USMLE Missed Qs Flashcards
(128 cards)
1
Q
Most common malignant bone tumor of childhood
A
Ewing Sarcoma
2
Q
Localized pain and swelling + tumor in diaphysis or pelvis + moth eaten or onion skinning
A
Ewing Sarcoma
3
Q
Management of child < 2 yo with first febrile UTI
A
Renal and Bladder US
4
Q
EPO levels in polycythemia vera
A
Low
5
Q
No cervical change for >/= 4 hours w/ adequate contraction or no cervical change for >/= 6 hours without adequate contractions
A
active phase arrest
6
Q
Cervical change slower than expected (<1 cm/2 hours)
A
Protracted Active Phase
7
Q
Management of active phase arrest
A
C-Section
8
Q
Treatment of tremor in Parkinson’s in a younger patient
A
Trihexyphenidyl
9
Q
Time frame for febrile nonhemolytic transfusion reaction in patients receiving blood during surgery
A
1-6 hours
10
Q
What labs to get when starting a patient on lithium
A
BMP (BUN, Cr), UA, Calcium, pregnancy tests, and thyroid function tests
11
Q
ECG Monitoring before and during a vasovagal syncopal episode
A
Sinus bradycardia and Asystole
12
Q
Reason for sinus bradycardia and asystole in vasovagal syncope
A
Cardioinhibitory response due to increased parasympathetic activity
13
Q
Elevated JVD + R ventricular 3rd heart sound + Tricuspid regurg murmur + hepatomegaly w/ pulsatile liver + lower extremity edema, ascites or pleural effusions
A
signs of R ventricular failure and cor pulmonale due to lung disease
14
Q
Increased R heart pressure of pulmonary artery systolic pressure > 25 mmHg
A
signs of R ventricular failure and cor pulmonale due to lung disease
15
Q
Study design best for determining the incidence of a disease
A
cohort study design
16
Q
loss of normal action of the pyloric sphincter due to injury or surgical bypass leading to rapid emptying of hypertonic gastric contents
A
dumping syndrome
17
Q
abdominal pain, nausea, diarrhea, HoTN, tachy, dizziness, confusion, fatigue, diaphoresis after gastric bypass surgery
A
dumping syndrome
18
Q
Initial management of dumping syndrome
A
dietary modifications
19
Q
consume frequent, small meals
avoid simple sugars
increase fiber and protein
drink fluids between rather than during meals
A
dietary modifications to counter dumping syndrome
20
Q
Most common location of a VIPoma
A
pancreatic tail
21
Q
watery diarrhea, + muscle cramps/weakness + hypo/achlorydia
A
VIPoma syndrome
22
Q
Anorexia, Nausea, vomiting, early say tidy, post prandial fullness, and impaired glycemic control.
A
Diabetic Gastroparesis
23
Q
Management of diabetic gastroparesis
A
Prokinetic agents like metoclopramide, erythromycin, cisapride
24
Q
Initial treatment of sciatica
A
Short term relief of symptoms with nonsteroidal anti-inflammatory drugs or acetaminophen
25
Paraneoplastic syndrome characterized by symmetrical proximal muscle weakness and erythematous rash over the door some of the fingers and/or upper eyelids
Dermatomyositis
26
A common cause of a wide confidence interval:
A small sample size
27
Symptoms of disseminated gonococcal infection:
Triad of polyarthralgias, tenosynovitis, and vesiculopustular skin lesions
28
Factorial design studies:
Involve randomization to different interventions (2 or more) with additional study of two or more variables/outcomes
29
Definitive treatment for SCID
Stem cell transplant
30
Clinical features of neurofibromatosis type 1:
Multiple café au-lait macules, axillary and inguinal freckling, lisch nodules, neurofibromas, Optic gliomas
31
Inheritance pattern of neurofibromatosis type 1:
Autosomal dominant
32
Diagnostic test for chronic granulomatous disease:
Dihydrorhodamine 123 or nitroblue tetrazolium test
33
When do you see acalculous cholecystitis?
In hospital patients who are critically ill (Recent surgery, severe trauma, extensive burns, sepsis or shock, prolonged fasting or total parenteral nutrition, critical illness requiring mechanical intubation)
34
Modifiable risk factors for Breast cancer:
Hormone replacement therapy
Nulliparity
Increased age at first live birth
Alcohol consumption
35
First line treatment of vulvar lichen sclerosus:
Superpotent topical corticosteroids (clobetasol)
36
One of the most common causes of fetal tachycardia:
Maternal fever due to intramniotic infection
37
Most sensitive test for diagnosis of hiatal hernia:
Barium swallow
38
The best test for diagnosis of hemodynamically stable patients with suspected AAA:
Abdominal CT
39
What type of ingestion causes dysphasia, severe pain, heavy salvation, and mouth burns?
