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Flashcards in packrat questions Deck (163):
1

initial tx for acute angle glaucoma

topical pilocarpine

2

what lab differentiates seizure from pseudo-seizure

serum prolactin

3

5 month history of schizophrenia symptoms including flattened affect, disorganized speech and poor hygiene. what is this disorder?

Schizophreniform disorder (similar to schizophrenia that cannot be dx until 6 months)

4

what is the mechanism associated with hornets syndrome: a disorder comprised of: ptosis, mitosis, & anhydrous

cranial sympathetic dysfunction that occurs due to nerve injury below the level of entry into the skull

5

increased tactile fremitus and egophony =

increased density such as effusion or pneumonia

6

what lab test should be followed bi-yearly for pts taking atypical antidepressants?

Glucose-blood sugar

7

trauma to the eye causing enopthalmos and flattened anterior chamber is suggestive of

globe rupture, shield eye and refer

8

pt has 225/130 bp what med should be used?

nitroprusside. it lower bp in seconds by direct arteriolar and venous dilation

9

herpangina is associated with what viruses? what are the symptoms?

enteroviruses, present with painful vesicles about the tonsillar fauces

10

Infliximab (Remicade) is a TNF inhibitor is used in the treatment of RA, what SE does it have

increased risk of developing infection, test for TB before starting medication

11

___ is the dominant hemoglobin found in sickle cell anemia

SS

12

what medication is recommending for family members of pts recently dx with Hep A?

Immuneglobin

13

young otherwise healthy pt with a recent viral syndrome, followed by acute, sharp, focal chest pain =

pleuritis

14

severe abdominal pain, vomiting for 6 hours, high white count, significant hypertriglyceridemia, and transient hyperglycemia =

acute pancreatitis

15

what PE finding indicates that delivery of the placenta is imminent?

uterus is higher and more globular in abdomen

16

right homonymous hemianopsia, where is the lesion located

left optic tract

17

what is the definitive treatment of OSA

tracheostomy

18

is a high fat diet is associated with prostate cancer?

yes

19

tx for otitis externa?

topical cipro it will kill pseudomonas and proteus

20

Noninflammatory causes of arthritis include

tumors, such as osteochondromas, osteoarthritis, trauma, and bone necrosis

21

What is the most common cardiac abnormality that develops in patients with undertreated acromegaly?

Cardiomyopathy

22

Which of the following best represents the initial evaluation of an otherwise healthy adult patient with the chief complaint of painless gross hematuria?

Urinalysis and culture. This is the best initial study for evaluation of hematuria. Centrigution of the urine specimen will help separate the sediment from the supernatant. Red sediment indicates hematuria, while red supernatant with a positive heme dipstick indicates hemoglobinuria vs myoglobinuria.

23

A 5 year old female is brought to your office by her mother who has noticed a rash on the palms of her hands and soles of her feet. She also reports that her daughter has had a fever of 100.5 F (38.1 C) and significantly decreased appetite for the past 3 days. What physical exam findings would you suspect in this patient?

Painful, small gray lesions on an erythematous base seen on the oral mucosa. This describes the aphthous ulcers commonly seen in Hand, foot, mouth disease caused by Coxsackie virus A16.

24

what is the usual tx of Polymyalgia Rheumatica.

Low dose corticosteroids for a couple of years and close follow-up with Rheumatology

25

A 45 year old male presents to the office with chronic rhinorrhea, and two weeks of purulent and bloody nasal discharge accompanied by a dry cough and pleuritic chest pain. He complains that over the last week his dyspnea has been worsening. You order labs and imaging studies. The CT scan reveals blood vessels leading to nodules within the lung, and he has a positive ANCA test, but otherwise labs are non-contributory. Which of the following is his most likely diagnosis?

Wegener’s Granulomatosis

26

What hematologic abnormality may be present in patients with chronic obstructive pulmonary disease?

Polycythemia can result in patients with this chronic lung disorder due to their chronic state of hypoxemia.

