coin-shaped plaques should make you think of what diagnosis?
Nummular eczema
391
What is the best lab test for scabies?
Microscopic examination under oil immersion
392
Honey-colored crusts should make you think of what diagnosis?
Impetigo
393
What is the treatment for seborrheic keratosis?
It is benign so there is no need to treat it. Lesions may be removed if unsightly
394
Are lesions from psoriasis typically found on flexor or extensor surfaces?
Extensor
395
How do you treat lichen simplex chronicus?
Get the patient to stop scratching it
396
Extremely pruritic lesions with burrows in runs should make you think of what diagnosis?
Scabies
397
How do you treat a stasis dermatitis?
Compression stockings
398
A patient with a history of herpes now presents with a target lesions. What is the most likely diagnosis?
Erythema multiforme
399
A teardrop lesion after a course of strep throat should make you think of what diagnosis?
Guttate psoriasis
400
Why should actinic keratosis be treated?
It may progress to squamous cell carcinoma
401
What dermatologic finding is associated with insulin insensitivity?
Acanthosis nigricans
402
Depigmented patches of skin should make you think of what diagnosis?
Vitiligo
403
Spaghetti and meatballs on KOH prep should make you think of what diagnosis?
Tinea versicolor
404
What dermatologic finding is associated with asthma?
Atopic dermatitis
405
A patient presents with flaky skin in the nasolabial folds and on her scalp. What is the most likely diagnosis?
Seborrheic dermatitis
406
Tapioca blisters should make you think of what diagnosis?
Dyshidrosis - these are usually on hands and feet
407
Nummular eczema is most like what other dermatological disorder?
Atopic dermatitis
408
How do you treat dyshidrosis?
Topical steroids
409
What is the first step in treating atopic dermatitis?
behavioral modifications - reduce bathing, only use soap on face and genitals, use natural breathable fabrics
410
What two human papillomaviruses are most responsible for condyloma acuminata?
HPV 6 and 11
411
What is the treatment for melanoma?
Wide local excision
412
Where are 90% of basal cell lesions found on the body?
On the head and neck
413
What is the first line treatment for rosacea?
Metronidazole, tetracycline is probably a close second
414
Rhinophyma should make you think of what diagnosis?
Acne rosacea
415
Melasma is most often found in what patient population?
Women of childbearing age
416
What is the best treatment for molluscum contagiosum?
It is self limiting, but can be removed if patient really wants it
417
What is the first line treatment for tinea corporis
Topical azoles
418
A waxy stuck on appearance should make you think of what diagnosis?
Seborrheic keratosis
419
A Christmas tree pattern should make you think of what diagnosis?
Pityriasis rosea
420
A positive Auspitz sign should make you think of what diagnosis?
Psoriasis
421
A 30 year old female presents with pustules on her face that spare the vermillion border. In her history she has been using topical steroids. What is the most likely diagnosis?
Perioral dermatitis
422
Hyperpigmented velvety plaques should make you think of what diagnosis?
Acanthosis nigricans
423
Purple, pruritic, polygonal, papules on physical exam should make you think of what diagnosis?
Lichen planus
424
Oval patches of hair loss should make you think of what diagnosis?
Alopecia areata
425
What is the key indicator for the prognosis of melanoma?
Thickness of the lesions
426
A pearly dome-shaped lesions with a central umbilication should make you think of what diagnosis?
Molluscum contagiousum
427
Giant cells on a Tzanck smear should make you think of what diagnosis?
Herpes simplex virus
428
A 5 year old presents in early January with a red itchy rash behind his knees. You notice it on the flexor surfaces of his elbows as well. What is the most likely diagnosis?
Atopic dermatitis
429
Silvery scales should make you think of what diagnosis?
Psoriasis
430
What is the first line treatment for genital warts?
Imiquimod (Aldara)
431
A slowly growing nodule with central depression and a pearly border should make you think of what diagnosis?
Basal cell carcinoma
432
What is the treatment for a bad brown recluse spider bite?
Debridement, the venom causes tissue necrosis
433
A double comedone is indicative of what diagnosis?
Hidradenitis suppurativa
434
Large doughy hands should make you think of what diagnosis?
Gigantism
435
Cortical adrenal insufficiency is also known as what disease?
Addison's disease
436
How do glitazones work?
They improve insulin sensitivity
437
Pretibial myxedema should make you think of what diagnosis?
Graves' disease
438
In Cushing's disease is ACTH elevated or decreased?
Elevated
439
In a patient with hyperthyroidism will TSH most likely be elevated or decreased?
Decreased
440
Positive antithyroid peroxidase and antithyroglobulin antibodies should make you think of what diagnosis?
Hashimoto's
441
What is the test to begin with if you suspect a pheochromocytoma?
24 hour urine for catecholamines
442
Stocking glove anesthesia should make you think of what diagnosis?
Diabetic neuropathy and B12 deficiency neuropathy
443
Which thyroid cancer is the most aggressive?
Anaplastic
444
How do sulonylureas work?
They stimulate the produce of insulin
445
What is the most common thyroid cancer?
Papillary, makes up about 80% of thyroid cancers
446
How does levothyroxine work?
It is a synthetic T4
447
What heparin complication is relevant to endocrinology?
Adrenal infarct leading to a Cushing's syndrome
448
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%
449
What role does C-peptide play in the diagnosis of diabetes?
It is a marker of insulin production. Elevated C-peptide points to DM 2. Decreased C-peptide points towards DM 1.
450
During pregnancy which is the preferred treatment of hyperthyroidism PTU or methimazole?
PTU
451
List four diagnostic criteria for diabetes?
Random glucose > 200, fasting glucose >126, two hour postprandial glucose > 200, HgA1c > 6.5%
452
What percentage of diabetes in the US is type 2?
80-90%
453
A 35 year old female presents with heat intolerance, weight loss, and palpitations. What diagnosis should you be thinking of?
Hyperthyroidism
454
Diabetes insipidus is caused by a deficiency of which hormone?
Vasopressin
455
Fruity breath should make you think of what diagnosis?
Diabetic ketoacidosis
456
List the 5 insulins in order of peak efficacy?
Lispro 1-2 hours, Regular 2-4 hours, NPH 5-7 hours, Lente 4-8 hours, Ultralente 8-14 hours
457
List 4 physical exam findings of Cushing's syndrome.
Moon face, buffalo hump, purple striae, central obesity, supraclavicular fat pads, easy bruising
458
What medication class does metformin (Glucophage) fall into?
Biguanide
459
How do statins work to affect the lipid profile?
They slow the rate limiting step of cholesterol synthesis
460
What is the treatment for Addison's disease?
Hydrocortisone or prednisone
461
Propranolol belongs to what class of medication?
Beta blockers
462
HLA-DR gene is a marker for what endocrine disorder?
DM type 1
463
What is the main function of parathyroid hormone?
Increase serum Ca
464
Is metformin indicated or contraindicated in renal failure?
Contraindicated
465
What is the best imaging for a thyroid nodule?
Ultrasound
466
What medication might you use prior to a thyroidectomy in a patient with hyperthyroidim?
Methimazole or propylthiouracil (PTU)
467
What lipid medication may cause flushing?
Niacin
468
What is the most common pituitary adenoma?
Prolactinoma
469
What is Graves' disease?
The most common cause of hyperthyroidism. It is an autoimmune disease
470
What is the first line medical treatment for a patient with palpitations and nervousness secondary to hyperthyroidism?
Beta Blockers
471
What is the least aggressive thyroid cancer?
Papillary
472
Moans, groans, stones and bones describe symptoms of what endocrine problem?
Hyperparathyroid
473
How do fibrates work to affect the lipid profile?
They inhibit synthesis of ALDL and elevate lipoprotein lipase
474
Hyperpigmentation of the skin along creases should make you think of what diagnosis?
Addison's disease
475
What is Trousseau's sign?
Inflate BP cuff and hold for 3 minutes. Patient will low Ca will get carpal tunnel symptoms
476
What is the most common cause of hypoparathyroid?
Post thyroidectomy with complication of parathyroidectomy
477
What is Chvostek's sign?
Tap on facial nerve and get a twitch with low Ca
478
How does nicotinic acid work to affect the lipid profile?
It inhibits secretion of VLDL
479
Exophthalmos should make you think of what diagnosis?
Hyperthyroidism
480
What is the first line medical treatment for a pheochromocytoma?
Alpha blockers
481
Will ACTH be elevated or decreased in Addison's disease?
Elevated if the problem is at the adrenal glands
482
What is the most common cause of DM type 1?
Autoimmune destruction of the islet cells in the pancreas
483
What life threatening side effect do statins have?
Rhabdomyolysis
484
List two ectopic tumors that may produce ACTH and give a patient Cushing's syndrome?
Small cell lung cancer, pancreatic islet cells, thymomas
485
How does metformin work?
Decreases the hepatic glucose production and increases peripheral glucose uptake
486
What are the 5 criteria for metabolic syndrome?
HDL < 40 men < 50 females, BP >135/85, Triglycerides > 150, Fasting glucose > 100, Waist > 40 inches in mean > 35 inches in women
487
Name two tests you might use to rule out Cushing's syndrome.
24 hour free cortisol urine test and dexamethasone suppression test
488
A patient presents with erectile dysfunction and complains of some numbness in his feet. On second thought he has noticed significant polyuria and polydipsia. What diagnosis should you be thinking of?
Diabetic neuropathy
489
How much more potent is T3 than T4?
3-4x
490
What is included in Whipple's triad of hypoglycemia?
History of previous hypoglycemia, serum glucose of < 40, immediate recovery upon administration of glucose
491
What specific breathing pattern is associated with diabetic ketoacidosis?
Kussmaul respirations
492
What is the suffix associated with sulfonylureas?
ide is the suffix. Examples are glipizide, tolbutamide, tolazamide
493
What class of medications is the first line for lowering LDL?
