Show:
MSK
Random
Randomer
Randomest
The Most Random Ever
100
Your patient has pain when you compress the tibula and fibula at the mid-calf. This is your working diagnosis.
What is syndesmosis (high ankle injury)
100
You patient has alcoholic hepatitis. This is the relationship you expect between serum total and direct bilirubin values.
What is conjugated hyperbilirubinemia - expect both to be elevated; viruses and obstruction also cause conjugated hyperbilirubinemia; hemolysis causes unconjugated hyperbilirubinemia and total bili would be up but direct would be normal.
100
These are the cut off Cr values (men and women) for referral to nephrology in patients with CKD.
What is men > 1.5; women > 1.2
100
This is the most common location of a gastrointestinal ulcer. This is empiric treatment for most commonly implicated infectious cause.
What is duodenum are most common overall (gastric ulcers most common in NSAID users); triple: clarithromycin + amoxicillin/metronidazole + omeprazole or quad: bismuth + metronidazole + a tetracycline + omeprazole
100
You suspect your patient is anemic. Lab tests show elevated serum homocysteine levels and anemia. Based on these results alone, this is your working diagnosis. If you're thinking of two things, this would differentiate the two.
What is folate deficiency. can be elevated in early B12 deficiency also. MMA levels are high in B12 only.
200
Your patient has pain when she internally rotates her humerus with elbow flexed to 90 degrees. External rotation in this position is asymptomatic. Hawkins sign is negative. She is unable to lift her hand when it is positioned on her lumbar spine. This muscle is injured.
What is subscapularis.
200
Suzie is 13 years old and has asthma - she has symptoms 4-5 times weekly that require she use her SABA inhaler. She wakes up at least once weekly with wheezing. Her FEV1 is 82% of predicted on lung function testing. FEV1/FVC is reduced by 3% since her last testing 1 year ago. This is the proper classification of her asthma, and treatment.
What is mild persistent asthma; SABA inhaler for rescue; daily ICST; 10 course oral CST for exacerbations
200
A woman with dyslipidemia would like to try medical therapy. Comorbidities include htn, NIDDM, PUD, and gout. This medication class is absolutely contraindicated for this woman.
What is Nicotinic acids (absolute CI: liver dz or severe gout; rel CI: DM, PUD). Fibrates CI in dyspepsia and gallstones BAS reduce absorption of other medications.
200
This serologic marker is diagnostic for acute HBV infection; it is also the only serologic marker that is detectable during the "window period" of HBV infection.
What is IgM anti-HBcAg (< 4 wks); HBsAg is present in acute and chronic infxn and assoc with contagiousness (+ HBsAG and - anti-HBcAg is chronic infxn); Anti-HBsAg is assoc with vaccination or resolved infxn (in absence of HBsAg)
200
This is how many hours of physical activity that is recommended each week for diabetic patients.
What is 150 hours
300
Your 56 year old female patient presents with knee pain of 1 day duration. She fell walking her dog onto concrete. There is mild swelling but no point tenderness of the head of the femur/tibula/fibula or the patella. While painful, she can flex and extend her knee fully. She could only walk 5-6 steps after the injury, and can ambulate in the exam room but walks with an obvious limp. This is your recommendation regarding knee X ray.
What is yes: Ottawa rules for knee x ray are age > 54, isolated patellar tenderness, fibular head tenderness, inability to flex knee to 90 degrees, and/or inability to bear weight for at least 4 steps immediately or in exam with or without limping.
300
If you had a high clinical suspicion, this is the only pathogen for which you would rx empiric antibiotics.
What is B. pertussis
300
You have an elderly patient who recently suffered a vertebral compression fracture. You are seeing her for a post-hospital visit. She has significant daily pain since the fracture, but is recovering. You tell her that _________ is her diagnosis, and you recommend __________ medication.
