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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
Q

You suspect a patient has polyarteritis nodosa. What is the test for a definitive diagnosis and what is the treatment?

A

biopsy, high dose steroids

26
Q

What are the four muscles of the rotator cuff?

A

Commonly referred to as the SITS muscles they are Supraspinatus, Infraspinatus, Teres minor, Subscapularis

27
Q

What is the most useful physical exam test for diagnosis an ACL tear?

A

Lachman’s followed by anterior drawer

28
Q

An African American female presents with malar rash and a positive double-stranded DNA antibody. What is the most likely diagnosis?

A

lupus

29
Q

A positive straight leg test indicates what diagnosis?

A

herniated disc

30
Q

What test do you do for Sjogren’s syndrome?

A

Schirmer test

31
Q

Which way does a Colles fracture angulate: dorsal or volar? What about a Smith fracture?

A

Colles = Dorsal, Smith = Volar

32
Q

What is a first line treatment for rheumatoid arthritis?

A

methotexate

33
Q

What is the most common knee injury?

A

medial meniscal tear

34
Q

What medication is used for patients with lupus?

A

systemic steroids

35
Q

A new mother presents with pain over the radial wrist. She has a positive Finkelstein’s test. What is the most likely diagnosis?

A

de Quervain’s tenosynovitis

36
Q

A positive Hawkins test indicated what diagnosis?

A

Rotator cuff impingement

37
Q

At what age should you begin ordering DEXA scans for male patients? What about female patients?

A

70 for males, 65 for females

38
Q

What is the medical term for tennis elbow?

A

lateral epicondylitis

39
Q

Tenderness over the anatomical snuffbox is indicative of what fracture?

A

scaphoid

40
Q

What is the first line treatment for carpal tunnel?

A

night splint

41
Q

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?

A

Achilles tendon rupture

42
Q

List three medication that may cause lupus.

A

procainamide, isoniazid, and quinidine

43
Q

A patient’s lab work shows positive Smith antibody and positive double-stranded DNA antibodies. What is the most likely diagnosis?

A

Lupus

44
Q

What is the most common cause of a hip dislocation? Is it usually anterior or posterior?

A

MVA, posterior

45
Q

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?

A

hip fracture

46
Q

What ligament is most commonly injured in an ankle sprain?

A

Anterior talofibular ligament (ATFL)

47
Q

A patient with a history of hepatitis B presents complaining of bilateral knee pain, fever and weight loss. What is the most likely diagnosis?

A

polyarteritis nodosa

48
Q

You recommend bisphosphonates for a patient with osteoporosis. What instruction do you give her for immediately after taking the medication?

A

remain upright for 30 minutes

49
Q

A positive crossover test indicates what diagnosis?

A

acromioclavicular joint injury (AC joint)

50
Q

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?

A

Neisseria gonorrhoeae

51
Q

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?

A

patella fracture

52
Q

Where are Heberden’s nodes found?

A

distal interphalangeal joint (DIP)

53
Q

What is the best imaging to diagnose osteomyelitis?

A

Bone scan or MRI

54
Q

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?

A

C-spine, anesthesia will want them due to concerns about instability of C1 and C2

55
Q

A bamboo spine indicates what diagnosis?

A

ankylosing spondylitis

56
Q

Anatomically where are 80% of clavicle fractures located?

A

middle third

57
Q

A positive McMurry indicated what diagnosis?

A

meniscal tear

58
Q

Anti-Jo 1 antibodies should make you think of what diagnosis?

A

polymyositis

59
Q

A patient presents to the ER with saddle anesthesia and loss of bowel and bladder function. What is the most likely diagnosis?

A

Cauda equina

60
Q

What would you expect the WBC count to be in the joint fluid of an infected knee?

A

> 50,000 at a minimum and probably much higher

61
Q

A patient presents with a painless mass in her right wrist. What is the most likely diagnosis?

A

ganglion cyst

62
Q

What will an x-ray show in acute osteomyelitis?

A

nothing - it will show bone destruction in chronic osteomyelitis

63
Q

There is a sunburst appearance on x-ray. What is the most likely diagnosis?

A

osteosarcoma

64
Q

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?

A

If it is truly an osteoid osteoma ibuprofen will resolve his pain

65
Q

A positive Finkelstein’s test indicates what diagnosis?

A

de Quervain’s tenosynovitis

66
Q

Give the DEXA score for osteopenia and osteoporosis

A

osteopenia = 1 to 2.4 standard deviations, osteoporosis = 2.5 standard deviations or greater

67
Q

Carpal tunnel affects what nerve and what parts of the hand?

A

Median nerve. Thumb, pointer and ring fingers, Thenar wasting is a sign of advanced disease

68
Q

Patient presents with conjunctivitis, urethritis, arthritis and oral lesions. What is the most likely diagnosis? What other lab might you expect to be positive?

A

Reactive arthritis, HLA B-27

69
Q

What is the most common fracture in children?

A

clavicle

70
Q

Clicking or locking of the knee indicates what diagnosis?

A

meniscal tear

71
Q

Describe the characteristics of a lytic lesion on x-ray.

A

spiculated, elevated periosteum, bone destruction (think bad, very bad things)

72
Q

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?

A

polymyositis

73
Q

A patient with a silver-fork deformity on x-ray. What is the most likely diagnosis?

A

Colles fracture

74
Q

What is the most common cause of C-spine fractures?

A

motor vehicle accidents

75
Q

What uric acid level helps to confirm a diagnosis of gout?

A

> 7.5

76
Q

What is another term for podagra?

A

gout

77
Q

A patient has a tremor with motion in his hands. What medication might you prescribe?

A

This patient has an active tremor therefore a beta blocker like propranolol is a good start

78
Q

A patient complains of muscle weakness and fatigability that improves with rest. What diagnosis should you be thinking of?

A

Myasthenia gravis

79
Q

A patient complains of an aching headache which feels like a band around his head. What diagnosis should you be thinking of?

A

Tension headache

80
Q

An EEG showing focal rhythmic discharges at the onset of the seizure should make you think of what diagnosis?

A

Simple partial seizure

81
Q

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?

A

Cluster headahce

82
Q

Name one abortive drug for migraines.

A

Triptans (sumatriptan, zolmitriptan), ergotamine

83
Q

What is the most common cause of dementia?

A

Alzheimer’s disease, it may be as high as 80%

84
Q

Duchenne’s and Becker’s muscular dystrophy have what genetic characteristic?

A

X-linked recessive

85
Q

What is the age range for Duchenne’s muscular dystrophy?

A

3-5 years old

86
Q

A patient presents with lateralized throbbing headache. He is also complaining of nausea, vomiting, and photophobia. What type of headache is most likely?

A

Migraine

87
Q

If CT is negative and you still believe there is a stroke what is the next best test to order?

A

Lumbar puncture

88
Q

A patient presents with a painful ipsilateral third nerve palsy. What diagnosis should you be thinking of?

A

Posterior communication artery aneurysm (PComA)

89
Q

Describe Kernig’s sign

A

The patient lies supine, flex hip while keeping knee straight. Back pain is positive

90
Q

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?

A

Complex partial

91
Q

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?

A

Benign essential tremor or familial tremor

92
Q

Which nerve root is responsible for the knee jerk reflex?

A

L3-L4

93
Q

What cranial nerve is affected with Bell’s palsy?

A

CN VII

94
Q

What is the medical treatment for a stroke in which the CT has shown no evidence of a hemorrhage?

A

Within the first 4 hours and with no contraindications thrombolytics should be given

95
Q

Alcohol may be a major factor in which encephalopathy?

A

Wernicke’s

96
Q

Under what conditions would aspirin or clopidogrel be used following a TIA as prophylaxis?

A

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
Q

An EEG showing generalized spikes and associated slow waves should make you think of what diagnosis?

A

Generalized or absence seizure

98
Q

What is the medication of choice for a patient with Tourette’s syndrome?

A

Haloperidol

99
Q

What are the most common primary cancer sties for metastasis to the brain?

A

Lung, breast, kidney

100
Q

A patient presents with what appears to be an inability to understand speech. Which aphasia should be at the top of your differential?

A

Wernicke’s aphasia

101
Q

At what age do symptoms of Huntington’s disease appear?

A

Around 30 years old

102
Q

Wilson’s disease is associated with a build up of what mineral?

A

There is a deficiency of the copper binding protein and therefore a buildup of copper

103
Q

A patient is brought in following a seizure in which she did not lose consciousness. What diagnosis should you be thinking of?

A

Simple partial seizure

104
Q

Which is the most commonly herniated vertebral disc?

A

L4-L5 followed by L5-S1

105
Q

A patient presents with signs of a stroke to the ER what is the most important test to get?

A

CT

106
Q

A patient presents complaining of the worst headache of his life. What might you expect their blood pressure to be?

A

Typically this is the description for a subarachnoid hemorrhage. You would expect the blood pressure to be elevated.

107
Q

A sudden thunderclap headache should make you think of what diagnosis?

A

Subarachnoid hematoma

108
Q

Lead pipe or cogwheel rigidity should make you think of what diagnosis?

A

Parkinson’s disease

109
Q

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?

A

Huntington’s disease

110
Q

What percentage of strokes are ischemic? What percentage are hemorrhagic?

A

80%, 20%

111
Q

Name three medications used to break a seziure?

A

Diazepam, lorazepam, phenytoin or fosphenytoin

112
Q

At what percentage of blockage is an endarterectomy indicated?

A

asymptomatic >70%, symptomatic >60%

113
Q

Elevated circulating acetylcholine receptor antibodies should make you think of what diagnosis?

A

Myasthenia gravis

114
Q

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?

A

Broca’s aphasia

115
Q

What are the genetic characteristics of Wilson’s disease?

A

Autosomal recessive, chromosome 13

116
Q

What four chromosome have been linked to dementia?

A

1, 14, 19, 21

117
Q

Decreased GABA and substance P should make you think of what diagnosis?

A

Huntington’s

118
Q

What is the defining symptom of Alzheimer’s?

A

Progressive memory impairment

119
Q

List three medications used to “treat” multiple sclerosis?

A

Steroids, interferon beta, copolymer 1

120
Q

A lumbar puncture for a patient with bacterial meningitis will show elevated or decreased WBCs? glucose? Protein?

A

Elevated WBCs, decreased glucose and elevated protein

121
Q

Weakness and numbness in the left hand might be a blockage in which carotid artery?

A

Right

122
Q

A resting or pill-rolling tremor should make you think of what diagnosis?

A

Parkinson’s disease

123
Q

A patient has an intracranial neoplasms causing auditory illusions, olfactory hallucinations and emotional changes. What lobe is the lesion likely in?

A

Temporal

124
Q

A study results comes back with intracellular neurofibrillary tangles and extracellular neuritic plaques. What diagnosis should you be thinking of?

A

Alzheimer’s disease

125
Q

Is the ankle jerk reflex of lumbar or sacral origin?

A

Sacral

126
Q

What is the most common cause of subarachnoid hemorrhage aside from trauma?

A

Ruptured cerebral aneurysm

127
Q

List six medications that can be used for migraine prophylaxis?

A

Beta blockers, tricyclics, calcium channel blockers, NSAIDs, and valproic acid

128
Q

There is an MRI result of multiple foci of demyelination in the white matter. What diagnosis should you be thinking of?

A

Multiple sclerosis

129
Q

List three drugs that treat cluster headaches.

A

Oxygen, sumatriptan, butorphanol

130
Q

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?

A

Guillain-Barre

131
Q

What three symptoms are classic for a normal pressure hydrocephalus?

A

Gait disturbance, dementia, and urinary incontinence

132
Q

What is the most common primary intracranial neoplasm?

A

Glioma

133
Q

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?

A

Multiple sclerosis

134
Q

List two medications you might use to treat an essential tremor.

A

Beta blocker (propranolol), primidone

135
Q

Give two classes of drug therapy for treating Parkinson’s.

A

Dopaminergic (levodopa), anticholinergics are second line.

136
Q

A shuffling gait should make you think of what diagnosis?

A

Parkinson’s disease

137
Q

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?

A

Anterior

138
Q

What is the single most important thing to be concerned about with a patient in status epilepticus?

A

Airway, followed by management of hyperthermia

139
Q

Is Huntington’s autosomal dominant or recessive?

A

dominant

140
Q

What symptom is associated with a classic migraine?

A

Having an aura

141
Q

An EEG showing interictal spikes should make you think of what diagnosis?

A

Complex partial seizure

142
Q

Describe Brudzinski’s sign.

A

When you lift the patient’s head the patient bends his hips.

143
Q

A slit lamp shows Kayser-Fleischer rings. What diagnosis should you be thinking of?

A

Wilson’s disease

144
Q

What seizure medication may cause overgrowth of the gums?

A

Phenytoin

145
Q

You are looking for lesions associated with multiple sclerosis. When you order an MRI do you order it with gadolinium or without?

A

With gadolinium

146
Q

A patient presents with facial paresis, arm drift, and abnormal speech. What are the first three tests to order?

A

Thinking of a stroke you order a non-contrast brain CT or MRI, serum glucose, and oxygen saturation.

147
Q

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?

A

Autism

148
Q

How is acute stress disorder different than posttraumatic stress disorder?

A

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
Q

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?

A

Generalized anxiety disorder

150
Q

What is the term for being afraid of being out in a terrible situation with no help available?

A

Agoraphobia

151
Q

What medication is clearly contraindicated in anorexia and bulimia?

A

Bupropion (Wellbutrin) because it can increase risk of seizures

152
Q

How do you treat alcohol withdrawal?

A

Benzodiazepines

153
Q

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?

A

Paranoid personality disorder

154
Q

List the four cluster B personality disorders.

A

“Bad” antisocial, borderline, histrionic, and narcissistic

155
Q

List the two cluster C personality disorders.

A

“Sad” avoidant and obsessive compulsive

156
Q

What is the major concern with using lithium?

A

It has a very narrow therapeutic window. Blood tests are needed every four weeks.

157
Q

What two psychiatric issues are more common in males than females?

A

Autism and ADD, the rest are all either equal or more common in females.

158
Q

A patient has very strange magical thinking. What diagnosis should you be thinking of?

A

Schizotypal personality disorder

159
Q

What causes anorexic patients to have osteopenia?

A

A decrease in estrogen

160
Q

A doughnut shaped burn should make you think of what issue?

A

Abuse, either child or elder

161
Q

What is necessary to diagnose a patient with bipolar 1?

A

One manic episode. They do not have to have the depressive episode for the diagnosis.

162
Q

Are hallucinations normal during a grieving period?

A

Yes, as long as they are not persistent or intrusive

163
Q

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?

A

Conduct disorder

164
Q

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?

A

Beta blocker - propranolol

165
Q

How long must symptoms occur before diagnosing schizophrenia?

A

At least six months

166
Q

What is the term for a chronic mild depression which has lasted greater than two years?

A

Dysthymia

167
Q

What type of behavioral therapy works best for borderline patients?

A

Dialectical behavior therapy

168
Q

When is the typical onset of Tourette’s syndrome?

A

3-8 years old

169
Q

Name three SSRIs.

A

fluoxetine, paroxetine, sertraline, citalopram, escitalopram, dapoxetine, zimelidine, mesembrine, seproxetine

170
Q

Borderline personality disorder is on the border of what two psychological disorders?

