PACKRAT Exam Questions with 100% Correct Answers | Verified | Updated 2024, Exams of Advanced Education

Download PACKRAT Exam Questions with 100% Correct Answers | Verified | Updated 2024 and more Exams Advanced Education in PDF only on Docsity! PACKRAT Exam Questions with 100% Correct Answers | Verified | Updated 2024 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? - Correct Answer-Adjustment disorder What is the prophylactic antibiotic most commonly given before a dental procedure if one is necessary? - Correct Answer-Amoxicillin 2 grams po 1 hour before procedure Wilson's disease is associated with a build up of what mineral? - Correct Answer-There is a deficiency of the copper binding protein and therefore a buildup of copper. Name one oral medication that can be used for MRSA. - Correct Answer-Linezolid (Zyvox) and Bactrim pg. 1 professoraxe l Which cardiac medication is used to help with cardiac contractility after you have optimized most of the other cardiac medications? - Correct Answer-Digoxin What medication used in hepatitis B infection helps prevent the need for liver transplant? - Correct Answer-Lamivudine How is celiac disease most commonly diagnosed? - Correct Answer-Endoscopic biopsy Mononucleosis 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? - Correct Answer-Wernicke's aphasia A patient presents with what appears to be an inability to understand speech. Which aphasia should be at the top of your differential? - Correct Answer-It is blood in the joint indicating a fracture even if the fracture line cannot be seen. A fat pad sign on a lateral x-ray of the elbow has what significance? - Correct Answer-It is blood in the joint indicating a fracture even if the fracture line cannot be seen. pg. 2 professoraxe l What is the major concern with using lithium? - Correct Answer-It has a very narrow therapeutic window. Blood tests are needed every four weeks. List the four most common places lung cancer will metastasize to. - Correct Answer-Bone, brain, adrenals and liver What is the main risk factor for esophagitis? - Correct Answer- Immunocompromised patient 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? - Correct Answer-Junctional rhythm List two diagnoses which require antibiotic prophylaxis for "dirty procedures?" - Correct Answer-Prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congential cyanotic heart defect Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work? - Correct Answer-No, a recent pg. 5 professoraxe l change moves mitral valve prolapse from high risk to moderate risk. A pregnant woman and cat litter should make you think of what diagnosis? - Correct Answer-Toxoplasmosis What two valvular issues do patients with Marfan's syndrome often have? - Correct Answer-Aortic regurgitation and mitral valve prolapse (you can tell them apart by where they are heard). What is the most common cause of sudden cardiac death? - Correct Answer-Ventricular fibrillation A positive straight leg test indicates what diagnosis? - Correct Answer-Herniated disc What two psychiatric issues are more common in males than females? - Correct Answer-Autism and ADD, the rest are all either equal or more common in females. How long must symptoms last before diagnosing ADD? - Correct Answer-6 months pg. 6 professoraxe l What are the two most common organisms responsible for cellulitis? - Correct Answer-Strep and Staph Does total lung capacity go up or down in COPD? What organism causes Lyme disease? - Correct Answer-It goes up. What organism is most commonly responsible for community acquired pneumonia? - Correct Answer-Borrelia burgdorferi An EEG showing focal rhythmic discharges at the onset of the seizure should make you think of what diagnosis? - Correct Answer-Strep pneumoniae What is the normal range for MCV? - Correct Answer-Simple partial seizure A patient's lab work shows positive Smith antibody and positive double-stranded DNA antibodies. What is the most likely diagnosis? - Correct Answer-80-100 Lupus pg. 7 professoraxe l Name the condition in which the head of the penis curves downward or upward, at the junction of the head and shaft of the penis. (Hint: It is often associated with hypospadias.) - Correct Answer-Chordee Acute sinusitis is most commonly caused by which two pathogens? - Correct Answer-Strep pneumoniae and haemophilus influenzae A physical exam finding of egophony should make you think of what diagonsis? - Correct Answer-Lobar pneumonia A patient presents with erectile dysfunction and complains of some numbness in his feet. On second thought he has noticed significant polyuria and polydipsia. What diagnosis should you be thinking of? - Correct Answer-Diabetic neuropathy What percentage of diabetes in the US is type 2? - Correct Answer-80-90% What is the treatment for pneumocystis jiroveci pneumonia? - Correct Answer-Bactrim pg. 10 professoraxe l What will the bowel sounds be early on in a small bowel obstruction? What will they be later on? - Correct Answer- Early they are hyperactive. Late they are absent. A feathery border in an eye exam should make you think of what diagnosis? - Correct Answer-Fungal infection List six medications that can be used for migraine prophylaxis? - Correct Answer-Beta blockers, tricyclics, calcium channel blockers, NSAIDs and valproic acid What is the #1 cause of retinal artery occlusion? - Correct Answer-Carotid atherosclerotic disease. What is the formula for calculating estimated date of confinement or due date? - Correct Answer-First day of last menstrual period + 7 days - 3 months The pap smear results on a 23 year old patient come back as atypical squamous cell uncertain significance (ASCUS). What is your next