Caustic ingestion
40
The top three risk factors for preterm labor:
Preterm labor in a prior pregnancy
Multiple gestation
A history of cervical surgery
41
What is the first step in evaluating the risk of preterm labor?
Transvaginal ultrasound to measure the cervical length in the second trimester
42
How do ingested eggs that hatch from Taenia Solium sprayed in the body?
Hematogenously
43
Vitamin B2 deficiency:
Chelitis, glossitis, stomatitis, normocytic anemia, seborrheic dermatitis
44
Most common cause of rectovaginal fistula?
Obsetric injury (3rd or 4th degree laceration)
45
Preferred modality for diagnosing a ureteral stone?
US or non-con spiral CT of abdomen and pelvis
46
Indications for exploratory laparotomy:
Peritonitis
AAA
abdominal trauma
47
When is a HIDA scan indicated?
In patients with acute cholecystitis and US cannot definitively demonstrate obstruction at the GB neck
48
Causes of multifocal atrial tachycardia
R atrial enlargement
Catecholamine surge (sepsis)
Electrolyte imbalances
49
Treatment of multifocal atrial tachycardia
Management if the inciting disturbance
50
Howell-Jolly bodies
Nuclear remnants within RBCs typically removed by spleen suggesting asplenia
51
Which SSRI causes dose dependent hypertension?
Venlafaxine
52
Sexual assault victims are at increased lifetime risk for what?
Major depression and contemplation of suicide or actual suicide attempts
53
Patient presenting with irritability, agitation, and psychosis. Physical signs include tachycardia, hypertension, hyper thermia, diaphoresis, and mydriasis. Symptoms resolve spontaneously:
Amphetamine intoxication
54
The best approach to the psychotic patient with no insight:
A nonjudgmental stance that acknowledges the patient experience and perspective without endorsing specific delusions or hallucinations
55
Indications for ECT
Treatment resistant depression
Depression with psychotic features
Emergency conditions (pregnancy, refusal to eat or drink, imminent risk for suicide)
56
The most common psychiatric complication of multiple sclerosis:
Depression
57
Withdrawal symptoms of a short acting benzodiazepine (alprazolam):
Generalized seizures and confusion
58
Dream enhancement that occurs during REM sleep if muscle atonia is absent
REM Sleep behavior disorder
59
Recurrent episodes of impulsive verbal or physical aggression that are unplanned and out of proportion to the provocation. Diagnosed after age 10
Intermittent explosive disorder
60
Come in early side affect of SSRI:
Nausea, diarrhea, headache, increased anxiety, insomnia or somnolence
61
Why should patients with anxiety disorders be started at lower doses of anti-depressant?
Because they are sensitive to the activating effects of antidepressants
62
First line treatment for specific phobia?
Exposure —based cognitive behavioral therapy
63
Hyperactivity of the hypothalamic-pituitary – adrenal axis is associated with what?
Major depressive disorder
64
Age less than 45, psychiatric disorder, personal or family history of substance disorder, or a legal history...
Risk factors for prescription opioid miss use
65
Alcohol withdrawal at 6 to 24 hours
Mild withdrawal
66
Alcohol withdrawal within 12 to 48 hours:
Seizures in alcoholic hallucinosis
67
Alcohol withdrawal in 48 to 96 hours:
Delirium tremens
68
Long acting benzodiazepines used to treat alcohol withdrawal
Diazepam and Chlordiazepoxide
69
What intermediate acting benzodiazepine is used to treat alcohol withdrawal
Lorazepam
70
Impatience treated with anti-Parkinson’s medications who develop psychotic symptoms...
Dose reduction should be considered
71
Two times in which vulvar lichen sclerosus presents:
Pre-pubertal girls and peri/postmenopausal women
72
A BPP of 04/10 indicates...
Fetal hypoxia —> urgent delivery
73
A BPP of 6/10 is...
Equivocal —> repeat testing in 1 week
74
Normal BPP score
8-10/10
75
When does a patient with gestational hypertension need to begin weekly BPP?
32 weeks gestation
76
What two antepartum surveillance tests are equivalent?
BPP and CST
77
Severe, long-standing (>10 yrs) RA characterized by neutropenia splenomegaly
Felty Syndrome
78
All nonpregnant patients >25 yo with CIN 3 require:
Excision of the transformation zone (cone biopsy) due to the risk of progression to invasive squamous cell carcinoma
79
Pulmonary contusion results in...
Inter-alveolar hemorrhage and Edema
80
Characteristic features of pulmonary contusion following blunt thoracic trauma:
Tachypnea, tachycardia, and hypoxia with rails and decreased breath sounds developing less than 24 hours after blunt thoracic trauma
81
Exaggerated unconjugated hyperbilirubinemia in the first week of life caused by insufficient intake of breast milk:
Breastfeeding jaundice
82
How often should exclusively breast-fed newborns feed
Greater than or equal to 10 to 20 minutes per breast every 2 to 3 hours
83
When does breast-feeding jaundice occur?
