Missed Practice Ques Flashcards by Ken Obi

What is the most appropriate treatment of a patient with rheumatic fever to ensure eradication of bacterial infection?

Penicillin

(best for the eradication of group A streptococcus)

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Sudden painless vision loss in seen in all of the following EXCEPT?

Angle-closure glaucoma

Painless vision loss is seen in:
Retinal detachment
Central retinal arterial occlusion (CRAO)
Central retinal venous occlusion (CRVO)

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On ECG, development of U waves is likely to be seen with what electrolyte derangement?

Hypokalemia

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What is the appropriate therapy for optic neuritis?

3 days of IV methyl prednisone, followed by oral prednisone taper

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Which ligament in the ankle is most commonly sprained?

Anterior talofibular ligament

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Which of the following interventions should be avoided in patients with cardiac tamponade?

Positive pressure ventilation

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Which of the following does NOT increase a patient’s risk for primary open-angle glaucoma?

Family history
Caucasian race
Elevated intraocular pressure (>21 mm Hg)
Age >40

Caucasian race

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What is the best treatment for chronic mesenteric ischemia ?

Surgical revascularization

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Which of the following is the safest and most timely imaging technique used in making a diagnosis of toxic megacolon?

Abdominal CT scan
Colonoscopy
Plain radiography of the abdomen
Sigmoidoscopy

Plain radiography of the abdomen

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An acoustic neuroma in an elderly patient who already wears a hearing device should be treated with which of the following modalities?

Watchful observation
Surgical excision
Stereotactic radiosurgery
Chemotherapy

Watchful observation

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A 34-year-old female presents with diffuse bilateral breast pain in the upper outer breast quadrants with radiation to the axilla that increases before menses. Which of the following is the first-line diagnostic measure for this condition?

Core-needle biopsy
Diagnostic mammogram
Targeted breast U/S
U/S-guided fine-needle aspiration (FNA)

Targeted breast U/S

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A 50-year-old female presents to the outpatient clinic with complaints of acute-on-chronic knee pain. She reports a prior history of an anterior cruciate ligament (ACL) tear 20 years ago, which was treated conservatively. She states she has been able to remain active, by avoiding high-impact activities, weight management, and leg strengthening. She states that the pain is focal along the medial joint line, and recently, she has felt some catching while flexing her knee. She denies reoccurring instability. X-rays were obtained, which demonstrate well-persevered joint spaces without acute osseous abnormality. Which of the following is most likely the underlying cause of her pain?

Medial meniscus tear
MCL tear
Pes anserine bursitis
Patellar tendinitis

Medial meniscus tear

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Which of the following is true regarding the management of hip fractures?

A patient who is nonambulatory does not require surgical intervention.
DVT prophylaxis should be started preoperatively and continued postoperatively.
Prompt surgical intervention does not improve postoperative outcomes.
Total hip arthroplasty is the recommended treatment for a femoral neck fracture.

DVT prophylaxis should be started preoperatively and continued postoperatively.

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Which of the following is the first-line treatment for galactorrhea not associated with hormonal changes or medications?

Eliminate nipple stimulation
Excise the causative ducts
Increase support for Cooper’s ligament
Use nursing pad in the breast area

Eliminate nipple stimulation

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You are seeing a sexually active 22-year-old female with reports of increased yellow to green frothy discharge and dysuria. On examination, you note cervicovaginitis (strawberry cervix). What do you suspect the diagnosis is?

Candidiasis
Trichomoniasis
Bacterial vaginosis
Genitourinary syndrome of menopause

Trichomoniasis

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Which of the following is NOT a hallmark of cardiac tamponade?

Jugular vein distention (JVD)
Pulsus alternans
Hypotension
Pulsus paradoxus

Pulsus alternans

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An 18-year-old male comes in for evaluation of the left eye after he was skateboarding and fell. You suspect that the patient has a globe rupture of his left eye. What does the patient likely present with?

Teardrop pupil
Oval pupil
Constricted pupil
Dilated pupil

Teardrop pupil

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Which of the following endoscopic finding is associated with ulcerative colitis?

Skip lesions
Loss of vascularity
Cobblestone appearance
Esophageal ulcerations

Loss of vascularity

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A 40-year-old female presents with fever, headache, and nausea. Temperature is 100 °F. She is disoriented to place and time. Cranial nerves are intact. Neck is supple without meningismus. Petechiae and purpura are noted on the bilateral lower extremities. Laboratory studies reveal low Hb, low platelet count, high reticulocyte count, schistocytes on peripheral blood smear, and high creatinine. Which of the following is the most appropriate initial treatment?

Cyclophosphamide
Methylprednisolone
RBC transfusion
Therapeutic plasma exchange

Therapeutic plasma exchange

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What is the common incubation period of syphilis after exposure?

3 weeks
3 hours
4 months
6 months

3 weeks

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Which of the following is the most common physical examination finding for gynecomastia?

Painful mound of adipose tissue located eccentric to the areola
Painless concentric ring of glandular tissue extending under the areola
Painless well-defined, mobile mass noted lateral to the areola
Painful discoid-shaped mass located deep to the areola

Painless concentric ring of glandular tissue extending under the areola

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Which of the following is TRUE regarding the diagnosis of polycystic ovarian disease (PCOS) in adults using the Rotterdam Diagnostic Criteria?

Diagnosis requires sonographic evidence of PCOS.
Menstrual irregularities alone, after exclusion of other causes, is sufficient for a diagnosis of PCOS.
Hirsutism is considered evidence of clinical hyperandrogenism.
Documentation of overweight or obesity is required for diagnosis of PCOS.

Hirsutism is considered evidence of clinical hyperandrogenism.

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A 65-year-old male with a history of coronary artery disease (CAD) and heart failure with reduced ejection fraction (EF) has a left bundle branch block (LBBB). In which leads do you expect to see prolonged, aberrant QRS complexes on an ECG?

II, III, and aVF
I, aVL, V5, and V6
V1 and V2
V5 and V6

I, aVL, V5, and V6

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The presence of which of the following cardiac conditions would warrant a patient receiving antibiotic prophylaxis before dental procedures?