Statins
494
As it related to diabetes, what is the dawn phenomenon?
Reduced insulin response between 5 and 8 am
495
Does niacin increase or decrease HDL?
Increase
496
What is Sheehan's syndrome?
Ischemia of the pituitary due to volume depletion during or after childbirth
497
What is Hashimoto's disease?
An autoimmune cause of hypothyroid
498
Name the four thyroid cancers.
Papillary, Follicular, Medullary, Anaplastic
499
What class of medications does pioglitazone (Actos) fall into?
Thiazolidinediones also known as glitazones
500
What is the most common cause of hyperparathyroidism?
Single parathyroid adenoma in 80% of cases
501
What is the most common cause of hypopituitarism?
Tumor
502
Typically what is the first medication started in type 2 DM?
Metformin
503
What two hormones are secreted by the posterior pituitary?
Oxytocin and antidiuretic hormone (ADH, vasopressin)
504
What is the treatment for myxedema?
Levothyroxine and slow warming
505
List the four things that suggest group A beta-hemolytic strep in a patient with pharyngitis.
Fever, tender anterior cervical adenopathy, no cough and an exudate in the throat.
506
What type of hearing loss would be caused by cerumen impaction?
Conductive
507
How do you treat allergic rhinitis?
Intranasal corticosteroid and antihistamines
508
Small grouped vesicles on the vermillion border should make you think of what diagnosis?
Herpes
509
A 45 year old female complains of feeling the ground rolling under her feet at times. What is the most likely diagnosis?
Vertigo
510
A white oral lesion which cannot be scraped off should make you think of what diagnosis?
Oral leukoplakia
511
Acute sinusitis is most commonly caused by what two pathogens?
Step pneumoniae and haemaophilus influenzae
512
List four complications of untreated strep throat
Scarlet fever, glomerulonephritis, rheumatic fever, and local abscess
513
When is watchful waiting with a diagnosis neuroma an appropriate plan?
This tumor is very slow growing. Watching a small tumors in an elderly patient is appropriate treatment
514
An x-ray of the skull revels coalescence of mastoid air cells. What is the most likely diagnosis?
Mastoiditis
515
What does Kiesselbach's plexus refer to?
A group of vein's in the anterior nose which bleed a lot
516
A patient presents with a hot potato or muffled voice. What is the most likely diagnosis?
Peritonsillar abscess
517
White oral lesions which can be scraped off leaving punctate bleeding should make you think of what diagnosis?
Oral candida
518
What is the treatment of choice for strep throat?
Penicillin, amoxicillin, erythromycin
519
How do you administer the Rinne hearing test?
Place the turning fork on the mastoid and then move it next to the ear.
520
A patient presents with acute onset of continuous severe vertigo for the past five days. He does have a history of URI 2 weeks ago. What is the most likely diagnosis?
Labrynthitis
521
What type of hearing loss is associated with aging?
Sensory
522
What virus causes mumps?
Paramyxovirus
523
What are three possible treatments for peritonsillar abscess?
Needle aspiration, I&D, and tonsillectomy
524
A child presenting with an erythematous sandpaper rash should make you think of what diagnosis?
Scarlet fever
525
List the time of year when each of the following allergens is most prominent. Pollen, Grass, Ragweed and Mold.
Pollen from trees and flowers = spring, grasses are the summer, mold and ragweed are fall.
526
A patient presents with unilateral hearing loss and a decrease in speech discrimination. She has also had difficulty with balance over the past week. What is the most likely diagnosis?
Acoustic neuroma
527
How long should pressure be applied to treat epistaxis?
15 minutes
528
A patient presents with several episodes of vertigo over the past few weeks. He has had intermittent unilateral hearing loss and a "blowing" in his ears. What is the most likely diagnosis?
Meniere's disease
529
A 14 year old field hockey player presents with prominent adenopathy, white purple exudates in the tort and a palpable spleen. What is the most likely diagnosis?
Mononucleosis
530
A patient with a history of smoking presents with a new onset hoarseness. This has been persistent for the past two weeks. What is the most likely diagnosis?
Laryngeal squamous cell carcinoma
531
How do you administer the Weber hearing test?
Tuning fork placed in the middle of the forehead.
532
Which is the most commonly affected sinus in acute sinusitis?
Maxillary
533
A patient presents drooling, with stridor and in tripod position. What is the diagnosis and how do you treat it?
Epiglottis is treated with a third generation cephalosporin - ceftriaxone
534
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
535
What time frame are we talking about for chronic sinusitis?
>3 months
536
In a patient with sensorineural hearing loss, what will be the results of the Weber test?
The patient will hear the sound louder in the unaffected ear
537
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.
538
After 10 days of worsening sinusitis what antibiotic should you start?
Augmentin (Amoxicillin/clavulanate)
539
A patient presents with acute swelling and pain in the cheek that increases at meals. What is the most likely diagnosis?
Sialadenitis (salivary gland infection)
| -Staph aureus
540
Oral herpes is best treated with systemic or topical antivirals?
Topical is the first line. Systemic antivirals will help but are only indicated for severe cases.
541
Often caused by chlamydia what is the syndrome characterized by urethritis (or cervicitis), arthritis and conjunctivitis?
Reiter's syndrome
542
Define phimosis.
Foreskin can not be retracted
543
Will serum potassium be decreased or elevated in renal failure?
Elevated
544
Muddy-brown sediment in the urine should make you think of what diagnosis?
Acute tubular necrosis
545
What are the two most common predisposing factors in the development of chronic renal failure?
HTN and DM
546
What is the best imaging to tule out testicular torsion?
Doppler U/S for decreased blood flow to the testes
547
List one major risk factor for bladder cancer?
Smoking
548
What is the condition where the urethral meatus is not at the tip of the penis?
Hypospadias and in far fewer cases epispadias
549
Define priapism.
Painful persistence erection.
550
A urine protein of >3.5 grams/day should make you think of what diagnosis?
Nephrotic syndrome
551
A 65 year old male presents with frequency. On digital rectal exam you feel an elastic moderately enlarged prostate. What diagnosis should you be thinking of?
BPH
552
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
553
Tenderness at the costovertebral angle should make you think of what diagnosis?
Pyelonephritis
554
Both testicles should be descended by what age?
3 months
555
What is the first line treatment for a varicocele?
Watchful waiting unless there is a question of futility
556
What is the most common type of kidney stone?
Calcium makes up 85% of kidney stones
557
An involuntary loss of urine during coughing or laughing is what type of incontinence?
Stress incontinence
558
What is the first line antibiotic for prostatitis?
Bactrim 4-6 weeks
559
What is the name of the condition that involves fibrous scar tissue in the penis causing a curvature of the erect penis?
Peyronie's disease
560
Which problem is an emergency phimosis or paraphimosis?
Paraphimosis
561
What is the most accurate way to diagnose urethritis?
Urine PCR
562
What is the most common type of testicular cancer?
Non-seminoma
563
List three possible treatments for stress incontinence in women.
Kegels, estrogen therapy, surgical placement of a urethral sling.
564
Give two major risk factors of erectile dysfunction.
Diabetes, hypertension, depression, coronary artery disease
565
An ABG shows a pH of 7.2, a bicarb of 25 and a PCO2 of 50. Is this respiratory or metabolic acidosis?
respiratory - CO2 is elebated
566
What is the normal pH of the blood?
7.35-7.45
567
A patient who has normal bladder function, but can not get to the bathroom has what type of incontinence?
Functional incontinence
568
How do you treat urethritis?
Ceftriaxone and doxycycline
569
What is the first line antibiotic treatment for cystitis?
Bactrim
570
What is the imaging study of choice if you suspect bladder cancer?
Cystoscopy and biopsy
571
A kidney stone of less than what size will likely pass on its own?
Less than 5 mm
572
What is the mot specific imaging modality for diagnosing kidney stones?
CT
573
Will epididymitis feel better with scrotal elevation?
Yes
574
Will a spermatocele transilluminate?
Yes
575
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.
576
Define paraphimosis.
Foreskin is retracted and cannot be reduced.
577
Name the condition in which the head of the penis curves downward or upward, at the junction of the head and shaft of the penis. (Hint: It is often associated with hypospadias.)
Chordee
578
A PSA above what level should start to make you concerned?
>4.0
579
What type of incontinence is often associated with BPH?
Overflow incontinence, the bladder cannot empty sufficiently
580
List two risk factors for prostate cancer.
Advancing age, African American, positive family history, high fat diet
581
What is the normal level or serum bicarbonate (HCO3)?
24 mEq/Liter
582
A 3 year old boy presents with hematuria and a painless palpable abdominal mass. What diagnosis should you be thinking of?
Wilms tumor
583
Where is the epididymis found?
It is found at the posterior upper pole.
584
What is considered a normal PCO2?
40 mmHG
585
What area of the prostate is the primary site for prostate cancer?
The peripheral zone
586
What area of the prostate is affected by BPH?
The transitional zone
587
Painless hematuria should make you think of what diagnosis?
Bladder cancer
588
What is the most likely diagnosis for a free floating, painless cystic mass found posterior and superior to the testes?
Spermatocele
589
What is the most common organism responsible for prostatitis?
E. coli
590
What is the treatment for epididymitis?
Ceftriaxone and doxycycline
591
Feeling a bag of worms in the scrotum should make you think of what diagnosis?
Varicocele
592
A prostate biopsy consists of how many samples?
6 to 12
593
A fluid filled painless mass found in the scrotum which transilluminates should make you think of what diagnosis?
Hydrocele
594
Name the sign which is defined as decreased pain with scrotal elevation?
Prehn's sign
595
White blood cell casts should make you think of what diagnosis?
Pyelonephritis
596
Tea-colored urine with red cell casts should make you think of what diagnosis?