27

Which of the following is the most common presenting symptom in diabetic gastroparesis?

Vomiting several hours after meals
This is the most common presenting complaint in patients with diabetic gastroparesis. Metoclopramide is the drug treatment of choice in this condition, due to the increase in gastric emptying that it causes.

28

best test for syphillis

FTA-ABS is the diagnostic test of choice when a diagnosis of Syphilis is suspected. Dark field microscopy is not generally used clinically today, and RPR and VDRL aren’t as specific as the Fluorescent treponemal antibody testing.

29

What is the currently accepted treatment regimen for bacterial meningitis in the population between 1 month and 50 years?

Cefotaxime and vancomycin

30

Which of the following is the initial drug of choice for mood stabilization?
A.

Lithium

31

What cluster of features make up Cushing's Triad and indicate increased intracranial pressure?

Hypertension, bradycardia, respiratory depression

32

What is the imaging modality of choice in suspected nephrolithiasis?

non contrast CT

33

Above which of the following levels is hypertriglyceridemia considered to be a significant risk for acute pancreatitis?

With triglyceride levels of > 1000, a patient may be at increased risk of developing pancreatitis; xanthomas (deposits of chylomicrons within macrophages in the skin) may also occur at this level.

34

Factors VIII and IX are part of the intrinsic pathway, so they share a prolonged_______

PTT

35

Which of the following is the correct equation for calculation of the anion gap?

Na – (HCO3 + Cl)

36

Erythema multiforme

Characterized by target lesions with centripetal spreading

37

This is the gold standard test for Malarial infection, and should be taken and sent to the laboratory as soon as you suspect this diagnosis due to the associated mortality of this disease. what the name of the test?

Peripheral blood smear with Giemsa staining

38

Which of the following organisms is most often implicated in infections caused by cat bites?

Pasteurella multocida

39

At times congestive heart failure patients are placed on dopamine to yield diuretic effects. Dopamine, however produces different peripheral responses depending on the dose administered. At what dosing level does dopamine exert the desired effect of diuresis?

2-5 ug/kg/min administered intravenously

40

Pain associated with the mouth lesions prevents the boy from wanting to eat or drink. Physical examination of the oropharynx shows several clusters of small vesicles with erythematous bases and areas of ulceration, both of which bleed easily, on the lips, buccal mucosa, tongue, gingiva and hard palate. Which of the following is the most likely diagnosis?

Gingivostomatitis (herpes simplex virus type 1) is generally made clinically, based upon the typical appearance and location of oral and extraoral lesions. The enanthem begins with red, edematous marginal gingivae that bleed easily and clusters of small vesicles. The vesicles become yellow after rupture and are surrounded by a red halo. They coalesce to form large, painful ulcers of the oral and perioral tissues. They bleed easily and may become covered with a black crust.

41

Which of the following is the next step in the management of a patient who has elevated bilirubin levels on his routine annual lab work and a history of Gilbert’s syndrome?

Reassurance
This is a congenital disease that often goes undiscovered for many years. In this condition, the patient’s liver has a difficult time processing bilirubin. This is completely benign and will resolve on its own, no medical therapy is necessary.

42

what migraine medications due to their vasoconstrictor properties are contraindicated in patients with a history of ischemic heart disease

triptans

43

Drug Eruption with Eosinophilia and Systemic Symptoms (DRESS) Syndrome most often caused by

long acting sulfonamides, allopurinol, or anticonvulsant drugs.

44


Bloody show may precede which stage of labor?

first stage of labor

45

A healthy 20 year old male presents to the clinic to be tested for tuberculosis. Which of the following is the most sensitive test for tuberculosis in this patient population?

PPD

46

Which of the following electrocardiographic findings is most consistent with a patient who has hypocalcemia?

Prolonged QT interval

47

vasculitis + HEP B =

polyartheritis nodosa

48

In a patient with a suspected cervical spine injury, which of the following views will yield the most results?