Bicuspid aortic valve
Hypertrophic cardiomyopathy (HCM)
Bioprosthetic mitral valve
Mitral valve prolapse

Bioprosthetic mitral valve

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A 25-year-old pregnant woman complains of spontaneous episodes of severe vertigo and emesis for 2 days. These episodes have increased in frequency and intensity. She thinks she may have some hearing loss in her left ear but is unsure because “it sounds like the ocean” in that ear. She is asymptomatic at present. Physical examination of ENT, neurologic, and heart and lung components reveals no abnormal findings. What is the most appropriate way to treat the patient’s underlying pathology? Crystal repositioning exercises Hydrochlorothiazide/triamterene Promethazine Surgery

Hydrochlorothiazide/triamterene

What diagnostic procedure is contraindicated if you suspect a globe rupture? Slit-lamp examination CT scan Tonometry Fluorescein testing

Tonometry

Which of the following is the gold standard for the diagnosis of acute mesenteric ischemia due to an arterial thrombosis? Mesenteric angiography CT scan with contrast Barium enema Plain film of the abdomen

Mesenteric angiography

Which of the following medications is thought to precipitate the microangiopathic hemolytic anemia associated with thrombotic thrombocytopenic purpura (TTP)? Clopidogrel Prednisone Rituximab Vincristine

Clopidogrel

The most common peripheral nerve involvement with Lyme disease affects which of the following nerves? Facial nerve Femoral nerve Optic nerve Oculomotor nerve

Facial nerve

Which is the most sensitive physical examination to diagnose an acute anterior cruciate ligament (ACL) injury? Anterior drawer Pivot shift Valgus/varus stress Lachman examination

Lachman examination

A 38-year-old woman is diagnosed with hypertrophic cardiomyopathy (HCM) after initially presenting to the ED with atypical chest pain. What should subsequent management for this patient include? Treatment with a negative inotropic agent, such as a β-blocker Genetic testing for each of the patient’s first-degree relatives Implementation of an intense exercise regimen to improve conditioning Emergent surgical myectomy

Treatment with a negative inotropic agent, such as a β-blocker

Your 38-year-old G3P2 patient, with no significant medical history, presents to your office for her routine visit but reports that she has been experiencing heavier-than-usual menstrual bleeding and cycles of longer duration over the past year. On examination, you find her uterus to be enlarged, leading you to suspect uterine fibroids, which is confirmed by TVUS. A CBC is consistent with anemia. Of the following, which treatment modality is most appropriate at this time? Gonadotropin-releasing hormone (GnRH) agonist Contraceptives containing progestin Endometrial ablation Lifestyle changes (ie, diet and exercise)

Contraceptives containing progestin

What eye muscle is more likely affected by trauma to the orbit causing a limited upward gaze on examination? Inferior rectus muscle Superior rectus muscle Lateral rectus muscle Medial rectus muscle

Superior rectus muscle

When investigating a new asymptomatic thrombocytosis, which of the following is NOT a useful first-line investigation? Iron studies and ferritin JAK2 V617F C-reactive protein Full blood count

JAK2 V617F Most causes of thrombocytosis are reactive in nature from infection/inflammation or from iron deficiency. One must confirm persistent thrombocytosis first, exclude inflammatory causes with CRP, and assess iron status before sending for molecular testing (JAK2 V617F).

The mother of one of your toddler-age patients contacts your office and notes that several children in her son’s daycare have pinworms. What is your recommendation to her at this point? Wake the child nightly to look for pinworms around the anus. Watch the child for perianal itching. Wash the child’s sheets and pajamas daily to prevent infection. Apply petrolatum jelly to the anus to suffocate the pinworms. Administer a one-time dose of mebendazole for prophylaxis.

Administer a one-time dose of mebendazole for prophylaxis.

Because her child has been scratching around his perianal area at night, a concerned parent brings in a stool sample for testing. What is your recommendation at this point? The stool sample will be helpful in determining the most likely diagnosis. A urine sample would more accurately aid in diagnosis. She should help the child perform better hygiene after bowel movements. Analysis of tape adhered and then removed from this area would be more helpful. Remove the child from his daycare because he may have gotten something there.

Analysis of tape adhered and then removed from this area would be more helpful.

Inflammation of the patellar ligament specifically at the tibial tuberosity where the growth plate has not completely closed is best known as what condition? Jumpers knee Osgood-Schlatter disease Runners knee Salter Harris type II fracture

Osgood-Schlatter disease

A 44-year-old male with a past medical history (PMH) of well-controlled major depressive disorder presents with bilateral breast enlargement and a thin milky breast discharge. Which of the following is the most likely cause of his current symptoms? Endocrine disorder Nipple stimulation Medications Prolactinoma

Medications The case describes both galactorrhea and gynecomastia. The patient has a history of major depressive disorder that is well controlled (presumably with medications). Antidepressants, particularly tricyclic antidepressants and SSRIs, have been associated with hyperprolactinemia and increase aromatase activity, so medications would be the first area to evaluate.

A 38-year-old woman with a new diagnosis of hypertension was placed on hydrochlorothiazide. The following day, she presented to the ED with an episode of presyncope and hypotension. Her resting ECG is normal. After her hypotension is treated, workup for which of the following cardiomyopathies is indicated? Dilated Hypertrophic Restrictive Alcoholic

Hypertrophic Diuretics are relatively contraindicated in patients with HCM because they may reduce preload, which in turn may exacerbate LV outflow tract obstruction and worsen symptoms and hypotension.