step? - Correct Answer-Repeat pap smear in 12 months although HPV test is acceptable. pg. 11 professoraxe l What causes Mallory-Weiss tears? - Correct Answer-Forced vomiting or retching (often involving alcohol) Ghon or Ranke complexes on CXR should make you think of what diagnosis? - Correct Answer-TB During pregnancy which is the prefered treatment of hyperthyroidism PTU or methimazole? - Correct Answer-PTU What are three causes for a postpartum hemorrhage? - Correct Answer-Uterine atony, genital laceration, retained placenta What is the name of the test for dry eyes? - Correct Answer- Schirmer's test Will serum potassium be decreased or elevated in renal failure? - Correct Answer-Elevated pg. 12 professoraxe l What two leads do you use to determine the axis of the heart? - Correct Answer-Lead I and AVF What is the other term for Mobitz type I? - Correct Answer- Wenckebach List three possible treatments for stress incontinence in women. - Correct Answer-Kegels, estrogen therapy, surgical placement of a urethral sling A patient presents with unproductive retching, acute localized epigastric distention and inability to pass a nasogastric tube. What is the most likely diagnosis? - Correct Answer-Gastric volvulus How do you treat amebiasis? - Correct Answer-Metronidazole (Flagyl) Alcohol may be a major factor in which encephalopathy? - Correct Answer-Wernicke's pg. 15 professoraxe l List the three diagnosis you should be thinking of if a question includes Heinz bodies. - Correct Answer-G6PD deficiency anemia, chronic liver disease, alpha thalassemia A patient presents complaining of the worst headache of his life. What might you expect their blood pressure to be? - Correct Answer-Typically this is the description for a subarachnoid hemorrhage. You would expect the blood pressure to be elevated. What is the best patient position to hear aortic regurge and aortic stenosis? - Correct Answer-Sitting up and leaning forward List the six P's of an ischemic limb. - Correct Answer-Pain, paresthesias, pallor, pulselessness, poikilothermia, paralysis Fasting gastrin will be above what level with gastrinoma? - Correct Answer->150 pg/ml How do you treat a Trichomonas infection? - Correct Answer- Metronidazole pg. 16 professoraxe l A Gram-positive organism in clusters should make you think of what diagnosis? - Correct Answer-Staph What is the most common cause of postpartum hemorrhage? - Correct Answer-Uterine atony An HIV patient with ground glass appearance on CXR should make you think of what diagnosis? - Correct Answer- Pneumocystis jiroveci pneumonia (PJP used to be know as PCP) Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis? - Correct Answer-CHF Pale and boggy nasal mucosa should make you think of what diagnosis? - Correct Answer-Allergic rhinitis Shortness of breath What is the most common patient complaint with emphysema? - Correct Answer-Conversion disorder A patient complains of acute paralysis in his left arm. This does not seem to bother him, but his wife made him come in. pg. 17 professoraxe l A child with a fever lasting longer than five days should make you think of what diagnosis? - Correct Answer-Kawasaki syndrome Which heart valve is most associated with rheumatic fever? - Correct Answer-Mitral What is the most common precipitating event for posttraumatic stress disorder in women? - Correct Answer- Rape Hampton's hump on CXR should make you think of what diagnosis? - Correct Answer-Pulmonary embolism Forchheimer spots are associated with what disease? - Correct Answer-Rubella 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? - Correct Answer-Ewing sarcoma pg. 20 professoraxe l What ligament is most commonly injured in an ankle sprain? - Correct Answer-Anterior talofibular ligament (ATFL) What is the treatment for epiglottitis? - Correct Answer-2nd or 3rd generation cephalosporin (ceftriaxone), macrolides may also be used (clindamycin) In Cushing's disease is ACTH elevated or decreased? - Correct Answer-Elevated What is the #1 cause of small bowel obstruction? - Correct Answer-Postoperative adhesions What Rh combination for mom and dad might cause the mother to create antiboides against the baby's red blood cells? - Correct Answer-Mom Rh-negative and dad Rh- positive Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions? - Correct Answer-Osler nodes What is the most common prophylactic antibiotic used preoperatively? - Correct Answer-Cefazolin = Ancef, Keflex = Cefalexin, The answer is Cefazolin (Ancef) pg. 21 professoraxe l What will an x-ray show in acute osteomyelitis? - Correct Answer-Nothing - it will show bone destruction in chronic osteomyelitis. You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis? - Correct Answer- Transesophageal echo As it relates to diabetics, what is the dawn phenomenon? - Correct Answer-Reduced insulin response between 5 and 8 am If you hear crackles in the lung fields list three pulmonary issues that should be in your differential. - Correct Answer- Pneumonia, fibrosis, CHF, Bronchitis A pathology report comes back showing negatively birefringent crystals. What is the most likely diagnosis? - Correct Answer-Gout Cottage cheese discharge should make you think of what diagnosis? - Correct Answer-Vaginal candidiasis pg. 22 professoraxe l What is the appropriate treatment for a patent ductus arteriosus. - Correct Answer-Indomethacin What is the term for difficulty swallowing? - Correct Answer- Dysphagia An RSR prime in leads V1 or V2 should make you think of what diagnosis? - Correct Answer-Right bundle branch block What is the age range for osteosarcoma? Where are they most typically found in the body? - Correct Answer-"Osteosarcoma usually