Glomerulonephritis
597
What is the most common bladder cancer?
Transitional cell cancer
598
What might you feel on a digital rectal exam of a patient with prostate cancer?
Enlarged prostate, hard nodules within the prostate
599
What is the most common organism that causes a bladder infection?
E. coli
600
List three possible causes of prerenal renal failure.
CHF, severe dehydration, hemorrhage
601
Maltese crosses in the urine should make you think of what diagnosis?
Nephrotic syndrome
602
What is the mot common cause of post renal failure?
BPH, post renal renal failure is secondary to an outflow obstruction
603
What hereditary pattern does polycystic kidney disease follow?
Autosomal dominant
604
What medication classes are prescribed in order to help prevent chronic renal failure in diabetic patients?
ACEIs or ARBs
605
What age range is typically associated with testicular torsion?
10-20 years old
606
In a folic acid deficiency anemia the folic acid level is typically below what level?
<150
607
What is the most common microcytic anemia?
Iron deficiency anemia
608
If a question presents a pregnant woman with anemia what is the most likely diagnosis?
Iron deficiency
609
A low retic count and a normal serum ferritin should make you think of what diagnosis?
Anemia of chronic disease
610
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 and B12 deficiency
611
Under normal conditions at what hemoglobin level would you begin to consider a transfusion?
8
612
You should be thinking alpha thalassemia if the question stem includes which four geographic areas?
Southeast Asia, China, Middle East, Africa
613
Auer rods are most commonly associated with what disease?
Acute myeloid leukemia
614
What is pica?
Eating non-food items including ice, paper, dirt, hair
615
What is Schilling's test used for?
Test for the cause of a B12 deficiency
616
An African American teenage presents with avascular necrosis of the his right femoral head. What diagnosis should you be thinking of?
Sickle cell disease
617
List four disease states in which you may find basophilic stippling.
Lead poisoning, beta or alpha thalassemia, sideroblastic anemia, arsenic poisoning
618
Would a B12 deficiency anemia most likely be microcytic, normocytic, or macrocytic?
Macrocytic
619
What molecule binds iron in the blood stream?
Transferrin
620
Inability to absorb vitamin B12 due to lack of intrinsic factor is what disease?
Pernicious anemia
621
Does an increase in reticulocytes indicate a decrease or an increase in RBC production?
An increase, reticulocytes are newly released "baby" RBC's
622
Will unconjugated bilirubin be high or low in a patient with sickle cell disease?
High
623
Would anemia of chronic disease most likely be macrocytic, normocytic, or microcytic?
Normocytic
624
Will the serum ferritin be high or low in a patient with iron deficiency anemia?
It will almost always be low
625
G6PD deficiency follows what pattern of inheritance?
X-linked
626
Strict vegans are at risk for what type of anemia?
B12 deficiency anemia
627
The term Philadelphia chromosome should make you think of what diagnosis?
Chronic myeloid leukemia
628
Will the retic count be elevated, decreased, or normal in B12 deficiency anemia?
Retic count will be low. Low building blocks means low production.
629
Stocking glove paresthesias should make you think of what two diagnoses?
B12 deficiency neuropathy and diabetic neuropathy
630
List the three diagnosis you should be thinking of if a question includes Heinz bodies.
G6PD deficiency anemia, chronic liver disease, alpha thalassmeia
631
What is the normal range for MCV?
80-100
632
Will the RBC's be large, small or normal size in B12 deficient anemia?
Macrocytes
633
What two main causes should you be thinking of in a macrocytic anemia?
Malnutrition and severe blood loss
634
Asplenism secondary to sickle cell disease increases a patient's risk for what type of infections?
Capsulated organisms like Strep pneumonia and H. flu.
635
Will a hemolytic anemia generally have an elevated or decreased retic count?
Elevated
636
Iron deficiency anemia will have a serum iron lower than what value?
30
637
Are target cells seen in mild or severe iron deficiency anemia?
Severe, they are also seen in alpha thalassemia, Chronic liver disease, and asplenia
638
What does koilonychia refer to?
Spoon-shaped nails which may be found in microcytic anemia
639
How do you treat a sickle cell crisis?
Fluids, oxygen, pain medication, transfusion may be necessary
640
Is sickle cell microcytic, macrocytic or normocytic?
Microcytic
641
What hematological disorder should you think of if the questions talks about the patient eating ice or dirt?
Iron deficiency anemia
642
A patient of Mediterranean descent is a clue for which type of anemia?
Beta Thalassemia
643
A leukemia patient has a CT of the liver which shows punched out lesions. What diagnosis should you be thinking of?
Hepatosplenic candida
644
Rice water stool should make you think of what diagnosis?
Cholera
645
What is the best test to diagnose malaria?
Peripheral blood smear
646
What class of antibiotics is sometimes prescribed specifically for its effects on increasing GI mobility?
Macrolides
647
What are the two important pieces of patient education for anyone diagnose with mononucleosis?
No contact sports (splenic rupture) and no kissing (highly contagious)
648
A patient ate out last night and today has cramping and bloody diarrhea. What is the most likely organism?
Salmonella
649
Why can't you give fluoroquinolones to kids?
They can cause cartilage development problems
650
What organism causes toxoplasmosis?
Toxoplasma gondii
651
Which herpesvirus causes Epstein-Barr?
Herpes 4
652
Owl eye inclusion bodies should make you think of what diagnosis?
Cytomegalovirus (CMV)
653
A patient complains of a rash on his palms and soles. He has a fever and chills. In conversation he mentions a strange painless chancre he had a few weeks ago. What diagnosis should you be thinking of?
Secondary syphilis. This is the most contagious stage.
654
What is the current drug of choice for treating MRSA?
Vancomycin
655
What might happen if you infuse vancomycin too fast?
Red Man syndrome
656
Syphilis is caused by what organism?
Treponema pallidum
657
How do you treat hookworms?
Azoles
658
What are three medications often combined as a first line treatment for H. pylori?
Omeprazole, clarithromycin and amoxicillin (PPI + 2 Antibiotics)
659
What is the most common prophylactic antibiotic used preoperatively?
Cefazolin = Ancef, Keflex = Cefalexin, The answer is Cefazolin (Ancef)
660
A painless, clean base chancre should make you think of what diagnosis?
Primary syphilis
661
What does trismus mean?
Lock jaw, often secondary to tetanus
662
What organism is the most common cause of an uncomplicated urinary tract infection?
E. Coli
663
What is the treatment for cholera?
Fluids
664
A patient presents to the ER with acute progressive weakness, diplopia and a very dry mouth. What organism may be causing this?
Clostridium botulinum
665
Is Klebsiella gram (+) or gram (-)?
Gram (-)
666
If you have a patient with positive blood cultures for candida what is the first line drug?
Amphotericin B
667
What organism is believed to be the main culprit in creating peptic ulcers?
Helicobacter pylori
668
Any reference to dark field microscopy should make you think of what organism?
Treponema pallidum
669
How do you treat white oral plaques that can be scraped off?
This is most likely candida. Topical nystatin or oral fluconazole 1 mg are first line choices
670
What is the current drug of choice for the cytomegalovirus?
Ganciclovir
671
A patient is bitten by a rabies infected raccoon. On what days do you give human haploid cells?
0, 3, 7, 14, 28
672
A patient presents complaining of a metallic taste in her mouth and dark brown urine. What antibiotic might she be on?
Metronidazole (Flagyl)
673
How do you definitively diagnose rabies?
Pathology of the brain of the animal that performed the bit using fluorescent antibody stain
674
What disease does Rickettsia rickettsii cause?
Rocky Mountain spotted fever
675
What drug do you use to treat pinworm?
You treat everyone in the house with albendazole. Two weeks later you treat them again.
676
What is the minimum amount of time needed for a tick to transfer Lyme disease to a human?
24 hours
677
What is the suffix used for most fluoroquinolone?
Oxacin
678
A patient being treated with penicillin for a syphilis infection develops fever, chills, muscle pain and headaches. Do you stop treatment?
No this is Jarisch-Herxheimer reaction. The patient must be closely monitored, but it is a response to released endotoxin from the death of the spirochetes and not an allergic reaction.
679
What drug is used for the treatment or prophylaxis of malaria?
Chloroquine
680
What organism has been linked to reactive arthritis?
Shigella, also remember that reactive arthritis has a positive HLA-B27
681
List two macrolides.
Erythromycin, azithromycin, clarithromycin
682
What is the drug of choice for treating Rocky Mountain spotted fever?
Doxycycline
683
What is the first symptom of a rabies infection?
Pain and anesthesia at the site of the bite
684
What is the drug of choice to treat a urethritis caused by neisseria?
Ceftriaxone (Rocephin)
685
Why aren't fluoroquinolones used more frequently?
They have lots of side effects
686
Name one oral medication that can be used for MRSA.
Linezolid (Zyvox) and Bactrim
687
What is the drug of choice for the treatment of syphilis?
Penicillin
688
What antibiotic class of choice for chlamydia?
Macrolides
689
What type of mosquitoes carry malaria?
Anopheles
690
What is the drug of choice to treat C. difficile?
Metronidazole (Flagyl)
691
What is the clinical name for whooping cough?
Pertussis
692
Is pseudomonos gram (+) or gram (-)?
Gram (-)
693
What are four steps in treating diphtheria?
Antitoxin, penicillin, remove membrane, report the case to the CDC
694
How do hookworm larvae enter the body?
The penetrate the skin usually through the soles of the feet
695
Is diphtheria a Gram-positive or negative organism?
Gram-positive
696
The scotch tape test is used to diagnose what disease?
Pinworm
697
An HIV patient presents with a nonproductive cough and a CXR showing diffuse interstitial infiltrates. What diagnosis should you be thinking of?
