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PANCE 5

PANCE 5

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Items (965)

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

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

  • Name one oral medication that can be used for MRSA.

    Linezolid (Zyvox) and Bactrim

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

    Lamivudine

  • How is celiac disease most commonly diagnosed?

    Endoscopic biopsy

  • A fat pad sign on a lateral x-ray of the elbow has what significance?

    It is blood in the joint indicating a fracture even if the fracture line cannot be seen.

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

    Esophageal spasms

  • What is the treatment for Turner's syndrome?

    Cyclical estrogen and progesterone

  • What is the gold standard for diagnosing myocarditis?

    Myocardial biopsy

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

    3 months

  • What is the most accurate way to diagnose urethritis?

    Urine PCR

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

    Lown-Ganong-Levine syndrome

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

    Tetralogy of Fallot

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

    Oxytocin (Pitocin)

  • What is the most common cause of a folate deficiency?

    Alcoholism

  • List three risk factors for placental abruption.

    HTN, smoking, AMA, cocaine use, PROM

  • What ejection fraction is typical for a patient with CHF?

    35-40%

  • What is the major concern with using lithium?

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

  • List the four most common places lung cancer will metastasize to.

    Bone, brain, adrenals and liver

  • What is the main risk factor for esophagitis?

    Immunocompromised patient

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

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

  • A pregnant woman and cat litter should make you think of what diagnosis?

    Toxoplasmosis

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

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

  • What is the most common cause of sudden cardiac death?

    Ventricular fibrillation

  • A positive straight leg test indicates what diagnosis?

    Herniated disc

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

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

  • How long must symptoms last before diagnosing ADD?

    6 months

  • What are the two most common organisms responsible for cellulitis?

    Strep and Staph

  • Does total lung capacity go up or down in COPD?

    It goes up.

  • What organism causes Lyme disease?

    Borrelia burgdorferi

  • What organism is most commonly responsible for community acquired pneumonia?

    Strep pneumoniae

  • What is the normal range for MCV?

    80-100

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

    Patent ductus arteriosus (PDA)

  • How do you administer the Weber hearing test?

    Tuning fork placed in the middle of the forehead

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

    24 months

  • Duchenne's and Becker's muscular dystrophy have what genetic characteristic?

    X-linked recessive

  • Why is folic acid given as a prenatal vitamin?

    Low folic acid can lead to neural tube defects.

  • Color blindness is transmitted through what genetic pattern?

    Dominant X-linked

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

    Right atrial enlargement

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

    Urea breath test

  • What it is the recommended treatment for hepatitis C infection?

    Pegylated interferon alpha-2

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

    Nulliparity is a risk factor for preeclampsia.

  • Acute sinusitis is most commonly caused by which two pathogens?

    Strep pneumoniae and haemophilus influenzae

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

    Lobar pneumonia

  • What percentage of diabetes in the US is type 2?

    80-90%

  • What is the treatment for pneumocystis jiroveci pneumonia?

    Bactrim

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

    Early they are hyperactive. Late they are absent.

  • A feathery border in an eye exam should make you think of what diagnosis?

    Fungal infection

  • List six medications that can be used for migraine prophylaxis?

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

  • What is the #1 cause of retinal artery occlusion?

    Carotid atherosclerotic disease.

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

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

  • What causes Mallory-Weiss tears?

    Forced vomiting or retching (often involving alcohol)

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

    TB

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

    PTU

  • What are three causes for a postpartum hemorrhage?

    Uterine atony, genital laceration, retained placenta

  • What is the name of the test for dry eyes?

    Schirmer's test

  • Will serum potassium be decreased or elevated in renal failure?

    Elevated

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

    Potassium, they may have hyperkalemia.

  • What is the first medication you should give for atrial flutter?

    Adenosine

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

    Sertraline (Zoloft)

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

    Abuse either child or elder

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

    Trichomonas

  • What is the first line treatment for carpal tunnel?

    Night splint

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

    MVA, posterior

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

    Nephrotic syndrome Cystoscopy and biopsy Spermatocele

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

    Orange-red discoloration of body fluids

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

    Lead I and AVF

  • What is the other term for Mobitz type I?

    Wenckebach

  • List three possible treatments for stress incontinence in women.

    Kegels, estrogen therapy, surgical placement of a urethral sling

  • How do you treat amebiasis?

    Metronidazole (Flagyl)

  • Alcohol may be a major factor in which encephalopathy?

    Wernicke's

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

    G6PD deficiency anemia, chronic liver disease, alpha thalassemia

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

    Sitting up and leaning forward

  • List the six P's of an ischemic limb.

    Pain, paresthesias, pallor, pulselessness, poikilothermia, paralysis

  • Fasting gastrin will be above what level with gastrinoma?

    >150 pg/ml

  • How do you treat a Trichomonas infection?

    Metronidazole

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

    Staph

  • What is the most common cause of postpartum hemorrhage?

    Uterine atony

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

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

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

    CHF

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

    Allergic rhinitis

  • What is the most common patient complaint with emphysema?

    Shortness of breath

  • How do you treat urethritis?

    Ceftriaxone and doxycycline

  • Posturing should make you think of what diagnosis?

    Catatonic depression

  • Describe Brudzinski's sign.

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

  • What is the hallmark physical exam finding for placenta previa?

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

  • What age range is typically associated with testicular torsion?

    10-20 years old

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

    Atrial septal defect

  • When does quickening occur?

    Nulliparous 18-20 weeks, multiparous 14-16 weeks

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

    Alopecia areata

  • Under routine circumstances when should patients begin getting screening colonoscopies?

    Age 50

  • The scotch tape test is used to diagnose what disease?

    Pinworm

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

    Kawasaki syndrome

  • Which heart valve is most associated with rheumatic fever?

    Mitral

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

    Rape

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

    Pulmonary embolism

  • Forchheimer spots are associated with what disease?

    Rubella

  • What ligament is most commonly injured in an ankle sprain?

    Anterior talofibular ligament (ATFL)

  • What is the treatment for epiglottitis?

    2nd or 3rd generation cephalosporin (ceftriaxone), macrolides may also be used (clindamycin)

  • In Cushing’s disease is ACTH elevated or decreased?

    Elevated

  • What is the #1 cause of small bowel obstruction?

    Postoperative adhesions

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

    Osler nodes

  • What is the most common prophylactic antibiotic used preoperatively?

    Cephalexin (Ancef)

  • What will an x-ray show in acute osteomyelitis?

    Nothing - it will show bone destruction in chronic osteomyelitis.

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

    Transesophageal echo

  • As it relates to diabetics, what is the dawn phenomenon?

    Reduced insulin response between 5 and 8 am

  • Cottage cheese discharge should make you think of what diagnosis?

    Vaginal candidiasis

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

    Haemophilus influenzae

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

    Conductive

  • A christmas tree pattern should make you think of what diagnosis?

    Pityriasis rosea

  • What is the age range for Duchenne's muscular dystrophy?

    3-5 years old

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

    Cocaine use

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

    High

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

    Amphotericin B

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

    Macrocytic

  • What is the most serious complication of Kawasaki syndrome?

    Aortic Aneurysm

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

    Indirect inguinal hernias makeup 50% of all adult hernias.

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

    Colles = Dorsal, Smith = Volar

  • What is the appropriate treatment for a patent ductus arteriosus.

    Indomethacin

  • What is the term for difficulty swallowing?

    Dysphagia

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

    Right bundle branch block

  • What is the age range for osteosarcoma? Where are they most typically found in the body?

    Osteosarcoma usually occur in 15-25 year old males and are most commonly found around the knee." "What is the most specific diagnostic test for pepti

  • ulcer disease?"