A

Neurosis and psychosis

171
Q

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?

A

Delusional disorder

172
Q

A patient’s wife complains that he is hypervigilant and has a hyperstartle response. What diagnosis should you be thinking of?

A

Posttraumatic stress disorder

173
Q

What is Russel’s sign?

A

Abraded knuckles from forcing oneself to vomit.

174
Q

List four symptoms of serotonin syndrome.

A

Hyperthermia, seizure, mental status change, tremor

175
Q

How long does menstruation need to be absent before secondary amenorrhea can be diagnosed?

A

If cycles have been previously normal: 3 months. If cycles have been previously irregular: 6 months.

176
Q

What medication is often used to treat postpartum depression in a women who is breast feeding?

A

Sertraline (Zoloft)

177
Q

What type of hallucinations are most common in schizophrenia auditory, visual, or olfactory?

A

auditory - hearing voices

178
Q

What medication is a good place to start treating bipolar 1 or 2?

A

Lithium

179
Q

List three positive symptoms of schizophrenia.

A

Hallucinations, delusions, movement disorder

180
Q

How long before normal grief resolves?

A

About one year

181
Q

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?

A

Narcissistic personality disorders

182
Q

List the three cluster A personality disorders.

A

“Mad” schizoid, schizotypal and paranoid

183
Q

To be diagnosed with ADD patients must exhibit symptoms before what age?

A

7 years old

184
Q

How long must symptoms last before diagnosing ADD?

A

6 months

185
Q

What is the generic name for Prozac?

A

Fluoxetine

186
Q

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?

A

Conversion disorder

187
Q

A psychiatric patient presents with confusion, fever, and lead pipe rigidity. What diagnosis should you be thinking of?

A

Neuroleptic malignant syndrome, this can occur with high dose antipsychotics

188
Q

Are patient with specific phobias aware they are strange?

A

Yes

189
Q

What is the time frame from the fist symptom of withdrawal from alcohol?

A

Tremor in 8-18 hours

190
Q

Is obsessive compulsive disorder egosyntonic or ego-dystonic? What about obsessive compulsive personality disorder?

A

OCD is ego-dystonic. OCPD is egosyntonic.

191
Q

A spiral fracture should make you think of what issue?

A

Abuse, either child or elder.

192
Q

How long does a panic attack typically last?

A

10-20 minutes

193
Q

A patient exhibits splitting, seeing others as all good or all bad. What diagnosis should be thinking of?

A

Borderline personality disorder

194
Q

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?

A

Schizoid personality disorder

195
Q

Waxy flexibility should make you think of what diagnosis?

A

Catatonic schizophrenia

196
Q

Posturing should make you think of what diagnosis?

A

Catatonic depression

197
Q

Antisocial personality disorder may not be diagnosed until what age?

A

18 years old

198
Q

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?

A

hypochondriasis

199
Q

Is anorexia egosyntonic or ego-dystonic? What about bulimia?

A

Anorexia is egosyntonic. Bulimia is ego-dystonic

200
Q

When treating psychiatric patients are benzodiazepines used more commonly for acute or chronic treatment?

A

acute

201
Q

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?

A

No, symptoms must occur in both settings for diagnosis

202
Q

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?

A

Avoidant personality disorder

203
Q

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?

A

Antisocial personality disorder

204
Q

What is the most common precipitating event for posttraumatic stress disorder in women?

A

Rape

205
Q

You have a patient with major depressive disorder. Once his symptoms have completely resolved how long should you continue with treatment?

A

A six month minimum is recommended due to very high relapse rates.

206
Q

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?

A

Adjustment disorder

207
Q

What two things are needed to make a diagnosis of bipolar 2?

A

One major depressive episode and one hypomanic episode

208
Q

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?

A

Histrionic personality disorder

209
Q

At what BMI should a patient be hospitalized for anorexia?

A

BMI < 17.5 or 20% below appropriate body weight

210
Q

A sawtooth pattern on EKG should make you think of what diagnosis?

A

Atrial flutter

211
Q

List the 4 minor criteria for diagnosing endocarditis.

A

Fever, embolic event (Janeway lesions or petechiae, splinter hemorrhages), immunological event (Osler nodes, glomerulonephritis), 1 positive blood culture

212
Q

List three class 1a antiarrhythmics.

A

Disopyramide, quinidine, procainamide

213
Q

An RSR prime in leads V5 or V6 should make you think of what diagnosis?

A

Left bundle branch block

214
Q

What is the first line IV inotropic agent when dealing with cardiogenic shock?

A

Dopamine

215
Q

A blockage of which artery causes an anterior wall MI?

A

Left anterior descending artery

216
Q

Following a myocardial infarction, what medication should you be using to treat hypertension?

A

Beta blocker

217
Q

Tall peaked P waves should make you think of what diagnosis?

A

Right atrial enlargement

218
Q

What is the best patient position to hear aortic regurge and aortic stenosis?

A

sitting up and leaning forward

219
Q

An elderly patient presents with dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely diagnosis?

A

Aortic stenosis

220
Q

Name one aldosterone antagonist.

A

Spironolactone, eplerenone

221
Q

A patient has a GFR of 25 and HTN. Which class should you use, a loop or a thiazide diuretic?

A

A loop will work no matter how low the GFR is. Thiazides will only work with a GFR over 30.

222
Q

After a thiazide diuretic, what medication should you start in a hypertensive patient who also has diabetes?

A

An ACEI or an ARB

223
Q

Which EKG lead are used to diagnose an anterior wall MI?

A

V1, V2 and V3

224
Q

Clot busting drugs should be used within 3 hours of which two cardiac events?

A

STEMI and new left bundle branch block

225
Q

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?

A

Mobitz I or Wenckebach

226
Q

Which hyperlipidemia medication may cause flushing?

A

Niacin

227
Q

Any ulcers from venous insufficiency painful or painless?

A

painless

228
Q

Where do most aortic dissections occur?

A

the ascending or descending thoracic aorta

229
Q

What two labs do you want to monitor in a patient on an ACEI?

A

serum creatinine and serum potassium

230
Q

What are the three major criteria for endocarditis?

A

2 positive blood cultures, a positive transesophageal echocardiography, new murmur

231
Q

Where is disease of the pulmonary valve best heard?

A

2nd left intercostal space

232
Q

A continuous murmur most likely involves what area of the heart?

A

It is most likely a septal defect

233
Q

Where on your patient should you listen for the murmur associated with an atrial septal defect?

A

At the left second or third interspace

234
Q

A patient recently started taking Lipitor. He is now complaining of aches and pains. What test should you order?

A

Serum creatinine kinase, you’re looking for rhabdomyolysis

235
Q

A patient complains of severe pleuritic chest pain that is relieved with sitting and leaning forward. What is the most likely diagnosis?

A

Pericarditis

236
Q

An EKG shows two premature ventricular contractions. These two QRS waves look very different. What is the term for this?

A

Multifocal premature ventricular contractions

237
Q

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?

A

Premature atrial contraction

238
Q

What side effect might make a patient stop taking an ACEI?

A

Cough

239
Q

On physical exam, you hear a harsh systolic murmur along the right sternal border. What is the most likely diagnosis?

A

Aortic stenosis

240
Q

An RSR prime in leads V1 or V2 should make you think of what diagnosis?

A

Right bundle branch block

241
Q

A patient has just received a cardiac stent. How long will he be on aspirin and clopidogrel?

A

One year

242
Q

A beta natriuretic peptide below what level rules out CHF?

A

< 100

243
Q

Define orthostatic hypotension

A

A drop in systolic blood pressure of > 20 mmHg when standing up

244
Q

Which EKG leads are used to diagnose an anterolateral MI?

A

V5 and V6

245
Q

What two leads do you use to determine the axis of the heart?

A

Lead I and AVF

246
Q

What medication might you switch to if a patient develops an intolerable cough on an ACEI?

A

Angiotensin receptor blocker (ARBs)

247
Q

Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis?

A

CHF

248
Q

Both lead I and AVF have positive QRS complexes. Does this represent normal axis, left axis deviation, or right axis deviation?

A

normal axis

249
Q

What is the first line medical treatment for torsades de pointes?

A

Magnesium sulfate

250
Q

What is the first line medical treatment for pericarditis?

A

Aspirin and NSAIDs

251
Q

What is the appropriate treatment for a patent ductus arteriosus.

A

Indomethacin

252
Q

What is the first line medical treatment for stage 1 hypertension?

A

Thiazide diuretic

253
Q

Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work?

A

No, a recent change moves mitral valve prolapse from high risk to moderate risk

254
Q

What is the best test for diagnosing CHF?

A

Echo

255
Q

Which lab should be tightly monitored in a patient taking an aldosterone antagonist?

A

Potassium, they may have hyerkalemia

256
Q

In a patient with aortic stenosis, will the PMI be medially displace, normal or laterally displaced?

A

It will be laterally displaced due to left ventricular hypertrophy

257
Q

Statins are the drug of choice to treat what type of dyslipidemia?

A

Elevated LDL

258
Q

Name two things that would constitute a positive stress test.

A

A drop in blood pressure, a new arrhythmia, an increase in angina symptoms, ST depressions

259
Q

A patient with mitral valve prolapse will often have what physical characteristics?

A

Often a thin female

260
Q

An 82 year old patient complains of headaches and jaw claudication. What is the most likely diagnosis?

A

Giant cell (temporal) arteritis

261
Q

What are the three inferior leads?

A

II, III, and aVF

262
Q

The EKG shows irregularly irregular narrow QRS waves. What is the most likely diagnosis?

A

Atrial fibrillation

263
Q

How do you treat polymyalgia rheumatica?

A

Low dose prednisone

264
Q

Which cardiac medication has gynecomastia in its side effect profile?

A

Spironolactone

265
Q

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?

A

Left axis deviation

266
Q

Are most pulmonary valve problems congenital or acquired?

A

95% are congenital

267
Q

You feel a pulse that seems to be vibrating. What term do you use to describe it?

A

Thrill

268
Q

Where is disease of tricuspid valve best heard?

A

Along the left lower sternal border

269
Q

What is Tietze syndrome?

A

Costochondritis

270
Q

What is the most important complication of giant cell arteritis?

A

Blindness

271
Q

What is the most common congenital heart disease?

A

Ventricular septal defect

272
Q

List three medications which may be used for pharmacological stress testing.

A

Adenosine, dobutamine, dipyridamole and persantine

273
Q

An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely diagnosis?

A

Supraventricular tachycardia

274
Q

A U wave on EKG should make you think of what diagnosis?

A

Hypokalemia

275
Q

Tall peaked T waves should make you think of what diagnosis?

A

Hyperkalemia

276
Q

What is the best way to diagnose an aortic dissection?

A

CT

277
Q

Rheumatic fever most commonly affects which valve?

A

The mitral valve

278
Q

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?

A

Intermittent claudication caused by peripheral arterial disease

279
Q

What is the treatment goal for a diabetic with hypertension?

A

130/80

280
Q

A question stem includes an IV drug user with a new heart murmur and fever. What is the most likely diagnosis?

A

Endocarditis

281
Q

How does ezetimibe work?

A

Decreases intestinal absorption of cholesterol

282
Q

A question about Prinzmetal’s angina will often contain what key thing in the patient’s history?

A

Cocaine use

283
Q

Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?

A

Osler nodes

284
Q

What is the definitive treatment for a patient with recurrent ventricular tachycardia?

A

Implanted defibrillator

285
Q

Who is more likely to have an aortic aneurysm males or females?

A

Males are eight times as likely to have an aortic aneurysm

286
Q

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?

A

Cushing’s disease

287
Q

What is the only cyanotic congenital heart disease on the NCCPA blueprint?

A

Tetralogy of Fallot

288
Q

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?

A

Coarctation of the aorta

289
Q

What is the most common cause of sudden death?

A

Ventricular fibrillation

290
Q

How do you define 1st degree AV block?

A

The PR interval is longer than 0.2 seconds or one block on EKG

291
Q

List three congenital heart diseases.

A

Atrial septal defect (ASD), ventricular septal defect (VSD), coarctation of the aorta, patent ductus arteriosus (PDA), tetralogy of Fallor

292
Q

A blockage of which artery causes a lateral wall MI?

A

left circumflex artery

293
Q

List the six P’s of an ischemic limb.

A

Pain, paresthesias, pallor, pulselessness, poikilothermia, paralysis

294
Q

What ejection fraction is typical for a patient with CHF?

A

35-40%

295
Q

The accessory pathway known as the James bundle should make you think of what syndrome?

A

Lown-Ganong-Levine syndrome

296
Q

What will a CXR show for a patient with an aortic dissection?

A

Widened mediastinum

297
Q

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?

A

Ruptured aortic aneurysm

298
Q

What medication calls is used to lower triglycerides?

A

Fibric acid derivatives

299
Q

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?

A

Premature ventricular contraction

300
Q

List three side effects of digoxin.

A

Nausea/vomiting, anorexia, confusion, arrhythmias (sinus brady, AV block), fatigue, vision disturbances etc.

301
Q

You hear a loud, hard pulmonary murmur along the left sternal border. What is the most likely diagnosis?

A

Ventricular septal defect

302
Q

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?

A

The answer is 100. The heart rates by counting boxes are 300, 150, 100, 75, 60.

303
Q

What is the treatment for giant cell arteritis?

A

High dose prednisone

304
Q

What is the most common cause of secondary hypertension?

A

Chronic kidney disease

305
Q

What is the initial treatment for a myocardial infarction?

A

MONA - morphine, oxygen, nitroglycerin and aspirin

306
Q

What is the first line medication for a patient with symptomatic bradycardia?

A

Atropine

307
Q

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?

A

Third degree AV block

308
Q

What is the best location to hear problems with the aortic valve?

A

2nd intercostal space

309
Q

What is the gold standard for diagnosis of giant cell arteritis?

A

Biopsy of the temporal artery

310
Q

If you hear a midsystolic click you should immediately be thinking about what diagnosis?

A

Mitral vale prolapse

311
Q

A wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what diagnosis?

A

Aortic regurgitation

312
Q

What terms will likely be include in a description of a patient with a pheochromocytoma?

A

Thin, diaphoretic, tachycardic, agitated

313
Q

Do loop diuretics causer hyperkalemia or hypokalemia?

A

Hypokalemia

314
Q

A boot-shaped heart on CXR should make you think of what congenital heart condition?

A

Tetralogy of Fallot

315
Q

A patient presents to the ER in acute CHF. What drug class will likely be the first choice?

A

Loop diuretics

316
Q

On auscultation, you hear a hard blowing pansystolic murmur at the apex. What is the most likely diagnosis?

A

Mitral regurgitation

317
Q

Define pulsus alternans.

A

EKG waveform changes from beat to beat

318
Q

What is the treatment for a patient with a Mobitz II AV block?

A

Pacemaker

319
Q

List two risk factors for an aortic dissection?

A

Hypertension, Marfan’s syndrome, bicuspid aortic valve, pregnancy

320
Q

You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?

A

Wolff-Parkinson-White syndrome

321
Q

Which finding requires immediate attention: left bundle branch block or right bundle branch block?

A

New left bundle branch block is at STEMI equivalent, Right bundle branch block is usually not a problem.

