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Terms in this set (1137)
Define orthostatic hypotension.
A drop in systolic BP of >20 mmhg when standing up.
What three things are in your differential if you have a paradoxical pulse?
Cardiac tamponade, pericarditis, and obstructive lung disease.
On palpation, what size is normal for the aorta?
Less than 3 cm
A fixed or consistent split S2 should make you think of what diagnosis?
Atrial septal defect
A pathologic S3 is most commonly associated with what diagnosis?
If you hear a midsystolic click you should immediately be thinking about what diagnosis?
Mitral valve prolapse
An opening snap on auscultation of the heart should make you think of what diagnosis?
It is most likely a mitral stenosis
You hear a continuous machine like murmur. What is the most likely diagnosis?
Patent ductus arteriousus
List three medications which may be used for pharmacological stress test
Adenosine, dobutamine, dipyridamole, and persantine
What is the gold standard for diagnosing coronary artery disease?
Define stage 1 hypertension according to JNC 7
Systolic pressure of 140-159 and diastolic of 90-99
What is the treatment goal for a diabetic with hypertension
What is the most common cause of secondary hypertension
Chronic kidney disease
No matter what medications you use you are having trouble keeping a patients BP under control. You also notice hyperpigmentation of skin and truncal obesity. What is the most likely diagnosis?
List three signs or symptoms which will likely be included in a description of a patient with a pheochromocytoma
Thin, diaphoretic, tachycardic, agitated, and hypertensive
You have a patient with a diagnosis of pheochromocytoma. While waiting for surgery should you use an alpha blocker or a beta blocker?
Alpha blocker. You should never use a pure beta blocker
According to the CDC what is the range for a normal BMI?
After a thiazide diuretic what medication should you start in a hypertensive patient who also has diabetes?
An ACEI or an ARB
Following an MI what medication should you use to treat hypertension?
What is the most common cause of CHF?
Coronary artery disease
What ejection fraction is typical for a patient with CHF?
Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis?
A BNP below what level rules out CHF?
What is the therapeutic range for INR following a MECHANICAL valve replacement?
What is the first line IV inotropic agent when dealing with cardiogenic shock?
List two diagnoses which require antibiotic prophylaxis for "dirty" procedures?
Prosthetic valve, valve repair with any prosthetic material, prior endocarditis, congenital cyanotic heart defect.
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.
What are the three major criteria for endocarditis?
2 Positive blood cultures
a positive TEE
Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?
List the 4 minor criteria for diagnosing endocarditis.
1 positive blood culture.
What are the 5 components of Tetralogy of Fallot?
Ventricular septal defect
right ventricular hypertrophy
right ventricular outflow obstruction (pulmonary valve stenosis)
right sided aortic arch.
What is the gold standard for diagnosing myocarditis?
Where do most aortic dissections occur?
Ascending or descending thoracic aorta
A patient complains of severe pleuritic chest pain that is worse when leaning forward. What is the most likely diagnosis?
What is the name of the syndrome that involves pericarditis several days after an MI?
A patient presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all of the leads. What is the most likely diagnosis?
Define paradoxical pulse
There is a large difference in pulse pressure between inhalation and exhalation
Define pulsus alternans
EKG waveform changes from beat to beat
On physical exam you hear a harsh systolic murmur along the right sternal border. What is the most likely diagnosis?
A wide pulse pressure witha blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what diagnosis?
What is the best location to hear problems with the aortic valve?
2nd right intercostal space
Where is disease of the pulmonary valve best heard?
2nd left intercostal spacce
What two antibiotics are used for empiric treatment of endocarditis?
Vancomycin and ceftriaxone together are first line.
What two valvular issues do patients with Marfan's syndrome often have?
Aortic regurgitation and mitral valve prolapse
What are the two main causes of aortic stenosis?
Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease.
An elderly patient presents with dyspnea, angina, and syncope on exertion. The EKG is normal. What is the most likely diganosis?
You suspect mitral regurgitation. What is the most acurate way to prove your diagnosis?
A patient with mitral valve prolapse will often have what physical characteristics?
What is the best patient position to hear aortic regurge and aortic stenosis?
Sitting up and leaning forward.
What is Tietze syndrome?
Are most pulmonary valve problems congenital or acquired?
95% are congenital
What is the therapeutic range for INR following an ORGANIC valve replacement?
In a patient with aortic stenosis, will the PMI be medially displaced, normal, or laterallly displaced?
It will be laterally displaced due to left ventricular hypertrophy.
A patient complains of severe crushing chest pain. EKG shows ST segment elevations. All labs including troponins and CK-MB are negative. What is the most likely diagnosis?
A question about Prinzmetal's angina will often contain what key thing in the patient's history?
Name at least two things that would constitute a postitive stress test.
A drop in BP, a new arrhythmia, an increase in angina symptoms, ST depressions.
Are ulcers form venous insufficiency painful or painless?
Where is disease of the mitral valve best heard?
At the apex
Clot busting drugs should be used within 3 hours of which two cardiac events?
STEMI and new left bundle branch block
List three catastrophic complications of an MI.
Papillary muscle rupture
myocardial wall rupture
left ventricular aneurysm
An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely diagnosis?
What is the most common cause of sudden death?
List at least three congenital heart diseases.
Atrial septal defect
ventricular septal defect
coarctication of the aorta
patent ductus arteriosus
tetralogy of Fallot
What is the most common cause of an atrial septal defect?
Patent foramen ovale
Where on your pateint should you listen for the murmur associated with an atrial septal defect?
At the left second or third interspace
A CXR shows a "3" sign with notching of the ribs. What is the most likely diagnosis?
Coarctication of the aorta
What is the appropriate treatement for a patent ductus arteriosus?
A Blalock procedure is used to correct what congenital heart condition?
Tetralogy of Fallot
You hear a loud, harsh pulmonary murmur along the left sternal border. What is the most likely diagnosis?
Ventral septal defect
What is the most common place for an aortic aneurysm?
In the abdomen and below the renal arteries.
Who is more likely to have an aortic aneurysm males or females?
Males are 8 times as likely
The accessory pathway known as the James bundle should make you think of what syndrome?
What imaging needs to be done before taking a patient to the OR with an aortic aneurysm?
List two risk factors for an aortic dissection.
bicuspid aortic valve
What will a CXR show for a patient with an aortic dissection?
You have a patient with pulsus paradoxus. What two diagnoses should you be thinking of?
obstructive lung issues.
A patient complains of pain in his legs when he walks. It goes away after sitting. What term comes to mind for this syndrome? What diagnosis is it associated with?
Intermittent claudication. Peripheral arterial disease
Giant cell arteritis is associated with what other disease?
What is the accessory pathway associated with Wolff-Parkinson-White syndrome?
The bundle of Kent
A biphasic P wave should make you think of what diagnosis?
Left atrial enlargement
What is the treatment for giant cell arteritis?
High dose prednisone
List the components of Virchow's triad.
Where is disease of the tricuspid valve best heard?
Along the left lower sternal border
Give two contraindications for using an ACEI
Bilateral renal artery stenosis
history of angioedema
What class of cardiac medications should be avoided in patients with asthma?
An RSR prime in leads V1 or V2 should make you think of what diagnosis?
Right bundle branch block
What lab should be tightly monitored in a patient taking an aldosterone antagonist?
Potassium, they may have hyperkalemia
What is the best test for diagnosing CHF?
Which cardiac medication is used to help with cardiac contractility after you have optimized most of the other cardiac medications?
A blockage of which artery causes an anterior wall MI?
Left anterior descending artery
What lab result will increase the risk of digoxin toxicity?
Hypokalemia or hypercalcemia
A patient presents to the ER with acute CHF. What drug class will likely be the first choice?
A patient has a GFR of 25 and HTN. Which class should you use, loop or thiazide diuretic?
A LOOP will work no matter how low the GFR is. Thiazides will only work with a GFR over 30.
Which EKG leads are used to diagnose an anterior wall MI?
V1, V2, and V3
Do loop diuretics cause hyperkalemia or hypokalemia?
Statins are the drug of choice to treat what type of dyslipidemia.
A patient recently started taking Lipitor. He is now complaining of aches and pains. What test should you order?
Serum creatinine kinase, you're looking for rhabdo
Which hyperlipidemia medication may cause flushing?
Name three medication "classes" which are indicated for reduction in LDL?
Name two fibric acid derivatives
Fenofibrate and gemfibrozil
List three class 1 antiarrhythmics
Disopyramide, quinidine, procainamide
German measles is also known as what disease?
Bruises may be purple, green, yellow, and brown. How may days old is a yellow bruise?
Purple 1-5 days
Green 5-7 days
Yellow 7-10 days
Brown 10-14 days
Pain with movement of the pinna or tragus should make you think of what diagnosis?
What is the first line treatment for pertussis?
By what age should a child be able to hold up her head?
A Salter-Harris type I fracture affects what area of the bone?
Only the physis (growth plate)
By what age should a child be able to sit up?
An overweight 15 year old boy with a limp presents to your office complaining of knee pain. There is no history of trauma. What is the most likely diagnosis?
Slipped capital femoral epiphysis (scfe)
A premature infant with hyaline membrane disease will have what apperance on CXR?
Bilateral atelectasis or ground glass appearance
Atypical or walking pneumonia is caused by what pathogen?
What antibiotic is the first liine treatment for mycoplasma pneumonia?
A macrolide (azithromycin or erythromicin)
A patient is having seizures along with a mouse-like odor from the urine. What is the most likely diagnosis?
A description of a dew drop on a rose petal should make you think of what diagnosis?
Pale and boggy nasal mucosa should make you think of what diagnosis?
List the five major Jones criteria for diagnosing rheumatic fever.
3) subcuticular nodes
4) erythema marginatum
Describe erythema marginatum
Pink rings of the trunk and inner surfaces of the limbs
A child with bulky greasy stool should make you think of what diagnosis?
At what age should an infant begin cooing?
Wht is the most common cause of an upper respiratory tract infection?
Koplik spots are clusters of white clustered lesions on the buccal mucosa. What virus are they pathoneumonic for?
What is the first line antibiotic for otitis media?
How do you treat a patient with respiratory syncytial virus?
Albuterol, steroids, and fluids
A child presents with painful ulcers in the mouth. On physical exam you find more of the same type of ulcers on his hands and feet. What virus is most likely causing these symptoms?
What is the gold standard for the diagnosis of cystic fibrosis?
Sweat chloride test
By what age should a child be able to walk?
If you believe there may be a foreign body obstructing a child's breathing what type of CXR should you order?
Expiratory view looking for hyperinflation due to air trapping.
What is the medical term for lazy eye?
A patient presents with a staccato cough but no fever. What is the most likely diagnosis?
What is the most serious complication of Kawasaki syndrome?
A musical vibratory murmur best heard at the apex in a child should make you think of what diagnosis?
A palpable olive-shaped epigastric mass in a one month old should make you think of what diagnosis?
At what age should a child be able to use a spoon and stack 3-4 blocks?
What is the x-ray finding that supports diagnosis of a slipped capital femoral epiphysis?
Ice cream falling off the cone
Which viral exanthem often has conjunctivitis as one of its symptoms?
What is the most common congenital heart defect?
Ventricular septal defect
A boot-shaped heart on CXR should make you think of what diagnosis?
Tetralogy of Fallot
During a physical exam of a child, you feel a tubular or sausage shaped mass. What is the most likely diagnosis?
What is the treatment for a volvulus in a child?
By what age should a child be able to roll over?
What is pertussis more commonly referred to as?