Lateral radiographs of the spine will reveal 80% of spinal fractures and injuries.

49

how do you remember the causes of asystole

PATCH 4 MD. Pneumothorax, acidosis, thrombosis, cardiac tamponade, (4 H’s) hypo/hyperkalemia, hypo/hyperthermia, hypoxemia, hypovolemia, massive MI or PE, and drug toxicities.

50

What is the worrisome complication associated with correcting chronic hyponatremia too quickly

Central Pontine Myelinolysis

51

This is the average age of menopause in the United States. It is important to recognize this for the proper diagnosis and treatment of patients.

51

52

Imaging and biopsy of her thyroid reveal a 3 cm follicular tumor in the right lobe. Which of the following is the best treatment plan for this patient?

Follicular tumors greater than 1cm in diameter should be treated with total thyroidectomy, followed by radioactive iodine ablation

53

In which of the following conditions are you likely to see an "apple core" lesion?

Barium contrast x-rays will show filling defects due to colonic masses seen in colon cancer

54

Which of the following is the correct description of a positive Brudzinski’s test?

Involuntary leg and hip flexion with passive neck flexion

55

A patient presents to the emergency room for evaluation of a non-convulsive generalized seizure. An electroencephalogram (EEG) is ordered. What would you expect this test to show?

Generalized spikes and associated slow waves

56

Wrist drop in this patient with a humeral shaft fracture indicates what type of nerve injury

radial nerve

57

Interstitial Cystitis

hallmark is increased urination (50x per day)

58

A blood chemistry panel is ordered and reveals a sodium level of 125, what is the next step in management of this patient?

Slow drip IV saline

59

Which of the following is the best pharmacologic therapy for a patient with a sustained erection of greater than four hours?

Phenylephrine
Alpha adrenergic agonists have been shown to be a successful treatment in priapism. This is likely due to their sympathomimetic vasopressor effect. Drugs such as terbutaline and methylene blue have also shown to be effective.

60

What is the most common cause of bronchiolitis?

RSV

61

horrible dysmenorrhea? then use.....

Mefenamic acid (Ponstel) is the only NSAID that is currently approved for use in spasmodic dysmenorrhea, and should be the first line therapy for this patient.

62

Which of the following types of HPV is the most severe and has the worse prognosis?

18 (the age when most of us get it)

63

Which of the following sexually transmitted organisms classically is associated with the development of large, painful inguinal lymph nodes that may rupture?

Chlamydia trachomatis

64

A 37 year old female presents to the emergency room complaining of sudden onset of the ‘worst headache of my life.’ Physical exam shows that she is in apparent distress, pupils are reacting normally to light, and abdominal exam is benign. Head CT is found to be normal. Which of the following is the most appropriate next step in the evaluation and management of this patient?
A.

LP

65

A 27 year old woman, with a recent diagnosis of sarcoidosis, presents to the urgent care with complaints of increasing dyspnea and abdominal pain over the last two days. Which finding on the abdominal exam would be most consistent with sarcoidosis?

Hepatosplenomegaly

66

what is Addisonian crisis

Adrenal (Addisonian) crisis secondary to abrupt withdrawal of exogenous steroid use is the most likely diagnosis. These patients should be treated aggressively to restore normal electrolyte levels, and should receive an injection of hydrocortisone.

67

most likely etiology of hypopituitarism without an identified cause.

hemochromatosis, look at serum ferritin

68

CD4 is below 50, patient has DMAC, what is the treatment

This condition should be treated with a combination of macrolide + rifampin + ethambutol

69

Glargine and Detemir are considered to be what type of insulin preparations.

long acting insulin preparations.

70

Which of the following is considered first line treatment for Bipolar Disorder especially for rapid cycling / aggression?

Valproic acid, lithium or carbamazepine

71

A 16 year old female patient presents with a transient disturbance of cerebral function, leading to episodes of rhythmic motions of the upper extremity. An EEG shows focal rhythmic discharge with slow onset prior to a convulsive bout, but appears normal ictally. Which of the following is the most likely diagnosis?