322
Q

What is represented by ST segment depressions greater than 1 mm on EKG?

A

Ischemia

323
Q

What is the gold standard for diagnosing myocarditis?

A

Myocardial biopsy

324
Q

What is the therapeutic range for INR following an organic valve replacement?

A

2 to 3

325
Q

Name a common cause of a junctional rhythm.

A

Digitoxin toxicity

326
Q

Calf pain should always make you think of what diagnosis?

A

DVT

327
Q

What are three things in your differential if you have a paradoxical pulse?

A

Cardiac tamponade, pericarditis, and pulmonary obstructive lung diseases (think COPD)

328
Q

What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?

A

Dressler’s syndrome

329
Q

What is the most common cause of CHF?

A

Coronary artery disease

330
Q

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?

A

He is in ventricular fibrillation. The treatment is defibrillation

331
Q

A biphasic P wave should make you think of what diagnosis?

A

Left atrial enlargement

332
Q

What is the management of a patient in supraventricular tachycardia?

A

Vagal maneuvers, carotid massage, adenosine

333
Q

What class of cardiac medications should be avoided in patients with asthma?

A

Beta blockers (blocks receptors for bronchodilators)

334
Q

What is the most common cause of sudden cardiac death?

A

Ventricular fibrillation

335
Q

What is the other term for Mobitz type I?

A

Wenckebach

336
Q

Giant cell arteritis is associated with what other disease?

A

Polymyalgia rheumatica

337
Q

Subacute endocarditis is most commonly caused by what organism?

A

Strep Viridans

338
Q

An Osborn or J wave on EKG should make you think of what diagnosis?

A

Hypothermia

339
Q

What is the most common cause of an atrial septal defect?

A

Patent foramen ovale

340
Q

What is the definitive treatment for cardiac tamponade?

A

Pericardiocentesis

341
Q

List the components of Virchow’s triad.

A

Stress, vascular injury, hypercoagulability

342
Q

On palpation, what size is normal for the aorta?

A

Less than 3 cm

343
Q

A CXR shows a “3” sign with notching of the ribs. What is the most likely diagnosis?

A

Coarctation of the aorta

344
Q

What will the heart rate be if the AV node is pacing the heart?

A

40-60 beats per minute

345
Q

What lab results will increase the risk of digoxin toxicity?

A

hypokalemia or hypercalcemia

346
Q

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?

A

Count QRS waves in a six second strip and multiply by 10 to get beats per minute

347
Q

Give two contraindications for using an ACEI.

A

Bilateral renal artery stenosis, history of angioedema, pregnancy

348
Q

A patient presents to the ER with tearing chest pain radiating to his back. What is the most likely diagnosis?

A

Aortic dissection

349
Q

What is the accessory pathway associated with Wolff-Parkinson-White syndrome?

A

The bundle of Kent

350
Q

What is the most likely diagnosis for a young man who experiences sudden death while playing sports?

A

Hypertrophic cardiomyopathy

351
Q

Paroxysmal nocturnal dyspnea should make you think of what diagnosis?

A

CHF

352
Q

List three catastrophic complications of a myocardial infarction.

A

Papillary muscle rupture, myocardial wall rupture and left ventricular aneurysm

353
Q

Acute endocarditis is most commonly caused by what organism?

A

Staph aureus

354
Q

An opening snap on auscultation of the heart should make you think of what diagnosis?

A

Mitral stenosis

355
Q

You have a patient with diagnosis of a pheochromocytoma. While waiting for surgery, should you use an alpha blocker or a beta blocker?

A

Alpha blocker. Never use a pure beta blocker.

356
Q

What is the most common place for an aortic aneurysm?

A

In the abdomen and below the renal arteries

357
Q

You hear a continuous machine-like murmur. What is the most likely diagnosis?

A

Patent ductus arteriosus (PDA)

358
Q

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?

A

Prinzmetal’s angina

359
Q

Define paradoxical pulse.

A

There is a large difference in pulse pressure between inhalation and exhalation

360
Q

You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis?

A

Transesophageal echo

361
Q

Which cardiac medication is used to help with cardiac contractility after you have optimized most of the other cardiac medications?

A

Digoxin

362
Q

What is the gold standard for diagnosing coronary artery disease?

A

Cardiac catheterization

363
Q

Are ulcers from arterial insufficiency painful or painless?

A

Painful

364
Q

What are the five components of teratology of Fallot?

A

Ventricular septal defect, right ventricular hypertrophy, right ventricular outflow obstruction (pulmonary valve stenosis), overriding aorta, right sided aortic arch

365
Q

List two diagnoses which require antibiotic prophylaxis for “dirty procedures”?

A

prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congenital cyanotic heart defect

366
Q

What are the two main causes of aortic stenosis?

A

Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease

367
Q

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?

A

Junctional rhythm

368
Q

Where is disease of the mitral valve best heard?

A

At the apex

369
Q

What is the definitive treatment for atrial flutter?

A

Radiofrequency catheter ablation

370
Q

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?

A

Pericarditis

371
Q

List two cause of right atrial enlargement.

A

Pulmonary HTN, severe lung disease, pulmonary valve stenosis

372
Q

A pathologic S3 is most commonly associated with what diagnosis?

A

CHF

373
Q

According to the CDC, what is the range for a normal BMI?

A

18.5-24.9

374
Q

You have a patient with pulsus paradoxus. What two diagnosis should you be thinking of?

A

Cardiac tamponade, pericarditis, pulmonary obstructive lung diseases (think COPD)

375
Q

A fixed or consistent split S2 should make you think of what diagnosis?

A

Atrial septal defect

376
Q

What two antibiotics are used for empiric treatment of endocarditis?

A

Vancomycin and ceftriaxone together are first line empiric treatment

377
Q

A Blalock procedure is used to correct what congenital heart condition?

A

Tetralogy of Fallot

378
Q

What imaging needs to be done before taking a patient to the OR with an aortic aneurysm?

A

CT (echo may be used as initial study, but CT is need for surgery)

379
Q

What two valvular issues do patients with Marfan’s syndrome often have?

A

Aortic regurgitation and mitral valve prolapse (you can tell them apart by where they are heard)

380
Q

Name three medication “classes” which are used to reduce LDL?

A

Statins, ezetimibe, niacin and nicotinic acid

381
Q

Define stage 1 hypertension according to JNC 7.

A

Systolic pressure of 140-149 and diastolic of 90-99

382
Q

What is the heart rate for tachycardia? How about bradycardia?

A

Tachycardia > 100, bradycardia < 60

383
Q

The term satellite lesion should make you think of what diagnosis?

A

Candida diaper rash

384
Q

Salmon-colored scales should make you think of what diagnosis?

A

Psoriasis

385
Q

What are the ABC’s of melanoma?

A

Asymmetry, border, color, diameter, elevation/irregularity, evolving

386
Q

Pitting nails are associated with what dermatologic disorder?

A

Psoriasis

387
Q

What are the two most common organisms responsible for cellulitis?

A

Strep and Staph

388
Q

A herald patch should make you think of what diagnosis ?

A

Pityriasis rosea

389
Q

How do you treat pityriasis rosea?

A

Reassurance

390
Q

Coin-shaped plaques should make you think of what diagnosis?

A

Nummular eczema

391
Q

What is the best lab test for scabies?

A

Microscopic examination under oil immersion

392
Q

Honey-colored crusts should make you think of what diagnosis?

A

Impetigo

393
Q

What is the treatment for seborrheic keratosis?

A

It is benign so there is no need to treat it. Lesions may be removed if unsightly

394
Q

Are lesions from psoriasis typically found on flexor or extensor surfaces?

A

Extensor

395
Q

How do you treat lichen simplex chronicus?

A

Get the patient to stop scratching it

396
Q

Extremely pruritic lesions with burrows in runs should make you think of what diagnosis?

A

Scabies

397
Q

How do you treat a stasis dermatitis?

A

Compression stockings

398
Q

A patient with a history of herpes now presents with a target lesions. What is the most likely diagnosis?

A

Erythema multiforme

399
Q

A teardrop lesion after a course of strep throat should make you think of what diagnosis?

A

Guttate psoriasis

400
Q

Why should actinic keratosis be treated?

A

It may progress to squamous cell carcinoma

401
Q

What dermatologic finding is associated with insulin insensitivity?

A

Acanthosis nigricans

402
Q

Depigmented patches of skin should make you think of what diagnosis?

A

Vitiligo

403
Q

Spaghetti and meatballs on KOH prep should make you think of what diagnosis?

A

Tinea versicolor

404
Q

What dermatologic finding is associated with asthma?

A

Atopic dermatitis

405
Q

A patient presents with flaky skin in the nasolabial folds and on her scalp. What is the most likely diagnosis?

A

Seborrheic dermatitis

406
Q

Tapioca blisters should make you think of what diagnosis?

A

Dyshidrosis - these are usually on hands and feet

407
Q

Nummular eczema is most like what other dermatological disorder?

A

Atopic dermatitis

408
Q

How do you treat dyshidrosis?

A

Topical steroids

409
Q

What is the first step in treating atopic dermatitis?

A

behavioral modifications - reduce bathing, only use soap on face and genitals, use natural breathable fabrics

410
Q

What two human papillomaviruses are most responsible for condyloma acuminata?

A

HPV 6 and 11

411
Q

What is the treatment for melanoma?

A

Wide local excision

412
Q

Where are 90% of basal cell lesions found on the body?

A

On the head and neck

413
Q

What is the first line treatment for rosacea?

A

Metronidazole, tetracycline is probably a close second

414
Q

Rhinophyma should make you think of what diagnosis?

A

Acne rosacea

415
Q

Melasma is most often found in what patient population?

A

Women of childbearing age

416
Q

What is the best treatment for molluscum contagiosum?

A

It is self limiting, but can be removed if patient really wants it

417
Q

What is the first line treatment for tinea corporis

A

Topical azoles

418
Q

A waxy stuck on appearance should make you think of what diagnosis?

A

Seborrheic keratosis

419
Q

A Christmas tree pattern should make you think of what diagnosis?

A

Pityriasis rosea

420
Q

A positive Auspitz sign should make you think of what diagnosis?

A

Psoriasis

421
Q

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?

A

Perioral dermatitis

422
Q

Hyperpigmented velvety plaques should make you think of what diagnosis?

A

Acanthosis nigricans

423
Q

Purple, pruritic, polygonal, papules on physical exam should make you think of what diagnosis?

A

Lichen planus

424
Q

Oval patches of hair loss should make you think of what diagnosis?

A

Alopecia areata

425
Q

What is the key indicator for the prognosis of melanoma?

A

Thickness of the lesions

426
Q

A pearly dome-shaped lesions with a central umbilication should make you think of what diagnosis?

A

Molluscum contagiousum

427
Q

Giant cells on a Tzanck smear should make you think of what diagnosis?

A

Herpes simplex virus

428
Q

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?

A

Atopic dermatitis

429
Q

Silvery scales should make you think of what diagnosis?

A

Psoriasis

430
Q

What is the first line treatment for genital warts?

A

Imiquimod (Aldara)

431
Q

A slowly growing nodule with central depression and a pearly border should make you think of what diagnosis?

A

Basal cell carcinoma

432
Q

What is the treatment for a bad brown recluse spider bite?

A

Debridement, the venom causes tissue necrosis

433
Q

A double comedone is indicative of what diagnosis?

A

Hidradenitis suppurativa

434
Q

Large doughy hands should make you think of what diagnosis?

A

Gigantism

435
Q

Cortical adrenal insufficiency is also known as what disease?

A

Addison’s disease

436
Q

How do glitazones work?

A

They improve insulin sensitivity

437
Q

Pretibial myxedema should make you think of what diagnosis?

A

Graves’ disease

438
Q

In Cushing’s disease is ACTH elevated or decreased?

A

Elevated

439
Q

In a patient with hyperthyroidism will TSH most likely be elevated or decreased?

A

Decreased

440
Q

Positive antithyroid peroxidase and antithyroglobulin antibodies should make you think of what diagnosis?

A

Hashimoto’s

441
Q

What is the test to begin with if you suspect a pheochromocytoma?

A

24 hour urine for catecholamines

442
Q

Stocking glove anesthesia should make you think of what diagnosis?

A

Diabetic neuropathy and B12 deficiency neuropathy

443
Q

Which thyroid cancer is the most aggressive?

A

Anaplastic

444
Q

How do sulonylureas work?

A

They stimulate the produce of insulin

445
Q

What is the most common thyroid cancer?

A

Papillary, makes up about 80% of thyroid cancers

446
Q

How does levothyroxine work?

A

It is a synthetic T4

447
Q

What heparin complication is relevant to endocrinology?

A

Adrenal infarct leading to a Cushing’s syndrome

448
Q

How often should a diabetic’s HgbA1c be checked and what should it be?

A

Every three months (remember the life of an RBC is 90-120 days) and it should be below 6.5%

449
Q

What role does C-peptide play in the diagnosis of diabetes?

A

It is a marker of insulin production. Elevated C-peptide points to DM 2. Decreased C-peptide points towards DM 1.

450
Q

During pregnancy which is the preferred treatment of hyperthyroidism PTU or methimazole?

A

PTU

451
Q

List four diagnostic criteria for diabetes?

A

Random glucose > 200, fasting glucose >126, two hour postprandial glucose > 200, HgA1c > 6.5%

452
Q

What percentage of diabetes in the US is type 2?

A

80-90%

453
Q

A 35 year old female presents with heat intolerance, weight loss, and palpitations. What diagnosis should you be thinking of?

A

Hyperthyroidism

454
Q

Diabetes insipidus is caused by a deficiency of which hormone?

A

Vasopressin

455
Q

Fruity breath should make you think of what diagnosis?

A

Diabetic ketoacidosis

456
Q

List the 5 insulins in order of peak efficacy?

A

Lispro 1-2 hours, Regular 2-4 hours, NPH 5-7 hours, Lente 4-8 hours, Ultralente 8-14 hours

457
Q

List 4 physical exam findings of Cushing’s syndrome.

A

Moon face, buffalo hump, purple striae, central obesity, supraclavicular fat pads, easy bruising

458
Q

What medication class does metformin (Glucophage) fall into?

A

Biguanide

459
Q

How do statins work to affect the lipid profile?

A

They slow the rate limiting step of cholesterol synthesis

460
Q

What is the treatment for Addison’s disease?

A

Hydrocortisone or prednisone

461
Q

Propranolol belongs to what class of medication?

A

Beta blockers

462
Q

HLA-DR gene is a marker for what endocrine disorder?

A

DM type 1

463
Q

What is the main function of parathyroid hormone?

A

Increase serum Ca

464
Q

Is metformin indicated or contraindicated in renal failure?

A

Contraindicated

465
Q

What is the best imaging for a thyroid nodule?

A

Ultrasound

466
Q

What medication might you use prior to a thyroidectomy in a patient with hyperthyroidim?

A

Methimazole or propylthiouracil (PTU)

467
Q

What lipid medication may cause flushing?

A

Niacin

468
Q

What is the most common pituitary adenoma?

A

Prolactinoma

469
Q

What is Graves’ disease?

A

The most common cause of hyperthyroidism. It is an autoimmune disease

470
Q

What is the first line medical treatment for a patient with palpitations and nervousness secondary to hyperthyroidism?