Which of the following is an ideal patient to perform a HINTS examination on? One who has continuous vertigo that is triggered One who has continuous vertigo that spontaneously occurs One who has episodes of vertigo that are triggered One who has episodes of vertigo that spontaneously occur

One who has continuous vertigo that spontaneously occurs

Which of the following treatments is the least appropriate treatment for a foreign body/corneal abrasion? Observation Topical antibiotics Topical steroids Eye protection (eg, patch)

Topical steroids

Which of the following over-the-counter medications should immediately be discontinued in patients with toxic megacolon? Acetaminophen Docusate sodium Ibuprofen Loperamide

Loperamide

Which of the following is a radiographic view of the ankle? Dorsoplantar (DP) Mortise Posteroanterior (PA) Skyline

Mortise

Which of the following is the most appropriate next step in evaluating a patient with galactorrhea and an elevated prolactin level? Clinical breast examination Diagnostic mammogram Ductography MRI

MRI

A 57-year-old postmenopausal woman is referred for evaluation of a 5-cm simple appearing ovarian cysts on her left ovary, found incidental during evaluation for diverticulitis. Last menstrual period (LMP) was at 50 years of age. She denies postmenopausal bleeding, bloating, or early satiety. What is the next best step in this patient’s management? Immediate surgical evaluation Refer to gynecology oncologist Reassurance, no further evaluation is necessary Check CA125, if normal, repeat TVUS in 6-12 weeks

Check CA125, if normal, repeat TVUS in 6-12 weeks

Which of the following is the most common cause of sick sinus syndrome (SSS)? Amyloidosis Cardiomyopathy Fibrosis of sinus node Hypothyroidism

Fibrosis of sinus node

A 2-year-old baby is brought to the urgent care center for inconsolable crying and fever over the past 24 hours. Physical examination of the left ear reveals copious otorrhea in the left ear canal and a swollen erythematous mastoid region with a forward placed pinna on the same side. Upon culture, which of the following organisms are you the most likely to find in this patient? Haemophilus influenzae Moraxella catarrhalis Pseudomonas aeruginosa Streptococcus pneumoniae Staphylococcus aureus

Streptococcus pneumoniae S. pneumoniae is the most common cause of mastoiditis in children

A 16-year-old female presents to the ER after playing softball where she was hit in her right eye. On examination, she had a limited upward gaze. You order a CT scan because you suspect she has an orbital blowout fracture. What sign would indicate she has an orbital blowout fracture? Teardrop sign indicating a bulging optic nerve Teardrop sign indicating herniated tissue and muscle Teardrop sign indicating blockage of the ciliary body Teardrop sign indicating increased intraocular pressure

Teardrop sign indicating herniated tissue and muscle

Definitive diagnosis of colonic ischemia is made using which of the following? Colonoscopy with biopsy CT scan with contrast Barium enema Mesenteric angiography

Colonoscopy with biopsy

What is the insertion point of the patella tendon? Inferior pole of the patella Superior pole of the patella Tibial plateau Tibial tuberosity

Tibial tuberosity

Which of the following is necessary to diagnose an adolescent with polycystic ovarian syndrome (PCOS) according to the 2015 Pediatric Endocrine Society Clinical Practice Guidelines? U/S evidence of polycystic ovaries Decreased levels of total serum testosterone Obesity Menstrual irregularities persistent 2 years after menarche

Menstrual irregularities persistent 2 years after menarche

What is considered first-line therapy for the management of mild inflammation in Crohn disease? Steroids Biologics Immune modulators Aminosalicylates

Aminosalicylates

Which of the following is the most appropriate management of dermoid cysts (teratoma) in a premenopausal woman? Refer for surgical evaluation, regardless of size Check CA125 Expectant management unless size >5 cm Refer for MRI to confirm U/S findings

Refer for surgical evaluation, regardless of size

How might acanthosis nigricans be treated? Cryosurgery Curettage Weight loss Corticosteroid taper

Weight loss

What is the most common cause of monocular transient vision loss? Cardioembolic stroke Giant cell arteritis Papilledema Angle-closure glaucoma

Cardioembolic stroke

Which of the following is the most significant risk factor for toxic megacolon? Colon polyps Diverticulitis Irritable bowel syndrome (IBS) Recent antibiotic use

Recent antibiotic use

A 50-year-old male presents to his primary care provider and is found to have a platelet count of 755 × 109/L. He has no other previous medical history. He is found to have a CALR variant mutation on peripheral blood, and a diagnosis of essential thrombocythemia is confirmed on bone marrow examination. What is the next best step? Active monitoring Cytoreductive therapy with hydroxycarbamide 500 mg once daily Low-dose aspirin 75 mg once daily Anticoagulation with rivaroxaban 20 mg once daily

Low-dose aspirin 75 mg once daily

Suprapubic pressure helps to facilitate delivery in cases of shoulder dystocia by which of the following? Rotating the pubis symphysis Adducting and rotating the fetal shoulders Flattening the maternal sacrum Rotating the fetal torso extravaginally Delivering the posterior arm or shoulder first

Adducting and rotating the fetal shoulders

Which of the following physical examination findings is expected in a small ventricular septal defect with a high gradient? Loud, harsh holosystolic murmur Palpable S2 in the pulmonic area Right ventricular heave Unequal peripheral pulses

Palpable S2 in the pulmonic area

Which of the following organs is most commonly involved in DRESS (drug rash with eosinophilia and systemic symptoms)? Lung Kidney Liver Heart

Liver

Which of the following is NOT a risk factor for otitis externa? Recent swimming Wearing hearing aids Excessive cerumen Previous radiation therapy

Excessive cerumen

Which of the following is a risk associated with ulcerative colitis? Enteroenteric fistula Small bowel obstruction Perirectal abscess Adenocarcinoma

Adenocarcinoma

A 19-year-old G0P0 female presents to her gynecology provider complaining of lower left quadrant pain with intercourse. Pelvic U/S shows an 8.5-cm complex cystic mass on the left ovary. Which of the following labs would be most helpful for diagnosing a germ cell tumor? CA125 α-Fetoprotein (AFP) Testosterone Inhibin

α-Fetoprotein (AFP)

A 21-year-old female, G1P1A0, is in active labor. The fetal head has been delivered but retracted back into the perineum. What is the most appropriate next step? McRoberts maneuver Woods corkscrew maneuver Rubin’s maneuver Posterior axillary traction Cesarean section

McRoberts maneuver

What is the association between prostaglandins and patient ductus arteriosus (PDA)? Relatively high levels of prostaglandins in the preterm newborn allow for persistence of the ductus arteriosus (DA) after birth. Increasing prostaglandin levels in the newborn stimulate normal closure of the DA. A genetic defect in the newborn’s ability to synthesize prostaglandins results in a chronically PDA. Declining prostaglandin levels in the developing fetus trigger closure of the DA in the first trimester.

