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Phys Clin Review Day Ureteral stenosis

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					Phys Clin Review Day 2
July 11, 2006

    1.   An abnormal popliteal swelling caused by herniation of synovial tissue through a weakening in the posterior
         capsule wall is called a
             a. Poplitial aneurysm – of the popliteal artery
             b. Popliteal thrombosis – again of the popliteal arterery, most serious sequelae would be pulmonary
                 embolism
             c. Baker’s cyst – the answer. Medial meniscus tear is associated with being a risk factor for Baker’s cyst.
                 Not associated with a lot of pain until it gets larger
             d. Biceps femoris tendonitis – something completely different, other findings, local swelling and pain.
                 Apply resisted motion to the structure, test resisted flexion of lower limb to see if it increases the pain.

    2.   Rheumatoid arthritis presents with a variety of systemic manifestations. The characteristic feature of RA is
            a. Bone erosions
            b. Persistent inflammatory synovitis – the answer, according to Harrison, better than the other answers
            c. Cartilage destruction – DJD or osteoarthritis
            d. Joint deformities – do present for RA
            e. Not a choice – RA discussion in class. Need to have 4 of the 7 criteria to dx RA:
                      i. Morning stiffness that resolves in more than an hour
                     ii. Arthritis in 3 + jts,
                    iii. Must be present for at least 6 wks
                    iv. Arthritis in hand jts, MCPs and PIPS, present for at least 6 weeks
                     v. Symmetric arthritic presentation
                    vi. Positive serum RF
                   vii. Radiographic changes

    3.   The presence of Heberden’s node (swelling of the distal interphalangeal joint) is generally pathognomic of
             a. Osteoarthritis – yes, it is just what is written above
             b. RA – affects PIPs and MCPs, called Hagarths’s nodes
             c. Gouty Arthritis – Metarsalphalangeal jt of big toe is where this presents
             d. Olecranon bursitis – affects the elbow

    4.   Tarsal tunnel syndrome is caused by nerve compression of the posterior tibial nerve due to trauma,
         inflammation, space occupying lesion, etc. The pt generally complains of pain in what location?
              a. Plantar aspect of foot, anterior calcaneus
              b. Dorsum of foot, anterior ankle
              c. Medial heel, medial longitudinal arch – the answer
              d. Lateral heel, lateral malleolus

    5.   A bunion is formed from a callous on the medial side of the metarsal bone, the bursa becomes thickened and
         inflamed resulting in an exostosis. The cause of this condition is called
              a. Hallux valgus – the answer, high heels and poor shoes causes this
              b. Hallux rigidus – osteoarthritis of first metatarsal phalangeal joint
              c. Pes Planus – flat feet, loss of arch, could develop plantar fasciitis
              d. Subtalar varus - ? missed this one

    6.   The normal quadriceps angle (Q angle) is 13 degrees for males and 18 degrees for females. An angle greater
         than 18 degrees is often associated with. (Females this angle is wider because of the hips, so more prone to
         chondromalacia.) Review what this angle is …
             a. Anterior capsule instability – Ant drawer sign Positive, anterior cruciate ligament tear for example
             b. Pateller tendonitis – inflammation of the patellar tendon (risk factors = overuse, jumper’s knee, excess
                  kneeling)
             c. Osgood-Schlatter disease (condition of the patellar tendon at insertion – inflammation of the tibial
                  tuberosity found in adolescent males)
             d. Chondromalacia patellae – the answer (Dx with the patellar grind test)
7.   A 40 yo female presents with hx of LBP since the birth of her child 4 mos ago. PE shows articular signs but with
     no evidence of dural signs. This exam finding is highly suggestive that her pains is related to?
         a. Osteoarthritis – possibly, but not the likely answer
         b. Osteomyelitis – is the answer – due to an infection from some trauma possibly, aerobic or anaerobic
             bacteria, fracture, fungal, prosethetic device, all put pt at higher risk for infection
         c. Spinal stenosis – do get dural signs, get some neurological compression, it is narrowing of
             interverterbral foramina
         d. Disc herniation – do get dural signs with this.

8.   A 25 yo male presents to your clinic with a CC of Low back morning stiffness. Past med hx includes 3 episodes
     of acute uveitis. An HLA B 27 blood test is positive and spinal x rays reveal blurring of the cortical margins of
     the subchondral bone. The most likely dx is
          a. Ankylosing spondylitis – the answer, associated with Klebsiella pnuemoniae
          b. Reiters syndrome – have renal conditions. Triad for Reiters = uveitis, arthritis, urethritis
          c. RA – recall previous diagnostic criteria and it is not associated with HLA B 27
          d. CMV – cytomegalo virus, not associated with HLA B27

9.   A 55 yo pt presents with a hx of acute low back pain, brought on form lifting his disabled wife. Has radiating
     pain down the left leg. PE reveals a sensory loss over the L5/S1 dermatome with pain on straight leg raise. Dx?
         a. Lumbar stenosis – not a sudden onset
         b. AS – ankylosing spondylitis – starts in SI jt
         c. Facet syndrome – what chiropractors treat, related to subluxations
         d. Herniated intervertebral disc – the answer based on hx of lifting and straight leg test positive

10. Plantar fasciitis manifests as heel/sole pain during walking or standing. The only PE finding is detection of a pt
    of deep tenderness on the origin of the plantar fascia located on the
        a. Anterior talus
        b. Lateral - missed the rest of this
        c. Cuboid
        d. Anterior medial calcaneous – the answer

11. The capusular pattern of restriction varies from jt to jt. This pattern of limited movement indicates
        a. Sprain/strain
        b. Tear/avulsion
        c. Arthritis/capsulitis/synovitis – the answer – each jt has a capsular pattern typical of arthritis, limitation
            of that movement consider arthritis, or synovitis
        d. Spasm/contraction lesion

12. Clinical experience has shown the most frequent reason for pain on resisted glenohumeral jt abduction is
        a. Instability of the labrum
        b. Tendonitis of infraspinatous
        c. Tendonitis of supraspinatous – the answer
        d. Tendonitis of subscapularis

13. In arthrosis or arthritis of the hip the most painful movement is
         a. Passive extension
         b. Passive medial rotation – the answer
         c. Passive adduction
         d. Passive abduction

14. Herniated intervertebral discs may produce tenderness of the sps the intervertebral jts, the sacrosciatic notch and
    the sciatic nerve. The are most commonly found
         a. L5 and S1 or btw L4 and L5

15. Lyme disease is a multisystem infections caused by Borrelia burgdoferi (sp?)spirochete. The disease has 3
    stages of progression. Signs associated with the third stage of infection include?
        a. Arthritis, acrodermatitis
                   i. The erythema migrans, is first the stage, migratory arthralgia (2 nd) and fever (2nd), chroinic
                      fatigue, impaired memory and impaired concentration. Endocarditis, cardiomyopathy in 3 rd
                      stage
         b.   erythema chronic migrans – part of 1st stage
         c.   Malaise/fatigue – part of 2nd stage
         d.   Myalgia/fever –2nd stage

16. Nodules on the distal interphalangeal jts (heberden’s nodes) and or the proximal jts (Bouchards) are common PE
    findings in
         a. RA
         b. Gouty arthritis
         c. Osteoarthritis – the answer
         d. Tenosynovitis

17. A 7 yo child presents , fell off a playground slide and fell on her extended her wrist. What PE finding will help
    to confirm fracture of the scaphoid?
         a. Tenderness over the distal radius – for Colles fracture
         b. Tenderness and swelling over the trapezium
         c. Tenderness over the anatomical “snuffbox” – the answer
         d. Presence of a Bouchard node – OA