A

Beta Blockers

471
Q

What is the least aggressive thyroid cancer?

A

Papillary

472
Q

Moans, groans, stones and bones describe symptoms of what endocrine problem?

A

Hyperparathyroid

473
Q

How do fibrates work to affect the lipid profile?

A

They inhibit synthesis of ALDL and elevate lipoprotein lipase

474
Q

Hyperpigmentation of the skin along creases should make you think of what diagnosis?

A

Addison’s disease

475
Q

What is Trousseau’s sign?

A

Inflate BP cuff and hold for 3 minutes. Patient will low Ca will get carpal tunnel symptoms

476
Q

What is the most common cause of hypoparathyroid?

A

Post thyroidectomy with complication of parathyroidectomy

477
Q

What is Chvostek’s sign?

A

Tap on facial nerve and get a twitch with low Ca

478
Q

How does nicotinic acid work to affect the lipid profile?

A

It inhibits secretion of VLDL

479
Q

Exophthalmos should make you think of what diagnosis?

A

Hyperthyroidism

480
Q

What is the first line medical treatment for a pheochromocytoma?

A

Alpha blockers

481
Q

Will ACTH be elevated or decreased in Addison’s disease?

A

Elevated if the problem is at the adrenal glands

482
Q

What is the most common cause of DM type 1?

A

Autoimmune destruction of the islet cells in the pancreas

483
Q

What life threatening side effect do statins have?

A

Rhabdomyolysis

484
Q

List two ectopic tumors that may produce ACTH and give a patient Cushing’s syndrome?

A

Small cell lung cancer, pancreatic islet cells, thymomas

485
Q

How does metformin work?

A

Decreases the hepatic glucose production and increases peripheral glucose uptake

486
Q

What are the 5 criteria for metabolic syndrome?

A

HDL < 40 men < 50 females, BP >135/85, Triglycerides > 150, Fasting glucose > 100, Waist > 40 inches in mean > 35 inches in women

487
Q

Name two tests you might use to rule out Cushing’s syndrome.

A

24 hour free cortisol urine test and dexamethasone suppression test

488
Q

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?

A

Diabetic neuropathy

489
Q

How much more potent is T3 than T4?

A

3-4x

490
Q

What is included in Whipple’s triad of hypoglycemia?

A

History of previous hypoglycemia, serum glucose of < 40, immediate recovery upon administration of glucose

491
Q

What specific breathing pattern is associated with diabetic ketoacidosis?

A

Kussmaul respirations

492
Q

What is the suffix associated with sulfonylureas?

A

ide is the suffix. Examples are glipizide, tolbutamide, tolazamide

493
Q

What class of medications is the first line for lowering LDL?

A

Statins

494
Q

As it related to diabetes, what is the dawn phenomenon?

A

Reduced insulin response between 5 and 8 am

495
Q

Does niacin increase or decrease HDL?

A

Increase

496
Q

What is Sheehan’s syndrome?

A

Ischemia of the pituitary due to volume depletion during or after childbirth

497
Q

What is Hashimoto’s disease?

A

An autoimmune cause of hypothyroid

498
Q

Name the four thyroid cancers.

A

Papillary, Follicular, Medullary, Anaplastic

499
Q

What class of medications does pioglitazone (Actos) fall into?

A

Thiazolidinediones also known as glitazones

500
Q

What is the most common cause of hyperparathyroidism?

A

Single parathyroid adenoma in 80% of cases

501
Q

What is the most common cause of hypopituitarism?

A

Tumor

502
Q

Typically what is the first medication started in type 2 DM?

A

Metformin

503
Q

What two hormones are secreted by the posterior pituitary?

A

Oxytocin and antidiuretic hormone (ADH, vasopressin)

504
Q

What is the treatment for myxedema?

A

Levothyroxine and slow warming

505
Q

List the four things that suggest group A beta-hemolytic strep in a patient with pharyngitis.

A

Fever, tender anterior cervical adenopathy, no cough and an exudate in the throat.

506
Q

What type of hearing loss would be caused by cerumen impaction?

A

Conductive

507
Q

How do you treat allergic rhinitis?

A

Intranasal corticosteroid and antihistamines

508
Q

Small grouped vesicles on the vermillion border should make you think of what diagnosis?

A

Herpes

509
Q

A 45 year old female complains of feeling the ground rolling under her feet at times. What is the most likely diagnosis?

A

Vertigo

510
Q

A white oral lesion which cannot be scraped off should make you think of what diagnosis?

A

Oral leukoplakia

511
Q

Acute sinusitis is most commonly caused by what two pathogens?

A

Step pneumoniae and haemaophilus influenzae

512
Q

List four complications of untreated strep throat

A

Scarlet fever, glomerulonephritis, rheumatic fever, and local abscess

513
Q

When is watchful waiting with a diagnosis neuroma an appropriate plan?

A

This tumor is very slow growing. Watching a small tumors in an elderly patient is appropriate treatment

514
Q

An x-ray of the skull revels coalescence of mastoid air cells. What is the most likely diagnosis?

A

Mastoiditis

515
Q

What does Kiesselbach’s plexus refer to?

A

A group of vein’s in the anterior nose which bleed a lot

516
Q

A patient presents with a hot potato or muffled voice. What is the most likely diagnosis?

A

Peritonsillar abscess

517
Q

White oral lesions which can be scraped off leaving punctate bleeding should make you think of what diagnosis?

A

Oral candida

518
Q

What is the treatment of choice for strep throat?

A

Penicillin, amoxicillin, erythromycin

519
Q

How do you administer the Rinne hearing test?

A

Place the turning fork on the mastoid and then move it next to the ear.

520
Q

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?

A

Labrynthitis

521
Q

What type of hearing loss is associated with aging?

A

Sensory

522
Q

What virus causes mumps?

A

Paramyxovirus

523
Q

What are three possible treatments for peritonsillar abscess?

A

Needle aspiration, I&D, and tonsillectomy

524
Q

A child presenting with an erythematous sandpaper rash should make you think of what diagnosis?

A

Scarlet fever

525
Q

List the time of year when each of the following allergens is most prominent. Pollen, Grass, Ragweed and Mold.

A

Pollen from trees and flowers = spring, grasses are the summer, mold and ragweed are fall.

526
Q

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?

A

Acoustic neuroma

527
Q

How long should pressure be applied to treat epistaxis?

A

15 minutes

528
Q

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?

A

Meniere’s disease

529
Q

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?

A

Mononucleosis

530
Q

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?

A

Laryngeal squamous cell carcinoma

531
Q

How do you administer the Weber hearing test?

A

Tuning fork placed in the middle of the forehead.

532
Q

Which is the most commonly affected sinus in acute sinusitis?

A

Maxillary

533
Q

A patient presents drooling, with stridor and in tripod position. What is the diagnosis and how do you treat it?

A

Epiglottis is treated with a third generation cephalosporin - ceftriaxone

534
Q

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?

A

Aphthous ulcers

535
Q

What time frame are we talking about for chronic sinusitis?

A

> 3 months

536
Q

In a patient with sensorineural hearing loss, what will be the results of the Weber test?

A

The patient will hear the sound louder in the unaffected ear

537
Q

Describe the result of a Weber hearing test in a patient with conductive hearing loss.

A

Patient will report the sound louder in the affected ear.

538
Q

After 10 days of worsening sinusitis what antibiotic should you start?

A

Augmentin (Amoxicillin/clavulanate)

539
Q

A patient presents with acute swelling and pain in the cheek that increases at meals. What is the most likely diagnosis?

A

Sialadenitis (salivary gland infection)

-Staph aureus

540
Q

Oral herpes is best treated with systemic or topical antivirals?

A

Topical is the first line. Systemic antivirals will help but are only indicated for severe cases.

541
Q

Often caused by chlamydia what is the syndrome characterized by urethritis (or cervicitis), arthritis and conjunctivitis?

A

Reiter’s syndrome

542
Q

Define phimosis.

A

Foreskin can not be retracted

543
Q

Will serum potassium be decreased or elevated in renal failure?

A

Elevated

544
Q

Muddy-brown sediment in the urine should make you think of what diagnosis?

A

Acute tubular necrosis

545
Q

What are the two most common predisposing factors in the development of chronic renal failure?

A

HTN and DM

546
Q

What is the best imaging to tule out testicular torsion?

A

Doppler U/S for decreased blood flow to the testes

547
Q

List one major risk factor for bladder cancer?

A

Smoking

548
Q

What is the condition where the urethral meatus is not at the tip of the penis?

A

Hypospadias and in far fewer cases epispadias

549
Q

Define priapism.

A

Painful persistence erection.

550
Q

A urine protein of >3.5 grams/day should make you think of what diagnosis?

A

Nephrotic syndrome

551
Q

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?

A

BPH

552
Q

At what age do you begin screening patients for prostate cancer? What two tests are used?

A

At age 50 an annual digital rectal exam and a PSA are recommended

553
Q

Tenderness at the costovertebral angle should make you think of what diagnosis?

A

Pyelonephritis

554
Q

Both testicles should be descended by what age?

A

3 months

555
Q

What is the first line treatment for a varicocele?

A

Watchful waiting unless there is a question of futility

556
Q

What is the most common type of kidney stone?

A

Calcium makes up 85% of kidney stones

557
Q

An involuntary loss of urine during coughing or laughing is what type of incontinence?

A

Stress incontinence

558
Q

What is the first line antibiotic for prostatitis?

A

Bactrim 4-6 weeks

559
Q

What is the name of the condition that involves fibrous scar tissue in the penis causing a curvature of the erect penis?

A

Peyronie’s disease

560
Q

Which problem is an emergency phimosis or paraphimosis?

A

Paraphimosis

561
Q

What is the most accurate way to diagnose urethritis?

A

Urine PCR

562
Q

What is the most common type of testicular cancer?

A

Non-seminoma

563
Q

List three possible treatments for stress incontinence in women.

A

Kegels, estrogen therapy, surgical placement of a urethral sling.

564
Q

Give two major risk factors of erectile dysfunction.

A

Diabetes, hypertension, depression, coronary artery disease

565
Q

An ABG shows a pH of 7.2, a bicarb of 25 and a PCO2 of 50. Is this respiratory or metabolic acidosis?

A

respiratory - CO2 is elebated

566
Q

What is the normal pH of the blood?

A

7.35-7.45

567
Q

A patient who has normal bladder function, but can not get to the bathroom has what type of incontinence?

A

Functional incontinence

568
Q

How do you treat urethritis?

A

Ceftriaxone and doxycycline

569
Q

What is the first line antibiotic treatment for cystitis?

A

Bactrim

570
Q

What is the imaging study of choice if you suspect bladder cancer?

A

Cystoscopy and biopsy

571
Q

A kidney stone of less than what size will likely pass on its own?

A

Less than 5 mm

572
Q

What is the mot specific imaging modality for diagnosing kidney stones?

A

CT

573
Q

Will epididymitis feel better with scrotal elevation?

A

Yes

574
Q

Will a spermatocele transilluminate?

A

Yes

575
Q

A sponge-like prostate on digital rectal exam should make you think of what diagnosis?

A

Prostatitis, but be careful. You can cause sepsis with a digital rectal exam.

576
Q

Define paraphimosis.

A

Foreskin is retracted and cannot be reduced.

577
Q

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.)

A

Chordee

578
Q

A PSA above what level should start to make you concerned?

A

> 4.0

579
Q

What type of incontinence is often associated with BPH?

A

Overflow incontinence, the bladder cannot empty sufficiently

580
Q

List two risk factors for prostate cancer.

A

Advancing age, African American, positive family history, high fat diet

581
Q

What is the normal level or serum bicarbonate (HCO3)?

A

24 mEq/Liter

582
Q

A 3 year old boy presents with hematuria and a painless palpable abdominal mass. What diagnosis should you be thinking of?

A

Wilms tumor

583
Q

Where is the epididymis found?

A

It is found at the posterior upper pole.

584
Q

What is considered a normal PCO2?

A

40 mmHG

585
Q

What area of the prostate is the primary site for prostate cancer?

A

The peripheral zone

586
Q

What area of the prostate is affected by BPH?

A

The transitional zone

587
Q

Painless hematuria should make you think of what diagnosis?

A

Bladder cancer

588
Q

What is the most likely diagnosis for a free floating, painless cystic mass found posterior and superior to the testes?

A

Spermatocele

589
Q

What is the most common organism responsible for prostatitis?

A

E. coli

590
Q

What is the treatment for epididymitis?

A

Ceftriaxone and doxycycline

591
Q

Feeling a bag of worms in the scrotum should make you think of what diagnosis?

A

Varicocele

592
Q

A prostate biopsy consists of how many samples?

A

6 to 12

593
Q

A fluid filled painless mass found in the scrotum which transilluminates should make you think of what diagnosis?

A

Hydrocele

594
Q

Name the sign which is defined as decreased pain with scrotal elevation?

A

Prehn’s sign

595
Q

White blood cell casts should make you think of what diagnosis?

A

Pyelonephritis

596
Q

Tea-colored urine with red cell casts should make you think of what diagnosis?

A

Glomerulonephritis

597
Q

What is the most common bladder cancer?

A

Transitional cell cancer

598
Q

What might you feel on a digital rectal exam of a patient with prostate cancer?

A

Enlarged prostate, hard nodules within the prostate

599
Q

What is the most common organism that causes a bladder infection?

A

E. coli

600
Q

List three possible causes of prerenal renal failure.

A

CHF, severe dehydration, hemorrhage

601
Q

Maltese crosses in the urine should make you think of what diagnosis?

A

Nephrotic syndrome

602
Q

What is the mot common cause of post renal failure?

A

BPH, post renal renal failure is secondary to an outflow obstruction

603
Q

What hereditary pattern does polycystic kidney disease follow?

A

Autosomal dominant

604
Q

What medication classes are prescribed in order to help prevent chronic renal failure in diabetic patients?

A

ACEIs or ARBs

605
Q

What age range is typically associated with testicular torsion?

A

10-20 years old

606
Q

In a folic acid deficiency anemia the folic acid level is typically below what level?

A

<150

607
Q

What is the most common microcytic anemia?

A

Iron deficiency anemia

608
Q

If a question presents a pregnant woman with anemia what is the most likely diagnosis?

A

Iron deficiency

609
Q

A low retic count and a normal serum ferritin should make you think of what diagnosis?

A

Anemia of chronic disease

610
Q

Which anemia should you think of if you see the term Howell-Jolly bodies?

A

Sickle cell due to the functional asplenia, but it may also show up in folic acid and B12 deficiency

611
Q

Under normal conditions at what hemoglobin level would you begin to consider a transfusion?

A

8

612
Q

You should be thinking alpha thalassemia if the question stem includes which four geographic areas?

A

Southeast Asia, China, Middle East, Africa

613
Q

Auer rods are most commonly associated with what disease?

A

Acute myeloid leukemia

614
Q

What is pica?

A

Eating non-food items including ice, paper, dirt, hair

615
Q

What is Schilling’s test used for?

A

Test for the cause of a B12 deficiency

616
Q

An African American teenage presents with avascular necrosis of the his right femoral head. What diagnosis should you be thinking of?

A

Sickle cell disease

617
Q

List four disease states in which you may find basophilic stippling.