Which heart valve is most associated with rhemuatic fever?
You hear a loud harsh holosystolive murmur in a child. It is heard best at the LLSB. What is the most likely diagnosis?
Ventricular septal defect
A child presents with paroxysmal abdominal pain, nauesea, vomiting, and diarrhea. What is the most likely diagnosis?
Is an upper respiratory infection which includes hoarseness most likely bacterial or viral?
At what age should a child begin to feed himself?
Describe Barlow's test
Adduction and internal rotation of the hips
A CXR finding of notched ribs in a child should make you think of what diagnosis?
Coarctation of the aorta
How long should you wait for a swallowed marble to pass through the body before considering surgery?
A 4 year old boy presents between October and March with wheezing, coughing, a runny nose and increased respiratory rate. What is the mostly likely pathogen?
Respiratory syncytial virus
Describe the pattern of weight gain in an infant over the following time periods: week one, 6 months, 12 months, 3 years and 4 years old.
Newborns lose 10% of their birth weight initally but are back to birth weight at 10 days,
6 months= 2x birth weight
12 months = 3x birth weight
3 years = 30 lbs and 30 inches
4 years = 40 lbs and 40 inches
By what age should a child be able to kick a ball?
A child with a fever lasting longer than 5 days should make you think of what diagnosis?
A widely split fixed S2 should make you think of what diagnosis?
Atrial septal defect
Nasal polyps should make you think of what diagnosis?
In order to diagnose rheumatic fever what one thing must you have?
Evidence of strep infection either positive titer or positive culture. In addition you need 2 major criteria OR 1 major and 2 minor criteria
Forchheimer spots are associated with what disease?
A Salter-Harris type III fracture affects what area of the bone?
The physis (growth plate) as well as the epiphysis
A lacey pink rash should make you think of what diagnosis?
Erythema infectiosum aka fifths disease aka slapped cheek
Unilateral purulent rhintis should make you think of what diagnosis?
What is the medical term for cross-eyed?
What organism is the most common cause of otitis media?
At what age should a child begin to say mamma and dadda?
At what age should you begin ordering DEXA scans for male patients? Female patients?
70 for men and 65 for women
Give the DEXA score for osteoporosis? Osteopenia?
Osteoporosis = 2.5 standard deviations or greater
Osteopenia = 1 to 2.4 standard deviations
What fracture is the #1 cause of compartment syndrome?
Tibial shaft fracture
A patient's lab work shows positive Smith antibody and positive double stranded DNA antibodies. What is the most likely diagnosis?
Where are Bouchard's nodes found?
Proximal interphalangeal joint (PIP)
What will an X-ray show in acute osteomyelitis?
Nothing, it will show bone destruction in CHRONIC osteomyelitis
What is the best imaging to diagnose osteomyelitis?
Either a bone scan or an MRI will provide the diagnosis
A 22 year old male presents with what is clearly a septic knee. You also notice lesions on his hands and feet. What is the most likely pathogen?
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.
A patient presents with a painless mass in her right wrist. What is the most likely diagnosis?
What is the age range for osteosacroma? 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.
You think a patient may have an osteoid osteoma due to his complaints of severe night pain. You set him up for an x-ray, but in the meantime what medication do you start him on?
If it is truly an osteoid osteoma ibuprofen will resolve his pain.
Clicking or locking of the knee indicates what diagnosis?
A 65 year old presents complaining of severe pain in his great toe that began when he woke up this morning. It is swollen, red, and very tender. What is the most likely diagnosis?
Gout would be number one b/c of location, but you might also think about an infection.
What uric acid level helps to confirm a diagnosis of gout?
What is the medical treatment for gout?
Allopurinol, colchicine, NSAIDs
a pathology report comes back with positive birefringent crystals. What is the most likely diagnosis?
(think + is good so pseudo, - is bad so gout)
A patient with a history of hepatitis B presents complaining of bilateral knee pain, fever, and weight loss. What is the most likely diagnosis?
You suspect a patient has polyarteritis nodosa. What is the test for a definitive diagnosis and what is the treatement?
Biopsy, high dose steroids
On physical exam you notice ulnar deviations and swan neck deformities. What is the most likely diagnosis?
A positive Neer's test indicates what diagnosis?
Rotator cuff impingement
List three medications that may cause lupus?
Procainamide, isoniazid, and quinidine
What test do you do for Sjogren's syndrome?
A patient with rheumatoid arthritis is heading to the OR for open reduction and internal fixation of the ankle. In addition to ankle films what other x-rays should you get?
C-spine, anesthesia will want them due to concerns about instability of C1 and C2
What carpal bone has a high rate of nonunion and occult fracture?
What medication is used for patients with lupus?
Scleroderma limited version has five main characteristics for which the CREST acronym is often used. What are those five things?
There is a sunburst appearance on x-ray. What is the most likely diagnosis?
Anatomically where are 80% of clavicle fractures located?
A pathology report comes back showing negatively birefringent crystals. What is the most likely diagnosis?
(think + is good so pseudo, - is bad so gout)
What are the four muscles of the rotator cuff?
Describe the characteristics of a lytic lesion on x-ray.
Spiculated, elevated periosteum, bone destruction
What ligament is most commonly injured in an ankle sprain?
Anterior talofibular ligament
Vasculitis with a hepatitis B history should make you think of what diagnosis?
What is the most common fracture in children?
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 can't be seen
A patient presents with progressive neck and proximal muscle weakness. On physical exam you see a reddish purple maculpappular rash. Her lab work shows an anti-Jo 1 antibodies. What is the most likely diagnosis?
Which way does a Colles fracture angulate dorsal or volar? What about a Smith fracture?
Colles = dorsal
Smith = volar
Tenderness over the anatomical snuffbox is indicative of what fracture?
What is the most common fracture in a patient with osteoporosis?
A compression fracture of a vertebral body followed by hip fractures.
A 15 year old boy presents complaining of night pain in the pelvis. Since you have no idea what to do you order an x-ray. The report comes back with a description of a mass with an "onion skin appearance". What is the most likely diagnosis?
What is the name for the 4th and 5th metacarpal fractures that often result from throwing a punch?
A new mother presents with pain over the radial wrist. She has a positive Finkelstein's test. What is the most likely diagnosis?
de Quervain's tenosynovitis
A positive McMurry indicates what diagnosis?
What is the first line treatment for carpal tunnel?
What is the most common cause of C-spine fractures?
Motor vehicle accidents
What is the medical term for hunchback?
What is another term for podagra?
A patient presents to the ER with saddle anesthesia and loss of bowel and bladder function. What is the most likely diagnosis?
A patient with HIV presents with severe groin pain. What is the most likely diagnosis?
Avascular necrosis of the femoral head. Antiretroviral medications put patients at an increased of an AVN.
A 95 year old female to the ER after a fall in her home. Her left leg is shortened and externally rotated. What is the most likely diagnosis?
Femoral neck fracture
You recommend bisphosphonates for a patient with osteoporosis. What instruction do you give her for immediately after taking the medication?
Remain upright for 30 min.
What is the most common cause of a hip dislocation? Is it usually anterior or posterior?
Which of the four rotator cuff muscles is most commonly injured?
What is the medical term for tennis elbow?
What is a first line treatment for rheumatoid arthritis?
A patient presents to the ER after taking a baseball bat to the knee. He is unable to actively extend his knee. What is the most likely diagnosis?
Are most shoulder dislocations anterior or posterior?
What is the msot useful physical exam test for diagnosing an ACL tear?
Lachman's followed by anterior drawer
What is the most common knee injury?
Medial meniscal tear
Where are Heberden's nodes found?
Distal interphalangeal joint (DIP)
A patient presents with knee pain following a soccer game two days ago. He has joing line tenderness medially and feels a locking in the knee from time to time. What two physical exam tests should you do?
This is probably a medial meniscal tear. McMurry and apply tests would be appropriate
A patient presents with conjunctivitis, urethritis, arthritis and oral lesions. What is the most likely diagnosis? What other lab might you expect to be positive?
Reactive arthritis, HLA B-27
A 46 year old male comes into ER limping a little on the right side. He states that it felt as though he was kicked in the back of the leg during a soccer game, but clearly no one was behind him. What is the most likely diagnosis?
Achilles tendon rupture
Anti-Jo1 antibodies should make you think of what diagnosis?
A positive crossover test indicates what diagnosis?
Acromioclavicular joint injury (AC joint)
A positive Hawkins test indicates what diagnosis?
Rotator cuff impingement
A positive Phalen and Tinel's sign indicates what diagnosis?
A bamboo spine indicates what diagnosis?
A positive straight leg test indicates what diagnosis?
An African American female presents with malar rash and a positive double-stranded DNA antibody. What is the most likely diagnosis?
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
A patient has a silver fork deformity on x-ray. What is the most likely diagnosis?
A positive Apley indicates what diagnosis?
What is the MC pt. complaint with emphysema?
Shortness of breath
At what age should vaccinations for pneumococcal pneumonia begin?
Prolonged expiration (low FEV 1) should make you think of what diagnosis?
Asthma or COPD
Hampton's hump on CRX should make you think of what diagnosis?
How long after administering a PPD should it be read?
A patient without a functioning spleen is more susceptible to what type of organisms?
Encapsulated organisms most commonly Strep pneumoniae and H. flu
What is the MC cause of pneumonia in children less than 1 yr?
What is the treatment for pneumocystis jiroveci pneumonia?
What occupations are associated with berylliosis?
Aerospace and nuclear plant workers
What CXR finding might make you think of berylliosis?
Diffuse inflitrates with hilar adenopathy
What is the gold standard for diagnosis of a pleural effusion?
When performing a decompression for a tension pneumothorax where do you put the needle?
2nd intercostal space at the midclavicular line
Zanamivir (Relenza) may be given to children above what age?
An HIV patient with ground glass appearance on CXR should make you think of what diagnosis?
Pneumocystis jiroveci pneumonia
A noncaseating granuloma should make you think of what diagnosis?
A pearl formation on CXR should make you think of what diagnosis?
Squamous cell lung cancer
Ghon or Ranke complexes on CXR should make you think of what diagnosis?
A Westermark sign on CXR should make you think of what diagnosis?
Mesothelioma is MC found in what lung location?
80% are found in the pleural lining
What CXR flinding might make you think of mesothelioma?
Pleural thickening, remember 80% are found in the pleural lining
Hyperinflation on a CXR as well as eosinophilia on CBC should make you think of what diagnosis?
A college student presents with pneumonia. What two organisms should you be thinking of?
Chlamydia and mycoplasma
What organism is the MC cause of pneumonia in a patient with cystic fibrosis?
At what size induration would a PPD be positive for an HIV patient?
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 the three MC used medical treatments for COPD
List 4 medications which may cause asthma
Nodular opacities in the upper lung fields should make you think of what diagnosis?
What is the treatment for active TB?
INH + RIF = EMB x several months typically followed by INH + RIF once sensativities come back
Caseating granulomas should make you think of what diagnosis?
Blue bloater refers to the characteristic physical exam findings of what disease?
A contralateral mediastinal shift should make you think of what diagnosis?
What is the best test to diagnose bronchiectasis?
What are the main side effects of isoniazid?
Hepatitis and peripheral neuropathy
You are treating a patient for TB. He has noticed that his body fluids now have an orange tint. What drug is most likely causing this?
Ethamutol has what two major side effects?
red green vision loss
If you see a question with anything to do with rats and the patient has pneumonia, what organism should you be thinking of?
What is the MC organism causing pneumonia in COPD patients?
Where is a Pancoast tumor found on CXR?