Pneumocystis jiroveci pneumonia (PCJ) formerly known as Pneumocystis pneumonia (PCP)
698
What is the treatment for a tetanus infections?
Penicillin, immune globulin and supportive care (especially respiratory care)
699
Pregnant woman and cat little should make you think of what diagnosis?
Toxoplasmosis
700
A COPD patient has apical cavities and calcified nodes on his CXR. You also discover he has a pet bat and a few birds. What diagnosis should you be thinking of?
Histoplasmosis
701
What class of antibiotics should you start with for community acquired pneumonia?
Macrolides
702
What type of organism causes botulism?
A Gram + rod, Clostridium botulinum
703
What tests are done to screen for HIV?
ELISA, then if positive the diagnosis is confirmed with a Western blot test
704
Which medication is worse to give a pediatric patient, tetracycline or an aminoglycoside?
Tetracycline
705
What type of organism causes tetanus?
A Gram + rod, Clostridium tetani
706
An India ink stain showing cysts should make you think of what diagnosis?
Cryptococcosis
707
What is the treatment for Shigella?
Bactrim or fluoroquinolones and hydration
708
What is the drug of choice to treat Lyme disease in kids or pregnant women?
Amoxicillin
709
A 16 year old girl presents with an exudative sore throat and general malaise. On physical exam you observe some posterior chain lymphadenopathy and mild splenomegaly. What diagnosis should you be thinking of?
Epstein-Barr virus
710
A Gram-positive organism in chains should make you think of what diagnosis?
Strep
711
A CT scan shows ring enhancing lesions in an HIV patient. What diagnosis should you be thinking of?
Toxoplasmosis
712
Diarrhea with blood and mucus should make you think of what diagnosis?
Shigella
713
Gummas or granulomatous nodules should make you think of what diagnosis?
Tertiary syphilis
714
How do you treat pneumocystis jiroveci pneumonia (PCJ) formerly known as pneumocystis pneumonia (PCP)?
Bactrim
715
What organism cause Lyme disease?
Borrelia burgdorferi
716
What is the best test for diagnosing Rocky Mountain spotted fever?
Indirect immunofluorescent antibodies
717
A stuck on grey membrane in the pharynx should make you think of what diagnosis?
Diphtheria
718
Name three serious reactions a patient may have with the use of vancomycin?
Nephrotoxicity, ototoxicity, and Stevens-Johnson syndrome
719
What antibiotic is most likely to cause C. diff?
Clindamycin
720
Is staph gram (+) or gram (-)?
Gram (+)
721
Pizza pie retinopathy should make you think of what diagnosis?
Cytomegalovirus (CMV)
722
A patient was camping a few days ago and now has a rash that began on his wrists and ankles. What diagnosis should you be thinking of?
Rocky Mountain spotted fever
723
White curd like vaginal discharge should make you think of what diagnosis?
Vaginal candida infection
724
Is neisseria gram (+) or gram (-)?
Gram (-)
725
A gram-negative coccobaccili found in the sputum of patient with pneumonia should make you think of what diagnosis?
H. flu
726
What is the treatment for pertussis?
Erythromycin x 7 days
727
What is the drug of choice for toxoplasmosis?
Bactrim
728
What is the drug of choice for the treatment of Lyme disease?
Doxycicline
729
What is the treatment for botulism?
Antitoxin
730
A Gram-negative diplococci should make you think of what diagnosis?
Neisseria
731
Honey and babies should make you think of what diagnosis?
Botulism
732
Community acquired carditis is most often caused by one of the HACEK organism. List the HACEK organisms.
Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella
733
A gram-positive organism in clusters should make you think of what diagnosis?
Staph
734
What is the prophylactic antibiotic most commonly given before a dental procedure if one is necessary?
Amoxicillin 2 grams po 1 hour before procedure
735
How do you treat amebiasis?
Metronidazole (Flagyl)
736
You place a patient on rifampin. What side effect should you warn her about?
Orange-red discoloration of body fluids
737
What organism is most commonly responsible for community acquired pneumonia?
Strep pneumoniase
738
A diaper rash with satellite lesions should make you think of of what diagnosis?
Candida
739
Bloody stool with cysts and trophozoites should make you think of what diagnosis?
Amebiasis
740
What oral antibiotic can be used for pseudomonas?
Ciprofloxacin
741
A patient presents with ruptured Achilles tendon. He states that he was recently in the hospital for a "blood infection and on a ton of antibiotics." What antibiotic class may he have been on?
Fluoroquinolones
742
What medication is used as prophylaxis for meningococcal meningitis?
Rifampin
743
A patient was in the woods yesterday and today presents with erythema migraines. What diagnosis should you be thinking of?
Lyme disease
744
At approximately how many weeks pregnant is the uterus at the level of the symphysis pubis?
12 weeks
745
List 2 risk factors for ovarian cancer.
BRCA1, family history, nulliparity, late menopause, Caucasian, Asian
746
What is the most common cause of secondary amenorrhea?
Pregnancy
747
What ethnic background is at an increased risk of fibroids?
African Americans are 5s more likely to have fibroids compared to Caucasian women.
748
Define the third stage of labor.
Delivery of the baby to delivery of placenta
749
What is the most popular term for Stein-Leventhal syndrome.
Polycystic ovarian syndrome
750
Vaginal infection with motile flagellated protozoa should make you think of what diagnosis?
Trichomonas vaginitis
751
List four risk factors for breast cancer?
BRCA1 or BRCA2 positive, unopposed estrogen, nulliparity, early menarche, late menopause
752
How is the first day of the menstrual cycle defined?
The first day of menstrual bleeding is the first day of the cycle
753
A cervical biopsy comes back as CIN1. What is the next step?
Repeat Pap smear in 6 months and repeat colposcopy in 12 months
754
List two mediation commonly used for hypertension in pregnancy.
Methyldopa and labetalol
755
If you see the term chocolate cyst, it should make you think of what diagnosis?
Endometrioma
756
Define abortion.
Delivery of uterine contents before 20 weeks.
757
Define menorrhagia.
Heavy prolonged menstrual flow
758
What is a cystocele?
A herniation of the bladder into the vagina
759
What is the mean age for ovarian cancer?
63, you will need to think of this in an older patient with vague abdominal symptoms
760
What medication is used to increase surfactant levels and help with lung maturity if you are worried about preterm labor?
Betamethasone
761
List two risk factors for cervical cancer.
Multiple sexual partners, smoking
762
Which is associated with painful third trimester bleeding placental abruption or placenta previa?
Placental abruption
763
List three risk factors for placental abruption.
HTN, smoking, AMA, cocaine use, PROM
764
What is the classic triad of pre-eclampsia?
HTN, edema and proteinuria
765
At what age is primary amenorrhea diagnose?
Age 14 if no secondary sex characteristics. Age 16 if some secondary development
766
What is the karyotype for a patient with Turner's syndrome?
(45, X) They are missing one sex chromosome
767
When is it recommended to begin Pap smears?
New guidelines suggest to begin testing women at age 21 and not before
768
What location within the pelvis is endometriosis most commonly found?
On an ovary
769
What is the #1 cause of septic arthritis in sexually active young adults?
Neisseria gonorrhoeae
770
How much time needs to pass before diagnosing secondary amenorrhea?
If cycles have been normal 3 months. If cycles have been irregular 6 months.
771
Give the definition for preterm labor.
Contractions that open the cervix before 37 weeks.
772
What would you expect to see on a KOH prep if the patient had vaginal candidiasis?
Pseudohyphae
773
A physical exam revealing a retroverted uterus or uterosacral ligament nodularity should make you think of what diagnosis?
Endometriosis
774
How many days after conception is a serum beta-HCG positive?
8
775
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.
776
What are two important things you need to tell your patients before putting them on metronidazole?
Stay out of the sun and avoid alcohol
777
Define missed abortion.
No vaginal bleeding, cervix is closed, production of conception are still inside.
778
What is the most common organism that causes mastitis?
Staph aureus
779
Define the first stage of labor.
Onset of contractions to full dilation of the cervix
780
How do you treat bacterial vaginosis?
Metronidazole x 7 days
781
About how much weight should a woman gain during pregnancy?
20-35 lbs
782
Define metrorrhagia.
Bleeding between menstrual cycles
783
What lab test is the gold standard for chlamydia?
Nucleic acid amplification test
784
An ovarian cyst that contains hair and teeth should make you think of what diagnosis?
Teratoma
785
At what point during pregnancy is RhoGAM given if it is needed?
28 weeks
786
What characteristics of pelvic inflammatory disease will help to differentiate it in a question stem from ectopic pregnancy, appendicitis, ovarian torsion and ovarian cyst?
It will be bilateral pain. Most other common abdominal complaints have unilateral pain.
787
A description of a young girl with a web neck or wide shield chest should make you think of what diagnosis?
Turner's syndrome
788
What organism causes us to warn pregnant patients to stay away from deli meats and soft cheese?
Listeria
789
What is the most common site of an ectopic pregnancy?
Within a fallopian tube
790
What are three ways you can check for ruptured membranes?
Ferning pattern on a slide, visualize leakage from the cervix, pooling in the vagina
791
What is the most common type of ovarian cyst?
Functional cyst - no treatment necessary
792
A patient believes she is pregnant. You notice the her cervix appears a little blue. What is the name of this sign?
Chadwick's sign
793
Grape-like vesicles or a sack of grapes on ultrasound should make you think of what diagnosis?
Hydatidiform mole
794
Is a nulliparous or mulitparous woman more likely to get preeclampsia?
Nullipartiy is a risk factor for preeclampsia
795
What is the most common infection following a C-section?
Metritis
796
Define inevitable abortion.
Vaginal bleeding, cervix is open, products of conception are still inside.
797
Cottage cheese discharge should make you think of what diagnosis?
Vaginal candidiasis
798
When does quickening occur?