A

Lead poisoning, beta or alpha thalassemia, sideroblastic anemia, arsenic poisoning

618
Q

Would a B12 deficiency anemia most likely be microcytic, normocytic, or macrocytic?

A

Macrocytic

619
Q

What molecule binds iron in the blood stream?

A

Transferrin

620
Q

Inability to absorb vitamin B12 due to lack of intrinsic factor is what disease?

A

Pernicious anemia

621
Q

Does an increase in reticulocytes indicate a decrease or an increase in RBC production?

A

An increase, reticulocytes are newly released “baby” RBC’s

622
Q

Will unconjugated bilirubin be high or low in a patient with sickle cell disease?

A

High

623
Q

Would anemia of chronic disease most likely be macrocytic, normocytic, or microcytic?

A

Normocytic

624
Q

Will the serum ferritin be high or low in a patient with iron deficiency anemia?

A

It will almost always be low

625
Q

G6PD deficiency follows what pattern of inheritance?

A

X-linked

626
Q

Strict vegans are at risk for what type of anemia?

A

B12 deficiency anemia

627
Q

The term Philadelphia chromosome should make you think of what diagnosis?

A

Chronic myeloid leukemia

628
Q

Will the retic count be elevated, decreased, or normal in B12 deficiency anemia?

A

Retic count will be low. Low building blocks means low production.

629
Q

Stocking glove paresthesias should make you think of what two diagnoses?

A

B12 deficiency neuropathy and diabetic neuropathy

630
Q

List the three diagnosis you should be thinking of if a question includes Heinz bodies.

A

G6PD deficiency anemia, chronic liver disease, alpha thalassmeia

631
Q

What is the normal range for MCV?

A

80-100

632
Q

Will the RBC’s be large, small or normal size in B12 deficient anemia?

A

Macrocytes

633
Q

What two main causes should you be thinking of in a macrocytic anemia?

A

Malnutrition and severe blood loss

634
Q

Asplenism secondary to sickle cell disease increases a patient’s risk for what type of infections?

A

Capsulated organisms like Strep pneumonia and H. flu.

635
Q

Will a hemolytic anemia generally have an elevated or decreased retic count?

A

Elevated

636
Q

Iron deficiency anemia will have a serum iron lower than what value?

A

30

637
Q

Are target cells seen in mild or severe iron deficiency anemia?

A

Severe, they are also seen in alpha thalassemia, Chronic liver disease, and asplenia

638
Q

What does koilonychia refer to?

A

Spoon-shaped nails which may be found in microcytic anemia

639
Q

How do you treat a sickle cell crisis?

A

Fluids, oxygen, pain medication, transfusion may be necessary

640
Q

Is sickle cell microcytic, macrocytic or normocytic?

A

Microcytic

641
Q

What hematological disorder should you think of if the questions talks about the patient eating ice or dirt?

A

Iron deficiency anemia

642
Q

A patient of Mediterranean descent is a clue for which type of anemia?

A

Beta Thalassemia

643
Q

A leukemia patient has a CT of the liver which shows punched out lesions. What diagnosis should you be thinking of?

A

Hepatosplenic candida

644
Q

Rice water stool should make you think of what diagnosis?

A

Cholera

645
Q

What is the best test to diagnose malaria?

A

Peripheral blood smear

646
Q

What class of antibiotics is sometimes prescribed specifically for its effects on increasing GI mobility?

A

Macrolides

647
Q

What are the two important pieces of patient education for anyone diagnose with mononucleosis?

A

No contact sports (splenic rupture) and no kissing (highly contagious)

648
Q

A patient ate out last night and today has cramping and bloody diarrhea. What is the most likely organism?

A

Salmonella

649
Q

Why can’t you give fluoroquinolones to kids?

A

They can cause cartilage development problems

650
Q

What organism causes toxoplasmosis?

A

Toxoplasma gondii

651
Q

Which herpesvirus causes Epstein-Barr?

A

Herpes 4

652
Q

Owl eye inclusion bodies should make you think of what diagnosis?

A

Cytomegalovirus (CMV)

653
Q

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?

A

Secondary syphilis. This is the most contagious stage.

654
Q

What is the current drug of choice for treating MRSA?

A

Vancomycin

655
Q

What might happen if you infuse vancomycin too fast?

A

Red Man syndrome

656
Q

Syphilis is caused by what organism?

A

Treponema pallidum

657
Q

How do you treat hookworms?

A

Azoles

658
Q

What are three medications often combined as a first line treatment for H. pylori?

A

Omeprazole, clarithromycin and amoxicillin (PPI + 2 Antibiotics)

659
Q

What is the most common prophylactic antibiotic used preoperatively?

A

Cefazolin = Ancef, Keflex = Cefalexin, The answer is Cefazolin (Ancef)

660
Q

A painless, clean base chancre should make you think of what diagnosis?

A

Primary syphilis

661
Q

What does trismus mean?

A

Lock jaw, often secondary to tetanus

662
Q

What organism is the most common cause of an uncomplicated urinary tract infection?

A

E. Coli

663
Q

What is the treatment for cholera?

A

Fluids

664
Q

A patient presents to the ER with acute progressive weakness, diplopia and a very dry mouth. What organism may be causing this?

A

Clostridium botulinum

665
Q

Is Klebsiella gram (+) or gram (-)?

A

Gram (-)

666
Q

If you have a patient with positive blood cultures for candida what is the first line drug?

A

Amphotericin B

667
Q

What organism is believed to be the main culprit in creating peptic ulcers?

A

Helicobacter pylori

668
Q

Any reference to dark field microscopy should make you think of what organism?

A

Treponema pallidum

669
Q

How do you treat white oral plaques that can be scraped off?

A

This is most likely candida. Topical nystatin or oral fluconazole 1 mg are first line choices

670
Q

What is the current drug of choice for the cytomegalovirus?

A

Ganciclovir

671
Q

A patient is bitten by a rabies infected raccoon. On what days do you give human haploid cells?

A

0, 3, 7, 14, 28

672
Q

A patient presents complaining of a metallic taste in her mouth and dark brown urine. What antibiotic might she be on?

A

Metronidazole (Flagyl)

673
Q

How do you definitively diagnose rabies?

A

Pathology of the brain of the animal that performed the bit using fluorescent antibody stain

674
Q

What disease does Rickettsia rickettsii cause?

A

Rocky Mountain spotted fever

675
Q

What drug do you use to treat pinworm?

A

You treat everyone in the house with albendazole. Two weeks later you treat them again.

676
Q

What is the minimum amount of time needed for a tick to transfer Lyme disease to a human?

A

24 hours

677
Q

What is the suffix used for most fluoroquinolone?

A

Oxacin

678
Q

A patient being treated with penicillin for a syphilis infection develops fever, chills, muscle pain and headaches. Do you stop treatment?

A

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
Q

What drug is used for the treatment or prophylaxis of malaria?

A

Chloroquine

680
Q

What organism has been linked to reactive arthritis?

A

Shigella, also remember that reactive arthritis has a positive HLA-B27

681
Q

List two macrolides.

A

Erythromycin, azithromycin, clarithromycin

682
Q

What is the drug of choice for treating Rocky Mountain spotted fever?

A

Doxycycline

683
Q

What is the first symptom of a rabies infection?

A

Pain and anesthesia at the site of the bite

684
Q

What is the drug of choice to treat a urethritis caused by neisseria?

A

Ceftriaxone (Rocephin)

685
Q

Why aren’t fluoroquinolones used more frequently?

A

They have lots of side effects

686
Q

Name one oral medication that can be used for MRSA.

A

Linezolid (Zyvox) and Bactrim

687
Q

What is the drug of choice for the treatment of syphilis?

A

Penicillin

688
Q

What antibiotic class of choice for chlamydia?

A

Macrolides

689
Q

What type of mosquitoes carry malaria?

A

Anopheles

690
Q

What is the drug of choice to treat C. difficile?

A

Metronidazole (Flagyl)

691
Q

What is the clinical name for whooping cough?

A

Pertussis

692
Q

Is pseudomonos gram (+) or gram (-)?

A

Gram (-)

693
Q

What are four steps in treating diphtheria?

A

Antitoxin, penicillin, remove membrane, report the case to the CDC

694
Q

How do hookworm larvae enter the body?

A

The penetrate the skin usually through the soles of the feet

695
Q

Is diphtheria a Gram-positive or negative organism?

A

Gram-positive

696
Q

The scotch tape test is used to diagnose what disease?

A

Pinworm

697
Q

An HIV patient presents with a nonproductive cough and a CXR showing diffuse interstitial infiltrates. What diagnosis should you be thinking of?

A

Pneumocystis jiroveci pneumonia (PCJ) formerly known as Pneumocystis pneumonia (PCP)

698
Q

What is the treatment for a tetanus infections?

A

Penicillin, immune globulin and supportive care (especially respiratory care)

699
Q

Pregnant woman and cat little should make you think of what diagnosis?

A

Toxoplasmosis

700
Q

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?

A

Histoplasmosis

701
Q

What class of antibiotics should you start with for community acquired pneumonia?

A

Macrolides

702
Q

What type of organism causes botulism?

A

A Gram + rod, Clostridium botulinum

703
Q

What tests are done to screen for HIV?

A

ELISA, then if positive the diagnosis is confirmed with a Western blot test

704
Q

Which medication is worse to give a pediatric patient, tetracycline or an aminoglycoside?

A

Tetracycline

705
Q

What type of organism causes tetanus?

A

A Gram + rod, Clostridium tetani

706
Q

An India ink stain showing cysts should make you think of what diagnosis?

A

Cryptococcosis

707
Q

What is the treatment for Shigella?

A

Bactrim or fluoroquinolones and hydration

708
Q

What is the drug of choice to treat Lyme disease in kids or pregnant women?

A

Amoxicillin

709
Q

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?

A

Epstein-Barr virus

710
Q

A Gram-positive organism in chains should make you think of what diagnosis?

A

Strep

711
Q

A CT scan shows ring enhancing lesions in an HIV patient. What diagnosis should you be thinking of?

A

Toxoplasmosis

712
Q

Diarrhea with blood and mucus should make you think of what diagnosis?

A

Shigella

713
Q

Gummas or granulomatous nodules should make you think of what diagnosis?

A

Tertiary syphilis

714
Q

How do you treat pneumocystis jiroveci pneumonia (PCJ) formerly known as pneumocystis pneumonia (PCP)?

A

Bactrim

715
Q

What organism cause Lyme disease?

A

Borrelia burgdorferi

716
Q

What is the best test for diagnosing Rocky Mountain spotted fever?

A

Indirect immunofluorescent antibodies

717
Q

A stuck on grey membrane in the pharynx should make you think of what diagnosis?

A

Diphtheria

718
Q

Name three serious reactions a patient may have with the use of vancomycin?

A

Nephrotoxicity, ototoxicity, and Stevens-Johnson syndrome

719
Q

What antibiotic is most likely to cause C. diff?

A

Clindamycin

720
Q

Is staph gram (+) or gram (-)?

A

Gram (+)

721
Q

Pizza pie retinopathy should make you think of what diagnosis?

A

Cytomegalovirus (CMV)

722
Q

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?

A

Rocky Mountain spotted fever

723
Q

White curd like vaginal discharge should make you think of what diagnosis?

A

Vaginal candida infection

724
Q

Is neisseria gram (+) or gram (-)?

A

Gram (-)

725
Q

A gram-negative coccobaccili found in the sputum of patient with pneumonia should make you think of what diagnosis?

A

H. flu

726
Q

What is the treatment for pertussis?

A

Erythromycin x 7 days

727
Q

What is the drug of choice for toxoplasmosis?

A

Bactrim

728
Q

What is the drug of choice for the treatment of Lyme disease?

A

Doxycicline

729
Q

What is the treatment for botulism?

A

Antitoxin

730
Q

A Gram-negative diplococci should make you think of what diagnosis?

A

Neisseria

731
Q

Honey and babies should make you think of what diagnosis?

A

Botulism

732
Q

Community acquired carditis is most often caused by one of the HACEK organism. List the HACEK organisms.

A

Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella

733
Q

A gram-positive organism in clusters should make you think of what diagnosis?

A

Staph

734
Q

What is the prophylactic antibiotic most commonly given before a dental procedure if one is necessary?

A

Amoxicillin 2 grams po 1 hour before procedure

735
Q

How do you treat amebiasis?

A

Metronidazole (Flagyl)

736
Q

You place a patient on rifampin. What side effect should you warn her about?

A

Orange-red discoloration of body fluids

737
Q

What organism is most commonly responsible for community acquired pneumonia?

A

Strep pneumoniase

738
Q

A diaper rash with satellite lesions should make you think of of what diagnosis?

A

Candida

739
Q

Bloody stool with cysts and trophozoites should make you think of what diagnosis?

A

Amebiasis

740
Q

What oral antibiotic can be used for pseudomonas?

A

Ciprofloxacin

741
Q

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?

A

Fluoroquinolones

742
Q

What medication is used as prophylaxis for meningococcal meningitis?

A

Rifampin

743
Q

A patient was in the woods yesterday and today presents with erythema migraines. What diagnosis should you be thinking of?

A

Lyme disease

744
Q

At approximately how many weeks pregnant is the uterus at the level of the symphysis pubis?

A

12 weeks

745
Q

List 2 risk factors for ovarian cancer.

A

BRCA1, family history, nulliparity, late menopause, Caucasian, Asian

746
Q

What is the most common cause of secondary amenorrhea?

A

Pregnancy

747
Q

What ethnic background is at an increased risk of fibroids?

A

African Americans are 5s more likely to have fibroids compared to Caucasian women.

748
Q

Define the third stage of labor.

A

Delivery of the baby to delivery of placenta

749
Q

What is the most popular term for Stein-Leventhal syndrome.

A

Polycystic ovarian syndrome

750
Q

Vaginal infection with motile flagellated protozoa should make you think of what diagnosis?

A

Trichomonas vaginitis

751
Q

List four risk factors for breast cancer?

A

BRCA1 or BRCA2 positive, unopposed estrogen, nulliparity, early menarche, late menopause

752
Q

How is the first day of the menstrual cycle defined?

A

The first day of menstrual bleeding is the first day of the cycle

753
Q

A cervical biopsy comes back as CIN1. What is the next step?

A

Repeat Pap smear in 6 months and repeat colposcopy in 12 months

754
Q

List two mediation commonly used for hypertension in pregnancy.

A

Methyldopa and labetalol

755
Q

If you see the term chocolate cyst, it should make you think of what diagnosis?

A

Endometrioma

756
Q

Define abortion.

A

Delivery of uterine contents before 20 weeks.

757
Q

Define menorrhagia.

A

Heavy prolonged menstrual flow

758
Q

What is a cystocele?

A

A herniation of the bladder into the vagina

759
Q

What is the mean age for ovarian cancer?

A

63, you will need to think of this in an older patient with vague abdominal symptoms

760
Q

What medication is used to increase surfactant levels and help with lung maturity if you are worried about preterm labor?

A

Betamethasone

761
Q

List two risk factors for cervical cancer.

A

Multiple sexual partners, smoking

762
Q

Which is associated with painful third trimester bleeding placental abruption or placenta previa?