    Endoscopy

  • What is the first line treatment for pertussis?

    Erythromycin

  • After 7 days of sinusitis what antibiotic would you start?

    Amoxicillin or Bactrim

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

    Anorexia is egosyntonic. Bulimia is ego-dystonic.

  • What is the most common cause of CHF?

    Coronary artery disease

  • What antibiotic class is the class of choice for chlamydia?

    Macrolides

  • A surge in what hormone leads to ovulation?

    Luteinizing hormone

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

    Pseudomonas

  • Propranolol belongs to what class of medication?

    Beta blockers

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

    Hydatidiform mole

  • List three positive symptoms of schizophrenia.

    Hallucinations, delusions, movement disorders

  • What is pertussis more commonly referred to as?

    Whooping cough

  • Name three medication "classes" which are indicated for reduction in LDL?

    Statins, ezetimibe, niacin and nicotinic acid

  • How do you treat a stasis dermatitis?

    Compression stockings

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

    Viral

  • Tenderness over the anatomical snuffbox is indicative of what fracture?

    Scaphoid

  • If you have heartburn that does not improve with medication what is the most likely diagnosis?

    Gastrinoma

  • Steatorrhea should make you think of what diagnosis?

    Pancreatitis

  • Describe Barlow's test.

    Adduct and internal rotation of the hips

  • What two viral hepatitis infections are self limiting?

    Hepatitis A and hepatitis E

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

    E. coli

  • Where are Heberden's nodes found?

    Distal interphalangeal joint (DIP)

  • What is the leading cause of iron deficiency anemia?

    Chronic GI bleed

  • What is the most common fracture in a patient with osteoporosis?

    A compression fracture of a vertebral body followed by hip fractures.

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

    20 weeks

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

    Beta blocker

  • What CXR finding might make you think of mesothelioma?

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

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

    Exacerbated

  • Which EKG leads are used to diagnose an anterior wall MI?

    V1, V2 and V3

  • At what BMI should a patient be hospitalized for anorexia?

    BMI of <17.5 or 20% below appropriate body weight

  • How do fibrates work to affect the lipid profile?

    They inhibit synthesis of VLDL and elevate lipoprotein lipase.

  • Describe Courvoisier's sign.

    Nontender, palpable gallbladder which may indicate pancreatic neoplasm.

  • When is the typical onset of Tourette's syndrome?

    3-8 years old

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

    Upper

  • List three causes of decreased tactile fremitus.

    COPD, Asthma, pleural effusion, pneumothorax

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

    12 weeks

  • What are the ABC's of melanoma?

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

  • What life threatening side effect do statins have?

    Rhabdomyolysis

  • What two hormones are secreted by the posterior pituitary?

    Oxytocin and antidiuretic hormone (ADH, vasopressin)

  • Define paraphimosis.

    Foreskin is retracted and cannot be reduced.

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

    Neurosis and psychosis

  • Does FEV1 go up or down with asthma?

    It goes down

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

    Left atrial enlargement

  • What is the treatment for a tetanus infections?

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

  • What are the genetic characteristics of Wilson's disease?

    Autosomal recessive, chromosome 13

  • How does metformin work?

    Decreases the hepatic glucose production and increases peripheral glucose uptake

  • Where is disease of the tricuspid valve best heard?

    Along the left lower sternal border

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

    Herpes simplex virus

  • A positive Finkelstein's test indicates what diagnosis?

    de Quervain's tenosynovitis

  • What medication is used for patients with lupus?

    Systemic steroids

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

    Amebiasis

  • Pearly dome-shaped lesion with a central umbilication should make you think of what diagnosis?

    Molluscum contagiousum

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

    Ice cream falling of the cone

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

    Mitral stenosis

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

    Silicosis

  • How much fiber should you normally get in a day?

    About 30 grams

  • How long must symptoms occur before diagnosing schizophrenia?

    At least six months

  • What is the normal pH of the blood?

    7.35-7.45

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

    7 years old

  • What are the three major criteria for endocarditis?

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

  • What is the treatment for cholera?

    Fluids

  • Which lipid medication may cause flushing?

    Niacin

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

    Subarachnoid hematoma

  • What is the treatment for pertussis?

    Erythromycin x 7 days

  • What are the two most common causes of epididymitis?

    Neisseria gonorrhea and chlamydia

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

    8

  • What is the most common endometrial cancer?

    75% are adenocarcinomas

  • A blockage of which artery causes a lateral wall MI?

    Left circumflex artery

  • What are two tocolytic medications you should be aware of?

    Magnesium sulfate and calcium channel blockers

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

    Retinal detachment

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

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

  • Define phimosis.

    Foreskin can not be retracted.

  • Do loop diuretics cause hyperkalemia or hypokalemia?

    Hypokalemia

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

    Pyelonephritis

  • Oral herpes is best treated with systemic or topical antivirals?

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

  • What medication class is used to lower triglycerides?

    Fibric acid derivatives

  • List the four cluster B personality disorders.

    Bad antisocial, borderline, histrionic and narcissistic

  • What specific breathing pattern is associated with diabetic ketoacidosis?

    Kussmaul respirations

  • What is Reynold's pentad and why does it matter?

    Charcot's triad + hypotension + altered mental status. It indicates high risk of sepsis.

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

    Loop diuretics

  • Define priapism

    Painful persistent erection

  • Are ulcers from arterial insufficiency painful or painless?

    Painful

  • Clue cells should make you think of what diagnosis?

    Bacterial vaginosis

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

    Tetracycline

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

    6-12 hours

  • What dermatologic finding is associated with insulin insensitivity?

    Acanthosis nigricans

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

    Vaginal candida infection

  • Is sickle cell microcytic, macrocytic or normocytic?

    Microcytic

  • Tapioca blisters should make you think of what diagnosis?

    Dyshidrosis - these are usually on the hands and feet

  • When is it recommended to begin pap smears?

    Guidelines suggest beginning at age 21 regardless of sexual history.

  • At what age is primary amenorrhea diagnosed?

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

  • What is the medical term for lazy eye?

    Amblyopia

  • What tests are done to screen for HIV?

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

  • A herald patch should make you think of what diagnosis?

    Pityriasis rosea

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

    1 year old

  • What does ERCP stand for?

    ndoscopic retrograde cholangiopancreatography

  • Define pellagra?

    Niacin (B3) deficiency Cytomegalovirus

  • Where is disease of the mitral valve best heard?

    At the apex

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

    10-13 weeks

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

    Metritis

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

    Lachman's, followed by anterior drawer

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

    Chronic myeloid leukemia

  • What two lung cancers are typically found centrally on CXR?

    Small cell and squamous cell

  • Honey and babies should make you think of what diagnosis?

    Botulism

  • Anatomically where are 80% of clavicle fractures located?

    Middle third

  • What molecule binds iron in the blood stream?

    Transferrin

  • What is the medical term for cross-eyed?

    Strabismus

  • Fruity breath should make you think of what diagnosis?

    Diabetic ketoacidosis

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

    Left bundle branch block

  • What dermatologic finding is associated with asthma?

    Atopic dermatitis

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

    Hydatidiform mole

  • List two risk factors for prostate cancer.

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

  • Zanamivir (Relenza) may be giv to children above what age?

    7 years old

  • At what age should a child begin to feed himself?

    6 months

  • What type of mosquitoes carry malaria?

    Anopheles

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

    Debridement, the venom causes tissue necrosis.

  • What antibiotic is the first line treatment for mycoplasma pneumonia?

    A macrolide (azithromycin or erythromycin)

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

    Huntington's

  • What is the most common thyroid cancer?

    Papillary makes up about 80% of thyroid cancers.