Nulliparous 18-20 weeks, multiparous 14-16 weeks
799
What is the first step of treatment for endometrial cancer?
Total hysterectomy and bilateral salpingo-oophorectomy
800
What age range is the HPV Vaccination recommended for?
9 to 26 years old
801
What medication can be used to control bleeding due to uterine atony?
Oxytocin (Pitocin)
802
At how many weeks of pregnancy can chorionic villus sampling be done?
10-13 weeks
803
A snowstorm appearance on ultrasound should make you think of what diagnosis?
Hydatidiform mole
804
Gestation diabetes put moms and baby at increased risk of what three things?
Preeclampsia, macrosomia (traumatic birth,) slowing in fetal lung development
805
What is the most common endometrial cancer?
75% are adenocarcinomas
806
How do you treat vaginal candida?
Fluconazole po 1 dose or azole cream x 1 week
807
Define full term
Delivery at 37-42 weeks
808
Which reproductive cancer carries the highest rate of death in women?
Ovarian cancer
809
What is the hallmark physical findings for placenta previa?
Trick question - NEVER do a physical exam on someone with presumed placenta previa
810
The baby was delivered several minutes ago. Suddenly there is an increased in blood flow from the vagina and the cored noticeable lengthens. What is the most likely cause of these signs?
Placental separation
811
A patient presents with irregular menses, hirsutism and infertility. What is the most likely diagnosis?
Polycystic ovarian syndrome
812
As part of the antepartum testing a baby has a positive stress test. What does that mean?
They have had two heart rate accelerations in a 20 minute period of 15 bets above baseline for at least 15 seconds. This is a good thing.
813
Think, sticky, malodorous vaginal discharge should make you think of what diagnosis?
Bacterial vaginosis
814
What organism is the most common sexually transmitted bacteria?
Chlamydia
815
Purulent cervical discharge should make you think of what diagnosis?
Neisseria gonorrhoeae
816
A rope-like breast mass should make you think of what diagnosis?
Fibrocystic breast mass
817
What is the first line treatment for mastitis?
Dicloxacillin is first line. Cephalexin or erythromycin are second line.
818
A patient presents with mucopurulent discharge and cervical motion tenderness. What is the most likely diagnosis?
Chlamydia - cervicitis
819
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
820
What is the average age of menopause?
51
821
What are the five components of the biophysical profile as part of antepartum testing?
A non-stress test, fetal breathing, two gross body movements, fetal tone, amniotic fluid index
822
The secretory phase of the menstrual cycle (day 14-28) is dominated by what hormone?
Progesterone
823
What. is the most common cause of postpartum hemorrhage?
Uterine atony
824
A surge in what hormone leads to ovulation?
Luteinizing hormone (LH)
825
You have a patient with PCOS who would like to get pregnant. What are two medications you may start her on?
Metformin and Clomid
826
Early on in pregnancy serial beta-HCG should double over what time period?
every 48-72 hours
827
What endocrine issue is associated with PCOS?
Insulin insensitivity
828
The pap smear results on a 23 year old patient come back as atypical squamous cell uncertain significance (ASCUS). What is you next step?
Repeat pap smear in 12 months although HPV test is acceptable
829
Which four human papillomaviruses are linked to cervical cancer?
HPV 16, 18, 31, and 33
830
List three risk factors for an ectopic pregnancy.
Previous ectopic, scarred tubes (hx of PID or salpingitis), IUD
831
A cervical biopsy comes back as CIN2 or CIN3. What is your next step?
Excision - LEEP, Cold knife (worry about incompetent cervix), Cryotherapy
832
What three labs should you order if you are considering secondary amenorrhea?
beta-HCG, TSH, Prolactin
833
How do you definitively diagnose endometriosis?
Exploratory laparoscopy
834
What is the term for when the placenta has implanted directly over the cervical os?
Placenta previa
835
A unilateral, single, mobile, firm, nontender solid breast mass should make you think of what diagnosis?
Fibroadenoma
836
At approximately how many weeks pregnant is the uterus at the level of the umbilicus?
20 weeks
837
Should a breast feeding mother stop breast feeding if she develops mastitis?
Mastitis is not in itself a reason to stop feeding. An abscess would be an indication to stop.
838
What are three treatments for uterine prolapse?
Pessary, Kegel's maneuvers, surgical repair
839
What are two medications used to induce labor?
Cervidil (prostaglandin gel applied to the cervix) which encourages cervical ripening and oxytocin which encourages uterine contractions
840
Why is folic acid given as a prenatal vitamin?
Low folic acid can lead to neural tube defects.
841
Interference with work or school is part of which diagnosis, premenstrual syndrome or premenstrual dysphoric disorder?
Premenstrual dysphoric disorder
842
A patient with primary amenorrhea and a low FSH should make you think of what diagnosis?
Hypothalamic pituitary insufficiency
843
Define procidentia.
Uterine prolapse beyond the introitus.
844
What are three causes for a postpartum hemorrhage?
Uterine atony, genital laceration, retained placenta
845
Why is ovarian cancer so hard to diagnosis?
There are no good markers and the symptoms are very vague
846
If the pap smear results come back anything other than negative or ASCUS what is your next step?
Coposcopy and biopsy
847
Define complete abortion.
Vaginal bleeding, cervix open, products of conception have passed
848
Does mastitis tend to be unilateral or bilateral
Unilateral and only on quadrant
849
What is the most common uterine tumor?
Leiomyoma, also known as fibroids
850
Define the second stage of labor.
Fully dilated to delivery
851
What RH combination for mom and dad might cause the mother to create antibodies against the baby's red blood cells?
Mom Rh-negative and dad Rh-positive
852
What is the treatment for ovarian cancer?
Total hysterectomy and bilateral salpingo-oophorectomy. Then chemo and radiation
853
Clue cells should make you think of what diagnosis?
Bacterial vaginosis
854
Are fibrocystic breast masses usually bilateral or unilateral?
Bilateral
855
Postmenopausal bleeding is immediately believed to be what diagnosis?
Endometrial cancer until proven otherwise
856
What is the formula for calculating estimated date of confinement or due date?
first day of last menstrual period + 7 days - 3 months
857
How do you treat a Trichomonas infection?
Metronidazole
858
During what portion of the menstrual cycle does PMS occur?
By definition it is in the second half and menstruation should relieve the symptoms
859
Define threatened abortion
Vaginal bleeding, closed cervix, products of conception are still inside
860
A strawberry cervix with copious yellow/green discharge should make you think of what diagnosis?
Trichomonas vaginitis
861
What is the medical treatment for an early ectopic pregnancy?
Metrotrexate
862
Define incomplete abortion.
Vaginal bleeding, cervix is open, products of conception partially passed
863
Since a genetic cause is the number one reason for primary amenorrhea what is one very important test?
Karyotype
864
Define premature birth.
Delivery before 37 weeks.
865
What medium do you need to grow out Neisseria gonorrhoeae?
Thayer-Martin
866
What is the normal range of fetal heart rate?
120-160
867
The follicular phase of menstruation is dominated by what hormone?
Estrogen
868
What are two tocolytic medications you should be aware of?
Magnesium sulfate and calcium channel blockers
869
A women presents to the ER concerned she is in preterm labor. What treatment should you begin before getting any imaging or lab results?
Give IV fluids (most often the patient is suffering from dehydration
870
At how many weeks of pregnancy can an amniocentesis be done?
15-20 weeks
871
List 4 risk factors for endometrial cancer.
Chronic unopposed estrogen, nulliparity, early menarche, late menopause, tamoxifen, DM, obesity, HTN, breast cancer, ovarian cancer
872
What is the treatment for Turner's syndrome?
Cyclical estoregn and progesterone
873
What medication(s) are used to treat a postpartum metritis?
Clindamycin and gentamicin together
874
What is the most common way of testing for metamorphopsia?
Amsler grid
875
What is the term for bilateral yellow plaques near the eyes?
Xanthelasma
876
You notice drusen deposits on fundal exam. What diagnosis should you be thinking of?
Macular degeneration
877
A patient presents saying that he doesn't seem to need his glasses anymore after 30 years. What is the most likely diagnosis?
Cataract
878
A patient has metamorphopsia and a central blind spot. What is the most likely diagnosis?
Macular degeneration
879
What is the term for eyelids that turn in?
Entropion
880
What should a primary care provider do for a presumed retinal detachment?
Refer and position patient with head down
881
What is the term for eyelids that turn out?
Ectropion
882
What is the first thing you should be thinking of if a pediatric patient comes in with blood in the anterior chamber of the eye (hyphema).
Child abuse until proven otherwise
883
What is the name for the triangular or wedge shaped growth on the conjunctiva that may interfere with vision?
Pterygium
884
A patient describes his vision loss as curtain coming down and then going back up. What might the diagnosis be?
Amaurosis fugax
885
Vision loss described as a curtain coming down should make you think of what diagnosis?
Retinal detachment
886
A fundal exam shows a cherry-red spot. What is the most likely diagnosis?
Central retinal artery occlusion
887
Which nerve is involved in herpes zoster ophthalmicus?
Trigeminal nerve, CN 5
888
A patient presents with a dense corneal infiltrate and an epithelial defect seen with fluorescein stain. What is the most likely diagnosis?
Corneal ulcer
889
You notice a bowing of the iris on exam. What diagnosis should you be thinking of?
Glaucoma
890
A patient presents with watery bilateral discharge from the eyes and nontender preauricular adenopathy. What is the most likely diagnosis? What is the most common pathogen?
Viral conjunctivitis, adenovirus
891
Is glaucoma more prevalent in males or females?
Females 3:1
892
What is the name of the test for dry eyes?
Schirmer's test
893
How do you test for color blindness?
Ishihara plates
894
What is the #1 cause of retinal artery occlusion?
Carotid atherosclerotic disease
895
What is the first line treatment for orbital cellulitis?