A

Placental abruption

763
Q

List three risk factors for placental abruption.

A

HTN, smoking, AMA, cocaine use, PROM

764
Q

What is the classic triad of pre-eclampsia?

A

HTN, edema and proteinuria

765
Q

At what age is primary amenorrhea diagnose?

A

Age 14 if no secondary sex characteristics. Age 16 if some secondary development

766
Q

What is the karyotype for a patient with Turner’s syndrome?

A

(45, X) They are missing one sex chromosome

767
Q

When is it recommended to begin Pap smears?

A

New guidelines suggest to begin testing women at age 21 and not before

768
Q

What location within the pelvis is endometriosis most commonly found?

A

On an ovary

769
Q

What is the #1 cause of septic arthritis in sexually active young adults?

A

Neisseria gonorrhoeae

770
Q

How much time needs to pass before diagnosing secondary amenorrhea?

A

If cycles have been normal 3 months. If cycles have been irregular 6 months.

771
Q

Give the definition for preterm labor.

A

Contractions that open the cervix before 37 weeks.

772
Q

What would you expect to see on a KOH prep if the patient had vaginal candidiasis?

A

Pseudohyphae

773
Q

A physical exam revealing a retroverted uterus or uterosacral ligament nodularity should make you think of what diagnosis?

A

Endometriosis

774
Q

How many days after conception is a serum beta-HCG positive?

A

8

775
Q

Is FSH high or low in Turner’s syndrome?

A

High, there are no ovaries to respond to FSH and so there is no negative feedback.

776
Q

What are two important things you need to tell your patients before putting them on metronidazole?

A

Stay out of the sun and avoid alcohol

777
Q

Define missed abortion.

A

No vaginal bleeding, cervix is closed, production of conception are still inside.

778
Q

What is the most common organism that causes mastitis?

A

Staph aureus

779
Q

Define the first stage of labor.

A

Onset of contractions to full dilation of the cervix

780
Q

How do you treat bacterial vaginosis?

A

Metronidazole x 7 days

781
Q

About how much weight should a woman gain during pregnancy?

A

20-35 lbs

782
Q

Define metrorrhagia.

A

Bleeding between menstrual cycles

783
Q

What lab test is the gold standard for chlamydia?

A

Nucleic acid amplification test

784
Q

An ovarian cyst that contains hair and teeth should make you think of what diagnosis?

A

Teratoma

785
Q

At what point during pregnancy is RhoGAM given if it is needed?

A

28 weeks

786
Q

What characteristics of pelvic inflammatory disease will help to differentiate it in a question stem from ectopic pregnancy, appendicitis, ovarian torsion and ovarian cyst?

A

It will be bilateral pain. Most other common abdominal complaints have unilateral pain.

787
Q

A description of a young girl with a web neck or wide shield chest should make you think of what diagnosis?

A

Turner’s syndrome

788
Q

What organism causes us to warn pregnant patients to stay away from deli meats and soft cheese?

A

Listeria

789
Q

What is the most common site of an ectopic pregnancy?

A

Within a fallopian tube

790
Q

What are three ways you can check for ruptured membranes?

A

Ferning pattern on a slide, visualize leakage from the cervix, pooling in the vagina

791
Q

What is the most common type of ovarian cyst?

A

Functional cyst - no treatment necessary

792
Q

A patient believes she is pregnant. You notice the her cervix appears a little blue. What is the name of this sign?

A

Chadwick’s sign

793
Q

Grape-like vesicles or a sack of grapes on ultrasound should make you think of what diagnosis?

A

Hydatidiform mole

794
Q

Is a nulliparous or mulitparous woman more likely to get preeclampsia?

A

Nullipartiy is a risk factor for preeclampsia

795
Q

What is the most common infection following a C-section?

A

Metritis

796
Q

Define inevitable abortion.

A

Vaginal bleeding, cervix is open, products of conception are still inside.

797
Q

Cottage cheese discharge should make you think of what diagnosis?

A

Vaginal candidiasis

798
Q

When does quickening occur?

A

Nulliparous 18-20 weeks, multiparous 14-16 weeks

799
Q

What is the first step of treatment for endometrial cancer?

A

Total hysterectomy and bilateral salpingo-oophorectomy

800
Q

What age range is the HPV Vaccination recommended for?

A

9 to 26 years old

801
Q

What medication can be used to control bleeding due to uterine atony?

A

Oxytocin (Pitocin)

802
Q

At how many weeks of pregnancy can chorionic villus sampling be done?

A

10-13 weeks

803
Q

A snowstorm appearance on ultrasound should make you think of what diagnosis?

A

Hydatidiform mole

804
Q

Gestation diabetes put moms and baby at increased risk of what three things?

A

Preeclampsia, macrosomia (traumatic birth,) slowing in fetal lung development

805
Q

What is the most common endometrial cancer?

A

75% are adenocarcinomas

806
Q

How do you treat vaginal candida?

A

Fluconazole po 1 dose or azole cream x 1 week

807
Q

Define full term

A

Delivery at 37-42 weeks

808
Q

Which reproductive cancer carries the highest rate of death in women?

A

Ovarian cancer

809
Q

What is the hallmark physical findings for placenta previa?

A

Trick question - NEVER do a physical exam on someone with presumed placenta previa

810
Q

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?

A

Placental separation

811
Q

A patient presents with irregular menses, hirsutism and infertility. What is the most likely diagnosis?

A

Polycystic ovarian syndrome

812
Q

As part of the antepartum testing a baby has a positive stress test. What does that mean?

A

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
Q

Think, sticky, malodorous vaginal discharge should make you think of what diagnosis?

A

Bacterial vaginosis

814
Q

What organism is the most common sexually transmitted bacteria?

A

Chlamydia

815
Q

Purulent cervical discharge should make you think of what diagnosis?

A

Neisseria gonorrhoeae

816
Q

A rope-like breast mass should make you think of what diagnosis?

A

Fibrocystic breast mass

817
Q

What is the first line treatment for mastitis?

A

Dicloxacillin is first line. Cephalexin or erythromycin are second line.

818
Q

A patient presents with mucopurulent discharge and cervical motion tenderness. What is the most likely diagnosis?

A

Chlamydia - cervicitis

819
Q

A 66 year old female patient presents with bouts of nausea, weight loss, and vague abdominal pain. What is the most likely diagnosis?

A

Ovarian cancer

820
Q

What is the average age of menopause?

A

51

821
Q

What are the five components of the biophysical profile as part of antepartum testing?

A

A non-stress test, fetal breathing, two gross body movements, fetal tone, amniotic fluid index

822
Q

The secretory phase of the menstrual cycle (day 14-28) is dominated by what hormone?

A

Progesterone

823
Q

What. is the most common cause of postpartum hemorrhage?

A

Uterine atony

824
Q

A surge in what hormone leads to ovulation?

A

Luteinizing hormone (LH)

825
Q

You have a patient with PCOS who would like to get pregnant. What are two medications you may start her on?

A

Metformin and Clomid

826
Q

Early on in pregnancy serial beta-HCG should double over what time period?

A

every 48-72 hours

827
Q

What endocrine issue is associated with PCOS?

A

Insulin insensitivity

828
Q

The pap smear results on a 23 year old patient come back as atypical squamous cell uncertain significance (ASCUS). What is you next step?

A

Repeat pap smear in 12 months although HPV test is acceptable

829
Q

Which four human papillomaviruses are linked to cervical cancer?

A

HPV 16, 18, 31, and 33

830
Q

List three risk factors for an ectopic pregnancy.

A

Previous ectopic, scarred tubes (hx of PID or salpingitis), IUD

831
Q

A cervical biopsy comes back as CIN2 or CIN3. What is your next step?

A

Excision - LEEP, Cold knife (worry about incompetent cervix), Cryotherapy

832
Q

What three labs should you order if you are considering secondary amenorrhea?

A

beta-HCG, TSH, Prolactin

833
Q

How do you definitively diagnose endometriosis?

A

Exploratory laparoscopy

834
Q

What is the term for when the placenta has implanted directly over the cervical os?

A

Placenta previa

835
Q

A unilateral, single, mobile, firm, nontender solid breast mass should make you think of what diagnosis?

A

Fibroadenoma

836
Q

At approximately how many weeks pregnant is the uterus at the level of the umbilicus?

A

20 weeks

837
Q

Should a breast feeding mother stop breast feeding if she develops mastitis?

A

Mastitis is not in itself a reason to stop feeding. An abscess would be an indication to stop.

838
Q

What are three treatments for uterine prolapse?

A

Pessary, Kegel’s maneuvers, surgical repair

839
Q

What are two medications used to induce labor?

A

Cervidil (prostaglandin gel applied to the cervix) which encourages cervical ripening and oxytocin which encourages uterine contractions

840
Q

Why is folic acid given as a prenatal vitamin?

A

Low folic acid can lead to neural tube defects.

841
Q

Interference with work or school is part of which diagnosis, premenstrual syndrome or premenstrual dysphoric disorder?

A

Premenstrual dysphoric disorder

842
Q

A patient with primary amenorrhea and a low FSH should make you think of what diagnosis?

A

Hypothalamic pituitary insufficiency

843
Q

Define procidentia.

A

Uterine prolapse beyond the introitus.

844
Q

What are three causes for a postpartum hemorrhage?

A

Uterine atony, genital laceration, retained placenta

845
Q

Why is ovarian cancer so hard to diagnosis?

A

There are no good markers and the symptoms are very vague

846
Q

If the pap smear results come back anything other than negative or ASCUS what is your next step?

A

Coposcopy and biopsy

847
Q

Define complete abortion.

A

Vaginal bleeding, cervix open, products of conception have passed

848
Q

Does mastitis tend to be unilateral or bilateral

A

Unilateral and only on quadrant

849
Q

What is the most common uterine tumor?

A

Leiomyoma, also known as fibroids

850
Q

Define the second stage of labor.

A

Fully dilated to delivery

851
Q

What RH combination for mom and dad might cause the mother to create antibodies against the baby’s red blood cells?

A

Mom Rh-negative and dad Rh-positive

852
Q

What is the treatment for ovarian cancer?

A

Total hysterectomy and bilateral salpingo-oophorectomy. Then chemo and radiation

853
Q

Clue cells should make you think of what diagnosis?

A

Bacterial vaginosis

854
Q

Are fibrocystic breast masses usually bilateral or unilateral?

A

Bilateral

855
Q

Postmenopausal bleeding is immediately believed to be what diagnosis?

A

Endometrial cancer until proven otherwise

856
Q

What is the formula for calculating estimated date of confinement or due date?

A

first day of last menstrual period + 7 days - 3 months

857
Q

How do you treat a Trichomonas infection?

A

Metronidazole

858
Q

During what portion of the menstrual cycle does PMS occur?

A

By definition it is in the second half and menstruation should relieve the symptoms

859
Q

Define threatened abortion

A

Vaginal bleeding, closed cervix, products of conception are still inside

860
Q

A strawberry cervix with copious yellow/green discharge should make you think of what diagnosis?

A

Trichomonas vaginitis

861
Q

What is the medical treatment for an early ectopic pregnancy?

A

Metrotrexate

862
Q

Define incomplete abortion.

A

Vaginal bleeding, cervix is open, products of conception partially passed

863
Q

Since a genetic cause is the number one reason for primary amenorrhea what is one very important test?

A

Karyotype

864
Q

Define premature birth.

A

Delivery before 37 weeks.

865
Q

What medium do you need to grow out Neisseria gonorrhoeae?

A

Thayer-Martin

866
Q

What is the normal range of fetal heart rate?

A

120-160

867
Q

The follicular phase of menstruation is dominated by what hormone?

A

Estrogen

868
Q

What are two tocolytic medications you should be aware of?

A

Magnesium sulfate and calcium channel blockers

869
Q

A women presents to the ER concerned she is in preterm labor. What treatment should you begin before getting any imaging or lab results?

A

Give IV fluids (most often the patient is suffering from dehydration

870
Q

At how many weeks of pregnancy can an amniocentesis be done?

A

15-20 weeks

871
Q

List 4 risk factors for endometrial cancer.

A

Chronic unopposed estrogen, nulliparity, early menarche, late menopause, tamoxifen, DM, obesity, HTN, breast cancer, ovarian cancer

872
Q

What is the treatment for Turner’s syndrome?

A

Cyclical estoregn and progesterone

873
Q

What medication(s) are used to treat a postpartum metritis?

A

Clindamycin and gentamicin together

874
Q

What is the most common way of testing for metamorphopsia?

A

Amsler grid

875
Q

What is the term for bilateral yellow plaques near the eyes?

A

Xanthelasma

876
Q

You notice drusen deposits on fundal exam. What diagnosis should you be thinking of?

A

Macular degeneration

877
Q

A patient presents saying that he doesn’t seem to need his glasses anymore after 30 years. What is the most likely diagnosis?

A

Cataract

878
Q

A patient has metamorphopsia and a central blind spot. What is the most likely diagnosis?

A

Macular degeneration

879
Q

What is the term for eyelids that turn in?

A

Entropion

880
Q

What should a primary care provider do for a presumed retinal detachment?

A

Refer and position patient with head down

881
Q

What is the term for eyelids that turn out?

A

Ectropion

882
Q

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).

A

Child abuse until proven otherwise

883
Q

What is the name for the triangular or wedge shaped growth on the conjunctiva that may interfere with vision?

A

Pterygium

884
Q

A patient describes his vision loss as curtain coming down and then going back up. What might the diagnosis be?

A

Amaurosis fugax

885
Q

Vision loss described as a curtain coming down should make you think of what diagnosis?

A

Retinal detachment

886
Q

A fundal exam shows a cherry-red spot. What is the most likely diagnosis?

A

Central retinal artery occlusion

887
Q

Which nerve is involved in herpes zoster ophthalmicus?

A

Trigeminal nerve, CN 5

888
Q

A patient presents with a dense corneal infiltrate and an epithelial defect seen with fluorescein stain. What is the most likely diagnosis?

A

Corneal ulcer

889
Q

You notice a bowing of the iris on exam. What diagnosis should you be thinking of?

A

Glaucoma

890
Q

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?

A

Viral conjunctivitis, adenovirus

891
Q

Is glaucoma more prevalent in males or females?

A

Females 3:1

892
Q

What is the name of the test for dry eyes?

A

Schirmer’s test

893
Q

How do you test for color blindness?

A

Ishihara plates

894
Q

What is the #1 cause of retinal artery occlusion?

A

Carotid atherosclerotic disease

895
Q

What is the first line treatment for orbital cellulitis?

A

IV antibiotics, followed by 2 weeks of oral antibiotics

896
Q

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?

A

Orbital fracture

897
Q

A patient having recently undergone cataract surgery presents complaining of vision loss in the operative eye. What diagnosis should you be thinking of?

A

Retinal detachment

898
Q

Your attending asks you to come and see an excellent example of Hutchinson’s sign. What diagnosis does the patient have?

A

Herpes zoster ophthalmicus

899
Q

What is the term for being nearsighted? What type of lens do you use to correct it?

A

Myopia, concave lenses

900
Q

A dendritic lesion is seen with fluorescein stain. What is the most likely diagnosis?

A

Herpes keratitis

901
Q

What are the most common colors lost in color blindness?