  • Currant jelly stool should make you think of what diagnosis?

    Intussusception

  • Melasma is most often found in what patient population?

    Women of childbearing age

  • Paradoxical pulses may be found in what pulmonary disorder?

    Asthma

  • Currant jelly stool should make you think of what diagnosis?

    Intussusception

  • A barrel chest should make you think of what diagnosis?

    Emphysema

  • Dullness to percussion should make you think of what diagonsis?

    Lobar pneumonia

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

    Psoriasis

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

    Indirect immunofluorescent antibodies

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

    Herpes keratitis

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

    Glomerulonephritis

  • Strict vegans are at risk for what type of anemia?

    B12 deficiency anemia

  • What are the most common colors lost in color blindness?

    Red and green

  • What might happen if you infuse vancomycin too fast?

    Red Man syndrome

  • Give the DEXA score for osteopenia? Osteoporosis?

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

  • Will ACTH be elevated or decreased in Addison's disease?

    Elevated if the problem is at the adrenal glands.

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

    Implanted defibrillator

  • What is the most common cause of dementia?

    Alzheimer's disease, it may be as high as 80%.

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

    DM type 1

  • At what age do symptoms of Huntington's disease appear?

    Around 30 years old

  • What is the most common cause of DM type 1?

    Autoimmune destruction of the islet cells in the pancreas

  • Name three medications used to break a seizure?

    Diazepam, lorazepam, phenytoin or fosphenytoin.

  • What organism causes toxoplasmosis?

    Toxoplasma gondii

  • What is a cystocele?

    A herniation of the bladder into the vagina.

  • What is the term for eyelids that turn in?

    Entropion

  • Giant cell arteritis is associated with what other disease?

    Polymyalgia rheumatica

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

    Ganglion cyst

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

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

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

    Hypothermia

  • What is the first line treatment for mastitis?

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

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

    Barium swallow will show the diverticulum.

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

    HTN and DM

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

    Cystic fibrosis

  • Describe how to perform the psoas sign.

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

  • What is the most common uterine tumor?

    Leiomyoma, also known as fibroids

  • What location within the pelvis is endometriosis most commonly found?

    On an ovary

  • What is the initial treatment for a myocardial infarction?

    MONA - morphine, oxygen, nitroglycerin and aspirin

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

    Diphtheria

  • What is tonometry used for?

    Determining intraocular pressure

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

    Acute tubular necrosis

  • Are patients with specific phobias aware they are strange?

    Yes

  • Name one abortive drug for migraines.

    Triptans (sumatriptan, zolmitriptan), ergotamine

  • What CXR finding might make you think of berylliosis?

    Diffuse infiltrates with hilar adenopathy

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

    Trichomonas

  • What siezure medication may cause overgrowth of the gums?

    Phenytoin

  • Tympany to percussion should make you think of what diagonsis?

    Large pneuomthorax

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

    Pacemaker

  • Where do most aortic dissections occur?

    The ascending or descending thoracic aorta

  • What medical treatment is given for a gastrinoma?

    Proton pump inhibitors

  • What is the clinical name for whooping cough?

    Pertussis

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

    Serum creatinine and serum potassium

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

    Patients older than 50

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

    Stress incontinence

  • Which thyroid cancer is the most aggressive?

    Anaplastic

  • Define threatened abortion.

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

  • How much more potent is T3 than T4?

    3-4x

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

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

  • What is the most common cause of hyperparathyroidism?

    Single parathyroid adenoma in 80% of cases.

  • Is staph gram (+) or gram (-)?

    Gram (+)

  • What are the two main causes of aortic stenosis?

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

  • You notice drusen deposits on fundal exam. What is the most likely diagnosis?

    Macular degeneration

  • List the 5 insulins in order of peak efficacy?

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

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

    Pseudohyphae

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

    Elevated

  • Define the third stage of labor.

    Delivery of baby to delivery of placenta

  • How do you treat alcohol withdrawal?

    Benzodiazepines

  • What is the treatment for myxedema?

    Levothyroxine and slow warming

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

    2 to 3

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

    >50,000 at a minimum and probably much higher.

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

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

  • What is the medical treatment for gout?

    Allopurinol, colchicine

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

    Hepatitis B

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

    Coarctation of the aorta

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

    Malnutrition and severe blood loss

  • Where are Bouchard's nodes found?

    Proximal interphalangeal joint (PIP)

  • What is the first line treatment for tinea corporis?

    Topical azoles

  • Which of the four rotator cuff muscles is most commonly injured?

    Supraspinatus

  • What three symptoms are classic for a normal pressure hydrocephalus?

    Gait disturbance, dementia and urinary incontinence

  • What is the treatment of choice for strep throat?

    Penicllin, amoxicillin, erythromycin

  • List 4 medications which may cause asthma.

    Beta blockers, NSAIDS, ACEI, ASA

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

    Macular degeneration

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

    >4.0

  • What is the first line medical treatment for pericarditis?

    Aspirin and NSAIDS

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

    Candida

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

    Upper lung fields

  • What is the gold standard for diagnosing coronary artery disease?

    Cardiac catheterization

  • What are two treatments you should consider for esophageal strictures?

    Dilation of the esophagus and long term PPIs.

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

    Don't use steroids. Topical antiviral and refer!

  • List four symptoms of serotonin syndrome.

    Hyperthermia!, seizure, mental status change, tremor

  • What is the karyotype for patient with Turner's syndrome?

    (45, X) They are missing one sex chromosome.

  • What happens to total lung capacity in sarcoidosis?

    It goes down

  • Which hyperlipidemia medication may cause flushing?

    Niacin

  • A double comedone is indicative of what diagnosis?

    Hidradenitis suppurativa

  • A positive crossover test indicates what diagnosis?

    Acromioclavicular joint injury (AC joint)

  • Silvery scales should make you think of what diagnosis?

    Psoriasis

  • What tumor marker may be used for liver cancer?

    alpha-Fetoprotein

  • What is considered a normal PCO2?

    40mmHG Respiratory - CO2 is elevated

  • What is the best lab test for scabies?

    Microscopic examination under oil immersion

  • Nasal polyps should make you think of what diagnosis?

    Cystic fibrosis

  • What is erythema nodosum?

    Tender red nodules usually found on the shins.

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

    Hemorrhoids

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

    Rhinovirus

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

    Ceftriaxone (Rocephin)

  • What is the medical treatment for an early ectopic pregnancy?

    Methotrexate

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

    The physis (growth plate) as well as the epiphysis

  • What is the treatment for Addison's disease?

    Hydrocortisone or prednisone

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

    Dysthymia

  • Which NSAID has the highest rate of peptic ulceration?

    Naproxen

  • What is the only curative therapy for gastric adenocarcinoma?

    Surgical resection

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

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

  • What is a good beta blocker to reduce portal HTN?

    Propranolol

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

    Seborrheic keratosis

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

    Atrial flutter

  • Ethambutol has what two major side effects?

    Optic neuritis, red green vision loss

  • How does levothyroxine work?

    It is a synthetic T4

  • How do you treat pityriasis rosea?

    Reassurance

  • Amenorrhea is defined by what time frame?

    3 months if periods were previously regular and 6 months if they were irregular.

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

    It will almost always be low.

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

    E. Coli

  • Is the ankle jerk reflex of lumbar or sacral origin?

    Sacral

  • What is the best test to diagnose bronchiectasis?

    CT

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

    Bowel obstruction

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

    Metformin

  • Subacute endocarditis is most commonly caused by what organism?

    Strep Viridans

  • What is the treatment for Shigella?

    Bactrim or fluoroquinolones and hydration.

  • What lab result will increase the risk of digoxin toxicity?