Simple seizures presents without impairment in consciousness. They can be motor, sensory, or autonomic and may exhibit tonic-clonic activity of a limb or transient altered sensory perception which may spread to the entire side of body.

72

While auscultating the lungs of a 44 year old male patient, you hear high-pitched wet discontinuous crackling sounds during inspiration. What auscultatory finding does this describe?

rales

73

Which of the following types of anemia may be present in patients with Celiac disease?

Iron deficiency anemia

74

Can a hyphema cause increased intraocular pressure

yes

75

Which of the following is the most common cause of peptic ulcer disease?
A.

Helicobacter pylori

76

utoimmune destruction of the adrenal cortex

80% of addison's disease

77

should you give hypotonic fluids to a CVA patient?

Administration of hypotonic fluids to a patients with CVA may induce cerebral edema, and could lead to death.

78

What abnormality would be found upon cerebral histology in an animal that had rabies?

Negri bodies are found on autopsy of animals with Rabies.

79

A 37 year old male presents to the clinic with a red rash in ring form covering his trunk and portions of his lower extremities as well as a fever. He also complains of bumps under the skin of his arms and legs, that you recognize as subcutaneous nodules. Which of following heart murmurs is most commonly noted as a late sequelae of this disease?

Low-pitched diastolic rumble, possibly with opening snap
The mitral valve is most commonly affected in rheumatic heart disease, the late sequelae of acute rheumatic fever. Mitral stenosis is the classic valvular complication associated with rheumatic heart disease, which is noted to have a low-pitched diastolic rumble, possibly with opening snap early in the course of the disease.

80

does causes of Torsades de Pointes hyperkalemia?

no

81

what is Auspitz sign, it is common in Psoriasis

bleeding from the plaques with even minor trauma

82

What is Koebner phenomenon?

a flare up of psoriatic symptoms after minimal irritation to the skin

83

chronic dry eyes tx

Topical cyclosporine

84

What is the most common cause of Viral Meningitis?

Enterovirus has been implicated in around 90% of cases of viral or aseptic mening

85

Brown Sequard Syndrome refers to

Partial (hemi) transection of the cord

86

two medication to avoid in hyperparathyroidism?

HCTZ and lithium

87

what direction does a retina detach

from the temporal side, lay the pt on the side of the affected eye and in supine position

88

what medication can be given to a post-gallbladder removal, who is now having increased frequency stool and looser?

Treat with cholestyramine

89

A 40 year old obese female presents to the emergency room complaining of abdominal pain which is worse after meals. She states that she has been having this pain for a few months, but it was been worse over the last few days. She denies any nausea, vomiting or heartburn. Physical exam reveals tenderness to palpation in the right upper quadrant. Ultrasound reveals gallstones without gallbladder wall thickening and no pericholecystic fluid. Which of the following is the most likely diagnosis?

his patient most likely has biliary colic. This condition will present with right upper quadrant belly pain and a with negative ultrasound. The cited ultrasound findings are normal. Gallstones often are present.

90

What is the most common etiological agent implicated in bacterial meningitis?

Streptococcus pneumoniae

91

What is the peak age of child physical abuse?

0-3

92

A 16 year old female, who competes regularly in gymnastics, presents with back pain that has become increasingly worse over the last month. You order radiographs, which reveal defects in the pars interarticularis. What is this patient’s diagnosis?

Spondylolysis

93

Which of the following best describes the mechanism of action of ipratropium?

Blockade of muscarinic receptors resulting in bronchodilation. This accurately describes the mechanism of action of ipratropium. Ipratropium is not very effective in asthmatics, but widely used in COPD.

94

Which of the following is the most sensitive screening test for prostate cancer? PSA or Transrectal ultrasound and biopsy?

PSA

95

In which of the following anatomical locations are peptic ulcers most likely to occur?