IV antibiotics, followed by 2 weeks of oral antibiotics
896
A 19 year old male took an elbow to the face while playing basketball this morning. The whole left side of his face is swollen and he can't look up. What is the most likely diagnosis?
Orbital fracture
897
A patient having recently undergone cataract surgery presents complaining of vision loss in the operative eye. What diagnosis should you be thinking of?
Retinal detachment
898
Your attending asks you to come and see an excellent example of Hutchinson's sign. What diagnosis does the patient have?
Herpes zoster ophthalmicus
899
What is the term for being nearsighted? What type of lens do you use to correct it?
Myopia, concave lenses
900
A dendritic lesion is seen with fluorescein stain. What is the most likely diagnosis?
Herpes keratitis
901
What are the most common colors lost in color blindness?
Red and green
902
A CT scan of the head shows broad infiltration of orbital fat. What is the most likely diagnosis?
Orbital cellulitis
903
What is the yellow, brown fleshy mass on conjunctiva which usually does not interfere with vision?
Pinguecula
904
In what age range do you expect most commonly find amaurosis fugax?
Patient older than 50
905
A patient complains of seeing halos and rainbows around lights. She also complains of moderate photophobia. What is the most likely diagnosis?
Glaucoma
906
A fundal exam shows a cup to disc ratio of >0.5. There are also vessels bending over the disc. What is the most likely diagnosis?
Glaucoma
907
A patient has a history of multiple stys. He now has a painless nodule on his eyelid and minor conjunctivitis. What is the most likely diagnosis?
Chalazion
908
A patient presents with a painful, red nodule on the eyelid. What is the most likely diagnosis? What treatment should you being with?
Hordeolum (sty). Warm compress and progress to topical antibiotics if necessary.
909
A fundal exam shows an opalescent retina and boxcarring of arterioles. What diagnosis should you be thinking of?
Central retinal artery occlusion
910
A patient presents with unilateral blurriness developing over a few days. Fundal exam shows a "blood and thunder" pattern. What diagnosis should you be thinking of?
Central vein occlusion
911
A patient presents with pain in one eye. The cornea is hazy and the pupils are fixed. What is the most likely diagnosis?
Glaucoma
912
A patient presents with sudden painless complete unilateral vision loss. What diagnosis should you be thinking of?
Central retinal artery occlusion
913
A patient presents with irritated, burning and tearing eyes. You notice some scurg and scales. Where do you begin treatment?
The is blepharitis. Treatment begins with good hygiene and moves on to topical antibiotics if necessary.
914
A patient with a history of asthma presents complaining of stringy discharge from both eyes and severe swelling around the eyes. What is the most likely diagnosis?
Allergic conjunctivitis
915
A feathery border in an eye exam shoudl mak you think of what diagnosis?
Fungal infection
916
What is the term for being farsighted? What type of lens do you use to correct it?
Hyperopia, convex
917
What is the treatment for subconjunctival hemorrhage?
Reassurance
918
What is appropriate treatment for central vein occlusion?
Typically self limited. Treat underlying disease.
919
Color blindness is transmitted through what genetic pattern?
Recessive X-linked
920
What is tonometry used for?
Determining intraocular pressure
921
What is the initial treatment for a chemical burn to the eyes?
Irrigate, irrigate, irrigate
922
A patient in the recovery room following foot surgery is complaining of severe photophobia. She feels as though there is something in her eye. What is the most likely diagnosis?
Corneal abrasion (pt's scratch their eyes before they are completely awake from anesthesia)
923
How long after a radiant energy burn do symptoms typically show?
6-12 hours
924
What should a primary care provider do for presumed central retinal artery occlusion?
Ophthalmic emergency! Refer and intermittent pressure and release of the eye
925
A college student presents with a little purulent drainage from one eye and nontender preauricular lymphadenopathy. What diagnosis and pathogen should you be thinking of?
Chlamydia conjunctivits
926
A college student presents with copious purulent drainage from one eye. What diagnosis and pathogen should you be thinking of?
Neisseria conjunctivits
927
Give two risk factors for glaucoma.
African American decent and diabetes
928
When treating herpes keratitis should you use topical antiviral, topical steroid or both?
Don't use steroid. Topical antiviral and refer!
929
What is the most common preceding event for orbital cellulitis?
URI
930
What is the most likely quadrant for a retinal detachment?
Superior temporal
931
What is the most common organism causing pneumonia in COPD patients?
Haemophilus influenzae
932
Pertussis is most commonly treated with with antibiotic?
Erythromycin
933
A thumbprint sign on x-ray should make you think of what two diagnosis?
Lateral C-spine = epiglottitis, abdominal = intestinal ischemia
934
At what size induration would a PPD be positive for a healthcare worker?
10 mm
935
A thin looking heart and flattened diaphragm on CXR should make you think of what diagnosis?
Emphysema
936
What CXR finding might make you think of berylliosis?
Diffuse infiltrates with hilar adenopathy
937
When you step up the diagnosis for intermittent asthma to mild persistent asthma what medication should you add?
An inhaled steroid like fluticasone
938
Paradoxical pulses may be found in what pulmonary disorder?
Asthma
939
Oseltamivir (Tamiflu) may be given to children above what age?
1 year old
940
A college student presents with pneumonia. What two organisms should you be thinking of?
Chlamydia and mycoplasma
941
What is it called when a patient says "ee" but on auscultion you here "ay"?
Egophony
942
What two lung cancers are typically found centrally on CXR?
Small cell and squamous cell
943
A Westermark sign on CXR should make you think of what diagnosis?
Pulmonary embolism
944
Does total lung capacity go up or down in COPD?
It goes up.
945
An exudative pleural effusion should make you think of what diagnosis?
TB, lung cancer and pneumonia
946
List the three most commonly used medical treatments for COPD?
Oxygen, ipratropium, and albuterol
947
What is the most common cause of bronchiectasis?
Cystic Fibrosis
948
What is the best test to diagnose bronchiectasis?
CT
949
Will evidence of TB be seen more frequently in the upper or lower lung lobes on CXR?
Upper
950
What is the initial treatment for active TB?
INH + RIF + PZA + EMB x several months typically followed by INH + RIF once sensitivities come back
951
What organism is the most common cause of pneumonia in a patient cystic fibrosis?
Pseudomonas
952
Dullness to percussion should make you think of what diagnosis?
Lobar pneumonia
953
What occupations are associated with berylliosis?
Aerospace and nuclear plant workers
954
What is the gold standard for diagnosis of pleural effusion?
Thoracocentesis
955
At what age should vaccinations for pneumococcal pneumonia begin?
65 years old
956
Any question about rabbits and pneumonia should make you think of what diagnosis?
Tularemia
957
What. is the most common patient complaint with emphysema?
Shortness of breath
958
If you hear crackles in the lung fields list three pulmonary issues that should be in your differential
Pneumonia, fibrosis, CHF, bronchitis
959
List 4 medications which may cause asthma.
Beta blockers, NSAIDs, ACEI, ASA
960
You are treating a patient for TB. He has noticed that his body fluids now have an orange tint. What drugs is most likely causing this?
Rifampin
961
Prolonged expiration (low FEV1) should make you think of what diagnosis?
Asthma or COPD
962
Transudative pleural effusions should make you think of what diagnosis?
Congestive heat failure
963
What are the main side effects of isoniazide?
Hepatitis and peripheral neuropathy
964
List six extrapulmonary complications of lung cancer.
SPHERE - SVC syndrome, Pancoast tumor, Horner's syndrome, Endocrine problems, Recurrent laryngeal symptoms, Effusions (exudative)
965
A physical exam finding of egophony should make you think of what diagnosis?
Lobar pneumonia
966
Ghon or Ranke complexed on CXR should make you think of what diagnosis?
TB
967
Zanamivir (Relenza) may be give to children about what age?
7 years old
968
Does FEV1 go up or down with asthma?
It goes down.
969
Caseating granulomas should make you think of what diagnosis?
TB
970
What is the most common cause of pneumonia in children less than 1 year old?
Respiratory syncytial virus (RSV)
971
A noncaseating granuloma should make you think of what diagnosis?
Sarcoidosis
972
A young child presents to ER and you see him waiting in tripod position. What is the most likely diagnosis?
Epiglottitis
973
A barrel chest should make you think of what diagnosis?
Emphysema
974
When performing a decompression for a tension pneumothorax where do you put the needle?
2nd intercostal space at the midclavicular line
975
An HIV patient with ground glass appearance on CXR should make you think of what diagnosis?
Pneumocystis jiroveci pneumonia (PJP used to be known as PCP)
976
An older patient presents with pneumonia and diarrhea. What diagnosis should you be thinking of?
Legionella pneumonia
977
Currant jelly sputum should make you think of what diagnosis?
Klebisiella pneumoniae
978
If you see a question with an alcohol who has been diagnosed with pneumonia what is the most likely organism?
Klebsiella pneumoniae
979
Tympany to percussion should make you think of what diagnosis?
Large pneumothorax
980
If you see a question with anything to do with pets and the patient has pneumonia, what organism should you be thinking of?
Yersinia pestis
981
Where is a Pancoast rumor found on CXR?
At the apex of either the right or left lung
982
You suspect a pneumothorax. What instructions should go along with the order for a CXR?
It should be an end expiratory view in order to look for visceral pleural air
983
List four indications for the flu vaccine.
Children 6-59 months, pregnant female, healthcare worker, age greater than 50
984
Mesothelioma is most commonly found in what lung location?
80% are found in the pleural lining
985
Eggshell opacities on the CXR should make you think of what diagnosis?
Silicosis and coal workers lung
986
What is erythema nodosum?
Tender red nodules usually found on the shins
987
Bullae and blebs on CXR should make you think of what diagnosis?