occur in 15-25 year old males and are most commonly found around the knee." What medication is used to increase surfactant levels and help with lung maturity if you are worried about preterm labor? - Correct Answer-Betamethasone What is the most specific diagnostic test for peptic ulcer disease? - Correct Answer-Endoscopy pg. 25 professoraxe l 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 diagnosis? - Correct Answer-Secondary syphilis. This is the most contagious stage. A patient presents with watery bilateral discharge from the eyes and nontender preauricular adenopathy. What is the most likely diagnosis? What is the most common pathogen? - Correct Answer-Viral conjunctivitis, adenovirus What is the first line treatment for pertussis? - Correct Answer-Erythromycin A patient presents with a painful ipsilateral third nerve palsy. What is the most likely diagnosis? - Correct Answer-Posterior communicating artery aneurysm (PComA) Your attending asks you to come and see an excellent example of Hutchinson's sign. What diagnosis does the patient have? - Correct Answer-Herpes zoster ophthalmicus pg. 26 professoraxe l After 7 days of sinusitis what antibiotic would you start? - Correct Answer-Amoxicillin or Bactrim Is anorexia egosyntonic or ego-dystonic? What about bulimia? - Correct Answer-Anorexia is egosyntonic. Bulimia is ego- dystonic. What is the most common cause of CHF? - Correct Answer- Coronary artery disease What antibiotic class is the class of choice for chlamydia? - Correct Answer-Macrolides A surge in what hormone leads to ovulation? - Correct Answer-Luteinizing hormone As part of the antepartum testing a baby has a positive stress test. What does that mean? - Correct Answer-They have had two heart rate accelerations in a 20 minute period of 15 beats above baseline for at least 15 seconds. This is a good thing. What organism is the most common cause of pneumonia in a patient with cystic fibrosis? - Correct Answer-Pseudomonas pg. 27 professoraxe l What two viral hepatitis infections are self limiting? - Correct Answer-Hepatitis A and hepatitis E What is the most common organism that causes a bladder infection? - Correct Answer-E. coli Where are Heberden's nodes found? - Correct Answer-Distal interphalangeal joint (DIP) What is the leading cause of iron deficiency anemia? - Correct Answer-E. coli 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? - Correct Answer-BPH What is the most common fracture in a patient with osteoporosis? - Correct Answer-A compression fracture of a vertebral body followed by hip fractures. pg. 30 professoraxe l At approximately how many weeks pregnant is the uterus at the level of the umbilicus? - Correct Answer-20 weeks Following a myocardial infarction, what medication should you be using to treat hypertension? - Correct Answer-Beta blocker 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? - Correct Answer-Histoplasmosis Since a genetic cause is the number one reason for primary amenorrhea what is one very important test? - Correct Answer-Karyotype "What is the name for the triangular or wedge shaped growth on the conjunctiva that may interfere with vision?" - Correct Answer-Pterygium Scleroderma limited version has five main characteristics for which the CREST acronym is often used. What are those five things? - Correct Answer-Calcinosis, Raynaud's, esophageal dysmotility, Sclerodactyly, Telangiectasia pg. 31 professoraxe l What CXR finding might make you think of mesothelioma? - Correct Answer-Pleural thickening, remember 80% are found in the pleura lining You recommend bisphosphonates for a patient with osteoporosis. What instruction do you give her for immediately after taking the medication? - Correct Answer- Remain upright for 30 minutes With a gastric ulcer are the patient's symptoms exacerbated or relieved with food? - Correct Answer-Exacerbated Which EKG leads are used to diagnose an anterior wall MI? - Correct Answer-V1, V2 and V3 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? - Correct Answer-Pericarditis A 45 year old female complains of feeling the ground rolling under her feet at times. What is the most likely diagnosis? - Correct Answer-Vertigo pg. 32 professoraxe l Does FEV1 go up or down with asthma? - Correct Answer-It goes down A biphasic P wave should make you think of what diagnosis? - Correct Answer-Left atrial enlargement What is the treatment for a tetanus infections? - Correct Answer-Penicillin, immune globulin and supportive care (especially respiratory support) What are the genetic characteristics of Wilson's disease? - Correct Answer-Autosomal recessive, chromosome 13 How does metformin work? - Correct Answer-Decreases the hepatic glucose production and increases peripheral glucose uptake Where is disease of the tricuspid valve best heard? - Correct Answer-Along the left lower sternal border pg. 35 professoraxe l Giant cells on a Tzanck smear should make you think of what diagnosis? - Correct Answer-Herpes simplex virus A positive Finkelstein's test indicates what diagnosis? - Correct Answer-de Quervain's tenosynovitis You have a patient with diagnosis of a pheochromocytoma. While waiting for surgery, should you use an alpha blocker or a beta blocker? - Correct Answer-Alpha blocker. You should never use a pure beta blocker. What medication is used for patients with lupus? - Correct Answer-Systemic steroids Bloody stool with cysts and trophozoites should make you think of what diagnosis? - Correct Answer-Amebiasis Pearly dome-shaped lesion with a central umbilication should make you think of what diagnosis? - Correct Answer- Molluscum contagiousum pg. 36 professoraxe l What is the x-ray finding that supports