    Hypokalemia or hypercalcemia

  • Which nerve is involved in herpes zoster ophthalmicus?

    Trigeminal nerve, CN 5

  • Why is ovarian cancer so hard to diagnose?

    There are no good markers and the symptoms are very vague.

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

    B12 deficiency neuropathy and diabetic neuropathy

  • Describe Cullen's sign.

    Umbilical ecchymosis often related to pancreatitis.

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

    Patent foramen ovale

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

    Atrial septal defect

  • Waxy flexibility should make you think of what diagnosis?

    Catatonic schizophrenia

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

    Right

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

    Mitral valve prolapse

  • A shuffling gait should make you think of what diagnosis?

    Parkinson's disease

  • What is the most common microcytic anemia?

    Iron deficiency anemia

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

    Silicosis

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

    Lichen planus

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

    0, 3, 7, 14, 28

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

    Irrigate, irrigate, irrigate

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

    STEMI and new left bundle branch block

  • Is pseudomonas gram (+) or gram (-)?

    Gram (-)

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

    every 48-72 hours

  • Mesothelioma is most commonly found in what lung location?

    80% are found in the pleural lining

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

    Peritonsillar abscess

  • What is the first line treatment for genital warts?

    Imiquimod (Aldara)

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

    Cough

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

    15-20 weeks

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

    Myopia, concave lenses

  • List 4 physical exam findings for Cushing's syndrome.

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

  • What is the best imaging for a thyroid nodule?

    Ultrasound

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

    Psoriasis

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

    Crohn's disease

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

    Supraventricular tachycardia

  • What is the treatment for a volvulus in a child?

    Barium enema

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

    Parkinson's disease

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

    Omeprazole, clarithromycin and amoxicillin (PPI + 2 Antibioitcs)

  • What is the treatment goal for a diabetic with hypertension?

    130/80

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

    Methimazole or propylthiouracil (PTU)

  • Is diphtheria a Gram-positive or negative organism?

    Gram-positive

  • How do you treat achalasia?

    Loosen up the muscle - botox, dilation or surgery

  • What is the most specific test for acute cholecystitis?

    HIDA

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

    Asthma or COPD

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

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

  • Define inevitable abortion.

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

  • List three medication that may cause lupus.

    Procainamide, isoniazid and Quinidine

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

    Addison's disease

  • Are most shoulder dislocations anterior or posterior?

    Anterior

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

    Cardiac tamponade, pericarditis and obstructive lung disease

  • How long should pressure be applied to treat epistaxis?

    15 minutes

  • What is the term for painful swallowing?

    Odynophagia

  • Cortical adrenal insufficiency is also known as what disease?

    Addison's disease

  • Currant jelly sputum should make you think of what diagnosis?

    Klebsiella pneumoniae

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

    70 for males, 65 for females

  • What are three treatments for uterine prolapse?

    Pessary, Kegel's maneuvers, surgical repair

  • What is Hashimoto's disease?

    An autoimmune cause of hypothyroid

  • Define menorrhagia.

    Heavy prolonged menstrual flow

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

    Helicobacter pylori

  • What are the two main complications of cirrhosis?

    Portal HTN & liver insufficiency

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

    Tension pneumothorax

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

    Emphysema

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

    Extensor

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

    Repeat pap smear in 6 months and repeat colposcopy in 12 months.

  • Antisocial personality disorder may not be diagnosed until what age?

    18 years old

  • Nummular eczema is most like what other dermatological disorder?

    Atopic dermatitis

  • What is the best imaging to diagnose osteomyelitis?

    Either a bone scan or an MRI will provide the diagnosis.

  • What is the most common vessel blocked with intestinal ischemia?

    Superior mesenteric artery

  • A CT scan shows ring enhancing lesions in an HIV patient. What is the most likely diagnosis?

    Toxoplasmosis

  • What two herpes viruses are most responsible for condyloma acuminata?

    HSV 6 and 11

  • List 2 risk factors for ovarian cancer.

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

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

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

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

    Achalasia

  • What are two common predisposing factors for esophageal varices?

    Portal HTN and cirrhosis often caused by alcoholism.

  • What is the best treatment for molluscum contagiosum?

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

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

    Males are eight times as likely to have an aortic aneurysm.

  • A positive Neer's test indicates what diagnosis?

    Rotator cuff impingement

  • What is the first step of treatment for endometrial cancer?

    Total hysterectomy and bilateral salpingo-oophorectomy

  • Salivary amylase breaks down what macronutrient?

    Carbohydrates

  • Name the four thyroid cancers.

    Papillary, Follicular, Medullary, Anaplastic

  • What is the most common organism that causes mastitis?

    Staph aureus

  • Blue bloater refers to the characteristic physical exam findings of what disease?

    Chronic bronchitis

  • What is the most common cause of postrenal renal failure?

    BPH, postrenal renal failure is secondary to an outflow obstruction

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

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

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

    Egophony

  • List two medications commonly used for hypertension in pregnancy.

    Methyldopa and labetalol

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

    24 hour urine for catecholamines

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

    28 weeks

  • What virus causes mumps?

    Paramyxovirus

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

    Stay out of the sun and avoid alcohol.

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

    Proton pump inhibitors - omeprazole, lansoprazole, pantoprazole

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

    Placental abruption

  • Paroxysmal nocturnal dyspnea should make you think of what diagnosis?

    CHF

  • How does ezetimibe work?

    Decreases intestinal absorption of cholesterol.

  • Does mastitis tend to be unilateral or bilateral?

    Unilateral and only one quadrant

  • What is the suffix associated with sulfonylureas?

    Ide is the suffix. Examples: glipizide, tolbutamide, tolazamide.

  • What is the first symptom of a rabies infection?

    Pain and anesthesia at the site of the bite

  • What two blood test can be used to diagnose celiac?

    IgA endomysial antibody and IgA tTG antibody

  • Which problem is an emergency phimosis or paraphimosis?

    Paraphimosis

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

    Pulmonary embolism

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

    The peripheral zone

  • Syphilis is caused by what organism?

    Treponema pallidum

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

    Intestinal ischemia

  • What cranial nerve is affected with Bell's palsy?

    CN VII

  • What is the medical term for hunchback?

    Kyphosis

  • How do you treat hookworm?

    Azoles

  • G6PD deficiency follows what pattern of inheritance?

    X- linked

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

    Primary syphilis

  • Define premature birth.

    Delivery of uterine contents between 20-36 weeks.

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

    Scabies

  • What organism is the most common cause of otitis media?

    Strep pneumonia

  • Pizza pie retinopathy should make you think of what diagnosis?

    Cytomegalovirus (CMV)

  • How long before normal grief resolves?

    About one year

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

    Chickenpox

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

    The patient will hear the sound louder in the unaffected ear.

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

    Bronchiectasis and idopathic pulmonary fibrosis

  • What is the treatment for most Mallory-Weiss tears?

    Watchful waiting, these will typically resolve within 48 hours.

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

    Tinea versicolor

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

    Hypokalemia

  • How long after administering a PPD should it be read?

    48-72 hours

  • What is the treatment for seborrheic keratosis?

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

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

    Bacterial vaginosis

  • What diagnosis is most likely in an IV drug user with a new heart murmur and fever?

    Endocarditis

  • What is the most common fracture in children?

    Clavicle

  • Which nerve root is responsible for the knee jerk reflex?

    L3-L4

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

    Lateral C-spine = epiglottitis, abdominal = intestinal ischemia

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

    Listeria

  • What is the most common cause of hypoparathyroid?

    Post thyroidectomy with the complication of parathyroidectomy.

  • Hyperpigmented velvety plaques should make you think of what diagnosis?