At the apex of either the right or left lung
Will evidence of TB be seen more frequently in the upper or lower lung lobes on CXR?
A patient has pneumonia with rust colored sputum. What is the most likely diagnosis?
Coal miners lung often shows nodular opacities in what lung fields?
Upper lung fields
When you step up the diagnosis from intermittent asthma to mild persistent asthma, what medication should you add?
An inhaled steroid like fluticasone
Any question about rabbits and pnuemonia should make you think of what diagnosis?
Dullness to percussion should make you think of what diagnosis?
A young child presents to the ER and you see him waiting in the tripod position. What is the most likely diagnosis?
At what size induration would a PPD be postiive for a healthcare worker?
List 6 extrapulmonary complications of lung cancer:
Recurrent laryngeal symptoms
Currant jelly sputum should make you think of what diagnosis?
What happens to total lung capacity in sarcoidosis?
It goes DOWN
What will the likely findings on a CXR of a patient with asbestosis?
Linear opacities at the bases with pleural plaques
Tympany to percussion should make you think of what diagnosis?
What are the three most common cancers to metastasize to the lungs?
A barrel chest should make you think of what diagnosis?
Are lungs noisy or quiet with COPD?
List 4 indications for the flu vaccine:
child 6-59 months
age greater than 50
Posttussive rales should make you think of what diagnosis?
Parenchymal metastasis and blebs on CXR should make you think of what diagnosis?
Rhonci or wheezes that clear after coughing suggest what diagnosis?
Bronchitis or atelectasis
Does FEV1 go up or down with asthma?
It goes DOWN
A very sick patient with diffuse infiltrates that spare the costrophrenic angles should make you think of what diagnosis?
Acute respiratory distress syndrome
What is the MC cause of bronchiectatsis?
An exudative pleural effusion should make you think of what diagnosis?
What is the treatment for epiglottis?
2nd or 3rd generation cephalosporin (ceftriaxone) macrolides may also be used
Transudative pleural effusions should make you think of what diagnosis?
Congestive heart failure
What two lung cancers are typically found centrally on CXR?
Adenocarcinoma and Large cell
Pertussis is MC treated with what antibiotic?
List the 4 MC places lung cancer will metastasize to
If you come across a question where the patient has erythema nodosum and an enlarged parotid glad what is the most likely diagnosis?
What is erythema nodosum?
Tender red nodules usually found on the shins
a thin looking heart and a flattened diaphragm on CXR should make you think of what diagnosis?
If you see a question with an alcoholic who has been diagnosed with pneumonia what is the most likely organism?
Honeycombing and tram tracks on the CXR should make you think of what diagnosis?
Bronchiectasis (Cystic Fibrosis) and idopathic pulmonary fibrosis
Paradoxical pulses may be found in what pulmonary disorder?
An older patient presents with pneumonia and diarrhea. What is the most likely diagosis?
Eggshell opaccities on CXR should make you think of what diagnosis?
List three causes of decreased tactile fremitus
Hyperresonance to percussion should make you think of what diagnosis?
If you hear crackles in the lung fields list three pulmonary issues that should be in your differential
Does total lung capacity go up or down in COPD?
it goes UP
List three things taht should be on your differential if you hear wheezes on a lung exam?
A physical exam finding of egophony should make you think of what diagnosis?
CXR shows vascular redistribution and blurred vascular outlines. What is the most likely diagnosis?
Rice water stool should make you think of what diagnosis?
Is diptheria a Gram-positive or negative organism?
A stuck on grey membrane in the pharynx should make you think of what diagnosis?
What are the four steps in treating diptheria
report the case to the CDC
What is the clinical name for whooping cough
What type of organism is tetanus?
A Gram + rod, Clostridium tetani
A patient ate out last night and today has cramping and bloody diarrhea. What is the most likely diagosis?
Diarrhea with blood and mucus should make you think of what diagnosis?
What is the best test to diagnose malaria?
Peripheral blood smear
What organism has been linked to reactive arthritis?
Shigella, also remember that reactive arthritis has a positive HLA-B27
What is the treatment for Shigella?
Bactrim or fluoroquinolones and hydration
What organism causes Lyme disease?
What is the minimum amout of time needed for a tick to transfer Lyme disease to a human?
White curd like vaginal discharge should make you think of what diagnosis?
Vaginal candida infection
Owl eye inclusion bodies should make you think of what diagnosis?
If you have a patient with positive blood cultures for candida what is the first line drug?
What is the treatment for pertussis?
Erythromycin x7 days
A leukemia patient has a CT of the liver which shows punched out lesions. What diagnosis shouldyou be thinking of?
What disease does Rickettsia rickettsii cause?
Rocky Mountain Spotted Fever
An India ink stain showing cysts should make you think of what diagnosis?
A COPD patient has apical cavities and calcified nodes on his CXR. You also discover he has a pet bat and a few birds. What is the most likely diagnosis?
An HIV patient presents with a nonproductive cough and a CXR showing diffuse interstitial infiltrates. What is the most likely diagnosis?
Pneumocystis jiroveci pneumonia
Honey and babies should make you think of what diagnosis?
What type of organism causes botulism?
A Gram + rod, Clostridium botulinum
What is the treatment for botulism?
A patient presents to the ER with acute progressive weakness, diplopia and a very dry mouth. What organsim may be causing this?
What is the drug of choice to treat Lyme disease in kids or pregnant women?
What is the drug of choice to treat C. difficile?
A patient was in the woods yestserday and today presents with erythema migrans. This should make you think of what diagnosis?
What drug is sused for the treatment or prophylaxis or malaria?
A patient was camping a few days ago and now has a rash that began on his wrists and ankles. What is the most likely diagnosis?
Rocky Mountain Spotted Fever
What is the drug of choice for treating Rocky Mountain Spotted Fever
What is the drug of choice for treating syphilis?
Any reference to dark field microscopy should make you think of what organism?
Is staph gram (+) or gram (-)?
A patient being treated with PCN for a syphilis infection develops fever, chills, muscle pain, and headaches. DO you stop treatment?
No, this is Jarisch-Herxheimer reaction. The patient must be closely monitored, but it is a response to released endotoxin from the death of the spirochetes and not an allergic reaction
What organism is believed to be the main culprit in creating peptic ulcers?
A painless, clean base chancre should make you think of what diagnosis?
Is pseudomonas gram (+) or gram (-)?
A patient complains of a rash on his palms and soles. He has a fever and chills. In conversation he mentions a strange painless chancre he had a few weeks ago. What is the most likely diagosis?
Secondary syphilis. This is the most contagious stage.
What is the treatment for cholera?
What is the current drug of choice for the cytomegalovirus?
Which herpesvirus causes Epstein-Barr?
A 16 year old girl presents with exudative sore throat and general malaise. On physical exam you observe some posterior chain lymphadenopathy and mild splenomegaly. What is the most likely diagosis?
Epstein-Barr virus (mono)
What are the two important peices of patient education for anyone diagnosed with mono?
No contact sports and no kissing
What is the first symptom of a rabies infection?
Pain and anesthesia at the site of the bite
How do you definitively diagnose rabies?
Pathology of the brain of the animal that performed the bite using fluorescent antibody stain
A patient is bitten by a rabies infected raccoon. On what days do you give human diploid cells?
0, 3, 7, 14, 28
A diaper rash with satellite lesions should make you think of what diagnosis?
Name three serious reactions a patient may have with the use of vancomycin?
What tests are done to screen for HIV?
ELISA and then if the positive diagnosis is confirmed with a Western blot test
What is the drug of choice for the treatment of Lyme disease?
What does trismus mean?
Lock jaw, often secondary to tetanus
How do you treat amebiasis?
What is the treatment for a tetanus infection?
PCN, immune globulin and supportive care (especially respriatory support)
How do hookworm larvae enter the body?
They penetrate the skin usually through the soles of the feet
How do you treat hookworm?
What type of mosquitoes carry malaria?
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.
A CT scan shows ring enhancing lesions in an HIV patient. What is the most likely diagnosis?
What is the drug of choice for toxoplasmosis?
What organism causes toxoplasmosis?
What drug do you use to treat pinworm?
You treat everyone in the house with albendazole. Two weeks later you treat them again.
The scotch tape test is used to diagnose what disease?
Is neisseria gram (+) or gram (-)?
Syphilis is caused by what organism?
A gram positive organism in chains should make you think of what diagnosis?
A gram negative diplococci should make you think of what diagnosis?
What oral antibiotic can be used for pseudomonas?
What is the MC prophylactic abx used preoperatively?
Why aren't fluoroquinolones used more frequently?
They have a lot of side effects
Why can't you give fluoroquinolones to kids?
they can cause cartilage development problems
What class of abx should you start with for a community acquired pneumonia?
List a few macrolides:
Erythromycin, azithromycin, clarithromycin
What ABX class is the class of choice for chlamydia?
What class of ABX is sometimes prescribed specifically for its effects on increasing GI motility?
Which medication is worse to give a pediatric patient, tetracycline or an aminoglycoside?
Pizza pie retinopathy should make you think of what diagnosis?
A patient presents complaining of a metallic taste in her mouth and dark brown urine. What ABX might she be on?
What ABX is most likely to cause C. difficile?
What is the drug of choice for treatint MRSA?
You place a patient on rifampin. What side effect should you warn her about?
Orange-red discoloration of bodily fluids
What might happen if you infuse vancomycin too fast?
Red man syndrome
Name one oral medication that can be used for MRSA
Linezolid (Zyvox) and Bactrim
What organism is most commonly responsible for community acquired pneumonia?
What organism is the most common cause of an uncomplicated urinary tract infection?
Gummas or granulomatous nodules should make you think of what diagnosis?
Bloody stools with cysts and trophozites should make you think of what diagnosis?
Community acquired carditis is most often caused by one of the HACEK organisms. List the HACEK organisms.
What are the three medications often combined as a first line treatment for H. pylori?
Amoxicillin (PPI + 2 ABX)
What is the prophylactic abx most commonly given before a dental procedure if one is necessary?
Amoxicillin 2 grams po 1 hour before the procedure
A pregnant woman and cat litter should make you think of what diagnosis?
What is the drug of choice to treat a urethritis caused by neisseria?
Is Klebsiella gram (+) or gram (-)?
A gram positive organism in clusters should make you think of what diagnosis?
What is the best test for diagnosing Rocky Mountian spotted fever?
Indirect immunofluoroscent antibodies
A gram negative coccobaccili found in the sputum of patient with pneumonia should make you think of what diagnosis?
What medication is used as prophylaxis for meningococcal meningitis?
List six medications that can be used for migraine prophylaxis:
Calcium channel blockers
A patient presents with what appears to be an inability to understand speech. Which aphasia should be at the top of your differential?
A patient presents with facial paresis, arm drift and abnormal speech. What are the first three tests to order?
Thinking of a stroke you order a non-contrast brain CT or MRI, serum glucose and oxygen saturation
A patient is brought in following a seizure in which she did not lose consciousness. What is the most likely diagnosis?
Simple partial seizure
A patient is having a stroke and there is no evidence of hemorrhage. What is the first line medical treatment?
Within the first 48 hours and with no contraindications thrombolytics should be given
What siezure medication may cause overgrowth of the gums?
A sudden thunderclap headache should make you think of what diagnosis?
Describe Kernig's sign
The patient lies supine, flex hip while keeping knee straight. Back pain is positive.
Imaging is negative for blood, but you strongly believe that there is a subarachnoid hemorrhage. What test can you order that will be definitive?