18. 2 yo presents crying and only one local sig finding is painful limitation of forearm supination. The child’s
    extended elbow was pulled while playing with older sibling. Dx?
        a. Sprain of the radioulnar ligament
        b. Subluxation of the radial head – the answer = nursemaids elbow
        c. Radial head is pulled through the annular ligament – dislocated elbow, more serious
        d. Fracture of the proximal radius

19. 36 yo female presents with pins and needles in her arms and fingers, it mainly happens at night when she is
    holding the newspaper in front of her eyes, what helps you to confirm dx of TOS (thoracic outlet syndrome)?
        a. Adson’s test/Roos test – the answer
        b. Tension tests (for cervical radiculopathy)/Spurlings test (for cervical radiculopathy)
        c. Drop arm test (Rotator Cuff Tear) /Yergason’s test (biceps tendonitis)
        d. DeQuervain’s test (stenosing tenosynovitis)/Tinel’s sign (CTS)
                  i. Extensor pollicis brevis and abductor pollicis longus – check these is the brevis and longus
                     reversed

20. A pt presenting with knee pain worse climbing stairs, reproduced with patellofemoral grinding test in the office.
    Dx?
        a. Chondromalacia patella or degenerative patellae – the answer. Pain in chondromalacia patella occurs,
             when they sit for long time and when they stand it hurts - movie goers sign
        b. Prepatellar bursitis – more painful
        c. Medial meniscus tear – not postitive on patellofemoral grinding test, the test is McMurrays and Apleys
        d. Sprain of the patellar tendon

21. Acute tenosynovitis may follow local injury to a finger. Tenderness and swelling develops along the course of
    the tendon sheath which cause
         a. Extreme pain on finger extension – the answer
         b. Extreme pain at the DIP and PIP
         c. Extreme pain with resisted finger extension
         d. Extreme pain on active finger flexion

22. To help confirm dx of lateral epicondylitis the practitioner might test the resisted motions of
        a. Wrist flexion/pronation
        b. Elbow extension/supination
        c. Wrist extension/supination – the answer
        d. Elbow flexion/pronation
    23. Calcific tendonitis and rotator cuff tendonitis most commonly affects which tendon?
            a. Infraspinatous
            b. Teres minor
            c. Subscapularis
            d. Supraspinatous – the answer, usually the culprit in rotator cuff muscles problems

    24. The “boutonniere” deformit y and swan neck are PE findings of?
            a. RA

    25. Inversion injury to the ankle may results in a fibular fracture or disruption of the distal syndesmosis if
            a. There is swelling proximal to the lateral malleolus – the answer
            b. There is swelling distal to the lateral malleolus
            c. Deep Trs are impaired at the Achilles tendon and tibialis anterior
            d. Pulses are absent at the peidla nd tibial level

    26. The upper limb tension test first described by Elvey was designed to stress neuro tissues, radial medial, ulnar
        nerves, etc. The most important feature when performing the test is?
            a. Deep ache or stretch in the cubital fosssa
            b. Production of intensification of pts symptoms – the answer
            c. Different symptoms btw R and L

    27. DeQuervains tenosynovitis involves inflammation of?
           a. Extensor pollicis brevis and abductor pollicis longus
                     i. Finkelstines is the test for DeQuervains

    28. Ankylosing spondyitis shows a striking correlation with the presence of HLAB27 antigen. The most common
        symptoms are articular pain . The most common extra articular manifestion is?
           a. Acute anterior uveitis

    29. Chondromlacia patellae syndrome is more likely to be considered in a female pt when the Q angle is greater
        than?
            a. 18 degrees – other degree s given, this is the answer

Quiz material

    30. The usual cause of acute shoulder pain in a 20 yo man who sustains an abduction and external rotation stress to
        the jt is?
             a. An impingement syndrome
             b. Subluxation or dislocation of the shoulder
             c. Shoulder separation
             d. Shoulder a hand syndrome, esp on L side – MI is big cause
             e. RSD – review – reflex… people get it from trauma typically

    31. The tumor most apt to cause shoulder pain in a 60 yo woman is?
            a. Osteogenic sarcoma – occurs more frequently in younger age group, uncommon in adults, primary bone
                tumjor more common in younge rpeople
            b. Synovial sarcoma – rare and esp not likely to occur in the shoulder
            c. Metastatic carcinoma – best answer, from lung, breast, kidney or GI tract
            d. Enchondroma – benign , asymptomatic

    32. 30 yo woman seen for a 6 day hx of R shoulder pain after a MVA. On exam she demonstrates weakness of grip
        strength and decreased sensation in the little and ring fingers of the R hand. It is likely that you will find
        additional abnormalities in further exam of?
             a. Chest
             b. Cervical spin – the answer
             c. Shoulder
             d. Wrist
33. A pt presents with involuntary movements of the distal extremities and face with progressive intellectual
    deterioration would most likely be suffering from?
        a. Huntington’s disease – the answer
        b. Supranuclear palsy – detractor – muscular rigidity, - check this? Loss of voluntary but not reflexive eye
             movement.
        c. Parkinson’s disease – not this since it presents with more of a masked face, shuffling gait, pill rolling
             tremor, ataxia, bradykinesia – slowed movement, cogwheel rigidity
        d. Tourette syndrom e – presents with twitching and vocal and auditory manifestations

34. A pt presents with sensory loss in the distal extremities and flaccid muscular weakness in the legs which
    followed an episode of pericarditis, is most likely suffereing from?
         a. Guillian-Barre syndrome – both sensory and motor weakness, and following pericarditis is one of the
             hallmarks is some type of an infective etiology. Also moves distal to proximal
         b. Multiple Sclerosis – urinary difficulty, review this
         c. Myasthenia gravis – fluctuating muscle weakness, AI disease, Ab block acetylcholine receptors, do not
             have sensory deficits.
         d. Neurofibromatosis – have café au lait spots and subq nodules that form on the skin

35. A pt presents with history of muscular weakness, parasthesias, bowel and bladder dysfunction , PE reveals
    nystagmus, grade 4/5 moteor weakenss in upper an lower extremities and sensory loss of their distal extremities.
        a. Parkinson’s disease – no sensory deficits
        b. Amyotrophic lateral sclerosis
        c. Myashenia gravis
        d. Multiple Sclerosis

36. Pheochromocytoma is an adrenal tumor of chromaffin cells that secretes catecholamines. The most prominent
    PE featere of the disease is?
        a. HTN – the answer
        b. Tachycardia
        c. Diaphoresis
        d. Palpitations

37. Pts with thyroiditis are best treated symptommatically until the condition resolves spontaneously. These pts will
    then require treatment for?
        a. Addison disease
        b. Goiter
        c. Thyromegaly
        d. Hypothyroidism – the answer

38. A 26 yo female presents with HX of anxiety and heart palpitations. PE reveals exopthalmos, moist warm skin,
    HR of 104/min. She has a diffuse enlarged thyroid gland. Auscultation of the precardium reveals ___ all
    confirming your suspicion of hyperthyroid disease
        a. Diastolic murmur – signifies aortic regurgitation
        b. Opening snap – mitral stenosis
        c. Midsystolic murmur – the answer, also occurs with MVP
        d. Pansystolic murmur – mitral and tricuspid regurgitation

39. Most food allergies are mediated through
       a. IgG antibodies – the answer, the delayed hypersensitivity reaction
       b. IgE - allergic reaction that is an immediate reaction that occurs from eating the food you are allergic to.
       c. IgM
       d. IgA

40. Kaposis Sarcoma a tumor of vascular origin is most common malignancy of AIDs
       a. In the anus, rectum and GI tract
       b. On the skin, oral cavity and viscera – the answer
41. An otherwise healthy pt develops recurrent viral gastroenteritis with no hx of travel, camping or intake of
    unusual substances. Food allergy and stool testing has revealed nothing so far. What could be the cause?
        a. PUD
        b. Crohn’s
        c. IgA deficiency – the answer
        d. Sickle Cell Anemia

42. A 55 yo Caucasion male ingested btw 100 and 150 mg of zinc for a number of days and months (phrased
    differently) and he develops a microcytic hypochromic anemia
         a. Copper deficiency
                   i. Zn competes with copper
         b. Iron def – also same type of anemia
         c. Folic acid def
         d. B12 def

43. A pt with sickle cell anemia develops a megaloblastic bone marrow at age 27 due to?
        a. Iron def
        b. Zn def
        c. Folic acid def – the answer
                   i. Not certain if this is common with sickle cell or not
        d. Copper def

44. A handicapped child presented with iron def anemia. Despite tx with iron supplements after 5 weeks, the anemia
    worsened. Other testing showed def of Vit C and folic acid after supplementation which both the child
        a. All of the above
                 i. Vit C def may have been the cause….oh missed these!