    Acanthosis nigricans

  • What oral antibiotic can be used for pseudomonas?

    Ciprofloxacin

  • What is the treatment for ovarian cancer?

    Total hysterectomy and bilateral salpingo-oophorectomy. Chemo + radiation.

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

    Only the physis (growth plate).

  • List four risk factors for breast cancer?

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

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

    10mm

  • Clicking or locking of the knee indicates what diagnosis?

    Meniscal tear

  • Purulent cervical discharge should make you think of what diagnosis?

    Neisseria gonorrhoeae

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

    Guttate psoriasis

  • Hyperresonance to percussion should make you think of what diagnosis?

    Emphysema, pneumothorax, asthma

  • What is the term for eyelids that turn out?

    Ectropion

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

    The bundle of Kent

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

    Small cell lung cancer, pancreatic islet cells, thymomas

  • Which is more likely to pass into the scrotum, a direct or indirect hernia?

    Indirect

  • Rope-like breast mass should make you think of what diagnosis?

    Fibrocystic breast mass

  • List four diagnostic criteria for diabetes?

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

  • What time frame are we talking about for chronic sinusitis?

    >3 months

  • What is Schilling's test used for?

    Test for the cause of a B12 deficiency.

  • What are the main side effects of isoniazid?

    Hepatitis and peripheral neuropathy

  • What is the most common preceding event for orbital cellulitis?

    URI

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

    Colles fracture

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

    Atropine

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

    Osteosarcoma

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

    Normocytic

  • How do you treat a sickle cell crisis?

    Fluids, oxygen, pain medication, transfusion may be necessary

  • List one major risk factor for bladder cancer?

    Smoking

  • What is the initial treatment for active TB?

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

  • How is the first day of the menstrual cycle defined?

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

  • A lacey pink rash should make you think of what diagnosis?

    Erythema infectiosum aka fifth disease aka slapped cheek

  • List the two cluster C personality disorders.

    Sad avoidant and obsessive compulsive

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

    Enlarged prostate, hard nodules within the prostate

  • What is the average age of menopause?

    51

  • Describe Kernig's sign.

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

  • Define missed abortion.

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

  • Describe erythema marginatum.

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

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

    80%, 20%

  • What is necessary to diagnose a patient with bipolar 1?

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

  • What is the mean age for ovarian cancer?

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

  • Name one aldosterone antagonist.

    Spironolactone, eplerenone

  • What is the most common way of testing for metamorphopsia?

    Amsler grid

  • During what portion of the menstrual cycle does PMS occur?

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

  • What medication class does metformin (Glucophage) fall into?

    Biguanide

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

    Clindamycin and gentamicin together

  • What disease does Rickettsia rickettsii cause?

    Rocky Mountain spotted fever

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

    older than 55, WBC>16, glucose>200, LDH>350, AST>250

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

    Nephrotoxicity, ototoxicity and Stevens-Johnson syndrome

  • A positive Hawkins test indicates what diagnosis?

    Rotator cuff impingement

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

    Breast, liver and colon

  • What is the most common pituitary adenoma?

    Prolactinoma

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

    Previous or ongoing hepatitis B infection

  • Describe Grey-Turner's sign.

    Flank ecchymosis often related to pancreatitis

  • What is the best test for diagnosing CHF?

    Echo

  • List three drugs that treat cluster headaches.

    Oxygen, sumatriptan, Stadol (butorphanol)

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

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

  • List three medications which may be used for pharmacological stress test.

    Adenosine, dobutamine, dipyridamole and Persantine

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

    8

  • What is appropriate treatment for central vein occlusion?

    Typically self limited. Treat underlying disease.

  • What is the medical term for tennis elbow?

    Lateral epicondylitis

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

    Mastitis is not a reason to stop breast feeding, but an abscess is.

  • What is the definitive treatment for cardiac tamponade?

    Pericardiocentesis

  • Define full term.

    Delivery at 37-42 weeks

  • What is the most common cause of hypopituitarism?

    Tumor

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

    Pericarditis, pericardial effusion and an obstructive lung issue

  • What is the generic name for Prozac?

    Fluoxetine

  • What is the drug of choice for toxoplasmosis?

    Bactrim

  • What is Tietze syndrome?

    Costochondritis

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

    Tachycardia >100, bradycardia <60

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

    Vitiligo

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

    Linear opacities at the bases with pleural plaques

  • What medication is clearly contraindicated in anorexia and bulimia?

    Bupropion (Wellbutrin) because it can increase risk of seizures.

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

    Doxycicline

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

    Tularemia

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

    Primary sclerosing cholangitis

  • What type of behavioral therapy works best for borderline patients?

    Dialectical behavior therapy

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

    One major depressive episode and one hypomanic episode

  • A slit lamp shows Kayser-Fleischer rings. What is the most likely diagnosis?

    Wilson's disease

  • What is the treatment for epididymitis?

    Ceftriaxone and doxycycline

  • What is the most common cause of acute bacterial cholangitis?

    Choledocholithiasis

  • A positive McMurry indicates what diagnosis?

    Meniscal tear

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

    Pyloric stenosis

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

    Often a thin female

  • What is the most common bladder cancer?

    Transitional cell cancer

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

    Anemia of chronic disease

  • List two risk factors for an aortic dissection?

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

  • What organism is the most common sexually transmitted infection?

    Chlamydia

  • List three medications used to "treat" multiple sclerosis?

    Steroids, interferon beta, copolymer 1

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

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

  • A positive Phalen and Tinel's sign indicates what diagnosis?

    Carpal tunnel

  • Describe how to perform the obturator sign.

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

  • Define paradoxical pulse.

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

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

    Statins

  • What is the best test to diagnose an aortic dissection?

    CT

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

    Ischemia

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

    Strep

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

    Hyperparathyroid

  • What is the first line antibiotic treatment for cystitis?

    Bactrim

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

    Impetigo

  • Will a spermatocele transillumnate?

    Yes

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

    Orbital cellulitis

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

    Both

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

    Cystoscopy and biopsy

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

    Gram (-)

  • What is the most common cause of lower GI bleed?

    Diverticulosis

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

    Hyperkalemia

  • A boot-shaped heart on CXR should make you think of what diagnosis?

    Tetralogy of Fallot

  • How do you treat dyshidrosis?

    Topical steroids

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

    Haloperidol

  • A spiral fracture should make you think of what issue?

    Abuse, either child or elder

  • What is the treatment for subconjunctival hemorrhage?

    Reassurance

  • A beta natriuretic peptide below what level rules out CHF?

    < 100

  • Which four human papillomaviruses are linked to cervical cancer?

    HPV 16, 18, 31 and 33

  • Large doughy hands should make you think of what diagnosis?

    Gigantism

  • How do you treat vaginal candida?

    Fluconazole po 1 dose or azole cream x 1 week

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

    Squamous cell lung cancer

  • A patient has very strange magical thinking. What is the most likely diagnosis?

    Schizotypal personality disorder

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

    Motor vehicle accidents

  • What are the two most common causes of pancreatitis?

    Cholelithiasis and ETOH

  • Why should actinic keratosis be treated?

    It may progress to squamous cell carcinoma.

  • An older patient presents with pneumonia and diarrhea. What is the most likely diagnosis?

    Legionella pneumonia

  • German measles is also known as what disease?

    Rubella

  • Which cardiac medication has gynecomastia in its side effect profile?

    Spironolactone

  • Which is the most commonly herniated vertebral disc?

    L4-L5 followed by L5-S1

  • What antibiotic is most likely to cause C. diff?

    Clindamycin

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

    An increase, reticulocytes are newly released "baby" RBC's

  • At what age should an infant begin cooing?