Emphysema
988
Are the lungs noisy or quiet in COPD?
quiet
989
A patient without a functioning spleen is more susceptible to what type of organism?
Encapsulated organisms most commonly Strep pneumoniae and H. flu
990
A pearl formation on CXR should make you think of what diagnosis?
Squamous cell lung cancer
991
A patient has pneumonia with rust colored sputum. What is the most likely diagnosis?
Strep pneumonia
992
What happens to total lung capacity in sarcoidosis?
It goes down.
993
A contralateral mediastinal shift should make you think of what diagnosis?
Tension pneumothorax
994
Ethambutol has what two major side effects?
Optic neuritis, red green vision loss
995
What is the treatment for pneumocystis jiroveci pneumonia?
Bactrim
996
List three caused of decreased tactile fremitus.
COPD, asthma, pleural effusion, pneumothorax
997
What two lung cancers are typically found peripherally on CXR?
Adenocarcinoma and Large cell
998
A CXR shows vascular redistribution and blurred vascular outlines. What is the most likely diagnosis?
CHF
999
Posttussive rales should make you think of what diagnosis?
TB
1000
What are the three most common cancers to metastasize to the lungs?
Breast, liver and colon
1001
List the four most common places lung cancer will metastazie to?
Bone, brain, adrenals, and liver
1002
What is the first line antibiotic for epiglottis?
Third generation cephalosporin - ceftriaxone
1003
Nodular opacities in the upper lung fields should make you think of what diagnosis?
Silicosis
1004
Rhonchi or wheezes that clear after coughing suggest what diagnosis?
Bronchitis or atelectasis
1005
Coal miners lung often shows nodular opacities in what lung fields?
Upper lung fields
1006
A very sick patient with diffuse infiltrates that spare the costophrenic angles should make you think of what diagnosis?
Acute respiratory distress syndrome (ARDS)
1007
Hyperinflation on a CXR as well as eosinophilia on CBC should make you think of what diagnosis?
Asthma
1008
How long are administering a PPD should it be read?
48-72 hours
1009
If you come across a question where the patient has erythema nodosum and an enlarged parotid gland what diagnosis should you be thinking of?
Sarcoidosis
1010
Blue bloaters refers to that characteristic physical exam findings of what disease?
Chronic bronchitis
1011
Hampton's hump on CXR should make you think of what diagnosis?
Pulmonary embolism
1012
What is the gold standard for the diagnosis of cystic fibrosis?
Sweat chloride test
1013
What CXR finding might make you think of mesothelioma?
Pleural thickening, remember 80% are found in the pleura lining
1014
At what size induration would a PPD be positive for an HIV patient?
5 mm
1015
List three things that should be in your differential if you hear wheezes on a lung exam?
Asthma, COPD, bronchitis
1016
Honeycombing and tram tracks on the CXR should make you think of what diagnosis?
Bronchiectasis and idopathic pulmonary fibrosis
1017
Hyperresonance to percussion should make you think of what diagnosis?
Emphysema, pneumothorax, asthma
1018
What is the likely findings be on a CXR of a patient with asbestosis?
Linear opacities at the bases with pleural plaques
1019
What is the most common cause of peptic ulcer disease?
H. pylori
1020
Steatorrhea should make you think of what diagnsosi?
Pancreatitis
1021
A patient presents complaining of right upper quadrant pain 20 minutes after meals. What is the most likely diagnosis?
Cholecystitis
1022
How do you treat achalasia?
Loosen up the muscle - botox, dilation or surgery
1023
What is the most common vessel blocked with intestinal ischemia?
Superior mesenteric artery
1024
What tumor marker can be used to follow pancreatic cancer?
CA-19-9
1025
What is the #1 cause of small bowel obstruction?
Postoperative adhesions
1026
A patient has had GERD for year. Over the past year, he has noticed an increase in difficulty swallowing his food. This should make you think of what diagnosis?
Esophageal strictures
1027
An elevated serum amylase and lipase should make you think of what diagnosis?
Pancreatitis
1028
What is the main risk factor for esophagitis?
Immunocompromised patient
1029
What is the medical term for feeling like there is a lump in your throat?
Globus
1030
Should diverticulitis always be admitted?
No mil cases can be treated as outpatients with rest and clear fluids
1031
Left lower quadrant pain and tenderness should make you think of what diagnosis?
Diverticulitis
1032
What is the most common cause of a folate deficiency?
Alcoholism
1033
Define pellagra?
Niacin (B3) deficiency
1034
What are two common predisposing factors for esophageal varices?
Portal HTN and cirrhosis often caused by alcoholism
1035
Describe Grey-Turner's sign.
Flank ecchymosis often related to pancreatitis
1036
What is the most common location of colorectal cancer?
Cecum about 38%
1037
At what age and how often should fecal occult blood tests be performed as a screening tool?
Beginning at age 50, and they should be done every year
1038
A patient complains of periumbilical pain which has now moved over McBurney's point. What is the most likely diagnosis?
Appendicitis
1039
Is peptic ulcer disease more common in the duodenum or the stomach?
Duodenum
1040
Projectile vomiting should make you think of what diagnosis?
Pyloric stenosis
1041
Does adenocarcinoma rise from the proximal or distal esophagus?
Distal
1042
What treatment should be started for asymptomatic diverticulosis?
None
1043
What is the imaging modality of choice for pancreatitis?
CT
1044
What does ERCP stand for?
Endoscopic retrograde cholangiopancreatography
1045
Epigastric abdominal pain which radiates to the back should make you think of what diagnosis?
Pancreatitis
1046
What is the term for an abscess in the sacrococcygeal cleft?
Pilonidal disease
1047
Salivary amylase breaks down what macronutrient?
Carbohydrates
1048
What is the most common cause of acute bacterial cholangitis?
Choledocholithiasis
1049
What is the leading cause of iron deficiency anemia?
Chronic GI bleed
1050
What is Reynold's pentad and why does it matter?
Charcot's triad + hypotension + altered mental status. It indicated high risk of sepsis.
1051
Bird-beak esophagus on barium swallow should make you think of what diagnosis?
Achalasia
1052
What is the best test to check for H. pylori?
Urea breath test
1053
What is the recommended treatment for hepatitis C infection?
Pegylated interferon alpha-2
1054
An endoscopy for presumed esophagitis shows multiple shallow ulcers. What is the most likely diagnosis?
Herpes simplex virus
1055
What medication is most commonly used for long term treatment for GERD?
Proton pump inhibitors - omeprazole, lansoprazole, pantoprazole
1056
What tumor marker may be used for liver cancer?
alpha-Fetoprotein
1057
A corkscrew appearance on barium study should make you think of what diagnosis?
Esophageal spasms
1058
What class of medication is first line to treat inflammatory bowel disease in the maintenance phase?
5-ASA products - sulfasalazine, mesalamine
1059
Crohn's is found where in the GI tract?
It can be from esophagus to anus
1060
What is the name of the sign when a patient shows inhibited inspiration with pressure over the RUQ? What diagnosis does it suggest?
Murphy's sign, Cholecystitis
1061
What medication used in hepatitis B infection helps prevent the need for liver transplant?
Lamivudine
1062
Currant jelly stool should make you think of what diagnosis?
Intussusception
1063
What does HBsAg (hep B surface antigen) indicate?
Active Hep B infection
1064
How often should patients with pernicious anemia have a screening endoscopy performed?
Every 5 years looking for signs of gastric carcinoma
1065
What are the two main complications of cirrhosis?
Portal HTN and liver insufficiency
1066
Are one half of all adult hernias direct or indirect inguinal hernias?
Indirect inguinal hernias makeup 50% of all adult hernias
1067
Is surgery curative for Crohn's or ulcerative colitis?
Ulcerative colitis
1068
An abdominal exam with pain out of proportion to the exam should make you think of what diagnosis?
Intestinal ischemia
1069
What is the best imaging study for acute appendicitis?
CT
1070
What is a common symptom that goes along with chest pain for GERD patients?
Dry cough
1071
A gastrinoma is also known as what syndrome?
Zollinger-Ellison syndrome
1072
Will a patient with achalasia have dysphagia to liquids, solid or both?
Both
1073
Describe Cullen's sign
Umbilical ecchymosis often related to pancreatitis
1074
What are the first three steps of managing pancreatitis?
NPO, pain control, fluids
1075
Pica is often related to what type of anemia?
Iron deficiency anemia
1076
Fasting gastrin will be above what level with gastronoma?
>150 pq/ml
1077
A patient complains of regurgitating undigested food several hours after a meal. What diagnosis should you be thinking of?
Zenker's diverticulum
1078
Under routine circumstances when should patient begin getting screening colonoscopies?
Age 50
1079
How is celiac disease most commonly diagnosed?
Endoscopic biopsy
1080
An epigastric olive-shaped mass should make you think of what diagnosis?
Pyloric stenosis
1081
How much fiber should you normally get in a day?
about 30 grams
1082
Air fluid levels on abdominal x-ray should make you think of what diagnosis?
Bowel obstruction
1083
What is the most specific test for acute cholecystitis?
HIDA
1084
Painless bright red blood per rectum should make you think of what diagnosis?
Hemorrhoids
1085
What is the diagnostic test of choice for Zenker's diverticulum?
Barium swallow will show the diverticulum
1086
A patient on sulfasalazine for an inflammatory bowel disease should be supplemented with what vitamin?
Folate
1087
What are the 5 points of Ranson's criteria on admission?
Older than 55, nWBC>16, glucose>200, LDH>350, AST>250
1088
What is the most common location for an anal fissure?
Posterior midline
1089
With a gastric ulcer are the patient's symptoms exacerbated or relieved with food?
Exacerbated
1090
What will the bowel sounds be early on in a small bowel obstruction? What will they be later on?
Early they are hyperactive. Late they are absent.