diagnosis of a slipped capital femoral epiphysis? - Correct Answer-Ice cream falling of the cone An opening snap on auscultation of the heart should make you think of what diagnosis? - Correct Answer-Mitral Stenosis Eggshell opacities on the CXR should make you think of what diagnosis? - Correct Answer-Silicosis How much fiber should you normally get in a day? - Correct Answer-About 30 grams How long must symptoms occur before diagnosing schizophrenia? - Correct Answer-At least six months What is the normal pH of the blood? - Correct Answer-7.35- 7.45 To be diagnosed with ADD patients must exhibit symptoms before what age? - Correct Answer-7 years old pg. 37 professoraxe l Vision loss described as curtain coming down should make you think of what diagnosis? - Correct Answer-Retinal detachment Carpal tunnel affects what nerve and what parts of the hand? - Correct Answer-Median nerve. Thumb, pointer and ring fingers. Thenar wasting is sign of advanced disease. Define phimosis. - Correct Answer-Foreskin can not be retracted. An HIV patient presents with a nonproductive cough and a CXR showing diffuse interstitial infiltrates. What is the most likely diagnosis? - Correct Answer-Pneumocystis jiroveci pneumonia (PCJ) formerly known as Pneumocystis pneumonia (PCP) Do loop diuretics cause hyperkalemia or hypokalemia? - Correct Answer-Hypokalemia White blood cell casts should make you think of what diagnosis? - Correct Answer-Pyelonephritis pg. 40 professoraxe l A young boy comes into your office. He has elevated blood pressure when taken in his arm, but no femoral pulses can be palpated. What is the most likely diagnosis? - Correct Answer- Coarctation of the aorta Oral herpes is best treated with systemic or topical antivirals? - Correct Answer-Topical is the first line. Systemic antivirals will help but are only indicated for severe cases. What medication class is used to lower triglycerides? - Correct Answer-Fibric acid derivatives List the four cluster B personality disorders. - Correct Answer- Bad antisocial, borderline, histrionic and narcissistic An 82 year old patient complains of headaches and jaw claudication. What is the most likely diagnosis? - Correct Answer-Giant cell (temporal) arteritis What specific breathing pattern is associated with diabetic ketoacidosis? - Correct Answer-Kussmaul respirations pg. 41 professoraxe l What is Reynold's pentad and why does it matter? - Correct Answer-Charcot's triad + hypotension + altered mental status. It indicates high risk of sepsis. What class of antibiotics is sometimes prescribed specifically for its effects on increasing GI motility? - Correct Answer- Macrolides A Gram-negative coccobaccili found in the sputum of patient with pneumonia should make you think of what diagonsis? - Correct Answer-Kussmaul respirations A patient presents to the ER in acute CHF. What drug class will likely be the first choice? - Correct Answer-Loop diuretics Define priapism - Correct Answer-Painful persistent erection Are ulcers from arterial insufficiency painful or painless? - Correct Answer-Painful An African American female presents with malar rash and a positive double-stranded DNA antibody. What is the most likely diagnosis? - Correct Answer-Lupus pg. 42 professoraxe l What is the medical term for lazy eye? - Correct Answer- Amblyopia What tests are done to screen for HIV? - Correct Answer-ELISA and then if the positive diagnosis is confirmed with a Western blot test A herald patch should make you think of what diagnosis? - Correct Answer-Pityriasis rosea Oseltamivir (Tamiflu) may be given to children above what age? - Correct Answer-1 year old A 30 year old female presents with pustules on her face that spare the vermilion border. In her history she has been using topical steroids. What is the most likely diagnosis? - Correct Answer-Perioral dermatitis What does ERCP stand for? - Correct Answer-endoscopic retrograde cholangiopancreatography pg. 45 professoraxe l Define pellagra? - Correct Answer-Niacin (B3) deficiency Cytomegalovirus Where is disease of the mitral valve best heard? - Correct Answer-At the apex At how many weeks of pregnancy can chorionic villus sampling be done? - Correct Answer-10-13 weeks What is the most common infection following a C-section? - Correct Answer-Metritis You have a patient with PCOS who would like to get pregnant. What are two medications you may start her on? - Correct Answer-Metformin and Clomid What is the most useful physical exam test for diagnosing an ACL tear? - Correct Answer-Lachman's, followed by anterior drawer The term Philadelphia chromosome should make you think of what diagnosis? - Correct Answer-Chronic myeloid leukemia pg. 46 professoraxe l What two lung cancers are typically found centrally on CXR? - Correct Answer-Small cell and squamous cell Honey and babies should make you think of what diagnosis? - Correct Answer-Botulism Anatomically where are 80% of clavicle fractures located? - Correct Answer-Middle third What molecule binds iron in the blood stream? - Correct Answer-Transferrin What is the medical term for cross-eyed? - Correct Answer- Strabismus Fruity breath should make you think of what diagnosis? - Correct Answer-Diabetic ketoacidosis An RSR prime in leads V5 or V6 should make you think of what diagnosis? - Correct Answer-Left bundle branch block pg. 47 professoraxe l Currant jelly stool should make you think of what diagnosis? - Correct Answer-Intussusception Melasma is most often found in what patient population? - Correct Answer-Women of childbearing age Paradoxical pulses may be found in what pulmonary disorder? - Correct Answer-Asthma Currant jelly stool should make you think of what