    2 months

  • Atypical or walking pneumonia is caused by what pathogen?

    mycoplasma

  • By what age should a child be able to walk?

    12 months

  • How do statins work to affect the lipid profile?

    They slow the rate limiting step of cholesterol synthesis.

  • What is the treatment for botulism?

    Antitoxin

  • Vasculitis with a hepatits B history should make you think of what diagnosis?

    Polyarteritis nodosa

  • What is Russell's sign?

    Abraded knuckles from forcing oneself to vomit.

  • What is the more popular term for Stein-Leventhal syndrome?

    Polycystic ovarian syndrome

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

    2nd right intercostal space

  • List the three cluster A personality disorders.

    Mad schizoid, schizotypal and paranoid

  • What type of organism is tetanus?

    A Gram + rod, Clostridium tetani

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

    beta-HCG, TSH, Prolactin

  • How do you treat bacterial vaginosis?

    Metronidazole x 7 days

  • Where is the epididymis found?

    It is found at the posterior upper pole.

  • List three risk factors for an ectopic pregnancy.

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

  • A gastrinoma is also known as what syndrome?

    Zollinger-Ellison syndrome

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

    Chlamydia and mycoplasma

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

    Treponema pallidum

  • What is the imaging modality of choice for pancreatitis?

    CT

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

    Scarlet fever

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

    Decreased

  • Stocking glove should make you think of what diagnosis?

    Diabetic neuropathy and B12 deficiency neuropathy

  • Posttussive rales should make you think of what diagnosis?

    TB

  • What does Kiesselbach's plexus refer to?

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

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

    Globus

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

    Neisseria

  • Caseating granulomas should make you think of what diagnosis?

    TB

  • How do you definitively diagnose endometriosis?

    Exploratory laparoscopy

  • What is the best imaging to rule out testicular torsion?

    Doppler U/S for decreased blood flow to the testes

  • How long does a panic attack typically last?

    10-20 minutes

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

    Parkinson's disease

  • Is metformin indicated or contraindicated in renal failure?

    Contraindicated

  • A pathologic S3 is most commonly associated with what diagnosis?

    CHF

  • Pitting nails are associated with what dermatologic disorder?

    Psoriasis

  • Gestational diabetes puts mom and baby at increased risk of for what three things?

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

  • What is the first line medical treatment for a pheochromocytoma?

    Alpha blocker. You should never use a pure beta blocker.

  • What ethnic background is at an increased risk of fibroids?

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

  • Are fibrocystic breast masses usually bilateral or unilateral?

    Bilateral

  • How do you treat a patient with respiratory syncytial virus?

    Albuterol, steroids and fluids

  • What tumor marker can be used to follow pancreatic cancer?

    CA-19-9

  • What is the most common type of ovarian cyst?

    Functional cyst - no treatment necessary.

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

    Biopsy of the temporal artery

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

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

  • What is the main function of parathyroid hormone?

    Increase serum Ca

  • What is the most common location for a pancreatic tumor?

    75% occur in the head of the pancreas.

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

    Widened mediastinum

  • Auer rods are most commonly associated with what disease?

    Acute myeloid leukemia

  • How do you treat allergic rhinitis?

    Intranasal corticosteroid and antihistamines

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

    Macrolides

  • What is the most common type of kidney stone?

    Calcium makes up 85% of kidney stones.

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

    40-60 beats per minute

  • What is Sheehan's syndrome?

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

  • The EKG shows irregularly irregular narrow QRS waves. What diagnosis should you be thinking of?

    Atrial fibrillation

  • About how much weight should a woman gain during pregnancy?

    20-35 lbs

  • What is the first line antibiotic for prostatitis?

    Bactrim 4-6 weeks

  • What is the most common congenital heart disease?

    Ventricular septal defect

  • What is the classic triad of pre-eclampsia?

    HTN, edema and proteinuria

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

    Duodenum

  • What is the most common primary intracranial neoplasm?

    Glioma

  • What type of hearing loss is associated with aging?

    Sensory

  • Give two classes of drug therapy for treating Parkinson's.

    Dopaminergic (levodopa), anticholinergics are second line

  • What is the least aggressive thyroid cancer?

    Papillary

  • Where is disease of the pulmonary valve best heard?

    2nd left intercostal space

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

    Asthma

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

    Below, internal hemorrhoids are not painful.

  • List two macrolides.

    Erythromycin, azithromycin, clarithromycin

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

    30

  • What are the first three steps of managing pancreatitis?

    NPO, pain control, fluids

  • Rhinophyma should make you think of what diagnosis?

    Acne rosacea

  • Define abortion.

    Delivery of uterine contents before 20 weeks.

  • What type of incontinence is often associated with BPH?

    Overflow incontinence, the bladder cannot empty sufficiently

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

    Elevated LDL

  • You notice a bowing of the iris on exam. What is the most likely diagnosis?

    Glaucoma

  • What is the best imaging study for acute appendicitis?

    CT

  • What is Graves' disease?

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

  • Acute endocarditis is most commonly caused by what organism?

    Staph aureus

  • What disease is defined as an immunologic response to gluten?

    Celiac

  • Name a common cause of a junctional rhythm.

    Digitoxin toxicity

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

    Coarctation of the aorta

  • Pertussis is most commonly treated with what antibiotic?

    Erythromycin

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

    Nephrotic syndrome

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

    Tetralogy of Fallot

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

    Tetralogy of Fallot

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

    Endometrioma

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

    One year

  • What medium do you need to grow out Neisseria gonorrhoeae?

    Thayer-Martin

  • What is the treatment for giant cell arteritis?

    High dose prednisone

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

    <150

  • Will the retic count be elevated, decreased or normal in a B12 deficient anemia?

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

  • Is surgery curative for Crohn's or ulcerative colitis?

    Ulcerative colitis

  • What organism has been linked to reactive arthritis?

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

  • A blockage of which artery causes an anterior wall MI?

    Left anterior descending artery

  • What two antibiotics are used for empiric treatment of endocarditis?

    Vancomycin and ceftriaxone together are first line empiric treatment

  • Give two major risk factors for erectile dysfunction

    Diabetes, hypertension, depression, coronary artery disease

  • A fundal exam shows a cherry-red spot. What diagnosis should you be thinking of?

    Central retinal artery occlusion

  • Colorectal cancer patients are almost all older than what age?

    90% of patients are older than 50.

  • What causes anorexic patients to have osteopenia?

    A decrease in estrogen

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

    6 months

  • Define metrorrhagia.

    Bleeding between menstrual cycles.

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

    Beta blocker (propranolol), primidone

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

    >7.5

  • What is the normal level of serum bicarbonate (HCO3)?

    24 mEq/Liter

  • What is the therapeutic range for INR following a mechanical valve replacement?

    2.5-3.5

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

    Pernicious anemia

  • Which EKG leads are used to diagnose an anterolateral MI?

    V5 and V6

  • On palpation, what size is normal for the aorta?

    Less than 3 cm Atrial septal defect

  • Give the time frame for preterm labor.

    20-37 weeks

  • What is pica?

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

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

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

  • List two common offending agents for pill induced esophagitis?

    NSAIDS, KCl, iron, antibiotics

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

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

  • What is the most common cause of bronchiectasis?

    Cystic Fibrosis

  • What does trismus mean?

    Lock jaw, often secondary to tetanus

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

    5mm

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

    Placenta previa

  • What treatment should be started for asymptomatic diverticulosis?

    None

  • What hereditary pattern does polycystic kidney disease follow?

    Autosomal dominant

  • What is the most common cause of secondary amenorrhea?

    Pregnancy

  • What is the most common location for an anal fissure?

    Posterior midline

  • What endocrine issue is associated with PCOS?