Lesser curvature of the stomach and the duodenal bulb

96

the most common cause of pulseless electrical activity

Hypovolemia

97

Which of the following is the proper grouping of Vitamin K dependant coagulation factors?

Factors II, VII, IX, X

98

What is the diagnostic test of choice used to confirm the diagnosis of Polyarteritis nodosa?

Blood vessel biopsy

99

A 5 year old boy is brought to the clinic because of a rash that began a few days after starting amoxicillin for a middle ear infection. Physical exam shows grouped erythematous papules and wheals accompanied by mild angioedema over the trunk and lower extremities. Oropharyngeal exam shows no lesions, breathing is unlabored, and lungs are clear to auscultation. Which of the following is the initial treatment of choice for this patient’s condition?

Hydroxyzine or another H1 receptor blocking agent is the treatment of choice in Urticaria. Other agents may be added if the patient is still having symptoms (corticosteroids, H2 receptor blockers, doxepin, etc)

100

are gastric ulcers usually caused by hypersecretion of acid by the parietal cells

No, usually by H. pylori infections and chronic NSAID

101

Which of the following tests gives a definitive diagnosis of bacterial meningitis?

Cerebrospinal fluid culture

102

The treatment for Factor XI deficiency is which of the following?

Fresh Frozen Plasma

103

A 4 week old infant is brought into the clinic by his mother who is very concerned that her son is not growing or getting enough nourishment. She states that after almost every feeding he vomits forcefully. Physical exam shows upper abdominal distention and an olive sized mass on deep palpation of the upper right abdomen. Which of the following is the next best test to confirm the suspected diagnosis?

Upper GI series

104

With a patient that has suffered burns, what is the formula to calculate how much fluid should be replaced in the first 24 hours?

Percentage of 2nd and 3rd degree burns X body weight in kilograms X 4cc

105

A 41 year old patient has had low grade fevers for the past week. He also complains of burning with urination, and increased frequency and urgency. Digital rectal exam reveals a tender prostate. Which of the following is the recommended therapy for this patient?

Ciprofloxacin x 14 days

106

A 27 year old woman, with a recent diagnosis of sarcoidosis, presents to the urgent care with complaints of increasing dyspnea and abdominal pain over the last two days. Which finding on the abdominal exam would be most consistent with sarcoidosis?

Hepatosplenomegaly

107

Vitamin K is essential in the activation of coagulation of what factors

factors VII, IX, X, and II. Proteins C and S also require Vitamin K for their activity. 2, 7, 9, 10 C and S

108

Idiopathic thrombocytopenic purpura (ITP) is the most common thrombocytopenia in pediatric patients. Which of the following laboratory tests is most helpful in establishing this diagnosis?

Platelet count: The platelet count is reduced to less than 20,000/mm

109

Which of the following ECG changes indicates that transmural ischemia is occurring?

ST elevations

110

A 35 year old female patient, with no history of IV drug use, recently hospitalized 3 months prior for pyelonephritis, presents with fever, cough, and malaise for the past week. On physical exam you notice red lesions on the palms and soles of the feet, and exudative lesions on the retina while performing fundoscopy. A new onset murmur is auscultated. ECG, chest x-ray, and blood cultures are ordered. Which of the following organisms is the most likely cause of her condition?

Staph aureus is the most common overall cause of infective endocarditis

111

Generalized spikes and associated slow waves, is related to what type of seizure?

non-convulsive seizures

112

bitemporal hemianopsia, where is the lesion?

optic chiasm

113

What is the definitive diagnostic test for a patient with suspected testicular torsion?

US

114

definitive dx for sarcoidosis

node biopsy

115

Which viral illness has a rash which starts on the face and spreads to the trunk and limbs?

ruby cheeks than onto the body
Rubella

116

what is the difference between spematocele, variocele,

variocele: dilated plexus of veins (pampiniform plexus) that lies along the spermatic cord, and drains the testicle. Increased pressure in the veins causes the plexus to become dilated, possibly causing symptoms such as heaviness or an aching discomfort

Spermatoceles are benign cystic accumulations of sperm that arise from the head of the epididymis. Most of these are smooth, soft, and well-circumscribed intrascrotal masses that are paratesticula

117

The incidence of infection with Norwalk-like virus is most common in which of the following months?

during the winter months

118

Which of the following physical exam tests is most sensitive when testing for dislocation of the patella?