diagnosis? - Correct Answer-Intussusception A barrel chest should make you think of what diagnosis? - Correct Answer-Emphysema A physical exam revealing a retroverted uterus or uterosacral ligament nodularity should make you think of what diagnosis? - Correct Answer-Endometriosis Dullness to percussion should make you think of what diagonsis? - Correct Answer-Lobar pneumonia pg. 50 professoraxe l A positive Auspitz sign should make you think of what diagnosis? - Correct Answer-Psoriasis What is the best test for diagnosing Rocky Mountain spotted fever? - Correct Answer-Indirect immunofluorescent antibodies A dendritic lesion is seen with fluorescein stain. What is the most likely diagnosis? - Correct Answer-Herpes keratitis A fluid filled painless mass found in the scrotum which transilluminates should make you think of what diagnosis? - Correct Answer-Hydrocele Tea-colored urine with red cell casts should make you think of what diagnosis? - Correct Answer-Glomerulonephritis When is watchful waiting with a diagnosis of acoustic neuroma an appropriate plan? - Correct Answer-This tumor is very slow growing. Watching a small tumor in an elderly patient is appropriate treatment. pg. 51 professoraxe l Strict vegans are at risk for what type of anemia? - Correct Answer-B12 deficiency anemia What are the most common colors lost in color blindness? - Correct Answer-Red and green 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? - Correct Answer-Central vein occlusion What might happen if you infuse vancomycin too fast? - Correct Answer-Red Man syndrom A 60 year old male presents to the ER with severe dizziness and back pain. His blood pressure is dropping, and you can feel an abdominal pulsatile mass on physical exam. What is the most likely diagnosis? - Correct Answer-Ruptured aortic aneurysm Give the DEXA score for osteopenia and osteoporosis. - Correct Answer-Osteopenia = 1 to 2.4 standard deviations, osteoporosis = 2.5 standard deviations or greater pg. 52 professoraxe l What is the term for eyelids that turn in? - Correct Answer- Entropion Are target cells seen in mild or severe iron deficiency anemia? - Correct Answer-Severe, they are also seen in alpha thalassemia, chronic liver disease and asplenia. An Osborn or J wave on EKG should make you think of what diagnosis? - Correct Answer-Hypothermia Name three medications used to break a seizure? - Correct Answer-Diazepam, lorazepam, phenytoin or fosphenytoin. What organism causes toxoplasmosis? - Correct Answer- Toxoplasma gondii Giant cell arteritis is associated with what other disease? - Correct Answer-Polymyalgia rheumatica A patient presents with a painless mass in her right wrist. What is the most likely diagnosis? - Correct Answer-Ganglion cyst pg. 55 professoraxe l What is the first line treatment for mastitis? - Correct Answer- Dicloxacillin is first line. Cephalexin or erythromycin are second line. What is the diagnostic test of choice for Zenker's diverticulum? - Correct Answer-Barium swallow will show the diverticulum. What are the two most common predisposing factors in the development of chronic renal failure? - Correct Answer-HTN and DM A child with bulky greasy stool should make you think of what diagnosis? - Correct Answer-Cystic fibrosis Describe how to perform the psoas sign. - Correct Answer-The patient is supine and attempts to raise the right leg against resistance. What is the most common uterine tumor? - Correct Answer- Leiomyoma, also known as fibroids pg. 56 professoraxe l What location within the pelvis is endometriosis most commonly found? - Correct Answer-On an ovary What is the initial treatment for a myocardial infarction? - Correct Answer-MONA - morphine, oxygen, nitroglycerin and aspirin A stuck on grey membrane in the pharynx should make you think of what diagnosis? - Correct Answer-Diphtheria An abdominal exam with pain out of proportion to the exam should make you think of what diagnosis? - Correct Answer- Intestinal ischemia A patient presents with sudden painless complete unilateral vision loss. What is the most likely diagnosis? - Correct Answer-Central retinal artery occlusion What is tonometry used for? - Correct Answer-Determining intraocular pressure Muddy-brown sediment in the urine should make you think of what diagnosis? - Correct Answer-Acute tubular necrosis pg. 57 professoraxe l What medical treatment is given for a gastrinoma? - Correct Answer-Proton pump inhibitors What is the clinical name for whooping cough? - Correct Answer-Pertussis What two labs do you want to monitor in a patient on an ACEI? - Correct Answer-Serum creatinine and serum potassium In what age range do you expect to most commonly find amaurosis fugax? - Correct Answer-Patients older than 50 An involuntary loss of urine during coughing or laughing is what type of incontinence? - Correct Answer-Stress incontinence Which thyroid cancer is the most aggressive? - Correct Answer-Anaplastic Define threatened abortion. - Correct Answer-Vaginal bleeding, closed cervix, products of conception are still inside pg. 60 professoraxe l How much more potent is T3 than T4? - Correct Answer-3-4x List four disease states in which you may find basophilic stippling. - Correct Answer-Lead poisoning, beta or alpha thalassemia, sideroblastic anemia, arsenic poisoning What is the most common cause of hyperparathyroidism? - Correct Answer-Single parathyroid adenoma in 80% of cases. Is staph gram (+) or gram (-)? - Correct Answer-Gram (+) What are the two main causes of aortic stenosis? - Correct Answer-Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease You notice drusen deposits on fundal exam. What is the most likely diagnosis? - Correct