A patient presents with lateralized throbbing headache. He is also complianing of nausea, vomiting, and photophobia. What type of headache is most likely?
A middle age male presents with unilateral periorbital headaches occurring daily for several weeks. These headaches are extremely painful. Which type is the most likely cause?
List three drugs that treat cluster headaches
A 34 year old presents with symptoms which are relapsing and remitting over the past few weeks. These include visual problems and weakness in her right arm. What is the most likely diagnosis?
A 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 shuffling gait should make you think of what diagnosis?
Give two classes of drug therapy for treating Parkinson's:
Dopaminergic (levodopa) anticholinergics are second line
Decreased GABA and substance P should make you think of what diagnosis?
Is Huntington's autosomal dominant or recessive?
A patient presents with weakness that he has felt in his lower legs and now feels in his knees and hips bilaterally. He has decreased deep tendon reflexes. This has been getting progressively worse. What is the most likely diagnosis?
What percentage of strokes are ischemic? What percentage are hemorrhagic?
You believe a patient has had a stroke. He presents with aphasia, loss of hearing in one ear and loss of vision in his left eye. Is the blockage likely in the anterior OR posterior circulation?
Under what conditions would aspirin or clopidogrel be used following a TIA as prophylaxis?
These are antiplatlet medications. They would be used unless there is a known cardiac etiology for the embolism. Patients iwth a cardiac cause should use heparin or Coumadin.
A patient who is asymptomatic should consider having an endarterectomy at what percent blockage of the carotid artery? How about in a symptomatic patient?
70% in an asymptomatic patient and greater than 60% in a symptomatic patient
A pateint presents complaining of the worst headache of his life. What might you exepct their blood pressure to be?
Typically this is the description for a subarachniod hemorrhage. You would expect the blood pressure to be elevated.
Name one abortive drug for migraines:
An EEG showing focal rhythmic discharges at the onset of the seizure should make you think of what diagnosis?
Simple partial seizure
What is the single most important thing to be considered about with a patient in status epilepticus?
Airway, followed by management of hyperthermia
Describe Brudzinski's sign
When you lift the patient's head the patient bends his hips
Name three medications used to break a seizure
There is an MRI result of multiple foci of demyelination in the white matter. What is the most likely diagnosis?
List three medication used to treat multiple sclerosis
What is the common cause of dementia?
Alzheimer's disease, it may be as high as 80%
What four choromosomes have been linked to demintia?
Is the ankle jerk reflex of lumbar or sacral origin?
A study result comes back with intracellular neurofibrillary tangles and extracellular neuritic plaques. What is the most likely diagnosis?
A patient complains of an aching headache which feels like a band around his head. What is the most likely diagnosis?
A patient presents to your office complaining of a tremor in his right hand. He states afer a beer it goes away completely. What is the most likely diagnosis?
Benign essential tremor or familial tremor
Decreased GABA and substance P should make you think of what diagnosis?
Is Huntington's autosomal dominant or recessive?
List two medications you might use to treat an essential tremor:
Beta blocker (propranolol)
At what age do symptoms of Huntington's disease appear?
Around 30 years old
A 35 year old patient comes to your office because his wife made him. He had been increasingly irritable and moody. She has also noticed that he is very restless. You order a CT scan which shows cerebral atrophy as well as atrophy of the caudate nucleus. What is the most likely diagnosis?
What is the medication of choice for a patient with Tourette's syndrome?
A slit lamp shows Kayser-Fleischer rings. What is the most likely diagnosis?
Wilson's disease is associated with a build up of what material?
There is a deficiency of the copper binding protein, therefore a buildup of copper.
What are the genetic characteristics of Wilson's disease?
Autosomal recessive, chromosome 13
What cranial nerve is affected with Bell's palsy?
A lumbar puncture for a patient with bacterial meningitis will show elevated or decreased WBCs? Glucose? Protein?
What symptom is associated with a classic migraine?
Having an aura
Elevated circulating acetylcholine receptor antibodies should make you think of what diagnosis?
Duchenne's and Becker's muscular dystrophy have what genetic characteristic?
What is the age range for Duchenne's muscular dystrophy?
3-5 years old
An EEG showing generalized spikes and associated slow waves should make you think of what diagnosis?
Generalized or absence seizure
What is the most common primary intracranial neoplasm?
What is the most common cause of subarachnoid hemorrhage aside from trauma?
Ruptured cerebral aneurysm
What are the most common primary cancer sites that metastasize to the brain?
Lung, breast, and kidney
A resting or pill-rolling tremor should make you think of what diagnosis?
Weakness and numbness in the left hand might be a blockage in which carotid artery?
A patient has an intracranial neoplasm causing auditory illusions, olfactory hallucinations and emotional changes. What lobe is the lesion likely in?
If you are looking for lesions associated with multiple sclerosis and you order an MRI do you order with gadolinium or without?
What is the defining symptom of Alzheimer's?
Progressive memory impairment
Which nerve root is responsible for the knee jerk reflex?
An EEG showing interictal spikes should make you think of what diagnosis?
Complex partial seizure
Which is the most commonly herniated vertebral disc?
L4-L5 followed by L5-S1
What three symptoms are classic for a normal pressure hydrocephalus?
A patient presents with inability to speak and right sided weakness. He seems to understand speech and follows commands well. What type of aphasia should you be thinking of?
Alcohol may be a major factor in which encephalopathy?
A patient complains of muscle weakness and fatigability that improves with rest. What is the most likely diagnosis?
Lead pipe or cogwheel rigidity should make you think of what diagnosis?
Why should actinic keratosis be treated?
It may progress to squamous cell carcinoma
What is the first line treatment for rosacea?
Metronidazole, tetracycline is probably a close second
Where are 90% of basal cell lesions found on the body?
On the head and neck
Purple, pruritic, polygonal, papule on physical exam should make you think of what diagnosis?
What are the ABCs of melanoma?
A positive Auspitz sign should make you think of what diagnosis?
What is the key indicator for the prognosis of melanoma?
Thickness of the lesion
What is the treatment for melanoma?
Wide local excision
A waxy stuck on appearance should make you think of what diagnosis?
A 5 year old presents in January with a red itchy rash behind his knees and on the flexor surfaces of the elbows. What is the most likely diagnosis?
The term satellite lesion should make you think of what diagnosis?
Candida diaper rash
Coin-shaped plaques should make you think of what diagnosis?
A 30 yr old female presents with pustules on her face that spare the vermillion border. In her history she has been using topical steroids. What is the most likely diagnosis?
A patient presents with flaky skin in the nasolabial folds and in her hair. What is the most likely diagnosis?
How do you treat stasis dermatitis?
Tapioca blisters should make you think of what diagnosis?
Dyshidrosis- these are usually on the hands and feet
How do you treat dyshidrosis?
Giant cells on a Tzanck smear should make you think of what diagnosis?
Herpes simples virus
How do you treat lichen simplex chronicus?
Get the patient to stop scratching it!
A herald patch should make you think of what diagnosis?
How do you treat pityriasis rosea?
A patient with a history of herpes now presents with a target lesion. What is the most likely diagnosis?
Rhinophyma should make you think of what diagnosis?
Silvery scales should make you think of what diagnosis?
Teardrop lesion after a course of strep throat should make you think of what diagnosis?
Are lesions from psoriasis typically found on flexor or extensor surfaces?
What is the first line treatment for tinea corporis?
What are the two most common organisms responsible for cellulitis?
Strep and Staph
Pitting nails are associated with what dermatologic disorder?
Nummular eczema is most like what other dermatologic disorder?
Honey-colored crusts should make you think of what diagnosis?
What two herpes viruses are most responsible for condyloma acuminata?
HSV 6 and 11
A double comedone is indicative of what diagnosis?
What is the best treatment for molluscum contagiousum?
It is self limiting, but can be removed if patient really wants it.
What is the treatment for seborrheic keratosis?
It is benign so there is no need to treat it. Lesions may be removed if unsightly
Hyperpigmented velvety plaques should make you think of what diagnosis?
Melasma is most often found in what patient population?
Women of childbearing age
Extremely pruritic lesions with borrows in runs should make you think of what diagnosis?
What is the first step in treating atopic dermatitis?
Behavioral modifications- reduce bathing, only use soap on face and genitals, use natural breathable fabrics.
What is the treatment for a bad brown recluse spider bite?
Debridement, the venom causes tissue necrosis
Salmon-colored scales should make you think of what diagnosis?
De-pigmented patches of skin should make you think of what diagnosis?
Spaghetti and meatballs on KOH prep should make you think of what diagnosis?
What dermatologic finding is associated with insulin insensitivity?
A slowly growing nodule with a central depression and a pearly border should make you think of what diagnosis?
Basal cell carcinoma
What dermatologic finding is associated with asthma?
A Christmas tree pattern should make you think of what diagnosis?
Oval patches of hair loss should make you think of what diagnosis?
What is the first line treatment for genital warts?
Pearly dome shaped lesion with a central umbilication should make you think of what diagnosis?
What is the best lab test for scabies?
Microscopic examination under oil immersion
What two hormones are secreted by the posterior pituitary?
Oxytocin and antidiuretic hormone (ADH, vasopressin)
What is Sheehan's syndrome?
Ischemia of the pituitary due to volume depletion during or after childbirth
How do glitazones work?
They improve insulin sensitivity
What is the most common pituitary adenoma?
Large doughy hands should make you think of what diagnosis?
Diabetes insipidus is caused by a deficiency of which hormone?
How much more potent is T3 than T4?
What is the first line medical treatment for pheochromocytoma?
Alpha blocker, you should never use a pure beta blocker
What is the best imaging for a thyroid nodule?
Patient presents with erectile dysfunction and complains of some numbness in his feet. On second thought he has noticed significant polyuria and polydipsia. What diagnosis should you be thinking of?
Pretibial myxedema should make you think of what diagnosis?
A 35 year old female presents with heat intolerance, weight loss, and palpitations. What is the most likely diagnosis?
What is the first line medical treatment for a patient who presents with palpitations and nervousness secondary to hyperthyroidism?
What is Hashimoto's disease?
An autoimmune cause of hypothyroidism
How does levothyroxine work?
It is a synthetic T4
What is the most common thyroid cancer?
Papillary makes up about 80% of thyroid cancers
In a patient with hyperthyroidism will TSH most likely be elevated or decreased?
How do fibrates work to affect the lipid profile?
They inhibit synthesis of VLDL and elevate lipoprotein lipase.
What medication might you use prior to thyroidectomy in a patient with hyperthyroidism?
Methimazole or propylthiouracil (PTU)
What is included in Whipple's triad of hypoglycemia?
History of previous hypoglycemia
serum glucose of <40
immediate recovery upon administration of glucose
Positive antithyroid peroxidase and antithyroglobulin antibodies should make you think of what diagnosis?
What is the treatment for myxedema?
Levothyroxine and slow warming
What is the most common cause of hypoparathyroid?
Post thyroidectomy with the complication of parathyroidectomy
What is Chvostek's sign?
Tap on facial nerve and get a twitch with low Ca
Cortical adrenal insufficiency is also known as what disease?
What is Trousseau's sign?
Inflate BP cuff and hold for 3 minutes. Patients with low Ca will get carpel tunnel symptoms
What is the most common cause of hyperparathyroidism?
Single parathyroid adenoma in 80% of cases
In Cushing's disease is ACTH elevated or decreased?
What is Graves' disease?
The most common cause of hyperthyroidism. it is an autoimmune disease
What specific breathing pattern is associated with diabetic ketoacidosis?
What is the least aggressive thyroid cancer?