A

Red and green

902
Q

A CT scan of the head shows broad infiltration of orbital fat. What is the most likely diagnosis?

A

Orbital cellulitis

903
Q

What is the yellow, brown fleshy mass on conjunctiva which usually does not interfere with vision?

A

Pinguecula

904
Q

In what age range do you expect most commonly find amaurosis fugax?

A

Patient older than 50

905
Q

A patient complains of seeing halos and rainbows around lights. She also complains of moderate photophobia. What is the most likely diagnosis?

A

Glaucoma

906
Q

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?

A

Glaucoma

907
Q

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?

A

Chalazion

908
Q

A patient presents with a painful, red nodule on the eyelid. What is the most likely diagnosis? What treatment should you being with?

A

Hordeolum (sty). Warm compress and progress to topical antibiotics if necessary.

909
Q

A fundal exam shows an opalescent retina and boxcarring of arterioles. What diagnosis should you be thinking of?

A

Central retinal artery occlusion

910
Q

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?

A

Central vein occlusion

911
Q

A patient presents with pain in one eye. The cornea is hazy and the pupils are fixed. What is the most likely diagnosis?

A

Glaucoma

912
Q

A patient presents with sudden painless complete unilateral vision loss. What diagnosis should you be thinking of?

A

Central retinal artery occlusion

913
Q

A patient presents with irritated, burning and tearing eyes. You notice some scurg and scales. Where do you begin treatment?

A

The is blepharitis. Treatment begins with good hygiene and moves on to topical antibiotics if necessary.

914
Q

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?

A

Allergic conjunctivitis

915
Q

A feathery border in an eye exam shoudl mak you think of what diagnosis?

A

Fungal infection

916
Q

What is the term for being farsighted? What type of lens do you use to correct it?

A

Hyperopia, convex

917
Q

What is the treatment for subconjunctival hemorrhage?

A

Reassurance

918
Q

What is appropriate treatment for central vein occlusion?

A

Typically self limited. Treat underlying disease.

919
Q

Color blindness is transmitted through what genetic pattern?

A

Recessive X-linked

920
Q

What is tonometry used for?

A

Determining intraocular pressure

921
Q

What is the initial treatment for a chemical burn to the eyes?

A

Irrigate, irrigate, irrigate

922
Q

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?

A

Corneal abrasion (pt’s scratch their eyes before they are completely awake from anesthesia)

923
Q

How long after a radiant energy burn do symptoms typically show?

A

6-12 hours

924
Q

What should a primary care provider do for presumed central retinal artery occlusion?

A

Ophthalmic emergency! Refer and intermittent pressure and release of the eye

925
Q

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?

A

Chlamydia conjunctivits

926
Q

A college student presents with copious purulent drainage from one eye. What diagnosis and pathogen should you be thinking of?

A

Neisseria conjunctivits

927
Q

Give two risk factors for glaucoma.

A

African American decent and diabetes

928
Q

When treating herpes keratitis should you use topical antiviral, topical steroid or both?

A

Don’t use steroid. Topical antiviral and refer!

929
Q

What is the most common preceding event for orbital cellulitis?

A

URI

930
Q

What is the most likely quadrant for a retinal detachment?

A

Superior temporal

931
Q

What is the most common organism causing pneumonia in COPD patients?

A

Haemophilus influenzae

932
Q

Pertussis is most commonly treated with with antibiotic?

A

Erythromycin

933
Q

A thumbprint sign on x-ray should make you think of what two diagnosis?

A

Lateral C-spine = epiglottitis, abdominal = intestinal ischemia

934
Q

At what size induration would a PPD be positive for a healthcare worker?

A

10 mm

935
Q

A thin looking heart and flattened diaphragm on CXR should make you think of what diagnosis?

A

Emphysema

936
Q

What CXR finding might make you think of berylliosis?

A

Diffuse infiltrates with hilar adenopathy

937
Q

When you step up the diagnosis for intermittent asthma to mild persistent asthma what medication should you add?

A

An inhaled steroid like fluticasone

938
Q

Paradoxical pulses may be found in what pulmonary disorder?

A

Asthma

939
Q

Oseltamivir (Tamiflu) may be given to children above what age?

A

1 year old

940
Q

A college student presents with pneumonia. What two organisms should you be thinking of?

A

Chlamydia and mycoplasma

941
Q

What is it called when a patient says “ee” but on auscultion you here “ay”?

A

Egophony

942
Q

What two lung cancers are typically found centrally on CXR?

A

Small cell and squamous cell

943
Q

A Westermark sign on CXR should make you think of what diagnosis?

A

Pulmonary embolism

944
Q

Does total lung capacity go up or down in COPD?

A

It goes up.

945
Q

An exudative pleural effusion should make you think of what diagnosis?

A

TB, lung cancer and pneumonia

946
Q

List the three most commonly used medical treatments for COPD?

A

Oxygen, ipratropium, and albuterol

947
Q

What is the most common cause of bronchiectasis?

A

Cystic Fibrosis

948
Q

What is the best test to diagnose bronchiectasis?

A

CT

949
Q

Will evidence of TB be seen more frequently in the upper or lower lung lobes on CXR?

A

Upper

950
Q

What is the initial treatment for active TB?

A

INH + RIF + PZA + EMB x several months typically followed by INH + RIF once sensitivities come back

951
Q

What organism is the most common cause of pneumonia in a patient cystic fibrosis?

A

Pseudomonas

952
Q

Dullness to percussion should make you think of what diagnosis?

A

Lobar pneumonia

953
Q

What occupations are associated with berylliosis?

A

Aerospace and nuclear plant workers

954
Q

What is the gold standard for diagnosis of pleural effusion?

A

Thoracocentesis

955
Q

At what age should vaccinations for pneumococcal pneumonia begin?

A

65 years old

956
Q

Any question about rabbits and pneumonia should make you think of what diagnosis?

A

Tularemia

957
Q

What. is the most common patient complaint with emphysema?

A

Shortness of breath

958
Q

If you hear crackles in the lung fields list three pulmonary issues that should be in your differential

A

Pneumonia, fibrosis, CHF, bronchitis

959
Q

List 4 medications which may cause asthma.

A

Beta blockers, NSAIDs, ACEI, ASA

960
Q

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?

A

Rifampin

961
Q

Prolonged expiration (low FEV1) should make you think of what diagnosis?

A

Asthma or COPD

962
Q

Transudative pleural effusions should make you think of what diagnosis?

A

Congestive heat failure

963
Q

What are the main side effects of isoniazide?

A

Hepatitis and peripheral neuropathy

964
Q

List six extrapulmonary complications of lung cancer.

A

SPHERE - SVC syndrome, Pancoast tumor, Horner’s syndrome, Endocrine problems, Recurrent laryngeal symptoms, Effusions (exudative)

965
Q

A physical exam finding of egophony should make you think of what diagnosis?

A

Lobar pneumonia

966
Q

Ghon or Ranke complexed on CXR should make you think of what diagnosis?

A

TB

967
Q

Zanamivir (Relenza) may be give to children about what age?

A

7 years old

968
Q

Does FEV1 go up or down with asthma?

A

It goes down.

969
Q

Caseating granulomas should make you think of what diagnosis?

A

TB

970
Q

What is the most common cause of pneumonia in children less than 1 year old?

A

Respiratory syncytial virus (RSV)

971
Q

A noncaseating granuloma should make you think of what diagnosis?

A

Sarcoidosis

972
Q

A young child presents to ER and you see him waiting in tripod position. What is the most likely diagnosis?

A

Epiglottitis

973
Q

A barrel chest should make you think of what diagnosis?

A

Emphysema

974
Q

When performing a decompression for a tension pneumothorax where do you put the needle?

A

2nd intercostal space at the midclavicular line

975
Q

An HIV patient with ground glass appearance on CXR should make you think of what diagnosis?

A

Pneumocystis jiroveci pneumonia (PJP used to be known as PCP)

976
Q

An older patient presents with pneumonia and diarrhea. What diagnosis should you be thinking of?

A

Legionella pneumonia

977
Q

Currant jelly sputum should make you think of what diagnosis?

A

Klebisiella pneumoniae

978
Q

If you see a question with an alcohol who has been diagnosed with pneumonia what is the most likely organism?

A

Klebsiella pneumoniae

979
Q

Tympany to percussion should make you think of what diagnosis?

A

Large pneumothorax

980
Q

If you see a question with anything to do with pets and the patient has pneumonia, what organism should you be thinking of?

A

Yersinia pestis

981
Q

Where is a Pancoast rumor found on CXR?

A

At the apex of either the right or left lung

982
Q

You suspect a pneumothorax. What instructions should go along with the order for a CXR?

A

It should be an end expiratory view in order to look for visceral pleural air

983
Q

List four indications for the flu vaccine.

A

Children 6-59 months, pregnant female, healthcare worker, age greater than 50

984
Q

Mesothelioma is most commonly found in what lung location?

A

80% are found in the pleural lining

985
Q

Eggshell opacities on the CXR should make you think of what diagnosis?

A

Silicosis and coal workers lung

986
Q

What is erythema nodosum?

A

Tender red nodules usually found on the shins

987
Q

Bullae and blebs on CXR should make you think of what diagnosis?

A

Emphysema

988
Q

Are the lungs noisy or quiet in COPD?

A

quiet

989
Q

A patient without a functioning spleen is more susceptible to what type of organism?

A

Encapsulated organisms most commonly Strep pneumoniae and H. flu

990
Q

A pearl formation on CXR should make you think of what diagnosis?

A

Squamous cell lung cancer

991
Q

A patient has pneumonia with rust colored sputum. What is the most likely diagnosis?

A

Strep pneumonia

992
Q

What happens to total lung capacity in sarcoidosis?

A

It goes down.

993
Q

A contralateral mediastinal shift should make you think of what diagnosis?

A

Tension pneumothorax

994
Q

Ethambutol has what two major side effects?

A

Optic neuritis, red green vision loss

995
Q

What is the treatment for pneumocystis jiroveci pneumonia?

A

Bactrim

996
Q

List three caused of decreased tactile fremitus.

A

COPD, asthma, pleural effusion, pneumothorax

997
Q

What two lung cancers are typically found peripherally on CXR?

A

Adenocarcinoma and Large cell

998
Q

A CXR shows vascular redistribution and blurred vascular outlines. What is the most likely diagnosis?

A

CHF

999
Q

Posttussive rales should make you think of what diagnosis?

A

TB

1000
Q

What are the three most common cancers to metastasize to the lungs?

A

Breast, liver and colon

1001
Q

List the four most common places lung cancer will metastazie to?

A

Bone, brain, adrenals, and liver

1002
Q

What is the first line antibiotic for epiglottis?

A

Third generation cephalosporin - ceftriaxone

1003
Q

Nodular opacities in the upper lung fields should make you think of what diagnosis?

A

Silicosis

1004
Q

Rhonchi or wheezes that clear after coughing suggest what diagnosis?

A

Bronchitis or atelectasis

1005
Q

Coal miners lung often shows nodular opacities in what lung fields?

A

Upper lung fields

1006
Q

A very sick patient with diffuse infiltrates that spare the costophrenic angles should make you think of what diagnosis?

A

Acute respiratory distress syndrome (ARDS)

1007
Q

Hyperinflation on a CXR as well as eosinophilia on CBC should make you think of what diagnosis?

A

Asthma

1008
Q

How long are administering a PPD should it be read?

A

48-72 hours

1009
Q

If you come across a question where the patient has erythema nodosum and an enlarged parotid gland what diagnosis should you be thinking of?

A

Sarcoidosis

1010
Q

Blue bloaters refers to that characteristic physical exam findings of what disease?

A

Chronic bronchitis

1011
Q

Hampton’s hump on CXR should make you think of what diagnosis?

A

Pulmonary embolism

1012
Q

What is the gold standard for the diagnosis of cystic fibrosis?

A

Sweat chloride test

1013
Q

What CXR finding might make you think of mesothelioma?

A

Pleural thickening, remember 80% are found in the pleura lining

1014
Q

At what size induration would a PPD be positive for an HIV patient?

A

5 mm

1015
Q

List three things that should be in your differential if you hear wheezes on a lung exam?

A

Asthma, COPD, bronchitis

1016
Q

Honeycombing and tram tracks on the CXR should make you think of what diagnosis?

A

Bronchiectasis and idopathic pulmonary fibrosis

1017
Q

Hyperresonance to percussion should make you think of what diagnosis?

A

Emphysema, pneumothorax, asthma

1018
Q

What is the likely findings be on a CXR of a patient with asbestosis?

A

Linear opacities at the bases with pleural plaques

1019
Q

What is the most common cause of peptic ulcer disease?

A

H. pylori

1020
Q

Steatorrhea should make you think of what diagnsosi?

A

Pancreatitis

1021
Q

A patient presents complaining of right upper quadrant pain 20 minutes after meals. What is the most likely diagnosis?

A

Cholecystitis

1022
Q

How do you treat achalasia?

A

Loosen up the muscle - botox, dilation or surgery

1023
Q

What is the most common vessel blocked with intestinal ischemia?

A

Superior mesenteric artery

1024
Q

What tumor marker can be used to follow pancreatic cancer?

A

CA-19-9

1025
Q

What is the #1 cause of small bowel obstruction?

A

Postoperative adhesions

1026
Q

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?

A

Esophageal strictures

1027
Q

An elevated serum amylase and lipase should make you think of what diagnosis?

A

Pancreatitis

1028
Q

What is the main risk factor for esophagitis?

A

Immunocompromised patient

1029
Q

What is the medical term for feeling like there is a lump in your throat?

A

Globus

1030
Q

Should diverticulitis always be admitted?

A

No mil cases can be treated as outpatients with rest and clear fluids

1031
Q

Left lower quadrant pain and tenderness should make you think of what diagnosis?

A

Diverticulitis

1032
Q

What is the most common cause of a folate deficiency?

A

Alcoholism

1033
Q

Define pellagra?

A

Niacin (B3) deficiency

1034
Q

What are two common predisposing factors for esophageal varices?

A

Portal HTN and cirrhosis often caused by alcoholism

1035
Q

Describe Grey-Turner’s sign.

A

Flank ecchymosis often related to pancreatitis

1036
Q

What is the most common location of colorectal cancer?

A

Cecum about 38%

1037
Q

At what age and how often should fecal occult blood tests be performed as a screening tool?

A

Beginning at age 50, and they should be done every year

1038
Q

A patient complains of periumbilical pain which has now moved over McBurney’s point. What is the most likely diagnosis?

A

Appendicitis

1039
Q

Is peptic ulcer disease more common in the duodenum or the stomach?

A

Duodenum

1040
Q

Projectile vomiting should make you think of what diagnosis?

A

Pyloric stenosis

1041
Q

Does adenocarcinoma rise from the proximal or distal esophagus?

A

Distal

1042
Q

What treatment should be started for asymptomatic diverticulosis?

A

None

1043
Q

What is the imaging modality of choice for pancreatitis?

A

CT

1044
Q

What does ERCP stand for?

A

Endoscopic retrograde cholangiopancreatography

1045
Q

Epigastric abdominal pain which radiates to the back should make you think of what diagnosis?

A

Pancreatitis

1046
Q

What is the term for an abscess in the sacrococcygeal cleft?