Relatively high levels of prostaglandins in the preterm newborn allow for persistence of the ductus arteriosus (DA) after birth.

What is the most common cause of secondary dysmenorrhea? Endometriosis Polycystic ovarian syndrome (PCOS) IUD system Inflammatory bowel disease Pelvic inflammatory disease (PID)

Endometriosis Other secondary sources: IUD Fibroid PID

What is the cause of primary dysmenorrhea?

High levels of prostaglandins causing strong uterine contractions (i.e. normal period pain from uterine contractions w/o underlying disease)

Which of the following best describes moderate variability on external fetal HR monitoring? It is worrisome and plans for delivery should be undertaken. It is a reassuring finding, and no intervention is necessary. It is worrisome and plans for delivery should be undertaken. It is worrisome and plans for delivery should be undertaken.

It is a reassuring finding, and no intervention is necessary.

When should treatment with a cyclooxygenase inhibitor be considered for a patient with a patient ductus arteriosus (PDA)? All patients with a PDA should undergo medical treatment with a cyclooxygenase inhibitor at the time of diagnosis or as soon thereafter as possible. Only preterm newborns who are experiencing functional effects of the PDA should receive cyclooxygenase inhibitor therapy. Infants and children age 3 months or older should receive a cyclooxygenase inhibitor after persistence of the PDA has been observed in multiple echocardiograms. Cyclooxygenase therapy is reserved as a preventative measure and only given to pregnant women when the fetus has confirmed presence of PDA in the third trimester.

Only preterm newborns who are experiencing functional effects of the PDA should receive cyclooxygenase inhibitor therapy.

A 5-year-old male presents with urticaria limited to his arms following several mosquito bites. He has intense pruritus, but no features concerning for angioedema or anaphylaxis. What is the most appropriate treatment? Oral corticosteroids Oral antihistamines Topical corticosteroid cream Intramuscular epinephrine

Oral antihistamines

A diagnosis of direct inguinal hernia is most often made with which of the following modalities? Clinical assessment Ultrasonography CT of the abdomen/pelvis MRI

Clinical assessment

A 40-year-old female with a family hx of colon cancer has recently been diagnosed with ovarian cancer(OC). Genetic studies reveal mutations in DNAMMR genes. This patient is diagnosed with which of the following? Hereditary breast and ovarian cancer (HBOC) syndrome Cowden syndrome Li-Fraumeni syndrome Lynch syndrome

Lynch syndrome

A 10-year-old boy presents to your pediatric clinic for a well-child visit. Neither he nor his mother reports any problems with his health over the past year. On physical examination, a BP of 150/95 mm Hg is found. Because of this finding, BP is also taken in the child’s lower extremities and is found to be 100/65 mm Hg. Which of the following conditions is the most likely cause of this patient’s hypertension? Coarctation of the aorta (CoA) Essential hypertension Obstructive sleep apnea Renal artery stenosis

Coarctation of the aorta (CoA)

Which of the following is NOT a risk factor for the development of cataracts? Diabetes Tobacco use History of extensive sun exposure Hypertension

Hypertension

Which of the following imaging modalities is most appropriate for evaluation of a thyroid nodule? CT with contrast CT without contrast MRI Ultrasound

Ultrasound

Which of the following is the most common clinical presentation in men with gonococcal urethritis? Testicular pain Mucopurulent penile discharge Without symptoms Suprapubic pain

Without symptoms

An adult patient with rapid-cycling bipolar disorder is treated with but has not responded to divalproex therapy. Which of the following options is the best treatment option to add at this time? Clozapine Escitalopram Lithium Lorazepam

Escitalopram

Which is NOT consistent with a history of prolapse? History of a reducible mass from the vaginal opening Acute, severe pelvic pain Difficulty emptying the bladder Worsening urinary incontinence

Difficulty emptying the bladder

In patients who have undergone total surgical repair of tetralogy of Fallot, which of the following is true regarding their ongoing care? Sequelae are rare and ongoing monitoring is unnecessary. Pulmonic regurgitation is common and right ventricular failure is possible. Endocarditis prophylaxis is unnecessary. Ventricular septal defect closure is not part of the surgical repair.

Pulmonic regurgitation is common and right ventricular failure is possible.

To differentiate preseptal cellulitis from orbital cellulitis, what is the imaging modality of choice? Ocular ultrasound CT of the orbits CT angiogram of the head Skull x-ray

CT of the orbits

Which of the following is a clinical finding in hyperparathyroidism? Perioral numbness Dysrhythmias Muscle tetany Nephrolithiasis

Nephrolithiasis

What is the most common manifestation of rheumatic fever? Chorea Erythema marginatum Polyarthritis Prolonged QT

Polyarthritis

Pharmacologic treatment of conduct disorder focuses on which of the following? Decreasing depression Decreasing sleep Increasing aggressiveness Increasing anxiety Increasing energy

Decreasing depression

You have a 33-year-old female patient diagnosed with premenstrual dysphoric disorder (PMDD) and menorrhagia who is not interested in conceiving in the next year. She has tried exercise, a healthy diet, adequate sleep, and stress reduction, but her symptoms persist. What would you try next for her treatment? Antidepressant Oral contraception Diet change Mineral supplementation

Oral contraception

Which of the following best describes the pathophysiologic effects of coarctation of the aorta (CoA) on the heart? Backward flow of blood leads to ventricular dilation and fluid overload. Coronary ischemia caused by stenosis leads to myocardial infarction. Associated genetic defects cause hypertrophy of the septum. Stenosis of the aorta leads to ventricular hypertrophy and heart failure.

Stenosis of the aorta leads to ventricular hypertrophy and heart failure.