Name two tests you might use to rule out Cushing's syndrome:
24 hour free cortisol urine test
dexamethasone suppression test
List two ectopic tumors that may produce ACTH and give a patient Cushing's syndrome?
Small cell lung cancer
pancreatic islet cells
What is the treatment for Addision's disease?
Hydrocortisone or prednisone
What is the test to begin with if you suspect pheochromocytoma?
24 hour urine for catecholamines
Exopthalmos should make you think of what diagnosis?
What percentage of diabetes in the US is Type 2?
HLA-DR gene is a marker for what endocrine disorder?
DM type 1
What is the main function of parathyroid hormone?
Increase serum Ca
List four diagnostic criteria for diabetes
Random glucose >200
Fasting plasma >126
Two hour postprandial glucose >200
Moans, groans, stones, and bones describe symptoms of what endocrine problem?
Stocking glove should make you think of what diagnosis?
Diabetic neuropathy and B12 deficiency neuropathy
Fruity breath should make you think of what diagnosis?
As it relates to diabetics, what is the dawn phenomenon?
Reduced insulin response between 5 am - 8am
What is the MC cause of hypopituitarism?
How does Metformin work?
Decreases the hepatic glucose production and increases peripheral glucose uptake
How do sulfonylureas medications work?
They stimulate the production of insulin
What class of medications does pioglitazone (Actos) fall into?
Thiazolidinediones known as glitazones
What is the suffix associated with sulfonylureas?
Ide is the suffix. Eg. glipizide, tolbutamide, tolazamide
Typically what is the first medication started in type 2 DM?
How often should a diabetic's A1c be checked and what should it be?
Every three months (remember the life cycle of an RBC is 90-120 days) and it should be below 6.5%
What are the 5 criteria for metabolic syndrome?
HDL <40 (men) <50 (women)
Fasting glucose >100
Waist >40 inches in men and >35 in women
What class of medications is the first line for lowering LDL?
Which lipid medication may cause flushing?
What life threatening side effect do statins have?
Does niacin increase or decrease HDL?
What medication class does metformin fall into?
List the 5 insulins in order of peak efficacy?
Lispro 1-2 hours
Regular 2-4 hours
NPH 5-7 hours
Lente 4-8 hours
Ultralente 8-14 hours
Is metformin indicated or contraindicated in renal failure?
What is the MC cause of DM type 1?
Autoimmune destruction of the islet cells in the pancreas
List 4 physical exam findings for Cushing's syndrome:
Supraclavicular fat pads
Propranolol belongs to what class of medication
During pregnancy which is the preferred treatment for hyperthyroidism, PTU or methimazole?
Name four thyroid cancers:
What heparin complication is relevant to endocrinology?
Adrenal infarcts leading to a Cushing's syndrome
How does nicotinic acid work to affect the lipid profile?
It inhibits secretion of VLDL
Hyperpigmentation of the skin along creases should make you think of what diagnosis?
Which thyroid cancer is the most aggressive?
How do statins work to affect the lipid profile?
They slow the rate limiting step of cholesterol synthesis
Will ACTH be elevated or decreased in Addison's disease?
Elevated if the problem is at the adrenal glands
What role does C-peptide play in the diagnosis of diabetes?
It is a marker of insulin production. Elevated C-peptide points to DM 2. Decreased C-peptide points towards DM 1.
Acute sinusitis is most commonly caused by what two pathogens?
Strep pneumo and H. flu
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
A patient presents with several episodes of vertigo over the past several weeks. He has had intermittent unilateral hearing loss and a "blowing" in his ears. What is the most likely diagnosis?
White oral lesions which cannot be scraped off should make you think of what diagnosis?
What type of hearing loss is assocated with aging?
Which is the most commonly affected sinus in acute sinusitis?
A patient presents with a hot potato or muffled voice. What is the most likely diagnosis?
What time are we talking about for chronic sinusitis?
List the time of year when each of the following allergens is most prominent: pollen, grass, mold, and ragweed
Pollen from trees and flowers: spring
Grasses- the summer
Mold and ragweed- fall
How long should pressure be applied to treat epitaxis?
List the four things that suggest group A beta-hemolytic strep in a patient with pharyngitis:
tender anterior cervical adenopathy
exudate in the throat
A child presnting with an erythematous sandpaper rash should make you think of what diagnosis?
In a patient with sensorinerual hearing loss what will be the results of the Weber test?
Patient will hear the sound louder in the unaffected ear
List four complications of untreated step throat
A patient presents with round ulcer in her mouth that is yellow-grey with a red halo. It is on the buccal mucosa and is painful. What is the most likely diagnosis?
A patient presents drooling, with stridor and in tripod position. What is the dianosis and how do you treat it?
You treat epiglottitis with a second or third generation cephalosporin like cefuroxime or ceftriaxone
White oral lesions which can be scraped off leaving punctate bleeding should make you think of what diagnosis?
What are the three possible treatments for peritonsillar abscesses?
What virus causes mumps?
How do you treat allergic rhinitis?
Intranasal corticosteroids and antihistamines
What is the treatment of choice for strep throat
A patient presents with unilateral hearing loss and a decrease in speech discrimination. She also had difficulty with balance over the past week. What is the most likely diagnosis?
Acute swelling and pain in the cheek that increases at meals. What is the most likely diagnosis?
Sialadenitis (salivary gland infection)
When is watchful waiting with a diagnosis of acoustic neuroma an appropriate plan?
This tumor is very slow growing. Watching a small turmor in an elderly patient is appropriate treatment
What type of hearing loss would be caused by cerumen impaction?
A 14 year old field hockey player presents with prominent adenopathy, white purple exudates in the throat and a palpable spleen. What is the most likely diagnosis?
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
An x-ray of the skull reveals coalescence of mastoid air cells. What is the most likely diagnosis?
After 7 days of sinusitis what antibiotic would you start?
Amoxicillin or Bactrim
A 45 year old female complains of feeling the ground rolling under her feet at times. What is the most likely diagnosis?
A patient with a history of smoking presents with a new onset of hoarsness. This has been persistant for the past two weeks. What is the most likely diagnosis?
Laryngeal squamous cell carcinoma
A patient presents with acute onset of continuous severe vertigo for the past five days. He does have a history of URI 2 weeks ago. What is the most likely diagnosis?
What does Kiesselbach's plexus refer to?
A group of vein's in the anterior nose which bleed a lot
Small grouped vesicles on the vermillion border should make you think of what diagnosis?
What is the MC type of kidney stone?
Calcium makes up 85% of kidney stones
What is the most specific imaging modality for diagnosing kidney stones?
Will a spermatocele transiluminate?
A kidney stone of less than what size will likely pass on its own.
Less than 5 mm
List three possible treatments for stress incontinence in women
surgical placement of a urethral sling
A 65 year old male presents with frequency. On digital rectal exam you feel an elastic moderately enlarged prostate. What is the most likely diagnosis?
A PSA above what level should make you concerned?
Give two major risk factors for erectile dysfunction?
coronary artery disease
List one major risk factor for bladder cancer
Foreskin is retracted and can't be reduced
What is the name of the condition that involves fibrous scar tissue in the penis causing a curvature of the erect penis?
Both testicles should be descended by what age?
Feeling a bag of worms in the scrotum should make you think of what diagnosis?
A fluid filled painless mass found in the scrotum which transilluminates should make you think of what diagnosis?
What is the first line treatment for a varicocele?
Watchful waiting unless there is a question of fertility
Name the sign which is defined as decreased pain with scrotal elevation
Maltese crosses in the urine should make you think of what diagnosis?
What is the imaging study of choice if you suspect bladder cancer?
Cystoscopy and biopsy
What is the most likely diagnosis for a free floating, painless, cystic mass found posterior and superior to the testes
What age range is typically associated with testicular torsion?
Where is the epididymis found?
It is found at the posterior upper pole
What is the best imaging to rule out testicular torsion?
Doppler US for decreased blood flow to the testes
What are the two MC causes of epididymitis?
Neisseria gonorrhea and chlamydia
What medication classes are prescribed in order to prevent chronic renal failure in diabetic patients?
ACEIs or ARBs
Will epididymitis feel better or worse with scrotal elevation?
What is the normal level of serum bicarbonate (HCO3)
What is the treatment for epididymitis?
ceftriaxone and doxycycline
What is the first line antibiotic treatment for cystitis?
What is the MC organism that causes bladder infections?
Tenderness at the costovertebral angle should make you think of what diagnosis?
What is the condition where the urethral meatus is not at the tip of the penis?
Hypospadias and in far fewer cases epispadias
What is the MC organism responsible for prostatisis?
What is the first line antibiotic for prostatitis?
Bactrim 4-6 weeks
List two risk factors for prostate cancer:
Positive family history
High fat diet
What might you feel on a digital rectal exam of a patient with prostate cancer?
Enlarged prostate, hard nodules within the prostate
Painful persistent erection
A prostate biopsy consists of how many samples?
Painless hematuria should make you think of what diagnosis?
What is the MC blader cancer?
Transitional cell cancer
Foreskin can't be retracted
Name the condition in which the head of the penis curves downward or upward, at the junction of the head and shaft of the penis.
It is often associated with hypospadia
How do you treat urethritis?
Ceftriaxone and doxycycline
A 3 year old boy presents with hematuria and a painless palpable abdominal mass. What is the most likely diagnosis??
List three possible causes of prerenal renal failure
Muddy-brown sediment in the urine should make you think of what diagnosis?
Acute tubular necrosis
Tea-colored urine with red cell casts should make you think of what diagnosis?
What are the two most common predisposing factors in the development of chronic renal failure
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 DRE
Will serum potassium be decreased or elevated in renal failure?
A urine protein of >3.5 grams/day should make you think of what diagnosis?
What hereditary pattern does polycystic kidney disease follow?
What is the normal pH of the blood?
What is the most accurate way to diagnose urethritis?
What is considered a normal PCO2?
An ABG shows a pH of 7.2, a bicarb of 25 and a PCO2 of 50. Is this respiratory or metabolic acidosis?
Respiratory-CO2 is elevated
White blood cell casts should make you think of what diagnosis?
What area of the prostate is affected by BPH?
the transitional zone
What area of the prostate is the primary site for prostate cancer?
the peripheral zone
An involuntary loss of urine during coughing or laughing is what type of incontinence?
A patient who has normal bladder function, but can't get to the bathroom has what type of incontinence?
What type of incontinence is often associated with BPH?
Overflow incontienence, the bladder can't empty sufficiently
At what age do you begin screening patients for prosate cancer? What two tests are used?
At age 50 an annual digital rectal exam and a PSA are recommended
Often caused by chlamydia what is the syndrome characterized by urethritis (or cervicitis), arthritis, and conjunctivitis.
What is the MC type of testicular cancer?
What is the normal range for MCV?
What is the MC microcytic anemia?
Iron deficiency anemia
Would anemia of chronic disease most likely be macrocytic, normocytic, or microcytic?
What two main causes should you be thinking of in a macrocytic anemia?
severe blood loss
Does an increase in reticulocytes indicate a decrease or an increase in RBC production?
An increase, reticulocytes are newly released "baby" RBCs
Auer rods are most commonly associated with what disease?
What molecule binds iron in the blood stream?
What does koilonychia refer to?
Spoon-shaped nails. This may be found in microcytic anemia
Will the serum ferritin be high or low in a patient with iron deficient anemia?
It will almost always be low
A low retic count and a normal serum ferritin should make you think of what diagnosis?
Anemia of chronic disease
Under normal conditions at what hemoglobin level would you begin to consider a transfusion?
