Ouch!
Blood and Guts
Geriatics
Brain power
Pediatrics
100
A 17 yo football player comes to the office the AM after he injured the middle finger of his right hand by grabbing the jersey of an opposing player as he tackled him. He felt severe pain tt the distal aspect of his finger. You find swelling and ecchymosis at the tip of the finger. He cannot flex it. What is the lesion?
avulsion of the flexor digitorm profundus from the distal phalynx, aka "jersey finger," surgical repair within 10-12 days to avoid contracutres
100
A 28 yo G3P2 pregnant female is diagnosed with a RLE DVT. What is the treatment of choice?
What is Low molecular weight heparin
100
Hearing loss is common in the elderly. Presbycusis is typically associated with the reduction in the hearing threshold for which frequency (high, low, midrange)?
What is higher frequencies
100
What is the number 1 risk factor for strokes in the US?
What is Hypertension, accounts for 2/3 of all strokes
100
If infants less than 4 months of age only receive breast milk, what supplement should they receive?
What is Vitamin D 400 IU
200
10 yo presents to your office with left elbow pain after a fall at school. He is able to fully flex at the elbow but unable to fully extend it. What is the lesion?
Elbow fracture, studies found that 100% of all pediatric fall injuries presenting with elbow pain and inability to extend resulted in fracture, even despite radiographic findings
200
38 yo F p/w R calf pain x 3 days. She had a lap chole 8 months ago. No FHx of DVT. She has 2+ b/l pitting ankle edema. What is you initial diagnostic study?
What is D-Dimer (WELLS criteria) Paralysis, paresis or recent orthopedic casting of lower extremity (1 point) Recently bedridden (more than 3 days) or major surgery within past 4 weeks (1 point) Localized tenderness in deep vein system (1 point) Swelling of entire leg (1 point) Calf swelling 3 cm greater than other leg (measured 10 cm below the tibial tuberosity) (1 point) Pitting edema greater in the symptomatic leg (1 point) Collateral non varicose superficial veins (1 point) Active cancer or cancer treated within 6 months (1 point) Alternative diagnosis more likely than DVT (Baker's cyst, cellulitis, muscle damage, superficial venous thrombosis, post phlebitic syndrome, inguinal lymphadenopathy, external venous compression) (-2 points)
200
According to USPSTF when and how should patients aged >65 receive immization against pneumonia?
What is PCV 13, followed by PCV 23 at least 8 weeks apart
200
Patient presents with a TIA and found to have carotid artery stenosis. At what degree of stenosis would you recommend endarterectomy?
What is: consider if > 50% if symptomtatic, indicated in symptomatic patients > 70%, recommended early surgery (2 weeks)
200
7 month old p/w 24 hours of abdominal pain, vomiting, blood in the diaper. Pain is episodic and severe, interspersed with periods of lethargy. On you exam the VSS and abdomen is soft, no bowel sounds, mass noted in RUQ. What is the most likely diagnosis?
What is Intussusception
300
A 4 yo M is brought into your office after falling in the garage and striking his forehead. No LOC, he has vomitted x 2. On exam + soft tissue swelling, no battle sign, raccon eyes or rhinorrhea. He is playful and alert. What is your next step in management?
What is observe for 24 hours (in medical setting or a reliable family member). Head imaging is only indicated if there are red flags.
300
The most common cause of uncorrectable visual acuity in > 70 yo is?
What is macular degeneration
300
What is the recommended acceptable tPA window for patients?
What is <4.5 hours if < 80, < 3 hours if >/= 80
300
What is the best initial treatment for nursemaid's elbow?
What is hyperpronation of the forearm
400
A 39 yo female runner presents with pain at anterior shin, worse with walking. She is currentlly taking an SSRI for depression. She has point tenderness over the bone. What lesion is she at risk for?
Anterior mid tibia stress fracture; medications that increase your risk for this: aromatase inhibitors, GnRH agonists, Depot medroxyprogesterone, anticonvulsants, SSRIs. Dx by Xray if sx persist x 2 weeks
400
You diagnosis your patient with H.pylori PUD, list the treatment of choice. She is penicillin allergic.
What are a PPI-clarithromycin (instead of amox)-metronidazole
400
Which osteoporosis therapy has an analgesic effect in the setting of acute vertebral fracture?
What is calcitonin
400
A 36 yo F presents with HAs that occur once a month for the past year, not changing in frequency or severity. They start with flashing lights, followed by L sidded throbbing and nausea. OTCs have not helped. What is the best initial therapy?
What is sumatripatan
400
A 6 yo presents with abdominal pain. You have a moderate degree of suspicion that the patient may have appendicitis. What would you do to confirm?
What is abdominal ultrasound
500
31 yo M is brought in after a steel scaffold struck and pinned his LLE for 2 hours. VSS, left ankle is swollen and tender, distal pulses intact. H/H 13/37, Udip + blood. What is his most likely diagnosis, what labs should you obtain?
What is rhabdomyolysis, CK, renal function
500
60 yo M presents to the office with 3 days of worsening RUQ pain. Pain radiates to R scapula, + n/v. Temp is 39C, P 122, BP 90/45. He is jaundiced and total bili is 7.8. RUQ is ttp. What is the diagnosis?
What is ascending cholangitis
500
80 yo complains of discomfort in his legs at night when trying to sleep, relieved by standing and walking. His only medication is prophylactic aspirin. The test most likely to reveal a treatable cause?
What is serum ferritin (RLS), In multiple studies, low serum ferritin levels (<50 mcg/L) correlate with RLS
500
A 65 yo M presents to the ED after having a seizure in his bedroom witness by his wife. She heard a cry and the fall and saw him stiffen and then shake all over, and become incontinent of urine. He was not arousable until he had been in the ED for several minutes. What kind of seizure did he have?
What is generalized tonic-clonic
500
3 yo F p/w 4 day history of fever and no other symptoms. Throat, ear, lung exams are all normal but she appears quite ill. What should your next step be.
What is U/A
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