You have diagnosed a 40-year-old male with DRESS several weeks after he began allopurinol for recurrent gout. He has a nonproductive cough, slight hypoxia, and a modest increase in liver function tests without signs of liver failure. In addition to discontinuing the allopurinol and counseling the patient to avoid the drug for life, what treatment is indicated? Topical and systemic corticosteroids IVIG Vancomycin No treatment necessary

Topical and systemic corticosteroids

Fine-needle aspiration is recommended for thyroid nodules with which of the following characteristics? Microcalcifications Fully cystic <1 cm in size Regular margins

Microcalcifications

What would you expect to find when performing a digital rectal examination of a patient with a suspected large bowel obstruction? Empty rectal vault Rectal vault full with bloody stool Large, fungating mass Decreased sphincter tone Rectal vault with soft brown stool and normal tone

Empty rectal vault

Following drug treatment for genital infection with chlamydia or gonorrhea, how long should patients minimally abstain from sexual intercourse after the last treatment dose? 1 day 10 days 2 weeks 1 week

1 week

Which of the following medications should be used cautiously in a patient with a previous suicide attempt? Sertraline Venlafaxine Amitriptyline Aripiprazole

Amitriptyline

Histologic examination of a resected ovarian tumor suggests metastatic adenocarcinoma of the ovary. This ovarian cancer (OC) is most likely the result of metastasis from which of the following sites? Stomach Liver Lung Brain

Stomach

A 37-year-old G1P0 is diagnosed with gestational diabetes mellitus. At what gestational age should intermittent external fetal monitoring begin? 28 weeks 30 weeks 32 weeks 36 weeks

32 weeks

Which of the following is an appropriate diagnostic test for hearing impairment in an infant? Audiometry Weber and Rinne Otoacoustic emissions Whisper test

Otoacoustic emissions

A 48-year-old male presents to his primary care provider with complaints of right groin pain after moving his mother into assisted living last weekend. On examination, the provider notes a reducible hernia just inferior to the inguinal canal. What is the correct diagnosis? Direct inguinal hernia Indirect inguinal hernia Abdominal wall hernia Femoral hernia

Femoral hernia

You have a 28-year-old female patient who complains of mood changes, such as sadness, hopelessness, irritability, anger, and anxiousness before the onset of her menses. To be considered premenstrual dysphoric disorder (PMDD), her symptoms must begin when? At the onset of menses During the follicular phase During the luteal phase At ovulation

During the luteal phase

Which of the following is an activity associated with the development of TM barotrauma? Jogging Scuba diving Bicycle riding Tennis

Scuba diving Activities that often result in barotrauma include diving, flying, blast injuries, and waterskiing. Hyperbaric wound care is a common iatrogenic cause of TM barotrauma.

Which of the following would NOT be included on the workup for an underlying etiology for central retinal arterial occlusion? ECG Echocardiography Doppler ultrasound of the legs Carotid artery imaging

Doppler ultrasound of the legs

Which of the following thyroid nodule characteristics is considered highly suspicious for thyroid cancer? Cystic texture Wider than tall shape Presence of microcalcifications Hyperechoic to surrounding thyroid tissue

Presence of microcalcifications

Which of the following is the most common form of mesenteric ischemia? Chronic mesenteric ischemia Mesenteric venous thrombosis Colonic ischemia Nonocclusive mesenteric ischemia

Colonic ischemia

Which of the following is the first-line antimicrobial treatment for tetanus? Azithromycin Metronidazole Penicillin Vancomycin

Metronidazole

In which of the following groups should mebendazole therapy be avoided? Elderly patients Immunocompromised patients Pregnant patients Patients who are breastfeeding Pediatric patients

Pregnant patients

Which of the following diphtheria vaccines is started at the 2-month-old well-child visit and is part of the five-dose series? Tdap DTaP DT DTP

DTaP

What is the most common type of patellar dislocation? Superior Inferior Medial Lateral

Lateral

Which of the following initial interventions are recommended when fetal distress is evidenced on external fetal HR monitoring? Increase the rate of uterine stimulants being used. Assess for any possible disruptions in the oxygenation pathway. Plan for immediate cesarean delivery. Perform amniotomy to check for presence of meconium.

Assess for any possible disruptions in the oxygenation pathway.

Increased flow across which of the following structures leads to the mid-systolic ejection murmur found in atrial septal defect? Atrial septum Pulmonic valve Tricuspid valve Ventricular septum

Pulmonic valve

Which of the following is a common cause of hearing impairment in infants? Acoustic neuroma Presbycusis Hereditary syndrome Cholesteatoma

Hereditary syndrome

Which of the following is most likely to precipitate a case of orbital cellulitis? Bacteremia Trauma Intraorbital infection Sinus infection

Sinus infection

What TSH level is appropriate for a thyroid cancer patient initially after thyroidectomy? 0.1–0.5 mU/L 0.5–1 mU/L 1–2 mU/L 0.5–2 mU/L

0.1–0.5 mU/L

A 22-year-old male is found to have an asymptomatic indirect inguinal hernia. Which of the following is most appropriate for the provider to tell the patient about this condition? It is most likely due to excessive lifting. It has likely been there since birth. Surgical intervention is recommended at this time. It is likely related to his cigarette smoking.

It has likely been there since birth.

A 24-year-old presents for a new patient examination. During the examination, she is visibly upset, complaining that everyone around her is incompetent, but she is grateful for you, since you are the only person who understands her. During the physical examination, you notice many fine scars on her forearms; she admits that cutting herself helps her manage anxiety. When you explain why you cannot prescribe the alprazolam she requests for anxiety, she angrily leaves the office. What personality disorder is most likely? Antisocial Borderline Histrionics Narcissistic Paranoid

Borderline This patient demonstrates some key features of borderline personality disorder including unstable relationships often with the perception that others are all good or all bad, lack of impulse control, sudden mood fluctuations. Patients with borderline personality often engage in self-mutilation.