    Insulin insensitivity

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

    Pyloric stenosis

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

    Recovery from infection or immunization to hepatitis B

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

    Auditory - hearing voices

  • Painless hematuria should make you think of what diagnosis?

    Bladder cancer

  • Pica is often related to what type of anemia?

    Iron deficiency anemia

  • Will epididymitis feel better with scrotal elevation?

    Yes

  • What does koilonychia refer to?

    Spoon-shaped nails. This may be found in microcytic anemia.

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

    Prehn's sign

  • Name two fibric acid derivatives.

    Fenofibrate and gemfibrozil

  • What is the most common organism responsible for prostatitis?

    E. coli

  • What is the most common type of testicular cancer?

    Nonseminoma

  • What are three ways you can check for ruptured membranes?

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

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

    TB, Lung cancer

  • Define procidentia.

    Uterine prolapse beyond the introitus

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

    Pilonidal disease

  • List two causes of right atrial enlargement?

    Pulmonary HTN, severe lung disease, pulmonary valve stenosis

  • How much time needs to pass before diagnosing secondary amenorrhea?

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

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

    Teratoma

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

    ERCP

  • What is the suffix used for most fluoroquinolones?

    Oxacin

  • There are vaccines for which two versions of hepatitis?

    Hepatitis A and hepatitis B

  • A prostate biopsy consists of how many samples?

    6 to 12

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

    Fluid and fiber

  • List the five major Jones criteria for diagnosing rheumatic fever.

    Polyarthritis, carditis, subcuticular nodes, erythema marginatum, chorea

  • How do you definitively diagnose rabies?

    Pathology of the brain of the animal that performed the bite using fluorescent antibody stain.

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

    Less than 5 mm

  • Why can't you give fluoroquinolones to kids?

    They can cause cartilage development problems.

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

    Xanthelasma

  • What is the best test to diagnose malaria?

    Peripheral blood smear

  • Diabetes insipidus is caused by a deficiency of which hormone?

    Vasopressin

  • Why aren't fluoroquinolones used more frequently?

    They have lots of side effects.

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

    At the left second or third interspace

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

    Dry cough

  • Is glaucoma more prevalent in males or females?

    Females 3:1

  • What is the most common knee injury?

    Medial meniscal tear

  • What is the management of a patient in supraventricular tachycardia?

    Vagal maneuvers, carotid massage, adenosine

  • What is the normal range of fetal heart rate?

    120-160

  • What is the first line treatment for orbital cellulitis?

    IV antibiotics, followed by 2 weeks of oral antibiotics

  • What is Trousseau's sign?

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

  • Define orthostatic hypotension.

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

  • What is the current drug of choice for treating MRSA?

    Vancomycin

  • Which reproductive cancer carries the highest rates of death in women?

    Ovarian cancer

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

    Beta thalassemia

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

    Colposcopy and biopsy

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

    Bilateral atelectasis or ground glass appearance

  • Transudative pleural effusions should make you think of what diagnosis?

    Congestive heart failure

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

    Dopamine

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

    On the head and neck

  • What is Charcot's triad?

    RUQ pain, fever, jaundice

  • What is the current drug of choice for the cytomegalovirus?

    Ganciclovir

  • What is the most common location of colorectal cancer?

    Cecum about 38%

  • Is Huntington's autosomal dominant or recessive?

    Dominant

  • How does nicotinic acid work to affect the lipid profile?

    It inhibits secretion of VLDL.

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

    Polymyositis

  • How do glitazones work?

    They improve insulin sensitivity.

  • What are three possible treatments for peritonsillar abscess?

    Needle aspiration, I&D and tonsillectomy

  • How do sulfonylureas work?

    They stimulate the production of insulin.

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

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

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

    Lithium

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

    Doxycycline

  • What is the first step in treating GERD?

    Lifestyle modification

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

    Gram (-)

  • How do you treat lichen simplex chronicus?

    Get the patient to stop scratching it.

  • Where is a Pancoast tumor found on CXR?

    At the apex of either the right or left lung

  • What is the gold standard for diagnosis of a pleural effusion?

    Thoracocentesis

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

    Patient will report the sound louder in the affected ear.

  • Exophthalmos should make you think of what diagnosis?

    Hyperthyroidism

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

    Macrocytes

  • Which herpesvirus causes Epstein–Barr?

    Herpes 4

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

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

  • Are most pulmonary valve problems congenital or acquired?

    95% are congenital

  • List three possible causes of prerenal renal failure.

    CHF, severe dehydration, hemorrhage

  • How do you test for color blindness?

    Ishihara plates

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

    Chloroquine

  • Are ulcers from venous insufficiency painful or painless?

    Painless

  • What occupations are associated with berylliosis?

    Aerospace and nuclear plant workers

  • Postmenopausal bleeding is immediately believed to be what diagnosis?

    Endometrial cancer until proven otherwise.

  • What are the most common primary cancer sites that metastasize to the brain?

    Lung, breast and kidney

  • List the three most commonly used medical treatments for COPD?

    Oxygen, ipratropium and albuterol

  • What area of the prostate is affected by BPH?

    The transitional zone

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

    Neisseria gonorrhoeae

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

    Complex partial seizure

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

    24 hour free cortisol urine test and dexamethasone suppression test

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

    Myasthenia gravis

  • Are the lungs noisy or quiet in COPD?

    Quiet

  • How do you define 1st degree AV block?

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

  • A patient presents with a staccato cough but no fever. What is the most likely diagnosis?

    Chlamydia pneumoniae

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

    Sweat chloride test

  • Unilateral purulent rhinitis should make you think of what diagnosis?

    Foreign body

  • Define the second stage of labor.

    Fully dilated to delivery

  • Most gallstones are made of what substance?

    Cholesterol

  • What is the most common congenital heart defect?

    Ventricular septal defect

  • What is Chvostek's sign?

    Tap on facial nerve and get a twitch with low Ca.

  • List four complications of untreated strep throat.

    Scarlet fever, glomerulonephritis, rheumatic fever and local abscess

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

    Cryptococcosis

  • What is the first line treatment for a varicocele?

    Watchful waiting unless there is a question of fertility.

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

    18.5-24.9

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

    Magnesium sulfate

  • What lab test is the gold standard for chlamydia?

    Nucleic acid amplification test

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

    Iron deficiency

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

    Asthma, COPD, Bronchitis

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

    Encapsulated organisms most commonly Strep pneumoniae and H. Flu.

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

    Pancreatitis

  • What carpal bone has a high rate of nonunion and occult fracture?

    Scaphoid

  • The follicular phase of menstruation is dominated by what hormone?

    Estrogen

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

    Emphysema

  • Define complete abortion.

    Vaginal bleeding, cervix open, products of conception have passed

  • Which is the most commonly affected sinus in acute sinusitis?

    Maxillary

  • What is the most common cause of peptic ulcer disease?

    H. pylori

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

    Agoraphobia

  • Define pulsus alternans.

    EKG waveform changes from beat to beat

  • A bamboo spine indicates what diagnosis?

    Ankylosing spondylitis

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

    Pancreatitis

  • What is the most likely quadrant for a retinal detachment?

    Superior temporal

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

    4 months

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

    Thiazide diuretic

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

    Hemorrhoids

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

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

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

    Measles/Rubeola

  • List three catastrophic complications of a myocardial infarction.

    Papillary muscle rupture, myocardial wall rupture and left ventricular aneurysm

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

    Respiratory syncytial virus (RSV)

  • List two risk factors for cervical cancer.

    Multiple sexual partners, smoking

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

    Herpes

  • What is the most important complication of giant cell arteritis?