1st week of life
84
When does breast milk jaundice occur?
Starts at age 3-5 days, peaks at 2 weeks.
85
How many wet diapers should a newborn baby produce?
1 per how many days old ( for the first week)
86
Spherocytes with no central pallor is seen in:
Hereditary spherocytosis and autoimmune hemolytic anemia
87
Fetal ultrasound findings in toxoplasmosis
Bilateral ventriculomegaly
| Diffuse intracranial calcification (especially basal ganglia)
88
Breath holding spells:
An episode of apnea precipitated by frustration anger or pain
89
Fever, skin rash, polyarthralgia occurring 1 to 2 weeks after exposure two antibiotics.
Serum-sickness like reaction
90
Most common complication of influenza
Secondary bacterial pneumonia (S. Pneumo or S. Aureus)
91
Patients with known of suspected measles infection should be isolated and placed on what precautions?
Airborne precautions
92
Post-exposure prophylaxis for pertussis:
Macrolides for all close contacts
93
Early satiety, nausea, nonbilious vomiting, weight loss
Gastric outlet obstruction
94
Pyloric stricture is seen in patients with a history of...
Acid ingestion
95
What measure of central tendency is most affected by an outlier?
Mean
96
Women with a history of HSV get what and when?
Antiviral ppx at 36 weeks
97
Strongest single factor predictive of suicide
Personal history of suicide attempt
98
Blood pressure medications associated with drug induced pancreatitis
Guys are diuretics and ACE inhibitors
99
When is ERCP indicated?
In patients with gallstone pancreatitis who have cholangitis, visible common bile duct dilation/obstruction, or increasing liver enzyme levels
100
Fasting blood glucose level target for gestational diabetes
Less than or equal to 95 mg/dL
101
1-hr postprandial glucose target for gestational diabetes:
Less than or equal to 140 mg/dL
102
2-hr post prandial blood glucose goals in gestational diabetes
Less than or equal to 120 mg/dL
103
Initial management of shoulder dystocia:
McRoberts maneuver (flexion of hips backward toward the abdomen) and the application of suprapubic pressure
104
Initial management of placenta previa:
Pelvic rest, abstinence from intercourse, and routine obstetric care
105
Definition of a short cervix:
Less than or equal to 2.5 cm
106
Where is the lesion located in hemi neglect syndrome
The right (non-dominant) parietal lobe
107
Risk factors for uterine rupture
Prior uterine surgery, induction of labor/prolonged labor, congenital uterine anomalies, fetal macrosomia
108
Clinical presentation of Uterine rupture:
Vaginal bleeding, intra-abdominal bleeding, fetal heart decelerations, loss of fetal station, palpable fetal parts or an abdominal examination, loss of intrauterine pressure
109
What does the biophysical profile assess?
Fetal Oxygenation
110
What defines oligohydramnios
A single deepest pocket less than 2 centimeters or an amniotic fluid index less than five
111
Agents used to reduce the risk of systemic thromboembolism in patients with afib and moderate to high risk thromboembolic events:
Warfarin or NOACs (apixiban, dabigatran, rivaroxaban)
112
Initial step in management of epidural spinal cord compression:
IV glucocorticoids
113
Most common cause of active phase protraction:
Cepahlopelvic disproportion
114
How to contract infantile botulism:
Ingestion of spores
115
Sine wave pattern on EKG indicates:
Hyperkalemia
116
Emergent treatment of hyperkalemia:
IV calcium (chloride or gluconate) to stabilize the cardiac myocyte
117
First prenatal screening labs:
HIV, HBV, chlamydia, syphilis
118
Risk factors for avascular necrosis of the femoral head:
Steroid use, alcohol use, Lupus, Antiphospholipid syndrome, sickle cell, infections, renal transplant, decompression sickness
119
Treatment of minimal change disease:
Corticosteroids
120
Multiple stomach ulcers and thickened gastric folds:
Zollinger Ellison Syndrome
121
Most common pathogenic organism in young patients with CF
Staphylococcus Aureus
122
Mulder sign:
Eliciting pain on the plantar surface of the foot and crepitus between the 3rd and 4th toe when squeezed
123
Most common cause of nutritional folic acid deficiency in the US:
Alcohol abuse
124
Most common neoplasm to metastasize to the brain:
Lung Cancer
125
Appearance of lung mets on MRI:
Multiple, well-circumscribed lesions with vasogenic edema at the gray and white matter junction
126
Causes of scurvy:
Alcoholism, drug abuse, psychiatric illness
127
Manifestations of scurvy:
Ecchymoses, follicular hyperkeratosis, petechiae, gingivitis, poor wound healing
128
How does raising the cutoff point affect sensitivity and specificity?
Decreases sensitivity
| Increases specificity