What is osteoporosis (dx with T score < -2.5, low impact/spontaneous fracture); calcitonin (primary mechanism is to inhibit bone resorption, but also moderate analgesia)
300
You patient comes in on Monday worried. She went on vacation with friends over the weekend but forgot her birth control pills and missed one active pill. She had unprotected intercourse while on the trip, and doesn't want to become pregnant. This is your recommendation.
What is emergency contraception immediately and restart pills on Tuesday (the following day). Use back up method of contraception for 5 days. If no intercourse had occurred within 5 days of the missed pill - take 2 pills and use backup contraception for 7 days.
300
The is the treatment of choice in ASA-induced asthma
What is leukotriene receptor antagonists (i.e. montelukast)
400
Your patient complains of back pain that radiates to his hamstring on the left side. The pain is worse with sneezing, but better when supine. His patellar and ankle reflexes are normal, but he has weakness with left foot dorsiflexion. The most likely diagnosis is "_______" from "______________" (+bonus question).
What is "sciatica" from "a herniated disk" at L4/L5 (L5 nerve roots)
400
Your 43 year old male patient has an abdominal aortic aneurysm. His blood pressure is 120/78 on HCTZ. His HDL is 37. His mother had a revascularization procedure on her coronary arteries at the age of 66. This is his LDL goal, and this is the LDL value at which should you recommend lifestyle modifications.
What is Goal is < 100 (bonus: VLDL should be < 70); lifestyle when > 129. Meds when > 189. He has CHD eq (AAA) and 3 CHD risk factors.
400
This is how frequently you should check albumin:Cr in Type I v Type II diabetes.
What is I: after 5 yrs of disease and annually thereafter; II: BL and annually thereafter
400
These are the 5 criteria that define controlled NIDDM
What is HbA1c < 7%; fasting glucose 70-130; post prandial glucose (1-2 hrs) < 180; LDL 70-100; BP < 130/80
400
These two measures should be taken in patients with CKD to prevent secondary hyperparathyroidism?
What is restriction of dietary phosphate; addition of phosphate binders in stage III CKD (GFR 30-59).
500
at 14 year old soccer player comes to your office with ankle pain. She jumped up to kick a ball and "landed wrong" 2 days ago. The ankle is swollen and bruised. The patient could not initially ambulate but can now in the office, albeit with considerable pain. There is mild joint instability. There is tenderness around the lateral malleolus and proximal lateral foot, but none over the midfoot or at the base of any toes. This is your working diagnosis (specific) and this is your next step for definitive diagnosis.
What is Grade 2 ankle sprain; get ankle x ray to r/o ankle fracture; foot x ray not indicated per Ottawa criteria.
500
Your patient with stage 4 CKD treated with ACE inhibitor and diuretics has a K measurement of 8 mEq/mL. You recommend hospitalization for treatment with this substance.
What is sodium polystyrene sulfonate (Kayexalate).
500
Your patient ate potato salad at a company picnic 8 hours ago and is now suffering from diarrhea. This is the most likely etiology of his diarrhea.
What is C. perfringes (< 6 hours is staph aureus; > 12 hours is E. coli or salmonella)
500
Your 100 kg male patient complains only of lower extremity edema. He drinks 2 L of water over 4 hours while standing the entire time. He urinates 43% of this fluid intake. He later drinks 2 L of water over 4 hours while recumbent the entire time. He urinates 70% of this fluid. This is his diagnosis.
What is Idiopathic edema (water load test).
500
Your 35 year old male patient presents with "shaking" in his lower leg. He says his father and sister both have similar problems with their head/neck, but he has been promoted recently and the leg shaking is causing him problems when he stands to give presentations. You prescribe a first line medication for this problem. 2 days later, the patient calls you complaining of nausea and vomiting. You see him that same day, and he has an ataxic gait. This was the medication prescribed. This is what you switch to.
What is primidone (for essential tremor). Switch to propranolol (first line) or topiramate/gabapentin (second line). Last line is ablation of the ventral intermediate (Vim) nucleus of thalamus