    Blindness

  • What heparin complication is relevant to endocrinology?

    Adrenal infarct leading to a Cushing's syndrome

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

    Hyperopia, convex

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

    12 months

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

    Oral leukoplakia

  • Projectile vomiting should make you think of what diagnosis?

    Pyloric stenosis

  • Pretibial myxedema should make you think of what diagnosis?

    Graves' disease

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

    Every 5 years looking for signs of gastric carcinoma.

  • What is first line treatment for rosacea?

    Metronidazole, tetracycline is probably a close second.

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

    Sweat chloride test

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

    Ruptured cerebral aneurysm

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

    Diverticulitis

  • What are the two important peices of patient education for anyone diagnosed with mononucleosis?

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

  • What type of organism causes botulism?

    A Gram + rod, Clostridium botulinum

  • What is the defining symptom of Alzheimer's?

    Progressive memory impairment

  • What is the time frame for the first symptoms of withdrawal from alcohol?

    Tremor in 8-18 hrs

  • Define the first stage of labor.

    Onset of contractions to full dilation of the cervix.

  • What is another term for podagra?

    Gout

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

    It is most likely a septal defect.

  • How do hookworm larvae enter the body?

    They penetrate the skin usually through the soles of the feet.

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

    Beta blockers (Blocks receptors for bronchodilators)

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

    24 hours

  • What age range is the HPV vaccination recommended for?

    9 to 26 years old

  • What is the most common place for an aortic aneurysm?

    In the abdomen and below the renal arteries

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

    Intestinal ischemia

  • What is the most common site of an ectopic pregnancy?

    Within a fallopian tube

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

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

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

    Wolff-Parkinson-White syndrome

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

    Hypospadias and in far fewer cases epispadias

  • Should diverticulitis always be admitted?

    No, mild cases can be treated as outpatients with rest and clear fluids.

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

    Strep pneumonia

  • What are two things that an anal fissure off midline might suggest?

    Crohn's, syphilis, HIV, neoplasm

  • What symptom is associated with a classic migraine?

    Having an aura

  • What are the three inferior leads?

    II, III and aVF

  • List the components of Virchow's triad.

    Stasis, vascular injury, hypercoagulability

  • What fracture is the #1 cause of compartment syndrome?

    Tibial shaft fracture

  • What two lung cancers are typically found peripherally on CXR?

    Adenocarcinoma and Large cell

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

    Thrill

  • At what age should vaccinations for pneumococcal pneumonia begin?

    65 years old

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

    Cytomegalovirus (CMV)

  • What is the key indicator for the prognosis of melanoma?

    Thickness of the lesion

  • Rheumatic fever most commonly affects which valve?

    The mitral valve

  • Rhonci or wheezes that clear after coughing suggest what diagnosis?

    Bronchitis or atelectasis

  • Define incomplete abortion.

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

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

    Tertiary syphilis

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

    Nummular eczema

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

    2nd intercostal space at the midclavicular line

  • What is the treatment for melanoma?

    Wide local excision

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

    Hypothalamic pituitary insufficiency

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

    18 months

  • Rice water stool should make you think of what diagnosis?

    Cholera

  • Give two risk factors for glaucoma.

    African American descent and diabetes

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

    Metronidazole (Flagyl)

  • Calf pain should always make you think of what diagnosis?

    DVT

  • What is the first line antibiotic for otitis media?

    Amoxicillin

  • Both testicles should be descended by what age?

    3 months

  • What four chromosomes have been linked to dementia?

    1,141,921

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

    Pencillin

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

    Ovarian cancer

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

    Thiazolidinediones also known as glitazones

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

    Refer & position patient with head down

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

    Angiotensin receptor blocker (ARBs)

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

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

  • How do you treat polymyalgia rheumatica?

    Low dose prednisone

  • Is FSH high or low in Turner's syndrome?

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

  • Does niacin increase or decrease HDL?

    Increase

  • How do you administer the Rinne hearing test?

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

  • A positive Apley indicates what diagnosis?

    Meniscal tear

  • Name two things that would constitute a positive stress test.

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

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

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

  • A noncaseating granuloma should make you think of what diagnosis?

    Sarcoidosis

  • What are four steps in treating diphtheria?

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

  • Crohn's is found where in the GI tract?

    It can be from esophagus to anus.

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

    Progesterone

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

    Candida diaper rash

  • What is the most common cause of secondary hypertension?

    Chronic kidney disease

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

    Pyelonephritis

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

    Amoxicillin

  • What does HBsAg (hep B surface antigen) indicate?

    Active Hep B infection

  • Give two contraindications for using an ACEI.

    Bilateral renal artery stenosis, history of angioedema, pregnancy

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

    Otitis externa

  • Are hallucinations normal during a normal grieving period?

    Yes, as long as they are not persistent or intrusive.

  • What is a first line treatment for rheumatoid arthritis?

    Methotrexate

  • List three class 1a antiarrhythmics.

    Disopyramide, quinidine, procainamide

  • Does adenocarcinoma arise from the proximal or distal esophagus?

    Distal

  • List four indications for the flu vaccine.

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

  • What medication is used as prophylaxis for meningococcal meningits?

    Rifampin

  • What test do you do for Sjogren's syndrome?

    Schirmer test

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

    Varicocele

  • What drug do you use to treat pinworm?

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

  • What is the most specific imaging modality for diagnosing kidney stones?

    CT

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

    Shigella

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

    Tetralogy of Fallot

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

    Macrocytes

  • What is the treatment for epiglottitis?

    2nd or 3rd generation cephalosporins (ceftriaxone), macrolides may also be used (clindamycin)

  • JNC 8 BP parameters: >60yr

    *Treat to 150/90 for >60yrs

  • JNC 8 BP parameters: <60yr

    *Treat to 140/90 for everyone else (including those with CKD, DM)

  • JNC 8 Antihypertensive Recommendations

    *4 equal drug classes: Thiazides, ACE, ARB, CCB (for non-black) - may start with any of the four to treat HTN

  • JNC 8 Antihypertensive Recommendations African A

    *Thiazides, CCB (black persons)

  • JNC 8 Antihypertensive Recommendations: CKD

    *>/= 18yrs with CKD should be on an ACE or ARB

  • Recommendation #1

    For the general population (those without CKD) >/= 60yrs, initiate medication at >/= 150 SBP, >/= 90 DBP and treat to < 150/<90

  • Recommendation #2

    For the general population </=60yrs initiate medication at DBP >/= 90 to achieve < 90

  • Recommendation #3

    For the general population </=60yrs initiate medication at SBP >/= 140 to achieve <140

  • Recommendation #4 (CKD) and #5 (DM)

    For the general population >/= 18yrs with CKD or DM initiate medication at SBP >/= 140, DBP >/= 90 and treat to <140/<90

  • Recommendation #6

    General non-black population including those with DM, initial medication should include: thiazide, CCB, ACE, ARB

  • Recommendation #7

    General black population including those with DM initial medication should include: thiazide or CCB

  • Recommendation #8

    All persons >/= 18yrs regardless of race or DM status with CKD medication should include: ACE or ARB to improve renal outcomes

  • Recommendation #9

    If goal not reached within 1 month of initiating treatment, increase dose of initial drug or add another. If can't reach goal with 2 drugs, add another. *Do not use ACE and ARB together*

  • JNC 8 Options for titrating A:

    A) Start 1st drug, titrate to max then; add 2nd drug and titrate to max then; add 3rd drug and titrate to max

  • JNC 8 Options for titrating B:

    B) Start 1st drug, add 2nd drug before reaching max

  • JNC 8 Options for titrating C:

    C) Begin with 2 drugs at same time either as 2 separate pills or as a single combo drug pill