Asplenism secondary to sickle cell disease increases a patient's risk for what type of infections?
Enapsulated organisms like Strep pneumo and H. flu
An African American teenager presents with avascular necrosis of his right femoral head. What is the most likely diagnosis?
Sickle cell disease
How do you treat sickle cell crisis?
Transfusion may be needed
Will unconjugated bilirubin be high or low in a patient with sickle cell disease?
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
G6PD deficiency follows what pattern of inheritance?
List three diagnosis you should be thinking of if a question includes Heinz bodies.
G6PD deficiency anemia
chronic liver disease
Are target cells seen in mild or severe iron deficiency anemia?
Severe, they are also seen in alpha thalassemia, chronic liver disease and aslpenia
Iron deficiency anemia will have a serum iron lower than what value?
Would a B12 deficiency anemia most likely be microcytic, normocytic, or macrocytic?
You should be thinking alpha thalassemia if the question stem includes which four geographic areas?
A patient of Mediterranean descent is a clue for which type of anemia?
In a folic acid deficiency anemia the folic acid level is typically below what level?
What hematological disorder should you think of if the question talks about the patient eating ice or dirt?
Iron deficiency anemia
Inability to absorb vitamin B12 due to lack of intrinsic factor is what disease?
Stocking glove paresthesias should make you think of what two diagnoses?
B12 deficiency neuropathy
Will the RBCs be large, small or normal size in a B12 deficient anemia?
Will the retic count be elevated, decreased, or normal in B12 deficient anemia?
Retic count will be low. Low building blocks means low production
What is Schilling's test used for?
Test for the cause of a B12 deficiency
Strict vegans are at risk for what type of anemia?
B12 deficiency anemia
Is sickle cell microcytic, normocytic, or macrocytic?
Will a hemolytic anemia generally have an elevated or decreased retic count?
List four disease states in which you may find basophilic stippling
Beta or alpha thalassemia
If a question presents a pregnant woman with anemia what is the most likely diagnosis?
The term Philadelphia chromosome you should make you think of what diagnosis?
The secretory phase of the menstraul cycle (day 14-28) is dominated by what hormone?
Is a nulliparous or multiparous woman more likely to get preeclampsia?
Nulliparity is a risk factor
Since a genetic cause is the number one reason for primary amenorrhea what is one very important test?
Purulent cervical discharge should make you think of what diagnosis?
A description of a young girl with a web neck or wide shield chest should make you think of what diagnosis?
Cervical biopsy comes back as CIN1. What is the next step?
Repeat pap smear in 6 months and repeat colposcopy in 12 months
What is the most common cause of secondary amenorrhea?
What three labs should you order if you are considering secondary amenorrhea?
Define premature birth
Delivery of uterine contents between 20-36 weeks
A unilateral, single, mobile, firm, nontender solid breast mass should make you think of what diagnosis?
Bleeding between menstrual cycles
Postmenopausal bleeding is immediately believed to be what diagnosis?
Endometrial cancer until proven otherwise
During what portion of the mentstual cycle does PMS occur?
In the second half and mensutration should relieve the symptoms
How do you treat bacterial vaginosis?
Metronidazole x 7 days
What location within the pelvis is endometriosis most commonly found?
On an ovary
What lab test is the gold standard for chlamydia?
Nucleic acid amplification test
Are fibrocytic breast masses usually bilateral or unilateral?
How do you definitively diagnose endometriosis?
What is the MC uterine tumor?
Leiomyoma, also known as fibroids
What ethnic background is at an increased risk of fibroids?
African Americans are 5x more likely to have fibroids compared to Caucasian women
How do you treat vaginal candida?
Fluconazole po 1 dose or azole cream x1 week
What is the first step of treatment for endometrial cancer?
Total hysterectomy and bilateral salpingo-oophrectomy
If you see the term chocolate cyst it should make you think of what diagnosis?
A surge in what hormone leads to ovulation?
A patient presents with irregular menses, hirsutism, and infertility. What is the most likely diagnosis?
Polycystic ovarian syndrome
What endocrine issue is associated with PCOS?
You have a patient with PCOS who would like to get pregnant. What two medications can you use?
What is the medical treatment for an ectopic pregnancy?
An ovarian cyst that contains hair and teeth should make you think of what diagnosis?
What is the mean age for ovarian cancer?
Define the second stage of labor
Fully dilated to delivery
A 66 year old female patient presents with bouts of nausea, weight loss, and vague abdominal pain. What is the most likely diagnosis?
When is it recommended to begin pap smears?
Cervical biopsy comes back as CIN2 or CIN3. What is the next step?
Excision- LEEP, cold knife, cryotherapy
List two risk factors for cervical cancer:
multiple sexual partners
How much time needs to pass before diagnosing secondary amenorrhea?
If cycles have been normal 3 months. If cycles have been irregular 6 months.
What is a cystocele?
A herniation of the bladder into the vagina
What is the treatment for Turner's syndrome?
Cyclical estrogen and progesterone
What are three treatments for uterine prolapse?
What is the MC organism that causes mastitis?
At approximately how many weeks pregnant is the uterus at the level of the umbilicus?
What is the MC cause of postpartum hemorrhage?
Define missed abortion
No vaginal bleeding, cervix is closed, products of conception are still inside
At what age is primary amenorrhea diagnosed?
Age 14 if no secondary sex characteristics. Age 16 if some secondary sex characteristics
What is the first line treatment for mastitis?
Dicloxacillin is first line. Cephalexin or erythromycin are second line.
Should a breast feeding mother stop breast feeding if she develops mastitis?
No, mastitis is not a reason to stop but an abscess is
A physical exam revealing a retroverted uterus or uterosacral ligament nodularity should make you think of what diagnosis?
At how many weeks of pregnancy can an amniocentesis be done?
List four risk factors for breast cancer:
BRCA1 or BRCA2 positive
What is the average age of menopause?
Cottage cheese discharge should make you think of what diagnosis?
What is the treatment for ovarian cancer?
Total hysterectomy and bilateral salpingo-oophorectomy, chemo + radiation
A patient believes she is pregnant. You notice her cervix appears a little blue. What is the name of this sign?
At approximately how many weeks pregnant is the uterus at the level of the symphysis pubis?
A snowstorm appearance on ultrasound should make you think of what diagnosis?
What medication can be used to control bleeding due to uterine atony?
What is the term for when the placenta has implanted directly over the cervical os?
At how many weeks of pregnancy can chorionic villus sampling be done?
Why is folic acid given as a prenatal vitamin?
Low folic acid can lead to neural tube defects
What is the MC endometrial cancer?
75% are adenocarcinomas
A strawberry cervix with copious yellow/green discharge should make you think of what diagnosis?
What organism causes us to warn pregnant patients to stay away from deli meats and soft cheeses?
The baby was delivered several minutes ago. Suddenly there is an increase in blood flow from the vagina and the cord noticeably lenthens. What is the most likely cause these signs?
What are two medications used to induce labor?
Cervidil which encourages cervical ripening
oxytocin which encourages uterine contractions
A 66 year old female patient presents with bouts of nausea, weight loss, and vague abdominal pain. What is the most likely diagnosis?
When is it recommended to begin pap smears?
Cervical biopsy comes back as CIN2 or CIN3. What is the next step?
Excision - LEEP, cold knife, cryotherapy
List two risk factors for cervical cancer
multiple sex partners
As part of the antepartum testing a baby has a postive stress test. What does that mean?
They have had two heart rate accelerations in a 20 min period of 15 beats above baseline for at least 15 seconds. This is a good thing.
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.
What is the most common type of ovarian cyst?
Functional cyst- no treatment is needed
Define threatened abortion.
Vaginal bleeding, closed cervix, products of conception are still inside
List 4 risk factors for endometrial cancer:
chronic unopposed estrogen
What would you expect to see on a KOH prep if the patient had vaginal candidiasis?
How many days after conception is a serum beta-HCG positive?
What is the #1 cause of septic arthritis in sexually active young adults?
If the pap smear results come back anything other than negative or ASCUS what is your next step?
Colposcopy and biopsy
List three risk factors for ectopic pregnancy:
scarred tubes (hx of PID or salpingitis)
Grape-like vesicles or a sack of grapes on ultrasound should make you think of what diagnosis?
What medication is used to increase surfactant levels and help with lung maturity if you are worried about preterm labor?
What are two tocolytic medications should you be aware of?
calcium channel blockers
A woman presents to the ER concerned she is in preterm labor. What treatment should you begin before even getting any imaging or lab results?
Give IV fluids (most often the patient is suffering from dehydration)
A pap smear comes back as atypical squamous cell uncertain significance (ASCUS). What is your next step?
Repeat pap smear in 4-6 months
What are three ways you can check for rupturedd membranes?
Ferning pattern on a slide, visualize leakage from the cervix, pooling in the vagina
What is the normal range of fetal heart rate?
Heavy prolonged menstraul flow
What Rh combination for mom and dad might cause the mother to create antibodies against the baby's red blood cells?
Mom Rh negative and dad Rh positive
At what point during pregnancy is RhoGAM given if it is needed?
Gestaional diabetes puts mom and baby at increased risk for what three things?
slowing in fetal lung development
Which is associated with painful third trimester bleeding placental abruption or placental previa?
What are three causes for a postpartum hemorrhage
Define the third stage of labor
Delivery of baby to delivery of the placenta
What medication(s) are used to treat a postpartum metritis?
Clindamycin and gentamicin together
What organism is the most common sexually transmitted infection?
Interference with work or school is part of which diagnosis premenstrual syndrome or premenstrual dysphoric disorder?
Premenstrual dysphoric disorder
Which reproductive cancer carries the hightest rages of death in women?
What is the most common infection following a C-section?
How do you treat a Trichomonas infection?
What is the MC site of an ectopic pregnancy?
Within a fallopian tube
Early on in pregnancy serial beta-HCG should double over what time period?
every 48-72 hours
Uterine prolapse beyond the introitus
What is the more popular term for Stein-Leventhal syndrome?
Polycystic ovarian syndrome
What is the formula for calculating estimated date of confinement or due date?
First day of last period + days -3 months
What are the five components of the biophysical profile as part of antepartum testing?
a non-stress test
two gross body movements
amniotic fluid index
Define the first stage of labor
Onset of contractions to full dilation of the cervix
Rope-like breast mass should make you think of what diagnosis?
Fibrocystic breast mass
What should a primary care provider do for a presumed retinal detachment?
Refer and position patient with head down
In what age range do you expect to most commonly find amaurosis fugax?
Patients older than 50
What is the #1 cause of retinal artery occlusion?
Carotid atherosclerotic disease
When treating herpes keratitis should you use topical antiviral, topical steroids, or both?
Don't use steroids. Topical antiviral and refer
A patient describes his vision loss as a curtain coming down and then going back up. What might the diagnosis be?
A patient presents with a painful, red nodule on the eyelid. What diagnosis should you be thinking of? What treatment should you begin with?
Hordeolum (sty). Warm compress and progress to topical antibiotics if needed
A fundal exam shows a cherry-red spot. What diagnosis should you be thinking of?
Central retinal artery occulsion
A college student presents with a little purulent drainage from one eye and nontender preauricular lymphadenopathy. What diagnosis and pathogen should you be thinking of?
What should a primary care provider do for a presumed central retinal artery occlusion?
Ophthalmic emergency! Refer and intermittent pressure and release of the eye.
A patient presents with unilateral blurriness developing over a few days. Fundal exam shows a "blood and thunder" pattern. What is the most likely diagnosis?