54. The cardinal sign of anterior urethral injury is?
        a. Hematoma of the penis
        b. Tenderness in the perineum
        c. Blood from the urethral meatus – the answer – distal to the sphincter
                  i. If proximal will only cause bleeding with urination
        d. Inability to void

55. Clinical findings associated with renal cell carcinoma include?
        a. Fever
        b. Hypercalcemia
        c. Polycythemia
        d. Amyloidosis
        e. All of the above – the answer
                   i. Big risk factor for developing renal carcinoma = cigarette smoking and exposure to petroleum
                      distillates
                  ii. Classic presenting symptoms with renal carcinoma are?
                           1. Flank tenderness
                           2. Palpable abdominal mass
                           3. Macroscopic hematuria

56. The most common type of renal calculus in the US is
        a. Uric acid – 5-10% -check this
        b. Calcium carbonate
        c. Caclium oxalate – the answer – up around 80% (60-80%)
        d. Magnesium phosphate – less than 10%
                i. Other kind of stone is called the Staghorn calculus

57. 26 yo female presents wth hx of pelvic pain. Has only been sexually active with her husband. PE reveals a
    significant adnexal tenderness BL and palpation of the cervix is very tender. She has PID which may be the
    cause of infertility due to
        a. Tubal obstruction/scarring
         b.   Ovarian dysfunction
         c.   Cervical cancer
         d.   Ovulation failure

58. Young married couple presents with concerns about not achieving pregnancy. They are both healthy and have
    had unprotected intercourse for past 2 years. What factors likely contribute to the male as being the infertile
    partner?
        a. Hx of chicken pox and hydrocele
        b. Hx of inguinal hernia and hypospadia
        c. Hx of herpes and epidermiod cysts
        d. History of mumps and varicocele – the answer
                 i. Also hot tub, tidy whiteys, and that their occupation involves extensive driving

59. Which of the following are potentially valuable tests to run in an infertile female pt?
       a. Serum prolactin levels – the answer. Most common cause of elevated prolactin levels is pituitary
           adenoma – your main concern
       b. Serum parathyroid levels
       c. CBC
       d. Chem panel

60. Persistent, severe V which endures into the 2nd trimester is refereed to as
        a. Hyperemesis gravidum – the answer
        b. N and V of pregnancy – usually resolves in the first trimester
        c. Vomitarus malignans
        d. Pre-eclampisa – hallmark is HTN, more often in the 3rd trimester

61. Which of the following organisms is usually benign but for its teratogenic potential
       a. Varicella zoster virus
       b. Rubella – the answer
       c. CMV
       d. Ebola

62. Fatigue during pregnancy is usually the second trimester compared to the first
        a. Worse
        b. Unchanged
        c. Improved – the answer
        d. Variable

63. Eliciting a complete sex HX is important except for
        a. Some conditions are caused by some sexual activities
        b. Pts with sexual abuse histories require an immediate referral – the answer – not necessary
        c. Other answers I didn’t get to write in

64. Infants who are being breast fed may need to be supplemented with what?
        a. Vit K
        b. Vit D – low in breast milk and will not get much sun exposure – leads to Rickets, the answer
        c. Vit E
        d. Potassium

65. You notice a long time pt of yours is beginning to repeat herself. You ask about memory but she denies
    problems. PE is unremarkable, the best next step is?
        a. CT of the brain
        b. Talk to the family – the answer so he says! Weird one
        c. MMse – mini mental status exam (as far as I am concerned this is the better answer)
        d. T4 and TSH level determinations
        e. Hearing test
66. One of your previously well pts is hospitalized with pneumonia. You visit her the next day and she is asleep.
    She wakes and does not recognize you and is confused about where she is. Neurological exam is unremarkable
    except for her abnormal mental status. The dx is?
        a. Dementia – a more severe psychotic state
        b. Psychosis that is secondary to hospitalization – she is not having psychosis
        c. Delirium – sudden onset and follows an acute illness
        d. Stroke

67. Many demented pts have behavioral problems that pose challenges for caregivers and even endanger the pt.
    Which one is most likely to cause safety problems?
       a. Wandering – is the answer
       b. Repeating oneself
       c. Losing household items
       d. Insomnia
       e. Incontinence of urine

68. Which one of the following is least likely to be an early sign of dementia?
       a. Complaint of memory loss by the pt – this is the answer, in true dementia they will not know that they
           are losing their memory, so will not tell you about this!

69. A 68 yo woman his shoulder pain after falling on her outstretched hand. The probable diagnosis is
       a. Acute rotator cuff tear
       b. Rupture of the biceps tendon
       c. Fracture of the surgical head of the humerus – the answer
       d. Dislocation of the shoulder

70. 28 yo construction worker complains of low back pain that does not radiate, it has been worsening and
    progressing slowly in severity over the past year. Exam shows no neurological abnormalities, slight decrease in
    ROM of the back and decreased chest expansion. Based on these findings your dx would be?
        a. Degenerative osteoarthritis – too young in this case, occurs in older pts
        b. Lumbar strain – would get better
        c. Ankylosing spondylitis - the answer, most common in 30 yo men, progressive. Hallmark – one of
            them is decrease chest expansion!
        d. Scheuermann’s disease – can end up being kyphosis

71. A 12 yo female is initially seen with low back pain of 1week duration. No neurological defect can be found, but
    she has a marked loss of lumbar lordosis with tight hamstring muscles. Straight leg raise testing can be done
    only to 20 degrees bilaterally. In your DDX at this time you would consider?
        a. Disc herniation – should consider this
        b. Spondylolisthesis – should consider this, common in female adolescents. However with this condition
             the lumbar lordosis would increase rather than become flattened.
        c. Veretebral osteomyelitis - - can present like this, but don’t have enough info to think this.
        d. Idiopathic sclerosis not the answer as it rarely causes pain
        e. Answer is A, B, C
                   i. Below 45 degrees think more of muscle tightness?

72. A 45 yo white woman presents with difficulty breathing due to a sharp pain the left side of her chest which has
    gradually gotten worse over the last two hours. Her partner, an emergency medical technician administered
    nitroglycerin which had no effect and he brought her promptly to see you. The Pts medical hx is unremarkable
    except for cholecystectomy at age 31 for recurrent cholelithiasis. Pressure on the indcated pt of pain cause it to
    worsen and radiate into her should. Given a nml ECG and serum cardiac enzyme leves what ist he most likely
    dx?
         a. Lung cancer
         b. Myocardial infarction
         c. Costochondritis – the answer
         d. Lymphoma

73. Shin splints are most commonly confused with which of these conditions?
Commonly is tibialis anterior
           a. Collateral knee ligament sprain
           b. Stress Fracture – the answer
           c. Tarsal Tunnel syndrome
           d. Patellar bursitis

    74. 15 year old presents with a hard nodule palpable just below the knee which is becoming more and more painful.
        It developed over a period of several months. Besides chicken pox and measles, the boy has no sig medical hx.
        A routine chem. screen shows an elevated serum alkaline phosphatase level. What is your biggest concern?
             a. Osteomyelitis
             b. Osgood –Schlatter
             c. Osteosarcoma – is the answer
             d. Legg-Calve-Perthes Disease – affects the hip, necrosis of the femoral head.