A

Pilonidal disease

1047
Q

Salivary amylase breaks down what macronutrient?

A

Carbohydrates

1048
Q

What is the most common cause of acute bacterial cholangitis?

A

Choledocholithiasis

1049
Q

What is the leading cause of iron deficiency anemia?

A

Chronic GI bleed

1050
Q

What is Reynold’s pentad and why does it matter?

A

Charcot’s triad + hypotension + altered mental status. It indicated high risk of sepsis.

1051
Q

Bird-beak esophagus on barium swallow should make you think of what diagnosis?

A

Achalasia

1052
Q

What is the best test to check for H. pylori?

A

Urea breath test

1053
Q

What is the recommended treatment for hepatitis C infection?

A

Pegylated interferon alpha-2

1054
Q

An endoscopy for presumed esophagitis shows multiple shallow ulcers. What is the most likely diagnosis?

A

Herpes simplex virus

1055
Q

What medication is most commonly used for long term treatment for GERD?

A

Proton pump inhibitors - omeprazole, lansoprazole, pantoprazole

1056
Q

What tumor marker may be used for liver cancer?

A

alpha-Fetoprotein

1057
Q

A corkscrew appearance on barium study should make you think of what diagnosis?

A

Esophageal spasms

1058
Q

What class of medication is first line to treat inflammatory bowel disease in the maintenance phase?

A

5-ASA products - sulfasalazine, mesalamine

1059
Q

Crohn’s is found where in the GI tract?

A

It can be from esophagus to anus

1060
Q

What is the name of the sign when a patient shows inhibited inspiration with pressure over the RUQ? What diagnosis does it suggest?

A

Murphy’s sign, Cholecystitis

1061
Q

What medication used in hepatitis B infection helps prevent the need for liver transplant?

A

Lamivudine

1062
Q

Currant jelly stool should make you think of what diagnosis?

A

Intussusception

1063
Q

What does HBsAg (hep B surface antigen) indicate?

A

Active Hep B infection

1064
Q

How often should patients with pernicious anemia have a screening endoscopy performed?

A

Every 5 years looking for signs of gastric carcinoma

1065
Q

What are the two main complications of cirrhosis?

A

Portal HTN and liver insufficiency

1066
Q

Are one half of all adult hernias direct or indirect inguinal hernias?

A

Indirect inguinal hernias makeup 50% of all adult hernias

1067
Q

Is surgery curative for Crohn’s or ulcerative colitis?

A

Ulcerative colitis

1068
Q

An abdominal exam with pain out of proportion to the exam should make you think of what diagnosis?

A

Intestinal ischemia

1069
Q

What is the best imaging study for acute appendicitis?

A

CT

1070
Q

What is a common symptom that goes along with chest pain for GERD patients?

A

Dry cough

1071
Q

A gastrinoma is also known as what syndrome?

A

Zollinger-Ellison syndrome

1072
Q

Will a patient with achalasia have dysphagia to liquids, solid or both?

A

Both

1073
Q

Describe Cullen’s sign

A

Umbilical ecchymosis often related to pancreatitis

1074
Q

What are the first three steps of managing pancreatitis?

A

NPO, pain control, fluids

1075
Q

Pica is often related to what type of anemia?

A

Iron deficiency anemia

1076
Q

Fasting gastrin will be above what level with gastronoma?

A

> 150 pq/ml

1077
Q

A patient complains of regurgitating undigested food several hours after a meal. What diagnosis should you be thinking of?

A

Zenker’s diverticulum

1078
Q

Under routine circumstances when should patient begin getting screening colonoscopies?

A

Age 50

1079
Q

How is celiac disease most commonly diagnosed?

A

Endoscopic biopsy

1080
Q

An epigastric olive-shaped mass should make you think of what diagnosis?

A

Pyloric stenosis

1081
Q

How much fiber should you normally get in a day?

A

about 30 grams

1082
Q

Air fluid levels on abdominal x-ray should make you think of what diagnosis?

A

Bowel obstruction

1083
Q

What is the most specific test for acute cholecystitis?

A

HIDA

1084
Q

Painless bright red blood per rectum should make you think of what diagnosis?

A

Hemorrhoids

1085
Q

What is the diagnostic test of choice for Zenker’s diverticulum?

A

Barium swallow will show the diverticulum

1086
Q

A patient on sulfasalazine for an inflammatory bowel disease should be supplemented with what vitamin?

A

Folate

1087
Q

What are the 5 points of Ranson’s criteria on admission?

A

Older than 55, nWBC>16, glucose>200, LDH>350, AST>250

1088
Q

What is the most common location for an anal fissure?

A

Posterior midline

1089
Q

With a gastric ulcer are the patient’s symptoms exacerbated or relieved with food?

A

Exacerbated

1090
Q

What will the bowel sounds be early on in a small bowel obstruction? What will they be later on?

A

Early they are hyperactive. Late they are absent.

1091
Q

A thumbprint sign on an abdominal film should make you think of what diagnosis?

A

Intestinal ischemia

1092
Q

What is the first step in treating GERD?

A

Lifestyle modification

1093
Q

Which NSAID has the highest rate of peptic ulceration?

A

Naproxen

1094
Q

What is the most common location for a pancreatic tumor?

A

75% occur in the head of the pancreas

1095
Q

What is the term for difficulty swallowing?

A

Dysphagia

1096
Q

If you have heartburn that does not improve with medication what diagnosis should you be thinking about?

A

Gastrinoma

1097
Q

Severe abdominal pain 30 minutes after a meal should make you think of what diagnosis?

A

Intestinal ischemia

1098
Q

Describe Courvoisier’s sign.

A

Nontender, palpable gallbladder which may indicate pancreatic neoplasm

1099
Q

What disease is defined as an immunologic response to gluten?

A

Celiac

1100
Q

What is the most specific diagnostic test for peptic ulcer disease?

A

Endoscopy

1101
Q

What is a good beta blocker to reduce portal HTN?

A

Propranolol

1102
Q

What is the treatment for most Mallory-Weiss tears?

A

Watchful waiting, these will typically resolve within 48 hours

1103
Q

Describe how to perform the obturator sign.

A

The patient is supine and attempts to flex and internally rotate right hip.

1104
Q

There are vaccines for which two versions of hepatitis?

A

Hepatitis A and hepatitis B

1105
Q

Describe the Psoas sign.

A

The patient is supine and attempt to raise the right leg against resistance.

1106
Q

What is the only curative therapy for gastric adenocarcinoma?

A

Surgical resection

1107
Q

What does an Anti-HBc (hep B core antibody) indicate?

A

Previous or ongoing hepatitis B infection

1108
Q

What is the gold standard for diagnosis and treatment of bile duct stones?

A

ERCP

1109
Q

How do you treat an H. pylori infection?

A

PPI + 2 antibiotics, commonly omeprazole + clarithromycin and amoxicillin or PPI + metronidazole + tetracycline

1110
Q

Colrectal cancer patients are almost all older than what age?

A

90% of patients are older than 50

1111
Q

What two viral hepatitis infections are self limiting?

A

Hepatitis A and hepatitis E

1112
Q

An endoscopy for presumed esophagitis shows several solitary deep ulcers. What is the most likely diagnosis?

A

Cytomegalovirus

1113
Q

What is the most likely to pass into the scrotum, a direct or indirect hernia?

A

Indirect

1114
Q

What are the two most common causes of pancreatitis?

A

Cholelithiasis and ETOH

1115
Q

What is the most common anorectal problem affecting patients over 50?

A

Hemorrhoids

1116
Q

Most gallstones are made of what substance?

A

Cholesterol

1117
Q

What does Anti-HBs (hep B surface antibody) indicate?

A

Recovery from infection or immunization to hepatitis B

1118
Q

A colonoscopy that shows cobblestone or skip lesions make you think of what diagnosis?

A

Crohn’s disease

1119
Q

What is the term for painful swallowing?

A

Odynophagia

1120
Q

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?

A

Scleroderma

1121
Q

What is the most common cause of lower GI bleed?

A

Diverticulosis

1122
Q

What causes Mallory-Weiss tears?

A

Forced vomiting or retching (often involving alcohol)

1123
Q

What two blood test can be used to diagnose celiac?

A

IgA endomysial antibody and IgA tTG antibody

1124
Q

Which are more painful, hemorrhoids above or below the dentate line?

A

Below, internal hemorrhoids are not painful

1125
Q

A string sign on barium swallow should make you think of what diagnosis?

A

Pyloric stenosis

1126
Q

Onion ring fibrosis from a bile duct biopsy should make you think of what diagnosis?

A

Primary sclerosing cholangitis

1127
Q

A patient presents with unproductive retching, acute localized epigastric distention and inability to pass a nasogastric tube. What is the most likely diagnosis?

A

Gastric volvulus

1128
Q

In order to contract hepatitis D what must you already have?

A

Hepatitis B

1129
Q

What is Charcot’s triad?

A

RUQ pain, fever, jaundice

1130
Q

What is the first line of treatment for an anal fissure?

A

Fluid and fiber

1131
Q

What are two treatments you should consider for esophageal strictures?

A

dilation of the esophagus and long term PPIs

1132
Q

What medical treatment is given for a gastrinoma?

A

Proton pump inhibitors

1133
Q

Atypical or walking pneumonia is caused by what pathogen?

A

Mycoplasma

1134
Q

A child with a fever lasting longer than five days should make you think of what diagnosis?

A

Kawasaki syndrome

1135
Q

A widely split fixed S2 should make you think of what diagnosis?

A

Atrial septal defect

1136
Q

List the five major Jones criteria for diagnosing rheumatic fever.

A

Polyarthritis, carditis, subcuticular nodes, erythema marginatum, chorea

1137
Q

Pale and boggy nasal mucosa should make you think of what diagnosis?

A

Allergic rhinitis

1138
Q

What organism is the most common cause of otitis media?

A

Strep pneumonia

1139
Q

Which viral exanthem often has conjunctivitis as one of it’s symptoms?

A

Measles/Rubeola

1140
Q

By what age should a child be able to roll over?

A

4 months

1141
Q

What is the x-ray finding that supports diagnosis of a slipped capital femoral epiphysis?

A

Ice cream falling of the cone

1142
Q

A CXR finding of notched ribs in a child should make you think of what diagnosis?

A

Coarctation of the aorta

1143
Q

Bruises may be purple, green, yellow, and brown. How many days old is a yellow bruise?

A

Purple day 1-5, Green Day 5-7, Yellow 7-10, Brown 10-14

1144
Q

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?

A

Respiratory syncytial virus

1145
Q

A child with bulky greasy stool should make you think of what diagnosis?

A

Cystic fibrosis

1146
Q

Describe erythema marginatum.

A

Pink rings on the trunk and inner surfaces of the limbs.

1147
Q

A palpable olive-shaped epigastric mass in one month should make you think of what diagnosis?

A

Pyloric stenosis

1148
Q

German measles is also known as what disease?

A

Rubella

1149
Q

By what age should a child be able to hold up her head?

A

3 months

1150
Q

At what age should a child begin to say momma and dadda?

A

12 months

1151
Q

What is the medical term for cross-eyed?

A

Strabismus

1152
Q

What is the first line treatment for pertussis?

A

Erythromycin

1153
Q

Koplik spots are white clustered lesions on the buccal mucosa. What virus are they pathognomonic for?

A

Measles/Rubeola

1154
Q

How long should you wait for a swallowed marble to pass through the body before considering surgery?

A

24 hours

1155
Q

In an upper respiratory infection which includes hoarseness most likely bacterial or viral?

A

Viral

1156
Q

In order to diagnose rheumatic fever what one thing must you have?

A

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
Q

What is the treatment for a volvulus in a child?

A

Barium enema

1158
Q

What antibiotic is the first line treatment for mycoplasma pneumonia?

A

A macrolide, erythromycin or azithromycin

1159
Q

What is pertussis more commonly referred to as?

A

Whooping cough

1160
Q

A 15 year old overweight boy presents to your office limping with knee pain. What is the most likely diagnosis?

A

Slipped capital femoral epiphysis

1161
Q

A premature infant with hyaline membrane disease will have what appearance on CXR?

A

Bilateral atelectasis or ground glass appearance

1162
Q

A Salter-Harris type III fracture affects what area of the bone?

A

The physis (growth plate) as well as the epiphysis

1163
Q

Unilateral purulent rhinitis should make you think of what diagnosis?

A

Foreign body

1164
Q

Describe Barlow’s test

A

Adduct and internal rotation of the hips

1165
Q

By what age should a child be able to sit up?

A

6 months

1166
Q

At what age should a child be able to use a spoon and stack 3-4 blocks?

A

18 months

1167
Q

If you believe there may be a foreign body obstructing a child’s breathing what type of CXR should you order?

A

Expiratory view looking for hyperinflation due to air trapping

1168
Q

Currant jelly stool should make you think of what diagnosis?

A

Intussusception

1169
Q

A child presents with paroxysmal abdominal pain, nausea, vomiting and diarrhea. What diagnosis should you be thinking of?

A

Intussusception

1170
Q

At what age should a child begin to feed himself?

A

6 months

1171
Q

A lacey pink rash on the face of a child should make you think of what diagnosis?

A

Erythema infectiosum aka fifth disease aka slapped cheek

1172
Q

Pain with movement of the pinna or tarsus should make you think of what diagnosis?

A

Otitis externa

1173
Q

What is the first line antibiotic for otitis media?

A

Amoxicillin

1174
Q

What is the gold standard for the diagnosis of cystic fibrosis?

A

Sweat chloride test

1175
Q

Which heart valve is most associated with rheumatic fever?

A

Mitral

1176
Q

By what age should a child be able to kick a ball?

A

24 months

1177
Q

What is the most common congenital heart defect?

A

Ventricular septal defect

1178
Q

How do treat a patient with respiratory syncytial virus?

A

Albuterol, steroids, and fluids

1179
Q

By what age should a child be able to walk?

A

12 months

1180
Q

You hear a loud harsh holosystolic murmur in a child. It is heard best at the LLSB. What diagnosis should you be thinking of?

A

Ventricular septal defect

1181
Q

The description of a dew drop on a rose petal should make you think of what diagnosis?

A

Chickenpox

1182
Q

Forchheimer spots are associated with what disease?

A

Rubella

1183
Q

A patient is having seizures along with a mouse-like odor from the urine. What diagnosis should make you be thinking of?

A

Phenylketonuria

1184
Q

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?

A

Coxsackie virus

1185
Q

What is the most common cause of an upper respiratory tract infection?

A

Rhinovirus

1186
Q

Nasal polyps should make you think of what diagnosis?

A

Cystic fibrosis

1187
Q

A Salter-Harris type I fracture affects what are of the bone?

A

Only the physis (growth plate)

1188
Q

A patient presents with a staccato cough but no fever. What diagnosis should you be thinking of?

A

Chlamydia pneumoniae

1189
Q

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

A

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
Q

What is the medical term for lazy eye?

A

Amblyopia

1191
Q

At what age should an infant begin cooing?

A

2 months

1192
Q

During a physical exam of a child, you feel a tubular or sausage-shaped mass. What diagnosis should you be thinking of?

A

Intussusception

1193
Q

A musical vibratory murmur best hear at the apex in a child should make you think of what diagnosis?

A

Still’s murmur