Central vein occlusion
What is the appropriate treatment for central vein occlusion?
Typically self limited. Treat underlying disease
Is glaucoma more prevalent in males or females?
Give two risk factors for glaucoma:
What is the yellow, brown fleshy mass on the conjunctiva which usually does not interfere with vision?
A fundal exam shows a cup to disc ratio of >0.5. There are also vessels bending over the disc. What is the most likely diagnosis?
A patient presents saying that he doesn't seem to need his glasses anymore after 30 years. What is the most likely diagnosis?
A patient has metamorphopsia and a central blind spot. What is the most likely diagnosis?
What is the most likely quadrant for a retinal detachment?
A patient presents with pain in one eye. The cornea is hazy and the pupils are fixed. What is the most likely diagnosis?
What is the most common way of testing for metamorphopsisa?
You notice drusen deposits on fundal exam. What is the most likely diagnosis?
A patient presents with irritated, burning and tearing eyes. You notice some scurf and scales. Where do you begin treatment?
This is blepharitis. Treatment begins with good hygiene and moves on to topical antibiotics if needed
A patient has a history of multiple stys. He now has a painless nodule on his eyelid and minor conjunctivitis. What is the most likely diagnosis?
What are the most common colors lost in color blindness?
Red and green
What is the term for eyelids that turn in?
What is the term for bilateral yellow plaques near the eyes?
A fundal exam shows an opalescent retina and boxcarring of arterioles. What is the most likely diagnosis?
Central retinal artery occlusion
What is the most common preceding event for orbital cellulitis?
Vision loss described as curtain coming down should make you think of what diagnosis?
You notice a bowing of the iris on exam. What is the most likely diagnosis?
A CT scan of the head shows broad infiltration of orbital fat. What is the most likely dianosis?
A patient presents with watery bilateral discharge from the eyes and nontender preauricular adenopathy. What is the most likely diagnosis and what is the most common pathogen?
How do you test for color blindness?
A patient with a history of asthma presents complaining of stringy discharge from both eyes and severe swelling around the eyes. What is the most likely diagnosis?
What is the name for the triangular or wedge shaped growth on the conjunctiva that may interfere with vision?
What is the name of the test for dry eyes?
A patient having recently undergone cataract surgery presents complaining of vision loss in the operative eye. What is the most likely diagnosis?
A patient presents with sudden painless complete unilateral vision loss. What is the most likely diagnosis?
Central retinal artery occlusion
A dendritic lesion is seen iwth fluorescein stain. What is the most likely diagnosis?
Which nerve is involved in herpes zoster ophthalmicus?
Trigeminal nerve, CN 5
Your attending asks you to come and see an excellent example of Hutchinson's sign. What diagnosis does this patient have?
Herpes zoster ophthalmicus
A patient presents with a dense corneal infiltrate and an epithelial defect seen with fluorescein stain. What diagnosis should you be thinking of?
A feathery border in an eye exam should make you think of what diagnosis?
A patient in the recovery room following foot surgery is complaining of severe photophobia. She feels as though there is something in her eye. What is the most likely diagnosis?
Corneal abrasion (pt's scratch their eyes before they are completely awake from anesthesia)
What is the treatment for subconjunctival hemorrhage?
A 19 year old male took an elbow to the face while playing basketball this morning. The whole left side of his face is swollen and he can't look up. What is the most likely diagnosis?
A patient complains of seeing halos and rainbows around lights. She also complains of moderate photophobia. What is the most likely diagnosis?
What is the first thing you should be thinking of if a pediatric patient comes in with blood in the anterior chamber of the eye (hyphema).
Child abuse until proven otherwise
How long after a radiant energy burn do symptoms typically show?
What is the term for eyelids that turn out?
What is the initial treatment for a chemical burn to the eyes.
Irrigate, irrigate, irrigate
Color blindness is transmitted through what genetic pattern?
What is the term for being nearsighted? What type of lens do you use to correct it?
Myopia, concave lenses
A college student presents with copius purulent drainage from one eye. What is the most likely diagnosis?
What isi the first line of treatment for orbital cellulitis?
IV abx, followed by two weeks of oral abx
What is the term for being farsighted? What type of lens do you use to correct it?
What is tonometry used for?
Determining intraocular pressure
What is the term for difficulty swallowing?
Birds-beak esophagus on barium swallow should make you think of what diagnosis?
What is the most common location for an anal fissure?
Crohn's is found where in the GI tract?
It can be from esophagus to anus
What does HBsAg (hep B surface antigen) indicate?
Active Hep B infection
How do you treat achalasia?
Loosen up the muscle- botox, dilation, or surgery
A corkscrew appearance on barium study should make you think of what diagnosis?
Epigastric abdominal pain which radiates to the back should make you think of what diagnosis?
In order to contract Hep D what must you already have?
Left lower quandrant pain and tenderness should make you think of what diagnosis?
What is the treatment for most Mallory-Weiss tears?
Watchful waiting, these will typically reslove within 48 hours
Thumbprint sign on abdominal film should make you think of what diagnosis?
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 patient has had GERD for years. Over the past year he has noticed an increase in difficulty swallowing his food. This should make you think of what diagnosis?
What are two treatments you should consider for esophageal strictures?
Dilation of the esophagus and long term PPIs.
What are two common predisposing factors for esophageal varices?
Portal HTN and cirrhosis often caused by alcoholism
What is a common symptom that goes along with chest pain for GERD patients?
What medication is most commonly used for long term treatment of GERD?
Proton pump inhibitors - omeprazole, lansoprazole, pantoprazole
What is the imaging of choice for pancreatitis?
What is the best test to check for H. pylori?
Urea breath test
Is peptic ulcer disease more common in the duodenum or the stomach?
What is the most common location for a pancreatic tumor?
75% occur in the head of the pancreas
With a gastric ulcer are the patient's symptoms exacerbated or relieved with food?
Fasting gastrin will be above what level with gastrinoma?
Projectile vomiting should make you think of what diagnosis?
Most gallstones are made of what substance?
What is the name of the sign when a patient shows inhibited inspiration with pressure over the RUQ? What diagnosis does it suggest?
Murphy's sign, cholecystitis
What is the most specific test for acute cholecystitis
What is the gold standard for diagnosis and treatment of bile duct stones?
What is Charcot's triad?
What is Reynold's pentad and why does it matter?
Charcot's triad (RUQ pain, fever, jaundice) PLUS
Altered mental status
It indicates high risk of sepsis
What disease is defined as an immunologic response to gluten?
What is the main risk factor for esophagitis?
An endoscopy for presumed esophagitis shows multiple shallow ulcers. What is the most likely diagnosis?
Herpes simplex virus
List two common offending agents for pill induced esophagitis?
A 30 year old AA woman presents with dysphagia. You notice she also has thickented skin. A barium swallow demonstrates the absence of peristalsis. What is the most likely diagnosis?
A patient complains of regurgitating undigested food several hours after a meal. What is the most likely diagnosis?
What is the most common cause of peptic ulcer disease?
What is the most specific diagnositic test for peptic ulcer disease?
What is the only curative therapy for gastric adenocarcinoma?
A patient presents complaining of right upper quadrant pain 20 min after meals. What is the most likely diagnosis?
What does ERCP stand for?
Endoscopic retrograde cholangiopancreatography
What is the most common cause of acute bacterial cholangitis?
Onion ring fibrosis from a bile duct biopsy should make you think of what diagnosis?
primary sclerosing cholangitis
What two viral hepatitis infections are self limiting?
Hep A and Hep E
Pica is often related to what type of anemia?
Iron deficiency anemia
What does an Anti-HBc (hep B core antibody) indicate?
Previous or ongoing hep B infection
What is the recommended treatment for Hep C infection?
Pegylated interferon alpha-2
What medication used in Hep B infection helps prevent the need for liver transplant?
There are vaccines for which two versions of hepatitis?
Hep A and Hep B
Will a patient with achalasia have dysphagia to liquids, solids, or both?
If you have heartburn that does not improve with medication what is the most likely diagnosis?
What are the two main complications of cirrhohsis?
Portal HTN and liver insufficiency
What is a good beta blocker is reduce portal HTN?
What tumor marker may be used for liver cancer?
What are the two most common causes of pancreatitis?
Cholelithiasis and ETOH
Describe Cullen's sign
Umbilical ecchymosis often related to pancreatitis
What are the 5 points of Ranson's criteria on admission?
Older than 55
What is the first step in treating GERD
Steatorrhea should make you think of what diagnosis?
Describe Courvoisier's sign
Nontender, palpable gallbladder which may indicate pancreatic neoplasm
What tumor maker can be used to follow pancreatic cancer?
A patient complains of periumbilical pain which has now moved over McBurney's point. What is the most likely diagnosis?
Describe how to perform the psoas sign
The patient is supine and attempts to raise right leg against resistance
What is the term for paiful swallowing
Describe how to perfomr the obturator sign
The patient is supine and attempts to flex and internally rotate right hip
What is the best imaging study for acute appendicitis?
What two blood test can be used to diagnose celiac?
IgA endomysial antibody and IgA tTG antibody
How much fiber should you normall get in a day?
about 30 grams
What treatment should be started for asymptomatic diverticulosis?
Is surgery curative for Crohn's or ulcerative colitis?
What causes Mallory-Weiss tears?
Forced vomiting or retching
A colonoscopy that shows cobblestone or skip lesions should make you think of what diagnosis?
What class of medication is first liine to treat inflammatory bowel disease in the maintenance phase?
5- ASA products- sulfasalazine, mesalamine
Currant jelly stool should make you think of what diagnosis?
Severe abdominal pain 30 min after a meal should make you think of what diagnosis?
What is the MC cause of lower GI bleed?
What is the MC location of colorectal cancer?
Cecum about 38%
Colorectal cancer patients are almost all older than what age?
90% of patients are older than 50
An epigastric olive-shaped mass should make you think of what diagnosis?
An elevated serum amylase and lipase should make you think of what diagnosis?
Under routine circumsnances when should patients begin getting screening diagnosis?
What is the #1 cause of small bowel obstruction?
Air fluid levels on abdominal x-ray should make you think of what diagnosis?
Which is more likely to pass into the scrotum, a direct OR indirect hernia?
A string sign on barium swallow should make you think of what diagnosis?
What is the first line of treatment for an anal fissure?
Fluid and fiber
What are two things that an anal fissure off midline might suggest?
What medical treatment is given for a gastrinoma?
What is the term for an abscess in the sacrococugeal cleft?
How do you treat an H. pylori infection?
PPI + 2 antibiotics, commonly
Omeprazole + clarithromycin and amoxicillin
PPI + metronidazole + tetracycline
Painless bright red blood per rectum should make you think of what diagnosis?
A patient on sulfasalazine for an inflammatory bowel disease should be supplemented with what vitamin?
What is the most common anorectal problem affecting patients over 50?
A gastrinoma is also known as what syndrome?
Salivary amylase breaks down as what macronutrient?
What is the medical term for feeling like there is a lump in your throat?
What is the most common vessel blocked with intestinal ischemia?
Superior mesenteric artery
Describe Grey-Turner's sign
Flank ecchymosis often realated to pancreatitis
What are the first three steps of managing pancreatitis?
A patient presents with unproductive retching, acute localized epigastric distention, and inability to pass a nasogastric tube. What is the most likely diagnosis?
What is the MC cause of a folate deficiency?
Should diverticulitis always be admitted?
No, mild cases can be treated as outpatients with rest and clear fluids
Which NSAID has the highest rate of peptic ulceration?