    75. A 12 yo boy complains of aching knees and elbows, a fever and loss of appetite. PE reveals painless
        subcutaneous nodules near his hips and shoulders. What is the most critical question to ask this child?
            a. Did you fall down in the last week?
            b. Have you had a sore throat any time recently? The answer
                     i. Trying to tell you the child had strep pharyngitis and is developing the sequelae of Oslers
                        nodes which are associated with the sequelae of strep. They are sub cutaneous nodules on
                        fingertips and toes, not on the shoulders and the hips (Bad Q). Child had Rheumatic fever
                        from strep and they are developing the sequelae. Bad question – for this to be the answer, they
                        should have said the PE reveals painless subcutaneous nodules on his fingertips and toes.
            c. Has the fever been getting worse?
            d. Which joint aches the worst?

    76. Cozen’s test is often positive in?
           a. Bicipital tendonitis – Yergason’s or Speeds test
           b. Baker’s cyst
           c. Lateral epicondylitis – the answer
           d. Dislocation of the shoulder – test is - best way is visual inspection, head of humerus is sitting on the
                anterior chest wall

    77. Colle’s fracture most often occurs as a result of which of these injuries?
            a. Severe ankle inversion
            b. Hyperpronation injury to the forearm
            c. Falling on wrist while it is extended – the answer
                       i. Fracture of the distal radius
            d. Hyperabduction of the thumb due to trauma

    78. A basketball player presents with ankle pain, swelling, bruising and difficulty walking he is likely suffering from
            a. Metatarsalgia – pain in the metatarsal jt, it would present in the metatarsal area
            b. Ankle sprain – the answer
            c. Stress fracture
            d. Strained or torn ankle tendons – could be correct too

    79. A pt presents with a persistent fever of 103.4 for 3 days and an occipital HA. Findings reveal cranial nerves
        intact, DTRs are nml BL cerebellar test shows no abnml, neck flexion reveals stiffness and worsening of the
        HA…missed the rest of the case!
            a. Meningitis – is the answer
            b. Increased intracranial pressure
            c. Migraine
            d. Temporal arteritis

    80. A seizure of generalized major motor convulsion where the pat loses conscious ness and may have an aura of
        giddiness, mood change, confusion or involuntary twitching is classified as
            a. Grand mal – the answer, pt has LOC
            b. Myoclonic – no LOC
             c.   Febrile
             d.   Petit mal – or absence seizure, no LOC

    81. A 36 yo female present with Bells palsy – what PE findings led you to confirm the dx? Review other aspects of
        Bells Palsy
            a. Facial weakness on the upper half of the face (forehead, eyebrow, eye)
            b. Facial weakness on the lower half of the face (lip, cheek, side of the mouth) – Might be stroke, upper
                 motor lesion – affects lower part of the face
            c. Facial weakness on the lower face (lips, cheeks, whole mouth)
            d. Facial weakness on half of the face – the answer – as it affects the whole half of the face.

    82. A 76 year old male presents with history of hand tremors for past several weeks. His wife is concerned about
        Parkinsons. What other findings on PE help to confirm the diagnosis
            a. Spasticity, oral facial dyskinesias, ankle clonus – Tardive dyskinesia SE from certain drugs, clonus
                associate d with upper motor neuron disease
            b. Flaccidity, paratonia, scissors gait, nystagmus – scissors gait would be cerebral palsy
            c. Drooling, dysarthria, mask like facies, muscle atrophy – this is the answer
            d. Winging of scapula, sensory loss – lesion on the long thoracic nerve

    83. Horner’s syndrome results from lesion to the sympathetic nerve supply to C8 and T1. The classic triad of
        symptoms in a pt with Horner’s syndrome is
           a. Paralysis of the legs, wrists and hands
           b. Ptosis, Miosis, Facial anyhdrosis- the answer
           c. Severe respiratory paralysis
           d. Quadriplegia

    84. Trigeminal neuralgia produces very severe sharp, lightening like facial pain in the 2 nd and 3rd divisions of cranial
        nerve V. Typical triggers include:
            a. Touching lower face or mouth, chewing, talking, brushing teeth – the answer
            b. Touching upper face or forehead, blinking eyes, squinting the eyes

    85. You are interviewing a 24 yo female pt who suddenly has a brief lapse of consciousness, she is unresponsive to
        questions and is remaining seated, staring with a twitching of the lips and hands. After a few seconds she regains
        consciousness s and alertness
            a. A tonic-clonic or grand mal seizure
            b. A simple partial seizure – limited to functional disturbance, no LOC, also called a Jacksonian seizure
            c. A myclonic attack
            d. An absence seizure – the answer, also called a petit mal

    86. Vertigo is an illusion of movement in which the pt feels they are resolving in space or their surroundings are
        revolving around them. Dizziness is a sensation of imbalance and light-headedness that is non-specific. Unlike
        dizziness, vertigo is commonly accompanied by?
            a. N, V sensory disturbance , visual disturbance
            b. N, V eye fatigue, denies vision changes, giddiness
            c. N, V, Nystagmus, tinnitus, hearing loss – the answer
            d. HA, Fatigue, malaise

4 pm on, day 2

    87. One of the most common cause of meningitis in children is?
           a. H influenza
           b. Neiseiria meningitis
           c. Strep Pneumoniae
           d. All of the above – all of the above

    88. Which of these absolutely contraindicates circumcision?
           a. Crytpochordism
           b. Low birth weight
         c.   Hypospadias – the answer, so they can use the tissue for surgical repair of the hypospadia
         d.   Priapism – persistent painful erections

89. Decide whether the statements are true or false?
       a. The younger the pt the more likely that impotence is psychogenic - True
       b. The older the pt the more likely that impotence is organic - True
       c. If libido persists the cause of impotence is organic – false
       d. IF nocturnal erections occur the cause of impotence is psychogenic – generally true
       e. If libido is lost, the cause of impotence is psychogenic – false

90. Which of the clinical pictures may result in falls in an elderly patient being treated for diabetes?
       a. Blood glucose 180 mg/dl
       b. Hyperactive reflexes and loss of position sense – the answer as well
       c. Chronic alcoholism – the answer
       d. Retinal microanyeursms – could lead to vision changes in future and cause falls, answers a re b and c

91. The most common cause of vertebral crush fracture is?
        a. Osteoporosis – the answer
        b. Multiple myeloma
        c. Extreme back trauma

92. Which of the following differentiates hyper-parthryoidsim from senile osteoporosis?
       a. Localized bone pain
       b. Hypercalcemia – the answer
       c. Normal serum levels of alkaline phosphatase
       d. Nml serum levels of phosphate

93. Senile dementia is characterized by all of the following but?
        a. Short term memory loss
        b. Loss of ability to function independently
        c. Incoordination
        d. Delusions and hallucinations – the answer, these are not hallmark findings in senile dementia.