1091
A thumbprint sign on an abdominal film should make you think of what diagnosis?
Intestinal ischemia
1092
What is the first step in treating GERD?
Lifestyle modification
1093
Which NSAID has the highest rate of peptic ulceration?
Naproxen
1094
What is the most common location for a pancreatic tumor?
75% occur in the head of the pancreas
1095
What is the term for difficulty swallowing?
Dysphagia
1096
If you have heartburn that does not improve with medication what diagnosis should you be thinking about?
Gastrinoma
1097
Severe abdominal pain 30 minutes after a meal should make you think of what diagnosis?
Intestinal ischemia
1098
Describe Courvoisier's sign.
Nontender, palpable gallbladder which may indicate pancreatic neoplasm
1099
What disease is defined as an immunologic response to gluten?
Celiac
1100
What is the most specific diagnostic test for peptic ulcer disease?
Endoscopy
1101
What is a good beta blocker to reduce portal HTN?
Propranolol
1102
What is the treatment for most Mallory-Weiss tears?
Watchful waiting, these will typically resolve within 48 hours
1103
Describe how to perform the obturator sign.
The patient is supine and attempts to flex and internally rotate right hip.
1104
There are vaccines for which two versions of hepatitis?
Hepatitis A and hepatitis B
1105
Describe the Psoas sign.
The patient is supine and attempt to raise the right leg against resistance.
1106
What is the only curative therapy for gastric adenocarcinoma?
Surgical resection
1107
What does an Anti-HBc (hep B core antibody) indicate?
Previous or ongoing hepatitis B infection
1108
What is the gold standard for diagnosis and treatment of bile duct stones?
ERCP
1109
How do you treat an H. pylori infection?
PPI + 2 antibiotics, commonly omeprazole + clarithromycin and amoxicillin or PPI + metronidazole + tetracycline
1110
Colrectal cancer patients are almost all older than what age?
90% of patients are older than 50
1111
What two viral hepatitis infections are self limiting?
Hepatitis A and hepatitis E
1112
An endoscopy for presumed esophagitis shows several solitary deep ulcers. What is the most likely diagnosis?
Cytomegalovirus
1113
What is the most likely to pass into the scrotum, a direct or indirect hernia?
Indirect
1114
What are the two most common causes of pancreatitis?
Cholelithiasis and ETOH
1115
What is the most common anorectal problem affecting patients over 50?
Hemorrhoids
1116
Most gallstones are made of what substance?
Cholesterol
1117
What does Anti-HBs (hep B surface antibody) indicate?
Recovery from infection or immunization to hepatitis B
1118
A colonoscopy that shows cobblestone or skip lesions make you think of what diagnosis?
Crohn's disease
1119
What is the term for painful swallowing?
Odynophagia
1120
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
1121
What is the most common cause of lower GI bleed?
Diverticulosis
1122
What causes Mallory-Weiss tears?
Forced vomiting or retching (often involving alcohol)
1123
What two blood test can be used to diagnose celiac?
IgA endomysial antibody and IgA tTG antibody
1124
Which are more painful, hemorrhoids above or below the dentate line?
Below, internal hemorrhoids are not painful
1125
A string sign on barium swallow should make you think of what diagnosis?
Pyloric stenosis
1126
Onion ring fibrosis from a bile duct biopsy should make you think of what diagnosis?
Primary sclerosing cholangitis
1127
A patient presents with unproductive retching, acute localized epigastric distention and inability to pass a nasogastric tube. What is the most likely diagnosis?
Gastric volvulus
1128
In order to contract hepatitis D what must you already have?
Hepatitis B
1129
What is Charcot's triad?
RUQ pain, fever, jaundice
1130
What is the first line of treatment for an anal fissure?
Fluid and fiber
1131
What are two treatments you should consider for esophageal strictures?
dilation of the esophagus and long term PPIs
1132
What medical treatment is given for a gastrinoma?
Proton pump inhibitors
1133
Atypical or walking pneumonia is caused by what pathogen?
Mycoplasma
1134
A child with a fever lasting longer than five days should make you think of what diagnosis?
Kawasaki syndrome
1135
A widely split fixed S2 should make you think of what diagnosis?
Atrial septal defect
1136
List the five major Jones criteria for diagnosing rheumatic fever.
Polyarthritis, carditis, subcuticular nodes, erythema marginatum, chorea
1137
Pale and boggy nasal mucosa should make you think of what diagnosis?
Allergic rhinitis
1138
What organism is the most common cause of otitis media?
Strep pneumonia
1139
Which viral exanthem often has conjunctivitis as one of it's symptoms?
Measles/Rubeola
1140
By what age should a child be able to roll over?
4 months
1141
What is the x-ray finding that supports diagnosis of a slipped capital femoral epiphysis?
Ice cream falling of the cone
1142
A CXR finding of notched ribs in a child should make you think of what diagnosis?
Coarctation of the aorta
1143
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
1144
A 4 year old boy presents between October and March with wheezing, coughing, a runny nose and increased respiratory rate. What is the most likely pathogen?
Respiratory syncytial virus
1145
A child with bulky greasy stool should make you think of what diagnosis?
Cystic fibrosis
1146
Describe erythema marginatum.
Pink rings on the trunk and inner surfaces of the limbs.
1147
A palpable olive-shaped epigastric mass in one month should make you think of what diagnosis?
Pyloric stenosis
1148
German measles is also known as what disease?
Rubella
1149
By what age should a child be able to hold up her head?
3 months
1150
At what age should a child begin to say momma and dadda?
12 months
1151
What is the medical term for cross-eyed?
Strabismus
1152
What is the first line treatment for pertussis?
Erythromycin
1153
Koplik spots are white clustered lesions on the buccal mucosa. What virus are they pathognomonic for?
Measles/Rubeola
1154
How long should you wait for a swallowed marble to pass through the body before considering surgery?
24 hours
1155
In an upper respiratory infection which includes hoarseness most likely bacterial or viral?
Viral
1156
In order to diagnose rheumatic fever what one thing must you have?
Evidence of a strep infection either positive titer or positive culture. In addition to that you need 2 major criteria or 1 major and 2 minor criteria
1157
What is the treatment for a volvulus in a child?
Barium enema
1158
What antibiotic is the first line treatment for mycoplasma pneumonia?
A macrolide, erythromycin or azithromycin
1159
What is pertussis more commonly referred to as?
Whooping cough
1160
A 15 year old overweight boy presents to your office limping with knee pain. What is the most likely diagnosis?
Slipped capital femoral epiphysis
1161
A premature infant with hyaline membrane disease will have what appearance on CXR?
Bilateral atelectasis or ground glass appearance
1162
A Salter-Harris type III fracture affects what area of the bone?
The physis (growth plate) as well as the epiphysis
1163
Unilateral purulent rhinitis should make you think of what diagnosis?
Foreign body
1164
Describe Barlow's test
Adduct and internal rotation of the hips
1165
By what age should a child be able to sit up?
6 months
1166
At what age should a child be able to use a spoon and stack 3-4 blocks?
18 months
1167
If you believe there may be a foreign body obstructing a child's breathing what type of CXR should you order?
Expiratory view looking for hyperinflation due to air trapping
1168
Currant jelly stool should make you think of what diagnosis?
Intussusception
1169
A child presents with paroxysmal abdominal pain, nausea, vomiting and diarrhea. What diagnosis should you be thinking of?
Intussusception
1170
At what age should a child begin to feed himself?
6 months
1171
A lacey pink rash on the face of a child should make you think of what diagnosis?
Erythema infectiosum aka fifth disease aka slapped cheek
1172
Pain with movement of the pinna or tarsus should make you think of what diagnosis?
Otitis externa
1173
What is the first line antibiotic for otitis media?
Amoxicillin
1174
What is the gold standard for the diagnosis of cystic fibrosis?
Sweat chloride test
1175
Which heart valve is most associated with rheumatic fever?
Mitral
1176
By what age should a child be able to kick a ball?
24 months
1177
What is the most common congenital heart defect?
Ventricular septal defect
1178
How do treat a patient with respiratory syncytial virus?
Albuterol, steroids, and fluids
1179
By what age should a child be able to walk?
12 months
1180
You hear a loud harsh holosystolic murmur in a child. It is heard best at the LLSB. What diagnosis should you be thinking of?
Ventricular septal defect
1181
The description of a dew drop on a rose petal should make you think of what diagnosis?
Chickenpox
1182
Forchheimer spots are associated with what disease?
Rubella
1183
A patient is having seizures along with a mouse-like odor from the urine. What diagnosis should make you be thinking of?
Phenylketonuria
1184
A child presents with painful ulcers in his mouth. On physical exam you find more of the same type of ulcers on his feet and hands. What virus is most likely causing these symptoms?
Coxsackie virus
1185
What is the most common cause of an upper respiratory tract infection?
Rhinovirus
1186
Nasal polyps should make you think of what diagnosis?
Cystic fibrosis
1187
A Salter-Harris type I fracture affects what are of the bone?
Only the physis (growth plate)
1188
A patient presents with a staccato cough but no fever. What diagnosis should you be thinking of?
Chlamydia pneumoniae
1189
Describe the pattern of weight gain in an infant over the following periods: week one, 6 months, 12 months, 3 year old, and 4 year old
Newborns lose 10% of their birth weight initially but are back to birth weight at 10 days, 6 m = 2x, 12m =3x birthweight, 3 y/o = 30 lbs x 30 inches, 4 y/o = 40 lbs x 40 inches
1190
What is the medical term for lazy eye?
Amblyopia
1191
At what age should an infant begin cooing?
2 months
1192
During a physical exam of a child, you feel a tubular or sausage-shaped mass. What diagnosis should you be thinking of?
Intussusception
1193
A musical vibratory murmur best hear at the apex in a child should make you think of what diagnosis?
Still's murmur