Answer-Macular degeneration List the 5 insulins in order of peak efficacy? - Correct Answer- Lispro 1-2 hrs, Regular 2-4 hrs, NPH 5-7 hrs, Lente 4-8 hrs, Ultralente 8-14 hrs pg. 61 professoraxe l What would you expect to see on a KOH prep if the patient had vaginal candidiasis? - Correct Answer-Pseudohyphae Will a hemolytic anemia generally have an elevated or decreased retic count? - Correct Answer-Elevated Define the third stage of labor. - Correct Answer-Delivery of baby to delivery of placenta How do you treat alcohol withdrawal - Correct Answer- Benzodiazepines What is the treatment for myxedema? - Correct Answer- Levothyroxine and slow warming What is the therapeutic range for INR following an organic valve replacement? - Correct Answer-2 to 3 What would you expect the WBC count to be in the joint fluid of an infected knee? - Correct Answer->50,000 at a minimum and probably much higher. pg. 62 professoraxe l What is the treatment of choice for strep throat? List 4 medications which may cause asthma. - Correct Answer- Penicllin, amoxicillin, erythromycin A patient has metamorphopsia and a central blind spot. What is the most likely diagnosis? - Correct Answer-Beta blockers, NSAIDS, ACEI, ASA A PSA above what level should start to make you concerned? - Correct Answer-Topical azoles A patient has an intracranial neoplasm causing auditory illusions, olfactory hallucinations and emotional changes. What lobe is the lesion likely in? - Correct Answer->4.0 Temporal What is the first line medical treatment for pericarditis? - Correct Answer-Aspirin and NSAIDS A 35 year old patient comes to your office because his wife made him. He has been increasingly irritable and moody. She has also noticed that he is very restless. You order a CT scan which shows cerebral atrophy as well as atrophy of the pg. 65 professoraxe l caudate nucleus. What is the most likely diagnosis? - Correct Answer-Topical azoles A diaper rash with satellite lesions should make you think of what diagnosis? - Correct Answer-Candida 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? - Correct Answer-Prinzmetal's angina Coal miners lung often shows nodular opacities in what lung fields? - Correct Answer-Upper lung fields What is the gold standard for diagnosing coronary artery disease? - Correct Answer-Cardiac catheterization What are two treatments you should consider for esophageal strictures? - Correct Answer-Dilation of the esophagus and long term PPIs. Community acquired carditis is most often caused by one of the HACEK organisms. List the HACEK organisms. - Correct pg. 66 professoraxe l Answer-Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella When treating herpes keratitis should you use topical antiviral, topical steroid or both? - Correct Answer-Don't use steroids. Topical antiviral and refer! List four symptoms of serotonin syndrome. - Correct Answer- Hyperthermia!, seizure, mental status change, tremor What is the karyotype for patient with Turner's syndrome? - Correct Answer-(45, X) They are missing one sex chromosome. What happens to total lung capacity in sarcoidosis? - Correct Answer-It goes down Which hyperlipidemia medication may cause flushing? - Correct Answer-Niacin A double comedone is indicative of what diagnosis? - Correct Answer-Hidradenitis suppurativa pg. 67 professoraxe l What is the drug of choice to treat a urethritis caused by neisseria? - Correct Answer-Rhinovirus What is the medical treatment for an early ectopic pregnancy? - Correct Answer-Ceftriaxone (Rocephin) A Salter-Harris type III fracture affects what area of the bone? - Correct Answer-Methotrexate What is the treatment for Addison's disease? - Correct Answer-The physis (growth plate) as well as the epiphysis What is the term for a chronic mild depression which has lasted greater than two years? - Correct Answer- Hydrocortisone or prednisone Dysthymia Which NSAID has the highest rate of peptic ulceration? - Correct Answer-Naproxen What is the only curative therapy for gastric adenocarcinoma? - Correct Answer-Surgical resection pg. 70 professoraxe l What should a primary care provider do for presumed central retinal artery occlusion? - Correct Answer-Ophthalmic emergency! Refer and intermittent pressure and release of the eye. What is a good beta blocker to reduce portal HTN? - Correct Answer-Propranolol A waxy stuck on appearance should make you think of what diagnosis? - Correct Answer-Seborrheic keratosis A sawtooth pattern on EKG should make you think of what diagnosis? - Correct Answer-Atrial flutter Ethambutol has what two major side effects? - Correct Answer-Optic neuritis, red green vision loss How does levothyroxine work? - Correct Answer-It is a synthetic T4 How do you treat pityriasis rosea? - Correct Answer- Reassurance pg. 71 professoraxe l How long does menstration need to be absent before secondary amenorrhea can be diagnosed? - Correct Answer-If cycles have been previously normal: 3 months. If cycles have been previously irregular: 6 months. 