94. Pain and weakness in hip and shoulder muscles accompanied by depression, fever and an elevated C reactive
    protein level in an elderly person most strongly suggest?
        a. Polymyalgia rheumatica – the answer
        b. RA
        c. Metastatic cancer
        d. Guillain-Barre syndrome

95. Diagnostic test for Alzheimer’s disease
        a. MR scanning – for Parkinson’s
        b. Cerebrospinal cytology
        c. Clinical neurological testing
        d. No Diagnostic test exists – the answer

96. You are assessing a 65 yo retired lawyer who has been brought into the office by his family for memory loss.
    You perform a mini mental status exam to assess his cognitive function. Which of the following is considered a
    higher cognitive function?
        a. Calculating ability – the answer
        b. Orientation
        c. Remote memory
        d. Recent memory

97. A 70 yo retired musician is brought to your clinic for a hospital follow-up visit after sustaining a stroke. He is
    able to articulate words, but they sound slurred or indistinct. You would dx him with?
        a. Dysarthria – defect of muscle control as result of a brain lesion like stroke or Parkinson’s disease - the
             answer
         b.   Dysphonia – impairment of volume or pitch
         c.   Dysphagia- impairment of speech from a brain lesion
         d.   Aphasia –

98. 55 yo teacher coming in for altered mental status. You are trying to distinguish between delirium and dementia.
    All of the following are true about delirium except?
        a. Delirium has an acute onset
        b. In delirium there is always a disturbed level of consciousness
        c. Orientation if fairly well maintained but becomes impaired in the later stages of life – the answer
        d. Attention fluctuates

99. Which of the following changes in BP is expected during eth process of aging?
       a. Decrease in systolic BP
       b. Increase in Diastolic BP – the answer
       c. Increase in BP with rising from a sitting to a standing position
       d. No changes in systole BP

100. A 78 yo retired teacher presents to your office for evaluation of a fainting spell. He had no warning signs, he just
     lost consciousness. His wife states that he came around after 1 minute and appeared to know where he was and
     spoke to her clearly when he opened his eyes - missed the rest of the question…
          a. Postural hypotension
          b. Ventricular ectopy – skipped beats, added beats – The pacemaker cells decline in the SA node with age.
              This is the answer.
          c. Isolated systolic hypertensive
          d. Atrial fibrillation

101. A 66 yo retired waitress presents to the clinic for evaluation of a possible allergy flare up after recent weather
     changes, she complains of itchy watery eyes and some blurry vision. This question is about the blurry vision
     and I missed the rest but the answer is below:
         a. Blurring of near vision is what you would expect to see in the aging process. When the lens loses its
             elasticity it is called presbyopia

102. 83 yo presents with his wife who is concerned about his hearing. Denies problems, his wife states he doesn’t
     hear her. PT can’t hear his wife. 83 yo man
         a. Loss of acuity for middle range sounds

103. Which of the following abnormal heart sounds is more likely to be heard in the adult population?
        a. Aortic stenosis – thickening and calcification of the aortic valves, will hear an ejection click, this is the
            answer. S1 with an ejection click.
        b. Sinus tachycardia
        c. Mitral valve prolapse
        d. Aortic regurgitation

104. A 75 yo retired housewife present with evaluation for pain with intercourse. She went through menopause at
     age of 55, and is not taking HRT. What do you see on PE? – What would you expect to see on PE
         a. Pale vaginal mucosa – the answer - atrophic vaginitis
         b. Pink vaginal mucosa
         c. Blue vaginal mucosa
         d. Purple vaginal mucosa

105. A 68 yo retired hairdresser presents because she is concerned about her memory. She scores a MMse 26 out of
     28. She denies getting lost or forgetting names of common objects.
         a. Benign forgetfulness – is the answer
         b. Dementia
         c. Meningitis
         d. Depression
    106. An 88 yo retired Business manager presents for annual check-up, he has a history of hypertension. An ECG is
         obtained and shows evidence of a prior MI. Which of the following symptoms of a heart attack would be typical
         for his age?
              a. Substernal chest pain
              b. Substernal chest pressure
              c. SOB – the answer, shortness of breath
              d. Wt loss

    105. Which is considered a geriatric condition?
           a. Atrial fibrillation
           b. Depression
           c. Falls - the answer
           d. HTN

    107. Which of the following is considered to be activities of daily living?
            a. Shopping
            b. Laundry
            c. Dressing – this is the one we think is the answer
            d. Food preparation – the answer because it represents basic self care ability!


Once again same day, different note taker. There is definitely some material below that is not contained above.

DAY 2
An abnormal popliteal swelling caused by herniation of synovial tissue through a weakening in the
posterior capsule wall is called a Baker’s cyst (assoc conditions RA, inflammatory arthritis and
meniscal injury); typically not a lot of pain until it gets rather large

Popliteal thrombosis significant sequelae is PE

RA presents with a variety of systemic manifestations, the characteristic feature of RA is persistent
inflammatory synovitis

Cartilage destruction occurs with OA

Presence of a Heberden’s node (swelling of the distal interphalangeal joint) is generally pathognomic
of OA (also have Bouchard’s nodes in OA)

Tarsal tunnel syndome is caused by nn compression of the post tibial nn d/t trauma, inflammation,
space soccupying lesion etc…the pt generally complains of pain in what location = medial heel,
medial longitudinal arch

A bunion is formed from a callous on the medial side of the metarasal bone. The bursa becomes
thickened and inflamed resulting tin an exostosis the cause of this condition is called hallux valgus

Risk factors for developing Hallux valgus include wearing high heels and poor filling shoes

The normal quadriceps angle (Q angle) is 13 degrees for males and 18 degrees for females, and angle
greater than 18 degrees is often associated with chondromalacia patellae

Osgood-Schlatter disease usually described as an inflammation of tibial tuberosity found in juv males
Patellar tendonitis comes from excess kneeling, jumping

40 yo female presents w/ hx of LBP since the birth of her child 4 mo ago PE finding include marked
articular signs, but with no evidence of dural signs, this exam finding is highly suggestive that her
pain is related to osteomylitis

25 yo male with cc of low back morning stiffness, past med hx includes 3 episodes of acute uveitis,
HLA B-27 blood test is positive and spinal X-rays reveal blurring of the cortical margins of the
subchondral bone, the most likely diagnosis is Ankylosing spondylitis; AS associated with infection
with Klesellia pneumoniae

Reiters syndrome “can’t see, can’t pee, can’t dance with me” involves urethritis, arthritis and uveitis

55 yo pt presents with hx of acute LBP brought on from lifting his diasabled wife, he has radiating
pain down the left leg; PE reveals sensory loss over the L5/S1 dermatome with pain on SLR, most
likely dx is herniated intervertebral disc

Facet syndrome is usually related to subluxation of vertebrae

Plantar fasciitis manifests as heel/sole pain during walking or standing the only PE finding is
detection of a pt of deep tenderness on the origin of the plantar fascia located on the anteriomedial
calcaneous

The capsular pattern of restriction varies from joint to joint, this pattern of limited movement
indicated arthritis/capsulitis/synovitis

Clinical experience has shown the most freq reason for pain on resisted glenohumeral joint abduction
is tendonitis of the supraspinatus mm

In arthrosis or arthritis of the hip the most painful movement is passive medial rotation

Herniated intervertebral discs may produce tenderness of the spinous processes, the intervertebral
joints, the sacrosciatic notch and the sciatic nn they are most commonly found between L4-L5 and
L5-S1

Lyme disease is a multisys infection caused by the Borrlia burgodoferi spirochete the dz has 3 stages
of progression; signs assoc with the third stage of infection include arthritis/acrodermatitis

Nodules on the DIP (Heberden’snodes) and or the proximal interphalangeal joints (Bouchards nodes)
are a common PE findings in patients with OA

A 7 yo child is brought to your office by her mother; the child fell off a playground slide and landed
of her extended wrist what PE finding will help you confirm a fx of a scaphoid is tenderness over the
anatomic “snuffbox”