The apprehension test is performed by stabilizing the knee and pushing the patella laterally.

119

treatment of choice in cases of Melasma.

topical hydroquinone

120

Are Chancre due to sypillis painful or painless lesion

painless

121

Which of the following is the most common cause of dysuria in an adult male?

Urethritis

122

Clindamycin used for UTI?

No

123

how do you dinstignish if a positive PPD, is due to BCG or tuberculosis?

One may order the interferon-gamma release assay to dinstinguish between positive tuberculin reactions due to BCG versus tuberculosis.

124

A 39 year old female patient is checking her basal body temperature daily in order to increase her chances of conception. The rise in basal body temperature is due to which of the following mechanisms?

progestrone

125

If you suspect a patient is in acute renal failure, which of the following is the best initial radiographic diagnostic study?

Renal US

126

dx for Hidradenitis suppurativa

1) lesions must be typical for HS - round, deep nodules the at may appear alone or in groups, 2) lesions must appear in typical locations - most often in axilla, groin, or inframammary, and 3) chronicity or relapses are common.

127

substance that lowers INR (stops bleeding)

FFP

128

medication for absent seizure

ethosuximide

129

how is aortic insufficiency best heard?

sitting up and leaning forward

130

what is the bad combo for Rh reaction

negative mother and positive father

131

post anterior MI, continued ST elevation and scar tissue that bulges

left ventricle aneurysm

132

How is LMWH dosed

by the weight of patient

133

malignant HTN is define

end organ damage

134

bug known to cause myocarditis

coxsackie

135

what do you treat housemates of bacterial meningitis pt with?

rocephin, cipro, rifampin, zithromax, levaquin

136

heniz body

G6PD

137

long term tx of RA

interferon

138

3rd degree vaginal tear if what is involved

rectal sphincter

139

>10g fetal fat =

celiac spuce

140

trauma pt x-ray shows confluent bilateral infiltrates + dyspnea

ARDS

141

tx for ARDS if pt is hypoxic?

intubation

142

tx for acute psychosis with schizophrenia

typical antipsychotic- halodol, olanzapine, and fluphenazine

143

conization define

cone biopsy of cervix

144

PE finding of tetro-fallot

palpable right ventricle lift

145

tx for narcissitic personality disorder

lithium

146

terry's nails

white, ground glass due to liver issues

147

most common drugs to cause a drug-induced lupus reaction?

procainamide and hydralazine

148

12yo pt with lyme dz, what medication do you use

amoxicillin

149

increased Q angle are at greater risk of what knee problem

more force directed laterally during flexion and are at greater risk of patellofemoral pain syndrome

150

good reason to hospitalize a kid with acute bronchiolitis

moderate tachypnea and feeding difficulites

151

potential complication of hyphema

glaucoma

152

how does misoprostol (cytotec) protect against GI complications?

analog of prostaglandins and used in the tx of NSAID induced ulcer disease

153

tx of inflammatory bowel dz

sulfasalazine

154

what are the classic signs of cushing dz

central obesity, glucose intolerance, and easy bruising

155

bitemporal hemianopia -lesion is located?

optic chiasm

156

typical findings of acute pancreatitis

nausea, vomiting and abdominal pain

157

test with knee placed in 20 degrees of flexion?

Lachman

158

what electrolyte abnormality with primary aldosteronism

hypokalemia and HTN

159

amantadine is for

the flu

160

ankle jerk is what spinal level

S1

161

plantar flexion

S1

162

dorsiflexion

L4-L5

163

TCA and phenothiazine affect warfarin?

yes, bind it to the intestines