What is the diagnositic test of choice for Zenker's diverticulum?
Barium swallow will show the diverticulum
What is the leading cause of iron deficiency anemia?
Chronic GI bleed
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
How often should patients with pernicious anemia have a screening endoscopy performed?
Every 5 years looking for signs of gastric carcinoma
Are one half of all adult hernias direct or indirect inguinal hernias?
Indirect inguinal hernias make up 50% of all adult hernias
How is celiac disease most commonly diagnosed
Niacin (B3) deficiency
An endoscopy for presumed esophagitis shows several solitary deep ulcers. What is the most likely diagnosis?
Which are more painful, hemorrhoids above or below the dentate line?
Below, internal hemorrhoids are not painful
An abodominal exam with pain out of proportion to the exam should make you think of what diagnosis?
Does adenocarcinoma arise from the proximal or distal esophagus?
A 6 year old boy seems to have all of the symptoms of ADD while at school, but at home he has no problems. Does he have ADD?
No, symptoms must occur in both settings for diagnosis
An 18 month old is not yet speaking. He does not point to objects. He does not make eye contact with others. What is the most likely diagnosis?
List three positive symptoms of schizophrenia
When is the typical onset of Tourette's syndrome?
3-8 year olds
Is anorexia egosyntonic or ego-dystonic? What about bulimia?
Anorexia is egosyntonic
Bulimia is ego-dystonic
List the three cluster A personality disorders
A 16 year old has just moved schools. He is quiet, moody, and not like himself at all. Within six months he seems to have completely changed back to his previous personality. What is the most likely diagnosis?
You have a patient with major depressive disorder. Once his symptoms have completely resolved how long should you continue with treatment?
A six month minimum is recomended due to very high relapse rates
What medication is often used to treat postpartum depression in a woman who is braest feeding?
A patient has very strange magical thinking. What is the most likely diagnosis?
Schizotypal personality disorder
List four symptoms of serotonin syndrome
Mental status change
What is the term for a chronic mild depression which has lasted greater than two years?
What is necessary to diagnose a patient with bipolar I?
One manic episode.
They do not have to have the depressive episode for the diagnosis.
What is the major concern with using lithium?
It has a very narrow therapeutic window. Blood tests are needed every four weeks.
A patient believes that her 15 year old daughter is sleeping with the mailman. She has no evidence of this. She has confronted her daughter who denies it. It is not interfering with her daily activities, but she does spend time thinking about it. What is the most likely diagnosis?
At what BMI should a patient be hospitalized for anorexia?
BMI of <17.5 OR 20% below appropriate body weight
What is the term for being afraid of being out in a terrible situation with no help available?
Borderline personality disorder is on the border of what two psychological disorders?
Neurosis and psychosis
Waxy flexibility should make you think of what diagnosis?
How long before normal grief resolves?
about one year
A patient of yours always craves attention, often using sex as a tool to gain it. She often acts like a c hild when she does not get what she wants. What is the most likely diagnosis?
Histrionic personality disorder
To be diagnosed with ADD patients must exhibit symptoms before what age?
7 years old
What is Russell's sign?
Abraded knuckles from forcing oneself to vomit
How long must symptoms occur before diagnosing schizophrenia?
At least 6 months
Posturing should make you think of what diagnosis?
A patient complains of acute paralysis in his left arm. This does not seem to bother him, but his wife made him come in. There was no traumatic event. A complete neurologic workup is negative. What is the most likely diagnosis?
A psychiatric patient presents with confusion, fever, and lead pipe rigidity. What is the most likely diagnosis?
Neuroleptic malignant syndrome, this can occur with high dose antipsychotics
A patient is very concerned that she has breast cancer. In order to reassure her you perform a full workup which is negative. She is still unsatisfied and convinced that she has breast cancer. What is the most likely diagnosis?
What is the time fram for the first symptoms of withdrawl from alcohol?
Tremor in 8-18 hours
How do you treat alcohol withdrawl?
List the four cluster B personality disorders
List the two cluster C personality disorders
What medication is clearly contraindicated in anorexia and bulimia?
Bupropion (Wellbutrin) because it can incerase risk of seizures and it can cause weight loss
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
A patient's mother has recommended that he see you. He lives on his own and is a computer programmer. He works from home. He has no friends and seldom leaves the house. She is concerned that he expresses no interest in meeting people and seems perfectly happy to be home alone all the time. What is the most likely diagnosis?
Schizoid personality disorder
Name three SSRI's
A patient expresses concern that he can't trust anyone. That everyone is out to get him, and his problems are all the faults of others. He has held very long grudges due to perceived past wrongs. What is the most likely diagnosis?
Antisocial personality disorder
Antisocial personality disorder may not be diagnosed until what age?
18 years old
A patient exhibits all of the characteristics of antisocial personality disorder, but he is only 14 years old. What is the most likely diagnosis?
A patient exhibits splitting, seeing others as all good or all bad. What is the most likely diagnosis?
Borderline personality disorder
What type of behavior therapy works best for borderline patients?
Dialectical behavoir therapy
A patient is arrogant with an inflated self image. He feels he is special and should be treated that way. What is the most likely diagnosis?
Narcissistic personality disorder
Is obsessive compulsive disorder egosyntonic or ego-dystonic? What about obsessive compulsive personality disorder?
OCD is ego-dystonic
OCPD is egosyntonic
What two things are needed to make a diagnosis of bipolar 2?
One major depressive episode and one hypomanic episode
What medication is a good place to start treating bipolar 1 or 2?
How is acute stress disorder different than posttraumatic stress disorder?
Acute stress disorder occurs within 1 month of event and resolves within about a month. PTSD begins at about 1 month after event and can last indefinitely.
A spiral fracture should make you think of what diagnosis?
Abuse, either child or elder
During an interveiew a patient states "I have been anxious for as long as I can remember". This statement should make you think of what diagnosis?
Generalized anxiety disorder
Are hallucinations normal during a normal grieving period?
Yes, as long as they are not persistent or intrusive
Calf pain should make you think of what diagnosis?
Where is disease of the tricuspid valve best heard?
Along the left lower sternal border
Are ulcers from arterial insufficiency painful or painless?
Both lead I and AVF have positive QRS complexes. Does this represent normal axis, left axis deviation, or right axis deviation?
What medication might you switch to if a patient develops an intolerable cough on an ACEI?
Angiotensin receptor blocker (ARBs)
A boot-shaped heart with CXR should make you think of what diagnosis?
Tetralogy of Fallot
You are counting boxes from the peak of a QRS wave on an EKG in order to determinee the heart rate. What would the heart rate be if the next QRS wave peak were three boxes away? What numbers are associated with the first five boxes?
The answer is 100, the heart rates by counting boxes are 300, 150, 100, 75, 60
A U wave on EKG should make you think of what diagnosis?
What will the heart rate be if the AV node is pacing the heart?
40-60 beats per minute
Which cardiact medication has gynecomastia in its side effects profile?
Lead I has a QRS that is up and the AVF lead as a QRS complex that is down. Does this represent normal axis, left axis deviation, or right axis deviation?
Left axis deviation
An Osborne or J wave on EKG should make you think of what diagnosis?
What is the first line medication for a patient with symptomatic bradycardia?
What is the heart rate for tachycardia? How about bradycardia?
On EKG there is an early but otherwise normal PQRS complex. After that beat there is a slight pause and then a normal rhythm continues. What is the term for this one beat?
Premature atrial contraction
How do you treat polymyalgia rheumatica?
Low does prednisone
What is the management of a patient in supraventricular tachycardia?
Vagal maneuvers, carotid massage, adenosine
What is the first medication you should give for atrial flutter?
An 82 year old pateint complains of headache and jaw claudication. What is the most likely diagnosis?
Giant Cell (temporal) arteritis
The EKG shows irregularly irregular narrow QRS waves. What diagnosis should you be thinking of?
An EKG shows a regular rate of 50 beats per minute. The QRS is narrow and there is no visible P wave. What is the most likely diagnosis?
Name a common cause of a junctional rhythm
An EKG shows two premature ventricular contractions. These two QRS waves look very different. What is the term for this?
Multifocal premature ventricular contractions
What is the MC cause of sudden cardiac death?
A patient in the ER has no pulse, but on EKG there are wide irregular "complexes" which are at an irregular rate. They all appear very different from one another. What is the treatment for this patient?
He is in ventricular fibrillation. The treatment is defibrillation
Tall peaked T waves should make you think of what diagnosis?
How do you define 1st degree AV block?
The PR interval is longer than 0.2 seconds or one block on EKG
What is the other term for Mobitz type I
What is the most important complicaiton of giant cell arteritis?
What two labs do you want to monitor in a patient on an ACEI?
Serum creatinine and serum potassium
The heart rate is irregular so you can't count the boxes between QRS waves to determine heart rate. What is another method you can use to determine rate on an EKG?
Count QRS waves in a six second strip and multiply by 10 to get beats per minute
What is the treatment for a patient with a Mobitz II AV block?
You see regular P waves and regular QRS complexes, but they do not seem to have any correlation to each other. What is the diagnosis?
Third degree AV block
Name one aldosterone antagonist
You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?
What two leads do you use to determine the axis of the heart?
Lead I and AVF
An RSR prime in leads V5 and V6 should make you think of what diagnosis?
Left bundle branch block
Which finding requires immediate attention, left bundle branch block or right bundle branch block?
New left bundle branch block is a STEMI equivalent. Right bundle branch block is usually not a problem
What medication class is used to lower triglycerides?
Fibric acid derivatives
Tall peaked P waves should make you think of what diagnosis?
Right atrial enlargement
List two causes of right atrial enlargement:
Severe lung disease
Pulmonary valve stenosis
Which EKG leads are used to diagnose an anterolateral MI?
V5 and V6
What are the three inferior leads?
II, III, and aVF
A blockage of which artery causes a lateral wall MI?
Left circumflex artery
What is represented by ST segment depressions greater than 1mm on EKG?
Rheumatic fever most commonly affects which valves?
What is the only cyanotic congenital heart disease on the NCCPA blueprints?
Tetralogy of Fallot
On EKG there is an early wide QRS complex with no associated P wave. After that beat there is a slight pause and then a normal rhythm continues. What is the term for this one beat?
Premature ventricular contraction
What is the definitive treatment for a patient with recurrent ventricular tachycardia?
On an EKG you notice a patient has a gradually lengthening PR interval and then a missed QRS complex. The pattern repeats again. What type of AV block is this?
Mobitz I or Wenckebach
List three side effects of digoxin
Arrhythmias (sinus brad, AV block)
What is the first line medical treatment for torsades de pointes?
An increase in Alk Phos can indicate what two things?
Biliary duct blockage
What lab should you check for your patients on lipitor?
Three main causes of fever in adults:
Connective tissue disease
Clinical complications that occur as result of fluid and electrolyte shifts during nutritional rehab of malnourished patients:
What is the lab hallmark of refeeding syndrome?
Ascitic fluid infection without an evident intra-abdominal surgically treated source:
Spontaneous bacterial peritonitis
Indications for dialysis:
Sudsy/foamy urine indicates increased levels of:
Autoimmune destruction of AcH receptors:
Symptoms increase with activity for this autoimmune disorder
Sudden unilateral paroxysms of pain in gums, cheek, chin, and temporal forehead:
Congo red stain with apple-green bifringements:
Prussion blue iron stains;
Always suspect _____ in a patient with a wide (>.12 sec) QRS tachycardia:
The name for PID that becomes ascending cholangitis:
Fitz Hughes Curtis
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