A 50-year-old woman presents to the clinic with concerns about unpredictable menstrual cycles and night sweats. In addition to the night sweats, for ~2 minutes, multiple times per day, she becomes hot, flushed, and diaphoretic. Her past medical history (PMH) is unremarkable, and she takes no medications or supplements. Which of the following is the most likely diagnosis? Perimenopause Menopause Postmenopause Primary ovarian insufficiency

Perimenopause

Which of the following is a function of parathyroid hormone? Increases osteoblastic activity Decreases calcitriol secretion Increases calcium secretion in the kidney Decreases phosphate reabsorption in the kidney

Decreases phosphate reabsorption in the kidney

What cardiac valve is most often affected by rheumatic fever? Aortic valve Mitral valve Pulmonic valve Tricuspid valve

Mitral valve

Which of the following is the most common injury associated with acute compartment syndrome of the lower extremity? Patellar fracture Distal femur fracture Tibial fracture Patellar dislocation

Tibial fracture

A 35-year-old patient is diagnosed with group 4 PH. Which of the following is the most appropriate definitive therapy for his condition? Symptomatic relief with oxygen and diuretics Systemic anticoagulation and referral for surgical thrombectomy Inhaled pulmonary vasodilator therapy Outpatient monitoring and serial screening CT

Systemic anticoagulation and referral for surgical thrombectomy

Which of the following is a contraindication for combined hormonal contraception (CHC)? Anemia Migraine with aura Thyroid disorders Uterine fibroids

Migraine with aura

Which of the following should be initiated in all patients who present with prelabor rupture of membranes after 24 weeks’ gestation? Screening for Group B Streptococcus (GBS) and prophylactic treatment when appropriate Prophylactic treatment of herpes simplex virus (HSV) with acyclovir Magnesium sulfate for fetal neuroprotection A single course of corticosteroids for fetal lung maturity

Screening for Group B Streptococcus (GBS) and prophylactic treatment when appropriate

What classification method is most appropriate for classifying Aortic Dissections ?

Stanford classification Types: Type A: involves ascending aorta Type B: involves descending aorta

What classification is used to stratify the severity of heart failure in the setting of acute MI ?

Killip classification

Young individual collapses while exercising presents with ECG showing a pseudo-RBBB and ST elevation in V1-V3 with a "coved" appearance. What is the likely diagnosis?

Brugada syndrome

62yo presents w/ sudden onset chest pain radiating to the left arm. ECG shows ST elevation in leads V1-V4. Troponin I is elevated at 0.9ng/mL (normal <0.4). What is the most appropriate next step in management?

Administer aspirin and heparin, then proceed to immediate coronary angiography. Gold standard for STEMI is Coronary Angiography with possible Percutaneous Coronary Intervention (PCI) when available with 90 minutes of first medical contact

52yo M with hx of CAD presents with acute, severe chest pain radiating to his back. He is hypertensive, diaphoretic and appears distressed. PE shows difference in BP between his right and left arm. ECG shows nonspecific ST-segment changes and Chest XR reveals a widened mediastinum. What is the most likely diagnosis?

Aortic dissection

72yo M w/ hx of MI 5years ago presents with worsening dyspnea on exertion. Echo shows ejection fraction of 25% with global hypokinesis. He has been on optimal medical therapy including ACE inhibitor, beta-blocker, and aldosterone antagonist. What intervention has been shown to reduce mortality in this patient population?

Implantable cardioverter-defibrillator (ICD)

70yo F with long hx of HTN and T2DM presents with sudden onset of right-sided weakness and difficulty speaking. On exam, has right facial droop, weakness in the right arm and leg. What is the most appropriate initial imaging study?

Non-contrast CT of the head ## Footnote CT is quick and can rule out hemorrhage, which would contraindicate thrombolytic therapy. MRI is more sensitive for ischemic stroke but takes longer so CT is always the initial choice, followed by MRI.

65yo M presents with chest pain, dyspnea and diaphoresis. PMH includes HTN and LBBB's on prior ECGs. His current ECG shows LBBB iwth 2mm of concordant ST elevation in leads V1 and V2. What is the most appropriate interpretation of the ECG finding?

Acute myocardial infarction with LBBB

34yo F presents with syncope during exercise. Her ECG shows a delta wave and a shortened PR interval. What is the likely diagnosis?

Wolff-Parkinson-White syndrome

52yo M with hx of HTN and diabetes presents with generalized lightheadedness. His ECG shows electrical alternans. What is the most likely underlying condition?

Pericardial effusion ## Footnote Electical alternans, characterized by alternating amplitudes of the QRS complexes, is a classic ECG finding in pericardial effusion, often due to the swinging of the heart in the fluid-filled pericardial sac.

40yo M presents to the ED after episode of syncope. His ECG shows a corrected QT interval of 530ms, using Bazett's formula. What is the most appropriate next step?

Admit for telemetry monitoring and evaluation for long QT syndrome ## Footnote A QTc > 500ms is concerning for long QT syndrome, which increases the risk of life-threatening arrhythmias such as torsades de pointe.

60yo F presents with fatigue and dyspnea. Her ECG shows low voltage QRS complexes and electrical alternans. What additional test is most likely to confirm the suspected diagnosis?

Echocardiogram ## Footnote Echocardiogram is the gold standard for diagnosing pericardial effusion, as it provides direct visualization of the fluid around the heart.

45yo M presents with recurrent episodes of palpitations. His ECG reveals a shortened PR interval, delta wave, and a wide QRS complex. He is diagnosed with Wolff-Parkinson-White syndrome. What is the most appropriate initial treatment to prevent recurrent arrythmias?

Flecainide ## Footnote This is a class IC antiarrhythmic commonly used to prevent paroxysmal arrhythmias in WPW syndrome by slowing conduction through the accessory pathway.

25yo with hx of fainting episodes undergoes an ECG that shows a coved ST-segment elevation in leads V1-V3. What is the first-line treatment to reduce his risk of sudden cardiac death?

Implantable cardioverter-defibrillator (ICD) ## Footnote In Brugada syndrome, patients are at high risk for sudden cardiac death due to ventricular arrhythmias. ICD implantation is the primary treatment to prevent suddent death.