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? - Correct Answer-Narcissistic personality disorder Will the serum ferritin be high or low in a patient with iron deficient anemia? - Correct Answer-It will almost always be low A patient presents with several episodes of vertigo over the past few weeks. He has had intermittent unilateral hearing loss and a "blowing" in his ears. What is the most likely diagnosis? - Correct Answer-Meniere's disease What organism is the most common cause of an uncomplicated urinary tract infection? - Correct Answer-E. Coli pg. 72 professoraxe l Why is ovarian cancer so hard to diagnose? - Correct Answer- There are no good markers and the symptoms are very vague. Stocking glove paresthesias should make you think of what two diagnoses? - Correct Answer-B12 deficiency neuropathy and diabetic neuropathy Describe Cullen's sign. - Correct Answer-Umbilical ecchymosis often related to pancreatitis. A 35 year old female presents with heat intolerance, weight loss and palpitations. What is the most likely diagnosis? - Correct Answer-Hyperthyroidism A patient exhibits all of the characteristics of antisocial personality disorder, but he is only 14 years old. What is the most likely diagnosis? - Correct Answer-Conduct disorder What is the most common cause of an atrial septal defect? - Correct Answer-Patent foramen ovale pg. 75 professoraxe l A widely split fixed S2 should make you think of what diagnosis? - Correct Answer-Atrial septal defect Waxy flexibility should make you think of what diagnosis? - Correct Answer-Catatonic schizophrenia Weakness and numbness in the left hand might be a blockage in which carotid artery? - Correct Answer-Right A patient with a history of herpes now presents with a target lesion. What is the most likely diagnosis? - Correct Answer- Erythema multiforme 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? - Correct Answer-He is in ventricular fibrillation. The treatment is defibrillation. If you hear a midsystolic click you should immediately be thinking about what diagnosis? - Correct Answer-Mitral valve prolapse pg. 76 professoraxe l A shuffling gait should make you think of what diagnosis? - Correct Answer-Parkinson's disease What is the most common microcytic anemia? - Correct Answer-Iron deficiency anemia Nodular opacities in the upper lung fields should make you think of what diagnosis? - Correct Answer-Silicosis If you see a question with anything to do with rats and the patient has pneumonia, what organism should you be thinking of? - Correct Answer-Yersinia pestis Purple, pruritic, polygonal, papules on physical exam should make you think of what diagnosis? - Correct Answer-Lichen planus A patient is bitten by a rabies infected raccoon. On what days do you give human diploid cells? - Correct Answer-0, 3, 7, 14, 28 What is the initial treatment for a chemical burn to the eyes? - Correct Answer-Irrigate, irrigate, irrigate pg. 77 professoraxe l You are counting boxes from the peak of a QRS wave on an EKG in order to determine the heart rate. What would the heart rate be if the next QRS wave peak were three boxes away? What numbers are associated with the first five boxes? - Correct Answer-The answer is 100. The heart rates by counting boxes are 300, 150, 100, 75, 60. A young child presents to ER and you see him waiting in tripod position. What is the most likely diagnosis? - Correct Answer- Epiglottitis A patient with HIV presents with severe groin pain. What is the most likely diagnosis? - Correct Answer-Avascular necrosis of the femoral head. Antiretroviral medications put patients at an increased risk of AVN. List 4 physical exam findings for Cushing's syndrome. - Correct Answer-Moon face, buffalo hump, purple striae, central obesity, supraclavicular fat pads, easy bruising What medicaton classes are prescribed in order to help prevent chronic renal failure in diabetic patients? - Correct Answer-ACEIs or ARBs pg. 80 professoraxe l What is the best imaging for a thyroid nodule? - Correct Answer-Ultrasound Salmon-colored scales should make you think of what diagnosis? - Correct Answer-Psoriasis A colonoscopy that shows cobblestone or skip lesions should make you think of what diagnosis? - Correct Answer-Crohn's disease The baby was delivered several minutes ago. Suddenly there is a increase in blood flow from the vagina and the cord noticeably lengthens. What is the most likely cause of these signs? - Correct Answer-Placental separation List three signs or symptoms which will likely be included in a description of a patient with a pheochromocytoma? - Correct Answer-Thin, diaphoretic, tachycardic, agitated and hypertensive Often caused by chlamydia what is the syndrome characterized by urethritis (or cervicitis), arthritis and conjuctivitis? - Correct Answer-Reiter's syndrome pg. 81 professoraxe l An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely diagnosis? - Correct Answer- Supraventricular tachycardia What is the treatment for a volvulus in a child? - Correct Answer-Barium enema 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? - Correct Answer-Gout would be number one because of the location, but you might also think about an infection. You suspect a patient has polyarteritis nodosa. What is the test for a definitive diagnosis and what is the treatment? - Correct Answer-Biopsy, high dose steroids A resting or pill-rolling tremor should make you think of what diagnosis? - Correct Answer-Parkinson's disease pg. 82 professoraxe l What are three things in your differential if you have a paradoxical pulse? - Correct Answer-Cardiac tamponade, pericarditis and obstructive lung disease How long should pressure be applied to treat epistaxis? - Correct Answer-15 minutes What is the term for painful swallowing? - Correct Answer- Odynophagia Cortical adrenal insufficiency is also known as what disease? - Correct Answer-Addison's disease Currant jelly sputum should make you think of what diagnosis? - Correct Answer-Klebsiella pneumoniae At what age should you begin ordering dexa scans for male patients? What about female patients? - Correct Answer-70 for males, 65 for females What are three treatments for uterine prolapse? - Correct Answer-Pessary, Kegel's maneuvers, surgical repair pg. 85 professoraxe l What is the name of the sign when a patient shows inhibited inspiration with pressure over the