2 yo child crying and only one significant local finding, painful limitation of forearm supination the
childs extended elbow was pulled with playing with an older sibling most likely diagnosis would be
subluxation of the radial head; called “nursemaids elbow”
36 yo female hx of pins and needles in the arms and fingers occurs mainly at night but also can occur
whenshe helds the newpspaper oin front of their eyes what PE findings helped you to confirm your
suspected dx of TOS = Adson’s test/Roos test

Spurlings test is to check for cervical radiculopathy and involves compression of axial region

Yergasons tests for bicipital tendonitis

Drop arm test checks for rotator cuff tear

Dequervain’s test tests for Dequervains tenosynovitis

Tinel’s test checks for carpal tunnel syndrome

A pt presenting with knee pain worse climbing stairs and reproduced with a patellofemoral grinding
test would likely indicated which condition chondromalacia patella or degenerative patellae; pain
upon arising from sitting for a long period of time happens wih this condition

Acute tenosynovitis may follow local injury to a finger; tenderness and selling develop along the
course of the tendon sheath which cause extreme pain n finger extension

To help confirm a dx of lateral epicondylitis the practitioner might test the resisted motions of wrist
extension/supination

Calcific tendonits and rotator cuff tendonitis most commonly affect which tendon is supraspinatus

The boutaniere deformity and swanneck deformity occur with RA

Inversion inj to the ankle may result in fibular fracture or disruption of the distal syndesmosis if there
is swelling proximal to the lateral malleolus

Upper limb tension tests first described by Elvey are designed tostress neurological tissues, radial,
median, ulnar nn etc…the most imp feature when performing the tests is production of or
intensification of pt’s sx’s

DeQuervains’ tenosynovitis involves inflammation of the extensor pollicis brevis/abductor pollicis
longus

AS shows a strikingcorrelation with the presence of the HLA-B27 antigien the most common
symptoms are articular pain the most common extra articular manifestation is acute anterior uveitis

Chondromalacia patella (patellofemoral syndrome) is more likely to be considered in a female pt with
a Q angle greater than 18 degrees

The usual cause of acute shoulder pain in a 20 yo man who sustains an abduction and external
rotation stress to the joint is subluxation or dislocation of the shoulder
Impingement syndrome of the shoulder can come from years of repeated use of supraspinatus tendon
affected

Shoulder hand syndrome usually synonym of reflex sympathetic dystrophy (RSD)

The tumor most apt to cause shoulder pain in a 60 yo woman is metastatic carcinoma

30 yo seen with a 6 day hx of R shoulder pn after a car wreck n exam she has weakness of grip
strength and decreased sensation in the little and ring fingers of the R hand; it is likely that you will
find additional abnormalities in further exam of the cervical spine

A pt presenting with involuntary movements of the distal extremities and face with progressive
intellectual deteriorationowuld most likely be suffering from Huntington’s disease

Parkinson’s pts have bradykinesia, mask like face, mm rigidity

Supranuclear palsy loss of voluntary but not reflexive eye movements, spastic weakness, dementia

A pt presenting with sensory loss in the distal extremities and flaccid muscular weakness in legs
which followed an episode of pericarditis is most likely suffering from Guillain-Barre syndrome;
hallmark of Guillain-Barre is that it follows an infection

Myasthenia gravis AI dz acetylcholine receptors are blocked

Neurofibromatosis has Café au lait spots

Pt presents with hx of mm weakness, paresthesias, bowl and bladder dysfunction; physical exam
reveals nystagmus, grade 4/5 motor weakness in the upper and lower extremities, and sensory loss
over the distal extremities; the most likely dx would be Multiple sclerosis

Pheochromocytoma is an adrenal tumor of chromaffin cells tht secrete catecholamines; the most
prominent physical exam finding or feature of the disease is HTN

Pt’s with thyroiditis are best tx symptomatically until the condition resolves spontaneously these pt’s
will then usually req tx for hypothyroidism

26 yo female presents with a hx of anxiety and heart palpitations PE reveals exophthalmos, moist,
warm skin, pulse rate of 104/min; she has a diffusely enlarged thyroid gland auscultaion of the
precardium reveals of a midsystolic murmur all confirming your suspicion of hyperthyroid disease

Pansystolic murmur occur with mitral and tricuspid regurgitation

Opening snap occurs with mitral stenosis

Most food allergies are mediated through IgG

Kaposis sarcoma occurs most oon the skin oral cavity and viscera
Recurrent viral gastroenteritis can be assoc with IgA deficiency

Zinc supplementation long term can cause copper deficiency leading to a microcytic hypochromic
anemia

A patient with a sickle cell anemia developed a megaloblastic bone marrow at age 27 due to folic
acid definciency

Cardinal sign of anterior urethral injury is blood from the urethral meatus

Inj proximal to the urethral sphincter causes bleeding only with urination

Clinical findings assoc with renal cell carcinoma can include fever, hypercalcemia, polycythemia,
and amyloidosis

The most common type of renal calculus in the US is calcium oxalate

Young married couple have concerns of achieving pregnancy both healthy unprotected intercourse
for the past 2 years what factors are likely to contribute to the male as being the infertile partner = hx
of mumps and varicocele

Running a serum prolactin levels would be a potentially valuable test to run in infertile female
patients

Persistent, sever vomiting which endures into the second trimester is referred to as hyperemesis
gravidarum

Which of the following organisms is usually benign except for its teratogenic potential is rubella

Fatigue during pregnancy is usually during the second trimester compared to the first = improved

Infants who are being breast fed may need to be supplemented with Vit D

One of previously well pt’s is hospitalized with pneumonia…you come to see her the next day and
she is asleep. When you wake her it is clear that she does not recognize you and is confused about
where she is. Neurologic exam is unremarkable except for her abnormal mental status the most likely
dx is delirium

Which of the follwing is least likely to be an early sign of dementia is complaint of memory loss by
the pt

68 yo female has a shoulder pn after falling on her out stretched hand – fracture of the surgical head
of the humerus

28 yo male ,low back pn, no radiation, slow progression. No neurologic abnml, slight decrease in
ROM and decreased chest expansion – Ankylosing Spondylitis (hallmark decreased chest
expansion)
DJD usually older
Lumbar strain – no acute event
Scheuermann’s dz - no kyphosis

12 yo female is initially seen with back pain of 1 week duration no neurologic defect can be found
but she has marked loss of lumbar lordosis wih tight hamstring mm’s, SLR testng can be done only to
20 degrees B/L, in your DDx you would consider disc herniation, spondylolistheis and vertebral
ostomyletis

15 yo boy presents with a hard nodule palpable just below the knee which is becoming more an more
painful it developed over a period of months besides chicken pox and measles what boy has no
significant medical hx. A routine chem. screen shows an elevated serum alkaline phosphates level.
What is your biggest concern? = Osteosarcoma

12 yo boy complains of aching knees and elbow a fever and loss of appetite. PE reveals painless
subQ nodules near his hips and shoulders. What is the most critical question to ask this child? =
Have you had a sore throat at anytime recently?