35yo F presents with lightheadedness and palpitations. Her ECG reveals a prolonged QT interval of 480 ms. Which of the following medications is most likely responsible for the ECG finding? Lisinopril Metoprolol Ondansetron Clopidogrel

Ondansetron ## Footnote A commonly used anitemetic know to prolong QT interval, increasing the risk of torsades de pointes.

58yo F presents with pleuritic chest pain, dyspnea, and low-grade fever. Her ECG shows diffuse ST-segment elevations in nearly all leads, and PR segment depression is noted. What the the most likely diagnosis?

Acute pericarditis ## Footnote The hallmark of acute pericarditis is diffuse ST-segment elevations and PR segment depression. Addition of pleuritic chest pain and low-grade fever supports the diagnosis.

56yo M with no significant medical hx presents to ED with palpitations and dizziness. His ECG shows a narrow complex tachycardia with a regular rhythym at a rate of 180bpm. Vagal maneuvers are attempted but fail to terminate the rhythm. What is the next best step in management?

Administer IV adenosine ## Footnote This is SVT. in stable patients with regular narrow-complex tachycardia, adenosine is the first-line pharmacologic agent after vagal maneuvers fail.

65yo F with hx of CAD presents with recurrent episodes of lightheadedness and fatigue. ECG shows sinus bradycardia with frequent episodes of sinus arrest followed by junctional escape rhythyms. What is the most appropriate treatment for her condition?

Implant a permanent pacemaker

47yo F with hx of long QT syndrome presents to the ED after fainting at work. She reports palpitations before the event. ECG shows polymorphic ventricular tachycardia with twisting QRS complexes, consistent with torsades de pointes. What is the first-line treatment for her condition?

Intravanous magnesium sulfate

35yo M presents with palpitations and HR of 200bpm. He is diagnosed with SVT. What is an appropriate vagal maneuver to attempt to terminate the arrhythmia?

Perform Valsalva maneuver

70yo M with hx of heart failure is found to be in A-Fib with rapid ventricular response. BP is 90/50mmHg. Pt is lethargic and has signs of hypoperfusion. What is the best immediate treatment?

Perform synchronized cardioversion ## Footnote Pt is hemodynamically unstable (hypotensive, hypoperfusion, lethargic) so synchronized cardioversion is indicated as first-line to restore sinus rhythm and stabilize the patient.

58yo F with hx of HTN presents to ED with sudden onset palpitations, SOB, and chest discomfort. ECG reveals wide-complex tachycardia at a rate of 180bpm. She is hemodynamically stable. What is the most appropriate next step?

Administer IV procainamide ## Footnote Procainamide is a common drug of choice for wide-complex tachycardia of wide-complex SVT. Adenosine is for narrow-complex SVT

77yo M with hx of A-Fib presents experiencing syncope. His ECG shows alternating episodes of bradycardia followed by A-Fib with rapid ventricular response? What is the most appropriate long-term management?

Placement of a permanent pacemaker ## Footnote This is tachy-brady syndrome. Permanent pacemaker placement is the best option.

60yo F with chronic systolic heart failure (EF 20%) is on optimal doses of an ACE inhibitor and beta blocker. Serum potassium is 4.2 (goal 3 - 5) and creatinine is 1.1. What is the most appropriate next step in management?

Add aldosterone antagonist (eg. spironolactone) ## Footnote Pt is already on optimal doses of ACE inhibitor and Beta-blocker. Next step in management is addition of Aldosterone antagonist before referral for ICD placement if medical management fails.

58yo F with dilated cardiomyopathy (EF 15%) has been stable on guideline-directed medical therapy for 6 months. She has mild dyspnea with daily activities but no fluid retention. HR is 68 bpm and BP 110/70 mmHg. Current medications include lisinopril 40mg QD, carvedilol 25mg BID, and spironolactone 25mg QD. What is the most appropriate next step in management?

Add sacubitril/valsartan and discontinue lisinopril ## Footnote Despite optimal medical therapy, pt remains symptomatic with severely reduced EF of 15%. Switching from ACE inhibitor to Angiotensin Receptor-Neprilysin Inhibitor has been shown to improve mortality in patients.

62yo with hx of heart failure with preserved ejection fraction (HFpEF) presents with dyspnea and lower extremity edema. Her BP is 150/90 mmHg. Which of the following medications has been shown to reduce mortality in HFpEF? a. spironolactone b. sacubitril/valsartan c. empagliflozin d. none of the above

None of the above ## Footnote Unlike heart failure with redcued ejection fraction (HFrEF), no medication has shown a definitive benefit in reducing mortality

55yo M with hx of heart failure (EF 25%) is on optimal doses of ACE inhibitor, beta-blocker, and aldosterone antagonist. However, his ECG shows QRS duration of 160 ms with LBBB morphology. What is the most appropriate next step in management?

Refer for cardiac resynchronization therapy

68yo F with chronic heart failure (EF 35%) on optimal medical therapy of lisinopril, metoprolol, and spironolactone. She presents w/ worsening dyspnea, elevated JVP, and bilateral lower extremity edema. Serum potassium is 5.2 (goal 3 - 5) and creatinine is 1.4 (goal < 1.0). What is the most appropriate next step in management?

Add furosemide and recheck electrolytes in 3 days ## Footnote Pt with signs of fluid overload and requires diuresis.

A normal FEV1/FVC ratio, reduced TLC, and reduced DCLO is characteristic of ?

Restrictive lung disease (eg: idiopathic pulmonary fibrosis) ## Footnote DCLO = diffusing capacity of the lungs for carbon monooxide TLC = total lung capacity

A decreased FEV1, normal or increased FEV1/FVC ratio, and reduced TLC is characteristic of?

Restrictive lung disease (eg: idiopathic pulmonary fibrosis)

A reduced FEV1/FVC ratio, reduced TLC, and reduced DCLO is characteristic of ?

Alveolar destruction (eg: Emphysema)

A reduced FEV1/FVC ratio and a concave pattern on the flow-volume loop during PFT, but NO improvement in FEV1 after bronchodilator administration is characteristic of ?