RUQ? What diagnosis does it suggest? - Correct Answer-Murphy's sign, Cholecystitis What is Hashimoto's disease? - Correct Answer-An autoimmune cause of hypothyroid 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? - Correct Answer-Hypochondriasis Define menorrhagia. - Correct Answer-Heavy prolonged menstrual flow What organism is believed to be the main culprit in creating peptic ulcers? - Correct Answer-Helicobacter pylori A woman presents to the ER concerned she is in preterm labor. What treatment should you begin before even getting pg. 86 professoraxe l any imaging or lab results? - Correct Answer-Give IV fluids (most often the patient is suffereing from dehydration). What are the two main complications of cirrhosis? - Correct Answer-Portal HTN & liver insufficiency A contralateral mediastinal shift should make you think of what diagnosis? - Correct Answer-Tension pneumothorax A thin looking heart and flattened diaphragm on CXR should make you think of what diagnosis? - Correct Answer- Emphysema Are lesions from psoriasis typically found on flexor or extensor surfaces? - Correct Answer-Extensor A cervical biopsy comes back as CIN1. What is the next step? - Correct Answer-Repeat pap smear in 6 months and repeat colposcopy in 12 months. Antisocial personality disorder may not be diagnosed until what age? - Correct Answer-18 years old pg. 87 professoraxe l Who is more likely to have an aortic aneurysm males or females? - Correct Answer-Males are eight times as likely to have an aortic aneurysm. A positive Neer's test indicates what diagnosis? - Correct Answer-Rotator cuff impingement Reactive arthritis, HLA B-27 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? - Correct Answer- Spermatocele What is the most likely diagnosis for a free floating, painless, cystic mass found posterior and superior to the testis? - Correct Answer-Total hysterectomy and bilateral salpingo- oophorectomy What is the first step of treatment for endometrial cancer? - Correct Answer-Cholecystitis A patient presents complaining of right upper quadrant pain 20 minutes after meals. What is the most likely diagnosis? - Correct Answer-Carbohydrates pg. 90 professoraxe l Salivary amylase breaks down what macronutrient? Name the four thyroid cancers. - Correct Answer-Papillary, Follicular, Medullary, Anaplastic A 22 year old male patient presents with what is clearly a septic knee. You also notice lesions on his hands and feet. What is the most likely pathogen? - Correct Answer-Neisseria gonorrhoeae What is the name of the condition that involves fibrous scar tissue in the penis causing a curvature of the erect penis? - Correct Answer-Peyronie's disease What is the most common organism that causes mastitis? - Correct Answer-Staph aureus Blue bloater refers to the characteristic physical exam findings of what disease? - Correct Answer-Chronic bronchitis What is the most common cause of postrenal renal failure? - Correct Answer-BPH, postrenal renal failure is secondary to an outflow obstruction pg. 91 professoraxe l Describe the characteristics of a lytic lesion on x-ray. - Correct Answer-Spiculated, elevated periosteum, bone destruction (think bad, very bad things) What is it called when a patient says "ee" but on auscultion you here "ay"? - Correct Answer-Egophony List two medications commonly used for hypertension in pregnancy. - Correct Answer-Methyldopa and labetalol What is the test to begin with if you suspect a pheochromocytoma? - Correct Answer-24 hour urine for catecholamines At what point during pregnancy is RhoGAM given if it is needed? - Correct Answer-28 weeks What virus causes mumps? - Correct Answer-Paramyxovirus pg. 92 professoraxe l Syphilis is caused by what organism? - Correct Answer- Treponema pallidum A thumbprint sign on an abdominal film should make you think of what diagnosis? - Correct Answer-Intestinal ischemia A study result comes back with intracellular neurofibrillary tangles and extracellular neuritic plaques. What is the most likely diagnosis? - Correct Answer-Alzheimer's disease What cranial nerve is affected with Bell's palsy? - Correct Answer-CN VII What is the medical term for hunchback? - Correct Answer- Kyphosis How do you treat hookworm? - Correct Answer-Azoles G6PD deficiency follows what pattern of inheritance? - Correct Answer-X- linked pg. 95 professoraxe l A painless, clean base chancre should make you think of what diagnosis? - Correct Answer-Primary syphilis 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? - Correct Answer-Patella fracture Define premature birth. - Correct Answer-Delivery before 37 weeks. Extremely pruritic lesions with burrows in runs should make you think of what diagnosis? - Correct Answer-Scabies What organism is the most common cause of otitis media? - Correct Answer-Strep pneumonia Pizza pie retinopathy should make you think of what diagnosis? - Correct Answer-Cytomegalovirus (CMV) 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 pg. 96 professoraxe l him. What is the most likely diagnosis? - Correct Answer- Achilles tendon rupture 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? - Correct Answer- Allergic conjunctivitis How long before normal grief resolves? - Correct Answer- About one year The description of a dew drop on a rose petal should make you think of what diagnosis? - Correct Answer-Chickenpox In a patient with sensorineural hearing loss, what will be the results of the Weber test? - Correct Answer-The patient will hear the sound louder in the unaffected ear. Honeycombing and tram tracks on the CXR should make you think of what diagnosis? - Correct Answer-Bronchiectasis and idopathic pulmonary fibrosis pg. 97 professoraxe l