Cozen’s test is often positive in lateral epicondylitis

Bakers cyst assoc with medial mensical tear

Colle’s fx most often occurs as a result of which of these injuries = falling on wrist while it is
extended

A basketball player who presents with ankle pain, swelling, bruising and difficulty walking is likely
suffering which of the following = ankle sprain

Pt presents with persistent fever for 103.4 for 3days and an occipital headache. PE reveals cranial nns
intact, deep tendon reflexes normal, cerebellar tests show no abnormalities, and motor strngh is +5
B/L. neck flexion reveals stiffness and exacerbating the HA likely dx of Meningitis

A sz of generalized major motor convulsion where the pt loses consciousness and may have an aura
of giddiness, mood change, confusion or involuntary twitching is classified as a Grand mal

36 yo female presents with a hx of gradual onset hemi facial weakness and drooling. She has a
diminished corneal reflex on the weak side on PE. You suspect a peripheral lesion, and can rule out a
central lesion on PE by testing facial mm movement. What findings did you see on PE to confirm a
Bell’s palsy = facial weakness on half of the face (forehead, eyebrow, eye, lip, and cheek)

76 yo male presents with a hx of hand tremors for the past several weeks. His wife is very concerned
that he might have Parkinsons disease…what other finding were present on PE to help confirm the dx
= drooling, dysarthria, mask like facies, mm atrophy, and shuffling gait

Winging of scapula assoc with lesion on the long thoracic nn

Ankle clonus assoc with upper motor neuron lesions
Scissors gait assoc with cerebral palsy

Horner’s syndrome results from lesions to the sympathetic nn supply at C8-T1 the classic triad of
sx’s in a pt with Horner’s syndrome is Ptosis/Miosis/Facial anhydrosis

Trigeminal neuralgia produces very sever, sharp, lightening-like facial pain in the 2nd and 3rd division
os cranial nn V, lasting seconds to minutes…typical triggers of attacks include touching lower face or
mouth, chewing, talking, brushing teeth

24 yo female has brief lapse of conciousness. She is unresponsive to questions and is remaining
seated, starring with a twitching of the lips and hands. After a few seconds, she regains
consciousness and alertness. This pt just had an ---absence seizure (petit mal)

Vertigo is an illusion of mvmt in which the pt feels they are revolving in space or their surroundings
are revolving around them. Dizziness is a sensation of imbalance and light headedness that is non
specific. Unlike dizziness, vertigo is commonly accompanied by nausea, vomiting, nystagmus,
tinnitus, hearing loss

A 50 yo male has pain in R shoulder for the last 20 years intermittently; it has been present daily for
the past 3 weeks; he has tried OTC analgesics but they do not relieves the sx’s five years ago he fell
on te icy pavement and landed on his shoulder. You perform a physical exam maneuver, b/c you
suspect a rotator cuff tear. What is the name of this test = Drop arm test

35 yo factory worker presents to your office for evaluation of pain in his left arm. Denies acute
trauma or injury. Job involves inspecting jars and he has to test opening and closing of lids. He
denies fever or chills,. ON PE there is no swelling over the elbow. You palpate the olecranon
process and he has tenderness on the left lateral epicondyle but not on the medial epicondyle. Based
on this info what is the most likely dx = lateral epicondylitis

Suspect carpal tunnel do a Tinel’s test

24 yo male present with a hx of neck pain that radiates to his right hand. There are sensory changes
over the C5 dermatome on R and he has segmental weakness with resisted shoulder rotation on the R.
Axial compression of the cervical sine intensifies his pain. The most likely cause of root pain for a pt
of this age would be: Neuroma (think of this when pt is longer and they develop neuro signs)

Partial sz’s are those that start with focal manifestations, i.e. numbness, tingling, hallucinations,
nausea…2 attributes indicate a partial sz that has become generalized, the recollection of an aura and
a unilateral neurologic deficit during the post ictal period (hyperactive reflexes, Babinski response)

Brief, rapid, jerky, irregular and unpredictable movements that seldom repeat themselves and affect
the face, head, lower arms and hands are classified as Chorea

Smoking is not a risk factor for developing overt type 2 diabetes

24 yo woman presents with sx’s of hypothyroidism 8 weeks following resolution of a viral URI. Her
thyroid gland is diffusely enlarged and tender to palpation; her ears are tended B/L as well what can
she be told about the nature and clinical course of her condition = she most likely has subacute
thyroiditis and her sx’s will resolve in 6 months

Hashimoto’s does have a enlarged thyroid but it is not TTP

Adrenocortical fxn is decreased in a female with panhypopituitarism

33 yo male co of pain with urination, fever and LBP, recently tx for urethritis cleared with
antibiotics…PE reveals B/L conjunctival injection, mild fever, and some pain and limited motion of
the low back. UA revels mild hematria and pyuria. What is the most likely dx = Reiter’s syndrome

Acid fast sputum staining can help to dx which of these complications of AIDS = Mycobacterium
avium-intercellularae infection

Acute onset of urticaria and dyspnea are signs of Anaphalaxis

The worst prognosis for survivial in a pt with leukemia is with CML

Enlarged lymph nodes due to infiltration by inflamm cells during an infection is lymphadenitis

55 yo male presents complaining of fatigue and jt pn for the past few months. He says that he has
noticed that his skin appears to be getting darker. PE reveals a hepat/splenomegaly and some
peripheral edema. Based on this info, the most likely dx would be = hemochromatosis

55 yo seen for gross hematuria. BUN and creatine are normal. You order and intravenous urogram
which shows a solitary L kidney mass in the lower pole. There is no evidence of metastases. Proper
therapy would be partial nephrectomy

Urethritis is most often caused by Chlamydia or gonorrhea

Risk factors for subclinical pyelonephritis = hx of multiple UTI’s in childhood, hx of 3 or more UTI’s
in the past year, sx’s present for 7-10days prior to seeking care, dx of pyelonephritis in the past year

40 yo black woman (G3 P3) enters her 33rd week of gestation when you detect elevated blood
pressure at a routine screening. There is mild weight gain and brisk reflexes as well as proteinuria.
What is the most likely dx = pre-eclampsia

A woman who previously ws pregnant but did not carry the baby to term experiences cramping pains
with passage of much blood, clots and tissue. Afterwards she develops a malodorous discharge and
fever. What has likely occurred? = Incomplete abortion with complicating endometritis

On Thurs 5 days after the big football game, the star halfback develops a gradually worsening,
persistent HA in the left hemicranium. Neuro testing reveals no abnormalities. The best thing to do
is CT

28 yo pt complains of sudden paralysis of both legs. There are no other sx’s neuro exam findings are
normal. Reflexes are equal, there are no pathological reflexes, and sensation is intact but the legs are
limp. The patient has hysteria
Since amyotrophic lateral sclerosis is a/an ___________________motor neuron dz, one would expect
to see a ____________________Babinski test = upper, positive

Epilepsy is diagnosed by clinical findings

You are evaluating a 22 yo woman who was brought to the ER with an alterd level of consciousness.
She is drowsy but she opens her eyes, looks at you, responds to questions and ten falls back asleep.
You would explain theis level of consciousness as obtunded

Brudzinski’s is flexion of the neck and hips and knees flex in response indicating meningial irritation

A 26 yo Asian woman presents for a routine PE she states that she like to exercise often but that her
activities have been limited recently due to bone and jt pn in her legs. One year ago she fx her tibia
after bumping her leg lightly against a treadmill. A routine chemistry panel reveals a serum calcium
of 11.5 mg/dL and an elevated PTH. What would be the cause other problems? Osteoporosis caused
by hyperparathyroidism

40 yo man presents complaining of infertility. He and his wife have been unsuccessfully trying to
have a child for the past 2 years. On PE you notice that he is a peculiar lookingman with a protruding
brow and lower ja, large nose and wide spaces between his teeth. What is the most imp diagnostic
test you should order? IGF-1 serology (to dx acromegaly)

Aldosterone deficiencies can occur in a pt that has congenital adrenal hyperplasia causing such things
as dehydration and poor skin turgor, vomiting after feeding and mm tone in a 1 month old

Serum transferrin saturation is the test of choice for the dx of hemochromatosis

A palpable mass in the neck is most likely to arise form the thyroid gland if it is located at the base of
the neck or a few cm from the midline and moves up and down with swallowing

Hx of repeated episodes of inflmmation, drainage of pus and reappearance of the mass occurs with
thyroglossal duct cyst or branchial cleft cyst