Emphysema (obstructive pattern)

A reduced FEV1/FVC ratio and a scooped pattern on the expiratory portion of the flow-volume loop, but NO improvement in FEV1 after bronchodilator administration is characteristic of ?

Emphysema (fixed obstruction)

A reduced FEV1/FVC ratio with significant improvement in FEV1 after bronchodilator use and a normal DCLO is characteristic of ?

Asthma

68yo M presents with dyspnea and pleuritic chest pain. His Well's score indicates a moderate probability for pulmonary embolism (PE), and his D-dimer result is 600 ng/mL (normal < 500). What is the most appropriate next step?

Obtain CT pulmonary angiography ## Footnote CT pulmonary angiography is the first-line imaging indicated for confirming a PE. A ventilation-perfusion (V/Q) scan is an alternative if pts cannot tolerate constrast in CT angiography.

72yo M with hx of CKD presents with suspected pulmonary embolism (PE). He is not a candidate for CT Angiography due to contrast allergies. What is the most appropriate imaging to confirm the diagnosis of PE?

Ventilation-perfusion (V/Q) scan ## Footnote V/Q scan is the next best imaging to confirm a PE behind CT Angiography

55yo F presents with confirmed diagnosis of pulmonary embolism. She is hemodynamically stable but has signs of right ventricular dysfunction on Echo. Which of the following is the most appropriate next step in her management? Initiate thrombolytic therapy Place an inferior vena cava (IVC) filter Adminiter low molecular weight heparin (LMWH) Perform urgent embolectomy

Administer low molecular weight heparin (LMWH) OR A direct oral anticoagulant (DOAC) ## Footnote Thrombolytic therapy is reserved for hemodynamically UNSTABLE pts. IVC is generally reserved for pts with contraindications to anticoagulation

34yo M presents to the ED with sudden-onset dyspnea, pleuritic chest pain, and hemoptysis. He has a hx of recent travel. Vitals shows HR of 120 bpm and O2 saturation of 92% on room air. Using Well's criteria for pulmonary embolism, what is his pretest probability of having a PE? Very low Low Moderate High

High ## Footnote Per Well's criteria, pt has multiple risk factors for PE including recent travel, signs of DVT, tachycardia, hemoptysis, pleuritic chest pain -- making his pretest probability for PE high.

40yo F presents with a massive pulmonary embolism and is hemodynamically unstable with a systolic BP of 80mmHg. Which of the following interventions is most appropriate to stablilize her condition? Low molecular weight heparin Inferior vena cava filter Systemic thrombolysis Direct oral anticoagulant (DOAC)

Systemic thrombolysis ## Footnote In a hemodynamically unstable pt with massive PE, systemic thrombolytic is indicated to dissolve the clot and restore circulation. Anticoagulation with LMWH or DOAC is indicated only in hemodynamically stable pts.

63yo M with hx of A-Fib presents to ED after being diagnosed with a pulmonary embolism. He has active GI bleeding, which precludes the use of anticoagulation. What is the most appropriate intervention? Surgical embolectomy Inferior vena cava filter (IVC) placement Systemic thrombolysis Direct oral anticoagulant (DOAC)

Inferior vena cava filter (IVC) placement ## Footnote IVC is the best option here given pt's active GI bleed, Surgical embolectomy is indicated for massive PE's in the setting of hemodynamic instability

58yo M presents with sudden SOB and pleuritic chest pain. BP is 85/60 and HR is 110 bpm. Echo shows right ventricular strain. Which of the following best describes the pt's condition? Submassive PE Massive PE Small PE Chronic thromboembolic pulmonary HTN

Massive PE ## Footnote Massive PE is defined by hemodynamic instability (hypotension and shock) in the presence of confirmed PE often with right ventricular strain. Submassive PE is right ventricular strain W/O hypotension

28yo F presents to clinic after being diagnosed with a small pulmonary embolism. She has no known risk factors for PE, including no recent surgery, immobility or family hx of clotting disorders. Which of the following lab tests should be considered to evaluate for an underlying cause of her PE? D-dimer Factor V Leiden mutation Troponin level Homocysteine level

Factor V Leiden mutation ## Footnote In a young patient with unprovoked PE and no identifiable risk factors, testing for inherited thrombophilias (such as Factor V Leiden) is warranted.

52yo F presents to the ED with severe chest pain and dyspnea. Her ECG shows S1Q3T3 pattern and her D-dimer is elevated. What is the most appropriate next step in her management?

Perform a CT pulmonary angiography

48yo M presents with excessive daytime sleepiness, snoring, and witness apnea. His Epworth Sleepiness Scale is 18 and BMI is 32. What is the next best step in his management?

Refer for polysomnography ## Footnote Polysomnography is gold standard for the diagnosis of OSA

28yo F presents with excessive daytime sleepiness despite 8hours of sleep each night. She reports frequent episodes of sleep paralysis (cataplexy) and vivid dreams. Polysomnography is normal. What is the next most appropriate diagnostic test?

Multiple sleep latency test (MSLT) ## Footnote MSLT is gold standard for diagnosing narcolepsy

34yo F presents with complaints of restlessness in her legs at night, leading to difficulty falling asleep. She has no significant PMH and her ferritin level is 60 ng/mL (normal > 50). What is the most appropriate pharmacologic treatment? Pramipexole Iron supplementation Clonazepam Diphenhydramine

Pramipexole (a dopamine agonist) ## Footnote Note: If ferritin levels are low (especially < 50 ng/mL), initiate iron supplementation therapy first as RLS is strongly associated with low ferritin levels.

72yo M with hx of COPD and daytime sleepiness is diagnosed with overlap syndrome (OSA + COPD). Polysomnography reveals significant oxygen desaturation during sleep. What is the best next step in management?

Prescribe a bilevel positive airway pressure (BiPAP) device ## Footnote BiPAP device is preferred for pts with overlap syndrome (OSA + COPD) as it helps with both oxygenation and ventilation; improving hypercapnia and obstructive events. CPAP is usually preferred for OSA only w/o COPD component

Missed Practice Ques Flashcards

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