Papillary cancer of the thyroid does not have diffuse enlargement of the thyroid gland

Which of the following diagnostic procedures would give the most valuable info in evaluating a pt
with a 4 week hx of polydipsia and polyuria = UA

Which of the following clues most strongly suggest DM as the cause of a 4 week hx of polydipsia
and polyuria = weight loss

What additional testingshould be performed in a pt with a known pheochromocytoma in order to
screen for the poss occurrence of a MEN syndrome? Serum calcium and calcitonin levels

All of the following are often found in assoc with hypertriglyceridemia except hypothyroidism

Hypertriglyceridemia is assoc with type II diabetes, HTN, obesity and atherosclerotic CAD
Which finding would confirm the presence of hyperparathyroidism? CI:P ratio of 35, elevated
phosphate clearance, and absolute elevation of serum parathyroid hormone

Previously asymptomatic HIV + 27 yo homosexual man presents with mucus in his stool, a
intermittent mild diarrhea and a slight fever. He is taking no medications but uses a multivitamin and
several herbal products daily. There are no perianal lesions visible and anoscopy reveal only
inflammation. Extensive stool testing is noncontributory except for the presence of occult blood.
Which is the most likely dx = CMV proctitis

Lumps in the left groin bring a healthy 28yo man to your office on exam the lumps are firm,
nontender, pathologic lymph nodes. Furthermore he has a 1 inch scar on his left food where a small
tumor was removed 6 mo ago. The first and most helpful action to do its get a pathology report on
“small tumor”

Hodgkin’s dz can have a many diff presentations. Which of the following presentations is/are
possible episodic fever and seats, SVC obstruction, generalized pruitis, hilar adenopathy on routine
radiograph

45 yo female presents with a hx of HA’s and dizziness for the past 6 weeks PE is unremarkable
except for some cyanosis and splenomegaly. You decide to run some lab tests which show an
elevated RBC, hematocrit and hemoglobin. You suspect she has a polycythemia. What ethnic
background is she most likely assoc with? = Jewish

Multiple myeloma is a neoplastic disase of the bone marrow plasma cells with massive
overproduction of Bence-Jones protein

Patients with COPD tend to develop respiratory acidosis

Overexercise can cause metabolic acidosis

Vomiting can cause metabolic alkalosis

Hyperventilating causes respiratory alkalosis

Who of the following is/are prone to have iron deficiency: a 9 mo baby girl fed only cow’s milk, ad
adolescent female, a man with prosthetic aortic cvalve that has become partially loosened, leading to
hemodynamic abnormalities and traumatic hemolysis of RBC;s a man with multiple telengectasia

Hemophilia is most likely to be the problem in which of these patients = a 5 yo boy with
hemarthrosis (= bleeding in the joints)

Hodgkin’s disease (HD) is characterized by______________ while non Hodgkins lymphoma is
characterized by _____________: a predictable course; an irregular course

Diarrhea – metabolic acidosis (exercise)
Vomiting – metabolic alkalosis
Hyperventilation – respiratory alkalosis
COPD – respiratory acidosis

40 yo male Italian ancestry complains of mild fatigue. Overweight and drinks etoh . . . thalasemia
minor

most common anemia in children – iron def anemia

thalassemia – meditteranean, African descent

Anemia in women should – instigate a diagnostic workup (chronic dz, bleeding, . . ?)

Megaloblastic anemia, dx finding - hypersegmented neutrophils

A pelvic exam would be included in the PE of a female with dysuria if it was assoc with which of the
following sx’s: vaginal discharge, onset of sexual activity

Which of the following are indications for performing a urine culture? PE that includes flank pain,
hx of renal calculi, hx of diabetes and other medical conditions

What organism is response for the majority of lower UTI and subclinical pyelonephritis = E. coli

Fanconi’s syndrome is a group of physiologic abnormalities that occur with proximal renal tuburlar
dysfunction that are assoc with all except ectopic kidney

Fanconi’s syndrome is assoc with failure to thrive multiple myeloma and anemia

The most common genetic renal disorder of children is polycystic kidney disease early clinical
presentation is enlarged abd with huge smoothly symmetric kidneys and renal failure

Mental retardation is related to nephrogenic diabetes insipidis

29 yo woman present sat office with fever, N/V and LBP she woks in a warehouse and has been
seeing you for tx of her chronic back pain related to lifting. Which of the following findings would
most strongly suggest pyelonephritis: bacterial cast in urine

22 yo college student presnts to office b/c she has not menstruated in 3 months…sexually active
monogamous, performPE and detemine she is pregnant what did you see and feel on examination of
the cervix and uterus cyanotic cervical os: soft to palpation

Leopold’s maneuvers determines size and position of the fetus

ADHD diagnosed before the age of 7

4 yo male abd pn, hematuria, fever, anorexia, N/V on PE he has a palpable abd mass at this pt the
main condition you would wish to rule out is Wilm’s tumor

Jaundice in a newborn can be caused by hepatitis, hemolytic anemia, congenital spherocytosis (not
caused by gallstones)
Crytorchidism can lad to infertility if not corrected by what age? 5 yo

3 yo stops growing develops a mild fever and complains arthritis in both hands and shoulders after
several courses of antibiotics were administered for recurrent otitis media. PE confirms the fever and
reveals widespread lyphadenopathy and splenomegaly. She has mild anemia according to the CBC.
The ESR is elevated with of the following are you most considering = juvenile RA (juv RA can be
assoc with antibiotic use)

What are the four classic signs and symptoms of infectious mononucleosis = fatigue, fever,
pharyngitis, and lymphadenopathy

Projectile vomiting with a palpable mass present in the upper abd in a recent newborn are all features
of what condition? = Pyloric stenosis

One of the most common causes of meningitis in children is streptococcus pneumoniae

Which of these absolutely contraindicates circumcision = hypospadias

The younger the pt is the more likely that impotence is psychogenic

The older the pt the more likely that impotencies organic

Generally if nocturnal erections occur, the cause of impotence is psychologic

Which of the clinical pictures may result in falls in an elderly pt being tx for diabetes = hyperactive
reflexes, loss of position sense in legs and chronic alcoholism

The most common cause of a vertebral crush fx is osteoporosis

Which of the following differentiates hyperparathyroidism from senile osteoporosis = hypercalcemia

Senile dementia is characterized by short term memory loss, loss of ability to fxn independently,
incoordination (there are not delusions and hallucinations)

Pain and weakness in hip and shoulder mm accompanied by depression, fever and an elevated C
reactive protein in an elderly person most strongly suggest polymyalgia rheumatica

No dx test exists for Alzheimers disease

You are assessing a 65 year old male brought in by his family for memory loss. You perform a mini
mental status exam to assess his cognitive fxn which of the following is considered a higher cognitive
fxn = calculating ability

A 70 yo retired musician is brought to your clinic for a hospital follow up visit after sustaining a
stroke. He is able to articulate words, but they sound slurred or indistinct you would diagnose him
with = Dysarthria
Delirium has an acute onset, there is always a disturbed level of consciousness and attention
fluctuates

Which of the following changes in blood pressure is expected during the process of aging: increase
in diastolic pressure

Ventricular ectopy has a skipped beat every third beat

Blurring of near vision occurs as part of the aging process

Which of the following abnormal heart sound/murmurs is more likely to be heard in an older adult
population = aortic stenosis

Aortic stenosis has an ejection click

75 yo retired housewife present for evaluation of pn with intercourse. Shewent though n=menopause
(non surgical at the age of 55, she is not taking hormone replacment therapy. What would you except
to see on physical exam of the vagina = pale vaginal mucosa

SOB is a typical presentation of acute MI in the elderly

				
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